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Santos-Baltuilhe S, Mallmann GS, França ALN, Azambuja KCO, Andrade PHM, Oliveira EF, Soares-Marangoni DA. Motor repertoire in 3- to 5- month-old infants with prenatal exposure to syphilis and toxoplasmosis. Early Hum Dev 2023; 183:105822. [PMID: 37454445 DOI: 10.1016/j.earlhumdev.2023.105822] [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: 05/25/2023] [Revised: 07/07/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
AIM To characterize the motor repertoire of 3- to 5-month-old infants who were prenatally exposed to the infectious agents of syphilis and toxoplasmosis. METHODS Exploratory observational study that evaluated 15 exposed infants (34.4 ± 3.5 weeks gestation) recruited from a referral center. Age assessment ranged 12-20 (median 12) weeks post-term. General Movement Assessment, including the Motor Optimality Score-Revised (MOS-R), was used to assess the global quality of fidgety movements (FMs) and to quantify and detail coexisting motor patterns. Clinical variables were also collected. Later motor outcomes were obtained from medical reports when possible. RESULTS MOS-R ranged 10-26 (median 24). There was a higher proportion of infants with normal (80.0 %) than aberrant FMs, but the proportion of infants with reduced MOS-R (80.0 %) was higher compared to optimal MOS-R. One infant with aberrant FMs was later diagnosed with cerebral palsy. Only 13.3 % of the infants showed smooth and fluent movement character. All observed tongue movements were abnormal. CONCLUSION Infants had predominantly normal FMs, but with reduced MOS-R and abnormalities in the coexisting motor repertoire.
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Affiliation(s)
- Sarita Santos-Baltuilhe
- Graduate Program in Movement Sciences, Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil; Specialized Rehabilitation Center, Association of Parents and Friends of Exceptional Children, Campo Grande, MS, Brazil
| | - Geruza Souza Mallmann
- Graduate Program in Movement Sciences, Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Andressa Lagoa Nascimento França
- Graduate Program in Health and Development, Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Paulo Henrique Muleta Andrade
- Specialized Rehabilitation Center, Association of Parents and Friends of Exceptional Children, Campo Grande, MS, Brazil
| | - Everton Falcão Oliveira
- Graduate Program in Infectious and Parasitic Diseases, Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | - Daniele Almeida Soares-Marangoni
- Graduate Program in Movement Sciences, Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil; Graduate Program in Health and Development, Faculty of Medicine, Federal University of Mato Grosso do Sul, Campo Grande, MS, Brazil.
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Marschik-Zhang D, Wang J, Shen X, Zhu X, Gao H, Yang H, Marschik PB. Building Blocks for Deep Phenotyping in Infancy: A Use Case Comparing Spontaneous Neuromotor Functions in Prader-Willi Syndrome and Cerebral Palsy. J Clin Med 2023; 12:784. [PMID: 36769434 PMCID: PMC9917638 DOI: 10.3390/jcm12030784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
With the increasing worldwide application of the Prechtl general movements assessment (GMA) beyond its original field of the early prediction of cerebral palsy (CP), substantial knowledge has been gained on early neuromotor repertoires across a broad spectrum of diagnostic groups. Here, we aimed to profile the neuromotor functions of infants with Prader-Willi syndrome (PWS) and to compare them with two other matched groups. One group included infants with CP; the other included patients who were treated at the same clinic and turned out to have inconspicuous developmental outcomes (IOs). The detailed GMA, i.e., the motor optimality score-revised (MOS-R), was used to prospectively assess the infants' (N = 54) movements. We underwent cross-condition comparisons to characterise both within-group similarities and variations and between-group distinctions and overlaps in infants' neuromotor functions. Although infants in both the PWS and the CP groups scored similarly low on MOS-R, their motor patterns were different. Frog-leg and mantis-hand postures were frequently seen in the PWS group. However, a PWS-specific general movements pattern was not observed. We highlight that pursuing in-depth knowledge within and beyond the motor domain in different groups has the potential to better understand different conditions, improve accurate diagnosis and individualised therapy, and contribute to deep phenotyping for precision medicine.
