RESUMO
BACKGROUND: UCHealth's Mobile Stroke Unit (MSU) at University of Colorado Hospital is an ambulance equipped with a computed tomography (CT) scanner and tele-stroke capabilities that began clinical operation in Aurora, Colorado January 2016. As one of the first MSU's in the United States, it was necessary to design unique and dynamic information technology infrastructure. This includes high-speed cellular connectivity, Health Insurance Portability and Accountability Act compliance, cloud-based and remote access to electronic medical records (EMR), and reliable and rapid image transfer. Here we describe novel technologies incorporated into the MSU. Technological data-handling aspects of the MSU were reviewed. Functions evaluated include wireless connectivity while in transit, EMR access and manipulation in the field, CT with image transfer from the MSU to the hospital's Picture Archiving Communication System (PACS), and video and audio communication for neurological assessment. METHODS/RESULTS: The MSU wireless system was designed with redundancy to avoid dropped signals during data transfer. Two separate Internet Protocol destinations with split-tunnel architecture are assigned, for videoconferencing and for EMR data transfer. Brain images acquired in the ambulance CT scanner are transferred initially to an onboard laptop, then via Citrix Receiver to the hospital-based PACS server where they can be viewed in PACS or EMR by the stroke neurologist, neuroradiologist, and other providers. PACS and Radiology Information System are 2 of the XenApps utilized by CT technologists on board the MSU. DISCUSSION/CONCLUSIONS: These technologies will serve as a blueprint for development of similar units elsewhere, and as a framework for improvement in this technology.
Assuntos
Ambulâncias/organização & administração , Diagnóstico por Computador , Registros Eletrônicos de Saúde/organização & administração , Unidades Móveis de Saúde/organização & administração , Acidente Vascular Cerebral/diagnóstico por imagem , Integração de Sistemas , Telerradiologia/organização & administração , Tomografia Computadorizada por Raios X , Tecnologia sem Fio/organização & administração , Colorado , Prestação Integrada de Cuidados de Saúde/organização & administração , Diagnóstico por Computador/instrumentação , Humanos , Valor Preditivo dos Testes , Prognóstico , Avaliação de Programas e Projetos de Saúde , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Telerradiologia/instrumentação , Fatores de Tempo , Tempo para o Tratamento , Tomografia Computadorizada por Raios X/instrumentação , Tecnologia sem Fio/instrumentação , Fluxo de TrabalhoRESUMO
INTRODUCTION: Targeting repeating-pattern atrial fibrillation (AF) sources (reentry or focal drivers) can help in patient-specific ablation therapy for AF; however, the development of reliable and accurate tools for locating such sources remains a major challenge. We describe iterative catheter navigation (ICAN) algorithm to locate AF drivers using a conventional circular Lasso catheter. METHODS AND RESULTS: At each step, the algorithm analyzes 10 bipolar electrograms recoded at a given catheter location and the history of previous catheter movements to determine if the source is inside the catheter loop. If not, it calculates new coordinates and selects a new position for the catheter. The process continues until a source is located. The algorithm was evaluated in a computer model of atrial tissue with various degrees of fibrosis under a broad range of arrhythmia scenarios. The latter included slow and fast reentry, macroreentry, figure-of-eight reentry, and fibrillatory conduction. Depending on the initial distance of the catheter from the source and scenario, it took about 3 to 16 steps to localize an AF source. In 94% of cases, the identified location was within 4 mm from the source, independently of the initial position of the catheter. The algorithm worked equally well in the presence of patchy fibrosis, low-voltage areas, fragmented electrograms, and dominant-frequency gradients. CONCLUSIONS: AF repeating-pattern sources can be localized using circular catheters without the need to map the entire tissue. The proposed algorithm has the potential to become a useful tool for patient-specific ablation of AF sources located outside the pulmonary veins.
