A control systems engineering approach for adaptive behavioral interventions: illustration with a fibromyalgia intervention

abstract: The term adaptive intervention has been used in behavioral medicine to describe operationalized and individually tailored strategies for prevention and treatment of chronic, relapsing disorders. Control systems engineering offers an attractive means for designing and implementing adaptive behavioral interventions that feature intensive measurement and frequent decision-making over time. This is illustrated in this paper for the case of a low-dose naltrexone treatment intervention for fibromyalgia. System identification methods from engineering are used to estimate dynamical models from daily diary reports completed by participants. These dynamical models then form part of a model predictive control algorithm which systematically decides on treatment dosages based on measurements obtained under real-life conditions involving noise, disturbances, and uncertainty. The effectiveness and implications of this approach for behavioral interventions (in general) and pain treatment (in particular) are demonstrated using informative simulations

Development of a Dynamical Systems Model and Adaptive Intervention Strategy for Stroke Rehabilitation

Each year, approximately 795000 people experience stroke in the United States. After stroke onset, about 80% of patients suffer from hemiparesis, the weakness of face or limb on one side. These people outside clinical setting may develop learned nonuse, which may result in long-term limitation in the outcome of motor recovery. Interventions such as the Constraint Induced Movement Therapy has shown promise in reversing nonuse. However, many chronic individuals do not have access to such training programs. Therefore, some novel tools capable of continuous monitoring patients\u27 health status and furthermore providing appropriate interventions for patients in ambient setting is required to optimize stroke rehabilitation.Dynamical systems modeling combined with wearable technologies may allow to quantitatively describe nonuse evolution. We developed and validated a pendulum-based dynamical model using experimental and simulated motion data. Without direct access to internal torques, we proposed an inverse dynamics-based metric to quantify and compare motor performance between limbs. The primary outcome measure is RMSE between the simulated driving torque for experimental and reference motions. Using RMSEs, we defined a novel within-person comparison factor w participant limb [w], and compared it to the Fugl-Mayer Assessment score. Our dynamic model is capable of mimicking upper-extremity shoulder flexion dynamics. RMSE is sensitive to differences in motor performance between limbs for both groups. Finally, the factor w participant limb [w] is related to post-stroke severity. The arm dynamical model may have great potential for monitoring time-varying motor impairment using noninvasive sensing.Markov decision process (MDP) is a comparatively simple approach of simulation modelling. We implemented MDP to understand the primary factors behind human dynamic decision making on limb choice during rehabilitation. The model showed good performance in understanding the crucial motivators (or barriers) underlying patients\u27 behaviors. We found that a patient with higher motivation, greater perceived benefits of paretic-limb use, and milder motor impairment, would show a better adherence to using paretic limb in physical activity, which suggests that we may provide related interventions in clinical practice to promote a better recovery outcome. MDP modelling may be suggestive in designing cost-effective adaptive intervention for stroke rehabilitation

System Identification, State Estimation, And Control Approaches to Gestational Weight Gain Interventions

abstract: Excessive weight gain during pregnancy is a significant public health concern and has been the recent focus of novel, control systems-based interventions. Healthy Mom Zone (HMZ) is an intervention study that aims to develop and validate an individually tailored and intensively adaptive intervention to manage weight gain for overweight or obese pregnant women using control engineering approaches. Motivated by the needs of the HMZ, this dissertation presents how to use system identification and state estimation techniques to assist in dynamical systems modeling and further enhance the performance of the closed-loop control system for interventions. Underreporting of energy intake (EI) has been found to be an important consideration that interferes with accurate weight control assessment and the effective use of energy balance (EB) models in an intervention setting. To better understand underreporting, a variety of estimation approaches are developed; these include back-calculating energy intake from a closed-form of the EB model, a Kalman-filter based algorithm for recursive estimation from randomly intermittent measurements in real time, and two semi-physical identification approaches that can parameterize the extent of systematic underreporting with global/local modeling techniques. Each approach is analyzed with intervention participant data and demonstrates potential of promoting the success of weight control. In addition, substantial efforts have been devoted to develop participant-validated models and incorporate into the Hybrid Model Predictive Control (HMPC) framework for closed-loop interventions. System identification analyses from Phase I led to modifications of the measurement protocols for Phase II, from which longer and more informative data sets were collected. Participant-validated models obtained from Phase II data significantly increase predictive ability for individual behaviors and provide reliable open-loop dynamic information for HMPC implementation. The HMPC algorithm that assigns optimized dosages in response to participant real time intervention outcomes relies on a Mixed Logical Dynamical framework which can address the categorical nature of dosage components, and translates sequential decision rules and other clinical considerations into mixed-integer linear constraints. The performance of the HMPC decision algorithm was tested with participant-validated models, with the results indicating that HMPC is superior to "IF-THEN" decision rules.Dissertation/ThesisDoctoral Dissertation Chemical Engineering 201

