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]}