Sensing and Signal Processing in Smart Healthcare

In the last decade, we have witnessed the rapid development of electronic technologies that are transforming our daily lives. Such technologies are often integrated with various sensors that facilitate the collection of human motion and physiological data and are equipped with wireless communication modules such as Bluetooth, radio frequency identification, and near-field communication. In smart healthcare applications, designing ergonomic and intuitive human–computer interfaces is crucial because a system that is not easy to use will create a huge obstacle to adoption and may significantly reduce the efficacy of the solution. Signal and data processing is another important consideration in smart healthcare applications because it must ensure high accuracy with a high level of confidence in order for the applications to be useful for clinicians in making diagnosis and treatment decisions. This Special Issue is a collection of 10 articles selected from a total of 26 contributions. These contributions span the areas of signal processing and smart healthcare systems mostly contributed by authors from Europe, including Italy, Spain, France, Portugal, Romania, Sweden, and Netherlands. Authors from China, Korea, Taiwan, Indonesia, and Ecuador are also included

State of the art of audio- and video based solutions for AAL

Working Group 3. Audio- and Video-based AAL ApplicationsIt is a matter of fact that Europe is facing more and more crucial challenges regarding health and social care due to the demographic change and the current economic context. The recent COVID-19 pandemic has stressed this situation even further, thus highlighting the need for taking action. Active and Assisted Living (AAL) technologies come as a viable approach to help facing these challenges, thanks to the high potential they have in enabling remote care and support. Broadly speaking, AAL can be referred to as the use of innovative and advanced Information and Communication Technologies to create supportive, inclusive and empowering applications and environments that enable older, impaired or frail people to live independently and stay active longer in society. AAL capitalizes on the growing pervasiveness and effectiveness of sensing and computing facilities to supply the persons in need with smart assistance, by responding to their necessities of autonomy, independence, comfort, security and safety. The application scenarios addressed by AAL are complex, due to the inherent heterogeneity of the end-user population, their living arrangements, and their physical conditions or impairment. Despite aiming at diverse goals, AAL systems should share some common characteristics. They are designed to provide support in daily life in an invisible, unobtrusive and user-friendly manner. Moreover, they are conceived to be intelligent, to be able to learn and adapt to the requirements and requests of the assisted people, and to synchronise with their specific needs. Nevertheless, to ensure the uptake of AAL in society, potential users must be willing to use AAL applications and to integrate them in their daily environments and lives. In this respect, video- and audio-based AAL applications have several advantages, in terms of unobtrusiveness and information richness. Indeed, cameras and microphones are far less obtrusive with respect to the hindrance other wearable sensors may cause to one’s activities. In addition, a single camera placed in a room can record most of the activities performed in the room, thus replacing many other non-visual sensors. Currently, video-based applications are effective in recognising and monitoring the activities, the movements, and the overall conditions of the assisted individuals as well as to assess their vital parameters (e.g., heart rate, respiratory rate). Similarly, audio sensors have the potential to become one of the most important modalities for interaction with AAL systems, as they can have a large range of sensing, do not require physical presence at a particular location and are physically intangible. Moreover, relevant information about individuals’ activities and health status can derive from processing audio signals (e.g., speech recordings). Nevertheless, as the other side of the coin, cameras and microphones are often perceived as the most intrusive technologies from the viewpoint of the privacy of the monitored individuals. This is due to the richness of the information these technologies convey and the intimate setting where they may be deployed. Solutions able to ensure privacy preservation by context and by design, as well as to ensure high legal and ethical standards are in high demand. After the review of the current state of play and the discussion in GoodBrother, we may claim that the first solutions in this direction are starting to appear in the literature. A multidisciplinary 4 debate among experts and stakeholders is paving the way towards AAL ensuring ergonomics, usability, acceptance and privacy preservation. The DIANA, PAAL, and VisuAAL projects are examples of this fresh approach. This report provides the reader with a review of the most recent advances in audio- and video-based monitoring technologies for AAL. It has been drafted as a collective effort of WG3 to supply an introduction to AAL, its evolution over time and its main functional and technological underpinnings. In this respect, the report contributes to the field with the outline of a new generation of ethical-aware AAL technologies and a proposal for a novel comprehensive taxonomy of AAL systems and applications. Moreover, the report allows non-technical readers to gather an overview of the main components of an AAL system and how these function and interact with the end-users. The report illustrates the state of the art of the most successful AAL applications and functions based on audio and video data, namely (i) lifelogging and self-monitoring, (ii) remote monitoring of vital signs, (iii) emotional state recognition, (iv) food intake monitoring, activity and behaviour recognition, (v) activity and personal assistance, (vi) gesture recognition, (vii) fall detection and prevention, (viii) mobility assessment and frailty recognition, and (ix) cognitive and motor rehabilitation. For these application scenarios, the report illustrates the state of play in terms of scientific advances, available products and research project. The open challenges are also highlighted. The report ends with an overview of the challenges, the hindrances and the opportunities posed by the uptake in real world settings of AAL technologies. In this respect, the report illustrates the current procedural and technological approaches to cope with acceptability, usability and trust in the AAL technology, by surveying strategies and approaches to co-design, to privacy preservation in video and audio data, to transparency and explainability in data processing, and to data transmission and communication. User acceptance and ethical considerations are also debated. Finally, the potentials coming from the silver economy are overviewed.publishedVersio

