Temporal and spatial localisation of general movement complexity and variation-Why Gestalt assessment requires experience

[Differences in the Distribution of the General Movements Classification Between Neonatal Risk Groups in the Children's Hospital Zurich: An Observational Study]

INTRODUCTION

Neonatal infants are at increased risk for motor development disorders.

OBJECTIVE

To compare General Movements (GMs) classification between three neonatal risk groups, correlate the GMs Assessment (GMA) with a standardized developmental neurological examination (SDNE) and determine risk factors for abnormal GMs.

METHODS

Monocentric observational study with three risk groups (children with operated congenital heart disease (CHD) n=26, with operated congenital gastrointestinal malformations (CGM) n=17 and with fetal operated myelomeningocele (MMC) n=12 who underwent inpatient video-based examination. GMA was evaluated according to Hadders-Algra classification and divided into 4 categories: normal optimal (NO), normal suboptimal (NS), mildly abnormal (MA), definitely abnormal (DA).

RESULTS

The distribution was as follows: CHD 80.8% NS, 19.2% MA, CGM 5.9% NO, 64.7% NS, 29.4% MA, MMC upper extremities 100% NS, lower extremities 33.3% NS, 33.3% MA and 33.3% DA (group comparison Kruskal-Wallis 10.729, p=0.003). GMA correlated significantly with SDNE (Spearman r _s=0.869, p<0.001). Binary logistic regression analysis showed that only gestational age (Chi²=11.93, p<0.001) correlated with abnormal GMs.

CONCLUSION

The majority of children showed normal GMs. Children with MMC and those with lower gestational age showed an increased risk of abnormal GMs. The GMA and SDNE represent complementary "bedside tools" to detect early motor abnormalities.

Temporal and spatial localisation of general movement complexity and variation-Why Gestalt assessment requires experience

Aim

General movements’ assessment (GMA), based on Gestalt perception, identifies infants at risk of cerebral palsy. However, the requirement of ample experience to construct the assessor's inner criteria for abnormal movement hampers its widespread clinical use. This study aims to describe details of general movements (GMs) in various body parts and to investigate their association with GMA‐Gestalt.

Methods

Participants were 24 typically developing infants and 22 very‐high‐risk infants. GMs were assessed during the writhing (0‐8 weeks) and/or fidgety GM phase (2‐5 months) by GMA‐Gestalt and a semi‐quantification of the duration of simple movements and complex movements in various body parts.

Results

During both GM phases, the quality of movement often varied within a single assessment, but the degree of complexity and variation of movements in trunk, arms and legs were interrelated (ρ = 0.32‐0.84). Longer durations of complex movements in arms and legs (P < .042) were further associated with a better quality in GMA‐Gestalt. Head movement was associated with movements in other body parts only in the writhing phase and not associated with GMA‐Gestalt during both GM phases.

Conclusion

Infants did not show consistently over time and across body parts simple or complex movements. Detailed description of movement characteristics may facilitate the development of computer‐based GMA.