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Introduction Early identification and intervention of infants who are at risk for or have developmental disorders is an important global health policy and action. The Global Research on Developmental Disabilities [...], Objective. Preterm infants are at high risk of neuromotor disorders. Recent advances in digital technology and machine learning algorithms have enabled the tracking and recognition of anatomical key points of the human body. It remains unclear whether the proposed pose estimation model and the skeleton-based action recognition model for adult movement classification are applicable and accurate for infant motor assessment. Therefore, this study aimed to develop and validate an artificial intelligence (AI) model framework for movement recognition in full-term and preterm infants. Methods. This observational study prospectively assessed 30 full-term infants and 54 preterm infants using the Alberta Infant Motor Scale (58 movements) from 4 to 18 months of age with their movements recorded by 5 video cameras simultaneously in a standardized clinical setup. The movement videos were annotated for the start/end times and presence of movements by 3 pediatric physical therapists. The annotated videos were used for the development and testing of an AI algorithm that consisted of a 17-point human pose estimation model and a skeleton-based action recognition model. Results. The infants contributed 153 sessions of Alberta Infant Motor Scale assessment that yielded 13,139 videos of movements for data processing. The intra and interrater reliabilities for movement annotation of videos by the therapists showed high agreements (88%-100%). Thirty-one of the 58 movements were selected for machine learning because of sufficient data samples and developmental significance. Using the annotated results as the standards, the AI algorithm showed satisfactory agreement in classifying the 31 movements (accuracy = 0.91, recall = 0.91, precision = 0.91, and F1 score = 0.91). Conclusion. The AI algorithm was accurate in classifying 31 movements in full-term and preterm infants from 4 to 18 months of age in a standardized clinical setup. Impact. The findings provide the basis for future refinement and validation of the algorithm on home videos to be a remote infant movement assessment. Keywords: Artificial Intelligence, Assessment, Machine Learning, Motor Development

The prevalence rate of developmental delays and disabilities has been reported as 5% to 17% in children younger than 17 years. (1,2) One Taiwan study demonstrated that one-third of such [...], Background. Caregiver engagement and collaborative team early childhood intervention (ECI) services are international trends; however, relevant evidence of collaborative home-visiting ECI in rural areas is as yet undetermined. Objective. The study aimed to investigate the effectiveness of a collaborative ECI program in a rural area of Taiwan. Design. The study was a pilot randomized control led trial. Methods. Children aged 6 to 33 months experiencing motor delays and their care-givers were enrolled in Taitung, Taiwan. Using stratified randomization, 24 participants were allocated to either experimental or control groups, and both received 5 home visits within 3 months. The experimental group received ECI services based on the International Classification of Functioning, Disability and Health framework and family-centered approaches. The control group received regular home visits by local social workers. Child outcomes included Pediatric Evaluation of Disability Inventory Chinese Version and Peabody Developmental Motor Scale, 2nd edition. Family outcomes included the Disability-Adapted Infant - Toddler version of Home Observation for Measurement, and Chinese versions of the Knowledge of Infant Development Inventory and Parental Stress Index-Short Form. A tester blinded to the study conducted assessments at baseline, postintervention, and 3-month follow-up. Two-way mixed analysis of variance was used with [alpha] = .05 (2-tailed). Results. The experimental group improved scores on the Disability-Adapted Infant-Toddler version of Home Observation for Measurement significantly more than the control group with an effect size of 0.64 at follow-up. In other outcomes, both groups showed no significant differences. The follow-up rate was 69%, and adherence to the ECI program was acceptable. Limitations. A limitation of the study was the heterogeneity of the sample. Conclusions. This pilot study revealed possible effectiveness in implementing collaborative ECI programs based on family-centered approaches and the International Classification of Functioning, Disability and Health in rural areas. Larger field studies are needed to confirm our findings.

