General movements: a window for early identification of children at high risk for developmental disorders

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Detection of children with a developmental disorder, such as cerebral palsy, at an early age is notoriously difficult. Recently, a new form of neuromotor assessment of young infants was developed, based on the assessment of the quality of general movements (GMs). GMs are movements of the fetus and young infant in which all parts of the body participate. The technique of GM assessment is presented and the features of normal, mildly abnormal, and definitely abnormal GMs discussed. Essential to GM assessment is the Gestalt evaluation of movement complexity and variation. The quality of GMs at 2 to 4 months postterm (so-called fidgety GM age) has been found to have the highest predictive value. The presence of definitely abnormal GMs at this age—that is, GMs devoid of complexity and variation—puts a child at very high risk for cerebral palsy. This implies that definitely abnormal GMs at fidgety age are an indication for early physiotherapeutic intervention.

Section snippets

Child's brain: a continuously changing system

The development of the human brain is a long-lasting process. It is at approximately 30 years of age that the nervous system obtains its adult configuration (Fig 1).1., 2. Development starts during the early phases of gestation with the proliferation of neurons in the germinal layers near the ventricles. Next, neurons migrate in an orderly fashion to their final places of destination, and they start to differentiate. Neuronal differentiation includes the formation of dendrites and axons, the

Normal development of general movements

Heinz Prechtl, a pioneer in the field of early neurological development, recognized the significance of spontaneous motor behavior in early life. Prechtl and others7., 8. realized that self-generated motility during early development plays an important role in survival and adaptation. In addition, Prechtl discovered that the quality of spontaneous motility, especially the quality of general movements (GMs), accurately reflects the condition of the nervous system of the fetus and young infant.9

Conclusions

The assessment of the quality of GMs is a sensitive tool to evaluate brain function in young infants. It has a function complementary to the traditional neurological examination. Prediction of developmental outcome on the basis of longitudinal series of GM assessment is best. Second best is prediction on the basis of an assessment at fidgety age. European experience indicates that a single GM assessment at fidgety age can be implemented relatively easily into clinical practice.

The presence of

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