The detection and prediction of surgical site infections using multi-modal sensors and machine learning: Results in an animal model.

Introduction: Surgical Site Infection (SSI) is a common healthcare-associated infection that imposes a considerable clinical and economic burden on healthcare systems. Advances in wearable sensors and digital technologies have unlocked the potential for the early detection and diagnosis of SSI, which can help reduce this healthcare burden and lower SSI-associated mortality rates. Methods: In this study, we evaluated the ability of a multi-modal bio-signal system to predict current and developing superficial incisional infection in a porcine model infected with Methicillin Susceptible Staphylococcus Aureus (MSSA) using a bagged, stacked, and balanced ensemble logistic regression machine learning model. Results: Results demonstrated that the expression levels of individual biomarkers (i.e., peri-wound tissue oxygen saturation, temperature, and bioimpedance) differed between non-infected and infected wounds across the study period, with cross-correlation analysis indicating that a change in bio-signal expression occurred 24 to 31 hours before this change was reflected by clinical wound scoring methods employed by trained veterinarians. Moreover, the multi-modal ensemble model indicated acceptable discriminability to detect the presence of a current superficial incisional SSI (AUC = 0.77), to predict an SSI 24 hours in advance of veterinarian-based SSI diagnosis (AUC = 0.80), and to predict an SSI 48 hours in advance of veterinarian-based SSI diagnosis (AUC = 0.74). Discussion: In sum, the results of the current study indicate that non-invasive multi-modal sensor and signal analysis systems have the potential to detect and predict superficial incisional SSIs in porcine subjects under experimental conditions.

Accuracy and Validity of a Single Inertial Measurement Unit-Based System to Determine Upper Limb Kinematics for Medically Underserved Populations.

Stroke is one of the leading causes of death and disability worldwide, with a disproportionate burden represented by low- and middle-income countries (LMICs). To improve post-stroke outcomes in LMICs, researchers have sought to leverage emerging technologies that overcome traditional barriers associated with stroke management. One such technology, inertial measurement units (IMUs), exhibit great potential as a low-cost, portable means to evaluate and monitor patient progress during decentralized rehabilitation protocols. As such, the aim of the present study was to determine the ability of a low-cost single IMU sensor-based wearable system (named the T'ena sensor) to reliably and accurately assess movement quality and efficiency in physically and neurologically healthy adults. Upper limb movement kinematics measured by the T'ena sensor were compared to the gold standard reference system during three functional tasks, and root mean square errors, Pearson's correlation coefficients, intraclass correlation coefficients, and the Bland Altman method were used to compare kinematic variables of interest between the two systems for absolute accuracy and equivalency. The T'ena sensor and the gold standard reference system were significantly correlated for all tasks and measures (r range = 0.648-0.947), although less so for the Finger to Nose task (r range = 0.648-0.894). Results demonstrate that single IMU systems are a valid, reliable, and objective method by which to measure movement kinematics during functional tasks. Context-appropriate enabling technologies specifically designed to address barriers to quality health services in LMICs can accelerate progress towards the United Nations Sustainable Development Goal 3.

Developing an mHealth app for post-stroke upper limb rehabilitation: Feedback from US and Ethiopian rehabilitation clinicians.

Stroke is the leading cause of adult disability worldwide, with 70 percent of survivors exhibiting residual impairments of the upper limb that require frequent in-person visits to rehabilitation clinic over several months. This study explored rehabilitation clinician's preferences for design features to be included in an mHealth-enabled app for post-stroke upper limb rehabilitation. Data were collected via online survey, sampling participants from Ethiopia (n = 69) and the United States (n = 75). Survey results indicated that Ethiopian and US rehabilitation clinicians have different opinions about the importance of design features that should be included in a stroke tele-rehabilitation system which are likely due to differences in culture, the availability of human and physical resources, and how the field of rehabilitation is organized and managed. Our results, thus, indicate that mHealth technologies must be tailored to the geographical and cultural context of the end users.

Task-specific and variability-driven activation of cognitive control processes during motor performance.

It has long been postulated that cognitive and motor functions are functionally intertwined. While the idea received convincing support from neuroimaging studies providing evidence that motor and cognitive processes draw on common neural mechanisms and resources, findings from behavioral studies are rather inconsistent. The purpose of the present study was to identify and verify key factors that act on the link between cognitive and motor functions. Specifically we investigated whether it is possible to predict motor skills from cognitive functions. While our results support the idea that motor and cognitive functions are functionally intertwined and different motor skills entail distinct cognitive functions, our data also strongly suggest that the impact of cognitive control processes on motor skill proficiency depends on performance variability, i.e. on how challenging a motor task is. Based on these findings, we presume that motor skills activate specific cognitive control processes on two levels: basic processes that are solely related to the type of the motor task, and variability-driven processes that come into play when performance variability is high. For practitioners, these findings call for specific and challenging motor training interventions to directly tap into the to-be-improved cognitive skills and to involve a maximum of cognitive processes.

