Clinical Decision Support Systems with Game-based Environments, Monitoring Symptoms of Parkinson’s Disease with Exergames

Parkinson’s Disease (PD) is a malady caused by progressive neuronal degeneration, deriving in several physical and cognitive symptoms that worsen with time. Like many other chronic diseases, it requires constant monitoring to perform medication and therapeutic adjustments. This is due to the significant variability in PD symptomatology and progress between patients. At the moment, this monitoring requires substantial participation from caregivers and numerous clinic visits. Personal diaries and questionnaires are used as data sources for medication and therapeutic adjustments. The subjectivity in these data sources leads to suboptimal clinical decisions. Therefore, more objective data sources are required to better monitor the progress of individual PD patients. A potential contribution towards more objective monitoring of PD is clinical decision support systems. These systems employ sensors and classification techniques to provide caregivers with objective information for their decision-making. This leads to more objective assessments of patient improvement or deterioration, resulting in better adjusted medication and therapeutic plans. Hereby, the need to encourage patients to actively and regularly provide data for remote monitoring remains a significant challenge. To address this challenge, the goal of this thesis is to combine clinical decision support systems with game-based environments. More specifically, serious games in the form of exergames, active video games that involve physical exercise, shall be used to deliver objective data for PD monitoring and therapy. Exergames increase engagement while combining physical and cognitive tasks. This combination, known as dual-tasking, has been proven to improve rehabilitation outcomes in PD: recent randomized clinical trials on exergame-based rehabilitation in PD show improvements in clinical outcomes that are equal or superior to those of traditional rehabilitation. In this thesis, we present an exergame-based clinical decision support system model to monitor symptoms of PD. This model provides both objective information on PD symptoms and an engaging environment for the patients. The model is elaborated, prototypically implemented and validated in the context of two of the most prominent symptoms of PD: (1) balance and gait, as well as (2) hand tremor and slowness of movement (bradykinesia). While balance and gait affections increase the risk of falling, hand tremors and bradykinesia affect hand dexterity. We employ Wii Balance Boards and Leap Motion sensors, and digitalize aspects of current clinical standards used to assess PD symptoms. In addition, we present two dual-tasking exergames: PDDanceCity for balance and gait, and PDPuzzleTable for tremor and bradykinesia. We evaluate the capability of our system for assessing the risk of falling and the severity of tremor in comparison with clinical standards. We also explore the statistical significance and effect size of the data we collect from PD patients and healthy controls. We demonstrate that the presented approach can predict an increased risk of falling and estimate tremor severity. Also, the target population shows a good acceptance of PDDanceCity and PDPuzzleTable. In summary, our results indicate a clear feasibility to implement this system for PD. Nevertheless, long-term randomized clinical trials are required to evaluate the potential of PDDanceCity and PDPuzzleTable for physical and cognitive rehabilitation effects

Unified Quality-Aware Compression and Pulse-Respiration Rates Estimation Framework for Reducing Energy Consumption and False Alarms of Wearable PPG Monitoring Devices

Due to the high demands of tiny, compact, lightweight, and low-cost photoplethysmogram (PPG) monitoring devices, these devices are resource-constrained including limited battery power. Consequently, it highly demands frequent charge or battery replacement in the case of continuous PPG sensing and transmission. Further, PPG signals are often severely corrupted under ambulatory and exercise recording conditions, leading to frequent false alarms. In this paper, we propose a unified quality-aware compression and pulse-respiration rates estimation framework for reducing energy consumption and false alarms of wearable and edge PPG monitoring devices by exploring predictive coding techniques for jointly performing signal quality assessment (SQA), data compression and pulse rate (PR) and respiration rate (RR) estimation without the use of different domains of signal processing techniques that can be achieved by using the features extracted from the smoothed prediction error signal. By using the five standard PPG databases, the performance of the proposed unified framework is evaluated in terms of compression ratio (CR), mean absolute error (MAE), false alarm reduction rate (FARR), processing time (PT) and energy saving (ES). The compression, PR, RR estimation, and SQA results are compared with the existing methods and results of uncompressed PPG signals with sampling rates of 125 Hz and 25 Hz. The proposed unified qualityaware framework achieves an average CR of 4%, SQA (Se of 92.00%, FARR of 84.87%), PR (MAE: 0.46 ±1.20) and RR (MAE: 1.75 (0.65-4.45), PT (sec) of 15.34 ±0.01) and ES of 70.28% which outperforms the results of uncompressed PPG signal with a sampling rate of 125 Hz. Arduino Due computing platformbased implementation demonstrates the real-time feasibility of the proposed unified quality-aware PRRR estimation and data compression and transmission framework on the limited computational resources. Thus, it has great potential in improving energy-efficiency and trustworthiness of wearable and edge PPG monitoring devices.publishedVersio

