Movement Quality Key for Early Preterm Motor Anomaly Detection

A significant longitudinal study, published by EMJ (European Medical Journal), highlights the critical role of assessing movement quality in the early detection of subtle motor difficulties among preterm infants. The findings suggest that focusing on the *quality* of movement can provide more detailed and nuanced insights into an infant's motor development than traditional milestone-based assessments, thereby enabling earlier identification and intervention for potential neurodevelopmental challenges. Preterm birth, defined as birth before 37 completed weeks of gestation, is a major global health concern, affecting approximately 15 million infants worldwide annually. These infants are at a significantly increased risk for adverse neurodevelopmental outcomes, including cerebral palsy, developmental coordination disorder, and other motor impairments, which can persist into childhood and adulthood. Early identification of such problems is paramount, as it allows for timely therapeutic interventions that can substantially ameliorate long-term outcomes. However, current clinical follow-up often relies heavily on motor milestone attainment, which, while important, indicates *whether* a task has been achieved but not *how* it is performed. This limitation means that infants with subtle motor vulnerabilities might appear to meet gross motor expectations, potentially delaying necessary interventions. The study, referenced as Hsieh CH et al. "Relationships between movement quality and motor milestones in preterm infants: A longitudinal study up to 18 months" in *Early Human Development* (2026), followed a prospective cohort of 90 preterm infants. Researchers assessed these infants at corrected ages of 8, 12, and 18 months. To evaluate movement quality, the Infant Motor Profile (IMP) was utilized, a tool designed to capture the qualitative aspects of infant movement. Motor milestone attainment, on the other hand, was measured using the Alberta Infant Motor Scale (AIMS), a widely recognized assessment for gross motor development. The key findings of the study underscore the distinct yet complementary information provided by movement quality assessment. The research observed that extremely to very preterm infants exhibited consistently lower total IMP and adaptability scores at 8 months, lower AIMS scores at 12 months, and lower total IMP, adaptability, fluency, and AIMS scores at 18 months when compared to moderate to late preterm infants. This finding reinforces the known higher vulnerability of more premature infants to developmental issues. Furthermore, the study explored the associations between IMP and AIMS scores longitudinally. At 8 and 18 months corrected age, IMP scores (excluding symmetry) showed a significant positive correlation with AIMS scores, with correlation coefficients ranging from 0.23 to 0.90. This suggests that movement quality and milestone attainment often align at these specific assessment points. However, a crucial and more complex pattern emerged at 12 months, where adaptability and total IMP scores were significantly *negatively* correlated with AIMS scores, with coefficients of -0.57 and -0.26, respectively. This age-dependent variability in the relationship between movement quality and milestone attainment highlights a significant insight: relying solely on milestone achievement might overlook underlying qualitative motor difficulties, especially at certain developmental stages. This distinction is clinically relevant, as infants who seemingly meet gross motor milestones might still present with reduced adaptability, fluency, variation, or other qualitative signs indicative of early motor vulnerability. The implications of these findings for early motor surveillance are substantial. The study advocates for strengthening developmental surveillance in preterm infants by incorporating movement quality assessments. This approach can identify subtle motor characteristics that milestone-based tools may not fully capture. For pediatric, neonatal, and developmental care teams, the study reinforces the importance of evaluating both *what* infants can do (milestones) and *how* they move (movement quality). This research aligns with a growing body of evidence supporting the value of qualitative motor assessments like the General Movements Assessment (GMA). The GMA, a non-invasive and cost-effective method, assesses spontaneous general movements in infants from birth up to 20 weeks corrected age. Abnormal or absent general movements are highly predictive of neurological conditions, particularly cerebral palsy (CP), with predictive values ranging from 95%–98% when combined with neuroimaging. Studies from India have also shown that GMA, including Motor Optimality Score–Revised (MOS-R), performed during the neonatal period and early infancy in preterm infants, is associated with neurodevelopmental outcomes in the first year of life. These qualitative assessments allow for earlier detection of neuromotor deficits, potentially enabling interventions to begin much sooner, which can lead to better outcomes. Integrating movement quality into follow-up programs for preterm infants can help clinicians identify those requiring closer monitoring or timely intervention, even when conventional motor milestones appear reassuring. This comprehensive approach is particularly relevant for countries like India, which face a high burden of preterm births and associated developmental challenges. Improving early detection methods can pave the way for more effective rehabilitation strategies and support systems for these vulnerable infants, ultimately enhancing their quality of life and developmental trajectories. In conclusion, the study published by EMJ provides compelling evidence for the superior detail and early detection capabilities offered by movement quality assessments in preterm infants. It underscores the necessity for healthcare professionals to adopt a holistic approach, moving beyond mere milestone attainment to understand the underlying qualitative aspects of motor development. This paradigm shift holds immense promise for improving the long-term neurodevelopmental outcomes for preterm infants globally, including in India, by facilitating earlier and more targeted interventions.

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