Feasibility of hand grip tests during and after hospitalization in geriatric patients: an observational study.

BACKGROUND: Monitoring the recovery trajectory during and after hospitalization can be a valuable method to observe whether additional care is needed to optimize recovery. Hand grip strength tests are commonly used to measure an individual's physical condition. Eforto® is a system to monitor hand grip strength and grip work as measures of recovery. We examined the feasibility of daily repeated hand grip tests measured with Eforto® in geriatric inpatients, during hospitalization and at home after discharge. METHODS: Geriatric inpatients (n = 191) were evaluated for grip strength and grip work with Eforto®, twice daily during their admission. We calculated attempt and success rates. Participants were divided into complete, high, moderate, and low attempt/success rate groups to study differences in patient characteristics. Reasons for non-attempt and unsuccessful tests were categorized and analyzed. Nine participants were interviewed about acceptability and user experience within the hospital setting. Four out of twenty participants accepted the invitation to continue the measurements after discharge at home for 4 weeks and were interviewed about acceptability and user experience. RESULTS: Across the 191 participants, the attempt rate was 85% and 86% of the attempted tests was successful. The main reasons for non-attempt were that the patient felt physically unwell (41%), and that the patient was otherwise engaged, for example receiving care or undergoing medical tests (40%). Measurements were unsuccessful mostly because of the patient not having enough strength to reach the 80% threshold needed for the grip work test (60%). Participants in the complete and high attempt/success rate groups had a shorter length of stay (p<0.05) and a lower mortality (p<0.05) than participants in the moderate/low groups. The interview data showed good acceptability and user experience during hospitalization. The acceptability was strengthened by experienced usefulness. Self-monitoring at home resulted in low inclusion rate (20%) and low success rate (25%), with the uncertain time after discharge from the hospital as the main barrier. CONCLUSIONS: For most patients, the tests were feasible in the supervised hospital setting. At-home testing with Eforto® is challenging, primarily because of the uncertain time after discharge from the hospital.

Validation of an mHealth System for Monitoring Fundamental Physiological Parameters in the Clinical Setting.

The aim of this work was to validate the measurements of three physiological parameters, namely, body temperature, heart rate, and peripheral oxygen saturation, captured with an out-of-the-lab device using measurements taken with clinically proven devices. The out-of-the-lab specialized device was integrated into a customized mHealth application, e-CoVig, developed within the AIM Health project. To perform the analysis, single consecutive measurements of the three vital parameters obtained with e-CoVig and with the standard devices from patients in an intensive care unit were collected, preprocessed, and then analyzed through classical agreement analysis, where we used Lin's concordance coefficient to assess the agreement correlation and Bland-Altman plots with exact confidence intervals for the limits of agreement to analyze the paired data readings. The existence of possible systematic errors was also addressed, where we found the presence of additive errors, which were corrected, and weak proportional biases. We obtained the mean overall agreement between the measurements taken with the novel e-CoVig device and the reference devices for the measured quantities. Although some limitations in this study were encountered, we present more advanced methods for their further assessment.

A Novel Smart Chair System for Posture Classification and Invisible ECG Monitoring.

In recent years, employment in sedentary occupations has continuously risen. Office workers are more prone to prolonged static sitting, spending 65−80% of work hours sitting, increasing risks for multiple health problems, including cardiovascular diseases and musculoskeletal disorders. These adverse health effects lead to decreased productivity, increased absenteeism and health care costs. However, lack of regulation targeting these issues has oftentimes left them unattended. This article proposes a smart chair system, with posture and electrocardiography (ECG) monitoring modules, using an "invisible" sensing approach, to optimize working conditions, without hindering everyday tasks. For posture classification, machine learning models were trained and tested with datasets composed by center of mass coordinates in the seat plane, computed from the weight measured by load cells fixed under the seat. Models were trained and evaluated in the classification of five and seven sitting positions, achieving high accuracy results for all five-class models (>97.4%), and good results for some seven-class models, particularly the best performing k-NN model (87.5%). For ECG monitoring, signals were acquired at the armrests covered with conductive nappa, connected to a single-lead sensor. Following signal filtering and segmentation, several outlier detection methods were applied to remove extremely noisy segments with mislabeled R-peaks, but only DBSCAN showed satisfactory results for the ECG segmentation performance (88.21%) and accuracy (90.50%).

Morphological Autoencoders for Beat-by-Beat Atrial Fibrillation Detection Using Single-Lead ECG.

