ObjectiveGross motor assessment tools have a critical role in identifying, diagnosing and evaluating motor difficulties in childhood. The objective of this review was to systematically evaluate the ...psychometric properties and clinical utility of gross motor assessment tools for children aged 2–12 years.MethodA systematic search of MEDLINE, Embase, CINAHL and AMED was performed between May and July 2017. Methodological quality was assessed with the COnsensus-based Standards for the selection of health status Measurement INstruments checklist and an outcome measures rating form was used to evaluate reliability, validity and clinical utility of assessment tools.ResultsSeven assessment tools from 37 studies/manuals met the inclusion criteria: Bayley Scale of Infant and Toddler Development-III (Bayley-III), Bruininks-Oseretsky Test of Motor Proficiency-2 (BOT-2), Movement Assessment Battery for Children-2 (MABC-2), McCarron Assessment of Neuromuscular Development (MAND), Neurological Sensory Motor Developmental Assessment (NSMDA), Peabody Developmental Motor Scales-2 (PDMS-2) and Test of Gross Motor Development-2 (TGMD-2). Methodological quality varied from poor to excellent. Validity and internal consistency varied from fair to excellent (α=0.5–0.99). The Bayley-III, NSMDA and MABC-2 have evidence of predictive validity. Test–retest reliability is excellent in the BOT-2 (intraclass correlation coefficient (ICC)=0.80–0.99), PDMS-2 (ICC=0.97), MABC-2 (ICC=0.83–0.96) and TGMD-2 (ICC=0.81–0.92). TGMD-2 has the highest inter-rater (ICC=0.88–0.93) and intrarater reliability (ICC=0.92–0.99).ConclusionsThe majority of gross motor assessments for children have good-excellent validity. Test–retest reliability is highest in the BOT-2, MABC-2, PDMS-2 and TGMD-2. The Bayley-III has the best predictive validity at 2 years of age for later motor outcome. None of the assessment tools demonstrate good evaluative validity. Further research on evaluative gross motor assessment tools are urgently needed.
Aim
To systematically review the predictive validity of spontaneous early infant movements for later cerebral palsy (CP).
Method
Cohort studies with published data to calculate predictive validity of ...early spontaneous movements for later CP were searched in four electronic databases: CINAHL, Embase, MEDLINE, and PsycINFO.
Results
Forty‐seven studies met inclusion criteria. The Prechtl General Movements Assessment (GMA) during the fidgety period (10–20wks corrected age) had the strongest sensitivity: 97 per cent (95% confidence interval CI 93–99) and specificity: 89% (95% CI 83–93). The sensitivity and specificity of the Prechtl GMA during the writhing period (birth–6wks) was 93% (95% CI 86–96) and 59% (95% CI 45–71) respectively. Cramped‐synchronized movements in the writhing period according to Prechtl had the best specificity (sensitivity: 70% 95% CI 54–82; specificity: 97% 95% CI 74–100). Hadders‐Algra's method of assessing general movements had a pooled sensitivity and specificity of 89% (95% CI 66–97) and 81% (95% CI 64–91) respectively. Presence of asymmetric postures and movement quality/quantity were reported under the Hammersmith Infant Neurological Examination, Hammersmith Neonatal Neurological Examination, and Movement Assessment of Infants but had weak associations with later CP.
Interpretation
Fidgety movements assessed by the Prechtl GMA have the strongest predictive validity for later CP, but cannot be considered in isolation because of the presence of false positive results.
What this paper adds
Fidgety general movements (Prechtl) are most predictive for later cerebral palsy compared with other spontaneous movements.
False positive results are high among all spontaneous movement assessments.
Resumen
Validez predictiva de los movimientos espontáneos tempranos en niños para parálisis cerebral: una revisión sistemática
Objetivo
Revisar sistemáticamente el valor predictivo de los movimientos espontáneos tempranos en niños con parálisis cerebral (PC).
Método
Estudio de cohorte con datos publicados para calcular la validez predictiva de los movimientos espontáneos tempranos en niños con PC, seleccionados de cuatro bases de datos electrónicas: CINAHL, Embase, MEDLINE, and PsycINFO.
Resultados
Cuarenta y cinco estudios reunieron los criterios de inclusión. La Evaluación de los Movimientos Generales de Prechtl (GMA) durante el periodo de movimientos de ajetreo (10–20 semanas de edad corregida) tuvieron la mayor sensibilidad: 97% (95% de intervalo de confianza IC 93–99%) y especificidad: 89% (95% IC 83–93%). La sensibilidad y especificidad de GMA durante el periodo de contorsión (desde el nacimiento hasta las 6 semanas de vida) fue el 93% (95% IC 86–96%) y 59% (95% IC45–71%) respectivamente. Los movimientos estrechos sincronizado en el periodo de contorsión de acuerdo a lo especificado por Prechtl tuvieron la mayor especificidad (sensibilidad: 70% 95% IC 54–82%; e specificidad: 97% 95% IC 74–100%). El método de evaluación de movimientos generales de Hadders‐Algra tuvo un grupo de sensibilidad y especificidad de 89% (95% IC 66–97%) y 81% (95% IC 64–91%) respectivamente. La presencia de posturas asimétricas y movimientos cuali/cuantitativos fue reportada en Hammersmith Infant Neurological Examination, Hammersmith Neonatal Neurological Examination, and Movement Assessment of Infants pero con débil asociación con la PC.
