Metodologías de modelado, monitorización y asistencia robótica en neurorrehabilitación funcional de extremidad superior

La Organización Mundial de la Salud (OMS) prevé que para el año 2020, el Daño Cerebral Adquirido (DCA) estará entre las 10 causas más comunes de discapacidad. Estas lesiones, dadas sus consecuencias físicas, sensoriales, cognitivas, emocionales y socioeconómicas, cambian dramáticamente la vida de los pacientes y sus familias. Las nuevas técnicas de intervención precoz y el desarrollo de la medicina intensiva en la atención al DCA han mejorado notablemente la probabilidad de supervivencia. Sin embargo, hoy por hoy, las lesiones cerebrales no tienen ningún tratamiento quirúrgico que tenga por objetivo restablecer la funcionalidad perdida, sino que las terapias rehabilitadoras se dirigen hacia la compensación de los déficits producidos. Uno de los objetivos principales de la neurorrehabilitación es, por tanto, dotar al paciente de la capacidad necesaria para ejecutar las Actividades de Vida Diaria (AVDs) necesarias para desarrollar una vida independiente, siendo fundamentales aquellas en las que la Extremidad Superior (ES) está directamente implicada, dada su gran importancia a la hora de la manipulación de objetos. Con la incorporación de nuevas soluciones tecnológicas al proceso de neurorrehabilitación se pretende alcanzar un nuevo paradigma centrado en ofrecer una práctica personalizada, monitorizada y ubicua con una valoración continua de la eficacia y de la eficiencia de los procedimientos y con capacidad de generar conocimientos que impulsen la ruptura del paradigma de actual. Los nuevos objetivos consistirán en minimizar el impacto de las enfermedades que afectan a la capacidad funcional de las personas, disminuir el tiempo de incapacidad y permitir una gestión más eficiente de los recursos. Estos objetivos clínicos, de gran impacto socio-económico, sólo pueden alcanzarse desde una apuesta decidida en nuevas tecnologías, metodologías y algoritmos capaces de ocasionar la ruptura tecnológica necesaria que permita superar las barreras que hasta el momento han impedido la penetración tecnológica en el campo de la rehabilitación de manera universal. De esta forma, los trabajos y resultados alcanzados en la Tesis son los siguientes: 1. Modelado de AVDs: como paso previo a la incorporación de ayudas tecnológicas al proceso rehabilitador, se hace necesaria una primera fase de modelado y formalización del conocimiento asociado a la ejecución de las actividades que se realizan como parte de la terapia. En particular, las tareas más complejas y a su vez con mayor repercusión terapéutica son las AVDs, cuya formalización permitirá disponer de modelos de movimiento sanos que actuarán de referencia para futuros desarrollos tecnológicos dirigidos a personas con DCA. Siguiendo una metodología basada en diagramas de estados UML se han modelado las AVDs 'servir agua de una jarra' y 'coger un botella' 2. Monitorización ubícua del movimiento de la ES: se ha diseñado, desarrollado y validado un sistema de adquisición de movimiento basado en tecnología inercial que mejora las limitaciones de los dispositivos comerciales actuales (coste muy elevado e incapacidad para trabajar en entornos no controlados); los altos coeficientes de correlación y los bajos niveles de error obtenidos en los corregistros llevados a cabo con el sistema comercial BTS SMART-D demuestran la alta precisión del sistema. También se ha realizado un trabajo de investigación exploratorio de un sistema de captura de movimiento de coste muy reducido basado en visión estereoscópica, habiéndose detectado los puntos clave donde se hace necesario incidir desde un punto de vista tecnológico para su incorporación en un entorno real 3. Resolución del Problema Cinemático Inverso (PCI): se ha diseñado, desarrollado y validado una solución al PCI cuando el manipulador se corresponde con una ES humana estudiándose 2 posibles alternativas, una basada en la utilización de un Perceptrón Multicapa (PMC) y otra basada en sistemas Artificial Neuro-Fuzzy Inference Systems (ANFIS). La validación, llevada a cabo utilizando información relativa a los modelos disponibles de AVDs, indica que una solución basada en un PMC con 3 neuronas en la capa de entrada, una capa oculta también de 3 neuronas y una capa de salida con tantas neuronas como Grados de Libertad (GdLs) tenga el modelo de la ES, proporciona resultados, tanto de precisión como de tiempo de cálculo, que la hacen idónea para trabajar en sistemas con requisitos de tiempo real 4. Control inteligente assisted-as-needed: se ha diseñado, desarrollado y validado un algoritmo de control assisted-as-needed para una ortesis robótica con capacidades de actuación anticipatoria de la que existe un prototipo implementado en la actualidad. Los resultados obtenidos demuestran cómo el sistema es capaz de adaptarse al perfil disfuncional del paciente activando la ayuda en instantes anteriores a la ocurrencia de movimientos incorrectos. Esta estrategia implica un aumento en la participación del paciente y, por tanto, en su actividad muscular, fomentándose los procesos la plasticidad cerebral responsables del reaprendizaje o readaptación motora 5. Simuladores robóticos para planificación: se propone la utilización de un simulador robótico assisted-as-needed como herramienta de planificación de sesiones de rehabilitación personalizadas y con un objetivo clínico marcado en las que interviene una ortesis robotizada. Los resultados obtenidos evidencian como, tras la ejecución de ciertos algoritmos sencillos, es posible seleccionar automáticamente una configuración para el algoritmo de control assisted-as-needed que consigue que la ortesis se adapte a los criterios establecidos desde un punto de vista clínico en función del paciente estudiado. Estos resultados invitan a