Francesc Claria

The term “bulbar involvement” is employed in ALS to refer to deterioration of motor neurons within the corticobulbar area of the brainstem, which results in speech and swallowing dysfunctions. One of the primary symptoms is a deterioration of the voice. Early detection is crucial for improving the quality of life and lifespan of ALS patients suffering from bulbar involvement. The main objective, and the principal contribution, of this research, was to design a new methodology, based on the phonatory-subsystem and time-frequency characteristics for detecting bulbar involvement automatically. This study focused on providing a set of 50 phonatory-subsystem and time-frequency features to detect this deficiency in males and females through the utterance of the five Spanish vowels. Multivariant Analysis of Variance was then used to select the statistically significant features, and the most common supervised classifications models were analyzed. A set of statistically significant features was obtained for males and females to capture this dysfunction. To date, the accuracy obtained (98.01% for females and 96.10% for males employing a random forest) outperformed the models in the literature. Adding time-frequency features to more classical phonatory-subsystem features increases the prediction capabilities of the machine-learning models for detecting bulbar involvement. Studying men and women separately gives greater success. The proposed method can be deployed in any kind of recording device (i.e., smartphone).

Spirometers are important devices for following up patients with respiratory diseases. These are mainly located only at hospitals, with all the disadvantages that this can entail. This limits their use and consequently, the supervision of patients. Research efforts focus on providing digital alternatives to spirometers. Although less accurate, the authors claim they are cheaper and usable by many more people worldwide at any given time and place. In order to further popularize the use of spirometers even more, we are interested in also providing user-friendly lung-capacity metrics instead of the traditional-spirometry ones. The main objective, which is also the main contribution of this research, is to obtain a person’s lung age by analyzing the properties of their exhalation by means of a machine-learning method. To perform this study, 188 samples of blowing sounds were used. These were taken from 91 males (48.4%) and 97 females (51.6%) aged between 17 and 67. A total of 42 spirometer and frequency-like features, including gender, were used. Traditional machine-learning algorithms used in voice recognition applied to the most significant features were used. We found that the best classification algorithm was the Quadratic Linear Discriminant algorithm when no distinction was made between gender. By splitting the corpus into age groups of 5 consecutive years, accuracy, sensitivity and specificity of, respectively, 94.69%, 94.45% and 99.45% were found. Features in the audio of users’ expiration that allowed them to be classified by their corresponding lung age group of 5 years were successfully detected. Our methodology can become a reliable tool for use with mobile devices to detect lung abnormalities or diseases.

Background: Bulbar involvement is a term used in amyotrophic lateral sclerosis (ALS) that refers to motor neuron impairment in the corticobulbar area of the brainstem, which produces a dysfunction of speech and swallowing. One of the earliest symptoms of bulbar involvement is voice deterioration characterized by grossly defective articulation; extremely slow, laborious speech; marked hypernasality; and severe harshness. Bulbar involvement requires well-timed and carefully coordinated interventions. Therefore, early detection is crucial to improving the quality of life and lengthening the life expectancy of patients with ALS who present with this dysfunction. Recent research efforts have focused on voice analysis to capture bulbar involvement.Objective: The main objective of this paper was (1) to design a methodology for diagnosing bulbar involvement efficiently through the acoustic parameters of uttered vowels in Spanish, and (2) to demonstrate that the performance of the automated diagnosis of bulbar involvement is superior to human diagnosis.Methods: The study focused on the extraction of features from the phonatory subsystem—jitter, shimmer, harmonics-to-noise ratio, and pitch—from the utterance of the five Spanish vowels. Then, we used various supervised classification algorithms, preceded by principal component analysis of the features obtained.Results: To date, support vector machines have performed better (accuracy 95.8%) than the models analyzed in the related work. We also show how the model can improve human diagnosis, which can often misdiagnose bulbar involvement.Conclusions: The results obtained are very encouraging and demonstrate the efficiency and applicability of the automated model presented in this paper. It may be an appropriate tool to help in the diagnosis of ALS by multidisciplinary clinical teams, in particular to improve the diagnosis of bulbar involvement.

