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  1. Article ; Online: Musical instrument classifier for early childhood percussion instruments.

    Rufino, Brandon / Khan, Ajmal / Dutta, Tilak / Biddiss, Elaine

    PloS one

    2024  Volume 19, Issue 4, Page(s) e0299888

    Abstract: While the musical instrument classification task is well-studied, there remains a gap in identifying non-pitched percussion instruments which have greater overlaps in frequency bands and variation in sound quality and play style than pitched instruments. ...

    Abstract While the musical instrument classification task is well-studied, there remains a gap in identifying non-pitched percussion instruments which have greater overlaps in frequency bands and variation in sound quality and play style than pitched instruments. In this paper, we present a musical instrument classifier for detecting tambourines, maracas and castanets, instruments that are often used in early childhood music education. We generated a dataset with diverse instruments (e.g., brand, materials, construction) played in different locations with varying background noise and play styles. We conducted sensitivity analyses to optimize feature selection, windowing time, and model selection. We deployed and evaluated our best model in a mixed reality music application with 12 families in a home setting. Our dataset was comprised of over 369,000 samples recorded in-lab and 35,361 samples recorded with families in a home setting. We observed the Light Gradient Boosting Machine (LGBM) model to perform best using an approximate 93 ms window with only 12 mel-frequency cepstral coefficients (MFCCs) and signal entropy. Our best LGBM model was observed to perform with over 84% accuracy across all three instrument families in-lab and over 73% accuracy when deployed to the home. To our knowledge, the dataset compiled of 369,000 samples of non-pitched instruments is first of its kind. This work also suggests that a low feature space is sufficient for the recognition of non-pitched instruments. Lastly, real-world deployment and testing of the algorithms created with participants of diverse physical and cognitive abilities was also an important contribution towards more inclusive design practices. This paper lays the technological groundwork for a mixed reality music application that can detect children's use of non-pitched, percussion instruments to support early childhood music education and play.
    MeSH term(s) Child ; Humans ; Child, Preschool ; Percussion ; Sound ; Algorithms ; Music ; Cognition
    Language English
    Publishing date 2024-04-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0299888
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  2. Article ; Online: Evaluating the impact of movement tracking feedback on engagement with home exercise programmes of children with cerebral palsy using a new therapy app: a protocol for a mixed-methods single-case experimental design with alternating treatments.

    Petrevska, Marina / Wright, F Virginia / Khan, Ajmal / Munce, Sarah / Fehlings, Darcy / Biddiss, Elaine

    BMJ open

    2024  Volume 14, Issue 3, Page(s) e082761

    Abstract: Introduction: Children with cerebral palsy (CP) are prescribed home exercise programmes (HEPs) to increase the frequency of movement practice, yet adherence to HEPs can be low. This paper outlines the protocol for a single-case experimental design (SCED) ...

    Abstract Introduction: Children with cerebral palsy (CP) are prescribed home exercise programmes (HEPs) to increase the frequency of movement practice, yet adherence to HEPs can be low. This paper outlines the protocol for a single-case experimental design (SCED) with alternating treatments, using a new home therapy exercise application, Bootle Boot Camp (BBCamp), offered with and without movement tracking feedback. This study will explore the impact of feedback on engagement, movement quality, lower limb function and family experiences to help understand how technology-supported HEPs should be translated and the added value, if any, of movement tracking technology.
    Methods and analysis: In this explanatory sequential mixed-methods study using a SCED, 16 children with CP (aged 6-12 years, Gross Motor Function Classification System levels I-II) will set lower limb goals and be prescribed an individualised HEP by their physiotherapist to complete using BBCamp on their home television equipped with a three-dimensional camera-computer system. Children will complete four weekly exercise sessions over 6 weeks. Children will be randomised to 1 of 16 alternating treatment schedules where BBCamp will provide or withhold feedback during the first 4 weeks. The version of BBCamp that results in the most therapeutic benefit will be continued for 2 final weeks. Goals will be re-evaluated and families interviewed. The primary outcome is adherence (proportion of prescribed exercise repetitions attempted) as a measure of behavioural engagement. Secondary outcomes are affective and cognitive engagement (smiley face ratings), exercise fidelity, lower limb function, goal achievement and participant experiences. SCED data will be analysed using visual and statistical methods. Quantitative and qualitative data will be integrated using joint displays.
    Ethics and dissemination: Ethical approval was obtained from the Research Ethics Boards at Bloorview Research Institute and the University of Toronto. Results will be distributed through peer-reviewed journals and scientific conferences.
    Trial registration number: NCT05998239; pre-results.
    MeSH term(s) Child ; Humans ; Cerebral Palsy/therapy ; Research Design ; Feedback ; Mobile Applications ; Exercise Therapy/methods
    Language English
    Publishing date 2024-03-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2023-082761
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  3. Article ; Online: Clinician perspectives on the implementation of inpatient cycling-based exergames for children with cerebral palsy: A qualitative study.

