Riverview Health Center

Winnipeg, Canada

Riverview Health Center

Winnipeg, Canada

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Yadollahi A.,University of Toronto | Yadollahi A.,Toronto Rehabilitation Institute | Yadollahi A.,University of Manitoba | Montazeri A.,University of Manitoba | And 3 more authors.
Annals of Biomedical Engineering | Year: 2013

Tracheal respiratory sound analysis is a simple and non-invasive way to study the pathophysiology of the upper airway and has recently been used for acoustic estimation of respiratory flow and sleep apnea diagnosis. However in none of the previous studies was the respiratory flow-sound relationship studied in people with obstructive sleep apnea (OSA), nor during sleep. In this study, we recorded tracheal sound, respiratory flow, and head position from eight non-OSA and 10 OSA individuals during sleep and wakefulness. We compared the flow-sound relationship and variations in model parameters from wakefulness to sleep within and between the two groups. The results show that during both wakefulness and sleep, flow-sound relationship follows a power law but with different parameters. Furthermore, the variations in model parameters may be representative of the OSA pathology. The other objective of this study was to examine the accuracy of respiratory flow estimation algorithms during sleep: we investigated two approaches for calibrating the model parameters using the known data recorded during either wakefulness or sleep. The results show that the acoustical respiratory flow estimation parameters change from wakefulness to sleep. Therefore, if the model is calibrated using wakefulness data, although the estimated respiratory flow follows the relative variations of the real flow, the quantitative flow estimation error would be high during sleep. On the other hand, when the calibration parameters are extracted from tracheal sound and respiratory flow recordings during sleep, the respiratory flow estimation error is less than 10%. © 2012 Biomedical Engineering Society.


PubMed | University of Western Ontario, Memorial University of Newfoundland, Li Ka Shing Knowledge Institute, Providence Healthcare and 8 more.
Type: Journal Article | Journal: The Lancet. Neurology | Year: 2016

Non-immersive virtual reality is an emerging strategy to enhance motor performance for stroke rehabilitation. There has been rapid adoption of non-immersive virtual reality as a rehabilitation strategy despite the limited evidence about its safety and effectiveness. Our aim was to compare the safety and efficacy of virtual reality with recreational therapy on motor recovery in patients after an acute ischaemic stroke.In this randomised, controlled, single-blind, parallel-group trial we enrolled adults (aged 18-85 years) who had a first-ever ischaemic stroke and a motor deficit of the upper extremity score of 3 or more (measured with the Chedoke-McMaster scale) within 3 months of randomisation from 14 in-patient stroke rehabilitation units from four countries (Canada [11], Argentina [1], Peru [1], and Thailand [1]). Participants were randomly allocated (1:1) by a computer-generated assignment at enrolment to receive a programme of structured, task-oriented, upper extremity sessions (ten sessions, 60 min each) of either non-immersive virtual reality using the Nintendo Wii gaming system (VRWii) or simple recreational activities (playing cards, bingo, Jenga, or ball game) as add-on therapies to conventional rehabilitation over a 2 week period. All investigators assessing outcomes were masked to treatment assignment. The primary outcome was upper extremity motor performance measured by total time to complete the Wolf Motor Function Test (WMFT) at the end of the 2 week intervention period, analysed in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NTC01406912.The study was done between May 12, 2012, and Oct 1, 2015. We randomly assigned 141 patients: 71 received VRWii therapy and 70 received recreational activity. 121 (86%) patients (59 in the VRWii group and 62 in the recreational activity group) completed the final assessment and were included in the primary analysis. Each group improved WMFT performance time relative to baseline (decrease in median time from 437 s [IQR 261-680] to 297 s [214-452], 320% reduction for VRWii vs 380 s [IQR 280-641] to 271 s [212-455], 287% reduction for recreational activity). Mean time of conventional rehabilitation during the trial was similar between groups (VRWii, 373 min [SD 322] vs recreational activity, 397 min [345]; p=070) as was the total duration of study intervention (VRWii, 528 min [SD 155] vs recreational activity, 541 min [142]; p=060). Multivariable analysis adjusted for baseline WMFT score, age, sex, baseline Chedoke-McMaster, and stroke severity revealed no significant difference between groups in the primary outcome (adjusted mean estimate of difference in WMFT: 41 s, 95% CI -144 to 226). There were three serious adverse events during the trial, all deemed to be unrelated to the interventions (seizure after discharge and intracerebral haemorrhage in the recreational activity group and heart attack in the VRWii group). Overall incidences of adverse events and serious adverse events were similar between treatment groups.In patients who had a stroke within the 3 months before enrolment and had mild-to-moderate upper extremity motor impairment, non-immersive virtual reality as an add-on therapy to conventional rehabilitation was not superior to a recreational activity intervention in improving motor function, as measured by WMFT. Our study suggests that the type of task used in motor rehabilitation post-stroke might be less relevant, as long as it is intensive enough and task-specific. Simple, low-cost, and widely available recreational activities might be as effective as innovative non-immersive virtual reality technologies.Heart and Stroke Foundation of Canada and Ontario Ministry of Health.


