FOLLOW UP STUDIES DURING THE 1ST 5 YEARS OF LIFE - A PERVASIVE ASSESSMENT OF NEUROLOGICAL FUNCTION
FOLLOW UP STUDIES DURING THE 1ST 5 YEARS OF LIFE - A PERVASIVE ASSESSMENT OF NEUROLOGICAL FUNCTION
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DOI：
10.1136/adc.64.4_spec_no.496
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发表时间：
1989-04-01
影响因子：
4.4
通讯作者：
STEWART, A
中科院分区：
文献类型：
--
作者：
AMIELTISON, C;STEWART, A
方法我们提出的方案旨在以纯粹客观的方式记录脑损伤的后果。客观的神经学信息是从结构化的神经学检查中获得的，使用标准化的程序来引出体征并判断结果。在婴儿出生后的第一年，可以使用我们中的一位已经描述过的神经系统检查的方案和标准。20该计划包括详细的指示，为引发的迹象。同样的原则和方法可以应用于从第二年的生活使用年龄适当的标准来判断的结果。经验表明，到出生后第一年结束时，所有重大损伤都可以检测出来，任何持续存在的轻微损伤都必须被视为重大损伤。因此，对这个年龄段的神经发育状况进行分类可能既有意义又有预测价值。[17]因此，我们在此给出了从9个月大开始的标准（表1），尽管在其他地方可以获得整个第一年使用的标准。20提供了每次检查获得的神经学数据的记录表（表2）。我们建议每个孩子都应该有一个单独的记录表。检查结果应根据是否存在体征或角度的绝对测量值（以度为单位）记录在此表上。然后，根据表1中给出的适合年龄的标准对结果进行判断，并将其与听力、视力和行为评估、头部生长测量和心理测量测试的结果相加，以对特定年龄的儿童进行全面评估。听力和视力测试方法的选择，以及心理测量评估，取决于儿童的年龄和测试的可用性。由于（例如，角度大小或测试分数福尔斯落在适合年龄的范围内）而被判定为正常的结果可能被编码为0。根据角度测量或测试评分判定为轻度偏离的结果可编码为1，严重偏离的结果可编码为2。这种编码信息可以记录在表3所示的图表中，以提供特定年龄儿童的所有调查结果的摘要。在进行此总结时，可以忽略单个轻度偏离项（编码1）。两个或两个以上轻度偏离项目（总计2个或2个以上）表示异常，严重偏离项目（编码2）始终表示异常，即使该类别中只有一个项目。最后，根据这一编码信息，神经发育状况可被描述为“未受损”、“受损但无残疾”（轻度异常）或“受损伴残疾”（严重异常）。由于我们建议的记录类型可能构成一套最低限度的儿童数据的基础，可用于监测进展或提供研究资料，因此在汇总表（表3）中规定在“其他资料”标题下记录一些额外的事实。这些包括虽然不一定是发展性的，但可能影响儿童进步的条件;如果需要，它们也可以用来提供更广泛的异常定义。例子包括屈光不正、慢性肺部或胃肠道疾病和生长。
MethodsThe scheme we propose is designed to record the consequences of brain damage in a purely objective manner. Objective neurological information is obtained from a structured neurological examination using standardised procedures to elicit the signs and to judge the findings. Throughout the first year of life the scheme and standards for neurological examination already described by one of us may be used. 20 The scheme includes detailed instructions for eliciting the signs. The same principle and methods may be applied from the second year of life using age-appropriate standardstojudge the findings. Experience has shown that by the end of the first year of life all major impairments can be detected, and any persisting minor impairments must be regarded as significant. Thus categorisation ofneurodevelopmental condition at this age may have both meaning and predictive value. 17 We therefore give here standards starting from the age of 9 months (table 1) although standards for use throughout the first year are available elsewhere. 20 A record form for the neurological data that are obtained at each examination is provided (table 2). We recommend that each child should have an individual record form. Findings should be recorded on this form either according to the presence or absence of a sign or as absolute measurements of angles in degrees. The findings may then be judged according to the standards appropriate for age given in table 1 and added to the results of assessments of hearing, vision, and behaviour, measurements of head growth, and of psychometric testing, to give a comprehensive assessment of a child at a particular age. The choice of methods for tests of hearing and vision, and of psychometric assessments, depends on the age of the child and the availability of the tests. Findings judged to be normal because-for example, the size of an angle or a testscore falls within the range appropriate for age-may be coded 0. Findings judged to be mildly deviant on the basis of angle measurements or test scores may be coded 1, and severely deviant findings may be coded 2. This coded information may be recorded on the chart given in table 3 to provide a summary of all the findings in an individual child at a particular age. When making this summary a single mildly deviant item (coded 1) may be ignored. Two or more mildly deviant items (giving a total of 2 or more) indicate abnormality, and severely deviant items (coded 2) always indicate abnormality, even if there is only one item in this category. Finally, on the basis of this coded information, neurodevelopmental condition can be described as' unimpaired','impaired, but without disability'(mildly deviant), or'impaired with disability'(severely deviant). Because the type of records that we propose may form the basis of a minimum set of data for an individual child that may be used to monitor progress or to provide information for research, provision has been made on the summary form (table 3) for recording some additional facts, under the heading'other information'. These include conditions which, although not necessarily developmental in origin, may influence a child's progress; they can also be used to provide a wider definition of abnormality if required. Examples include refractive errors, chronic lung or gastrointestinal disease, and growth.