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Sandro FIORETTI

Pubblicazioni

Sandro FIORETTI

 

263 pubblicazioni classificate nel seguente modo:

Nr. doc. Classificazioni
137 4 Contributo in Atti di Convegno (Proceeding)
92 1 Contributo su Rivista
24 2 Contributo in Volume
9 5 Altro
1 6 Brevetti
Anno Risorsa
2019 Glucose effectiveness and its components in relation to body mass index
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION
Autore/i: Morettini, M.; Di Nardo, F.; Ingrillini, L.; Fioretti, S.; Gobl, C.; Kautzky-Willer, A.; Tura, A.; Pacini, G.; Burattini, L.
Classificazione: 1 Contributo su Rivista
Abstract: Background: Obesity is known to induce a deterioration of insulin sensitivity (SI), one of the insulin-dependent components of glucose tolerance. However, few studies investigated whether obesity affects also the insulin-independent component, that is glucose effectiveness (SG). This cross-sectional study aimed to analyse SG and its components in different body mass index (BMI) categories. Materials and methods: Three groups of subjects spanning different BMI (kg m−2) categories underwent a 3-h frequently sampled intravenous glucose tolerance test: Lean (LE; 18.5 ≤ BMI < 25, n = 73), Overweight (OW; 25 ≤ BMI < 30, n = 90), and Obese (OB; BMI ≥ 30, n = 41). OB has been further divided into two subgroups, namely Obese I (OB-I; 30 ≤ BMI < 35, n = 27) and Morbidly Obese (OB-M; BMI ≥ 35, n = 14). Minimal model analysis provided SG and its components at zero (GEZI) and at basal (BIE) insulin. Results: Values for SG were 1.98 ± 1.30 × 10−2·min−1 in all subjects grouped and 2.38 ± 1.23, 1.84 ± 0.82, 1.59 ± 0.61 10−2·min−1 in LE, OW and OB, respectively. In all subjects grouped, a significant inverse linear correlation was found between the log-transformed values of SG and BMI (r = −0.3, P < 0.0001). SG was significantly reduced in OW and OB with respect to LE (P < 0.001) but no significant difference was detected between OB and OW (P = 0.35) and between OB-I and OB-M (P = 0.25). Similar results were found for GEZI. BIE was not significantly different among NW, OW and OB (P = 0.11) and between OB-I and OB-M (P ≥ 0.07). Conclusions: SG and its major component GEZI deteriorate in overweight individuals compared to those in the normal BMI range, without further deterioration when BMI increases above 30 kg m−2.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/267129 Collegamento a IRIS

2019 Wavelet filtering of fetal phonocardiography: A comparative analysis
MATHEMATICAL BIOSCIENCES AND ENGINEERING
Autore/i: Tomassini, S.; Strazza, A.; Sbrollini, A.; Marcantoni, I.; Morettini, M.; Fioretti, S.; Burattini, L.
Classificazione: 1 Contributo su Rivista
Abstract: Fetal heart rate (FHR) monitoring can serve as a benchmark to identify high-risk fetuses. Fetal phonocardiogram (FPCG) is the recording of the fetal heart sounds (FHS) by means of a small acoustic sensor placed on maternal abdomen. Being heavily contaminated by noise, FPCG processing implies mandatory filtering to make FPCG clinically usable. Aim of the present study was to perform a comparative analysis of filters based on Wavelet transform (WT) characterized by different combinations of mothers Wavelet and thresholding settings. By combining three mothers Wavelet (4th-order Coiflet, 4th-order Daubechies and 8th-order Symlet), two thresholding rules (Soft and Hard) and three thresholding algorithms (Universal, Rigorous and Minimax), 18 different WT-based filters were obtained and applied to 37 simulated and 119 experimental FPCG data (PhysioNet/PhysioBank). Filters performance was evaluated in terms of reliability in FHR estimation from filtered FPCG and noise reduction quantified by the signal-to-noise ratio (SNR). The filter obtained by combining the 4th-order Coiflet mother Wavelet with the Soft thresholding rule and the Universal thresholding algorithm was found to be optimal in both simulated and experimental FPCG data, since able to maintain FHR with respect to reference (138.7[137.7; 140.8] bpm vs. 140.2[139.7; 140.7] bpm, P > 0.05, in simulated FPCG data; 139.6[113.4; 144.2] bpm vs. 140.5[135.2; 146.3] bpm, P > 0.05, in experimental FPCG data) while strongly incrementing SNR (25.9[20.4; 31.3] dB vs. 0.7[−0.2; 2.9] dB, P < 10-14, in simulated FPCG data; 22.9[20.1; 25.7] dB vs. 15.6[13.8; 16.7] dB, P < 10-37, in experimental FPCG data). In conclusion, the WT-based filter obtained combining the 4th-order Coiflet mother Wavelet with the thresholding settings constituted by the Soft rule and the Universal algorithm provides the optimal WT-based filter for FPCG filtering according to evaluation criteria based on both noise and clinical features.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/269344 Collegamento a IRIS

2019 An interactive tool for the analysis of muscular recruitment during walking task
COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION
Autore/i: Mengarelli, Alessandro; Cardarelli, Stefano; DI NARDO, Francesco; Burattini, Laura; Verdini, Federica; Fioretti, Sandro
Classificazione: 1 Contributo su Rivista
Abstract: The present work proposes an interactive software tool for surface electromyography signal processing and analysis, focused on the assessment of muscular activations during walking and easy-to-use also for users without signal treatment knowledge. The tool is based on two logical steps: first, an automatic detection of muscle activations is provided; then, the user can tune the value of each processing parameter, with a real-time visual feedback. A stride-to-stride evaluation of muscular recruitment and a co-contraction recognition are available, together with the computation of an average myoelectric activation pattern. The tunable signal processing tailors the analysis to any considered application, allowing to extract information from low-quality signals. A muscle activity characterisation from the single stride to the whole walking trial is also provided. Beyond gait analysis and muscles activation timing identification, this tool could be valuable also in an educational scenario, considering the interactive characteristics of the graphical user interface.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/260812 Collegamento a IRIS

2018 Surface EMG patterns for quantification of thigh muscle co-contraction in school-age children: Normative data during walking
GAIT & POSTURE
Autore/i: Di Nardo, Francesco; Strazza, Annachiara; Mengarelli, Alessandro; Ercolani, Serena; Morgoni, Nicole; Burattini, Laura; Agostini, Valentina; Knaflitz, Marco; Fioretti, Sandro
Classificazione: 1 Contributo su Rivista
Abstract: Muscle co-contractions are particularly relevant in analyzing children pathologies. To interpret surface electromyography (sEMG) in pathological conditions, reliable normative data in non-pathological children are required for direct comparison. Aim of the study was the quantification of co-contraction activity between quadriceps femoris (QF) and hamstring muscles during walking in healthy children. To this aim, Statistical gait analysis was performed on sEMG signals from rectus femoris (RF), vastus medialis (VM), and lateral hamstrings (LH), in 16401 strides walked by 100 healthy school-age children. Co-contractions were assessed as overlapping period between activation intervals of considered muscles. Results showed full superimpositions of LH with both RF and VL activity from terminal swing, 80–100% of gait cycle, to successive loading response (0–15% of gait cycle), in around 90% of strides, as reported in adults. This indicates that children regularly use a cocontraction activity between QF and hamstring muscles in weight acceptance during walking, supporting the hypothesis of a regulatory role of co-contraction in providing knee joint stability. Concomitant activity of QF and hamstring muscles was detected also during push-off phase (30–50% of gait cycle), showing a large variability intra and inter subjects and a lower occurrence frequency (around 25% of strides). This could be intended for controlling rapid knee flexion and/or stabilizing pelvis during body progression. Present findings represent the first attempt to provide normative sEMG dataset on variability of QF and hamstring muscles co-contractions during child walking, useful for discriminating physiological and pathological behavior and for designing future studies on maturation of gait.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/252424 Collegamento a IRIS

2018 Detection of surface-EMG activity from the extensor digitorum brevis muscle in healthy children walking
PHYSIOLOGICAL MEASUREMENT
Autore/i: Di Nardo, Francesco; Strazza, Annachiara; Palmieri, Michela Sara; Mengarelli, Alessandro; Burattini, Laura; Orsini, Ornella; Bortone, Antonio; Fioretti, Sandro
Classificazione: 1 Contributo su Rivista
Abstract: Objective: The purpose of the study was the assessment of activation patterns of the extensor digitorum brevis (EDB) muscle in healthy children, during walking at self-selected speed and cadence. Approach: To this end, statistical gait analysis was performed on surface electromyographic (sEMG) signals of the EDB, in a large number (hundreds) of strides per subject. sEMG data from the tibialis anterior (TA) and gastrocnemius lateralis (GL) were also investigated for comparative purposes. Main results: Results from 23 healthy children showed a large variability in the number of muscle activations, occurrence frequency, and onset-offset instants across considered strides. The assessment of different modalities of muscle activation allowed the identification of a single activity pattern, common to all the modalities and we were able to characterize the behavior of the EDB during the gait of healthy children. The pattern of EDB activity centered in two main regions of the gait cycle: in the second half of the stance phase (detected in 100% of subjects) and in the final swing phase (50%). Comparison with the TA and GL regions of activity suggested that the EDB and TA worked mainly as antagonist muscles for the ankle joint, while the EDB and GL did not oppose each other in action, but acted in synergy for the control of the ankle joint during walking. Significance: The 'Normality' pattern for the EDB activity reported here represents the first attempt to develop a reference for dynamic sEMG of the EDB in healthy children, enabling us to include the physiological variability of the phenomenon. Present results could be useful for discriminating physiological and pathological behavior in children and for deepening the maturation of the gait.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/253158 Collegamento a IRIS

2018 A time-frequency approach for the assessment of dynamic muscle co-contractions
IFMBE Proceedings
Autore/i: Strazza, A.; Verdini, F.; Mengarelli, A.; Cardarelli, S.; Burattini, L.; Fioretti, S.; Di Nardo, F.
Editore: Springer Verlag
Classificazione: 2 Contributo in Volume
Abstract: Co-contraction is defined as the activity of agonist and antagonist muscles around a joint, enhancing stability and balance. The quantitative assessment of muscle co-contractions would be meaningful for deepening the comprehension of this physiological mechanism. Thus, the purpose of this work is to quantify muscle co-contraction using energy localization in time-frequency domain of sEMG signal during straight walking. To this purpose, sEMG from tibialis anterior (TA) and gastrocnemius lateralis (GL) and basographic signals were acquired in five healthy subjects during walking. Basographic signals were analyzed to quantify foot-floor contact. sEMG signals were processed using Wavelet Transform (WT) to identify muscular co-contractions, according to the following steps. Daubechies (order 4 with 6 levels of decomposition) was chosen as mother wavelet. A denoising algorithm based on Daubechies mother wavelet was applied for removing noise from raw signals. Denoised signals were decomposed into WT coefficients with different frequency content, and then recombined to achieve the co-scalogram function, a localized statistical assessment of cross-energy density between signals. The localization of regions with maximum cross-energy density provided the assessment of co-contractions in time-frequency domain. This methodology applied to TA and GL signals was able to detect GL/TA co-contractions during mid-stance (30–34% of GC) phase, matching with literature. Moreover, WT approach was able to provide also the frequency band of information content for muscle co-contractions: 65–164 Hz. In conclusion, this study proposed WT cross-energy density as a reliable estimation of muscle co-contraction in time-frequency domain.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/260829 Collegamento a IRIS

2018 Are extensor digitorum brevis and gastrocnemius working together? Surface EMG analysis in healthy children
IFMBE Proceedings
Autore/i: Di Nardo, F.; Strazza, A.; Mengarelli, A.; Cardarelli, S.; Burattini, L.; Verdini, F.; Fioretti, S.
Editore: Springer Verlag
Classificazione: 2 Contributo in Volume
Abstract: A relationship between intrinsic and extrinsic foot muscles is acknowledged during walking. Literature on foot-muscle recruitment in children is not very extensive. Purpose of the study was the surface-EMG-based evaluation of possible concomitant recruitment of intrinsic and extrinsic foot muscles during healthy-children walking. Gastrocnemius lateralis (GL) was analyzed as representative for extrinsic foot muscles (ankle plantar flexor). Extensor digitorum brevis (EDB) is one of the main intrinsic foot muscles, controlling foot movement and stability. In this study, EDB was considered as representative of foot muscles. Surface-EMG signals during 4-min walking trial were acquired in eight healthy school-age children (mean ± SD: age 8.3 ± 1.7 years; height 136 ± 8 cm; mass 30.9 ± 6.2 kg) to fulfill the goal of the study. Then, Statistical gait analysis, a recent methodology performing a statistical characterization of gait, was applied to process EMG data. An exceptional number of strides were analyzed to consider the expected variability (mean ± SD = 265 ± 30 strides for each child, nearly 2500 in total). The research was undertaken in compliance with ethical principles of Helsinki Declaration and approved by institutional expert committee. Results showed that EDB activity is localized in two separate regions of gait cycle: mid-stance (from 8.2 ± 7.0 to 50.3 ± 15.0% of gait cycle) and swing phase, from 73.8 ± 13.8 to 95.1 ± 4.7%. Main GL activity occurred in the same regions: mid-stance (from 5.7 ± 2.5 to 49.7 ± 4.6% of gait cycle) and swing phase, from 69.2 ± 18.7 to 95.4 ± 5.4%. These findings showed that regions of activity of EDB and GL were practically overlapped, suggesting that EDB and GL worked synergistically for foot and ankle-joint control in children walking, in a large percentage of strides. Present study produced novel data on the variability of the reciprocal role of EDB and GL during children walking, providing a deeper insight in mechanisms regulating ankle-foot stability.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/260833 Collegamento a IRIS

2018 Antagonist activity of extensor digitorum brevis and tibialis anterior during child walking
MeMeA 2018 - 2018 IEEE International Symposium on Medical Measurements and Applications, Proceedings
Autore/i: Strazza, Annachiara; Mengarelli, Alessandro; Burattini, Laura; Fioretti, Sandro; DI NARDO, Francesco
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Synergic and antagonist actions of intrinsic and extrinsic foot muscles are acknowledged during walking of adult people. Conversely, reciprocal role of these muscles in children walking has not been adequately deepened yet. Purpose of the study was the surface-EMG-based evaluation of mutual recruitment of intrinsic and extrinsic foot muscles during healthy-children walking. Extensor digitorum brevis (EDB) is one of the main intrinsic foot muscles, controlling foot movement and stability. In this study, EDB and tibialis anterior (TA) were considered as representative of intrinsic and extrinsic foot muscles, respectively. Surface-EMG signals during 4-minute walking trial were acquired in eight healthy school-age children (mean±SD: age 8.3±1.7 years; height 136±8 cm; mass 30.9±6.2 kg) to fulfill the goal of the study. Then, Statistical gait analysis, a recent methodology performing a statistical characterization of gait, was applied to process EMG data. Data from an exceptional number of strides were acquired and analyzed to consider the expected variability (mean±SD = 265±30 strides for each child, nearly 2500 in total). Results showed that: 1) the most frequent recruitment of EDB muscle occurred between 25% and 55% of gait cycle, i.e. in Flat foot contact and Push off phases; 2) the most frequent recruitment of TA occurred from 55% to following 10% of gait cycle, i.e. during Swing and Heel strike phases. This indicated that the most significant EDB activity overlapped the region of no activity (or infrequent activity) for TA and vice versa. In conclusion, present study suggests that TA and EDB muscles acted mainly as antagonist muscles for foot/ankle-joint movement during children walking. These findings highlighted the need of measuring the mutual activity of extrinsic vs. intrinsic foot muscles as tool for a deeper understanding of mechanisms regulating ankle-foot stability and as a possible marker of pathology of neuro-muscular system.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/260824 Collegamento a IRIS

2018 Gait asymmetry in winters group I hemiplegic children: Role of tibialis anterior
IFMBE Proceedings
Autore/i: Di Nardo, F; Mengarelli, A.; Strazza, A.; Verdini, F.; Cardarelli, S.; Burattini, L.; Fioretti, S.
Editore: Springer Verlag
Classificazione: 2 Contributo in Volume
Abstract: Hemiplegia is a neurological disorder that occurs quite often in children, affecting up to one child in one thousand. Typically, only one side of the body is affected by hemiplegia, while the other side is maintaining an apparently normal behavior. Purpose of present analysis was assessing gait asymmetry in group I (W1) hemiplegic children according to Winters classification, where W1 is characterized by presence of drop foot in swing in the hemiplegic side. Asymmetry was quantified by differences between hemiplegic and non-hemiplegic side in terms of foot-floor contact and electromyographic (EMG) activity. Surface EMG from tibialis anterior (TA) and foot-floor contact data were acquired in ten hemiplegic W1 children during walking to fulfill this aim. An exceptional number of strides was analyzed to consider the data variability, expected in W1 (mean ± SD = 287 ± 62 strides for each child, more than 3000 in total). Statistical gait analysis, a recent methodology performing a statistical characterization of gait, was applied to process EMG data. The research was undertaken in compliance with ethical principles of Helsinki Declaration and approved by institutional expert committee. Results showed that asymmetries were detected in basographic data: W1 children showed a significant decrease (p < 0.05) of strides with normal foot-floor contact (HFPS sequence: heel contact, flat-foot contact, push-off, swing) in hemiplegic side with respect to non-hemiplegic side. Also, TA recruitment presented asymmetries during walking, characterized by a curtailed, less frequent activity (p < 0.05) during terminal swing and a lack of activity at heel strike in hemiplegic side, with respect to non-hemiplegic side. In conclusion, present study suggested that walking in W1 children is characterized by asymmetries in both foot-floor contact patterns and TA recruitment.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/260831 Collegamento a IRIS

2018 Validity of the Nintendo Wii Balance Board for the Assessment of Balance Measures in the Functional Reach Test
IEEE TRANSACTIONS ON NEURAL SYSTEMS AND REHABILITATION ENGINEERING
Autore/i: Mengarelli, Alessandro; Cardarelli, Stefano; Strazza, Annachiara; Di Nardo, Francesco; Fioretti, Sandro; Verdini, Federica
Classificazione: 1 Contributo su Rivista
Abstract: The functional reach test (FRT) is widely used for assessing dynamic balance stability in elderly and pathological subjects. Force platforms (FPs) represent a fundamental part of the instrumented FRT experimental setup due to the central role of center-of-pressure (COP) displacement in FRT analysis. Recently, the nintendo wii balance board (NBB) has been suggested as a low-cost and reliable device for ground reaction force and COP measurement in poorly dynamic motor tasks. Therefore, this paper aimed to compare NBB-COP data with those obtained from a laboratory-grade platform during FRT. Data from 48 healthy subjects were simultaneously acquired from both devices. FP-COP and NBB-COP trajectories showed a remarkable correlation in both directions (r>0.990) and low root-mean-square error values (1.14 ± 0.88 mm and 0.55 ± 0.28 mm for anterior-posterior and medial-lateral direction). Fixed biases between COP-based parameters did not exceed 2% of the FP outcomes with high consistency throughout the present measurement range (ICC consistency always >0.950). Only the COP mean velocity exhibited a tendency toward proportional errors, which can be adjusted by a calibration of NBB data. Findings of this paper confirmed the NBB validity for COP measurement in a widely used motor task as the functional reach, supporting the feasibility of NBB in research scenarios.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/259193 Collegamento a IRIS

2018 Co-activation patterns of gastrocnemius and quadriceps femoris in controlling the knee joint during walking
JOURNAL OF ELECTROMYOGRAPHY AND KINESIOLOGY
Autore/i: Mengarelli, Alessandro; Gentili, Andrea; Strazza, Annachiara; Burattini, Laura; Fioretti, Sandro; Di Nardo, Francesco
Classificazione: 1 Contributo su Rivista
Abstract: Muscular co-activation is a well-known mechanism for lower limb joint stabilization in both healthy and pathological individuals. This muscular feature appears particularly important for the knee joint, not only during challenging motor tasks such as cutting and landing but also during walking, due to knee cyclic loading. Gastrocnemius acts on the knee joint with a flexor activity and co-activations with quadriceps muscles lead to greater knee ligament strain with respect to an isolated burst of either muscle. Thus, this study aimed to assess possible co-activations between gastrocnemius and quadriceps muscles during walking. Five co-activation periods were assessed: during early stance (identified in 5.7 ± 5.1% of total strides), early and late foot-contact (88.9 ± 8.9% and 8.9 ± 8.2%), push-off (23.9 ± 12.2%) and late swing (29.0 ± 16.1%). Outcomes showed that late foot-contact and swing co-activations could deserve particular attention: in both cases the knee joint was close to the full extension (around 3.5° and 6° respectively) and thus, considering also the anterior tibia translation due to the quadriceps activity, the simultaneous gastrocnemius burst could lead to an enhanced knee ligaments elongation. Findings of this study represent the first attempt to provide a reference knee joint co-activation framework, useful also for further evaluation in cohorts with knee failures.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/260181 Collegamento a IRIS

