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Toma AI, Dima V, Alexe A, Bojan C, Nemeș AF, Gonț BF, Arghirescu A, Necula AI, Fieraru A, Stoiciu R, Mirea A, Calomfirescu Avramescu A, Isam AJ. Early Intervention Guided by the General Movements Examination at Term Corrected Age-Short Term Outcomes. Life (Basel) 2024; 14:480. [PMID: 38672751 PMCID: PMC11050901 DOI: 10.3390/life14040480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/17/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND AND AIM The early identification of the former premature neonates at risk of neurologic sequelae could lead to early intervention and a better prognosis. This pilot study aimed to investigate whether the General Movement patterns observed at term-equivalent age in former premature infants could serve as predictors for guiding early intervention and improving prognosis. MATERIALS AND METHODS In a population of 44 premature neonates (mean gestational age 33.59 weeks (+2.43 weeks)) examined at term-equivalent age, 10 neonates with a cramped-synchronized General Movements motor pattern were identified. These neonates were included in an early intervention program consisting of physiotherapy executed both by the therapist and by the parents at home. They were again examined at a corrected age of 12 weeks. The presence or absence of fidgety movements and the MOS-R (motor optimality score revised) was noted. The examinations were performed by certified specialists. RESULTS Normal fidgety movements and a MOS-R of 20-24 were presented in 9/10 of the former premature infants, with normal foot to foot contact present in 7/10, and normal hand to hand contact present in 5/10. The atypical patterns noted were side to side movements of the head in 5/10, a non-centered head in 9/10, asymmetric tonic neck reflex in 9/10 and jerky movements in 10/10. One patient presented with no fidgety movements and a MOS-R score of 9. CONCLUSION Early intervention in our group of patients allowed for an improvement in the neurologic status, demonstrated by the presence of fidgety movements. We suggest that early intervention should be indicated in all premature infants that present with a cramped-synchronized GM pattern during examination at term-equivalent age. However, due to the small sample size, the absence of statistical analysis and a control group, and the limited follow-up period, the conclusions must be approached with caution.
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Affiliation(s)
- Adrian Ioan Toma
- Life Memorial Hospital, 010719 Bucharest, Romania
- Faculty of Medicine, University Titu Maiorescu, 040441 Bucharest, Romania
| | - Vlad Dima
- Neonatology Department Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | | | - Cristina Bojan
- Kinetotherapy Department, Pediatric Neurology Alexandru Obregia Hospital, 041914 Bucharest, Romania
| | - Alexandra Floriana Nemeș
- Life Memorial Hospital, 010719 Bucharest, Romania
- Faculty of Medicine, University Titu Maiorescu, 040441 Bucharest, Romania
| | | | | | | | | | | | - Andrada Mirea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | | | - Al Jashi Isam
- Faculty of Medicine, University Titu Maiorescu, 040441 Bucharest, Romania
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Yardımcı-Lokmanoğlu BN, Demir N, Porsnok D, Sırtbaş-Işık G, Cengiz E, Serel-Arslan S, Mutlu A. Are sucking patterns and early spontaneous movements related to later developmental functioning outcomes? A cohort study. Eur J Pediatr 2024; 183:1435-1446. [PMID: 38217695 PMCID: PMC10951042 DOI: 10.1007/s00431-024-05422-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
Sucking patterns and early spontaneous movements have an important role in the determination of later developmental problems, but the relationship of the two together with long-term outcomes has not been investigated. The objectives of this study were to (i) examine the relationship between sucking patterns using the Neonatal Oral Motor Assessment Scale (NOMAS) and fidgety movements and other movement patterns using detailed General Movements Assessment (GMA), and (ii) investigate the relationship between these early assessment methods and developmental functioning outcomes at later ages. We analyzed the NOMAS from 34 weeks' postmenstrual age up to 10 weeks post-term and GMA between 9 and 20 weeks post-term age, and the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) was applied for the developmental functioning outcomes to 62 infants (61%, 62/102) between 12 and 42 months of age. Among 102 infants at-risk, 70 (69%) showed a normal sucking pattern, and 85 (83%) had fidgety movements. The median Motor Optimality Score-Revised (MOS-R), as determined by GMA, of all infants was 24. The NOMAS was related to the MOS-R and its subcategories (p < 0.05) in all infants at-risk. The NOMAS, MOS-R and its subcategories were also related to cognitive, language, and motor development at later ages according to Bayley-III (p < 0.05). Conclusion: This longitudinal study showed that the quality of sucking patterns, fidgety movements, and MOS-R were related to later developmental functioning, indicating that abnormal sucking patterns, aberrant fidgety movements, and lower MOS-R might predict developmental disorders. What is Known: • Sucking patterns and early spontaneous movements in which central pattern generators play an important role are related. • Sucking patterns and early spontaneous movements might be used separately to predict developmental outcomes. What is New: • Sucking patterns and early spontaneous movements, when used together, were related to later developmental functioning, including cognitive, language, and motor development in at-risk infants. • Predictive value of sucking patterns was lower for each developmental functioning outcome than early spontaneous movements.
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Affiliation(s)
- Bilge N Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye.
| | - Numan Demir
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Swallowing Disorders Unit, Ankara, Türkiye
| | - Doğan Porsnok
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye
| | - Gülsen Sırtbaş-Işık
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye
| | - Emre Cengiz
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Swallowing Disorders Unit, Ankara, Türkiye
| | - Selen Serel-Arslan
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Swallowing Disorders Unit, Ankara, Türkiye
| | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Türkiye
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The General Movements Motor Optimality Score in High-Risk Infants: A Systematic Scoping Review. Pediatr Phys Ther 2023; 35:2-26. [PMID: 36288244 DOI: 10.1097/pep.0000000000000969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The aim of this systematic scoping review was to explore the use of the motor optimality score in the fidgety movement period in clinical practice, and to investigate evidence for the motor optimality score in predicting neurodevelopmental outcomes. SUMMARY OF KEY POINTS Thirty-seven studies, with 3662 infants, were included. Studies were conceptualized and charted into 4 categories based on the motor optimality score: prediction, outcome measure, descriptive, or psychometric properties. The most represented populations were preterm or low-birth-weight infants (16 studies), infants with cerebral palsy or neurological concerns (5 studies), and healthy or term-born infants (4 studies). CONCLUSION The motor optimality score has the potential to add value to existing tools used to predict risk of adverse neurodevelopmental outcomes. Further research is needed regarding the reliability and validity of the motor optimality score to support increased use of this tool in clinical practice. What this adds to the evidence : The motor optimality score has potential to improve the prediction of adverse neurodevelopmental outcomes. Further research on validity and reliability of the motor optimality score is needed; however, a revised version, the motor optimality score-R (with accompanying manual) will likely contribute to more consistency in the reporting of the motor optimality score in future.
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The Early Motor Repertoire in Preterm Infancy and Cognition in Young Adulthood: Preliminary Findings. J Int Neuropsychol Soc 2023; 29:80-91. [PMID: 34974853 DOI: 10.1017/s1355617721001351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Preterm birth poses a risk to cognition during childhood. The resulting cognitive problems may persist into young adulthood. The early motor repertoire in infancy is predictive of neurocognitive development in childhood. Our present aim was to investigate whether it also predicts neurocognitive status in young adulthood. METHOD We conducted an explorative observational follow-up study in 37 young adults born at a gestational age of less than 35 weeks and/or with a birth weight below 1200 g. Between 1992 and 1997, these individuals were videotaped up until 3 months' corrected age to assess the quality of their early motor repertoire according to Prechtl. The assessment includes general movements, fidgety movements (FMs), and a motor optimality score (MOS). In young adulthood, the following cognitive domains were assessed: memory, speed of information processing, language, attention, and executive function. RESULTS Participants in whom FMs were absent in infancy obtained lower scores on memory, speed of information processing, and attention than those with normal FMs. Participants with aberrant FMs, that is, absent or abnormal, obtained poorer scores on memory, speed of information processing speed, attention, and executive function compared to peers who had normal FMs. A higher MOS was associated with better executive function. CONCLUSIONS The quality of the early motor repertoire is associated with performance in various cognitive domains in young adulthood. This knowledge may be applied to enable the timely recognition of preterm-born individuals at risk of cognitive dysfunctions.
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Örtqvist M, Einspieler C, Ådén U. Early prediction of neurodevelopmental outcomes at 12 years in children born extremely preterm. Pediatr Res 2022; 91:1522-1529. [PMID: 33972686 DOI: 10.1038/s41390-021-01564-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Extremely preterm (EPT) birth is a major risk factor for neurodevelopmental impairments. The aim was to evaluate the predictive value of Prechtl General Movement Assessment (GMA), including the Motor Optimality Score-Revised (MOS-R), at 3 months corrected age (CA) for adverse neurodevelopmental outcome at the age of 12 years. METHODS The GMA, including the MOS-R, was applied at 3 months CA and outcomes were assessed at 12 years by Touwen's neurological examination, the Movement Assessment Battery for Children-2, and chart reviews. RESULTS Fifty-three infants born EPT (33 boys, mean GA 25 weeks, mean body weight 805 ± 156 g) were included. Forty-two (79%) children participated in the follow-up (mean age 12.3 ± 0.4) and 62% of these had adverse outcomes. The MOS-R differed between groups (p = 0.007). The respective predictive values of GMA, aberrant FMs, and the MOS-R cut-off of 21 for adverse outcomes were positive predictive values (PPVs) of 1.00 and 0.77, negative predictive value of 0.47 and 0.63, sensitivity of 0.31 and 0.77, and specificity of 1.00 and 0.77. CONCLUSIONS Using the Prechtl GMA, including the MOS-R, at 3 months CA predicted an overall adverse neurodevelopment at 12 years, with a high PPV, specificity, and sensitivity in children born EPT. IMPACT The Prechtl GMA, including the MOS-R, can improve early identification of long-term adverse neurodevelopmental outcomes. This is the first study to investigate the predictive value of the MOS-R for neurodevelopmental outcome at mid-school age in children born EPT. Using the GMA, including the MOS-R, is suggested as one important part of the neurological assessment at 3 months CA in children born EPT. Aberrant FMs in combination with a MOS of <21 is an indicator of an increased risk of future adverse neurodevelopment in children born EPT.
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Affiliation(s)
- Maria Örtqvist
- Neonatal Research Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.
| | - Christa Einspieler
- Research Unit Interdisciplinary Developmental Neuroscience, Dept. Phoniatrics, Medical University of Graz, Graz, Austria
| | - Ulrika Ådén
- Neonatal Research Unit, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
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Early Spontaneous Movements and Postural Patterns in Infants With Extremely Low Birth Weight. Pediatr Neurol 2022; 129:55-61. [PMID: 35240363 DOI: 10.1016/j.pediatrneurol.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/20/2021] [Accepted: 01/26/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Extremely-low-birth-weight (ELBW) infants are at high risk of morbidity, mortality, and long-term neurodevelopmental disorders. Evaluating infants' early spontaneous movements and postural patterns could facilitate the early detection of neurological dysfunction. This study aimed to analyze the results of global-and detailed-General Movements Assessment (GMA) in ELBW infants at a corrected age of three to five months and to compare with normal-birth-weight (NBW) infants. METHODS Fifty-two ELBW infants (median birth weight = 915.5 g) and 50 NBW infants were included. All infants were assessed according to GMA using Motor Optimality Score for 3- to 5-Month-Old Infants-Revised score sheet (MOS-R). In addition, later diagnoses of ELBW infants with atypical development were presented. RESULTS Fidgety movements were observed in 36 (69.2%) of ELBW infants and all NBW infants. MOS-R scores were lower in the ELBW group (median = 24) compared with the NBW group (median = 26). The ELBW infants scored lower than NBW infants in all MOS-R subcategories. Twenty-three (44.2%) of ELBW infants were diagnosed as atypical in the later period, although all control infants had normal development. CONCLUSIONS The study indicated that ELBW might increase the risk of atypical development in infants. The MOS-R could help us to find the risk of atypical development in infants with ELBW.
