newsletter february 2008 rev - sandta · 2009-09-15 · south african neurodevelopmental therapy...

SOUTH AFRICAN NEURODEVELOPMENTAL THERAPY ASSOCIATION NEWSLETTER 1

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SANDTA

SOUTH AFRICAN NEURODEVELOPMENTAL THERAPY ASSOCIATION

SANDTA CONTACT DETAILS Address: P.O. Box 39976 Queensburgh 4070 Cell: 076 374 6739 email: [email protected] website: http://www.sandta.org.za

THE NEC Chairperson: Shelley Broughton (031) 7081785 (W) (031) 7081789 (F) [email protected] Vice Chairperson: Faatima Ebrahim-Abbas 021 7978239 (W) 082 3626045 [email protected] Treasurer: Sonja Berry 031 9041593 082 297 1519 [email protected] Secretary: Sonia Swart 082 332 8943 [email protected] Newsletter: Eunice König 082 927 7776 [email protected] Professional & Public Relations: VACANT AT PRESENT ANY VOLUNTEERS? Adult NDT Liaison Nina Strydom (031) 2041300 x 361 (W) (031) 5661281 (H)A 084 5661281 [email protected] Education: Corneli Strydom 082 950 4289 [email protected] Branch Liaison Sonia Swart 082 332 8943 [email protected]

076 374 6739

Newsletter February 2008 CONTENTS

SANDTA CONGRESS Call for Abstracts……………………..….….……..…2

Prechtl’s Method on the Qualitative Assessment of General Movements:……..Marlette Burger …….4 NAPCPSA Annual Conference…………………….12

Report on the 61st meeting of the AACPDM ……………………………..….Dr. F. Bischof……….13 From the WWW……………………………………....15

COURSES…………………………………………….16

New Site for Malamulele onward …………………………………Estelle Brown……….18

Malemulele Onward – Outreach Dates…………….19

Branch Activities………………………………………20

SANDTA YEARPLAN………..……………………….21

THE BACKPAGE - INFO……….……………..……22


SOUTH AFRICAN NEURODEVELOPMENTAL THERAPY ASSOCIATION CONGRESS

22-24 October 2008 Johannesburg, South Africa

Call for Papers

Theme: TIMELINES – Rehabilitation through the Ages

DEADLINE FOR SUBMISSION OF ABSTRACTS: APRIL 7, 2008

The South African Neurodevelopmental Therapy Association is now awaiting submission of abstracts for oral and poster presentations plus short workshops for the above congress. The theme of the Congress is neurodevelopmental therapy throughout the lifespan – from infants to adults. The objective of the Congress is to provide practical and scientific content that stimulates the interest of all disciplines involved in rehabilitation of babies, children, adolescents and adults with central motor disturbances.

Abstracts will be reviewed for acceptance on their scientific merit and should therefore be of a high standard and relevant to the theme of the congress. Abstracts must be submitted by e-mail, in English and per the instructions below, to the following e-mail address: [email protected]. Faxed abstracts will not be accepted. Abstracts that do not conform to the instructions below will not be considered.

In your e-mail, please indicate a) your profession; b) your place of work; c) comprehensive contact details; and d) what type of presentation you would like to do (oral or poster presentation). If you would like to present a workshop, please indicate the proposed length of the workshop in hours. Workshops will be offered in the afternoon on two of the congress days.

Presenters ARE required to register for at least the day of their presentation.

Authors will be informed by 15 May 2008 whether their abstracts have been accepted.

INSTRUCTIONS FOR THE PREPARATION OF ABSTRACTS (as per separate form) Form can be downloaded from http://www.sandta.org.za or obtained from [email protected]

– Title should be typed in CAPITAL LETTERS, bold and left aligned.

– Presenting author’s name should be underlined and bolded.

– Font: Times New Roman, size 12 points, single spacing.

– If submitting more than one abstract, each abstract must be sent as a separate e-mail and the

title should indicate that these are separate abstracts, i.e. JOAN SMITH ABSTRACT 1;

JOAN SMITH ABSTRACT 2; etc.

– Abstracts should be no longer than 300 words.

– No references, end–notes, diagrams or frames should be included in the abstract

– Audio-visual and other equipment requirements should NOT be included in the abstract.


Prechtl’s Method on the Qualitative Assessment of General Movements: A Diagnostic Tool for the Functional Assessment of

Neurological Outcome in High-Risk Infants.

Marlette Burger Introduction: Early identification of infants at risk of developing cerebral palsy The chances of survival for extreme preterm and/or low birth-weight infants has improved significantly over the past two decades. This is primarily due to technological advances and enhanced antenatal, perinatal and neonatal intensive medical care (Aylward, 2005; Colvin, McGuire & Fowlie, 2004). However, the increased survival rate of these infants is mirrored by increases in neurodevelopmental disabilities (Hack & Fanaroff, 2000). The prevalence of cerebral palsy in extreme low birth-weight infants is about 30% (Vohr, Wright, Poole & Scott, 2005) and therefore early recognition of these infants, who are at risk of brain damage, is needed in order to introduce therapeutic interventions prior to the development of pathological features of cerebral palsy (Campbell, 1996).

