A Movement Classification of Polymyalgia Rheumatica Patients Using Myoelectric Sensors.

Gait disorder is common among people with neurological disease and musculoskeletal disorders. The detection of gait disorders plays an integral role in designing appropriate rehabilitation protocols. This study presents a clinical gait analysis of patients with polymyalgia rheumatica to determine impaired gait patterns using machine learning models. A clinical gait assessment was conducted at KATH hospital between August and September 2022, and the 25 recruited participants comprised 18 patients and 7 control subjects. The demographics of the participants follow: age 56 years ± 7, height 175 cm ± 8, and weight 82 kg ± 10. Electromyography data were collected from four strained hip muscles of patients, which were the rectus femoris, vastus lateralis, biceps femoris, and semitendinosus. Four classification models were used-namely, support vector machine (SVM), rotation forest (RF), k-nearest neighbors (KNN), and decision tree (DT)-to distinguish the gait patterns for the two groups. SVM recorded the highest accuracy of 85% among the classifiers, while KNN had 75%, RF had 80%, and DT had the lowest accuracy of 70%. Furthermore, the SVM classifier had the highest sensitivity of 92%, while RF had 86%, DT had 90%, and KNN had the lowest sensitivity of 84%. The classifiers achieved significant results in discriminating between the impaired gait pattern of patients with polymyalgia rheumatica and control subjects. This information could be useful for clinicians designing therapeutic exercises and may be used for developing a decision support system for diagnostic purposes.

Design Validation of a Low-Cost EMG Sensor Compared to a Commercial-Based System for Measuring Muscle Activity and Fatigue.

Electromyography (EMG) sensors have been used for measuring muscle signals and for diagnosing neuromuscular disease. Available commercial EMG sensor are expensive and not easily available for individuals. The aim of the study is to validate our designed low-cost sensor against a well-known commercial system for measuring muscle activity and fatigue assessment. The evaluation of the designed system was done through a series of dynamic exercises performed by volunteers. Our low-cost EMG sensor and the commercially available system were placed on the vastus lateralis muscle to concurrently record the signal in a maximum voluntary contraction (MVC). The signal analysis was done using two validation indicators: Spearman's correlation, and intra-class cross correlation on SPSS 26.0 version. For the muscle fatigue assessment, the root mean square (RMS), mean absolute value (MAV) and mean frequency (MNF) indicators were used. The results at the peak and mean level muscle contraction intensity were computed. The relative agreement for the two systems was excellent at peak level muscle contraction range (ICC 0.74-0.92), average 0.83 and mean level muscle contraction intensity range (ICC 0.65-0.85) with an average of 0.74. The Spearman's correlation average was 0.76 with the range of (0.71-0.85) at peak level contraction, whiles the mean level contraction average was 0.71 at a range of (0.62-0.81). In determining muscle fatigue, the RMS and MAV showed increasing values in the time domain, while the MEF decreased in the frequency domain. Overall, the results indicated a good to excellent agreement of the two systems and confirmed the reliability of our design. The low-cost sensor also proved to be suitable for muscle fatigue assessment. Our designed system can therefore be implemented for rehabilitation, sports science, and ergonomics.

A Review on the Use of Microsoft Kinect for Gait Abnormality and Postural Disorder Assessment.

Gait and posture studies have gained much prominence among researchers and have attracted the interest of clinicians. The ability to detect gait abnormality and posture disorder plays a crucial role in the diagnosis and treatment of some diseases. Microsoft Kinect is presented as a noninvasive sensor essential for medical diagnostic and therapeutic purposes. There are currently no relevant studies that attempt to summarise the existing literature on gait and posture abnormalities using Kinect technology. The purpose of this study is to critically evaluate the existing research on gait and posture abnormalities using the Kinect sensor as the main diagnostic tool. Our studies search identified 458 for gait abnormality, 283 for posture disorder of which 26 studies were included for gait abnormality, and 13 for posture. The results indicate that Kinect sensor is a useful tool for the assessment of kinematic features. In conclusion, Microsoft Kinect sensor is presented as a useful tool for gait abnormality, postural disorder analysis, and physiotherapy. It can also help track the progress of patients who are undergoing rehabilitation.

