Use of the Motor Optimality Score-Revised (MOS-R) to predict neurodevelopmental outcomes in infants with congenital anomalies

The predictive validity of HINE, Bayley, general movements and MOS-R in infancy

INTRODUCTION

Infants born with congenital anomalies requiring surgery are at greater risk of developmental delays. Early screening tools are needed to identify infants who would benefit from early intervention. This study aimed to investigate the concurrent predictive validity of the General Movements Assessment (GMA), Motor Optimality Score - Revised (MOS-R), Hammersmith Infant Neurological Examination (HINE) and Bayley-III in identifying infants at risk of adverse neurodevelopmental outcomes.

METHODS

A retrospective cohort study of 95 surgical infants. Participants were assessed at 3 months using the GMA, MOS-R, HINE, and Bayley-III. Development was assessed at 1 year using the Bayley-III. Logistic regression investigated the relationship between measures at 3 months and developmental outcome, using sensitivity, specificity, positive (PPV) and negative (NPV) predictive value and area under the ROC curve (AUC).

RESULTS

All assessments had a relationship with development. Combining assessments at 3 months did not increase predictive value. MOS-R < 23 or HINE<60 had >70 % sensitivity for identifying delays in ≥2 domains of the Bayley-III at 1 year, and > 80 % accuracy in ruling out infants not at risk. MOS-R < 23 (NPV 0.957), and HINE <60 (NPV 0.971) were significantly correlated with delayed cognition.

DISCUSSION

In a surgical cohort, the concurrent predictive validity of the GMA, MOS-R, HINE and Bayley-III, administered at 3 months of age was low, however all assessment tools showed correlations with outcomes. The HINE and MOS-R might help to identify infants who need support with cognition. Further exploration of early screening tools may help to identify infants who would benefit from early intervention.

General movements and neurodevelopmental outcome at 6 years in extremely preterm born children

BACKGROUND

Infants born extremely preterm (EPT) face a variety of neurodevelopmental challenges. Those most at risk of adverse outcomes should be detected early.

AIMS

To assess General Movements (GMs) at fidgety age in EPT infants and to investigate whether fidgety movements (FMs) and Motor Optimality Scores - Revised (MOS-R) are associated with neurodevelopmental outcome at six years.

STUDY DESIGN

Longitudinal cohort study.

SUBJECTS

Thirty-eight EPT children (< 28 weeks of gestation, 11 girls).

OUTCOME MEASURES

GMs were assessed from video recordings at three months corrected age using the Prechtl General Movements Assessment and The Motor Optimality Score for 3- to 5-Month-Old Infants - Revised. Neurological (Touwen), cognitive (WPPSI-III) and neuropsychological (NEPSY-II, visuospatial and attention) outcomes were evaluated at six years.

RESULTS

Nine (24 %) of the infants had aberrant (abnormal/sporadic/absent) FMs and all but one had abnormal movement character. Median MOS-R was 21. Infants with aberrant FMs had significantly higher odds ratio (OR) for full-scale intelligence quotient ≤ 85 (FSIQ, OR 7.7, p = 0.03) and auditory attention ≤ -1SD (OR 12.8, p = 0.04). MOS-R scores correlated positively with FSIQ (Spearman r = 0.39, p = 0.02), performance IQ (r = 0.47, p = 0.004), visuospatial processing (Geometric Puzzles, r = 0.53, p = 0.006) and visual attention (r = 0.29, p = 0.01). Overall outcome or neurological outcome did not reach statistical significance in associations with aberrant FMs or MOS-R.

CONCLUSION

Aberrant FMs and lower MOS-R are associated with worse neurodevelopmental outcomes when compared to normal FMs and/or higher MOS-R.

The role of fidgety movements and early motor repertoire in predicting mobility outcomes in infants with myelomeningocele

OBJECTIVE

To describe fidgety movements and co-occurring movements and postures in infants with myelomeningocele (MMC) and their association with mobility at preschool ages.

METHODS

A retrospective cohort with early assessment via general movement assessment, followed by mobility assessment between 36 and 70 months of age.

RESULTS

Twelve infants were included; 12 of 12 had fidgety movements in the upper limbs, with seven exhibiting them also in the hips and three in both the hips and ankles. The presence of fidgety movements in the lower limbs, kicking, a non-flat posture, a non-monotonous movement character, and a non-absent age-adequate movement repertoire were independently associated with mobility using the Hoffer modified classification and functional mobility scale (FMS) at 5 and 50 m. An optimality score was calculated based on leg movements and postures, ranging from 0 to 10 points. Infants who scored at least 4 points achieved household ambulation and FMS (5 m) of at least level 4. Community ambulation and an FMS (50 m) of level 5 were achieved with a score of at least 7.5.

