Optimizing the Scale of a Wavelet-Based Method for the Detection of Gait Events from a Waist-Mounted Accelerometer under Different Walking Speeds.

The accurate and reliable extraction of specific gait events from a single inertial sensor at waist level has been shown to be challenging. Among several techniques, a wavelet-based method for initial contact (IC) and final contact (FC) estimation was shown to be the most accurate in healthy subjects. In this study, we evaluated the sensitivity of events detection to the wavelet scale of the algorithm, when walking at different speeds, in order to optimize its selection. A single inertial sensor recorded the lumbar vertical acceleration of 20 subjects walking at three different self-selected speeds (slow, normal, and fast) in a motion analysis lab. The scale of the wavelet method was varied. ICs were generally accurately detected in a wide range of wavelet scales under all the walking speeds. FCs detection proved highly sensitive to scale choice. Different gait speeds required the selection of a different scale for accurate detection and timing, with the optimal scale being strongly correlated with subjects' step frequency. The best speed-dependent scales of the algorithm led to highly accurate timing in the detection of IC (RMSE < 22 ms) and FC (RMSE < 25 ms) across all speeds. Our results pave the way for the optimal adaptive selection of scales in future applications using this algorithm.

Thermal Energy Harvesting on the Bodily Surfaces of Arms and Legs through a Wearable Thermo-Electric Generator.

This work analyzes the results of measurements on thermal energy harvesting through a wearable Thermo-electric Generator (TEG) placed on the arms and legs. Four large skin areas were chosen as locations for the placement of the TEGs. In order to place the generator on the body, a special manufactured band guaranteed the proper contact between the skin and TEG. Preliminary measurements were performed to find out the value of the resistor load which maximizes the power output. Then, an experimental investigation was conducted for the measurement of harvested energy while users were performing daily activities, such as sitting, walking, jogging, and riding a bike. The generated power values were in the range from 5 to 50 μW. Moreover, a preliminary hypothesis based on the obtained results indicates the possibility to use TEGs on leg for the recognition of locomotion activities. It is due to the rather high and different biomechanical work, produced by the gastrocnemius muscle, while the user is walking rather than jogging or riding a bike. This result reflects a difference between temperatures associated with the performance of different activities.

Haralick's texture features for the prediction of response to therapy in colorectal cancer: a preliminary study.

PURPOSE: Haralick features Texture analysis is a recent oncologic imaging biomarker used to assess quantitatively the heterogeneity within a tumor. The aim of this study is to evaluate which Haralick's features are the most feasible in predicting tumor response to neoadjuvant chemoradiotherapy (CRT) in colorectal cancer. MATERIALS AND METHODS: After MRI and histological assessment, eight patients were enrolled and divided into two groups based on response to neoadjuvant CRT in complete responders (CR) and non-responders (NR). Oblique Axial T2-weighted MRI sequences before CRT were analyzed by two radiologists in consensus drawing a ROI around the tumor. 14 over 192 Haralick's features were extrapolated from normalized gray-level co-occurrence matrix in four different directions. A dedicated statistical analysis was performed to evaluate distribution of the extracted Haralick's features computing mean and standard deviation. RESULTS: Pretreatment MRI examination showed significant value (p < 0.05) of 5 over 14 computed Haralick texture. In particular, the significant features are the following: concerning energy, contrast, correlation, entropy and inverse difference moment. CONCLUSIONS: Five Haralick's features showed significant relevance in the prediction of response to therapy in colorectal cancer and might be used as additional imaging biomarker in the oncologic management of colorectal patients.

Measurements of Generated Energy/Electrical Quantities from Locomotion Activities Using Piezoelectric Wearable Sensors for Body Motion Energy Harvesting.

In this paper, two different piezoelectric transducers-a ceramic piezoelectric, lead zirconate titanate (PZT), and a polymeric piezoelectric, polyvinylidene fluoride (PVDF)-were compared in terms of energy that could be harvested during locomotion activities. The transducers were placed into a tight suit in proximity of the main body joints. Initial testing was performed by placing the transducers on the neck, shoulder, elbow, wrist, hip, knee and ankle; then, five locomotion activities-walking, walking up and down stairs, jogging and running-were chosen for the tests. The values of the power output measured during the five activities were in the range 6 µW-74 µW using both transducers for each joint.

