Refining the Hammersmith Infant Neurological Examination proforma to facilitate the recording of neurological findings

AIM: To report on changes to the Hammersmith Infant Neurological Examination (HINE) proforma that facilitate the recording of neurological findings. METHOD: We first identified items that would benefit from more detail in the way they were presented on the proforma to aid correct administration and scoring. We then introduced additional details without changing the scoring system. These changes were piloted in infants with and without neurological concerns to find out whether examiners found the changes confusing or if the changes made might affect the original scoring system. RESULTS: Eight of the 26 items in the main section of the HINE were identified for possible change: three items in the tone section, two in the reflexes and reactions section, and three in the posture section. For these items, more detail was added to the recording options within each column, without altering the main structure of the proforma or the scoring system. Users did not find the additions an extra burden; they felt that the more detailed options facilitated accuracy in recording observations and that the scoring of the proforma was not affected. INTERPRETATION: Small changes made to the HINE proforma facilitate more accuracy in recording detail in the examination, particularly with regard to tone and posture, without changing the established scoring system. This should facilitate the recording of more subtle changes that reflect typical development or may occur in response to possible intervention.