{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:29:51Z","timestamp":1792153791964,"version":"4.4.0"},"reference-count":70,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T00:00:00Z","timestamp":1570147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP 1128871"],"award-info":[{"award-number":["OPP 1128871"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004061","name":"Oesterreichische Nationalbank","doi-asserted-by":"publisher","award":["P16430"],"award-info":[{"award-number":["P16430"]}],"id":[{"id":"10.13039\/501100004061","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Shaw Research Grant in Nursing and Allied Health Professions","award":["A16-0012"],"award-info":[{"award-number":["A16-0012"]}]},{"DOI":"10.13039\/501100004229","name":"Fondazione Pierfranco e Luisa Mariani","doi-asserted-by":"publisher","award":["R15-96"],"award-info":[{"award-number":["R15-96"]}],"id":[{"id":"10.13039\/501100004229","id-type":"DOI","asserted-by":"publisher"}]},{"name":"JSPS KAKENHI","award":["15K11705; 18K10748"],"award-info":[{"award-number":["15K11705; 18K10748"]}]},{"name":"Australasian Cerebral Palsy Clinical Trials Network","award":["1116442"],"award-info":[{"award-number":["1116442"]}]},{"name":"National Health and Medical Research Council of Australia, Centre of Excellence","award":["1153176"],"award-info":[{"award-number":["1153176"]}]},{"name":"National Health and Medical Research Council of Australia, Career Development Fellowship","award":["1108714"],"award-info":[{"award-number":["1108714"]}]},{"name":"Shanghai Municipal Commission of Health and Family Planning","award":["2019SY032"],"award-info":[{"award-number":["2019SY032"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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\u20135 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\u2019s 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 &gt; 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS &gt; 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III\u2013V), 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.<\/jats:p>","DOI":"10.3390\/jcm8101616","type":"journal-article","created":{"date-parts":[[2019,10,4]],"date-time":"2019-10-04T10:54:58Z","timestamp":1570186498000},"page":"1616","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":211,"title":["Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0900-5206","authenticated-orcid":false,"given":"Christa","family":"Einspieler","sequence":"first","affiliation":[{"name":"Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arend F.","family":"Bos","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Center Groningen, Beatrix Children\u2019s Hospital, Division of Neonatology, 9713 GZ Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdalena","family":"Krieber-Tomantschger","sequence":"additional","affiliation":[{"name":"Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elsa","family":"Alvarado","sequence":"additional","affiliation":[{"name":"National Rehabilitation Institute, Cerebral Palsy Department, 14389 Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa M.","family":"Barbosa","sequence":"additional","affiliation":[{"name":"University of Illinois at Chicago, UI Health, Department of Occupational and Physical Therapy, Chicago, IL 60612, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9275-8801","authenticated-orcid":false,"given":"Natascia","family":"Bertoncelli","sequence":"additional","affiliation":[{"name":"University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlette","family":"Burger","sequence":"additional","affiliation":[{"name":"Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Health and Rehabilitation Sciences, Cape Town 8000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2570-1597","authenticated-orcid":false,"given":"Olena","family":"Chorna","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina","family":"Del Secco","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raye-Ann","family":"DeRegnier","sequence":"additional","affiliation":[{"name":"Ann &amp; Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6815-5573","authenticated-orcid":false,"given":"Britta","family":"H\u00fcning","sequence":"additional","affiliation":[{"name":"University Hospital Essen, Department of Pediatrics I, 45122 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jooyeon","family":"Ko","sequence":"additional","affiliation":[{"name":"Daegu Health College, Department of Physical Therapy, 41453 Daegu, Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Lucaccioni","sequence":"additional","affiliation":[{"name":"University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoki","family":"Maeda","sequence":"additional","affiliation":[{"name":"Oita University Faculty of Medicine, Department of Pediatrics, 879-5593 Oita, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viviana","family":"Marchi","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy"},{"name":"Institute of Life Sciences, Scuola Superiore Sant\u2019Anna, 56127 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika","family":"Mart\u00edn","sequence":"additional","affiliation":[{"name":"Children\u2019s Rehabilitation Institute Teleton, 72825 Puebla, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3670-0845","authenticated-orcid":false,"given":"Catherine","family":"Morgan","sequence":"additional","affiliation":[{"name":"The University of Sydney Medical School, Children\u2019s Hospital at Westmead Clinical School, The Discipline of Child and Adolescent Health, Sydney 2050, NSW, Australia"},{"name":"The University of Sydney, Cerebral Palsy Alliance Research Institute, Sydney 