7 research outputs found

    Evaluación no invasiva del impulso neural respiratorio y su relación con la respuesta mecánica mediante el análisis de señales electromiográficas de músculos respiratorios

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    Respiratory muscle contraction occurs in response to the electrical stimulation of the muscles. These electrical stimuli originate in the respiratory neurons of the brainstem, are transmitted via motor nerves to the neuromuscular junctions and propagate along muscle fibers. Respiratory electromyography measures the electrical activity of respiratory muscles in response to this nerve stimulation. The neural respiratory drive (NRD) is best expressed in a phrenic neurogram, but this is not feasible in humans. Alternatively, measurements of the diaphragm electromyographic signal (EMGdi) would most likely reflect phrenic neurogram activity. EMGdi signal can be recorded using invasive methods, involving the use of needle electrodes or electrodes positioned in the esophagus at the level of the diaphragm. As a non-invasive alternative, the study of respiratory muscle activity can be addressed by surface electromyography. The onset and offset of the neural inspiratory time (nton and ntoff, respectively) are fundamentally important measurements in studies of patient-ventilator interaction, where the level of assistance delivered by the ventilator is controlled by patient demand. Cardiac artifacts (ECG) often make it difficult to utilize EMGdi. To overcome the shortcoming of the ECG, in this thesis is proposed to use sample entropy with fixed tolerance values (fSampEn), a robust technique against impulsive noise. To evaluate nton and ntoff estimation it has been carried out an experimental study with surface EMGdi signals recorded in healthy subjects during two respiratory protocols designed to evaluate the influence of different breathing patterns on the EMGdi. These protocols consisted of a stepwise increase in respiratory rate (RR) with constant fractional inspiratory time (Ti/Ttot) and a stepwise decrement in the Ti/Ttot with constant RR, respectively. The developed algorithms allowed to determine the nton and ntoff and derive the RR, Ti and Ti/Ttot neural ventilatory parameters. The EMGdi amplitude provides a real-time indirect measure of the NRD, which reflects the load on the respiratory muscles. The NRD, assessed by normalized EMGdi signals, is higher in patients with respiratory disease than in healthy subjects. To evaluate the behavior of the fSamp En, as a method for improving the measurement of NRD from EMGdi signals in the presence of cardiac activity, compared to the average rectified value and root mean square value approaches, first, these methods have been applied to synthetic EMGdi signals . Secondly, we tested the proposed methods in an experimental study with EMGdi signals recorded in healthy subjects during an incremental inspiratory load test. The EMGdi amplitude allowed to evaluate changes in the respiratory muscle activation patterns and estimate the NRD. Also, this thesis contributes to the study of the respiratory activity by the non-invasive recording of mechanomyographic low frequency (BF) activity in healthy subjects and in patients with chronic obstructive pulmonary disease, allowing the study of bilateral asynchrony of the diaphragm and the RR. Finally, we have proposed the use of concentric ring electrodes as an alternative to improve the spatial resolution of electromyographic recordings, and eliminate the problems associated with the location and orientation of the bipolar configuration. The approaches presented in this doctoral thesis based on the analysis of electromyographic and mechanomyographic signals of respiratory museles allow to extract complementary information to current use techniques of and contribute to the study of respiratory function in the clinical setting .La contracción de los músculos respiratorios se produce en respuesta a la estimulación eléctrica. Estos estímulos se originan en las neuronas respiratorias del tronco del encéfalo, se transmiten a través de los nervios motores a las uniones neuromusculares y se propagan a lo largo de las fibras musculares. La electromiografía respiratoria mide la actividad eléctrica de los músculos respiratorios en respuesta a esta estimulación nerviosa. El impulso neural respiratorio (NRD) se expresa mejor a través del neurograma frénico, pero esto no es factible en los seres humanos. Como alternativa, la medida de la señal electromiográfica del diafragma (EMGdi) refleja de forma indirecta la actividad frénica. La señal EMGdi puede registrarse utilizando métodos invasivos, lo que implica el uso de electrodos de aguja o electrodos colocados en el esófago a nivel del diafragma . Como alternativa no invasiva, el estudio de la actividad muscular respiratoria puede abordarse mediante la electromiografía de superficie. El inicio y fin del tiempo neural inspiratorio (nton y ntoff, respectivamente) son medidas de importancia en los estudios de interacción paciente-ventilador, donde el nivel de la asistencia proporcionada por el ventilador es controlado por la demanda del paciente. Los artefactos cardíacos (ECG) a menudo hacen que sea difícil de utilizar la señal EMGdi. Para superar el inconveniente de la interferencia ECG, en la presente tesis se propone utilizar la entropía muestra! con valores de tolerancia fijos (fSampEn), una técnica que es robusta contra el ruido de tipo impulsivo. Para evaluar la estimación del nton y ntoff se ha realizado un estudio experimental con señales EMGdi superficie registrada en sujetos sanos durante dos protocolos respiratorios, diseñados para evaluar la influencia de los diferentes patrones respiratorios sobre la señal EMGdi. Estos protocolos consistieron en un aumento gradual de la frecuencia respiratoria (RR) con un tiempo inspiratorio (Ti) fracciona! constante (Ti!Ttot) y en una disminución gradual en el Ti!Ttot con una RR constante, respectivamente. Los algoritmos desarrollados han permitido determinar el nton y el ntoff y derivar los parámetros ventilatorios RR, Ti, y TifTtot neurales. La amplitud de la EMGdi proporciona una medida indirecta del NRD, que refleja la carga sobre los músculos respiratorios. El NRD, evaluado en señales EMGdi normalizadas, es mayor en pacientes con enfermedades respiratorias que en sujetos sanos. Para evaluar el comportamiento de la fSampEn, como un método para mejorar la medición del NRD a partir de señales EMGdi en presencia de ECG, en comparación con los enfoques basados en el uso del valor rectificado medio y valor cuadrático medio, primero, se han aplicado estos métodos a señales EMGdi sintéticas . En segundo lugar, hemos probado los métodos propuestos en un estudio experimental con señales EMGdi registradas en sujetos sanos durante una prueba de carga inspiratoria incremental. La amplitud de la EMGdi permitió evaluar los cambios en el patrón de activación de los músculos respiratorios y estimar el NRO. Asimismo, esta tesis doctoral contribuye al estudio de la actividad respiratoria mediante el registro no invasivo de actividad mecanomiográfica de baja frecuencia (BF) en sujetos sanos y en pacientes con enfermedad obstructiva crónica, permitiendo el estudio de la asincronía bilateral del diafragma y la RR. Finalmente, hemos propuesto el uso de electrodos de anillos concéntricos como una alternativa para mejorar la resolución espacial de los registros electromiográficos, y eliminar los problemas asociados a la localización y orientación de la configuración bipolar. Los enfoques presentados en esta tesis doctoral basados en el análisis de señales electromiográficas y mecanomiográficas de los músculo

