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Construction of an Infant Neurological International

Battery (INFANIB) for the Assessment of


Neurological Integrity in Infancy
Patricia H Ellison, John L Horn and Carol A Browning
PHYS THER. 1985; 65:1326-1331.

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Construction of an Infant Neurological International
Battery (INFANIB) for the Assessment of Neurological
Integrity in Infancy

PATRICIA H. ELLISON,
JOHN L. HORN,
and CAROL A. BROWNING

In this article, we describe the construction of an instrument for the assessment


of the neurological integrity of infants. In a follow-up program for infants from the
neonatal intensive care unit, 365 evaluations of 308 infants were made by using
a 32-item battery with items from four methods. Factor analyses were used for
data analyses, which yielded a 20-item instrument with five factors. We named
the instrument the Infant Neurological International Battery (Infanib). The Infanib
has sufficient reliability for clinical and research purposes. We have formed
scoring sheets, which permit clinical use of the instrument. Cut points are
recommended for the separation of infants with normal, transiently abnormal,
and abnormal neurologic development. The quantified scoring system enables
comparison of infants on item scores, subscores (factor scores), and total scores.
It also permits entry of these scores in the computer so that more complex
descriptions are possible of the relationship of the neurological assessment of
infants both to earlier (eg, birth) and later variables (eg, cerebral palsy, cognitive
function, and school performance).
Key Words: Abnormalities, Evaluation studies, Infants, Neurologic manifestations.

We constructed an instrument to as- must be adequately documented); 3) Appropriate informed consent was ob-
sess the neurological integrity of infants sufficient reliability and validity for both tained.
tofillan important gap for professionals clinical and research purposes; and 4) Follow-up assessments were sched-
working in follow-up programs for the acceptability by clinicians for the time uled for 6- and 15-months corrected
neonatal intensive care unit. Neurolog- required for assessment, clarity of items, gestational age. As we have found pre-
ical assessment of infants is of key im- and simplicity of scoring. viously in follow-up work, however, as-
portance for three reasons: 1) for iden- We have formed the assessment in- sessments were also made throughout
tification of abnormalities that should strument the Infant Neurological Inter- infancy. A full neurological assessment
be referred for physical and occupa- national Battery (Infanib) on the basis was done at each visit.
tional therapy,1"3 2) as a marker for of factor analysis. This analysis implies
problems during the early school that the items in each group are inter- Outside validation of neurologic ab-
years,4-6 and 3) for research about the related. It also permits the formation of normality was obtained through evalu-
causes and outcomes of these abnor- a subscore for each factor and a total ation in programs to which those infants
malities.4"7 score for the combined factors. were referred and from evaluation by
pediatric neurologists at the Medical
A neurological assessment instrument The Infanib is practical for clinical
College of Wisconsin. All younger in-
that meets these needs must have the use. The examination can be completed
fants were followed beyond the time
following qualities: 1) quantification in a few minutes. Both subscores and
range in which data were collected as a
and easy computer entry; 2) reliability total scores can be compared from one
part of the scheduled evaluation. In pre-
across the age range of infancy (many evaluation to the next, from one infant
vious work, we have found that identi-
changes occur in this age range that to another, or from infants with one type
fication of neurological abnormality was
of condition (eg, infants who had grade
possible in infants aged 10 to 15 months
3 or 4 intraventricular hemorrhage) to
old. Other researchers have confirmed
Dr. Ellison is Research Professor, Department infants with another condition (eg, in-
thisfindingas well.4,6,8 Very few infants
of Psychology, University of Denver, 2030 S York fants who did not have intraventricular
St, Denver, CO 80208 (USA). who have been carefully examined re-
Dr. Horn is Professor of Psychology, University
hemorrhage).
turn later with undiagnosed abnormali-
of Denver.
Dr. Browning is Assistant Professor of Pediatrics, ties unless there has been an intervening
Medical College of Wisconsin, 8700 W Wisconsin METHOD event such as meningitis or head injury.
Ave, Milwaukee, WI 53226.
Funds for this research were supported partially The subjects were infants followed in The follow-up evaluation consisted of
by NINCDS—IF33NS07435. the Southeastern Wisconsin Regional an examination by a pediatric nurse
This article was submitted August 9, 1984; was
with the authors for revision six weeks; and was Perinatal Follow-through Program from practitioner who obtained anthropo-
accepted March 21, 1985. October 1, 1981, to November 30, 1982. metric measures and performed the