Earables: Wearable Computing on the Ears

Kopfhörer haben sich bei Verbrauchern durchgesetzt, da sie private Audiokanäle anbieten, zum Beispiel zum Hören von Musik, zum Anschauen der neuesten Filme während dem Pendeln oder zum freihändigen Telefonieren. Dank diesem eindeutigen primären Einsatzzweck haben sich Kopfhörer im Vergleich zu anderen Wearables, wie zum Beispiel Smartglasses, bereits stärker durchgesetzt. In den letzten Jahren hat sich eine neue Klasse von Wearables herausgebildet, die als "Earables" bezeichnet werden. Diese Geräte sind so konzipiert, dass sie in oder um die Ohren getragen werden können. Sie enthalten verschiedene Sensoren, um die Funktionalität von Kopfhörern zu erweitern. Die räumliche Nähe von Earables zu wichtigen anatomischen Strukturen des menschlichen Körpers bietet eine ausgezeichnete Plattform für die Erfassung einer Vielzahl von Eigenschaften, Prozessen und Aktivitäten. Auch wenn im Bereich der Earables-Forschung bereits einige Fortschritte erzielt wurden, wird deren Potenzial aktuell nicht vollständig abgeschöpft. Ziel dieser Dissertation ist es daher, neue Einblicke in die Möglichkeiten von Earables zu geben, indem fortschrittliche Sensorikansätze erforscht werden, welche die Erkennung von bisher unzugänglichen Phänomenen ermöglichen. Durch die Einführung von neuartiger Hardware und Algorithmik zielt diese Dissertation darauf ab, die Grenzen des Erreichbaren im Bereich Earables zu verschieben und diese letztlich als vielseitige Sensorplattform zur Erweiterung menschlicher Fähigkeiten zu etablieren. Um eine fundierte Grundlage für die Dissertation zu schaffen, synthetisiert die vorliegende Arbeit den Stand der Technik im Bereich der ohr-basierten Sensorik und stellt eine einzigartig umfassende Taxonomie auf der Basis von 271 relevanten Publikationen vor. Durch die Verbindung von Low-Level-Sensor-Prinzipien mit Higher-Level-Phänomenen werden in der Dissertation anschließ-end Arbeiten aus verschiedenen Bereichen zusammengefasst, darunter (i) physiologische Überwachung und Gesundheit, (ii) Bewegung und Aktivität, (iii) Interaktion und (iv) Authentifizierung und Identifizierung. Diese Dissertation baut auf der bestehenden Forschung im Bereich der physiologischen Überwachung und Gesundheit mit Hilfe von Earables auf und stellt fortschrittliche Algorithmen, statistische Auswertungen und empirische Studien vor, um die Machbarkeit der Messung der Atemfrequenz und der Erkennung von Episoden erhöhter Hustenfrequenz durch den Einsatz von In-Ear-Beschleunigungsmessern und Gyroskopen zu demonstrieren. Diese neuartigen Sensorfunktionen unterstreichen das Potenzial von Earables, einen gesünderen Lebensstil zu fördern und eine proaktive Gesundheitsversorgung zu ermöglichen. Darüber hinaus wird in dieser Dissertation ein innovativer Eye-Tracking-Ansatz namens "earEOG" vorgestellt, welcher Aktivitätserkennung erleichtern soll. Durch die systematische Auswertung von Elektrodenpotentialen, die um die Ohren herum mittels eines modifizierten Kopfhörers gemessen werden, eröffnet diese Dissertation einen neuen Weg zur Messung der