Predictive Value of General Movement Assessment for Cerebral Palsy in Routine Clinical Practice

Background Early identification of children at high risk of future neurodevelopmental disability is important for the initiation of appropriate therapy. In research settings, the assessment of fidgety movements (FMs) at 3 months supports a general movement assessment (GMA) as a strong predictor for subsequent motor development, but there are few studies from routine clinical settings. Objective The study objective was to examine the relationship between FMs and neurodevelopmental outcome by the age of 2 years in high-risk infants in a routine hospital clinical setting. Design This was a prospective study. Methods A GMA was performed in 87 high-risk infants at 3 months after term age. The infants were clinically assessed for cerebral palsy (CP) at 2 years. Sensitivity, specificity, likelihood ratios, and positive and negative predictive values were computed. The relative risk of motor problems by the age of 2 years, according to the GMA, was estimated. Results Of the infants with normal FMs, 93% (50/54) had normal development and none was diagnosed with CP, whereas 75% (12/16) with abnormal or sporadic FMs had normal development. In contrast, 53% (9/17) of those without FMs had CP. When the GMA was considered to be a test for CP and absent FMs were considered to be a positive test result, the sensitivity was 90% and the specificity was 90%. The likelihood ratios for positive and negative test results were 8.7 and 0.1, respectively. The negative predictive value was 99%, and the positive predictive value was 53%. The risk of motor problems by the age of 2 years increased linearly with the extent of pathological results on the GMA and was 10 times higher when FMs were absent at 3 months than when FMs were normal. Limitations The relatively small study sample was a study limitation. Conclusions When applied in a routine clinical setting, the GMA strongly predicted neurodevelopmental impairments at 2 years in high-risk infants.

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The Predictive Accuracy of the General Movement Assessment for Cerebral Palsy: A Prospective, Observational Study of High-Risk Infants in a Clinical Follow-Up Setting

Journal of Clinical Medicine ◽

10.3390/jcm8111790 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1790 ◽

Cited By ~ 5

Author(s):

Ragnhild Støen ◽

Lynn Boswell ◽

Raye-Ann de Regnier ◽

Toril Fjørtoft ◽

Deborah Gaebler-Spira ◽

...

Keyword(s):

Cerebral Palsy ◽

High Risk ◽

Observational Study ◽

Predictive Values ◽

Increased Risk ◽

Movement Assessment ◽

General Movement ◽

Neonatal Imaging ◽

High Risk Infants

Background: Early prediction of cerebral palsy (CP) using the General Movement Assessment (GMA) during the fidgety movements (FM) period has been recommended as standard of care in high-risk infants. The aim of this study was to determine the accuracy of GMA, alone or in combination with neonatal imaging, in predicting cerebral palsy (CP). Methods: Infants with increased risk of perinatal brain injury were prospectively enrolled from 2009–2014 in this multi-center, observational study. FM were classified by two certified GMA observers blinded to the clinical history. Abnormal GMA was defined as absent or sporadic FM. CP-status was determined by clinicians unaware of GMA results. Results: Of 450 infants enrolled, 405 had scorable video and follow-up data until at least 18–24 months. CP was confirmed in 42 (10.4%) children at mean age 3 years 1 month. Sensitivity, specificity, positive and negative predictive values, and accuracy of absent/sporadic FM for CP were 76.2, 82.4, 33.3, 96.8, and 81.7%, respectively. Only three (8.1%) of 37 infants with sporadic FM developed CP. The highest accuracy (95.3%) was achieved by a combination of absent FM and abnormal neonatal imaging. Conclusion: In infants with a broad range of neonatal risk factors, accuracy of early CP prediction was lower for GMA than previously reported but increased when combined with neonatal imaging. Sporadic FM did not predict CP in this study.

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1302 The correlation between early general movement assessment and 2 year neurodevelopmental outcome in high risk infants

10.1136/archdischild-2021-rcpch.542 ◽

2021 ◽

Author(s):

Anneli Allman ◽

Debbie Paris ◽

Margaret Manton

Keyword(s):

High Risk ◽

Neurodevelopmental Outcome ◽

Movement Assessment ◽

General Movement ◽

High Risk Infants

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In-Motion-App for remote General Movement Assessment: a multi-site observational study

BMJ Open ◽

10.1136/bmjopen-2020-042147 ◽

2021 ◽

Vol 11 (3) ◽

pp. e042147

Author(s):

Lars Adde ◽

Annemette Brown ◽

Christine van den Broeck ◽

Kris DeCoen ◽

Beate Horsberg Eriksen ◽

...

Keyword(s):

High Risk ◽

Observational Study ◽

Video Recordings ◽

Video Record ◽

Spontaneous Movements ◽

Home Based ◽

Movement Assessment ◽

General Movement ◽

High Risk Infants ◽

Point Body

ObjectivesTo determine whether videos taken by parents of their infants’ spontaneous movements were in accordance with required standards in the In-Motion-App, and whether the videos could be remotely scored by a trained General Movement Assessment (GMA) observer. Additionally, to assess the feasibility of using home-based video recordings for automated tracking of spontaneous movements, and to examine parents’ perceptions and experiences of taking videos in their homes.DesignThe study was a multi-centre prospective observational study.SettingParents/families of high-risk infants in tertiary care follow-up programmes in Norway, Denmark and Belgium.MethodsParents/families were asked to video record their baby in accordance with the In-Motion standards which were based on published GMA criteria and criteria covering lighting and stability of smartphone. Videos were evaluated as GMA ‘scorable’ or ‘non-scorable’ based on predefined criteria. The accuracy of a 7-point body tracker software was compared with manually annotated body key points. Parents were surveyed about the In-Motion-App information and clarity.ParticipantsThe sample comprised 86 parents/families of high-risk infants.ResultsThe 86 parent/families returned 130 videos, and 121 (96%) of them were in accordance with the requirements for GMA assessment. The 7-point body tracker software detected more than 80% of body key point positions correctly. Most families found the instructions for filming their baby easy to follow, and more than 90% reported that they did not become more worried about their child’s development through using the instructions.ConclusionsThis study reveals that a short instructional video enabled parents to video record their infant’s spontaneous movements in compliance with the standards required for remote GMA. Further, an accurate automated body point software detecting infant body landmarks in smartphone videos will facilitate clinical and research use soon. Home-based video recordings could be performed without worrying parents about their child’s development.Trials registration numberNCT03409978.

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