Advancements in perinatal and neonatal care have significantly improved the survival of preterm infants with very low birth weight (VLBW; birth weight of < 1500 g) in the past few [...], Background. Family-centered intervention for preterm infants has shown short- to medium-term developmental benefits; however, the neurological effects of intervention have rarely been explored. Objective. The objectives of this study were to examine the effect of a family-centered intervention program (FCIP) on neurophysiological functions in preterm infants with very low birth weight (VLBW; birth weight of < 1500 g) in Taiwan, to compare the effect of the FCIP with that of a usual-care program (UCP), and to explore the FCIP-induced changes in neurobehavioral and neurophysiological functions. Design. This was a multicenter, single-blind randomized controlled trial. Setting. The study took place in 3 medical centers in northern and southern Taiwan. Participants. Two hundred fifty-one preterm infants with VLBW were included. Intervention. The FCIP group received a family-centered intervention and the UCP group received standard care during hospitalization. Measurements. Infants were assessed in terms of neurobehavioral performance using the Neonatal Neurobehavioral Examination-Chinese version, and their neurophysiological function was assessed using electroencephalography/event-related potentials during sleep and during an auditory oddball task during the neonatal period. Results. The FCIP promoted more mature neurophysiological function than the UCP, including greater negative mean amplitudes of mismatch negativities in the left frontal region in the oddball task in all infants, lower intrahemispheric prefrontal-central coherence during sleep in infants who were small for gestational age, and higher interhemispheric frontal coherence during sleep in those who were appropriate for gestational age. Furthermore, interhemispheric coherence was positively associated with the total neurobehavioral score in preterm infants who were appropriate for gestational age (r = 0.20). Limitations. The fact that more parental adherence strategies were used in the FCIP group than in the UCP group might have favored the intervention effect in this study. Conclusions. Family-centered intervention facilitates short-term neurophysiological maturation in preterm infants with VLBW in Taiwan.

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder that occurs in approximately 1 in 68 children aged 8 years. (1) It is primarily characterized by limited social interaction and [...], Background. Increasing evidence shows common motor deficits associated with autism spectrum disorder (ASD) that can relate to impaired planning and control processes of the sensorimotor system. Catching is a fundamental motor skill that requires coordination between vision, posture, and arm movements. Although postural control and ball catching have been shown to be impaired in children with ASD, previous studies have not investigated how these components are integrated. Objective. The objective of this study was to investigate the sensorimotor control of arm movements and postural adjustments during ball catching in children with and without ASD. Design. This study employed a cross-sectional design. Methods. Fifteen children with ASD (mean [SD] age = 8.8 [1.2] years; 12 boys) and 15 age- and sex-matched typically developing children participated in this study. Children were asked to catch a ball rolling down a ramp in 6 test conditions in which visual inputs and ramp direction were manipulated to provide different sensory conditions and postural demands. Results. Compared with their typically developing peers, children with ASD had increased difficulties catching balls, especially those from lateral directions. They less often used visual information to plan for catching motion, demonstrated fewer and delayed anticipatory postural adjustments, and exhibited increased corrective control. Limitations. The sample excluded children with intellectual disability and attention deficit and hyperactivity disorders that might reduce the generalizability to the whole ASD population. Conclusions. Our results suggest that motor difficulties present in children with ASD can result from compromised sensorimotor integration in planning and control of movements.

Background. Family-centered care for preterm infants in Western societies has yielded short- to medium-term benefits. However, the intervention effects have rarely been validated in Eastern societies. Objective. The aim of [...]

Background. Early identification of motor dysfunction in preterm infants with very low birth weight (VLBW) is important in order to provide early intervention. Objective. This study was to examine the [...]

Infants born prematurely enter this world with a disadvantage and face many challenges when they are most fragile. Preterm infants who survive sustain an increased risk of neurodevelopmental sequelae compared [...], Background. Treadmill training in supported stepping has been used as part of rehabilitation programs for children with neurodevelopmental problems to facilitate earlier onset of walking. However, information concerning the developmental continuity between supported stepping and walking is limited. Objective. The aims of this study were to longitudinally examine supported stepping in preterm and full-term infants and to explore the step parameters associated with walking attainment. Design. A cohort study with a longitudinal follow-up design was used. Methods. Twenty-nine preterm infants and 20 full-term infants were examined bimonthly with supported stepping on a treadmill from 7 months of age until walking attainment or 18 months of corrected age. The associations between step variables and walking outcome were examined using Cox proportional hazard regression and logistic regression. Results. Walking attainment for preterm infants was later than for full-term infants (median=12.8 versus 11 months, respectively). The percentage of alternating steps, hip-knee correlation, hip-ankle correlation, and asymmetry ratio (AR) of stance time of stepping movement from 7 to 9 months of corrected age were found to be associated with age of walking attainment in all infants. Manifestation of at least 3 of 4 step features (ie, ≥ 80% alternating steps, ≤ .37 hip-knee correlation, ≥ .73 hip-ankle correlation, and ≤ 1.40 AR of stance time) at 7 months predicted walking attainment prior to 11 months of corrected age (accuracy=75%-77%). Failure to achieve such competencies at 7 or 9 months of corrected age was predictive of failure in walking attainment by 15 months (accuracy=72%-98%). Limitations. The limitations of this study included a small sample size and commencement of stepping assessment as early as 7 months of corrected age. Conclusions. The emergence of walking may involve cooperation of alternating pattern generation, interjoint coordination, and interlimb coordination in supported stepping in preterm and full-term infants. The identified step predictors may assist clinicians in designing appropriate treadmill training programs for those infants with delayed walking.

