By Emily Leclerc | Waisman Science Writer
At a Glance:
- Atypical Infant Movements & Cerebral Palsy Risk – Certain movement patterns in infants who have had a brain injury (like a stroke or hemorrhage) may indicate a higher likelihood of developing cerebral palsy.
- Brain Connectivity May Play a Role – Researchers studied brain pathways in infants and found that differences in white matter connectivity across multiple brain regions—not just motor-specific pathways—could be linked to these atypical movements.
- Future Research Could Improve Early Detection – The findings suggest new ways to identify early signs of neurodevelopmental impairment, which could lead to better biomarkers and earlier interventions for infants at risk.
Brain connectivity differences linked to atypical infant movements may aid the early prediction of cerebral palsy development after a perinatal brain injury, a new Waisman Center study shows.
Atypical movements can be used to predict the likelihood of infants developing cerebral palsy after a perinatal brain injury such as a stroke or hemorrhage. Differences in the integrity of brain pathways may be associated with developing these atypical movements, the Waisman study shows, potentially leading to the development of new biomarkers of early neurodevelopmental impairment.
Cerebral palsy (CP) is the most common lifelong motor disability, often caused by an early brain injury. Early identification of infants at risk for CP and timely access to interventions are essential for improving long-term outcomes.
A motor assessment called the General Movements Assessment (GMA) is a clinical tool that looks at spontaneous infant movement patterns and can be predictive of whether a child will develop CP after experiencing a brain injury around the time of birth. “Even though it is very strongly predictive, we still don’t really have a clear sense of how and why these different patterns of general movements are emerging in the first place,” says Ellen Sutter, PT, DPT, PhD, who was the lead author on the study.
This new study, from the lab of Director Bernadette Gillick, PhD, MSPT, PT professor of pediatrics and developmental pediatrics and rehabilitation medicine, looked at the relationship between findings from the GMA and brain connectivity in infants with perinatal brain injury using magnetic resonance imaging (MRI) to further understand how the atypical movements emerge.
Using infant-specific neuroimaging methods developed at the Waisman Center, the researchers looked at white matter integrity in infants with and without a perinatal injury. “White matter pathways are the communication pathways of the brain. And it has generally been thought that many brain regions might be implicated in these [atypical] movements,” Sutter says. “So, looking at the connections between [different brain regions] felt like a natural focus for this work.”
Due to its role in motor function and vulnerability to injury, the group looked specifically at integrity of the corticospinal tract but also assessed broader white matter networks.
They found no differences in the integrity of the corticospinal tract between infants with and without typical movements. However, infants who showed different patterns of spontaneous movements on each side of their bodies – or asymmetric spontaneous movements – also showed greater asymmetry of the tract between brain hemispheres. “Infants who have asymmetries in their spontaneous movements are more likely to develop either asymmetric or unilateral cerebral palsy,” Sutter explains.
White matter integrity across several brain regions differed between infants with typical and atypical movements, suggesting that more global whole brain connectivity plays a role in the development of these movements.
Future research from the Gillick lab will look at some of these connections in more detail and at different ages, and determine if these differences in brain white matter can also be predictive of CP development after a perinatal brain injury. ‘We are at a crucial moment in exploring the early diagnosis and resultant early intervention for these children at this highly neuroplastic time in their lives. These discoveries can impact children throughout their lifespan, improving quality of life substantially.’ Dr. Gillick stated.
This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke (R01HD098202), the National Institute of Mental Health (R00MH110596), and the Foundation for Physical Therapy Research Promotion of Doctoral Studies I and II Scholarships. This work was supported in part by a core grant to the Waisman Center from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (P50 HD105353) and an NIH High-End Instrumentation grant (S10 OD030415).