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Übersicht

Die Bedeutung fötaler und neonataler Motorik für die kindliche Entwicklung und die Früherkennung von Entwicklungsstörungen

Published Online:January 11, 2021https://doi.org/10.1026/0942-5403/a000323

Abstract

Zusammenfassung.Theoretischer Hintergrund: Die von Central Pattern Generators (CPGs) generierten Bewegungen des Neugeborenen und jungen Säuglings haben eine lange pränatale Vorgeschichte. Fragestellung: Welche Bedeutung hat die Analyse der CPG-Aktivität, besonders der General Movements (GMs) in der entwicklungsneurologischen Diagnostik? Methode: Unsere Übersichtsarbeit bezieht sich auf Prechtl’s General Movement Assessment (GMA), das ab dem Frühgeborenenalter bis zum Ende des 5. Monats nach einer Termingeburt anwendbar ist. Ergebnisse: Das GMA ermöglicht die Vorhersage einer Zerebralparese mit einer Sensitivität von 98 % und einer Spezifität von 91 %. Abnormale cramped-synchronized GMs sind ein früher Marker für spastische Zerebralparesen. Das Fehlen von Fidgety Movements (im 3.–5. Monat) weist auf alle Formen der Zerebralparese hin und kann auch bei bestimmten genetischen Erkrankungen auftreten. Zwei von drei Säuglingen mit einer späteren Diagnose Autismus haben atypische GMs und fallen vor allem durch ihre Monotonie in den Bewegungen auf. Diskussion und Schlussfolgerung: Mittels GMA lassen sich mit großer Treffsicherheit typische Entwicklungsverläufe vorhersagen oder aber ein Risiko für einen atypischen Verlauf erkennen und somit frühzeitige Interventionen einleiten.


The Significance of Fetal and Neonatal Spontaneous Movements for Development and Early Identification of Developmental Disorders‍‍

Abstract.Theoretical Background: The human neonate presents a continuum of motor patterns extending from prenatal to early postnatal life. Independent of any external and sensory input, central pattern generators (CPGs) engender a variety of distinct spontaneous movements from the 8‍‍‍‍‍‍‍‍‍th week postmenstrual age onward. These gradually emerging patterns in the fetus include side-to-side movements of the head, startles, breathing movements, hiccupping, stretching, yawning, sucking, swallowing, eye movements, blinking, smiling, as well as the isolated head, arm, or leg movements. Among the rich repertoire of early spontaneous movement patterns, the general movements (GMs) appear most frequently and are more complex. GMs involve the entire body. They are variable flows of elegant and smooth arm, leg, neck, and trunk movements, evidencing the integrity of the developing nervous system. Around the 3rd month postterm age, a distinct transformation occurs. GMs appear as fidgety movements (FMs), referring to the continuous small-amplitude movements of shoulders, wrists, hips, and ankles in all directions and of variable accelerations. FMs gradually fade out after 5 months of age, when voluntary movements become dominant. Objective: This review aims to examine the significance of CPG-generated GMs in neurodevelopmental diagnostics. Method: We summarize the clinical research on the Prechtl general movements assessment (GMA), a diagnostic tool applicable from preterm to 5 months of age. Results: The existing studies revealed that the presence of normal, variable GMs is indicative of typical brain development in general, whereas atypical, monotonous GMs, especially the absence of FMs, is highly suggestive of an adverse neurological development. GMA enables the prediction of cerebral palsy with remarkable sensitivity (98 %; 95 % CI [74, 100]) and specificity (91 %; 95 % CI [83, 93]). In particular, the abnormal cramped-synchronized GMs at perinatal age and the absence of FMs at 3 – 5 months are reliable markers for cerebral palsy. Not only infants with an early brain injury, but also infants with various genetic disorders (e. g., Rett syndrome, Down syndrome, Smith–Magenis syndrome) might not develop FMs. Additionally, the quality of GMs is related to the cognitive outcomes of infants born preterm. GMA has recently been extended to the field of autism spectrum disorders (ASD). Two thirds of infants with a later diagnosis of ASD display atypical GMs and are notable for their monotony in movements. Discussion and Conclusion: GMA has repeatedly proven to be a sensitive readout of the integrity of the developing brain. Especially in regions of limited resources, GMA is highly beneficial in providing a cost-effective and reliable neurodevelopmental diagnosis. GMA plays a critical part in identifying infants with neurological impairments in the very first months of life where early targeted interventions are most efficient and effective.

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