It Is Not Too Early: Clinical Implications of Early Spontaneous Movements

The spontaneous movements of the neonate have a long prenatal history: from 8 weeks postmenstrual age onwards the embryo/fetus moves in distinct motor patterns (startles, general movements, isolated limb movements, breathing movements, sucking movements, eye movements etc.). It only takes a few neurons to generate these movements, which are, in turn, necessary for further development of the structure – in other words normal fetal development requires adequate fetal activity. Apart from the general interest in the evolution of early motor activity, the observation and assessment of spontaneous fetal and neonatal motility, particularly of the so-called General Movements (GMs), has also clinical implications, since a reduced modulation of the generating neural networks results in less variable movements and indicates fetal or neonatal compromise.

The Prechtl assessment of spontaneous general movements (GMs) has shown its merit for the evaluation of the integrity of the young nervous system. It is a reliable and valid tool for distinguishing between infants who are at significant risk of developing neuromotor deficits and infants who are not. So-called cramped-synchronized GMs and the absence of fidgety movements (the GM pattern specific for 3 to 4 months after term) are particularly good predictors of cerebral palsy, whereas so-called poor repertoire GMs and abnormal fidgety movements are more likely associated with minor neurological dysfunctions later in life. Only recently, attention shifted to the question whether GM assessment might also shed light on cognitive and language development. Monotonous GMs beyond term age might indicate a high risk for later cognitive dysfunction.