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dos Santos TTS, Marques AP, Monteiro LCP, Santos EGDR, Pinto GHL, Belgamo A, Costa e Silva ADA, Cabral ADS, Kuliś S, Gajewski J, Souza GS, da Silva TJ, da Costa WTA, Salomão RC, Callegari B. Intra and Inter-Device Reliabilities of the Instrumented Timed-Up and Go Test Using Smartphones in Young Adult Population. Sensors (Basel) 2024; 24:2918. [PMID: 38733024 PMCID: PMC11086236 DOI: 10.3390/s24092918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 05/13/2024]
Abstract
The Timed-Up and Go (TUG) test is widely utilized by healthcare professionals for assessing fall risk and mobility due to its practicality. Currently, test results are based solely on execution time, but integrating technological devices into the test can provide additional information to enhance result accuracy. This study aimed to assess the reliability of smartphone-based instrumented TUG (iTUG) parameters. We conducted evaluations of intra- and inter-device reliabilities, hypothesizing that iTUG parameters would be replicable across all experiments. A total of 30 individuals participated in Experiment A to assess intra-device reliability, while Experiment B involved 15 individuals to evaluate inter-device reliability. The smartphone was securely attached to participants' bodies at the lumbar spine level between the L3 and L5 vertebrae. In Experiment A, subjects performed the TUG test three times using the same device, with a 5 min interval between each trial. Experiment B required participants to perform three trials using different devices, with the same time interval between trials. Comparing stopwatch and smartphone measurements in Experiment A, no significant differences in test duration were found between the two devices. A perfect correlation and Bland-Altman analysis indicated good agreement between devices. Intra-device reliability analysis in Experiment A revealed significant reliability in nine out of eleven variables, with four variables showing excellent reliability and five showing moderate to high reliability. In Experiment B, inter-device reliability was observed among different smartphone devices, with nine out of eleven variables demonstrating significant reliability. Notable differences were found in angular velocity peak at the first and second turns between specific devices, emphasizing the importance of considering device variations in inertial measurements. Hence, smartphone inertial sensors present a valid, applicable, and feasible alternative for TUG assessment.
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Affiliation(s)
| | - Amélia Pasqual Marques
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo 05403-000, SP, Brazil;
| | - Luis Carlos Pereira Monteiro
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, PA, Brazil; (L.C.P.M.); (G.S.S.)
| | - Enzo Gabriel da Rocha Santos
- Instituto de Ciências Exatas e Naturais, Universidade Federal do Pará, R. Augusto Corrêa, 01, Belém 66093-020, PA, Brazil; (E.G.d.R.S.); (G.H.L.P.)
| | - Gustavo Henrique Lima Pinto
- Instituto de Ciências Exatas e Naturais, Universidade Federal do Pará, R. Augusto Corrêa, 01, Belém 66093-020, PA, Brazil; (E.G.d.R.S.); (G.H.L.P.)
| | - Anderson Belgamo
- Instituto Federal de São Paulo, Piracicaba 17607-220, SP, Brazil;
| | - Anselmo de Athayde Costa e Silva
- Programa de Pós Graduação em Ciências do Movimento, Universidade Federal do Pará, Av. Generalíssimo Deodoro 01, Belém 66073-000, PA, Brazil;
| | - André dos Santos Cabral
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Tv. Perebebuí, 2623-Marco, Belém 66087-662, PA, Brazil;
| | - Szymon Kuliś
- Faculty of Rehabilitation, Józef Piłsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland;
| | - Jan Gajewski
- Faculty of Physical Education, Józef Piłsudski University of Physical Education in Warsaw, Marymoncka 34, 00-968 Warsaw, Poland;
| | - Givago Silva Souza
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém 66075-110, PA, Brazil; (L.C.P.M.); (G.S.S.)
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Rua Augusto Corrêa 01, Belém 66075-110, PA, Brazil
| | - Tacyla Jesus da Silva
- Centro de Ciências Biológicas e da Saúde-Campus VIII, Universidade Estadual do Pará, Av. Helía, s/n-Amapá, Marabá 68502-100, PA, Brazil; (T.J.d.S.); (W.T.A.d.C.); (R.C.S.)
| | - Wesley Thyago Alves da Costa
- Centro de Ciências Biológicas e da Saúde-Campus VIII, Universidade Estadual do Pará, Av. Helía, s/n-Amapá, Marabá 68502-100, PA, Brazil; (T.J.d.S.); (W.T.A.d.C.); (R.C.S.)
| | - Railson Cruz Salomão
- Centro de Ciências Biológicas e da Saúde-Campus VIII, Universidade Estadual do Pará, Av. Helía, s/n-Amapá, Marabá 68502-100, PA, Brazil; (T.J.d.S.); (W.T.A.d.C.); (R.C.S.)
| | - Bianca Callegari
- Laboratório de Estudos da Motricidade Humana, Av. Generalíssimo Deodoro 01, Belém 66073-000, PA, Brazil;
- Instituto de Ciências Exatas e Naturais, Universidade Federal do Pará, R. Augusto Corrêa, 01, Belém 66093-020, PA, Brazil; (E.G.d.R.S.); (G.H.L.P.)
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Corrêa BDC, Santos EGR, Belgamo A, Pinto GHL, Xavier SS, Silva CC, Dias ÁRN, Paranhos ACM, Cabral ADS, Callegari B, Costa e Silva ADA, Quaresma JAS, Falcão LFM, Souza GS. Smartphone-based evaluation of static balance and mobility in long-lasting COVID-19 patients. Front Neurol 2023; 14:1277408. [PMID: 38148981 PMCID: PMC10750373 DOI: 10.3389/fneur.2023.1277408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/20/2023] [Indexed: 12/28/2023] Open
Abstract
Background SARS-CoV-2 infection can lead to a variety of persistent sequelae, collectively known as long COVID-19. Deficits in postural balance have been reported in patients several months after COVID-19 infection. The purpose of this study was to evaluate the static balance and balance of individuals with long COVID-19 using inertial sensors in smartphones. Methods A total of 73 participants were included in this study, of which 41 had long COVID-19 and 32 served as controls. All participants in the long COVID-19 group reported physical complaints for at least 7 months after SARS-CoV-2 infection. Participants were evaluated using a built-in inertial sensor of a smartphone attached to the low back, which recorded inertial signals during a static balance and mobility task (timed up and go test). The parameters of static balance and mobility obtained from both groups were compared. Results The groups were matched for age and BMI. Of the 41 participants in the long COVID-19 group, 22 reported balance impairment and 33 had impaired balance in the Sharpened Romberg test. Static balance assessment revealed that the long COVID-19 group had greater postural instability with both eyes open and closed than the control group. In the TUG test, the long COVID-19 group showed greater acceleration during the sit-to-stand transition compared to the control group. Conclusion The smartphone was feasible to identify losses in the balance motor control and mobility of patients with long-lasting symptomatic COVID-19 even after several months or years. Attention to the balance impairment experienced by these patients could help prevent falls and improve their quality of life, and the use of the smartphone can expand this monitoring for a broader population.
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Affiliation(s)
| | | | | | | | - Stanley Soares Xavier
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém, Brazil
| | - Camilla Costa Silva
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém, Brazil
| | | | - Alna Carolina Mendes Paranhos
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém, Brazil
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil
| | | | - Bianca Callegari
- Instituto de Ciências da Saúde, Universidade Federal do Pará, Belém, Brazil
| | | | - Juarez Antônio Simões Quaresma
- Centro de Ciências Biológicas e da Saúde, Universidade do Estado do Pará, Belém, Brazil
- School of Medicine, São Paulo University, São Paulo, São Paulo, Brazil
| | | | - Givago Silva Souza
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brazil
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Velazquez-Diaz D, Arco JE, Ortiz A, Pérez-Cabezas V, Lucena-Anton D, Moral-Munoz JA, Galán-Mercant A. Use of Artificial Intelligence in the Identification and Diagnosis of Frailty Syndrome in Older Adults: Scoping Review. J Med Internet Res 2023; 25:e47346. [PMID: 37862082 PMCID: PMC10625070 DOI: 10.2196/47346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/09/2023] [Accepted: 07/27/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Frailty syndrome (FS) is one of the most common noncommunicable diseases, which is associated with lower physical and mental capacities in older adults. FS diagnosis is mostly focused on biological variables; however, it is likely that this diagnosis could fail owing to the high biological variability in this syndrome. Therefore, artificial intelligence (AI) could be a potential strategy to identify and diagnose this complex and multifactorial geriatric syndrome. OBJECTIVE The objective of this scoping review was to analyze the existing scientific evidence on the use of AI for the identification and diagnosis of FS in older adults, as well as to identify which model provides enhanced accuracy, sensitivity, specificity, and area under the curve (AUC). METHODS A search was conducted using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines on various databases: PubMed, Web of Science, Scopus, and Google Scholar. The search strategy followed Population/Problem, Intervention, Comparison, and Outcome (PICO) criteria with the population being older adults; intervention being AI; comparison being compared or not to other diagnostic methods; and outcome being FS with reported sensitivity, specificity, accuracy, or AUC values. The results were synthesized through information extraction and are presented in tables. RESULTS We identified 26 studies that met the inclusion criteria, 6 of which had a data set over 2000 and 3 with data sets below 100. Machine learning was the most widely used type of AI, employed in 18 studies. Moreover, of the 26 included studies, 9 used clinical data, with clinical histories being the most frequently used data type in this category. The remaining 17 studies used nonclinical data, most frequently involving activity monitoring using an inertial sensor in clinical and nonclinical contexts. Regarding the performance of each AI model, 10 studies achieved a value of precision, sensitivity, specificity, or AUC ≥90. CONCLUSIONS The findings of this scoping review clarify the overall status of recent studies using AI to identify and diagnose FS. Moreover, the findings show that the combined use of AI using clinical data along with nonclinical information such as the kinematics of inertial sensors that monitor activities in a nonclinical context could be an appropriate tool for the identification and diagnosis of FS. Nevertheless, some possible limitations of the evidence included in the review could be small sample sizes, heterogeneity of study designs, and lack of standardization in the AI models and diagnostic criteria used across studies. Future research is needed to validate AI systems with diverse data sources for diagnosing FS. AI should be used as a decision support tool for identifying FS, with data quality and privacy addressed, and the tool should be regularly monitored for performance after being integrated in clinical practice.
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Affiliation(s)
- Daniel Velazquez-Diaz
- ExPhy Research Group, Department of Physical Education, Faculty of Education Sciences, University of Cadiz, Cádiz, Spain
- Advent Health Research Institute, Neuroscience Institute, Orlando, FL, United States
| | - Juan E Arco
- Department of Communications Engineering, University of Malaga, Málaga, Spain
- Andalusian Research Institute in Data Science and Computational Intelligence, Granada, Spain
- Department of Signal Theory, Networking and Communications, University of Granada, Granada, Spain
| | - Andres Ortiz
- Department of Communications Engineering, University of Malaga, Málaga, Spain
- Andalusian Research Institute in Data Science and Computational Intelligence, Granada, Spain
| | - Verónica Pérez-Cabezas
- MOVE-IT Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, University of Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz, Cádiz, Spain
| | - David Lucena-Anton
- Biomedical Research and Innovation Institute of Cádiz, Cádiz, Spain
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain
| | - Jose A Moral-Munoz
- Biomedical Research and Innovation Institute of Cádiz, Cádiz, Spain
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain
| | - Alejandro Galán-Mercant
- MOVE-IT Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, University of Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz, Cádiz, Spain
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Bohlke K, Redfern MS, Rosso AL, Sejdic E. Accelerometry applications and methods to assess standing balance in older adults and mobility-limited patient populations: a narrative review. Aging Clin Exp Res 2023; 35:1991-2007. [PMID: 37526887 PMCID: PMC10881067 DOI: 10.1007/s40520-023-02503-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
Accelerometers provide an opportunity to expand standing balance assessments outside of the laboratory. The purpose of this narrative review is to show that accelerometers are accurate, objective, and accessible tools for balance assessment. Accelerometry has been validated against current gold standard technology, such as optical motion capture systems and force plates. Many studies have been conducted to show how accelerometers can be useful for clinical examinations. Recent studies have begun to apply classification algorithms to accelerometry balance measures to discriminate populations at risk for falls. In addition to healthy older adults, accelerometry can monitor balance in patient populations such as Parkinson's disease, multiple sclerosis, and traumatic brain injury. The lack of software packages or easy-to-use applications have hindered the shift into the clinical space. Lack of consensus on outcome metrics has also slowed the clinical adoption of accelerometer-based balance assessments. Future studies should focus on metrics that are most helpful to evaluate balance in specific populations and protocols that are clinically efficacious.
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Affiliation(s)
- Kayla Bohlke
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Mark S Redfern
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Andrea L Rosso
- Department of Epidemiology, School of Public Health, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA, 15260, USA
| | - Ervin Sejdic
- The Edward S. Rogers Department of Electrical and Computer Engineering, Faculty of Applied Science and Engineering, University of Toronto, 27 King's College Cir, Toronto, ON, M5S, Canada.
- North York General Hospital, 4001 Leslie St., Toronto, ON, M2K, Canada.
