Using the Audio Respiration Signal for Multimodal Discrimination of Expressive Movement Qualities

In this paper we propose a multimodal approach to distinguish between movements displaying three different expressive qualities: fluid, fragmented, and impulsive movements. Our approach is based on the Event Synchronization algorithm, which is applied to compute the amount of synchronization between two low-level features extracted from multimodal data. In more details, we use the energy of the audio respiration signal captured by a standard microphone placed near to the mouth, and the whole body kinetic energy estimated from motion capture data. The method was evaluated on 90 movement segments performed by 5 dancers. Results show that fragmented movements display higher average synchronization than fluid and impulsive movements

Chronic cough—the limitation and advances in assessment techniques

Accurate and consistent assessments of cough are essential to advance the understanding of the mechanisms of cough and individualised the management of patients. Considerable progress has been made in this work. Here we reviewed the currently available tools for subjectively and objectively measuring both cough sensitivity and severity. We also provided some opinions on the new techniques and future directions. The simple and practical Visual Analogue Scale (VAS), the Leicester Cough Questionnaire (LCQ), and the Cough Specific Quality of Life Questionnaire (CQLQ) are the most widely used self-reported questionnaires for evaluating and quantifying cough severity. The Hull Airway Reflux Questionnaire (HARQ) is a tool to elucidate the constellation of symptoms underlying the diagnosis of chronic cough. Chemical excitation tests are widely used to explore the pathophysiological mechanisms of the cough reflex, such as capsaicin, citric acid and adenosine triphosphate (ATP) challenge test. Cough frequency is an ideal primary endpoint for clinical research, but the application of cough counters has been limited in clinical practice by the high cost and reliance on aural validation. The ongoing development of cough detection technology for smartphone apps and wearable devices will hopefully simplify cough counting, thus transitioning it from niche research to a widely available clinical application

Multichannel analysis of normal and continuous adventitious respiratory sounds for the assessment of pulmonary function in respiratory diseases

