UBC Theses and Dissertations
The validity of the "Eight month movement assessment of infants" as a predictor of motor outcome in extremely low birth weight infants Kaye, Liisa
With improvements in neonatal intensive care, more extremely low birth weight (ELBW) infants are surviving and are followed in developmental clinics from birth to adulthood. Early research with this population describes increasing frequencies of motor handicaps with decreasing birth weight. Although identification of major and subtle motor disabilities in these ELBW infants remains complex and difficult, it is important so that therapeutic interventions can be initiated at an early stage of the infants' development. In 1980, three therapists working with ELBW infants in a follow-up clinic designed the Movement Assessment of Infants (MAI),to be used for early identification of motor dysfunction in this population. The MAI has two profiles, a four month profile and an eight month profile. Since its publication, research evaluating the MAI has used the four month profile. Although this profile has been shown to be a reliable measure, it has not been found to be predictive of long term motor outcome in ELBW infants. There is little research reporting the predictive validity of the eight month profile. The major purpose of this study is to determine whether the eight month MAI profile is predictive of motor outcome at four and a half years in ELBW infants. In addition, the predictive ability of another eight month measure, one which is based on clinicians' subjective ratings of neuromotor status (NMS), is investigated. The seventy-two infants included in this study were cared for in the Special Care Nursery at British Columbia's Children's Hospital and were followed in the Neonatal Follow-up Clinic Assessment tools were administered at eight months corrected chronological age (corrected for prematurity) and again at four anda half years by the clinic occupational therapist. The eight month assessment included the MAI and the NMS. Outcome assessments administered at four and a half years included the Peabody Developmental Motor Scale-Fine Motor Subtest, Gross Motor Screening Items and another NMS rating. Finally, all infants were given a neurological assessment by the clinic paediatrician to diagnose cerebral palsy (CP) and identify any other medical problems. The ability of the eight month MAI and NMS to correctly identify infants with CP was determined using sensitivity and specificity analyses. The ability of the eight month measures to predict fine motor outcome at four and a half years was determined using Spearman's rank correlations. Finally, using a multivariate approach, the eight month measures were correlated with all four and a half year outcome measures using canonical analysis. Analyses revealed that the eight month NMS had both higher sensitivity and specificity than the MAI in identifying CP in ELBW infants. The eight Month MAI was not predictive of fine motor outcome at four and a half years, but was predictive of gross motor outcome. Finally, the eight month NMS rating was the best predictor of both fine and gross motor outcome at four years.
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