Energy-Efficient Sleep Apnea Detection Using a Hyperdimensional Computing Framework Based on Wearable Bracelet Photoplethysmography.

OBJECTIVE: Sleep apnea syndrome (SAS) is a common sleep disorder, which has been shown to be an important contributor to major neurocognitive and cardiovascular sequelae. Considering current diagnostic strategies are limited with bulky medical devices and high examination expenses, a large number of cases go undiagnosed. To enable large-scale screening for SAS, wearable photoplethysmography (PPG) technologies have been used as an early detection tool. However, existing algorithms are energy-intensive and require large amounts of memory resources, which are believed to be the major drawbacks for further promotion of wearable devices for SAS detection. METHODS: In this paper, an energy-efficient method of SAS detection based on hyperdimensional computing (HDC) is proposed. Inspired by the phenomenon of chunking in cognitive psychology as a memory mechanism for improving working memory efficiency, we proposed a one-dimensional block local binary pattern (1D-BlockLBP) encoding scheme combined with HDC to preserve dominant dynamical and temporal characteristics of pulse rate signals from wearable PPG devices. RESULTS: Our method achieved 70.17% accuracy in sleep apnea segment detection, which is comparable with traditional machine learning methods. Additionally, our method achieves up to 67× lower memory footprint, 68× latency reduction, and 93× energy saving on the ARM Cortex-M4 processor. CONCLUSION: The simplicity of hypervector operations in HDC and the novel 1D-BlockLBP encoding effectively preserve pulse rate signal characteristics with high computational efficiency. SIGNIFICANCE: This work provides a scalable solution for long-term home-based monitoring of sleep apnea, enhancing the feasibility of consistent patient care.

Role of arm reaching movement kinematics in friction perception at initial contact with smooth surfaces.

When manipulating objects, humans begin adjusting their grip force to friction within 100 ms of contact. During motor adaptation, subjects become aware of the slipperiness of touched surfaces. Previously, we have demonstrated that humans cannot perceive frictional differences when surfaces are brought in contact with an immobilised finger, but can do so when there is submillimeter lateral displacement or subjects actively make the contact movement. Similarly, in, we investigated how humans perceive friction in the absence of intentional exploratory sliding or rubbing movements, to mimic object manipulation interactions. We used a two-alternative forced-choice paradigm in which subjects had to reach and touch one surface followed by another, and then indicate which felt more slippery. Subjects correctly identified the more slippery surface in 87 ± 8% of cases (mean ± SD; n = 12). Biomechanical analysis of finger pad skin displacement patterns revealed the presence of tiny (<1 mm) localised slips, known to be sufficient to perceive frictional differences. We tested whether these skin movements arise as a result of natural hand reaching kinematics. The task was repeated with the introduction of a hand support, eliminating the hand reaching movement and minimising fingertip movement deviations from a straight path. As a result, our subjects' performance significantly declined (66 ± 12% correct, mean ± SD; n = 12), suggesting that unrestricted reaching movement kinematics and factors such as physiological tremor, play a crucial role in enhancing or enabling friction perception upon initial contact. KEY POINTS: More slippery objects require a stronger grip to prevent them from slipping out of hands. Grip force adjustments to friction driven by tactile sensory signals are largely automatic and do not necessitate cognitive involvement; nevertheless, some associated awareness of grip surface slipperiness under such sensory conditions is present and helps to select a safe and appropriate movement plan. When gripping an object, tactile receptors provide frictional information without intentional rubbing or sliding fingers over the surface. However, we have discovered that submillimeter range lateral displacement might be required to enhance or enable friction sensing. The present study provides evidence that such small lateral movements causing localised partial slips arise and are an inherent part of natural reaching movement kinematics.

Open-Source Instrumented Object to Study Dexterous Object Manipulation.

