Motor and Postural Patterns Concomitant with General Movements Are Associated with Cerebral Palsy at Term and Fidgety Age in Preterm Infants
Abstract
:1. Introduction
- (a)
- Which type of GM trajectories were associated with cerebral palsy in preterm infants?
- (b)
- Which concomitant motor and postural patterns, with or without GMs, were associated with cerebral palsy at three key ages (preterm, term, and fidgety age)?
- (c)
- Which concomitant motor and postural patterns were longitudinally considered to increase the association of GMs to cerebral palsy?
2. Methods
2.1. Study Design
2.2. Video Recordings
2.3. Evaluation of Spontaneous Motor Repertoire
2.4. Statistical Methods
- Normal trajectory, when normal GMs were present at both preterm and term age (N-N);
- Transient poor repertoire trajectory, when poor repertoire GMs were present at either preterm or term age (PR-N or N-PR);
- Persistent poor repertoire trajectory, when poor repertoire was present at both preterm and term age (PR-PR);
- Transient cramped-synchronized trajectory, when cramped-synchronized was present at either preterm or term age (CS-PR or PR-CS);
- Persistent cramped-synchronized trajectory, when cramped-synchronized was present at both preterm and term age (CS-CS).
- N-N, F+
- PR-N, F+ or N-PR, F+
- PR-N, F− or N-PR, F−
- PR-PR, F+
- PR-PR, F−
- CS-PR, F+ or PR-CS, F+
- CS-PR, F− or PR-CS, F−
- CS-CS, F−
3. Results
3.1. GM Trajectories Associated with Cerebral Palsy in Preterm Infants
3.2. Concomitant Motor and Postural Patterns Associated with Cerebral Palsy Regardless of GMs in Preterm Infants
- (a)
- At preterm age, only two patterns were associated with cerebral palsy: open hand posture and absence of signs pointing to loss of balance.
- (b)
- At term age, the following seven patterns were associated with cerebral palsy: tremors, movements towards midline in upper limbs (few or absent), movements towards midline in lower limbs (absent), open hand posture, monotonous/stereotyped limbs movements, head posture on a side, and pathological head movements.
- (c)
- At fidgety age, all concomitant motor and postural patterns were associated with cerebral palsy.
3.3. Concomitant Motor and Postural Patterns That, along with GMs, were Associated with Cerebral Palsy at the Three Key Ages
3.4. Concomitant Motor and Postural Pattern Trajectories Associated with Cerebral Palsy
4. Discussion
Limitations
5. Conclusions
Author Contributions
Conflicts of Interest
Appendix A
Age | Model | −2 Log-Likelihood | ΔLL | Degrees of Freedom | Δdf | p |
---|---|---|---|---|---|---|
Preterm age | GMs | 82.577 | - | 2 | - | <0.001 |
GMs + LB | 76.245 | 6.332 | 3 | 1 | 0.012 | |
GMs + T | 82.102 | 0.474 | 3 | 1 | 0.491 | |
GMs + MTM-UL | 79.827 | 2.749 | 3 | 1 | 0.097 | |
GMs + MTM-LL | 82.216 | 0.361 | 3 | 1 | 0.548 | |
GMs + OHP | 74.523 | 8.054 | 3 | 1 | 0.005 | |
GMs + FS | 79.720 | 2.857 | 3 | 1 | 0.091 | |
GMs + MSLM | 80.562 | 2.015 | 3 | 1 | 0.156 | |
GMs + ATN | 81.437 | 1.140 | 3 | 1 | 0.286 | |
GMs + HPS | 80.216 | 2.361 | 3 | 1 | 0.124 | |
