Automatic Posture and Movement Tracking of Infants with Wearable Movement Sensors

Infants' spontaneous and voluntary movements mirror developmental integrity of brain networks since they require coordinated activation of multiple sites in the central nervous system. Accordingly, early detection of infants with atypical motor development holds promise for recognizing those infants who are at risk for a wide range of neurodevelopmental disorders (e.g., cerebral palsy, autism spectrum disorders). Previously, novel wearable technology has shown promise for offering efficient, scalable and automated methods for movement assessment in adults. Here, we describe the development of an infant wearable, a multi-sensor smart jumpsuit that allows mobile accelerometer and gyroscope data collection during movements. Using this suit, we first recorded play sessions of 22 typically developing infants of approximately 7 months of age. These data were manually annotated for infant posture and movement based on video recordings of the sessions, and using a novel annotation scheme specifically designed to assess the overall movement pattern of infants in the given age group. A machine learning algorithm, based on deep convolutional neural networks (CNNs) was then trained for automatic detection of posture and movement classes using the data and annotations. Our experiments show that the setup can be used for quantitative tracking of infant movement activities with a human equivalent accuracy, i.e., it meets the human inter-rater agreement levels in infant posture and movement classification. We also quantify the ambiguity of human observers in analyzing infant movements, and propose a method for utilizing this uncertainty for performance improvements in training of the automated classifier. Comparison of different sensor configurations also shows that four-limb recording leads to the best performance in posture and movement classification.Peer reviewe

Comparison of End-to-End Neural Network Architectures and Data Augmentation Methods for Automatic Infant Motility Assessment Using Wearable Sensors

Infant motility assessment using intelligent wearables is a promising new approach for assessment of infant neurophysiological development, and where efficient signal analysis plays a central role. This study investigates the use of different end-to-end neural network architectures for processing infant motility data from wearable sensors. We focus on the performance and computational burden of alternative sensor encoder and time series modeling modules and their combinations. In addition, we explore the benefits of data augmentation methods in ideal and nonideal recording conditions. The experiments are conducted using a dataset of multisensor movement recordings from 7-month-old infants, as captured by a recently proposed smart jumpsuit for infant motility assessment. Our results indicate that the choice of the encoder module has a major impact on classifier performance. For sensor encoders, the best performance was obtained with parallel two-dimensional convolutions for intrasensor channel fusion with shared weights for all sensors. The results also indicate that a relatively compact feature representation is obtainable for within-sensor feature extraction without a drastic loss to classifier performance. Comparison of time series models revealed that feedforward dilated convolutions with residual and skip connections outperformed all recurrent neural network (RNN)-based models in performance, training time, and training stability. The experiments also indicate that data augmentation improves model robustness in simulated packet loss or sensor dropout scenarios. In particular, signal- and sensor-dropout-based augmentation strategies provided considerable boosts to performance without negatively affecting the baseline performance. Overall, the results provide tangible suggestions on how to optimize end-to-end neural network training for multichannel movement sensor data