The ultimate goal of early diagnosis of neurological impairments is the provision of early therapeutic intervention and support for the families. This allows for quicker access to support systems and resources, as well as helping the family to decrease the distress they face when reasons for their infant’s motor behaviour is unknown. Early intervention gives the family the opportunity to develop an understanding of the implications of their infant’s motor problems, and to assist them to meet the long-term developmental needs of the infant as effectively as possible (Bennett, 1999; Blauw-Hospers & Hadders-Algra, 2005). The reliable identification of infants with cerebral palsy in very young infants is extremely difficult and this is usually not established until late in the first year (Ferrari, Cioni, Einspieler, Roversi, Bos, Paolicelli, Ranzi & Pretchl, 2002). The difficulty in predicting developmental outcome in early infancy can be attributed to the characteristics of the developing nervous system. The continuous developing changes of the brain during infancy can lead to a disappearance of signs of dysfunction present at an early age. These early neurological symptoms are neither sensitive nor specific enough to ensure reliable prognoses (Hadders-Algra, 2004). The difficulty in predicting outcome in young infants is reflected by the diverse techniques available to assess the brain at an early age (Hadders-Algra, 2001). These techniques vary from clinical bedside methods requiring no equipment, such as various methods of neurological examinations, to more sophisticated technical procedures, such as brain imaging (cranial ultrasound, magnetic resonance imaging and computer tomography) and neurophysiological tests, including electroencephalogram (Hadders-Algra, 2001). The sensitivities, specificities and accuracies of all these assessment techniques to predict neurological outcome are quite variable, and the quest for a safe, inexpensive and effective screening test to predict neurodevelopmental outcome in the young infant has been an ongoing process (Hadders-Algra, 1996). Limited resources in developing countries like South-Africa lead to restrictions in the use of expensive technical evaluation procedures and comprehensive, time-consuming neurological examinations to detect brain dysfunction in high-risk premature infants (Pieper, Smith, Maree & Pohl, 2003). Not even cranial ultrasound, which is to date the most frequently used and the least expensive neuro-imaging technique to detect structural changes in the newborn’s brain, can be offered to all high-risk infants in the neonatal units at government hospitals. There is thus a need for a quick, simple, inexpensive and non-invasive assessment method with a high validity and reliability for the early recognition of those high-risk premature infants who will require neurological intervention and treatment.


Such a neurological evaluation method, based on the spontaneous motor activity of the infants, was introduced more than ten years ago by Professor Heinz Prechtl and his co-workers (Einspieler, Prechtl, Ferrari, Cioni & Bos, 1997). The quality of spontaneous motor activity, the so-called general movements, in early infancy reflects the condition of the nervous system of the young infant (Prechtl, 1986). Observation of the young infant’s general movements, especially during the fidgety stage, has shown to be a highly valid predictor of neurological impairment, specifically cerebral palsy. Most striking, was the finding that the predictive values based on fidgety movements were higher than predictions based on neurological examinations and cranial ultrasound studies (Cioni, Ferrari, Einspieler, Paolicelli, Barbani & Pretchl, 1997). Spontaneous movements in the foetus and young infant The historical development in the assessment of spontaneous movements dates back to the beginning of Heinz Prechtl’s foetal studies in the early 1970’s. After having worked for 25 years in the field of infant neurology, Prechtl started to explore the prenatal development of the different spontaneous motor patterns seen in the newborn infant. Prechtl hypothesized that the birth could not be the starting point of spontaneous motor patterns in the human infant and that these movements must have a longer prenatal history (Prechtl & Hopkins, 1986). However, in the early 1970’s, ultrasound equipment was not yet sufficiently developed to allow the intra-uterine observation of foetal movements, and Prechtl started to carefully observe selected low-risk healthy preterm infants. These infants showed a large variety of spontaneous movement patterns, which could easily be recognised each time they occurred. These specific motor patterns were endogenously generated, i.e. without any external stimulation. In 1981, intra-uterine foetal studies, again with the focus on the complex repertoire of spontaneous foetal movement patterns, could commence with technically more advanced ultrasound equipment. Prechtl and his co-workers (Figure 1) found that the first two months after birth are in a certain way a continuation of foetal motor behaviour (Prechtl, 1986).

Figure 1. Heinz Prechtl (second from the right) and his co-workers


The first movement to occur in the human foetus is side flexion of the neck and this is seen at 7½ to 8 weeks postmenstrual age (counted from the first day of the last menstruation before amenorrhoea). At 9 to 10 weeks postmenstrual age, complex and generalised movements patterns occur which Prechtl (1997) and his co-workers named general movements (GMs). From the many distinct movement patterns appearing during the course of development from the foetus to the young infant, general movements remain the most frequently occurring and most complex motor patterns. After birth, general movements can be observed until 3 to 4 months postterm, when they are gradually replaced by voluntary, goal-directed anti-gravity movements (Hadders-Algra, 2001). Characteristics of normal general movements Prechtl (1990) defined normal general movements as a combination of gross and fine movements involving the whole body. What is particular about them is the variable sequence of arm, leg, neck and trunk movements. They wax and wane in intensity, force and speed and they have a gradual onset and end. Rotations along the axis of the limbs, and slight changes in the direction of movements, make them fluent and elegant and create the impression of complexity and variability. They may last from a few seconds to a couple of minutes. Three very distinct phases can be observed during the development of normal general movements. Before term they are called foetal or preterm general movements. At term age and until 6 to 9 weeks postterm age they are called writhing movements. At 6 to 9 weeks postterm general movements, with a writhing character, gradually disappear and are replaced by a continuous stream of tiny fidgety movements. Fidgety movements are present up to 20 weeks postterm when intentional and antigravity movements occur and start to dominate (Hadders-Algra & Prechtl, 1992) (Figure 2).

Figure 2. Developmental course of normal general movements


Preterm general movements:

No difference can be observed between foetal and preterm general movements, indicating that neither the increase of gravity after birth nor the maturation process of the infant has an influence on the appearance of general movements. The general movements of a preterm infant may occasionally demonstrate large amplitude movements of the limbs and the movements are often of a fast speed (Cioni & Prechtl, 1990).

Writhing general movements: At term age and during 6 to 9 weeks postterm, general movements are commonly referred to as writhing movements. The movements are characterised by small to moderate amplitude, and by slow to moderate speed. Typically, they are ellipsoid in form, which creates the impression of a writhing quality (Prechtl, Bos, Cioni, Einspieler & Ferrari, 1997a). Fidgety general movements: At 6 to 9 weeks postterm age, writhing movements gradually disappear, while fidgety general movements gradually emerge. Fidgety movements are small circular movements of moderate speed and variable acceleration in all directions involving the neck, trunk, pelvis, shoulders, wrists, hips and ankles. The optimum time to observe and assess fidgety movements is between 10-15 weeks postterm, when fidgety movements can be observed continually in the awake infant, except for short pauses or when the infant is fussing or crying (Hadders-Algra, Nakae, van Eykern, Klip-van den Nieuwdijk & Prechtl, 1993). Fidgety movements are present until 20 weeks postterm and then become more sporadic when anti gravity and goal directed movements start to dominate.

