General Movement Research Articles

The Comparison of Three Assessment Scales in a Neonatal Unit in Poland

Abstract The aim of this study was to analyse the relationship between the following three assessments: the Neonatal Behavioral Assessment Scale (NBAS), the Alberta Infant Motor Scale (AIMS), and the General Movement Assessment (GMA). 29 patients from the neonatal unit of the Gynecology and Obstetrics Clinical Hospital were examined. The study was conducted between feedings by a person properly trained in the use of the NBAS, the AIMS, and the GMA. The average postmenstrual age of the examined newborns was 35.6 weeks. The average week of gestation was the 29th, the average birth weight was 1469 g, and the Median Apgar score in the fifth minute of life was 7. A relationship was found between the AIMS and the NBAS. It was concluded that the Neonatal Behavioral Assessment Scale and the Alberta Infant Motor Scale may be used to determine the motor development of preterm infants. Moreover, it is advisable to use more than one assessment method in order to adjust the intervention.

Nusinersen: A Review in 5q Spinal Muscular Atrophy.

Survival motor neuron 1 (SMN1), located on chromosome 5q, encodes the survival motor neuron (SMN) protein. A deletion or mutation in SMN1 results in a rare neuromuscular disorder: 5q spinal muscular atrophy (SMA). In such patients, SMN protein production relies solely on SMN2. Nusinersen (Spinraza®) is a modified antisense oligonucleotide approved for the treatment of 5q SMA. Administered intrathecally, it modifies SMN2 pre-messenger RNA splicing, thereby increasing full-length SMN protein levels. Interim analyses from an ongoing phase II study suggest substantial clinical benefits with nusinersen initiation in presymptomatic patients. In phase III studies, nusinersen achieved significant and/or clinically relevant improvements in motor function in symptomatic patients with infantile- and later-onset 5q SMA, and significantly improved event-free survival and overall survival in patients with infantile-onset 5q SMA. Longer term (up to a median of ≈ 6 years of available data), motor function was maintained or improved in symptomatic patients. Nusinersen had a favourable safety profile in clinical studies in presymptomatic and symptomatic patients. Real-world experience supports the effectiveness, safety and tolerability of nusinersen in symptomatic patients of all ages. Thus, nusinersen remains an important treatment option among a broad range of 5q SMA patients.

Ramesh Mallipeddi. Spectacular Suffering: Witnessing Slavery in the Eighteenth-Century British Atlantic.

Ramesh Mallipeddi. <i>Spectacular Suffering: Witnessing Slavery in the Eighteenth-Century British Atlantic</i>.

Experimental assessment of eigenfrequencies and stiffness of the elastically supported body

The aim of the research is to derive an analytical solution describing the vibrations of railway wagons caused by asymmetrical loading of cargo for prediction of dangerous conditions. A presumption for the dynamic analysis and assessment of the driving quality of railway vehicles is an important experimental determination and verification of the basic characteristics of the suspension respectively. A method for determining these characteristics for two-axle vehicles has been developed and applied. This method requires knowledge of the position of the center of gravity and the main central moments of inertia. Vehicle bodies, chassis frames, and wheelsets are assumed to be rigid bodies under the investigation of these characteristics. The characteristics of the springs are linear or can be linearized. The vehicle body performs a general spatial movement. The result of the investigation is an analytical method to obtain the required characteristics needed for the dynamic analysis of the vehicle.

General movement optimality score and general movements trajectories following early parent-administrated physiotherapy in the neonatal intensive care unit