Humans use tactile feedback to perform skillful manipulation. When tactile sensory feedback is unavailable, for instance, if the fingers are anesthetized, dexterity is severely impaired. Imaging the deformation of the finger pad skin when in contact with a transparent plate provides information about the tactile feedback received by the central nervous system. Indeed, skin deformations are transduced into neural signals by the mechanoreceptors of the finger pad skin. Understanding how this feedback is used for active object manipulation would improve our understanding of human dexterity. In this paper, we present a new device for imaging the skin of the finger pad of one finger during manipulation performed with a precision grip. The device's mass (300 g) makes it easy to use during unconstrained dexterous manipulation. Using this device, we reproduced the experiment performed in Delhaye et al. (2021) We extracted the strains aligned with the object's movement, i.e., the vertical strains in the ulnar and radial parts of the fingerpad, to see how correlated they were with the grip force (GF) adaptation. Interestingly, parts of our results differed from those in Delhaye et al. (2021) due to weight and inertia differences between the devices, with average GF across participants differing significantly. Our results highlight a large variability in the behavior of the skin across participants, with generally low correlations between strain and GF adjustments, suggesting that skin deformations are not the primary driver of GF adaptation in this manipulation scenario.

Automatic Segmentation of the Paediatric Femoral Head.

Developmental dysplasia of the hip (DDH) is a developmental deformity occurring in 0.1-3.4% of infants. Timely surgical intervention can ameliorate the condition in stable hips and reduce future cases of osteoarthritis and total hip replacement. However, current definitions of DDH are subjective, and thus would benefit from a more objective and reliable assessment metric. Since the shape of the femoral head and its congruence with the acetabulum are disrupted by DDH, analysis of the femoral head could potentially play a role in the development of novel objective morphological metric for stable DDH. Therefore, this paper aimed to segment the paediatric femoral head in stable hips from radiographs, which has not been attempted before in the chosen focus age group (1-16 years) where the pelvis and hip joint undergo significant development. Two techniques were compared against a baseline U-Net: data augmentation and region-of-interest (ROI) networks. Four models were developed either without, with just one, or with both techniques. Evaluated using tenfold cross-validation, the U-Net trained with both techniques achieved the best results, with a Dice Similarity Coefficient (DSC) of 0.951±0.037 (mean ± standard deviation, calculated with 720 images). Future work will use this segmentation algorithm to accurately characterise hip joint morphology and estimate the benefit of early surgical intervention in DDH.

Design, Fabrication, and Characterization of a Novel Optical Six-Axis Distributed Force and Displacement Tactile Sensor for Dexterous Robotic Manipulation.

Real-time multi-axis distributed tactile sensing is a critical capability if robots are to perform stable gripping and dexterous manipulation, as it provides crucial information about the sensor-object interface. In this paper, we present an optical-based six-axis tactile sensor designed in a fingertip shape for robotic dexterous manipulation. The distributed sensor can precisely estimate the local XYZ force and displacement at ten distinct locations and provide the global XYZ force and torque measurements. Its compact size, comparable to that of a human thumb, and minimal thickness allow seamless integration onto existing robotic fingers, eliminating the need for complex modifications to the gripper. The proposed sensor design uses a simple, low-cost fabrication method. Moreover, the optical transduction approach uses light angle and intensity sensing to infer force and displacement from deformations of the individual sensing units that form the overall sensor, providing distributed six-axis sensing. The local force precision at each sensing unit in the X, Y, and Z axes is 20.89 mN, 19.19 mN, and 43.22 mN, respectively, over a local force range of approximately ±1.5 N in X and Y and 0 to -2 N in Z. The local displacement precision in the X, Y, and Z axes is 56.70 µm, 50.18 µm, and 13.83 µm, respectively, over a local displacement range of ±2 mm in the XY directions and 0 to -1.5 mm in Z (i.e., compression). Additionally, the sensor can measure global torques, Tx, Ty, and Tz, with a precision of of 1.90 N-mm, 1.54 N-mm, and 1.26 N-mm, respectively. The fabricated design is showcased by integrating it with an OnRobot RG2 gripper and illustrating real-time measurements during in simple demonstration task, which generated changing global forces and torques.

Biomechanics of the finger pad in response to torsion.

