D.M. Simpson

Calculation of area of stabilometric signals using principal component analysis

In stabilometry, the sway of the human body in an upright posture is studied by monitoring the displacement of its centre of pressure in the lateral (x) and anterio-posterior (y) directions. The area covered by this trace has been defined as that of an ellipse fitted to the data. Conventionally, its angle of inclination is found through linear regression (LR) on the data in the x-y plane. In the present paper, principal component analysis (PCA) is proposed as providing a more suitable basis for the estimation of angle and area. Results of simulations and stabilometric tests confirm large differences between area and angle estimates obtained by regression of x over y, and y over x, with PCA generally agreeing with either one or the other of the LRs. The PCA technique is therefore recommended as an improved basis for measuring area and inclination of stabilograms, or similar data sets.

Multivariate dynamic analysis of cerebral blood flow regulation in humans

The contributions of beat-to-beat changes in mean arterial blood pressure (MABP) and breath-by-breath fluctuations in end-tidal CO/sub 2/ (EtCO/sub 2/) as determinants of the spontaneous variability of cerebral blood flow velocity (CBFV) were studied in 16 normal subjects at rest. The two input variables (MABP and EtCO/sub 2/) had significant cross-correlations with CBFV but not between them. Transfer functions were estimated as the multivariate least mean square finite impulse response causal filters. MABP showed a very significant effect in explaining CBFV variability (p<10/sup -11/, Fishers aggregated-p test) and the model mean square error was significantly reduced (p<0.001) by also including the contribution EtCO/sub 2/. The estimated mean CBFV step response to MABP displayed the characteristic return to baseline caused by the cerebral autoregulatory response. The corresponding response to EtCO/sub 2/ showed a gradual rise taking approximately 10 s to reach a plateau of 2.5%/mmHg. This study demonstrated that spontaneous fluctuations in EtCO/sub 2/ can help to explain the CBFV variability at rest if appropriate signal processing techniques are employed to address the limited power and bandwidth of the breath-by-breath EtCO/sub 2/ signal.

Transfer function analysis of dynamic cerebral autoregulation: A white paper from the International Cerebral Autoregulation Research Network

Cerebral autoregulation is the intrinsic ability of the brain to maintain adequate cerebral perfusion in the presence of blood pressure changes. A large number of methods to assess the quality of cerebral autoregulation have been proposed over the last 30 years. However, no single method has been universally accepted as a gold standard. Therefore, the choice of which method to employ to quantify cerebral autoregulation remains a matter of personal choice. Nevertheless, given the concept that cerebral autoregulation represents the dynamic relationship between blood pressure (stimulus or input) and cerebral blood flow (response or output), transfer function analysis became the most popular approach adopted in studies based on spontaneous fluctuations of blood pressure. Despite its sound theoretical background, the literature shows considerable variation in implementation of transfer function analysis in practice, which has limited comparisons between studies and hindered progress towards clinical application. Therefore, the purpose of the present white paper is to improve standardisation of parameters and settings adopted for application of transfer function analysis in studies of dynamic cerebral autoregulation. The development of these recommendations was initiated by (but not confined to) the Cerebral Autoregulation Research Network (CARNet – www.car-net.org).

Size at Birth and Autonomic Function During Psychological Stress

Small size at birth is associated with exaggerated blood pressure responses to psychological stressors, which increase the risk of developing sustained hypertension in adult life. Explanatory mechanisms for this association are not well characterized. We investigated the hypothesis that an adverse fetal environment, reflected by small size at birth, persistently alters autonomic nervous system and baroreflex control of cardiovascular function, resulting in exaggerated blood pressure and heart rate responses to stressors. Men and women from an Australian prospective cohort study underwent a series of 3 psychological stressors (Stroop, mirror-tracing, and speech) while their blood pressure was recorded continuously using a Portapres. Indices of autonomic function were derived using spectrum analysis (wavelet packet transform), and baroreflex function was estimated using an adaptive autoregressive model. We found that women who were small at birth demonstrated increased levels of low-frequency blood pressure variability at rest (r=−0.28; P<0.05) and during stress (r=−0.42; P<0.001), reduced levels of high-frequency heart period variability (r=0.22; P<0.05), and reduced baroreflex sensitivity (r=0.34; P<0.01). These findings were not present in the men. This study provides evidence that markers of impaired fetal growth are related to autonomic cardiovascular control involving modulation of both sympathetic and parasympathetic function but in a sex-specific manner. We also provide the first human evidence of a relationship between size at birth and baroreflex function.

