Preliminary Study of Novel Bio-Crypto Key Generation Using Clustering-Based Binarization of ECG Features.

In modern society, the popularity of wearable devices has highlighted the need for data security. Bio-crypto keys (bio-keys), especially in the context of wearable devices, are gaining attention as a next-generation security method. Despite the theoretical advantages of bio-keys, implementing such systems poses practical challenges due to their need for flexibility and convenience. Electrocardiograms (ECGs) have emerged as a potential solution to these issues but face hurdles due to intra-individual variability. This study aims to evaluate the possibility of a stable, flexible, and convenient-to-use bio-key using ECGs. We propose an approach that minimizes biosignal variability using normalization, clustering-based binarization, and the fuzzy extractor, enabling the generation of personalized seeds and offering ease of use. The proposed method achieved a maximum entropy of 0.99 and an authentication accuracy of 95%. This study evaluated various parameter combinations for generating effective bio-keys for personal authentication and proposed the optimal combination. Our research holds potential for security technologies applicable to wearable devices and healthcare systems.

Prognostic Impact of In-Hospital Use of Mechanical Cardiopulmonary Resuscitation Devices Compared with Manual Cardiopulmonary Resuscitation: A Nationwide Population-Based Observational Study in South Korea.

Background and Objectives: This study analyzed the prognostic impact of mechanical cardiopulmonary resuscitation (CPR) devices in out-of-hospital cardiac arrest (OHCA) patients, in comparison to manual CPR. Materials and Methods: This study was a nationwide population-based observational study in South Korea. Data were retrospectively collected from 142,905 OHCA patients using the South Korean Out-of-Hospital Cardiac Arrest Surveillance database. We included adult OHCA patients who received manual or mechanical CPR in the emergency room. The primary outcome was survival at discharge and the secondary outcome was sustained return of spontaneous circulation (ROSC). Statistical analysis included propensity score matching and multivariate logistic regression. Results: A total of 19,045 manual CPR and 1125 mechanical CPR cases (671 AutoPulseTM vs. 305 ThumperTM vs. 149 LUCASTM) were included. In the matched multivariate analyses, all mechanical CPR devices were associated with a lower ROSC than that of manual CPR. AutoPulseTM was associated with lower survival in the multivariate analysis after matching (aOR with 95% CI: 0.57 (0.33-0.96)), but the other mechanical CPR devices were associated with similar survival to discharge as that of manual CPR. Witnessed arrest was commonly associated with high ROSC, but the use of mechanical CPR devices and cardiac origin arrest were associated with low ROSC. Only target temperature management was the common predictor for high survival. Conclusions: The mechanical CPR devices largely led to similar survival to discharge as that of manual CPR in OHCA patients; however, the in-hospital use of the AutoPulseTM device for mechanical CPR may significantly lower survival compared to manual CPR.

ECG Authentication Based on Non-Linear Normalization under Various Physiological Conditions.

The development and use of wearable devices require high levels of security and have sparked interest in biometric authentication research. Among the available approaches, electrocardiogram (ECG) technology is attracting attention because of its strengths in spoofing. However, morphological changes of ECG, which are affected by physical and psychological factors, can make authentication difficult. In this paper, we propose authentication using non-linear normalization of ECG beats that is robust to changes in ECG waveforms according to heart rate fluctuations in various daily activities. We performed a non-linear normalization method through the analysis of ECG alongside heart rate, evaluating similarities and authenticating the performance of our new method compared to existing methods. Compared with beats before normalization, the average similarity of the proposed method increased 23.7% in the resting state and 43% in the non-resting state. After learning in the resting state, authentication performance reached 99.05% accuracy for the resting state and 88.14% for the non-resting state. The proposed method can be applicable to an ECG-based authentication system under various physiological conditions.

Motion Artifact Reduction in Wearable Photoplethysmography Based on Multi-Channel Sensors with Multiple Wavelengths.

