Brain, Vol. 122, No. 4, 727-740,
April 1999
© 1999 Oxford University Press
Periventricular leucomalacia and preterm birth have different detrimental effects on postural adjustments
1 Departments of Woman and Child Health and 2 Neuroscience, Karolinska Institute, Stockholm, Sweden and 3 Department of Medical Physiology–Developmental Neurology, University of Groningen, Groningen,The Netherlands
Correspondence to:
Dr Mijna Hadders-Algra, University Hospital Groningen, Developmental Neurology, CMC IV, 3rd floor, Hanzeplein 1, 9713 GZ Groningen, The Netherlands E-mail: m.hadders-algra{at}med.rug.nl
Postural adjustments during sitting on a moveable platform were assessed by means of multiple surface EMGs of neck, trunk and leg muscles and kinematics in three groups of children, aged 1½–4½ years. The first group consisted of 13 preterm children (born at a gestational age of 25–34 weeks), whose neonatal ultrasounds had shown distinct lesions of the periventicular white matter (PWM). The second group was the preterm control group, consisting of 13 preterm children with normal neonatal brain scans, matched to the PWM group with respect to gestational age at birth, birth weight, sex and age of postural assessment. The third group was formed by 13 healthy children born at term and matched to the PWM group with respect to sex and age at examination. In addition to the postural assessment an age-specific neurological examination was carried out. Three of the children of the PWM group developed a cerebral palsy syndrome, nine showed minor neurological dysfunction and one child was neurologically normal. In the preterm control group one child showed minor neurological dysfunction, while the remaining 12 children of this group and all children of the full-term group were neurologically normal. The postural assessment revealed that preterm birth was associated with two types of postural dysfunction. One dysfunction was related to the presence of a PWM lesion and consisted of a limited repertoire of response variation. The other dysfunction was not related to the presence of a PWM lesion, but to preterm birth itself. It consisted of a change in the ability to modulate the postural responses. Preterm children showed a higher sensitivity to platform velocity than full-term children, and they lacked the capacity to modulate EMG amplitude with respect to initial sitting position.
prematurity; periventricular leukomalacia; postural control; EMG; neurological development
HAM = hamstring muscles; NE = neck extensor muscles; NF = neck flexor muscles; PWM = periventricular white matter; RA = rectus abdominis muscle; RF = rectus femoris muscle; TE/LE = thoracic and lumbar extensor muscles
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