Evaluating Attentional Impulsivity: A Biomechatronic Approach

Executive function, also known as executive control, is a multifaceted construct encompassing several cognitive abilities, including working memory, attention, impulse control, and cognitive flexibility. To accurately measure executive functioning skills, it is necessary to develop assessment tools and strategies that can quantify the behaviors associated with cognitive control. Impulsivity, a range of cognitive control deficits, is typically evaluated using conventional neuropsychological tests. However, this study proposes a biomechatronic approach to assess impulsivity as a behavioral construct, in line with traditional neuropsychological assessments. The study involved thirty-four healthy adults who completed the Barratt Impulsiveness Scale (BIS-11) as an initial step. A low-cost biomechatronic system was developed, and an approach based on standard neuropsychological tests, including the trail-making test and serial subtraction-by-seven, was used to evaluate impulsivity. Three tests were conducted: WTMT-A (numbers only), WTMT-B (numbers and letters), and a dual-task of WTMT-A and serial subtraction-by-seven. The preliminary findings suggest that the proposed instrument and experiments successfully generated an attentional impulsivity score and differentiated between participants with high and low attentional impulsivity.Comment: 10 pages, 5 figures, 5 table

Non-invasive wearable sensing systems for continuous health monitoring and long-term behavior modeling

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Electrical Engineering and Computer Science, February 2006.Includes bibliographical references (p. 212-228).Deploying new healthcare technologies for proactive health and elder care will become a major priority over the next decade, as medical care systems worldwide become strained by the aging populations. This thesis presents LiveNet, a distributed mobile system based on low-cost commodity hardware that can be deployed for a variety of healthcare applications. LiveNet embodies a flexible infrastructure platform intended for long-term ambulatory health monitoring with real-time data streaming and context classification capabilities. Using LiveNet, we are able to continuously monitor a wide range of physiological signals together with the user's activity and context, to develop a personalized, data-rich health profile of a user over time. Most clinical sensing technologies that exist have focused on accuracy and reliability, at the expense of cost-effectiveness, burden on the patient, and portability. Future proactive health technologies, on the other hand, must be affordable, unobtrusive, and non-invasive if the general population is going to adopt them.(cont.) In this thesis, we focus on the potential of using features derived from minimally invasive physiological and contextual sensors such as motion, speech, heart rate, skin conductance, and temperature/heat flux that can be used in combination with mobile technology to create powerful context-aware systems that are transparent to the user. In many cases, these non-invasive sensing technologies can completely replace more invasive diagnostic sensing for applications in long-term monitoring, behavior and physiology trending, and real-time proactive feedback and alert systems. Non-invasive sensing technologies are particularly important in ambulatory and continuous monitoring applications, where more cumbersome sensing equipment that is typically found in medical and clinical research settings is not usable. The research in this thesis demonstrates that it is possible to use simple non-invasive physiological and contextual sensing using the LiveNet system to accurately classify a variety of physiological conditions. We demonstrate that non-invasive sensing can be correlated to a variety of important physiological and behavioral phenomenon, and thus can serve as substitutes to more invasive and unwieldy forms of medical monitoring devices while still providing a high level of diagnostic power.(cont.) From this foundation, the LiveNet system is deployed in a number of studies to quantify physiological and contextual state. First, a number of classifiers for important health and general contextual cues such as activity state and stress level are developed from basic non-invasive physiological sensing. We then demonstrate that the LiveNet system can be used to develop systems that can classify clinically significant physiological and pathological conditions and that are robust in the presence of noise, motion artifacts, and other adverse conditions found in real-world situations. This is highlighted in a cold exposure and core body temperature study in collaboration with the U.S. Army Research Institute of Environmental Medicine. In this study, we show that it is possible to develop real-time implementations of these classifiers for proactive health monitors that can provide instantaneous feedback relevant in soldier monitoring applications. This thesis also demonstrates that the LiveNet platform can be used for long-term continuous monitoring applications to study physiological trends that vary slowly with time.(cont.) In a clinical study with the Psychiatry Department at the Massachusetts General Hospital, the LiveNet platform is used to continuously monitor clinically depressed patients during their stays on an in-patient ward for treatment. We show that we can accurately correlate physiology and behavior to depression state, as well as to track changes in depression state over time through the course of treatment. This study demonstrates how long-term physiology and behavioral changes can be captured to objectively measure medical treatment and medication efficacy. In another long-term monitoring study, the LiveNet platform is used to collect data on people's everyday behavior as they go through daily life. By collecting long-term behavioral data, we demonstrate the possibility of modeling and predicting high-level behavior using simple physiologic and contextual information derived solely from ambulatory mobile sensing technology.by Michael Sung.Ph.D

