part-2 standardized assessments of infant development there are many different standardized assessments which are available for infants to age 0 to 12 months I've listed a number of them here on this slide if you would like some further readings post this mini lecture I would encourage you to read Alicia's piddles 2008 article published which investigated a systematic review of the cleaner metric properties of neuromotor assessments for preterm infants during the first year of life for the purpose of this course however we are going to focus on four main standardized assessments the infant development namely we're going to explore their Alberta infant motor scale or the aims the general movements assessment so we'll learn how to conduct one of these assessments but not score one because that requires further training will also investigate that Hammersmith infant neonatal examination and then finally discuss the neuro sensory motor developmental assessment or the NS MDA which is quite common here with Queensland pediatric physiotherapists so firstly the Alberta infant motor scale the Ames is an observational gross motor assessment for infants aged 0 to 18 months this assessment tool is norm reference and has discriminative predictive and evaluative validity firstly the Ames is discriminative meaning that it can identify gross motor performance in reference to a norm sample it is also predictive and there have been cutoff values which have been established for four and eight months to predict poor motor performance at 18 months and finally it can evaluate change in an infant's mode of performance over time and monitor changes in infants demonstrating delayed or immature motor skills but essentially have normal patterns of movement not super important so the aims is not appropriate for infants with a typical patterns of movement for example cerebral palsy but it can be used for infants who are at risk or those with disorders or conditions causing delayed motor development so for example those infants who may have been diagnosed with fetal alcohol syndrome Down syndrome or failure to thrive healthcare professionals with an understanding of the following can administer the aims so they need to have an understanding of the essential components of each item they need to have skill in the observational assessment of movement and established reliability on the items this assessment is great because you don't need many materials all you need is a match or a carpeted area and some age-appropriate toys as well as your score sheet and the booklet so the aim has has four sub scales including prone supine sitting and standing and you can see those sub scales there on the right with an infant so in that top left hand corner we've got an infant in prone and they're demonstrating prone propping on the elbows and then on that right top hand corner we've got an infant in supine and it's demonstrating a lovely hands to feet there and then in the bottom left-hand corner we've got the sitting sub scale and you can see there the infant's trying maybe trying to reach for something and hopefully it might demonstrate some rotation as well and then finally we have the standing sub scale so what's the posture of the infant like in standing and are they taking work weight well through those legs and we can score that so in that window there it's an observational assessment so we circle or write an oval no besides the movements that we see so for example therefore the sitting subscale you can see here for this example score sheets that reaching with rotation and sitting was observed however the therapists did not observe the child's going from sitting into prone but they did observe them going from sitting into 4.8 kneeling so we call it this window of development when you conduct this assessment it's important that infants are either naked or only have a nappy on for the assessment it's also important that you don't facilitate too much throughout the assessment toys can however be used to motivate the infant to move parents are encouraged to be present for this assessment to be able to undress them and comfort them if they become distressed or anxious and as I mentioned before you score them based on on observed or not observed on the score sheet there is a manual and score sheets and there is a cost associated with it but the cost is fairly minimal compared to some other pediatric standardized assessments you don't need any specialized equipment and it takes between 10 to 30 minutes which is quite reasonable when you generally have an hour for a new assessment for an infant qualifications I mentioned previously on the last slide and no training is specifically required but a good thorough understanding on how to perform the assessment and knowledge and skills and the observation of movements critical for this assessment this is what the score sheet looks like so it's quite a big score sheet and that goes across horizontally I think it's probably approximately three a four sheets across or more in the top we have that prone sub scale and then the next one down is the supine sub scale the sitting sub scale and then the standing so it's got a great pictorial it's it's got great pictures to accompany our the descriptions as well so it gives you an idea of what the child can do and can't do but not why so it'll tell you what the child can do in prone and supine and sitting and standing but it can't really tell you that why next up we have the general movements assessment so it's a non-invasive and cost effective way to identify neurological issues which may lead to cerebral palsy and other developmental difficulties it can be completed from birth to 20 weeks of age infants they generally have typical and distinct spontaneous movement so we call them general movements or fidgety movements and they can be absent or abnormal movements all those with absent or abnormal movements are at a higher risk of neurological conditions it involves taking a three to five-minute video of the infant in supine in just their nappy taken from a bob so you get the whole infant in for that general movements assessment that's all it takes to conduct the assessment but to actually score it you need to be trained so why do we use the general movements assessment well historically the diagnosis of cerebral palsy so a neurological condition was made between the age of 12 to 24 months so parents may not have received a diagnosis for their child cerebral palsy until their child was two years but now we can make the diagnosis before six months corrected age before five months corrected age the most predictive tools for detecting risk a term age MRI and the pretzels quality assessment of general movements or what we call the general movements assessment and the hammersmith infant neurological examination the combined use of the Huynh and the general movements assessment at three months improves early detect it detection and can be specifically discriminate between those infants likely to have bilateral versus unilateral cerebral palsy there's a really nice YouTube video there on the right which you can watch from a researcher in Italy who describes the general