Joint mobility and motor development.

Abstract

SUMMARY The association of joint hypermobility and motor development was sequentially investigated in 715 infants from the ages of 8 to 14 months. Seven joints were evaluated for mobility, and each infant underwent a physical and neurological examination. Parents were given a Denver Developmental Parents' Questionnaire. All subjects with a general developmental delay, systemic illness or syndrome were excluded. The infants were classified as having normal or delayed motor development with normal or delayed joint mobility. They were re-examined six months later. Multivariate statistical techniques was used for categorical analysis, and three joints were found to be significantly associated with motor delay at the first examination-hip abduction, elbow hyperextension, and foot dorsiflexion. Of the 715 infants, 126 had joint hypermobility and of these 38 (30-2%) had motor delay. Sixty four of 589 (10.9%) with normal joints had delayed motor development. Six months later 23 out of 35 of the group with joint hypermobility and 42 out of 53 of the group with normal joints had normal motor function.Joint hypermobility is associated with an increased incidence of motor delay in infancy. Over the ensuing six months most of the subjects will catch up. These findings, indicating a favourable prognosis, have implications regarding clinical assessment and parental counselling.Paediatricians frequently encounter infants presenting with delayed gross motor development. The evaluation of such cases entails comprehensive paediatric and neurodevelopmental examination, and when cerebral palsy, mental retardation, and other neuromuscular aetiologies have been excluded, a group of slow motor developers of unknown aetiology and prognosis remains. The rather dramatic presentation of an infant who does not attain sitting, crawling, or walking at the same time as his peers often engenders anxiety in the parents. It has been our experience that a number of these infants have hypermobile joints and that they ultimately seem to catch up in motor development.Previous reports suggest that hypermobile joints can be the result of either increased laxity of the ligaments and joint capsule' or muscle hypotonia.2

The Relationship Between Generalized Joint Hypermobility and Motor Development

“…We found a delay in motor development in 56% of children younger than three years of age, whereas Jaffe et al 18 reported a delay in about 30% in a group of 715 children between eight and 14 months of age. Davidovitch et al 30 reported, as we also found in our study, no relationship between generalized joint hypermobility and gross and fine motor performance in children between five and seven years of age.…”

“…Some authors stated that in early childhood a delay in motor development is present with catch up in most children before the age of two years, while others stated that gross and fine motor development remained significantly delayed in children who exhibited joint hypermobility and motor delay in infancy. 18,19 Multiple explanations for the motor delay in infancy exist. As early as birth, congenital benign hypotonia or floppy infant syndrome and hypermobility of the joints have been associated with each other.…”

Hypermobility Syndrome

“…Six months later, 75.9% of the infants with HMS no longer had hypermobility; 83.3% of these infants caught up in motor development, whereas only 54.5% of the infants who remained hypermobile caught up. 43 At 5 years of age, children who had hypermobility and motor delay at age 18 months were 3 times as likely as other children to have motor delay. 44 Other reports have shown no motor delay in elementary school children with HMS.…”

Osteogenesis imperfecta: profiles of motor development as assessed by a postal questionnaire

“…Disease-related pro®les have been suggested or established in hypermobile children [9], in visually handicapped children [1], in children with Down syndrome [11], even in patients with neurological syndromes [10]. We observed that the severity of OI in¯uences age and sequence of achieving motor milestones signi®-cantly.…”