On the Use of Non-Contact Capacitive Sensors for the Assessment of Postural Hand Tremor of Individuals with Parkinson's Disease.

Parkinsonian tremor manifests in different types: rest, postural, and action tremors. The postural tremor occurs while a body part is held straight out from the body in a stable position against gravity. The Unified Parkinson's Disease Rating Scale (UPDRS), which is a subjective assessment performed by the qualitative judgment of neurologists, is the clinical standard for parkinsonian tremor assessment. Despite the common use of subjective methods, inertial measurement unit (IMU) sensors are largely used in many studies as a motion capture system to objective assessment of tremors. However, this kind of sensor must be attached to the patient's body, it limits the patient's movements and requires specific techniques for correct positioning in the limb. In this sense, non-contact capacitive (NCC) sensors are an alternative proposed in this research to record the motor activity of the hand and wrist during a pose against gravity. In order to assess the postural tremor and evaluate this novel sensing technology, data from ten subjects, five with Parkinson's disease (PD) and five neurologically healthy (H) matched in age and sex, were collected. We analyzed the instantaneous mean frequency (IMNF) of the signals from NCC and gyroscope sensors for both groups. The selected descriptive statistical variables allowed discrimination (p <; 0.05) among subjects from H and PD groups while using the gyroscope or the NCC sensor. The obtained results indicate that the NCC sensor can measure the postural hand tremor, and also that frequency features extracted from the collected signals can be used to discriminate subjects from both groups.

Objective Assessment of Bradykinesia Estimated from the Wrist Extension in Older Adults and Patients with Parkinson's Disease.

Parkinson's disease (PD) presents several motor signs, including tremor and bradykinesia. However, these signs can also be found in other motor disorders and in neurologically healthy older adults. The incidence of bradykinesia in PD is relatively high in all stages of the disorder, even when compared to tremor. Thus, this research proposes an objective assessment of bradykinesia in patients with PD (G PD: 15 older adults with Parkinson's disease, 65.3 ± 9.1 years) and older adults (G HV: 12 healthy older adults, 60.1 ± 6.1 years). The severity of bradykinesia in the participants of G PD was assessed using the Unified Parkinson's Disease Rating Scale. Movement and muscular activity were detected by means of inertial (accelerometer, gyroscope, magnetometer) and electromyographic sensors while the participants performed wrist extension against gravity with the forearm on pronation. Mean and standard error of inertial and electromyographic signal parameters could discriminate PD patients from healthy older adults (p value <0.05). In discriminating patients with PD from healthy older adults, the mean sensitivity and specificity were respectively 86.67 and 83.33%. The discrimination between the groups, based on the objective evaluation of bradykinesia, may contribute to the accurate diagnosis of PD and to the monitoring of therapies to control parkinsonian bradykinesia, and opens the possibility for further comparative studies considering individuals suffering from other motor disorders.

Estimated features from surface EMG of the lower limb correlate with the subjective sensation of pain

Pain assessment is very important in establishing the efficacy of analgesics and therapies, but because pain is a subjective experience, using methods that represent pain objectively is necessary. A number of biopotentials have been employed in studies of the objective assessment of pain. However, few investigations have considered the peripheral nervous system response to electrical stimulation. The present study evaluated a method for pain quantification based on the analysis of biopotentials. We assessed electromyographic activity that resulted from evoked movements from the nociceptive flexion reflex (NFR). We investigated correlations between stimulus intensity, features extracted from surface electromyography (EMG), and subjective pain reported by subjects using a Visual Analog Scale (VAS). A total of 10 healthy male subjects without any pain disorder, aged 20-27 years, participated in the study. A high correlation (r2 > .87) was found between stimulus intensity and the following features extracted from the EMG: area, root mean square (RMS), and entropy. A high correlation (r2 > .99) was also found between stimulus intensity and subjective pain reported on the VAS. We conclude that estimating features from electromyographic signals that are correlated with subjective pain sensations and the intensity of the electrical stimulus is possible. Entropy, RMS, and the area of the electromyographic signal appear to be relevant parameters in correlations with subjective pain.

Estimated features from surface EMG of the lower limb correlate with the subjective sensation of pain

Pain assessment is very important in establishing the efficacy of analgesics and therapies, but because pain is a subjective experience, using methods that represent pain objectively is necessary. A number of biopotentials have been employed in studies of the objective assessment of pain. However, few investigations have considered the peripheral nervous system response to electrical stimulation. The present study evaluated a method for pain quantification based on the analysis of biopotentials. We assessed electromyographic activity that resulted from evoked movements from the nociceptive flexion reflex (NFR). We investigated correlations between stimulus intensity, features extracted from surface electromyography (EMG), and subjective pain reported by subjects using a Visual Analog Scale (VAS). A total of 10 healthy male subjects without any pain disorder, aged 20-27 years, participated in the study. A high correlation (r2 > .87) was found between stimulus intensity and the following features extracted from the EMG: area, root mean square (RMS), and entropy. A high correlation (r2 > .99) was also found between stimulus intensity and subjective pain reported on the VAS. We conclude that estimating features from electromyographic signals that are correlated with subjective pain sensations and the intensity of the electrical stimulus is possible. Entropy, RMS, and the area of the electromyographic signal appear to be relevant parameters in correlations with subjective pain.(AU)

Assessment of inter-examiner agreement and variability in the manual classification of auditory brainstem response.

