The Motor Optimality Score—Revised Improves Early Detection of Unilateral Cerebral Palsy in Infants with Perinatal Cerebral Stroke
Abstract
:1. Introduction
2. Aims of the Study
3. Materials and Methods
3.1. Study Design
3.2. Subjects
3.3. General Movements Assessment and MOS-R
3.4. Brain Magnetic Resonance Imaging (MRI)
3.5. Outcome Assessment
4. Results
4.1. GMs Assesment
4.2. Movement Patterns
4.3. Postural Patterns
4.4. Movement Character
4.5. Motor Optimality List
4.6. Neurodevelopmental Outcome and Prognostic Factors
5. Discussion
6. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Infants | Type of Lesion | Outcome | Fidgety Movements | MOS-R Score | Asymmetry Index | Griffiths DQ | GMFCS Score |
---|---|---|---|---|---|---|---|
1 | Right PCA | Left UCP | Absent | 6 | −1 | 69 | 2 |
2 | Right PCA | Left UCP | Sporadic | 13 | −0.29 | 94 | 1 |
3 | Left MCA (post) | Right UCP | Absent | 9 | −0.33 | 97 | 1 |
4 | Left MCA (ant) | Right UCP | Absent | 6 | −0.33 | 115 | 2 |
5 | Right MCA (ant) | Left UCP | Absent | 6 | −0.23 | 103 | 2 |
6 | Left MCA + ACA | Right UCP | Absent | 6 | −0.11 | 49 | 2 |
7 | Right MCA_(ant) | Normal | Normal | 15 | −0.5 | 106 | 0 |
8 | Left MCA (ant) | Right UCP | Absent | 7 | −0.2 | 115 | 1 |
9 | Left MCA | Right UCP | Absent | 6 | −1 | 48 | 5 |
10 | Right MCA (ant) | Left UCP | Absent | 6 | −0.33 | 103 | 1 |
11 | Left MCA (post) | Right UCP | Absent | 6 | −0.22 | 105 | 1 |
12 | Right MCA (ant) | Left UCP | Absent | 8 | −0.2 | 94 | 1 |
13 | Left MCA (ant) | Right UCP | Sporadic | 6 | −0.6 | 105 | 2 |
14 | Right MCA (post) | Left UCP | Absent | 6 | −0.5 | 89 | 1 |
15 | Left MCA | Right UCP | Absent | 7 | −0.16 | 110 | 2 |
16 | Left MCA | Normal | Normal | 22 | 0.33 | 104 | 0 |
17 | Right MCA/PCA | Left UCP | Absent | 12 | −0.09 | 105 | 1 |
18 | Left MCA (post) | Right UCP | Absent | 6 | −0.2 | 112 | 1 |
19 | Left MCA | Right UCP | Absent | 12 | −0.29 | 80 | 1 |
20 | Right PCA | Normal | Normal | 20 | 0.33 | 112 | 0 |
21 | Right PCA | Left UCP | Absent | 6 | −0.14 | 100 | 1 |
22 | Right MCA + ACA | Left UCP | Sporadic | 6 | −0.14 | 93 | 1 |
23 | Left PCA | Right UCP | Absent | 6 | −0.11 | 88 | 1 |
24 | Right PCA | Left UCP | Sporadic | 6 | −0.14 | 105 | 1 |
Movement Patterns | Cases | Controls | Total | p-Value | ||
---|---|---|---|---|---|---|
N (%) | A (%) | N (%) | A (%) | 22 | ||
Swipes | 8/9 (89) | 1/9 (11) | 13/13 (100) | 0 | 26 | 0.8499 |
Wiggling–Oscillating | 5/7 (71.4) | 2/7 (28.6) | 19/19 (100) | 0 | 22 | 0.1106 |
Kicking | 2.6 (33.3) | 4/6 (66.7) | 15/16 (93.8) | 1/16 (6.2) | 8 | 0.0147 |
Excitement Bursts | 0 | 1/1 (100) | 77 (100) | 0 | 20 | 0.2254 |
Smiles | 5/8 (62.5) | 3/8 (37.5) | 12/12 (100) | 0 | 39 | 0.0966 |
Mouth Movements | 4/17 (23.5) | 13/13 (76.5) | 22/22 (100) | 0 | 12 | <0.0001 |
Tongue Movements | 0 | 11/11 (100) | 1/1 (100) | 5 | 0.0094 | |
Side-to-side Movement of the Head | 0 | 5/5 (100) | 0 | 0 | NA | NA |
Hand-to-Mouth Contact | 3/3 (100) | 0 | 1/1 (100) | 0 | 4 | 0.6171 |
Hand-to hand Contact | 3/3 (100) | 0 | 5/5 (100) | 0 | 8 | 0.7237 |
Fiddling | 5/7 (71.4) | 2/7 (28.6) | 16/16 (100) | 0 | 23 | 0.1517 |
Reaching | 0 | 0 | 0 | 0 | 0 | NA |
Foot-to-Foot Contact | 7/14 (50) | 7/14 (50) | 5/6 (83.3) | 1/6 (16.7) | 20 | 0.37 |
Legs lift | 0 | 0 | 1/1 (100) | 0 | 1 | NA |
Hand-to-toe Contact | 0 | 0 | 1/1 (100) | 1 | NA | |
Segmental Movement of Wrists | 22/22 (100) | 0 | 22 | NA | ||
Arching | 2/3 (66.7) | 1/3 (33.3) | 3/3 (100) | 0 | 6 | 1 |
Rolling to side | 0 | 2/2 (100) | 2/2 (100) | 0 | 4 | 0.3173 |
Visual Exploration | 7/7 (100) | 0 | 17/17 (100) | 0 | 24 | 0.0662 |
Hand Regard | 0 | 5/5 (100) | 5 | NA | ||
Head Anteflexion | 0 | 0 | 0 | 0 | 0 | NA |
