RESUMEN

Introduction: Unassisted rowing across the Atlantic Ocean is an extreme undertaking challenging the human body in every possible way. The reported rowing journey lasted for 42 days in a small vessel with 12 rowers, each rowing for 12 h a day, broken into 3 h shifts. This schedule disrupts the natural circadian cycle and autonomic balance, affecting subjective and objective wellbeing and sleep quality, that lack continuous empirical quantification. Methods: With a self-reported questionnaire and objective heart rate variability measurements every second day in a single female rower, we monitor evolutions of the subjective sleep quality and mental wellbeing as well as autonomic body control over the journey duration. We evaluate the hypothesis that extreme rowing impairs subjective and objective data in a similar way over time and that 3 h shifts diminish the circadian rhythm of the autonomic body control. Results: The sleep quality was mainly influenced by wake ups during sleep, while mental wellbeing was predominantly influenced by physical exhaustion. The perceived sleep quality and wellbeing dropped 2-3 days after the start with the rower not yet accommodated, in the middle of the journey with major wake ups, and again 5-6 days prior to the end with major exhaustion of the participant. Evolutions of the subjective perceptions diverge from that of the heart rate variability. The body's autonomic recovery during short sleep periods progressively decreases over the journey duration while the vagal activity rises and the sympathovagal balance shifts towards vagal tone. The shifts of 3 h weaken the circadian rhythm of the heart rate variability. Discussion: Our results demonstrate how human body meets extreme mental and physical exhaustion on the high seas. The gained physiological and psychological insights also offer a basis for effective preparation of undertakings involving extreme physical exhaustion and sleep deprivation.

RESUMEN

BACKGROUND: Chronic low back pain is a global health problem having a tremendous effect on the quality of life of patients. OBJECTIVES: An online therapy management system (TMS) is developed for comprehensive management of chronic low back pain patients. METHODS: A smartphone and a web app are built based on the Keep-In-Touch Telehealth Platform. The smartphone app allows entering patient reported outcomes and connection to third party devices to monitor physiological data and parameters of therapy. RESULTS: The TMS has been realized and a wearable auricular vagus nerve stimulation device has been integrated. The TMS is currently evaluated in a randomized clinical trial.

Asunto(s)

Dolor Crónico , Dolor de la Región Lumbar , Aplicaciones Móviles , Telemedicina , Dolor Crónico/terapia , Humanos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/terapia , Calidad de Vida , Teléfono Inteligente

RESUMEN

Auricular vagus nerve stimulation (aVNS) is a novel neuromodulatory therapy used for treatment of various chronic systemic disorders. Currently, aVNS is non-individualized, disregarding the physiological state of the patient and therefore making it difficult to reach optimum therapeutic outcomes. A closed-loop aVNS system is required to avoid over-stimulation and under-stimulation of patients, leading to personalized and thus improved therapy. This can be achieved by continuous monitoring of individual physiological parameters that serve as a basis for the selection of optimal aVNS settings. In this work we developed a novel aVNS hardware for closed-loop application, which utilizes cardiorespiratory sensing using embedded sensors (and/or external sensors), processes and analyzes the acquired data in real-time, and directly governs settings of aVNS. We show in-lab that aVNS stimulation can be arbitrarily synchronized with respiratory and cardiac phases (as derived from respiration belt, electrocardiography and/or photo plethysmography) while mimicking baroreceptor-related afferent input along the vagus nerve projecting into the brain. Our designed system identified > 90% of all respiratory and cardiac cycles and activated stimulation at the target point with a precision of ± 100 ms despite the intrinsic respiratory and heart rate variability reducing the predictability. The developed system offers a solid basis for future clinical research into closed-loop aVNS in favour of personalized therapy.