BackgroundThe Prechtl General Movement Assessment (GMA) is a reliable tool for the functional assessment of the young nervous system. It is based on a global assessment of the quality of infants' movements. In addition, detailed steps of assessment have been developed – one for preterm and term age, and one for use between 3 and 5 months. One potential benefit of such a detailed analysis is the documentation of subtle changes in the infants' spontaneous movements caused by early intervention. AimTo present detailed scores of the infants' general movements (GMs) at preterm age, and of the infants' motor repertoire at 3 months' postterm age (PTA), for infants having participated in a randomized controlled trial (RCT) of early intervention, and to examine possible group differences. In addition, the aim is also to present the GMA from preterm to 3 months' PTA, comparing the intervention and the control group. Study designA retrospective study on infants who had participated in an RCT of parent-administered early intervention. Subjects141 infants born very preterm. Outcome measuresGMA, “Detailed Assessment of General Movements During Preterm and Term Age” and “Assessment of Motor Repertoire at 3 to 5 months”. ResultsThe GMA and the detailed assessments of GMs conducted at 36 weeks' post menstrual age (PMA) showed the same distribution of normal and abnormal movements in both the intervention and in the control group, as did the assessment of motor repertoire at 3 months' PTA. ConclusionNeither the GMA nor the detailed assessments of GMs at 36 weeks' PMA and of the motor repertoire at 13 weeks' PTA suggest that early intervention, performed before term, changes the GMs of very preterm-born infants.

The use of neuroimaging, Prechtl's general movement assessment and the Hammersmith infant neurological examination in determining the prognosis in 2-year-old infants with hypoxic ischemic encephalopathy who were treated with hypothermia

BackgroundThe use of neuroimaging, the General Movement Assessment (GMA), and the Hammersmith Infant Neurological Examination (HINE) to identify the risk of neurodevelopmental delay in early infancy is recommended. AimThe aim of this study was to examine the predictive power of neuroimaging, GMA and HINE for neurodevelopmental delay and cerebral palsy (CP) in infants with hypoxic ischemic encephalopathy (HIE) who were treated with hypothermia. Study designRetrospective cohort. Subjects and outcome measuresThis retrospective study included 47 (18 female and 29 male) infants who were treated with hypothermia due to HIE. Neonates with a diagnosis of HIE were followed and assessed using neuroimaging, GMA, HINE and the Bayley Scales of Infant and Toddler Development-II (Bayley II) between 3 m and 2 years of age. ResultsOut of the 47 infants with HIE, no fidgety movements were observed in 5 infants. The sensitivity and specificity in determining the psychomotor developmental index (PDI) score were 97% and 100%, respectively, for MRI; 92.9% and 100% for GMA; and 91.9% and 80% for the HINE. The sensitivity and specificity in determining the mental developmental index (MDI) score were 95% and 85.7%, respectively, for MRI; 90.5% and 80% for GMA; and 91.9% and 50% for HINE. The sensitivity and specificity in determining CP diagnosis at the age of 2 years were 83.3% and 95%, respectively, for MRI; 83.3% and 100% for GMA; and 83.3% and 87.8% for HINE. ConclusionThe interpretation of MRI, GMA, and HINE that are performed within the early period of life may be the gold standard for the early detection of neurodevelopmental risks in 2-year-old infants with HIE. Clinical implementation of these methods in the early period in the follow-up of these infants offers useful information for the early identification of neurodevelopmental risk and for planning early intervention.

A pilot study of the General Movement Optimality Score detects early signs of motor disorder in neonates with arterial ischemic stroke

AimTo explore whether the General Movement Optimality Score (GMOS) could help to identify asymmetric movement in infants with neonatal arterial ischemic stroke (NAIS) in the early stage. MethodTwenty-seven infants with NAIS (16 males, 11 females) were enrolled. The general movement video was recorded approximately one month after birth. The GMOS focused separately on the neck and trunk and the upper and lower extremities. The differences between the ipsilesional and contralesional limbs were analyzed. ResultsEight infants who developed cerebral palsy (CP) had middle cerebral artery (MCA) infarction involving the main branch. By GMOS evaluation, the scores of the contralesional upper and/or lower limbs were lower than those of the ipsilesional side (p < 0.05). In the contralesional limbs, the CP group had a lower GMOS than the non-CP group. Distal rotatory components of the contralesional upper limbs and tremulous movement of the lower limbs showed significant differences. InterpretationThe GMOS could help to quantitatively find and assess the asymmetric movement of global and contralesional limbs. Distal rotatory movement of the upper limbs could be an early sign of abnormal motor function in infants with NAIS.