Surface skin deformation of the finger pad during partial slippage at finger-object interfaces elicits firing of the tactile sensory afferents. A torque around the contact normal is often present during object manipulation, which can cause partial rotational slippage. Until now, studies of surface skin deformation have used stimuli sliding rectilinearly and tangentially to the skin. Here, we study surface skin dynamics under pure torsion of the right index finger of seven adult participants (four males). A custom robotic platform stimulated the finger pad with a flat clean glass surface, controlling the normal forces and rotation speeds applied while monitoring the contact interface using optical imaging. We tested normal forces between 0.5 N and 10 N at a fixed angular velocity of 20° s-1 and angular velocities between 5° s-1 and 100° s-1 at a fixed normal force of 2 N. We observe the characteristic pattern by which partial slips develop, starting at the periphery of the contact and propagating towards its centre, and the resulting surface strains. The 20-fold range of normal forces and angular velocities used highlights the effect of those parameters on the resulting torque and skin strains. Increasing normal force increases the contact area, the generated torque, strains and the twist angle required to reach full slip. On the other hand, increasing angular velocity causes more loss of contact at the periphery and higher strain rates (although it has no impact on resulting strains after the full rotation). We also discuss the surprisingly large inter-individual variability in skin biomechanics, notably observed in the twist angle the stimulus needs to rotate before reaching full slip.

A Smartphone-Based Model of Care to Support Patients With Cardiac Disease Transitioning From Hospital to the Community (TeleClinical Care): Pilot Randomized Controlled Trial.

BACKGROUND: Patients hospitalized with acute coronary syndrome (ACS) or heart failure (HF) are frequently readmitted. This is the first randomized controlled trial of a mobile health intervention that combines telemonitoring and education for inpatients with ACS or HF to prevent readmission. OBJECTIVE: This study aims to investigate the feasibility, efficacy, and cost-effectiveness of a smartphone app-based model of care (TeleClinical Care [TCC]) in patients discharged after ACS or HF admission. METHODS: In this pilot, 2-center randomized controlled trial, TCC was applied at discharge along with usual care to intervention arm participants. Control arm participants received usual care alone. Inclusion criteria were current admission with ACS or HF, ownership of a compatible smartphone, age ≥18 years, and provision of informed consent. The primary end point was the incidence of unplanned 30-day readmissions. Secondary end points included all-cause readmissions, cardiac readmissions, cardiac rehabilitation completion, medication adherence, cost-effectiveness, and user satisfaction. Intervention arm participants received the app and Bluetooth-enabled devices for measuring weight, blood pressure, and physical activity daily plus usual care. The devices automatically transmitted recordings to the patients' smartphones and a central server. Thresholds for blood pressure, heart rate, and weight were determined by the treating cardiologists. Readings outside these thresholds were flagged to a monitoring team, who discussed salient abnormalities with the patients' usual care providers (cardiologists, general practitioners, or HF outreach nurses), who were responsible for further management. The app also provided educational push notifications. Participants were followed up after 6 months. RESULTS: Overall, 164 inpatients were randomized (TCC: 81/164, 49.4%; control: 83/164, 50.6%; mean age 61.5, SD 12.3 years; 130/164, 79.3% men; 128/164, 78% admitted with ACS). There were 11 unplanned 30-day readmissions in both groups (P=.97). Over a mean follow-up of 193 days, the intervention was associated with a significant reduction in unplanned hospital readmissions (21 in TCC vs 41 in the control arm; P=.02), including cardiac readmissions (11 in TCC vs 25 in the control arm; P=.03), and higher rates of cardiac rehabilitation completion (20/51, 39% vs 9/49, 18%; P=.03) and medication adherence (57/76, 75% vs 37/74, 50%; P=.002). The average usability rating for the app was 4.5/5. The intervention cost Aus $6028 (US $4342.26) per cardiac readmission saved. When modeled in a mainstream clinical setting, enrollment of 237 patients was projected to have the same expenditure compared with usual care, and enrollment of 500 patients was projected to save approximately Aus $100,000 (approximately US $70,000) annually. CONCLUSIONS: TCC was feasible and safe for inpatients with either ACS or HF. The incidence of 30-day readmissions was similar; however, long-term benefits were demonstrated, including fewer readmissions over 6 months, improved medication adherence, and improved cardiac rehabilitation completion. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12618001547235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375945.

Submillimeter Lateral Displacement Enables Friction Sensing and Awareness of Surface Slipperiness.

