Reaching While Learning to Sit: Capturing the Kinematics of Co-Developing Skills at Home.

This study examined the co-development of infant reaching and postural control across the transition to arms-free sitting at home. We observed infants with typical likelihood (TL; n = 24) and elevated likelihood (EL; n = 20) for autism at four biweekly sessions spanning the transition to arms-free sitting (infant age = 4.5-8 months at first session). At each session, infants sat on a pressure-sensitive mat with external support or independently, wore magneto-inertial sensors on both wrists, and reached for toys presented at midline. Analyses focused on characterizing and comparing control of sitting during reaching actions and standard kinematic metrics of reaching during Supported versus Independent Sitting. Although EL infants achieved arms-free sitting later than TL peers, there were no group differences on any measures. Across sessions, infants' control of the sitting posture during concurrent reaching movements improved in both contexts, though they were less stable as they reached when sitting independently compared to when sitting with support. A similar effect was apparent in the kinematics of reaches, with overall improvement over time, but evidence of poorer control in Independent relative to Supported Sitting. Taken together, these findings underscore the mutually influential and dynamic relations between emerging skills and well-established behaviors.

Real-Time Visual Feedback Based on MIMUs Technology Reduces Bowing Errors in Beginner Violin Students.

Violin is one of the most complex musical instruments to learn. The learning process requires constant training and many hours of exercise and is primarily based on a student-teacher interaction where the latter guides the beginner through verbal instructions, visual demonstrations, and physical guidance. The teacher's instruction and practice allow the student to learn gradually how to perform the correct gesture autonomously. Unfortunately, these traditional teaching methods require the constant supervision of a teacher and the interpretation of non-real-time feedback provided after the performance. To address these limitations, this work presents a novel interface (Visual Interface for Bowing Evaluation-VIBE) to facilitate student's progression throughout the learning process, even in the absence of direct teacher intervention. The proposed interface allows two key parameters of bowing movements to be monitored, namely, the angle between the bow and the string (i.e., α angle) and the bow tilt (i.e., ß angle), providing real-time visual feedback on how to correctly move the bow. Results collected on 24 beginners (12 exposed to visual feedback, 12 in a control group) showed a positive effect of the real-time visual feedback on the improvement of bow control. Moreover, the subjects exposed to visual feedback judged the latter as useful to correct their movement and clear in terms of the presentation of data. Although the task was rated as harder when performed with the additional feedback, the subjects did not perceive the presence of a violin teacher as essential to interpret the feedback.

Sleep Spindle Generation Before and After Epilepsy Surgery: A Source Imaging Study in Children with Drug-Resistant Epilepsy.

INTRODUCTION: Literature lacks studies investigating the cortical generation of sleep spindles in drug-resistant epilepsy (DRE) and how they evolve after resection of the epileptogenic zone (EZ). Here, we examined sleep EEGs of children with focal DRE who became seizure-free after focal epilepsy surgery, and aimed to investigate the changes in the spindle generation before and after the surgery using low-density scalp EEG and electrical source imaging (ESI). METHODS: We analyzed N2-sleep EEGs from 19 children with DRE before and after surgery. We identified slow (8-12 Hz) and fast spindles (13-16 Hz), computed their spectral features and cortical generators through ESI and computed their distance from the EZ and irritative zone (IZ). We performed two-way ANOVA testing the effect of spindle type (slow vs. fast) and surgical phase (pre-surgery vs. post-surgery) on each feature. RESULTS: Power, frequency and cortical activation of slow spindles increased after surgery (p < 0.005), while this was not seen for fast spindles. Before surgery, the cortical generators of slow spindles were closer to the EZ (57.3 vs. 66.2 mm, p = 0.007) and IZ (41.3 vs. 55.5 mm, p = 0.02) than fast spindle generators. CONCLUSIONS: Our data indicate alterations in the EEG slow spindles after resective epilepsy surgery. Fast spindle generation on the contrary did not change after surgery. Although the study is limited by its retrospective nature, lack of healthy controls, and reduced cortical spatial sampling, our findings suggest a spatial relationship between the slow spindles and the epileptogenic generators.

