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Hassan M, Lin J, Fateh AA, Zhuang Y, Lin G, Khan D, Mohammed AAQ, Zeng H. Trends in brain MRI and CP association using deep learning. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01893-w. [PMID: 39388027 DOI: 10.1007/s11547-024-01893-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 09/20/2024] [Indexed: 10/15/2024]
Abstract
Cerebral palsy (CP) is a neurological disorder that dissipates body posture and impairs motor functions. It may lead to an intellectual disability and affect the quality of life. Early intervention is critical and challenging due to the uncooperative body movements of children, potential infant recovery, a lack of a single vision modality, and no specific contrast or slice-range selection and association. Early and timely CP identification and vulnerable brain MRI scan associations facilitate medications, supportive care, physical therapy, rehabilitation, and surgical interventions to alleviate symptoms and improve motor functions. The literature studies are limited in selecting appropriate contrast and utilizing contrastive coupling in CP investigation. After numerous experiments, we introduce deep learning models, namely SSeq-DL and SMS-DL, correspondingly trained on single-sequence and multiple brain MRIs. The introduced models are tailored with specialized attention mechanisms to learn susceptible brain trends associated with CP along the MRI slices, specialized parallel computing, and fusions at distinct network layer positions to significantly identify CP. The study successfully experimented with the appropriateness of single and coupled MRI scans, highlighting sensitive slices along the depth, model robustness, fusion of contrastive details at distinct levels, and capturing vulnerabilities. The findings of the SSeq-DL and SMSeq-DL models report lesion-vulnerable regions and covered slices trending in age range to assist radiologists in early rehabilitation.
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Affiliation(s)
- Muhammad Hassan
- Department of Radiology, Shenzhen Children's Hospital, Futian, Shenzhen, 518038, Guangdong, China
| | - Jieqiong Lin
- Department of Radiology, Shenzhen Children's Hospital, Futian, Shenzhen, 518038, Guangdong, China
| | - Ahmad Ameen Fateh
- Department of Radiology, Shenzhen Children's Hospital, Futian, Shenzhen, 518038, Guangdong, China
| | - Yijiang Zhuang
- Department of Radiology, Shenzhen Children's Hospital, Futian, Shenzhen, 518038, Guangdong, China
| | - Guisen Lin
- Department of Radiology, Shenzhen Children's Hospital, Futian, Shenzhen, 518038, Guangdong, China
| | - Dawar Khan
- King Abdullah University of Science and Technology, Thuwal, 6900, Kingdom of Saudi Arabia
| | - Adam A Q Mohammed
- School of Computer Science and Engineering, Southeast University, Nanjing, 211189, China
| | - Hongwu Zeng
- Department of Radiology, Shenzhen Children's Hospital, Futian, Shenzhen, 518038, Guangdong, China.
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Dewan MV, Weber PD, Felderhoff-Mueser U, Huening BM, Dathe AK. A Simple MRI Score Predicts Pathological General Movements in Very Preterm Infants with Brain Injury-Retrospective Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1067. [PMID: 39334600 PMCID: PMC11430197 DOI: 10.3390/children11091067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 08/22/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND/OBJECTIVES Very preterm infants are at increased risk of brain injury and impaired brain development. The Total Abnormality Score and biometric parameters, such as biparietal width, interhemispheric distance and transcerebellar diameter, are simple measures to evaluate brain injury, development and growth using cerebral magnetic resonance imaging data at term-equivalent age. The aim of this study was to evaluate the association between the Total Abnormality Score and biometric parameters with general movements in very preterm infants with brain injury. METHODS This single-center retrospective cohort study included 70 very preterm infants (≤32 weeks' gestation and/or <1500 g birth weight) born between January 2017 and June 2021 in a level-three neonatal intensive care unit with brain injury-identified using cerebral magnetic resonance imaging data at term-equivalent age. General movements analysis was carried out at corrected age of 8-16 weeks. Binary logistic regression and Spearman correlation were used to examine the associations between the Total Abnormality Score and biometric parameters with general movements. RESULTS There was a significant association between the Total Abnormality Score and the absence of fidgety movements [OR: 1.19, 95% CI = 1.38-1.03] as well as a significant association between the transcerebellar diameter and fidgety movements (Spearman ρ = -0.269, p < 0.05). CONCLUSIONS Among very preterm infants with brain injury, the Total Abnormality Score can be used to predict the absence of fidgety movements and may be an easily accessible tool for identifying high-risk very preterm infants and planning early interventions accordingly.
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Affiliation(s)
- Monia Vanessa Dewan
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany; (M.V.D.); (U.F.-M.); (B.M.H.)