GMs + PHM | 82.556 | 0.021 | 3 | 1 | 0.885 | |
GMs + ASY | 82.556 | 0.021 | 3 | 1 | 0.885 | |
Term age | GMs | 78.878 | - | 2 | - | <0.001 |
GMs + LB | 76.318 | 2.005 | 3 | 1 | 0.157 | |
GMs + T | 73.680 | 4.642 | 3 | 1 | 0.031 | |
GMs + MTM-UL | 73.027 | 5.295 | 4 | 1 | 0.071 | |
GMs + MTM-LL | 73.681 | 4.642 | 4 | 1 | 0.098 | |
GMs + OHP | 66.528 | 11.794 | 3 | 1 | 0.001 | |
GMs + FS | 76.732 | 1.590 | 3 | 1 | 0.207 | |
GMs + MSLM | 63.337 | 14.985 | 3 | 1 | <0.001 | |
GMs + ATN | 75.938 | 2.384 | 3 | 1 | 0.123 | |
GMs + HPS | 77.795 | 0.527 | 3 | 1 | 0.468 | |
GMs + PHM | 76.668 | 1.654 | 3 | 1 | 0.198 | |
GMs + ASY | 77.956 | 0.366 | 3 | 1 | 0.545 | |
Fidgety age | GMs | 59.968 | - | 1 | - | <0.001 |
GMs + LB | 49.048 | 10.920 | 2 | 1 | 0.001 | |
GMs + T | 55.225 | 4.743 | 2 | 1 | 0.029 | |
GMs + MTM-UL | 52.257 | 7.712 | 4 | 1 | 0.052 | |
GMs + MTM-LL | 45.225 | 14.743 | 4 | 1 | 0.002 | |
GMs + OHP | 58.950 | 1.018 | 2 | 1 | 0.313 | |
GMs + FS | 53.952 | 6.016 | 2 | 1 | 0.014 | |
GMs + MSLM | 34.729 | 25.239 | 2 | 1 | <0.001 | |
GMs + ATN | 51.601 | 8.367 | 2 | 1 | 0.004 | |
GMs + HPS | 58.945 | 1.024 | 2 | 1 | 0.312 | |
GMs + PHM | 57.004 | 2.964 | 2 | 1 | 0.085 | |
GMs + ASY | 53.578 | 6.390 | 2 | 1 | 0.011 |
Age | Model | −2 Log-Likelihood | ΔLL | Degrees of Freedom | Δdf | p |
---|---|---|---|---|---|---|
Preterm age | GMs | 82.577 | - | 1 | - | <0.001 |
GMs + OHP | 74.523 | 8.054 | 2 | 1 | 0.005 | |
GMs + LB + OHP | 68.626 | 5.897 | 3 | 1 | 0.015 | |
Term age | GMs | 81.066 | - | 1 | - | <0.001 |
GMs + MSLM | 66.049 | 15.017 | 2 | 1 | <0.001 | |
GMs + MSLM + OHP | 54.566 | 11.483 | 3 | 1 | 0.001 | |
Fidgety age | GMs | 48.715 | - | 1 | - | <0.001 |
GMs + MSLM | 34.729 | 13.986 | 2 | 1 | <0.001 |
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Patterns | Definition | Score |
---|---|---|
Signs pointing to loss of balance | Presence of at least one minor and one major sign. Major signs are sudden abduction-extension of the four limbs, burst of tremors, abrupt rolling to the side, abrupt limb movements and/or head rotation at lifting of hips, burst of fast movements at three or four limbs lifting, side-to-side oscillation of lower limbs. Minor signs are finger spreading, abrupt abduction-extension of arms. | 0. Absent 1. Present |
Tremors | Involuntary, rhythmical oscillatory movement of equal amplitude around a fixed axis. | 0. Absent 1. Some 2. Many |
Movements towards midline in upper limbs | Antigravity movements in which a part of upper limbs moves towards or exceeds the midline (ideally considered as a line from the vertex to the lower extremities in supine position) resulting in contacts between two body parts. We distinguished simple contacts (many or some) from manipulation. | 0. Manipulation 1. Many contacts 2. Some contacts 3. Absent |
Movements towards midline in lower limbs | Antigravity movements in which a part of lower limbs moves towards or exceeds the midline (ideally considered as a line from the vertex to the lower extremities in supine position) resulting in contacts between two body parts. We distinguished simple contacts (many or some) from manipulation. | 0. Manipulation 1. Many contacts 2. Some contacts 3. Absent |
