Understanding personalized dynamics to inform precision medicine: a dynamic time warp analysis of 255 depressed inpatients

Background: Major depressive disorder (MDD) shows large heterogeneity of symptoms between patients, but within patients, particular symptom clusters may show similar trajectories. While symptom clusters and networks have mostly been studied using cross-sectional designs, temporal dynamics of symptoms within patients may yield information that facilitates personalized medicine. Here, we aim to cluster depressive symptom dynamics through dynamic time warping (DTW) analysis. Methods: The 17-item Hamilton Rating Scale for Depression (HRSD-17) was administered every 2 weeks for a median of 11 weeks in 255 depressed inpatients. The DTW analysis modeled the temporal dynamics of each pair of individual HRSD-17 items within each patient (i.e., 69,360 calculated “DTW distances”). Subsequently, hierarchical clustering and network models were estimated based on similarities in symptom dynamics both within each patient and at the group level. Results: The sample had a mean age of 51 (SD 15.4), and 64.7% were female. Clusters and networks based on symptom dynamics markedly differed across patients. At the group level, five dynamic symptom clusters emerged, which differed from a previously published cross-sectional network. Patients who showed treatment response or remission had the shortest average DTW distance, indicating denser networks with more synchronous symptom trajectories. Conclusions: Symptom dynamics over time can be clustered and visualized using DTW. DTW represents a promising new approach for studying symptom dynamics with the potential to facilitate personalized psychiatric care

A modular approach for modeling, detecting, and tracking freezing of gait in Parkinson disease using inertial sensors

Parkinson disease, the second most common neurodegenerative disorder, is caused by the loss of dopaminergic subcortical neurons. Approximately 50% of people with Parkinson disease experience freezing of gait (FOG), a brief, episodic absence or marked reduction of forward progression of the feet despite the intention to walk. FOG causes falls and is resistant to medication in more than 50% of cases. FOG episodes can often be interrupted by mechanical interventions (e.g., a verbal reminder to march), but it is often not practical to apply these interventions on demand (e.g., there is not usually another person to detect an FOG episode and provide the reminder).Wearable sensors offer the possibility of detecting FOG episodes in real time and thus developing a “closed-loop” treatment: real-time detection can be coupled with on-demand interventions. Objective evaluation methods using wearable sensor technology to monitor and assess FOG have met with varying success. They do not use a signal model that captures FOG patterns explicitly, and they are of limited help in understanding the underlying mechanisms in the structure of the sensor data captured during FOG. In this dissertation, we first develop physically-based signal models for the sensor data, design statistical signal processing methods to detect FOG based on its patterns, and compute the probability of FOG. Then, we proceed to validate the system, using data from experimental gait assessment in a group of people with Parkinson disease.We further develop a modular approach to model, detect, and track FOG in Parkinson disease, using four modules, namely the detection, navigation, validation, and filtering modules. To capture the gait motion, we use an inertial measurement unit (IMU) consisting of a three-axis accelerometer and a three-axis gyroscope. We first build physically-based signal models that describe “no movement” and “trembling motion” during FOG events. In the detection module, we design a generalized likelihood ratio test framework to develop a two-stage detector for determining the zero-velocity event intervals (ZVEI) and trembling event intervals (TREI) that are associated with FOG. However, not all the detected TREI are associated with FOG. Therefore, to filter out the TREI which are not associated with FOG, we consider the fact that the alternating trembling motion in FOG is associated with low foot speeds and small pitch angles. Next, to estimate these gait parameters, we employ a zero-velocity aided inertial navigation system (ZV-INS) in the navigation module. The ZV-INS uses the ZVEI as pseudo measurements, along with a Kalman filter, to estimate the position, velocity, and orientation angles of the foot.To track the degradation of the gait parameters prior to the incidence of FOG, we detect valid gait cycles in the validation module. We first identify the non-stationary segments of the gyroscope signal in the sagittal plane, using ZVEI. Next, we preprocess the non-stationary segments by scaling and interpolating the signal. Finally, we validate the preprocessed non-stationary segment of the gyroscope signal in the sagittal plane as a valid gait cycle, using an optimization framework called sparsity-assisted wavelet denoising (SAWD). In the SAWD algorithm, we simultaneously combine low-pass filtering, multiresolution representations (wavelets), and a sparsity-inducing norm to obtain a sparse representation of the gyroscope signal in the sagittal plane for valid gait cycles, in the form of a discrete wavelet transform coefficient vector. We compute the root-mean-square error between the generated template and the sparse representation of the non-stationary segment of the gyroscope data in the sagittal plane, obtained using the SAWD algorithm. If the root-mean-square error is less than a fixed threshold, then the gait cycle is considered valid.Finally, to detect the onset and duration of FOG, we develop a point-process filter that computes the probability of FOG (pFOG). We model the edges of the TREI as a point-process, then assign weights to the edges, which depend on a participant-specific tunable parameter and the average value of the gait parameters observed in the bin containing the edge. To compute pFOG, we develop a Bayesian recursive filter and integrate the weights assigned to the edges of the TREI over a time window. To adaptively adjust the participant-specific tunable parameter, we develop two novel approaches that assign weights to the edges of the TREI based on the gait parameters extracted from the last valid gait cycle and the foot motion dynamics. We validate the performance of the modular system design using real data obtained from people with Parkinson disease who performed a battery of gait tasks known to trigger FOG. The results indicate improved performance, with an average accuracy greater than 85% and an average false positive rate of less than 14%. Altogether, we not only improve the accuracy of FOG detection but also open new avenues towards the development of low-cost remote health monitoring systems, which will help provide insights into the frequency and patterns of FOG that affect the quality of daily life in people with Parkinson disease