Premi extraordinari doctorat UPC curs 2015-2016, àmbit d’Enginyeria IndustrialRespiratory sounds (RS) are produced by turbulent airflows through the airways and are inhomogeneously transmitted through different media to the chest surface, where they can be recorded in a non-invasive way. Due to their mechanical nature and airflow dependence, RS are affected by respiratory diseases that alter the mechanical properties of the respiratory system. Therefore, RS provide useful clinical information about the respiratory system structure and functioning. Recent advances in sensors and signal processing techniques have made RS analysis a more objective and sensitive tool for measuring pulmonary function. However, RS analysis is still rarely used in clinical practice. Lack of a standard methodology for recording and processing RS has led to several different approaches to RS analysis, with some methodological issues that could limit the potential of RS analysis in clinical practice (i.e., measurements with a low number of sensors, no controlled airflows, constant airflows, or forced expiratory manoeuvres, the lack of a co-analysis of different types of RS, or the use of inaccurate techniques for processing RS signals). In this thesis, we propose a novel integrated approach to RS analysis that includes a multichannel recording of RS using a maximum of five microphones placed over the trachea and the chest surface, which allows RS to be analysed at the most commonly reported lung regions, without requiring a large number of sensors. Our approach also includes a progressive respiratory manoeuvres with variable airflow, which allows RS to be analysed depending on airflow. Dual RS analyses of both normal RS and continuous adventitious sounds (CAS) are also proposed. Normal RS are analysed through the RS intensity–airflow curves, whereas CAS are analysed through a customised Hilbert spectrum (HS), adapted to RS signal characteristics. The proposed HS represents a step forward in the analysis of CAS. Using HS allows CAS to be fully characterised with regard to duration, mean frequency, and intensity. Further, the high temporal and frequency resolutions, and the high concentrations of energy of this improved version of HS, allow CAS to be more accurately characterised with our HS than by using spectrogram, which has been the most widely used technique for CAS analysis. Our approach to RS analysis was put into clinical practice by launching two studies in the Pulmonary Function Testing Laboratory of the Germans Trias i Pujol University Hospital for assessing pulmonary function in patients with unilateral phrenic paralysis (UPP), and bronchodilator response (BDR) in patients with asthma. RS and airflow signals were recorded in 10 patients with UPP, 50 patients with asthma, and 20 healthy participants. The analysis of RS intensity–airflow curves proved to be a successful method to detect UPP, since we found significant differences between these curves at the posterior base of the lungs in all patients whereas no differences were found in the healthy participants. To the best of our knowledge, this is the first study that uses a quantitative analysis of RS for assessing UPP. Regarding asthma, we found appreciable changes in the RS intensity–airflow curves and CAS features after bronchodilation in patients with negative BDR in spirometry. Therefore, we suggest that the combined analysis of RS intensity–airflow curves and CAS features—including number, duration, mean frequency, and intensity—seems to be a promising technique for assessing BDR and improving the stratification of BDR levels, particularly among patients with negative BDR in spirometry. The novel approach to RS analysis developed in this thesis provides a sensitive tool to obtain objective and complementary information about pulmonary function in a simple and non-invasive way. Together with spirometry, this approach to RS analysis could have a direct clinical application for improving the assessment of pulmonary function in patients with respiratory diseases.Los sonidos respiratorios (SR) se generan con el paso del flujo de aire a través de las vías respiratorias y se transmiten de forma no homogénea hasta la superficie torácica. Dada su naturaleza mecánica, los SR se ven afectados en gran medida por enfermedades que alteran las propiedades mecánicas del sistema respiratorio. Por lo tanto, los SR proporcionan información clínica relevante sobre la estructura y el funcionamiento del sistema respiratorio. La falta de una metodología estándar para el registro y procesado de los SR ha dado lugar a la aparición de diferentes estrategias de análisis de SR con ciertas limitaciones metodológicas que podrían haber restringido el potencial y el uso de esta técnica en la práctica clínica (medidas con pocos sensores, flujos no controlados o constantes y/o maniobras forzadas, análisis no combinado de distintos tipos de SR o uso de técnicas poco precisas para el procesado de los SR). En esta tesis proponemos un método innovador e integrado de análisis de SR que incluye el registro multicanal de SR mediante un máximo de cinco micrófonos colocados sobre la tráquea yla superficie torácica, los cuales permiten analizar los SR en las principales regiones pulmonares sin utilizar un número elevado de sensores . Nuestro método también incluye una maniobra respiratoria progresiva con flujo variable que permite analizar los SR en función del flujo respiratorio. También proponemos el análisis combinado de los SR normales y los sonidos adventicios continuos (SAC), mediante las curvas intensidad-flujo y un espectro de Hilbert (EH) adaptado a las características de los SR, respectivamente. El EH propuesto representa un avance importante en el análisis de los SAC, pues permite su completa caracterización en términos de duración, frecuencia media e intensidad. Además, la alta resolución temporal y frecuencial y la alta concentración de energía de esta versión mejorada del EH permiten caracterizar los SAC de forma más precisa que utilizando el espectrograma, el cual ha sido la técnica más utilizada para el análisis de SAC en estudios previos. Nuestro método de análisis de SR se trasladó a la práctica clínica a través de dos estudios que se iniciaron en el laboratorio de pruebas funcionales del hospital Germans Trias i Pujol, para la evaluación de la función pulmonar en pacientes con parálisis frénica unilateral (PFU) y la respuesta broncodilatadora (RBD) en pacientes con asma. Las señales de SR y flujo respiratorio se registraron en 10 pacientes con PFU, 50 pacientes con asma y 20 controles sanos. El análisis de las curvas intensidad-flujo resultó ser un método apropiado para detectar la PFU , pues encontramos diferencias significativas entre las curvas intensidad-flujo de las bases posteriores de los pulmones en todos los pacientes , mientras que en los controles sanos no encontramos diferencias significativas. Hasta donde sabemos, este es el primer estudio que utiliza el análisis cuantitativo de los SR para evaluar la PFU. En cuanto al asma, encontramos cambios relevantes en las curvas intensidad-flujo yen las características de los SAC tras la broncodilatación en pacientes con RBD negativa en la espirometría. Por lo tanto, sugerimos que el análisis combinado de las curvas intensidad-flujo y las características de los SAC, incluyendo número, duración, frecuencia media e intensidad, es una técnica prometedora para la evaluación de la RBD y la mejora en la estratificación de los distintos niveles de RBD, especialmente en pacientes con RBD negativa en la espirometría. El método innovador de análisis de SR que se propone en esta tesis proporciona una nueva herramienta con una alta sensibilidad para obtener información objetiva y complementaria sobre la función pulmonar de una forma sencilla y no invasiva. Junto con la espirometría, este método puede tener una aplicación clínica directa en la mejora de la evaluación de la función pulmonar en pacientes con enfermedades respiratoriasAward-winningPostprint (published version

The role of respiration audio in multimodal analysis of movement qualities

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A framework for automated heart and lung sound analysis using a mobile telemedicine platform

Thesis (M. Eng.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, 2010.Cataloged from PDF version of thesis.Includes bibliographical references (p. 246-261).Many resource-poor communities across the globe lack access to quality healthcare,due to shortages in medical expertise and poor availability of medical diagnostic devices. In recent years, mobile phones have become increasingly complex and ubiquitous. These devices present a tremendous opportunity to provide low-cost diagnostics to under-served populations and to connect non-experts with experts. This thesis explores the capture of cardiac and respiratory sounds on a mobile phone for analysis, with the long-term aim of developing intelligent algorithms for the detection of heart and respiratory-related problems. Using standard labeled databases, existing and novel algorithms are developed to analyze cardiac and respiratory audio data. In order to assess the algorithms' performance under field conditions, a low-cost stethoscope attachment is constructed and data is collected using a mobile phone. Finally, a telemedicine infrastructure and work-flow is described, in which these algorithms can be deployed and trained in a large-scale deployment.by Katherine L. Kuan.M.Eng