The term 'cerebral palsy' (CP) describes a group of movements and posture that are attributed to nonprogressive impairments in the developing fetal or infant brain. (1) Approximately half of children [...], Background and Purpose Virtual reality (VR) creates an exercise environment in which the intensity of practice and positive feedback can be systematically manipulated in various contexts. The purpose of this study was to investigate the training effects of a VR intervention on reaching behaviors in children with cerebral palsy (CP). Participants Four children with spastic CP were recruited. Method A single-subject design (A-B with follow-up) was used. All children were evaluated with 3 baseline, 4 intervention, and 2 follow-up measures. A 4-week individualized VR training program (2 hours per week) with 2 VR systems was applied to all children. The outcome measures included 4 kinematic parameters (movement time, path length, peak velocity, and number of movement units) for mail-delivery activities in 3 directions (neutral, outward, and inward) and the Fine Motor Domain of the Peabody Developmental Motor Scales-Second Edition (PDMS-2). Visual inspection and the 2-standard-deviation-band method were used to compare the outcome measures. Results Three children who had normal cognition showed improvements in some aspects of reaching kinematics, and 2 children's change scores on the PDMS-2 reached the minimal detectable change during the intervention. The improvements in kinematics were partially maintained during follow-up. Discussion and Conclusion A 4-week individualized VR training program appeared to improve the quality of reaching in children with CP, especially in children with normal cognition and good cooperation. The training effects were retained in some children after the intervention.

Improvements in the management of newborn infants have been associated with a decrease in neonatal mortality among preterm infants with very low birth weight (VLBW) (gestational age of Spontaneous movements [...], Background and Purposes. Although early kicking differences have been reported for preterm infants without overt cranial sonographic abnormalities, their functional importance remains unclear because no outcomes have been measured. Therefore, the first purpose of this prospective study was to examine the age of walking attainment in preterm infants who had very low birth weight (VLBW) but no overt neurosonographic abnormalities and full-term infants without known impairments or pathology. The second purpose was to examine the relationship between spontaneous kicking and age of walking attainment in these infants. Subjects and Methods. Twenty-two preterm infants and 22 full-term infants were examined for kicking movements at 2 and 4 months corrected age and were followed up for age of walking attainment until 18 months corrected age. Results. Survival analysis showed that infants with VLBW attained walking ability at older ages than full-term infants after correction for prematurity. Cox proportional-hazards regression analyses for all infants revealed that a high hip-knee correlation at 2 months corrected age, a high kick frequency at 4 months corrected age, and a short intra-kick pause together with a low variability in interlimb coordination at 2 and 4 months corrected age were all associated with a decreased rate of walking attainment. Discussion and Conclusion. The results indicated that preterm infants who had VLBW but no overt neurosonographic abnormalities had an increased risk of delayed walking attainment compared with full-term infants. Alterations of spontaneous kicking may predict a decreased rate of walking attainment in both preterm and full-term infants. [Jeng SF, Chen LC, Tsou KI, et al. Relationship between spontaneous kicking and age of walking attainment in preterm infants with very low birth weight and full-term infants. Phys Ther. 2004;84:159-172.] Key Words: Kicking movement, Kinematic analysis, Prematurity, Walking.