    Cardenas, Analyssa / Petrevska, Marina / Biddiss, Elaine / Fehlings, Darcy

    Developmental neurorehabilitation

    2022  Volume 25, Issue 8, Page(s) 531–541

    Abstract: Objective: To understand the perspectives of key stakeholder clinicians in implementing inpatient cycling-based exergames for children with cerebral palsy (CP) into pediatric rehabilitation.: Methods: Sixteen clinicians (nurses, physiotherapists, ... ...

    Abstract Objective: To understand the perspectives of key stakeholder clinicians in implementing inpatient cycling-based exergames for children with cerebral palsy (CP) into pediatric rehabilitation.
    Methods: Sixteen clinicians (nurses, physiotherapists, recreational therapists) that participated in a study exploring the feasibility of implementing cycling-based exergames for inpatient children with CP were interviewed. Clinicians' responses were coded using the Theoretical Domains Framework (TDF). Beliefs were generated from each response and relevant domains were identified.
    Results: Ten domains from the TDF were identified as relevant. Key enablers to clinician participation in future implementation included revision of clinician roles and responsibilities, the belief that children with CP will benefit from exergames, and the belief in potential applicability to other pediatric populations. Barriers included clinician limited time and exergame responsibilities not aligning with perceived clinician roles.
    Conclusions: This study identifies key barriers and enablers that future inpatient pediatric rehabilitation settings should consider when incorporating exergames into rehabilitation practice.
    MeSH term(s) Cerebral Palsy/rehabilitation ; Child ; Exergaming ; Humans ; Inpatients ; Physical Therapists ; Qualitative Research
    Language English
    Publishing date 2022-07-11
    Publishing country England
    Document type Journal Article
    ZDB-ID 2280007-4
    ISSN 1751-8431 ; 1751-8423
    ISSN (online) 1751-8431
    ISSN 1751-8423
    DOI 10.1080/17518423.2022.2099474
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  4. Article ; Online: Measuring functional hand use in children with unilateral cerebral palsy using accelerometry and machine learning.

    Mathew, Sunaal P / Dawe, Jaclyn / Musselman, Kristin E / Petrevska, Marina / Zariffa, José / Andrysek, Jan / Biddiss, Elaine

    Developmental medicine and child neurology

    2024  

    Abstract: Aim: To investigate wearable sensors for measuring functional hand use in children with unilateral cerebral palsy (CP).: Method: Dual wrist-worn accelerometry data were collected from three females and seven males with unilateral CP (mean age = 10 ... ...

    Abstract Aim: To investigate wearable sensors for measuring functional hand use in children with unilateral cerebral palsy (CP).
    Method: Dual wrist-worn accelerometry data were collected from three females and seven males with unilateral CP (mean age = 10 years 2 months [SD 3 years]) while performing hand tasks during video-recorded play sessions. Video observers labelled instances of functional and non-functional hand use. Machine learning was compared to the conventional activity count approach for identifying unilateral hand movements as functional or non-functional. Correlation and agreement analyses compared the functional usage metrics derived from each method.
    Results: The best-performing machine learning approach had high precision and recall when trained on an individual basis (F
    Interpretation: With further development, wearable accelerometry combined with machine learning may enable quantitative monitoring of everyday functional hand use in children with unilateral CP.
    Language English
    Publishing date 2024-03-02
    Publishing country England
    Document type Journal Article
    ZDB-ID 80369-8
    ISSN 1469-8749 ; 0012-1622
    ISSN (online) 1469-8749
    ISSN 0012-1622
    DOI 10.1111/dmcn.15895
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  5. Article ; Online: Understanding a videogame home intervention for children with hemiplegia: a mixed methods multi-case study.

    Chan-Víquez, Daniela / Khan, Ajmal / Munce, Sarah / Fehlings, Darcy / Wright, F Virginia / Biddiss, Elaine

    Frontiers in medical technology

    2023  Volume 5, Page(s) 1217797

    Abstract: Introduction: Access to rehabilitation therapies is a salient and growing issue for children with cerebral palsy (CP) and their families, motivating interest in home-based interventions. Bootle Blast is a low-cost, movement-tracking videogame that can ... ...

