Automated postural asymmetry assessment in infants neurodevelopmental evaluation using novel video-based features.

BACKGROUND AND OBJECTIVE: Neurodevelopmental assessment enables the identification of infant developmental disorders in the first months of life. Thus, the appropriate therapy can be initiated promptly, increasing the chances for correct motor function. Posture asymmetry is one of the crucial aspects evaluated during the diagnosis. Available diagnostic methods are mainly based on qualitative assessment and subjective expert opinion. Current trends in computer-aided diagnosis focus mostly on analyzing infants' spontaneous movement videos using artificial intelligence methods, based primarily on limbs movement. This study aims to develop an automatic method for determining the infant's positional asymmetry in a video recording using computer image processing methods. METHODS: We made the first attempt to determine positional preferences in a recording automatically. We proposed six quantitative features describing trunk and head position based on pose estimation. As a result of our algorithm, we estimate the percentage of each trunk position in a recording using known machine learning methods. The training and test sets were created from 51 recordings collected during our research and 12 recordings from the benchmark dataset evaluated by five of our experts. The method was assessed using the leave-one-subject-out cross-validation method for ground truth video fragments and different classifiers. Log loss for multiclass classification and ROC AUC were determined to evaluate the results for both our and benchmark datasets. RESULTS: In a classification of the shortened side, the QDA classifier yields the most accurate results, gaining the lowest log loss of 0.552 and AUC of 0.913. The high accuracy (92.03) and sensitivity (93.26) confirm the method's potential in screening for asymmetry. CONCLUSIONS: The method allows obtaining quantitative information about positional preference, a valuable extension of basic diagnostics without additional tools and procedures. In combination with an analysis of limbs movement, it may constitute one of the elements of a novelty computer-aided infants' diagnosis system in the future.

Temporal and spatial variability of the fidgety movement descriptors and their relation to head position in automized general movement assessment.

PURPOSE: In clinical practice, motor development in infants is assessed subjectively. Many researchers propose objective methods, which have numerous limitations, by attaching markers or sensors to the child's limbs. The purpose of this study is to attempt to develop objectified numerical indices to describe the limb movements of infants without interfering with spontaneous activity. METHODS: 20-minute video recordings of three infants' movements who were purposively selected from 51 subjects were included in the study. The procedure of automatic calculation of head position time in 3 positions was applied. Movement features were determined to allow for the delineation of coefficients describing the movement in numerical values. RESULTS: Presented parameters describe three infant's movement aspects: quality (strength), distribution of postural tonus and asymmetry in relation to head position, described as four independent values. Estimated parameters variability over time was weighted up according to expert observations. The presented method is a direct reflection of infants' observation, currently performed by highly educated and experienced therapists. CONCLUSIONS: The interpretability and usefulness of the presented parameters were proved. All parameters estimation is fully automated. The conducted research is a prelude to future work related to creating an objective and repeatable tool, initially monitoring and ultimately supporting early diagnosis for differentiating normal and abnormal motor development.

Writhing Movement Detection in Newborns on the Second and Third Day of Life Using Pose-Based Feature Machine Learning Classification.

Observation of neuromotor development at an early stage of an infant's life allows for early diagnosis of deficits and the beginning of the therapeutic process. General movement assessment is a method of spontaneous movement observation, which is the foundation for contemporary attempts at objectification and computer-aided diagnosis based on video recordings' analysis. The present study attempts to automatically detect writhing movements, one of the normal general movement categories presented by newborns in the first weeks of life. A set of 31 recordings of newborns on the second and third day of life was divided by five experts into videos containing writhing movements (with occurrence time) and poor repertoire, characterized by a lower quality of movement in relation to the norm. Novel, objective pose-based features describing the scope, nature, and location of each limb's movement are proposed. Three machine learning algorithms are evaluated in writhing movements' detection in leave-one-out cross-validation for different feature extraction time windows and overlapping time. The experimental results make it possible to indicate the optimal parameters for which 80% accuracy was achieved. Based on automatically detected writhing movement percent in the video, infant movements are classified as writhing movements or poor repertoire with an area under the ROC (receiver operating characteristics) curve of 0.83.

Development of low postural tone compensatory patterns in children - theoretical basis.

Neurological literature indicates the existence of children with low postural tone without association with central nervous system damage. This fact induces to think about mechanisms, which allow these children to maintain upright posture. There is a suspicion that compensatory mechanism included in this process, enables to achieve upright posture, but at expense of body posture quality. Observations of children's developmental stages caused determination of some postural tone area, which comprise both children with normotonia and with low postural tone without characteristics of central nervous system (CNS) damage. Set of specific qualities allows determination of two types of low postural tone: spastoidal and atetoidal type. Spastoidal type is characterized by deep trunk muscles (local) low postural tone compensated by excessive tension of superficial muscles (global). Atetoidal type includes children with low postural tone in both deep and superficial muscles. At inefficient active subsystem, verticalization proceeds at excessive use of passive subsystem qualities, that is meniscus, ligament, bone shape, and muscles passive features. From neurodevelopmental point of view compensatory mechanisms can be used in children with low postural tone in order to achieve upright posture, but at expense of body posture quality.

Development of low postural tone compensatory patterns - predicted dysfunction patterns in upper part of the body.

Lower postural tone is not always associated with central nervous system structures damage. There is a such kind of tone that stays within the broadly defined normal range, but is characterized by distinct decrease of tone of the deep muscles responsible for stabilization. External syndromes are features of active or passive compensation observed in the postural and motor patterns. Active compensation of the lower muscle tone is associated with excessive use of the superficial muscles for stabilization that leads to limitation of motion in the joints and to functional shortening of some muscles. Active compensation mechanisms in the upper part of the body cause translation of the head before the line of the shoulders, high alignment of the shoulder girdle and increase of the thoracic kyphosis (spastoidal type). Passive compensation is initiated in case of decreased tone of both deep and superficial muscles. Stabilization is kept with considerable participation of the spatial shape of bones, ligaments, meniscus and passive properties of the muscles. Tendency to hypermobility of the periarthritis elements is observed, which is manifested by the increase of the physiological range of motion in the joints. As a result in the upper part of the body postural faults develop, which are characterized by decreased thoracic kyphosis and sunken chest (atetoidal type). These observations indicate that lower tone of the muscles responsible for stabilization triggers off the sequence of compensatory mechanisms that ultimately lead to specific postural faults.

Development of low postural tone compensatory patterns - predicted dysfunction patterns in lower part of the body.

Lower postural tone is not always associated with central nervous system structural damage. There is such kind of tone that stays within the broadly defined normal range, but is characterized by distinct decrease of tone of the deep muscles responsible for stabilization. External syndromes are features of active or passive compensation observed in the postural and motor patterns. Active compensation of the lower muscle tone is associated with excessive use of the superficial muscles for stabilization that leads to limitation of motion in the joints and to functional shortening of some muscles. Active compensation mechanisms in the lower part of the body cause decreased anterior pelvic tilt, functional shortening of the hamstring muscles and pes cavus (spastoidal type). Passive compensation is initiated in case of decreased tone of both deep and superficial muscles. Stabilization is kept with considerable participation of the spatial shape of bones, ligaments, meniscus and passive properties of the muscles. Tendency to hypermobility of the periarthritis elements is observed, which is manifested by increase of the physiological range of motion in the joints. As a result in the lower part of the body postural faults develop, which are characterized by increased lumbar lordosis, anterior pelvic tilt, valgus knee and feet (atetoidal type). Observations indicate that lower tone of the muscles responsible for stabilization triggers off the sequence of compensatory mechanisms that ultimately lead to specific postural faults.

Assessment of connection between the bite plane and body posture in children and teenagers.

