General movements and HINE — formative SAQs

SAQ 1 (10 marks)

An ex-26-week infant is reviewed at 13 weeks post-term age. A trained assessor reports absent fidgety movements on video. HINE optimality is low. Prior MRI showed bilateral white-matter injury. Parents ask what these tools mean. [1] [5]

1. Define general movements assessment and name the two main age periods used in clinical teaching. (3) [4] [5]
2. Explain how HINE differs from GMs and what an optimality concept means. (3) [6] [7] [8]
3. Outline how you combine these findings with imaging to counsel and act today. (4) [1] [3] [10]

Model answer — SAQ 1

GMs and periods (3): Trained qualitative assessment of spontaneous whole-body movement quality (Prechtl method). Writhing period early post-term; fidgety period roughly 9–20 weeks post-term (often discussed around three to five months corrected). Absent fidgety movements are highly concerning when trained. [4] [5]

HINE (3): Structured scored neurological examination (posture, tone, reflexes, movements, cranial nerve items), typically used across early infancy into the second year. Optimality scoring: lower optimality associates with higher risk of adverse motor outcome in context; do not invent uncited universal cut-offs. Complements GMs rather than duplicating video movement quality. [6] [7] [8]

Combine and act (4): Converging abnormal GMs, low HINE and MRI injury support high-probability cerebral palsy language. Start early intervention now, plan serial review, explain that phenotype still refines, avoid waiting for walking age. [1] [3] [10]

SAQ 2 (10 marks)

A registrar films a GMs video while the infant is crying continuously after a feed, scores it without training, and tells the family “definitely not CP” after a single early assessment despite extreme prematurity. [4] [1]

1. List four validity threats or pitfalls in this scenario. (4) [4] [5]
2. State who should be prioritised for early motor surveillance with these tools. (3) [1] [2]
3. Give three reasons predictive performance is better when tools are combined. (3) [2] [3]

Model answer — SAQ 2

Pitfalls (4): Wrong behavioural state (crying/sleep); untrained scoring; single early normal or incomplete assessment used for absolute reassurance; ignoring residual high perinatal risk; filming outside age window (any of these score). [4] [5] [1]

Priority groups (3): Extreme preterm/VLBW, neonatal encephalopathy/HIE, perinatal stroke, significant brain injury or infection, other high-risk neonatal pathways; also community infants with motor red flags needing escalation. [1] [2]

Combination (3): Systematic reviews and pooled accuracy work show complementary information from imaging, GMs and neurological examination; single tools miss cases the combination catches; early detection frameworks and implementation data support multi-tool high-probability classification. [2] [3] [16]