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Oct 03,  · The Baby Moves prospective cohort study protocol: using a smartphone application with the General Movements Assessment to predict neurodevelopmental outcomes at age 2 years for extremely preterm or extremely low birthweight infants. From AA, AAA, C, D, 9V to Car Batteries we're the one store trusted most for all your battery needs for home and office. Visit your nearby Interstate All Battery Center of Victoria, TX today. Online treatment provides convenient and private alcohol and drug addiction treatment by trained experts via the Internet. It offers many of the benefits of traditional treatment approaches, including group sessions led by addiction counselors, peer support and tools for recovery.


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The General Movements Assessment GMA in early infancy has high predictive validity for neurodevelopmental outcomes in preterm smartphone treatment center victoria. Baby Moves is a smartphone application app developed for caregivers to video and upload their infant's general movements to be scored remotely by a certified GMA assessor. Videos will be scored by certified GMA assessors and classified as normal or abnormal. Parental satisfaction using the Baby Moves app will be assessed via survey, smartphone treatment center victoria.

Study findings will be disseminated via peer-reviewed publications and conference presentations. The strengths of this study include the use of an app, called Baby Moves, to assist in early detection of cerebral palsy CP and other neurodevelopmental outcomes in a geographical smartphone treatment center victoria. The Baby Moves app provides a format for accessing general movements GMswhich is not limited by geographical distance or clinicians' skill levels at a local service, smartphone treatment center victoria, as users will be able to upload the infant's GMs directly to a trained assessor.

If the Baby Moves app is shown to be effective in early detection, future studies involving other developed countries along with developing countries will be needed. There is a growing body of evidence that early intervention improves functional outcomes for infants with neurodevelopmental impairment and is economically cost-effective as it reduces the rate of later problems.

However, it is challenging for clinicians to identify those infants who are at highest risk for neurodevelopmental impairment, and this can delay access to early intervention during a crucial period of brain plasticity and musculoskeletal development.

Neurodevelopmental assessments that can identify those at highest risk for adverse neurodevelopment during early infancy are therefore vital for clinicians to target early intervention and counsel parents. Given that the GMs can be assessed from a short video, with no specific handling needed, it is possible to score the GMA off-site. Therefore, we have developed a smartphone application appsmartphone treatment center victoria, called Baby Moves, so that parents can directly upload a video of their infant's GMs to be assessed by a clinician or researcher trained in the GMA.

As such, the Baby Moves app provides access to a GMA for parents of high-risk infants without the need for attending an on-site appointment. Further, the results of the GMA can be communicated with the parents via their managing clinical team with no additional requirement to introduce the infant to another professional, smartphone treatment center victoria.

With advances in technology and mobile communications, smartphone treatment center victoria, smartphones are increasingly viewed smartphone treatment center victoria handheld computers smartphone treatment center victoria than phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development.

There is increasing evidence that smartphone apps have the ability to transform healthcare, improving access to clinical diagnosis and interventions, especially in resource-poor settings. However, none of the studies were of high quality; no studies had a low risk of bias and there were none that reported objective clinical outcomes. Therefore, given the potential of smartphone apps to facilitate the early smartphone treatment center victoria of neurodevelopmental impairments, such as CP in high-risk infants, a high-quality research trial is needed to determine whether an app, such as Baby Moves, using the GMA, is useful for the accurate early identification of infants at risk for CP smartphone treatment center victoria other neurodevelopmental impairments.

The Baby Moves app is designed for the caregiver eg, parent to record a video of their infant's GMs for remote assessment by a scorer trained in the GMA. Parents upload a video of their infant's GMs to a secure server to be assessed by a health professional with GMA certification, smartphone treatment center victoria.

The app involves the caregiver entering a unique study number de-identified with their infant's date of birth and expected date of delivery. Prior to videoing their infant, the app provides brief instructions on obtaining usable GMs, and an overlay shape provides guidance to optimal positioning to ensure that the infant's entire body is included in the video see figure 1.