Intermuscular coherence contributions in synergistic muscles during pedaling.

The execution of rhythmical motor tasks requires the control of multiple skeletal muscles by the Central Nervous System (CNS), and the neural mechanisms according to which the CNS manages their coordination are not completely clear yet. In this study, we analyze the distribution of the neural drive shared across muscles that work synergistically during the execution of a free pedaling task. Electromyographic (EMG) activity was recorded from eight lower limb muscles of eleven healthy untrained participants during an unconstrained pedaling exercise. The coordinated activity of the lower limb muscles was described within the framework of muscle synergies, extracted through the application of nonnegative matrix factorization. Intermuscular synchronization was assessed by calculating intermuscular coherence between pairs of EMG signals from co-active, both synergistic and non-synergistic muscles within their periods of co-activation. The spatiotemporal structure of muscle coordination during pedaling was well represented by four muscle synergies for all the subjects. Significant coherence values within the gamma band (30-60 Hz) were identified only for one out of the four extracted muscle synergies. This synergy is mainly composed of the activity of knee extensor muscles, and its function is related to the power production and crank propelling during the pedaling cycle. In addition, a significant coherence peak was found in the lower frequencies for the GAM/SOL muscle pair, possibly related to the ankle stabilizing function of these two muscles during the pedaling task. No synchronization was found either for the other extracted muscle synergies or for pairs of co-active but non-synergistic muscles. The obtained results seem to suggest the presence of intermuscular synchronization only when a functional force production is required, with the observed gamma band contribution possibly reflecting a cortical drive to synergistic muscles during pedaling.

Pre-Processing Effect on the Accuracy of Event-Based Activity Segmentation and Classification through Inertial Sensors.

Inertial sensors are increasingly being used to recognize and classify physical activities in a variety of applications. For monitoring and fitness applications, it is crucial to develop methods able to segment each activity cycle, e.g., a gait cycle, so that the successive classification step may be more accurate. To increase detection accuracy, pre-processing is often used, with a concurrent increase in computational cost. In this paper, the effect of pre-processing operations on the detection and classification of locomotion activities was investigated, to check whether the presence of pre-processing significantly contributes to an increase in accuracy. The pre-processing stages evaluated in this study were inclination correction and de-noising. Level walking, step ascending, descending and running were monitored by using a shank-mounted inertial sensor. Raw and filtered segments, obtained from a modified version of a rule-based gait detection algorithm optimized for sequential processing, were processed to extract time and frequency-based features for physical activity classification through a support vector machine classifier. The proposed method accurately detected >99% gait cycles from raw data and produced >98% accuracy on these segmented gait cycles. Pre-processing did not substantially increase classification accuracy, thus highlighting the possibility of reducing the amount of pre-processing for real-time applications.

Intelligent Human-Computer Interaction: Combined Wrist and Forearm Myoelectric Signals for Handwriting Recognition.

Recent studies have highlighted the possibility of using surface electromyographic (EMG) signals to develop human-computer interfaces that are also able to recognize complex motor tasks involving the hand as the handwriting of digits. However, the automatic recognition of words from EMG information has not yet been studied. The aim of this study is to investigate the feasibility of using combined forearm and wrist EMG probes for solving the handwriting recognition problem of 30 words with consolidated machine-learning techniques and aggregating state-of-the-art features extracted in the time and frequency domains. Six healthy subjects, three females and three males aged between 25 and 40 years, were recruited for the study. Two tests in pattern recognition were conducted to assess the possibility of classifying fine hand movements through EMG signals. The first test was designed to assess the feasibility of using consolidated myoelectric control technology with shallow machine-learning methods in the field of handwriting detection. The second test was implemented to assess if specific feature extraction schemes can guarantee high performances with limited complexity of the processing pipeline. Among support vector machine, linear discriminant analysis, and K-nearest neighbours (KNN), the last one showed the best classification performances in the 30-word classification problem, with a mean accuracy of 95% and 85% when using all the features and a specific feature set known as TDAR, respectively. The obtained results confirmed the validity of using combined wrist and forearm EMG data for intelligent handwriting recognition through pattern recognition approaches in real scenarios.