1326 PHYSICAL THERAPY


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RESEARCH

Denver Developmental Screening Test.9 The physical therapist scored each in- their accuracy in predicting each of the
One of two physical therapists assessed fant in two other ways: 1) degree of categories of normality-abnormality.17
and scored each infant on 32 neurolog- neurologic normality-abnormality (se- Two types of variations were used in
ical items for the neurological assess- verely abnormal, moderately abnormal, these analyses: 1) a variation using
ment; both physical therapists were mildly abnormal, minimally abnormal, standard scores for the subscores or
skilled in the neurological evaluation of or normal) and 2) category of normality- squares of standard scores for the sub-
infants using the quantified Milani- abnormality (spastic tetraparesis and scores and 2) a variation in categories of
Comparetti and Gidoni (MCG) dyskinesia, spastic hemiparesis, spastic abnormalities. These latter variations
method.10 diplegia, hypotonia, transient abnor- were 1) a grouping of six categories of
mality, and normal). normality-abnormality (spastic tetrapa-
resis/dyskinesia, spastic diplegia, hypo-
Neurological Items and Scoring Data Analysis tonia, two gradations of transient ab-
normality, and normal) and 2) a group
The items for the neurological assess- We obtained correlations among the
ment were selected from four methods 32 items. The matrix of these correla-
of neurological examination: 1) the tions was factored by using several pro- TABLE 1
MCG method,11 2) the French "angles" cedures of factor analysis. The root one Description of 365 Infants by Corrected
method,8 3) the primitive reflexes criterion15, 16 was examined along with Gestational Age and Sex
method,12, 13 and 4) the Paine and Oppe other criteria for determining the correct
method.14 number of factors. In rotation, we con- Corrected
Number of
Gestational Age
In previous work, we used three types sidered both the Varimax (orthogonal) Infants
(mo)
of data analyses—chi-square, product- and Promax (oblique) solutions. The
moment correlation, and analysis of oblique rotation with afive-factorsolu- 3 1
variance (ANOVA) at six age levels (6, tion described the data well. Four high 4 1
5 8
7 to 8, 9 to 10, 11 to 12, 15 to 16, and loading items were selected to measure
6 95
17 to 21 months old)—to reduce the each factor, although most factors had 7 41
items of the MCG method from 27 to more than four items with loadings 8 41
20 items.10 We used those 20 MCG greater than .30. Thus, a 20-item battery 9 26
items in this study. Five items were used with five factors was formed. Internal 10 13
from the French angles method. We consistencies or reliabilities were calcu- 11 10