Advancements in perinatal care in past decades have resulted in a marked improvement in the survival rate of preterm infants with very low birth weight (VLBW) (birth weight of Spontaneous [...], Background and Purpose. Study of kicking development provides important information to understand how early spontaneous movements change in infants as they acquire voluntary control. Researchers have investigated the kicking movements of preterm infants; however, the movement patterns that they have described were inconsistent. The purpose of this study, therefore, was to examine the development of kicking movements with kinematic analysis in preterm infants with very low birth weight (VLBW) and full-term infants. Subjects and Methods. Twenty-two infants with VLBW who were divided into low gestational age (gestational age of ≥ 30 weeks, n=9) and high gestational age (gestational age of ≥ 30 weeks, n=13) classes and 22 full-term infants were evaluated during kicking movements using 4 synchronized cameras and 3-dimensional kinematic analysis when the infants were 2 and 4 months of corrected age. Results. The infants with VLBW and a high gestational age showed similar kicking movements compared with the full-term infants. In contrast, the infants with VLBW and a low gestational age exhibited a higher kick frequency and a shorter flexion phase at 4 months of corrected age. They also exhibited a higher hip-knee correlation and lower variability in the interlimb coordination pattern at 2 and 4 months of corrected age. Discussion and Conclusion. The findings indicate that infants with VLBW, particularly those with a low gestational age, have age-related differences in movement organization and coordination of kicking compared with full-term infants. [Jeng SF, Chen LC, Yau KIT. Kinematic analysis of kicking movements in preterm infants with very low birth weight and full-term infants. Key Words: Kicking movement, Kinematic analysis, Prematurity, Very low birth weight.

Infants born prematurely have a higher risk for developmental delays than full-term infants do, with motor delays accounting for the largest proportion of these problems,[1-3] Recent approaches to identifying and [...], Background and Purpose. The goal of this study was to examine the reliability and validity of measurements obtained with the Alberta Infant Motor Scale (AIMS) for evaluation of preterm infants in Taiwan. Subjects. Two independent groups of preterm infants were used to investigate the reliability (n=45) and validity (n=41) for the AIMS. Methods. In the reliability study, the AIMS was administered to the infants by a physical therapist, and infant performance was videotaped. The performance was then rescored by the same therapist and by 2 other therapists to examine the intrarater and interrater reliability. In the validity study, the AIMS and the Bayley Motor Scale were administered to the infants at 6 and 12 months of age to examine criterion-related validity. Results. Intraclass correlation coefficients (ICCs) for intrarater and interrater reliability of measurements obtained with the AIMS were high (ICC=.97-.99). The AIMS scores correlated with the Bayley Motor Scale scores at 6 and 12 months (r=.78 and .90), although the AIMS scores at 6 months were only moderately predictive of the motor function at 12 months (r=.56). Conclusion and Discussion. The results suggest that measurements obtained with the AIMS have acceptable reliability and concurrent validity but limited predictive value for evaluating preterm Taiwanese infants. [Jeng SF, Yau KIT, Chen LC, Hsiao SF. Alberta Infant Motor Scale: reliability and validity when used on preterm infants in Taiwan. Phys Ther. 2000;80:168-178.] Key Words: Infant motor test, Motor development, Prematurity, Reliability, Validity.

Enormous financial and human costs are generated as a result of injuries sustained from falling. Elderly people and children with cerebral palsy, for example, face a greater risk of falls [...], Background and Purpose. The location of several sensory systems in the head implies that maintenance of head stability may be a potentially important part of locomotor activity. A limited amount of research, however, has been conducted to measure stability or to compare head stability among different groups. The purpose of this study was to determine whether a method for measuring head stability during walking could differentiate among 3 groups: (1) children with cerebral palsy, (2) children without neurological impairment, and (3) adults without neurological impairment. Subjects. Eight adults without known neurological impairment, 6 children without known neurological impairment, and 6 children with cerebral palsy and mild spastic hemiplegia were compared. Methods. Subjects walked on a treadmill at their preferred speed at a number of frequencies. Head stability was characterized by fluctuations in period and amplitude of head motion in the sagittal plane across walking cycles. Results. Mean period fluctuation was lower for the adults than for the children, and it was lower for the children without neurological impairments than for the children with cerebral palsy. Conclusion and Discussion. The method can be used to differentiate head stability among different groups during functional activities. [Holt KG, Ratcliffe R, Jeng SF. Head stability in walking in children with cerebral palsy and in children and adults without neurological impairment. Phys Ther. 1999;79:1153-1162.] Key Words: Balance, Cerebral palsy, Head stability, Shock absorption.