Detecting negative myoclonus during long-term home measurements using wearables

OBJECTIVE

The aim of this study was to develop a feasible method for the detection of negative myoclonus (NM) through long-term home measurements in patients with progressive myoclonus epilepsy type 1.

METHODS

The number and duration of silent periods (SP) associated with NM were detected during a 48 h home recording using wearable surface electromyography (EMG) sensors.

RESULTS

A newly developed algorithm was able to find short (50-69 ms), intermediate (70-100 ms), and long (101- 500 ms) SPs from EMG data. Negative myoclonus assessed by the algorithm correlated significantly with the video-recorded and physician-evaluated unified myoclonus rating scale (UMRS) scores of NM and action myoclonus. Silent period duration, number, and their combination, correlated strongly and significantly also with the Singer score, which assesses functional status and ambulation.

CONCLUSIONS

Negative myoclonus can be determined objectively using long-term EMG measurements in home environment. With long-term measurements, we can acquire more reliable quantified information about NM as a symptom, compared to short evaluation at the clinic.

SIGNIFICANCE

As measured using SPs, NM may be a clinically useful measure for monitoring disease progression or assessing antimyoclonic drug effects objectively.

Prediction of Knee Joint Compartmental Loading Maxima Utilizing Simple Subject Characteristics and Neural Networks

Joint loading may affect the development of osteoarthritis, but patient-specific load estimation requires cumbersome motion laboratory equipment. This reliance could be eliminated using artificial neural networks (ANNs) to predict loading from simple input predictors. We used subject-specific musculoskeletal simulations to estimate knee joint contact forces for 290 subjects during over 5000 stance phases of walking and then extracted compartmental and total joint loading maxima from the first and second peaks of the stance phase. We then trained ANN models to predict the loading maxima from predictors that can be measured without motion laboratory equipment (subject mass, height, age, gender, knee abduction-adduction angle, and walking speed). When compared to the target data, our trained models had NRMSEs (RMSEs normalized to the mean of the response variable) between 0.14 and 0.42 and Pearson correlation coefficients between 0.42 and 0.84. The loading maxima were predicted most accurately using the models trained with all predictors. We demonstrated that prediction of knee joint loading maxima may be possible without laboratory-measured motion capture data. This is a promising step in facilitating knee joint loading predictions in simple environments, such as a physician's appointment. In future, the rapid measurement and analysis setup could be utilized to guide patients in rehabilitation to slow development of joint disorders, such as osteoarthritis.

Force-velocity profiling in ice hockey skating: reliability and validity of a simple, low-cost field method

In recent years, a simple method for force-velocity (F-v) profiling, based on split times, has emerged as a potential tool to examine mechanical variables underlying running sprint performance in field conditions. In this study, the reliability and concurrent validity of F-v profiling based on split times were examined when used for ice hockey skating. It was also tested how a modification of the method, in which the start instant of the sprint is estimated based on optimisation (time shift method), affects the reliability and validity of the method. Both intra- and inter-rater reliability were markedly improved when using the time shift method (approximately 50% decrease in the standard error of measurement). Moreover, the results calculated using the time shift method highly correlated (r > 0.83 for all variables) with the results calculated from a continuously tracked movement of the athlete, which was considered here as the reference method. This study shows that a modification to the previously published simple method for F-v profiling improves intra- and inter-rater reliability of the method in ice hockey skating. The time shift method tested here can be used as a reliable tool to test a player's physical performance characteristic underlying sprint performance in ice hockey skating.

Developmental models of motor-evoked potential features by transcranial magnetic stimulation across age groups from childhood to adulthood

To derive the maturation of neurophysiological processes from childhood to adulthood reflected by the change of motor-evoked potential (MEP) features. 38 participants were recruited from four groups (age mean in years [SD in months], number (males)): children (7.3 [4.2], 7(4)), preadolescents (10.3 [6.9], 10(5)), adolescents (15.3 [9.8], 11(5)), and adults (26.9 [46.2], 10(5)). The navigated transcranial magnetic stimulation was performed on both hemispheres at seven stimulation intensity (SI) levels from sub- to supra-threshold and targeted to the representative cortical area of abductor pollicis brevis muscle. MEPs were measured from three hand- and two forearm-muscles. The input-output (I/O) curves of MEP features across age groups were constructed using linear mixed-effect models. Age and SI significantly affected MEP features, whereas the stimulated side had a minor impact. MEP size and duration increased from childhood to adulthood. MEP onset- and peak-latency dropped in adolescence, particularly in hand muscles. Children had the smallest MEPs with the highest polyphasia, whereas I/O curves were similar among preadolescents, adolescents, and adults. This study illustrates some of the changing patterns of MEP features across the ages, suggesting developing patterns of neurophysiological processes activated by TMS, and to motivate studies with larger sample size.

Open-source software library for real-time inertial measurement unit data-based inverse kinematics using OpenSim

Background

Inertial measurements (IMUs) facilitate the measurement of human motion outside the motion laboratory. A commonly used open-source software for musculoskeletal simulation and analysis of human motion, OpenSim, includes a tool to enable kinematics analysis of IMU data. However, it only enables offline analysis, i.e., analysis after the data has been collected. Extending OpenSim's functionality to allow real-time kinematics analysis would allow real-time feedback for the subject during the measurement session and has uses in e.g., rehabilitation, robotics, and ergonomics.

Methods

We developed an open-source software library for real-time inverse kinematics (IK) analysis of IMU data using OpenSim. The software library reads data from IMUs and uses multithreading for concurrent calculation of IK. Its operation delays and throughputs were measured with a varying number of IMUs and parallel computing IK threads using two different musculoskeletal models, one a lower-body and torso model and the other a full-body model. We published the code under an open-source license on GitHub.

Results

A standard desktop computer calculated full-body inverse kinematics from treadmill walking at 1.5 m/s with data from 12 IMUs in real-time with a mean delay below 55 ms and reached a throughput of more than 90 samples per second. A laptop computer had similar delays and reached a throughput above 60 samples per second with treadmill walking. Minimal walking kinematics, motion of lower extremities and torso, were calculated from treadmill walking data in real-time with a throughput of 130 samples per second on the laptop and 180 samples per second on the desktop computer, with approximately half the delay of full-body kinematics.

Conclusions

The software library enabled real-time inverse kinematical analysis with different numbers of IMUs and customizable musculoskeletal models. The performance results show that subject-specific full-body motion analysis is feasible in real-time, while a laptop computer and IMUs allowed the use of the method outside the motion laboratory.

Short- and long-interval intracortical inhibition in EPM1 is related to genotype

OBJECTIVE

Progressive myoclonic epilepsy type 1 (EPM1) is caused by biallelic alterations in the CSTB gene, most commonly dodecamer repeat expansions. Although transcranial magnetic stimulation (TMS)-induced long-interval intracortical inhibition (LICI) was previously reported to be normal in EPM1, short-interval intracortical inhibition (SICI) was reduced. We explored the association between these measures and the clinical and genetic features in a separate group of patients with EPM1.