Blickrichtung. Dabei ist das Verfahren weniger aufdringlich und komfortabler als bisherige Ansätze. Darüber hinaus wird ein Regressionsmodell eingeführt, um absolute Änderungen des Blickwinkels auf der Grundlage von earEOG vorherzusagen. Diese Entwicklung eröffnet neue Möglichkeiten für Forschung, welche sich nahtlos in das tägliche Leben integrieren lässt und tiefere Einblicke in das menschliche Verhalten ermöglicht. Weiterhin zeigt diese Arbeit, wie sich die einzigarte Bauform von Earables mit Sensorik kombinieren lässt, um neuartige Phänomene zu erkennen. Um die Interaktionsmöglichkeiten von Earables zu verbessern, wird in dieser Dissertation eine diskrete Eingabetechnik namens "EarRumble" vorgestellt, die auf der freiwilligen Kontrolle des Tensor Tympani Muskels im Mittelohr beruht. Die Dissertation bietet Einblicke in die Verbreitung, die Benutzerfreundlichkeit und den Komfort von EarRumble, zusammen mit praktischen Anwendungen in zwei realen Szenarien. Der EarRumble-Ansatz erweitert das Ohr von einem rein rezeptiven Organ zu einem Organ, das nicht nur Signale empfangen, sondern auch Ausgangssignale erzeugen kann. Im Wesentlichen wird das Ohr als zusätzliches interaktives Medium eingesetzt, welches eine freihändige und augenfreie Kommunikation zwischen Mensch und Maschine ermöglicht. EarRumble stellt eine Interaktionstechnik vor, die von den Nutzern als "magisch und fast telepathisch" beschrieben wird, und zeigt ein erhebliches ungenutztes Potenzial im Bereich der Earables auf. Aufbauend auf den vorhergehenden Ergebnissen der verschiedenen Anwendungsbereiche und Forschungserkenntnisse mündet die Dissertation in einer offenen Hard- und Software-Plattform für Earables namens "OpenEarable". OpenEarable umfasst eine Reihe fortschrittlicher Sensorfunktionen, die für verschiedene ohrbasierte Forschungsanwendungen geeignet sind, und ist gleichzeitig einfach herzustellen. Hierdurch werden die Einstiegshürden in die ohrbasierte Sensorforschung gesenkt und OpenEarable trägt somit dazu bei, das gesamte Potenzial von Earables auszuschöpfen. Darüber hinaus trägt die Dissertation grundlegenden Designrichtlinien und Referenzarchitekturen für Earables bei. Durch diese Forschung schließt die Dissertation die Lücke zwischen der Grundlagenforschung zu ohrbasierten Sensoren und deren praktischem Einsatz in realen Szenarien. Zusammenfassend liefert die Dissertation neue Nutzungsszenarien, Algorithmen, Hardware-Prototypen, statistische Auswertungen, empirische Studien und Designrichtlinien, um das Feld des Earable Computing voranzutreiben. Darüber hinaus erweitert diese Dissertation den traditionellen Anwendungsbereich von Kopfhörern, indem sie die auf Audio fokussierten Geräte zu einer Plattform erweitert, welche eine Vielzahl fortschrittlicher Sensorfähigkeiten bietet, um Eigenschaften, Prozesse und Aktivitäten zu erfassen. Diese Neuausrichtung ermöglicht es Earables sich als bedeutende Wearable Kategorie zu etablieren, und die Vision von Earables als eine vielseitige Sensorenplattform zur Erweiterung der menschlichen Fähigkeiten wird somit zunehmend realer

