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Martino Cinnera A, Morone G, Iosa M, Bonomi S, Calabrò RS, Tonin P, Cerasa A, Ricci A, Ciancarelli I. Artificial neural network analysis of factors affecting functional independence recovery in patients with lumbar stenosis after neurosurgery treatment: An observational cohort study. J Orthop 2024; 55:38-43. [PMID: 38638115 PMCID: PMC11021912 DOI: 10.1016/j.jor.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/20/2024] Open
Abstract
Background and aim Lumbar spinal stenosis (LSS) is a leading cause of low back pain and lower limbs pain often associated with functional impairment which entails the loss or the impairment of independence in older adults. Conservative treatment is effective in a small percentage of patients, while a significant percentage undergo surgery, even if often without a complete resolution of clinical symptoms and motor deficits. The aim of the study is to identify clinical and demographic prognostic factors characterising the patients who would benefit most from surgical treatment in relation to the functional independence recovery using an innovative approach based on an artificial neural network. Methods Adult patients with LSS and indication of neurosurgical treatment were enrolled in the study. Clinical evaluation was performed in the preoperative-phase (into the 48 h before surgery) and after two months. Clinical battery investigated the motor, functional, cognitive, behavioural, and pain status. Demographics and clinical characteristics were analysed via Artificial Neural Network (ANN) using 24 input variables, 2 hidden layers and a single final output layer to predict the outcome. ANN results were compared with those of a multiple linear regression. Results 108 patients were included in the study and 90 of them [66.5 ± 12.8 years; 27.8 % F] were submitted to surgery treatment and completed longitudinal evaluation. Statistically significant improvement was recorded in all clinical scales comparing pre- and post-surgery. The ANN results showed a prediction ability up to 81 %. Disability, functional limitations, and pain concerning clinical assessment and stature, onset and age about demographic characteristics are the main variables impacting on surgical outcome. Conclusions ANN can support clinical decision making, using clinical and demographic characteristics of patients with LSS identifying the characteristics of those who might benefit more from the surgical treatment in terms of global functional recovery.
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Affiliation(s)
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, Italy
| | - Marco Iosa
- IRCCS Santa Lucia Foundation Hospital, Rome, Italy
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | | | - Antonio Cerasa
- Sant'Anna Institute, Crotone, Italy
- Institute for Biomedical Research and Innovation, National Research Council of Italy (IRIB-CNR), Messina, Italy
- Pharmacotechnology Documention and Transfer Unit, Preclinical and Traslation Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, Arcavacata, Italy
| | - Alessandro Ricci
- Department of Neurosurgery, San Salvatore Hospital, ASL Avezzano-Sulmona-L’Aquila, L'Aquila, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- Territorial Rehabilitation, ASL Avezzano-Sulmona-L’Aquila, L'Aquila, Italy
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Tamburella F, Lena E, Mascanzoni M, Iosa M, Scivoletto G. Harnessing Artificial Neural Networks for Spinal Cord Injury Prognosis. J Clin Med 2024; 13:4503. [PMID: 39124769 PMCID: PMC11313443 DOI: 10.3390/jcm13154503] [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: 07/02/2024] [Revised: 07/25/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Background: Prediction of neurorehabilitation outcomes after a Spinal Cord Injury (SCI) is crucial for healthcare resource management and improving prognosis and rehabilitation strategies. Artificial neural networks (ANNs) have emerged as a promising alternative to conventional statistical approaches for identifying complex prognostic factors in SCI patients. Materials: a database of 1256 SCI patients admitted for rehabilitation was analyzed. Clinical and demographic data and SCI characteristics were used to predict functional outcomes using both ANN and linear regression models. The former was structured with input, hidden, and output layers, while the linear regression identified significant variables affecting outcomes. Both approaches aimed to evaluate and compare their accuracy for rehabilitation outcomes measured by the Spinal Cord Independence Measure (SCIM) score. Results: Both ANN and linear regression models identified key predictors of functional outcomes, such as age, injury level, and initial SCIM scores (correlation with actual outcome: R = 0.75 and 0.73, respectively). When also alimented with parameters recorded during hospitalization, the ANN highlighted the importance of these additional factors, like motor completeness and complications during hospitalization, showing an improvement in its accuracy (R = 0.87). Conclusions: ANN seemed to be not widely superior to classical statistics in general, but, taking into account complex and non-linear relationships among variables, emphasized the impact of complications during the hospitalization on recovery, particularly respiratory issues, deep vein thrombosis, and urological complications. These results suggested that the management of complications is crucial for improving functional recovery in SCI patients.