METHODS

TMS combined with electromyography was performed under neuronavigation. LICI was induced with an inter-stimulus interval (ISI) of 100 ms, and SICI with ISIs of 2 and 3 ms, and their means (mSICIs) were expressed as the ratio of conditioned to unconditioned stimuli. LICI and mSICI were compared between patients and controls. Nonparametric correlation was used to study the association between inhibition and parameters of clinical severity, including the Unified Myoclonus Rating Scale (UMRS); among patients with EPM1 due to biallelic expansion repeats, also the association with the number of repeats was assessed.

RESULTS

The study protocol was completed in 19 patients (15 with biallelic expansion repeats and 4 compound heterozygotes), and 7 healthy, age- and sex-matched control participants. Compared to controls, patients demonstrated significantly less SICI (median mSICI ratio 1.18 vs 0.38; p < .001). Neither LICI nor SICI was associated with parameters of clinical severity. In participants with biallelic repeat expansions, the number of repeats in the more affected allele (greater repeat number [GRN]) correlated with LICI (rho = 0.872; p < .001) and SICI (rho = 0.689; p = .006).

SIGNIFICANCE

Our results strengthen the finding of deranged γ-aminobutyric acid (GABA)ergic inhibition in EPM1. LICI and SICI may have use as markers of GABAergic impairment in future trials of disease-modifying treatment in this condition. Whether a higher number of expansion repeats leads to greater GABAergic impairment warrants further study.

Autonomic responses to tooth clenching and handgrip test

OBJECTIVE

The aim was to study the differences in autonomic nervous system activation between maximal tooth clenching task and handgrip test during and after the tasks. Also, the possible activation of trigeminocardiac reflex during the clenching task was explored.

MATERIAL AND METHODS

We compared autonomic responses to maximal tooth clenching and handgrip in 28 participants. Responses in heart rate variability, heart rate, and blood pressure were evaluated before, during, and after tests. Although all study participants were considered healthy during recruitment, 14 of them showed painful temporomandibular disorders in the clinical examination, which was taken into account in the analyses.

RESULTS

Handgrip and tooth clenching caused similar autonomic responses. However, tooth clenching seemed to activate the trigeminocardiac reflex shown as clenching-related vagal activation. The painful signs of temporomandibular disorders may interfere with the heart rate variability both at the baseline and during both tests causing significant variation in them.

CONCLUSIONS

Both handgrip and tooth clenching affect the autonomic nervous system function. Tooth clenching differs from the handgrip due to trigeminocardiac reflex. Painful signs of temporomandibular disorders are interfering with the results of the tests and maybe underestimated in the studies of autonomic responses to both tasks.

Towards Tailored Rehabilitation by Implementation of a Novel Musculoskeletal Finite Element Analysis Pipeline

Tissue-level mechanics (e.g., stress and strain) are important factors governing tissue remodeling and development of knee osteoarthritis (KOA), and hence, the success of physical rehabilitation. To date, no clinically feasible analysis toolbox has been introduced and used to inform clinical decision making with subject-specific in-depth joint mechanics of different activities. Herein, we utilized a rapid state-of-the-art electromyography-assisted musculoskeletal finite element analysis toolbox with fibril-reinforced poro(visco)elastic cartilages and menisci to investigate knee mechanics in different activities. Tissue mechanical responses, believed to govern collagen damage, cell death, and fixed charge density loss of proteoglycans, were characterized within 15 patients with KOA while various daily activities and rehabilitation exercises were performed. Results showed more inter-participant variation in joint mechanics during rehabilitation exercises compared to daily activities. Accordingly, the devised workflow may be used for designing subject-specific rehabilitation protocols. Further, results showed the potential to tailor rehabilitation exercises, or assess capacity for daily activity modifications, to optimally load knee tissue, especially when mechanically-induced cartilage degeneration and adaptation are of interest.

An EMG-assisted muscle-force driven finite element analysis pipeline to investigate joint- and tissue-level mechanical responses in functional activities: towards a rapid assessment toolbox

Joint tissue mechanics (e.g., stress and strain) are believed to have a major involvement in the onset and progression of musculoskeletal disorders, e.g., knee osteoarthritis (KOA). Accordingly, considerable efforts have been made to develop musculoskeletal finite element (MS-FE) models to estimate highly detailed tissue mechanics that predict cartilage degeneration. However, creating such models is time-consuming and requires advanced expertise. This limits these complex, yet promising MS-FE models to research applications with few participants and makes the models impractical for clinical assessments. Also, these previously developed MS-FE models have not been used to assess activities other than gait. This study introduces and verifies a semi-automated rapid state-of-the-art MS-FE modeling and simulation toolbox incorporating an electromyography- (EMG) assisted MS model and a muscle-force driven FE model of the knee with fibril-reinforced poro(visco)elastic cartilages and menisci. To showcase the usability of the pipeline, we estimated joint- and tissue-level knee mechanics in 15 KOA individuals performing different daily activities. The pipeline was verified by comparing the estimated muscle activations and joint mechanics to existing experimental data. To determine the importance of EMG-assisted MS approach, results were compared to those from the same FE models but driven by static-optimization-based MS models. The EMG-assisted MS-FE pipeline bore a closer resemblance to experiments compared to the static-optimization-based MS-FE pipeline. Importantly, the developed pipeline showed great potential as a rapid MS-FE analysis toolbox to investigate multiscale knee mechanics during different activities of individuals with KOA. The template FE model of the study is freely available here.

A Perturbed Postural Balance Test Using an Instrumented Treadmill - Precision and Accuracy of Belt Movement and Test-Retest Reliability of Balance Measures

A perturbed postural balance test can be used to investigate balance control under mechanical disturbances. The test is typically performed using purpose-built movable force plates. As instrumented treadmills become increasingly common in biomechanics laboratories and in clinical settings, these devices could be potentially used to assess and train balance control. The purpose of the study was to investigate how an instrumented treadmill applies to perturbed postural balance test. This was investigated by assessing the precision and reliability of the treadmill belt movement and the test-retest reliability of perturbed postural balance test over 5 days. Postural balance variables were calculated from the center of pressure trajectory and included peak displacement, time to peak displacement, and recovery displacement. Additionally, the study investigated short-term learning effects over the 5 days. Eight healthy participants (aged 24–43 years) were assessed for 5 consecutive days with four different perturbation protocols. Center of pressure (COP) data were collected using the force plates of the treadmill while participant and belt movements were measured with an optical motion capture system. The results show that the treadmill can reliably deliver the intended perturbations with <1% deviation in total displacement and with minimal variability between days and participants (typical errors 0.06–2.71%). However, the treadmill was not able to reach the programmed 4 m/s² acceleration, reaching only about 75% of it. Test–retest reliability of the selected postural balance variables ranged from poor to good (ICC 0.156–0.752) with typical errors between 4.3 and 28.2%. Learning effects were detected based on linear or quadratic trends (p < 0.05) in peak displacement of the slow forward and fast backward protocols and in time to peak displacement in slow and fast backward protocols. The participants altered the initial location of the COP relative to the foot depending on the direction of the perturbation. In conclusion, the precision and accuracy of belt movement were found to be excellent. Test-retest reliability of the balance test utilizing an instrumented treadmill ranged from poor to good which is, in line with previous investigations using purpose-built devices for perturbed postural balance assessment.

