Motor Optimality Score Research Articles

Neurodevelopmental outcome at two years of age and predictive value of General Movement Assessment in infants exposed to alcohol and/or drugs during pregnancy: a prospective cohort study

BackgroundExposure to alcohol and/or other addictive drugs in pregnancy is a documented risk factor for neurological impairment. We aimed to assess neurodevelopmental outcome at two years of age in infants exposed to prenatal alcohol and/or other addictive drugs and to examine the predictive value of early motor assessment.MethodsThis was a follow-up at two years of age in the prospective cohort study Children Exposed to Alcohol and/or Drugs in Intrauterine Life (CEADIL). The exposed group comprised 73 infants recruited from primary health care and included in a hospital follow-up programme at St. Olavs Hospital, Trondheim University Hospital, Norway. The control group comprised 93 healthy, unexposed infants recruited from the maternity ward at the same hospital. All children had been assessed by physiotherapists using the General Movement Assessment (GMA) at three months of age. Presence of fidgety movements, movement character and the Motor Optimality Score – Revised (MOS-R) were used. At two years of age, the children were assessed by trained examiners using the Bayley Scales of Infant and Toddler Development – Third Edition (BSID-III), Ages & Stages Questionnaires: Social-Emotional (ASQ:SE) and the Hollingshead Two-Factor Index of Social Position (SES).ResultsThe cognitive, language and motor composite scores of BSID-III were considerably lower in the exposed group than in the control group. Mean differences adjusted for age and parental SES ranged from − 13.3 (95% confidence interval, CI: -18.6 to -8.0) to -17.7 (95% CI: -23.3 to -12.2). Suboptimal fidgety movements and monotonous movement character had high sensitivity (0.94 to 0.74), but low specificity (0.10 to 0.32), while sensitivity and specificity of the MOS-R was around 50 and 60%, respectively.ConclusionsNeurodevelopmental outcome at two years of age was poorer in a group of children exposed to alcohol and/or drugs in pregnancy compared with a control group of healthy, unexposed children. Sensitivity of suboptimal fidgety movements and monotonous movement character at three months of age for later neurodevelopmental outcome was high to acceptable, but the MOS-R had limited sensitivity.

General Movements Assessment in Infants with High Birth Weight

BackgroundHigh birth weight (HBW) describes fetal birth weight of more than 4000 g. Infants with HBW have a high risk of developing neurological and developmental problems. Until recently, there were no studies in the literature that investigated the quality of spontaneous movements and the integrity of the developing nervous system in infants with HBW. The aims of this study were (1) to describe age-specific detailed early spontaneous movements in infants with HBW and (2) to compare the detailed early spontaneous movements of infants with HBW and normal birth weight (NBW). MethodsTwenty-two infants with HBW (median birth weight = 4190 g) and 22 infants with NBW (median birth weight = 3255 g) were included at 10 to 19 weeks post-term age (median = 13 weeks). All infants were assessed according to General Movement Assessment using three- to five-minute video recordings. Video recordings of each infant were evaluated using Motor Optimality Score for three- to five-month-old infants-Revised score sheet. ResultsMotor Optimality Score-Revised (MOS-R) (P < 0.001), observed postural patterns (P < 0.001), and age-adequate movement repertoire (P = 0.005) were significantly lower in the infants with HBW. Infants with HBW had more aberrant (abnormal or absent) fidgety movements (18%) than those with NBW (0%). ConclusionsThe results of this study demonstrated that the motor repertoire of infants with HBW tended to decrease more than that of those with NBW. To enable the follow-up of progression as a result of these assessments infants in need should be referred to age-adequate early intervention programs.

Development of Movement and Postural Patterns in Full-Term Infants Who Are at Low Risk in Belgium, India, Norway, and the United States.