Montazeri A.,University of Manitoba | Giannouli E.,University of Manitoba | Moussavi Z.,University of Manitoba | Moussavi Z.,Riverview Health Center
Annals of Biomedical Engineering | Year: 2012

In this article, a novel technique for assessment of obstructive sleep apnea (OSA) during wakefulness is proposed; the technique is based on tracheal breath sound analysis of normal breathing in upright sitting and supine body positions. We recorded tracheal breath sounds of 17 non-apneic individuals and 35 people with various degrees of severity of OSA in supine and upright sitting positions during both nose and mouth breathing at medium flow rate. We calculated the power spectrum, Kurtosis, and Katz fractal dimensions of the recorded signals and used the one-way analysis of variance to select the features, which were statistically significant between the groups. Then, the maximum relevancy minimum redundancy method was used to reduce the number of characteristic features to two. Using the best two selected features, we classified the participant into severe OSA and non-OSA groups as well as non-OSA or mild vs. moderate and severe OSA groups; the results showed more than 91 and 83% accuracy; 85 and 81% specificity; 92 and 95% sensitivity, for the two types of classification, respectively. The results are encouraging for identifying people with OSA and also prediction of OSA severity. Once verified on a larger population, the proposed method offers a simple and non-invasive screening tool for prediction of OSA during wakefulness. © 2011 Biomedical Engineering Society.


Rumbolt C.B.C.,University of Manitoba | Hooper D.R.,Riverview Health Center
Muscle and Nerve | Year: 2015

Introduction: In patients with clinically diagnosed carpal tunnel syndrome (CTS) the more symptomatic hand may be different from the more severely affected hand on electrodiagnostic testing. This study aims to determine the level of agreement which should be expected between these measures and consequently the level of suspicion for co-occurring pathology which is warranted if there is discordance. Methods: This was a single center retrospective review of 252 patients referred for upper extremity electrodiagnostic evaluation who were diagnosed subsequently with CTS. Comparison was made between the patient's perceived worst side and the more abnormal side on electrodiagnostic studies. Results: We found a significant level of agreement (κ=0.676) between patient symptoms and electrodiagnostic testing when identifying the side with more severe CTS. Conclusions: Discordance between patient perception and electrodiagnostic results regarding which hand is affected more severely in patients with CTS should alert the clinician to possible coexisting nonneurologic pathology and prompt regional musculoskeletal examination as indicated. © 2014 Wiley Periodicals, Inc.


