Evaluation of neuromotor function in infancy-A systematic review of available methods

Towards automatic assessment of atypical early motor development?

Atypical motor development is an early indicator for several neurodevelopmental conditions, including cerebral palsy and Rett Syndrome, prompting early diagnosis and intervention. While not currently part of the diagnostic criteria for other conditions like Autism Spectrum Disorder, the frequent retrospective diagnosis of motor impairments alongside these conditions highlights the necessity of a deeper understanding of the relations between motor and cognitive development. Traditional clinical assessments, while considered the gold standard, rely on movement characteristics discernible to the trained eye of professionals. The emergence of automated technologies, including computer vision and wearable sensors, promises more objective and scalable detections. However, these methods are not without challenges, including concerns over data quality, generalizability, interpretability, and ethics. By reviewing recent advances, we highlight the potential and the challenges of integrating automated detections into research and clinical practice. While we agree that these technologies can revolutionize pediatric care, we believe their use must be tempered with caution and supported by clinical expertise to ensure effective outcomes.

Infants' organization of pull-to-stand behaviors during play: A longitudinal investigation

Pulling-to-stand (PTS) is an important transitional posture which may facilitate the shift to walking, but infants still frequently PTS even after learning to walk. Using a group of 13 infants who had learned to PTS about three weeks prior, we aimed to track how gains in PTS, standing, and walking experience contributed to infants' selection of more skilled PTS strategies and reorganized how infants used PTS to facilitate free play. We tracked spontaneous PTS over 10 biweekly laboratory sessions and video-coded functional measures of PTS skill, including hand-, knee-, and foot-use (e.g., lateral sides, hand- and foot-steps), and how infants used PTS during play, including behaviors immediately following PTS. Results showed infants frequently adopted skilled half-kneel strategies en route to PTS even though they were slower than symmetric PTS strategies. Most PTS involved asymmetrical and diagonal activation of the hands and legs, offering a stable center of gravity, and lateralized foot preferences were strong and stable. Other functional measures of PTS skill revealed increased efficiency over time, as infants PTS using fewer alternating hand-steps. Initially, infants PTS using stationary objects and then interacted with objects and mothers, but over time, infants increasingly PTS using the stairs and stair rails and engaged in more locomotor exploration following PTS. Even months after its initial onset, infants continued to refine PTS strategies and efficiency and used PTS differently for object interactions and locomotor exploration during play, which highlights the importance of tracking patterns of interlimb coordination during PTS and goal-directed behavior in context.

Neurological assessment tool for screening infants during the first year after birth: The Brief-Hammersmith Infant Neurological Examination

AIM

To develop a short version of the original Hammersmith Infant Neurological Examination (HINE) to be used as a screening tool (Brief-HINE) and to establish if the short examination maintains good accuracy and predictive power for detecting infants with cerebral palsy (CP).

METHOD

Eleven items were selected from the original HINE ('visual response'; 'trunk posture'; 'movement quantity'; 'movement quality'; 'scarf sign'; 'hip adductor angles'; 'popliteal angle'; 'pull to sit'; 'lateral tilting'; 'forward parachute reaction'; 'tendon reflexes') identifying those items previously found to be more predictive of CP in both low- and high-risk infants. In order to establish the sensitivity of the new module, the selected items were applied to existing data, previously obtained using the full HINE at 3, 6, 9, and 12 months, in 228 infants with typical development at 2 years and in 82 infants who developed CP.

RESULTS

Brief-HINE scores showed good sensitivity and specificity, at each age of assessment, for detecting infants with CP. At 3 months, a score of less than 22 was associated with CP with a sensitivity of 0.88 and a specificity of 0.92; at 6, 9, and 12 months, the cut-off scores were less than 25 (sensitivity 0.93; specificity 0.87), less than 27 (sensitivity 0.95; specificity 0.81), and less than 27 (sensitivity 1; specificity 0.86) respectively. The presence of more than one warning sign, or items that are not optimal for the age of assessment, imply the need for a full examination reassessment.

INTERPRETATION

These findings support the validity of the Brief-HINE as a routine screening method and the possibility of its use in clinical practice.

The Importance of Follow-Up Visits for Children at Risk of Developmental Delay-A Review

Structured follow-up visits should be accessible for children at risk for developmental delay. Follow-up visits should include a serial neuromotor assessment in the first two years of life (e.g., 3-6, 12, 24 months corrected age), which are repeated during the transition to school. The diagnosis of neuromotor development may be prognostic for important skills later in life. The early diagnosis of a child's general movements can be helpful in planning appropriately for proper treatment and intervention. These diagnostic assessments should be conducted by qualified healthcare professionals. The evaluation of neuromotor developmental health is specified in the national guidelines and funded by either a national government or public or private healthcare insurance and based on standardized assessment scales. The aim of this study is to show what elements of follow-up visits are recommended.

OBJECTIVES

The group of patients for whom the structured follow-up systems are intended were children born very preterm (<32 weeks gestation) or full-term born children with severe neonatal complications.

MATERIAL AND METHODS

The methods for monitoring neurodevelopment include the following: The General Movements Assessment (GMA), the Ages and Stages Questionnaire (ASQ-3), the Bayley Scales of Infant and Toddler Development (BSID-4), and the Parent Report of Children's Abilities-Revised (PARCA-R).

RESULTS

The results of follow-up visits should be registered.

CONCLUSIONS

The benefits of follow-up neuromotor development assessments can be observed at school age and even in adulthood.

Towards novel classification of infants' movement patterns supported by computerized video analysis

BACKGROUND

Positional preferences, asymmetry of body position and movements potentially indicate abnormal clinical conditions in infants. However, a lack of standardized nomenclature hinders accurate assessment and documentation of these preferences over time. Video tools offer a safe and reproducible method to analyze and describe infant movement patterns, aiding in physiotherapy management and goal planning. The study aimed to develop an objective classification system for infant movement patterns with particular emphasis on the specific distribution of muscle tension, using methods of computer analysis of video recordings to enhance accuracy and reproducibility in assessments.

METHODS

The study involved the recording of videos of 51 infants between 6 and 15 weeks of age, born at term, with an Apgar score of at least 8 points. Based on observations of a recording of infant spontaneous movements in the supine position, experts identified postural-motor patterns: symmetry and typical asymmetry linked to the asymmetrical tonic neck reflex. Deviations from the typical postural-motor system were indicated, and subcategories of atypical patterns were distinguished. A computer-based inference system was developed to automatically classify individual patterns.

RESULTS

The following division of motor patterns was used: (1) normal patterns, including (a) typical (symmetrical, asymmetrical: variants 1 and 2); and (b) atypical (variants: 1 to 4), (2) positional preference, and (3) abnormal patterns. The proposed automatic classification method achieved an expert decision mapping accuracy of 84%. For atypical patterns, the high reproducibility of the system's results was confirmed. Lower reproducibility, not exceeding 70%, was achieved with typical patterns.

CONCLUSIONS

Based on the observation of infant spontaneous movements, it is possible to identify movement patterns divided into typical and atypical patterns. Computer-based analysis of infant movement patterns makes it possible to objectify and satisfactorily reproduce diagnostic decisions.

Revolutionizing Neonatal Care: A Comprehensive Assessment of Neuromotor Development in At-Risk Infants Using the Novel Neonatal Infant Motor Assessment Scale (NIMAS) Test Battery

We developed a new neonatal neuromotor test battery, the Neonatal Infant Motor Assessment Scale (NIMAS), to perform a detailed neuromotor and holistic assessment of at-risk infants in the neonatal period.

METHODS

A total of 68 infants (28-41 Gestational weeks) hospitalised in the Neonatal Intensive Care Unit were included in the study. The NIMAS is a scale consisting of Automatic Motor Area, Functional Motor Area and sociodemographic form. The Dubowitz Neurological Examination and the Amiel-Tison Neurological Assessment Tests were also applied to evaluate the construct validity of the test.

RESULTS

The mean gestational age at birth was 34.62 ± 3.07 weeks and birth weight was 2305.66 ± 738.95. Fifty-one (75%) of the babies were premature and 17 (25%) were term babies. The KMO value to test the adequacy of the distribution for factor analysis was found to be at a very good level. Barlett's test result was 2198.389 (p < 0.05). The amount of variance obtained as 44.76% in the study was at a sufficient level. The factor loads of the questions in the automatic motor domain dimension varied between 0.523 and 0.694 and the factor loads of the questions in the functional motor domain dimension varied between 0.619 and 0.772. Since Cronbach's alpha was above 0.70, the reliability was adequate. Inter-rater scale agreement in the automatic motor domain was 81.1%; scale agreement in the functional motor domFain was 92.9%; and the NIMAS total score agreement was 93.4%. These agreements were statistically significant (p < 0.05). Total correlation above 0.20 indicates that the item is important for the question. According to the results obtained, total correlation values were between 0.258 and 0.720.

CONCLUSIONS

The NIMAS is the first test battery to assess the "Functional Motor Area" and this questionnaire, based on the results of the analyses, is a valid, reliable and clinically usable measurement tool for the infant at-risk at the neonatal period.

