Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome.
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Einspieler Christa, Bos Arend F, Krieber-Tomantschger Magdalena, Alvarado Elsa, Barbosa Vanessa M, Bertoncelli Natascia, Burger Marlette, Chorna Olena, Del Secco Sabrina, DeRegnier Raye-Ann, Hüning Britta, Ko Jooyeon, Lucaccioni Laura, Maeda Tomoki, Marchi Viviana, Martín Erika, Morgan Catherine, Mutlu Akmer, Nogolová Alice, Pansy Jasmin, Peyton Colleen, Pokorny Florian B, Prinsloo Lucia R, Ricci Eileen, Saini Lokesh, Scheuchenegger Anna, Silva Cinthia R D, Soloveichick Marina, Spittle Alicia J, Toldo Moreno, Utsch Fabiana, van Zyl Jeanetta, Viñals Carlos, Wang Jun, Yang Hong, Yardımcı-Lokmanoğlu Bilge N, Cioni Giovanni, Ferrari Fabrizio, Guzzetta Andrea, Marschik Peter B
Аннотация
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.