Comparing Loose Clothing-Mounted Sensors with Body-Mounted Sensors in the Analysis of Walking.

A person's walking pattern can reveal important information about their health. Mounting multiple sensors onto loose clothing potentially offers a comfortable way of collecting data about walking and other human movement. This research investigates how well the data from three sensors mounted on the lateral side of clothing (on a pair of trousers near the waist, upper thigh and lower shank) correlate with the data from sensors mounted on the frontal side of the body. Data collected from three participants (two male, one female) for two days were analysed. Gait cycles were extracted based on features in the lower-shank accelerometry and analysed in terms of sensor-to-vertical angles (SVA). The correlations in SVA between the clothing- and body-mounted sensor pairs were analysed. Correlation coefficients above 0.76 were found for the waist sensor pairs, while the thigh and lower-shank sensor pairs had correlations above 0.90. The cyclical nature of gait cycles was evident in the clothing data, and it was possible to distinguish the stance and swing phases of walking based on features in the clothing data. Furthermore, simultaneously recording data from the waist, thigh, and shank was helpful in capturing the movement of the whole leg.

Comparing Clothing-Mounted Sensors with Wearable Sensors for Movement Analysis and Activity Classification.

Inertial sensors are a useful instrument for long term monitoring in healthcare. In many cases, inertial sensor devices can be worn as an accessory or integrated into smart textiles. In some situations, it may be beneficial to have data from multiple inertial sensors, rather than relying on a single worn sensor, since this may increase the accuracy of the analysis and better tolerate sensor errors. Integrating multiple sensors into clothing improves the feasibility and practicality of wearing multiple devices every day, in approximately the same location, with less likelihood of incorrect sensor orientation. To facilitate this, the current work investigates the consequences of attaching lightweight sensors to loose clothes. The intention of this paper is to discuss how data from these clothing sensors compare with similarly placed body worn sensors, with additional consideration of the resulting effects on activity recognition. This study compares the similarity between the two signals (body worn and clothing), collected from three different clothing types (slacks, pencil skirt and loose frock), across multiple daily activities (walking, running, sitting, and riding a bus) by calculating correlation coefficients for each sensor pair. Even though the two data streams are clearly different from each other, the results indicate that there is good potential of achieving high classification accuracy when using inertial sensors in clothing.

TITAN: phase III study of doxorubicin/cyclophosphamide followed by ixabepilone or paclitaxel in early-stage triple-negative breast cancer.

PURPOSE: Ixabepilone is a microtubule stabilizer with activity in taxane-refractory metastatic breast cancer and low susceptibility to taxane-resistance mechanisms including multidrug-resistant phenotypes and high ß-III tubulin expression. Since these resistance mechanisms are common in triple-negative breast cancer (TNBC), ixabepilone may have particular advantages in this patient population. This study evaluated the substitution of ixabepilone for paclitaxel following doxorubicin/cyclophosphamide (AC) in the adjuvant treatment of early-stage TNBC. METHODS: Patients with operable TNBC were eligible following definitive breast surgery. Patients were randomized (1:1) to receive four cycles of AC followed by either four cycles (12 weeks) of ixabepilone or 12 weekly doses of paclitaxel. RESULTS: 614 patients were randomized: 306 to AC/ixabepilone and 308 to AC/paclitaxel. At a median follow-up of 48 months, 59 patients had relapsed (AC/ixabepilone, 29; AC/paclitaxel, 30). The median time from diagnosis to relapse was 20.8 months. The 5-year disease-free survival (DFS) rates of the two groups were similar [HR 0.92; ixabepilone 87.1% (95% CI 82.6-90.5) vs. paclitaxel 84.7% (95% CI 79.7-88.6)]. The estimated 5-year overall survival (OS) rates were also similar [HR 1.1; ixabepilone 89.7% (95% CI 85.5-92.7) vs. paclitaxel 89.6% (95% CI 85.0-92.9)]. Peripheral neuropathy was the most common grade 3/4 event. Dose reductions and treatment discontinuations occurred more frequently during paclitaxel treatment. CONCLUSIONS: Treatment with AC/ixabepilone provided similar DFS and OS in patients with operable TNBC when compared to treatment with AC/paclitaxel. The two regimens had similar toxicity, although treatment discontinuation, dose modifications, and overall peripheral neuropathy were more frequent with AC/paclitaxel. TRIAL REGISTRATION: Clinical Trials.gov Identifier, NCT00789581.