movements in lay terms so you can get a better understanding on what we're looking at the Queensland center of a cerebral palsy and Rehab Research Center also has an example general movements video available talking you through how to conduct that assessment so I would encourage you to watch this one too because it gives you a thorough overview of the general movements assessment we're going to have more detail about this later in our course our third measure we're going to discuss is the hammersmith infant neurological examination so it is a standardized neurological examination which is practical and score scorable for infants between two to 24 months of age the Huynh website provides free videos on how to perform the assessment as well as scoring sheets so receives a massive tick for clinical utility how often do you get a standardized assessment which has free training videos and scoring sheets it is a discriminative and predictive measure however again it should not be used as an outcome measure for pre post intervention the Hein has three parts neurological which is scored developmental milestones which are not scored and behavior which is not scored scores are based on a scale of 0 to 3 where higher scores represent better neurological functioning the maximum score are for this assessment is 78 when you sum up all 26 items the 5 domains for the neurological exam I split up into cranial nerve function posture quality and quantity of movements muscle tone and reflexes and reactions as you can see here here is an example of what the score sheet looks like and I've just taken out the tone subsection there it's really lovely because it has descriptions there on the left and then it's got also images for you to look at when to assist you when you're scoring and an infant to be able to watch the videos and get access to the score sheets you do need to register but registration is free there's no fee associated with it as I said before it's there's no cost an email gets sent to you with all of the video passwords so once you've got access to that I would encourage you to watch 6 minutes 35 through to 15 minutes 15 and here they demonstrate how to perform the hi on examination video and you can also download those score sheets to particularly important if you'd like career in pediatric physiotherapy and you're looking for different outcome measures upon graduation or maybe you're on one of your five week clinical placement blocks and you'd really like to use a home video on an appropriate infant this is an example of the motor milestones and it's got the different sections there so for example the sitting motor milestones you'd score them based on cannot sit sitting with support at the hips which is normal at four months propping with those hands out in front normal at six months and very soon after becomes independent sitting or stable sitting which is normal at seven to eight months and then pivoting while they're sitting so gaining that confidence and stability and strength to be able to move in that sitting position as you can see there those months are slightly different to perhaps the websites that you've looked at or other information we've already given you so just keeping in mind that for each of those modal milestones there's always um Oh a window for typical development and finally we're going to look at the neuro sensory motor developmental assessment or the NS MDA it is a Queensland based paediatric physiotherapy assessment you can purchase the manual and we have copies at both libraries at both campuses you should have a look at however the assessment sheets are only available if you do a two-day course at YouTube so you do get the free assessment sheets but you need to do the two-day UQ course first as I said before he can purchase the assessment guide so it profiles motor development at specific ages it starts at 1 month and goes all the way through to 6 years and there's a different assessment sheets depending on the age of the child it identifies areas of concern or abnormal dysfunction and it classifies motor dysfunction as normal minimal mild moderate or severe it also predicts motor development it should not be used as an outcome measure a pre/post intervention to evaluate the effectiveness of an intervention there's different test areas of the NS MDA and I've got an example of the gross motor domain for an eight-month-old scoresheet but the full assessment has but body structure and function so it goes through neurological reflexes and reactions posture and balance proprioception vestibular and vision and hearing and then the activity so gross motor and fine motor and I've got the eight month old description there on the right so for this measure you score each item on a scale of one to four where one is abnormal or absent two is suspect delayed immature ah three is within normal limits for age and four is above all better than expected so you give each item a score and I've got an image there on the right which is prone progression creeping and you can see there what the different levels of attainment are and I'll just flip back to the previous slide so you can see that full front page of the score sheet and all of the different items so for each item in gross motor posture supine support on arms rolling prone progression creeping and then crawling on hands and knees for each one of those you would give them a score from 1 to 4 you then can also give a functional grade for each area so for gross motor fine motor posture you would give a functional grade so functional grades are the opposite so the lower the score the better so one is within normal limits to a slight deviation three is mild or moderate deviation for as definitely abnormal motor performance affecting function five is no independent function in that area so functional grades are really the therapists interpretation of the test results so at the end of the gross motor section you would give the infant a functional grade based on your interpretation as a general guide usually an infant or school mainly threes and fours to get a functional grade of one or two a functional grade of three would indicate that most items scored a - just as a reference point there so total scores for the NSM da what we do is we give give each area or functional grade and then those six grades are summed and then we get a total score so children's whose performance is six to eight points is within normal limits and then the higher your score is the the the more significant the dysfunction is so for example twelve to fourteen points would indicate mild dysfunction all the way through to twenty five to thirty points a profound disability so in this mini lecture part two standardized assessments the infant development age zero to twelve months we have gone through four different assessments which are available and we're going to focus on for this course we have gone through the Alberta infant motor scale all the aims we've also taken a look at the general movements assessment and then the hammersmith infant neurological examination and then finally that NSM da which is really a Queensland based physiotherapy outcome measure thank you very much