Citation: Marques FJP, Teixeira MCS, Barra RR, Lima FM, Dias BLS, Pupe C, Nascimento OJM, Leyser M. Children Born With Congenital Zika Syndrome Display Atypical Gross Motor Development and a Higher Risk for Cerebral Palsy. Journal of Child Neurology. 2019; 34(2): 81-85. Doi: 10.1177/0883073818811234
Purpose: The purpose of this study was to look into the potential effects of congenital Zika syndrome on overall motor development and risk of cerebral palsy using the AIMS and the Bayley III Scales alongside neuroimaging and lab testing.
Study Population: This study looked at 39 infants (23 male and 16 female) who had been diagnosed with congenital Zika syndrome. The study began at 6 months old and ended at 18 months. 30 of the initial 69 infants that were recruited were excluded due to various reasons such as irregular follow-up appointments and other conditions that would affect outcomes.
Methods: The authors initially recruited 69 infants ranging from 0-6 months. After excluding 30 of these infants due to exclusion factors, the AIMS (Alberta Infant Motor Scale) was performed on 39 infants with diagnosed congenital Zika syndrome. The AIMS was performed at 6 months, 12 months, and 18 months 5 randomly assigned pediatricians specializing in development. The Bayley III Scales of Infants and Toddlers Development was also performed on 25 of the participants at 12 months by 2 Physical Therapists and a Psychologist. Neuroimaging and history were also performed for the infants studied. Diagnosis of CP was determined by impaired motor development and positive neuroimaging and/or history indicating risk factors.
Outcome Measures Used: In this study, the authors used the AIMS (Alberta Infant Motor Scale), which looks at prone, supine, seated, and standing posture/movement, and the Bayley III Scales, which the authors focused on the motor aspect during this study.
Results: For the AIMS, on average, the infants in this study scored significantly lower than their age (in months) normative values (e.g. the average score at 6 months matched that of a 2-3 months of age score). The results at 6, 12, and 18 months improved minimally in a statistically significant manner, which shows that they are developing and progressing, but their scores were still significantly lower than age norms. Similarly, those who performed the Bayley III Scales also demonstrated below normal gross motor function. All-in-all 35 of the 39 infants met requirements for a diagnosis of CP.
Strengths: The outcome measures used are strong, reliable outcome measures that are commonly used for determining motor development progression/comparison. Overall, their results were statistically significant and supported their hypothesis as well.
Limitations: One limitation of this study is the sample size. However, despite the small sample size, the authors did find statistically significant data supporting their hypothesis. Another limitation that the authors mention is the inability to “reliably confirm” the Zika virus infection with the lab tests they performed due to the timing of recruitment. Although the authors had age-normative values, they lacked a control group, which could also be a limitation to this study. Finally, I believe the sentence structure in certain parts made the article difficult to comprehend.
Conclusion: Although the individuals studied are showing some motor development, they are significantly behind age-matched “healthy” individuals. Overall, those with congenital Zika syndrome seem to be at higher risk of developing cerebral palsy. As PTs, recognizing developmental delays is crucial in determining the treatment plan for our patients. The Alberta Infant Motor Scale could be a useful tool to use to track progression at different stages of treatment.