Task-based functional neuroimaging in infants: a systematic review.

Background: Infancy is characterized by rapid neurological transformations leading to consolidation of lifelong function capabilities. Studying the infant brain is crucial for understanding how these mechanisms develop during this sensitive period. We review the neuroimaging modalities used with infants in stimulus-induced activity paradigms specifically, for the unique opportunity the latter provide for assessment of brain function. Methods: Conducted a systematic review of literature published between 1977-2021, via a comprehensive search of four major databases. Standardized appraisal tools and inclusion/exclusion criteria were set according to the PRISMA guidelines. Results: Two-hundred and thirteen papers met the criteria of the review process. The results show clear evidence of overall cumulative growth in the number of infant functional neuroimaging studies, with electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) to be the most utilized and fastest growing modalities with behaving infants. However, there is a high level of exclusion rates associated with technical limitations, leading to limited motor control studies (about 6%) in this population. Conclusion: Although the use of functional neuroimaging modalities with infants increases, there are impediments to effective adoption of existing technologies with this population. Developing new imaging modalities and experimental designs to monitor brain activity in awake and behaving infants is vital.

User-centred assistive technology assessment of a portable open-area body weight support system for in-home use.

PURPOSE: Current paediatric technology lacks mobility devices that support early, high-dose and variable movement that can be managed by professionals and parents outside of the lab or clinic. Parent acceptability of the technology is a critical piece to the continued use of devices by their infants. The purpose of this study was to determine the level of feasibility of an in-home application of a novel portable body weight support system (PBWSS), designed for community use. METHOD: Sixteen typically and atypically developing infants used the system for four sessions at the home and lab. Parents assisted with the in-home system setup and completed a questionnaire on their: (a) infant's behavioural change, (b) infant's enjoyment, (c) own satisfaction, need and predicted use of the device, and (d) recommendations for future modifications. RESULTS: Parents and their infants successfully used the device during a wide range of activities. Parents noted positive changes in their infants' behaviour including their infants initiating certain behaviours for the first time. Parents quickly learned to setup and use the device and were satisfied with its current structure. Future modifications included increasing the wearable harness comfort. CONCLUSION: Infant performance and parent perceptions support the development of devices that place body-weight supported activity in real-world environments to promote high-dose, enriched experiences for young infants with mobility challenges.Implications for rehabilitationAssistive technology that can support multiple aspects of mobility in developing infants is limited.The in-home application of open-area body weight support systems has the potential to support early, enriched, high-dose mobility.Users of this technology, infants and their parents, were meaningfully involved throughout the assessment process.Preliminary findings support that: (1) this device was successfully implemented in these homes, (2) parents and infants enjoyed using the device, (3) parents noted positive changes in their infant's behavior, and (4) parents perceived the device to be safe and easy to use.Future studies can now determine the optimal use of this device with a range of pediatric populations.

In-Home Mobility Training With a Portable Body Weight Support System of an Infant With Down Syndrome.

PURPOSE: To report on the feasibility of an open-area, portable body weight support system (PBWSS) for in-home use and overground mobility training in an infant with Down syndrome. SUMMARY OF KEY POINTS: The family used the PBWSS on average 4 days/week and for a mean duration of 27.9 minutes/day. Within sessions, the infant's mobility in the open area was greater with PBWSS assistance. The infant's mobility increased whereas variable trends were noted in the infant's motor, language, and cognitive development. CONCLUSIONS: The long-term and frequent use of the PBWSS by this family provided opportunities to practice on emerging motor skills and exploratory actions that may have had a positive effect on her mobility and overall development. RECOMMENDATION FOR CLINICAL PRACTICE: High-dose, body weight-supported training on emerging motor skills is feasible in the infants' natural environments. Future studies using a large sample will quantify the effects.

GEARing smart environments for pediatric motor rehabilitation.

