The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3–5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant’s later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III–V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.

GMAGeneral movement assessment GMOS General movement optimality score AIM To explore the appropriateness of applying a detailed assessment of general movements and characterize the relationship between global and detailed assessment. METHOD The analysis was based on 783 video recordings of 233 infants (154 males, 79females) who had been videoed from 27 to 45 weeks postmenstrual age. Apart from assessing the global general movement categories (normal, poor repertoire, crampedsynchronized, or chaotic general movements), we scored the amplitude, speed, spatial range, proximal and distal rotations, onset and offset, tremulous and cramped components of the upper and lower extremities. Applying the optimality concept, the maximum general movement optimality score of 42 indicates the optimal performance. RESULTS General movement optimality scores (GMOS) differentiated between normalgeneral movements (median 39 [25-75th centile 37-41]), poor repertoire general movements (median 25 [22][23][24][25][26][27][28][29]), and cramped-synchronized general movements (median 12 [10-14]; p<0.01). The optimality score for chaotic general movements (mainly occurring at late preterm age) was similar to those for cramped-synchronized general movements (median 14 [12-17]). Short-lasting tremulous movements occurred from very preterm age (<32wks) to post-term age across all general movement categories, including normal general movements.The detailed score at post-term age was slightly lower compared to the scores at preterm and term age for both normal (p=0.02) and poor repertoire general movements (p<0.01).INTERPRETATION Further research might demonstrate that the GMOS provides a solid base for the prediction of improvement versus deterioration within an individual general movement trajectory.Abnormal general movements are among the most reliable early markers for neurodevelopmental disorders. 1,2Recently, Bosanquet et al. 3 reviewed various structural and functional assessment techniques for which the accuracy of predicting cerebral palsy was reported. Compared to cranial ultrasound, magnetic resonance imaging and neurological examination, the general movement assessment (GMA) provided best evidence, with a sensitivity of 98% (95% confidence interval [CI] 74-100) and a specificity of 91% (95% CI 83-93).3 Apart from the first promising attempts to analyse general movements with the aid of computerbased tools, 4,5 GMA is based on visual Gestalt perception. General movements are considered to be normal if the sequence, amplitude, speed, and intensity are variable. Abnormal general movements are characterized by a lack of variability, especially in the movement sequence. 1,6 Gestalt perception is a powerful tool when it comes to the analysis of complex phenomena. Experienced observers consistently achieved high interscorer agreements, ranging from 89% to 93%. 6 In addition to the global assessment of general movement patterns, it can also be worthwhile to look at different aspects and components of general movements, particularly i...

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Predominantly, qualitative aspects of the early motor repertoire at the age of 3 and 5months are associated with language development.

BackgroundEven though Down syndrome is the most common chromosomal cause of intellectual disability, studies on early development are scarce.AimTo describe movements and postures in 3- to 5-month-old infants with Down syndrome and assess the relation between pre- and perinatal risk factors and the eventual motor performance.Methods and proceduresExploratory study; 47 infants with Down syndrome (26 males, 27 infants born preterm, 22 infants with congenital heart disease) were videoed at 10–19 weeks post-term (median = 14 weeks). We assessed their Motor Optimality Score (MOS) based on postures and movements (including fidgety movements) and compared it to that of 47 infants later diagnosed with cerebral palsy and 47 infants with a normal neurological outcome, matched for gestational and recording ages.Outcomes and resultsThe MOS (median = 13, range 10–28) was significantly lower than in infants with a normal neurological outcome (median = 26), but higher than in infants later diagnosed with cerebral palsy (median = 6). Fourteen infants with Down syndrome showed normal fidgety movements, 13 no fidgety movements, and 20 exaggerated, too fast or too slow fidgety movements. A lack of movements to the midline and several atypical postures were observed. Neither preterm birth nor congenital heart disease was related to aberrant fidgety movements or reduced MOS.Conclusions and implicationsThe heterogeneity in fidgety movements and MOS add to an understanding of the large variability of the early phenotype of Down syndrome. Studies on the predictive values of the early spontaneous motor repertoire, especially for the cognitive outcome, are warranted.What this paper addsThe significance of this exploratory study lies in its minute description of the motor repertoire of infants with Down syndrome aged 3–5 months. Thirty percent of infants with Down syndrome showed age-specific normal fidgety movements. The rate of abnormal fidgety movements (large amplitude, high/slow speed) or a lack of fidgety movements was exceedingly high. The motor optimality score of infants with Down syndrome was lower than in infants with normal neurological outcome but higher than in infants who were later diagnosed with cerebral palsy. Neither preterm birth nor congenital heart disease were related to the motor performance at 3–5 months.