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Zhussupova Z, Jaxybayeva A, Ayaganov D, Tekebayeva L, Mamedbayli A, Tamadon A, Zharmakhanova G. General movement assessment efficacy for assessment of nervous system integrity in children after hypoxic-ischemic encephalopathy in middle income countries. Early Hum Dev 2024; 192:105992. [PMID: 38574696 DOI: 10.1016/j.earlhumdev.2024.105992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Many infants who survive hypoxic-ischemic encephalopathy (HIE) face long-term complications like epilepsy, cerebral palsy, and developmental delays. Detecting and forecasting developmental issues in high-risk infants is critical. AIM This study aims to assess the effectiveness of standardized General Movements Assessment (GMA) and Hammersmith Infant Neurological Examinations (HINE) in identifying nervous system damage and predicting neurological outcomes in infants with HIE. DESIGN Prospective. SUBJECTS AND MEASURES We examined full-term newborns with perinatal asphyxia, classifying them as Grade 2 HIE according to Sarnat and Sarnat. The study included 31 infants, with 14 (45.2 %) receiving therapeutic hypothermia (Group 1) and 17 (54.8 %) not (Group 2). We evaluated general movements during writhing and fidgety phases and conducted neurological assessments using the HINE. RESULTS All infants exhibited cramped-synchronized - like movements, leading to cerebral palsy (CP) diagnosis. Three children in Group 1 and four in Group 2 lacked fidgety movements. During active movements, HINE and GMA showed high sensitivity and specificity, reaching 96 % and 100 % for all children. The ROC curve's area under the curve (AUC) was 0.978. CONCLUSION Our study affirms HINE and GMA as effective tools for predicting CP in HIE-affected children. GMA exhibits higher sensitivity and specificity during fidgety movements. However, study limitations include a small sample size and data from a single medical institution, necessitating further research.
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Affiliation(s)
- Zhanna Zhussupova
- Department of Neurology, Psychiatry and Narcology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.
| | | | - Dinmukhamed Ayaganov
- Department of Neurology, Psychiatry and Narcology, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.
| | - Latina Tekebayeva
- Department of Children's Diseases, Kazakhstan's Medical University Higher School of Public Health LLP, Almaty, Kazakhstan.
| | - Ayten Mamedbayli
- Neurology Department, Azerbaijan Medical University, Baku, Azerbaijan
| | - Amin Tamadon
- Department of Natural Sciences, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan
| | - Gulmira Zharmakhanova
- Department of Natural Sciences, West Kazakhstan Marat Ospanov Medical University, Aktobe, Kazakhstan.
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Einspieler C, Bos AF, Spittle AJ, Bertoncelli N, Burger M, Peyton C, Toldo M, Utsch F, Zhang D, Marschik PB. The General Movement Optimality Score-Revised (GMOS-R) with Socioeconomically Stratified Percentile Ranks. J Clin Med 2024; 13:2260. [PMID: 38673533 PMCID: PMC11050782 DOI: 10.3390/jcm13082260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The general movement optimality score (GMOS) quantifies the details of general movements (GMs). We recently conducted psychometric analyses of the GMOS and developed a revised scoresheet. Consequently, the GMOS-Revised (GMOS-R) instrument necessitated validation using new percentile ranks. This study aimed to provide these percentile ranks for the GMOS-R and to investigate whether sex, preterm birth, or the infant's country of birth and residence affected the GMOS-R distribution. Methods: We applied the GMOS-R to an international sample of 1983 infants (32% female, 44% male, and 24% not disclosed), assessed in the extremely and very preterm period (10%), moderate (12%) and late (22%) preterm periods, at term (25%), and post-term age (31%). Data were grouped according to the World Bank's classification into lower- and upper-middle-income countries (LMICs and UMICs; 26%) or high-income countries (HICs; 74%), respectively. Results: We found that sex and preterm or term birth did not affect either GM classification or the GMOS-R, but the country of residence did. A lower median GMOS-R for infants with normal or poor-repertoire GMs from LMICs and UMICs compared with HICs suggests the use of specific percentile ranks for LMICs and UMICs vs. HICs. Conclusion: For clinical and scientific use, we provide a freely available GMOS-R scoring sheet, with percentile ranks reflecting socioeconomic stratification.