Characteristics of abnormal general movements The primary two parameters of general movement quality are variation and complexity. Complexity refers to the spatial variation of the movements. Complex movements are movements during which the infant actively produces frequent changes in direction of the participating body parts. Continuously varying combinations of flexion-extension, abduction-adduction and external-internal rotation of the participating joints bring about the changes in movement direction and gives it a complex character. Variation and complexity of general movements is the fundamental feature of the function of a healthy young nervous system. If the nervous system is impaired, general movements loose their complexity, variation and fluency. This is reflected by the absence of variation in muscle coordination and the movement patterns consist either of a stereotyped synchronous activation of most participating muscles or a stereotyped pattern of reciprocal activity. According to Prechtl, abnormal general movements can be described during the writhing period (preterm to 6 to 9 weeks postterm age) as poor-repertoire, cramped-synchronised or chaotic. During the fidgety period (from 6 to 9 weeks until 20 weeks postterm) abnormal general movements are defined as either abnormal fidgety or the absence of fidgety movements (Einspieler & Prechtl, 2005).

Poor-repertoire general movements: This abnormal general movement pattern occurs during preterm, term and early postterm age. The sequence of the successive movement components is monotonous, and the movements of the different body parts do not occur in a complex way as seen in normal general movements. Poor-repertoire general movements are seen in infants with cranial ultrasound abnormalities and the infant can develop normal, absent or abnormal fidgety movements. Poor-repertoire general movements are a very low predictor of the development of neurological impairments in high-risk or low-risk infants (Einspieler & Prechtl, 2005) (Figure 3).


Figure 3 Developmental course of normal and abnormal general movements

Cramped-synchronised general movements: This abnormal general movement pattern is seen from preterm age past the fidgety period and even when the infant is 6 or 7 months postterm. Movements appear rigid and lack the normal smooth and fluent character; all limb and trunk muscles contract and relax simultaneously. If this abnormal pattern is observed consistently during a number of weeks, it is of high predictive value for the development of severe spastic cerebral palsy (Prechtl, 1997) (Figure 3).

Chaotic general movements: Movements of all the limbs are consistently abrupt and of large amplitude. The movements occur in a chaotic order without any fluency or smoothness. Chaotic movements are rare, but can be observed during preterm, term and early postterm age. Infants with chaotic movements seen during the preterm age or term age often develop cramped-synchronised general movements a few weeks later (Bos, van Asperen, de Leeuw & Prechtl, 1997a). Abnormal fidgety movements: These movements look like normal fidgety movements, but their amplitude, speed and jerkiness are greatly exaggerated. Abnormal fidgety movements are rare and their predictive value is low (Einspieler, Prechtl, Bos, Ferrari & Cioni, 2004).

Absent fidgety movements: If fidgety movements are never observed from 9 to 20 weeks postterm, it is called the “absence of fidgety movements”. However, other movements, i.e. anti gravity movements, can be commonly observed. The absence of fidgety movements is highly predictive for later neurological impairments, particularly for the development of cerebral palsy. If cramped synchronised movements are still present at 3 to 4 months postterm, fidgety movements will be absent (Prechtl et al., 1997a) (Figure 3).

*MR = Mental Retardation *DCD = Developmental Coordination Disorder


Specific signs predicting cerebral palsy during early infancy The first longitudinal study on the predictive value of the various abnormal general movement patterns, revealed cramped-synchronised general movements as highly predictive for severe neurological outcome (Ferrari, Prechtl & Cioni, 1990). Prechtl, Einspieler, Cioni, Bos, Ferrari, & Sontheimer (1997b) confirm the importance of cramped-synchronised general movements in a longitudinal study of 130 low and high-risk infants. All 40 infants, who at repeated assessments showed consistent cramped-synchronised general movements, later developed severe spastic cerebral palsy. In a recent study of 84 preterm infants with brain lesions confirmed by cranial ultrasound scans, Ferrari et al (2002) reported that the earlier consistent cramped-synchronised general movements occurred, the worse was the later motor impairment. There is yet another significant early marker for the later development of cerebral palsy. In the above-mentioned study (Prechtl et al., 1997b), only 3 out of 70 infants with normal fidgety movements had later cognitive or minor motor impairment or both, and 67 (96%) were normal at 2 years of age. None of the 70 infants developed cerebral palsy. On the other hand, 44 out of the 130 infants never displayed any fidgety movements and 43 of them (98%) developed severe spastic cerebral palsy. The remaining infant had severe cognitive impairment and was developmentally delayed. Several other studies confirmed the high correlation between fidgety movements and neurological outcome (Einspieler et al, 2004). Thus, in addition to consistently cramped-synchronised general movements during the preterm and early postterm age, the absence of fidgety movements is a specific sign of the development of cerebral palsy. Both abnormal qualities of general movements can be seen at an age at which no evidence on a standard neurological examination of cerebral palsy is present yet, namely from as early as foetal life onwards or from preterm or term birth until the third month postterm (Einspieler & Prechtl, 2005). THE USE OF PRECHTL’S GENERAL MOVEMENTS TO PREDICT THE NEUROLOGICAL OUTCOME OF HIGH-RISK INFANTS IN SOUTH AFRICA Prechtl’s method on the qualitative assessment of general movement, is to date, not widely used outside Europe, and neither published nor unpublished data could be found on the outcome of fidgety movement assessments in non-white infants. I received my basic training in Prechtl’s method on the qualitative assessment of general movements in 2000 and completed the advanced course in 2005. I decided to investigate if Prechtl’s fidgety movements’ assessment technique can be used in a government hospital in South Africa to predict neurological outcome of high risk infants with the same success than Einspieler and Prechtl (2005) have demonstrated in Europe. I will give a very brief description of my study method and the results. RESEARCH QUESTION What is the predictive validity of fidgety movements to determine the neuro-developmental outcome of very low birth-weight and extremely low birth-weight infants admitted to the neonatal intensive care unit of Tygerberg Children’s Hospital? STUDY OBJECTIVES The objectives of the study were:

• to assess the type of motility (normal or absent) that infants display during their fidgety stage at 3 months corrected age.

• to determine the infant’s final motor outcome at 12 months corrected age with the following three standardised tests: Peabody Developmental Motor Scale – 2nd edition; Alberta Infant Motor Scale and Amiel-Tison and Gosselin.

