Developmental changes in motor control during the first few months of life. (Dr Theresa Sukal-Moulton)

0:00Welcome to the ResearchWorks podcast broadcasting live from the Oceana Academy of Civil Palsy and other childhood on-set disabilities conference 2026 in beautiful city of Hope Art Australia. Join Dr. Danipool and the ResearchWorks team as we bring you an exclusive series of interviews with visionary keynote speakers and leading presenters. Captured right here can meet the groundbreaking discussions and innovations, shaping the future of disability research and care. Hello everyone. Welcome back. We are nearing the end of our conference series. I have been loving it. We're at Oceana 2026 in case you haven't realized. Marissa, I'm back again. Not like the backstreet boy. That I'm back. I nearly broken to song. You should have. This is what happens towards the end of the conference. This is what's happy. So who's back? No, I mean, can you show Marissa? He's back and ready to concentrate. Oh, I'll try to bait you again for another time. My goal by the end of the conference series is to get you to sing. No, I'm not. I'm not. I reckon I can't do it. I reckon I can do it. All right. Well,

1:05we have been really enjoying all of our conversations lately. Concey building on the topics and they're just layering on top of each other and this one is no exception. Welcome back to the friend of the show. Teresa Sacalmonton. Thank you so much. I'm delighted to be here. So nice to see you in person. Once again, I saw you in Hottelberg in person. But then we interviewed you as part of your role in organizing the AACPDM in New Orleans last year, which was a huge success, wasn't it? It was wonderful. It was so great to be in person with people and to just see all of your humans. I know that you were not able to come, but we're looking forward to seeing you this year. I'm very excited. Being here in this space is just such a reminder of the power of being together and what we learn from one another and how we just get energized by one another. We really do. It's so wonderful. And if you're an introvert somehow, your extrovert self comes out and then you go back into your

2:06shell again at the end of the day. I might need two weeks to recover, but it has been worth it. Worth it, right? Yes. Well, that's what the flat home is for is to reflect and catch up on all your research works podcast episode. We were just talking about that tree. Yeah, she actually is going to and I will too. Her flat is longer. The number of productivity that you have that have managed here is amazing. It is sorting me out for the plate home. I'm so glad. Look, what we normally do this, we try to go for say 20 episodes, then I get a little bit excited. Then we go to 25 and sometimes we hit the 30, which we may have done this time round again, but hopefully great content that everyone's going to love. And what we're talking about with you today, I have heard throughout the conference, actually, Teresa, and it's been pretty topical. We just spoke with Monica Tui talking about the hind and identifying children with hemiplegic cerebral palsy. And we were all looking at Shana, I could tell, like just reading each other's minds. We wanted to talk about this particular

3:07topic and who you are. The title of your presentation here at conferences, selective motor control changes from term age to three months of age in infants, both with and without cerebral palsy. So many questions around that. First of all, selective motor control in infants. I think a lot of us have known about assessments for selective motor control in school age children. You've got the scale. You've got the door selection one that Rose Boyd and Cook Graham did. But infants, tell us more about it. Yeah. Well, the construct that you mentioned is exactly it. It's, can you isolate one joint at a time without bringing in all the other joints of the body? And are you doing it at a relatively fast speed? Because in older kids, we really think that it's a marker of corticospinal tract health, meaning that part of your brain that really gets into fine motor control that allows you to do the things that make you function well.

4:10And so we can't ask infants to isolate their joint movement, but they're moving all the time. And we can watch their spontaneous movement for instances of these isolated joint controls. We call it selective control because it is the same construct as we're looking at later in development. But in fact, it may be more accurate to say independent joint control at that younger age because we don't think it's an intentional movement. It's part of their spontaneous movement repertoire that we're just watching for. I see. So when we see an infant's moving, what should we be seeing? I suppose because this one was from from term age to three months. Yeah. Very early. Yeah. Yeah. You see lots of things happening. That's a beautiful part about watching babies that this age is that they're moving regularly and usually quite a lot. And so what we look for is just one minute of recorded video. We reuse the videos that were made for general movement

5:11assessment. Beautiful. So it's no additional burden to the families, no additional time spent. And in fact, in most of our studies right now, we're looking at retrospective videos so that we can build up a large enough sample size. But we're watching for a minute at 32 different joints of the body to see, did we have the opportunity to seek capacity for an individual joint movement during that time? If we do, we score a point. Yes. And if we don't, what we then do is describe what we did see. Were they moving in a way that was grouped as in flexing altogether, extending altogether, maybe mirroring between the other sides of the body? It's an opportunity to really have a more positive view around description of what is happening. You know, it's not just about the deficit of what you're not doing. What they do in fact, like this is how you are moving and how you're exploring and how you're learning. And so it gives us a lot of information about the state of the nervous system we think and gives us some clues as clinicians about maybe what we could access

