Figure - uploaded by Alexander Refsum Jensenius
Content may be subject to copyright.
Motor repertoire at 9e16 weeks post term and Peabody Developmental Motor Scale quotients at 12 months post term.
Source publication
Background:
Most studies on Prechtl's method of assessing General Movements (GMA) in young infants originate in Europe.
Aim:
To determine if motor behavior at an age of 3 months post term is associated with motor development at 12 months post age in VLBW infants in India.
Methods:
243 VLBW infants (135 boys, 108 girls; median gestational age 3...
Contexts in source publication
Context 1
... of them had video length of more than 5 min and 5 between 2 and 3 min. One infant had a video of 1 min and 40 s Further details about the motor repertoire are presented in Table 3. Lack of midline movements was observed in 10 (91%) of 11 infants with a reduced or absent age-adequate repertoire, and in 41 (18%) of 232 infants with an ageadequate repertoire of co-existent other movements. ...Citations
... It was stated that MOS total and sub-category scores are associated with gross and fine motor development at 12 months, and the evaluation of motor repertoire in addition to global GMA was useful in detecting abnormal motor development [34,50]. Kwong et al. found that MOS-R was associated with CP diagnosis and neurodevelopment at 2 years [51]. ...
Background: Researchers have attempted to automate the spontaneous movement assessment and have sought quantitative and objective methods over the past decade. The purpose of the study was to present a quantitative assessment method of spontaneous movement using center-of-pressure (COP) movement analysis.
Methods: A total of 101 infants were included in the study. The infants were placed in the supine position on the force plate with the cranial-caudal orientation. In this position, the recording of video and COP movement data were made simultaneously for 3 min. Video recordings were used to observe global and detailed general movement assessment (GMA), and COP time series data were used to obtain quantitative movement parameters.
Results: According to the global GMA, 13 infants displayed absent fidgety movements (FMs) and 88 infants displayed normal FMs. The binary logistic regression model indicated significant association between global GMA and COP movement parameters (chi-square = 20.817, p < 0.001). The sensitivity, specificity, and overall accuracy of this model were 85% (95% CI: 55-98), 83% (95% CI: 73-90), and 83% (95% CI: 74-90), respectively. The multiple linear regression model showed a significant association between detailed GMA (motor optimality score-revised/MOS-R) and COP movement parameters (F = 10.349, p < 0.001). The MOS-R total score was predicted with a standard error of approximately 1.8 points (6%).
Conclusions: The present study demonstrated the possible avenues for using COP movement analysis to objectively detect the absent FMs and MOS-R total score in clinical settings. Although the method presented in this study requires further validation, it may complement observational GMA and be clinically useful for infant screening purposes, particularly in clinical settings where access to expertise in observational GMA is not available.
... The other prediction studies reported on the association of the MOS with general developmental outcomes (cognitive, motor, language, and behavior) or minor neurological dysfunction [13][14][15]17,[26][27][28] Although the MOS predicted CP with 100% accuracy, it was not diagnostically associated with developmental delay, developmental coordination disorder, pervasive developmental disability, or attention deficit hyperactivity disorder (ADHD). However, the subsample for conditions such as ADHD was very small; thus, it is difficult to draw conclusions about prediction of these disorders. ...
... The presence and normality of movement patterns was not associated with outcomes in infants born extremely low weight. 26 For infants with CP, the association between the number of normal/atypical movement patterns and the GMFCS level was inconsistent; no association using the MOS in 1 study, 23 compared with a strong negative association using the MOS in another. 16 Infants exposed to the Zika virus had less normal movement patterns compared with controls. ...
... There were 6 studies in term infants, 5 of which (n = 662) reported a normal age-adequate repertoire in 68% to 74% of infants, 17,29,30,45,46 with 1 study (n = 38) reporting 94%. 25 In the preterm and very-low-birth-weight population, there were inconsistent findings across the 5 studies (n = 918) with a normal age-adequate repertoire ranging from 19% 46 to 95%. 26 Reduced or absent age-adequacy of the concurrent motor repertoire was reported to be significantly associated with lower gross motor outcomes at 12 months of age. 26 In 5 studies investigating children with CP, only 4% (28 out of 632) of infants had a normal age-adequate repertoire. ...
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.
... The sample size was calculated using our previous study [8] where 13% of infants had abnormal fidgety movements. We assumed a 95% level of confidence (Z value) and precision of 5%. ...
... Detailed description of the recording of GMs is given in our earlier article. [8] All video recordings were coded and identifying information removed. The classification of movements was done as described by Einspieler and Prechtl [1] and elucidated in Supplementary Table 1 by the principal investigator who completed advanced certification in GM assessment. ...