A Novel Control Engineering Approach to Designing and Optimizing Adaptive Sequential Behavioral Interventions

abstract: Control engineering offers a systematic and efficient approach to optimizing the effectiveness of individually tailored treatment and prevention policies, also known as adaptive or ``just-in-time'' behavioral interventions. These types of interventions represent promising strategies for addressing many significant public health concerns. This dissertation explores the development of decision algorithms for adaptive sequential behavioral interventions using dynamical systems modeling, control engineering principles and formal optimization methods. A novel gestational weight gain (GWG) intervention involving multiple intervention components and featuring a pre-defined, clinically relevant set of sequence rules serves as an excellent example of a sequential behavioral intervention; it is examined in detail in this research.   A comprehensive dynamical systems model for the GWG behavioral interventions is developed, which demonstrates how to integrate a mechanistic energy balance model with dynamical formulations of behavioral models, such as the Theory of Planned Behavior and self-regulation. Self-regulation is further improved with different advanced controller formulations. These model-based controller approaches enable the user to have significant flexibility in describing a participant's self-regulatory behavior through the tuning of controller adjustable parameters. The dynamic simulation model demonstrates proof of concept for how self-regulation and adaptive interventions influence GWG, how intra-individual and inter-individual variability play a critical role in determining intervention outcomes, and the evaluation of decision rules.   Furthermore, a novel intervention decision paradigm using Hybrid Model Predictive Control framework is developed to generate sequential decision policies in the closed-loop. Clinical considerations are systematically taken into account through a user-specified dosage sequence table corresponding to the sequence rules, constraints enforcing the adjustment of one input at a time, and a switching time strategy accounting for the difference in frequency between intervention decision points and sampling intervals. Simulation studies illustrate the potential usefulness of the intervention framework. The final part of the dissertation presents a model scheduling strategy relying on gain-scheduling to address nonlinearities in the model, and a cascade filter design for dual-rate control system is introduced to address scenarios with variable sampling rates. These extensions are important for addressing real-life scenarios in the GWG intervention.Dissertation/ThesisDoctoral Dissertation Chemical Engineering 201

A Novel Engineering Approach to Modelling and Optimizing Smoking Cessation Interventions

abstract: Cigarette smoking remains a major global public health issue. This is partially due to the chronic and relapsing nature of tobacco use, which contributes to the approximately 90% quit attempt failure rate. The recent rise in mobile technologies has led to an increased ability to frequently measure smoking behaviors and related constructs over time, i.e., obtain intensive longitudinal data (ILD). Dynamical systems modeling and system identification methods from engineering offer a means to leverage ILD in order to better model dynamic smoking behaviors. In this dissertation, two sets of dynamical systems models are estimated using ILD from a smoking cessation clinical trial: one set describes cessation as a craving-mediated process; a second set was reverse-engineered and describes a psychological self-regulation process in which smoking activity regulates craving levels. The estimated expressions suggest that self-regulation more accurately describes cessation behavior change, and that the psychological self-regulator resembles a proportional-with-filter controller. In contrast to current clinical practice, adaptive smoking cessation interventions seek to personalize cessation treatment over time. An intervention of this nature generally reflects a control system with feedback and feedforward components, suggesting its design could benefit from a control systems engineering perspective. An adaptive intervention is designed in this dissertation in the form of a Hybrid Model Predictive Control (HMPC) decision algorithm. This algorithm assigns counseling, bupropion, and nicotine lozenges each day to promote tracking of target smoking and craving levels. Demonstrated through a diverse series of simulations, this HMPC-based intervention can aid a successful cessation attempt. Objective function weights and three-degree-of-freedom tuning parameters can be sensibly selected to achieve intervention performance goals despite strict clinical and operational constraints. Such tuning largely affects the rate at which peak bupropion and lozenge dosages are assigned; total post-quit smoking levels, craving offset, and other performance metrics are consequently affected. Overall, the interconnected nature of the smoking and craving controlled variables facilitate the controller's robust decision-making capabilities, even despite the presence of noise or plant-model mismatch. Altogether, this dissertation lays the conceptual and computational groundwork for future efforts to utilize engineering concepts to further study smoking behaviors and to optimize smoking cessation interventions.Dissertation/ThesisDoctoral Dissertation Bioengineering 201