Photoplethysmography (PPG) is an easy and convenient method by which to measure heart rate (HR). However, PPG signals that optically measure volumetric changes in blood are not robust to motion artifacts. In this paper, we develop a PPG measuring system based on multi-channel sensors with multiple wavelengths and propose a motion artifact reduction algorithm using independent component analysis (ICA). We also propose a truncated singular value decomposition for 12-channel PPG signals, which contain direction and depth information measured using the developed multi-channel PPG measurement system. The performance of the proposed method is evaluated against the R-peaks of an electrocardiogram in terms of sensitivity (Se), positive predictive value (PPV), and failed detection rate (FDR). The experimental results show that Se, PPV, and FDR were 99%, 99.55%, and 0.45% for walking, 96.28%, 99.24%, and 0.77% for fast walking, and 82.49%, 99.83%, and 0.17% for running, respectively. The evaluation shows that the proposed method is effective in reducing errors in HR estimation from PPG signals with motion artifacts in intensive motion situations such as fast walking and running.

Clip-On IMU System for Assessing Age-Related Changes in Hand Functions.

Hand functions affect the instrumental activities of daily living. While functional outcome measures, such as a targeted box and block test, have been widely used in clinical settings and provide a useful measure of overall performance, the advent of a wearable Inertial Measurement Unit(IMU)-based system enables the examination of the specific performance and kinematic parameters of hand movements. This study proposed a novel clip-on IMU system to facilitate the clinically fitted measurements of fine-motor finger and wrist joint movements. Clinical validation was conducted with the aim of characterising age-related changes in hand functions, namely grasping, transporting, and releasing blocks. Eighteen young (age 20-31) and sixteen healthy older adults (age 75-89) were evaluated during the box and block test. The results demonstrated that an older age was characterized by slower movements and higher variations and kinematic alterations in the hand functions, such as a larger range of motions at the fingers as well as kinematic trajectories. The proposed IMU system and subsequent validations highlight the value of the performance and kinematics parameters for a more comprehensive understanding of fine-motor finger and wrist movements that could shed light on further implementations in clinical and practical settings.

Comparing the standards of one metabolic equivalent of task in accurately estimating physical activity energy expenditure based on acceleration.

The purpose of the study is to analyse how the standard of resting metabolic rate (RMR) affects estimation of the metabolic equivalent of task (MET) using an accelerometer. In order to investigate the effect on estimation according to intensity of activity, comparisons were conducted between the 3.5 ml O2 · kg-1 · min-1 and individually measured resting VO2 as the standard of 1 MET. MET was estimated by linear regression equations that were derived through five-fold cross-validation using 2 types of MET values and accelerations; the accuracy of estimation was analysed through cross-validation, Bland and Altman plot, and one-way ANOVA test. There were no significant differences in the RMS error after cross-validation. However, the individual RMR-based estimations had as many as 0.5 METs of mean difference in modified Bland and Altman plots than RMR of 3.5 ml O2 · kg-1 · min-1. Finally, the results of an ANOVA test indicated that the individual RMR-based estimations had less significant differences between the reference and estimated values at each intensity of activity. In conclusion, the RMR standard is a factor that affects accurate estimation of METs by acceleration; therefore, RMR requires individual specification when it is used for estimation of METs using an accelerometer.

Spectral Analysis of Acceleration Data for Detection of Generalized Tonic-Clonic Seizures.

Generalized tonic-clonic seizures (GTCSs) can be underestimated and can also increase mortality rates. The monitoring devices used to detect GTCS events in daily life are very helpful for early intervention and precise estimation of seizure events. Several studies have introduced methods for GTCS detection using an accelerometer (ACM), electromyography, or electroencephalography. However, these studies need to be improved with respect to accuracy and user convenience. This study proposes the use of an ACM banded to the wrist and spectral analysis of ACM data to detect GTCS in daily life. The spectral weight function dependent on GTCS was used to compute a GTCS-correlated score that can effectively discriminate between GTCS and normal movement. Compared to the performance of the previous temporal method, which used a standard deviation method, the spectral analysis method resulted in better sensitivity and fewer false positive alerts. Finally, the spectral analysis method can be implemented in a GTCS monitoring device using an ACM and can provide early alerts to caregivers to prevent risks associated with GTCS.

Low-frequency oscillations in cerebrovascular and cardiovascular hemodynamics: Their interrelationships and the effect of age.