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Agathos CP, Velisar A, Shanidze NM. A Comparison of Walking Behavior during the Instrumented TUG and Habitual Gait. Sensors (Basel) 2023; 23:7261. [PMID: 37631797 PMCID: PMC10459909 DOI: 10.3390/s23167261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023]
Abstract
The timed up and go test (TUG) is a common clinical functional balance test often used to complement findings on sensorimotor changes due to aging or sensory/motor dysfunction. The instrumented TUG can be used to obtain objective postural and gait measures that are more sensitive to mobility changes. We investigated whether gait and body coordination during TUG is representative of walking. We examined the walking phase of the TUG and compared gait metrics (stride duration and length, walking speed, and step frequency) and head/trunk accelerations to normal walking. The latter is a key aspect of postural control and can also reveal changes in sensory and motor function. Forty participants were recruited into three groups: young adults, older adults, and older adults with visual impairment. All performed the TUG and a short walking task wearing ultra-lightweight wireless IMUs on the head, chest, and right ankle. Gait and head/trunk acceleration metrics were comparable across tasks. Further, stride length and walking speed were correlated with the participants' age. Those with visual impairment walked significantly slower than sighted older adults. We suggest that the TUG can be a valuable tool for examining gait and stability during walking without the added time or space constraints.
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Pedrero-Sánchez JF, De-Rosario-Martínez H, Medina-Ripoll E, Garrido-Jaén D, Serra-Añó P, Mollà-Casanova S, López-Pascual J. The Reliability and Accuracy of a Fall Risk Assessment Procedure Using Mobile Smartphone Sensors Compared with a Physiological Profile Assessment. Sensors (Basel) 2023; 23:6567. [PMID: 37514860 PMCID: PMC10385364 DOI: 10.3390/s23146567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
Falls in older people are a major health concern as the leading cause of disability and the second most common cause of accidental death. We developed a rapid fall risk assessment based on a combination of physical performance measurements made with an inertial sensor embedded in a smartphone. This study aimed to evaluate and validate the reliability and accuracy of an easy-to-use smartphone fall risk assessment by comparing it with the Physiological Profile Assessment (PPA) results. Sixty-five participants older than 55 performed a variation of the Timed Up and Go test using smartphone sensors. Balance and gait parameters were calculated, and their reliability was assessed by the (ICC) and compared with the PPAs. Since the PPA allows classification into six levels of fall risk, the data obtained from the smartphone assessment were categorised into six equivalent levels using different parametric and nonparametric classifier models with neural networks. The F1 score and geometric mean of each model were also calculated. All selected parameters showed ICCs around 0.9. The best classifier, in terms of accuracy, was the nonparametric mixed input data model with a 100% success rate in the classification category. In conclusion, fall risk can be reliably assessed using a simple, fast smartphone protocol that allows accurate fall risk classification among older people and can be a useful screening tool in clinical settings.
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Affiliation(s)
- José-Francisco Pedrero-Sánchez
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Edificio 9C, Camino de Vera S/N, 46022 Valencia, Spain
| | - Helios De-Rosario-Martínez
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Edificio 9C, Camino de Vera S/N, 46022 Valencia, Spain
| | - Enrique Medina-Ripoll
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Edificio 9C, Camino de Vera S/N, 46022 Valencia, Spain
| | - David Garrido-Jaén
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Edificio 9C, Camino de Vera S/N, 46022 Valencia, Spain
| | - Pilar Serra-Añó
- Unidad de Biomecánica Clínica (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, Carrer Gascó Oliag 5, 46010 Valencia, Spain
| | - Sara Mollà-Casanova
- Unidad de Biomecánica Clínica (UBIC), Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, Carrer Gascó Oliag 5, 46010 Valencia, Spain
| | - Juan López-Pascual
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Edificio 9C, Camino de Vera S/N, 46022 Valencia, Spain
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Lee CH, Mendoza T, Huang CH, Sun TL. Comparative Analysis of Fall Risk Assessment Features in Community-Elderly and Stroke Survivors: Insights from Sensor-Based Data. Healthcare (Basel) 2023; 11:1938. [PMID: 37444772 PMCID: PMC10341555 DOI: 10.3390/healthcare11131938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Fall-risk assessment studies generally focus on identifying characteristics that affect postural balance in a specific group of subjects. However, falls affect a multitude of individuals. Among the groups with the most recurrent fallers are the community-dwelling elderly and stroke survivors. Thus, this study focuses on identifying a set of features that can explain fall risk for these two groups of subjects. Sixty-five community dwelling elderly (forty-nine female, sixteen male) and thirty-five stroke-survivors (twenty-two male, thirteen male) participated in our study. With the use of an inertial sensor, some features are extracted from the acceleration data of a Timed Up and Go (TUG) test performed by both groups of individuals. A short-form berg balance scale (SFBBS) score and the TUG test score were used for labeling the data. With the use of a 100-fold cross-validation approach, Relief-F and Extra Trees Classifier algorithms were used to extract sets of the top 5, 10, 15, 20, 25, and 30 features. Random Forest classifiers were trained for each set of features. The best models were selected, and the repeated features for each group of subjects were analyzed and discussed. The results show that only the stand duration was an important feature for the prediction of fall risk across all clinical tests and both groups of individuals.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Data Science, Soochow University, No. 70, Linxi Road, Shilin District, Taipei 111, Taiwan;
| | - Tomas Mendoza
- Department of Industrial Engineering and Management, Yuan Ze University, 135 Yuan Tung Road, Chungli District, Taoyuan 320, Taiwan;
| | - Chien-Hua Huang
- Department of Eldercare, Central Taiwan University of Science and Technology, Taichung 40601, Taiwan;
| | - Tien-Lung Sun
- Department of Industrial Engineering and Management, Yuan Ze University, 135 Yuan Tung Road, Chungli District, Taoyuan 320, Taiwan;
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Pedrero-Sánchez JF, Belda-Lois JM, Serra-Añó P, Mollà-Casanova S, López-Pascual J. Classification of Parkinson's disease stages with a two-stage deep neural network. Front Aging Neurosci 2023; 15:1152917. [PMID: 37333459 PMCID: PMC10272759 DOI: 10.3389/fnagi.2023.1152917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/16/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Parkinson's disease is one of the most prevalent neurodegenerative diseases. In the most advanced stages, PD produces motor dysfunction that impairs basic activities of daily living such as balance, gait, sitting, or standing. Early identification allows healthcare personnel to intervene more effectively in rehabilitation. Understanding the altered aspects and impact on the progression of the disease is important for improving the quality of life. This study proposes a two-stage neural network model for the classifying the initial stages of PD using data recorded with smartphone sensors during a modified Timed Up & Go test. Methods The proposed model consists on two stages: in the first stage, a semantic segmentation of the raw sensor signals classifies the activities included in the test and obtains biomechanical variables that are considered clinically relevant parameters for functional assessment. The second stage is a neural network with three input branches: one with the biomechanical variables, one with the spectrogram image of the sensor signals, and the third with the raw sensor signals. Results This stage employs convolutional layers and long short-term memory. The results show a mean accuracy of 99.64% for the stratified k-fold training/validation process and 100% success rate of participants in the test phase. Discussion The proposed model is capable of identifying the three initial stages of Parkinson's disease using a 2-min functional test. The test easy instrumentation requirements and short duration make it feasible for use feasible in the clinical context.
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Affiliation(s)
| | - Juan Manuel Belda-Lois
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Valencia, Spain
- Department of Mechanical and Materials Engineering (DIMM), Universitat Politècnica de València, Valencia, Spain
| | - Pilar Serra-Añó
- UBIC, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, Valencia, Spain
| | - Sara Mollà-Casanova
- UBIC, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, Valencia, Spain
| | - Juan López-Pascual
- Instituto de Biomecánica (IBV), Universitat Politècnica de València, Valencia, Spain
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Almajid R, Appiah-Kubi KO, Cipriani D, Goel R. Dual-tasking interference is exacerbated outdoors: A pilot study. Front Sports Act Living 2023; 5:1077362. [PMID: 36891128 PMCID: PMC9986320 DOI: 10.3389/fspor.2023.1077362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 01/31/2023] [Indexed: 02/22/2023] Open
Abstract
Introduction Walking while texting can create gait disturbances that may increase fall risk, especially in outdoors environment. To date, no study has quantified the effect of texting on motor behavior using different dynamic tasks in outdoor environments. We aimed to explore the impact of texting on dynamic tasks in indoor and outdoor environments. Methods Twenty participants (age 38.3 ± 12.5 years, 12 F) had a Delsys inertial sensor fixed on their back and completed walk, turn, sit-to-stand, and stand-to-sit subtasks with and without texting in both indoor and outdoor environments. Results While there was no difference in texting accuracy (p = 0.3), there was a higher dual-tasking cost in walking time with texting outdoors than indoors (p = 0.008). Discussion Dual tasking has a greater impact on walking time outdoors compared to an indoor environment. Our findings highlight the importance of patient education concerning dual-tasking and pedestrian safety in clinical settings.
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Affiliation(s)
- Rania Almajid
- Department of Physical Therapy, Stockton University, Galloway, United States
- Department of Physical Therapy, West Coast University, Los Angeles, CA, United States
| | | | - Daniel Cipriani
- Department of Physical Therapy, West Coast University, Los Angeles, CA, United States
| | - Rahul Goel
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
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Röhling HM, Otte K, Rekers S, Finke C, Rust R, Dorsch EM, Behnia B, Paul F, Schmitz-Hübsch T. RGB-Depth Camera-Based Assessment of Motor Capacity: Normative Data for Six Standardized Motor Tasks. Int J Environ Res Public Health 2022; 19:16989. [PMID: 36554871 PMCID: PMC9779698 DOI: 10.3390/ijerph192416989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Instrumental motion analysis constitutes a promising development in the assessment of motor function in clinical populations affected by movement disorders. To foster implementation and facilitate interpretation of respective outcomes, we aimed to establish normative data of healthy subjects for a markerless RGB-Depth camera-based motion analysis system and to illustrate their use. METHODS We recorded 133 healthy adults (56% female) aged 20 to 60 years with an RGB-Depth camera-based motion analysis system. Forty-three spatiotemporal parameters were extracted from six short, standardized motor tasks-including three gait tasks, stepping in place, standing-up and sitting down, and a postural control task. Associations with confounding factors, height, weight, age, and sex were modelled using a predictive linear regression approach. A z-score normalization approach was provided to improve usability of the data. RESULTS We reported descriptive statistics for each spatiotemporal parameter (mean, standard deviation, coefficient of variation, quartiles). Robust confounding associations emerged for step length and step width in comfortable speed gait only. Accessible normative data usage was lastly exemplified with recordings from one randomly selected individual with multiple sclerosis. CONCLUSION We provided normative data for an RGB depth camera-based motion analysis system covering broad aspects of motor capacity.
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Affiliation(s)
- Hanna Marie Röhling
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, 13125 Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany
- Motognosis GmbH, 10119 Berlin, Germany
| | - Karen Otte
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, 13125 Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany
- Motognosis GmbH, 10119 Berlin, Germany
| | - Sophia Rekers
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Carsten Finke
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Rebekka Rust
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, 13125 Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Eva-Maria Dorsch
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, 13125 Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Behnoush Behnia
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 12203 Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, 13125 Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, a Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité—Universitätsmedizin Berlin, 13125 Berlin, Germany
- Experimental and Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13125 Berlin, Germany
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, 10117 Berlin, Germany
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11
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Droby A, Varangis E, Habeck C, Hausdorff JM, Stern Y, Mirelman A, Maidan I. Effects of aging on cognitive and brain inter-network integration patterns underlying usual and dual-task gait performance. Front Aging Neurosci 2022; 14:956744. [PMID: 36247996 PMCID: PMC9557358 DOI: 10.3389/fnagi.2022.956744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Aging affects the interplay between cognition and gait performance. Neuroimaging studies reported associations between gait performance and structural measures; however, functional connectivity (FC) analysis of imaging data can help to identify dynamic neural mechanisms underlying optimal performance. Here, we investigated the effects on divergent cognitive and inter-network FC patterns underlying gait performance during usual (UW) and dual-task (DT) walking. Methods A total of 115 community-dwelling, healthy participants between 20 and 80 years were enrolled. All participants underwent comprehensive cognitive and gait assessments in two conditions and resting state functional MRI (fMRI) scans. Inter-network FC from motor-related to 6 primary cognitive networks were estimated. Step-wise regression models tested the relationships between gait parameters, inter-network FC, neuropsychological scores, and demographic variables. A threshold of p < 0.05 was adopted for all statistical analyses. Results UW was largely associated with FC levels between motor and sustained attention networks. DT performance was associated with inter-network FC between motor and divided attention, and processing speed in the overall group. In young adults, UW was associated with inter-network FC between motor and sustained attention networks. On the other hand, DT performance was associated with cognitive performance, as well as inter-network connectivity between motor and divided attention networks (VAN and SAL). In contrast, the older age group (> 65 years) showed increased integration between motor, dorsal, and ventral attention, as well as default-mode networks, which was negatively associated with UW gait performance. Inverse associations between motor and sustained attention inter-network connectivity and DT performance were observed. Conclusion While UW relies on inter-network FC between motor and sustained attention networks, DT performance relies on additional cognitive capacities, increased motor, and executive control network integration. FC analyses demonstrate that the decline in cognitive performance with aging leads to the reliance on additional neural resources to maintain routine walking tasks.