Open hand posture | Open hand posture mainly maintained throughout the observation. | 0. Absent 1. Present |
Finger spreading | Abrupt unilateral or bilateral full or partial extension of fingers. | 0. Absent 1. Present |
Monotonous/stereotyped limbs movements | Repetition of the same limbs’ movements over time. Examples are:
| 0. Absent 1. Present |
Asymmetric tonic neck posture | Face turned to one side with extended arm and leg on the same side and flexed arm and leg on the opposite side. | 0. Absent 1. Occasional 2. Frequent/dominant |
Head posture on a side | Head posture mainly maintained throughout most of the observation. | 0. Absent 1. Present |
Pathological head movements | Repetitive side-to-side head movements, and/or neck hyperextension. | 0. Absent 1. Present |
Asymmetries | Lack of equality in posture or movements between the two body sides. | 0. Absent 1. Present |
Patterns | Trajectory | Description |
---|---|---|
Signs pointing to loss of balance | Low risk | Signs pointing to loss of balance disappearing before fidgety age |
High risk | Patterns pointing to loss of balance still present at fidgety age | |
Tremors | Low risk | Tremors disappearing before fidgety age |
High risk | Tremors still present at fidgety age | |
Movements towards midline in upper limbs | Low risk | Manipulation appears at fidgety age. When there is no manipulation at fidgety age, many contacts on the midline must be present starting from term age |
High risk | Occasional movements towards midline at term age and no manipulation at fidgety age | |
Movements towards midline in lower limbs | Low risk | Manipulation appearing at fidgety age. When there is no manipulation at fidgety age, many contacts on the midline must be present starting from term age |
High risk | Occasional movement towards midline at term age and no manipulation at fidgety age | |
Open hand posture | Low risk | Open hand posture disappearing before term age |
High risk | Open hand posture still present at term and/or fidgety age | |
Finger spreading | Low risk | Finger spreading disappearing before fidgety age |
High risk | Finger spreading still present at fidgety age | |
Monotonous/stereotyped limbs movements | Low risk | Monotonous or stereotyped limbs movements disappearing before term age |
High risk | Monotonous or stereotyped limbs movements still present at term and/or fidgety age | |
Asymmetric tonic neck (ATN) posture | Low risk | ATN posture disappearing or becoming occasional at fidgety age |
High risk | ATN posture frequent or dominant at fidgety age | |
Head posture on a side | Low risk | Head-on-midline posture predominant at fidgety age |
High risk | Head posture on a side predominant at fidgety age | |
Pathological head movements | Low risk | Normal head movements present from term age |
High risk | Side-to-side head movements or neck hyperextension present at term and/or fidgety age | |
