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Assessment of general movements: towards a better understanding of a sensitive method to evaluate brain function in
M Hadders-Algra1, A Klip-Van den Nieuwendijk, A Martijn
1Department of Medical Physiology-Developmental Neurology, University of Groningen, The Netherlands.
Insights
Abnormal general movements (GMs) in infants can indicate neurological disability risk. A new classification system helps predict outcomes, with
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Movement Science
Background:
- Abnormal general movements (GMs) in early infancy are associated with a high risk of neurological disability.
- Early identification of neurological risks is crucial for timely intervention.
- A standardized classification of GMs is needed to assess their prognostic significance.
Purpose of the Study:
- To develop and validate a classification system for abnormal general movements (GMs).
- To determine the predictive value of different GM categories for neurodevelopmental outcomes.
- To elucidate the significance of GM quality assessed at a single time point.
Main Methods:
- Longitudinal video and electromyographic (EMG) recordings of six term and ten preterm infants with abnormal GMs.
- Classification of abnormal GMs into two main categories: mildly abnormal (lacking fluency) and definitely abnormal (lacking fluency and complexity).
- Correlation of GM types with neonatal ultrasound findings and neurodevelopmental outcomes at 1.5 years of age.
Main Results:
- Two categories of abnormal GMs were identified: mildly abnormal (two types) and definitely abnormal (four types).
- GM type before 39 weeks postmenstrual age (PMA) correlated with neonatal brain ultrasound findings.
- GM quality after 47 weeks PMA strongly predicted neurodevelopmental outcome at 1.5 years, with the absence of 'fidgety' GMs indicating potential disability.
Conclusions:
- A classification system for abnormal general movements (GMs) can differentiate neurological risks.
- Early GM assessment, particularly the presence or absence of 'fidgety' movements, is a valuable predictor of neurodevelopmental outcome.
- This system aids in identifying infants at high risk for neurological disabilities, enabling earlier intervention.
Abstract:
The consistent presence of an abnormal quality of general movements (GMs) during the first postnatal months points to a high risk for the development of a neurological disability. To elucidate the significance of abnormal GMs during a single assessment, a classification system for abnormal GMs was developed. To this end six term and ten preterm infants with abnormal GMs were studied longitudinally with video and electromyographic (EMG) recordings till 59 weeks postmenstrual age (PMA). Two basic categories of abnormal GMs were distinguished: (1) mildly abnormal GMs (two types), which lacked fluency while conserving pattern complexity, and (2) definitely abnormal GMs (four types), which lacked fluency and complexity altogether. GM type before 39 weeks PMA correlated with findings on neonatal ultrasound brain scans. GM quality after 47 weeks PMA was strongly related to neurodevelopmental outcome at 1 1/2 years of age, suggesting that the absence of the age-specific 'fidgety' character of GMs could be a herald of disability.