Sex-specific programming of cardiovascular physiology in children

AIMS Increasing evidence suggests that adverse prenatal environments, as indicated by low birth weight, cause long-term changes in cardiovascular physiology that predispose to circulatory disease. The mechanisms are poorly understood, most human studies have been carried out in adults and little is known about early pathophysiological changes. Therefore, we have assessed the relationship between birth weight and cardiovascular physiology in children. METHODS AND RESULTS In 140 healthy boys and girls (aged 7-9 years), born at term and followed prospectively, we continuously recorded blood pressure, electrocardiograms and cardiac impedance before, during, and after 10 min of psychosocial stress (Trier Social Stress Test for Children). In boys, an association of lower birth weight with higher resting systemic arterial pressure (β = -6.8 mmHg/kg, P= 0.03) and a trend towards higher vascular resistance (β = -87 dyne s/cm(5)/kg, ns) were substantially strengthened following stress (β = -9.5 mmHg/kg, P= 0.003 and β = -139 dyne s/cm(5)/kg, P = 0.02, respectively). In girls, lower birth weight was associated with a shorter pre-ejection period (β = 8.0 ms/kg, P = 0.005) and corrected QT interval (β = 11.9 ms/kg, P = 0.003) at rest and little changed by stress. CONCLUSION Smaller size at birth is associated with sex-specific alterations in cardiac physiology; boys had higher systemic vascular resistance and girls had increased cardiac sympathetic activation.

Objective response detection in an electroencephalogram during somatosensory stimulation.

AbstractTechniques for objective response detection aim to identify the presence of evoked potentials based purely on statistical principles. They have been shown to be potentially more sensitive than the conventional approach of subjective evaluation by experienced clinicians and could be of great clinical use. Three such techniques to detect changes in an electroencephalogram (EEG) synchronous with the stimuli, namely, magnitude-squared coherence (MSC), the phase-synchrony measure (PSM) and the spectral F test (SFT) were applied to EEG signals of 12 normal subjects under conventional somatosensory pulse stimulation to the tibial nerve. The SFT, which uses only the power spectrum, showed the poorest performance, while the PSM, based only on the phase spectrum, gave results almost as good as those of the MSC, which uses both phase and power spectra. With the latter two techniques, stimulus responses were evident in the frequency range of 20–80 Hz in all subjects after 200 stimuli (5 Hz stimulus frequency), whereas for visual recognition at least 500 stimuli are usually applied. Based on these results and on simulations, the phase-based techniques appear promising for the automated detection and monitoring of somatosensory evoked potentials.

Postural sway changes during pregnancy: A descriptive study using stabilometry

OBJECTIVE This study aims to analyse changes in body sway over the course of pregnancy. STUDY DESIGN This is a descriptive study in which stabilometric tests were applied at three stages of pregnancy and with a combination of different visual conditions (eyes open/closed) and support base configuration (feet together/apart). Twenty healthy pregnant women participated in the study. Changes in postural control with pregnancy were analysed via the elliptical area of the stabilograms and spectral analysis of the displacements of the centre of pressure (COP) along the lateral and anterior/posterior directions. RESULTS The elliptical area encompassing the COP significantly increased over the course of the pregnancy for the feet apart and eyes closed test protocols. The spectral analysis revealed a significant increase of COP oscillations along the anterior-posterior direction when subjects stood with the eyes open/feet together and feet apart. A reduction (significant) of the lateral oscillations of COP was observed for the eyes open/feet together protocol. CONCLUSION Pregnancy induced significant changes in the postural control when pregnant women stood with a reduced support base or with eyes closed.

