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Background: Previously it had been had reported that active head lifting from supine (AHLS) in high-risk infants was associated with lower cognitive scores in the second year. AHLS was generally accompanied by stereotyped leg movements., Aims: To examine in a standardized way whether AHLS with or without stereotyped leg movements in the general population is associated with prenatal, perinatal, neonatal and socio-economic risk factors or with lower scores on concurrent infant tests., Study Design: Cross-sectional study SUBJECTS: 1700 infants aged 2-18 months representative of the Dutch population., Outcome Measures: Infant Motor Profile (IMP) and Standardized Infant NeuroDevelopmental Assessment (SINDA). Assessments were video-recorded and included at the youngest ages 3min of behaviour in supine. AHLS and the presence of stereotyped leg movements were recorded. Standardized information on early risk factors was available., Results: AHLS occurred at 4-9 months (prevalence per months: 1-14%; highest prevalence at 6 months). It was not associated with early risk factors or scores on infant tests. When AHLS was accompanied by stereotyped leg movements it was associated with a higher prevalence of an IMP-variation score < P15 (Odds Ratio (OR) 2.472 [95%CI 1.017; 6.006]). Stereotyped leg movements irrespective of AHLS were associated with more unfavourable total IMP scores and IMP performance scores (B coefficients -3.212 [-4.065; -2.360], -2.521 [-3.783; -1.259]) and IMP variation and SINDA neurological scores (ORs 5.432 [3.409; 8.655], 3.098 [1.548; 6.202])., Conclusions: The data suggest that AHLS is not a red flag. Rather its co-occurring stereotyped leg movements may signal less favourable neurodevelopment., (Copyright © 2021. Published by Elsevier B.V.)

