Relationship between using MRI, TIMP and GMA to assess neurodevelopment in preterm infants
Peyton C, Yang E, Kocherginsky M, et al. Relationship between white matter pathology and performance on the General Movement Assessment and the Test of Infant Motor Performance in very preterm infants. Elsevier. January 2016:23-27.
Introduction: Clinicians sometimes face difficulty in choosing and administering tests on high-risk preterm infants to determine whether or not they may have a neurological impairment because there are so many tests to choose from. MRI, GMA (General Movement Assessment), and the TIMP (Test of Infant Motor Performance) are three different ways to assess neurological development in preterm infants, and they each have perks and drawbacks. In previous studies, MRIs have been found to predict outcomes based on the amount of white matter is seen in the baby’s brain. More white matter may be correlated with cognitive delay, sensory deficits, and cerebral palsy. However, MRIs do not test motor performance in infants, so they cannot be used alone in determining neurodevelopmental function. The GMA assesses the quality of an infant’s natural movements which have been associated in previous studies to white matter pathologies. One downfall of this test is that it does not test prompted movements of infants, but the TIMP does. In previous studies, the TIMP has predicted developmental delay in infants. There is currently no concurrent validity between the tests.
Purpose: There were 3 purposes to this article. The first was to delve in on the GMA and TIMP at 3 months and see if there was a relationship between them. The second was to see if MRI white matter was related at all to scores on the GMA, and the third was to see if MRI white matter was related at all to scores on the TIMP (both at 10-15 weeks of age).
Methods: This study was done on 53 infants (with parental consent) who were born at 31 weeks or less, weighed less than or equal to 1500 g at birth, and also needed to use oxygen at birth. The assessments included performing an MRI, the GMA, and the TIMP on each participant. The MRI (done after birth) examined the amount of white and gray matter in the infant’s brain, and classified white matter from normal, mild, moderate to severe. The GMA (done at 10-15 weeks post-birth) assessed fidgety movements which were organized as normal, aberrant, sporadic, or absent. The TIMP (done at 10-15 weeks post-birth) was scored as average, low average, below average, and far below average.
Results: All participants showed normal gray matter levels. Seventy-seven percent of participants had normal white matter scores, and 23% had abnormal white matter scores. Seventy-nine percent of participants showed normal fidgety movements with the GMA test, and 21% had aberrant movements. Eighty-nine percent of participants showed normal TIMP scores, and 6% had abnormal scores. Only three infants scored abnormal results on all three tests.
The statistical significance: The infants with abnormal white matter scores were significantly more likely to display aberrant fidgety movements with the GMA and lower TIMP scores.
Infants with aberrant fidgety movements from the GMA were significantly more likely to have lower TIMP scores.
Discussion and Conclusion: These results indicate that there is a relationship between abnormal white matter and abnormal scores on the GMA and TIMP. All three tests are very different and offer clinicians different insight to neurodevelopmental issues that may arise in preterm infants. They may be valuable to use together to provide referrals to early intervention as needed.
Strengths/limitations and overall conclusion of article: I found this article helpful in describing the differences between the three tests and what information each test provides. I think the authors did a great job at detailing their methods and it is very clear what they did, when, and why. However, the article is not an easy read for any lay person and requires more concentration and possibly outside research on clinical terms. The results are also presented in an unorganized fashion, often repeated in other sections of the article. With a little extra digging and working backwards, I was able to comprehend the results, though and overall was a helpful article on the topic. I would recommend this article to people who are having difficulty deciding which test to use to determine neurodevelopment in preterm infants, and how each one may be beneficial.
2 responses to “Relationship between using MRI, TIMP and GMA to assess neurodevelopment in preterm infants”
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Very interesting that this study found a relationship between abnormal white matter and scores on other outcome measures. Great job sorting through a somewhat wordy and complex article to find the most important clinical takeaways. I was previously unaware of what outcome measures there were to assess pre-term infants and these seem like they’d be more feasible and appropriate than conducting an MRI on a pre-term child as well.
When I was reading your summary of this study, I guess that increased white matter would show a correlation to more movement but to more neural pathways; boy was I wrong. I also thought that it was interesting that all of the infants showed normal amounts of grey matter. I think the results of this study can save some facilities money by reducing costs of running tests on infants if their goal is to assess movement.