Automatic non-invasive blood pressure measurement in left ventricular assist device patients with a photoplethysmography assisted device.

INTRODUCTION: Non-invasive measurement of blood pressure in patients with a left ventricular assist device (LVAD) is challenging due to the mechanical properties of these circulatory support devices. Keeping blood pressure in a target range is crucial to reduce the risk of LVAD complications. As current assessment methods require trained personnel resulting in infrequent monitoring, devices for home-based measurements are sorely needed. OBJECTIVES: In this paper, we report a measurement method and a custom-made monitoring device based on photoplethysmography (PPG) enabling automated measurement of the mean arterial pressure (MAP) of patients with LVAD. METHODS: The method and the device were tested on 21 adult patients with LVAD, and the estimated MAP values were compared to MAP values measured simultaneously by a human expert applying the commonly used Doppler-based method. RESULTS: Results of the proposed method showed highly significant correlation with Doppler-based MAP values (R = 0.85 for inflation, p < 0.001; R = 0.96 for deflation, p<0.001). The mean difference of the proposed method to the Doppler-based MAP values was 1.48 ± 5.43 mmHg for inflation and -0.19 ± 2.71 mmHg for deflation. CONCLUSION: The results demonstrate that the proposed method is a promising direction to achieve accurate, automated, non-invasive BP measurement, applicable in home health monitoring for patients with LVAD.

Effectiveness of unilateral pallidotomy for meige syndrome confirmed by motion analysis.

BACKGROUND: We report the case of a 64-year-old woman with bilateral manifestation of Meige syndrome (MS) successfully treated with left-side unilateral ventroposterolateral pallidotomy. METHODS: Symptoms were evaluated according to the Burke-Fahn-Marsden dystonia rating scale. Head tremor, blepharospasm and orofacial dyskinesia were measured with an infrared, video-based, computerized, real-time passive marker-based analyzer of motions (RTPAM). RESULTS: The Burke-Fahn-Marsden score showed a 90.2% reduction (from 25.5 to 2.5) at 6 months, and an 88.2% long-lasting benefit (to 3.0) at the 3-year follow-up with good bilateral control of the blepharospasm and orofacial movements. The RTPAM showed a substantial regression of acceleration for all markers, and abolishment of the 4.8-Hz head tremor. The correlation between symmetrical markers, and between markers within the right and left sides, was significantly decreased. CONCLUSIONS: Pallidotomy with staged procedure is recommended for the treatment of MS in patients on whom deep brain stimulation could not be performed. In case of good bilateral benefits from the unilateral procedure, contralateral surgery is not needed. The RTPAM is a useful tool for the mapping of facial involuntary movements.

[Movement analyzing devices for assessing the actual state of patients with movement disorders]. / Mozgásérzékelô eszközök neurológiai betegségben szenvedôk aktuális állapotának elemzésére.

Movement analysis gives valuable information on the actual state of patients. Based on it, the early diagnosis and objective assessment of the progress of several diseases can be helped. Our research work has been focused on developing clinically applicable movement analyzing devices.

Early experiences with a novel (robot hand) technique in the course of microneurosurgery.

BACKGROUND: The physiologic tremor may cause difficulties in microsurgery, in spite of using armrest. The new (robot hand) technique consists of the I-III finger support, which holds the instruments on Bethlehem (ANDAN BT, Budapest, Hungary) bridge above the operation area, which reduces the tremor at the end of the instruments. METHODS: Exact measurement of tremor reduction was performed. Last year, 23 microsurgical cases were operated on by the robot hand technique. RESULTS: The tremors of the operating hand and the number of complications have decreased effectively. CONCLUSION: By this technique, the microsurgical work has become more precise.

[Master course in biomedical engineering]. / Egészségügyi mérnöki mesterképzés.