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Kwong AKL, Boyd RN, Chatfield MD, Ware RS, Colditz PB, George JM. Early Motor Repertoire of Very Preterm Infants and Relationships with 2-Year Neurodevelopment. J Clin Med 2022; 11:1833. [PMID: 35407440 PMCID: PMC9000187 DOI: 10.3390/jcm11071833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023] Open
Abstract
The Motor Optimality Score, revised (MOS-R) is an extension of the Prechtl General Movements Assessment. This study aims to determine the relationship between MOS-R and 2-year neurodevelopmental outcomes in a cohort of 169 infants born very preterm (<31 weeks’ gestational age), and to examine the predictive validity of the MOS-R at 3−4 months’ corrected age (CA) above perinatal variables associated with poor outcomes, including Prechtl fidgety movements. Development at 2 years’ CA was assessed using Bayley Scales of Infant and Toddler Development, Third edition (Bayley-III) (motor/cognitive impairment: Bayley-III ≤ 85) and Neurological, Sensory, Motor, Developmental Assessment (NSMDA) (neurosensory motor impairment: NSMDA ≥ 12). Cerebral palsy (CP) was classified at 2 years as definite or clinical. The MOS-R was related to 2-year outcomes: Bayley-III motor (BMOS-R = 1.24 95% confidence interval (0.78, 1.70)), cognitive (BMOS-R = 0.91 (0.48, 1.35)), NSMDA scores (BMOS-R = −0.34 (−0.42, −0.25)), definite CP (odds ratio [OR] 0.67 (0.53, 0.86)), clinical CP (OR 0.74 (0.66, 0.83)) for each 1-point increase in MOS-R. MOS-R ≤ 23 predicted motor (sensitivity 78% (60−91%); specificity 63% (54−72%)) and neurosensory motor impairment (sensitivity 86% (64−97%); specificity 59% (51−68%)). The MOS-R is strongly related to CP and motor and cognitive delay at 2 years and is a good predictor of motor and neurosensory motor impairment.
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Affiliation(s)
- Amanda K.-L. Kwong
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4101, Australia; (A.K.-L.K.); (R.N.B.); (M.D.C.)
- Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, VIC 3052, Australia
- Department of Physiotherapy, University of Melbourne, Parkville, VIC 3010, Australia
| | - Roslyn N. Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4101, Australia; (A.K.-L.K.); (R.N.B.); (M.D.C.)
- Australian Cerebral Palsy Clinical Trials Network CRE, The University of Queensland, Brisbane, QLD 4101, Australia
| | - Mark D. Chatfield
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4101, Australia; (A.K.-L.K.); (R.N.B.); (M.D.C.)
- Australian Cerebral Palsy Clinical Trials Network CRE, The University of Queensland, Brisbane, QLD 4101, Australia
| | - Robert S. Ware
- Menzies Health Institutes Queensland, Griffith University, Brisbane, QLD 4222, Australia;
| | - Paul B. Colditz
- University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, QLD 4072, Australia;
- Perinatal Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, QLD 4029, Australia
| | - Joanne M. George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4101, Australia; (A.K.-L.K.); (R.N.B.); (M.D.C.)
- Australian Cerebral Palsy Clinical Trials Network CRE, The University of Queensland, Brisbane, QLD 4101, Australia
- Physiotherapy Department, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Brisbane, QLD 4101, Australia
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Middendorf L, Gellhaus A, Iannaccone A, Köninger A, Dathe AK, Bendix I, Reisch B, Felderhoff-Mueser U, Huening B. The Impact of Increased Maternal sFlt-1/PlGF Ratio on Motor Outcome of Preterm Infants. Front Endocrinol (Lausanne) 2022; 13:913514. [PMID: 35846340 PMCID: PMC9279729 DOI: 10.3389/fendo.2022.913514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio serves as a clinical biomarker to predict the hypertensive, placenta-derived pregnancy disorder pre-eclampsia which is often associated with placental dysfunction and fetal growth restriction. Additionally elevated levels also indicate an increased risk for prematurity. However, its predictive value for subsequent neonatal neurological outcome has not been studied. OBJECTIVE This study aimed to evaluate the correlation of maternal sFlt-1/PlGF ratio with early motor outcome of preterm infants. Design/Methods: 88 preterm infants (gestational age ≤ 34 + 0) born between February 2017 and August 2020 at the Department of Obstetrics and Gynecology, University Hospital Essen in Germany, were included, when the following variables were available: maternal sFlt-1/PlGF levels at parturition and general movement assessment of the infant at the corrected age of 3 to 5 months. The infants were stratified into high and low ratio groups according to maternal sFlt-1/PlGF cut-off values of 85. To investigate the early motor repertoire and quality of spontaneous movements of the infant, the Motor Optimality Score (MOS-R) based on antigravity movements and posture patterns, was applied. In the given age, special attention was paid to the presence of fidgety movements. Linear regressions were run to test differences in infants motor repertoire according to the maternal sFlt-1/PIGF ratio. RESULTS Linear regression analysis showed that the sFlt-1/PlGF ratio does not predict the MOS-R score (β=≤0.001; p=0.282). However, children with birth weight below the 10th percentile scored significantly lower (mean 20.7 vs 22.7; p=0.035). These children were 91% in the group with an increased ratio, which in turn is a known predictor of low birth weight (β= -0.315; p <0.001). In the group with a high sFlt-1/PLGF ratio above 85 the mothers of female infants had a lower average sFlt-1/PlGF ratio compared to a male infant (median: 438 in female vs. 603 in male infant, p=0.145). CONCLUSIONS In our cohort, especially low birth weight, which correlated with an elevated sFlt-1/PlGF ratio, had a negative effect on the outcome in the MOS-R. A direct correlation between an increased ratio and a worse motor outcome was not demonstrated.
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Affiliation(s)
- Lisa Middendorf
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Alexandra Gellhaus
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Antonella Iannaccone
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Angela Köninger
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
- Department of Obstetrics and Gynecology, University of Regensburg, Clinic St Hedwig of the Order of St. John, Regensburg, Germany
| | - Anne-Kathrin Dathe
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, Jena, Germany
| | - Ivo Bendix
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- Department of Pediatrics I, Neonatology and Experimental Perinatal Neurosciences, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Beatrix Reisch
- Department of Obstetrics and Gynecology, University Hospital Essen, Essen, Germany
| | - Ursula Felderhoff-Mueser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
| | - Britta Huening
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University Duisburg-Essen, Essen, Germany
- *Correspondence: Britta Huening,
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Robinson H, Hart D, Vollmer B. Predictive validity of a qualitative and quantitative Prechtl's General Movements Assessment at term age: Comparison between preterm infants and term infants with HIE. Early Hum Dev 2021; 161:105449. [PMID: 34481188 DOI: 10.1016/j.earlhumdev.2021.105449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/25/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
AIM To determine (1) if the General Movement Optimality Score (GMOS) at term age enhances prediction of motor impairment at 12 and 24 months of age in high-risk infants, when compared to a global General Movement Assessment (GMA), and (2) compare predictive validity for two high-risk populations: infants born preterm and infants born at term with hypoxic ischaemic encephalopathy who have received therapeutic hypothermia. METHODS Fifty-nine extremely preterm or term age infants with hypoxic ischaemic encephalopathy underwent term age GMA. A GMA score of normal or abnormal, and a comparative numerical General Movement Optimality Score (GMOS, total values 5-42) were assigned. Neurology and motor assessment were carried out at age 12 and 24 months using standardised assessments; Alberta Infant Motor Scale, Bayley Scales of Infant and Toddler Development or Ages and Stages Questionnaire. Outcomes were recorded as normal, motor delayed or cerebral palsy. Motor outcome prediction at 12 and 24 months of age was calculated using the GMA and, using ROC analysis, GMOS cut-off scores were determined. RESULTS At 12 and 24 months global GMA sensitivity for preterms was 80% and 100%, and for Term HIE was 100% at both ages. Specificity values for preterm infants at 12 and 24 months were 68.8% and 60% versus 28.8% and 21.4% for term HIE. Median GMOS scores were lower in the term HIE group than the preterm group in the normal and poor repertoire categories. Optimality cut off scores enhanced specificity, but values remained low. INTERPRETATION At term age, specificity for identification of infants with later normal motor outcome is low. The GMOS may assist identification of infants with the highest probability of motor impairment, enabling targeted intervention during critical periods for neuroplasticity.
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Affiliation(s)
- Helen Robinson
- Dept of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Physiotherapy Department, Musgrove Park Hospital, Taunton, UK.
| | - Denise Hart
- Neonatal Neurology, Southampton Children's Hospital, University Hospital Southampton, UK
| | - Brigitte Vollmer
- Dept of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Neonatal Neurology, Southampton Children's Hospital, University Hospital Southampton, UK
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Yardımcı-Lokmanoğlu BN, Einspieler C, Sırtbaş G, Porsnok D, Arıkan Z, Livanelioğlu A, Mutlu A. The Effects of Different Exteroceptive Experiences on the Early Motor Repertoire in Infants With Down Syndrome. Phys Ther 2021; 101:6309593. [PMID: 34174075 DOI: 10.1093/ptj/pzab163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 03/07/2021] [Accepted: 05/12/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Down syndrome is a chromosomal abnormality in which muscle tone, motor development, and sensory systems are affected. The objectives of this study were to examine the changes in movements and postures of 3- to 5-month-old infants with Down syndrome and infants who were neurotypical controls during exposure to a rough-textured surface and to compare the differences occurring before and during an exteroceptive condition that was different between the 2 groups. METHODS In this quasi-experimental study, participants were 20 infants with Down syndrome (8 female infants; age range = 10-18 weeks, mean [SD] = 12 weeks 2 days [2 weeks 2 days]) and 20 age-matched infants with typical development (8 female infants; age range = 9-17 weeks, mean (SD) = 12 weeks 6 days [1 week 5 days]). The movements and postures of the infants, including fidgety movements, were assessed according to the General Movements Assessment, which determines the Motor Optimality Score (MOS), on 2 surfaces. RESULTS The MOS outcomes of the infants with Down syndrome (median = 21.5, range = 6-28) were significantly lower than those of the infants who were neurotypical (median = 28, range = 23-28) on a standard mattress. The postures were found to be significantly better in infants with Down syndrome during exposure to a rough-textured surface. The MOS did not change due to the different exteroceptive experiences in infants with Down syndrome and infants who were neurotypical. CONCLUSION The different exteroceptive experiences caused only postural alterations, which might play a crucial role in early intervention programs for infants with Down syndrome. IMPACT This is the first study, to our knowledge, on the effects of different exteroceptive conditions, such as a coco coir mattress covered with muslin fabric, on the early motor repertoire in infants with Down syndrome. The findings showed that infants with Down syndrome had heterogeneity in their fidgety movements and large variability of the MOS, and the MOS results from infants with Down syndrome were lower than those of infants who were neurotypical. Fidgety movements and the MOS did not change due to the different exteroceptive experiences in either group. Significant improvements in posture were observed during exposure to a rough-textured surface. The improvement of posture is essential; clinicians might consider the positive effect of putting an infant with Down syndrome on a rough-textured surface and include this strategy in early intervention programs.
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Affiliation(s)
- Bilge Nur Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Christa Einspieler
- Medical University of Graz, Division of Phoniatrics, Research Unit Interdisciplinary Developmental Neuroscience (iDN), Graz, Austria
| | - Gülsen Sırtbaş
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Doğan Porsnok
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Zeynep Arıkan
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Ayşe Livanelioğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
| | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Ankara, Turkey
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11
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Salavati S, Bos AF, Doyle LW, Anderson PJ, Spittle AJ. Very Preterm Early Motor Repertoire and Neurodevelopmental Outcomes at 8 Years. Pediatrics 2021; 148:peds.2020-049572. [PMID: 34452979 DOI: 10.1542/peds.2020-049572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Children born very preterm (<32 weeks' gestation) have more neurodevelopmental problems compared with term-born peers. Aberrant fidgety movements (FMs) are associated with adverse motor outcomes in children born very preterm. However, associations of aberrant FMs combined with additional movements and postures to give a motor optimality score-revised (MOS-R) with school-aged cognitive and motor outcomes are unclear. Our aim with this study was to determine those associations. METHODS Of 118 infants born <30 weeks' gestation recruited into a randomized controlled trial of early intervention, 97 had a general movements assessment at 3 months' corrected age and were eligible for this study. Early motor repertoire including FMs and MOS-R were scored from videos of infant's spontaneous movement at 3 months' corrected age. At 8 years' corrected age, cognitive and motor performances were evaluated. Associations of early FMs and MOS-R with outcomes at 8 years were determined using linear regression. RESULTS Seventy-eight (80%) infants with early motor repertoire data had neurodevelopmental assessments at 8 years. A higher MOS-R, and favorable components of the individual subscales of the MOS-R, including the presence of normal FMs, were associated with better performance for general cognition, attention, working memory, executive function and motor function at 8 years; eg, presence of normal FMs was associated with a 21.6 points higher general conceptual ability score (95% confidence interval: 12.8-30.5; P < .001) compared with absent FMs. CONCLUSIONS Favorable early motor repertoire of infants born <30 weeks is strongly associated with improved cognitive and motor performance at 8 years.
