A metamodel-based flexible insulin therapy for type 1 diabetes patients subjected to aerobic physical activity.

Patients with type 1 diabetes are subject to exogenous insulin injections, whether manually or through (semi)automated insulin pumps. Basic knowledge of the patient's characteristics and flexible insulin therapy (FIT) parameters are then needed. Specifically, artificial pancreas-like closed-loop insulin delivery systems are some of the most promising devices for substituting for endogenous insulin secretion in type 1 diabetes patients. However, these devices require self-reported information such as carbohydrates or physical activity from the patient, introducing potential miscalculations and delays that can have life-threatening consequences. Here, we display a metamodel for glucose-insulin dynamics that is subject to carbohydrate ingestion and aerobic physical activity. This metamodel incorporates major existing knowledge-based models. We derive comprehensive and universal definitions of the underlying FIT parameters to form an insulin sensitivity factor (ISF). In addition, the relevance of physical activity modelling is assessed, and the FIT is updated to take physical exercise into account. Specifically, we cope with physical activity by using heart rate sensors (watches) with a fully automated closed insulin loop, aiming to maximize the time spent in the glycaemic range (75.5% in the range and 1.3% below the range for hypoglycaemia on a virtual patient simulator).These mathematical parameter definitions are interesting on their own, may be new tools for assessing mathematical models and can ultimately be used in closed-loop artificial pancreas algorithms or to extend distinguished FIT.

Recursive Decomposition of Electromyographic Signals With a Varying Number of Active Sources: Bayesian Modeling and Filtering.

OBJECTIVE: This paper describes a sequential decomposition algorithm for single-channel intramuscular electromyography (iEMG) generated by a varying number of active motor neurons. METHODS: As in previous work, we establish a hidden Markov model of iEMG, in which each motor neuron spike train is modeled as a renewal process with inter-spike intervals following a discrete Weibull law and motor unit action potentials are modeled as impulse responses of linear time-invariant systems with known prior. We then expand this model by introducing an activation vector associated with the state vector of the hidden Markov model. This activation vector represents recruitment/derecruitment of motor units and is estimated together with the state vector using Bayesian filtering. Non-stationarity of the model parameters is addressed by means of a sliding window approach, thus making the algorithm adaptive to variations in contraction force and motor unit action potential waveforms. RESULTS: The algorithm was validated using simulated and experimental iEMG signals with varying number of active motor units. The experimental signals were acquired from the tibialis anterior and abductor digiti minimi muscles by fine wire and needle electrodes. The decomposition accuracy in both simulated and experimental signals exceeded 90%. CONCLUSION: The recruitment/derecruitment was successfully tracked by the algorithm. Because of its parallel structure, this algorithm can be efficiently accelerated, which lays the basis for its real-time applications in human-machine interfaces. SIGNIFICANCE: The proposed method substantially broadens the domains of applicability of the algorithm.

On-Line Recursive Decomposition of Intramuscular EMG Signals Using GPU-Implemented Bayesian Filtering.

OBJECTIVE: Real-time intramuscular electromyography (iEMG) decomposition, which is needed in biofeedback studies and interfacing applications, is a complex procedure that involves identifying the motor neuron spike trains from a streaming iEMG recording. METHODS: We have previously proposed a sequential decomposition algorithm based on a Hidden Markov Model of EMG, which used Bayesian filter to estimate unknown parameters of motor unit (MU) spike trains, as well as their action potentials (MUAPs). Here, we present a modification of this original model in order to achieve a real-time performance of the algorithm as well as a parallel computation implementation of the algorithm on Graphics Processing Unit (GPU). Specifically, the Kalman filter previously used to estimate the MUAPs, is replaced by a least-mean-square filter. Additionally, we introduce a number of heuristics that help to omit the most improbable decomposition scenarios while searching for the best solution. Then, a GPU-implementation of the proposed algorithm is presented. RESULTS: Simulated iEMG signals containing up to 10 active MUs, as well as five experimental fine-wire iEMG signals acquired from the tibialis anterior muscle, were decomposed in real time. The accuracy of decompositions depended on the level of muscle activation, but in all cases exceeded 85 %. CONCLUSION: The proposed method and implementation provide an accurate, real-time interface with spinal motor neurons. SIGNIFICANCE: The presented real time implementation of the decomposition algorithm substantially broadens the domain of its application.

Simulation of Motor Unit Action Potential Recordings From Intramuscular Multichannel Scanning Electrodes.

Multi-channel intramuscular EMG (iEMG) provides information on motor neuron behavior, muscle fiber (MF) innervation geometry and, recently, has been proposed as a means to establish a human-machine interface. OBJECTIVE: to provide a reliable benchmark for computational methods applied to such recordings, we propose a simulation model for iEMG signals acquired by intramuscular multi-channel electrodes. METHODS: we propose several modifications to the existing motor unit action potentials (MUAPs) simulation methods, such as farthest point sampling (FPS) for the distribution of motor unit territory centers in the muscle cross-section, accurate fiber-neuron assignment algorithm, modeling of motor neuron action potential propagation delay, and a model of multi-channel scanning electrode. RESULTS: we provide representative applications of this model to the estimation of motor unit territories and the iEMG decomposition evaluation. Also, we extend it to a full multi-channel iEMG simulator using classic linear EMG modeling. CONCLUSIONS: altogether, the proposed models provide accurate MUAPs across the entire motor unit territories and for various electrode configurations. SIGNIFICANCE: they can be used for the development and evaluation of mathematical methods for multi-channel iEMG processing and analysis.

Individuals have unique muscle activation signatures as revealed during gait and pedaling.

Although it is known that the muscle activation patterns used to produce even simple movements can vary between individuals, these differences have not been considered to prove the existence of individual muscle activation strategies (or signatures). We used a machine learning approach (support vector machine) to test the hypothesis that each individual has unique muscle activation signatures. Eighty participants performed a series of pedaling and gait tasks, and 53 of these participants performed a second experimental session on a subsequent day. Myoelectrical activity was measured from eight muscles: vastus lateralis and medialis, rectus femoris, gastrocnemius lateralis and medialis, soleus, tibialis anterior, and biceps femoris-long head. The classification task involved separating data into training and testing sets. For the within-day classification, each pedaling/gait cycle was tested using the classifier, which had been trained on the remaining cycles. For the between-day classification, each cycle from day 2 was tested using the classifier, which had been trained on the cycles from day 1. When considering all eight muscles, the activation profiles were assigned to the corresponding individuals with a classification rate of up to 99.28% (2,353/2,370 cycles) and 91.22% (1,341/1,470 cycles) for the within-day and between-day classification, respectively. When considering the within-day classification, a combination of two muscles was sufficient to obtain a classification rate >80% for both pedaling and gait. When considering between-day classification, a combination of four to five muscles was sufficient to obtain a classification rate >80% for pedaling and gait. These results demonstrate that strategies not only vary between individuals, as is often assumed, but are unique to each individual.NEW & NOTEWORTHY We used a machine learning approach to test the uniqueness and robustness of muscle activation patterns. We considered that, if an algorithm can accurately identify participants, one can conclude that these participants exhibit discernible differences and thus have unique muscle activation signatures. Our results show that activation patterns not only vary between individuals, but are unique to each individual. Individual differences should, therefore, be considered relevant information for addressing fundamental questions about the control of movement.

Walking Gait Step Length Asymmetry Induced by Handheld Device.

The modeling and feature extraction of human gait motion are crucial in biomechanics studies, human localization, and robotics applications. Recent studies in pedestrian navigation aim at extracting gait features based on the data of low-cost sensors embedded in handheld devices, such as smartphones. The general assumption in pedestrian dead reckoning (PDR) strategy for navigation application is that the presence of a device in hand does not impact the gait symmetry and that all steps are identical. This hypothesis, which is used to estimate the traveled distance, is investigated in this paper with an experimental study. Ten healthy volunteers participated in motion lab tests with a 0.190 kg device in hand. Several walking trials with different device carrying modes and several gait speeds were performed. For a fixed walking speed, it is shown that the steps differ in their duration when holding a mass equivalent to a smartphone mass, which invalidates classical symmetry hypothesis in the PDR step length modeling. It is also shown that this hypothesis can lead to a 2.5% to 6.3% error on the PDR estimated traveled distance for the different walking trials.

