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Wang H, Mao Z, Du Y, Li H, Jin H. Predictive Value of Fidgety Movement Assessment and Magnetic Resonance Imaging for Cerebral Palsy in Infants. Pediatr Neurol 2024; 153:131-136. [PMID: 38382245 DOI: 10.1016/j.pediatrneurol.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The early prediction of cerebral palsy (CP) could enable the follow-up of high-risk infants during the neuroplasticity period. This study aimed to explore the predictive value of fidgety movement assessment (FMA) and brain magnetic resonance imaging (MRI) for the development of CP in clinic rehabilitation setting. METHODS This retrospective observational study included infants who underwent FMA and brain MRI at age nine to 20 weeks at Children's Hospital, Zhejiang University School of Medicine, between March 2018 and September 2019. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy of FMA and MRI for predicting the development of CP were assessed. RESULTS A total of 258 infants (169 males, gestational age 37.4 ± 3.0 weeks, birth weight 2987.9 ± 757.1 g) were included. Fifteen children had CP after age two years. The diagnostic value of FMA and brain MRI combination showed 86.7% sensitivity (95% confidence interval [CI]: 58.4% to 97.7%), 98.4% specificity (95% CI: 95.6% to 99.5%), and 97.7% accuracy (95% CI: 95.0% to 99.1%); the combination diagnostic value also showed a significantly higher AUC for predicting CP after age two years than FMA alone (AUC: 0.981 vs 0.893, P = 0.013). CONCLUSIONS The diagnostic value of FMA and brain MRI combination during infancy showed a high predictive value for CP development in clinical rehabilitation setting.
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Affiliation(s)
- Hui Wang
- Department of Pediatric Rehabilitation, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Zhenghuan Mao
- Department of Pediatric Rehabilitation, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yu Du
- Department of Pediatric Rehabilitation, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Haifeng Li
- Department of Pediatric Rehabilitation, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.
| | - Huiying Jin
- Department of Pediatric Rehabilitation, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
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Zago AC, Trettim JP, Rubin BB, Scholl CC, Coelho FT, Ulguim F, Pinheiro LMDS, de Matos MB, Pinheiro RT, Quevedo LDA. Early motor development: risk factors for delay in a population study in Southern Brazil. Rev Saude Publica 2023; 57:59. [PMID: 37878845 PMCID: PMC10519674 DOI: 10.11606/s1518-8787.2023057004991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/25/2022] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To assess risk factors associated with motor development delay at three months of age. METHODS Cross-sectional study with mothers and their three-month-old babies in Southern Brazil. The Bayley-III Scale of Infant and Toddler Development (BSID-III) and the Alberta Infant Motor Scale (AIMS) were used to assess motor development. RESULTS We evaluated 756 mothers and their three-month-old babies. The overall mean motor development assessed by the BSID-III and the AIMS was 104.7 (SD 13.5) and 55.4 (SD 25.4), respectively. When assessed by the BSID-III, the lowest motor development scores were among babies born by cesarean delivery (p = 0.002), prematurely (p < 0.001), and with low birth weight (p < 0.001). When assessed by the AIMS, babies born prematurely (p = 0.002) and with low birth weight (p=0.004) had the lowest motor development means. After a cluster analysis, we found that babies born by cesarean delivery, with low birth weight, and prematurely had more impaired motor development compared with children born without any risk factors. CONCLUSION Identifying risk factors allows the implementation of early interventions to prevent motor development delay and, therefore, reduce the probability of other future problems.
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Affiliation(s)
- Ana Carolina Zago
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
- Centro Universitário da Região da CampanhaBagéRSBrasilCentro Universitário da Região da Campanha. Bagé, RS, Brasil.
| | - Jéssica Puchalski Trettim
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Bárbara Borges Rubin
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Carolina Coelho Scholl
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Fernanda Teixeira Coelho
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Fernanda Ulguim
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Luísa Mendonça de Souza Pinheiro
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Mariana Bonati de Matos
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Ricardo Tavares Pinheiro
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
| | - Luciana de Avila Quevedo
- Universidade Católica de PelotasPrograma de Pós-Graduação em Saúde e ComportamentoPelotasRSBrasilUniversidade Católica de Pelotas. Programa de Pós-Graduação em Saúde e Comportamento. Pelotas, RS, Brasil.
