Publications by authors named "Nilanjan Sarkar"

61 Publications

Validating a Computerized Program for Supporting Visual Analysis During Functional Analysis: The Problem Behavior Multilevel Interpreter (PB.MI).

Behav Anal Pract 2022 Jun 14;15(2):485-494. Epub 2021 Oct 14.

Vanderbilt University, Department of Mechanical Engineering, Nashville, TN USA.

Computerized programs have been specifically developed in the field of applied behavior analysis for the purpose of automating data collection. Although they can potentially improve practicality of data collection for applied researchers and clinicians, program features of existing computerized programs do not include graphs and data interpretation generated in real time. We developed the Problem Behavior Multilevel Interpreter (PB.MI), which is designed to (a) allow for ongoing visual analysis of data displayed in real time and (b) support visual analysis with a computerized interpretation of functional control. The program was intended to be used during the functional analysis of problem behavior, specifically the single-session, interview-informed synthesized contingency analysis. In this article, we describe the program's functioning abilities and how we validated those abilities. In addition, we discuss the PB.MI program's practical utility.

Supplementary Information: The online version contains supplementary material available at 10.1007/s40617-021-00656-7.
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http://dx.doi.org/10.1007/s40617-021-00656-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9120334PMC
June 2022

Radiological Diagnosis of a Rare Prepontine Lesion: Ecchordosis Physaliphora.

Cureus 2022 Apr 21;14(4):e24335. Epub 2022 Apr 21.

Radiology, Tata Main Hospital, Jamshedpur, IND.

Ecchordosis physaliphora (EP) is a notochordal remnant tissue rarely encountered during routine clinical practice. These lesions usually do not produce any significant symptoms as they are slow-growing and mostly small in size. Symptoms are due to mass effects on adjacent structures when they are large or extra-tumoral hemorrhage. Because of histological similarity with chordoma, diagnosis is challenging, and this differentiation is essential as the disease course and treatment differ significantly. Imaging plays a crucial role in identifying and distinguishing these lesions. We report the case of a 16-year-old male who presented with intermittent headache and neck pain for six months. His routine clinical examinations were within normal limits. On neurological assessment, there was no focal neurodeficit. Evaluation of cranial nerves did not reveal any evidence of palsy. Routine hematological tests were also normal. A computed tomography (CT) scan of the brain revealed a mass in front of the pons. Magnetic resonance imaging (MRI) for further evaluation revealed a T1 hypointense and T2/fluid-attenuated inversion recovery hyperintense lesion in the pre-pontine cistern. There was no enhancement in the mass either in the post-contrast CT or MRI scans. There was no bony erosion and clivus was normal. Based on the location and characteristic imaging features, a diagnosis of EP was made. There may be several other lesions that may present as a mass in the pre-pontine region. Histopathological tests may find it difficult to distinguish between lesions that originate from notochord remnants. Imaging studies play a vital role in confirming the diagnosis and help in planning treatment and follow-up.
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http://dx.doi.org/10.7759/cureus.24335DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9123648PMC
April 2022

Design of an Intelligent Agent to Measure Collaboration and Verbal-Communication Skills of Children with Autism Spectrum Disorder in Collaborative Puzzle Games.

IEEE Trans Learn Technol 2021 Jun 6;14(3):338-352. Epub 2020 Oct 6.

Department of Electrical Engineering and Computer Science, Department of Mechanical Engineering and Robotics and Autonomous Systems Laboratory, Vanderbilt University, Olin Hall Room 101, 2400 Highland Avenue, Nashville, TN, USA.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by core deficits in social interaction and communication. Collaborative puzzle games are interactive activities that can be played to foster the collaboration and verbal-communication skills of children with ASD. In this paper, we have designed an intelligent agent that can play collaborative puzzle games with children and verbally communicate with them as if it is another human player. Furthermore, this intelligent agent is also able to automatically measure children's task-performance and verbal-communication behaviors throughout game play. Two preliminary studies were conducted with children with ASD to evaluate the feasibility and performance of the intelligent agent. Results of Study I demonstrated the intelligent agent's ability to play games and communicate with children within the game-playing domain. Results of Study II indicated its potential to measure the communication and collaboration skills of human users.
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http://dx.doi.org/10.1109/tlt.2020.3029223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966619PMC
June 2021

Study of Profile of Mucormycosis During the Second Wave of COVID-19 in a Tertiary Care Hospital.

Cureus 2022 Jan 9;14(1):e21054. Epub 2022 Jan 9.

Internal Medicine, Tata Main Hospital, Jamshedpur, IND.