consider that these five items represent lated for each factor. 12 7
distinctive aspects of that method and Although the five factors were math- 13 6
have used them previously,1 We used all ematically independent, they were pos- 14 3
items from the primitive reflex method, itively correlated. We therefore summed 15 63
and chose three items from the Paine 16 27
the subscores from the five factors to
17 7
and Oppe method on the basis of clini- obtain a total score. Internal consisten- 18 7
cal experience. The 32 items that com- cies or reliabilities were calculated for 19 2
prised the neurological assessment are the items for the total score for two age 20 6
shown in Appendix A. ranges: 7 months or less and 8 months 22 1
A scoring system was developed so or more, corrected gestational age. TOTAL
that each item was scored from 1 to 5 205 (boys)
points (severely abnormal to normal). Mean of Total Scores,
160 (girls)
For the MCG items, the scoring was the Subscores, and Normality and
same as that described in our previous Abnormality Scores
work.10 For the French angles method, TABLE 2
items one age level away from the ex- Because some items were not scored Description of 365 Infants by Degree and
pected developmental level were scored in the earlier ages (eg, forward para- Category of Normality-Abnormality
3 or 4; items two or more age levels chute), means and standard deviations Normality- Number of
away from the expected developmental for the total score were obtained for two Abnormality Infants
level were scored 1 or 2. The primitive age groups: infants 7 months or less and
infants 8 months or more, corrected Degree
reflexes were scored as described by Ca-
severely abnormal 6
pute et al.13 Reflexes were scored 5 gestational age. These scores were ob-
moderately abnormal 49
points for normal or 2+ reflexes, 3 to 4 tained for the five degrees of normality- mildly abnormal 38
points for 1+ or 3+ reflexes, and 1 to 2 abnormality that the examiners had minimally abnormal 101
points for 0 or 4+ reflexes. Hand posi- been asked to rate. An ANOVA was normal 169
tion was scored 5 points for open, 3 to obtained for each of the two age cate- Category
4 points for closed recurrently, and 1 to gories to assess whether the five degrees spastic tetraparesis/ 28
2 points for usually closed. (An open of normality-abnormality were signifi- dyskinesia
hand pattern was considered normal be- cantly different from each other, as spastic hemiparesis 5
cause all the infants were 3 months of measured by the total score. spastic diplegia 17
hypotonia 21
age or older.) A full set of the scoring Subscores, obtained by summing the
transient abnormality 134
for all 32 items is available from the item scores for each factor, were used in 160
normal
senior author (P.H.E.). several discriminant analyses to assess

