IntroductionA novel system that combines a compact mobile instrument and Internet communications is presented in this paper for remote evaluation of tremors. The system presents a high potential application in Parkinson's disease and connects to the Internet through a TCP/IP protocol. Tremor transduction is carried out by accelerometers, and the data processing, presentation and storage were obtained by a virtual instrument. The system supplies the peak frequency (fp), the amplitude (Afp) and power in this frequency (Pfp), the total power (Ptot), and the power in low (1-4 Hz) and high (4-7 Hz) frequencies (Plf and Phf, respectively).MethodsThe ability of the proposed system to detect abnormal tremors was initially demonstrated by a fatigue study in normal subjects. In close agreement with physiological fundamentals, the presence of fatigue increased fp, Afp, Pfp and Pt (p < 0.05), while the removal of fatigue reduced all the mentioned parameters (p < 0.05). The system was also evaluated in a preliminary in vivo test in parkinsonian patients. Afp, Pfp, Ptot, Plf and Phf were the most accurate parameters in the detection of the adverse effects of this disease (Se = 100%, Sp = 100%), followed by fp (Se = 100%, Sp = 80%). Tests for Internet transmission that realistically simulated clinical conditions revealed adequate acquisition and analysis of tremor signals and also revealed that the user could adequately receive medical recommendations.ConclusionsThe proposed system can be used in a wide spectrum of telemedicine scenarios, enabling the home evaluation of tremor occurrence under specific medical treatments and contributing to reduce the costs of the assistance offered to these patients.

Physiological studies of swallowing and the diagnosis and treatment of dysphagia are crucially dependent of detailed information of respiratory and feeding events. Home telemonitoring is of great interest in this area, where large numbers of people have long term conditions. The purpose of this study was twofold: (1) describe a new configurable instrument that can be used in ambulatory and telemedicine applications and (2) evaluate the performance of this device in the description of physiological and abnormal events during water swallowing. The instrument is able to detect when water is beginning to enter the mouth of the volunteer, to unobtrusively monitor the respiration, and to characterize the elevation of the larynx. The performance of the system was tested in normal subjects and patients with dysphagia, showing results in close agreement with the physiology. We concluded that the developed system could be a useful tool for the ambulatory evaluation of respiratory and feeding events and for the implementation of telemedicine services, contributing to reduce the costs of the assistance offered to patients with dysphagia.

The scientific and clinical value of a measure of complexity is potentially enormous because complexity appears to be lost in the presence of illness. The changes introduced by asthma in respiratory mechanics and control of breathing may result in modifications in the airflow pattern. These changes may be interesting clinically, since they can reduce the ability of the patient to perform daily life activities. In this paper, we examine the effect of elevated airway obstruction on the complexity of the airflow pattern of asthmatic patients using the approximate entropy method (ApEnQ). This study involved 5 healthy and asthmatics with normal spirometric exam (5), mild (5), moderate (6) and severe (5) airway obstruction. A significant (p〈0.002) reduction in ApEnQ was observed in asthmatic patients. This reduction was significantly correlated with spirometric indices of airway obstruction (R=0.60; p〈0.001). These results are in close agreement with pathophysiological fundamentals, and suggest that in asthmatic patients the airflow pattern becomes less complex, which may reduce the adaptability of the respiratory system to perform exercise associated with daily life activities. Furthermore, our findings also suggest that ApEnQ may help the clinical evaluation of asthmatic patients.

Changes in thoracoabdominal motion are highly prevalent in patients with chronic respiratory diseases. Home care services that use telemedicine techniques and Internet-based monitoring have the potential to improve the management of these patients. However, there is no detailed description in the literature of a system for Internet-based monitoring of patients with disturbed thoracoabdominal motion. The purpose of this work was to describe the development of a new telemedicine instrument for Internet-based home monitoring of thoracoabdominal movement. The instrument directly measures changes in the thorax and abdomen circumferences and transfers data through a transmission control protocol∕Internet protocol connection. After the design details are described, the accuracy of the electronic and software processing units of the instrument is evaluated by using electronic signals simulating normal subjects and individuals with thoracoabdominal motion disorders. The results obtained during in vivo studies on normal subjects simulating thoracoabdominal motion disorders showed that this new system is able to detect a reduction in abdominal movement that is associated with abnormal thoracic breathing (p < 0.0001) and the reduction in thoracic movement during abnormal abdominal breathing (p < 0.005). Simulated asynchrony in thoracoabdominal motion was also adequately detected by the system (p < 0.0001). The experimental results obtained for patients with respiratory diseases were in close agreement with the expected values, providing evidence that this instrument can be a useful tool for the evaluation of thoracoabdominal motion. The Internet transmission tests showed that the acquisition and analysis of the thoracoabdominal motion signals can be performed remotely. The user can also receive medical recommendations. The proposed system can be used in a spectrum of telemedicine scenarios, which can reduce the costs of assistance offered to patients with respiratory diseases.

Home telemonitoring is of great interest in respiratory medicine where large numbers of people have long term conditions. We developed a telemedicine instrument for home monitoring of patients with disturbed respiratory muscles. The instrument measures the maximum inspiratory pressure (Pimax), the inspiratory time constant (τ(i)) and connects to the Internet through TCP/IP protocol. The instrument was evaluated by means of a comparative analysis in 18 normal individuals and 15 COPD patients. In close agreement with the pathophysiology, a reduction in Pimax (p < 0.0001) and an increase in τ(i) (p < 0.001) was observed in COPD patients. We concluded that the developed system could be a useful tool for the evaluation of inspiratory muscle and for the implementation of telemedicine services, contributing to reduce the costs of the assistance offered to patients with respiratory diseases.