Temporal and spatial localisation of general movement complexity and variation—Why Gestalt assessment requires experience

Aim: General movements’ assessment (GMA), based on Gestalt perception, identifies infants at risk of cerebral palsy. However, the requirement of ample experience to construct the assessor's inner criteria for abnormal movement hampers its widespread clinical use. This study aims to describe details of general movements (GMs) in various body parts and to investigate their association with GMA-Gestalt. Methods: Participants were 24 typically developing infants and 22 very-high-risk infants. GMs were assessed during the writhing (0-8 weeks) and/or fidgety GM phase (2-5 months) by GMA-Gestalt and a semi-quantification of the duration of simple movements and complex movements in various body parts. Results: During both GM phases, the quality of movement often varied within a single assessment, but the degree of complexity and variation of movements in trunk, arms and legs were interrelated (ρ = 0.32-0.84). Longer durations of complex movements in arms and legs (P <.042) were further associated with a better quality in GMA-Gestalt. Head movement was associated with movements in other body parts only in the writhing phase and not associated with GMA-Gestalt during both GM phases. Conclusion: Infants did not show consistently over time and across body parts simple or complex movements. Detailed description of movement characteristics may facilitate the development of computer-based GMA.