Muscle tone assessments for children aged 0 to 12 years: a systematic review

AimThe aim of this study was to identify and examine the psychometric properties of muscle tone assessments for children aged 0 to 12years. MethodFour electronic databases were searched to identify studies that included assessments of resting and/or active muscle tone. Methodological quality and overall psychometric evidence of studies were rated using the COnsensus-based Standards for the selection of health Measurement INstruments checklist. ResultsTwenty-one assessments were identified from 97 included studies. All assessments were broad developmental assessments that included muscle tone items or subscales. Most assessments (16/21) were designed for young children (<2y). Four assessments measured resting and active tone and demonstrated at least moderate validity or reliability: the Amiel-Tison Neurological Assessment (ATNA) at term, Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS), Premie-Neuro for newborn infants, and the Hammersmith Infant Neurological Examination (HINE) for infants aged 2 months to 2 years. For children over 2 years, the Neurological Sensory Motor Developmental Assessment (NSMDA) assesses resting and active tone but has limited validity. InterpretationThe ATNA at term, NNNS, Premie-Neuro, HINE, and NSMDA can assess resting and active tone in infants and/or children. Further psychometric research is required to extend reliability, validity, and responsiveness data, particularly for older children.