Assuntos
Potenciais de Ação , Fibrilação Atrial/diagnóstico , Cateteres Cardíacos , Diagnóstico por Computador/instrumentação , Eletrodos , Técnicas Eletrofisiológicas Cardíacas/instrumentação , Frequência Cardíaca , Algoritmos , Fibrilação Atrial/fisiopatologia , Simulação por Computador , Desenho de Equipamento , Humanos , Modelos Cardiovasculares , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Processamento de Sinais Assistido por ComputadorRESUMO
OBJECTIVE: The purpose of this study was to investigate the intrarater reliability of a skin-surface instrument (Spinal Mouse, Idiag, Voletswil, Switzerland) in measuring standing sagittal curvature and global mobility of the spine in older women with and without hyperkyphosis. METHODS: Measurements were made in 19 women with hyperkyphosis (thoracic kyphosis angle ≥50°), mean age 67 ± 5 years, and 14 women without hyperkyphosis (thoracic kyphosis angle <50°), mean age 63 ± 6 years. Sagittal thoracic and lumbar curvature and mobility of the spine were assessed with the Spinal Mouse during neutral standing, full spinal flexion, and full spinal extension. Tests were performed by the same examiner on 2 days with a 72-hour interval. The intrarater reliability of the measurements was analyzed using the intraclass correlation coefficient, standard error of measurement and minimal detectable change. RESULTS: Intraclass correlation coefficients ranged from 0.89 to 0.99 in both groups. The standard errors of measurement ranged from 1.02° to 2.06° in the hyperkyphosis group and from 1.15° to 2.22° in the normal group. The minimal detectable change ranged from 2.85° to 5.73° in the hyperkyphosis group and from 3.20° to 6.17° in the normal group. CONCLUSIONS: Our results indicated that the Spinal Mouse has excellent intrarater reliability for the measurement of sagittal thoracic and lumbar curvature and mobility of the spine in older women.
Assuntos
Envelhecimento/fisiologia , Artrometria Articular/instrumentação , Diagnóstico por Computador/instrumentação , Amplitude de Movimento Articular/fisiologia , Fatores Etários , Idoso , Artrometria Articular/métodos , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Cifose , Pessoa de Meia-Idade , Variações Dependentes do Observador , Posicionamento do Paciente , Postura , Estudos Prospectivos , Valores de Referência , Reprodutibilidade dos Testes , Medição de Risco , Curvaturas da Coluna Vertebral , SuíçaRESUMO
OBJECTIVE: To evaluate a Dutch online speech-in-noise screening test (in Dutch: "Kinderhoortest") in normal-hearing school-age children. Sub-aims were to study test-retest reliability, and the effects of presentation type and age on test results. DESIGN: An observational cross-sectional study at school. Speech reception thresholds (SRTs) were obtained through the online test in a training condition, and two test conditions: on a desktop computer and smartphone. The order of the test conditions was counterbalanced. STUDY SAMPLE: Ninety-four children participated (5-12 years), of which 75 children were normal-hearing (≤25 dB HL at 0.5 kHz, ≤20 dB HL at 1-4 kHz). RESULTS: There was a significant effect for test order for the two test conditions (first or second test), but not for presentation type (desktop computer or smartphone) (repeated measures analyses, F(1,75) = 12.48, p < 0.001; F(1,75) = 0.01, p = 0.982). SRT significantly improved by age year (first test: 0.25 dB SNR, 95% CI: -0.43 to -0.08, p = 0.004. Second test: 0.29 dB SNR, 95% CI: -0.46 to -0.11; p = 0.002). CONCLUSIONS: The online test shows potential for routine-hearing screening of school-age children, and can be presented on either a desktop computer or smartphone. The test should be evaluated further in order to establish sensitivity and specificity for hearing loss in children.
