Assessment of Affordances in the Home Environment and Neurodevelopment of Children With Congenital Zika Syndrome

Congenital Zika syndrome (CZS) is characterized by brain abnormalities caused by in utero exposure to the Zika virus (ZIKV), resulting in significant neurodevelopmental, motor and visual impairments in affected children. These impairments hinder their ability to engage in social interactions and explore their surroundings. However, personalized and continuous sensory stimulation, particularly within the home environment, may play a crucial role in supporting motor and visual development in these children. Therefore, this study aimed to explore the relationship between sensory stimulation in the home environment and the motor and visual development of children with CZS.

This cross-sectional study included children with CZS. The Affordances in the Home Environment for Motor Development (AHEMD) instrument was administered to caregivers to assess motor stimulation opportunities at home. All children underwent neurodevelopmental milestone assessments using the Brazilian Portuguese version of the Bayley Scales of Infant Development-Third Edition (BSID-III). Gross motor function was further assessed with the Gross Motor Function Measure (GMFM), and functional vision was evaluated by using the functional vision developmental milestones test (FVDMT).

Eighty-five children with a mean age of 39.9 ± 2.3 (24.0-42.0) months were included. Forty-one children (48.2%) lived in homes with 'very weak' environmental stimulation. The children showed profound developmental delays in all domains of the BSID-III with an average neurodevelopmental age of 39.9 ± 2.3 (24-42) months. On the GMFM, over 90.0% of children could not initiate or maintain the required movements and postures for sitting, crawling, standing, walking, running and jumping. A significant positive correlation was found between the variety of home sensory stimulation with the AHEMD and the scores at the BSID-III motor scales as well as the GMFM. More fine motor materials in the home context correlated with better gross motor scores on the BSID-III (p = 0.016), increased likelihood of passing the 'sitting' (p = 0.041) and 'standing' (p = 0.019) items of the GMFM. Children with less visual impairment in parameters of the FVDMT ['eye contact' (p = 0.032), 'social smile' (p = 0.031) and 'movements to achieve' (p = 0.007)] had more stimulating home environment.

Nearly half of the children with CZS who exhibited neurodevelopmental delays lived in homes lacking appropriate sensory stimulation. This study suggests that motor and visual development, including fine and gross motor skills as well as functional vision, may be benefited by the quantity and quality of play and stimulation opportunities available at home.