Correlations between Motor Performance and Cognitive Functions in Children Born < 1250 g at School Age

Abstract

Very low birth weight born children manifest a higher prevalence of motor and cognitive impairments than term children. Seventy-four prospectively enrolled children born < 1250 g underwent testing of motor (Zurich neuromotor assessment ZNA: timed motor performances and associated movements) and cognitive functions (Kaufman-ABC) at age six years. Children with cerebral palsy or mental retardation were excluded. Adaptive motor tasks (pegboard and dynamic balance) and visuomotor cognitive functions were specifically impaired, and a distinct correlation pattern between motor and cognitive abilities was detected. The adaptive fine motor task (pegboard) correlated with visuomotor functions of the Kaufman-ABC (“triangles”, r = 0.35; “matrix analogies”, r = 0.39), while pure motor tasks of the ZNA (repetitive, alternating, and sequential movements) did not in spite of impaired motor performance. Timed motor performance below the 10th percentile correlated strongly with cognitive delay (IQ < 85: adaptive fine motor: OR 6.0 [95 % CI] 4.7 - 7.3; adaptive gross motor: OR 7.0 [CI 5.6 - 8.4]; static balance: OR 9.6 [CI 8.2 - 11.0]). In conclusion, motor deficits in children born < 1250 g without severe disabilities correlate with specific cognitive impairments, in particular of the visuomotor domain. The correlation pattern may indicate specific dysfunction in visuomotor transformation, the intermediate process between visual-perceptual input and motor output. Early assessment of both motor and cognitive functions using standardized assessment tools is important to determine the extent and combination of specific developmental disturbances and to tailor therapeutic intervention.

Key words

Motor performance - visuomotor - cognition ·- correlation ·- very low birth weight

References

• 1 Allen G, McColl R, Barnard H, Ringe W K, Fleckenstein J, Cullum C M. Magnetic resonance imaging of cerebellar-prefrontal and cerebellar-parietal functional connectivity.  Neuroimage. 2005;  28 39-48
• 2 Aylward G P. Cognitive and neuropsychological outcomes: more than IQ scores.  Ment Retard Dev Disabil Res Rev. 2002;  8 234-240
• 3 Cohen Y E, Andersen R A. A common reference frame for movement plans in the posterior parietal cortex.  Nat Rev Neurosci. 2002;  3 553-562
• 4 de Vries L S, Eken P, Dubowitz L M. The spectrum of leukomalacia using cranial ultrasound.  Behav Brain Res. 1992;  49 1-6
• 5 Drummond P M, Colver A F. Analysis by gestational age of cerebral palsy in singleton births in north-east England 1970 - 94.  Paediatr Perinat Epidemiol. 2002;  16 172-180
• 6 Foulder-Hughes L A, Cooke R W. Motor, cognitive, and behavioural disorders in children born very preterm.  Dev Med Child Neurol. 2003;  45 97-103
• 7 Gervini D, Rousson V. Criteria for evaluating dimension-reducing components for multivariate data.  The American Statistician. 2004;  58 72-76
• 8 Ghilardi M, Ghez C, Dhawan V, Moeller J, Mentis M, Nakamura T. et al . Patterns of regional brain activation associated with different forms of motor learning.  Brain Res. 2000;  871 127-145
• 9 Goyen T A, Lui K, Woods R. Visual-motor, visual-perceptual, and fine motor outcomes in very-low-birthweight children at 5 years.  Dev Med Child Neurol. 1998;  40 76-81
• 10 Hagberg B, Hagberg G, Olow I. The changing panorama of cerebral palsy in Sweden 1954 - 1970. I. Analysis of the general changes.  Acta Paediatr Scand. 1975;  64 187-192
• 11 Hagberg B, Hagberg G, Olow I, van Wendt L. The changing panorama of cerebral palsy in Sweden. VII. Prevalence and origin in the birth year period 1987 - 90.  Acta Paediatr. 1996;  85 954-960
• 12 Jongmans M, Mercuri E, Dubowitz L MS, Henderson S E. Perceptual-motor difficulties and their concomitants in six-year-old children born prematurely.  Hum Mov Sci. 1998;  17 629-653
• 13 Kaufman A, Kaufman N. Kaufman Assessment Battery for Children (K‐ABC). Circle Pines, Minn; American Guidance Service 1983
• 15 Largo R H, Caflisch J A, Hug F, Muggli K, Molnar A A, Molinari L. Neuromotor development from 5 to 18 years. Part 2: associated movements.  Dev Med Child Neurol. 2001;  43 444-453
• 16 Largo R H, Caflisch J A, Hug F, Muggli K, Molnar A A, Molinari L. et al . Neuromotor development from 5 to 18 years. Part 1: timed performance.  Dev Med Child Neurol. 2001;  43 436-443
• 17 Largo R H, Fischer J E, Caflisch J A. Manual for the Zurich Neuromotor Assessment. Zurich; AWE-Verlag 2002
• 18 Largo R H, Pfister D, Molinari L, Kundu S, Lipp A, Duc G. Significance of prenatal, perinatal and postnatal factors in the development of AGA preterm infants at five to seven years.  Dev Med Child Neurol. 1989;  31 440-456
• 19 Lemons J A, Bauer C R, Oh W, Korones S B, Papile L A, Stoll B J. et al . Very low birth weight outcomes of the National Institute of Child health and human development neonatal research network, January 1995 through December 1996. NICHD Neonatal Research Network.  Pediatrics. 2001;  107 E1
• 20 Luoma L, Herrgard E, Martikainen A. Neuropsychological analysis of the visuomotor problems in children born preterm at < or = 32 weeks of gestation: a 5-year prospective follow-up.  Dev Med Child Neurol. 1998;  40 21-30
• 21 Marlow N, Roberts L, Cooke R. Outcome at 8 years for children with birth weights of 1250 g or less.  Arch Dis Child. 1993;  68 286-290
• 22 Melchers P. Kaufman-Assessment Battery for Children, Durchführungs- und Auswertungshandbuch. 5th ed. Leiden; PITS 2001
• 23 Melchers P, Preuss U. Kaufman Assessment Battery for Children (K-ABC). Deutschsprachige Fassung. Frankfurt; Swets and Zeitlinger 1991
• 24 Morrison D F. Multivariate Statistical Methods. 3rd ed. New York; McGraw Hill 1990
• 25 Olsen P, Vainionpaa L, Paakko E, Korkman M, Pyhtinen J, Jarvelin M R. Psychological findings in preterm children related to neurologic status and magnetic resonance imaging.  Pediatrics. 1998;  102 329-336
• 26 Papile L A, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm.  J Pediatr. 1978;  92 529-534
• 27 Powls A, Botting N, Cooke R W, Marlow N. Motor impairment in children 12 to 13 years old with a birthweight of less than 1250 g.  Arch Dis Child Fetal Neonatal Ed. 1995;  73 F62-66
• 28 Richardson D K, Gray J E, Gortmaker S L, Goldmann D A, Pursley D M, McCormick M C. Declining severity adjusted mortality: evidence of improving neonatal intensive care.  Pediatrics. 1998;  102 893-899
• 29 van den Hout B M, Stiers P, Haers M, van der Schouw Y T, Eken P, Vandenbussche E. et al . Relation between visual perceptual impairment and neonatal ultrasound diagnosis of haemorrhagic-ischaemic brain lesions in 5-year-old children.  Dev Med Child Neurol. 2000;  42 376-386
• 30 Wolke D, Meyer R. Cognitive status, language attainment, and prereading skills of 6-year-old very preterm children and their peers: the Bavarian Longitudinal Study.  Dev Med Child Neurol. 1999;  41 94-109