Investigation on Inter-Limb Coordination and Motion Stability, Intensity and Complexity of Trunk and Limbs during Hands-Knees Crawling in Human Adults

Abnormal interlimb coordination of motor developmental delay during infant crawling based on kinematic synergy analysis

BACKGROUND

Previous studies have reported that abnormal interlimb coordination is a typical characteristic of motor developmental delay (MDD) during human movement, which can be visually manifested as abnormal motor postures. Clinically, the scale assessments are usually used to evaluate interlimb coordination, but they rely heavily on the subjective judgements of therapists and lack quantitative analysis. In addition, although abnormal interlimb coordination of MDD have been studied, it is still unclear how this abnormality is manifested in physiology-related kinematic features.

OBJECTIVES

This study aimed to evaluate how abnormal interlimb coordination of MDD during infant crawling was manifested in the stability of joints and limbs, activation levels of synergies and intrasubject consistency from the kinematic synergies of tangential velocities of joints perspective.

METHODS

Tangential velocities of bilateral shoulder, elbow, wrist, hip, knee and ankle over time were computed from recorded three-dimensional joint trajectories in 40 infants with MDD [16 infants at risk of developmental delay, 11 infants at high risk of developmental delay, 13 infants with confirmed developmental delay (CDD group)] and 20 typically developing infants during hands-and-knees crawling. Kinematic synergies and corresponding activation coefficients were derived from those joint velocities using the non-negative matrix factorization algorithm. The variability accounted for yielded by those synergies and activation coefficients, and the synergy weightings in those synergies were used to measure the stability of joints and limbs. To quantify the activation levels of those synergies, the full width at half maximum and center of activity of activation coefficients were calculated. In addition, the intrasubject consistency was measured by the cosine similarity of those synergies and activation coefficients.

RESULTS

Interlimb coordination patterns during infant crawling were the combinations of four types of single-limb movements, which represent the dominance of each of the four limbs. MDD mainly reduced the stability of joints and limbs, and induced the abnormal activation levels of those synergies. Meanwhile, MDD generally reduced the intrasubject consistency, especially in CDD group.

CONCLUSIONS

These features have the potential for quantitatively evaluating abnormal interlimb coordination in assisting the clinical diagnosis and motor rehabilitation of MDD.

Muscle synergy analysis of eight inter-limb coordination modes during human hands-knees crawling movement

In order to reveal in-depth the neuromuscular control mechanism of human crawling, this study carries out muscle synergy extraction and analysis on human hands-knees crawling under eight specific inter-limb coordination modes, which are defined according to the swing sequence of limbs and includes two-limb swing crawling modes and six single-limb swing crawling modes. Ten healthy adults participate in crawling data collection, and surface electromyography (sEMG) signals are recorded from 30 muscles of limbs and trunk. Non-negative matrix factorization (NNMF) algorithm is adopted for muscle synergy extraction, and a three-step muscle synergy analysis scheme is implemented by using the hierarchical clustering method. Based on results of muscle synergy extraction, 4 to 7 synergies are extracted from each participant in each inter-limb coordination mode, which supports the muscle synergy hypothesis to some extent, namely, central nervous system (CNS) controls the inter-limb coordination modes during crawling movement by recruiting a certain amount of muscle synergies, rather than a single muscle. In addition, when different participants crawl in the same inter-limb coordination mode, they share more temporal features in recruiting muscle synergies. Further, by extracting and analyzing intra-mode shared synergies among participants and inter-mode shared synergies among the eight inter-limb coordination modes, the CNS is found to realize single-limb swing crawling modes by recruiting the four inter-mode shared synergy structures related to the swing function of each limb in different orders, and realize the two-limb swing crawling modes by recruiting synchronously two intra-mode shared synergy structures. The research results of the muscle synergy analysis on the eight specific inter-limb coordination modes, on the one hand, provide a basis for muscle synergy hypothesis from the perspective of crawling motion, on the other hand, also provide a possible explanation for the choice of the inter-limb coordination mode in human crawling.

