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Research on human posture and balance control has grown in recent years, leading to continued advances in their understanding. The ability to maintain balance is attributed to the interplay of the visual, vestibular, and somatosensory systems, although an important role is also played by the auditory system. The lack or deficit in any of these systems leads to a reduced stability that may be counterbalanced by the integration of all the remaining sensory information. Auditory and vibratory stimulation have been found to be useful to enhance balance alongside daily activities either in healthy or pathological subjects; nevertheless, while widely investigated, the literature relating to these approaches is still fragmented. This review aims at addressing this by collecting, organising, and discussing all the literature to date on the effects of the various acoustic and vibratory stimulation techniques available on static upright posture in healthy subjects. In addition, this review intends to provide a solid and comprehensive starting point for all the researchers interested in these research areas. A systematic search of the literature was performed and a total of 33 articles (24 on vibratory stimulation and 9 on acoustic stimulation) were included in our analysis. For all articles, several elements were highlighted including: the study sample, the characteristics of the stimulations, the recording instruments, the experimental protocols, and outcomes. Overall, both stimulations analysed were found to have a positive effect on balance but more research is needed to align those alternative approaches to the traditional ones.

For decades, postural control has been believed to be dominated by reflexive mechanisms, but more recent evidence characterizes it as an articulate system which relies on multisensory integration (vestibular, visual, proprioceptive) and cortical coordination to preserve balance in the wake of external disruptions to the quiet stance. Corrective strategies to stabilise the body’s center of mass and prevent falls are planned at the central nervous system level and executed through the modulation of muscular activity, especially in the lower legs muscles: gastrocnemius, soleus and tibialis. In this study, we use localized proprioceptive vibratory stimulation to induce a perturbation of the subjects’ quiet stance. By integrating traditional force plate data with electrophysiological signals (EEG and EMG), we use cortico-muscular and inter-muscular coherence to investigate how brain and muscles interact to shape an effective response to a postural challenge. Our results show how the cortical drive is enhanced in beta [13-30]Hz and gamma [30-45]Hz bands, specifically for the soleus and gastrocnemius muscles, during the task execution. We also reveal a remodulation of the lower legs muscle network, with a distributed strengthening of muscle activity coupling.

The objective of the present work is to measure postural kinematics and power spectral variation from HD-EEG to assess changes in cortical activity during adaptation and habituation to postural perturbation. To evoke proprioceptive postural perturbation, vibratory stimulation at 85 Hz was applied to the calf muscles of 33 subjects over four 75-second stimulation periods. Stimulation was performed according to a pseudorandom binary sequence. Vibratory impulses were synchronized to high-density electroencephalography (HD-EEG, 256 channels). Changes in absolute spectral power (ASP) were analyzed over four frequency bands (Delta: 0.5-3.5 Hz; theta: 3.5-7.5 Hz; alpha: 7.5-12.5 Hz; beta:12.5-30 Hz). A force platform recorded torque actuated by the feet, and normalized sway path length (SPL) was computed as a construct for postural performance during each period. SPL values indicated improvement in postural performance over the trial periods. Significant variation in absolute power values (ASP) was found in assessing postural adaptation: an increase in theta band ASP in the frontal-central region for closed-eyes trials, an increase in theta and beta band ASP in the parietal region for open-eyes trials. In habituation, no significant variations in ASP were observed during closed-eyes trials, whereas an increase in theta, alpha, and beta band ASP was observed with open eyes. Furthermore, open-eyed trials generally yielded a greater number of significant ASP differences across all bands during both adaptation and habituation, suggesting that following cortical activity during postural perturbation may be up-regulated with the availability of visual feedback. Results provide deeper insight into pathological postural control failure by exploring the dynamic changes in both cortical activity and postural kinematics during adaptation and habituation to proprioceptive postural perturbation., 6 figures