Performance Factors in Neurosurgical Simulation and Augmented Reality Image Guidance

Virtual reality surgical simulators have seen widespread adoption in an effort to provide safe, cost-effective and realistic practice of surgical skills. However, the majority of these simulators focus on training low-level technical skills, providing only prototypical surgical cases. For many complex procedures, this approach is deficient in representing anatomical variations that present clinically, failing to challenge users’ higher-level cognitive skills important for navigation and targeting. Surgical simulators offer the means to not only simulate any case conceivable, but to test novel approaches and examine factors that influence performance. Unfortunately, there is a void in the literature surrounding these questions. This thesis was motivated by the need to expand the role of surgical simulators to provide users with clinically relevant scenarios and evaluate human performance in relation to image guidance technologies, patient-specific anatomy, and cognitive abilities. To this end, various tools and methodologies were developed to examine cognitive abilities and knowledge, simulate procedures, and guide complex interventions all within a neurosurgical context. The first chapter provides an introduction to the material. The second chapter describes the development and evaluation of a virtual anatomical training and examination tool. The results suggest that learning occurs and that spatial reasoning ability is an important performance predictor, but subordinate to anatomical knowledge. The third chapter outlines development of automation tools to enable efficient simulation studies and data management. In the fourth chapter, subjects perform abstract targeting tasks on ellipsoid targets with and without augmented reality guidance. While the guidance tool improved accuracy, performance with the tool was strongly tied to target depth estimation – an important consideration for implementation and training with similar guidance tools. In the fifth chapter, neurosurgically experienced subjects were recruited to perform simulated ventriculostomies. Results showed anatomical variations influence performance and could impact outcome. Augmented reality guidance showed no marked improvement in performance, but exhibited a mild learning curve, indicating that additional training may be warranted. The final chapter summarizes the work presented. Our results and novel evaluative methodologies lay the groundwork for further investigation into simulators as versatile research tools to explore performance factors in simulated surgical procedures

Use of informatics methods to identify problems and then design, develop and evaluate solutions to support health workers in their management of malaria...

Malaria is both a preventable and curable disease if treated early and appropriately. However, it is estimated that every 30 seconds a child dies of malaria in sub-Saharan Africa. The use of innovative eHealth/mHealth tools for malaria that seamlessly integrate into the workflow of healthcare workers could potentially ameliorate this problem. Successful design and development of these tools require an overarching understanding of the socio-technical context for the problems and opportunities in the application domain. A series of studies involving malaria management in the Millennium Village Project (MVP) cluster in rural Ghana were performed. A new method introduced by the author was applied to prioritize health information needs of stakeholders that have the potential to have a higher impact in solving health related problems. The result of applying this method was a group of impactful interventions for the MVP malaria program in Ghana. Findings from this study were validated with the MVP Ghana eHealth team, and after mutual agreement, an eHealth/mHealth intervention around malaria supply chain management was selected for further study. User-Centered Design (UCD) methods were adapted for use in a resource poor setting. Functional and non-functional requirements were identified. A low fidelity prototype was created and early usability inputs were collected. A high fidelity prototype was created to provide decision support to health workers through visualizations of stock levels and recommendations of quantities to order. Results from evaluation studies of the high fidelity prototype with end users suggest that they perceive the prototype as both easy to use and useful, with a potential for adoption and with a low risk of implementation. Usability problems found during the course of the study should be addressed to increase the potential of adoption. To obtain a more complete list of usability issues, both users’ and experts’ evaluations are recommended as well as the use of native and foreign test facilitators

