Lorenzo Chiari

Audio-biofeedback for balance improvement: an accelerometry-based system

This paper introduces a prototype audio-biofeedback system for balance improvement through the sonification using trunk kinematic information. In tests of this system, normal healthy subjects performed several trials in which they stood quietly in three sensory conditions while wearing an accelerometric sensory unit and headphones. The audio-biofeedback system converted in real-time the two-dimensional horizontal trunk accelerations into a stereo sound by modulating its frequency, level, and left/right balance. Preliminary results showed that subjects improved balance using this audio-biofeedback system and that this improvement was greater the more that balance was challenged by absent or unreliable sensory cues. In addition, high correlations were found between the center of pressure displacement and trunk acceleration, suggesting accelerometers may be useful for quantifying standing balance.

An improved technique for the extraction of stochastic parameters from stabilograms

An improved characterization of the dynamics of postural sway can provide a better understanding about the functional organization of the postural control system as well as a more robust tool for postural pattern recognition. To this aim, a novel parameterization was applied to the stabilogram diffusion analysis formerly proposed by Collins and De Luca [Collins JJ, De Luca CJ. Open-loop and closed-loop control of posture: a random-walk analysis of center-of-pressure trajectories. Exp Brain Res 1993;95:308-18] that considered the act of maintaining posture as a stochastic process. The main purpose of the present technique was to overcome some drawbacks of the model presented by Collins and De Luca that may restrain its potential application in clinical practice. The approach uses a unique non-linear model to describe the center of pressure (COP) dynamics that reduces the number of parameters and decreases their intra-subject variability; consequently, fewer trials are required to perform reliable estimates of stochastic parameters and this is of particular importance for subjects that cannot afford many repeated measurements because of age or pathology. Four new statistical mechanics parameters (NSMP) were computed on the log-log stabilogram diffusion plots and their estimates were compared in terms of reliability and sensitivity to the visual conditions with: (1) a minimal set of four summary statistic scores (SSS); and (2) the six statistical mechanics parameters (SMP) proposed by Collins and De Luca. All four NSMP showed at least a fair-to-good reliability (intraclass correlation coefficient, ICC>0.49) while SMP (ICC>0.20) showed some poor reliability. A better overall reliability was also observed with respect to SSS. Moreover, only NSMP had a similar score for eyes open and eyes closed conditions. Three out of four NSMP were also significantly sensitive to eyes open or closed conditions (P<0.001) while only three out of six SMP were sensitive to operating conditions (P<0.01).

A comprehensive simulator of the human respiratory system: Validation with experimental and simulated data

A comprehensive model of oxygen (O2) and carbon dioxide (CO2) exchange, transport, and storage in the adult human is presented, and its ability to provide realistic responses under different physiological conditions is evaluated. The model comprises three compartments (i.e., lung, body tissue, and brain tissue) and incorporates a controller that adjusts alveolar ventilation and cardiac output dynamically integrating stimuli coming from peripheral and central chemoreceptors. A new realistic CO2 dissociation curve based on a two-buffer model of acid-base chemical regulation is included. In addition, the model explicitly considers relevant physiological factors such as buffer base, the nonlinear interaction between the O2 and CO2 chemoreceptor responses, pulmonary shunt, dead space, variable time delays, and Bohr and Haldane effects. Model simulations provide results consistent with both dynamic and steady-state responses measured in subjects undergoing inhalation of high CO2 (hypercapnia) or low O2 (hypoxia) and subsequent recovery. An analysis of the results indicates that the proposed model fits the experimental data of ventilation and gas partial pressures as some meaningful simulators now available and in a very large range of gas intake fractions. Moreover, it also provides values of blood concentrations of CO2, HCO−3, and hydrogen ions in good agreement with more complex simulators characterized by an implicit formulation of the CO2 dissociation curve. In the experimental conditions analyzed, the model seems to represent a single theoretical framework able to appropriately describe the different phenomena involved in the control of respiration.

