Motion Analysis of Balance Pre and Post Sensorimotor Exercises to Enhance Elderly Mobility: A Case Study.

Quantitative assessment of movement using motion capture provides insights on mobility which are not evident from clinical evaluation. Here, in older individuals that were healthy or had suffered a stroke, we aimed to investigate their balance in terms of changes in body kinematics and muscle activity. Our research question involved determining the effects on post- compared to pre-sensorimotor training exercises on maintaining or improving balance. Our research hypothesis was that training would improve the gait and balance by increasing joint angles and extensor muscle activities in lower extremities and spatiotemporal measures of stroke and elderly people. This manuscript describes a motion capture-based evaluation protocol to assess joint angles and spatiotemporal parameters (cadence, step length and walking speed), as well as major extensor and flexor muscle activities. We also conducted a case study on a healthy older participant (male, age, 65) and an older participant with chronic stroke (female, age, 55). Both participants performed a walking task along a path with a rectangular shape which included tandem walking forward, right side stepping, tandem walking backward, left side stepping to the starting location. For the stroke participant, the training improved the task completion time by 19 s. Her impaired left leg had improved step length (by 0.197 m) and cadence (by 10 steps/min) when walking forward, and cadence (by 12 steps/min) when walking backward. The non-impaired right leg improved cadence when walking forward (by 15 steps/min) and backward (by 27 steps/min). The joint range of motion (ROM) did not change in most cases. However, the ROM of the hip joint increased significantly by 5.8 degrees (p = 0.019) on the left leg side whereas the ROMs of hip joint and knee joint increased significantly by 4.1 degrees (p = 0.046) and 8.1 degrees (p = 0.007) on the right leg side during backward walking. For the healthy participant, the significant changes were only found in his right knee joint ROM having increased by 4.2 degrees (p = 0.031) and in his left ankle joint ROM having increased by 5.5 degrees (p = 0.006) during the left side stepping.

Investigating Relationships between Balance Confidence and Balance Ability in Older Adults.

Increasing balance confidence in older individuals is important towards improving their quality of life and reducing activity avoidance. Here, we investigated if balance confidence (perceived ability) and balance performance (ability) in older adults were related to one another and would improve after balance training. The relationship of balance confidence in conjunction with balance performance for varied conditions (such as limiting vision, modifying somatosensory cues, and also base of support) was explored. We sought to determine if balance confidence and ability, as well as their relationship, could change after several weeks of training. Twenty-seven healthy participants were trained for several weeks during standing and walking exercises. In addition, seven participants with a higher risk of imbalance leading to falls (survivors of stroke) were also trained. Prior to and after training, balance ability and confidence were assessed via the Balance Error Scoring System (BESS) and Activities Specific Balance Confidence (ABC) Scale, respectively. Both groups showed improvements in balance abilities (i.e., BESS errors significantly decreased after training). Balance confidence was significantly higher in the healthy group than in the stroke group; however, ABC results reflected that balance confidence did not significantly increase after training for each. The correlations between balance ability and balance confidence were explored. Encouragingly, healthy participants displayed a negative correlation between BESS errors and ABC (i.e., enhancements in balance confidence (increases in ABC Scale results) were related to improvements in balance ability (decreases in BESS errors)). For the stroke participants, despite improvements in balance ability, our results showed that there was no relation to balance confidence (i.e., no correlation between BESS errors and ABC) in this group.

A Robust Context-Based Deep Learning Approach for Highly Imbalanced Hyperspectral Classification.

Hyperspectral imaging is an area of active research with many applications in remote sensing, mineral exploration, and environmental monitoring. Deep learning and, in particular, convolution-based approaches are the current state-of-the-art classification models. However, in the presence of noisy hyperspectral datasets, these deep convolutional neural networks underperform. In this paper, we proposed a feature augmentation approach to increase noise resistance in imbalanced hyperspectral classification. Our method calculates context-based features, and it uses a deep convolutional neuronet (DCN). We tested our proposed approach on the Pavia datasets and compared three models, DCN, PCA + DCN, and our context-based DCN, using the original datasets and the datasets plus noise. Our experimental results show that DCN and PCA + DCN perform well on the original datasets but not on the noisy datasets. Our robust context-based DCN was able to outperform others in the presence of noise and was able to maintain a comparable classification accuracy on clean hyperspectral images.