Wearable and Nearable Biosensors and Systems for Healthcare

Biosensors and systems in the form of wearables and “nearables” (i.e., everyday sensorized objects with transmitting capabilities such as smartphones) are rapidly evolving for use in healthcare. Unlike conventional approaches, these technologies can enable seamless or on-demand physiological monitoring, anytime and anywhere. Such monitoring can help transform healthcare from the current reactive, one-size-fits-all, hospital-centered approach into a future proactive, personalized, decentralized structure. Wearable and nearable biosensors and systems have been made possible through integrated innovations in sensor design, electronics, data transmission, power management, and signal processing. Although much progress has been made in this field, many open challenges for the scientific community remain, especially for those applications requiring high accuracy. This book contains the 12 papers that constituted a recent Special Issue of Sensors sharing the same title. The aim of the initiative was to provide a collection of state-of-the-art investigations on wearables and nearables, in order to stimulate technological advances and the use of the technology to benefit healthcare. The topics covered by the book offer both depth and breadth pertaining to wearable and nearable technology. They include new biosensors and data transmission techniques, studies on accelerometers, signal processing, and cardiovascular monitoring, clinical applications, and validation of commercial devices

Towards Touch-to-Access Device Authentication Using Induced Body Electric Potentials

This paper presents TouchAuth, a new touch-to-access device authentication approach using induced body electric potentials (iBEPs) caused by the indoor ambient electric field that is mainly emitted from the building's electrical cabling. The design of TouchAuth is based on the electrostatics of iBEP generation and a resulting property, i.e., the iBEPs at two close locations on the same human body are similar, whereas those from different human bodies are distinct. Extensive experiments verify the above property and show that TouchAuth achieves high-profile receiver operating characteristics in implementing the touch-to-access policy. Our experiments also show that a range of possible interfering sources including appliances' electromagnetic emanations and noise injections into the power network do not affect the performance of TouchAuth. A key advantage of TouchAuth is that the iBEP sensing requires a simple analog-to-digital converter only, which is widely available on microcontrollers. Compared with existing approaches including intra-body communication and physiological sensing, TouchAuth is a low-cost, lightweight, and convenient approach for authorized users to access the smart objects found in indoor environments.Comment: 16 pages, accepted to the 25th Annual International Conference on Mobile Computing and Networking (MobiCom 2019), October 21-25, 2019, Los Cabos, Mexic

IoMT-based biomedical measurement systems for healthcare monitoring: a review

Biomedical measurement systems (BMS) have provided new solutions for healthcare monitoring and the diagnosis of various chronic diseases. With a growing demand for BMS in the field of medical applications, researchers are focusing on advancing these systems, including Internet of Medical Things (IoMT)-based BMS, with the aim of improving bioprocesses, healthcare systems and technologies for biomedical equipment. This paper presents an overview of recent activities towards the development of IoMT-based BMS for various healthcare applications. Different methods and approaches used in the development of these systems are presented and discussed, taking into account some metrological aspects related to the requirement for accuracy, reliability and calibration. The presented IoMT-based BMS are applied to healthcare applications concerning, in particular, heart, brain and blood sugar diseases as well as internal body sound and blood pressure measurements. Finally, the paper provides a discussion about the shortcomings and challenges that need to be addressed along with some possible directions for future research activities.</p

Wearable sensor for continuous monitoring of physiological parameters

Providing high quality health care to a mass population is becoming one of the great endeavors of modern society. In order to do so, there is a urge to embrace the use of new technologies that can provide comfort while ensuring the safety and reliability of traditional methods. The system hereby proposed ought to be capable of monitoring a person's vital signs therefore being very flexible regarding its application scenarios. It can be used not only in emergency wards and screening diseases but also in a home environment to monitor elderly people or young children. Furthermore, it is not exclusive to monitoring and preventing diseases, it can also be an instrument that aids sports training at high intensity levels. This product can measure a patient's heart rate and oxygen saturation levels ensuring comfort and easy usage. Another advantage when compared to traditional machines used to fit the same purpose is the fact that it is much cheaper, takes up less space and it encompasses two functional- ities that are otherwise measured with different machines. This system has two major components, an ESP32 microprocessor and a MAX30100 Pho- toPletysmoGraphy (PPG) sensor. The ESP32 module was chosen due to its computing capacity (dual-core 32-bit processor), having a WiFi module built in with full TCP/IP stack and having 3 pre-defined sleep modes to reduce power consumption. The MAX30100 sensor was picked because it is a compact and small module with simple usage. Furthermore, the goal of this disser- tation is to build this system to be energy efficient, maximizing its battery life while not compro- mising its logical correctness. The configuration chosen that produced steady results whilst consuming lowest energy possi- ble was: 37 mA of current for the IR LED, sampling frequency of 50 Hz and pulse width of 200 μs