Impaired trunk stability in individuals at high risk for Parkinson's disease

Background The search for disease-modifying treatments for Parkinsons disease advances, however necessary markers for early detection of the disease are still lacking. There is compelling evidence that changes of postural stability occur at very early clinical stages of Parkinsons disease, making it tempting to speculate that changes in sway performance may even occur at a prodromal stage, and may have the potential to serve as a prodromal marker for the disease. Methodology/Principal Findings Balance performance was tested in 20 individuals with an increased risk of Parkinsons disease, 12 Parkinsons disease patients and 14 controls using a cross-sectional approach. All individuals were 50 years or older. Investigated groups were similar with respect to age, gender, and height. An accelerometer at the centre of mass at the lower spine quantified sway during quiet semitandem stance with eyes open and closed, as well as with and without foam. With increasing task difficulty, individuals with an increased risk of Parkinsons disease showed an increased variability of trunk acceleration and a decrease of smoothness of sway, compared to both other groups. These differences reached significance in the most challenging condition, i.e. the eyes closed with foam condition. Conclusions/Significance Individuals with an increased risk of Parkinsons disease have subtle signs of a balance deficit under most challenging conditions. This preliminary finding should motivate further studies on sway performance in individuals with an increased risk of Parkinsons disease, to evaluate the potential of this symptom to serve as a biological marker for prodromal Parkinsons disease.

Classification of visual strategies in human postural control by stochastic parameters

In a significant proportion of individuals, the expected increase of body sway upon eye closure is not actually observed. This result prefigures different visual contributions to the fine regulation of body sway. The present paper documents a method to classify healthy subjects into one visual or non-visual group according to the fractal properties of center of pressure (COP) profiles. The recognition of the sensory strategy consists of several phases: first, stabilogram diffusion analysis is carried out on the time-series of COP; then, stochastic features are extracted by two models of different complexity. In particular, a new technique is proposed which describes with continuity the transition among different scaling regimes. Finally, a linear classifier is designed. The method gave very high performance classifying, with the best set of features, provided by the two parameters of the new model, 93.3% of the examined subjects in agreement with the preclassification, provided by percentage difference of sway between eyes open and eyes closed conditions and computed over the area of the 95% confidence ellipse.

Bio-feedback system for rehabilitation based on a wireless body area network

In this paper we describe bio-WWS, a bio-feedback system for rehabilitation based on dedicated, wireless, sensor-network architecture. The sensor network is designed to be distributed on the users body for balance monitoring and correction. The hardware and software architecture (communication protocols, power management policies and application-level control) have been tuned to optimize cost, battery autonomy and real-time performance required for this application. Bio-WWS is an example of complete vertical integration: the sensor network is fully integrated with processing and auditory feedback generation

Influence of body segment parameters and modeling assumptions on the estimate of center of mass trajectory.

This study sought to determine the effect of inaccuracies in body segment parameters and modeling assumptions on the estimate of antero-posterior center of mass (COM) trajectory. Four different methods, one based on segmental kinematics, and three methods based on kinetic recordings were compared via simulation. Kinematic patterns (quiet stance, ankle-related sway, hip-ankle-related sway, sit-up and sit-up-sit-down) were tested with a 2D four-link model of the body and the ground reaction force vector was obtained by inverse dynamics. Errors in the estimation of body segment parameters were simulated by applying a +/-10% variation to one or more parameters at a time. These errors propagated differently to the COM estimated location between methods, between parameters within the same method, and between tasks. The kinematics-based method was the most sensitive to body segment parameters, with special regards to segment lengths and head-arms-trunk parameters. Root mean square error between estimated and simulated COM location reached 19mm in balance-related tasks and 38.3mm in sit-up-sit-down. The kinetics-based methods were largely less sensitive to inaccuracies in body segment parameters. In particular, the technique proposed by Zatsiorsky and King (J. Biomech. 31 (1998) 161), was completely insensitive to segment parameters. On the other hand the kinetics-based methods showed an intrinsic estimation error, due to the underlying model assumptions. The methods based on the double integration of horizontal force had better outcomes with tasks challenging such assumptions, with a maximal error in COM location of 15mm in the sit-up-sit-down. The method proposed by Shimba (J. Biomech. 17 (1984) 53) showed the best trade-off between sensitivity to body segment parameters and estimation performances given the ideal test conditions.

