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）， 测量患有和不患有轻偏瘫型脑瘫的婴幼儿的自发伸手和抓握。 接触和掌握对于促进健康发展和积极参与环境至关重要。 该建议关注婴儿上肢快速发育的8 - 36个月的关键时期 技能，移动性，认知和语言;以及当偏瘫特异性治疗，如限制诱导 运动疗法可以开始了BAM将推进关于手臂典型运动的科学知识 和手以及运动的改变。这将产生 标准化的，客观的衡量标准，量化受损和典型发展之间的距离， 扩大治疗诱导恢复的精确测量。该项目包括前瞻性纵向 从典型发育中的婴儿和幼儿获得的数据，并利用视频共享和支持， StrokeNet关于强制性运动疗法的III期随机对照试验。 在AIM 1中，我们将使用80个典型发展中国家的伸手和抓握行为来制定BAM指数。 婴儿/幼儿和240名婴儿/幼儿患有围产期动脉缺血性中风和偏瘫性脑瘫。 视频将被编码为自发达到和抓握频率，持续时间和探索行为， 共同的对象。将采用多种统计模型来制定四个标准化的BAM指数。 在AIM 2中，我们将（a）评估四个BAM指数的变化，其中1040个纵向视频来自 队列和（B）使用以下方法建立BAM指数的心理测量学特性： 测量（神经功能缺损和功能）;粗大运动功能测量-66（粗大运动），Bayley量表 婴幼儿发育第4版（精细运动、粗大运动、语言和认知分量表），迷你版 和辅助手评估（麻痹手）;父母报告的结果测量（婴儿运动活动日志， MacArthur-Bates沟通发展量表）;以及临床/父母结局联合测量 （新兴行为量表）。 该项目有可能通过提供一种新颖，可靠， 精确、灵敏的接触和抓握测量-适用于数十万有婴儿的儿童 中风和偏瘫性脑瘫。此外，还介绍了数据共享和视频编码的新用途。 对于科学可重复性、降低成本至关重要，并将支持改善健康和 脑瘫和其他身体残疾的婴儿和幼儿的身体功能。

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.