Stand-Alone Wearable System for Ubiquitous Real-Time Monitoring of Muscle Activation Potentials

Prediction of biomedical signals using deep learning techniques

The electrocardiogram (ECG), electroencephalogram (EEG), and electromyogram (EMG) are all very useful diagnostic techniques. The widespread availability of mobile devices plus the declining cost of ECG, EEG, and EMG sensors provide a unique opportunity for making this kind of study widely available. The fundamental need for enhancing a country’s healthcare industry is the ability to foresee the plethora of ailments with which people are now being diagnosed. It’s no exaggeration to say that heart disease is one of the leading causes of mortality and disability in the world today. Diagnosing heart disease is a difficult process that calls for much training and expertise. Electrocardiogram (ECG) signal is an electrical signal produced by the human heart and used to detect the human heartbeat. Emotions are not simple phenomena, yet they do have a major impact on the standard of living. All of these mental processes including drive, perception, cognition, creativity, focus, attention, learning, and decision making are greatly influenced by emotional states. Electroencephalogram (EEG) signals react instantly and are more responsive to changes in emotional states than peripheral neurophysiological signals. As a result, EEG readings may disclose crucial aspects of a person’s emotional states. The signals generated by electromyography (EMG) are gaining prominence in both clinical and biological settings. Differentiating between neuromuscular illnesses requires a reliable method of detection, processing, and classification of EMG data. This study investigates potential deep learning applications by constructing a framework to improve the prediction of cardiac-related diseases using electrocardiogram (ECG) data, furnishing an algorithmic model for sentiment classification utilizing EEG data, and forecasting neuromuscular disease classification utilizing EMG signals.

Development and Characterization of Embroidery-Based Textile Electrodes for Surface EMG Detection

The interest in wearable devices has expanded to measurement devices for building IoT-based mobile healthcare systems and sensing bio-signal data through clothing. Surface electromyography, called sEMG, is one of the most popular bio-signals that can be applied to health monitoring systems. In general, gel-based (Ag/AgCl) electrodes are mainly used, but there are problems, such as skin irritation due to long-time wearing, deterioration of adhesion to the skin due to moisture or sweat, and low applicability to clothes. Hence, research on dry electrodes as a replacement is increasing. Accordingly, in this study, a textile-based electrode was produced with a range of electrode shapes, and areas were embroidered with conductive yarn using an embroidery technique in the clothing manufacturing process. The electrode was applied to EMG smart clothing for fitness, and the EMG signal detection performance was analyzed. The electrode shape was manufactured using the circle and wave type. The wave-type electrode was more morphologically stable than the circle-type electrode by up to 30% strain, and the electrode shape was maintained as the embroidered area increased. Skin-electrode impedance analysis confirmed that the embroidered area with conductive yarn affected the skin contact area, and the impedance decreased with increasing area. For sEMG performance analysis, the rectus femoris was selected as a target muscle, and the sEMG parameters were analyzed. The wave-type sample showed higher EMG signal strength than the circle-type. In particular, the electrode with three lines showed better performance than the fill-type electrode. These performances operated without noise, even with a commercial device. Therefore, it is expected to be applicable to the manufacture of electromyography smart clothing based on embroidered electrodes in the future.

Biopotential Signal Monitoring Systems in Rehabilitation: A Review

Monitoring physical activity in medical and clinical rehabilitation, in sports environments or as a wellness indicator is helpful to measure, analyze and evaluate physiological parameters involving the correct subject’s movements. Thanks to integrated circuit (IC) technologies, wearable sensors and portable devices have expanded rapidly in monitoring physical activities in sports and tele-rehabilitation. Therefore, sensors and signal acquisition devices became essential in the tele-rehabilitation path to obtain accurate and reliable information by analyzing the acquired physiological signals. In this context, this paper provides a state-of-the-art review of the recent advances in electroencephalogram (EEG), electrocardiogram (ECG) and electromyogram (EMG) signal monitoring systems and sensors that are relevant to the field of tele-rehabilitation and health monitoring. Mostly, we focused our contribution in EMG signals to highlight its importance in rehabilitation context applications. This review focuses on analyzing the implementation of sensors and biomedical applications both in literature than in commerce. Moreover, a final review discussion about the analyzed solutions is also reported at the end of this paper to highlight the advantages of physiological monitoring systems in rehabilitation and individuate future advancements in this direction. The main contributions of this paper are (i) the presentation of interesting works in the biomedical area, mainly focusing on sensors and systems for physical rehabilitation and health monitoring between 2016 and up-to-date, and (ii) the indication of the main types of commercial sensors currently being used for biomedical applications.