Assuntos
Diagnóstico por Computador/métodos , Perda Auditiva/diagnóstico , Internet , Ruído/efeitos adversos , Mascaramento Perceptivo , Percepção da Fala , Teste do Limiar de Recepção da Fala/métodos , Estimulação Acústica , Fatores Etários , Audiometria de Tons Puros , Limiar Auditivo , Criança , Comportamento Infantil , Pré-Escolar , Compreensão , Estudos Transversais , Diagnóstico por Computador/instrumentação , Audição , Perda Auditiva/fisiopatologia , Perda Auditiva/psicologia , Humanos , Aplicativos Móveis , Países Baixos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Smartphone , Inteligibilidade da Fala , Teste do Limiar de Recepção da Fala/instrumentaçãoRESUMO
Individuals with autism are often characterized by impairments in communication, reciprocal social interaction and explicit expression of their affective states. In conventional techniques, a therapist adjusts the intervention paradigm by monitoring the affective state e.g., anxiety of these individuals for effective floor-time-therapy. Conventional techniques, though powerful, are observation-based and face resource limitations. Technology-assisted systems can provide a quantitative, individualized rehabilitation platform. Presently-available systems are designed primarily to chain learning via aspects of one's performance alone restricting individualization. Specifically, these systems are not sensitive to one's anxiety. Our presented work seeks to bridge this gap by developing a novel VR-based interactive system with Anxiety-Sensitive adaptive technology. Specifically, such a system is capable of objectively identifying and quantifying one's anxiety level from real-time biomarkers, along with performance metrics. In turn it can adaptively respond in an individualized manner to foster improved social communication skills. In our present research, we have used Virtual Reality (VR) to design a proof-of-concept application that exposes participants to social tasks of varying challenges. Results of a preliminary usability study indicate the potential of our VR-based Anxiety-Sensitive system to foster improved task performance, thereby serving as a potent complementary tool in the hands of therapist.
Assuntos
Ansiedade/prevenção & controle , Transtorno Autístico/reabilitação , Biorretroalimentação Psicológica/instrumentação , Transtorno de Comunicação Social/reabilitação , Terapia Assistida por Computador/métodos , Interface Usuário-Computador , Adolescente , Ansiedade/fisiopatologia , Ansiedade/psicologia , Transtorno Autístico/fisiopatologia , Transtorno Autístico/psicologia , Biorretroalimentação Psicológica/métodos , Criança , Diagnóstico por Computador/instrumentação , Diagnóstico por Computador/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Relações Interpessoais , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Transtorno de Comunicação Social/fisiopatologia , Transtorno de Comunicação Social/psicologia , Terapia Assistida por Computador/instrumentação , Resultado do TratamentoRESUMO
Cardiac electrogram (EGM) signals and electrophysiologic (EP) characteristics derived from them such as amplitude and timing are central to the diagnosis and therapeutic management of arrhythmias. Bipolar EGMs are often used but possess polarity and shape dependence on catheter orientation contributing to uncertainty. OBJECTIVE: We describe a novel method to map cardiac activation that resolves signals into meaningful directions and is insensitive to electrode directional effects. METHODS: Multielectrode catheters that span 2- and 3-D space are used to derive local electric field (E-field) signals. A traveling wave model of local EGM propagation motivates a new "omnipolar" reference frame in which to understand EGM E-field signals and provide bipolar component EGMs aligned with these anatomic and physiologic directions. We validate the basis of this technology and determine its accuracy using a saline tank in which we simulate physiologic propagation. RESULTS: Omnipole signals from healthy tissue are nearly free of catheter orientation effects and are constrained by biophysics to consistent morphologies and thus consistent measured amplitudes and timings. Using a 3-D EP mapping system, traveling wave treatment, and omnipolar technology (OT) E-field loops, we derived a new and nearly instantaneous means to determine conduction velocity and activation direction. CONCLUSION: We describe the basis of OT and validate it with ablation and mapping catheters in a saline tank. Finally, we illustrate OT with signals from live subjects. SIGNIFICANCE: OT's novel approach with signal processing and real-time visualization allows for a newly detailed characterization of myocardial activation that is insensitive to catheter orientation.