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Affiliation(s)
- Sahar Salavati
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lex W Doyle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Obstetrics and Gynaecology.,Paediatrics, University of Melbourne, Melbourne, Australia.,Newborn Research, Royal Women's Hospital, Melbourne, Australia
| | - Peter J Anderson
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Turner Institute for Brain and Mental Health, Monash University, Clayton, Victoria, Australia
| | - Alicia J Spittle
- Victorian Infant Brain Studies, Murdoch Children's Research Institute, Melbourne, Australia.,Departments of Physiotherapy.,Newborn Research, Royal Women's Hospital, Melbourne, Australia
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12
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A comparison of the early motor repertoire of very preterm infants and term infants. Eur J Paediatr Neurol 2021; 32:73-79. [PMID: 33848955 DOI: 10.1016/j.ejpn.2021.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To obtain reference data on the early motor repertoire of very preterm infants compared with healthy term infants at three months' post-term age. STUDY DESIGN In this observational study, using Prechtl's method on the assessment of the early motor repertoire, we compared the quality of fidgety movements and the concurrent motor optimality score - revised of infants with a gestational age <30 weeks and/or a birth weight <1000 g with healthy infants with a gestational age of 37-42 weeks. RESULTS One hundred eighty very preterm and 180 healthy term infants participated. The median motor optimality scores - revised of very preterm infants were significantly lower in comparison to those of term infants, with scores of 24 (25th-75th percentiles: 23-26) and 26 (25th-75th percentiles: 26-28), respectively. Fidgety movements were aberrant (abnormal or absent) more often in very preterm infants than in term infants. The odds ratio was 4.59 (95% CI, 1.51-13.92). Compared with term infants, very preterm infants had poorer scores on the subscales age-adequate movement repertoire, observed postural patterns, and movement character with odds ratios ≥2.97. We found no differences regarding observed movement patterns. CONCLUSION This study provides reference data on the early motor repertoire of very preterm and healthy term infants. It demonstrates that the early motor repertoire of very preterm infants is poorer than that of term infants, a finding consistent with existing knowledge that prematurity increases the risk of poor neurodevelopment.
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13
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The ontogeny of limbs movements towards midline in healthy infants born at term. Early Hum Dev 2021; 155:105324. [PMID: 33581484 DOI: 10.1016/j.earlhumdev.2021.105324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/04/2021] [Accepted: 01/24/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Movements towards midline are part of the age-adequate motor repertoire of infants. They develop contemporaneously to general movements, changing from occasional simple contact to proper midline motor patterns. AIM The aim of this study is to describe the ontogeny of movements towards midline in full term healthy infants. STUDY DESIGN Parents were asked to record their infant every second week, from term age to 22 weeks post-term. SUBJECTS 25 healthy full-term infants. RESULTS Three main epochs of development were detected: in the first one, between birth and 4 weeks post-term, movements towards midline were occasional, apparently due to the dominant flexed posture of elbow and knees and the adducted posture of shoulders and hips. In the second epoch, from 4 to 8 weeks, the limbs movements towards midline markedly decreased. In the third one, after 8 weeks, movements towards midline increased again in frequency, first appearing in lower limbs then in upper limbs, first solely as contact and thereafter as manipulation. A temporal overlapping with the occurrence of intermittent or continual fidgety movements was detected. CONCLUSIONS Movements towards midline progressively change, through a defined timeline, in full term healthy infants. The increased knowledge about the normal age-adequate motor repertoire can help physicians in clinical assessment of high risk infants.
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14
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Silva N, Zhang D, Kulvicius T, Gail A, Barreiros C, Lindstaedt S, Kraft M, Bölte S, Poustka L, Nielsen-Saines K, Wörgötter F, Einspieler C, Marschik PB. The future of General Movement Assessment: The role of computer vision and machine learning - A scoping review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 110:103854. [PMID: 33571849 PMCID: PMC7910279 DOI: 10.1016/j.ridd.2021.103854] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND The clinical and scientific value of Prechtl general movement assessment (GMA) has been increasingly recognised, which has extended beyond the detection of cerebral palsy throughout the years. With advancing computer science, a surging interest in developing automated GMA emerges. AIMS In this scoping review, we focused on video-based approaches, since it remains authentic to the non-intrusive principle of the classic GMA. Specifically, we aimed to provide an overview of recent video-based approaches targeting GMs; identify their techniques for movement detection and classification; examine if the technological solutions conform to the fundamental concepts of GMA; and discuss the challenges of developing automated GMA. METHODS AND PROCEDURES We performed a systematic search for computer vision-based studies on GMs. OUTCOMES AND RESULTS We identified 40 peer-reviewed articles, most (n = 30) were published between 2017 and 2020. A wide variety of sensing, tracking, detection, and classification tools for computer vision-based GMA were found. Only a small portion of these studies applied deep learning approaches. A comprehensive comparison between data acquisition and sensing setups across the reviewed studies, highlighting limitations and advantages of each modality in performing automated GMA is provided. CONCLUSIONS AND IMPLICATIONS A "method-of-choice" for automated GMA does not exist. Besides creating large datasets, understanding the fundamental concepts and prerequisites of GMA is necessary for developing automated solutions. Future research shall look beyond the narrow field of detecting cerebral palsy and open up to the full potential of applying GMA to enable an even broader application.
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Affiliation(s)
- Nelson Silva
- iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria; Know-Center GmbH, Graz, Austria
| | - Dajie Zhang
- iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria; Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany; Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany
| | - Tomas Kulvicius
- Department for Computational Neuroscience, Third Institute of Physics-Biophysics, Georg-August-University of Göttingen, Göttingen, Germany
| | - Alexander Gail
- Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany; German Primate Center - Leibniz Institute for Primate Research, Göttingen, Germany
| | - Carla Barreiros
- Know-Center GmbH, Graz, Austria; Institute of Interactive Systems and Data Science, Graz University of Technology, Graz, Austria
| | - Stefanie Lindstaedt
- Know-Center GmbH, Graz, Austria; Institute of Interactive Systems and Data Science, Graz University of Technology, Graz, Austria
| | - Marc Kraft
- Department of Medical Engineering, Technical University Berlin, Berlin, Germany
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Curtin Autism Research Group, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Luise Poustka
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany; Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany
| | - Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, David Geffen UCLA School of Medicine, USA
| | - Florentin Wörgötter
- Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany; Department for Computational Neuroscience, Third Institute of Physics-Biophysics, Georg-August-University of Göttingen, Göttingen, Germany; Institute of Physics, Department for Computational Neuroscience at the Bernstein Center Göttingen, Georg-August-University of Göttingen, Göttingen, Germany
| | - Christa Einspieler
- iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Peter B Marschik
- iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria; Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany; Leibniz-ScienceCampus Primate Cognition, Göttingen, Germany; Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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15
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Lim YH, Licari M, Spittle AJ, Watkins RE, Zwicker JG, Downs J, Finlay-Jones A. Early Motor Function of Children With Autism Spectrum Disorder: A Systematic Review. Pediatrics 2021; 147:peds.2020-011270. [PMID: 33510035 DOI: 10.1542/peds.2020-011270] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Early motor impairments have been reported in children with neurodevelopmental disorders (NDD), but it is not clear if early detection of motor impairments can identify children at risk for NDD or how early such impairments might be detected. OBJECTIVE To characterize early motor function in children later diagnosed with NDD relative to typically developing children or normative data. DATA SOURCES The Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, PsycINFO, and Scopus electronic databases were searched. STUDY SELECTION Eligible studies were required to include an examination of motor function in children (0-24 months) with later diagnosis of NDD by using standardized assessment tools. DATA EXTRACTION Data were extracted by 4 independent researchers. The quality of the studies was assessed by using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields checklist. RESULTS Twenty-five studies were included in this review; in most of the studies, the authors examined children with later autism spectrum disorder (ASD). Early motor impairments were detected in children later diagnosed with ASD. The meta-analysis results indicated that differences in fine, gross, and generalized motor functions between the later ASD and typically developing groups increased with age. Motor function across different NDD groups was found to be mixed. LIMITATIONS Results may not be applicable to children with different types of NDD not reported in this review. CONCLUSIONS Early motor impairments are evident in children later diagnosed with ASD. More research is needed to ascertain the clinical utility of motor impairment detection as an early transdiagnostic marker of NDD risk.
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Affiliation(s)
- Yi Huey Lim
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Melissa Licari
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Alicia J Spittle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Neonatal Services, The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia
| | | | - Jill G Zwicker
- British Columbia Children's Hospital Research Institute and.,Sunny Hill Health Center, British Columbia Children's Hospital, Vancouver, Canada.,Departments of Occupational Science and Occupational Therapy and.,Pediatrics, The University of British Columbia, Vancouver, Canada
| | - Jenny Downs
- Telethon Kids Institute, Nedlands, Western Australia, Australia.,The University of Western Australia, Perth, Western Australia, Australia.,Schools of Physiotherapy and Exercise Science and
| | - Amy Finlay-Jones
- Telethon Kids Institute, Nedlands, Western Australia, Australia; .,Psychology, Curtin University, Bentley, Western Australia, Australia
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16
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Yardımcı-Lokmanoğlu BN, Mutlu A, Livanelioğlu A. General Movements and Developmental Functioning in an Individual with Rhizomelic Chondrodysplasia Punctata within the First Months of the Life: A Case Report. Phys Occup Ther Pediatr 2021; 41:326-335. [PMID: 33161810 DOI: 10.1080/01942638.2020.1841870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS Rhizomelic chondrodysplasia punctata (RCDP) is an autosomal recessive inherited disorder. Individuals with RCDP have a wide range of neurodevelopmental outcomes, but there are limited descriptions of their early motor development before 5 months of age. This study aimed to describe in detail the age-specific spontaneous movements and examine the developmental functioning in an individual with RCDP. METHODS A female infant (born at 39 weeks' gestation), diagnosed with RCDP at 3 weeks of age, was assessed at 4 and 16 weeks for general movements (GMs) and concurrent motor repertoire; the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) was also applied at the same ages. RESULTS At 4 weeks, the infant showed poor repertoire GMs, with a detailed General Movement Optimality Score of 16/42. At 16 weeks, age-specific fidgety movements were absent, and the movement character was monotonous and stiff; the detailed Motor Optimality Score was severely reduced (7/28). All Bayley-III scores were <2 SD, that is <70 indicating severe developmental delay. CONCLUSION Functional assessments such as the GM assessment and age-specific detailed assessment could be complementary to neuroimaging assessments to predict the neurodevelopmental outcomes in infants with RCDP.
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Affiliation(s)
- Bilge Nur Yardımcı-Lokmanoğlu
- Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Hacettepe University, Ankara, Turkey
| | - Akmer Mutlu
- Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Hacettepe University, Ankara, Turkey
| | - Ayşe Livanelioğlu
- Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, Hacettepe University, Ankara, Turkey
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17
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Einspieler C, Zhang D, Marschik PB. Die Bedeutung fötaler und neonataler Motorik für die kindliche Entwicklung und die Früherkennung von Entwicklungsstörungen. KINDHEIT UND ENTWICKLUNG 2021. [DOI: 10.1026/0942-5403/a000323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die von Central Pattern Generators (CPGs) generierten Bewegungen des Neugeborenen und jungen Säuglings haben eine lange pränatale Vorgeschichte. Fragestellung: Welche Bedeutung hat die Analyse der CPG-Aktivität, besonders der General Movements (GMs) in der entwicklungsneurologischen Diagnostik? Methode: Unsere Übersichtsarbeit bezieht sich auf Prechtl’s General Movement Assessment (GMA), das ab dem Frühgeborenenalter bis zum Ende des 5. Monats nach einer Termingeburt anwendbar ist. Ergebnisse: Das GMA ermöglicht die Vorhersage einer Zerebralparese mit einer Sensitivität von 98 % und einer Spezifität von 91 %. Abnormale cramped-synchronized GMs sind ein früher Marker für spastische Zerebralparesen. Das Fehlen von Fidgety Movements (im 3.–5. Monat) weist auf alle Formen der Zerebralparese hin und kann auch bei bestimmten genetischen Erkrankungen auftreten. Zwei von drei Säuglingen mit einer späteren Diagnose Autismus haben atypische GMs und fallen vor allem durch ihre Monotonie in den Bewegungen auf. Diskussion und Schlussfolgerung: Mittels GMA lassen sich mit großer Treffsicherheit typische Entwicklungsverläufe vorhersagen oder aber ein Risiko für einen atypischen Verlauf erkennen und somit frühzeitige Interventionen einleiten.
