Predictive Validity of the Trajectory of General Movements on Motor Development in High-risk Infants at One Year of Age

整體動作軌跡評估於高危險群嬰幼兒一歲之動作發展的預測效度

徐碧真(Bih-Jen Hsue) ； 簡珮君(Pei-Jyun Jian) ； 林永傑(Yung-Chien Lin)

《物理治療》 42卷4期 (2017/12) Pp. 370-371

https://doi.org/10.6215/FJPT.2017.74.P42

摘要

Background and Purpose: Infants with prematurity, low birth weight or hypoxic encephalopathy are at higher risks for developmental delay. The qualitative assessment of general movements (GMsA) based on observation of infant’s spontaneous movements is a method with minimal handling to detect the integrity of the central nerve system The purposes of this study are to examine the predictive validity of GMsA trajectory on motor development outcome at 1 year of age. Methods: Sixty nine infants who met the inclusion criteria of high risk in developmental delay were recruited from Neonatal Intensive Care Unit (NICU) of National Cheng Kung University Hospital. Spontaneous movements were recorded by at least two digital camcorders from preterm, writhing fidgety periods. Motor development outcome was measured by Peabody developmental motor scale second edition (PDMS-2) and Alberta infant motor scale (AIMS) at 1 year of age. The GMsA were dichotomized to normal and abnormal for the purpose of analysis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated. Trajectory was considered abnormal end or consistent abnormal as abnormal. Motor development outcome was determined by AIMS at 1 years of age with cutoff point of 10%. The cutoff point of PDMS- 2 was total motor quotient score of 85. Results: Fifty five and 14 of participants were classified as normal and abnormal based on GMsA trajectory, respectively. GMsA had a specificity of 91%, sensitivity of 75%, NPV 94%, PPV of 64% and accuracy of 88% in predicting motor delay at 1 year of age. The GMs trajectory had an accuracy of 79-85% for predicting motor outcome at 2 years which was better than that of in preterm and writhing period. The predictive validity found in this study was similar to the previous findings on infants with more severe health conditions. Conclusion: This study indicated that the predictive validity of GMsA using trajectory data on motor development at 1 year of age was good and better than the prediction validity of each single period. Clinical Relevance: GMsA has the advantage of being noninvasive and minimal handling which is suitable for fragile high risk infants. This study helps to establish the evidence base for GMsA, and suggests the use of GMsA trajectory instead of a single period.