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collapsing the two categories of spastic­ TABLE 3
ity into one and the two categories of The 20 Items Selected for the Infanib Using Factor Analysis (Promax Rotation)
transient abnormality into one. The re­
sulting four categories of normality-ab­ Factor Items Factor Loading Reliabilitya
normality were spasticity, hypotonia, 1. Spasticity asymmetric tonic neck reflex .71
transient abnormality, and normal. The tonic labyrinthine in prone .78
number of infants with spastic hemipa- tonic labyrinthine in supine .77
resis was too small to permit inclusion hands held open or closed .61 .86
of that as a category. II. Vestibular function backward parachute .88
forward parachute .88
sideway parachute .63
Clinical Application
body rotative .89 .89
The 20-item scoring method was then III. Head and trunk sitting .65
pulled to sitting .71
used in clinics and follow-up programs
all fours .73
by physicians and physical therapists to .74
body derotative .86
test its practicality. Because many clini­ IV. French angles scarf sign .67
cians had difficulty scoring a 5-point heel to ear .75
range for each item, we rescored the data popliteal angle .78
and repeated the data analyses. Items abductor's angle .82 .89
originally scored 5 were retained as 5, V. Legs standing .56
items scored 3 or 4 were rescored as 3, foot grasp .70
and items scored 1 or 2 were rescored dorsiflexion of foot .67
as 1. Cut points for three degrees of positive support reflex .66 .72
normality-abnormality were then made a
Total score reliabilities: All subjects .91, 7 months or less .88, 8 months or more .93.
for total scores of infants 4 to 8 months
old and infants 8 months or older. A
similar cut point was made for infants TABLE 4
Means, Standard Deviations, and ANOVA F Values for the Total Score (Summation of
less than 4 months old on the basis of
Scores from the 20 Infanib Items)
infants seen in the clinics.
Degree of Normality-
Age s ANOVA F
Abnormality
RESULTS
7 months or less severely abnormal 32.3 2.9
Three hundred and sixty-five neuro­ moderately abnormal 55.3 10.1
logical assessments were made. Two mildly abnormal 64.9 6.8
hundred and sixty-one infants were minimally abnormal 71.0 4.6
evaluated on one occasion, 37 were eval­ normal 76.6 3.6 82.0(<.001)
uated on two occasions, and 10 were 8 months or more severely abnormal 38.1 7.5
evaluated on three occasions. The num­ moderately abnormal 60.9 11,5
mildly abnormal 74.3 10.4
ber of infants between 3 and 22 months
minimally abnormal 85.2 7.2
old evaluated each month is shown in normal 95.6 6.1 140.1 (<.01)
Table 1.
The number of infants with each of
the five degrees of normality-abnormal­ The means, standard deviations, and scores and not of item scores. Hypotonia
ity and the number of infants in each ANOVA F values with the level of sig­ was less accurately identified as a sepa­
category of normality-abnormality are nificance for the five degrees of normal­ rate category than other categories; spas­
shown in Table 2. A wide spectrum of ity-abnormality are shown in Table 4. ticity, transient abnormality, and nor­
normality-abnormality was assessed. Clinicians may choose to divide nor­ mality were accurately discriminated
Thus, the instrument for assessment was mality-abnormality into different num­ with the use of subscores.
- constructed on the basis of the evalua­ bers of degrees. In previous work, we The cut points for infants less than 4
tion of infants with normal and abnor­ have used three degrees: normal, tran­ months old were established as follows:
mal neurologic development. siently abnormal, and abnormal.1, 10 We abnormal ≤ 48, transient = 49-65, nor­
The factor loadings for the 20 items consider that five degrees are as many mal≥66. For infants 4 to 8 months old,
obtained in the five-factor solution with as we need for practical use. Even with the cut points were abnormal ≤ 54,
a Promax (oblique) rotation are shown this large number of degrees, the 20- transient = 55-71, and normal ≥ 72.
in Table 3. The internal consistencies or item Infanib discriminates significantly For infants 8 months old or more, the
reliabilities for each factor are also given. between the degrees of normality-abnor­ cut points were abnormal ≤ 68, tran­
Each of the factors except Factor V (legs) mality. sient = 69-82, and normal ≥ 83.
had sufficient reliability as a separate The percentage of infants who were
factor at the upper age levels (8 months identified correctly by discriminant
or older). The reliability for the total analyses for two different categoriza­ DISCUSSION
score is large enough, both above and tions of normality-abnormality are
below age 8 months old, for clinical and shown in Table 5. The discriminant The construction of an instrument for
research purposes.18 analyses were based on the use of sub- the measurement of neurological integ-