Frankenstein Redux

Frankenstein Redux

General movement assessment is correlated with neonatal behavior neurological assessment/cerebral magnetic resonance imaging in preterm infants

To explore the relationship between general movements (GMs) and neonatal behavior neurological assessment (NBNA)/cerebral magnetic resonance imaging (MRI) in preterm infants.Forty preterm infants were examined with GMs assessment before gestational age of 40 weeks; NBNA was performed at the age of 40 weeks; cerebral MRI was performed at the age of 42 weeks.Our experiment showed that preterm infants with poor GMs scores are more likely to have low NBNA scores (P = .001); preterm infants with abnormal cerebral MRI are more likely to have low NBNA scores (P = .002); preterm infants with poor GMs scores are more likely to have abnormal cerebral MRI (P = .012).GM assessment is correlated with NBNA and MRI results in preterm infants for neurological development.

Local movements and site-tenacity of minke whale in Iceland in relation to feeding and a northward distribution shift

ABSTRACT Population dynamics, movement patterns and migratory routes of common minke whales (Balaenoptera acutorostrata) in the North Atlantic are not yet fully understood. Small-scale movements of minke whales within Skjálfandi Bay, Iceland, were analysed and discussed in relation to population dynamics in the North Atlantic. Local distribution and abundance of minke whales were investigated on both individual and population basis. Data were obtained through continuous sighting surveys from 2005 to 2018, conducted by trained volunteers using whale watching vessels as opportunistic research platforms. Variations in abundance might reflect a species distribution shift to higher latitudes. Competition for prey and the general movement of several species from different taxonomic groups support a potential range shift. For the first time, habitat use of minke whales in Skjálfandi Bay was revealed through spatial analysis, as well as small-scale site-tenacity, proven through modelling of distances between individual and random relocations. To improve the status of the declining minke whale population around Iceland we suggest recognition of separate minke whale management units using different areas. Additionally, we encourage the protection of different feeding grounds which will reduce local anthropogenic stressors and likely improve minke whales' coping with climate change and shifts in prey.

Neonatal Hemoglobin Levels in Preterm Infants Are Associated with Early Neurological Functioning

Background: Neonatal anemia may compromise oxygen transport to the brain. The effects of anemia and cerebral oxygenation on neurological functioning in the early neonatal period are largely unknown. Objective: This study aimed to determine the association between initial hemoglobin levels (Hb) and early neurological functioning in preterm infants by assessing their general movements (GMs). Methods: A retrospective analysis of prospectively collected data on preterm infants born before 32 weeks of gestation was conducted. We excluded infants with intraventricular hemorrhage > grade II. On day 8, we assessed infants’ GMs, both generally as normal/abnormal and in detail using the general movement optimality score (GMOS). We measured cerebral tissue oxygen saturation (r_cSO₂) on day 1 using near-infrared spectroscopy. Results: We included 65 infants (median gestational age 29.9 weeks [IQR 28.2–31.0]; median birth weight 1,180 g [IQR 930–1,400]). Median Hb on day 1 was 10.3 mmol/L (range 4.2–13.7). Lower Hb on day 1 was associated with a higher risk of abnormal GMs (OR = 2.3, 95% CI: 1.3–4.1) and poorer GMOSs (B = 0.9, 95% CI: 0.2–1.7). Hemoglobin strongly correlated with r_cSO₂ (rho = 0.62, p < 0.01). Infants with lower r_cSO₂ values tended to have a higher risk of abnormal GMs (p = 0.06). After adjusting for confounders, Hb on day 1 explained 44% of the variance of normal/abnormal GMs and r_cSO₂ explained 17%. Regarding the explained variance of the GMOS, this was 25% and 16%, respectively. Conclusions: In preterm infants, low Hb on day 1 is associated with impaired neurological functioning on day 8, which is partly explained by low cerebral oxygenation.