A phase II study of two dose levels of ofatumumab induction followed by maintenance therapy in symptomatic, previously untreated chronic lymphocytic leukemia.

Despite the recent advances in treatment of CLL with targeted agents such as ibrutinib, availability of nonchemotherapy based therapies is desired. Given the 58% response rate (1996 NCI-WG criteria) of single agent ofatumumab in CLL refractory to fludarabine and alemtuzumab, we initiated a phase II trial examining response, safety, and progression-free survival (PFS) of ofatumumab as front-line monotherapy. Patients enrolled included untreated, symptomatic CLL patients over the age of 65 or those who were inappropriate/did not desire chemotherapy. Two cohorts were enrolled sequentially examining either 1 g (33 patients) or 2 g (44 patients) weekly for 8 weeks followed by maintenance dosing every 2 months for a total of 24 months. Patients receiving 1 g were older than those receiving 2 g, but there were no significant differences in other clinical characteristics. The best overall response rates in the 1 and 2 g patient cohorts were 72 and 89% (1996 NCI-WG criteria), respectively (54 and 68%, respectively, using 2008 IWCLL criteria). All but two responses were partial. The 24-month estimated PFS rates were 46 and 78%, respectively. Response and PFS was lower in del(17p) and del(11q) CLL patients. Differences in PFS between dose cohorts were statistically significant and remained so when adjusting for age or high-risk cytogenetics. Toxicity of this treatment was mild with only six patients not completing therapy due to toxicity. Ofatumumab induction followed by maintenance therapy in untreated CLL represents a well-tolerated and active regimen, particularly with the 2 g of ofatumumab. Am. J. Hematol. 91:1020-1025, 2016. © 2016 Wiley Periodicals, Inc.

A Survey on Wireless Body Area Networks for eHealthcare Systems in Residential Environments.

Current progress in wearable and implanted health monitoring technologies has strong potential to alter the future of healthcare services by enabling ubiquitous monitoring of patients. A typical health monitoring system consists of a network of wearable or implanted sensors that constantly monitor physiological parameters. Collected data are relayed using existing wireless communication protocols to a base station for additional processing. This article provides researchers with information to compare the existing low-power communication technologies that can potentially support the rapid development and deployment of WBAN systems, and mainly focuses on remote monitoring of elderly or chronically ill patients in residential environments.

Paclitaxel, bevacizumab, and everolimus/placebo as first-line treatment for patients with metastatic HER2-negative breast cancer: a randomized placebo-controlled phase II trial of the Sarah Cannon Research Institute.

Amplified PI3K/Akt/mTOR signaling is common in metastatic breast cancer (MBC). The mTOR inhibitor everolimus improves progression-free survival (PFS) when added to steroidal aromatase inhibitor therapy. This randomized phase II trial compares the efficacy of paclitaxel/bevacizumab/everolimus and paclitaxel/bevacizumab/placebo as first-line treatment for MBC. Patients with untreated HER2-negative MBC were randomized (1:1) to receive 28-day cycles of paclitaxel 90 mg/m(2) IV (days 1, 8, and 15) and bevacizumab 10 mg/kg IV (days 1, 15) with either everolimus 10 mg (Arm 1) or placebo (Arm 2) daily. Treatment continued (evaluation every 8 weeks) until progression or unacceptable toxicity. Treatment of 110 patients allowed detection of an improvement in median PFS from 11 to 16 months (70 % power, α = 0.10). Between August 2009 and June 2011, 113 patients (median age 58 years; 88 % ER or PR positive) were randomized (Arm 1, 56; Arm 2, 57). Patients in both arms received a median of six treatment cycles. Median PFS (95 % CI) was 9.1 months (6.8-18.8) for Arm 1, and 7.1 months (5.6-10.8) for Arm 2 (p = 0.89). Comparisons of other efficacy endpoints were also similar in the two treatment arms. Patients receiving everolimus had more anemia, stomatitis, diarrhea, rash, and arthralgia/myalgia, although the overall incidence of severe (grade 3/4) toxicity was similar. The addition of everolimus did not improve the efficacy of weekly paclitaxel/bevacizumab as first-line treatment for patients with HER2-negative MBC. These results contrast with the demonstrated efficacy of adding everolimus to either hormonal or HER2-targeted therapy in previously treated patients.

