A Review of Non-Invasive Techniques to Detect and Predict Localised Muscle Fatigue

Muscle fatigue is an established area of research and various types of muscle fatigue have been investigated in order to fully understand the condition. This paper gives an overview of the various non-invasive techniques available for use in automated fatigue detection, such as mechanomyography, electromyography, near-infrared spectroscopy and ultrasound for both isometric and non-isometric contractions. Various signal analysis methods are compared by illustrating their applicability in real-time settings. This paper will be of interest to researchers who wish to select the most appropriate methodology for research on muscle fatigue detection or prediction, or for the development of devices that can be used in, e.g., sports scenarios to improve performance or prevent injury. To date, research on localised muscle fatigue focuses mainly on the clinical side. There is very little research carried out on the implementation of detecting/predicting fatigue using an autonomous system, although recent research on automating the process of localised muscle fatigue detection/prediction shows promising results

Prolonged Low-Level Exposure to the Aroma of Peppermint Essential Oil Enhances Aspects of Cognition and Mood in Healthy Adults

The possible positive impact of aromas of plant essential oils is an area with a long history and one that is receiving increasing interest from modern science. Previous research has demonstrated beneficial effects of acute exposure on a range of variables. The current study set out to investigate for the first time whether extended exposure to the aroma of peppermint essential oil could provide benefits to healthy young adults. One hundred participants were randomly assigned to either wear a peppermint infused non-transdermal skin patch or a blank patch, for a period of six hours during which time they went about their normal daily routine. Cognitive and mood assessments were completed and a multivariate analysis of variance indicated a significant difference to exist between the two groups when all variables were analysed together. Further analyses on the individual variables revealed small to medium positive effects of peppermint aroma on aspects of memory and attention and feelings of subjective alertness. These findings add to a growing body of evidence that suggests aroma of peppermint essential oil may act as a positive and easy intervention delivering beneficial objective and subjective outcomes. The findings are discussed in terms of putative mechanisms that might underpin the effects with a focus on possible pharmacological influences

Design and conduct of 'Xtreme Alps' : a double-blind, randomised controlled study of the effects of dietary nitrate supplementation on acclimatisation to high altitude

The study of healthy human volunteers ascending to high altitude provides a robust model of the complex physiological interplay that emulates human adaptation to hypoxaemia in clinical conditions. Nitric oxide (NO) metabolism may play an important role in both adaptation to high altitude and response to hypoxaemia during critical illness at sea level. Circulating nitrate and nitrite concentrations can be augmented by dietary supplementation and this is associated with improved exercise performance and mitochondrial efficiency. We hypothesised that the administration of a dietary substance (beetroot juice) rich in nitrate would improve oxygen efficiency during exercise at high altitude by enhancing tissue microcirculatory blood flow and oxygenation. Furthermore, nitrate supplementation would lead to measurable increases in NO bioactivity throughout the body. This methodological manuscript describes the design and conduct of the ‘Xtreme Alps’ expedition, a double-blind randomised controlled trial investigating the effects of dietary nitrate supplementation on acclimatisation to hypobaric hypoxia at high altitude in healthy human volunteers. The primary outcome measure was the change in oxygen efficiency during exercise at high altitude between participants allocated to receive nitrate supplementation and those receiving a placebo. A number of secondary measures were recorded, including exercise capacity, peripheral and microcirculatory blood flow and tissue oxygenation. Results from this study will further elucidate the role of NO in adaption to hypoxaemia and guide clinical trials in critically ill patients. Improved understanding of hypoxaemia in critical illness may provide new therapeutic avenues for interventions that will improve survival in critically ill patients

New Horizons in Time-Domain Diffuse Optical Spectroscopy and Imaging

Jöbsis was the first to describe the in vivo application of near-infrared spectroscopy (NIRS), also called diffuse optical spectroscopy (DOS). NIRS was originally designed for the clinical monitoring of tissue oxygenation, and today it has also become a useful tool for neuroimaging studies (functional near-infrared spectroscopy, fNIRS). However, difficulties in the selective and quantitative measurements of tissue hemoglobin (Hb), which have been central in the NIRS field for over 40 years, remain to be solved. To overcome these problems, time-domain (TD) and frequency-domain (FD) measurements have been tried. Presently, a wide range of NIRS instruments are available, including commonly available commercial instruments for continuous wave (CW) measurements, based on the modified Beer–Lambert law (steady-state domain measurements). Among these measurements, the TD measurement is the most promising approach, although compared with CW and FD measurements, TD measurements are less common, due to the need for large and expensive instruments with poor temporal resolution and limited dynamic range. However, thanks to technological developments, TD measurements are increasingly being used in research, and also in various clinical settings. This Special Issue highlights issues at the cutting edge of TD DOS and diffuse optical tomography (DOT). It covers all aspects related to TD measurements, including advances in hardware, methodology, the theory of light propagation, and clinical applications

Neuroergonomic Assessment of Wheelchair Control Using Mobile fNIRS

For over two centuries, the wheelchair has been one of the most common assistive devices for individuals with locomotor impairments without many modifications. Wheelchair control is a complex motor task that increases both the physical and cognitive workload. New wheelchair interfaces, including Power Assisted devices, can further augment users by reducing the required physical effort, however little is known on the mental effort implications. In this study, we adopted a neuroergonomic approach utilizing mobile and wireless functional near infrared spectroscopy (fNIRS) based brain monitoring of physically active participants. 48 volunteers (30 novice and 18 experienced) self-propelled on a wheelchair with and without a PowerAssist interface in both simple and complex realistic environments. Results indicated that as expected, the complex more difficult environment led to lower task performance complemented by higher prefrontal cortex activity compared to the simple environment. The use of the PowerAssist feature had significantly lower brain activation compared to traditional manual control only for novices. Expertise led to a lower brain activation pattern within the middle frontal gyrus, complemented by performance metrics that involve lower cognitive workload. Results here confirm the potential of the Neuroergonomic approach and that direct neural activity measures can complement and enhance task performance metrics. We conclude that the cognitive workload benefits of PowerAssist are more directed to new users and difficult settings. The approach demonstrated here can be utilized in future studies to enable greater personalization and understanding of mobility interfaces within real-world dynamic environments