Purpose: This study aimed to translate the Convergence Insufficiency Symptom Survey (CISS) into the Italian language and assess psychometric properties of the translated questionnaire (CISS_I). Methods: The CISS_I was arranged according to guidelines for a comprehensive multistep methodologic process for translating, adapting, and validating psychometric instruments in health care research. The CISS_I questionnaire was administered to 103 volunteers (21.8 ± 2.2 years), students in higher education, at two different times. A complete optometric evaluation was performed including subjective refraction, best corrected visual acuity, near point of convergence, prism fusional ranges to blur, diplopia and recovery, TNO stereo test and prism cover test for measurement of heterophoria. Results: The performance of the CISS_I in terms of validity showed some points of weakness. Sensitivity was 42%, specificity was 74%, positive predictive value was 27% and negative predictive value was 85%. The area under the ROC curve was 0.672. On the contrary, the results showed good internal consistency of the CISS_I (Cronbach's alpha - α=0.89) and good test-retest reliability (ICC = 0.92). Rasch analysis showed good model fit (all items, except one, with infit and outfit mean square between 0.7 and 1.3), good measurement precision (person separation = 2.66) and good targeting –0,81 logits but also some evidence of multidimensionality. Conclusions: The CISS_I showed some point of weakness in terms of validity but also good psychometric properties and has been shown to be applicable to an Italian speaking population to quantify the visual discomfort associated with near vision in higher education students. The results show that high CISS_I score is not necessarily linked to convergence insufficiency, while low scores can exclude the presence of this anomaly. The CISS_I can help in interpreting and monitoring convergence insufficiency symptoms in already identified subjects, but it is not suitable for screening a general population of young adults.

Lower limb muscles actively contribute to maintain body posture but also act to attenuate soft tissues oscillations that occur during everyday life. This elicited activity can be exploited as a mean of neuromuscular training or rehabilitation. In this study, Whole Body Vibrations (WBV) at different frequencies were delivered to healthy subjects while holding static postures to test the transient muscles mechanical responses. Twenty-five participants underwent WBV at 15, 20, 25 and 30 Hz while holding either a static ‘hack squat’ or ‘fore feet’ posture. Soft tissue accelerations and surface electromyography (sEMG) were recorded from Gastrocnemius Lateralis (GL), Soleus (SOL) and Tibialis Anterior (TA) muscles. Estimated displacement at muscle bellies revealed a resonant pattern, different across frequencies and postures (p

PurposeTo characterise the mechanical and neuromuscular response of lower limb muscles in subjects undergoing Whole Body Vibration (WBV) at different frequencies while holding two static postures.MethodsTwenty-five participants underwent WBV at 15, 20, 25 and 30 Hz while holding a static ‘hack squat’ and on ‘fore feet’ posture. Surface electromyography (sEMG) and soft tissue accelerations were collected from Gastrocnemius Lateralis (GL), Soleus (SOL) and Tibialis Anterior (TA) muscles.ResultsOnly specific WBV settings led to a significant increase in muscle contraction. Specifically, the WBV-induced activation of SOL and GL was maximal in fore-feet and in response to higher frequencies. Estimated displacement at muscle bellies revealed a resonant pattern never highlighted before. After stimulation starts, muscle oscillation reaches a peak followed by a drop and a further stabilisation (few seconds after the peak) that suggests the occurrence of a neuromuscular activation to reduce the vibration-induced oscillation.ConclusionLower leg muscles need a response time to tune to a vibratory stimulation, which discourages the use of dynamic exercises on vibrating platforms. To maximize calf muscle response to WBVs, a stimulation frequency in the range of 25-30 Hz and an ‘on fore feet’ posture are recommended.

X-ray fluoroscopy is a medical imaging modality that provides continuous real-time screening of patient’s organs and various radiopaque surgical objects. Fluoroscopy usually requires long and unpredictable exposure times, thus radiation intensity must be heavily reduced to limit patient’s dose. This gives rise to the well-known Poisson noise, which results in very poor image quality. Commercial fluoroscopes usually improve image quality via real-time temporal averaging, which produces motion blur in moving scenes. The Noise Variance Conditioned Average (NVCA) algorithm exploits the a priori knowledge of Poisson noise statistics to provide efficient noise reduction, while preserving the edges of moving objects. However, accurate setting of NVCA parameters is required to achieve the best results, and this could be supported by image quality assessment (IQA) indices. This study presents a novel, edge-aware IQA index, named Sensitivity of Edge Detection (SED), and compares it against the well-established Feature Similarity (FSIM) index, to assess their efficiency in determining the optimal parameters for NVCA. The preliminary results obtained in this study suggest SED could be more efficient than FSIM in identifying the best trade-off between noise reduction and edge preservation, and could be also used to determine the optimal parameters of other denoising algorithms.