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RESEARCH

TABLE 5
aspects of neurological integrity. The In-
Percentage Correct Achieved in Discriminant Function Analyses in Two Categorizations fanib scale is short enough to be used in
of Diagnosis practice and the reliabilities are ade-
quate for research purposes.
Grouping Category of Normality-Abnormality % correct
On the other hand, a single item
First spastic tetraparesis/dyskinesia 84.6 would hardly be sufficient to describe
spastic diplegia 70.6
neurological abnormality. Single items
hypotonia 53.8
less transient 76.0
can identify, however, some aspect of
more transient 88.0 abnormality. The Babinski maneuver,
normal 88.0 for example, has been a sine qua non of
Second spasticity 93.0 determining neurological abnormality.
hypotonia 38.5 Nevertheless, considerable neurological
transient abnormality 84.0 abnormality may be present without a
normal 88.0 positive Babinski sign. Patients with a
overidentification of a factor. In general, positive Babinski sign may also have a
rity should be based firmly on the prin-
spectrum of abnormalities. In general,
ciples and theories of measurement the- the process of describing interrelation-
the neurological assessment requires a
ory.18 The first step is descriptive. The ships among variables, of reducing the
variety of items.
neurological function and movement of number of variables, and of determining
infants have been described by several reliabilities among variables has re- Items must be scored, which is an-
observant clinicians.8, 11, 14, 19-21 The ceived little attention in neurological other complex process. We described
monograph of Bly is noteworthy for its testing. the use of a 5-point scale in scoring the
rich detail.21 Thus, some consensus of After initial construction, most in- MCG method.10 For some items, mak-
normality and of deviance or abnor- struments need refinement. The Infanib ing that many gradations was difficult.
mality has been achieved in the area. was used in several clinical settings by The more gradations there are, the more
The next step is the formation of sin- likely that interrater reliability will de-
both physicians and physical therapists.
gle items as representations of these gen- crease. On a practical basis, we found
Adjustments were then made on the
eral descriptions. In the construction of that many clinicians had difficulty
basis of this experience.
the Infanib, items from four methods of choosing among five gradations in neu-
Some clinicians asked us why we did
neurological evaluations were used to rological items. Because the major goals
not use all of the items from any one of this work were the creation of a prac-
expand the scope of the assessment. In method. They expressed concerns that
test development, this expansion is tical and psychometrically sound assess-
some items were not included. This is a ment instrument, we reduced the num-
phrased as "generating an item pool."22 major issue in measurement. How
The assembled items were then ad- ber of gradations to three: 1, 3, and 5
many items are required to identify or points. Each gradation was indicated on
ministered to a representative sample. adequately measure a quality? Beyond
Because the initial goal of our study was a scoring sheet (Appendix B), so that the
a certain point, items that measure the clinician had a clear indication of how
the construction of an instrument for same aspect of neurological abnormality
clinical and research purposes for neo- to score.
become redundant. They increase the
natal programs, we chose a sample of As a result of the scoring, a total score
reliability of the assessment marginally.
infants who were initially treated in the is achieved We have indicated three
Our decision to limit the number of
neonatal intensive care unit. Sample size degrees of normality-abnormality for
items was not based on a lack of avail-
is important as well. We considered that regular use even though the results show
able items or even on the lack of avail- that finer gradations were possible. In
a sample of 200 or 300 infants was
able items with large loadings on a fac- Table 4, five degrees of abnormality
needed to assure stability of results. By
tor. Our decision was based on practi- were significantly different when scored
using a large sample, we increased the
probability that the testing of a second cality and psychometric principles. We by experienced examiners.
or third sample of infants would show obtained values for internal consistency
A subscore, indicated on the scoring
similar results. Chandler et al used a both as a measure of the strength of
sheet as a factor score, is also achieved.
similar process in developing the Move- association among the items and as an
Based on clinical experience, we con-
ment Assessment Instrument.23 An item indicator that sufficient items were in-
sider Factor I an excellent indicator of
pool was generated and a sample of cluded. The factors of the Infanib have
spasticity, although other factors also
infants was tested. Their results need high internal consistencies with only contain items that measure spasticity.
confirmation with other samples be- four items. Using more items gains little Factor II assesses vestibular function
cause of the very small sample size. reliability. Because many items from the with three parachute items. The item,
The next step is one of data analyses MCG method loaded on two factors "body rotative," is linked to parachute
in which the relationships among items (Factors II and III), inclusion of even 20 items by the mathematical-statistical
and the relationships of items to the MCG items was considered excessive. analysis; it is also linked neurologically
objective are described. When a large In addition, our experience indicates in that a certain level of vestibular com-
pool of items is used, part of this process that clinicians do not use lengthy neu- petence is required before the infant can
is usually one of reducing the number rological methods. We need a reasona- perform the body rotative maneuver.
of items. One method for this is factor ble compromise between measuring Factor III measures head and trunk con-
analysis, through which the number of everything and establishing a workable trol, Factor IV measures resting tone,
items can be reduced on the basis of scale that reflects accurately the different and Factor V describes the legs.

