Hand Assessment for Infants: normative reference values.

AIM: To create normative reference values for unilateral and bilateral use of the hands, using the Hand Assessment for Infants (HAI), a newly developed criterion-referenced assessment measuring hand use in infants aged 3 months to 12 months at risk of cerebral palsy (CP). METHOD: In total, 489 HAI assessments of typically developing infants (243 females, 246 males), aged 3 months to 10 months (mean 6mo 14d [SD 2mo 5d]), were collected in Italy and Sweden. Normative growth curves based on mean and SDs were created, as well as skill acquisition curves for each test item. Correlation to age and differences between groups based on sex and nationality, as well as differences between the right and the left hand, were investigated. RESULTS: The growth curves showed a steady increase in mean value and a decrease in SD over age. There were no differences between groups based on sex or nationality. There was a negligible mean difference (0.1 raw score) between the right and left hands. INTERPRETATION: HAI normative reference values are now available, which can assist in identifying deviating hand use for each month of age, as well as a side difference between hands in infants at risk of CP. WHAT THIS PAPER ADDS: A Hand Assessment for Infants (HAI) result greater than 2SD below the mean indicates atypical hand use. Skill acquisition curves describe the age at which typically developing infants master the HAI items. Most typically developing infants do not demonstrate asymmetry in hand use.

EVALUACIÓN DE LA FUNCIÓN DE LA MANO PARA BEBÉS (HAI): VALORES NORMATIVOS DE REFERENCIA: OBJETIVO: Para crear valores de referencia normativos para el uso unilateral y bilateral de las manos, utilizando la Evaluación de la Mano para Infantes (HAI), una evaluación recientemente desarrollada basada en criterios que mide el uso de las manos en lactantes de 3 a 12 meses con riesgo de parálisis cerebral (PC). MÉTODO: En total, se recolectaron 489 evaluaciones usando el HAI de bebés con desarrollo típico (243 femeninos, 246 masculinos), de 3 a 10 meses (media 6 meses 14 días [DS 2 meses 5 días]), en Italia y Suecia. Se crearon curvas de crecimiento normativas basadas en la media y las desviaciones estándar, así como curvas de adquisición de habilidades para cada elemento de prueba. Se investigó la correlación con la edad y las diferencias entre grupos según el sexo y la nacionalidad, así como las diferencias entre la mano derecha y la mano izquierda. RESULTADOS: Las curvas de crecimiento mostraron un aumento constante en el valor medio y una disminución en el DE a lo largo de la edad. No hubo diferencias entre grupos por sexo o nacionalidad. Hubo una diferencia de medias insignificante (puntaje bruto de 0,1) entre las manos derecha e izquierda. INTERPRETACIÓN: Este estudio aporta los valores de referencia normativos de HAI, los cuales están disponibles, lo que puede ayudar a identificar la función de las manos que se desvía de los parámetros considerados como normales para cada mes de edad, así como una diferencia lateral entre las manos de los bebés en riesgo de PC.

AVALIAÇÃO DA MÃO PARA LACTENTES (AML): VALORES NORMATIVOS DE REFERÊNCIA: OBJETIVO: Criar valores normativos de referência para uso unilateral e bilateral das mãos, usando a Avaliação da mão para lactentes (AML), uma avaliação baseada em critérios que foi desenvolvida recentemente para mensurar o uso da mão em lactentes de 3 a 12 anos em risco para paralisia cerebral (PC). MÉTODO: No total, 489 avaliações da AML de lactentes com desenvolvimento típico (243 do sexo feminino, 246 do sexo masculino), com idades de 3 a 10 meses (média 6m 14d [DP 2m 5]), foram coletadas na Itália e na Suécia. Curvas normativas de crescimento baseadas em médias e desvios padrão foram criadas, assim como curvas de aquisição de habilidades para cada item do teste. Correlação com a idade e diferenças entre grupos baseadas no sexo e na nacionalidade, assim como diferenças entre mão direita e esquerda, foram investigadas. RESULTADOS As curvas de crescimento mostraram aumento contínuo na média e diminuição no DP com a idade. Não houve diferenças enter grupos com base no sexo ou nacionalidade. Houve uma diferença média inexpressiva (0,1 escore bruto) entre mãos direita e esquerda. INTERPRETAÇÃO: Valores normativos de referência da AML agora estão disponíveis, o que pode ajudar a identificar o uso anormal da mão para cada mês de vida, assim como diferenças entre lados em lactentes em risco para PC.

The effectiveness of Baby-CIMT in infants younger than 12 months with clinical signs of unilateral-cerebral palsy; an explorative study with randomized design.

AIM: To explore the effectiveness of baby-CIMT (constraint-induced movement therapy) and baby-massage for improving the manual ability of infants younger than 12 months with unilateral cerebral palsy (CP). METHOD: Infants eligible for inclusion were 3-8 months old with asymmetric hand function and at high risk of developing unilateral CP. Thirty-seven infants were assigned randomly to receive baby-CIMT or baby-massage. At one year of age 31 children were diagnosed with unilateral CP, 18 (8 boys, 6.1±1.7months) of these had received baby-CIMT and 13 (8 boys, 5.0±1.6months) baby-massage. There were two 6-week training periods separated by a 6-week pause. The Hand Assessment for Infants (HAI), Assisting Hand Assessment (AHA), the Parenting Sense of Competence Scale (PSCS) and a questionnaire concerning feasibility were applied. RESULTS: There was improvement in the "Affected hand score" of HAI from median 10 (6;13 IQR) to 13 (7;17 IQR) raw score in the baby-CIMT group and from 5 (4;11 IQR) to 6 (3;12 IQR) for baby-massage with a significant between group difference (p=0.041). At 18-month of age, the median AHA score were 51 (38;72 IQR) after baby-CIMT (n=18) compared to 24 (19;43 IQR) baby-massage (n=9). The PSCS revealed an enhanced sense of competence of being a parent among fathers in the baby-CIMT group compared to fathers in the baby-massage (p=0.002). Parents considered both interventions to be feasible. CONCLUSION: Baby-CIMT appears to improve the unimanual ability of young children with unilateral CP more than massage.

