Displaying publications 1 - 20 of 42 in total

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  1. Palaniappan R, Sundaraj K, Sundaraj S, Huliraj N, Revadi SS
    Clin Respir J, 2016 Jul;10(4):486-94.
    PMID: 25515741 DOI: 10.1111/crj.12250
    BACKGROUND: Monitoring respiration is important in several medical applications. One such application is respiratory rate monitoring in patients with sleep apnoea. The respiratory rate in patients with sleep apnoea disorder is irregular compared with the controls. Respiratory phase detection is required for a proper monitoring of respiration in patients with sleep apnoea.

    AIMS: To develop a model to detect the respiratory phases present in the pulmonary acoustic signals and to evaluate the performance of the model in detecting the respiratory phases.

    METHODS: Normalised averaged power spectral density for each frame and change in normalised averaged power spectral density between the adjacent frames were fuzzified and fuzzy rules were formulated. The fuzzy inference system (FIS) was developed with both Mamdani and Sugeno methods. To evaluate the performance of both Mamdani and Sugeno methods, correlation coefficient and root mean square error (RMSE) were calculated.

    RESULTS: In the correlation coefficient analysis in evaluating the fuzzy model using Mamdani and Sugeno method, the strength of the correlation was found to be r = 0.9892 and r = 0.9964, respectively. The RMSE for Mamdani and Sugeno methods are RMSE = 0.0853 and RMSE = 0.0817, respectively.

    CONCLUSION: The correlation coefficient and the RMSE of the proposed fuzzy models in detecting the respiratory phases reveals that Sugeno method performs better compared with the Mamdani method.

  2. Nabi FG, Sundaraj K, Lam CK, Palaniappan R
    J Asthma, 2020 04;57(4):353-365.
    PMID: 30810448 DOI: 10.1080/02770903.2019.1576193
    Objective: This study aimed to statistically analyze the behavior of time-frequency features in digital recordings of wheeze sounds obtained from patients with various levels of asthma severity (mild, moderate, and severe), and this analysis was based on the auscultation location and/or breath phase. Method: Segmented and validated wheeze sounds were collected from the trachea and lower lung base (LLB) of 55 asthmatic patients during tidal breathing maneuvers and grouped into nine different datasets. The quartile frequencies F25, F50, F75, F90 and F99, mean frequency (MF) and average power (AP) were computed as features, and a univariate statistical analysis was then performed to analyze the behavior of the time-frequency features. Results: All features generally showed statistical significance in most of the datasets for all severity levels [χ2 = 6.021-71.65, p 
  3. Yuvaraj R, Murugappan M, Omar MI, Ibrahim NM, Sundaraj K, Mohamad K, et al.
    Int J Neurosci, 2014 Jul;124(7):491-502.
    PMID: 24168328 DOI: 10.3109/00207454.2013.860527
    Although an emotional deficit is a common finding in Parkinson's disease (PD), its neurobiological mechanism on emotion recognition is still unknown. This study examined the emotion processing deficits in PD patients using electroencephalogram (EEG) signals in response to multimodal stimuli.
  4. Ali MA, Sundaraj K, Ahmad RB, Ahamed NU, Islam MA, Sundaraj S
    Technol Health Care, 2014;22(4):617-25.
    PMID: 24990168 DOI: 10.3233/THC-140833
    Normally, surface electromyography electrodes are used to evaluate the activity of superficial muscles during various kinds of voluntary contractions of muscle fiber. The objective of the present study was to investigate the effect of repetitive isometric contractions on the three heads of the triceps brachii muscle during handgrip force exercise.
  5. Samsudin WS, Sundaraj K, Ahmad A, Salleh H
    Technol Health Care, 2016 Mar 14;24(2):287-94.
    PMID: 26578273 DOI: 10.3233/THC-151103
    An initial assessment method that can classify as well as categorize the severity of paralysis into one of six levels according to the House-Brackmann (HB) system based on facial landmarks motion using an Optical Flow (OF) algorithm is proposed. The desired landmarks were obtained from the video recordings of 5 normal and 3 Bell's Palsy subjects and tracked using the Kanade-Lucas-Tomasi (KLT) method. A new scoring system based on the motion analysis using area measurement is proposed. This scoring system uses the individual scores from the facial exercises and grades the paralysis based on the HB system. The proposed method has obtained promising results and may play a pivotal role towards improved rehabilitation programs for patients.
  6. Ahamed NU, Sundaraj K, Alqahtani M, Altwijri O, Ali MA, Islam MA
    Technol Health Care, 2014 Oct 15.
    PMID: 25318958
    BACKGROUND: The relationship between surface electromyography (EMG) and force have been the subject of ongoing investigations and remain a subject of controversy. Even under static conditions, the relationships at different sensor placement locations in the biceps brachii (BB) muscle are complex.

