Associating neuromotor outcomes at 12 months with wearable sensor measures collected during early infancy in rural Guatemala

BACKGROUND

Sensitive measures to predict neuromotor outcomes from data collected early in infancy are lacking. Measures derived from the recordings of infant movement using wearable sensors may be a useful new technique.

METHODS

We collected full-day leg movement of 41 infants in rural Guatemala across 3 visits between birth and 6 months of age using wearable sensors. Average leg movement rate and fuzzy entropy, a measure to describe the complexity of signals, of the leg movements' peak acceleration time series and the time series itself were derived. We tested the three measures for the predictability of infants' developmental outcome, Bayley Scales of Infant and Toddler Development III motor, language, or cognitive composite score assessed at 12 months of age. We performed quantile regressions with clustered standard errors, accounting for the multiple visits for each infant.

RESULTS

Fuzzy entropy was associated with the motor composite score at the 0.5 quantiles; this association was not found for the other two measures. Also, no leg movement characteristic was associated with language or cognitive composite scores.

CONCLUSION

We propose that the entropy of leg movement associated peak accelerations calculated from the wearable sensor data collected for a full-day can be considered as one predictor for infants' motor developmental outcome assessed with Bayley Scales of Infant and Toddler Development III at 12 months of age.

NONAN GaitPrint: An IMU gait database of healthy young adults

An ongoing thrust of research focused on human gait pertains to identifying individuals based on gait patterns. However, no existing gait database supports modeling efforts to assess gait patterns unique to individuals. Hence, we introduce the Nonlinear Analysis Core (NONAN) GaitPrint database containing whole body kinematics and foot placement during self-paced overground walking on a 200-meter looping indoor track. Noraxon Ultium MotionTM inertial measurement unit (IMU) sensors sampled the motion of 35 healthy young adults (19-35 years old; 18 men and 17 women; mean ± 1 s.d. age: 24.6 ± 2.7 years; height: 1.73 ± 0.78 m; body mass: 72.44 ± 15.04 kg) over 18 4-min trials across two days. Continuous variables include acceleration, velocity, position, and the acceleration, velocity, position, orientation, and rotational velocity of each corresponding body segment, and the angle of each respective joint. The discrete variables include an exhaustive set of gait parameters derived from the spatiotemporal dynamics of foot placement. We technically validate our data using continuous relative phase, Lyapunov exponent, and Hurst exponent-nonlinear metrics quantifying different aspects of healthy human gait.

Distinct clusters of movement entropy in children's exploration of a virtual reality balance beam

Although assessing motor competence is vital to advancing current understandings of motor development and its significance in various fields, no consensus exists on how the construct should be operationalised and measured. Existing approaches to assessing motor competence in children typically involve applying qualitative and/or quantitative scoring procedures in which children's performance is evaluated according to certain levels of assessment-specific task performance dependent upon predefined sets of instructions and procedures. Building upon ecological dynamics as a framework, different levels of motor competence can be identified in children's attempts to coordinate their degrees of freedom while trying to complete the interactive task and environmental constraints. Given the dynamic, nonlinear features of that coordinating process, assessments need to consider the inherit structure of inter- and intra-individual variability in patterns of movement. Against that background, we investigated 7-10-year-old children's (n = 58) whole-body joint kinematics as they freely explored a balance beam in a virtual reality playground. Specifically, we used exploratory cluster analysis to examine the discriminatory capability of utilising joint-specific sample entropy as a window into individual differences in movement coordination that emerged from children's exploration of the constraints embedded in the virtual task. Among the results, three clusters of children with distinct profiles of movement variability emerged, all of which showed heterogeneous levels of repeatability in joint movements in combination with the level of spatiotemporal exploration on the balance beam that could not be explained by between-cluster differences in age and gender distributions. Those findings suggest that entropy from whole-body movements can be used to cluster children into distinct groups with different profiles regarding the structure of movement variability, which can inform new understandings and the development of gross motor competence assessments for children.

