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Does a detailed assessment of poor repertoire general movements help to identify those infants who will develop
Yayohi Nakajima1, Christa Einspieler, Peter B Marschik
1Institute of Physiology, Developmental Physiology and Developmental Neurology, Center for Physiological Medicine, Medical University of Graz, Harrachgasse 21/5, A-8010 Graz, Austria.
Insights
Detailed scoring of poor repertoire general movements (GMs) in infants did not improve neurological outcome prediction. Clinical assessment should still focus on fidgety movements for better prognostication in infants with abnormal GMs.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Movement Science
Background:
- General movements (GMs) assessment is crucial for early detection of infant brain dysfunction.
- Poor repertoire GMs are common in early infancy but have low predictive value for neurological outcomes.
- Current methods require refinement for improved prognostic accuracy.
Purpose of the Study:
- To determine if detailed scoring of poor repertoire general movements enhances prediction of neurological outcomes in infants.
- To investigate the utility of Prechtl's optimality concept in scoring abnormal GMs.
- To improve early identification of neurological abnormalities.
Main Methods:
- Studied 18 preterm infants with repeated video recordings from birth to 22 weeks postterm.
- Assessed poor repertoire GMs using detailed scoring based on neck, trunk, arm, and leg movements.
- Correlated detailed GM scores with neurological outcomes at 8-10 years (normal, mild abnormalities, cerebral palsy).
Main Results:
- Detailed scoring of poor repertoire general movements showed no significant relationship with long-term neurological outcomes.
- The refined scoring method did not improve the predictive accuracy for cerebral palsy or other neurological deficits.
- Findings indicate limitations in using detailed poor repertoire GM analysis alone for prognostication.
Conclusions:
- Detailed scoring of poor repertoire general movements is not sufficient for predicting neurological outcomes.
- Clinical assessment of general movements should prioritize the evaluation of fidgety movements for accurate prognostication.
- Further research may be needed to identify optimal predictive markers for neurological development in infants with abnormal GMs.
Background:
The assessment of the quality of general movements (GMs) in young infants is a reliable and valid diagnostic tool for detecting brain dysfunction early in life. Poor repertoire GMs are the most frequently observed abnormal GMs during the preterm, term and early postterm period. However, their predictive value for the neurological outcome is low.
Aim:
To find out whether a detailed scoring of poor repertoire GMs might lead to a better prediction of the neurological outcome.
Subjects:
We studied 18 preterm infants who were repeatedly videoed from birth to 22 weeks postterm age, including several recordings assessed as poor repertoire GMs. At 8 to 10 years, six children were neurologically normal, six had mild neurological abnormalities, and the remaining six were classified as cerebral palsy.
Study Design:
Each GM globally assessed as poor repertoire was scored in details according to several aspects of neck and trunk, arm and leg movements applying Prechtl's optimality concept.
Results:
By and large, the detailed score of poor repertoire GMs was not related to the neurological outcome.
Conclusion:
For the clinical application of the GM assessment, it remains important to assess the fidgety movements of those infants with poor repertoire GM trajectories in order to predict their outcome.