2050, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akmer","family":"Mutlu","sequence":"additional","affiliation":[{"name":"Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, 06100 Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4424-7406","authenticated-orcid":false,"given":"Alice","family":"Nogolov\u00e1","sequence":"additional","affiliation":[{"name":"Municipal Hospital of Ostrava, Children \u2019s Department, 72880 Ostrava, Czech Republic"},{"name":"Masaryk University, Faculty of Medicine, 62500 Brno, Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmin","family":"Pansy","sequence":"additional","affiliation":[{"name":"Medical University of Graz, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4753-7246","authenticated-orcid":false,"given":"Colleen","family":"Peyton","sequence":"additional","affiliation":[{"name":"Northwestern University, Department of Physical Therapy and Human Movement Science, Chicago, IL 60611, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian B.","family":"Pokorny","sequence":"additional","affiliation":[{"name":"Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4226-531X","authenticated-orcid":false,"given":"Lucia R.","family":"Prinsloo","sequence":"additional","affiliation":[{"name":"Cerebral Palsy Association Eastern Cape, Port Elizabeth 6001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Ricci","sequence":"additional","affiliation":[{"name":"University of New England\/Maine LEND Program, Portland, ME 04103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lokesh","family":"Saini","sequence":"additional","affiliation":[{"name":"Post Graduate Institute of Medical Education and Research, Department of Pediatrics, Pediatric Neurology Division, Chandigarh 160012, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2415-2899","authenticated-orcid":false,"given":"Anna","family":"Scheuchenegger","sequence":"additional","affiliation":[{"name":"Medical University of Graz, Department of Pediatrics and Adolescent Medicine, Division of Neonatology, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cinthia R. D.","family":"Silva","sequence":"additional","affiliation":[{"name":"Rede SARAH de Hospitais de Reabilita\u00e7\u00e3o, Reabilita\u00e7\u00e3o Infantil, 30510-000 Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Soloveichick","sequence":"additional","affiliation":[{"name":"Lady Davis Carmel Medical Center, NICU Developmental Follow-up Clinic, 34362 Haifa, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6535-661X","authenticated-orcid":false,"given":"Alicia J.","family":"Spittle","sequence":"additional","affiliation":[{"name":"University of Melbourne, School of Health Sciences, Department of Physiotherapy, Parkville 3052, Australia"},{"name":"Murdoch Children\u2019s Research Institute, Parkville 3052, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moreno","family":"Toldo","sequence":"additional","affiliation":[{"name":"Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi 221011, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabiana","family":"Utsch","sequence":"additional","affiliation":[{"name":"Rede SARAH de Hospitais de Reabilita\u00e7\u00e3o, Reabilita\u00e7\u00e3o Infantil, 30510-000 Belo Horizonte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanetta","family":"van Zyl","sequence":"additional","affiliation":[{"name":"Stellenbosch University, Faculty of Medicine and Health Sciences, Department of Paediatrics and Child Health, Cape Town 8000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Vi\u00f1als","sequence":"additional","affiliation":[{"name":"National Rehabilitation Institute, Cerebral Palsy Department, 14389 Mexico City, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Wang","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Fudan University, Department of Rehabilitation, Shanghai 201102, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Yang","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Fudan University, Department of Rehabilitation, Shanghai 201102, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilge N.","family":"Yard\u0131mc\u0131-Lokmano\u011flu","sequence":"additional","affiliation":[{"name":"Hacettepe University, Faculty of Physical Therapy and Rehabilitation, Developmental and Early Physiotherapy Unit, 06100 Ankara, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Cioni","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio","family":"Ferrari","sequence":"additional","affiliation":[{"name":"University of Modena and Reggio Emilia, Department of Clinical and Surgical Sciences for Mothers, Children and Adults, Neonatal Intensive Care Unit, 41124 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3868-0059","authenticated-orcid":false,"given":"Andrea","family":"Guzzetta","sequence":"additional","affiliation":[{"name":"IRCCS Fondazione Stella Maris, Department of Developmental Neuroscience, 56128 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8932-0980","authenticated-orcid":false,"given":"Peter B.","family":"Marschik","sequence":"additional","affiliation":[{"name":"Research Unit iDN, Division of Phoniatrics, Medical University of Graz, 8036 Graz, Austria"},{"name":"University Medical Center G\u00f6ttingen, Child and Adolescent Psychiatry and Psychotherapy, 37075 G\u00f6ttingen, Germany"},{"name":"Karolinska Institutet, Department of Women\u2019s and Children\u2019s Health, Center of Neurodevelopmental Disorders (KIND), 11330 Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,10,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/jamapediatrics.2017.1689","article-title":"Early, accurate diagnosis and early intervention in cerebral palsy. 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