A prospective comparative study between a cooling device and manual cooling after total knee arthroplasty.

Studies have shown that the use of cryotherapy after a total knee arthroplasty can have beneficial effect on blood loss, pain and medication usage. In this study, the effect of the applied cryotherapy procedure is investigated. 52 patients underwent a total knee arthroplasty. The test group received continuous cooling, whereas the control group received manual conventional cooling with ice dressing. The knee circumference and range of motion, medication use, satisfaction and pain were investigated. There is no statistical significant difference in pain and medication usage. A significant difference is observed in the swelling of the knee on the first postoperative day, the range of motion on the 7 th , 10 th , 11 th and 12 th postoperative day, and the satisfaction rate. This study shows that continuous cooling has a positive effect on the swelling and range of motion of the knee, and on the satisfaction of the treatment. Clinical trial registration number : Clinical trial number : EudraCT2015-000259-26.

Using a texture analyser to objectively quantify foot orthoses.

BACKGROUND AND AIM: Foot orthoses alter the kinematics and kinetics in gait. With the increasing importance of evidence based practice and with the permanent development of subtractive manufacturing and introduction of additive manufacturing, there is a growing need for quantification of orthoses parameters. We describe a measurement method and protocol to quantify different parameters of a foot orthosis. TECHNIQUE: A texture analyser is used to impose a displacement of the surface of the orthosis, while the applied force is measured. The measured points are determined based on the location of anatomical landmarks on the foot. Out of the measured data, parameters are calculated representing the stiffness, compression set and shape. DISCUSSION: To illustrate the proposed technique, five different parameters are extracted from three example orthoses. Results show the added value of the proposed technique as the parameters are not only defined by the material but also by the shape.

Evaluation of the influence of cyclic loading on a laser sintered transtibial prosthetic socket using Digital Image Correlation (DIC).

People with a transtibial amputation worldwide rely on their prosthetic socket to regain their mobility. Patient comfort is largely affected by the weight and strength of these prosthetic sockets. The use of additive manufacturing could give the prosthetist a range of new design possibilities when designing a prosthetic socket. These new design possibilities can in turn lead to improved socket designs and more comfortable prosthetic sockets. This new way of designing and producing prosthetic sockets radically differs from the manual traditional production process. This makes it difficult for prosthetists to understand how all these new design possibilities influence the mechanical properties of the additive manufactured prosthetic socket. Therefore there is a growing need for a method to evaluate the strength and stiffness of newly developed socket designs.We propose a method to evaluate the strength and stiffness of prosthetic sockets. A robotic gait simulator is used to apply realistic kinetics of amputee gait to the tested socket. A Digital Image Correlation (DIC) system is then used to measure the deformation of a prosthetic socket under different loading conditions. This way it is possible to check if plastic deformation will occur in the designed transtibial socket. Furthermore it is possible to assess the effect of cyclic loading on the 3D printed socket.To illustrate the proposed method, a transtibial prosthetic socket was designed using CAD software and produced with laser sintering PA12. DIC measurements were performed on this transtibial socket both before and after it was subjected to a cyclic load of 1 million cycles (mimicking realistic amputee gait).

Feature selection methods for accelerometry-based seizure detection in children.

We investigate the application of feature selection methods and their influence on distinguishing nocturnal motor seizures in epileptic children from normal nocturnal movements using accelerometry signals. We studied two feature selection methods applied one after the other to reduce the complexity and computation costs of least-squares support vector machine (LS-SVM) models. Simultaneous feature selection analyses were performed for each seizure type individually and jointly. Starting from 140 features, a filter method based on mutual information was applied to remove irrelevant and redundant features. The obtained subset was further reduced through a wrapper feature selection strategy using an LS-SVM classifier with both forward search and backward elimination. The discriminative power of each feature subset was evaluated on the test data in terms of the area under the receiver operating characteristic curve, sensitivity, and false detection rate per hour. We showed that, by using only a filter method for feature selection, it was possible to obtain classification results of comparable or slightly reduced performance with respect to the complete feature set. The attained results could facilitate further development of accelerometry-based seizure detection and alarm systems.

