Computer-based analysis of general movements reveals stereotypies predicting cerebral palsy.

AIM: To evaluate a kinematic paradigm of automatic general movements analysis in comparison to clinical assessment in 3-month-old infants and its prediction for neurodevelopmental outcome. METHOD: Preterm infants at high risk (n=49; 26 males, 23 females) and term infants at low risk (n=18; eight males, 10 females) of developmental impairment were recruited from hospitals around Heidelberg, Germany. Kinematic analysis of general movements by magnet tracking and clinical video-based assessment of general movements were performed at 3 months of age. Neurodevelopmental outcome was evaluated at 2 years. By comparing the general movements of small samples of children with and without cerebral palsy (CP), we developed a kinematic paradigm typical for infants at risk of developing CP. We tested the validity of this paradigm as a tool to predict CP and neurodevelopmental impairment. RESULTS: Clinical assessment correctly identified almost all infants with neurodevelopmental impairment including CP, but did not predict if the infant would be affected by CP or not. The kinematic analysis, in particular the stereotypy score of arm movements, was an excellent predictor of CP, whereas stereotyped repetitive movements of the legs predicted any neurodevelopmental impairment. INTERPRETATION: The automatic assessment of the stereotypy score by magnet tracking in 3-month-old spontaneously moving infants at high risk of developmental abnormalities allowed a valid detection of infants affected and unaffected by CP.

Kinematic assessment of stereotypy in spontaneous movements in infants.

Movement variation constitutes a crucial feature of infant motor development. Reduced variation of spontaneous infant movements, i.e. stereotyped movements, may indicate severe neurological deficit at an early stage. Hitherto evaluation of movement variation has been mainly restricted to subjective assessment based on observation. This article introduces a method for quantitative assessment yielding an objective definition of stereotyped movements which may be used for the prognosis of neurological deficits such as cerebral palsy (CP). Movements of 3-month-old infants were recorded with an electromagnetic tracking system facilitating the analysis of joint angles of the upper and lower limb. A stereotypy score based on dynamic time warping has been developed describing movements which are self-similar in multiple degrees of freedom. For clinical evaluation, this measure was calculated in a group of infants at risk for neurological disorders (n=54) and a control group of typically developing children (n=21) on the basis of spontaneous movements at the age of 3 months. The stereotypy score was related to outcome at the age of 24 months in terms of CP (n=10) or no-CP (n=53). Using the stereotypy score of upper limb movements CP cases could be identified with a sensitivity of 90% and a specificity of 96%. The corresponding score of the leg movements did not allow for valid discrimination of the groups. The presented stereotypy feature is a promising candidate for a marker that may be used as a simple and noninvasive quantitative measure in the prediction of CP. The method can be adopted for the assessment of infant movement variation in research and clinical applications.

Compensation of large motion sensor displacements during long recordings of limb movements.

In motion capture applications using electromagnetic tracking systems the process of anatomical calibration associates the technical frames of sensors attached to the skin with the human anatomy. Joint centers and axes are determined relative to these frames. A change of orientation of the sensor relative to the skin renders this calibration faulty. This sensitivity regarding sensor displacement can turn out to be a serious problem with movement recordings of several minutes duration. We propose the "dislocation distance" as a novel method to quantify sensor displacement and to detect gradual and sudden changes of sensor orientation. Furthermore a method to define a so called fixed technical frame is proposed as a robust reference frame which can adapt to a new sensor orientation on the skin. The proposed methods are applied to quantify the effects of sensor displacement of 120 upper and lower limb movement recordings of newborns revealing the need for a method to compensate for sensor displacement. The reliability of the fixed technical frame is quantified and it is shown that trend and dispersion of the dislocation distance can be significantly reduced. A working example illustrates the consequences of sensor displacement on derived angle time series and how they are avoided using the fixed technical frame.

Quantification of the segmental kinematics of spontaneous infant movements.

This article introduces a method to capture the movements of the upper and the lower limb of infants using an electromagnetic tracking system and to reliably calculate the segmental kinematics. Analysis of the spontaneous movements of infants is important e.g. in the context of the "General Movement Analysis", which aims at the early diagnosis of motor dysfunctions. Due to special constraints regarding infant anatomy, previous approaches based on optical tracking could only gather position data of the infant' segments, whereas with this method in addition relative segment angles can be calculated. The spontaneous movements of the infant and simple calibration movements of the hand and the foot are used to calculate the joint centers and the joint axes of a multi-segmental chain model. The quality of the calibration movements is assessed at calibration time by calculating the root mean square deviation from the total least squares regression plane. The general accuracy of the recording is evaluated by the difference between recorded and estimated sensor positions and the difference between recorded and estimated sensor orientations. Movements of 20 infants between term and 3 months post term age were recorded and processed. A first application illustrates how abnormal movement patterns are manifested in the segmental kinematics. The results show that the presented method is a practicable and reliable way to record spontaneous infant movements and to calculate the segmental kinematics.