    Abstract Introduction: Access to rehabilitation therapies is a salient and growing issue for children with cerebral palsy (CP) and their families, motivating interest in home-based interventions. Bootle Blast is a low-cost, movement-tracking videogame that can be used at home to encourage upper limb (UL) functional exercise tailored to each child's abilities and therapy goals. The study objectives were to: 1) Establish the extent to which children achieve their self-directed play-time goal over a 12-week intervention, 2) Measure changes in UL motor outcomes, and 3) Explore participants' experiences of using Bootle Blast at home.
    Methods: Mixed methods case series study of four children with hemiplegic cerebral palsy (HCP), each with a participating parent. Participants played Bootle Blast at home for 12 weeks. Study assessments occurred at baseline, post-intervention and four week follow up. A post-intervention interview explored participants' experiences. Game-logs provided play time and progress data.
    Results: Three of four participants (8-13 yrs., Manual Ability Classification Level I-II) completed the intervention. One dropped out at week 6. Play-time goals were achieved in most weeks, with two of four children surpassing their overall intervention goals. Outcomes varied across the three participants, however consistent improvements were observed on the Canadian Occupational Performance Measure and the Box and Blocks Test. Inductive analysis generated four main themes: 1) Intrinsic motivators fostered play engagement, 2) Virtual play for real-world gains, 3) Therapy on demand (at home), and 4) Shifting the onus from the parent to the game. Integration of qualitative and quantitative data was important for interpreting play patterns/usage and clinical outcomes.
    Discussion: This mixed methods study describes a novel videogaming intervention designed for home-rehabilitation for children with HCP and provides preliminary evidence to guide future study design and research.
    Clinical trial registration: [https://clinicaltrials.gov/ct2/show/NCT04009031?recrs=h&cond=Cerebral+Palsy&cntry=CA&city=Toronto&draw=2&rank=1], identifier [NCT04009031].
    Language English
    Publishing date 2023-07-12
    Publishing country Switzerland
    Document type Journal Article
    ISSN 2673-3129
    ISSN (online) 2673-3129
    DOI 10.3389/fmedt.2023.1217797
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  6. Article ; Online: A Classification and Calibration Procedure for Gesture Specific Home-Based Therapy Exercise in Young People With Cerebral Palsy.

    Macintosh, Alexander / Vignais, Nicolas / Desailly, Eric / Biddiss, Elaine / Vigneron, Vincent

    IEEE transactions on neural systems and rehabilitation engineering : a publication of the IEEE Engineering in Medicine and Biology Society

    2021  Volume 29, Page(s) 144–155

    Abstract: Movement-based video games can provide engaging practice for repetitive therapeutic gestures towards improving manual ability in youth with cerebral palsy (CP). However, home-based gesture calibration and classification is needed to personalize therapy ... ...

    Abstract Movement-based video games can provide engaging practice for repetitive therapeutic gestures towards improving manual ability in youth with cerebral palsy (CP). However, home-based gesture calibration and classification is needed to personalize therapy and ensure an optimal challenge point. Nineteen youth with CP controlled a video game during a 4-week home-based intervention using therapeutic hand gestures detected via electromyography and inertial sensors. The in-game calibration and classification procedure selects the most discriminating, person-specific features using random forest classification. Then, a support vector machine is trained with this feature subset for in-game interaction. The procedure uses features intended to be sensitive to signs of CP and leverages directional statistics to characterize muscle activity around the forearm. Home-based calibration showed good agreement with video verified ground truths (0.86 ± 0.11, 95%CI = 0.93-0.97). Across participants, classifier performance (F1-score) for the primary therapeutic gesture was 0.90 ± 0.05 (95%CI = 0.87-0.92) and, for the secondary gesture, 0.82 ± 0.09 (95%CI = 0.77-0.86). Features sensitive to signs of CP were significant contributors to classification and correlated to wrist extension improvement and increased practice time. This study contributes insights for classifying gestures in people with CP and demonstrates a new gesture controller to facilitate home-based therapy gaming.
    MeSH term(s) Adolescent ; Calibration ; Cerebral Palsy ; Electromyography ; Gestures ; Hand ; Humans ; Wrist Joint
    Language English
    Publishing date 2021-02-26
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1166307-8
    ISSN 1558-0210 ; 1063-6528 ; 1534-4320
    ISSN (online) 1558-0210
    ISSN 1063-6528 ; 1534-4320
    DOI 10.1109/TNSRE.2020.3038370
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  7. Article ; Online: Musical Stairs: A motivational therapy tool for children with disabilities featuring automated detection of stair-climbing gait events via inertial sensors.