• to determine if absent and/or abnormal fidgety movements (observed at 49 to 55 weeks postmenstrual age) serves as an early marker for the development of cerebral palsy.


SAMPLE A successive sampling method was used to recruit preterm infants who were born between the 1st of January and the 31st of December 2004, and admitted to the neonatal intensive care of Tygerberg Children’s Hospital. INCLUSION CRITERIA The following inclusion criteria applied:

• birth-weight of less than 1250g. • infants admitted within 48 hours after birth to the neonatal intensive care unit of Tygerberg

Children’s Hospital from the 1st of January 2004 till the 31st of December 2004. EXCLUSION CRITERIA The following exclusion criteria applied:

• infants diagnosed with chromosomal defects or known syndromes [e.g. Down Syndrome, Rett Syndrome as well as Foetal Alcohol Syndrome (FAS)] and/or infants with birth malformations of the central nervous system (e.g. Myelomeningocele).

• infants who did not display any fidgety movements between 49 to 55 weeks postmenstrual age (9 to 15 weeks corrected age) on the day of testing, due to any illness that inhibited spontaneous movement patterns and/or medication that caused depression of the central nervous system.

• infants who were HIV exposed and infected. • infants without written consent by the parent or legal guardian.

INSTRUMENTATION Four outcome measures were used to assess the neurodevelopmental outcome of the infants.

• At three months corrected age Prechtl’s method of the qualitative assessment of general movements during the fidgety period were used.

• At 12 months corrected age the following following three standardised tests were used: the Peabody Developmental Motor Scale – 2nd edition; the Alberta Infant Motor Scale and Amiel-Tison and Gosselin.

RESULTS SAMPLE SIZE The neonatal intensive care of Tygerberg Children’s Hospital admitted approximately 500 infants between the 1st of January and the 31st of December 2004. Of these, 121 infants were eligible for the study. One infant was withdrawn due to a Ventricular Septum Defect (VSD) that led to congestive heart failure; another infant was lost to the 12-month follow-up and four infants died before their 12-month neurological assessment. The sample at 12 months corrected age thus consisted of 115 infants. TEST SCORE RESULTS AT 3 AND 12 MONTHS CORRECTED AGE OUTCOME OF FIDGETY MOVEMENT ASSESSMENT AT 3 MONTHS CORRECTED AGE At 3 months corrected age, 106 infants displayed normal fidgety movements. Ten infants did not display fidgety movements, thus their movements were classified as absent. OUTCOME OF ASSESSMENTS AT 12 MONTHS CORRECTED AGE At 12 months corrected age, each infant’s results on the PDMS-2, AIMS and neurological assessment according to Amiel-Tison and Gosselin, were analysed. Based on all the infants’ assessment outcomes, the final motor developmental outcome for each child was categorised into three groups:

normal suspect abnormal

Nine infants had cerebral palsy and were categorised as abnormal, five infants had suspect motor development and 101 infants were normal.


WAS THERE ANY CORRELATION BETWEEN THE INFANTS’ GENERAL MOVEMENTS AND THE INFANTS’ NEUROLOGICAL OUTCOME? PREDICTIVE VALIDITY OF FIDGETY MOVEMENTS The sensitivity of fidgety movements is the proportion or percentage of infants with an abnormal motor outcome, who are correctly identified by the absence of normal fidgety movements. The specificity of fidgety movements is the proportion or percentage of infants who are normal, and who are correctly identified as negative by a normal quality of fidgety movements. In order to determine the sensitivity and specificity of fidgety movements, the suspect infants (n=5) were taken out of the analysis. A chi-square test was performed to determine the relationship between the fidgety movement score, and the infants with cerebral palsy and normal motor outcome at 12 months corrected age (Table 1). Table 1 The sensitivity and specificity of fidgety movements QUALITY OF FIDGETY MOVEMENTS

CEREBRAL PALSY AT ONE YEAR

NORMAL OUTCOME AT ONE YEAR

TOTAL

ABSENT

8 (89%)

0 (0%)

8

NORMAL 1 (11%) 101 (100%) 102

TOTAL 9 101 110

A highly predictive relationship (p<0.01) with a sensitivity of 89% and a specificity of 100% was found for this analysis. The positive predictive value (PPV) was 100% and the negative predictive value (NPV) was 99%. CONCLUSION: The results of this study indicated that Prechtl’s qualitative method of fidgety movement assessment, used in a clinical setting, was a highly sensitive and specific method to predict neurological outcome in premature infants. Not only were absent fidgety movements at 3 months corrected age indicative of a poor motor outcome, but normal fidgety movements were an excellent predictor for normal neurological outcome on the AIMS, PDMS-2 and Amiel-Tison and Gosselin at 12 months corrected age. The technique is non-invasive, inexpensive and by contrast with time-consuming neurological examinations, an experienced observer needs only a few minutes to do the assessment. The methodological breakthrough of using Prechtl’s method, which was confirmed in this study, lies in the fact that it predicts the development of cerebral palsy at a much earlier age than was previously possible. Prechtl’s method offers an excellent way to distinguish between infants in need of close surveillance and intervention, and those infants for whom this is not necessary. The great advantage of being able to detect the risk of later development of cerebral palsy so early is the possibility to introduce therapeutic interventions long before the pathological features of cerebral palsy develop. Although it is unlikely that any form of therapeutic intervention will prevent the development of cerebral palsy, it may help to prevent secondary defects as well as provide much needed psychological support for parents. The predictive validity of fidgety movements can be effectively utilised at hospitals and clinics in South Africa in order to effectively follow-up high risk infants and to introduce early intervention to those infants identified at 9 to 15 weeks corrected age with absent or abnormal fidgety movements.


TRAINING AND ADDITIONAL INFORMATION: Information on Prechtl’s general movements can be obtained from the General Movements Trust web-site: http://www.general-movements-trust.info/ or you can contact Marlette Burger at [email protected] or 021-9389300/3 (W). REFERENCES • Aylward GP. Neurodevelopmental outcomes of infants born prematurely. J Dev Behav

Pediatr 2005; 26(6): 427–440. • Bennet, F.C. 1999. Diagnosing cerebral palsy – the earlier the better. Contemporary

Pediatrics, 16(7):65-73. • Blauw-Hospers, C.H. & Hadders-Algra, M. 2005. A systematic review of the effects of early

intervention on motor development. Developmental Medicine and Child Neurology, 47(6):421-432.