Pulse diagnosis using signal processing and machine learning techniques

Capstone Project submitted to the Department of Engineering, Ashesi University in partial fulfillment of the requirements for the award of Bachelor of Science degree in Electrical and Electronic Engineering, May 2021For many centuries, pulse diagnosis has been a technique studied and applied in determining the state of health of the human body. However, its subjective nature puts it at a disadvantage in presenting an accurate diagnosis of the human body. In this project, practical research is done to standardize pulse diagnosis by acquiring body signals and applying signal processing and machine learning techniques for analysis. A prototype acquisition system is designed to obtain the body signals such as the pressure pulse waves from arteries and ECG signals. The system's efficiency was verified using cross-correlation analysis between the data acquired from the system and the standard data from Lei Zhang’s database and MIT physio net database. For the diagnostic system for the signal analysis, the time domain, frequency domain, and time-frequency domain of the signal processing techniques are adopted to extract features such as the power spectral density to be further used for classification and distinction between different signal groups. Applying the different techniques showed a distinction between the different groups of signals that aided the Support Vector Machine and K-Nearest Neighbour classification models to achieve above 90% and 80% accuracy. The experimental process and results provided insight into ways pulse diagnosis could be standardized for healthcare services.Ashesi Universit

Characterization and processing of novel neck photoplethysmography signals for cardiorespiratory monitoring

Epilepsy is a neurological disorder causing serious brain seizures that severely affect the patients' quality of life. Sudden unexpected death in epilepsy (SUDEP), for which no evident decease reason is found after post-mortem examination, is a common cause of mortality. The mechanisms leading to SUDEP are uncertain, but, centrally mediated apneic respiratory dysfunction, inducing dangerous hypoxemia, plays a key role. Continuous physiological monitoring appears as the only reliable solution for SUDEP prevention. However, current seizure-detection systems do not show enough sensitivity and present a high number of intolerable false alarms. A wearable system capable of measuring several physiological signals from the same body location, could efficiently overcome these limitations. In this framework, a neck wearable apnea detection device (WADD), sensing airflow through tracheal sounds, was designed. Despite the promising performance, it is still necessary to integrate an oximeter sensor into the system, to measure oxygen saturation in blood (SpO2) from neck photoplethysmography (PPG) signals, and hence, support the apnea detection decision. The neck is a novel PPG measurement site that has not yet been thoroughly explored, due to numerous challenges. This research work aims to characterize neck PPG signals, in order to fully exploit this alternative pulse oximetry location, for precise cardiorespiratory biomarkers monitoring. In this thesis, neck PPG signals were recorded, for the first time in literature, in a series of experiments under different artifacts and respiratory conditions. Morphological and spectral characteristics were analyzed in order to identify potential singularities of the signals. The most common neck PPG artifacts critically corrupting the signal quality, and other breathing states of interest, were thoroughly characterized in terms of the most discriminative features. An algorithm was further developed to differentiate artifacts from clean PPG signals. Both, the proposed characterization and classification model can be useful tools for researchers to denoise neck PPG signals and exploit them in a variety of clinical contexts. In addition to that, it was demonstrated that the neck also offered the possibility, unlike other body parts, to extract the Jugular Venous Pulse (JVP) non-invasively. Overall, the thesis showed how the neck could be an optimum location for multi-modal monitoring in the context of diseases affecting respiration, since it not only allows the sensing of airflow related signals, but also, the breathing frequency component of the PPG appeared more prominent than in the standard finger location. In this context, this property enabled the extraction of relevant features to develop a promising algorithm for apnea detection in near-real time. These findings could be of great importance for SUDEP prevention, facilitating the investigation of the mechanisms and risk factors associated to it, and ultimately reduce epilepsy mortality.Open Acces