Introduction and aim Mucormycosis is a lethal opportunistic infection caused by filamentous fungi of the family Mucoraceae (black fungus). There has been a sudden increase in the incidence of these cases during the second wave of the COVID-19 pandemic due to the immunocompromised state caused by the disease and its treatment. Early diagnosis and appropriate medical management are essential to reduce disease morbidity and mortality. Through this study, we aim to study the clinical features, risk factors, laboratory investigations, and radiological findings of patients with mucormycosis as well as evaluate the clinical outcomes in each case. Methods and materials This was a prospective study that included only confirmed mucormycosis cases admitted in Tata Main Hospital (TMH) from April 2021 to July 2021. A case of mucormycosis was defined as the one in which clinical and radiological features were consistent with mucormycosis and fungus was demonstrated in the tissue by potassium hydroxide (KOH) mount/culture/histopathological examination (HPE). Data relating to epidemiology, risk factors, clinico-radiological features, and outcomes were analyzed and expressed as a percentage of total cases. Results Of the total 15 cases, three patients (33.3%) had active COVID-19 infection, eight (53.3%) were in the post-COVID-19 state, two (13.4%) had COVID-19 like illness and two (13.4%) patients did not have COVID-19 in the recent past. There was male predominance with the male to female ratio being 2.75:1. The commonest associated co-morbid condition was diabetes mellitus (13 patients, 86.7%). Amongst the myriad manifestations, periorbital swelling was the commonest symptom (11 patients, 73.3%). Among neurological manifestations, involvement of cranial nerves was found in nine (60%) patients with the third cranial nerve being the most commonly affected nerve (eight patients, 53.3%). Cavernous sinus thrombosis (CST) was found in one (6.7%) patient. Diagnostic nasal endoscopy (DNE) revealed eschar at various sites in 13 patients (86.7%). Central retinal artery occlusion (CRAO) was found bilaterally in one patient (6.7%) while two patients (13.3%) had CRAO on the left. Radiologically, the most commonly involved sinuses were maxillary and ethmoidal (eight patients, 53.3%). Bilateral sinus involvement was more common (46.7%) than unilateral sinus involvement. The average length of stay (LOS) was 17.5±7.8 days. The overall mortality was 40%. Five (33.3%) patients developed secondary bacterial infections. All patients received medical therapy with intravenous amphotericin B. In addition, seven (46.7%) patients underwent functional endoscopic sinus surgery (FESS) with debridement of which, five (71.4%) patients survived and made a good recovery. One patient (6.7%) with pulmonary mucormycosis underwent lobectomy. Conclusion New-onset headache, black nasal discharge, periorbital swelling, retro-orbital pain, visual diminution, restriction of eye movements should prompt an immediate search for mucormycosis especially in the background of history of diabetes mellitus in patient with recent or current COVID-19 disease. Radio-imaging with computerized tomography and magnetic resonance imaging are complementary to clinical evaluation in assessing the disease extent and diagnosis of complications. Prompt diagnosis is essential due to the angio-invasive nature of the mucor and requires aggressive anti-fungal therapy and debridement of the devitalized tissue.
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http://dx.doi.org/10.7759/cureus.21054DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8824768PMC
January 2022

Use of robots to encourage social engagement between older adults.

Geriatr Nurs 2022 Jan-Feb;43:97-103. Epub 2021 Nov 27.

Research Professor, College of Nursing, Ohio State University, Columbus OH. Electronic address:

We designed a robotic architecture system within a commercially available socially assistive robot to engage pairs of older adults in multimodal activities over 3 weeks for 6 sessions. The study took place in two assisted living facilities. Seven pairs (14 individuals) completed the experiment. Ages ranged from 70 to 90 years with a mean age of 83.0 (± 6.1). Most were women (79%). Three adults were screened as having normal cognition, 10 had mild cognitive impairment, and 1 adult self-reported a diagnosis of Alzheimer's disease. All sessions were video recorded and analyzed using Noldus Observer XT. Individuals demonstrated high levels of both human-human interaction and human-robot interaction, but the activity influenced the type of interaction. Engagement measures (visual, verbal, behavioral) also varied by type of activity. Future studies will focus on further development of activities that can engage older adults with varying levels of cognitive impairment and apathy.
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http://dx.doi.org/10.1016/j.gerinurse.2021.11.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8821416PMC
March 2022

Paraganglioma of Urinary Bladder: An Uncommon Entity in Uropathology.

Cureus 2021 Aug 17;13(8):e17265. Epub 2021 Aug 17.

Urology, Royal Hospital, Muscat, OMN.

Paraganglioma of the urinary bladder is a rare neoplasm. It may be functional, secreting catecholamines, or nonfunctional. Clinically and histopathologically, it has the potential to be misdiagnosed as a more common urothelial carcinoma, especially in nonfunctional cases. A high index of suspicion on the part of pathologist can help in identification of characteristic histopathologic feature which coupled with immunohistochemistry can help in establishing the correct diagnosis. We present a case of paraganglioma in a 78-year-old male patient presenting with haematuria. Clinical provisional diagnosis rendered based on cystoscopic findings and radiology was urothelial carcinoma; however, was confirmed to be a case of paraganglioma of bladder on histopathological and immunohistochemical evaluation. A long follow-up is warranted. Herein, we also briefly review the relevant literature.
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http://dx.doi.org/10.7759/cureus.17265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8448256PMC
August 2021

Design of an Interactive Virtual Reality System, InViRS, for Joint Attention Practice in Autistic Children.

IEEE Trans Neural Syst Rehabil Eng 2021 16;29:1866-1876. Epub 2021 Sep 16.