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Affiliation(s)
- Christa Einspieler
- iDN – interdisciplinary Developmental Neuroscience, Klinische Abteilung für Phoniatrie, Medizinische Universität Graz
| | - Dajie Zhang
- iDN – interdisciplinary Developmental Neuroscience, Klinische Abteilung für Phoniatrie, Medizinische Universität Graz
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen
- Leibniz-WissenschaftsCampus Primatenkognition, Göttingen
| | - Peter B. Marschik
- iDN – interdisciplinary Developmental Neuroscience, Klinische Abteilung für Phoniatrie, Medizinische Universität Graz
- Kinder- und Jugendpsychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen
- Leibniz-WissenschaftsCampus Primatenkognition, Göttingen
- Center of Neurodevelopmental Disorders (KIND), Department of Women’s and Children’s Health, Karolinska Institutet Stockholm
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18
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De Roubaix A, Van de Velde D, Roeyers H, Van Waelvelde H. Standardized motor assessments before the age of five predicting school-aged motor outcome including DCD: A systematic review. Eur J Paediatr Neurol 2021; 30:29-57. [PMID: 33385976 DOI: 10.1016/j.ejpn.2020.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/10/2020] [Accepted: 12/05/2020] [Indexed: 10/22/2022]
Abstract
AIM Developmental Coordination Disorder (DCD) is a common neurodevelopmental disorder usually diagnosed at primary-school-age. This systematic review aimed to summarize available standardized motor assessments before five years of age predicting DCD, complex Minor Neurological Disorder (cMND) and motor delay assessed by a standardized motor test. METHODS A systematic search was performed in MEDLINE, CINAHL, WoS, Scopus, CENTRAL and ERIC. A hand search was executed. Only data of non-Cerebral Palsy children was included. RESULTS At or before two years, the BSID, motor subtests of GMDS, NOMAS, and NSMDA might be valuable in detecting school-aged motor delay, while starting at three years, the PDMS, motor subtests of GMDS, NSDMA, M-ABC-2, and CAMPB show promising results. General movements Assessment is associated with cMND, but does not seem sensitive enough to detect DCD. Predictive values are superior in high-risk groups and improve as children age. However, no assessment instrument reached 80% sensitivity and specificity. CONCLUSION Standardized motor assessments before five years seem valuable in detecting early motor problems. More longitudinal research commencing in infancy, including multiple assessments over time and the implementation of clear diagnostic criteria is imperative.
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Affiliation(s)
- Amy De Roubaix
- Faculty of Medicine and Health Care Sciences, Department of Rehabilitation Sciences, Ghent University, Entrance 46, UZ Ghent, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Dominique Van de Velde
- Faculty of Medicine and Health Care Sciences, Department of Rehabilitation Sciences, Ghent University, Entrance 46, UZ Ghent, C. Heymanslaan 10, 9000, Ghent, Belgium.
| | - Herbert Roeyers
- Faculty of Psychology and Educational Sciences, Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium.
| | - Hilde Van Waelvelde
- Faculty of Medicine and Health Care Sciences, Department of Rehabilitation Sciences, Ghent University, Entrance 46, UZ Ghent, C. Heymanslaan 10, 9000, Ghent, Belgium.
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19
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Mandich M, Scott K. Commentary on "Early Spontaneous Movements in Infants With Hypoxic-Ischemic Encephalopathy". Pediatr Phys Ther 2021; 33:23. [PMID: 33337770 DOI: 10.1097/pep.0000000000000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- MaryBeth Mandich
- Division of Physical Therapy West Virginia University Morgantown, West Virginia
| | - Kimberley Scott
- School of Health and Rehabilitation Sciences The Ohio State University Columbus, Ohio
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20
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Abstract
OBJECTIVE The aim of this study was to determine motor repertoire at 3 to 5 months of age in infants with hypoxic-ischemic encephalopathy (HIE) and to examine changes according to HIE severity. METHODS Participants were 38 infants aged 3 to 5 months with HIE and 38 infants in the comparison group. The general movement assessment and the Motor Optimality Score (MOS) were used. RESULTS Infants in the HIE group had a significantly lower total MOS and scores for fidgety movements, age adequacy of motor repertoire, and quality of movement patterns compared with the comparison group. Infants with grade III HIE compared with grade I had a significantly lower MOS. CONCLUSIONS Infants with HIE had poorer motor repertoire at age 3 to 5 months when compared with peers. Motor repertoire deteriorated as HIE severity increased. Detecting potential developmental delays as early as possible allows for early intervention and rehabilitation in this population.
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21
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Einspieler C, Bos AF, Krieber-Tomantschger M, Alvarado E, Barbosa VM, Bertoncelli N, Burger M, Chorna O, Del Secco S, DeRegnier RA, Hüning B, Ko J, Lucaccioni L, Maeda T, Marchi V, Martín E, Morgan C, Mutlu A, Nogolová A, Pansy J, Peyton C, Pokorny FB, Prinsloo LR, Ricci E, Saini L, Scheuchenegger A, Silva CRD, Soloveichick M, Spittle AJ, Toldo M, Utsch F, van Zyl J, Viñals C, Wang J, Yang H, Yardımcı-Lokmanoğlu BN, Cioni G, Ferrari F, Guzzetta A, Marschik PB. Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome. J Clin Med 2019; 8:E1616. [PMID: 31590221 PMCID: PMC6833082 DOI: 10.3390/jcm8101616] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/21/2019] [Accepted: 09/25/2019] [Indexed: 11/17/2022] Open
Abstract
The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3-5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant's later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III-V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.
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Affiliation(s)
- Christa Einspieler
- Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria.
| | - Arend F Bos
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital, Division of Neonatology, 9713 GZ Groningen, The Netherlands.
| | | | - Elsa Alvarado
- National Rehabilitation Institute, Cerebral Palsy Department, 14389 Mexico City, Mexico.
| | - Vanessa M Barbosa
- University of Illinois at Chicago, UI Health, Department of Occupational and Physical Therapy, Chicago, IL 60612, USA.
| | - Natascia Bertoncelli
- University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy.
| | - Marlette Burger
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Health and Rehabilitation Sciences, Cape Town 8000, South Africa.
| | - Olena Chorna
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy.
| | - Sabrina Del Secco
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy.
| | - Raye-Ann DeRegnier
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
| | - Britta Hüning
- University Hospital Essen, Department of Pediatrics I, 45122 Essen, Germany.
| | - Jooyeon Ko
- Daegu Health College, Department of Physical Therapy, 41453 Daegu, Korea.
| | - Laura Lucaccioni
- University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy.
| | - Tomoki Maeda
- Oita University Faculty of Medicine, Department of Pediatrics, 879-5593 Oita, Japan.
| | - Viviana Marchi
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy.
- Institute of Life Sciences, Scuola Superiore Sant'Anna, 56127 Pisa, Italy.
| | - Erika Martín
- Children's Rehabilitation Institute Teleton, 72825 Puebla, Mexico.
| | - Catherine Morgan
- The University of Sydney Medical School, Children's Hospital at Westmead Clinical School, The Discipline of Child and Adolescent Health, Sydney 2050, NSW, Australia.
- The University of Sydney, Cerebral Palsy Alliance Research Institute, Sydney 2050, NSW, Australia.
| | - Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, 06100 Ankara, Turkey.
| | - Alice Nogolová
- Municipal Hospital of Ostrava, Children 's Department, 72880 Ostrava, Czech Republic.
- Masaryk University, Faculty of Medicine, 62500 Brno, Czech Republic.
| | - Jasmin Pansy
- Medical University of Graz, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, 8036 Graz, Austria.
| | - Colleen Peyton
- Northwestern University, Department of Physical Therapy and Human Movement Science, Chicago, IL 60611, USA.
| | - Florian B Pokorny
- Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria.
| | - Lucia R Prinsloo
- Cerebral Palsy Association Eastern Cape, Port Elizabeth 6001, South Africa.
| | - Eileen Ricci
- University of New England/Maine LEND Program, Portland, ME 04103, USA.
| | - Lokesh Saini
- Post Graduate Institute of Medical Education and Research, Department of Pediatrics, Pediatric Neurology Division, Chandigarh 160012, India.
| | - Anna Scheuchenegger
- Medical University of Graz, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, 8036 Graz, Austria.
| | - Cinthia R D Silva
- Rede SARAH de Hospitais de Reabilitação, Reabilitação Infantil, 30510-000 Belo Horizonte, Brazil.
| | - Marina Soloveichick
- Lady Davis Carmel Medical Center, NICU Developmental Follow-up Clinic, 34362 Haifa, Israel.
| | - Alicia J Spittle
- University of Melbourne, School of Health Sciences, Department of Physiotherapy, Parkville 3052, Australia.
- Murdoch Children's Research Institute, Parkville 3052, Victoria, Australia.
| | - Moreno Toldo
- Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi 221011, India.
| | - Fabiana Utsch
- Rede SARAH de Hospitais de Reabilitação, Reabilitação Infantil, 30510-000 Belo Horizonte, Brazil.
| | - Jeanetta van Zyl
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Cape Town 8000, South Africa.
| | - Carlos Viñals
- National Rehabilitation Institute, Cerebral Palsy Department, 14389 Mexico City, Mexico.
| | - Jun Wang
- Children's Hospital of Fudan University, Department of Rehabilitation, Shanghai 201102, China.
| | - Hong Yang
- Children's Hospital of Fudan University, Department of Rehabilitation, Shanghai 201102, China.
| | - Bilge N Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, 06100 Ankara, Turkey.
| | - Giovanni Cioni
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy.
| | - Fabrizio Ferrari
- University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy.
| | - Andrea Guzzetta
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy.
| | - Peter B Marschik
- Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria.
- University Medical Center Göttingen, Child and Adolescent Psychiatry and Psychotherapy, 37075 Göttingen, Germany.
- Karolinska Institutet, Department of Women's and Children's Health, Center of Neurodevelopmental Disorders (KIND), 11330 Stockholm, Sweden.
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22
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Marchi V, Hakala A, Knight A, D'Acunto F, Scattoni ML, Guzzetta A, Vanhatalo S. Automated pose estimation captures key aspects of General Movements at eight to 17 weeks from conventional videos. Acta Paediatr 2019; 108:1817-1824. [PMID: 30883894 DOI: 10.1111/apa.14781] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/06/2019] [Accepted: 03/12/2019] [Indexed: 11/27/2022]
Abstract
AIM General movement assessment requires substantial expertise for accurate visual interpretation. Our aim was to evaluate an automated pose estimation method, using conventional video records, to see if it could capture infant movements using objective biomarkers. METHODS We selected archived videos from 21 infants aged eight to 17 weeks who had taken part in studies at the IRCCS Fondazione Stella Maris (Italy), from 2011 to 2017. Of these, 14 presented with typical low-risk movements, while seven presented with atypical movements and were later diagnosed with cerebral palsy. Skeleton videos were produced using a computational pose estimation model adapted for infants and these were blindly assessed to see whether they contained the information needed for classification by human experts. Movements of skeletal key points were analysed using kinematic metrics to provide a biomarker to distinguish between groups. RESULTS The visual assessments of the skeleton videos were very accurate, with Cohen's K of 0.90 when compared with the classification of conventional videos. Quantitative analysis showed that arm movements were more variable in infants with typical movements. CONCLUSION It was possible to extract automated estimation of movement patterns from conventional video records and convert them to skeleton footage. This could allow quantitative analysis of existing footage.
