A home environment test battery for status assessment in patients with motor fluctuations

Background and aims Evaluating status in patients with motor fluctuations is complex and occasional observations/measurements do not give an adequate picture as to the time spent in different states. We developed a test battery to assess advanced Parkinson patients' status consisting of diary assessments and motor tests. This battery was constructed and implemented on a handheld computer with built-in mobile communication. In fluctuating patients, it should typically be used several times daily in the home environment, over periods of about one week. The aim of this battery is to provide status information in order to evaluate treatment effects in clinical practice and research, follow up treatments and disease progression and predict outcome to optimize treatment strategy. Methods Selection of diary questions was based on a previous study with Duodopa® (DIREQT). Tapping tests (with and without visual cueing) and a spiral drawing test were added. Rapid prototyping was used in development of the user interface. An evaluation with two pilot patients was performed before and after receiving new treatments for advanced disease (one received Duodopa® and one received DBS). Speed and proportion missed taps were calculated for the tapping tests and entropy of the radial drawing velocity was calculated for the spiral tests. Test variables were evaluated using non-parametric statistics. Results Post-treatment improvement was detected in both patients in many of the test variables. Conclusions Although validation work remains, preliminary results are promising and the test battery is currently being evaluated in a long-term health economics study with Duodopa® (DAPHNE).

Visualization of spirography-based objective measures in Parkinson's disease

Objective: To investigate whether advanced visualizations of spirography-based objective measures are useful in differentiating drug-related motor dysfunctions between Off and dyskinesia in Parkinson’s disease (PD). Background: During the course of a 3 year longitudinal clinical study, in total 65 patients (43 males and 22 females with mean age of 65) with advanced PD and 10 healthy elderly (HE) subjects (5 males and 5 females with mean age of 61) were assessed. Both patients and HE subjects performed repeated and time-stamped assessments of their objective health indicators using a test battery implemented on a telemetry touch screen handheld computer, in their home environment settings. Among other tasks, the subjects were asked to trace a pre-drawn Archimedes spiral using the dominant hand and repeat the test three times per test occasion. Methods: A web-based framework was developed to enable a visual exploration of relevant spirography-based kinematic features by clinicians so they can in turn evaluate the motor states of the patients i.e. Off and dyskinesia. The system uses different visualization techniques such as time series plots, animation, and interaction and organizes them into different views to aid clinicians in measuring spatial and time-dependent irregularities that could be associated with the motor states. Along with the animation view, the system displays two time series plots for representing drawing speed (blue line) and displacement from ideal trajectory (orange line). The views are coordinated and linked i.e. user interactions in one of the views will be reflected in other views. For instance, when the user points in one of the pixels in the spiral view, the circle size of the underlying pixel increases and a vertical line appears in the time series views to depict the corresponding position. In addition, in order to enable clinicians to observe erratic movements more clearly and thus improve the detection of irregularities, the system displays a color-map which gives an idea of the longevity of the spirography task. Figure 2 shows single randomly selected spirals drawn by a: A) patient who experienced dyskinesias, B) HE subject, and C) patient in Off state. Results: According to a domain expert (DN), the spirals drawn in the Off and dyskinesia motor states are characterized by different spatial and time features. For instance, the spiral shown in Fig. 2A was drawn by a patient who showed symptoms of dyskinesia; the drawing speed was relatively high (cf. blue-colored time series plot and the short timestamp scale in the x axis) and the spatial displacement was high (cf. orange-colored time series plot) associated with smooth deviations as a result of uncontrollable movements. The patient also exhibited low amount of hesitation which could be reflected both in the animation of the spiral as well as time series plots. In contrast, the patient who was in the Off state exhibited different kinematic features, as shown in Fig. 2C. In the case of spirals drawn by a HE subject, there was a great precision during the drawing process as well as unchanging levels of time-dependent features over the test trial, as seen in Fig. 2B. Conclusions: Visualizing spirography-based objective measures enables identification of trends and patterns of drug-related motor dysfunctions at the patient’s individual level. Dynamic access of visualized motor tests may be useful during the evaluation of drug-related complications such as under- and over-medications, providing decision support to clinicians during evaluation of treatment effects as well as improve the quality of life of patients and their caregivers. In future, we plan to evaluate the proposed approach by assessing within- and between-clinician variability in ratings in order to determine its actual usefulness and then use these ratings as target outcomes in supervised machine learning, similarly as it was previously done in the study performed by Memedi et al. (2013).