Steps towards “Patient-Tailored therapy” in intensive care: the role of microvascular monitoring

openIntroduzione: La ”Patient-tailored therapy” è un approccio terapeutico al paziente critico che prevede di utilizzare al meglio le evidenze scientifiche della Evidence Based Medicine, caratterizzando però ogni singolo paziente, allo scopo di utilizzare le terapie di seconda linea solo qualora specificatamente indicate. Metodi: Nel contesto della patient-tailored therapy il monitoraggio bedside del microcircolo sublinguale potrebbe avere un ruolo importante. Questo lavoro riporta una serie di studi clinici atti a contestualizzare il monitoraggio del microcircolo sublinguale nella pratica clinica quotidiana della terapia intensiva, evidenziandone problemi aperti e recenti evoluzioni. Sono quindi descritti i risultati di alcuni studi clinici che valutano la risposta del microcircolo a singoli trattamenti, la relazione con markers e biomarkers. Risultati: Questo lavoro vuole individuare stato dell’arte, prospettive future e limiti del monitoraggio bedside del microcircolo nel contesto di patient-tailored therapy. Conclusioni: Una migliore caratterizzazione del paziente critico, che includa il monitoraggio del microcircolo subliguale, potrebbe aprire la strada ad un filone di ricerca scientifica specifico e a risvolti terapeutici estremamente interessanti.This manuscript describes the new concept of "Patient-tailored therapy" and the possible and doable role of microvascular monitoring in critical care patients. The patient-tailored approach combines the EBM (Evidence Base Medicine) provided by international guidelines with a more single-patient-focused attitude. In critical care patients microcirculation can be severely impaired, and if this derangement is not corrected, microcirculatory dysfunction can lead to respiratory distress in tissue cells and to subsequent organ injury. Therefore, bedside microvascular monitoring should be part of the careful characterization of our patients and of the patient-tailored approach in critical care.SCIENZE BIOMEDICHEembargoed_20210930Domizi, Robert

Motor learning induced neuroplasticity in minimally invasive surgery

Technical skills in surgery have become more complex and challenging to acquire since the introduction of technological aids, particularly in the arena of Minimally Invasive Surgery. Additional challenges posed by reforms to surgical careers and increased public scrutiny, have propelled identification of methods to assess and acquire MIS technical skills. Although validated objective assessments have been developed to assess motor skills requisite for MIS, they poorly understand the development of expertise. Motor skills learning, is indirectly observable, an internal process leading to relative permanent changes in the central nervous system. Advances in functional neuroimaging permit direct interrogation of evolving patterns of brain function associated with motor learning due to the property of neuroplasticity and has been used on surgeons to identify the neural correlates for technical skills acquisition and the impact of new technology. However significant gaps exist in understanding neuroplasticity underlying learning complex bimanual MIS skills. In this thesis the available evidence on applying functional neuroimaging towards assessment and enhancing operative performance in the field of surgery has been synthesized. The purpose of this thesis was to evaluate frontal lobe neuroplasticity associated with learning a complex bimanual MIS skill using functional near-infrared spectroscopy an indirect neuroimaging technique. Laparoscopic suturing and knot-tying a technically challenging bimanual skill is selected to demonstrate learning related reorganisation of cortical behaviour within the frontal lobe by shifts in activation from the prefrontal cortex (PFC) subserving attention to primary and secondary motor centres (premotor cortex, supplementary motor area and primary motor cortex) in which motor sequences are encoded and executed. In the cross-sectional study, participants of varying expertise demonstrate frontal lobe neuroplasticity commensurate with motor learning. The longitudinal study involves tracking evolution in cortical behaviour of novices in response to receipt of eight hours distributed training over a fortnight. Despite novices achieving expert like performance and stabilisation on the technical task, this study demonstrates that novices displayed persistent PFC activity. This study establishes for complex bimanual tasks, that improvements in technical performance do not accompany a reduced reliance in attention to support performance. Finally, least-squares support vector machine is used to classify expertise based on frontal lobe functional connectivity. Findings of this thesis demonstrate the value of interrogating cortical behaviour towards assessing MIS skills development and credentialing.Open Acces

Measuring cognitive load and cognition: metrics for technology-enhanced learning

This critical and reflective literature review examines international research published over the last decade to summarise the different kinds of measures that have been used to explore cognitive load and critiques the strengths and limitations of those focussed on the development of direct empirical approaches. Over the last 40 years, cognitive load theory has become established as one of the most successful and influential theoretical explanations of cognitive processing during learning. Despite this success, attempts to obtain direct objective measures of the theory's central theoretical construct – cognitive load – have proved elusive. This obstacle represents the most significant outstanding challenge for successfully embedding the theoretical and experimental work on cognitive load in empirical data from authentic learning situations. Progress to date on the theoretical and practical approaches to cognitive load are discussed along with the influences of individual differences on cognitive load in order to assess the prospects for the development and application of direct empirical measures of cognitive load especially in technology-rich contexts