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Affiliation(s)
- Viviana Marchi
- Institute of Life Sciences Scuola Superiore Sant'Anna Pisa Italy
- Department of Developmental Neuroscience IRCCS Fondazione Stella Maris Pisa Italy
| | - Anna Hakala
- Neuro Event Labs Oy (2712284‐1) Tampere Finland
| | | | - Federica D'Acunto
- Department of Developmental Neuroscience IRCCS Fondazione Stella Maris Pisa Italy
| | - Maria Luisa Scattoni
- Research Coordination and Support Service Istituto Superiore di Sanità Rome Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience IRCCS Fondazione Stella Maris Pisa Italy
- Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology Children′s Hospital University of Helsinki and Helsinki University Hospital (HUH) Helsinki Finland
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23
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Ferrari F, Plessi C, Lucaccioni L, Bertoncelli N, Bedetti L, Ori L, Berardi A, Della Casa E, Iughetti L, D'Amico R. Motor and Postural Patterns Concomitant with General Movements Are Associated with Cerebral Palsy at Term and Fidgety Age in Preterm Infants. J Clin Med 2019; 8:E1189. [PMID: 31398881 PMCID: PMC6723626 DOI: 10.3390/jcm8081189] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/24/2019] [Accepted: 08/06/2019] [Indexed: 11/16/2022] Open
Abstract
General movements (GMs) in combination with neurological examination and magnetic resonance imaging at term age can accurately determine the risk of cerebral palsy. The present study aimed to assess whether 11 motor and postural patterns concomitant with GMs were associated with cerebral palsy. Video recordings performed after birth in 79 preterm infants were reviewed retrospectively. Thirty-seven infants developed cerebral palsy at 2 years corrected age and the remaining 42 showed typical development. GMs were assessed from preterm to fidgety age and GM trajectories were defined. The 11 motor and postural patterns were evaluated at each age and longitudinally, alone and in combination with GM trajectories. A logistic regression model was used to assess the association between GMs, concomitant motor and postural patterns, and cerebral palsy. We confirmed that high-risk GM trajectories were associated with cerebral palsy (odds ratio = 44.40, 95% confidence interval = 11.74-167.85). An association between concomitant motor and postural patterns and cerebral palsy was found for some of the patterns at term age and for all of them at fidgety age. Therefore, at term age, concomitant motor and postural patterns can support GMs for the early diagnosis of cerebral palsy.
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Affiliation(s)
- Fabrizio Ferrari
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Carlotta Plessi
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy.
| | - Laura Lucaccioni
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Natascia Bertoncelli
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Luca Bedetti
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Luca Ori
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Alberto Berardi
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Elisa Della Casa
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of Mother, Children and Adults, University Hospital of Modena, 41124 Modena, Italy
| | - Roberto D'Amico
- Statistic Unit, Department of Medical and Surgical Sciences, University of Modena, 41124 Modena, Italy
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24
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Brain maturation in the first 3 months of life, measured by electroencephalogram: A comparison between preterm and term-born infants. Clin Neurophysiol 2019; 130:1859-1868. [PMID: 31401493 DOI: 10.1016/j.clinph.2019.06.230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/02/2019] [Accepted: 06/28/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Preterm infants are at risk for altered brain maturation resulting in neurodevelopmental impairments. Topographical analysis of high-density electroencephalogram during sleep matches underlying brain maturation. Using such an EEG mapping approach could identify preterm infants at risk early in life. METHODS 20 preterm (gestational age < 32 weeks) and 20 term-born infants (gestational age > 37 weeks) were recorded by 18-channel daytime sleep-EEG at term age (GA 40 weeks for preterm and 2-3 days after birth for term infants) and 3 months (corrected age for preterm infants). RESULTS Preterm infant's power spectrum at term age is immature, leveling off with term infants at 3 months of age. Topographical distribution of maximal power density however, reveals qualitative differences between the groups until 3 months of age. Preterm infants exhibit more temporal than central activation at term age and more occipital than central activation at 3 months of age. Moreover, being less mature at term age predicts being less mature at 3 months of age. CONCLUSION Topographical analysis of sleep EEG reveals changes in brain maturation between term and preterm infants early in life. SIGNIFICANCE In future, automated analysis tools using topographical power distribution could help identify preterm infants at risk early in life.
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25
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Kepenek-Varol B, Tanrıverdi M, İşcan A, Alemdaroğlu-Gürbüz İ. The acute effects of physiotherapy on general movement patterns in preterm infants: A single-blind study. Early Hum Dev 2019; 131:15-20. [PMID: 30798037 DOI: 10.1016/j.earlhumdev.2019.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/27/2018] [Accepted: 02/13/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The General Movement Assessment (GMA) is a video analysis method developed by Heinz Prechtl that examines the infant's spontaneous movements. In recent years, although many studies have been performed in preterm infants by applying GMA, few studies have shown the effects of early intervention on GMA. AIMS Current study was planned to determine the acute effects of a single-session early physiotherapy approach on preterm infants' general spontaneous movements, and to reveal the change in Motor Optimality Scale (MOS) score including FMs. STUDY DESIGN Prospective, single-blind study. SUBJECTS Current study was carried out with 32 preterm infants at postterm 12-16 weeks. OUTCOME MEASURES The infants included in the study were videotaped by a physiotherapist during 10-15 min before the physiotherapy session at postterm 12-16 weeks for GMA. After a single physiotherapy session, the same physiotherapist performed the same video footage second time. A blind evaluator assessed the videos taken before and after session and scored Motor Optimality Scale (MOS). RESULTS AND CONCLUSIONS There was no statistically significant difference between MOS sub-category and total score of the infants before and after the session (p > 0.05). According to the results of present study, a single-session early physiotherapy intervention did not have an acute effect on the spontaneous movements of preterm infants at postterm 12-16 weeks. Future studies are needed to demonstrate the short and long-term effects of early physiotherapy approaches to risky infants.
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Affiliation(s)
- Büşra Kepenek-Varol
- Nuh Naci Yazgan University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Kayseri, Turkey
| | - Müberra Tanrıverdi
- Bezmialem Vakıf University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, İstanbul, Turkey.
| | - Akın İşcan
- Bezmialem Vakıf University, Faculty of Medicine, Pediatric Neurology Department, İstanbul, Turkey
| | - İpek Alemdaroğlu-Gürbüz
- Hacettepe University, Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Ankara, Turkey.
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26
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Abstract
Neonatal Arterial Ischemic Stroke (NAIS) affects 6-17 newborns on 100 000-birth term neonates, most of these children keeping long-term motor and cognitive impairments. Based on a literature review, the objectives of this paper are to describe motor and cognitive outcomes after a NAIS and to propose a consensual monitoring of these children to improve their management. About 30 % of children after a NAIS will develop a unilateral cerebral palsy requiring a management by a team with expertise in physical medicine and rehabilitation. Unlike adults, especially after a left NAIS, children will not present aphasia but between 50 and 90 % will present disorders of speech and language in expression and/or reception. After NAIS, the global intellectual efficiency is usually preserved except when the size of the lesion is very important or when severe epilepsy occurs. Several studies are also in favor of vulnerability in visuospatial functions. To quantify impairments, activity limitations and participation restrictions resulting from this NAIS, early and at least yearly evaluations with reliable tools must be carried out systematically until puberty. A multidisciplinary team with a longitudinal follow-up, in all the different developmental dimensions, must conduct these evaluations in term of motor skills, cognitive impairment, behavior, autonomy, quality of life, and participation. Consequences on family functioning need to be evaluate in order to help children and family coping with this event.
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27
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Kwong AKL, Fitzgerald TL, Doyle LW, Cheong JLY, Spittle AJ. Predictive validity of spontaneous early infant movement for later cerebral palsy: a systematic review. Dev Med Child Neurol 2018; 60:480-489. [PMID: 29468662 DOI: 10.1111/dmcn.13697] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 11/30/2022]
Abstract
AIM To systematically review the predictive validity of spontaneous early infant movements for later cerebral palsy (CP). METHOD Cohort studies with published data to calculate predictive validity of early spontaneous movements for later CP were searched in four electronic databases: CINAHL, Embase, MEDLINE, and PsycINFO. RESULTS Forty-seven studies met inclusion criteria. The Prechtl General Movements Assessment (GMA) during the fidgety period (10-20wks corrected age) had the strongest sensitivity: 97 per cent (95% confidence interval [CI] 93-99) and specificity: 89% (95% CI 83-93). The sensitivity and specificity of the Prechtl GMA during the writhing period (birth-6wks) was 93% (95% CI 86-96) and 59% (95% CI 45-71) respectively. Cramped-synchronized movements in the writhing period according to Prechtl had the best specificity (sensitivity: 70% [95% CI 54-82]; specificity: 97% [95% CI 74-100]). Hadders-Algra's method of assessing general movements had a pooled sensitivity and specificity of 89% (95% CI 66-97) and 81% (95% CI 64-91) respectively. Presence of asymmetric postures and movement quality/quantity were reported under the Hammersmith Infant Neurological Examination, Hammersmith Neonatal Neurological Examination, and Movement Assessment of Infants but had weak associations with later CP. INTERPRETATION Fidgety movements assessed by the Prechtl GMA have the strongest predictive validity for later CP, but cannot be considered in isolation because of the presence of false positive results. WHAT THIS PAPER ADDS Fidgety general movements (Prechtl) are most predictive for later cerebral palsy compared with other spontaneous movements. False positive results are high among all spontaneous movement assessments.
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Affiliation(s)
- Amanda K L Kwong
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Tara L Fitzgerald
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Jeanie L Y Cheong
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia
| | - Alicia J Spittle
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Physiotherapy, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Women's Hospital, Parkville, Victoria, Australia
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28
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Peyton C, Einspieler C. General Movements: A Behavioral Biomarker of Later Motor and Cognitive Dysfunction in NICU Graduates. Pediatr Ann 2018; 47:e159-e164. [PMID: 29668025 DOI: 10.3928/19382359-20180325-01] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Infants who have graduated from a neonatal intensive care unit require close follow-up because they have a greater chance of experiencing later motor and cognitive difficulties; however, these difficulties are often challenging to identify at an early age. The General Movement Assessment is a low-cost and highly reliable tool that can indicate abnormal neurological development in young high-risk infants, but it has not yet been widely implemented in the United States. In this review, we discuss the literature about the use of the General Movement Assessment in high-risk infants and how to implement the tool in a clinical setting. [Pediatr Ann. 2018;47(4):e159-e164.].
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29
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Tomantschger I, Herrero D, Einspieler C, Hamamura C, Voos MC, Marschik PB. The general movement assessment in non-European low- and middle-income countries. Rev Saude Publica 2018; 52:6. [PMID: 29412374 PMCID: PMC5802721 DOI: 10.11606/s1518-8787.2018052000332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 04/10/2017] [Indexed: 11/13/2022] Open
Abstract
Abnormal general movements are among the most reliable markers for cerebral palsy. General movements are part of the spontaneous motor repertoire and are present from early fetal life until the end of the first half year after term. In addition to its high sensitivity (98%) and specificity (91%), the assessment of general movements is non-invasive and time- and cost-efficient. It is therefore ideal for assessing the integrity of the young nervous system, most notably in lowresource settings. Studies on the general movements assessment in low- and middle-income countries such as China, India, Iran, or South Africa are still rare but increasing. In Brazil, too, researchers have demonstrated that the evaluation of general movements adds to the functional assessment of the young nervous system. Applying general movements assessment in vulnerable populations in Brazil is therefore highly recommended.
