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The Predictive Accuracy of the General Movement Assessment for Cerebral Palsy: A Prospective, Observational Study of
Ragnhild Støen1,2, Lynn Boswell3, Raye-Ann de Regnier3,4
1Department of Neonatology, St. Olavs hospital, Trondheim University Hospital, 7006 Trondheim, Norway.
Insights
General Movement Assessment (GMA) shows moderate accuracy in predicting cerebral palsy (CP) in high-risk infants. Combining GMA with neonatal imaging significantly improves early CP prediction accuracy.
Area of Science:
- Neurology
- Developmental Pediatrics
- Medical Imaging
Background:
- Early prediction of cerebral palsy (CP) is crucial for timely intervention in high-risk infants.
- General Movement Assessment (GMA) during the fidgety movements (FM) period is recommended as standard care.
- The study aimed to evaluate GMA's accuracy alone and with neonatal imaging for CP prediction.
Purpose of the Study:
- To determine the predictive accuracy of GMA for cerebral palsy (CP) in high-risk infants.
- To assess if combining GMA with neonatal imaging enhances CP prediction.
- To investigate the role of sporadic fidgety movements in CP prediction.
Main Methods:
- Prospective, multi-center observational study of 450 high-risk infants (2009-2014).
- Fidgety movements (FM) classified by blinded GMA observers; abnormal GMA defined as absent or sporadic FM.
- CP status determined by clinicians unaware of GMA results; follow-up to 18-24 months.
Main Results:
- Of 405 infants with data, 42 (10.4%) developed CP.
- Absent/sporadic FM showed 76.2% sensitivity, 82.4% specificity, and 81.7% accuracy for CP.
- Combining absent FM with abnormal neonatal imaging yielded the highest accuracy (95.3%).
- Sporadic FM in 37 infants resulted in CP in only 3 (8.1%).
Conclusions:
- GMA's early CP prediction accuracy was lower than previously reported but improved with neonatal imaging.
- Sporadic FM, as assessed by GMA, did not reliably predict CP in this cohort.
- Combined GMA and neonatal imaging offer a more accurate approach for early CP detection in at-risk infants.
Background:
Early prediction of cerebral palsy (CP) using the General Movement Assessment (GMA) during the fidgety movements (FM) period has been recommended as standard of care in high-risk infants. The aim of this study was to determine the accuracy of GMA, alone or in combination with neonatal imaging, in predicting cerebral palsy (CP).
Methods:
Infants with increased risk of perinatal brain injury were prospectively enrolled from 2009-2014 in this multi-center, observational study. FM were classified by two certified GMA observers blinded to the clinical history. Abnormal GMA was defined as absent or sporadic FM. CP-status was determined by clinicians unaware of GMA results.
Results:
Of 450 infants enrolled, 405 had scorable video and follow-up data until at least 18-24 months. CP was confirmed in 42 (10.4%) children at mean age 3 years 1 month. Sensitivity, specificity, positive and negative predictive values, and accuracy of absent/sporadic FM for CP were 76.2, 82.4, 33.3, 96.8, and 81.7%, respectively. Only three (8.1%) of 37 infants with sporadic FM developed CP. The highest accuracy (95.3%) was achieved by a combination of absent FM and abnormal neonatal imaging.
Conclusion:
In infants with a broad range of neonatal risk factors, accuracy of early CP prediction was lower for GMA than previously reported but increased when combined with neonatal imaging. Sporadic FM did not predict CP in this study.