    OBJECTIVE: The aim of this study was to compare the activity and relationship between surface EMG and static force from the BB muscle in terms of three sensor placement locations.

    METHODS: Twenty-one right hand dominant male subjects (age 25.3 ± 1.2 years) participated in the study. Surface EMG signals were detected from the subject's right BB muscle. The muscle activation during force was determined as the root mean square (RMS) electromyographic signal normalized to the peak RMS EMG signal of isometric contraction for 10 s. The statistical analysis included linear regression to examine the relationship between EMG amplitude and force of contraction [40-100% of maximal voluntary contraction (MVC)], repeated measures ANOVA to assess differences among the sensor placement locations, and coefficient of variation (CoV) for muscle activity variation.

    RESULTS: The results demonstrated that when the sensor was placed on the muscle belly, the linear slope coefficient was significantly greater for EMG versus force testing (r^{2} = 0.61, P > 0.05) than when placed on the lower part (r^{2}=0.31, P< 0.05) and upper part of the muscle belly (r^{2}=0.29, P > 0.05). In addition, the EMG signal activity on the muscle belly had less variability than the upper and lower parts (8.55% vs. 15.12% and 12.86%, respectively).

    CONCLUSION: These findings indicate the importance of applying the surface EMG sensor at the appropriate locations that follow muscle fiber orientation of the BB muscle during static contraction. As a result, EMG signals of three different placements may help to understand the difference in the amplitude of the signals due to placement.

  7. Sahayadhas A, Sundaraj K, Murugappan M
    Sensors (Basel), 2012 Dec 07;12(12):16937-53.
    PMID: 23223151 DOI: 10.3390/s121216937
    In recent years, driver drowsiness has been one of the major causes of road accidents and can lead to severe physical injuries, deaths and significant economic losses. Statistics indicate the need of a reliable driver drowsiness detection system which could alert the driver before a mishap happens. Researchers have attempted to determine driver drowsiness using the following measures: (1) vehicle-based measures; (2) behavioral measures and (3) physiological measures. A detailed review on these measures will provide insight on the present systems, issues associated with them and the enhancements that need to be done to make a robust system. In this paper, we review these three measures as to the sensors used and discuss the advantages and limitations of each. The various ways through which drowsiness has been experimentally manipulated is also discussed. We conclude that by designing a hybrid drowsiness detection system that combines non-intrusive physiological measures with other measures one would accurately determine the drowsiness level of a driver. A number of road accidents might then be avoided if an alert is sent to a driver that is deemed drowsy.
  8. Uwamahoro R, Sundaraj K, Feroz FS
    Sensors (Basel), 2023 Sep 29;23(19).
    PMID: 37836995 DOI: 10.3390/s23198165
    Neuromuscular electrical stimulation plays a pivotal role in rehabilitating muscle function among individuals with neurological impairment. However, there remains uncertainty regarding whether the muscle's response to electrical excitation is affected by forearm posture, joint angle, or a combination of both factors. This study aimed to investigate the effects of forearm postures and elbow joint angles on the muscle torque and MMG signals. Measurements of the torque around the elbow and MMG of the biceps brachii (BB) muscle were conducted in 36 healthy subjects (age, 22.24 ± 2.94 years; height, 172 ± 0.5 cm; and weight, 67.01 ± 7.22 kg) using an in-house elbow flexion testbed and neuromuscular electrical stimulation (NMES) of the BB muscle. The BB muscle was stimulated while the forearm was positioned in the neutral, pronation, or supination positions. The elbow was flexed at angles of 10°, 30°, 60°, and 90°. The study analyzed the impact of the forearm posture(s) and elbow joint angle(s) on the root-mean-square value of the torque (TQRMS). Subsequently, various MMG parameters, such as the root-mean-square value (MMGRMS), the mean power frequency (MMGMPF), and the median frequency (MMGMDF), were analyzed along the longitudinal, lateral, and transverse axes of the BB muscle fibers. The test-retest interclass correlation coefficient (ICC21) for the torque and MMG ranged from 0.522 to 0.828. Repeated-measure ANOVAs showed that the forearm posture and elbow flexion angle significantly influenced the TQRMS (p < 0.05). Similarly, the MMGRMS, MMGMPF, and MMGMDF showed significant differences among all the postures and angles (p < 0.05). However, the combined main effect of the forearm posture and elbow joint angle was insignificant along the longitudinal axis (p > 0.05). The study also found that the MMGRMS and TQRMS increased with increases in the joint angle from 10° to 60° and decreased at greater angles. However, during this investigation, the MMGMPF and MMGMDF exhibited a consistent decrease in response to increases in the joint angle for the lateral and transverse axes of the BB muscle. These findings suggest that the muscle contraction evoked by NMES may be influenced by the interplay between actin and myosin filaments, which are responsible for muscle contraction and are, in turn, influenced by the muscle length. Because restoring the function of limbs is a common goal in rehabilitation services, the use of MMG in the development of methods that may enable the real-time tracking of exact muscle dimensional changes and activation levels is imperative.
  9. Talib I, Sundaraj K, Lam CK
    Sci Rep, 2019 11 07;9(1):16166.
    PMID: 31700129 DOI: 10.1038/s41598-019-52536-4
    This study aimed to quantify the association of four anthropometric parameters of the human arm, namely, the arm circumference (CA), arm length (LA), skinfold thickness (ST) and inter-sensor distance (ISD), with amplitude (RMS) and crosstalk (CT) of mechanomyography (MMG) signals. Twenty-five young, healthy, male participants were recruited to perform forearm flexion, pronation and supination torque tasks. Three accelerometers were employed to record the MMG signals from the biceps brachii (BB), brachialis (BRA) and brachioradialis (BRD) at 80% maximal voluntary contraction (MVC). Signal RMS was used to quantify the amplitude of the MMG signals from a muscle, and cross-correlation coefficients were used to quantify the magnitude of the CT among muscle pairs (BB & BRA, BRA & BRD, and BB & BRD). For all investigated muscles and pairs, RMS and CT showed negligible to low negative correlations with CA, LA and ISD (r = -0.0001--0.4611), and negligible to moderate positive correlations with ST (r = 0.004-0.511). However, almost all of these correlations were statistically insignificant (p > 0.05). These findings suggest that RMS and CT values for the elbow flexor muscles recorded and quantified using accelerometers appear invariant to anthropometric parameters.
  10. Talib I, Sundaraj K, Hussain J, Lam CK, Ahmad Z
    Sci Rep, 2022 Sep 27;12(1):16086.
    PMID: 36168025 DOI: 10.1038/s41598-022-20223-6
    This study aimed to analyze anthropometrics and mechanomyography (MMG) signals as forearm flexion, pronation, and supination torque predictors. 25 young, healthy, male participants performed isometric forearm flexion, pronation, and supination tasks from 20 to 100% maximal voluntary isometric contraction (MVIC) while maintaining 90° at the elbow joint. Nine anthropometric measures were recorded, and MMG signals from the biceps brachii (BB), brachialis (BRA), and brachioradialis (BRD) muscles were digitally acquired using triaxial accelerometers. These were then correlated with torque values. Significant positive correlations were found for arm circumference (CA) and MMG root mean square (RMS) values with flexion torque. Flexion torque might be predicted using CA (r = 0.426-0.575), a pseudo for muscle size while MMGRMS (r = 0.441), an indication of muscle activation.
  11. Ahamed NU, Sundaraj K, Poo TS
    Proc Inst Mech Eng H, 2013 Mar;227(3):262-74.
    PMID: 23662342
    This article describes the design of a robust, inexpensive, easy-to-use, small, and portable online electromyography acquisition system for monitoring electromyography signals during rehabilitation. This single-channel (one-muscle) system was connected via the universal serial bus port to a programmable Windows operating system handheld tablet personal computer for storage and analysis of the data by the end user. The raw electromyography signals were amplified in order to convert them to an observable scale. The inherent noise of 50 Hz (Malaysia) from power lines electromagnetic interference was then eliminated using a single-hybrid IC notch filter. These signals were sampled by a signal processing module and converted into 24-bit digital data. An algorithm was developed and programmed to transmit the digital data to the computer, where it was reassembled and displayed in the computer using software. Finally, the following device was furnished with the graphical user interface to display the online muscle strength streaming signal in a handheld tablet personal computer. This battery-operated system was tested on the biceps brachii muscles of 20 healthy subjects, and the results were compared to those obtained with a commercial single-channel (one-muscle) electromyography acquisition system. The results obtained using the developed device when compared to those obtained from a commercially available physiological signal monitoring system for activities involving muscle contractions were found to be comparable (the comparison of various statistical parameters) between male and female subjects. In addition, the key advantage of this developed system over the conventional desktop personal computer-based acquisition systems is its portability due to the use of a tablet personal computer in which the results are accessible graphically as well as stored in text (comma-separated value) form.
  12. Islam MA, Sundaraj K, Ahmad RB, Sundaraj S, Ahamed NU, Ali MA
    PLoS One, 2014;9(8):e104280.
    PMID: 25090008 DOI: 10.1371/journal.pone.0104280
    In mechanomyography (MMG), crosstalk refers to the contamination of the signal from the muscle of interest by the signal from another muscle or muscle group that is in close proximity.
  13. Islam MA, Sundaraj K, Ahmad RB, Sundaraj S, Ahamed NU, Ali MA
    PLoS One, 2014;9(5):e96628.
    PMID: 24802858 DOI: 10.1371/journal.pone.0096628
    This study aimed: i) to examine the relationship between the magnitude of cross-talk in mechanomyographic (MMG) signals generated by the extensor digitorum (ED), extensor carpi ulnaris (ECU), and flexor carpi ulnaris (FCU) muscles with the sub-maximal to maximal isometric grip force, and with the anthropometric parameters of the forearm, and ii) to quantify the distribution of the cross-talk in the MMG signal to determine if it appears due to the signal component of intramuscular pressure waves produced by the muscle fibers geometrical changes or due to the limb tremor.
  14. Islam MA, Sundaraj K, Ahmad RB, Ahamed NU
    PLoS One, 2013;8(3):e58902.
    PMID: 23536834 DOI: 10.1371/journal.pone.0058902
    BACKGROUND: Mechanomyography (MMG) has been extensively applied in clinical and experimental practice to examine muscle characteristics including muscle function (MF), prosthesis and/or switch control, signal processing, physiological exercise, and medical rehabilitation. Despite several existing MMG studies of MF, there has not yet been a review of these. This study aimed to determine the current status on the use of MMG in measuring the conditions of MFs.

    METHODOLOGY/PRINCIPAL FINDINGS: Five electronic databases were extensively searched for potentially eligible studies published between 2003 and 2012. Two authors independently assessed selected articles using an MS-Word based form created for this review. Several domains (name of muscle, study type, sensor type, subject's types, muscle contraction, measured parameters, frequency range, hardware and software, signal processing and statistical analysis, results, applications, authors' conclusions and recommendations for future work) were extracted for further analysis. From a total of 2184 citations 119 were selected for full-text evaluation and 36 studies of MFs were identified. The systematic results find sufficient evidence that MMG may be used for assessing muscle fatigue, strength, and balance. This review also provides reason to believe that MMG may be used to examine muscle actions during movements and for monitoring muscle activities under various types of exercise paradigms.

    CONCLUSIONS/SIGNIFICANCE: Overall judging from the increasing number of articles in recent years, this review reports sufficient evidence that MMG is increasingly being used in different aspects of MF. Thus, MMG may be applied as a useful tool to examine diverse conditions of muscle activity. However, the existing studies which examined MMG for MFs were confined to a small sample size of healthy population. Therefore, future work is needed to investigate MMG, in examining MFs between a sufficient number of healthy subjects and neuromuscular patients.

  15. Hussain J, Sundaraj K, Subramaniam ID
    PLoS One, 2020;15(1):e0228089.
    PMID: 31999750 DOI: 10.1371/journal.pone.0228089
    INTRODUCTION: Cognitive stress (CS) changes the peripheral attributes of a muscle, but its effect on multi-head muscles has not been investigated. The objective of the current research was to investigate the impact of CS on the three heads of the triceps brachii (TB) muscle.

    METHODS: Twenty-five young and healthy university students performed a triceps push-down exercise at 45% one repetition maximum (1RM) with and without CS until task failure, and the rate of fatigue (ROF), endurance time (ET) and number of repetitions (NR) for both exercises were analyzed. In addition, the first and last six repetitions of each exercise were considered non-fatiguing (NF) and fatiguing (Fa), respectively, and the root mean square (RMS), mean power frequency (MPF) and median frequency (MDF) for each exercise repetition were evaluated.

    RESULTS: The lateral and long head showed significant differences (P<0.05) in the ROF between the two exercises, and all the heads showed significant (P<0.05) differences in the RMS between the two exercises under NF conditions. Only the long head showed a significant difference (P<0.05) in the MPF and MDF between the two exercises. CS increases the ET (24.74%) and NR (27%) of the exercise. The three heads showed significant differences (P<0.05) in the RMS, MPF and MDF under all exercise conditions.

    CONCLUSION: A lower ROF was obtained with CS. In addition, the RMS was found to be better approximator of CS, whereas MPF and MDF were more resistant to the effect of CS. The results showed that the three heads worked independently under all conditions, and the non-synergist and synergist head pairs showed similar behavior under Fa conditions. The findings from this study provide additional insights regarding the functioning of each TB head.

