Cognitive Evolution in the Perinatal Period

Maria Vendemmia, Anamaria Ciubara, Francesco Raimondi

Abstract


Neurological development is a complex process in which the nervous system reaches its fullness in adulthood stage. This development begins before birth, continues in both the last months of gestation and in the first months after birth, in response to a continuous remodeling due to the ability of nerve cells to eliminate excess components through apoptosis. One of the most important and ambitious objectives of developmental neurology is the early identification of those at risk for the development of subsequent disabilities: an early rehabilitation intervention can improve the quality of their life. The most important long-term outcome of periventricular leukomalacia is represented by spastic diplegia, which is also the most frequent motor deficit associated with prematurity. This high incidence seems to be due to the specific localization of the lesion involving the cortico-medullary bundles descending from the motor areas assigned to the movement of the lower limbs. In the presence of larger lesions, which also involve the semi-oval center, tetraparesis can be found accompanied by severe alteration of the intellectual function. The follow-up of the high-risk child and newborn is now established in the most developed countries. Physiotherapy is a relatively recent therapeutic modality in the Intensive Care Units and is performed through different techniques, with the aim of reducing respiratory work, maintaining airway viability and improving ventilation and gas exchange, improving neurosensory skills. A sensitive period for performing an intervention with a set schedule is from birth to 24 months of correct age. The program is tailored to the child and his family. An intervention program must promote the neurobehavioral development of the child, the quality of the organization and of the relational, sensorial, motor and cognitive skills and their integration, with the aim of an adequate development, without the pretension of modifying or accelerating its natural learning.


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