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Published on: March 4, 2018
Predictive Value of General Movement Assessment for Cerebral Palsy in Routine Clinical Practice
Gunn Kristin Øberg1, Bjarne Koster Jacobsen2, Lone Jørgensen3
1G.K. Øberg, PT, PhD, Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, MH Building, Breivika Tromsø 9037, Norway, and Department of Clinical Therapeutic Services, University Hospital of North Norway, Tromsø, Norway. gunn.kristin.oeberg@uit.no.
Insights
The General Movement Assessment (GMA) effectively predicts neurodevelopmental outcomes in high-risk infants. Absent fidgety movements (FMs) at 3 months strongly indicate cerebral palsy (CP) by age 2.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Movement Science
Background:
- Early identification of high-risk infants is crucial for timely therapeutic intervention.
- General Movement Assessment (GMA) with fidgety movements (FMs) is a validated research tool for predicting motor development.
- Limited data exists on GMA's utility in routine clinical settings.
Purpose of the Study:
- To assess the predictive value of FMs within a GMA for neurodevelopmental outcomes in high-risk infants.
- To evaluate GMA's performance in a routine clinical setting for identifying cerebral palsy (CP).
- To examine the relationship between FM assessment at 3 months and neurodevelopmental status at 2 years.
Main Methods:
- Prospective study of 87 high-risk infants.
- General Movement Assessment (GMA) performed at 3 months corrected age.
- Clinical assessment for cerebral palsy (CP) at 2 years of age.
- Calculation of sensitivity, specificity, predictive values, and likelihood ratios for GMA as a CP screening tool.
Main Results:
- 93% of infants with normal FMs had normal development; none developed CP.
- 53% of infants with absent FMs were diagnosed with CP.
- GMA demonstrated 90% sensitivity and 90% specificity for CP detection.
- Absent FMs at 3 months increased the risk of motor problems by age 2 tenfold compared to normal FMs.
Conclusions:
- The General Movement Assessment (GMA) is a powerful predictor of neurodevelopmental impairments in high-risk infants within a routine clinical setting.
- GMA, particularly the assessment of fidgety movements (FMs), can reliably identify infants at high risk for cerebral palsy.
- Further research with larger cohorts is warranted to confirm these findings.
Background:
Early identification of children at high risk of future neurodevelopmental disability is important for the initiation of appropriate therapy. In research settings, the assessment of fidgety movements (FMs) at 3 months supports a general movement assessment (GMA) as a strong predictor for subsequent motor development, but there are few studies from routine clinical settings.
Objective:
The study objective was to examine the relationship between FMs and neurodevelopmental outcome by the age of 2 years in high-risk infants in a routine hospital clinical setting.
Design:
This was a prospective study.
Methods:
A GMA was performed in 87 high-risk infants at 3 months after term age. The infants were clinically assessed for cerebral palsy (CP) at 2 years. Sensitivity, specificity, likelihood ratios, and positive and negative predictive values were computed. The relative risk of motor problems by the age of 2 years, according to the GMA, was estimated.
Results:
Of the infants with normal FMs, 93% (50/54) had normal development and none was diagnosed with CP, whereas 75% (12/16) with abnormal or sporadic FMs had normal development. In contrast, 53% (9/17) of those without FMs had CP. When the GMA was considered to be a test for CP and absent FMs were considered to be a positive test result, the sensitivity was 90% and the specificity was 90%. The likelihood ratios for positive and negative test results were 8.7 and 0.1, respectively. The negative predictive value was 99%, and the positive predictive value was 53%. The risk of motor problems by the age of 2 years increased linearly with the extent of pathological results on the GMA and was 10 times higher when FMs were absent at 3 months than when FMs were normal.
Limitations:
The relatively small study sample was a study limitation.
Conclusions:
When applied in a routine clinical setting, the GMA strongly predicted neurodevelopmental impairments at 2 years in high-risk infants.
