Computational Methods for Identifying Hypertrophic Cardiomyopathy using 12-lead ECG

Hypertrophic cardiomyopathy (HCM) is a cardiovascular disease where the heart muscle is partially thickened and blood flow is - potentially fatally - obstructed. It is one of the leading causes of sudden cardiac death in young people. Electrocardiography (ECG) and Echocardiography (Echo) are the standard tests for identifying HCM and other cardiac abnormalities. The American Heart Association has recommended using a pre-participation questionnaire for young athletes instead of ECG or Echo tests due to considerations of cost and time involved in interpreting the results of these tests by an expert cardiologist. Initially we set out to develop a classifier for automated prediction of young athletes’ heart conditions based on the answers to the questionnaire. Classification results and further in-depth analysis using computational and statistical methods indicated significant shortcomings of the questionnaire in predicting cardiac abnormalities. Automated methods for analyzing ECG signals can help reduce cost and save time in the pre-participation screening process by detecting HCM and other cardiac abnormalities. Therefore, the main goal of this dissertation work is to identify HCM through computational analysis of 12-lead ECG. ECG signals recorded on one or two leads have been analyzed in the past for classifying individual heartbeats into different types of arrhythmia as annotated primarily in the MIT-BIH database. In contrast, we classify complete sequences of 12-lead ECGs to assign patients into two groups: HCM vs. non-HCM. The challenges and issues we address include missing ECG waves in one or more leads and the dimensionality of a large feature-set. We address these by proposing imputation and feature-selection methods. We develop heartbeat-classifiers by employing Random Forests and Support Vector Machines, and propose a method to classify full 12-lead ECGs based on the proportion of heartbeats classified as HCM. The results from our experiments show that the classifiers developed using our methods perform well in identifying HCM. Thus the two contributions of this thesis are the utilization of computational and statistical methods for discovering shortcomings in a current screening procedure and the development of methods to identify HCM through computational analysis of 12-lead ECG signals.

Computational models for improved diagnosis and prognosis of stroke using robot-based biomarkers

Stroke is a leading cause of death and permanent disability worldwide, affecting millions of individuals. Traditional clinical scores for assessment of stroke-related impairments are inherently subjective and limited by inter-rater and intra-rater reliability, as well as floor and ceiling effects. In contrast, robotic technologies provide objective, highly repeatable tools for quantification of neurological impairments following stroke. KINARM is an exoskeleton robotic device that provides objective, reliable tools for assessment of sensorimotor, proprioceptive and cognitive brain function by means of a battery of behavioral tasks. As such, KINARM is particularly useful for assessment of neurological impairments following stroke. This thesis introduces a computational framework for assessment of neurological impairments using the data provided by KINARM. This is done by achieving two main objectives. First, to investigate how robotic measurements can be used to estimate current and future abilities to perform daily activities for subjects with stroke. We are able to predict clinical scores related to activities of daily living at present and future time points using a set of robotic biomarkers. The findings of this analysis provide a proof of principle that robotic evaluation can be an effective tool for clinical decision support and target-based rehabilitation therapy. The second main objective of this thesis is to address the emerging problem of long assessment time, which can potentially lead to fatigue when assessing subjects with stroke. To address this issue, we examine two time reduction strategies. The first strategy focuses on task selection, whereby KINARM tasks are arranged in a hierarchical structure so that an earlier task in the assessment procedure can be used to decide whether or not subsequent tasks should be performed. The second strategy focuses on time reduction on the longest two individual KINARM tasks. Both reduction strategies are shown to provide significant time savings, ranging from 30% to 90% using task selection and 50% using individual task reductions, thereby establishing a framework for reduction of assessment time on a broader set of KINARM tasks. All in all, findings of this thesis establish an improved platform for diagnosis and prognosis of stroke using robot-based biomarkers.

3D considerations for motion perception and visuomotor transformations

Moving through a stable, three-dimensional world is a hallmark of our motor and perceptual experience. This stability is constantly being challenged by movements of the eyes and head, inducing retinal blur and retino-spatial misalignments for which the brain must compensate. To do so, the brain must account for eye and head kinematics to transform two-dimensional retinal input into the reference frame necessary for movement or perception. The four studies in this thesis used both computational and psychophysical approaches to investigate several aspects of this reference frame transformation. In the first study, we examined the neural mechanism underlying the visuomotor transformation for smooth pursuit using a feedforward neural network model. After training, the model performed the general, three-dimensional transformation using gain modulation. This gave mechanistic significance to gain modulation observed in cortical pursuit areas while also providing several testable hypotheses for future electrophysiological work. In the second study, we asked how anticipatory pursuit, which is driven by memorized signals, accounts for eye and head geometry using a novel head-roll updating paradigm. We showed that the velocity memory driving anticipatory smooth pursuit relies on retinal signals, but is updated for the current head orientation. In the third study, we asked how forcing retinal motion to undergo a reference frame transformation influences perceptual decision making. We found that simply rolling one's head impairs perceptual decision making in a way captured by stochastic reference frame transformations. In the final study, we asked how torsional shifts of the retinal projection occurring with almost every eye movement influence orientation perception across saccades. We found a pre-saccadic, predictive remapping consistent with maintaining a purely retinal (but spatially inaccurate) orientation perception throughout the movement. Together these studies suggest that, despite their spatial inaccuracy, retinal signals play a surprisingly large role in our seamless visual experience. This work therefore represents a significant advance in our understanding of how the brain performs one of its most fundamental functions.