第十八屆 早期整體動作評估預測高危險群嬰幼兒一歲動作發展之效度

早期整體動作評估預測高危險群嬰幼兒一歲動作發展之效度

Predictive Validity of Assessment of General Movements during Writhing Period on Motor Development in High-Risk Infants at One Years of Age

徐碧真^1,2、簡珮君^1,3、林永傑⁴

Bih-Jen Hsue^1,2, Pei-Jyun Jian³, Yung-Chien Lin⁴

¹成功大學醫學院物理治療學系暨研究所、²成功大學醫學院附設醫院物理治療中心、

³彰化基督教醫療財團法人彰化基督教醫院物理治療組 ⁴功大學醫學院附設醫院小兒部新生兒科

¹School and Graduate Institute of Physical Therapy, College of Medicine, National Cheng Kung University; ²Physical Therapy Center, National Cheng Kung University Hospital, ³Department of physical therapy, Changhua Christian Medical Foundation Changhua Christian Hospital, Changhua , Taiwan; ⁴Division of Neonatology, Department of Pediatrics, National Cheng Kung University Hospital, ,Tainan, Taiwan

Background and Purpose: Infants with prematurity, low birth weight or hypoxic encephalopathy are at higher risks for developmental disability. Several methods have been used in clinical practice to identify possible developmental problems in order to provide early intervention and prevent further negative sequelae. The Qualitative Assessment of General Movements (GMsA) is a method for detecting the integrity of the central nerve system based on observation of infants’ spontaneous movements with minimal handling. There are limited studies regarding predictive validity of GMsA in writhing period. The purpose of this study is to examine the predictive validity of GMsA in this period on motor development outcome determined by Alberta Infant Motor Scale (AIMS) at 1 year of age.

Methods: Seventy infants who met the inclusion criteria were recruited. Spontaneous movements were recorded by two digital camcorders for one hour. . The GMs was categorized as normal, poor repertoire, chaotic, and cramped-synchronized movements, and further dichotomized to normal and abnormal for the purpose of analysis. Motor development outcome was determined by AIMS at 1 years of age with cutoff point of 10%. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated. Spearman’s correlation coefficient was applied for the neonatal assessments and motor outcome assessed at 1 years.

Results and Discussion: Forty and 30 of participants were classified as normal and abnormal, respectively, in preterm period. GMsA had a fair specificity of 60% and good NPV of 87%, fair sensitivity 58%, poor PPV of 23% and fair accuracy of 59% for predicting motor delay at 1 years of age. Overall, the predictive validity in this period was not satisfactory. The predictive validity found in this study was lower than the findings of other similar studies, and the possible reasons might be the differences in target population, the focuses of outcome measurement, and the age at which outcome was assessed.

Conclusion: This study indicated that the predictive validity of GMsA in writhing period on motor development at 1 years of age was fair. Combination of GMsA and neonatal neurobehavioral examination might be necessary to improve the predictive validity.

Keywords: Qualitative Assessment of General Movements, Infants, Predictive validity, Motor development