... Podobne obserwacje poczyniono w badaniach Adde'a i wsp. oraz Burger i wsp., również dotyczących dzieci przedwcześnie urodzonych i ze skrajnie niską masą urodzeniową: nieprawidłowości w zakresie FMs i nieprawidłowy współwystępujący repertuar motoryczny (concurrent motor repertoire) były istotnie związane z niższymi wynikami w PDMS-2 (Adde et al., 2016) i AIMS (Adde et al., 2016;Burger et al., 2011) w wieku 12 miesięcy. Co więcej, niemowlęta z encefalopatią niedotlenieniowo-niedokrwienną, u których występowały prawidłowe FMs, miały istotnie wyższe wyniki w podskali poznawczej Bayley-III niż niemowlęta bez FMs. ...
... Podobne obserwacje poczyniono w badaniach Adde'a i wsp. oraz Burger i wsp., również dotyczących dzieci przedwcześnie urodzonych i ze skrajnie niską masą urodzeniową: nieprawidłowości w zakresie FMs i nieprawidłowy współwystępujący repertuar motoryczny (concurrent motor repertoire) były istotnie związane z niższymi wynikami w PDMS-2 (Adde et al., 2016) i AIMS (Adde et al., 2016;Burger et al., 2011) w wieku 12 miesięcy. Co więcej, niemowlęta z encefalopatią niedotlenieniowo-niedokrwienną, u których występowały prawidłowe FMs, miały istotnie wyższe wyniki w podskali poznawczej Bayley-III niż niemowlęta bez FMs. ...
W związku z rozwojem medycyny pre- i postnatalnej, a w rezultacie zwiększoną przeżywalnością noworodków z grup ryzyka, wzrasta liczba dzieci, które już na pierwszych etapach życia wymagają wielospecjalistycznej opieki i podjęcia działań z zakresu wczesnej interwencji. Zidentyfikowanie nieprawidłowości w początkowych fazach rozwoju pozwala na wczesne wdrożenie leczenia, a zatem zwiększa szanse na dobry efekt terapeutyczny. Podstawą oceny rozwoju dziecka jest obserwacja motoryki i zachowania, kluczowy jest jednak prawidłowy dobór metod obserwacji i oceny. Ocena globalnych wzorców ruchowych metodą Prechtla (general movements assessment, GMsA) stosowana u dziecka w pierwszym półroczu życia umożliwia identyfikację i przewidywanie zaburzeń neurorozwojowych już na wczesnym etapie rozwoju. Celem pracy jest zaprezentowanie metody Prechtla na podstawie przeglądu zakresu literatury oraz podsumowanie wiedzy na ten temat. Praca ukazuje najważniejsze kwestie związane z procedurą badania, rzetelnością, wiarygodnością i zgodnością narzędzia oraz z jego wykorzystaniem w predykcji zaburzeń neurorozwojowych. Dodatkowo przeanalizowano zastosowanie GMsA w połączeniu z metodami neuroobrazowymi i skalami służącymi do oceny rozwoju neuromotorycznego oraz podsumowano wiedzę dotyczącą użycia nowych technologii w celu automatyzacji GMsA. Ze względu na nieinwazyjny charakter, dużą dostępność, łatwość zastosowania i przede wszystkim skuteczność metody zwrócono uwagę na jej użyteczność w praktyce klinicznej. Znajomość GMsA pozwala na uważniejszą obserwację motoryki dziecka, a dzięki temu może pomóc zarówno lekarzom czy terapeutom, jak i rodzicom we wczesnej identyfikacji zaburzeń neurorozwojowych i szybkim wdrożeniu optymalnego leczenia i rehabilitacji.
... The analysis of the participants' movements was performed using the GMA, with the aim of early detection of early trajectory abnormalities [17]. The method was created in the English language, and the group of creators prevents translations of the terms used for the classification of ...
Preterm infants who do not have fidgety movements at 3 months of corrected age have up to ten times greater risk of developing cerebral palsy or other alterations in motor development, compared to infants who exhibit such movements. The General Movements Assessment (GMA) is a validated tool that may predict the fidgety movement period.
This study aimed to describe the trajectory of the General Movements Assessment (GMA) during the preterm and writhing movements periods in preterm infants and determine the best time point to predict the fidgety movements period.
Fifty-two preterm newborns were evaluated by the GMA method. Results: GMA assessment at the age of 5 weeks post term was found the most predictive of neuromotor development disorders in at-risk newborns, with a sensitivity and specificity of 86% and 58%, respectively, and a high negative predictive value (92%) and increased hit ratio (69% accuracy).
Preterm infants with ≤34 weeks of gestational age have a high prevalence of poor repertoire classifications on the GMA and one single assessment with GMA near the time of NICU discharge seems to be the best time to determine infants who need to be followed more carefully, but the best time point to predict the fidgety movements period was 5 weeks post term.