Wearable and Nearable Biosensors and Systems for Healthcare

Biosensors and systems in the form of wearables and “nearables” (i.e., everyday sensorized objects with transmitting capabilities such as smartphones) are rapidly evolving for use in healthcare. Unlike conventional approaches, these technologies can enable seamless or on-demand physiological monitoring, anytime and anywhere. Such monitoring can help transform healthcare from the current reactive, one-size-fits-all, hospital-centered approach into a future proactive, personalized, decentralized structure. Wearable and nearable biosensors and systems have been made possible through integrated innovations in sensor design, electronics, data transmission, power management, and signal processing. Although much progress has been made in this field, many open challenges for the scientific community remain, especially for those applications requiring high accuracy. This book contains the 12 papers that constituted a recent Special Issue of Sensors sharing the same title. The aim of the initiative was to provide a collection of state-of-the-art investigations on wearables and nearables, in order to stimulate technological advances and the use of the technology to benefit healthcare. The topics covered by the book offer both depth and breadth pertaining to wearable and nearable technology. They include new biosensors and data transmission techniques, studies on accelerometers, signal processing, and cardiovascular monitoring, clinical applications, and validation of commercial devices

State of the Art of Audio- and Video-Based Solutions for AAL

It is a matter of fact that Europe is facing more and more crucial challenges regarding health and social care due to the demographic change and the current economic context. The recent COVID-19 pandemic has stressed this situation even further, thus highlighting the need for taking action. Active and Assisted Living technologies come as a viable approach to help facing these challenges, thanks to the high potential they have in enabling remote care and support. Broadly speaking, AAL can be referred to as the use of innovative and advanced Information and Communication Technologies to create supportive, inclusive and empowering applications and environments that enable older, impaired or frail people to live independently and stay active longer in society. AAL capitalizes on the growing pervasiveness and effectiveness of sensing and computing facilities to supply the persons in need with smart assistance, by responding to their necessities of autonomy, independence, comfort, security and safety. The application scenarios addressed by AAL are complex, due to the inherent heterogeneity of the end-user population, their living arrangements, and their physical conditions or impairment. Despite aiming at diverse goals, AAL systems should share some common characteristics. They are designed to provide support in daily life in an invisible, unobtrusive and user-friendly manner. Moreover, they are conceived to be intelligent, to be able to learn and adapt to the requirements and requests of the assisted people, and to synchronise with their specific needs. Nevertheless, to ensure the uptake of AAL in society, potential users must be willing to use AAL applications and to integrate them in their daily environments and lives. In this respect, video- and audio-based AAL applications have several advantages, in terms of unobtrusiveness and information richness. Indeed, cameras and microphones are far less obtrusive with respect to the hindrance other wearable sensors may cause to one’s activities. In addition, a single camera placed in a room can record most of the activities performed in the room, thus replacing many other non-visual sensors. Currently, video-based applications are effective in recognising and monitoring the activities, the movements, and the overall conditions of the assisted individuals as well as to assess their vital parameters. Similarly, audio sensors have the potential to become one of the most important modalities for interaction with AAL systems, as they can have a large range of sensing, do not require physical presence at a particular location and are physically intangible. Moreover, relevant information about individuals’ activities and health status can derive from processing audio signals. Nevertheless, as the other side of the coin, cameras and microphones are often perceived as the most intrusive technologies from the viewpoint of the privacy of the monitored individuals. This is due to the richness of the information these technologies convey and the intimate setting where they may be deployed. Solutions able to ensure privacy preservation by context and by design, as well as to ensure high legal and ethical standards are in high demand. After the review of the current state of play and the discussion in GoodBrother, we may claim that the first solutions in this direction are starting to appear in the literature. A multidisciplinary debate among experts and stakeholders is paving the way towards AAL ensuring ergonomics, usability, acceptance and privacy preservation. The DIANA, PAAL, and VisuAAL projects are examples of this fresh approach. This report provides the reader with a review of the most recent advances in audio- and video-based monitoring technologies for AAL. It has been drafted as a collective effort of WG3 to supply an introduction to AAL, its evolution over time and its main functional and technological underpinnings. In this respect, the report contributes to the field with the outline of a new generation of ethical-aware AAL technologies and a proposal for a novel comprehensive taxonomy of AAL systems and applications. Moreover, the report allows non-technical readers to gather an overview of the main components of an AAL system and how these function and interact with the end-users. The report illustrates the state of the art of the most successful AAL applications and functions based on audio and video data, namely lifelogging and self-monitoring, remote monitoring of vital signs, emotional state recognition, food intake monitoring, activity and behaviour recognition, activity and personal assistance, gesture recognition, fall detection and prevention, mobility assessment and frailty recognition, and cognitive and motor rehabilitation. For these application scenarios, the report illustrates the state of play in terms of scientific advances, available products and research project. The open challenges are also highlighted. The report ends with an overview of the challenges, the hindrances and the opportunities posed by the uptake in real world settings of AAL technologies. In this respect, the report illustrates the current procedural and technological approaches to cope with acceptability, usability and trust in the AAL technology, by surveying strategies and approaches to co-design, to privacy preservation in video and audio data, to transparency and explainability in data processing, and to data transmission and communication. User acceptance and ethical considerations are also debated. Finally, the potentials coming from the silver economy are overviewed