Non-EEG seizure detection systems and potential SUDEP prevention: State of the art: Review and update.

PURPOSE: Detection of, and alarming for epileptic seizures is increasingly demanded and researched. Our previous review article provided an overview of non-invasive, non-EEG (electro-encephalography) body signals that can be measured, along with corresponding methods, state of the art research, and commercially available systems. Three years later, many more studies and devices have emerged. Moreover, the boom of smart phones and tablets created a new market for seizure detection applications. METHOD: We performed a thorough literature review and had contact with manufacturers of commercially available devices. RESULTS: This review article gives an updated overview of body signals and methods for seizure detection, international research and (commercially) available systems and applications. Reported results of non-EEG based detection devices vary between 2.2% and 100% sensitivity and between 0 and 3.23 false detections per hour compared to the gold standard video-EEG, for seizures ranging from generalized to convulsive or non-convulsive focal seizures with or without loss of consciousness. It is particularly interesting to include monitoring of autonomic dysfunction, as this may be an important pathophysiological mechanism of SUDEP (sudden unexpected death in epilepsy), and of movement, as many seizures have a motor component. CONCLUSION: Comparison of research results is difficult as studies focus on different seizure types, timing (night versus day) and patients (adult versus pediatric patients). Nevertheless, we are convinced that the most effective seizure detection systems are multimodal, combining for example detection methods for movement and heart rate, and that devices should especially take into account the user's seizure types and personal preferences.

Long-term accelerometry-triggered video monitoring and detection of tonic-clonic and clonic seizures in a home environment: Pilot study.

PURPOSE: The aim of our study was to test the efficacy of the VARIA system (video, accelerometry, and radar-induced activity recording) and validation of accelerometry-based detection algorithms for nocturnal tonic-clonic and clonic seizures developed by our team. METHODS: We present the results of two patients with tonic-clonic and clonic seizures, measured for about one month in a home environment with four wireless accelerometers (ACM) attached to wrists and ankles. The algorithms were developed using wired ACM data synchronized with the gold standard video-/electroencephalography (EEG) and then run offline on the wireless ACM signals. Detection of seizures was compared with semicontinuous monitoring by professional caregivers (keeping an eye on multiple patients). RESULTS: The best result for the two patients was obtained with the semipatient-specific algorithm which was developed using all patients with tonic-clonic and clonic seizures in our database with wired ACM. It gave a mean sensitivity of 66.87% and false detection rate of 1.16 per night. This included 13 extra seizures detected (31%) compared with professional caregivers' observations. CONCLUSION: While the algorithms were previously validated in a controlled video/EEG monitoring unit with wired sensors, we now show the first results of long-term, wireless testing in a home environment.

Eigenfoot decomposition of plantar pressure images and case study of feature prediction of two modalities.

The registration of plantar pressure images is a widely used technique to support human gait analysis. In plantar pressure images, most of the time conventionally derived features are used for further processing. Recently, automatic feature extraction based on PCA and kPCA is being used, to increase the information that can be extracted from this data. In this paper, we describe our work flow and a case study on the application of predicting two pressure features and a non-pressure feature out of the automatically derived PCA features. This includes the normalization of the pressure images, the PCA based feature extraction, and building and testing the regression model based on a linear and kernel SVM.

Dynamic 3D scanning as a markerless method to calculate multi-segment foot kinematics during stance phase: methodology and first application.

Multi-segmental foot kinematics have been analyzed by means of optical marker-sets or by means of inertial sensors, but never by markerless dynamic 3D scanning (D3DScanning). The use of D3DScans implies a radically different approach for the construction of the multi-segment foot model: the foot anatomy is identified via the surface shape instead of distinct landmark points. We propose a 4-segment foot model consisting of the shank (Sha), calcaneus (Cal), metatarsus (Met) and hallux (Hal). These segments are manually selected on a static scan. To track the segments in the dynamic scan, the segments of the static scan are matched on each frame of the dynamic scan using the iterative closest point (ICP) fitting algorithm. Joint rotations are calculated between Sha-Cal, Cal-Met, and Met-Hal. Due to the lower quality scans at heel strike and toe off, the first and last 10% of the stance phase is excluded. The application of the method to 5 healthy subjects, 6 trials each, shows a good repeatability (intra-subject standard deviations between 1° and 2.5°) for Sha-Cal and Cal-Met joints, and inferior results for the Met-Hal joint (>3°). The repeatability seems to be subject-dependent. For the validation, a qualitative comparison with joint kinematics from a corresponding established marker-based multi-segment foot model is made. This shows very consistent patterns of rotation. The ease of subject preparation and also the effective and easy to interpret visual output, make the present technique very attractive for functional analysis of the foot, enhancing usability in clinical practice.

Accelerometry-based home monitoring for detection of nocturnal hypermotor seizures based on novelty detection.

Nocturnal home monitoring of epileptic children is often not feasible due to the cumbersome manner of seizure monitoring with the standard method of video/EEG-monitoring. We propose a method for hypermotor seizure detection based on accelerometers attached to the extremities. From the acceleration signals, multiple temporal, frequency, and wavelet-based features are extracted. After determining the features with the highest discriminative power, we classify movement events in epileptic and nonepileptic movements. This classification is only based on a nonparametric estimate of the probability density function of normal movements. Such approach allows us to build patient-specific models to classify movement data without the need for seizure data that are rarely available. If, in the test phase, the probability of a data point (event) is lower than a threshold, this event is considered to be an epileptic seizure; otherwise, it is considered as a normal nocturnal movement event. The mean performance over seven patients gives a sensitivity of 95.24% and a positive predictive value of 60.04%. However, there is a noticeable interpatient difference.

Detecting rare events using extreme value statistics applied to epileptic convulsions in children.

OBJECTIVE: Nocturnal home monitoring of epileptic children is often not feasible due to the cumbersome manner of seizure detection with the standard method of video electroencephalography monitoring. The goal of this paper is to propose a method for hypermotor seizure detection based on accelerometers that are attached to the extremities. METHODS: Supervised methods that are commonly used in literature need annotation of data and hence require expert (neurologist) interaction resulting in a substantial cost. In this paper an unsupervised method is proposed that uses extreme value statistics and seizure detection based on a model of normal behavior that is estimated using all recorded and unlabeled data. In this way the expensive interaction can be avoided. RESULTS: When applying this method to a labeled dataset, acquired from 7 patients, all hypermotor seizures are detected in 5 of the 7 patients with an average positive predictive value (PPV) of 53%. For evaluating the performance on an unlabeled dataset, seizure events are presented to the system as normal movement events. Since hypermotor seizures are rare compared to normal movements, the very few abnormal events have a negligible effect on the quality of the model. In this way, it was possible to evaluate the system for 3 of the 7 patients when 3% of the training set was composed of seizure events. This resulted in sensitivity scores of 80%, 22% and 90% and a PPV of 89%, 21% and 44% respectively. These scores are comparable with a state-of-the-art supervised machine learning based approach which requires a labeled dataset. CONCLUSIONS: A person-dependent epileptic seizure detection method has been designed that requires little human interaction. In contrast to traditional machine learning approaches, the imbalance of the dataset does not cause substantial difficulties.

Non-EEG seizure-detection systems and potential SUDEP prevention: state of the art.

PURPOSE: There is a need for a seizure-detection system that can be used long-term and in home situations for early intervention and prevention of seizure related side effects including SUDEP (sudden unexpected death in epileptic patients). The gold standard for monitoring epileptic seizures involves video/EEG (electro-encephalography), which is uncomfortable for the patient, as EEG electrodes are attached to the scalp. EEG analysis is also labour-intensive and has yet to be automated and adapted for real-time monitoring. It is therefore usually performed in a hospital setting, for a few days at the most. The goal of this article is to provide an overview of body signals that can be measured, along with corresponding methods, state-of-art research, and commercially available systems, as well as to stress the importance of a good detection system. METHOD: Narrative literature review. RESULTS: A range of body signals can be monitored for the purpose of seizure detection. It is particularly interesting to include monitoring of autonomic dysfunction, as this may be an important patho-physiological mechanism of SUDEP, and of movement, as many seizures have a motor component. CONCLUSION: The most effective seizure detection systems are multimodal. Such systems should also be comfortable and low-power. The body signals and modalities on which a system is based should take account of the user's seizure types and personal preferences.