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Affiliation(s)
- Iris Tomantschger
- Medical University of Graz. Research Unit Interdisciplinary Developmental Neuroscience. Department of Phoniatrics. Graz, Austria
| | - Dafne Herrero
- Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Saúde Materno Infantil. São Paulo, SP, Brasil
| | - Christa Einspieler
- Medical University of Graz. Research Unit Interdisciplinary Developmental Neuroscience. Department of Phoniatrics. Graz, Austria
| | - Cristina Hamamura
- Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Saúde Materno Infantil. São Paulo, SP, Brasil
| | - Mariana Calil Voos
- Universidade de São Paulo. Faculdade de Medicina. Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional. São Paulo, SP, Brasil
| | - Peter B Marschik
- Medical University of Graz. Research Unit Interdisciplinary Developmental Neuroscience. Department of Phoniatrics. Graz, Austria.,Karolinska Institutet. Center of Neurodevelopmental Disorders. Stockholm, Sweden
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30
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Salavati S, Einspieler C, Vagelli G, Zhang D, Pansy J, Burgerhof JGM, Marschik PB, Bos AF. The association between the early motor repertoire and language development in term children born after normal pregnancy. Early Hum Dev 2017; 111:30-35. [PMID: 28549271 PMCID: PMC5951278 DOI: 10.1016/j.earlhumdev.2017.05.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 05/03/2017] [Accepted: 05/15/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The assessment of the early motor repertoire is a widely used method for assessing the infant's neurological status. AIM To determine the association between the early motor repertoire and language development. STUDY DESIGN Prospective cohort study. SUBJECTS 22 term children born after normal pregnancy; video recorded for the assessment of the early motor repertoire including their motor optimality score (MOS), according to Prechtl, at 3 and 5months post term. OUTCOME MEASURES At 4years 7months and 10years 5months, we tested the children's language performance by administering three tests for expressive language and two for receptive language. RESULTS Smooth and fluent movements at 3months of age was associated with better expressive language outcome at both 4years 7months and 10years 5months (betas 0.363 and 0.628). A higher MOS at 5months was associated with better expressive language at both ages (betas 0.486 and 0.628). The item postural patterns at 5months was the only aspect associated with poorer expressive language outcome (beta -0.677). CONCLUSION Predominantly, qualitative aspects of the early motor repertoire at the age of 3 and 5months are associated with language development.
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Affiliation(s)
- Sahar Salavati
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria.
| | - Christa Einspieler
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria
| | - Giulia Vagelli
- SMILE Lab, Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Dajie Zhang
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria
| | - Jasmin Pansy
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Johannes G M Burgerhof
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter B Marschik
- iDN - Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Austria; Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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31
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Herrero D, Einspieler C, Panvequio Aizawa CY, Mutlu A, Yang H, Nogolová A, Pansy J, Nielsen-Saines K, Marschik PB. The motor repertoire in 3- to 5-month old infants with Down syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 67:1-8. [PMID: 28586709 PMCID: PMC5515547 DOI: 10.1016/j.ridd.2017.05.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/21/2017] [Accepted: 05/21/2017] [Indexed: 05/20/2023]
Abstract
BACKGROUND Even though Down syndrome is the most common chromosomal cause of intellectual disability, studies on early development are scarce. AIM To describe movements and postures in 3- to 5-month-old infants with Down syndrome and assess the relation between pre- and perinatal risk factors and the eventual motor performance. METHODS AND PROCEDURES Exploratory study; 47 infants with Down syndrome (26 males, 27 infants born preterm, 22 infants with congenital heart disease) were videoed at 10-19 weeks post-term (median=14 weeks). We assessed their Motor Optimality Score (MOS) based on postures and movements (including fidgety movements) and compared it to that of 47 infants later diagnosed with cerebral palsy and 47 infants with a normal neurological outcome, matched for gestational and recording ages. OUTCOMES AND RESULTS The MOS (median=13, range 10-28) was significantly lower than in infants with a normal neurological outcome (median=26), but higher than in infants later diagnosed with cerebral palsy (median=6). Fourteen infants with Down syndrome showed normal fidgety movements, 13 no fidgety movements, and 20 exaggerated, too fast or too slow fidgety movements. A lack of movements to the midline and several atypical postures were observed. Neither preterm birth nor congenital heart disease was related to aberrant fidgety movements or reduced MOS. CONCLUSIONS AND IMPLICATIONS The heterogeneity in fidgety movements and MOS add to an understanding of the large variability of the early phenotype of Down syndrome. Studies on the predictive values of the early spontaneous motor repertoire, especially for the cognitive outcome, are warranted. WHAT THIS PAPER ADDS The significance of this exploratory study lies in its minute description of the motor repertoire of infants with Down syndrome aged 3-5 months. Thirty percent of infants with Down syndrome showed age-specific normal fidgety movements. The rate of abnormal fidgety movements (large amplitude, high/slow speed) or a lack of fidgety movements was exceedingly high. The motor optimality score of infants with Down syndrome was lower than in infants with normal neurological outcome but higher than in infants who were later diagnosed with cerebral palsy. Neither preterm birth nor congenital heart disease were related to the motor performance at 3-5 months.
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Affiliation(s)
- Dafne Herrero
- School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Christa Einspieler
- Research Unit iDN, Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria.
| | - Carolina Y Panvequio Aizawa
- Department of Physical Therapy, Communication Science & Disorders and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Akmer Mutlu
- Developmental and Early Physiotherapy Unit, Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Hong Yang
- Rehabilitation Department, Children's Hospital of Fudan University, Shanghai, China
| | - Alice Nogolová
- Children's Department, City Hospital of Ostrava, Ostrava, Czech Republic
| | - Jasmin Pansy
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Karin Nielsen-Saines
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Peter B Marschik
- Research Unit iDN, Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Medical University of Graz, Graz, Austria; Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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32
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Zang FF, Yang H, Han Q, Cao JY, Tomantschger I, Krieber M, Shi W, Luo DD, Zhu M, Einspieler C. Very low birth weight infants in China: the predictive value of the motor repertoire at 3 to 5months for the motor performance at 12months. Early Hum Dev 2016; 100:27-32. [PMID: 27391870 PMCID: PMC5010039 DOI: 10.1016/j.earlhumdev.2016.03.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/05/2016] [Accepted: 03/18/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies on motor performance and its early markers are rare in China, especially in very low birth weight (VLBW) infants. OBJECTIVE Apart from the assessment of the inter-scorer agreement, we aimed to analyze to what extent the motor repertoire at 10 to 18weeks postterm was related to neonatal complications, and gross and fine motor performance at 12months after term. STUDY DESIGN Exploratory prospective study. SUBJECTS Seventy-four VLBW infants (58 males; mean gestational age=29weeks; mean birth weight=1252g). METHOD Five-minute video recordings were performed at 10 to 18weeks after term; fidgety movements and the concurrent motor patterns (resulting in a motor optimality score) were assessed according to the Prechtl general movements assessment (GMA). The gross and fine motor performance was assessed by means of the Peabody Developmental Motor Scales, second edition, at 12months. RESULTS Reliability was excellent. Pneumonia was associated with absent fidgety movements; the motor optimality score was lower in infants with pneumonia and/or bronchopulmonary dysplasia. Both absent fidgety movements and a lower motor optimality score were associated with a poor or very poor gross and fine motor performance at the 12-month-assessment. CONCLUSION Both the assessment of fidgety movements and the evaluation of the concurrent motor repertoire contribute significantly to an identification of VLBW children with a poor gross and fine motor outcome at 12months. The results of this study document the need for an early identification of infants at high risk for a poor motor performance.
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Affiliation(s)
- Fei-Fei Zang
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Qian Han
- Health Service Center, Meilong Community, Minhang District, Shanghai, PR China
| | - Jia-Yan Cao
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Iris Tomantschger
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria
| | - Magdalena Krieber
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria
| | - Wei Shi
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Dan-Dan Luo
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Mo Zhu
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China
| | - Christa Einspieler
- Department of Rehabilitation, Children's Hospital of Fudan University, Key Laboratory of Neonatal Diseases, Ministry of Health, Shanghai, PR China.
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Einspieler C, Peharz R, Marschik PB. Fidgety movements - tiny in appearance, but huge in impact. J Pediatr (Rio J) 2016; 92:S64-70. [PMID: 26997356 DOI: 10.1016/j.jped.2015.12.003] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/15/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To describe fidgety movements (FMs), i.e., the spontaneous movement pattern that typically occurs at 3-5 months after term age, and discuss its clinical relevance. SOURCES A comprehensive literature search was performed using the following databases: MEDLINE/PubMed, CINAHL, The Cochrane Library, Science Direct, PsycINFO, and EMBASE. The search strategy included the MeSH terms and search strings ('fidgety movement*') OR [('general movement*') AND ('three month*') OR ('3 month*')], as well as studies published on the General Movements Trust website (www.general-movements-trust.info). SUMMARY OF THE DATA Virtually all infants develop normally if FMs are present and normal, even if their brain ultrasound findings and/or clinical histories indicate a disposition to later neurological deficits. Conversely, almost all infants who never develop FMs have a high risk for neurological deficits such as cerebral palsy, and for genetic disorders with a late onset. If FMs are normal but concurrent postural patterns are not age-adequate or the overall movement character is monotonous, cognitive and/or language skills at school age will be suboptimal. Abnormal FMs are unspecific and have a low predictive power, but occur exceedingly in infants later diagnosed with autism. CONCLUSIONS Abnormal, absent, or sporadic FMs indicate an increased risk for later neurological dysfunction, whereas normal FMs are highly predictive of normal development, especially if they co-occur with other smooth and fluent movements. Early recognition of neurological signs facilitates early intervention. It is important to re-assure parents of infants with clinical risk factors that the neurological outcome will be adequate if FMs develop normally.
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Affiliation(s)
- Christa Einspieler
- Research Unit Interdisciplinary Developmental Neuroscience (iDN), Institute of Physiology, Medical University of Graz, Graz, Austria.
| | - Robert Peharz
- Research Unit Interdisciplinary Developmental Neuroscience (iDN), Institute of Physiology, Medical University of Graz, Graz, Austria
| | - Peter B Marschik
- Research Unit Interdisciplinary Developmental Neuroscience (iDN), Institute of Physiology, Medical University of Graz, Graz, Austria
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Einspieler C, Peharz R, Marschik PB. Fidgety movements – tiny in appearance, but huge in impact. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Einspieler C, Marschik PB, Urlesberger B, Pansy J, Scheuchenegger A, Krieber M, Yang H, Kornacka MK, Rowinska E, Soloveichick M, Ferrari F, Guzzetta A, Cioni G, Bos AF. The general movement optimality score: a detailed assessment of general movements during preterm and term age. Dev Med Child Neurol 2016; 58:361-8. [PMID: 26365130 PMCID: PMC5951275 DOI: 10.1111/dmcn.12923] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 11/30/2022]
Abstract
AIM To explore the appropriateness of applying a detailed assessment of general movements and characterize the relationship between global and detailed assessment. METHOD The analysis was based on 783 video recordings of 233 infants (154 males, 79 females) who had been videoed from 27 to 45 weeks postmenstrual age. Apart from assessing the global general movement categories (normal, poor repertoire, cramped-synchronized, or chaotic general movements), we scored the amplitude, speed, spatial range, proximal and distal rotations, onset and offset, tremulous and cramped components of the upper and lower extremities. Applying the optimality concept, the maximum general movement optimality score of 42 indicates the optimal performance. RESULTS General movement optimality scores (GMOS) differentiated between normal general movements (median 39 [25-75th centile 37-41]), poor repertoire general movements (median 25 [22-29]), and cramped-synchronized general movements (median 12 [10-14]; p<0.01). The optimality score for chaotic general movements (mainly occurring at late preterm age) was similar to those for cramped-synchronized general movements (median 14 [12-17]). Short-lasting tremulous movements occurred from very preterm age (<32wks) to post-term age across all general movement categories, including normal general movements. The detailed score at post-term age was slightly lower compared to the scores at preterm and term age for both normal (p=0.02) and poor repertoire general movements (p<0.01). INTERPRETATION Further research might demonstrate that the GMOS provides a solid base for the prediction of improvement versus deterioration within an individual general movement trajectory.