Sensors for Context-Aware Smart Healthcare: A Security Perspective

The advances in the miniaturisation of electronic devices and the deployment of cheaper and faster data networks have propelled environments augmented with contextual and real-time information, such as smart homes and smart cities. These context-aware environments have opened the door to numerous opportunities for providing added-value, accurate and personalised services to citizens. In particular, smart healthcare, regarded as the natural evolution of electronic health and mobile health, contributes to enhance medical services and people's welfare, while shortening waiting times and decreasing healthcare expenditure. However, the large number, variety and complexity of devices and systems involved in smart health systems involve a number of challenging considerations to be considered, particularly from security and privacy perspectives. To this aim, this article provides a thorough technical review on the deployment of secure smart health services, ranging from the very collection of sensors data (either related to the medical conditions of individuals or to their immediate context), the transmission of these data through wireless communication networks, to the final storage and analysis of such information in the appropriate health information systems. As a result, we provide practitioners with a comprehensive overview of the existing vulnerabilities and solutions in the technical side of smart healthcare.

Shedding Light on Nocturnal Movements in Parkinson's Disease: Evidence from Wearable Technologies

In Parkinson’s disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which significantly impact quality of life. In PD patients, these nocturnal disturbances can reflect disease-related complications (e.g., nocturnal akinesia), primary sleep disorders (e.g., rapid eye movement behaviour disorder), or both, thus requiring different therapeutic approaches. Wearable technologies based on actigraphy and innovative sensors have been proposed as feasible solutions to identify and monitor the various types of abnormal nocturnal movements in PD. This narrative review addresses the topic of abnormal nocturnal movements in PD and discusses how wearable technologies could help identify and assess these disturbances. We first examine the pathophysiology of abnormal nocturnal movements and the main clinical and instrumental tools for the evaluation of these disturbances in PD. We then report and discuss findings from previous studies assessing nocturnal movements in PD using actigraphy and innovative wearable sensors. Finally, we discuss clinical and technical prospects supporting the use of wearable technologies for the evaluation of nocturnal movements.

Motor and Sensory Features of Cervical Dystonia Subtypes: Data From the Italian Dystonia Registry

Introduction: Cervical dystonia (CD) is one of the most common forms of adult-onset isolated dystonia. Recently, CD has been classified according to the site of onset and spread, in different clinical subgroups, that may represent different clinical entities or pathophysiologic subtypes. In order to support this hypothesis, in this study we have evaluated whether different subgroups of CD, that clinically differ for site of onset and spread, also imply different sensorimotor features.

Methods: Clinical and demographic data from 842 patients with CD from the Italian Dystonia Registry were examined. Motor features (head tremor and tremor elsewhere) and sensory features (sensory trick and neck pain) were investigated. We analyzed possible associations between motor and sensory features in CD subgroups [focal neck onset, no spread (FNO-NS); focal neck onset, segmental spread (FNO-SS); focal onset elsewhere with segmental spread to neck (FOE-SS); segmental neck involvement without spread (SNI)].

Results: In FNO-NS, FOE-SS, and SNI subgroups, head tremor was associated with the presence of tremor elsewhere. Sensory trick was associated with pain in patients with FNO-NS and with head tremor in patients with FNO-SS.

Conclusion: The frequent association between head tremor and tremor elsewhere may suggest a common pathophysiological mechanism. Two mechanisms may be hypothesized for sensory trick: a gating mechanism attempting to reduce pain and a sensorimotor mechanism attempting to control tremor.

Fifteen Years of Wireless Sensors for Balance Assessment in Neurological Disorders

Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined.

Evaluating depression with multimodal wristband-type wearable device: screening and assessing patient severity utilizing machine-learning

OBJECTIVE

We aimed to develop a machine learning algorithm to screen for depression and assess severity based on data from wearable devices.

METHODS

We used a wearable device that calculates steps, energy expenditure, body movement, sleep time, heart rate, skin temperature, and ultraviolet light exposure. Depressed patients and healthy volunteers wore the device continuously for the study period. The modalities were compared hourly between patients and healthy volunteers. XGBoost was used to build machine learning models and 10-fold cross-validation was applied for the validation.

RESULTS

Forty-five depressed patients and 41 healthy controls participated, creating a combined 5,250 days' worth of data. Heart rate, steps, and sleep were significantly different between patients and healthy volunteers in some comparisons. Similar differences were also observed longitudinally when patients' symptoms improved. Based on seven days' data, the model identified symptomatic patients with 0.76 accuracy and predicted Hamilton Depression Rating Scale-17 scores with a 0.61 correlation coefficient. Skin temperature, sleep time-related features, and the correlation of those modalities were the most significant features in machine learning.

LIMITATIONS

The small number of subjects who participated in this study may have weakened the statistical significance of the study. There are differences in the demographic data among groups although we performed a correction for multiple comparisons. Validation in independent datasets was not performed, although 10-fold cross validation with the internal data was conducted.