Cuffless Blood Pressure Monitoring: Estimation of the Waveform and its Prediction Interval

Cuffless blood pressure (BP) estimation devices are receiving considerable attention as tools for improving the management of hypertension, a condition that affects 1.13 billion people worldwide. It is an approach that can provide continuous BP monitoring, which is not possible with existing non-invasive tools. Therefore, it yields a more comprehensive picture of the patient’s state. Cuffless BP monitoring relies on surrogate models of BP and the information encoded in alternative physiological measures, such as photoplethysmography (PPG) or electrocardiography (ECG), to continuously estimate BP. Existing models have typically relied upon pulse-wave delay between two arterial segments or other pulse waveform features in the estimation process. However, the models available in the literature (1) provide an estimation of the systolic BP (SBP), diastolic BP (DBP), and mean BP (MAP) only, (2) are validated solely in controlled environments, and (3) do not assign a confidence metric to the estimates. At this point, cuffless methods are not used by clinicians due to their inaccuracy, the validation inadequacy, and/or the unevaluated uncertainty of the existing methods. The first objective of this thesis is to develop a cuffless modeling approach to estimate the BP waveform from ECG and PPG, and extract important BP features, such as the SBP, DBP, and MAP. Access to the full waveform has significant advantages over previous cuffless BP estimation tools in terms of accuracy and access to additional cardiovascular health markers (e.g., cardiac output), as well as potentially providing arterial stiffness. The second objective of this thesis is to validate cuffless BP estimation during activities of daily living, an uncontrolled environment, but also in more challenging physiological conditions such as during exercise. Such validation is important to increase confidence in cuffless BP monitoring, it also helps understand the limitation of the method and how they would affect clinical outcomes. Finally, in an effort to improve confidence in the cuffless BP estimation framework (third objective), a prediction interval (PI) estimation method is introduced. For potential clinical uses, it is imperative to assess the uncertainty of the BP estimate for acute outcome evaluation and it is even more so if cuffless BP is to be employed outside of the clinic. In this thesis, user-specific nonlinear autoregressive models with exogenous inputs (NARX) are implemented using an artificial neural network (ANN) to predict the BP waveforms using ECG and/or PPG signals as inputs. To validate the NARX-based BP estimation framework during activities of daily living, data were collected during six-hours testing phase wherein the participants go about their normal daily living activities. Data are further collected at four-month and six-month time points to validate long-term performance. To broaden the range of BP in the training data, subjects followed a short procedure consisting of sitting, standing, walking, Valsalva maneuvers, and static handgrip exercises. To evaluate the uncertainty of the BP estimates, one-class support vector machines (OCSVM) models are trained to cluster data in terms of the percentage of outliers. New BP estimates are then assigned to a cluster using the OCSVMs hyperplanes, and the PIs are estimated using the BP error standard deviation associated with different training data clusters. The OCSVM is used to estimate the PI for three BP model architectures: NARX models, feedforward ANN models, and pulse arrival time (PAT models). The three BP estimations from the models are fused using the covariance intersection fusion algorithm, which improves BP and PI estimates in comparison with individual model performance. The proposed method models the BP as a dynamical system leading to better accuracy in the estimation of SBP, DBP and MAP when compared to the PAT model. Moreover, the NARX model, with its ability to provide the BP waveform, yields more insight into patient health. The NARX model demonstrates superior accuracy and correlation with “ground truth” SBP and DBP measures compared to the PAT models and a clear advantage in estimating the large range of BP. Preliminary results show that the NARX models can accurately estimate