Early Identification of Developmental Disorders in Infants

DESCRIPTION (provided by applicant): Due to improvements in obstetrical and neonatal care, and an associated decrease in perinatal mortality, as well as increased risks associated with in vitro fertilization procedures, the number of preterm (< 37 weeks postmenstrual age) very low birth weight (< 1,500 g) infants born is growing [2]. Of the approximately 50,000 infants born yearly in the United States with a low birth weight, approximately 85% survive. These infants have an increased risk of long-term developmental disabilities, with approximately 5-15% exhibiting major neurodevelopmental disabilities (e.g., cerebral palsy, mental retardation) and an additional 25-50% exhibiting mild to moderate neurodevelopmental disabilities (e.g., school failure) [59, 95]. This SBIR Phase I grant application is concerned with the detection of developmental disorders at a very early age. Assessment of the consequences of low birth weight, adverse pregnancies, or complicated births on the structure and function of an infant's central nervous system (CNS) and its development is important for ob- taining valid estimates of behavior and neurological status, documenting recovery from acute effects, predicting subsequent outcome, and suggesting specific intervention strategies for any problems noted. Although brain imaging, such as cranial ultrasound, computed tomography, and magnetic resonance imaging, can document structural brain damage, assessment of infants' endogenously-generated (i.e., spontaneous) movement patterns, known as "general movements" (GMs), provides a method by which to assess CNS function. In the past 25 years, an extensive literature has shown that motility, first of the fetus and subsequently of the young infant, has strong clinical significance as an indicator of brain function and dysfunction. Presently, assessment of GMs is based on the Gestalt evaluation of video-recorded infant movement patterns. Assessment of GMs is a useful adjunct to the standard neurological examination, primitive reflex profile, and assessment of muscle strength and tone. However, use of video recording is not ideal since it is tedious, subjective, labor intensive, and expensive, requiring specially-trained practitioners to evaluate stored image sequences of line. To overcome these limitations, we propose to develop the General Movements for the Identification of Neurological disorders in Infants (GEMINI) system, a low-cost tool for objectively and automatically assessing infant GMs in hospital and non settings. The GEMINI system will exploit Barron Associates' recently-patented [73] six degrees-of-freedom wireless motion monitoring capability and sophisticated signal processing to identify the key qualitative and quantitative attributes of GMs, and thereby automate the assessment of GMs. Based on the proposed multi-phase research program, the requisite knowledge will be obtained to enable realization of a low-cost, low-profile GEMINI product that can reliably perform the required discrimination tasks and serve as a valuable research tool in documenting and better understanding movements and movement precursors for other disorders, such as autism. Identification of movement dysregulation can lead to early interventions (e.g., developmental physical therapy) and treatment strategies aimed at facilitating normal movement patterns during the critical period of early CNS plasticity. The GEMINI tool will also enable GM assessment of infants in rural areas where access to specially- trained practitioners is unavailable. Furthermore, the tool will be helpful in research studies for providing objective outcome measures by which to evaluate the effectiveness of interventions, and may also be useful in identifying the underlying process that determines normal and abnormal motor outcomes.