An improved technique for increasing the accuracy of joint-to-ground distance tracking in kinect v2 for foot-off and foot contact detection.

The Kinect sensor has been widely used in different applications such as rehabilitation and gait analysis. Whilst Kinect v2 was released with several improvements over its predecessor, it still incorporates depth-map intrinsic inaccuracies. This results in inconsistencies in skeletal-data acquisition, especially in joint localisation and distance-to-ground tracking with respect to the Kinect's 3-D Cartesian coordinate reference point. This research proposes a correction technique based on the two-point linear equation derived from the information gathered from different subjects' skeletal data and data regression analysis to compensate the inaccuracies in joint-to-ground data collection. The research also proposes a new footsteps detection method based on skeletal data and plane detection techniques that calculates a footstep by using the ankle's Euclidean distance from the floor, regardless of the subject's distance from the camera. The results show that after the correction technique was applied, data acquisition proved to be consistent and more accurate within a distance range of 1.6-2.9 m from the Kinect camera, regardless of the subject's location to the camera's reference point. Moreover, the inconsistency of joint data read by the Kinect was reduced from 25.69% to 5.25% and the footsteps detection accuracy increased from 42.85% to 79.76% on average for both legs.

Using Kinect v2 to Control a Laser Visual Cue System to Improve the Mobility during Freezing of Gait in Parkinson's Disease.

Different auditory and visual cues have been proven to be very effective in improving the mobility of people with Parkinson's (PwP). Nonetheless, many of the available methods require user intervention and so on to activate the cues. Moreover, once activated, these systems would provide cues continuously regardless of the patient's needs. This research proposes a new indoor method for casting dynamic/automatic visual cues for PwP based on their head direction and location in a room. The proposed system controls the behavior of a set of pan/tilt servo motors and laser pointers, based on the real-time skeletal information acquired from a Kinect v2 sensor. This produces an automatically adjusting set of laser lines that can always be in front of the patient as a guideline for where the next footstep would be placed. A user interface was also created that enables users to control and adjust the settings based on the preferences. The aim of this research was to provide PwP with an unobtrusive/automatic indoor system for improving their mobility during a Freezing of gait (FOG) incident. The results showed the possibility of employing such system, which does not rely on the subject's input nor does it introduce any additional complexities to operate.

Kinect4FOG: monitoring and improving mobility in people with Parkinson's using a novel system incorporating the Microsoft Kinect v2.

Parkinson's is a neurodegenerative condition associated with several motor symptoms including tremors and slowness of movement. Freezing of gait (FOG); the sensation of one's feet being "glued" to the floor, is one of the most debilitating symptoms associated with advanced Parkinson's. FOG not only contributes to falls and related injuries, but also compromises quality of life as people often avoid engaging in functional daily activities both inside and outside the home. In the current study, we describe a novel system designed to detect FOG and falling in people with Parkinson's (PwP) as well as monitoring and improving their mobility using laser-based visual cues cast by an automated laser system. The system utilizes a RGB-D sensor based on Microsoft Kinect v2 and a laser casting system consisting of two servo motors and an Arduino microcontroller. This system was evaluated by 15 PwP with FOG. Here, we present details of the system along with a summary of feedback provided by PwP. Despite limitations regarding its outdoor use, feedback was very positive in terms of domestic usability and convenience, where 12/15 PwP showed interest in installing and using the system at their homes. Implications for Rehabilitation Providing an automatic and remotely manageable monitoring system for PwP gait analysis and fall detection. Providing an automatic, unobtrusive and dynamic visual cue system for PwP based on laser line projection. Gathering feedback from PwP about the practical usage of the implemented system through focus group events.

