(104) Implementation of GMA Across Large Hospital System for Access to Early Detection for All Infants

Background: Early detection of cerebral palsy (CP) using evidence-based assessments was recommended in 2017. Prechtl’s General Movement Assessment (GMA) can be assessed at < 5 months of age and is one of the tools with the best predictive validity for determining if an infant will develop CP or other motor impairments. General movements and atypical findings vary by age and are categorized by certified raters. Detailed Motor Optimality Scores (MOS-R) are also scored to assess movement, posture patterns, and movement quality. The MOS-R has been shown to differentiate infant risk status for a range of adverse neurodevelopmental outcomes.

Objectives: Our objective is that all appropriate patients at Ann & Robert H. Lurie Children’s Hospital of Chicago (LCH) will have access to the GMA to support screening for neuromotor deficits. We created a multidisciplinary “Early Detection Team” including GMA certified members from outpatient, inpatient and Early Childhood Clinic and implemented a protocol for use of GMA across all settings. Early identification allows for appropriate intervention to improve functional outcomes.

Design/Methods: LCH is a pediatric specialty hospital providing skilled services for high-risk infants across settings including a level IV NICU, acute care, follow up clinics and multiple outpatient therapy centers. GMA was made accessible across all settings to infants receiving OT or PT. Our "Early Detection Team" started in 2019 with 8 certified GMA clinicians; currently there are 24 dedicated raters. Therapists, clinic nurses, neonatal practitioners and physicians are educated on inclusion criteria, recording and uploading videos. A secure drive for video storage and data was created. At least 2 GMA certified raters score videos, with a third confirmation rater if severe abnormalities (cramped synchronous or absent/sporadic fidgety movements) are noted. MOS-R is completed for all videos taken at 3-5 mos. Feedback to the clinical team is provided.

Results: In 2019, 69 GMAs were rated, increasing annually to 413 videos in 2024. The process evolved to ensure all appropriate infants receive GMA and follow-up videos as needed regardless of location. Since implementation, 108 children have been diagnosed with CP at an average of 9.6 months within our NICU- ICU-CCU graduates.

Conclusions: The implementation of early detection screening using the GMA was successful across a large medical center. We demonstrated that this process can be implemented on a substantial scale with a core group of dedicated raters.