Early Identification of Developmental Disorders in Infants

描述(申请人提供)：由于产科和新生儿护理的改善，围产期死亡率的相关下降，以及与体外受精手术相关的风险增加，早产(&lt；37周月经后)极低出生体重(&lt；1500克)新生儿的数量正在增长[34]。在美国每年出生的大约5万名低出生体重的新生儿中，大约85%的人存活下来。这些婴儿患长期发育障碍的风险增加，有5%-15%的婴儿表现出严重的神经发育障碍(如脑瘫、智力低下)，另外25%-50%的婴儿表现出轻度至中度的神经发育障碍(如学业失败)[40，74]。这项SBIR第二阶段赠款申请涉及在很小的年龄就发现发育障碍。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)及其发育的结构和功能的影响，对于获得对行为和神经状态的有效估计，记录急性事件的恢复，预测后续结果，并针对所指出的任何问题提出特殊的干预策略非常重要。虽然脑成像，如头颅超声、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，即所谓的一般运动(GM)，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，首先是胎儿的运动，然后是新生儿的运动，作为脑功能和功能障碍的指标具有很强的临床意义。目前，对转基因婴儿的评估是基于对录像婴儿运动模式的格式塔评估。GMS评估是标准神经学检查、原始肌力检查以及肌肉力量和张力评估的有用补充。然而，视频记录的使用并不理想，它繁琐、主观、劳动强度大、费用昂贵，需要经过专门培训的从业人员在线评估存储的图像序列。拟议的婴儿神经疾病鉴定通用运动(Gemini)系统是一种在医院和非医院环境中客观和自动评估婴儿转基因生物的低成本工具，将克服这些限制。Gemini系统将利用Barron Associates获得专利的六自由度运动监控能力和复杂的信号处理来识别转基因生物的关键定性和定量属性，从而实现转基因生物的自动化评估。在拟议的多阶段研究计划的基础上，将获得必要的知识，以实现低成本、低收入的双子座产品，该产品能够可靠地执行所需的辨别，并作为记录和更好地了解神经疾病的运动和运动前驱的宝贵研究工具。 公共卫生相关性：识别运动失调可导致早期干预(例如，发育性物理治疗)和治疗策略，旨在促进中枢神经系统可塑性较高的早期关键期的正常运动模式。双子座工具还将能够对农村地区的婴儿进行转基因评估，因为农村地区很少有受过专门培训的从业人员。此外，该工具将有助于在临床和研究研究中提供客观的衡量标准，以评估后续干预的有效性，并可能有助于识别决定正常和异常运动结果的潜在过程。

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. PUBLIC HEALTH RELEVANCE: Identication of movement dysregulation can lead to early interventions (e.g., developmental physical therapy) and treatment strategies aimed at facilitating normal movement patterns during an early critical period when CNS plasticity is presumed high. The GEMINI tool will also enable GM assessment of infants in rural areas where access to specially-trained practitioners is rarely available. Furthermore, the tool will be helpful in clinical and research studies for providing objective measures against which to evaluate the eectiveness of subsequent interventions, and may also be useful in identifying the underlying processes that determines normal and abnormal motor outcomes.