The objective of this study was to investigate the influences on motor development in infants who are at low risk from Belgium, India, Norway, and the United States using the General Movement Assessment at 10-16weeks postterm age. This was a cross-sectional study of prospectively enrolled full-term infants at low risk (n = 186). Certified General Movement Assessment observers rated the fidgety movements, quality of the movement patterns, age-adequacy of the movement repertoire, postural patterns, movement character, and overall Motor Optimality Score-Revised (MOS-R). Scores were evaluated for associations with sex, birth weight category, gestational age, postterm age at video, and country. The majority of infants had normal fidgety movements (179/186, 96.2%). This did not vary by sex, birth weight, gestational age, postterm age at video, or country. All infants showed normal>atypical movement patterns. Variability was seen for age adequacy (optimal: 137/183, 74.9%), postural patterns (normal>atypical: 164/183, 89.6%), and smooth/ fluent movement character (138/183, 75.4%). Gestational age and postterm age at video were associated with atypical postural patterns, but in multivariable regression, only younger postterm age retained significance (OR = 2.94, 95% CI = 1.05-8.24). Lack of age adequacy was associated with postterm age (OR = 13.15, 95% CI = 4.36-39.72) and country (compared with Norway; Belgium OR = 3.38 95% CI = 12.4-9.22; India OR = 3.16, 95% CI = 1.01-9.87; United States not significant). Infants from India also showed lower rates of an optimal MOS-R (25-28) than infants from Norway. The normality and temporal organization of fidgety movements did not differ by sex, birth weight, postterm age, or country, suggesting that the fidgety movements are free of cultural and environmental influences. The majority of full-term infants who were healthy in this cohort showed normal scores for all aspects of motor development tested using the MOS-R. Differences in age adequacy and MOS-R by country warrant investigation with larger cohorts and longitudinal follow-up. Understanding variations in typical motor development is essential to interpreting patterns of movement and posture in infants at risk for atypical development. Using the framework of Prechtl's General Movement Assessment, this study showed that the development of movement and posture in healthy infants was affected by age and country of birth, but the development of the fidgety movements appeared to be free of these influences. Local norms may be needed to interpret the Motor Optimality Score-Revised in all populations, but further research on this topic is needed.

Stability of the Motor Optimality Score Revised (MOS-R) in medically complex infants

BackgroundThe Motor Optimality Score-Revised (MOS-R) is a clinical test of infant spontaneous movement at 3–5 months of age and has been associated with neurodevelopmental outcomes in infants with medical complexity. However the stability of the MOS-R tested at different developmental ages is not yet known. AimTo determine if the repeated scoring of the MOS-R remained consistent when tested at two developmental ages in young infants. Study designIn this prospective cohort study, infants were tested twice with the MOS-R between 12 and 13 weeks corrected age (CA) and 14–16 weeks CA. Bland Altman Plots were used to calculate agreement between the scores. Infants were grouped as having higher or lower medical complexity. MOS-R threshold scores were analyzed to assess changes over time within each group using Fisher's exact test. Subjects85 infants with history of hospitalization in a neonatal intensive care unit (NICU). ResultsThe MOS-R scores had a high agreement with negligible bias (0.058) between timepoints (95 % CI -1.10, 1.22). Using a MOS-R cut point of 19, infants with higher medical complexity were more likely to change groups between timepoints than infants with lower medical complexity (p = 0.008), but this was not significantly different using cut points of 20 or 21. ConclusionThe MOS-R scores were stable when measured repeatedly in infants who were hospitalized in a NICU. Infants with high medical complexity had less stable MOS-R scores using certain cut points than infants with lower medical complexity.

Early Intervention Guided by the General Movements Examination at Term Corrected Age-Short Term Outcomes.

