THE EFFECT OF PERIPHERAL NEUROPATHY ON GROSS MOTOR FUNCTION IN CHILDREN WHO ARE INFECTED WITH HIV

Benjamin N.¹, Potterton J.¹, Kamerman P.²

¹University of the Witwatersrand, Physiotherapy, Johannesburg, South Africa, ²University of the Witwatersrand, Physiology, Johannesburg, South Africa

Background: Distal symmetrical polyneuropathy (DSP) is a common complication of HIV infection and treatment in adults, but less is known about the prevalence and impact of the neuropathy in the paediatric population. In particular, the effects of having DSP on gross motor function in children with HIV-related is unknown.

Purpose: We investigated the effect of the distal symmetrical polyneuropathy on gross motor development in children that are HIV positive.

Methods: A cross-sectional study was conducted to ascertain the prevalence of DSP in children infected with HIV, who attend Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa. After obtaining informed consent from the caregivers and assent from the children. Participants were then screened for PN using the Brief Peripheral Neuropathy Screen (BPNS), The BPNS assesses symptoms (pain/burning, numbness, tingling/pins-and-needles) and signs (reduced vibration sense, absent ankle reflexes). We defined DSP and the presence of at least one bilateral sign. Gross motor function was assessed using the Movement-ABC-2® (M-ABC-II®). The M-ABC-II® assesses a child’s performance in balancing, throwing, and manual dexterity tasks, benchmarked against age-appropriate norms. Basic demographic, anthropomorphic, and most recent HIV disease information was obtained from the childrens’ medical files.

Results: BPNS: A total of 135 participants between the ages of 4-10 years were assessed. Fifty three percent (72) were male and 47 % (63) female. The mean age was 6 years (SD ±1). A total of 18 participants tested positive for DSP (13%). Of the 18 participants who tested positive, 5 (28%) were asymptomatic and 13 (72%) were symptomatic, with pain being the most common symptom (80%). No demographic (age, sex), anthropomorphic (weight, height), or HIV disease indicators (CD4 T-cell count, viral load, antiretroviral therapy) associated with the presence of DSP. M-ABC-II® Of those who presented with DSP, 23% participants fell into the Red category for gross motor function, which indicates poor motor function. The remainder were 39% and 48% in the amber and green categories respectively. However, there was no association between having DSP and any of the sub-scales of the M-ABC-II® or the summative traffic light categories.

Conclusion(s): We identified a high burden of gross motor dysfunction, particularly in manual dexterity and throwing, but not balance. DSP occurred in 30% of the children, and was not associated with motor dysfunction. Thus, other factors must be the primary determinants of the impairment in gross motor development.

Implications: All children with a diagnosis of HIV should be routinely screened for peripheral neuropathy and gross motor function should be assessed. The long-term consequences of the motor impairments and DSP are unknown, and intervention strategies for the gross motor function should be implemented as early as possible, and so too for the DSP if it is painful.

Funding acknowledgements: National Research Foundation- THUTHUKA FUNDING INSTRUMENT (PhD Track)
National Research Foundation - Sabbatical Grant to complete PhD
SASP Research Foundation

Topic: Paediatrics

Ethics approval: Ethical approval was obtained from the University of the Witwatersrand Human Research Ethics Committee (Clearance number: M 120767).

All authors, affiliations and abstracts have been published as submitted.