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Affiliation(s)
- Amgad Droby
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility (CMCM), Tel Aviv Sourasky Medical Center, Neurological Institute, Tel Aviv, Israel
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Eleanna Varangis
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY, United States
| | - Christian Habeck
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY, United States
| | - Jeffrey M. Hausdorff
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility (CMCM), Tel Aviv Sourasky Medical Center, Neurological Institute, Tel Aviv, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
- Department of Orthopedic Surgery, Rush Alzheimer’s Disease Center, Rush University, Chicago, IL, United States
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaakov Stern
- Cognitive Neuroscience Division, Department of Neurology, Columbia University, New York, NY, United States
| | - Anat Mirelman
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility (CMCM), Tel Aviv Sourasky Medical Center, Neurological Institute, Tel Aviv, Israel
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Inbal Maidan
- Laboratory for Early Markers of Neurodegeneration (LEMON), Center for the Study of Movement, Cognition, and Mobility (CMCM), Tel Aviv Sourasky Medical Center, Neurological Institute, Tel Aviv, Israel
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv-Yafo, Israel
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12
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Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, Aguilar-Navarro S, Alexander NB, Becker C, Blain H, Bourke R, Cameron ID, Camicioli R, Clemson L, Close J, Delbaere K, Duan L, Duque G, Dyer SM, Freiberger E, Ganz DA, Gómez F, Hausdorff JM, Hogan DB, Hunter SMW, Jauregui JR, Kamkar N, Kenny RA, Lamb SE, Latham NK, Lipsitz LA, Liu-Ambrose T, Logan P, Lord SR, Mallet L, Marsh D, Milisen K, Moctezuma-Gallegos R, Morris ME, Nieuwboer A, Perracini MR, Pieruccini-Faria F, Pighills A, Said C, Sejdic E, Sherrington C, Skelton DA, Dsouza S, Speechley M, Stark S, Todd C, Troen BR, van der Cammen T, Verghese J, Vlaeyen E, Watt JA, Masud T. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing 2022; 51:afac205. [PMID: 36178003 PMCID: PMC9523684 DOI: 10.1093/ageing/afac205] [Citation(s) in RCA: 223] [Impact Index Per Article: 111.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 08/26/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. OBJECTIVES to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. METHODS a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. RECOMMENDATIONS all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. CONCLUSIONS the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.
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Affiliation(s)
- Manuel Montero-Odasso
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Nathalie van der Velde
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Finbarr C Martin
- Population Health Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mirko Petrovic
- Department of Internal Medicine and Paediatrics, Section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Maw Pin Tan
- Centre for Innovation in Medical Engineering (CIME), Faculty of Engineering, University of Malaya, Kuala Lumpur 50603, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Jesper Ryg
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sara Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Neil B Alexander
- Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan; Veterans Administration Ann Arbor Healthcare System Geriatrics Research Education Clinical Center, Ann Arbor, MI, USA
| | - Clemens Becker
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Hubert Blain
- Department of Geriatrics, Montpellier University hospital and MUSE, Montpellier, France
| | - Robbie Bourke
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and Faculty of Medicine and Health, University of Sydney. Department of Medicine (Neurology) and Neuroscience and Mental Health, Sydney, NSW, Australia
| | - Richard Camicioli
- Department of Medicine (Neurology), Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Lindy Clemson
- Sydney School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, NSW, Australia
- Prince of Wales Clinical School, Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kim Delbaere
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia; School of Population Health, University of New South Wales, Kensington, NSW, Australia
| | - Leilei Duan
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Gustavo Duque
- Research Institute of the McGill University HealthCentre, Montreal, Quebec, Canada
| | - Suzanne M Dyer
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Ellen Freiberger
- Friedrich-Alexander-University Erlangen-Nürnberg, Institute for Biomedicine of Aging, Nürnberg, Germany
| | - David A Ganz
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA and Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Fernando Gómez
- Research Group on Geriatrics and Gerontology, International Association of Gerontology and Geriatrics Collaborative Center, University Caldas, Manizales, Colombia
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Orthopaedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - David B Hogan
- Brenda Strafford Centre on Aging, O’BrienInstitute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Susan M W Hunter
- School of Physical Therapy, Faculty of Health Sciences, Elborn College, University of Western Ontario, London, ON, Canada
| | - Jose R Jauregui
- Ageing Biology Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nellie Kamkar
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
| | - Rose-Anne Kenny
- Department of Medical Gerontology Trinity College Dublin and Mercers Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Sarah E Lamb
- Faculty of Health and Life Sciences, Mireille Gillings Professor of Health Innovation, Medical School Building, Exeter, England, UK
| | | | - Lewis A Lipsitz
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Teresa Liu-Ambrose
- Djavad Mowafaghian Centre for Brain Health, Center for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Pip Logan
- School of Medicine, University of Nottingham, Nottingham, England, UK
| | - Stephen R Lord
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney, NSW, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Louise Mallet
- Department of Pharmacy, Faculty of Pharmacy, McGill University Health Center, Université de Montréal, Montreal, QC, Canada
| | - David Marsh
- University College London, London, England, UK
| | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Rogelio Moctezuma-Gallegos
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán”. Mexico City, Mexico
- Geriatric Medicine Program, Tecnologico de Monterrey, School of Medicine and Health Sciences. Monterrey, Nuevo León, Mexico
| | - Meg E Morris
- Healthscope and Academic and Research Collaborative in Health (ARCH), La Trobe University, Australia
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Neurorehabilitation Research Group (eNRGy), KU Leuven, Leuven, Belgium
| | - Monica R Perracini
- Master’s and Doctoral programs in Physical Therapy, Universidade Cidade de Sao Paulo (UNICID), Sao Paulo, Brazil
| | - Frederico Pieruccini-Faria
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Alison Pighills
- Mackay Institute of Research and Innovation, Mackay Hospital and Health Service, Mackay, QLD, Australia
| | - Catherine Said
- Western Health, University of Melbourne, Parkville, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, VIC, Australia
- Melbourne School of Health Sciences The University of Melbourne, Parkville, Australia
| | - Ervin Sejdic
- Department of Electrical and Computer Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Dawn A Skelton
- School of Health and Life Sciences, Research Centre for Health (ReaCH), Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland, UK
| | - Sabestina Dsouza
- Department of Occupational Therapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
- Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Susan Stark
- Program in Occupational Therapy, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Chris Todd
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, UK
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK
| | - Bruce R Troen
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Jacobs School of Medicine & Biomedical Sciences, University of Buffalo; Research Service, Veterans Affairs Western New York Healthcare System, Buffalo, New York, USA
| | - Tischa van der Cammen
- Department of Human-Centred Design, Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
- Section of Geriatric Medicine, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joe Verghese
- Division of Geriatrics, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ellen Vlaeyen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Jennifer A Watt
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tahir Masud
- Department of Geriatric Medicine, The British Geriatrics Society, Nottingham University Hospitals NHS Trust, Nottingham, England, UK
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13
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Poole VN, Dawe RJ, Lamar M, Esterman M, Barnes L, Leurgans SE, Bennett DA, Hausdorff JM, Buchman AS. Dividing attention during the Timed Up and Go enhances associations of several subtask performances with MCI and cognition. PLoS One 2022; 17:e0269398. [PMID: 35921260 PMCID: PMC9348700 DOI: 10.1371/journal.pone.0269398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/19/2022] [Indexed: 11/18/2022] Open
Abstract
We tested the hypothesis that dividing attention would strengthen the ability to detect mild cognitive impairment (MCI) and specific cognitive abilities from Timed Up and Go (TUG) performance in the community setting. While wearing a belt-worn sensor, 757 dementia-free older adults completed TUG during two conditions, with and without a concurrent verbal serial subtraction task. We segmented TUG into its four subtasks (i.e., walking, turning, and two postural transitions), and extracted 18 measures that were summarized into nine validated sensor metrics. Participants also underwent a detailed cognitive assessment during the same visit. We then employed a series of regression models to determine the combinations of subtask sensor metrics most strongly associated with MCI and specific cognitive abilities for each condition. We also compared subtask performances with and without dividing attention to determine whether the costs of divided attention were associated with cognition. While slower TUG walking and turning were associated with higher odds of MCI under normal conditions, these and other subtask associations became more strongly linked to MCI when TUG was performed under divided attention. Walking and turns were also most strongly associated with executive function and attention, particularly under divided attention. These differential associations with cognition were mirrored by performance costs. However, since several TUG subtasks were more strongly associated with MCI and cognitive abilities when performed under divided attention, future work is needed to determine how instrumented dual-task TUG testing can more accurately estimate risk for late-life cognitive impairment in older adults.
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Affiliation(s)
- Victoria N. Poole
- Rush Alzheimer’s Disease Research Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Robert J. Dawe
- Rush Alzheimer’s Disease Research Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Melissa Lamar
- Rush Alzheimer’s Disease Research Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Michael Esterman
- National Center for PTSD & Boston Attention and Learning Laboratory, VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Lisa Barnes
- Rush Alzheimer’s Disease Research Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Sue E. Leurgans
- Rush Alzheimer’s Disease Research Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - David A. Bennett
- Rush Alzheimer’s Disease Research Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Jeffrey M. Hausdorff
- Rush Alzheimer’s Disease Research Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, United States of America
- Center for the Study of Movement, Cognition, and Mobility, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sagol School of Neuroscience and Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Research Center, Rush University Medical Center, Chicago, Illinois, United States of America
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
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14
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Choi J, Knarr BA, Gwon Y, Youn JH. Prediction of Stability during Walking at Simulated Ship's Rolling Motion Using Accelerometers. Sensors (Basel) 2022; 22:5416. [PMID: 35891095 PMCID: PMC9320816 DOI: 10.3390/s22145416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/30/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Due to a ship's extreme motion, there is a risk of injuries and accidents as people may become unbalanced and be injured or fall from the ship. Thus, individuals must adjust their movements when walking in an unstable environment to avoid falling or losing balance. A person's ability to control their center of mass (COM) during lateral motion is critical to maintaining balance when walking. Dynamic balancing is also crucial to maintain stability while walking. The margin of stability (MOS) is used to define this dynamic balancing. This study aimed to develop a model for predicting balance control and stability in walking on ships by estimating the peak COM excursion and MOS variability using accelerometers. We recruited 30 healthy individuals for this study. During the experiment, participants walked for two minutes at self-selected speeds, and we used a computer-assisted rehabilitation environment (CAREN) system to simulate the roll motion. The proposed prediction models in this study successfully predicted the peak COM excursion and MOS variability. This study may be used to protect and save seafarers or passengers by assessing the risk of balance loss.
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Affiliation(s)
- Jungyeon Choi
- College of Information Science and Technology, University of Nebraska at Omaha, Omaha, NE 68182, USA;
| | - Brian A. Knarr
- Department of Biomechanics, University of Nebraska at Omaha, Omaha, NE 68182, USA;
| | - Yeongjin Gwon
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Jong-Hoon Youn
- College of Information Science and Technology, University of Nebraska at Omaha, Omaha, NE 68182, USA;
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15
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Pedrero-Sánchez JF, Belda-Lois JM, Serra-Añó P, Inglés M, López-Pascual J. Classification of healthy, Alzheimer and Parkinson populations with a multi-branch neural network. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Tulipani LJ, Meyer B, Allen D, Solomon AJ, McGinnis RS. Evaluation of unsupervised 30-second chair stand test performance assessed by wearable sensors to predict fall status in multiple sclerosis. Gait Posture 2022; 94:19-25. [PMID: 35220031 PMCID: PMC9086135 DOI: 10.1016/j.gaitpost.2022.02.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 02/03/2022] [Accepted: 02/13/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND One in two people with multiple sclerosis (PwMS) will fall in a three-month period. Predicting which patients will fall remains a challenge for clinicians. Standardized functional assessments provide insight into balance deficits and fall risk but their use has been limited to supervised visits. RESEARCH QUESTION The study aim was to characterize unsupervised 30-second chair stand test (30CST) performance using accelerometer-derived metrics and assess its ability to classify fall status in PwMS compared to supervised 30CST. METHODS Thirty-seven PwMS (21 fallers) performed instrumented supervised and unsupervised 30CSTs with a single wearable sensor on the thigh. In unsupervised conditions, participants performed bi-hourly 30CSTs and rated their balance confidence and fatigue over 48-hours. ROC analysis was used to classify fall status for 30CST performance. RESULTS Non-fallers (p = 0.02) but not fallers (p = 0.23) differed in their average unsupervised 30CST performance (repetitions) compared to their supervised performance. The unsupervised maximum number of 30CST repetitions performed optimized ROC classification AUC (0.79), accuracy (78.4%) and specificity (90.0%) for fall status with an optimal cutoff of 17 repetitions. SIGNIFICANCE Brief durations of instrumented unsupervised monitoring as an adjunct to routine clinical assessments could improve the ability for predicting fall risk and fluctuations in functional mobility in PwMS.
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Affiliation(s)
- Lindsey J. Tulipani
- M-Sense Research Group, Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, United States
| | - Brett Meyer
- M-Sense Research Group, Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, United States
| | - Dakota Allen
- M-Sense Research Group, Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, United States
| | - Andrew J. Solomon
- Department of Neurological Sciences, University of Vermont, Burlington, VT, United States
| | - Ryan S. McGinnis
- M-Sense Research Group, Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT, United States
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17
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Almajid R, Goel R. Assessment of dual-tasking during a dynamic balance task using a smartphone app: a pilot study. J Phys Ther Sci 2022; 34:115-121. [PMID: 35221514 PMCID: PMC8860690 DOI: 10.1589/jpts.34.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/11/2021] [Indexed: 11/28/2022] Open
Abstract
[Purpose] To assess if the instrumented Timed Up and Go (iTUG) task score calculated
with an iPhone application can detect gait changes under dual-tasking conditions.