Using digital watermarking to enhance security in wireless medical image transmission.

OBJECTIVES: During the last few years, wireless networks have been increasingly used both inside hospitals and in patients' homes to transmit medical information. In general, wireless networks suffer from decreased security. However, digital watermarking can be used to secure medical information. In this study, we focused on combining wireless transmission and digital watermarking technologies to better secure the transmission of medical images within and outside the hospital. METHODS: We utilized an integrated system comprising the wireless network and the digital watermarking module to conduct a series of tests. RESULTS: The test results were evaluated by medical consultants. They concluded that the images suffered no visible quality degradation and maintained their diagnostic integrity. DISCUSSION: The proposed integrated system presented reasonable stability, and its performance was comparable to that of a fixed network. This system can enhance security during the transmission of medical images through a wireless channel.

DoctorEye: A clinically driven multifunctional platform, for accurate processing of tumors in medical images.

UNLABELLED: This paper presents a novel, open access interactive platform for 3D medical image analysis, simulation and visualization, focusing in oncology images. The platform was developed through constant interaction and feedback from expert clinicians integrating a thorough analysis of their requirements while having an ultimate goal of assisting in accurately delineating tumors. It allows clinicians not only to work with a large number of 3D tomographic datasets but also to efficiently annotate multiple regions of interest in the same session. Manual and semi-automatic segmentation techniques combined with integrated correction tools assist in the quick and refined delineation of tumors while different users can add different components related to oncology such as tumor growth and simulation algorithms for improving therapy planning. The platform has been tested by different users and over large number of heterogeneous tomographic datasets to ensure stability, usability, extensibility and robustness with promising results. AVAILABILITY: the platform, a manual and tutorial videos are available at: http://biomodeling.ics.forth.gr. it is free to use under the GNU General Public License.

DoctorEye: A multifunctional open platform for fast annotation and visualization of tumors in medical images.

This paper describes a flexible and easy-to-use annotation platform (GUI) for quick and precise identification and delineation of tumors in medical images. The design of the platform is clinically driven in order to ensure that the clinician can efficiently and intuitively annotate large number of 3D tomographic datasets. Both manual and well-known semiautomatic segmentation techniques are available in the platform allowing clinician to annotate multiple regions of interest at the same session. Additionally, it includes contour drawing, refinement and labeling tools that can effectively assist in the delineation of tumors. Furthermore, segmented tumor regions can be annotated, labeled, deleted, added and redefined. The platform has been tested over several MRI datasets to assess usability, extensibility and robustness with promising results.

Using HSPA to improve the telemedical links on a moving ambulance.

As the demand for faster and more effective health care increases, there is a growing need to establish mobile, high-speed communications between a moving ambulance and a consultation point (usually a hospital). The recent addition of HSPA (HSDPA and HSUPA) into the UMTS suite provides higher bandwidth and reduced delays, making this choice ideal for real-time telemedical applications. In this paper, we will describe a set of scenarios that took place in a typical large city area, along with their equivalent results: a moving ambulance was linked with a consultation station using HSPA and several videoconferencing sessions were initiated. Best-case, worst-case and average scenarios were recorded. Furthermore, in areas where the UMTS reception was marginal, a repeater was placed on top of the vehicle to boost up the signal power and thus maintain the higher bandwidth. Finally, treating doctors were asked to evaluate the effectiveness of this system's outputs, based on a variety of objective and subjective criteria.

Mobile consultant: evaluation of additional services.

As the need for mobility in the medical world increases, newer systems and applications came to light; many of them based on wireless and mobile networks. PDA based systems were presented in the past, capable of videoconferencing and transmitting high quality images between a roaming consultant and a fixed point in the hospital. These systems not only had desirable characteristics but also incorporated additional services that were found of value: paging, Voice over IP calling, Internet, email, intranet, patient record update, etc This paper presents an engineering and clinical evaluation of those additional services based on both objective and subjective criteria. It concludes that such complementary services can be desirable as they increase personnel mobility, utilize the hospital resources more efficiently while at the same time increase productivity and decrease the cost of hardware and communications.