The Bologna Declaration aims at harmonizing the European higher education structure. In accordance with the Declaration, biomedical engineering will be offered as a master (MSc) course also in Hungary, from year 2009. Since 1995 biomedical engineering course has been held in cooperation of three universities: Semmelweis University, Budapest Veterinary University, and Budapest University of Technology and Economics. One of the latter's faculties, Faculty of Electrical Engineering and Informatics, has been responsible for the course. Students could start their biomedical engineering studies - usually in parallel with their first degree course - after they collected at least 180 ECTS credits. Consequently, the biomedical engineering course could have been considered as a master course even before the Bologna Declaration. Students had to collect 130 ECTS credits during the six-semester course. This is equivalent to four-semester full-time studies, because during the first three semesters the curriculum required to gain only one third of the usual ECTS credits. The paper gives a survey on the new biomedical engineering master course, briefly summing up also the subjects in the curriculum.

[Application of robot hand technique in the course of microneurosurgical operations]. / Robotkéztechnika alkalmazása a mikroszkópos idegsebészeti mutéteknél.

INTRODUCTION: The aim of this study was to determine whether the new robot hand technique can help to avoid the complication in the course of high precise microneurosurgical operations. METHODS: The physical efficacy was measured by tremorometry. The comparative study of the incidence of complications measured the clinical efficacy. RESULTS: The tremors of the operating hand and the number of complications have decreased effectively. CONCLUSION: The precise level of robots could be available by novel robot hand technique. By this technique the microsurgical work has become more effective.

Quantification of the Upper Extremity Motor Functions of Stroke Patients Using a Smart Nine-Hole Peg Tester.

This paper introduces a smart nine-hole peg tester (s-9HPT), which comprises a standard nine-hole peg test pegboard, but with light-emitting diodes (LEDs) next to each hole. The s-9HPT still supports the traditional nine-hole peg test operating mode, in which the order of the peg placement and removal can be freely chosen. Considering this, the s-9HPT was used in lab research to analyze the traditional procedure and possible new procedures. As this analysis required subjects with similar levels of dexterity, measurement data from 16 healthy subjects (seven females, nine males, 25-80 years old) were used. We consequently found that illuminating the LEDs in various patterns facilitated guided tests of diverse complexity levels. Next, to demonstrate the clinical application of the s-9HPT, the improvement in the hand dexterity of 12 hospitalized stroke patients (45-80 years old, six females and six males) was monitored during their rehabilitation. Here, we used traditional and guided tests validated by healthy subjects. Consequently, improvements were found to be patient specific. At the beginning of rehabilitation, traditional tests suitably indicate improvements, while guided tests are beneficial following improvements in motor functions. Further, the guided tests motivated certain patients, meaning the rehabilitation was more effective for these individuals.

Development of an effective therapy and objective assessment for children with birth injuries.

Sitting in a Huple, a patented hemisphere-like tool, permanently stimulates the vestibular system, thus improving the balancing ability of children with movement disorders. The Gézengúz Foundation for Children with Birth Injuries has been successfully applying this tool in therapy. By attaching x-Inertial Measurement Unit, a wireless three-dimensional orientation sensor, to the Huple, it can serve as an input peripheral for simple PC games. Children are thus motivated; they willingly perform balance training as well as participate in the game-like test. This improves the accuracy and reproducibility of the assessment. Knowing the actual state of the participants is an important element of feedback for the therapy. This paper describes in detail the development of the therapeutic and assessment method on the basis of the Huple: the definition of the movement pattern, the parameters characterizing the movement, and the algorithms used to rank children. Measurement series of 10 children with movement disorders validate the effectiveness of the game-like assessment.

Analysis of finger-tapping movement.

The piano-playing-like finger-tapping movement has been analyzed with a precision image-based motion analyzer (PRIMAS). 32 healthy subjects (148 recordings) and 10 Parkinsonian patients (25 recordings) were tested. The tracking of fingers during the whole movement increased the level of information obtained from the finger-tapping test compared to visual observation or to measurement with simple contact sensors. Different feature extraction methods have been developed to evaluate the movement and thus the actual performance of the tested person. The reliability of a novel parameter, the finger-tapping test score (FTTS), that takes into account both the speed and the regularity (periodicity) of finger-tapping, was assessed in six control subjects, with four subjects tested at least 14 times. FTTS helps in staging of Parkinsonian patients. A simple and cheap device (passive marker-based analyser of movement, PAM) has been developed that is affordable for routine clinical use.