Simultaneous hyperkinetic movement disorders phenotyping: a cross-cohort pediatric transfer study using routine videos, markerless pose estimation and a tabular foundation model

Spontaneous movement is one of the earliest windows onto an infant's neuromotor health, and structured clinical instruments that score it are validated early predictors of cerebral-palsy risk. However, they require specially trained raters, are time-consuming, and carry inter-rater variability. This motivates automated, video-based markerless assessment, especially as marker-based motion capture is impractical in infants. Yet the foundation models that make markerless capture possible are trained almost entirely on adults: our recent multi-view infant study found that no single model is jointly best, with strong 2D keypoint accuracy and direct 3D body recovery split across different models. While that study identifies this trade-off, it does not resolve it. Here, we perform cross-model distillation from the Sapiens 2 pose model into the SAM 3D Body model, using unannotated infant video alone. A frozen teacher supplies dense pseudo-labels, and a differentiable renderer aligns the predicted mesh to them in the training loop. On eleven held-out infants (18 sessions, 173 recordings) under our prior study's multi-view protocol, fine-tuning improves same-view 2D keypoint agreement with the Sapiens reference (median body percentage of correct keypoints @ 10px 0.22 -> 0.42, face 0.22 -> 0.42) and Procrustes-aligned mean per joint 3D position error (25.5 -> 22.2 mm). This demonstrates how cross-model distillation improves SAM 3D Body model performance on infants.

arly identification of motor impairment in infancy relies on expert visual assessment of spontaneous movement, motivating the development of automated, objective alternatives. One promising approach is using computer vision, which benefits from high quality pose estimation from video. In this study, we systematically evaluated three state-of-the-art pose estimation frameworks (MeTRAbs-ACAE, SAM 3D Body, and Sapiens) on 100 videos over 13 sessions of 8 infants recorded with a multi-view markerless motion capture system. We quantified keypoint detection accuracy using reprojection error, geometric consistency, and Procrustes-aligned 3D position error, and demonstrated proof-of-concept for fitting an inverse kinematic framework to infant data. While Sapiens achieved the lowest reprojection error and highest geometric consistency of the methods evaluated (22.8 pixels and 0.82, respectively), SAM 3D Body provided the most comprehensive 3D information for kinematic reconstruction with Procrustes-aligned position errors of 19 to 28 mm. We demonstrate in a case comparison example that biomechanical models fit to SAM 3D estimates distinguish representative movement patterns in infants related to motor development, as identified by a clinical expert. Together, these findings highlight both the promise and current limitations of 3D pose estimation for infant biomechanics and establish preliminary groundwork for scalable, video-based assessment of early motor development.

Cerebral Palsy (CP) is a neurological disorder of movement and the most common cause of lifelong physical disability in childhood. Approximately 75% of children with CP are ambulatory, and accurate gait assessment is central to preserving walking function, which deteriorates by mid-adulthood in a quarter to half of adults with CP. The Rodda and Graham classification system quantifies sagittal-plane gait deviations using ankle and knee z-scores derived from 3D Instrumented Gait Analysis (3D-IGA), but 3D-IGA is expensive and limited to specialized centers, while observational assessment shows only moderate inter-rater agreement. We developed a markerless gait analysis pipeline that quantifies Rodda and Graham knee and ankle z-scores directly from single-view clinical gait videos. Across 1,058 bilateral limb samples from 529 trials of 152 children (88 male, 63 female; age 12.1 $\pm$ 4.0 years; 60 distinct primary diagnoses, cerebral palsy the most common at $n=54$), the sagittal-view model achieved $R^2 = 0.80 \pm 0.02$ and CCC $= 0.89 \pm 0.02$ for knee z-scores and $R^2 = 0.57 \pm 0.02$ and CCC $= 0.72 \pm 0.02$ for ankle z-scores against 3D-IGA. Binary screening for excess knee flexion achieves AUROC $= 0.88$, correctly identifying 83% of affected children, and applying Rodda and Graham rules yields $43 \pm 1$% 7-class accuracy with macro-AUROC $= 0.78 \pm 0.01$, ankle prediction error remaining the primary bottleneck. Beyond cross-sectional screening, continuous z-scores support longitudinal trajectory tracking across visits, providing a quantitative substrate for monitoring disease progression and treatment response unavailable from observational scales. These results demonstrate the feasibility of video-based z-score estimation, excess-flexion screening, and longitudinal trajectory tracking as a path toward scalable, objective gait assessment in low-resource clinical settings.