CONCLUSIONS

Assessing fidgety movements with other leg movements and postures in infants with MMC provided relevant information that could potentially predict mobility at preschool age and thus could be used for early intervention planning.

Stability of the Motor Optimality Score Revised (MOS-R) in medically complex infants

BACKGROUND

The Motor Optimality Score-Revised (MOS-R) is a clinical test of infant spontaneous movement at 3-5 months of age and has been associated with neurodevelopmental outcomes in infants with medical complexity. However the stability of the MOS-R tested at different developmental ages is not yet known.

AIM

To determine if the repeated scoring of the MOS-R remained consistent when tested at two developmental ages in young infants.

STUDY DESIGN

In this prospective cohort study, infants were tested twice with the MOS-R between 12 and 13 weeks corrected age (CA) and 14-16 weeks CA. Bland Altman Plots were used to calculate agreement between the scores. Infants were grouped as having higher or lower medical complexity. MOS-R threshold scores were analyzed to assess changes over time within each group using Fisher's exact test.

SUBJECTS

85 infants with history of hospitalization in a neonatal intensive care unit (NICU).

RESULTS

The MOS-R scores had a high agreement with negligible bias (0.058) between timepoints (95 % CI -1.10, 1.22). Using a MOS-R cut point of 19, infants with higher medical complexity were more likely to change groups between timepoints than infants with lower medical complexity (p = 0.008), but this was not significantly different using cut points of 20 or 21.

CONCLUSION

The MOS-R scores were stable when measured repeatedly in infants who were hospitalized in a NICU. Infants with high medical complexity had less stable MOS-R scores using certain cut points than infants with lower medical complexity.

Relationship between early infant motor repertoire and neurodevelopment on the hammersmith infant neurological examination in a developmentally vulnerable First Nations cohort

AIM

To implement a culturally-adapted screening program aimed to determine the ability of infant motor repertoire to predict early neurodevelopment on the Hammersmith Infant Neurological Examination (HINE) and improve Australian First Nations families' engagement with neonatal screening.

METHODS

A prospective cohort of 156 infants (55 % male, mean (standard deviation [SD]) gestational age 33.8 (4.6) weeks) with early life risk factors for adverse neurodevelopmental outcomes (ad-NDO) participated in a culturally-adapted screening program. Infant motor repertoire was assessed using Motor Optimality Score-revised (MOS-R), captured over two videos, 11-13+6 weeks (V1; <14 weeks) and 14-18 weeks (V2; ≥14 weeks) corrected age (CA). At 4-9 months CA neurodevelopment was assessed on the HINE and classified according to age-specific cut-off and optimality scores as; developmentally 'on track' or high chance of either adverse neurodevelopmental outcome (ad-NDO) or cerebral palsy (CP).

RESULTS

Families were highly engaged, 139/148 (94 %) eligible infants completing MOS-R, 136/150 (91 %), HINE and 123 (83 %) both. Lower MOS-R at V2 was associated with reduced HINE scores (β = 1.73, 95 % confidence interval [CI] = 1.03-2.42) and high chance of CP (OR = 2.63, 95%CI = 1.21-5.69) or ad-NDO (OR = 1.38, 95%CI = 1.10-1.74). The MOS-R sub-category 'observed movement patterns' best predicted HINE, infants who score '4' had mean HINE 19.4 points higher than score '1' (95%CI = 12.0-26.9). Receiver-operator curve analyses determined a MOS-R cut-off of <23 was best for identifying mild to severely reduced HINE scores, with diagnostic accuracy 0.69 (sensitivity 0.86, 95%CI 0.76-0.94 and specificity 0.40, 95 % CI 0.25-0.57). A trajectory of improvement on MOS-R (≥2 point increase in MOS-R from 1st to 2nd video) significantly increased odds of scoring optimally on HINE (OR = 5.91, 95%CI 1.16-29.89) and may be a key biomarker of 'on track' development.

INTERPRETATION

Implementation of a culturally-adapted program using evidence-based assessments demonstrates high retention. Infant motor repertoire is associated with HINE scores and the early neurodevelopmental status of developmentally vulnerable First Nations infants.