6:16in our interventions. It's interesting. It's amazing. I really didn't know that babies had the capacity for selective motor control. Even from when we're at uni and we learn about gross motor milestones, and I just focus on head control, you know, zero to three months. By three months, we have some, you know, head in the control. But thinking of their fine motor level, I select, sorry, selective motor control level. Yeah. Well, and I mean, it's because it's maybe not volitional yet at that age. We can't elicit it. Actually, we just need to be patient and watch when they're in a good state. Yes. They'll show us. We don't actually need to do anything except use our eyeballs to look for it. And so yeah, I think that's actually a very powerful part of it. And we weren't sure what we would see either. So when we started at three months, we were delighted to see how how prognostic it was for later development. So what we're presenting here is, okay, well, we didn't know we could go from childhood to three months of age. Can we actually go backwards in time even further? Yeah. Wow. It's really fascinating, isn't it? I

7:23think this is what I love about science is that, you know, you you have general movements, for example, has been like the pillar and so many streams for what we're doing. We know that these measurements are important, but now we're trying to tease out in more detail, aren't we of of the why? And there is a lot of data, like you said now, because it's been implemented so widely all over the world. There is a lot of video now. So much to look at. So what a great opportunity to delve in a little bit deeper. I wanted to ask about the one minute, which is interesting. Before we go on to who was involved in this particular study for you to look at the results, why one minute when you have, you have three minutes for them. Typically we do, yes. And so we chose that to make it clinically feasible because actually the ability to have clinicians utilize this data. There is a scientific rationale for doing it and just for the sake of knowing something about the nervous system, but actually we wanted it to be applied. Beautiful. And so you do

8:28need to watch it a couple of times because you have to kind of systematically go through the different joints of the body. And so three minutes was just way too much. Of course. And so we actually did the study to say is one minute enough. Yeah. And we found that it was and it had reliability, regardless of which minute in the clip that you watch. Yes. And maybe if we held on for three minutes, we would see a little bit more capacity in all of the babies, but it doesn't seem to have a utility actually, because we have a lot of information from just one minute. And that's a good point, isn't it? It's not just looking at overall movements in that one minute. You are watching parts of it to isolate and joints to make sure that you what you're seeing is what you're actually seeing. And yeah, that's really important. Okay. So in this particular study, how many infants were involved? Do you remember? I think 62. 62. Yes. That's no small number. That's a lot of videos. And we watched two videos for each of them. Two videos for each of them.

9:28Where were these infants from? So all through like Niku that being referred to some of them were from the Niku. It's all retrospective data. So it's ones that we have either collected because they were born early and we were following them over time. Or they were folks that were born in the community and happened to have videos or were part of another study where they were a control arm. Okay. Wonderful. All right. And then once you've done the two videos, you apply the scoring system, which does have a name. Correct. Yes. It's called baby Oscar. What does that stand for? So observation of selective control appraisal. I love that. And it's baby Oscar. It's very easy to remember. I like it. He came up with that. Well, you have to have an acronym, right? We cycled through quite a lot of things. That's why appraisal is the oh and the r kind of capitalized together. Yes. You have to be a little bit forgiving of how it came up, but it was really, it felt most right when we came upon it. Really? Love it. I actually sat

10:34in the presentation the other day and I was like, observational selection control assessment record. I was trying to come up with all these. Okay. You've just, yes. That's right. Perfectly. But I love it. It's very catchy. Yeah. It's really good. And so what does the scale actually look like? Do you mind us giving us a bit of a visual representation in our mind of like scoring and yeah, numbers. So as I mentioned, there's 32 different directions. So that means that in the upper extremity, for example, we're looking at shoulder flexion extension plane of motion, abduction, adduction plane of motion, rotational plane of motion, horizontal, that's four items. Yes. Albow flexion extension, pronation, supination, et cetera. Right. And so the score sheet just lists all of those out segmented by legs and arms because the legs can be combined into a score that's valid and so can the arms. And so that's why they're sort of grouped in that way. And then we have, if you observed it, you'd tick a box in the observed column. Okay. And if you didn't observe it, that's where you have to say, well, what did you observe? Yes. It's not good

