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Gaspar Morey
08-11-2003, 02:28 AM
Here is the summary of responses to a message I posted on behalf of a
friend. For further comments, please reply to the address shown below
the original question.

----------------------
Original question:


Assessment of the quality of movement in newborn infants at risk has
shown
to be a very useful tool in neonatal medicine (e.g. general movement
assessment
according to Prechtl et al.). As a rule a fluent, highly variable,
smooth,
esthetic, writhing movement pattern usually indicates a normal brain
development.
It would be tempting to investigate these infant using the biomechanical
tools.

Therefore, my questions:
Has someone experience assessing the movement of neonates or even
preterm
infants using modern biomechanical tools ? Has someone tried to define a
fluent, highly variable, smooth, esthetic, writhing movement pattern
Which parameter should be measured to quantify the beauty of a
movement?
Would be very interested to know, whether anyone has dealt with
similar?
problems.

Frank Pillekamp MD
Pediatrician
University of Cologne
Germany
pi@tiscali.de


Summary of Answers:

I've received an unexpected large number of answers to my questions (see
below). An astonishingly high number of people from various parts of the
world seem to have recognized the importance of the assessment of
movement
in preterm infants, neonates, and older infants.

Several answers demonstrated that different groups have developed ?
probably
independently ? observations techniques to score movement patterns in
neonates.
And, some of the answers pointed to clinical observations tools, that
I?ve
not been aware of. My impression is that though each clinical scoring
system
seems to vary a little bit ? some characteristics might be in common,
and
these might be the characteristics one should concentrate on.

The majority of answers was related to clinical scoring techniques,
perhaps
using videotapes. I was astonished that in this forum designated to
answer
biomechanical questions ? up to now ? only a few answers actually
reported
on results obtained using more ?sophisticated? biomechanical tools
though
many people seem to be interested in this topic or are currently working
on it. Unfortunately, especially the question of how to describe
?fluency,
variability, writhing movements, etc.? using biomechanical tools was
only
marginally adressed. I wonder, whether perhaps, this might be a more
complex
goal than I have imagined.

Thanks for the interesting answers,

Frank Pillekamp, MD
Pediatrician
University of Cologne
pi@tiscali.de

Answer 1:

Dear Frank,
I am attching a manuscript for you that may answer some of your
questions.

Nick

****************************************
Nick Stergiou, PhD
HPER Biomechanics Laboratory
University of Nebraska at Omaha
Omaha, NE 68182-0216
tel. 402-5543247
fax. 402-5543693
e-mail: nstergiou@mail.unomaha.edu
*****************************************
Nonlinear Analysis of the Development of Sitting Postural Control

Regina T. Harbourne
Munroe-Meyer Institute
University of Nebraska Medical Center
Omaha, NE 68198?5450
E-mail: rharbour@unmc.edu
Nicholas Stergiou
HPER Biomechanics Laboratory
University of Nebraska at Omaha
Omaha, NE 68182

ABSTRACT: The development of sitting postural control in five normal
infants
was
examined longitudinally at three stages of sitting: Stage 1, when
infants
could hold
up their head and upper trunk, but could not sit independently; Stage 2,
when
infants began to sit independently briefly; and Stage 3, when infants
could
sit
independently. Methods from nonlinear dynamics were used to analyze
center
of
pressure (COP) data during sitting in terms of stability of the
neuromuscular
system
(Lyapunov Exponent), movement dimensionality (Correlation Dimension),
and
complexity/regularity (Approximate Entropy). Results indicated
significant
changes
in the nonlinear measures over time, with increased stability and
increased
regularity
revealing a more stable and periodic strategy of maintaining postural
control. Dimensionality decreased from Stage 1 to 2, indicating a
constraint
of the
degrees of freedom. Subsequently, dimensionality increased from Stage 2
to 3,
indicating a release of the degrees of freedom as sitting independence
emerged.
Nonlinear analysis of the COP time series supports the perspective that
the development
of postural control is a dynamic process whereby the infant learns to
control
the body?s degrees of freedom to achieve the sitting posture. _ 2003
Wiley
Periodicals, Inc. Dev Psychobiol 42: 368?377, 2003.

Answer 2:

Dear Frank,
There is a relatively large body of literature measuring the movements
of

newborns and young infants. It is worth-while to check the work of
Thelen,

Piek, Heriza, etc.
Currently, a student of mine is examining the arm movement patterns of
fetuses and newborns using biomechanical tools (automatic digitization
of

ultrasound images, and video images). However, she is in the early
stages

of data collection.
Your question is an important one. I encourage the research community to

follow on this one.
Sincerely,
__________________________________________________ _______________
Rosa M. Angulo-Barroso, Ph.D. Office:(734) 647-9851
Department of Movement Science Fax:(734) 936-1925
Division of Kinesiology, 4732 Lab:(734) 764-9955
University of Michigan
Ann Arbor, MI 48109-2214 E-mail: rangulo@umich.edu

Answer 3:
Dr. Pillekamp,

We have just begun a pilot study to assess the kinematics of
spontaneous kicking patterns in 3 month old (corrected age) VLBW
preterms, in correlation with neonatal brain MRI. We are also
interested in movements of the upper extremities, particularly the
hands, as an assessment of motor quality. You may also want to contact
with Dr. Linda Fetters at Boston University. I believe she has a good
deal of experience in the area of infant motor coordination assessed
with kinematic measures.
I look forward to hearing your thoughts on this matter.

Erin

Erin E. Butler, M.S.
Biomechanical Engineer
Motion & Gait Analysis Laboratory
Lucile Packard Children's Hospsital
Stanford University
phone: 650.723.5308
fax: 650.498.7167

Answer 4:
Richard Smith R.Smith@fhs.usyd.edu.au, Mon, 28 Jul 2003 10:41:44 +1000

Dear Frank,
We recorded the 3D motion of the limbs, trunk and head of 9 normal
infants

from four weeks to 12 months during supported lying, reaching, and
supported stepping. We conducted a linear systems analysis as a measure
of
coordination.

If you are interested let me know.

Richard

Answer 5:
"Wiebren Zijlstra"
Kind regards, Wiebren Zijlstra.
Wiebren Zijlstra, PhD Tel. : ++ 31 (0)50 363 7868
Institute of Human Movement Sciences Fax. : ++ 31 (0)50 363 3150
University of Groningen
A. Deusinglaan 1
PO Box 196
NL-9700 AD GRONINGEN
THE NETHERLANDS

Anwer 6:
Andrea Galitz