Wearable monitoring of positive and negative myoclonus in progressive myoclonic epilepsy type 1

OBJECTIVE

To develop and test wearable monitoring of surface electromyography and motion for detection and quantification of positive and negative myoclonus in patients with progressive myoclonic epilepsy type 1 (EPM1).

METHODS

Surface electromyography and three-dimensional acceleration were measured from 23 EPM1 patients from the biceps brachii (BB) of the dominant and the extensor digitorum communis (EDC) of the non-dominant arm for 48 hours. The patients self-reported the degree of myoclonus in a diary once an hour. Severity of myoclonus with action was evaluated by using video-recorded Unified Myoclonus Rating Scale (UMRS). Correlations of monitored parameters were quantified with the UMRS scores and the self-reported degrees of myoclonus.

RESULTS

The monitoring-based myoclonus index correlated significantly (p < 0.001) with the UMRS scores (ρ = 0.883 for BB and ρ = 0.823 for EDC) and with the self-reported myoclonus degrees (ρ = 0.483 for BB and ρ = 0.443 for EDC). Ten patients were assessed as probably having negative myoclonus in UMRS, while our algorithm detected that in twelve patients.

CONCLUSIONS

Wearable monitoring was able to detect both positive and negative myoclonus in EPM1 patients.

SIGNIFICANCE

Our method is suitable for quantifying objective, real-life treatment effects at home and progression of myoclonus.

Evaluation of the Effect of Bariatric Surgery-Induced Weight Loss on Knee Gait and Cartilage Degeneration

The objective of the study was to investigate the effects of bariatric surgery-induced weight loss on knee gait and cartilage degeneration in osteoarthritis (OA) by combining magnetic resonance imaging (MRI), gait analysis, finite element (FE) modeling, and cartilage degeneration algorithm. Gait analyses were performed for obese subjects before and one-year after the bariatric surgery. FE models were created before and after weight loss for those subjects who did not have severe tibio-femoral knee cartilage loss. Knee cartilage degenerations were predicted using an adaptive cartilage degeneration algorithm which is based on cumulative overloading of cartilage, leading to iteratively altered cartilage properties during OA. The average weight loss was 25.7±11.0 kg corresponding to a 9.2±3.9 kg/m2 decrease in body mass index (BMI). External knee rotation moment increased, and minimum knee flexion angle decreased significantly (p < 0.05) after weight loss. Moreover, weight loss decreased maximum cartilage degeneration by 5±23% and 13±11% on the medial and lateral tibial cartilage surfaces, respectively. Average degenerated volumes in the medial and lateral tibial cartilage decreased by 3±31% and 7±32%, respectively, after weight loss. However, increased degeneration levels could also be observed due to altered knee kinetics. The present results suggest that moderate weight loss changes knee kinetics and kinematics and can slow-down cartilage degeneration for certain patients. Simulation results also suggest that prediction of cartilage degeneration is subject-specific and highly depend on the altered gait loading, not just the patient's weight.

An Overview of Strategies for Reducing Upper Extremity Physical Exposure Associated With Floor Mopping: A Systematic Review

OBJECTIVE

This systematic review synthesizes literature on upper extremity physical exposure associated with floor mopping, in order to (a) assess the impact of changes in mopping systems on physical exposure and (b) propose recommendations for strategies to reduce exposure.

BACKGROUND

Floor-cleaning tools and equipment have undergone major improvements. Existing studies have focused on mop design modifications and cleaning efficiency. However, less is known about strain responses caused by modern tools and methods.

METHOD

Studies from 1987 to February 2017 were identified by electronic and manual search. All selected studies underwent a quality assessment. The evidence was organized into categories representing different strategies for reducing exposure. The levels of evidence were determined using a best evidence synthesis approach.

RESULTS

Eleven studies were included. Based on the review findings, currently there is moderate evidence suggesting that reduced physical exposure has been achieved through development of mopping systems. Levels of evidence for strategies associated with positive effects on physical exposure were: moderate evidence for mop design and handle type, insufficient evidence for mopping technique, and mixed evidence for mopping methods and environment modifications. Therefore, the present study suggests the use of adjustable mop handles as a strategy for reducing physical exposure.

CONCLUSION

A more comprehensive approach to reducing physical exposure concerning floor mopping work is necessary.

APPLICATION

Knowledge regarding physical exposure reduction can be applied as the basis for decision making in cleaning practice. Information can be incorporated into future research regarding development of floor-cleaning methods.

Tooth Clenching Induces Abnormal Cerebrovascular Responses in Migraineurs

Prevalence of masticatory parafunctions, such as tooth clenching and grinding, is higher among migraineurs than non-migraineurs, and masticatory dysfunctions may aggravate migraine. Migraine predisposes to cerebrovascular disturbances, possibly due to impaired autonomic vasoregulation, and sensitization of the trigeminovascular system. The relationships between clenching, migraine, and cerebral circulation are poorly understood. We used Near-Infrared Spectroscopy to investigate bilateral relative oxy- (%Δ[O₂Hb]), deoxy- (%Δ[HHb]), and total (%Δ[tHb]) hemoglobin concentration changes in prefrontal cortex induced by maximal tooth clenching in twelve headache-free migraineurs and fourteen control subjects. From the start of the test, migraineurs showed a greater relative increase in right-side %Δ[HHb] than controls, who showed varying reactions, and right-side increase in %Δ[tHb] was also greater in migraineurs (p < 0.001 and p < 0.05, respectively, time-group interactions, Linear mixed models). With multivariate regression model, migraine predicted the magnitude of maximal blood pressure increases, associated in migraineurs with mood scores and an intensity of both headache and painful signs of temporomandibular disorders (pTMD). Although changes in circulatory parameters predicted maximal NIRS responses, the between-group differences in the right-side NIRS findings remained significant after adjusting them for systolic blood pressure and heart rate. A family history of migraine, reported by all migraineurs and four controls, also predicted maximal increases in both %Δ[HHb] and %Δ[tHb]. Presence of pTMD, revealed in clinical oral examination in eight migraineurs and eight controls, was related to maximal %Δ[HHb] increase only in controls. To conclude, the greater prefrontal right-side increases in cerebral %Δ[HHb] and %Δ[tHb] may reflect disturbance of the tooth clenching-related cerebral (de)oxygenation based on impaired reactivity and abnormal microcirculation processes in migraineurs. This finding may have an impact in migraine pathophysiology and help to explain the deleterious effect of masticatory dysfunctions in migraine patients. However, the role of tooth clenching as a migraine trigger calls for further studies.

