High levels of alcohol consumption during pregnancy affect the development of the baby's central nervous system. Pregnant women were interviewed about their alcohol consumption during pregnancy, when they first visited the maternity hospital in Roubaix, France. Of the 698 women interviewed, 156 of their children were investigated at the age of 4 ½ years with a standardised examination to assess the effects of prenatal alcohol exposure on neurological status. Two scores were calculated: a posture score, which measured items while the child was standing; and a minor neurological signs score. The posture score was not related to prenatal alcohol exposure. Consumption of 21 drinks/week (3 drinks/day) or more during pregnancy was significantly associated with a higher number of minor neurological signs, after controlling for relevant covariables. Although prenatal alcohol exposure was related to a lower General Cognitive Index (GCI), minor neurological signs were associated with prenatal alcohol exposure after controlling for GCI.

The purpose of this study is to compare the work experiences of adolescents with spinal cord injuries (SCI) to peers without disabilities. Twenty-eight adolescents with SCI and 25 age-matched individuals without disabilities (controls) took part in the study. A structured telephone questionnaire was used to assess their experience of household chores, volunteer jobs, and paid work. The mean age at interview was 16.2 years for those with SCI and 16.0 years for control participants. There was no significant difference between the individuals with SCI and the control participants in chores or volunteer work experiences, but the individuals with SCI were significantly less likely to have paid work experience than control participants (χ2 = 13.670, p<0.001). Of the older adolescents, aged >15 to 19 years, five of 15 individuals with SCI and 16 of 16 control participants had paid work (Fisher exact test p<0.001). Of individuals with SCI, those with milder injuries and those injured at a younger age were more likely to have work experience

Little is known about the developmental course of striking action. This cross-sectional study explored the refinement of striking in 28 children aged between 4 and 12 years and investigated how well they could use kinaesthesis to gauge the length of an unseen bat. The kinematic data (including smoothness of movement) showed quantitative differences between the age groups. In contrast, no differences were found in the children's ability to judge the length of the unseen bat: within three strikes all of the children had made a clean hit, indicating that they had successfully judged bat length. The children then appeared to memorize the bat with which they had accurately hit the target and made: (1) minimal errors when using this bat in later trials and (2) predictable errors when using two other bats of different sizes. The results show that the striking action becomes optimized over childhood, with smoothness of movement providing an index of this refinement. The findings also suggest that young children have a higher level of kinaesthetic sensitivity than has been assumed previously on the basis of static limb positioning tasks. The results suggest that the striking task used in this study might be a useful tool for investigating the development of movement skills in children with developmental disorders.

Somatosensory evoked potentials (SSEPs) are a very sensitive measure of the functional integrity of the neuroaxis, including peripheral and central structures. When used in diagnostic mode they can provide additional information regarding the probable areas of dysfunction. SSEPs were recorded from 44 children (64 feet with congenital talipes equinovarus, CTEV), between the ages of 2 to 15 years, who had structural CTEV deformity previously treated by surgery, with no clinical evidence of neurological deficit. SSEPs were elicited after sequential and bilateral stimulation (0.1ms/5Hz/10 to 20mA) of the posterior tibial nerve and the common peroneal nerve and were recorded cortically (P40). In half the children, additional recordings were conducted at the knee (N5), the first lumbar spinous process (N14), and the seventh cervical spinous process (N20). Eighteen children had abnormal responses, four children had non-reproducible responses, and 22 children had normal responses. Analysis of the data at different levels of the nervous system showed that eight children had abnormality at the spinal level. The surgical outcome was influenced by the neurological abnormality, with an excellent or good outcome in 34 of 36 feet with normal neurology and 19 of 28 feet where a deficit was present (p<0.05). These findings support the neurological theory as an etiological factor in CTEV deformity.

The tonic stretch reflex threshold in children with cerebral palsy (CP) was measured to determine its test–retest reliability and its concurrent validity as a potential measure of spasticity. Fourteen children with spastic CP aged 6 to 18 years were tested on three separate occasions for clinical spasticity and stretch reflex thresholds of affected elbow flexors. Electromyographic (EMG) recordings were obtained by surface electrodes for elbow flexors and extensors during mechanical displacements of the passive joint towards extension. Displacements were produced by a torque motor at seven velocities which randomly varied from trial to trial. EMG activity was measured in the stretched flexor muscles to determine threshold angles and velocities for each velocity of stretch. These were plotted on a velocity–angle-phase diagram and regression analysis was used to determine the static stretch reflex threshold for each participant. The measure showed good test–retest reliability for the group (ICC 0.73, p<0.001) whereas a significant correlation between the measure and the clinical spasticity scale was not found. This technique is a potential outcome variable for measuring the efficacy of treatments aimed at decreasing spasticity in children with CP.

