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Asymmetric Walkway: A Novel Behavioral Assay for Studying Asymmetric Locomotion
Published on: January 15, 2016
Dissociated motor development--developmental patterns, clinical characteristics, causal factors and outcome, with
Insights
Dissociated motor development, characterized by delayed gross motor skills without neurological issues, affects many children. Early indicators like late sitting and muscle hypotonia can predict outcomes, aiding in diagnosis and prognosis for late walkers.
Area of Science:
- Developmental Pediatrics
- Neurology
- Clinical Research
Background:
- Dissociated motor development presents as significant gross motor delay with normal fine motor skills.
- Understanding the long-term outcomes and predictive factors for children with this condition is crucial.
Purpose of the Study:
- To prospectively study children with dissociated motor development.
- To identify clinical features and outcomes in late walkers.
- To differentiate between symptomatic and idiopathic late walkers.
Main Methods:
- Prospective study of 78 children (7-23 months) with dissociated motor development.
- Clinical assessment at initial examination and long-term follow-up (average age 4.2 years).
- Analysis of clinical features, neurological signs, and etiological factors.
Main Results:
- At follow-up, 65 children were classified as late walkers.
- Common features included muscular hypotonia (71%), shuffling (51%), and delayed sitting (79%).
- 46% had a defined clinical condition (symptomatic), while 54% were idiopathic; girls were overrepresented in the idiopathic group.
- Complete normalization was more frequent in idiopathic (66%) versus symptomatic (27%) late walkers.
- Heredity for shuffling, normal perinatal history, late sitting, and shuffling predicted a better outcome.
Conclusions:
- Early differentiation between normalizing and handicapped late walkers is challenging but possible.
- Identifying specific clinical features and developmental patterns aids in predicting outcomes.
- Muscular hypotonia and specific sitting/crawling patterns are associated with increased risk for later handicaps.
Abstract:
Dissociated motor development, defined as marked gross motor delay without any abnormal neurological signs and contrasting to a normal fine motor-adaptive performance, was studied prospectively in a consecutive in a consecutive series of 78 children, 48 girls and 30 boys, aged 7-23 months at first examination. When 17 months of age, 10 of them had become normalized, and in further three a disability explaining their gross motor delay had been diagnosed. At an average age of 4.2 years, the remaining 65 late walkers were, regardless of cause and developmental and neurological findings at final follow-up, characterized by a number of deviating clinical features as muscular hypotonia (71%), shuffling (51%) and dissociated or late pattern of learning to sit (79%). In 30 out of 65 late walkers (46%) a defined clinical condition of probable pathogenetic implication was found. In 35 out of 65 late walkers (54%), no explaining clinical condition was found. They have been designed to be idiopathic late walkers. Except for muscular hypotonia, present in 77%, conventional neurology was normal in this group. Minor neurological signs such as a positive Foerster sign, defect balance reactions in standing, or asymmetry in prewalking locomotion were, however, occasionally and temporarily observed. Girls were overrepresented among idiopathic late walkers, 69% compared to 43% among the symptomatic late walkers. Complete normalization was more common in the idiopathic group (66%) than in the symptomatic group (27%). Early differentiation between the late walkers who were normalized and those who developed mild mental retardation or neurological handicaps was difficult but not quite impossible. Heredity for shuffling, a non-revealing pre- and perinatal history, a developmental pattern of late learning to sit, and shuffling favoured a normal outcome. Creepers with a dissociated pattern of learning to sit and crawlers with muscular hypotonia were found to have an increased risk for later handicap.