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Affiliation(s)
- Federica Tamburella
- Department of Life Sciences, Health and Health Professions, Link Campus University, 00165 Rome, Italy;
- Spinal Center, Spinal Rehabilitation Laboratory, IRCCS Fondazione S. Lucia, 00179 Rome, Italy; (E.L.); (M.M.); (G.S.)
| | - Emanuela Lena
- Spinal Center, Spinal Rehabilitation Laboratory, IRCCS Fondazione S. Lucia, 00179 Rome, Italy; (E.L.); (M.M.); (G.S.)
| | - Marta Mascanzoni
- Spinal Center, Spinal Rehabilitation Laboratory, IRCCS Fondazione S. Lucia, 00179 Rome, Italy; (E.L.); (M.M.); (G.S.)
| | - Marco Iosa
- Department of Psychology, Sapienza University of Rome, 00183 Rome, Italy
- Smart Lab, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Giorgio Scivoletto
- Spinal Center, Spinal Rehabilitation Laboratory, IRCCS Fondazione S. Lucia, 00179 Rome, Italy; (E.L.); (M.M.); (G.S.)
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Bhupal N, Bures L, Peterson E, Nicol S, Figeys M, Cruz AM. Technological interventions in functional capacity evaluations: An insight into current applications. Work 2024:WOR230560. [PMID: 38875068 DOI: 10.3233/wor-230560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Functional Capacity Evaluation (FCE) is a crucial component within return-to-work decision making. However, clinician-based physical FCE interpretation may introduce variability and biases. The rise of technological applications such as machine learning and artificial intelligence, could ensure consistent and precise results. OBJECTIVE This review investigates the application of information and communication technologies (ICT) in physical FCEs specific for return-to-work assessments. METHODS Adhering to the PRISMA guidelines, a search was conducted across five databases, extracting study specifics, populations, and technological tools employed, through dual independent reviews. RESULTS Nine studies were identified that used ICT in FCEs. These technologies included electromyography, heart rate monitors, cameras, motion detectors, and specific software. Notably, although some devices are commercially available, these technologies were at a technology readiness level of 5-6 within the field of FCE. A prevailing trend was the combined use of diverse technologies rather than a single, unified solution. Moreover, the primary emphasis was on the application of technology within study protocols, rather than a direct evaluation of the technology usability and feasibility. CONCLUSION The literature underscores limited ICT integration in FCEs. The current landscape of FCEs, marked by a high dependence on clinician observations, presents challenges regarding consistency and cost-effectiveness. There is an evident need for a standardized technological approach that introduces objective metrics to streamline the FCE process and potentially enhance its outcomes.
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Affiliation(s)
- Nake Bhupal
- Department of Occupational Therapy. Faculty of Rehabilitation Medicine. University of Alberta. 2-64 Corbett Hall, Edmonton, AB. Canada T6 G 2G4
| | - Laura Bures
- Department of Occupational Therapy. Faculty of Rehabilitation Medicine. University of Alberta. 2-64 Corbett Hall, Edmonton, AB. Canada T6 G 2G4
| | - Emika Peterson
- Department of Occupational Therapy. Faculty of Rehabilitation Medicine. University of Alberta. 2-64 Corbett Hall, Edmonton, AB. Canada T6 G 2G4
| | - Spencer Nicol
- Department of Occupational Therapy. Faculty of Rehabilitation Medicine. University of Alberta. 2-64 Corbett Hall, Edmonton, AB. Canada T6 G 2G4
| | - Mathieu Figeys
- Department of Occupational Therapy. Faculty of Rehabilitation Medicine. University of Alberta. 2-64 Corbett Hall, Edmonton, AB. Canada T6 G 2G4
| | - Antonio Miguel Cruz
- Department of Occupational Therapy. Faculty of Rehabilitation Medicine. University of Alberta. 2-64 Corbett Hall, Edmonton, AB. Canada T6 G 2G4
- Glenrose Rehabilitation Research, Innovation & Technology (GRRIT). Glenrose Rehabilitation Hospital, Edmonton, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Samadi Kohnehshahri F, Merlo A, Mazzoli D, Bò MC, Stagni R. Machine learning applied to gait analysis data in cerebral palsy and stroke: A systematic review. Gait Posture 2024; 111:105-121. [PMID: 38663321 DOI: 10.1016/j.gaitpost.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/08/2024] [Accepted: 04/08/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Among neurological pathologies, cerebral palsy and stroke are the main contributors to walking disorders. Machine learning methods have been proposed in the recent literature to analyze gait data from these patients. However, machine learning methods still fail to translate effectively into clinical applications. This systematic review addressed the gaps hindering the use of machine learning data analysis in the clinical assessment of cerebral palsy and stroke patients. RESEARCH QUESTION What are the main challenges in transferring proposed machine learning methods to clinical applications? METHODS PubMed, Web of Science, Scopus, and IEEE databases were searched for relevant publications on machine learning methods applied to gait analysis data from stroke and cerebral palsy patients until February the 23rd, 2023. Information related to the suitability, feasibility, and reliability of the proposed methods for their effective translation to clinical use was extracted, and quality was assessed based on a set of predefined questions. RESULTS From 4120 resulting references, 63 met the inclusion criteria. Thirty-one studies used supervised, and 32 used unsupervised machine learning methods. Artificial neural networks and k-means clustering were the most used methods in each category. The lack of rationale for features and algorithm selection, the use of unrepresentative datasets, and the lack of clinical interpretability of the clustering outputs were the main factors hindering the clinical reliability and applicability of these methods. SIGNIFICANCE The literature offers numerous machine learning methods for clustering gait data from cerebral palsy and stroke patients. However, the clinical significance of the proposed methods is still lacking, limiting their translation to real-world applications. The design of future studies must take into account clinical question, dataset significance, feature and model selection, and interpretability of the results, given their criticality for clinical translation.