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Assessing the Utility of Neonatal Screening Assessments in Early Diagnosis of Cerebral Palsy in Preterm Infants. Brain Sci 2022; 12:brainsci12070847. [PMID: 35884654 PMCID: PMC9313369 DOI: 10.3390/brainsci12070847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Early diagnosis of cerebral palsy (CP) in high-risk infants is possible at 3−4 months’ corrected age (CA) using standardised assessments. Aim: To assess the utility of neonatal screening assessments—writhing general movements (GMs) and the Hammersmith Neonatal Neurological Examination (HNNE)—to predict CP/high-risk status at 3−4 months’ CA in extremely preterm infants. Methods: Retrospective cohort study of high-risk preterm infants (born < 29 weeks’ gestation and/or birth weight < 1000 g) attending an Early Neurodevelopment Clinic. Data from neonatal assessments were compared with CP/high-risk diagnosis at 3−4 months’ CA, fidgety GMs, and Hammersmith Infant Neurological Examinations (HINE) using logistic regression, linear regression, and Spearman rank correlation. Results: Two hundred and two preterm infants (median gestation age at birth 27.3 (IQR 25.4−28.3) weeks, mean birth weight 870.3 (SD 248.4) grams) were included. A total of 26 (12.8%) infants received early CP/high-risk diagnoses at 3−4 months’ CA. A lower gestational age (GA) (OR = 0.78; p = 0.029, 95% CI [0.26, 0.97]) and abnormal writhing GMs (OR 1.56; p = 0.019, 95% CI [1.07, 2.27]) were predictive of CP/high-risk diagnosis. Although after adjustment for sex, GA, birth weight, and growth restriction, GA (aOR = 0.67; p = 0.068, 95% CI [0.44, 1.03]) and writhing GMs (aOR = 1.44; p = 0.087, 95% CI [0.95, 2.20]) were not significant, a strong trend still persisted. The HNNE scores significantly correlated with both the HINE evaluation (rs = 0.43, p < 0.001, 95% CI [0.31, 0.56]) and fidgety GMs (rs = −0.10, p = 0.012, 95% CI [−0.32, −0.04]). Linear regression confirmed the HNNE was highly predictive of the HINE (correlation coefficient 0.82; p < 0.001, 95% CI [0.48, 1.15]). Writhing GMs did not significantly correlate with either fidgety GMs (p = 0.723, 95% CI [−0.12, 0.17]) or the HINE (p = 0.173, 95% CI [−0.24, 0.04]). Conclusions: Abnormal writhing GMs in the neonatal period were non-significantly associated with early CP/high-risk diagnoses in extremely preterm infants in a multivariate analysis. Additionally, the HNNE significantly correlated with both fidgety GMs and the HINE.
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Handsfield GG, Williams S, Khuu S, Lichtwark G, Stott NS. Muscle architecture, growth, and biological Remodelling in cerebral palsy: a narrative review. BMC Musculoskelet Disord 2022; 23:233. [PMID: 35272643 PMCID: PMC8908685 DOI: 10.1186/s12891-022-05110-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/12/2022] [Indexed: 11/16/2022] Open
Abstract
Cerebral palsy (CP) is caused by a static lesion to the brain occurring in utero or up to the first 2 years of life; it often manifests as musculoskeletal impairments and movement disorders including spasticity and contractures. Variable manifestation of the pathology across individuals, coupled with differing mechanics and treatments, leads to a heterogeneous collection of clinical phenotypes that affect muscles and individuals differently. Growth of muscles in CP deviates from typical development, evident as early as 15 months of age. Muscles in CP may be reduced in volume by as much as 40%, may be shorter in length, present longer tendons, and may have fewer sarcomeres in series that are overstretched compared to typical. Macroscale and functional deficits are likely mediated by dysfunction at the cellular level, which manifests as impaired growth. Within muscle fibres, satellite cells are decreased by as much as 40–70% and the regenerative capacity of remaining satellite cells appears compromised. Impaired muscle regeneration in CP is coupled with extracellular matrix expansion and increased pro-inflammatory gene expression; resultant muscles are smaller, stiffer, and weaker than typical muscle. These differences may contribute to individuals with CP participating in less physical activity, thus decreasing opportunities for mechanical loading, commencing a vicious cycle of muscle disuse and secondary sarcopenia. This narrative review describes the effects of CP on skeletal muscles encompassing substantive changes from whole muscle function to cell-level effects and the effects of common treatments. We discuss growth and mechanics of skeletal muscles in CP and propose areas where future work is needed to understand these interactions, particularly the link between neural insult and cell-level manifestation of CP.
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Affiliation(s)
- Geoffrey G Handsfield
- Auckland Bioengineering Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand.
| | - Sîan Williams
- Liggins Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand.,School of Allied Health, Curtin University, Kent St, Bentley, WA, 6102, Australia
| | - Stephanie Khuu
- Auckland Bioengineering Institute, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
| | - Glen Lichtwark
- School of Human Movement and Nutrition Sciences, University of Queensland, QLD, St Lucia, 4072, Australia
| | - N Susan Stott
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland CBD, Auckland, 1010, New Zealand
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Gajewska E, Moczko J, Naczk M, Naczk A, Steinborn B, Winczewska-Wiktor A, Komasińska P, Sobieska M. Crawl Position Depends on Specific Earlier Motor Skills. J Clin Med 2021; 10:5605. [PMID: 34884307 PMCID: PMC8658627 DOI: 10.3390/jcm10235605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/21/2022] Open
Abstract
Early assessment of motor performance should allow not only the detection of disturbances but also create a starting point for the therapy. Unfortunately, a commonly recognised method that should combine these two aspects is still missing. The aim of the study is to analyse the relationship between the qualitative assessment of motor development at the age of 3 months and the acquisition of the crawl position in the 7th month of life. A total of 135 children were enrolled (66 females). The analysis was based on physiotherapeutic and neurological assessment and was performed in the 3rd, 7th and 9th months of life in children, who were classified according to whether they attained the crawl position or not in the 7th month. Children who did not attain the crawl position in the 7th month did not show distal elements of motor performance at the age of 3 months and thus achieved a lower sum in the qualitative assessment. Proper position of the pelvis at the age of 3 months proved to be very important for the achievement of the proper crawl position at the 7th month. Failure to attain the crawl position in the 7th month delays further motor development. The proximal-distal development must be achieved before a child is able to assume the crawl position. Supine position in the 3rd month seemed more strongly related to achieving the crawl position than assessment in the prone position.
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Affiliation(s)
- Ewa Gajewska
- Department of Developmental Neurology, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (B.S.); (A.W.-W.); (P.K.)
| | - Jerzy Moczko
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 60-806 Poznan, Poland;
| | - Mariusz Naczk
- Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, 65-417 Zielona Gora, Poland;
| | - Alicja Naczk
- Department of Physical Education and Sport, Faculty of Physical Culture in Gorzow Wielkopolski, University School of Physical Education in Poznan, 66-400 Gorzow Wielkopolski, Poland;
| | - Barbara Steinborn
- Department of Developmental Neurology, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (B.S.); (A.W.-W.); (P.K.)
| | - Anna Winczewska-Wiktor
- Department of Developmental Neurology, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (B.S.); (A.W.-W.); (P.K.)
| | - Paulina Komasińska
- Department of Developmental Neurology, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (B.S.); (A.W.-W.); (P.K.)
| | - Magdalena Sobieska
- Department of Rehabilitation and Physiotherapy, Poznan University of Medical Sciences, 61-545 Poznan, Poland;
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6
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Gajewska E, Moczko J, Kroll P, Naczk M, Naczk A, Sobieska M. How motor elements at 3 months influence motor performance at the age of 6 months. Medicine (Baltimore) 2021; 100:e27381. [PMID: 34678865 PMCID: PMC8542161 DOI: 10.1097/md.0000000000027381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/10/2021] [Indexed: 01/05/2023] Open
Abstract
One of the most important achievements of infancy is mobility, through which the child gradually becomes independent and can discover new places and objects. One form of mobility that occurs in a child's development is rolling over from supine-to-prone.The assumption of the work was to check whether all particular motor elements from the 3rd month had a comparable effect on development in the 6th month of life.The study population included 119 children, 69 born at term, and 50 born preterm. Children were born at week 38 ± 3 (born at term 40 ± 1/preterm 34 ± 3), with a mean body weight of 3100 ± 814 g (born at term 3462 ± 505/ preterm 2282 ± 788). Pre-term children were assessed at the corrected age. The physiotherapeutic qualitative assessment at the age of 3 months was performed in the prone and supine positions, and the qualitative assessment included 15 elements in the prone position and 15 in the supine position. A detailed mathematical analysis was then performed. Values of Cramer's V coefficient with confidence range, Goodman-Kruskal's coefficient, and the values of the probability coefficient p were given.The position of the scapulae and pelvis (3rd month) had the strongest impact on achieving proper support on the upper extremities in the 6th month of life, while the supine position was most significantly affected by the position of the head, spine, and pelvis.