The aim of this study was to investigate how the interrelationships between low-frequency oscillations (LFOs) in the cerebral and systemic cardiovascular hemodynamic systems change with aging and systemic hemodynamic perturbation. Seventeen young adult (28.4±3.5years) and seventeen elderly subjects (69.4±8.7years) underwent continuous measurements of arterial blood pressure (ABP), heart rate (HR), and cerebral oxygenation (oxy-hemoglobin, deoxy-hemoglobin, and total hemoglobin) using near-infrared spectroscopy. The LFOs were subdivided into three frequency intervals (FI-1: 0.01-0.02Hz, FI-2: 0.02-0.06Hz, and FI-3: 0.06-0.15Hz) via spectral analysis based on continuous wavelet transform. The amplitudes of the LFOs at these FIs were calculated to examine the effects of aging and head-up tilt (HUT) on cerebral and cardiovascular hemodynamics. Granger causality (GC) was used for analyzing the causal relationships between the LFOs observed in ABP, oxy-hemoglobin, and HR. The amplitudes of the LFOs were generally higher in young adults than in the elderly and increased significantly only in the younger subjects after HUT. GCs in FI-3 oscillations were significantly higher in young subjects compared to older participants in the HUT state. These results indicate that aging dampens systemic and cerebral hemodynamic regulatory mechanisms, and the interrelationships between systemic and cerebral hemodynamics become weaker with age.

Analysis of taVNS effects on autonomic and central nervous systems in healthy young adults based on HRV, EEG parameters.

OBJECTIVE: Transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive method of stimulating the vagus nerve, simultaneously affects the autonomic nervous system (ANS) and central nervous system (CNS) through efferent and afferent pathways. The purpose of this study is to analyze the effect of taVNS on the ANS and CNS through heart rate variability (HRV) and electroencephalography (EEG) parameters of identified responders. APPROACH: Two sets of data were collected from each of 10 healthy adult male subjects in their 20s, and five HRV parameters from the time domain (RMSSD, pNN50, pNN30, pNN20, ppNNx) and two EEG parameters (power of alpha band, power of delta band) were extracted. MAIN RESULTS: Based on pNN50, responders to taVNS were identified; among them, pNN50 (p = 0.0041) and ppNNx (p = 0.0037) showed significant differences before and after taVNS. At the same time, for alpha power and delta power of EEG, significant difference (p < 0.05) was observed in most channels after taVNS compared to before stimulation. SIGNIFICANCE: This study demonstrated the validity of identifying responders using pNN50 and the influence of taVNS on both the ANS and CNS. We conclude that taVNS can be used to treat a variety of diseases and as a tool to help control the ANS and CNS.

Effects of Game-Related Tasks for the Diagnosis and Classification of Gaming Disorder.

Gaming disorder (GD) is an addictive behavior characterized by an insatiable need to play video games and shares similar symptoms with the failure of self-control due to a decline in cognitive function. Current GD diagnostic and screening tools rely on questionnaires and behavioral observations related to cognitive functions to assess an individual's capacity to maintain self-control in everyday life. However, current GD screening approaches rely on subjective symptoms, and a reliable diagnosis requires long-term clinical follow-up. Recent studies have measured biosignals along with cognitive functional tasks to provide objectivity to GD diagnosis and to acquire immediate results. However, people with GD are hypersensitive to game-related cues, so their responses may vary depending on the type of stimuli, and the difference in response to stimuli might manifest as a difference in the degree of change in the biosignal. Therefore, it is critical to choose the correct stimulus type when performing GD diagnostic tasks. In this study, we investigated the task dependence of cognitive decline in GD by comparing two cognitive functional tasks: a continuous performance task (CPT) and video game play. For this study, 69 young male adults were classified into either the gaming disorder group (GD, n = 39) or a healthy control group (HC, n = 30). CPT score, EEG signal (theta, alpha, and beta), and HRV-HF power were assessed. We observed differences in the left frontal region (LF) of the brain between the GD and HC groups during online video game play. The GD group also showed a significant difference in HF power of HRV between CPT and online video gaming. Furthermore, LF and HRV-HF significantly correlated with Young's Internet Addiction Test (Y-IAT) score, which is positively associated with impulsivity score. The amount of change in theta band activity in LF and HRV-HF-both biomarkers for changes in cognitive function-during online video game play suggests that people with GD express task-dependent cognitive decline compared with HC. Our results demonstrate the feasibility of quantifying individual self-regulation ability for gaming and underscore its importance for GD classification.

Videographic analysis of glottic view with increasing cricoid pressure force.