Evaluation of Sensor Configurations for Robotic Surgical Instruments.

Designing surgical instruments for robotic-assisted minimally-invasive surgery (RAMIS) is challenging due to constraints on the number and type of sensors imposed by considerations such as space or the need for sterilization. A new method for evaluating the usability of virtual teleoperated surgical instruments based on virtual sensors is presented. This method uses virtual prototyping of the surgical instrument with a dual physical interaction, which allows testing of different sensor configurations in a real environment. Moreover, the proposed approach has been applied to the evaluation of prototypes of a two-finger grasper for lump detection by remote pinching. In this example, the usability of a set of five different sensor configurations, with a different number of force sensors, is evaluated in terms of quantitative and qualitative measures in clinical experiments with 23 volunteers. As a result, the smallest number of force sensors needed in the surgical instrument that ensures the usability of the device can be determined. The details of the experimental setup are also included.

Classification of static postures with wearable sensors mounted on loose clothing.

Inertial Measurement Units (IMUs) are a potential way to monitor the mobility of people outside clinical or laboratory settings at an acceptable cost. To increase accuracy, multiple IMUs can be used. By embedding multiple sensors into everyday clothing, it is possible to simplify having to put on individual sensors, ensuring sensors are correctly located and oriented. This research demonstrates how clothing-mounted IMU readings can be used to identify 4 common postures: standing, sitting, lying down and sitting on the floor. Data were collected from 5 healthy adults, with each providing 1-4 days of data with approximately 5 h each day. Each day, participants performed a fixed set of activities that were video-recorded to provide a ground truth. This is an analysis of accelerometry data from 3 sensors incorporated into right trouser-leg at the waist, thigh and ankle. Data were classified as static/ dynamic activities using a K-nearest neighbour (KNN) algorithm. For static activities, the inclination angles of the three sensors were estimated and used to train a second KNN classifier. For this highly-selected dataset (60000-70000 data points/posture), the static postures were classified with 100% accuracy, illustrating the potential for clothing-mounted sensors to be used in posture classification.

Inertial measurement data from loose clothing worn on the lower body during everyday activities.

Embedding sensors into clothing is promising as a way for people to wear multiple sensors easily, for applications such as long-term activity monitoring. To our knowledge, this is the first published dataset collected from sensors in loose clothing. 6 Inertial Measurement Units (IMUs) were configured as a 'sensor string' and attached to casual trousers such that there were three sensors on each leg near the waist, thigh, and ankle/lower-shank. Participants also wore an Actigraph accelerometer on their dominant wrist. The dataset consists of 15 participant-days worth of data collected from 5 healthy adults (age range: 28-48 years, 3 males and 2 females). Each participant wore the clothes with sensors for between 1 and 4 days for 5-8 hours per day. Each day, data were collected while participants completed a fixed circuit of activities (with a video ground truth) as well as during free day-to-day activities (with a diary). This dataset can be used to analyse human movements, transitional movements, and postural changes based on a range of features.

The effect of Functional Electrical Stimulation-assisted posture-shifting in bone mineral density: case series-pilot study.