2018 Ankle muscles co-activation during walking: A gender comparison in adults and children
2017 IEEE Biomedical Circuits and Systems Conference, BioCAS 2017 - Proceedings
Autore/i: Mengarelli, Alessandro; Strazza, Annachiara; Fioretti, Sandro; Burattini, Laura; DI NARDO, Francesco; Agostini, Valentina; Knaflitz, Marco
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The present study aimed to evaluate possible gender-related differences in adults and children co-activation and antagonistic behavior of ankle muscles (Tibialis Anterior and Gastrocnemius) during walking. The statistical gait analysis technique, applied to a total of 40 subjects (20 children and 20 young adults), allowed the statistical description of gait, considering spatial-temporal and electromyography parameters over a large number (hundreds) of consecutive strides per subject. Co-activations were computed as the overlapping periods of muscles bursts, while antagonism occurred when no simultaneous muscular activity was detected. Outcomes showed no significant differences in temporal characteristics of co-activations in children and adults. Evaluating antagonistic and co-contraction activity in terms of number of strides where each pattern happened, i.e. their occurrence frequency, no significant differences were observed between males and females in children, while in adults group co-contraction pattern resulted significantly more recurrent in females with respect to males. Furthermore, the direct comparison between adults and children showed significant differences in the recurrence of both co-activation and antagonist pattern only for males. Results suggested a possible age-related change in males muscular recruitment during walking, which could lead to the gender differences in co-contraction activity observed in adults but not in children.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/260804 Collegamento a IRIS

2018 Position estimation of an IMU placed on Pelvis through meta-heuristically optimised WFLC
IFMBE Proceedings
Autore/i: Cardarelli, Stefano; Verdini, Federica; Mengarelli, Alessandro; Strazza, Annachiara; DI NARDO, Francesco; Burattini, Laura; Fioretti, Sandro
Editore: Springer Verlag
Classificazione: 2 Contributo in Volume
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/260811 Collegamento a IRIS

2018 Role of the visual feedback on balance responses to upright stance perturbations
IFMBE Proceedings
Autore/i: Mengarelli, Alessandro; Cardarelli, Stefano; Fioretti, Sandro; Strazza, Annachiara; Andrea, Tigrini; DI NARDO, Francesco; Burattini, Laura; Verdini, Federica
Editore: Springer Verlag
Classificazione: 2 Contributo in Volume
Abstract: In this study an evaluation of visual feedback on the balance response to upright stance perturbations is proposed. Subjects underwent to base of support translations in backward direction at fixed velocity in an eye-open (EO) and eye-closed (EC) condition. Center of pressure (COP) and center of mass (COM) were acquired, showing a repeatable double-peak shape which mirrors two different response periods: a destabilizing phase and a counterbalancing phase. Thus, COP and COM were analyzed on the basis of their temporal and spatial features. Further, also the angular displacement of lower limb joints, trunk and head were considered and lower limb muscular activity in terms of myoelectric latencies. Results showed several differences in COP and COM based parameters between EO and EC condition. Moreover, angular range variations seemed to indicate a different role of each joint in the two considered sensory conditions, highlighting the switch from an ankle-based strategy (EO condition) to a more complex kinematic strategy (EC condition). Outcomes of this study could add information about: (A) the suitability of considering COP displacement in perturbed posture analyses with sensory deprivation and (B) the significant role of the visual feedback in balance maintenance when a sudden and quasi-impulsive disruption is employed.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/260809 Collegamento a IRIS

2018 Balance assessment during squatting exercise: A comparison between laboratory grade force plate and a commercial, low-cost device
JOURNAL OF BIOMECHANICS
Autore/i: Mengarelli, Alessandro; Verdini, Federica; Cardarelli, Stefano; Di Nardo, Francesco; Burattini, Laura; Fioretti, Sandro
Classificazione: 1 Contributo su Rivista
Abstract: Testing balance through squatting exercise is a central part of many rehabilitation programs and sports and plays also an important role in clinical evaluation of residual motor ability. The assessment of center of pressure (CoP) displacement and its parametrization is commonly used to describe and analyze squat movement and the laboratory-grade force plates (FP) are the gold standard for measuring balance performances from a dynamic view-point. However, the Nintendo Wii Balance Board (NWBB) has been recently proposed as an inexpensive and easily available device for measuring ground reaction force and CoP displacement in standing balance tasks. Thus, this study aimed to compare the NWBB-CoP data with those obtained from a laboratory FP during a dynamic motor task, such as the squat task. CoP data of forty-eight subjects were acquired simultaneously from a NWBB and a FP and the analyses were performed over the descending squatting phase. Outcomes showed a very high correlation (r) and limited root-mean-square differences between CoP trajectories in anterior-posterior (r > 0.99, 1.63 ± 1.27 mm) and medial-lateral (r > 0.98, 1.01 ± 0.75 mm) direction. Spatial parameters computed from CoP displacement and ground reaction force peak presented fixed biases between NWBB and FP. Errors showed a high consistency (standard deviation < 2.4% of the FP outcomes) and a random spread distribution around the mean difference. Mean velocity is the only parameter which exhibited a tendency towards proportional values. Findings of this study suggested the NWBB as a valid device for the assessment and parametrization of CoP displacement during squatting movement.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/256928 Collegamento a IRIS

2018 A sliding mode control model for perturbed upright stance in healthy subjects
IFMBE Proceedings
Autore/i: Mengarelli, Alessandro; Fioretti, Sandro; Orlando, Giuseppe; Cardarelli, Stefano; Fioretti, Ismaele; Marco Paci, Gian; Burattini, Laura; DI NARDO, Francesco; Strazza, Annachiara; Verdini, Federica
Editore: Springer Verlag
Classificazione: 2 Contributo in Volume
Abstract: Human upright stance and balance maintenance in quiet conditions have been extensively evaluated throughout the years. However, relatively less information is available on how the central nervous system (CNS) acts to maintain balance after sudden perturbations of stance. Here, a sliding mode control (SMC) model for the characterization of balance maintenance after external perturbations is proposed. Human stance was modeled as an inverted pendulum (IP), which describes kinematics in the sagittal plane; the choice of a SMC allowed to avoid model linearization, commonly employed when using a single-link IP for bipedal stance modeling, thus providing a more accurate description of the human-stance system dynamics. Model was applied on experimental data obtained from perturbed stance trials consisting of a series of disruptions of the same magnitude. This experimental condition was able to elicit a well-known feature called “habituation rate”, which refers to the subject capacity to self-adapt his/her responses to identical perturbations. SMC parameters were identified through a robust optimization procedure. Results showed limited tracking errors for center of mass displacement. One of the SMC parameters exhibited a clear trend from the first to the last trial, appearing able to quantify the habituation rate effect. The application of such a control model to the non-quiet stance can provide additional information in understanding how the CNS tailors balance responses in different conditions.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/260810 Collegamento a IRIS

2018 Assessment of glucose effectiveness from short IVGTT in individuals with different degrees of glucose tolerance
ACTA DIABETOLOGICA
Autore/i: Morettini, Micaela; DI NARDO, Francesco; Burattini, Laura; Fioretti, Sandro; Christian göbl,  ·; Alexandra kautzky‑willer,  ·; Giovanni pacini,  ·; Andrea tura,  ·
Classificazione: 1 Contributo su Rivista
Abstract: Aims Minimal model analysis of intravenous glucose tolerance test (IVGTT) data represents the reference method to assess insulin sensitivity (SI) and glucose effectiveness (SG) that quantify the insulin-dependent and insulin-independent processes of glucose disappearance, respectively. However, test duration (3 h) and need for modeling expertise limit the applicability of this method. Aim of this study was providing a simple predictor of SG applicable to short test (1 h), as previously done with SI. Methods Three groups of subjects reflecting different glucose tolerance degrees underwent a 3 h IVGTT: subjects with normal glucose tolerance (NGT, n = 164), with defective glucose regulation (DGR, n = 191), and with type 2 diabetes (T2D, n = 39). Minimal model analysis provided reference SG and its components at zero (GEZI) and basal (BIE) insulin. The simple predictor CSG (calculated SG) was described by the formula CSG = α0 + α1 × KG/Gpeak, being KG the glucose disappearance rate (between 10 and 50 min) and Gpeak the maximum of the glucose curve during the test; α0 and α1 coefficients were provided by linear regression analysis. Results CSG and SG showed a markedly significant relationship in the whole dataset (r = 0.72, p < 0.0001) and in the single groups (r = 0.70 in NGT, r = 0.71 in DGR and r = 0.70 in T2D, p < 0.0001 for all); α1 × KG/Gpeak was significantly related to GEZI (r ≥ 0.60). Conclusions The interest for insulin-independent glucose disappearance is increasing, due to the recent availability of SGLT2 pharmacological agents, lowering glycemic levels without requiring insulin action. This study proposes a reliable predictor of SG based on IVGTT lasting 1 h only, and not requiring mathematical modeling skills.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/260624 Collegamento a IRIS

2018 Automatic Identification and Classification of Fetal Heart-Rate Decelerations from Cardiotocographic Recordings
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Sbrollini, Agnese; Carnicelli, Amalia; Massacci, Alessandra; Tomaiuolo, Leonardo; Zara, Tommaso; Marcantoni, Ilaria; Burattini, Luca; Morettini, Micaela; Fioretti, Sandro; Burattini, Laura
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Cardiotocography (CTG) consists in the simultaneous recording of two distinct traces, the fetal heart rate (FHR; bpm) and the maternal uterine contractions (UCs; mmHg). CTG analysis consists in the evaluation of specific features of traces, among which fetal decelerations (DECs) are considered the 'center-stage' since possibly related to fetal distress. DECs are classified based on their duration and occurrence in relation to UCs as prolonged, early, late and variable; each class associates to a specific status of the fetus health. Typically, CTG traces are visually interpreted; however, computerized CTG analysis may overcome subjectivity in CTG interpretation. Thus, this study proposes a new automatic algorithm for computerized identification and classification of DECs. The algorithm was tested on the 552 CTG recordings constituting the 'CTU-CHB intra-partum CTG database' of Physionet. Of these, 470 (85.15%) were found suitable for automatic DECs identification and classification. Overall, 5888 DECs were identified, of which 3255 (55.28%) were classified while the other 2633 (44.72%) remained unclassified due to very strict preliminary classification criteria (now required for avoiding misclassifications). Among the classified DECs, 468 (14.38%) were classified as prolonged, 1498 (46.02%) as early, 32 (0.98%) as late, 1257 (38.62%) as variable. Thus, among the classified DECs, the most common are the early and the variable ones (overall 84.64%), the occurrence of which ranged from 0 to 14 DECs per recording. These findings are in agreement with what reported in literature. In conclusion, the proposed algorithm for automatic DECs identification and classification represents a useful tool for computerized CTG analysis.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/262590 Collegamento a IRIS

2018 Electrocardiogram Derived Respiratory Signal through the Segmented-Beat Modulation Method
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Pambianco, Benedetta; Sbrollini, Agnese; Marcantoni, Ilaria; Morettini, Micaela; Fioretti, Sandro; Burattini, Laura
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Respiration rate and variability are indicators of health-condition changes. In chronic disease management, it is becoming increasingly desirable to use wearable devices in order to minimize invasiveness and maximize comfort. However, not all wearable devices integrate sensors for direct acquisition of respiratory (DAR) signal. In these cases, the breathing extraction can be done through indirect methods, typically from the electrocardiogram (ECG). The aim of the present study is to propose a single-ECG-lead procedure based on the Segmented-Beat Modulation Method (SBMM) as a suitable tool for ECG-derived respiratory (EDR) signal estimation and respiration frequency (RF) identification. Clinical data consisted of combined measurements of two-lead (I and II) ECG and DAR signals from 20 healthy subjects ('CEBS' database by Physionet). Each respiration-affected ECG lead was submitted to a specifically designed SBMMbased procedure for EDR estimation by ECG subtraction. RF from EDR and DAR were identified as the frequency at which the Fourier spectrum has a maximum in the 0.07-1.00 Hz frequency range. Results indicated that mean RF values over the population from EDR signals (0.27 ± 0.09 Hz and 0.27 ± 0.09 Hz from leads I and II, respectively) were not significantly different from that from DAR (0.28 ± 0.09 Hz). Moreover, differences in RF identification (0.01 ± 0.03 Hz and 0.00 ± 0.02 Hz from leads I and II, respectively) were, on average not significantly different from 0. Thus, SBMM-based procedure is robust and accurate for EDR estimation and RF identification.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/262588 Collegamento a IRIS

2018 eCTG: an automatic procedure to extract digital cardiotocographic signals from digital images
COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE
Autore/i: Sbrollini, Agnese; Agostinelli, Angela; Marcantoni, Ilaria; Morettini, Micaela; Burattini, Luca; Di Nardo, Francesco; Fioretti, Sandro; Burattini, Laura
Classificazione: 1 Contributo su Rivista
Abstract: Background and objective: Cardiotocography (CTG), consisting in the simultaneous recording of fetal heart rate (FHR) and maternal uterine contractions (UC), is a popular clinical test to assess fetal health status. Typically, CTG machines provide paper reports that are visually interpreted by clinicians. Consequently, visual CTG interpretation depends on clinician's experience and has a poor reproducibility. The lack of databases containing digital CTG signals has limited number and importance of retrospective studies finalized to set up procedures for automatic CTG analysis that could contrast visual CTG interpretation subjectivity. In order to help overcoming this problem, this study proposes an electronic procedure, termed eCTG, to extract digital CTG signals from digital CTG images, possibly obtainable by scanning paper CTG reports. Methods: eCTG was specifically designed to extract digital CTG signals from digital CTG images. It includes four main steps: pre-processing, Otsu's global thresholding, signal extraction and signal calibration. Its validation was performed by means of the “CTU-UHB Intrapartum Cardiotocography Database” by Physionet, that contains digital signals of 552 CTG recordings. Using MATLAB, each signal was plotted and saved as a digital image that was then submitted to eCTG. Digital CTG signals extracted by eCTG were eventually compared to corresponding signals directly available in the database. Comparison occurred in terms of signal similarity (evaluated by the correlation coefficient ρ and the mean signal error MSE) and clinical features (including FHR baseline and variability; number, amplitude and duration of tachycardia, bradycardia, acceleration and deceleration episodes; number of early, variable, late and prolonged decelerations; and UC number, amplitude, duration and period). Results: The value of ρ between eCTG and reference signals was 0.85 (P < 10−560) for FHR and 0.97 (P < 10−560) for UC. On average, MSE value was 0.00 for both FHR and UC. No CTG feature was found significantly different when measured in eCTG vs. reference signals. Conclusions: eCTG procedure is a promising useful tool to accurately extract digital FHR and UC signals from digital CTG images.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/255236 Collegamento a IRIS

2018 Surface electromyography low-frequency content: Assessment in isometric conditions after electrocardiogram cancellation by the Segmented-Beat Modulation Method
INFORMATICS IN MEDICINE UNLOCKED
Autore/i: Sbrollini, Agnese; Strazza, Annachiara; Candelaresi, Silvia; Marcantoni, Ilaria; Morettini, Micaela; Fioretti, Sandro; Di Nardo, Francesco; Burattini, Laura
Classificazione: 1 Contributo su Rivista
Abstract: Background: Surface electromyography (SEMG) is widely used in clinics for assessing muscle functionality. All procedures proposed for noise reduction alter SEMG spectrum, especially in the low-frequency band (below 30 Hz). Indeed, low-frequency band is generally addressed to motion artifacts and electrocardiogram (ECG) interference without any further investigation on the possibility of SEMG having significant spectral content. The aim of the present study was evaluating SEMG frequency content to understand if low-frequency spectral content is negligible or, on the contrary, represents a significant SEMG portion potentially providing relevant clinical information. Method: Isometric recordings of five muscles (sternocleidomastoideus, erectores spinae at L4, rectus abdominis, rectus femoris and tibialis anterior) were acquired in 10 young healthy voluntary subjects. These recordings were not affected by motion artifacts by construction and were pre-processed by the Segmented-Beat Modulation Method for ECG deletion before performing spectral analysis. Results: Results indicated that SEMG frequency content is muscle and subject dependent. Overall, the 50th[25th;75th] percentiles spectrum median frequency and spectral power below 30 Hz were 74[54; 87] Hz and 18[10; 31] % of total (0–450 Hz) spectral power. Conclusions: Low-frequency spectral content represents a significant SEMG portion and should not be neglected.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/262204 Collegamento a IRIS

2018 Automatic T-Wave Alternans Identification in Indirect and Direct Fetal Electrocardiography
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Marcantoni, Ilaria; Sbrollini, Agnese; Burattini, Luca; Morettini, Micaela; Fioretti, Sandro; Burattini, Laura
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Fetal T-wave alternans (TWA) is a still littleknown marker for severe fetus-heart instabilities and may be related to some currently unjustified fetal deaths. Automatically detecting TWA on direct fetal electrocardiograms (DFECG) means possibility of providing fetuses the right treatment during delivery. Instead, automatically identifying TWA on indirect fetal electrocardiograms (IFECG) means possibility of providing fetuses the right treatment even during pregnancy, when taking actions for outcome improvement is still possible. Moreover, TWA identification from IFECG is noninvasive, and thus safe for both fetuses and mothers. The aim of this work was testing the heart-rate adaptive match filter (HRAMF) for automatic TWA identification in IFECG and comparing HRAMF performance in IFECG against DFECG. To this aim, simultaneously recorded DFECG and IFECG tracings from 5 healthy fetuses were used ('Abdominal and Direct Fetal Electrocardiogram Database' from Physionet). TWA measurements (frequency, mean amplitude, maximum amplitude, and amplitude standard deviation) in IFECG (1.09±0.04 Hz, 11±5 μV, 21±12 μV and 7±3 μV) were of the same order of magnitude of those in DFECG (1.07±0.02 Hz, 9±2 μV, 30±11 μV and 6±2 μV). Moreover, a direct correlation (ñ) was found between maximum TWA and fetal heart rate (IFECG: ρ=0.999; P=0.022; DEFEG: ρ=0.642; P=0.243). Thus, HRAMF was able to detect TWA from IFECG as well as from DFECG.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/262587 Collegamento a IRIS

2018 PCG-Delineator: an Efficient Algorithm for Automatic Heart Sounds Detection in Fetal Phonocardiography
Computing in Cardiology
Autore/i: Strazza, Annachiara; Sbrollini, Agnese; di Battista, Valeria; Ricci, Rita; Trillini, Letizia; Marcantoni, Ilaria; Morettini, Micaela; Fioretti, Sandro; Burattini, Laura
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Fetal phonocardiography (FPCG) is a non-invasive electronic recording of the acoustic cardiac signals. Unfortunately, FPCG is hidden by high-amplitude noise which makes detection of FPCG waveforms challenging. Aim of the study is to propose PCG-Delineator as an algorithm for automatic detection of the first and second heart sound (S1 and S2, respectively) from FPCG. To this aim, 37 simulated FPCG tracings (Physionet) are filtered by a wavelet-based procedure (4th order Coiflets mother wavelet with 7 decomposition levels) to erase noise. Successively, S1 and S2 are detected. S1 detection procedure is threshold-based (threshold=30% of the filtered FPCG signal maximum amplitude), under the condition that 40ms separate two consecutive S1 sounds. S2 detection procedure is also threshold-based, but under the conditions that S2 has to fall 100ms after preceding S1 and 200ms before successive S1, and that S2 has to have an amplitude lower than 80% that of preceding S1. Sensitivity (SE) and positive predictive values (PPV) were computed. Results indicate that PCG-Delineator was able to reduce noise (our SNR: from -1.1÷7.4dB to 12.9÷17.9dB; P<10-14) and to accurately detect both S1 (SE: 88%; PPV: 91%) and S2 (SE: 77%; PPV:99%). In conclusion, PCG-Delineator is an efficient algorithm for automatic heart sounds detection in FPCG.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/264730 Collegamento a IRIS

