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Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria
University of Groningen, University Medical Center Groningen, Beatrix Children’s Hospital, Division of Neonatology, 9713 GZ Groningen, The Netherlands
National Rehabilitation Institute, Cerebral Palsy Department, 14389 Mexico City, Mexico
University of Illinois at Chicago, UI Health, Department of Occupational and Physical Therapy, Chicago, IL 60612, USA
University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy
Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Health and Rehabilitation Sciences, Cape Town 8000, South Africa
IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy
Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
University Hospital Essen, Department of Pediatrics I, 45122 Essen, Germany
Daegu Health College, Department of Physical Therapy, 41453 Daegu, Korea
Oita University Faculty of Medicine, Department of Pediatrics, 879-5593 Oita, Japan
Institute of Life Sciences, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
Children’s Rehabilitation Institute Teleton, 72825 Puebla, Mexico
The University of Sydney Medical School, Children’s Hospital at Westmead Clinical School, The Discipline of Child and Adolescent Health, Sydney 2050, NSW, Australia
The University of Sydney, Cerebral Palsy Alliance Research Institute, Sydney 2050, NSW, Australia
Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, 06100 Ankara, Turkey
Municipal Hospital of Ostrava, Children ’s Department, 72880 Ostrava, Czech Republic
Masaryk University, Faculty of Medicine, 62500 Brno, Czech Republic
Medical University of Graz, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, 8036 Graz, Austria
Northwestern University, Department of Physical Therapy and Human Movement Science, Chicago, IL 60611, USA
Cerebral Palsy Association Eastern Cape, Port Elizabeth 6001, South Africa
University of New England/Maine LEND Program, Portland, ME 04103, USA
Post Graduate Institute of Medical Education and Research, Department of Pediatrics, Pediatric Neurology Division, Chandigarh 160012, India
Rede SARAH de Hospitais de Reabilitação, Reabilitação Infantil, 30510-000 Belo Horizonte, Brazil
Lady Davis Carmel Medical Center, NICU Developmental Follow-up Clinic, 34362 Haifa, Israel
University of Melbourne, School of Health Sciences, Department of Physiotherapy, Parkville 3052, Australia
Murdoch Children’s Research Institute, Parkville 3052, Victoria, Australia
Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi 221011, India
Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Cape Town 8000, South Africa
Children’s Hospital of Fudan University, Department of Rehabilitation, Shanghai 201102, China
University Medical Center Göttingen, Child and Adolescent Psychiatry and Psychotherapy, 37075 Göttingen, Germany
Karolinska Institutet, Department of Women’s and Children’s Health, Center of Neurodevelopmental Disorders (KIND), 11330 Stockholm, Sweden
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
These are co-senior authors.
J. Clin. Med. 2019, 8(10), 1616;
Received: 27 August 2019 / Revised: 21 September 2019 / Accepted: 25 September 2019 / Published: 4 October 2019
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. View Full-Text
Keywords: cerebral palsy; dyskinesia; fidgety movements; general movements; GMFCS; hemiplegia; hypotonia; identification; motor optimality score; segmental movements cerebral palsy; dyskinesia; fidgety movements; general movements; GMFCS; hemiplegia; hypotonia; identification; motor optimality score; segmental movements
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MDPI and ACS Style

Einspieler, C.; Bos, A.F.; Krieber-Tomantschger, M.; Alvarado, E.; Barbosa, V.M.; Bertoncelli, N.; Burger, M.; Chorna, O.; Del Secco, S.; DeRegnier, R.-A.; Hüning, B.; Ko, J.; Lucaccioni, L.; Maeda, T.; Marchi, V.; Martín, E.; Morgan, C.; Mutlu, A.; Nogolová, A.; Pansy, J.; Peyton, C.; Pokorny, F.B.; Prinsloo, L.R.; Ricci, E.; Saini, L.; Scheuchenegger, A.; Silva, C.R.D.; Soloveichick, M.; Spittle, A.J.; Toldo, M.; Utsch, F.; van Zyl, J.; Viñals, C.; Wang, J.; Yang, H.; Yardımcı-Lokmanoğlu, B.N.; Cioni, G.; Ferrari, F.; Guzzetta, A.; Marschik, P.B. Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome. J. Clin. Med. 2019, 8, 1616.

AMA Style

Einspieler C, Bos AF, Krieber-Tomantschger M, Alvarado E, Barbosa VM, Bertoncelli N, Burger M, Chorna O, Del Secco S, DeRegnier R-A, Hüning B, Ko J, Lucaccioni L, Maeda T, Marchi V, Martín E, Morgan C, Mutlu A, Nogolová A, Pansy J, Peyton C, Pokorny FB, Prinsloo LR, Ricci E, Saini L, Scheuchenegger A, Silva CRD, Soloveichick M, Spittle AJ, Toldo M, Utsch F, van Zyl J, Viñals C, Wang J, Yang H, Yardımcı-Lokmanoğlu BN, Cioni G, Ferrari F, Guzzetta A, Marschik PB. Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome. Journal of Clinical Medicine. 2019; 8(10):1616.

Chicago/Turabian Style

Einspieler, Christa, Arend F. Bos, Magdalena Krieber-Tomantschger, Elsa Alvarado, Vanessa M. Barbosa, Natascia Bertoncelli, Marlette Burger, Olena Chorna, Sabrina Del Secco, Raye-Ann DeRegnier, Britta Hüning, Jooyeon Ko, Laura Lucaccioni, Tomoki Maeda, Viviana Marchi, Erika Martín, Catherine Morgan, Akmer Mutlu, Alice Nogolová, Jasmin Pansy, Colleen Peyton, Florian B. Pokorny, Lucia R. Prinsloo, Eileen Ricci, Lokesh Saini, Anna Scheuchenegger, Cinthia R.D. Silva, Marina Soloveichick, Alicia J. Spittle, Moreno Toldo, Fabiana Utsch, Jeanetta van Zyl, Carlos Viñals, Jun Wang, Hong Yang, Bilge N. Yardımcı-Lokmanoğlu, Giovanni Cioni, Fabrizio Ferrari, Andrea Guzzetta, and Peter B. Marschik. 2019. "Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome" Journal of Clinical Medicine 8, no. 10: 1616.

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