• Bos, A.F., van Asperen, R.M., de Leeuw, D.M. & Prechtl, H.F.R. 1997a. The influence of septicemia on spontaneous motility in preterm infants. Early Human Development, 50:61-70.

• Campbell SK. Quantifying the effects of intervention for movement disorders resulting from cerebral palsy. J Child Neurol 1996; 11: S61–S70.

• Cioni, G. & Prechtl, H.F.R. 1990. Preterm and early post term motor behaviour in low-risk premature infants. Early Human Development, 23:159-193.

• Cioni, G., Ferrari, F., Einspieler, C., Paolicelli, P.B., Barbani, M.T. & Prechtl, H.F.R. 1997. Comparison between observation of spontaneous movements and neurological examination in preterm infants. Journal of Pediatrics, 130:704-711

• Colvin M, McGuire W, Fowlie PW. ABC of preterm birth: neurodevelopmental outcomes after preterm birth. BMJ 2004; 329: 1390–1393.

• Einspieler, C. & Prechtl, H.F.R. 2005. Prechtl’s assessment of general movements: A diagnostic tool for the functional assessment of the young nervous system. Mental Retardation & Developmental Disabilities Research Reviews, 11:61-67.

• Einspieler, C., Prechtl, H.F.R., Bos, A.F., Ferrari, F., Cioni, G. (eds.). 2004. Prechtl’s method on the qualitative assessment of general movements in preterm, term and young infants. London: Mac Keith Press.

• Einspieler, C., Prechtl, H.F.R., Ferrari, F., Cioni, G. & Bos, A.F. 1997. The qualitative assessment of general movements in preterm, term and young infants – review of the methodology. Early Human Development, 50:47-60.

• Ferrari, F., Cioni, C., Einspieler, C., Roversi, M.F., Bos, A.F., Paolicelli, P.B., Ranzi, A. & Prechtl, H.F.R. 2002. Cramped synchronised general movements in preterm infants as an early marker for cerebral palsy. Archives of Pediatrics & Adolescent Medicine, 156:460-467.

• Ferrari, F., Prechtl, H.F.R. & Cioni, G. 1990. Qualitative changes of general movements in preterm infants with brain lesions. Early Human Development, 23:193-233.

• Hack M, Fanaroff AA. Outcomes of children of extremely low birthweight and gestational age in the 1990s. Semin Neonatol 2000; 5: 89–106.

• Hadders-Algra, M. & Prechtl, H.F.R. 1992. Developmental course of general movements in early infancy: Descriptive analysis of Change in form. Early Human Development, 28:201-213.

• Hadders-Algra, M. 1996. The assessment of general movements is a valuable technique for detecting brain dysfunction in young infants. A review. Acta Pediatrica. Supplement, 416:39–43.

• Hadders-Algra, M. 2001. Evaluation of motor function in young infants by means of assessment of general movements: a review. Pediatric Physical Therapy, 13:27-36.

• Hadders-Algra, M. 2004. General movements: A window for early identification of children at high risk for developmental disorders. Journal of Pediatrics, 145:S12-S18.

• Hadders-Algra, M., Nakae, Y., van Eykern, L.A., Klip-van den Nieuwendijk, A.W. & Prechtl, H.F.R. 1993. The effect of behavioural state on general movements in healthy term newborns. A polymyographic study. Early Human Development, 35:63-79.

• Pieper, C.H., Smith, J., Maree, D. & Pohl, F.C. 2003. Is NCPAP of value in extreme preterms with no access to neonatal intensive care? Journal of Tropical Pediatrics, 49:148-152.


• Prechtl, H.F.R. & Hopkins, B. 1986. Developmental transformations of spontaneous movements in early infancy. Early Human Development, 4:233-238.

• Prechtl, H.F.R. 1986. New perspectives in early human development. European Journal of Obstetrics, Gynecology and Reproductive Biology, 21:347-355.

• Prechtl, H.F.R. 1990. Qualitative changes of spontaneous movements in fetus and preterm infants are a marker of neurological dysfunction. Early Human Development, 23:151-159.

• Prechtl, H.F.R. 1997. State of the art of a new functional assessment of the young nervous system. An early predictor of cerebral palsy. Early Human Development, 50:1-11.

• Prechtl, H.F.R., Bos, A.F., Cioni, G., Einspieler, C. & Ferrari, F. 1997a. Spontaneous motor activity as a diagnostic tool. (Demonstration video). London and Graz: the GM Trust.

• Prechtl, H.F.R., Einspieler, C., Cioni, G., Bos, A.F., Ferrari, F. & Sontheimer, D. 1997b. An early marker for neurological deficits after perinatal brain lesions. Lancet, 349: 1361-1363.

• Vohr BR, Wright LL, Poole WK, Scott A. Neurodevelopmental outcomes of extremely low birth weight infants < 32 weeks’ gestation between 1993 and 1998. Pediatrics 2005; 116 (3): 635–643.

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The National Association for Persons with

Cerebral Palsy in South Africa (NAPCPSA)

Annual Conference in Kimberley,

From the 12-14 May 2008

For further information contact

Faith Bischof,

Vice Chairperson of the NAPCPSA,

Cell Number 083 269 1428,

Or

mailto: [email protected]


