Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome

Christa Einspieler, Arend F Bos, Magdalena Krieber-Tomantschger, Elsa Alvarado, Vanessa M Barbosa, Natascia Bertoncelli, Marlette Burger, Olena Chorna, Sabrina Del Secco, Raye-Ann DeRegnier, Britta Hüning, Jooyeon Ko, Laura Lucaccioni, Tomoki Maeda, Viviana Marchi, Erika Martín, Catherine Morgan, Akmer Mutlu, Alice Nogolová, Jasmin PansyColleen Peyton, Florian B Pokorny, Lucia R Prinsloo, Eileen Ricci, Lokesh Saini, Anna Scheuchenegger, Cinthia R D Silva, Marina Soloveichick, Alicia J Spittle, Moreno Toldo, Fabiana Utsch, Jeanetta van Zyl, Carlos Viñals, Jun Wang, Hong Yang, Bilge N Yardımcı-Lokmanoğlu, Giovanni Cioni, Fabrizio Ferrari, Andrea Guzzetta, Peter B Marschik

Research output: Contribution to journalArticle

Abstract

The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3-5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant's later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III-V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.

Original languageEnglish (US)
JournalJournal of Clinical Medicine
Volume8
Issue number10
DOIs
StatePublished - Oct 4 2019

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Cerebral Palsy
Biomarkers
Phenotype
Muscle Spasticity
Walking

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Einspieler, C., Bos, A. F., Krieber-Tomantschger, M., Alvarado, E., Barbosa, V. M., Bertoncelli, N., ... Marschik, P. B. (2019). Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome. Journal of Clinical Medicine, 8(10). https://doi.org/10.3390/jcm8101616
Einspieler, Christa ; Bos, Arend F ; Krieber-Tomantschger, Magdalena ; Alvarado, Elsa ; Barbosa, Vanessa M ; Bertoncelli, Natascia ; Burger, Marlette ; Chorna, Olena ; Del Secco, Sabrina ; DeRegnier, Raye-Ann ; Hüning, Britta ; Ko, Jooyeon ; Lucaccioni, Laura ; Maeda, Tomoki ; Marchi, Viviana ; Martín, Erika ; Morgan, Catherine ; Mutlu, Akmer ; Nogolová, Alice ; Pansy, Jasmin ; Peyton, Colleen ; Pokorny, Florian B ; Prinsloo, Lucia R ; Ricci, Eileen ; Saini, Lokesh ; Scheuchenegger, Anna ; Silva, Cinthia R D ; Soloveichick, Marina ; Spittle, Alicia J ; Toldo, Moreno ; Utsch, Fabiana ; van Zyl, Jeanetta ; Viñals, Carlos ; Wang, Jun ; Yang, Hong ; Yardımcı-Lokmanoğlu, Bilge N ; Cioni, Giovanni ; Ferrari, Fabrizio ; Guzzetta, Andrea ; Marschik, Peter B. / Cerebral Palsy : Early Markers of Clinical Phenotype and Functional Outcome. In: Journal of Clinical Medicine. 2019 ; Vol. 8, No. 10.
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Einspieler, C, Bos, AF, Krieber-Tomantschger, M, Alvarado, E, Barbosa, VM, Bertoncelli, N, Burger, M, Chorna, O, Del Secco, S, DeRegnier, R-A, Hüning, B, Ko, J, Lucaccioni, L, Maeda, T, Marchi, V, Martín, E, Morgan, C, Mutlu, A, Nogolová, A, Pansy, J, Peyton, C, Pokorny, FB, Prinsloo, LR, Ricci, E, Saini, L, Scheuchenegger, A, Silva, CRD, Soloveichick, M, Spittle, AJ, Toldo, M, Utsch, F, van Zyl, J, Viñals, C, Wang, J, Yang, H, Yardımcı-Lokmanoğlu, BN, Cioni, G, Ferrari, F, Guzzetta, A & Marschik, PB 2019, 'Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome', Journal of Clinical Medicine, vol. 8, no. 10. https://doi.org/10.3390/jcm8101616

Cerebral Palsy : Early Markers of Clinical Phenotype and Functional Outcome. / Einspieler, Christa; Bos, Arend F; Krieber-Tomantschger, Magdalena; Alvarado, Elsa; Barbosa, Vanessa M; Bertoncelli, Natascia; Burger, Marlette; Chorna, Olena; Del Secco, Sabrina; DeRegnier, Raye-Ann; Hüning, Britta; Ko, Jooyeon; Lucaccioni, Laura; Maeda, Tomoki; Marchi, Viviana; Martín, Erika; Morgan, Catherine; Mutlu, Akmer; Nogolová, Alice; Pansy, Jasmin; Peyton, Colleen; Pokorny, Florian B; Prinsloo, Lucia R; Ricci, Eileen; Saini, Lokesh; Scheuchenegger, Anna; Silva, Cinthia R D; Soloveichick, Marina; Spittle, Alicia J; Toldo, Moreno; Utsch, Fabiana; van Zyl, Jeanetta; Viñals, Carlos; Wang, Jun; Yang, Hong; Yardımcı-Lokmanoğlu, Bilge N; Cioni, Giovanni; Ferrari, Fabrizio; Guzzetta, Andrea; Marschik, Peter B.

In: Journal of Clinical Medicine, Vol. 8, No. 10, 04.10.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cerebral Palsy

T2 - Early Markers of Clinical Phenotype and Functional Outcome

AU - Einspieler, Christa

AU - Bos, Arend F

AU - Krieber-Tomantschger, Magdalena

AU - Alvarado, Elsa

AU - Barbosa, Vanessa M

AU - Bertoncelli, Natascia

AU - Burger, Marlette

AU - Chorna, Olena

AU - Del Secco, Sabrina

AU - DeRegnier, Raye-Ann

AU - Hüning, Britta

AU - Ko, Jooyeon

AU - Lucaccioni, Laura

AU - Maeda, Tomoki

AU - Marchi, Viviana

AU - Martín, Erika

AU - Morgan, Catherine

AU - Mutlu, Akmer

AU - Nogolová, Alice

AU - Pansy, Jasmin

AU - Peyton, Colleen

AU - Pokorny, Florian B

AU - Prinsloo, Lucia R

AU - Ricci, Eileen

AU - Saini, Lokesh

AU - Scheuchenegger, Anna

AU - Silva, Cinthia R D

AU - Soloveichick, Marina

AU - Spittle, Alicia J

AU - Toldo, Moreno

AU - Utsch, Fabiana

AU - van Zyl, Jeanetta

AU - Viñals, Carlos

AU - Wang, Jun

AU - Yang, Hong

AU - Yardımcı-Lokmanoğlu, Bilge N

AU - Cioni, Giovanni

AU - Ferrari, Fabrizio

AU - Guzzetta, Andrea

AU - Marschik, Peter B

PY - 2019/10/4

Y1 - 2019/10/4

N2 - The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3-5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant's later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III-V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.

AB - The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3-5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant's later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III-V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.

U2 - 10.3390/jcm8101616

DO - 10.3390/jcm8101616

M3 - Article

C2 - 31590221

VL - 8

JO - Journal of Clinical Medicine

JF - Journal of Clinical Medicine

SN - 2077-0383

IS - 10

ER -

Einspieler C, Bos AF, Krieber-Tomantschger M, Alvarado E, Barbosa VM, Bertoncelli N et al. Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome. Journal of Clinical Medicine. 2019 Oct 4;8(10). https://doi.org/10.3390/jcm8101616