Journal of Clinical Medicine (Oct 2019)
Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome
- Christa Einspieler,
- Arend F. Bos,
- Magdalena Krieber-Tomantschger,
- Elsa Alvarado,
- Vanessa M. Barbosa,
- Natascia Bertoncelli,
- Marlette Burger,
- Olena Chorna,
- Sabrina Del Secco,
- Raye-Ann DeRegnier,
- Britta Hüning,
- Jooyeon Ko,
- Laura Lucaccioni,
- Tomoki Maeda,
- Viviana Marchi,
- Erika Martín,
- Catherine Morgan,
- Akmer Mutlu,
- Alice Nogolová,
- Jasmin Pansy,
- Colleen Peyton,
- Florian B. Pokorny,
- Lucia R. Prinsloo,
- Eileen Ricci,
- Lokesh Saini,
- Anna Scheuchenegger,
- Cinthia R. D. Silva,
- Marina Soloveichick,
- Alicia J. Spittle,
- Moreno Toldo,
- Fabiana Utsch,
- Jeanetta van Zyl,
- Carlos Viñals,
- Jun Wang,
- Hong Yang,
- Bilge N. Yardımcı-Lokmanoğlu,
- Giovanni Cioni,
- Fabrizio Ferrari,
- Andrea Guzzetta,
- Peter B. Marschik
Affiliations
- Christa Einspieler
- Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
- Arend F. Bos
- University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, Division of Neonatology, 9713 GZ Groningen, The Netherlands
- Magdalena Krieber-Tomantschger
- Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
- Elsa Alvarado
- National Rehabilitation Institute, Cerebral Palsy Department, 14389 Mexico City, Mexico
- Vanessa M. Barbosa
- University of Illinois at Chicago, UI Health, Department of Occupational and Physical Therapy, Chicago, IL 60612, USA
- Natascia Bertoncelli
- University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy
- Marlette Burger
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Health and Rehabilitation Sciences, Cape Town 8000, South Africa
- Olena Chorna
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy
- Sabrina Del Secco
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy
- Raye-Ann DeRegnier
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Britta Hüning
- University Hospital Essen, Department of Pediatrics I, 45122 Essen, Germany
- Jooyeon Ko
- Daegu Health College, Department of Physical Therapy, 41453 Daegu, Korea
- Laura Lucaccioni
- University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy
- Tomoki Maeda
- Oita University Faculty of Medicine, Department of Pediatrics, 879-5593 Oita, Japan
- Viviana Marchi
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy
- Erika Martín
- Children’s Rehabilitation Institute Teleton, 72825 Puebla, Mexico
- Catherine Morgan
- The University of Sydney Medical School, Children’s Hospital at Westmead Clinical School, The Discipline of Child and Adolescent Health, Sydney 2050, NSW, Australia
- Akmer Mutlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, 06100 Ankara, Turkey
- Alice Nogolová
- Municipal Hospital of Ostrava, Children ’s Department, 72880 Ostrava, Czech Republic
- Jasmin Pansy
- Medical University of Graz, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, 8036 Graz, Austria
- Colleen Peyton
- Northwestern University, Department of Physical Therapy and Human Movement Science, Chicago, IL 60611, USA
- Florian B. Pokorny
- Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
- Lucia R. Prinsloo
- Cerebral Palsy Association Eastern Cape, Port Elizabeth 6001, South Africa
- Eileen Ricci
- University of New England/Maine LEND Program, Portland, ME 04103, USA
- Lokesh Saini
- Post Graduate Institute of Medical Education and Research, Department of Pediatrics, Pediatric Neurology Division, Chandigarh 160012, India
- Anna Scheuchenegger
- Medical University of Graz, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, 8036 Graz, Austria
- Cinthia R. D. Silva
- Rede SARAH de Hospitais de Reabilitação, Reabilitação Infantil, 30510-000 Belo Horizonte, Brazil
- Marina Soloveichick
- Lady Davis Carmel Medical Center, NICU Developmental Follow-up Clinic, 34362 Haifa, Israel
- Alicia J. Spittle
- University of Melbourne, School of Health Sciences, Department of Physiotherapy, Parkville 3052, Australia
- Moreno Toldo
- Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi 221011, India
- Fabiana Utsch
- Rede SARAH de Hospitais de Reabilitação, Reabilitação Infantil, 30510-000 Belo Horizonte, Brazil
- Jeanetta van Zyl
- Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Cape Town 8000, South Africa
- Carlos Viñals
- National Rehabilitation Institute, Cerebral Palsy Department, 14389 Mexico City, Mexico
- Jun Wang
- Children’s Hospital of Fudan University, Department of Rehabilitation, Shanghai 201102, China
- Hong Yang
- Children’s Hospital of Fudan University, Department of Rehabilitation, Shanghai 201102, China
- Bilge N. Yardımcı-Lokmanoğlu
- Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, 06100 Ankara, Turkey
- Giovanni Cioni
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy
- Fabrizio Ferrari
- University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy
- Andrea Guzzetta
- IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy
- Peter B. Marschik
- Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
- DOI
- https://doi.org/10.3390/jcm8101616
- Journal volume & issue
-
Vol. 8,
no. 10
p. 1616
Abstract
The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3−5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant’s later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III−V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.
Keywords
- cerebral palsy
- dyskinesia
- fidgety movements
- general movements
- gmfcs
- hemiplegia
- hypotonia
- identification
- motor optimality score
- segmental movements
