Use of the General Movement Assessment as an Early Marker of CP

Use of the General Movement Assessment as an Early Marker of CP

Authors: Yvette R. Johnson, MD, MPH; Treka L. Rogers, CPNP-AC; Chelsea L. Sapit, CPNP-PC; Kimberly Barber, PT; Robin Grady, OT; Betsy O’Hara, OTR; Heather Hilliard, DPT; Grace Rustom; Nisha Mistry, MS; Michelle Lee, MS; Tyler Hamby, PhD

Purpose:

Cerebral palsy (CP) is the most common physical disability in children affecting 1 in 500 live births. The average national standard of detecting CP occurs after 2 years of age by analysis of neurological signs. Since December 2014, the NICU Early Support and care Transition (N.E.S.T.) Clinic at Cook Children’s Medical Center has provided multidisciplinary comprehensive follow-up to high-risk NICU survivors. Cook Children’s Medical Center implemented an Early CP detection program in 2019 using the General Movement Assessment (GMA) in the NICU and NEST Clinic. There has been emerging evidence that evaluation of general movements in early infancy (writhing and fidgety periods) is predictive of a future CP diagnosis in an infant. This early diagnosis is key for better neurodevelopmental outcomes.

Methods:

Infants who met inclusion criteria had GMA videos captured shortly after birth during the NICU stay. Infants with abnormal GMA videos had further evaluation at 3-4 months corrected gestational age, during their NEST clinic visit. The data from the NEST clinic were then compiled to include high-risk variables. Retrospective review and analysis of data previously collected for the Early CP detection program was performed under the direction of Dr. Yvette Johnson and her Early Detection Team. Univariate Cox regression analyses were performed to determine which variables were predictive of CP diagnosis.

Results:

There were 471 patients who met inclusion criteria, including 292 (62%) very low birth weight (VLBW), 131 (28%) hypoxic-ischemic encephalopathy (HIE), 15 (3%) congenital diaphragmatic hernia (CDH), 8 (2%) extracorporeal membrane oxygenation (ECMO), and 25 (5%) congenital heart disease (CHD) infants. Four hundred ten (87%) had GMA’s in the writhing phase and 205 (44%) had GMA’s in the fidgety phase. The median (range) age of CP diagnosis was 1.07 (0.34-1.93) years, and 91% had been diagnosed by 1.50 years. The infants with HIE had a statistically significant increased risk of CP diagnosis compared to those in the VLBW category (10% vs. 6%, HR=2.50, p=0.014). The infants with an absent or abnormal fidgety GMA interpretation during the fidgety period had a statistically significant increased risk of CP diagnosis compared to those with other interpretations (46% vs. 3%, HR=15.69, p<0.0001).

Conclusion:

The results showed that having an abnormal or absent fidgety general movements during the fidgety phase was a significantly strong predictor of CP outcomes. These data can be extrapolated in clinical settings to provide early and evidence-based interventions that can improve long-term functional motor outcomes.