[Participants and Methods] Twenty participants (age 38.30 ± 12.54, 12 females) were asked
to complete the TUG as a single task and under two dual-tasking conditions: 1) verbal
fluency and 2) mental calculation. We used a smartphone, stopwatch, digital camera, and
wearable sensor to calculate the dependent variables which included time, step count, gait
speed, and iTUG score and, the dual-tasking cost (DTC) of those variables. We used
Friedman analyses of variance and Wilcoxon tests for statistical analyses. [Results] the
iTUG score, step count, gait speed, and the time measured by the stopwatch and wearable
sensor differed significantly for all tasks, but the smartphone time did not. [Conclusion]
We conclude that the iTUG score could be used as a sensitive measure for identifying gait
changes under dual-tasking conditions. With the growing demands of telehealth, using
technology as an objective tool for movement analysis is needed for clinicians and payers.
Our findings demonstrate the potential value of the iTUG score to assess and track
patient’s progress.
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Affiliation(s)
- Rania Almajid
- Physical Therapy Program, Stockton University: 101 Vera King Farris Drive, Galloway, New Jersey 08205, USA
| | - Rahul Goel
- Department of Neuroscience, Baylor College of Medicine, USA
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18
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Atrsaei A, Hansen C, Elshehabi M, Solbrig S, Berg D, Liepelt-Scarfone I, Maetzler W, Aminian K. Effect of Fear of Falling on Mobility Measured During Lab and Daily Activity Assessments in Parkinson's Disease. Front Aging Neurosci 2021; 13:722830. [PMID: 34916920 PMCID: PMC8669821 DOI: 10.3389/fnagi.2021.722830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/21/2021] [Indexed: 12/24/2022] Open
Abstract
In chronic disorders such as Parkinson’s disease (PD), fear of falling (FOF) is associated with falls and reduced quality of life. With inertial measurement units (IMUs) and dedicated algorithms, different aspects of mobility can be obtained during supervised tests in the lab and also during daily activities. To our best knowledge, the effect of FOF on mobility has not been investigated in both of these settings simultaneously. Our goal was to evaluate the effect of FOF on the mobility of 26 patients with PD during clinical assessments and 14 days of daily activity monitoring. Parameters related to gait, sit-to-stand transitions, and turns were extracted from IMU signals on the lower back. Fear of falling was assessed using the Falls Efficacy Scale-International (FES-I) and the patients were grouped as with (PD-FOF+) and without FOF (PD-FOF−). Mobility parameters between groups were compared using logistic regression as well as the effect size values obtained using the Wilcoxon rank-sum test. The peak angular velocity of the turn-to-sit transition of the timed-up-and-go (TUG) test had the highest discriminative power between PD-FOF+ and PD-FOF− (r-value of effect size = 0.61). Moreover, PD-FOF+ had a tendency toward lower gait speed at home and a lower amount of walking bouts, especially for shorter walking bouts. The combination of lab and daily activity parameters reached a higher discriminative power [area under the curve (AUC) = 0.75] than each setting alone (AUC = 0.68 in the lab, AUC = 0.54 at home). Comparing the gait speed between the two assessments, the PD-FOF+ showed higher gait speeds in the capacity area compared with their TUG test in the lab. The mobility parameters extracted from both lab and home-based assessments contribute to the detection of FOF in PD. This study adds further evidence to the usefulness of mobility assessments that include different environments and assessment strategies. Although this study was limited in the sample size, it still provides a helpful method to consider the daily activity measurement of the patients with PD into clinical evaluation. The obtained results can help the clinicians with a more accurate prevention and treatment strategy.
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Affiliation(s)
- Arash Atrsaei
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Clint Hansen
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Morad Elshehabi
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Susanne Solbrig
- Department of Neurodegeneration, Center for Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany.,Department of Neurodegeneration, Center for Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegeneration, Center for Neurology and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases, Tübingen, Germany.,IB-Hochschule, Stuttgart, Germany
| | - Walter Maetzler
- Department of Neurology, UKSH, Christian-Albrechts-University, Kiel, Germany
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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19
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Lockhart TE, Soangra R, Yoon H, Wu T, Frames CW, Weaver R, Roberto KA. Prediction of fall risk among community-dwelling older adults using a wearable system. Sci Rep 2021; 11:20976. [PMID: 34697377 DOI: 10.1038/s41598-021-00458-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 10/11/2021] [Indexed: 11/28/2022] Open
Abstract
Falls are among the most common cause of decreased mobility and independence in older adults and rank as one of the most severe public health problems with frequent fatal consequences. In the present study, gait characteristics from 171 community-dwelling older adults were evaluated to determine their predictive ability for future falls using a wearable system. Participants wore a wearable sensor (inertial measurement unit, IMU) affixed to the sternum and performed a 10-m walking test. Measures of gait variability, complexity, and smoothness were extracted from each participant, and prospective fall incidence was evaluated over the following 6-months. Gait parameters were refined to better represent features for a random forest classifier for the fall-risk classification utilizing three experiments. The results show that the best-trained model for faller classification used both linear and nonlinear gait parameters and achieved an overall 81.6 ± 0.7% accuracy, 86.7 ± 0.5% sensitivity, 80.3 ± 0.2% specificity in the blind test. These findings augment the wearable sensor's potential as an ambulatory fall risk identification tool in community-dwelling settings. Furthermore, they highlight the importance of gait features that rely less on event detection methods, and more on time series analysis techniques. Fall prevention is a critical component in older individuals’ healthcare, and simple models based on gait-related tasks and a wearable IMU sensor can determine the risk of future falls.
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20
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Choi J, Parker SM, Knarr BA, Gwon Y, Youn JH. Wearable Sensor-Based Prediction Model of Timed up and Go Test in Older Adults. Sensors (Basel) 2021; 21:6831. [PMID: 34696041 DOI: 10.3390/s21206831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022]
Abstract
The Timed Up and Go (TUG) test has been frequently used to assess the risk of falls in older adults because it is an easy, fast, and simple method of examining functional mobility and balance without special equipment. The purpose of this study is to develop a model that predicts the TUG test using three-dimensional acceleration data collected from wearable sensors during normal walking. We recruited 37 older adults for an outdoor walking task, and seven inertial measurement unit (IMU)-based sensors were attached to each participant. The elastic net and ridge regression methods were used to reduce gait feature sets and build a predictive model. The proposed predictive model reliably estimated the participants' TUG scores with a small margin of prediction errors. Although the prediction accuracies with two foot-sensors were slightly better than those of other configurations (e.g., MAPE: foot (0.865 s) > foot and pelvis (0.918 s) > pelvis (0.921 s)), we recommend the use of a single IMU sensor at the pelvis since it would provide wearing comfort while avoiding the disturbance of daily activities. The proposed predictive model can enable clinicians to assess older adults' fall risks remotely through the evaluation of the TUG score during their daily walking.
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21
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Picerno P, Iosa M, D'Souza C, Benedetti MG, Paolucci S, Morone G. Wearable inertial sensors for human movement analysis: a five-year update. Expert Rev Med Devices 2021; 18:79-94. [PMID: 34601995 DOI: 10.1080/17434440.2021.1988849] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The aim of the present review is to track the evolution of wearable IMUs from their use in supervised laboratory- and ambulatory-based settings to their application for long-term monitoring of human movement in unsupervised naturalistic settings. AREAS COVERED Four main emerging areas of application were identified and synthesized, namely, mobile health solutions (specifically, for the assessment of frailty, risk of falls, chronic neurological diseases, and for the monitoring and promotion of active living), occupational ergonomics, rehabilitation and telerehabilitation, and cognitive assessment. Findings from recent scientific literature in each of these areas was synthesized from an applied and/or clinical perspective with the purpose of providing clinical researchers and practitioners with practical guidance on contemporary uses of inertial sensors in applied clinical settings. EXPERT OPINION IMU-based wearable devices have undergone a rapid transition from use in laboratory-based clinical practice to unsupervised, applied settings. Successful use of wearable inertial sensing for assessing mobility, motor performance and movement disorders in applied settings will rely also on machine learning algorithms for managing the vast amounts of data generated by these sensors for extracting information that is both clinically relevant and interpretable by practitioners.
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Affiliation(s)
- Pietro Picerno
- SMART Engineering Solutions & Technologies (SMARTEST) Research Center, Università Telematica "Ecampus", Novedrate, Comune, Italy
| | - Marco Iosa
- Department of Psychology, Sapienza University, Rome, Italy.,Irrcs Santa Lucia Foundation, Rome, Italy
| | - Clive D'Souza
- Center for Ergonomics, Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA.,Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS-Istituto Ortopedico Rizzoli, Bologna, Italy
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22
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Bezold J, Krell-Roesch J, Eckert T, Jekauc D, Woll A. Sensor-based fall risk assessment in older adults with or without cognitive impairment: a systematic review. Eur Rev Aging Phys Act 2021; 18:15. [PMID: 34243722 PMCID: PMC8272315 DOI: 10.1186/s11556-021-00266-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Higher age and cognitive impairment are associated with a higher risk of falling. Wearable sensor technology may be useful in objectively assessing motor fall risk factors to improve physical exercise interventions for fall prevention. This systematic review aims at providing an updated overview of the current research on wearable sensors for fall risk assessment in older adults with or without cognitive impairment. Therefore, we addressed two specific research questions: 1) Can wearable sensors provide accurate data on motor performance that may be used to assess risk of falling, e.g., by distinguishing between faller and non-faller in a sample of older adults with or without cognitive impairment?; and 2) Which practical recommendations can be given for the application of sensor-based fall risk assessment in individuals with CI? A systematic literature search (July 2019, update July 2020) was conducted using PubMed, Scopus and Web of Science databases. Community-based studies or studies conducted in a geriatric setting that examine fall risk factors in older adults (aged ≥60 years) with or without cognitive impairment were included. Predefined inclusion criteria yielded 16 cross-sectional, 10 prospective and 2 studies with a mixed design. RESULTS Overall, sensor-based data was mainly collected during walking tests in a lab setting. The main sensor location was the lower back to provide wearing comfort and avoid disturbance of participants. The most accurate fall risk classification model included data from sit-to-walk and walk-to-sit transitions collected over three days of daily life (mean accuracy = 88.0%). Nine out of 28 included studies revealed information about sensor use in older adults with possible cognitive impairment, but classification models performed slightly worse than those for older adults without cognitive impairment (mean accuracy = 79.0%). CONCLUSION Fall risk assessment using wearable sensors is feasible in older adults regardless of their cognitive status. Accuracy may vary depending on sensor location, sensor attachment and type of assessment chosen for the recording of sensor data. More research on the use of sensors for objective fall risk assessment in older adults is needed, particularly in older adults with cognitive impairment. TRIAL REGISTRATION This systematic review is registered in PROSPERO ( CRD42020171118 ).
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Affiliation(s)
- Jelena Bezold
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Janina Krell-Roesch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | - Tobias Eckert
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Darko Jekauc
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany
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23
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Gallucci A, Trimarchi PD, Abbate C, Tuena C, Pedroli E, Lattanzio F, Stramba-Badiale M, Cesari M, Giunco F. ICT technologies as new promising tools for the managing of frailty: a systematic review. Aging Clin Exp Res 2021; 33:1453-1464. [PMID: 32705589 DOI: 10.1007/s40520-020-01626-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Frailty is a major health issue as it encompasses functional decline, physical dependence, and increased mortality risk. Recent studies explored Information and Communication Technology (ICT) interventions as alternatives to manage frailty in older persons. The aim of the present systematic review was to synthesize current evidence on ICT application within the complex models of frailty care in older people. METHODS Data sources included PubMed, PsycINFO, EMBASE and Web of Science, considering eligible those reviews on ICT application in samples of older persons formally assessed as frail. Records were screened by two independent researchers, who extracted data and appraised methodological quality of reviews and studies. RESULTS Among the 764 retrieved papers, two systematic reviews were included. Most of the studies analyzed defined frailty considering only few components of the phenotype and used ICT to stratify different levels of frailty or to support traditional screening strategies. Assessment of frailty was the context in which ICT has been mostly tested as compared to intervention. Cost effectiveness evaluations of the ICT technologies were not reported. CONCLUSIONS The research investigating the use of ICT in the context of frailty is still at the very beginning. Few studies strictly focused on the assessment of frailty, while intervention on frailty using ICT was rarely reported. The lack of a proper characterization of the frail condition along with the methodological limitations prevented the investigation of ICT within complex care models. Future studies are needed to effectively integrate ICT in the care of frailty in orders.
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Affiliation(s)
- Alessia Gallucci
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | | | - Carlo Abbate
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Cosimo Tuena
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Catholic University of the Sacred Hearth, Milan, Italy
| | - Elisa Pedroli
- Applied Technology for Neuro-Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Faculty of Psychology, University of eCampus, Novedrate, Italy
| | | | - Marco Stramba-Badiale
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Matteo Cesari
- Geriatric Unit, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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24
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Roshdibenam V, Jogerst GJ, Butler NR, Baek S. Machine Learning Prediction of Fall Risk in Older Adults Using Timed Up and Go Test Kinematics. Sensors (Basel) 2021; 21:3481. [PMID: 34067644 DOI: 10.3390/s21103481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 01/24/2023]
Abstract
Falls among the elderly population cause detrimental physical, mental, financial problems and, in the worst case, death. The increasing number of people entering the higher risk age-range has increased clinicians’ attention to intervene. Clinical tools, e.g., the Timed Up and Go (TUG) test, have been created for aiding clinicians in fall-risk assessment. Often simple to evaluate, these assessments are subject to a clinician’s judgment. Wearable sensor data with machine learning algorithms were introduced as an alternative to precisely quantify ambulatory kinematics and predict prospective falls. However, they require a long-term evaluation of large samples of subjects’ locomotion and complex feature engineering of sensor kinematics. Therefore, it is critical to build an objective fall-risk detection model that can efficiently measure biometric risk factors with minimal costs. We built and studied a sensor data-driven convolutional neural network model to predict older adults’ fall-risk status with relatively high sensitivity to geriatrician’s expert assessment. The sample in this study is representative of older patients with multiple co-morbidity seen in daily medical practice. Three non-intrusive wearable sensors were used to measure participants’ gait kinematics during the TUG test. This data collection ensured convenient capture of various gait impairment aspects at different body locations.
