Assessment of general movement among infants not at risk of developmental delay
Keywords:infants, motor development, general movements
Introduction. The functional assessment of general movements (GMs) is a common test for the developing nervous system. The high predictive validity of abnormal GMs for cerebral palsy has been documented among preterm infants.
Aim. The present study examined whether term infants without any documented risk factors for neurodevelopment delay may benefit from an assessment of GMs.
Material and Methods. One hundred and four infants ranging in age from 1–4 months were evaluated using Prechtl’s method, of which, thirty-eight were younger than two months of age and the remaining sixty-eight were older than two months of age (with available detailed neonatal characteristics). The following movements were considered among younger infants, writhing, poor repertoire and cramped synchronised, whereas fidgety, cramped synchronised, poor repertoire, chaotic and abnormal GMs were evaluated in older infants. Infants were classified as ‘normal’ or ‘abnormal’ groups based on their presenting GMs. We determined postural positional preference, following Kaplan recommendations, with features categorised as either ‘present’ or ‘absent’, as well as activity level and general muscle tone (‘normal’ or ‘abnormal’).
Results. Cramped synchronised GMs were observed in seven (18.4%) younger infants and in eleven (16.7%) older infants. There was no difference in the clinical characteristics of children with normal vs. abnormal GMs. Abnormal muscle tone was associated with a higher OR (p = 0.0039) of presenting with abnormal GMs (4.6063; 95%CI: 1.6303–13.0149). Although the infants studied were not at risk for developmental disorders, almost one-fifth required follow-up neurological consultation.
Conclusions. An assessment of GMs should be considered as a universal screening tool among healthy infants without risk factor(s) for developmental deficits.
Nakajima Y, Einspieler C, Marschik PB, Bos AF, Prechtl HF. Does a detailed assessment of poor repertoire general movements help to identify those infants who will develop normally?. Early Human Development. 2006 Jan;82(1):53-59. https://doi.org/10.1016/j.earlhumdev.2005.07.010
Einspieler C, Prechtl HFR. Prechtl's assessment of general movements: A diagnostic tool for the functional assessment of the young nervous system. Mental Retardation and Developmental Disabilities Research Reviews. 2005;11(1):61-67. https://doi.org/10.1002/mrdd.20051
Ferrari F, Cioni G, Einspieler C, Roversi MF, Bos AF, Paolicelli PB, Ranzi A, Prechtl HFR. Cramped Synchronized General Movements in Preterm Infants as an Early Marker for Cerebral Palsy. Archives of Pediatrics & Adolescent Medicine. 2002 May 1;156(5):460. https://doi.org/10.1001/archpedi.156.5.460
Hadders-Algra M. General movements: a window for early identification of children at high risk for developmental disorders. The Journal of Pediatrics. 2004 Aug;145(2):S12-S18. https://doi.org/10.1016/j.jpeds.2004.05.017
Smith T, Groen AD, Wynn JW. Randomized Trial of Intensive Early Intervention for Children With Pervasive Developmental Disorder. American Journal on Mental Retardation. 2000;105(4):269. https://doi.org/10.1352/0895-8017(2000)105<0269:rtoiei>2.0.co;2
Stellwagen L, Hubbard E, Chambers C, Jones KL. Torticollis, facial asymmetry and plagiocephaly in normal newborns. Archives of Disease in Childhood. 2008 Apr 1;93(10):827-831. https://doi.org/10.1136/adc.2007.124123
van Vlimmeren LA, van der Graaf Y, Boere-Boonekamp MM, L’Hoir MP, Helders PJM, Engelbert RHH. Effect of Pediatric Physical Therapy on Deformational Plagiocephaly in Children With Positional Preference. Archives of Pediatrics & Adolescent Medicine. 2008 Aug 1;162(8):712. https://doi.org/10.1001/archpedi.162.8.712
Brazelton TB, Nugent JK. The Neonatal Behavioral Assessment Scale. London: Mac Keith Press; 2011.
