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...

To improve the neurodevelopmental outcome in infants with high grade intraventricular haemorrhage and cramped-synchronised (CS) general movements (GMs). Four very preterm infants with intraventricular haemorrhage grade III (n = 3) or intraventricular haemorrhage with apparent periventricular haemorrhagic infarction (n = 1) were diagnosed with CS GMs at 33 to 35 weeks postmenstrual age. A few days later MIT-PB [Movement Imitation Therapy for Preterm Babies], an early intervention programme, was commenced: the instant an infant showed CS movements, the therapist intervened by gently guiding the infant's limbs so as to manoeuvre and smoothen the movements, thereby imitating normal GM sequences as closely as possible (at least for 10 min, 5 times a day, with increasing frequency over a period of 10 to 12 weeks). After a period of consistent CS GMs, the movements improved. At 14 weeks postterm age, the age specific GM pattern, fidgety movements, were normal in three infants, one infant had abnormal fidgety movements. At preschool age, all participants had a normal neurodevelopmental outcome. This report on four cases demonstrates that mimicking normal and variable GM sequences might have a positive cascading effect on neurodevelopment. The results need to be interpreted with caution and replication studies on larger samples are warranted. Nonetheless, this innovative approach may represent a first step into a new intervention strategy.

The assessment of General Movements (GMs), i.e. age-specific motor patterns during the first months of life, has repeatedly proven to be a valuable tool to predict neurodevelopmental outcomes. Abnormal spontaneous GMs were found to be among the most reliable markers for cerebral palsy. To add to the knowledge of the abnormal early motor repertoire we analysed prospectively collected video recordings of a boy clinically diagnosed with Cornelia de Lange syndrome. The observed atypical GMs are a further step to disentangle early motor peculiarities in the light of the genetic impact on the developing brain.

Brain and nervous system development are experience dependent. Indeed, the sequence of development is laid out genetically, but early environmental events are major contributors to the system's development and optimal functioning. Various fetal injuries and birth trauma make babies vulnerable to developmental problems: cerebral palsy, seizures, abnormal muscle tone, delayed developmental milestones, sensory integration, and more. Our goal in the study presented here was to improve the neurodevelopmental track of babies at risk using Infant Neural Aquatic. Parent and baby dyads who met initial criteria were recruited for a 5-6 months intervention period through an open invitation, followed by a conversation and signing informed consent. In the beginning and end of intervention period, participants completed questionnaires, and developmental features of the babies were assessed using analysis of neuro-motor and vocal characteristics. Significant neurodevelopmental delta between values at the end and beginning of intervention period, comparing intervention and control, is described, and the strength of INA specific intervention tool is analyzed.