BACKGROUND: The analysis of the Auditory Brainstem Response (ABR) is of fundamental importance to the investigation of the auditory system behaviour, though its interpretation has a subjective nature because of the manual process employed in its study and the clinical experience required for its analysis. When analysing the ABR, clinicians are often interested in the identification of ABR signal components referred to as Jewett waves. In particular, the detection and study of the time when these waves occur (i.e., the wave latency) is a practical tool for the diagnosis of disorders affecting the auditory system. Significant differences in inter-examiner results may lead to completely distinct clinical interpretations of the state of the auditory system. In this context, the aim of this research was to evaluate the inter-examiner agreement and variability in the manual classification of ABR. METHODS: A total of 160 ABR data samples were collected, for four different stimulus intensity (80dBHL, 60dBHL, 40dBHL and 20dBHL), from 10 normal-hearing subjects (5 men and 5 women, from 20 to 52 years). Four examiners with expertise in the manual classification of ABR components participated in the study. The Bland-Altman statistical method was employed for the assessment of inter-examiner agreement and variability. The mean, standard deviation and error for the bias, which is the difference between examiners' annotations, were estimated for each pair of examiners. Scatter plots and histograms were employed for data visualization and analysis. RESULTS: In most comparisons the differences between examiner's annotations were below 0.1 ms, which is clinically acceptable. In four cases, it was found a large error and standard deviation (>0.1 ms) that indicate the presence of outliers and thus, discrepancies between examiners. CONCLUSIONS: Our results quantify the inter-examiner agreement and variability of the manual analysis of ABR data, and they also allows for the determination of different patterns of manual ABR analysis.

Quantification of physiological kinetic tremor and its correlation with aging.

Tremor is the most common movement disorder characterized by repetitive and stereotyped movements. The analysis of hand-drawing movements is commonly used in the evaluation of patients with tremor. The data collection conducted under kinetic conditions and while performing a voluntary movement highlights the kinetic tremor. Most investigations on tremor attempt to understand its relation to neuromuscular dysfunctions. Therefore, there is a lack of studies that aim to investigate the complex relation between the physiological tremor and aging, especially in kinetic conditions. In this context, the main motivation of this research was to generalize the results obtained in Almeida et al., a study that quantified age-related changes in the kinetic tremor of clinically healthy individuals. For this, a number of features extracted from tremor activity, obtained from digitized drawings of Archimedes' spirals, were analyzed. The analyses followed the sequence: Linearization of the Archimedes' spiral; Estimate of tremor activity; Data pre-processing; Feature extraction from the tremor activity; and Application of Linear Discriminant Analysis (LDA) technique as described in Almeida et al.. The generalization of the obtained results showed that the method based on LDA allows for a linear correlation between physiological kinetic tremor and aging.

Investigation of age-related changes in physiological kinetic tremor.

Tremor is the most common movement disorder characterized by repetitive and stereotyped movements. Most investigations on tremor attempt to understand its relation to neuromuscular dysfunctions. Therefore, there is a lack of studies that aim to investigate the complex relation between the physiological tremor and aging, especially in kinetic conditions. In this context, the main motivation of this research was to quantify age-related changes in the kinetic tremor of clinically healthy individuals. For this, a number of features extracted from tremor activity, obtained from digitized drawings of Archimedes' spirals, were analyzed. In total, 59 subjects participated in the experiments. These individuals were divided into seven groups according to their ages and two types of analysis were carried out. First, the tremor activity of young and elderly adults was investigated by means of traditional features commonly used in tremor analysis, and secondly, linear discriminant analysis (LDA) was employed for the study of the correlation between age and tremor. The results showed significant statistical differences between the kinetic tremor activity of the young and elderly groups. Furthermore, it was found that LDA allowed for the estimate of a unique feature, so-called LDA-value, which showed to be linearly correlated with age.

The approximate entropy of the electromyographic signals of tremor correlates with the osmotic fragility of human erythrocytes.

