SUMMARY The ages at attainment of 12 gross motor milestones were obtained prospectively during well‐baby visits in the first two years of life for 381 children. All had been born at term and were judged to be normal at one year. A longitudinal analysis, using an index summarising each chilďs progress for eight selected milestones, is reported for the 284 children for whom data were complete. A high percentage of parents were able to report the age at attaining milestones with an acceptable degree of variability. The children attained milestones at earlier ages than traditionally reported. There were only minor sex differences in age at attainment, but black children attained milestones earlier than white children. RÉSUMÉ Développement moteur fondamental normal: influence de la race, du sexe et de la classe socio‐économique Les ǎges oil sont atteints 12 réperes moteurs fondamentaux ont été obtenus prospectivement durant des visites de contrôle de bonne santé dans les deux premières années de la vie, chez 381 enfants. Tous étaient nés a terme et jugés normaux à I'ǎge ďun an. Une analyse longitudinale utilisant un index résumant les progrés de chaque enfant pour huit repéres séléctionnés est rapportée pour les 284 enfants, pour lesquels les données étaient complétes. Un pourcentage éléve de parents ont pu indiquer L'ǎge auquel les repèrés étaient atteints avec un degré acceptable de précision. Les enfants atteignaient les etapés à des ages plus précoces qu'il n'est traditionnellement rapporté. II n'a été rapporte que des différences minimes ďǎge de réussite selon le sexe mais les enfants noirs atteignaient les repéres plus tôt que les enfants blancs. ZUSAMMENFASSUNG Normale allgemein‐molorische Entwicklung: Beeinflussung durch Rasse, Geschlecht und gesellschafllichen Stand Bei 381 Kindern wurde prospektiv bei Kontrolluntersuchungen in den ersten zwei Lebensjahren bestimmt, in welchem Alter die 12 Meilensteine der motorischen Entwicklung erreicht wurden. Alle Kinder wurden zum Termin geboren und im Alter von einem Jahr füesund befunden. Für 284 Kinder, deren Daten vollstandig waren, wird eine Longituinalanalyse gegeben, bei der ein Index verwendet wurde, der den Fortschritt eines jeden Kindes für acht ausgewählte Meilensteine zusammenfaßte. Die meisten Eltern konnten das Alter, mit dem die Meilensteine erreicht wurden, mit nur geringen Abweichungen angeben. Die Kinder erreichten die Meilensteine früher als bisher beschrieben. Es fanden sich nur unwestetliche Geschlechtsunterschiede, aber die schwarzen Kinder erreichten die Meilensteine eher als die weißen. RESUMEN Desarrollo motor grosero normal: influencia de la raza, sexo y nivel socio‐económico Se obtuvieron prospectivamente 12 hitos de consecución de la motilidad no fina en el curso de visitas de puericultura realizadas en 381 niños en los primeros dos años de vida. Todos eran recién nacidos a término eran considerados normales al año de edad. Se muestra un estudio longitudinal, haciendo uso de un indice que resumía los progresos d...
Legislatively mandated programs for early intervention on behalf of handicapped infants often stipulate the inclusion of physical therapy as a major component of treatment for cerebral palsy. To evaluate the effects of physical therapy, we randomly assigned 48 infants (12 to 19 months of age) with mild to severe spastic diplegia to receive either 12 months of physical therapy (Group A) or 6 months of physical therapy preceded by 6 months of infant stimulation (Group B). The infant-stimulation program included motor, sensory, language, and cognitive activities of increasing complexity. Masked outcome assessment was performed after both 6 and 12 months of therapy to evaluate motor quotient, motor ability, and mental quotient. After six months, the infants in Group A had a lower mean motor quotient than those in Group B (49.1 vs. 58.1, P = 0.02) and were less likely to walk (12 vs. 35 percent, P = 0.07). These differences persisted after 12 months of therapy (47.9 vs. 63.3, P less than 0.01, and 36 vs. 73 percent, P = 0.01, respectively). We noted no significant differences between the groups in the incidence of contractures or the need for bracing or orthopedic surgery. Group A also had a lower mean mental quotient than Group B after six months of therapy (65.6 vs. 75.5, P = 0.05). The routine use of physical therapy in infants with spastic diplegia offered no short-term advantage over infant stimulation. Because of the limited scope of the trial, our conclusions favoring infant stimulation are preliminary. The results suggest that further study of the effects of both physical therapy and infant stimulation is indicated.
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