2017 Is child walking conditioned by gender? Surface EMG patterns in female and male children
GAIT & POSTURE
Autore/i: Di Nardo, Francesco; Laureati, Giulio; Strazza, Annachiara; Mengarelli, Alessandro; Burattini, Laura; Agostini, Valentina; Nascimbeni, Alberto; Knaflitz, Marco; Fioretti, Sandro
Classificazione: 1 Contributo su Rivista
Abstract: EMG-based differences between females and males during walking are generally acknowledged in adults. Aim of the study was the quantification of possible gender differences in myoelectric activity of gastrocnemius lateralis (GL) and tibialis anterior (TA) during walking in school-age children. Gender-related comparison with adults was also provided to get possible novel insight in maturation of gait. To this aim, Statistical gait analysis, a recent methodology performing a statistical characterization of gait by averaging spatial-temporal and surface-EMG-based parameters over hundreds of strides, was performed in100 healthy school-age children (C-group) and in 33 healthy young adults (YA-group). On average, 301±110 consecutive strides were analyzed for each subject. In C-group, no significant differences (p>0.05) were observed between females and males in GL and TA, considering mean onset/offset instants of activation and occurrence frequency. Stratifying the C-group for age, small differences between females and males in occurrence frequency of GL arose in oldest children. In YA-group, females showed a significant propensity for a more complex recruitment of TA and GL (higher number of activations during gait cycle, quantified by occurrence frequency) compared to males. These outcomes suggest that gender-related differences in sEMG parameters do not characterize the recruitment of GL and TA during child walking in early years (6-8 years), start occurring when adolescence is approaching (10-12 years), and are acknowledged in both ankle muscles only in adults. Present findings seem to support previous studies on maturation of gait which indicate adolescence as the time-range where gait is completing its maturation path.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/245755 Collegamento a IRIS

2017 Co-contraction activity of ankle muscles during walking: A gender comparison
BIOMEDICAL SIGNAL PROCESSING AND CONTROL
Autore/i: Mengarelli, Alessandro; Maranesi, Elvira; Burattini, Laura; Fioretti, Sandro; Di Nardo, Francesco
Classificazione: 1 Contributo su Rivista
Abstract: The study aimed to assess possible differences between healthy, young males and females in co-contraction activity of tibialis anterior and gastrocnemius lateralis during gait at self-selected speed and cadence. The Statistical-Gait-Analysis methodology, allowing a statistical characterization of gait by averaging spatial-temporal and sEMG-based parameters over hundreds of strides per walking trial, was applied on thirty age-matched subjects: 15 males and 15 females. Co-contractions were assessed as the overlapping periods between muscular activities. Results showed the occurrence of four different co-contractions during gait cycle, for both groups. No significant differences in activation instants (ON-OFF) were detected between groups. Otherwise, all the co-contractions occurred in higher number of strides (%) in females, respect to males: in early stance (40.7 ± 18.7% vs. 18.9 ± 11.0%, p < 0.001), mid-stance (41.5 ± 15.2% vs. 26.0 ± 22.8%, p < 0.005), pre-swing (16.6 ± 7.3% vs. 7.1 ± 4.7%, p < 0.001), and swing (79.4 ± 13.7% vs. 55.6 ± 19.3%, p < 0.001). This overall higher occurrence of ankle-muscle co-contractions, associated to a more complex muscular recruitment, seems to reflect a female need for a higher level of ankle-joint stabilization. Thus, present findings indicated gender as a not negligible factor in the interpretation of muscular co-contraction variability during walking and suggested the suitability of gender-based approaches in clinical studies and in developing reference frameworks.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/241694 Collegamento a IRIS

2017 Acellular dermal matrix and heel reconstruction: a new prospective
JOURNAL OF APPLIED BIOMATERIALS & FUNCTIONAL MATERIALS
Autore/i: Scalise, Alessandro; Torresetti, Matteo; Verdini, Federica; Capecci, Marianna; Andrenelli, Elisa; Mengarelli, Alessandro; Ceravolo, Maria Gabriella; Fioretti, Sandro; Di Benedetto, Giovanni
Classificazione: 1 Contributo su Rivista
Abstract: Heel reconstruction represents a challenge for all plastic surgeons due to the anatomical and functional features of this weight-bearing area. In the last decade a combined use of acellular dermal matrices and skin grafts has been proposed as a reliable and less invasive alternative for complex wound management; nevertheless only a few cases have been reported in the literature.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/249780 Collegamento a IRIS

2017 Surface-EMG analysis for the quantification of thigh muscle dynamic co-contractions during normal gait
GAIT & POSTURE
Autore/i: Strazza, Annachiara; Mengarelli, Alessandro; Fioretti, Sandro; Burattini, Laura; Agostini, Valentina; Knaflitz, Marco; Di Nardo, Francesco
Classificazione: 1 Contributo su Rivista
Abstract: The research purpose was to quantify the co-contraction patterns of quadriceps femoris (QF) vs. hamstring muscles during free walking, in terms of onset-offset muscular activation, excitation intensity, and occurrence frequency. Statistical gait analysis was performed on surface-EMG signals from vastus lateralis (VL), rectus femoris (RF), and medial hamstrings (MH), in 16315 strides walked by 30 healthy young adults. Results showed full superimpositions of MH with both VL and RF activity from terminal swing, 80 to 100% of gait cycle (GC), to the successive loading response (≈0–15% of GC), in around 90% of the considered strides. A further superimposition was detected during the push-off phase both between VL and MH activation intervals (38.6 ± 12.8% to 44.1 ± 9.6% of GC) in 21.9 ± 13.6% of strides, and between RF and MH activation intervals (45.9 ± 5.3% to 50.7 ± 9.7 of GC) in 32.7 ± 15.1% of strides. These findings led to identify three different co-contractions among QF and hamstring muscles during able-bodied walking: in early stance (in ≈90% of strides), in push-off (in 25–30% of strides) and in terminal swing (in ≈90% of strides). The co-contraction in terminal swing is the one with the highest levels of muscle excitation intensity. To our knowledge, this analysis represents the first attempt for quantification of QF/hamstring muscles co-contraction in young healthy subjects during normal gait, able to include the physiological variability of the phenomenon.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/240027 Collegamento a IRIS

2017 IVGTT-based simple assessment of glucose tolerance in the Zucker fatty rat: Validation against minimal models
PLOS ONE
Autore/i: Morettini, Micaela; Faelli, Emanuela; Perasso, Luisa; Fioretti, Sandro; Burattini, Laura; Ruggeri, Piero; Di Nardo, Francesco
Classificazione: 1 Contributo su Rivista
Abstract: For the assessment of glucose tolerance from IVGTT data in Zucker rat, minimal model methodology is reliable but time- and money-consuming. This study aimed to validate for the first time in Zucker rat, simple surrogate indexes of insulin sensitivity and secretion against the glucose-minimal-model insulin sensitivity index (SI) and against first- (φ1) and second-phase (φ2) β-cell responsiveness indexes provided by C-peptide minimal model. Validation of the surrogate insulin sensitivity index (ISI) and of two sets of coupled insulinbased indexes for insulin secretion, differing from the cut-off point between phases (FPIR3- SPIR3, t = 3 min and FPIR5- SPIR5, t = 5 min), was carried out in a population of ten Zucker fatty rats (ZFR) and ten Zucker lean rats (ZLR). Considering the whole rat population (ZLR+ZFR), ISI showed a significant strong correlation with SI (Spearman's correlation coefficient, r = 0.88; P<0.001). Both FPIR3 and FPIR5 showed a significant (P<0.001) strong correlation with φ1 (r = 0.76 and r = 0.75, respectively). Both SPIR3 and SPIR5 showed a significant (P<0.001) strong correlation with φ2 (r = 0.85 and r = 0.83, respectively). ISI is able to detect (P<0.001) the well-recognized reduction in insulin sensitivity in ZFRs, compared to ZLRs. The insulin-based indexes of insulin secretion are able to detect in ZFRs (P<0.001) the compensatory increase of first- and second-phase secretion, associated to the insulinresistant state. The ability of the surrogate indexes in describing glucose tolerance in the ZFRs was confirmed by the Disposition Index analysis. The model-based validation performed in the present study supports the utilization of low-cost, insulin-based indexes for the assessment of glucose tolerance in Zucker rat, reliable animal model of human metabolic syndrome.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/245897 Collegamento a IRIS

2017 A new parameter for quantifying the variability of surface electromyographic signals during gait: The occurrence frequency
JOURNAL OF ELECTROMYOGRAPHY AND KINESIOLOGY
Autore/i: DI NARDO, Francesco; Mengarelli, Alessandro; Strazza, Annachiara; Agostini, Valentina; Knaflitz, Marco; Burattini, Laura; Fioretti, Sandro
Classificazione: 1 Contributo su Rivista
Abstract: Natural variability of myoelectric activity during walking was recently analyzed considering hundreds of strides. This allowed assessing a parameter seldom considered in classic surface EMG (sEMG) studies: the occurrence frequency, defined as the frequency each muscle activation occurs with, quantified by the number of strides when a muscle is recruited with that specific activation modality. Aim of present study was to propose the occurrence frequency as a new parameter for assessing sEMG-signal variability during walking. Aim was addressed by processing sEMG signals acquired from Gastrocnemius Lateralis, Tibialis Anterior, Rectus Femoris and Biceps femoris in 40 healthy subjects in order to: (1) show that occurrence frequency is not correlated with ON/OFF instants (Rmean = 0.11 ± 0.07; P > 0.05) and total time of activation (Rmean = 0.15 ± 0.08; P > 0.05); (2) confirm the above results by two handy examples of application (analysis of gender and age) which highlighted that significant (P < 0.05) gender-related and age-related differences within population were detected in occurrence frequency, but not in temporal sEMG parameters. In conclusion, present study demonstrated that occurrence frequency is able to provide further information, besides those supplied by classical temporal sEMG parameters and thus it is suitable to complement them in the evaluation of variability of myoelectric activity during walking.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/250212 Collegamento a IRIS

2017 Heart Rate Detection Using Microsoft Kinect: Validation and Comparison to Wearable Devices
SENSORS
Autore/i: Gambi, Ennio; Agostinelli, Angela; Belli, Alberto; Burattini, Laura; Cippitelli, Enea; Fioretti, Sandro; Pierleoni, Paola; Ricciuti, Manola; Sbrollini, Agnese; Spinsante, Susanna
Classificazione: 1 Contributo su Rivista
Abstract: Contactless detection is one of the new frontiers of technological innovation in the field of healthcare, enabling unobtrusive measurements of biomedical parameters. Compared to conventional methods for Heart Rate (HR) detection that employ expensive and/or uncomfortable devices, such as the Electrocardiograph (ECG) or pulse oximeter, contactless HR detection offers fast and continuous monitoring of heart activities and provides support for clinical analysis without the need for the user to wear a device. This paper presents a validation study for a contactless HR estimation method exploiting RGB (Red, Green, Blue) data from a Microsoft Kinect v2 device. This method, based on Eulerian Video Magnification (EVM), Photoplethysmography (PPG) and Videoplethysmography (VPG), can achieve performance comparable to classical approaches exploiting wearable systems, under specific test conditions. The output given by a Holter, which represents the gold-standard device used in the test for ECG extraction, is considered as the ground-truth, while a comparison with a commercial smartwatch is also included. The validation process is conducted with two modalities that differ for the availability of a priori knowledge about the subjects' normal HR. The two test modalities provide different results. In particular, the HR estimation differs from the ground-truth by 2% when the knowledge about the subject's lifestyle and his/her HR is considered and by 3.4% if no information about the person is taken into account.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/250486 Collegamento a IRIS

2017 Antagonist thigh-muscle activity in 6-to-8-year-old children assessed by surface EMG during walking
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Di Nardo, Francesco; Strazza, Annachiara; Mengarelli, Alessandro; Ercolani, Serena; Burattini, Laura; Fioretti, Sandro
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Analysis of muscle co-contractions seems to be relevant in the characterization of children pathologies such as spastic cerebral palsy. The aim of the study was the quantification of thigh-muscle co-contractions during walking in healthy children. To this aim, the Statistical Gait Analysis, a recent methodology providing a statistical characterization of gait, was performed on surface EMG signals from Vastus Medialis (VM) and Lateral Hamstrings (LH) in 30 healthy 6-to-8-year-old children. Muscular co-contraction was assessed as the overlapping period between activation intervals of agonist and antagonist muscles. As in adults, VM activity occurring from terminal swing to the following loading response superimposed LH activity in the same percentage of the gait cycle. This co-contraction occurred in order to control knee joint stability during weight acceptance. It was acknowledged in the totality (100 %) of the considered strides. Concomitant activity of VM and LH was detected also in the second half of stance phase in 17.1 ± 4.8 % of the considered strides. Working VM and LH on different joints, this concomitant activity of antagonist muscles should not be considered as an actual co-contraction. Present findings provide new information on the variability of the reciprocal role of VM and LH during child walking, useful for comparison between normal and pathological walking in the clinical context and for designing future studies on maturation of gait.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/255429 Collegamento a IRIS

2017 Center of pressure based assessment of balance responses to repeated perturbations of upright stance
IFMBE Proceedings
Autore/i: Mengarelli, A.; Cardarelli, S.; Fioretti, S.; Burattini, L.; Di Nardo, F.; Verdini, F.
Editore: Springer Verlag
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: In this study a description of balance response to sudden external perturbations of the upright posture was performed. To this aim, subjects underwent to a series of translational perturbations at fixed speed in backward and forward direction. Center of pressure (CoP) displacement was analyzed in terms of temporal and spatial characteristics, showing a repeatable waveform which allowed the identification of two main response periods: the destabilizing and the counterbalancing phase. Different control features of balance response have been observed in both phases, with a temporal-based control of CoP displacement in the first phase and an amplitude-based control in the second one. Moreover, the analysis of CoP could be useful to identify the presence of the first trial effect and the habituation rate, two well-known features of perturbed posturography. These findings could contribute to the understanding of balance control in perturbed conditions and suggest CoP as a valuable measure in studying not only the quiet but also the perturbed stance.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/250214 Collegamento a IRIS

2017 T-Wave alternans identification in direct fetal electrocardiography
Computing in Cardiology
Autore/i: Marcantoni, Ilaria; Vagni, Marica; Agostinelli, Angela; Sbrollini, Agnese; Morettini, Micaela; Burattini, Luca; Di Nardo, Francesco; Fioretti, Sandro; Burattini, Laura
Editore: IEEE Computer Society
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Very little is known about the incidence and etiology of fetal T-wave alternans (TWA), an electrophysiologic phenomenon potentially associated to fetal suboptimal outcomes. Thus, availability of automatic methods for quantification of TWA from digital electrocardiograms (ECG) is desirable, since TWA occurrence might indicate the need of taking actions before or during delivery. The heart-rate adaptive match filter (HRAMF) is a wellestablished method to identify TWA in adult ECG. Aim of the present study was to investigate the possibility of using HRAMF to identify and quantify TWA also in direct fetal ECG (DFECG) recordings. To this aim, HRAMF was applied to 5 min-long DFECG acquired during delivery (“Abdominal and Direct Fetal Electrocardiogram Database” by Physionet) of five healthy fetuses. Significant levels of TWA were measured in all DFECG. Specifically, on average, TWA was quite high in amplitude (9±2 µV) and variable in time, as indicated by values of standard deviation (6±2 µV) and maximum (28±10 µV) of TWA amplitude. Eventually, a positive correlation (ρ=0.68) was observed between maximum TWA and fetal heart rate, even though the limited number of recordings makes this result preliminary. In conclusion, HRAMF proved to be a suitable tool to automatically identify TWA from DFECG.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/259390 Collegamento a IRIS

2017 Separation of superimposed electrocardiographic and electromyographic signals
IFMBE Proceedings
Autore/i: Sbrollini, A.; Agostinelli, A.; Morettini, M.; Verdini, F.; Di Nardo, F.; Fioretti, S.; Burattini, L.
Editore: Springer Verlag
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Electrocardiography (ECG) and surface electromyography (SEMG) are two non-invasive tests to evaluate cardiac and muscular functionality, respectively. They are both acquired by placing electrodes on the body surface so they become one the interference of the other. Typically, linear filters are used for ECG and SEMG separation: high-pass filters with cutoff at 20 Hz to attenuate ECG interference in SEMG, and low-pass filters with cut-off at 50 Hz to attenuate SEMG interference in ECG. In spite of that, linear filtering is not adequate due to the presence of a 20-50 Hz frequency-band in which the two signal spectra overlap. The aim of the present study was to evaluate the ability of the Segmented-Beat Modulation Method (SBMM) for ECG and SEMG separation and by accurately maintaining signals characteristics. SBMM is a template-based technique for ECG denoising: under the hypothesis of ECG and SEMG linearly superimposed, it first provides an ECG estimation, and then an SEMG estimation by subtraction. In order to test the method under several conditions, SBMM was applied to simulated as well as clinical recordings with superimposed ECG and SEMG. SBMM was able to accurately estimate both ECG and SEMG in all cases. Indeed, ECG and SEMG were estimated by maintain their features such as amplitude (estimation errors <6%), heart rate and heart-rate variability. Moreover, estimated ECG was always characterized by a spectrum mostly (76.4-100.0%) included in the 0-50 Hz frequency-band, whereas estimated SEMG was always characterized by a spectrum mostly (80.9-95.6%) included in the 20-450 Hz frequency-band. Such results confirm the existence of a 20-50 Hz frequency-band in which ECG and SEMG spectral components are overlapped. Thus, SBMM is a robust filtering procedure to separate superimposed ECG and SEMG.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/250221 Collegamento a IRIS

2017 No changes in glucose effectiveness in condition of reduced insulin action but preserved glucose tolerance as assessed by minimal model analysis
IFMBE Proceedings
Autore/i: Morettini M; Di Nardo, F.; Fioretti, S.; Pacini, G.; Tura, A.; Burattini, L
Editore: Springer Verlag
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Glucose effectiveness (SG) represents the ability of glucose per se, under basal insulin concentrations, to stimulate its own uptake and to suppress its own production. SG and its two components BIE (Basal Insulin Effect) and GEZI (Glucose Effectiveness at Zero Insulin) are known to decline in subjects whose glycemic status worsens, but no study aimed to analyze whether changes may occur even before, when a normal glucose tolerance status is still preserved but insulin resistance has already arisen. To investigate this issue, SG, BIE and GEZI were estimated from the minimal model interpretation of frequently sampled intravenous glucose tolerance (FSIGT) test data in two groups of subjects with normal glucose tolerance (basal glycemia < 5.6 mmol/l): a group of control participants (CNT, n=50) and a group of subjects with pathologies or conditions causing insulin resistance (IR, n=50). No difference in mean values of SG was observed in the IR with respect to the CNT group (2.3 ± 0.9 vs. 2.5 ± 0.9 10-2 min-1; p = 0.17). BIE was found to be the minor component of SG in both CNT and IR group. The GEZI component provided a significantly higher proportional contribution to SG in the IR with respect to CNT (89% vs. 81% of SG, p <0.0001). In proportion, a significantly lower contribution was provided by BIE in IR group (11 ± 1 vs. 18 ± 1, p <0.0001). These results indicate that, at the real starting phase of the process of glucose tolerance impairment (reduced insulin action but normal tolerance), no variation in SG occurs with respect to normality. An increased proportional contribution of GEZI, when BIE declines, may allow the maintenance of normal glucose effectiveness.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/250219 Collegamento a IRIS