profundizar en el desarrollo de algoritmos más avanzados de selección de parámetros a partir de baterías de simulaciones Estos trabajos han servido para corroborar las hipótesis de investigación planteadas al inicio de la misma, permitiendo, asimismo, la apertura de nuevas líneas de investigación. Summary The World Health Organization (WHO) predicts that by the year 2020, Acquired Brain Injury (ABI) will be among the ten most common ailments. These injuries dramatically change the life of the patients and their families due to their physical, sensory, cognitive, emotional and socio-economic consequences. New techniques of early intervention and the development of intensive ABI care have noticeably improved the survival rate. However, in spite of these advances, brain injuries still have no surgical or pharmacological treatment to re-establish the lost functions. Neurorehabilitation therapies address this problem by restoring, minimizing or compensating the functional alterations in a person disabled because of a nervous system injury. One of the main objectives of Neurorehabilitation is to provide patients with the capacity to perform specific Activities of the Daily Life (ADL) required for an independent life, especially those in which the Upper Limb (UL) is directly involved due to its great importance in manipulating objects within the patients' environment. The incorporation of new technological aids to the neurorehabilitation process tries to reach a new paradigm focused on offering a personalized, monitored and ubiquitous practise with continuous assessment of both the efficacy and the efficiency of the procedures and with the capacity of generating new knowledge. New targets will be to minimize the impact of the sicknesses affecting the functional capabilitiies of the subjects, to decrease the time of the physical handicap and to allow a more efficient resources handling. These targets, of a great socio-economic impact, can only be achieved by means of new technologies and algorithms able to provoke the technological break needed to beat the barriers that are stopping the universal penetration of the technology in the field of rehabilitation. In this way, this PhD Thesis has achieved the following results: 1. ADL Modeling: as a previous step to the incorporation of technological aids to the neurorehabilitation process, it is necessary a first modelling and formalization phase of the knowledge associated to the execution of the activities that are performed as a part of the therapy. In particular, the most complex and therapeutically relevant tasks are the ADLs, whose formalization will produce healthy motion models to be used as a reference for future technological developments. Following a methodology based on UML state-chart diagrams, the ADLs 'serving water from a jar' and 'picking up a bottle' have been modelled 2. Ubiquitous monitoring of the UL movement: it has been designed, developed and validated a motion acquisition system based on inertial technology that improves the limitations of the current devices (high monetary cost and inability of working within uncontrolled environments); the high correlation coefficients and the low error levels obtained throughout several co-registration sessions with the commercial sys- tem BTS SMART-D show the high precision of the system. Besides an exploration of a very low cost stereoscopic vision-based motion capture system has been carried out and the key points where it is necessary to insist from a technological point of view have been detected 3. Inverse Kinematics (IK) problem solving: a solution to the IK problem has been proposed for a manipulator that corresponds to a human UL. This solution has been faced by means of two different alternatives, one based on a Mulilayer Perceptron (MLP) and another based on Artificial Neuro-Fuzzy Inference Systems (ANFIS). The validation of these solutions, carried out using the information regarding the previously generated motion models, indicate that a MLP-based solution, with an architecture consisting in 3 neurons in the input layer, one hidden layer of 3 neurons and an output layer with as many neurons as the number of Degrees of Freedom (DoFs) that the UL model has, is the one that provides the best results both in terms of precission and in terms of processing time, making in idoneous to be integrated within a system with real time restrictions 4. Assisted-as-needed intelligent control: an assisted-as-needed control algorithm with anticipatory actuation capabilities has been designed, developed and validated for a robotic orthosis of which there is an already implemented prototype. Obtained results demonstrate that the control system is able to adapt to the dysfunctional profile of the patient by triggering the assistance right before an incorrect movement is going to take place. This strategy implies an increase in the participation of the patients and in his or her muscle activity, encouraging the neural plasticity processes in charge of the motor learning 5. Planification with a robotic simulator: in this work a robotic simulator is proposed as a planification tool for personalized rehabilitation sessions under a certain clinical criterium. Obtained results indicate that, after the execution of simple parameter selection algorithms, it is possible to automatically choose a specific configuration that makes the assisted-as-needed control algorithm to adapt both to the clinical criteria and to the patient. These results invite researchers to work in the development of more complex parameter selection algorithms departing from simulation batteries Obtained results have been useful to corroborate the hypotheses set out at the beginning of this PhD Thesis. Besides, they have allowed the creation of new research lines in all the studied application fields

