Reliability and validity of the Hempel Neurological Assessment at preschool age

Ubels, A.E. (Annelou) (2016) Reliability and validity of the Hempel Neurological Assessment at preschool age. thesis, Medicine.

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Abstract

Background: Newborns with prenatal, perinatal or neonatal problems, e.g. extremely preterm (EP) infants and infants with neonatal hypoxic ischaemic encephalopathy (HIE), are at high risk of minor neurological dysfunction (MND). MND implies the presence of a coherent cluster of neurological symptoms, without having a major neurological diagnosis. MND helps to determine a child’s susceptibility to develop motor, learning, or behavioural problems. Early detection of MND offers the opportunity for early intervention, which may improve developmental outcome. A promising neurological examination to detect MND at preschool age is the Hempel Neurological Assessment, but there is limited information regarding its reliability and validity in clinical setting. Aim: To determine the reliability and validity of the Hempel Neurological Assessment at preschool age in clinical setting. Methods: Thirty-one participants who were born EP (n=13), had neonatal HIE (n=15), or had another high risk condition (n=3), attending their routine follow-up appointment at age two years (median 24 months and seven days), were examined using the Hempel assessment. The assessment was video recorded and three assessors scored the videos independently offline. Findings were expressed in a clinical neurological classification (normal, simple MND, complex MND and abnormal neurological condition) and in the Neurological Optimality Score (NOS) (0-54). Intra-rater reliability and interrater reliability were determined. Construct validity and concurrent validity were assessed by studying associations with neonatal risk factors and developmental outcome as assessed with the Bayley Scales of Infant Development-III (BSID-III) and the Child Behavior Checklist (CBCL). Results: Twenty-five participants had a normal neurological condition, three had simple MND, one had complex MND, and two had an abnormal neurological condition. Intra-rater reliability (κ=1.000, r=0.835) and interrater reliability (κ=0.703, r=0.806) for clinical neurological classification and NOS were good to very good. Neurological condition of EP and HIE participants was similar. MND was associated with neonatal seizures (p=0.049) and non-optimal General Movements at age three months (p=0.044), but not with neonatal MRI or ultrasound findings, sex, or socioeconomic status. Clinical neurological classification was moderately correlated with the BSID-III total motor score (ρ=-0.488, p=0.016) and the CBCL total problem score (ρ=0.581, p=0.002), and strongly correlated to the CBCL internalising behaviour score (ρ=0.633, p=0.001). No correlation with the CBCL externalising behaviour score or BSID-III cognitive and language score was seen. Conclusion: The Hempel assessment is a reliable instrument to assess neurological function in preschool aged children in clinical setting. The study supports the preliminary evidence for the validity of the Hempel assessment. Future research should focus on the validity of the Hempel assessment with larger sample sizes and more cases of complex MND.

Item Type:	Thesis (Thesis)
Supervisor name:	Faculty supervisor: and Hadders-Algra, Prof Dr. Mijna MD
Supervisor name:	Southampton supervisor: and Vollmer, igitte MD PhD and Institution: University of Southampton and University Hospit and Department: Clinical Neurosciences and University Child Heal
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:02
Last Modified:	25 Jun 2020 11:02
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2252

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