A Shape-Based Functional Index for Objective Assessment of Pediatric Motor Function

Clinical assessments for neuromuscular disorders, such as Spinal Muscular Atrophy (SMA) and Duchenne Muscular Dystrophy (DMD), continue to rely on subjective measures to monitor treatment response and disease progression. We introduce a novel method using wearable sensors to objectively assess motor function during daily activities in 19 patients with DMD, 9 with SMA, and 13 age-matched controls. Pediatric movement data is complex due to confounding factors such as limb length variations in growing children and variability in movement speed. Our approach uses Shape-based Principal Component Analysis to align movement trajectories and identify distinct kinematic patterns, including variations in motion speed and asymmetry. Both DMD and SMA cohorts have individuals with motor function on par with healthy controls. Notably, patients with SMA showed greater activation of the motion asymmetry pattern. We further combined projections on these principal components with partial least squares (PLS) to identify a covariation mode with a canonical correlation of r = 0.78 (95% CI: [0.34, 0.94]) with muscle fat infiltration, the Brooke score (a motor function score), and age-related degenerative changes, proposing a novel motor function index. This data-driven method can be deployed in home settings, enabling better longitudinal tracking of treatment efficacy for children with neuromuscular disorders.

Shape Analysis for Pediatric Upper Body Motor Function Assessment

Neuromuscular disorders, such as Spinal Muscular Atrophy (SMA) and Duchenne Muscular Dystrophy (DMD), cause progressive muscular degeneration and loss of motor function for 1 in 6,000 children. Traditional upper limb motor function assessments do not quantitatively measure patient-performed motions, which makes it difficult to track progress for incremental changes. Assessing motor function in children with neuromuscular disorders is particularly challenging because they can be nervous or excited during experiments, or simply be too young to follow precise instructions. These challenges translate to confounding factors such as performing different parts of the arm curl slower or faster (phase variability) which affects the assessed motion quality. This paper uses curve registration and shape analysis to temporally align trajectories while simultaneously extracting a mean reference shape. Distances from this mean shape are used to assess the quality of motion. The proposed metric is invariant to confounding factors, such as phase variability, while suggesting several clinically relevant insights. First, there are statistically significant differences between functional scores for the control and patient populations (p$=$0.0213$\le$0.05). Next, several patients in the patient cohort are able to perform motion on par with the healthy cohort and vice versa. Our metric, which is computed based on wearables, is related to the Brooke's score ((p$=$0.00063$\le$0.05)), as well as motor function assessments based on dynamometry ((p$=$0.0006$\le$0.05)). These results show promise towards ubiquitous motion quality assessment in daily life.