Early Identification of Developmental Disorders in Infants

描述（由申请人提供）：由于产科和新生儿护理的改善，以及围产期死亡率的相关降低，以及与体外受精程序相关的风险增加，早产（月经后37周以下）极低出生体重（< 1,500 g）新生儿的数量正在增加。美国每年大约有5万名出生体重过轻的新生儿，其中约85%存活下来。这些婴儿出现长期发育障碍的风险增加，其中5-15%表现为严重神经发育障碍（如脑瘫、智力迟钝），另外25-50%表现为轻度至中度神经发育障碍（如学业失败）[40,74]。这项SBIR II期拨款申请关注的是早期发育障碍的检测。评估低出生体重、不良妊娠或复杂分娩对婴儿中枢神经系统（CNS）的结构和功能及其发育的影响，对于获得对行为和神经状态的有效估计、记录急性反应的恢复、预测后续结果以及提出针对任何注意到的问题的特定干预策略非常重要。虽然脑成像，如颅超声、计算机断层扫描和磁共振成像，可以记录结构性脑损伤，但对婴儿内源性（即自发）运动模式的评估，即“一般运动”（GMs），提供了一种评估中枢神经系统功能的方法。在过去的25年里，大量的文献表明，运动，首先是胎儿，随后是新生儿，作为脑功能和功能障碍的一个指标，具有很强的临床意义。目前，对GMs的评估是基于视频记录的婴儿运动模式的格式塔评估。GMs的评估是标准神经学检查、原始反射、肌肉力量和张力评估的有用辅助。然而，视频记录的使用并不理想；它是乏味的，主观的，劳动密集，和昂贵的，需要专门训练的从业者评估存储的图像序列到线。提出的婴儿神经系统疾病识别通用运动（GEMINI）系统是一种低成本的工具，用于客观和自动评估医院和非医院环境中的婴儿神经系统疾病，将克服这些局限性。GEMINI系统将利用Barron Associates的专利六自由度运动监测能力和复杂的信号处理来识别gm的关键定性和定量属性，从而自动评估gm。基于所提出的多阶段研究计划，将获得必要的知识，以实现低成本，低成本的GEMINI产品，该产品可以可靠地执行所需的识别，并作为记录和更好地理解神经系统疾病的运动和运动前体的有价值的研究工具。

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) neonates born is growing [34]. Of the approximately 50,000 neonates 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 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) [40, 74]. This SBIR Phase II 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 obtaining valid estimates of behavior and neurological status, documenting recovery from acute eects, predicting subsequent outcome, and suggesting specic 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 body of literature has shown that motility, rst of the fetus and subsequently of the neonate, has strong clinical signicance 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 reex prole, and assessment of muscle strength and tone. However, the use of video recording is not ideal; it is tedious, subjective, labor intensive, and expensive, requiring specially-trained practitioners to evaluate stored image sequences o line. The proposed GEneral Movements for the Identication of Neurological disorders in Infants (GEMINI) sys- tem, a low-cost tool for objectively and automatically assessing infant GMs in hospital and non-hospital settings, will overcome these limitations. The GEMINI system will exploit Barron Associates' patented six degrees-of- freedom 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-prole GEMINI product that can reliably perform the required discrimination and serve as a valuable research tool in documenting and better understanding movements and movement precursors for neurological disorders.