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Predictive value of the General Movements Assessment and Standardized Infant NeuroDevelopmental Assessment in
Mijna Hadders-Algra1, Uta Tacke2, Joachim Pietz3
1University of Groningen, University Medical Center Groningen, Department of Paediatrics, Division of Developmental Neurology, Groningen, the Netherlands.
Insights
The General Movements Assessment (GMA) and Standardized Infant NeuroDevelopmental Assessment (SINDA) effectively predict neurodevelopmental outcomes in infants. Both tools show similar predictive accuracy for atypical development, including cerebral palsy.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Neurodevelopmental Assessment
Background:
- Early identification of atypical neurodevelopment is crucial for timely intervention in at-risk infants.
- The General Movements Assessment (GMA) and Standardized Infant NeuroDevelopmental Assessment (SINDA) are established tools for evaluating infant neurodevelopment.
Purpose of the Study:
- To compare the predictive accuracy of the GMA and SINDA for identifying atypical neurodevelopmental outcomes in 3-month-old at-risk infants.
- To evaluate the ability of both assessments to predict cerebral palsy (CP) and developmental delays.
Main Methods:
- A cohort of 109 at-risk infants (gestational age 30 weeks) were assessed using GMA and SINDA at 3 months corrected age.
- Atypical neurodevelopmental outcome was defined at 24 months corrected age as CP or a Bayley Scales score below 70.
- GMA focused on general movement complexity and the presence of fidgety movements.
Main Results:
- Both GMA and SINDA demonstrated high predictive values for atypical neurodevelopmental outcomes.
- GMA, when considering both movement complexity and fidgety movements, showed high specificity and predictive values (>0.900) with a sensitivity of 0.687.
- SINDA achieved sensitivity, specificity, and negative predictive values greater than 0.900, with a positive predictive value of 0.652.
Conclusions:
- The GMA and SINDA neurological scales are equally effective in predicting atypical neurodevelopmental outcomes and CP in infants.
- The GMA is most effective when assessing both general movement complexity and fidgety movements.
- SINDA is noted as easier to learn and allows for caregiver feedback during consultations, unlike the typically video-based GMA.
Aim:
To compare the predictive values of the General Movements Assessment (GMA) and the Standardized Infant NeuroDevelopmental Assessment (SINDA) neurological scale for atypical neurodevelopmental outcome in 3-month-old at-risk infants.
Method:
A total of 109 infants (gestational age 30 weeks; range: 24-41; 52 males) attending a non-academic outpatient clinic were assessed with the GMA and the SINDA at 3 (2-4) months corrected age. The GMA pays attention to the complexity of general movements and presence of fidgety movements. Atypical neurodevelopmental outcome at 24 months corrected age (and older) implied cerebral palsy (CP) or a Bayley Mental Development Index or Bayley Psychomotor Development Index lower than 70.
Results:
At 24 months corrected (and older) age, 16 children had an atypical outcome, including 14 children with CP. Regarding markedly reduced general movement complexity in combination with absent or sporadic fidgety movements, the GMA predicted an atypical outcome with specificity, positive, and negative predictive values greater than 0.900, and sensitivity of 0.687 (95% confidence interval [CI] = 0.460-0.915). SINDA predicted an atypical outcome with sensitivity, specificity, and negative predictive value greater than 0.900 and a positive predictive value of 0.652 (95% CI = 0.457-0.847). Regarding absent fidgety movements only or markedly reduced general movement complexity, the GMA predicted the outcome less well than both general movement criteria.
Interpretation:
The SINDA and GMA both predict neurodevelopmental outcome well, but SINDA is easier to learn than the GMA; being a non-video-based assessment, it allows caregiver feedback during the consultation whereas the GMA usually does not.
What This Paper Adds:
The General Movements Assessment (GMA) and Standardized Infant NeuroDevelopmental Assessment (SINDA) neurological scale predict atypical neurodevelopmental outcome equally well. The GMA and SINDA neurological scale predict CP and atypical neurodevelopmental outcome well. The GMA works best to predict neurodevelopmental outcome when based on both general movement complexity and fidgety movements.
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