CONCLUSION

The results indicated that utilizing wearable devices and machine learning may be useful in identifying depression as well as assessing severity.

Actigraphy for evaluation of mood disorders: A systematic review and meta-analysis

BACKGROUND

Actigraphy has enabled consecutive observation of individual health conditions such as sleep or daily activity. This study aimed to examine the usefulness of actigraphy in evaluating depressive and/or bipolar disorder symptoms.

METHOD

A systematic review and meta-analysis was conducted. We selected studies that used actigraphy to compare either patients vs. healthy controls, or pre- vs. post-treatment data from the same patient group. Common actigraphy measurements, namely daily activity and sleep-related data, were extracted and synthesized.

RESULTS

Thirty-eight studies (n = 3,758) were included in the analysis. Compared with healthy controls, depressive patients were less active (standardized mean difference; SMD=1.27, 95%CI=[0.97, 1.57], P<0.001) and had longer wake after sleep onset (SMD= - 0.729, 95%CI=[- 1.20, - 0.25], p = 0.003). Total sleep time (SMD= - 0.33, 95%CI=[- 0.55, - 0.11], P = 0.004), sleep latency (SMD= - 0.22, 95%CI=[- 0.42, - 0.02], P = 0.032), and wake after sleep onset (SMD= - 0.22, 95%CI=[- 0.39, - 0.04], P = 0.015) were longer in euthymic/remitted patients compared to healthy controls. In pre- and post-treatment comparisons, sleep latency (SMD=- 0.85, 95%CI=[- 1.53, - 0.17], P = 0.015), wake after sleep onset (SMD= - 0.65, 95%CI=[- 1.20, - 0.10], P = 0.022), and sleep efficiency (SMD=0.77, 95%CI=[0.29, 1.24], P = 0.002) showed significant improvement.

LIMITATION

The sample sizes for each outcome were small. The type of actigraphy devices and patients' illness severity differed across studies. It is possible that hospitalizations and medication influenced the outcomes.

CONCLUSION

We found significant differences between healthy controls and mood disorders patients for some actigraphy-measured modalities. Specific measurement patterns characterizing each mood disorder/status were also found. Additional actigraphy data linked to severity and/or treatment could enhance the clinical utility of actigraphy.

A Review of Psychophysiological Measures to Assess Cognitive States in Real-World Driving

As driving functions become increasingly automated, motorists run the risk of becoming cognitively removed from the driving process. Psychophysiological measures may provide added value not captured through behavioral or self-report measures alone. This paper provides a selective review of the psychophysiological measures that can be utilized to assess cognitive states in real-world driving environments. First, the importance of psychophysiological measures within the context of traffic safety is discussed. Next, the most commonly used physiology-based indices of cognitive states are considered as potential candidates relevant for driving research. These include: electroencephalography and event-related potentials, optical imaging, heart rate and heart rate variability, blood pressure, skin conductance, electromyography, thermal imaging, and pupillometry. For each of these measures, an overview is provided, followed by a discussion of the methods for measuring it in a driving context. Drawing from recent empirical driving and psychophysiology research, the relative strengths and limitations of each measure are discussed to highlight each measures' unique value. Challenges and recommendations for valid and reliable quantification from lab to (less predictable) real-world driving settings are considered. Finally, we discuss measures that may be better candidates for a near real-time assessment of motorists' cognitive states that can be utilized in applied settings outside the lab. This review synthesizes the literature on in-vehicle psychophysiological measures to advance the development of effective human-machine driving interfaces and driver support systems.

Wearable Sensors System for an Improved Analysis of Freezing of Gait in Parkinson's Disease Using Electromyography and Inertial Signals

We propose a wearable sensor system for automatic, continuous and ubiquitous analysis of Freezing of Gait (FOG), in patients affected by Parkinson’s disease. FOG is an unpredictable gait disorder with different clinical manifestations, as the trembling and the shuffling-like phenotypes, whose underlying pathophysiology is not fully understood yet. Typical trembling-like subtype features are lack of postural adaptation and abrupt trunk inclination, which in general can increase the fall probability. The targets of this work are detecting the FOG episodes, distinguishing the phenotype and analyzing the muscle activity during and outside FOG, toward a deeper insight in the disorder pathophysiology and the assessment of the fall risk associated to the FOG subtype. To this aim, gyroscopes and surface electromyography integrated in wearable devices sense simultaneously movements and action potentials of antagonist leg muscles. Dedicated algorithms allow the timely detection of the FOG episode and, for the first time, the automatic distinction of the FOG phenotypes, which can enable associating a fall risk to the subtype. Thanks to the possibility of detecting muscles contractions and stretching exactly during FOG, a deeper insight into the pathophysiological underpinnings of the different phenotypes can be achieved, which is an innovative approach with respect to the state of art.