Computing optimal shortcuts for networks

We study augmenting a plane Euclidean network with a segment, called shortcut, to minimize the largest distance between any two points along the edges of the resulting network. Questions of this type have received considerable attention recently, mostly for discrete variants of the problem. We study a fully continuous setting, where all points on the network and the inserted segment must be taken into account. We present the first results on the computation of optimal shortcuts for general networks in this model, together with several results for networks that are paths, restricted to two types of shortcuts: shortcuts with a fixed orientation and simple shortcuts.Peer ReviewedPostprint (published version

Computing optimal shortcuts for networks

We augment a plane Euclidean network with a segment or shortcut to minimize the largest distance between any two points along the edges of the resulting network. In this continuous setting, the problem of computing distances and placing a shortcut is much harder as all points on the network, instead of only the vertices, must be taken into account. Our main result for general networks states that it is always possible to determine in polynomial time whether the network has an optimal shortcut and compute one in case of existence. We also improve this general method for networks that are paths, restricted to using two types of shortcuts: those of any fixed direction and shortcuts that intersect the path only on its endpoints.Peer ReviewedPostprint (published version

Active Ageing Index: Application to Spanish regions

The World Health Organization definition for active ageing and the approach and measurement made by the UNECE/EC to define an Active Ageing Index (AAI) are the starting points for this work. This paper reflects on the proposed methodology of the European AAI for measuring and adapting it to sub-national spaces, in this case Spain and its regions. Consistently, evaluation of specific data sources and indicators that can be built from them, trying to homogenise with the national-level AAI, according to its calculation methodology, are also essential objectives of this paper. In general, Spanish data sources are broadly similar to those which have been used for calculating the AAI in Europe, while some limitations, difficulties for homogenization and distortions are inevitable due to the AAI specificity. These factors have conditioned the calculation of some indicators, tentatively replaced by other alternatives and approximations. The AAI for Spain, calculated on the basis of Spanish data sources, is consistent with the European AAI, although slightly lower. However, it is closely connected with other general indicators in Spain (Gross Domestic Product, Synthetic Quality of Life Index, New Index of Human Development) to differentiate the level of economic and social development of the Spanish regions. The future development of the AAI in Spain requires delving into the use of more adequate indicators and weights, and more crucially advancing its usefulness to assess the public policies for the elderly in Spain. In addition, it aims to extend its use to certain Latin American countries.This research was carried under the ELES Project (Ageing in Spain Longitudinal Study) funded by the Spanish Ministry of Science and Competitiveness (National R&D&I Plan, Ref. CSO2011-30210-C02-01, PI. V. Rodriguez-Rodriguez). It is connected with other ongoing projects: i) the thematic networks ENACTIBE (Active Ageing in Ibero-America) (MINECO, ref. CSO2015-71193-REDT, PI. V. Rodriguez-Rodriguez) and RIIIES (Ibero-American Research Network on Ageing and Society, PI. F. Villar); ii) ENVACES project (Building the Active Ageing in Spain: self-assessment, determinants and quality of life expectations) MINECO/FEDER/ UE, ref. CSO2015-64115-R; PI. F Rojo-Perez); iii) ENCAGE-CM programme (Active Ageing, Quality of Life and Gender) (Community of Madrid and European Social Fund; ref. S2015/HUM-3367; Coord. G. Fernandez-Mayoralas). The authors thank Asghar Zaidi and the Editorial Board of the International Seminar of the Active Ageing Index, the Editor of the Journal of Population Ageing, and the two anonymous referees for their valuable comments that have helped to improve this paper.Peer reviewe

