A new system for quantitative evaluation of infant gaze capabilities in a wide visual field.

Background: The visual assessment of infants poses specific challenges: many techniques that are used on adults are based on the patient’s response, and are not suitable for infants. Significant advances in the eye-tracking have made this assessment of infant visual capabilities easier, however, eye-tracking still requires the subject’s collaboration, in most cases and thus limiting the application in infant research. Moreover, there is a lack of transferability to clinical practice, and thus it emerges the need for a new tool to measure the paradigms and explore the most common visual competences in a wide visual field. This work presents the design, development and preliminary testing of a new system for measuring infant’s gaze in the wide visual field called CareToy C: CareToy for Clinics. Methods: The system is based on a commercial eye tracker (SmartEye) with six cameras running at 60 Hz, suitable for measuring an infant’s gaze. In order to stimulate the infant visually and audibly, a mechanical structure has been designed to support five speakers and five screens at a specific distance (60 cm) and angle: one in the centre, two on the right-hand side and two on the left (at 30° and 60° respectively). Different tasks have been designed in order to evaluate the system capability to assess the infant’s gaze movements during different conditions (such as gap, overlap or audiovisual paradigms). Nine healthy infants aged 4–10 months were assessed as they performed the visual tasks at random. Results: We developed a system able to measure infant’s gaze in a wide visual field covering a total visual range of ±60° from the centre with an intermediate evaluation at ±30°. Moreover, the same system, thanks to different integrated software, was able to provide different visual paradigms (as gap, overlap and audio-visual) assessing and comparing different visual and multisensory sub-competencies. The proposed system endowed the integration of a commercial eye-tracker into a purposive setup in a smart and innovative way. Conclusions: The proposed system is suitable for measuring and evaluating infant’s gaze capabilities in a wide visual field, in order to provide quantitative data that can enrich the clinical assessment

New Technological Approach for the Evaluation of Postural Control Abilities in Children with Developmental Coordination Disorder

Background: Developmental Coordination Disorder (DCD) causes difficulties in postural control which are crucial to assess due to their impact on everyday life. There is a lack of suitable tools to acquire quantitative data and deeply analyze postural control, especially during the developmental age. The aim of this study is to investigate postural control skills in children with DCD and typically developing children (TD) using the Virtual Reality Rehabilitation System (VRRS). Methods: 18 children with DCD and 30 TD children (mean age 9.12 +/- 2.65 and 7.12 +/- 2.77 years, respectively) were tested by using the Movement Assessment Battery for Children Second Edition (MABC-2) and a VRRS stabilometric balance platform. A t-test was performed to identify differences in the VRRS parameters between the two groups. Furthermore, we investigated whether a correlation exists between the VRRS data and the MABC-2. Results: Significant differences (p < 0.05) in mean distance and frequency of the COP are found in the two groups. These parameters also correlate with the MABC-2 total score (p <= 0.05) and balance subscales (p <= 0.05). Conclusions: This study opens a new frontier for the assessment of postural skills in children with DCD and represents a potential basis for a tailored rehabilitation program, from which their postural stability and, consequently, their everyday life will benefit

Reorganization of the Action Observation Network and Sensory-Motor System in Children with Unilateral Cerebral Palsy: An fMRI Study

Little is known about the action observation network (AON) in children with unilateral cerebral palsy (UCP). Using fMRI, we aimed to explore AON and sensory-motor network (SMN) in UCP children and compare them to typically developed (TD) children and analyse the relationship between AON (re-)organization and several neurophysiological and clinical measures. Twelve UCP children were assessed with clinical scales and transcranial magnetic stimulation (TMS). For the fMRI study, they underwent a paradigm based on observation of complex and simple object-manipulation tasks executed by dominant and nondominant hand. Moreover, UCP and TD children carried out a further fMRI session to explore SMN in both an active motor and passive sensory task. AON in the UCP group showed higher lateralization, negatively related to performances on clinical scales, and had greater activation of unaffected hemisphere as compared to the bilateral representation in the TD group. In addition, a good congruence was found between bilateral or contralateral activation of AON and activation of SMN and TMS data. These findings indicate that our paradigm might be useful in exploring AON and the response to therapy in UCP subjects

Home-based, early intervention with mechatronic toys for preterm infants at risk of neurodevelopmental disorders (CARETOY):a RCT protocol

Background: Preterm infants are at risk for neurodevelopmental disorders, including motor, cognitive or behavioural problems, which may potentially be modified by early intervention. The EU CareToy Project Consortium ( http://www.caretoy.eu ) has developed a new modular system for intensive, individualized, home-based and family-centred early intervention, managed remotely by rehabilitation staff. A randomised controlled trial (RCT) has been designed to evaluate the efficacy of CareToy training in a first sample of low-risk preterm infants. Methods/Design: The trial, randomised, multi-center, evaluator-blinded, parallel group controlled, is designed according to CONSORT Statement. Eligible subjects are infants born preterm without major complications, aged 3-9 months of corrected age with specific gross-motor abilities defined by Ages & Stages Questionnaire scores. Recruited infants, whose parents will sign a written informed consent for participation, will be randomized in CareToy training and control groups at baseline (T0). CareToy group will perform four weeks of personalized activities with the CareToy system, customized by the rehabilitation staff. The control group will continue standard care. Infant Motor Profile Scale is the primary outcome measure and a total sample size of 40 infants has been established. Bayley-Cognitive subscale, Alberta Infants Motor Scale and Teller Acuity Cards are secondary outcome measures. All measurements will be performed at T0 and at the end of training/control period (T1). For ethical reasons, after this first phase infants enrolled in the control group will perform the CareToy training, while the training group will continue standard care. At the end of open phase (T2) all infants will be assessed as at T1. Further assessment will be performed at 18 months corrected age (T3) to evaluate the long-term effects on neurodevelopmental outcome. Caregivers and rehabilitation staff will not be blinded whereas all the clinical assessments will be performed, videotaped and scored by blind assessors. The trial is ongoing and it is expected to be completed by April 2015. Discussion: This paper describes RCT methodology to evaluate CareToy as a new tool for early intervention in preterm infants, first contribution to test this new type of system. It presents background, hypotheses, outcome measures and trial methodology. Trial registration: ClinicalTrials.gov: NCT01990183 . EU grant ICT-2011.5.1-287932