Human tactile perception and motor control rely on the frictional estimates that stem from the deformation of the skin and slip events. However, it is not clear how exactly these mechanical events relate to the perception of friction. This study aims to quantify how minor lateral displacement and speed enables subjects to feel frictional differences. In a 2-alternative forced-choice protocol, an ultrasonic friction-reduction device was brought in contact perpendicular to the skin surface of an immobilized index finger; after reaching 1N normal force, the plate was moved laterally. A combination of four displacement magnitudes (0.2, 0.5, 1.2 and 2 mm), two levels of friction (high, low) and three displacement speeds (1, 5 and 10 mm/s) were tested. We found that the perception of frictional difference was enabled by submillimeter range lateral displacement. Friction discrimination thresholds were reached with lateral displacements ranging from 0.2 to 0.5 mm and surprisingly speed had only a marginal effect. These results demonstrate that partial slips are sufficient to cause awareness of surface slipperiness. These quantitative data are crucial for designing haptic devices that render slipperiness. The results also show the importance of subtle lateral finger movements present during dexterous manipulation tasks.

Trials and Tribulations: mHealth Clinical Trials in the COVID-19 Pandemic.

INTRODUCTION: Mobile phone-based interventions in cardiovascular disease are growing in popularity. A randomised control trial (RCT) for a novel smartphone app-based model of care, named TeleClinical Care - Cardiac (TCC-Cardiac), commenced in February 2019, targeted at patients being discharged after care for an acute coronary syndrome or episode of decompensated heart failure. The app was paired to a digital sphygmomanometer, weighing scale and a wearable fitness band, all loaned to the patient, and allowed clinicians to respond to abnormal readings. The onset of the COVID-19 pandemic necessitated several modifications to the trial in order to protect participants from potential exposure to infection. The use of TCC-Cardiac during the pandemic inspired the development of a similar model of care (TCC-COVID), targeted at patients being managed at home with a diagnosis of COVID-19. METHODS: Recruitment for the TCC-Cardiac trial was terminated shortly after the World Health Organization announced COVID-19 as a global pandemic. Telephone follow-up was commenced, in order to protect patients from unnecessary exposure to hospital staff and patients. Equipment was returned or collected by a 'no-contact' method. The TCC-COVID app and model of care had similar functionality to the original TCC-Cardiac app. Participants were enrolled exclusively by remote methods. Oxygen saturation and pulse rate were measured by a pulse oximeter, and symptomatology measured by questionnaire. Measurement results were manually entered into the app and transmitted to an online server for medical staff to review. RESULTS: A total of 164 patients were involved in the TCC-Cardiac trial, with 102 patients involved after the onset of the pandemic. There were no hospitalisations due to COVID-19 in this cohort. The study was successfully completed, with only three participants lost to follow-up. During the pandemic, 5 of 49 (10%) of patients in the intervention arm were readmitted compared to 12 of 53 (23%) in the control arm. Also, in this period, 28 of 29 (97%) of all clinically significant alerts received by the monitoring team were managed successfully in the outpatient setting, avoiding hospitalisation. Patients found the user experience largely positive, with the average rating for the app being 4.56 out of 5. 26 patients have currently been enrolled for TCC-COVID. Recruitment is ongoing. All patients have been safely and effectively monitored, with no major adverse clinical events or technical malfunctions. Patient satisfaction has been high. CONCLUSION: The TCC-Cardiac RCT was successfully completed despite the challenges posed by COVID-19. Use of the app had an added benefit during the pandemic as participants could be monitored safely from home. The model of care inspired the development of an app with similar functionality designed for use with patients diagnosed with COVID-19.

Friction sensing mechanisms for perception and motor control: passive touch without sliding may not provide perceivable frictional information.