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Affiliation(s)
- Christa Einspieler
- Interdisciplinary Developmental Neuroscience—iDN, Division of Phoniatrics, Medical University of Graz, 8010 Graz, Austria
| | - Arend F. Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, 9712 GZ Groningen, The Netherlands
| | - Alicia J. Spittle
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Natascia Bertoncelli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy;
| | - Marlette Burger
- Physiotherapy Division, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Moreno Toldo
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi 221011, India;
| | - Fabiana Utsch
- Reabilitação Infantil, Rede SARAH de Hospitais de Reabilitação, Belo Horizonte 30510-000, Brazil;
| | - Dajie Zhang
- Interdisciplinary Developmental Neuroscience—iDN, Division of Phoniatrics, Medical University of Graz, 8010 Graz, Austria
- Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls University, 69115 Heidelberg, Germany
| | - Peter B. Marschik
- Interdisciplinary Developmental Neuroscience—iDN, Division of Phoniatrics, Medical University of Graz, 8010 Graz, Austria
- Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls University, 69115 Heidelberg, Germany
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Leibniz-ScienceCampus Primate Cognition, 37075 Göttingen, Germany
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden
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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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McCarty DB, Letzkus L, Attridge E, Dusing SC. Efficacy of Therapist Supported Interventions from the Neonatal Intensive Care Unit to Home: A Meta-Review of Systematic Reviews. Clin Perinatol 2023; 50:157-178. [PMID: 36868703 DOI: 10.1016/j.clp.2022.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Infants born preterm or with complicated medical conditions requiring care in the neonatal intensive care unit (NICU) are at high risk for long-term developmental disabilities. The transition from NICU to early intervention/outpatient settings results in a disruptive gap in a therapeutic intervention during a period of maximal neuroplasticity and development. This meta-review evaluated evidence from existing systematic reviews regarding therapeutic interventions that start in the NICU and continue at home with the goal of improving developmental outcomes for infants at high risk for cerebral palsy. We also evaluated the impact of these interventions on parents' mental health outcomes.
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Affiliation(s)
- Dana B McCarty
- Division of Physical Therapy, Department of Health Sciences, The University of North Carolina at Chapel Hill, 3024 Bondurant Hall, CB#7135, Chapel Hill, NC 27599-7135, USA
| | - Lisa Letzkus
- Division of Neurodevelopmental and Behavioral Pediatrics, Department of Pediatrics, University of Virginia, 101 Hospital Drive, Charlottesville, VA, 22903 USA
| | - Elaine Attridge
- Claude Moore Health Sciences Library, University of Virginia, PO Box 800722, Charlottesville, VA 22908, USA
| | - Stacey C Dusing
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP 155, Los Angeles CA 90033, USA.
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Koziol NA, Butera CD, Kretch KS, Harbourne RT, Lobo MA, McCoy SW, Hsu LY, Willett SL, Kane AE, Bovaird JA, Dusing SC. Effect of the START-Play Physical Therapy Intervention on Cognitive Skills Depends on Caregiver-Provided Learning Opportunities. Phys Occup Ther Pediatr 2022; 42:510-525. [PMID: 35350970 DOI: 10.1080/01942638.2022.2054301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/08/2022] [Indexed: 10/18/2022]
Abstract
AIMS This study evaluated whether caregiver-provided learning opportunities moderated the effect of START-Play physical therapy intervention on the cognitive skills of young children with neuromotor delays, and whether START-Play impacted caregiver-provided learning opportunities over time. METHODS One hundred and twelve children with neuromotor delays (7-16 months) participated in a multisite randomized clinical trial evaluating the efficacy of START-Play. Children were assessed at baseline and 3 (post intervention), 6, and 12 months post baseline. Cognition was scored from the Bayley Scales of Infant & Toddler Development, Third Edition, cognitive scale. The proportion of time caregivers spent providing learning opportunities was coded from a 5-minute caregiver-child free play interaction. RESULTS Baseline caregiver-provided learning opportunities moderated the 3- and 12-month effects of START-Play on cognition. Cognitive gains due to START-Play were more pronounced for children whose caregivers provided more learning opportunities. START-Play did not impact caregiver-provided learning opportunities over time. CONCLUSIONS START-Play may have a lasting effect on children's cognition, but this effect is contingent on caregivers providing their child with ample opportunities to practice cognitive skills. Strategies for improving caregivers' uptake and transfer of START-Play principles to their daily routines should be evaluated. TRIAL REGISTRATION ClinicalTrials.gov NCT02593825.
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Affiliation(s)
| | | | - Kari S Kretch
- University of Southern California, Los Angeles, California, USA
| | | | | | | | - Lin-Ya Hsu
- University of Washington, Seattle, Washington, USA
| | - Sandra L Willett
- Munroe Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Audrey E Kane
- Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Stacey C Dusing
- University of Southern California, Los Angeles, California, USA
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