Circular Arm Movements | 0 | 0 | 0 | NA | ||
Almost no Leg Movements | 0 | 0 | 0 | NA |
Postural Patterns | Cases | Controls | Total | p-Value | ||
---|---|---|---|---|---|---|
N (%) | A (%) | N (%) | A (%) | |||
Head-Centered | 6/24 (25) | 18/24 (75) | 20/24 (83.3) | 4/24 (16.7) | 48 | 0.0002 |
Body Symmetry | 4/24 (16.7) | 18/24 (83.3) | 3/24 (12.5) | 21/24 (87.5) | 48 | 1 |
Asymmetric Tonic Neck (ATN) Posture | 19/24 (79.2) | 5/24 (20.8) | 24/24 (100) | 48 | 0.0588 | |
Flat Posture | 1 (100) | 0 | 1 | NA | ||
Variability of Finger Posture | 7/24 (29.2) | 17/24 (70.8) | 21/23 (91.3) | 2/23 (8.7) | 47 | 0.0001 |
Predominant Fisting | 6/6 (100) | 2/2 (100) | 8 | 0.2888 | ||
Synchronized Opening and Closing of Fingers | 0 | 0 | 0 | NA | ||
Finger Spreading | 6/6 (100) | 2/2 (100) | 8 | 0.2888 | ||
Asymmetry of Finger Posture | 10/10 (100) | 3/3 (100) | 13 | 0.961 | ||
Hyperextension of Neck | 0 | 0 | 0 | NA | ||
Hyperextension of Trunk | 0 | 0 | 0 | NA | ||
Extended Arms | 2/2 (100) | 0 | 2 | NA | ||
Extended Legs | 0 | 0 | 0 | NA |
Movement Character | Cases | Controls | Total | p-Value | ||
---|---|---|---|---|---|---|
Yes (%) | No (%) | Yes (%) | No (%) | |||
Smooth and Fluent | 0 | 24/24 (100) | 22/24 (91.7) | 2/24 (8.3) | 48 | <0.0001 |
Monotonous | 22/24 (91.7) | 2/24 (8.3) | 1/24 (4.2) | 23/24 (95.8) | 48 | <0.0001 |
Jerky | 12/24 (50) | 12/24 (50) | 1/24 (4.2) | 23/24 (95.8) | 48 | 0.0012 |
Stiff | 7/24 (29.2) | 17/24 (70.8) | 0 | 24/24 | 48 | 0.0141 |
Predominantly Slow | 2/24 (8.3) | 22/24 (91.7) | 0 | 24/24 (100) (100) | 48 | 0.4701 |
Predominantly Fast | 2/24 (8.3) | 22/24 (91.7) | 0 | 24/24 (100) | 48 | 0.4701 |
Motor Optimality List | Cases | Controls | p-Value |
---|---|---|---|
Median (IC) | Median (IC) | ||
Fidgety Movements | 1 (1–1) | 12 (12–12) | <0.0001 |
Observed Movement Patterns | 1 (1–2) | 4 (4–4) | <0.0001 |
Age-Adequate Movement Repertoire | 1 (1–1) | 2 (2–4) | 0.0005 |
Observed Postural Pattern | 1 (1–1) | 4 (2–4) | 0.0001 |
Movement Character | 2 (2–2) | 4 (4–4) | <0.0001 |
MOS-R Score | 6 (6–9) | 26 (25–26) | <0.0001 |
Sensitivity (%) (CI 95%) | Specificity (%) (CI 95%) | PPV (%) | NPV (%) | ROC (CI 95%) | |
---|---|---|---|---|---|
MOS-R (<13) | 100 (83.7–100) | 100 (30.5–100) | 100 | 100 | 1 (0.86–1) |
AI (<−0.09) | 100 (83.7–100) | 66.7 (11.6–94.5) | 95.5 | 100 | 0.72 (0.50–0.88) |
Arterial branch (MCA) | 71.4 (41.9–91.4) | 33.3 (55.5–88.4) | 83.3 | 20 | 0.52 (0.27–0.76) |
Fidgety Movements | 100 (83.7–100) | 100 (30.5–100) | 100 | 100 | 1 (0.86–1) |
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Bertoncelli, N.; Corso, L.; Bedetti, L.; Della Casa, E.M.; Roversi, M.F.; Toni, G.; Pugliese, M.; Guidotti, I.; Miselli, F.; Lucaccioni, L.; et al. The Motor Optimality Score—Revised Improves Early Detection of Unilateral Cerebral Palsy in Infants with Perinatal Cerebral Stroke. Children 2024, 11, 940. https://doi.org/10.3390/children11080940
Bertoncelli N, Corso L, Bedetti L, Della Casa EM, Roversi MF, Toni G, Pugliese M, Guidotti I, Miselli F, Lucaccioni L, et al. The Motor Optimality Score—Revised Improves Early Detection of Unilateral Cerebral Palsy in Infants with Perinatal Cerebral Stroke. Children. 2024; 11(8):940. https://doi.org/10.3390/children11080940
Chicago/Turabian StyleBertoncelli, Natascia, Lucia Corso, Luca Bedetti, Elisa Muttini Della Casa, Maria Federica Roversi, Greta Toni, Marisa Pugliese, Isotta Guidotti, Francesca Miselli, Laura Lucaccioni, and et al. 2024. "The Motor Optimality Score—Revised Improves Early Detection of Unilateral Cerebral Palsy in Infants with Perinatal Cerebral Stroke" Children 11, no. 8: 940. https://doi.org/10.3390/children11080940