The forward parachute reaction and independent walking in infants with brain lesions

Abstract

FPRForward parachute reaction AIM The aim of this study was to assess the onset of forward parachute reaction (FPR) in infants with brain lesions and its correlation with age of walking.METHOD FPR was assessed at 6, 9, and 12 months in 140 infants with brain lesions (78 males, 62 females; mean gestational age 31wks; SD 3.6wks; mean birthweight 1450g, SD 252g). On cranial ultrasound 62 infants had mild and 78 had major abnormalities; 86 developed cerebral palsy. All were followed for 5 years, and the age at which each child achieved independent walking was recorded. Infants who had been born small for gestational age (weight <10th centile) were excluded, as were those who had major congenital malformations, severe postnatal infectious diseases, or metabolic or haematological complications.RESULTS A complete FPR was present in eight infants at 6 months, in 42 at 9 months, and in 71 at 12 months. At 12 months, 29 infants presented incomplete FPR and 40 presented absent FPR. Seventy-three infants were able to walk independently between the ages of 11 months and 60 months (67 with complete FPR and six with incomplete FPR at 12mo). A complete FPR at 12 months was a good predictor of independent walking. The age at onset of complete FPR was also a good predictor of age of walking. INTERPRETATIONThe late acquisition of a complete FPR appears to be an early sign of a more general delayed maturation of functional abilities.

Prognostic significance of neurological signs in high‐risk infants – a systematic review

“…reported in 8‐month‐old infants a moderate NPV of abnormal responses for CP. The other two studies indicated that the PPV of an absent parachute reaction for ‘no independent walking’ increased with age …”

“…We restricted our review to neurological signs that were addressed in at least three different papers. This was true for six signs which were addressed in a total of 14 papers . First, we provide an overview of the predictive properties of the six signs.…”

“…Calculation of psychometric properties was possible for 15 papers (Table ) . Two of the 15 papers reported only predictive values or the sensitivity and specificity, but did not allow for additional calculations.…”

“…There are two methodological issues to consider when interpreting the results of the review. First, most of the research papers did not report the reliability of single neurological items: only data were available on interrater agreement for the ATNR (78% and ‘high’), the Moro response (72%), and the parachute reaction (>95%) . Second, it should be realized that the infants studied had a high a priori risk for CP and other developmental disorders.…”

“…Original articles were selected if they fulfilled the following criteria: (1) initial assessment within the first 12 months of age, (2) follow‐up assessment beyond 1 year of corrected age, (3) description of single neurological items, (4) inclusion of infants at risk for developmental disorders, and (5) publication in English. Twenty articles fulfilled the criteria . An additional three articles were discovered by checking the reference lists of articles of interest (original articles and reviews) …”