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University of Groningen Neurological development in infancy Touwen, B.C L IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 1975 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Touwen, B. C. L. (1975). Neurological development in infancy. [S.l.]: [S.n.]. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 12-11-2019 BERT TOUWEN NEUROLOGICAL DEVELOPMENT IN INFANCY ERRATA Page 73 footnote: am grateful ...• read: I am grateful ... Page 26 Group IV: A group of Items which did not show .. read: A group of Items which did show . Page 34 Fifth line from above, table XI and XIII; read: table XII and XIV Page 35 Third line from below, table XI and XIII; read: table XII and XIV Page 37 Nlneth line from below, 4 read 3 Page 38 First line above, 2 read 7 Seventh and eighth line from above, table X and XII; read: table XI and XIII Page 44 Sixth line from above, 2 and 4, read 7 and 3 Page 49 and 51 Exchange figures 70 and 7 7 Page 49 Seventh line from above, 10, 31 and 21, read 70, 34 and 24 Page 6 7 Heading: Recording: 2. wriggling . ., read 1. wriggling . Page 78 Table VII: first changes of standing up and of other Items; read: first changes of standing up and final changes of other Items .. Page 88 First line, ... final first changes ... ; read: final and first changes .. RIJKSUNIVERSITEIT TE GRONINGEN NEUROLOGICAL DEVELOPMENT IN INFANCY PROEFSCHRIFT TER VERKRIJGING VAN HET DOCTORAAT IN DE GENEESKUNDE AAN DE RIJKSUNIVERSITEIT TE GRONINGEN OP GEZAG VAN DE RECTOR MAGNIFICUS DR. M. J. JANSSEN IN HET OPENBAAR TE VERDEDIGEN OP WOENSDAG 8 OKTOBER 1975 DES NAMIDDAGS TE 2.45 UUR PRECIES. DOOR BERT CHRISTIAAN LOUIS TOUWEN GEBOREN TE DEN HAAG DRUKKERIJ GRASMEIJER WIJNGAARD - GRONINGEN & 0 -6 '"0 .....0 .....0 30 30 0 0 :: :: '"0 '"0 .....0 .....0 :"""' :"""' CJ CJ :"' :"' ;t ;t ;t :-n � � '"0 ::c0 .....CD <Q CD �(') .....1\J � STELLINGEN BD de extrapolatie van neurologische verschUnselen en hun betekenis bD het zich ontwikkelende kind naar de volwassene en omgekeerd wordt ten onrechte kwalitatieve identiteit van het kinderiUke en volwassen zenuwstelsel ge"impliceerd. 11 LeeftUdsnormen voor de kinderiUke funktie-ontwikkeling zUn slechts in beperkte mate bruikbaar voor- de diagnostiek van hersenaandoeningen. Ill lnconsistentie gedurende de ontwikkeling van de motoriek is een karakteristieke eigenschap van het gezonde zenuw­ stelsel. IV De vraagstelling: ,Veroorzaakt ondervoeding stoornissen in de ontwikkeling van het centrale zenuwstelsel?" gaat voorbU aan interacties tussen een toestand van ondervoeding en direct en indirect daarmee samenhangende andere omgevingsfaktoren. De vraagstelling dient dan ook te luiden: ,Draagt ondervoeding bU tot het ontstaan van stoornissen in de ontwikkeling van het centrale zenuwstelsel?" V Het instellen van fysiotherapeutische behandeling van motorische stoornissen dient niet te wachten tot een specifieke diagnose volgens een der klassifikaties van cerebrale paresen gesteld of uitgesloten is. VI Gedurende de eerste levensjaren is er geen wezeniUk verschil tussen fysiotherapie, ergotherapie en logopedie. De opleidingen van fysiotherapeuten, ergotherapeuten en logopedisten dient hieraan te zUn aangepast. VII Zolang er geen deugdeiUke internationale overeenstemming bestaat over de definitie van hypoglycaemie in de zuigelingen­ periode, is naonderzoek naar de gevolgen van hypogly­ caemie in de eerste levensdagen zinloos. VIII De door Raine voorgestelde glycine-medicatie bU de behandeling van een prolinemie type 11 heeft als bezwaar dat vooral in het pasgeborene-tUdperk de verhoogde concentratie van glycine in de weefsels een schadeiUke bUwerking kan hebben. IX BU het stellen van de indicatie tot partus arte praematurus dienen intra- en extra-uterine risico's zorgvuldig tegenover elkaar te warden afgewogen. Vooral de laatste plegen te warden onderschat. X Voor de beoordeling van de funktie ontwikkeling van een prematuur geborene dient diens kalenderleeftUd gecorrigeerd te warden voor de duur van de zwangerschap. XI Het verschUnsel dat Nederland aan de top staat van de Europese landen wat betreft het jaariUks aantal kinder­ slachtoffers van het verkeer, dient o.m. de arts te stimuleren tot een aktieve houding ten aanzien van de nog steeds toe­ nemende verkeersproblematiek. XII Aan de omgang met patienten en de stervensbegeleiding wordt tUdens de opleiding tot arts en tot specialist te weinig aandacht besteed. XIII De ambivalentie van vooral de oudere Engelse literatuur­ kritiek ten aanzien van Joseph Conrad is ten dele te verklaren uit diens positie van Engels schrUvende niet-Engelsman. XIV De arts dient zich met polemologie bezig te houden. XV lronie is de enige mogeiUkheid tot overleven. Stellingen behorende bU het proefschrift van B. C. L. Touwen. 