Assuntos
Cateterismo Cardíaco/métodos , Cateteres Cardíacos , Diagnóstico por Computador/métodos , Técnicas Eletrofisiológicas Cardíacas/instrumentação , Sistema de Condução Cardíaco/fisiologia , Modelos Cardiovasculares , Algoritmos , Cateterismo Cardíaco/instrumentação , Simulação por Computador , Diagnóstico por Computador/instrumentação , Técnicas Eletrofisiológicas Cardíacas/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Analog blanking periods (BPs) that hold down the display of electrograms (EGMs) in cardiac rhythm devices have received much less attention than the well-known digital BPs which do not influence the EGM display. In Biotronik devices (Biotronik GmbH, Berlin, Germany), when a paced event initiates an analog BP in one chamber (right atrium, right ventricle [RV], or left ventricle [LV]), an identical cross-chamber analog BP starts in the other two chambers. METHODS: All clinical observations were recorded from patients with Biotronik devices. The effect of the atrial cross-chamber analog BP initiated by a ventricular paced event on the atrial EGM was studied in the records of seven patients with frequent paroxysmal atrial flutter to determine the effect of critically timed RV paced event (RVp) or LV paced event (LVp) upon the atrial EGM. The effect of atrial pacing triggering cross-chamber analog BPs in the RV and LV channels on the RV and LV EGMs was also investigated in cases of conducted supraventricular beats and ventricular premature complexes. The effect of a triggered LVp initiating a cross-chamber analog BP in the RV channel on the EGM of a sensed RV sensed event was evaluated in 10 cases. Simulation studies were also performed to verify the clinical observations. RESULTS: Patients with atrial flutter showed intermittent truncation or deformity and even disappearance of the atrial signals due to an atrial cross-chamber analog BP initiated by RVp and/or LVp. Three patients demonstrated deformity of the signal shape of ventricular premature beats falling within a ventricular cross-chamber analog BP initiated by right atrial paced event (RAp). We found only one case of a supraventricular QRS complex trapped in a ventricular cross-chamber analog BP initiated by RAp. All the recordings of LVp triggering upon RVs revealed a variety of RV signal deformities occasionally with preservation of the terminal part of the RV signal. Simulation studies confirmed the effect of the analog BP on the atrial and the ventricular EGMs. CONCLUSION: The analog BP of Biotronik devices may cause truncation or deformity of atrial and ventricular signals and the occasional disappearance of an atrial signal during atrial flutter. These effects must not be interpreted as device malfunction. In the clinical evaluation of the EGM curves, the effects of the analog BPs have to be carefully considered in order to avoid possible misinterpretation.
Assuntos
Conversão Análogo-Digital , Artefatos , Flutter Atrial/diagnóstico , Flutter Atrial/prevenção & controle , Dispositivos de Terapia de Ressincronização Cardíaca , Técnicas Eletrofisiológicas Cardíacas/instrumentação , Diagnóstico por Computador/instrumentação , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Próteses e Implantes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Avaliação da Tecnologia Biomédica , Terapia Assistida por Computador/instrumentação , Resultado do Tratamento , Interface Usuário-ComputadorRESUMO
Electronic processes and communication technologies are more and more often employed to provide healthcare services to caregivers and their patients. Such solutions are currently referred as e-health, the most popular and widely distributed being those based on telemedicine and mobile health (m-health). A specific application of telemedicine for hypertension management is blood pressure telemonitoring (BPT), which allows remote data transmission of BP and additional information on patients' health status from their living site or from a community setting to the doctor's office or the hospital. Several randomized studies have documented a significant BP reduction with regular BPT compared to usual care, particularly in high risk hypertensive patients. Additional benefits are observed when BPT is offered under the supervision of a team of healthcare professionals, including a community pharmacist. BPT may also be provided in the context of m-health solutions, which commonly include wireless diagnostic and clinical decision support tools. M-health has the potential to promote patient's self-management, as a complement to the doctor's intervention, and encourage greater participation in medical decision making. Current statistics show that half of smartphone owners gather health information through their phone and 19 % use a health app. In case of hypertensive patients the most popular apps are those with tracking function, including BPT. Thus, e-health, and in particular BPT and m-health, are progressively gaining a key role in the management of hypertensive patients, having the potential to improve the quality of the delivered care and to more effectively prevent cardiovascular consequences of high BP.