Beyond mobile apps: a survey of technologies for mental well-being

Mental health problems are on the rise globally and strain national health systems worldwide. Mental disorders are closely associated with fear of stigma, structural barriers such as financial burden, and lack of available services and resources which often prohibit the delivery of frequent clinical advice and monitoring. Technologies for mental well-being exhibit a range of attractive properties, which facilitate the delivery of state-of-the-art clinical monitoring. This review article provides an overview of traditional techniques followed by their technological alternatives, sensing devices, behaviour changing tools, and feedback interfaces. The challenges presented by these technologies are then discussed with data collection, privacy, and battery life being some of the key issues which need to be carefully considered for the successful deployment of mental health toolkits. Finally, the opportunities this growing research area presents are discussed including the use of portable tangible interfaces combining sensing and feedback technologies. Capitalising on the data these ubiquitous devices can record, state of the art machine learning algorithms can lead to the development of robust clinical decision support tools towards diagnosis and improvement of mental well-being delivery in real-time

Quantifying Quality of Life

Describes technological methods and tools for objective and quantitative assessment of QoL Appraises technology-enabled methods for incorporating QoL measurements in medicine Highlights the success factors for adoption and scaling of technology-enabled methods This open access book presents the rise of technology-enabled methods and tools for objective, quantitative assessment of Quality of Life (QoL), while following the WHOQOL model. It is an in-depth resource describing and examining state-of-the-art, minimally obtrusive, ubiquitous technologies. Highlighting the required factors for adoption and scaling of technology-enabled methods and tools for QoL assessment, it also describes how these technologies can be leveraged for behavior change, disease prevention, health management and long-term QoL enhancement in populations at large. Quantifying Quality of Life: Incorporating Daily Life into Medicine fills a gap in the field of QoL by providing assessment methods, techniques and tools. These assessments differ from the current methods that are now mostly infrequent, subjective, qualitative, memory-based, context-poor and sparse. Therefore, it is an ideal resource for physicians, physicians in training, software and hardware developers, computer scientists, data scientists, behavioural scientists, entrepreneurs, healthcare leaders and administrators who are seeking an up-to-date resource on this subject

Tracking Visible Features of Speech for Computer-Based Speech Therapy for Childhood Apraxia of Speech

At present, there are few, if any, effective computer-based speech therapy systems (CBSTs) that support the at-home component for clinical interventions for Childhood Apraxia of Speech (CAS). PROMPT, an established speech therapy intervention for CAS, has the potential to be supported via a CBST, which could increase engagement and provide valuable feedback to the child. However, the necessary computational techniques have not yet been developed and evaluated. In this thesis, I will describe the development of some of the key underlying computational components that are required for the development of such a system. These components concern camera-based tracking of visible features of speech which concern jaw kinematics. These components would also be necessary for the serious game that we have envisioned