The early identification of the former premature neonates at risk of neurologic sequelae could lead to early intervention and a better prognosis. This pilot study aimed to investigate whether the General Movement patterns observed at term-equivalent age in former premature infants could serve as predictors for guiding early intervention and improving prognosis. In a population of 44 premature neonates (mean gestational age 33.59 weeks (+2.43 weeks)) examined at term-equivalent age, 10 neonates with a cramped-synchronized General Movements motor pattern were identified. These neonates were included in an early intervention program consisting of physiotherapy executed both by the therapist and by the parents at home. They were again examined at a corrected age of 12 weeks. The presence or absence of fidgety movements and the MOS-R (motor optimality score revised) was noted. The examinations were performed by certified specialists. Normal fidgety movements and a MOS-R of 20-24 were presented in 9/10 of the former premature infants, with normal foot to foot contact present in 7/10, and normal hand to hand contact present in 5/10. The atypical patterns noted were side to side movements of the head in 5/10, a non-centered head in 9/10, asymmetric tonic neck reflex in 9/10 and jerky movements in 10/10. One patient presented with no fidgety movements and a MOS-R score of 9. Early intervention in our group of patients allowed for an improvement in the neurologic status, demonstrated by the presence of fidgety movements. We suggest that early intervention should be indicated in all premature infants that present with a cramped-synchronized GM pattern during examination at term-equivalent age. However, due to the small sample size, the absence of statistical analysis and a control group, and the limited follow-up period, the conclusions must be approached with caution.

Do moderate-to-late preterm twins and singletons differ in the early motor repertoire and later developmental functioning?

Purpose: The aim of this study was to investigate the differences in early motor repertoire and later developmental functioning between moderate-to-late preterm twins and singletons. Material and Methods: The study included 40 moderate-to-late preterm twin infants (50% female), and 40 moderate-to-late preterm singleton infants (50% female). All infants were assessed from 9 up to 20 post-term weeks of corrected age using the General Movement Assessment (GMA), and between 24 and 42 months of age using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Results: There were no differences between the Motor Optimality Score (MOS) and its subcategories, including fidgety movements, obtained as a result of detailed GMA (p&gt;0.05), when the early motor repertoire results were examined. At later ages, there were also no significant differences in cognitive, language, and motor domain composite scores between twin and singleton infants, according to Bayley-III (p&gt;0.05). Discussion: Our results suggest moderate-to-late preterm twin infants had a similar developmental process to moderate-to-late preterm singleton infants from early periods up to 3.5 years of age. However, all preterm infants, including moderate-to-late infants, should be assessed in the clinic in terms of the risks of developmental problems from the early period of life.

A Study of General Movement Assessment and Its Association With Neurodevelopmental Outcome at Age 12 to 15 Months Among Term Neonates With Hyperbilirubinemia

BackgroundTo determine the association between optimality score at term age and age three to five months and neurodevelopmental outcome among neonates with hyperbilirubinemia. MethodsFifty infants with and without hyperbilirubinemia were enrolled. The motor repertoires of the infants were evaluated through general movement assessment (GMA) at term age and three to five months post-term. The association between the General Movement Optimality Score (GMOS), Motor Optimality Score (MOS), and Development Assessment Scale for Indian Infants (DASII) at age 12 to 15 months was also assessed. ResultsDuring term age, the median GMOS was significantly lower among infants in the study group when compared with the control group (40 [29 to 42] vs 42 [42 to 42], P < 0.001). However, at age three to five months, there was no significant difference between the groups. Significantly higher number of neonates had abnormal motor repertoire at term age and age three to five months in the study group when compared with the control group (18 [36%] vs 2 [4%], P = 0.001, at term age and 6 [12.2%] vs 1 [2%], P =0.04, at age three to five months). Among neonates with hyperbilirubinemia, the median GMOS and MOS were significantly lower at term age and age three to five months in infants with motor and mental developmental quotient scores <85 when compared with ≥85. ConclusionsGMA including GMOS and MOS performed in neonates with hyperbilirubinemia during the neonatal period and early infancy is associated with neurodevelopmental outcomes in the first year of life. GMA can help initiate early intervention in such neonates.