The purposes of this study were to evaluate whether resistance to stretch could be measured in a reproducible manner from day to day in children with severe multiple disabilities, and whether 6 weeks of daily activity, including one daily stretch, would modify passive resistance to stretch. Passive resistance to stretch was measured in six children using an established model that synchronously and continuously measured knee flexion moment (Nm) and EMG activity of the hamstring, while the velocity and angle of a static stretch was controlled. Resistance to stretch was evaluated in the absence of EMG activity. Measurements were taken on two separate occasions with a 2-week hiatus, and before and after a 6-week activity period which included a daily 1-minute static stretch. There was no significant change in resistance to stretch when tested 2 weeks apart (test 1, 8.6±1.2Nm; test 2, 8.3±1.2Nm, p<0.05) which yielded a strong correlation coefficient (Spearman r=1.0, p<0.01; Pearson r=0.953, p<0.01). Similarly, there was no difference in resistance to stretch before and after the 6-week period (mean difference 0.22±0.75Nm, p<0.05). Data from this study demonstrate that resistance to stretch of the hamstring muscle group could be measured in a reproducible manner from day to day in children with multiple disabilities. Further, resistance to stretch was unchanged after 6 weeks of daily activity, including a daily 1-minute static stretch.

The aim was to investigate the performance of children with attention-deficit–hyperactivity disorder (ADHD) in tasks involving motor–memory representations. A special grip object recorded forces generated by the fingertips during a precision grip–lift task. Common objects were lifted from a linear scale. Twenty-five boys with ADHD were evaluated and grouped according to the presence (ADHD+) or absence (ADHD) of movement dysfunction using the Movement Assessment Battery for Children (Henderson and Sugden 1992). Mean group ages were 11.4 years(range 9.0 to 11.0 years) and 11.7 years (9.0 to 15.6 years), respectively. They were compared to a control group of 25 age-matched boys, mean group age 11.8 years (range 9.0 to 13.0 years). Variability of motor performance was predominant in the ADHD+ group. Several of these participants presented a higher grip-force output during the gripping movement. They also had difficulties in adapting the motor output to target different weights, suggesting deficient anticipatory parameter control based on memory representations. The results suggest that in some children motor problems are due to detrimental neural control functions rather than core symptoms of ADHD.

This paper describes the neuroimaging and neuropathological findings in five cases of severe brain damage after traumatic mid-trimester amniocentesis, all performed between 1986 and 1994. Although fetal injury after amniocentesis has been reported, reports of brain injury are infrequent. Continuous ultrasound monitoring may reduce the risk of fetal injury but follow-up ultrasound scans can be falsely reassuring. Withdrawal of blood-stained fluid, particularly if it contains tissue fragments, should alert the operator to the possibility of fetal damage. Histological examination of such tissue fragments may confirm the nature of the fetal damage. The consequences of fetal brain injury are severe, all five of our cases showed evidence of disruption of brain development compatible with mid-term injury. Obstetricians and their patients should be aware of the small but significant risk of brain damage after mid-term amniocentesis.

Intrathecal baclofen infusion (IBI) is being used with increasing frequency in children to treat spasticity and dystonia. In this report, we summarize the clinical course of a 9-year-old boy with quadriplegic cerebral palsy with mixed tonal abnormalities (spasticity and dystonia) experiencing withdrawal from intrathecal baclofen. His clinical course is compared to that of adults experiencing withdrawal from IBI and to neuroleptic malignant syndrome. If unrecognized, this disorder may have significant potential for morbidity and mortality. Clues to diagnosis, appropriate evaluation, and potential treatments are discussed. When a child treated with IBI presents with unexplained multiorgan system dysfunction, particularly if accompanied by evidence of rhabdomyolysis, the integrity of the IBI system must be evaluated. In some cases, evaluation might necessitate surgical exploration. Caregivers most commonly seek urgent evaluation and treatment from their primary care provider when their child experiences fever or acute illness. Primary care providers of children treated with IBI should be made aware of this clinical scenario to prevent delays in diagnosis.

During the last century, knowledge of the mechanisms governing the functions of the central nervous system increased rapidly as sophisticated physiological, neurochemical, and imaging techniques developed. In the field of motor control, better understanding of neurophysiology caused a gradual shift from the concept that motor behaviour is largely controlled by reflex mechanisms towards the notion that motility is the net result of complex spinal or brainstem activity, which is subtly modulated by segmental afferent information and ingeniously controlled by supraspinal networks. Nowadays it is assumed that motor control of rhythmical movements like locomotion, respiration, sucking, and mastication is based on so-called central pattern generators (CPGs): neuronal networks which can generate complex basic activation patterns of the muscles without any sensory signals. Nevertheless, sensory information of the movement is important in adapting the movement to the environment. The activity of the networks, which are usually located in the spinal cord or brainstem, is controlled from supraspinal areas via descending motor pathways. The supraspinal activity itself is organized in large-scale networks in which cortical areas are functionally connected through direct recursive interaction or through intermediary cortical or subcortical (striatal, cerebellar) structures.