Assuntos
Determinação da Pressão Arterial/instrumentação , Pressão Sanguínea , Computadores de Mão , Diagnóstico por Computador/instrumentação , Hipertensão/diagnóstico , Hipertensão/terapia , Aplicativos Móveis , Telemedicina/instrumentação , Terapia Assistida por Computador/instrumentação , Determinação da Pressão Arterial/economia , Serviços Comunitários de Farmácia , Computadores de Mão/economia , Análise Custo-Benefício , Prestação Integrada de Cuidados de Saúde , Diagnóstico por Computador/economia , Custos de Cuidados de Saúde , Nível de Saúde , Humanos , Hipertensão/economia , Hipertensão/fisiopatologia , Aplicativos Móveis/economia , Valor Preditivo dos Testes , Melhoria de Qualidade , Indicadores de Qualidade em Assistência à Saúde , Telemedicina/economia , Terapia Assistida por Computador/economia , Resultado do TratamentoRESUMO
We constructed an intracardiac vectorcardiogram from 3 configurations of intracardiac cardiovertor defibrilator (ICD) electrograms (EGMs). Six distinctive 3 lead combinations were selected out of five leads: can to right ventricular coil (RVC); RVC to superior vena cava coil (SVC); atrial lead tip (A-tip) to right ventricular (RV)-ring; can to RV-ring; RV-tip to RVC, in a patient with dual chamber ICD. Surface spatial QRS-T angle (119.8°) was similar to intracardiac spatial QRS-T angle derived from ICD EGMs combination A (101.3°), B (96.1°), C (92.8°), D (95.2), E (99.0), F (96.2) and median (101.5). Future validation of the novel method is needed.
Assuntos
Desfibriladores Implantáveis , Diagnóstico por Computador/métodos , Técnicas Eletrofisiológicas Cardíacas/instrumentação , Técnicas Eletrofisiológicas Cardíacas/métodos , Vetorcardiografia/instrumentação , Vetorcardiografia/métodos , Algoritmos , Diagnóstico por Computador/instrumentação , Humanos , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Biofeedback of heart rate variability (HRV) was applied to patients with diabetic polyneuropathy using a new mobile device allowing regularly scheduled self-measurements without the need of visits to a special autonomic laboratory. Prolonged generation of data over an eight-week period facilitated more precise investigation of cardiac autonomic function and assessment of positive and negative trends of HRV parameters over time. Statistical regression analyses revealed significant trends in 11 of 17 patients, while no significant differences were observed when comparing autonomic screening by short-term HRV and respiratory sinus arrhythmia at baseline and after the 8 weeks training period. Four patients showed positive trends of HRV parameters despite the expected progression of cardiac autonomic dysfunction over time. Patient compliance was above 50% in all but two patients. The results of this preliminary study indicate a good practicality of the handheld device and suggest a potential positive effect on cardiac autonomic neuropathy in patients with type 2 diabetes.
Assuntos
Doenças do Sistema Nervoso Autônomo/fisiopatologia , Biorretroalimentação Psicológica/instrumentação , Neuropatias Diabéticas/fisiopatologia , Eletrocardiografia Ambulatorial/instrumentação , Frequência Cardíaca , Armazenamento e Recuperação da Informação , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Sistema Nervoso Autônomo/diagnóstico , Doenças do Sistema Nervoso Autônomo/etiologia , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/diagnóstico , Diagnóstico por Computador/instrumentação , Diagnóstico por Computador/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: In Traditional Chinese Medicine (TCM) tongue diagnosis and pulse diagnosis are the major diagnostic methods up till now. As western research has tended to focus on acupuncture, attempts to standardize the classic diagnostic methods have been few. METHODS: A digital camera with a ring flash was fixed in a frame, so that the tongue-lens-distance and illumination were kept constant. A pilot study testing the inter-methods reliability, test-retest reliability, and interrater reliability of 2 observers was conducted: the tongues (1 ×) as well as the tongue images (2 ×) from 76 patients from our ward were assessed with a standardized rating list in a randomized order by both observers, who were mutually blinded. As primary outcome measure we used agreement beyond chance (Cohen's kappa). RESULTS: The colors of the tongue body / the tongue coating were the main criteria for the authentic reproduction of the tongue in our images. Inter-methods reliability for the color of the tongue body/coating was kappa 0.35 / 0.34 (p < 0.001) for observer 1 and 0.59 / 0.57 (p < 0.001) for observer 2. Test-retest reliability for the color of the tongue body / the tongue coating was kappa 0.53 / 0.48 (p< 0.001) for observer 1 and 0.65 / 0.62 (p < 0.001) for observer 2. Interrater reliability was generally low. CONCLUSIONS: The introduced device represents a first step towards standardization of tongue diagnosis. However, inter-methods as well as test-retest reliability vary between observers and different morphological characteristics.
