A Novel Workflow to Estimate Limb Orientation from Wearable Sensors to Monitor Infant Motor Development

Background: Wearable sensors have gained increasing popularity as an objective method for remotely monitoring infant movement in naturalistic settings. Over the first year of life, infants generate a wide range of motions, from goal-directed to spontaneous movement. These include linear movements, such as kicks, and orientation changes, such as postural transitions. Many sensor processing pipelines emphasize capturing linear movements through movement-generated acceleration while focusing less on information about orientation embedded in the gravitational part of the data. Here, we introduce a complementary gravity-referenced approach that extracts the gravitational component of accelerometer signals to estimate limb orientation, extending the reliable quantification of rich and detailed aspects of infant movement. Infant orientation has demonstrated clinical relevance, including associations with later neuromotor outcomes, and it can be used to chart infant motor development, motivating the development of objective methods to quantify orientation from sensor data. Methods: Wearable sensors (Opal APDM) were used to longitudinally evaluate infant motor activity recorded in sessions conducted at 3, 6, 9, and 12 months of age. We extracted data from a 5 min segment that has simultaneous video recordings. From these datasets, applying the gravity-referenced method, we computed pitch, roll, and yaw, angles that collectively describe limb orientation. We then quantified orientation variability using axis-specific circular standard deviations (SDs) for pitch, roll, and yaw and a multi-axis composite measure based on generalized variance. Results: Axis-specific circular SDs for pitch, roll, and yaw, as well as the composite generalized variance, increased significantly from 3 to 12 months (p ≤ 0.01 for each metric). Composite variability was strongly associated with Mullen gross motor outcomes at 9 and 12 months of age (r = 0.55, p < 0.001). Conclusions: Overall, gravity-referenced pitch, roll, and yaw provide rich orientation features that increased as infants develop more postural transitions. Furthermore, the orientation features correlated with standardized measures of infant motor function. These orientation metrics can complement traditional linear kinematic measures and improve our ability to granularly track infant motor development in the first year of life.