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Pia Deborah Weber
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany; (M.V.D.); (U.F.-M.); (B.M.H.)
| | - Ursula Felderhoff-Mueser
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany; (M.V.D.); (U.F.-M.); (B.M.H.)
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Britta Maria Huening
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany; (M.V.D.); (U.F.-M.); (B.M.H.)
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
| | - Anne-Kathrin Dathe
- Neonatology, Paediatric Intensive Care and Paediatric Neurology, Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany; (M.V.D.); (U.F.-M.); (B.M.H.)
- Centre for Translational Neuro- and Behavioural Sciences, C-TNBS, Faculty of Medicine, University of Duisburg-Essen, 45122 Essen, Germany
- Department of Health and Nursing, Occupational Therapy, Ernst-Abbe-University of Applied Sciences, 07745 Jena, Germany
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Einspieler C, Bos AF, Spittle AJ, Bertoncelli N, Burger M, Peyton C, Toldo M, Utsch F, Zhang D, Marschik PB. The General Movement Optimality Score-Revised (GMOS-R) with Socioeconomically Stratified Percentile Ranks. J Clin Med 2024; 13:2260. [PMID: 38673533 PMCID: PMC11050782 DOI: 10.3390/jcm13082260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The general movement optimality score (GMOS) quantifies the details of general movements (GMs). We recently conducted psychometric analyses of the GMOS and developed a revised scoresheet. Consequently, the GMOS-Revised (GMOS-R) instrument necessitated validation using new percentile ranks. This study aimed to provide these percentile ranks for the GMOS-R and to investigate whether sex, preterm birth, or the infant's country of birth and residence affected the GMOS-R distribution. Methods: We applied the GMOS-R to an international sample of 1983 infants (32% female, 44% male, and 24% not disclosed), assessed in the extremely and very preterm period (10%), moderate (12%) and late (22%) preterm periods, at term (25%), and post-term age (31%). Data were grouped according to the World Bank's classification into lower- and upper-middle-income countries (LMICs and UMICs; 26%) or high-income countries (HICs; 74%), respectively. Results: We found that sex and preterm or term birth did not affect either GM classification or the GMOS-R, but the country of residence did. A lower median GMOS-R for infants with normal or poor-repertoire GMs from LMICs and UMICs compared with HICs suggests the use of specific percentile ranks for LMICs and UMICs vs. HICs. Conclusion: For clinical and scientific use, we provide a freely available GMOS-R scoring sheet, with percentile ranks reflecting socioeconomic stratification.
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Affiliation(s)
- Christa Einspieler
- Interdisciplinary Developmental Neuroscience—iDN, Division of Phoniatrics, Medical University of Graz, 8010 Graz, Austria
| | - Arend F. Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children’s Hospital, University Medical Center Groningen, University of Groningen, 9712 GZ Groningen, The Netherlands
| | - Alicia J. Spittle
- Department of Physiotherapy, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC 3010, Australia;
| | - Natascia Bertoncelli
- Neonatal Intensive Care Unit, Department of Medical and Surgical Sciences of Mothers, Children and Adults, University Hospital of Modena, 41124 Modena, Italy;
| | - Marlette Burger
- Physiotherapy Division, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa;
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Moreno Toldo
- Department of Medical Rehabilitation, Kiran Society for Rehabilitation and Education of Children with Disabilities, Varanasi 221011, India;
| | - Fabiana Utsch
- Reabilitação Infantil, Rede SARAH de Hospitais de Reabilitação, Belo Horizonte 30510-000, Brazil;
| | - Dajie Zhang
- Interdisciplinary Developmental Neuroscience—iDN, Division of Phoniatrics, Medical University of Graz, 8010 Graz, Austria
- Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls University, 69115 Heidelberg, Germany
| | - Peter B. Marschik
- Interdisciplinary Developmental Neuroscience—iDN, Division of Phoniatrics, Medical University of Graz, 8010 Graz, Austria
- Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Ruprecht-Karls University, 69115 Heidelberg, Germany
- Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Göttingen, Leibniz-ScienceCampus Primate Cognition, 37075 Göttingen, Germany
- Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, 171 77 Stockholm, Sweden
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Wang H, Mao Z, Du Y, Li H, Jin H. Predictive Value of Fidgety Movement Assessment and Magnetic Resonance Imaging for Cerebral Palsy in Infants. Pediatr Neurol 2024; 153:131-136. [PMID: 38382245 DOI: 10.1016/j.pediatrneurol.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The early prediction of cerebral palsy (CP) could enable the follow-up of high-risk infants during the neuroplasticity period. This study aimed to explore the predictive value of fidgety movement assessment (FMA) and brain magnetic resonance imaging (MRI) for the development of CP in clinic rehabilitation setting. METHODS This retrospective observational study included infants who underwent FMA and brain MRI at age nine to 20 weeks at Children's Hospital, Zhejiang University School of Medicine, between March 2018 and September 2019. The area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy of FMA and MRI for predicting the development of CP were assessed. RESULTS A total of 258 infants (169 males, gestational age 37.4 ± 3.0 weeks, birth weight 2987.9 ± 757.1 g) were included. Fifteen children had CP after age two years. The diagnostic value of FMA and brain MRI combination showed 86.7% sensitivity (95% confidence interval [CI]: 58.4% to 97.7%), 98.4% specificity (95% CI: 95.6% to 99.5%), and 97.7% accuracy (95% CI: 95.0% to 99.1%); the combination diagnostic value also showed a significantly higher AUC for predicting CP after age two years than FMA alone (AUC: 0.981 vs 0.893, P = 0.013). CONCLUSIONS The diagnostic value of FMA and brain MRI combination during infancy showed a high predictive value for CP development in clinical rehabilitation setting.
