Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

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Einspieler C., Bos A. F., Krieber-Tomantschger M., Alvarado E., Barbosa V. M., Bertoncelli N., ...More

JOURNAL OF CLINICAL MEDICINE, vol.8, no.10, 2019 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 8 Issue: 10
  • Publication Date: 2019
  • Doi Number: 10.3390/jcm8101616
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Keywords: cerebral palsy, dyskinesia, fidgety movements, general movements, GMFCS, hemiplegia, hypotonia, identification, motor optimality score, segmental movements, LOW-BIRTH-WEIGHT, GENERAL MOVEMENT ASSESSMENT, WHITE-MATTER PATHOLOGY, EARLY MOTOR REPERTOIRE, PRETERM-INFANTS, FULL-TERM, FIDGETY MOVEMENTS, SOCIOECONOMIC-STATUS, BABY-CIMT, CHILDREN
  • Hacettepe University Affiliated: Yes


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.