BP even months apart from the training. Preliminary testing suggests that it is robust against variabilities due to sensor placement. The employed model fusion architecture establishes a method for cuffless BP estimation and its PI during activities of daily living that can be used for continuous monitoring and acute hypotension and hypertension detection. The NARX model, with its capacity to estimate a large range of BP, is next tested during moderate and heavy intensity exercise. Participants performed three cycling exercises: a ramp-incremental exercise test to exhaustion, a moderate and a heavy pseudorandom binary sequence exercise tests on an electronically braked cycle ergometer. Subject-specific and population-based NARX models are compared with feedforward ANN models and PAT (and heart rate) models. Population-based NARX models, when trained on 11 participants’ three cycling tests (tested on the participant left out of training), perform better than the other models and show good capability at estimating large changes in MAP. A limitation of the approach is the incapability of the models to track consistent decreases in BP during the exercise caused by a decrease in peripheral resistance since this information is apparently not encoded in either the forehead PPG or ECG signals. Nevertheless, the NARX model shows good precision during the whole 21 minutes testing window, a precision that is increased when using a shorter evaluation time window, and that can potentially be even further increased if trained on more data. The validation protocols and the use of a confidence metric developed in this thesis is of great value for such health monitoring application. Through such methodology, it is hoped that cuffless BP estimation becomes, one day, a well-established BP measurement method

A pervasive body sensor network for monitoring post-operative recovery

Over the past decade, miniaturisation and cost reduction brought about by the semiconductor industry has led to computers smaller in size than a pin head, powerful enough to carry out the processing required, and affordable enough to be disposable. Similar technological advances in wireless communication, sensor design, and energy storage have resulted in the development of wireless “Body Sensor Network (BSN) platforms comprising of tiny integrated micro sensors with onboard processing and wireless data transfer capability, offering the prospect of pervasive and continuous home health monitoring. In surgery, the reduced trauma of minimally invasive interventions combined with initiatives to reduce length of hospital stay and a socioeconomic drive to reduce hospitalisation costs, have all resulted in a trend towards earlier discharge from hospital. There is now a real need for objective, pervasive, and continuous post-operative home recovery monitoring systems. Surgical recovery is a multi-faceted and dynamic process involving biological, physiological, functional, and psychological components. Functional recovery (physical independence, activities of daily living, and mobility) is recognised as a good global indicator of a patient’s post-operative course, but has traditionally been difficult to objectively quantify. This thesis outlines the development of a pervasive wireless BSN system to objectively monitor the functional recovery of post-operative patients at home. Biomechanical markers were identified as surrogate measures for activities of daily living and mobility impairment, and an ear-worn activity recognition (e-AR) sensor containing a three-axis accelerometer and a pulse oximeter was used to collect this data. A simulated home environment was created to test a Bayesian classifier framework with multivariate Gaussians to model activity classes. A real-time activity index was used to provide information on the intensity of activity being performed. Mobility impairment was simulated with bracing systems and a multiresolution wavelet analysis and margin-based feature selection framework was used to detect impaired mobility. The e-AR sensor was tested in a home environment before its clinical use in monitoring post-operative home recovery of real patients who have undergone surgery. Such a system may eventually form part of an objective pervasive home recovery monitoring system tailored to the needs of today’s post-operative patient.Open acces