Long-term home monitoring of hypermotor seizures by patient-worn accelerometers.

Long-term home monitoring of epileptic seizures is not feasible with the gold standard of video/electro-encephalography (EEG) monitoring. The authors developed a system and algorithm for nocturnal hypermotor seizure detection in pediatric patients based on an accelerometer (ACM) attached to extremities. Seizure detection is done using normal movement data, meaning that the system can be installed in a new patient's room immediately as prior knowledge on the patient's seizures is not needed for the patient-specific model. In this study, the authors compared video/EEG-based seizure detection with ACM data in seven patients and found a sensitivity of 95.71% and a positive predictive value of 57.84%. The authors focused on hypermotor seizures given the availability of this seizure type in the data, the typical occurrence of these seizures during sleep, i.e., when the measurements were done, and the importance of detection of hypermotor seizures given their often refractory nature and the possible serious consequences. To our knowledge, it is the first detection system focusing on this type of seizure in pediatric patients.

Using Spatio-Temporal Interest Points (STIP) for myoclonic jerk detection in nocturnal video.

In this study we introduce a method for detecting myoclonic jerks during the night with video. Using video instead of the traditional method of using EEG-electrodes, permits patients to sleep without any attached sensors. This improves the comfort during sleep and it makes long term home monitoring possible. The algorithm for the detection of the seizures is based on spatio-temporal interest points (STIPs), proposed by Ivan Laptev, which is the state-of-the-art in action recognition.We applied this algorithm on a group of patients suffering from myoclonic jerks. With an optimal parameter setting this resulted in a sensitivity of over 75% and a PPV of over 85%, on the patients' combined data.

Automatic video detection of body movement during sleep based on optical flow in pediatric patients with epilepsy.

The aim of our work is to investigate whether the optical flow algorithm applied to video recordings can be used to detect movement during sleep in pediatric patients with epilepsy. The optical flow algorithm allocates intensities to pixels proportional to their involvement in movement of an object. The average of a percentage of the highest movement vectors was plotted as a function of time (R(t)). The used dataset contains video data acquired at the University Hospital of Leuven consisting of normal sleep movement and seizure movement. We investigated R(t), to make a distinction between movement and non-movement. We used the acquisition parameters (320 x 240 at 12.5 fps), derived from a previous study (Cuppens et al., Proceedings of the 4th European congress of the international federation for medical and biological engineering (MBEC 2008), ECIFBME 2008, Antwerp, Belgium, IFMBE Proceedings, vol 22, pp 784-789, 2008). Two experiments were concluded, one with global thresholds of R(t) in all datasets and one with a variable threshold in each dataset. The latter is obtained by inspecting a non-movement epoch and calculating the mean and standard deviations of R(t) over time. The variable threshold on R(t) was then obtained for each dataset by adding to the mean a fixed multiple of the standard deviation. Optimal thresholds were derived based on a three-fold cross-validation. The best result was achieved when using a variable threshold, which resulted in a sensitivity of one in all the test sets and a PPV of 1, 0.821, and 1, respectively, for the three test sets.

Detection of nocturnal frontal lobe seizures in pediatric patients by means of accelerometers: a first study.

The monitoring of epileptic seizures is mainly done by means of video/EEG-monitoring. Although this method is considered as the golden standard, it is not comfortable for the patient as the EEG-electrodes have to be attached to the scalp which hampers the patient's movement. This makes long term home monitoring not feasible. A detection system with accelerometers attached to the wrists and ankles can solve this problem. Nocturnal frontal lobe seizures often include bicycle pedaling movements or uncontrolled movements with the arms which are clearly visible in the accelerometer signals. Data from three patients suffering from nocturnal frontal lobe seizures is used in this paper for the development of an automatic detection algorithm for this type of seizure. First movement epochs are detected as a preprocessing step by calculating the standard deviation of a sliding window. Afterwards a moving average filter is applied to the data and thresholds are set to the signals of the arms and legs to detect the seizures. This resulted in an algorithm with a sensitivity of 91.67% and a specificity of 83.92%.