Comparison of derivative operators via quantitative performance analysis is rarely addressed in medical imaging. Indeed, the main application of such operators is the extraction of edges and, since there is no unequivocal definition of edges, the common trend is to identify the best performing operator based on a qualitative match between the extracted edges and the fickle human perception of object boundaries. This study presents an objective comparison of four first-order derivative operators through quantitative analysis of results yielded in a specific task, i.e. a spine kinematics application. Such application is based on a template matching method, which estimates common kinematic parameters of intervertebral segments from an X-ray fluoroscopy sequence of spine motion, by operating on the image derivatives of each frame. Therefore, differences in image derivatives, computed via different derivative operators, may lead to differences in estimated parameters of intervertebral kinematics. The comparison presented in this study focused on the trajectory of the instantaneous center of rotation (ICR) of an intervertebral segment, as it is particularly sensitive even to very small differences in displacements and velocities. Therefore, a quantitative analysis of the discrepancies between the ICR trajectories, obtained with each of the four considered derivative operators, was carried out by defining quantitative measures. The results showed detectable differences in the obtained ICR trajectories, thus highlighting the need for quantitative analysis of derivative operator performances in applications aimed at providing quantitative results. However, the significance level of such differences for clinical applications should be further assessed, but, currently, it is not possible, as there is no consensus and sufficient data on kinematic parameters features associated with specific spinal pathologies.

Important features of a hand prosthesis are certainly the comfort in wearing it, the ease of use, the activation speed, the low energy consumption and no less important the anthropomorphic aspect. This study focused on the activation speed and the energy consumption of an under-actuated, low-cost, active hand prosthesis named “Federica”. The prosthesis is moved by a single servomotor able to rotate 180 degrees. Video acquisitions of complete rotations of the servomotor, when it works freely or fixed to the mechanical components of the prosthesis, were used to compare the different kinematic behaviors of the servomotor. A current sensor was used to measure the absorbed current, i.e. the energy absorption, by the servomotor under different uses of the prosthesis (at rest, grasping objects, raising water bottles, etc.). The comparison between the kinematic behaviors of the servomotor alone or connected to the prosthesis, showed the mechanical efficiency of the prosthesis with very low latencies and small variations in velocity and acceleration profiles. The prosthesis took about half a second from the muscle sensor trigger to the complete closure of the hand, showing a significant speed. Finally, tests on current absorption of the servomotor in various conditions resembling prosthesis daily usage, revealed the capacity to guarantee an autonomy of at least one day when powered by 7.4 V, 3000 mAh battery pack.

Modern 3D printing technologies and wide availability of microcontroller boards allow to make active prosthetic devices in a simple way. This is the case of “Federica”, a very low-cost, under-actuated, active hand prosthesis. The five fingers of the prosthesis are moved by a single motor through inelastic tendons. The control system of the prosthesis is proportional to muscle contraction: firstly, EMG was used, then mechanical sensors that measure muscle volumetric variation were successfully utilized. This prosthesis proved to be particularly energy efficient and fast; it provided a general grasp function by adapting the exerted forces, thus allowing to easily catch even deformable objects. This study presents further analyses and design improvements of this prosthesis. In particular, a new, extremely simple but effective conditioning system of a force sensor resistor was presented and tested. In addition, the actual three-dimensional kinematics of a single finger was captured by means of high frame rate cameras and then analyzed. The new sensor conditioning system was characterized. It proved to be as effective as the EMG envelope to proportionally control the hand prosthesis motion, and it allowed an easier connection to common microcontroller boards. Kinematic analysis allowed to accurately reconstruct the actual phalanges motion over time.

This paper presents forcecardiography (FCG), a novel technique to measure local, cardiac-induced vibrations onto the chest wall. Since the 19th century, several techniques have been proposed to detect the mechanical vibrations caused by cardiovascular activity, the great part of which was abandoned due to the cumbersome instrumentation involved. The recent availability of unobtrusive sensors rejuvenated the research field with the most currently established technique being seismocardiography (SCG). SCG is performed by placing accelerometers onto the subject&rsquo, s chest and provides information on major events of the cardiac cycle. The proposed FCG measures the cardiac-induced vibrations via force sensors placed onto the subject&rsquo, s chest and provides signals with a richer informational content as compared to SCG. The two techniques were compared by analysing simultaneous recordings acquired by means of a force sensor, an accelerometer and an electrocardiograph (ECG). The force sensor and the accelerometer were rigidly fixed to each other and fastened onto the xiphoid process with a belt. The high-frequency (HF) components of FCG and SCG were highly comparable (r &gt, 0.95) although lagged. The lag was estimated by cross-correlation and resulted in about tens of milliseconds. An additional, large, low-frequency (LF) component, associated with ventricular volume variations, was observed in FCG, while not being visible in SCG. The encouraging results of this feasibility study suggest that FCG is not only able to acquire similar information as SCG, but it also provides additional information on ventricular contraction. Further analyses are foreseen to confirm the advantages of FCG as a technique to improve the scope and significance of pervasive cardiac monitoring.