Early object skill supports growth in role-differentiated bimanual manipulation in infants

The ability to coordinate the hands together to act on objects where each hand does something different is known as role-differentiated bimanual manipulation (RDBM). This study investigated two motor skills that may support the development of RDBM: infants' early object skill and their early sitting skill. To evaluate these potential predictors of RDBM growth, 90 infants were examined in a lab-based longitudinal design over a 9-month period. Latent growth modeling was used to estimate RDBM growth trajectories over 9 to 14 months from infants' object and sitting skills at 6 months, controlling for infant's sex, mother's education, and family income. Higher object skill, controlling for sitting skill, was related to a higher increase in RDBM over time. Sitting did not predict infants' change in RDBM over time, controlling for object skill. The ability to manage multiple objects may support collaborative hand use by providing infants with opportunities to practice actions that will be needed later for RDBM. By comparison, sitting may free the hands in an unspecified manner for manipulation.

Early neurological and motor function in infants born moderate to late preterm or small for gestational age at term: a prospective cohort study

BACKGROUND

There are inconsistent findings regarding neurological and motor development in infants born moderate to late preterm and infants born small for gestational age at term. The primary aim of this study was to compare neurological and motor function between preterm, term SGA and term AGA infants aged three to seven months corrected age using several common assessment tools. The secondary aim was to investigate their motor function at two years.

METHODS

In this prospective cohort study, we included 43 infants born moderate to late preterm with gestational age 32-36 + 6 weeks, 39 infants born small for gestational age (SGA) at term with a birthweight ≤ 10th centile for gestational age, and 170 infants born at term with appropriate weight for gestational age (AGA). Neurological and motor function were assessed once in infancy between three to seven months corrected age by using four standardised assessment tools: Hammersmith Infant Neurological Examination (HINE), Test of Infant Motor Performance, General Movements Assessment and Alberta Infant Motor Scale. The Ages and Stages Questionnaire (ASQ-2) was used at two years.

RESULTS

At three to seven months corrected age, mean age-corrected HINE scores were 61.8 (95% confidence interval (CI): 60.5 to 63.1) in the preterm group compared with 63.3 (95% CI: 62.6 to 63.9) in the term AGA group. Preterm infants had 5.8 (95% CI: 2.4 to 15.4) higher odds for HINE scores < 10th percentile. The other test scores did not differ between the groups. At two years, the preterm group had 17 (95% CI: 1.9 to 160) higher odds for gross motor scores below cut-off on ASQ-2 compared with the term AGA group.

CONCLUSIONS

The present study found subtle differences in neurological function between preterm and term AGA infants in infancy. At two years, preterm children had poorer gross motor function. The findings indicate that moderate prematurity in otherwise healthy infants pose a risk for neurological deficits not only during the first year, but also at two years of age when compared with term AGA children.

Automated postural asymmetry assessment in infants neurodevelopmental evaluation using novel video-based features

BACKGROUND AND OBJECTIVE

Neurodevelopmental assessment enables the identification of infant developmental disorders in the first months of life. Thus, the appropriate therapy can be initiated promptly, increasing the chances for correct motor function. Posture asymmetry is one of the crucial aspects evaluated during the diagnosis. Available diagnostic methods are mainly based on qualitative assessment and subjective expert opinion. Current trends in computer-aided diagnosis focus mostly on analyzing infants' spontaneous movement videos using artificial intelligence methods, based primarily on limbs movement. This study aims to develop an automatic method for determining the infant's positional asymmetry in a video recording using computer image processing methods.

METHODS

We made the first attempt to determine positional preferences in a recording automatically. We proposed six quantitative features describing trunk and head position based on pose estimation. As a result of our algorithm, we estimate the percentage of each trunk position in a recording using known machine learning methods. The training and test sets were created from 51 recordings collected during our research and 12 recordings from the benchmark dataset evaluated by five of our experts. The method was assessed using the leave-one-subject-out cross-validation method for ground truth video fragments and different classifiers. Log loss for multiclass classification and ROC AUC were determined to evaluate the results for both our and benchmark datasets.

RESULTS

In a classification of the shortened side, the QDA classifier yields the most accurate results, gaining the lowest log loss of 0.552 and AUC of 0.913. The high accuracy (92.03) and sensitivity (93.26) confirm the method's potential in screening for asymmetry.

CONCLUSIONS

The method allows obtaining quantitative information about positional preference, a valuable extension of basic diagnostics without additional tools and procedures. In combination with an analysis of limbs movement, it may constitute one of the elements of a novelty computer-aided infants' diagnosis system in the future.

The reliability and predictive ability of the Test of Infant Motor Performance (TIMP) in a community-based study in Bhaktapur, Nepal

AIM

In a Nepalese setting, to measure the reliability of the Test of Infant Motor Performance (TIMP) and its ability to predict development scores at 6 months.

METHODS

Nepalese infants (n = 705) were assessed by the TIMP when they were 8-12 weeks old and the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III) at 6 months. Inter-rater agreement was expressed by intraclass correlation coefficients (ICCs), the internal consistency by Cronbach's alphas and Pearson correlation coefficients. Predictive ability was estimated in linear regression models.

RESULTS

Inter-rater agreement was excellent (ICCs > 0.93). Alphas for the TIMP total scores were 0.76 for infants born to term and 0.72 in those born preterm. Correlation coefficients between TIMP total and Bayley-III subscale-scores ranged from 0.05 to 0.28 for term infants and from 0.15 to 0.43 for preterm infants. Using American norms, 56.3 % had TIMP scores within average and 43.7 % below average range. Bayley-III subscale scores were lower in children with TIMP scores below the average range, with the strongest estimates for Gross motor and Socio-emotional development.

INTERPRETATION

The reliability of the TIMP was acceptable, and the TIMP could be a feasible tool to monitor infant motor development in low-resource settings. Properties of the TIMP differed according to gestational age.

Motor development in infants with complex congenital heart disease: A longitudinal study

AIM

To evaluate whether infants with complex congenital heart disease (CCHD) have an increased risk of impaired quality of motor behavior and delayed motor milestones.

METHOD

A cohort of 69 infants with CCHD (43 males, 26 females) were assessed with the Infant Motor Profile (IMP) at three time periods between 6 to 18 months, mean ages in months (SD): 6.4 (0.7); 12.7 (1.0); 18.5 (0.7) IMP data were available from a reference sample of 300 Dutch infants. Analyses included multivariable logistic regression analysis to estimate differences in IMP scores below the 15th centile between children with CCHD and the reference group, and linear mixed-effects models to assess the effect of ventricular physiology and systemic oxygen saturation (SpO2) of less than 90% on IMP outcomes.

RESULTS

Infants with CCHD had increased risks of total IMP scores below the 15th centile (lowest odds ratio [OR] at 18mo: 6.82 [95% confidence interval {CI} 2.87-16.19]), especially because of lower scores in the domains of variation, adaptability, and performance. Children with single ventricle CCHD scored consistently 3.03% (95% CI 1.00-5.07) lower than those with two ventricle physiology, mainly from contributions of the variation and performance domains. SpO2 of less than 90% was associated with 2.52% (95% CI 0.49-4.54) lower IMP scores.

INTERPRETATION

CCHD, especially single ventricle physiology, increases risk of impaired motor development.

WHAT THIS PAPER ADDS

Complex congenital heart disease (CCHD) substantially increases risk of impaired motor development. CCHD is associated with motor delay and reduced motor variation and adaptability. Single ventricle physiology increases the risk of impaired motor behavior.

Psychometric properties of the Infant Motor Profile (IMP): A scoping review protocol

INTRODUCTION

The IMP is a novel video-based instrument to assess motor behavior of infants. It evaluates gross and fine motor behavior in five domains: variation, adaptability, symmetry, fluency, and performance. The latter assesses motor milestones, the other four domains assess qualitative aspects of movements. Literature suggests that it is a promising tool for pediatric health care, as its assists early detection of neurodevelopmental disorders and facilitates the design and monitoring of early intervention. This, this scoping review (ScR) aims to evaluate the psychometric properties of the Infant Motor Profile (IMP).

MATERIAL AND METHODS

A systematic search will be conducted to identify relevant studies up to October 15, 2022. All papers published in English that evaluated or used the IMP in children under two years of age will be included. The search will be performed in Pubmed, Lilacs, PEDro, Scielo, CINAHL, Embase, Web of Science, Ovid PsycINFO, Cochrane Database of Systematic Reviews, as well as in gray literature sources following the University of Toronto library guidelines. Standardized data extraction forms (Excel Tables) will be used to collect information. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for the Scoping Reviews (PRISMA-ScR) Checklist and JBI guidelines will be taken into consideration for results analysis and reporting.

DISCUSSION

This Scoping Review will summarize available knowledge on the psychometric properties of the IMP. By proving that IMP is a reliable tool, a valid predictor of neurodevelopmental outcomes and a responsive instrument to measure change induced by early intervention, this will facilitate the implementation of the IMP in pediatric health care. It will assist the detection of infants at high risk of neurodevelopmental disorders, and it will facilitate the design of the tailor-made early intervention.

SCOPING REVIEW PROTOCOL REGISTRATION

This scoping review protocol has been registered at Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/4HYKZ).