BACKGROUND Bulbar involvement is a term used in amyotrophic lateral sclerosis (ALS) that refers to motor neuron impairment in the corticobulbar area of the brainstem, which produces a dysfunction of speech and swallowing. One of the earliest symptoms of bulbar involvement is voice deterioration characterized by grossly defective articulation; extremely slow, laborious speech; marked hypernasality; and severe harshness. Bulbar involvement requires well-timed and carefully coordinated interventions. Therefore, early detection is crucial to improving the quality of life and lengthening the life expectancy of patients with ALS who present with this dysfunction. Recent research efforts have focused on voice analysis to capture bulbar involvement. OBJECTIVE The main objective of this paper was (1) to design a methodology for diagnosing bulbar involvement efficiently through the acoustic parameters of uttered vowels in Spanish, and (2) to demonstrate that the performance of the automated diagnosis of bulbar involvement is superior to human diagnosis. METHODS The study focused on the extraction of features from the phonatory subsystem—jitter, shimmer, harmonics-to-noise ratio, and pitch—from the utterance of the five Spanish vowels. Then, we used various supervised classification algorithms, preceded by principal component analysis of the features obtained. RESULTS To date, support vector machines have performed better (accuracy 95.8%) than the models analyzed in the related work. We also show how the model can improve human diagnosis, which can often misdiagnose bulbar involvement. CONCLUSIONS The results obtained are very encouraging and demonstrate the efficiency and applicability of the automated model presented in this paper. It may be an appropriate tool to help in the diagnosis of ALS by multidisciplinary clinical teams, in particular to improve the diagnosis of bulbar involvement.

Introduction: This article is part of the Focus Theme of Methods of Information in Medicine on “Biosignal Interpretation: Advanced Methods for Neural Signals and Images“. Objectives: An efficient way to investigate the neural basis of nociceptive responses is the analysis of the event-related brain potentials (ERPs). The main objective of this work was to study how adaptation and fatigue affect the ERPs to stimuli of different modalities, by characterizing the responses to infrequent and frequent stimulation in different recording periods. Methods: In this work, series of averaged EEG epochs recorded after thermal, electrical and auditory stimulation were analyzed with time-frequency representation and non-linear measures as spectral entropy and auto-mutual information function. The study was performed by considering the traditional EEG frequency bands. Results: The defined measures presented a statistical significance p-value < 0.01 and accuracy higher than 60% by differentiating windows of response to infrequent (I) and frequent (F) stimuli between the start and end of the EEG recording. Conclusions: These measures permitted to observe some aspects of the subject’s adaptation and the nociceptive response.

The theory of Shannon entropy was applied to the Choi-Williams time-frequency distribution (CWD) of time series in order to extract entropy information in both time and frequency domains. In this way, four novel indexes were defined: (1) partial instantaneous entropy, calculated as the entropy of the CWD with respect to time by using the probability mass function at each time instant taken independently; (2) partial spectral information entropy, calculated as the entropy of the CWD with respect to frequency by using the probability mass function of each frequency value taken independently; (3) complete instantaneous entropy, calculated as the entropy of the CWD with respect to time by using the probability mass function of the entire CWD; (4) complete spectral information entropy, calculated as the entropy of the CWD with respect to frequency by using the probability mass function of the entire CWD. These indexes were tested on synthetic time series with different behavior (periodic, chaotic and random) and on a dataset of electroencephalographic (EEG) signals recorded in different states (eyes-open, eyes-closed, ictal and non-ictal activity). The results have shown that the values of these indexes tend to decrease, with different proportion, when the behavior of the synthetic signals evolved from chaos or randomness to periodicity. Statistical differences (p-value < 0.0005) were found between values of these measures comparing eyes-open and eyes-closed states and between ictal and non-ictal states in the traditional EEG frequency bands. Finally, this paper has demonstrated that the proposed measures can be useful tools to quantify the different periodic, chaotic and random components in EEG signals.