The effects of cognitive intervention on inter-joint coordination during walking in the older adults with balance impairment

BACKGROUND

Cognitive interventions are among the effective training-on-gait parameters; however, the effects of such trainings on inter-joints coordination has not been much considered.

RESEARCH QUESTION

Can dual task and executive function training affect inter-joint coordination during walking in elderly with poor balance?

METHODS

Thirty elderly men were purposefully divided into three groups: 1) dual-task training group (DTG), 2) executive function training group (EFG) and 3) control group. After the pre-test, the experimental groups participated in 24 training sessions while the control group were required to do their normal daily tasks. VICON three-dimensional motion analysis system with four T20 series cameras was used to evaluate inter-joints coordination during the experiment. Participants had to walk a 12-meter path while kinematics of their joints was recorded. The inter-joint coordination at the sagittal plane and in four phases were assessed using the vector coding technique.

RESULTS

The findings of this study showed that the greatest effect of the intervention on the coordination between the joints was in the loading and mid-stance phases (p < 0.05). Also, the variability in the coupling angle showed a significant decrease in most phases (p < 0.05).

SIGNIFICANCE

Based on the obtained results, it can be argued that the loading and mid-stance are more involved in postural control and balance because the center of gravity is transferred between the legs and the person is normally on single-leg stance in these phases.

Leveraging a virtual alley with continuously varying width modulates step width variability during self-paced treadmill walking

Increased fall risk in older adults and clinical populations is linked with increased amount and altered temporal structure of step width variability. One approach to rehabilitation seeks to reduce fall risk in older adults by reducing the amount of step width variability and restoring the temporal structure characteristic of healthy young adults. The success of such a program depends on our ability to modulate step width variability effectively. To this end, we investigated how manipulation of the visual walking space in a virtual environment could modulate the amount and temporal structure of step width variability. Nine healthy adults performed self-paced treadmill walking in a virtual alley in a fixed-width Control condition (1.91 m) and two conditions in which the alley's width oscillated sinusoidally at 0.03 Hz: between 0.38 and 1.14 m and 0.38-2.67 m in Narrow and Wide conditions, respectively. The step width time series from each condition was evaluated using: (i) the standard deviation to identify changes in the amount of variability and (ii) the fractal scaling exponent estimated using detrended fluctuation analysis (DFA) to identify changes in the temporal structure of variability in terms of persistence in fluctuations. The Wide condition neither affected the standard deviation nor the fractal scaling exponent of step width time series. The Narrow condition did not affect the standard deviation of step width time series compared to the Control condition but significantly increased its fractal scaling exponent compared to the Control and Wide conditions, suggestive of more persistent fluctuations characteristic of a healthy gait. These results show that virtual reality based rehabilitative intervention can modulate step width variability to potentially reduce fall risk in older adults and clinical populations.

A Novel Hierarchical Framework for Measuring the Complexity and Irregularity of Multimodal Speech Signals and Its Application in the Assessment of Speech Impairment in Amyotrophic Lateral Sclerosis

Purpose The purposes of this study are to develop a novel multimodal framework for measuring variability at the muscular, kinematic, and acoustic levels of the motor speech hierarchy and evaluate the utility of this framework in detecting speech impairment in amyotrophic lateral sclerosis (ALS). Method The myoelectric activities of three bilateral jaw muscle pairs (masseter, anterior temporalis, and anterior belly of digastric), jaw kinematics, and speech acoustics were recorded in 13 individuals with ALS and 10 neurologically healthy controls during sentence reading. Thirteen novel measures (six muscular, three kinematic, four acoustic), which characterized two different but interrelated aspects of variability-complexity and irregularity-were derived using linear and nonlinear methods. Exploratory factor analysis was applied to identify the latent factors underlying these measures. Based on the latent factors, three supervised classifiers-support vector machine (SVM), random forest (RF), and logistic regression (Logit)-were used to differentiate between the speech samples for patients and controls. Results Four interpretable latent factors were identified, representing the complexity of jaw kinematics, the irregularity of jaw antagonists functioning, the irregularity of jaw agonists functioning, and the irregularity of subband acoustic signals, respectively. Based on these latent factors, the speech samples for patients and controls were classified with high accuracy (> 96% for SVM and RF; 88.64% for Logit), outperforming the unimodal measures. Two factors showed significant between-groups differences, as characterized by decreased complexity of jaw kinematics and increased irregularity of jaw antagonists functioning in patients versus controls. Conclusions Decreased complexity of jaw kinematics presumably reflects impaired fine control of jaw movement, while increased irregularity of jaw antagonists functioning could be attributed to reduced synchronization of motor unit firing in ALS. The findings provide preliminary evidence for the utility of the multimodal framework as a novel quantitative assessment tool for detecting speech impairment in ALS and (potentially) in other neuromotor disorders.