A markerless pipeline to analyze spontaneous movements of preterm infants

BACKGROUND AND OBJECTIVE

The analysis of spontaneous movements of preterm infants is important because anomalous motion patterns can be a sign of neurological disorders caused by lesions in the developing brain. A diagnosis in the first weeks of child's life is crucial to plan timely and appropriate rehabilitative interventions. An accurate visual assessment of infants' spontaneous movements requires highly specialized personnel, not always available, and it is operator dependent. Motion capture systems, markers and wearable sensors are commonly used for human motion analysis, but they can be cumbersome, limiting their use in the study of infants' movements.

METHODS

In this paper we propose a computer-aided pipeline to characterize and classify infants' motion from 2D video recordings. The final goal is detecting anomalous motion patterns. The implemented pipeline is based on computer vision and machine learning algorithms and includes a specific step to increase the interpretability of the results. Specifically, it can be summarized by the following steps: (i) body keypoints detection: we rely on a deep learning-based semantic features detector to localize the positions of meaningful landmark points on infants' bodies; (ii) parameters extraction: starting from the trajectories of the detected landmark points, we extract quantitative parameters describing infants motion patterns; (iii) classification: we implement different classifiers (Support Vector Machines, Random Forest, fully connected Neural Network, Long Short Term Memory) that, starting from the motion parameters, classify between normal or abnormal motion patterns.

RESULTS

We tested the proposed pipeline on a dataset, recorded at the 40th gestational week, of 142 infants, 59 with evidence of neuromotor disorders according to a medical assessment carried out a posteriori. Our procedure successfully discriminates normal and anomalous motion patterns with a maximum accuracy of 85.7%.

CONCLUSIONS

In conclusion, our pipeline has the potential to be adopted as a tool to support the early detection of abnormal motion patterns in preterm infants.

The prevalence and clinical relevance of hyperhomocysteinemia suggesting vitamin B12 deficiency in presumed healthy infants

BACKGROUND

Previous studies have demonstrated a high prevalence of biochemical vitamin B12 deficiency in infants in Norway. Increased total homocysteine (tHcy) is the most important marker of B12 deficiency in infants. There is a need to evaluate its clinical relevance.

AIMS

To investigate the prevalence of hyperhomocysteinemia (S-tHcy > 8 μmol/L) suggestive of suboptimal B12 status and the prevalence of clinically relevant hyperhomocysteinemia in presumed healthy infants in Norway. Further, to evaluate risk factors, presence of symptoms and psychomotor development in these children.

METHODS

In a prospective study we clinically examined 252 infants aged 3-7 months using standardized neurological and psychomotor tests prior to analyzing biochemical B12 deficiency markers in 250 infants.

RESULTS

Twenty-five of 250 (10%) infants had hyperhomocysteinemia combined with clinically relevant symptoms suggestive of B12 deficiency. Hyperhomocysteinemia was associated with tremor, excessive sleep, and sub-normal scores in the fine motor section of the Ages and Stages Questionnaire. One-hundred and fourteen of 250 (46%) infants had hyperhomocysteinemia. Multiple regression analysis showed months of infant formula use as the strongest negative predictor for hyperhomocysteinemia.

CONCLUSION

We have demonstrated associations between symptoms suggestive of infant B12 deficiency and increased levels of tHcy in presumed healthy infants The combination of hyperhomocysteinemia and associated relevant symptoms suggestive of B12 deficiency was a common finding, albeit most infants with hyperhomocysteinemia did not show symptoms.

Functional movement assessment with the Test of Infant Motor Performance

The purpose of this article is to review research on the Test of Infant Motor Performance, a functional assessment of movement capabilities with age standards for infants from 34 weeks postmenstrual age through 17 weeks post term (corrected age). The Test of Infant Motor Performance was normed on a U.S. population-based sample to support its use as a tool for diagnosing delayed motor development in early infancy. The test is one of the preferred methods for parents of babies in special care nurseries to learn about their infant's development. The test was used in a variety of clinical trials to document effects of early therapy and can be used as a short-term outcome measure for other interventions expected to impact functional motor performance.

Concurrent and predictive validity of the infant motor profile in infants at risk of neurodevelopmental disorders

BACKGROUND

Preterm infants and infants with perinatal brain injury show a higher incidence of neurodevelopmental disorders (NDD). The Infant Motor Profile (IMP) is a clinical assessment which evaluates the complexity of early motor behaviour. More data are needed to confirm its predictive ability and concurrent validity with other common and valid assessments such as the Alberta Infant Motor Scale (AIMS) and Prechtl's General Movement Assessment (GMA). The present study aims to evaluate the concurrent validity of the IMP with the AIMS, to assess its association with the GMA, to evaluate how the IMP reflects the severity of the brain injury and to compare the ability of the IMP and the AIMS to predict an abnormal outcome in 5-month-old infants at risk of NDD.

METHODS

86 infants at risk of NDD were retrospectively recruited among the participants of two clinical trials. Preterm infants with or without perinatal brain injury and term infants with brain injury were assessed at 3 months corrected age (CA) using the GMA and at 5 months CA using the IMP and the AIMS. The neurodevelopmental outcome was established at 18 months.

RESULTS

Results confirm a solid concurrent validity between the IMP Total Score and the AIMS (Spearman's ρ 0.76; p < .001) and a significant association between IMP Total Score and the GMA. Unlike the AIMS, the IMP Total score accurately reflects the severity of neonatal brain injury (p < .001) and proves to be the strongest predictor of NDD (p < .001). The comparison of areas under receiver operating characteristic curves (AUC) confirms that the IMP Total score has the highest diagnostic accuracy at 5 months (AUC 0.92). For an optimal IMP Total Score cut-off value of 70, the assessment shows high sensitivity (93%) and specificity (81%) (PPV 84%; NPV 90%).

CONCLUSIONS

Early motor behaviour assessed with the IMP is strongly associated with middle-term neurodevelopmental outcome. The present study confirms the concurrent validity of the IMP with the AIMS, its association with the GMA and its ability to reflect brain lesion load, hence contributing to the construct validity of the assessment.

TRIAL REGISTRATION

NCT01990183 and NCT03234959 (clinicaltrials.gov).

Standardized motor assessments before the age of five predicting school-aged motor outcome including DCD: A systematic review

AIM

Developmental Coordination Disorder (DCD) is a common neurodevelopmental disorder usually diagnosed at primary-school-age. This systematic review aimed to summarize available standardized motor assessments before five years of age predicting DCD, complex Minor Neurological Disorder (cMND) and motor delay assessed by a standardized motor test.

METHODS

A systematic search was performed in MEDLINE, CINAHL, WoS, Scopus, CENTRAL and ERIC. A hand search was executed. Only data of non-Cerebral Palsy children was included.

RESULTS

At or before two years, the BSID, motor subtests of GMDS, NOMAS, and NSMDA might be valuable in detecting school-aged motor delay, while starting at three years, the PDMS, motor subtests of GMDS, NSDMA, M-ABC-2, and CAMPB show promising results. General movements Assessment is associated with cMND, but does not seem sensitive enough to detect DCD. Predictive values are superior in high-risk groups and improve as children age. However, no assessment instrument reached 80% sensitivity and specificity.

CONCLUSION

Standardized motor assessments before five years seem valuable in detecting early motor problems. More longitudinal research commencing in infancy, including multiple assessments over time and the implementation of clear diagnostic criteria is imperative.

Kaul Y, Strand Brodd K, Persson K, Hellström‐Westas L. Structured Observation of Motor Performance in Infants: Level and quality associated with later motor development

AIM

The aim of this study was to investigate the level of motor development and the quality of motor performance during the first 10 months in relation to the Bayley Scales of Infant Development-third edition (Bayley-III) motor index at 2.5 years.

METHODS

Children born very preterm from a population-based study (n = 113) were assessed with the Structured Observation of Motor Performance in Infants (SOMP-I) at 2, 4, 6 and 10 months corrected age and the Bayley-III motor index at 2.5 years corrected age (n = 98). Logistic regressions were performed to investigate the independent association of each SOMP-I domain to Bayley-III motor index.

RESULTS

There were significant associations between the SOMP-I-scores and Bayley-III motor index per every assessment age. At 4 months, both level and quality were independently associated with a later motor outcome, OR for level was 1.26 (95% CI = 1.08-1.50, P = .002) and for quality, 0.75 (95% CI = 0.63-0.90, P = .002). Quality was independently associated with the Bayley-III motor index at 6 and 10 months: OR 0.080 (95% CI = 0.67-0.95 P = .010) and 0.79 (95% CI = 0.64-0.97, P = .026).

CONCLUSION

Both SOMP-I domains, level and quality, are markers to identify motor problems early. Quality became more important with age.

Alberta Infant Motor Scale: Cross-cultural analysis of gross motor development in Dutch and Canadian infants and introduction of Dutch norms

BACKGROUND

The Alberta Infant Motor Scale (AIMS) has been developed in Canada in the 90ies. The AIMS and its Canadian norms are frequently used across the world to monitor infants' gross motor development. Currently, it is disputed whether the Canadian norms are valid for non-Canadian infants.

AIMS

To compare scores on the AIMS of Dutch infants with that of the Canadian norms, to compare the sequence of motor milestones in Dutch and Canadian infants, and to establish Dutch AIMS norms.

STUDY DESIGN

Cross-sectional study.

SUBJECTS

1697 infants, aged 2-18 months, representative of the Dutch population (gestational age 39.7 weeks (27-42)).

