Measure and comparison of speech pause duration in subjects with disfluency speech

This work has lhe goal of comparing the pause duration in lhe disfluency speech and nonnal speech. Disfluency and normal sponlaneous spccch was rccordcd in a contcxl were the subjcels had to deseribe a scenc fram each othcr. 1l1C pause determin;Jtion algorithm was dcvelopcd. The automatic pause determinations allowed lhe measure of percenlage of silence along the record of several minutcs of spcech. As expecled lhese paramelers is ralher diffcrent in subjecIs with and wi thout disfluency spcech. but it do nol scems that it is proponional la lhe sevcrity of lhe disfluency

Usability testing of a respiratory interface using computer screen and facial expressions videos

Computer screen videos (CSVs) and users' facial expressions videos (FEVs) are recommended to evaluate systems performance. However, software combining both methods is often non-accessible in clinical research fields. The Observer-XT software is commonly used for clinical research to assess human behaviours. Thus, this study reports on the combination of CSVs and FEVs, to evaluate a graphical user interface (GUI). Eight physiotherapists entered clinical information in the GUI while CSVs and FEVs were collected. The frequency and duration of a list of behaviours found in FEVs were analysed using the Observer-XT-10.5. Simultaneously, the frequency and duration of usability problems of CSVs were manually registered. CSVs and FEVs timelines were also matched to verify combinations. The analysis of FEVs revealed that the category most frequently observed in users behaviour was the eye contact with the screen (ECS, 32±9) whilst verbal communication achieved the highest duration (14.8±6.9 min). Regarding the CSVs, 64 problems, related with the interface (73%) and the user (27%), were found. In total, 135 usability problems were identified by combining both methods. The majority were reported through verbal communication (45.8%) and ECS (40.8%). “False alarms” and “misses” did not cause quantifiable reactions and the facial expressions problems were mainly related with the lack of familiarity (55.4%) felt by users when interacting with the interface. These findings encourage the use of Observer-XT-10.5 to conduct small usability sessions, as it identifies emergent groups of problems by combining methods. However, to validate final versions of systems further validation should be conducted using specialized software

Usability of Computerized Lung Auscultation–Sound Software (CLASS) for learning pulmonary auscultation

The mastering of pulmonary auscultation requires complex acoustic skills. Computer-assisted learning tools (CALTs) have potential to enhance the learning of these skills; however, few have been developed for this purpose and do not integrate all the required features. Thus, this study aimed to assess the usability of a new CALT for learning pulmonary auscultation. Computerized Lung Auscultation-Sound Software (CLASS) usability was assessed by eight physiotherapy students using computer screen recordings, think-aloud reports, and facial expressions. Time spent in each task, frequency of messages and facial expressions, number of clicks and problems reported were counted. The timelines of the three methods used were matched/synchronized and analyzed. The tasks exercises and annotation of respiratory sounds were the ones requiring more clicks (median 132, interquartile range [23-157]; 93 [53-155]; 91 [65-104], respectively) and where most errors (19; 37; 15%, respectively) and problems (n = 7; 6; 3, respectively) were reported. Each participant reported a median of 6 problems, with a total of 14 different problems found, mainly related with CLASS functionalities (50%). Smile was the only facial expression presented in all tasks (n = 54). CLASS is the only CALT available that meets all the required features for learning pulmonary auscultation. The combination of the three usability methods identified advantages/disadvantages of CLASS and offered guidance for future developments, namely in annotations and exercises. This will allow the improvement of CLASS and enhance students' activities for learning pulmonary auscultation skills

Computerised lung auscultation: sound software (CLASS)

Computer-assisted learning tools have been shown to promote self-directed learning and enhance problem-solving skills. However, few have been developed in the area of respiratory medicine and the majority does not include all the required features for integration of knowledge (e.g., sound recording and analysis). Thus, we aimed to develop and evaluate an open-source computer-assisted learning application for respiratory sound recording, analysis and interpretation, the Computerised Lungs Auscultation – Sound Software (CLASS). CLASS is the only computer-assisted learning tool which simultaneously allows the recording and analyses of respiratory sounds. The usability of CLASS has been tested by eight physiotherapy students through an open-ended questionnaire and a focus group interview. Participants highlighted its utility and great potential to be used in academic and clinical environments, and they also identified some drawbacks. New developments are being incorporated to improve CLASS usability in the academic context but also to make it available in health professionals’ clinical practice

Sons respiratórios computorizados em crianças com infeção respiratória do trato inferior : um estudo comparativo

