Measuring movement fluency during the sit-to-walk task

Sit-to-walk strategy classification in healthy adults using hip and knee joint angles at gait initiation

Forward continuation, balance, and sit-to-stand-and-walk (STSW) are three common movement strategies during sit-to-walk (STW) executions. Literature identifies these strategies through biomechanical parameters using gold standard laboratory equipment, which is expensive, bulky, and requires significant post-processing. STW strategy becomes apparent at gait-initiation (GI) and the hip/knee are primary contributors in STW, therefore, this study proposes to use the hip/knee joint angles at GI as an alternate method of strategy classification. To achieve this, K-means clustering was implemented using three clusters corresponding to the three STW strategies; and two feature sets corresponding to the hip/knee angles (derived from motion capture data); from an open access online database (age: 21-80 years; n = 10). The results identified forward continuation with the lowest hip/knee extension, followed by balance and then STSW, at GI. Using this classification, strategy biomechanics were investigated by deriving the established biomechanical quantities from literature. The biomechanical parameters that significantly varied between strategies (P < 0.05) were time, horizontal centre of mass (COM) momentum, braking impulse, centre of pressure (COP) range and velocities, COP-COM separation, hip/knee torque and movement fluency. This alternate method of strategy classification forms a generalized framework for describing STW executions and is consistent with literature, thus validating the joint angle classification method.

Analysis of Fluency of Movement in Parkour Using a Video and Inertial Measurement Unit Technology

Fluency is a movement parameter combining smoothness and hesitation, and its objective measurement may be used to determine the effects of practice on sports performance. This study aimed to measure fluency in parkour, an acrobatic discipline comprising complex non-cyclical movements, which involves fluency as a critical aspect of performance. Inter-individual fluidity differences between advanced and novice athletes as well as intra-individual variations of fluency between different parts and subsequent repetitions of a path were addressed. Seventeen parkour participants were enrolled and divided into two groups based on their experience. We analysed signals captured from an inertial measurement unit fixed on the back of the pelvis of each participant during three consecutive repetitions of a specifically designed parkour routine under the guidance of video analysis. Two fluency parameters, namely smoothness and hesitation, were measured. Smoothness was calculated as the number of inflexions on the so-called jerk graph; hesitation was the percentage of the drop in the centre of mass velocity. Smoothness resulted in significantly lower values in advanced athletes (mean: 126.4; range: 36-192) than in beginners (mean: 179.37; range: 98-272) during one of the three motor activities (p = 0.02). A qualitative analysis of hesitation showed that beginner athletes tended to experience more prominent velocity drops and negative deflection than more advanced athletes. In conclusion, a system based on a video and an inertial measurement unit is a promising approach for quantification and the assessment of variability of fluency, and it is potentially beneficial to guide and evaluate the training process.

Instrumented 5-Time Sit-To-Stand Test: Parameters Predicting Serious Falls beyond the Duration of the Test

BACKGROUND

Falls are a major cause of injuries in older adults. To evaluate the risk of falls in older adults, clinical assessments such as the 5-time sit-to-stand (5xSTS) test can be performed. The development of inertial measurement units (IMUs) has provided the possibility of a more in-depth analysis of the movements' biomechanical characteristics during this test. The goal of the present study was to investigate whether an instrumented 5xSTS test provides additional information to predict multiple or serious falls compared to the conventional stopwatch-based method.

METHODS

Data from 458 community-dwelling older adults were analyzed. The participants were equipped with an IMU on the trunk to extract temporal, kinematic, kinetic, and smoothness movement parameters in addition to the total duration of the test by the stopwatch.

RESULTS

The total duration of the test obtained by the IMU and the stopwatch was in excellent agreement (Pearson's correlation coefficient: 0.99), while the total duration obtained by the IMU was systematically 0.52 s longer than the stopwatch. In multivariable analyses that adjusted for potential confounders, fallers had slower vertical velocity, reduced vertical acceleration, lower vertical power, and lower vertical jerk than nonfallers. In contrast, the total duration of the test measured by either the IMU or the stopwatch did not differ between the 2 groups.