Parameters of Surface Electromyogram Suggest That Dry Immersion Relieves Motor Symptoms in Patients With Parkinsonism

Dry immersion (DI) is acknowledged as a reliable space flight analog condition. At DI, subject is immersed in water being wrapped in a waterproof film to imitate microgravity (μG). Microgravity is known to decrease muscle tone due to deprivation of the sensory stimuli that activate the reflexes that keep up the muscle tone. In contrary, parkinsonian patients are characterized by elevated muscle tone, or rigidity, along with rest tremor and akinesia. We hypothesized that DI can diminish the elevated muscle tone and/or the tremor in parkinsonian patients. Fourteen patients with Parkinson's disease (PD, 10 males, 4 females, 47-73 years) and 5 patients with vascular parkinsonism (VP, 1 male, 4 females, 65-72 years) participated in the study. To evaluate the effect of DI on muscles' functioning, we compared parameters of surface electromyogram (sEMG) measured before and after a single 45-min long immersion session. The sEMG recordings were made from the biceps brachii muscle, bilaterally. Each recording was repeated with the following loading conditions: with arms hanging freely down, and with 0, 1, and 2 kg loading on each hand with elbows flexed to 90°. The sEMG parameters comprised of amplitude, median frequency, time of decay of mutual information, sample entropy, correlation dimension, recurrence rate, and determinism of sEMG. These parameters have earlier been proved to be sensitive to PD severity. We used the Wilcoxon test to decide which parameters were statistically significantly different before and after the dry immersion. Accepting the p < 0.05 significance level, amplitude, time of decay of mutual information, recurrence rate, and determinism tended to decrease, while median frequency and sample entropy of sEMG tended to increase after the DI. The most statistically significant change was for the determinism of sEMG from the left biceps with 1 kg loading, which decreased for 84% of the patients. The results suggest that DI can promptly relieve motor symptoms of parkinsonism. We conclude that DI has strong potential as a rehabilitation method for parkinsonian patients.

Autonomic responses to tooth clenching in migraineurs-augmented trigeminocardiac reflex?

BACKGROUND

Systemic autonomic changes are well known in migraineurs. Also, masticatory disorders are reported to be associated with migraine. However, if those phenomena are interrelated, and how, is unclear. Moreover, the knowledge on the autonomic responses to masticatory stimuli in migraineurs is limited.

OBJECTIVE

To investigate tooth clenching-related cardiac autonomic regulation in migraineurs.

METHODS

We compared maximal tooth clenching-induced systemic autonomic responses, indicated by heart rate variability and blood pressure changes, in headache-free migraineurs (n = 17) and control subjects (n = 22).

RESULTS

Levels of high-frequency power, reflecting vagal activity, were lower in migraineurs at baseline but increased after tooth clenching whereas in controls they returned to baseline (P < 0.05, mixed model analysis). In multivariate regression model, the presence of migraine predicted the baseline levels of low- and high-frequency power and sympathovagal balance, and the post-test increase in high-frequency power, with the attack frequency and side of headache as the modifiers of the measured changes in migraineurs. The painful signs of temporomandibular disorders, found in clinical oral examination, enhanced both maximal changes in RR intervals and post-test vagal responses to tooth clenching only in migraineurs.

CONCLUSION

The enhanced post-clenching vagal activation may represent a marker of the augmented trigeminocardiac reflex to stimulation of trigeminal area, sensitised in migraineurs. Our results support an involvement of autonomic mechanisms in migraine pathophysiology and are interesting in terms of interactions between migraine and masticatory disorders, elucidating one potential way how masticatory disorders may aggravate migraine.

Levodopa-Induced Changes in Electromyographic Patterns in Patients with Advanced Parkinson's Disease

Levodopa medication is the most efficient treatment for motor symptoms of Parkinson's disease (PD). Levodopa significantly alleviates rigidity, rest tremor, and bradykinesia in PD. The severity of motor symptoms can be graded with UPDRS-III scale. Levodopa challenge test is routinely used to assess patients' eligibility to deep-brain stimulation (DBS) in PD. Feasible and objective measurements to assess motor symptoms of PD during levodopa challenge test would be helpful in unifying the treatment. Twelve patients with advanced PD who were candidates for DBS treatment were recruited to the study. Measurements were done in four phases before and after levodopa challenge test. Rest tremor and rigidity were evaluated using UPDRS-III score. Electromyographic (EMG) signals from biceps brachii and kinematic signals from forearm were recorded with wireless measurement setup. The patients performed two different tasks: arm isometric tension and arm passive flexion-extension. The electromyographic and the kinematic signals were analyzed with parametric, principal component, and spectrum-based approaches. The principal component approach for isometric tension EMG signals showed significant decline in characteristics related to PD during levodopa challenge test. The spectral approach on passive flexion-extension EMG signals showed a significant decrease on involuntary muscle activity during the levodopa challenge test. Both effects were stronger during the levodopa challenge test compared to that of patients' personal medication. There were no significant changes in the parametric approach for EMG and kinematic signals during the measurement. The results show that a wireless and wearable measurement and analysis can be used to study the effect of levodopa medication in advanced Parkinson's disease.

Nutritive sucking induces age-specific EEG-changes in 0-24 week-old infants

Little is known how the brain of the newborn infant responds to the postnatal nutrition and care. No systematic studies exist in which the effects of nutritional and non-nutritional sucking on the brain activity of the infant were compared. We recorded the EEG activity of 40 infants at the ages of 0,6,12 and 24 weeks in four successive behavioral stages: while the infants were hungry and waiting for sucking, during non-nutritional and nutritional sucking, and during satiation after completed feeding. Quantitative EEG analysis was performed using occipital, parietal and central EEG channels. In the newborn infants, a significant reduction in the EEG power was found after nutritional sucking in the all EEG frequency bands studied (1-10Hz), which was paralleled by a significant behavioral alertness decline. This response decayed during the subsequent neonatal period and was completely absent at the age of 12 weeks. In 24-week-old infants, nutritional sucking was accompanied with an increase in rhythmic theta activity during which no significant alertness change took place. Non-nutritional sucking was connected with minor and non-significant effects on the EEG. We conclude that in newborn infants nutritional sucking has a direct effect on the EEG, which has a soothing character and is connected with an alertness decline. In 24-week-old infants the response to nutritional sucking is of a different type and consists of an organized, rhythmical theta activity in the EEG not directly linked with alertness change. Our findings suggest a developmental relationship between nursing and infant brain function with plausible affective and cognitive implications.

