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Detection of Unilateral Arm Paresis after Stroke by Wearable Accelerometers and Machine Learning.

ABSTRACT: Recent advances in stroke treatment have provided effective tools to successfully treat ischemic stroke, but still a majority of patients are not treated due to late arrival to hospital. With modern stroke treatment, earlier arrival would greatly improve the overall treatment results. This prospective study was performed to asses the capability of bilateral accelerometers worn in bracelets 24/7 to detect unilateral arm paralysis, a hallmark symptom of stroke, early enough to receive treatment. Classical machine learning algorithms as well as state-of-the-art deep neural networks were evaluated on detection times between 15 min and 120 min. Motion data were collected using triaxial accelerometer bracelets worn on both arms for 24 h. Eighty-four stroke patients with unilateral arm motor impairment and 101 healthy subjects participated in the study. Accelerometer data were divided into data windows of different lengths and analyzed using multiple machine learning algorithms. The results show that all algorithms performed well in separating the two groups early enough to be clinically relevant, based on wrist-worn accelerometers. The two evaluated deep learning models, fully convolutional network and InceptionTime, performed better than the classical machine learning models with an AUC score between 0.947-0.957 on 15 min data windows and up to 0.993-0.994 on 120 min data windows. Window lengths longer than 90 min only marginally improved performance. The difference in performance between the deep learning models and the classical models was statistically significant according to a non-parametric Friedman test followed by a post-hoc Nemenyi test. Introduction of wearable stroke detection devices may dramatically increase the portion of stroke patients eligible for revascularization and shorten the time to treatment. Since the treatment effect is highly time-dependent, early stroke detection may dramatically improve stroke outcomes.

SUBMITTER: Wasselius J

PROVIDER: S-EPMC8659933 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:Atrial Fibrillation is the most common arrhythmia worldwide with a global age adjusted prevalence of 0.5% in 2010. Anticoagulation treatment using warfarin or direct oral anticoagulants is effective in reducing the risk of AF-related stroke by approximately two-thirds and can provide a 10% reduction in overall mortality. There has been increased interest in detecting AF due to its increased incidence and the possibility to prevent AF-related strokes. Inexpensive consumer devices which measure the ECG may have the potential to accurately detect AF but do not generally incorporate diagnostic algorithms. Machine learning algorithms have the potential to improve patient outcomes particularly where diagnoses are made from large volumes or complex patterns of data such as in AF. METHODS:We designed a novel AF detection algorithm using a de-correlated Lorenz plot of 60 consecutive RR intervals. In order to reduce the volume of data, the resulting images were compressed using a wavelet transformation (JPEG200 algorithm) and the compressed images were used as input data to a Support Vector Machine (SVM) classifier. We used the Massachusetts Institute of Technology (MIT)-Beth Israel Hospital (BIH) Atrial Fibrillation database and the MIT-BIH Arrhythmia database as training data and verified the algorithm performance using RR intervals collected using an inexpensive consumer heart rate monitor device (Polar-H7) in a case-control study. RESULTS:The SVM algorithm yielded excellent discrimination in the training data with a sensitivity of 99.2% and a specificity of 99.5% for AF. In the validation data, the SVM algorithm correctly identified AF in 79/79 cases; sensitivity 100% (95% CI 95.4%-100%) and non-AF in 328/336 cases; specificity 97.6% (95% CI 95.4%-99.0%). CONCLUSIONS:An inexpensive wearable heart rate monitor and machine learning algorithm can be used to detect AF with very high accuracy and has the capability to transmit ECG data which could be used to confirm AF. It could potentially be used for intermittent screening or continuously for prolonged periods to detect paroxysmal AF. Further work could lead to cost-effective and accurate estimation of AF burden and improved risk stratification in AF.

Project description:ObjectiveTracking seizures is crucial for epilepsy monitoring and treatment evaluation. Current epilepsy care relies on caretaker seizure diaries, but clinical seizure monitoring may miss seizures. Wearable devices may be better tolerated and more suitable for long-term ambulatory monitoring. This study evaluates the seizure detection performance of custom-developed machine learning (ML) algorithms across a broad spectrum of epileptic seizures utilizing wrist- and ankle-worn multisignal biosensors.MethodsWe enrolled patients admitted to the epilepsy monitoring unit and asked them to wear a wearable sensor on either their wrists or ankles. The sensor recorded body temperature, electrodermal activity, accelerometry (ACC), and photoplethysmography, which provides blood volume pulse (BVP). We used electroencephalographic seizure onset and offset as determined by a board-certified epileptologist as a standard comparison. We trained and validated ML for two different algorithms: Algorithm 1, ML methods for developing seizure type-specific detection models for nine individual seizure types; and Algorithm 2, ML methods for building general seizure type-agnostic detection, lumping together all seizure types.ResultsWe included 94 patients (57.4% female, median age = 9.9 years) and 548 epileptic seizures (11 066 h of sensor data) for a total of 930 seizures and nine seizure types. Algorithm 1 detected eight of nine seizure types better than chance (area under the receiver operating characteristic curve [AUC-ROC] = .648-.976). Algorithm 2 detected all nine seizure types better than chance (AUC-ROC = .642-.995); a fusion of ACC and BVP modalities achieved the best AUC-ROC (.752) when combining all seizure types together.SignificanceAutomatic seizure detection using ML from multimodal wearable sensor data is feasible across a broad spectrum of epileptic seizures. Preliminary results show better than chance seizure detection. The next steps include validation of our results in larger datasets, evaluation of the detection utility tool for additional clinical seizure types, and integration of additional clinical information.

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Project description:BACKGROUND:Physical activity (PA) level is associated with multiple health benefits during early childhood. However, inconsistency in the methods for quantification of PA levels among preschoolers remains a problem. OBJECTIVE:This study aimed to develop PA intensity cut points for wrist-worn accelerometers by using machine learning (ML) approaches to assess PA in preschoolers. METHODS:Wrist- and hip-derived acceleration data were collected simultaneously from 34 preschoolers on 3 consecutive preschool days. Two supervised ML models, receiver operating characteristic curve (ROC) and ordinal logistic regression (OLR), and one unsupervised ML model, k-means cluster analysis, were applied to establish wrist-worn accelerometer vector magnitude (VM) cut points to classify accelerometer counts into sedentary behavior, light PA (LPA), moderate PA (MPA), and vigorous PA (VPA). Physical activity intensity levels identified by hip-worn accelerometer VM cut points were used as reference to train the supervised ML models. Vector magnitude counts were classified by intensity based on three newly established wrist methods and the hip reference to examine classification accuracy. Daily estimates of PA were compared to the hip-reference criterion. RESULTS:In total, 3600 epochs with matched hip- and wrist-worn accelerometer VM counts were analyzed. All ML approaches performed differently on developing PA intensity cut points for wrist-worn accelerometers. Among the three ML models, k-means cluster analysis derived the following cut points: ?2556 counts per minute (cpm) for sedentary behavior, 2557-7064 cpm for LPA, 7065-14532 cpm for MPA, and ?14533 cpm for VPA; in addition, k-means cluster analysis had the highest classification accuracy, with more than 70% of the total epochs being classified into the correct PA categories, as examined by the hip reference. Additionally, k-means cut points exhibited the most accurate estimates on sedentary behavior, LPA, and VPA as the hip reference. None of the three wrist methods were able to accurately assess MPA. CONCLUSIONS:This study demonstrates the potential of ML approaches in establishing cut points for wrist-worn accelerometers to assess PA in preschoolers. However, the findings from this study warrant additional validation studies.

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Detection of Unilateral Arm Paresis after Stroke by Wearable Accelerometers and Machine Learning.

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