БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ
|
ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ
|
JOURNAL OF BIOMEDICINE AND PRACTICE
№3 | 2021
165
NEUROLOGY
Umida Tajimuratovna BABAJANOVA
Nodira Abdujabbarovna KHAMIDOVA
Department of neurology, pediatric neurology and
medical genetics, Tashkent pediatric medical institute
VIOLATION OF THE RATE OF PSYCHOMOTOR DEVELOPMENT IN YOUNG
CHILDREN WITH SOMATIC PATHOLOGY
For citation: U.T. Babajanova, N.A. Khamidova VIOLATION OF THE RATE OF
PSYCHOMOTOR DEVELOPMENT IN YOUNG CHILDREN WITH SOMATIC PATHOLOGY
Journal of Biomedicine and Practice. 2021, vol. 6, issue 3, pp. 165-169
http://dx.doi.org/10.26739/2181-9300-2021-3-25
ANNOTATION
"Psychomotor" development refers to changes in a child's cognitive, emotional, motor, and social
abilities from the beginning of life through the embryonic and neonatal periods, infancy, childhood,
and adolescence. This happens in a wide variety of fields. Knowledge of typical child development
and related theories and models is very useful for clinical practice, leading to the recognition of
developmental disorders and how to treat them. A thorough but focused history and neurological
examination remain the most important initial elements of neurological diagnosis at any age.
Key words:
psychomotor development, somatic pathology
Умида Таджимуратовна БАБАДЖАНОВА
Нодира Абдужаббаровна ХАМИДОВА
Кафедра неврологии, детской неврологии и медицинской генетики
Ташкентский педиатрический медицинский институт
НАРУШЕНИЕ ТЕМПА ПСИХОМОТОРНОГО РАЗВИТИЯ У ДЕТЕЙ РАННЕГО
ВОЗРАСТА С СОМАТИЧЕСКОЙ ПАТОЛОГИЕЙ
АННОТАЦИЯ
"Психомоторное" развитие относится к изменениям в когнитивных, эмоциональных,
двигательных и социальных способностях ребенка с самого начала жизни через
эмбриональный и неонатальный периоды, младенчество, детство и юность. Это происходит в
самых разных областях. Знание типичного развития ребенка и связанных с ним теорий и
моделей очень полезно для клинической практики, приводя к распознаванию нарушений
развития и способов их лечения. Тщательный, но целенаправленный анамнез и
неврологическое обследование остаются наиболее важными начальными элементами
неврологической диагностики в любом возрасте.
Ключевые слова:
психомоторное развитие, соматическая патология.
БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ
|
ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ
|
JOURNAL OF BIOMEDICINE AND PRACTICE
№3 | 2021
166
Умида Таджимуратовна БАБАДЖАНОВА
Нодира Абдужаббаровна ХАМИДОВА
Неврология, болалар неврологияси ва тиббиёт генетикаси кафедраси
Тошкент педиатрия тиббиёт институти
СОМАТИК ПАТОЛОГИЯЛИ ЁШ БОЛАЛАРДА ПСИХОМОТОР РИВОЖЛАНИШ
ТЕЗЛИГИНИНГ БУЗИЛИШИ
АННОТАЦИЯ
"Психомотор" ривожланиш эмбрионал ва неонатал даврларда, чақалоқлик, болалик ва
ўсмирлик даврида боланинг когнитив, ҳиссий, ҳаракат ва ижтимоий қобилиятларининг
ўзгаришини англатади. Бу турли жараёнда содир бўлади. Одатда болаларнинг ривожланиши
ва улар билан боғлиқ бўлган тегишли назариялар ва моделлар ҳақида билиш клиник амалиёт
учун жуда фойдали бўлиб, ривожланишдаги касалликларини аниқлашда ва уларни даволашда
аҳамиятли. Тўлиқ, мақсадга йўналтирилган анамнез ва неврологик текширув ҳар қандай ёшда
неврологик ташхиснинг энг муҳим бошланғич элементлари ҳисобланади.
Калит сўзлар:
психомотор ривожланиш, соматик патология
The relevance of the problem.
The prevalence of psychomotor development delay (PMTD) among
the child population is 8-10% [1,2,3,4]. SPD of somatogenic origin occurs in children with chronic
somatic diseases of the heart, aorta and large vessels, lungs, kidneys, endocrine system, blood
diseases, etc. Disorders of the nervous system in somatic diseases have a lot in common [6,7,8]. Most
often, they are functional at first, and then turn into organic, due to metabolic disorders. And this in
turn leads to a violation of the psychomotor development of children. There are many unexplored
aspects of neurological pathology in somatic diseases in children [11,12]. The problem of somatically
conditioned disorders of psychomotor development in children is widely studied in our country.