Multidirectional Overground Robotic Training Leads to Improvements in Balance in Older Adults.

For the rapidly growing aging demographic worldwide, robotic training methods could be impactful towards improving balance critical for everyday life. Here, we investigated the hypothesis that non-bodyweight supportive (nBWS) overground robotic balance training would lead to improvements in balance performance and balance confidence in older adults. Sixteen healthy older participants (69.7 ± 6.7 years old) were trained while donning a harness from a distinctive NaviGAITor robotic system. A control group of 11 healthy participants (68.7 ± 5.0 years old) underwent the same training but without the robotic system. Training included 6 weeks of standing and walking tasks while modifying: (1) sensory information (i.e., with and without vision (eyes-open/closed), with more and fewer support surface cues (hard or foam surfaces)) and (2) base-of-support (wide, tandem and single-leg standing exercises). Prior to and post-training, balance ability and balance confidence were assessed via the balance error scoring system (BESS) and the Activities specific Balance Confidence (ABC) scale, respectively. Encouragingly, results showed that balance ability improved (i.e., BESS errors significantly decreased), particularly in the nBWS group, across nearly all test conditions. This result serves as an indication that robotic training has an impact on improving balance for healthy aging individuals.

Sensory integration training improves balance in older individuals.

With the massive growth of the aging population worldwide, of utmost importance is reducing falls. Critical to reducing fall risk is one's ability to weight incoming sensory information towards maintaining balance. The purpose of this research was to investigate if simple, targeted sensory training on aging individuals (50 - 80 years old), including twelve healthy and eight individuals with chronic stroke, could improve their balance. Repeated sensory training targeted visual (via eyesopen/closed) and somatosensory inputs (via light touch to the fingertip as well as hard, soft foam, and hard foam support surfaces to the feet) during standing and dynamic base-ofsupport (BOS) exercises. Study participants underwent six weeks of training. Prior to and post training, standing balance was assessed via a simple, clinical measure: the balance error scoring system (BESS). Following several weeks of training, participants showed significant improvements in BESS errors: healthy participants for small BOS with limited somatosensory information (i.e., tandem and single-leg standing on foam) and participants with stroke in all conditions.Clinical Relevance- This research study demonstrated that simple, accessible exercises, can positively impact balance in the aging population, a pressing need.

Young Women Exposed Actively to the Value of Biomedical Engineering.

To bridge the gap between the biological sciences (typically female-dominated) and engineering (typically male-dominated), biomedical engineering (BME) activities could potentially be used as a vehicle to alter female students' perception of engineering as a whole. Female's pursuit of STEM (Science, Technology, Engineering and Math) degrees is typically confined to the biological sciences and females earn a high proportion of degrees in nursing, psychology and the social sciences, yet male presence persists in physical sciences and engineering. Female's participation in engineering remains much lower than men at all degree levels. Here, research questions included do female high school students: 1) perceive engineering as relevant? 2) have an interest & aptitude towards exploring engineering in college and as a career? 3) have anxiety in terms of engineering? 4) have engineering "role-confidence"? Participants, a randomly selected pool of 28 high school students (almost exclusively female from schools throughout the DC Metro area) took part in a week-long, all-day workshop where they were exposed to female engineering mentors, peers, and activities tied to BME & Engineering. Pre and post surveys, adapted from standard STEM surveys, were administered to the pool of participants. Increases in confidence and interest in engineering and decreased anxiety were observed following female high school students' participation in hands-on activities in BME.

A machine learning approach to epileptic seizure prediction using Electroencephalogram (EEG) Signal.