Assuntos
Diagnóstico por Computador/instrumentação , Medicina Tradicional Chinesa/instrumentação , Língua/anatomia & histologia , Fatores Etários , Cor , Humanos , Medicina Tradicional Chinesa/normas , Reprodutibilidade dos TestesRESUMO
BACKGROUND AND OBJECTIVE: Dizziness is a major consequence of imbalance and vestibular dysfunction. Compared to surgery and drug treatments, balance training is non-invasive and more desired. However, training exercises are usually tedious and the assessment tool is insufficient to diagnose patient's severity rapidly. METHODS: An interactive virtual reality (VR) game-based rehabilitation program that adopted Cawthorne-Cooksey exercises, and a sensor-based measuring system were introduced. To verify the therapeutic effect, a clinical experiment with 48 patients and 36 normal subjects was conducted. Quantified balance indices were measured and analyzed by statistical tools and a Support Vector Machine (SVM) classifier. RESULTS: In terms of balance indices, patients who completed the training process are progressed and the difference between normal subjects and patients is obvious. CONCLUSIONS: Further analysis by SVM classifier show that the accuracy of recognizing the differences between patients and normal subject is feasible, and these results can be used to evaluate patients' severity and make rapid assessment.
Assuntos
Diagnóstico por Computador/métodos , Tontura/diagnóstico , Tontura/reabilitação , Terapia Assistida por Computador/métodos , Interface Usuário-Computador , Doenças Vestibulares/diagnóstico , Doenças Vestibulares/reabilitação , Adulto , Algoritmos , Inteligência Artificial , Biorretroalimentação Psicológica/instrumentação , Biorretroalimentação Psicológica/métodos , Diagnóstico por Computador/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reconhecimento Automatizado de Padrão/métodos , Terapia Assistida por Computador/instrumentação , Resultado do Tratamento , Jogos de VídeoRESUMO
Although Chinese medicine treatments have become popular recently, the complicated Chinese medical knowledge has made it difficult to be applied in computer-aided diagnostics. The ability to model and use the knowledge becomes an important issue. In this paper, we define the diagnosis in Traditional Chinese Medicine (TCM) as discovering the fuzzy relations between symptoms and syndromes. An Ontology-oriented Diagnosis System (ODS) is created to address the knowledge-based diagnosis based on a well-defined ontology of syndromes. The ontology transforms the implicit relationships among syndromes into a machine-interpretable model. The clinical data used for feature selection is collected from a national TCM research institute in China, which serves as a training source for syndrome differentiation. The ODS analyzes the clinical cases to obtain a statistical mapping relation between each syndrome and associated symptom set, before rechecking the completeness of related symptoms via ontology refinement. Our diagnostic system provides an online web interface to interact with users, so that users can perform self-diagnosis. We tested 12 common clinical cases on the diagnosis system, and it turned out that, given the agree metric, the system achieved better diagnostic accuracy compared to nonontology method-92% of the results fit perfectly with the experts' expectations.
Assuntos
Diagnóstico por Computador/instrumentação , Diagnóstico por Computador/métodos , Diagnóstico Diferencial , Medicina Tradicional Chinesa/métodos , Algoritmos , Teorema de Bayes , China , Humanos , Internet , Conhecimento , Modelos Estatísticos , Probabilidade , Linguagens de Programação , Software , Terminologia como Assunto , Interface Usuário-ComputadorRESUMO
Epilepsy affects approximately 1% of the world population. Antiepileptic drugs are ineffective in approximately 30% of patients and have side effects. We are developing a noninvasive, or minimally invasive, transcranial focal electrical stimulation system through our novel tripolar concentric ring electrodes to control seizures. In this study, we demonstrate feasibility of an automatic seizure control system in rats with pentylenetetrazole-induced seizures through single and multiple stimulations. These stimulations are automatically triggered by a real-time electrographic seizure activity detector based on a disjunctive combination of detections from a cumulative sum algorithm and a generalized likelihood ratio test. An average seizure onset detection accuracy of 76.14% was obtained for the test set (n = 13). Detection of electrographic seizure activity was accomplished in advance of the early behavioral seizure activity in 76.92% of the cases. Automatically triggered stimulation significantly (p = 0.001) reduced the electrographic seizure activity power in the once stimulated group compared to controls in 70% of the cases. To the best of our knowledge this is the first closed-loop automatic seizure control system based on noninvasive electrical brain stimulation using tripolar concentric ring electrode electrographic seizure activity as feedback.