Evaluating Handwriting Skills through Human-Machine Interaction: A New Digitalized System for Parameters Extraction.

Handwriting is an important component of academic curricula and grapho-motor skills (GMS) support learning, reading, memory and self-confidence. Teachers and clinicians report increase in children experiencing problems with acquiring fluid and legible handwriting. To date gold-standard tests evaluating children's GMS, mostly rely on pen and paper tests, requiring extensive coding time and subject to high inter-rater variability. This work presents preliminary data on a new digital platform for Grapho-motor Handwriting Evaluation & Exercise (GHEE), attempting to overcome limitations of available digitalized methods for GMS evalution. In fact, contrary to previous systems, GHEE design originated from comparisons among multiple standardized tests and was based on a human-machine interaction approach. GHEE hardware and software is presented as well as data on preliminary testing. Cursive handwriting data from six adult volunteers was analyzed according to six parameters of relevance, both automatically (i.e., using GHEE software) and manually (i.e., by a human coder). Comparisons among machine and human data sets allowed parsing out parameters to be extracted automatically and parameters requiring human-machine interaction. Results confirmed platform efficacy and feasibility of the proposed approach.

Novel User-Friendly Application for MRI Segmentation of Brain Resection following Epilepsy Surgery.

Delineation of resected brain cavities on magnetic resonance images (MRIs) of epilepsy surgery patients is essential for neuroimaging/neurophysiology studies investigating biomarkers of the epileptogenic zone. The gold standard to delineate the resection on MRI remains manual slice-by-slice tracing by experts. Here, we proposed and validated a semiautomated MRI segmentation pipeline, generating an accurate model of the resection and its anatomical labeling, and developed a graphical user interface (GUI) for user-friendly usage. We retrieved pre- and postoperative MRIs from 35 patients who had focal epilepsy surgery, implemented a region-growing algorithm to delineate the resection on postoperative MRIs and tested its performance while varying different tuning parameters. Similarity between our output and hand-drawn gold standards was evaluated via dice similarity coefficient (DSC; range: 0-1). Additionally, the best segmentation pipeline was trained to provide an automated anatomical report of the resection (based on presurgical brain atlas). We found that the best-performing set of parameters presented DSC of 0.83 (0.72-0.85), high robustness to seed-selection variability and anatomical accuracy of 90% to the clinical postoperative MRI report. We presented a novel user-friendly open-source GUI that implements a semiautomated segmentation pipeline specifically optimized to generate resection models and their anatomical reports from epilepsy surgery patients, while minimizing user interaction.

Assessing the Bowing Technique in Violin Beginners Using MIMU and Optical Proximity Sensors: A Feasibility Study.

Bowing is the fundamental motor action responsible for sound production in violin playing. A lot of effort is required to control such a complex technique, especially at the beginning of violin training, also due to a lack of quantitative assessments of bowing movements. Here, we present magneto-inertial measurement units (MIMUs) and an optical sensor interface for the real-time monitoring of the fundamental parameters of bowing. Two MIMUs and a sound recorder were used to estimate the bow orientation and acquire sounds. An optical motion capture system was used as the gold standard for comparison. Four optical sensors positioned on the bow stick measured the stick-hair distance. During a pilot test, a musician was asked to perform strokes using different sections of the bow at different paces. Distance data were used to train two classifiers, a linear discriminant (LD) classifier and a decision tree (DT) classifier, to estimate the bow section used. The DT classifier reached the best classification accuracy (94.2%). Larger data analysis on nine violin beginners showed that the orientation error was less than 2°; the bow tilt correlated with the audio information (r134=-0.973, 95% CI -0.981,-0.962,  p<0.001). The results confirmed that the interface provides reliable information on the bowing technique that might improve the learning performance of violin beginners.

Changes in the Functional Brain Network of Children Undergoing Repeated Epilepsy Surgery: An EEG Source Connectivity Study.

