The present invention relates to an automatic method for measuring a baby's, particularly a newborn's, cry, and the related apparatus, that allows in a simple, reliable, and inexpensive way to provide an indication of the pain level suffered by the baby starting from the analysis of his/her cry acoustic characteristics.
Pain has different levels, quantifiable from zero up to a maximum, and the behaviour of babies consequently varies. In the last years, pain scales have been developed for discriminating the level of pain suffered by a newborn.
By way of example, the score scale known as Newborn's Sharp Pain, or DAN (Douleur Aiguë Nouveau-né), evaluates facial expressions, limb movements, and newborn's vocalizations for generating a score ranging from 0 (corresponding to lack of pain) and 10 (corresponding to maximum pain).
However, such scales are hardly usable, since they cannot be easily automated so as to provide objective and repeatable indications, because they require an active evaluation by an operator.
It is therefore an object of the present invention to provide in a simple, reliable, and inexpensive way an automatic, and hence objective and repeatable, indication of a baby's, in particular a newborn's, pain level.
It is specific subject matter of the present invention an automatic method for measuring a baby's cry, comprising the following step:
In other words, the automatic method according to the invention measures a baby's, in particular a newborn's, cry starting from its time and/or spectral acoustic analysis.
In particular, the method is based on recording and analysing newborn's cry. The pain level is preferably assigned through the combined evaluation of a set of one or more measurable acoustic parameters, which are related to the pain level. A quantitative estimate of the pain level is obtained on the basis of a validated pain scale, based on the cry acoustic characteristics.
The acoustic parameters used for the diagnosis comprise one or more of the following three ones: the fundamental or pitch frequency; the normalised amplitude, with respect to the maximum value, of the root-mean-square or rms value; and the presence of a specific characteristic of cry frequency and amplitude modulation, which characteristic is defined as “siren cry”. The method provides as output value a score, preferably ranging from 0 to 6, that is proposed as an adequate scale for describing the pain level.
Further characteristics of other embodiments of the method according to the invention are defined in the enclosed claims 2-29.
It is still subject matter of the present invention an apparatus for measuring a baby's cry, comprising processing means, characterised in that it is capable to perform the previously described automatic method for measuring a baby's cry, the apparatus preferably further comprising means for detecting acoustic signals, and sampling means, capable to sample said acoustic signals.
In other words, the apparatus according to the invention performs the aforementioned automatic method for measuring a baby's cry, through an automatic acoustic analysis of the newborn's cry, in order to provide an objective estimate of the newborn's pain level.
The present invention will now be described, by way of illustration and not by way of limitation, according to its preferred embodiments, by particularly referring to the Figures of the enclosed drawings, in which:
In the following of the description same references will be used to indicate alike elements in the Figures.
As mentioned, the cry acoustic parameters which are measured by the method according to the invention for providing a measure of the cry, indicative of the pain level suffered by the baby, comprise:
The higher the values of such acoustic parameters are, the higher is the pain level of the baby.
The normalised to its maximum value rms value is not a measure of the cry absolute intensity, but it is rather a measure of the emission constancy: in other words, it measures the fraction of the observation time along which the signal is close to its maximum. This is related to the pain level, since a suffering newborn tends to cry for long time close to its maximum reachable level. Preferably, a normalised rms value over 0.15-0.2 is associated with high pain levels.
The fundamental frequency or pitch is typically higher in cry caused by pain. A pitch frequency over 350-450 Hz is typically correlated with high pain levels.
Another specific characteristic of cry due to a high pain is the regularity and reproducibility of the configurations of amplitude and frequency modulation on a short time scale, of the order of 1 second, which configurations define the so-called siren cry, with a persistent configuration lasting several periods. The time-frequency intensity configuration of this siren cry shows a periodical modulation of the fundamental frequency F0 and of its multiple frequencies, while the mean power spectrum has a quasi-periodical peak structure.
All the three cry acoustic parameters described above are correlated with the pain level, independently evaluated by using the DAN score scale.
With reference to
Afterwards, the method comprises a step 2 of processing a first score on the basis of the root-mean-square value in the period P of the N samples p(i) of the acoustic signal p(t).
