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1. Multi-Shared-Task Self-Supervised CNN-LSTM for Monitoring Free-Body Movement UPDRS-III Using Wearable Sensors

   https://doi.org/10.3390/bioengineering11070689  

   Shuqair, Mustafa; Jimenez-Shahed, Joohi; Ghoraani, Behnaz (July 2024, Bioengineering)

   The Unified Parkinson’s Disease Rating Scale (UPDRS) is used to recognize patients with Parkinson’s disease (PD) and rate its severity. The rating is crucial for disease progression monitoring and treatment adjustment. This study aims to advance the capabilities of PD management by developing an innovative framework that integrates deep learning with wearable sensor technology to enhance the precision of UPDRS assessments. We introduce a series of deep learning models to estimate UPDRS Part III scores, utilizing motion data from wearable sensors. Our approach leverages a novel Multi-shared-task Self-supervised Convolutional Neural Network–Long Short-Term Memory (CNN-LSTM) framework that processes raw gyroscope signals and their spectrogram representations. This technique aims to refine the estimation accuracy of PD severity during naturalistic human activities. Utilizing 526 min of data from 24 PD patients engaged in everyday activities, our methodology demonstrates a strong correlation of 0.89 between estimated and clinically assessed UPDRS-III scores. This model outperforms the benchmark set by single and multichannel CNN, LSTM, and CNN-LSTM models and establishes a new standard in UPDRS-III score estimation for free-body movements compared to recent state-of-the-art methods. These results signify a substantial step forward in bioengineering applications for PD monitoring, providing a robust framework for reliable and continuous assessment of PD symptoms in daily living settings. 

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2. Continuous Classification of Locomotion in Response to Task Complexity and Anticipatory State

   https://doi.org/10.3389/fbioe.2021.628050  

   Kazemimoghadam, Mahdieh; Fey, Nicholas P. (April 2021, Frontiers in Bioengineering and Biotechnology)

   Objective Intent recognition in lower-extremity assistive devices (e.g., prostheses and exoskeletons) is typically limited to either recognition of steady-state locomotion or changes of terrain (e.g., level ground to stair) occurring in a straight-line path and under anticipated condition. Stability is highly affected during non-steady changes of direction such as cuts especially when they are unanticipated, posing high risk of fall-related injuries. Here, we studied the influence of changes of direction and user anticipation on task recognition, and accordingly introduced classification schemes accommodating such effects. Methods A linear discriminant analysis (LDA) classifier continuously classified straight-line walking, sidestep/crossover cuts (single transitions), and cuts-to-stair locomotion (mixed transitions) performed under varied task anticipatory conditions. Training paradigms with varying levels of anticipated/unanticipated exposures and analysis windows of size 100–600 ms were examined. Results More accurate classification of anticipated relative to unanticipated tasks was observed. Including bouts of target task in the training data was necessary to improve generalization to unanticipated locomotion. Only up to two bouts of target task were sufficient to reduce errors to <20% in unanticipated mixed transitions, whereas, in single transitions and straight walking, substantial unanticipated information (i.e., five bouts) was necessary to achieve similar outcomes. Window size modifications did not have a significant influence on classification performance. Conclusion Adjusting the training paradigm helps to achieve classification schemes capable of adapting to changes of direction and task anticipatory state. Significance The findings could provide insight into developing classification schemes that can adapt to changes of direction and user anticipation. They could inform intent recognition strategies for controlling lower-limb assistive to robustly handle “unknown” circumstances, and thus deliver increased level of reliability and safety. 

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3. Ensemble deep model for continuous estimation of Unified Parkinson’s Disease Rating Scale III

   https://doi.org/10.1186/s12938-021-00872-w  

   Hssayeni, Murtadha D.; Jimenez-Shahed, Joohi; Burack, Michelle A.; Ghoraani, Behnaz (December 2021, BioMedical Engineering OnLine)

   null (Ed.)