2017 Ankle muscles co-activation patterns during normal gait: An amplitude evaluation
IFMBE Proceedings
Autore/i: Cardarelli, S.; Gentili, A.; Mengarelli, A.; Verdini, F.; Fioretti, S.; Burattini, L.; Di Nardo, F
Editore: Springer Verlag
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The objective of this work was to quantify co-activations of ankle muscles during able-bodied walking, in terms of amplitude values of surface electromyographic signal (sEMG). Gastrocnemius lateralis (GL) was analyzed as representative muscles for plantar-flexion. Tibialis anterior (TA) was analyzed as representative muscles for dorsi-flexion. Rudolph’s dynamic co-activation index was computed on the sEMG acquired from 182 strides, with the aim of quantifying the ankle-muscles co-contraction amplitude. Four different co-activations between GL and TA were observed during Heel strike (HS), Foot contact (FC), Push-off (PO), and Swing (SW), respectively. No differences were detected in time-duration of co-contractions detected in the different phases (p<0.05). TA/GL co-contraction activity is more intense in stance phase (especially during HS and FC), where a more intensive muscular control is needed for weight-support and Center of pressure (COP) progression. Co-contractions in swing phase are more frequent but milder. SW co-contraction in adults was pointed out only recently; to our knowledge, the present work is the first that quantifies it in terms of absolute and comparative amplitude. PO seems to be a transitory phase between high-level (HS and FC) and low-level (SW) co-contraction intensity regions. Present findings could be useful for deepening the physiological interpretation of ankle muscles co-activity during walking.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/250216 Collegamento a IRIS

2017 Simple assessment of insulin sensitivity in the zucker rat
IFMBE Proceedings
Autore/i: Morettini, M.; Faelli, E.; Perasso, L.; Fioretti, S.; Burattini, L.; Ruggeri, P.; Di Nardo, F
Editore: Springer Verlag
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The model-based assessment of insulin sensitivity in Zucker rat from Intravenous Glucose Tolerance Test (IVGTT) data is a common procedure. The minimal model methodology provides a very reliable assessment but requires specific competence for running the model. The aim of this study was presenting calculated SI (CSI), as a surrogate index for the simple assessment of insulin sensitivity in the Zucker Rat from IVGTT data. To this aim 25 Zucker Lean Rats (ZLR) and 25 Zucker Fatty Rats (ZFR) were considered. Reference insulin sensitivity (SI) was estimated in each rat through the minimal model methodology. CSI is defined as the ratio between the rate of glucose disappearance (KG) and the mean supra-basal area under the insulin curve during the test (ΔAUCINS), corrected by the proportionality term, α. Regression analysis between SI and KG/ΔAUCINS was performed to identify the α coefficient. Results showed as the computed value of CSI presented a high correlation (r = 0.89, R-square = 0.80 and p < 0.0001, slope ≈1) with SI. Mean value of CSI over the whole population was not significantly different from correspondent SI value (p = 0.17). CSI is able to detect the well-known reduction of insulin sensitivity in the ZFR group (1.0±0.1 vs. 5.0±0.7 min-1/μU·ml-1, p < 0.001), in accordance with the results provided by SI. In conclusion, the present study proposes CSI, as a suitable empiric index for a simple and reliable assessment of insulin sensitivity in Zucker rat and able to provide the same quantitative information of model-based SI.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/250217 Collegamento a IRIS

2017 Fetal phonocardiogram denoising by wavelet transformation: Robustness to noise
Computing in Cardiology
Autore/i: Sbrollini, Agnese; Strazza, Annachiara; Caragiuli, Manila; Mozzoni, Claudia; Tomassini, Selene; Agostinelli, Angela; Morettini, Micaela; Fioretti, Sandro; Di Nardo, Francesco; Burattini, Laura
Editore: IEEE Computer Society
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Fetal phonocardiography (fPCG) is a clinical test to assess fetal wellbeing during pregnancy, labor and delivery. Still, its interpretation may be jeopardized by the presence of noise. Specifically, fPCG is typically corrupted by maternal heart and body organs sounds, fetal movements noise and surrounding environment noise. Thus, appropriate filtering procedures have to be applied in order to make fPCG clinically usable. Wavelet transformation (WT) has been proposed to filter fPCG; however, WT robustness to noise remains unknown. Thus, aim of the present work is to evaluate WT ability and robustness to denoise fPCG characterized by varying signal-to-noise ratios (SNR). To this aim a filtering procedure based on Coiflets mother wavelet (4th order, 7 levels of decomposition) was applied to 37 fPCG simulated tracings, all available in the Simulated Fetal PCGs database by Physionet. Original SNR values ranged from -1.38 dB to 4.54 dB; after application of WT-filtering procedure to fPCG, SNR increased significantly, ranging from 12.95 dB to 17.94 dB (P<10- 14). Moreover, SNR values before and after filtering were associated by a low correlation (ρ=0.4; P=0.01). Eventually, WT filtering introduced no fPCG signal delay and left heart rate unaltered. Thus, WT filtering is a suitable and robust technique to denoise fPCG signals.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/259394 Collegamento a IRIS

2017 Association between accelerations and decelerations of fetal heart rate
IFMBE Proceedings
Autore/i: Agostinelli, A.; Belgiovine, G.; Fiorentino, M.C.; Turri, G.; Sbrollini, A.; Burattini, L.; Morettini, M.; Di Nardo, F.; Fioretti, S.; Burattini, L.
Editore: Springer Verlag
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Cardiotocography (CTG) is the most popular test for establishing the fetal health status. Among its characterizing features there are the fetal heart rate (FHR) accelerations (ACC), usually considered a sign of fetal well-being; and decelerations (DEC), some of which may indicate the risk of fetal hypoxia. Thus, ACC and DEC are usually considered independent phenomena possibly providing opposite information on the fetus clinical status. CTG is typically analyzed by visual inspection; still a computerized analysis may provide a more objective CTG interpretation and precise ACC and DEC characterization. Aim of the present study is to propose an automatic procedure for ACC and DEC identification and characterization, and to investigate a potential relationship between their occurrence. The 552 tracings of the Physionet “CTU-CHB intra-partum CTG database” were analyzed according to a procedure that includes: FHR pre-processing; 20 min windowing; baseline estimation; and ACC and DEC identification and characterization. Specifically, ACC and DEC were defined as FHR deviations from baseline of at least 15 bpm for at least 15 s and then characterized in terms of length (s), amplitude (bpm) and area (length·amplitude; bpm·s). Only 383 (69.4%) CTG recordings showed sufficiently good FHR signal quality to be enrolled in the study. Number of DEC per window was significantly higher than ACC (4.0 vs 2.5; P<10-14). DEC were characterized by a comparable length but higher amplitude and area than ACC (LNG: 56 s vs 61 s, P=0.2573; AMP: 12 bpm vs 10 bpm, P<10-11; AREA: 688 s·bpm vs 618 s·bpm, P=0.0032). DEC total area in a 20-min window was higher than that of ACC (3074 s·bpm vs 2007 s·bpm, P<10-9), but such areas were also strictly correlated (ρ=0.72; P<10-62). Thus, in a CTG recording, ACC and DEC are not independent phenomena but their occurrence is strictly associated.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/250213 Collegamento a IRIS

2017 Noninvasive Fetal Electrocardiography Part II: Segmented-Beat Modulation Method for Signal Denoising
THE OPEN BIOMEDICAL ENGINEERING JOURNAL
Autore/i: Agostinelli, Angela; Sbrollini, Agnese; Burattini, Luca; Fioretti, Sandro; Di Nardo, Francesco; Burattini, Laura
Classificazione: 1 Contributo su Rivista
Abstract: Background: Fetal well-being evaluation may be accomplished by monitoring cardiac activity through fetal electrocardiography. Direct fetal electrocardiography (acquired through scalp electrodes) is the gold standard but its invasiveness limits its clinical applicability. Instead, clinical use of indirect fetal electrocardiography (acquired through abdominal electrodes) is limited by its poor signal quality. Objective: Aim of this study was to evaluate the suitability of the Segmented-Beat Modulation Method to denoise indirect fetal electrocardiograms in order to achieve a signal-quality at least comparable to the direct ones. Method: Direct and indirect recordings, simultaneously acquired from 5 pregnant women during labor, were filtered with the Segmented-Beat Modulation Method and correlated in order to assess their morphological correspondence. Signal-to-noise ratio was used to quantify their quality. Results: Amplitude was higher in direct than indirect fetal electrocardiograms (median:104 µVvs. 22 µV; P=7.66·10-4), whereas noise was comparable (median:70 µV vs. 49 µV, P=0.45). Moreover, fetal electrocardiogram amplitude was significantly higher than affecting noise in direct recording (P=3.17·10-2) and significantly in indirect recording (P=1.90·10-3). Consequently, signal-to-noise ratio was initially higher for direct than indirect recordings (median:3.3 dB vs. -2.3 dB; P=3.90·10-3), but became lower after denoising of indirect ones (median:9.6 dB; P=9.84·10-4). Eventually, direct and indirect recordings were highly correlated (median: ρ=0.78; P<10-208), indicating that the two electrocardiograms were morphologically equivalent. Conclusion: Segmented-Beat Modulation Method is particularly useful for denoising of indirect fetal electrocardiogram and may contribute to the spread of this noninvasive technique in the clinical practice.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/246940 Collegamento a IRIS

2017 CaRiSMA 1.0: Cardiac risk self-monitoring assessment
THE OPEN SPORTS SCIENCES JOURNAL
Autore/i: Agostinelli, Angela; Morettini, Micaela; Sbrollini, Agnese; Maranesi, Elvira; Migliorelli, Lucia; Di Nardo, Francesco; Fioretti, Sandro; Burattini, Laura
Classificazione: 1 Contributo su Rivista
Abstract: Background: Sport-related sudden cardiac death (SRSCD) can only be fought through prevention. Objective: The aim of this study is to propose an innovative software application, CaRiSMA 1.0 (Cardiac Risk Self-Monitoring Assessment), as a potential tool to help contrasting SRSCD and educating to a correct training. Methods: CaRiSMA 1.0 analyzes the electrocardiographic and heart-rate (HR) signals acquired during a training session through wearable sensors and provides intuitive graphical outputs consisting of two traffic lights, one related to cardiac health, based on resting QTc (a parameter quantifying the duration of ventricular contraction and subsequent relaxation), and one related to training, based on exercise HR. Safe and worthwhile training sessions have green traffic lights. A red QTc traffic light indicates the need of a medical consultation, whereas a red HR traffic light indicate the need of a reduction of training intensity. By way of example, CaRiSMA 1.0 was applied to sample data acquired in 10 volunteers (age= 27±11 years; males/females 3/7). Results: Two acquisitions (20.0%) were rejected because too noisy, indicating that wearable sensors may record poor quality signals. The QTc traffic light was red in 1 case, indicating that people practicing sport may not be aware of being at risk. The HR traffic light was red in 0 cases. Conclusion: CaRiSMA 1.0 is a software application that, for the first time in the sport context, uses QTc, the most important index of cardiac risk in clinics. Thus, it has the potential for giving a contribution in the fight against SRSCD.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/252423 Collegamento a IRIS

2017 Epidemiology/Genetics
DIABETES
Autore/i: Morettini, Micaela; DI NARDO, Francesco; Burattini, Laura; Fioretti, Sandro; Tura, Andrea; Pacini, Giovanni
Classificazione: 1 Contributo su Rivista
Abstract: Two are the main processes regulating post-challenge glucose uptake: one insulin-dependent, and the other mainly due to glucose disappearance per se (glucose effectiveness, SG, min-1), accounting for 60-80% of the whole disappearance. Aim of this study was providing an easy method for assessing SG with a short IVGTT (regular). Three groups of subjects were considered: CNT (control subjects, with normal glucose tolerance: n=158), PRE (subjects with prediabetes and/or pathologies causing insulin resistance: n=220), and T2D (subjects with type 2 diabetes: n=31). Fasting glucose and insulin (mean±SD) were 4.7±0.6, 4.8±0.9, 5.9±1.0 mmol·L-1 and 8.3±3.8, 12.3±9.3, 11.0±4.3 pmol·L-1, for CNT, PRE, T2D, respectively. Reference SG was assessed by Minimal Model analysis. In all grouped subjects, regression analyses were performed to identify a simple predictor (calculated SG, CSG) of reference SG, yielding CSG=α0+α1·KG/Gpeak, with KG slope of the glucose curve (10-50 min), Gpeak maximum glucose, α0=0.007 and α1=0.141. We found SG=0.022±0.010 min-1 and CSG=0.021±0.007 min-1. CSG showed excellent correlation with SG (r=0.65, p<0.001). Similar results were found in each group (r=0.64, p<0.001 in CNT, r=0.63, p<0.001 in PRE, r=0.75, p<0.001 in T2D). Also, SG and CSG were not significantly different, both in all subjects (p=0.34, paired t-test) and in the single groups (p>0.10). Bland-Altman analysis confirmed the substantial equivalence of the two indices, showing only 5% of samples outside the limits of agreement (both in all subjects and the single groups). When comparing SG and CSG among groups, both indices consistently showed lower values in PRE and T2D compared to CNT (p<0.008 for SG and p<0.0001 for CSG, by ANOVA). In conclusion, the first 50 minutes of the IVGTT are sufficient to yield a reliable estimation of glucose effectiveness through a simple approach, not requiring sophisticated mathematical modeling.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/255420 Collegamento a IRIS

2017 Gait asymmetry in Winters’ group I hemiplegic children
IFMBE Proceedings
Autore/i: Di Nardo, Francesco; Agostini, V.; Strazza, A.; Nascimbeni, A.; Knaflitz, M.; Burattini, L.; Fioretti, S.
Editore: Springer Verlag
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Hemiplegia is a neurological disorder that in children is a common consequence of cerebral palsy. Hemiplegia involves one-half of the body, while the other half is typically not affected. Aim of the study was to evaluate gait asymmetry in Winters’ group I hemiplegic children (W1), by identifying possible differences between hemiplegic and non-hemiplegic side in foot-floor contact and activation patterns of gastrocnemius lateralis (GL). To this aim, basographic and EMG data from 12 hemiplegic cerebral palsy children (Winters’ group I) were analyzed. Gait data from 100 normal developing children were used as reference. Mean decrease (p<0.05) of normal cycles (i.e. normal sequence of gait phases HFPS) and a concomitant increase (p<0.05) of atypical cycles (PFPS) were detected in hemiplegic side of W1, with respect to both non-hemiplegic side and control group. No relevant variations of GL recruitment were observed between hemiplegic and non-hemiplegic side of W1, in terms of muscle activation patterns and occurrence frequency. In conclusion, the study suggested that gait asymmetries detected in W1 lie in foot-floor contact patterns, but not in GL recruitment.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/250215 Collegamento a IRIS

2017 Time-frequency analysis of surface EMG signals for maximum energy localization during walking
IFMBE Proceedings
Autore/i: Strazza, A.; Verdini, F.; Burattini, L.; Fioretti, S.; Di Nardo, F
Editore: Springer Verlag
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The purpose of this work is to assess the maximum energy localization in time-frequency domain of the surface EMG signal of the main lower-limb muscles usually involved in able-bodied walking. The maximum energy localization in time-frequency domain has been identified by means of Continuous Wavelet Transform (CWT), a time-scale analysis method for multiresolution decomposition of continuous-time signals. WT coefficients allowed to reconstruct the scalogram function, providing an estimate of the local time-frequency energy density of a signal. Then, localization of maximum energy density has been identified as the interval in time-frequency where the scalogram is exceeding the 72% of the peak value of energy density in both time and frequency domain. Results showed that the localization of maximum signal energy in time coincided with the region of maximum muscle recruitment during walking. A common frequency band of maximum information content was identified for all muscles between 70 and 160 Hz. These findings could be suitable for both supporting the use of WT for sEMG analysis and providing clinical indications on muscle recruitment during walking.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/250224 Collegamento a IRIS

2017 CTG Analyzer: A graphical user interface for cardiotocography
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Sbrollini, Agnese; Agostinelli, Angela; Burattini, Luca; Morettini, Micaela; Di Nardo, Francesco; Fioretti, Sandro; Burattini, Laura
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Cardiotocography (CTG) is the most commonly used test for establishing the good health of the fetus during pregnancy and labor. CTG consists in the recording of fetal heart rate (FHR; bpm) and maternal uterine contractions (UC; mmHg). FHR is characterized by baseline, baseline variability, tachycardia, bradycardia, acceleration and decelerations. Instead, UC signal is characterized by presence of contractions and contractions period. Such parameters are usually evaluated by visual inspection. However, visual analysis of CTG recordings has a well-demonstrated poor reproducibility, due to the complexity of physiological phenomena affecting fetal heart rhythm and being related to clinician's experience. Computerized tools in support of clinicians represents a possible solution for improving correctness in CTG interpretation. This paper proposes CTG Analyzer as a graphical tool for automatic and objective analysis of CTG tracings. CTG Analyzer was developed under MATLAB®; it is a very intuitive and user friendly graphical user interface. FHR time series and UC signal are represented one under the other, on a grid with reference lines, as usually done for CTG reports printed on paper. Colors help identification of FHR and UC features. Automatic analysis is based on some unchangeable features definitions provided by the FIGO guidelines, and other arbitrary settings whose default values can be changed by the user. Eventually, CTG Analyzer provides a report file listing all the quantitative results of the analysis. Thus, CTG Analyzer represents a potentially useful graphical tool for automatic and objective analysis of CTG tracings.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/255424 Collegamento a IRIS

2017 Statistical baseline assessment in cardiotocography
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Agostinelli, Angela; Braccili, Eleonora; Marchegiani, Enrico; Rosati, Riccardo; Sbrollini, Agnese; Burattini, Luca; Morettini, Micaela; Di Nardo, Francesco; Fioretti, Sandro; Burattini, Laura
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Cardiotocography (CTG) is the most common non-invasive diagnostic technique to evaluate fetal well-being. It consists in the recording of fetal heart rate (FHR; bpm) and maternal uterine contractions. Among the main parameters characterizing FHR, baseline (BL) is fundamental to determine fetal hypoxia and distress. In computerized applications, BL is typically computed as mean FHR±ΔFHR, with ΔFHR=8 bpm or ΔFHR=10 bpm, both values being experimentally fixed. In this context, the present work aims: to propose a statistical procedure for ΔFHR assessment; to quantitatively determine ΔFHR value by applying such procedure to clinical data; and to compare the statistically-determined ΔFHR value against the experimentally-determined ΔFHR values. To these aims, the 552 recordings of the 'CTU-UHB intrapartum CTG database' from Physionet were submitted to an automatic procedure, which consisted in a FHR preprocessing phase and a statistical BL assessment. During preprocessing, FHR time series were divided into 20-min sliding windows, in which missing data were removed by linear interpolation. Only windows with a correction rate lower than 10% were further processed for BL assessment, according to which ΔFHR was computed as FHR standard deviation. Total number of accepted windows was 1192 (38.5%) over 383 recordings (69.4%) with at least an accepted window. Statistically-determined ΔFHR value was 9.7 bpm. Such value was statistically different from 8 bpm (P<10-19) but not from 10 bpm (P=0.16). Thus, ΔFHR=10 bpm is preferable over 8 bpm because both experimentally and statistically validated.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/255427 Collegamento a IRIS

2017 Noninvasive Fetal Electrocardiography Part I: Pan-Tompkins' Algorithm Adaptation to Fetal R-peak Identification
THE OPEN BIOMEDICAL ENGINEERING JOURNAL
Autore/i: Agostinelli, Angela; Marcantoni, Ilaria; Moretti, Elisa; Sbrollini, Agnese; Fioretti, Sandro; Di Nardo, Francesco; Burattini, Laura
Classificazione: 1 Contributo su Rivista
Abstract: Background: Indirect fetal electrocardiography is preferable to direct fetal electrocardiography because of being noninvasive and is applicable also during the end of pregnancy, besides labor. Still, the former is strongly affected by noise so that even R-peak detection (which is essential for fetal heart-rate evaluations and subsequent processing procedures) is challenging. Some fetal studies have applied the Pan-Tompkins’ algorithm that, however, was originally designed for adult applications. Thus, this work evaluated the PanTompkins’ algorithm suitability for fetal applications, and proposed fetal adjustments and optimizations to improve it. Method: Both Pan-Tompkins’ algorithm and its improved version were applied to the “Abdominal and Direct Fetal Electrocardiogram Database” and to the “Noninvasive Fetal Electrocardiography Database” of Physionet. R-peak detection accuracy was quantified by computation of positive-predictive value, sensitivity and F1 score. Results: When applied to “Abdominal and Direct Fetal Electrocardiogram Database”, the accuracy of the improved fetal Pan-Tompkins’ algorithm was significantly higher than the standard (positive-predictive value: 0.94 vs. 0.79; sensitivity: 0.95 vs. 0.80; F1 score: 0.94 vs. 0.79; P<0.05 in all cases) on indirect fetal electrocardiograms, whereas both methods performed similarly on direct fetal electrocardiograms (positive-predictive value, sensitivity and F1 score all close to 1). Improved fetal Pan-Tompkins’ algorithm was found to be superior to the standard also when applied to “Noninvasive Fetal Electrocardiography Database” (positive-predictive value: 0.68 vs. 0.55, P<0.05; sensitivity: 0.56 vs. 0.46, P=0.23; F1 score: 0.60 vs. 0.47, P=0.11). Conclusion: In indirect fetal electrocardiographic applications, improved fetal Pan-Tompkins’ algorithm is to be preferred over the standard, since it provides higher R-peak detection accuracy for heart-rate evaluations and subsequent processing.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/246939 Collegamento a IRIS

