The general movement checklist: A guide to the assessment of general movements during preterm and term age

Abstract Objectives To develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score. Methods Three examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31-45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers' satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction). Results The scorers' satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p < 0.001). The checklist score also differentiated between poor-repertoire (median = 13) and cramped-synchronized general movements (median = 7; p = 0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal general movements was good to excellent (Kappa = 0.68-1.00); (ii) the distinction between the four general movement categories was considerable to excellent (Kappa = 0.56-0.93); (iii) the checklist was good to excellent (ICC = 0.77-0.96). Conclusion The general movement checklist proved an important tool for the evaluation of normal and abnormal general movements; its score may potentially document individual trajectories and the effect of therapeutic intervention.

Application of early assessment and intervention in motor development of high-risk infants with cerebral palsy / 中华实用儿科临床杂志

Objective:To evaluate the clinical value of the General Movements (GMs) in predicting the neurological outcome of high-risk infants with cerebral palsy in the early stage, and to analyze the application of the Peabody Developmental Motor Scale-Gross Motor (PDMS-GM) and Gross Motor Function Measure Scale (GMFM) in the rehabilitation assessment and intervention of high-risk infants with cerebral palsy.Methods:The gross motor function of 64 high-risk infants with cerebral palsy before treatment and after 2 months of treatment in Department of Child Rehabilitation, Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2017 to December 2019 was evaluated using PDMS-GM and GMFM.The total percentage of PDMS-GM and GMFM before and after treatment, and the monthly relative percentage of PDMS-GM and GMFM were compared.The correlation between PDMS-GM and GMFM original scores in the writhing and fidgety movements period before treatment, and that between PDMS-GM and GMFM original scores before and after treatment were compared.High-risk infants with cerebral palsy were followed up to 1 year old, and their neurological outcome was determined according to the clinical diagnosis and evaluation results.The predictive value of GMs on the outcome of cerebral palsy was evaluated.Results:Compared with that before treatment, the total percentage of PDMS-GM and GMFM in high-risk infants with cerebral palsy increased significantly after treatment [PDMS-GM: (37.250±13.690)% vs.(20.992±10.273)%, t=-15.793, P<0.01; GMFM: (22.672±8.438)% vs.(10.601±7.890)%, t=-16.442, P<0.01]. PDMS-GM original scores in the writhing movements period and fidgety movements period before treatment were highly correlated with those of GMFM (writhing movements period: r=0.922, P<0.01; fidgety movements period: r=0.905, P<0.01). PDMS-GM original score before and after treatment were highly correlated with those of GMFM (before treatment: r=0.901, P<0.01; after treatment: r=0.801, P<0.01). There was no significant difference in the monthly relative percentage of PDMS-GM and GMFM [(97.286±88.330)% vs.(76.885±43.815)%, t=-1.656, P=0.103]. The sensitivity, specificity, positive predictive value and negative predictive value of the writhing movements period to the prediction of cerebral palsy outcome were 90.7%, 82.3%, 23.4%, and 95.8%, respectively, which were 98.3%, 88.1%, 27.6% and 96.8% in the fidgety movements period, respectively.At 1-year-old follow-up, 3 cases of spastic cerebral palsy were found in a high risk with cerebral palsy, and 1 case was cramped synchronized and 2 cases were absence of fidgety movements. Conclusions:Gross motor function of high-risk infants with cerebral palsy was significantly improved after treatment compared with that before treatment, and PDMS-GM and GMFM were consistent in the assessment of gross motor function of high-risk infants with cerebral palsy in the writhing and fidgety movements period before and after treatment.In the early screening of infants at high risk of cerebral palsy, absence of fidgety movements and cramped synchronized maybe predict spastic cerebral palsy more sensitively, and fidgety movements assessment was more sensitive to predict spastic cerebral palsy outcome than writhing movements assessment.

