Prechtl's Method

1. Movement analysis
Prechtl’s method

2.  First two months - Continuation of foetal behavior
 Third month - Major transformation of many neural
functions occurs, and only then is the young human infant
much more adapted to the requirements of extra-uterin
life (Prechtl 1984a, 1984b)
- Infant’s muscle power increases;
- The body posture changes from a body-oriented to a
space-oriented postural control
(Prechtl 1989a)

3.  With the exception of the developmental delay, the
developing organism is during each developmental stage
adapted to the internal and external requirements
 Each developmental stage must be studied in its own
right and not in relation to later developmental stages
 At different ages we are dealing with qualitatively different
nervous systems

4.  These differences comprise the structure as well as the
functional repertoire

5. Spontaneous movements
 Young human nervous system endogenously, i.e. without
being constantly triggered by specific sensory input,
generates a variety of motor patterns
 Contradicts sherrington

6. General movements
 From the rich repertoire of distinct spontaneous movement
patterns the so-called general movements (GMs)
 GMs involve the whole body in a variable sequence of arm,
leg, neck and trunk movements. They wax and wane in
intensity, force and speed, and they have a gradual
beginning and end.
 Rotations along the axis of the limbs and slight changes in the
direction of movements make them fluent and elegant (Prechtl
1990)

7. Movements
 First movement to be seen is side bending of head
 Seen at 7 ½ weeks of postmenstrual age

8. 9 to 10 weeks postmenstrual age
 Complex and generalised movements occur
 These are the so-called general movements and the
startles

9. 10 to 11 weeks
 Local and isolated
movements of one arm or
leg emerge
 Traditionally, it is
accepted that the early
ontogenetic process goes
from cranial to caudal
 However, motor system
does not follow this rule

12.  6- 9 weeks post terms writhing disappears
 Fidgety GM gradually emerge at the end of 9 weeks
 Fidgety movements are present up to the end of the first
half-year of life
 Intentional and antigravity movements occur and start to
dominate after the end of fidgety movements

13. Preterm General Movements
 No difference can be observed between
foetal and preterm GM
 Neither the increase of the force of
gravity after birth nor maturation has an
influence on the appearance of GMs

14. Writhing
Term and first two months
Small to moderate amplitude and
Slow to moderate speed

15. Fidgety movements
3 months
Fidgety movements are small movements of moderate speed and
variable acceleration, of neck, trunk and limbs, in all directions, continual in
the awake infant ( except during fussing and crying)

16.  General movements change their quality if the nervous
system is impaired
 GMs lose their complex and variable character and have
a poor repertoire, and are cramped-synchronised or
chaotic

17. Recording general movements
 Camera arrangements

19. Scoring

20. Interference with the movement quality
 Skin-to-skin holding, also known as kangaroo care -
shown to be beneficial for the preterm infant
 Drugs
 Septicemia, glucose transport disease, protein
breakdown of muscle tissue affect GM
 Siezures movements are stereotyped (monotonous)

21. Contextual factors
 FM are not affected by proprioceptive loading – Fidgety
movements remain the same even if the infant is
weighted on one side with up to 140 grams per arm and
leg

22. Contextual factors
 Environmental interferences do not change the quality
nor the temporal organisation of fidgety movements
 It is to be noted that the major function of the young
nervous system is to generate spontaneous activity:
spontaneous activity that is robust and relatively
independent of sensory stimulation
 Fidgety movements are a transient but very stable and
predominant feature of the young nervous system

23.  None of the stimuli change the quality of fidgety
movements, however, the temporal organization changes
 For e.g. decrease or stop of fidgety movements last for
about 20 seconds and subsequently followed by an
increase - therefore highly interesting toy must be
avoided

24. Impact of sound and social interference
 Short and unfamiliar sounds up to 88 dB do not influence
the temporal organization of fidgety movements –
implication - one need not necessarily assess the infant
in a quiet room
 Social interference - fidgety movements are not
influenced by social interference

25. Summary
 Fidgety movements may be considered as an age-
specific fine-tuning of the proprioceptive system
 FM are not affected by proprioceptive loading – Fidgety
movements remain the same even if the infant is
weighted on one side with up to 140 grams per arm and
leg

26. Implications
 Early signs of hemiplegia
 Early detection of dyskinetic CP

27. Cerebral palsy

30. Normal