1
|
Xu H, Zheng W, Zhang Y, Zhao D, Wang L, Zhao Y, Wang W, Yuan Y, Zhang J, Huo Z, Wang Y, Zhao N, Qin Y, Liu K, Xi R, Chen G, Zhang H, Tang C, Yan J, Ge Q, Cheng H, Lu Y, Gao L. A fully integrated, standalone stretchable device platform with in-sensor adaptive machine learning for rehabilitation. Nat Commun 2023; 14:7769. [PMID: 38012169 PMCID: PMC10682047 DOI: 10.1038/s41467-023-43664-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 11/16/2023] [Indexed: 11/29/2023] Open
Abstract
Post-surgical treatments of the human throat often require continuous monitoring of diverse vital and muscle activities. However, wireless, continuous monitoring and analysis of these activities directly from the throat skin have not been developed. Here, we report the design and validation of a fully integrated standalone stretchable device platform that provides wireless measurements and machine learning-based analysis of diverse vibrations and muscle electrical activities from the throat. We demonstrate that the modified composite hydrogel with low contact impedance and reduced adhesion provides high-quality long-term monitoring of local muscle electrical signals. We show that the integrated triaxial broad-band accelerometer also measures large body movements and subtle physiological activities/vibrations. We find that the combined data processed by a 2D-like sequential feature extractor with fully connected neurons facilitates the classification of various motion/speech features at a high accuracy of over 90%, which adapts to the data with noise from motion artifacts or the data from new human subjects. The resulting standalone stretchable device with wireless monitoring and machine learning-based processing capabilities paves the way to design and apply wearable skin-interfaced systems for the remote monitoring and treatment evaluation of various diseases.
Collapse
Affiliation(s)
- Hongcheng Xu
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Weihao Zheng
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Yang Zhang
- Department of Medical Electronics, School of Biomedical Engineering, Air Force Medical University, Xi'an, 710032, China
| | - Daqing Zhao
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 710032, China
| | - Lu Wang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Air Force Medical University, Xi'an, 710032, China
| | - Yunlong Zhao
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, Xiamen University, Xiamen, 361102, China
| | - Weidong Wang
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China.
| | - Yangbo Yuan
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Ji Zhang
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Zimin Huo
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Yuejiao Wang
- Applied Mechanics Laboratory, Department of Engineering Mechanics, Tsinghua University, Beijing, 100084, China
| | - Ningjuan Zhao
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Yuxin Qin
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Ke Liu
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Ruida Xi
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Gang Chen
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Haiyan Zhang
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Chu Tang
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi, 710126, China
| | - Junyu Yan
- School of Mechano-Electronic Engineering, Xidian University, Xian, 710071, China
| | - Qi Ge
- Department of Mechanical and Energy Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Huanyu Cheng
- Department of Engineering Science and Mechanics, The Pennsylvania State University, University Park, PA, 16802, USA.
| | - Yang Lu
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong, 999077, Hong Kong SAR.
| | - Libo Gao
- Pen-Tung Sah Institute of Micro-Nano Science and Technology, Xiamen University, Xiamen, 361102, China.
| |
Collapse
|
2
|
Miller KJW, Macrae P, Sands GB, Huckabee ML, Cheng LK. An Accurate Fiducial Marker for Aligning EMG signals with Swallow Onset . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38082870 DOI: 10.1109/embc40787.2023.10340093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Swallowing involves the precise coordination of a large number of muscles. This coordination can be quantified non-invasively by electromyographic (EMG) time-series analysis of swallowing events. The temporal alignment of swallow events is critical for defining coordination patterns. Here, a new framework was developed to use the acoustic signal associated with the opening of the Eustachian tube as a fiducial marker to align EMG signals with swallowing. To investigate its accuracy, manometry, audio from the Eustachian tube, and EMG were simultaneously recorded from two participants while performing different swallowing maneuvers. Eustachian tube opening consistently occurred alongside EMG activations and within 0.025 ± 0.022 s of the gold standard manometry-determined functional swallowing onset. A comparison with two traditional EMG alignment methods based on the integrated and rectified EMG signals was then performed over eight participants. Discrepancies of between 0.2 to 0.3 s were found between the initiation of swallowing and the onset or peak EMG activity. Eustachian tube opening served as a more accurate fiducial marker for temporal data alignment, compared to the traditional EMG alignment methods that were based on EMG parameters.Clinical Relevance- The proposed method will allow EMG recordings to be directly associated with the functional onset of swallowing. This provides a more accurate foundation for time-series analysis of muscle coordination and thus the identification of EMG biomarkers associated with healthy and dysphagic swallowing.