Development of the Hand Assessment for Infants: evidence of internal scale validity.

AIM: The aim of this study was to develop a descriptive and evaluative assessment of upper limb function for infants aged 3 to 12 months and to investigate its internal scale validity for use with infants at risk of unilateral cerebral palsy. METHOD: The concepts of the test items and scoring criteria were developed. Internal scale validity and aspects of reliability were investigated on the basis of 156 assessments of infants at 3 to 12 months corrected age (mean 7.2mo, SD 2.5) with signs of asymmetric hand use. Rasch measurement model analysis and non-parametric statistics were used. RESULTS: The new test, the Hand Assessment for Infants (HAI), consists of 12 unimanual and five bimanual items, each scored on a 3-point rating scale. It demonstrated a unidimensional construct and good fit to the Rasch model requirements. The excellent person reliability enabled person separation to six significant ability strata. The HAI produced an interval-level measure of bilateral hand use as well as unimanual scores of each hand, allowing a quantification of possible asymmetry expressed as an asymmetry index. INTERPRETATION: The HAI can be considered a valid assessment tool for measuring bilateral hand use and quantifying side difference between hands among infants at risk of developing unilateral cerebral palsy. WHAT THIS PAPER ADDS: The Hand Assessment for Infants (HAI) measures the use of both hands and quantifies a possible asymmetry of hand use. HAI is valid for infants at 3 to 12 months corrected age at risk of unilateral cerebral palsy.

Efficacy of the small step program in a randomised controlled trial for infants below age 12 months with clinical signs of CP; a study protocol.

BACKGROUND: Children with cerebral palsy (CP) have life-long motor disorders, and they are typically subjected to extensive treatment throughout their childhood. Despite this, there is a lack of evidence supporting the effectiveness of early interventions aiming at improving motor function, activity, and participation in daily life. The study will evaluate the effectiveness of the newly developed Small Step Program, which is introduced to children at risk of developing CP during their first year of life. The intervention is based upon theories of early learning-induced brain plasticity and comprises important components of evidence-based intervention approaches used with older children with CP. METHOD AND DESIGN: A two-group randomised control trial will be conducted. Invited infants at risk of developing CP due to a neonatal event affecting the brain will be randomised to either the Small Step Program or to usual care. They will be recruited from Astrid Lindgren Children's Hospital at regular check-up and included at age 3-8 months. The Small Step Program was designed to provide individualized, goal directed, and intensive intervention focusing on hand use, mobility, and communication in the child's own home environment and carried out by their parents who have been trained and coached by therapists. The primary endpoint will be approximately 35 weeks after the start of the intervention, and the secondary endpoint will be at 2 years of age. The primary outcome measure will be the Peabody Developmental Motor Scale (second edition). Secondary assessments will measure and describe the children's general and specific development and brain pathology. In addition, the parents' perspective of the program will be evaluated. General linear models will be used to compare outcomes between groups. DISCUSSION: This paper presents the background and rationale for developing the Small-Step Program and the design and protocol of a randomized controlled trial. The aim of the Small Step Program is to influence development by enabling children to function on a higher level than if not treated by the program and to evaluate whether the program will affect parent's ability to cope with stress and anxiety related to having a child at risk of developing CP. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT02166801 . Registered June 12, 2014.

Efficacy of baby-CIMT: study protocol for a randomised controlled trial on infants below age 12 months, with clinical signs of unilateral CP.

BACKGROUND: Infants with unilateral brain lesions are at high risk of developing unilateral cerebral palsy (CP). Given the great plasticity of the young brain, possible interventions for infants at risk of unilateral CP deserve exploration. Constraint-induced movement therapy (CIMT) is known to be effective for older children with unilateral CP but is not systematically used for infants. The development of CIMT for infants (baby-CIMT) is described here, as is the methodology of an RCT comparing the effects on manual ability development of baby-CIMT versus baby-massage. The main hypothesis is that infants receiving baby-CIMT will develop manual ability in the involved hand faster than will infants receiving baby-massage in the first year of life. METHOD AND DESIGN: The study will be a randomised, controlled, prospective parallel-group trial. Invited infants will be to be randomised to either the baby-CIMT or the baby-massage group if they: 1) are at risk of developing unilateral CP due to a known neonatal event affecting the brain or 2) have been referred to Astrid Lindgren Children's Hospital due to asymmetric hand function. The inclusion criteria are age 3-8 months and established asymmetric hand use. Infants in both groups will receive two 6-weeks training periods separated by a 6-week pause, for 12 weeks in total of treatment. The primary outcome measure will be the new Hand Assessment for Infants (HAI) for evaluating manual ability. In addition, the Parenting Sense of Competence scale and Alberta Infant Motor Scale will be used. Clinical neuroimaging will be utilized to characterise the brain lesion type. To compare outcomes between treatment groups generalised linear models will be used. DISCUSSION: The model of early intensive intervention for hand function, baby-CIMT evaluated by the Hand Assessment for Infants (HAI) will have the potential to significantly increase our understanding of how early intervention of upper limb function in infants at risk of developing unilateral CP can be performed and measured. TRIAL REGISTRATION: SFO-V4072/2012, 05/22/2013.