MOTOR PERFORMANCE AND PERCEIVED MOTOR COMPETENCE IN EIGHT-YEAR-OLD CHILDREN AFTER NEONATAL VENO-ARTERIAL EXTRACORPOREAL MEMBRANE OXYGENATION (VA-ECMO)
Leontien Toussaint, MPP,1,3 Hanneke IJsselstijn, MD, PhD,2 Dick Tibboel, MD, PhD,2 Monique van der Cammen-van Zijp, PT, PhD1,21Department of Rehabilitation Medicine and Physical Therapy and 2Department of Pediatric Surgery, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands 3Master of Pediatric Physical Therapy Course, University of Applied Sciences Rotterdam
INTRODUCTION: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a cardio-pulmonary bypass technique providing life support in acute reversible cardiorespiratory failure. A large UK-trial showed a survival advantage of neonatal ECMO over conventional management. Detailed assessment of long-term morbidity seems essential. In 2009 we published characteristics of motor performance of five-year-old children treated with neonatal ECMO. The ECMO population seemed highly at risk for motor problems.
AIM: The aim of the present study is to evaluate motor performance and perceived motor competence in eight-year-old children who underwent VA-ECMO therapy as neonates. We also determined the association between motor performance and duration of VA-ECMO, highest oxygenation index prior to ECMO (OI), the primary diagnosis and perceived motor competence.
METHODS: We evaluated data of eight-year-old children all treated with neonatal ECMO in the Erasmus MC - Sophia Children's Hospital. The children participated in our structured follow-up program. The Movement-ABC I (M-ABC) was used to evaluate the children's motor performance, and the m-CBSK questionnaire for the perceived motor competence. Clinical characteristics were collected from our ECMO database.
RESULTS: Between 1993 and 2002, 192 neonates received ECMO support in our hospital. Fifty-five of them died (28.6%). Twenty-two of the survivors were lost to follow-up: refusal to participate n = 16, not traceable n = 6. Twenty-two other children were seen for follow-up, but not by the physical therapist or not at the exact age of eight. Seven children (5.1%) were not able to perform the M-ABC because of neurological dysfunction and 2 (1.4%) because of mental retardation.
Final analyses concerned 84 children (61.3% of all survivors). The primary diagnosis of these children were meconium aspiration syndrome (MAS): n = 49, persistent pulmonary hypertension (PPH): n = 15, congenital diaphragmatic hernia (CDH): n = 13, and other diagnoses: n = 7.
Fifty-nine of the 84 children (70.2%) had an overall percentile score on the M ABC within normal range (>P15), 11 (13.1%) were classified as borderline (P6-P15) and 14 (16.7%) had a motor problem (<P6). This distribution was different from the reference population (Chi-square: p < 0.001). Manual dexterity and ball skills were most affected.
Impaired motor performance was mainly observed in CDH patients (30.8%) and those with PPH (26.7%), whereas children with other diagnoses had an overall score within the normal range.
The perceived motor competence did not significantly differ from reference values (p = 0.57). The overall percentile score of the M-ABC did not correlate with the perceived motor competence, the duration of VA-ECMO and the highest OI prior to ECMO.
CONCLUSION: In eight-year-old children who underwent neonatal ECMO the prevalence of impaired motor performance was higher than in the reference population. Adverse outcome was mainly seen in patients with CDH and PPH. Clinical characteristics such as highest OI or duration of ECMO did not correlate with motor performance. That motor performance and perceived motor competence do not correlate suggests that children with impaired motor function seems satisfied with their motor performance. Prospective multidisciplinary follow-up of ECMO-treated patients is needed to determine which factors contribute to impaired motor performance and to evaluate the effects of early intervention.
IS A THIRTY MINUTE “COGNITIVE ORIENTATION TO DAILY OCCUPATIONAL PERFORMANCE” (CO-OP) INTERVENTION EFFECTIVE TO IMPROVE SKILLS IN CHILDREN WITH DEVELOPMENTAL COORDINATION DISORDER?
Marieke Maas-Altenburg,1,2 Master Pediatric Physiotherapy
Ivonne Duiser, Msc,1 Senior Lecturer
1Master Pediatric Physiotherapy Course, University for Applied Sciences, Rotterdam, the Netherlands, Burgemeester s'Jacobplein 1, 3015 CA, Rotterdam, the Netherlands.
2Pediatric Physiotherapist, Zaans Medisch Centrum, department ‘Child rehabilitation', Koningin Julianalaan 58, 1502 DV, Zaandam, the Netherlands.
BACKGROUND: Cognitive Orientation to daily Occupational Performance (CO-OP) is an often used task-oriented intervention (1) for children with Developmental Coordination Disorder (DCD).
A CO-OP intervention usually takes one hour and focuses on three set goals. A CO-OP intervention utilizes the executive functions, selective -and sustained attention. Selective and sustained attention are still developing in children between six and ten years of age (2). Compared to healthy peers children with DCD have more difficulty utilizing executive functions and remaining focused (3). Treatment strategies for children with DCD should take the reduced attention of these children into account. An intervention period of 30 minutes is considered suitable for children with DCD between six and ten years of age.
PURPOSE: This pilot aimed to determine if it is possible to reach two goals in an intervention period of twelve times 30 minutes. A second purpose was to determine whether generalization to other motor skills applies. Finally the impact of this intervention on family life was investigated.
METHODS: A modified CO-OP intervention of twelve sessions lasting 30 minutes each was provided to five children with DCD, aged six to ten years. Two motor skill goals were set. Evaluation of 1) performance of the motor skill and 2) satisfaction about the achieved goal, both measured with the Canadian Occupational Performance Measure (COPM), was carried out pre- and post intervention. Subsequently it was evaluated whether generalization to other motor skills occurs, measured with the Movement Assessment Battery for Children – version 2 (Movement ABC-2). Additionally, two parents were interviewed to determine the impact of the intervention on family life.
RESULTS: Five children with DCD were included (four boys and one girl). Median age was 8.1 years (range: 7.4 years – 10.7 years). Goals were to tie laces, jump rope, write on the line and play basketball. Significant differences were found on performance (p < 0.05) of the practiced skill. Clinical relevant improvement (two points or more difference pre- and post-intervention) was shown both on performance and satisfaction. Also, significant differences were found on ‘total'- score (p < 0.05), ‘Manual Dexterity'- score (p < 0.05) and ‘Balance'- score (p < 0.05) of the Movement ABC-2.
Although, only two parents have been interviewed; both parents were positive about the modified CO-OP. Due to distracting weather conditions, amount of homework or family matters practicing at home appeared to be feasible in either families for 30 minutes each week.
CONCLUSION: Reducing the duration of CO-OP interventions to 30 minutes for children with DCD resulted in significant improvement in skill performance and satisfaction about the acquired goal. Generalization of skills appeared to take place. This modified CO-OP intervention corresponds with the recent knowledge regarding reduced attention of children with DCD.
Finally, parents were able to apply the CO-OP strategy when a child was practicing intervention goals at home.
1. Polatajko HJ, Mandich A., Miller T., et al. Cognitive orientation to daily occupational performance (CO-OP): Part II- The Evidence, Physical & Occupational Therapy in Pediatrics: 2001b;20(2/3):83–106.
2. Betts J, McKay J, Maruff P, Anderson V. The development of sustained attention in children: the effect of age and task load. Child Neuropsychol. 2006;12(3);205–21.
3. Cruddace SA, Riddell PM. Attention processes in children with movement difficulties, reading difficulties of both. J. Abnorm
. Child Psychol. 2006;34(5):675–83.