Wearable in-ear pulse oximetry: theory and applications

Wearable health technology, most commonly in the form of the smart watch, is employed by millions of users worldwide. These devices generally exploit photoplethysmography (PPG), the non-invasive use of light to measure blood volume, in order to track physiological metrics such as pulse and respiration. Moreover, PPG is commonly used in hospitals in the form of pulse oximetry, which measures light absorbance by the blood at different wavelengths of light to estimate blood oxygen levels (SpO2). This thesis aims to demonstrate that despite its widespread usage over many decades, this sensor still possesses a wealth of untapped value. Through a combination of advanced signal processing and harnessing the ear as a location for wearable sensing, this thesis introduces several novel high impact applications of in-ear pulse oximetry and photoplethysmography. The aims of this thesis are accomplished through a three pronged approach: rapid detection of hypoxia, tracking of cognitive workload and fatigue, and detection of respiratory disease. By means of the simultaneous recording of in-ear and finger pulse oximetry at rest and during breath hold tests, it was found that in-ear SpO2 responds on average 12.4 seconds faster than the finger SpO2. This is likely due in part to the ear being in close proximity to the brain, making it a priority for oxygenation and thus making wearable in-ear SpO2 a good proxy for core blood oxygen. Next, the low latency of in-ear SpO2 was further exploited in the novel application of classifying cognitive workload. It was found that in-ear pulse oximetry was able to robustly detect tiny decreases in blood oxygen during increased cognitive workload, likely caused by increased brain metabolism. This thesis demonstrates that in-ear SpO2 can be used to accurately distinguish between different levels of an N-back memory task, representing different levels of mental effort. This concept was further validated through its application to gaming and then extended to the detection of driver related fatigue. It was found that features derived from SpO2 and PPG were predictive of absolute steering wheel angle, which acts as a proxy for fatigue. The strength of in-ear PPG for the monitoring of respiration was investigated with respect to the finger, with the conclusion that in-ear PPG exhibits far stronger respiration induced intensity variations and pulse amplitude variations than the finger. All three respiratory modes were harnessed through multivariate empirical mode decomposition (MEMD) to produce spirometry-like respiratory waveforms from PPG. It was discovered that these PPG derived respiratory waveforms can be used to detect obstruction to breathing, both through a novel apparatus for the simulation of breathing disorders and through the classification of chronic obstructive pulmonary disease (COPD) in the real world. This thesis establishes in-ear pulse oximetry as a wearable technology with the potential for immense societal impact, with applications from the classification of cognitive workload and the prediction of driver fatigue, through to the detection of chronic obstructive pulmonary disease. The experiments and analysis in this thesis conclusively demonstrate that widely used pulse oximetry and photoplethysmography possess a wealth of untapped value, in essence teaching the old PPG sensor new tricks.Open Acces

Wearable-based human activity recognition: from a healthcare application to a kinetic energy harvesting approach

Wearable technology is changing society by becoming an essential component of daily life. Human activity recognition (HAR) is one of the most prominent research areas where wearable devices play a key role. The first major contribution to the field in this dissertation is a smart physical work- load tracking system that combines wearable-based HAR and heart rate tracking. The proposed system employs a concept from ergonomics, the Frimat’s method, to compute the physical workload from heart rate measurements within a specified time window. This dissertation includes a case of study where tracking of an individual over the course of 20 days corroborates the ability of the system to assess adaptation to an exercise routine. The second and third contributions of this dissertation point to KEH in wearable environments. The second contribution is an energy logger for wrist-worn systems, with the purpose of tracking energy generation in KEH systems during daily activities. Thus, it is possible to determine if the harvested energy is enough to power a conventional wearable device. The proposed system computes the harvested energy using the characteristics of the objective load, which in this case is a battery charger. I carried out experiments with multiple subjects to examine the generation capabilities of a commercial harvester under the conditions of human motion. This study provides insights of the performance and limitations of kinetic harvesters as battery chargers. The third contribution is a KEH-based HAR system using deep learning, data augmentation and transfer learning to outperform existing classification approaches in the KEH domain. The proposed architecture comprises convolutional neural networks (CNN) and long short-term memory networks (LSTM), which has been demonstrated to outperform other architectures found in the literature. Since deep learning classifiers require large amounts of data, and KEH datasets are limited in size, this thesis also includes the proposal of three data augmentation methods to synthesize KEH signals simulating new users. Finally, transfer learning is employed to build a system that maintains performance independent of device location or the subject wearing the device.DoctoradoDoctor en Ingeniería Eléctrica y Electrónic