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Sánchez-Sánchez ML, Ruescas-Nicolau MA, Arnal-Gómez A, Iosa M, Pérez-Alenda S, Cortés-Amador S. Validity of an android device for assessing mobility in people with chronic stroke and hemiparesis: a cross-sectional study. J Neuroeng Rehabil 2024; 21:54. [PMID: 38616288 PMCID: PMC11017601 DOI: 10.1186/s12984-024-01346-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/22/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Incorporating instrument measurements into clinical assessments can improve the accuracy of results when assessing mobility related to activities of daily living. This can assist clinicians in making evidence-based decisions. In this context, kinematic measures are considered essential for the assessment of sensorimotor recovery after stroke. The aim of this study was to assess the validity of using an Android device to evaluate kinematic data during the performance of a standardized mobility test in people with chronic stroke and hemiparesis. METHODS This is a cross-sectional study including 36 individuals with chronic stroke and hemiparesis and 33 age-matched healthy subjects. A simple smartphone attached to the lumbar spine with an elastic band was used to measure participants' kinematics during a standardized mobility test by using the inertial sensor embedded in it. This test includes postural control, walking, turning and sitting down, and standing up. Differences between stroke and non-stroke participants in the kinematic parameters obtained after data sensor processing were studied, as well as in the total execution and reaction times. Also, the relationship between the kinematic parameters and the community ambulation ability, degree of disability and functional mobility of individuals with stroke was studied. RESULTS Compared to controls, participants with chronic stroke showed a larger medial-lateral displacement (p = 0.022) in bipedal stance, a higher medial-lateral range (p < 0.001) and a lower cranio-caudal range (p = 0.024) when walking, and lower turn-to-sit power (p = 0.001), turn-to-sit jerk (p = 0.026) and sit-to-stand jerk (p = 0.001) when assessing turn-to-sit-to-stand. Medial-lateral range and total execution time significantly correlated with all the clinical tests (p < 0.005), and resulted significantly different between independent and limited community ambulation patients (p = 0.042 and p = 0.006, respectively) as well as stroke participants with significant disability or slight/moderate disability (p = 0.024 and p = 0.041, respectively). CONCLUSION This study reports a valid, single, quick and easy-to-use test for assessing kinematic parameters in chronic stroke survivors by using a standardized mobility test with a smartphone. This measurement could provide valid clinical information on reaction time and kinematic parameters of postural control and gait, which can help in planning better intervention approaches.
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Affiliation(s)
- M Luz Sánchez-Sánchez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Maria-Arantzazu Ruescas-Nicolau
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain.
| | - Anna Arnal-Gómez
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Marco Iosa
- Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy
- Smart Lab, Santa Lucia Foundation IRCCS, Via Ardeatina 306, 00179, Rome, Italy
| | - Sofía Pérez-Alenda
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
| | - Sara Cortés-Amador
- Physiotherapy in Motion. Multispeciality Research Group (PTinMOTION), Department of Physiotherapy, Faculty of Physiotherapy, University of Valencia, Gascó Oliag n 5, 46010, Valencia, Spain
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Pérez-López JF, Cano-de-la-Cuerda R, Ortiz-Gutiérrez RM. Accelerometry in the Functional Assessment of Balance in People with Stroke: A Systematic Review. J Clin Med 2023; 12:7701. [PMID: 38137771 PMCID: PMC10743978 DOI: 10.3390/jcm12247701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/07/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023] Open
Abstract
Balance disturbances in people with lived experience of stroke affect activities of daily living and social participation, so assessing them is essential to know the level of functional independence. Accelerometers are electronic devices that allow kinematic variables of balance to be recorded and are a tool of great interest in the assessment of functional balance. To determine the validity and reliability of, as well as the most performed protocols using accelerometers in the functional assessment of balance in people with experience of stroke, a systematic search of articles published in the electronic databases PubMed, Scopus, the Web of Science, the Cochrane Library, the PEDro and the Virtual Health Library from Spain was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We used QUADAS-2 to assess the quality of the included studies. Eight studies met the inclusion criteria, two studied reliability and validity, two studied reliability and four studied the validity of accelerometers in the assessment of balance in people with stroke. All studies indicated the kind of accelerometer, localization on the body, tests and outcome variables. The results indicate that accelerometers show excellent reliability values in the assessment of balance in people who had a prior stroke and disparate results in terms of validity. Triaxial accelerometers were most used, and the 4th and 5th lumbar and 1st and 2nd sacral vertebrae were the body areas most used for their placement.