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Affiliation(s)
- Christa Einspieler
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Graz, Austria
| | - Peter B. Marschik
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Graz, Austria,Center of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Jasmin Pansy
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Anna Scheuchenegger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Magdalena Krieber
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Graz, Austria
| | - Hong Yang
- Department of Rehabilitation, Children’s Hospital of Fudan University, Shanghai, PR China
| | - Maria K. Kornacka
- Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland
| | - Edyta Rowinska
- Neonatal and Intensive Care Department, Medical University of Warsaw, Warsaw, Poland
| | - Marina Soloveichick
- Preterm and High Risk Babies Follow-Up Clinic, Carmel Medical Center, Haifa, Israel
| | - Fabrizio Ferrari
- Department of Neonatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Cioni
- Department of Developmental Neuroscience, Stella Maris Scientific Institute, Pisa, Italy,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Arend F. Bos
- Division of Neonatology, Beatrix Children’s Hospital, University Medical Center, University of Groningen, Groningen, the Netherlands
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Einspieler C, Bos AF, Libertus ME, Marschik PB. The General Movement Assessment Helps Us to Identify Preterm Infants at Risk for Cognitive Dysfunction. Front Psychol 2016; 7:406. [PMID: 27047429 PMCID: PMC4801883 DOI: 10.3389/fpsyg.2016.00406] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/07/2016] [Indexed: 01/12/2023] Open
Abstract
Apart from motor and behavioral dysfunctions, deficits in cognitive skills are among the well-documented sequelae of preterm birth. However, early identification of infants at risk for poor cognition is still a challenge, as no clear association between pathological findings based on neuroimaging scans and cognitive functions have been detected as yet. The Prechtl General Movement Assessment (GMA) has shown its merits for the evaluation of the integrity of the young nervous system. It is a reliable tool for identifying infants at risk for neuromotor deficits. Recent studies on preterm infants demonstrate that abnormal general movements (GMs) also reflect impairments of brain areas involved in cognitive development. The aim of this systematic review was to discuss studies that included (i) the Prechtl GMA applied in preterm infants, and (ii) cognitive outcome measures in six data bases. Seven studies met the inclusion criteria and yielded the following results: (a) children born preterm with consistently abnormal GMs up to 8 weeks after term had lower intelligence quotients at school age than children with an early normalization of GMs; (b) from 3 to 5 months after term, several qualitative, and quantitative aspects of the concurrent motor repertoire, including postural patterns, were predictive of intelligence at 7–10 years of age. These findings in 428 individuals born preterm suggest that normal GMs along with a normal motor repertoire during the first months after term are markers for normal cognitive development until at least age 10.
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Affiliation(s)
- Christa Einspieler
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz Graz, Austria
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center, University of Groningen Groningen, Netherlands
| | - Melissa E Libertus
- Department of Psychology, Learning Research Development Center, University of Pittsburgh Pittsburgh, PA, USA
| | - Peter B Marschik
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of GrazGraz, Austria; Center of Neurodevelopmental Disorders, Department of Women's Children's Health, Karolinska InstitutetStockholm, Sweden
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Xie K, Zheng H, Li H, Zhang C, Li H, Jin H, Ma B. The Study of Effect for General Movements Assessment in the Diagnosis of Neurological Development Disorders: A Meta-Analysis. Clin Pediatr (Phila) 2016; 55:36-43. [PMID: 26130397 DOI: 10.1177/0009922815592878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To discuss the value of general movements assessment in predicting the neurological disorders. METHODS Using PubMed as the search engine, we searched to identify relevant studies in English and Chinese language published up to November 2014 and 19 studies were selected. Standard methods in meta-analyses were used to provide diagnostic accuracy by Meta-DiSc 1.4. RESULTS For non-cerebral palsy (non-CP) as outcome for writhing period, the results suggested a good sensitivity and a specificity of 0.74, the Q-value was 0.80. The area under the curve (AUC) was 0.87. For non-CP as outcome for fidgety period, the results suggested both high level for sensitivity and specificity. And the Q-value was 0.914, the AUC was 0.9664. For CP as outcome for writhing and fidgety periods, good sensitivity and specificity were found in the analysis, and the Q-value was 0.9034 while the AUC was 0.9592. CONCLUSION General movements assessment is a good predictor for diagnosing neurological disorders.
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Affiliation(s)
- Kegong Xie
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China
| | - Hong Zheng
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China
| | - Huawei Li
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China
| | - Chi Zhang
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China
| | - Hongbo Li
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China
| | - Hui Jin
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China
| | - Bingxiang Ma
- The First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, Henan Province, China
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Predictive Value of General Movement Assessment for Cerebral Palsy in Routine Clinical Practice. Phys Ther 2015; 95:1489-95. [PMID: 26023214 DOI: 10.2522/ptj.20140429] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 05/21/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Early identification of children at high risk of future neurodevelopmental disability is important for the initiation of appropriate therapy. In research settings, the assessment of fidgety movements (FMs) at 3 months supports a general movement assessment (GMA) as a strong predictor for subsequent motor development, but there are few studies from routine clinical settings. OBJECTIVE The study objective was to examine the relationship between FMs and neurodevelopmental outcome by the age of 2 years in high-risk infants in a routine hospital clinical setting. DESIGN This was a prospective study. METHODS A GMA was performed in 87 high-risk infants at 3 months after term age. The infants were clinically assessed for cerebral palsy (CP) at 2 years. Sensitivity, specificity, likelihood ratios, and positive and negative predictive values were computed. The relative risk of motor problems by the age of 2 years, according to the GMA, was estimated. RESULTS Of the infants with normal FMs, 93% (50/54) had normal development and none was diagnosed with CP, whereas 75% (12/16) with abnormal or sporadic FMs had normal development. In contrast, 53% (9/17) of those without FMs had CP. When the GMA was considered to be a test for CP and absent FMs were considered to be a positive test result, the sensitivity was 90% and the specificity was 90%. The likelihood ratios for positive and negative test results were 8.7 and 0.1, respectively. The negative predictive value was 99%, and the positive predictive value was 53%. The risk of motor problems by the age of 2 years increased linearly with the extent of pathological results on the GMA and was 10 times higher when FMs were absent at 3 months than when FMs were normal. LIMITATIONS The relatively small study sample was a study limitation. CONCLUSIONS When applied in a routine clinical setting, the GMA strongly predicted neurodevelopmental impairments at 2 years in high-risk infants.
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Zappella M, Einspieler C, Bartl-Pokorny KD, Krieber M, Coleman M, Bölte S, Marschik PB. What do home videos tell us about early motor and socio-communicative behaviours in children with autistic features during the second year of life--An exploratory study. Early Hum Dev 2015; 91:569-75. [PMID: 26246137 PMCID: PMC5951277 DOI: 10.1016/j.earlhumdev.2015.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 07/08/2015] [Accepted: 07/10/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about the first half year of life of individuals later diagnosed with autism spectrum disorders (ASD). There is even a complete lack of observations on the first 6 months of life of individuals with transient autistic behaviours who improved in their socio-communicative functions in the pre-school age. AIM To compare early development of individuals with transient autistic behaviours and those later diagnosed with ASD. STUDY DESIGN Exploratory study; retrospective home video analysis. SUBJECTS 18 males, videoed between birth and the age of 6 months (ten individuals later diagnosed with ASD; eight individuals who lost their autistic behaviours after the age of 3 and achieved age-adequate communicative abilities, albeit often accompanied by tics and attention deficit). METHOD The detailed video analysis focused on general movements (GMs), the concurrent motor repertoire, eye contact, responsive smiling, and pre-speech vocalisations. RESULTS Abnormal GMs were observed more frequently in infants later diagnosed with ASD, whereas all but one infant with transient autistic behaviours had normal GMs (p<0.05). Eye contact and responsive smiling were inconspicuous for all individuals. Cooing was not observable in six individuals across both groups. CONCLUSIONS GMs might be one of the markers which could assist the earlier identification of ASD. We recommend implementing the GM assessment in prospective studies on ASD.
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Affiliation(s)
| | - Christa Einspieler
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Graz, Austria.
| | - Katrin D Bartl-Pokorny
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Graz, Austria
| | - Magdalena Krieber
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Graz, Austria
| | - Mary Coleman
- Foundation for Autism Research, Inc., New York, NY, USA
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden; Child and Adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden
| | - Peter B Marschik
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Graz, Austria; Center of Neurodevelopmental Disorders (KIND), Department of Women's & Children's Health, Karolinska Institutet, Stockholm, Sweden
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Lev-Enacab O, Sher-Censor E, Einspieler C, Daube-Fishman G, Beni-Shrem S. The Quality of Spontaneous Movements of Preterm Infants: Associations with the Quality of Mother-Infant Interaction. INFANCY 2015. [DOI: 10.1111/infa.12096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Einspieler C, Yang H, Bartl-Pokorny KD, Chi X, Zang FF, Marschik PB, Guzzetta A, Ferrari F, Bos AF, Cioni G. Are sporadic fidgety movements as clinically relevant as is their absence? Early Hum Dev 2015; 91:247-52. [PMID: 25748086 PMCID: PMC5951271 DOI: 10.1016/j.earlhumdev.2015.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/05/2015] [Accepted: 02/10/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Infants with normal fidgety movements at 3 to 5 months after term are very likely to show neurologically normal development, while the absence of fidgety movements is an early marker for an adverse neurological outcome, mainly cerebral palsy (CP). The clinical significance of so-called sporadic fidgety movements (i.e., fidgety movements occur isolated in a few body parts and are of 1- to 3-second-duration) is not yet known. AIMS Our objective was to determine whether infants who had developed CP and had sporadic fidgety movements have a better outcome than infants who did not have fidgety movements. STUDY DESIGN Longitudinal study. Retrospective analysis of prospectively collected data. SUBJECTS 61 infants who developed CP (46 male, 15 female; 29 infants born preterm; videoed for the assessment of movements and postures at 9 to 16 weeks post-term age). OUTCOME MEASURES The Gross Motor Function Classification System (GMFCS) was applied at 3 to 5 years of age. RESULTS There was no difference between children diagnosed with CP who had sporadic fidgety movements at 9 to 16 weeks post-term age (n = 9) and those who never developed fidgety movements (n = 50) with regard to their functional mobility and activity limitation at 3 to 5 years of age. One infant had normal FMs and developed unilateral CP, GMFCS Level I; the remaining infant had abnormal FMs and developed bilateral CP, GMFCS Level II. CONCLUSIONS There is no evidence that the occurrence of occasional isolated fidgety bursts indicates a milder type of CP.
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Affiliation(s)
- Christa Einspieler
- Research Unit iDN, Interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria.
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, PR China
| | - Katrin D Bartl-Pokorny
- Research Unit iDN, Interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria
| | - Xia Chi
- Department of Pediatrics, Nanjing Maternity and Child Health Hospital, Nanjing Medical University, PR China
| | - Fei-Fei Zang
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, PR China
| | - Peter B Marschik
- Research Unit iDN, Interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria; Center of Neurodevelopmental Disorders, Karolinska Institutet, Stockholm, Sweden
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, University of Pisa, Italy; IRCCS Fondazione Stella Maris, Pisa, Italy
| | - Fabrizio Ferrari
- Dept. of Neonatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Arend F Bos
- Division of Neonatology, Beatrix Children's Hospital, University Medical Center, University of Groningen, The Netherlands
| | - Giovanni Cioni
- Department of Developmental Neuroscience, University of Pisa, Italy; IRCCS Fondazione Stella Maris, Pisa, Italy
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Marschik PB, Soloveichick M, Windpassinger C, Einspieler C. General movements in genetic disorders: A first look into Cornelia de Lange syndrome. Dev Neurorehabil 2015; 18:280-2. [PMID: 24304241 PMCID: PMC5951282 DOI: 10.3109/17518423.2013.859180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The assessment of General Movements (GMs), i.e. age-specific motor patterns during the first months of life, has repeatedly proven to be a valuable tool to predict neurodevelopmental outcomes. Abnormal spontaneous GMs were found to be among the most reliable markers for cerebral palsy. To add to the knowledge of the abnormal early motor repertoire we analysed prospectively collected video recordings of a boy clinically diagnosed with Cornelia de Lange syndrome. The observed atypical GMs are a further step to disentangle early motor peculiarities in the light of the genetic impact on the developing brain.
