Background: Early identification of cerebral palsy (CP) during infancy will provide opportunities for early therapies and treatments. The aim of the present study was to present a novel machine-learning model, the Computer-based Infant Movement Assessment (CIMA) model, for clinically feasible early CP prediction based on infant video recordings. Methods: The CIMA model was designed to assess the proportion (%) of CP risk-related movements using a time-frequency decomposition of the movement trajectories of the infant's body parts. The CIMA model was developed and tested on video recordings from a cohort of 377 high-risk infants at 9-15 weeks corrected age to predict CP status and motor function (ambulatory vs. non-ambulatory) at mean 3.7 years age. The performance of the model was compared with results of the general movement 2 of 17 assessment (GMA) and neonatal imaging. Results: The CIMA model had sensitivity (92.7%) and specificity (81.6%), which was comparable to observational GMA or neonatal cerebral imaging for the prediction of CP. Infants later found to have non-ambulatory CP had significantly more CP risk-related movements (median: 92.8%, p = 0.02) compared with those with ambulatory CP (median: 72.7%). Conclusion: The CIMA model may be a clinically feasible alternative to observational GMA.

Clinical reasoning is essential in physical therapy practice. Instrumental approaches and more recent narrative approaches to clinical reasoning guide physical therapists in their understanding of the patient's movement disturbances and help them to plan strategies to improve function. To the extent that instrumental and/or narrative models of clinical reasoning represent impairments as mere physical disturbances, we argue that such models remain incomplete. We draw on a phenomenologically inspired approach to embodied cognition (termed "enactivism") to suggest that the dynamics of lived bodily engagement between physical therapist and patient contribute to and help to constitute the clinical reasoning process. This article outlines the phenomenologically informed enactive perspective on clinical reasoning, with special reference to clinical work that addresses impairments as sequelae of neurological diseases.

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OBJECTIVE: To investigate the short-term effect of parent-administered physical therapy in the preterm period on motor performance in medically stable infants. METHODS:This study was a pragmatic, multicenter, randomized controlled trial including 153 infants born at gestational age ≤32 weeks and randomized to an intervention (n = 74) or a control (n = 79) group. The intervention promoted postural control, head control, and midline orientation. Parents, supervised by a physical therapist, conducted the intervention 10 minutes twice a day for 3 weeks from 34 to 36 weeks' postmenstrual age (PMA). The control group received usual care. The Test of Infant Motor Performance Screening Items was used at baseline and the Test of Infant Motor Performance postintervention (week 37 PMA). Linear mixed models were used to assess change in motor performance between groups from 34 to 37 weeks' PMA by using z scores. Effect size was measured by using Cohen's d. RESULTS:The mean baseline z score was 0.06 (95% confidence interval, -0.48 to 0.60). After the intervention, there was a significant group difference, indicating a change in motor performance from week 34 to 37 PMA favoring the intervention group. The estimated difference in z scores was 0.42 (95% confidence interval, 0.13 to 0.72; P = .005), and the effect size was 0.40.CONCLUSIONS: Parent-administered physical therapy conducted before term-equivalent age improved motor performance at 37 weeks' PMA more than conventional care. All infants will be followed up until 2 years' corrected age to evaluate the long-term effects of this brief intervention. Mrs Ustad participated in planning the study, baseline and postintervention assessments, statistical analyses, and drafting of the manuscript; Dr Evensen was involved in supervision of statistical analyses and preparation of the manuscript; Drs Campbell and Girolami participated in planning the study, in preparation of the manuscript, and in proofreading; Dr Helbostad supervised the statistical analyses and preparation of the manuscript; Drs Kaaresen and Jørgensen participated in planning the study and in preparation of the manuscript; and Dr Øberg was responsible for design and planning the study and participated in postintervention assessments from video recordings, statistical analyses, and preparation of the manuscript. All authors approved the fi nal manuscript as submitted and agree to be accountable for all aspects of the work. WHAT'S KNOWN ON THIS SUBJECT: Studies on early intervention to improve motor function in preterm infants have failed to show large effects. Interventions involving parents seem to be more effective than when therapists conduct the intervention. WHAT THIS STUDY ADDS:Three weeks of parentadministered physical therapy implemented before term-equivalent age in very preterm infants improved short-term motor performance more than in the control group. The intervention was feasible and well tolerated by the infants.by guest on May 10, 2018 http://pediatrics.aappublications.org/ Downloaded from U...

When applied in a routine clinical setting, the GMA strongly predicted neurodevelopmental impairments at 2 years in high-risk infants.

Background: Early prediction of cerebral palsy (CP) using the General Movement Assessment (GMA) during the fidgety movements (FM) period has been recommended as standard of care in high-risk infants. The aim of this study was to determine the accuracy of GMA, alone or in combination with neonatal imaging, in predicting cerebral palsy (CP). Methods: Infants with increased risk of perinatal brain injury were prospectively enrolled from 2009–2014 in this multi-center, observational study. FM were classified by two certified GMA observers blinded to the clinical history. Abnormal GMA was defined as absent or sporadic FM. CP-status was determined by clinicians unaware of GMA results. Results: Of 450 infants enrolled, 405 had scorable video and follow-up data until at least 18–24 months. CP was confirmed in 42 (10.4%) children at mean age 3 years 1 month. Sensitivity, specificity, positive and negative predictive values, and accuracy of absent/sporadic FM for CP were 76.2, 82.4, 33.3, 96.8, and 81.7%, respectively. Only three (8.1%) of 37 infants with sporadic FM developed CP. The highest accuracy (95.3%) was achieved by a combination of absent FM and abnormal neonatal imaging. Conclusion: In infants with a broad range of neonatal risk factors, accuracy of early CP prediction was lower for GMA than previously reported but increased when combined with neonatal imaging. Sporadic FM did not predict CP in this study.

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BackgroundKnowledge about early physiotherapy to preterm infants is sparse, given the risk of delayed motor development and cerebral palsy.Methods/DesignA pragmatic randomized controlled study has been designed to assess the effect of a preventative physiotherapy program carried out in the neonatal intensive care unit. Moreover, a qualitative study is carried out to assess the physiotherapy performance and parents' experiences with the intervention. The aim of the physiotherapy program is to improve motor development i.e. postural control and selective movements in these infants. 150 infants will be included and randomized to either intervention or standard follow-up. The infants in the intervention group will be given specific stimulation to facilitate movements based on the individual infant's development, behavior and needs. The physiotherapist teaches the parents how to do the intervention and the parents receive a booklet with photos and descriptions of the intervention. Intervention is carried out twice a day for three weeks (week 34, 35, 36 postmenstrual age). Standardized tests are carried out at baseline, term age and at three, six, 12 and 24 months corrected age. In addition eight triads (infant, parent and physiotherapist) are observed and videotaped in four clinical encounters each to assess the process of physiotherapy performance. The parents are also interviewed on their experiences with the intervention and how it influences on the parent-child relationship. Eight parents from the follow up group are interviewed about their experience. The interviews are performed according to the same schedule as the standardized measurements. Primary outcome is at two years corrected age.DiscussionThe paper presents the protocol for a randomized controlled trial designed to study the effect of physiotherapy to preterm infants at neonatal intensive care units. It also studies physiotherapy performance and the parent's experiences with the intervention.Trial registrationClinicalTrials.gov NCT01089296