Feasibility of Remote General Movements Assessment (GMA) for Early Recognition and Rehabilitation of Cerebral Palsy in Nepal

Cerebral Palsy (CP) is a syndrome of non-progressive movement and posture disorder caused by damage to the developing brain during pregnancy, delivery or first two years of life. It is the most common form of motor disability in childhood affecting around 2-3 children per 1000 live births. Early intervention started during the first two years of life has been shown to improve functional outcome in children at risk of CP. Novel tools enable early recognition of these children, but access to early diagnosis is limited in Low- and Middle-Income Countries (LMIC), where the majority of affected children live. Facility based studies in Nepal show that many children with CP access rehabilitation first around school age. This missed opportunity results in decreased quality of life for both affected children and their parents.

General Movements Assessment (GMA) is a cheap, non-invasive method for recognizing children at high risk of CP based on observing their spontaneous movements. Already at 3 months’ age it can predict CP with over 90% sensitivity and specificity enabling start of early rehabilitation interventions for children at high risk of CP. Lack of doctors and physiotherapists trained in the methodology has thus far limited its spread to LMIC, but smart phone technology can help to overcome this barrier.

Studies in high-income settings have shown that GMA can be administered remotely using video films recorded by parents at home with help of a smart phone application (app).

Study Aim:

We aim to conduct a follow up study on feasibility of remote General Movements Assessment (GMA) using smart phones at home through an application at Paropakar Maternity and Women’s Hospital (PMWH). Term infants at high risk of CP due to birth asphyxia or neonatal seizures will be recruited for the follow-up.