全身运动质量评估对足月脑损伤儿脑瘫发育结局的预测价值

目的 研究全身运动(general movements, GMs)质量评估技术在足月脑损伤儿脑瘫发育结局中的预测价值。方法 回顾性纳入在复旦大学附属儿科医院康复科就诊的足月脑损伤儿55例, 所有研究对象均进行GMs评估并至少有一次不安运动阶段的评估, 随访至1周岁后根据临床神经学表现及Peabody运动发育量表(PDMS-2)明确其运动发育结局, 分析GMs评估对脑性瘫痪发育结局的预测敏感性、特异性、阳性预测值及阴性预测值。结果 纳入研究的55例足月脑损伤儿的GMs评估中, 20例为不安运动缺乏, 35例为不安运动存在。随访结局:1周岁后19例临床诊断为脑性瘫痪, 36例临床诊断为非脑性瘫痪。GMs评估(不安运动阶段)对足月脑损伤儿是否发展成为脑性瘫痪的预测效度为:敏感性89%、特异性92%、阳性预测值85%、阴性预测值94%。结论 GMs评估对于足月脑损伤儿的远期运动发育结局(是否发育为脑性瘫痪)具有良好的预测价值, 作为一种非侵入性、非干扰性的新型神经运动评估工具, GMs评估适合在足月脑损伤儿随访工作中推广应用。

Predictive value of qualitative assessment of general movements for motor developmental outcome (cerebral palsy) in full-term infants with cerebral damage.

Objective To study the predictive value of qualitative assessment of general movements (GMs) for motor developmental outcome (cerebral palsy) in full-term infants with cerebral damage. Methods A total of 55 full-term infants with brain damage were retrospectively included in the Rehabilitation Department of Children's Hospital of Fudan University.All of them received GM assessments at least once during fidgety-movement period and their motor development outcome were determined after 1-year-old by their neurological examination and results of Peabody Developmental Motor Scale-2.Sensitivity, specificity, positive predictive value and negative predictive value of GMs assessment for cerebral palsy were calculated. Results Among the 55 infants with brain damage, 20 infants didn't show fidgety movements while 35 did.After 1-year-old, 19 children were diagnosed with cerebral palsy while 36 children were not.The predictive values of GMs assessment for cerebral palsy were as following: sensitivity 89%, specificity 92%, positive predictive value 85%, negative predictive value 94%. Conclusions The qualitative assessment of GMs has a good predictive value for long-term motor developmental outcome (cerebral palsy) in full-term infants with brain damage.As a new method of non-invasive, non-intrusive neurological assessment, the assessment of general movements is suitable for wide application in follow-ups among full-term infants with brain damage.