The effect of basic assumptions on the tissue oxygen saturation value of near infrared spectroscopy.

Tissue oxygen saturation (StO(2)), a potentially important parameter in clinical practice, can be measured by near infrared spectroscopy (NIRS). Various devices use the multi-distance approach based on the diffusion approximation of the radiative transport equation [1, 2]. When determining the absorption coefficient (µ (a)) by the slope over multiple distances a common assumption is to neglect µ (a) in the diffusion constant, or to assume the scattering coefficient (µ(s)) to be constant over the wavelength. Also the water influence can be modeled by simply subtracting a water term from the absorption. This gives five approaches A1-A5. The aim was to test how these different methods influence the StO(2) values. One data set of 30 newborn infants measured on the head and another of eight adults measured on the nondominant forearm were analyzed. The calculated average StO(2) values measured on the head were (mean ± SD): A1: 79.99 ± 4.47%, A2: 81.44 ± 4.08%, A3: 84.77 ± 4.87%, A4: 85.69 ± 4.38%, and A5: 72.85 ± 4.81%. The StO(2) values for the adult forearms are: A1: 58.14 ± 5.69%, A2: 73.85 ± 4.77%, A3: 58.99 ± 5.67%, A4: 74.21 ± 4.76%, and A5: 63.49 ± 5.11%. Our results indicate that StO(2) depends strongly on the assumptions. Since StO(2) is an absolute value, comparability between different studies is reduced if the assumptions of the algorithms are not published.

Exploring the Potential of Conversational Interfaces for Care of Older Adults: Insights from Stakeholder Workshops.

This study aimed to explore the utilisation of conversational interfaces (CIs) by local care service providers (CSPs) and their potential applications in improving the quality of life for older adults. Two workshops were conducted with stakeholders to gather insights and requirements. Although currently not yet utilised by CSPs, stakeholders expressed their openness towards CIs and believed that older adults are very likely to appear receptive to them. Loneliness and isolation were identified as significant challenges, even among older adults living in care institutions. Key requirements for chatbots included complementarity to in-person interactions, user-friendliness, 24/7 availability, and seamless integration into daily life. Ethical considerations, data privacy, and security were emphasised, also highlighting the importance of transparency and limited data retention. Various use cases were discussed, such as assistance, self-management tools, and reminders. The financing issues remained inconclusive, but health insurances showed their potential interest in solutions targeting loneliness.

Cerebral hemodynamic changes in stroke during sleep-disordered breathing.

BACKGROUND AND PURPOSE: Sleep-disordered breathing (SDB) negatively impacts stroke outcome. Near-infrared spectroscopy showed the acute cerebral hemodynamic effects of SDB. METHODS: Eleven patients (7 men, age 61±13 years) with acute/subacute middle cerebral artery stroke (National Institutes of Health Stroke Scale score 10±7) and SDB (apnea-hypopnea index 32±28/hour) were assessed with nocturnal polysomnography and bilateral near-infrared spectroscopy recording. Cerebral oxygenation and hemoglobin concentration changes during obstructive and central apneas were analyzed. RESULTS: During SDB, near-infrared spectroscopy showed asymmetrical patterns of cerebral oxygenation and hemoglobin concentrations with changes significantly larger on the unaffected compared with the affected hemisphere. Brain tissue hypoxia was more severe during obstructive compared with central apneas. CONCLUSIONS: Profound cerebral deoxygenation effects of SDB occurred in acute/subacute stroke. These changes may contribute to poor outcome, arising in the possibility of a potential benefit of SDB treatment in stroke management.

Reproducibility and sensitivity of detecting brain activity by simultaneous electroencephalography and near-infrared spectroscopy.

The aims were (1) to determine the sensitivity and reproducibility to detect the hemodynamic responses and optical neuronal signals to brain stimulation by near-infrared spectroscopy (NIRS) and evoked potentials by electroencephalography (EEG) and (2) to test the effect of novel filters on the signal-to-noise ratio. This was achieved by simultaneous NIRS and EEG measurements in 15 healthy adults during visual stimulation. Each subject was measured three times on three different days. The sensitivity of NIRS to detect hemodynamic responses was 55.2 % with novel filtering and 40 % without. The reproducibility in single subjects was low. For the EEG, the sensitivity was 86.4 % and the reproducibility 57.1 %. An optical neuronal signal was not detected, although novel filtering considerably reduced noise.

Nocturnal cerebral hemodynamics in snorers and in patients with obstructive sleep apnea: a near-infrared spectroscopy study.

