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Jaundice is a common problem and occurs as a result of the increase in bilirubin level in infants. Infants may be adversely affected by this situation. The aim of this study is to determine whether neonatal jaundice affects the movements and postures of 3- to 5-month-old infants with hyperbilirubinemia and the correlation of motor repertoire at the same age with bilirubin levels. The study group included 30 infants (9 girls, 21 boys) with hyperbilirubinemia and a control group of 30 infants (11 girls, 19 boys) with typical development without hyperbilirubinemia. The motor repertoires of the infants were evaluated through detailed general movement (GM) analysis using video recordings made at 9–17 weeks post-term. The infants with hyperbilirubinemia had lower motor optimality score and subcategory scores (including observed movement patterns, age-adequate movement repertoire, observed postural patterns, and movement character) compared with the control group. The fidgety movement scores decreased as bilirubin value increased in infants.Conclusion: Infants with hyperbilirubinemia had poorer motor repertoire when compared to a control group. For this reason, detailed GM analysis of these infants will predict probable neurodevelopmental problems and infants with needs can begin individualized early intervention suitable for movement repertoire and posture at the earliest time. What is Known:• GMs of infants with hyperbilirubinemia were previously described.• However, the motor repertoires of infants with hyperbilirubinemia were not described in detail.What is New:• Infants with hyperbilirubinemia had poorer motor repertoire when compared to peers.• This is important in determining the need for individualized early intervention.

The aims of this study were (i) to describe the early spontaneous movements in 3-to 5-month-old infants in groups of infants born to mothers with GDM and/or PE, (ii) to compare them, and (iii) to analyze the differences between infants with these risk factors and typically developing infants born to mothers without GDM and/or PE and other risk factors. This cohort study included 255 infants in 4 groups: (i) 96 infants born to mothers with GDM, (ii) 78 infants born to mothers with PE, (iii) 31 infants born to mothers with GDM and PE, and (iv) 50 typically developing infants. Early spontaneous movements, including not only fidgety movements but also concurrent movement and postural patterns, were assessed using the General Movements Assessment (GMA), which determines the Motor Optimality Score-Revised (MOS-R). Comparisons were made using one-way ANOVA for normally distributed continuous variables, Kruskal-Wallis test for non-normally distributed data, and Pearson chi-squared for categorical variables. Univariate logistic regression analyses were used to determine the odds ratios (OR) with 95% confidence intervals (CI). There were no differences between the three groups, which included infants whose mothers had at least one of these risk factors (p>0.05). Infants born to mothers with GDM, infants born to mothers with PE, and infants born to mothers with both GDM and PE had more aberrant fidgety movements, reduced age-adequate movement repertoire, and more abnormal postural patterns than typically developing infants (p<0.05), in addition to lower MOS-R. When looking at those with ≤24 in MOS-R, the odds ratios were ≥2.74. Findings suggest that early spontaneous movements, GMA, may play a crucial role in understanding developmental outcomes of these infants and in determining infants who need early intervention.

Eccentric Chin Closure (ECC) exercise is a model designed to strengthen the suprahyoid muscles, aligned with the principles of eccentric exercise and the characteristics of these muscles. This study aimed to investigate the effects of the ECC exercise on submental muscle activation, muscle strength, dysphagia limit, perceived exertion, and pain, in comparison to the Shaker and Chin-Tuck Against Resistance (CTAR) exercises. In this parallel randomized controlled trial, for the initial assessment fifty-four healthy volunteers aged between 19-28 years with submental activations were recorded during the isotonic components of the Shaker, CTAR, and ECC exercises using surface electromyography. After the initial assessment, the volunteers were randomized to the Shaker, CTAR, and ECC exercise groups with 18 volunteers each group, and followed an 8-week exercise program. Maximum voluntary isometric contractions (MVC), muscle strength, dysphagia limit, perceived exertion, and pain were recorded at baseline in 4th week and 8th week. At the initial assessment, lower submental muscle activation was observed during the Shaker exercise (p<0.05). Follow-up measurements demonstrated that the eight weeks of exercise was effective in increasing MVC activations and muscle strength across all groups. Considering the group*time effect, CTAR (0.36 ± 0.10) and ECC (0.40 ± 0.14) exercises were found to be more effective in increasing MVC than the Shaker (0.29 ± 0.19) exercise (F = 7.203, p<0.001), and the ECC (32.87 ± 6.55) exercise was more effective in improving muscle strength than both the Shaker (26.03 ± 5.86) and CTAR (27.95 ± 6.33) exercises (F = 6.786, p<0.001). Perceived exertion (F = 1.044, p = 0.388) and pain scores (F = 0.346, p = 0.846) showed statistically similar changes across the Shaker, CTAR, and ECC exercise groups. The ECC exercise demonstrated similar effects on MVC to CTAR, but resulted in greater MVC than the Shaker exercise among healthy volunteers at 8 weeks. ECC was also more effective compared to Shaker and CTAR in terms of strength gain, with all exercises showing comparable levels of perceived exertion and pain.