2017 Second heart sound onset to identify T-wave offset
Computing in Cardiology
Autore/i: Sbrollini, Agnese; Bartoli, Marta Beghella; Agostinelli, Angela; Morettini, Micaela; Di Nardo, Francesco; Fioretti, Sandro; Burattini, Laura
Editore: IEEE Computer Society
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Phonocardiography (PCG) second heart sound represents aortic-pulmonary valves closure and beginning of isovolumetric relaxation of the ventricles. Electrocardiography (ECG) T wave represents electrical repolarization of the ventricles. Ventricular electrical repolarization is known to drive ventricular mechanical relaxation. Thus, the aim of the present study was to investigate whether, in normal conditions, second heart sound onset (S2on) matches in time T-wave offset (Toff) so that S2on may be used to identify Toff. To this aim, 99 couples of simultaneously recorded short (around 30 s PCG and ECG) signals relative to normal subjects (selected from PhysioNet/CinC Challenge 2016: Training Set A) were analyzed. S2on was identified by application of our newly developed threshold-based algorithm to the median beat of the PCG envelope. Instead, Toff was identified by application of the Laguna and Thakor algorithm to the median ECG beat. Median time-distance (δt) between S2on and Toff was 5 ms (P=0.007). Thus, in normal conditions, S2on and Toff differ on average of 5 ms, whose meaning remain to be defined. Still, 5 ms is included in the Toff identification variability (of the order of tens ms) due to different Toff identification methods and electrocardiographic leads. Consequently, in normal condition, S2on may be used to estimate Toff
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/259389 Collegamento a IRIS

2017 Overnight T-wave alternans in sleep apnea patients
Computing in Cardiology
Autore/i: Burattini, Laura; Ciotti, Ilaria; D'Ignazio, Michela; Miccoli, Alessandro; Agostinelli, Angela; Sbrollini, Agnese; Morettini, Micaela; Di Nardo, Francesco; Fioretti, Sandro
Editore: IEEE Computer Society
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Sleep apnea (SA) is linked to cardiovascular complications and to an increased risk of sudden cardiac death. Microvolt T-wave alternans (TWA) is a noninvasive electrocardiographic (ECG) index of cardiovascular risk; its rate of occurrence in SA patients remains unknown. Thus, this study investigated the occurrence of TWA in SA patients during night. To this aim, overnight ECG recordings of 16 SA patients were analyzed for TWA identification by means of our heart rate adaptive match filter. Results indicate that overnight TWA was characterized by a low mean amplitude (mean TWA: 6±3 µV). However, higher-amplitude transient TWA episodes (max TWA: 29±21 µV) occurred overnight, sometimes when patients were awake (max TWA: 33±18 µV; 56% of cases) and sometimes when patients were sleeping (max TWA: 24±23 µV; 44% of cases with 13%, 19%, 6% and 6% during sleep stage 1, 2, 3 and 4, respectively). In only 3 subjects (19%) TWA peaks occurred during an SA episode: during obstructive apnea with arousal in two cases (max TWA of 7 µV and 17 µV, during stages 1 and 2, respectively) and during hypoapnea with arousal in one case (max TWA of 6 µV while awake). Thus, SA patients show significant transient overnight TWA episodes, not necessarily occurring during a SA episode.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/259391 Collegamento a IRIS

2017 AThrIA: A new adaptive threshold identification algorithm for electrocardiographic P Waves
Computing in Cardiology
Autore/i: Sbrollini, Agnese; Mercanti, Sofia; Agostinelli, Angela; Morettini, Micaela; Di Nardo, Francesco; Fioretti, Sandro; Burattini, Laura
Editore: IEEE Computer Society
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Proposed algorithms for P-wave identification and segmentation usually search for it within a window just before the R peak, thus hypothesizing the presence of at most one P wave, as it is in a normal electrocardiographic (ECG) tracings. In presence of abnormal atrial depolarization, however, there might be no P waves (as in atrial fibrillation) or multiple P waves (as in second- or third-degree atrioventricular blocks). Thus, this study proposes a new Adaptive Threshold Identification Algorithm (AThrIA) for ECG P-waves whose most innovative feature is to look for P waves all along the heartbeat, potentially allowing multiple Pwaves identification. AThrIA ability to identify and segment (finding onset, maximum and offset) P waves was tested in simulated and experimental ECG tracings with no P waves, one P wave and two P waves, respectively. All P waves involved in the study were annotated. Results indicate that AThrIA correctly identified all P waves (no false-negative or false-positive detections). Segmentation errors were 0 ms for the simulated ECG tracings, and no more than 10 ms for the experimental tracings. Thus, AThrIA represents a promising tool for P-wave identification and segmentation in both physiological (one P wave) and pathological (none or multiple P waves) conditions.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/259393 Collegamento a IRIS

2017 Quantification of fetal ST-segment deviations
Computing in Cardiology
Autore/i: Agostinelli, Angela; Di Cosmo, Mariachiara; Sbrollini, Agnese; Burettini, Luca; Morettini, Micaela; Di Nardo, Francesco; Fioretti, Sandro; Burattini, Laura
Editore: IEEE Computer Society
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: By fetal electrocardiogram (FECG) analysis it has been found that changes in the ST segment are associated with acid-base status, and thus fetus health state. Currently, the most popular estimation of fetal STsegment deviations is performed as ratio between T-wave height and QRS-complex amplitude using the STAN monitor. Thus, this evaluation is indirect because not directly derived from measurements on the ST segment. This study proposes a new procedure for an automated direct quantification of fetal ST-segment deviations, which are described in terms of ST-amplitude and STtrend. Particularly, ST-amplitude corresponds to the maximum of the mean amplitude values obtained through a moving-average (15 ms) operation over the ST segment. Instead, ST-trend corresponds to the difference between the ST-segment amplitudes calculated in the first and the last of three intervals in which the ST segment is divided; thus, ST-trend sign indicates a ST-segment elevation (positive sign) or depression (negative sign). The procedure was evaluated on five direct FECG recordings (in https://physionet.org/physiobank/database/adfecgdb/). Mean values (over population) of ST-amplitude and STtrend were 9.6 ± 5.5 μV and 1.4 ± 2.3 μV, respectively. All found values were validated by visual inspection of the magnified FECG plots.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/259395 Collegamento a IRIS

2016 Co-activation periods of gastrocnemius and vastus lateralis during walking evaluated by surface electromyography
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Mengarelli, Alessandro; Strazza, Annachiara; Sbrollini, Agnese; Agostinelli, Angela; Burattini, Laura; Fioretti, Sandro; Di Nardo, Francesco
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: 'In vivo' studies reported that the co-activation of gastrocnemius and quadriceps femoris (QF) muscles produces ACL strain values greater than those caused by an isolated activation of either muscle. Aim of this study was to assess the co-activation of gastrocnemius (lateral head, GL) and vastus lateralis (VL) in healthy and young adults during walking. To this purpose the Statistical Gait Analysis was performed, that allows a characterization of gait considering hundreds of strides belonging to the same walking trial. Three GL/VL co-activations were detected during a single gait cycle: in foot-contact phase, from 6.8±8.5% to 22.9±23.3% of gait cycle, (FC co-activation), in push-off phase, from 33.0±11.9% to 41.5±13.4% (PO co-activation), and in swing phase, from 86.5±6.7% to 93.2±5.9% (SW co-activation). FC co-activation was the most recurrent (in 100% of the strides, P<0.001) and longest (16% of gait cycle) one. Thus, the ACL strain due to the co-activation between GL and VL is longer and more frequently during FC phase, than in all the others gait phases. Moreover, the position of the knee and the amount of the weight-bearing on knee, achieved in this gait phase, suggested that FC co-activation is the one that produces a highest strain value of anterior cruciate ligament (ACL). These findings could help to better understand risk factors of the ACL injuries and to design more focused preventive and rehabilitative strategies.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/245158 Collegamento a IRIS

2016 Frequency-of-occurrence of myoelectric patterns to evaluate gait motor control strategies after hip replacement surgery
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Agostini, Valentina; Di Nardo, Francesco; Fioretti, Sandro; Burattini, Laura; Rosati, Samanta; Balestra, Gabriella; Knaflitz, Marco
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Gait alterations are observed even years after hip replacement surgery. Such long-lasting alterations may arise from a global change of the motor control strategies. The aim of this work is to investigate the changes in gait motor control strategies of patients after hip replacement surgery by analyzing the frequency of occurrence (OF) of myoelectric activation patterns. We studied five lower limb muscles during gait, in hip prosthesis patients and controls. We found that patients adopt a motor control strategy that tends to prefer 'simplified' myoelectric patterns, showing a smaller number of activations within the gait cycle. This altered motor control was present both on the prosthesis and the sound side, and did not improve during the 12-month follow-up. The reduced number of activations is even more evident in lateral hamstrings and gluteus medius, which are the muscles more affected by hip replacement surgery. Furthermore, this study demonstrated that the OF is a sensitive parameter able to discover subtle changes in motor control strategies. Its use can be extended to other studies involving motor coordination, motor learning and motor control adaptations.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/245157 Collegamento a IRIS

2016 A MATLAB-based graphical user interface for the identification of muscular activations from surface electromyography signals
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Mengarelli, Alessandro; Cardarelli, Stefano; Verdini, Federica; Burattini, Laura; Fioretti, Sandro; Di Nardo, Francesco
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: In this paper a graphical user interface (GUI) built in MATLAB® environment is presented. This interactive tool has been developed for the analysis of superficial electromyography (sEMG) signals and in particular for the assessment of the muscle activation time intervals. After the signal import, the tool performs a first analysis in a totally user independent way, providing a reliable computation of the muscular activation sequences. Furthermore, the user has the opportunity to modify each parameter of the on/off identification algorithm implemented in the presented tool. The presence of an user-friendly GUI allows the immediate evaluation of the effects that the modification of every single parameter has on the activation intervals recognition, through the real-time updating and visualization of the muscular activation/deactivation sequences. The possibility to accept the initial signal analysis or to modify the on/off identification with respect to each considered signal, with a real-time visual feedback, makes this GUI-based tool a valuable instrument in clinical, research applications and also in an educational perspective.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/245155 Collegamento a IRIS

2016 Dynamic knee muscle co-contraction quantified during walking
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Strazza, Annachiara; Mengarelli, Alessandro; Agostini, Valentina; Knaflitz, Marco; Burattini, Laura; Fioretti, Sandro; Di Nardo, Francesco
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The purpose of the present study was the quantification of the co-activation patterns of the knee extensor and flexor muscles during walking at self-selected speed and cadence. To this aim, the Statistical Gait Analysis, a recent methodology providing a statistical characterization of gait, was performed on surface EMG signals from Vastus Lateralis (VL) and Medial Hamstrings (MH) in 14 healthy young adult subjects. Muscular co-contraction was assessed as the overlapping period between activation intervals of agonist and antagonist muscles. Superimpositions between VL and MH activity were detected from terminal swing to the following loading response in 100% of the considered strides. This superimposition could be intended as an actual co-contraction of VL and MH, working across the same joint, the knee. It occurs in this gait phase likely in order to assist knee extension, developing muscle tension for weight acceptance during loading response, and to control knee flexion. A further less frequent (28.9±13.6% of the strides, P<0.001) superimposition was detected in terminal stance; this superimposition, however, should not be considered a real co-contraction, because VL and MH work on different joints. These findings have the merit to provide a novel data on the variability of the reciprocal role of VL and MH during walking, allowing a deeper insight in the physiological mechanisms that regulate the knee flexion/extension.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/245159 Collegamento a IRIS

2016 Are the rectus femoris and the vastus lateralis concurrently recruited during walking?
IFMBE Proceedings
Autore/i: Di Nardo, Francesco; Mengarelli, A.; Strazza, A.; Maranesi, E.; Burattini, L.; Fioretti, S.
Editore: Springer Verlag
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The aim of the study was the quantitative assessment of the concomitant recruitment of rectus femoris (RF) and vastus lateralis (VL) in a group of 11 healthy young adults during walking. To this aim, Statistical gait analysis, a recent methodology performing a statistical characterization of gait by averaging spatial-temporal and surface-EMG-based parameters over numerous strides, was performed in each subject. Superimpositions between RF and VL activity were detected from terminal swing to the following loading response in 99.0±25.8% of strides. This superimposition could be intended as a synergic action of the two muscles for controlling weight bearing, to assist knee extension and to control knee flexion. A further infrequent (<5% of the strides) superimposition was detected in mid and terminal stance, suggesting that the two muscles are working on different joints: RF activity could be interpreted as active participation in hip flexion, while VL activity as the main contribution in modulating rapid knee flexion. These findings have the merit to provide a novel data on the variability of the reciprocal role of RF and VL during walking, allowing a deeper insight in the physiological mechanisms that regulate the knee flexion/extension.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236250 Collegamento a IRIS

2016 Heart Rate-Dependent Hysteresis of T-Wave Alternans in Primary Prevention ICD Patients
ANNALS OF NONINVASIVE ELECTROCARDIOLOGY
Autore/i: Burattini, Laura; Man, Sumche; Fioretti, Sandro; Di Nardo, Francesco; Swenne, Cees A.
Classificazione: 1 Contributo su Rivista
Abstract: Background: T-wave alternans (TWA) is usually performed at accelerated heart rates (HR) during exercise, while recovery TWA is typically not analyzed. Consequently, it is still unknown if TWA shows a HR-dependent hysteresis or not. Thus, the aim of the present study was to investigate TWA dependency on HR during both the exercise and recovery phases of an ergometer test, and to evaluate if recovery TWA may contribute to identify subjects at increased risk of arrhythmic events. Methods: Our HR adaptive match filter was used to identify TWA from electrocardiographic recordings acquired during a bicycle ergometer test in 266 patients with implanted cardio-defibrillator. During the 4-year follow-up, 76 patients developed tachycardia or ventricular fibrillation (ICD_Cases) and 190 did not (ICD_Controls). Results: TWA was statistically lower during exercise than recovery for HRs between 75 and 110 bpm (16-21 μV vs 20-27 μV; P < 0.05), and reverse for HRs between 120 and 130 bpm (41-51 μV vs 28 μV; P < 0.05). ICD_Cases and ICD_Controls showed significantly different TWA at 80 bpm (20 μV vs 15 μV; P < 0.05) and 140 bpm (15 μV vs 22 μV; P < 0.05) during exercise, and at 90 bpm (38 μV vs 21 μV; P < 0.05) and 95 bpm (33-24 μV vs 28 μV; P < 0.05) during recovery. Conclusions: TWA shows a HR-dependent hysteresis and there is a different behavior of TWA in ICD_Cases and ICD_Controls groups. Consequently, beside exercise TWA also recovery TWA may contribute to identify subjects at increased risk of arrhythmic events.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236053 Collegamento a IRIS

2016 Estimation of second-phase insulin secretion in the Zucker fatty rat
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Morettini, Micaela; Di Nardo, Francesco; Cogo, Carla E.; Faelli, Emanuela; Fioretti, Sandro; Burattini, Laura; Ruggeri, Piero
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The purpose of the present study was to test the efficacy of the empiric index SPIR (Second-phase Insulin Release) in the quantification of second-phase insulin secretion in the Zucker Fatty Rat. SPIR index is defined as the area under the curve of insulin between 8 and 90 min after an Intravenous Glucose Tolerance Test (IVGTT). The validation of such index was performed against the second-phase β-cell responsiveness index (Φ2) provided by C-peptide minimal model. To this aim, Φ2 and SPIR were simultaneously computed from IVGTT data, measured in six Zucker fatty rats (ZFR), 7-to-9week-old, and seven age-matched Zucker lean rats (ZLR). SPIR index showed a significant linear correlation with Φ2 (Pearson's correlation coefficient, r = 0.91, R-square = 0.82, P<0.001). Moreover, both Φ2 (P<0.001) and SPIR (P<0.001) showed a significant increase, in the ZFRs, compared to control group (ZLR). These findings suggest that the SPIR index is able to provide similar information of Φ2, in the evaluation of the second-phase insulin secretion and of its alteration in Zucker Fatty Rats. Thus, the study proposes the SPIR, as a suitable index for a simple, reliable and low-cost quantification of the second-phase insulin secretion in ZFR.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/245028 Collegamento a IRIS

2016 A markerless system based on smartphones and webcam for the measure of step length, width and duration on treadmill
COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE
Autore/i: Barone, V.; Verdini, F.; Burattini, L.; Di Nardo, F.; Fioretti, S.
Classificazione: 1 Contributo su Rivista
Abstract: Background and objective: A markerless low cost prototype has been developed for the deter-mination of some spatio-temporal parameters of human gait: step-length, step-width andcadence have been considered. Only a smartphone and a high-definition webcam have beenused.Methods: The signals obtained by the accelerometer embedded in the smartphone are usedto recognize the heel strike events, while the feet positions are calculated through imageprocessing of the webcam stream. Step length and width are computed during gait trials ona treadmill at various speeds (3, 4 and 5 km/h).Results: Six subjects have been tested for a total of 504 steps. Results were compared withthose obtained by a stereo-photogrammetric system (Elite, BTS Engineering). The maximumaverage errors were 3.7 cm (5.36%) for the right step length and 1.63 cm (15.16%) for the rightstep width at 5 km/h. The maximum average error for step duration was 0.02 s (1.69%) at5 km/h for the right steps.Conclusion: The system is characterized by a very high level of automation that allows itsuse by non-expert users in non-structured environments. A low cost system able to auto-matically provide a reliable and repeatable evaluation of some gait events and parametersduring treadmill walking, is relevant also from a clinical point of view because it allows theanalysis of hundreds of steps and consequently an analysis of their variability.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/230084 Collegamento a IRIS

2016 A statistical approach to discriminate between non-fallers, rare fallers and frequent fallers in older adults based on posturographic data
CLINICAL BIOMECHANICS
Autore/i: Maranesi, E; Merlo, A.; Fioretti, S.; Zemp, D.D.; Campanini, I.; Quadri, P.
Classificazione: 1 Contributo su Rivista
Abstract: Background Identification of future non-fallers, infrequent and frequent fallers among older people would permit focusing the delivery of prevention programs on selected individuals. Posturographic parameters have been proven to differentiate between non-fallers and frequent fallers, but not between the first group and infrequent fallers. Methods In this study, postural stability with eyes open and closed on both a firm and a compliant surface and while performing a cognitive task was assessed in a consecutive sample of 130 cognitively able elderly, mean age 77(7)years, categorized as non-fallers (N = 67), infrequent fallers (one/two falls, N = 45) and frequent fallers (more than two falls, N = 18) according to their last year fall history. Principal Component Analysis was used to select the most significant features from a set of 17posturographic parameters. Next, variables derived from principal component analysis were used to test, in each task, group differences between the three groups. Findings One parameter based on a combination of a set of Centre of Pressure anterior-posterior variables obtained from the eyes-open on a compliant surface task was statistically different among all groups, thus distinguishing infrequent fallers from both non-fallers (P < 0.05) and frequent fallers (P < 0.05). Interpretation For the first time, a method based on posturographic data to retrospectively discriminate infrequent fallers was obtained. The joint use of both the eyes-open on a compliant surface condition and this new parameter could be used, in a future study, to improve the performance of protocols and to verify the ability of this method to identify new-fallers in elderly without cognitive impairment.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/247622 Collegamento a IRIS