The method still comprises a step 3 of processing a second score on the basis of the fundamental or pitch frequency F0 of the acoustic signal p(t), that is on the basis of the minimum frequency at which a peak in the spectrum of the acoustic signal p(t) occurs.
Furthermore, the method comprises a step 4 of processing a third score on the basis of the characteristic defined as “siren cry”, preferably not null only in case of persistent cry, i.e. with value of the first score larger than a corresponding threshold value.
Finally, the method comprises a step 5 of adding up the three calculated scores, that is given as output in a step 6.
With reference to
In particular,
Preferably the first function g1(prmsnorm) is continuous, more preferably equal to:
where coefficients α and β are preferably equal to the following values:
α=100
β=0.14 [2]
so that the values of score(prmsnorm) meet the following conditions:
for prmsnorm<<0.1 it is score(prmsnorm)≈0
for prmsnorm=0.1 it is score(prmsnorm)=0.15
for prmsnorm=0.14 it is score(prmsnorm)=1
for prmsnorm=0.18 it is score(prmsnorm)=1.85
for prmsnorm>>0.18 it is score(prmsnorm)≈2
Alternatively, the first function g1(prmsnorm) may be discrete, so that the possible values of prmsnorm are subdivided into at least two ranges to which a respective value of score(prmsnorm) corresponds. Preferably, such discrete function may be the following:
With reference to
N
D
=N/M=2(A-B).
In order to avoid in the successive frequency analysis the introduction of spurious spectral characteristics caused by cutting the waveform off, in sub-step 31 a Hanning window WH(j) (for 0, 1, . . . , (ND−1)) is applied to each interval, thus obtaining, for each one of the M intervals, ND samples pHk(j) (where k is the interval index, i.e. k=0, 1, . . . , (M−1));
p
Hk(j)=p(ND·k+j)·WH(j)
In successive sub-step 32, it is calculated for each interval the power spectrum of the digitised signal:
S
Hk(j)=FTND{pHk(j)}
where y(j)=FTND{x(j)} indicates the operator FTND (preferably the Fourier transform of the autocorrelation function) that transforms ND samples x(j) from the time domain to ND samples y(j) in the frequency domain. As a consequence, in sub-step 32 it is obtained a time sequence of M spectra, each one with a frequency resolution Rf equal to:
R
f
=f
s
/N
D
and a bandwidth B1 equal to the Nyquist frequency:
B1=fs/2.
Afterwards, in sub-step 33 it is calculated the mean spectrum
Sub-step 34 determines the mean value Smean of the mean spectrum
Sub-step 35 determines the pitch F0 as the minimum frequency at which a peak of the mean power spectrum
F
0
=R
f·min{j|max_relative[
This definition of the pitch F0 is independent from the absolute calibration.
In particular,
Still with reference to
Preferably the second function g2(F0) is continuous, more preferably equal to:
where coefficients γ and δ are preferably equal to the following values:
γ=100
δ=0.4 [4]
so that the values of score(F0) meet the following conditions:
for F0<<350 Hz it is score(F0)≈0
for F0=350 Hz it is score(F0)=0.13
for F0=400 Hz it is score(F0)=1
for F0=450 Hz it is score(F0)=1.87
for F0>>450 Hz it is score(F0)≈2
Alternatively, the second function g2(F0) may be discrete, so that the possible values of F0 are subdivided into at least two ranges to which a respective value of score(F0) corresponds. Preferably, such discrete function may be as follows:
With reference to
In sub-step 42, it is calculated the mean value
In sub-step 43, it is calculated the deviation ΔEF3
ΔEF3
In sub-step 44, a window Wflat-top(k) (for k=0, 1, . . . , (M−1)) having spectrum with flat top main lobe, known as flat-top window, is applied to such deviation, thus obtaining M samples ΔEF3
ΔEF3
In next sub-step 45, it is calculated the digitised power spectrum VF3
V
F3
F4(k)=FTM{ΔEF3
VR
f
=f
s
/N
and a bandwidth B2 equal to:
B2=fs/(2·ND).