Mouse ECG findings in aging, with conduction system affecting drugs and in cardiac pathologies: Development and validation of ECG analysis algorithm in mice

Mouse models are extremely important in studying cardiac pathologies and related electrophysiology, but very few mouse ECG analysis programs are readily available. Therefore, a mouse ECG analysis algorithm was developed and validated. Surface ECG (lead II) was acquired during transthoracic echocardiography from C57Bl/6J mice under isoflurane anesthesia. The effect of aging was studied in young (2–3 months), middle‐aged (14 months) and old (20–24 months) mice. The ECG changes associated with pharmacological interventions and common cardiac pathologies, that is, acute myocardial infarction (AMI) and progressive left ventricular hypertrophy (LVH), were studied. The ECG raw data were analyzed with an in‐house ECG analysis program, modified specially for mouse ECG. Aging led to increases in P‐wave duration, atrioventricular conduction time (PQ interval), and intraventricular conduction time (QRS complex width), while the R‐wave amplitude decreased. In addition, the prevalence of arrhythmias increased during aging. Anticholinergic atropine shortened PQ time, and beta blocker metoprolol and calcium‐channel blocker verapamil increased PQ interval and decreased heart rate. The ECG changes after AMI included early JT elevation, development of Q waves, decreased R‐wave amplitude, and later changes in JT/T segment. In progressive LVH model, QRS complex width was increased at 2 and especially 4 weeks timepoint, and also repolarization abnormalities were seen. Aging, drugs, AMI, and LVH led to similar ECG changes in mice as seen in humans, which could be reliably detected with this new algorithm. The developed method will be very useful for studies on cardiovascular diseases in mice.

Nonlinear parameters of surface EMG in schizophrenia patients depend on kind of antipsychotic therapy

We compared a set of surface EMG (sEMG) parameters in several groups of schizophrenia (SZ, n = 74) patients and healthy controls (n = 11) and coupled them with the clinical data. sEMG records were quantified with spectral, mutual information (MI) based and recurrence quantification analysis (RQA) parameters, and with approximate and sample entropies (ApEn and SampEn). Psychotic deterioration was estimated with Positive and Negative Syndrome Scale (PANSS) and with the positive subscale of PANSS. Neuroleptic-induced parkinsonism (NIP) motor symptoms were estimated with Simpson-Angus Scale (SAS). Dyskinesia was measured with Abnormal Involuntary Movement Scale (AIMS). We found that there was no difference in values of sEMG parameters between healthy controls and drug-naïve SZ patients. The most specific group was formed of SZ patients who were administered both typical and atypical antipsychotics (AP). Their sEMG parameters were significantly different from those of SZ patients taking either typical or atypical AP or taking no AP. This may represent a kind of synergistic effect of these two classes of AP. For the clinical data we found that PANSS, SAS, and AIMS were not correlated to any of the sEMG parameters.

CONCLUSION

with nonlinear parameters of sEMG it is possible to reveal NIP in SZ patients, and it may help to discriminate between different clinical groups of SZ patients. Combined typical and atypical AP therapy has stronger effect on sEMG than a therapy with AP of only one class.

Surface EMG parameters in schizophrenia patients

The aim of the study was to compare a variety of surface EMG (sEMG) parameters in several groups of schizophrenia (SZ, n=69) patients and healthy controls (n=44). We computed spectral, mutual information (MI) based and recurrence quantification analysis (RQA) parameters of sEMG. The major finding is that sEMG of the controls had higher values of the MI-based parameter, mean and median spectrum frequencies, and lower values of most of RQA parameters. It means higher content of recurrent fragments in sEMG of SZ patients. We suggest that the differences might be caused by either denervation/renervation process of single muscle fibers in SZ patients and/or by increased motor unit synchronization induced by antipsychotic therapy.

Autonomic nervous system response to L-dopa in patients with advanced Parkinson's disease

Levodopa is the main treatment method for reducing the symptoms of Parkinson's disease. Whereas it reduces the motor symptoms efficiently, its effect on autonomous nervous system is not clear. The information about effect of levodopa on heart rate variability is not coherent between the studies. In this study, ECG of 11 patients with Parkinson's disease was measured during levodopa challenge with pronounced dose of fast release levodopa to ensure the positive drug effect for deep brain stimulation treatment. Heart rate variability analysis was done at three time points, before administration of levodopa, 30 and 60 minutes after administration. After 30 minutes of administration, the HRV parameters show that parasympathetic nervous system activity is decreased and the sympatho-vagal balance is shifted towards sympathetic control. At 60 minutes after administration the parasympathetic nervous system activates slightly and causes a decrease in heart rate.

Nonlinear state-space modeling of human motion using 2-D marker observations

A novel method for the estimation of human kinematics, based on state-space modeling, is proposed. The state consists of the positions, orientations, velocities, and accelerations of an articulated model. Estimation is performed using the unscented Kalman filter (UKF) algorithm with a fixed-interval smoother. Impulsive acceleration at floor contact of the foot is estimated by implementing a contact constraint in the UKF evolution model. The constraint inserts an acceleration impulse into the model state. The estimation method was applied to marker-based motion analysis in a motion laboratory. Validation measurements were performed with a rigid test device and with human gait. A triaxial accelerometer was used to evaluate acceleration estimates. Comparison between the proposed method and the extended Kalman smoother showed a clear difference in the quality of estimates during impulsive accelerations. The proposed approach enables estimation of human kinematics during both continuous and transient accelerations. The approach provides a novel way of estimating acceleration at foot initial contact, and thus enables more accurate evaluation of loading from the beginning of the floor contact.

Kubios HRV--heart rate variability analysis software

Kubios HRV is an advanced and easy to use software for heart rate variability (HRV) analysis. The software supports several input data formats for electrocardiogram (ECG) data and beat-to-beat RR interval data. It includes an adaptive QRS detection algorithm and tools for artifact correction, trend removal and analysis sample selection. The software computes all the commonly used time-domain and frequency-domain HRV parameters and several nonlinear parameters. There are several adjustable analysis settings through which the analysis methods can be optimized for different data. The ECG derived respiratory frequency is also computed, which is important for reliable interpretation of the analysis results. The analysis results can be saved as an ASCII text file (easy to import into MS Excel or SPSS), Matlab MAT-file, or as a PDF report. The software is easy to use through its compact graphical user interface. The software is available free of charge for Windows and Linux operating systems at http://kubios.uef.fi.

