Concepts in Fetal Movement Research

Joyce W Sparling

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781135837952
• Edition: 1
• Topic: Medicine
• Subtopic: Occupational Therapy

Here is an informative book that provides theoretical perspectives on the study of fetal movement and introduces observational assessments that can be used in fetal research. It provides research tools that can be used to delineate early patterns of movement, preparing therapists for neonatal intervention and leading to a better understanding of functional activity of the fetus. Concepts in Fetal Movement Research describes various ideas in fetal development and contains original research on a variety of topics, including:

• the way in which events experienced in utero help neonatal interaction with parents
• inductive and deductive approaches to assessment development
• scapular movement
• activity/inactivity of the 12-20 week old fetus
• two different research tools for assessing fetal movement.
• future directions for research by physical therapists in collaboration with other researchersResearchers, clinicians, obstetricians, radiologists, sonographers, and neonatologists will all find this book full of helpful information. Concepts in Fetal Movement Research is an invaluable guide for both their research and their day-to-day work with patients.

Q-MOVE:
Development of a Qualitative Assessment
of Fetal Movement

Sandra Green
Joyce W. Sparling

SUMMARY. The study of fetal movement has been characterized in qualitative and quantitative ways. This paper clarifies the use of the term “qualitative” and describes previously developed qualitative assessments of movement. Based on Laban’s, Kestenberg’s and AP’s theories of movement analysis and their terminology, the process of developing a qualitative scale to assess fetal movement is described. The components of the instrument are presented and future use of the research tool are suggested.

Normal human fetal movement, spontaneous and reflexive, is observed at 7.5 weeks gestational age (GA). Coordination of movements into identifiable patterns occurs at least by 15–20 weeks gestational age.^{1, 2} Qualitative differences in these complex, spontaneous

fetal movements have been used as indicators of neurological status.^{3, 4} The most sensitive indicators of neural integrity, accortading to Prechtl, are gross “general” movements involving the whole body. General movements in the normal healthy fetus are “fluent and elegant,” creating an “impression of complexity and variability.”^{3, p153}

The subtle underlying kinetic components of complex spontaneous fetal movements have received limited examination because of the lack of adequate motor assessments and the two-dimensional nature of images. The purpose of this paper is to describe the systematic process of developing a theory-based movement assessment designed to differentiate the qualitative characteristics of early human movement. Our analysis differs from previous fetal movement research in its deductive application of a movement analysis system to organize observations. The result of this approach is the Qualitative Assessment of Fetal Movement (Q-MOVE). In this paper, movement quality is defined, previous work on assessing fetal motor quality is reviewed, and four movement analysis systems are described. One of these systems is applied to the formation of the Q-MOVE.

MOVEMENT QUALITY

The quality of a motion is the way in which a movement takes place, the “how” or style of a movement. Any movement or sequence of movements may be expressed in a variety of ways. Quality refers to the simultaneous blending of characteristics of spatial use, time and force quality into dynamic patterns of movement. In contrast to qualitative analysis and its focus on movement style and dynamics, quantitative analysis addresses the objective characteristics of motor activities that may include frequency, duration, velocity and amplitude. Both types of analysis offer a critical perspective on fetal movement and health status.

In quantitative studies, the frequency of fetal movement has been related typically to heart rate variations,⁷ behavioral states,⁸ and circadian sleep-activity cycles.⁹ Accurate visualization of the fetal movement is not always possible, however, preventing the achievement of adequate reliability in quantifying movement characteristics. For example, measuring force accurately is difficult when exact mass and velocity cannot be precisely determined. Although three-dimensional (3-D) ultrasound imaging will help with this problem, we are some years away from a commercially available 3-D imaging system. Qualitative assessment, however, permits evaluation of the subtle characteristics of fetal movement. An accurate recording system is needed to describe more reliably these subtle features of fetal motility.

History

The modern history of fetal movement assessment began with nineteenth century investigations of quickening, the time at which the mother first senses fetal movement. Fetal motility was known to exist, however, long before the mother’s initial report of movement at 14–22 weeks of gestation.⁸ In the late 1880’s, Preyer used palpation and the stethoscope to detect this early movement and recognized even then its spontaneous nature.⁹

Contrary to the opinion of Preyer, Hooker¹⁰ and Humphrey¹¹ believed fetal motility was mainly reflexive in origin. Although he knew of Preyer’s work, Hooker thought that a primary phase of movement existed that resulted from exteroceptive stimulation. Movements in response to stimuli were characterized as stereotyped, patterned, identical and constant within the pattern. Hooker’s and Humphrey’s research was conducted on spontaneously aborted fetuses who survived only briefly outside of the uterus. Although they were primarily interested in identifying the onset of reflex movements, they did note that some movements seen at 8.5 and 9.5 weeks were spontaneous in nature. In addition, the quality of fetal response to stimulation changed from the automated and stereotyped movements seen at 8.5 weeks to smooth and fluid movements at 13.5 weeks.