Machine learning to detect, stage and classify diseases and their symptoms based on inertial sensor data: a mapping review.

This article presents a systematic review aimed at mapping the literature published in the last decade on the use of machine learning (ML) for clinical decision-making through wearable inertial sensors. The review aims to analyze the trends, perspectives, strengths, and limitations of current literature in integrating ML and inertial measurements for clinical applications. The review process involved defining four research questions and applying four relevance assessment indicators to filter the search results, providing insights into the pathologies studied, technologies and setups used, data processing schemes, ML techniques applied, and their clinical impact. When combined with ML techniques, inertial measurement units (IMUs) have primarily been utilized to detect and classify diseases and their associated motor symptoms. They have also been used to monitor changes in movement patterns associated with the presence, severity, and progression of pathology across a diverse range of clinical conditions. ML models trained with IMU data have shown potential in improving patient care by objectively classifying and predicting motor symptoms, often with a minimally encumbering setup. The findings contribute to understanding the current state of ML integration with wearable inertial sensors in clinical practice and identify future research directions. Despite the widespread adoption of these technologies and techniques in clinical applications, there is still a need to translate them into routine clinical practice. This underscores the importance of fostering a closer collaboration between technological experts and professionals in the medical field.

Modalities of sequential human robot collaboration trigger different modifications of trunk oscillations.

Introduction: Human robot collaboration is quickly gaining importance in the robotics and ergonomics fields due to its ability to reduce biomechanical risk on the human operator while increasing task efficiency. The performance of the collaboration is typically managed by the introduction of complex algorithms in the robot control schemes to ensure optimality of its behavior; however, a set of tools for characterizing the response of the human operator to the movement of the robot has yet to be developed. Methods: Trunk acceleration was measured and used to define descriptive metrics during various human robot collaboration strategies. Recurrence quantification analysis was used to build a compact description of trunk oscillations. Results and discussion: The results show that a thorough description can be easily developed using such methods; moreover, the obtained values highlight that, when designing strategies for human robot collaboration, ensuring that the subject maintains control of the rhythm of the task allows to maximize comfort in task execution, without affecting efficiency.

Automated conduction velocity estimation based on isochronal activation of heart chambers.

BACKGROUND: Spatial differences in conduction velocity (CV) are critical for cardiac arrhythmias induction. We propose a method for an automated CV calculation to identify areas of slower conduction during cardiac arrhythmias and sinus rhythm. METHODS: Color-coded representations of the isochronal activation map using data coming from the RHYTHMIA™ Mapping System were reproduced by applying a temporal isochronal window at 20 ms. Geodesic distances of the 3D mesh were calculated using an algorithm selecting the minimum distance pathway (MDP). The CV estimation was performed considering points on the boundary of two spatially and temporally adjacent isochrones. For each of the boundary points of a given isochrone, the nearest boundary point of the consecutive isochrone was chosen, the MDP was evaluated, and a map of CV was created. The proposed method has been applied to a population of 29 patients. RESULTS: In all cases of perimitral atrial flutter (16 pts out of 29 (55%)), areas with significantly low CV (< 30 cm/s) were found. Half of the cases present regions with low CV located in the anterior wall. No case with low CV at the so-called LA isthmus was observed. Right atrial maps during common atrial flutters showed low CV areas mainly located in the inferior inter-atrial septum. No areas of low CV were observed in subjects without a history of atrial arrhythmia while pts affected by paroxysmal AF showed areas with a limited extension of low CV. CONCLUSIONS: The proposed software for automated CV estimation allows the identification of low CV areas, potentially helping electrophysiologists to plan the ablation strategy.

A free geometry model-independent neural eye-gaze tracking system.

