Prechtl's Method on the Qualitative Assessment of General Movements in Preterm, Term and Young Infants

Description

A quick, non-invasive, non-intrusive and cost-effective method with high reliability and high validity is much in demand for the early detection of neurological anomalies which point to cerebral palsy and developmental deficits later on in life. Over his years as a distinguished developmental neurologist, Heinz Prechtl has devised such a method; a qualitative assessment of general movements (GMs) as a specific predictor for neurological impairments. His method is described in this book. GMs form part of a distinct pattern of movements in preterm babies, term newborns and young infants. They are complex, frequent, and usually of sufficient length. Changes in the normal quality of GMs are a reliable indicator of brain dysfunction. CONTENTS AUTHORS’ APPOINTMENTS ACKNOWLEDGEMENTS INTRODUCTION: HOW IT ALL CAME ABOUT Heinz F.R. Prechtl 1. BASIC CONCEPTS OF DEVELOLOPMENTAL NEUROLOGY The assessment of general movements within the concept of ontogenetic adaption From reflex and tonus testing to observation of spontaneous movements 2. WHAT ARE SPONTANEOUS MOVEMENTS? The evidence of endogenously generated motility The rich movement repertoire: the continuity from prenatal to postnatal life What are general movements? General movements are most probably generated supraspinally General movements change their quality if the nervous system is impaired 3. HOW TO RECORD AND ASSESS GENERAL MOVEMENTS Recording technique Visual Gestalt perception as a scientific tool for general movement analysis Individual developmental trajectories based on longitudinal recordings Two age-specific motor optimality scores for semi-quantitative assessment 4. WHAT COULD INTERFERE WITH THE QUALITY OF GENERAL MOVEMENTS? Developmental care for preterm infants Is general movement assessment under intensive care conditions possible? Effect of drugs on general movement quality Systemic diseases do not mimic brain lesion Avoiding confusion between abnormal general movements and seizures Does sensory stimulation interfere with fidgety movements? 5. HOW OBJECTIVE, RELIABLE AND VALID IS THE GENERAL MOVEMENT ASSESSMENT? Inter-observer agreement and test–retest reliability are very high The validity of the general movement assessment Specific signs predicting cerebral palsy Prediction of neurological deficits other than cerebral palsy 6. THE CLINICAL APPLICATION OF THE METHOD Periventricular leukomalacia (PVL) and flares Intracranial haemorrhage Unilateral lesions Hypoxic ischaemic encephalopathy (HIE) in fullterm infants Chronic lung disease Infantile apnoeas Brain malformations Spina bifida aperta Rett syndrome Intra-uterine growth retardation Maternal diabetes mellitus Early blindness 7. QUANTITATIVE ASSESSMENT IS AN INSENSITIVE INDICATOR OF IMPAIRED INTEGRITY OF THE NERVOUS SYSTEM 8. BRAIN ULTRASOUND AND GENERAL MOVEMENT ASSESSMENT 9. NEUROLOGICAL EXAMINATION AND GENERAL MOVEMENT ASSESSMENT The preterm infant The fullterm infant 10. WHAT OTHER METHODS OF GENERAL MOVEMENT ASSESSMENT EXIST? EPILOGUE REFERENCES INDEX