Sleep characteristics, early spontaneous movements, and developmental functioning in preterm infants in the early postnatal period

ObjectiveThis study aimed to investigate the following: (i) sleep characteristics in preterm infants at 9–20 weeks of corrected age, and (ii) differences in early spontaneous movements and developmental functioning results between the groups based on some sleep characteristics. MethodsSeventy-four preterm infants (36 female) were included. Sleep characteristics were assessed according to the Brief Infant Sleep Questionnaire (BISQ). The infants were divided into two groups based on total sleep duration: less than 12 h (38 infants), and 12 h and more (36 infants). Video recordings were made for the General Movements Assessment (GMA) and evaluated using the Motor Optimality Score for 3- to 5-Month-Old-Infants-Revised (MOS). Cognitive, language, and motor development were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). ResultsThe total sleep duration of all preterm infants (mean ± SD) was 11.8 ± 3.3 h. Infants who had absent fidgety movements slept less than 12 h, and fidgety movements differed between the groups (p = 0.012). Infants who slept 12 h or more had significantly higher MOS (p = 0.041), cognitive (p = 0.002), language (p < 0.001), and motor (p = 0.002) development results. Infants who snored had lower MOS (p = 0.001), cognitive (p = 0.004), language (p = 0.002), and motor (p = 0.001) development results. Infants with fewer than three nocturnal awakenings had significantly higher Bayley-III cognitive (p = 0.007), language (p = 0.032), and motor (p = 0.005) domain results. Prone and supine sleeping positions showed higher motor domain results than lateral positions (p = 0.001). ConclusionsSleep in preterm infants might be a key factor in early developmental functioning processes and nervous system integrity. Even in the first months of life, there are substantial differences in cognitive, language, and motor development in association with sleep characteristics.

Early Spontaneous Movements and Sensory Processing in Preterm Infants.

Preterm infants are at higher risk of motor development abnormalities and sensory processing difficulties. Few studies have examined both movement development and sensory processing in the early months of life, and the results are controversial. In this cross-sectional study, we investigated (1) differences in early spontaneous movements and sensory processing between preterm infants born at <32 wk gestation and those born at 32 to 36 wk gestation when they reached corrected (postterm) age 3 to 5 mo and (2) the relationship between early spontaneous movements and sensory processing. We included 50 preterm infants born at <32 wk gestation and 61 preterm infants born at 32 to 36 wk gestation. We assessed early spontaneous movements, including fidgety movements, using the General Movements Assessment (GMA), which provides the Motor Optimality Score (MOS), and sensory processing using the Infant Sensory Profile-2. The preterm infants born at <32 wk gestation had lower MOS results (p = .035) and more sensory processing difficulties (p = .006) than those born at 32 to 36 wk gestation. We found no significant relationship between early spontaneous movements and sensory processing (p > .05). Preterm infants born at <32 wk gestation are at increased risk for motor development abnormalities and sensory processing difficulties. What This Article Adds: Assessment of both motor development and sensory processing can play a crucial role in identifying infants who need early intervention.

Early markers of neurodevelopmental disorders based on general movements for very preterm infants: study protocol for a multicentre prospective cohort study in a clinical setting in China

IntroductionVery preterm (VPT) infants may experience varying degrees of neurodevelopmental challenges. Lack of early markers for neurodevelopmental disorders may delay referral to early interventions. The detailed General Movements Assessment (GMA)...

Systemic postnatal corticosteroid use for the prevention of bronchopulmonary dysplasia and its relationship to early neurodevelopment in extremely preterm infants