Concurrent and predictive validity of the infant motor profile in infants at risk of neurodevelopmental disorders

BACKGROUND: Preterm infants and infants with perinatal brain injury show a higher incidence of neurodevelopmental disorders (NDD). The Infant Motor Profile (IMP) is a clinical assessment which evaluates the complexity of early motor behaviour. More data are needed to confirm its predictive ability and concurrent validity with other common and valid assessments such as the Alberta Infant Motor Scale (AIMS) and Prechtl's General Movement Assessment (GMA). The present study aims to evaluate the concurrent validity of the IMP with the AIMS, to assess its association with the GMA, to evaluate how the IMP reflects the severity of the brain injury and to compare the ability of the IMP and the AIMS to predict an abnormal outcome in 5-month-old infants at risk of NDD.METHODS: 86 infants at risk of NDD were retrospectively recruited among the participants of two clinical trials. Preterm infants with or without perinatal brain injury and term infants with brain injury were assessed at 3months corrected age (CA) using the GMA and at 5months CA using the IMP and the AIMS. The neurodevelopmental outcome was established at 18months.RESULTS: Results confirm a solid concurrent validity between the IMP Total Score and the AIMS (Spearman's rho 0.76; p<.001) and a significant association between IMP Total Score and the GMA. Unlike the AIMS, the IMP Total score accurately reflects the severity of neonatal brain injury (p<.001) and proves to be the strongest predictor of NDD (p<.001). The comparison of areas under receiver operating characteristic curves (AUC) confirms that the IMP Total score has the highest diagnostic accuracy at 5months (AUC 0.92). For an optimal IMP Total Score cut-off value of 70, the assessment shows high sensitivity (93%) and specificity (81%) (PPV 84%; NPV 90%).CONCLUSIONS: Early motor behaviour assessed with the IMP is strongly associated with middle-term neurodevelopmental outcome. The present study confirms the concurrent validity of the IMP with the AIMS, its association with the GMA and its ability to reflect brain lesion load, hence contributing to the construct validity of the assessment.TRIAL REGISTRATION: NCT01990183 and NCT03234959 (clinicaltrials.gov)

Parental Practices and Environmental Differences among Infants Living in Upper-Middle and High-Income Countries: A Cross-Sectional Study

Parental practices and environmental factors can impact a child's development and, consequently, functionality. The objective is to assess the parental practices and environmental differences in healthy and at-risk infants at 3-6 months of age living in upper-middle (Brazil) and high-income (Italy) countries. A total group of 115 infants was identified and classified into four groups: healthy Italian infants (H_IT); Italian infants exposed to biological risk factors (R_IT); healthy Brazilian infants (H_BR); and Brazilian infants exposed to environmental risk factors (L_BR). The dependent variables were parental practices and environmental factors, which were assessed through a semi-structured interview and the "variety of stimulation dimension" from the Affordances in the Home Environment for Motor Development-Infant Scale (AHEMD-IS) questionnaire. Descriptive analyses, a multivariate analysis of variance (MANOVA), and correlation tests were applied. Regarding the environment and parental practices, the mother's age, maternal and paternal education, civil status, and variety of stimulation showed significant differences among the infants living in Brazil or in Italy. There were strong dissimilarities in parental practices and environmental factors among infants living in low/upper-middle and high-income countries. Since the home environment is the main stimulus for infant growth and development, our results are meaningful for providing knowledge about these two different cultures

Educational Robotics and empowerment of executive cognitive processes: from typical development to special educational needs

This paper describes a new Educational Robotic (ER) approach aimed to empower higher cognitive functions in school-setting. As robot programming requires to mentally plan a complex sequence of actions before the motor act, ER may indeed promote several crucial cognitive processes underlying learning. The steps needed and the mental acts for robot programming may involve Executive Functions (EF), that are complex higher cognitive processes, particularly crucial in the early development, because they are the base for abstraction and logical reasoning, decision-making, sequential thinking, maintaining and updating information in memory and problem-solving. Recent studies attempting to attest with a scientific approach the effect of ER on executive functioning are described. They concern both classroom with typical development or special educational needs and rehabilitation environment for children with developmental disorder. Robotica Educativa e potenziamento dei processi cognitivi esecutivi: dallo sviluppo tipico ai bisogni educativi specialiIl presente lavoro descrive come la Robotica Educativa (RE) possa essere utilizzata per potenziare alcune funzioni cognitive di controllo. Le azioni necessarie e gli atti mentali per la programmazione di un robot implicano le Funzioni Esecutive (FE), processi cognitivi di alto ordine, particolarmente importanti durante lo sviluppo cognitivo perché coinvolti nel ragionamento logico e nell’astrazione, nel decision-making, nel pensiero sequenziale, nel problem-solving e nel mantenimento/ aggiornamento delle informazioni in memoria. Nell’articolo sono sintetizzati e discussi gli studi con cui abbiamo cercato di provare con metodi scientifici l’effetto della RE sulle FE, nel gruppo classe per bambini con sviluppo tipico o con bisogni educativi speciali, e in ambito riabilitativo per bambini con disturbo del neurosviluppo