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Affiliation(s)
- Dajie Marschik-Zhang
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
- Leibniz Science Campus Primate Cognition, 37077 Göttingen, Germany
- iDN—Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
| | - Jun Wang
- Department of Rehabilitation, Children’s Hospital, Fudan University, Shanghai 201102, China
| | - Xiushu Shen
- Department of Rehabilitation, Children’s Hospital, Fudan University, Shanghai 201102, China
| | - Xiaoyun Zhu
- Department of Rehabilitation, Children’s Hospital, Fudan University, Shanghai 201102, China
| | - Herong Gao
- Department of Rehabilitation, Children’s Hospital, Fudan University, Shanghai 201102, China
| | - Hong Yang
- Department of Rehabilitation, Children’s Hospital, Fudan University, Shanghai 201102, China
| | - Peter B. Marschik
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, 37075 Göttingen, Germany
- Leibniz Science Campus Primate Cognition, 37077 Göttingen, Germany
- iDN—Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Child and Adolescent Psychiatry, Region Stockholm, Karolinska Institutet & Stockholm Health Care Services, 17176 Stockholm, Sweden
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The trajectory of general movements from birth until 12 - 14 weeks corrected age in very low birthweight and extremely low-birthweight infants born preterm. SOUTH AFRICAN JOURNAL OF CHILD HEALTH 2022. [DOI: 10.7196/sajch.2022.v16i2.1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background. General movement assessment (GMA) is an assessment tool with high predictive validity for neurodevelopmental outcomes in preterm infants. Information available describing the trajectory of general movements (GMs) in high-risk preterm-born infants and the use thereof in low- and middle-income countries is limited.
Objective. To describe the trajectories of GMs from birth until 12 - 14 weeks’ corrected age, and determine the association of known perinatal risk factors on GM trajectories in very low-birthweight and extremely low-birthweight preterm infants.
Methods. This was a longitudinal, prospective cohort study with 119 preterm infants born at <33 weeks’ gestation and with a birthweight <1 500 g. GMs were recorded at four key age periods: 1 - 2 weeks after birth to 33 weeks post menstrual age (PMA); 34 - 37 weeks PMA; term equivalent age (TEA); and 12 - 14 weeks corrected age. Detailed perinatal data were collected.
Results. A total of 300 GMAs were conducted, 157 during the preterm age, 55 during TEA and 88 at 12 - 14 weeks corrected age. At <33 weeks PMA, 96% of GMs were abnormal and 4% normal. At 34 - 37 weeks PMA, 89% of GMs were abnormal and 11% normal. All GMs recorded at term equivalent age were abnormal. At 12 - 14 weeks corrected age, 7% of GMs were abnormal and 93% normal.
Conclusion. GMs were predominantly abnormal prior to term with a significant decrease in abnormality at 12 - 14 weeks corrected age. Lower birthweight and lower PMA were associated with increased odds for abnormal GMs. In a resource-constrained environment, observing GMs at 12 - 14 weeks corrected age (during the fidgety period) is a time- and cost-effective method to determine the risk for adverse neurodevelopment.
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Burger M, Einspieler C, Jordaan ER, Unger M, Niehaus DJH. Early motor behavior of infants exposed to maternal mental health disorders - A South African perspective. Early Hum Dev 2022; 168:105572. [PMID: 35461052 DOI: 10.1016/j.earlhumdev.2022.105572] [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: 07/21/2021] [Revised: 01/20/2022] [Accepted: 04/11/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Over the past five decades the bulk of research on exposure to maternal mental health disorders and infant neurodevelopment has been generated in high-income countries. The current study included infants, residing in low-income communities in South Africa, born to mothers with a history of psychiatric disorders. AIM To assess the motor behavior of 10- to 20-week-old infants exposed to maternal mental health disorders, and a subgroup of infants with prenatal psychotropic medication exposure. METHODS The present study is a cross-sectional descriptive study, with a longitudinal subgroup analysis. General Movement Assessment (GMA), including the Motor Optimality Score-Revised (MOS-R), was used at 10-20 weeks corrected age to assess infant motor behavior. RESULTS The study included 112 infants. No significant difference (p = 0.523) was found on the MOS-R between infants exposed to maternal mental health disorders (n = 70) and the comparison group (n = 42). Both the exposed and comparison groups scored within the mildly reduced range on the MOS-R. No significant differences were found in a subgroup of infants with prenatal exposure to multi-class psychotropic medication (n = 17), mono-class psychotropic medication (n = 35) or valproate exposure (n = 10) (p > 0.1). CONCLUSION No association was found between exposure to maternal mental health disorders or exposure to psychotropic medication and infant motor behavior at 10-20 weeks post-term age on the MOS-R. Future research should focus on the contribution of exposure to specific classes and types of psychotropic medication on neurodevelopmental outcome of infants in larger cohorts.