CONCLUSIONS

An instrumented 5xSTS test provides additional information that better discriminates among older adults those at risk of multiple or serious falls than the conventional stopwatch-based assessment.

Investigating the Relationships Between Three Important Functional Tasks Early After Stroke: Movement Characteristics of Sit-To-Stand, Sit-To-Walk, and Walking

Background: Walking, sit-to-stand (STS) and sit-to-walk (STW) are all considered important functional tasks in achieving independence after stroke. Despite knowledge that sensitive measurement of movement patterns is crucial to understanding neuromuscular restitution, there is surprisingly little information available about the detailed biomechanical characteristics of, and relationships between, walking, sit-to-stand and sit-to-walk, particularly in the important time window early after stroke. Hence, here, the study aimed to:

Identify the biomechanical characteristics of and determine any differences in both movement fluidity (hesitation, coordination and smoothness) and duration of movement phases, between sit-to-stand (STS) and sit-to-walk (STW) in people early after stroke.

Determine whether measures of movement fluidity (hesitation, coordination, and smoothness) and movement phases during sit-to-stand (STS) and/or sit-to-walk (STW) are correlated strongly to commonly used measures of walking speed and/or step length ratio in people early after stroke.

Methods: This study consisted of secondary data analysis from the SWIFT Cast Trial. Specifically, we investigated movement fluidity using established assessments of smoothness, hesitation and coordination and the time duration for specific movement phases in a group of 48 people after stroke. Comparisons were made between STS and STW and relationships to walking measures were explored.

Results: Participants spent significantly more time in the initial movement phase, flexion momentum, during STS [mean time (SD) 1.74 ±1.45 s] than they did during STW [mean time (SD) 1.13 ± 1.03 s]. STS was also completed more smoothly but with more hesitation and greater coordination than the task of STW. No strong relationships were found between movement fluidity or duration with walking speed or step length symmetry.

Conclusions: Assessment of movement after stroke requires a range of functional tasks and no one task should predominate over another. Seemingly similar or overlapping tasks such as STS and STW create distinct biomechanical characteristics which can be identified using sensitive, objective measures of fluidity and movement phases but there are no strong relationships between the functional tasks of STS and STW with walking speed or with step-length symmetry.

Assessing Stability of Crutch Users by Non-Contact Methods

Enhancing gait stability in people who use crutches is paramount for their health. With the significant difference in gait compared to users who do not require an assistive device, the use of standard gait analysis tools to measure movement for temporary crush users and physically disabled people proves to be more challenging. In this paper, a novel approach based on video analysis is proposed as non-contact low-cost solution to the more expensive alternative with the data collected from processed videos, two values are calculated: the Signal to Noise Ratio (SNR) of acceleration, and the Signal to Noise Ratio of the jerk (time derivative of acceleration), to assess the user’s stability while they walk with crutches. The adopted methodology has been tested on a total of 10 participants. Five are temporary users of assistive devices with one being a long-term user and the other four novice users, and five are disabled participants who use those assistive devices permanently. Preliminary results show differences between novice users, long-term users, and physically disabled users. The approach is promising and could improve the assessment of crutch user stability, allowing for the correction of gait for individuals while using an inexpensive non-contact setup and preventing unnecessary falls.

Identifying consistent biomechanical parameters across rising-to-walk subtasks to inform rehabilitation in practice: A systematic literature review

BACKGROUND

The best approach to rehabilitate the control of everyday whole-body movement (e.g. rise-to-walk) after pathology remains unclear in part because the associated controlled performance variables are not known. Rise-to-walk can be performed fluidly (sit-to-walk) or non-fluidly (sit-to-stand, proceeded by gait-initiation). Biomechanical variables that remain consistent in health regardless of how rise-to walk is performed represent controlled performance variable candidates which could monitor rehabilitative change.

RESEARCH QUESTION

To determine if any biomechanical parameters remain consistent across rising-to-walk (RTW) subtasks (sit-to-stand, gait-initiation, and sit-to-walk) in healthy adults for purposes of movement control assessment in clinical practice.