    High-Performance Accelerometer Based On Asymmetric Gapped Cantilevers For Physiological Acoustic Sensing

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    Continuous or mobile monitoring of physiological sounds is expected to play important role in the emerging mobile healthcare field. Because of the miniature size, low cost, and easy installation, accelerometer is an excellent choice for continuous physiological acoustic signal monitoring. However, in order to capture the detailed information in the physiological signals for clinical diagnostic purpose, there are more demanding requirements on the sensitivity/noise performance of accelerometers. In this thesis, a unique piezoelectric accelerometer based on the asymmetric gapped cantilever which exhibits significantly improved sensitivity is extensively studied. A meso-scale prototype is developed for capturing the high quality cardio and respiratory sounds on healthy people as well as on heart failure patients. A cascaded gapped cantilever based accelerometer is also explored for low frequency vibration sensing applications such as ballistocardiogram monitoring. Finally, to address the power issues of wireless sensors such as wireless wearable health monitors, a wide band vibration energy harvester based on a folded gapped cantilever is developed and demonstrated on a ceiling air condition unit

    Evaluación no invasiva de la función muscular respiratoria mediante el análisis de la señal mecanomiográfica en pacientes con enfermedad pulmonar obstructiva crónica

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    El estudio y evaluación de la función muscular respiratoria en enfermedades respiratorias a través de técnicas no invasivas representa un tema de gran interés, dado que hasta la fecha no existen métodos satisfactorios aplicables en situaciones clínicas. En la enfermedad pulmonar obstructiva crónica (EPOC), el trabajo mecánico de los músculos respiratorios aumenta dando lugar a la fatiga, disminución de los movimientos de la caja torácica, y por tanto una disminución de la eficiencia muscular respiratoria. Es conocido que el músculo diafragma, principal responsable de la actividad mecánica respiratoria, al igual que otros músculos esqueléticos vibra lateralmente durante su contracción. De ahí, que estas vibraciones puedan ser registradas mediante micrófonos, sensores piezoeléctricos o acelerómetros posicionados encima de la pared inferior del pecho en la zona de aposición del diafragma con la caja torácica. El registro de estas vibraciones da lugar a la señal mecanomiográfica del diafragma (MMGdi). El principal objetivo de esta tesis ha sido el estudio y caracterización no invasiva de la función muscular respiratoria en pacientes con EPOC a través de la señal MMGdi registrada mediante acelerómetros posicionados entre el séptimo y octavo espacios intercostales, en la línea axilar izquierda y derecha del cuerpo durante la realización de los protocolos respiratorios de carga incremental progresiva y de flujo incremental progresivo. Para mejorar la estimación de la amplitud de la señal MMGdi se han propuesto tres nuevos índices, que tienen en cuenta la naturaleza aleatoria y el ruido asociado en las señales MMGdi, y están basados en: el algoritmo de Lempel-Ziv (LZM), la entropía aproximada (fApEn), y la entropía muestral (fSampEn). Todos ellos son calculados con intervalos de cuantificación fijos y empleando ventanas móviles. Los resultados obtenidos con éstos índices han permitido estimar con mayor fiabilidad y robustez la amplitud de las señales MMGdi, en relación a los métodos clásicos utilizados en el estudio de señales miográficas. El estudio del valor medio de los parámetros analizados ha mostrado, que existe una tendencia incremental de éste en los parámetros de amplitud, y una tendencia decreciente en los parámetros frecuenciales (frecuencias media y máxima), con el incremento de la carga y/o flujo. En este sentido, se ha observado que el valor medio es mayor cuanto mayor es la severidad del paciente con EPOC. Por otra parte, se ha observado que existe una fuerte correlación entre los parámetros de amplitud y la presión inspiratoria máxima en el protocolo de flujo incremental progresivo, con una tendencia decreciente con la severidad. Del