儿童肌张力低下评估方法的现状与进展

Current status and advances in the assessment of hypotonia in children

摘要

肌张力低下是儿科常见的运动功能障碍,多见于神经发育类疾病。近年来儿童肌张力低下的发病率不断上升,且常合并运动发育迟缓及认知功能障碍。现有临床评估高度依赖操作者经验,缺乏标准化量化工具,导致结果主观性强、重复性差。本文整理并叙述了常用临床量表和客观检测技术在儿童肌张力低下评估中的应用现状与局限,梳理其信效度证据和国内实践基础,并提出规范化、本土化及智能化的优化路径,为中国儿童肌张力低下早期筛查与干预提供参考。

Abstract

Hypotonia is a common pediatric motor dysfunction, frequently observed in neurodevelopmental disorders. In recent years, the prevalence of hypotonia in infants and young children has been increasing and is often accompanied by delayed motor development and impairments in cognitive function. Current clinical assessments rely heavily on examiner experience and lack standardized quantitative tools, resulting in high subjectivity and poor repeatability. This article reviews the current applications and limitations of commonly used clinical rating scales and objective measurement techniques for assessing pediatric hypotonia. It summarizes evidence on their reliability, validity, and practical use in China, and proposes optimization strategies focusing on standardization, localization, and intelligent assessment, with the aim of informing early screening and intervention for hypotonia in Chinese children.