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Affiliation(s)
- Ewa Gajewska
- Department of Developmental Neurology, Poznan University of Medical Sciences, Poland
| | - Jerzy Moczko
- Department of Computer Science and Statistics, Poznan University of Medical Sciences
| | - Paweł Kroll
- Pediatric Surgery and Urology Clinic, Neurourology Unit, Poznan, Poland
| | - Mariusz Naczk
- Institute of Health Sciences, Collegium Medicum, University of Zielona Gora, Zielona Gora, Poland
| | - Alicja Naczk
- Department of Physical Education and Sport, Faculty of Physical Culture in Gorzow Wielkopolski, University School of Physical Education in Poznan, Gorzow Wielkopolski, Poland
| | - Magdalena Sobieska
- Department of Rehabilitation and Physiotherapy, Poznan University of Medical Sciences, Poland
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A Souza F, C L Nogueira C, J Silva A, S C Chagas P, S Frônio J. Preterm and writhing movements: is it possible to predict fidgety movements in preterm infants? J Perinatol 2021; 41:2442-2448. [PMID: 33986474 DOI: 10.1038/s41372-021-01064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/26/2021] [Accepted: 04/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Preterm infants who do not have fidgety movements at 3 months of corrected age have up to ten times greater risk of developing cerebral palsy or other alterations in motor development, compared to infants who exhibit such movements. The General Movements Assessment (GMA) is a validated tool that may predict the fidgety movement period. OBJECTIVE This study aimed to describe the trajectory of the General Movements Assessment (GMA) during the preterm and writhing movements periods in preterm infants and determine the best time point to predict the fidgety movements period. STUDY DESIGN Fifty-two preterm newborns were evaluated by the GMA method. RESULTS GMA assessment at the age of 5 weeks post term was found the most predictive of neuromotor development disorders in at-risk newborns, with a sensitivity and specificity of 86% and 58%, respectively, and a high negative predictive value (92%) and increased hit ratio (69% accuracy). CONCLUSION Preterm infants with ≤34 weeks of gestational age have a high prevalence of poor repertoire classifications on the GMA and one single assessment with GMA near the time of NICU discharge seems to be the best time to determine infants who need to be followed more carefully, but the best time point to predict the fidgety movements period was 5 weeks post term.
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Affiliation(s)
- Felipe A Souza
- Graduate Program in Rehabilitation Sciences and Physical and Functional Performance, Universidade Federal de Juiz de Fora (UFJF), Hospital Regional Dr. João Penido/FHEMIG, Juiz de Fora, MG, Brazil
| | - Caroline C L Nogueira
- Graduate Program in Rehabilitation Sciences and Physical and Functional Performance, Universidade Federal de Juiz de Fora (UFJF), Santa Casa de Misericordia de Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Andrea J Silva
- Hospital Regional Dr. João Penido/FHEMIG, Juiz de Fora, MG, Brazil
| | - Paula S C Chagas
- School of Physical Therapy and Graduate Program in Rehabilitation Sciences and Physical and Functional Performance, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil
| | - Jaqueline S Frônio
- School of Physical Therapy and Graduate Program in Rehabilitation Sciences and Physical and Functional Performance, Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, MG, Brazil.
