This subproject is one of many research subprojects utilizing theresources provided by a Center grant funded by NIH/NCRR. The subproject andinvestigator (PI) may have received primary funding from another NIH source,and thus could be represented in other CRISP entries. The institution listed isfor the Center, which is not necessarily the institution for the investigator.Cerebral palsy (CP) is considered a clinical syndrome caused by a preceding brain injury early in brain development that results in static neurological deficits. These deficits usually involve the somatomotor system manifesting as hemi-, di- or quadriplegia. Cerebral palsy can also manifest as hypertonicity and contractures, sensory deficits, hearing and visual difficulties, feeding problems and global developmental delay and other chronic medical problems such as lung disease. The most common cause of cerebral palsy is a hypoxic-ischemic brain injury, periventricular leukomalacia or intraventricular and/or parenchymal hemorrhage that occurs in the first year of life. Less common etiologies are genetic disorders, infections and intrapartum injuries. The current treatments of cerebral palsy are targeted to maintaining function, relieving contractures, improving nutrition and providing developmental supportive care, but to date there is no cure or preventive guideline. Moreover, supportive measures and family counseling is delayed since cerebral palsy can be diagnosed only at the age of 18-24 months. If an intervention or cure was discovered that could prevent the development of cerebral palsy, this intervention would be delayed due to the lack of a predictive diagnostic assessment within the first six months of life. Until about ten years ago, there was still no clinical, laboratory or imaging study that could accurately predict the development of cerebral palsy in the first six months of life. Head ultrasound, EEG and functional MRI were tested for their predictive value before the actual diagnosis of cerebral palsy, however, the low sensitivity of these studies showed that they are not useful as screening tools. Heinz F.R. Prechtl, an Austrian neurologist, developed a clinical assessment method to study the spontaneous movements of preterm and term infants. Monitoring of cramped synchronized generalized movements and fidgety movements resulted in 100% sensitivity and 95% specificity in predicting cerebral palsy. These studies were repeated by two other groups with similar results. A meta-analysis of predictive tools for cerebral palsy identified Prechtl's method as the most superior assessment that showed higher positive predictive value (PPV) than head ultrasound or MRI. These studies have not been repeated in the USA.
Our aim i n this proposal is to assess the predictive value of Prechtl's method in preterm and term infants with and without lung disease, who are at risk for development of cerebral palsy in Hawaii. We will compare the incidence of pulmonary diseases and cerebral palsy and observe any relationship between the development of lung disease and brain injury. We will identify at risk infants and observe their generalized movements according to Prechtl's assessment. We will conduct a 2-year longitudinal follow up of our patients and interpret the predictive value of our assessment based on the diagnosis of cerebral palsy. We will compare the sensitivity and PPV of head ultrasound and the assessment of generalized movements. This assessment will allow us to start supportive measures at an earlier stage of life, thus improving the outcome of children with cerebral palsy. The improvement of their musculoskeletal status and development allow children with cerebral palsy to have a better pulmonary status and will decrease the number and length of hospitalizations mainly due to complications of chronic lung disease.
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