Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct 4;8(10):1616.
doi: 10.3390/jcm8101616.

Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

Christa Einspieler  1 , Arend F Bos  2 , Magdalena Krieber-Tomantschger  3 , Elsa Alvarado  4 , Vanessa M Barbosa  5 , Natascia Bertoncelli  6 , Marlette Burger  7 , Olena Chorna  8 , Sabrina Del Secco  9 , Raye-Ann DeRegnier  10 , Britta Hüning  11 , Jooyeon Ko  12 , Laura Lucaccioni  13 , Tomoki Maeda  14 , Viviana Marchi  15   16 , Erika Martín  17 , Catherine Morgan  18   19 , Akmer Mutlu  20 , Alice Nogolová  21   22 , Jasmin Pansy  23 , Colleen Peyton  24 , Florian B Pokorny  25 , Lucia R Prinsloo  26 , Eileen Ricci  27 , Lokesh Saini  28 , Anna Scheuchenegger  29 , Cinthia R D Silva  30 , Marina Soloveichick  31 , Alicia J Spittle  32   33 , Moreno Toldo  34 , Fabiana Utsch  35 , Jeanetta van Zyl  36 , Carlos Viñals  37 , Jun Wang  38 , Hong Yang  39 , Bilge N Yardımcı-Lokmanoğlu  40 , Giovanni Cioni  41 , Fabrizio Ferrari  42 , Andrea Guzzetta  43 , Peter B Marschik  44   45   46
Affiliations

Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

Christa Einspieler et al. J Clin Med. .

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.

PubMed Disclaimer

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).
See this image and copyright information in PMC

References

    1. Novak I., Morgan C., Adde L., Blackman J., Boyd R.N., Brunstrom-Hernandez J., Cioni G., Damiano D., Darrah J., Eliasson A.C., et al. Early, accurate diagnosis and early intervention in cerebral palsy. Advances in diagnosis and treatment. JAMA Pediatr. 2017;171:897–907. doi: 10.1001/jamapediatrics.2017.1689. - DOI - PMC - PubMed
    1. Herskind A., Greisen G., Nielsen J.B. Early identification and intervention in cerebral palsy. Dev. Med. Child Neurol. 2015;57:29–36. doi: 10.1111/dmcn.12531. - DOI - PubMed
    1. Morgan C., Fahey M., Roy B., Novak I. Diagnosing cerebral palsy in full-term infants. J. Paediatr. Child Health. 2018;54:1159–1164. doi: 10.1111/jpc.14177. - DOI - PubMed
    1. Hutchon B., Gibbs D., Harniess P., Jary S., Crossley S.L., Moffat J.V., Basu N., Basu A. Early intervention programmes for infants at high risk of atypical neurodevelopmental outcome. Dev. Med. Child Neurol. 2019 doi: 10.1111/dmcn.14187. - DOI - PubMed
    1. Einspieler C., Prechtl H.F.R., Bos A.F., Ferrari F., Cioni G. Prechtl’s Method on the Qualitative Assessment of General Movements in Preterm, Term and Young Infants. MacKeith Press; London, UK: 2004. pp. 1–104. - PubMed

LinkOut - more resources