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Pouppirt NR, Martin V, Pagnotto-Hammitt L, Spittle AJ, Flibotte J, DeMauro SB. The General Movements Assessment in Neonates With Hypoxic Ischemic Encephalopathy. J Child Neurol 2021; 36:601-609. [PMID: 33439066 DOI: 10.1177/0883073820981515] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Clinical measures after birth and studies such as electroencephalogram (EEG) and brain imaging do not fully predict neurodevelopmental outcomes of infants with hypoxic-ischemic encephalopathy. Early detection of adverse neurologic outcomes, and cerebral palsy in particular, in high-risk infants is essential for ensuring timely management. The General Movements Assessment is a tool that can be used in the early detection of cerebral palsy in infants with brain injury. The majority of studies on the General Movements Assessment in the late preterm and term population were performed prior to the introduction of therapeutic hypothermia. AIMS To apply the General Movements Assessment in late preterm and term infants with hypoxic-ischemic encephalopathy (including those who received therapeutic hypothermia), to determine if clinical markers of hypoxic-ischemic encephalopathy predict abnormal General Movements Assessment findings, and to evaluate interrater reliability of the General Movements Assessment in this population. Study design: Pilot prospective cohort study Subjects: We assessed 29 late preterm and full-term infants with mild, moderate, and severe hypoxic-ischemic encephalopathy in Philadelphia, PA. RESULTS Most infants' general movements normalized by the fidgety age. Only infants with moderate or severe hypoxic-ischemic encephalopathy had abnormal general movements in both the writhing and the fidgety ages (n = 6). Seizure at any point during the initial hospitalization was the clinical sign most predictive of abnormal general movements in the fidgety age (sensitivity 100%, specificity 55%, positive predictive value 40%, negative predictive value 100%). Interrater reliability was greatest during the fidgety age (κ = 0.67). CONCLUSIONS Seizures were the clinical predictor most closely associated with abnormal findings on the General Movements Assessment. However, clinical markers of hypoxic-ischemic encephalopathy are not fully predictive of abnormal General Movements Assessment findings. Larger future studies are needed to evaluate the associations between the General Movements Assessment and childhood neurologic outcomes in patients with hypoxic-ischemic encephalopathy who received therapeutic hypothermia.
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Affiliation(s)
- Nicole R Pouppirt
- Division of Neonatology, Feinberg School of Medicine, Northwestern University, 2429Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Valerie Martin
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Linda Pagnotto-Hammitt
- Department of Physical Therapy, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alicia J Spittle
- 34361Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - John Flibotte
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sara B DeMauro
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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9
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Aita M, De Clifford Faugère G, Lavallée A, Feeley N, Stremler R, Rioux É, Proulx MH. Effectiveness of interventions on early neurodevelopment of preterm infants: a systematic review and meta-analysis. BMC Pediatr 2021; 21:210. [PMID: 33926417 PMCID: PMC8082967 DOI: 10.1186/s12887-021-02559-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As preterm infants' neurodevelopment is shaped by NICU-related factors during their hospitalization, it is essential to evaluate which interventions are more beneficial for their neurodevelopment at this specific time. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of interventions initiated during NICU hospitalization on preterm infants' early neurodevelopment during their hospitalization and up to two weeks corrected age (CA). METHODS This systematic review referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines and was registered in PROSPERO (CRD42017047072). We searched CINAHL, MEDLINE, PubMed, EMBASE (OVID), Cochrane Systematic Reviews, CENTRAL, and Web of Science from 2002 to February 2020 and included randomized controlled/clinical trials conducted with preterm infants born between 24 and 366/7 weeks of gestation. All types of interventions instigated during NICU hospitalization were included. Two independent reviewers performed the study selection, data extraction, assessment of risks of bias and quality of evidence. RESULTS Findings of 12 studies involving 901 preterm infants were synthesized. We combined three studies in a meta-analysis showing that compared to standard care, the NIDCAP intervention is effective in improving preterm infants' neurobehavioral and neurological development at two weeks CA. We also combined two other studies in a meta-analysis indicating that parental participation did not significantly improve preterm infants' neurobehavioral development during NICU hospitalization. For all other interventions (i.e., developmental care, sensory stimulation, music and physical therapy), the synthesis of results shows that compared to standard care or other types of comparators, the effectiveness was either controversial or partially effective. CONCLUSIONS The overall quality of evidence was rated low to very low. Future studies are needed to identify interventions that are the most effective in promoting preterm infants' early neurodevelopment during NICU hospitalization or close to term age. Interventions should be appropriately designed to allow comparison with previous studies and a combination of different instruments could provide a more global assessment of preterm infants' neurodevelopment and thus allow for comparisons across studies. TRIAL REGISTRATION Prospero CRD42017047072 .
