Development of upper extremity behavioral assessment methods for reach-and-grasp and physical rehabilitation

该提案的总体目标是开发和推进行为评估方法(BAM)，以 测量患有和不患有偏瘫的婴幼儿的自然伸展和抓握能力。 伸展和把握对于促进健康发展和积极参与环境至关重要。 这项建议的重点是8-36月龄婴儿上肢快速发育的关键时期。 技能、行动能力、认知和语言；以及当偏瘫的特定治疗，如强制诱导 运动疗法，可以开始了。BAM将推进有关手臂典型运动的科学知识 以及偏瘫脑瘫儿童的运动改变。这将产生一个 标准化、客观的度量标准，用于量化受损与典型发育和意志之间的距离 扩大治疗后恢复的精准测量。该项目包括预期的纵向 从典型的婴幼儿发育中获得的数据，并利用视频共享和来自 StrokeNet的强制性诱导运动治疗的第三阶段随机对照试验。 在目标1中，我们将使用80个典型发展中的REACH和GRAPH行为来开发BAM指数 婴幼儿和240名婴幼儿/幼儿围产期动脉缺血性卒中和偏瘫脑瘫。 将对视频进行编码，以供自发访问，并通过 公共对象集。将采用多种统计模型来开发四个标准化的BAM指数。 在AIM 2中，我们将(A)使用1040个纵向视频来评估四个BAM指数的变化 队列和(B)建立BAM指数的心理测量学特性：使用：儿童卒中结局 测量(神经功能缺陷和功能)；粗大运动功能测量-66(粗大运动)，贝利量表 婴幼儿发展第4版(精细运动、粗大运动、语言和认知分量表)，迷你 和辅助手评估(偏瘫的手)；父母报告的结果测量(婴儿运动活动日志， 麦克阿瑟-贝茨沟通发展量表)；以及临床/父母联合结果测量 (新兴行为量表)。 该项目有可能推动儿科康复研究，为儿童康复提供一种新颖、可靠、 精确、灵敏的伸展和抓取测量-适用于数十万有婴儿的儿童 中风和偏瘫脑瘫。此外，数据共享和视频编码的新用途是 科学重现性，降低成本，并将支持改善健康和 脑性瘫痪和其他肢体残疾婴幼儿的身体功能。

The overall goal of this proposal is to develop and advance behavioral assessment methods (BAM) to measure spontaneous reach and grasp in infants and toddlers with and without hemiparetic cerebral palsy. Reach and grasp are critical to promoting healthy development and active engagement with the environment. This proposal focuses on the key period from 8 – 36 months of age when infants rapidly develop upper extremity skills, mobility, cognition, and language; and when hemiparesis-specific treatments, such as constraint-induced movement therapy, can be started. BAM will advance scientific knowledge about typical movements of the arms and hands as well as altered movements in children with hemiparetic cerebral palsy. This will yield a standardized, objective metric that quantifies the distance between impaired and typical development and will expand the precise measurement of treatment-induced recovery. This project includes prospective longitudinal data obtained from typically developing infants and toddlers and leverages video-sharing and support from StrokeNet’s Phase III randomized controlled trial of constraint-induced movement therapy. In AIM 1 we will develop the BAM Index using reach and grasp behaviors in 80 typically developing infants/toddlers and 240 infants/toddlers with perinatal arterial ischemic stroke and hemiparetic cerebral palsy. Videos will be coded for spontaneous reach and grasp frequency, duration, and exploratory behaviors with a common set of objects. Multiple statistical models will be employed to develop four standardized BAM Indices. In AIM 2 we will (a) evaluate the changes of four BAM Indices with 1040 longitudinal videos from the cohorts and (b) establish psychometric properties of the BAM Indices using: the Pediatric Stroke Outcome Measure (Neurological deficit and function); Gross Motor Function Measure-66 (Gross Motor), Bayley Scales of Infant and Toddler Development 4th edition (Fine Motor, Gross Motor, Language, and Cognition subscales), mini- and Assisting Hand Assessment (paretic hand); parent-reported outcome measures (Infant Motor Activity Log, MacArthur-Bates Communicative Developmental Inventories); and a combined clinical/parent outcome measure (Emerging Behaviors Scale). This project has the potential to advance pediatric rehabilitation research by affording a novel, reliable, precise, and sensitive measure of reach and grasp – applicable to hundreds of thousands of children with infant stroke and hemiparetic cerebral palsy. Furthermore, the novel use of data sharing and video coding are imperative for scientific reproducibility, reduction in cost, and will support the ability to improve health and physical function in infants and toddlers with cerebral palsy and other physical disabilities.