   Abstract Background Unified Parkinson Disease Rating Scale-part III (UPDRS III) is part of the standard clinical examination performed to track the severity of Parkinson’s disease (PD) motor complications. Wearable technologies could be used to reduce the need for on-site clinical examinations of people with Parkinson’s disease (PwP) and provide a reliable and continuous estimation of the severity of PD at home. The reported estimation can be used to successfully adjust the dose and interval of PD medications. Methods We developed a novel algorithm for unobtrusive and continuous UPDRS-III estimation at home using two wearable inertial sensors mounted on the wrist and ankle. We used the ensemble of three deep-learning models to detect UPDRS-III-related patterns from a combination of hand-crafted features, raw temporal signals, and their time–frequency representation. Specifically, we used a dual-channel, Long Short-Term Memory (LSTM) for hand-crafted features, 1D Convolutional Neural Network (CNN)-LSTM for raw signals, and 2D CNN-LSTM for time–frequency data. We utilized transfer learning from activity recognition data and proposed a two-stage training for the CNN-LSTM networks to cope with the limited amount of data. Results The algorithm was evaluated on gyroscope data from 24 PwP as they performed different daily living activities. The estimated UPDRS-III scores had a correlation of $$0.79\, (\textit{p}<0.0001)$$ 0.79 ( p < 0.0001 ) and a mean absolute error of 5.95 with the clinical examination scores without requiring the patients to perform any specific tasks. Conclusion Our analysis demonstrates the potential of our algorithm for estimating PD severity scores unobtrusively at home. Such an algorithm could provide the required motor-complication measurements without unnecessary clinical visits and help the treating physician provide effective management of the disease. 

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4. Subject-Independent Continuous Locomotion Mode Classification for Robotic Hip Exoskeleton Applications

   https://doi.org/10.1109/TBME.2022.3165547  

   Kang, Inseung; Molinaro, Dean D.; Choi, Gayeon; Camargo, Jonathan; Young, Aaron J. (October 2022, IEEE Transactions on Biomedical Engineering)

   Autonomous lower-limb exoskeletons must modulate assistance based on locomotion mode (e.g., ramp or stair ascent) to adapt to the corresponding changes in human biological joint dynamics. However, current mode classification strategies for exoskeletons often require user-specific tuning, have a slow update rate, and rely on additional sensors outside of the exoskeleton sensor suite. In this study, we introduce a deep convolutional neural network-based locomotion mode classifier for hip exoskeleton applications using an open-source gait biomechanics dataset with various wearable sensors. Our approach removed the limitations of previous systems as it is 1) subject-independent (i.e., no user-specific data), 2) capable of continuously classifying for smooth and seamless mode transitions, and 3) only utilizes minimal wearable sensors native to a conventional hip exoskeleton. We optimized our model, based on several important factors contributing to overall performance, such as transition label timing, model architecture, and sensor placement, which provides a holistic understanding of mode classifier design. Our optimized DL model showed a 3.13% classification error (steady-state: 0.80 ± 0.38% and transitional: 6.49 ± 1.42%), outperforming other machine learning-based benchmarks commonly practiced in the field (p<0.05). Furthermore, our multi-modal analysis indicated that our model can maintain high performance in different settings such as unseen slopes on stairs or ramps. Thus, our study presents a novel locomotion mode framework, capable of advancing robotic exoskeleton applications toward assisting community ambulation. 

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5. Wearable Sensors for Estimation of Parkinsonian Tremor Severity during Free Body Movements

   https://doi.org/10.3390/s19194215  

   Hssayeni, Murtadha D; Burack, Michelle A.; Jimenez-Shahed, Joohi; Ghoraani, Behnaz (September 2019, Sensors)

   Tremor is one of the main symptoms of Parkinson’s Disease (PD) that reduces the quality of life. Tremor is measured as part of the Unified Parkinson Disease Rating Scale (UPDRS) part III. However, the assessment is based on onsite physical examinations and does not fully represent the patients’ tremor experience in their day-to-day life. Our objective in this paper was to develop algorithms that, combined with wearable sensors, can estimate total Parkinsonian tremor as the patients performed a variety of free body movements. We developed two methods: an ensemble model based on gradient tree boosting and a deep learning model based on long short-term memory (LSTM) networks. The developed methods were assessed on gyroscope sensor data from 24 PD subjects. Our analysis demonstrated that the method based on gradient tree boosting provided a high correlation (r = 0.96 using held-out testing and r = 0.93 using subject-based, leave-one-out cross-validation) between the estimated and clinically assessed tremor subscores in comparison to the LSTM-based method with a moderate correlation (r = 0.84 using held-out testing and r = 0.77 using subject-based, leave-one-out cross-validation). These results indicate that our approach holds great promise in providing a full spectrum of the patients’ tremor from continuous monitoring of the subjects’ movement in their natural environment. 

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