Original ArticleImproving the Neonatal Research Network Annual Certification for Neurologic Examination of the 18-22 Month Child
Section snippets
Methods
The NICHD NRN maintains a study manual with standard definitions (Table I). A diagnosis of neurodevelopmental impairment (NDI) is implemented for both randomized trials and observational follow-up studies. The definition of NDI is the presence of any of the following: moderate to severe CP, bilateral blindness, bilateral hearing impairment requiring amplification, (GMFCS)6, 7 ≥level 2 reflecting moderate to severe motor impairment, or a Bayley Scales of Infant and Toddler Development 3rd
Results
The 4 neurologic outcomes on the training videos for 2009 and 2010 are shown in Table III to illustrate the diagnoses chosen for the training process. In 2009, the centers' pre-workshop DVD scoring agreed with the Gold Standard rater 83% for normal neurologic exam to 91% for the GMFCS ≥ level 2 across the 6 videos (Table IV). During the workshop for real-time certification training in 2009, agreement on the test video increased to 100% for the diagnoses of abnormal neurologic exam and presence
Discussion
Challenges remain in the attempt to achieve inter-rater reliability for the neurologic exam and for the diagnosis of CP in young children. Although use of the GMFCS in conjunction with the classic neurologic exam has improved examiner accuracy, diagnosing severity of impairment is not a perfect science.11 A number of investigators have made substantial progress in initiatives to simplify and categorize the methodology for diagnosing CP.10, 17, 18 The NRN has begun to use the classification
References (19)
- et al.
Inter-rater reliability of early intervention providers scoring the Alberta Infant Motor Scale
Pediatr Phys Ther
(2004) - et al.
Effect of rater training on reliability of Melbourne Assessment of Unilateral Upper Limb Function scores
Dev Med Child Neurol
(2005) - et al.
Effect of rater training on reliability and accuracy of mini-CEX scores: a randomized, controlled trial
J Gen Intern Med
(2009) - et al.
National Institutes of Health Stroke Scale certification is reliable across multiple venues
Stroke
(2009) - et al.
Neurological development from birth to six years; guide for examination and evaluation
(2001) - et al.
Validation of a model of gross motor function for children with cerebral palsy
Phys Ther
(2000) - et al.
Development and reliability of a system to classify gross motor function in children with cerebral palsy
Dev Med Child Neurol
(1997) Bayley Scales of Infant and Toddler Development
(2006)- et al.
The Brief Infant-Toddler Social and Emotional Assessment: screening for social-emotional problems and delays in competence
J Pediatr Psychol
(2004)
Cited by (0)
The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) provided grant support for the Neonatal Research Network's (NRN) Follow-Up Study. Data collected at participating sites of the NICHD NRN were transmitted to RTI International, the data coordinating center for the network, which stored, managed, and analyzed the data for this study. J.N.'s time was supported by the NICHD Neonatal Research Network, as the Data Coordinating Center coordinator for the Follow-Up Study. The authors declare no conflicts of interest.
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A list of members of the Follow-Up Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network is available at www.jpeds.com (Appendix).