Non-contact Sleep/Wake Monitoring Using Impulse-Radio Ultrawideband Radar in Neonates

Background: The gold standard for sleep monitoring, polysomnography (PSG), is too obtrusive and limited for practical use with tiny infants or in neonatal intensive care unit (NICU) settings. The ability of impulse-radio ultrawideband (IR-UWB) radar, a non-contact sensing technology, to assess vital signs and fine movement asymmetry in neonates was recently demonstrated. The purpose of this study was to investigate the possibility of quantitatively distinguishing and measuring sleep/wake states in neonates using IR-UWB radar and to compare its accuracy with behavioral observation-based sleep/wake analyses using video recordings.Methods: One preterm and three term neonates in the NICU were enrolled, and voluntary movements and vital signs were measured by radar at ages ranging from 2 to 27 days. Data from a video camcorder, amplitude-integrated electroencephalography (aEEG), and actigraphy were simultaneously recorded for reference. Radar signals were processed using a sleep/wake decision algorithm integrated with breathing signals and movement features.Results: The average recording time for the analysis was 13.0 (7.0–20.5) h across neonates. Compared with video analyses, the sleep/wake decision algorithm for neonates correctly classified 72.2% of sleep epochs and 80.6% of wake epochs and achieved a final Cohen's kappa coefficient of 0.49 (0.41–0.59) and an overall accuracy of 75.2%.Conclusions: IR-UWB radar can provide considerable accuracy regarding sleep/wake decisions in neonates, and although current performance is not yet sufficient, this study demonstrated the feasibility of its possible use in the NICU for the first time. This unobtrusive, non-contact radar technology is a promising method for monitoring sleep/wake states with vital signs in neonates.

Bilateral actigraphic quantification of upper extremity movement in hemiparetic children with perinatal stroke: a case control study

Background Hemiparetic cerebral palsy impacts millions of people worldwide. Assessment of bilateral motor function in real life remains a major challenge. We evaluated quantification of upper extremity movement in hemiparetic children using bilateral actigraphy. We hypothesized that movement asymmetry correlates with standard motor outcome measures. Methods Hemiparetic and control participants wore bilateral wrist Actiwatch2 (Philips) for 48 h with movement counts recorded in 15-s intervals. The primary outcome was a novel statistic of movement asymmetry, the Actigraphic Movement Asymmetry Index (AMAI). Relationships between AMAI and standard motor outcomes (Assisting Hand Assessment, Melbourne Assessment, and Box and Block Test [BB]) were explored with Pearson or Spearman correlation. Results 30 stroke (mean 11 years 2 months (3 years 10 months); 13 female, 17 male) and 23 control (mean 11 years 1 month (4 years 5 months); 8 female, 15 male) were enrolled. Stroke participants demonstrated higher asymmetry. Correlations between AMAI and standard tests were moderate and strongest during sleep (BB: r = 0.68, p < 0.01). Conclusions Standard tests may not reflect the extent of movement asymmetry during daily life in hemiparetic children. Bilateral actigraphy may be a valuable complementary tool for measuring arm movement, potentially enabling improved evaluation of therapies with a focus on child participation.

Effect of Speed and Surface Type on Individual Rein and Combined Left–Right Circle Movement Asymmetry in Horses on the Lunge