Application of whole body exercise quality assessment in prognosis evaluation of asphyxia children / 中国小儿急救医学

Neonatal asphyxia is a clinical disease in which newborns are unable to establish regular and effective respiration after birth due to various factors, resulting in hypoxia, acidosis and hypercapnia.Severe cases can cause damage to the nervous system of children, mental retardation, cerebral palsy, and even death.The quality assessment of systemic exercise(general movements, GMs)is a simple, non-invasive and easy to implement technique for early diagnosis of neurodevelopmental disorders in children.Although GMs quality assessment has been widely used in the assessment of nervous system injury after asphyxia resuscitation at home and abroad, there has not been a systematic introduction to its pathogenesis, specific manifestations and the correlation between them.Therefore, this paper systematically reviewed the above problems combined with the latest research at home and abroad, in order to provide help for clinical work.

Further discussion of general movements quality assessment(writhing movements) in early prediction validity of motor developmental outcome of high-risk infants / 中国小儿急救医学

Objective@#To study the predictive value of general movements(GMs) quality assessment technique(writhing movements)on the motor development outcome of high-risk infants, so as to provide a reference basis for clinical diagnosis and treatment.@*Methods@#A retrospective analysis was made on the high-risk infants who were hospitalized in the Neonatal Department of the Affiliated Hospital of Inner Mongolia Medical University from January 1, 2017 to December 31, 2018, and the GMs quality assessment was finished and followed up to 12-month-old among high-risk infants.The clinical diagnostic criteria for patients with cerebral palsy and Peabody Development Motor Scales-2(PDMS-2)were used to evaluate the motor development outcome of 12-month-old high-risk infants.Furthermore, the predictive value of GMs writhing movements on the motor development outcome of high-risk infants were evaluated.@*Results@#The predictive validity of writhing movements phase[cramped synchronized(CS)+ poor repertoire(PR)]for motor retardation and cerebral palsy in high-risk infants who met the inclusion criteria were as follows: the sensitivity, specificity, positive predictive value, negative predictive value were 94.44%, 23.03%, 11.04%, 97.62% and 100%, 21.88%, 2.60%, 100%, respectively.The predictive sensitivity and negative predictive value of writhing movements PR for motor retardation and cerebral palsy were 92.31%, 100%; 98.18%, 100% respectively.The predictive sensitivity, specificity and negative predictive value of writhing movements CS for motor retardation and cerebral palsy were 100%, 95.81%, 100% and 100%, 95.31% and 100%, respectively.@*Conclusion@#GMs quality assessment(writhing movements)has high reliability in predicting the motor development outcome of high-risk infants, especially cramped-synchronized has significant value in early screening of children with motor retardation and cerebral palsy.

The predictive value of writhing stage general movement assessment for motor development outcomes in infants with severe neonatal jaundice / 中国新生儿科杂志

Objective To study the predictive values of the general movements (GMs) assessment in writhing stage for motor development outcomes in infants with severe neonatal jaundice.Method From December of 2012 to December of 2017,infants with severe neonatal jaundice (serum bilirubin reaching the corresponding level of exchange transfusion according to the reference nomogram) in our hospital were enrolled in the study.Inclusion criteria included corrected gestational age of 37 to 48 weeks,serum bilirubin level below phototherapy intervention value after treatment and general and detailed assessment were carried out in writhing stage when the infant was stable.The patients were regularly followed-up until one-year-old to evaluate the predictive values.Result A total of 241 patients with severe neonatal jaundice were enrolled in the study,including 153 males (63.5％) and 88 females (36.5％),with gestational age between 35 and 42 weeks.The mean gestational age was (37.9± 1.8) weeks,the average birth weight was (3 057±480) g,and the mean serum bilirubin value was (458.9± 119.1) μmol/L.The general evaluation of the GMs was normal in 15 cases (6.2％),and abnormal in 226 cases (93.8％) with 217 cases (90.0％) were poor repertoire (PR) and 9 cases (3.7％) were cramped-synchronized (CS).The predictive values of abnormal GMs for abnormal motor development outcomes were as following:sensitivity 100％,specificity 7.6％,negative predictive value(NPV) 100％.The predictive values of CS for cerebral palsy were as following:sensitivity 22.2％,specificity 97.8％,NPV 94.0％.Detailed evaluation of 241 subjects showed that 13 items had statistically significant differences in the prediction of cerebral palsy (P＜0.05),and 18 items in the prediction of abnormal motor development (P＜0.05).Conclusion The CS pattern and detailed assessment of GMs in the writhing stage may be correlated with the outcomes of motor development in infants with severe neonatal jaundice until one-year-old.