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Affiliation(s)
- Farshad Samadi Kohnehshahri
- Department of Electronic and Information Engineering, University of Bologna, Italy; Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera, Rimini, Italy.
| | - Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera, Rimini, Italy.
| | - Davide Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera, Rimini, Italy.
| | - Maria Chiara Bò
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera, Rimini, Italy; Merlo Bioengineering, Parma, Italy.
| | - Rita Stagni
- Department of Electronic and Information Engineering, University of Bologna, Italy.
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Badreau M, Fadel M, Roquelaure Y, Bertin M, Rapicault C, Gilbert F, Porro B, Descatha A. Comparison of Machine Learning Methods in the Study of Cancer Survivors' Return to Work: An Example of Breast Cancer Survivors with Work-Related Factors in the CONSTANCES Cohort. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:750-756. [PMID: 36935460 DOI: 10.1007/s10926-023-10112-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Machine learning (ML) methods showed a higher accuracy in identifying individuals without cancer who were unable to return to work (RTW) compared to the classical methods (e.g. logistic regression models). We therefore aim to discuss the value of these methods in relation to RTW for cancer survivors. METHODS Breast cancer (BC) survivors who were working at diagnosis within the CONSTANCES cohort were included in the study. RTW was assessed five years after the BC diagnosis (early retirement was considered as non-RTW). Age and occupation at diagnosis, and physical occupational job exposures assessed using the Job Exposure Matrix, JEM-CONSTANCES, were evaluated as predictors of RTW five years after BC diagnosis. The following four ML methods were used: (i) k-nearest neighbors; (ii) random forest; (iii) neural network; and (iv) elastic net. RESULTS The training sample included 683 BC survivors (RTW: 85.7%), and the test sample 171 (RTW: 85.4%). The elastic net method had the best results despite low sensitivity (accuracy = 76.6%; sensitivity = 31.7%; specificity = 90.8%), and the random forest model was the most accurate (= 79.5%) but also the least sensitive (= 14.3%). CONCLUSION This study takes a first step towards opening up new possibilities for identifying the occupational determinants of cancer survivors' RTW. Further work, including a larger sample size, and more predictor variables, is now needed.
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Affiliation(s)
- Marie Badreau
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, IRSET-ESTER, SFR ICAT, Angers, F-49000, France
| | - Marc Fadel
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, IRSET-ESTER, SFR ICAT, Angers, F-49000, France
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, IRSET ESTER, SFR ICAT, Angers, F-49000, France
| | - Yves Roquelaure
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, IRSET-ESTER, SFR ICAT, Angers, F-49000, France
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, IRSET ESTER, SFR ICAT, Angers, F-49000, France
| | - Mélanie Bertin
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, IRSET ESTER, SFR ICAT, Angers, F-49000, France
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé) - U 1309, Rennes, F-35000, France
| | - Clémence Rapicault
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, IRSET-ESTER, SFR ICAT, Angers, F-49000, France
| | - Fabien Gilbert
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, IRSET-ESTER, SFR ICAT, Angers, F-49000, France
| | - Bertrand Porro
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, IRSET-ESTER, SFR ICAT, Angers, F-49000, France.
- Department of Human and Social Sciences, Institut de Cancerologie de l'Ouest (ICO), Angers, 49055, France.
| | - Alexis Descatha
- Univ Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, IRSET-ESTER, SFR ICAT, Angers, F-49000, France
- Univ Angers, CHU Angers, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail), UMR_S 1085, IRSET ESTER, SFR ICAT, Angers, F-49000, France
- Centre antipoison et de toxicovigilance Grand Ouest, CHU Angers, CHU Angers, Angers, France
- Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine, Hofstra, Northwell, USA
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Kim H, Kim JW, Ko J. Adaptive Control Method for Gait Detection and Classification Devices with Inertial Measurement Unit. SENSORS (BASEL, SWITZERLAND) 2023; 23:6638. [PMID: 37514932 PMCID: PMC10385410 DOI: 10.3390/s23146638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023]
Abstract
Cueing and feedback training can be effective in maintaining or improving gait in individuals with Parkinson's disease. We previously designed a rehabilitation assist device that can detect and classify a user's gait at only the swing phase of the gait cycle, for the ease of data processing. In this study, we analyzed the impact of various factors in a gait detection algorithm on the gait detection and classification rate (GDCR). We collected acceleration and angular velocity data from 25 participants (1 male and 24 females with an average age of 62 ± 6 years) using our device and analyzed the data using statistical methods. Based on these results, we developed an adaptive GDCR control algorithm using several equations and functions. We tested the algorithm under various virtual exercise scenarios using two control methods, based on acceleration and angular velocity, and found that the acceleration threshold was more effective in controlling the GDCR (average Spearman correlation -0.9996, p < 0.001) than the gyroscopic threshold. Our adaptive control algorithm was more effective in maintaining the target GDCR than the other algorithms (p < 0.001) with an average error of 0.10, while other tested methods showed average errors of 0.16 and 0.28. This algorithm has good scalability and can be adapted for future gait detection and classification applications.