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Affiliation(s)
- Marlette Burger
- Physiotherapy Division, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa.
| | - Christa Einspieler
- Research Unit iDN - Interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Esme R Jordaan
- Biostatistics Unit, South African Medical Research Council, Parow, South Africa; Statistics and Population Studies, University of the Western Cape, Cape Town, Western Cape, South Africa
| | - Marianne Unger
- Physiotherapy Division, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Dana J H Niehaus
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
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Reich S, Zhang D, Kulvicius T, Bölte S, Nielsen-Saines K, Pokorny FB, Peharz R, Poustka L, Wörgötter F, Einspieler C, Marschik PB. Novel AI driven approach to classify infant motor functions. Sci Rep 2021; 11:9888. [PMID: 33972661 PMCID: PMC8110753 DOI: 10.1038/s41598-021-89347-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/12/2021] [Indexed: 02/02/2023] Open
Abstract
The past decade has evinced a boom of computer-based approaches to aid movement assessment in early infancy. Increasing interests have been dedicated to develop AI driven approaches to complement the classic Prechtl general movements assessment (GMA). This study proposes a novel machine learning algorithm to detect an age-specific movement pattern, the fidgety movements (FMs), in a prospectively collected sample of typically developing infants. Participants were recorded using a passive, single camera RGB video stream. The dataset of 2800 five-second snippets was annotated by two well-trained and experienced GMA assessors, with excellent inter- and intra-rater reliabilities. Using OpenPose, the infant full pose was recovered from the video stream in the form of a 25-points skeleton. This skeleton was used as input vector for a shallow multilayer neural network (SMNN). An ablation study was performed to justify the network's architecture and hyperparameters. We show for the first time that the SMNN is sufficient to discriminate fidgety from non-fidgety movements in a sample of age-specific typical movements with a classification accuracy of 88%. The computer-based solutions will complement original GMA to consistently perform accurate and efficient screening and diagnosis that may become universally accessible in daily clinical practice in the future.
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Affiliation(s)
- Simon Reich
- University Medical Center Göttingen, Child and Adolescent Psychiatry and Psychotherapy, 37075, Göttingen, Germany
| | - Dajie Zhang
- University Medical Center Göttingen, Child and Adolescent Psychiatry and Psychotherapy, 37075, Göttingen, Germany
- Division of Phoniatrics, Research Unit interdisciplinary Developmental Neuroscience, Medical University of Graz, 8036, Graz, Austria
- Leibniz ScienceCampus Primate Cognition, 37075, Göttingen, Germany
| | - Tomas Kulvicius
- University Medical Center Göttingen, Child and Adolescent Psychiatry and Psychotherapy, 37075, Göttingen, Germany
- Georg-August University Göttingen, Third Institute of Physics-Biophysics, 37077, Göttingen, Germany
| | - Sven Bölte
- Department of Women's and Children's Health, Karolinska Institutet, Center of Neurodevelopmental Disorders (KIND), 113 30, Stockholm, Sweden
| | - Karin Nielsen-Saines
- University of California, David Geffen School of Medicine, Los Angeles, CA, 90095, USA
| | - Florian B Pokorny
- Division of Phoniatrics, Research Unit interdisciplinary Developmental Neuroscience, Medical University of Graz, 8036, Graz, Austria
- University of Augsburg, EIHW-Chair of Embedded Intelligence for Health Care and Wellbeing, 86159, Augsburg, Germany
| | - Robert Peharz
- Department of Mathematics and Computer Science, Eindhoven University of Technology, 5600 MB, Eindhoven, The Netherlands
| | - Luise Poustka
- University Medical Center Göttingen, Child and Adolescent Psychiatry and Psychotherapy, 37075, Göttingen, Germany
- Leibniz ScienceCampus Primate Cognition, 37075, Göttingen, Germany
| | - Florentin Wörgötter
- Leibniz ScienceCampus Primate Cognition, 37075, Göttingen, Germany
- Georg-August University Göttingen, Third Institute of Physics-Biophysics, 37077, Göttingen, Germany
| | - Christa Einspieler
- Division of Phoniatrics, Research Unit interdisciplinary Developmental Neuroscience, Medical University of Graz, 8036, Graz, Austria
| | - Peter B Marschik
- University Medical Center Göttingen, Child and Adolescent Psychiatry and Psychotherapy, 37075, Göttingen, Germany.
- Division of Phoniatrics, Research Unit interdisciplinary Developmental Neuroscience, Medical University of Graz, 8036, Graz, Austria.
- Leibniz ScienceCampus Primate Cognition, 37075, Göttingen, Germany.
- Department of Women's and Children's Health, Karolinska Institutet, Center of Neurodevelopmental Disorders (KIND), 113 30, Stockholm, Sweden.
