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Posture, spontaneous movements, and behavioural state organisation in infants affected by brain
Fabrizio Fermi”‘“, Heinz F.R. Prechtl”, Giovanni Cionib, M. Federica Roversi”, Christa Einspieler”, Claudia Gallo”,
Paola B. Paolicellib, Giovanni Battista Cavazzutia “Institute of Paediatrics and Neonatal Medicine, University of Modena, Modem, Ztuly
bStelZa Man’s Scientific Znstitute and INPE University of Piss, Piss, Italy ‘Institute of Physiology, University of Graz, Graz, Austria
Received 10 June 1997; accepted 27 August 1997
Posture, quantity of spontaneous movement patterns, quality of general movements (GMs), and behavioural state organisation were studied in nine infants affected by documented brain malformations. A single 1 h video recording of five infants and two or more serial video recordings of another four infants were performed after birth. The graphic representation of single movement patterns (actogram) and of behavioural states of one video recording was performed in eight out of nine infants. The quality of GMs was assessed according to Prechtl’s method in all video recordings. All nine infants showed a less variable posture than normal newborn infants and an unusual resting posture was detected in seven infants. Poor behavioural state organisation without sleep cycles was common to the nine infants and excessive wakefulness was observed in six infants. As for the quantity of single movement patterns, six infants lacked one or two movement patterns normally present in healthy newborn infants. An abnormal quality of GMs was noted in all nine infants and distinct motor abnormalities were observed in single infants. A monotonous and sometimes stereotyped sequence of different body parts involved in the movement (i.e. poor repertoire GMs) was common to all infants. In the four infants of whom two or more video recordings were available, initial poor repertoire GMs were followed by a further deterioration in movement quality. No relationship was found between the quantity of defective brain tissue, lack of a specific part of the brain, type and severity of GM and posture abnormalities. 0 1997 Elsevier Science Ireland Ltd.
*Corresponding author. Tel.: + 39 59 422178; fax: + 39 59 424583; e-mail: ferrarif@C220.unimo.it
0378-3782/97/$17.00 0 1997 Elsevier Science Ireland Ltd. All rights reserved. PZZ SO378-3782(97)00095-9
88 F. Ferrari et al. I Early Human Development 50 (1997) 87-11.3
Key~ods: Newborn infant; Brain malformation: Spontaneous movements; General movement quality; Posture; Behavioural states
A number of studies on fetuses and newborn infants [ 1,3,4,9,11,17,19,22,24] have shown that spontaneous motor activity is affected by brain lesions or impairment. Of the whole motor repertoire, attention has been focused on a specific motor pattern i.e. general movements (GMs) which, when observed repeatedly, can be used as an early marker for brain dysfunction . GMs are gross body movements involving head. trunk and limbs with variable amplitude, speed, and force: they can be recognised in fetal life from 9-10 weeks postmenstrual age (PMA)  onwards, and after birth the! continue to be present until 16-20 weeks post-term age [ 171.
In the case of brain damage a number of GM abnormalities have been recognised. namely poor repertoire of GMs, cramped-synchronised GMs and chaotic GMs 191 (for definitions see below). The most severe lesions (i.e. extensive cystic periventricu- lar and/or subcortical leukomalacia, severe hypoxic-ischaemic encephalopathy ) are usually accompanied by the cramped-synchronized GM t:ype [4.9,19]. Less severe lesions, like germinal matrix/intraventricular haemorrhages (GMH-NH) and/or non-cystic leukomalacia, as well as localised periventricular leukomalacia with small cysts, are usually accompanied by poor repertoire GMs of variable duration [4,9,19]. Chaotic GMs are also observed transiently in Iarge GMH-IVHs and in anencephalic fetuses [9,24]. From previous findings it is evident that fetuses with major brain malformations will not produce GMs of normal quality.
Which are the motor abnormalities, if any, observed in infants affected by more 111 less severe brain malformations?
The present study examines posture, spontaneous movements and behavioural srate organisation in infants affected by distinct brain malformations.
The following questions are specifically addressed:
1. what is the repertoire of spontaneous movements and postures in a variety of brain malformations?
2. does the lack of specific parts of the brain specifically influence GM quality and posture?
3. is there a relationship between the quantity of defective brain tissue and the degrw of abnormality of GMs?
4. is the state organisation affected in infants with brain malformations?
Posture, quantity of spontaneous movement patterns, quality of general move- ments, and behavioural state organisation were studied in 6 full-term and in 3 preteml infants selected on the basis of documented brain malformation. All the infants were born between 1985 and 1996 either in Modena or in Pisa. Parents gave their informed consent for the video recordings. Clinical data of the cases are provided in Table 1.
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