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Affiliation(s)
- Marilyn Aita
- Faculty of Nursing, Université de Montréal, P.O. Box 6128, Succursale centre-ville, Montréal, QC, H3C 3J7, Canada.
- CHU Sainte-Justine Research Centre, 3175, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada.
- Quebec Network on Nursing Intervention Research, PO Box 6128, Centre-ville, Montréal, QC, H3C 3J7, Canada.
| | - Gwenaëlle De Clifford Faugère
- Faculty of Nursing, Université de Montréal, P.O. Box 6128, Succursale centre-ville, Montréal, QC, H3C 3J7, Canada
- CHU Sainte-Justine Research Centre, 3175, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Andréane Lavallée
- Faculty of Nursing, Université de Montréal, P.O. Box 6128, Succursale centre-ville, Montréal, QC, H3C 3J7, Canada
- CHU Sainte-Justine Research Centre, 3175, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Nancy Feeley
- Quebec Network on Nursing Intervention Research, PO Box 6128, Centre-ville, Montréal, QC, H3C 3J7, Canada
- Ingram School of Nursing, McGill University, 680 Rue Sherbrooke Ouest #1800, Montréal, QC, H3A 2M7, Canada
- Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, M5T 1P8, Canada
- Hospital for Sick Children (SickKids), 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Émilie Rioux
- Faculty of Nursing, Université de Montréal, P.O. Box 6128, Succursale centre-ville, Montréal, QC, H3C 3J7, Canada
- Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
| | - Marie-Hélène Proulx
- Faculty of Nursing, Université de Montréal, P.O. Box 6128, Succursale centre-ville, Montréal, QC, H3C 3J7, Canada
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10
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Kalteren WS, Mebius MJ, Verhagen EA, Tanis JC, Kooi EMW, Bos AF. Neonatal Hemoglobin Levels in Preterm Infants Are Associated with Early Neurological Functioning. Neonatology 2021; 118:593-599. [PMID: 34515185 DOI: 10.1159/000518655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/10/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neonatal anemia may compromise oxygen transport to the brain. The effects of anemia and cerebral oxygenation on neurological functioning in the early neonatal period are largely unknown. OBJECTIVE This study aimed to determine the association between initial hemoglobin levels (Hb) and early neurological functioning in preterm infants by assessing their general movements (GMs). METHODS A retrospective analysis of prospectively collected data on preterm infants born before 32 weeks of gestation was conducted. We excluded infants with intraventricular hemorrhage > grade II. On day 8, we assessed infants' GMs, both generally as normal/abnormal and in detail using the general movement optimality score (GMOS). We measured cerebral tissue oxygen saturation (rcSO2) on day 1 using near-infrared spectroscopy. RESULTS We included 65 infants (median gestational age 29.9 weeks [IQR 28.2-31.0]; median birth weight 1,180 g [IQR 930-1,400]). Median Hb on day 1 was 10.3 mmol/L (range 4.2-13.7). Lower Hb on day 1 was associated with a higher risk of abnormal GMs (OR = 2.3, 95% CI: 1.3-4.1) and poorer GMOSs (B = 0.9, 95% CI: 0.2-1.7). Hemoglobin strongly correlated with rcSO2 (rho = 0.62, p < 0.01). Infants with lower rcSO2 values tended to have a higher risk of abnormal GMs (p = 0.06). After adjusting for confounders, Hb on day 1 explained 44% of the variance of normal/abnormal GMs and rcSO2 explained 17%. Regarding the explained variance of the GMOS, this was 25% and 16%, respectively. CONCLUSIONS In preterm infants, low Hb on day 1 is associated with impaired neurological functioning on day 8, which is partly explained by low cerebral oxygenation.