However, there is insufficient data concerning the clinical manifestations, age-related features of the
dynamics of psychosomatic disorders in children [9,10].
Objective:
to study the features of neuropsychiatric development in sick children with somatic
burden (diseases of the gastrointestinal tract, respiratory and cardiovascular systems).
Materials and methods of research.
To perform the tasks of the scientific study, a sample was
created with the allocation of two groups of clinical observation: 60 children of the main group with
somatic pathology and 25 conditionally healthy children of the comparison group. The study was
conducted in the somatic department at the TashPMI clinic.
The average age of children in the main group was 19.0±9.3 months, in the comparison group
– 18.6±9.7 months (p>0.05). Among the examined children there were 35 (58.3%) boys and 25 girls
(41.7%). The main group consisted of children with diseases of the gastrointestinal tract, respiratory
and cardiovascular systems. The comparison group consisted of young children of the department
who were hospitalized as planned for a control examination, convalescents of somatic diseases and
who did not have a deficit in weight indicators at the time of hospitalization. Children with acute
infectious inflammatory diseases, severe forms of chromosomal and genetic diseases, and congenital
malformations in the decompensation stage were excluded from the study group.
All children underwent a standard clinical examination, including the collection of complaints
and anamnesis, general examination, clinical neurological and psychodiagnostic studies. Anamnestic
information was obtained when the child was admitted to the department from the outpatient card
(registration form 112/y) simultaneously with an active survey of the child's mother. Anamnestic data
includes: assessment of social (family composition and completeness, education of family members,
presence or absence of bad habits in parents, psychological microclimate in the family), biological
(antenatal, intranatal, postnatal) and genealogical history (calculation of the index of the burden of
genealogical history). To assess the psychomotor development of children, we used the scale of
assessment of the neuropsychiatric development of G. V. Pantyukhina-K. L. Pechora - E. L. Frucht
[7]. The method checks the state of eight lines of development: visual and auditory orientation
reactions, emotions and social behavior, general movements, actions with objects, speech
БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ
|
ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ
|
JOURNAL OF BIOMEDICINE AND PRACTICE
№3 | 2021
167
understanding, preparatory stages of active speech, skills and abilities in the feeding process.
Diagnosis is based on a standardized procedure for observing the child in everyday life, evaluating
the reaction to toys, taking into account the information provided by his mother. This scale is designed
to study babies from 10 days to 3 years old. The authors developed indicators of these areas of
development on a monthly basis in the first year of life, quarterly in the second year and semi-annually
in the third year. The list of indicators is a formalized requirements for the skills and abilities of the
child in each age micro period. For example, in the field of sensory development, a child in 1 year 1
month should catch differences in the sizes of objects with a difference of 3 cm. In 1 year 7 months—
1 year 9 months, he must distinguish between 3 contrasting sizes of objects, and in 2.5 years, select
items of 4 primary colors from the sample. When diagnosing play activity and understanding speech,
the ability of children to perform play actions according to the instructions of an adult ("feed the doll",
"put the doll in the crib", etc.) is revealed. The assessment of the level of development of the VPF
was made in points. At the same time, the absence of a particular ability to perform an action in the
present time was estimated at 0 points, the delay in the development of the ability in comparison with
the age standards for 2-3 epicrisis periods (up to 1 year 1 epicrisis period is 1 month, 1-2 years 1
epicrisis period is 3 months, 2-3 years 1 epicrisis period is 6 months) in 1 point, the presence of the
studied skill according to the age standard is 2 points. For children aged 3 months, a score of 14-16
points is regarded as a variant of the age norm; with an assessment of 10-14 points, children are
classified as an absolute risk group for developmental delay; a score of 6-9 points indicates
developmental delay; a group of children with a score of less than 6 points are patients with severe
general developmental delay. After 6 months to 3 years, another parameter is added to the VPF
assessment criteria – skills and abilities, so the total number of points increases. A variant of normal
development is considered to be a score of 16-18 points, a risk group for developmental delay-12-15
points, developmental delay-8-11 points, severe general developmental delay-if the score is below 8
points.
Statistical processing of the results was carried out using Microsoft Office Excel and Statistica
software.
Discussion of the research results.