11:38enough to say they didn't do it. Yes. What are they doing instead? Yes. And so then we summarize it at the bottom. We just, the very complicated maths of counting up the ticks. We also appreciate when red cap does it for us. Because then they're obviously set up exactly. Yes. Thank you very much. So we total things up and then we also do a subtraction of the two sides to understand asymmetry. Right. And that's actually a space where we've been really excited back to the question around the hind. Yes. When might we have the opportunity to see kids that have really mild presentations and could still benefit from support and especially early support if they have a likelihood of a homoplegic representation? Yes. Which as Monica said, it's been really hard to find early on. It does take a little while to find. Yes. And it seems like if we look at enough of these joints, as we have that in many cases, the asymmetries come to the surface enough for us to see at three months of age. Wow. That is brilliant. Okay. So the children that you saw within this particular

12:45group, we were able to classify from a g-message level. Was it a quite a wide range representation in the end? Yeah. We didn't have, so it's 62 children. The majority of them actually didn't have cerebral palsy, so we had four with unilateral right-sided, four with unilateral left-sided, and I think 16 that were bilaterally representation. And they're spread across GMFCS, but it's not a large enough sample to really say that we've done an amazing job of coverage. But what we were really interested in is what if the CP diagnosis meant that you changed at a different rate between those two different time points, because we had already seen that if you have CP, you score lower at three months of age. Okay. And we were curious, like, would that still be the case at term age? Like, could we do the same exact measure at term age and have a good confidence about CP diagnosis? Not yet. So at term age, they're actually statistically undistinguishable. Okay. Which makes sense

13:46actually with the nervous system. Like, it kind of tracks that we shouldn't yet quite be able to know because what we're looking for isn't mature in anybody yet. That's right. Whether or not you have CP. That's right. Okay. And everybody got better. Okay. So those with CP and those without CP improved over that time period. So there was maturation that occurred. But the key was that they improved at different rates. So those without CP had a bigger capacity jump in that time window than those that have a CP diagnosis. That's really interesting and really, really fixes, I guess, it quantifies probably things that we're probably suspecting, but we're not able to, yeah, actually be able to communicate that in the way that we'd like it to be done. So those are both really interesting results. Would there's anything else that was surprising to you with your results that really stuck out of this specific study? Yeah. Well, we, this was our follow on. We had looked at the preterm period as well. And the findings were very similar. So

14:47I suppose I was thinking that maybe around term age, we would start to see a difference, but it's really telling us that in fact, we have to be a little bit more patient. So we've done some preliminary analysis on trajectories that that suggests that maybe like four to five weeks might be enough patients. But that is the next thing that we need to be looking at is if that we can reliably establish a cut point at that earlier time period. Would it be wonderful to know the trajectory? Oh, it's like to make a control. So is that what's happening next? Is that in a way we actually have one article out that's looked at that over a group of infants that were born very early and looking at those trajectories. And so that does give us some information. It's a bit of a noisy signal, but the math of that trajectory does show us that we begin to see a statistical separation at about 41 weeks. But it's noisy. So on an individual level, that's kind of where we want to know as a clinical utility to that. And it showed separation. In that study, if you want to

15:52know the sneak preview of that one, separation between CP and no CP, and then we also could see separation in asymmetries and GMFCS levels. But those are much smaller sample sizes. So we interpret those with caution for now. But it gives us a good idea where we're to head and to investigate, isn't it? It's just that one thing leads to another. You would not believe the list of ideas and future directions. That's what I was about to ask if it just came naturally, but then that's the end question. So with the asymmetry scores between the two time points, was there a difference, like a change in the amount of difference of asymmetry? In this group, not really. Although I didn't look at that so specifically in this group, partially because we only had eight with a unilateral representation. So I could go back and look at that, but that's sort of a bigger question that I think we want a bit bigger data. So how do you

16:53envisage baby Oscar being used clinically then? I know that you've been here in Australia for a little bit longer than everyone else because we've had some training here as well. So what's the goal of that? And how do you see it being utilized clinically from day to day? What would you like it to see? And I know there's a lot of research to be done still. Sure, sure, sure. Well, yeah, we sort of joked earlier that it's been gestating for seven years and it's just been born. And so we have a lot to learn about our little baby Oscar in fact. Yeah, it feels so right now. I don't know if we'll ever get to Teenage Oscar, but you know, I Teenage, so be careful. That's true. Actually, I'm a little bit in love to see. But what I think we would love to see happen is have this as a compliment to some of the tools that are already there. GMA is a wonderful tool to very quickly be able to assess risk with really good predictive value. But what it's not so great at is helping to understand whether or not

17:56the you will be likely to ambulate with or without assistance, for example, in having some of those pieces. So we envision that if you have an absent fidgety movements that this would be a really nice follow-on tool to utilize the same video and watch through one minute of it where the babies in a good state to then have a baby Oscar score that can help to just give a little bit more framing around what the prognosis in terms of body topography might be and future gross motor function. And actually the max has been pretty well related as well. So kind of have a pretty good indication of the kinds of things that you may be moving towards. We're not taking away hope around things. We just start a wonderful keynote speaker around the topic of hope. It was beautiful. But just like how you might shape some conversations or how you might shape your thinking around utilization of the capacity that you do see. And so how that gets implemented though, to be honest, we were so honored and thrilled to be here in Australia. The implementer like masters of the glow.