Automatic Pain Assessment by Learning from Multiple Biopotentials

Kivun täsmällinen arviointi on tärkeää kivunhallinnassa, erityisesti sairaan- hoitoa vaativille ipupotilaille. Kipu on subjektiivista, sillä se ei ole pelkästään aistituntemus, vaan siihen saattaa liittyä myös tunnekokemuksia. Tällöin itsearviointiin perustuvat kipuasteikot ovat tärkein työkalu, niin auan kun potilas pystyy kokemuksensa arvioimaan. Arviointi on kuitenkin haasteellista potilailla, jotka eivät itse pysty kertomaan kivustaan. Kliinisessä hoito- työssä kipua pyritään objektiivisesti arvioimaan esimerkiksi havainnoimalla fysiologisia muuttujia kuten sykettä ja käyttäytymistä esimerkiksi potilaan kasvonilmeiden perusteella. Tutkimuksen päätavoitteena on automatisoida arviointiprosessi hyödyntämällä koneoppimismenetelmiä yhdessä biosignaalien prosessointnin kanssa. Tavoitteen saavuttamiseksi mitattiin autonomista keskushermoston toimintaa kuvastavia biopotentiaaleja: sydänsähkökäyrää, galvaanista ihoreaktiota ja kasvolihasliikkeitä mittaavaa lihassähkökäyrää. Mittaukset tehtiin terveillä vapaaehtoisilla, joille aiheutettiin kokeellista kipuärsykettä. Järestelmän kehittämiseen tarvittavaa tietokantaa varten rakennettiin biopotentiaaleja keräävä Internet of Things -pohjainen tallennusjärjestelmä. Koostetun tietokannan avulla kehitettiin biosignaaleille prosessointimenetelmä jatku- vaan kivun arviointiin. Signaaleista eroteltiin piirteitä sekuntitasoon mukautetuilla aikaikkunoilla. Piirteet visualisoitiin ja tarkasteltiin eri luokittelijoilla kivun ja kiputason tunnistamiseksi. Parhailla luokittelumenetelmillä saavutettiin kivuntunnistukseen 90% herkkyyskyky (sensitivity) ja 84% erottelukyky (specificity) ja kivun voimakkuuden arviointiin 62,5% tarkkuus (accuracy). Tulokset vahvistavat kyseisen käsittelytavan käyttökelpoisuuden erityis- esti tunnistettaessa kipua yksittäisessä arviointi-ikkunassa. Tutkimus vahvistaa biopotentiaalien avulla kehitettävän automatisoidun kivun arvioinnin toteutettavuuden kokeellisella kivulla, rohkaisten etenemään todellisen kivun tutkimiseen samoilla menetelmillä. Menetelmää kehitettäessä suoritettiin lisäksi vertailua ja yhteenvetoa automaattiseen kivuntunnistukseen kehitettyjen eri tutkimusten välisistä samankaltaisuuksista ja eroista. Tarkastelussa löytyi signaalien eroavaisuuksien lisäksi tutkimusmuotojen aiheuttamaa eroa arviointitavoitteisiin, mikä hankaloitti tutkimusten vertailua. Lisäksi pohdit- tiin mitkä perinteisten prosessointitapojen osiot rajoittavat tai edistävät ennustekykyä ja miten, sekä tuoko optimointi läpimurtoa järjestelmän näkökulmasta.Accurate pain assessment plays an important role in proper pain management, especially among hospitalized people experience acute pain. Pain is subjective in nature which is not only a sensory feeling but could also combine affective factors. Therefore self-report pain scales are the main assessment tools as long as patients are able to self-report. However, it remains a challenge to assess the pain from the patients who cannot self-report. In clinical practice, physiological parameters like heart rate and pain behaviors including facial expressions are observed as empirical references to infer pain objectively. The main aim of this study is to automate such process by leveraging machine learning methods and biosignal processing. To achieve this goal, biopotentials reflecting autonomic nervous system activities including electrocardiogram and galvanic skin response, and facial expressions measured with facial electromyograms were recorded from healthy volunteers undergoing experimental pain stimulus. IoT-enabled biopotential acquisition systems were developed to build the database aiming at providing compact and wearable solutions. Using the database, a biosignal processing flow was developed for continuous pain estimation. Signal features were extracted with customized time window lengths and updated every second. The extracted features were visualized and fed into multiple classifiers trained to estimate the presence of pain and pain intensity separately. Among the tested classifiers, the best pain presence estimating sensitivity achieved was 90% (specificity 84%) and the best pain intensity estimation accuracy achieved was 62.5%. The results show the validity of the proposed processing flow, especially in pain presence estimation at window level. This study adds one more piece of evidence on the feasibility of developing an automatic pain assessment tool from biopotentials, thus providing the confidence to move forward to real pain cases. In addition to the method development, the similarities and differences between automatic pain assessment studies were compared and summarized. It was found that in addition to the diversity of signals, the estimation goals also differed as a result of different study designs which made cross dataset comparison challenging. We also tried to discuss which parts in the classical processing flow would limit or boost the prediction performance and whether optimization can bring a breakthrough from the system’s perspective