In next sub-step 46, it is calculated the energy contribution VXTND
In next sub-step 47, it is calculated the energy contribution VSHRT
Afterwards, step 4 evaluates the presence and, possibly, the level of the so-called siren cry on the basis of a comparison of the energy contribution VSHRT
Preferably, the third function g3(VXTND
In fact, as shown in
score(siren cry)=2
Instead, in the case when the verification of sub-step 48 gives a negative outcome, the siren cry characteristic is considered as absent, and sub-step 50 is performed, in which a null value is assigned to the third score:
score(siren cry)=0
Such score is preferably also assigned in the case when there is no persistent cry, i.e. in the case when the normalised rms value of the acoustic signal is low. As shown in
In the case when the verification of sub-step 40 has a positive outcome, i.e. a persistent cry has been recognised, then step 4 of
Otherwise, i.e. in the case when the verification of sub-step 40 has a negative outcome, step 4 of
Alternatively, the third function g3(VXTND
Still alternatively, the third function g3(VXTND
In the following a prototype made by the inventors is illustrated, that operates according to a preferred embodiment of the method according to the invention for discriminating different pain levels. In particular, the prototype has been tested by analysing the cry, during heel prick, of 57 newborns, the pain intensity of which has been independently evaluated according the DAN index.
The acoustic signal coming from a ½ inch (i.e. 1.27 cm) microphone, with a 50 mV/Pa sensitivity, has been sample at a frequency of 44.1 kHz, corresponding to a Nyquist frequency of 22.05 kHz. This frequency corresponds to the standard sampling rate of commercial audio devices. A digitised electronic files of about 23.77 s of duration (thus comprising N=220 samples) has been extracted by each recording, starting from a given time t0 established by the operator.
The digitised waveform has been divided into M=256 (equal to 28) time intervals, each one of about 92.88 ms of duration. The signal power spectrum has been calculated for each interval for providing a time sequence of 256 spectra for each newborn, with a frequency resolution of about 10.77 Hz. As said, in order to avoid the introduction of spurious spectral characteristics caused by cutting the waveform off, a Hanning window has been applied to each interval. Time evolution of these spectra has been displayed as time-frequency intensity graphs, which may be used for a preliminary heuristic analysis. The acoustic pressure signal p(t) of each cry sequence has been normalised to its maximum amplitude pmax. The rms value of the normalised acoustic pressure has been calculated for each waveform. A first score has been assigned to the normalised rms value by means of the continuous function [1] that is optimised as in [2].
It has been then calculated the mean of the 256 spectra, in order to determine the pitch F0 as the minimum frequency at which a peak of the mean power spectrum occurs. In particular, a peak has been considered as such when the signal exceeds by at least 5 dB the mean level of the spectrum within the frequency range 3-7.5 kHz.
A third score has been assigned to the pitch value F0 by means of the continuous function [3] that is optimised as in [4].
It has been then performed the automatic procedure for recognising the “siren cry”, which is only applied in case of persistent cry, i.e. with pain score due to a normalised rms value larger than a threshold (equal to 1.85). In particular:
The pain score as illustrated in
in the case when the siren cry is present,
score(siren cry)=2;
in the case when the siren cry is absent,
score(siren cry)=0.
The total score PainScore, equal to the sum of the three (possibly weighed) scores which are calculated with respect to the three characteristics of the cry acoustic signal:
PainScore=score(prmsnorm)+score(F0)+score(siren cry)
has given a reliable indication of the level of pain suffered by the newborn by means of the following correspondence table, validated in literature:
The prototype implementation of the analysis procedure has been made by using the software LabVIEW from the National Instruments.
The instrument has been successfully tested on the recordings of 57 crying newborns, whose pain level has been independently evaluated by using the DAN index, providing values in accordance with the ones of the prototype.
The preferred embodiments have been above described and some modifications of this invention have been suggested, but it should be understood that those skilled in the art can make other variations and changes, without so departing from the related scope of protection, as defined by the following claims.
Number | Date | Country | Kind |
---|---|---|---|
RM2005A000110 | Mar 2005 | IT | national |
Filing Document | Filing Date | Country | Kind | 371c Date |
---|---|---|---|---|
PCT/IT06/00145 | 3/10/2006 | WO | 00 | 10/15/2007 |