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Affiliation(s)
- Peter B Marschik
- Institute of Physiology (Research Unit iDN – interdisciplinary Developmental Neuroscience), Center for Physiological Medicine, Medical University of Graz, Austria
| | | | | | - Christa Einspieler
- Institute of Physiology (Research Unit iDN – interdisciplinary Developmental Neuroscience), Center for Physiological Medicine, Medical University of Graz, Austria
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Rihar A, Mihelj M, Kolar J, Pašič J, Munih M. Sensory data fusion of pressure mattress and wireless inertial magnetic measurement units. Med Biol Eng Comput 2014; 53:123-35. [PMID: 25367736 DOI: 10.1007/s11517-014-1217-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/20/2014] [Indexed: 11/28/2022]
Abstract
Head movement of infants is an important parameter for analysing infant motor patterns. Despite its importance, this field has received little sensory-based research in the past years. Therefore, we present a sensory-supported data fusion model for head movement analysis of infants in supine position. The sensory system comprises a pressure mattress and two wireless inertial magnetic measurement units, rendering precise, objective and non-intrusive information on pressure distribution and 3D trunk orientation, respectively. Algorithms first perform pressure data pre-processing and calculate image moments to acquire 2D trunk orientation. Afterwards, unscented Kalman filter is used for sensory data fusion. After additional data processing, head and trunk coordinates are calculated along with head displacement distance. The sensory system was tested on experimental measurements, performed in eight normally developing infants aged from 1 to 5 months. Results of several algorithm combinations were compared to referential video recordings in terms of head lifts. Combination of algorithms, incorporating head tracking and sensory data fusion provides completely accurate results in comparison to normative data. Statistical data analysis and referential optoelectronic measurements were performed to evaluate accuracy of the sensory fusion model. Suitability of the proposed sensory system for head movement analysis of infants in supine position was verified.
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Affiliation(s)
- Andraž Rihar
- Laboratory of Robotics, Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia,
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Einspieler C, Sigafoos J, Bölte S, Bratl-Pokorny KD, Landa R, Marschik PB. Highlighting the first 5 months of life: General movements in infants later diagnosed with autism spectrum disorder or Rett Syndrome. RESEARCH IN AUTISM SPECTRUM DISORDERS 2014; 8:286-291. [PMID: 29770159 PMCID: PMC5951269 DOI: 10.1016/j.rasd.2013.12.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We review literature identifying an association between motor abnormality in the first 5 months of infancy and later diagnosis of autism spectrum disorder (ASD) or Rett syndrome (RTT). The assessment of the quality of early spontaneous movements (also known as the assessment of general movements; GMs) is a diagnostic tool that has repeatedly proven to be valuable in detecting early markers for neurodevelopmental disorders. Even though the rate of occurrence of abnormal GMs is exceedingly high in infants later diagnosed with ASD, we endorse further studies using this method either based on family videos or its prospective implementation in high-risk sibling studies to evaluate the power of GM assessment as one potential marker for early maldevelopment in this cohort.
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Affiliation(s)
- Christa Einspieler
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria
| | - Jeff Sigafoos
- School of Educational Psychology, Victoria University of Wellington, New Zealand
| | - Sven Bölte
- Dept. of Women’s and Children’s Health, Center of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden
| | - Katrin D. Bratl-Pokorny
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria
| | - Rebecca Landa
- Kennedy Krieger Institute, Center for Autism and Related Disorders, Baltimore, USA
| | - Peter B. Marschik
- Research Unit iDN – interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria
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Johnson P, Ahamat B, Mcconnachie A, Puckering C, Marwick H, Furnivall D, Marwick R, Gillberg C, Heron J, Wilson P. Motor activity at age one year does not predict ADHD at seven years. Int J Methods Psychiatr Res 2014; 23:9-18. [PMID: 24496957 PMCID: PMC6878585 DOI: 10.1002/mpr.1436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/30/2012] [Accepted: 07/11/2012] [Indexed: 01/26/2023] Open
Abstract
We have examined the predictive utility of motor activity in infancy towards diagnosis of attention deficit hyperactivity disorder (ADHD) in later childhood. We conducted a nested case-control study using videos of infants in the Avon Longitudinal Study of Parents and Children (ALSPAC). Sixty videos of children who received any Development and Well-being Assessment (DAWBA) psychiatric diagnosis at age 91 months (including 16 with ADHD) plus two controls per case were selected for data analysis. Body movements were measured at age one year: associations between motor activity-derived variables using factor analysis, and later ADHD diagnoses were sought. No significant association was found between infant motor activity and later ADHD. A positive association between motor activity and inattentive ADHD was found in males. Motor activity at age one year did not predict ADHD at age seven years. The positive association with inattentive ADHD in males requires further investigation.
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Affiliation(s)
- Paul Johnson
- Robertson Centre for BiostatisticsUniversity of GlasgowGlasgowUK
| | - Boolang Ahamat
- Institute of Health and WellbeingUniversity of GlasgowRoyal Hospital for Sick ChildrenGlasgowUK
| | - Alex Mcconnachie
- Robertson Centre for BiostatisticsUniversity of GlasgowGlasgowUK
| | - Christine Puckering
- Institute of Health and WellbeingUniversity of GlasgowRoyal Hospital for Sick ChildrenGlasgowUK
| | - Helen Marwick
- National Centre for Autism StudiesUniversity of StrathclydeGlasgowUK
| | - Daniel Furnivall
- Institute of Health and WellbeingUniversity of GlasgowRoyal Hospital for Sick ChildrenGlasgowUK
| | - Robbie Marwick
- Institute of Health and WellbeingUniversity of GlasgowRoyal Hospital for Sick ChildrenGlasgowUK
| | - Christopher Gillberg
- Institute of Health and WellbeingUniversity of GlasgowRoyal Hospital for Sick ChildrenGlasgowUK
| | - Jon Heron
- School of Social and Community MedicineBristolUK
| | - Philip Wilson
- Institute of Health and WellbeingUniversity of GlasgowRoyal Hospital for Sick ChildrenGlasgowUK
- Centre for Rural HealthUniversity of AberdeenUK
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Intra-uterine exposure to maternal opiate abuse and HIV: the impact on the developing nervous system. Early Hum Dev 2013; 89:229-35. [PMID: 23490656 DOI: 10.1016/j.earlhumdev.2013.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 02/08/2013] [Accepted: 02/15/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Both intra-uterine exposure to maternal drugs and HIV are known to adversely affect the developing central nervous system. AIMS (1) To describe the quality of GMs in infants who were intra-uterinely exposed to maternal opiate abuse and HIV; and (2) to analyze to what extent (a) perinatal events, (b) status of HIV-infection, and (c) the quality of GMs are associated with the neurodevelopmental outcome at 2 to 3years of age. PATIENTS AND METHOD Seventy-seven children intra-uterinely exposed to both maternal opiate abuse and HIV in utero (41 boys and 36 girls; 39 born preterm) were videoed twice: first during the first 2months after term (writhing GMs) and again at 3-5months (fidgety GMs). Neurodevelopmental outcome was assessed at 2-3years of age. RESULTS Thirty-eight infants showed abnormal writhing GMs; 25 infants had abnormal or absent fidgety movements; 22 children had an adverse neurodevelopmental outcome. The association between GM trajectories and outcome revealed a Cramer-V=0.75 (p<0.001). Those infants with active HIV-infection (n=10) did not differ from the 67 infants who were HIV-exposed but uninfected with respect to their GM quality or outcome. CONCLUSIONS Serial assessment of GMs in infants who were intra-uterinely exposed to maternal opiates and to HIV can be utilized for early identification of infants at a higher risk for later deficits and needing early intervention.
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Einspieler C, Hirota H, Yuge M, Dejima S, Marschik PB. Early behavioural manifestation of Smith-Magenis syndrome (del 17p11.2) in a 4-month-old boy. Dev Neurorehabil 2012; 15:313-6. [PMID: 22724898 DOI: 10.3109/17518423.2011.654281] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There is little systematic data on early neurodevelopmental functioning of infants with Smith-Magenis syndrome, since early diagnosis is rare. METHODS A boy with cytogenetically confirmed Smith-Magenis syndrome was videotaped at 4 months and 1 week of age. His posture and spontaneous movements were analysed without knowing the diagnosis. RESULTS The motor repertoire appeared significantly reduced; fidgety general movements, which are typical of that age, were missing. Posture was abnormal and overall movements were jerky and monotonous. The findings indicate a severe motor impairment by no more than 4 months of age. CONCLUSION It was concluded that an absence of fidgety movements that goes along with subtle dysmorphic features indicates an increased risk of maldevelopment and justifies the need to refer for genetic evaluation with the potential of facilitating earlier diagnosis.
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Affiliation(s)
- Christa Einspieler
- Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Austria.
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Einspieler C, Marschik PB, Bos AF, Ferrari F, Cioni G, Prechtl HFR. Early markers for cerebral palsy: insights from the assessment of general movements. FUTURE NEUROLOGY 2012. [DOI: 10.2217/fnl.12.60] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Overt clinical symptoms of cerebral palsy do not emerge before a child is at least half a year old. Among the most reliable early markers for cerebral palsy are abnormal ‘general movements’ (GMs). Two specific abnormal GM patterns predict cerebral palsy: cramped-synchronized GMs (during preterm and term age), which lack the usual smoothness and fluent character; and limb and trunk muscles contract almost simultaneously and relax almost simultaneously. In addition, the absence of so-called fidgety movements at 3–5 months post-term age. Fidgety movements are small movements of the neck, trunk and limbs in all directions and of variable acceleration. Beside a high sensitivity (>91%) and specificity (>81%), the assessment of GMs is quick, nonintrusive and easy to acquire.
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Affiliation(s)
- Christa Einspieler
- Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21, A - 8010 Graz, Austria
| | - Peter B Marschik
- Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21, A - 8010 Graz, Austria
- Center for Genetic Disorders of Cognition & Behavior, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Arend F Bos
- Division of Neonatology, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit & Neonatology Department, Department of Maternal & Infantile Medicine, University Hospital Modena, Italy
| | - Giovanni Cioni
- Division of Child Neurology & Psychiatry, University of Pisa & IRCCS Stella Maris, Italy
| | - Heinz FR Prechtl
- Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21, A - 8010 Graz, Austria
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Yang H, Einspieler C, Shi W, Marschik PB, Wang Y, Cao Y, Li H, Liao YG, Shao XM. Cerebral palsy in children: movements and postures during early infancy, dependent on preterm vs. full term birth. Early Hum Dev 2012; 88:837-43. [PMID: 22795821 PMCID: PMC3437561 DOI: 10.1016/j.earlhumdev.2012.06.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/15/2012] [Accepted: 06/19/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND A deviant motor behaviour at age 3 to 5 months is predictive of cerebral palsy (CP). Particular features of the early motor repertoire even proved predictive of the degree of functional limitations as classified on the Gross Motor Function Classification System (GMFCS) in children with CP, born preterm. AIMS We aimed to determine whether an association between the early motor repertoire and the GMFCS also holds true for children born at term. STUDY DESIGN Longitudinal study. SUBJECTS 79 infants (60 boys and 19 girls; 47 infants born at term; video recorded for the assessment of movements and posture at age 9 to 20 weeks postterm age) who developed CP. OUTCOME MEASURES The GMFCS was applied at age 2 to 5 years. RESULTS Motor optimality at age 3 to 5 months showed a significant correlation with functional mobility and activity limitation as classified on the GMFCS at age 2 to 5 years in both children born at term (Spearman rho=-0.66, p<0.001) and born preterm (rho=-0.37, p<0.05). Infants born preterm were more likely to show normal movement patterns than infants born at term. A normal posture and an abnormal, jerky (yet not monotonous) movement character resulted in better levels of function and mobility. With the exception of one, none of the infants showed fidgety movements. A cramped-synchronised movement character, repetitive opening and closing of the mouth, and abnormal finger postures characterised children who would show a poor self-mobility later. CONCLUSIONS Assessing the quality of motor performance at 9 to 20 weeks postterm age (irrespective of the gestational age) improves our ability to predict later functional limitations in children with CP.
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Affiliation(s)
- Hong Yang
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, PR China
| | - Christa Einspieler
- Institute of Physiology (Developmental Physiology and Developmental Neurology), Center for Physiological Medicine, Medical University of Graz, Austria,Corresponding author at: Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria. Tel.: + 43 316 380 4266; fax: + 43 316 380 9630.
| | - Wei Shi
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, PR China
| | - Peter B. Marschik
- Institute of Physiology (Developmental Physiology and Developmental Neurology), Center for Physiological Medicine, Medical University of Graz, Austria,Center for Genetic Disorders of Cognition and Behavior, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, PR China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, PR China
| | - Hui Li
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, PR China
| | - Yuan-Gui Liao
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, PR China
| | - Xiao-Mei Shao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, PR China
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