Automatic strategy for extraction of anthropometric measurements for the diagnostic and evaluation of deformational plagiocephaly from infant’s head models

Deformational Plagiocephaly (DP) refers to an asymmetrical distortion of an infant's skull resulting from external forces applied over time. The diagnosis of this condition is performed using asymmetry indexes that are estimated from specific anatomical landmarks, whose are manually defined on head models acquired using laser scans. However, this manual identification is susceptible to intra-/inter-observer variability, being also time-consuming. Therefore, automatic strategies for the identification of the landmarks and, consequently, extraction of asymmetry indexes, are claimed. A novel pipeline to automatically identify these landmarks on 3D head models and to estimate the relevant cranial asymmetry indexes is proposed. Thus, a template database is created and then aligned with the unlabelled patient through an iterative closest point (ICP) strategy. Here, an initial rigid alignment followed by an affine one are applied to remove global misalignments between each template and the patient. Next, a non-rigid alignment is used to deform the template information to the patient-specific shape. The final position of each landmark is computed as a local weight average of all candidate results. From the identified landmarks, a head's coordinate system is automatically estimated and later used to estimate cranial asymmetry indexes. The proposed framework was evaluated in 15 synthetic infant head's model. Overall, the results demonstrated the accuracy of the identification strategy, with a mean average distance of 2.8 +/- 0.6 mm between the identified landmarks and the ground-truth. Moreover, for the estimation of cranial asymmetry indexes, a performance comparable to the inter-observer variability was achieved.The present submission corresponds to original research work of the authors and has never been submitted elsewhere. Moreover, this work was funded by the project NORTE-01-0145-FEDER-024300, supported by Northern Portugal Regional Operational Programme (Norte2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER). Moreover, this work has been also supported by FCT - Fundação para a Ciência e Tecnologia within the Project Scope: UID/CEC/00319/2019. Furthermore, the authors acknowledge FCT, Portugal, and the European Social Found, European Union, for funding support through the "Programa Operacional Capital Humano" (POCH) in the scope of the PhD grants SFRH/BD/136721/2018 (Bruno Oliveira), SFRH/BD/136670/2018 (Helena R. Torres), and SFRH/BD/131545/2017 (Fernando Veloso)

The relationship between Infantile Postural Asymmetry and unsettled behavior in babies: a quantitative observational study

A thesis submitted to the University of Bedfordshire in partial fulfilment of the requirements for the degree of Professional DoctorateBackground: Unsettled infant behaviour is a common problem of infancy without known aetiology or effective management, and it is costly in both social and economic terms. Some osteopaths propose that musculoskeletal dysfunction contributes to unsettled infant behaviour, yet reported improvement following osteopathic treatment is anecdotal. A primary issue is the absence of a measurement tool to test musculoskeletal dysfunction in infants. Aims and Objectives: This research aimed to investigate: the reliability and validity of the infantile postural asymmetry (IPA) measurement scale; whether there was a relationship between IPA and unsettled infant behaviour as measured by the Revised Infant Behavior Questionnaire – short form (IBQ-Rs); and whether any relationship between IPA and unsettled infant behaviour was mediated by, or confounded with, the demographic variables of age, sex, birth weight and weight gain in twelve- to sixteen-week-old infants. Methods: Fifty-eight infants aged twelve- to sixteen-weeks-old were recruited through public health clinics, and their behaviour was assessed using the parent-report IBQ-Rs. Infantile asymmetry was measured using observer ratings of spontaneous movements in the IPA scale. A quantitative cross-sectional observational design was used to investigate the relationship between IPA and unsettled behaviour. Results: An association between unsettled behaviour and musculoskeletal dysfunction was not found in twelve- to sixteen-week-old infants using the IPA measurement scale. Ratings for the trunk convexity parameter of the IPA scale were unreliable and excluded from statistical analysis. A significant difference between high and low cervical rotation deficit groups for Surgency was detected in female babies and needs further examination. Some subsets of the IBQ-Rs were unstable when measuring behaviour in twelve- to sixteen-week-old infants. Future research targeting infants younger than twelve-weeks-old, and presenting with unsettled behaviour, is indicated. Conclusion: A causal relationship between unsettled infant behaviour and musculoskeletal dysfunction is still unproven. The literature suggests benefits associated with a consistent approach to providing parents with information, support and advice on normal behaviour patterns and optimal handling of infants. Non-specific effects cannot be ruled out in reported improvements following osteopathic treatment. Management strategies require early implementation and a multidisciplinary approach. The absence of common terminology in infant behaviour problems is an obstacle in cross-professional communication. A role for osteopathy may be in developing a shared language to facilitate management and research, and to examine the importance of positioning and handling practices on infant asymmetry and the relationship with the musculoskeletal system