About 30% of children with drug-resistant epilepsy (DRE) continue to have seizures after epilepsy surgery. Since epilepsy is increasingly conceptualized as a network disorder, understanding how brain regions interact may be critical for planning re-operation in these patients. We aimed to estimate functional brain connectivity using scalp EEG and its evolution over time in patients who had repeated surgery (RS-group, n = 9) and patients who had one successful surgery (seizure-free, SF-group, n = 12). We analyzed EEGs without epileptiform activity at varying time points (before and after each surgery). We estimated functional connectivity between cortical regions and their relative centrality within the network. We compared the pre- and post-surgical centrality of all the non-resected (untouched) regions (far or adjacent to resection) for each group (using the Wilcoxon signed rank test). In alpha, theta, and beta frequency bands, the post-surgical centrality of the untouched cortical regions increased in the SF group (p < 0.001) whereas they decreased (p < 0.05) or did not change (p > 0.05) in the RS group after failed surgeries; when re-operation was successful, the post-surgical centrality of far regions increased (p < 0.05). Our data suggest that removal of the epileptogenic focus in children with DRE leads to a gain in the network centrality of the untouched areas. In contrast, unaltered or decreased connectivity is seen when seizures persist after surgery.

Embodying melody through a conducting baton: a pilot comparison between musicians and non-musicians.

Finger-tapping tasks have been widely adopted to investigate auditory-motor synchronization, i.e., the coupling of movement with an external auditory rhythm. However, the discrete nature of these movements usually limits their application to the study of beat perception in the context of isochronous rhythms. The purpose of the present pilot study was to test an innovative task that allows investigating bodily responses to complex, non-isochronous rhythms. A conductor's baton was provided to 16 healthy subjects, divided into 2 different groups depending on the years of musical training they had received (musicians or non-musicians). Ad hoc-created melodies, including notes of different durations, were played to the subjects. Each subject was asked to move the baton up and down according to the changes in pitch contour. Software for video analysis and modelling (Tracker®) was used to track the movement of the baton tip. The main parameters used for the analysis were the velocity peaks in the vertical axis. In the musician group, the number of velocity peaks exactly matched the number of notes, while in the non-musician group, the number of velocity peaks exceeded the number of notes. An exploratory data analysis using Poincaré plots suggested a greater degree of coupling between hand-arm movements and melody in musicians both with isochronous and non-isochronous rhythms. The calculated root mean square error (RMSE) between the note onset times and the velocity peaks, and the analysis of the distribution of velocity peaks in relationship to note onset times confirmed the effect of musical training. Notwithstanding the small number of participants, these results suggest that this novel behavioural task could be used to investigate auditory-motor coupling in the context of music in an ecologically valid setting. Furthermore, the task may be used for rhythm training and rehabilitation in neurological patients with movement disorders.

Nutritive sucking abnormalities and brain microstructural abnormalities in infants with established brain injury: a pilot study.

OBJECTIVE: To determine the relationship between nutritive sucking and microstructural integrity of sensorimotor tracts in newborns with brain injury. STUDY DESIGN: Diffusion imaging was performed in ten newborns with brain injury. Nutritive sucking was assessed using Nfant®. The motor, sensory, and corpus callosum tracts were reconstructed via tractography. Fractional anisotropy, radial, axial, and mean diffusivity were estimated for these tracts. Multiple regression models were developed to test the association between sucking features and diffusion parameters. RESULTS: Low-sucking smoothness correlated with low-fractional anisotropy of motor tracts (p = 0.0096). High-sucking irregularity correlated with high-mean diffusivity of motor (p = 0.030) and corpus callosum tracts (p = 0.032). For sensory tracts, high-sucking irregularity (p = 0.018) and low-smoothness variability (p = 0.002) correlated with high-mean diffusivity. INTERPRETATION: We show a correlation between neuroimaging-demonstrated microstructural brain abnormalities and variations in sucking patterns of newborns. The consistency of this relationship should be shown on larger cohorts.

Motor performance in a shape sorter task: A longitudinal study from 14 to 36 months of age in children with an older sibling ASD.