BACKGROUND: Eye Gaze Tracking Systems (EGTSs) estimate the Point Of Gaze (POG) of a user. In diagnostic applications EGTSs are used to study oculomotor characteristics and abnormalities, whereas in interactive applications EGTSs are proposed as input devices for human computer interfaces (HCI), e.g. to move a cursor on the screen when mouse control is not possible, such as in the case of assistive devices for people suffering from locked-in syndrome. If the user's head remains still and the cornea rotates around its fixed centre, the pupil follows the eye in the images captured from one or more cameras, whereas the outer corneal reflection generated by an IR light source, i.e. glint, can be assumed as a fixed reference point. According to the so-called pupil centre corneal reflection method (PCCR), the POG can be thus estimated from the pupil-glint vector. METHODS: A new model-independent EGTS based on the PCCR is proposed. The mapping function based on artificial neural networks allows to avoid any specific model assumption and approximation either for the user's eye physiology or for the system initial setup admitting a free geometry positioning for the user and the system components. The robustness of the proposed EGTS is proven by assessing its accuracy when tested on real data coming from: i) different healthy users; ii) different geometric settings of the camera and the light sources; iii) different protocols based on the observation of points on a calibration grid and halfway points of a test grid. RESULTS: The achieved accuracy is approximately 0.49°, 0.41°, and 0.62° for respectively the horizontal, vertical and radial error of the POG. CONCLUSIONS: The results prove the validity of the proposed approach as the proposed system performs better than EGTSs designed for HCI which, even if equipped with superior hardware, show accuracy values in the range 0.6°-1°.

Classifying reaching height through muscle synergies in unconstrained scenarios.

Muscle synergy analysis has been widely adopted in the literature for the analysis of upper limb surface electromyographic signals during reaching tasks and for the prediction of movement direction for myoelectric control purposes. However, previous studies have characterized movements in constrained or semi-constrained scenarios, in which the subjects performing the movement were instructed to reach particular targets or were given some kind of feedback. In this work, the same synergy model has been applied to a completely unconstrained upper limb reaching experiment, with the aim of classifying the height of the target starting from the activity of the synergies. Results show that the synergistic model is able to extract compact features that can identify with good performance three different reaching heights. Moreover, this representation is able to isolate the signals that contain predictive information about the movement direction from the ones that are related to movement timing; this, together with the good performance of the synergy-based classifier supports the proposal of applying this model to the pre-processing of electromyographic signals when dealing with control systems that use signals from multiple muscles to predict movements.

Use of a modified SIR-V model to quantify the effect of vaccination strategies on hospital demand during the Covid-19 pandemic.

A novel compartmental model that includes vaccination strategy, permanence in hospital wards and tracing of infected individuals has been implemented to forecast hospital overload caused by COVID-19 pandemics in Italy. The model parameters were calibrated according to available data on cases, hospital admissions, and number of deaths in Italy during the second wave, and were validated in the timeframe corresponding to the first successive wave where vaccination campaign was fully operational. This model allowed quantifying the decrease of hospital demand in Italy associated with the vaccination campaign. Clinical relevance This study provides evidence for the ability of deterministic SIR-based models to accurately forecast hospital demand dynamics, and support informed decisions regarding dimensioning of hospital personnel and technologies to respond to large-scale epidemics, even when vaccination campaigns are available.

Short-Term Effects of Mitigation Measures for the Containment of the COVID-19 Outbreak: An Experience From Northern Italy.

We evaluated the short-term effects of mitigation measures imposed by the Italian government on the first 10 municipalities affected by Sars-Cov-2 spread. Our results suggest that the effects of containment measures can be appreciated in about approximately 2 wk.

Investigating the Determinants of High Case-Fatality Rate for Coronavirus Disease 2019 in Italy.

Case-Fatality Rate (CFR) for COVID-19 in Italy is apparently much higher than in other countries. Using data from Italy and other countries we evaluated the role of different determinants of this phenomenon. We found that the Italian testing strategy could explain an important part of the observed difference in CFR. In particular, the majority of patients that are currently tested in Italy have severe clinical symptoms that usually require hospitalization and this translates to a large CFR. We are confident that, once modifications in the testing strategy leading to higher population coverage are consistently adopted in Italy, CFR will realign with the values reported worldwide.