When studying the social history, we found that every third child
of the main group had a moderate burden of social history (36.7%), while the children of the
comparison group were characterized by a low burden of social history (80%) (p<0.05).
When analyzing the biological history, as the antenatal period, it was found that in mothers of sick
children, extragenital diseases occurred in 54% of cases, and in the comparison group in 14.5% of
women (p<0.01). Kidney pathology was significantly more frequent in mothers of children of the
main group (15.9%, p<0.05), while exacerbation of chronic pyelonephritis during pregnancy in
mothers of sick children was noted in 13.7% of cases and 2.3% of pregnant women developed
gestational pyelonephritis, while in mothers of children of the comparison group there was no
exacerbation of chronic pyelonephritis (p<0.05).The frequency of early toxicosis of pregnant women
among mothers of children of the main group was 48.3%, and among women of children of the
comparison group 8.6% (p<0.05). At the same time, there were no severe forms of early toxicosis
requiring hospitalization. The pathological course of pregnancy in the form of a threat of termination
was detected in every third (29.9% and 11.4%, respectively, p<0.05) and gestosis in every second
(36.8% and 8.5%, respectively, p<0.05) mother of children of the main group, which is 1.3 times
more common than in women of children of the comparison group. Anemia of pregnant women
developed in every second mother of children of the main group (47.1%), which is 2.5 times more
common than in mothers of children of the comparison group (p<0.05). Chronic urogenital infections
were observed in 13.7% of mothers of children of the main group, which is significantly more
frequent than in mothers of children of the comparison group (2.9%, p<0.05). When analyzing the
features of the intranatal period, we noted that preterm birth was observed 1.8 times more often in the
mothers of children of the main group compared to the mothers of children of the comparison group
(52.9% and 28.6%, respectively, p<0.05). The course of labor in mothers of children of the main
group was complicated by weakness of labor forces (35.6%, p<0.01), discoordinated labor activity
(2.3%, p<0.05), labor injuries (3.5%, p<0.05) and bleeding in the postpartum period (4.6%, p<0.05).
БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ
|
ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ
|
JOURNAL OF BIOMEDICINE AND PRACTICE
№3 | 2021
168
A high percentage of cesarean sections was observed in the mothers of the children of the main group
in relation to the mothers of the children of the comparison group (31.0%, p>0.05).
When analyzing the div's resistance to the frequency of acute respiratory diseases, we obtained the
following data. In the main group of children, there was a 1.6-fold decrease in the proportion of
children with normal resistance compared to the comparison group and a high incidence of acute
respiratory diseases during the year (five or more times a year) (p<0.01). Every fourth child of the
main group has a low resistance and every tenth child has a very low resistance (p<0.05).
We evaluated the presence of chronic somatic pathology.
Russian pediatricians assign the greatest importance in the development of young children to such
background conditions as anemia and rickets. In our study, it was found that anemia was 1.8 times
more common, and rickets was 6 times more common among sick children compared to children in
the comparison group.
When studying the clinical and neurological features of sick children, the syndrome of motor
disorders was revealed in 10%, the syndrome of neuro-reflex excitability in 20%, the myotonic
syndrome in 11.70%, the vegeta-visceral syndrome in 18.30%, the MMD syndrome in 28.3%, and
the cerebrastenic syndrome in 31.7%.
We found that the delay in psychomotor development is 4.5 times more common in children
of the main group (p<0.01) in relation to children of the comparison group. In the comparison group,
only one child had delayed speech development (2.9%). We found a general developmental delay in
half of the sick children, as well as in 14% of the children from the control group (p<0.05). The total
score allows us to generalize the development of higher mental functions. We were also interested in
quantifying each individual parameter.
As a result of a quantitative assessment of the neuropsychiatric development of sick children,
we found that the degree of delay varies according to various indicators of the development of higher
subcortical functions.
The delay in the formation of motor function in children of the main groups averaged 1
epicrisic period. The children of the main groups of large motor skills were estimated at 1.59 points,
the comparison group-at 1.93 points (p>0.05), the development of small motor skills at 1.49 and 1.84
points (p>0.05). Considering the results obtained by us in assessing the function of speech, we found
that the function of active speech suffers more than its understanding. During the survey, we received
a lower assessment of the formation of active speech. The average assessment of the function of active
speech in sick children was 1.36-1.49 points. In the children of the control group, active speech was
estimated at 1.89 – 1.96 points (p<0.001).