OUTCOME MEASURE

AIMS assessments, based on standardized video. Perinatal and social information was obtained by questionnaire and medical records. To create Dutch reference values quantile regression with polynomial splines was used.

RESULTS

1236 Dutch infants (73%) scored below the 50th (P50) percentile of the Canadian norms, 653 (38%) below the P10 and 469 (28%) below the P5. In infants aged 6 to 12 months these values were: 567 infants (81%) < P50, 288 infants (41%) < P10, 201 infants (29%) < P5. The sequence of achievement of motor milestones of Dutch and Canadian infants was similar. Dutch norm-reference values of the AIMS were calculated.

CONCLUSIONS AND IMPLICATIONS

Gross motor development of Dutch infants is considerably slower than that of the Canadian AIMS norms sample. To prevent overdiagnosis of developmental delay and overreferral to paediatric physiotherapy Dutch AIMS norms are required. The paper introduces these norms, including percentile ranks.

The quality of general movements in infants with complex congenital heart disease undergoing surgery in the neonatal period

BACKGROUND

Advances in diagnostic technologies, surgical management, and perioperative care have increased survival for neonates with complex congenital heart disease (CCHD). The success of these advances exposed a heightened risk of brain injury and developmental disabilities. The General Movements Assessment, a non-invasive method, may detect early neurodevelopmental impairments in high-risk infants.

AIMS

To examine whether infants with CCHD undergoing neonatal surgery have higher prevalence of atypical general movements (GMs) than a reference group, and whether single ventricle physiology with systemic oxygen saturations <90% increases risk for atypical GMs.

METHODS

Serial General Movements Assessment (GMA) in a cohort of infants with CCHD (n = 74) at writhing (term-6 weeks) and fidgety (7-17 weeks) GM-age. GMA focused on the presence of definitely abnormal GM-complexity and absent fidgety movements. Single GMAs at 3 months were available from a reference sample of Dutch infants (n = 300). Regression analyses examined relationships between cardiac characteristics and definitely abnormal GM-complexity.

RESULTS

Higher prevalence of definitely abnormal GM-complexity in infants with CCHD compared to reference infants (adjusted OR 5.938, 95% CI 2.423-14.355), single ventricle CCHD increased the risk. Occurrence of absent fidgety movements was similar in infants with CCHD and reference infants (adjusted OR 0.475, 95% CI 0.058-3.876). Systemic postoperative oxygen saturations <90% was associated with higher risk of definitely abnormal GM-complexity at fidgety (adjusted OR 16.445 95% CI 1.149-235.281), not at writhing age.

CONCLUSIONS

Infants with CCHD, especially those with single ventricle CCHD, are at increased risk of definitely abnormal GM-complexity. GMA at fidgety age is recommended.

Using network analysis to capture developmental change: An illustration from infants' postural transitions

Network analysis is a tool typically used to assess interrelationships between social entities in a system. In this methodological report, we introduce how concepts from network analysis can be utilized to capture, condense, and extract complex developmental changes in individual behaviors over time. Using infant postural-locomotor development as an example, we demonstrate how network analysis principles can be applied to rich empirical data. We used existing free-play data from 13 infants followed longitudinally as they progressed from sitting to walking. We documented the range of postures adopted during play, how often infants transitioned between postures in their postural networks, and derived parameters of density and centrality. Analysis revealed that posture network density increased after infants learned to crawl and gained crawling experience as one might expect, but density did not further expand with gains in upright locomotion. Certain postures held different roles in the overall posture network displayed by an infant, and these centrality patterns depended on the time period involved. More central postures in the network were not always postures in which infants spent the most time. We discuss how network analysis might be utilized to better understand infant behaviors in other contexts (e.g., problem-solving, interventions, humanoid robotics).

The general movements assessment in term and late-preterm infants diagnosed with neonatal encephalopathy, as a predictive tool of cerebral palsy by 2 years of age: a scoping review protocol

BACKGROUND

Prediction of long-term neurodevelopmental outcomes remains an elusive goal for neonatology. Clinical and socioeconomic markers have not proven to be adequately reliable. The limitation in prognostication includes those term and late-preterm infants born with neonatal encephalopathy. The General Movements Assessment tool by Prechtl has demonstrated reliability for identifying infants at risk for neuromotor impairment. This tool is non-invasive and cost-effective. The purpose of this study is to identify the published literature on how this tool applies to the prediction of cerebral palsy in term and late-preterm infants diagnosed with neonatal encephalopathy and so detect the research gaps.

METHODS

We will conduct a systematic scoping review for data on sensitivity, specificity, positive, and negative predictive value and describe the strengths and limitations of the results. This review will consider studies that included infants more than or equal to 34 + 0 weeks gestational age, diagnosed with neonatal encephalopathy, with a General Movements Assessment done between birth to six months of life and an assessment for cerebral palsy by at least 2 years of age. Experimental and quasi-experimental study designs including randomized controlled trials, non-randomized controlled trials, before and after studies, interrupted time-series studies and systematic reviews will be considered. Case reports, case series, case control, and cross-sectional studies will be included. Text, opinion papers, and animal studies will not be considered for inclusion in this scoping review as this is a highly specific and medical topic. Studies in the English language only will be considered. Studies published from at least 1970 will be included as this is around the time when the General Movements Assessment was first introduced in neonatology as a potential predictor of neuromotor outcomes. We will search five databases (MEDLINE, Embase, PsychINFO, Scopus, and CINAHL). Two reviewers will conduct all screening and data extraction independently. The articles will be categorized according to key findings and a critical appraisal performed.

DISCUSSION

The results of this review will guide future research to improve early identification and timely intervention in infants with neonatal encephalopathy at risk of neuromotor impairment.

SYSTEMATIC REVIEW REGISTRATION

Title registration with Joanna Briggs Institute https://joannabriggs.org/ebp/systematic_review_register .

Reliability and Responsiveness of the Observable Movement Quality Scale for Children with Mild to Moderate Motor Impairments

AIM

The Observable Movement Quality (OMQ) scale measures generic movement quality and is used alongside standardized age-adequate motor performance tests. The scale consists of 15 items, each focusing on a different aspect; together, the entire construct of movement quality is assessed. This study aimed to determine interrater and intrarater reliability, and responsiveness of the OMQ scale.

METHODS

A prospective intervention study with pre-post design in pediatric physical therapy practices. For interrater reliability, 3 physical therapists observed video-recorded motor assessments of 30 children with mild to moderate motor impairments -aged 4 to 12 years-using the OMQ scale. One therapist scored baseline assessment a second time for intrarater reliability, and to calculate smallest detectable change (SDC). Responsiveness (n = 28) was tested by comparing outcomes before and after intervention.

RESULTS

Interrater reliability was moderate to good (ICC_2,1: 0.79); intrarater reliability was high (ICC_2,1: 0.97). Responsiveness results revealed an SDC of 2.4 and a minimal important change of 2.5; indicating sufficient validity in differentiating groups of children showing improved versus unchanged movement quality.

CONCLUSION

The OMQ scale is reliable and responsive to change when used to assess movement quality in clinical practice for children with mild to moderate motor impairments, aged 4-12 year.

Early Clinical Features of Cerebral Palsy in Children Without Perinatal Risk Factors: A Scoping Review

BACKGROUND

The early identification of cerebral palsy (CP) in the primary care context is often problematic and referral for diagnosis often delayed. This study aimed to identify clinical features associated with the early detection of CP that can be used by the primary care provider.

METHODS

We performed a scoping review by searching six electronic databases. We included English language articles that addressed the diagnosis of CP and/or its differential diagnosis in children and ways of detecting CP before the diagnosis is established (i.e., early clinical signs of CP) via (1) questions on the patient's clinical history, (2) developmental screening and/or health questionnaires, or (3) physical or neurological examination.

RESULTS

Included studies (n = 41; 27 overview studies and 14 original studies) were grouped into the three themes. Most of the overview articles relied on expert opinion, and all original studies included patients at high risk of developing CP. The most commonly identified features from each theme were early hand preference on clinical history, delayed or absent achievement of motor developmental milestones on developmental screening, and persistent primitive reflexes on neurological examination.

CONCLUSIONS

Overall, the literature on the early observable clinical signs that should prompt referral for investigation of possible CP in the specific context of well-baby care surveillance was sparse and inconsistent. Further research should focus on evaluating the contribution of readily identifiable clinical features.

Using accelerometry for measurement of motor behavior in children: Relationship of real-world movement to standardized evaluation

BACKGROUND

When detected, children with asymmetrical motor impairment are referred for therapeutic interventions to maximize the child's ability to reach their health and developmental potential. Referal is dependent on standardized evaluation, which rarely examines upper extremity (UE) function within the context of real-world activity. Accelerometry provides an efficient method to objectively measure movement in children. The purpose of this study was to compare accelerometry to clinical assessment, specifically the Melbourne Assessment of Unilateral Upper Limb Function-2 (MA-2).

METHODS

A total of 52 children between 1-17 years of age with asymmetrical motor deficits and age matched controls participated in this study. Participants wore bilateral accelerometers for 4 x 25 h. The use ratio (UR) and mono-arm use index (MAUI) were calculated to quantify asymmetrical impairment. The Melbourne Assessment of Unilateral Upper Limb Function-2 (MA-2) was administered and compared to accelerometry variables.