Smartphone-Based Answering to School Subject Questions Alters Gait in Young Digital Natives.

Smartphone texting while walking is a very common activity among people of different ages, with the so-called "digital natives" being the category most used to interacting with an electronic device during daily activities, mostly for texting purposes. Previous studies have shown how the concurrency of a smartphone-related task and walking can result in a worsening of stability and an increased risk of injuries for adults; an investigation of whether this effect can be identified also in people of a younger age can improve our understanding of the risks associated with this common activity. In this study, we recruited 29 young adolescents (12 ± 1 years) to test whether walking with a smartphone increases fall and injuries risk, and to quantify this effect. To do so, participants were asked to walk along a walkway, with and without the concurrent writing task on a smartphone; several different parameters linked to stability and risk of fall measures were then calculated from an inertial measurement unit and compared between conditions. Smartphone use determined a reduction of spatio-temporal parameters, including step length (from 0.64 ± 0.08 to 0.55 ± 0.06 m) and gait speed (1.23 ± 0.16 to 0.90 ± 0.16 m/s), and a general worsening of selected indicators of gait stability. This was found to be mostly independent from experience or frequency of use, suggesting that the presence of smartphone activities while walking may determine an increased risk of injury or falls also for a population that grew up being used to this concurrency.

Progression of muscular co-activation and gait variability in children with Duchenne muscular dystrophy: A 2-year follow-up study.

BACKGROUND: Duchenne muscular dystrophy is an X-linked muscle disease caused by dystrophin absence. Muscle weakness is a major determinant of the gait impairments in patients with Duchenne muscular dystrophy and it affects lower limbs more often than upper limbs. Monitoring progression of motor symptoms is key to plan treatments for prolonging ambulation. METHODS: The progression of gait impairment in a group of ten patients with Duchenne muscular dystrophy was observed longitudinally three times over a period of 2 years by computerized gait analysis system. Spatio-temporal parameters of gait, and variability indicators were extracted from kinematics, while lower limb muscles coactivation were measured at the baseline and at each follow-up evaluation. The 6-min walk test was used to evaluate functional capacity at each time session. FINDINGS: We found a significant increase in stride width and in both stride width and stride length variability at the 1-and 2-year follow-up evaluations. Furthermore, significant higher values in proximal muscle coactivation and significant lower values in both distal muscle coactivation and functional capacity were found at the 2-year follow-up evaluation. Significant negative correlations between muscle coactivation at proximal level and functional capacity and between muscle coactivation at distal level and gait variability were observed. INTERPRETATION: Our findings suggest that patients with Duchenne muscular dystrophy exhibit decline in functional capacity after 2 years from the baseline. Moreover, to cope with disease progression, patients try to maintain an effective gait by changing the balance dynamic strategies (i.e. increase in proximal muscle coactivation) during the course of disease.

Wearable-based Temporal Parameters of Gait in Circuitous Routes under Dual-Task Conditions.

12 young adults were requested to walk along a circuitous path including turns, slaloms, stair ascending and descending, while wearing an inertial sensor placed on the back at the lumbar level. The path was completed under two conditions: with no additive cognitive task, and while performing a cognitive task and texting on a smartphone. Different temporal global parameters of gait were extracted from the inertial sensor data, to check for differences driven by the presence of the cognitive task. Regularity, durations, and temporal characteristics of gait resulted significantly affected from the presence of the additional task, and this effect was only in part due to a modification coming from the decrease in walking speed.

Automated Segmentation of Colorectal Tumor in 3D MRI Using 3D Multiscale Densely Connected Convolutional Neural Network.