During development, motor skills are fundamental in supporting interactions with the external world. The ability to plan actions is a particularly important aspect of motor skill since it is involved in many daily activities. In this work, we studied the development of motor planning longitudinally in children with an older sibling with Autism Spectrum Disorder (ASD) who are at heightened risk (HR) for the disorder and children with no such risk (low risk; LR) using a shape sorter task. Children were observed at 14, 18, 24 and 36 months. Three HR children with a later diagnosis of ASD (HR-ASD) were analyzed separately from the rest of the sample. Behavioral and kinematic data indicated that precision demands significantly influenced children's actions, and that children's performance improved with age. No differences were found between the HR and LR groups, but a descriptive analysis of data from the three HR-ASD suggested differences in the variables describing children's action (as reaching time and acceleration) as well as variables describing children's performance (as the adjustment of the shapes).

Assessment of feeding teats: an experimental study.

This work aims to present a quantitative metric to assess the impact of feeding teats on the nutritive sucking of newborns. Two different teat models are compared: a classical model (model C), and a model provided with two opposite recesses to match the anatomical characteristics of the mouth of a newborn (model I). This latter feeding teat model has been specifically designed to promote the attachment of the baby, thus improving her/his nutritive sucking performance.Feeding teats are instrumented with a device to assess nutritive sucking (the Feeding Assessment Monitor, FAM). The device records feeding pressures and a software extracts quantitative features already used and validated in clinical applications.Comparative cross-over analysis on 30 healthy newborns, demonstrates the appropriateness of the proposed metric to reveal differences in the teat models. In particular, our data confirm the better attachment of newborns when fed with the I model: they show a longer feeding, with higher level of depressurization, higher regularity, and higher number of sucking events.

Monitoring Sucking Abilities in Newborns: Design and Validation on Adult Of a Wearable System for Non-Invasive Deglutition Detection.

Nutritive Sucking (NS) is one of the earliest motor activity performed by infants, strictly related to both neurological and motor development of newborns. The main components of NS are sucking, respiration and deglutition. Despite its recognized importance, current clinical practice lacks quantitative tools for the assessment of NS. This work aims to identify a non-invasive objective method to assess deglutition. In details, we propose a new sensor fusion approach to merge both inertial and acoustic data in order to estimate deglutition time. The algorithm uses two classification criteria: one is based on signal intensity thresholding and the other on the evaluation of Waveform Dimension Trajectory (WDT). Our preliminary results on 9 healthy adult volunteers show that the sensor fusion of audio and IMU signals provides a high precision (0.93) and a good recall (0.72). Moreover, the algorithm has a good accuracy (0.84) and high specificity (0.95).

Surgical resection of ripple onset predicts outcome in pediatric epilepsy.

OBJECTIVE: In patients with medically refractory epilepsy (MRE), interictal ripples (80-250Hz) are observed in large brain areas whose resection may be unnecessary for seizure freedom. This limits their utility as epilepsy biomarkers for surgery. We assessed the spatiotemporal propagation of interictal ripples on intracranial electroencephalography (iEEG) in children with MRE, compared it with the propagation of spikes, identified ripples that initiated propagation (onset-ripples), and evaluated their clinical value as epilepsy biomarkers. METHODS: Twenty-seven children who underwent epilepsy surgery were studied. We identified propagation sequences of ripples and spikes across multiple iEEG contacts and calculated each ripple or spike latency from the propagation onset. We classified ripples and spikes into categories (ie, onset, spread, and isolated) based on their spatiotemporal characteristics and correlated their mean rate inside and outside resection with outcome (good outcome, Engel 1 versus poor outcome, Engel≥2). We determined, as onset-zone, spread-zone, and isolated-zone, the areas generating the corresponding ripple or spike category and evaluated the predictive value of their resection. RESULTS: We observed ripple propagation in all patients and spike propagation in 25 patients. Mean rate of onset-ripples inside resection predicted the outcome (odds ratio = 5.37; p = 0.02) and correlated with Engel class (rho = -0.55; p = 0.003). Resection of the onset-ripple-zone was associated with good outcome (p = 0.047). No association was found for the spread-ripple-zone, isolated-ripple-zone, or any spike-zone. INTERPRETATION: Interictal ripples propagate across iEEG contacts in children with MRE. The association between the onset-ripple-zone resection and good outcome indicates that onset-ripples are promising epilepsy biomarkers, which estimate the epileptogenic tissue better than spread-ripples or onset-spikes. Ann Neurol 2018;84:331-346.

