Wearable neuroimaging technologies for the neonatal intensive care unit: mapping sensorimotor disruption in infants at risk of cerebral palsy.

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Newborn infants are extremely vulnerable to brain injury. The cause and nature of newborn brain injuries varies widely, but one common factor is that infants who suffer a brain injury at birth often go on to develop cerebral palsy.Cerebral palsy is a group of permanent movement disorders that can severely limit the control of the muscles, and can have a devastating impact on quality of life. Cerebral palsy is the most common form of childhood disability in Europe and every year, approximately 1800 children in the UK are diagnosed with the condition. Cerebral palsy also has a significant impact on families and on society. It is estimated that the costs of care and support for people with cerebral palsy exceeds £1.4 Billion per year in the UK.The early diagnosis of cerebral palsy is critical. While there is no cure for the condition, there are a number of treatments that can improve an infant's long-term motor ability. During the first few weeks and months of life the brain is highly adaptable, which means it is likely to be at its most susceptible to treatment. If infants with abnormal motor development could be identified early, these treatments would have the greatest chance of success. At present, the majority of infants with cerebral palsy are not diagnosed until 1 or 2 years-of-age. By this point it is likely too late for treatment to have the best possible impact. In 2015, the government held an inquiry into issues surrounding cerebral palsy in the UK and highlighted the urgent need for more research to support the early and objective diagnosis of the condition.In healthy children and adults, the parts of the brain that control movement and receive somatosensory input (such as touch sensation) are organized like a map of the body. It has been shown that this organization is disrupted in children and adults with cerebral palsy. If we could monitor this disruption in the infant at the cot-side, it would be possible to provide an early and objective identification of infants who are developing abnormally. At present, there is no technology that can provide the precision, resolution, patient comfort or motion tolerance necessary to achieve this.The aim of this fellowship is to address these challenges and develop a new wearable functional brain imaging technology that will allow infant somatosensory and motor organization to be mapped at the cot-side. I will use flexible electronics to construct a miniaturized imaging array that will incorporate hundreds of emitters and detectors of near-infrared light to safely monitor infant brain function. This imaging array will be fixed into a soft, elastic head-cap that can be worn comfortably by a newborn baby. By designing and integrating an advanced form of motion tracking, and by developing novel signal processing approaches, I will maximize the precision and motion tolerance of this imaging technology to allow brain function to be mapped during touch stimulation and during natural movement. I will then validate this system using carefully controlled laboratory experiments and a comprehensive functional imaging study in healthy adults. Finally, I will translate this technology to the neonatal clinic and investigate the development of somatosensory and motor function in both healthy and brain-injured infants from preterm through to 6 months-of-age. In doing so, I aim to demonstrate a new approach to the objective identification and monitoring of infants with cerebral palsy.