Many children with Autism Spectrum Disorder (ASD) exhibit atypical gaze behaviors related to joint attention, a fundamental social-communication skill. Specifically, children with ASD show differences in the skills of gaze sharing and gaze following. In this work we present a novel virtual reality (VR)-based system, called InViRS, in which children with ASD play games allowing them to practice gaze sharing and gaze following. InViRS has three main design contributions: (i) a closed-loop joint attention paradigm with real-time tracking of the participant's eye gaze and game performance measures, (ii) an assistive feedback mechanism that provides guidance and hints in real time, and (iii) a controller that adaptively changes the avatar's gaze prompts according to the performance measures. Results from a pilot study to evaluate the feasibility of InViRS with 9 autistic children and 9 typically developing (TD) children offered preliminary support for the feasibility of successful gameplay as well as positive impacts on the targeted skills of gaze sharing and gaze following.
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http://dx.doi.org/10.1109/TNSRE.2021.3108351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8482411PMC
October 2021

PYCR2 Mutation Causing Hypomyelination and Microcephaly in an Indian Child.

Cureus 2021 Apr 24;13(4):e14661. Epub 2021 Apr 24.

Radiology, Tata Main Hospital, Jamshedpur, IND.

Hypomyelinating leukodystrophy (HLD) represents a group of clinically overlapping but genetically heterogeneous diseases. This group of disorders has the improper formation of myelin sheaths in the central nervous system (CNS), resulting in abnormal white matter, with characteristic MRI findings and clinical presentations of mostly motor dysfunction with variable cognitive and language impairment. We report a case of a three-year-old boy with global developmental delay, dysmorphic facies, motor signs, progressive microcephaly, and failure to thrive. The child was born of a non-consanguineous marriage. All basic investigations and metabolic tests were normal. Magnetic resonance imaging (MRI) of the brain showed hypomyelination of the deep and subcortical white matter, appearing as hyperintense T2 and isointense T1-weighted images, cerebral atrophy with the thinning of the corpus callosum, with normal cerebellum, brainstem, and deep grey nuclei. Further genetic testing in the form of clinical exome sequencing revealed compound heterozygous mutation of the PYCR2 gene and matching the clinical phenotype with the genotype. Therefore, a final diagnosis of hypomyelinating leukodystrophy-10 was made. There is a wide range of aetiologies for debilitating neurologic disorders, which have common and overlapping clinical presentations. Advances in the field of genetics, growing awareness, and availability of genetic tests help in a better workup of complex neurological cases. A precise diagnosis is useful in outlining the course, treatment (if available), and prognosis of the disease to parents and plays a vital role in planning future pregnancies.
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http://dx.doi.org/10.7759/cureus.14661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8143271PMC
April 2021

An Immersive Computer-Mediated Caregiver-Child Interaction System for Young Children With Autism Spectrum Disorder.

IEEE Trans Neural Syst Rehabil Eng 2021 18;29:884-893. Epub 2021 May 18.

Autism Spectrum Disorder (ASD) affects 1 in 54 children in the United States. A core social communication skill negatively impacted by ASD is joint attention (JA), which influences the development of language, cognitive, and social skills from infancy onward. Although several technology-based JA studies have shown potential, they primarily focus on response to joint attention (RJA). The other important component of JA, the initiation of joint attention (IJA), has received less attention from a technology-based intervention perspective. In this work, we present an immersive Computer-mediated Caregiver-Child Interaction (C3I) system to help children with ASD practice IJA skills. C3I is a novel computerized intervention system that integrates a caregiver in the teaching loop, thereby preserving the advantages of both human and computer-administered intervention. A feasibility study with 6 dyads (caregiver-child with ASD) was conducted. A near significant increase with medium effect size on IJA performance was observed. Meanwhile, physiology-based stress analysis showed that C3I did not increase stress of the caregivers over the course of the study. To the best of our knowledge, this is the first autonomous system designed for teaching IJA skills to children with ASD incorporating caregivers within the loop to enhance the potential for generalization in real-world.
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http://dx.doi.org/10.1109/TNSRE.2021.3077480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189254PMC
June 2021

Field Testing of Ro-Tri, a Robot-Mediated Triadic Interaction for Older Adults.

Int J Soc Robot 2021 21;13(7):1711-1727. Epub 2021 Feb 21.

Department of Mechanical Engineering, Vanderbilt University, Nashville, TN USA.

Older adults residing in long term care (LTC) settings commonly experience apathy, a neuropsychiatric condition with adverse consequences of increased morbidity and mortality. Activities that combine social, physical and cognitive stimuli are most effective in engaging older adults with apathy but are time consuming and require significant staff resources. We present the results from an initial pilot field study of our socially assistive robotic (SAR) system, Ro-Tri, capable of multi-modal interventions to foster social interaction between pairs of older adults. Seven paired participants attended two sessions a week for three weeks. Sessions consisted of robot-mediated triadic interactions with three types of activities repeated once over the 3 weeks. Ro-Tri gathered quantitative interaction data, head pose, vocal sound, and physiological signals to automatically evaluate older adults' activity and social engagement. Ro-Tri functioned smoothly without any technical issues. Older adults had > 90% attendance and 100% completion rate and remained engaged with the system throughout the study duration. Participants' visual attention toward the SAR system and their partners increased 7.2% and 4.7%, respectively, with their interaction effort showing an increase of 2.9%. Older adults and LTC staff had positive perceptions with the system. These initial results demonstrate Ro-Tri's ability to engage older adults, encourage social human-to-human interaction, and assess the changes using quantitative metrics. Future studies will determine SAR's impact on apathy in LTC older adults.
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http://dx.doi.org/10.1007/s12369-021-00760-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897418PMC
February 2021

A Predictive Multimodal Framework to Alert Caregivers of Problem Behaviors for Children with ASD (PreMAC).