    Khan, Ajmal / Biddiss, Elaine

    Medical engineering & physics

    2017  Volume 40, Page(s) 95–102

    Abstract: Stair-climbing is a key component of rehabilitation therapies for children with physical disabilities. This paper reports on the design of a system, Musical Stairs, to provide auditory feedback during stair-climbing therapies. Musical Stairs is composed ... ...

    Abstract Stair-climbing is a key component of rehabilitation therapies for children with physical disabilities. This paper reports on the design of a system, Musical Stairs, to provide auditory feedback during stair-climbing therapies. Musical Stairs is composed of two foot-mounted inertial sensors, a step detection algorithm, and an auditory feedback response. In Phase 1, we establish its clinical feasibility via a Wizard-of-Oz AB/BA cross-over design with 17 children, aged 4-6 years, having diverse diagnoses and gait abilities. Self-, therapist- and blinded-observer reports indicated increased motivation with auditory feedback. Phase 2 describes the construction of a database comprised of synchronized video and inertial data associated with 1568 steps up and down stairs completed by 26 children aged 4-6 years with diverse diagnoses and gait. Lastly, in Phase 3, data from 18 children in the database were used to train a rule-based step detection algorithm based on local minima in the acceleration profile and the foot's swing angle. A step detection rate of 96% [SD=3%] and false positive rate of 6% [SD=5%] were achieved with an independent test set (n=8). Recommendations for future development and evaluation are discussed.
    MeSH term(s) Auditory Perception ; Automation ; Biomechanical Phenomena ; Child ; Child, Preschool ; Disabled Children/psychology ; Disabled Children/rehabilitation ; Feedback, Physiological ; Female ; Gait ; Humans ; Male ; Monitoring, Physiologic/instrumentation ; Motivation ; Rehabilitation/psychology
    Language English
    Publishing date 2017-01-16
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1181080-4
    ISSN 1873-4030 ; 1350-4533
    ISSN (online) 1873-4030
    ISSN 1350-4533
    DOI 10.1016/j.medengphy.2016.12.009
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  8. Article ; Online: Multi-domain assessment of sports-related and military concussion recovery: A scoping review.

    DuPlessis, Danielle / Lam, Emily / Xie, Lucy / Reed, Nick / Wright, F Virginia / Biddiss, Elaine / Scratch, Shannon E

    Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine

    2022  Volume 59, Page(s) 103–114

    Abstract: Objective: This review explores the literature on multi-domain assessments used in concussion recovery, to inform evidence-based and ecologically valid return-to-play. It asks: What simultaneous, dynamic multi-domain paradigms are used to assess ... ...

    Abstract Objective: This review explores the literature on multi-domain assessments used in concussion recovery, to inform evidence-based and ecologically valid return-to-play. It asks: What simultaneous, dynamic multi-domain paradigms are used to assess recovery of youth and adults following concussion?
    Methods: Five databases were searched (CINAHL, EMBASE, MEDLINE, PsycInfo, SPORTDiscus) until September 30, 2021. Records were limited to those published in peer-reviewed journals, in English, between 2002 and 2021. Included studies were required to describe the assessment of concussion recovery using dynamic paradigms (i.e., requiring sport-like coordination) spanning multiple domains (i.e., physical, cognitive, socio-emotional functioning) simultaneously.
    Results: 7098 unique articles were identified. 64 were included for analysis, describing 36 unique assessments of 1938 concussed participants. These assessments were deconstructed into their constituent tasks: 13 physical, 17 cognitive, and one socio-emotional. Combinations of these "building blocks" formed the multi-domain assessments. Forty-six studies implemented level walking with a concurrent cognitive task. The most frequently implemented cognitive tasks were 'Q&A' paradigms requiring participants to answer questions aloud during a physical task.
    Conclusions: A preference emerged for dual-task assessments, specifically combinations of level walking and Q&A tasks. Future research should balance ecological validity and clinical feasibility in multi-domain assessments, and work to validate these assessments for practice.
    MeSH term(s) Adolescent ; Humans ; Athletic Injuries/diagnosis ; Military Personnel ; Brain Concussion/diagnosis ; Sports ; Physical Examination
    Language English
    Publishing date 2022-12-05
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2008604-0
    ISSN 1873-1600 ; 1466-853X
    ISSN (online) 1873-1600
    ISSN 1466-853X
    DOI 10.1016/j.ptsp.2022.11.010
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  9. Article ; Online: Musical stairs: the impact of audio feedback during stair-climbing physical therapies for children.

