Soft Electronics Enabled Ergonomic Human-Computer Interaction for Swallowing Training

We introduce a skin-friendly electronic system that enables human-computer interaction (HCI) for swallowing training in dysphagia rehabilitation. For an ergonomic HCI, we utilize a soft, highly compliant (“skin-like”) electrode, which addresses critical issues of an existing rigid and planar electrode combined with a problematic conductive electrolyte and adhesive pad. The skin-like electrode offers a highly conformal, user-comfortable interaction with the skin for long-term wearable, high-fidelity recording of swallowing electromyograms on the chin. Mechanics modeling and experimental quantification captures the ultra-elastic mechanical characteristics of an open mesh microstructured sensor, conjugated with an elastomeric membrane. Systematic in vivo studies investigate the functionality of the soft electronics for HCI-enabled swallowing training, which includes the application of a biofeedback system to detect swallowing behavior. The collection of results demonstrates clinical feasibility of the ergonomic electronics in HCI-driven rehabilitation for patients with swallowing disorders

Prediction of larynx function using multichannel surface EMG classification

Total laryngectomy (TL) affects critical functions such as swallowing, coughing and speaking. An artificial, bioengineered larynx (ABL), operated via myoelectric signals, may improve quality of life for TL patients. To evaluate the efficacy of using surface electromyography (sEMG) as a control signal to predict instances of swallowing, coughing and speaking, sEMG was recorded from submental, intercostal and diaphragm muscles. The cohort included TL and control participants. Swallowing, coughing, speaking and movement actions were recorded, and a range of classifiers were investigated for prediction of these actions. Our algorithm achieved F1-scores of 76.0 ± 4.4 % (swallows), 93.8 ± 2.8 % (coughs) and 70.5 ± 5.4 % (speech) for controls, and 67.7 ± 4.4 % (swallows), 71.0 ± 9.1 % (coughs) and 78.0 ± 3.8 % (speech) for TLs, using a random forest (RF) classifier. 75.1 ± 6.9 % of swallows were detected within 500 ms of onset in the controls, and 63.1 ± 6.1 % in TLs. sEMG can be used to predict critical larynx movements, although a viable ABL requires improvements. Results are particularly encouraging as they encompass a TL cohort. An ABL could alleviate many challenges faced by laryngectomees. This study represents a promising step toward realising such a device

Evaluation of motor neuron excitability by CMAP scanning with modulated current

It is important to have better evaluation and understanding of the motor neuron physiology, with the goal to early and objectively diagnose and treat patients with neurodegenerative pathologies. The Compound Muscle Action Potential (CMAP) scan is a non-invasive diagnosis technique for neurodegenerative pathologies, such as ALS, and enables a quick analysis of the muscle action potentials in response to motor nerve stimulation. This work aims to study the influence of different pulse modulated waveforms in peripheral nerve excitability by CMAP scan technique on healthy subjects. A total of 13 healthy subjects were submitted to the same test. The stimuli were applied in the medium nerve on the right wrist and electromyography signal collected on the Abductor Pollicis Brevis (APB) muscle surface on the right thumb. Stimulation was performed with an increasing intensities range from 4 to 30 mA, with varying steps, 3 stimuli per step. The procedure was repeated 4 times per subject, each repetition using a different single pulse stimulation waveform: monophasic square, monophasic triangular, monophasic quadratic and biphasic square. Results were retrieved from the averaging of the stimuli on each current intensity step. The square pulse needs less current intensity to generate the same response amplitude regarding the other waves and presents a more steep curve slope and this effect is gradually decreasing for the triangular and quadratic pulse,respectively, being the difference even more evident regarding the biphasic pulse. The control of the waveform stimulation pulse allows varying the stimulusresponse curve slope

Rehabilitation process using electromyography and biofeedback

Treballs Finals de Grau d'Enginyeria Biomèdica. Facultat de Medicina i Ciències de la Salut. Universitat de Barcelona. Curs: 2020-2021. Director: José Luis Parreño Catalan. Tutor: Manel Puig Vidal.A good rehabilitation routine is essential for the best possible recovery after an injury or to increase the quality of life of those who suffer from neuromusculoskeletal diseases. It is of particular relevance to maintain the motivation throughout all the process, for which videogames may play an essential role. Biofeedback is a process that provides real time information from psychophysiological recordings about the levels at which physiological systems are functioning. In this project the biofeedback system has been implemented by means of a low-cost EMG system created using Arduino. The EMG system has been developed using an Olimexino-328 microcontroller and an EMG-Shield, both from Olimex. The program was developed using Arduino IDE. To assess the quality of the signal of the prototype, it was compared to a professional EMG device, the DataLog from Biometrics Ltd. The comparison showed promising results although it could be improved by means of post-processing algorithms. An audio-visual Biofeedback system targeting maximum strength and explosiveness of the muscles was created using Python. Flappy Bird game commands were changed to control them with the EMG low-cost prototype. The flap logic of the game is guided by a threshold fixed automatically by the software at the 60% of the maximum signal obtained by the EMG system. The system was tested to optimize its performance and fix possible flaws. Although it is simple and further investigation may be needed, having in mind the fewer resources used, the system performance is encouraging, and a clinical trial should be performed to assess its real behaviour, usefulness, and efficiency for rehabilitation purposes

The Possibilities of Smart Clothing in Adult Speech Therapy : Speech Therapists' Visions for the Future