This study investigates the properties of the brain electrical activity from different recording regions and physiological states for seizure detection. Neurophysiologists will find the work useful in the timely and accurate detection of epileptic seizures of their patients. We explored the best way to detect meaningful patterns from an epileptic Electroencephalogram (EEG). Signals used in this work are 23.6 s segments of 100 single channel surface EEG recordings collected with the sampling rate of 173.61 Hz. The recorded signals are from five healthy volunteers with eyes closed and eyes open, and intracranial EEG recordings from five epilepsy patients during the seizure-free interval as well as epileptic seizures. Feature engineering was done using; i) feature extraction of each EEG wave in time, frequency and time-frequency domains via Butterworth filter, Fourier Transform and Wavelet Transform respectively and, ii) feature selection with T-test, and Sequential Forward Floating Selection (SFFS). SVM and KNN learning algorithms were applied to classify preprocessed EEG signal. Performance comparison was based on Accuracy, Sensitivity and Specificity. Our experiments showed that SVM has a slight edge over KNN.

An Engineering Model to Test for Sensory Reweighting: Nonhuman Primates Serve as a Model for Human Postural Control and Vestibular Dysfunction.

Quantitative animal models are critically needed to provide proof of concept for the investigation of rehabilitative balance therapies (e.g., invasive vestibular prostheses) and treatment response prior to, or in conjunction with, human clinical trials. This paper describes a novel approach to modeling the nonhuman primate postural control system. Our observation that rhesus macaques and humans have even remotely similar postural control motivates the further application of the rhesus macaque as a model for studying the effects of vestibular dysfunction, as well as vestibular prosthesis-assisted states, on human postural control. Previously, system identification methodologies and models were only used to describe human posture. However, here we utilized pseudorandom, roll-tilt balance platform stimuli to perturb the posture of a rhesus monkey in normal and mild vestibular (equilibrium) loss states. The relationship between rhesus monkey trunk sway and platform roll-tilt was determined via stimulus-response curves and transfer function results. A feedback controller model was then used to explore sensory reweighting (i.e., changes in sensory reliance), which prevented the animal from falling off of the tilting platform. Conclusions involving sensory reweighting in the nonhuman primate for a normal sensory state and a state of mild vestibular loss led to meaningful insights. This first-phase effort to model the balance control system in nonhuman primates is essential for future investigations toward the effects of invasive rehabilitative (balance) technologies on postural control in primates, and ultimately, humans.

A Patient-Centered Emergency Department Management Strategy for Sickle-Cell Disease Super-Utilizers.

INTRODUCTION: A subpopulation of sickle-cell disease patients, termed super-utilizers, presents frequently to emergency departments (EDs) for vaso-occlusive events and may consume disproportionate resources without broader health benefit. To address the healthcare needs of this vulnerable patient population, we piloted a multidisciplinary intervention seeking to create and use individualized patient care plans that alter utilization through coordinated care. Our goals were to assess feasibility primarily, and to assess resource use secondarily. METHODS: We evaluated the effects of a single-site interventional study targeted at a population of adult sickle-cell disease super-utilizers using a pre- and post-implementation design. The pre-intervention period was 06/01/13 to 12/31/13 (seven months) and the post-intervention period was 01/01/14 to 02/28/15 (14 months). Our approach included patient-specific best practice advisories (BPA); an ED management protocol; and formation of a "medical home" for these patients. RESULTS: For 10 subjects targeted initially we developed and implemented coordinated care plans; after deployment, we observed a tendency toward reduction in ED and inpatient utilization across all measured indices. Between the annualized pre- and post-implementation periods we found the following: ED visits decreased by 16.5 visits/pt-yr (95% confidence interval [CI] [-1.32-34.2]); ED length of state (LOS) decreased by 115.3 hours/pt-yr (95% CI [-82.9-313.5]); in-patient admissions decreased by 4.20 admissions/pt-yr (95% CI [-1.73-10.1]); in-patient LOS decreased by 35.8 hours/pt-yr (95% CI [-74.9-146.7]); and visits where the patient left before treatment were reduced by an annualized total of 13.7 visits. We observed no patient mortality in our 10 subjects, and no patient required admission to the intensive care unit 72 hours following discharge. CONCLUSION: This effort suggests that a targeted approach is both feasible and potentially effective, laying a foundation for broader study.

Postural compensation strategy depends on the severity of vestibular damage.