Menores y alfabetización digital. Teleclip TV: cuatro años de producción infantil y televisión por Internet

[Resumen]: La producción y consumo de productos audiovisuales ya no están destinados exclusivamente para la televisión, sino que con las TIC móviles: celulares, tabletas y consolas, el acceso es mayor y la demanda también. En el ámbito de niños y jóvenes, es importante que exista una formación en lectura de mensaje audiovisual para que la recepción y consumo de los jóvenes no sean bancarias sino participativas y desde ellos puedan proponerse narrativas audiovisuales para la enseñanza y el entretenimiento educativo. El texto reseña el caso de Teleclip TV un proyecto que tiene cuatro años de desarrollo

Comparison of machine learning algorithms for wildland-urban interface fuelbreak planning integrating ALS and UAV-Borne LiDAR data and multispectral images

Producción CientíficaControlling vegetation fuels around human settlements is a crucial strategy for reducing fire severity in forests, buildings and infrastructure, as well as protecting human lives. Each country has its own regulations in this respect, but they all have in common that by reducing fuel load, we in turn reduce the intensity and severity of the fire. The use of Unmanned Aerial Vehicles (UAV)-acquired data combined with other passive and active remote sensing data has the greatest performance to planning Wildland-Urban Interface (WUI) fuelbreak through machine learning algorithms. Nine remote sensing data sources (active and passive) and four supervised classification algorithms (Random Forest, Linear and Radial Support Vector Machine and Artificial Neural Networks) were tested to classify five fuel-area types. We used very high-density Light Detection and Ranging (LiDAR) data acquired by UAV (154 returns·m−2 and ortho-mosaic of 5-cm pixel), multispectral data from the satellites Pleiades-1B and Sentinel-2, and low-density LiDAR data acquired by Airborne Laser Scanning (ALS) (0.5 returns·m−2, ortho-mosaic of 25 cm pixels). Through the Variable Selection Using Random Forest (VSURF) procedure, a pre-selection of final variables was carried out to train the model. The four algorithms were compared, and it was concluded that the differences among them in overall accuracy (OA) on training datasets were negligible. Although the highest accuracy in the training step was obtained in SVML (OA=94.46%) and in testing in ANN (OA=91.91%), Random Forest was considered to be the most reliable algorithm, since it produced more consistent predictions due to the smaller differences between training and testing performance. Using a combination of Sentinel-2 and the two LiDAR data (UAV and ALS), Random Forest obtained an OA of 90.66% in training and of 91.80% in testing datasets. The differences in accuracy between the data sources used are much greater than between algorithms. LiDAR growth metrics calculated using point clouds in different dates and multispectral information from different seasons of the year are the most important variables in the classification. Our results support the essential role of UAVs in fuelbreak planning and management and thus, in the prevention of forest fires.Ministerio de Economía, Industria y Competitividad (DI-16-08446; DI-17-09626; PTQ-16-08411; PTQ- 16-08633)European Commission through the project ‘MySustainableForest’ (H2020-EO-2017; 776045

Catalytic Cyclization of o‐Alkynyl Phenethylamines via Osmacyclopropene Intermediates: Direct Access to Dopaminergic 3‐Benzazepines

NOTICE: This is the peer reviewed version of the following article: Álvarez-Pérez, A., González-Rodríguez, C., García-Yebra, C., Varela, J. A., Oñate, E., Esteruelas, M. A., Saá, C. (2015). Catalytic Cyclization of o‐Alkynyl Phenethylamines via Osmacyclopropene Intermediates: Direct Access to Dopaminergic 3‐Benzazepines. Angew. Chem. Int. Ed., 54, 45, 13357-13361. [doi: 10.1002/anie.201505782]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for self-archivingA novel osmium‐catalyzed cyclization of o‐alkynyl phenethylamines to give 3‐benzazepines is reported. The procedure allows the straightforward preparation of a broad range of dopaminergic 3‐benzazepine derivatives. Mechanistic investigations revealed that the process takes place via osmacyclopropene intermediates, which were isolated and characterized by X‐ray crystallography.This work was supported by MICINN (projects CTQ2011-28258, CTQ2014-52799-P, and CTQ2014-51912REDC), Xunta de Galicia and European Regional Development Fund (projects GRC2014/032 and EM 2012/051), the DGA (E-35) and the European Social Fund (SFE). A. A.-P. and C. G.-R. thank Spanish MICINN for a predoctoral FPI fellowship and Juan de la Cierva Contract (JCI-2011-09946), respectivelyS

Segmentación y seguimiento de estructuras en imágenes laparoscópicas

La estimación de la posición 3D de las diferentes estructuras que aparecen en cirugía laparoscópica es una medida de gran importancia para el desarrollo de aplicaciones para la formación y aprendizaje de futuros cirujanos. Para dicha estimación se hace necesaria una etapa previa de segmentación de estructuras y de seguimiento de las mismas a lo largo de la secuencia de imágenes que compone la intervención. En este trabajo de investigación se propone un método de segmentación semiautomática basada en la combinación de sobresegmentación y crecimiento de regiones y un algoritmo de seguimiento de la estructura segmentada. Para el desarrollo de estos algoritmos se utilizan técnicas de tratamiento de imágenes junto con métodos basados en la estadística paramétrica y no paramétrica

Ruthenium-Catalyzed Oxidative Amidation of Alkynes to Amides

NOTICE: This is the peer reviewed version of the following article: Álvarez-Pérez, A., Esteruelas, M. A., Izquierdo, S., Varela, J. A., Saá, C. (2019). Ruthenium-Catalyzed Oxidative Amidation of Alkynes to Amides. Org. Lett., 21, 13, 5346-5350. [doi: 10.1021/acs.orglett.9b01993]. This article may be used for non-commercial purposes in accordance with American Chemical Society Terms and Conditions for self-archivingComplex CpRuCl(PPh3)2 catalyzes reactions of terminal alkynes with 4-picoline N-oxide and primary and secondary amines to afford the corresponding amides. The reactions occur in chlorinated solvent and aqueous medium, showing applications in peptide chemistry. Stoichiometric studies reveal that the true catalysts of the processes are the vinylidene cations [CpRu(═C═CHR)(PPh3)2]+ which are oxidized to the Ru(η2-CO)-ketenes by the N-oxide. Finally, nucleophilic additions of primary and secondary amines to the free ketenes yield the corresponding amides.This work has received financial support from MINECO (projects CTQ2014-59015R, CTQ2017-87939R, CTQ2017-82935-P and ORFEO-CINQA network CTQ2016-81797-REDC), the Xunta de Ga-licia (project GRC2014/032, ED431C 2018/04, Centro singular de in-vestigación de Galicia accreditation 2016–2019, ED431G/09), DGA (No.E06_17R) and the European Union (European Regional Develop-ment Fund - ERDF). A. A.-P. thanks Spanish MICINN for a predoctoral FPI fellowshipS

Comparación del movimiento de alcance entre sujetos Sanos y Patológicos en Neurorrehabilitación Funcional de Extremidad Superior

El presente trabajo de investigación tiene como propósito principal realizar una comparación del movimiento de alcance entre sujetos aquejados de Daño Cerebral Adquirido y el correspondiente patrón de normalidad. La finalidad de esta comparación es detectar los déficits motores que permitan posteriormente emitir una valoración funcional del movimiento como parte de un método de evaluación objetiva de la función motora. La comparación del movimiento se basa en las medidas de parámetros espaciales y de similitud. En este trabajo se han utilizado modelos de movimiento de sujetos sanos en ejecuciones de Actividades de Vida Diaria (e.g. 'servir agua de una jarra'), como punto de referencia para encontrar diferencias relevantes con respecto a los datos de movimiento de cuatro pacientes bajo un proceso de Neurorrehabilitación Funcional de Extremidad Superi