Coherence between one random and one periodic signal for measuring the strength of responses in the electro-encephalogram during sensory stimulation

Coherence between a pulse train representing periodic stimuli and the EEG has been used in the objective detection of steady-state evoked potentials. This work aimed to quantify the strength of the stimulus responses based on the statistics of coherence estimate between one random and one periodic signal, focusing on the confidence limits and power of significance tests in detecting responses. To detect the responses in 95% of cases, a signal-to-noise ratio of about −7.9 dB was required when using 48 windows (M) in the coherence estimation. The ratio, however, increased to −1.2 dB when M was 12. The results were tested in Monte Carlo simulations and applied to EEGs obtained from 14 subjects during visual stimulation. The method showed differences in the strength of responses at the stimulus frequency and its harmonics, as well as variations between individuals and over cortical regions. In contrast to those from the parietal and temporal regions, results for the occipital region gave confidence limits (with M=12) that were above zero for all subjects, indicating statistically significant responses. The proposed technique extends the usefulness of coherence as a measure of stimulus responses and allows statistical analysis that could also be applied usefully in a range of other biological signals.

A parametric approach to measuring cerebral blood flow autoregulation from spontaneous variations in blood pressure

AbstractAutoregulation maintains cerebral blood flow (CBF) almost constant in the face of changes in arterial blood pressure (ABP). Tests for impairment of this process using only spontaneous fluctuations in ABP, without provoking large variations, are of great clinical interest, and a range of different approaches have previously been applied. Extending earlier work based on linear filters, we propose a simple parametric method using a first order finite impulse response filter. We evaluate the method on ABP and CBF velocity [(CBFV), from trancranial Doppler ultrasound] signals collected in 60 patients with stenosis or occlusion of the carotid arteries. Data were collected during the inspiration of ambient air, a 5% CO2/air mixture, and finally the return to ambient air. Equivalent data were collected in 15 normal subjects. The filters estimated from the data segments with constant inspiratory pCO2 showed the expected high-pass characteristic, which was reduced during hypercapnia and also in patients. Highly significant correlation between the filter parameters and cerebrovascular reactivity (percent increase in CBFV per unit change in end-tidal pCO2) gives further evidence that the filters reflect autoregulation. The method allows simple parametrization of the dynamic autoregulatory responses in CBFV, and the analysis of short (1 min) data segments.

Detection of Impaired Cerebral Autoregulation Improves by Increasing Arterial Blood Pressure Variability

Although the assessment of dynamic cerebral autoregulation (CA) based on measurements of spontaneous fluctuations in arterial blood pressure (ABP) and cerebral blood flow (CBF) is a convenient and much used method, there remains uncertainty about its reliability. We tested the effects of increasing ABP variability, provoked by a modification of the thigh cuff method, on the ability of the autoregulation index to discriminate between normal and impaired CA, using hypercapnia as a surrogate for dynamic CA impairment. In 30 healthy volunteers, ABP (Finapres) and CBF velocity (CBFV, transcranial Doppler) were recorded at rest and during 5% CO2 breathing, with and without pseudo-random sequence inflation and deflation of bilateral thigh cuffs. The application of thigh cuffs increased ABP and CBFV variabilities and was not associated with a distortion of the CBFV step response estimates for both normocapnic and hypercapnic conditions (P = 0.59 and P = 0.96, respectively). Sensitivity and specificity of CA impairment detection were improved with the thigh cuff method, with the area under the receiver–operator curve increasing from 0.746 to 0.859 (P = 0.031). We conclude that the new method is a safe, efficient, and appealing alternative to currently existing assessment methods for the investigation of the status of CA.