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Which of these factors or which com- to-physical therapist evaluation, and 5, all categories except hypotonia, as
bination of these factors is the best in- perhaps even pediatric neurologist-to- indicated by the physical therapists,
dicator of neurological integrity? Fur- developmental pediatrician evaluation were accurately identified with the use
ther work is needed to determine the because these are the professionals who of discriminant analyses based on the
relationshp between the factor or sub- perform most of the neurological assess- factor scores. We consider that the less
scores and preceding events, such as fe- ments of infants. These studies are in accurate identification of hypotonia
tal bradycardia or neonatal seizures, and progress. Examiners from different with discriminant analysis did not re-
to link these to outcome variables, such training backgrounds often use quite dif- flect shortcomings of either the exam-
as mental retardation, motor abnormal- ferent methods of evaluation, for which iners or the assessment instrument.
ity, learning disabilities, hyperactivity, formal assessments of validity generally Rather, the problem is how to separate
and behavioral abnormalities. A longi- have been lacking.3 Therefore, we rea- hypotonia from the category of "tran-
tudinal study with a large sample size soned that two types of rating by ex- sient abnormality," because much tran-
would be needed to study this properly. aminers experienced in the examination sient abnormality is simply a mild hy-
Until such a project can be initiated and of infants would best serve as the stand- potonia. In other words, this problem is
completed, we recommend simply sum- ard in this step of test construction. The an issue of definitions and designation
ming the factor or subscores to obtain a examiner was asked to rate the degree of categories rather than an issue of
total score. With this approach, each of normality-abnormality (scored 1 to identification of abnormality. In the
factor or subscore is considered equal 5) and the type of normality-abnormal- scoring sheets and cut points, we pro-
(ie, unweighted). The summation of un- ity. vide appropriate approximate designa-
weighted scores generally has more sta- The role of physical therapists has not tions of categories for clinical and re-
bility from one sample to another.24 been that of making diagnoses. Physical search purposes.
What is the standard against which a therapists, however, who are experi- The sample for this study consisted of
new scale should be compared? We con- enced in the evaluation and treatment infants from the neonatal intensive care
sider that further studies with the In- of infants (as were the two who per- unit. Such a sample will, of course, in-
fanib should compare physician-to-phy- formed the evaluations in this study) clude abnormal infants (although in-
sician evaluation, physician-to-physical have considerable knowledge about di- fants with spastic hemiparesis have
therapist evaluation, physical therapist- agnostic categories. As shown in Table tended to be few). Testing the Infanib in
samples of infants who were not treated
APPENDIX A in a neonatal intensive care unit, that is,
The 32 Items in the Neurological Evaluation testing a basically well-baby sample, is
also important. Fewer infants with both
Test Items abnormality and transient neurological
Milani-Comparetti and Gidoni abnormality are anticipated in such a
(MCG) body lying supine sample.
asymmetrical tonic neck reflex (ATNR) The present study was limited in the
pulled to sitting
number of infants 1 to 5 months old
sitting
and 9 to 12 months old. Future studies
sideway parachute
backward parachute
should fill these gaps. Although defini-
head in space tions of infancy vary, a sensible goal is
downward parachute to make the Infanib appropriate for a 1-
standing to 18-month age range.
foot grasp
body in sagittal plane CONCLUSION
forward parachute
all fours We constructed an assessment instru-
symmetrical tonic neck reflex (STNR) ment for the neurological evaluation of
body derotative infants. The 20-item instrument, named
standing from supine the Infanib, has sufficient reliability for
body rotative both clinical and research purposes. The
tilting prone results of the assessment are quantified
tilting sitting and ready for computer entry for item
French angles scarf sign
scores, factor scores, and total scores.
heel to ear
popliteal angle
The assessment is practical because it
leg abduction can be completed by the clinician in
dorsiflexion angle of the foot several minutes. A scoring sheet was also
Primitive reflex items (in addition constructed and has been tested in clin-
to those in the MCG) positive support reflex ical use by professionals with different
tonic labyrinthine reflex—prone types of training.
tonic labyrinthine reflex—supine The Infanib incorporates several
galant reflex methods of the neurological evaluation
Others hands held open or closed of infants in one instrument. The quan-
head in extension or flexion
tified scores enable comparisons of eval-
patellar reflexes
uations from one assessment to the next,