Mestrado em FisioterapiaBackground: Lower respiratory tract infections (LRTI) are the main cause of health burden in the first years of age. To enhance the diagnosis and monitoring of infants with LRTI, researchers have been trying to use the large advantages of conventional auscultation. Computerised respiratory sound analysis (CORSA) is a simple method to detect and characterise Normal Respiratory Sounds (NRS) and Adventitious Respiratory Sounds (ARS). However, if this measure is to be used in the paediatric population, reference values have to be established first. Aim: To compare and characterise NRS and ARS in healthy infants and infants with LRTI. Methods: A cross-sectional descriptive-comparative study was conducted in three institutions. Infants were diagnosed by the paediatrician as presenting or not presenting an LRTI, healthy volunteers were recruited from the institutions. Socio-demographic, anthropometric and cardio-respiratory parameters were collected. Respiratory sounds were recorded with a digital stethoscope. Frequency at maximum intensity (Fmax), maximum intensity (Imax) and mean intensity (Imean) over the whole frequency range were collected to characterise NRS. Location, mean number, type, duration and frequency were collected to characterise ARS. All analysis was performed per breathing phase (i.e., inspiration and expiration). Results: Forty nine infants enrolled in this study: 25 healthy infants (G1) and 24 infants with LRTI. Inspiratory Fmax (G1: M 116.1 Hz IQR [107.2-132.4] vs G2: M 118.9Hz IQR [113.2-128.7], p=0.244) and expiratory frequencies (G1: M 107.3Hz IQR [102.9-116.9] vs G2: M 112.6Hz IQR [106.6-122.6], p= 0.083) slightly higher than their healthy peers. Wheeze occupation rate was statistically significantly different between groups in inspiration (G1: M 0 IQR [0-0.1] vs G2: M 0.2 IQR [0-5.2] p= 0.032) and expiration (G1: M 0 IQR [0-1.9] vs G2: M 1.5 IQR [0.2-6.7] p= 0.015), being the infants with LRTI the ones presenting more wheezes. Conclusion: Computerised respiratory sounds in healthy infants and infants with LRTI presented differences. The main findings indicated that NRS have Fmax higher in infants with LRTI than in healthy infant and Wh% was the characteristic that differ the most between infant with LRTI and healthy infant.Enquadramento: As infeções respiratórias do trato inferior (IRTI) constituem o principal problema de saúde nos primeiros anos de vida das crianças. Desta forma, a investigação tem-se focado no desenvolvimento de medidas objetivas para o diagnóstico de IRTI, utilizando essencialmente as vantagens da auscultação convencional incorporadas numa análise computorizada e automática. Contudo, apesar da análise computorizada de sons respiratórios ser um método simples de deteção e caraterização dos sons respiratórios normais (SRN) e adventícios (SRA), desconhecem-se quais os valores de referência dos sons respiratórios em crianças, o que limita a sua aplicação na prática clínica Objetivos: Caraterizar e comparar os SRN e os SRA em crianças saudáveis e com IRTI. Métodos: Estudo descritivo, comparativo e transversal realizado em três instituições. Eram elegíveis crianças diagnosticadas pelo pediatra com IRTI e voluntários para crianças saudáveis. Foram recolhidos dados sócio demográficos, antropométricos e parâmetros cardiorrespiratórios. Os sons respiratórios foram registados com um estetoscópio digital. Foram analisados diversos parâmetros para os SRN: a frequência na intensidade máxima (Fmax), a intensidade máxima (Imax) e a média da intensidade ao longo de toda a faixa de frequência (Imean). Nos SRA foram analisados: a taxa de ocupação por wheezes (Wh%), a média wheezes (Wh), o número e o tipo Wh, a frequência e a localização Wh por região; o número crackles (Cr), o tipo e a frequência Cr, a duração da deflexão inicial, da maior deflexão e dos dois ciclos de deflexão dos Cr. Todos estes dados foram analisados por fase do ciclo respiratório (i.e., inspiração e expiração). Resultados: Quarenta e nove crianças foram incluídas neste estudo: 25 saudáveis (G1) e 24 com IRTI (G2). A Fmax inspiratória (G1: M 116,1 Hz IQR [107,2-132,4] vs G2: M 118.9Hz IQR [113,2-128,7], p = 0,244) e expiratória (G1: M 107.3Hz IQR [102,9-116,9] vs G2: M 112.6Hz IQR [106,6-122,6], p = 0,083) foi superior nas crianças com IRTI relativamente às crianças saudáveis. A Wh% foi significativamente superior nas crianças com IRTI, relativamente às crianças saudáveis na inspiração (G1: M 0 IQR [0-0,1] vs G2: M 0,2 IQR [0-5,2] p = 0,032) e na expiração (G1: M 0 IQR [0-1,9] vs G2: M 1,5 IQR [0,2-6,7] p = 0,015). Conclusão: Os sons respiratórios computorizados de crianças saudáveis e com IRTI apresentam diferenças. Os principais resultados indicam que os sons respiratórios normais apresentam uma Fmax maior em crianças com IRTI do que em saudáveis e que Wh% é a característica que mais difere entre os dois grupos

