Development of an evidence-based clinical algorithm for practice in hypotonia assessment: a proposal

Pragashnie Naidoo, Pragashnie Naidoo

Abstract

Background: Assessing muscle tone in children is essential during the neurological assessment and is often essential in ensuring a more accurate diagnosis for appropriate management. While there have been advances in child neurology, there remains much contention around the subjectivity of the clinical assessment of hypotonia, which is often the first step in the diagnostic process.

Objective: In response to this challenge, the objective of the study is to develop and validate a prototype of a decision making process in the form of a clinical algorithm that will guide clinicians during this assessment process.

Methods: Design research within a pragmatic stance will be employed in this study. Multi-phase stages of assessment, prototyping and evaluation will occur. These will include processes that include a systematic review, processes of reflection and action as well as validation methods. Given the mixed methods nature of this study, use of NVIVO or ATLAS-ti will be used in the analysis of qualitative data and SPSS for quantitative data.

Results: Initial results from the systematic review revealed a paucity of scientific literature that documented the objective assessment of hypotonia in children. The review identified the need for more studies with greater methodological rigor in order to determine best practice with respect to the methods used in the assessment of low muscle tone in the paediatric population.

Conclusions: It is envisaged that this proposal will contribute to a more accurate clinical diagnosis of children with low muscle tone in the absence of a gold standard. We anticipate that the use of this tool will ultimately assist clinicians towards moving to evidenced based practice whilst upholding best practice in the care of children with hypotonia.

Keywords: clinical assessment; evidenced-based; hypotonia; low muscle tone.

Conflict of interest statement

Conflicts of Interest: This study is supported by the Medical Research Council of South Africa in terms of the National Health Scholars Programme from funds provided for this purpose by the National Department of Health.

References

    1. Blauw-Hospers CH, Hadders-Algra M. A systematic review of the effects of early intervention on motor development. Dev Med Child Neurol. 2005 Jun;47(6):421–32.
    1. Pilon JM, Sadler GT, Bartlet DJ. Relationship of Hypotonia and Joint Laxity to Motor Development During Infancy. Pediatric Physical Therapy. 2000;12:10–15.
    1. Bodensteiner JB The Evaluation of the Hypotonic Infant. Seminars in Pediatric Neurology. 2008;15(1):10–20.
    1. Martin K, Inman J, Kirschner A, Deming K, Gumbel R, Voelker L. Characteristics of hypotonia in children: a consensus opinion of pediatric occupational and physical therapists. Pediatr Phys Ther. 2005;17(4):275–82.
    1. Martin K, Kaltenmark T, Lewallen A, Smith C, Yoshida A. Clinical characteristics of hypotonia: a survey of pediatric physical and occupational therapists. Pediatr Phys Ther. 2007;19(3):217–26. doi: 10.1097/PEP.0b013e3180f62bb0.
    1. Jan MMS The hypotonic infant: Clinical approach. Journal of Pediatric Neurology. 2007;5(3):181–187.
    1. Leyenaar J, Camfield P, Camfield C. A schematic approach to hypotonia in infancy. Paediatr Child Health. 2005 Sep;10(7):397–400.
    1. Paro-Panjan D, Neubauer D. Congenital hypotonia: is there an algorithm? J Child Neurol. 2004 Jun;19(6):439–42.
    1. Harris SR Congenital hypotonia: clinical and developmental assessment. Developmental Medicine and Child Neurology. 2008;50(12):889–892.
    1. Laugel V, Cossée M, Matis J, de Saint-Martin A, Echaniz-Laguna A, Mandel JL, Astruc D, Fischbach M, Messer J. Diagnostic approach to neonatal hypotonia: retrospective study on 144 neonates. Eur J Pediatr. 2008 May;167(5):517–23. doi: 10.1007/s00431-007-0539-3.
    1. Prasad AN, Prasad C. Genetic evaluation of the floppy infant. Semin Fetal Neonatal Med. 2011 Apr;16(2):99–108. doi: 10.1016/j.siny.2010.11.002.
    1. Miller VS, Delgado M, Iannaccone ST. Neonatal hypotonia. Semin Neurol. 1993 Mar;13(1):73–83. doi: 10.1055/s-2008-1041110.
    1. United Nations: Goal 4: Reduce child mortality - Child deaths are falling, but not quickly enough to reach the target. [2014-11-23]. The Millennium Development Goal Report 2010: Addendum .
    1. Naidoo P Current Practices in the Assessment of hypotonia in children. South African Journal of Occupational Therapy. 2013;43(2):12–17.
    1. Naidoo P, Joubert RW. Consensus on hypotonia via Delphi process. Indian J Pediatr. 2013 Aug;80(8):641–50. doi: 10.1007/s12098-013-1018-7.
    1. World Health Organization . International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY. Geneva: World Health Organisation; 2007. International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY.
    1. Khalil PN, Kleespies A, Angele MK, Thasler WE, Siebeck M, Bruns CJ, Mutschler W, Kanz KG. The formal requirements of algorithms and their implications in clinical medicine and quality management. Langenbecks Arch Surg. 2011 Jan;396(1):31–40. doi: 10.1007/s00423-010-0713-3.
    1. Eitel F, Kanz KG, Hortig E, Tesche A. Do we face a fourth paradigm shift in medicine--algorithms in education? J Eval Clin Pract. 2000 Aug;6(3):321–33.
    1. Kanz KG, Eitel F, Waldner H, Schweiberer L. [Development of clinical algorithms for quality assurance in management of multiple trauma] Unfallchirurg. 1994 Jun;97(6):303–7.
    1. Holloway I. In: Qualitative Research in Nursing Healthcare. Holloway I, Wheeler S, editors. UK: Wiley-Blackwell; 2010.
    1. Skulmoski GJ, Hartman FT, Krahn J. The Delphi Method for Graduate Research. Journal of Information Technology Education: Research. 2007;6(1):1–20.
    1. AGREE Collaboration Development and validation of an international appraisal instrument for assessing the quality of clinical practice guidelines: The AGREE project. Qual Saf Health Care. 2003;12:18–23.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever