Remote Biofeedback Method for Biomedical Data Analysis

In recent years, the introduction of methods supported by technology has positively modified the traditional paradigm of rehabilitation. Interactive systems have been developed to facilitate patient involvement and to help therapist in patient\u2019s management. ReMoVES (REmote MOnitoring Validation Engineering System) platform addresses the problem of continuity of care in a smart and economical way. It can help patients with neurological, post-stroke and orthopedic impairments in recovering physical, psychological and social functions; such system will not only improve the quality of life and accelerate the recovery process for patients, but also aims at rationalizing and help the manpower required monitoring and coaching individual patients at rehabilitation centers. In order to help and support therapist work, the Remote Biofeedback Method is proposed as an instrument to understand how the patient has executed the rehabilitation exercises without seeing him directly. Therefore, the purpose of this method is to demonstrate that through the joint observation of data from simple sensors, it is possible to determine: time and method of execution of the exercises, performance and improvements during the rehabilitation session, pertinence of exercise and plan of care. The system, during the rehabilitation session, automatically transmits patient\u2019s biofeedback through three different channels: movement, physiological signals and a questionnaire. The therapist uses patient\u2019s data to determine whether the plan of care assigned is appropriate for the recovery of lost functionalities. He will then return a remote feedback to the patient who will not see any kind of graphical or verbal output, but you will see lighter rehabilitative session if it was too difficult or more intense if one assigned was too simple. The rehabilitation protocol proposed consists of the performance of different exercises, which begins with a breathing activity, designed to relax the patient before the \u201ceffective\u201d rehabilitation session. To make the subject comfortable, and to bring again the heartbeat to a basal value, before the rehabilitation session, the patient, in a sitting position, is leading to breathing with a regular rhythm by following a \u201cbreath ball\u201d. From the results obtained in the breathing exercise, it can be concluded that the negative trend of the regression line that approximates the heartbeat signal is an index of relaxation, principal goal for which the exercise was designed. The proposed activities include execution of reaching and grasping, balance and control posture functional exercises, masked through serious games to simulate some of the most common gestures of daily life. In some exercises, a cognitive component will also be involved in achieving the goal required by the activity. For each activity, heart rate, gameplay scores, and different motion parameters were captured and analyzed depending on the type of exercise performed. The heart rate was used as an indicator of motivation and involvement during the execution of several rehabilitative exercises. Others parameters analyzed are the score obtained during the execution of the task, and the time interval between the execution of one exercise and the following one. In addition to the analysis of the individual signals, a preliminary analysis of the correlation between the trend of the heart rate and the performance of the score was also carried out. The results showed that heartbeat in conjunction with score and inter-exercise time could be a high-quality indicator of a patient\u2019s status. The indicators extracted, in fact, in most cases, correspond to the information reported from the therapist who observed the patients during the rehabilitation session. A deep analysis of movement signal was carried on, with the extraction of several indicators for the different body segments involved in rehabilitation, such as the upper limb, the hand, the lower limbs and the posture, included the detection of compensation strategies to reach the targets proposed by the exercise. The results have been extracted by comparing the patient performance to a model extracted by a healthy subjects group. Of particular importance is the spatial map for patients with neglect, an innovative tool that traces the positions where the movement was performed and also provides the therapist with the spatial coordinates where the targets were proposed. Another innovative aspect is the analysis of Center of Pressure (CoP) without the use of a specific footboard, but only through the processing of data from the motion sensor. The results obtained by the application of the Remote Biofeedback Methods to the signals acquired during ReMoVES testing phase show interesting applications of the method to the clinical practice. In fact, the indicators extracted show a realistic correspondence between the disabilities affected the patients and the performance obtained during the execution of the exercises. From the study of the different exercises it can be concluded that the analysis of the signals and the parameters extracted individually, do not provide enough information to outline how the rehabilitation exercise has been executed. By combining the different indicators, it is possible to outline an accurate picture that allows the therapist to make decisions about the assigned plan of care. In conclusion, the Remote Biofeedback Method proposed is now ready to be tested on a wider dataset in order to be consolidated on a larger number of athologies and to associate, if necessary, particular indicators to a particular disease. The future steps will be, a creation of a model starting from patients signals, in order to have a better comparison term, and a testing phase on a larger number of patients, following a clinical protocol, subdividing subject by disease

Sustainable cooperative distance learning system for education in developing countries

The use of Information and Communication Technologies (ICTs) in a cooperative way can give a good improvement in the educational field; in developing countries, especially in Sub-Saharan area. Sustainable technologies and collaborative LMS are investigated in a case study as possible ways to improve, towards distance learning systems, education and towards it, social empowerment and development. A web-based system, customized for an academic year proposal in medicine and surgery field, helps the development of cooperation among universities and research empowerment and exchange, useful for both entities and their stakeholders. Different uses and approaches to the technological solution allow different participants to model and interact with the project despite difficulties and environmental gabs that could occur in some territories of the Sub-Saharan countries

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Infrastructure for data management and user centered rehabilitation in Rehab@Home project

In this paper, we describe the Rehab@Home Operational Infrastructure which functioning essentially relies on the acquisition, processing, exchange and interpretation of a large set of heterogeneous data and information. These data are coming from existing clinical data records, rehabilitation workflow structure, user-system interaction, and explicit user feedback, basic information about expected and actual rehabilitation progress, biophysical sensors, ambient and contextual sensors. What in a more precise and detailed way has been described and analyzed is the specification and development of data protocol and data integration devoted to the acquisition, processing, exchange and interpretation of a large set of heterogeneous data and information coming from biophysical sensors, ambient and contextual sensors, existing clinical data records. It has been carried a study of user profiling and personalization, which will be exploited to adapt process and services with the aim of enhancing user satisfaction. Thanks to personalization of the user-system interaction, the explicit user feedback, the basic information about expected and actual rehabilitation progress are made available in the best way. Case-based reasoning further improves the extraction of useful information from a single patient and from compared analysis. Identification of the most relevant risk factors related to the rehabilitation process and the monitoring of the whole rehabilitation process was another field of study

Definition of Motion and Biophysical Indicators for Home-Based Rehabilitation through Serious Games

In this paper, we describe Remote Monitoring Validation Engineering System (ReMoVES), a newly-developed platform for motion rehabilitation through serious games and biophysical sensors. The main features of the system are highlighted as follows: motion tracking capabilities through Microsoft Kinect V2 and Leap Motion are disclosed and compared with other solutions; the emotional state of the patient is evaluated with heart rate measurements and electrodermal activity monitored by Microsoft Band 2 during the execution of the functional exercises planned by the therapist. The ReMoVES platform is conceived for home-based rehabilitation after the hospitalisation period, and the system will deploy machine learning techniques to provide an automated evaluation of the patient performance during the training. The algorithms should deliver effective reports to the therapist about the training performance while the patient exercises on their own. The game features that will be described in this manuscript represent the input for the training set, while the feedback provided by the therapist is the output. To face this supervised learning problem, we are describing the most significant features to be used as key indicators of the patient&rsquo;s performance along with the evaluation of their accuracy in discriminating between good or bad patient actions

Infrastructure for data management and user centered rehabilitation in Rehab@Home project

In this paper, we describe the Rehab@Home Operational Infrastructure which functioning essentially relies on the acquisition, processing, exchange and interpretation of a large set of heterogeneous data and information. These data are coming from existing clinical data records, rehabilitation workflow structure, user-system interaction, and explicit user feedback, basic information about expected and actual rehabilitation progress, biophysical sensors, ambient and contextual sensors. What in a more precise and detailed way has been described and analyzed is the specification and development of data protocol and data integration devoted to the acquisition, processing, exchange and interpretation of a large set of heterogeneous data and information coming from biophysical sensors, ambient and contextual sensors, existing clinical data records. It has been carried a study of user profiling and personalization, which will be exploited to adapt process and services with the aim of enhancing user satisfaction. Thanks to personalization of the user-system interaction, the explicit user feedback, the basic information about expected and actual rehabilitation progress are made available in the best way. Case-based reasoning further improves the extraction of useful information from a single patient and from compared analysis. Identification of the most relevant risk factors related to the rehabilitation process and the monitoring of the whole rehabilitation process was another field of study

Biophysical and motion features extraction for an effective home-based rehabilitation

In this paper, we describe ReMoVES (REmote MOnitoring Validation Engineering System) which is a newly developed platform for motion rehabilitation through serious-games and biophysical sensors. The main features of the system are highlighted: motion tracking capabilities are disclosed and compared with other solutions; the emotional state of the patient is evaluated with heart rate measurements and electrodermal activity monitoring during the execution of the functional exercises planned by the therapist. Preliminary results about the extraction of significant features from motion and biophysical data will be discussed: the personal rehabilitation program is meant to be performed at home by the patient himself while ReMoVES platform should deliver effective reports to the therapist about the training performance

Technical Concept of Health Data Collection and Integration Data Analysis for Gaining Meaningful Medical Information

The collection of data for therapeutic purposes when using Serious Games in a home environment is essential to help therapists and medical doctors deliver better therapy. It is necessary to use different sensors for collecting such data. This requires using standards as HL71 as much as possible to provide a general purpose approach. On the other hand, the collected data needs an extensive evaluation and interpretation and tools are required to provide the therapist and medical doctor with meaningful information. In this chapter we offer a closer look to standards and propose tools for the analysis of collected data for later use by therapists and medical doctors as a result of the Rehab@Home project

Monitoring game-based motor rehabilitation of patients at home for better plans of care and quality of life

This paper describes the biomedical, remote monitoring infrastructure developed and currently tested in the EU REHAB@HOME project to support home rehabilitation of the upper extremity of persons post-stroke and in persons with other neurological disorders, such as Multiple Sclerosis patients, in order to track their progress over therapy and improve their Quality of Life. The paper will specifically focus on describing the initial testing of the tele-rehabilitation system's components for patients' biomedical monitoring over therapy, which support the delivery and monitoring of more personalized, engaging plans of care by rehabilitation centers and services