Effects of Stroke on Ipsilesional End-Effector Kinematics in a Multi-Step Activity of Daily Living.

Background: Stroke frequently impairs activities of daily living (ADL) and deteriorates the function of the contra- as well as the ipsilesional limbs. In order to analyze alterations of higher motor control unaffected by paresis or sensory loss, the kinematics of ipsilesional upper limb movements in patients with stroke has previously been analyzed during prehensile movements and simple tool use actions. By contrast, motion recording of multi-step ADL is rare and patient-control comparisons for movement kinematics are largely lacking. Especially in clinical research, objective quantification of complex externally valid tasks can improve the assessment of neurological impairments. Methods: In this preliminary study we employed three-dimensional motion recording and applied kinematic analysis in a multi-step ADL (tea-making). The trials were examined with respect to errors and sub-action structure, durations, path lengths (PLs), peak velocities, relative activity (RA) and smoothness. In order to check for specific burdens the sub-actions of the task were extracted and compared. To examine the feasibility of the approach, we determined the behavioral and kinematic metrics of the (ipsilesional) unimanual performance of seven chronic stroke patients (64a ± 11a, 3 with right/4 with left brain damage (LBD), 2 with signs of apraxia, variable severity of paresis) and compared the results with data of 14 neurologically healthy age-matched control participants (70a ± 7a). Results: T-tests revealed that while the quantity and structure of sub-actions of the task were similar. The analysis of end-effector kinematics was able to detect clear group differences in the associated parameters. Specifically, trial duration (TD) was increased (Cohen's d = 1.77); the RA (Cohen's d = 1.72) and the parameters of peak velocities (Cohen's d = 1.49/1.97) were decreased in the patient group. Analysis of the task's sub-actions repeated measures analysis of variance (rmANOVA) revealed no impact of the different demands of the sub-actions on the relative performance of the patient group. Conclusion: The analyses revealed kinematic peculiarities in the performance with the ipsilesional hand. These deficits apparently arose from the cognitive demands like sequencing rather than motor constraints. End-effector kinematics proved as a sensitive method to detect and quantify aspects of disturbed multi-step ADL performance after stroke. If standardized, the examination and the analysis are quick and deliver objective data supporting clinical research.

Self-Paced Reaching after Stroke: A Quantitative Assessment of Longitudinal and Directional Sensitivity Using the H-Man Planar Robot for Upper Limb Neurorehabilitation.

Technology aided measures offer a sensitive, accurate and time-efficient approach for the assessment of sensorimotor function after neurological insult compared to standard clinical assessments. This study investigated the sensitivity of robotic measures to capture differences in planar reaching movements as a function of neurological status (stroke, healthy), direction (front, ipsilateral, contralateral), movement segment (outbound, inbound), and time (baseline, post-training, 2-week follow-up) using a planar, two-degrees of freedom, robotic-manipulator (H-Man). Twelve chronic stroke (age: 55 ± 10.0 years, 5 female, 7 male, time since stroke: 11.2 ± 6.0 months) and nine aged-matched healthy participants (age: 53 ± 4.3 years, 5 female, 4 male) participated in this study. Both healthy and stroke participants performed planar reaching movements in contralateral, ipsilateral and front directions with the H-Man, and the robotic measures, spectral arc length (SAL), normalized time to peak velocities (TpeakN ), and root-mean square error (RMSE) were evaluated. Healthy participants went through a one-off session of assessment to investigate the baseline. Stroke participants completed a 2-week intensive robotic training plus standard arm therapy (8 × 90 min sessions). Motor function for stroke participants was evaluated prior to training (baseline, week-0), immediately following training (post-training, week-2), and 2-weeks after training (follow-up, week-4) using robotic assessment and the clinical measures Fugl-Meyer Assessment (FMA), Activity-Research-Arm Test (ARAT), and grip-strength. Robotic assessments were able to capture differences due to neurological status, movement direction, and movement segment. Movements performed by stroke participants were less-smooth, featured longer TpeakN , and larger RMSE values, compared to healthy controls. Significant movement direction differences were observed, with improved reaching performance for the front, compared to ipsilateral and contralateral movement directions. There were group differences depending on movement segment. Outbound reaching movements were smoother and featured longer TpeakN values than inbound movements for control participants, whereas SAL, TpeakN , and RMSE values were similar regardless of movement segment for stroke patients. Significant change in performance was observed between initial and post-assessments using H-Man in stroke participants, compared to conventional scales which showed no significant difference. Results of the study indicate the potential of H-Man as a sensitive tool for tracking changes in performance compared to ordinal scales (i.e., FM, ARAT).

