Panvequio Aizawa CY1, Einspieler C2, Françoso Genovesi F1, Ibidi SM3, Hydee Hasue R1
1University of Sao Paulo, Department of Physical Therapy, Communication Sciences and Disorders, and Occupational Therapy, São Paulo, Brazil, 2Medical University of Graz, iDN- Interdisciplinary Developmental Neuroscience, Department of Phoniatrics, Graz, Austria, 3University of Sao Paulo, University Hospital, São Paulo, Brazil
Background: The General Movement Assessment (GMA) has a high predictive power for the neurodevelopmental outcome in preterm and term infants with risk factors and consists on an important tool for early detection of neurological deficits in infants up to 5 months. Despite of its importance, the method is not always available, especially not in low- and middle-income countries and, even in countries as Brazil that has recently pressed ahead with GMA, the certification alone does not guarantee the high reliability found in experts.
Purpose: To develop a checklist describing features of normal and abnormal general movements (GMs) in order to guide General Movement Assessment (GMA) novices through the assessment procedure; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score.
Methods: Three examinors used GMA and the newly developed GMA checklist to assess 20 videos of 16 infants (seven males) recorded at 31 to 45 weeks postmenstrual age (writhing GMs). Inter- and intra-scorer agreement was determined for GMA (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation - ICC - values). The scorers' satisfaction with the usefulness of the checklist was assessed by means of a questionnaire (score 10 for maximum satisfaction).
Results: The scorers' satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal GMs was significantly higher than that of the eleven videos showing abnormal GMs (26 vs. 11, p 0.001). The checklist score also differentiated between poor-repertoire (median=13) and cramped-synchronized GMs (median=7; p=0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal GMs was good to excellent (Kappa=0.68-1.00); on (ii) the distinction between the four GM categories was considerable to excellent (Kappa=0.56-0.93); and on (iii) the checklist was good to excellent (ICC=0.77-0.96).
Conclusion(s): The GM checklist proved to be an important tool for the evaluation of normal and abnormal GMs and clearly facilitates assessments for novices; scorers found it easy to differentiate between normal and abnormal GMs and between subcategories of abnormal GMs.
Implications: The GMA checklist can facilitate decision-making on highly predictive GMA, may potentially document individual trajectories and the effect of therapeutic intervention. Its score also allow more robust statistical analysis on future researches.
Keywords: Child development, neurologic examination, general movement assessment
Funding acknowledgements: This study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP 2013/21041-7.
Purpose: To develop a checklist describing features of normal and abnormal general movements (GMs) in order to guide General Movement Assessment (GMA) novices through the assessment procedure; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score.
Methods: Three examinors used GMA and the newly developed GMA checklist to assess 20 videos of 16 infants (seven males) recorded at 31 to 45 weeks postmenstrual age (writhing GMs). Inter- and intra-scorer agreement was determined for GMA (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation - ICC - values). The scorers' satisfaction with the usefulness of the checklist was assessed by means of a questionnaire (score 10 for maximum satisfaction).
Results: The scorers' satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal GMs was significantly higher than that of the eleven videos showing abnormal GMs (26 vs. 11, p 0.001). The checklist score also differentiated between poor-repertoire (median=13) and cramped-synchronized GMs (median=7; p=0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal GMs was good to excellent (Kappa=0.68-1.00); on (ii) the distinction between the four GM categories was considerable to excellent (Kappa=0.56-0.93); and on (iii) the checklist was good to excellent (ICC=0.77-0.96).
Conclusion(s): The GM checklist proved to be an important tool for the evaluation of normal and abnormal GMs and clearly facilitates assessments for novices; scorers found it easy to differentiate between normal and abnormal GMs and between subcategories of abnormal GMs.
Implications: The GMA checklist can facilitate decision-making on highly predictive GMA, may potentially document individual trajectories and the effect of therapeutic intervention. Its score also allow more robust statistical analysis on future researches.
Keywords: Child development, neurologic examination, general movement assessment
Funding acknowledgements: This study was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo - FAPESP 2013/21041-7.
Topic: Paediatrics; Neurology
Ethics approval required: Yes
Institution: Faculdade de Medicina da Universidade de São Paulo
Ethics committee: Faculdade de Medicina da Universidade de São Paulo
Ethics number: Protocol CAPPESQ 091/14 and 283/15
All authors, affiliations and abstracts have been published as submitted.