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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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Fjørtoft T, Brandal M, Brubakk AM, Adde L, Ustad T, Vågen R, Evensen KAI. Maternal alcohol and drug use during pregnancy affects the motor behaviour and general movements of infants aged 3-4 months. Early Hum Dev 2020; 151:105171. [PMID: 32977207 DOI: 10.1016/j.earlhumdev.2020.105171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/24/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Exposure of alcohol and/or other addictive drugs in pregnancy is a documented risk factor for later neurological impairment. AIMS The aim of the study was to determine whether infants suffering from prenatal exposure to addictive drugs and alcohol develop an abnormal motor behaviour at three to four months of age. STUDY DESIGN Controlled cohort study of infants exposed to alcohol and/or other addictive drugs in pregnancy who were recruited from a hospital follow-up programme. The control group consisted of healthy, unexposed infants. SUBJECTS The study group of 108 infants exposed to alcohol and/or addictive drugs in pregnancy were enrolled based on referrals from primary health care. The control group included 106 infants who had not been exposed to the aforementioned substances. OUTCOME MEASURES We assessed the general movements (Prechtl's General-Movement-Assessment, GMA), the motor repertoire (Assessment-of-Motor-Repertoire, AMR), and the Alberta-Infant Motor-Scale (AIMS) in all infants at three to four months of age. RESULTS None of the infants in either group had absent fidgety movements (FMs). In the study group 5(5%) had exaggerated FMs and 5(5%) had sporadic FMs; and 68(63%) infants in the study group displayed an abnormal movement character, compared to 23(22%) in the control group (p<0.001). On the AIMS, 46(44%) infants in the study group scored below the 10th percentile, compared to 2(3%) controls (p< 0.001). CONCLUSION The study describes an abnormal movement character of infants exposed to alcohol and/or addictive drugs in pregnancy when their motor repertoire was assessed at three to four months of age. The AIMS also showed negative effects on their motor behaviour.
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Affiliation(s)
- T Fjørtoft
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
| | - M Brandal
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - A M Brubakk
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pediatrics, St. Olav's Hospital, Trondheim University Hospital, Norway
| | - L Adde
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - T Ustad
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - R Vågen
- Clinic of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - K A I Evensen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Department of Public Health and Nursing, Norwegian University of Science and Technology, Norway; Unit for Physiotherapy Services, Trondheim Municipality, Norway; Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
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Nunes SF, Chiquetti EMDS, Moraes ABD, Souza APRD. Avaliação dos Movimentos Gerais de Prechtl (GMA) na detecção precoce de risco ao desenvolvimento. FISIOTERAPIA E PESQUISA 2020. [DOI: 10.1590/1809-2950/19008427042020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Verificar a relação entre a avaliação dos movimentos gerais (General Movements Assessment - GMA) com as variáveis obstétricas (aleitamento materno, intercorrência na gestação, medicação na gestação, álcool na gestação, fumo na gestação, intercorrência ao nascer, necessidade de internação em UTI neonatal e necessidade de ventilação mecânica), a presença de risco psíquico e o desfecho no desenvolvimento da linguagem, cognitivo e motor aos 18 e 24 meses. A amostra foi composta por 42 bebês, que foram filmados até a faixa etária de quatro meses, em movimentação espontânea por 15 minutos. Os movimentos gerais foram avaliados por vídeos usando a avaliação qualitativa de Prechtl e classificados como normais ou anormais dependendo da presença de fluência, complexidade e variabilidade. Os dados foram analisados estatisticamente em sua relação com variáveis obstétricas e com a presença de risco psíquico, avaliada por meio dos Sinais PREAUT, dos indicadores clínicos de risco ao desenvolvimento e do M-CHAT. Verificou-se que não houve associação entre o método GMA e as variáveis analisadas. Acredita-se que, pelo fato de a amostra ter sido composta, em sua maioria, por bebês nascidos a termo ou prematuros tardios sem intercorrências e de a avaliação ter sido de forma transversal, em um único momento, não foi possível analisar se os movimentos avaliados como anormais foram ou não transitórios. A alteração dos movimentos por meio do método Prechtl não apresentou associação com as variáveis analisadas na amostra de bebês prematuros tardios e nascidos a termo.
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Tackling the challenges of perinatal HIV infection as a cause of developmental regression. Neurosci Biobehav Rev 2019; 105:81-82. [PMID: 31377217 DOI: 10.1016/j.neubiorev.2019.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/15/2019] [Accepted: 07/31/2019] [Indexed: 11/23/2022]
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10
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McCarty DB, Peat JR, O'Donnell S, Graham E, Malcolm WF. "Choose Physical Therapy" for Neonatal Abstinence Syndrome: Clinical Management for Infants Affected by the Opioid Crisis. Phys Ther 2019; 99:771-785. [PMID: 31155664 DOI: 10.1093/ptj/pzz039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 02/13/2019] [Indexed: 11/14/2022]
Abstract
In response to the opioid crisis, the American Physical Therapy Association has strongly advocated for physical therapy as a safe alternative to pharmacological pain management through the "#ChoosePT" campaign and the dedication of a PTJ special issue to the nonpharmacological management of pain. Physical therapists not only play an important role in the rehabilitation of the nearly 2 million adolescents and adults addicted to prescription opioids but also provide care to infants born to mothers with various drug addictions. This Perspective article explores the incidence, pathophysiology, and risk factors for neonatal abstinence syndrome and describes the clinical presentations of withdrawal and neurotoxicity in infants. Discipline-specific recommendations for the physical therapist examination and plan of care, including pharmacological management considerations, are outlined. Nonpharmacological management, including supportive care, feeding, parent education, social aspects of care, and follow-up services, are discussed from a physical therapy perspective. Finally, this article reviews developmental outcomes in infants with neonatal abstinence syndrome and reflects on challenges and future directions of research in this area.