BackgroundSystemic postnatal corticosteroid use in extremely preterm infants poses a risk of adverse neurodevelopmental outcomes. This study explores their use beyond seven days of age with early neurodevelopmental assessments during the fidgety period (9–20 weeks postterm age).MethodsThis retrospective single-center cohort study included inborn extremely preterm infants from 1 January 2014 to 31 December 2018. Outborn infants, those with congenital or genetic abnormalities, and those who received postnatal corticosteroids for nonrespiratory reasons were excluded. The cohort was dichotomized based on the status of corticosteroid receipt. Early neurodevelopmental outcomes were reported using Prechtl’s General Movements Assessment.ResultsOf the 282 infants, 67 (23.75%) received corticosteroids. Of these, 34 (50.75%) received them for dependency on invasive ventilation (intermittent positive-pressure ventilation), and the remainder received them for dependency on non-invasive ventilation continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP). Abnormal or absent fidgety movements were observed in 13% of infants (7/54) who received corticosteroids compared to 2% of infants (3/146) who did not. An increased odds for an abnormal general movements assessment from corticosteroid use after adjusting for gestational age [adjusted odds ratio (aOR) = 5.5, 95% confidence interval (CI) = 1.14–26.56] was observed. The motor optimality scores differed between the two groups [corticosteroid group: 25.5 (23–26) versus no-corticosteroid group: 26 (24–28); z = − 2.02]. A motor optimality score < 20 was observed in 14.8% of infants (8/54) in the corticosteroid group compared to 2% of infants (3/146) in the noncorticosteroid group. This difference was significant after adjustment for gestational age (aOR 5.96, 95% CI 1.28–27.74).ConclusionsAbnormal early neurodevelopment was observed in infants who received systemic postnatal corticosteroids. The relationship between these findings and other factors influencing early neurodevelopment needs further exploration.

General Movement Assessment in Babies Born Preterm: Motor Optimality Score–Revised (MOS-R), Trajectory, and Neurodevelopmental Outcomes at 1 Year

To assess the association between the General Movement Assessment (GMA) findings, including Motor Optimality Scores-Revised (MOS-R) at 16weeks, and neuromotor outcome assessed by the Amiel-Tison Neurological Assessment at 9months of corrected age and the Developmental Assessment Scales for Indian Infants (DASII) at 1year of corrected age in preterm ≤32weeks. Serial GMA videos of infants born preterm ≤32weeks were recorded on day 7, 35weeks of postmenstrual age, 40weeks of postmenstrual age, and 16weeks of corrected age. The association between GMA findings, including MOS-R scores and GM trajectory between 35 to 40weeks and the Amiel-Tison Neurological Assessment and DASII scores, was assessed by Spearman correlation, Fisher exact tests, and ordinal regression. Moderate correlations were observed between MOS-R and the DASII motor DQ (Spearman r=0.70, P<.001) and between MOS-R and DASII Mental DQ (r=0.65, P<.001). The GMA trajectory at 35-40weeks was associated with DASII motor DQ (Fisher exact, P=.002), and also with the Amiel-Tison Neurological Assessment at 9months of corrected age (P<.01 by the Fisher exact test). On analysis by performing ordinal regression of predictive values of the general movements (GM)at 7days of age, GM at 35weeks, GM at 40weeks, GM at 16weeks, and MOS-R at 16weeks, MOS-R alone was a statistically significant predictor of motor DQ at 1year of age (OR -0.59; 95% CI -0.97 to -0.22; Wald statistics, P<.02). Consistent with findings in high-income countries, GMA including MOS-R scores performed in Indian infants born preterm during the neonatal period and early infancy is associated with neurodevelopmental outcomes in the first year of life. GMA can help initiate focused early intervention in low- and middle-income settings, where resources may be limited.

The General Movements Motor Optimality Score in High-Risk Infants: A Systematic Scoping Review.

The aim of this systematic scoping review was to explore the use of the motor optimality score in the fidgety movement period in clinical practice, and to investigate evidence for the motor optimality score in predicting neurodevelopmental outcomes. Thirty-seven studies, with 3662 infants, were included. Studies were conceptualized and charted into 4 categories based on the motor optimality score: prediction, outcome measure, descriptive, or psychometric properties. The most represented populations were preterm or low-birth-weight infants (16 studies), infants with cerebral palsy or neurological concerns (5 studies), and healthy or term-born infants (4 studies). The motor optimality score has the potential to add value to existing tools used to predict risk of adverse neurodevelopmental outcomes. Further research is needed regarding the reliability and validity of the motor optimality score to support increased use of this tool in clinical practice. What this adds to the evidence : The motor optimality score has potential to improve the prediction of adverse neurodevelopmental outcomes. Further research on validity and reliability of the motor optimality score is needed; however, a revised version, the motor optimality score-R (with accompanying manual) will likely contribute to more consistency in the reporting of the motor optimality score in future.