Interpretacion
Los movimientos de ajetreo (fidgety) evaluados por Prechtl – GMA ‐ tienen la mayor validez predictiva en PC, pero no pueden ser considerados aisladamente por la presencia de resultados falsos positivos.
Resumo
Validade preditiva do movimento espontâneo precoce na infãncia para paralisia cerebral posteriormente: uma revisão sistemática
Objetivo
Revisar sistematicamente a validade preditiva dos movimentos espontâneos precoces para paralisia cerebral (PC) posteriormente.
Método
Estudos de coorte com dados publicados para calcular a validade preditiva dos preditiva dos movimentos espontâneos precoces para PC posteriormente foram buscados em quatro bases de dados eletrônicas: CINAHL, Embase, MEDLINE, e PsycINFO.
Resultados
Quarenta e cinco estudos atenderam aos critérios de inclusão. A Avaliação dos Movimentos Gerais de Prechtl (AMG) durante o período fidgety (10‐20 semanas de idade corrigida) teve a maior sensibilidade: 97% (intevalo de confiança IC 95% 93‐99%) e especificidade: 89% (IC 95% 83‐93%). A sensibilidade e especificidade do AMG de Precthl durante o período whrithing (nascimento a 6 semanas) foram 93% (IC 95% 86‐96%) e 59% (IC 95% 74‐100%), respectivamente. Movimentos cramped‐synchronized no período de writhing de acordo com Prechtl tiveram a melhor especificidade (sensibilidade: 70% IC 95% 54–82%; especificidade: 97% IC 95% 74–100%). O método de Hadders‐Algra para avaliar movimentos gerais teve sensibilidade e especificidade agrupadas de 89% (IC 95% 66–97%) 81% (IC 95% 64–91%), respectivamente. A presença de posturas assimétricas e qualidade/quantidade do movimento foram relatadas pelo Exame Neurológico do Lactente de Hammersmith, Exame Neurológico Neonatal de Hammersmith, e Avaliação dos Movimentos de Lactentes, mas tiveram pobres associações com a PC posteriormente.
Interpretação
Os movimentos de fidgety avaliados pelos AMG de Prechtl tiveram a mais forte validade preditiva para PC posteriormente, mas não podem ser considerados isoladamente por causa da presença de resultados falsos positivos.
What this paper adds
Fidgety general movements (Prechtl) are most predictive for later cerebral palsy compared with other spontaneous movements.
False positive results are high among all spontaneous movement assessments.
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IMPORTANCE: Moderate and late preterm (MLPT) births comprise most preterm infants. Therefore, long-term developmental concerns in this population potentially have a large public health influence. ...While there are increasing reports of developmental problems in MLPT children, detail is lacking on the precise domains that are affected. OBJECTIVE: To compare neurodevelopment and social-emotional development between MLPT infants and term-born control infants at age 2 years. DESIGN, SETTING, AND PARTICIPANTS: This investigation was a prospective longitudinal cohort study at a single tertiary hospital. Participants were MLPT infants (32-36 weeks’ completed gestation) and healthy full-term controls (≥37 weeks’ gestation) recruited at birth. During a 3-year period between December 7, 2009, and November 7, 2012, MLPT infants were recruited at birth from the neonatal unit and postnatal wards of the Royal Women’s Hospital, Melbourne, Australia. The term control recruitment extended to March 26, 2014. The dates of the data developmental assessments were February 23, 2012, to April 8, 2016. EXPOSURE: Moderate and late preterm birth. MAIN OUTCOMES AND MEASURES: Cerebral palsy, blindness, and deafness assessed by a pediatrician; cognitive, language, and motor development assessed using the Bayley Scales of Infant Development–Third Edition (developmental delay was defined as less than −1 SD relative to the mean in controls in any domain of the scales); and social-emotional and behavioral problems assessed by a parent questionnaire (Infant Toddler Social Emotional Assessment). Outcomes were compared between birth groups using linear and logistic regression, adjusted for social risk. RESULTS: In total, 198 MLPT infants (98.5% of 201 recruited) and 183 term-born controls (91.0% of 201 recruited) were assessed at 2 years’ corrected age. Compared with controls, MLPT children had worse cognitive, language, and motor development at age 2 years, with adjusted composite score mean differences of −5.3 (95% CI, −8.2 to −2.4) for cognitive development, −11.4 (95% CI, −15.3 to −7.5) for language development, and −7.3 (95% CI, −10.6 to −3.9) for motor development. The odds of developmental delay were higher in the MLPT group compared with controls, with adjusted odds ratios of 1.8 (95% CI, 1.1-3.0) for cognitive delay, 3.1 (95% CI, 1.8-5.2) for language delay, and 2.4 (95% CI, 1.3-4.5) for motor delay. Overall social-emotional competence was worse in MLPT children compared with controls (t statistic mean difference, −3.6 (95% CI, −5.8 to −1.4), but other behavioral domains were similar. The odds of being at risk for social-emotional competence were 3.9 (95% CI, 1.4-10.9) for MLPT children compared with controls. CONCLUSIONS AND RELEVANCE: Moderate and late preterm children exhibited developmental delay compared with their term-born peers, most marked in the language domain. This knowledge of developmental needs in MLPT infants will assist in targeting surveillance and intervention.