Aim: General movements' assessment (GMA), based on Gestalt perception, identifies infants at risk of cerebral palsy. However, the requirement of ample experience to construct the assessor's inner criteria for abnormal movement hampers its widespread clinical use. This study aims to describe details of general movements (GMs) in various body parts and to investigate their association with GMA-Gestalt., Methods: Participants were 24 typically developing infants and 22 very-high-risk infants. GMs were assessed during the writhing (0-8 weeks) and/or fidgety GM phase (2-5 months) by GMA-Gestalt and a semi-quantification of the duration of simple movements and complex movements in various body parts., Results: During both GM phases, the quality of movement often varied within a single assessment, but the degree of complexity and variation of movements in trunk, arms and legs were interrelated (ρ = 0.32-0.84). Longer durations of complex movements in arms and legs (P < .042) were further associated with a better quality in GMA-Gestalt. Head movement was associated with movements in other body parts only in the writhing phase and not associated with GMA-Gestalt during both GM phases., Conclusion: Infants did not show consistently over time and across body parts simple or complex movements. Detailed description of movement characteristics may facilitate the development of computer-based GMA., (© 2020 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Background: Advances in diagnostic technologies, surgical management, and perioperative care have increased survival for neonates with complex congenital heart disease (CCHD). The success of these advances exposed a heightened risk of brain injury and developmental disabilities. The General Movements Assessment, a non-invasive method, may detect early neurodevelopmental impairments in high-risk infants., Aims: To examine whether infants with CCHD undergoing neonatal surgery have higher prevalence of atypical general movements (GMs) than a reference group, and whether single ventricle physiology with systemic oxygen saturations <90% increases risk for atypical GMs., Methods: Serial General Movements Assessment (GMA) in a cohort of infants with CCHD (n = 74) at writhing (term-6 weeks) and fidgety (7-17 weeks) GM-age. GMA focused on the presence of definitely abnormal GM-complexity and absent fidgety movements. Single GMAs at 3 months were available from a reference sample of Dutch infants (n = 300). Regression analyses examined relationships between cardiac characteristics and definitely abnormal GM-complexity., Results: Higher prevalence of definitely abnormal GM-complexity in infants with CCHD compared to reference infants (adjusted OR 5.938, 95% CI 2.423-14.355), single ventricle CCHD increased the risk. Occurrence of absent fidgety movements was similar in infants with CCHD and reference infants (adjusted OR 0.475, 95% CI 0.058-3.876). Systemic postoperative oxygen saturations <90% was associated with higher risk of definitely abnormal GM-complexity at fidgety (adjusted OR 16.445 95% CI 1.149-235.281), not at writhing age., Conclusions: Infants with CCHD, especially those with single ventricle CCHD, are at increased risk of definitely abnormal GM-complexity. GMA at fidgety age is recommended., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The Alberta Infant Motor Scale (AIMS) has been developed in Canada in the 90ies. The AIMS and its Canadian norms are frequently used across the world to monitor infants' gross motor development. Currently, it is disputed whether the Canadian norms are valid for non-Canadian infants., Aims: To compare scores on the AIMS of Dutch infants with that of the Canadian norms, to compare the sequence of motor milestones in Dutch and Canadian infants, and to establish Dutch AIMS norms., Study Design: Cross-sectional study., Subjects: 1697 infants, aged 2-18 months, representative of the Dutch population (gestational age 39.7 weeks (27-42))., Outcome Measure: AIMS assessments, based on standardized video. Perinatal and social information was obtained by questionnaire and medical records. To create Dutch reference values quantile regression with polynomial splines was used., Results: 1236 Dutch infants (73%) scored below the 50th (P50) percentile of the Canadian norms, 653 (38%) below the P10 and 469 (28%) below the P5. In infants aged 6 to 12 months these values were: 567 infants (81%) < P50, 288 infants (41%) < P10, 201 infants (29%) < P5. The sequence of achievement of motor milestones of Dutch and Canadian infants was similar. Dutch norm-reference values of the AIMS were calculated., Conclusions and Implications: Gross motor development of Dutch infants is considerably slower than that of the Canadian AIMS norms sample. To prevent overdiagnosis of developmental delay and overreferral to paediatric physiotherapy Dutch AIMS norms are required. The paper introduces these norms, including percentile ranks., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Aim: To determine the prevalence of atypical general movements (GMs) in the general population, to examine its time trend and associated factors., Methods: Participants consisted of 300 infants born in 2016-2018 (current cohort; gestational age 39.4 weeks (27-42); 162 boys), representative of the Dutch population. GMs were assessed at 2-4 months corrected age in terms of GM-complexity (definitely abnormal (DA) or not) and fidgety movements (present or absent). GM-complexity data from a cohort of 455 Dutch infants born in 2001-2002 were used to investigate the time trend., Results: In the current cohort, 10 infants (3%) showed DA GM-complexity and 8 (3%) absent fidgety movements. Only one infant had both GM-impairments (0.3%). The prevalence of DA GM-complexity did not differ from that in the 2001-2002 cohort (adjusted odds ratio (OR) = 1.47 [0.53, 4.06]). DA GM-complexity was associated with maternal smoking (adjusted OR = 3.59 [1.56, 8.28]) and marginally with prematurity (adjusted OR = 2.78 [1.00, 7.74]); absence of fidgety movements was curvilinearly associated with assessment age only (OR = 1.06 [1.01, 1.12])., Conclusion: In the general population, the prevalence of DA GM-complexity and absent fidgety movements is 3%. The finding that they rarely co-occur and are associated with different factors indicates that GM-assessment needs to address both aspects., (© 2020 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Background: Movement complexity and the presence of fidgety movements (FMs) during general movements (GMs) both reflect aspects of neurological integrity in early infancy., Aim: To assess interrelations between the degree of movement complexity and characteristics of FMs during typical GMs and to investigate associations between mildly impaired GMs and risk factors and neurodevelopmental condition., Study Design: Observational cohort study., Subjects: 283 infants (25 born preterm) at 2-4 months corrected age, representative of the general Dutch population., Outcome Measures: GMs were classified in terms of GM-complexity (normal or mildly abnormal (MA)) and FMs (clearly present, sporadic, or exaggerated). Concurrent neurological, developmental and socio-emotional status were measured with the Standardized Infant NeuroDevelopmental Assessment (SINDA)., Results: Infants with MA GM-complexity had a higher risk of having sporadic FMs and exaggerated FMs. Perinatal complications were not associated with mildly impaired GMs. MA GM-complexity was associated with advanced maternal age (adjusted OR = 2.29 [1.11, 4.76]) and having a non-native Dutch mother (adjusted OR = 2.93 [1.29, 6.64]). It was also associated with atypical neurological (OR = 7.62 [3.51, 16.54]) and developmental scores (OR = 2.38 [1.16, 4.88]). Sporadic and exaggerated FMs were associated with low-to-middle maternal education (adjusted OR = 2.88, [1.45, 5.72]) and having a non-native Dutch father (adjusted OR = 7.16 [1.41, 36.32]), respectively. However, neither sporadic nor exaggerated FMs were associated with the SINDA outcomes., Conclusions: GM-complexity and FMs are two interrelated but different aspects of GMs. Mild impairments in GM-complexity and FMs share a non-optimal socio-economic background as risk factor, but only MA GM-complexity is associated with a concurrent non-optimal neurodevelopmental condition., Competing Interests: Declaration of competing interest None., (Copyright © 2020. Published by Elsevier B.V.)