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Affiliation(s)
- Dana B McCarty
- Division of Physical Therapy, The University of North Carolina at Chapel Hill, 3044 Bondurant Hall, CB#7135, Chapel Hill, NC 27599 (USA)
| | - Jennifer R Peat
- Department of Physical Therapy, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Shannon O'Donnell
- Department of Physical and Occupational Therapy, Duke University Medical Center, Durham, North Carolina
| | - Elisabeth Graham
- Department of Physical and Occupational Therapy, Duke University Medical Center
| | - William F Malcolm
- Department of Pediatrics/Neonatology, Duke University Medical Center
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Einspieler C, Utsch F, Brasil P, Panvequio Aizawa CY, Peyton C, Hydee Hasue R, Françoso Genovesi F, Damasceno L, Moreira ME, Adachi K, Marschik PB, Nielsen-Saines K. Association of Infants Exposed to Prenatal Zika Virus Infection With Their Clinical, Neurologic, and Developmental Status Evaluated via the General Movement Assessment Tool. JAMA Netw Open 2019; 2:e187235. [PMID: 30657537 PMCID: PMC6431234 DOI: 10.1001/jamanetworkopen.2018.7235] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
IMPORTANCE There is an urgent need to assess neurodevelopment in Zika virus (ZIKV)-exposed infants. OBJECTIVES To perform general movement assessment (GMA) at 9 to 20 weeks' postterm age and to evaluate whether the findings are associated with neurodevelopmental outcomes at age 12 months in infants prenatally exposed to acute maternal illness with rash in Brazil during the ZIKV outbreak and in age-matched controls. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, infants prenatally exposed to acute maternal illness with rash were recruited at medical institutions in Rio de Janeiro and Belo Horizonte, Brazil, from February 1, 2016, to April 30, 2017, while infants without any exposure to maternal illness originated from the Graz University Audiovisual Research Database for the Interdisciplinary Analysis of Neurodevelopment. Participants were 444 infants, including 76 infants without congenital microcephaly, 35 infants with microcephaly, and 333 neurotypical children matched for sex, gestational age at birth, and age at GMA. MAIN OUTCOMES AND MEASURES General movement assessment performed at 9 to 20 weeks' postterm age, with negative predictive value, positive predictive value, sensitivity, and specificity generated, as well as clinical, neurologic, and developmental status (Bayley Scales of Infant and Toddler Development, Third Edition [Bayley-III] scores) at age 12 months. Motor Optimality Scores were generated based on the overall quality of the motor repertoire. Adverse outcomes were defined as a Bayley-III score less than 2 SD in at least 1 domain, a score less than 1 SD in at least 2 domains, and/or atypical neurologic findings. RESULTS A total of 444 infants were enrolled, including 111 children prenatally exposed to a maternal illness with rash and 333 children without any prenatal exposure to maternal illness (57.7% male and mean [SD] age, 14 [2] weeks for both groups); 82.1% (46 of 56) of ZIKV-exposed infants without congenital microcephaly were healthy at age 12 months. Forty-four of 46 infants were correctly identified by GMA at 3 months, with a negative predictive value of 94% (95% CI, 85%-97%). Seven of 10 ZIKV-exposed children without microcephaly with adverse neurodevelopmental outcomes were identified by GMA. The GMA positive predictive value was 78% (95% CI, 46%-94%), sensitivity was 70% (95% CI, 35%-93%), specificity was 96% (95% CI, 85%-99%), and accuracy was 91% (95% CI, 80%-97%). Children with microcephaly had bilateral spastic cerebral palsy; none had normal movements. The Motor Optimality Score differentiated outcomes: the median Motor Optimality Score was 23 (interquartile range [IQR], 21-26) in children with normal development, 12 (IQR, 8-19) in children with adverse outcomes, and 5 (IQR, 5-6) in children with microcephaly, a significant difference (P = .001). CONCLUSIONS AND RELEVANCE This study suggests that although a large proportion of ZIKV-exposed infants without microcephaly develop normally, many do not. The GMA should be incorporated into routine infant assessments to enable early entry into targeted treatment programs.