Assuntos
Eletrodos Implantados , Eletroencefalografia/instrumentação , Convulsões/diagnóstico , Convulsões/prevenção & controle , Terapia Assistida por Computador/métodos , Estimulação Magnética Transcraniana/instrumentação , Animais , Biorretroalimentação Psicológica , Diagnóstico por Computador/instrumentação , Diagnóstico por Computador/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Estudos de Viabilidade , Ratos , Ratos Sprague-Dawley , Convulsões/fisiopatologia , Terapia Assistida por Computador/instrumentação , Estimulação Magnética Transcraniana/métodos , Resultado do TratamentoRESUMO
This paper proposes the cybernetic rehabilitation aid (CRA) based on the concept of direct teaching using tactile feedback with electromyography (EMG)-based motor skill evaluation. Evaluation and teaching of motor skills are two important aspects of rehabilitation training, and the CRA provides novel and effective solutions to potentially solve the difficulties inherent in these two processes within a single system. In order to evaluate motor skills, EMG signals measured from a patient are analyzed using a log-linearized Gaussian mixture network that can classify motion patterns and compute the degree of similarity between the patient's measured EMG patterns and the desired pattern provided by the therapist. Tactile stimulators are used to convey motion instructions from the therapist or the system to the patient, and a rehabilitation robot can also be integrated into the developed prototype to increase its rehabilitation capacity. A series of experiments performed using the developed prototype demonstrated that the CRA can work as a human-human, human-computer and human-machine system. The experimental results indicated that the healthy (able-bodied) subjects were able to follow the desired muscular contraction levels instructed by the therapist or the system and perform proper joint motion without relying on visual feedback.
Assuntos
Cibernética/instrumentação , Diagnóstico por Computador/instrumentação , Articulação do Cotovelo/fisiologia , Eletromiografia/métodos , Contração Muscular/fisiologia , Terapia Assistida por Computador/instrumentação , Articulação do Punho/fisiologia , Biorretroalimentação Psicológica/instrumentação , Biorretroalimentação Psicológica/métodos , Biorretroalimentação Psicológica/fisiologia , Cibernética/métodos , Diagnóstico por Computador/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Sistemas Homem-Máquina , Movimento/fisiologia , Reconhecimento Automatizado de Padrão/métodos , Projetos Piloto , Reabilitação/instrumentação , Reabilitação/métodos , Reprodutibilidade dos Testes , Robótica/instrumentação , Robótica/métodos , Sensibilidade e Especificidade , Terapia Assistida por Computador/métodos , Tato , Interface Usuário-ComputadorRESUMO
INTRODUCTION AND OBJECTIVE: The purposes of this study are to demonstrate the use of the mobile voice lab in type I thyroplasty with Gore-Tex(®) using analysis of spectrogram and fundamental frequency in the operating room, and also to show how to do this procedure. METHODS: Voice samples were recorded in the operating room immediately before and during type I thyroplasty. Six-week postoperative samples were also taken in the voice laboratory. Fundamental frequency and spectral analysis were analyzed. Spectrograms were evaluated by blind panel of 4 judges on a 100mm visual analogue scale. All three time points were compared and statistical analysis performed. Pre and postoperative V-RQOL scores were also compared. RESULTS: Significant improvement in spectrogram ratings were seen between before and during (P<.001), and before and after voice samples (P<.017). There was no significant difference between during and after scores, suggesting the persistence of the intraoperative improvement in this measure. Changes in fundamental frequency were not statistically significant, although fundamental frequency tended to increase in women and decrease in men after type I thyroplasty. Mean V-RQOL scores improved from 48.08 a 85.08 (P<.001). CONCLUSIONS: The mobile voice laboratory may be useful during type I thyroplasty with Gore-Tex(®). It offers an opportunity for the surgeon and voice pathologist to continue to collaborate in the treatment of patients with unilateral vocal fold paralysis.