Children with motor development disorders benefit greatly from early interventions. An early diagnosis in pediatric preventive care (U2-U5) can be improved by automated screening. Current approaches to automated motion analysis, however, are expensive, require lots of technical support, and cannot be used in broad clinical application. Here we present an inexpensive, marker-free video analysis tool (KineMAT) for infants, which digitizes 3‑D movements of the entire body over time allowing automated analysis in the future.Three-minute video sequences of spontaneously moving infants were recorded with a commercially available depth-imaging camera and aligned with a virtual infant body model (SMIL model). The virtual image generated allows any measurements to be carried out in 3‑D with high precision. We demonstrate seven infants with different diagnoses. A selection of possible movement parameters was quantified and aligned with diagnosis-specific movement characteristics.KineMAT and the SMIL model allow reliable, three-dimensional measurements of spontaneous activity in infants with a very low error rate. Based on machine-learning algorithms, KineMAT can be trained to automatically recognize pathological spontaneous motor skills. It is inexpensive and easy to use and can be developed into a screening tool for preventive care for children.

This review summarizes early human motor development. From early fetal age motor behavior is based on spontaneous neural activity: activity of networks in the brainstem and spinal cord that is modulated by supraspinal activity. The supraspinal activity, first primarily brought about by the cortical subplate, later by the cortical plate, induces movement variation. Initially, movement variation especially serves exploration; its associated afferent information is primarily used to sculpt the developing nervous system, and less to adapt motor behavior. In the next phase, beginning at function-specific ages, movement variation starts to serve adaptation. In sucking and swallowing, this phase emerges shortly before term age. In speech, gross and fine motor development, it emerges from 3 to 4 months post-term onwards, i.e., when developmental focus in the primary sensory and motor cortices has shifted to the permanent cortical circuitries. With increasing age and increasing trial-and-error exploration, the infant improves its ability to use adaptive and efficicient forms of upright gross motor behavior, manual activities and vocalizations belonging to the native language., (Copyright © 2018 The Author. Published by Elsevier Ltd.. All rights reserved.)

Background: In typical development, postural adjustments during reaching change in the second half of infancy, including increasing rates of direction-specific adjustments. These changes are absent or different in infants at risk of cerebral palsy (CP). To discover whether these changes are related to acquisition of independent walking, we studied postural adjustments during reaching in infants before and after they learned to walk., Methods: Ten typically developing (TD) infants and 11 infants at very high risk (VHR) of CP were assessed before and after they learned to walk. Reaching movements were elicited during supported sitting, while surface electromyography was recorded of arm, neck, and trunk muscles. Percentages of direction-specific adjustments (first level of control), and recruitment patterns and anticipatory activation (second level of control) were calculated., Results: In both groups, postural adjustments during reaching were similar before and after acquisition of independent walking. Direction-specificity increased with age in typically developing infants but not in VHR-infants., Conclusion: Increasing age rather than the transition to independent walking is associated with increasing direction-specificity of TD-infants during reaching while sitting, while infants at very high risk of CP show no increase in direction-specificity, suggesting that they gradually grow into a postural deficit., (Copyright © 2017 Elsevier Inc. All rights reserved.)

General movements are present from early fetal life to 3 to 5 months corrected age. Atypical general movements, especially in the last, so-called fidgety general movement phase, are predictive of cerebral palsy (CP). This review updates knowledge on the neural substrate and clinical significance of typical and atypical general movements. Typical general movements are primarily characterized by complexity and variation. Presumably these core characteristics are initially induced by modulating activity of the cortical subplate. When the subplate gradually dissolves between 3 months before term and 3 months corrected age the cortical plate takes over. This coincides with the fidgety general movement phase. Conceivably, fidgety activity reflects 'sparsification', i.e. fragmentation of cortical network activity. The quintessential feature of atypical general movements is reduced complexity and variation. This is attributed to impaired integrity of extensive cortical-subcortical networks, in which the subplate and periventricular white matter play a prominent role. The most serious forms of network impairment are associated with absent fidgety movements., What This Paper Adds: The emergence of fidgety movements reflects a developmental transition from widespread to fragmented cortical network activity. Atypical general movements characterized by reduced complexity and variation are attributed to impaired integrity of extensive cortical-subcortical networks., (© 2017 Mac Keith Press.)

Cerebral palsy is a non-progressive neurological disorder occurring in early childhood affecting body movement and muscle control. Early identification can help improve outcome through therapy-based interventions. Absence of so-called "fidgety movements" is a strong predictor of cerebral palsy. Currently, infant limb movements captured through either video cameras or accelerometers are analyzed to identify fidgety movements. However both modalities have their limitations. Video cameras do not have the high temporal resolution needed to capture subtle movements. Accelerometers have low spatial resolution and capture only relative movement. In order to overcome these limitations, we have developed a system to combine measurements from both camera and sensors to estimate the true underlying motion using extended Kalman filter. The estimated motion achieved 84% classification accuracy in identifying fidgety movements using Support Vector Machine.

