This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Hypothesis 1: Severity and pattern of gait abnormalities in preterm children at 4 yrs of age will be significantly related to severity and laterality of abnormalities of neonatal brain structure. Hypothesis 2: Neurological outcome at 18-24 months of age will relate to the severity of gait abnormalities at 4 yrs of age. Goals This study aims to identify early and accurate predictors of gait abnormalities in preterm children in order to guide targeted, early intervention that will prevent growth related deformities, reduce the need for surgery and minimize gait disorders. Cerebral palsy (CP) is the most common motor disorder in children born prematurely, affecting 15% of very low birth weight (VLBW) preterm infants, and it has the highest lifetime costs per new case among the most common birth defects. Establishing appropriate treatment at an early age has been impeded by an inability to predict the severity and pattern of future gait disorders. Previous studies have reported a global association between white matter damage (e.g. periventricular leukomalacia, PVL) on conventional magnetic resonance imaging (MRI) and the risk of developing CP. New MR diffusion tensor imaging (DTI) techniques have recently been developed that offer more refined regional analysis of the brain. This study proposes to examine the relations between brain abnormalities on neonatal MRI, performed around term equivalent age, before discharge from the nursery, and measures of severity and pattern of gait deformities in premature children age 4 yrs. This age was selected because most of the important characteristics of mature gait stabilize by 4 yrs of age, making this an ideal age to evaluate gait characteristics, before current treatment is usually initiated. If we are successful, we will identify specific neonatal brain abnormalities on MRI that provide early and accurate predictors of the severity and pattern of gait abnormalities in VLBW preterm children. If we find clear-cut relations between the neonatal MRI and gait abnormalities at 4 yrs of age, this will allow early identification of infants at risk for specific gait abnormalities before discharge from the nursery. Early identification can guide early monitoring of muscle-bone growth rate discrepancy and early intervention such as range of motion therapy, casting, strength training, functional electrical stimulation and botulinum toxin treatments. Early intervention with these treatments can prevent the development of, for example, hamstring contracture and crouched gait. Furthermore, early identification of children at risk for more severe gait abnormalities can provide a basis for early implementation of promising new treatments, such as weight relieved treadmill gait therapy, at a time when it is most likely to be the successful.
Showing the most recent 10 out of 589 publications
