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Prechtl’s General Movements Assessment at writhing age guides MRI use in clinical implementation network

Pediatric Research volume 95, pages 1188–1190 (2024)Cite this article

Prechtl’s General Movement Assessment (GMA) has been used for decades as a rapid and feasible bedside evaluation of neuromotor patterns.1 Abnormal GMA patterns at 36–44 weeks corrected gestational age (writhing period) are associated with neuroimaging abnormalities and later poor neuromotor, cognitive and behavioral outcomes.2,3 Cramped synchronized (CS) GMA patterns in particular are associated with spastic types of cerebral palsy.4 The GMA has expanded to more clinical settings worldwide and as it more commonly becomes standard care, may serve other purposes than a qualitative evaluation of movement: integration into neonatal intensive care work flows could transform the GMA into a clinical decision tool on par with any point-of-care test.

Currently, the American Academy of Pediatrics (AAP) recommends the use of cranial ultrasound (CUS) to evaluate abnormal findings associated with neuromotor disorders such as CP in high-risk infants.5 CUS has excellent specificity in detection of abnormalities associated with neuromotor disorders and is more routinely feasible than MRI. However, MRI is often more sensitive than CUS, particularly in detecting white matter injury, ischemia, and subtle developmental or structural abnormalities. Although numerous studies have examined the potential role of term-equivalent MRI in prognostication for high-risk infants, current recommendations for its routine use exist only for those with neonatal encephalopathy.6,7 Potential costs of universal MRI use and occasional equivocal findings have been cited as barriers to routine use.8

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Fig. 1: Flowchart describing the neuroimaging modality performed and the severity of findings in a cohort of 144 infants with cramped synchronized (CS) patterns on General Movements Assessment (GMA) in the neonatal intensive care unit.

Data availability

Depersonalized data will be available on request as permitted by respective IRBs.

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Funding

This research was supported by a grant from the Cerebral Palsy Foundation for Implementation of Early Diagnosis and Intervention for Cerebral Palsy to B.O. and N.M.

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Authors and Affiliations

  1. Department of Pediatrics, University of Utah Hospital and Primary Children’s Hospital, Salt Lake City, UT, USA

    Allison J. Chirigos & Betsy Ostrander

  2. Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA

    Vera Joanna Burton

  3. Department of Neurology and Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Vera Joanna Burton

  4. Shepherd Center, Atlanta, GA, USA

    Marissa Mirecki

  5. Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Nathalie L. Maitre

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  1. Allison J. Chirigos
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  4. Marissa Mirecki
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  5. Nathalie L. Maitre
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Consortia

in collaboration with the Cerebral Palsy Foundation Early Detection and Intervention Network

  • Betsy Ostrander
  • , Vera Joanna Burton
  •  & Nathalie L. Maitre

Contributions

A.J.C. was involved in the analysis and interpretation of data, wrote the first draft of the manuscript, contributed to revisions, and approved the final manuscript. B.O., N.M. and V.J.B. made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data, revising the article critically for important intellectual content, and gave final approval of the version to be published. M.M. contributed to manuscript revisions and approval of the final manuscript.

Corresponding author

Correspondence to Betsy Ostrander.

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Competing interests

This data was also presented at Early Diagnosis of Cerebral Palsy E-Health Summit (August 2021) and the AAN Annual Meeting (April 2023). There are no potential conflicts of interest.

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Chirigos, A.J., Ostrander, B., Burton, V.J. et al. Prechtl’s General Movements Assessment at writhing age guides MRI use in clinical implementation network. Pediatr Res 95, 1188–1190 (2024). https://doi.org/10.1038/s41390-023-02856-z

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