mismo modo la eficiencia muscular respiratoria, evaluada como la relación entre la fuerza que producen los músculos respiratorios (la presión inspiratoria en boca) y lo que gastan o necesitan para producir esta presión (la vibración de los músculos respiratorios evaluada mediante las señales MMGdi), ha mostrado en general una tendencia decreciente con el aumento de la severidad. Finalmente, los resultados que se desprenden de esta tesis indican que el estudio de la señal MMGdi representa una herramienta útil con un gran potencial para evaluar el grado de la severidad presente en sujetos con EPOC y su relación con la debilidad de la musculatura respiratoria, y por tanto su aplicación en estudios clínicos podría ser de gran ayuda para evaluar el desarrollo de la EPOC.The study and evaluation of the respiratory muscles function in people who suffer from respiratory diseases can be evaluated through the use of noninvasive techniques. This is a topic of great interest considering there are currently no existing methods that can be successfully applied in clinical situations. In chronic obstructive pulmonary disease (COPD), the mechanical work of the respiratory muscles increases, which could lead to muscular fatigue, decreased movement of the ribcage, and, therefore, a decrease in the respiratory muscle efficiency. The diaphragm muscle is the principal muscle of inspiration and the main mechanical responsible for the ventilation. Similar to other skeletal muscles the diaphragm laterally vibrates during its contraction. These vibrations can be recorded by microphones, piezoelectric sensors or accelerometers, which are placed above the lower chest wall in the area of apposition of the diaphragm to the ribcage. The record of these vibrations is known as mechanomyographic signal of the diaphragm muscle (MMGdi). The main objective of this thesis has been the study and noninvasive characterization of the respiratory muscles function in patients with COPD. This characterization has been made possible through the use of MMGdi signals recorded by accelerometers placed between the seventh and eighth intercostals spaces on the left and right anterior axillary lines of the body during two respiratory protocols. The first protocol is called progressive incremental load protocol and the second one progressive incremental flow protocol. In this thesis three new indices have been proposed to improve the MMGdi amplitude estimation. These indices take into account the random nature and the associated noise in the MMGdi signals, and are based on the: Lempel-Ziv algorithm (MLZ), approximate entropy (fApEn), and sample entropy (fSampEn). All of them are calculated with fixed quantization intervals and using moving windows. The obtained results with these new indices have shown improved reliability and robustness in the MMGdi amplitude estimation in comparison with classic methods used to study myographic signals. The study of the mean value of the analyzed parameters has shown an increasing trend of the amplitude parameters and a decreasing trend of the frequency parameters (mean and maximum frequencies) with increasing load and/or flow. Furthermore, we found that there was a direct relationship between these mean values and the severity of COPD; hence, the greater the mean value, the greater the severity of COPD. Moreover, we have seen that there is a strong correlation between the amplitude parameters and the maximum inspiratory pressure in the progressive incremental flow protocol with a decreasing trend as the severity of the patients increases. Likewise, the respiratory muscle efficiency, evaluated as the ratio between the force produced by the respiratory muscles (mouth inspiratory pressure) and what they need to produce this pressure (the vibration of respiratory muscles assessed by MMGdi signals), has also shown a generally decreasing trend as the severity of patients increases. Finally, the results of this thesis suggest that the study of the MMGdi signal is a useful tool with great potential to assess the relationship between respiratory muscle weakness and the degree of severity in patients with COPD. Therefore, the application of this innovative tool in clinical studies may be helpful to assess the development of COPD