The app then lets the user know when the video has been uploaded successfully. Baby Moves has been developed for use on both iPhone iOS 7. Key features of the Baby Moves app include notifications to caregivers about the timing of the assessment based on the infant's estimated date of delivery, smartphone treatment center victoria, prompts to instruct caregivers on the correct technique to acquire usable footage eg, the infant needs to be supine with no stimulation smartphone treatment center victoria specific functionality for multiple births given the high rates of multiple births in the preterm population, smartphone treatment center victoria.

A secondary aim of the study is to examine the functionality and utility of the app including parent satisfaction using the Baby Moves app to record their infant's GMs for remote GMA, and the percentage of GMs videos obtained that can be scored. Cross-checking for verification of the number of live births will be carried out using multiple data sources the four level-III neonatal intensive care units in Victoria, the Paediatric Infant Perinatal Emergency Retrieval service and the Victorian Perinatal Data Collection Unit.

Control children will be excluded if they receive resuscitation at birth, require admission to neonatal intensive care or if they are identified to have a condition that would affect later neurodevelopment, such as a chromosomal anomaly. Live births resulting from termination of pregnancy secondary to lethal abnormalities. Eligible infants will be recruited from the neonatal units and the postnatal wards of the tertiary perinatal centres in Victoria, Australia.

A research coordinator will approach parents of eligible infants prior to discharge home or transfer to a neonatal unit at a lower level hospital. The research coordinator will explain the study, including the time commitment, and provide written information about the study. Following recruitment, research nurses will collect data from the medical records regarding maternal medical complications and treatment such as preeclampsia, antenatal corticosteroids and significant medical conditions eg, diabetes mellitus and epilepsy.

Data will also be collected regarding smartphone treatment center victoria events that reflect complications during labour and delivery, eg, antepartum haemorrhage and neonatal medical complications including bronchopulmonary dysplasia, postnatal corticosteroid treatment, major brain injury, infection and neonatal surgery.

Sociodemographic information about employment, family income and parent educational level will also be collected via interview and questionnaire see online supplementary 1. When participants are recruited, the researcher will enter the infant's identification number and date of birth into the database so that uploaded videos are linked to smartphone treatment center victoria specific identification number within the REDCap database.

Parents will then download the app, select and enter in their infant s identification number sdate smartphone treatment center victoria birth and estimated date of delivery.

Two videos are being recorded to ensure that age-specific fidgety GMs can be observed according to the individual infant's development. All video data will be stored on secure servers smartphone treatment center victoria the Murdoch Childrens Research Institute. Each video will be scored by two GMA certified assessors independent of each other and who are unaware of the participant's gestation at birth and neonatal history.

GMs will be scored according to Prechtl's GMA and categorised as normal if fidgety GMs are intermittently or continuously present, absent if fidgety GMs are not observed or are sporadically present, or abnormal if fidgety GMs are exaggerated in speed and amplitude. If there is a disagreement between the two assessors, then a third experienced assessor and GMs trainer AJS or CE will make the final decision.

GMs will be considered scorable if the infant is positioned in supine, is in an active behavioural state, the infant's whole body can be viewed and the recording is of adequate quality. Criteria for scorable and unscorable GMs are outlined in table 1. Infant dressed in minimal clothing ie, nappy and singlet so that movements can be identified. If an infant has an abnormal GMA, it will be recommended that the infant has an objective, standardised neurological examination and motor assessment as an outpatient.

Parents will also be asked to complete a brief online survey about their experience using the app. The survey will include questions about the usability of the app, smartphone treatment center victoria, whether there were any issues uploading the video to the database and parent perception of using the Baby Moves app for a remote GMA rather than a face-to-face visit to a health professional see online supplement 2.

If the child is unable to attend the hospital, a home visit will be offered. The assessment will be conducted by researchers who are unaware of the child's gestation at birth, perinatal course and previous GMA smartphone treatment center victoria. A paediatrician will perform a standardised neurological evaluation to assess the quality of motor skills, coordination and gait.

CP will be described using standard criteria, including topography unilateral vs bilateralmotor type spastic vs non-spastic and functional outcomes using the Gross Motor Function Classification System GMFCS. Developmental delay will be defined using scores from either the cognitive or language composite scores from the Bayley-III, with cut-offs compared relative to the mean and SD scores for the controls on the respective scores.

