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Published on: November 3, 2016
The Motor Optimality Score-Revised Improves Early Detection of Unilateral Cerebral Palsy in Infants with Perinatal
Natascia Bertoncelli1, Lucia Corso2, Luca Bedetti1
1Neonatology Unit, Mother-Child Department, University Hospital of Modena, 41125 Modena, Italy.
Insights
Early detection of cerebral palsy (CP) in infants with arterial cerebral stroke (ACS) is possible. Absent fidgety movements and the Motor Optimality Score-Revised (MOS-R) effectively predict CP, enabling timely intervention.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Neonatal cerebral stroke (NCS) affects approximately 1 in 3000 live births, leading to significant adverse outcomes, primarily unilateral cerebral palsy (CP) in over 50% of affected children.
- Early identification of signs like segmental movement asymmetry at three months can improve prognostic assessment and facilitate early, targeted interventions for infants with unilateral brain damage.
Purpose of the Study:
- To evaluate early indicators of cerebral palsy (CP) in infants diagnosed with arterial cerebral stroke (ACS).
- To assess the utility of the General Movements Assessment (fidgety movements) and the Motor Optimality Score-Revised (MOS-R) in identifying CP risk.
Main Methods:
- A cohort of 24 infants with ACS and 24 healthy controls were assessed at 11-14 weeks post-term using General Movements (GMs) and MOS-R from video recordings.
- Cognitive and motor outcomes were evaluated at 24 months using Griffiths III and Amiel-Tison examination, with CP severity categorized by the GMFCS-E&R.
- The study included 12 male and 12 female infants with ACS, and 16 female and 8 male healthy controls.
Main Results:
- A high rate of unilateral CP (87.5%) was observed in infants with ACS, predominantly with low GMFCS-E&R grades (1 or 2).
- Absence or abnormality of fidgety movements (FMs) was noted in 87.5% of infants with ACS, and 91.7% exhibited segmental movement asymmetry.
- The MOS-R revealed significant differences in motor items, postural patterns, and movement character between infants with ACS and controls, with a lower median global score in the ACS group (6 vs 26; p < 0.01).
Conclusions:
- The Motor Optimality Score-Revised (MOS-R) demonstrated high sensitivity and specificity (≥13 predicting GMFCS-E&R grade ≥2 CP) for predicting CP in infants with ACS.
- A significant correlation exists between absent FMs, MOS-R scores, and the development of unilateral CP in infants with ACS.
- Combined assessment of FMs and MOS-R can enhance the identification of high-risk infants, facilitating early, individualized interventions for unilateral CP.
Background:
Neonatal cerebral stroke includes a range of focal and multifocal ischemic and hemorrhagic brain lesions, occurring in about one of 3000 live births. More than 50% of children with neonatal stroke develop adverse outcomes, mainly unilateral cerebral palsy. Asymmetries in segmental movements at three months have been proven to be an early sign of CP in infants with unilateral brain damage. Recognition of additional early signs could enhance prognostic assessment and enable an early and targeted intervention.
Aim:
The aim of the study was to assess early signs of CP in infants with arterial cerebral stroke through the General Movements Assessment and the Motor Optimality Score-Revised (MOS-R).
Method:
Twenty-four infants born at term (12 females and 12 males) diagnosed with ACS, and 24 healthy infants (16 females and 8 males) were assessed. The GMs (fidgety movements) and MOS-R were assessed from videos recorded at 11-14 weeks of post-term age. Cognitive and motor outcomes were assessed at 24 months using the Griffiths III developmental quotient and Amiel-Tison neurological examination. The gross motor function classification system expanded and revised (GMFCS-E&R) was adopted to categorize CP.
Results:
Among infants with ACS, 21 (87.5%) developed unilateral CP. Most of them showed non-disabling CP (14 had GMFCS-E&R grade 1 [66.6%], 6 grade 2 [28.6%], and 1 grade 5 [4.8%]). Fidgety movements (FMs) were absent in 17 (70.8%), sporadic in 4 (16.7%) infants, and normal in 3 (12.5%). Segmental movement asymmetry was found in 22/24 (91.7%). According to the MOS-R, motor items (kicking, mouth movements), postural patterns (midline centered head, finger posture variability), and movement character (monotonous and stiff) were statistically different among infants with ACS and healthy infants. The MOS-R median global score was lower in the group with ACS compared to the control group (6 vs 26; p < 0.01). FMs, segmental movement asymmetry, and MOS-R global score were significantly correlated with abnormal outcome. MOS-R global scores less than or equal to 13 had 100% specificity and sensitivity in predicting GMFCS-E&R grade ≥ 2 CP in infants with ACS.
Conclusions:
The rate of CP was high among infants with ACS, but in most cases it showed low GMFCS-E&R grades. The study highlighted a significant correlation between MOS-R, together with absent FMs and unilateral CP in infants with ACS. Moreover, the MOS-R showed high sensitivity and specificity in the prediction of CP. Combined assessment of FMs and MOS-R could help to better identify infants at high risk of developing UCP in a population of infants with ACS. Early identification of precocious signs of unilateral CP is fundamental to providing an early individualized intervention.