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Affiliation(s)
- Hyeonjong Kim
- Division of Mechanical Engineering, (National) Korea Maritime and Ocean University, Busan 49112, Republic of Korea
| | - Ji-Won Kim
- Division of Biomedical Engineering, Konkuk University, Chungju 27478, Republic of Korea
- BK21 Plus Research Institute of Biomedical Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Junghyuk Ko
- Division of Mechanical Engineering, (National) Korea Maritime and Ocean University, Busan 49112, Republic of Korea
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Application of an Artificial Neural Network to Identify the Factors Influencing Neurorehabilitation Outcomes of Patients with Ischemic Stroke Treated with Thrombolysis. Biomolecules 2023; 13:biom13020334. [PMID: 36830703 PMCID: PMC9953156 DOI: 10.3390/biom13020334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
The administration of thrombolysis usually reduces the risk of death and the consequences of stroke in the acute phase. However, having received thrombolysis administration is not a prognostic factor for neurorehabilitation outcome in the subacute phase of stroke. It is conceivably due to the complex intertwining of many clinical factors. An artificial neural network (ANN) analysis could be helpful in identifying the prognostic factors of neurorehabilitation outcomes and assigning a weight to each of the factors considered. This study hypothesizes that the prognostic factors could be different between patients who received and those who did not receive thrombolytic treatment, even if thrombolysis is not a prognostic factor per se. In a sample of 862 patients with ischemic stroke, the tested ANN identified some common factors (such as disability at admission, age, unilateral spatial neglect), some factors with higher weight in patients who received thrombolysis (hypertension, epilepsy, aphasia, obesity), and some other factors with higher weight in the other patients (dysphagia, malnutrition, total arterial circulatory infarction). Despite the fact that thrombolysis is not an independent prognostic factor for neurorehabilitation, it seems to modify the relative importance of other clinical factors in predicting which patients will better respond to neurorehabilitation.
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Donisi L, Cesarelli G, Pisani N, Ponsiglione AM, Ricciardi C, Capodaglio E. Wearable Sensors and Artificial Intelligence for Physical Ergonomics: A Systematic Review of Literature. Diagnostics (Basel) 2022; 12:3048. [PMID: 36553054 PMCID: PMC9776838 DOI: 10.3390/diagnostics12123048] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/24/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Physical ergonomics has established itself as a valid strategy for monitoring potential disorders related, for example, to working activities. Recently, in the field of physical ergonomics, several studies have also shown potential for improvement in experimental methods of ergonomic analysis, through the combined use of artificial intelligence, and wearable sensors. In this regard, this review intends to provide a first account of the investigations carried out using these combined methods, considering the period up to 2021. The method that combines the information obtained on the worker through physical sensors (IMU, accelerometer, gyroscope, etc.) or biopotential sensors (EMG, EEG, EKG/ECG), with the analysis through artificial intelligence systems (machine learning or deep learning), offers interesting perspectives from both diagnostic, prognostic, and preventive points of view. In particular, the signals, obtained from wearable sensors for the recognition and categorization of the postural and biomechanical load of the worker, can be processed to formulate interesting algorithms for applications in the preventive field (especially with respect to musculoskeletal disorders), and with high statistical power. For Ergonomics, but also for Occupational Medicine, these applications improve the knowledge of the limits of the human organism, helping in the definition of sustainability thresholds, and in the ergonomic design of environments, tools, and work organization. The growth prospects for this research area are the refinement of the procedures for the detection and processing of signals; the expansion of the study to assisted working methods (assistive robots, exoskeletons), and to categories of workers suffering from pathologies or disabilities; as well as the development of risk assessment systems that exceed those currently used in ergonomics in precision and agility.
