دانلود رایگان ترجمه مقاله آیا رفتار محرک ناشی از ضایعه مغزی در سنین پایین، ناآزموده است؟ (نشریه هینداوی 2003)

اختلال هماهنگی رشد: آیا رفتار محرک ناشی از ضایعه مغزی در سنین پایین، ناآزموده است؟

Developmental Coordination Disorder: Is Clumsy Motor Behavior Caused By a Lesion of the Brain At Early Age?

SUMMARY

Children presenting with Developmental Coordination Disorder or clumsiness often exhibit signs of minor neurological dysfunction (MND). The data of the Groningen Perinatal Project, a long-term follow-up project on the relations between prenatal and perinatal adversities and neurological, behavioral, and cognitive development revealed that two basic forms ofMND can be distinguished: simple and complex MND. During school age children with simple MND are characterized by the presence of one or two dysfunctional clusters of MND, in adolescence by the presence of choreiform dyskinesia or hypotonia. Probably the major sources of origin of simple MND are genetic constitution and stress during early life. Simple MND might reftect the lower tail of the normal distribution of the quality of non-pathological brain function. In line with this hypothesis is the finding that simple MND is associated with only a moderately increased risk for learningand behavioral problems. Children with complex MND present at school age with at least three dysfunctional clusters of MND, in adolescence with problems in fine manipulation or coordination. Perinatal adversities play an evident etiological role in the development of complex MND, suggesting that it might be attributed to a lesion of the brain at early age. In line with this idea is the finding that complex MND shows a strong correlation with attention and learning problems.

1 Introduction

During the last century many terms, such as dyspraxia, minimal brain dysfunction, sensory integrative dysfunction, and developmental coordination disorder have been used to describe children with clumsy motor behavior (Geuze et al., 2001; Henderson & Henderson, 2003). But gradually it was realized that the heterogeneity in labels was confusing and counterproductive. Participants at an international, multidisciplinary consensus meeting in 1994 agreed to use the DSMN tenn Developmental Coordination Disorder or DCD (American Psychiatric Association, 1994; Polatajko et al., 1995). The tenn DCD in general refers to children with nonnal intelligence who have poor motor coordination without evidence of frank neurological pathology, such as cerebral palsy or muscular dystrophy.1 The motor problems of children with DCD are so serious that they affect daily activities at home and at school.

The heterogeneity in terminology has hampered research, such as the search for etiological factors and the understanding of pathogenetic mechanisms of clumsy motor behavior or DCD. What percentage of DCD cases can be attributed to damage of the nervous system remains to be determined, and for those cases in which this attribution can be made, whether the damage occurred in prenatal, perinatal, or early postnatal development. At present these questions can not be answered. But, recent research allows for the answering of a relatively close question: what part of minor neurological dysfunction in childhood is caused by a lesion of the brain at early age? The aim of the present paper is to discuss the latter question.