Collapse
|
3
|
Analysis of electrophysiological and mechanical dimensions of swallowing by non-invasive biosignals. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
4
|
Hoffmann J, Roldan-Vasco S, Krüger K, Niekiel F, Hansen C, Maetzler W, Orozco-Arroyave JR, Schmidt G. Pilot Study: Magnetic Motion Analysis for Swallowing Detection Using MEMS Cantilever Actuators. SENSORS (BASEL, SWITZERLAND) 2023; 23:3594. [PMID: 37050654 PMCID: PMC10099077 DOI: 10.3390/s23073594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 06/19/2023]
Abstract
The swallowing process involves complex muscle coordination mechanisms. When alterations in such mechanisms are produced by neurological conditions or diseases, a swallowing disorder known as dysphagia occurs. The instrumental evaluation of dysphagia is currently performed by invasive and experience-dependent techniques. Otherwise, non-invasive magnetic methods have proven to be suitable for various biomedical applications and might also be applicable for an objective swallowing assessment. In this pilot study, we performed a novel approach for deglutition evaluation based on active magnetic motion sensing with permanent magnet cantilever actuators. During the intake of liquids with different consistency, we recorded magnetic signals of relative movements between a stationary sensor and a body-worn actuator on the cricoid cartilage. Our results indicate the detection capability of swallowing-related movements in terms of a characteristic pattern. Consequently, the proposed technique offers the potential for dysphagia screening and biofeedback-based therapies.
Collapse
Affiliation(s)
- Johannes Hoffmann
- Department of Electrical and Information Engineering, Faculty of Engineering, Kiel University, 24118 Kiel, Germany
| | - Sebastian Roldan-Vasco
- GITA Lab, Faculty of Engineering, Universidad de Antioquia, Medellín 050010, Colombia
- Faculty of Engineering, Instituto Tecnológico Metropolitano, Medellín 050536, Colombia
| | - Karolin Krüger
- Department of Electrical and Information Engineering, Faculty of Engineering, Kiel University, 24118 Kiel, Germany
| | - Florian Niekiel
- Fraunhofer Institute for Silicon Technology ISIT, 25524 Itzehoe, Germany
| | - Clint Hansen
- Department of Neurology, Kiel University, 24118 Kiel, Germany
| | - Walter Maetzler
- Department of Neurology, Kiel University, 24118 Kiel, Germany
| | - Juan Rafael Orozco-Arroyave
- GITA Lab, Faculty of Engineering, Universidad de Antioquia, Medellín 050010, Colombia
- Pattern Recognition Lab, Friedrich-Alexander-Universität, 91054 Erlangen, Germany
| | - Gerhard Schmidt
- Department of Electrical and Information Engineering, Faculty of Engineering, Kiel University, 24118 Kiel, Germany
| |
Collapse
|
5
|
Synchronization between videofluoroscopic swallowing study and surface electromyography in patients with neurological involvement presenting symptoms of dysphagia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:650-664. [PMID: 36511672 PMCID: PMC9814368 DOI: 10.7705/biomedica.6446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 12/14/2022]
Abstract
Introduction: Dysphagia is defined as the difficulty in transporting food and liquids from the mouth to the stomach. The gold standard to diagnose this condition is the videofluoroscopic swallowing study. However, it exposes patients to ionizing radiation. Surface electromyography is a non-radioactive alternative for dysphagia evaluation that records muscle electrical activity during swallowing.
Objective: To evaluate the relationship between the relative activation times of the muscles involved in the oral and pharyngeal phases of swallowing and the kinematic events detected in the videofluoroscopy.
Materials and methods: Electromiographic signals from ten patients with neurological involvement who presented symptoms of dysphagia were analyzed simultaneously with
videofluoroscopy. Patients were given 5 ml of yogurt, 10 ml of water, and 3 g of crackers. Masseter, suprahyoid, and infrahyoid muscle groups were studied bilaterally. The bolus transit through the mandibular line, vallecula, and the cricopharyngeus muscle was analyzed in relation to the onset and offset times of each muscle group activation.