Computerized respiratory sounds: a comparison between patients with stable and exacerbated COPD

INTRODUCTION: Diagnosis of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is often challenging as it relies on patients' clinical presentation. Computerized respiratory sounds (CRS), namely crackles and wheezes, may have the potential to contribute for the objective diagnosis/monitoring of an AECOPD. OBJECTIVES: This study explored if CRS differ during stable and exacerbation periods in patients with COPD. METHODS: 13 patients with stable COPD and 14 with AECOPD were enrolled. CRS were recorded simultaneously at trachea, anterior, lateral and posterior chest locations using seven stethoscopes. Airflow (0.4-0.6l/s) was recorded with a pneumotachograph. Breathing phases were detected using airflow signals; crackles and wheezes with validated algorithms. RESULTS: At trachea, anterior and lateral chest, no significant differences were found between the two groups in the number of inspiratory/expiratory crackles or inspiratory wheeze occupation rate. At posterior chest, the number of crackles (median 2.97-3.17 vs. 0.83-1.2, P < 0.001) and wheeze occupation rate (median 3.28%-3.8% vs. 1.12%-1.77%, P = 0.014-0.016) during both inspiration and expiration were significantly higher in patients with AECOPD than in stable patients. During expiration, wheeze occupation rate was also significantly higher in patients with AECOPD at trachea (median 3.12% vs. 0.79%, P < 0.001) and anterior chest (median 3.55% vs. 1.28%, P < 0.001). CONCLUSION: Crackles and wheezes are more frequent in patients with AECOPD than in stable patients, particularly at posterior chest. These findings suggest that these CRS can contribute to the objective diagnosis/monitoring of AECOPD, which is especially valuable considering that they can be obtained by integrating computerized techniques with pulmonary auscultation, a noninvasive method that is a component of patients' physical examination

RIBS@UA: interface to collect and store respiratory data, a preliminary study

Objectives: The development of effective graphical user interfaces (GUIs) has been in an emergent demand in healthcare technologies, for assessing, managing and storing patients’ clinical data. Nevertheless, specifically for respiratory care there is a lack of tools to produce a multimedia database, where the main respiratory clinical data can be available in a single repository. Therefore, this study reports on the development of a usable application to collect, organise and store respiratory-related data in a single multimedia database. Methods: A GUI, named RIBS@UA, organised in a multilayer of windows was developed in MATLAB and evaluated. The evaluation consisted of usability inspection (by two respiratory health professionals and two system designers during the development of the prototype) and usability testing (by seven physiotherapists). Results: The users reported on the utility of the new application and its potential to be used in clinical/research settings. It was also stated that RIBS@UA facilitates diagnosis/assessment and contributes to the implementation of standardised interventions and treatment procedures. Nevertheless, some drawbacks were identified and suggestions were given to improve the content of specific features in the physiotherapy sessions window. Conclusions: RIBS@UA interface is an innovative application to collect, store and organise the main respiratory-related data, in a single multimedia database. Nevertheless, further improvements are still recommended before the final implementation of RIBS@UA

Effects of a respiratory physiotherapy session in patients with LRTI: a pre/post-test study

Introduction The role of respiratory physiotherapy (RP) in lower respiratory tract infections (LRTI) has been questioned. However, studies have focused on hospitalised patients, and the presence/absence of an underlying disease has been neglected. Objectives To assess the effects of a RP session in community patients with LRTI and to explore the differences between patients with pneumonia (restrictive disease – AR) and those with exacerbations of an obstructive disease (AO). Methods A pre/post-test study was conducted. A RP session was applied to patients with LRTI and crackles, wheezes, dyspnoea, perception of sputum and oxygen saturation were collected pre/post session. Comparisons were performed using paired t-tests or Wilcoxon tests. Results Thirty patients (14 males, 55.23 ± 17.78 years) with pneumonia (AR, n = 12), exacerbations of chronic obstructive pulmonary disease, acute bronchitis and asthma (AO, n = 18) were enrolled. After treatment, the total sample presented lower wheeze rates at trachea (P = 0.02; r = −0.54) and less sputum (P = 0.01; r = −0.47). AR patients presented a decrease in the number of crackles (P < 0.05; 0.30 < dz < 0.26) and number and rate of wheezes at chest locations (P < 0.05; −0.56 < r < −0.48). AO patients showed an increase in the number of crackles (P < 0.05; 0.20 <dz <0.31), wheeze frequency (P = 0.03; r = −0.27) and dyspnoea (P = 0.04; r = −0.55); and a decrease in the number of wheezes at trachea (P = 0.02; r = −0.54). Conclusions RP seems effective in reducing wheezes and perception of sputum in patients with LRTI. However, when considering AR and AO diseases separately, further changes in respiratory sounds and dyspnoea emerged. This highlights the importance of considering subgroups of patients with LRTI to develop RP evidence-base practice