Sensors (Basel) 2021 Jan 7;21(2). Epub 2021 Jan 7.

Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37240, USA.

Autism Spectrum Disorder (ASD) impacts 1 in 54 children in the US. Two-thirds of children with ASD display problem behavior. If a caregiver can predict that a child is likely to engage in problem behavior, they may be able to take action to minimize that risk. Although experts in Applied Behavior Analysis can offer caregivers recognition and remediation strategies, there are limitations to the extent to which human prediction of problem behavior is possible without the assistance of technology. In this paper, we propose a machine learning-based predictive framework, PreMAC, that uses multimodal signals from precursors of problem behaviors to alert caregivers of impending problem behavior for children with ASD. A multimodal data capture platform, M2P3, was designed to collect multimodal training data for PreMAC. The development of PreMAC integrated a rapid functional analysis, the interview-informed synthesized contingency analysis (IISCA), for collection of training data. A feasibility study with seven 4 to 15-year-old children with ASD was conducted to investigate the tolerability and feasibility of the M2P3 platform and the accuracy of PreMAC. Results indicate that the M2P3 platform was well tolerated by the children and PreMAC could predict precursors of problem behaviors with high prediction accuracies.
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http://dx.doi.org/10.3390/s21020370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7826816PMC
January 2021

A Randomized Controlled Trial of an Intelligent Robotic Response to Joint Attention Intervention System.

J Autism Dev Disord 2020 Aug;50(8):2819-2831

Department of Electrical Engineering and Computer Science, Vanderbilt University, Olin Hall Room 101, 2400 Highland Avenue, Nashville, TN, 37212, USA.

Although there has been growing interest in utilizing robots for intervention in autism spectrum disorder (ASD), there have been very few controlled trials to assess the actual impacts of such systems on social communication vulnerabilities. This study reports a randomized controlled trial to investigate a robot-mediated response to joint attention intervention in a small (23 recruited; 20 completed) group of young children (average age = 2.54 years) with ASD. Small and nonsignificant group differences were observed regarding improvements in response to joint attention skills within and beyond the intervention. The sample showed tremendous individual variability in response to the system. Results highlight the current challenges related to developing pragmatic, beneficial, and generalizable robotic intervention systems for the targeted population.
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http://dx.doi.org/10.1007/s10803-020-04388-5DOI Listing
August 2020

Assessing Social Communication and Collaboration in Autism Spectrum Disorder Using Intelligent Collaborative Virtual Environments.

J Autism Dev Disord 2020 Jan;50(1):199-211

Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA.

Existing literature regarding social communication outcomes of interventions in autism spectrum disorder (ASD) depends upon human raters, with limited generalizability to real world settings. Technological innovation, particularly virtual reality (VR) and collaborative virtual environments (CVE), could offer a replicable, low cost measurement platform when endowed with intelligent agent technology and peer-based interactions. We developed and piloted a novel collaborative virtual environment and intelligent agent (CRETA) for the assessment of social communication and collaboration within system and peer interactions. The system classified user statements with moderate to high accuracies. We found moderate to high agreement in displayed communication and collaboration skills between human-human and human-agent interactions. CRETA offers a promising avenue for future development of autonomous measurement systems for ASD research.
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http://dx.doi.org/10.1007/s10803-019-04246-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6949374PMC
January 2020

Radiological diagnosis of rare pancreatic serous cystadenoma.

J Family Med Prim Care 2019 Aug 28;8(8):2744-2746. Epub 2019 Aug 28.

Department of Radiology, Tata Main Hospital, Jamshedpur, Jharkhand, India.

Serous cystadenoma of the pancreas, also known as microcystic adenoma, is a very rare type of pancreatic neoplasm. It is a benign cystic lesion. It is composed of many small cysts lined by cuboidal or flattened cells containing glycogen. Herein, we report a rare case of serous cystadenoma of the pancreas in an 82-year-old male. The tumor was located in the body and tail of the pancreas and postoperative sample revealed a sponge-like appearance due to multiple tiny cysts containing clear serous fluid. Microscopic analysis showed cystic spaces lined by cuboidal cells with intracytoplasmic glycogen.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_454_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753810PMC
August 2019

Non-functional retroperitoneal paraganglioma: A case report.

J Family Med Prim Care 2019 Apr;8(4):1497-1499

Department of Pathology, Tata Main Hospital, Jamshedpur, Jharkhand, India.