There are increasing numbers of surviving children who were born extremely preterm (EP; gestational age <28 weeks) or extremely low birth weight (ELBW; birth weight <1000 g). Our objective in this ...study was to compare the rates of motor impairment at 8 years of age between 3 cohorts of EP and/or ELBW and term-born children to establish if motor impairment rates are changing over time.
All children born EP and/or ELBW in the calendar years of 1991-1992, 1997, and 2005 in Victoria, Australia, were recruited at birth. Randomly selected normal birth weight (>2499 g) and term-born controls were matched for expected date of birth, sex, and sociodemographic status. At 8 years' corrected age, motor impairment was defined as cerebral palsy (CP) or a score less than the fifth centile on the Movement Assessment Battery for Children for the 1991-1992 and 1997 cohorts and less than or equal to the fifth centile on the Movement Assessment Battery for Children-Second Edition for the 2005 cohort.
Motor impairment was more likely in children born EP and/or ELBW compared with children born at term for all epochs. There was a significant increase in motor impairment in EP and/or ELBW children over the 3 eras, from 23% in 1991-1992 and 26% in 1997 to 37% in 2005 (χ
= 10.2;
= .001). This was due to an increase in non-CP motor impairment (13% in 1991 to 1992; 15% in 1997; 26% in 2005; χ
= 12.5;
< .001), not CP (11% in 1991 to 1992; 11% in 1997; 12% in 2005).
The rate of motor impairment in EP and/or ELBW children assessed at 8 years of age increased between eras, an increase caused by non-CP motor impairment.
This study aimed to assess the sensitivity and specificity of the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III), Cognitive and Language scales at 24 months for ...predicting cognitive impairments in preterm children at 4 years.
Children born <30 weeks' gestation completed the Bayley-III at 24 months and the Differential Ability Scale, Second Edition (DAS-II), at 4 years to assess cognitive functioning. Test norms and local term-born reference data were used to classify delay on the Bayley-III Cognitive and Language scales. Impairment on the DAS-II Global Conceptual Ability, Verbal, and Nonverbal Reasoning indices was classified relative to test norms. Scores < -1 SD relative to the mean were classified as mild/moderate delay or impairment, and scores < -2 SDs were classified as moderate delay or impairment.
A total of 105 children completed the Bayley-III and DAS-II. The sensitivity of mild/moderate cognitive delay on the Bayley-III for predicting impairment on DAS-II indices ranged from 29.4% to 38.5% and specificity ranged from 92.3% to 95.5%. The sensitivity of mild/moderate language delay on the Bayley-III for predicting impairment on DAS-II indices ranged from 40% to 46.7% and specificity ranged from 81.1% to 85.7%. The use of local reference data at 24 months to classify delay increased sensitivity but reduced specificity. Receiver operating curve analysis identified optimum cut-point scores for the Bayley-III that were more consistent with using local reference data than Bayley-III normative data.
In our cohort of very preterm children, delay on the Bayley-III Cognitive and Language scales was not strongly predictive of future impairments. More children destined for later cognitive impairment were identified by using cut-points based on local reference data than Bayley-III norms.
IMPORTANCE: Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but ...now can be made before 6 months’ corrected age. OBJECTIVES: To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy–specific early intervention that should follow early diagnosis to optimize neuroplasticity and function. EVIDENCE REVIEW: This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. FINDINGS: Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months’ corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months’ corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence. CONCLUSIONS AND RELEVANCE: Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
This systematic review evaluates assessments used to discriminate, predict, or evaluate the motor development of preterm infants during the first year of life. Eighteen assessments were identified; ...nine met the inclusion criteria. The Alberta Infant Motor Scale (AIMS), Bayley Scale of Infant and Toddler Development ‐ Version III, Peabody Developmental Motor Scales ‐ Version 2, Test of Infant Motor Performance (TIMP), and Toddler and Infant Motor Examination have good discriminative validity when examined in large populations. The AIMS, Prechtl's Assessment of General Movements (GMs), Neuro Sensory Motor Development Assessment (NSMDA), and TIMP were designed for preterm infants and are able to detect more subtle changes in movement quality. The best predictive assessment tools are age dependent: GMs, the Movement Assessment of Infants, and TIMP are strongest in early infancy (age 4mo or less) and the AIMS and NSMDA are better at older ages (8‐12mo). The TIMP is the only tool that has demonstrated a difference between groups in response to intervention in two randomized controlled trials. The AIMS, TIMP, and GMs demonstrated the highest levels of overall reliability (interrater and intrarater intraclass correlation coefficient or κ>0.85). Selection of motor assessment tools during the first year of life for infants born preterm will depend on the intended purpose of their use for discrimination, prediction, and/or evaluation.
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