STUDY OBJECTIVE: Cricoid pressure may negatively affect laryngeal view and compromise airway patency, according to previous studies of direct laryngoscopy, endoscopy, and radiologic imaging. In this study, we assess the effect of cricoid pressure on laryngeal view with a video laryngoscope, the Pentax-AWS. METHODS: This cross-sectional survey involved 50 American Society of Anesthesiologists status I and II patients who were scheduled to undergo elective surgery. The force measurement sensor for cricoid pressure and the video recording system using a Pentax-AWS video laryngoscope were newly developed by the authors. After force and video were recorded simultaneously, 11 still images were selected per 5-N (Newton; 1 N = 1 kg·m·s(-2)) increments, from 0 N to 50 N for each patient. The effect of cricoid pressure was assessed by relative percentage compared with the number of pixels on an image at 0 N. RESULTS: Compared with zero cricoid pressure, the median percentage of glottic view visible was 89.5% (interquartile range [IQR] 64.2% to 117.1%) at 10 N, 83.2% (IQR 44.2% to 113.7%) at 20 N, 76.4% (IQR 34.1% to 109.1%) at 30 N, 51.0% (IQR 21.8% to 104.2%) at 40 N, and 47.6% (IQR 15.2% to 107.4%) at 50 N. The number of subjects who showed unworsened views was 20 (40%) at 10 N, 17 (34%) at 20 and 30 N, and 13 (26%) at 40 and 50 N. CONCLUSION: Cricoid pressure application with increasing force resulted in a worse glottic view, as examined with the Pentax-AWS Video laryngoscope. There is much individual difference in the degree of change, even with the same force. Clinicians should be aware that cricoid pressure affects laryngeal view with the Pentax-AWS and likely other video laryngoscopes.

Quantitative analysis of pulse arrival time and PPG morphological features based cuffless blood pressure estimation: a comparative study between diabetic and non-diabetic groups.

Pulse arrival time (PAT) and PPG morphological features have attracted much interest in cuffless blood pressure (BP) estimation, but their effects are not clearly understood when vascular characteristics are affected by diseases such as diabetes. This work quantitatively analyzes the effect of diabetic disease on the PAT and PPG morphological features-based BP estimation. We selected 112 diabetic patients and 308 non-diabetic subjects from VitalDB, and extracted 16 features including PAT, PPG morphological features, and heart rate. BP estimation performance was statistically compared between groups using linear regression models with several feature sets, and the relative importance of each feature in the optimal feature set was extracted. As a result, the standard deviation of the error and mean absolute error of PAT-based BP estimation were significantly higher in the diabetic group than in the non-diabetic group (p < 0.01). A feature set containing PAT and PPG morphological features achieved the best performance in both groups. However, the relative importance of each feature for BP estimation differed notably between groups. The results indicate that different features are important depending on the vascular characteristics, which could help to construct different models to accommodate specific diseases.

Mental Stress Assessment Using Ultra Short Term HRV Analysis Based on Non-Linear Method.

Mental stress is on the rise as one of the major health problems in modern society. It is important to detect and manage mental stress to prevent various diseases caused by stress and to maintain a healthy life. The purpose of this paper is to present new heart rate variability (HRV) features based on empirical mode decomposition and to detect acute mental stress through short-term HRV (5 min) and ultra-short-term HRV (under 5 min) analysis. HRV signals were acquired from 74 young police officers using acute stressors, including the Trier Social Stress Test and horror movie viewing, and a total of 26 features, including the proposed IMF energy features and general HRV features, were extracted. A support vector machine (SVM) classification model is used to classify the stress and non-stress states through leave-one-subject-out cross-validation. The classification accuracies of short-term HRV and ultra-short-term HRV analysis are 86.5% and 90.5%, respectively. In the results of ultra-short-term HRV analysis using various time lengths, we suggest the optimal duration to detect mental stress, which can be applied to wearable devices or healthcare systems.

Automated remote decision-making algorithm as a primary triage system using machine learning techniques.