A web-based system for visualizing upper limb motor performance of Parkinson’s disease patients

Objective To design, develop and set up a web-based system for enabling graphical visualization of upper limb motor performance (ULMP) of Parkinson’s disease (PD) patients to clinicians. Background Sixty-five patients diagnosed with advanced PD have used a test battery, implemented in a touch-screen handheld computer, in their home environment settings over the course of a 3-year clinical study. The test items consisted of objective measures of ULMP through a set of upper limb motor tests (finger to tapping and spiral drawings). For the tapping tests, patients were asked to perform alternate tapping of two buttons as fast and accurate as possible, first using the right hand and then the left hand. The test duration was 20 seconds. For the spiral drawing test, patients traced a pre-drawn Archimedes spiral using the dominant hand, and the test was repeated 3 times per test occasion. In total, the study database consisted of symptom assessments during 10079 test occasions. Methods Visualization of ULMP The web-based system is used by two neurologists for assessing the performance of PD patients during motor tests collected over the course of the said study. The system employs animations, scatter plots and time series graphs to visualize the ULMP of patients to the neurologists. The performance during spiral tests is depicted by animating the three spiral drawings, allowing the neurologists to observe real-time accelerations or hesitations and sharp changes during the actual drawing process. The tapping performance is visualized by displaying different types of graphs. Information presented included distribution of taps over the two buttons, horizontal tap distance vs. time, vertical tap distance vs. time, and tapping reaction time over the test length. Assessments Different scales are utilized by the neurologists to assess the observed impairments. For the spiral drawing performance, the neurologists rated firstly the ‘impairment’ using a 0 (no impairment) – 10 (extremely severe) scale, secondly three kinematic properties: ‘drawing speed’, ‘irregularity’ and ‘hesitation’ using a 0 (normal) – 4 (extremely severe) scale, and thirdly the probable ‘cause’ for the said impairment using 3 choices including Tremor, Bradykinesia/Rigidity and Dyskinesia. For the tapping performance, a 0 (normal) – 4 (extremely severe) scale is used for first rating four tapping properties: ‘tapping speed’, ‘accuracy’, ‘fatigue’, ‘arrhythmia’, and then the ‘global tapping severity’ (GTS). To achieve a common basis for assessment, initially one neurologist (DN) performed preliminary ratings by browsing through the database to collect and rate at least 20 samples of each GTS level and at least 33 samples of each ‘cause’ category. These preliminary ratings were then observed by the two neurologists (DN and PG) to be used as templates for rating of tests afterwards. In another track, the system randomly selected one test occasion per patient and visualized its items, that is tapping and spiral drawings, to the two neurologists. Statistical methods Inter-rater agreements were assessed using weighted Kappa coefficient. The internal consistency of properties of tapping and spiral drawing tests were assessed using Cronbach’s α test. One-way ANOVA test followed by Tukey multiple comparisons test was used to test if mean scores of properties of tapping and spiral drawing tests were different among GTS and ‘cause’ categories, respectively. Results When rating tapping graphs, inter-rater agreements (Kappa) were as follows: GTS (0.61), ‘tapping speed’ (0.89), ‘accuracy’ (0.66), ‘fatigue’ (0.57) and ‘arrhythmia’ (0.33). The poor inter-rater agreement when assessing “arrhythmia” may be as a result of observation of different things in the graphs, among the two raters. When rating animated spirals, both raters had very good agreement when assessing severity of spiral drawings, that is, ‘impairment’ (0.85) and irregularity (0.72). However, there were poor agreements between the two raters when assessing ‘cause’ (0.38) and time-information properties like ‘drawing speed’ (0.25) and ‘hesitation’ (0.21). Tapping properties, that is ‘tapping speed’, ‘accuracy’, ‘fatigue’ and ‘arrhythmia’ had satisfactory internal consistency with a Cronbach’s α coefficient of 0.77. In general, the trends of mean scores of tapping properties worsened with increasing levels of GTS. The mean scores of the four properties were significantly different to each other, only at different levels. In contrast from tapping properties, kinematic properties of spirals, that is ‘drawing speed’, ‘irregularity’ and ‘hesitation’ had a questionable consistency among them with a coefficient of 0.66. Bradykinetic spirals were associated with more impaired speed (mean = 83.7 % worse, P < 0.001) and hesitation (mean = 77.8% worse, P < 0.001), compared to dyskinetic spirals. Both these ‘cause’ categories had similar mean scores of ‘impairment’ and ‘irregularity’. Conclusions In contrast from current approaches used in clinical setting for the assessment of PD symptoms, this system enables clinicians to animate easily and realistically the ULMP of patients who at the same time are at their homes. Dynamic access of visualized motor tests may also be useful when observing and evaluating therapy-related complications such as under- and over-medications. In future, we foresee to utilize these manual ratings for developing and validating computer methods for automating the process of assessing ULMP of PD patients.

