Patients' functional recovery at home following surgery may be evaluated by monitoring their activities of daily living. Existing tools for assessing these activities are labor-intensive to administer and rely heavily on recall. This study describes the use of a wireless ear-worn activity recognition sensor to monitor postoperative activity levels continuously using a Bayesian activity classification framework. The device was used to monitor the postoperative recovery of five patients following abdominal surgery. Activity was classified into four groups ranging from very low (level 0) to high (level 3). Overall, patients were found to be undertaking a higher proportion of level 0 activities on postoperative day 1 which was gradually replaced by higher-level activities over the next 3 days. This study demonstrates how a pervasive healthcare technology can objectively monitor functional recovery in the unsupervised home setting. This may be a useful adjunct to existing postoperative monitoring systems.
A series of 300 patients were implanted for chronic cerebellar stimulation (CCS) from February 1974 to June 1980. The charge density was in the range of 0.7–1.6 µCi/cm2/phase. There is a very narrow range of stimulation in which CCS is effective. Increasing above the range, clinical benefits cease; at levels over 10 µCi/cm2/phase, damage to the underlying conducting elements occurs which renders the prosthesis ineffective. Periodic monitoring of the implanted equipment is mandatory for a successful clinical program. Scalp recordings and radiography have detected a 53% failure rate in the I-108 RF linked system. The failed receivers were replaced with more reliable I-110 receivers and later with a fully implantable pulse generator. No change has been detected in the electrode button-cortex interface when measuring the access resistance up to 5 years later.
Surgery to the trunk often results in a change of gait, most pronounced during walking. This change is usually transient, often as a result of wound pain, and returns to normal as the patient recovers. Quantifying and monitoring gait impairment therefore represents a novel means of functional postoperative home recovery follow-up. Until now, this type of assessment could only be made in a gait lab, which is both expensive and labor intensive to administer on a large scale. The objective of this work is to validate the use of an ear-worn activity recognition (e-AR) sensor for quantification of gait impairment after abdominal wall and perianal surgery. The e-AR sensor was used on 2 comparative simulated data sets (N = 32) of truncal impairment to observe walking patterns. The sensor was also used to observe the walking patterns of preoperative and postoperative surgical patients who had undergone abdominal wall (n = 5) and perianal surgery (n = 5). Methods for multiresolution feature extraction, selection, and classification are investigated using the raw ear-sensor data. Results show that the method demonstrates a good separation between impaired and nonimpaired classes for both simulated and real patient data sets. This indicates that the e-AR sensor may be used as a tool for the pervasive assessment of postoperative gait impairment, as part of functional recovery monitoring, in patients at their own homes.
Of the 32 patients with active intractable seizures, 27 had spastic cerebral palsy (CP) and 5 had epilepsy (EP), and all underwent chronic cerebellar stimulation (CCS) (amplitude 1–2 µC/cm2phase, rate 10–180 pps, duration of implantation 0.5–7 years, average 4.5 years). Grand mal seizures occurred in 23 patients (19 CP, 4 EP); with CCS 17 patients stopped, 4 had a reduction, 3 were unchanged. Petit mal occurred in 9 patients (8 CP, 1 EP); with CCS 4 patients ceased seizuring, 3 reduced and 2 were unchanged. Myoclonic seizures were present in 6 patients (5 CP, 1 EP); with CCS 1 patient stopped, 3 had a reduction while 2 patients were unaffected. Severe psychomotor seizuring affected 2 EP patients, 1 had a marked behavioral improvement and finally stopped seizuring for the past 9 months. Overall, CCS stopped 18 (57%) of the patients seizuring, reduced a further 9 (28%), with no effect in 5 patients (15%).
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