OBJECTIVE: An objective and convenient primary triage procedure is needed for prioritizing patients who need help in mass casualty incident (MCI) situations, where there is a lack of medical staff and available resources. This study aimed to develop an automated remote decision-making algorithm that remotely categorize a patient's emergency level using clinical parameters that can be measured with a wearable device. APPROACH: The algorithm was developed according to the following procedures. First, we used the National Trauma Data Bank data set, a large open trauma patient data set assembled by the American College of Surgeons (ACS). In addition, we performed pre-processing to exclude data when the vital sign or consciousness indicator value was missing or physiologically in an abnormal range. Second, we selected the T-RTS method, which classifies emergency levels into four classes (Delayed, Urgent, Immediate and Dead), as the primary outcome. Third, three machine learning methods widely used in the medical field, logistic regression, random forest, and deep neural network (DNN), were applied to build the algorithm. Finally, each method was evaluated using quantitative performance indicators including the macro-averaged f1 score, macro-averaged mean absolute error (MMAE), and the area under the receiver operating characteristic curve (AUC). MAIN RESULTS: For total sets, the logistic regression had a macro-averaged f1 score of 0.673, an MMAE of 0.387 and an AUC value of 0.844 (95% CI, 0.843-0.845), while the random forest and DNN had macro-averaged f1 scores of 0.783 and 0.784, MMAEs of 0.297 and 0.298 and AUC values of 0.882 (95% CI, 0.881-0.883) and 0.883(95% CI, 0.881-0.884), respectively. SIGNIFICANCE: In a comprehensive analysis of these results, our algorithm demonstrated a viable approach that could be practically adopted in an MCI. In addition, it can be employed to transfer patients and to redistribute available resources according to their priorities.

Effects of knee osteoarthritis severity on inter-joint coordination and gait variability as measured by hip-knee cyclograms.

Inter-joint coordination and gait variability in knee osteoarthritis (KOA) has not been well investigated. Hip-knee cyclograms can visualize the relationship between the hip and knee joint simultaneously. The aim of this study was to elucidate differences in inter-joint coordination and gait variability with respect to KOA severity using hip-knee cyclograms. Fifty participants with KOA (early KOA, n = 20; advanced KOA, n = 30) and 26 participants (≥ 50 years) without KOA were recruited. We analyzed inter-joint coordination by hip-knee cyclogram parameters including range of motion (RoM), center of mass (CoM), perimeter, and area. Gait variability was assessed by the coefficient of variance (CV) of hip-knee cyclogram parameters. Knee RoM was significantly reduced and total perimeter tended to be decreased with KOA progression. KOA patients (both early and advanced) had reduced stance phase perimeter, swing phase area, and total area than controls. Reduced knee CoM and swing phase perimeter were observed only in advanced KOA. Both KOA groups had a greater CV for CoM, knee RoM, perimeter (stance phase, swing phase and total) and swing phase area than the controls. Increased CV of hip RoM was only observed in advanced KOA. These results demonstrate that hip-knee cyclograms can provide insights into KOA patient gait.

Impact of a Smart-Ring-Based Feedback System on the Quality of Chest Compressions in Adult Cardiac Arrest: A Randomized Preliminary Study.

This study aimed to assess the effectiveness of a novel chest compression (CC) smart-ring-based feedback system in a manikin simulation. In this randomized, crossover, controlled study, we evaluated the effect of smart-ring CC feedback on cardiopulmonary resuscitation (CPR). The learnability and usability of the tool were evaluated with the System Usability Scale (SUS). Participants were divided into two groups and each performed CCs with and without feedback 2 weeks apart, using different orders. The primary outcome was compression depth; the proportion of accurate-depth (5-6 cm) CCs, CC rate, and the proportion of complete CCs (≤1 cm of residual leaning) were assessed additionally. The feedback group and the non-feedback group showed significant differences in compression depth (52.1 (46.3-54.8) vs. 47.1 (40.5-49.9) mm, p = 0.021). The proportion of accurate-depth CCs was significantly higher in the interventional than in the control condition (88.7 (30.0-99.1) vs. 22.6 (0.0-58.5%), p = 0.033). The mean SUS score was 83.9 ± 8.7 points. The acceptability ranges were 'acceptable', and the adjective rating was 'excellent'. CCs with smart-ring feedback could help achieve the ideal range of depth during CPR. The smart-ring may be a valuable source of CPR feedback.

Development of Smart-Ring-Based Chest Compression Depth Feedback Device for High Quality Chest Compressions: A Proof-of-Concept Study.

