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Changes in General Movements During Early Intensive Rehabilitation in High-Risk Infants with Structural Brain Injury:
Svetislav Polovina1, Andrea Polovina1, Jelena Erceg1
1Polyclinic "Prof. dr. sc. Milena Stojčević Polovina", Svetice 36, 10000 Zagreb, Croatia.
Insights
Early intensive rehabilitation for high-risk infants showing abnormal writhing movements (WMs) improved motor skills. The Early Intensive Stojčević-Polovina Rehabilitation Method (EIR-SPM) showed positive changes in general movements (GMs) and motor optimality scores.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Abnormal general movements (GMs) in high-risk infants are key early indicators of cerebral palsy (CP) and neurodevelopmental disorders.
- The Early Intensive Stojčević-Polovina Rehabilitation Method (EIR-SPM) is designed for infants at risk of CP, initiating intervention within the first three months of corrected age.
Purpose of the Study:
- To describe changes in GM quality over time in high-risk infants undergoing EIR-SPM.
- To evaluate the effectiveness of EIR-SPM initiated during the writhing movement (WM) period.
Main Methods:
- Eight high-risk infants with abnormal WMs and brain injury received EIR-SPM between 41 and 47 weeks postmenstrual age (PMA) until 60 weeks PMA.
- Assessments included Prechtl's General Movements Assessment (GMA), Detailed GM score, and Motor Optimality Score-Revised (MOS-R).
Main Results:
- GM patterns shifted, with some infants transitioning from cramped-synchronized (CS) to poor repertoire (PR).
- In the fidgety period, improvements were noted in fidgety movement (FM) classifications (F+ and sFM increased).
- Median MOS-R scores significantly increased from 17.0 to 19.5 (p=0.027), indicating improved motor optimality.
Conclusions:
- EIR-SPM initiated during the writhing period shows promise in improving motor repertoire in high-risk infants.
- Preliminary findings suggest positive motor outcomes, but larger controlled studies are necessary for confirmation.
Abstract:
Background/Objectives: Abnormal general movements (GMs) in high-risk infants are among the most sensitive early predictors of cerebral palsy (CP) and other neurodevelopmental disorders. This study described changes in the quality of GMs over time in high-risk infants who received the Early Intensive Stojčević-Polovina Rehabilitation Method (EIR-SPM). The EIR-SPM is a rehabilitation method designed for children with CP, those at risk of developing CP, and children with other developmental disabilities. In high-risk infants, it is initiated within the first three months of corrected age, preferably while writhing movements (WMs) are still present. Methods: This study was conducted in eight high-risk infants with abnormal WMs and structural brain injury. The EIR-SPM was initiated between 41 and 47 weeks postmenstrual age (PMA) and was applied until 60 weeks PMA. Prechtl's General Movements Assessment (GMA), the Detailed GM score, and the Motor Optimality Score-Revised (MOS-R) were assessed. Results: During the writhing period, two infants showed a poor repertoire (PR) pattern and six showed a cramped-synchronized (CS) pattern of GMs; at follow-up, three showed PR, and five showed CS. During the fidgety period, two infants showed normal fidgety movements (F+), two sporadic fidgety movements (sFM), one infant showed abnormal fidgety movements (aFM), and three showed absent fidgety movements (F-) at the first assessment, while at the second assessment, three infants showed F+, two sFM, one aFM, and two F-. The median Detailed GM score increased from 12 (range 11-17) to 13.5 (range 11-19; p = 0.068). The median MOS-R increased from 17.0 (range 12-24) to 19.5 (range 17-27) between the two fidgety assessments (p = 0.027). Conclusions: Improvements in motor repertoire, reflected by increased MOS-R scores, were observed during the EIR-SPM initiated in the writhing period. Larger controlled studies are needed to confirm these preliminary observations.