Paragangliomas are extra-adrenal tumors of the autonomic nervous system and may be found within the skull base, neck, chest, and abdomen. When presenting within the abdominal cavity, they may arise as a primary retroperitoneal neoplasm and can mimic vascular malformations or other conditions related to specific retroperitoneal organs such as the pancreas, kidneys. They synthesize, store, and secrete catecholamines because of which they may present with headache, sweating, palpitation, and symptoms of hypertension (functional). In the absence of histological diagnosis and symptoms of catecholamine excess (non-functional), these may be mistaken for GISTs. We are reporting a case of a 36-year-old female who was clinically diagnosed as GIST, underwent excision, and postoperative histopathological examination was found to be paraganglioma.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_189_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6510092PMC
April 2019

Decoupling of spontaneous facial mimicry from emotion recognition in schizophrenia.

Psychiatry Res 2019 05 20;275:169-176. Epub 2019 Mar 20.

Department of Psychology, Vanderbilt University, 111 21st Ave. S, Wilson Hall, Room 311, Nashville, TN 37240, USA; Global Academy for Future Civilizations, Kyung Hee University, Seoul, Korea.

Past research indicates that spontaneous mimicry facilitates the decoding of others' emotions, leading to enhanced social perception and interpersonal rapport. Individuals with schizophrenia (SZ) show consistent deficits in emotion recognition and expression associated with poor social functioning. Given the prominence of blunted affect in schizophrenia, it is possible that spontaneous facial mimicry may also be impaired. However, studies assessing automatic facial mimicry in schizophrenia have yielded mixed results. It is therefore unknown whether emotion recognition deficits and impaired automatic facial mimicry are related in schizophrenia. SZ and demographically matched controls (CO) participated in a dynamic emotion recognition task. Electromyographic activity in muscles responsible for producing facial expressions was recorded during the task to assess spontaneous facial mimicry. SZ showed deficits in emotion identification compared to CO, but there was no group difference in the predictive power of spontaneous facial mimicry for avatar's expressed emotion. In CO, facial mimicry supported accurate emotion recognition, but it was decoupled in SZ. The finding of intact facial mimicry in SZ bears important clinical implications. For instance, clinicians might be able to improve the social functioning of patients by teaching them to pair specific patterns of facial muscle activation with distinct emotion words.
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http://dx.doi.org/10.1016/j.psychres.2019.03.035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080256PMC
May 2019

Extraction of Emotional Information via Visual Scanning Patterns: A Feasibility Study of Participants with Schizophrenia and Neurotypical Individuals.

ACM Trans Access Comput 2018 Nov;11(4)

Department Of Mechanical Engineering, Vanderbilt University.

Emotion recognition impairment is a core feature of schizophrenia (SZ), present throughout all stages of this condition, and leads to poor social outcome. However, the underlying mechanisms that give rise to such deficits have not been elucidated and hence, it has been difficult to develop precisely targeted interventions. Evidence supports the use of methods designed to modify patterns of visual attention in individuals with SZ in order to effect meaningful improvements in social cognition. To date, however, attention-shaping systems have not fully utilized available technology (e.g., eye tracking) to achieve this goal. The current work consisted of the design and feasibility testing of a novel gaze-sensitive social skills intervention system called MASI-VR. Adults from an outpatient clinic with confirmed SZ diagnosis (n=10) and a comparison sample of neurotypical participants (n=10) were evaluated on measures of emotion recognition and visual attention at baseline assessment, and a pilot test of the intervention system was evaluated on the SZ sample following five training sessions over three weeks. Consistent with the literature, participants in the SZ group demonstrated lower recognition of faces showing medium intensity fear, spent more time deliberating about presented emotions, and had fewer fixations in comparison to neurotypical peers. Furthermore, participants in the SZ group showed significant improvement in the recognition of fearful faces post-training. Preliminary evidence supports the feasibility of a gaze-sensitive paradigm for use in assessment and training of emotion recognition and social attention in individuals with SZ, thus warranting further evaluation of the novel intervention.
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http://dx.doi.org/10.1145/3282434DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322689PMC
November 2018

Brief Report: Evaluating the Utility of Varied Technological Agents to Elicit Social Attention from Children with Autism Spectrum Disorders.

J Autism Dev Disord 2019 Apr;49(4):1700-1708

Research Center for Child Mental Development, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan.

Technological agents could be effective tools to be used in interventions for enhancing social orienting for some young children with ASD. We examined response to social bids in preschool children with ASD and typical development (TD) at a very early age (i.e., around 3 years) using social prompts presented by technological agents of various forms and human comparisons. Children with ASD demonstrated less response overall to social bids compared to TD controls, across agents or human. They responded more often to a simple humanoid robot and the simple avatar compared to the human. These results support the potential utilization of specific robotic and technological agents for harnessing and potentially increasing motivation to socially-relevant behaviors in some young children with ASD.
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http://dx.doi.org/10.1007/s10803-018-3841-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450844PMC
April 2019

Hand-in-Hand: A Communication-Enhancement Collaborative Virtual Reality System for Promoting Social Interaction in Children with Autism Spectrum Disorders.