Differences in movement asymmetry between surfaces and with increasing speed increase the complexity of incorporating gait analysis measurements from lunging into clinical decision making. This observational study sets out to quantify by means of quantitative gait analysis the influence of surface and speed on individual-rein movement asymmetry measurements and their averages across reins (average-rein measurements). Head, withers, and pelvic movement asymmetry was quantified in 27 horses, identified previously as presenting with considerable movement asymmetries on the straight, during trot in hand and on the lunge on two surfaces at two speeds. Mixed linear models (p &lt; 0.05) with horse as the random factor and surface and speed category (and direction) as fixed factors analyzed the effects on 11 individual-rein and average-rein asymmetry measures. Limits of agreement quantified differences between individual-rein and average-rein measurements. A higher number of individual-rein asymmetry variables—particularly when the limb that contributed to movement asymmetry on the straight was on the inside of the circle—were affected by speed (nine variables, all p ≤ 0.047) and surface (three variables, all p ≤ 0.037) compared with average-rein asymmetry variables (two for speed, all p ≤ 0.003; two for surface, all p ≤ 0.046). Six variables were significantly different between straight-line and average-rein assessments (all p ≤ 0.031), and asymmetry values were smaller for average-rein assessments. Limits of agreement bias varied between +0.4 and +4.0 mm with standard deviations between 3.2 and 12.9 mm. Fewer average-rein variables were affected by speed highlighting the benefit of comparing left and right rein measurements. Only one asymmetry variable showed a surface difference for individual-rein and average-rein data, emphasizing the benefit of assessing surface differences on each rein individually. Variability in straight-line vs. average-rein measurements across horses and exercise conditions highlight the potential for average-rein measurements during the diagnostic process; further studies after diagnostic analgesia are needed.

Smartphone-Based Pelvic Movement Asymmetry Measures for Clinical Decision Making in Equine Lameness Assessment

Visual evaluation of hindlimb lameness in the horse is challenging. Objective measurements, simultaneous to visual assessment, are used increasingly to aid clinical decision making. The aim of this study was to investigate the association of pelvic movement asymmetry with lameness scores (UK scale 0–10) of one experienced veterinarian. Absolute values of pelvic asymmetry measures, quantifying differences between vertical minima (AbPDMin), maxima (AbPDMax) and upward movement amplitudes (AbPDUp), were recorded during straight-line trot with a smartphone attached to the sacrum (n = 301 horses). Overall, there was a significant difference between lameness grades for all three asymmetry measures (p < 0.001). Five pair-wise differences (out of 10) were significant for AbPDMin (p ≤ 0.02) and seven for AbPDMax (p ≤ 0.03) and AbPDUp (p ≤ 0.02). Receiver operating curves assessed sensitivity and specificity of asymmetry measures against lameness scores. AbPDUp had the highest discriminative power (area under curve (AUC) = 0.801–0.852) followed by AbPDMax (AUC = 0.728–0.813) and AbPDMin (AUC = 0.688–0.785). Cut-off points between non-lame (grade 0) and lame horses (grades 1–4) with a minimum sensitivity of 75% were identified as AbPDUp ≥ 7.5 mm (67.6% specificity), AbPDMax ≥ 4.5 mm (51.9% specificity) and AbPDMin ≥ 2.5 mm (33.3% specificity). In conclusion, pelvic upward movement amplitude difference (AbPDUp) was the asymmetry parameter with the highest discriminative power in this study.

Effects of horse housing on musculoskeletal system post-exercise recovery

This study examined the effects of two housing systems (control housing and loose housing) on musculoskeletal condition during recovery from race-like exercise in Standardbred horses. The hypothesis was that a loose housing system provides better conditions for musculoskeletal recovery than the control housing. Eight adult geldings (mean age 11 years) were used in a study with a cross-over design, with the control housing (CH) and loose housing (LH) treatments each run for 21 days. The horses had ad libitum access to forage and performed two similar race-like exercise tests (ET), on day 7 and day 14 in each treatment. Blood samples were collected before ET, at finish line, and at 7, 22, and 44 h of recovery and analysed for the muscle enzyme activities of creatine kinase and amino transferase. Before and three days after ET, hind leg fetlock joint region circumference and diameter, joint range of motion in right hock and carpus, mechanical nociceptive threshold in back muscle, and movement asymmetry were recorded. Overall circumference and overall diameter of hind fetlock joint region were lower in LH horses than CH horses (P=0.045 and P=0.017, respectively), but no other differences were observed. In conclusion, a loose housing system did not alter the recovery of musculoskeletal condition other than preventing a post exercise enlargement of the circumference and diameter of the hind fetlock joint region.