REPORT ON THE 61ST MEETING OF THE AACPDM

Dr. F. Bischof I was fortunate to be able to attend this meeting, which was held in Vancouver, Canada in October 2007. My flight over was via Zurich and Toronto, a very long journey. Before the conference I took a bus down to Seattle, and stayed with a good friend and professional colleague, Dr. Charlene Butler. Charlene and her husband live on a boat, and I enjoyed the novelty of boat life for a few days, as well as being shown around the beautiful city of Seattle. Charlene is a former president of the AACPDM. Her doctorate is in special education, and her research proved the benefits of early motorised wheelchair use. She is also NDT trained, having done the course with Mrs Bobath. She is on the Treatment Outcomes Committee of the Academy and has written an article on evidence based reviews of CP interventions, as well as many other publications. Charlene and I travelled up to the conference by train, a beautiful trip along the Pacific coast line. We stayed together at the Pan Pacific Hotel, situated on the harbour with magnificent view of the Fraser River and mountains. We shared a family room with two other physiotherapists! Since we arrived a day before the proceedings started, I was able to explore some of Vancouver on foot, including the historic Gastown. This meeting was attended by more than 800 delegates from all over the world. There were 71 free papers, 72 scientific posters and 35 instructional courses. Free paper sessions ran concurrently and were grouped into the subject areas of Therapy, Developmental Paediatrics and Orthopaedics. So many interesting papers were being presented and it was difficult to choose which sessions to attend. To highlight some trends in research: there is ongoing investigation of strength and fitness training programmes in CP, and more emphasis in measuring outcomes in terms of function and quality of life rather than changes in impairment. In orthopaedics there is emphasis on single event multilevel surgery performed on the CP child at about age 7. In some countries (particularly the States and Australia), a lot of surgery is being done, but most studies presented only short term outcomes. More long term studies are needed to assess if these multi-level corrections (which combine bony and soft tissue surgery) are functionally beneficial. The positive results of Botox, combined with therapy, were presented in several papers. The GMFCS (Gross Motor Function Classification System) was the most common classification used in the papers. Outcome measures are too numerous to mention in detail. The PEDI (Paediatric Evaluation of Disability Inventory), GMFM (Gross Motor Function Measure), GAS (Goal Attainment Scale), Quest (Quality of Upper Extremity Skills Test), FMS (Functional Mobility Scale) and CP-child were some of the instruments employed to assess the effect of an intervention. A very beneficial part of the programme was the ‘Breakfast with Experts’ sessions where one had the opportunity in smaller groups to listen to an expert in a particular field, and engage in a discussion on the topic. I was only able to attend three instructional courses, because of time constraints and expense. These were:

1. Hip displacement in children with cerebral palsy (CP), 2. Botox – A: specific aftercare, and 3. Transitional needs of adolescents and young adults with developmental disabilities.


A welcome trend in CP research is investigation of the problems and special needs of adults with CP, with an increasing number of papers and courses being presented which deal with these issues. The posters were also valuable learning tools and there was plenty of opportunity to review them and ask authors questions. A whole session was devoted to the popular point – counter point debates in which two experts take opposite sides on a current topic. Charlene Butler and Eileen Fowler, a PhD physiotherapist from the University of California, Los Angeles (UCLA) titled their debate, ‘Walk or Roll?’ Charlene argued the merits of early wheelchair mobility while Eileen advocated therapy to attain walking ability. The conclusion was that in the more involved children, assisted walking should be maintained for transfers and limited indoor mobility, but that wheelchair use is the practical solution for mobility in the community. A tongue in cheek debated entitled ‘Botox – Friend or Foe?’ was presented by two eminent orthopaedic surgeons. Special guest speakers at the meeting included Dr. Martin Bax, senior editor for many years of Developmental Medicine & Child Neurology; and Dr. Susan Harris, physiotherapy professor at the University of British Columbia. Apart from all the scientific events, there was ample opportunity for networking during the breaks and in the evenings. Charlene and I attended a small reception in the suite of Helen Horstmann who has just edited the new edition of Professor Eugene Bleck’s textbook on Orthopaedic Management of Cerebral Palsy. Prof. Bleck was a guest of honour. The new president of the AACPDM was there – Dian Daminiano. She is the first physiotherapist in the history of the Academy to fill this position. I met up with Peter Rosenbaum at a dinner with the red Journal Press. He is really looking forward to our SANDTA conference, and visiting South Africa. At an awards ceremony on the last day of the conference, he was given a special Mentorship Award.

This was a truly exciting and stimulating meeting. My attendance was assisted by a grant from Genop Healthcare, distributors of Botox, which covered about one third of the cost of the trip. I would like to encourage SANDTA members to become members of the AACPDM – there are many benefits including scholarships to attend the meetings, and access to a wealth of information on developmental disability. You can participate in online seminars and ‘Grand Rounds’ conducted by experts in the field. The membership fee is $35 per annum. You can also gain access to the prestigious red journal – Developmental Medicine & Child Neurology. Please contact me if you require further information. My e-mail address is [email protected].

Reception with Diane Damiano and Eugene Bleck Charlene Butler and Susan Harris Dinner with Dr. Peter Rosenbaum


Relevant Articles from the Top Ten in Developmental Paediatrics, 2007

Presented at the annual meeting of the AACPDM, Vancouver, October 12, 2007 Compiled by Gordon Worley, MD & Gregory Liptak, MD

5. Strauss D, Shavelle R, Reynolds R, Rosenbloom L, Day S. SURVIVAL IN CEREBRAL PALSY IN THE LAST 20 YEARS: SIGNS OF IMPROVEMENT? Dev Med Child Neurol. 2007 Feb;49(2):86-92. This study investigated the possibility of improved survival in cerebral palsy (CP) over a 20-year period. Participants were 47 259 persons with CP receiving services from the State of California between 1983 and 2002. The person-year approach was used. This asks whether the probability of dying in a given calendar year changes over the study period after age and severity of disability are taken into account. An appreciable improvement over time was found in children with severe disabilities and in adults who required gastrostomy feeding. In these groups, mortality rates fell by 3.4% per year. Therefore, life expectancies reported in earlier studies should be increased by approximately 5 years if adjustments to 2002 mortality rates are made. For other persons with CP there was, at most, a small improvement over the 20-year period. The results suggest there have been improvements in the treatment and care of the most medically fragile children. Gastrostomy feeding has become much more widespread over the past two decades, and the improved survival of persons with gastrostomies may reflect better understanding of their requirements.

****************************** 4. Bjornson KF, Schmale GA, Adamczyk-Foster A, McLaughlin J. THE EFFECT OF DYNAMIC ANKLE FOOT ORTHOSES ON FUNCTION IN CHILDREN WITH CEREBRAL PALSY. J Pediatr Orthop. 2006 Nov-Dec;26(6):773-6. Dynamic ankle-foot orthoses (DAFOs), with free plantarflexion, are frequently prescribed to facilitate the gross motor skills of children with cerebral palsy. Employing a randomized crossover design, this project documents the short-term effect of DAFOs in 23 ambulatory children with cerebral palsy aged 1.9 to 7.3 years. Significant improvements in crawling/kneeling, standing, and walking/running and jumping skills, as measured by using the Gross Motor Function Measure (GMFM) 88 and 66, were documented (P < 0.001). Increased motor skills with the use of DAFOs were mildly correlated with the leg length of the participants. Increasing age was negatively correlated with standing skill improvement while wearing the DAFOs. Young children who are independent walkers seem to benefit greater from the DAFOs with free plantarflexion than do children using assistive devices. Future research needs to clarify the long-term influence of the use of DAFOs on gross motor skill acquisition in young children with cerebral palsy.


