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, 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

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: GMFCS; cerebral palsy; dyskinesia; fidgety movements; general movements; hemiplegia; hypotonia; identification; motor optimality score; segmental movements.

Conflict of interest statement

C.E., A.F.B., N.B., L.L., C.P., A.J.S., H.Y., F.F., A.G., and G.C. are certified tutors of the GM Trust; C.M. and A.M. are GM Trust tutors in training. No other disclosures were reported.

Figures

Figure 1
Figure 1
Regions of origin of participants (absolute numbers per region), including percentage (%) of individuals born preterm (PT) and percentage (%) of males (♂). For Asia, we provide information on three of the five geographical subregions: Western Asia (sand color), South Asia (orange), and East Asia (yellow).
Figure 2
Figure 2
Consensus revised version of the Assessment of the Motor Repertoire at 3–5 months in order to obtain the Motor Optimality Score.
Figure 3
Figure 3
Illustration of the postural item “Body Symmetry”. Score normal if an imaginary line through the shoulder joints and an imaginary line through the hip joints run parallel (left; green lines). Score atypical if this is not the case (right, red lines).
Figure 4
Figure 4
Distribution of the Motor Optimality Score (MOS) within the levels of the Gross Motor Function Classification System—Expanded & Revised (GMFCS-E&R). Whiskers indicate an interquartile range (IQR) × 1.5. Key: ° outliers (within 3 × IQR), * extreme outliers (>3 × IQR).

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