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To see how spinal muscular atrophy (SMA) affects movement, healthcare providers often check a person’s motor skills — the ability to control and coordinate muscles. One test they may use is called the Hammersmith Infant Neurological Examination, Part 2, or HINE-2. It helps providers track how well someone with SMA can move and whether their abilities are changing over time.
Read on to discover more about how the HINE-2 test may be used for people with SMA.
As a child grows, they usually reach physical milestones. Milestones fall into several different categories. SMA often affects motor milestones, which include skills like holding the head up, grabbing objects, or sitting up.
HINE-2 is a test that helps determine whether infants or young children are able to reach motor milestones. This tool measures how well children can perform different activities that require using muscles. There’s a structure that providers use to give a child a score for each milestone. HINE-2 isn’t only used for cases of pediatric SMA, though. Doctors may also use this test to check motor function — how well a child’s muscles work to move their body — in children with other neuromuscular conditions, such as cerebral palsy.
The full Hammersmith Infant Neurological Exam (HINE) contains three sections. Section 1 tests how well the nerves work. It analyzes how active the nerves are by measuring a person’s movements and reflexes. Section 3 focuses on behavior, including mood and how alert or responsive a person is.
Section 2 of HINE tests motor skills. When this section is used alone as a clinical test, without sections 1 and 3, it’s called HINE-2.
Doctors may use other motor function assessments instead of or in addition to HINE-2 to test motor function. These include the:
Each of these tests measures different muscle-related abilities and functions. Doctors choose which test to use based on several factors, including how old the person with SMA is, which SMA type they have, and whether the person is able to sit or walk.
HINE is designed for infants and toddlers between 2 months and 24 months of age. HINE-2 is often used for children who can’t sit, such as those with SMA type 1.
The HINE-2 helps doctors understand how well a child with SMA is able to carry out normal daily activities. This information can help doctors decide which therapies or devices might make daily life easier.
This test also helps track how a child’s motor function changes over time. Doctors can measure a person’s baseline function — how well a child can complete motor skills when first diagnosed or before treatment. Then, motor function can be measured again during multiple follow-up visits. This helps doctors understand whether SMA is progressing. If doctors notice that a baby is starting to lose motor skills, it may mean a different treatment plan is needed.
The HINE-2 test is often used in SMA clinical trials. These research studies test how safe and effective new treatments are. Researchers have used the HINE-2 test to understand how SMA typically progresses and to identify which developmental milestones people with different SMA types can reach.
HINE-2 has also been used in clinical trials for new SMA therapies. This test helps researchers see whether a particular treatment helps improve motor skills for people with SMA. For example, researchers used HINE-2 to measure whether nusinersen (Spinraza) was an effective treatment for SMA. This clinical study found that infants with SMA were better able to reach motor milestones after using this therapy. It’s also been used in trials for other therapies, too.
In general, doctors recommend that children with SMA undergo tests to measure motor function every six months. In some cases, a doctor may recommend a different testing schedule based on a child’s individual needs. HINE-2 is conducted by a doctor or physical therapist.
HINE-2 analyzes eight different motor skills:
During the HINE-2 test, the healthcare professional measures each of these motor skills and assigns the skill a number. Each skill may receive a maximum of 3 to 5 points. The higher the number, the more function a child has within that area. A score of 0 means that the child lacks that particular motor skill. A low score means that the child has some level of function in that area. A high score indicates that the child is able to fully complete the motor skill.
All the scores for each motor skill are added up to provide one total score. The maximum score a child can get on HINE-2 is 26. A child’s score depends on their age, level of development, and how severe their SMA is.
The HINE-2 motor test gives doctors and researchers a clear way to measure how SMA affects movement in young children. By tracking changes in motor skills over time, the test can help guide treatment decisions and show whether therapies are working. For families, it offers a way to see progress that might otherwise be hard to measure. That can make a big difference in understanding how SMA care is helping their child.
On mySMAteam, people share their experiences with SMA, get advice, and find support from others who understand.
Do you have experience with the HINE-2 motor test? Let others know in the comments below.
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