BACKGROUND: The main problem of tremor is the damage caused to the quality of the life of patients, especially those at more advanced ages. There is not a consensus yet about the origins of this disorder, but it can be examined in the correlations between the biological signs of aging and the tremor characteristics. METHODS: This work sought correlations between the osmotic fragility of erythrocytes and features extracted from electromyographic (EMG) activity resulting from physiological tremor in healthy patients (N = 44) at different ages (24-87 years). The osmotic fragility was spectrophotometrically evaluated by the dependence of hemolysis, provided by the absorbance in 540 nm (A54o), on the concentration of NaCl. The data were adjusted to curves of sigmoidal regression and characterized by the half transition point (H50), amplitude of lysis transition (dx) and values of A540 in the curve regions that characterize the presence of lysed (A1) and preserved erythrocytes (A2). The approximate entropy was estimated from EMG signals detected from the extensor carpi ulnaris muscle during the movement of the hand of subjects holding up a laser pen towards an Archimedes spiral, fixed in a whiteboard. The evaluations were carried out with the laser pen at rest, at the center of the spiral, and in movement from the center to the outside and from outside to the center. The correlations among the parameters of osmotic fragility, tremor and age were tested. RESULTS: Negative correlations with age were found for A1 and dx. With the hand at rest, a positive correlation with H50 was found for the approximate entropy. Negative correlations with H50 were found for the entropy with the hand in movement, as from the center to the outside or from the outside to the center of the spiral. CONCLUSION: In healthy individuals, the increase in the erythrocyte osmotic fragility was associated with a decrease in the approximate entropy for rest tremor and with an increase of the entropy for movement tremor. This suggests that the neuromuscular degeneration associated with tremor entails also the mechanisms involved in the breakdown of structural homeostasis of the erythrocyte membrane.

Study of age-related changes in postural control during quiet standing through linear discriminant analysis.

BACKGROUND: The human body adopts a number of strategies to maintain an upright position. The analysis of the human balance allows for the understanding and identification of such strategies. The displacement of the centre of pressure (COP) is a measure that has been successfully employed in studies regarding the postural control. Most of these investigations are related to the analysis of individuals suffering from neuromuscular disorders. Recent studies have shown that the elderly population is growing very fast in many countries all over the world, and therefore, researches that try to understand changes in this group are required. In this context, this study proposes the analysis of the postural control, measured by the displacement of the COP, in groups of young and elderly adults. METHODS: In total 59 subjects participated of this study. They were divided into seven groups according to their age. The displacement of the COP was collected for each subject standing on a force plate. Two experimental conditions, of 30 seconds each, were investigated: opened eyes and closed eyes. Traditional and recent digital signal processing tools were employed for feature computation from the displacement of the COP. Statistical analyses were carried out in order to identify significant differences between the features computed from the distinct groups that could allow for their discrimination. RESULTS: Our results showed that Linear Discrimination Analysis (LDA), which is one of the most popular feature extraction and classifier design techniques, could be successfully employed as a linear transformation, based on the linear combination of standard features for COP analysis, capable of estimating a unique feature, so-called LDA-value, from which it was possible to discriminate the investigated groups and show a high correlation between this feature and age. CONCLUSION: These results show that the analysis of features computed from the displacement of the COP are of great importance in studies trying to understand the ageing process. In particular, the LDA-value showed to be an adequate feature for assessment of changes in the postural control which can be related to functional changes that occur over the ageing.

Fuzzy cluster stability analysis with missing values using resampling.

Exploratory data analysis is often necessary to evaluate potential hypotheses for subsequent studies such as grouping the data in clusters. In real data sets the occurrence of incompleteness is very common. We propose a method that tolerates missing values for fuzzy clustering using resampling (bootstrapping) and cluster stability analysis. The quality of classification is based on the measures like F1 and Hubert. The central idea is to compare a reference cluster with many clusters from sub-samples of the original data set. The results demonstrate that our method is capable of identifying relevant partitions even with high presence of missing values.

A computational method for recording and analysis of mandibular movements.

This study proposed the development of a new clinical tool capable of quantifying the movements of opening-closing, protrusion and laterotrusion of the mandible. These movements are important for the clinical evaluation of the temporomandibular function and muscles involved in mastication. Unlike current commercial systems, the proposed system employs a low-cost video camera and a computer program that is used for reconstructing the trajectory of a reflective marker that is fixed on the mandible. In order to illustrate the clinical application of this tool, a clinical experiment consisting on the evaluation of the mandibular movements of 12 subjects was conducted. The results of this study were compatible with those found in the literature with the advantage of using a low cost, simple, non-invasive, and flexible tool customized for the needs of the practical clinic.

A computational method for recording and analysis of mandibular movements

This study proposed the development of a new clinical tool capable of quantifying the movements of opening-closing, protrusion and laterotrusion of the mandible. These movements are important for the clinical evaluation of the temporomandibular function and muscles involved in mastication. Unlike current commercial systems, the proposed system employs a low-cost video camera and a computer program that is used for reconstructing the trajectory of a reflective marker that is fixed on the mandible. In order to illustrate the clinical application of this tool, a clinical experiment consisting on the evaluation of the mandibular movements of 12 subjects was conducted. The results of this study were compatible with those found in the literature with the advantage of using a low cost, simple, non-invasive, and flexible tool customized for the needs of the practical clinic.

A review on techniques for tremor recording and quantification.

Tremor is the most common movement disorder and differs from other disorders by its repetitive, stereotyped movements, with regular frequency and amplitude. The three most frequent pathological forms of it are the essential tremor (ET), the Parkinson's disease (PD) tremor, and the enhanced physiological tremor. The ET and PD tremor affect the older population mostly. Although there are cases of tremor reported since ancient times, there is currently no consensus about its causes or about its main differential characteristics. In this article, we present a review of the methods more frequently used in measurement and analysis of tremor and the difficulties encountered in the research for the identification of methodologies that allow a significant advance in the study of tremor.