Variability and Stereotypy of Spontaneous Motility as a Predictor of Neurological Development of Preterm Infants

Abstract

SUMMARY Observations of the variability stereotypy ratio of spontaneous motility in a group of 47 preterm infants showed that stereotyped motor activity was related to the neurological diagnosis at term age. A minority of the neurologically deviant infants at term recovered during infancy. The presence or absence of intra‐uterine growth retardation and an accumulation of obnoxious antenatal, perinatal and postnatal events seemed to affect outcome, particularly in the presence of extensive and permanent ultrasound findings. A normal neurological condition at term indicates a high probability of normal development. RÉSUMÉ Variabilité et stéréotypie de la motricité spontanée comme pronostic du développement neurologique du prématuré Des observations du rapport variabilité‐stéréotypie de la motricité spontanée sur un groupe de 47 prématurés a montré que l'activité motrice stéréotypée etait reliée au diagnostic neurologique au terme. Une minorité de prématurés neurologiquement déviants au terme ont récupéré la première enfance. La présence ou l'absence d'un retard de croissance intra‐utérine et l'accumulation d'évènements nocifs anténataux, paranataux et postnataux semblait altérer le devenir particulièrement en cas de données échographiques extensives et permanentes. Une condition neurologique normale à terme indique une forte probabilité de développement normal. ZUSAMMENFASSUNG Variabilitàt und Stereotypie der Spontanbewegungen als prognostisches Zeichen für die neurologische Entwicklung von Frühgeborenen Die Beobachtungen des Verhältnisses zwischen Variabilität und Stereotypie der Spontanbewegungen bei einer Gruppe von 47 Frühgeborenen zeigte, daß eine Relation zwischen stereotyper motorischer Aktivität und neurologischer Diagnose am Termin bestand. Nur wenige, der am Termin neurologisch auffàlligen Kinder, normalisierten sich im Kindesalter. Das Vorliegen oder Fehlen einer intra‐uterinen Wachstumsver zögerung und eine Häufung von schädlichen prä‐, peri‐ und postnatalen Einflüssen schienen sich auf den Outcome auszuwirken, insbesondere wenn ausgedehnte und bleibende Ultraschallbefunde vorlagen. Normale neurologische Befunde am Termin deuten mit hoher Wahrscheinlichkeit auf eine normale Entwicklung hin. RESUMEN Variabilidad y estereotipia de la motilidad espontánea como predictores del desarrollo neurológico de lactantes pretérmino Las observaciones de la variabilidad‐estereotipia de la motilidad espontánea en un grupo de 47 lactantes pretérmino, mostró que la actividad motora espereotipada estaba en relación con el diagnóstico neurológico a le edad de término. La presencia o ausencia de un retraso de crecimiento intrauterino y el acúmulo de acontecimientos nocivos antenatales, parantatales y postnatales parecen afectar el curso, sobre todo en presencia de hallazgos ultrasónicos extensos y permanentes. Unas características normales a la edad de término indican una alta probabilidad de un desarrollo normal.

Reliability and predictive validity of the Standardized Infant NeuroDevelopmental Assessment neurological scale

“…The classification of movement variation versus stereotypy is based on clinical observation, not on video assessment as in the assessment of general movements . This implies that only striking stereotypies, including consistent asymmetries, are recorded as atypical, in line with clinical practices . The inclusion of seven items on movement quality also means that asymmetries, such as a head‐turn preference with an accompanying asymmetry in arm movements, and eventually in hand movements which occurs relatively frequently in 2‐month or 3‐month‐old infants, only results in a reduction of 2 or 3 points.…”

“…1 This implies that only striking stereotypies, including consistent asymmetries, are recorded as atypical, in line with clinical practices. 7,[10][11][12] The inclusion of seven items on movement quality also means that asymmetries, such as a head-turn preference with an accompanying asymmetry in arm movements, and eventually in hand movements which occurs relatively frequently in 2-month or 3-month-old infants, only results in a reduction of 2 or 3 points. The latter may be interpreted as a minor dysfunction.…”

Early motor repertoire is related to level of self‐mobility in children with cerebral palsy at school age

“…Reduced complexity (monotony), jerkiness, and ⁄ or a cramped character were considered to be signs of abnormality and were scored separately. [16][17][18] Differences in the degree of monotony, jerkiness, and cramped character were not scored.…”

“…The median motor optimality score was 9 (range 7-15) in the group with a low level of self-mobility (GMFCS levels III-V) and 12 (range [9][10][11][12][13][14][15][16][17][18][19][20][21][22] in the group with a high level of self-mobility (GMFCS levels I and II). The optimal cut-off point of the motor optimality score for distinguishing between these two groups, determined by the receiver operating characteristics curve, was 9.…”

Reaching strategies of very preterm infants at 8 months corrected age

“…In addition to reaching, a battery of neuromotor examinations (NME) were performed by a physiotherapist and a neonatologist at 2 and 10 months CA. The infants’ neurological status was examined by the neonatologist using a modified version of Touwen and Amiel-Tison’s methods (Touwen 1978; Amiel-Tison and Grenier 1986; Touwen 1990). The physiotherapist used the instrument “Structured observation of Motor Behavior” (SOMP) that estimates both the infant’s level of motor development and the quality of the achieved motor function level.…”