... Zang ve ark.; toplam MOS puanı ile 12. ay kaba ve ince motor geliĢimin iliĢkili olduğunu ve global GMA"nın yanı sıra motor repertuarın da değerlendirilmesinin anormal motor geliĢimin saptanmasında faydalı olduğunu ifade etmiĢlerdir[74]. Bir baĢka çalıĢmada da benzer sonuçlar elde edilmiĢ; MOS"un alt bölümleri olan fidgety hareketler, yaĢa uygun motor repertuar ve hareket karakterinin 12. ay motor geliĢimle iliĢkili olduğu bulunmuĢtur[75]. ...
... This was an unexpected result as none of the infants had a pathological cranial ultrasound finding. Sporadic FMs are considered to be aberrant [24,25,39] and are usually observed in infants later diagnosed with cognitive, language and/or motor delays [39][40][41][42] including cerebral palsy [21,30,41]. It is possible that four of those seven recorded infants with sporadic FMs were too young (i.e., 9 or 10 weeks after term; Table 1), as the best age to score FMs is 12 to 16 weeks [27]. ...
Background:
The Prechtl General Movement Assessment (GMA) predicts various neurological and developmental disorders while also documenting therapeutic effects.
Aims:
To describe the temporal organization of fidgety general movements in infants with mild to moderate postural asymmetries and/or tonus regulation problems, and to analyze to what extent the temporal organization of fidgety movements will change after physiotherapy.
Study design:
Repeated measure design.
Participants:
Twelve infants (five females) with mild to moderate postural asymmetries and/or tonus regulation problems were admitted for an early intervention program. The gestational age ranged from 27 to 40 weeks (Median, 36 weeks; nine infants born preterm) with birth weights ranging from 740 g to 3500 g (Median, 2590 g).
Measures:
Fidgety movements and their temporal organization were measured using the Prechtl GMA at 9 to 19 weeks post term age (Median, 14 weeks) before and after an early motor training procedure. The movements of one of the infants were analysed using a computer-based approach, measuring the mean and standard deviation of quantity of motion, height of motion and width of motion.
Results:
Seven infants had sporadic fidgety movements, and five had intermittent fidgety movements. None had continual fidgety movements before the intervention was initiated. After intervention, the temporal organization of fidgety movements increased in all infants. The observations of these movements were supported by computer-based analysis.
Conclusion:
The study indicates that early intervention increases the temporal organization of fidgety movements in infants with postural asymmetries and/or tonus regulation problems. The clinical significance of this finding needs to be further evaluated.
... Whereas the specificity coincides with that of previous studies 8,10,11 irrespective of the outcome assessment age, the sensitivity in the present study is lower than the summary estimate (98%) for outcomes at 2 to 3 years 10,11 but is in line with other studies reporting outcome assessments at age 12 months. With sensitivity ranging from 60% to 80%, the absence of fidgety movements was similar to that in our study and was related to lower scores in various developmental tests in a convenience high-risk sample in the United States, 25 among infants after neonatal surgery in Australia, 26 and in very low-birth-weight infants in China 27 and India, 28 as well as to any pathological findings in the 12-month neurologic examination. 19,29 We acknowledge that an outcome at such a young age may be preliminary; some disorders might be diagnosed later in childhood, and milder forms of dysfunction may subsequently resolve. ...
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.
... An absence of FM, by contrast, indicates a neurologically adverse development even in infants with no structural impairment 41 . These findings have been repeatedly confirmed all over the world 2,9,49,50 , with a sensitivity of 91%-98% and a specificity of 81%-91% 4,8 . ...
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.
Aim
To systematically review the scientific literature to determine the predictive validity of technology-assisted measures of observable infant movement in infants less than six months of corrected age (CA) to identify high-risk of motor disability.
Method
A comprehensive search for randomised and non-randomised controlled trials, cohort studies and cross-comparison trials was performed on five electronic databases up to Feb 2021. Studies were included if they quantified infant movement before 6 months CA using some method of technology-assistance and compared the instrumented measure to a diagnostic clinical measure of neurodevelopment. Studies were excluded if they did not report a technology-assisted measure of infant movement. Methodological quality of the included studies was assessed using the Downs and Black scale.
Results
23 studies met the full inclusion and exclusion criteria. Methodological quality of the included papers ranged from 9 to 24 (out of 26) on the Downs and Black scale. Infant movement assessments included the General Movements Assessment (GMA) and domains of the Hammersmith Infant Neurological Assessment (HINE). Studies used 2D video recordings, RGB-Depth recordings, accelerometry, and electromagnetic motion tracking technologies to quantify movement. Analytical approaches and movement features of interest were individual and varied. Technology assisted quantitative assessments identified cases of later diagnosed CP with sensitivity 44–100 %, specificity 59–95 %, Area under the ROC Curve 82–93 %; and typical development with sensitivity range 30–46 %, specificity 88–95 %, Area under the ROC Curve 68 %.
Interpretation
Technology-assisted assessments of movement in infants less than 6 months CA using current technologies are feasible. Validation of measurement tools are limited. Although methods and results appear promising clinical uptake of technology-assisted assessments remains limited.
