Quantitative measures of spontaneous and intervention-induced perceptual-motor development in children with neurodevelopmental disorders

Neurodevelopmental disorders encompass a group of clinical heterogeneous conditions with onset in the developmental period and Cerebral Palsy is one of the most common ones. Early diagnosis is crucial for make an early intervention possible and incisive. This, together with progresses in medicine and evidence-based paradigm highlighted the importance of the standardization of measures, both for assessment and rehabilitative purposes. In clinical practice, both for research and clinical aims, there is an increasing interest in finding standardized outcome measures. In parallel, improvements in engineering provide more devices able to extract quantitative data from measurement. Starting from the needs, new technological outcome measures have been designed and validated. This thesis shows the application of technology in two main fields, that are quantitative assessment and rehabilitative proposal for infants and children. The first part is focused on infant eye and head movements, presenting the design, the development and preliminary testing of a new system for measuring infant’s gaze in the wide visual field, which demonstrates its possible applicability to young infants, providing quantitative data which can enrich the clinical assessment. The second part is focused on infants with neurodevelopmental disorder and presented CareToy H, that is a biomechatronic gym aimed to measure and promote infants’ development. This modular system has been used for home rehabilitation of infants at risk for developing a cerebral palsy and its components (in particular ,toys) was designed and empirically evaluated as a non-invasive tool capable of monitoring infants’ manipulation capabilities in a quantitative way directly at home by means of a simple and easy to use setup. A RCT study on the effects of a home-based early intervention with the CareToy system has been conducted and a total of 41 preterm infants participated to this study, confirming that CareToy system can provide effective home-based early intervention. Then, a pilot study with a small population of infants with Down Syndrome open the possibility to include also this population in future projects with this system. The third part of this thesis is focused on quantitative assessment of upper limb use in children with typical development and with neurodevelopmental disorders by inertial sensors. In details, a systematic review introduces the use of sensors for the assessment of upper limb. Moreover, the validation of Actigraphs (wereable inertial sensors) have been conducted in 50 children with unilateral cerebral palsy and 50 healthy peers or detecting asymmetries in the use of upper limbs. Finally, an innovative approach is presented, that is Action Observation Therapy, based on Mirror Neurons System, which is combined with technology in an RCT currently ongoing from which a pilot study is presented. In these studies, the Tele-UPCAT system (a platform for the observation of videos and a kit of object for replicate actions) is used and preliminary data are very promising and confirm findings of previous literature. This thesis aims to highlight the increasing need of quantitative tools for assessment and rehabilitative purposes, demonstrating that the union between medicine and engineering could overcome the lack of standardized measure. We are just entered in the period of change in this sense, and there's a long road ahead, but this work aims to represent a milestone for the quantitative measures of spontaneous and intervention-induced perceptual-motor development in children with neurodevelopmental disorders.