Asymmetries | Low risk | Asymmetric postures and movements disappearing before fidgety age |
High risk | Asymmetric postures and movements present at fidgety age |
Clinical Characteristics | Cases N = 37 | Controls N = 42 | p | |
---|---|---|---|---|
Infant Characteristics at Birth | ||||
Male/female ratio | 16:21 | 14:28 | 0.368 | |
Birth gestational age in weeks (mean ± SD 1) | 28.4 ± 3 | 28.7 ± 2 | 0.395 | |
Birth weight (mean ± SD) | 1148 ± 499 | 1065 ± 240 | 0.694 | |
Birth head circumference (mean ± SD) | 26 ± 3 | 26 ± 2 | 0.579 | |
Birth weight for gestational age | Number of SGA2infants (%) | 2 (5.4%) | 10 (23.8%) | 0.080 |
Number of AGA3infants (%) | 29 (78.4%) | 26 (61.9%) | ||
Number of LGA4infants (%) | 6 (16.2%) | 6 (14.3%) | ||
Apgar score | Number of infants with 1-min Apgar score < 7 (%) | 27 (73.0%) | 19 (45.2%) | 0.005 |
Number of infants with 5-min Apgar score < 7 (%) | 12 (32.4%) | 8 (19.0%) | 0.122 | |
US cerebral lesions | ||||
Number of IVH 5 1 (%) | 2 (5.4%) | 1 (2.4%) | <0.001 | |
Number of IVH 2 (%) | 10 (27.0%) | 1 (2.4%) | ||
Number of IVH 3 (%) | 8 (21.6%) | 0 (0.0%) | ||
Number of IVH 4 (%) | 4 (10.8%) | 0 (0.0%) | ||
Number of PVL 6 1 (%) | 8 (21.6%) | 12 (28.6%) | 0.001 | |
Number of PVL 2 (%) | 4 (10.8%) | 5 (11.9%) | ||
Number of PVL 3 (%) | 8 (21.6%) | 0 (0.0%) | ||
Number of PVL 4 (%) | 4 (10.8%) | 0 (0.0%) |
Trajectories | Group | OR | 95% CI | p | |||
---|---|---|---|---|---|---|---|
Control N = 42 | Case N = 42 | ||||||
n | % | n | % | ||||
Normal GMs and F+ | 6 | 14.3 | 0 | 0 | Ref. | - | - |
Transient PR and F+ | 14 | 33.3 | 0 | 0 | 2.23 | 0.04–125.22 | 0.6962 |
Persistent PR and F+ | 16 | 38.1 | 5 | 13.5 | 4.33 | 0.21–90.05 | 0.3435 |
Transient CS and F+ | 1 | 2.4 | 0 | 0 | 4.33 | 0.03–560.31 | 0.5545 |
Persistent PR and F− | 5 | 11.9 | 16 | 43.2 | 39.00 | 0.67–2257.11 | 0.0768 |
Transient CS and F− | 0 | 0 | 7 | 18.9 | 195.00 | 3.37–11,285.55 | 0.0109 |
Persistent CS and F− | 0 | 0 | 7 | 18.9 | 195.00 | 10.65–3569.68 | 0.0004 |
Trajectories | Group | OR | 95% CI | p | |||
---|---|---|---|---|---|---|---|
Control | Case | ||||||
n/N | % | n/N | % | ||||
Low risk | 37 | 88.1 | 5 | 13.5 | - | - | - |
High risk | 5 | 11.9 | 30 | 81.1 | 44.40 | 11.74–167.85 | <0.001 |
Patterns | Odds Ratio (95% CI) | |||
---|---|---|---|---|
Preterm Age | Term Age | Fidgety Age | ||
LB | 0.23 (0.09–0.62) | 0.59 (0.23–1.48) | 20.90 (1.15–379.98) * | |
T | 0.80 (0.25–2.55) | 5.19 (1.87–14.43) | 46.84 (2.67–822.91) * | |
MTM-UL | Many | - | - | 13.89 (2.90–66.62) |
Some | - | 5.20 (1.66–16.26) | 16.67 (3.84–72.33) | |
Absent | 2.56 (0.77–8.53) | 12.00 (1.84–78.37) | 22.22 (3.72–132.75) | |
MTM-LL | Many | - | - | 14.88 (1.75–126.50) |
Some | - | 2.22 (0.52–9.54) | 27.20 (2.71–272.83) | |
Absent | 1.04 (0.42–2.55) | 6.06 (1.37–26.76) | 59.50 (5.95–595.04) | |
OHP | 3.83 (1.49–9.89) | 7.81 (2.51–24.30) | 9.57 (1.12–81.93) | |
FS | 0.34 (0.10–1.11) | 0.49 (0.15–1.66) | 17.54 (0.95–322.99) | |
MSLM | 3.25 (0.77–13.68) | 12.50 (4.14–37.74) | 175.71 (20.52–1504.80) | |
ATN | 1.85 (0.53–6.45) | 2.44 (0.93–6.39) | 10.85 (3.47–33.98) | |