关键词

肌张力低下 / 评估方法 / 神经发育 / 运动功能障碍 / 儿童

Key words

hypotonia / assessment / neurodevelopment / motor dysfunction / children

[1] Paleg GS,Hidalgo Robles Á, Govender P, et al. Occupational and physical therapy interventions for young children with developmental central hypotonia: An overview of systematic reviews[J]. Disabilities, 2025, 5(1): 14.
[2] De Santos-Moreno MG, Velandrino-Nicolás AP, Gómez-Conesa A. Hypotonia:Is it a clear term and an objective diagnosis? An exploratory systematic review[J]. Pediatr Neurol, 2023, 138: 107-117.
[3] Parau D, Todoran AB, Balasa R. Physiotherapy intervention on premature infants—A pilot study[J]. Medicina, 2024, 60(1): 138.
[4] Madhok SS, Shabbir N.Hypotonia[M/OL].In:StatPearls[Internet].Treasure Island (FL):StatPearls Publishing, 2022.https://www.ncbi.nlm.nih.gov/books/nbk562209/.
[5] Gabis LV,Shaham M,Leon Attia O,et al.The weak link:Hypotonia in infancy and autism early identification[J].Front Neurol,2021,12:612674.
[6] Hidalgo Robles Á, Paleg GS, Livingstone RW. Identifying and evaluating young children with developmental central hypotonia: An overview of systematic reviews and tools[J]. Healthcare, 2024, 12(4): 493.
[7] Govender P, Joubert RWE. Evidence-based clinical algorithm for hypotonia assessment: To pardon the errs[J]. Occup Ther Int, 2018, 2018: 8967572.
[8] Osagie IE, InoyatI, Ayerdi AM. Infant head lag[M/OL]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2023. https://www.ncbi.nlm.nih.gov/books/NBK567782/.
[9] Hammond CK, Oppong E, Ameyaw E,et al. Spinal muscular atrophy in Ghanaian children confirmed by molecular genetic testing:A case series[J]. Pan Afr Med J, 2023, 46:78.
[10] Zoccante L, Ciceri ML, Di Gennaro G, et al. A new method to evaluate jointhypermobility in paediatric patients with neurodevelopmental disorders: A preliminary study[J]. Children, 2024, 11(9): 1150.
[11] Akin MA, Balci NC, Demirsoz M. Revolutionizing neonatal care: A comprehensive assessment of neuromotor development in at-risk infants using the novel neonatal infant motor assessment scale (NIMAS) test battery[J]. Children, 2024, 11(4): 445.
[12] Troha Gergeli A,Škofljanec A, Neubauer D, et al. Prognostic value of various diagnostic methods for long-term outcome of newborns after hypoxic-ischemic encephalopathy treated with hypothermia[J].Front Pediatr,2022,10:856615.
[13] Connors R, Sackett V, Machipisa C, et al.Assessing the utility of neonatal screening assessments in early diagnosis of cerebral palsy in preterm infants[J]. Brain Sci,2022,12(7):847.
[14] Howard GT, Baque E, Colditz PB, et al.Diagnostic accuracy of the Hammersmith Neonatal Neurological Examination in predicting motor outcome at 12 months for infants born very preterm[J].Dev Med Child Neurol,2023,65(8):1061-1072.
[15] Correr MT, Pfeifer LI. Cultural adaptation and reliability assessment of the Hammersmith Neonatal Neurological Examination for Brazilian newborns at risk of cerebral palsy[J].Arq Neuropsiquiatr,2023,81(1):47-54.
[16] Einspieler C, Bos AF, Krieber-Tomantschger M, et al.Cerebral palsy:Early markers of clinical phenotype and functional outcome[J].J Clin Med,2019,8(10):1616.
[17] Kapil N, Majmudar-Sheth B, Johnson T. Hammersmith Infant Neurological Examination subscores are predictive of cerebral palsy[J]. Pediatr Neurol, 2024, 151: 84-89.
[18] Cowan FM, Martinez Biarge M, Vollmer B,et al. Hammersmith Infant Neurological Examination (HINE): Guidance notes for completion of the proforma (update December 2023)[EB/OL].(2024-01-23)[2025-07-05].http://www.mackeith.co.uk/hammersmith-neurological-examinations/.
[19] Harris SR, Haley SM, Tada WL, et al. Reliability of observational measures of the movement assessment of infants[J]. Phys Ther, 1984, 64(4): 471-475.
[20] Hadders-Algra M, Tacke U, Pietz J, et al. Reliability and predictive validity of the Standardized Infant NeuroDevelopmental Assessment neurological scale[J]. Dev Med Child Neurol, 2019, 61(6): 654-660.
[21] American Physical Therapy Association.Harris Infant Neuromotor Test(HINT)[EB/OL]. (2021-07-12)[2025-08-04].https://www.apta.org/patient-care/evidence-based-practice-resources/test-measures/harris-infant-neuromotor-test.
[22] Williams MF. Comparative predictive validity of the Harris Infant Neuromotor Test and the Alberta Infant Motor Scale[J]. Dev Med Child Neurol, 2011, 53(7): 669.
[23] Hamad AP, Caldas CATC,de Sá e Silva ICM, et al. Could minor neurological dysfunction be a type of non-cerebral palsy motor impairment?[J]. Arq Neuropsiquiatr, 2025, 83(5): 1-1
[24] Brown L, Goo M. Clinimetrics: Neurosensory motor developmental assessment[J]. J Physiother, 2024, 70(3): 240.
[25] Saraf R, Marks R. Neurodevelopmental screening and surveillance: Brief evidence review for the Well Child Tamariki Ora Programme (Domain 1)[R]. Wellington (NZ): Ministry of Health, 2021.
[26] Eeles AL, Olsen JE, Walsh JM,et al. Reliability of neurobehavioral assessments from birth to term equivalent age in preterm and term born infants[J]. Phys Occup Ther Pediatr, 2017,37(1): 108-119.
[27] Pineda R, Smith J, Roussin J, et al. Randomized clinical trial investigating the effect of consistent, developmentally-appropriate, and evidence-based multisensory exposures in the NICU[J]. J Perinatol, 2021, 41(10): 2449-2462.
[28] Modayur B, Fair-Field T, Komori S. Enhancing motor screening efficiency:Toward an empirically derived abridged version of the Alberta Infant Motor Scale[J]. Early Hum Dev, 2023, 177: 105723.
[29] Fair-Field T, Modayur B. Clinical validation of an abridged AIMS: Streamlining motor screening in the first-year infant[J]. Early Hum Dev, 2025, 202: 106207.
[30] Narayan A, Anand PSS, Karnad SD, et al. Comparison of the predictive validity of the Alberta Infant Motor Scale and Infant Neurological International Battery in low-birth-weight infants:A prospective longitudinal study[J].Physiother Quart,2025,33(2):39-44.
[31] 郭英英, 赵瑾珠, 郝燕. Infanib量表和Gesell发育量表在儿童运动发育评估中的一致性研究[J]. 中国中西医结合儿科学, 2024, 16(2): 144-147.
Guo YY, Zhao JZ, Hao Y. Consistency of Infanib Scales and Gesell Developmental Scales in the assessment of motor development in children[J]. Chin Pediatr Integr Tradit West Med, 2024, 16(2): 144-147. (in Chinese)
[32] Chandler LS, Terhorst L, Rogers JC, et al. Movement Assessment of Children (MAC): Validity, reliability, stability and sensitivity to change in typically developing children[J]. Child Care Health Dev, 2016, 42(4): 513-520.
[33] Tran HLT, Einhellig K, Tran LTK, et al. Validity and reliability of the comfort behavior scale in children undergoing wound dressing replacement in Vietnam[J]. Med Pharm Res,2020,4(3):26-33.
[34] Glanzman AM, Mazzone E, Main M, et al. The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND): Test development and reliability[J]. Neuromuscul Disord, 2010, 20(3): 155-161.
[35] Gower L,Jenkins D,Fraser JL, et al.Early developmental assessment with a short screening test, the STEP, predicts one-year outcomes[J]. J Perinatol,2019,39(2):184-192.
[36] Gulati S, Aneja S, Juneja M, et al. INCLEN Diagnostic Tool for Neuromotor Impairments (INDT-NMI) for primary care physician: Development and validation[J]. Indian Pediatr,2014, 51(8):613-619.
[37] Kumar H, Agrawal D. Diagnostic tool for neuromotor impairment for primary care physician[J].Indian Pediatr,2014,51(8):607-608.
[38] Seo H, Kim J, Yu C, et al. Intra-rater and inter-rater reliability analysis of muscle-tone evaluation using a myotonometer for children with developmental disabilities[J]. Healthcare, 2023, 11(6): 782.
[39] Karacabey BN, Bayramoğlu Z, Coşkun O, et al. Shear wave elastography in patients with spinal muscular atrophy types 2 and 3[J]. Neuropediatrics, 2023, 54(4): 273-278.
[40] Li Y, Gao L, Huang M, et al. Quantitative assessment of muscle atrophy and structural changes in children with spinal muscular atrophy using ultrasound imaging[J]. Eur J Paediatr Neurol,2025,57:1-6.
[41] Basak I, Tiwari AK, Prasad R, et al.Nerve conduction study in young children suffering from cerebral palsy[J].Indian J Physiol Pharmacol,2023,67:118-124.
[42] Sarker DS, Azam DAZM, Quaderi DHR. Electromyogram (EMG) and nerve conduction study (NCS) findings in children with neuromuscular disorders[J]. Glob Acad J Med Sci, 2022, 4(2): 78-82.

基金资助

深圳市龙岗区科技创新专项资金医疗卫生技术攻关项目(LGKCYLWS2023006);中国康复医学会2023年度科研课题计划(KFKT-2023-034);深圳市龙岗区医疗卫生科技计划项目非扶持类(LGWJ2023-57、LGWJ2023-66);深圳市龙岗区妇幼保健院科研启动资金项目(Y2024010)