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25
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Lima M, Rodrigues SR, Bezerra P, Rodrigues LP, Cancela JM. Monitorization of Timed Up and Go Phases in Elderly. Physical & Occupational Therapy In Geriatrics 2021. [DOI: 10.1080/02703181.2020.1836111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Miguel Lima
- Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain
| | - Sílvia Rocha Rodrigues
- Escola Superior de Desporto e Lazer de Melgaço, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Research Center, Sports Sciences Health and Human Development, CIDESD, Vila Real, Portugal
- Tumor & Microenvironment Interactions Group, Porto, Portugal
| | - Pedro Bezerra
- Escola Superior de Desporto e Lazer de Melgaço, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Research Center, Sports Sciences Health and Human Development, CIDESD, Vila Real, Portugal
| | - Luís Paulo Rodrigues
- Escola Superior de Desporto e Lazer de Melgaço, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Research Center, Sports Sciences Health and Human Development, CIDESD, Vila Real, Portugal
| | - José Maria Cancela
- Faculty of Education and Sport Sciences, University of Vigo, Pontevedra, Spain
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26
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Maidan I, Mirelman A, Hausdorff JM, Stern Y, Habeck CG. Distinct cortical thickness patterns link disparate cerebral cortex regions to select mobility domains. Sci Rep 2021; 11:6600. [PMID: 33758214 PMCID: PMC7988162 DOI: 10.1038/s41598-021-85058-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 02/19/2021] [Indexed: 01/03/2023] Open
Abstract
The cortical control of gait and mobility involves multiple brain regions. Therefore, one could speculate that the association between specific spatial patterns of cortical thickness may be differentially associated with different mobility domains. To test this possibility, 115 healthy participants aged 27–82 (mean 60.5 ± 13.8) underwent a mobility assessment (usual-walk, dual-task walk, Timed Up and Go) and MRI scan. Ten mobility domains of relatively simple (e.g., usual-walking) and complex tasks (i.e., dual task walking, turns, transitions) and cortical thickness of 68 ROIs were extracted. All associations between mobility and cortical thickness were controlled for age and gender. Scaled Subprofile Modelling (SSM), a PCA-regression, identified thickness patterns that were correlated with the individual mobility domains, controlling for multiple comparisons. We found that lower mean global cortical thickness was correlated with worse general mobility (r = − 0.296, p = 0.003), as measured by the time to complete the Timed Up and Go test. Three distinct patterns of cortical thickness were associated with three different gait domains during simple, usual-walking: pace, rhythm, and symmetry. In contrast, cortical thickness patterns were not related to the more complex mobility domains. These findings demonstrate that robust and topographically distinct cortical thickness patterns are linked to select mobility domains during relatively simple walking, but not to more complex aspects of mobility. Functional connectivity may play a larger role in the more complex aspects of mobility.
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Affiliation(s)
- Inbal Maidan
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel. .,Department of Neurology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Anat Mirelman
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.,Department of Neurology, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Laboratory of Early Markers of Neurodegeneration, Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Orthopaedic Surgery, Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Yaakov Stern
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain and G.H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Christian G Habeck
- Cognitive Neuroscience Division of the Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain and G.H. Sergievsky Center, Columbia University Irving Medical Center, New York, NY, USA
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27
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Marques DL, Neiva HP, Pires IM, Zdravevski E, Mihajlov M, Garcia NM, Ruiz-Cárdenas JD, Marinho DA, Marques MC. An Experimental Study on the Validity and Reliability of a Smartphone Application to Acquire Temporal Variables during the Single Sit-to-Stand Test with Older Adults. Sensors (Basel) 2021; 21:s21062050. [PMID: 33803927 PMCID: PMC8000467 DOI: 10.3390/s21062050] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 02/17/2021] [Accepted: 03/11/2021] [Indexed: 12/26/2022]
Abstract
Smartphone sensors have often been proposed as pervasive measurement systems to assess mobility in older adults due to their ease of use and low-cost. This study analyzes a smartphone-based application’s validity and reliability to quantify temporal variables during the single sit-to-stand test with institutionalized older adults. Forty older adults (20 women and 20 men; 78.9 ± 8.6 years) volunteered to participate in this study. All participants performed the single sit-to-stand test. Each sit-to-stand repetition was performed after an acoustic signal was emitted by the smartphone app. All data were acquired simultaneously with a smartphone and a digital video camera. The measured temporal variables were stand-up time and total time. The relative reliability and systematic bias inter-device were assessed using the intraclass correlation coefficient (ICC) and Bland-Altman plots. In contrast, absolute reliability was assessed using the standard error of measurement and coefficient of variation (CV). Inter-device concurrent validity was assessed through correlation analysis. The absolute percent error (APE) and the accuracy were also calculated. The results showed excellent reliability (ICC = 0.92–0.97; CV = 1.85–3.03) and very strong relationships inter-devices for the stand-up time (r = 0.94) and the total time (r = 0.98). The APE was lower than 6%, and the accuracy was higher than 94%. Based on our data, the findings suggest that the smartphone application is valid and reliable to collect the stand-up time and total time during the single sit-to-stand test with older adults.
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Affiliation(s)
- Diogo Luís Marques
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (D.L.M.); (H.P.N.); (D.A.M.)
| | - Henrique Pereira Neiva
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (D.L.M.); (H.P.N.); (D.A.M.)
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 6201-001 Covilhã, Portugal
| | - Ivan Miguel Pires
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal; (I.M.P.); (N.M.G.)
- Computer Science Department, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
- Health Sciences Research Unit: Nursing, School of Health, Polytechnic Institute of Viseu, 3504-510 Viseu, Portugal
| | - Eftim Zdravevski
- Faculty of Computer Science and Engineering, University Ss Cyril and Methodius, 1000 Skopje, North Macedonia;
| | - Martin Mihajlov
- Laboratory for Open Systems and Networks, Jozef Stefan Institute, 1000 Ljubljana, Slovenia;
| | - Nuno M. Garcia
- Instituto de Telecomunicações, Universidade da Beira Interior, 6200-001 Covilhã, Portugal; (I.M.P.); (N.M.G.)
| | - Juan Diego Ruiz-Cárdenas
- Physiotherapy Department, Faculty of Health Sciences, Catholic University of Murcia, 30107 Murcia, Spain;
| | - Daniel Almeida Marinho
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (D.L.M.); (H.P.N.); (D.A.M.)
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 6201-001 Covilhã, Portugal
| | - Mário Cardoso Marques
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (D.L.M.); (H.P.N.); (D.A.M.)
- Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, 6201-001 Covilhã, Portugal
- Correspondence:
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Bet P, Castro PC, Ponti MA. Foreseeing future falls with accelerometer features in active community-dwelling older persons with no recent history of falls. Exp Gerontol 2020; 143:111139. [PMID: 33189837 DOI: 10.1016/j.exger.2020.111139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acceleration sensors are a viable option for monitoring gait patterns and its application on monitoring falls and risk of falling. However the literature still lacks prospective studies to investigate such risk before the occurrence of falls. OBJECTIVE To investigate features extracted from accelerometer signals with the purpose of predicting future falls in individuals with no recent history of falls. METHODS In this study we investigate the risk of fall in active and healthy community-dwelling living older persons with no recent history of falls, using a single accelerometer and variants of the Timed Up and Go (TUG) test. A prospective study was conducted with 74 healthy non-fallers older persons. After collecting acceleration data from the participants at the baseline, the occurrence of falls (outcome) was monitored quarterly during one year. A set of frequency features were extracted from the signal and their ability to predict falls was evaluated. RESULTS The best individual feature result shows an accuracy of 0.75, sensitivity of 0.71 and specificity of 0.76. A fusion of the three best features increases the sensitivity to 0.86. On the other hand, the cut-off points of the TUG seconds, often used to assess fall risk, did not demonstrate adequate sensitivity. CONCLUSION The results confirms previous evidence that accelerometer features can better estimate fall risk, and support potential applications that try to infer falls risk in less restricted scenarios, even in a sample stratified by age and gender composed of active and healthy community-dwelling living older persons.
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Affiliation(s)
- Patricia Bet
- Programa de Pós-Graduação Interunidades em Bioengenharia - Universidade de São Paulo, São Carlos, SP 13566-590, Brazil; DGero - Universidade Federal de São Carlos, São Carlos, SP, Brazil.
| | - Paula C Castro
- DGero - Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Moacir A Ponti
- ICMC - Universidade de São Paulo, São Carlos, SP 13566-590, Brazil
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Lee CH, Chen SH, Jiang BC, Sun TL. Estimating Postural Stability Using Improved Permutation Entropy via TUG Accelerometer Data for Community-Dwelling Elderly People. Entropy (Basel) 2020; 22:E1097. [PMID: 33286865 PMCID: PMC7597195 DOI: 10.3390/e22101097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 01/03/2023]
Abstract
To develop an effective fall prevention program, clinicians must first identify the elderly people at risk of falling and then take the most appropriate interventions to reduce or eliminate preventable falls. Employing feature selection to establish effective decision making can thus assist in the identification of a patient's fall risk from limited data. This work therefore aims to supplement professional timed up and go assessment methods using sensor technology, entropy analysis, and statistical analysis. The results showed the different approach of applying logistic regression analysis to the inertial data on a fall-risk scale to allow medical practitioners to predict for high-risk patients. Logistic regression was also used to automatically select feature values and clinical judgment methods to explore the differences in decision making. We also calculate the area under the receiver-operating characteristic curve (AUC). Results indicated that permutation entropy and statistical features provided the best AUC values (all above 0.9), and false positives were avoided. Additionally, the weighted-permutation entropy/statistical features test has a relatively good agreement rate with the short-form Berg balance scale when classifying patients as being at risk. Therefore, the proposed methodology can provide decision-makers with a more accurate way to classify fall risk in elderly people.
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Affiliation(s)
- Chia-Hsuan Lee
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (C.-H.L.); (B.C.J.)
| | - Shih-Hai Chen
- Department of Industrial Engineering and Management, Yuan Ze University, Taoyuan 320, Taiwan;
| | - Bernard C. Jiang
- Department of Industrial Management, National Taiwan University of Science and Technology, Taipei 106, Taiwan; (C.-H.L.); (B.C.J.)
| | - Tien-Lung Sun
- Department of Industrial Engineering and Management, Yuan Ze University, Taoyuan 320, Taiwan;
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Reches T, Dagan M, Herman T, Gazit E, Gouskova NA, Giladi N, Manor B, Hausdorff JM. Using Wearable Sensors and Machine Learning to Automatically Detect Freezing of Gait during a FOG-Provoking Test. Sensors (Basel) 2020; 20:E4474. [PMID: 32785163 PMCID: PMC7472497 DOI: 10.3390/s20164474] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/06/2020] [Accepted: 08/08/2020] [Indexed: 12/19/2022]
Abstract
Freezing of gait (FOG) is a debilitating motor phenomenon that is common among individuals with advanced Parkinson's disease. Objective and sensitive measures are needed to better quantify FOG. The present work addresses this need by leveraging wearable devices and machine-learning methods to develop and evaluate automated detection of FOG and quantification of its severity. Seventy-one subjects with FOG completed a FOG-provoking test while wearing three wearable sensors (lower back and each ankle). Subjects were videotaped before (OFF state) and after (ON state) they took their antiparkinsonian medications. Annotations of the videos provided the "ground-truth" for FOG detection. A leave-one-patient-out validation process with a training set of 57 subjects resulted in 84.1% sensitivity, 83.4% specificity, and 85.0% accuracy for FOG detection. Similar results were seen in an independent test set (data from 14 other subjects). Two derived outcomes, percent time frozen and number of FOG episodes, were associated with self-report of FOG. Bother derived-metrics were higher in the OFF state than in the ON state and in the most challenging level of the FOG-provoking test, compared to the least challenging level. These results suggest that this automated machine-learning approach can objectively assess FOG and that its outcomes are responsive to therapeutic interventions.
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Affiliation(s)
- Tal Reches
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo 6492416, Israel; (T.R.); (M.D.); (T.H.); (E.G.); (N.G.)
| | - Moria Dagan
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo 6492416, Israel; (T.R.); (M.D.); (T.H.); (E.G.); (N.G.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Talia Herman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo 6492416, Israel; (T.R.); (M.D.); (T.H.); (E.G.); (N.G.)
| | - Eran Gazit
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo 6492416, Israel; (T.R.); (M.D.); (T.H.); (E.G.); (N.G.)
| | - Natalia A. Gouskova
- Harvard Medical School, Boston, MA 02115, USA; (N.A.G.); (B.M.)
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA 02131, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Nir Giladi
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo 6492416, Israel; (T.R.); (M.D.); (T.H.); (E.G.); (N.G.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Brad Manor
- Harvard Medical School, Boston, MA 02115, USA; (N.A.G.); (B.M.)
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Roslindale, MA 02131, USA
- Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo 6492416, Israel; (T.R.); (M.D.); (T.H.); (E.G.); (N.G.)
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Rush Alzheimer’s Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
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Figueiredo AI, Balbinot G, Brauner FO, Schiavo A, Baptista RR, Pagnussat AS, Hollands K, Mestriner RG. SPARC Metrics Provide Mobility Smoothness Assessment in Oldest-Old With and Without a History of Falls: A Case Control Study. Front Physiol 2020; 11:540. [PMID: 32587523 PMCID: PMC7298141 DOI: 10.3389/fphys.2020.00540] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/30/2020] [Indexed: 11/25/2022] Open
Abstract
Aging-related neuromuscular and neurocognitive decline induces unsmooth movements in daily functional mobility. Here, we used a robust analysis of linear and angular spectral arc length (SPARC) in the single and dual task instrumented timed up-and-go (iTUG) test to compare functional mobility smoothness in fallers and non-fallers aged 85 and older. 64 participants aged 85 and older took part in this case control study. The case group (fallers, n = 32) had experienced falls to the ground in the 6 months prior to the assessment. SPARC analyses were conducted in all phases of the single and dual task iTUGs. We also performed correlation mapping to test the relation of socio-demographic and clinical features on SPARC metrics. The magnitude of between-group differences was calculated using D-Cohen effect size (ES). SPARC was able to distinguish fallers during the single iTUG (ES ≈ 4.18). Turning while walking in the iTUG induced pronounced unsmooth movements in the fallers (SPARC ≈ −13; ES = 3.52) and was associated with the ability to maintain balance in the functional reach task. This information is of importance in the study of functional mobility in the oldest-old and to assess the efficacy of fall-prevention programs.
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Affiliation(s)
- Anelise Ineu Figueiredo
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo Balbinot
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Fabiane Oliveira Brauner
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aniuska Schiavo
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Reimann Baptista
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aline Souza Pagnussat
- Department of Physical Therapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Kristen Hollands
- School of Health Sciences, University of Salford Manchester, Salford, United Kingdom
| | - Régis Gemerasca Mestriner
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Buisseret F, Catinus L, Grenard R, Jojczyk L, Fievez D, Barvaux V, Dierick F. Timed Up and Go and Six-Minute Walking Tests with Wearable Inertial Sensor: One Step Further for the Prediction of the Risk of Fall in Elderly Nursing Home People. Sensors (Basel) 2020; 20:E3207. [PMID: 32516995 DOI: 10.3390/s20113207] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/26/2020] [Accepted: 06/03/2020] [Indexed: 12/13/2022]
Abstract
Assessing the risk of fall in elderly people is a difficult challenge for clinicians. Since falls represent one of the first causes of death in such people, numerous clinical tests have been created and validated over the past 30 years to ascertain the risk of falls. More recently, the developments of low-cost motion capture sensors have facilitated observations of gait differences between fallers and nonfallers. The aim of this study is twofold. First, to design a method combining clinical tests and motion capture sensors in order to optimize the prediction of the risk of fall. Second to assess the ability of artificial intelligence to predict risk of fall from sensor raw data only. Seventy-three nursing home residents over the age of 65 underwent the Timed Up and Go (TUG) and six-minute walking tests equipped with a home-designed wearable Inertial Measurement Unit during two sets of measurements at a six-month interval. Observed falls during that interval enabled us to divide residents into two categories: fallers and nonfallers. We show that the TUG test results coupled to gait variability indicators, measured during a six-minute walking test, improve (from 68% to 76%) the accuracy of risk of fall’s prediction at six months. In addition, we show that an artificial intelligence algorithm trained on the sensor raw data of 57 participants reveals an accuracy of 75% on the remaining 16 participants.
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Fino PC, Wilhelm J, Parrington L, Stuart S, Chesnutt JC, King LA. Inertial Sensors Reveal Subtle Motor Deficits When Walking With Horizontal Head Turns After Concussion. J Head Trauma Rehabil 2019; 34:E74-81. [PMID: 30045224 DOI: 10.1097/HTR.0000000000000418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine whether horizontal head turns while seated or while walking, when instrumented with inertial sensors, were sensitive to the acute effects of concussion and whether horizontal head turns had utility for concussion management. SETTING Applied field setting, athletic training room. PARTICIPANTS Twenty-four collegiate athletes with sports-related concussion and 25 healthy control athletes. DESIGN Case-control; longitudinal. MAIN MEASURES Peak head angular velocity and peak head angle (range of motion) when performing head turns toward an auditory cue while seated or walking. Gait speed when walking with and without head turns. RESULTS Athletes with acute sports-related concussion turned their head slower than healthy control subjects initially (group β = -49.47; SE = 16.33; P = .003) and gradually recovered to healthy control levels within 10 days postconcussion (group × time β = 4.80; SE = 1.41; P < .001). Peak head velocity had fair diagnostic accuracy in differentiating subjects with acute concussion compared with controls (areas under the receiver operating characteristic curve [AUC] = 0.71-0.73). Peak head angle (P = .17) and gait speed (P = .64) were not different between groups and showed poor diagnostic utility (AUC = 0.57-0.62). CONCLUSION Inertial sensors can improve traditional clinical assessments by quantifying subtle, nonobservable deficits in people following sports-related concussion.
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Bergquist R, Vereijken B, Mellone S, Corzani M, Helbostad JL, Taraldsen K. App-based Self-administrable Clinical Tests of Physical Function: Development and Usability Study. JMIR Mhealth Uhealth 2020; 8:e16507. [PMID: 32338616 PMCID: PMC7215517 DOI: 10.2196/16507] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/07/2020] [Accepted: 02/21/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Objective measures of physical function in older adults are widely used to predict health outcomes such as disability, institutionalization, and mortality. App-based clinical tests allow users to assess their own physical function and have objective tracking of changes over time by use of their smartphones. Such tests can potentially guide interventions remotely and provide more detailed prognostic information about the participant's physical performance for the users, therapists, and other health care personnel. We developed 3 smartphone apps with instrumented versions of the Timed Up and Go (Self-TUG), tandem stance (Self-Tandem), and Five Times Sit-to-Stand (Self-STS) tests. OBJECTIVE This study aimed to test the usability of 3 smartphone app-based self-tests of physical function using an iterative design. METHODS The apps were tested in 3 iterations: the first (n=189) and second (n=134) in a lab setting and the third (n=20) in a separate home-based study. Participants were healthy adults between 60 and 80 years of age. Assessors observed while participants self-administered the tests without any guidance. Errors were recorded, and usability problems were defined. Problems were addressed in each subsequent iteration. Perceived usability in the home-based setting was assessed by use of the System Usability Scale, the User Experience Questionnaire, and semi-structured interviews. RESULTS In the first iteration, 7 usability problems were identified; 42 (42/189, 22.0%) and 127 (127/189, 67.2%) participants were able to correctly perform the Self-TUG and Self-Tandem, respectively. In the second iteration, errors caused by the problems identified in the first iteration were drastically reduced, and 108 (108/134, 83.1%) and 106 (106/134, 79.1%) of the participants correctly performed the Self-TUG and Self-Tandem, respectively. The first version of the Self-STS was also tested in this iteration, and 40 (40/134, 30.1%) of the participants performed it correctly. For the third usability test, the 7 usability problems initially identified were further improved. Testing the apps in a home setting gave rise to some new usability problems, and for Self-TUG and Self-STS, the rates of correctly performed trials were slightly reduced from the second version, while for Self-Tandem, the rate increased. The mean System Usability Scale score was 77.63 points (SD 16.1 points), and 80-95% of the participants reported the highest or second highest positive rating on all items in the User Experience Questionnaire. CONCLUSIONS The study results suggest that the apps have the potential to be used to self-test physical function in seniors in a nonsupervised home-based setting. The participants reported a high degree of ease of use. Evaluating the usability in a home setting allowed us to identify new usability problems that could affect the validity of the tests. These usability problems are not easily found in the lab setting, indicating that, if possible, app usability should be evaluated in both settings. Before being made available to end users, the apps require further improvements and validation.
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Affiliation(s)
- Ronny Bergquist
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sabato Mellone
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| | - Mattia Corzani
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| | - Jorunn L Helbostad
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristin Taraldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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Coluzzi D, Rivolta MW, Mastropietro A, Porcelli S, Mauri ML, Civiello MTL, Denna E, Rizzo G, Sassi R. Design and Validation of a Minimal Complexity Algorithm for Stair Step Counting. Computers 2020; 9:31. [DOI: 10.3390/computers9020031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Wearable sensors play a significant role for monitoring the functional ability of the elderly and in general, promoting active ageing. One of the relevant variables to be tracked is the number of stair steps (single stair steps) performed daily, which is more challenging than counting flight of stairs and detecting stair climbing. In this study, we proposed a minimal complexity algorithm composed of a hierarchical classifier and a linear model to estimate the number of stair steps performed during everyday activities. The algorithm was calibrated on accelerometer and barometer recordings measured using a sensor platform worn at the wrist from 20 healthy subjects. It was then tested on 10 older people, specifically enrolled for the study. The algorithm was then compared with other three state-of-the-art methods, which used the accelerometer, the barometer or both. The experiments showed the good performance of our algorithm (stair step counting error: 13.8%), comparable with the best state-of-the-art (p > 0.05), but using a lower computational load and model complexity. Finally, the algorithm was successfully implemented in a low-power smartwatch prototype with a memory footprint of about 4 kB.
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Ponciano V, Pires IM, Ribeiro FR, Marques G, Garcia NM, Pombo N, Spinsante S, Zdravevski E. Is The Timed-Up and Go Test Feasible in Mobile Devices? A Systematic Review. Electronics 2020; 9:528. [DOI: 10.3390/electronics9030528] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The number of older adults is increasing worldwide, and it is expected that by 2050 over 2 billion individuals will be more than 60 years old. Older adults are exposed to numerous pathological problems such as Parkinson’s disease, amyotrophic lateral sclerosis, post-stroke, and orthopedic disturbances. Several physiotherapy methods that involve measurement of movements, such as the Timed-Up and Go test, can be done to support efficient and effective evaluation of pathological symptoms and promotion of health and well-being. In this systematic review, the authors aim to determine how the inertial sensors embedded in mobile devices are employed for the measurement of the different parameters involved in the Timed-Up and Go test. The main contribution of this paper consists of the identification of the different studies that utilize the sensors available in mobile devices for the measurement of the results of the Timed-Up and Go test. The results show that mobile devices embedded motion sensors can be used for these types of studies and the most commonly used sensors are the magnetometer, accelerometer, and gyroscope available in off-the-shelf smartphones. The features analyzed in this paper are categorized as quantitative, quantitative + statistic, dynamic balance, gait properties, state transitions, and raw statistics. These features utilize the accelerometer and gyroscope sensors and facilitate recognition of daily activities, accidents such as falling, some diseases, as well as the measurement of the subject’s performance during the test execution.
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Montero-Odasso M, Almeida QJ, Bherer L, Burhan AM, Camicioli R, Doyon J, Fraser S, Muir-Hunter S, Li KZH, Liu-Ambrose T, McIlroy W, Middleton L, Morais JA, Sakurai R, Speechley M, Vasudev A, Beauchet O, Hausdorff JM, Rosano C, Studenski S, Verghese J. Consensus on Shared Measures of Mobility and Cognition: From the Canadian Consortium on Neurodegeneration in Aging (CCNA). J Gerontol A Biol Sci Med Sci 2020; 74:897-909. [PMID: 30101279 PMCID: PMC6521916 DOI: 10.1093/gerona/gly148] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 02/02/2023] Open
Abstract
Background A new paradigm is emerging in which mobility and cognitive impairments, previously studied, diagnosed, and managed separately in older adults, are in fact regulated by shared brain resources. Deterioration in these shared brain mechanisms by normal aging and neurodegeneration increases the risk of developing dementia, falls, and fractures. This new paradigm requires an integrated approach to measuring both domains. We aim to identify a complementary battery of existing tests of mobility and cognition in community-dwelling older adults that enable assessment of motor-cognitive interactions. Methods Experts on mobility and cognition in aging participated in a semistructured consensus based on the Delphi process. After performing a scoping review to select candidate tests, multiple rounds of consultations provided structured feedback on tests that captured shared characteristics of mobility and cognition. These tests needed to be sensitive to changes in both mobility and cognition, applicable across research studies and clinics, sensitive to interventions, feasible to perform in older adults, been previously validated, and have minimal ceiling/floor effects. Results From 17 tests appraised, 10 tests fulfilled prespecified criteria and were selected as part of the “Core-battery” of tests. The expert panel also recommended a “Minimum-battery” of tests that included gait speed, dual-task gait speed, the Montreal Cognitive Assessment and Trail Making Test A&B. Conclusions A standardized assessment battery that captures shared characteristics of mobility and cognition seen in aging and neurodegeneration may increase comparability across research studies, detection of subtle or common reversible factors, and accelerate research progress in dementia, falls, and aging-related disabilities.
