A comparison of three procedures to assess the motor ability of 12-month-old infants with cerebral palsy

Movement analysis in the early detection of newborns at risk for developing spasticity due to infantile cerebral palsy

In order to limit the consequences of infantile cerebral palsy (ICP), physiotherapy should start as early as possible. This requires that infants at risk are detected at the earliest age possible. Today, diagnosis is based on visual observation by physicians and as such is influenced by subjective impressions. Objective methods, quantifying the pathological deviation from normal spontaneous motor activity would be preferable as they, for example, allow an inter- and intra-individual comparison of movement. In this paper we have developed a methodology that allows the 3-dimensional acquisition of unconstrained movement in newborn babies, using a motion analysis system. From the recorded movement data we have extracted 53 quantitative parameters that describe the differences between healthy and affected participants. Considered individually, each of these parameters does not permit a conclusive statement to be made as to whether or not the patient is at risk. Cluster analysis based on Euclidian distances therefore has been used to find an optimal combination of eight parameters. The optimal combination has been subsequently applied to organize the participants' movement into preferably homogeneous classes labelled "healthy" or "at risk". Classification was performed utilising quadratic discriminant analysis. The methodology presented allows a reliable discrimination between healthy and affected participants. Overall detection rate reached 73%. This value is expected to rise with increasing patient and norm collective database size.

A randomized controlled trial of early physiotherapy for high-risk infants

The aim of this study was to investigate the hypothesis that infants at high risk of cerebral palsy would benefit from early physiotherapy. In total, 105 infants with abnormal cranial ultrasound scans were randomized at around term to early physiotherapy or standard treatment (delaying physiotherapy until abnormal physical signs became apparent). At 12 and 30 months there were clinical and objective assessments. Nine infants died and nine were lost to follow-up by 12 months when 87 infants were assessed. One other child had died and three others were lost to follow-up by 30 months when 83 children were assessed. Cerebral palsy was only accurately predicted in 45 (54%) infants. There was no difference in outcome. The difficulty of predicting cerebral palsy reliably and the heterogeneity of the condition should be borne in mind when planning treatment and assessing its efficacy.

Structured observation of motor performance (SOMP-I) applied to neonatally healthy fullterm infants at the ages of 0-10 months

A new protocol for structured observation of motor performance in infants, SOMP-I, was applied to 72 neonatally healthy fullterm infants at 0, 2, 4, 6 and 10 months of age. It contains 13 items, formed as ascending scales, consisting of detailed descriptions of motor performance in different body positions and body parts. The observed motor performance is assessed regarding level of development (progress), and degree and type of deviation from the described performance (quality). When observed according to the new protocol, the infants' motor performance corresponded to higher levels of motor development with increasing age and agreed with descriptions in other standardized developmental scales. With age, the motor performance observed was distributed over more levels in the different scales and the number of infants with deviations from the described performance increased in most positions, but decreased in the prone position. The item for the head, at 2 months, showed the largest number of infants with deviations. The total number of deviations in each infant was small. In conclusion, the SOMP-I protocol can describe motor performance in a group of infants who were healthy at birth and is detailed enough to identify differences regarding progress of motor development and quality of motor performance. The assessment is easily performed.