Neurological Assessment during Infancy

We currently assess

Neurological assessment in infancy

Professor Bert C.L. Touwen, MD, PhD, described in 1976 neurological development in infancy. This formed the basis of a standardized neurological assessment during infancy (see Hadders-Algra et al. 2010).

Recently a group of German neuropaediatricians and the Institute of Developmental Neurology developed a standardized neurodevelopmental assessment for infants in general paediatric practice (Standardized Infant Neurodevelopmental Assessment, SINDA). It aims to enhance the early detection of children with a developmental disorder. SINDA is designed for infants aged 6 weeks to 12 months corrected age. SINDA consists of three scales:

- Neurological scale – duration: less than 10 minutes
- Developmental scale – duration varies from 5-7 minutes in the youngest infants to 10-15 minutes in the oldest infants
- Socio-emotional scale – the items are assessed during the entire assessment – no extra time involved.

SINDA has good psychometric properties, including a good predictive value for develomental disorders, including cerebral palsy and intellectual disability.
Currently SINDA's manual is being written; it will include norm data collected in the IMP-SINDA project.

Neurological assessment in pre-school age

Dr. Rietje Hempel described in 1992 a standardized neurological assessment for pre-school age. The instrument is promising, for instance to document neurological function in children born preterm. Currently an international group assesses the instrument’s reliability and validity.


Dr, Jeanie Cheong                                
Neonatologie, Melbourne

Prof. Dr. Mijna Hadders-Algra               
Ontwikkelingsneurologie, UMCG

Dr Heike Philippi
Sozial Pädiatrisches Zentrum, Frankfurt

Prof. Dr. Joachim Pietz                        
Universitäts Kinderklinik, Heidelberg        1

Dr. Uta Tacke
Universitäts Kinderklinik, Basel

Dr. Rietje van Wijlen-Hempel, MD, PhD
Revalidatie, LUMC

Dr. Brigitte Vollmer, MD
Neuropaediatrie, Southampton   

Key publications

  • Hadders-Algra M, Heineman KR, Bos AF, Middelburg KJ. The assessment of Minor Neurological Dysfunction using the Touwen Infant Neurological Examination: strengths and limitations. Dev Med Child Neurol 2010;52:87-92.
  • Hadders-Algra M. The neuromotor examination of the preschool child and its prognostic significance.  Ment Retard Dev Disabil Res Rev 2005; 11:180-8.
  • Hamer EG, Hadders-Algra M. Prognostic significance of neurological signs in high risk infants – a systematic review. Dev Med Child Neurol, 2016; 58 (suppl 4): 53-60.
  • Hamer EG, Dijkstra LJ, Hooijsma SJ, Zijdewind I, Hadders-Algra M. Knee jerk responses in infants at high risk for cerebral palsy: an observational EMG study. Pediatr Res. 2016; 80: 363-70.
  • Hamer EG, Vermeulen RJ, Dijkstra LJ, Hielkema T, Kos C, Bos AF, Hadders-Algra M. Slow pupillary light response in infants at high risk for cerebral palsy were associated with periventricular leukomalacia and neurological outcome. Acta Paediatr. 2016; 105: 1493-1501.
  • Schendelaar P, Seggers J, Heineman MJ, Hadders-Algra M. Neurological condition assessed with the Hempel examination and cognition and behaviour at 4 years. Early Hum Dev 2017; 112: 9-13.
  • Hamer E, La Bastide-Van Gemert S, Boxum A, Dijkstra L, Hielkema T, Vermeulen RJ, Hadders-Algra M. The tonic response to the infant knee jerk as an early sign of cerebral palsy. Early Hum Dev. 2018; 119: 38-44.
  • Hadders-Algra M, Tacke U, Pietz J, Rupp A, Philippi H. Reliability and predictive validity of the Standardized Infant NeuroDevelopmental Assessment neurological scale. Dev Med Child Neurol, epub ahead of print.
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