General movements assessment and Alberta Infant Motor Scale in neurodevelopmental outcome of preterm infants.

We aimed to compare the General Movement Assessment (GMA) and the Alberta Infant Motor Scale (AIMS) in preterm infants for the prediction of cerebral palsy (CP) and neurodevelopmental delay (NDD). Additionally, we aimed to evaluate the diagnostic compatibility of the General Movement Optimality Score (GMOS), the Motor Optimality Score (MOS), and AIMS for detecting CP and NDD. Seventy-five preterm infants with gestational age (GA) 24-37 weeks were enrolled. Group 1 was composed of infants with 24-28GA (n=22); groups 2 and 3 consisted of infants with 29-32GA weeks (n=23) and 33-37GA (n=30) weeks, respectively. The infants were assessed during the writhing period, the fidgety period, and at 6-12 months of corrected age with GMOS, MOS, and AIMS, respectively. In the writhing period, a cramped-synchronized pattern was observed in 17 (22%) infants, whereas a poor repertoire pattern was observed in 34 (45%) infants. In the fidgety period of the 63 infants, 29 (46%) presented with fidgety movements absent. The MOS and AIMS scores of the infants in group 1 were significantly lower than the other groups, which were statistically significant (p=0.004, p˂0.001). High and positive compatibility (Kappa coefficient: 0.709; p=0.001) was found between AIMS and GMOS scores and between AIMS and MOS scores (Kappa coefficient: 0.804; p<0.001). In all groups, a statistically significant association was found between total GMOS scores (p=0.003) and the presence of fidgety movements (p=0.003). GMOS, MOS, and AIMS were found to be associated with CP and NDD (p<0.001). GMA is an important tool for the prediction of CP and NDD. The combined use of GMOS, MOS, and AIMS may guide the clinical practice for the valid and reliable diagnosis of CP and NDD.

The Impact of Increased Maternal sFlt-1/PlGF Ratio on Motor Outcome of Preterm Infants.

BackgroundThe sFlt-1 (soluble fms-like tyrosine kinase-1)/PlGF (placental growth factor) ratio serves as a clinical biomarker to predict the hypertensive, placenta-derived pregnancy disorder pre-eclampsia which is often associated with placental dysfunction and fetal growth restriction. Additionally elevated levels also indicate an increased risk for prematurity. However, its predictive value for subsequent neonatal neurological outcome has not been studied.ObjectiveThis study aimed to evaluate the correlation of maternal sFlt-1/PlGF ratio with early motor outcome of preterm infants. Design/Methods: 88 preterm infants (gestational age ≤ 34 + 0) born between February 2017 and August 2020 at the Department of Obstetrics and Gynecology, University Hospital Essen in Germany, were included, when the following variables were available: maternal sFlt-1/PlGF levels at parturition and general movement assessment of the infant at the corrected age of 3 to 5 months. The infants were stratified into high and low ratio groups according to maternal sFlt-1/PlGF cut-off values of 85. To investigate the early motor repertoire and quality of spontaneous movements of the infant, the Motor Optimality Score (MOS-R) based on antigravity movements and posture patterns, was applied. In the given age, special attention was paid to the presence of fidgety movements. Linear regressions were run to test differences in infants motor repertoire according to the maternal sFlt-1/PIGF ratio.ResultsLinear regression analysis showed that the sFlt-1/PlGF ratio does not predict the MOS-R score (β=≤0.001; p=0.282). However, children with birth weight below the 10th percentile scored significantly lower (mean 20.7 vs 22.7; p=0.035). These children were 91% in the group with an increased ratio, which in turn is a known predictor of low birth weight (β= -0.315; p <0.001). In the group with a high sFlt-1/PLGF ratio above 85 the mothers of female infants had a lower average sFlt-1/PlGF ratio compared to a male infant (median: 438 in female vs. 603 in male infant, p=0.145).ConclusionsIn our cohort, especially low birth weight, which correlated with an elevated sFlt-1/PlGF ratio, had a negative effect on the outcome in the MOS-R. A direct correlation between an increased ratio and a worse motor outcome was not demonstrated.

