Children with Functional Motor Limitations

Silja Pirilä Children with functional motor limitations A three-level approach Tampere: University of Tampere, Department of Psychology, Finland, 2006. The aim of the study was to investigate children with functional motor limitations. An effort was made to integrate the studies into a current structure of International Classification of Functioning, Disability and Health (ICF; WHO, 2001). The studies examined linkages between three levels: (1) the level of most immediate environment of the child: i.e. family strengths, social-economical status, assistance of the child in daily activities; (2) the level of activity limitations: i.e. functional gross and fine motor skills in addition to skills in self-care, mobility and social function; and (3) the level of body functions and structure: i.e. neonatal brain lesion, birth weight, intellectual functions, neuropsychological functions, language and motor speech skills. Sixty-nine children receiving special health care services in the Department of Pediatric Neurology, Tampere University Hospital, for identified developmental disabilities, such as cerebral palsy (CP), psychomotor or motor delay, chromosomal anomalies, etc., participated in the current study. Most of the children (n=61) and their caretakers were recruited from the Play Project which was an early intervention program for disabled children run in the years 1994 to 1997 (Korpela & Nieminen, 2001). For methodological reasons the sample was enlarged with 8 children. The children were as infants treated in the neonatal intensive care unit and followed up later in the Department of Pediatric Neurology in Tampere. Due to prenatal or perinatal brain insults most of them developed functional motor limitations over time. The extent of disability ranged from mild impairment to severe multiple disabilities. The results showed that the family strengths were rather high. However, the combination of the severity of the functional motor limitations and cognitive difficulties of a child showed some effects on family functioning. The children showed functional limitations in the domains of self-care, mobility and social function. In the domains of self-care and mobility, the functional limitations triggered the needed assistance by the caregivers. However, in the social function domain the assistance the caregivers offered did not differ from the norm especially when the children had cognitive level in the normal range. The severity of the CP and cognitive level were associated with motor speech and language problems. CP with comorbid cognitive difficulties (IQ < 70) produced language deficits in the expressive and comprehensive domains. Half of the children with the cognitive level at or close to norms showed deficits in their motor speech skills. In children with diplegia spastica, neuropsychological deficits were found within sensorimotor functions, visuospatial processing, attention/executive functions, and speeded naming whereas language and memory/learning functions were at or close to norms. The neonatal brain ultrasound methodology predicted moderately the severity of CP, not the intelligence, neuropsychological functions, language, or motor speech skills. Children with functional motor limitations, family strengths, functionality in self-care, mobility, and social functions, intellectual and neuropsychological skills, periventricular leukomalacia