METHODS

Data sources included Medline, Cinahl, and Scopus databases, and the grey literature. Study selection was based on eligibility criteria and must have reported spatiotemporal, kinematic and/or kinetic biomechanical parameters featuring >1 RTW subtask. Data extraction and synthesis; standardised-mean-differences (SMDs) were calculated (pooled if replicated in >1 study) for each parameter. Consistency was determined if SMD95 %CIs included the zero-effect line.

RESULTS

Nine studies (n = 99) were included (40 ± 7.5yrs). Seven parameters were replicated in >1 study and subjected to meta-analysis (fixed-effect model). Two were consistent between sit-to-stand and sit-to-walk: flexion-momentum time (M(95 %CI) = 0.055(-0.423 to 0.533); p = 0.823) and peak whole-body-centre-of-mass vertical velocity (M(95 %CI)= -0.415(-0.898 to 0.069); p = 0.093); and centre-of-pressure to whole-body-centre-of-mass distance at toe-off (M(95 %CI)= -0.137(-0.712 to 0.439); p = 0.642) between gait-initiation and sit-to-walk. Another 20 parameters were consistent based on single-study SMDs.

SIGNIFICANCE

Consistent parameters might exist across RTW subtasks. However, the evidence is based on few studies with small samples and variable RTW protocols. Future studies designed to confirm consistency using a standardised RTW protocol are needed.

Transient Effect at the Onset of Human Running

While training and competing as a runner, athletes often sense an unsteady feeling during the first meters on the road. This sensation, termed as transient effect, disappears after a short period as the runners approach their individual running rhythm. The foundation of this work focuses on the detection and quantification of this phenomenon. Thirty athletes ran two sessions over 60 min on a treadmill at moderate speed. Three-dimensional acceleration data were collected using two MEMS sensors attached to the lower limbs. By using the attractor method and Fourier transforms, the transient effect was isolated from noise and further components of human cyclic motion. A substantial transient effect was detected in 81% of all measured runs. On average, the transient effect lasted 5.25 min with a range of less than one minute to a maximum of 31 min. A link to performance data such as running level, experience and weekly training hours could not be found. The presented work provides the methodological basis to detect and quantify the transient effect at moderate running speeds. The acquisition of further physical or metabolic performance data could provide more detailed information about the impact of the transient effect on athletic performance.

Biomechanical analysis of sit-to-walk in different Parkinson's disease subtypes

BACKGROUND

The Parkinson's disease Postural Instability and Gait Difficulty subtype is well-known to exhibit higher levels of gait and postural instability and higher frequency of falls. However, no studies have investigated the impact of Parkinson's disease subtypes when performing a highly-challenging postural task, such as sit-to-walk. This task is often used daily and can highlight balance impairments. Thus, the aim of this study was to compare Tremor Dominant and Postural Instability and Gait Difficulty subtypes during sit-to-walk measured by performance, kinematic and kinetic analyses.

METHODS

Twenty-four people with Parkinson's disease participated in this study, and were divided into two groups: Tremor Dominant (n = 14) and Postural Instability and Gait Difficulty subtype (n = 10). They performed the sit-to-walk under a time constraint (to pick up a phone placed 4 meters away in order to answer an urgent call). Sit-to-walk overall performance, kinetic and kinematic data were assessed as outcome measures.

FINDINGS

The Postural Instability and Gait Difficulty group demonstrated a slower anteroposterior center-of-mass velocity at seat-off, a longer duration of transitional phase and poorer movement fluidity. Furthermore, the Postural Instability and Gait Difficulty group showed a longer sit-to-walk total time. These results indicate that the Postural Instability and Gait Difficulty group performed the task slowly and split the task into two subtasks (sit-to-stand and walking), rather than performing a single, continuous task.

INTERPRETATION

The Postural Instability and Gait Difficulty group is unable to perform the sit-to-walk continuously, which might reflect the clinical impairments observed in this Parkinson's disease subtype.