STUDY OBJECTIVES: Sleep disordered breathing (SDB) of the obstructive type causes hemodynamic consequences, leading to an increased cerebrovascular risk. The severity of SDB at which detrimental circulatory consequences appear is matter of controversy. Aim of the present study is the investigation of cerebral hemodynamics in patients with SDB of variable severity using near-infrared spectroscopy (NIRS). DESIGN: N/A. SETTING: Sleep laboratory. PATIENTS OR PARTICIPANTS: Nineteen patients with SDB. INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Patients underwent nocturnal videopolysomnography (VPSG) coupled with cerebral NIRS. NIRS data were averaged for each patient, and a new method (integral) was applied to quantify cerebral hemodynamic alterations. Nocturnal VPSG disclosed various severities of SDB: snoring (7 patients, apnea-hypopnea index [AHI] = 2 +/- 2/h, range: 0.5-4.5); mild SDB (7 patients, AHI = 14 +/- 8/h, range: 6.3-28.6); and severe obstructive sleep apnea syndrome (5 patients, AHI = 79 +/- 20/h, range: 39.6-92.9). Relative changes of NIRS parameters were significantly larger during obstructive apneas (compared with hypopneas; mean deoxygenated hemoglobin [HHb] change of 0.72 +/- 0.23 and 0.13 +/- 0.08 micromol/L per sec, p value = 0.048) and in patients with severe SDB (as compared with patients with mild SDB and simple snorers; mean HHb change of 0.84 +/- 0.24, 0.02 +/- 0.09, and 0.2 +/- 0.08 micromol/L per sec, respectively, p value = 0.020). In this group, NIRS and concomitant changes in peripheral oxygen saturation correlated. CONCLUSIONS: The results of this study suggest that acute cerebral hemodynamic consequences of SDB lead to a failure of autoregulatory mechanisms with brain hypoxia only in the presence of frequent apneas (AHI > 30) and obstructive events.

Task complexity relates to activation of cortical motor areas during uni- and bimanual performance: a functional NIRS study.

Hand motor tasks are frequently used to assess impaired motor function in neurology and neurorehabilitation. Assessments can be varied by means of hand laterality, i.e. unimanual or bimanual performance, as well as by means of task complexity, i.e. different degrees ranging from simple to complex sequence tasks. The resulting functional activation in human primary motor cortex (M1) has been studied intensively by traditional neuroimaging methods. Previous studies using functional near-infrared spectroscopy (fNIRS) investigated simple hand motor tasks. However, it is unknown whether fNIRS can also detect changes in response to increasing task complexity. Our hypothesis was to show that fNIRS could detect activation changes in relation to task complexity in uni- and bimanual tasks. Sixteen healthy right-handed subjects performed five finger-tapping tasks: unimanual left and right, simple and complex tasks as well as bimanual complex tasks. We found significant differences in oxy-hemoglobin (O(2)Hb) and deoxy-hemoglobin (HHb) concentration in the right hemisphere over M1. Largest O(2)Hb concentration changes were found during complex (0.351+/-0.051 micromol/l) and simple (0.275+/-0.054 micromol/l) right hand tasks followed by bimanual (0.249+/-0.047 micromol/l), complex (0.154+/-0.034 micromol/l) and simple (0.110+/-0.034 micromol/l) left hand tasks. Largest HHb concentration changes were found during bimanual (-0.138+/-0.006 micromol/l) tasks, followed by simple right hand (-0.12+/-0.016 micromol/l), complex left (-0.0875+/-0.007 micromol/l), complex right (-0.0863+/-0.005 micromol/l) and simple left (-0.0674+/-0.005 micromol/l) hand tasks. We report for the first time that fNIRS detects oxygenation changes in relation to task complexity during finger-tapping. The study aims to contribute to the establishment of fNIRS as a neuroimaging method to assess hand motor function in clinical settings where traditional neuroimaging methods cannot be applied.

RelaxedCare - Connecting people in care situations: User involvement to collect informal caregivers needs.

"How is my mom doing right now?" Answering this question in a quick, clear way without the need of calling or stopping by could take away a lot of stress from informal caregivers. The RelaxedCare system aims to develop a solution built upon an existing AAL platform, using a multi-level pattern recognition approach to detect the current state of an assisted person, and then to communicate the state in a pervasive and unobtrusive way (i.e. lava lamp, smartphone widget, picture frame) to the caregiver. For the development of the RelaxedCare system a user centred design approach has been chosen applying especially the ISO 9241-210 [3] and the user-inspired innovation process [2]. A first technical prototype was evaluated with representative end users in lab trials via usability testing to find out, how the generated ideas match with the end user needs. The results show that the project is on the correct path. The majority of participants approved, that the RelaxedCare system supports the informal caregiver in a worry-free way to care for the assisted person (thus allowing the older generation to live longer in their own homes). 19 of 25 participants felt an advantage by using the system in their care situation in general. Overall 18 of them rate the advantage of the usage at home positively and 20 of them rate the usage positively, if they use it on the way. Also interesting is that in total 19 participants could imagine, that there would be an improvement of the care situation for their own family through the RelaxedCare system.