8-WEEK BASIC PAEDIATRIC NDT COURSE PORT ELIZABETH – 2008

Where: Port Elizabeth Dates: 1 – 26 September 2008 (1st block) 10 November – 5 December (2nd block) Course fees: R9452

Please note: 20% discount for South African registered therapists working in South Africa /Africa: R7562

Contact: Estelle Brown Tel: (011) 674 5272 / 073 1482178 Fax: 086 6667452 E-mail: [email protected]

ADVANCED LEVEL 2 COURSE ON THE ASSESSMENT AND TREATMENT OF CHILDREN WITH CEREBRAL PALSY AND

RELATED CONDITIONS FOCUSING ON UPPER LIMB FUNCTION

The course will emphasize enabling the child to take an active part in age-appropriate

functional activities and play. The use of the ICF will be emphasized in assessment and treatment, working from the identification of participation restrictions through

analysis of the functional activities required to overcome these restrictions, and the identification of underlying impairments. The principles of forced use will be

incorporated. The role of vision will be stressed

The course will be accredited. SANDTA certificates will be issued upon completion

Venue – Nuwe Hoop Skool, Pretoria.

Dates – 28 July – 8 August 2008

Instructors - Sheena Irwin-Carruthers, Senior Instructor SANDTA Christa Scholtz, Occupational Therapy Instructor SANDTA

Fee – R3100. A deposit of R250 will be required upon acceptance.

Applications should be made by 31 May 2008 to:

Christa Scholtz: [email protected]


Proposed Courses Interested in an adult NDT course in Gauteng in the last half of 2008? Lynne Fernhead is prepared to present the course in Gauteng, divided into a 2 week block, and then a one week block, assisted by Estelle Buys. What would be your preference - during term/school holidays?

************************

Interested in a 3 week adult course in East London Jun/Jul - presented by Lynne Fernhead, and assisted by Estelle Buys?

Should you be interested please contact: Nina Strydom

email: [email protected] Tel: + 27 312041300 Mobile: + 27 84 5661281 Fax: + 27 866781450

What skills do you need to be a Malamulele volunteer?

It’s really simple – you need to have completed an 8 week basic paediatric course (does not matter how long ago), be interested in working with children

and their caregivers; you need to be adaptable and flexible and to enjoy working in a team with colleagues.

Volunteers to do non-therapy tasks during the week are also needed – like

helping to make equipment; sewing; taking photographs and videos – so if you are a therapist interested in paediatrics, willing to work hard and to have the opportunity of watching and learning from NDT therapists, you are welcome

and I would love to hear from you.

Please do not hesitate if you need any further information.

I really look forward to hearing from you Warm regards Gillian Saloojee

[email protected]

Application Form for SANDTA Courses attached as a separate document to the Newsletter – both as a PDF and WORD document.

The application form can also be downloaded from:

http://www.sandta.org.za


NEW SITE FOR MALAMULELE ONWARD

A new site in Limpopo was identified at Dilokong Hospital, near Burgersfort. In September 2007 Estelle led a screening visit with the help of Joy Mathye, Nomsa Mashiane and Nolubeko (all three NDT trained OTs from Limpopo). 32 children were selected for the intervention programme. This took place from12 – 16 November with the following NDT volunteers: Estelle Brown, Andrea Fraser, Leny Loock, Joy Mathye, Kirsty Nourse, Mindy Silva, Claire Hochfield, Philippa Glogauer, Veda Da Silva. We welcome the last 5 therapists on this list as new volunteers to Malamulele Onward. A special thank you to Centapaeds, a private practice in Johannesburg, as the last 4 names are from their busy practice! We were also joined by 2 Community Service therapists from Mpumulanga: Sally Gush and Estie Breytenbach. Community Service therapists are increasingly showing their worth on these projects, as there are so many peripheral jobs to be done during the intervention week, and their enthusiasm and willingness to learn from the NDT trained therapists, are fantastic. 2 Community Rehabilitation Workers from Malamulele Hospital, who had been involved with our first projects at that site, also joined us at Dilokong. This is of special significance, as the continuing growth in their ability to understand and handle the children with cerebral palsy, is adding to the sustainability of good service to the children and their families in their area. This forms an important part of the vision of Malamulele Onwards.

Once more the mothers were most appreciative by what was offered to them and their children, and at the re-evaluation visit done 6 weeks later, the changes made during the therapy week were in most cases maintained. Some comments from mothers: “I appreciate mostly the follow-up they do concerning the previous treatment. They make us concentrate on the exercises we’ve been taught.” “I would like to see our doctors participating in the Physio department to check our children. The most important thing we like about this treatment is that it has drawn our neighbours and some of our families nearer. They wanted


to know where we get the buggies and other useful equipment from, and they are now happy for us and started to allow their children to visit” Thank you for everybody’s time, donations and adding wonderful new slants to our projects. Estelle Brown (Project leader)

OUTREACH DATES FOR 2008 This year we will be returning to Butterworth/ Tafalofefe in the Eastern Cape and to Dilokong in Limpopo. We are also going to a new site – Madwaleni, which is in deep rural Eastern Cape, near Elliotdale. The dates of the therapy weeks are as follows: Madwaleni 14 – 18 April 2008 Dilokong 18 – 22 August 2008 Tafalofefe (group 1) 29 September – 3 October 2008 Tafalofefe (group 2) 6 – 10 October 2008 All the children in the Tafalofefe group need GMFM assessments done before and after the therapy intervention. If you are interested in doing GMFMs, please let us know. You will receive training and also be paid for doing the assessments. Your accommodation and travel costs (within South Africa) for the therapy week are covered. You will also receive 10 CEUs for the week. All we need is from you is your time! If you are interested in becoming a Malamulele Onward volunteer, please contact Gillian Saloojee at [email protected] or on 072 483 5766; or Estelle Brown at [email protected] or on 073 148 2178

