Low-Resource Screening Tool Demonstrates Superior Predictive Value for Cerebral Palsy in Infants

Low-Resource Screening Tool Demonstrates Superior Predictive Value for Cerebral Palsy in Infants 1024 683 JoAnna Pendergrass, DVM

The use of lower-resource screening tools for cerebral palsy in infants can help increase early detection of the condition and promote access to early interventions.


A recent study reported that the Hammersmith Infant Neurological Examination (HINE), when compared with the Test of Infant Motor Performance (TIMP), had the better predictive value for detecting cerebral palsy in infants.

The study was conducted by Lindsay Pietruszewski, PT, DPT, a physical therapist in the Center for Perinatal Research in the Abigail Wexner Research Institute at Nationwide Children’s Hospital, and her research team. Results were published in Early Human Development.

Cerebral palsy is a common physical disability in children in the United States, characterized by non-progressive brain injury leading to motor impairments and activity limitations.

Early identification of cerebral palsy provides affected children with access to early interventions, staying within the critical time window for neuroplasticity and therefore helping the children achieve optimal motor function.

MRI and the General Movements Assessment (GMA) are the recommended screening tools for the early detection of cerebral palsy. However, they are expensive and require specialized training.

Lower-resource screening tools for cerebral palsy include the HINE and TIMP. The TIMP does not screen specifically for cerebral palsy; instead, it assesses functional motor performance in infants. Compared to MRI and the GMA, the HINE and TIMP are less expensive, require less training and are easier to administer.

Unfortunately, inequities exist in access to these four screening tools, delaying cerebral palsy diagnosis and subsequent care.

For their 5-year retrospective observational study, the researchers analyzed the electronic medical records of 1,389 infants 3 to 4 months corrected age who received the HINE and TIMP during a follow-up visit at a high-risk infant facility at Nationwide Children’s from January 2014 to December 2018.

Analysis revealed that the HINE alone had the best predictive value for cerebral palsy, when compared to the TIMP alone or in combination with the HINE. The superior predictive value of the HINE alone confirmed previous findings.

Although the combination of tools did not improve predictive ability, Dr. Pietruszewski notes several benefits to using both tools in infants.

For example, the TIMP provides additional information about a child’s motor deficits and what these deficits will look like in the future, allowing a provider to create a personalized treatment plan.

Dr. Pietruszewski offers several strategies to improve access to cerebral palsy screening tools. For the HINE and TIMP, she suggests connecting providers with underserved, low-resource communities and training the providers to administer these tools in those communities.

Telehealth is another option.

“Telehealth has provided an excellent way to implement the HINE and TIMP, especially during the pandemic, with parents being the ‘hands’ of the doctors,” she says.

Dr. Pietruszewski emphasizes the need for wider implementation of cerebral palsy screening tools. “Standardized assessments and surveillance for cerebral palsy need to be deployed more consistently on a global scale to give all babies equal opportunity to receive excellent early intervention,” she states.



Pietruszewski L, Moore-Clingenpeel M, Moellering GCJ, Lewandowski D, Batterson N, Maitre NL. Predictive value of the test of the infant motor performance and the Hammersmith infant neurological examination for cerebral palsy in infants. Early Human Development. 2022 Nov;174:105665.

Image credit: Adobe Stock

About the author

JoAnna Pendergrass, DVM, is a veterinarian and freelance medical writer in Atlanta, GA. She received her veterinary degree from the Virginia-Maryland College of Veterinary Medicine and completed a 2-year postdoctoral research fellowship at Emory University’s Yerkes Primate Research Center before beginning her career as a medical writer.

As a freelance medical writer, Dr. Pendergrass focuses on pet owner education and health journalism. She is a member of the American Medical Writers Association and has served as secretary and president of AMWA’s Southeast chapter.

In her spare time, Dr. Pendergrass enjoys baking, running, and playing the viola in a local community orchestra.