Motor Outcomes in Premature Infants

Maureen Connors Lenke, BS, OTR/L

Disclosures

NAINR. 2003;3(3) 

In This Article

Subtle Impairments Related to Early Neurological Injury

At the 2-, 3-, and 4-year follow-up visits, refinement and higher-level coordination of fine motor, gross motor, and adaptive self care skills should be evident. It is at these later follow-up visits that the more subtle neurological deficits associated with prematurity will become apparent if they are present.[8] Deficits noted at these visits may include poor shoulder stability that will interfere with age appropriate prehension patterns necessary for drawing, writing, and manipulative tasks. Small tremulous involuntary hand movement is often seen. Poor proximal muscle strength will impact higher-level balance skill necessary for running, jumping, and stair climbing. Difficulties with postural control and gross motor coordination may be present.

Deficits in self-care skills including self-feeding and dressing may be present because of inadequate motor planning abilities or decreased body awareness. Motor deficits will become more obvious in the classroom and on the playground.

Even when a major neurological disorder has been ruled out in the premature infant, there are subtle deficits associated with prematurity and early brain injury that may persist.[8] The total impact of prematurity may not be obvious until the preschool years. A recent study of a group of infants born at <29 weeks indicated that 23% of those children with no diagnosed physical impairment required additional special school services at age 4 to 10 years.[14] Sensory processing deficits or hypersensitivity to sensory stimuli such as touch, sound, and movement frequently occurs in addition to a motor impairment.[4] Decreased attention and high levels of activity, difficulty with self regulation of the arousal system, and fine motor and bilateral coordination deficits are frequently identified in the preschool and school age children, greatly impacting functional and academic performance.[4] Specific learning deficits in the visual motor area continue to be noted in research of low birth weight infants.[15] The terms "subtle" or "minor" impairments do not always reflect the degree of impact that the deficit will have on the child's long-term outcome or the impact the child's deficit will have on the family. These findings support the continued monitoring and follow-up of preterm infants into the school years to optimize performance.

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