Table 1.

NICHD Neonatal Research Network 2009–2010 Definitions for the 18–22 Month Neurologic Exam

Parameter	Definition
Normal	No abnormalities of tone, reflexes or function noted in the neurologic exam.
Cerebral Palsy	Abnormalities observed in tone, deep tendon reflexes, coordination and movement. Some disorder of motor function must be present Aberrations in primitive reflexes and postural reactions may be present.
GMFCS	Normal - Walks 10 steps independently and fluently Possible Level 1 - Walks 10 steps independently but not fluently; child exhibits toe walking (mild diplegia) or asymmetric walking (possible hemiplegia) Level 1 - Infants move in and out of sitting and floor-sit with both hands free to manipulate objects. Infants creep or crawl on hands and knees, pull to stand and take steps holding onto furniture. Infants walk between 18 months and 2 years of age without holding on Level 2 - Infants maintain floor sitting but may need to use their hands for support to maintain balance. Infants creep on their stomach or crawl on hands and knees. Infants may pull to stand and take steps holding onto furniture Level 3 - Infants maintain floor sitting when the low back is supported. Infants roll and creep forward on their stomachs Level 4 - Infants have head control but trunk support is required for floor sitting. Infants can roll to supine and may roll to prone Level 5 - Physical impairments limit voluntary control of movements. Infants are unable to maintain antigravity head and trunk postures in prone and sitting. Infants require adult assistance to roll.
Neurodevelopmental Impairment	The presence of any one of the following: Moderate to Severe CP with a GMFCS score of ≥ 2, bilateral blind with vision 20/200 or worse, bilateral permanent hearing loss ± amplification that does not permit the child to understand instructions of the examiner, or a Bayley Scales-III cognitive or motor score < 70.