Characterizing Movement Fluency in Musical Performance: Toward a Generic Measure for Technology Enhanced Learning

Virtuosity in music performance is often associated with fast, precise, and efficient sound-producing movements. The generation of such highly skilled movements involves complex joint and muscle control by the central nervous system, and depends on the ability to anticipate, segment, and coarticulate motor elements, all within the biomechanical constraints of the human body. When successful, such motor skill should lead to what we characterize as fluency in musical performance. Detecting typical features of fluency could be very useful for technology-enhanced learning systems, assisting and supporting students during their individual practice sessions by giving feedback and helping them to adopt sustainable movement patterns. In this study, we propose to assess fluency in musical performance as the ability to smoothly and efficiently coordinate while accurately performing slow, transitionary, and rapid movements. To this end, the movements of three cello players and three drummers at different levels of skill were recorded with an optical motion capture system, while a wireless electromyography (EMG) system recorded the corresponding muscle activity from relevant landmarks. We analyzed the kinematic and coarticulation characteristics of these recordings separately and then propose a combined model of fluency in musical performance predicting music sophistication. Results suggest that expert performers' movements are characterized by consistently smooth strokes and scaling of muscle phasic coactivation. The explored model of fluency as a function of movement smoothness and coarticulation patterns was shown to be limited by the sample size, but it serves as a proof of concept. Results from this study show the potential of a technology-enhanced objective measure of fluency in musical performance, which could lead to improved practices for aspiring musicians, instructors, and researchers.

A Mobile Acquisition System and a Method for Hips Sway Fluency Assessment

The present contribution focuses on the estimation of the Cartesian kinematic jerk of the hips’ orientation during a full three-dimensional movement in the context of enabling eHealth applications of advanced mathematical signal analysis. The kinematic jerk index is estimated on the basis of gyroscopic signals acquired offline through a smartphone. A specific free mobile application is used to acquire the gyroscopic signals and to transmit them to a personal computer through a wireless network. The personal computer elaborates the acquired data and returns the kinematic jerk index associated with a motor task. A comparison of the kinematic jerk index value on a number of data sets confirms that such index can be used to evaluate the fluency of hips orientation during motion. The present research confirms that the proposed gyroscopic data acquisition/processing setup constitutes an inexpensive and portable solution to motion fluency analysis. The proposed data-acquisition and data-processing setup may serve as a supporting eHealth technology in clinical bio-mechanics as well as in sports science.

Parameters that remain consistent independent of pausing before gait-initiation during normal rise-to-walk behaviour delineated by sit-to-walk and sit-to-stand-and-walk

BACKGROUND

Rising-to-walk is an everyday transitional movement task rarely employed in gait rehabilitation. Sit-to-walk (STW) and sit-to-stand-and-walk (STSW), where a pause separates sit-to-stand and gait-initiation (GI) represent extremes of rising-to-walk behaviour. Delayed GI can indicate pathological impairment but is also observed in healthy individuals. We hypothesise that healthy subjects express consistent biomechanical parameters, among others that differ, during successful rising-to-walk task performance regardless of behaviour. This study therefore sought to identify if any parameters are consistent between STW and STSW in health because they represent normal rise-to-walk performance independent of pause, and also because they represent candidate parameters sensitive enough to monitor change in pathology.

METHODS

Ten healthy volunteers performed 5 trials of STW and STSW. Event timing, ground-reaction-forces (GRFs), whole-body-centre-of-mass (BCoM) displacement, and centre-of-pressure (CoP) to extrapolated BCoM (xCoM) distance (indicator of positional stability) up to the 3rd step were compared between-tasks with paired t-tests. For consistent parameters; agreement between-tasks was assessed using Bland-Altman analyses and minimal-detectable-change (MDC) calculations.

RESULTS

Mean vertical GRFs, peak forward momentum and fluidity during rising; CoP-xCoM separation at seat-off, upright, GI-onset, and steps1-2; and forward BCoM velocity were all significantly greater in STW. In contrast, peak BCoM vertical momentum, flexion-momentum time, and 3rd step stability were consistent between tasks and yielded acceptable reliability.

CONCLUSION

STW is a more challenging task due to the merging of rising with GI reflected by greater CoP-xCoM separation compared to STSW indicative of more positional instability. However, BCoM vertical momentum, flexion-momentum time, and step3 stability remained consistent in healthy individuals and are therefore candidates with which to monitor change in gait rehabilitation following pathology. Future studies should impose typical pause-durations observed in pathology upon healthy subjects to determine if the parameters we have identified remain consistent.