The Application of Statistical Parametric Mapping to Evaluate Differences in Topspin Backhand between Chinese and Polish Female Table Tennis Players

The research is aimed at comparing the kinematics (the movement pattern in the most important joints and accelerations of the playing hand) between female table tennis players coached in Poland (POL) and China (CHIN) during the performance of a topspin backhand stroke (so-called quick topspin). The study involved six female table tennis players at a high sports skill level, playing in Poland's highest league. Three were national team members of Poland (age: 20.3 ± 1.9), while the other three were players from China (age: 20.0 ± 0.0). Kinematics was measured using MR3 myoMuscle Master Edition system—inertial measurement unit (IMU) system. The participants performed one task of topspin backhand as a response to a topspin ball, repeated 15 times. Statistical parametric mapping (SPM) was calculated using SPM1D in a Python package that offered a high-level interface to SPM1D. The SPM method allowed for the determination of differences between the Chinese and Polish female athletes. The differences found are probably mainly due to differences in the training methodologies caused by different coaching systems. The observed differences include, among others, greater use of the so-called small steps in order to adapt and be ready during the back to ready position and backswing phases, which gives the CHIN players slightly better conditions for preparation for the next plays. The CHIN players' position compared to that of the POL players favours a quicker transition from the backhand to the forehand play. This difference is probably related to the difference in the dominant playing styles of the groups studied. Despite the differences in movement patterns in both groups, the exact value of playing hand was achieved. This may be a manifestation of the phenomenon of equifinality and compensation. All the differences found are probably mainly due to differences in the training methodologies caused by different coaching systems.

Discrimination capability of linear and nonlinear gait features in group classification

The variability of human movement can be defined as normal variations occurring in motor activity and quantified using linear statistics or nonlinear methods. In the human movement field, linear and nonlinear measures of variability have been used to discriminate groups and conditions in different contexts. Indeed, some authors support the idea that these gait features provide complementary information about movement. However, it is unclear which type of gait variability measure best discriminates different groups or conditions, as a comparison of the discrimination capacity between linear and nonlinear gait variability features in different groups has not been assessed. Therefore, the main objective of this study was to test the discrimination capacity of linear and nonlinear gait features to determine which type of feature would be the most efficient for discriminating older and younger adults and between lower limb amputees and nonamputees using classification algorithms. Data from previously published studies were used. The classification task was performed using the k-nearest neighbors and random forest algorithms. Our results showed that using a combination of linear and nonlinear features resulted in the highest mean accuracy rates (>90%) in group classification, reinforcing the idea that these features are complementary and express different aspects of movement.

Postural control development from late childhood through young adulthood

BACKGROUND

The development of stable postural control is characterized by changes in sway variability and periods of rapid reorganization of motor system components.

RESEARCH QUESTION

The current study examined whether changing biomechanical and perceptual demands influences the postural control behavior during development.

