Early identification of cerebral palsy using a profile of abnormal motor patterns.
OBJECTIVE
To determine whether a profile of abnormal motor patterns can identify children with cerebral palsy (CP) in the first year of life.


METHODS
The Early Motor Pattern Profile (EMPP) consists of 15 items reflecting variations in muscle tone, reflexes, and movement that have been organized into a standardized format to provide the clinician with an objective picture of neurologic status. A three-point scoring system was applied to each item, delineating a clearly normal response from a clearly abnormal one and placing all partial or inconsistent responses in the middle. Twelve hundred forty-seven high-risk infants who were enrolled in a neonatal intensive care unit follow-up program were examined at 6 and/or 12 months' corrected age using the EMPP. These infants were followed to at least 36 months of age to distinguish those with CP from those with normal motor outcome or minimal impairment (no CP).


RESULTS
Predictive validity of the EMPP at the 6- and 12-month examinations was determined using various pass-fail cutoffs. The optimal cutoff score at 6 months was between 9 and 10, at which the positive predictive value was 89.4, sensitivity was 87.1, and specificity was 97.8. The optimal cutoff score at 12 months was between 3 and 4, at which the positive predictive value was 91.0, sensitivity was 91.5, and specificity was 97.9.


CONCLUSIONS
The EMPP offers the clinician an effective instrument to identify children in the first year of life who are at greatest risk for the development of CP. The EMPP can be incorporated into a routine health maintenance visit, adding only a few minutes to the process, and has high sensitivity and specificity.
Morgan
A M
AM
Department of Pediatrics, University of Illinois at Chicago, College of Medicine at Peoria, USA.
Aldag
J C
JC
D002547:Cerebral Palsy / Q000175:diagnosis*; D016009:Chi-Square Distribution; D002657:Child Development; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D009460:Neurologic Examination / Q000379:methods / Q000706:statistics & numerical data; D011379:Prognosis; D011596:Psychomotor Disorders / Q000175:diagnosis*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013997:Time Factors