Recently, a smart-device-based chest compression depth (CCD) feedback system that helps ensure that chest compressions have adequate depth during cardiopulmonary resuscitation (CPR) was developed. However, no CCD feedback device has been developed for infants, and many feedback systems are inconvenient to use. In this paper, we report the development of a smart-ring-based CCD feedback device for CPR based on an inertial measurement unit, and propose a high-quality chest compression depth estimation algorithm that considers the orientation of the device. The performance of the proposed feedback system was evaluated by comparing it with a linear variable differential transformer in three CPR situations. The experimental results showed compression depth errors of 2.0 ± 1.1, 2.2 ± 0.9, and 1.4 ± 1.1 mm in the three situations. In addition, we conducted a pilot test with an adult/infant mannequin. The results of the experiments show that the proposed smart-ring-based CCD feedback system is applicable to various chest compression methods based on real CPR situations.

Effects of mobile messenger counseling on case management success for individuals engaging in self-harm or suicide attempts who were discharged from emergency departments.

OBJECTIVE: Postdischarge case management for self-harm or suicide attempters often fails; therefore, this study aimed to investigate the effects of mobile messenger counseling (MMC) on the postdischarge case management results among this patient group. METHODS: A retrospective analysis was done with data collected from March 2015 to February 2020 that included self-harm or suicide attempters who had visited a Korean emergency department and were discharged. If patients consented, postdischarge case management and MMC were conducted from March 2017. The primary outcome was the rate of successful case management, which reflects the patients either connecting to a local psychiatric healthcare center or undergoing a follow-up at a neuropsychiatric outpatient department at least once following discharge. Using univariate and multivariate logistic regression analyses, we evaluated MMC's effects on these patients' postdischarge case management. RESULTS: Of 913 patients, 604 participated in this study. In terms of successful case management, the MMC group showed a significantly higher rate than the non-MMC one (28.3% vs. 16.1%, P=0.001). A multivariate analysis demonstrated that access to postdischarge MMC (odds ratio, 2.149; 95% confidence interval, 1.357-3.403; P=0.001) and giving consent for case management while in the emergency department were significantly associated with successful case management (odds ratio, 8.917; 95% confidence interval, 5.610-14.173; P<0.001). CONCLUSION: The use of MMC for self-harm or suicide attempters is associated with higher case management success rates by increasing their chances of connecting to a psychiatric healthcare center or a neuropsychiatric outpatient department.

Can Mobile Videocall Assist Laypersons' Use of Automated External Defibrillators? A Randomized Simulation Study and Qualitative Analysis.

OBJECTIVE: To investigate the feasibility of mobile videocall guidance to facilitate AED use by laypersons. Design, setting, and participants. A total of 90 laypersons were randomized into three groups: the mobile video call-guided, voice call-guided, and non-guided groups. Participants were exposed to simulated cardiac arrest to use an AED, and guided by video calls, voice calls, or were not guided. We recorded the simulation experiments as a videoclip, and other researchers who were blinded to the simulation assessed the performance according to the prespecified checklist after simulations. Outcomes measure and analysis. We compared the performance score and time intervals from AED arrival to defibrillation among the three groups and analyzed the common errors. RESULTS: There was no significant difference among the three groups in terms of baseline characteristics. Performance scores in the checklist for using AED were higher in the mobile video call-guided group, especially in the category of "Power on AED" and "Correctly attaches pads" than in the other groups. However, the time interval to defibrillation was significantly longer in the mobile video call-guided group. CONCLUSIONS: Mobile video call guidance might be an alternative method to facilitate AED use by laypersons. Therefore, further well-designed research is needed to evaluate the feasibility of this approach in OHCA.

Patterns of enhancement in paretic shoulder kinematics after stroke with musical cueing.

Musical cueing has been widely utilised in post-stroke motor rehabilitation; however, the kinematic evidence on the effects of musical cueing is sparse. Further, the element-specific effects of musical cueing on upper-limb movements have rarely been investigated. This study aimed to kinematically quantify the effects of no auditory, rhythmic auditory, and melodic auditory cueing on shoulder abduction, holding, and adduction in patients who had experienced hemiparetic stroke. Kinematic data were obtained using inertial measurement units embedded in wearable bands. During the holding phase, melodic auditory cueing significantly increased the minimum Euler angle and decreased the range of motion compared with the other types of cueing. Further, the root mean square error in the angle measurements was significantly smaller and the duration of movement execution was significantly shorter during the holding phase when melodic auditory cueing was provided than when the other types of cueing were used. These findings indicated the important role of melodic auditory cueing for enhancing movement positioning, variability, and endurance. This study provides the first kinematic evidence on the effects of melodic auditory cueing on kinematic enhancement, thus suggesting the potential use of pitch-related elements in psychomotor rehabilitation.