Asynchronicity of facial blood perfusion in migraine

Asymmetrical changes in blood perfusion and asynchronous blood supply to head tissues likely contribute to migraine pathophysiology. Imaging was widely used in order to understand hemodynamic variations in migraine. However, mapping of blood pulsations in the face of migraineurs has not been performed so far. We used the Blood Pulsation Imaging (BPI) technique, which was recently developed in our group, to establish whether 2D-imaging of blood pulsations parameters can reveal new biomarkers of migraine. BPI characteristics were measured in migraineurs during the attack-free interval and compared to healthy subjects with and without a family history of migraine. We found a novel phenomenon of transverse waves of facial blood perfusion in migraineurs in contrast to healthy subjects who showed synchronous blood delivery to both sides of the face. Moreover, the amplitude of blood pulsations was symmetrically distributed over the face of healthy subjects, but asymmetrically in migraineurs and subjects with a family history of migraine. In the migraine patients we found a remarkable correlation between the side of unilateral headache and the direction of the blood perfusion wave. Our data suggest that migraine is associated with lateralization of blood perfusion and asynchronous blood pulsations in the facial area, which could be due to essential dysfunction of the autonomic vascular control in the face. These findings may further enhance our understanding of migraine pathophysiology and suggest new easily available biomarkers of this pathology.

Non-Linear EMG Parameters for Differential and Early Diagnostics of Parkinson's Disease

The pre-clinical diagnostics is essential for management of Parkinson’s disease (PD). Although PD has been studied intensively in the last decades, the pre-clinical indicators of that motor disorder have yet to be established. Several approaches were proposed but the definitive method is still lacking. Here we report on the non-linear characteristics of surface electromyogram (sEMG) and tremor acceleration as a possible diagnostic tool, and, in prospective, as a predictor for PD. Following this approach we calculated such non-linear parameters of sEMG and accelerometer signal as correlation dimension, entropy, and determinism. We found that the non-linear parameters allowed discriminating some 85% of healthy controls from PD patients. Thus, this approach offers considerable potential for developing sEMG-based method for pre-clinical diagnostics of PD. However, non-linear parameters proved to be more reliable for the shaking form of PD, while diagnostics of the rigid form of PD using EMG remains an open question.

Acral coldness in migraineurs

In search for new biomarkers of vascular disturbances accompanying migraine, we compared the facial and hand skin temperatures in 41 women, including 12 migraine patients during the headache-free period and 29 healthy controls. Compared to the controls, the acral skin temperatures were lower in migraineurs, especially in those with right-sided headache. Our findings suggest that migraine is associated with a peripheral coldness possibly due to abnormal autonomic vascular control. The cold nose and hands may represent easily assessable biomarkers of these disorders.

Nitroglycerin-induced changes in facial skin temperature: 'cold nose' as a predictor of headache?

Nitroglycerin (NTG) often induces headaches when used to treat cardiac diseases. Such property of NTG has been widely used in modelling of migraine-like headaches. However, background reasons, predisposing to the development of NTG-headache, are less studied. The main aim of our study was to find, using NTG model, easily accessible markers of the vascular changes associated with headache. Because changes in the blood flow alter the local skin temperature (Tsk), we studied the relationship between the regional changes in the facial Tsk and NTG-induced headaches. Tsk was measured with infrared thermography in 11 healthy women during 3 h after sublingual NTG administration. NTG caused headache in five women, and four of them were the first-degree relatives of migraine patients. Notably, before NTG administration, subjects in the headache group had lower Tsk values, especially in the nose area, than women in the pain-free group (n = 6). NTG-induced headache was associated with a long-lasting increase of Tsk over the baseline. In sharp contrast, in the pain-free group, the Tsk reduced and returned rapidly to the baseline. Thus, the low baseline level and greater increase of regional Tsk correlated with the incidence of headache that supports a role of greater vascular changes in headache happening on the basis of the dissimilarities in vascular tone. An easily accessible phenomenon of 'cold nose' may indicate background vascular dysfunctions in individuals with predisposition to headache. Facial infrared thermography, coupled with NTG administration, suggests a novel temporally controlled approach for non-invasive investigation of vascular processes accompanying headaches.

Monitoring functional impairment and recovery after traumatic brain injury in rats by FMRI

The present study was designed to test a hypothesis that functional magnetic resonance imaging (fMRI) can be used to monitor functional impairment and recovery after moderate experimental traumatic brain injury (TBI). Moderate TBI was induced by lateral fluid percussion injury in adult rats. The severity of brain damage and functional recovery in the primary somatosensory cortex (S1) was monitored for up to 56 days using fMRI, cerebral blood flow (CBF) by arterial spin labeling, local field potential measurements (LFP), behavioral assessment, and histology. All the rats had reduced blood-oxygen-level-dependent (BOLD) responses during the 1st week after trauma in the ipsilateral S1. Forty percent of these animals showed recovery of the BOLD response during the 56 day follow-up. Unexpectedly, no association was found between the recovery in BOLD response and the volume of the cortical lesion or thalamic neurodegeneration. Instead, the functional recovery occurred in rats with preserved myelinated fibers in layer VI of S1. This is, to our knowledge, the first study demonstrating that fMRI can be used to monitor post-TBI functional impairment and consequent spontaneous recovery. Moreover, the BOLD response was associated with the density of myelinated fibers in the S1, rather than with neurodegeneration. The present findings encourage exploration of the usefulness of fMRI as a noninvasive prognostic biomarker for human post-TBI outcomes and therapy responses.

EMG signal morphology in essential tremor and Parkinson's disease

The aim of this work was to differentiate patients with essential tremor from patients with Parkinson's disease. The electromyographic signal from the biceps brachii muscle was measured during isometric tension from 17 patients with essential tremor, 35 patients with Parkinson's disease, and 40 healthy controls. The EMG signals were high pass filtered and divided to smaller segments from which histograms were calculated using 200 histogram bins. EMG signal histogram shape was analysed with a feature dimension reduction method, the principal component analysis, and the shape parameters were used to differentiate between different patient groups. The height of the histogram and the side difference between left and right hand were the best discriminators between essential tremor and Parkinson's disease groups. With this method, it was possible to discriminate 13/17 patients with essential tremor from 26/35 patients with Parkinson's disease and 14/17 patients with essential tremor from 29/40 healthy controls.

Differences in heart rate variability of female nurses between and within normal and extended work shifts

The aim of this study was to investigate differences in heart rate variability (HRV) reflecting the function of autonomic nervous system (ANS) and psycho-physiological strain associated with normal and extended work shifts in nursing work. Complete data were available from 51 female nurses with a mean age of 40 yr, and based on two comparable 36-h HRV measurements supplemented with a questionnaire. Time-domain (meanRR, SDNN, RMSSD) and frequency-domain (LF power, HF power) parameters represented the HRV data, and were analyzed by linear mixed models. The differences between the compared work shifts were minor, revealing mainly increased sympathetic activity at the beginning of the normal work shift. The HRV parameters detected significant differences between work and leisure-time during the normal and extended work shifts in female nurses. During work shifts, an increase in sympathetic and a decrease in parasympathetic control of HRV was observed when compared to the leisure-time situation. Older subjects had overall lower HRV than younger subjects indicating increased sympathetic activation of ANS, especially during work. HRV parameters revealed significant differences between work, leisure-time and sleep of female nurses, but there were few differences between normal and extended work shifts in HRV parameters. This lack of differences between work shifts may be a consequence of the adaptation of nurses to the extended shifts or the more flexible organization of work duties possible during extended work shifts.

