Quality of general movements as a means to evaluate the integrity of the young nervous system

Detection of children with a developmental disorder, such as cerebral palsy, at early age is notoriously difficult. Recently a new form of neuromotor assessment of young infants has been 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 hallmark of typical GMs is movement complexity and variation; in abnormal GMs movement complexity and variation is reduced or absent. Recently it has been hypothesized 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. Multiple studies indicated that 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. This implies that definitely abnormal GMs at fidgety age are an indication for early physiotherapeutic intervention.