Assessment of Nervous System of High-risk Infants: 236 Cases Report / 中国康复理论与实践

Objective:To investigate evaluation methods to predict the outcome of nervous system development in high-risk infants. Methods:From March, 2015 to March, 2016, 336 high-risk infants were enrolled. They were assessed by General Movements (GMs) Quality Assessment, 0~1 Years Old 20 Items Neuromotor Assessment and Gesell Developmental Schedules. Results:A total of 236 infants finishied the study. GMs Quality Assessment showed that 203 cases were normal and 33 cases were abnormal in the writhing movements stage; 218 cases were normal and 18 cases were abnormal in the fidgety movemonts stage. 0~1 Years Old 20 Items Neuromotor Assessment showed that 202 cases were normal and 34 cases were abnormal. Gesell Developmental Schedules showed that 12 cases were abnormal. Conclusion:The combination of GMs Quality Assessment, 0~1 Years Old 20 Items Neuromotor Assessment and Gesell Developmental Schedules could better predict the nervous system development of high-risk infants.

Application of whole body exercise quality assessment in prognosis evaluation of asphyxia children / 中国小儿急救医学

Neonatal asphyxia is a clinical disease in which newborns are unable to establish regular and effective respiration after birth due to various factors, resulting in hypoxia, acidosis and hypercapnia. Severe cases can cause damage to the nervous system of children,mental retardation,cerebral palsy,and even death. The quality assessment of systemic exercise(general movements,GMs) is a simple,non-invasive and easy to implement technique for early diagnosis of neurodevelopmental disorders in children. Although GMs quality assessment has been widely used in the assessment of nervous system injury after asphyxia resuscita-tion at home and abroad,there has not been a systematic introduction to its pathogenesis,specific manifesta-tions and the correlation between them. Therefore, this paper systematically reviewed the above problems combined with the latest research at home and abroad,in order to provide help for clinical work.

Further discussion of general movements quality assessment( writhing movements) in early prediction validity of motor developmental outcome of high-risk infants / 中国小儿急救医学

Objective To study the predictive value of general movements( GMs) quality assess-ment technique(writhing movements)on the motor development outcome of high-risk infants,so as to pro-vide a reference basis for clinical diagnosis and treatment. Methods A retrospective analysis was made on the high-risk infants who were hospitalized in the Neonatal Department of the Affiliated Hospital of Inner Mongolia Medical University from January 1,2017 to December 31,2018,and the GMs quality assessment was finished and followed up to 12-month-old among high-risk infants. The clinical diagnostic criteria for patients with cerebral palsy and Peabody Development Motor Scales-2 ( PDMS-2) were used to evaluate the motor development outcome of 12-month-old high-risk infants. Furthermore, the predictive value of GMs writhing movements on the motor development outcome of high-risk infants were evaluated. Results The predictive validity of writhing movements phase[cramped synchronized(CS) +poor repertoire(PR)]for mo-tor retardation and cerebral palsy in high-risk infants who met the inclusion criteria were as follows:the sensi-tivity,specificity, positive predictive value, negative predictive value were 94. 44%, 23. 03%, 11. 04%, 97. 62% and 100%,21. 88%,2. 60%,100%,respectively. The predictive sensitivity and negative predictive value of writhing movements PR for motor retardation and cerebral palsy were 92. 31%,100%;98. 18%, 100% respectively. The predictive sensitivity,specificity and negative predictive value of writhing movements CS for motor retardation and cerebral palsy were 100%,95. 81%,100% and 100%,95. 31% and 100%, respectively. Conclusion GMs quality assessment(writhing movements)has high reliability in predicting the motor development outcome of high-risk infants,especially cramped-synchronized has significant value in ear-ly screening of children with motor retardation and cerebral palsy.

