Predictive validity of the Hand Assessment for Infants in infants at risk of unilateral cerebral palsy.
Ulrike C Ryll, Lena Krumlinde-Sundholm, Cornelia H Verhage and 4 others
PMID 33251586WHAT IT FOUND
The Hand Assessment for Infants accurately predicts unilateral cerebral palsy in at-risk infants, but only from about 3.5 months of age.
Scores before this time are too variable to rely on. The single-hand score and asymmetry index perform best.
Key findings
01The predictive accuracy of the Hand Assessment for Infants improves with age, becoming excellent from 3.5 months onwards.
02At 3 months, the test's ability to distinguish between infants who will and will not develop unilateral cerebral palsy is only moderate.
03The contralesional hand score and asymmetry index are better predictors than the combined both-hands score in the first few months.
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 study used a convenience sample of infants already identified as high-risk, so the results may not apply to all infants. Infants were assessed at different ages and different numbers of times, which may have introduced selection bias. The final diagnosis of cerebral palsy was based on medical records at 24 months, which might have missed very mild cases. The cut-off values for prediction were derived from the same sample they were tested on, so they need external validation. Subgroup analyses by country or specific brain lesion type were not possible due to small numbers.
Declared interests
The authors declared no conflicts of interest. The study was supported by non-U.S. government grants.
The easy way to misread this
Do not use HAI scores at 3 months to rule out unilateral cerebral palsy. The test's accuracy at this age is only moderate, meaning it will miss some infants who will later develop the condition. Wait until at least 3.5 months for a reliable prediction.