The function of passive speech, that is, the ability to understand speech in children was formed
late, an average of 1-2 epicritic period, the average rating is 1.4 – 1.6 points (p>0.05).
In the diagnosis of sensory development of children, the major groups were formed with a lag of 1
epicritic of time relative to children in the comparison group (p>0.05).
The acquisition of social skills, the development of playing abilities in sick children was formed with
a lag of 1 epicrisic period. The assessment of the formation of the emotional sphere was statistically
significantly different. The children of the main groups were dominated by negative emotions, the
average score was 1.6-1.8 (p>0.05).
Conclusions.
Thus, conducting a quantitative assessment of the formation of VPF in sick children
allows us to more accurately determine which functions suffer more, and therefore require more
correction, using those functions that are formed better. According to the results of our study, the
greatest delay was revealed in the formation of fine and large motor skills, active and passive speech,
sensory development and the emotional sphere. These results are significantly lower in sick children
with chronic somatic pathologies.
БИОМЕДИЦИНА ВА АМАЛИЁТ ЖУРНАЛИ
|
ЖУРНАЛ БИОМЕДИЦИНЫ И ПРАКТИКИ
|
JOURNAL OF BIOMEDICINE AND PRACTICE
№3 | 2021
169
List of references
1.
Rossman M.J. The CAT/CLAMS assessment for early intervention services. Clinical Adaptive
Test/Clinical Linguistic and Auditory Milestone Scale. / Rossman MJ, Hyman SL, Rorabaugh
ML, Berlin LE, Allen MC, Modlin JF. // Clinical Pediatry., 1994. V. 33 № 7. P. 404-9.
2.
Rydz D. Screening for developmental delay in the setting of a community pediatric clinic: A
prospective assessment of parent-report questionnaires. / Rydz D., Srour M., Oskovi M., Marget
N., Shiller M., Birnbaum R., Majnemer & Shevell M.I. // Pediatrics, 2006.V.118. P.1178-1186.
3.
Skellern C. A parent completed developmental questionnaire: Follow-up of premature infants.
/ Skellern C., Rogers Y., O’Callaghan M.J. // Journal of Pediatrics and Child Health, 2001.
V.37.P. 125-129.
4.
Squires J. Revision of a parent-completed developmental screening tool: Ages and Stages
Questionnaire. / Squires J., Bricker D., & Potter L. // Journal of Pediatric Psychology, 1996.
V.22 P. 313-328.
5.
Teclin J. Pediatric Physical Therapy 4thed. /Teclin J. USA. 2008. P.71-73.
6.
Zlofazova M. Yu. Delay in development (clinical and psychological, age and rehabilitation
aspects):
synopsis.
MD-http:
//www.dissercat.com/content/zaderzhka-psikhicheskogo-
razvitiya-kliniko-psikhologicheskie-sravnitelno-vozrastnye-i reabil # ixzz56rE4ZJyW
7.
Borovtsova L. A., Kozodaeva L. F. Prevention of speech disorders in young children / /
Psychological and pedagogical journal Gaudeamus. - 2015. - № 1 (25). - paragraphs 111-120
8.
Klee T. Concurrent and predictive validity of an early language screening program. / Klee T.,
Carson D. K., Gavin W. J., Hall L., Kent A., & Reece, S. // Journal of Speech, Language, and
Hearing Research, 1998. V.41. P. 627-641.
9.
Lee L.L.S. Psychometric properties and standardization samples of four screening tests for
infants and young children: A review. / Lee L.L.S, Harris SR. // Pediatric Physical Therapy,
2005. V.7. P 140-147.
10.
Macias M.M. Infant screening: The usefulness of the Bayley Infant Neurodevelopmental
Screener and the Clinical Adaptive Test/Clinical Linguistic auditory Milestone Scale. / Macias,
M.M., Saylor, C.F., Greer, M.K., Charles, J.M., Bell, N., Katikaneni, L.D. // Developmental
and Behavioral Pediatrics, 1998. V.19. P.155-161
11.
National Association for the Education of Young Children. Screening and Assessment of
Young English-Language Learners. - Supplement to the NAEYC position statement on early
childhood curriculum, assessment, and program evaluation, 2005.
12.
Rose-Jacobs R. The Movement Assessment of Infants (MAI) as a predictor of two-year
neurodevelopmental outcome for infants born at term who are at social risk. / Rose-Jacobs R.,
Cabral H., Beeghly M., Brown E.R., Frank D.A. // Pediatric Phisical Therapy, 2004. V. 16(4)
P. 212-221.