A review of the effectiveness of lower limb orthoses used in cerebral palsy

To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO

A MECHANISTIC APPROACH TO POSTURAL DEVELOPMENT IN CHILDREN

Upright standing is intrinsically unstable and requires active control. The central nervous system's feedback process is the active control that integrates multi-sensory information to generate appropriate motor commands to control the plant (the body with its musculotendon actuators). Maintaining standing balance is not trivial for a developing child because the feedback and the plant are both developing and the sensory inputs used for feedback are continually changing. Knowledge gaps exist in characterizing the critical ability of adaptive multi-sensory reweighting for standing balance control in children. Furthermore, the separate contributions of the plant and feedback and their relationship are poorly understood in children, especially when considering that the body is multi-jointed and feedback is multi-sensory. The purposes of this dissertation are to use a mechanistic approach to study multi-sensory abilities of typically developing (TD) children and children with Developmental Coordination Disorder (DCD). The specific aims are: 1) to characterize postural control under different multi-sensory conditions in TD children and children with DCD; 2) to characterize the development of adaptive multi-sensory reweighting in TD children and children with DCD; and, 3) to identify the plant and feedback for postural control in TD children and how they change in response to visual reweighting. In the first experiment (Aim 1), TD children, adults, and 7-year-old children with DCD are tested under four sensory conditions (no touch/no vision, with touch/no vision, no touch/with vision, and with touch/with vision). We found that touch robustly attenuated standing sway in all age groups. Children with DCD used touch less effectively than their TD peers and they also benefited from using vision to reduce sway. In the second experiment (Aim 2), TD children (4- to 10-year-old) and children with DCD (6- to 11-year-old) were presented with simultaneous small-amplitude touch bar and visual scene movement at 0.28 and 0.2 Hz, respectively, within five conditions that independently varied the amplitude of the stimuli. We found that TD children can reweight to both touch and vision from 4 years on and the amount of reweighting increased with age. However, multi-sensory fusion (i.e., inter-modal reweighting) was only observed in the older children. Children with DCD reweight to both touch and vision at a later age (10.8 years) than their TD peers. Even older children with DCD do not show advanced multisensory fusion. Two signature deficits of multisensory reweighting are a weak vision reweighting and a general phase lag to both sensory modalities. The final aim involves closed-loop system identification of the plant and feedback using electromyography (EMG) and kinematic responses to a high- or low-amplitude visual perturbation and two mechanical perturbations in children ages six and ten years and adults. We found that the plant is different between children and adults. Children demonstrate a smaller phase difference between trunk and leg than adults at higher frequencies. Feedback in children is qualitatively similar to adults. Quantitatively, children show less phase advance at the peak of the feedback curve which may be due to a longer time delay. Under the high and low visual amplitude conditions, children show less gain change (interpreted as reweighting) than adults in the kinematic and EMG responses. The observed kinematic and EMG reweighting are mainly due to the different use of visual information by the central nervous system as measured by the open-loop mapping from visual scene angle to EMG activity. The plant and the feedback do not contribute to reweighting

Evaluation of cervical posture improvement of children with cerebral palsy after physical therapy based on head movements and serious games

Background: This paper presents the preliminary results of a novel rehabilitation therapy for cervical and trunk control of children with cerebral palsy (CP) based on serious videogames and physical exercise. Materials: The therapy is based on the use of the ENLAZA Interface, a head mouse based on inertial technology that will be used to control a set of serious videogames with movements of the head. Methods: Ten users with CP participated in the study. Whereas the control group (n=5) followed traditional therapies, the experimental group (n=5) complemented these therapies with a series of ten sessions of gaming with ENLAZA to exercise cervical flexion-extensions, rotations and inclinations in a controlled, engaging environment. Results: The ten work sessions yielded improvements in head and trunk control that were higher in the experimental group for Visual Analogue Scale, Goal Attainment Scaling and Trunk Control Measurement Scale (TCMS). Significant differences (27% vs. 2% of percentage improvement) were found between the experimental and control groups for TCMS (p<0.05). The kinematic assessment shows that there were some improvements in the active and the passive range of motion. However, no significant differences were found pre- and post-intervention. Conclusions:Physical therapy that combines serious games with traditional rehabilitation could allow children with CP to achieve larger function improvements in the trunk and cervical regions. However, given the limited scope of this trial (n=10) additional studies are needed to corroborate this hypothesis

The relation of visual fixation and pursuit to posture in four month infants

The frozen posture of a young child as he visually attends to something of interest, or the very young infantTs wide open eyes and mouth as he fixes on a stimulus, illustrate dramatically the close relationship between the visual system and the total action system. The two appear to be inseparable and interdependent. When vision is impaired, control of posture may be impaired as evidenced by the typical delay in head righting in prone and all-fours postures of the blind infant. (Gesell and Amatruda, 1941; Gesell et al, 1949) In other children with severe visual impairment a peculiar head posture may be assumed in order to fix the eyes to receive the object stimulus on the most favorable part of the retina. (Gesell et al, 1949) Certain children with learning disabilities may also reflect visual problems either of oculomotor or perceptual causes in peculiar postures as they perform visuomotor tasks