A Wearable System for Real-Time Continuous Monitoring of Physical Activity.

Over the last decades, wearable systems have gained interest for monitoring of physiological variables, promoting health, and improving exercise adherence in different populations ranging from elite athletes to patients. In this paper, we present a wearable system for the continuous real-time monitoring of respiratory frequency (fR), heart rate (HR), and movement cadence during physical activity. The system has been experimentally tested in the laboratory (by simulating the breathing pattern with a mechanical ventilator) and by collecting data from one healthy volunteer. Results show the feasibility of the proposed device for real-time continuous monitoring of fR, HR, and movement cadence both in resting condition and during activity. Finally, different synchronization techniques have been investigated to enable simultaneous data collection from different wearable modules.

Quantitative Analysis of Bradykinesia and Rigidity in Parkinson's Disease.

BACKGROUND: In the last decades, several studies showed that wearable sensors, used for assessing Parkinson's disease (PD) motor symptoms and recording their fluctuations, could provide a quantitative and reliable tool for patient's motor performance monitoring. OBJECTIVE: The aim of this study is to make a step forward the capability of quantitatively describing PD motor symptoms. The specific aims are: identify the most sensible place where to locate sensors to monitor PD bradykinesia and rigidity, and identify objective indexes able to discriminate PD OFF/ON motor status, and PD patients from healthy subjects (HSs). METHODS: Fourteen PD patients (H&Y stage 1-2.5), and 13 age-matched HSs, were enrolled. Five magneto-inertial wearable sensors, placed on index finger, thumb, metacarpus, wrist, and arm, were used as motion tracking systems. Sensors were placed on the most affected arm of PD patients, and on dominant hand of HS. Three UPDRS part III tasks were evaluated: rigidity (task 22), finger tapping (task 23), and prono-supination movements of the hands (task 25). A movement disorders expert rated the three tasks according to the UPDRS part III scoring system. In order to describe each task, different kinematic indexes from sensors were extracted and analyzed. RESULTS: Four kinematic indexes were extracted: fatigability; total time; total power; smoothness. The last three well-described PD OFF/ON motor status, during finger-tapping task, with an index finger sensor. During prono-supination task, wrist sensor was able to differentiate PD OFF/ON motor condition. Smoothness index, used as a rigidity descriptor, provided a good discrimination of the PD OFF/ON motor status. Total power index, showed the best accuracy for PD vs healthy discrimination, with any sensor location among index finger, thumb, metacarpus, and wrist. CONCLUSION: The present study shows that, in order to better describe the kinematic features of Parkinsonian movements, wearable sensors should be placed on a distal location on upper limb, on index finger or wrist. The proposed indexes demonstrated a good correlation with clinical scores, thus providing a quantitative tool for research purposes in future studies in this field.

Performance Evaluation of Bluetooth Low Energy: A Systematic Review.

Small, compact and embedded sensors are a pervasive technology in everyday life for a wide number of applications (e.g., wearable devices, domotics, e-health systems, etc.). In this context, wireless transmission plays a key role, and among available solutions, Bluetooth Low Energy (BLE) is gaining more and more popularity. BLE merges together good performance, low-energy consumption and widespread diffusion. The aim of this work is to review the main methodologies adopted to investigate BLE performance. The first part of this review is an in-depth description of the protocol, highlighting the main characteristics and implementation details. The second part reviews the state of the art on BLE characteristics and performance. In particular, we analyze throughput, maximum number of connectable sensors, power consumption, latency and maximum reachable range, with the aim to identify what are the current limits of BLE technology. The main results can be resumed as follows: throughput may theoretically reach the limit of ~230 kbps, but actual applications analyzed in this review show throughputs limited to ~100 kbps; the maximum reachable range is strictly dependent on the radio power, and it goes up to a few tens of meters; the maximum number of nodes in the network depends on connection parameters, on the network architecture and specific device characteristics, but it is usually lower than 10; power consumption and latency are largely modeled and analyzed and are strictly dependent on a huge number of parameters. Most of these characteristics are based on analytical models, but there is a need for rigorous experimental evaluations to understand the actual limits.

