Medical & Biological Engineering & Computing

, Volume 57, Issue 2, pp 427–439 | Cite as

Infant posture and movement analysis using a sensor-supported gym with toys

  • Andraž RiharEmail author
  • Matjaž Mihelj
  • Jure Pašič
  • Giuseppina Sgandurra
  • Francesca Cecchi
  • Giovanni Cioni
  • Paolo Dario
  • Marko Munih
Original Article


Infant posture and motor pattern development are normally analyzed by clinical assessment scales. Lately, this approach is combined with the use of sensor-supported systems, such as optical, inertial, and electromagnetic measurement systems, as well as novel assessment devices, such as CareToy. CareToy is a modular device for assessment and rehabilitation of preterm infants, comprising pressure mattresses, inertial and magnetic measurement units, and sensorized toys. Since such integrated sensor system combination is new to the field of sensor-supported infant behavior assessment and rehabilitation, dedicated methods for data analysis were developed and presented. These comprise trunk rotation, arm movement, forearm orientation, and head movement analysis, along with toy play and trunk posture stability evaluation. Methods were tested on case study data, evaluating suitability of developed algorithms for infant posture and activity analysis, regardless of behavioral responses. Obtained results demonstrate suitability of the proposed methods for successful use in studies of different motor pattern subfields. This represents an important step on the course towards objective, accurate, sensor-supported infant motor development assessment.

Graphical abstract

Posture and movement assessment of infants using analysis of sensory data, obtained with a dedicated sensorized gym with toys


Data processing algorithms Infant activity assessment Pressure mattress Inertial and magnetic measurement units Sensorized toys 



Alberta Infant Motor Scale








coronal plane








wireless magneto-inertial measurement unit








randomized clinical trial


root-mean-square displacement




test of infant motor performance


unscented Kalman filter



The authors gratefully acknowledge Elena Beani and Emanuela Inguaggiato for monitoring infants’ training, as well as Matteo Giampietri and Laura Bartalena for enrolling infants at Santa Chiara Hospital of Pisa (Neonatal Intensive Care Unit).

Funding information

This work was funded by the European Union Collaborative Project CareToy grant ICT-2011.5.1-287932 and additionally supported by the Slovenian Research Agency.

Compliance with ethical standards

Signed informed consent was obtained from infant parents before the start of assessment, while the measurements were performed in compliance with Helsinki Declaration. Suitability of the measurement protocol was approved by Tuscan Region Pediatric Ethics Committee and Italian Ministry of Health (DGDFSC 0066613-P-17/09/2013).