Perception of the frictional properties of a surface contributes to the multidimensional experience of exploring various materials; we slide our fingers over a surface to feel it. In contrast, during object manipulation, we grip objects without such intended exploratory movements. Given that we are aware of the slipperiness of objects or tools that are held in the hand, we investigated whether the initial contact between the fingertip skin and the surface of the object is sufficient to provide this consciously perceived frictional information. Using a two-alternative forced-choice protocol, we examined human capacity to detect frictional differences using touch, when two otherwise structurally identical surfaces were brought in contact with the immobilized finger perpendicularly or under an angle (20° or 30°) to the skin surface (passive touch). An ultrasonic friction reduction device was used to generate three different frictions over each of three flat surfaces with different surface structure: 1) smooth glass, 2) textured surface with dome-shaped features, and 3) surface with sharp asperities (sandpaper). Participants (n = 12) could not reliably indicate which of the two surfaces was more slippery under any of these conditions. In contrast, when slip was induced by moving the surface laterally by a total of 5 mm (passive slip), participants could clearly perceive frictional differences. Thus making contact with the surface, even with moderate tangential forces, was not enough to perceive frictional differences, instead conscious perception required a sufficient size slip.NEW & NOTEWORTHY This study contributes to understanding how frictional information is obtained and used by the brain. When the skin is contacting surfaces of identical topography but varying frictional properties, the deformation pattern is different; however, available sensory cues did not get translated into perception of frictional properties unless a sufficiently large lateral movement was present. These neurophysiological findings may inform how to design and operate haptic devices relying on friction modulation principles.

A review of the neurobiomechanical processes underlying secure gripping in object manipulation.

O'SHEA, H. and S. J. Redmond. A review of the neurobiomechanical processes underlying secure gripping in object manipulation. NEUROSCI BIOBEHAV REV 286-300, 2021. Humans display skilful control over the objects they manipulate, so much so that biomimetic systems have yet to emulate this remarkable behaviour. Two key control processes are assumed to facilitate such dexterity: predictive cognitive-motor processes that guide manipulation procedures by anticipating action outcomes; and reactive sensorimotor processes that provide important error-based information for movement adaptation. Notwithstanding increased interdisciplinary research interest in object manipulation behaviour, the complexity of the perceptual-sensorimotor-cognitive processes involved and the theoretical divide regarding the fundamentality of control mean that the essential mechanisms underlying manipulative action remain undetermined. In this paper, following a detailed discussion of the theoretical and empirical bases for understanding human dexterous movement, we emphasise the role of tactile-related sensory events in secure object handling, and consider the contribution of certain biophysical and biomechanical phenomena. We aim to provide an integrated account of the current state-of-art in skilled human-object interaction that bridges the literature in neuroscience, cognitive psychology, and biophysics. We also propose novel directions for future research exploration in this area.

Process Evaluation of a Randomised Controlled Trial for TeleClinical Care, a Smartphone-App Based Model of Care.

BACKGROUND: A novel smartphone app-based model of care (TeleClinical Care - TCC) for patients with acute coronary syndrome (ACS) and heart failure (HF) was evaluated in a two-site, pilot randomised control trial of 164 participants in Sydney, Australia. The program included a telemonitoring system whereby abnormal blood pressure, weight and heart rate readings were monitored by a central clinical team, who subsequently referred clinically significant alerts to the patients' usual general practitioner (GP, also known as primary care physician in the United States), HF nurse or cardiologist. While the primary endpoint, 30-day readmissions, was neutral, intervention arm participants demonstrated improvements in readmission rates over 6 months, cardiac rehabilitation (CR) completion and medication compliance. A process evaluation was designed to identify contextual factors and mechanisms that influenced the results, as well as strategies of improving site and participant recruitment and the delivery of the intervention, for a planned larger effectiveness trial of over 1,000 patients across the state of New South Wales, Australia (TCC-Cardiac). METHODS: Multiple data sources were used in this mixed-methods process evaluation, including interviews with four TCC team members, three GPs and three cardiologists. CR completion rates, HF outreach service (HFOS) referrals and cardiologist follow-up appointments were audited. A patient questionnaire was also analysed for evidence of improved self-care as a hypothesised mechanism of the TCC app. An implementation research logic model was used to synthesise our findings. RESULTS: Rates of HFOS referral (83 vs. 72%) and cardiologist follow-up (96 vs. 93%) were similarly high in the intervention and control arms, respectively. Team members were largely positive towards their orientation and training, but highlighted several implementation strategies that could be optimised for TCC-Cardiac: streamlining of the enrolment process, improving the reach of the trial by screening patients in non-cardiac wards, and ensuring team members had adequate time to recruit (>15 h per week). GPs and cardiologists viewed the intervention acceptably regarding potential benefit of closely monitoring, and responding to abnormalities for their patients, though there were concerns of the potential additional workload generated by alerts that did not merit clinical intervention. Clear delineation of which clinician (GP or cardiologist) was primarily responsible for alert management was also recommended, as well as a preference to receive regular summary data. Several patients commented on the mechanisms of improved self-management because of TCC, which could have led to the outcome of improved medication compliance. DISCUSSION: Use of TCC was associated with several benefits, including higher patient engagement and completion rates with CR. The conduct and delivery of TCC-Cardiac will be improved by the findings of this process evaluation to optimise recruitment, and establishing the roles of GPs and cardiologists as part of the model.

