The general movement assessment in non-European low- and middle-income countries

Tomantschger, Iris; Herrero, Dafne; Einspieler, Christa; Hamamura, Cristina; Voos, M.; Marschik, Peter B.

doi:10.11606/s1518-8787.2018052000332

Cited by 19 publications

(22 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We could also not focus on influencing environmental factors such as socio-economic status, teratogens, drug intake, viral infections, or malnutrition, to name but a few potential confounders. Some of these factors have been investigated with respect to GMA [46,67], but their impact on the MOS is yet to be studied. Second, this being a worldwide study, one might consider the participants’ varied ethnic backgrounds as problematic.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

Einspieler

Bos

Krieber-Tomantschger

et al. 2019

JCM

147

218

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

Einspieler

Bos

Krieber-Tomantschger

et al. 2019

JCM

147

218

View full text Add to dashboard Cite

show abstract

“… 11 19 Both have simple administration (the GMs a 3 min video taken on a smart phone, the HINE a truncated 26-item neurological examination) which we believe can be feasibly administered in the community context in LMIC and scored by expert certified raters. 20 A community-based intervention of active goal-directed strategies and environmental enrichment delivered peer to peer in the home also presents a viable solution for accessible and scalable intervention in this context. The aims of this study are twofold; to determine the predictive validity of a community-based early detection programme for infants at risk of CP in LMIC and to determine the effectiveness of a home-based peer delivered early intervention.…”

Section: Introductionmentioning

confidence: 99%

Community-based parent-delivered early detection and intervention programme for infants at high risk of cerebral palsy in a low-resource country (Learning through Everyday Activities with Parents (LEAP-CP): protocol for a randomised controlled trial

et al. 2018

View full text Add to dashboard Cite

IntroductionCerebral palsy (CP) is the most common childhood physical disability, with 80% estimated to be in low-middle-income countries. This study aims to (1) determine the accuracy of General Movements (GMs)/Hammersmith Infant Neurological Examination (HINE) for detecting CP at 18 months corrected age (CA); (2) determine the effectiveness of a community-based parent-delivered early intervention for infants at high risk of CP in West Bengal, India (Learning through Everyday Activities with Parents for infants with CP; LEAP-CP).MethodsThis study comprises two substudies: (1) a study of the predictive validity of the GMs and HINE for detecting CP; (2) randomised, double-blinded controlled trial of a novel intervention delivered through peer trainers (Community Disability Workers, CDW) compared with health advice (15 fortnightly visits). 142 infants at high risk of CP (‘absent fidgety’ GMs; ‘high risk score’ on HINE) aged 12–40 weeks CA will be recruited to the intervention substudy, with infants randomised based on a computer-generated sequence. Researchers will be masked to group allocation, and caregivers and CDWs naïve to intervention status. Visits will include therapeutic modules (goal-directed active motor/cognitive strategies and LEAP-CP games) and parent education. Health advice is based on the Integrated Management of Childhood Illness, WHO. Infants will be evaluated at baseline, post intervention and 18 months CA. The primary hypothesis is that infants receiving LEAP-CP will have greater scaled scores on the Pediatric Evaluation of Disability Inventory—Computer Adaptive Test (mobility domain) at 18 months compared with health advice. Secondary outcomes include infant functional motor, cognitive, visual and communication development; infant growth; maternal mental health.Ethics and disseminationThis study is approved through appropriate Australian and Indian ethics committees (see in text) with families providing written informed consent. Findings from this trial will be disseminated through peer-reviewed journal publications and conference presentations.Trial registration number12616000653460p; Pre-results.

show abstract

“… 23 GMA is ideal for the neurological assessment of young infants, especially in low- and middle-income countries that struggle to provide expensive medical equipment for diagnoses. 24 From birth to the end of the second month post-term age, normal general movements (GMs) include a fluctuating sequence of arm, neck, trunk and leg movements. They wax and wane with changing intensity, speed and range of motion.…”

Section: Methods and Analysesmentioning

confidence: 99%

Enhancing early detection of neurological and developmental disorders and provision of intervention in low-resource settings in Uttar Pradesh, India: study protocol of the G.A.N.E.S.H. programme

Toldo¹,

Varishthananda

Einspieler

et al. 2020

BMJ Open

Self Cite

View full text Add to dashboard Cite

IntroductionAround 9% of India’s children under six are diagnosed with neurodevelopmental disorders. Low-resource, rural communities often lack programmes for early identification and intervention. The Prechtl General Movement Assessment (GMA) is regarded as the best clinical tool to predict cerebral palsy in infants <5 months. In addition, children with developmental delay, intellectual disabilities, late detected genetic disorders or autism spectrum disorder show abnormal general movements (GMs) during infancy. General Movement Assessment in Neonates for Early Identification and Intervention, Social Support and Health Awareness (G.A.N.E.S.H.) aims to (1) provide evidence as to whether community health workers can support the identification of infants at high-risk for neurological and developmental disorders and disabilities, (2) monitor further development in those infants and (3) initiate early and targeted intervention procedures.MethodsThis 3-year observational cohort study will comprise at least 2000 infants born across four districts of Uttar Pradesh, India. Community health workers, certified for GMA, video record and assess the infants’ GMs twice, that is, within 2 months after birth and at 3–5 months. In case of abnormal GMs and/or reduced MOSs, infants are further examined by a paediatrician and a neurologist. If necessary, early intervention strategies (treatment as usual) are introduced. After paediatric and neurodevelopmental assessments at 12–24 months, outcomes are categorised as normal or neurological/developmental disorders. Research objective (1): to relate the GMA to the outcome at 12–24 months. Research objective (2): to investigate the impact of predefined exposures. Research objective (3): to evaluate the interscorer agreement of GMA.Ethics and disseminationG.A.N.E.S.H. received ethics approval from the Indian Government Chief Medical Officers of Varanasi and Mirzapur and from the Ramakrishna Mission Home of Service in Varanasi. GMA is a worldwide used diagnostic tool, approved by the Ethics Committee of the Medical University of Graz, Austria (27-388 ex 14/15). Apart from peer-reviewed publications, we are planning to deploy G.A.N.E.S.H. in other vulnerable settings.

show abstract

The general movement assessment in non-European low- and middle-income countries

Cited by 19 publications

References 38 publications

Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

Community-based parent-delivered early detection and intervention programme for infants at high risk of cerebral palsy in a low-resource country (Learning through Everyday Activities with Parents (LEAP-CP): protocol for a randomised controlled trial

Enhancing early detection of neurological and developmental disorders and provision of intervention in low-resource settings in Uttar Pradesh, India: study protocol of the G.A.N.E.S.H. programme

Contact Info

Product

Resources

About