Wearable Sensors in the Evaluation of Gait and Balance in Neurological Disorders

The aging population and the increased prevalence of neurological diseases have raised the issue of gait and balance disorders as a major public concern worldwide. Indeed, gait and balance disorders are responsible for a high healthcare and economic burden on society, thus, requiring new solutions to prevent harmful consequences. Recently, wearable sensors have provided new challenges and opportunities to address this issue through innovative diagnostic and therapeutic strategies. Accordingly, the book “Wearable Sensors in the Evaluation of Gait and Balance in Neurological Disorders” collects the most up-to-date information about the objective evaluation of gait and balance disorders, by means of wearable biosensors, in patients with various types of neurological diseases, including Parkinson’s disease, multiple sclerosis, stroke, traumatic brain injury, and cerebellar ataxia. By adopting wearable technologies, the sixteen original research articles and reviews included in this book offer an updated overview of the most recent approaches for the objective evaluation of gait and balance disorders

Recent Advances in Motion Analysis

The advances in the technology and methodology for human movement capture and analysis over the last decade have been remarkable. Besides acknowledged approaches for kinematic, dynamic, and electromyographic (EMG) analysis carried out in the laboratory, more recently developed devices, such as wearables, inertial measurement units, ambient sensors, and cameras or depth sensors, have been adopted on a wide scale. Furthermore, computational intelligence (CI) methods, such as artificial neural networks, have recently emerged as promising tools for the development and application of intelligent systems in motion analysis. Thus, the synergy of classic instrumentation and novel smart devices and techniques has created unique capabilities in the continuous monitoring of motor behaviors in different fields, such as clinics, sports, and ergonomics. However, real-time sensing, signal processing, human activity recognition, and characterization and interpretation of motion metrics and behaviors from sensor data still representing a challenging problem not only in laboratories but also at home and in the community. This book addresses open research issues related to the improvement of classic approaches and the development of novel technologies and techniques in the domain of motion analysis in all the various fields of application

Sensing via signal analysis, analytics, and cyberbiometric patterns

Includes bibliographical references.2022 Fall.Internet-connected, or Internet of Things (IoT), sensor technologies have been increasingly incorporated into everyday technology and processes. Their functions are situationally dependent and have been used for vital recordings such as electrocardiograms, gait analysis and step counting, fall detection, and environmental analysis. For instance, environmental sensors, which exist through various technologies, are used to monitor numerous domains, including but not limited to pollution, water quality, and the presence of biota, among others. Past research into IoT sensors has varied depending on the technology. For instance, previous environmental gas sensor IoT research has focused on (i) the development of these sensors for increased sensitivity and increased lifetimes, (ii) integration of these sensors into sensor arrays to combat cross-sensitivity and background interferences, and (iii) sensor network development, including communication between widely dispersed sensors in a large-scale environment. IoT inertial measurement units (IMU's), such as accelerometers and gyroscopes, have been previously researched for gait analysis, movement detection, and gesture recognition, which are often related to human-computer interface (HCI). Methods of IoT Device feature-based pattern recognition for machine learning (ML) and artificial intelligence (AI) are frequently investigated as well, including primitive classification methods and deep learning techniques. The result of this research gives insight into each of these topics individually, i.e., using a specific sensor technology to detect carbon monoxide in an indoor environment, or using accelerometer readings for gesture recognition. Less research has been performed on analyzing the systems aspects of the IoT sensors themselves. However, an important part of attaining overall situational awareness is authenticating the surroundings, which in the case of IoT means the individual sensors, humans interacting with the sensors, and other elements of the surroundings. There is a clear opportunity for the systematic evaluation of the identity and performance of an IoT sensor/sensor array within a system that is to be utilized for "full situational awareness". This awareness may include (i) non-invasive diagnostics (i.e., what is occurring inside the body), (ii) exposure analysis (i.e., what has gone into the body through both respiratory and eating/drinking pathways), and (iii) potential risk of exposure (i.e., what the body is exposed to environmentally). Simultaneously, the system has the capability to harbor security measures through the same situational assessment in the form of multiple levels of biometrics. Through the interconnective abilities of the IoT sensors, it is possible to integrate these capabilities into one portable, hand-held system. The system will exist within a "magic wand", which will be used to collect the various data needed to assess the environment of the user, both inside and outside of their bodies. The device can also be used to authenticate the user, as well as the system components, to discover potential deception within the system. This research introduces levels of biometrics for various scenarios through the investigation of challenge-based biometrics; that is, biometrics based upon how the sensor, user, or subject of study responds to a challenge. These will be applied to multiple facets surrounding "situational awareness" for living beings, non-human beings, and non-living items or objects (which we have termed "abiometrics"). Gesture recognition for intent of sensing was first investigated as a means of deliberate activation of sensors/sensor arrays for situational awareness while providing a level of user authentication through biometrics. Equine gait analysis was examined next, and the level of injury in the lame limbs of the horse was quantitatively measured and classified using data from IoT sensors. Finally, a method of evaluating the identity and health of a sensor/sensory array was examined through different challenges to their environments