BACKGROUND: There is a lack of early (infant) mobility rehabilitation approaches that incorporate natural and complex environments and have the potential to concurrently advance motor, cognitive, and social development. The Grounded Early Adaptive Rehabilitation (GEAR) system is a pediatric learning environment designed to provide motor interventions that are grounded in social theory and can be applied in early life. Within a perceptively complex and behaviorally natural setting, GEAR utilizes novel body-weight support technology and socially-assistive robots to both ease and encourage mobility in young children through play-based, child-robot interaction. This methodology article reports on the development and integration of the different system components and presents preliminary evidence on the feasibility of the system. METHODS: GEAR consists of the physical and cyber components. The physical component includes the playground equipment to enrich the environment, an open-area body weight support (BWS) device to assist children by partially counter-acting gravity, two mobile robots to engage children into motor activity through social interaction, and a synchronized camera network to monitor the sessions. The cyber component consists of the interface to collect human movement and video data, the algorithms to identify the children's actions from the video stream, and the behavioral models for the child-robot interaction that suggest the most appropriate robot action in support of given motor training goals for the child. The feasibility of both components was assessed via preliminary testing. Three very young children (with and without Down syndrome) used the system in eight sessions within a 4-week period. RESULTS: All subjects completed the 8-session protocol, participated in all tasks involving the selected objects of the enriched environment, used the BWS device and interacted with the robots in all eight sessions. Action classification algorithms to identify early child behaviors in a complex naturalistic setting were tested and validated using the video data. Decision making algorithms specific to the type of interactions seen in the GEAR system were developed to be used for robot automation. CONCLUSIONS: Preliminary results from this study support the feasibility of both the physical and cyber components of the GEAR system and demonstrate its potential for use in future studies to assess the effects on the co-development of the motor, cognitive, and social systems of very young children with mobility challenges.

Exploring the Unmet Need for Technology to Promote Motor Ability in Children Younger Than 5 Years of Age: A Systematic Review.

OBJECTIVE: To (1) identify types of technology that promote motor ability in children younger than 5 years of age, (2) report on the type of support these devices provide, and (3) evaluate their potential for use in the community (outside of the laboratory or clinic). DATA SOURCES: A literature search of PubMed was conducted in February 2019 using specific terms, including child, rehabilitation, movement, and instrumentation. STUDY SELECTION: The search yielded 451 peer-reviewed articles, which were screened by multiple reviewers. Articles that described the use of devices for the purpose of motor rehabilitation and/or assistance (regardless of device type or body part targeted) in the age range of 0-5 years were eligible for inclusion. DATA EXTRACTION: In conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, final stage data extraction consisted of full text readings where each article was reviewed twice by 3 independent reviewers. DATA SYNTHESIS: About half of the devices available (46%) for children younger than 5 years of age are orthotics and corrective casting devices. There are more facilitative (ie, power mobility devices) than inhibitive (ie, casting) technologies being used. Approximately 60% of the devices are designed for use by a single body part. Walking is the most common motor skill addressed. Although most of the devices were used to some degree outside of the laboratory or clinic, most of the devices available are considered investigative and are not available for commercial purchase. CONCLUSIONS: Many types of pediatric devices to assist movement exist, but the current scope of employed devices is limited. There is a need for developing technology that allows for, if not supports, high-dosage, early, and variable motor practice that can take place in community settings.

Use of an In-Home Body Weight Support System by a Child With Spina Bifida.

PURPOSE: To examine the feasibility of a new open-area body weight support system (BWSS) to act as both an "assistive" and a "rehabilitative" device within the home. INTERVENTION: A 5-year-old boy with spina bifida used the BWSS during self-selected activities for 10 weeks. Feasibility, behavioral, and clinical assessments provided a quantification of his activity in and out of the BWSS. OUTCOMES: On average, the child used the device on 2.7 days/week and for 67 minutes/day during intervention. When in the BWSS (assistive role), the child's locomotor activity and engagement in adapted sports activities increased. When not in the BWSS (rehabilitative role), the child's functional mobility and ambulatory ability increased. WHAT THIS CASE ADDS: The use of the open-area in-home BWSS was feasible for regular home use and associated with an increase in functional mobility for a child with spina bifida.

Learning models of Human-Robot Interaction from small data.

This paper offers a new approach to learning discrete models for human-robot interaction (HRI) from small data. In the motivating application, HRI is an integral part of a pediatric rehabilitation paradigm that involves a play-based, social environment aiming at improving mobility for infants with mobility impairments. Designing interfaces in this setting is challenging, because in order to harness, and eventually automate, the social interaction between children and robots, a behavioral model capturing the causality between robot actions and child reactions is needed. The paper adopts a Markov decision process (MDP) as such a model, and selects the transition probabilities through an empirical approximation procedure called smoothing. Smoothing has been successfully applied in natural language processing (NLP) and identification where, similarly to the current paradigm, learning from small data sets is crucial. The goal of this paper is two-fold: (i) to describe our application of HRI, and (ii) to provide evidence that supports the application of smoothing for small data sets.

Infant sitting postural control appears robust across changes in surface context.

AIM OF THE STUDY: Independent sitting requires the control of the involved body segments over the base of support using information obtained from the three sensory systems (visual, vestibular, and somatosensory). The contribution of somatosensory information in infant sitting has not been explored. To address this gap, we altered the context of the sitting support surface and examined the infants' immediate postural responses. MATERIALS AND METHODS: Ten 7-month-old typically developing infants sat on compliant and firm surfaces in one session. Spatial, frequency, and temporal measures of postural control were obtained using center of pressure data. Results Our results suggest that infants' postural sway is not immediately affected by the different types of foam surface while sitting. CONCLUSIONS: It seems that mature sitter infants are able to adapt to different environmental constraints by disregarding the distorted somatosensory information from the support surface and relying more on their remaining senses (visual and vestibular) to control their sitting posture.