IEEE Trans Hum Mach Syst 2018 Apr 23;48(2):136-148. Epub 2018 Jan 23.

Mechanical Engineering Department, Vanderbilt University, Nashville, TN 37212 USA

Children with autism spectrum disorders (ASD) often exhibit impairments in communication and social interaction, and thus face various social challenges in collaborative activities. Given the cost of ASD intervention and lack of access to trained clinicians, technology-assisted ASD intervention has gained momentum in recent years. In this paper, we present a novel collaborative virtual environment (CVE) based social interaction platform for ASD intervention. The development of CVE technology for ASD intervention may lead to the creation of a novel low-cost intervention environment that will foster collaboration with peers and provide flexibility in communication. The presented Communication-Enhancement CVE system, Hand-in-Hand, allows two children to play a series of interactive games in a virtual reality environment by using simple hand gestures to collaboratively move virtual objects that are tracked in real-time via cameras. Further, these games are designed to promote natural communication and cooperation between the users via the presented mode that allows users to share information and discuss game strategies using gaze and voice based communication. The results of a feasibility study with 12 children with ASD and 12 typically developing peers show that this system was well accepted by both the children with and without ASD, improved their cooperation in game play, and demonstrated the potential for fostering their communication and collaboration skills.
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http://dx.doi.org/10.1109/THMS.2018.2791562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193496PMC
April 2018

Design, Development, and Evaluation of a Noninvasive Autonomous Robot-mediated Joint Attention Intervention System for Young Children with ASD.

IEEE Trans Hum Mach Syst 2018 Apr 14;48(2):125-135. Epub 2017 Dec 14.

Mechanical Engineering Department, Vanderbilt University, Nashville, TN 37212 USA.

Research indicates that human-robot interaction can help children with Autism Spectrum Disorder (ASD). While most early robot-mediated interaction studies were based on free interactions, recent studies have shown that robot-mediated interventions that focus on the core impairments of ASD such as joint attention deficit tend to produce better outcomes. Joint attention impairment is one of the core deficits in ASD that has an important impact in the neuropsychological development of these children. In this work, we propose a novel joint attention intervention system for children with ASD that overcomes several existing limitations in this domain such as the need to use body-worn sensors, non-autonomous robot operation requiring human involvement and lack of a formal model for robot-mediated joint attention interaction. We present a fully autonomous robotic system, called NORRIS, that can infer attention through a distributed non-contact gaze inference mechanism with an embedded Least-to-Most (LTM) robot-mediated interaction model to address the current limitations. The system was tested in a multi-session user study with 14 young children with ASD. The results showed that participants' joint attention skills improved significantly, their interest in the robot remained consistent throughout the sessions, and the LTM interaction model was effective in promoting the children's performance.
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http://dx.doi.org/10.1109/THMS.2017.2776865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6193505PMC
April 2018

The acceptability and feasibility of a novel virtual reality based social skills training game for schizophrenia: Preliminary findings.

Psychiatry Res 2018 12 9;270:496-502. Epub 2018 Oct 9.

Department of Psychology, Vanderbilt University, Nashville, TN, USA; Global Academy for Future Civilizations, Kyung Hee University, Seoul, Korea. Electronic address:

Social impairment is a core feature of schizophrenia that presents a major barrier toward recovery. Some of the psychotic symptoms are partly ameliorated by medication but the route to recovery is hampered by social impairments. Since existing social skills interventions tend to suffer from lack of availability, high-burden and low adherence, there is a dire need for an effective, alternative strategy. The present study examined the feasibility and acceptability of Multimodal Adaptive Social Intervention in Virtual Reality (MASI-VR) for improving social functioning and clinical outcomes in schizophrenia. Out of eighteen patients with schizophrenia who enrolled, seventeen participants completed the pre-treatment assessment and 10 sessions of MASI-VR, but one patient did not complete the post-treatment assessments. Therefore, the complete training plus pre- and post-treatment assessment data are available from sixteen participants. Clinical ratings of symptom severity were obtained at pre- and post-training. Retention rates were very high and training was rated as extremely satisfactory for the majority of participants. Participants exhibited a significant reduction in overall clinical symptoms, especially negative symptoms following 10 sessions of MASI-VR. These preliminary results support the feasibility and acceptability of a novel virtual reality social skills training program for individuals with schizophrenia.
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http://dx.doi.org/10.1016/j.psychres.2018.10.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314809PMC
December 2018

Feasibility of Automated Mobility Assessment of Older Adults via an Instrumented Cane.

IEEE J Biomed Health Inform 2019 07 4;23(4):1631-1638. Epub 2018 Oct 4.