2016 T-Wave Alternans Hysteresis on Heart Rate
Computing in Cardiology 2015
Autore/i: Laura, Burattini; Sumche, Man; Sandro, Fioretti; Francesco, Di Nardo; Cees A, Swenne
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Microvolt T-wave alternans (TWA) increases with heart rate (HR). Thus, TWA is usually analyzed during exercise. However, since TWA during recovery is usually not analyzed, it is not clear if TWA and HR are linked by a one-to-one correspondence, or if it does exist a TWA hysteresis on HR. To investigate such issue TWA was identified in ECG recordings of 266 patients with implanted cardio-defibrillator acquired during a bicycle ergometer test, which included a HR-increasing exercise and a HR-decreasing recovery, both characterized by a HR from 80 to 125 bpm. TWA was always found to have a positive association with HR but, at each HR, exercise TWA was typically different from recovery TWA. Specifically, TWA increased exponentially during exercise (fitting-exponential-curve correlation: ρ=0.99, P<10-7) while decreased linearly during recovery (fittingline correlation: ρ=0.94, P<10-4). The two fitting curves crossed at about 115 bpm, so that for lower HRs (80-110 bpm) exercise TWA was significantly lower than recovery TWA (16-21 µV vs. 22-27 µV; P<0.01), while for higher HRs (120-125 bpm) exercise TWA was significantly higher than recovery TWA (41-51µV vs. 28 µV; P<10-6). Thus, it does exist a TWA hysteresis on HR since TWA does not depend only on the actual value of HR but also on such value being reached during exercise or recovery.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236095 Collegamento a IRIS

2016 Logistic Regression to Enhance Risk Assessment by Left Ventricular Ejection Fraction and f99
Computing in Cardiology 2015
Autore/i: Giuliani, Corrado; Swenne, Cees A; Man, Sumche; Fioretti, Sandro; Di Nardo, Francesco; Burattini, Laura
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Sudden cardiac death remains one of the leading causes of death in developed countries. Left ventricular ejection fraction (LVEF) and f99 are two noninvasive indexes of cardiovascular risk (traditional the former and innovative the latter) which, taken singularly, have not shown sufficiently high SCD predictive power to justify preventive actions. Thus, the aim of the present study was to investigate if their combination improves predictability of ventricular arrhythmias. To this aim, ECG recordings from 266 ICD patients, of which 76 developed ventricular tachycardia or fibrillation during the 4-year follow-up (ICD_Cases), and 190 did not (ICD_Controls). The ECGs of each patient was used to compute the f99, a repolarization index defined as the frequency at which the cumulative power energy reaches 99%. Eventually, a logistic regression between LVEF and f99 was performed in order to derive a combined predictor (CP) of ventricular arrhythmia. Goodness of each index was evaluated in terms of the area under the receiver operator curve (AUC). When used singularly, LVEF and f99 respectively provided an AUC of 0.67 and 0.64. When combined to get CP=-0.15-0.05·LVEF+0.03·f99, this provided an AUC of 0.71. In conclusion, use of logistic regression improves LVEF and f99 predictability of ventricular arrhythmias.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236093 Collegamento a IRIS

2016 Muscle activation patterns related to diabetic neuropathy in elderly subjects: a Functional Reach Test study
CLINICAL BIOMECHANICS
Autore/i: E. MARANESI; F. DI NARDO; R.A. RABINI; G. G. GHETTI; L. BURATTINI; O. MERCANTE; S. FIORETTI
Classificazione: 1 Contributo su Rivista
Abstract: Background. This study was designed to assess, in healthy elderly, non-neuropathic and neuropathic diabetic subjects, the activation patterns of the main muscles involved in the Functional Reach Test, a well-recognised method to identify elderly subjects at risk of balance impairments. Methods. Surface electromyographic analysis of Sternocleidomastoideus, Rectus Abdominis, Erectores Spinae at L4 level, Rectus Femoris, Hamstrings, Tibialis Anterior and Soleus was performed in 10 healthy, 10 diabetic non-neuropathic and 10 diabetic neuropathic subjects. Findings. Results showed that in every group the first motor is Tibialis Anterior, that is recruited before the start of the test. An earlier activation of Tibialis Anterior (p<0.05) was detected in diabetic neuropathic (ON at -24% of the test period), compared with healthy (-11%) and diabetic non-neuropathic (-13%) groups. A significant earlier activation of Sternocleidomastoideus and Rectus Abdominis was found in diabetic neuropathic group, only with respect to healthy subjects. No significant difference was found in Rectus Femoris, Soleus, Hamstrings an Erectores Spinae onset among the three groups. Interpretation. Results suggest a trend of diabetic neuropathic patients in earlier anticipation of the activation of the anterior body-muscles. In particular, the earlier onset of Tibialis Anterior is likely to be performed to adjust the movement timing and to compensate for the delay in the recruitment of the motor units. This anticipation might be involved in the altered postural control with increased balance impairment detected in diabetic neuropathic patients, and thereby it might also be proposed as an index of neuropathy, evidenced in a simple and non-invasive manner.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/228460 Collegamento a IRIS

2016 The surface electromyographic evaluation of the Functional Reach in elderly subjects
JOURNAL OF ELECTROMYOGRAPHY AND KINESIOLOGY
Autore/i: Maranesi, E; Fioretti, S; Ghetti, G G; Rabini, R A; Burattini, L; Mercante, O; Di Nardo, F
Classificazione: 1 Contributo su Rivista
Abstract: This study proposes a comprehensive assessment of myoelectric activity of the main muscles involved in the Functional Reach (FR) test, in 24 elderly subjects. A specific protocol for the surface electromyography (sEMG) signal acquisition during FR-test was developed. Results show that anterior muscles activate following a caudo-cranial order. Tibialis Anterior (TA) is the first to be activated (-18.0±16.3% of the FR-period), together with Rectus Femoris (-10.4±17.9%). Then, Rectus Abdominis (19.7±24.7%) and Sternocleidomastoideus (19.9±15.6%) activate after the FR-start. Hamstrings, Soleus, and L4-level Erectores Spinae (posterior muscles) activate after the FR-start in this order (11.4±16.8%, 17.7±16.6%, and 35.2±29.0%, respectively) and remain active until the movement end. The analysis of the kinematic strategies adopted by subjects revealed an association between TA-activation patterns and two kinematic strategies (hip/mixed strategy), quantified by an increase (p<0.05) of TA-activity duration in subjects adopting the hip strategy (89.9±34.5) vs. subjects adopting the mixed strategy (27.0±16.8). This suggests that TA sEMG activity could be able to discriminate among kinematic strategies, providing different information on balance control. Thus, the present analysis represents the first attempt to quantify the sEMG activity during FR-test in elderly subjects, providing an early contribution in building a reference frame for balance assessment in clinical context.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/230167 Collegamento a IRIS

2016 On the Heart-Rate Signal Provided by the Zephyr BioHarness 3.0
Proceeding of the 8th International workshop on Biosignal Interpretation
Autore/i: Nepi, D.; Agostinelli, A.; Maranesi, E.; Sbrollini, A.; Morettini, M.; Di Nardo, F.; Fioretti, S.; Burattini, L.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The BioHarness 3 system (BH3) by Zephyr is a wearable cardiac sensor specifically designed for training optimization of professional athletes. BH3 records the electrocardiogram (BH3_ECG) and the heart-rate signal (BH3_HRS). Specifically, BH3_HRS is neither the popular tachogram nor the direct not-uniformly sampled heart-rate sequence as function of time. Consequently, the aim of the present study is to gain more insights on BH3_HRS that, if found reliable, would allow a future evaluation of the possibility of a clinical use of the sensor for cardiac risk evaluation. Data were acquired from an amateur athlete (male, 25 years old) during a 5-min rest followed by a 10 min exercise. R-peak detection was performed on BH3_ECG, and the obtained heart-rate signal (HRS) was low-pass filtered using the following six filters: 3-, 4-, and 5-sample averages and 0.30 Hz, 0.35 Hz, and 0.40 Hz 6th order Butterworth low-pass filters. The filtered HRSs were then compared to BH3_HRS in terms of correlation coefficient (ρ), mean square error (MSE), resting heart-rate variability (HRV) and exercise maximum heart rate. Results indicate that the HRS closest to BH3_HRS was obtained with the 3-point average (ρ=0.9688-0.9991, MSE=0.45-0.47 mV2; comparable resting HRV and exercise maximum heart rate).
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/247675 Collegamento a IRIS

2016 Robustness of the Segmented-Beat Modulation Method to Noise
Computing in Cardiology 2015
Autore/i: Angela, Agostinelli; Corrado, Giuliani; Sandro, Fioretti; Francesco, Di Nardo; Laura, Burattini
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Typically, ECG is corrupted by baseline wander (BW), electrode motion artifact (EM) and muscular artifact (MA). To eliminate them, ECG is usually pre-filtered by application of linear techniques which, however, do not remove in-band components which may limit the ECG clinical usefulness if further processing is not performed. The Segmented-Beat Modulation Method (SBMM) is a template-based filtering technique which segments each cardiac beat into QRS and TUP segments, respectively independent and proportional to heart-rate, and adaptively adjusts each reconstructed beat to its original length by modulating and demodulating the TUP segments. The aim of the present study was to evaluate SBMM robustness to noise by applying it to one synthetic and 18 clinical ECG tracings before and after corruption with BW, EM and MA. Results indicate that, in all cases, clean ECGs are estimated with errors <0.15 mV, typically greater in the QRS than in the TUP segments (0123 µV µV vs 0-25 µV; P<10-5). Moreover, MA little affected ECG estimation, while BW and EM caused higher errors especially in the QRS segment which however remained quite small. Thus, the SBMM resulted to be a filtering technique quite robust to noise.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236094 Collegamento a IRIS

2016 Automatic Identification of the Repolarization Endpoint by Computing the Dominant T-wave on a Reduced Number of Leads
THE OPEN BIOMEDICAL ENGINEERING JOURNAL
Autore/i: Giuliani, C.; Agostinelli, A.; Di Nardo, F.; Fioretti, S.; Burattini, L.
Classificazione: 1 Contributo su Rivista
Abstract: Abstract: Electrocardiographic (ECG) T-wave endpoint (Tend) identification suffers lack of reliability due to the presence of noise and variability among leads. Tend identification can be improved by using global repolarization waveforms obtained by combining several leads. The dominant T-wave (DTW) is a global repolarization waveform that proved to improve Tend identification when computed using the 15 (I to III, aVr, aVl, aVf, V1 to V6, X, Y, Z) leads usually available in clinics, of which only 8 (I, II, V1 to V6) are independent. The aim of the present study was to evaluate if the 8 independent leads are sufficient to obtain a DTW which allows a reliable Tend identification. To this aim Tend measures automatically identified from 15-dependent-lead DTWs of 46 control healthy subjects (CHS) and 103 acute myocardial infarction patients (AMIP) were compared with those obtained from 8-independent-lead DTWs. Results indicate that Tend distributions have not statistically different median values (CHS: 340 ms vs. 340 ms, respectively; AMIP: 325 ms vs. 320 ms, respectively), besides being strongly correlated (CHS: ρ=0.97, AMIP: 0.88; P<10-27). Thus, measuring Tend from the 15-dependent-lead DTWs is statistically equivalent to measuring Tend from the 8-independent-lead DTWs. In conclusion, for the clinical purpose of automatic Tend identification from DTW, the 8 independent leads can be used without a statistically significant loss of accuracy but with a significant decrement of computational effort. The lead dependence of 7 out of 15 leads does not introduce a significant bias in the Tend determination from 15 dependent lead DTWs.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/235647 Collegamento a IRIS

2016 Normative EMG patterns of ankle muscle co-contractions in school-age children during gait
GAIT & POSTURE
Autore/i: Di Nardo, Francesco; Mengarelli, Alessandro; Burattini, Laura; Maranesi, Elvira; Agostini, Valentina; Nascimbeni, Alberto; Knaflitz, Marco; Fioretti, Sandro
Classificazione: 1 Contributo su Rivista
Abstract: Purpose: The study was designed to assess the co-contractions of tibialis anterior (TA) and gastrocnemius lateralis (GL) in healthy school-age children during gait at self-selected speed and cadence, in terms of variability of onset-offset muscular activation and occurrence frequency. Methods: Statistical gait analysis, a recent methodology performing a statistical characterization of gait by averaging spatio-temporal and sEMG-based parameters over numerous strides, was performed in 100 healthy children, aged 6-11 years. Co-contractions were assessed as the period of overlap between activation intervals of TA and GL. Results: On average, 165 ± 27 strides were analyzed for each child, resulting in approximately 16,500 strides. Results showed that GL and TA act as pure agonist/antagonists for ankle plantar/dorsiflexion (no co-contractions) in only 19.2 ± 10.4% of strides. In the remaining strides, statistically significant (p < 0.05) co-contractions appear in early stance (46.5 ± 23.0% of the strides), mid-stance (28.8 ± 15.9%), pre-swing (15.2 ± 9.2%), and swing (73.2 ± 22.6%). This significantly increased complexity in muscle recruitment strategy beyond the activation as pure ankle plantar/dorsiflexors, suggests that in healthy children co-contractions are likely functional to further physiological tasks as balance improvement and control of joint stability. Conclusions: This study represents the first attempt for the development in healthy children of a normative dataset for GL/TA co-contractions during gait, achieved on an exceptionally large number of strides in every child and in total. The present reference frame could be useful for discriminating physiological and pathological behavior in children and for designing more focused studies on the maturation of gait.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/234881 Collegamento a IRIS

2016 Validation of the Heart:Rate Signal Provided by the Zephyr BioHarness 3.0
Computing in Cardiology 2016
Autore/i: Nepi, Daniele; Sbrollini, Agnese; Agostinelli, Angela; Maranesi, Elvira; Morettini, Micaela; Di Nardo, Francesco; Fioretti, Sandro; Pierleoni, Paola; Pernini, Luca; Valenti, Simone; Burattini, Laura
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The Zephyr BioHarness 3.0 (BH3) is a popular wearable system specifically designed for training optimization of professional athletes. BH3 provides the electrocardiogram (ECG BH3) and the heart-rate signal (HRSBH3). Aim of this study is to evaluate the reliability of HRSBH3 to assess its clinical applicability to the general population for cardiac-risk evaluations. Data were acquired from 10 healthy subjects (age: 34±17 years) during a 5-minutes rest. Since the tachogram represents the standard signal for studying the heart rate (HR) and its variability, ECG BH3 was elaborated in order to get the tachogram (HRSTG). HRSBH3 and HRSTG were compared in terms of mean HR (MHR, bpm), HR standard deviation (HRSD, bpm) and HRSD error (bpm). HRSBH3 and HRSTG provided comparable MHR (73.07±15.53 bpm vs 72.86±15.57 bpm, respectively) while HRSD by HRSBH3 was significantly lower than HRSD by HRS TG (4.51 ±2.29 bpm vs 5.63±2.99 bpm, respectively; P=0.0043). HRSD error was significantly greater than zero (0.20-3.00 bpm; P=0.0043); moreover, it was strongly correlated to HRSD by HRS TG (p=0.82, P=0.0036). Thus, HRS BH3 is appropriate only for sport applications based on MHR estimations, but not to clinical evaluations based on HRV measurements.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/246953 Collegamento a IRIS

2016 Relationship between Deceleration Areas in the Second Stage of Labor and Neonatal Acidemia
Computing in Cardiology 2016
Autore/i: Agostinelli, Angela; Palmieri, Flavio; Biagini, Alessandra; Sbrollini, Agnese; Burattini, Luca; Di Nardo, Francesco; Fioretti, Sandro; Burattini, Laura
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Understanding the fetal heart rate (FHR) in the second stage of labor is important to recognize critical clinical outcomes. During this time, fetus is subject to head compression that activate baroreceptor reflexes that cause FHR deceleration. Large deceleration areas (DA: measured as duration by depth), have been associated to critical fetal outcomes. A preliminary study on 33 pregnant women reported a significant inverse correlation between DA in the last 60 minutes before delivery and umbilical pH at birth (fetal-distress measure when < 7.1). The aim of this study is to further characterize the relationship between DA in the last 60 minutes before delivery and pH at birth on a larger population. Thus, 433 FHR recordings from the 'CTU-CHB Intrapartum Cardiotocography Database' of Physionet were used. Signals were classified as Cases (pH < 7.1) and Controls (pH > 7.1). Results confirmed that Cases have significantly higher DA than Controls (5.32 cm2 vs 1.44 cm2; P < 0.05). The inverse correlation between DA in the last 60 minutes before delivery and pH at birth, was weak but significant (ρ=-0.23, P<10-6). Thus, results confirm that critical fetal outcomes increase with increasing acidemia; however, such relationship may not be strictly linear. Future studies are focused on discrimination of fetal distress using DA.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/246949 Collegamento a IRIS

2016 Evaluation of the low-frequency components in surface electromyography
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Sbrollini, Agnese; Agostinelli, Angela; Di Nardo, Francesco; Maranesi, Elvira; Mengarelli, Alessandro; Fioretti, Sandro; Burattini, Laura
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The surface electromyogram (SEMG) is a signal noninvasively (through electrodes located on the body surface) acquired for evaluating the electrical activity produced by skeletal muscles. In thoracic acquisitions, SEMG is typically affected by the electrocardiographic (ECG) signal, representing the electrical activity of the heart. SEMG and ECG power spectra mainly fall within 5-450 Hz and 0.05-50 Hz, respectively. Consequently, SEMG and ECG components overlap in the 5-50 Hz range. Although removing SEMG low spectral components, high-pass linear filtering (LF) with a cut-off frequency of 20 Hz remains the standard technique to clean SEMG from ECG. Thus, the aim of the present study was to propose the Segmented Beat Modulation Method (SBMM) as a tool to clean SEMG from ECG without removing SEMG components below 20 Hz. A SEMG recording was first acquired from the left rectus abdominis of a subject, and then filtered using both SBMM and LF. Filtered SEMGs obtained with the two techniques were compared. Results indicate that SBMM eliminates ECG interference from SEMG better than LF, since the latter procedure maintains ECG components between 20 and 50 Hz. In addition, after ECG removal by SBMM, SEMG showed a significant amount of spectral components (up to 20%) in the low-frequency range. Maintaining such low-frequency components, which go lost when applying LF, is desirable since they likely associate to the firing rates of the active motor units. In conclusion, SBMM represents a useful tool to clean SEMG from ECG without loss of frequency components.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/245029 Collegamento a IRIS

2016 Activation pattern of Extensor digitorum brevis muscle during child walking
Proceeding of the 8th International workshop on Biosignal Interpretation
Autore/i: Strazza A; Palmieri MS; Mengarelli A; Fioretti S; Burattini L; Orsini O; Bortone A; Di Nardo F
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The purpose of the study was the assessment of the activation pattern of Extensor digitorum brevis (EDB) muscle in healthy children, during walking at self-selected speed and cadence. To this aim, the Statistical Gait Analysis was performed on surface electromyographic (sEMG) signals, in a large number (hundreds) of strides per subject. Results from eight healthy children showed a large variability in number of muscle activations, occurrence frequency, and onset-offset instants across strides analyzed. The assessment of the different modalities of activation allowed identifying a single activity pattern, common for all the modalities and able to characterize the behavior of EDB during normal gait. The pattern of muscle activity centered in two main regions of the gait cycle: the second half of the stance phase (detected in 100% of the subjects) and in final swing phase (50%). This ‘‘normality’’ pattern represents the first attempt to develop a reference for dynamic sEMG of EDB in healthy children that is able to include the physiological variability of the phenomenon. The present results could be useful for discriminating physiological and pathological behavior in children and for deepening the maturation of gait.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/247674 Collegamento a IRIS

2016 Segmented beat modulation method for electrocardiogram estimation from noisy recordings
MEDICAL ENGINEERING & PHYSICS
Autore/i: Agostinelli, Angela; Sbrollini, Agnese; Giuliani, Corrado; Fioretti, Sandro; Di Nardo, Francesco; Burattini, Laura
Classificazione: 1 Contributo su Rivista
Abstract: Clinical utility of an electrocardiogram (ECG) affected by too high levels of noise such as baseline wanders, electrode motion artifacts, muscular artifacts and power-line interference may be jeopardized if not opportunely processed. Template-based techniques have been proposed for ECG estimation from noisy recordings, but usually they do not reproduce physiological ECG variability, which, however, provides clinically useful information on the patient's health. Thus, this study proposes the Segmented-Beat Modulation Method (SBMM) as a new template-based filtering procedure able to reproduce ECG variability, and assesses SBMM robustness to the aforementioned noises in comparison to a standard template method (STM). SBMM performs a unique ECG segmentation into QRS segment and TUP segment, and successively modulates demodulates (by stretching or compressing) the former segments in order to adaptively adjust each estimated beat to its original morphology and duration. Consequently, SBMM estimates ECG with significantly lower estimation errors than STM when applied to recordings affected by various levels of the considered noises (SBMM: 176-232 mu V and 79-499 mu V; STM: 215-496 mu V and 93-1056 mu V, for QRS and TUP segments, respectively). Thus, SBMM is able to reproduce ECG variability and is more robust to noise than STM.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236052 Collegamento a IRIS