Hypoglycemia detection based on cardiac repolarization features

Hypoglycemia is known to affect repolarization characteristics of the heart. These changes are shown from ECG by prolonged QT-time and T-wave flattening. In this study we constructed a classifier based on these ECG parameters. By using the classifier we tried to detect hypoglycemic events from measurements of 22 test subjects. Hypoglycemic state was achieved using glucose clamp technique. Used test protocol consisted of three stages: normoglycemic period, transition period (blood glucose concentration decreasing) and hypoglycemic period. Subjects were divided into three groups: 9 healthy controls (Healthy), 6 otherwise healthy type 1 diabetics (T1DM) and 7 type 1 diabetics with disease complications (T1DMc). Detection of hypoglycemic event could be made passably from 15/22 measurements. In addition, we found that detection process is easier for healthy and T1DM groups than T1DMc group diabetics because in T1DMc group subjects' have lower autonomic response to hypoglycemic events. Also we noticed that changes in ECG occurs few minutes after blood glucose is decreased below 3.5 mmol/1.

Kinematic and kinetic changes in obese gait in bariatric surgery-induced weight loss

This study examines the effects of a radical bariatric surgery-induced weight loss on the gait of obese subjects. We performed a three-dimensional motion analysis of lower limbs, and collected force platform data in the gait laboratory to calculate knee and hip joint moments. Subjects (n=13) performed walking trials in the laboratory before and 8.8 months (SD 4.2) after the surgical procedure at two gait speeds (1.2m/s and 1.5m/s). The average weight loss was 26.7kg (SD 9.2kg), corresponding to 21.5% (SD 6.8%) of the initial weight. We observed a decrease in step width at both gait speeds, but no changes in relative double support or swing time or stride length. A significant decrease was noted in the absolute values of peak knee abductor, peak knee flexor and peak hip extensor moments. However, the moment values normalized by the body weight and height remained unchanged in most cases. Thus, we conclude that weight loss reduces hip and knee joint moments in proportion to the amount of weight lost.

Heart rate variability dynamics during low-dose propofol and dexmedetomidine anesthesia

Heart rate variability (HRV) has been observed to decrease during anesthesia, but changes in HRV during loss and recovery of consciousness have not been studied in detail. In this study, HRV dynamics during low-dose propofol (N = 10) and dexmedetomidine (N = 9) anesthesia were estimated by using time-varying methods. Standard time-domain and frequency-domain measures of HRV were included in the analysis. Frequency-domain parameters like low frequency (LF) and high frequency (HF) component powers were extracted from time-varying spectrum estimates obtained with a Kalman smoother algorithm. The Kalman smoother is a parametric spectrum estimation approach based on time-varying autoregressive (AR) modeling. Prior to loss of consciousness, an increase in HF component power indicating increase in vagal control of heart rate (HR) was observed for both anesthetics. The relative increase of vagal control over sympathetic control of HR was overall larger for dexmedetomidine which is in line with the known sympatholytic effect of this anesthetic. Even though the inter-individual variability in the HRV parameters was substantial, the results suggest the usefulness of HRV analysis in monitoring dexmedetomidine anesthesia.

Estimation of arterial baroreflex sensitivity in relation to carotid artery stiffness

Arterial baroreflex has a significant role in regulating blood pressure. It is known that increased stiffness of the carotid sinus affects mecanotransduction of baroreceptors and therefore limits baroreceptors capability to detect changes in blood pressure. By using high resolution ultrasound video signal and continuous measurement of electrocardiogram (ECG) and blood pressure, it is possible to define elastic properties of artery simultaneously with baroreflex sensitivity parameters. In this paper dataset which consist 38 subjects, 11 diabetics and 27 healthy controls was analyzed. Use of diabetic and healthy test subjects gives wide scale of arteries with different elasticity properties, which provide opportunity to validate baroreflex and artery stiffness estimation methods.

Analysis of EMG and acceleration signals for quantifying the effects of deep brain stimulation in Parkinson's disease

Deep brain stimulation (DBS) is effective in reducing motor symptoms in Parkinson's disease (PD). However, objective methods for quantifying its efficacy are lacking. We present a principal component (PC)-based tracking method for quantifying the effects of DBS in PD by using electromyography (EMG) and acceleration measurements. Ten parameters capturing PD characteristic signal features were initially extracted from isometric EMG and acceleration recordings. Using a PC approach, the original parameters were transformed into a smaller number of PCs. Finally, the effects of DBS were quantified by examining the PCs in a low-dimensional feature space. The EMG and acceleration data from 13 PD patients with DBS ON and OFF, and 13 healthy age-matched controls were used for analysis. Clinical evaluation of patients showed that their motor symptoms were effectively reduced with DBS. The analysis results showed that the signal characteristics of 12 patients were more similar to those of the healthy controls with DBS ON than with DBS OFF. These observations indicate that the PC-based tracking method can be used to objectively quantify the effects of DBS on the neuromuscular function of PD patients. Further studies are suggested to estimate the clinical sensitivity of the method to different types of PD.

Dynamic estimation of cardiac repolarization characteristics during hypoglycemia in healthy and diabetic subjects

Hypoglycemia is known to affect the repolarization characteristics of the heart, but the mechanisms behind these changes are not completely understood. We analyzed repolarization characteristics continuously from 22 subjects during normoglycemic period, transition period (blood glucose concentration decreasing) and hypoglycemic period from nine healthy controls (Healthy), six otherwise healthy type 1 diabetics (T1DM) and seven type 1 diabetics with disease complications (T1DMc). An advanced principal component regression (PCR)-based method was used for estimating ECG parameters beat-by-beat, and thus, continuous comparison between the repolarization characteristics and blood glucose values was made. We observed that hypoglycemia related ECG changes in the T1DMc group were smaller than changes in the Healthy and T1DM groups. We also noticed that when glucose concentration remained at a low level, the heart rate corrected QT interval prolonged progressively. Finally, a few minutes time lag was observed between the start of hypoglycemia and cardiac repolarization changes. One explanation for these observations could be that hypoglycemia related hormonal changes have a significant role behind the repolarization changes. This could explain at least the observed time lag (hormonal changes are slow) and the lower repolarization changes in the T1DMc group (hormonal secretion lowered in long duration diabetics).