This study explored the feasibility of automated characterization of functional mobility via an Instrumented Cane System (ICS) within an older adult sample of cane users. An off-the-shelf offset cane was instrumented with inertial, force, and ultrasound sensors for noninvasive data collection. Eighteen patients from a neurological out-patient rehabilitation clinic and nine independently mobile controls participated in standard clinical evaluations of mobility using the ICS while under the care of an attending physical therapist. Feasibility of the ICS was gauged through two studies. The first demonstrated the capability of the ICS to reliably collect meaningful usage metrics, and the second provided preliminary support for the discriminability of high and low falls risk from system-reported metrics. Specifically, the cane significantly differentiated patients and controls (p < 0.05), and a measure of the variation in rotational velocity was associated with total scores on the Functional Gait Assessment (partial r = 0.61, p < 0.01). These findings may ultimately serve to complement and even extend current clinical assessment practices.
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http://dx.doi.org/10.1109/JBHI.2018.2873991DOI Listing
July 2019

A Novel Multisensory Stimulation and Data Capture System (MADCAP) for Investigating Sensory Trajectories in Infancy.

IEEE Trans Neural Syst Rehabil Eng 2018 08 9;26(8):1526-1534. Epub 2018 Jul 9.

Sensory processing differences, including responses to auditory, visual, and tactile stimuli, are ideal targets for early detection of neurodevelopmental risks, such as autism spectrum disorder. However, most existing studies focus on the audiovisual paradigm and ignore the sense of touch. In this paper, we present a multisensory delivery system that can deliver audio, visual, and tactile stimuli in a controlled manner and capture peripheral physiological, eye gaze, and electroencephalographic response data. The novelty of the system is the ability to provide affective touch. In particular, we have developed a tactile stimulation device that delivers tactile stimuli to infants with precisely controlled brush stroking speed and force on the skin. A usability study of 10 3-20 month-old infants was conducted to investigate the tolerability and feasibility of the system. Results have shown that the system is well tolerated by infants and all the data were collected robustly. This paper paves the way for future studies charting the sensory response trajectories in infancy.
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http://dx.doi.org/10.1109/TNSRE.2018.2854672DOI Listing
August 2018

Understanding Performance and Verbal-Communication of Children with ASD in a Collaborative Virtual Environment.

J Autism Dev Disord 2018 08;48(8):2779-2789

Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA.

Collaborative virtual environments (CVEs), which allow naturalistic communication between two or more individuals in a shared virtual environment, hold promise as a tool for measuring and promoting social communication between peers. In this work, a CVE platform and a set of CVE-based collaborative games are designed for children with autism spectrum disorder (ASD). Two groups (7 ASD/TD pairs; 7 TD/TD pairs) participated in a pilot study to establish system feasibility and tolerability. We also designed a methodology for capturing meaningful metrics of social communication. Based on these metrics, we found improved game performance and trends in communication of these participants over time. Although preliminary, these results provide important insights on CVE-based interaction for ASD intervention.
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http://dx.doi.org/10.1007/s10803-018-3544-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6041154PMC
August 2018

Can Robotic Systems Promote Self-Disclosure in Adolescents with Autism Spectrum Disorder? A Pilot Study.

Front Psychiatry 2018 9;9:36. Epub 2018 Feb 9.

Department of Clinical Research on Social Recognition and Memory, Research Center for Child Mental Development, Kanazawa University, Ishikawa, Japan.

Research suggests that many individuals with autism spectrum disorder (ASD) often demonstrate challenges providing appropriate levels of information during conversational interchanges. Considering the preference of individuals with ASD, and recent rapid technological advances, robotic systems may yield promise in promoting certain aspects of conversation and interaction such as self-disclosure of appropriate personal information. In the current work, we evaluated personal disclosures of events with specific emotional content across two differing robotic systems (android and simplistic humanoid) and human interactions. Nineteen participants were enrolled in this study: 11 (2 women and 9 men) adolescents with ASD and 8 (4 women and 4 men) adolescents with TD. Each participant completed a sequence of three interactions in a random order. Results indicated differences regarding comfort level and length of disclosures between adolescents with ASD and typically developing (TD) controls in relation to system interactions. Specifically, adolescents with ASD showed a preference for interacting with the robotic systems compared to TD controls and demonstrated lengthier disclosures when interacting with the visually simple humanoid robot compared to interacting with human interviewer. The findings suggest that robotic systems may be useful in eliciting and promoting aspects of social communication such as self-disclosure for some individuals with ASD.
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http://dx.doi.org/10.3389/fpsyt.2018.00036DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5811466PMC
February 2018

Impressions of Humanness for Android Robot may Represent an Endophenotype for Autism Spectrum Disorders.

J Autism Dev Disord 2018 02;48(2):632-634

Research Center for Child Mental Development, Kanazawa University, 13-1, Takaramachi, Kanazawa, Ishikawa, 920-8640, Japan.

Identification of meaningful endophenotypes may be critical to unraveling the etiology and pathophysiology of autism spectrum disorders (ASD). We investigated whether impressions of "humanness" for android robot might represent a candidate characteristic of an ASD endophenotype. We used a female type of android robot with an appearance similar to that of a real person. Significant differences in overall impressions of 'humanness' for android robot were found between adolescents with ASD and typical development (TD) controls, as well as parents of children with ASD and parents of TD controls. Our current work does suggest robotic systems could potentially play an intelligent role in dissecting ASD heterogeneity.
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http://dx.doi.org/10.1007/s10803-017-3365-0DOI Listing
February 2018

Cognitive Load Measurement in a Virtual Reality-based Driving System for Autism Intervention.