Early Spontaneous Movements and Upper Extremity Movement Score in Infants With all Narakas Types of Obstetric Brachial Plexus Palsy

BackgroundObstetric brachial plexus palsy (OBPP) is a birth injury that affects upper extremity performance. However, some children with OBPP might have central nervous system disorder or developmental disabilities. This study aimed to investigate (1) the early spontaneous movements using General Movements Assessment (GMA) in infants with OBPP according to the Narakas classification, (2) the differences from typical infants, and (3) the relationship between the GMA and the affected upper extremity movements score. MethodsFifty-six infants with OBPP (39 females; median gestational age 40 weeks, range = 34 to 42) and 50 typical infants (20 females; median gestational age 38 weeks, range = 37 to 41) were assessed at age three to five months using the GMA, which is a determined Motor Optimality Score (MOS) for fidgety movements and concurrent motor repertoire, and using the Active Movement Scale (AMS) for affected upper extremity movements. ResultsThere were no differences in MOS and its subcategories between Narakas types in infants with OBPP (P > 0.05); however, infants with OBPP had a higher degree of aberrant fidgety movements and a lower score in MOS and its subcategories than typical infants (P < 0.05). There was no relationship between AMS scores, and MOS and its subcategories. ConclusionsInfants with OBPP, except Narakas type I, might have an increased risk of central nervous disorder and developmental problems in addition to peripheral nerve injury. Each test, GMA and AMS, contributes to the identification of their own specific risk in these infants.

Interrater Reliability of Motor Optimality Score of General Movement Assessment

Objective: The Prechtl’s general movement assessment (GMA) has been established as the most valid tool in early detection of cerebral palsy. GMA is based on a global gestalt perception and it involves the individual’s judgement for assessment. Interobserver variability can affect the results and has cascading effects on the child’s prognosis. The objective of the present study is to establish interobserver agreement between a novice rater and an expert. Study Design: Video recordings of 50 infants (corrected gestational age 29 weeks to post term age 20 weeks) were assessed by the 2 raters. Raters used an interactive process to interpret terms used in GMA and technical aspects of recording as a preliminary study. Intraclass correlation coefficient (ICC) and Kappa statistics were utilized to assess the reliability. Results: Interobserver agreement in the assessment of the total “motor optimality score” was excellent between both the raters, as ICC was 0.96. Good-to-high interobserver reliability was found in the assessment of “fidgety movements” (Cohen’s kappa 0.727). Conclusion: Interobserver reliability between a novice rater and an expert was excellent for total motor optimality score in all age groups (preterm, writhing, and fidgety).

Developmental Functioning Outcomes in Infants With Cystic Fibrosis: A 24- to 36-Month Follow-Up Study.