2016 Webcam and smartphone for the measure of spatial-temporal parameters of gait for treadmill use
Lecture Notes in Electrical Engineering
Autore/i: Barone, Vinicio; Verdini, F.; Di Nardo, F.; Maranesi, E.; Burattini, L.; Fioretti, S.
Editore: Springer Verlag
Classificazione: 2 Contributo in Volume
Abstract: First author search in Pubmed(opens in a new window)|View at Publisher| Export | Download | Add to List | More... Lecture Notes in Electrical Engineering Volume 392, 2016, Pages 261-272 International Workshop on Mobile Networks for Biometric Data Analysis, 2014; Ancona; Italy; 30 October 2014 through 31 October 2014; Code 179299 Webcam and smartphone for the measure of spatial-temporal parameters of gait for treadmill use (Conference Paper) Barone, V. , Verdini, F., Di Nardo, F., Maranesi, E., Burattini, L., Fioretti, S. Università Politecnica delle Marche, Ancona, Italy View references (16) Abstract A very low cost prototype has been developed for the spatial and temporal analysis of human movement using an integrated system of last generation smartphones and a high-definition webcam, controlled by a laptop. The system can be used to analyse mainly planar motions in non-structured environments. In this paper, the accelerometer signal captured by the 3D sensor embedded in one smartphone, and the position of coloured markers extracted from the analysis of the webcam frames, are used for the computation of spatial-temporal parameters of gait. The system has been tested on a treadmill at different gait speeds. Accuracy of results is compared with that obtainable by a gold-standard stereometric instrumentation. The system is characterised by a very low cost and a very high level of automation. It has been thought to be used by non-expert users in ambulatory settings.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/240336 Collegamento a IRIS

2016 The relative role of insulin action and secretion in experimental animal models of metabolic syndrome
IFMBE Proceedings
Autore/i: Morettini, M.; Di Nardo, F; Cogo, C.E.; Faelli, E.; Fioretti, S.; Burattini, L.; Ruggeri, P.
Editore: Springer Verlag
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: In the present study we evaluated insulin action and secretion in a group of 7 young Zucker fatty rats (ZFR), and in a group of 8 spontaneously hypertensive rats (SHR), compared with two control groups of 7 young Zucker lean rats (ZLR) and 8 Wistar Kyoto rats (WKY), respectively. Our goal is to broaden the characterization of glucose tolerance, including insulin secretion, in two animal models used for the characterization of human metabolic syndrome: the ZFR and the SHR. Reliable estimates of insulin sensitivity index, SI, was provided by minimal model analysis of IVGTT data. To characterize insulin secretion we calculated an index based on IVGTT data: AIRG, i.e. the acute insulin response after glucose bolus, related to the first phase insulin secretion. The ZFR showed a significantly (p<0.005) lower mean estimate of SI, and a significantly (p<0.001) higher mean value of AIRG, compared to control groups (ZLR and WKY) and hypertensive rats (SHR). Thus, only the ZFR shows a reduced insulin action, compensated only partially by insulin hypersecretion. This suggests obesity, with respect to hypertension, as a primary factor in the deterioration of glucose tolerance. © Springer International Publishing Switzerland 2016.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236267 Collegamento a IRIS

2016 sEMG-based evaluation of muscle recruitment variability during walking in terms of activation length and occurrence frequency
Lecture Notes in Electrical Engineering
Autore/i: Mengarelli, A.; Maranesi, E.; Burattini, L.; Fioretti, S.; Di Nardo, F
Editore: Springer Verlag
Classificazione: 2 Contributo in Volume
Abstract: Surface electromyography (sEMG) is commonly used in gait analysis for detecting muscle activity in a non-invasive way, preserving the normal mobility of the subject. The purpose of the study was to assess the variability of sEMG signals acquired from lower-limb muscles during walking. To this aim, a statistical analysis of sEMG signals from a large number (hundreds) of strides per subject was performed in twenty-two healthy young caucasian volunteers. Tibialis Anterior, Gastrocnemius Lateralis, Rectus Femoris, Biceps Femoris and Vastus Lateralis were selected to represent both proximal and distal leg segments. Besides the muscular activation onset-offset instants, the study was aimed to analysed the occurrence frequency of muscle recruitment, a parameter seldom considered because of the low number of strides usually analysed in classic EMG studies. Findings illustrated that a single muscle showed a different number of activation intervals in different strides of the same walking. The number of times when muscle activates during a single gait cycle defined the modality of muscle recruitment, that in the present study was referred to as activation modality, i.e. n-activation modality consists of n-activation intervals for the considered muscle, during a single gait cycle. For each of the selected muscles, five activation modalities were detected. Each of these activation modalities is characterized by a different occurrence frequency and by different onset-offset activation instants. Concomitance of these results indicates a large variability in onset-offset muscular activation and occurrence frequency, which should be considered in discriminating pathological from physiological behaviour and for designing focused gait studies.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/240328 Collegamento a IRIS

2016 A new segmented-beat modulation algorithm for maternal ECG estimation from abdominal recordings
Lecture Notes in Electrical Engineering
Autore/i: Agostinelli, A.; Giuliani, C.; Fioretti, S.; Di Nardo, F.; Burattini, L
Editore: Springer Verlag
Classificazione: 2 Contributo in Volume
Abstract: The noninvasive fetal electrocardiogram (fECG) provides precious information about the physiological fetus state. It is extracted from abdominal recordings, obtained positioning surface electrodes on the maternal abdomen, by subtraction of the maternal ECG (mECG), often roughly estimated by simply concatenating a maternal-beat template. Aim of the present study is to propose a new algorithm for the mECG estimation based on a segmented-beat modulation method (SBMM) that adjusts the template length to the maternal physiological heart-rate variability (HRV) and reduces the level of noise. According to the SBMM, each maternal cardiac cycle (CC) is segmented into two segments, QRS and TUP, respectively independent and proportional to preceding RR interval. The estimated mECG is the concatenation of the template-beat, obtained as the median of the maternal beat after modulation and demodulation of TUP segment. The algorithm was applied to two (ARec1 and ARec2) 4-channel abdominal recordings obtained from pregnant women. ARec1 and ARec2 were both 60 s long and characterized by similar heart rate (HR: 80 bpm and 82 bpm) but different HRV (42 ms vs. 139 ms). Results indicate that the error in the mECG estimation is always small (<2.5 μV) but increases with HRV (ARec1: 0.87–1.65 μV; ARec2: 1.98–2.37 μV). In conclusion, the proposed algorithm based on the SBMM allows a clean mECG estimation from abdominal recordings thanks to a modulation procedure introduced to track physiological variation in the maternal heart rhythm.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/240327 Collegamento a IRIS

2016 Predictive Power of f99 Repolarization Index for the Occurrence of Ventricular Arrhythmias
ANNALS OF NONINVASIVE ELECTROCARDIOLOGY
Autore/i: Corrado, Giuliani; Cees, A. Swenne M.D.; Sumche Man, M.D; Angela, Agostinelli; Sandro, Fioretti; Francesco Di, Nardo; Laura, Burattini
Classificazione: 1 Contributo su Rivista
Abstract: Background.Defects of cardiac repolarization, noninvasively identifiable by analyzing the electrocardiographic (ECG) ST segment and T wave, are among the major causes of sudden cardiac death. Still, no repolarization-based index has so far shown sufficient sensitivity and specificity to justify preventive treatments. Thus, the aim of this work was to evaluate the predictive power of our recently proposed f99 index for the occurrence of ventricular arrhythmias. Methods. Our study populations included 170 patients with implanted cardiac defibrillator (ICD), 44 of which developed ventricular tachycardia and/or fibrillation during the 4-year follow-up (ICD_Cases) and 126 did not (ICD_Controls). The f99 index, defined as the frequency at which the repolarization normalized cumulative energy reaches 99%, was computed in each of the 15 (I to III, aVl, aVr, aVf, V1–V6, X, Y, Z) available ECG leads independently, and then maximized over the 6 precordial leads (f99_MaxV1–V6), 12 standard leads (f99_Max12STD) and three orthogonal leads (f99_MaxXYZ) to avoid dispersion-related issues. Each index predictive power was quantified as the area under the receiving operating characteristic curve (AUC). Results.Median f99_MaxV1–V6, f99_Max12STD and f99_MaxXYZ values were significantly higher in the ICD_Cases than in the ICD_Controls (48 Hz vs. 35 Hz, P<0.05; 51 Hz vs. 43 Hz, P<0.05; 45 Hz vs. 31 Hz, P<10−3; respectively), indicating a more fragmented repolarization in the former group. The AUC values were 0.62, 0.63 and 0.68, respectively. Conclusions.The f99 represents a promising risk index for the occurrence of ventricular arrhythmias, especially when maximized over the three orthogonal leads.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/234896 Collegamento a IRIS

2016 The wireless surface electromyographic technique for supporting the assessment of fall risk in diabetic neuropathic patients
Lecture Notes in Electrical Engineering
Autore/i: Maranesi, E; Fioretti, S.; Barone, V.; Ghetti, G.G.; Mercante, O.; Rabin, R.A.; Burattini, L.; Di Nardo, F.
Editore: Springer Verlag
Classificazione: 2 Contributo in Volume
Abstract: The Functional Reach (FR) Test is commonly used in the clinical practice to identify elderly subjects at risk of recurrent falls. This study was designed to provide a useful tool for supporting the assessment of fall risk in diabetic neuropathic (DN) subjects: a non-invasive analysis of muscle activation patterns involved in the FR test using wireless surface electromyography (sEMG). Kinematic analysis was also performed to support results achieved by sEMG technique. A population of diabetic non-neuropathic subjects was considered as control group (CTRL). Kinematics was acquired by a 6-camera Elite optoelectronic system and passive markers were placed according to Davis protocol, with an additional marker placed on dominant wrist. sEMG analysis of Sternocleidomastoideus, Rectus Abdominis, Erectores Spinae at L4 level (L4), Rectus Femoris, Hamstrings (Ham), Tibialis Anterior (TA) and Soleus (Sol) was performed. No significant differences (p-value for evaluation of statistical significance was <0.05) were detected between groups in the computed kinematics parameters. sEMG analysis shows that in CTRL subjects, TA was identified as the first motor, since it activates before the start of FR movement; its action can be attributed to the anticipatory muscular activity necessary to initiate the body forward displacement. Sol and Ham, followed by L4, act mainly as tonic muscles, opposing the movement and preventing falls. Compared to CTRL group, DN subjects show an anticipatory recruitment of TA. The earlier activation of TA in DN group suggests that this anticipation could be a predictor of a greater propensity of the DN subjects to fall compared to non-neuropathic diabetic subjects.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/240337 Collegamento a IRIS

2016 A method for computing the Functional Ambulation Profile score by stereophotogrammetric data
Lecture Notes in Electrical Engineering
Autore/i: Maranesi, E; Petrini, M.; Ghetti, G.G.; Mercante, O.; Barone, V.; Burattini, L.; Di Nardo, F.; Fioretti, S.
Editore: Springer Verlag
Classificazione: 2 Contributo in Volume
Abstract: The Functional Ambulation Profile (FAP) Score is a performance index based on the assessment of selected time and distance parameters, during standard gait test. FAP is considered a reliable global parameter for gait evaluation. The first and original FAP score is provided in an automatic way by the GAITRite System, a portable electronic mat embedded with pressure-activated sensors. The present study was designed to achieve a FAP score computation which could be independent from its native environment, and could be implemented by means of classic gait analysis systems, as stereophotogrammetry. This goal was pursued computing the parameters, which FAP definition is based on, by means of processing of stereophotogrammetric data. The reliability of FAP computation was tested by direct comparison with the original GAITRite FAP score, in a single subject, during different walking trials (comfortable gait, very slow gait; very fast gait) and simulating several pathological gaits (gait with small step; “foot-drop” gait; “festinating” gait; “spastic” gait). No relevant differences detected between stereophotogrammetry-based and GAITRitebased estimates indicate that the proposed method is able to provide a reliable assessment of FAP in different kind of natural/pathological walking. The capability of FAP index to identify alterations of walking is also preserved. In conclusion, this study proposes the stereophotogrammetry-based computation of FAP as a valid alternative to the original GAITRite FAP. The convenience of an easy integration with classic stereophotogrammetry-based gait analysis parameters, supports the usefulness of stereophotogrammetry-based FAP in providing a complete picture of subject walking, without needing a further measurement system.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/240335 Collegamento a IRIS

2016 Estimation of first-phase insulin secretion in the Zucker Fatty Rat
IFMBE Proceedings
Autore/i: Di Nardo, Francesco; Morettini, M.; Cogo, C.E.; Faelli, E.; Fioretti, S.; Burattini, L.; Ruggeri, P.
Editore: Springer Verlag
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The present study was designed to test the efficacy of the popular index AIRG(i.e. acute insulin response after glucose bolus) in the characterization of the first-phase insulin secretion in the Zucker Fatty Rat. The reliability of the AIRGwas evaluated by direct comparison with the first-phase β-cell responsiveness index (Φ1)provided by C-peptide minimal model. To this aim, AIRG and Φ1were simultaneously computed from IVGTT data, measured in six Zucker fatty rats (ZFR), 7-to-9week-old, and seven age-matched Zucker lean rats (ZLR). In the whole 13 rats population, the AIRG showed a significant linear correlation with Φ1(r = 0.89, P < 0.0001). Moreover, both Φ1(P < 0.05) and AIRG (p<0.001) showed a significant increase, in the ZFRs, compared to control group (ZLR). These findings suggest that the AIRG index is able to provide similar information of Φ1, in the evaluation of the alteration of the first-phase insulin secretion in Zucker Fatty Rats. Thus, the present study proposes the AIRG, as a suitable empiric index for a simple, reliable and low-cost quantification of the first-phase insulin secretion in Zucker Fatty Rats. © Springer International Publishing Switzerland 2016.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236266 Collegamento a IRIS

2015 Gender differences in the myoelectric activity of lower limb muscles in young healthy subjects during walking
BIOMEDICAL SIGNAL PROCESSING AND CONTROL
Autore/i: Francesco Di Nardo; Alessandro Mengarelli; Elvira Maranesi; Laura Burattini; Sandro Fioretti
Classificazione: 1 Contributo su Rivista
Abstract: The present study was designed to achieve a comprehensive analysis of gender-related differences in themyoelectric activity of lower limb muscles during normal walking at self-selected speed and cadence,in terms of muscle activation patterns and occurrence frequencies. To this aim, statistical gait analysis(SGA) of surface EMG signal from tibialis anterior (TA), gastrocnemius lateralis (GL), rectus femoris (RF),biceps femoris (BF) and vastus lateralis (VL) was performed in 11 female (F-group) and 11 male (M-group)age-matched healthy young adults. SGA is a recent methodology performing a statistical characteriza-tion of gait, by averaging spatio-temporal and sEMG-based parameters over numerous strides. Findingsshowed that males and females walk at the same comfortable speed, despite the significantly lowerheight and higher cadence detected in females. No significant differences in muscle onset/offset weredetected between groups. The analysis of occurrence frequencies of muscle activity showed no signif-icant differences in BF and RF, between groups. Conversely, in F-group, compared with M-group, GL,TA and VL showed a significantly higher occurrence frequency in the modalities with a high number ofactivations, and a significantly lower occurrence frequency in the modalities with a low number of acti-vations. These findings indicate a propensity of females for a more complex recruitment of TA, GL and VLduring walking, compared to males. The observed differences recommend the suitability of developingelectromyographic databases, separated for males and females.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/224133 Collegamento a IRIS

2015 A biomechanical model for the evaluation by electrogoniometry of spatio-temporal parameters during walking
INTERNATIONAL JOURNAL OF BIOMECHATRONICS AND BIOMEDICAL ROBOTICS
Autore/i: Maranesi, Elvira; DI NARDO, Francesco; Giacomo, G. GHETTI; Burattini, Laura; Fioretti, Sandro
Classificazione: 1 Contributo su Rivista
Abstract: The aim of the study is to propose a new methodology to assess step length, duration and speed, using only two 1-degree-of-freedom electrogoniometers, positioned on hip and knee joints. To this purpose, a novel model was introduced, which represents the lower limb modelled as two rigid segments (thigh and shank). Model validation was performed comparing the results with those automatically achieved from two classic gait analysis systems (a 6-camera stereophotogrammetric system and GAITRite), during walking at three different speeds (natural, fast and slow). The absence of significant differences among parameter values estimated by the three systems indicates a strong reliability of the model. Thus, the study candidates this electrogoniometer-based model as a reliable and not expensive tool for an easy and flexible assessment of spatio-temporal gait parameters in normal subjects, and propose it as a valid alternative to traditional methods using foot switches, ground reaction forces, IMU or stereo-photogrammetric systems.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/228445 Collegamento a IRIS

2015 Assessment of the variability of vastii myoelectric activity in young healthy females during walking: A statistical gait analysis
JOURNAL OF ELECTROMYOGRAPHY AND KINESIOLOGY
Autore/i: Di Nardo, Francesco; Maranesi, Elvira; Mengarelli, Alessandro; Ghetti, Giacomo; Burattini, Laura; Fioretti, Sandro
Classificazione: 1 Contributo su Rivista
Abstract: The study was designed to assess the natural variability of the activation modalities of vastus medialis (VM) and vastus lateralis (VL) during walking at a self-selected speed and cadence of 30 young, healthy, females. This was achieved by conducting statistical gait analysis on the surface electromyographic signals from hundreds of strides for each subject. Results revealed variability in the number of activations, occurrence frequency, and onset-offset instants across the thousands of strides analyzed. However, despite the variability, there was one activation occurrence which remained consistent across subjects for both VM and VL. This occurred from terminal swing to the following loading response (observed in 100% of strides). A second, less frequent, activation occurred between mid-stance up to pre-swing (observed in 39.3 ± 22.4% of strides for VM and in 35.1 ± 20.6% for VL). No significant differences (p>. 0.05) were observed in the onset-offset instants or in the occurrence frequency, which suggest a simultaneous recruitment of VM and VL. This "normality" pattern represents the first attempt at developing a reference frame for vastii sEMG activity during walking, that is able to include the physiological variability of the phenomenon and control the confounding effects of age and gender.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/228439 Collegamento a IRIS

2015 A 3D multibody approach to the study of human motion: jumps and gait analyses
Atti del XXII Congresso AIMETA - Associazione Italiana di Meccanica Teorica e Applicata
Autore/i: Palmieri, Giacomo; Callegari, Massimo; Fioretti, Sandro; Palpacelli, Matteo-Claudio; Verdini, Federica
Editore: De Ferrari Comunicazione
Luogo di pubblicazione: Genova
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Motion analysis of the human body can be supported by several experimental techniques developed in recent years. The use of three-dimensional stereophotogrammetric motion capture systems has become a fundamental technique for the kinematic analysis of complex motions. Such systems are usually combined with other instruments exploited for the dynamic measurements: ground reaction forces can be measured by single or multiaxial force platforms. Even if a great amount of experimental data can be obtained from experimental investigations it is sometimes difficult to establish cause-effect relationships in complex dynamic systems directly from measurements. Therefore, computer modeling and simulation, based on experimental data, can provide useful insights for human biomechanics. This work describes the analyses of two common gestures, jumps [1] and gait, which represent two test cases where the proposed methodology is applied. The motions have been executed in laboratory where a 3D motion capture system has been used to acquire the coordinates of a set of markers placed at anatomical landmarks, while a six-axis force plate has been used to measure the ground reaction forces. Simulations of the acquired motions have been developed by means of the multibody software OpenSim [2], an open-source platform for modeling, simulating, and analyzing the human body motion. After a 3D multibody model of the human body has been set up and scaled on the basis of the specific anthropometric characteristics, the kinematic and dynamic experimental data have been provided as input for the inverse kinematics and inverse dynamics analyses. Such operations, combined with a residual reduction algorithm which minimizes the error between the measured reaction forces and the reactions forces obtained form the inverse dynamics analysis, allows to perform a simulation of the human body motions with dynamically consistent kinematic data. Results of simulations can be processed in order to obtain the joint angles, moments and powers. Furthermore, a series of auxiliary data can be estimated, including the joint reactions and the motion of the center of gravity of the single limbs or of the whole body.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/228098 Collegamento a IRIS