RESULTS

The UR and MAUI were significantly different in children with and without deficits. The MAUI was significantly correlated with all domains of the MA-2: accuracy (r = 0.44, p = 0.026); fluency (r = 0.52, p = 0.006); dexterity (r = 0.53, p = 0.005); and range of motion (r = 0.49, p = 0.011).

CONCLUSIONS

Our findings suggest a relationship between real-world movement and clinical evaluation.

Construct Validity of the Observable Movement Quality Scale in Pediatrics: Hypothesis Testing of a Formative Measurement Model

BACKGROUND

The Observable Movement Quality (OMQ) Scale measures generic movement quality. Each item of the OMQ Scale focuses on a different element; together, the 15 items assess the whole construct of movement quality.

OBJECTIVE

The aim of this study was to determine the construct validity of the OMQ Scale using 7 hypotheses defined to conform to the Consensus-Based Standards for the Selection of Health Measurement Instruments.

DESIGN

This was an exploratory validation study.

METHODS

A pediatric physical therapist assessed motor performance in 101 children using an age-specific motor test and the OMQ Scale. The direction, magnitude, and rationale for 7 hypotheses, which concerned relationships (n = 2), probability of low scores (n = 4), and difference between diagnosis subgroups (n = 1), were defined.

RESULTS

The results confirmed 6 of the 7 hypotheses, indicating sufficient construct validity. Significant positive relationships were found between OMQ Scale total scores and the severity of motor disabilities (r = 0.72) and z scores on motor tests (r = 0.60). Probabilities for low scores on OMQ Scale items-exceeding the chi-square critical value-were confirmed for children diagnosed with spasticity, psychomotor retardation, mitochondrial diseases, and ataxia; however, probabilities for low OMQ Scale item scores on strength regulation in children with ataxia were not confirmed. OMQ Scale total scores for children who were not ambulatory because of neurological conditions were significantly different from those for children who were not ambulatory because of fatigue (r = 0.66).

LIMITATIONS

The sample of children was based on theoretical assumptions about relevant variations in clinical representations; on the basis of the results, it appears that children with low strength regulation were underrepresented.

CONCLUSION

The confirmation of nearly all hypotheses supported the validity of the OMQ Scale for measuring movement quality in clinical practice in addition to standardized age-adequate motor performance tests.

Reliability and predictive validity of the Standardized Infant NeuroDevelopmental Assessment neurological scale

AIM

To assess reliability and predictive validity of the neurological scale of the Standardized Infant NeuroDevelopmental Assessment (SINDA), a recently developed assessment for infants aged 6 weeks to 12 months.

METHOD

To assess reliability, three assessors independently rated video-recorded neurological assessments of 24 infants twice. Item difficulty and discrimination were determined. To evaluate predictive validity, 181 infants (median gestational age 30wks [range 22-41wks]; 92 males, 89 females) attending a non-academic outpatient clinic were assessed with SINDA's neurological scale (28 dichotomized items). Atypical neurodevelopmental outcome at 24 months or older corrected age implied a Bayley Mental Developmental Index or Psychomotor Developmental Index lower than 70 or a diagnosis of cerebral palsy (CP). Predictive values were calculated from SINDA (2-12mo corrected age, median 3mo) and typical versus atypical outcome.

RESULTS

Intraclass correlation coefficients of intrarater and interrater agreement of the neurological score varied between 0.923 and 0.965. Item difficulty and discrimination were satisfactory. At 24 months or older, 56 children (31%) had an atypical outcome (29 had CP). Atypical neurological scores (below 25th centile, ≤21) predicted atypical outcome and CP with sensitivities of 89% and 100%, and specificities of 94% and 81% respectively.

INTERPRETATION

SINDA's neurological scale is reliable and in a non-academic outpatient setting has a satisfactory predictive validity for atypical developmental outcome, including CP, at 24 months or older.

WHAT THIS PAPER ADDS

The Standardized Infant NeuroDevelopmental Assessment's neurological scale has a good to excellent reliability. The scale has promising predictive validity for cerebral palsy. The scale has promising predictive validity for other types of atypical developmental outcome.

The role of the family in early intervention of preterm infants with abnormal general movements

Objectives:

To determine the effect of family-based intervention on motor function in preterm infants.

Methods:

This study was designed as a randomized controlled trial between August 2015 and September 2016. Forty-two preterm infants were randomized and split equally between the family-based intervention group, composed of a physiotherapeutic and a familial component (8 males, 8 females; mean age 91±3.09 days), and the traditional early intervention group (8 females, 8 males, mean age: 91.06±2.4 days). Both groups received a treatment program based on a neurodevelopmental approach during 3- to 12-months-old. The groups were evaluated at corrected ages of the third, sixth, ninth, twelfth, and 24th months using the Bayley Scale of Infant and Toddler Development, Third Edition (Bayley-III).

Results:

Within-group changes over time were statistically significant using multivariate tests of fine motor (Multivariate analysis of variance (MANOVA); F=1515.27, p<0.001) and gross motor (MANOVA; F=1950.59, p=0.001) development. However, there was no interaction between groups in fine (MANOVA; F=0.027, p=0.872) and gross motor development (MANOVA; F=0.022, p=0.883).

Conclusion:

The early intervention approaches might support fine and gross motor function development in preterm infants in the first year of life.

Changes in Posture and Interactive Behaviors as Infants Progress From Sitting to Walking: A Longitudinal Study

This longitudinal study assessed how infants and mothers used different postures and modulated their interactions with their surroundings as the infants progressed from sitting to walking. Thirteen infants and their mothers were observed biweekly throughout this developmental period during 10 min laboratory free-play sessions. For every session, we tracked the range of postures mothers and infants produced (e.g., sitting, kneeling, and standing), we assessed the type of interactions they naturally engaged in (no interactions, passive involvement, fine motor manipulation, or gross motor activity), and documented all target transitions. During the crawling transition period, when infants used sitting postures, they engaged mainly in fine motor manipulations of targets and often maintained their activity on the same target. As infants became mobile, their rate of fine motor manipulation declined during sitting but increased while kneeling/squatting. During the walking transition, their interactions with targets became more passive, particularly when sitting and standing, but they also engaged in greater gross motor activity while continuing to use squatting/kneeling postures for fine motor manipulations. The walking period was also marked by an increase in target changes and more frequent posture changes during object interactions. Throughout this developmental period, mothers produced mainly no or passive activity during sitting, kneeling/squatting, and standing. As expected, during this developmental span, infants used their body in increasingly varied ways to explore and interact with their environment, but more importantly, progression in posture variations significantly altered how infants manually interacted with their surrounding world.

Diagnosing cerebral palsy in full-term infants

More than 50% of infants with cerebral palsy (CP) are born at or near term, with the vast majority having pre- or perinatally acquired CP. While some have a clinical history predictive of CP, such as neonatal encephalopathy or neonatal stroke, others have no readily identifiable risk factors. Paediatricians are often required to discriminate generalised motor delay from a variety of other diagnoses, including CP. This paper outlines known causal pathways to CP in term-born infants with a focus on differential diagnosis. Early and accurate diagnosis is important as it allows prompt access to early intervention during the critical periods of brain development. A combination of clinical history taking, standard clinical examination, neuroimaging and genetic testing should be started at the time of referral. Attention to the investigation of common comorbidities of CP, including feeding and sleep difficulties, and referral to early intervention are recommended.

CONCURRENT VALIDITY OF THE BRUNET-LÉZINE SCALE WITH THE BAYLEY SCALE FOR ASSESSMENT OF THE DEVELOPMENT OF PRETERM INFANTS UP TO TWO YEARS

Objective:

To verify the correlation between the areas evaluated by the Brunet-Lézine and the Bayley III scales of preterm infants up to two years.

Methods:

The study included 88 children who were divided into 3 groups: Group 1 (1 month to 5 months and 29 days of corrected chronological ages - CCA) with 32 children; Group 2 (6 months to 11 months and 29 days of CCA) with 36 participants; and Group 3 (18 -23 months and 23 days of CCA) with 20 children. The concurrent validity of the Brunet-Lézine scale and the Bayley III scale was calculated using the Pearson correlation or its non-parametric version, the Spearman correlation.

Results:

Group 1 showed moderate correlation between the developmental quotient for hand-eye and fine motor coordination (DQE), and fine motor score (ρ=0.448; p=0.01). Group 2 had moderate correlation between the developmental quotient for posture and gross motor function (DQP), and the gross motor score (ρ=0.484; p=0.003, between the DQE and fine motor score (r=0.489; p=0.002), and between the developmental quotient for social reactions (DQS) and the socio emotional score (r=0.435; p=0.008). Group 3 showed moderate correlation between the DQP and the gross motor score (ρ=0.468; p=0.037) and strong correlation between developmental quotient for language (DQL) and the score of language (r=0.890; p<0.001).

Conclusions:

The Brunet-Lézine scale showed strong correlation with the Bayley III scale regarding the language domain in Group 3, suggesting its validity to assess the language of children aged between 18 and 24 months.