The potential of technology in healthcare has been closely explored in recent years. Increasingly more innovative technology-Assisted rehabilitation methods for various customer groups are constantly being developed. However, the possibilities of smart clothing in adult speech rehabilitation have not been previously studied. The purpose of this study was to discover speech therapists' visions about the possibilities of smart clothing in adult rehabilitation. We organized an ideation workshop in December 2020 with four speech therapists who had worked in adult rehabilitation for at least five years. The workshop was held online on the Zoom platform. In the workshop we presented three questions for the speech therapists: 1) Which adult speech therapy clients could benefit from smart clothing? 2) What could smart clothing be used for in speech therapy rehabilitation for adults? and 3) How could smart clothing be used in speech therapy rehabilitation for adults? Qualitative data from this research was analyzed by thematic analysis. The main results of this study were that patients with dysphagia and patients with voice disorders were seen as the groups with the greatest potential use smart clothing, and continuous registration of various physiological functions of voice and swallowing were voted as the most usable applications of smart clothing. The most discussed topics were using smart clothing to monitor rehabilitation and using the clothing to activate and motivate the client by giving feedback. And finally, the easiest ways to control smart clothing were seen to be body movements, gestures, and touch.acceptedVersionPeer reviewe

Investigation into pathophysiology of naturally occurring palatal instability and intermittent dorsal displacement of the soft palate (DDSP) in racehorses: Thyro-hyoid muscles fatigue during exercise

Exercise induced intermittent dorsal displacement of the soft palate (DDSP) is a common cause of airway obstruction and poor performance in racehorses. The definite etiology is still unclear, but through an experimental model, a role in the development of this condition was identified in the dysfunction of the thyro-hyoid muscles. The present study aimed to elucidate the nature of this dysfunction by investigating the spontaneous response to exercise of the thyro-hyoid muscles in racehorses with naturally occurring DDSP. Intramuscular electrodes were implanted in the thyro-hyoid muscles of nine racehorses, and connected to a telemetric unit for electromyographic monitoring implanted subcutaneously. The horses were recruited based on upper airway function evaluated through wireless endoscopy during exercise. Five horses, with normal function, were used as control; four horses were diagnosed as DDSP-affected horses based on repeated episodes of intermittent dorsal displacement of the soft palate. The electromyographic activity of the thyro-hyoid muscles recorded during incremental exercise tests on a high-speed treadmill was analyzed to measure the mean electrical activity and the median frequency of the power spectrum, thereafter subjected to wavelet decomposition. The affected horses had palatal instability with displacement on repeated exams prior to surgical implantation. Although palatal instability persisted after surgery, only two of these horses displaced the palate after instrumentation. The electromyographic traces from this group of four horses showed, at highest exercise intensity, a decrease in mean electrical activity and median power frequency, with progressive decrease in the contribution of the high frequency wavelets, consistent with development of thyro-hyoid muscle fatigue. The results of this study identified fatigue as the main factor leading to exercise induced palatal instability and DDSP in a group of racehorses. Further studies are required to evaluate the fiber type composition and metabolic characteristics of the thyro-hyoid muscles that could predispose to fatigue

Recognizing swallowing movements using a textile-based device

Dysphagia can stem from various etiologies and cause several serious complications. Instrumental evaluation methods for swallowing require special equipment not available everywhere. Thus, an instrumental means to evaluate swallowing that could be used outside a hospital setting would be critical. Dual-axis accelerometers have been utilized in earlier research to recognize swallowing movements. However, no textile-based approaches have been reported. In this study, we developed a textile-based prototype device for identifying swallowing movements. The device used accelerometers and gyroscopes, with eight sensors attached to the fabric. Two female participants were asked to perform two tasks while wearing the device around their neck: sitting still and taking 10 sips of water. The sensor attached to the middle of the thyroid notch level and the two sensors horizontally aligned to both sides of the hyoid bone level were the most accurate in recognizing swallowing movements. No sensor alone could recognize all swallows. However, all the swallows were identified using the combined data from the sensors. Thus, based on these preliminary results, it seems like a textile-based device using accelerometers and gyroscopes could identify swallowing movements.publishedVersionPeer reviewe

Wearable Sensors and Smart Devices to Monitor Rehabilitation Parameters and Sports Performance: An Overview

A quantitative evaluation of kinetic parameters, the joint’s range of motion, heart rate, and breathing rate, can be employed in sports performance tracking and rehabilitation monitoring following injuries or surgical operations. However, many of the current detection systems are expensive and designed for clinical use, requiring the presence of a physician and medical staff to assist users in the device’s positioning and measurements. The goal of wearable sensors is to overcome the limitations of current devices, enabling the acquisition of a user’s vital signs directly from the body in an accurate and non–invasive way. In sports activities, wearable sensors allow athletes to monitor performance and body movements objectively, going beyond the coach’s subjective evaluation limits. The main goal of this review paper is to provide a comprehensive overview of wearable technologies and sensing systems to detect and monitor the physiological parameters of patients during post–operative rehabilitation and athletes’ training, and to present evidence that supports the efficacy of this technology for healthcare applications. First, a classification of the human physiological parameters acquired from the human body by sensors attached to sensitive skin locations or worn as a part of garments is introduced, carrying important feedback on the user’s health status. Then, a detailed description of the electromechanical transduction mechanisms allows a comparison of the technologies used in wearable applications to monitor sports and rehabilitation activities. This paves the way for an analysis of wearable technologies, providing a comprehensive comparison of the current state of the art of available sensors and systems. Comparative and statistical analyses are provided to point out useful insights for defining the best technologies and solutions for monitoring body movements. Lastly, the presented review is compared with similar ones reported in the literature to highlight its strengths and novelties