Unconstrained video monitoring of breathing behavior and application to diagnosis of sleep apnea

This paper presents a new real-time automated infrared video monitoring technique for detection of breathing anomalies, and its application in the diagnosis of obstructive sleep apnea. We introduce a novel motion model to detect subtle, cyclical breathing signals from video, a new 3-D unsupervised self-adaptive breathing template to learn individuals' normal breathing patterns online, and a robust action classification method to recognize abnormal breathing activities and limb movements. This technique avoids imposing positional constraints on the patient, allowing patients to sleep on their back or side, with or without facing the camera, fully or partially occluded by the bed clothes. Moreover, shallow and abdominal breathing patterns do not adversely affect the performance of the method, and it is insensitive to environmental settings such as infrared lighting levels and camera view angles. The experimental results show that the technique achieves high accuracy (94% for the clinical data) in recognizing apnea episodes and body movements and is robust to various occlusion levels, body poses, body movements (i.e., minor head movement, limb movement, body rotation, and slight torso movement), and breathing behavior (e.g., shallow versus heavy breathing, mouth breathing, chest breathing, and abdominal breathing). © 2013 IEEE

Wearable sensors system for an improved analysis of freezing of gait in Parkinson's disease using electromyography and inertial signals

We propose a wearable sensor system for automatic, continuous and ubiquitous analysis of Freezing of Gait (FOG), in patients affected by Parkinson's disease. FOG is an unpredictable gait disorder with different clinical manifestations, as the trembling and the shuffling-like phenotypes, whose underlying pathophysiology is not fully understood yet. Typical trembling-like subtype features are lack of postural adaptation and abrupt trunk inclination, which in general can increase the fall probability. The targets of this work are detecting the FOG episodes, distinguishing the phenotype and analyzing the muscle activity during and outside FOG, toward a deeper insight in the disorder pathophysiology and the assessment of the fall risk associated to the FOG subtype. To this aim, gyroscopes and surface electromyography integrated in wearable devices sense simultaneously movements and action potentials of antagonist leg muscles. Dedicated algorithms allow the timely detection of the FOG episode and, for the first time, the automatic distinction of the FOG phenotypes, which can enable associating a fall risk to the subtype. Thanks to the possibility of detecting muscles contractions and stretching exactly during FOG, a deeper insight into the pathophysiological underpinnings of the different phenotypes can be achieved, which is an innovative approach with respect to the state of art

Objective dysphonia quantification in vocal fold paralysis: comparing nonlinear with classical measures

Clinical acoustic voice recording analysis is usually performed using classical perturbation measures including jitter, shimmer and noise-to-harmonic ratios. However, restrictive mathematical limitations of these measures prevent analysis for severely dysphonic voices. Previous studies of alternative nonlinear random measures addressed wide varieties of vocal pathologies. Here, we analyze a single vocal pathology cohort, testing the performance of these alternative measures alongside classical measures.

We present voice analysis pre- and post-operatively in unilateral vocal fold paralysis (UVFP) patients and healthy controls, patients undergoing standard medialisation thyroplasty surgery, using jitter, shimmer and noise-to-harmonic ratio (NHR), and nonlinear recurrence period density entropy (RPDE), detrended fluctuation analysis (DFA) and correlation dimension. Systematizing the preparative editing of the recordings, we found that the novel measures were more stable and hence reliable, than the classical measures, on healthy controls.

RPDE and jitter are sensitive to improvements pre- to post-operation. Shimmer, NHR and DFA showed no significant change (p > 0.05). All measures detect statistically significant and clinically important differences between controls and patients, both treated and untreated (p < 0.001, AUC > 0.7). Pre- to post-operation, GRBAS ratings show statistically significant and clinically important improvement in overall dysphonia grade (G) (AUC = 0.946, p < 0.001).