The Prechtl General Movement Assessment (GMA) has become a cornerstone assessment in early identification of cerebral palsy (CP), particularly during the fidgety movement period at 3–5 months of age. Additionally, assessment of motor repertoire, such as antigravity movements and postural patterns, which form the Motor Optimality Score (MOS), may provide insight into an infant’s later motor function. This study aimed to identify early specific markers for ambulation, gross motor function (using the Gross Motor Function Classification System, GMFCS), topography (unilateral, bilateral), and type (spastic, dyskinetic, ataxic, and hypotonic) of CP in a large worldwide cohort of 468 infants. We found that 95% of children with CP did not have fidgety movements, with 100% having non-optimal MOS. GMFCS level was strongly correlated to MOS. An MOS > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III–V), including atypical arching and persistent cramped-synchronized movements. Asymmetrical segmental movements were strongly associated with unilateral CP. Circular arm movements were associated with dyskinetic CP. This study demonstrated that use of the MOS contributes to understanding later CP prognosis, including early markers for type and severity.

Background. The preschool years constitute a critical period during which significant changes are experienced in the acquisition of locomotor skills due to maturation of the nervous system. Our aim was to investigate the developmental parameters and physical fitness in preschool children with Minor Neurological Dysfunction (MND). Methods. The study was carried out in 212 preschool children without any known health problems. Sociodemographic characteristics of children were recorded. Denver Developmental Screening Test (DDST) II, Touwen Neurological Examination, and Preschool Physical Fitness (PREFIT) test battery were used to assess developmental parameters, neurological status, and physical fitness, respectively. Results. There was a statistical difference in the physical fitness and developmental parameters in preschool children with MND compared with healthy peers (p < 0.05). There was also a relationship between physical fitness and developmental parameters (p < 0.05). Conclusions. Early identification of problems in developmental parameters and physical fitness in preschool children with MND might help to implement early supportive physiotherapy and rehabilitation.

Background Researchers have attempted to automate the spontaneous movement assessment and have sought quantitative and objective methods over the past decade. The purpose of the study was to present a quantitative assessment method of spontaneous movement using center-of-pressure (COP) movement analysis. Methods A total of 101 infants were included in the study. The infants were placed in the supine position on the force plate with the cranial-caudal orientation. In this position, the recording of video and COP movement data were made simultaneously for 3 min. Video recordings were used to observe global and detailed general movement assessment (GMA), and COP time series data were used to obtain quantitative movement parameters. Results According to the global GMA, 13 infants displayed absent fidgety movements (FMs) and 88 infants displayed normal FMs. The binary logistic regression model indicated significant association between global GMA and COP movement parameters (chi-square = 20.817, p  < 0.001). The sensitivity, specificity, and overall accuracy of this model were 85% (95% CI: 55–98), 83% (95% CI: 73–90), and 83% (95% CI: 74–90), respectively. The multiple linear regression model showed a significant association between detailed GMA (motor optimality score-revised/MOS-R) and COP movement parameters (F = 10.349, p  < 0.001). The MOS-R total score was predicted with a standard error of approximately 1.8 points (6%). Conclusions The present study demonstrated the possible avenues for using COP movement analysis to objectively detect the absent FMs and MOS-R total score in clinical settings. Although the method presented in this study requires further validation, it may complement observational GMA and be clinically useful for infant screening purposes, particularly in clinical settings where access to expertise in observational GMA is not available.

To examine the impairments, activity limitations, and participation restrictions in children with spastic unilateral and bilateral cerebral palsy (CP). We investigated the relationship between these factors according to the international classification of functioning, disability, and health (ICF) model. Methods: This prospective cross sectional study included 60 children aged between 4-18 years with spastic CP (30 unilateral, 30 bilateral involvement) classified as Levels I and II on the gross motor function classification system. Children had been referred to the Pediatric Rehabilitation Unit in the Department of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey between March 2014 and March 2015. The Physician Rating scale was used to assess body functions and structures. The Gillette Functional Assessment Questionnaire 22-item skill set, Pediatric Functional Independence Measure, and Pediatric Outcomes Data Collection Instrument were used to assess activity and participation levels. Results: There was a significant positive correlation between impairments and activity limitations (r=0.558; p=0.000), as well as between activity limitations and participation restrictions (r=0.354, p=0.005). Conclusion: These results show that activity limitations in children with unilateral and bilateral ambulatory CP may be related to their impairments and participation restrictions, although the sample size of our study is not large enough for generalizations. Overall, our study highlights the need for up-to-date, practical evaluation methods according to the ICF model.