Multimodal recording of brain activity in term newborns during photic stimulation by near-infrared spectroscopy and electroencephalography.

In this study 14 healthy term newborns (postnatal mean age 2.1 days) underwent photic stimulation during sleep on two different days. Near-infrared spectroscopy (NIRS) and electroencephalography (EEG) was acquired simultaneously. The aims of the study were: to determine (i) the sensitivity and (ii) the repeatability of NIRS to detect the hemodynamic response, (iii) the sensitivity and (iv) the repeatability of EEG to detect a visual evoked potential (VEP), (v) to analyze optical data for the optical neuronal signal, and (vi) to test whether inadequate stimulation could be reason for absent hemodynamic responses. The results of the study were as follows. (i) Sensitivity of NIRS was 61.5% to detect hemodynamic responses; (ii) their reproducibility was 41.7%. A VEP was detected (iii) in 96.3% of all subjects with (iv) a reproducibility of 92.3%. (v) In two measurements data met the criteria for an optical neuronal signal. The noise level was 9.6·10-5% change in optical density. (vi) Insufficient stimulation was excluded as reason for absent hemodynamic responses. We conclude that NIRS is an promising tool to study cognitive activation and development of the brain. For clinical application, however, the sensitivity and reproducibility on an individual level needs to be improved.

Precision of cerebral oxygenation and hemoglobin concentration measurements in neonates measured by near-infrared spectroscopy.

BACKGROUND AND AIM: One source of error with near-infrared spectroscopy (NIRS) is the assumption that the measured tissue is optically homogeneous. This is not always the case. Our aim is to assess the impact of tissue homogeneity (TH) on the precision of NIRS measurements in neonates. METHODS: On 36 term and 27 preterm neonates at least five 1-min measurements are performed on each subject using the OxiplexTS. The sensor position is slightly changed before each measurement while assessing TH. The precision for cerebral tissue oxygenation saturation (StO(2)) and total hemoglobin concentration (tHb) are calculated by repeated measures analysis of variance. RESULTS: The mean StO(2) is not significantly different between term and preterm infants. The mean tHb is significantly lower in preterm infants (p < 0.01). With increasing TH, the precision of StO(2) increase from 5.6 to 4.6% for preterm and from 11.0 to 2.0% for term infants; the precision of tHb increases from 10.1 to 7.5µM for preterm and from 16.4 to 3.5 µM for term infants. The precision for StO(2) is higher in term than in preterm infants. The precision for tHb shows no significant difference between the two groups. CONCLUSIONS: The precision of NIRS measurements correlates with tissue homogeneity.

Reproducibility of cerebral tissue oxygen saturation measurements by near-infrared spectroscopy in newborn infants.

Early detection of cerebral hypoxemia is an important aim in neonatology. A relevant parameter to assess brain oxygenation may be the cerebral tissue oxygen saturation (StO(2)) measured by near-infrared spectroscopy (NIRS). So far the reproducibility of StO(2) measurements was too low for clinical application, probably due to inhomogeneities. The aim of this study was to test a novel sensor geometry which reduces the influence of inhomogeneities. Thirty clinically stable newborn infants, with a gestational age of median 33.9 (range 26.9 to 41.9) weeks, birth weight of 2220 (820 to 4230) g, postnatal age of 5 (1 to 71) days were studied. At least four StO(2) measurements of 1 min duration were carried out using NIRS on the lateral head. The sensor was repositioned between measurements. Reproducibility was calculated by a linear mixed effects model. The mean StO(2) was 79.99 ± 4.47% with a reproducibility of 2.76% and a between-infant variability of 4.20%. Thus, the error of measurement only accounts for 30.1% of the variability. The novel sensor geometry leads to considerably more precise measurements compared to previous studies with, e.g., ∼5% reproducibility for the NIRO 300. The novel StO(2) values hence have a higher clinical relevance.

Periodic leg movements during sleep and cerebral hemodynamic changes detected by NIRS.

OBJECTIVE: Periodic leg movements during sleep (PLMS) have been shown to be associated with changes in autonomic and hemispheric activities. Near infrared spectroscopy (NIRS) assesses hemodynamic changes linked to hemispheric/cortical activity. We applied NIRS to test whether cerebral hemodynamic alterations accompany PLMS. METHODS: Three PLMS patients underwent nocturnal polysomnography coupled with cerebral NIRS. EEG correlates of PLMS were scored and NIRS data were analysed for the identification of correspondent hemodynamic changes. RESULTS: PLMS were constantly associated with cerebral hemodynamic fluctuations that showed greater amplitude when associated to changes in EEG and were present also in absence of any visually detectable arousal or A phase in the EEG. CONCLUSION: This is the first study documenting cerebral hemodynamic changes linked to PLMS. SIGNIFICANCE: The clinical relevance of these observations remains to be determined.