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Beyond "low tone". What do the General Movements Assessment and Motor Optimality Score tell us about infants with
Álvaro Hidalgo-Robles1, Daniele Soares-Marangoni2, Olena Chorna3
1Universidad Internacional de La Rioja, 26006, Logroño, Spain; INAT (Early Intervention Research Team-Equipo de Investigación en Atención Temprana), Universidad Internacional de La Rioja, 26006, Logroño, Spain.
Insights
General Movements Assessment (GMA) and Motor Optimality Score-Revised (MOS-R) can reliably assess early motor skills in infants with developmental central hypotonia, aiding detection and surveillance.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Movement Science
Background:
- Developmental central hypotonia, characterized by low muscle tone from non-degenerative brain impairment, lacks standardized quantification in infants.
- Subjective clinical examination challenges early motor phenotyping for hypotonia.
- Accurate early assessment is crucial for timely intervention and management.
Purpose of the Study:
- To conduct a scoping review mapping the use of General Movements Assessment (GMA) and Motor Optimality Score-Revised (MOS-R) in infants (<5 months corrected age) with developmental central hypotonia.
- To identify common motor phenotypes associated with hypotonia across various diagnoses.
- To evaluate the feasibility and reliability of GMA and MOS-R in this population.
Main Methods:
- Searched major databases (PubMed, Scopus, etc.) from inception to November 2025 for studies on infants with developmental central hypotonia using GMA and/or MOS-R.
- Included 14 studies covering 12 diagnoses (e.g., Down syndrome, Prader-Willi syndrome, hypotonic cerebral palsy).
- Analyzed spontaneous motor behavior patterns, including movement variability, repertoire, posture, and fidgety movements.
Main Results:
- Consistent motor patterns observed across conditions: reduced variability/complexity, below-age repertoire, atypical posture, and predominantly slow/monotonous movements.
- Atypical fidgety movements were frequent, though present in some infants with Down syndrome and Prader-Willi syndrome.
- Evidence base is limited and heterogeneous, with small, descriptive studies.
Conclusions:
- General Movements Assessment (GMA) and Motor Optimality Score-Revised (MOS-R) are feasible and reliable tools for assessing early motor phenotypes in developmental central hypotonia.
- These assessments can enhance detection and surveillance pathways for infants at risk.
- Further prospective, longitudinal studies are needed to standardize MOS-R reporting and confirm clinical utility and responsiveness to intervention.
Abstract:
Developmental central hypotonia is a broad clinical term describing low muscle tone secondary to non-degenerative brain impairment. Because there is no widely implemented, standardized way to quantify hypotonia in young children, and low tone is still judged largely through subjective clinical examination, early motor phenotyping remains challenging. We conducted a scoping review to map how Prechtl's General Movements Assessment (GMA) and the Motor Optimality Score-Revised (MOS-R) have been used in infants with developmental central hypotonia aged <5 months corrected age. PubMed, Scopus, ProQuest, Web of Science and the Cochrane Library were searched from inception to November 2025. Included studies assessed preterm or term infants with developmental central hypotonia using GMA and/or MOS-R. Fourteen studies met inclusion criteria, covering 12 diagnoses and etiologies (including Cornelia de Lange syndrome, hypotonic cerebral palsy, Cri du chat syndrome, Down syndrome, Prader-Willi syndrome, Smith-Magenis syndrome, and West syndrome). Across conditions, spontaneous motor behavior showed a consistent pattern: reduced variability and complexity, a below-age-expected repertoire, and atypical posture, with predominantly slow or monotonous movement character. Atypical fidgety patterns were frequent, although fidgety movements could still be present in infants diagnosed with Down syndrome or Prader-Willi syndrome. Evidence was limited and heterogeneous, with most studies small and descriptive. GMA and MOS-R are feasible, reliable tools to assess early motor phenotypes in developmental central hypotonia and may strengthen detection and surveillance pathways. Prospective longitudinal studies should standardize MOS-R subdomain reporting and evaluate clinical utility by examining associations with later functional and hypotonia trajectories, and responsiveness to early intervention.
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