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Affiliation(s)
- Hui Wang
- Department of Pediatric Rehabilitation, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Zhenghuan Mao
- Department of Pediatric Rehabilitation, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Yu Du
- Department of Pediatric Rehabilitation, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Haifeng Li
- Department of Pediatric Rehabilitation, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China.
| | - Huiying Jin
- Department of Pediatric Rehabilitation, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
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Wang J, Shen X, Yang H, Li Z, Liang S, Wu F, Tang X, Mao X, He M, Xu F, Li X, Li C, Qian S, Zhu X, Meng F, Wu Y, Gao H, Cao J, Yin H, Wang Y, Huang Y. Early markers of neurodevelopmental disorders based on general movements for very preterm infants: study protocol for a multicentre prospective cohort study in a clinical setting in China. BMJ Open 2023; 13:e069692. [PMID: 37142311 PMCID: PMC10163464 DOI: 10.1136/bmjopen-2022-069692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Very preterm (VPT) infants may experience varying degrees of neurodevelopmental challenges. Lack of early markers for neurodevelopmental disorders may delay referral to early interventions. The detailed General Movements Assessment (GMA) could help us to identify early markers for VPT infants at risk of atypical neurodevelopmental clinical phenotype in the very early stage of life as soon as possible. Preterm infants with high risk of atypical neurodevelopmental outcomes will have the best possible start to life if early precise intervention in critical developmental windows is allowed. METHODS AND ANALYSIS This is a nationwide, multicentric prospective cohort study that will recruit 577 infants born <32 weeks of age. This study will determine the diagnostic value of the developmental trajectory of general movements (GMs) at writhing and fidgety age with qualitative assessment for different atypical developmental outcomes at 2 years evaluated by the Griffiths Development Scales-Chinese. The difference in the General Movement Optimality Score (GMOS) will be used to distinguish normal (N), poor repertoire (PR) and cramped sychronised (CS) GMs. We plan to build the percentile rank of GMOS (median, 10th, 25th, 75th and 90th percentile rank) in N, PR and CS of each global GM category and analyse the relationship between GMOS in writhing movements and Motor Optimality Score (MOS) in fidgety movements based on the detailed GMA. We explore the subcategories of the GMOS list, and MOS list that may identify specific early markers that help us to identify and predict different clinical phenotypes and functional outcomes in VPT infants. ETHICS AND DISSEMINATION The central ethical approval has been confirmed from the Research Ethical Board of Children's Hospital of Fudan University (ref approval no. 2022(029)) and the local ethical approval has been also obtained by the corresponding ethics committees of the recruitment sites. Critical analysis of the study results will contribute to providing a basis for hierarchical management and precise intervention for preterm infants in very early life. TRIAL REGISTRATION NUMBER ChiCTR2200064521.