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Adolph KE, Berger SE (2005) Physical and motor development. In: Bornstein MH, Lamb ME (eds) Developmental science: an advanced textbook, 5th edn. Lawrence Erlbaum Associates, Inc., NJ, Mahwah, pp 223–281Google Scholar
  2. 2.
    Allievi AG, Arichi T, Gordon AL, Burdet E (2014) Technology-aided assessment of sensorimotor function in early infancy. Front Neurol 5(197):1–10Google Scholar
  3. 3.
    Berthier NE, Carrico RL (2010) Visual information and object size in infant reaching. Infant Behav Dev 33(4):555–566CrossRefGoogle Scholar
  4. 4.
    Bhat AN, Galloway JC (2006) Toy-oriented changes during early arm movements: hand kinematics. Infant Behav Dev 29(3):358–372CrossRefGoogle Scholar
  5. 5.
    Bhat AN, Heathcock J, Galloway JC (2005) Toy-oriented changes in hand and joint kinematics during the emergence of purposeful reaching. Infant Behav Dev 28(4):445–465CrossRefGoogle Scholar
  6. 6.
    Cecchi F, Serio SM, Del Maestro M, Laschi C, Sgandurra G, Cioni G, Dario P (2010) Design and development of biomechatronic gym for early detection of neurological disorders in infants. In: Proc IEEE EMBC, Argentina, p 3414–3417Google Scholar
  7. 7.
    Cecchi F, Sgandurra G, Mihelj M, Mici L, Zhang J, Munih M, Cioni G, Laschi C, Dario P (2016) CareToy: an intelligent baby gym for intervention at home in infants at risk for neurodevelopmental disorders. IEEE Robot Autom Mag 23(4):63–72CrossRefGoogle Scholar
  8. 8.
    Cioni G, Inguaggiato E, Sgandurra G (2016) Early intervention in neurodevelopmental disorders: underlying neural mechanisms. Dev Med Child Neurol 58(S4):61–66CrossRefGoogle Scholar
  9. 9.
    Deffeyes JE, Harbourne RT, Kyvelidou A, Stuberg WA, Stergiou N (2009) Nonlinear analysis of sitting postural sway indicates developmental delay in infants. Clin Biomech 24(7):564–570CrossRefGoogle Scholar
  10. 10.
    Dusing SC, Kyvelidou A, Mercer VS, Stergiou N (2009) Infants born preterm exhibit different patterns of center-of-pressure movement than infants born at full term. Phys Ther 89(12):1354–1362CrossRefGoogle Scholar
  11. 11.
    Dusing SC, Mercer VS, Yu B, Reilly M, Thorpe D (2005) Trunk position in supine of infants born preterm and at term: an assessment using a computerized pressure mat. Pediatr Phys Ther 17(1):2–10CrossRefGoogle Scholar
  12. 12.
    First LR, Palfrey JS (1994) The infant or young child with develop-mental delay. New Engl J Med 330(7):478–483CrossRefGoogle Scholar
  13. 13.
    Heineman KR, Hadders-Algra M (2008) Evaluation of neuromotor function in infancy–a systematic review of available methods. J Dev Behav Pediatr 29(4):315–323CrossRefGoogle Scholar
  14. 14.
    Jaspers E, Desloovere K, Bruyninckx H, Molenaers G, Klingels K, Feys H (2009) Review of quantitative measurements of upper limb movements in hemiplegic cerebral palsy. Gait Posture 30(4):395–404CrossRefGoogle Scholar
  15. 15.
    Kyvelidou A, Harbourne RT, Shostrom VK, Stergiou N (2010) Reliability of centre of pressure measures for assessing the development of sitting postural control in infants with or at risk of cerebral palsy. Arch Phys Med Rehabil 91(10):1593–1601CrossRefGoogle Scholar
  16. 16.
    Lee HM, Galloway JC (2012) Early intensive postural and movement training advances head control in very young infants. Phys Ther 92(7):935–947CrossRefGoogle Scholar
  17. 17.
    Lima CD, Carvalho RP, Barros RML, Tudella E (2008) Two different methods for kinematic analysis of head movements relating to eye-head coordination in infants. Brazilian J Phys Ther 12(5):425–431CrossRefGoogle Scholar
  18. 18.
    Mallat S (1989) A theory for multiresolution signal decomposition: the wavelet representation. IEEE Trans Pattern Anal 11(7):674–693CrossRefGoogle Scholar
  19. 19.
    Piek JP, Dawson L, Smith LM, Gasson N (2008) The role of early fine and gross motor development on later motor and cognitive ability. Hum Mov Sci 27(5):668–681CrossRefGoogle Scholar
  20. 20.
    Rihar A, Mihelj M, Kolar J, Pašič J, Munih M (2015) Sensory data fusion of pressure mattress and wireless inertial magnetic measurement units. Med Biol Eng Comput 53(2):123–135CrossRefGoogle Scholar
  21. 21.
    Rihar A, Mihelj M, Pašič J, Kolar J, Munih M (2014) Infant trunk posture and arm movement assessment using pressure mattress, inertial and magnetic measurement units (IMUs). J Neuroeng Rehabil 11(133):1–14Google Scholar
  22. 22.
    Rihar A, Sgandurra G, Beani E, Cecchi F, Pašič J, Cioni G, Dario P, Mihelj M, Munih M (2016) CareToy: stimulation and assessment of preterm infant’s activity using a novel sensorized system. Ann Biomed Eng 44(12):3593.3605CrossRefGoogle Scholar
  23. 23.
    Rocha NACF, Tudella E (2008) The influence of lying positions and postural control on hand–mouth and hand–hand behaviors in 0–4-month-old infants. Infant Behav Dev 31(1):107–114CrossRefGoogle Scholar
  24. 24.
    Sacrey LAR, Karl JM, Whishaw IQ (2012) Development of rotational movements, hand shaping, and accuracy in advance and withdrawal for the reach-to-eat movement in human infants aged 6–12 months. Infant Behav Dev 35(3):543–560CrossRefGoogle Scholar
  25. 25.
    Sgandurra G, Bartalena L, Cecchi F, Cioni G, Giampietri M, Greisen G, Nielsen JB, Orlando M, Dario P (2016) A pilot study on early home-based intervention through an intelligent baby gym (CareToy) in preterm infants. Res Dev Disabil 53-54:32–42CrossRefGoogle Scholar
  26. 26.
    Sgandurra G, Bartalena L, Cioni G, Greisen G, Herskind A, Inguaggiato E, Lorentzen J, Nielsen JB, Sicola E (2014) Home-based, early intervention with mechatronic toys for preterm infants at risk of neurodevelopmental disorders (CARETOY): a RCT protocol. BMC Pediatr 14(268):1–9Google Scholar
  27. 27.
    Sgandurra G, Cecchi F, Serio SM, Del Maestro M, Laschi C, Dario P, Cioni G (2012) Longitudinal study of unimanual actions and grasping forces during infancy. Infant Behav Dev 35(2):205–214CrossRefGoogle Scholar
  28. 28.
    Spittle AJ, Doyle LW, Boyd RN (2008) A systematic review of the clinimetric properties of neuromotor assessments for preterm infants during the first year of life. Dev Med Child Neurol 50(4):254–266CrossRefGoogle Scholar
  29. 29.
    Teitelbaum P, Teitelbaum O, Nye J, Fryman J, Maurer RG (1998) Movement analysis in infancy may be useful for early diagnosis of autism. Proc Natl Acad Sci U S A 95(23):13982–13987CrossRefGoogle Scholar
  30. 30.
    Thelen E, Spencer JP (1998) Postural control during reaching in young infants: a dynamic systems approach. Neurosci Biobehav Rev 22(4):507–514CrossRefGoogle Scholar
  31. 31.
    Van der Merwe R (2004) Sigma-point Kalman filters for probabilistic inference in dynamic state-space models. PhD dissertation, Oregon Health Sci. Univ., Portland, ORGoogle Scholar
  32. 32.
    Van Hof P, Van der Kamp J, Savelsbergh GJP (2002) The relation of unimanual and bimanual reaching to crossing the midline. Child Dev 73(5):1353–1362CrossRefGoogle Scholar
  33. 33.
    Westeyn TL, Abowd GD, Starner TE, Johnson JM, Presti PW, Weaver KA (2012) Monitoring children’s developmental progress using augmented toys and activity recognition. Pers Ubiquit Comput 16(2):169–191CrossRefGoogle Scholar

Copyright information

© International Federation for Medical and Biological Engineering 2018

Authors and Affiliations

  1. 1.Laboratory of Robotics, Faculty of Electrical EngineeringUniversity of LjubljanaLjubljanaSlovenia
  2. 2.IRCCS Fondazione Stella MarisCalambroneItaly
  3. 3.Scuola Superiore Sant’ AnnaThe BioRobotics InstitutePontederaItaly
  4. 4.Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly

Personalised recommendations