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Affiliation(s)
- Leandro Donisi
- Department of Chemical, Materials and Production Engineering, University of Naples Federico II, 80125 Naples, Italy
- Istituti Clinici Scientifici ICS Maugeri, 27100 Pavia, Italy
| | - Giuseppe Cesarelli
- Department of Chemical, Materials and Production Engineering, University of Naples Federico II, 80125 Naples, Italy
- Istituti Clinici Scientifici ICS Maugeri, 27100 Pavia, Italy
| | - Noemi Pisani
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Alfonso Maria Ponsiglione
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, 80125 Naples, Italy
| | - Carlo Ricciardi
- Istituti Clinici Scientifici ICS Maugeri, 27100 Pavia, Italy
- Department of Information Technology and Electrical Engineering, University of Naples Federico II, 80125 Naples, Italy
| | - Edda Capodaglio
- Istituti Clinici Scientifici ICS Maugeri, 27100 Pavia, Italy
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Hu W, Combden O, Jiang X, Buragadda S, Newell CJ, Williams MC, Critch AL, Ploughman M. Machine learning corroborates subjective ratings of walking and balance difficulty in multiple sclerosis. Front Artif Intell 2022; 5:952312. [PMID: 36248625 PMCID: PMC9556653 DOI: 10.3389/frai.2022.952312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Machine learning can discern meaningful information from large datasets. Applying machine learning techniques to raw sensor data from instrumented walkways could automatically detect subtle changes in walking and balance. Multiple sclerosis (MS) is a neurological disorder in which patients report varying degrees of walking and balance disruption. This study aimed to determine whether machine learning applied to walkway sensor data could classify severity of self-reported symptoms in MS patients. Ambulatory people with MS (n = 107) were asked to rate the severity of their walking and balance difficulties, from 1-No problems to 5-Extreme problems, using the MS-Impact Scale-29. Those who scored less than 3 (moderately) were assigned to the “mild” group (n = 35), and those scoring higher were in the “moderate” group (n = 72). Three machine learning algorithms were applied to classify the “mild” group from the “moderate” group. The classification achieved 78% accuracy, a precision of 85%, a recall of 90%, and an F1 score of 87% for distinguishing those people reporting mild from moderate walking and balance difficulty. This study demonstrates that machine learning models can reliably be applied to instrumented walkway data and distinguish severity of self-reported impairment in people with MS.
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Affiliation(s)
- Wenting Hu
- Ubiquitous Computing and Machine Learning Research Lab, Department of Computer Science, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Owen Combden
- Ubiquitous Computing and Machine Learning Research Lab, Department of Computer Science, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Xianta Jiang
- Ubiquitous Computing and Machine Learning Research Lab, Department of Computer Science, Memorial University of Newfoundland, St. John's, NL, Canada
- *Correspondence: Xianta Jiang
| | - Syamala Buragadda
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Caitlin J. Newell
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Maria C. Williams
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Amber L. Critch
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Michelle Ploughman
- Recovery and Performance Laboratory, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
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Cerasa A, Tartarisco G, Bruschetta R, Ciancarelli I, Morone G, Calabrò RS, Pioggia G, Tonin P, Iosa M. Predicting Outcome in Patients with Brain Injury: Differences between Machine Learning versus Conventional Statistics. Biomedicines 2022; 10:biomedicines10092267. [PMID: 36140369 PMCID: PMC9496389 DOI: 10.3390/biomedicines10092267] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/06/2022] [Accepted: 09/09/2022] [Indexed: 11/29/2022] Open
Abstract
Defining reliable tools for early prediction of outcome is the main target for physicians to guide care decisions in patients with brain injury. The application of machine learning (ML) is rapidly increasing in this field of study, but with a poor translation to clinical practice. This is basically dependent on the uncertainty about the advantages of this novel technique with respect to traditional approaches. In this review we address the main differences between ML techniques and traditional statistics (such as logistic regression, LR) applied for predicting outcome in patients with stroke and traumatic brain injury (TBI). Thirteen papers directly addressing the different performance among ML and LR methods were included in this review. Basically, ML algorithms do not outperform traditional regression approaches for outcome prediction in brain injury. Better performance of specific ML algorithms (such as Artificial neural networks) was mainly described in the stroke domain, but the high heterogeneity in features extracted from low-dimensional clinical data reduces the enthusiasm for applying this powerful method in clinical practice. To better capture and predict the dynamic changes in patients with brain injury during intensive care courses ML algorithms should be extended to high-dimensional data extracted from neuroimaging (structural and fMRI), EEG and genetics.
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Affiliation(s)
- Antonio Cerasa
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
- S. Anna Institute, 88900 Crotone, Italy
- Correspondence:
| | - Gennaro Tartarisco
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
| | - Roberta Bruschetta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
- Department of Engineering, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy
- San Raffaele Sulmona Institute, 67039 Sulmona, Italy
| | | | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
| | | | - Marco Iosa
- IRCCS Centro Neurolesi “Bonino-Pulejo”, 98123 Messina, Italy
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
- Santa Lucia Foundation IRCSS, 00179 Rome, Italy
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11
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Ciancarelli I, Morone G, Tozzi Ciancarelli MG, Paolucci S, Tonin P, Cerasa A, Iosa M. Identification of Determinants of Biofeedback Treatment's Efficacy in Treating Migraine and Oxidative Stress by ARIANNA (ARtificial Intelligent Assistant for Neural Network Analysis). Healthcare (Basel) 2022; 10:941. [PMID: 35628078 PMCID: PMC9141187 DOI: 10.3390/healthcare10050941] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022] Open
Abstract
Migraines are a public health problem that impose severe socioeconomic burdens and causes related disabilities. Among the non-pharmacological therapeutic approaches, behavioral treatments such as biofeedback have proven effective for both adults and children. Oxidative stress is undoubtedly involved in the pathophysiology of migraines. Evidence shows a complex relationship between nitric oxide (NO) and superoxide anions, and their modification could lead to an effective treatment. Conventional analyses may fail in highlighting the complex, nonlinear relationship among factors and outcomes. The aim of the present study was to verify if an artificial neural network (ANN) named ARIANNA could verify if the serum levels of the decomposition products of NO-nitrite and nitrate (NOx)-the superoxide dismutase (SOD) serum levels, and the Migraine Disability Assessment Scores (MIDAS) could constitute prognostic variables predicting biofeedback's efficacy in migraine treatment. Twenty women affected by chronic migraine were enrolled and underwent an EMG-biofeedback treatment. The results show an accuracy for the ANN of 75% in predicting the post-treatment MIDAS score, highlighting a statistically significant correlation (R = -0.675, p = 0.011) between NOx (nitrite and nitrate) and MIDAS only when the peroxide levels in the serum were within a specific range. In conclusion, the ANN was proven to be an innovative methodology for interpreting the complex biological phenomena and biofeedback treatment in migraines.