The advent of ultrasound imaging permitted in utero observation of real-time movements. In 1978, Birnholz, Stephens, and Faria¹² conducted an ultrasound study based on Hooker’s and Humphrey’s categories of fetal movement. These investigators identified 11 movement patterns occurring between 6 and 40 weeks GA, but, in contrast to Hooker and Humphrey, described them as spontaneous. The patterns were mainly denoted by body part and anatomical action. One category, “combined/repetitive,” was similar to Prechtl’s “general” movements and described “simultaneous or serial movements of the head or trunk and limbs which do not have a sudden, jerky or ‘spastic’ quality.”

In one of the earliest real-time ultrasound studies of spontaneous fetal movement, Reinold¹³ divided movements into two basic categories: strong, brisk movements or slow, sluggish movements. The strong movements had a forceful initial impulse involving the entire body and caused a change in fetal location and posture. No initial impulse was revealed with the slow movements, and only isolated body parts moved, with no change in trunk location or posture. Reinold observed a higher number of strong, brisk movements than slow, sluggish movements between 11 and 16 weeks GA in normal pregnancies and normal fetuses.

A more extensive ultrasound study was undertaken in 1981 by Ianniruberto and Tajani,¹⁴ who followed 2000 subjects from 8–41 weeks of gestation. Their study specifically attempted to describe the quality of fetal movement patterns. In the conclusion of their study, the authors stated that fetal motor behavior was so “varied and rich” that their descriptions were “inadequate.”^{14, 180}

Milani Comparetti¹⁵ applied the technique of “pattern analysis” developed with neonates and handicapped infants to the fetal data collected by Ianniruberto and Tajani. In this study, fetal movements were described as the primary motor patterns (PMP) that afford fetal locomotion, propulsive movements for birth, and other motor competencies necessary for survival. He concluded that no neonatal patterns originated at birth, since PMP’s gave rise to all neonatal patterns. Milani Comparetti labelled actions as “propulsive” and used few qualitative descriptors to characterize the style of the movements.

The most extensive descriptions of the qualitative aspects of fetal movement have been provided by Ianniruberto and Tajani¹⁴ and the deVries groups.² The longitudinal study by deVries, Visser and Prechtl² on the “emergence” and development of fetal movement contained details of action patterns and qualitative descriptors. The qualitative terminology used by these two groups is compared in Table 1. In comparing these two studies, every term referring to actions and action sequences was extracted from the two terminologies and organized according to use of space, time, and force.

Both groups describe the same fetal actions. The deVries group lists 16 patterns of movement corresponding to those seen by Ianniruberto and Tajani, with the addition of isolated retroflexion and anteflexion of the head. The deVries group, however, gives more detail of patterns, time usage, flow and initiation, but their assessment lacks description of the force of movements and some aspects of body shaping.

SYSTEMS OF MOVEMENT ANALYSIS

Movement analysis and notation systems have been applied to movement and movement behavior problems in dance, anthropology, ethology, behavioral psychology and physical education. The use of a movement analysis system provides methods or tools for data collection, recording and storage, and analysis. We reviewed four well-developed systems of analysis for possible application to fetal movement. All four include a two-dimensional symbolic notation system. Although they use entirely different descriptors, each system is organized, comprehensive and flexible.¹⁶

Laban Movement Analysis

The most com...

Table of contents

• Cover
• Half Title
• Full Title
• Copyright
• Contents
• About the Editor
• Preface
• Concepts in Fetal Movement Research
• Relationship of Mechanical and Movement Factors to Prenatal Musculoskeletal Development
• The Origins of the Mother-Child Relationship–A Review
• Obstetric Ultrasound: An Overview
• Ultrasound Safety: A Descriptive Study of the Potential Effects of Early Imaging
• Quantitative Measurement of Fetal Movement: Fetal-Posture and Movement Assessment (F-PAM)
• Q-MOVE: Development of a Qualitative Assessment of Fetal Movement
• Behavioral States in the Human Fetus
• Periods of Activity and Inactivity in the 12-to 16-Week Fetus
• Kinematic Study of Human Fetal Shoulder Movement in Utero: Preliminary Results
• The Development of Fetal Behaviors and Their Relationship to Neonatal Behavioral Organization
• The Future of Fetal Imaging: One Person’s Perspective
• Index