  16. Islam A, Sundaraj K, Ahmad RB, Sundaraj S, Ahamed NU, Ali MA
    Muscle Nerve, 2015 Jun;51(6):899-906.
    PMID: 25204740 DOI: 10.1002/mus.24454
    In this study, we analyzed the crosstalk in mechanomyographic (MMG) signals generated by the extensor digitorum (ED), extensor carpi ulnaris (ECU), and flexor carpi ulnaris (FCU) muscles of the forearm during wrist flexion (WF) and extension (WE) and radial (RD) and ulnar (UD) deviations.
  17. Lam CK, Sundaraj K, Sulaiman MN
    Medicina (Kaunas), 2013;49(1):1-8.
    PMID: 23652710
    The aim of this study was to review the capability of virtual reality simulators in the application of phacoemulsification cataract surgery training. Our review included the scientific publications on cataract surgery simulators that had been developed by different groups of researchers along with commercialized surgical training products, such as EYESI® and PhacoVision®. The review covers the simulation of the main cataract surgery procedures, i.e., corneal incision, capsulorrhexis, phacosculpting, and intraocular lens implantation in various virtual reality surgery simulators. Haptics realism and visual realism of the procedures are the main elements in imitating the actual surgical environment. The involvement of ophthalmology in research on virtual reality since the early 1990s has made a great impact on the development of surgical simulators. Most of the latest cataract surgery training systems are able to offer high fidelity in visual feedback and haptics feedback, but visual realism, such as the rotational movements of an eyeball with response to the force applied by surgical instruments, is still lacking in some of them. The assessment of the surgical tasks carried out on the simulators showed a significant difference in the performance before and after the training.
  18. Ahamed NU, Ahmed N, Alqahtani M, Altwijri O, Ahmad RB, Sundaraj K
    J Phys Ther Sci, 2015 Jan;27(1):39-40.
    PMID: 25642033 DOI: 10.1589/jpts.27.39
    [Purpose] This study investigated the changes in the slope of EMG-time curves (relationship) at the maximal and different levels of dynamic (eccentric and concentric) and static (isometric) contractions. [Subjects and Methods] The subject was a 17 year-old male adolescent. The surface EMG signal of the dominant arm's biceps brachii (BB) was recorded through electrodes placed on the muscle belly. [Results] The results obtained during the contractions show that the regression slope was very close to 1.00 during concentric contraction, whereas those of eccentric and isometric contractions were lower. Significant differences were found for the EMG amplitude and time lags among the contractions. [Conclusion] The results show that the EMG signal of the BB varies among the three modes of contraction and the relationship of the EMG amplitude with a time lag gives the best fit during concentric contraction.
  19. Yuvaraj R, Murugappan M, Ibrahim NM, Sundaraj K, Omar MI, Mohamad K, et al.
    J Neural Transm (Vienna), 2015 Feb;122(2):237-52.
    PMID: 24894699 DOI: 10.1007/s00702-014-1249-4
    Parkinson's disease (PD) is not only characterized by its prominent motor symptoms but also associated with disturbances in cognitive and emotional functioning. The objective of the present study was to investigate the influence of emotion processing on inter-hemispheric electroencephalography (EEG) coherence in PD. Multimodal emotional stimuli (happiness, sadness, fear, anger, surprise, and disgust) were presented to 20 PD patients and 30 age-, education level-, and gender-matched healthy controls (HC) while EEG was recorded. Inter-hemispheric coherence was computed from seven homologous EEG electrode pairs (AF3-AF4, F7-F8, F3-F4, FC5-FC6, T7-T8, P7-P8, and O1-O2) for delta, theta, alpha, beta, and gamma frequency bands. In addition, subjective ratings were obtained for a representative of emotional stimuli. Interhemispherically, PD patients showed significantly lower coherence in theta, alpha, beta, and gamma frequency bands than HC during emotion processing. No significant changes were found in the delta frequency band coherence. We also found that PD patients were more impaired in recognizing negative emotions (sadness, fear, anger, and disgust) than relatively positive emotions (happiness and surprise). Behaviorally, PD patients did not show impairment in emotion recognition as measured by subjective ratings. These findings suggest that PD patients may have an impairment of inter-hemispheric functional connectivity (i.e., a decline in cortical connectivity) during emotion processing. This study may increase the awareness of EEG emotional response studies in clinical practice to uncover potential neurophysiologic abnormalities.
  20. Hussain J, Sundaraj K, Subramaniam ID, Lam CK
    J Musculoskelet Neuronal Interact, 2019 09 01;19(3):276-285.
    PMID: 31475934
    OBJECTIVE: The objective of this study was to investigate fatigue in the three heads of the triceps brachii (TB) muscle using surface electromyography (sEMG) obtained at 30%, 45% and 60% of maximal voluntary contraction (MVC).

    METHODS: Twenty-five subjects performed isometric elbow extension until failure, and the rate of fatigue (ROF), time to fatigue (TTF) and normalized TTF (NTTF) were statistically analysed. Subsequently, the behaviour of root-mean-square (RMS), mean-power frequency (MPF) and median-power frequency (MDF) under pre-, onset- and post-fatigue conditions were compared.

    RESULTS: The findings indicated that, among the heads, ROF was statistically significant at 30% and 45% MVC (P<0.05) but TTF and NTTF at all intensities was statistically insignificant (P>0.05). For every head, only TTF was statistically significant (P<0.05) at different intensities. MPF and MDF under pre-, onset- and post-fatigue conditions were statistically significant (P<0.05) among the heads at all intensities, whereas RMS showed no such behaviour.

    CONCLUSION: The investigated parameters reveal that the three heads of TB act independently before fatigue onset and appear to work in union after fatigue. Synergist head pairs exhibit similar spectral and temporal behaviour in contrast to the non-synergist TB head pair. We find spectral parameters to be more specific predictors of fatigue.

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