General movements assessment and Hammersmith infant neurological examination

A four-month corrected-age graduate of extreme prematurity lies on a mat. The video looks “busy,” yet a trained scorer says fidgety movements are absent. The Hammersmith score is low. MRI already showed white-matter injury. Parents ask whether this is cerebral palsy. Your job on this page is not to re-teach the whole CP classification leaf. Your job is to use general movements assessment (GMA/GMs) and the Hammersmith Infant Neurological Examination (HINE) correctly: what they are, when to use them, what they do and do not prove, and how results change counselling and referral. ^{[1] [5] [12]}

This leaf owns the tools. Companion pages own CP phenotype/function labels, long-term surveillance, normal motor variation, and hypotonia work-up. ^[1]

Overview & Definition

General movements are spontaneous, endogenously generated whole-body movements present from fetal life through early infancy. Prechtl’s functional assessment treats the quality of those movements — fluency, variability, complexity — as a window into central motor network integrity. The method is often called Prechtl’s general movements assessment or GMA. It is not a checklist of milestones. It is a trained observation of how the infant moves when free and alert. ^{[4] [5]}

Two broad age periods matter in clinical teaching. In the writhing period (term age into the first weeks post-term), movements have a writhing character. Cramped-synchronised patterns in this window are a high-risk qualitative abnormality. In the fidgety period (commonly taught as roughly 9–20 weeks post-term age, peaking around three to five months corrected), small circular movements of neck, trunk and limbs appear in normal infants. Absent fidgety movements are strongly associated with later cerebral palsy risk when scored by trained assessors. Abnormal fidgety quality can also flag later minor neurological dysfunction pathways. ^{[4] [5] [14]}

The Hammersmith Infant Neurological Examination (HINE) is a standardised neurological examination for infants, classically used from about two to twenty-four months of age. Items cover cranial nerve function, posture, movements, tone and reflexes. Scores yield an optimality profile: lower optimality associates with higher probability of adverse motor outcomes, including cerebral palsy, when used in trained hands and interpreted with age and population context. A Brief-HINE screening adaptation exists for settings that cannot always complete a full exam. Scoring aids support consistent early-detection practice. Do not invent a single universal numeric cut-off in a viva unless you can defend the exact age band and source. State the principle: suboptimal optimality plus risk plus abnormal movements raises probability. ^{[6] [7] [8] [9]}

Together with perinatal risk and neuroimaging, GMs and HINE underpin modern early, high-probability cerebral palsy pathways. They support action before independent walking. They do not replace clinical judgement, family partnership or differential diagnosis for progressive disease. ^{[1] [3] [18]}

References18ShowHide

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