A new approach for tracking respiratory mechanical parameters in real-time

A new recursive least-squares procedure for on-line tracking of changes in viscoelastic properties of respiratory mechanics is proposed and applied to artificially ventilated patients. Classical least-squares methods based on simple first-order linear models with time-constant parameters generally provide systematic residuals that hardly satisfy standard statistical tests for model validation in terms of residuals. On the other hand, high order and/or nonlinear models introduce parameters whose estimates are of difficult interpretation in a clinical context. The present procedure overcomes these limitations by using the well-known first-order model of respiratory mechanics, wherein variability of resistance and elastance during the breathing cycle is allowed to take into account nonlinear and high-order behavior. Mean and standard deviation of resistance and elastance estimates, relative to a respiratory cycle, are then determined recursively. Feasibility of the method is evaluated by applying it both to experimental and simulated pressure-airflow signals measured in an intensive care unit during mechanical ventilation of patients recovering from heart surgery. Results demonstrate that the proposed procedure provides data description satisfying statistical tests, such as residual whiteness, and reliable estimates of viscoelastic lung parameters even during substantial and fast variations in the respiratory status. In addition, unlike classical methods, the new technique provides the means for on-line evaluation of parameter variability during each respiratory cycle, by the estimate of their standard deviations. This is important in clinical practice, because only the knowledge of reliable parameter values and standard deviations enables significant changes in the respiratory viscoelastic characteristics, and thus in patient status, to be assessed.

The age-related changes of trunk responses to Achilles tendon vibration

The contribution of different sensory modalities to balance control is modified by age. Postural responses to Achilles tendon vibration were investigated in order to understand the influence of age on proprioceptive input from lower legs in human stance. Postural responses to bilateral vibrations of Achilles tendon with 10s duration were recorded at three frequencies (40, 60 and 80 Hz) in 9 healthy young (range, 24-27 years) and in 9 healthy older adults (59-70 years). Subjects were instructed to keep standing on firm surface with eyes closed. They performed three trials in each of three vibration frequencies. Postural responses were characterized by displacement of the centre of foot pressure (CoP) and by kinematics of body segments in the anterior-posterior direction. Bilateral vibrations of Achilles tendon induced backward body lean increasing with frequency of vibration and with age. The leg angle response to vibration was found similar in both groups of subjects. Slight trunk tilts from vertical position were induced by vibration in young subjects while in older subjects the trunk tilted backward together with the whole body. This observation was supported also by the minimal change of hip angle in older subjects contrary to increased hip activity in young subjects. The findings showed that the trunk and hip angle responses to proprioceptive stimulation might be a good indicator of age-related destabilization in balance control.

Prediction of Solute Kinetics, Acid-Base Status, and Blood Volume Changes During Profiled Hemodialysis

AbstractA mathematical model of solute kinetics oriented to the simulation of hemodialysis is presented. It includes a three-compartment model of body fluids (plasma, interstitial and intracellular), a two-compartment description of the main solutes K+,Na+,Cl- urea, HCO3-,H+), and acid-base equilibrium through two buffer systems (bicarbonate and noncarbonic buffers). Tentative values for the main model parameters can be given a priori, on the basis of body weight and plasma concentration values measured before beginning the session. The model allows computation of the amount of sodium removed during hemodialysis, and may enable the prediction of plasma volume and osmolarity changes induced by a given sodium concentration profile in the dialysate and by a given ultrafiltration profile. Model predictions are compared with clinical data obtained during 11 different profiled hemodialysis sessions, both with all parameters assigned a priori, and after individual estimation of dialysances and mass-transfer coefficients. In most cases, the agreement between the time pattern of model solute concentrations in plasma and clinical data was satisfactory. In two sessions, blood volume changes were directly measured in the patient, and in both cases the agreement with model predictions was acceptable. The present model can be used to improve the dialysis session taking some characteristics of individual patients into account, in order to minimize intradialytic unbalances (such as hypotension or disequilibrium syndrome).