State Monopolies and the Free Movement of Goods in EU Law: Getting Beyond Obscure Clarity

The special provision relating to state monopolies of a commercial character within the EU’s internal market is nestled in the Treaties as the final provision regarding the free movement of goods. This special provision of Article 37 of the Treaty on the Functioning of the European Union (TFEU) is often overlooked, given it is seen to be of lesser significance than the general provisions on goods concerning quantitative restrictions and measures having equivalent effect contained in Articles 34– 36 TFEU. Whilst the case law on state monopolies in respect of goods is elaborate, it is still far from clear how state monopolies within the meaning of Article 37 TFEU are to be handled, as evident from the case law of the Court of Justice. The article analyses three arising issues. Firstly, it investigates the boundary between the special provision of Article 37 TFEU and the general provisions of Articles 34–36 TFEU; secondly, it critiques the public interest aim that was once read into Article 37 TFEU by the Court of Justice; and thirdly, it questions the discrimination reading of Article 37 TFEU, rather than a more elaborate restrictions reading. Conclusively, the article offers grounds for why the special provision of Article 37 TFEU ought to be repealed, which in turn, would provide for a more concerted and consistent approach by subjecting state monopolies to the general free movement of goods provisions of the EU Treaties. State monopolies, Free movement of goods, State-owned enterprises, European Union law, Law of the internal market

Early detection relationship of cerebral palsy markers using brain structure and general movements in infants born

AimTo detect early brain structural and clinical functional markers of brain injury and development based on a magnetic resonance imaging (MRI) scoring system and a general movement assessment (GMA) for preterm infants later diagnosed with cerebral palsy (CP). Study designRetrospective cohort study. General movements (GMs) were scored according to a semiquantitative scoring system: the GMs optimality score (GMOS) at preterm and term ages and the Motor Optimality Score (MOS) at the corrected age of 3 months after birth. Brain magnetic resonance imaging (MRI) at term-equivalent age was scored using an MRI scoring system. We analyzed the relationship between the early degree of cerebral white matter (WM) abnormality and the GMOS and the MOS for infants born <32 weeks gestational age later diagnosed with CP in a comparison group of neurotypical controls. SubjectsSixteen preterm infants were included in this study who underwent MRI and GMs assessment. 8 out of the 16 preterm infants were later diagnosed with CP, while the other 8 infants with normal motor development (N) were placed into the control group. Their median gestational age was 30w6d and 27w6d for each group respectively. ResultsThe cerebral WM MRI scores were significantly higher in the CP group than in the control group (p < 0.01). The GMOS and MOS were significantly higher in the control group than in the CP group (p < 0.05). The MOS showed a strong correlation to the cerebral WM MRI score (r = -0.88) and the subscale of cerebral WM items (the cystic degeneration and the focal signal abnormalities) of the MRI score (r = -0.94) in the CP group. The MOS also showed a correlation with corrected biparietal diameter (cBPD) in the preterm infant group with CP (r = 0.75). Results of linear regression analyses between term MRI and GMs measures in preterm infants with CP are presented. Cerebral WM scores were associated with the MOS (β = −0.63; 95%CI = −0.97, −0.29; p < 0.01). Cerebral WM injury, including the subscale of cystic degeneration and focal signal abnormalities was closely associated with the MOS (β = −0.83; 95%CI = −1.13, −0.54; p < 0.001). ConclusionCerebral WM scores show a strong association with a decreased motor performance on the MOS in preterm infants later diagnosed with CP. Severe white matter injury and significantly decreased MOS scores may provide useful early markers and strong evidence to early predict the risk of later development of cerebral palsy in preterm infants.

An Automated Approach for General Movement Assessment: A Pilot Study.

Objective: The objective of the study was to develop an automatic quantitative approach to identify infants with abnormal movements of the limbs at term equivalent age (TEA) compared with general movement assessment (GMA).Methods: GMA was performed at TEA by a trained operator in neonates with neurological risk. GMs were classified as normal (N) or abnormal (Ab), which included poor repertoire and cramped synchronized movements. The signals from four micro-accelerometers placed on all limbs were recorded for 10 min simultaneously. A global index (KC_index), quantifying the characteristics of individual limb movements and the coordination among the limbs, was obtained by adding normalized kurtosis of the distribution of the first principal component of the acceleration signals to the cross-correlation of the jerk for the upper and lower limbs.Results: Sixty-eight infants were studied. A KC_index cut-off of 201.5 (95% CI: 199.9–205.0) provided specificity = 0.86 and sensitivity = 0.88 in identifying infants with Ab movements.Conclusions: KC_index provides an automatic and quantitative measure that may allow the identification of infants who require further neurological evaluation.