HPS | 1.88 (0.57–6.12) | 2.67 (1.07–6.64) | 6.43 (1.29–32.05) | |
PHM | 5.29 (0.56–49.71) | 15.19 (1.84–125.53) | 5.50 (1.40–21.64) | |
ASY | 2.49 (0.22–28.62) | 1.14 (0.07–18.87) | 7.04 (1.82–27.28) |
Age | Pattern | OR | 95% CI | |
Preterm age | GMs | Normal | reference | reference |
PR | 15.60 | 0.87–280.15 | ||
CS | 323.00 | 5.75–18131.35 | ||
LB | Absent | reference | reference | |
Present | 0.23 | 0.09–0.62 | ||
OHP | Absent | reference | reference | |
Present | 3.83 | 1.49–9.89 | ||
Term age | GMs | Normal | reference | reference |
PR | 33.00 | 1.87–581.28 | ||
CS | 178.20 | 7.87–4037.41 | ||
MSLM | Absent | reference | reference | |
Present | 12.50 | 4.14–37.74 | ||
OHP | Absent | reference | reference | |
Present | 7.81 | 2.51–24.30 | ||
Fidgety age | GMs | F + | reference | reference |
F − | 47.36 | 12.57–178.51 | ||
MSLM | Absent | reference | reference | |
Present | 175.71 | 20.52–1504.80 |
Sensitivity % (95% CI) | Specificity % (95% CI) | |
---|---|---|
GMs trajectories | 85.7 (69.7–95.2) | 85.7 (71.5–94.6) |
GMs trajectories + LB trajectories | 91.4 (76.9–98.2) | 100 (91.6–100 *) |
GMs trajectories + T trajectories | 94.3 (80.8–99.3) | 100 (91.6–100*) |
GMs trajectories + MTM–UL trajectories | 100 (90.0–100 *) | 92.9 (80.5–98.5) |
GMs trajectories + MTM–LL trajectories | 97.1 (85.1–99.9) | 100 (91.6–100 *) |
GMs trajectories + OHP trajectories | 97.1 (85.1–99.9) | 95.2 (83.8–99.4) |
GMs trajectories + FS trajectories | 88.6 (73.3–96.8) | 100 (91.6–100 *) |
GMs trajectories + MSLM trajectories | 94.3 (80.8–99.3) | 97.6 (87.4–99.9) |
GMs trajectories + ATN trajectories | 91.4 (76.9–98.2) | 100 (91.6–100 *) |
GMs trajectories + HPS trajectories | 85.7 (69.7–95.2) | 100 (91.6–100 *) |
GMs trajectories + PHM trajectories | 91.4 (76.9–98.2) | 97.6 (87.4–99.9) |
GMs trajectories + ASY trajectories | 91.4 (76.9–98.2) | 100 (91.6–100 *) |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
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Ferrari, F.; Plessi, C.; Lucaccioni, L.; Bertoncelli, N.; Bedetti, L.; Ori, L.; Berardi, A.; Della Casa, E.; Iughetti, L.; D’Amico, R. Motor and Postural Patterns Concomitant with General Movements Are Associated with Cerebral Palsy at Term and Fidgety Age in Preterm Infants. J. Clin. Med. 2019, 8, 1189. https://doi.org/10.3390/jcm8081189
Ferrari F, Plessi C, Lucaccioni L, Bertoncelli N, Bedetti L, Ori L, Berardi A, Della Casa E, Iughetti L, D’Amico R. Motor and Postural Patterns Concomitant with General Movements Are Associated with Cerebral Palsy at Term and Fidgety Age in Preterm Infants. Journal of Clinical Medicine. 2019; 8(8):1189. https://doi.org/10.3390/jcm8081189
Chicago/Turabian StyleFerrari, Fabrizio, Carlotta Plessi, Laura Lucaccioni, Natascia Bertoncelli, Luca Bedetti, Luca Ori, Alberto Berardi, Elisa Della Casa, Lorenzo Iughetti, and Roberto D’Amico. 2019. "Motor and Postural Patterns Concomitant with General Movements Are Associated with Cerebral Palsy at Term and Fidgety Age in Preterm Infants" Journal of Clinical Medicine 8, no. 8: 1189. https://doi.org/10.3390/jcm8081189