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Affiliation(s)
- Christa Einspieler
- Interdisciplinary Developmental Neuroscience–iDN, Medical University of Graz, Graz, Austria
| | - Fabiana Utsch
- Rede SARAH de Hospitais de Reabilitação, Reabilitação Infantil, Belo Horizonte, Brazil
| | - Patricia Brasil
- Laboratorio de Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Carolina Y. Panvequio Aizawa
- Department of Physical Therapy, Communication Sciences & Disorders, and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Science, Northwestern University, Chicago, Illinois
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Renata Hydee Hasue
- Department of Physical Therapy, Communication Sciences & Disorders, and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Fernanda Françoso Genovesi
- Department of Physical Therapy, Communication Sciences & Disorders, and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Luana Damasceno
- Laboratorio de Doenças Febris Agudas, Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | | | - Kristina Adachi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
| | - Peter B. Marschik
- Interdisciplinary Developmental Neuroscience–iDN, Medical University of Graz, Graz, Austria
- Interdisciplinary Developmental Neuroscience–iDN, Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
- Center of Neurodevelopmental Disorders (KIND), Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Karin Nielsen-Saines
- Division of Pediatric Infectious Diseases, Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles
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Soares-Marangoni DDA, Tedesco NM, Nascimento AL, Almeida PRD, Santos Pereira CND. General movements and motor outcomes in two infants exposed to Zika virus: brief report. Dev Neurorehabil 2019; 22:71-74. [PMID: 29452026 DOI: 10.1080/17518423.2018.1437843] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We described the general movements (GMs) in the fidgety period and the motor performance of two infants who were exposed to Zika virus (ZIKV) during distinct trimesters of gestation. METHODS Infants were assessed at 4 and 12 months of age. Prechtl's GM assessment and the Alberta Infant Motor Scale were used. RESULTS In Case 1, the mother presented confirmed ZIKV infection in the 10th week of gestation and the infant was born full-term with brain abnormalities and microcephaly. Fidgety movements were absent at 16 weeks after term and motor development was severely impaired at 12 months of age. In Case 2, the mother presented confirmed ZIKV infection in the 34th week of gestation and the infant was born full-term with no signs of brain changes or microcephaly. Fidgety movements at 13 weeks were normal in presentation and motor outcome was typical at 12 months. CONCLUSION GM assessment can be useful for ZIKV-exposed infants. These findings represent the first information on GMs and long-term motor outcomes in ZIKV-exposed infants.
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Affiliation(s)
| | - Natália Matos Tedesco
- b Program of Post-Graduation in Health and Development , Faculty of Medicine, UFMS , Campo Grande , Brazil
| | - Andressa Lagoa Nascimento
- b Program of Post-Graduation in Health and Development , Faculty of Medicine, UFMS , Campo Grande , Brazil
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Marschik PB, Pokorny FB, Peharz R, Zhang D, O'Muircheartaigh J, Roeyers H, Bölte S, Spittle AJ, Urlesberger B, Schuller B, Poustka L, Ozonoff S, Pernkopf F, Pock T, Tammimies K, Enzinger C, Krieber M, Tomantschger I, Bartl-Pokorny KD, Sigafoos J, Roche L, Esposito G, Gugatschka M, Nielsen-Saines K, Einspieler C, Kaufmann WE. A Novel Way to Measure and Predict Development: A Heuristic Approach to Facilitate the Early Detection of Neurodevelopmental Disorders. Curr Neurol Neurosci Rep 2017; 17:43. [PMID: 28390033 PMCID: PMC5384955 DOI: 10.1007/s11910-017-0748-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Substantial research exists focusing on the various aspects and domains of early human development. However, there is a clear blind spot in early postnatal development when dealing with neurodevelopmental disorders, especially those that manifest themselves clinically only in late infancy or even in childhood. RECENT FINDINGS This early developmental period may represent an important timeframe to study these disorders but has historically received far less research attention. We believe that only a comprehensive interdisciplinary approach will enable us to detect and delineate specific parameters for specific neurodevelopmental disorders at a very early age to improve early detection/diagnosis, enable prospective studies and eventually facilitate randomised trials of early intervention. In this article, we propose a dynamic framework for characterising neurofunctional biomarkers associated with specific disorders in the development of infants and children. We have named this automated detection 'Fingerprint Model', suggesting one possible approach to accurately and early identify neurodevelopmental disorders.
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Affiliation(s)
- Peter B Marschik
- Research Unit iDN-interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, 8010, Graz, Austria.
- Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
- BEE-PRI: Brain, Ears & Eyes-Pattern Recognition Initiative, BioTechMed-Graz, Graz, Austria.
| | - Florian B Pokorny
- Research Unit iDN-interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, 8010, Graz, Austria
- BEE-PRI: Brain, Ears & Eyes-Pattern Recognition Initiative, BioTechMed-Graz, Graz, Austria
- Machine Intelligence & Signal Processing group, MMK, Technische Universität München, Munich, Germany
| | - Robert Peharz
- Research Unit iDN-interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, 8010, Graz, Austria
- BEE-PRI: Brain, Ears & Eyes-Pattern Recognition Initiative, BioTechMed-Graz, Graz, Austria
| | - Dajie Zhang
- Research Unit iDN-interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, 8010, Graz, Austria
| | - Jonathan O'Muircheartaigh
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, St. Thomas' Hospital, King's College London, London, UK
| | - Herbert Roeyers
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Sven Bölte
- Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry, Center of Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - Alicia J Spittle
- University of Melbourne, Melbourne, Australia
- Murdoch Childrens Research Institute, Melbourne, Australia
- The Royal Women's Hospital, Melbourne, Australia
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Björn Schuller
- Chair of Complex and Intelligent Systems, University of Passau, Passau, Germany
- Machine Learning Group, Imperial College London, London, UK
| | - Luise Poustka
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Sally Ozonoff
- MIND Institute, Davis Health System, University of California, Sacramento, CA, USA
| | - Franz Pernkopf
- Signal Processing and Speech Communication Laboratory, Graz University of Technology, Graz, Austria
| | - Thomas Pock
- Institute for Computer Graphics and Vision, Graz University of Technology, Graz, Austria
| | - Kristiina Tammimies
- Center of Neurodevelopmental Disorders (KIND), Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Child and Adolescent Psychiatry, Center of Psychiatry Research, Stockholm County Council, Stockholm, Sweden
| | - Christian Enzinger
- Department of Neurology and Division of Neuroradiology, Vascular & Interventional Radiology, Department of Radiology, 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, Harrachgasse 21/5, 8010, Graz, Austria
| | - Iris Tomantschger
- Research Unit iDN-interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, 8010, Graz, Austria
| | - Katrin D Bartl-Pokorny
- Research Unit iDN-interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, 8010, Graz, Austria
| | - Jeff Sigafoos
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Laura Roche
- School of Education, Victoria University of Wellington, Wellington, New Zealand
| | - Gianluca Esposito
- Social & Affective Neuroscience Lab, Division of Psychology-HSS, Nanyang Technological University, Singapore, Singapore
- Affiliative Behaviour and Physiology Lab, Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
| | - Markus Gugatschka
- Department of Phoniatrics, Medical University of Graz, Graz, Austria
| | - Karin Nielsen-Saines
- Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Christa Einspieler
- Research Unit iDN-interdisciplinary Developmental Neuroscience, Institute of Physiology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, 8010, Graz, Austria.
| | - Walter E Kaufmann
- Center for Translational Research, Greenwood Genetic Center, Greenwood, SC, USA
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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De Bock F, Will H, Behrenbeck U, Jarczok MN, Hadders-Algra M, Philippi H. Predictive value of General Movement Assessment for preterm infants' development at 2 years - implementation in clinical routine in a non-academic setting. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 62:69-80. [PMID: 28113095 DOI: 10.1016/j.ridd.2017.01.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 01/02/2017] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND General movements (GM) are used in academic settings to predict developmental outcome in infants born preterm. However, little is known about the implementation and predictive value of GM in non-academic settings. AIMS The aim of this study is twofold: To document the implementation of GM assessment (GMA) in a non-academic setting and to assess its predictive value in infants born preterm. METHODS AND PROCEDURES We documented the process of implementing GMA in a non-academic outpatient clinic. In addition, we assessed the predictive value of GMA at 1 and 3 months' corrected age for motor and cognitive development at 2 years in 122 children born <33 weeks' gestation. Outcome at two years was based upon the Bayley Scales of Infant Development-II (mental/psychomotor developmental index (MDI, PDI)) and a neurological examination. The infants' odds of atypical outcome (MDI or PDI ≤70 or diagnosis CP) and the predictive accuracy of abnormal GMA were calculated in a clinical routine scenario, which used all available GM information (primarily at 3 months or at 1 month, when 3 months were not available). In addition, separate analysis was undertaken for the samples of GMA at 1 and 3 months. OUTCOMES AND RESULTS Tips to facilitate GMA implementation are described. In our clinical routine scenario, children with definitely abnormal GM were more likely to have an atypical two-year outcome than children with normal GM (OR 13.2 (95% CI 1.56; 112.5); sensitivity 55.6%, specificity 82.1%). Definitely abnormal GM were associated with reduced MDI (-12.0, 95% CI -23.2; -0.87) and identified all children with cerebral palsy (CP) in the sample of GMA at 3 months only. CONCLUSIONS AND IMPLICATIONS GMA can be successfully implemented in a non-academic outpatient setting. In our clinical routine scenario, GMA allowed for adequate prediction of neurodevelopment in infants born preterm, thereby allaying concerns about diagnostic accuracy in non-academic settings.