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Affiliation(s)
- Juan Francisco Pérez-López
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Madrid, Spain;
| | - Roberto Cano-de-la-Cuerda
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Universidad Rey Juan Carlos, 28922 Madrid, Spain;
| | - Rosa María Ortiz-Gutiérrez
- Radiology, Rehabilitation and Physiotherapy Department, Nursing, Physiotherapy and Podiatry Faculty, Complutense of Madrid University, Plaza Ramón y Cajal 3, 28040 Madrid, Spain;
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Ghani HA, Alghwiri AA, Hisham H, Manaf H. Lower Limb Muscle Fatigue Alters Spatiotemporal Gait Parameters and Turning Difficulty Characteristics in Parkinson's Disease. Ann Rehabil Med 2023; 47:282-290. [PMID: 37558204 PMCID: PMC10475814 DOI: 10.5535/arm.23067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/07/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To determine the effects of lower limb muscle fatigue on spatiotemporal gait parameters and turning difficulty characteristics during the extended Timed Up and Go (extended TUG) test in individuals with different severity stages of Parkinson's disease (PD). METHODS Forty individuals with PD, classified as Hoehn and Yahr (H&Y) stages 2 and 3 participated in this pre- and post-experimental study design. The participants performed a continuous sit-to-stand task from a chair based on 30 cycles/min set-up to induce lower limb muscle fatigue. They performed extended TUG test immediately before and after completing the fatigue protocol. Spatiotemporal gait parameters and turning difficulty characteristics were recorded using two GoPro® Hero 4 Silver cameras. Data were subjected to a repeated-measure ANOVA. RESULTS Individuals with PD experience significant changes in spatiotemporal gait parameters, specifically stride velocity and length, under conditions of lower limb muscle fatigue (p=0.001). These changes were more pronounced in individuals with PD in the H&Y stage 3 group. Additionally, both PD groups exhibited difficulty with turning, requiring more than five steps to complete a 180° turn and taking more than 3 seconds to accomplish it. CONCLUSION These findings highlight the impact of muscle fatigue on gait performance in PD and suggest that individuals in later stages of the disease may be particularly affected. Further research is needed to explore interventions that can mitigate these gait impairments and improve mobility in individuals with PD.
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Affiliation(s)
- Halimatul Abd Ghani
- Physiotherapy Program, Institut Latihan Kementerian Kesihatan Malaysia, Johor, Malaysia
| | - Alia A. Alghwiri
- Department of Physiotherapy, Faculty of Allied Medical Sciences, Applied Science Private University, Amman, Jordan
| | - Hafifi Hisham
- Physiotherapy Program, Center for Rehabilitation and Special Needs Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Haidzir Manaf
- Centre for Physiotherapy Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam Campus, Puncak Alam, Malaysia
- Integrative Pharmacogenomics Institute, Universiti Teknologi MARA, Puncak Alam Campus, Puncak Alam, Malaysia
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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] [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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Fujishita H, Ikuta Y, Maeda N, Komiya M, Morikawa M, Arima S, Sakamitsu T, Obayashi H, Fukuhara K, Ushio K, Adachi N. Effects of Rearfoot Eversion on Foot Plantar Pressure and Spatiotemporal Gait Parameters in Adolescent Athletes. Healthcare (Basel) 2023; 11:1842. [PMID: 37444676 DOI: 10.3390/healthcare11131842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/25/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Foot malalignment can augment the risk of lower-extremity injuries and lead to musculoskeletal disorders. This study aimed to clarify the contribution of rearfoot alignment to plantar pressure distribution and spatiotemporal parameters during gait in healthy adolescent athletes. METHODS This retrospective study included 39 adolescent athletes who were divided into the rearfoot eversion and control groups according to a leg heel angle of 7°. A total of 78 legs were analyzed (45 and 33 legs in the rearfoot eversion [women, 53.3%] and control groups [women, 48.5%], respectively). Gait was assessed using an in-shoe plantar pressure measuring system and a wearable inertial sensor. RESULTS The foot plantar pressure distribution in the hallux was higher in the rearfoot eversion group than that in the control group (p = 0.034). Spatiotemporal parameters showed that the foot pitch angle at heel strike was significantly larger in the rearfoot eversion group than that in the control group (24.5° vs. 21.7°; p = 0.015). Total sagittal range of motion of the ankle during the stance phase of gait was significantly larger in the rearfoot eversion group than that in the control group (102.5 ± 7.1° vs. 95.6 ± 15.8°; p = 0.020). Logistic regression analysis revealed that plantar pressure at the hallux and medial heel and foot pitch angle at heel strike were significantly associated with rearfoot eversion. CONCLUSIONS Our findings suggest that rearfoot eversion affects the gait patterns of adolescent athletes. Notably, leg heel angle assessment, which is a simple and quick procedure, should be considered as an alternative screening tool for estimating plantar pressure and spatiotemporal gait parameters to prevent sports-related and overuse injuries in adolescent athletes.
