Paeds Cases · growth-development-and-behaviour
GMs and HINE counselling — OSCE station
OSCE on explaining GMs and HINE findings and acting on high-probability CP risk.
osce communication and clinical reasoning
On this page & tools
Target exams
MRCPCH ClinicalRACP DCE
Prompt
Parents of a 4-month corrected-age preterm graduate; trained clinic reports absent fidgety movements and low HINE; MRI white-matter injury.
Station brief
You are in neonatal follow-up. Corrected age is four months after extreme prematurity. A trained assessor reports absent fidgety movements. HINE optimality is low. MRI shows white-matter injury. Parents ask: “Is the video saying he has cerebral palsy? Should we wait and see?” [1] [5]
Tasks
- Explain what general movements assessment and HINE measure in plain language. [4] [6]
- Interpret the combined findings using high-probability language without false finality. [1] [3] [16]
- Agree an immediate plan: early intervention, serial review, safety-net. [10] [12]
- Check understanding and invite questions. [12]
Expected performance
- Distinguishes movement-quality video (GMs) from scored neurological exam (HINE). [4] [6]
- Names high probability when tools and imaging converge; does not demand walking age. [1] [16]
- Starts early intervention in parallel with ongoing assessment. [10]
- Avoids untrained over-certainty and avoids false reassurance. [5] [12]
Examiner prompts
- “Could this still be normal prematurity?” — discuss serial tools and combination accuracy. [2] [3]
- “What is a fidgety movement?” — small continuous movements of neck, trunk and limbs in the post-term fidgety window. [4] [5]
- “Do we need more tests before physiotherapy?” — therapy can start while reviews continue. [1] [10]
Common fails
- Untrained dismissal of video findings or over-calling without training context.
- Waiting for age two before any support.
- Inventing numeric HINE cut-offs without age band.
- Jargon without teach-back. [1] [8]
References
- [1]Novak I Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA pediatrics, 2017.PMID 28715518
- [2]Bosanquet M A systematic review of tests to predict cerebral palsy in young children. Developmental medicine and child neurology, 2013.PMID 23574478
- [3]Morgan C The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study. Journal of clinical medicine, 2019.PMID 31694305
- [4]Prechtl HF State of the art of a new functional assessment of the young nervous system. An early predictor of cerebral palsy. Early human development, 1997.PMID 9467689
- [5]Einspieler C Cerebral Palsy: Early Markers of Clinical Phenotype and Functional Outcome. Journal of clinical medicine, 2019.PMID 31590221
- [6]Haataja L Optimality score for the neurologic examination of the infant at 12 and 18 months of age. The Journal of pediatrics, 1999.PMID 10431108
- [8]Fehlings D The Hammersmith Infant Neurological Exam Scoring Aid supports early detection for infants with high probability of cerebral palsy. Developmental medicine and child neurology, 2024.PMID 38818710
- [10]Morgan C Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews. JAMA pediatrics, 2021.PMID 33999106
- [12]Te Velde A Age of Diagnosis, Fidelity and Acceptability of an Early Diagnosis Clinic for Cerebral Palsy: A Single Site Implementation Study. Brain sciences, 2021.PMID 34439692
- [16]Kwong AK Early high risk of cerebral palsy classification is predictive of cerebral palsy at 2 years: an implementation cohort study. Archives of disease in childhood, 2025.PMID 40877021