The first year of life is a period of rapid development, and perhaps the best time both to detect problems and to intervene. Hand function is one of the key aspects of motor and sensory development. Manual motor skills are one of the most frequent deficits in developmental problems. Many boys and girls present incoordination, lack of strength or precision, and difficulties with grasping in writing or with buttons. Therefore, early detection in the baby is key. But how to evaluate the hand function of a baby.
With the PIMT concept, we always insist that the clinical examination has to be accompanied by measurable and objective scales. This good habit reduces errors in the evaluation, allows the results to be better objectified and improves communication between professionals. That is why a clinical developmental examination of a baby has to be accompanied by a good scale like the AIMS. This gives seriousness to our work as physiotherapists.
The problem comes to choose the appropriate scale for the hand function in babies. The truth is that it is not easy. I love the review by Krumlinde-Sundholm y cols. del 2015 on the assessment of hand function in babies. In it, the authors review different and well-known scales such as the BSID-III (Bayley), the GM, the TIMP or the Peabody. Their conclusions? Well, only three tests include a specific fine motor scale. But these scales include tasks to be performed with only the dominant hand. There are no ratings for scales from each hand to quantify asymmetry. Only the new HAI (Hand Assessment for Infants) tool seems to consider these aspects in the manual function of babies at risk of developing unilateral cerebral palsy (CP). Very recently the HAI scale demonstrated very good to excellent accuracy in predicting CP in at-risk infants between 3.5 months and 12 months. Precision increased with age of assessment (Ryll et al., 2020).
Having this proof is a big step. It is not clear if the scale will be useful for babies with genetic alterations, developmental problems, consequences of a obstetric brachial plexus injury (OBPI) or cervical dysfunctions. Let us remember the high incidence of cervical problems in babies and the consequences they have for the upper limb.
PIMT clinical evaluation
In any case, a good clinical evaluation must be available. PIMT proposes a complete clinical evaluation of hand function that includes:
• Evaluation of postural control of the upper limbs in prone positions and in transfers (eg from sitting to quadruped)
• Visual and kinesthetic solicitation for grasping objects in the supine and prone position (possible from 4 months on)
• Evaluation of circuits such as primitive grasp (before 4 months) or asymmetric tonic cervical circuits with passive head rotation.
• Examination of postural responses. The traction test or “pull to sit” or the horizontal Collis reaction are excellent evaluation systems.
• And of course, the musculoskeletal evaluation of the cervical spine, dorsal spine and thorax is essential. This evaluation must integrate active and passive cervical ROM examinations, evaluation of vertebral segmental mobility with precise and very gentle evaluative techniques, evaluation of muscles and aponeurosis, respiratory function, and the costosternal joints.
It seems that it is not easy to know how to evaluate hand function in babies and that the objective scales and tests undoubtedly require the help of a thorough clinical examination in pediatric physical therapy. This evaluation must be comprehensive and integrate the clinical reasoning of manual therapy.
What assessments evaluate use of hands in infants? A literature review.
Krumlinde-Sundholm L, Ek L, Eliasson AC.Dev Med Child Neurol. 2015 Apr;57 Suppl 2:37-41.
Predictive validity of the Hand Assessment for Infants in infants at risk of unilateral cerebral palsy.
Ryll UC, Krumlinde-Sundholm L, Verhage CH, Sicola E, Sgandurra G, Bastiaenen CH, Eliasson AC.Dev Med Child Neurol. 2020 Nov 29.
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