The main goal of this work is to automatically segment colorectal tumors in 3D T2-weighted (T2w) MRI with reasonable accuracy. For such a purpose, a novel deep learning-based algorithm suited for volumetric colorectal tumor segmentation is proposed. The proposed CNN architecture, based on densely connected neural network, contains multiscale dense interconnectivity between layers of fine and coarse scales, thus leveraging multiscale contextual information in the network to get better flow of information throughout the network. Additionally, the 3D level-set algorithm was incorporated as a postprocessing task to refine contours of the network predicted segmentation. The method was assessed on T2-weighted 3D MRI of 43 patients diagnosed with locally advanced colorectal tumor (cT3/T4). Cross validation was performed in 100 rounds by partitioning the dataset into 30 volumes for training and 13 for testing. Three performance metrics were computed to assess the similarity between predicted segmentation and the ground truth (i.e., manual segmentation by an expert radiologist/oncologist), including Dice similarity coefficient (DSC), recall rate (RR), and average surface distance (ASD). The above performance metrics were computed in terms of mean and standard deviation (mean ± standard deviation). The DSC, RR, and ASD were 0.8406 ± 0.0191, 0.8513 ± 0.0201, and 2.6407 ± 2.7975 before postprocessing, and these performance metrics became 0.8585 ± 0.0184, 0.8719 ± 0.0195, and 2.5401 ± 2.402 after postprocessing, respectively. We compared our proposed method to other existing volumetric medical image segmentation baseline methods (particularly 3D U-net and DenseVoxNet) in our segmentation tasks. The experimental results reveal that the proposed method has achieved better performance in colorectal tumor segmentation in volumetric MRI than the other baseline techniques.

A neural tracking and motor control approach to improve rehabilitation of upper limb movements.

BACKGROUND: Restoration of upper limb movements in subjects recovering from stroke is an essential keystone in rehabilitative practices. Rehabilitation of arm movements, in fact, is usually a far more difficult one as compared to that of lower extremities. For these reasons, researchers are developing new methods and technologies so that the rehabilitative process could be more accurate, rapid and easily accepted by the patient. This paper introduces the proof of concept for a new non-invasive FES-assisted rehabilitation system for the upper limb, called smartFES (sFES), where the electrical stimulation is controlled by a biologically inspired neural inverse dynamics model, fed by the kinematic information associated with the execution of a planar goal-oriented movement. More specifically, this work details two steps of the proposed system: an ad hoc markerless motion analysis algorithm for the estimation of kinematics, and a neural controller that drives a synthetic arm. The vision of the entire system is to acquire kinematics from the analysis of video sequences during planar arm movements and to use it together with a neural inverse dynamics model able to provide the patient with the electrical stimulation patterns needed to perform the movement with the assisted limb. METHODS: The markerless motion tracking system aims at localizing and monitoring the arm movement by tracking its silhouette. It uses a specifically designed motion estimation method, that we named Neural Snakes, which predicts the arm contour deformation as a first step for a silhouette extraction algorithm. The starting and ending points of the arm movement feed an Artificial Neural Controller, enclosing the muscular Hill's model, which solves the inverse dynamics to obtain the FES patterns needed to move a simulated arm from the starting point to the desired point. Both position error with respect to the requested arm trajectory and comparison between curvature factors have been calculated in order to determine the accuracy of the system. RESULTS: The proposed method has been tested on real data acquired during the execution of planar goal-oriented arm movements. Main results concern the capability of the system to accurately recreate the movement task by providing a synthetic arm model with the stimulation patterns estimated by the inverse dynamics model. In the simulation of movements with a length of +/- 20 cm, the model has shown an unbiased angular error, and a mean (absolute) position error of about 1.5 cm, thus confirming the ability of the system to reliably drive the model to the desired targets. Moreover, the curvature factors of the factual human movements and of the reconstructed ones are similar, thus encouraging future developments of the system in terms of reproducibility of the desired movements. CONCLUSION: A novel FES-assisted rehabilitation system for the upper limb is presented and two parts of it have been designed and tested. The system includes a markerless motion estimation algorithm, and a biologically inspired neural controller that drives a biomechanical arm model and provides the stimulation patterns that, in a future development, could be used to drive a smart Functional Electrical Stimulation system (sFES). The system is envisioned to help in the rehabilitation of post stroke hemiparetic patients, by assisting the movement of the paretic upper limb, once trained with a set of movements performed by the therapist or in virtual reality. Future work will include the application and testing of the stimulation patterns in real conditions.