Gianluca Barabino

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.

NInFEA: an embedded framework for the real-time evaluation of fetal ECG extraction algorithms

Abstract Fetal electrocardiogram (ECG) extraction from non-invasive biopotential recordings is a long-standing research topic. Despite the significant number of algorithms presented in the scientific literature, it is difficult to find information about embedded hardware implementations able to provide real-time support for the required features, bridging the gap between theory and practice. This article presents the NInFEA (non-invasive fetal ECG analysis) tool, an embedded hardware/software framework based on the hybrid dual-core OMAP-L137 low-power processor for the real-time evaluation of fetal ECG extraction algorithms. The hybrid platform, including a digital signal processor (DSP) and a general-purpose processor (GPP), allows achieving the best performance compared with single-core architectures. The GPP provides a portable graphical user interface, whereas the DSP is extensively used for advanced signal processing tasks. As a case study, three state-of-the-art fetal ECG extraction algorithms have been ported onto NInFEA, along with some support routines needed to provide the additional information required by the clinicians and supported by the user interface. NInFEA can be regarded both as a reference design for similar applications and as a common embedded low-power testbed for real-time fetal ECG extraction algorithms.

Home tele-rehabilitation for rheumatic patients: impact and satisfaction of care analysis

Introduction In this paper, we evaluated patients’ perspectives on the use of a system for home tele-rehabilitation, designed for subjects with low computer literacy suffering hand impairment due to rheumatic diseases. Methods After a clinical trial assessing device effectiveness, the Psychosocial Impact of Assistive Devices Scale (PIADS), Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST) and Individually Prioritised Problem Assessment (IPPA) questionnaires were administered to evaluate the system’s impact on each patient’s life, and the results were correlated with clinical indices. Patients were asked to continue self-administered rehabilitation with common objects. One year later, a semi-structured telephone interview gathered data on their experience. Results The system received a positive QUEST score (4.5 ± 0.3) and a modest PIADS score (0.84 ± 0.8) due to the small impact on adaptability and self-esteem. The IPPA (3.7 ± 3.4) revealed improvement in the ability to perform tasks considered important, which was significantly correlated (r = 0.60; p < 0.02) with the clinical Health Assessment Questionnaire (HAQ) index improvement. The interviews revealed a positive engagement effect, enhanced by the need to develop skills to be able to use the device (technological challenge) and by the perception of more attention by the medical staff. This may explain the significant dropout rate (80%) from the post-trial rehabilitation of the patients who used the device. Discussion The system was largely accepted by the patients. The results suggest that the need for information on their rehabilitation progress and the technological challenge deserves further study to make patients more autonomous in cases of continuous rehabilitation.

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

Real-Time Neural Signals Decoding onto Off-the-Shelf DSP Processors for Neuroprosthetic Applications

The control of upper limb neuroprostheses through the peripheral nervous system (PNS) can allow restoring motor functions in amputees. At present, the important aspect of the real-time implementation of neural decoding algorithms on embedded systems has been often overlooked, notwithstanding the impact that limited hardware resources have on the efficiency/effectiveness of any given algorithm. Present study is addressing the optimization of a template matching based algorithm for PNS signals decoding that is a milestone for its real-time, full implementation onto a floating-point digital signal processor (DSP). The proposed optimized real-time algorithm achieves up to 96% of correct classification on real PNS signals acquired through LIFE electrodes on animals, and can correctly sort spikes of a synthetic cortical dataset with sufficiently uncorrelated spike morphologies (93% average correct classification) comparably to the results obtained with top spike sorter (94% on average on the same dataset). The power consumption enables more than 24 h processing at the maximum load, and latency model has been derived to enable a fair performance assessment. The final embodiment demonstrates the real-time performance onto a low-power off-the-shelf DSP, opening to experiments exploiting the efferent signals to control a motor neuroprosthesis.

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.