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Affiliation(s)
- Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
- Address correspondence to: Manuel Montero-Odasso MD, PhD, AGSF, FRCPC, FGSA, Gait and Brain Lab, Parkwood Institute, University of Western Ontario and Lawson Health Research Institute, 550 Wellington Road, London, Ontario N6C 0A7, Canada. E-mail:
| | - Quincy J Almeida
- Department of Kinesiology and Physical Education, Sun Life Financial Movement Disorders Research Centre, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Louis Bherer
- Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Quebec, Canada
- Department of Medicine, University of Montreal, Quebec, Canada
- Montreal Heart Institute, Research Centre, Quebec, Canada
| | - Amer M Burhan
- Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Richard Camicioli
- Department of Medicine, Geriatric and Cognitive Neurology, University of Alberta, Edmonton, Canada
| | - Julien Doyon
- Functional Neuroimaging Unit, University of Montreal, Quebec, Canada
| | - Sarah Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Susan Muir-Hunter
- Department of Medicine, Division of Geriatric Medicine, University of Western Ontario, London, Canada
- Faculty of Health Sciences, School of Physical Therapy, University of Western Ontario, London, Canada
| | - Karen Z H Li
- Department of Psychology and PERFORM Centre, Concordia University, Montréal, Quebec, Canada
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Centre for Hip Health and Mobility, University of British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Research Institute, University of British Columbia, Canada
| | - William McIlroy
- Division of Neurology and Department of Medicine, University of Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Ontario, Canada
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - Laura Middleton
- Department of Kinesiology, University of Waterloo, Ontario, Canada
| | - José A Morais
- Department of Medicine, Division of Geriatrics and Centre of Excellence in Aging and Chronic Disease, McGill University, Montréal, Quebec, Canada
| | - Ryota Sakurai
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, Ontario, Canada
| | - Mark Speechley
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada
| | - Akshya Vasudev
- Department of Psychiatry, Geriatric Psychiatry, Schulich School of Medicine, University of Western Ontario, London, Canada
- Department of Medicine, Division of Clinical Pharmacology, University of Western Ontario, London, Canada
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montréal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada
- RUIS McGill Centre of Excellence on Aging and Chronic Disease – CEViMaC, Montréal, Quebec, Canada
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Israel
- Rush Alzheimer’s Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, Pennsylvania
| | - Stephanie Studenski
- Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pennsylvania
| | - Joe Verghese
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
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Patel M, Pavic A, Goodwin VA. Wearable inertial sensors to measure gait and posture characteristic differences in older adult fallers and non-fallers: A scoping review. Gait Posture 2020; 76:110-121. [PMID: 31756666 DOI: 10.1016/j.gaitpost.2019.10.039] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 09/27/2019] [Accepted: 10/27/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Wearable inertial sensors have grown in popularity as a means of objectively assessing fall risk. This review aimed to identify gait and posture differences among older adult fallers and non-fallers which can be measured with the use of wearable inertial sensors. In addition to describing the number of sensors used to obtain measures, the concurrent anatomical locations, how these measures compare to current forms of clinical fall risk assessment tests and the setting of tests. METHODS Following the development of a rigorous search strategy, MEDLINE, Web of Science, Cochrane, EMBASE, PEDro, and CINAHL were systematically searched for studies involving the use of wearable inertial sensors, to determine gait and postural based differences among fallers or those at high fall risk compared with non-fallers and low fall risk adults aged 60 years and older. RESULTS Thirty five papers met the inclusion criteria. One hundred and forty nine gait and posture characteristic differences were identified using wearable inertial sensors. There were sensor derived measures which significantly and strongly correlated with traditional clinical tests. The use of a single wearable inertial sensor located at the lower posterior trunk, was most the most effective location and enough to ascertain multiple pertinent fall risk factors. CONCLUSION This review identified the capabilities of identifying fall risk factors among older adults with the use of wearable inertial sensors. The lightweight portable nature makes inertial sensors an effective tool to be implemented into clinical fall risk assessment and continuous unsupervised home monitoring, in addition to, outdoor testing.
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Affiliation(s)
- Mubarak Patel
- Vibration Engineering Section, College of Engineering, Mathematics and Physical Sciences, University of Exeter, UK.
| | - Aleksandar Pavic
- Vibration Engineering Section, College of Engineering, Mathematics and Physical Sciences, University of Exeter, UK
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Almajid R, Tucker C, Wright WG, Vasudevan E, Keshner E. Visual dependence affects the motor behavior of older adults during the Timed Up and Go (TUG) test. Arch Gerontol Geriatr 2019; 87:104004. [PMID: 31877530 DOI: 10.1016/j.archger.2019.104004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Older adults show greater postural instabilities under misleading visual cues relative to younger adults. We investigated the effects of age-related visual dependence on motor performance under increased attention demands by adding a motor task and visual stimulus to the Timed Up and Go (TUG) test sub-components. METHOD We designed a cross-sectional quantitative study. Twenty-eight younger (n = 12) and older (n = 16) adults completed the TUG test while wearing a head-mounted display (HMD) that presented a visual stimulus and/or carrying a cup of water. Outcome measures were turning cadence; gait speed; pitch, yaw, and roll peak trunk velocities (PTVs); and acceleration ranges of sit-to-stand and stand-to-sit. RESULTS Wearing the HMD caused significant performance differences in the TUG test tasks due to age and visual dependence, although performance was lower across all groups with the HMD (p < 0.01). Older adults showed lower roll PTV in turning compared to younger adults (p = 0.03). Visually dependent older adults showed smaller mediolateral and vertical acceleration ranges (p < 0.04) in sit-to-stand compared to visually independent older adults. CONCLUSION The demand for orienting posture to a vertical position during sit-to-stand may differentiate older adults who are more visually dependent-and thus at greater fall risk- from those who are more visually independent. Age-related differences in turning behavior suggest a relationship with fall risk that warrants further investigation.
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Affiliation(s)
- Rania Almajid
- Department of Physical Therapy, West Coast University, 590 N Vermont Ave, Los Angeles, CA, 90004, USA; Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA.
| | - Carole Tucker
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA.
| | - William Geoffrey Wright
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA; Department of Bioengineering, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA.
| | - Erin Vasudevan
- Department of Health and Rehabilitation Sciences, School of Health Technology and Management, Stony Brook University, 101 Nicolls Road, Health Sciences Center, Stony Brook, 11794, USA.
| | - Emily Keshner
- Department of Physical Therapy, Temple University, 1801 N Broad St., Philadelphia, PA, 19122, USA.
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Mitsutake T, Sakamoto M, Horikawa E. The effects of electromyography-triggered neuromuscular electrical stimulation plus tilt sensor functional electrical stimulation training on gait performance in patients with subacute stroke: a randomized controlled pilot trial. Int J Rehabil Res 2019; 42:358-64. [DOI: 10.1097/mrr.0000000000000371] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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O'Brien MK, Hidalgo-Araya MD, Mummidisetty CK, Vallery H, Ghaffari R, Rogers JA, Lieber R, Jayaraman A. Augmenting Clinical Outcome Measures of Gait and Balance with a Single Inertial Sensor in Age-Ranged Healthy Adults. Sensors (Basel) 2019; 19:E4537. [PMID: 31635375 PMCID: PMC6832985 DOI: 10.3390/s19204537] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 01/24/2023]
Abstract
Gait and balance impairments are linked with reduced mobility and increased risk of falling. Wearable sensing technologies, such as inertial measurement units (IMUs), may augment clinical assessments by providing continuous, high-resolution data. This study tested and validated the utility of a single IMU to quantify gait and balance features during routine clinical outcome tests, and evaluated changes in sensor-derived measurements with age, sex, height, and weight. Age-ranged, healthy individuals (N = 49, 20-70 years) wore a lower back IMU during the 10 m walk test (10MWT), Timed Up and Go (TUG), and Berg Balance Scale (BBS). Spatiotemporal gait parameters computed from the sensor data were validated against gold standard measures, demonstrating excellent agreement for stance time, step time, gait velocity, and step count (intraclass correlation (ICC) > 0.90). There was good agreement for swing time (ICC = 0.78) and moderate agreement for step length (ICC = 0.68). A total of 184 features were calculated from the acceleration and angular velocity signals across these tests, 36 of which had significant correlations with age. This approach was also demonstrated for an individual with stroke, providing higher resolution information about balance, gait, and mobility than the clinical test scores alone. Leveraging mobility data from wireless, wearable sensors can help clinicians and patients more objectively pinpoint impairments, track progression, and set personalized goals during and after rehabilitation.
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Affiliation(s)
- Megan K O'Brien
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611, USA.
| | - Marco D Hidalgo-Araya
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA.
- Department of BioMechanical Engineering, Delft University of Technology, 2628CD Delft, The Netherlands.
| | - Chaithanya K Mummidisetty
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA.
- Shirley Ryan AbilityLab, Chicago, IL 60611, USA.
| | - Heike Vallery
- Department of BioMechanical Engineering, Delft University of Technology, 2628CD Delft, The Netherlands.
| | - Roozbeh Ghaffari
- Center for Bio-Integrated Electronics, Departments of Materials Science and Engineering, Biomedical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, IL 60208, USA.
| | - John A Rogers
- Center for Bio-Integrated Electronics, Departments of Materials Science and Engineering, Biomedical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, IL 60208, USA.
| | | | - Arun Jayaraman
- Max Nader Lab for Rehabilitation Technologies and Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL 60611, USA.
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Lin I, Yang C, Lai Y, Guo L. Combining Multifactorial Assessment Tools and Dimensionality Reduction Analysis for Fall Risk Classification in Community-Dwelling Older Adults. Topics in Geriatric Rehabilitation 2019; 35:273-9. [DOI: 10.1097/tgr.0000000000000245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Bet P, Castro PC, Ponti MA. Fall detection and fall risk assessment in older person using wearable sensors: A systematic review. Int J Med Inform 2019; 130:103946. [PMID: 31450081 DOI: 10.1016/j.ijmedinf.2019.08.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND wearable sensors are often used to acquire data for gait analysis as a strategy to study fall events, due to greater availability of acquisition platforms, and advances in computational intelligence. However, there are no review papers addressing the three most common types of applications related to fall using sensors, namely: fall detection, fallers classification and fall risk screening. OBJECTIVE To identify the state of art of fall-related events detection in older person using wearable sensors, as well as the main characteristics of the studies in the literature, pointing gaps for future studies. METHODS A systematic review design was used to search peer-reviewed literature on fall detection and risk in elderly through inertial sensors, published in English, Portuguese, Spanish or French between August 2002 and June 2019. The following questions are investigated: the type of sensors and their sampling rate, the type of signal and data processing employed, the scales and tests used in the study and the type of application. RESULTS We identified 608 studies, from which 29 were included. The accelerometer, with sampling rate 50 or 100 Hz, allocated in the waist or lumbar was the most used sensor setting. Methods comparing features or variables extracted from the accelerometry signal are the most common, and fall risk screening the most observed application. CONCLUSION This review identifies the main elements to be addressed in studies on the detection of events related to falls in the elderly and may help in future studies on the subject. However, some aspects are still no reach consensus in the literature such as the size of the sample to be studied, the population under study and how to acquire data for each application.
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Affiliation(s)
- Patricia Bet
- DGero - Universidade Federal de São Carlos, São Carlos, SP, Brazil.
| | - Paula C Castro
- DGero - Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | - Moacir A Ponti
- ICMC - Universidade de São Paulo, São Carlos, 13566-590, SP, Brazil
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Bet P, Castro PC, Chagas MHN, Ponti MA. Accelerometry data analysis for identification of fallers using the six-minute walk test. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab43d4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pinto C, Schuch CP, Balbinot G, Salazar AP, Hennig EM, Kleiner AFR, Pagnussat AS. Movement smoothness during a functional mobility task in subjects with Parkinson's disease and freezing of gait - an analysis using inertial measurement units. J Neuroeng Rehabil 2019; 16:110. [PMID: 31488184 PMCID: PMC6729092 DOI: 10.1186/s12984-019-0579-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 08/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background Impairments of functional mobility may affect locomotion and quality of life in subjects with Parkinson’s disease (PD). Movement smoothness measurements, such as the spectral arc length (SPARC), are novel approaches to quantify movement quality. Previous studies analyzed SPARC in simple walking conditions. However, SPARC outcomes during functional mobility tasks in subjects with PD and freezing of gait (FOG) were never investigated. This study aimed to analyze SPARC during the Timed Up and Go (TUG) test in individuals with PD and FOG. Methods Thirty-one participants with PD and FOG and six healthy controls were included. SPARC during TUG test was calculated for linear and angular accelerations using an inertial measurement unit system. SPARC data were correlated with clinical parameters: motor section of the Unified Parkinson’s Disease Rating Scale, Hoehn & Yahr scale, Freezing of Gait Questionnaire, and TUG test. Results We reported lower SPARC values (reduced smoothness) during the entire TUG test, turn and stand to sit in subjects with PD and FOG, compared to healthy controls. Unlike healthy controls, individuals with PD and FOG displayed a broad spectral range that encompassed several dominant frequencies. SPARC metrics also correlated with all the above-mentioned clinical parameters. Conclusion SPARC values provide valid and relevant clinical data about movement quality (e.g., smoothness) of subjects with PD and FOG during a functional mobility test. Electronic supplementary material The online version of this article (10.1186/s12984-019-0579-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Camila Pinto
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 245 Sarmento Leite Street, Porto Alegre, RS, 90050170, Brazil.,Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Clarissa Pedrini Schuch
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 245 Sarmento Leite Street, Porto Alegre, RS, 90050170, Brazil
| | - Gustavo Balbinot
- Brain Institute, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | - Ana Paula Salazar
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 245 Sarmento Leite Street, Porto Alegre, RS, 90050170, Brazil.,Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ewald Max Hennig
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Aline Souza Pagnussat
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), 245 Sarmento Leite Street, Porto Alegre, RS, 90050170, Brazil. .,Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
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Sunderaraman P, Maidan I, Kozlovski T, Apa Z, Mirelman A, Hausdorff JM, Stern Y. Differential Associations Between Distinct Components of Cognitive Function and Mobility: Implications for Understanding Aging, Turning and Dual-Task Walking. Front Aging Neurosci 2019; 11:166. [PMID: 31312137 PMCID: PMC6614511 DOI: 10.3389/fnagi.2019.00166] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/14/2019] [Indexed: 11/17/2022] Open
Abstract
Objective Cognition and mobility are interrelated. However, this association can be impacted by the specific facets of cognition and mobility that are measured, and further by the different task conditions, e.g., single- versus dual-task walking, under which these associations are evaluated. Systematically studying the multiple facets of cognitive-mobility associations under both the task conditions is critical because both cognition and mobility change with age and pose significant risks associated with falls, morbidity, and disability. Methods Using a cross-sectional, prospective study design, data from 124 healthy adults [mean age (SD) = 61.51 (11.90); mean education (SD) = 15.94 (2.18)] were collected. A comprehensive battery of cognitive tests was administered, and gait was assessed using a small, lightweight, three-axis accelerometer with a gyroscope. Analytical Plan Data were transformed, and only relatively strong relationships survived after strict statistical criteria adjusting for multiple comparisons were applied. Spearman rho correlation coefficients were used to examine the matrix of correlations between the cognitive-motor variables while adjusting for age and gender. Results Executive functions, processing speed, and language were associated with distinct facets of variability, pace, and asymmetry, especially under the dual-task walking condition. Both turns and transitions were also associated with cognition during the Timed Up and Go Task. Conclusion Our results extend converging evidence of the involvement of executive functions and processing speed in specific aspects of mobility, along with the role of language. The study has important implications for aging in terms of both assessment and rehabilitation of cognition and gait as well as for the emerging dual-tasking theories and the role of the neural pathways involved in mobility.
