To date there has been no clear evidence on the predictive accuracy of GMA in low-risk infants . Child rearing practices have been reported to have a role to play in infant development . Therefore, validity measures reported from other cultures may not be entirely replicable to Indian populations. Evidence from India on GMA is emerging but there are only limited studies on predictive validity . Predictive validity of GMA in the Indian context is essential for advancing early detection and intervention strategies for CP to improve outcomes for infants at risk and mitigate the long-term impact of CP on individuals, families, and society.
One forty-one children including high and low risk for CP were enrolled in this observational study. A robust video recording guideline was created to guarantee uniformity in the assessment of GMA of all infants. After this the intra- rater reliability of the primary rater and inter-rater reliability of GMA was established between the primary rater and senior expert were established. Predictive validity of GMA was assessed by assessing the children at all ages using GMA. The results included likelihood ratios, sensitivity, specificity, negative value, and positive predictive value.
Recording standards were determined at optimum levels including camera placement and environmental characteristics. The intra-rater reliability indicated excellent reliability that was intra class corelation coefficient (ICC) was 0.91 and inter-rater agreement showed good reliability between the raters that was Cohen’s kappa(k) value showed 0.72 for fidgety age. Hundred thirteen infants had follow-up data until at least 12 months. CP was confirmed in 7 (6%) children at mean age 12 months of age. Sensitivity, specificity, positive and negative likelihood ratio values for CP in fidgety age (49-60 weeks CGA) for entire low and high-risk cohorts were 81.2%, 98.4%, 41.73, 0.19% respectively. Predictive value of GMA for low-risk cohort could not be determined as no child had an adverse neurodevelopmental outcome.
GMA had excellent intra and inter-rater agreement for both high and low risk infants. In infants with a broad range of neonatal risk factors, accuracy of early CP prediction using GMA was high. Excessive tremulous and jerky movement and cramped synchronized movement throughout the writhing age (40-46 weeks CGA) was significantly predictive of CP.
Use of GMA in routine care will assist in early detection of CP which will in turn facilitate early intervention to improve neurodevelopmental outcomes.
neuro developmental disorders
early screening
