Publications
Speech as a biomarker: opportunities, interoperability, and challenges
February 11, 2022
Journal Article
Published in:
Perspectives of the ASHA Special Interest Groups, Vo. 7, February 2022, pp. 276-83.
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Summary
Purpose: Over the past decade, the signal processing and machine learning literature has demonstrated notable advancements in automated speech processing with the use of artificial intelligence for medical assessment and monitoring (e.g., depression, dementia, and Parkinson's disease, among others). Meanwhile, the clinical speech literature has identified several interpretable, theoretically motivated measures that are sensitive to abnormalities in the cognitive, linguistic, affective, motoric, and anatomical domains. Both fields have, thus, independently demonstrated the potential for speech to serve as an informative biomarker for detecting different psychiatric and physiological conditions. However, despite these parallel advancements, automated speech biomarkers have not been integrated into routine clinical practice to date. Conclusions: In this article, we present opportunities and challenges for adoption of speech as a biomarker in clinical practice and research. Toward clinical acceptance and adoption of speech-based digital biomarkers, we argue for the importance of several factors such as robustness, specificity, diversity, and physiological interpretability of speech analytics in clinical applications.
Summary
Purpose: Over the past decade, the signal processing and machine learning literature has demonstrated notable advancements in automated speech processing with the use of artificial intelligence for medical assessment and monitoring (e.g., depression, dementia, and Parkinson's disease, among others). Meanwhile, the clinical speech literature has identified several interpretable, theoretically motivated...
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EEG alpha and pupil diameter reflect endogenous auditory attention switching and listening effort
January 19, 2022
Journal Article
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Eur. J. Neurosci., 2022, pp. 1-16.
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Everyday environments often contain distracting competing talkers and background noise, requiring listeners to focus their attention on one acoustic source and reject others. During this auditory attention task, listeners may naturally interrupt their sustained attention and switch attended sources. The effort required to perform this attention switch has not been well studied in the context of competing continuous speech. In this work, we developed two variants of endogenous attention switching and a sustained attention control. We characterized these three experimental conditions under the context of decoding auditory attention, while simultaneously evaluating listening effort and neural markers of spatial-audio cues. A least-squares, electroencephalography (EEG) based, attention decoding algorithm was implemented across all conditions. It achieved an accuracy of 69.4% and 64.0% when computed over non-overlapping 10 and 5-second correlation windows, respectively. Both decoders illustrated smooth transitions in the attended talker prediction through switches at approximately half of the analysis window size (e.g. the mean lag taken across the two switch conditions was 2.2 seconds when the 5-second correlation window was used). Expended listening effort, as measured by simultaneous EEG and pupillometry, was also a strong indicator of whether the listeners sustained attention or performed an endogenous attention switch (peak pupil diameter measure (p = 0.034) and minimum parietal alpha power measure (p = 0.016)). We additionally found evidence of talker spatial cues in the form of centrotemporal alpha power lateralization (p = 0.0428). These results suggest that listener effort and spatial cues may be promising features to pursue in a decoding context, in addition to speech-based features.
Summary
Everyday environments often contain distracting competing talkers and background noise, requiring listeners to focus their attention on one acoustic source and reject others. During this auditory attention task, listeners may naturally interrupt their sustained attention and switch attended sources. The effort required to perform this attention switch has not been...
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Gait instability and estimated core temperature predict exertional heat stroke
January 12, 2022
Journal Article
Published in:
Br J Sports Med., online ahead of print, 12 January 2022.
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Objective Exertional heat stroke (EHS), characterised by a high core body temperature (Tcr) and central nervous system (CNS) dysfunction, is a concern for athletes, workers and military personnel who must train and perform in hot environments. The objective of this study was to determine whether algorithms that estimate Tcr from heart rate and gait instability from a trunk-worn sensor system can forward predict EHS onset. Methods Heart rate and three-axis accelerometry data were collected from chest-worn sensors from 1806 US military personnel participating in timed 4/5-mile runs, and loaded marches of 7 and 12 miles; in total, 3422 high EHS-risk training datasets were available for analysis. Six soldiers were diagnosed with heat stroke and all had rectal temperatures of >41°C when first measured and were exhibiting CNS dysfunction. Estimated core temperature (ECTemp) was computed from sequential measures of heart rate. Gait instability was computed from three-axis accelerometry using features of pattern dispersion and autocorrelation. Results The six soldiers who experienced heat stroke were among the hottest compared with the other soldiers in the respective training events with ECTemps ranging from 39.2°C to 40.8°C. Combining ECTemp and gait instability measures successfully identified all six EHS casualties at least 3.5 min in advance of collapse while falsely identifying 6.1% (209 total false positives) examples where exertional heat illness symptoms were neither observed nor reported. No false-negative cases were noted. Conclusion The combination of two algorithms that estimate Tcr and ataxic gate appears promising for real-time alerting of impending EHS.
Summary
Objective Exertional heat stroke (EHS), characterised by a high core body temperature (Tcr) and central nervous system (CNS) dysfunction, is a concern for athletes, workers and military personnel who must train and perform in hot environments. The objective of this study was to determine whether algorithms that estimate Tcr from...
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Alternative cue and response modalities maintain the Simon effect but impact task performance
January 7, 2022
Journal Article
Published in:
Appl. Ergon., Vol. 100, 2022, 103648.
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Inhibitory control, the ability to inhibit impulsive responses and irrelevant stimuli, enables high level functioning and activities of daily living. The Simon task probes inhibition using interfering stimuli, i.e., cues spatially presented on the opposite side of the indicated response; incongruent response times (RT) are slower than congruent RTs. Operational applicability of the Simon task beyond finger/hand manipulations and visual/auditory cues is unclear, but important to consider as new technologies provide tactile cues and require motor responses from the lower extremity (e.g., exoskeletons). In this study, twenty participants completed the Simon task under four conditions, each combination of two cue (visual/tactile) and response (upper/lower-extremity) modalities. RT were significantly longer for incongruent than congruent cues across cue-response pairs. However, alternative cue-response pairs yielded slower RT and decreased accuracy for tactile cues and lower extremity responses. Results support operational usage of the Simon task to probe inhibition using tactile cues and lower-extremity responses relevant for new technologies like exoskeletons and immersive environments.
Summary
Inhibitory control, the ability to inhibit impulsive responses and irrelevant stimuli, enables high level functioning and activities of daily living. The Simon task probes inhibition using interfering stimuli, i.e., cues spatially presented on the opposite side of the indicated response; incongruent response times (RT) are slower than congruent RTs. Operational...
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Individuals differ in muscle activation patterns during early adaptation to a powered ankle exoskeleton
January 1, 2022
Journal Article
Published in:
Applied Ergonomics Volume 98, January 2022, 103593
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Exoskeletons have the potential to assist users and augment physical ability. To achieve these goals across users, individual variation in muscle activation patterns when using an exoskeleton need to be evaluated. This study examined individual muscle activation patterns during walking with a powered ankle exoskeleton. 60% of the participants were observed to reduce medial gastrocnemius activation with exoskeleton powered and increase with the exoskeleton unpowered during stance. 80% of the participants showed a significant increase in tibialis anterior activation upon power addition, with inconsistent changes upon power removal during swing. 60% of the participants that were able to adapt to the system, did not de-adapt after 5 min. Muscle activity patterns differ between individuals in response to the exoskeleton power state, and affected the antagonist muscle behavior during this early adaptation. It is important to understand these different individual behaviors to inform the design of exoskeleton controllers and training protocols.
Summary
Exoskeletons have the potential to assist users and augment physical ability. To achieve these goals across users, individual variation in muscle activation patterns when using an exoskeleton need to be evaluated. This study examined individual muscle activation patterns during walking with a powered ankle exoskeleton. 60% of the participants were...
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AI-enabled, ultrasound-guided handheld robotic device for femoral vascular access
December 18, 2021
Journal Article
Published in:
Biosensors, Vol. 11, No. 12, 18 December 2021, 522.