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Affiliation(s)
- Willemien S Kalteren
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Mirthe J Mebius
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elise A Verhagen
- Division of Neonatology, Department of Pediatrics, Amsterdam University Medical Center, location VU Medical Center, Amsterdam, The Netherlands
| | - Jozien C Tanis
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Elisabeth M W Kooi
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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Olsen JE, Cheong JLY, Eeles AL, FitzGerald TL, Cameron KL, Albesher RA, Anderson PJ, Doyle LW, Spittle AJ. Early general movements are associated with developmental outcomes at 4.5-5 years. Early Hum Dev 2020; 148:105115. [PMID: 32615517 DOI: 10.1016/j.earlhumdev.2020.105115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/03/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prechtl's general movements assessment (GMA) post-term has high predictive validity for cerebral palsy, but less is known about whether earlier GMA, including before term, are associated with other developmental problems. AIMS To examine the relationships between GMA prior to term and at term-equivalent, with developmental outcomes at 4.5-5 years' corrected age. STUDY DESIGN Prospective cohort study. SUBJECTS 122 very preterm infants born <30 weeks' gestation and 91 healthy term controls. OUTCOME MEASURES GMA (categorised as 'normal' or 'abnormal') were assessed at <32, 32-33 and 34-36 weeks' postmenstrual age for the preterm infants, and at term-equivalent for both groups. Children were assessed at 4.5-5 years' corrected age using the Movement Assessment Battery for Children-2nd edition (MABC-2), Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), Pediatric Quality of Life Inventory (PedsQL), Little Developmental Coordination Disorder Questionnaire (Little DCD-Q) and Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV). RESULTS Prior to term, abnormal GMA at the first two timepoints were associated with lower scores on the Little DCD-Q, and abnormal GMA at the second and third timepoints with lower quality of life scores and PEDI-CAT mobility domain scores. Abnormal GMA at term-equivalent were associated with lower MABC-2, mobility and quality of life scores for preterm infants, and worse social/cognitive domain scores for both groups. CONCLUSIONS Abnormal GMA prior to term and at term-equivalent are associated with worse motor, functional and cognitive outcomes at 4.5-5 years' corrected age, and may be useful to identify infants for developmental surveillance/early intervention.
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Affiliation(s)
- Joy E Olsen
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia.
| | - Jeanie L Y Cheong
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
| | - Abbey L Eeles
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
| | - Tara L FitzGerald
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
| | - Kate L Cameron
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia
| | - Reem A Albesher
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Peter J Anderson
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; Monash University, Wellington Road, Clayton, Victoria 3168, Australia
| | - Lex W Doyle
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
| | - Alicia J Spittle
- University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia; The Royal Women's Hospital, 20 Flemington Road, Parkville, Victoria 3052, Australia
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12
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Pires CDS, Marba STM, Caldas JPDS, Stopiglia MDCS. PREDICTIVE VALUE OF THE GENERAL MOVEMENTS ASSESSMENT IN PRETERM INFANTS: A META-ANALYSIS. ACTA ACUST UNITED AC 2020; 38:e2018286. [PMID: 32401947 PMCID: PMC7212559 DOI: 10.1590/1984-0462/2020/38/2018286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/13/2019] [Indexed: 11/24/2022]
Abstract
Objective: To discuss the predictive value of the General Movements Assessment for the
diagnosis of neurodevelopment disorders in preterm newborns. Data source: We conducted a systematic literature review using the following databases:
Scientific Electronic Library Online (SciELO), National Library of Medicine,
National Institutes of Health (PubMed), and Excerpta Medica Database
(EMBASE). The articles were filtered by language, year of publication,
population of interest, use of Prechtl’s Method on the Qualitative
Assessment of General Movements, and presence of variables related to the
predictive value. The Quality Assessment of Diagnostic Accuracy Studies 2
was used to assess the methodology of the included studies. Sensitivity,
specificity, Diagnostic Odds Ratio, positive and negative likelihood ratio,
and parameter of accuracy were calculated. Data synthesis: Six of 342 articles were included. The evaluation of Writhing Movements is a
good indicator for recognizing cerebral palsy, as it has high values for the
sensitivity and accuracy parameters. The evaluation of Fidgety Movements has
the strongest predictive validity for cerebral palsy, as it has high values
in all measures of diagnostic accuracy. The quality assessment shows high
risk of bias for patient selection and flow and timing of the evaluation.
Therefore, the scale has potential to detect individuals with
neurodevelopment disorders. However, the studies presented limitations
regarding the selection of subjects and the assessment of neurological
outcomes. Conclusions: Despite the high predictive values of the tool to identify neurological
disorders, research on the subject is required due to the heterogeneity of
the current studies.