Results: The average time of the pharyngeal phase was 0.89 ± 0.12 s. Muscle activation was mostly observed prior to the bolus transit through the mandibular line and vallecula. The end of the muscle activity suggested that the passage of the bolus through the cricopharyngeus muscle was almost complete.
Conclusión: The muscle activity times, duration of the pharyngeal phase, and sequence of the muscle groups involved in swallowing were determined using sEMG validated with the videofluoroscopic swallowing study.
Collapse
|
6
|
Murakami C, Sasaki M, Shimoda S, Tamada Y. Quantification of the Swallowing Mechanism Through Muscle Synergy Analysis. Dysphagia 2022; 38:973-989. [PMID: 36149515 DOI: 10.1007/s00455-022-10523-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Abstract
Decreased swallowing function increases the risk of choking and aspiration pneumonia. Videofluoroscopy and computed tomography allow for detailed observation of the swallowing movements but have radiation risks. Therefore, we developed a method using surface electromyography (sEMG) to noninvasively assess swallowing function without radiation exposure. A 44-channel flexible sEMG sensor was used to measure the sEMG signals of the hyoid muscles during swallowing in 14 healthy young adult and 14 elderly subjects. Muscle synergy analysis was performed to extract the muscle synergies from the sEMG signals, and the three synergies were extracted from the hyoid muscle activities during the swallowing experiments. The experimental results showed that the three synergies represent the oral, early pharyngeal, and late pharyngeal swallowing phases and that swallowing strength is tuned by the strength of the muscle activities, whereas swallowing volume is controlled by adjusting muscle activation timing. In addition, the timing of the swallowing reflex is slower in elderly individuals. The results confirm that the proposed approach successfully quantifies swallowing function from sEMG signals, mapping the signals to the swallowing phases.
Collapse
Affiliation(s)
- Chiaki Murakami
- Division of Biorobotics, Graduate School of Science and Engineering, Iwate University, 4-3-5 Ueda, Morioka, Iwate, 020-8551, Japan
| | - Makoto Sasaki
- Division of Biorobotics, Graduate School of Science and Engineering, Iwate University, 4-3-5 Ueda, Morioka, Iwate, 020-8551, Japan.
| | - Shingo Shimoda
- Intelligent Behavior Control Unit, RIKEN CBS-Toyota Collaboration Center, 2271-130 Anagahora, Shimoshidami, Moriyama-ku, Nagoya, Aichi, 463-0003, Japan
| | - Yasushi Tamada
- Department of Dysphagia Rehabilitation and Department of Special Care Dentistry, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8102, Japan
| |
Collapse
|
7
|
Oinuma M, Kato R, Okumura T, Hara K. Bio-signal Feature Analysis to Detect Aspiration Caused by Dysphagia. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:414-417. [PMID: 36085808 DOI: 10.1109/embc48229.2022.9871927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Dysphagia causes aspiration symptoms and can trigger aspiration pneumonia, poor nutritional status, etc. To address these risks, it is important to properly evaluate dysphagia and link it with treatment and training. However, current dysphagia evaluation methods cannot assess a swallowing function equivalent to that in daily life, owing to the examination method and environment. In this study, we analyzed bio-signal features to realize a system that can detect aspiration symptoms in daily life. Focusing on the neck electrical impedance, swallowing sounds, and a surface electromyogram of the suprahyoid muscles, we created a swallowing-measurement device and analyzed the bio-signals of the throat movement during swallowing. By measuring the swallowing of dysphagic patients, we investigated the characteristic differences, depending on the presence or absence of aspiration symptoms. The analysis results suggest that there were differences in each bio-signal depending on the presence or absence of aspiration symptoms, and these bio-signals could detect aspiration symptoms. This method can detect aspiration symptoms in daily life and evaluate dysphagia more appropriately and simply than current evaluation methods.
Collapse
|
8
|
Miller KJW, Macrae P, Paskaranandavadivel N, Huckabee ML, Cheng LK. Non-invasive assessment of swallowing using flexible high-density electromyography arrays. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:5120-5123. [PMID: 36083930 DOI: 10.1109/embc48229.2022.9871168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Swallowing is a vital function that serves to safely transport food and fluid to the stomach, while simultaneously protecting our airways. Evaluation of swallowing is important for the diagnosis and rehabilitation of individuals with dysphagia, a disorder of swallowing. Flexible high-density surface electromyography (HD sEMG) arrays were designed and fabricated to span the floor of mouth and neck muscles. These arrays were applied on 6 healthy participants over duplicate recording sessions. During each recording session, participants performed three different swallowing motor tasks. The HD sEMG signals were filtered and tasks extracted. For each task, the RMS amplitude was computed, visualized, and compared. Dynamic motor coordination was evident in the filtered signals traces, with different electrode locations showing unique temporal activations. The 2D topographical maps allowed the location of different RMS intensities to be visualized, revealing qualitatively similar patterns across participants and tasks. These motor task trends were also seen within RMS quantifications. The RMS metric across all participants identified significant differences between non-effortful 3 ml and effortful 3 ml swallow tasks ( p=0.006) and there was a minimal variation of 3.1±1.9 μV RMS for repeated recording sessions by each participant. The HD-sEMG array successfully recorded differences in muscle activations during swallowing and was able to discern between two different motor tasks. The arrays offers a spatially detailed non-invasive assessment of the neuromuscular performance of swallowing. Clinical Relevance- The utility of HD-sEMG arrays for evaluation of the muscles involved in swallowing could enable diagnosis and rehabilitation of individuals with dysphagia.
Collapse
|
9
|
Ye-Lin Y, Prats-Boluda G, Galiano-Botella M, Roldan-Vasco S, Orozco-Duque A, Garcia-Casado J. Directed Functional Coordination Analysis of Swallowing Muscles in Healthy and Dysphagic Subjects by Surface Electromyography. SENSORS 2022; 22:s22124513. [PMID: 35746295 PMCID: PMC9230381 DOI: 10.3390/s22124513] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 12/04/2022]
Abstract
Swallowing is a complex sequence of highly regulated and coordinated skeletal and smooth muscle activity. Previous studies have attempted to determine the temporal relationship between the muscles to establish the activation sequence pattern, assessing functional muscle coordination with cross-correlation or coherence, which is seriously impaired by volume conduction. In the present work, we used conditional Granger causality from surface electromyography signals to analyse the directed functional coordination between different swallowing muscles in both healthy and dysphagic subjects ingesting saliva, water, and yoghurt boluses. In healthy individuals, both bilateral and ipsilateral muscles showed higher coupling strength than contralateral muscles. We also found a dominant downward direction in ipsilateral supra and infrahyoid muscles. In dysphagic subjects, we found a significantly higher right-to-left infrahyoid, right ipsilateral infra-to-suprahyoid, and left ipsilateral supra-to-infrahyoid interactions, in addition to significant differences in the left ipsilateral muscles between bolus types. Our results suggest that the functional coordination analysis of swallowing muscles contains relevant information on the swallowing process and possible dysfunctions associated with dysphagia, indicating that it could potentially be used to assess the progress of the disease or the effectiveness of rehabilitation therapies.
Collapse
Affiliation(s)
- Yiyao Ye-Lin
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (Y.Y.-L.); (M.G.-B.); (J.G.-C.)
| | - Gema Prats-Boluda
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (Y.Y.-L.); (M.G.-B.); (J.G.-C.)
- Correspondence:
| | - Marina Galiano-Botella
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (Y.Y.-L.); (M.G.-B.); (J.G.-C.)
| | - Sebastian Roldan-Vasco
- Grupo de Investigación en Materiales Avanzados y Energía, Instituto Tecnológico Metropolitano, Medellin 050034, Colombia;
| | - Andres Orozco-Duque
- Grupo de Investigación e Innovación Biomédica, Instituto Tecnológico Metropolitano, Medellin 050034, Colombia;
| | - Javier Garcia-Casado
- Centro de Investigación e Innovación en Bioingeniería, Universitat Politècnica de València, 46022 Valencia, Spain; (Y.Y.-L.); (M.G.-B.); (J.G.-C.)
| |
Collapse
|
10
|
Automatic detection of poor quality signals as a pre-processing scheme in the analysis of sEMG in swallowing. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
11
|
Matsuzaki T, Suzuki Y, Tanimoto M, Masuyama K, Osano M, Sakata O, Morisawa M. Bolus Inflow Detection Method by Ultrasound Video Processing for Evaluation of Swallowing. ADVANCED BIOMEDICAL ENGINEERING 2021. [DOI: 10.14326/abe.10.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | | | | | | | - Osamu Sakata
- Department of Engineering, Tokyo University of Science
| | | |
Collapse
|