Position of pelvis in the 3rd month of life predicts further motor development

The aim of the study is to select elements of motor skills assessed at 3 months that provide the best predictive properties for motor development at 9 months. In all children a physiotherapeutic assessment of the quantitative and qualitative development at the age of 3 months was performed in the prone and supine positions, which was presented in previous papers as the quantitative and qualitative assessment sheet of motor development. The neurological examination at the age of 9 months was based on the Denver Development Screening Test II and the evaluation of reflexes, muscle tone (hypotony and hypertony), and symmetry. The particular elements of motor performance assessment were shown to have distinct predictive value for further motor development (as assessed at 9 months), and the pelvis position was the strongest predictive element. Irrespective of the symptomatic and anamnestic factors the inappropriate motor performance may already be detected in the 3rd month of life and is predictive for further motor development. The assessment of the motor performance should be performed in both supine and prone positions. The proper position of pelvis summarizes the proper positioning of the whole spine and ensures proper further motor development. To our knowledge, the presented motor development assessment sheet allows the earliest prediction of motor disturbances.

Interrater Reliability of the Observable Movement Quality Scale for Children

Purpose: The authors investigated the interrater reliability, the standard deviation of the random measurement error, and the limits of agreement (LoA) of the Observable Movement Quality (OMQ) scale in children. Movement quality is important in the recognition of motor problems, and the OMQ scale, a questionnaire used by paediatric physical therapists, has been developed for use with an age-specific motor test to observe movement quality and score relative to what is expected for a child's age. Method: Paediatric physical therapists (n=28; 2 men, 26 women) observed video-recorded assessments of age-related motor tests in children (n=9) aged 6 months to 6 years and filled in the OMQ scale (possible score range 15-75 points). For our analyses, we used linear mixed models without fixed effects. Results: The interrater reliability was moderate (intra-class correlation coefficient [ICC2,1]: 0.67, 95% CI: 0.47, 0.88); neither work setting nor work experience exerted any influence on it. The standard deviation of the random measurement error was 5.7, and the LoA was 31.5. Item agreement was good (proportion of observed agreement [Po] total 0.82-0.99). Conclusion: The OMQ scale showed moderate interrater reliability when being used by therapists who were unfamiliar with the questionnaire and who had received only 2 hours of training. Feedback from the participants suggested a need for more comprehensive training in using the OMQ scale in clinical practice.

Development of the Hand Assessment for Infants: evidence of internal scale validity

AIM

The aim of this study was to develop a descriptive and evaluative assessment of upper limb function for infants aged 3 to 12 months and to investigate its internal scale validity for use with infants at risk of unilateral cerebral palsy.

METHOD

The concepts of the test items and scoring criteria were developed. Internal scale validity and aspects of reliability were investigated on the basis of 156 assessments of infants at 3 to 12 months corrected age (mean 7.2mo, SD 2.5) with signs of asymmetric hand use. Rasch measurement model analysis and non-parametric statistics were used.

RESULTS

The new test, the Hand Assessment for Infants (HAI), consists of 12 unimanual and five bimanual items, each scored on a 3-point rating scale. It demonstrated a unidimensional construct and good fit to the Rasch model requirements. The excellent person reliability enabled person separation to six significant ability strata. The HAI produced an interval-level measure of bilateral hand use as well as unimanual scores of each hand, allowing a quantification of possible asymmetry expressed as an asymmetry index.

INTERPRETATION

The HAI can be considered a valid assessment tool for measuring bilateral hand use and quantifying side difference between hands among infants at risk of developing unilateral cerebral palsy.

WHAT THIS PAPER ADDS

The Hand Assessment for Infants (HAI) measures the use of both hands and quantifies a possible asymmetry of hand use. HAI is valid for infants at 3 to 12 months corrected age at risk of unilateral cerebral palsy.

The Structured Observation of Motor Performance in Infants can detect cerebral palsy early in neonatal intensive care recipients

BACKGROUND

The detection of motor problems in infancy requires a detailed assessment method that measures both the infants' level of motor development and movement quality.

AIMS

To evaluate the ability of the Structured Observation of Motor Performance in Infants (SOMP-I) to detect cerebral palsy (CP) in neonatal intensive care recipients.

STUDY DESIGN

Prospective cohort study analyzed retrospectively.

SUBJECTS

212 (girls: 96) neonatal intensive care recipients (mean gestational age 34weeks, range: 23-43). Twenty infants were diagnosed with CP.

OUTCOME MEASURES

The infants were assessed using SOMP-I at 2, 4, 6 and 10months' corrected age. Accuracy measures were calculated for level of motor development, quality of motor performance and a combination of the two to detect CP at single and repeated assessments.

RESULTS

At 2months, 17 of 20 infants with CP were detected, giving a sensitivity of 85% (95% CI 62-97%) and a specificity of 48% (95% CI 40-55%), while the negative likelihood ratio was 0.3 (95% CI 0.1-0.9) and the positive likelihood ratio was 1.6 (95% CI 1.3-2.0). At 6months all infants with CP were detected using SOMP-I, and all infants had repeatedly been assessed outside the cut-offs. Specificity was generally lower for all assessment ages, however, for repeated assessments sensitivity reached 90% (95% CI 68-99%) and specificity 85% (95% CI 79-90%).

CONCLUSIONS

SOMP-I is sensitive for detecting CP early, but using the chosen cut-off can lead to false positives for CP. Assessing level and quality in combination and at repeated assessments improved predictive ability.

Treadmill interventions in children under six years of age at risk of neuromotor delay

BACKGROUND

Delayed motor development may occur in children with Down syndrome, cerebral palsy, general developmental delay or children born preterm. It limits the child's exploration of the environment and can hinder cognitive and social-emotional development. Literature suggests that task-specific training, such as locomotor treadmill training, facilitates motor development.

OBJECTIVES

To assess the effectiveness of treadmill interventions on locomotor development in children with delayed ambulation or in pre-ambulatory children (or both), who are under six years of age and who are at risk for neuromotor delay.

SEARCH METHODS

In May 2017, we searched CENTRAL, MEDLINE, Embase, six other databases and a number of trials registers. We also searched the reference lists of relevant studies and systematic reviews.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs that evaluated the effect of treadmill intervention in the target population.

DATA COLLECTION AND ANALYSIS

Four authors independently extracted the data. Outcome parameters were structured according to the International Classification of Functioning, Disability and Health model.

MAIN RESULTS

This is an update of a Cochrane review from 2011, which included five trials. This update includes seven studies on treadmill intervention in 175 children: 104 were allocated to treadmill groups, and 71 were controls. The studies varied in population (children with Down syndrome, cerebral palsy, developmental delay or at moderate risk for neuromotor delay); comparison type (treadmill versus no treadmill; treadmill with versus without orthoses; high- versus low-intensity training); study duration, and assessed outcomes. Due to the diversity of the studies, only data from five studies were used in meta-analyses for five outcomes: age of independent walking onset, overall gross motor function, gross motor function related to standing and walking, and gait velocity. GRADE assessments of quality of the evidence ranged from high to very low.The effects of treadmill intervention on independent walking onset compared to no treadmill intervention was population dependent, but showed no overall effect (mean difference (MD) -2.08, 95% confidence intervals (CI) -5.38 to 1.22, 2 studies, 58 children; moderate-quality evidence): 30 children with Down syndrome benefited from treadmill training (MD -4.00, 95% CI -6.96 to -1.04), but 28 children at moderate risk of developmental delay did not (MD -0.60, 95% CI -2.34 to 1.14). We found no evidence regarding walking onset in two studies that compared treadmill intervention with and without orthotics in 17 children (MD 0.10, 95% CI -5.96 to 6.16), and high- versus low-intensity treadmill interventions in 30 children with Down syndrome (MD -2.13, 95% -4.96 to 0.70).Treadmill intervention did not improve overall gross motor function (MD 0.88, 95% CI -4.54 to 6.30, 2 studies, 36 children; moderate-quality evidence) or gross motor skills related to standing (MD 5.41, 95% CI -1.64 to 12.43, 2 studies, 32 children; low-quality evidence), and had a negligible improvement in gross motor skills related to walking (MD 4.51, 95% CI 0.29 to 8.73, 2 studies, 32 children; low-quality evidence). It led to improved walking skills in 20 ambulatory children with developmental delay (MD 7.60, 95% CI 0.88 to 14.32, 1 study) and favourable gross motor skills in 12 children with cerebral palsy (MD 8.00, 95% CI 3.18 to 12.82). A study which compared treadmill intervention with and without orthotics in 17 children with Down syndrome suggested that adding orthotics might hinder overall gross motor progress (MD -8.40, 95% CI -14.55 to -2.25).Overall, treadmill intervention showed a very small increase in walking speed compared to no treadmill intervention (MD 0.23, 95% CI 0.08 to 0.37, 2 studies, 32 children; high-quality evidence). Treadmill intervention increased walking speed in 20 ambulatory children with developmental delay (MD 0.25, 95% CI 0.08 to 0.42), but not in 12 children with cerebral palsy (MD 0.18, 95% CI -0.09 to 0.45).

AUTHORS' CONCLUSIONS

This update of the review from 2011 provides additional evidence of the efficacy of treadmill intervention for certain groups of children up to six years of age, but power to find significant results still remains limited. The current findings indicate that treadmill intervention may accelerate the development of independent walking in children with Down syndrome and may accelerate motor skill attainment in children with cerebral palsy and general developmental delay. Future research should first confirm these findings with larger and better designed studies, especially for infants with cerebral palsy and developmental delay. Once efficacy is established, research should examine the optimal dosage of treadmill intervention in these populations.