International audience; Objective. Maintaining upright posture is a complex task governed by the integration of afferent sensorimotor and visual information with compensatory neuromuscular reactions. The objective of the present work was to characterize the visual dependency and functional dynamics of cortical activation during postural control. Approach. Proprioceptic vibratory stimulation of calf muscles at 85 Hz was performed to evoke postural perturbation in open-eye (OE) and closed-eye (CE) experimental trials, with pseudorandom binary stimulation phases divided into four segments of 16 stimuli. 64-channel EEG was recorded at 512 Hz, with perturbation epochs defined using bipolar electrodes placed proximal to each vibrator. Power spectra variation and linearity analysis was performed via fast Fourier transformation into six frequency bands (Δ, 0.5-3.5 Hz; θ, 3.5-7.5 Hz; α, 7.5-12.5 Hz; β, 12.5-30 Hz; γ_low, 30-50 Hz; and γ_high, 50-80 Hz). Finally, functional connectivity assessment was explored via network segregation and integration analyses. Main Results. Spectra variation showed waveform and vision-dependent activation within cortical regions specific to both postural adaptation and habituation. Generalized spectral variation yielded significant shifts from low to high frequencies in CE adaptation trials, with overall activity suppressed in habituation; OE trials showed the opposite phenomenon, with both adaptation and habituation yielding increases in spectral power. Finally, our analysis of functional dynamics reveals novel cortical networks implicated in postural control using EEG source-space brain networks. In particular, our reported significant increase in local θ connectivity may signify the planning of corrective steps and/or the analysis of falling consequences, while α band network integration results reflect an inhibition of error detection within the cingulate cortex, likely due to habituation. Significance. Our findings principally suggest that specific cortical waveforms are dependent upon the availability of visual feedback, and we furthermore present the first evidence that local and global brain networks undergo characteristic modification during postural control.

Objective: Provide a definitive analysis of the spectrum of a motor unit action potential train elicited by mechanical vibratory stimulation via a detailed and concise mathematical formulation. Experimental studies demonstrated that motor unit action potentials are not exactly synchronized with the vibratory stimulus but show a variable latency jitter, whose effects have not been investigated yet. Methods: Synchronized action potential train was represented as a quasi-periodic sequence of a given motor unit waveform. The latency jitter of action potentials was modeled as a Gaussian stochastic process, in accordance to previous experimental studies. Results: A mathematical expression for power spectrum of a synchronized motor unit action potential train has been derived. The spectrum comprises a significant continuous component and discrete components at the vibratory frequency and its harmonics. Their relevance is correlated to the level of synchronization: the weaker the synchronization, the more relevant the continuous spectrum. EMG rectification enhances the discrete components. Conclusion: The derived equations have general validity and well describe the power spectrum of actual EMG recordings during vibratory stimulation. Results are obtained by appropriately setting the level of synchronization and vibration frequency. Significance: This study definitively clarifies the nature of changes in spectrum of raw EMG recordings from muscles undergoing vibratory stimulation. Results confirm the need of motion artifact filtering for raw EMG recordings during stimulation and strongly suggests to avoid EMG rectification that significantly alters the spectrum characteristics.

Optical coherence tomography (OCT) is increasingly used in areas such as ophthalmology and contact lens metrology. However, in such cases, image distortion can occur due to the non-planar nature of the measured sample. Postprocessing algorithms can be implemented to correct this distortion. Here we present an OCT phantom designed to confirm the validity of post-processing algorithms used for measuring curved surfaces. A multi-purpose OCT phantom has been created within a fused silica plano-convex lens using the direct femtosecond laser writing technique. This phantom can be used to calibrate and quantitatively assess the performance (e.g. resolution, sensitivity and distortion) of OCT systems and associated post-processing algorithms for curved structures such as lenses. This novel OCT phantom has been characterized using an optical microscope and OCT systems.

Electrocardiography (ECG) has been recently proposed as biometric trait for identification purposes. Intra-individual variations of ECG might affect identification performance. These variations are mainly due to Heart Rate Variability (HRV). In particular, HRV causes changes in the QT intervals along the ECG waveforms. This work is aimed at analysing the influence of seven QT interval correction methods (based on population models) on the performance of ECG-fiducial-based identification systems. In addition, we have also considered the influence of training set size, classifier, classifier ensemble as well as the number of consecutive heartbeats in a majority voting scheme. The ECG signals used in this study were collected from thirty-nine subjects within the Physionet open access database. Public domain software was used for fiducial points detection. Results suggested that QT correction is indeed required to improve the performance. However, there is no clear choice among the seven explored approaches for QT correction (identification rate between 0.97 and 0.99). MultiLayer Perceptron and Support Vector Machine seemed to have better generalization capabilities, in terms of classification performance, with respect to Decision Tree-based classifiers. No such strong influence of the training-set size and the number of consecutive heartbeats has been observed on the majority voting scheme.