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Affiliation(s)
- Hironori Fujishita
- Department of Sports Medical Center, Hiroshima University Hospital, Hiroshima 734-8551, Japan
| | - Yasunari Ikuta
- Department of Sports Medical Center, Hiroshima University Hospital, Hiroshima 734-8551, Japan
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
| | - Noriaki Maeda
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | - Makoto Komiya
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | - Masanori Morikawa
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | - Satoshi Arima
- Department of Sports Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | - Tetsuhiko Sakamitsu
- Department of Sports Medical Center, Hiroshima University Hospital, Hiroshima 734-8551, Japan
| | - Hiromune Obayashi
- Department of Sports Medical Center, Hiroshima University Hospital, Hiroshima 734-8551, Japan
| | - Kouki Fukuhara
- Department of Sports Medical Center, Hiroshima University Hospital, Hiroshima 734-8551, Japan
| | - Kai Ushio
- Department of Rehabilitation Medicine, Hiroshima University Hospital, Hiroshima 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
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Sana V, Ghous M, Kashif M, Albalwi A, Muneer R, Zia M. Effects of vestibular rehabilitation therapy versus virtual reality on balance, dizziness, and gait in patients with subacute stroke: A randomized controlled trial. Medicine (Baltimore) 2023; 102:e33203. [PMID: 37327306 PMCID: PMC10270552 DOI: 10.1097/md.0000000000033203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Stroke is a neurological disorder with a vascular cause, such as cerebral infarction or hemorrhage, and causes dizziness, balance, and gait impairments in patients. Vestibular rehabilitation therapy (VRT) involves a variety of exercises that can improve balance, gait, and gaze stability in stroke patients by affecting the vestibular system and improving dynamic balance. By providing a virtual environment, the use of virtual reality (VR) can aid stroke patients in improving their balance and gait. OBJECTIVE This study aimed to evaluate the comparative effects of vestibular rehabilitation with virtual reality on dizziness, balance, and gait in patients with subacute stroke. METHODS The randomized clinical trial involved 34 subacute stroke patients randomly assigned to 2 groups; 1 received VRT and the other VR treatment. To assess mobility and balance, the Time Up and Go test was used, the Dynamic Gait Index was used to assess the gait, and the Dizziness Handicap Inventory was used to determine the level of dizziness symptoms. Each group received 24 sessions of allocated treatment, 3 sessions every week for 8 weeks. Using SPSS 20, both groups pretest and posttest readings were analyzed and compared. RESULTS Between the VR and VRT groups, balance (P-.01) and gait (P-.01) were significantly improved in the VR group, while dizziness was significantly improved in the VRT group with P < .001. On within-group comparison, both groups showed significant improvements in balance, gait, and dizziness with P < .001. CONCLUSION Both vestibular rehabilitation therapy and VR improved dizziness, balance, and gait in subacute stroke patients. However, VR was more effective in improving balance and gait among patients with subacute strokes.
