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 3-5 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's 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 > 14 was most likely associated with GMFCS outcomes I or II, whereas GMFCS outcomes IV or V were hardly ever associated with an MOS > 8. A number of different movement patterns were associated with more severe functional impairment (GMFCS III-V), 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.

Ann and Robert H Lurie Children's Hospital of Chicago Chicago IL 60611 USA

Cerebral Palsy Association Eastern Cape Port Elizabeth 6001 South Africa

Children's Hospital of Fudan University Department of Rehabilitation Shanghai 201102 China

Children's Rehabilitation Institute Teleton 72825 Puebla Mexico

Daegu Health College Department of Physical Therapy 41453 Daegu Korea

Hacettepe University Faculty of Physical Therapy and Rehabilitation Developmental and Early Physiotherapy Unit 06100 Ankara Turkey

Institute of Life Sciences Scuola Superiore Sant'Anna 56127 Pisa Italy

IRCCS Fondazione Stella Maris Department of Developmental Neuroscience 56128 Pisa Italy

Karolinska Institutet Department of Women's and Children's Health Center of Neurodevelopmental Disorders 11330 Stockholm Sweden

Kiran Society for Rehabilitation and Education of Children with Disabilities Varanasi 221011 India

Lady Davis Carmel Medical Center NICU Developmental Follow up Clinic 34362 Haifa Israel

Masaryk University Faculty of Medicine 62500 Brno Czech Republic

Medical University of Graz Department of Pediatrics and Adolescent Medicine Division of Neonatology 8036 Graz Austria

Municipal Hospital of Ostrava Children 's Department 72880 Ostrava Czech Republic

Murdoch Children's Research Institute Parkville 3052 Victoria Australia

National Rehabilitation Institute Cerebral Palsy Department 14389 Mexico City Mexico

Northwestern University Department of Physical Therapy and Human Movement Science Chicago IL 60611 USA

Oita University Faculty of Medicine Department of Pediatrics 879 5593 Oita Japan

Post Graduate Institute of Medical Education and Research Department of Pediatrics Pediatric Neurology Division Chandigarh 160012 India

Rede SARAH de Hospitais de Reabilitação Reabilitação Infantil 30510 000 Belo Horizonte Brazil

Research Unit iDN Division of Phoniatrics Medical University of Graz 8036 Graz Austria

Stellenbosch University Faculty of Medicine and Health Sciences Department of Health and Rehabilitation Sciences Cape Town 8000 South Africa

Stellenbosch University Faculty of Medicine and Health Sciences Department of Paediatrics and Child Health Cape Town 8000 South Africa

The University of Sydney Cerebral Palsy Alliance Research Institute Sydney 2050 NSW Australia

The University of Sydney Medical School Children's Hospital at Westmead Clinical School The Discipline of Child and Adolescent Health Sydney 2050 NSW Australia

University Hospital Essen Department of Pediatrics 1 45122 Essen Germany

University Medical Center Göttingen Child and Adolescent Psychiatry and Psychotherapy 37075 Göttingen Germany

University of Groningen University Medical Center Groningen Beatrix Children's Hospital Division of Neonatology 9713 GZ Groningen The Netherlands

University of Illinois at Chicago UI Health Department of Occupational and Physical Therapy Chicago IL 60612 USA

University of Melbourne School of Health Sciences Department of Physiotherapy Parkville 3052 Australia

University of Modena and Reggio Emilia Department of Clinical and Surgical Sciences for Mothers Children and Adults Neonatal Intensive Care Unit 41124 Modena Italy

University of New England Maine LEND Program Portland ME 04103 USA

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