Functional strength training and movement performance therapy produce analogous improvement in sit-to-stand early after stroke: early-phase randomised controlled trial

OBJECTIVES

Restoring independence in the sit-to-stand (STS) task is an important objective for stroke rehabilitation. It is not known if a particular intervention, strength training or therapy focused on movement performance is more likely to improve STS recovery. This study aimed to compare STS outcomes from functional strength training, movement performance therapy and conventional therapy.

DESIGN

Randomised controlled trial.

SETTING

Acute stroke units.

PARTICIPANTS

Medically well patients (n=93) with recent (<42 days) stroke. The mean age of patients was 68.8 years, mean time post ictus was 33.5 days, 54 (58%) were male, 20 showed neglect (22%) and 37 (40%) had a left-sided brain lesion.

INTERVENTIONS

Six weeks of either conventional therapy, functional strength training or movement performance therapy. Subjects were allocated to groups on a random basis.

MAIN OUTCOME MEASURES

STS ability, timing, symmetry, co-ordination, smoothness and knee velocity were measured at baseline, outcome (after 6 weeks of intervention) and follow-up (3 months after outcome).

RESULTS

No significant differences were found between the groups. All three groups improved their STS ability, with 88% able to STS at follow-up compared with 56% at baseline. Few differences were noted in quality of movement, with only symmetry when rising showing significantly greater improvement in the movement performance therapy group; this benefit was not evident at follow-up.

CONCLUSIONS

Recovery of the STS movement is consistently good during stroke rehabilitation, irrespective of the type of therapy experienced. Changes in quality of movement did not differ according to group allocation, indicating that the type of therapy is less important. Clinical trial registration number NCT00322192.

Sit-to-walk Task in Hemiplegic Stroke Patients: Relationship between Movement Fluidity and the Motor Strategy in Initial Contact

PURPOSE

Generally, stroke patients can walk and stand up fluidly but fulfill the sit-to-walk (STW) task with difficulty. The purpose of this study was to investigate the relationship between movement fluidity and motor strategy in the initial contact of the STW task.

METHOD

Thirty stroke patients and ten healthy subjects performed the STW task from a sitting position, and their movement was measured by a motion analysis system. The differences in data between patients and healthy subjects were analyzed using the Mann-Whitney U test. The relationship between fluidity index (FI) and other indices (kinetic and kinematic data in STW, functional independence measure [FIM], and Fugl-Meyer Assessment [FMA]) were analyzed using Spearman's rank correlation coefficient.

RESULTS

The stroke patients had lower FI values than the healthy subjects and exhibited shortened step length and prolonged duration from onset to the first stance leg off. FI values correlated with trunk flexure angle at initial contact, first step length, and maximum vertical floor reaction force. The independent level of the FIM of stair climbing and walking ability and the FMA of balance also correlated with FI.

CONCLUSION

There is a possibility that poor balance is one of the reasons why stroke patients are unable to start walking fluently from the sitting position. To perform the STW fluidly, patients must start walking before the trunk extension is fully completed. The relationship between FI and indices of physical ability, namely stair climbing and balance, may have therapeutic benefits for coaching the STW task to stroke patients.

Emotional influences on sit-to-walk in healthy young adults

The purpose of this study was to investigate influences of emotional feelings on sit-to-walk (STW). Eighteen healthy young adults performed STW while feeling sadness, anger, joy and neutral emotion. Emotions were elicited using an autobiographical memories task. We used an optoelectronic motion capture system to collect motion data and assessed kinematics of STW. Emotion-related differences in STW kinematics were consistent with differences in movement speed. Compared to neutral emotion, sadness was associated with increased STW duration and phase durations, decreased peak forward and vertical center-of-mass (COM) velocity, increased drop in forward COM velocity, and increased forward and vertical normalized jerk score (NJS). Anger and joy were associated with decreased STW duration and phase durations, increased peak forward and vertical COM velocity, decreased drop in forward COM velocity, and decreased forward and vertical NJS compared to neutral emotion. Findings suggest that emotional feelings affect movement speed, hesitation, and movement smoothness during STW.