Quality of general movements and the development of minor neurological dysfunction at toddler and school age

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.