Inter-rater reliability and agreement of the General Movement Assessment and Motor Optimality Score-Revised in a large population-based sample

Breech presentation at birth has short-term but no long-term effect on neurodevelopmental outcome in moderate and late preterm infants

AIM

To investigate the effects of fetal presentation at birth on spontaneous postnatal movements, postures and neurodevelopmental outcome in moderate and late preterm (MLPT) infants.

METHODS

The study population comprised 154 infants (55 % male, 55 % singletons) of whom 33 (21 %) were born in breech presentation. During the neonatal period and at 3-4 months post-term age, categorical Prechtl general movements assessment (GMA) and detailed scoring of motor functions was performed by means of the General Movement Optimality Score (GMOS) neonatally and Motor Optimality Score-Revised (MOS-R) later. Neurodevelopment was assessed at one year using Bayley-III.

RESULTS

Infants born in breech presentation more frequently exhibited pathological GMs (p = 0.05) with increased stiffness in the lower extremities (p < 0.01) at neonatal age. Detailed motor assessments at 3-4 months post-term age (MOS-R) showed lower scores in infants born in breech compared to those with cephalic presentation at birth. Fetal presentation at the time of delivery did not impact neurodevelopmental outcomes at 12 months.

CONCLUSION

Breech presentation at birth affected GMs and movement assessments in the early postnatal period but had no persistent impact on neurodevelopmental outcomes at one year, suggesting a transient effect on lower extremity movements. Given stiffness in the extremities in neonates is an alarm sign and might relate to cramped synchronized GMs indicating an increased risk for cerebral palsy, fetal presentation at birth should be taken into consideration in neonatal neuromotor assessments.

Sex-Related Differences in Hip Kinematics During General Movements in Early Infancy: A Biomechanical Cross-Sectional Study

The General Movements Assessment provides early insight into motor development's range of motion; however, its relationship with joint kinematics, such as hip abduction range of motion, remains underexplored. This study analyzed hip abduction kinematics during General Movements, evaluating potential sex differences and variations in movement patterns (Fidgety vs. Writhing), and aimed to provide quantitative data that complement qualitative pediatric assessments. This cross-sectional observational study analyzed video recordings of spontaneous motor activity in 32 infants under three months of corrected age. Hip abduction range of motion was extracted using biomechanical analysis during General Movements. Interrater reliability was evaluated using Fleiss's Kappa. Correlations were assessed using Pearson's test, and a two-way ANOVA examined the effects of sex and the type of movements on range of motion. Interrater reliability for movement classification was excellent (Kappa = 0.909, p < 0.001). No significant correlations were found between sex or General Movements type and hip abduction range of motion (p > 0.68). Two-way ANOVA showed no significant effects of sex, movement pattern, or their interaction on range of motion in either hip (right: p = 0.726, left: p = 0.823), with small effect sizes (η2 < 0.013). A minor asymmetry favoring the right hip was observed but was not clinically significant. Sex and General Movements type did not significantly influence hip abduction range of motion in infants under three months. Early joint mobility appears consistent across sexes and movement patterns, supporting its reliability as a biomechanical marker of typical development.

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.

Reproducibility of the Motor Optimality Score-Revised in infants with an increased risk of adverse neurodevelopmental outcomes

AIM

To determine reproducibility of the Motor Optimality Score-Revised (MOS-R) to assess infants at high risk of adverse neurodevelopmental outcomes, including cerebral palsy (CP), autism, and developmental delays.

METHOD

Thirty infants (18 males, 12 females, gestational age mean [range] = 32.5 [23-41] weeks) were randomly selected, according to 2-year outcome (typically developing; CP; or adverse neurodevelopmental outcome [ad-NDO]) from a prospective cohort. Participants had two General Movements videos between 12 weeks and 15 + 6 weeks corrected age. Six assessors, masked to history and outcomes, independently scored the MOS-R from videos. Assessors scored either one (Group 1; n = 3) or two videos for each infant (Group 2; n = 3). Intraclass correlation coefficient (ICC), Gwet's agreement coefficient, and limits of agreement were calculated.

RESULTS

Combined interassessor reliability (IRR) over six assessors for total MOS-R was 'fair' (ICC = 0.56, 95% confidence interval [CI] 0.41-0.72), and 'excellent' with consensus agreement (ICC = 0.99, 95% CI 0.98-0.99). Analyses demonstrated a mean interrater difference of 0.316 (95% limits of agreement -11.51, 12.14) over 450 comparisons (15 pairs). IRR was 'moderate' to 'almost perfect' across subcategories, with the highest reliability 'movement patterns' (Gwet's agreement coefficient = 0.73-1.00) and the lowest 'postural patterns' (0.45-0.73). Assessors who scored two videos (Group 2) demonstrated higher reproducibility. IRR for total MOS-R was 'excellent' when infants were typically developing (ICC = 0.90), and 'good' for CP (0.74) and ad-NDO (0.68).

INTERPRETATION

The MOS-R is a highly reproducible tool for assessing infants at high risk of ad-NDOs and is feasible for implementation in clinical settings. Reproducibility is best when the tool is used by experienced assessors to gain consensus agreement.

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.