A summary report of the 2-year smartphone treatment center victoria assessment will be sent to families. If there are any additional concerns identified during the assessment that families were previously unaware of, researchers will provide feedback to families and will refer the child to appropriate services, with parental consent.

The equivalent numbers for earlier cohorts were per year in —, in and in An equal number of matched term born controls will be recruited over the same time period from 1 April to 31 March Data will be analysed according to the aims of the study. All regression analyses will be fitted using generalised estimating equations with robust sandwich estimation of SEs to account for clustering due to multiple births.

Infants who were not assessed via the Baby Moves app will not be included in this analysis. To assess parent experience using the Baby Moves app, survey data will be analysed regarding how easy the app was to use, how useful reminders were, smartphone treatment center victoria, and any feedback on changes that are recommended to the app.

Data will also be collected on the number of GMs obtained and the percentage of GMs that can be scored versus not scored according to the criteria in table 1. The number of families who smartphone treatment center victoria not have access to a smartphone and those who subsequently submit a video via USB or elect to have a face-to-face appointment will be noted.

These families will not be required to complete the survey or be included in the analysis of scorable versus non-scorable GMA. All study data will be stored in a secure manner. Paper files will be kept in locked filing cabinets and computer and video files will be stored on password-protected servers. Identifiable information ie, contact and consent details will be stored in locked filing cabinets separately from other information collected.

Only the researchers associated with the study and ethics committees will have access to the data. Video recordings will be stored as digital files on password-protected servers with study identification numbers only. The researchers will monitor the cohort for any infant deaths. The details of deceased infants will be removed from the database so that parents do not receive notifications from the Baby Moves app after their infant has passed away.

If parents do not have smartphone access, they will be offered other options for GMA, including sending in a video of their infant using a prepaid envelope and USB provided by the researchers, or a face-to-face assessment at home or a hospital visit according to their preference.

Infants identified with neurodevelopmental concerns at any time point during the study will be referred to appropriate intervention services smartphone treatment center victoria parental consent.

The results from the study will be submitted to peer-reviewed journals, as well as presented at national and international conferences. All results presented will be of group data only, and individual participants will not be identifiable, smartphone treatment center victoria. Parents of participants in the study will be provided with information about the study findings through regular newsletters that include summaries of any published findings.

The Baby Moves app provides a format for accessing a GMA that is not limited by geographical distance or clinicians' skill levels at a local service, as users will be able to upload the infant's GMs directly to a GMA trained assessor.

Further, since infants can be assessed remotely, it is also likely to be highly cost-effective due to reducing the need to attend clinics on-site for a GMA. However, smartphone treatment center victoria, using the Baby Moves app will not replace infants' current routine medical and neurological follow-up; rather, it offers the ability for additional GMA for those infants who would not have otherwise had access.

The Baby Moves app also provides support for the secure downloading of data to mitigate privacy concerns with transferring smartphone treatment center victoria data, and as such will be a useful tool for researchers and clinicians.

Future development of the app could potentially involve a clinician version, to be used for infants attending follow-up clinics, using similar principles such as prompts for correct technique and secure downloading of data to a purpose built server. Future development of the app is planned so that GMs can be recorded at other time points.

Given the potential for the Baby Moves app to smartphone treatment center victoria used for remote assessment, future applications of Baby Moves may also include other developmental assessments that can be scored from a video recording by health professionals with expertise in infant development. While this will be the first study to assess the use of an app to predict CP and other neurodevelopmental outcomes in a geographical cohort, there are limitations to the study.

Further, smartphone usage in Victoria, Australia may not reflect national and international smartphone usage, and future studies involving other developed countries along with developing countries will be needed.

Twitter: Follow Alicia Spittle at aliciaspittle. All authors were smartphone treatment center victoria in the design of the study and contributed to drafting and revising the manuscript. Patient consent: Obtained. Provenance and peer review: Not commissioned; externally peer reviewed, smartphone treatment center victoria.

National Center for Biotechnology Smartphone treatment center victoriaU. BMJ Open. Published online Oct 3. Author information Article notes Copyright and License information Disclaimer. Correspondence to Dr AJ Spittle; ua. This article has been cited by other articles in PMC.

Associated Data Supplementary Materials supplementary data. Strengths and limitations of this study. Open in a separate window.

 

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