8 oktober 197 5. lama is la nature ne no us livrerait ses secrets; elle n' avait pas de secrets; c' est no us qui inventions des questions, et qui fac;onnions ensuite des n§ponses: et jamais nous ne decouvrions au fond de nos comues que nos propres pensees; ces pensees pouvaient au cours des siec/es se multiplier, se comp/iquer, former des systemes de plus en plus vastes et subtils, jamais el/es ne m' arracheraient moi-meme. a (Simone de Beauvoir, 1946) 3 CONTENTS Chapter I : INTRODUCTION 9 purpose of the present study Chapter : DESIGN OF THE STUDY 11 13 predictionbands interrelationships Chapter Ill : THE CRITERIA FOR THE SELECTION 17 Chapter IV : THE FOLLOW-UP EXAMINATION 21 Chapter V : A SHORT DESCRIPTION OF THE COURSE OF THE EXAMINATION 24 Chapter VI : THE PRESENTATION OF THE RESULTS 26 Chapter VII : GROUP ITEMS WHICH DID NOT SHOW 1: DIFFERENTIATION AMONG THE INFANTS 28 facial innervation 28 pupils 28 optical blink 28 acoustical blink 28 reaction to sound 29 muscle tone 29 head control 30 abdominal skin reflex 30 cremasteric reflex 30 withdrawal reaction 30 Chapter VIII : GROUP ITEMS WHICH SHOWED LITTLE 11: DIFFERENTIATION AND/OR A RAPID DEVELOPMENTAL COURSE 32 spontaneous tremor 32 tremor during Mora-reactions 33 conjugation of eyemovements 33 fixation time 34 visual pursuit movements 34 convergence of the eyes 35 pupillary reaction to convergence 36 corneal reflex 36 doll's eye phenomenon 36 4 rotation test 37 lip-tap response 37 recoil of the elbow 38 biceps reflex 38 ankle jerk 38 stepping movements 39 Chapter IX GROUP Ill: ITEMS WHICH SHOWED AN·EVIDENT DEVELOPMENTAL SEQUENCE 41 Observation of posture and motility 43 spontaneous posture and motility of arms and legs 43 spontaneous motil ity of the legs in vertical suspension 48 goal-directed motil ity of arms and hands 50 type of voluntary grasping 54 coordination of the upper extremities 57 posture of head, trunk and arms in prone position 58 locomotion in prone position 61 rolling over from supine into prone position 64 rolling back from prone into supine position 67 spontaneous head lift in supine position- 68 sitting up 69 duration of sitting 71 posture of the trunk during sitting 75 standing up 77 walking 79 Reactions and Responses 82 rooting reflexes 82 asymmetric tonic neck responses 84 palmar grasp reflex 86 reaction to push against the shoulder during sitting 89 following of an object with the eyes and rotation of head and trunk when sitting 91 optical placing reaction of the hands 92 parachute reaction of arms and hands in prone suspension 93 optical placing reaction of the feet 94 footsole response 95 acoustical orienting 99 the Moro reaction 101 5 Chapter X : GROUP IV: ITEMS WITH SO MANY INCONSISTENT CHANGES DURING THE FOLLOW-UP PERIOD THAT A DEFINITE DEVELOPMENTAL SEQUENCE COULD NOT BE ESTABLISHED 109 Observation of posture and motility 109 spontaneous posture of the hands 109 posture of head and trunk during prone suspension (Landau) 110 Reactions and Responses 112 reaction to tactile stimulation of the dorsum of hand and fingers 112 palmomental response 1 13 knee jerk 114 ankle clonus 115 plantar grasp 115 magnet response 116 crossed extension response 116 positive supporting reaction 117 tactile placing of the feet 1 18 Schaltenbrandt-reaction 119 Bauer-reaction 119 Galant response 120 threaten-reflex 120 Chapter XI : ANTHROPOMETRIC AND PSYCHOSOCIAL ITEMS 123 body weight 123 body length 123 skull circumference 123 fontanels 123 vocalization and speech 124 smiling 125 reaction to strangers 125 lacrimation 126 Chapter XII . : SEX DIFFERENCES 127 Chapter XIII : THE PARAMETERS- INTRA-ITEM RELATIONSHIPS 131 Chapter XIV : INTER-ITEM RELATIONSHIPS 138 Chapter XV : DISCUSSION AND CONCLUSIONS 148 6 TABLES Table I : Some studies of infantile responses published after 1950 10 Table 11 : Occupation or vocational training of the fathers 18 Table Ill : Items which did not show differentiation among the infants (group I) 28 Table IV : Items which showed little
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