Alessia Dessì

Fully Textile, PEDOT:PSS Based Electrodes for Wearable ECG Monitoring Systems

Goal: To evaluate a novel kind of textile electrodes based on woven fabrics treated with PEDOT:PSS, through an easy fabrication process, testing these electrodes for biopotential recordings. Methods: Fabrication is based on raw fabric soaking in PEDOT:PSS using a second dopant, squeezing and annealing. The electrodes have been tested on human volunteers, in terms of both skin contact impedance and quality of the ECG signals recorded at rest and during physical activity (power spectral density, baseline wandering, QRS detectability, and broadband noise). Results: The electrodes are able to operate in both wet and dry conditions. Dry electrodes are more prone to noise artifacts, especially during physical exercise and mainly due to the unstable contact between the electrode and the skin. Wet (saline) electrodes present a stable and reproducible behavior, which is comparable or better than that of traditional disposable gelled Ag/AgCl electrodes. Conclusion: The achieved results reveal the capability of this kind of electrodes to work without the electrolyte, providing a valuable interface with the skin, due to mixed electronic and ionic conductivity of PEDOT:PSS. These electrodes can be effectively used for acquiring ECG signals. Significance: Textile electrodes based on PEDOT:PSS represent an important milestone in wearable monitoring, as they present an easy and reproducible fabrication process, very good performance in wet and dry (at rest) conditions and a superior level of comfort with respect to textile electrodes proposed so far. This paves the way to their integration into smart garments.

Telemedicine Applied to Kinesiotherapy for Hand Dysfunction in Patients with Systemic Sclerosis and Rheumatoid Arthritis: Recovery of Movement and Telemonitoring Technology

Objective. To describe a feasibility study focused on a telemonitoring approach to self-managed kinesiotherapy sessions for the rehabilitation of hand function in patients with systemic sclerosis (SSc) and rheumatoid arthritis (RA). Methods. Ten patients with SSc and 10 with RA were enrolled in a 3-month controlled trial (approval no. 9751/2012 – Italian Department of Health) to perform a home kinesiotherapy protocol, consisting of strengthening and mobility exercises, using a newly developed telemedicine system (a portable device and the related telemonitoring infrastructure). A further 10 patients with SSc and 10 with RA were enrolled as controls to perform a similar home kinesiotherapy protocol with the aid of common daily-life objects. Both groups were evaluated at baseline and at followup, after 6 and 12 weeks. The primary outcome of the trial was hand function measured by Dreiser’s index (Functional Index for Hand OA, FIHOA), Health Assessment Questionnaire (HAQ), and the Hand Mobility in Scleroderma (HAMIS) test (only for SSc). Results. Patients with SSc showed an improvement of FIHOA in both arms (p < 0.01) but the HAQ (p = 0.016) and the HAMIS test (right hand p = 0.016, left hand p = 0.075) improved significantly only in the experimental arm. Patients with RA showed a statistically significant improvement of FIHOA (p = 0.013) and HAQ (p = 0.015) in the experimental arm, while patients in the control arm did not significantly improve. However, no statistically significant differences in outcome measures between treatment methods were observed. Withdrawals were higher in control arms (SSc 20%; RA 30%) than in experimental arms (SSc 10%; RA 10%). Conclusion. Telemonitoring of self-administered kinesiotherapy programs is a promising approach to the rehabilitation of hand functions in patients with rheumatic disease.

A Device for Local or Remote Monitoring of Hand Rehabilitation Sessions for Rheumatic Patients

Current clinical practice suggests that recovering the hand functionality lost or reduced by injuries, interventions, and chronic diseases requires, beyond pharmacological treatments, a kinesiotherapic intervention. This form of rehabilitation consists of physical exercises adapted to the specific pathology. Its effectiveness is strongly dependent on the patients adhesion to such a program. In this paper, we present a novel device with remote monitoring capabilities expressly conceived for the needs of rheumatic patients. It comprises several sensorized tools and can be used either in an outpatient clinic for hand functional evaluation, connected to a PC, or afforded to the patient for home kinesiotherapic sessions. In the latter case, the device guides the patient in the rehabilitation session, transmitting the relevant statistics about his performance to a TCP/IP server exploiting a GSM/GPRS connection for deferred analysis. An approved clinical trial has been set up in Italy, involving 10 patients with rheumatoid arthritis and 10 with systemic sclerosis, enrolled for 12 weeks in a home rehabilitation program with the proposed device. Their evaluation has been performed not only with traditional methods, but also with the proposed device. Subjective (hand algofunctional Dreisers index) and objective (ROM, strength, and dexterity) parameters showed a sustained improvement throughout the follow-up. The obtained results proved that the device is an effective and safe tool for assessing hand disability and monitoring kinesiotherapy exercise, portending the potential exploitability of such a methodology in the clinical practice.