The Role of Visual and Haptic Feedback During Dynamically Coupled Bimanual Manipulation.

The mechanisms that underlie the control of bimanual actions in which the two hands act separately to manipulate different objects (uncoupled independent control) has been well studied. In contrast, much less is known about how the central nervous system controls bimanual actions that require the two hands act cooperatively to manipulate a single object (dynamically coupled control). Furthermore, there is scant research into the manual lateralization and role assignment in the processing of visual and haptic feedback during dynamically coupled bimanual tasks. In this experiment, we examined the role of the dominant and non-dominant hands during a dynamically coupled bimanual task in which visual and haptic feedback regarding object penetration were manipulated. Twelve subjects performed a bimanual grasp and reach task towards different target locations in the workspace by using two identical wrist robotic devices. Results showed haptic feedback is necessary for task completion, and that hand specialization plays a fundamental role in spatial and temporal coordination between the two limbs.

Upper extremity proprioception in healthy aging and stroke populations, and the effects of therapist- and robot-based rehabilitation therapies on proprioceptive function.

The world's population is aging, with the number of people ages 65 or older expected to surpass 1.5 billion people, or 16% of the global total. As people age, there are notable declines in proprioception due to changes in the central and peripheral nervous systems. Moreover, the risk of stroke increases with age, with approximately two-thirds of stroke-related hospitalizations occurring in people over the age of 65. In this literature review, we first summarize behavioral studies investigating proprioceptive deficits in normally aging older adults and stroke patients, and discuss the differences in proprioceptive function between these populations. We then provide a state of the art review the literature regarding therapist- and robot-based rehabilitation of the upper extremity proprioceptive dysfunction in stroke populations and discuss avenues of future research.

Manual (a)symmetries in grasp posture planning: a short review.

Many activities of daily living require that we physically interact with one or more objects. Object manipulation provides an intriguing domain in which the presence and extent of manual asymmetries can be studied on a motor planning and a motor execution level. In this literature review we present a state of the art for manual asymmetries at the level of motor planning during object manipulation. First, we introduce pioneering work on grasp posture planning. We then sketch the studies investigating the impact of future task demands during unimanual and bimanual object manipulation tasks in healthy adult populations. In sum, in contrast to motor execution, there is little evidence for hand-based performance differences in grasp posture planning. We discuss potential reasons for the lack of manual asymmetries in motor planning and outline potential avenues of future research.

Simulating my own or others action plans?--Motor representations, not visual representations are recalled in motor memory.

Action plans are not generated from scratch for each movement, but features of recently generated plans are recalled for subsequent movements. This study investigated whether the observation of an action is sufficient to trigger plan recall processes. Participant dyads performed an object manipulation task in which one participant transported a plunger from an outer platform to a center platform of different heights (first move). Subsequently, either the same (intra-individual task condition) or the other participant (inter-individual task condition) returned the plunger to the outer platform (return moves). Grasp heights were inversely related to center target height and similar irrespective of direction (first vs. return move) and task condition (intra- vs. inter-individual). Moreover, participants' return move grasp heights were highly correlated with their own, but not with their partners' first move grasp heights. Our findings provide evidence that a simulated action plan resembles a plan of how the observer would execute that action (based on a motor representation) rather than a plan of the actually observed action (based on a visual representation).

The influence of initial and final precision on motor planning: individual differences in end-state comfort during unimanual grasping and placing.

People will often grasp an object with an uncomfortable initial grasp if this affords more comfort at the end of the movement. The authors' primary objective was to examine whether grasp planning is influenced by precision demands at the start and end of the movement. Twenty right-handed individuals performed a unimanual grasping and placing task in which the precision requirements at the start and end of the movement were either identical (low initial and final precision, high initial and final precision) or different (low initial and high final precision, high initial and low final precision). The major finding to emerge was the presence of individual differences. 50% of participants changed their initial grasps based on the precision requirements of the task, and were more likely to satisfy end-state comfort when the final precision requirements were high than when they were low. In contrast, 50% of participants generally planned their movements to satisfy end-state comfort (regardless of precision requirements). The authors hypothesized that the former group of participants was sensitive to the precision demands of the task, and participants planned their grips in accordance with these demands. In contrast, the latter group of participants reduced the cognitive costs by using previously successful grasp plans.