STUDY DESIGN: A training intervention study using standing dynamic load-shifting Functional Electrical Stimulation (FES) in a group of individuals with complete spinal cord injury (SCI) T2 to T10. OBJECTIVES: Investigate the effect of FES-assisted dynamic load-shifting exercises on bone mineral density (BMD). SETTING: University Lab within the Biomedical Engineering METHODS: Twelve participants with ASIA A SCI were recruited for this study. Three participants completed side-to-side load-shifting FES-assisted exercises for 29 ± 5 weeks, 2× per week for 1 h, and FES knee extension exercises on alternate days 3× per week for 1 h. Volumetric Bone Mineral density (vBMD) at the distal femur and tibia were assessed using peripheral quantitative computed tomography (pQCT) before and after the intervention study. RESULTS: Participants with acute and subacute SCI showed an absolute increase of f trabecular vBMD (vBMDTRAB) in the proximal (mean of 26.9%) and distal tibia (mean of 22.35%). Loss of vBMDTRAB in the distal femur was observed. CONCLUSION: Improvements in vBMDTRAB in the distal tibia were found in acute and subacute SCI participants, and in the proximal tibia of acute participants, when subjected to anti-gravity FES-assisted load-bearing exercises for 29 ± 5 weeks. No vBMD improvement in distal femur or tibial shaft were observed in any of the participants as was expected. However, improvements of vBMD in the proximal and distal tibia were observed in two participants. This study provides evidence of an improvement of vBMDTRAB, when combining high-intensity exercises with lower intensity exercises 5× per week for 1 h.

A novel approach for modelling and classifying sit-to-stand kinematics using inertial sensors.

Sit-to-stand transitions are an important part of activities of daily living and play a key role in functional mobility in humans. The sit-to-stand movement is often affected in older adults due to frailty and in patients with motor impairments such as Parkinson's disease leading to falls. Studying kinematics of sit-to-stand transitions can provide insight in assessment, monitoring and developing rehabilitation strategies for the affected populations. We propose a three-segment body model for estimating sit-to-stand kinematics using only two wearable inertial sensors, placed on the shank and back. Reducing the number of sensors to two instead of one per body segment facilitates monitoring and classifying movements over extended periods, making it more comfortable to wear while reducing the power requirements of sensors. We applied this model on 10 younger healthy adults (YH), 12 older healthy adults (OH) and 12 people with Parkinson's disease (PwP). We have achieved this by incorporating unique sit-to-stand classification technique using unsupervised learning in the model based reconstruction of angular kinematics using extended Kalman filter. Our proposed model showed that it was possible to successfully estimate thigh kinematics despite not measuring the thigh motion with inertial sensor. We classified sit-to-stand transitions, sitting and standing states with the accuracies of 98.67%, 94.20% and 91.41% for YH, OH and PwP respectively. We have proposed a novel integrated approach of modelling and classification for estimating the body kinematics during sit-to-stand motion and successfully applied it on YH, OH and PwP groups.

Mutual Skill Learning and Adaptability to Others via Haptic Interaction.

When learning a new skill through an unknown environment, should we practice alone, or together with another beginner, or learn from the expert? It is normally helpful to have an expert guiding through unknown environmental dynamics. The guidance from the expert is fundamentally based on mutual interactions. From the perspective of the beginner, one needs to face dual unknown dynamics of the environment and motor coordination of the expert. In a cooperative visuo-haptic motor task, we asked novice participants to bring a virtual mass onto the specified target location under an unknown external force field. The task was completed by an individual or with an expert or another novice. In addition to evaluation of the motor performance, we evaluated the adaptability of the novice participants to a new partner while attempting to achieve a common goal together. The experiment was set in five phases; baseline for skill transfer and adaptability, learning and evaluation for adaptability and skill transfer respectively. The performance of the participants was characterized by using the time to target, effort index, and length of the trajectory. Experimental results suggested that (1) peer-to-peer interactions among paired beginners enhanced the motor learning most, (2) individuals practicing on their own (learning as a single) showed better motor learning than practicing under the expert's guidance, and (3) regarding the adaptability, peer-to-peer interactions induced higher adaptability to a new partner than the novice-to-expert interactions while attempting to achieve a common goal together. Thus, we conclude that the peer-to-peer interactions under a collaborative task can realize the best motor learning of the motor skills through the new environmental dynamics, and adaptability to others in order to achieve a goal together. We suggest that the peer-to-peer learning can induce both adaptability to others and learning of motor skills through the unknown environmental dynamics under mutual interactions. On the other hand, during the peer-to-peer interactions, the novice can learn how to coordinate motion with his/her partner (even though one is a new partner), and thus, is able to learn the motor skills through new environmental dynamics.