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Affiliation(s)
- Freia De Bock
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Ludolf-Krehl Strasse 7-11, 68167 Mannheim, Germany; Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany.
| | - Heike Will
- Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany
| | - Ulrike Behrenbeck
- Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany
| | - Marc N Jarczok
- Mannheim Institute of Public Health, Social and Preventive Medicine, University Medicine Mannheim, Heidelberg University, Ludolf-Krehl Strasse 7-11, 68167 Mannheim, Germany
| | - Mijna Hadders-Algra
- University of Groningen, University Medical Center Groningen, Beatrix Children's Hospital - Institute of Developmental Neurology, Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - Heike Philippi
- Center for Child Neurology, Theobald-Christ-Strasse 16, 60316 Frankfurt a.M., Germany
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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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Abstract
Poppy extract accompanied the human infant for more than 3 millenia. Motives for its use included excessive crying, suspected pain, and diarrhea. In antiquity, infantile sleeplessness was regarded as a disease. When treatment with opium was recommended by Galen, Rhazes, and Avicenna, baby sedation made its way into early medical treatises and pediatric instructions. Dabbing maternal nipples with bitter substances and drugging the infant with opium were used to hasten weaning. A freerider of gum lancing, opiates joined the treatment of difficult teething in the 17th century. Foundling hospitals and wet-nurses used them extensively. With industrialization, private use was rampant among the working class. In German-speaking countries, poppy extracts were administered in soups and pacifiers. In English-speaking countries, proprietary drugs containing opium were marketed under names such as soothers, nostrums, anodynes, cordials, preservatives, and specifics and sold at the doorstep or in grocery stores. Opium's toxicity for infants was common knowledge; thousands of cases of lethal intoxication had been reported from antiquity. What is remarkable is that the willingness to use it in infants persisted and that physicians continued to prescribe it for babies. Unregulated trade, and even that protected by governments, led to greatly increased private use of opiates during the 19th century. Intoxication became a significant factor in infant mortality. As late as 1912, the International Hague Convention forced governments to implement legislation that effectively curtailed access to opium and broke the dangerous habit of sedating infants.
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Affiliation(s)
- Michael Obladen
- Department of Neonatology, Charité University Medicine, Berlin, Germany
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18
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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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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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Einspieler C, Marschik PB, Domingues W, Talisa VB, Bartl-Pokorny KD, Wolin T, Sigafoos J. Monozygotic twins with Rett syndrome: Phenotyping the first two years of life. JOURNAL OF DEVELOPMENTAL AND PHYSICAL DISABILITIES 2014; 26:171-182. [PMID: 29769795 PMCID: PMC5951272 DOI: 10.1007/s10882-013-9351-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The first two years of life for children with Rett syndrome (RTT) have previously been viewed as relatively asymptomatic. However, it is possible that subtle symptoms may be present in early development. To identify possible early indicators of RTT, we analysed videotapes of two twin girls with RTT. The videotapes were analysed to (a) describe the motor and communicative development of this twin pair with RTT; and to (b) explore whether early abnormalities and their age of onset differed between the twins and were related to their later clinical phenotypes. The results indicated several neurodevelopmental abnormalities present before the children exhibited any obvious signs of regression. Abnormalities were evident in the motor, speech-language and communicative domains. These data support an emerging evidence base showing the presence of developmental abnormalities in children with RTT during the first year of life. The results have implications for early screening and clinical assessment.
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Affiliation(s)
- Christa Einspieler
- Institute of Physiology (IN:spired; Developmental Physiology & Developmental Neuroscience), Center for Physiological Medicine, Medical University of Graz, Graz, Austria
| | - Peter B. Marschik
- Institute of Physiology (IN:spired; Developmental Physiology & Developmental Neuroscience), Center for Physiological Medicine, Medical University of Graz, Graz, Austria
| | | | - Victor B. Talisa
- Center for Genetic Disorders of Cognition and Behavior, Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Katrin D. Bartl-Pokorny
- Institute of Physiology (IN:spired; Developmental Physiology & Developmental Neuroscience), Center for Physiological Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Wolin
- Institute of Physiology (IN:spired; Developmental Physiology & Developmental Neuroscience), Center for Physiological Medicine, Medical University of Graz, Graz, Austria
| | - Jeff Sigafoos
- School of Educational Psychology and Pedagogy, Victoria University of Wellington, Wellington, New Zealand
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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: 54] [Impact Index Per Article: 5.4] [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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