General Movement Assessment in infancy and later cognitive outcomes: A systematic review and meta-analysis

To evaluate whether the General Movement Assessment (GMA) in infancy is associated with later cognitive outcomes from early childhood through adulthood.

Cohort and case-control studies examining associations between Prechtl's GMA and cognitive outcomes from 6 months of age were eligible. Six databases were searched to 17th November 2025. Risk of bias was assessed using the Quality in Prognosis Studies tool. Data were synthesized according to GMA type, cognitive outcome, and follow-up age using narrative or meta-analytical methods. Certainty of evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Forty-seven studies met the inclusion criteria; 45 included high-risk infants with or without cerebral palsy. Evidence for associations between GMA and cognition varied in certainty. Moderate-certainty evidence indicated that aberrant writhing classification is associated with reduced cognitive ability in early childhood, and aberrant fidgety classification with lower intellectual, verbal, and visual cognitive abilities in later childhood. Moderate-certainty evidence supported associations between lower motor optimality scores at fidgety age and poorer verbal and visual cognitive abilities in later childhood. There was low-certainty to very-low-certainty evidence for associations between GMA and classification of cognitive impairment.

This review demonstrates that GMA is probably associated with some cognitive outcomes in childhood, although the certainty of evidence varies. High-quality prospective studies using multivariable models are needed to clarify prognostic utility.