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Hemorrhage is a leading cause of trauma death, particularly in prehospital environments when evacuation is delayed. Obtaining central vascular access to a deep artery or vein is important for administration of emergency drugs and analgesics, and rapid replacement of blood volume, as well as invasive sensing and emerging life-saving interventions. However, central access is normally performed by highly experienced critical care physicians in a hospital setting. We developed a handheld AI-enabled interventional device, AI-GUIDE (Artificial Intelligence Guided Ultrasound Interventional Device), capable of directing users with no ultrasound or interventional expertise to catheterize a deep blood vessel, with an initial focus on the femoral vein. AI-GUIDE integrates with widely available commercial portable ultrasound systems and guides a user in ultrasound probe localization, venous puncture-point localization, and needle insertion. The system performs vascular puncture robotically and incorporates a preloaded guidewire to facilitate the Seldinger technique of catheter insertion. Results from tissue-mimicking phantom and porcine studies under normotensive and hypotensive conditions provide evidence of the technique's robustness, with key performance metrics in a live porcine model including: a mean time to acquire femoral vein insertion point of 53 plus or minus 36 s (5 users with varying experience, in 20 trials), a total time to insert catheter of 80 plus or minus 30 s (1 user, in 6 trials), and a mean number of 1.1 (normotensive, 39 trials) and 1.3 (hypotensive, 55 trials) needle insertion attempts (1 user). These performance metrics in a porcine model are consistent with those for experienced medical providers performing central vascular access on humans in a hospital.
Summary
Hemorrhage is a leading cause of trauma death, particularly in prehospital environments when evacuation is delayed. Obtaining central vascular access to a deep artery or vein is important for administration of emergency drugs and analgesics, and rapid replacement of blood volume, as well as invasive sensing and emerging life-saving interventions...
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Relationships between cognitive factors and gait strategy during exoskeleton-augmented walking
November 12, 2021
Conference Paper
Published in:
Proc. Human Factors and Ergonomics Society Annual Mtg, HFES, Vol. 65, No. 1, 2021.
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Individual variation in exoskeleton-augmented gait strategy may arise from differences in cognitive factors, e.g., ability to respond quickly to stimuli or complete tasks under divided attention. Gait strategy is defined as different approaches to achieving gait priorities (e.g., walking without falling) and is observed via changes in gait characteristics like normalized stride length or width. Changes indicate shifting priorities like increasing stability or coordination with an exoskeleton. Relationships between cognitive factors and exoskeleton gait characteristics were assessed. Cognitive factors were quantified using a modified Simon task and a speed achievement task on a self-paced treadmill with and without a secondary go/no-go task. Individuals with faster reaction times and decreased ability to maintain a given speed tended to prioritize coordination with an exoskeleton over gait stability. These correlations indicate relationships between cognitive factors and individual exoskeleton-augmented gait strategy that should be further investigated to understand variation in exoskeleton use.
Summary
Individual variation in exoskeleton-augmented gait strategy may arise from differences in cognitive factors, e.g., ability to respond quickly to stimuli or complete tasks under divided attention. Gait strategy is defined as different approaches to achieving gait priorities (e.g., walking without falling) and is observed via changes in gait characteristics like...
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Utility of inter-subject transfer learning for wearable-sensor-based joint torque prediction models
October 31, 2021
Conference Paper
Published in:
43rd Annual Intl. Conf. of the IEEE Engineering in Medicine & Biology, 31 October 2021-4 November 2021.
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Generalizability between individuals and groups is often a significant hurdle in model development for human subjects research. In the domain of wearable-sensor-controlled exoskeleton devices, the ability to generalize models across subjects or fine-tune more general models to individual subjects is key to enabling widespread adoption of these technologies. Transfer learning techniques applied to machine learning models afford the ability to apply and investigate the viability and utility such knowledge-transfer scenarios. This paper investigates the utility of single- and multi-subject based parameter transfer on LSTM models trained for "sensor-to-joint torque" prediction tasks, with regards to task performance and computational resources required for network training. We find that parameter transfer between both single- and multi-subject models provide useful knowledge transfer, with varying results across specific "source" and "target" subject pairings. This could be leveraged to lower model training time or computational cost in compute-constrained environments or, with further study to understand causal factors of the observed variance in performance across source and target pairings, to minimize data collection and model retraining requirements to select and personalize a generic model for personalized wearable-sensor-based joint torque prediction technologies.