Einspieler C, Bos AF, Libertus ME, Marschik PB. The General Movement Assessment Helps Us to Identify Preterm Infants at Risk for Cognitive Dysfunction. Frontiers in Psychology. 2016 Mar 22;7. https://doi.org/10.3389/fpsyg.2016.00406
Spittle A, Orton J, Anderson PJ, Boyd R, Doyle LW. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database of Systematic Reviews. 2015 Nov 24;. https://doi.org/10.1002/14651858.cd005495.pub4
Gajewska E, Sobieska M, Kaczmarek E, Suwalska A, Steinborn B. Achieving Motor Development Milestones at the Age of Three Months May Determine, but Does Not Guarantee, Proper Further Development. The Scientific World Journal. 2013;2013:1-11. https://doi.org/10.1155/2013/354218
Hodges K, Wong MM. Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale. Journal of Child and Family Studies. 1996 Dec;5(4):445-467. https://doi.org/10.1007/bf02233865
International Classification of Functioning, Disability and Health (ICF). https://www.who.int/classifications/icf/en
Gower L, Jenkins D, Fraser JL, Ramakrishnan V, Coker-Bolt P. Early developmental assessment with a short screening test, the STEP, predicts one-year outcomes. Journal of Perinatology. 2018 Oct 9;39(2):184-192. https://doi.org/10.1038/s41372-018-0234-4
Chugani HT, Phelps ME, Mazziotta JC. Positron emission tomography study of human brain functional development. Annals of Neurology. 1987 Oct;22(4):487-497. https://doi.org/10.1002/ana.410220408
International classification of functioning, disability and health: children and youth version: ICF-CY. https://apps.who.int/iris/handle/10665/43737
Fjørtoft T, Grunewaldt KH, Løhaugen GCC, Mørkved S, Skranes J, Evensen KAI. Assessment of motor behaviour in high-risk-infants at 3months predicts motor and cognitive outcomes in 10years old children. Early Human Development. 2013 Oct;89(10):787-793. https://doi.org/10.1016/j.earlhumdev.2013.06.007
Prechtl HF, Einspieler C, Cioni G, Bos AF, Ferrari F, Sontheimer D. An early marker for neurological deficits after perinatal brain lesions. The Lancet. 1997 May;349(9062):1361-1363. https://doi.org/10.1016/s0140-6736(96)10182-3
Einspieler C, Marschik PB, Milioti S, Nakajima Y, Bos AF, Prechtl HF. Are abnormal fidgety movements an early marker for complex minor neurological dysfunction at puberty?. Early Human Development. 2007 Aug;83(8):521-525. https://doi.org/10.1016/j.earlhumdev.2006.10.001
Bruggink JL, Einspieler C, Butcher PR, Van Braeckel KN, Prechtl HF, Bos AF. The Quality of the Early Motor Repertoire in Preterm Infants Predicts Minor Neurologic Dysfunction at School Age. The Journal of Pediatrics. 2008 Jul;153(1):32-39.e1. https://doi.org/10.1016/j.jpeds.2007.12.047
Yuge M, Marschik PB, Nakajima Y, Yamori Y, Kanda T, Hirota H, Yoshida N, Einspieler C. Movements and postures of infants aged 3 to 5months: To what extent is their optimality related to perinatal events and to the neurological outcome?. Early Human Development. 2011 Mar;87(3):231-237. https://doi.org/10.1016/j.earlhumdev.2010.12.046
Papazian O. Encefalopatía hipóxica-isquémica neonatal [Neonatal hypoxic-ischemic encephalopathy]. Medicina (B Aires). 2018;78(Suppl. 2):36-41. PMID 30199363
Razaz N, Cnattingius S, Persson M, Tedroff K, Lisonkova S, Joseph KS. One-minute and five-minute Apgar scores and child developmental health at 5 years of age: a population-based cohort study in British Columbia, Canada. BMJ Open. 2019 May;9(5):e027655. https://doi.org/10.1136/bmjopen-2018-027655
How to Cite
Copyright (c) 2020 Roksana Malak, Joanna Borek, Dorota Sikorska, Przemysław Keczmer, Włodzimierz Samborski
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.