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. 2021 Jan;110(1):290-300.
doi: 10.1111/apa.15300. Epub 2020 Jun 22.

Temporal and spatial localisation of general movement complexity and variation-Why Gestalt assessment requires experience

Ying-Chin Wu  1 , Ilse M van Rijssen  1 , Maria T Buurman  1 , Linze-Jaap Dijkstra  1 , Elisa G Hamer  1   2 , Mijna Hadders-Algra  1
Affiliations

Temporal and spatial localisation of general movement complexity and variation-Why Gestalt assessment requires experience

Ying-Chin Wu et al. Acta Paediatr. 2021 Jan.

Abstract

Aim: General movements' assessment (GMA), based on Gestalt perception, identifies infants at risk of cerebral palsy. However, the requirement of ample experience to construct the assessor's inner criteria for abnormal movement hampers its widespread clinical use. This study aims to describe details of general movements (GMs) in various body parts and to investigate their association with GMA-Gestalt.

Methods: Participants were 24 typically developing infants and 22 very-high-risk infants. GMs were assessed during the writhing (0-8 weeks) and/or fidgety GM phase (2-5 months) by GMA-Gestalt and a semi-quantification of the duration of simple movements and complex movements in various body parts.

Results: During both GM phases, the quality of movement often varied within a single assessment, but the degree of complexity and variation of movements in trunk, arms and legs were interrelated (ρ = 0.32-0.84). Longer durations of complex movements in arms and legs (P < .042) were further associated with a better quality in GMA-Gestalt. Head movement was associated with movements in other body parts only in the writhing phase and not associated with GMA-Gestalt during both GM phases.

Conclusion: Infants did not show consistently over time and across body parts simple or complex movements. Detailed description of movement characteristics may facilitate the development of computer-based GMA.

Keywords: general movements; general movements’ assessment; motor behaviour; semi-quantification; variation.

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Conflict of interest statement

Prof. dr Mijna Hadders‐Algra has provided courses on the assessment of GMs since 1993. The honorarium of the courses flows into the Research Fund of Developmental Neurology. She did not get a honorarium, grant or other form of payment to produce the manuscript. Other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of assessments. A diagram of the assessment schedule and data collection. MA = mildly abnormal GMs, DA = definitely abnormal GMs
Figure 2
Figure 2
Examples of the semi‐quantified analysis of general movement (GM). Details of GM characteristics in various body parts during minutes of (A) an infant with normal GMs, (B) an infant with mildly abnormal GMs and (C) an infant with definitely abnormal GMs. The bars indicate the time when a specific movement characteristic was observed. The three infants show frequent head turns and varied trunk movements. They differ, however, in arm and leg movements. Infant (A) frequently shows complex and varied movements, but also short periods of simple movements are present. Infant (B) shows many simple movements, interchanged with some complex movements. Infant (C) has short bursts of complex movements embedded in predominantly simple movements of the arms and legs
Figure 3
Figure 3
Associations between clinical Gestalt and details of general movements (GM). The three groups represent the infants with normal GMs, mildly abnormal (MA) GMs and definitely abnormal (DA) GMs. Figures in left panel show the GMs during the writhing phase (normal: n = 12, MA: n = 3, DA: n = 2); figures in right panel are the GMs during the fidgety phase (normal: n = 19; MA: n = 7, DA: n = 17). Data are presented as median (horizontal bar), interquartile ranges (boxes) and ranges (vertical lines). * indicates P < .05 in group comparisons. **Indicates P < .017 in group comparisons, adjusted for the multiple testing
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