    Computational Intelligence in Electromyography Analysis

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    Electromyography (EMG) is a technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG may be used clinically for the diagnosis of neuromuscular problems and for assessing biomechanical and motor control deficits and other functional disorders. Furthermore, it can be used as a control signal for interfacing with orthotic and/or prosthetic devices or other rehabilitation assists. This book presents an updated overview of signal processing applications and recent developments in EMG from a number of diverse aspects and various applications in clinical and experimental research. It will provide readers with a detailed introduction to EMG signal processing techniques and applications, while presenting several new results and explanation of existing algorithms. This book is organized into 18 chapters, covering the current theoretical and practical approaches of EMG research

    A Systematic Review and Meta-Analysis of the Incidence of Injury in Professional Female Soccer

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    The epidemiology of injury in male professional football is well documented and has been used as a basis to monitor injury trends and implement injury prevention strategies. There are no systematic reviews that have investigated injury incidence in women’s professional football. Therefore, the extent of injury burden in women’s professional football remains unknown. PURPOSE: The primary aim of this study was to calculate an overall incidence rate of injury in senior female professional soccer. The secondary aims were to provide an incidence rate for training and match play. METHODS: PubMed, Discover, EBSCO, Embase and ScienceDirect electronic databases were searched from inception to September 2018. Two reviewers independently assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement using a 22-item STROBE checklist. Seven prospective studies (n=1137 professional players) were combined in a pooled analysis of injury incidence using a mixed effects model. Heterogeneity was evaluated using the Cochrane Q statistic and I2. RESULTS: The epidemiological incidence proportion over one season was 0.62 (95% CI 0.59 - 0.64). Mean total incidence of injury was 3.15 (95% CI 1.54 - 4.75) injuries per 1000 hours. The mean incidence of injury during match play was 10.72 (95% CI 9.11 - 12.33) and during training was 2.21 (95% CI 0.96 - 3.45). Data analysis found a significant level of heterogeneity (total Incidence, X2 = 16.57 P < 0.05; I2 = 63.8%) and during subsequent sub group analyses in those studies reviewed (match incidence, X2 = 76.4 (d.f. = 7), P <0.05; I2 = 90.8%, training incidence, X2 = 16.97 (d.f. = 7), P < 0.05; I2 = 58.8%). Appraisal of the study methodologies revealed inconsistency in the use of injury terminology, data collection procedures and calculation of exposure by researchers. Such inconsistencies likely contribute to the large variance in the incidence and prevalence of injury reported. CONCLUSIONS: The estimated risk of sustaining at least one injury over one football season is 62%. Continued reporting of heterogeneous results in population samples limits meaningful comparison of studies. Standardising the criteria used to attribute injury and activity coupled with more accurate methods of calculating exposure will overcome such limitations
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