AIM: Attempt to compare the occlusion condition in groups of children with different body posture. MATERIAL AND METHODS: 336 children aged from 8 to 14 years were investigated. The subjects were selected in orthodontic clinics (237 children) and at schools (98 children). All participants were divided into groups with different body posture according to Kasperczyk's point method. The comparison of the occlusion quality was performed with the use of a scale developed by Emmerich-Poplatek. RESULTS: The studied group comprised following number of persons: 12 (3.56%) with no malocclusion, 37 (10.98%) with mild, 162 (48.37%) with moderate and 124 (37.09%) with severe malocclusion. In relation to the body posture, 52.67% of the participants had correct posture, 45.53 % had a faulty posture of mild degree and 1.78% of severe degree. A considerable differentiation of the occlusion condition was discovered within the three groups. In view of a small number of participants with a faulty posture of considerable degree (n=6) the comparative analysis of the occlusion condition was performed between the group with a correct body posture and group with faulty posture (created by combining group 2 and 3). The result of the analysis suggests a significant differentiation of the occlusion condition between the groups mentioned above (p<0.01). CONCLUSION: Children with faulty postures present more intense malocclusions than children with a correct body posture. Results of this type suggest the need for interdisciplinary look at people with malocclusions whose therapy should involve body posture correction.

"The inhibiting casts" used in cerebral palsed children.

Inhibiting casts, introduced to rehabilitation practice by NDT-Bobath therapists, are being used with increasing frequency in the physiotherapy of children with cerebral palsy (CP). In the literature these plaster casts are known as tone-reducing plasters, spasticity-reducing plasters, or short leg plaster casts. The casts are installed on the lower leg and foot in the form of plaster shoes to immobilize the foot and ankle joints in the proper position. This creates conditions for constant manipulation of the limb using key points located on the lower leg and foot. According to the NDT-Bobath concept, this enables positive changes in postural and locomotor patterns, as well as the distribution of postural tone. The construction and application of these inhibitive casts are not the same as in the standard plaster casts used to correct foot deformations. The casts are placed on both feet regardless of the type of paresis, for a period from one to three weeks, depending on the child's age. New casts can be applied repeatedly during the child's rehabilitation. Experience shows that inhibitive casts are a very important aid in the treatment of CP children. The decision to use plaster casting requires experience and detailed functional assessment for each individual child, in terms of muscle tone distribution, the necessary compensatory patterns, and disturbances in the coordination of motor patterns.

Epidemiology of occupational noise-induced hearing loss (ONIHL) in Poland.

Noise-induced hearing loss is a major health risk worldwide. In Europe about 35 million people are exposed to detrimental noise levels (> 85 dB-A) in industrial plants, and occupational deafness is a leading occupational compensible disease in the all countries; it is an insidious slow process that develops over a period of approximately 10 to 20 years. Accordingly to the latest estimations, more than 650,000 workers (of a total 5 million employed in industry) are put at risk in Poland. Despite progress in engineering approaches for reducing noise in the work environment and in improving hearing conservation programs (both the technical and medical) the ONIHL still remains a common and costly disability. The aim of this study is presentation of the most recent data on the incidence of ONIHL in Poland in the years 1992-2002 considered to be a base for implementing the effective prophylactic activities. The analysed data were derived from the central state register which collects all cases of occupational diseases recognized in the country. The highest incidence was found in such key industrial branches as coal mining, iron and steel, metallurgical and transport equipment; majority of cases were observed in southern and western provinces, mainly in the Silesian district, known from the significant concentration of noisy enterprises. The most affected were those workers aged 50-59 years and exposed to noise for over 20 years. More than 30 new cases of ONIHL were identified in the years 1992-1998 annually per 100,000 employees, and with beginning 1999 the rate was significantly decreased to 10 cases in 2002. One may presume that it results from the set up of national program of hearing preservation introduced in 1999 with obligatory pre-employment and follow-up pure-tone audiometry, as well as with hearing screening by means of the otoacoustic emissions.

[Occupational hearing loss: new diagnostic opportunities]. / Zawodowe uszkodzenie sluchu: nowe mozliwosci diagnostyczne.

Noise-induced hearing loss together with presbyacusis are the most frequent causes of the disorders of the inner ear among adults. The authors present briefly epidemiological, diagnostic and certification aspects of this issue. Their attention was mainly focused on the role of objective methods of hearing examinations (impedance audiometry, brainstem electric response audiometry, recording of otoacoustic emissions) in diagnostic procedures. A growing significance of these methods, especially in frequent cases of the aggravation and simulation among persons who claim for certification of occupational noise-induced hearing loss, was highlighted.