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Affiliation(s)
- Preeti Sunderaraman
- Cognitive Neuroscience Division, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States
| | - Inbal Maidan
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Tal Kozlovski
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Zoltan Apa
- Cognitive Neuroscience Division, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States
| | - Anat Mirelman
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Neurology and Neurosurgery, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Center for the Study of Movement Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Department of Physical Therapy, Sackler Faculty of Medicine, and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.,Rush Alzheimer's Disease Center and Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Yaakov Stern
- Cognitive Neuroscience Division, Gertrude H. Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Columbia University Irving Medical Center, New York, NY, United States.,Department of Neurology, Columbia University Irving Medical Center, New York, NY, United States
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Buchman AS, Dawe RJ, Leurgans SE, Curran TA, Truty T, Yu L, Barnes LL, Hausdorff JM, Bennett DA. Different Combinations of Mobility Metrics Derived From a Wearable Sensor Are Associated With Distinct Health Outcomes in Older Adults. J Gerontol A Biol Sci Med Sci 2019; 75:1176-1183. [PMID: 31246244 PMCID: PMC8456516 DOI: 10.1093/gerona/glz160] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Gait speed is a robust nonspecific predictor of health outcomes. We examined if combinations of gait speed and other mobility metrics are associated with specific health outcomes.
Methods
A sensor (triaxial accelerometer and gyroscope) placed on the lower back, measured mobility in the homes of 1,249 older adults (77% female; 80.0, SD = 7.72 years). Twelve gait scores were extracted from five performances, including (a) walking, (b) transition from sit to stand, (c) transition from stand to sit, (d) turning, and (e) standing posture. Using separate Cox proportional hazards models, we examined which metrics were associated with time to mortality, incident activities of daily living disability, mobility disability, mild cognitive impairment, and Alzheimer’s disease dementia. We used a single integrated analytic framework to determine which gait scores survived to predict each outcome.
Results
During 3.6 years of follow-up, 10 of the 12 gait scores predicted one or more of the five health outcomes. In further analyses, different combinations of 2–3 gait scores survived backward elimination and were associated with the five outcomes. Sway was one of the three scores that predicted activities of daily living disability but was not included in the final models for other outcomes. Gait speed was included along with other metrics in the final models predicting mortality and activities of daily living disability but not for other outcomes.
Conclusions
When analyzing multiple mobility metrics together, different combinations of mobility metrics are related to specific adverse health outcomes. Digital technology enhances our understanding of impaired mobility and may provide mobility biomarkers that predict distinct health outcomes.
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Affiliation(s)
- Aron S Buchman
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Department of Neurological Sciences, Chicago, Illinois
| | - Robert J Dawe
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Department of Diagnostic Radiology and Nuclear Medicine, Chicago, Illinois
| | - Sue E Leurgans
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Department of Neurological Sciences, Chicago, Illinois
| | | | | | - Lei Yu
- Rush Alzheimer’s Disease Center, Chicago, Illinois
| | - Lisa L Barnes
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Department of Neurological Sciences, Chicago, Illinois
- Department of Behavioral Sciences Rush University Medical Center, Chicago, Illinois
| | - Jeffrey M Hausdorff
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Tel Aviv University Medical School Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Medical Center, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel
- Sagol School of Neuroscience, Tel Aviv University, Israel
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Chicago, Illinois
- Department of Neurological Sciences, Chicago, Illinois
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von Coelln R, Dawe RJ, Leurgans SE, Curran TA, Truty T, Yu L, Barnes LL, Shulman JM, Shulman LM, Bennett DA, Hausdorff JM, Buchman AS. Quantitative mobility metrics from a wearable sensor predict incident parkinsonism in older adults. Parkinsonism Relat Disord 2019; 65:190-196. [PMID: 31272924 PMCID: PMC6774889 DOI: 10.1016/j.parkreldis.2019.06.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/19/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Mobility metrics derived from wearable sensor recordings are associated with parkinsonism in older adults. We examined if these metrics predict incident parkinsonism. METHODS Parkinsonism was assessed annually in 683 ambulatory, community-dwelling older adults without parkinsonism at baseline. Four parkinsonian signs were derived from a modified Unified Parkinson's Disease Rating Scale (UPDRS). Parkinsonism was based on the presence of 2 or more signs. Participants wore a sensor on their back while performing a 32 foot walk, standing posture, and Timed Up and Go (TUG) tasks. 12 mobility scores were extracted. Cox proportional hazards models with backward elimination were used to identify combinations of mobility scores independently associated with incident parkinsonism. RESULTS During follow-up of 2.5 years (SD = 1.28), 139 individuals developed parkinsonism (20.4%). In separate models, 6 of 12 mobility scores were individually associated with incident parkinsonism, including: Speed and Regularity (from 32 ft walk), Sway (from standing posture), and 3 scores from TUG subtasks (Posterior sit to stand transition, Range stand to sit transition, and Yaw, a measure of turning efficiency). When all mobility scores were analyzed together in a single model, 2 TUG subtask scores, Range from stand to sit transition (HR, 1.42, 95%CI, 1.09, 1.82) and Yaw from turning (HR, 0.56, 95%CI, 0.42, 0.73) were independently associated with incident parkinsonism. These results were unchanged when controlling for chronic health covariates. CONCLUSION Mobility metrics derived from a wearable sensor complement conventional gait testing and have potential to enhance risk stratification of older adults who may develop parkinsonism.
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Affiliation(s)
- Rainer von Coelln
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Robert J Dawe
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Sue E Leurgans
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Thomas A Curran
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Timothy Truty
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Lei Yu
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Lisa L Barnes
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Joshua M Shulman
- Departments of Neurology, Neuroscience, and Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA; Jan and Dan Duncan Neurologic Research Institute, Texas Children's Hospital, Houston, TX, 77030, USA
| | - Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - David A Bennett
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jeffrey M Hausdorff
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Medical Center, Tel-Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; (i)Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Aron S Buchman
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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González-Sánchez M, Cuesta-Vargas AI, Del Mar Rodríguez González M, Caro ED, Núñez GO, Galán-Mercant A, Belmonte JJB. Effectiveness of a muticomponent workout program integrated in an evidence based multimodal program in hyperfrail elderly patients: POWERAGING randomized clinical trial protocol. BMC Geriatr 2019; 19:171. [PMID: 31226936 PMCID: PMC6588921 DOI: 10.1186/s12877-019-1188-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 06/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short-term and mid-term comparison of the efficacy of a multimodal program that incorporates a therapeutic workout program, medication review, diet adjustment and health education, in comparison to the standard medical practice in the improvement of the neuromuscular and physiological condition. Furthermore, it is intended to analyse the maintenance of these effects in a long-term follow-up (12 months) from the onset of the intervention. METHODS A randomized clinical trial of elderly frail patients drawn from the Clinical Management Unit "Tiro de Pichón", Health District of Malaga, will be included in the study (after meeting the inclusion / exclusion criteria) will be randomized in two groups: a control group that will undergo an intervention consistent of medication review + diet adjustment + health education (regular workout recommendations within a complete advice on healthy lifestyles) and an experimental group whose intervention will consist of a multimodal treatment: therapeutic workout program+ medication review+ diet adjustment + health education. The sociodemographic, clinical and tracing variables will be reflected at the beginning of the study. In addition, the follow-up variables will be gathered at the second and sixth months after the beginning of the treatment and at the third and sixth months after the treatment (follow-up). The follow-up variables that will be measured are: body mass index, general health condition, fatigue, frailty, motor control, attention- concentration- memory, motor memory, spatial orientation, grip strength, balance (static, semi-dynamic), gait speed and metabolomics. A descriptive analysis of the sociodemographic variables of the participants will be conducted. One-Factor ANOVA will be used for the Within-Subject analysis and as for the Between-Subject analysis, the outcome variables between both the groups in each moment of the data collection will be compared. DISCUSSION A multimodal program that incorporates a therapeutic workout program, medication review, diet adjustment and health education may be effective treatment to reduce the functional decline in elderly. The results of the study will provide information on the possible strengths and benefits in multimodal program in elderly. TRIAL REGISTRATION ClinicalTrials.gov NCT02772952 registered May 2017.
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Affiliation(s)
- Manuel González-Sánchez
- Department of Physiotherapy, Faculty of Health Sciences, Instituto de Investigación de Biomedicina de Malaga (IBIMA), Universidad de Malaga, Málaga, Spain
| | - Antonio Ignacio Cuesta-Vargas
- Department of Physiotherapy, Faculty of Health Sciences, Instituto de Investigación de Biomedicina de Malaga (IBIMA), Universidad de Malaga, Málaga, Spain.
- School of Clinical Science, Faculty of Health, Queensland University of Technology, QLD, Kelvin Grove, Australia.
| | - María Del Mar Rodríguez González
- Servicio Andaluz de Salud, Distrito Sanitario Málaga. CS. Tiro Pichón, Instituto de Investigación de Biomedicina de Malaga (IBIMA), Malaga, Spain
| | - Elvira Díaz Caro
- Servicio Andaluz de Salud, Distrito Sanitario Málaga. CS. Tiro Pichón, Instituto de Investigación de Biomedicina de Malaga (IBIMA), Malaga, Spain
| | - Germán Ortega Núñez
- Department of Physiotherapy, Faculty of Health Sciences, Instituto de Investigación de Biomedicina de Malaga (IBIMA), Universidad de Malaga, Málaga, Spain
- Servicio Andaluz de Salud, Distrito Sanitario Málaga. CS. Tiro Pichón, Instituto de Investigación de Biomedicina de Malaga (IBIMA), Malaga, Spain
- Department of Health Sciences, University of Jaen, Jaen, Spain
| | - Alejandro Galán-Mercant
- MOVE-IT Research group and Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy University of Cádiz, Cádiz, Spain
- Biomedical Research and Innovation Institute of Cádiz (INiBICA) Research Unit, Puerta del Mar University Hospital University of Cádiz, Cádiz, Spain
| | - Juan José Bedoya Belmonte
- Servicio Andaluz de Salud, Distrito Sanitario Málaga. CS. Tiro Pichón, Instituto de Investigación de Biomedicina de Malaga (IBIMA), Malaga, Spain
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Saporito S, Brodie MA, Delbaere K, Hoogland J, Nijboer H, Rispens SM, Spina G, Stevens M, Annegarn J. Remote timed up and go evaluation from activities of daily living reveals changing mobility after surgery. Physiol Meas 2019; 40:035004. [PMID: 30840937 DOI: 10.1088/1361-6579/ab0d3e] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mobility impairment is common in older adults and negatively influences the quality of life. Mobility level may change rapidly following surgery or hospitalization in the elderly. The timed up and go (TUG) is a simple, frequently used clinical test for functional mobility; however, TUG requires supervision from a trained clinician, resulting in infrequent assessments. Additionally, assessment by TUG in clinic settings may not be completely representative of the individual's mobility in their home environment. OBJECTIVE In this paper, we introduce a method to estimate TUG from activities detected in free-living, enabling continuous remote mobility monitoring without expert supervision. The method is used to monitor changes in mobility following total hip arthroplasty (THA). METHODS Community-living elderly (n = 239, 65-91 years) performed a standardized TUG in a laboratory and wore a wearable pendant device that recorded accelerometer and barometric sensor data for at least three days. Activities of daily living (ADLs), including walks and sit-to-stand transitions, and their related mobility features were extracted and used to develop a regularized linear model for remote TUG test estimation. Changes in the remote TUG were evaluated in orthopaedic patients (n = 15, 55-75 years), during 12-weeks period following THA. MAIN RESULTS In leave-one-out-cross-validation (LOOCV), a strong correlation (ρ = 0.70) was observed between the new remote TUG and standardized TUG times. Test-retest reliability of 3-days estimates was high (ICC = 0.94). Compared to week 2 post-THA, remote TUG was significantly improved at week 6 (11.7 ± 3.9 s versus 8.0 ± 1.8 s, p < 0.001), with no further change at 12-weeks (8.1 ± 3.9 s, p = 0.37). SIGNIFICANCE Remote TUG can be estimated in older adults using 3-days of ADLs data recorded using a wearable pendant. Remote TUG has discriminatory potential for identifying frail elderly and may provide a convenient way to monitor changes in mobility in unsupervised settings.
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Affiliation(s)
- Salvatore Saporito
- Philips Research Europe, High Tech Campus 34, 5656AE, Eindhoven, The Netherlands. Author to whom any correspondence should be addressed
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