METHOD

The center of pressure (COP) was assessed via a cross-sectional design. Data were collected from 48 females in three age groups (late childhood, mid-adolescence, and young adulthood) during four quiet stance conditions: (1) eyes open with feet apart, (2) eyes open with feet together, (3) eyes closed with feet apart, and (4) eyes closed with feet together. Linear measures included total path length of the COP and the mean/standard deviation of the overall COP position and speed. To characterize the sway patterns via nonlinear analyses, the speed and two-dimensional positional time series were submitted to sample entropy and Renyi entropy, respectively.

RESULTS

The linear results indicated that the late childhood group displayed longer COP trajectories (p < .001) and faster and more variable COP speed (p's < .001). These results held for both the feet apart and feet together conditions, independent of vision. The nonlinear results indicated that the late childhood group exhibited less regularity, overall, in their COP sway position (i.e., Renyi entropy) compared to the two older groups in the feet apart condition (p's ≤ .041), and to the young adults in the feet together condition, independent of vision (p <  .001). However, the mid-adolescent group demonstrated greater regularity in their COP speed (i.e., sample entropy) when their eyes were closed compared to the other two groups, independent of stance (p's < .05).

SIGNIFICANCE

The linear results support previous findings, while the nonlinear measures indicate sway characteristics that may provide a window into the development of underlying control processes that regulate quiet standing.

Variability and coordination patterns of walking with different speeds in active and non-active children with Down syndrome: A cross-sectional case-control study

Purpose: Children with Down syndrome (DS) have multiple difficulties in gait pattern. So, the effect of the activity level and speed on the gait coordination and variability was investigated. Methods: In this case-control observational study, 24 participants in three groups of active and non-active children with DS, and the control group without intellectual disability were asked to walk on a treadmill with two speeds of 0.8 and 1.2 m/s. Continuous Relative Phase (CRP) and variability of CRP in thigh-leg and leg-foot coupling were assessed. Results: CRP and variability of CRP in the leg-foot coupling in the control group were significantly higher than active and non-active groups with DS. Speed led to increase the CRP of leg-foot in the active group with DS and increase the variability of this coupling in non-active group with DS. Conclusion: In this study, the activity level provided the compatibility with speed changes of walking in CRP of leg-foot in children with DS.

Standing balance in preschoolers using nonlinear dynamics and sway density curve analysis

The aim of the present study was to investigate how age and sensory deprivation affect the temporal organization of CoP sway variability and the postural corrective commands during standing balance in typically developing preschoolers. A sample of 57 children aged 3-5 years participated in the study. Structural stabilometric descriptors of sample entropy (SEn), detrended fluctuation analysis (DFA), and sway density curve (SDC) analysis were employed to assess features of center of pressure sway. A force platform was used to collect center of pressure data during standing balance over 40 s in four conditions: standing on rigid and foam surfaces with eyes open and closed. The main results are as follows: (1) sample entropy decreased and DFA_coefficient increased with age, while the SDC variables remained unaltered among the 3-, 4-, and 5-year-old children; (2) as sensory conditions became more challenging, sample entropy decreased and DFA_coefficient increased, while MT and MD decreased and MD increased; age did not influence the responses to sensorial deprivation. In conclusion, 5-year-old children showed decreased variability of CoP sway during standing balance compared with the younger children, but all children used the same corrective torques to control for perturbations. More challenging sensory deprivation conditions resulted in decreased variability of postural sway, higher amplitudes and more frequent correcting torques for stabilization, but age did not influence these behaviors.

Children with moderate to severe cerebral palsy may not benefit from stochastic vibration when developing independent sitting

PURPOSE

Determine sitting postural control changes for children with cerebral palsy (CP), using a perceptual-motor intervention and the same intervention plus stochastic vibration through the sitting surface.

METHODS

Two groups of children with moderate or severe CP participated in the 12 week interventions. The primary outcome measure was center of pressure data from which linear and nonlinear variables were extracted and the gross motor function measure (GMFM).

RESULTS

There were no significant main effects of intervention or time or an interaction. Both treatment groups increased the Lyapunov exponent values in the medial-lateral direction three months after the start of treatment as well as their GMFM scores in comparison with baseline.