Engineered feature extraction can compromise the ability of Atrial Fibrillation (AFib) detection algorithms to deliver near real-time results. Autoencoders (AEs) can be used as an automatic feature extraction tool, tailoring the resulting features to a specific classification task. By coupling an encoder to a classifier, it is possible to reduce the dimension of the Electrocardiogram (ECG) heartbeat waveforms and classify them. In this work we show that morphological features extracted using a Sparse AE are sufficient to distinguish AFib from Normal Sinus Rhythm (NSR) beats. In addition to the morphological features, rhythm information was included in the model using a proposed short-term feature called Local Change of Successive Differences (LCSD). Using single-lead ECG recordings from two referenced public databases, and with features from the AE, the model was able to achieve an F1-score of 88.8%. These results show that morphological features appear to be a distinct and sufficient factor for detecting AFib in ECG recordings, especially when designed for patient-specific applications. This is an advantage over state-of-the-art algorithms that need longer acquisition times to extract engineered rhythm features, which also requires careful preprocessing steps. To the best of our knowledge, this is the first work that presents a near real-time morphological approach for AFib detection under naturalistic ECG acquisition with a mobile device.

Benchmarking of Sensor Configurations and Measurement Sites for Out-of-the-Lab Photoplethysmography.

Photoplethysmography (PPG) is used for heart-rate monitoring in a variety of contexts and applications due to its versatility and simplicity. These applications, namely studies involving PPG data acquisition during day-to-day activities, require reliable and continuous measurements, which are often performed at the index finger or wrist. However, some PPG sensors are susceptible to saturation, motion artifacts, and discomfort upon their use. In this paper, an off-the-shelf PPG sensor was benchmarked and modified to improve signal saturation. Moreover, this paper explores the feasibility of using an optimized sensor in the lower limb as an alternative measurement site. Data were collected from 28 subjects with ages ranging from 18 to 59 years. To validate the sensors' performance, signal saturation and quality, wave morphology, performance of automatic systolic peak detection, and heart-rate estimation, were compared. For the upper and lower limb locations, the index finger and the first toe were used as reference locations, respectively. Lowering the amplification stage of the PPG sensor resulted in a significant reduction in signal saturation, from 18% to 0.5%. Systolic peak detection at rest using an automatic algorithm showed a sensitivity and precision of 0.99 each. The posterior wrist and upper arm showed pulse wave morphology correlations of 0.93 and 0.92, respectively. For these locations, peak detection sensitivity and precision were 0.95, 0.94 and 0.89, 0.89, respectively. Overall, the adjusted PPG sensors are a good alternative for obtaining high-quality signals at the fingertips, and for new measurement sites, the posterior pulse and the upper arm allow for high-quality signal extraction.

Validation of a Low-Cost Electrocardiography (ECG) System for Psychophysiological Research.

BACKGROUND AND OBJECTIVE: The reliability of low-cost mobile systems for recording Electrocardiographic (ECG) data is mostly unknown, posing questions regarding the quality of the recorded data and the validity of the extracted physiological parameters. The present study compared the BITalino toolkit with an established medical-grade ECG system (BrainAmp-ExG). METHODS: Participants underwent simultaneous ECG recordings with the two instruments while watching pleasant and unpleasant pictures of the "International Affective Picture System" (IAPS). Common ECG parameters were extracted and compared between the two systems. The Intraclass Correlation Coefficients (ICCs) and the Bland-Altman Limits of Agreement (LoA) method served as criteria for measurement agreement. RESULTS: All but one parameter showed an excellent agreement (>80%) between both devices in the ICC analysis. No criteria for Bland-Altman LoA and bias were found in the literature regarding ECG parameters. CONCLUSION: The results of the ICC and Bland-Altman methods demonstrate that the BITalino system can be considered as an equivalent recording device for stationary ECG recordings in psychophysiological experiments.

Three-dimensional printed exoskeletons and orthoses for the upper limb-A systematic review.

This systematic review aims to assess and summarize the current landscape in exoskeletons and orthotic solutions developed for upper limb medical assistance, which are partly or fully produced using 3-dimensional printing technologies and contain at least the elbow or the shoulder joints. The initial search was conducted on Web of Science, PubMed, and IEEEXplore, resulting in 92 papers, which were reduced to 72 after removal of duplicates. From the application of the inclusion and exclusion criteria and selection questionnaire, 33 papers were included in the review, being divided according to the analyzed joints. The analysis of the selected papers allowed for the identification of different solutions that vary in terms of their target application, actuation type, 3-dimensional printing techniques, and material selection, among others. The results show that there has been far more research on the elbow joint than on the shoulder joint, which can be explained by the relative complexity of the latter. Moreover, the findings of this study also indicate that there is still a gap between the research conducted on these devices and their practical use in real-world conditions. Based on current trends, it is anticipated that the future of 3-dimensional printed exoskeletons will revolve around the use of flexible and high-performance materials, coupled with actuated devices. These advances have the potential to replace the conventional fabrication methods of exoskeletons with technologies based on additive manufacturing.

