Assessing how babies move, from birth to 4 months
Our latest tool in assessing how babies move, and identifying those needing early intervention
I have emerged 4 days in a darkened room watching videos of babies lying down, looking at how they wriggle around.
Sound a bit strange?
Assessing spontaneous movements in newborns and infants
The General Movements Assessment (GMA) looks at spontaneous movements in newborn babies and young infants. It is qualitative, in that it looks at the specific details of HOW a baby moves. We then decide which classification to give a baby's movement at that point in time. Repeated assessments over time show the trajectory of how a baby's movement is developing.
There are two stages to movement that can be assessed in babies:
1. General Movements (GMs): looks at the writhing movements that are spontaneously made in the foetus, newborn and infant
2. Fidgety Movements (FMs): looks at specific small movements that are most easily seen in babies aged 9 - 15 weeks (ie 3 months of age, give or take 3 weeks).
How babies move can predict who is at high risk of neurodevelopmental conditions
"Research over the last 20 years has found that using the qualitative assessment of spontaneous movement in the foetus, newborn and young infant is an early and reliable indicator for diagnosis and prognosis of neurological disorders." (General Movements Trust)
Babies can be assessed from newborn to 4 months using the GMA
To see if the GMA indicates typical or atypical development, clinicians follow:
the trajectory a baby's movement takes over repeated assessments, as they either stay within the same classification or move between classifications. There are trajectories that are typical of babies at at high risk of developing particular neurodevelopmental conditions
whether certain classifications of movement are present in the General Movements stage, as these are indicative of babies at high risk of developing neurodevelopmental conditions
whether Fidgety Movements are present at 3 months of age, as if they are absent this is predictive of babies at at high risk of developing cerebral palsy
whether asymmetrical Fidgety Movements are present at 3 months of age, as if they are present this is predictive of babies at high risk of developing hemiplegic cerebral palsy
Like all clinical assessment, the General Movements Assessment is not absolute. It is a highly useful tool to be used in combination with other clinical assessments performed by your medical and allied health team.
And of course, there are other assessments that can be used both up to 4 months alongside the GMA, and afterwards to track development.
Early identification of babies at high risk of developing cerebral palsy means early intervention
The GMA has a strong role to play in the early identification of babies at high risk of going on to develop cerebral palsy.
This means these babies can be targeted to receive early intervention therapy from 3 months of age, rather than waiting for clear signs of cerebral palsy to appear later on before starting therapy.
Most NICU and SCU teams in Australia use the GMA to assist their decision making and referrals for babies under their care.
The assessment is simple, non invasive, and safe for babies
Babies are lain on their backs, and a video is taken of their movement. The length of time required depends on the age of the baby. Babies born prematurely may need 60 minutes of video, and babies around 3 months of age only a few minutes. The key thing is that we have enough movement recorded to make a classification. Australian research has shown that this is safe to do for babies in NICU, and that they are not adversely affected.
Your clinician then spends time going through the video and the classification criteria and plots this information on a trajectory.
The team behind the General Movements Assessment
The General Movements Assessment (GMA) was developed by Prechtl and his team. The General Movements Trust:
provides training for clinicians, with a final test at the end, to receive a certificate of reliability. This is important in statistical analysis of any assessment, to know that clinicians using the assessment are likely to give the same result for the same baby at the same point in time
supports ongoing research into use of the GMA in assessment, prediction of neurodevelopmental conditions, and to predict the likely severity of these neurodevelopmental conditions. See the research here which have been published in peer reviewed scientific journals.
Babies we see here at Splash Physiotherapy
I will now be able to add this assessment for the babies I see. Examples of when I am asked to see newborns and infants:
follow up of babies born pre term upon discharge from hospital, to supplement services provided in the public system or where they cannot be accessed
when the family has a query or concern about the way their baby is moving, or the way they are using or positioning a body part
a family has been recommended to seek advice and assessment from their Maternal and Child Health Nurse, GP, paediatrician, neonatologist or neurologist
In all these cases,
we do a thorough assessment at your home,
look at strategies to promote your baby's development,
and importantly, integrate them into your day to day life as much as possible. eg. ways to carry your baby, ways to pick them up off the change table etc.
We know caring for a baby is more than a full time job, so integrating practice into things you are already doing helps it to get done, without adding an extra workload for you.
Here's my classmates, thrilled to have passed our final test, and our tutor A / Prof Andrea Guzzetta who travelled over to teach us all the way from Pisa, Italy! There were another 2 classes of people being trained as well. Physiotherapists did dominate, but were joined by occupational therapists, speech therapists, neurologists and neonatologists. A lot of Melbournians, some interstaters, and a whole team from United Arab Emirates. It was a great bunch of people who worked hard together to learn the skills. A big 4 days, relieved to have success at the end of it!
This is the whole group, including all 3 course groups and teachers.
Shayna Gavin is a physiotherapist who is passionate about helping babies, children and young people learn functional skills so they can participate in life at home, school and in their community. Recognising that children do best in their own environments, she visits homes, schools, and leisure activities from football fields to ballet classes. She also has daily aquatic physiotherapy sessions available at two private swimming schools in Moonee Ponds and Greensborough, Melbourne. She combines principles of paediatric physiotherapy, Neuro Developmental Treatment / Bobath, motor learning, Sensory Integration and swimming teaching to address the individual needs of each child and their family. She loves providing professional development to physiotherapists, allied health and education professionals, allied health assistants and swimming teachers.
Images show: (1) Newborn baby wrapped up with hospital ID tag on wrist (2) Infant lying on back looking at camera (3) father holding newborn baby in arms (4) Shayna with classmates and A/Prof Andreas Guzzetta after their final test at the GMA training, Melbourne. Images 1 to 3 under creative commons, from Pixabay. Image 4 shared with us by the GMA teaching team.