CONCLUSIONS

The stochastic vibration did not seem to advance the development of sitting postural control in children between the ages of 2 and 6 years. However, perceptual-motor intervention was found beneficial in advancing sitting behavior.

Speed synchronization, physical workload and match-to-match performance variation of elite football players

This study aimed to: (i) examine whether the speed synchronization and physical performance of an elite football team changed between the first and the second half, using match time blocks of 15-min, and (ii) explore the match-to-match variation of players' speed synchronization performance. Twenty-eight outfield elite footballers participated in 51 official matches. Positional data were gathered and used to calculate the total distance covered as a physical workload indicator. For all the outfield teammate dyad combinations (45 pairs), it was processed the percentage of time that players' speed was synchronized during walking, jogging and running using relative phase (Hilbert Transform). Also, the match-to-match variation of the players' speed synchronization, expressed in coefficient of variation was computed. The differences in the total distance covered from all players within the different match's time block periods revealed a moderate decrease in the distance covered in the last 15-min of the match compared to the first 15-min (-6.5; ±1.07%, most likely: change in means with 95% confidence limits). However, when compared the last minutes from both halves a small increase was observed (2.7; ±1.2%, likely) from first to second half. The synchronization of the players' speed displacements revealed small to moderate decreases in the % of synchronization in the second half periods for the jogging and running speed, while the opposite was found for the walking speed (~13 to 24% more, most likely). The playing position analysis for the walking zone showed similar trends between the groups, with small to moderate higher values in the second half, with the exception of [30'-45'] vs [75'-90'] in the midfielder's dyads and in [15'-30'] vs [60'-75'] match periods for forwards. Similar trend was found during the running speed, in which small to moderate higher synchronization was found during the first half periods, with the exception of [15'-30'] vs [60'-75'] and [30'-45'] vs [75'-90'] in midfielder's dyads. Regarding to the match-to-match variation of the players' speed synchronization, overall results showed small to moderate increases in coefficient of variation during jogging and running displacements from the beginning to the end of the match (32.1; ±13.2% increase in jogging and 26.2; ±10.5% in running, both comparisons most likely). The higher distance covered during most of the first half periods and the higher dyadic synchronization at high speeds might have limited players' performance in the second half. In addition, the decrease trend in speed synchronization during the second half periods might have resulted from accumulated muscular and mental fatigue towards the match. Within, the match-to-match variation in tactical-related variables increased across the match duration, with especial focus in the midfielder dyads. Dyadic speed synchronization might provide relevant information concerning the individual and collective performance.

Multifractality, Interactivity, and the Adaptive Capacity of the Human Movement System: A Perspective for Advancing the Conceptual Basis of Neurologic Physical Therapy

BACKGROUND AND PURPOSE

Physical therapists seek to optimize movement as a means of reducing disability and improving health. The short-term effects of interventions designed to optimize movement ultimately are intended to be adapted for use across various future patterns of behavior, in potentially unpredictable ways, with varying frequency, and in the context of multiple tasks and environmental conditions. In this perspective article, we review and discuss the implications of recent evidence that optimal movement variability, which previously had been associated with adaptable motor behavior, contains a specific complex nonlinear feature known as "multifractality."

SUMMARY OF KEY POINTS

Multifractal movement fluctuation patterns reflect robust physiologic interactivity occurring within the movement system across multiple time scales. Such patterns provide conceptual support for the idea that patterns of motor behavior occurring in the moment are inextricably linked in complex, physiologic ways to patterns of motor behavior occurring over much longer periods. The human movement system appears to be particularly tuned to multifractal fluctuation patterns and exhibits the ability to reorganize its output in response to external stimulation embedded with multifractal features.