Intelligent Biosignal Processing in Wearable and Implantable Sensors

This reprint provides a collection of papers illustrating the state-of-the-art of smart processing of data coming from wearable, implantable or portable sensors. Each paper presents the design, databases used, methodological background, obtained results, and their interpretation for biomedical applications. Revealing examples are brain–machine interfaces for medical rehabilitation, the evaluation of sympathetic nerve activity, a novel automated diagnostic tool based on ECG data to diagnose COVID-19, machine learning-based hypertension risk assessment by means of photoplethysmography and electrocardiography signals, Parkinsonian gait assessment using machine learning tools, thorough analysis of compressive sensing of ECG signals, development of a nanotechnology application for decoding vagus-nerve activity, detection of liver dysfunction using a wearable electronic nose system, prosthetic hand control using surface electromyography, epileptic seizure detection using a CNN, and premature ventricular contraction detection using deep metric learning. Thus, this reprint presents significant clinical applications as well as valuable new research issues, providing current illustrations of this new field of research by addressing the promises, challenges, and hurdles associated with the synergy of biosignal processing and AI through 16 different pertinent studies. Covering a wide range of research and application areas, this book is an excellent resource for researchers, physicians, academics, and PhD or master students working on (bio)signal and image processing, AI, biomaterials, biomechanics, and biotechnology with applications in medicine

Wearables for Movement Analysis in Healthcare

Quantitative movement analysis is widely used in clinical practice and research to investigate movement disorders objectively and in a complete way. Conventionally, body segment kinematic and kinetic parameters are measured in gait laboratories using marker-based optoelectronic systems, force plates, and electromyographic systems. Although movement analyses are considered accurate, the availability of specific laboratories, high costs, and dependency on trained users sometimes limit its use in clinical practice. A variety of compact wearable sensors are available today and have allowed researchers and clinicians to pursue applications in which individuals are monitored in their homes and in community settings within different fields of study, such movement analysis. Wearable sensors may thus contribute to the implementation of quantitative movement analyses even during out-patient use to reduce evaluation times and to provide objective, quantifiable data on the patients’ capabilities, unobtrusively and continuously, for clinical purposes

Wearable and BAN Sensors for Physical Rehabilitation and eHealth Architectures

The demographic shift of the population towards an increase in the number of elderly citizens, together with the sedentary lifestyle we are adopting, is reflected in the increasingly debilitated physical health of the population. The resulting physical impairments require rehabilitation therapies which may be assisted by the use of wearable sensors or body area network sensors (BANs). The use of novel technology for medical therapies can also contribute to reducing the costs in healthcare systems and decrease patient overflow in medical centers. Sensors are the primary enablers of any wearable medical device, with a central role in eHealth architectures. The accuracy of the acquired data depends on the sensors; hence, when considering wearable and BAN sensing integration, they must be proven to be accurate and reliable solutions. This book is a collection of works focusing on the current state-of-the-art of BANs and wearable sensing devices for physical rehabilitation of impaired or debilitated citizens. The manuscripts that compose this book report on the advances in the research related to different sensing technologies (optical or electronic) and body area network sensors (BANs), their design and implementation, advanced signal processing techniques, and the application of these technologies in areas such as physical rehabilitation, robotics, medical diagnostics, and therapy

Intelligent Sensors for Human Motion Analysis

The book, "Intelligent Sensors for Human Motion Analysis," contains 17 articles published in the Special Issue of the Sensors journal. These articles deal with many aspects related to the analysis of human movement. New techniques and methods for pose estimation, gait recognition, and fall detection have been proposed and verified. Some of them will trigger further research, and some may become the backbone of commercial systems