Automatic and objective assessment of alternating tapping performance in Parkinson’s disease

This paper presents the development and evaluation of a method for enabling quantitative and automatic scoring of alternating tapping performance of patients with Parkinson’s disease (PD). Ten healthy elderly subjects and 95 patients in different clinical stages of PD have utilized a touch-pad handheld computer to perform alternate tapping tests in their home environments. First, a neurologist used a web-based system to visually assess impairments in four tapping dimensions (‘speed’, ‘accuracy’, ‘fatigue’ and ‘arrhythmia’) and a global tapping severity (GTS). Second, tapping signals were processed with time series analysis and statistical methods to derive 24 quantitative parameters. Third, principal component analysis was used to reduce the dimensions of these parameters and to obtain scores for the four dimensions. Finally, a logistic regression classifier was trained using a 10-fold stratified cross-validation to map the reduced parameters to the corresponding visually assessed GTS scores. Results showed that the computed scores correlated well to visually assessed scores and were significantly different across Unified Parkinson’s Disease Rating Scale scores of upper limb motor performance. In addition, they had good internal consistency, had good ability to discriminate between healthy elderly and patients in different disease stages, had good sensitivity to treatment interventions and could reflect the natural disease progression over time. In conclusion, the automatic method can be useful to objectively assess the tapping performance of PD patients and can be included in telemedicine tools for remote monitoring of tapping.

Desenvolvimento de um sistema informatizado para coleta, armazenamento e processamento dos dados referentes à cesta básica do Município de Botucatu -SP

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Sistema informatizado para dispositivos móveis de coleta dos dados referentes à cesta básica do município de Botucatu/SP

The collection of prices for basic goods supply is very important for the population, based on the collection and processing of these data the CLI (Cost Living Index) is calculated among others, helping consumers to shop more rationally and with a clearer view of each product impact of each product on their household budget, not only food, but also cleaning products and personal hygiene ones. Nowadays, the project of collection of prices for basic goods supply is conducted weekly in Botucatu - SP through a spreadsheet. The aim of this work was to develop a software which utilized mobile devices in the data collection and storage phase, concerning the basic goods supply in Botucatu -SP. This was created in order to eliminate the need of taking notes in paper spreadsheets, increasing efficiency and accelerating the data processing. This work utilized the world of mobile technology and development tools, through the platform".NET" - Compact Framework and programming language Visual Basic".NET" was used in the handheld phase, enabling to develop a system using techniques of object oriented programming, with higher speed and reliability in the codes writing. A HP Pavilion dv3 personal computer and an Eten glofish x500+ handheld computer were used. At the end of the software development, collection, data storing and processing in a report, the phase of in loco paper spreadsheets were eliminated and it was possible to verify that the whole process was faster, more consistent, safer, more efficient and the data were more available.