The purpose of this study was to investigate the effects of various levels of vestibular function on balance in two, free-standing rhesus monkeys. We hypothesized that postural control strategy depended on the severity of vestibular damage. More specifically, that increased muscle stiffness (via short-latency mechanisms) was adequate to compensate for mild damage, but long-latency mechanisms must be utilized for more severe vestibular damage. One animal was studied for pre-ablated and mild vestibular dysfunction states, while a second animal was studied in a pre-ablated and severe vestibular dysfunction state. The vestibulo-ocular reflex (VOR), an eye movement reflex directly linked to vestibular function, was used to quantify the level of vestibular damage. A postural feedback controller model, previously only used for human studies, was modified to interpret non-human primate postural responses (differences observed in the measured trunk roll) for these three levels of vestibular function. By implementing a feedback controller model, we were able to further interpret our empirical findings and model results were consistent with our above hypothesis. This study establishes a baseline for future studies of non-human primate posture.

The Declining Incidence of Legg-Calve-Perthes' Disease in Northern Ireland: An Epidemiological Study.

BACKGROUND: Legg-Calve-Perthes' disease (LCPD) is an idiopathic disease of the femoral head affecting the pediatric population. The causative factors remains poorly understood and it is associated with significant hip pathology in adult life. Research has demonstrated wide geographical variation in the incidence rates of LCPD with a relatively high incidence occurring in Northern Ireland (NI) shown in a previous study of incidence from the same unit. The number of new diagnoses of LCPD seems to be declining over time. This study aimed to track changes in the incidence of LCPD within the 0- to 14-year-old population over a 15-year period in NI. METHODS: An established database was utilized to collate information of any individual between the ages of 0 to 14 years with a diagnosis of LCPD. The data were compared with electronic radiologic records to confirm the diagnosis. Postal code data were used to the determine location of residence and used as a proxy measure of deprivation. RESULTS: The results of this epidemiological study have demonstrated a 61% decrease in the incidence of LCPD over a 15-year period within the pediatric population of NI. Comparison between 2 cohorts reveals no distinguishable change in distribution of age or sex. The relationship between geographical proxy measures of deprivation in NI and LCPD remains evident. CONCLUSIONS: The number of new cases of LCPD is decreasing over time. The epidemiological data are unchanged between 2 cohorts over a 15-year period, and this therefore supports a change within the patients' environment relating to this decline. This change could relate to a number of factors including smoking rates, breastfeeding, lead use, and vaccination implementation. LEVEL OF EVIDENCE: Level IV-retrospective cohort study.

Balance Performance as Observed by Center-of-Pressure Parameter Characteristics in Male Soccer Athletes and Non-Athletes.

Static balance has a relevant influence on athletic performance as well as on reducing the risk of injury. The main goal of this study was to assess soccer athlete versus non-athlete balance performance via displacement and velocity parameters extracted from the center-of-pressure (COP) position time series. In order to accomplish our goal, we investigated standing balance in two male groups with unimpaired balance: non-athletes (n = 12) and collegiate varsity soccer athletes (n = 12). In order to make the standing balancing task more or less difficult, we altered participant base-of-support, as well as vision, yielding static (quiet stance) test conditions increasing in difficulty. From the COP position time series, displacement and velocity parameters were computed and plotted as a function of increasing test condition difficulty level. COP parameters showed steeper increases with increased test difficulty in non-athletes compared to athletes; this demonstrated athletes' better ability to control their balance. We concluded that balance performance could be characterized via COP displacement and velocity response curves. This study lends new insights into how COP parameters can be utilized to determine and characterize improvements in balance between un-impaired subject populations (athletes versus non-athletes).

Vestibular ablation and a semicircular canal prosthesis affect postural stability during head turns.

In our study, we examined postural stability during head turns for two rhesus monkeys: one animal study contrasted normal and mild bilateral vestibular ablation and a second animal study contrasted severe bilateral vestibular ablation with and without prosthetic stimulation. The monkeys freely stood, unrestrained on a balance platform and made voluntary head turns between visual targets. To quantify each animals' posture, motions of the head and trunk, as well as torque about the body's center of mass, were measured. In the mildly ablated animal, we observed less foretrunk sway in comparison with the normal state. When the canal prosthesis provided electric stimulation to the severely ablated animal, it showed a decrease in trunk sway during head turns. Because the rhesus monkey with severe bilateral vestibular loss exhibited a decrease in trunk sway when receiving vestibular prosthetic stimulation, we propose that the prosthetic electrical stimulation partially restored head velocity information. Our results provide an indication that a semicircular canal prosthesis may be an effective way to improve postural stability in patients with severe peripheral vestibular dysfunction.

