Reliability,Validity And Application Of Detailed General Movements Assessment During Writhing Movements Stage In High Risk Infant Follow Up

Objective:General movements assesment(GMA)was an early diagnosis technique for childhood developmental disorders established in 1990.GMA is an evaluation method developed in recent years for the neuromotor behavior of high-risk premature infants.Compared with traditional neurological examination methods,GMA has higher sensitivity and specificity,which can help clinicians predict neurodevelopmental outcomes at an early stage.By applying the Prechtl optimality concept,we are able to achieve a semi-quantification of the quality of general movements.For every movement criterion such as amplitude,speed,range in space,onset and offset of general movements,a score is given whereby a higher score expresses a more optimal performance.The higher the total optimality score the better the quality of general movements.With such a detailed,semi-quantitative approach we can document associations between small changes in the quality of general movements and other clinical parameters,e.g.polygraphical findings.Another potential of such a detailed GMA lies in the evaluation of therapeutic interventions.At present,many evaluation methods are traditional neurobehavioral methods,but there are some shortcomings such as low reliability and hysteresis.GMA has been introduced to domestic as one of the effective tools for early prediction of cerebral palsy.There are few domestic studies on the reliability and validity of detailed GMA.Our research provides more theoretical basis for use of detailed GMA,and adds an important means for early screening of neuromotor dysplasia.So we study the inter-rater reliability and test-retest reliability of detailed GMA in writhing movements stage,establish a corresponding basis for its clinical work in high-risk children's development follow-up;To study the predictive validity of detailed GMA for gross motor development outcomes and cerebral palsy in high-risk children in writhing movements stage;To study the consistency of GMA and detailed GMA in writhing movements stage;The detailed GMA in writhing movements stage is a valuable tool for predicting abnormal brain function in infants.Discusses the influencing factors of detailed GMA in infant in writhing movements stage and the effect of early intervention on GMA,guide clinicians,parents to avoid high-risk factors and improve infant neurodevelopmental prognosis.Methods618 videotapes of 618 high-risk children evaluated by GMs were included,ranging from 3 days after birth to corrected gestational age within 4 weeks.The evaluator used "the Detailed Assessment of General Movements During Preterm and Term Age" scale to score and obtain the optimal score for GMs;Intraclass correlation coefficients(ICC)were calculated between the two evaluators and the same evaluator;After the children were followed up to the age of 1 year,the gross motor development outcomes and whether they were cerebral palsy were evaluated according to the clinical manifestations,Peabody Sports Development Scale 2;The sensitivity,specificity,positive predictive value,negative predictive value and Kappa value of GMs and detailed GMA were calculated and compared.639 infants were selected for detailed GMA.According to the GMA results,all subjects were divided into less than 19 groups(n=44),19-35 groups(n=144),and 36-42 groups(n=451).20 variables were collected that may affect infant detailed GMA results,one-way ANOVA,chi-square test and multivariate logistic regression analysis were used to analysis data.Results(1)Inter-evaluator reliability of detailed GMA in the writhing phase:a single measurement and the average measurement of the total ICC score of the inter-evaluator was 0.987 and 0.993,the difference is statistically significant(F=151.959,P=0.000).A single measurement and the mean measurement of the upper limb ICC value was 0.974 and 0.987,the difference was statistically significant(F=75.626,P=0.000).A single measurement and the average measurement of the ICC value of the lower limbs was 0.973 and 0.987,the difference is statistically significant(F=74.283,P=0.000).A single measurement and the average measurement of the ICC values for the neck and motion sequence was 0.912 and 0.954,the difference is statistically significant(F=21.779,P=0.000).As can be seen from Table 5,A single measurement and the average measurement of the ICC value of the evaluator 1 total item was 0.979 and 0.989,the difference was statistically significant(F=92.473,P=0.000).A single measurement and the average measurement of the upper limb ICC value was 0.967 and 0.983,the difference was statistically significant(F=58.939,P=0.000).A single measurement and the average measurement of the ICC value of the lower extremity was 0.965 and 0.982,the difference was statistically