RECOMMENDATIONS FOR CLINICAL PRACTICE

As a fundamental feature of human movement, multifractality opens new avenues for conceptualizing the link between physiologic interactivity and adaptive capacity. Preliminary evidence supporting the positive influence of multifractal rhythmic auditory stimulation on the gait patterns of individuals with Parkinson disease is used to illustrate how physical therapy interventions might be devised to specifically target the adaptive capacity of the human movement system.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A183).

Gaze behaviours in infancy: Rethinking their development as a dynamic system

PURPOSE

Eye gaze is an important element of communication and serves as an index of deficits in atypically developing children. This study examined the development of gaze behaviours in typically-developing infants within the Dynamic Systems framework which stresses variability and nesting in the development of any behaviour.

METHOD

Nine infants (six males and three females) were videotaped during play/interactions with their primary caregiver between the ages of 3-12 months. The video samples were coded for the occurrence of six gaze behaviours. The rates of occurrence of these behaviours were calculated and non-linear methods were used to analyse the data.

RESULT

The growth trajectories of three behaviours revealed non-linear and linear patterns and environment exploration-related behaviours demonstrated an age at which reliable change in the rate of occurrence was seen within the developmental period. Further, correlations in the occurrence of few behaviours indicated that the gaze system exhibits nested growth.

CONCLUSION

These results suggest, with caution, that development in the gaze system is dynamic in nature. Thus, development should not only be viewed as skills achieved by an expected age due to biological maturation, but also as variable skills whose occurrence is dependent on factors such as environmental and parental influences.

Technical performance and match-to-match variation in elite football teams

Recent research suggests that match-to-match variation adds important information to performance descriptors in team sports, as it helps measure how players fine-tune their tactical behaviours and technical actions to the extreme dynamical environments. The current study aims to identify the differences in technical performance of players from strong and weak teams and to explore match-to-match variation of players' technical match performance. Performance data of all the 380 matches of season 2012-2013 in the Spanish First Division Professional Football League were analysed. Twenty-one performance-related match actions and events were chosen as variables in the analyses. Players' technical performance profiles were established by unifying count values of each action or event of each player per match into the same scale. Means of these count values of players from Top3 and Bottom3 teams were compared and plotted into radar charts. Coefficient of variation of each match action or event within a player was calculated to represent his match-to-match variation of technical performance. Differences in the variation of technical performances of players across different match contexts (team and opposition strength, match outcome and match location) were compared. All the comparisons were achieved by the magnitude-based inferences. Results showed that technical performances differed between players of strong and weak teams from different perspectives across different field positions. Furthermore, the variation of the players' technical performance is affected by the match context, with effects from team and opposition strength greater than effects from match location and match outcome.

Amputation effects on the underlying complexity within transtibial amputee ankle motion

The presence of chaos in walking is considered to provide a stable, yet adaptable means for locomotion. This study examined whether lower limb amputation and subsequent prosthetic rehabilitation resulted in a loss of complexity in amputee gait. Twenty-eight individuals with transtibial amputation participated in a 6 week, randomized cross-over design study in which they underwent a 3 week adaptation period to two separate prostheses. One prosthesis was deemed "more appropriate" and the other "less appropriate" based on matching/mismatching activity levels of the person and the prosthesis. Subjects performed a treadmill walking trial at self-selected walking speed at multiple points of the adaptation period, while kinematics of the ankle were recorded. Bilateral sagittal plane ankle motion was analyzed for underlying complexity through the pseudoperiodic surrogation analysis technique. Results revealed the presence of underlying deterministic structure in both prostheses and both the prosthetic and sound leg ankle (discriminant measure largest Lyapunov exponent). Results also revealed that the prosthetic ankle may be more likely to suffer loss of complexity than the sound ankle, and a "more appropriate" prosthesis may be better suited to help restore a healthy complexity of movement within the prosthetic ankle motion compared to a "less appropriate" prosthesis (discriminant measure sample entropy). Results from sample entropy results are less likely to be affected by the intracycle periodic dynamics as compared to the largest Lyapunov exponent. Adaptation does not seem to influence complexity in the system for experienced prosthesis users.