Pediatric Deep Brain Stimulation Using Awake Recording and Stimulation for Target Selection in an Inpatient Neuromodulation Monitoring Unit.

Deep brain stimulation (DBS) for secondary (acquired, combined) dystonia does not reach the high degree of efficacy achieved in primary (genetic, isolated) dystonia. We hypothesize that this may be due to variability in the underlying injury, so that different children may require placement of electrodes in different regions of basal ganglia and thalamus. We describe a new targeting procedure in which temporary depth electrodes are placed at multiple possible targets in basal ganglia and thalamus, and probing for efficacy is performed using test stimulation and recording while children remain for one week in an inpatient Neuromodulation Monitoring Unit (NMU). Nine Children with severe secondary dystonia underwent the NMU targeting procedure. In all cases, 4 electrodes were implanted. We compared the results to 6 children who had previously had 4 electrodes implanted using standard intraoperative microelectrode targeting techniques. Results showed a significant benefit, with 80% of children with NMU targeting achieving greater than 5-point improvement on the Burke⁻Fahn⁻Marsden Dystonia Rating Scale (BFMDRS), compared with 50% of children using intraoperative targeting. NMU targeting improved BFMDRS by an average of 17.1 whereas intraoperative targeting improved by an average of 10.3. These preliminary results support the use of test stimulation and recording in a Neuromodulation Monitoring Unit (NMU) as a new technique with the potential to improve outcomes following DBS in children with secondary (acquired) dystonia. A larger sample size will be needed to confirm these results.

Adaptive routing for dynamic on-body wireless sensor networks.

Energy is scarce in mobile computing devices including wearable and implantable devices in a wireless body area network. In this paper, an adaptive routing protocol is developed and analyzed which minimizes the energy cost per bit of information by using the channel information to choose the best strategy to route data. In this approach, the source node will switch between direct and relayed communication based on the quality of the link and will use the relay only if the channel quality is below a certain threshold. The mathematical model is then validated through simulations which shows that the adaptive routing strategy can improve energy efficiency significantly compared with existing methods.

A novel approach to joint flexion/extension angles measurement based on wearable UWB radios.

In this paper, a new method for measuring and monitoring human body joint angles, which uses wearable ultrawideband (UWB) transceivers mounted on body segments, is proposed and investigated. The model is based on providing a high ranging accuracy (intersensor distance) between a pair of transceivers placed on the adjacent segments of the joint center of rotation. The measured distance is then used to compute the joint angles based on the law of cosines. The performance of the method was compared with a flexible goniometer by simultaneously measuring joint flexion-extension angles at different angular velocities, ranging between 8 and 90(°) /s. The measurement errors were evaluated by the average differences between two sets of data (ranging from 0.8(°) for slow movement to 2.8(°) for fast movement), by standard deviation (ranging from 1.2(°) to 4.2(°) for various movement speeds) and by the Pearson correlation coefficient (greater than 0.99) which demonstrates the very good performance of the UWB-based approach. The experimental results have shown that the system has sufficient accuracy for clinical applications, such as rehabilitation.

Using wearable UWB radios to measure foot clearance during walking.

Foot clearance above ground is a key factor for a better understanding of the complicated relationship between falls and gait. This paper proposes a wearable system using UWB transceivers to monitor the vertical heel/toe clearance during walking. First, a pair of very small and light antennas is placed on a point approximating to the heel/toe of the foot, acting as a transmitter and receiver. Then, the reflected signal from ground is captured and propagation delay is detected using noise suppressed Modified-Phase-Only-Correlator (MPOC). The performance of the UWB-based system was compared with an ultrasound system for stationary movements. The experimental results show that an overall mean difference between these two systems is about 0.634mm with correlation coefficient value of 0.9604. The UWB-based system is then used to measure foot clearance during walking which shows promising results for gait events detection.

Measurement of knee flexion/extension angle using wearable UWB radios.

This paper proposes a wearable system using UWB transceivers to measure the knee flexion/extension angle parameter, who is known to be of clinical importance. First, a pair of very small and light antennas is placed on the adjacent segments of knee joint. Then, the range data between these two antennas is acquired using Time of Arrival (TOA) estimator. We further use the measured distance to compute the flexion/extension angle using the law of cosines. The performance of the method was compared with a flexible goniometer by simultaneously measuring knee flexion-extension angle. The experimental results show that the system has reasonable performance and has sufficient accuracy for clinical applications.