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Affiliation(s)
- Irene Ciancarelli
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (I.C.); (M.G.T.C.)
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (I.C.); (M.G.T.C.)
| | | | | | - Paolo Tonin
- S. Anna Rehabilitation Institute, RAN-Research on Advanced Neurorehabilitation, 88900 Crotone, Italy; (P.T.); (A.C.)
| | - Antonio Cerasa
- S. Anna Rehabilitation Institute, RAN-Research on Advanced Neurorehabilitation, 88900 Crotone, Italy; (P.T.); (A.C.)
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 98164 Messina, Italy
- Pharmacotechnology Documentation and Transfer Unit, Preclinical and Translational Pharmacology, Department of Pharmacy, Health Science and Nutrition, University of Calabria, 87036 Rende, Italy
| | - Marco Iosa
- Santa Lucia Foundation IRCSS, 00179 Roma, Italy; (S.P.); (M.I.)
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy
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12
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Mangone M, Agostini F, de Sire A, Cacchio A, Chiaramonte A, Butterini G, Martano A, Paoloni M, Bernetti A, Paolucci T. Effect of virtual reality rehabilitation on functional outcomes for return-to-work patients with Parkinson's disease: An umbrella review of systematic reviews. NeuroRehabilitation 2022; 51:201-211. [PMID: 35599505 DOI: 10.3233/nre-220029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative disease characterized by loss of substantia nigra neurons with deficiency of dopamine. The main symptoms are tremor, rigidity and bradykinesia. Rehabilitation has an important role in the treatment of this condition and virtual reality (VR) is one of the most recent tools. OBJECTIVE The purpose of this umbrella review is to evaluate the effectiveness of VR systems on gait control for return to work in patients with PD. METHODS The electronic search, for reviews and meta-analysis studies that investigated the effectiveness of VR on gait control in PD patients, was performed through December 2021 using the following databases: PubMed, Scopus, PEDro, and Google Scholar. Mesh terms used were: Job integration/reintegration OR return-to-work AND Parkinson's disease AND virtual reality OR exergame. No limit on the year of publication of the article was used. CONCLUSIONS A total of 14 articles were included in our analysis. The included evidence shows a stride length improvement in patients treated with VR compared to conventional active treatments. No difference was found in walking speed. Also, the included articles show an improvement on various measures of balance, motor function and severity of PD motor symptoms. In addition, the literature shows an improvement in the quality of life and neuropsychiatric symptoms in patients undergoing VR rehabilitation training. RESULTS he results of our study suggest that VR rehabilitation improves gait performance, particularly stride length, thus being able to provide an improvement in the quality of life and a more effective return to work training in patients with PD.
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Affiliation(s)
- Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Angelo Cacchio
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Angelo Chiaramonte
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Giulia Butterini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Andrea Martano
- Department of Medical, Oral and Biotechnological Sciences, Unit of Physical and Rehabilitation Medicine, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Andrea Bernetti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University of Rome, Rome, Italy
| | - Teresa Paolucci
- Department of Medical, Oral and Biotechnological Sciences, Unit of Physical and Rehabilitation Medicine, G. D'Annunzio University of Chieti-Pescara, Chieti, Italy
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13
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Artificial Neural Network Detects Hip Muscle Forces as Determinant for Harmonic Walking in People after Stroke. SENSORS 2022; 22:s22041374. [PMID: 35214276 PMCID: PMC8963097 DOI: 10.3390/s22041374] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 01/21/2022] [Accepted: 02/09/2022] [Indexed: 02/01/2023]
Abstract
Many recent studies have highlighted that the harmony of physiological walking is based on a specific proportion between the durations of the phases of the gait cycle. When this proportion is close to the so-called golden ratio (about 1.618), the gait cycle assumes an autosimilar fractal structure. In stroke patients this harmony is altered, but it is unclear which factor is associated with the ratios between gait phases because these relationships are probably not linear. We used an artificial neural network to determine the weights associable to each factor for determining the ratio between gait phases and hence the harmony of walking. As expected, the gait ratio obtained as the ratio between stride duration and stance duration was found to be associated with walking speed and stride length, but also with hip muscle forces. These muscles could be important for exploiting the recovery of energy typical of the pendular mechanism of walking. Our study also highlighted that the results of an artificial neural network should be associated with a reliability analysis, being a non-deterministic approach. A good level of reliability was found for the findings of our study.