Re-calculating AUCs from other study data, we compare these results in terms of clinical importance. We conclude that, when preparative editing is systematized, nonlinear random measures may be useful UVFP treatment effectiveness monitoring tools, and there may be applications for other forms of dysphonia.
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Intervention and Prevention of Hereditary Hemolytic Disorders in Two Ethnic Communities of Sundargarh District of Orissa, India: An Experience from KAP Studies

Hereditary hemolytic disorders are important public health challenges in India. They cause a high degree of morbidity, mortality and fetal wastage in vulnerable communities. Tradition-bound-psychosocial influences are detrimental to the process of prevention. This study was designed to create awareness, motivate, and sensitize two major vulnerable tribal communities: Bhuyan and Kharia for hemoglobin and allied hemolytic disorders in addition to imparting prospective and retrospective genetic/marriage counseling. Bhuyan and Kharia tribal people in Orissa live in clusters practicing inter-village tribal endogamy and clan exogamy. For the present study, random sampling procedure for the selection of whole village was followed. Imparting of education, motivation and sensitization for carrier detection were carried out through IEC materials, holding interactive meetings and discussions at district, block and village levels. Both prospective and retrospective intervention and genetic/marriage counseling was done through the local PHC doctor. The pre- and post-intervention knowledge, attitude and practice (KAP) studies were conducted. Tribal people were not knowing the signs and symptoms of sickle cell disease (2.1%) and beta-thalassemia (1.0%), but after IEC, their knowledge was considerably improved (67.8%, 56.4%, respectively). Sickle cell patient needs treatment (37.6%) like folic acid, blood transfusion, etc. Beta-thalassemia is disease causes bloodlessness and is a transfusion dependent (73.2%). All patients of thalassemia major or sickle cell disease have carrier parents and carriers do not suffer from any clinical ailments. After intervention, it was known that G-6-PD is an enzyme, which helps in glucose metabolism of red cells (76.4%) and its hereditary deficiency causes hemolytic anemia, jaundice and black urination (73.8%) in malaria cases when anti-malarials are administered. Methodical and prudent intervention and preventive strategies found positive and encouraging impact on the affected people. Success of strategy showed apparent overwhelming response of the tribal people towards changing the traditional mindset and improving their health and quality of life

Analysis of Vocal Disorders in a Feature Space

This paper provides a way to classify vocal disorders for clinical applications. This goal is achieved by means of geometric signal separation in a feature space. Typical quantities from chaos theory (like entropy, correlation dimension and first lyapunov exponent) and some conventional ones (like autocorrelation and spectral factor) are analysed and evaluated, in order to provide entries for the feature vectors. A way of quantifying the amount of disorder is proposed by means of an healthy index that measures the distance of a voice sample from the centre of mass of both healthy and sick clusters in the feature space. A successful application of the geometrical signal separation is reported, concerning distinction between normal and disordered phonation.Comment: 12 pages, 3 figures, accepted for publication in Medical Engineering & Physic

Contactless recording of sleep apnea and periodic leg movements by nocturnal 3-D-video and subsequent visual perceptive computing

Contactless measurements during the night by a 3-D-camera are less time-consuming in comparison to polysomnography because they do not require sophisticated wiring. However, it is not clear what might be the diagnostic benefit and accuracy of this technology. We investigated 59 persons simultaneously by polysomnography and 3-D-camera and visual perceptive computing (19 patients with restless legs syndrome (RLS), 21 patients with obstructive sleep apnea (OSA), and 19 healthy volunteers). There was a significant correlation between the apnea hypopnea index (AHI) measured by polysomnography and respiratory events measured with the 3-D-camera in OSA patients (r = 0.823; p < 0.001). The receiver operating characteristic curve yielded a sensitivity of 90% for OSA with a specificity of 71.4%. In RLS patients 72.8% of leg movements confirmed by polysomnography could be detected by 3-D-video and a significant moderate correlation was found between PLM measured by polysomnography and by the 3-D-camera (RLS: r = 0.654; p = 0.004). In total, 95.4% of the sleep epochs were correctly classified by the machine learning approach, but only 32.5% of awake epochs. Further studies should investigate, if this technique might be an alternative to home sleep testing in persons with an increased pre-test probability for OSA