Assuntos
Diagnóstico por Computador/métodos , Disfonia/prevenção & controle , Cuidados Intraoperatórios/métodos , Laringoplastia/métodos , Politetrafluoretileno , Espectrografia do Som , Telas Cirúrgicas , Paralisia das Pregas Vocais/cirurgia , Qualidade da Voz , Anestesia Local , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/cirurgia , Diagnóstico por Computador/instrumentação , Disfonia/etiologia , Feminino , Glote/fisiopatologia , Humanos , Cuidados Intraoperatórios/instrumentação , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/fisiopatologia , Edema Laríngeo/etiologia , Edema Laríngeo/fisiopatologia , Laringoplastia/efeitos adversos , Masculino , Microcomputadores , Variações Dependentes do Observador , Qualidade de Vida , Método Simples-Cego , Software , Espectrografia do Som/instrumentação , Espectrografia do Som/métodos , Inquéritos e Questionários , Paralisia das Pregas Vocais/complicações , Paralisia das Pregas Vocais/diagnósticoRESUMO
Measurements of human sound discrimination and localization are important for basic empirical and clinical applications. After a short survey of other methods such as evoked potentials, the development of a new device to measure human sound localization is described and its use illustrated with some examples. Built from a polyacrylic hemisphere or--in a later version--from an orbicular aluminum frame, the apparatus uses multiple speakers to emit auditory stimuli. The patient sits in the middle of the perimeter and has to press a button when a sound is perceived. In addition, the participant has to identify the correct speaker as the source of the sound. With this method it is possible to map the auditory field.
Assuntos
Estimulação Acústica/instrumentação , Testes Auditivos/instrumentação , Localização de Som , Adolescente , Atenção , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Pré-Escolar , Diagnóstico por Computador/instrumentação , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Lateralidade Funcional , Humanos , Lactente , Masculino , Valores de Referência , Design de Software , Interface Usuário-ComputadorRESUMO
A balance control model was applied to interpret how subjects with a severe vestibular loss (VL) used vibrotactile information from a balance prosthesis to enhance balance control. Experimental data were from 5 VL subjects standing with eyes closed and responding to continuous pseudorandom surface tilts of the stance platform. Results showed that vibrotactile feedback information reduced sway at frequencies below ~0.6 Hz, but vibrotactile feedback was less effective in reducing sway as stimulus amplitude increased. This experimental pattern was accurately predicted by the model, which was based on time-delayed sensory feedback control. The model predicted that changes to the vibrotactor activation scheme could improve performance of the prosthesis and demonstrated that further improvements might be possible if motor learning, acquired by practice and training, could increase VL subjects' reliance on the prosthesis.
Assuntos
Biorretroalimentação Psicológica/instrumentação , Modelos Biológicos , Equilíbrio Postural , Próteses e Implantes , Tato , Doenças Vestibulares/fisiopatologia , Doenças Vestibulares/reabilitação , Actigrafia/instrumentação , Simulação por Computador , Diagnóstico por Computador/instrumentação , Diagnóstico por Computador/métodos , Desenho de Equipamento , Análise de Falha de Equipamento , Humanos , Monitorização Ambulatorial/instrumentação , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Terapia Assistida por Computador/instrumentação , Terapia Assistida por Computador/métodos , Resultado do Tratamento , Doenças Vestibulares/diagnóstico , Vibração/uso terapêuticoRESUMO
Vibrotactile feedback about body position and velocity has been shown to be effective at reducing low frequency body sway (below about 0.5 Hz) in response to balance perturbations while standing. However, current devices cause an undesirable increase in high frequency body sway. In addition, unlike other sensory prostheses such as hearing aids, which are fine-tuned to the user, current vibrotactile balance prostheses largely employ a "one size fits all" approach, in that they use the same settings (i.e. parameter values) for all subjects. Rather than using a fixed design consisting of position and velocity feedback for all subjects, we propose a "custom design" approach that employs system identification methods to identify the feedback required to achieve a desired body sway frequency response for the subject. Our derivations and simulations show that in order to accomplish this objective, feedback consisting of a subject-specific filtered combination of body position, velocity and acceleration is required. Simulation results are provided to illustrate the results.