Summary
Generalizability between individuals and groups is often a significant hurdle in model development for human subjects research. In the domain of wearable-sensor-controlled exoskeleton devices, the ability to generalize models across subjects or fine-tune more general models to individual subjects is key to enabling widespread adoption of these technologies. Transfer learning...
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Metrics for quantifying cognitive factors that may underlie individual variation in exoskeleton use
October 4, 2021
Journal Article
Published in:
Proc. of the Human Factors and Ergonomics Society Annual Meeting, Vol. 65, No. 1, 2021, pp. 216-20.
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Individual differences in adaptation to exoskeletons have been observed, but are not well understood. Kinematic, kinetic, and physiologic factors are commonly used to assess these systems. Parameters from experimental psychology and gait literature wereadapted to probe the lower extremity perception-cognition-action loop using measures of reaction times, gait task performance, and gait strategy. Parameters were measured in 15 subjects via two tasks: (1) a modified Simon task and (2) a speed-achievement task with secondary go/no-go cues on a self-paced treadmill. Outcome metrics were assessed for significantly different intra- versus inter-subject variability. Reaction time measures from the modified Simon task, as well two speed-achievement metrics and one gait-strategy characteristic were found to show significant differences in intra- versus inter-subject variability. These results suggest that select cognitive factors may differentiate between individuals and be potential predictors for individual variation during exoskeleton system operation.
Summary
Individual differences in adaptation to exoskeletons have been observed, but are not well understood. Kinematic, kinetic, and physiologic factors are commonly used to assess these systems. Parameters from experimental psychology and gait literature wereadapted to probe the lower extremity perception-cognition-action loop using measures of reaction times, gait task performance, and...
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Detecting pathogen exposure during the non-symptomatic incubation period using physiological data: proof of concept in non-human primates
September 3, 2021
Journal Article
Published in:
Front Physiol., Vol. 12, September 2021, Article 691074.
Summary
Background and Objectives: Early warning of bacterial and viral infection, prior to the development of overt clinical symptoms, allows not only for improved patient care and outcomes but also enables faster implementation of public health measures (patient isolation and contact tracing). Our primary objectives in this effort are 3-fold. First, we seek to determine the upper limits of early warning detection through physiological measurements. Second, we investigate whether the detected physiological response is specific to the pathogen. Third, we explore the feasibility of extending early warning detection with wearable devices. Research Methods: For the first objective, we developed a supervised random forest algorithm to detect pathogen exposure in the asymptomatic period prior to overt symptoms (fever). We used high-resolution physiological telemetry data (aortic blood pressure, intrathoracic pressure, electrocardiograms, and core temperature) from non-human primate animal models exposed to two viral pathogens: Ebola and Marburg (N = 20). Second, to determine reusability across different pathogens, we evaluated our algorithm against three independent physiological datasets from non-human primate models (N = 13) exposed to three different pathogens: Lassa and Nipah viruses and Y. pestis. For the third objective, we evaluated performance degradation when the algorithm was restricted to features derived from electrocardiogram (ECG) waveforms to emulate data from a non-invasive wearable device. Results: First, our cross-validated random forest classifier provides a mean early warning of 51 ± 12 h, with an area under the receiver-operating characteristic curve (AUC) of 0.93 ± 0.01. Second, our algorithm achieved comparable performance when applied to datasets from different pathogen exposures – a mean early warning of 51 ± 14 h and AUC of 0.95 ± 0.01. Last, with a degraded feature set derived solely from ECG, we observed minimal degradation – a mean early warning of 46 ± 14 h and AUC of 0.91 ± 0.001. Conclusion: Under controlled experimental conditions, physiological measurements can provide over 2 days of early warning with high AUC. Deviations in physiological signals following exposure to a pathogen are due to the underlying host’s immunological response and are not specific to the pathogen. Pre-symptomatic detection is strong even when features are limited to ECG-derivatives, suggesting that this approach may translate to non-invasive wearable devices.
Summary
Background and Objectives: Early warning of bacterial and viral infection, prior to the development of overt clinical symptoms, allows not only for improved patient care and outcomes but also enables faster implementation of public health measures (patient isolation and contact tracing). Our primary objectives in this effort are 3-fold. First...
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