Building a more diverse biomedical engineering workforce: Biomedical engineering at the university of the district of Columbia, a historically black college & university.

Biomedical Engineering (BME) is a new, multidisciplinary, and rapidly growing field, however, the BME Workforce suffers from limited ethnic and gender diversity. Despite the demand and growth of this new field due to its public health importance, only 4 out of the 107 Historically Black Colleges and Universities (HBCUs) nationwide offers a Bachelor's of Science (B.S.) in Bio-Engineering related fields. In order to contribute to a growing BME Workforce, HBCUs need to react and offer more degree-programs relevant to BME. At the University of the District of Columbia (UDC), an HBCU and the District's only public institution for higher learning, we have recently established a new, degree program: Bachelor of Science in Biomedical Engineering (B.S. in BME) full-board approved in Fall 2014, with program activities initiated in Fall 2015. The educational goal of this program is to enhance the quality and diversity of the BME Workforce via student professional development, new and relevant BME courses, and BME scholarly activities (e.g., guest lectures and journal club sessions), ultimately to increase the number of ethnic minorities pursuing careers and degrees in BME. Through our program activities, we are aiming to meet the nation's demand to contribute to a diverse BME workforce, directed towards solving problems in human health. A secondary, but related goal, is to increase the diversity of STEM-related fields. This paper summarizes our initial, but encouraging, BME activity-related findings. However, this study will be longitudinal (on a multiple year time period) to observe the true outcomes of our initiative.

The Promise of Intravaginal Rings for Prevention: User Perceptions of Biomechanical Properties and Implications for Prevention Product Development.

Intravaginal rings (IVRs) are currently under investigation as devices for the delivery of agents to protect against the sexual transmission of HIV and STIs, as well as pregnancy. To assist product developers in creating highly acceptable rings, we sought to identify characteristics that intravaginal ring users consider when making decisions about ring use or non-use. We conducted four semi-structured focus groups with 21 women (aged 18-45) who reported using an IVR in the past 12 months. Participants manipulated four prototype rings in their hands, discussed ring materials, dimensionality, and "behavior," and shared perceptions and appraisals. Five salient ring characteristics were identified: 1) appearance of the rings' surfaces, 2) tactile sensations of the cylinder material, 3) materials properties, 4) diameter of the cylinder, and 5) ring circumference. Pliability (or flexibility) was generally considered the most important mechanical property. Several ring properties (e.g., porousness, dimensionality) were associated with perceptions of efficacy. Women also revealed user behaviors that may impact the effectiveness of certain drugs, such as removing, rinsing and re-inserting the ring while bathing, and removing the ring during sexual encounters. As product developers explore IVRs as prevention delivery systems, it is critical to balance product materials and dimensions with use parameters to optimize drug delivery and the user experience. It is also critical to consider how user behaviors (e.g., removing the ring) might impact drug delivery.

"Set it and forget it": women's perceptions and opinions of long-acting topical vaginal gels.

Women's initial understandings and anticipated acceptability of long-acting vaginal gels as potential anti-HIV microbicides was investigated by exploring the perceptibility variables associated with prototype formulations. Four focus groups with 29 women, aged 18-45, were conducted to consider gel prototypes with varied physicochemical and rheological properties. Participants responded favorably to the concept of long-acting vaginal gels as microbicides. Distinctions in understandings and stated needs regarding product dosing, characteristics, and effectiveness offer valuable insights into product design. Long-acting vaginal gels capable of protecting against HIV/STIs will be a viable option among potential users, with dosing frequency being an important factor in willingness to use.

Responses evoked by a vestibular implant providing chronic stimulation.