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RESEARCH

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3. Ellison P: Neurologic development of the high- Primitive reflex profile: A pilot study. Phys Ther of components in scoring psychological varia-
risk infant. Clin Perinatal 11:41-58,1984 58:1061-1065,1978 bles. Acta Psychol (Amst) 21:184-217,1963

APPENDIX B
Description of Items

1. Hands closed or open: Observe whether way between the scapulae and rub the 14. Tonic labyrinthine—prone: Place infant
hands held fisted, closed sometimes, or back. Observe for shoulder retraction, in prone position. Flex the head and
open most of the time. secondary flexion of arms (decorticate observe for increase in flexion of extrem-
2. Scarf sign: Place infant in supine posi- sign) or extension of arms (decerebrate ities.
tion. Grasp upper arm near shoulder joint sign), and extensor posturing of legs. 15. Sitting: Place the infant in sitting position.
and move arm across upper chest. Ob- 9. Asymmetric tonic neck reflex: Place in- Observe the rounding or straightening of
serve the angle formed by the upper arm fant in supine position, lining up neck the back and the lumbar vertebra that
and a line parallel to the body. Second- and body. Turn head to side and watch demarcates the straightened part of the
arily, observe the place at which the for fencing position (arm extended in back.
elbow lands on the chest. direction faced, arm flexed on opposite 16. Sideway parachute: Hold infant in sitting
3. Heel to ear: Place infant in supine posi- side). Test both sides. position, tip deliberately to each side,
tion. Grasp legs above ankles, then 10. Pull to sitting: With infant in supine po- and observe for extension of arm on that
move the infant's feet toward his nose. sition, hold forearms and pull to sitting; side.
Observe the angle between the infant's observe head and arms for lag and for 17. Backward parachute: Hold infant in sit-
trunk and legs. flexion. Observe the arms for flexion and ting position with one hand on back and
4. Popliteal angle: Place infant in supine extension at elbows. one hand on abdomen, then deliberately
position. Grasp legs at knee. Keep in-
11. Body derotative: Place infant in supine tip backwards, and observe for exten-
fant's buttocks on the table while ex-
position. Grasp both his feet. Twist him sion of arms backwards or turning to
tending the legs at the knees. Observe one side.
the angle formed by the back of the with the feet as though initiating rolling
over. Observe for segmental twisting (ie, 18. Weight bearing: Lower infant slowly to-
infant's upper leg, knee, and lower leg.
infant does not roll all-in-one, like a log). ward examining table until his feet touch
5. Leg abduction: Place infant in supine
If infant is over 4 months old and does the table; observe his ability to support
position. Grasp legs above the knee.
not respond, ask the mother if he rolls his weight. Also observe for flexing of
Abduct the legs. Observe the angle of
over spontaneously. Give credit for nor- the knee and positioning of the hips.
leg-crotch-leg.
mal for a positive answer. 19. Positive support reaction: Hold infant un-
6. Dorsiflexion of foot: Press each foot up
against its leg. Observe the angle be- 12. Body rotative: Observe for spontaneous der each armpit and lower to the table
tween foot and leg. segmental rolling vs. log-rolling from su- surface; observe whether the feet are
7. Foot grasp: Place your thumb at the pine to prone position and pull to stand- flat on the table surface or are positioned
base of the toes of each foot of the ing with use of object such as chair or with toes touching and heels elevated.
infant. Watch for curling of the toes to- crib. Parental report is sufficient evi- 20. Forward parachute: Hold the infant at
ward your thumb. dence for passing this item. mid-trunk with your hands at his sides
8. Tonic labyrinthine—supine: Place infant 13. All fours: Place infant in prone position and tip him forward quickly; observe for
in supine position; place your hand mid- and observe head, arms, and legs. extension of arms forward.

Volume 65/ Number 9, September 1985 1331


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Construction of an Infant Neurological International
Battery (INFANIB) for the Assessment of
Neurological Integrity in Infancy
Patricia H Ellison, John L Horn and Carol A Browning
PHYS THER. 1985; 65:1326-1331.

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