On the Orientation Error of IMU: Investigating Static and Dynamic Accuracy Targeting Human Motion.

The accuracy in orientation tracking attainable by using inertial measurement units (IMU) when measuring human motion is still an open issue. This study presents a systematic quantification of the accuracy under static conditions and typical human dynamics, simulated by means of a robotic arm. Two sensor fusion algorithms, selected from the classes of the stochastic and complementary methods, are considered. The proposed protocol implements controlled and repeatable experimental conditions and validates accuracy for an extensive set of dynamic movements, that differ in frequency and amplitude of the movement. We found that dynamic performance of the tracking is only slightly dependent on the sensor fusion algorithm. Instead, it is dependent on the amplitude and frequency of the movement and a major contribution to the error derives from the orientation of the rotation axis w.r.t. the gravity vector. Absolute and relative errors upper bounds are found respectively in the range [0.7° ÷ 8.2°] and [1.0° ÷ 10.3°]. Alongside dynamic, static accuracy is thoroughly investigated, also with an emphasis on convergence behavior of the different algorithms. Reported results emphasize critical issues associated with the use of this technology and provide a baseline level of performance for the human motion related application.

Performance of Motor Sequences in Children at Heightened vs. Low Risk for ASD: A Longitudinal Study from 18 to 36 Months of Age.

Recent research shows that motor difficulties are a prominent component of the behavioral profile of autism spectrum disorder (ASD) and are also apparent from early in development in infants who have an older sibling with ASD (High Risk; HR). Delays have been reported for HR infants who do and who do not receive an eventual diagnosis of ASD. A growing body of prospective studies has focused on the emergence of early motor skills primarily during the first year of life. To date, however, relatively little work has examined motor skills in the second and third years. Thus, the present research was designed to investigate motor performance in object transport tasks longitudinally in HR and LR (Low Risk) children between the ages of 18 and 36 months. Participants (15 HR children and 14 LR children) were observed at 18, 24, and 36 months. Children completed two motor tasks, the Ball Task and the Block Task, each of which included two conditions that varied in terms of the precision demands of the goal action. Kinematic data were acquired via two magneto inertial sensors worn on each wrist. In the Block Task, HR children reached more slowly (i.e., mean acceleration was lower) compared to LR children. This finding is in line with growing evidence of early delays in fine motor skills in HR children and suggests that vulnerabilities in motor performance may persist into the preschool years in children at risk for ASD.

An Automated System for the Analysis of Newborns' Oral-Motor Behavior.

The assessment of oral-motor behavior (OMB) represents one the earliest noninvasive ways to evaluate newborns' well-being and neuromotor behavior. This work aimed at developing a new low-cost, easy-to-use and noninvasive system for a technology-aided assessment of newborns' OMB during bottle feeding. A SUcking MOnitoring Device (SUMOD) was designed and developed to be easily integrated on a typical feeding bottle. A software system was developed to automatically treat and analyze the acquired data: proper algorithms for a fully automatic segmentation and features extraction are proposed and implemented. A set of measures of motor control and coordination are introduced and implemented for the specific application to the OMB analysis. Experimental data were collected on two groups of newborns (healthy versus low birth weight) with the SUMOD in a clinical setting.

The sound of actions: a new tool to study music perception in young children.

In this work we describe a new sensing technique to study auditory preferences in young children based on the interaction between perception and action. Manipulation is assessed thanks to a novel device instrumented with a magneto-inertial sensing core. This system allows estimating the manipulation in terms of angular displacements with errors lower than Io. The laboratory validation is presented and discussed in details. Moreover, a pilot trial on two children aged 34 and 35 months is reported to evaluate the appropriateness of the technology to the experimental aims. Preliminary results foster the application of this method to investigate music preferences in young listeners.