Directors : Dr. GM Saloojee, JA Snyman, E. Brown, T. Seon (Can), B. Harrison (Can), S. Broughton, Prof. AD Rothberg, Dr. MR Mphahlele, JC Whitter, T. Ralintja


SANDTA NORTH GAUTENG

Will be hosting a workshop on the suck- swallow- breathe synchrony (SSB)

Presented by RINA VAN DER WALT

The suck-swallow-breathe synchrony is an important precursor for sensorimotor and cognitive

development. It has an influence on speech and language development, state regulation, postural control, feeding, eye-hand coordination and social and emotional tone. The therapeutic intervention is appropriate

in the treatment of patients with articulation difficulties, breath control problems, modulation disorders, postural instability and neurological impairments

7 & 8 March 2008 Rietondale Lodge

259 Soutpansberg Road, Rietondale R950 - 00

This workshop is open to all speech, physio and occupational therapists

Only 30 places available

For details and/or an application form ** – please e-mail:

[email protected]

Closing date for applications 20 February 2008

Please ensure your completed application form is received via fax or e-mail by 20 February 2008.

You will be contacted on that date to let you know if you have received a place and banking details will be forwarded to you.

All monies to be paid and proof of payment faxed or e-mailed by 28 February to confirm your booking.

There will be a R300 non-refundable deposit should you cancel your booking after 28 February 2008.

Application form as attachment to the Newsletter but can also be downloaded from http://www.sandta.org.za

KZN Branch

DATE TOPIC CONTACT / PRESENTER

VENUE

26 February UL Treatment Estelle Buys Entabeni Rehab 25 March Seating Estelle Buys

TJ Witteveen Entabeni Rehab

29 April AAC Estelle Buys Margie Lilienveldt

Entabeni Rehab

24 May Serial Casting Morning Workshop

Estelle Buys Megan Ballington

Entabeni Rehab

24 June Normal movement High and low tone

Estelle Buys Entabeni Rehab

29 July Management of CVA’s & TBI’s Estelle Buys Dr. H. Staub

Entabeni Rehab

26 August Cognitive activities Estelle Buys Entabeni Rehab 30 September HIV Jane Markham Browns School 28 October Premature Child

And neonates Jane Markham Browns School

25 November Impact of Quad and para Jane Markham Browns School


SANDTA YEAR PLAN 2008

Date NDT Courses NEC Branch Meetings & Workshops N Gaut. S Gaut. KZN FS Bloem FS Gold W Cape E Cape Jan Adv Upper Limb Function 29 W/shop

Teleconf.

NDT & Groups

Feb Basic 8 week Bobath/NDT 19 Splinting of 15-Feb 05-Feb (Bloem) Part 1 Teleconf Upper Limb Vision ST, AAC Adv 2 week Baby

(CT)(25Jan-7 Feb) Adults

Mch 7/8 Mch Seating 12-Mar

SSB

Wshop Lunch meet

Pta

Apr Basic

8 week Bobath/NDT Bloem) Part 2) AAC 07-May

Working in classrooms

May Upper Limb 19-May 04-Jun Postural NDT info CP & Diet

Control

Jun N mvmnt Vision &

Play 17-Jun

Feldenkrais1 high & low w/shop 21-Jun tone Feldenkrais2 Jul Basic July Adult Feldenkrais3

Course

Aug Cognitive 29-Aug Assmt&Treat visiospatial

Activities Case

studies 20-Aug Adults Case studies Sept Basic 8 week Bobath/NDT HIV Gagik Part 1 (PE) Splinting

Oct SANDTA 21 Oct? 21-Oct 21-Oct 21-Oct 21-Oct 21-Oct 21-Oct 21-Oct

CONGRESS Annual Meeting of SANDTA Branch Reps. in JHBG. 22 - 24 Oct JHB 24-Oct C O N G R E S S AGM Nov Quad & 27-Oct 06-Nov

Basic 8 week Bobath/NDT Paraplegia Case

studies CP & Part 2 (PE) Community Dec 1 week

NDT

Course


BRANCH CONTACTS

Submission of material for inclusion in body of newsletter:

To simplify editing, please use Word documents or plain text

Paper size – A4. Font: Ariel

Font size: Titles 14 pt. Body of document 11 pt.

Any photos/pictures to be sent separate from text with a labelled text box in the

document at insertion point.

Advertising Rates: In body of Newsletter Full A4 page - R 200 Textbox A5 size - R 100 Textbox ½ A5 size - R 50 Scanning if not in electronic format R 50/page.

Inclusion of flyers (postal & electronic) R 100/page – to be supplied ready for inclusion - Printed and Electronic form (PDF). NO CHARGE FOR SANDTA RELATED COURSE ADDS

Schools/Centres/Clinics catering for people with cerebral palsy will be charged a nominal amount (R50) to help cover printing and postage.

Newsletter deadline Submissions for the newsletter must reach the editor before

30 APRIL 2008

SOUTHERN GAUTENG: Mindy Silva: [email protected] Clair Hochfeld: [email protected] 0834065017 011 7262227mailto:clairehochfelNORTHERN GAUTENG: Gina Loudon [email protected] 082 665 8385 KZN Jane Markham [email protected] Tel: 031 700 3535 Cell: 084 421 5062 WESTERN PROVINCE: Jennifer Bradshaw: [email protected] 021 696 4134 (work) 021 696 8228 (fax) 083 775 1995 (cell)

EASTERN CAPE Clare Hubbard [email protected] TEL. (041) 3733780 FAX (041) 3733781 CE Mobility 80 Cape Road Mill Park 6001 OFS Corina Botha: [email protected] Tel: 082 2025952 051-5201234 (W) 051-5201231(F)

FS Goldfields (interest group) Rina van Zyl: Tel: 057 388 4543 [email protected]

To negotiate rates please contact the editor: e-mail: [email protected] tel: 021 794 6903 (preferable ) or cell: 082 9277776

newsletter february 2008 rev - sandta · 2009-09-15 · south african neurodevelopmental therapy...

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