LACK OF PREDICTIVE VALIDITY OF EARLY NEUROMOTOR DYSFUNCTION IN INFANTS

Abstract

The Movement Assessment Index, a standardized neuromotor examination developed at the University of Washington, Seattle, was used at four months to evaluate four areas: muscle tone, primitive reflexes, automatic reactions and volitional movement. There were 135 infants examined at 4 and 12 months as part of the ICN Follow-up Program. Eighty-two infants (61%) were classified as normal at 4 months, 1 had subsequent evidence of spastic diplegia. Twenty-five (18%) were in the suspicious range, 3 were subsequently found to have cerebral palsy. Twenty-eight (21%) were in the abnormal range, 9 subsequently had cerebral palsy. Developmental outcome was assessed with the Bayley Scales. Seventy-three infants in the normal category at 4 months scored ≥85 at 12 months (89%); 17 infants suspicious at 4 months (68%) and 13 in the abnormal category (46%) were functioning at this level. Ten infants in the abnormal category had MDIs <50 while no infants in the other categories showed such developmental dysfunction. Although there is a linear relationship between neuromotor assessment at 4 months and subsequent 12-month performance across the entire group, the relationship is not sufficient for a clinical prediction in an individual case. Use of 4-month categories would significantly over-identify infants as having neurodevelopmental difficulties at 1 year. Infants incorrectly classified were predominantly prematures who had transient dystonia.

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