Clinical utility of the Structured Observation of Motor Performance in Infants within the child health services

AIM

This study aimed to evaluate the clinical utility of the Structured Observation of Motor Performance in Infants (SOMP-I) when used by nurses in routine child healthcare by analyzing the nurses' SOMP-I assessments and the actions taken when motor problems were suspected.

METHOD

Infants from three child health centers in Uppsala County, Sweden, were consecutively enrolled in a longitudinal study. The 242 infants were assessed using SOMP-I by the nurse responsible for the infant as part of the regular well-child visits at as close to 2, 4, 6 and 10 months of age as possible. The nurses noted actions taken such as giving advice, scheduling an extra follow-up or referring the infant to specialized care. The infants' motor development was reassessed at 18 months of age through review of medical records or parental report.

RESULTS

The assessments of level of motor development at 2 and 10 months showed a distribution corresponding to the percentile distribution of the SOMP-I method. Fewer infants than expected were assessed as delayed at 4 and 6 months or deficient in quality at all assessment ages. When an infant was assessed as delayed in level or deficient in quality, the likelihood of the nurse taking actions increased. This increased further if both delay and quality deficit were found at the same assessment or if one or both were found at repeated assessments. The reassessment of the motor development at 18 months did not reveal any missed infants with major motor impairments.

INTERPRETATION

The use of SOMP-I appears to demonstrate favorable clinical utility in routine child healthcare as tested here. Child health nurses can assess early motor performance using this standardized assessment method, and using the method appears to support them the clinical decision-making.

Impact of Maternal Selenium Status on Infant Outcome during the First 6 Months of Life

Pregnant women and infants are at risk for selenium deficiency, which is known to have negative effects on immune and brain function. We have investigated selenium levels in 158 healthy never-pregnant women and in 114 pregnant and lactating women and their infants at age 6 months and related this to clinical outcomes during the first 6 months of life. Neurodevelopment was assessed with the parental questionnaire Ages and Stages (ASQ) at 6 months. A maternal selenium level ≤0.90 µmol/L in pregnancy week 18 was negatively related to infant neurodevelopment at 6 months (B = -20, p = 0.01), whereas a selenium level ≤0.78 µmol/L in pregnancy week 36 was associated with an increased risk (odds ratio 4.8) of having an infant infection during the first 6 weeks of life. A low maternal selenium status in pregnancy was found to be associated with an increased risk of infant infection during the first 6 weeks of life and a lower psychomotor score at 6 months. We suggest a cutoff for maternal serum selenium deficiency of 0.90 µmol/L in pregnancy week 18 and 0.78 µmol/L in pregnancy week 36. This should be reevaluated in an intervention study.

The Structured Observation of Motor Performance in Infants has convergent and discriminant validity in preterm and term infants

AIM

Methods are needed to evaluate the level of early motor development and quality of motor performance in infants. We examined the convergent and discriminant validity of the Structured Observation of Motor Performance in Infants (SOMP-I) for evaluating the level of motor development and quality of motor performance in preterm and term infants.

METHODS

A regional cohort of 111 preterm infants with a gestational age of <32 weeks and 72 healthy term born infants were assessed with the SOMP-I, at two, four, six and 10 months of corrected age. Convergent validity was analysed with a mixed model analysis of the motor performance over time. Discriminant validity was analysed with the Mann-Whitney U-test in groups with different neonatal characteristics.

RESULTS

Convergent validity was supported, as the level of motor development increased with age and the quality of motor performance improved over time. The method discriminated for both level and quality between the preterm and the term infants. The preterm infants demonstrated different quality deficits regardless of the level of motor development.

CONCLUSION

Convergent validity and discriminant validity of the SOMP-I were supported in preterm and term infants and facilitates early identification of infants with atypical motor development.

Bayley-III motor scale and neurological examination at 2 years do not predict motor skills at 4.5 years

AIM

To determine whether Bayley Scales of Infant and Toddler Development (3rd edition) (Bayley-III) motor scores and neurological examination at 2 years corrected age predict motor difficulties at 4.5 years corrected age.

METHOD

A prospective cohort study of children born at risk of neonatal hypoglycaemia in Waikato Hospital, Hamilton, New Zealand. Assessment at 2 years was performed using the Bayley-III motor scale and neurological examination, and at 4.5 years using the Movement Assessment Battery for Children (2nd edition) (MABC-2).

RESULTS

Of 333 children, 8 (2%) had Bayley-III motor scores below 85, and 50 (15%) had minor deficits on neurological assessment at 2 years; 89 (27%) scored less than or equal to the 15th centile, and 54 (16%) less than or equal to the 5th centile on MABC-2 at 4.5 years. Motor score, fine and gross motor subtest scores, and neurological assessments at 2 years were poorly predictive of motor difficulties at 4.5 years, explaining 0 to 7% of variance in MABC-2 scores. A Bayley-III motor score below 85 predicted MABC-2 scores less than or equal to the 15th centile with a positive predictive value of 30% and a negative predictive value of 74% (7% sensitivity and 94% specificity).

INTERPRETATION

Bayley-III motor scale and neurological examination at 2 years were poorly predictive of motor difficulties at 4.5 years.

Evidence for spared attention to faces in 7-month-old infants after prenatal exposure to antiepileptic drugs

INTRODUCTION

Prenatal antiepileptic drug (AED) exposure is associated with an increased risk of cognitive impairment and autism spectrum disorders detected mainly at the age of two to six years. We examined whether the developmental aberrations associated with prenatal AED exposure could be detected already in infancy and whether effects on visual attention can be observed at this early age.

MATERIAL AND METHODS

We compared a prospective cohort of infants with in utero exposure to AED (n=56) with infants without drug exposures (n=62). The assessments performed at the age of seven months included standardized neurodevelopmental scores (Griffiths Mental Developmental Scale and Hammersmith Infant Neurological Examination) as well as a novel eye-tracking-based test for visual attention and orienting to faces. Background information included prospective collection of AED exposure data, pregnancy outcome, neuropsychological evaluation of the mothers, and information on maternal epilepsy type.

RESULTS

Carbamazepine, oxcarbazepine, and valproate, but not lamotrigine or levetiracetam, were associated with impaired early language abilities at the age of seven months. The general speed of visuospatial orienting or attentional bias for faces measured by eye-tracker-based tests did not differ between AED-exposed and control infants.

DISCUSSION

Our findings support the idea that prenatal AED exposure may impair verbal abilities, and this effect may be detected already in infancy. In contrast, the early development of attention to faces was spared after in utero AED exposure.

Knee jerk responses in infants at high risk for cerebral palsy: an observational EMG study

BACKGROUND

Following our clinical observation of tonic responses in response to the knee jerk in infants at very high risk for cerebral palsy (VHR infants), we systematically studied tonic responses, clonus, and reflex irradiation. We questioned (i) whether these responses occurred more often in VHR infants than in typically developing (TD) infants, and (ii) whether they were associated with abnormal general movement quality.

METHODS

Twenty-four VHR and 26 TD infants were assessed around 3 mo corrected age. Surface electromyograms of leg, trunk, neck, and arm muscles were recorded while eliciting the knee jerk. All assessments were video-recorded.

RESULTS

VHR infants more often than TD infants showed tonic responses in the ipsilateral quadriceps and hamstring (Mann-Whitney U; P = 0.0005 and P = 0.0009), clonus (Chi-square; P = 0.0005) and phasic responses in the contralateral quadriceps and hamstring (Mann-Whitney U; P = 0.002 and P = 0.0003, respectively). Widespread reflex irradiation occurred in VHR and TD infants. Definitely abnormal general movements and stiff movements were associated with tonic responses (Mann-Whitney U; P = 0.0005, P = 0.007, respectively) and clonus (Mann-Whitney U; P = 0.003 and P = 0.0005) in the ipsilateral quadriceps.

CONCLUSION

Similar to clonus, tonic responses may be regarded as a marker of a loss of supraspinal control. Reflex irradiation primarily is a neurodevelopmental phenomenon of early ontogeny.

Intra-observer reliability of Prechtl's method for the qualitative assessment of general movements in Taiwanese infants

[Purpose] The aim of this study was to examine the intra-observer reliability for Prechtl's General Movements Assessment in Taiwanese infants. This includes the global General Movements Assessment, the Optimality List for Preterm General Movements and Writhing Movements, and the Assessment of Motor Repertoire-3 to 5 Months. [Subjects and Methods] Fifty-nine videos of 37 infants were observed and rated by one physical therapist twice. [Results] The intra-observer reliability ranged from good to very good for the global General Movements Assessment. The overall intra-observer reliabilities for the total score of the Optimality List from preterm up to postmenstrual age 46 weeks and the total score of the Assessment of Motor Repertoire for postmenstrual age 49 to 60 weeks were both good. [Conclusion] The results suggest that the intra-observer reliability of a certified physical therapist was satisfactory for Prechtl's method in Taiwanese infants.

