Measurement of intervertebral cervical motion by means of dynamic X-ray image processing and data interpolation

Accurate measurement of intervertebral kinematics of the cervical spine can support the diagnosis of widespread diseases related to neck pain, such as chronic whiplash dysfunction, arthritis, and segmental degeneration. The natural inaccessibility of the spine, its complex anatomy, and the small range of motion only permit concise measurement in vivo. Low dose X-ray fluoroscopy allows time-continuous screening of cervical spine during patient's spontaneous motion. To obtain accurate motion measurements, each vertebra was tracked by means of image processing along a sequence of radiographic images. To obtain a time-continuous representation of motion and to reduce noise in the experimental data, smoothing spline interpolation was used. Estimation of intervertebral motion for cervical segments was obtained by processing patient's fluoroscopic sequence; intervertebral angle and displacement and the instantaneous centre of rotation were computed. The RMS value of fitting errors resulted in about 0.2 degree for rotation and 0.2 mm for displacements

Measurement of intervertebral cervical motion by means of dynamic X-ray image processing and data interpolation

Accurate measurement of intervertebral kinematics of the cervical spine can support the diagnosis of widespread diseases related to neck pain, such chronic whiplash dysfunction, arthritis, segmental degeneration. The natural inaccessibility of the spine, its complex anatomy and the small range of motion only permit concise measurement in-vivo. Low dose X-ray fluoroscopy allows time-continuous screening of cervical spine during patient’s spontaneous motion. To obtain accurate motion measurements, each vertebra was tracked by means of image processing along a sequence of radiographic images. To obtain a time-continuous representation of motion and to reduce noise in the experimental data, smoothing spline interpolation was used. Estimation of intervertebral motion for cervical segments was obtained by processing patient’s fluoroscopic sequence: intervertebral angle and displacement and the instantaneous centre of rotation were computed. The RMS value of fitting errors resulted about 0.2 degree for rotation and 0.2 mm for displacement

A Logistic Regression Model for Biomechanical Risk Classification in Lifting Tasks

Lifting is one of the most potentially harmful activities for work-related musculoskeletal disorders (WMSDs), due to exposure to biomechanical risk. Risk assessment for work activities that involve lifting loads can be performed through the NIOSH (National Institute of Occupational Safety and Health) method, and specifically the Revised NIOSH Lifting Equation (RNLE). Aim of this work is to explore the feasibility of a logistic regression model fed with time and frequency domains features extracted from signals acquired through one inertial measurement unit (IMU) to classify risk classes associated with lifting activities according to the RNLE. Furthermore, an attempt was made to evaluate which are the most discriminating features relating to the risk classes, and to understand which inertial signals and which axis were the most representative. In a simplified scenario, where only two RNLE variables were altered during lifting tasks performed by 14 healthy adults, inertial signals (linear acceleration and angular velocity) acquired using one IMU placed on the subject's sternum during repeated rhythmic lifting tasks were automatically segmented to extract several features in the time and frequency domains. The logistic regression model fed with significant features showed good results to discriminate "risk" and "no risk" NIOSH classes with an accuracy, sensitivity and specificity equal to 82.8%, 84.8% and 80.9%, respectively. This preliminary work indicated that a logistic regression model-fed with specific inertial features extracted by signals acquired using a single IMU sensor placed on the sternum-is able to discriminate risk classes according to the RNLE in a simplified context, and therefore could be a valid tool to assess the biomechanical risk in an automatic way also in more complex conditions (e.g., real working scenarios)