Unobtrusive Photoplethysmographic Monitoring Under the Foot Sole while in a Standing Posture

Photoplethysmography (PPG) of the foot sole could provide additional health-related information compared with traditional PPG of the finger or wrist. Previously, foot PPG required the procedural binding of a light-emitting diode (LED)-photodetector (PD) pair. We achieved PPG of the foot sole without binding any sensors to the foot while the participant stood in a natural standing position on the testing device. Foot PPG was performed using multiple LED-PD pairs to overcome motion artefacts caused by stabilization. We identified regions of the sole suitable for reliable sensor positioning with optimal LED-PD pairs on the basis of the estimated heart rate (HR) and signal quality index derived by dynamic time warping (wSQI). The first experiment included four participants with direct skin-to-sensor contact, and the results showed a mean HR estimation error of 0.01 beats/min and a wSQI of 0.909. The extended experiment with 53 participants, which involved including a gap between the skin and sensors to consider real-life applications, yielded a mean HR estimation error of 0.638 beats/min and a wSQI of 0.751. Based on the selection ratio of optimal LED-PD pairs, the best region of the sole for PPG was the midfoot, except the medial longitudinal arch. In conclusion, we confirmed that foot PPG using multiple LED-PD pairs is appropriate for HR evaluation and further applications

Objective assessment of upper limb motor symptoms in Parkinson's Disease using body-worn sensors

MD ThesisBackground There is a need for an objective method of symptom assessment in Parkinson's disease (PD) to enable better treatment decisions and to aid evaluation of new treatments. Current assessment methods; patient-completed symptom diaries and clinical rating scales, have limitations. Accelerometers (sensors capable of capturing data on human movement) and analysis using artificial neural networks (ANNs) have shown potential as a method of motor symptom evaluation in PD. It is unknown whether symptom monitoring with body-worn sensors is acceptable to PD patients due to a lack of previous research. Methods 34 participants with PD wore bilateral wrist-worn accelerometers for 4 hours in a research facility (phase 1) and then for 7 days in their homes (phase 2) whilst also completing symptom diaries. An ANN designed to predict a patient’s motor status, was developed and trained based on accelerometer data during phase 2. ANN performance was evaluated (leave-one-out approach) against patient-completed symptom diaries during phase 2, and against clinician rating of disease state during phase 1 observations. Participants’ views regarding the sensors were obtained via a Likert-style questionnaire completed after each phase. Differences in responses between phases were assessed for using the Wilcoxon rank-sum test. Results ANN-derived values of the proportion of time in each disease state (phase 2), showed strong, significant correlations with values derived from patient-completed symptom diaries. ANN disease state recognition during phase 1 was sub-optimal. High concordance with sensors was seen. Prolonged wearing of the sensors did not adversely affect participants’ opinions on the wearability of the sensors, when compared to their responses following phase 1 Conclusions Accelerometers and ANNs produced results comparable to those of symptom diaries. Our findings suggest that long-term monitoring with wrist-worn sensors is acceptable to PD patients