Computerized respiratory sounds are a reliable marker in COPD

Introduction: Computerized respiratory sounds (RS) have shown potential to monitor respiratory status in patients with COPD. However, variability and reliability of this promising marker in COPD are unknown. Therefore, this study assessed the variability and reliability of RS at distinct airflows and standardized anatomic locations in patients with COPD. Methods: A two-part study was conducted. Part one assessed the intra-subject reliability of RS at spontaneous and target (0.4-0.6L/s and 0.7-1L/s) airflows in 13 outpatients (69.3±8.6yrs; FEV1 70.9±21.4% predicted). Part two characterized the inter-subject variability and intrasubject reliability of RS at each standardized anatomic location, using the most reliable airflow, in a sample of 63 outpatients (67.3±10.4yrs; FEV1 75.4±22.9% predicted). RS were recorded simultaneously at seven anatomic locations (trachea, right and left: anterior, lateral and posterior chest). Airflow was recorded with a pneumotachograph. Normal RS intensity, mean number of crackl and wheezes were analyzed with developed algorithms. Inter-subject variability was assessed with the coefficient of variation (CV) and intra-subject reliability with Intraclass Correlation Coefficient (ICC) and Bland and Altman plots. Results: Relative reliability was moderate to excellent for normal RS intensity and mean number of crackles (ICCs .66-.89) and excellent for mean number of wheezes (ICCs .75-.99) at the three airflows. Absolute reliability was greater at target airflows; especially at 0.4-0.6L/s. Intersubject variability was high for all RS parameters and across locations (CV .12-2.22). RS parameters had acceptable relative and absolute intra-subject reliability at the different anatomic locations. The only exception was the mean number of crackles at trachea, which relative and absolute reliability was poor. Conclusions: RS parameters are more reliable at an airflow of 0.4-0.6L/s and overall reliable at all anatomic locations. This should be considered in future studies using computerized auscutation

Enhancing our understanding of computerised adventitious respiratory sounds in different COPD phases and healthy people

Background: Timely diagnosis of acute exacerbations of COPD (AECOPD) is challenging as it depends on patients’ reports. AECOPD are characterised by increased airway obstruction, mucus and air trapping, which results in changes in lung acoustics. Thus, adventitious respiratory sounds (ARS) may be useful to detect/monitor AECOPD. Objective: To evaluate computerised ARS changes during AECOPD. Methods: 25 non-hospitalised patients with AECOPD (16♂ 70 [62.5–77.0]yrs, FEV1 59 [31.5–73.0]%predicted) and 34 healthy volunteers (17♂ 63.5 [57.7–72.3]yrs, FEV1 103.0 [88.8–125.3]%predicted) were enrolled. ARS at anterior and posterior right and left chest were recorded at hospital presentation (T1), 15 days (T2) and 45 days (T3) after hospital presentation from patients with AECOPD and only once from healthy participants. A subsample of 9 patients (7♂; 66 [60.0–76.0]yrs; FEV1 62 [26.5–74.0]%predicted) was also included to study ARS pre-AECOPD (T0). Number of crackles and wheeze occupation rate (%Wh) were processed using validated algorithms. Results: During AECOPD, patients presented more inspiratory crackles at T1 than T3 (p = 0.013) and more inspiratory %Wh at T1 than T2 (p = 0.006), at posterior chest. Patients with stable COPD presented more inspiratory crackles (p = 0.012), at posterior chest, and more expiratory %Wh, both at anterior (p 0.05). Conclusions: Inspiratory crackles seem to persist until 15 days post exacerbation whilst inspiratory %Wh decreased after this period. ARS seem to be sensitive to monitor AECOPD. This information may allow advances in monitoring the recovery time of patients with AECOPD across all clinical and non-clinical settings.publishe