Patients with bilateral vestibular loss experience dehabilitating visual, perceptual, and postural difficulties, and an implantable vestibular prosthesis that could improve these symptoms would be of great benefit to these patients. In previous work, we have shown that a one-dimensional, unilateral canal prosthesis can improve the vestibulooccular reflex (VOR) in canal-plugged squirrel monkeys. In addition to the VOR, the potential effects of a vestibular prosthesis on more complex, highly integrative behaviors, such as the perception of head orientation and posture have remained unclear. We tested a one-dimensional, unilateral prosthesis in a rhesus monkey with bilateral vestibular loss and found that chronic electrical stimulation partially restored the compensatory VOR and also that percepts of head orientation relative to gravity were improved. However, the one-dimensional prosthetic stimulation had no clear effect on postural stability during quiet stance, but sway evoked by head-turns was modestly reduced. These results suggest that not only can the implementation of a vestibular prosthesis provide partial restitution of VOR but may also improve perception and posture in the presence of bilateral vestibular hypofunction (BVH). In this review, we provide an overview of our previous and current work directed towards the eventual clinical implementation of an implantable vestibular prosthesis.

Vestibular prosthesis tested in rhesus monkeys.

We are studying the effectiveness of a semicircular canal prosthesis to improve postural control, perception of spatial orientation, and the VOR in rhesus monkeys with bilateral vestibular hypofunction. Balance is examined by measuring spontaneous sway of the body during quiet stance and postural responses evoked by head turns and rotation of the support surface; perception is measured with a task derived from the subjective visual vertical (SVV) test during static and dynamic rotation in the roll plane; and the angular VOR is measured during rotation about the roll, pitch, and yaw axes. After the normal responses are characterized, bilateral vestibular loss is induced with intratympanic gentamicin, and then multisite stimulating electrodes are chronically implanted into the ampullae of all three canals in one ear. The postural, perceptual, and VOR responses are then characterized in the ablated state, and then bilateral, chronic electrical stimulation is applied to the ampullary nerves using a prosthesis that senses angular head velocity in three-dimensions and uses this information to modulate the rate of current pulses provided by the implanted electrodes. We are currently characterizing two normal monkeys with these paradigms, and vestibular ablation and electrode implantation are planned for the near future. In one prior rhesus monkey tested with this approach, we found that a one-dimensional (posterior canal) prosthesis improved balance during head turns, perceived head orientation during roll tilts, and the VOR in the plane of the instrumented canal. We therefore predict that the more complete information provided by a three-dimensional prosthesis that modulates activity in bilaterally-paired canals will exceed the benefits provided by the one-dimensional, unilateral approach used in our preliminary studies.

Differential lysis of tumors by polyclonal T cell lines and T cell clones specific for hTERT.

The human telomerase reverse transcriptase hTERT is overexpressed in most human tumors and contributes importantly to oncogenesis by maintaining the integrity of telomeric DNA. Despite being a self-antigen, the hTERT enzyme is immunogenic. Peptides derived from hTERT have been shown both in vitro and in vivo to drive the activation and proliferation of peptide-specific T lymphocytes. An HLA-A2-binding peptide from Htert (I540, ILAKFLHWL) has been used to generate peptide-specific T cells in vitro and in vivo in patients that lyse telomerase-positive tumors in an MHC-restricted fashion. Although these and other data suggest that I540 is naturally processed and presented on the surface of certain tumor cells, there are reports that I540-specific T cells, and in particular, T cell clones, do not lyse tumors in vitro. Here, we compared cytotoxic function of I540-specfic T cell clones vs. polyclonal T cell lines, including clones and lines generated from the same donor. We found that I540-specific polyclonal T cell lines lyse telomerase-positive tumors whereas non-specific polyclonal T cell lines and I540-specific T cell clones do not. Estimated TCR avidity for I540, as well as cell surface expression of CD45RO, CD45RA, CD28, CD27, CD57 and CD62L were similar between lines and clones. V beta usage, however, differed such that the majority of the I540-specific TCR repertoire found in polyclonal T cell lines was not represented in clones generated from the same source material. Thus, I540-specific T cells can vary in cytotoxic potential depending on the method of generation, isolation and expansion.