19:04I think really we want to learn from the clinicians that are using it also to see where it has been helpful and where it sort of thrives. But that's where we see it as a compliment to some of the early detection tools that are currently being used to give that bit of extra information. Yes, yes. And up to what age can you use baby Oscar? What's it intended for? Yeah, so right now it's up to about 20 weeks of corrected age. So same as the fidgety age kind of window. We actually do I guess in a way have a teenage Oscar because you mentioned at some point that the idea that we ask a child to do a certain motion. And then we watch what they can understand and replicate. Yeah. And there is a huge group of children that may have intact selective control but may have challenges with sitting still and following directions in a way that allows us to observe that. And so we've collected some data with a small pilot grant that we had of looking at children of who can follow instructions and who cannot follow instructions. Later on in life

20:08to see can we still pick up on these behaviors? Because the correlation between baby Oscar and scale and task and childhood is very strong. This construct carries across. And so but we can only do scale and task with a subset of children. And so to validate that and verify that construct, we need to be able to observe it in the kids that can't follow directions. Yes. Because of cognition, because of neurodifferences, all kinds of reasons. So much to think about there, right? You think about being able to screen for selective motor control of where maybe good switch access points might be a thousand. That is exactly an amazing use case communication at a year of age or younger because you know where they can access that. That's right. Me so important, you know, on time ability and just trying to give people confidence about where they might need to go next. It's really that roadmap. I mean, the roadmap terms been coming up a lot through this whole conference.

21:09What's the roadmap? I'll probably come up in a summary episode, Eric. Okay. Let's draw a roadmap. I love it. There we go. Let's draw a roadmap. Money to think about that over the night. But yeah, there's so much potential for just a greater understanding. And like you said, not to take away hope, but to actually capitalize on what we do have. But you know, at the same time, what is it that we don't quite realize and understand yet, either in terms of how joints interact that may make a functional task more and more more likely to be achieved. So absolutely. That's very exciting. Yeah. Yeah. I can see why I've got to hold this a question. There's a lot of studies and seeking plenty of collaborators. I mean, we can't do it alone. So I think that they're one of the things that's been so validating about the training and being here and talking to people. The joy of all being together is that there's so much expertise of slightly different perspectives, wildly different perspectives that contribute to some of the excitement around what we could do together.

22:10Yeah. And the collaboration when you bring your ideas together, like you said, there's around high and then you're looking at baby Oscar. And then even the kids you've been talking about, you know, following them up as they, you know, enter, you know, five and six-year-olds and looking at their GMFCS levels and correlating that back to their baby Oscar scores. Like, lots. I like it. Yeah. It's so much to do. How exciting. Yes. Is there a shortage? Job security? Yes. I don't know. It's certainly a very long time to come. And it's, you know, it's also just really exciting for people who are clinicians, like a call out to clinicians who are seeing this and are interested in it in research. Like, there's so many avenues to go down here, aren't they? Absolutely. And just it's so important that at conferences like this, you reach out to people and go, look, I'm really interested in research. And be careful, if you speak to Rose Boyd, you will get into a PhD within 45 minutes of a conversation. That's probably the average. Yeah. Pretty much. That's pretty much how it goes. So just, if you need to be tipped over the edge a little bit, have a chat to Rose. Yes. You know who to risk the gap. That's right. We'll be the gentle. Come alongside. And then

23:12should do the final. No, it's absolutely wonderful. Thank you so much for sharing this breadth of work. I know we spoke about this presentation, but there's so much there. And thank you for being generous and give us an insight into what's to come as well. It's been pleasure. So, so good. Well, to all of our listeners, hope you really enjoyed that as well. I think there's so much we can gain from this, so much we can utilize and think about implementing. And yeah, let's let's go ahead and do it, hey? Yeah. Yep. Thanks, Marissa. Wonderful. Thanks Teresa. We'll talk again really soon. Bye, everyone. Bye.