Estimating Lower Limb Kinematics Using a Reduced Wearable Sensor Count.

GOAL: This paper presents an algorithm for accurately estimating pelvis, thigh, and shank kinematics during walking using only three wearable inertial sensors. METHODS: The algorithm makes novel use of a constrained Kalman filter (CKF). The algorithm iterates through the prediction (kinematic equation), measurement (pelvis position pseudo-measurements, zero velocity update, flat-floor assumption, and covariance limiter), and constraint update (formulation of hinged knee joints and ball-and-socket hip joints). RESULTS: Evaluation of the algorithm using an optical motion capture-based sensor-to-segment calibration on nine participants (7 men and 2 women, weight [Formula: see text] kg, height [Formula: see text] m, age [Formula: see text] years old), with no known gait or lower body biomechanical abnormalities, who walked within a [Formula: see text] m 2 capture area shows that it can track motion relative to the mid-pelvis origin with mean position and orientation (no bias) root-mean-square error (RMSE) of [Formula: see text] cm and [Formula: see text], respectively. The sagittal knee and hip joint angle RMSEs (no bias) were [Formula: see text] and [Formula: see text], respectively, while the corresponding correlation coefficient (CC) values were [Formula: see text] and [Formula: see text]. CONCLUSION: The CKF-based algorithm was able to track the 3D pose of the pelvis, thigh, and shanks using only three inertial sensors worn on the pelvis and shanks. SIGNIFICANCE: Due to the Kalman-filter-based algorithm's low computation cost and the relative convenience of using only three wearable sensors, gait parameters can be computed in real-time and remotely for long-term gait monitoring. Furthermore, the system can be used to inform real-time gait assistive devices.

Deep Learning for Activity Recognition in Older People Using a Pocket-Worn Smartphone.

Activity recognition can provide useful information about an older individual's activity level and encourage older people to become more active to live longer in good health. This study aimed to develop an activity recognition algorithm for smartphone accelerometry data of older people. Deep learning algorithms, including convolutional neural network (CNN) and long short-term memory (LSTM), were evaluated in this study. Smartphone accelerometry data of free-living activities, performed by 53 older people (83.8 ± 3.8 years; 38 male) under standardized circumstances, were classified into lying, sitting, standing, transition, walking, walking upstairs, and walking downstairs. A 1D CNN, a multichannel CNN, a CNN-LSTM, and a multichannel CNN-LSTM model were tested. The models were compared on accuracy and computational efficiency. Results show that the multichannel CNN-LSTM model achieved the best classification results, with an 81.1% accuracy and an acceptable model and time complexity. Specifically, the accuracy was 67.0% for lying, 70.7% for sitting, 88.4% for standing, 78.2% for transitions, 88.7% for walking, 65.7% for walking downstairs, and 68.7% for walking upstairs. The findings indicated that the multichannel CNN-LSTM model was feasible for smartphone-based activity recognition in older people.

Estimating Lower Limb Kinematics Using a Lie Group Constrained Extended Kalman Filter with a Reduced Wearable IMU Count and Distance Measurements.