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14
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Guzik A, Wolan-Nieroda A, Drużbicki M. Assessment of Agreement Between a New Application to Compute the Wisconsin Gait Score and 3-Dimensional Gait Analysis, and Reliability of the Application in Stroke Patients. Front Hum Neurosci 2022; 16:775261. [PMID: 35185497 PMCID: PMC8851887 DOI: 10.3389/fnhum.2022.775261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Currently, there are no computerized tools enabling objective interpretation of observational gait assessment based on Wisconsin Gait Scale (WGS), which is a reliable and well-tested tool. The solution envisaged by us may provide a practical tool for assessing gait deviations in patients with hemiparesis after stroke. The present study assessed agreement between a new application software for computerized WGS and 3-dimensional gait analysis (3DGA), and reliability of the application. The study involved 33 individuals with hemiparesis after stroke. The software was developed based on a model designed taking into account components of the WGS and incorporating auxiliary lines passing through the relevant anthropometric points on the patient’s body, as well as measurements of angular values, distances and duration of the specific gait phases, which make it possible to substantiate assessment based on this scale. Series of videos were made to record gait of the qualified patients. After the gait evaluation was carried out using the app, the data were retrieved from the software. The gait assessment was performed separately by three independent examiners who reviewed the video recording using the new app twice (two weeks apart). Additionally, 3DGA was carried out for all the subjects, and the results of the app-aided assessment were compared to those acquired using 3DGA. The findings show statistically significant correlations (p < 0.05) between majority of the WGS items measured using the new app, and the relevant spatiotemporal and kinematic parameters identified by 3DGA. Agreement between the scores reported by the three examiners was high in both measurements, as reflected by Cronbach’s alpha exceeding 0.8. The findings reflect very good intra-observer reliability (as reflected by kappa coefficients from 0.847 to 1) and inter-observer reliability (as reflected by kappa coefficients from 0.634 to 1) of the new application software for computerized WGS. The opportunities offered by the observational gait scale objectified through our new software for computerized WGS result from the fact that the tool provides a useful low-cost and time-effective feedback to monitor ongoing treatments or formulate hypotheses.
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Harris EJ, Khoo IH, Demircan E. A Survey of Human Gait-Based Artificial Intelligence Applications. Front Robot AI 2022; 8:749274. [PMID: 35047564 PMCID: PMC8762057 DOI: 10.3389/frobt.2021.749274] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/01/2021] [Indexed: 12/17/2022] Open
Abstract
We performed an electronic database search of published works from 2012 to mid-2021 that focus on human gait studies and apply machine learning techniques. We identified six key applications of machine learning using gait data: 1) Gait analysis where analyzing techniques and certain biomechanical analysis factors are improved by utilizing artificial intelligence algorithms, 2) Health and Wellness, with applications in gait monitoring for abnormal gait detection, recognition of human activities, fall detection and sports performance, 3) Human Pose Tracking using one-person or multi-person tracking and localization systems such as OpenPose, Simultaneous Localization and Mapping (SLAM), etc., 4) Gait-based biometrics with applications in person identification, authentication, and re-identification as well as gender and age recognition 5) “Smart gait” applications ranging from smart socks, shoes, and other wearables to smart homes and smart retail stores that incorporate continuous monitoring and control systems and 6) Animation that reconstructs human motion utilizing gait data, simulation and machine learning techniques. Our goal is to provide a single broad-based survey of the applications of machine learning technology in gait analysis and identify future areas of potential study and growth. We discuss the machine learning techniques that have been used with a focus on the tasks they perform, the problems they attempt to solve, and the trade-offs they navigate.
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Affiliation(s)
- Elsa J Harris
- Human Performance and Robotics Laboratory, Department of Mechanical and Aerospace Engineering, California State University Long Beach, Long Beach, CA, United States
| | - I-Hung Khoo
- Department of Electrical Engineering, California State University Long Beach, Long Beach, CA, United States.,Department of Biomedical Engineering, California State University Long Beach, Long Beach, CA, United States
| | - Emel Demircan
- Human Performance and Robotics Laboratory, Department of Mechanical and Aerospace Engineering, California State University Long Beach, Long Beach, CA, United States.,Department of Biomedical Engineering, California State University Long Beach, Long Beach, CA, United States
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16
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Picerno P, Iosa M, D'Souza C, Benedetti MG, Paolucci S, Morone G. Wearable inertial sensors for human movement analysis: a five-year update. Expert Rev Med Devices 2021; 18:79-94. [PMID: 34601995 DOI: 10.1080/17434440.2021.1988849] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The aim of the present review is to track the evolution of wearable IMUs from their use in supervised laboratory- and ambulatory-based settings to their application for long-term monitoring of human movement in unsupervised naturalistic settings. AREAS COVERED Four main emerging areas of application were identified and synthesized, namely, mobile health solutions (specifically, for the assessment of frailty, risk of falls, chronic neurological diseases, and for the monitoring and promotion of active living), occupational ergonomics, rehabilitation and telerehabilitation, and cognitive assessment. Findings from recent scientific literature in each of these areas was synthesized from an applied and/or clinical perspective with the purpose of providing clinical researchers and practitioners with practical guidance on contemporary uses of inertial sensors in applied clinical settings. EXPERT OPINION IMU-based wearable devices have undergone a rapid transition from use in laboratory-based clinical practice to unsupervised, applied settings. Successful use of wearable inertial sensing for assessing mobility, motor performance and movement disorders in applied settings will rely also on machine learning algorithms for managing the vast amounts of data generated by these sensors for extracting information that is both clinically relevant and interpretable by practitioners.
