Borba Raíne, Falcão Juliane, Freitas Tatiane, Marques Cláudia, Nóbrega Lucélia, O Ventura Liana, Sallum Juliana, V Ventura Camila, Higino Taciana, Rocha Camilla, Wheeler Anne C
Rehabilitation Center, Altino Ventura Foundation, Recife, Brazil.
Department of Ophthalmology, Altino Ventura Foundation, Recife, Brazil.
Child Care Health Dev. 2025 Jan;51(1):e70015. doi: 10.1111/cch.70015.
Congenital Zika syndrome (CZS) is characterized by brain abnormalities caused by in utero exposure to the Zika virus (ZIKV), resulting in significant neurodevelopmental, motor and visual impairments in affected children. These impairments hinder their ability to engage in social interactions and explore their surroundings. However, personalized and continuous sensory stimulation, particularly within the home environment, may play a crucial role in supporting motor and visual development in these children. Therefore, this study aimed to explore the relationship between sensory stimulation in the home environment and the motor and visual development of children with CZS.
This cross-sectional study included children with CZS. The Affordances in the Home Environment for Motor Development (AHEMD) instrument was administered to caregivers to assess motor stimulation opportunities at home. All children underwent neurodevelopmental milestone assessments using the Brazilian Portuguese version of the Bayley Scales of Infant Development-Third Edition (BSID-III). Gross motor function was further assessed with the Gross Motor Function Measure (GMFM), and functional vision was evaluated by using the functional vision developmental milestones test (FVDMT).
Eighty-five children with a mean age of 39.9 ± 2.3 (24.0-42.0) months were included. Forty-one children (48.2%) lived in homes with 'very weak' environmental stimulation. The children showed profound developmental delays in all domains of the BSID-III with an average neurodevelopmental age of 39.9 ± 2.3 (24-42) months. On the GMFM, over 90.0% of children could not initiate or maintain the required movements and postures for sitting, crawling, standing, walking, running and jumping. A significant positive correlation was found between the variety of home sensory stimulation with the AHEMD and the scores at the BSID-III motor scales as well as the GMFM. More fine motor materials in the home context correlated with better gross motor scores on the BSID-III (p = 0.016), increased likelihood of passing the 'sitting' (p = 0.041) and 'standing' (p = 0.019) items of the GMFM. Children with less visual impairment in parameters of the FVDMT ['eye contact' (p = 0.032), 'social smile' (p = 0.031) and 'movements to achieve' (p = 0.007)] had more stimulating home environment.
Nearly half of the children with CZS who exhibited neurodevelopmental delays lived in homes lacking appropriate sensory stimulation. This study suggests that motor and visual development, including fine and gross motor skills as well as functional vision, may be benefited by the quantity and quality of play and stimulation opportunities available at home.
先天性寨卡综合征（CZS）的特征是子宫内感染寨卡病毒（ZIKV）导致脑异常，致使患病儿童出现严重的神经发育、运动和视觉障碍。这些障碍阻碍了他们参与社交互动和探索周围环境的能力。然而，个性化且持续的感官刺激，尤其是在家居环境中，可能对支持这些儿童的运动和视觉发育起到关键作用。因此，本研究旨在探讨家居环境中的感官刺激与CZS儿童运动和视觉发育之间的关系。
这项横断面研究纳入了CZS儿童。向照料者发放家居环境中运动发育的可供性（AHEMD）工具，以评估家中的运动刺激机会。所有儿童均使用巴西葡萄牙语版的贝利婴幼儿发展量表第三版（BSID-III）进行神经发育里程碑评估。使用粗大运动功能测量（GMFM）进一步评估粗大运动功能，并通过功能性视觉发育里程碑测试（FVDMT）评估功能性视力。
纳入了85名平均年龄为39.9±2.3（24.0 - 42.0）个月的儿童。41名儿童（48.2%）生活在环境刺激“非常弱”的家庭中。这些儿童在BSID-III的所有领域均表现出严重的发育迟缓，平均神经发育年龄为39.9±2.3（24 - 42）个月。在GMFM测试中，超过90.0%的儿童无法启动或维持坐、爬、站、走、跑和跳所需的动作和姿势。发现AHEMD评估的家庭感官刺激多样性与BSID-III运动量表得分以及GMFM得分之间存在显著正相关。家中更多的精细运动材料与BSID-III上更好的粗大运动得分相关（p = 0.016），增加了通过GMFM中“坐”（p = 0.041）和“站”（p = 0.019）项目的可能性。在FVDMT参数中视觉损伤较轻的儿童[“眼神接触”（p = 0.032）、“社交微笑”（p = 0.031）和“实现动作”（p = 0.007）]拥有更具刺激性的家庭环境。
近一半表现出神经发育迟缓的CZS儿童生活在缺乏适当感官刺激的家庭中。本研究表明，家庭中可获得的游戏和刺激机会的数量和质量可能有益于运动和视觉发育，包括精细和粗大运动技能以及功能性视力。