Discriminant ability of the Infant Neurological International Battery (INFANIB) as a screening tool for the neurological follow-up of high-risk infants in Colombia

AIM

The aim of this study was to assess the discriminative ability of the Infant Neurological International Battery (INFANIB), applied at 3, 6 and 9 months of corrected age (CA), on neurological outcomes at 1 year of CA.

METHOD

An observational analytic study was conducted on a cohort of 5857 infants, followed up to 1 year of CA in a Kangaroo Mother Care programme from 1993 to 2010 in Bogotá, Colombia. Infants were included if they had two complete INFANIB results at 3 or 6 or 9 months of CA and at 12 months of CA, including the Griffiths Scale. The outcome was defined as the presence of a neurological abnormality, as evidenced by the results of both the INFANIB and Griffiths Scale.

RESULTS

The sensitivity of the INFANIB at 3 months was 62.2%, and specificity was 76.1%, with a receiver operating characteristic (ROC) area of 0.69. At 6 months, the results were 77.5% for sensitivity and 74.4% for specificity (ROC 0.76), and at 9 months, they were 77.2% for sensitivity and 91.1% for specificity (ROC 0.84).

CONCLUSION

The INFANIB was an appropriate neurological screening test with regard to determining which Colombian infants would benefit from a timely intervention for neuromotor disorders.

'Now I use words like asymmetry and unstable': nurses' experiences in using a standardized assessment for motor performance within routine child health care

RATIONALE, AIMS AND OBJECTIVES

There is an increasing recognition that early intervention is important for children with motor disorders. The use of standardized assessment methods within the Swedish Child Health Services (CHS) may improve early identification of these children and thereby their development and quality of care. Given the key role of nurses within the CHS, we explored their experiences of using a structured assessment of motor performance (SOMP-I) in a clinical setting, and investigated possible barriers and facilitators for implementation of the method within the CHS.

METHODS

The study was conducted in 2013 in Uppsala County, Sweden. Ten child health nurses participated in two focus group interviews, which were analysed using systematic text condensation.

RESULTS

The analysis yielded three themes: (1) increased knowledge and professional pride - nurses described their desire to provide high-quality care for which SOMP-I was a useful tool; (2) improved parent-provider relationship - nurses felt that using SOMP-I involved both the parents and their infant to a greater extent than routine care; and (3) conditions for further implementation - nurses described that the time and effort needed to master new skills must be considered and practical barriers, such as lack of examination space, resource constraints and difficulties in documenting the assessment must be addressed before implementing the SOMP-I method in routine care.

CONCLUSION

Child health nurses felt that the SOMP-I method fitted well with their professional role and increased the quality of care provided. However, significant barriers to implementing SOMP-I into routine child health care were described.

In extremely preterm infants, do the Movement Assessment of Infants and the Alberta Infant Motor Scale predict 18-month outcomes using the Bayley-III?

BACKGROUND

Extremely preterm infants are at high-risk for neurodevelopmental disabilities. The Movement Assessment of Infants (MAI) and the Alberta Infant Motor Scale (AIMS) have been designed to predict outcome with modest accuracy with the Bayley-I or Bayley-II.

AIMS

To examine and compare the predictive validity of the MAI and AIMS in determining neurodevelopmental outcome with the Bayley-III.

DESIGN

Retrospective cohort study of 160 infants born at ≤ 28 weeks gestation.

METHOD

At their corrected age, infants underwent the MAI at 4 months, the AIMS at 4 and 10-12 months, and the Bayley-III and neurological examination at 18 months. Sensitivity and specificity were calculated.

RESULTS

Infants had a mean gestation of 26.3 ± 1.4 weeks and birth weight of 906 ± 207 g. A high-risk score (≥ 14) for adverse outcome was obtained by 57% of infants on the MAI. On the AIMS, a high-risk score (<5th percentile) was obtained by 56% at 4 months and 30% at 10-12 months. At 18 months, infants with low-risk scores on either the MAI or AIMS had higher cognitive, language, and motor Bayley-III scores than those with high-risk scores. They were less likely to have severe neurodevelopmental impairment. To predict Bayley-III scores <70, sensitivity and specificity were 91% and 49%, respectively, for the MAI and 78% and 48%, respectively, for the AIMS.

CONCLUSIONS

Extremely preterm infants with low-risk MAI at 4 months or AIMS scores at 4 or 10-12 months had better outcomes than those with high-risk scores. However, both tests lack specificity to predict individual neurodevelopmental status at 18 months.

Inter- and Intrarater Reliability of the Infant Motor Profile in 3- to 18-Month-Old Infants

PURPOSE

To investigate inter- and intrarater reliability scoring the Infant Motor Profile (IMP).

METHODS

A total of 20 infants at risk for motor developmental delay were assessed using the IMP. Six infants were born at term (gestational age: 38-42 weeks), and 14 infants were preterm (gestational age: 24-35 weeks). Videos were analyzed twice with an interval of 1 month by 4 assessors after 2 days of IMP training.

RESULTS

Spearman rank scores demonstrated strong interrater and intrarater reliability for total IMP scores (inter: r = 0.80-0.96; intra: r = 0.85-0.97) and the domain of performance (r = 0.95-0.99). Reliability for the domains of variation, variability, and fluency was satisfactory (inter: r = 0.15-0.85; intra: r = 0.30-0.92). The weakest agreement was found in the domain of symmetry (inter: r = 0.20-0.69; intra: r = 0.33-0.65).

CONCLUSION

Therapists naive to the IMP demonstrate good intra and interrater reliability (after 2 days of training) for most domains with the exception of symmetry.

Motor development related to duration of exclusive breastfeeding, B vitamin status and B12 supplementation in infants with a birth weight between 2000-3000 g, results from a randomized intervention trial

Background

Exclusive breastfeeding for 6 months is assumed to ensure adequate micronutrients for term infants. Our objective was to investigate the effects of prolonged breastfeeding on B vitamin status and neurodevelopment in 80 infants with subnormal birth weights (2000-3000 g) and examine if cobalamin supplementation may benefit motor function in infants who developed biochemical signs of impaired cobalamin function (total homocysteine (tHcy) > 6.5 μmol/L) at 6 months.

Methods

Levels of cobalamin, folate, riboflavin and pyridoxal 5´-phosphate, and the metabolic markers tHcy and methylmalonic acid (MMA), were determined at 6 weeks, 4 and 6 months (n = 80/68/66). Neurodevelopment was assessed with the Alberta Infants Motor Scale (AIMS) and the parental questionnaire Ages and Stages (ASQ) at 6 months.

At 6 months, 32 of 36 infants with tHcy > 6.5 μmol/L were enrolled in a double blind randomized controlled trial to receive 400 μg hydroxycobalamin intramuscularly (n = 16) or sham injection (n = 16). Biochemical status and neurodevelopment were evaluated after one month.

Results

Except for folate, infants who were exclusively breastfed for >1 month had lower B vitamin levels at all assessments and higher tHcy and MMA levels at 4 and 6 months. At 6 months, these infants had lower AIMS scores (p = 0.03) and ASQ gross motor scores (p = 0.01).

Compared to the placebo group, cobalamin treatment resulted in a decrease in plasma tHcy (p < 0.001) and MMA (p = 0.001) levels and a larger increase in AIMS (p = 0.02) and ASQ gross motor scores (p = 0.03).

Conclusions

The findings suggest that prolonged exclusive breastfeeding may not provide sufficient B vitamins for small infants, and that this may have a negative effect on early gross motor development. In infants with mild cobalamin deficiency at 6 months, cobalamin treatment significantly improvement cobalamin status and motor function, suggesting that the observed impairment in motor function associated with long-term exclusive breastfeeding, may be due to cobalamin deficiency.

Clinical trial registration

ClinicalTrials.gov, number NCT01201005

Can nurses be key players in assessing early motor development using a structured method in the child health setting?

RATIONAL, AIMS AND OBJECTIVES

Increasing evidence highlights the importance of early interventions for motor disorders in children. Given the key medical role of the nurse within the Swedish Child Health Service (CHS), we aimed to examine if nurses could apply a structured assessment of early motor development at the child health centre to enable early identification of children at risk.

METHODS

Structured Observation of Motor Performance in Infants (SOMP-I) assesses infant's level of motor development and quality of motor performance using subscales converted to total scores. The total score for both level and quality can then be plotted within the SOMP-I percentile distribution at the child's age for comparison with a reference population. Fifty-five infants (girls: 30) were assessed according to SOMP-I at three child health centres. Assessments were performed by nurses (n = 10) in a clinical setting; one nurse performed the assessment while another nurse and a physiotherapist observed.

RESULTS

Agreement for the assessment of level as a continuous variable was excellent [intraclass correlation coefficient (ICC) 0.97-0.98], but was lower for quality (ICC 0.02-0.46). When the children were categorized according to the percentile range categories, the assessors were in agreement for the majority of the children, with respect to both level (78-82%) and quality (78-87%).

CONCLUSION

Despite brief experience with SOMP-I, the agreement was excellent when assessing the level of motor development, but was less satisfactory for the assessment of quality of motor performance. More extensive education and training may be necessary to improve the nurses' ability to assess quality, as this domain was an entirely new concept to the nurses. Further research is warranted to determine the applicability of SOMP-I as a standardized method for nurses to assess motor development within the CHS.