A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

Background: Many infants in developing countries are faced with poverty, poor nutrition, limited access to healthcare, and exposure to communicable diseases that place them at risk for negative developmental consequences. Dysphagia is estimated to occur in 25-40% of normally developing, and 80-90% of infants with disabilities. International studies report the common causes of dysphagia to be of gastro-intestinal and neurological origin, yet limited research exists into the profile of paediatric dysphagia within developing contexts. Objective: To describe the profile of paediatric dysphagia in state hospitals, Gauteng. Methods: By means of a retrospective record review, this study investigated paediatric dysphagia (0-18 months) in state hospitals, Johannesburg. Hospital records of 263 infants with feeding impairments were analysed using descriptive statistics, phi correlations and logistical regression. Results: Findings revealed 214 underlying aetiological combinations whereby 65% (n=171) of infants experienced dysphagia secondary to a systemic illness, predominantly communicable diseases. The health professionals, management strategies and procedures employed in the assessment and intervention of paediatric dysphagia were context specific and related to the aetiological and social factors influencing the infants. Conclusion: Results differ significantly to those reflected in studies from developed countries. Of concern is the fact that 65% of infants experienced dysphagia secondary to a systemic illness, since with adequate nutrition, sanitation and health care, these conditions are potentially preventable. By improving social circumstances, the effects of systemic illnesses may be minimised, and may consequently decrease the number of infants affected by dysphagia. This implies that paediatric dysphagia in South Africa is no longer merely a health dilemma, but one which involves basic human rights.

The way in which infants play with objects can be indicative of their developmental progress and may serve as an early indicator for developmental delays. However, the observation of children interacting with toys for the purpose of quantitative analysis can be a difficult task. To better quantify how play may serve as an early indicator, researchers have conducted retrospective studies examining the differences in object play behaviors among infants. However, such studies require that researchers repeatedly inspect videos of play often at speeds much slower than real-time to indicate points of interest. The research presented in this dissertation examines whether a combination of sensors embedded within toys and automatic pattern recognition of object play behaviors can help expedite this process. For my dissertation, I developed the Child'sPlay system which uses augmented toys and statistical models to automatically provide quantitative measures of object play interactions, as well as, provide the PlayView interface to view annotated play data for later analysis. In this dissertation, I examine the hypothesis that sensors embedded in objects can provide sufficient data for automatic recognition of certain exploratory, relational, and functional object play behaviors in semi-naturalistic environments and that a continuum of recognition accuracy exists which allows automatic indexing to be useful for retrospective review. I designed several augmented toys and used them to collect object play data from more than fifty play sessions. I conducted pattern recognition experiments over this data to produce statistical models that automatically classify children's object play behaviors. In addition, I conducted a user study with twenty participants to determine if annotations automatically generated from these models help improve performance in retrospective review tasks. My results indicate that these statistical models increase user performance and decrease perceived effort when combined with the PlayView interface during retrospective review. The presence of high quality annotations are preferred by users and promotes an increase in the effective retrieval rates of object play behaviors.