    Khan, Ajmal / Biddiss, Elaine

    Disability and rehabilitation. Assistive technology

    2015  Volume 10, Issue 3, Page(s) 231–235

    Abstract: Purpose: Enhanced biofeedback during rehabilitation therapies has the potential to provide a therapeutic environment optimally designed for neuroplasticity. This study investigates the impact of audio feedback on the achievement of a targeted ... ...

    Abstract Purpose: Enhanced biofeedback during rehabilitation therapies has the potential to provide a therapeutic environment optimally designed for neuroplasticity. This study investigates the impact of audio feedback on the achievement of a targeted therapeutic goal, namely, use of reciprocal steps.
    Methods: Stair-climbing therapy sessions conducted with and without audio feedback were compared in a randomized AB/BA cross-over study design. Seventeen children, aged 4-7 years, with various diagnoses participated. Reports from the participants, therapists, and a blinded observer were collected to evaluate achievement of the therapeutic goal, motivation and enjoyment during the therapy sessions.
    Results: Audio feedback resulted in a 5.7% increase (p = 0.007) in reciprocal steps. Levels of participant enjoyment increased significantly (p = 0.031) and motivation was reported by child participants and therapists to be greater when audio feedback was provided.
    Discussion: These positive results indicate that audio feedback may influence the achievement of therapeutic goals and promote enjoyment and motivation in young patients engaged in rehabilitation therapies. This study lays the groundwork for future research to determine the long term effects of audio feedback on functional outcomes of therapy.
    Implications for rehabilitation: Stair-climbing is an important mobility skill for promoting independence and activities of daily life and is a key component of rehabilitation therapies for physically disabled children. Provision of audio feedback during stair-climbing therapies for young children may increase their achievement of a targeted therapeutic goal (i.e., use of reciprocal steps). Children's motivation and enjoyment of the stair-climbing therapy was enhanced when audio feedback was provided.
    MeSH term(s) Child ; Child, Preschool ; Cross-Over Studies ; Feedback, Sensory ; Female ; Humans ; Male ; Motivation ; Music ; Patient Preference ; Physical Therapy Modalities/psychology ; Walking
    Language English
    Publishing date 2015-05
    Publishing country England
    Document type Clinical Trial ; Journal Article ; Randomized Controlled Trial
    ZDB-ID 2221782-4
    ISSN 1748-3115 ; 1748-3107
    ISSN (online) 1748-3115
    ISSN 1748-3107
    DOI 10.3109/17483107.2014.886085
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  10. Article ; Online: Engaging children with cerebral palsy in interactive computer play-based motor therapies: theoretical perspectives.

    Biddiss, Elaine / Chan-Viquez, Daniela / Cheung, Stephanie T / King, Gillian

    Disability and rehabilitation

    2019  Volume 43, Issue 1, Page(s) 133–147

    Abstract: Purpose: To provide a theoretically grounded understanding of engagement in interactive computer play-based motor therapies by children with cerebral palsy in home settings.: Methods: A motivational framework for engagement and its relationship with ... ...

    Abstract Purpose: To provide a theoretically grounded understanding of engagement in interactive computer play-based motor therapies by children with cerebral palsy in home settings.
    Methods: A motivational framework for engagement and its relationship with three contemporary theories (self-determination theory, expectancy-value theory, social cognitive theory of self-regulation) was overviewed. A scoping review was conducted to understand how engagement is influenced by features of the technology and intervention design that impact intrinsic and extrinsic motivation, child and parent values and expectancies, and the processes of self-regulation. Multiple reviewers screened and extracted data from 26 articles describing home-based clinical trials of interactive computer play-based motor interventions for children with cerebral palsy. A narrative synthesis framework was used for analysis.
    Results: Features of the
    Conclusions: Optimizing engagement in interactive computer play-based motor interventions requires closer alignment with client-led values/goals; design of technologies and interventions that sustain intrinsic motivation; and feedback that informs/builds self-efficacy. Implications for rehabilitation The decision to prescribe an interactive computer play-based motor intervention should be guided by client-led goals and an informed understanding of the capacity of the interactive computer play-based intervention to meet individual client values/expectancies. Sustaining intrinsic motivation in interactive computer play-based motor therapies is greatly influenced by features of the technology (e.g., calibration, feedback, personalization)
    MeSH term(s) Allied Health Personnel ; Cerebral Palsy ; Child ; Computers ; Humans ; Motivation ; Parents
    Language English
    Publishing date 2019-05-19
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 1104775-6
    ISSN 1464-5165 ; 0963-8288
    ISSN (online) 1464-5165
    ISSN 0963-8288
    DOI 10.1080/09638288.2019.1613681
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