664 General movement assessment: motor optimality score correlation with later neurodevelopmental outcome

Objectives

General Movement Assessment (GMA), in particular the absence of Fidgety Movements (FM-) at 3–4 months of age (corrected) has improved early identification of infants at high risk of adverse neurodevelopmental outcomes.¹ Motor Optimality Score-revised (MOS-R) is a more in-depth analysis of infants’ motor repertoire at that stage which has been shown may correlate with the level of future motor difficulties in children with emerging adverse neurodevelopmental outcomes.^{2 3} We compared MOS-R with motor outcome in our cohort.

Methods

Infants born preterm or with significant hypoxic ischaemic encephalopathy at our Level 3 Neonatal Unit between 2015–2021 and who had been classified as FM- on GMA video analysis were retrieved from neonatal databases. MOS-R was completed reanalysing their previous GMA videos. MOS-R ranges from 5 to 28 maximum, with a score <21 an indicator of increased risk of adverse neurodevelopment, and >8 rarely associated in children with later significant adverse neurodevelopmental outcome.^{2 3} Motor disability level was measured using the age appropriate Gross Motor Functional Classification System score (GMFCS).

Results

30 infants that had previously been identified as FM- were retrospectively scored for motor optimality using MOS-R. All had a GMFCS score recorded between 2 and 6 years. All 30 children had neurodevelopmental difficulties; 22 (73%) cerebral palsy and 8 (27%) global developmental delay. Of the 30 infants, 14 had MOS-R <8. 12 of the 14 had GMFCS Level of III, IV or V showing significantly reduced mobility. 2 had GMFCS level of II; both of these had significant autistic spectrum difficulties. 16 of the 30 had MOS-R >8. 13 of these had GMFCS Level I or II showing higher mobility level. 3 children were classified GMFCS Level III. Graph 1 demonstrates the correlation between MOS-R and level of later motor difficulties.

Conclusion

GMA and absence of FM is now widely adopted as a means of early identification of infants at high risk of adverse neurodevelopmental outcome. MOS-R assesses motor repertoire at that time which has been shown to correlate predict later motor. Although our cohort is small, it demonstrates a correlation between low MOS-R and future greater motor disability in infants classified as FM- on GMA. As well as advocating GMA for all high risk neonates, we recommend motor optimality scoring to predict the degree of future mobility deficit, therefore enabling more individualised targeted early intervention therapy for high risk infants and families and support for guiding parental expectations.

References

Novak I, et al. Early, accurate diagnosis and early intervention in cerebral palsy:advances in diagnosis and treatment. JAMA Pediatr. 2017;171:897–907. Einspieler C, et al. Cerebral palsy: early markers of clinical phenotype and functional outcome. J. Clin. Med. 2019;8(10):1616. Örtqvist M, et al. Early prediction of neurodevelopmental outcomes at 12 years in children born extremely preterm. Pediatr Res. 2022;91(6):1522–1529.