Periventricular leucomalacia and preterm birth have different detrimental effects on postural adjustments

Abstract

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 1 1/2-4 1/2 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.