The challenge of collaborative telerehabilitation: conception and evaluation of a telehealth system enhancement for home-therapy follow-up

Telerehabilitation aims to solve problems like equitable access to the rehabilitation and cost reduction by providing rehabilitation services at a distance. The largest part of telerehabilitation systems implement a real‐time one‐to‐one process involving patient and therapist. Even though they can be successfully exploited in conditions such as post‐traumatic recovery, in complex scenarios, this simple model should be replaced by a more structured collaborative one envisioning a multidisciplinary team.

A portable real-time monitoring system for kinesitherapic hand rehabilitation exercises

Rheumatic diseases, such as rheumatoid arthritis and systemic sclerosis, may seriously reduce the quality of life of the patients. Nowadays, their progress can be controlled only through personalised pharmacological treatments. Kinesitherapy can also help in faster movement recovery, also contrasting the disability worsening. This paper presents a portable low-cost system for the real-time quantitative monitoring and evaluation of hand rehabilitation exercises. The system, based on a MSP430 microcontroller central unit, provides a platform for the analysis of fine characteristics hitherto unavailable of 4 exercises required for the hand rehabilitation in rheumatic patients. The system can be controlled, through a Bluetooth connection, by a graphical user interface running on the physician’s PC. The first prototypical systems have been developed for experimental outpatient

Evaluation of novel textile electrodes for ECG signals monitoring based on PEDOT:PSS-treated woven fabrics.

Despite surface electrodes technology for biopotential recording is well established, different researches are aimed at overcoming the limitations exhibited by the available solutions. In this paper, a proposal for the low-cost development of textile electrodes based on woven fabrics treated with polymer poly-3,4-ethylenedioxythiophene doped with poly(styrene sulfonate) (PEDOT:PSS), is presented. Compared to other approaches, the proposed one can be exploited on any finished fabric. An accurate analysis of the electrodes performance, based on impedance measurements and signal processing techniques, both in wet and dry conditions, reveals the virtues and vices of the proposed solution, when used for electrocardiogram recording. In particular, the potentialities of these electrodes clearly emerge, in terms of ability to work without any electrolyte, providing a valuable interface between the skin and the electrode, in some cases achieving better performance than commercial disposable electrodes.

A collaborative approach to the telerehabilitation of patients with hand impairments

Telehealth systems represent an ICT solution for delivering health services to the patients from a distance (Patient to Doctor/Doctor to Patient systems, P2D and D2P) or facilitating the consultation between the health professionals (Doctor to Doctor systems, D2D). Whether P2D/D2P systems aim at defining an interaction between the two involved figures crossing the boundaries of the hospital, D2D systems foster a professional interaction between physicians, typically for a second opinion or for a collaborative approach to the treatment. In this paper we present a collaborative extension of a system for telerehabilitation (patent pending), belonging to the P2D category, in order to include also some D2D features. The proposed extension promotes a collaborative scenario involving several actors with different roles and privileges on the system: the patient, the physiotherapist, the physiatrist, a consulting specialist and the administrator. All the involved figures interact through the telehealth system thanks to an expressly designed software infrastructure. The main P2D information How is ensured by the telerehabilitation kit, able to record and send over the internet the statistics on the main performance parameters extracted during the home rehabilitation sessions. Beyond the administrator, the system enables the interactions between the other figures (D2D) in order to propose, validate and comment possible rehabilitation protocol modifications in response to the performance trend of the patient, taking into account the possible effect of different systemic treatments the patient is subjected to. The design of such a collaborative framework descends from an engineering analysis of the experience gained in the context of the ongoing experimental trials about hand rehabilitation of rheumatic patients with the P2D system.