Effects of Hazmat Train Speed Restrictions on Train Delay Performance and Railroad Line Capacity: Comparative Study with Two Railway Simulation Tools

In response to multiple derailments involving hazmat trains, in early February 2020 Transport Canada released ministerial order (MO) 20-02, imposing speed restrictions of 20 to 25 mph on trains transporting a sufficient quantity of hazardous material. Since much of the North American freight network is used by multiple train types, the extreme speed heterogeneity created by this mandate substantially reduced train performance. Although this order was replaced within 2 weeks by new speed restrictions that were in turn replaced in May, MO 20-02 introduced the most extreme levels of train speed heterogeneity. The research team investigated the corresponding capacity effects to better understand the effects of train speed heterogeneity at low speed and inform agencies on future speed restrictions in this range. Using Rail Traffic Controller and General Train Movement Simulator, we quantitatively investigated the capacity loss from these speed restrictions and found that MO 20-02 can double or triple average train delay and lead to mainline capacity loss in excess of 60% on a representative single-track mainline.

Volunteer and staff participants in social movements: a comparison of two local coalitions

ABSTRACT This paper examines how volunteer and staff participants influence coalition functioning and outcomes. We compare two environmental coalitions in Pittsburgh, Pennsylvania: the Clean Rivers Campaign (CRC), which was supported by a general progressive movement community and led by organizational staff members, and Protect Our Parks (POP), an all-volunteer alliance that was part of a more specific anti-fracking movement community. While much research on social movement coalitions focuses on their formation, we show how coalition structure and types of participants affect the mobilization, longevity and goal achievement of our two cases. Both coalitions succeeded in mobilizing supporters for their campaigns, but the CRC enjoyed greater longevity and had a clearer impact on public policy. Paid staff and organizational members were better able to recruit new activists, maintain commitment and transform coalition goals, affecting longevity and goal achievement. This finding contributes to our understanding of the impacts of different types of structures and activists on coalition outcomes, suggesting that paid organizers do not necessarily limit the range of coalition tactics and goals.

WORLD-SYSTEM ANALYSIS AND HISTORICAL GLOBALIZATION

Modern historical science is in crisis because it is fragmented and highly specialized. Today, knowledge, split into many disciplines not related to each other, generates a flow of poorly integrated information. Such dismemberment is a brake on the process of integrating social science disciplines into a single whole, since all of them, for the most part, explore a common object — the evolution of societies at different periods of world history. A systematic approach and the concept of historical global adaptation by actual paradigms capable of combining a set of elements into an integral and general picture of the development of societies of various levels of complexity within the framework of the general movement of historical evolution from primitiveness to modern times.

Predictive validity of a qualitative and quantitative Prechtl's General Movements Assessment at term age: Comparison between preterm infants and term infants with HIE

AimTo determine (1) if the General Movement Optimality Score (GMOS) at term age enhances prediction of motor impairment at 12 and 24 months of age in high-risk infants, when compared to a global General Movement Assessment (GMA), and (2) compare predictive validity for two high-risk populations: infants born preterm and infants born at term with hypoxic ischaemic encephalopathy who have received therapeutic hypothermia. MethodsFifty-nine extremely preterm or term age infants with hypoxic ischaemic encephalopathy underwent term age GMA. A GMA score of normal or abnormal, and a comparative numerical General Movement Optimality Score (GMOS, total values 5–42) were assigned. Neurology and motor assessment were carried out at age 12 and 24 months using standardised assessments; Alberta Infant Motor Scale, Bayley Scales of Infant and Toddler Development or Ages and Stages Questionnaire. Outcomes were recorded as normal, motor delayed or cerebral palsy. Motor outcome prediction at 12 and 24 months of age was calculated using the GMA and, using ROC analysis, GMOS cut-off scores were determined. ResultsAt 12 and 24 months global GMA sensitivity for preterms was 80% and 100%, and for Term HIE was 100% at both ages. Specificity values for preterm infants at 12 and 24 months were 68.8% and 60% versus 28.8% and 21.4% for term HIE. Median GMOS scores were lower in the term HIE group than the preterm group in the normal and poor repertoire categories. Optimality cut off scores enhanced specificity, but values remained low. InterpretationAt term age, specificity for identification of infants with later normal motor outcome is low. The GMOS may assist identification of infants with the highest probability of motor impairment, enabling targeted intervention during critical periods for neuroplasticity.

