Predictive validity of the Hand Assessment for Infants in infants at risk of unilateral cerebral palsy

Abstract

Aim To evaluate the sensitivity, specificity, and predictive value of the Hand Assessment for Infants (HAI) in identifying infants at risk of being diagnosed with unilateral cerebral palsy (CP), and to determine cut‐off values for this purpose. Method A convenience sample of 203 infants (106 females, 97 males) was assessed by the HAI at 3, 6, 9, and 12 months. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using receiver operating characteristic curve analysis. Cut‐off values were derived for different ages. The clinical outcome (unilateral CP yes/no) at 24 months or more served as an external criterion to investigate the predictive validity of HAI. Results Half of the infants developed unilateral CP. The area under the curve ranged from 0.77 (95% CI [confidence interval] 0.63–0.91) to 0.95 (95% CI 0.90–1.00) across HAI scales and age intervals. Likewise, sensitivity ranged from 63% to 93%, specificity from 62% to 91%, and accuracy from 73% to 94%. Interpretation HAI scores demonstrated overall accuracy that ranged from very good to excellent in predicting unilateral CP in infants at risk aged between 3.5 and 12 months. This accuracy increased with age at assessment and the earliest possible prediction was at 3.5 months of age, when appropriate HAI cut‐off values for different ages were applied. The Hand Assessment for Infants (HAI) predicts unilateral cerebral palsy (CP) with high accuracy. HAI cut‐off values can guide clinical practice for early identification and diagnosis of unilateral CP.

Development of muscle tone impairments in high-risk infants: Associations with cerebral palsy and cystic periventricular leukomalacia

“…Our results are in line with those of Ryll and colleagues, who recently reported that prediction of unilateral CP in infants with a specific high risk for unilateral CP on the basis of arm-hand activities can be reliably done from 3.5-4.5 months CA onwards, and that its diagnostic accuracy increases with increasing age. 32 Muscle tone impairment in the lower extremities during infancy did not predict CP; only at the age of the diagnosis of CP hypertonia in the ankles was significantly associated with CP.…”

Multisensory Stimulation and Priming (MuSSAP) in 4-10 Months Old Infants with a Unilateral Brain Lesion: A Pilot Randomised Clinical Trial

“…Inclusion of the infants was based on outcomes of cerebral imaging studies and the clinical judgement of the paediatric neurologist. At the time of inclusion, the asymmetry index cut-off values of the HAI [29] were not yet available. Post hoc we could conclude that one child in the EI-UL-MuSSAP scored within the normal range of the HAI and could therefore have been excluded.…”

Feasibility and safety of intranasally administered mesenchymal stromal cells after perinatal arterial ischaemic stroke in the Netherlands (PASSIoN): a first-in-human, open-label intervention study

“…An abnormal score on the HAI was defined in two ways: first, as an asymmetry index of at least 9% or a both-hands measure of 44 or lower at 13-14 weeks of age; or second, as an asymmetry index of at least 30% or a both-hands measure of 49 or lower at 15-19 weeks of age. 24 Moreover, a side difference of at least 2 points between the each-hand sum score was considered an aberrant score. 25…”