Lobchuk M.M.,University of Manitoba | Rosenberg F.,Riverview Health Center
Journal of Wound, Ostomy and Continence Nursing | Year: 2014

PURPOSE: The purpose of the original mixed-design study was to compare affected individual and family caregiver perceptions of urinary incontinence quality of life in relation to their empathic responses toward one another and to explore their qualitative responses of factors that hinder or facilitate these responses. The aim of this secondary analysis is to report responses shared by affected individuals and family caregivers on how their lives have been impacted by urinary incontinence. DESIGN: Qualitative study with content analysis. SUBJECTS AND SETTING: The sample comprised 13 persons with urinary incontinence and 13 family caregivers. Their mean age was 78 years and the mean age for caregivers was 67 years. Caregivers were mainly the spouses or daughters of affected respondents. Interviews were conducted in participants' homes in Winnipeg, Manitoba, Canada. METHODS: Data were collected via 26 audio-recorded interviews. Content analysis was used to capture major themes arising from the data. RESULTS: Five major themes with respective subthemes highlight how urinary incontinence infl uenced the quality of life of affected individuals and their family caregivers, including (1) life changes, (2) psychological responses and coping, (3) painful responses of others, (4) reticence to seek medical attention, and (5) advice to health care professionals. CONCLUSIONS: Health care professionals should recognize that dealing with urinary incontinence in the home is a "team effort" between affected individuals and family caregivers. Educational efforts need to counter attitudes in care providers who avoid talking about urinary continence and enhance sensitivities toward affected individuals' and family caregivers' ongoing need for control in continence care based on their unique needs and preferences. © 2014 by the Wound, Ostomy and Continence Nurses Society.


Friesen M.R.,University of Manitoba | Hamel C.,Riverview Health Center | McLeod R.D.,University of Manitoba
International Journal of Environmental Research and Public Health | Year: 2013

This paper reports on the findings of a user trial of a mHealth application for pressure ulcer (bedsore) documentation. Pressure ulcers are a leading iatrogenic cause of death in developed countries and significantly impact quality of life for those affected. Pressure ulcers will be an increasing public health concern as the population ages. Electronic information systems are being explored to improve consistency and accuracy of documentation, improve patient and caregiver experience and ultimately improve patient outcomes. A software application was developed for Android Smartphones and tablets and was trialed in a personal care home in Western Canada. The software application provides an electronic medical record for chronic wounds, replacing nurses' paper-based charting and is positioned for integration with facility's larger eHealth framework. The mHealth application offers three intended benefits over paper-based charting of chronic wounds, including: (1) the capacity for remote consultation (telehealth between facilities, practitioners, and/or remote communities), (2) data organization and analysis, including built-in alerts, automatically-generated text-based and graph-based wound histories including wound images, and (3) tutorial support for non-specialized caregivers. The user trial yielded insights regarding the software application's design and functionality in the clinical setting, and highlighted the key role of wound photographs in enhancing patient and caregiver experiences, enhancing communication between multiple healthcare professionals, and leveraging the software's telehealth capacities. © 2013 by the authors; licensee MDPI, Basel, Switzerland.


Azarbarzin A.,University of Manitoba | Moussavi Z.,University of Manitoba | Moussavi Z.,Riverview Health Center
Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS | Year: 2012

This paper presents the results of our study on investigating the acoustical properties of snoring sounds (SS) recorded by two microphones (one over trachea and one hung in the air within 30-50 cm away from the subject) in relation to sleep apnea. Several features were extracted from SS segments of 50 snorers with different Apnea-Hypopnea Index (AHI). We used an optimal subset of the sound features to cluster the SS segments into two clusters (A and B). Then, the number of SS segments in cluster A was calculated and normalized by the total number of SS segments for each subject, resulting in 50×1 vector R. A correlation analysis was run between AHI and R. The results show a difference in acoustical properties of the tracheal and ambient snoring sounds and their ability to distinguish two types of snoring; the ambient snoring sounds are not as characteristic as tracheal snoring sounds. © 2012 IEEE.