Documenting the Ikpana interrogative system

This article provides a comprehensive treatment of the interrogative system of Ikpana (ISO 639-3: lgq), an endangered language spoken in the southeastern part of Ghana’s Volta region. The article features a description and analysis of both the morphosyntax and intonation of questions in the language. Polar questions in Ikpana are associated with dedicated prosodic patterns and may be segmentally marked. As for wh- interrogatives, Ikpana allows for optional wh- movement. Interrogative expressions may appear clause-internally in their base-generated positions or in the left periphery followed by one of two optionally droppable particles with distinct syntactic properties. In this way, wh- movement structures are either focus-marked constructions or cleft structures depending on the accompanying particle. We identify an interesting wh- movement asymmetry – unlike all other wh- movement structures, ‘how’ questions may not be formed via the focus-marked or cleft strategy. We document a number of other attested wh- structures in the language, including long-distance wh- movement, partial wh- movement, long-distance wh- in-situ, and multiple wh- questions. We argue that by allowing our documentation efforts to be shaped and guided by theoretically driven research questions, we reach deeper levels of description than would have been possible if approached from a purely descriptive-documentary perspective.

Voice Quality and Laryngeal Findings in Patients With Suspected Lung Cancer

Objective To describe laryngeal findings and voice quality in patients with suspected lung cancer, relative to voice quality and possible laryngeal pathology. Study Design Prospective cohort study. Setting Tertiary care center. Methods Patients with known or suspected lung cancer were approached before planned thoracic surgery, and they completed acoustic analysis, the Voice-Related Quality of Life (V-RQOL) questionnaire, and stroboscopy. The prevalence of dysphonia, V-RQOL and Cepstral Spectral Index of Dysphonia (CSID) scores, and laryngeal findings were examined and compared between patients ultimately found to have lung cancer and those without cancer. Results Sixty-one patients (45 cancer, 16 noncancer) were analyzed. Patients with cancer were older than those without (mean ± SD, 72.3 ± 9.94 vs 62.6 ± 9.30 years; P = .001). Otherwise, the distribution of stroboscopy findings, acoustic measures, and self-reported voice handicap were similar between the cancer and noncancer cohorts. Prior to surgery, no patients had vocal cord paralysis or obvious neoplasm, though 4 (6.56%) had leukoplakia and 28 (45.9%) had vocal fold movement asymmetry on stroboscopy. Overall, 21 patients (35.0%) had average CSID scores >19, and 13 (21.7%) had CSID scores >24; however, only 4 self-described their voice as not working as it should, and only 2 had a V-RQOL score <85. Conclusion Patients with suspected lung cancer have moderate dysphonia on acoustic measures, though self-reported impact on quality of life is low. While leukoplakia was seen in 4 patients, obvious neoplasm and occult paralysis were not seen in this cohort. Together, these findings suggest that patients with suspected lung cancer should be assessed for subjective voice dysfunction, but routine laryngeal screening may otherwise be unnecessary.

Actigraphic Measurement of the Upper Limbs for the Prediction of Ischemic Stroke Prognosis: An Observational Study

Background: It is often challenging to formulate a reliable prognosis for patients with acute ischemic stroke. The most accepted prognostic factors may not be sufficient to predict the recovery process. In this view, describing the evolution of motor deficits over time via sensors might be useful for strengthening the prognostic model. Our aim was to assess whether an actigraphic-based parameter (Asymmetry Rate Index for the 24 h period (AR2_24 h)) obtained in the acute stroke phase could be a predictor of a 90 d prognosis. Methods: In this observational study, we recorded and analyzed the 24 h upper limb movement asymmetry of 20 consecutive patients with acute ischemic stroke during their stay in a stroke unit. We recorded the motor activity of both arms using two programmable actigraphic systems positioned on patients’ wrists. We clinically evaluated the stroke patients by NIHSS in the acute phase and then assessed them across 90 days using the modified Rankin Scale (mRS). Results: We found that the AR2_24 h parameter positively correlates with the 90 d mRS (r = 0.69, p < 0.001). Moreover, we found that an AR2_24 h > 32% predicts a poorer outcome (90 d mRS > 2), with sensitivity = 100% and specificity = 89%. Conclusions: Sensor-based parameters might provide useful information for predicting ischemic stroke prognosis in the acute phase.