“Implementation of general movements assessment for early detection and treatment of infants at-risk of cerebral palsy – translating evidence into practice in a low resource setting”

Abstract

Background: High-risk infants, particularly those with Cerebral Palsy (CP), face major challenges. Early identification of CP is crucial to reducing the disease burden and initiating early intervention. The General Movement Assessment (GMA) is a gold-standard assessment that is cost-effective, non-invasive, and highly reliable. However, translation into clinical practice remains challenging in low-resource settings. Aims and objective: To implement GMA for at least 80% of the eligible infants accessing the High-Risk Neonatal Follow-up clinic (HRNFC) and assess its contribution to the follow-up rates. Method: This study was conducted in HRNFC from July 2024 to March 2025 and is ongoing. After counselling and consent, eligible infants (37–43 weeks and 9–20 weeks of corrected gestational age (CGA) were enrolled. GMA standard videos were taken, stored securely, and reported by 2 certified assessors, then shared with parents. Infants with absent/ abnormal fidgety were referred for multidisciplinary team (MDT) evaluation. Result: 188 infants were enrolled, and 252 GMA videos were recorded. Since August 2024, GMA enrolment sustained at 80%. 16 infants were identified with absent/ abnormal fidgety movements, and 12(75%) of them accessed MDT services before 5 months of CGA. Follow-up rates improved at 40 weeks (58%-65%; p = 0.1736) and at 3 months (30%-41%; p = 0.0422). 75% of infants accessed MDT before 5 months of CGA (p = 0.0001). Conclusion: GMA was successfully implemented and sustained as part of routine HRNFC. The majority (75%) of the identified infants who were abnormal were enrolled in MDT services before 5 months, with improved follow-up continuity and access to early intervention. The GMA corner setup demonstrates a high cost benefit.