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13
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Neuromotor and sensory development in preterm infants: prospective study. Turk Arch Pediatr 2020; 55:46-53. [PMID: 32231449 PMCID: PMC7096571 DOI: 10.14744/turkpediatriars.2019.88709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/31/2019] [Indexed: 11/20/2022]
Abstract
Aim To investigate the relationship between motor and sensory development in the first 4 months of life in preterm infants born at 32 gestational weeks and below. Material and Methods The study consisted of 56 high-risk infants with a corrected age of 1 month who were born at 32 gestational weeks and stayed in the neonatal intensive care unit for at least 15 days. Neuro Sensory Motor Developmental Assessment and Infant Sensory Profile-2 were used for evaluation. These assessments were applied to preterm infants at the 1st and 4th months. The results of assessments were analyzed using the Wilcoxon test. The relationship between the results of motor and sensory assessments was analyzed using Spearman's correlation test. Results The mean gestational age of the infants was 29.58±2.09 weeks, their birth weights were 1233.87±251.22 grams, and their duration of stay in the neonatal intensive care unit was 26.48±9.58 days. There was a statistically significant difference between the Neuro Sensory Motor Developmental Assessment and Infant Sensory Profile-2 scores between the 1st and 4th months (p<0.05). It was found that there was a risk in terms of sensory development in 86-91% of the preterm infants at the 1st month and in 69-85% at the 4th month. There was moderate-strong degree of significant relationship between motor and sensory development. Conclusion Considering the findings of our study, preterm infants are at risk for motor and sensory development. There is, therefore, a need for future research to investigate the effect of early sensory-based intervention approaches on preterm infants.
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14
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Zlatanović D, Čolović H, Živković V, Kocić M, Stanković A, Vučić J, Bojović N, Raičević M, Golubović M, Dinić L, Stanković T. THE IMPORTANCE OF THE PRECHTL METHOD FOR ULTRA-EARLY PREDICTION OF NEUROLOGICAL ABNORMALITIES IN NEWBORNS AND INFANTS. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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Zorzenon RFM, Takaara LK, Linhares MBM. General spontaneous movements in preterm infants differentiated by post-conceptional ages. Early Hum Dev 2019; 134:1-6. [PMID: 31063888 DOI: 10.1016/j.earlhumdev.2019.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to assess general spontaneous motor development in the neonatal phase in groups of neonatal high-risk preterm infants who were differentiated by post-conceptional (PCo) age until term age. METHOD The sample included 54 preterm infants (<32 weeks of gestational age) with low birthweight and neurological injuries of both sexes. The General Movements Assessment (GMA) was used to evaluate motor development from 30 to 40 weeks of PCo age, using the General Movements Optimality Score (GMOS). Between-group and within-group comparisons were performed. RESULTS Significant differences in GMOS scores and the upper extremities score, specifically in the neck and trunk, were found between 30 and 33 weeks, 34 and 36 weeks, and 38 and 40 weeks of PCo age. Preterm infants had gradually higher GMOSs from 30 weeks of PCo age to term age (38-40 weeks of PCo age). No significant differences in general movements were found between 30 and 33 and 34 and 36 weeks of PCo age. CONCLUSION The preterm infants presented poor spontaneous motor movements, assessed by the GMOS, but gradual improvement was observed from 30 weeks of PCo age until term age.
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16
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Gajewska E, Sobieska M, Moczko J. Position of pelvis in the 3rd month of life predicts further motor development. Hum Mov Sci 2018; 59:37-45. [PMID: 29602050 DOI: 10.1016/j.humov.2018.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 03/05/2018] [Accepted: 03/18/2018] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Ewa Gajewska
- Department of Developmental Neurology, Poznan University of Medical Sciences, Poland.
| | - Magdalena Sobieska
- Department of Rheumatology and Rehabilitation, Poznan University of Medical Sciences, Poland
| | - Jerzy Moczko
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poland
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17
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Rosenbloom L. What is the role of the General Movements Assessment in clinical practice? Dev Med Child Neurol 2018; 60:6. [PMID: 29105750 DOI: 10.1111/dmcn.13605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Lewis Rosenbloom
- Honorary Consultant Paediatric Neurologist, Alder Hey Children's Hospital, Liverpool, UK
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