2015 Assessment of the surface electromyographic activity of thigh muscles in males and females
INTERNATIONAL JOURNAL OF BIOMECHATRONICS AND BIOMEDICAL ROBOTICS
Autore/i: DI NARDO, Francesco; Mengarelli, Alessandro; Maranesi, Elvira; Burattini, Laura; Fioretti, Sandro
Classificazione: 1 Contributo su Rivista
Abstract: Surface electromyographic (sEMG) signal is commonly used as input information to control robotic systems. sEMG signals vary from person to person; gender is a factor influencing this variation. The aim of the study is to detect gender-related differences in sEMG activity of main three thigh muscles (rectus femoris, RF, biceps femoris, BF and vastus lateralis, VL) during walking at comfortable speed and cadence. Statistical analysis of sEMG signals, performed in seven male (M-group) and seven female (F-group) adults, showed clear gender-related differences in VL behavior and no relevant differences in the behavior of RF and BF. F-group, indeed, adopts a walking modality with a higher number of VL activations during gait cycle, compared to M-group. This suggests a female propensity for a more complex VL recruitment, during walking. This novel information suggests considering separate approaches for males and females, in providing electromyographic signals as input information to control robotic systems.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/228448 Collegamento a IRIS

2015 Analytical and multibody modeling for the power analysis of standing jumps
COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING
Autore/i: Palmieri, Giacomo; Callegari, Massimo; Fioretti, Sandro
Classificazione: 1 Contributo su Rivista
Abstract: Two methods for the power analysis of standing jumps are proposed and compared in this article. The first method is based on a simple analytical formulation which requires as input the coordinates of the center of gravity in three specified instants of the jump. The second method is based on a multibody model that simulates the jumps processing the data obtained by a three-dimensional (3D) motion capture system and the dynamometric measurements obtained by the force platforms. The multibody model is developed with OpenSim, an open-source software which provides tools for the kinematic and dynamic analyses of 3D human body models. The study is focused on two of the typical tests used to evaluate the muscular activity of lower limbs, which are the counter movement jump and the standing long jump. The comparison between the results obtained by the two methods confirms that the proposed analytical formulation is correct and represents a simple tool suitable for a preliminary analysis of total mechanical work and the mean power exerted in standing jumps.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/176114 Collegamento a IRIS

2015 Clinical application of the Segmented-Beat Modulation Method for fetal ECG extraction
2015 12th International Workshop on Intelligent Solutions in Embedded Systems, WISES 2015
Autore/i: Agostinelli, A.; Fioretti, S.; Di Nardo, F.; Burattini, L.
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: The assessment of the fetal well-being is accomplished with the monitoring of fetal cardiac activity. In presence of risk labor, direct fetal electrocardiography (fECG) can be obtained by positioning an electrode on the fetal scalp. However, its invasiveness and application limited to labor have led to the introduction of the indirect (noninvasive) fECG, obtained by applying the electrodes on the maternal abdomen. The abdominal recordings are corrupted by the maternal ECG (mECG) that often covers the fECG (the signal of interest). To extract the fECG, the mECG has to be estimated and then subtracted from the abdominal recording. To this aim, template-based techniques are often applied. However, such techniques are typically not able to reproduce physiological heart rate (HR) and morphological variability. To overcome this limit, an innovative template-based filtering technique termed the Segmented-Beat Modulation Method (SBMM) has recently been proposed. To evaluate its ability to extract the fECG, SBMM is applied here to an abdominal recording. Direct fECG was simultaneously recorded for comparison. Each RR interval of the direct fECG was correlated with the corresponding RR interval of the indirect fECG, and a statistically significant strong correlation (ρ=0.86, P<10-26) was found. Thus, the SBMM proved to be a potentially useful tool to provide a reliable fECG signal (extracted from an abdominal recording) that can be used for monitoring the fetus health conditions.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236109 Collegamento a IRIS

2015 Heart-rate dependency of T-wave alternans during the exercise and recovery
2015 12th International Workshop on Intelligent Solutions in Embedded Systems, WISES 2015
Autore/i: Burattini, L.; Agostinelli, A.; Fioretti, S.; Di Nardo, F.; Man, S.; Swenne, C.A.
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Microvolt T-wave alternans (TWA), a subtle every-other-beat fluctuation of the electrocardiographic (ECG) T-wave amplitude, is a risk index for the occurrence of malignant ventricular arrhythmias. It is well-known that TWA increases with HR so that TWA is often analyzed during exercise. Since TWA during recovery is usually not evaluated, it is not clear if there is a HR-TWA one-to-one correspondence, or if TWA depends on how such HR was reached. Thus, the aim of the present study was to investigate TWA during both HR-increasing exercise and HR-decreasing recovery. To this aim, our HR adaptive match filter (AMF) for automatic TWA identification was applied to ECG recordings of 266 patients with implanted cardio-defibrillator (ICD). HR varied from 70 bpm to 125 bpm during exercise and vice versa during recovery. Our results indicate that TWA increased (from 17 μV to 51 μV) with increasing HR during exercise, and decreased (from 28 μV to 17 μV) with decreasing HR during recovery. However, such TWA changes did not occur symmetrically, but TWA was significantly lower during exercise than during recovery at low HRs (17-18 μV vs. 20-25 μV for HR<100 bpm; P100 bpm; P<10-6). Thus, there is not a HR-TWA one-to-one correspondence but the value of TWA at a specific HR depends on how such HR was reached.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236111 Collegamento a IRIS

2015 Assessment of the ankle muscle co-contraction during normal gait: A surface electromyography study
JOURNAL OF ELECTROMYOGRAPHY AND KINESIOLOGY
Autore/i: Francesco Di Nardo; Alessandro Mengarelli; Elvira Maranesi; Laura Burattini; Sandro Fioretti
Classificazione: 1 Contributo su Rivista
Abstract: The study was designed to assess the co-contractions of tibialis anterior (TA) and gastrocnemius lateralis (GL) in healthy young adults during gait at self-selected speed and cadence, in terms of variability of onset–offset muscular activation and occurrence frequency. Statistical gait analysis (SGA), a recent methodology performing a statistical characterization of gait by averaging spatio-temporal and EMG-based parameters over numerous strides, was performed in twenty-four healthy young adults. Co-contractions were assessed as the period of overlap between activation intervals of TA and GL. Results showed that GL and TA act as pure agonist/antagonists for ankle plantar/dorsiflexion (no co-contractions) in only 21.3 ± 8.2% of strides. In the remaining strides, statistically significant (p < 0.05) co-contractions appear in early stance (29.2 ± 1.7%), mid-stance (32.1 ± 18.3%) and swing (62.2 ± 2.0%). This significantly increased complexity in muscle recruitment strategy beyond the activation as pure ankle plantar/dorsiflexors, suggests that cocontractions are likely functional to further physiological tasks as foot inversion, balance improvement, control of ankle stability and knee flexion. This study represents the first attempt for the development in healthy young adults of a ‘‘normality’’ reference frame for GL/TA co-contractions, able to include the physiological variability of the phenomenon and eliminate the confounding effect of age.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/205328 Collegamento a IRIS

2015 Evaluation of gender-related differences in co-contraction activity of shank muscles during gait
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Mengarelli, A.; Maranesi, E.; Barone, V.; Burattini, L.; Fioretti, S.; Di Nardo, F
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: This study aims to investigate the possible differences between genders in co-contractions of tibialis anterior (TA) and gastrocnemius lateralis (GL), during walking at self-selected speed. To this purpose, the statistical gait analysis (SGA) was performed on seven female (F-group) and seven male (M-group) adults. SGA is a recently developed methodology for the characterization of gait, by averaging spatiotemporal and electromyographic parameters over hundreds of strides per subject. Co-contractions were assessed as the overlapping periods between TA and GL activity. Results showed that four co-contraction intervals are present during gait cycle in both groups. No relevant differences between genders were detected in onset-offset time instants of co-activations or in their temporal length. On the contrary, significant differences were observed in the number of strides where each co-contraction happens (i.e. the occurrence frequency). All the four co-contraction intervals result significantly (p<0.05) more recurrent in females compared to males. This outcome suggests a larger presence of co-contraction activity in females walking, related to a female tendency for a more complex muscular strategy during gait. These findings could be useful to better understand gender differences in walking mechanisms and to develop separated normal walking reference frames for males and females.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/234913 Collegamento a IRIS

2015 The occurrence frequency: A suitable parameter for the evaluation of the myoelectric activity during walking
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Di Nardo, Francesco; Agostini, Valentina; Knaflitz, Marco; Mengarelli, Alessandro; Maranesi, Elvira; Burattini, Laura; Fioretti, Sandro
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Many studies have recently addressed the quantification of the natural variability of myoelectric activity during walking, considering hundreds of strides. The availability of so many strides allows assessing a parameter seldom considered in classic surface EMG (sEMG) studies: the occurrence frequency, defined as the frequency each muscle activation occurs with, quantified by the number of strides in which a muscle is recruited with that specific activation modality. Aim of this study is to point out the occurrence frequency as a suitable parameter for the evaluation of the variability of the myoelectric activity during walking. This goal was pursued by means of the statistical gait analysis of sEMG signal acquired from Gastrocnemius Lateralis (GL) in six healthy subjects, with different characteristics. Results show that among these six subjects relevant differences were not detected in the temporal parameters, i.e., activation onset/offset instant and activation duration. In the same subjects, the values of the occurrence frequency ranged from 3% to 74% in the different activation modalities, indicating a large variability of this parameter. These findings show that occurrence frequency is able to provide further and different information with respect to classical temporal parameters. Thus, the occurrence frequency is proposed as a suitable parameter to support the classic temporal parameters in the evaluation of variability of myoelectric activity during walking.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/234917 Collegamento a IRIS

2015 Apparecchiatura per l'allenamento dell'equilibrio
Autore/i: Pasquapina, Ciarmela; Maria Gabriella Ceravolo, ; Mario, Castellucci; Sandro, Fioretti; Matteo Claudio Palpacelli, ; Giacomo, Palmieri; Gianluca, Ippoliti; Giuseppe, Orlando
Classificazione: 6 Brevetti
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/252221 Collegamento a IRIS

2015 A System with Line Lasers and Webcam for 3D Reconstruction: A Feasibility Study
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS.
Autore/i: Barone, V; Verdini, F; Di Nardo, F; Burattini, L; Fioretti, S
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236154 Collegamento a IRIS

2015 Comparison of ankle-muscles activity between school-aged children and young adults during gait: An electromyographic analysis
2015 12th International Workshop on Intelligent Solutions in Embedded Systems, WISES 2015
Autore/i: Mengarelli, A.; Fioretti, S.; Maranesi, E.; Burattini, L.; Di Nardo, F.; Agostini, V.; Knaflitz, M.; Nascimbeni, A.
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Electrocardiogram (ECG) represents, with the electroencephalogram (EEG), the principal bio-vital signals, providing information on the human physical condition. Although surface electromyogram (sEMG) is not classified as bio-vital, it is frequently used to integrate and increase information obtained from ECG and EEG, making these three signals the main electric-biological signals. The sEMG is widely used for the assessment of muscular activity during gait, providing valuable information in particular for subjects presenting impaired or non-completely developed gait, like children. Thus, this study aimed to quantify and compare lower limb muscle activity during walking in healthy, school-aged children (C-group) and young adults (A-group). The statistical analysis of tibialis anterior (TA) and gastrocnemius lateralis (GL) myoelectric signal revealed the absence of any significant difference between the two groups in the activation modalities adopted by both muscles, in terms of temporal characteristics and occurrence frequency. These outcomes underline similar activation patterns for children and adults during gait, confirming the hypothesis about an achieved mature gait in 6-to-8-year-old children, also in terms of sEMG activity. The findings of this study could help for better understanding the degree of mature gait advancement in children and for discriminating muscular physiological behavior in healthy and pathological children
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/234889 Collegamento a IRIS

2015 Myoelectric activity of antagonist ankle-muscles in 6-to-8-year-old children during walking
2015 12th International Workshop on Intelligent Solutions in Embedded Systems, WISES 2015
Autore/i: Di Nardo, Francesco; Mengarelli, Alessandro; Maranesi, Elvira; Burattini, Laura; Fioretti, Sandro; Agostini, Valentina; Knaflitz, Marco; Nascimbeni, Alberto
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Great co-contraction, i.e. simultaneous contraction of agonist and antagonist muscles crossing a joint, of ankle muscles during the stance phase has been identified as one of the typical features of the immature gait. The goal of the present study was the assessment of the co-contractions of tibialis anterior (TA) and gastrocnemius lateralis (GL) during walking in 20 healthy 6-to-8-year-old children, critical age for the maturation of gait. To this aim, Statistical gait analysis, a recent methodology performing a statistical characterization of gait by averaging spatial-temporal and surface-EMG-based parameters over numerous strides, was performed in each subject. Co-contractions were assessed as the period of overlap between activation intervals of TA and GL. Results showed that GL and TA act as pure antagonists for ankle plantar/dorsiflexion (no co-contractions) in only 18.7% of strides. In the remaining strides, statistically significant (p<0.05) co-contractions were detected in early stance (45.0% of the strides), mid-stance (27.7%), pre-swing (14.6%), and swing (74.1%). The presence of all these different kinds of ankle-muscle co-contractions seems to suggest the need of a stabilizing control in children, supporting the hypothesis that a young neurocontrol system can operate on more degrees of freedom. In conclusion, the present analysis represents the first attempt for providing a quantitative assessment for ankle-muscle co-contraction in healthy 6-to-8-year-old children, in order to give further information on the maturation of gait in children.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/234891 Collegamento a IRIS

2015 The segmented-beat modulation method for ECG estimation
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Agostinelli, A.; Giuliani, C.; Fioretti, S.; Di Nardo, F.; Burattini, L
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Electrocardiographic (ECG) tracings corrupted by noise with frequency components in the ECG frequency band, may result useless unless appropriately processed. The estimation of the clean ECG from such recordings, however, is quite challenging; being linear filtering inappropriate. In the common situations in which the R peaks are detectable, template-based techniques have been proposed to estimate the ECG by a template-beat concatenation. However, such techniques have the major limit of not being able to reproduce physiological heart-rate and morphological variability. Thus, the aim of the present study was to propose the segmented-beat modulation method (SBMM) as the technique that overcomes such limit. The SBMM is an improved template-based technique that provides good-quality estimations of ECG tracings characterized by some heart-rate and morphological variability. It segments the template ECG beat into QRS and TUP segments and then, before concatenation, it applies a modulation/demodulation process to the TUP-segment so that the estimated-beat duration and morphology adjust to those of the corresponding original-beat. To test its performance, the SBMM was applied to 19 ECG tracings from normal subjects. There were no errors in estimating the R peak location, and the errors in the QRS and TUP segments were low (≤65 μV and ≤30 μV, respectively), with the former ones being significantly higher than the latter ones. Eventually, TUP errors tended to increase with increasing heart-rate variability (correlation coefficient:0.59, P<10-2). In conclusion, the new SBMM proved to be a useful tool for providing good-quality ECG estimations of tracings characterized by heart-rate and morphological variability.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236150 Collegamento a IRIS

2015 Dependence of gait parameters on height in typically developing children
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Agostini, Valentina; Nascimbeni, Alberto; Di Nardo, Francesco; Fioretti, Sandro; Burattini, Laura; Knaflitz, Marco
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: In clinical gait analysis is fundamental to have access to normative data, to be used as a reference in the interpretation of pathological walking. In a paediatric population this may be complicated by the dependence of gait parameters on child growth. The aim of this work is to provide the correlations of spatial-temporal gait parameters with children's height. We obtained the regression lines of cadence, double support, and gait phases, with respect to height, from a sample of 85 normally typically developing children aged 6 to 11. Our analysis of gait phases was not limited to the traditional analysis of stance and swing, but rather focused on the sub-phases of stance - heel contact, flat foot contact, push off - which proved to be an innovative approach to gait analysis. Heel contact decreased, flat foot contact increased and push off remained essentially unchanged with respect to children's height. These results may be useful in the interpretation of gait data in developing children, and the regression lines obtained may be used to normalize their gait parameters.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/236153 Collegamento a IRIS

2015 Assessment of the activation patterns of the muscles involved in the FR test in diabetic neuropathic patients
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Maranesi, E; Di Nardo, F.; Ghetti, G.G.; Mercante, O.; Rabini, R.A.; Burattini, L.; Fioretti, S.
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: This study was designed to assess, in elderly neuropathic diabetic (DN) patients, the activation patterns of the main muscles involved in the Functional Reach (FR) Test, a well-recognized method to identify elderly subjects at risk of recurrent falls. Surface electromyographic (sEMG) analysis of Sternocleidomastoideus (Scm), Rectus Abdominis (RAbd), Erectores Spinae at L4 level (L4), Rectus Femoris (RF), Hamstrings (Ham), Tibialis Anterior (TA) and Soleus (Sol) was performed to this aim. Results in DN patients are compared with a control group (CH) of healthy age-matched subjects. In DN patients, TA is identified as the first muscle to be recruited (ON at -34% of the FR-period) before the movement start, in order to initiate the body forward displacement. RF is the first muscle to be recruited after TA and, togheter with RAbd, showed a progressive earlier onset from CH group. Sol and Ham (ON after the FR-start), followed by L4, act mainly as tonic muscles, opposing the movement and preventing falls. Compared to the CH group, the DN subjects show an anticipatory recruitment (-34%±6%) of TA, showing a statistically significant difference (p<0.05) in comparison to CH group, together with the Scm activation. Results suggest a trend of DN patients in anticipating the activation of the anterior muscles of the body. This is likely due to an attempt to compensate the neuropathy-related proprioception dysfunction and to adjust the movement timing. In conclusion, the present study shows that sEMG is a suitable tool to deepen the interpretation of the FR-test execution and proposes the earlier start of TA as a possible element to identify the presence of neuropathy in diabetic subjects
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/234918 Collegamento a IRIS

2015 A stereophotogrammetric-based method to assess spatio-temporal gait parameters on healthy and Parkinsonian subjects
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
Autore/i: Maranesi, E; Capitanelli, L.; Capecci, M.; Ghetti, G.G.; Mercante, O.; Di Nardo, F.; Burattini, L.; Ceravolo, M.G.; Fioretti, S.
Editore: Institute of Electrical and Electronics Engineers Inc.
Classificazione: 4 Contributo in Atti di Convegno (Proceeding)
Abstract: Generally, the study of gait requires the detection of successive heel contacts and toe-off instants. Traditional gait analysis methods obtain these gait events using dynamometric platforms together with stereophotogrammetric data. Usually, are kept valid only those walking trials where the subjects step on each platform by only one foot. For subjects suffering from walking impairments it is very difficult or sometimes impossible to walk naturally and step properly on the dynamometric platforms. The aim of the present study is to propose a new method to identify, in an automatic manner, the initial contact (IC) and the toe-off (TO) time instants using only stereophotogrammetric data and a classic gait analysis protocol. The assessment of spatio-temporal gait variables during natural walking is also performed. The study consisted in analyzing healthy and Parkinsonian elderly subjects. The reliability of the proposed stereophotogrammetric-based method was tested by direct comparison with the IC and TO instants determined by the dynamometric platform data. The absence of any statistically significant differences between the values estimated by the two different modalities, highlights the reliability of the proposed method in the assessment of these two gait events. Results underline, as expected, the reduction of walking velocity in pathological patients during free ambulation. The present study proposes this method as a valid alternative to the traditional technique that use dynamometric platforms to identify main gait events, for subjects unable to walk naturally and to step properly on the platforms.
Scheda della pubblicazione: https://iris.univpm.it/handle/11566/234691 Collegamento a IRIS


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