A Long-Term Model of the Glucose-Insulin Dynamics of Type 1 Diabetes.

A new glucose-insulin model is introduced which fits with the clinical data from in- and outpatients for two days. Its stability property is consistent with the glycemia behavior for type 1 diabetes. This is in contrast to traditional glucose-insulin models. Prior models fit with clinical data for a few hours only or display some nonnatural equilibria. The parameters of this new model are identifiable from standard clinical data as continuous glucose monitoring, insulin injection, and carbohydrate estimate. Moreover, it is shown that the parameters from the model allow the computation of the standard tools used in functional insulin therapy as the basal rate of insulin and the insulin sensitivity factor. This is a major outcome as they are required in therapeutic education of type 1 diabetic patients.

Sequential decoding of intramuscular EMG signals via estimation of a Markov model.

This paper addresses the sequential decoding of intramuscular single-channel electromyographic (EMG) signals to extract the activity of individual motor neurons. A hidden Markov model is derived from the physiological generation of the EMG signal. The EMG signal is described as a sum of several action potentials (wavelet) trains, embedded in noise. For each train, the time interval between wavelets is modeled by a process that parameters are linked to the muscular activity. The parameters of this process are estimated sequentially by a Bayes filter, along with the firing instants. The method was tested on some simulated signals and an experimental one, from which the rates of detection and classification of action potentials were above 95% with respect to the reference decomposition. The method works sequentially in time, and is the first to address the problem of intramuscular EMG decomposition online. It has potential applications for man-machine interfacing based on motor neuron activities.

Spike sorting by stochastic simulation.

The decomposition of multiunit signals consists of the restoration of spike trains and action potentials in neural or muscular recordings. Because of the complexity of automatic decomposition, semiautomatic procedures are sometimes chosen. The main difficulty in automatic decomposition is the resolution of temporally overlapped potentials. In a previous study , we proposed a Bayesian model coupled with a maximum a posteriori (MAP) estimator for fully automatic decomposition of multiunit recordings and we showed applications to intramuscular EMG signals. In this study, we propose a more complex signal model that includes the variability in amplitude of each unit potential. Moreover, we propose the Markov Chain Monte Carlo (MCMC) simulation and a Bayesian minimum mean square error (MMSE) estimator by averaging on samples that converge in distribution to the joint posterior law. We prove the convergence property of this approach mathematically and we test the method representatively on intramuscular multiunit recordings. The results showed that its average accuracy in spike identification is greater than 90% for intramuscular signals with up to 8 concurrently active units. In addition to intramuscular signals, the method can be applied for spike sorting of other types of multiunit recordings.

Unsupervised Bayesian decomposition of multiunit EMG recordings using Tabu search.

Intramuscular electromyography (EMG) signals are usually decomposed with semiautomatic procedures that involve the interaction with an expert operator. In this paper, a Bayesian statistical model and a maximum a posteriori (MAP) estimator are used to solve the problem of multiunit EMG decomposition in a fully automatic way. The MAP estimation exploits both the likelihood of the reconstructed EMG signal and some physiological constraints, such as the discharge pattern regularity and the refractory period of muscle fibers, as prior information integrated in a Bayesian framework. A Tabu search is proposed to efficiently tackle the nondeterministic polynomial-time-hard problem of optimization w.r.t the motor unit discharge patterns. The method is fully automatic and was tested on simulated and experimental EMG signals. Compared with the semiautomatic decomposition performed by an expert operator, the proposed method resulted in an accuracy of 90.0% +/- 3.8% when decomposing single-channel intramuscular EMG signals recorded from the abductor digiti minimi muscle at contraction forces of 5% and 10% of the maximal force. The method can also be applied to the automatic identification and classification of spikes from other neural recordings.