Tracking the kinematics of human movement usually requires the use of equipment that constrains the user within a room (e.g., optical motion capture systems), or requires the use of a conspicuous body-worn measurement system (e.g., inertial measurement units (IMUs) attached to each body segment). This paper presents a novel Lie group constrained extended Kalman filter to estimate lower limb kinematics using IMU and inter-IMU distance measurements in a reduced sensor count configuration. The algorithm iterates through the prediction (kinematic equations), measurement (pelvis height assumption/inter-IMU distance measurements, zero velocity update for feet/ankles, flat-floor assumption for feet/ankles, and covariance limiter), and constraint update (formulation of hinged knee joints and ball-and-socket hip joints). The knee and hip joint angle root-mean-square errors in the sagittal plane for straight walking were 7.6±2.6∘ and 6.6±2.7∘, respectively, while the correlation coefficients were 0.95±0.03 and 0.87±0.16, respectively. Furthermore, experiments using simulated inter-IMU distance measurements show that performance improved substantially for dynamic movements, even at large noise levels (σ=0.2 m). However, further validation is recommended with actual distance measurement sensors, such as ultra-wideband ranging sensors.

Estimating Lower Limb Kinematics using Distance Measurements with a Reduced Wearable Inertial Sensor Count.

This paper presents an algorithm that makes novel use of distance measurements alongside a constrained Kalman filter to accurately estimate pelvis, thigh, and shank kinematics for both legs during walking and other body movements using only three wearable inertial measurement units (IMUs). The distance measurement formulation also assumes hinge knee joint and constant body segment length, helping produce estimates that are near or in the constraint space for better estimator stability. Simulated experiments have shown that inter-IMU distance measurement is indeed a promising new source of information to improve the pose estimation of inertial motion capture systems under a reduced sensor count configuration. Furthermore, experiments show that performance improved dramatically for dynamic movements even at high noise levels (e.g., σdist = 0.2 m), and that acceptable performance for normal walking was achieved at σdist = 0.1 m. Nevertheless, further validation is recommended using actual distance measurement sensors.

Smart Triggering of the Barometer in a Fall Detector Using a Semi-Permeable Membrane.

The inclusion of a barometer in a wearable fall detector has been shown to improve the detection accuracy by measuring the altitude change associated with a fall event. However, the barometer is a power-hungry sensor, and the sensing power of barometer can be the dominant power consumption source in a wearable fall detector. In this study, we propose a triggering method that reduces barometer power consumption and prolongs the battery life. This approach utilizes a hermetically sealed and waterproof enclosure, with a small inlet covered by a semi-permeable membrane (SPM) to delay the time at which equilibrium between the internal and external pressures is reached, allowing the barometer to be woken from an idle low-power mode and capture the rising air pressure caused by the decrease in altitude during the fall. Two alternative signal processing methods were applied to the pressure waveform to detect the rising pressure pattern, a differential moving average filter (DMAF) and a Kalman filter (KF). The proposed fall detector was evaluated with data collected from a laboratory-based trial and a free-living trial, in which the barometric pressure data, recorded in open-air, were passed through a mathematical model of the leaky enclosure and the SPM assembly. The results show that the proposed fall detector with a 3.7 V, 140 mAh lithium-polymer battery provides a long battery life (DMAF 447 days, KF 444 days) while not compromising the sensitivity (DMAF 91.8%, KF 91.9%), specificity (DMAF 95.2% and KF 95.5%), or the false alarm rate (DMAF 0.035 alarms/hour and KF 0.064 alarms/hour).

Digital assessment of falls risk, frailty, and mobility impairment using wearable sensors.

Falls are among the most frequent and costly population health issues, costing $50bn each year in the US. In current clinical practice, falls (and associated fall risk) are often self-reported after the "first fall", delaying primary prevention of falls and development of targeted fall prevention interventions. Current methods for assessing falls risk can be subjective, inaccurate, have low inter-rater reliability, and do not address factors contributing to falls (poor balance, gait speed, transfers, turning). 8521 participants (72.7 ± 12.0 years, 5392 female) from six countries were assessed using a digital falls risk assessment protocol. Data consisted of wearable sensor data captured during the Timed Up and Go (TUG) test along with self-reported questionnaire data on falls risk factors, applied to previously trained and validated classifier models. We found that 25.8% of patients reported a fall in the previous 12 months, of the 74.6% of participants that had not reported a fall, 21.5% were found to have a high predicted risk of falls. Overall 26.2% of patients were predicted to be at high risk of falls. 29.8% of participants were found to have slow walking speed, while 19.8% had high gait variability and 17.5% had problems with transfers. We report an observational study of results obtained from a novel digital fall risk assessment protocol. This protocol is intended to support the early identification of older adults at risk of falls and inform the creation of appropriate personalized interventions to prevent falls. A population-based approach to management of falls using objective measures of falls risk and mobility impairment, may help reduce unnecessary outpatient and emergency department utilization by improving risk prediction and stratification, driving more patients towards clinical and community-based falls prevention activities.