The assessment of general movements in term and late-preterm infants diagnosed with neonatal encephalopathy, as a predictive tool of cerebral palsy by 2\xa0years of age\u2014a scoping review

BackgroundThe General Movements Assessment is a non-invasive and cost-effective tool with demonstrated reliability for identifying infants at risk for cerebral palsy. Early detection of cerebral palsy allows for the implementation of early intervention and is associated with better functional outcomes. No review to date has summarized the utility of the General Movements Assessment to predict cerebral palsy in term and late-preterm infants diagnosed with neonatal encephalopathy.MethodsWe conducted a scoping review involving infants born greater than or equal to 34 weeks gestational age to identify all available evidence and delineate research gaps. We extracted data on sensitivity, specificity, and positive and negative predictive values and described the strengths and limitations of the results. We searched five databases (MEDLINE, Embase, PsychINFO, Scopus, and CINAHL) and the General Movements Trust website. Two reviewers conducted all screening and data extraction independently. The articles were categorized according to key findings, and a critical appraisal was performed.ResultsOnly three studies, a cohort and two case series, met all of the inclusion criteria. The total number of participants was 118. None of the final eligible studies included late-preterm neonates. All three studies reported on sensitivity, specificity, and positive predictive and negative predictive values. An abnormal General Movement Assessment at 3–5 months has a high specificity (84.6–98%) for cerebral palsy with a similarly high negative predictive value (84.6–98%) when it was normal. Absent fidgety movements, in particular, are highly specific (96%) for moderate to severe cerebral palsy and carry a high negative predictive value (98%) when normal. In the time period between term and 4–5 months post-term, any cramped synchronized movements had results of 100% sensitivity and variable results for specificity, positive predictive value, and negative predictive value.ConclusionsA normal General Movements Assessment at 3 months in a term high-risk infant is likely associated with a low risk for moderate/severe cerebral palsy. The finding of cramped synchronized General Movements is a strong predictor for the diagnosis of cerebral palsy by 2 years of age in the term population with neonatal encephalopathy. The deficit of high-quality research limits the applicability, and so the General Movements Assessment should not be used in isolation when assessing this population.Systematic review registrationTitle registration with Joanna Briggs Institute. URL: http://joannabriggswebdev.org/research/registered_titles.aspx.

Assessing parasympathetic measures of heart rate variability shortly after birth to predict motor repertoire at four months in low risk preterm infants born between 28 and 32 weeks of gestation

In low risk preterm infants, the risk for mild to moderate neuro-motor impairment is extremely high. Additionally, the autonomic nervous system (ANS) function was also found to be impaired. ANS activity may predict neuro-motor development at four months corrected age. This study examines the predictive value of the ANS function in detecting neuro-motor impairments during the first 4 months of life among low risk preterm infants born between 28 and 32 weeks of gestation. 46 infants were recruited. For each infant, heart rate variability (HRV) measures were obtained at week born, 32- and 35-weeks postmenstrual age (PMA). The General Movement Assessment (GMA) and the Motor Optimality Score for 3- to 5- Month- Old Infants (MOS) were performed at 35 weeks PMA and at 4 months corrected age respectively. A significant correlation was found between the parasympathetic nervous system (PSNS) components of HRV and the MOS evaluation. Preterm infants with suboptimal MOS scores showed significantly lower HRV values in the components of the PSNS (0.01 < p-value <0.04). A weak correlation was found between the HRV and the GMA. A Receiver Operating Characteristic was designed and revealed the predictive validity of the PSNS in preterm infants with a suboptimal MOS score. The current study shows that among very preterm infants with no additional risk factors, the PSNS component of HRV can predict neuro-motor outcome at 4 months corrected age and may be used as an early sign for mild neuro-motor impairments in order to initiate an early intervention program.