PreEpiSeizures: description and outcomes of physiological data acquisition using wearable devices during video-EEG monitoring in people with epilepsy.

The PreEpiSeizures project was created to better understand epilepsy and seizures through wearable technologies. The motivation was to capture physiological information related to epileptic seizures, besides Electroencephalography (EEG) during video-EEG monitorings. If other physiological signals have reliable information of epileptic seizures, unobtrusive wearable technology could be used to monitor epilepsy in daily life. The development of wearable solutions for epilepsy is limited by the nonexistence of datasets which could validate these solutions. Three different form factors were developed and deployed, and the signal quality was assessed for all acquired biosignals. The wearable data acquisition was performed during the video-EEG of patients with epilepsy. The results achieved so far include 59 patients from 2 hospitals totaling 2,721 h of wearable data and 348 seizures. Besides the wearable data, the Electrocardiogram of the hospital is also useable, totalling 5,838 h of hospital data. The quality ECG signals collected with the proposed wearable is equated with the hospital system, and all other biosignals also achieved state-of-the-art quality. During the data acquisition, 18 challenges were identified, and are presented alongside their possible solutions. Though this is an ongoing work, there were many lessons learned which could help to predict possible problems in wearable data collections and also contribute to the epilepsy community with new physiological information. This work contributes with original wearable data and results relevant to epilepsy research, and discusses relevant challenges that impact wearable health monitoring.

Neuroorganoleptics: Organoleptic Testing Based on Psychophysiological Sensing.

There is an increasing interest, in consumer behaviour research related to food and beverage, in taking a step further from the traditional self-report questionnaires and organoleptic properties assessment. With the growing availability of psychophysiological data acquisition devices, and advancements in the study of the underlying signal sources seeking affective state assessment, the use of psychophysiological data analysis is a natural evolution in organoleptic testing. In this paper we propose a protocol for what can be defined as neuroorganoleptic analysis, a method that combines traditional approaches with psychophysiological data acquired during sensory testing. Our protocol was applied to a case study project named MobFood, where four samples of food were tested by a total of 83 participants, using preference and acceptance tasks, across three different sessions. Best practices and lessons learned regarding the laboratory setting and the acquisition of psychophysiological data were derived from this case study, which are herein described. Preliminary results show that certain Heart Rate Variability (HRV) features have a strong correlation with the preferences self-reported by the participants.

Morphological autoencoders for apnea detection in respiratory gating radiotherapy.

BACKGROUND AND OBJECTIVE: Respiratory gating training is a common technique to increase patient proprioception, with the goal of (e.g.) minimizing the effects of organ motion during radiotherapy. In this work, we devise a system based on autoencoders for classification of regular, apnea and unconstrained breathing patterns (i.e. multiclass). METHODS: Our approach is based on morphological analysis of the respiratory signals, using an autoencoder trained on regular breathing. The correlation between the input and output of the autoencoder is used to train and test several classifiers in order to select the best. Our approach is evaluated in a novel real-world respiratory gating biofeedback training dataset and on the Apnea-ECG reference dataset. RESULTS: Accuracies of 95 ± 3.5% and 87 ± 6.6% were obtained for two different datasets, in the classification of breathing and apnea. These results suggest the viability of a generalised model to characterise the breathing patterns under study. CONCLUSIONS: Using autoencoders to learn respiratory gating training patterns allows a data-driven approach to feature extraction, by focusing only on the signal's morphology. The proposed system is prone to be used in real-time and could potentially be transferred to other domains.

Benchmarking of the BITalino biomedical toolkit against an established gold standard.

The low-cost multimodal platform BITalino is being increasingly used for educational and research purposes. However, there is still a lack of well-structured work comparing data acquired by this toolkit against a reference device, using established experimental protocols. This work intends to fill the said gap by benchmarking the performance of BITalino against the BioPac MP35 Student Lab Pro device. This work followed a methodical experimental protocol to acquire data from the two devices simultaneously. Four physiological signals were acquired: electrocardiography, electromyography, electrodermal activity and electroencephalography. Root mean square error and coefficient of determination were computed to analyse differences between BITalino and BioPac. Electrodermal activity signals were very similar for the two devices, even without applying any major signal processing techniques. For electrocardiography, a simple morphological comparison also revealed high similarity between devices, and this similarity increased after a common segmentation procedure was followed. Regarding electromyography and electroencephalography data, the approach consisted of comparing features extracted using common post-processing methods. The differences between BITalino and BioPac were again small. Overall, the results presented here show a close similarity between data acquired by the BITalino and by the reference device. This is an important validation step for all researchers working with this multimodal platform.