Learning the Orientation of a Loosely-Fixed Wearable IMU Relative to the Body Improves the Recognition Rate of Human Postures and Activities.

Features were developed which accounted for the changing orientation of the inertial measurement unit (IMU) relative to the body, and demonstrably improved the performance of models for human activity recognition (HAR). The method is proficient at separating periods of standing and sedentary activity (i.e., sitting and/or lying) using only one IMU, even if it is arbitrarily oriented or subsequently re-oriented relative to the body; since the body is upright during walking, learning the IMU orientation during walking provides a reference orientation against which sitting and/or lying can be inferred. Thus, the two activities can be identified (irrespective of the cohort) by analyzing the magnitude of the angle of shortest rotation which would be required to bring the upright direction into coincidence with the average orientation from the most recent 2.5 s of IMU data. Models for HAR were trained using data obtained from a cohort of 37 older adults (83.9 ± 3.4 years) or 20 younger adults (21.9 ± 1.7 years). Test data were generated from the training data by virtually re-orienting the IMU so that it is representative of carrying the phone in five different orientations (relative to the thigh). The overall performance of the model for HAR was consistent whether the model was trained with the data from the younger cohort, and tested with the data from the older cohort after it had been virtually re-oriented (Cohen's Kappa 95% confidence interval [0.782, 0.793]; total class sensitivity 95% confidence interval [84.9%, 85.6%]), or the reciprocal scenario in which the model was trained with the data from the older cohort, and tested with the data from the younger cohort after it had been virtually re-oriented (Cohen's Kappa 95% confidence interval [0.765, 0.784]; total class sensitivity 95% confidence interval [82.3%, 83.7%]).

Peripheral Nerve Activation Evokes Machine-Learnable Signals in the Dorsal Column Nuclei.

The brainstem dorsal column nuclei (DCN) are essential to inform the brain of tactile and proprioceptive events experienced by the body. However, little is known about how ascending somatosensory information is represented in the DCN. Our objective was to investigate the usefulness of high-frequency (HF) and low-frequency (LF) DCN signal features (SFs) in predicting the nerve from which signals were evoked. We also aimed to explore the robustness of DCN SFs and map their relative information content across the brainstem surface. DCN surface potentials were recorded from urethane-anesthetized Wistar rats during sural and peroneal nerve electrical stimulation. Five salient SFs were extracted from each recording electrode of a seven-electrode array. We used a machine learning approach to quantify and rank information content contained within DCN surface-potential signals following peripheral nerve activation. Machine-learning of SF and electrode position combinations was quantified to determine a hierarchy of information importance for resolving the peripheral origin of nerve activation. A supervised back-propagation artificial neural network (ANN) could predict the nerve from which a response was evoked with up to 96.8 ± 0.8% accuracy. Guided by feature-learnability, we maintained high prediction accuracy after reducing ANN algorithm inputs from 35 (5 SFs from 7 electrodes) to 6 (4 SFs from one electrode and 2 SFs from a second electrode). When the number of input features were reduced, the best performing input combinations included HF and LF features. Feature-learnability also revealed that signals recorded from the same midline electrode can be accurately classified when evoked from bilateral nerve pairs, suggesting DCN surface activity asymmetry. Here we demonstrate a novel method for mapping the information content of signal patterns across the DCN surface and show that DCN SFs are robust across a population. Finally, we also show that the DCN is functionally asymmetrically organized, which challenges our current understanding of somatotopic symmetry across the midline at sub-cortical levels.