Sarraf Shirazi S.,University of Manitoba | Birjandi A.H.,University of Manitoba | Moussavi Z.,University of Manitoba | Moussavi Z.,Riverview Health Center
Medical and Biological Engineering and Computing | Year: 2014

Swallowing aspiration is known as the most clinically significant symptom of swallowing disorders (dysphagia). Noninvasive methods for detection of aspiration (the entry of food into airway due to dysphagia) are of great interest as they will lead to better management of dysphagia; thus, the risk of pneumonia, length of hospital stay and overall health care expenses can be reduced. The risk of aspiration is much higher in severely dysphagic patients. Normally, aspiration is detected by an imaging technique during swallowing, which is time consuming, costly and requires the patient's cooperation. In this study, we investigated the application of acoustical analysis of breathing and swallowing sounds for identifying patients at high risk of aspiration. We propose a novel method based on phase-space analysis of breathing sounds immediately after the swallow followed by support vector machine classification for use as a diagnostic aid for identifying patients with high risk of aspiration. We evaluated the method using breath and swallowing sounds recorded from 50 dysphagic individuals, 27 of which demonstrated silent aspiration (without cough or throat clearance) during either fiberoptic endoscopic evaluation of swallowing (FEES) or videofluoroscopic swallowing (VFS) assessment. The classification result of the proposed method was compared with those of the FEES/VFS assessment provided by speech-language pathologists; it showed 91 % sensitivity and 85 % specificity in detection of patients with severe aspiration (high risk dysphagia). The result is promising to suggest the proposed phase-space acoustical analysis method as a quick and noninvasive screening clinical tool to detect patients developing severe aspiration. © 2014 International Federation for Medical and Biological Engineering.


Azarbarzin A.,University of Manitoba | Moussavi Z.,University of Manitoba | Moussavi Z.,Riverview Health Center
Medical Engineering and Physics | Year: 2013

Snoring sounds vary significantly within and between snorers. In this study, the variation of snoring sounds and its association with obstructive sleep apnea (OSA) are quantified. Snoring sounds of 42 snorers with different degrees of obstructive sleep apnea and 15 non-OSA snorers were analyzed. The sounds were recorded by a microphone placed over the suprasternal notch of trachea, simultaneously with polysomnography (PSG) data over the entire night. We hypothesize that snoring sounds vary significantly within a subject depending on the level of obstruction, and thus the level of airflow. We also hypothesize that this variability is associated with the severity of OSA. For each individual, we extracted snoring sound segments from the respiratory recordings, and divided them into three classes: non-apneic, hypopneic, and post-apneic using their PSG information. Several features were extracted from the snoring sound segments, and compared using a nonparametric statistical test. The results show significant shift in the median of features among the snoring sound classes (p< 0.00001) of an individual. In contrast to hypopneic and post-apneic classes, the characteristics of snoring sounds did not vary significantly over time in non-apneic class. Therefore, we used the total variation norm of each subject to classify the participants as OSA and non-OSA snorers. The results showed 92.9% sensitivity, 100% specificity and 96.4% accuracy. © 2012 IPEM.


Sarraf Shirazi S.,University of Manitoba | Buchel C.,Riverview Health Center | Daun R.,Riverview Health Center | Lenton L.,Riverview Health Center | And 2 more authors.
Medical and Biological Engineering and Computing | Year: 2012

In this study, the feasibility of acoustical analysis for detection of swallowing silent aspiration is investigated. As a pilot study, we analyzed the breath sounds of 21 dysphagic individuals, 11 of which demonstrated aspiration during the fiberoptic endoscopic evaluation of swallowing (FEES) or videofluoroscopic swallowing study (VFSS). We found that the low frequency components of the power spectrum of the breath sounds after a swallow show higher magnitude when there is aspiration. Thus, we divided the frequency range below 300 Hz into three sub-bands and calculated the average power of the breath sound signal in each sub-band as the characteristic features for the stage 1 classification into two groups of aspirated and non-aspirated patients. Then, for the aspirated group, the unsupervised fuzzy k-means clustering algorithm was deployed to label the breath sounds immediately after a swallow as aspiration or non-aspiration. The results were compared with the FEES/VFSS assessments provided by the speech language pathologists. The results are encouraging: more than 86 % accuracy in detection of silent aspiration. While the proposed method should be verified on a larger dataset, the results are promising for the use of acoustical analysis as a clinical tool to detect silent aspiration. © 2012 International Federation for Medical and Biological Engineering.

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