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Affiliation(s)
- Jun Wang
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Xiushu Shen
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Zhihua Li
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Shuyi Liang
- Department of Rehabilitation, Xiamen Children's Hospital, Xiamen, China
| | - Furong Wu
- Department of Rehabilitation, Xiamen Children's Hospital, Xiamen, China
| | - Xinglu Tang
- Department of Rehabilitation, Taizhou Women and Children's Hospital, Taizhou, China
| | - Xujie Mao
- Department of Neonatology, Yueqing People's Hospital, Yueqing, China
| | - Minsi He
- Department of Rehabilitation, Panyu Maternal and Child Health Hospital, Guangzhou, China
| | - Fengdan Xu
- Department of Neonatology, Dongguan Children's Hospital, Dongguan, China
| | - Xueyan Li
- Department of Rehabilitation, Dehong People's Hospital, Dehong, China
| | - Chengmei Li
- Department of Rehabilitation, Dehong People's Hospital, Dehong, China
| | | | - Xiaoyun Zhu
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Fanzhe Meng
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Yun Wu
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Herong Gao
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Jiayan Cao
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Huanhuan Yin
- Department of Rehabilitation, Children's Hospital of Fudan University, Shanghai, China
| | - Yin Wang
- Clinical Trial Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Yanxiang Huang
- Shanghai Medical College of Fudan University, Shanghai, China
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Zhang CY, Yan BF, Mutalifu N, Fu YW, Shao J, Wu JJ, Guan Q, Biedelehan SH, Tong LX, Luan XP. Predicting the brain age of children with cerebral palsy using a two-dimensional convolutional neural networks prediction model without gray and white matter segmentation. Front Neurol 2022; 13:1040087. [PMID: 36504669 PMCID: PMC9730825 DOI: 10.3389/fneur.2022.1040087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/02/2022] [Indexed: 11/27/2022] Open
Abstract
Background Abnormal brain development is common in children with cerebral palsy (CP), but there are no recent reports on the actual brain age of children with CP. Objective Our objective is to use the brain age prediction model to explore the law of brain development in children with CP. Methods A two-dimensional convolutional neural networks brain age prediction model was designed without segmenting the white and gray matter. Training and testing brain age prediction model using magnetic resonance images of healthy people in a public database. The brain age of children with CP aged 5-27 years old was predicted. Results The training dataset mean absolute error (MAE) = 1.85, r = 0.99; test dataset MAE = 3.98, r = 0.95. The brain age gap estimation (BrainAGE) of the 5- to 27-year-old patients with CP was generally higher than that of healthy peers (p < 0.0001). The BrainAGE of male patients with CP was higher than that of female patients (p < 0.05). The BrainAGE of patients with bilateral spastic CP was higher than those with unilateral spastic CP (p < 0.05). Conclusion A two-dimensional convolutional neural networks brain age prediction model allows for brain age prediction using routine hospital T1-weighted head MRI without segmenting the white and gray matter of the brain. At the same time, these findings suggest that brain aging occurs in patients with CP after brain damage. Female patients with CP are more likely to return to their original brain development trajectory than male patients after brain injury. In patients with spastic CP, brain aging is more serious in those with bilateral cerebral hemisphere injury than in those with unilateral cerebral hemisphere injury.
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Wang J, Shen X, Yang H, Shi W, Zhu X, Gao H, Yin H, Meng F, Wu Y. Inter- and intra-observer reliability of the "Assessment of Motor Repertoire- 3 to 5 Months" based on video recordings of infants with Prader-Willi syndrome. BMC Pediatr 2022; 22:150. [PMID: 35317775 PMCID: PMC8939132 DOI: 10.1186/s12887-022-03224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background The “Assessment of Motor Repertoire—3 to 5 Months”, which is a part of Prechtl's General Movements Assessment (GMA), has been gradually applied to infants with genetic metabolic disorders. However, there have been no studies on the application of the GMA for infants with Prader-Willi syndrome (PWS). Aims The purpose of this study was to determine the inter- and intra-observer reliability of the assessment tool in a population of infants with PWS. Study design This was a reliability and agreement study. Subjects This was a cross-sectional study with15 infants with PWS born at an average gestational age of 38 weeks. Outcome measures Standardized video recordings of 15 infants with PWS (corrected ages of 3 to 5 months) were independently assessed by three observers. Kappa and ICC statistics were applied in inter- and intra- observer reliability analyses. Results The overall reliability ICC values of the “Motor Optimality Score” (MOS) ranged from 0.84 to 0.98, and the pairwise agreement ranged between 0.86 and 0.95 for inter- observe reliability. In addition, ICC values for the MOS ranged between 0.95 and 0.98 for tester agreement in intra-observer reliability. Complete agreement reliability (100%) was achieved in the subcategories of “Fidgety Movements” and “Movement Character” for the inter- and intra-observer reliability. Moderate to high inter- and intra-observer reliability were found in the subcategories of “Repertoire of Co-Existent Other Movements”, “Quality of Other Movements” and “Posture”, with kappa values ranging between 0.63 and 1.00. Conclusion There were high levels of inter-and intra-observer agreement in the “Assessment of Motor Repertoire—3 to 5 Months” for infants with PWS. It is possible to carry out standardized quantitative assessments of the motor performance of infants with PWS.
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Affiliation(s)
- Jun Wang
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China.
| | - Xiushu Shen
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China. .,Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, 201102, China.
| | - Wei Shi
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Xiaoyun Zhu
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Herong Gao
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Huanhuan Yin
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Fanzhe Meng
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Yun Wu
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
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