Design and Optimization of Power Delivery and Distribution Systems Using Evolutionary Computation Techniques

Nowadays computing platforms consist of a very large number of components that require to be supplied with diferent voltage levels and power requirements. Even a very small platform, like a handheld computer, may contain more than twenty diferent loads and voltage regulators. The power delivery designers of these systems are required to provide, in a very short time, the right power architecture that optimizes the performance, meets electrical specifications plus cost and size targets. The appropriate selection of the architecture and converters directly defines the performance of a given solution. Therefore, the designer needs to be able to evaluate a significant number of options in order to know with good certainty whether the selected solutions meet the size, energy eficiency and cost targets. The design dificulties of selecting the right solution arise due to the wide range of power conversion products provided by diferent manufacturers. These products range from discrete components (to build converters) to complete power conversion modules that employ diferent manufacturing technologies. Consequently, in most cases it is not possible to analyze all the alternatives (combinations of power architectures and converters) that can be built. The designer has to select a limited number of converters in order to simplify the analysis. In this thesis, in order to overcome the mentioned dificulties, a new design methodology for power supply systems is proposed. This methodology integrates evolutionary computation techniques in order to make possible analyzing a large number of possibilities. This exhaustive analysis helps the designer to quickly define a set of feasible solutions and select the best trade-off in performance according to each application. The proposed approach consists of two key steps, one for the automatic generation of architectures and other for the optimized selection of components. In this thesis are detailed the implementation of these two steps. The usefulness of the methodology is corroborated by contrasting the results using real problems and experiments designed to test the limits of the algorithms.

Handheld 3D thermography using range sensing and computer vision

This thesis developed a method for real-time and handheld 3D temperature mapping using a combination of off-the-shelf devices and efficient computer algorithms. It contributes a new sensing and data processing framework to the science of 3D thermography, unlocking its potential for application areas such as building energy auditing and industrial monitoring. New techniques for the precise calibration of multi-sensor configurations were developed, along with several algorithms that ensure both accurate and comprehensive surface temperature estimates can be made for rich 3D models as they are generated by a non-expert user.

Human-computer interaction and innovation in handheld, mobile and wearable technologies

Handheld and mobile technologies have witnessed significant advances in functionality, leading to their widespread use as both business and social networking tools. Human-Computer Interaction and Innovation in Handheld, Mobile and Wearable Technologies reviews concepts relating to the design, development, evaluation, and application of mobile technologies. Studies on mobile user interfaces, mobile learning, and mobile commerce contribute to the growing body of knowledge on this expanding discipline.

HeatWave : a handheld 3D thermography system for energy auditing

Energy auditing is an effective but costly approach for reducing the long-term energy consumption of buildings. When well-executed, energy loss can be quickly identified in the building structure and its subsystems. This then presents opportunities for improving energy efficiency. We present a low-cost, portable technology called "HeatWave" which allows non-experts to generate detailed 3D surface temperature models for energy auditing. This handheld 3D thermography system consists of two commercially available imaging sensors and a set of software algorithms which can be run on a laptop. The 3D model can be visualized in real-time by the operator so that they can monitor their degree of coverage as the sensors are used to capture data. In addition, results can be analyzed offline using the proposed "Spectra" multispectral visualization toolbox. The presence of surface temperature data in the generated 3D model enables the operator to easily identify and measure thermal irregularities such as thermal bridges, insulation leaks, moisture build-up and HVAC faults. Moreover, 3D models generated from subsequent audits of the same environment can be automatically compared to detect temporal changes in conditions and energy use over time.

