Does general movements quality in term infants predict cerebral palsy and milder forms of limited mobility at 6 years?

Abstract

In term infants, definitely abnormal general movements at fidgety age do predict CP, but with lower accuracy than in preterm infants. General movements quality does not predict limited mobility in children without CP. The study supports suggestions that predictive value of general movements assessment in term infants is lower than that in preterm infants.

Predictive validity of spontaneous early infant movement for later cerebral palsy: a systematic review

“…Fifty-five records met inclusion criteria and represented 47 study cohorts, of which 31 16,18, were prospective studies, five [69][70][71][72][73][74] were retrospective studies, five 13,14,[75][76][77][78][79] were studies of selections from previous cohorts, and two were follow-up studies 80-83 from randomized controlled trials where outcomes between intervention arms did not differ. One study 79 reported on two cohorts for writhing general movements and seven studies 37,50,57,61,[78][79][80] for fidgety general movements using Hadders-Algra's method. The characteristics of each study are summarized in fidgety movements, and five studies 13,18,42,51,59 for cramped-synchronized movements under the Prechtl GMA for prediction of later CP.…”

“…Seventeen studies 16,18,37,39,[41][42][43]54,57,58,60,61,[69][70][71][72]82,83 defined the type and topography of later CP but did not relate specific observed items to the type of CP that developed. Only four studies 13,17,52,77 contained data to correlate specific movements for the type or topography of CP.…”

“…14 13,16,44,51,53,61,[67][68][69][70][71]77 Therefore, flow and follow-up rates could not be calculated accurately. Three studies used Hagberg or Palisano criteria to diagnose CP.…”

Predictive validity of the General Movements Assessment: type of population versus type of assessment

“…We previously reported that predictive validity of the General Movements Assessment (GMA) for CP is better in infants born preterm than those born at term. 2,3 This is best illustrated by the forest plots in the supplementary material of the paper by Kwong et al, particularly by the studies with the least bias. Presumably this difference in predictive validity is brought about by the difference in the type of lesions of the brain.…”

“…However, this pooling does not correspond to the Hadders-Algra classification, where mildly abnormal general movements are regarded to reflect normal (but non-optimal) brain function and definitely abnormal general movements brain dysfunction. 3,5 It goes without saying that such erroneous pooling would reduce the predictive validity of the GMA according to Hadders-Algra. Yet, the forest plot summarizing the predictive value of the Hadders-Algra classification suggests that Kwong et al did not consistently apply their pooling rule.…”