Paeds Vivas · growth-development-and-behaviour
General movements and HINE — branching viva
Viva on GMs, HINE, combined early detection and family communication.
On this page & tools
Target exams
Branch A — Definitions
Examiner: What are general movements and what is HINE?
Candidate: General movements are spontaneous whole-body movements assessed qualitatively for fluency, variability and age-typical fidgety character using Prechtl’s trained method. HINE is a structured scored neurological examination of the infant that yields an optimality profile. [4] [5] [6]
Branch B — Timing
Examiner: When do you look for fidgety movements?
Candidate: In the fidgety window, roughly 9–20 weeks post-term age, often around three to five months corrected, in a quiet alert state—not during continuous crying or deep sleep. I use corrected age for preterm infants. [4] [5]
Branch C — High-risk findings
Examiner: Which GMs findings worry you most?
Candidate: Cramped-synchronised patterns in the writhing period and absent fidgety movements in the fidgety period, when scored by trained assessors. Abnormal fidgety quality also raises concern for later neurological dysfunction pathways. [4] [5] [14]
Branch D — Combining tools
Examiner: Why not rely on one tool?
Candidate: Predictive performance for early CP detection in high-risk infants is stronger when neuroimaging, GMs and neurological examination are combined. A single early normal exam does not erase residual high risk. [1] [2] [3]
Branch E — Action
Examiner: Tools converge toward high probability. What now?
Candidate: I use high-probability cerebral palsy language, start early intervention per 0–2 year guidance, arrange serial review, and continue investigations in parallel. I do not wait for independent walking. [1] [10] [16]
Branch F — Pitfalls
Examiner: What mistakes fail candidates?
Candidate: Untrained video scoring, wrong behavioural state, inventing HINE cut-offs without age context, false reassurance, and delaying therapy for absolute certainty. [4] [6] [8] [12]
Branch G — Communication
Examiner: Counsel the parents.
Candidate: I explain what we filmed and examined, what high probability means, what we will do this week, and that labels refine as the child grows. Plain language, teach-back, written plan, no catastrophic certainty and no false reassurance. [1] [12] [18]
Examiner traps
- Waiting until walking age despite converging tools.
- Treating GMs as untrained “eyeballing.”
- Quoting a universal HINE cut-off without source.
- Discharging high residual risk after one normal early exam. [1] [3] [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
- [7]Romeo DM Hammersmith Infant Neurological Examination in infants born at term: Predicting outcomes other than cerebral palsy. Developmental medicine and child neurology, 2022.PMID 35201619
- [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
- [9]Romeo DM Neurological assessment tool for screening infants during the first year after birth: The Brief-Hammersmith Infant Neurological Examination. Developmental medicine and child neurology, 2024.PMID 38287208
- [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
- [14]Einspieler C Are abnormal fidgety movements an early marker for complex minor neurological dysfunction at puberty? Early human development, 2007.PMID 17129688
- [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
- [18]Rosenbaum P A report: the definition and classification of cerebral palsy April 2006. Developmental medicine and child neurology. Supplement, 2007.PMID 17370477