This study aimed to examine early motor repertoire using Prechtl General Movement Assessment (GMA) and later developmental functioning of infants with cystic fibrosis (CF). Early motor repetoire was evaluated using Prechtl GMA, and developmental functioning was assessed using Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) in infants with CF and their peers who were neurotypical, as the control group. Twelve infants with CF clinically stable and 12 infants who were neurotypical, with respective median post-term ages of 14 and 13weeks, were assessed using GMA. At 24 to 36months, the Bayley-III was applied to the CF group (median post-term age = 27.5months) and the control group (median post-term age = 27.0months). Fidgety movements were absent in 5 infants with CF, whereas all infants who were neurotypical had normal fidgety movements. The Motor Optimality Score was significantly lower in the CF group (median = 18.5) compared with the control group (median = 26). The CF group had significantly lower composite scores in the Bayley-III cognition, language, and motor domains compared with the control group. Cognitive, language, and motor development was delayed in infants with CF. Developmental functioning of infants with CF should be assessed as early as possible and monitored, and age-specific early intervention programs should be considered when necessary. Infants with CF may have motor, cognitive, and language developmental delays compared with peers who are neurotypical during early childhood, and hospitalization was negatively correlated with motor development at 24 to 36months of age. This study highlights the importance of early assessment of developmental functioning and age-specific, early intervention programs when necessary in infants with CF. It is important to assess developmental functioning as early as possible in infants with CF and to consider age-specific early intervention programs when necessary.

Early Motor Repertoire of Very Preterm Infants and Relationships with 2-Year Neurodevelopment.

The Motor Optimality Score, revised (MOS-R) is an extension of the Prechtl General Movements Assessment. This study aims to determine the relationship between MOS-R and 2-year neurodevelopmental outcomes in a cohort of 169 infants born very preterm (<31 weeks’ gestational age), and to examine the predictive validity of the MOS-R at 3–4 months’ corrected age (CA) above perinatal variables associated with poor outcomes, including Prechtl fidgety movements. Development at 2 years’ CA was assessed using Bayley Scales of Infant and Toddler Development, Third edition (Bayley-III) (motor/cognitive impairment: Bayley-III ≤ 85) and Neurological, Sensory, Motor, Developmental Assessment (NSMDA) (neurosensory motor impairment: NSMDA ≥ 12). Cerebral palsy (CP) was classified at 2 years as definite or clinical. The MOS-R was related to 2-year outcomes: Bayley-III motor (BMOS-R = 1.24 95% confidence interval (0.78, 1.70)), cognitive (BMOS-R = 0.91 (0.48, 1.35)), NSMDA scores (BMOS-R = −0.34 (−0.42, −0.25)), definite CP (odds ratio [OR] 0.67 (0.53, 0.86)), clinical CP (OR 0.74 (0.66, 0.83)) for each 1-point increase in MOS-R. MOS-R ≤ 23 predicted motor (sensitivity 78% (60–91%); specificity 63% (54–72%)) and neurosensory motor impairment (sensitivity 86% (64–97%); specificity 59% (51–68%)). The MOS-R is strongly related to CP and motor and cognitive delay at 2 years and is a good predictor of motor and neurosensory motor impairment.

Effect of mobile phone usage duration during pregnancy on the general motor movements of infants

Radiofrequency radiation (RFR) emitted from wireless devices increases rapidly and the most sensitive groups are pregnant women and children. Therefore, we aimed to evaluate the fidgety movements (FMs) and motor repertoires of the infants of pregnant women with different durations of mobile phone usage (DOMFU) in the prenatal period by performing a general movement assessment (GMA) using the Prechtl method. Infants suitable for the study were divided into 4 groups according to their mothers’ duration of mobile phone usage during pregnancy, comprising those who did not talk on a mobile phone (Control Group, n: 31), those with mobile phone usage (MFU) of ∼20 min a day (Group 1, n: 33), those with MFU of ∼40 min a day (Group 2, n: 31), and those with MFU of ∼2 h a day (Group 3, n: 28). The analysis showed that the abnormal fidgety (AF) and absent fidgety (F–), suboptimal motor optimality score (MOS) and reduced motor repertoire were statistically higher in Group 3 compared to the other groups. Normal posture and the quality of other movements were statistically higher in the Control, and Groups 1 and 2 compared to Group 3. According to the findings, infants of mothers with different DOMFU during pregnancy differed with regard to the quality of FMs, MOS, repertoire, posture and other movements. In conclusion, the findings suggested that there may be a relationship between prenatal RFR exposure and motor development in infants. More long-term studies are needed to determine whether these changes are temporary or permanent.