An efficient alpha helix model and simulation framework for stationary electrostatic interaction force estimation.

The alpha-helix coiled-coils within talin's rod domain have mechanical and signalling functions through their unfolding and refolding dynamics. A better understanding of talin unfolding events and the forces that are involved should allow better prediction of talin signalling. To overcome the current limitations of force measuring in molecular dynamics simulations, a new simulation framework was developed which operated directly within the force domain. Along with a corresponding alpha-helix modelling method, the simulation framework was developed drawing on robotic kinematics to specifically target force interactions. Coordinate frames were used efficiently to compartmentalise the simulation structures and static analysis was applied to determine the propagation of forces and torques through the protein structure. The results of the electrostatic approximation using Coulomb's law shows a simulated force interaction within the physiological relevant range of 5-40 pN for the rod sub-domains of talin. This covers the range of forces talin operates in and is 2-3 orders of magnitude closer to experimentally measured values than the compared all-atom and coarse-grained molecular dynamics. This targeted, force-based simulation is, therefore, able to produce more realistic forces values than previous simulation methods.

Multi-Compliance Printing Techniques for the Fabrication of Customisable Hand Exoskeletons.

To be successful, hand exoskeletons require customisable low encumbrance design with multi-compliant materials. This paper details the modification and testing of a fused filament fabrication printer to produce three categories of multi-compliant material that can be incorporated into the design of hand exoskeletons. Demonstration of the multi-compliant material for some common problems in hand exoskeleton design are presented. This method of manufacturing multi-compliant materials could result in widespread use of exoskeleton design in both the rehabilitation and assistive fields.

Novel instrumented frame for standing exercising of users with complete spinal cord injuries.

This paper describes a Functional Electrical Stimulation (FES) standing system for rehabilitation of bone mineral density (BMD) in people with Spinal Cord Injury (SCI). BMD recovery offers an increased quality of life for people with SCI by reducing their risk of fractures. The standing system developed comprises an instrumented frame equipped with force plates and load cells, a motion capture system, and a purpose built 16-channel FES unit. This system can simultaneously record and process a wide range of biomechanical data to produce muscle stimulation which enables users with SCI to safely stand and exercise. An exergame provides visual feedback to the user to assist with upper-body posture control during exercising. To validate the system an alternate weight-shift exercise was used; 3 participants with complete SCI exercised in the system for 1 hour twice-weekly for 6 months. We observed ground reaction forces over 70% of the full body-weight distributed to the supporting leg at each exercising cycle. Exercise performance improved for each participant by an increase of 13.88 percentage points of body-weight in the loading of the supporting leg during the six-month period. Importantly, the observed ground reaction forces are of higher magnitude than other studies which reported positive effects on BMD. This novel instrumentation aims to investigate weight bearing standing therapies aimed at determining the biomechanics of lower limb joint force actions and postural kinematics.

Identifying balance impairments in people with Parkinson's disease using video and wearable sensors.

BACKGROUND: Falls and near falls are common among people with Parkinson's (PwP). To date, most wearable sensor research focussed on fall detection, few studies explored if wearable sensors can detect instability. RESEARCH QUESTION: Can instability (caution or near-falls) be detected using wearable sensors in comparison to video analysis? METHODS: Twenty-four people (aged 60-86) with and without Parkinson's were recruited from community groups. Movements (e.g. walking, turning, transfers and reaching) were observed in the gait laboratory and/or at home; recorded using clinical measures, video and five wearable sensors (attached on the waist, ankles and wrists). After defining 'caution' and 'instability', two researchers evaluated video data and a third the raw wearable sensor data; blinded to each other's evaluations. Agreement between video and sensor data was calculated on stability, timing, step count and strategy. RESULTS: Data was available for 117 performances: 82 (70%) appeared stable on video. Ratings agreed in 86/117 cases (74%). Highest agreement was noted for chair transfer, timed up and go test and 3 m walks. Video analysts noted caution (slow, contained movements, safety-enhancing postures and concentration) and/or instability (saving reactions, stopping after stumbling or veering) in 40/134 performances (30%): raw wearable sensor data identified 16/35 performances rated cautious or unstable (sensitivity 46%) and 70/82 rated stable (specificity 85%). There was a 54% chance that a performance identified from wearable sensors as cautious/unstable was so; rising to 80% for stable movements. SIGNIFICANCE: Agreement between wearable sensor and video data suggested that wearable sensors can detect subtle instability and near-falls. Caution and instability were observed in nearly a third of performances, suggesting that simple, mildly challenging actions, with clearly defined start- and end-points, may be most amenable to monitoring during free-living at home. Using the genuine near-falls recorded, work continues to automatically detect subtle instability using algorithms.