Feasibility and Effectiveness of a Novel Exoskeleton for an Infant With Arm Movement Impairments.

PURPOSE: To determine whether a novel exoskeletal device (Pediatric-Wilmington Robotic Exoskeleton [P-WREX]) is feasible and effective for intervention to improve reaching and object interaction for an infant with arm movement impairments. METHODS: An 8-month old infant with arthrogryposis was followed up every 2 weeks during a 1-month baseline, 3-month intervention, and 1-month postintervention. At each visit, reaching and looking behaviors were assessed. RESULTS: Within sessions, the infant spent more time contacting objects across a larger space, contacting objects with both hands, and looking at objects when wearing the P-WREX. Throughout intervention, the infant increased time contacting objects both with and without the device and increased bilateral active shoulder flexion. CONCLUSIONS: (1) It may be feasible for families to use exoskeletons for daily intervention, (2) exoskeletons facilitate immediate improvements in function for infants with impaired upper extremity mobility, and (3) interventions using exoskeletons can improve independent upper extremity function across time.

Effect of Short-Term Training on Reaching Behavior in Infants: A Randomized Controlled Clinical Trial.

The purpose of this study was to test the effect of short-term training on reaching behavior in infants at the onset of reaching. The study was a single-blind, parallel group design, randomized controlled clinical trial. Thirty healthy infants were randomly assigned to a social control group (n = 15) or a reaching training group (n = 15). Infants began the study up to 3 days after the onset of reaching and were assessed three times across 2 days: pretraining (before training), posttraining 1 (after 1 session of training), and posttraining 2 (after 3 sessions of training). The reaching training group received 3 sessions of training by a physical therapist while the control group received a similar amount of time sitting in the therapist's lap. The data were analyzed using repeated-measures analyses of variance, and independent-samples tests with Bonferroni adjustments. Short-term training resulted in increased frequency of object contacts, shorter and smoother reaches, and improved hand positioning. The few short training sessions likely provided opportunities for infants to explore and learn to select movements from their existing movement repertoire. These results demonstrate that adaptive changes in infants' novel behaviors can emerge rapidly, and highlight the need for increased understanding of how to most effectively time early interventions.

Infants born preterm demonstrate impaired object exploration behaviors throughout infancy and toddlerhood.

BACKGROUND: Object exploration behaviors form the foundation for future global development, but little is known about how these behaviors are exhibited by infants born preterm. OBJECTIVE: The study objective was to longitudinally compare a comprehensive set of object exploration behaviors in infants born preterm and infants born full-term from infancy into toddlerhood. DESIGN: Twenty-two infants born full-term and 28 infants born preterm were monitored as they interacted with objects throughout their first 2 years. METHODS: Infants were provided up to 30 seconds to interact with each of 7 objects across 9 visits. Experimenters coded videos of infants' behaviors. Growth modeling and t tests were used to compare how much infants exhibited behaviors and how well they matched their behaviors to the properties of objects. RESULTS: Infants born preterm explored objects less in the first 6 months, exhibited less visual-haptic multimodal exploration, displayed reduced variability of exploratory behavior in a manner that reflected severity of risk, and were less able to match their behaviors to the properties of objects in a manner that reflected severity of risk. Infants born preterm with significant brain injury also had impaired bimanual abilities. LIMITATIONS: There was a limited sample of infants born preterm with significant brain injury. CONCLUSIONS: Infants born preterm have impaired abilities to interact with objects even in the first months of life. This impairment likely limits the knowledge they acquire about objects and about how they can act on them; this limited knowledge may, in turn, impair their early learning abilities. These results highlight the need for assessment and intervention tools specific for object exploration in young infants.

Not just playing around: infants' behaviors with objects reflect ability, constraints, and object properties.

This study describes infants' behaviors with objects in relation to age, body position, and object properties. Object behaviors were assessed longitudinally in 22 healthy infants supine, prone, and sitting from birth through 2 years. Results reveal: (1) infants learn to become intense and sophisticated explorers within the first 6 months of life; (2) young infants dynamically and rapidly shift among a variety of behavioral combinations to gather information; (3) behaviors on objects develop along different trajectories so that behavioral profiles vary across time; (4) object behaviors are generally similar in supine and sitting but diminished in prone; and (5) infants begin matching certain behaviors to object properties as newborns. These data demonstrate how infants learn to match their emerging behaviors with changing positional constraints and object affordances.