Electromyography in the Study of Muscle Reactions to Vibration Treatment

Electromyography (EMG) is a common used technique to evaluate muscular activity. Analysis of EMG recordings is important for assessing muscle activation, its relationship to the force developed during specific tasks and for evaluating fatigue processes occurring in response to physical activity. Electromyography can be performed using different types of electrodes, depending on the specific analysis: surface (or skin) electrodes or inserted electrodes (wire and needle); the first it is used to monitor the overall activity of a muscle while the second is generally used to reveal the electrical activity of a nerve root. (De Luca, 1997, Basmajan and De Luca, 1985) Electrode types and configurations, as well as associated instrumentation, influence the quality of the EMG signal detected and displayed, recorded or processed (Merletti et al, 2001; Saitou et al, 2000; Rainoldi et al, 2004, Nishihara et al, 2008). Various studies have been dedicated to the matter and guidelines in EMG recording are available (Basmajan and De Luca, 1985, Hermens H.J. et al, 1999). Surface electromyography (SEMG) analysis is a largely used EMG recording method as it is non–invasive, safe, it does not cause pain and it is simple to perform. Root mean square (RMS) of the surface EMG signals is often used as a concise quantitative index of muscle activity; indeed, electromyography devices often provide EMG RMS output. SEMG is often used for the assessment of muscle activity occurring in response to physiological or to externally applied stimuli, i.e. vibratory stimulation. Vibration stimulus is a mechanical muscle excitation, applied generally to a tendon, a muscle or to the body as a whole, aimed to activate muscles by eliciting stretch reflexes. Local tendon vibrations induce activiy of the muscle spindle Ia fibers, mediated by monosynaptic and/or polysynaptic pathways; the reflex muscle contraction that arises in response to such vibratory stimulus has been named Tonic Vibration Reflex (TVR). (Roll et al, 1989; Bongiovanni and Hagbart, 1990; Romaiguére et al, 1991; Person and Kozhina, 1992; Martin and Park, 1997) As well as in other external stimulation, vibratory muscle activation can be examined by the analysis of electromyography recordings. Many studies report a significant increase of EMG RMS values in the lower body muscles during vibration training, these changes suggested an increase in neuromuscular activity (Cardinale and Bosco, 2003; Verschueren et al, 2004). Specific WBV frequencies seem to produce a higher EMG RMS signal than others (Cardinale and Lim 2003). However, as well as in every surface bio-potential recording, during local or whole body vibration treatment the EMG signal can be affected by artifacts. Motion artifacts may in fact arise from relative motion between electrodes and skin and also between skin layers. The only skin stretch may result in a variation of electrode potential (Turker, 1993, De Talhouet and Webster, 1996; Ödman and Öberg, 1982, Searle and Kirkup, 2000, Tam and Webster, 1977). In classical clinical EMG recordings (isokinetic, isotonic, gait, etc.), frequency content of motion artifact is considered below 10-20 Hz, then the general approach to motion artifact reduction is to apply a high-pass filter (e.g. with a cut-off frequency of 20 Hz). During vibratory stimulation the artifact frequency contents, typically limited at vibratory frequency and its har onics, extend within the EMG spectrum (Fratini et al, 2009) and standard high-pass filters are not suitable for filtering out this artifact. In the majority of the cases appropriate filtering is used to remove motion artifacts before any signal analysis, while in some other they are used to characterize the mechanical response of the tissue to a specific stimulus (mechanogram) and its correlation to the stimulus itself (Person and Kozhina, 1992; Fratini et al, 2009). With this chapter the authors aim to investigate the use and the efficacy of surface electromyography in the study of muscle response to vibration treatments. A review ofvibration characterization and analysis is reported, SEMG recordings of Rectus Femori, Vastus Medialis and Vastus Lateralis were collected and analyzed. Specific artifacts were revealed and the role of those artifact was investigated and assessed. Since the use of vibratory stimulus produces peculiar EMG response a specific model was adopted to describe the EMG synchronization effect and its influence on the resultant recorded muscle activity (Person and Kozhina, 1992)

Information in a network of neuronal cells: Effect of cell density and short-term depression

Neurons are specialized, electrically excitable cells which use electrical to chemical signals to transmit and elaborate information. Understanding how the cooperation of a great many of neurons in a grid may modify and perhaps improve the information quality, in contrast to few neurons in isolation, is critical for the rational design of cell-materials interfaces for applications in regenerative medicine, tissue engineering, and personalized lab-on-a-chips. In the present paper, we couple an integrate-and-fire model with information theory variables to analyse the extent of information in a network of nerve cells. We provide an estimate of the information in the network in bits as a function of cell density and short-term depression time. In the model, neurons are connected through a Delaunay triangulation of not-intersecting edges; in doing so, the number of connecting synapses per neuron is approximately constant to reproduce the early time of network development in planar neural cell cultures. In simulations where the number of nodes is varied, we observe an optimal value of cell density for which information in the grid is maximized. In simulations in which the posttransmission latency time is varied, we observe that information increases as the latency time decreases and, for specific configurations of the grid, it is largely enhanced in a resonance effect

Fast track surgery for knee replacement surgery: a lean six sigma approach

PurposeThe reduction of costs has a more and more relevant role in the healthcare context, therefore, a large effort is done by health providers to this aim, for example, by reducing the length of hospital stay (LOS) of patients undergoing surgery. Fast track surgery fits perfectly this issue and was applied to patients undergoing knee replacement surgery due to Osteoarthritis, one of the most common diseases of aged population. The paper aims to discuss these issues.Design/methodology/approachLean six sigma was applied to analyze the implementation of fast track surgery through the define, measure, analyze, improve, control roadmap, used as a typical problem-solving approach. It is characterized by five operational phases, which make possible the achievement of fixed goals through a rigorous process of defining, measuring, analyzing, improving and controlling business problems.FindingsThe corrective action, consisting in the application of fast track surgery, improved both effectiveness and efficiency of the process of care. The average length of hospital stay (LOS) was reduced from 8.34 to 6.68 days (–19.9 percent) and its standard deviation from 2.41 to 1.99 days (–17.1 percent). The statistical significance of this decrease was verified by means of proper tests. Moreover, some variables influencing the LOS were identified.Research limitations/implicationsThe follow up and the satisfaction of patients were not analyzed and could be a future development of this study.Practical implicationsPatients will experience a faster recovery while the hospital will benefit from a rise of available beds. The effect is a general improvement of hospital management.Originality/valueThe introduction of fast track surgery for patients undergoing knee replacement surgery made significantly reduce LOS and, consequently, costs' with a money saving of more than 50,000 euro per year