significant(F=56.274,P=0.000).A single measurement and the average measurement of the-ICC values for the neck and motion sequence were 0.880 and 0.936,the difference was statistically significant(F = 15.719,P = 0.000).A single measurement and the average measurement of the evaluator 2 total item ICC value was 0.970 and 0.985,the difference was statistically significant(F=66.337,P=0.000).A single measurement and the average measurement of the upper limb ICC value was 0.939 and 0.969,the difference was statistically significant(F=32.004,P=0.000).A single measurement and the average measurement of the ICC value of the lower limbs was 0.919 and 0.958,the difference was statistically significant(F=23.678,P=0.000).A single measurement and the average measurement of the ICC values for the neck and motion was 0.850 and 0.919,the difference was statistically significant(F=12.363?P=0.000).(2)Of the 618 subjects,38 patients(6.15%)had cerebral palsy after follow-up to 1 year of age,52(14.56%)had gross motor development retardation(including 38 cerebral palsy)and 528 patients is normal 528(85.44%);The predictive validity of general movement optimality score(GMOS)<36 for motor developmental abnormalities(cerebral palsy and retardation)is 85.76%,sensitivity is 98.89%,specificity is 83.52%,positive predictive value is 98.89%,negative predictive value is 83.52%and Kappa value = 0.590,P = 0.000.The predictive validity of GMOS<36 for cerebral palsy is 77.67%,sensitivity is 100%,specificity is 76.21%,positive predictive value is 21.59%,negative predictive value is 100%and Kappa value =0.283,P = 0.000;The predictive validity of GMOS<19for cerebral palsy is 98.87%,sensitivity is 97.37%,specificity is 98.97%,positive predictive value is 86.05%,negative predictive value is 99.83%and Kappa Value = 0.908,P = 0.000.(3)GMA:408 cases is normal,167 cases is poor repertoire(PR),43 cases is cramped-synchronised(CS),no chaotic(CH)was collected.Detailed GMA were conducted in 618 high-risk children in writhing movements stage.442 cases were 36-42 points(71.52%),133 cases were 19-35 points(21.52%),43 cases were less than 19 points(6.96%);GMOS of the evaluator 1 differentiated between normal general movements(median 38.46[25-75th centile 35.50-40.80]),poor repertoire general movements(median 25.88[19.40-31.59]),and cramped-synchronized general movements(median 14[8.65-17.41](F=708.05,P=0.000).GMOS of the evaluator 2 differentiated between normal general movements(median 38.90[25-75th centile 36.43-41.21]),poor repertoire general movements(median 25.83[19.10-31.68]),and cramped-synchronized general movements(median 13.57[8.36-16.77](F=852.78,P=0.000).GMOS of the evaluator 1 differentiated between normal general movements(37.77±3.60),poor repertoire general movements(25.91±7.29),and cramped-synchronized general movements(13.0±4.88)(F=708.05,P=0.000).GMOS of the evaluator 2 differentiated between normal general movements(38.47±3.16),poor repertoire general movements(25.78±7.31),and cramped-synchronized general movements(12.86±4.55)(F=852.78,P=0.000).Kappa value of GMOS and GMA consistency test is 0.715;Kappa value of GMOS<19 and CS consistency is 0.975;Kappa value of GMOS 19-42 and N,PR consistency is 0.975;Kappa value of GMOS 19-35 and PR consistency is 0.650;Kappa value of GMOS 36-42 and N consistency is 0.700.(4)6 factors including birth gestational age,birth weight,severe asphyxia,intracranial hemorrhage,amniotic fluid contamination and Apgar score(1 min)were statistically significant by one-way analysis of variance or chi-square test.Then logistic regression analysis was performed.The risk factors of GMOS<19 in writhing movements stage were gestational age(OR=0.687,P=0.000)and birth weight(OR=0.254,P= 0.000),severe asphyxia(OR=108.395,P=0.012),intracranial hemorrhage(OR=0.023,P=0.001).The risk factors of GMOS<36 in writhing movements stage were birth gestational age(OR=0.849,P=0.001),birth weight(OR=0.130,P=0.000),severe asphyxia(OR=9.165,P=0.000),intracranial hemorrhage(OR=0.834,P=0.000).In the early intervention group,the number of normal GMs was significantly higher than that of control group,while the number of PR and CS was significantly less than that of control group.Conclusion(1)Detailed GMA in writhing movements stage has good inter-rater reliability and test-retest reliability,which can be applied to the follow-up of high-risk children.(2)Detailed GMA in writhing movements stage has high predictive validity for motor retardation and cerebral palsy of high-risk infants;GMA and detailed GMA have a good consistency in assessment of central nervous system development.(3)Low delivery gestational age,low birth weight,severe asphyxia and hyperbilirubinemia are high risk factors and predictors for abnormal detailed GMA in infants.Early intervention can reduce PR and CS incidence,increase incidence of normal GMs in premature and HIE..