The fidgety general movement assessment can predict motor development outcomes for pre-term twins or multiplets / 中华物理医学与康复杂志

Objective To study the predictive validity of fidgety general movement assessment in pre-term twins and multiplets for motor development outcomes.Methods A total of 53 pre-term twins or multiplets delivered between July 2011 and February 2016 participated in this study.They were assessed using a general movements (GM) assessment and participated in the follow-up program until one year old.The motor development outcomes of the infants at one year old were determined according to clinical diagnoses and the Peabody developmental motor scale number two (PDMS-2) evaluation.The predictive validity of fidgety general movement assessment for motor development outcomes was calculated against the standard motor development of infants at one year old.Results There were 53 twins or multiplets who accepted the GM assessment of fidgety movement period.Of these,43 were assessed as normal (NF) and ten (19％) as lacking a normal level of fidgety movement (F-).All 53 cases were followed-up for the motor development outcome.Forty-three cases (81.1％) were assessed as normal at one year old,while ten (18.9％) were assessed as abnormal.All ten had cerebral palsy,and no motor development retardation was found.The predictive value of F-for cerebral palsy was 90.0％ in terms of sensitivity,97.7％ in terms of specificity,90.0％ in positive predictive value,and 97.7％ in terms of negative predictive value.Conclusions Among pre-term twins or multiplets,the fidgety general movement assessment can be a useful early indicator of motor development difficulties.

Early prediction of neurodevelopmental outcomes in very low birth weight infants with general movements assessment / 国际儿科学杂志

Very low birth weight children due to its central nervous system immature,are more prone to brain damage,and neurological developmental disorders.Numerous studies have demonstrated that the general movements assessment can predict early stage neurodevelopmental outcomes in high risk infants and can be used as a tool to predict neurodevelopmental outcome in very low birth weight infants.Early prediction and timely intervention can reduce the morbidity of very low birth weight infants.

Fidgety movements – tiny in appearance, but huge in impact / Movimentos irregulares - pequenos na aparência, porém enormes no impacto

Abstract Objectives: To describe fidgety movements (FMs), i.e., the spontaneous movement pattern that typically occurs at 3–5 months after term age, and discuss its clinical relevance. Sources: A comprehensive literature search was performed using the following databases: MEDLINE/PubMed, CINAHL, The Cochrane Library, Science Direct, PsycINFO, and EMBASE. The search strategy included the MeSH terms and search strings (‘fidgety movement*’) OR [(‘general movement*’) AND (‘three month*’) OR (‘3 month*’)], as well as studies published on the General Movements Trust website (www.general-movements-trust.info). Summary of the data: Virtually all infants develop normally if FMs are present and normal, even if their brain ultrasound findings and/or clinical histories indicate a disposition to later neurological deficits. Conversely, almost all infants who never develop FMs have a high risk for neurological deficits such as cerebral palsy, and for genetic disorders with a late onset. If FMs are normal but concurrent postural patterns are not age-adequate or the overall movement character is monotonous, cognitive and/or language skills at school age will be suboptimal. Abnormal FMs are unspecific and have a low predictive power, but occur exceedingly in infants later diagnosed with autism. Conclusions: Abnormal, absent, or sporadic FMs indicate an increased risk for later neurological dysfunction, whereas normal FMs are highly predictive of normal development, especially if they co-occur with other smooth and fluent movements. Early recognition of neurological signs facilitates early intervention. It is important to re-assure parents of infants with clinical risk factors that the neurological outcome will be adequate if FMs develop normally.

Resumo Objetivos: Descrever os movimentos irregulares (FMs), ou seja, o padrão de movimentos espontâneos que normalmente ocorrem entre três e cinco meses após o nascimento e discutir sua relevância clínica. Fontes: Uma pesquisa abrangente na literatura foi feita nas seguintes bases de dados: Medline/PubMed, Cinahl, The Cochrane Library, Science Direct, PsycINFO e Embase. A estratégia de busca incluiu os termos e cadeias de pesquisa do MeSH [(“fidgety movement*”) OU [(“general movement*”) E (“three month*”) OU (“3 month*”)], bem como estudos publicados no website da General Movements Trust (www.general-movements-trust.info). Resumo dos dados: Praticamente todos os neonatos se desenvolveram normalmente se os FMs estiveram presentes e foram normais, mesmo se seus resultados do ultrassom do cérebro e/ou históricos clínicos indicassem tendência a déficits neurológicos posteriores. Por outro lado, quase todos os neonatos que nunca desenvolveram FMs apresentaram maior risco de déficits neurológicos, como paralisia cerebral, e doenças genéticas de início tardio. Caso os FMs fossem normais, porém simultâneos a padrões posturais não adequados para a idade, ou o caráter geral dos movimentos fosse monótono, as capacidades cognitivas e/ou de linguagem na idade escolar seriam abaixo do ideal. Os FMs anormais não são específicos e têm baixo poder preditivo, porém ocorrem em grande parte em neonatos posteriormente diagnosticados com autismo. Conclusões: FMs anormais, ausentes ou esporádicos indicam um risco maior de disfunções neurológicas posteriores, ao passo que FMs normais são altamente preditivos de desenvolvimento normal, principalmente se forem simultâneos a outros movimentos suaves e fluentes. O reconhecimento precoce de sinais neurológicos facilita a intervenção antecipada. É importante garantir aos pais de neonatos com fatores de risco clínicos que o resultado neurológico será adequado se os FMs se desenvolverem normalmente.