Background. Cri du chat syndrome (CdCS) is a rare orphan genetic disorder. Infants with CdCS have a neurodevelopmental dysfunction, but there are limited studies on their spontaneous movements or effect of the early interventions in children with CdCS. This study aimed to describe early spontaneous movements and investigate the effects of an early intervention in an infant with the CdCS. Case. We analyzed the detailed general movements assessment (GMA) of an infant with CdCS at 14 weeks, and the Bayley Scales of Infant and Toddler Development-third edition (Bayley-III) were used for the determining and the follow-up of developmental functioning at 14 weeks, 6 months and 12 months. The infant was included in an early intervention beginning from 14 weeks. Fidgety movements were absent. The motor repertoire appeared significantly reduced, and the movement character was monotonous at 14 weeks. Although the infant achieved some developmental milestones with the early intervention program, the improvements were not reflected in the Bayley-III composite score. Conclusions. As a consequence, abnormal GMA results, including fidgety movements and concurrent movement patterns, seen in CdCS can be associated with early signs of neurodevelopmental dysfunction. Early intervention programs in infants with genetic disorders could help enable the early achievement of motor milestones.

This study was performed to assess the neurological status of high-risk infants by \"general movements\" (GMs) method and to compare it with the findings of standard clinical neurological examination and neuroimaging findings during the early rehabilitation period. Neurodevelopmental examination was performed by a neonatologist at the corrected ages of 40 weeks, and 3, 6 and 12 months. Assessment of the physiotherapist included video recording of \"Prechtl Analysis of GMs\" from the first week of life to the corrected age of 5 months. All infants underwent an early physiotherapy program, and follow-up examinations continued until 12 months. A percentage of agreement of 0.86 was found between cranial ultrasound imaging results and GMs and of 0.78 between neurological examination and GMs. Prechtl analysis was found to be important for detecting neurological dysfunction and differentiating normal neurological development in high-risk infants during the early intervention period. This analysis can be used complementary to other diagnostic and imaging techniques in the follow-up of preterm infants.

This study aimed to analyze spatiotemporal gait characteristics of preterm children from 3 to 4 years of age according to different gestational age groups and to examine the relationship between the detailed general movements assessment and spatiotemporal gait characteristics. A total of 74 preterm children, 32 extremely preterm and very preterm (EP-VP, < 32 weeks gestational age) and 42 moderate to late preterm (MLP, 32 to < 37 weeks gestational age), were included in this prospective study, along with 38 term children. Early spontaneous movements of preterm children were assessed from videos at 9–20 weeks post-term according to the general movements assessment, which determines the Motor Optimality Score-Revised (MOS-R). The spatiotemporal gait characteristics of all children were evaluated using the GAITRite ® electronic walkway at self-selected walking speeds. EP-VP children walked with shorter step lengths ( p  = 0.039), and MLP children walked with greater step length variability ( p  = 0.003) than their term peers. The MOS-R results were related to step length ( r  = 0.36, p  = 0.042), step length variability ( r  =  −0.56, p  = 0.001), and base of support ( r  =  −0.37, p  = 0.038) in EP-VP children. The MOS-R subcategories, age-adequate movement repertoire, and postural patterns were related to some of the spatiotemporal gait characteristics, including step length, step length variability, and base of support ( p  < 0.05).   Conclusion : EP-VP and MLP children might catch up to their term peers at 3 to 4 years of age in terms of most gait parameters. In addition to the MOS-R, age-adequate movement repertoire and postural patterns of preterm children without cerebral palsy in early life may be a marker of later neurodevelopmental dysfunction. What is Known: • Preterm children walk with a wider step width, a greater step length asymmetry and step time, and a shorter stride length at 18 to 22 months of age compared with term children at a self-selected speed, while these differences disappear in children 4.5–5 years old and older. What is New: • Early spontaneous movements were related to some spatiotemporal gait characteristics. • Preterm children might catch up to term children at 3–4 years of age in spatiotemporal gait characteristics while walking at a self-selected speed.