BabyOSCAR: Support for measuring underlying coordination of spontaneous movements in infancy

Spontaneous movements represent the foundation of infant sensorimotor experiences and unfold over developmental time from the initial flutters of movement that are observable in utero, to kicks of the legs, wriggles of the trunk, and flaps of the arms that are characteristic in early infancy.

These three papers are comprehensive first steps in developing a new tool – an appraisal of selective joint control in infants using spontaneous movements.^1,2,3 Endogenous spontaneous behaviors are thought to be a window into the central nervous system where atypical brain development produces atypical movements and healthy brain development results in typical movements. Often, typical movements mean the presence of complexity and variability that is reduced in atypical development.

The data set in these papers is curated from a corpus of video recordings on the General Movement Assessment (GMA) in a high-risk infant population. These recordings are used for secondary analysis and tool development. There is knowledge of outcomes at 2 years of age for a medical diagnosis of cerebral palsy (CP) which forms the anchor of many of the studies – diagnosis of spastic CP or not. We are now all familiar with the GMA which dictates a minimum of 3-minutes of video recording of alert young infants in supine and moving spontaneously.⁴ Categorizations of movements are holistic in periods of writhing and fidgety. The presence or absence of certain general movements are highly predictive of CP and part of the criteria for early detection of CP.⁵ Implementation of GMA in clinical practice (especially the presence of cramped synchronous in the writhing period or absent fidgety in the fidgety period) have reduced the age of CP diagnosis by months if not years and represent a major translation success in the improvement of clinical care and management for infants and families.⁶

Most assessment tools for identification of delayed development (across all domains of child development) include aspects that are elicited or require a response to some kind of prompt. Although young infants can, and do, demonstrate some ability to modify and voluntarily control their own movements through sucking, vocalizations, looking, or kicking paradigms – the primary observable, real-world behaviors of infants are spontaneous. Spontaneous movements are often undervalued as prognosticators given the variability of such movements; yet they represent a rich and complex opportunity for observation.⁷ The results from the psychometric analysis and test development of the Baby Observational Selective Control AppRaisal (BabyOSCAR) suggest that convergent and discriminant validity, reliability, construct validity, and test performance are more than adequate.

Even though the BabyOSCAR is a detailed and objective tool (provided in full with instructions), the premise and bottom lines of these three papers add much-needed evidence that despite the complexities and time required to measure infant movements: (1) There are movement characteristics of spastic CP that are measurable in infancy. (2) There are movement characteristics of topography of CP that are measurable in infancy. (3) There are movement characteristics of severity of CP that are measurable in infancy. (4) Lack of isolation of individual joint movement, a hallmark of movement in children and adults with spastic CP, is present in infants with spastic CP. (5) Measurement of movement at each joint of the upper and lower extremities is valuable. (6) It might be important to look at selective joint control of the arms, legs, side of the body, and total body individually. (7) People can reliably score aspects of typical and atypical movement from video with training. (8) A wealth of information on coordination and movement is available in very short (a single minute) standardized video recording with an alert moving infant. (9) There is potential for clinical application that could improve identification of CP, including severity and topography. (10) Secondary analysis of curated video sets is a rich and often underutilized source of responsible data on child development that can result in new assessment tools and treatment targets for childhood disabilities (at a minimum).