Effect of Early Intervention on General Movements in Preterm Infants during Fidgety Movement / 中国康复理论与实践

Objective To investigate the effect of early intervention on general movements (GM) in preterm infants during fidgety move-ment. Methods 315 preterm infants during fidgety movement period were divided into intervention group (n=160) and control group (n=155). The intervention group accepted very early intervention program consisted of hospital intervention and family intervention, and the control group accepted routine treatment and nursing. The incidences of different kinds of GMs were compared. Results There is no statisti-cal difference (χ2=0.641, P=0.726) in writhing movement before intervention, and the fidgety movement presented more in the intervention group than in the control group (χ2=8.710, P=0.003), while the absence of fidgety movement was significantly fewer (χ2=5.685, P=0.017) af-ter intervention. Conclusion Very early intervention can reduce the incidence of absence of fidgety movement and improve fidgety move-ment.

Predicting cerebral palsy of high risk neonates:A comparative analysis of the validity of general movement assessment and classical neurological motor examination / 中华物理医学与康复杂志

Objective To compare the validity of general movements ( GM ) assessment with that of a 52 item neurological motor examination in predicting cerebral palsy among high risk neonates.Methods Eighty-four infants aged 12 months at high risk were evaluated simultaneously with GM assessment and the 52 item neurological motor examination.The utility of the two methods in predicting cerebral palsy was then compared.Results There were 4 cerebral palsy patients among the 84 high risk neonates.The GM assessment's predictive validity for Monotonous movements was 78.57％,its sensitivity was 25％,its specificity was 81.25％,its positive predictive value was 6.25％,its negative predictive value was 95.59％,and its kappa value was 0.215.The comparable values for the Cramped-synchronised scale were validity 96.43％,sensitivity 50％,specificity 98.75％,positive predictive value 66.67％,negative predictive value 97.53％,and kappa value O.553.The values for the absence of Fidgety movements were validity 98.81％,sensitivity 75％,specificity 100％,positive predictive value 100％,negative predictive value 98.77％,and kappa value 0.851.For the entire 52 items of the neurological motor examination the corresponding values were validity 51.19％,sensitivity 100％,specificity 48.75％,positive predictive value 8.89％,negative predictive value 100％,and kappa value 0.083.Conclusions GM assessment can predict the severe neurological deficits of cerebral palsy among high risk neonates by the age of 12 months.The 52-item neurological motor examination can detect mild and moderate neurological deficits.GM assessment combined with the 52-item neurological motor examination is a desirable and effective way to assess high risk infants.

Agreement between Two Kinds of Neurological Assessment in Preterm Infants during Early Infantile Period / 中国康复理论与实践

@#Objective To study the agreement of the two kinds of assessment for neurological development, the Qualitative Assessment of General Movements (GMs) and the 52 Items Neurological Assessment from Birth to 1 Year, in preterm infants during the early infantile period. Methods16 preterm infants with or without risk factors for brain injury were assessed with GMs and the 52 Items Neurological Assessment from Birth to 1 Year within 3 months after birth. ResultsFor the GMs, 11 infants were assessed as normal, 4 as poor repertoire (PR) and 1 as cramped synchronized (CS). For the 52 Items Neurological Assessment from Birth to 1 Year, 12 infants were normal, 4 were moderate abnormal. Kappa=0.709.ConclusionThe result of GMs agrees with that of 52 Items Neurological Assessment from Birth to 1 Year for preterm infants during the early infantile period.