Novel Measurements of Cough and Breathing Abnormalities during Sleep in Cystic Fibrosis

This Doctor of Philosophy thesis describes cystic fibrosis (CF), sleep parameters and novel measurement techniques to determine the effect of lung disease on sleep using non-invasive techniques. Cystic Fibrosis (CF) is characterised by lungs that are normal at birth, but as lung disease progresses with age, adults with CF can develop sleep abnormalities including alteration in sleep architecture and sleep disordered breathing. This thesis seeks to investigate simple non-invasive measures which can detect abnormalities of sleep and breathing in CF adults. The identification of respiratory sounds (normal lung sounds, coughs, crackles, wheezes and snores) will be examined using the non-invasive sleep and breathing measurement device, the Sonomat. The characterisation of these respiratory sounds will be based on spectrographic and audio analysis of the Sonomat. Cross-sectional and longitudinal analysis of adults with CF using polysomnography and the Sonomat will further assess objective sleep and breathing abnormalities. Additional to the examination of objective measurements of sleep, subjective evaluation using CF-specific and sleep-specific questionnaires will assess subjective sleep quality and QoL in adults with CF

Oximetry use in obstructive sleep apnea

Producción CientíficaIntroduction. Overnight oximetry has been proposed as an accessible, simple, and reliable technique for obstructive sleep apnea syndrome (OSAS) diagnosis. From visual inspection to advanced signal processing, several studies have demonstrated the usefulness of oximetry as a screening tool. However, there is still controversy regarding the general application of oximetry as a single screening methodology for OSAS. Areas covered. Currently, high-resolution portable devices combined with pattern recognition-based applications are able to achieve high performance in the detection this disease. In this review, recent studies involving automated analysis of oximetry by means of advanced signal processing and machine learning algorithms are analyzed. Advantages and limitations are highlighted and novel research lines aimed at improving the screening ability of oximetry are proposed. Expert commentary. Oximetry is a cost-effective tool for OSAS screening in patients showing high pretest probability for the disease. Nevertheless, exhaustive analyses are still needed to further assess unattended oximetry monitoring as a single diagnostic test for sleep apnea, particularly in the pediatric population and in especial groups with significant comorbidities. In the following years, communication technologies and big data analysis will overcome current limitations of simplified sleep testing approaches, changing the detection and management of OSAS.This research has been partially supported by the projects DPI2017-84280-R and RTC-2015-3446-1 from Ministerio de Economía, Industria y Competitividad and European Regional Development Fund (FEDER), the project 66/2016 of the Sociedad Española de Neumología y Cirugía Torácica (SEPAR), and the project VA037U16 from the Consejería de Educación de la Junta de Castilla y León and FEDER. D. Álvarez was in receipt of a Juan de la Cierva grant IJCI-2014-22664 from the Ministerio de Economía y Competitividad

An investigation into the efficacy and mechanisms of action of novel therapeutics for chronic cough

Whilst cough is a defensive reflex, in respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) the cough reflex may become exaggerated and unproductive, leading to presentation of chronic cough as a troublesome symptom. Chronic cough is the most common reason that patients seek ambulatory care in the UK, and cough medications are one of the largest segments of the global over-the-counter drugs market, yet there are no cough medications (prescription or OTC) available that are both efficacious AND safe, indicating a large unmet clinical need. β-adrenergic receptor (β-AR) agonists, methylxanthines (theophylline) and fatty acid amide hydrogenase inhibitors (FAAHi) are peripherally acting drugs with a proven safety profile in humans for other uses, but are not currently recognised as anti-tussive medications. This thesis aimed to examine whether these drugs possess anti-tussive activity, and if so, the mechanisms by which they inhibit cough. These drugs were all effective at blocking the in vivo cough response to tussive stimuli in naïve guinea pigs, and in addition β-AR agonists and theophylline inhibited tussive stimulus evoked cough in guinea pigs previously exposed to cigarette-smoke, which display a clinically relevant enhanced cough phenotype. In vitro and in vivo assays of guinea pig vagus nerve/neuron activation were used to show that these compounds inhibit depolarisation of airway-innervating peripheral sensory nerves. Pharmacological and genetic tools were used to investigate the receptors and signalling pathways activated by these drugs. Whilst β-AR agonists, theophylline and FAAHi had different mechanisms of action, a common component was that all three classes of compound act on various potassium channels, thereby reducing the excitability of sensory neurons. This work suggests that drugs that inhibit peripheral sensory nerve activity have the potential to be efficacious as anti-tussives. Specifically the compounds tested have improved clinical side-effect profiles over currently used anti-tussives, and therefore have potential as therapies for chronic cough.Open Acces