Hammersmith Infant Neurological Examination Clinical Use to Recommend Therapist Assessment of Functional Hand Asymmetries.
Lindsay Pietruszewski, Mary Ann Nelin, Nancy Batterson and 5 others
PMID 34417428WHAT IT FOUND
HINE asymmetry score 4 or higher in infants 3-12 months flagged infants for therapist HAI assessment.
It caught all infants with a 3-point hand difference and correctly cleared 88% of those without that difference. For 2-point differences, it did not catch all infants.
Key findings
01A HINE AS of 4 or more had 100% sensitivity and 88% specificity for predicting an atypical HAI hand point difference of 3 or more in the full cohort.
02For predicting a 2-point or more hand difference, HINE AS of 4 or more had lower sensitivity of 79-80% and specificity of 89-91%.
03Upper AS, Arm AS, and the combined rule had significantly lower predictive values for atypical HAI than HINE AS in the full cohort.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The atypically developing infants were recruited mainly from high-risk follow-up and therapy settings and were selected partly by abnormal motor or HINE scores, so the sample does not represent all high-risk infants, including some with mild cerebral palsy who test within normal ranges. The prevalence of abnormal motor development and neurological status in the sample was likely higher than in routine clinical practice, so the test performance may not generalize. Only 8 infants were 4 months corrected age or younger, so HINE AS performance in very young infants was not evaluated separately. The atypical HAI definitions were created for this study, including a 3-point or more and a 2-point or more hand difference, so these thresholds are not established prior definitions. Some infants diagnosed with asymmetric cerebral palsy had HINE AS of 5 or lower, including 2 with HINE AS of 4, so a single HINE AS threshold should not override clinical reasoning.
Declared interests
The supplied text does not include a conflicts-of-interest declaration. The article is labeled as supported by NIH extramural research.
The easy way to misread this
Do not treat a HINE AS of 4 or more as a diagnosis of cerebral palsy or proof that an infant needs targeted therapy. The study compared HINE AS with HAI asymmetry scores, not with later function or treatment outcomes.