Multivariate analysis of the Fugl-Meyer outcome measures assessing the effectiveness of GENTLE/S robot-mediated stroke therapy.

BACKGROUND: Robot-mediated therapies offer entirely new approaches to neurorehabilitation. In this paper we present the results obtained from trialling the GENTLE/S neurorehabilitation system assessed using the upper limb section of the Fugl-Meyer (FM) outcome measure. METHODS: We demonstrate the design of our clinical trial and its results analysed using a novel statistical approach based on a multivariate analytical model. This paper provides the rational for using multivariate models in robot-mediated clinical trials and draws conclusions from the clinical data gathered during the GENTLE/S study. RESULTS: The FM outcome measures recorded during the baseline (8 sessions), robot-mediated therapy (9 sessions) and sling-suspension (9 sessions) was analysed using a multiple regression model. The results indicate positive but modest recovery trends favouring both interventions used in GENTLE/S clinical trial. The modest recovery shown occurred at a time late after stroke when changes are not clinically anticipated. CONCLUSION: This study has applied a new method for analysing clinical data obtained from rehabilitation robotics studies. While the data obtained during the clinical trial is of multivariate nature, having multipoint and progressive nature, the multiple regression model used showed great potential for drawing conclusions from this study. An important conclusion to draw from this paper is that this study has shown that the intervention and control phase both caused changes over a period of 9 sessions in comparison to the baseline. This might indicate that use of new challenging and motivational therapies can influence the outcome of therapies at a point when clinical changes are not expected. Further work is required to investigate the effects arising from early intervention, longer exposure and intensity of the therapies. Finally, more function-oriented robot-mediated therapies or sling-suspension therapies are needed to clarify the effects resulting from each intervention for stroke recovery.

Utilization of kinematical redundancy of a rehabilitation robot to produce compliant motions under limitation on actuator performance.

This paper addresses the mechanical structure and control method of a redundant drive robot (RDR) to produce compliant motions, and show how the design parameters of the RDR can effect the produced motions and the mechanical and performance limitations of the actuators of the RDR. The structure and control method of the RDR can have been proper to produce compliant motions, but the effect of the design parameters of the RDR to the mechanical and performance limitations have not been clear. Therefore, the feasibility of producing compliant motions in the case of the prototype of the RDR is confirmed by conducting simulations and experiments, and then the design parameters of the RDR to the mechanical and performance limitations are verified by conducting simulations.

Application of data fusion techniques and technologies for wearable health monitoring.

Technological advances in sensors and communications have enabled discrete integration into everyday objects, both in the home and about the person. Information gathered by monitoring physiological, behavioural, and social aspects of our lives, can be used to achieve a positive impact on quality of life, health, and well-being. Wearable sensors are at the cusp of becoming truly pervasive, and could be woven into the clothes and accessories that we wear such that they become ubiquitous and transparent. To interpret the complex multidimensional information provided by these sensors, data fusion techniques are employed to provide a meaningful representation of the sensor outputs. This paper is intended to provide a short overview of data fusion techniques and algorithms that can be used to interpret wearable sensor data in the context of health monitoring applications. The application of these techniques are then described in the context of healthcare including activity and ambulatory monitoring, gait analysis, fall detection, and biometric monitoring. A snap-shot of current commercially available sensors is also provided, focusing on their sensing capability, and a commentary on the gaps that need to be bridged to bring research to market.