Motor Outcomes in Premature Infants

Maureen Connors Lenke, BS, OTR/L


NAINR. 2003;3(3) 

In This Article

Types of CP

The most common type of CP diagnosed in the premature population is spastic CP. These infants are usually initially hypotonic, with spasticity developing over time. Spasticity is characterized by increased stretch reflexes, resistance to passive movement with a clasp-knife phenomena, ankle clonus, and increased deep tendon reflexes.[9] The major movement blocks that emerge are at the neck and shoulders at 4 months of age and through the hips and pelvis at 9 months of age.

Most premature infants with CP are diagnosed with spastic diplegia.[1] Spastic diplegia involves increased muscle tone that primarily affects the lower extremities, with the upper extremities being less affected. Spastic quadriplegia interferes with the function of both upper extremities and both lower extremities, with spasticity present at all four limbs. Head and trunk control are decreased.

Spastic quadriplegia tends to be evident in the first 6 months of life and is more commonly associated with PVL.[1] Signs of early spastic hemiplegia include decreased spontaneous activity on the affected side, early hand preference, delayed reaching on the affected side, an absent or delayed positive supporting reflex through one leg, and a tendency to only roll to one side.

Athetoid CP, which is characterized by writhing movements, is not typically associated with prematurity.[1] Ataxic CP is relatively rare and is also not typically associated with prematurity.[9] Proximal hypotonia typically is part of the movement disorder associated with spastic CP, but isolated hypotonia as a predominant motor impairment is very rare.[1]


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