On the power spectrum of motor unit action potential trains synchronized with mechanical vibration

Objective: Provide a definitive analysis of the spectrum of a motor unit action potential train elicited by mechanical vibratory stimulation via a detailed and concise mathematical formulation. Experimental studies demonstrated that motor unit action potentials are not exactly synchronized with the vibratory stimulus but show a variable latency jitter, whose effects have not been investigated yet. Methods: Synchronized action potential train was represented as a quasi-periodic sequence of a given motor unit waveform. The latency jitter of action potentials was modeled as a Gaussian stochastic process, in accordance to previous experimental studies. Results: A mathematical expression for power spectrum of a synchronized motor unit action potential train has been derived. The spectrum comprises a significant continuous component and discrete components at the vibratory frequency and its harmonics. Their relevance is correlated to the level of synchronization: the weaker the synchronization, the more relevant the continuous spectrum. EMG rectification enhances the discrete components. Conclusion: The derived equations have general validity and well describe the power spectrum of actual EMG recordings during vibratory stimulation. Results are obtained by appropriately setting the level of synchronization and vibration frequency. Significance: This study definitively clarifies the nature of changes in spectrum of raw EMG recordings from muscles undergoing vibratory stimulation. Results confirm the need of motion artifact filtering for raw EMG recordings during stimulation and strongly suggests to avoid EMG rectification that significantly alters the spectrum characteristics

Diagnostic Applications of Intraoral Scanners: A Systematic Review

In addition to their recognized value for obtaining 3D digital dental models, intraoral scanners (IOSs) have recently been proven to be promising tools for oral health diagnostics. In this work, the most recent literature on IOSs was reviewed with a focus on their applications as detection systems of oral cavity pathologies. Those applications of IOSs falling in the general area of detection systems for oral health diagnostics (e.g., caries, dental wear, periodontal diseases, oral cancer) were included, while excluding those works mainly focused on 3D dental model reconstruction for implan tology, orthodontics, or prosthodontics. Three major scientific databases, namely Scopus, PubMed, and Web of Science, were searched and explored by three independent reviewers. The synthesis and analysis of the studies was carried out by considering the type and technical features of the IOS, the study objectives, and the specific diagnostic applications. From the synthesis of the twenty-five included studies, the main diagnostic fields where IOS technology applies were highlighted, ranging from the detection of tooth wear and caries to the diagnosis of plaques, periodontal defects, and other complications. This shows how additional diagnostic information can be obtained by combining the IOS technology with other radiographic techniques. Despite some promising results, the clinical evidence regarding the use of IOSs as oral health probes is still limited, and further efforts are needed to validate the diagnostic potential of IOSs over conventional tool

Design and validation of an e-textile-based wearable system for remote health monitoring

The paper presents a new e-textile-based system, named SWEET Shirt, for the remote monitoring of biomedical signals. The system includes a textile sensing shirt, an electronic unit for data transmission, a custom-made Android application for real-time signal visualisation and a software desktop for advanced digital signal processing. The device allows for the acquisition of electrocardiographic, bicep electromyographic and trunk acceleration signals. The sensors, electrodes, and bus structures are all integrated within the textile garment, without any discomfort for users. A wide-ranging set of algorithms for signal processing were also developed for use within the system, allowing clinicians to rapidly obtain a complete and schematic overview of a patient's clinical status. The aim of this work was to present the design and development of the device and to provide a validation analysis of the electrocardiographic measurement and digital processing. The results demonstrate that the information contained in the signals recorded by the novel system is comparable to that obtained via a standard medical device commonly used in clinical environments. Similarly encouraging results were obtained in the comparison of the variables derived from the signal processing.</p

Lean Six Sigma: A new approach to the management of patients undergoing prosthetic hip replacement surgery

Rationale, aims and objectives In 2012, health care spending in Italy reached €114.5 billion, accounting for 7.2% of the Gross Domestic Product (GDP) and 14.2% of total public spending. Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that Lean Six Sigma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery. Methods The methodology used for the development of a new clinical pathway was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC (Define, Measure, Analyse, Improve, Control) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems. Results The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (-44%). Conclusion This article shows there is no trade-off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs