Browsing by Author "Jansen van Rensburg, Emma Anita"

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    The predictive validity of Hammersmith Infant Neurological Examination versus prechtl’s general movement assessment with the Motor optimality score on gross motor outcomes in high-risk infants at 12-15 months corrected age : a descriptive study
    (Stellenbosch : Stellenbosch University, 2022-04) Jansen van Rensburg, Emma Anita; Burger, Marlette; Unger, Marianne; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Physiotherapy.
    ENGLISH SUMMARY: BACKGROUND: Advances in neonatal and maternal care have caused an increase in survival rate of high-risk infants, however with increased risk for developing adverse neurodevelopmental outcomes such as cerebral palsy (CP). Evidence supports the predictive value of Prechtl’s General Movement Assessment (GMA) with Motor Optimality Score (MOS), and the Hammersmith Infant Neurological Examination (HINE) for CP outcome before 5 months corrected age. Exploring usefulness of these measures and understanding how these two compare in predicting gross motor outcome in high-risk infants may enable earlier referrals for all and not just those at risk for developing CP. OBJECTIVE: To compare the predictive validity of the HINE versus Prechtl’s GMA with MOS (measured at 11-16 weeks corrected age) for determining the gross motor outcomes in high-risk infants at 12-15 months corrected age as measured by the Alberta Infant Motor Scale (AIMS). METHODOLOGY: A longitudinal descriptive study was conducted at Tygerberg Children’s Hospital (TCH). All high-risk infants assessed at 11-16 weeks corrected age using Prechtl’s GMA with MOS and HINE and whose parents consented to participation were re-evaluated using the AIMS to determine their gross motor outcome at 12-15 months corrected age. Data was analysed using STATA version 16 and IBS SPSS software. HINE and Prechtl’s GMA with MOS cut-off scores were determined and ROC curve analysis utilised to determine sensitivity and specificity values for both measures. RESULTS: The study enrolled 100 infants with a mean birthweight of 1525.6g and a mean gestational age of 31.1 weeks. Fifteen infants scored <5th percentile on the AIMS at 12-15 months corrected age and seven infants were suspected to have CP. The HINE with a sample specific cut-off score of 62.5 had an area under the curve (AUC) of 0.867 to predict gross motor delay with sensitivity of 87% and specificity of 81%, and positive predictive value (PPV) of 45%, negative predictive value (NPV) of 97%. Prechtl’s GMA with the MOS had AUC=0.713 with sensitivity of 47% and specificity of 100%, and PPV of 100%, NPV of 91%. The reflexes and reactions subcategory on the HINE, and the observed postural patterns and fidgety movements subcategories on the MOS were predictive of gross motor outcome. Both HINE and GMA with MOS total scores were more predictive of gross motor outcome than subcategory scores or single items. CONCLUSION: The results of this study indicate that both the HINE and Prechtl’s GMA with MOS are valid measures for predicting gross motor delay as determined by the AIMS in high-risk infants. The HINE, however, is more sensitive to predict gross motor delay than the GMA with MOS. The HINE showed lower PPV to predict gross motor delay compared to the GMA with MOS, however NPV values for both were similar. For both measures total scores were more predictive of gross motor outcome than subcategory or single item scores. The results of our study suggest either HINE or GMA with MOS total scores be used to predict gross motor outcome. However due to small sample size and recruitment from one site this topic warrants further research.