Use of the General Movements Assessment for the Early Detection of Cerebral Palsy in Infants with Congenital Anomalies Requiring Surgery.

Iona Novak,Nadia Badawi,Cathryn Crowle,Alison Loughran Fowlds

doi:10.3390/jcm8091286

Abstract

The general movements (GMs) assessment is recognised as one of the most important tools in the early detection of cerebral palsy (CP). However, there remains a paucity of data on its application to infants with congenital anomalies requiring surgery. This was a prospective study of 202 infants (mean gestation 38 weeks, SD 2.2) who had undergone major surgery for congenital anomalies in the neonatal period. Infants were assessed at three months of age (mean 12 weeks, SD 1.6) and GMs videos were independently rated by three clinicians, two blinded to clinical details. Developmental follow-up was at three years of age. Of the twenty-five infants (9%) rated as having an absence of fidgety movements, 22 were seen at 3 years, and 17 had an abnormal outcome: 11 with CP, and 6 with a developmental disability. Infants with absent fidgety movements were 21.5 (95% CI 7.3–63.8) times more likely to have an abnormal outcome including CP. None of the infants with normal fidgety movements had a diagnosis of CP and 86% were assessed to be developing normally. The GMs assessment has predictive value for cerebral palsy and neurodevelopment for infants with congenital anomalies, and should be incorporated into routine follow-up to facilitate early referral.

Highlights

The general movements (GMs) assessment is recognised to be one of the best tools for the early prediction of neurodevelopmental outcomes in infancy, especially cerebral palsy [1,2]
The aim of this paper was to determine the effectiveness of the GMs assessment in predicting neurodevelopmental outcomes, including cerebral palsy, at three years of age in a cohort of infants with congenital anomalies requiring major surgery in the neonatal period
The GMs results at three months post-term age showed that the majority of infants had normal fidgety movements (n = 248, 89%); 25 (9%) had absent fidgety movements, and 5 (2%) had abnormal fidgety movements

Summary

Introduction

The general movements (GMs) assessment is recognised to be one of the best tools for the early prediction of neurodevelopmental outcomes in infancy, especially cerebral palsy [1,2] This assessment involves a visual/Gestalt perspective of an infant’s spontaneous movements which are recorded for several minutes when the infant is in a calm, awake state [3]. Training is required to rate an infant’s movements as normal or abnormal, and further into descriptive categories. This assessment can be used in the preterm and term age to assess an infant’s writhing movements, and again between 7–20 weeks to determine the presence of ‘fidgety’ movements. Absent fidgety movements have a strong association with the prediction of cerebral palsy (97–98% sensitivity, 89–91% specificity) [2,5]

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