Impacts of Motor Developmental Delay on the Inter-Joint Coordination Using Kinematic Synergies of Joint Angles During Infant Crawling

Motor developmental delay (MDD) usually affects the inter-joint coordination for limb movement. However, the mechanism between the abnormal inter-joint coordination and MDD is still unclear, which poses a challenge for clinical diagnosis and motor rehabilitation of MDD in infant's early life. This study aimed to explore whether the joint activities of limbs during infant crawling are represented with kinematic synergies of joint angles, and evaluate the impacts of MDD on the inter-joint coordination using those synergies. 20 typically developing infants, 16 infants at risk of developmental delay, 11 infants at high risk of developmental delay and 13 infants with confirmed developmental delay were recruited for self-paced crawling on hands and knees. A motion capture system was employed to trace infants' limbs in space, and angles of shoulder, elbow, hip and knee over time were computed. Kinematic synergies were derived from joint angles using principal component analysis. Sample entropy and Spearman's rank correlation coefficients were calculated among those synergies to evaluate the crawling complexity and the symmetry of bilateral limbs, respectively. We found that the first two synergies with different contributions to the crawling movements sufficiently represented the joint angular profiles of limbs. MDD further delayed the development of motor function for lower limbs and mainly increased the crawling complexity of joint flexion/extension to some extent, but did not obviously change the symmetry of bilateral limbs. These results suggest that the time-varying kinematic synergy of joint angles is a potential index for objectively evaluating the abnormal inter-joint coordination affected by MDD.

Modularity underlying the performance of unusual locomotor tasks inspired by developmental milestones

Motor behaviors are often hypothesized to be set up from the combination of a small number of modules encoded in the central nervous system. These modules are thought to combine such that a variety of motor tasks can be realized, from reproducible tasks such as walking to more unusual locomotor tasks that typically exhibit more step-by-step variability. We investigated the impact of step-by-step variability on the modular architecture of unusual tasks compared with walking. To this aim, 20 adults had to perform walking and two unusual modes of locomotion inspired by developmental milestones (cruising and crawling). Sixteen surface electromyography (EMG) signals were recorded to extract both spatial and temporal modules. Modules were extracted from both averaged and nonaveraged (i.e., single step) EMG signals to assess the significance of step-to-step variability when participants practiced such unusual locomotor tasks. The number of modules extracted from averaged data was similar across tasks, but a higher number of modules was required to reconstruct nonaveraged EMG data of the unusual tasks. Although certain walking modules were shared with cruising and crawling, task-specific modules were necessary to account for the muscle patterns underlying these unusual locomotion modes. These results highlight a more complex modularity (e.g., more modules) for cruising and crawling compared with walking, which was only apparent when the step-to-step variability of EMG patterns was considered. This suggests that considering nonaveraged data is relevant when muscle modularity is studied, especially in motor tasks with high variability as in motor development.NEW & NOTEWORTHY This study addresses the general question of modularity in locomotor control. We demonstrate for the first time the importance of intraindividual variability in the muscle modularity of unusual locomotor behaviors that exhibit greater step-by-step variability than standard walking. Crawling and cruising, the unusual locomotor modes considered, are based on a more complex modular organization than walking. More spatial and temporal modules, task specific or shared with walking modules, are needed to reconstruct muscle patterns.

Sample Entropy Identifies Differences in Spontaneous Leg Movement Behavior between Infants with Typical Development and Infants at Risk of Developmental Delay

We are interested in using wearable sensor data to analyze detailed characteristics of movement, such as repeatability and variability of movement patterns, over days and months to accurately capture real-world infant behavior. The purpose of this study was to explore Sample Entropy (SampEn) from wearable sensor data as a measure of variability of spontaneous infant leg movement and as a potential marker of the development of neuromotor control. We hypothesized that infants at risk (AR) of developmental delay would present significantly lower SampEn values than infants with typical development (TD). Participants were 11 infants with TD and 20 infants AR. We calculated SampEn from 1–4 periods of data of 7200 samples in length when the infants were actively playing across the day. The infants AR demonstrated smaller SampEn values (median 0.21) than the infants with TD (median 1.20). Lower values of SampEn indicate more similarity in patterns across time, and may indicate more repetitive, less exploratory behavior in infants AR compared to infants with TD. In future studies, we would like to expand to analyze longer periods of wearable sensor data and/or determine how to optimally sample representative periods across days and months.