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Affiliation(s)
- Pietro Picerno
- SMART Engineering Solutions & Technologies (SMARTEST) Research Center, Università Telematica "Ecampus", Novedrate, Comune, Italy
| | - Marco Iosa
- Department of Psychology, Sapienza University, Rome, Italy.,Irrcs Santa Lucia Foundation, Rome, Italy
| | - Clive D'Souza
- Center for Ergonomics, Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
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Prognostic Factors in Neurorehabilitation of Stroke: A Comparison among Regression, Neural Network, and Cluster Analyses. Brain Sci 2021; 11:brainsci11091147. [PMID: 34573168 PMCID: PMC8466358 DOI: 10.3390/brainsci11091147] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022] Open
Abstract
There is a large body of literature reporting the prognostic factors for a positive outcome of neurorehabilitation performed in the subacute phase of stroke. Despite the recent development of algorithms based on neural networks or cluster analysis for the identification of these prognostic factors, the literature lacks a rigorous comparison among classical regression, neural network, and cluster analysis. Moreover, the three methods have rarely been tested on a sample independent from that in which prognostic factors have been identified. This study aims at providing this comparison on a wide sample of data (1522 patients) and testing the results on an independent sample (1000 patients) using 30 variables. The accuracy was similar among regression, neural network, and cluster analyses on the analyzed sample (76.6%, 74%, and 76.1%, respectively), but on the test sample, the accuracy of neural network decreased (70.1%). The three models agreed in identifying older age, severe impairment, unilateral spatial neglect, and total anterior circulation infarcts as important prognostic factors. The binary regression analysis also provided solid results in the test sample, especially in terms of specificity (81.8%). Cluster analysis also showed a high sensitivity in the test sample (82.6%) and allowed a meaningful easy-to-use classification tree to be obtained.
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18
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Mohan DM, Khandoker AH, Wasti SA, Ismail Ibrahim Ismail Alali S, Jelinek HF, Khalaf K. Assessment Methods of Post-stroke Gait: A Scoping Review of Technology-Driven Approaches to Gait Characterization and Analysis. Front Neurol 2021; 12:650024. [PMID: 34168608 PMCID: PMC8217618 DOI: 10.3389/fneur.2021.650024] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Gait dysfunction or impairment is considered one of the most common and devastating physiological consequences of stroke, and achieving optimal gait is a key goal for stroke victims with gait disability along with their clinical teams. Many researchers have explored post stroke gait, including assessment tools and techniques, key gait parameters and significance on functional recovery, as well as data mining, modeling and analyses methods. Research Question: This study aimed to review and summarize research efforts applicable to quantification and analyses of post-stroke gait with focus on recent technology-driven gait characterization and analysis approaches, including the integration of smart low cost wearables and Artificial Intelligence (AI), as well as feasibility and potential value in clinical settings. Methods: A comprehensive literature search was conducted within Google Scholar, PubMed, and ScienceDirect using a set of keywords, including lower extremity, walking, post-stroke, and kinematics. Original articles that met the selection criteria were included. Results and Significance: This scoping review aimed to shed light on tools and technologies employed in post stroke gait assessment toward bridging the existing gap between the research and clinical communities. Conventional qualitative gait analysis, typically used in clinics is mainly based on observational gait and is hence subjective and largely impacted by the observer's experience. Quantitative gait analysis, however, provides measured parameters, with good accuracy and repeatability for the diagnosis and comparative assessment throughout rehabilitation. Rapidly emerging smart wearable technology and AI, including Machine Learning, Support Vector Machine, and Neural Network approaches, are increasingly commanding greater attention in gait research. Although their use in clinical settings are not yet well leveraged, these tools promise a paradigm shift in stroke gait quantification, as they provide means for acquiring, storing and analyzing multifactorial complex gait data, while capturing its non-linear dynamic variability and offering the invaluable benefits of predictive analytics.
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Affiliation(s)
- Dhanya Menoth Mohan
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Ahsan Habib Khandoker
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Sabahat Asim Wasti
- Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sarah Ismail Ibrahim Ismail Alali
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Herbert F Jelinek
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Kinda Khalaf
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
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