Background: Assessing the quality of general movements (GMs) is a non-invasive tool to identify at early age infants at risk for developmental disorders., Aim: To investigate whether specific characteristics of definitely abnormal GMs are associated with developmental outcome at school age., Study Design: Observational cohort study (long-term follow-up)., Subjects: Parents of 40 children (median age 8.3 years, 20 girls) participated in this follow-up study. In infancy (median corrected age 10 weeks), the children (median gestational age 30.3 weeks; birth weight 1243 g) had shown definitely abnormal GMs according to Hadders-Algra (2004). Information on specific GM characteristics such as the presence of fidgety movements, degree of complexity and variation, and stiff movements, was available (see Hamer et al. 2011)., Outcome Measures: A standardised parental interview (presence of CP, attendance of school for special education, Vineland Adaptive Behavior Scale to determine functional performance) and questionnaires (Developmental Coordination Disorder Questionnaire [DCD-Q] to evaluate mobility and Child Behavior Checklist to assess behaviour) were used as outcome measures., Results: Six children had cerebral palsy (CP), ten children attended a school for special education, and eight children had behavioural problems. Both the absence of fidgety movements and the presence of stiff movements were associated with CP (p=0.001; p=0.003, respectively). Stiff movements were also related to the need of special education (p=0.009). A lack of movement complexity and variation was associated with behavioural problems (p=0.007). None of the GM characteristics were related to DCD-Q scores., Conclusions: The evaluation of fidgety movements and movement stiffness may increase the predictive power of definitely abnormal GMs for motor outcome--in particular CP. This study endorses the notion that the quality of GMs reflects the integrity of the infant's brain, assisting prediction of long-term outcome., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: General movement (GM) assessment is a well-established tool to predict cerebral palsy in high-risk infants. Little is known on the predictive value of GM assessment in low-risk populations., Aims: To assess the predictive value of GM quality in early infancy for the development of the clinically relevant form of minor neurological dysfunction (complex MND) and behavioral problems at preschool age., Study Design: Prospective cohort study., Subjects: A total of 216 members of the prospective Groningen Assisted Reproductive Techniques (ART) cohort study were included in this study. ART did not affect neurodevelopmental outcome of these relatively low-risk infants born to subfertile parents., Outcome Measures: GM quality was determined at 2 weeks and 3 months. At 18 months and 4 years, the Hempel neurological examination was used to assess MND. At 4 years, parents completed the Child Behavior Checklist; this resulted in the total problem score (TPS), internalizing problem score (IPS), and externalizing problem score (EPS). Predictive values of definitely (DA) and mildly (MA) abnormal GMs were calculated., Results: DA GMs at 2 weeks were associated with complex MND at 18 months and atypical TPS and IPS at 4 years (all p<0.05). Sensitivity and positive predictive value of DA GMs at 2 weeks were rather low (13%-60%); specificity and negative predictive value were excellent (92%-99%). DA GMs at 3 months occurred too infrequently to calculate prediction. MA GMs were not associated with outcome., Conclusions: GM quality as a single predictor for complex MND and behavioral problems at preschool age has limited clinical value in children at low risk for developmental disorders., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Aim: To evaluate a kinematic paradigm of automatic general movements analysis in comparison to clinical assessment in 3-month-old infants and its prediction for neurodevelopmental outcome., Method: Preterm infants at high risk (n=49; 26 males, 23 females) and term infants at low risk (n=18; eight males, 10 females) of developmental impairment were recruited from hospitals around Heidelberg, Germany. Kinematic analysis of general movements by magnet tracking and clinical video-based assessment of general movements were performed at 3 months of age. Neurodevelopmental outcome was evaluated at 2 years. By comparing the general movements of small samples of children with and without cerebral palsy (CP), we developed a kinematic paradigm typical for infants at risk of developing CP. We tested the validity of this paradigm as a tool to predict CP and neurodevelopmental impairment., Results: Clinical assessment correctly identified almost all infants with neurodevelopmental impairment including CP, but did not predict if the infant would be affected by CP or not. The kinematic analysis, in particular the stereotypy score of arm movements, was an excellent predictor of CP, whereas stereotyped repetitive movements of the legs predicted any neurodevelopmental impairment., Interpretation: The automatic assessment of the stereotypy score by magnet tracking in 3-month-old spontaneously moving infants at high risk of developmental abnormalities allowed a valid detection of infants affected and unaffected by CP., (© 2014 Mac Keith Press.)

Background: The effect of in vitro fertilisation (IVF) on neurodevelopment is not fully understood. Probably, IVF does not affect traditional measures of neurodevelopment in infancy. Recently, an instrument, the Infant Motor Profile (IMP), was developed that evaluates the quality of motor behaviour. It includes the evaluation of movement variation (i.e. movement repertoire size), a parameter reflecting the integrity of cortical connectivity., Aim: To evaluate the effect of ovarian hyperstimulation and the in vitro procedure on movement variation during infancy., Study Design: Prospective cohort study., Subjects: Singletons born following IVF or intracytoplasmic sperm injection (ICSI) with conventional controlled ovarian hyperstimulation (COH-IVF/ICSI, n=68), in a modified natural cycle (MNC-IVF/ICSI, n=57) and natural conception born to subfertile couples (Sub-NC, n=90)., Outcome Measures: Children were assessed with the IMP at 4, 10 and 18 months, resulting in a total IMP score and five domain scores: variation, variability, symmetry, fluency and performance. Primary outcome was the domain score variation., Results: A significant effect of study group was observed for the variation score up until 18 months of age (p=0.039). COH-IVF/ICSI children had a significantly lower mean variation score than MNC-IVF/ICSI children (mean difference [95% confidence interval] -1.010 [-1.766; -0.254]). Mean variation scores of COH-IVF/ICSI and Sub-NC children were similar; the same held true for the comparison between MNC-IVF/ICSI and Sub-NC. Total IMP scores and other domain scores of the three groups were similar., Conclusion: The present study did not demonstrate a clear effect of ovarian hyperstimulation and the in vitro procedure on movement variation throughout infancy., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Knowledge on the development of postural adjustments during infancy, in particular on the development of postural muscle coordination, is limited. This study aimed at the evaluation of the development of postural control during reaching in a supported sitting condition. Eleven typically developing infants participated in the study and were assessed at the ages of 4, 6, 10 and 18 months. We elicited reaching movements by presenting small toys at an arm's length distance, whilst activity of multiple arm, neck and trunk muscles was recorded using surface EMG. A model-based computer algorithm was used to detect the onset of phasic muscle activity. The results indicated that postural muscle activity during reaching whilst sitting supported is highly variable. Direction-specific postural activity was inconsistently present from early age onwards and increased between 10 and 18 months without reaching a 100 % consistency. The dominant pattern of activation at all ages was the 'complete pattern', in which all direction-specific muscles were recruited. At 4 months, a slight preference for top-down recruitment existed, which was gradually replaced by a preference for bottom-up recruitment. We conclude that postural control during the ecological task of reaching during supported sitting between 4 and 18 months of age is primarily characterized by variation. Already from 4 months onwards, infants are-within the variation-sometimes able to select muscle recruitment strategies that are optimal to the task at hand.

Movement variation constitutes a crucial feature of infant motor development. Reduced variation of spontaneous infant movements, i.e. stereotyped movements, may indicate severe neurological deficit at an early stage. Hitherto evaluation of movement variation has been mainly restricted to subjective assessment based on observation. This article introduces a method for quantitative assessment yielding an objective definition of stereotyped movements which may be used for the prognosis of neurological deficits such as cerebral palsy (CP). Movements of 3-month-old infants were recorded with an electromagnetic tracking system facilitating the analysis of joint angles of the upper and lower limb. A stereotypy score based on dynamic time warping has been developed describing movements which are self-similar in multiple degrees of freedom. For clinical evaluation, this measure was calculated in a group of infants at risk for neurological disorders (n=54) and a control group of typically developing children (n=21) on the basis of spontaneous movements at the age of 3 months. The stereotypy score was related to outcome at the age of 24 months in terms of CP (n=10) or no-CP (n=53). Using the stereotypy score of upper limb movements CP cases could be identified with a sensitivity of 90% and a specificity of 96%. The corresponding score of the leg movements did not allow for valid discrimination of the groups. The presented stereotypy feature is a promising candidate for a marker that may be used as a simple and noninvasive quantitative measure in the prediction of CP. The method can be adopted for the assessment of infant movement variation in research and clinical applications., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Aim: The aim of this study was to improve the understanding of brain function in children with autism spectrum disorder (ASD) in relation to minor neurological dysfunctions (MNDs)., Method: We studied MNDs in 122 children (93 males, 29 females; mean age 8 y 1 mo, SD 2 y 6 mo) who, among a total cohort of 705 children (513 males, 192 females; mean age 9 y, SD 2 y 0.5 mo) referred to a regional outpatient non-academic psychiatric centre in the Netherlands, were diagnosed with ASD after an extensive multidisciplinary psychiatric assessment. Children with clear neurological abnormalities (e.g. cerebral palsy or spina bifida) were excluded from the study. MNDs were assessed in all 705 children using the Touwen examination method. Special attention was paid to the severity and type of MND. Data of the children with ASD were compared with neurological morbidity data of children with other psychiatric disorders and with children in the general population, who were born at Groningen University Hospital between 1975 and 1978., Results: Seventy-four percent of the children with ASD showed complex MNDs compared with 52% of the children with other psychiatric disorders and 6% of the reference group (χ(2) =18.0, p<0.001; χ(2) =937.5, p<0.001 respectively). Specific dysfunctions frequently encountered in ASD were dysfunctional posture and muscle tone, fine manipulative disability, dyscoordination, and excessive associated movements., Conclusion: These findings suggest a contribution of dysfunctional supraspinal networks involving multiple parts of the brain in the pathogenesis of ASD. This is consistent with findings from neuroimaging studies, and highlights the importance of neurological examinations in paediatric psychiatric assessments., (© The Authors. Developmental Medicine & Child Neurology © 2011 Mac Keith Press.)

Background: Perinatal asphyxia may result in a developmental disorder. A recently developed non-invasive tool to investigate brain function at an early age is the assessment of general movements (GMs)., Aim: To evaluate relationships between perinatal risk factors and the quality of GMs in the neonatal period and at 3 months in term newborns with asphyxia in a secondary paediatric setting., Methods: 64 term (>36 weeks postmenstrual age (PMA)) infants with perinatal asphyxia were studied. GMs were assessed at 'writhing' GM age (38-47 weeks PMA) and at 'fidgety' GM age (48-56 weeks PMA). Pre- and perinatal factors were collected in a standardized way., Results: Multivariate analysis revealed that DA GMs at 'writhing' age mainly correlated with asphyxia related illness. DA GMs at 'fidgety' age correlated in particular with abnormalities on the neonatal ultrasound scan of the brain., Conclusion: In secondary paediatric settings GM-assessment especially around 3 months is a valuable tool for the assessment of the integrity of the nervous system in term infants with asphyxia.

Background: General movements (GMs) form the basic motility of young infants. The quality of GMs may predict neurological outcome, but little is known about relationships between GM-quality and behavioral problems, including those resulting in overt psychiatric morbidity., Aim: To explore relationships between abnormal GMs and behavioral problems, in particular relationships between abnormal GMs and Attention Deficit Hyperactivity Disorder (ADHD) with or without psychiatric co-morbidity at school-age., Methods: Twenty-five low-risk full term infants and 16 infants at high risk for neurodevelopmental disorder but without cerebral palsy were studied prospectively. GM-quality was assessed during 'writhing' age (around term till 2 months post-term) and 'fidgety' age (2-4 months post-term). GMs were classified into normal and abnormal movements. When the children were 9-12 years, parents completed the Child Behavior Checklist (CBCL) and provided information on the presence of psychiatric diagnoses; teachers completed the Teachers Report Form (TRF). Both parents and teachers completed a questionnaire on ADHD-like behavior., Results: Abnormal GMs at 'writhing' and 'fidgety' age were related to the presence of ADHD with psychiatric co-morbidity (p<0.05), but not to isolated ADHD. Abnormal GMs at 'fidgety' age were weakly related to problematic behavior at school (TRF-scores) and hyperactive behavior at home (ADHD-questionnaire)., Conclusions: This explorative study suggests that abnormal GMs in early infancy may be associated with an increased risk for behavioral problems, in particular for ADHD with psychiatric co-morbidity at school-age.

Perinatal qualitative assessment of general movements (GMs) is a tool to evaluate the integrity of the young nervous system. The aim of this investigation was to study the emergence of GMs. Fetal onset of GMs was studied sonographically in 18 fetuses during the first trimester of uncomplicated in vitro fertilization (IVF) pregnancies in weekly assessments. The earliest motility consisting of small and simple sideways bending (SB) of head and/or rump starts at 7 wk, lasting about 1 s. Between 7 and 8.5 wk, motility differentiates further into movements in which also one or two arms or legs become active; movements are still slow, small, and in one direction, but the duration increases to a few seconds. The transition into GMs at 9-10 wk is characterized by variation in participating body parts and amplitude, speed, and direction during longer periods of time. Between 9 and 13 wk, simple and stereotyped SBs and GMs may coexist. At 9 wk, the incidence of SBs decreases (p = 0.01) and that of GMs increases (p = 0.006). The data suggest that initial simple fetal motility is generated by spinal and brainstem circuitries, and the emergence of complex and variable GMs denotes the onset of supraspinal modulation of this spinal and brainstem activity.

During the last decade it has become clear that the assessment of the quality of general movements (GMs) in foetus and young infant is a sensitive tool to evaluate the integrity of the young nervous system. GMs are movements in which all parts of the body participate. The hallmark of typical GMs is movement complexity and variation; in abnormal GMs movement complexity and variation is reduced or absent. Abnormal GMs may predict developmental outcome. Prediction on the basis of longitudinal series of GM assessments is best. Second best is prediction on the basis of an assessment at 'fidgety' GM age, i.e. at 2-4 months post-term. Definitely abnormal GMs at 'fidgety' age are related to cerebral palsy, mildly abnormal GMs to minor neurological dysfunction at school age. In the present paper the hypothesis is advanced that GM complexity and variation are brought about by the transiently present cortical subplate and that abnormal GMs are the result of damage or dysfunction of the subplate and its efferent motor connections in the periventricular white matter.

Assessment of the quality of general movements (GMs) in early infancy is a powerful instrument to predict cerebral palsy (CP). The aim of the present study is to explore the value of GM assessment in predicting minor neurological dysfunction (MND) at 9 to 12 years of age. Two groups of infants were studied prospectively: 28 low-risk full-term infants (11 females, 17 males) and 24 high-risk infants, mostly born preterm (<37 weeks; 11 females, 13 males). In each group the quality of GMs (normal or abnormal) was assessed during two developmental periods: the age at which 'writhing' GMs occur (36 weeks' postmenstrual age to 7 weeks' postterm) and the age at which 'fidgety' GMs occur (8 to 17 weeks' postterm). Eight of 24 high-risk infants were diagnosed as having CP at 4 to 9 years of age. The remaining 44 children were followed-up at 9 to 12 years. In children without CP, quality of GMs at 'fidgety age' was related to neurological condition (normal, simple MND, complex MND) at follow-up (rho=0.46, p<0.01). Abnormal GMs at 'fidgety-GM age' showed a specific relationship to the development of coordination problems (chi2=6.1, p=0.01) and fine manipulative disability (Fisher, p<0.05) at 9 to 12 years. This finding supports the notion that the quality of GMs may provide information on the integrity of complex supraspinal circuitries.

Kinematic characteristics of reaching movements of the dominant arm were assessed in 51 sitting preterm children who were aged 2-11 y and had cerebral palsy (CP), including 33 with spastic hemiplegia and 18 with bilateral CP (Bi-CP). Reference data of 29 typically developing children were present. The results indicated that the quality of reaching movements from the dominant arm of children with CP was significantly worse than that of typically developing children. This held true in particular for the children with Bi-CP. For example, reaching movements of children with CP took more time and consisted less often of one movement unit. The quality of reaching was related to the severity of lesion present on the neonatal ultrasound scan of the brain, the severity of motor disorder, the degree of spasticity, and the ability to perform activities of daily life. The last indicates that movements of the dominant arm in children with spastic hemiplegia and Bi-CP deserve clinical attention.

The present paper presents clinical and neurophysiological data of postural behavior in preterm children without CP. Clinical follow-up studies of preterm infants until toddler and school age have reported that low-risk preterm infants may have atypical postural behavior in terms of reduced amount of rotation during crawling, delayed dynamic balance, delayed onset of and a poor quality of early walking behavior. At school age, dysfunctions such as problems in standing on one leg and poor hopping are reported. Neurophysiological data of postural control at early age indicated the presence of a dysfunction in the capacity to modulate postural activity, and the postural activity has been characterized by temporal disorganization of EMG responses. Postural responses to goal-directed reaching in supine lying have been recorded and analyzed in terms of the total body center of pressure. In this study, preterm infants show less mobile postural behavior compared with full-term infants. In infancy, the less mobile postural behavior seemed to be adequate as it was related to better goal-directed reaching quality, but the results indicated that the relatively immobile postural behavior during reaching in early age was related to less favorable neuromotor behavior in school-age.

The present paper reviews the development of postural adjustments during infancy. In the control of posture, two functional levels can be distinguished. The basic level deals with the generation of direction-specific adjustments, meaning that dorsal muscles are primarily activated when the body sways forward, whereas ventral muscles are primarily activated when the body sways backward. The second level is involved in adaptation of the direction-specific adjustments. Postural development starts with a repertoire of direction-specific adjustments suggesting that the basic level of control has an innate origin. At first, during the phase of primary variability, postural activity is largely variable and can be minimally adapted to environmental constraints. At 3 months, postural activity shows a transient period during which few postural muscles participate in postural activity. From 6 months onward, the phase of secondary variability starts, during which the second level of postural control becomes functionally active and infants develop the ability to adapt postural activity to the specifics of the situation. Initially, adaptation can be accomplished in a simple way only, but from 9-10 months onward, it can be performed by the subtle adaptation of the degree of muscle contraction. Around 13-14 months, anticipatory postural adjustments emerge. It is concluded that the development of postural adjustments is characterized by four periods of transition occurring at the ages of 3, 6, 9-10, and 13-14 months. The major transition occurs at 6 months, when infants move from the phase of non-adaptive, primary variability to the phase of adaptive, secondary variability.

Detection of children with a developmental disorder, such as cerebral palsy, at an early age is notoriously difficult. Recently, a new form of neuromotor assessment of young infants was developed, based on the assessment of the quality of general movements (GMs). GMs are movements of the fetus and young infant in which all parts of the body participate. The technique of GM assessment is presented and the features of normal, mildly abnormal, and definitely abnormal GMs discussed. Essential to GM assessment is the Gestalt evaluation of movement complexity and variation. The quality of GMs at 2 to 4 months postterm (so-called fidgety GM age) has been found to have the highest predictive value. The presence of definitely abnormal GMs at this age--that is, GMs devoid of complexity and variation--puts a child at very high risk for cerebral palsy. This implies that definitely abnormal GMs at fidgety age are an indication for early physiotherapeutic intervention., (Copyright 2004 Elsevier Inc.)

Objective: To evaluate the reliability of assessing infants' general movements (GMs) using a new classification and its validity in predicting complex minor neurological dysfunction (MND) at toddler and at school age., Design: Prospective study of two groups of infants, each consisting of a mix of low-risk and high-risk infants., Setting: University Hospital Groningen, the Netherlands., Subjects: Group A consisted of 16 low-risk and 21 high-risk infants; group B of 28 low-risk and 24 high-risk infants., Main Outcome Measures: Between term age and four months post term: multiple assessments of neurological condition by means of (a) assessment of GMs, and (b) a traditional neurological examination. GMs were classified into four classes using a standardized qualitative description: two classes of normal movements (normal-optimal and normal-suboptimal) and two classes of abnormal movements (mildly and definitely abnormal movements). Follow-up neurological examination with special attention to presence of MND was carried out in group A at 1 1/2 years, in group B at 4-9 years., Results: GMs could be assessed reliably. They were stable over age in about 60% of the infants. Both the condition of the GMs and the infant neurological condition were significantly related to neurological condition at follow-up. Best prediction of complex MND was achieved when both types of infant assessment at the age of 2-4 months post term were combined., Conclusions: The assessment of GMs is a valuable tool, in particular when combined with the traditional neurological examination, to predict at early age the development of complex MND.

Background: Whether long-chain polyunsaturated fatty acids (LCPs) play a role in the development of the young nervous system in term infants is debated., Objective: We investigated whether supplementation of formula with LCPs for 2 mo improves the quality of general movements (GMs) in healthy term infants at 3 mo of age., Design: A prospective, double-blind, randomized controlled study was conducted with 2 groups of healthy term infants: a control-formula (CF) group (n = 131) and an LCP-supplemented-formula (LF) group (n = 119). A breastfed (BF) group (n = 147) served as a reference. Information on potential confounders was collected at enrollment. Videotapes were made of the infants' spontaneous motor behavior at 3 mo of age to assess the quality of their GMs. On the basis of quality, normal GMs were classified as normal-optimal or normal-suboptimal, and abnormal GMs were classified as mildly or definitely abnormal. Attrition at 3 mo of age was 15% and nonselective. Multivariate regression analyses with adjustment for confounders were carried out to evaluate the effect of the type of feeding., Results: None of the infants had definitely abnormal GMs. Infants in the CF group had mildly abnormal GMs significantly more often than did infants in the LF and BF groups (31% compared with 19% and 20%, respectively). Infants in the BF group had normal-optimal GMs more frequently than did infants in the LF and CF groups (34% compared with 18% and 21%, respectively). Logistic regression analyses confirmed these findings., Conclusion: Supplementation of healthy term infants with LCPs during the first 2 mo of life reduces the occurrence of mildly abnormal GMs.

We evaluated the development of postural adjustments accompanying reaching movements in sitting children. Twenty-nine typically developing children aged, 2-11 years, and ten adults were studied with multiple surface electromyograms (EMGs) and kinematics during reaching in four conditions: sitting with the seat-surface oriented horizontally with and without an additional task load, and sitting with the seat-surface tilted 15 degrees forward and 15 degrees backward. The development of postural adjustments during reaching in a sitting position turned out to have a non-linear and protracted course, which is not finished by the age of 11 years. The development of these adjustments is characterised by variation, yet specific developmental sequences could be distinguished. Firstly, the development of postural adjustments during reaching from the age of 2 years onwards lacked a preference for an en bloc strategy, which consists of an in concert activation of the direction-specific neck and trunk muscles. Secondly, anticipatory postural muscle activity, which was consistently present in adults, was virtually absent between 2 and 11 years of age. Thirdly, the data demonstrated that with increasing age the head gradually becomes the dominant frame of reference. In addition, the study suggested that, in terms of postural control, the forward-tilted position is the most efficient one.

Many preterm infants may experience so-called minor developmental disorders; however, in general, the problems in motor behavior are not detected until school age. To introduce therapies aimed at the prevention of these problems, we need to increase our knowledge of motor function and dysfunction at early age. The present study focused on the organization of reaching movements in full-term and preterm infants without cerebral palsy. The reaching behavior of premature infants (n = 63) was assessed longitudinally at the corrected ages of 4 and 6 mo. Clinical assessments were made at 6 and 12 mo of age. On the basis of the infant's morbidity during the early stay in the neonatal intensive care unit, the preterm infants were allocated into a high-risk and a low-risk group. Results from a previous study in full-term infants (n = 13) were included. Kinematics of reaching movements in supine position were measured, and the analysis focused on movement velocity and movement units. A compound parameter of kinematic variables was created, reflecting the quality of reaching movements. The present study showed that at the age of 4 mo, low-risk preterm infants showed more often optimal reaching behavior than full-term and preterm high-risk infants. This better reaching performance was related to a better general motor and behavioral development during the first year of life. At the age of 6 mo, the advantage of the low-risk group in reaching behavior had disappeared and a disadvantage in the form of nonoptimal reaching behavior of the high-risk group emerged.