Performance of a wireless telemedicine system in a hospital accident and emergency department.

We developed a mobile, wireless videoconferencing system suitable for use in a hospital accident and emergency (A&E) department. Four consultants, eight junior doctors and 11 nurses working in the A&E department tested the system. Transmission of three types of data (audio, still images and video) was tested. The audio for the breath and heart sounds was judged to have some disturbance. One consultant rated the diagnostic quality as good and one rated it as fair. The quality of the still images was judged to be from fair to excellent. The quality of the video was rated as good. Possible interference between the wireless local-area network and various medical devices in the A&E department were examined, but none was detected. The four consultants who tested the system were very positive in their initial comments. Eight of the 11 nurses remained sceptical about its use. Of a total of 20 patients who answered a survey, 13 were slightly anxious about the use of the system to transmit their data to a distant point. Overall, the performance of the system was satisfactory for use in the A&E role.

Use of 3G mobile phone links for teleconsultation between a moving ambulance and a hospital base station.

We developed a mobile teleconsultation system based on third-generation mobile phone links. The system comprised a laptop computer and a digital camcorder. It was installed inside an ambulance to allow video-conferencing between the moving vehicle and a doctor at a base station. In addition to video and voice, high-quality still images could also be transmitted. A series of 17 trial runs with real ambulance patients was conducted in the city of Athens. In general, the videoconferencing sessions produced relatively clear video. The bandwidth was high enough for a satisfactory video of 10-15 frames/s. During a total testing period of 23 h and in an area of about 180 km2, there were nine instances of signal loss, amounting to a total of 17 min. The general opinion formed by the doctors was that the system produced good results. All initial diagnoses made using the system agreed with the final diagnoses of the patients. The study showed that the mobile system could reduce the time before an ambulance patient is seen by a doctor.

Mobile consultant: combining total mobility with constant access.

Minimizing the time required for a medical consultant to offer his/her expert opinion, can be viewed as a life-saving procedure. We have designed and tested an integrated system that will allow a medical consultant to freely move either within, or outside the hospital, while still maintaining constant contact with the patients via videoconferencing and high-resolution imaging. The above system is explained in this paper, along with its advantages and its potential limitations. Conclusively, we demonstrate that such a system further increases the mobility of the medical consultant, while improving the healthcare service.

Ambulance 3G.

Minimising the time required for a patient to receive primary care has always been the concern of the Accidents and Emergency units. Ambulances are usually the first to arrive on the scene and to administer first aid. However, as the time that it takes to transfer the patient to the hospital increases, so does the fatality rate. In this paper, a mobile teleconsultation system is presented, based primarily on third generation mobile links and on Wi-Fi hotspots around a city. This system can be installed inside an ambulance and will permit high-resolution videoconferencing between the moving vehicle and a doctor or a consultant within a base station (usually a hospital). In addition to video and voice, high quality still images and screenshots from medical equipment can also be sent. The test was carried out in Athens, Greece where a 3G system was recently deployed by Vodafone. The results show that the system can perform satisfactory in most conditions and can effectively increase the patient's quality of service, while having a modest cost.

3G Networks in Emergency Telemedicine - An In-Depth Evaluation & Analysis.

The evolution of telecommunications technologies in connection with the robustness and the fidelity these new systems provide, have opened up many new horizons as regards the provision of healthcare and the quality of service from the side of the experts to that of the patients. The purpose of this paper is to evaluate the third generation telecommunications systems that are only recently being deployed in Europe, as well as argue on why a transition from 2G and 2.5G to 3G telecommunications systems could prove to be crucial, especially in relation to emergency telemedicine. The experimental results of the use of these systems are analyzed, the implementation of a tele-consultation unit is presented and their exploitation capabilities are explored.