IEEE Trans Affect Comput 2017 Apr-Jun;8(2):176-189. Epub 2017 May 23.

Department of Electrical Engineering and Computer Science and Department of Mechanical Engineering, Vanderbilt University, Robotics and Autonomous Systems Laboratory, Vanderbilt University, Department of Mechanical Engineering, Olin Hall Room 101, 2400 Highland Avenue, Nashville, TN, USA. 37212.

Autism Spectrum Disorder (ASD) is a highly prevalent neurodevelopmental disorder with enormous individual and social cost. In this paper, a novel virtual reality (VR)-based driving system was introduced to teach driving skills to adolescents with ASD. This driving system is capable of gathering eye gaze, electroencephalography, and peripheral physiology data in addition to driving performance data. The objective of this paper is to fuse multimodal information to measure cognitive load during driving such that driving tasks can be individualized for optimal skill learning. Individualization of ASD intervention is an important criterion due to the spectrum nature of the disorder. Twenty adolescents with ASD participated in our study and the data collected were used for systematic feature extraction and classification of cognitive loads based on five well-known machine learning methods. Subsequently, three information fusion schemes-feature level fusion, decision level fusion and hybrid level fusion-were explored. Results indicate that multimodal information fusion can be used to measure cognitive load with high accuracy. Such a mechanism is essential since it will allow individualization of driving skill training based on cognitive load, which will facilitate acceptance of this driving system for clinical use and eventual commercialization.
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http://dx.doi.org/10.1109/TAFFC.2016.2582490DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614512PMC
May 2017

A Pilot Study Assessing Performance and Visual Attention of Teenagers with ASD in a Novel Adaptive Driving Simulator.

J Autism Dev Disord 2017 Nov;47(11):3405-3417

Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA.

Individuals with Autism Spectrum Disorder (ASD), compared to typically-developed peers, may demonstrate behaviors that are counter to safe driving. The current work examines the use of a novel simulator in two separate studies. Study 1 demonstrates statistically significant performance differences between individuals with (N = 7) and without ASD (N = 7) with regards to the number of turning-related driving errors (p < 0.01). Study 2 shows that both the performance-based feedback group (N = 9) and combined performance- and gaze-sensitive feedback group (N = 8) achieved statistically significant reductions in driving errors following training (p < 0.05). These studies are the first to present results of fine-grained measures of visual attention of drivers and an adaptive driving intervention for individuals with ASD.
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http://dx.doi.org/10.1007/s10803-017-3261-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693648PMC
November 2017

Socially Assistive Robots: Measuring Older Adults' Perceptions.

J Gerontol Nurs 2017 Dec 13;43(12):35-43. Epub 2017 Jul 13.

To address manpower shortages, health care leaders recommend technology, including robots, to facilitate and augment processes for delivery of efficient, safe care. Little is known regarding older adults' perceptions of socially assistive robots (SARs). Using the Unified Theory of Acceptance and Use Technology framework, a survey was developed and tested for capturing older adults' likelihood to use SARs. The Robot Acceptance Survey (RAS) comprises three subscales: Performance Expectancy, Effort Expectancy, and Attitude. Older adults completed the RAS pre- and post-experimental procedure with a SAR. Cronbach's alpha coefficients for the subscales ranged from 0.77 to 0.89. Subscales were sensitive to change, with more positive reactions after exposure to SAR activities. Future studies must identify robotic programming capable of providing cognitive, physical, and social assistance, as well as person-, activity-, situation-, and robot-specific factors that will influence older adults' acceptance of SARs. [Journal of Gerontological Nursing, 43(12), 35-43.].
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http://dx.doi.org/10.3928/00989134-20170707-04DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5989313PMC
December 2017

Design of an Autonomous Social Orienting Training System (ASOTS) for Young Children With Autism.

IEEE Trans Neural Syst Rehabil Eng 2017 06;25(6):668-678

Social communication is among the core areas of impairment for children with Autism Spectrum Disorders (ASD). The training of social orientation is important for improving social communication of children with ASD. In recent years, technology-assisted ASD intervention had gained momentum due to its potential advantages in terms of precision, sustainability, flexibility and cost. In this paper, we propose a closed-loop autonomous computer system, named ASOTS, for training social orientation skills to young children with ASD. This system is designed to detect and track a child's attention in response to social orientation bids and help the child towards appropriate social orientation when needed. Response to name, an important social orientation skill, was used to demonstrate the functionality of the proposed system. Ten toddlers with ASD participated in a pilot user study to show whether the system could be used on young children who have been diagnosed with ASD. Another pilot user study with 10 TD infants tested whether this system has a potential to be applied for early detection for infants who were younger than the age when ASD diagnoses can be done. This was done intentionally to separately demonstrate utility and functionality for the clinical population of interest and to demonstrate functionality beyond current clinical identification capacity (i.e., infants). The results showed that the proposed system and the protocol were well tolerated by both groups, successfully captured young children's attention, and elicited the desired behavior.
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http://dx.doi.org/10.1109/TNSRE.2016.2598727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5582800PMC
June 2017
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