Analysis of heart rate variability dynamics during propofol and dexmedetomidine anesthesia

It has been observed that heart rate variability (HRV) diminishes during anesthesia, but the exact mechanisms causing it are not completely understood. The aim of this paper was to study the dynamics of HRV during low dose propofol (N=9) and dexmedetomidine (N=8) anesthesia by using state-of-the-art time-varying methods, and thereby ultimately try to improve the safety of anesthesia. The time-varying spectrum is estimated by using a Kalman smoother approach. The results show that there is an overall increase in HRV and decrease in heart rate prior to loss of consciousness. For dexmedetomidine these changes are more considerable than for propofol. For dexmedetomidine the variability also seems to start decreasing right after loss of consciousness, whereas for propofol HRV continues increasing.

EMG and acceleration signal analysis for quantifying the effects of medication in Parkinson's disease

Parkinson's disease (PD) is characterized by motor disabilities that can be alleviated reasonably with appropriate medication. However, there is a lack of objective methods for quantifying the efficacy of treatment in PD. We applied here an objective method for quantifying the effects of medication in PD using EMG and acceleration measurements and analysis. In the method, four signal features were calculated from the EMG and acceleration recordings of both sides of the body: the kurtosis and recurrence rate of EMG, and the amplitude and sample entropy of acceleration. Principal component approach was used for reducing the number of variables. EMG and acceleration data measured from nine PD patients were used for analysis. The patients were measured in four different medication conditions: with medication off, and two and three and four hours after taking the medication. The results showed that in eight patients the EMG recordings changed into less spiky and the acceleration recordings into more complex after taking the medication. A reverse phenomenon in the signal characteristics was observed in seven patients 3-4 hours after taking the medication. The results indicate that the presented method is potentially useful for quantifying objectively the effects of medication on the neuromuscular function in PD.

Discrimination of EMG and acceleration measurements between patients with Parkinson's disease and healthy persons

In this paper, we examine the potential of electromyographic (EMG) and acceleration measurements in discriminating patients with Parkinson's disease (PD) from healthy persons. Two types of muscle contractions are examined: static contractions of biceps brachii muscles and elbow extension movements. Twelve features are extracted from static and ten features from extension measurements. These features describe signal morphology and nonlinear characteristics, power spreading in EMG wavelet scalograms and spectral coherence. Principal component approach is applied separately for static and extension trial to reduce the number of features before discrimination. The discrimination between subjects is done in a two-dimensional space by applying cluster analysis to the best discriminating principal components. The discrimination power of the used method was estimated with EMG and acceleration data measured from 56 patients with PD and 59 healthy controls. In the cluster analysis, three clusters were formed: one cluster with most (85%) of the healthy persons and two clusters with 80% of patients. Patients were divided into two clusters based on their type of motor disability (problems during movement and/or static contraction). Discrimination results show that EMG and acceleration measurements are potential for discriminating patients with PD from healthy persons. Furthermore, they have potential in the objective clinical assessment of PD.

Method for Testing Motion Analysis Laboratory Measurement Systems

This paper proposes a method for comparing data from accelerometers, optical based 3D motion capture systems, and force platforms (FPs) in the context of spatial and temporal differences. Testing method is based on the motion laboratory accreditation test (MLAT), which can be used to test FP and camera based motion capture components of a motion analysis laboratory. This study extends MLAT to include accelerometer data. Accelerometers were attached to a device similar to the MLAT rod. The elevation of the rod from the plane of the floor is computed and compared with the force platform vector orientation and the rod orientation obtained by optical motion capture system. Orientation of the test device is achieved by forming nonlinear equation group, which describes the components of the measured accelerations. Solution for this equation group is estimated by using the Gauss–Newton method. This expanded MLAT procedure can be used in the laboratory setting were either FP, camera based motion capture, or any other motion capture system is used along with accelerometer measurements.

Postural control and thigh muscle activity in men with knee osteoarthritis

The aim of this study was to examine the standing balance and the function of vastus medialis (VM) and biceps femoris (BF) muscles with surface electromyography (EMG). Fifty-four subjects with uni- or bilateral knee osteoarthritis (OA) (aged 50-69 years) and 53 age-matched randomly selected clinically and radiologically healthy men participated in this study. Postural control was assessed on a force platform with a bipedal stance with eyes open (EO) and closed (EC) and a monopedal stance with EO. The balance parameters, mean sway velocity, velocity along AP and ML axes, elliptical area, standard deviation of center of pressure, average radial displacement, mean frequency and frequency domain balance parameters and different power spectral density frequency bands were determined. Root mean square (RMS) for EMG amplitude, mean EMG frequency (f(EMG,mean)) and median EMG frequency (f(EMG,med)) of motor unit activity were calculated from the normalized EMG data. During bipedal stance with EC and EO, there were no significant differences in balance parameters between groups, but during bipedal stance with EO, the RMS in VM was about 56% higher (p<0.05) in subjects with knee OA than in the control subjects and the values of f(EMG,mean) and f(EMG,med) were about 48% higher (p<0.05) in control subjects than subjects with knee OA. It is concluded that subjects with knee OA do not have any standing balance deficit, but they do exhibit increased muscle activity in VM muscle compared to control subjects.

Time-varying spectrum estimation of heart rate variability signals with Kalman smoother algorithm

A time-varying parametric spectrum estimation method for analyzing dynamics of heart rate variability (HRV) signals is presented. In the method, HRV signal is first modeled with a time-varying autoregressive model and the model parameters are solved recursively with a Kalman smoother algorithm. Time-varying spectrum estimates are then obtained from the estimated model parameters. The obtained spectrum can be further decomposed into separate components, which is especially advantageous in HRV applications where low frequency (LF) and high frequency (HF) components are generally aimed to be distinguished. As case studies, the dynamics of HRV signals recorded during 1) orthostatic test, 2) exercise test and 3) simulated driving task are analyzed.

A principal component regression approach for estimation of ventricular repolarization characteristics

The time interval between Q-wave onset and T-wave offset, i.e., QT interval, in an ECG corresponds to the total ventricular activity, including both depolarization and repolarization times. It has been suggested that abnormal QT variability could be a marker of cardiac diseases such as ventricular arrhythmias, and QT-interval has also been observed to lengthen during hypoglycemia. In this paper, we propose a robust method for estimating ventricular repolarization characteristics such as QT interval and T-wave amplitude. The method is based on principal component regression. In the method, QT epochs are first extracted from ECG in respect of R-waves. Then, correlation matrix of the extracted epochs is formed and its eigenvectors computed. The most significant eigenvectors are then fitted to the data to obtain noise-free estimates of QT epochs. Nonstationarities in QT-epoch characteristics can also be modeled by updating the eigenvectors dynamically. The main benefit of the proposed method is robustness to noise, i.e., it works also when using ECGs that have low SNR, for example, signals measured during normal-life environments. One application of the proposed method could be the detection of the hypoglycemia.