The development of a screening tool to evaluate gross motor function in HIV-infected infants

Abstract

Neurodevelopmental delay or HIV encephalopathy is a stage four disease indicator for paediatric HIV/AIDS according to the World Health Organisation (WHO), and may be used as a criterion for initiation of highly active antiretroviral therapy (HAART). To date, the only means of prevention of this condition is early initiation of HAART. Studies which have been carried out in South African clinics have revealed the high prevalence of this condition. In developing countries, commencement of HAART is based on declining virologic and immunologic status, as standardised neurodevelopmental assessment tools are not widely available. A standardised developmental screening tool which is suitable for use in a developing country is therefore necessary in order to screen for neurodevelopmental delay to allow for further assessment and referral to rehabilitation services, as well as providing an additional assessment criterion for initiation of HAART. The infant gross motor screening test (IGMST) was developed for this purpose. The standardisation sample of the IGMST consisted of 112 HIV-infected infants between six and 18 months of age. Item selection for the IGMST was based on the Gross Motor scale of the Bayley Scales of Infant Development (BSID)-III. Content validity was assessed by a panel of experts using a nominal group technique (NGT; agreement >80%). Concurrent validity (n=60) of the IGMST was carried out against the BSID-III, and agreement was excellent (K=0.85). The diagnostic properties of the IGMST were evaluated and revealed: sensitivity 97.4%, specificity 85.7%, positive predictive value (PPV) 92.7%, and negative predictive value (NPV) 94.7%. Reliability testing (n=30) revealed inter-rater reliability as: r=1, test-retest reliability: r=0.98 and intra-rater reliability: r=0.98. The results indicate that the statistical properties of the IGMST are excellent, and the tool is suitable for use within the paediatric HIV setting.

Seizures in Children with HIV infection in South Africa: A retrospective case control study

“…In addition, status epilepticus was defined as any seizure that persisted for more than five minutes and typically required medical intervention to terminate the seizure [14]. HIV encephalopathy (HIVE) was diagnosed in children who presented with at least one of the following signs that had persisted for a minimum of 2 months in the absence of any illness other that HIV [15][16][17];). The signs include: (i) a failure to attain or loss of developmental milestones or intellectual ability, (ii) impaired brain growth seen by head circumference measurements or imaging and or (iii) acquired symmetric motor deficits that include paresis, pathologic reflexes and or ataxia.…”

Paediatric HIV - Looking beyond CD4 Counts

“…The majority of the children (85%) were antiretroviral naïve. In a subsequent cohort study conducted in Soweto, South Africa (Hilburn et al, 2011) the majority of children (68%) were already receiving HAART when they were assessed. Their CD4 counts were significantly higher (23.16%) than the children assessed in 2004 yet despite this the children still presented with delayed development across all facets of development (Hilburn et al, 2011).…”

The Acute Care Physical Therapy HIV/AIDS Patient Population

“…Physical rehabilitation services include, but are not limited to, physical, occupational, and speech-language therapies. In the HAART era, research pertaining to physical therapy and HIV/AIDS is sparse and narrow in scope, investigating efficacy [13][14][15][16][17][18][19][20][21][22] or knowledge. 11,23,24 Studies examining efficacy of physical therapy intervention in patients with HIV infection are mainly limited to specific techniques in small patient subpopulations [13][14][15][16] or case reports.…”

“…Physical rehabilitation services include, but are not limited to, physical, occupational, and speech-language therapies. In the HAART era, research pertaining to physical therapy and HIV/AIDS is sparse and narrow in scope, investigating efficacy 13–22 or knowledge. 11,23,24…”

“…11,23,24 Studies examining efficacy of physical therapy intervention in patients with HIV infection are mainly limited to specific techniques in small patient subpopulations [13][14][15][16] or case reports. [17][18][19] In addition, Hilburn et al 20 developed and evaluated a gross motor screening test for infants with HIV infection in developing countries. Dawad and Jobson 21 explored the use of a community-based rehabilitation program as a model for HIV-related task-shifting programs in South Africa.…”