Morgan and Aldag evaluated motor patterns in infants using the Early Motor Pattern Profile (EMPP). This can help identify infants who require a more complete evaluation for cerebral palsy. The authors are from the University of Illinois at Chicago in Peoria.
Parameters:
(1) head lag (when pulled from supine to sitting position)
(2) "slip through" (need for lateral pressure to prevent infant from slipping between hands providing support at the axillae)
(3) astasis (weight bearing during supported standing; astasia = motor incoordination with an inability to stand)
(4) hip abduction
(5) ankle dorsiflexion
(6) deep tendon reflexes (DTR) in the ankles
(7) tonic labyrinthine (lift shoulders slightly while supine and look for an effort to flex forward)
(8) asymmetric tonic neck reflex (ATNR)
(9) protective extension
(10) equilibrium while sitting
(11) fisting (hands tightly clenched at rest)
(12) shoulder retraction
(13) tonic extension
(14) scissoring (legs adduction in vertical suspension or supported standing)
(15) equinus (on toes in supported standing)
|
Parameter |
Finding |
Points |
|---|---|---|
|
head lag |
none |
0 |
|
|
<= 30 degrees |
1 |
|
|
> 30 degrees |
2 |
|
slip through |
none |
0 |
|
|
partial |
1 |
|
|
complete |
2 |
|
astasis |
none |
0 |
|
|
partial |
1 |
|
|
complete astasia |
2 |
|
hip abduction |
normal |
0 |
|
|
stiff or loose |
1 |
|
|
complete (abnormal) |
2 |
|
ankle dorsiflexion |
normal |
0 |
|
|
stiff or loose |
1 |
|
|
complete (abnormal) |
2 |
|
deep tendon reflexes at ankle |
1+ or 2+ |
0 |
|
|
0 or 3+ |
1 |
|
|
clonus |
2 |
|
tonic labyrinthine |
resolved |
0 |
|
|
resolving |
1 |
|
|
present all of the time |
2 |
|
ATNR |
resolved |
0 |
|
|
resolving |
1 |
|
|
present all of the time |
2 |
|
protective extension |
normal |
0 |
|
|
emerging |
1 |
|
|
absent |
2 |
|
equilibrium while sitting |
normal |
0 |
|
|
emerging |
1 |
|
|
absent |
2 |
|
fisting |
none |
0 |
|
|
inconsistent |
1 |
|
|
present all of the time |
2 |
|
shoulder retraction |
none |
0 |
|
|
inconsistent |
1 |
|
|
present all of the time |
2 |
|
tonic extension |
none |
0 |
|
|
inconsistent |
1 |
|
|
present all of the time |
2 |
|
scissoring |
none |
0 |
|
|
inconsistent |
1 |
|
|
present all of the time |
2 |
|
equinus |
none |
0 |
|
|
inconsistent |
1 |
|
|
present all of the time |
2 |
total score =
= SUM(points for the 15 parameters)
Interpretation:
• minimum score: 0
• maximum score: 30
• The higher the score the more abnormal the motor pattern.
• A score >=10 at 6 months is abnormal (cutoff between 9 and 10).
• A score >= 4 at 12 months is abnormal (cutoff between 3 and 4)
• An abnormal result is not diagnostic of cerebral palsy. It identifies an infant who should undergo further evaluation.
Performance:
• The sensitivity at 6 months was 87% with a specificity of 98% and a positive predictive value of 89%.
• The sensitivity at 12 months was 92% with a specificity of 98% and a positive predictive value of 91%.
Specialty: Pedatrics, Neurology