A configurable biopotentials acquisition module suitable for fetal electrocardiography studies

The issue of biopotentials acquisition with surface electrodes has been studied for several years, during which a number of reliable techniques have been developed. Nowadays, they form a solid background of practices exploited in every commercially available biopotential acquisition module. Nevertheless, in some application fields where signal processing of the acquired signals is controversial, due to the lack of a deep understanding of the underlying physical aspects, there is the need to test several recording setups to define the one producing the best results. In fact, signal acquisition has strong influence on the signal processing techniques that can be deployed to post-process the data. Non-invasive fetal electrocardiography (ECG) is one of those field. In order to enable the investigation of the aspects connected with the signal acquisition, we developed a custom biopotential acquisition unit, with configurable measurement setup. It is intrinsically general purpose, but has been conceived to support studies on non-invasive fetal ECG on the animal model. Based on the ADS1298 analog front-end, the developed system achieves comparable performance with respect to commercial systems for physiological research opening to the first animals studies about the influence of the acquisition setup on the effectiveness of the signal processing algorithms for fetal ECG extraction.

Neuromodulation on Cerebral Activities

During a motor task, a causal relation occurs between the motor command generated in the cortex and the proprioceptive feedbacks that go from the activated muscles through the corticospinal pathway. This causal relation is of interest in neurorehabilitation to improve motor function for people with motor difficulties. Previous neurorehabilitation methods used external stimulation to modify the corticospinal pathway controlling the motor function of the affected body parts. An alternative to these approaches is to reinforce the corticospinal pathway by identifying the cortical motor command naturally generated when a person imagines or attempts a movement, and combine it with peripheral nerve stimulation. The research group of Professor D. Farina has developed a method exploiting Brain–computer Interface technology to detect the cortical motor command and use it to trigger peripheral nerve stimulation in order to reinforce the efficiency of the corticospinal pathway. A detailed description of the method and an interview with Prof. D. Farina is presented in this chapter.

Validation of a Portable Device (RE.MO.TE.) for the Hand Functional Assessment in Patients with Chronic Rheumatic Diseases

Background Patients with inflammatory rheumatic diseases characterized by a chronic progressive course, such as Rheumatoid Arthritis (RA) and Systemic Sclerosis (SSc), develop a disability of the hand which requires an adequate assessment and therapeutic intervention through a pharmacological treatment and a proper rehabilitation program. The Re.Mo.Te. device consists of sensorized aids, allowing the execution of hand rehabilitation exercises and the extraction of relevant parameters (motion, force, pressure, speed of execution) from the analysis of several repetitions of the same movement, performed in real rehabilitation exercises typically prescribed to RA and SSs patients (1). These data are part of a larger project called Re.Mo.Te. Recovery Movement and Telemonitoring for rheumatology patients with disabilities of the hand. Objectives To validate portable device Re.Mo.Te for the evaluation of hand disability in patients with RA and SSc. Methods Ten RA patients (10F, age 56.9 ± 13.1 years) and 10 SSc patients (9F, age 56.3 ± 10.4 years) underwent an assessment of hands function through the device Re.Mo.Te. and through the measurement of: 1) Range Of Movement (ROM) of the wrists and 2) grip strength (pinch and grip) of the hand and fingers, 3) hands and fingers extension. The HAQ and the algo-functional index of Dreiser were administered to both RA and SSc patients while the Hamis test was administered exclusively to SSc patients. The Spearman’s correlation coefficient was applied to test the validity of the results obtained with the Re.Mo.Te. device and to compare them with traditional assessment; p values <0.05 were considered significant. Results All patients had a reversible hand disability (HAQ = AR: 1.5 ± 0.82; SSc: 1.4 ± 0.65 - Dreiser’s index = AR: 15.7 ± 6.0; SSc: 15.0 ± 5.7). The Spearman’s correlation coefficients between the traditional hand functional assessment and the Re.Mo.Te. device assessment were high (0.67-0.79) and statistically significant for the measurement of grip strength (p <0.0001) and overall extent (p <0.001). The ROM results showed significant correlation with the global finger extension (p <0.01) and the speed of fingers extension (p <0.001) abilities evaluated by Re.Mo.Te. Conclusions The Re.Mo.Te. device is a valuable aid for the assessment of hand disability in chronically ill subjects requiring a quantitative evaluation for the proper set up of a personalized rehabilitation program. References D. Pani, G. Barabino, A. Dessì, M. Piga, I. Tradori, A. Mathieu, L. Raffo “An integrated Portable Device for the hand functional assessment in the clinical practice” Biomedical Engineering Systems and Technologies 2012 - Revised Selected Papers, J. Gabriel et al. Eds., in press Disclosure of Interest None Declared