Efficiently capturing large, complex cultural heritage sites with a handheld mobile 3D laser mapping system

Accurate three-dimensional representations of cultural heritage sites are highly valuable for scientific study, conservation, and educational purposes. In addition to their use for archival purposes, 3D models enable efficient and precise measurement of relevant natural and architectural features. Many cultural heritage sites are large and complex, consisting of multiple structures spatially distributed over tens of thousands of square metres. The process of effectively digitising such geometrically complex locations requires measurements to be acquired from a variety of viewpoints. While several technologies exist for capturing the 3D structure of objects and environments, none are ideally suited to complex, large-scale sites, mainly due to their limited coverage or acquisition efficiency. We explore the use of a recently developed handheld mobile mapping system called Zebedee in cultural heritage applications. The Zebedee system is capable of efficiently mapping an environment in three dimensions by continually acquiring data as an operator holding the device traverses through the site. The system was deployed at the former Peel Island Lazaret, a culturally significant site in Queensland, Australia, consisting of dozens of buildings of various sizes spread across an area of approximately 400 × 250 m. With the Zebedee system, the site was scanned in half a day, and a detailed 3D point cloud model (with over 520 million points) was generated from the 3.6 hours of acquired data in 2.6 hours. We present results demonstrating that Zebedee was able to accurately capture both site context and building detail comparable in accuracy to manual measurement techniques, and at a greatly increased level of efficiency and scope. The scan allowed us to record derelict buildings that previously could not be measured because of the scale and complexity of the site. The resulting 3D model captures both interior and exterior features of buildings, including structure, materials, and the contents of rooms.

Design of a tablet sized human-computer interface and its effect on situation awareness

Emergency Response Teams increasingly use interactive technology to help manage information and communications. The challenge is to maintain a high situation awareness for different interactive devices sizes. This research specifically compared a handheld interactive device in the form of an iPad with a large interactive multi-touch tabletop. A search and rescue inspired simulator was designed to test operator situation awareness for the two sized devices. The results show that operators had better situation awareness on the tabletop device when the operation related to detecting of moving targets, searching target locations, distinguishing target types, and comprehending displayed information.

Pervasive handheld computing systems

The technological role of handheld devices is fundamentally changing. Portable computers were traditionally application specific. They were designed and optimised to deliver a specific task. However, it is now commonly acknowledged that future handheld devices need to be multi-functional and need to be capable of executing a range of high-performance applications. This thesis has coined the term pervasive handheld computing systems to refer to this type of mobile device. Portable computers are faced with a number of constraints in trying to meet these objectives. They are physically constrained by their size, their computational power, their memory resources, their power usage, and their networking ability. These constraints challenge pervasive handheld computing systems in achieving their multi-functional and high-performance requirements. This thesis proposes a two-pronged methodology to enable pervasive handheld computing systems meet their future objectives. The methodology is a fusion of two independent and yet complementary concepts. The first step utilises reconfigurable technology to enhance the physical hardware resources within the environment of a handheld device. This approach recognises that reconfigurable computing has the potential to dynamically increase the system functionality and versatility of a handheld device without major loss in performance. The second step of the methodology incorporates agent-based middleware protocols to support handheld devices to effectively manage and utilise these reconfigurable hardware resources within their environment. The thesis asserts the combined characteristics of reconfigurable computing and agent technology can meet the objectives of pervasive handheld computing systems.

Handheld-assisted field data collection for occupational risk assessment.

A computerized handheld procedure is presented in this paper. It is intended as a database complementary tool, to enhance prospective risk analysis in the field of occupational health. The Pendragon forms software (version 3.2) has been used to implement acquisition procedures on Personal Digital Assistants (PDAs) and to transfer data to a computer in an MS-Access format. The data acquisition strategy proposed relies on the risk assessment method practiced at the Institute of Occupational Health Sciences (IST). It involves the use of a systematic hazard list and semi-quantitative risk assessment scales. A set of 7 modular forms has been developed to cover the basic need of field audits. Despite the minor drawbacks observed, the results obtained so far show that handhelds are adequate to support field risk assessment and follow-up activities. Further improvements must still be made in order to increase the tool effectiveness and field adequacy.