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Affiliation(s)
- Vishal Sana
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | - Misbah Ghous
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | - Muhammad Kashif
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
- Islam College of Physical Therapy, Sialkot, Pakistan
- Grand Asian University Sialkot, Sialkot, Pakistan
| | - Abdulaziz Albalwi
- Department of Physical Therapy, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Rashida Muneer
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
| | - Mahnoor Zia
- Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University, Islamabad, Pakistan
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Ortega-Bastidas P, Gómez B, Aqueveque P, Luarte-Martínez S, Cano-de-la-Cuerda R. Instrumented Timed Up and Go Test (iTUG)-More Than Assessing Time to Predict Falls: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:3426. [PMID: 37050485 PMCID: PMC10098780 DOI: 10.3390/s23073426] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
The Timed Up and Go (TUG) test is a widely used tool for assessing the risk of falls in older adults. However, to increase the test's predictive value, the instrumented Timed Up and Go (iTUG) test has been developed, incorporating different technological approaches. This systematic review aims to explore the evidence of the technological proposal for the segmentation and analysis of iTUG in elderlies with or without pathologies. A search was conducted in five major databases, following PRISMA guidelines. The review included 40 studies that met the eligibility criteria. The most used technology was inertial sensors (75% of the studies), with healthy elderlies (35%) and elderlies with Parkinson's disease (32.5%) being the most analyzed participants. In total, 97.5% of the studies applied automatic segmentation using rule-based algorithms. The iTUG test offers an economical and accessible alternative to increase the predictive value of TUG, identifying different variables, and can be used in clinical, community, and home settings.
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Affiliation(s)
- Paulina Ortega-Bastidas
- Health Sciences PhD Programme, International Doctoral School, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Kinesiology Department, Faculty of Medicine, Universidad de Concepción, Concepción, 151 Janequeo St., Concepcion 4030000, Chile
| | - Britam Gómez
- Biomedical Engineering, Faculty of Engineering, Universidad de Santiago de Chile, Libertador Bernardo O’Higgins Av., Santiago 9170022, Chile
| | - Pablo Aqueveque
- Department of Electrical Engineering, Faculty of Engineering, Universidad de Concepción, 219 Edmundo Larenas St., Concepción 4030000, Chile
| | - Soledad Luarte-Martínez
- Kinesiology Department, Faculty of Medicine, Universidad de Concepción, Concepción, 151 Janequeo St., Concepcion 4030000, Chile
| | - Roberto Cano-de-la-Cuerda
- Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Universidad Rey Juan Carlos, 28922 Madrid, Spain
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Spina S, Facciorusso S, D'Ascanio MC, Morone G, Baricich A, Fiore P, Santamato A. Sensor based assessment of turning during instrumented Timed Up and Go Test for quantifying mobility in chronic stroke patients. Eur J Phys Rehabil Med 2023; 59:6-13. [PMID: 36511168 PMCID: PMC10035361 DOI: 10.23736/s1973-9087.22.07647-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Turning may be particularly challenging for stroke patients leading to decreased mobility and increased functional restriction. Timed up and go instrumentation using a simple technology in the clinical context could allow for the collection of both traditional and potentially more discriminatory variables in turning ability. AIM Determine whether the speed turning metrics obtained by a single inertial sensor are suitable for differentiating between stroke patients with varying levels of mobility and disability. DESIGN Cross-sectional study. SETTING Outpatients setting. POPULATION Chronic stroke patients. METHODS A total of 48 chronic stroke patients and 23 healthy controls were included. Stroke patients were divided in two groups based on the total iTUG score: an impaired mobility (> 20 seconds) and an available mobility (<20 seconds) group. All subjects performed an instrumented Timed Up and Go (iTUG) wearing a single IMU sensor on the lower back. Time of subcomponents of the timed up and go test and kinematic parameters of turning were quantified. Other clinical outcomes were: 10 meters walk test, Functional Ambulation Categories Scale (FAC), the Rivermead Mobility Index (RMI), Modified Rankin Scale and the Saltin-Grimby Physical Activity Level Scale (SGPALS). RESULTS There were significant differences (P<0.01) in iTUG phases and turning speeds among groups. Low to strong significant correlations were found between measures derived from the turning speeds and clinical measures. The area under the curve (AUC) of Receiver Operating Characteristic (ROC) turning speeds was demonstrated to be able to discriminate (AUC: 0.742-0.912) from available to impaired stroke patients. CONCLUSIONS This study provides evidence that turning speeds during timed up and go test are accurate measures of mobility and capable of discriminating stroke patients with impaired mobility from those with normal mobility. CLINICAL REHABILITATION IMPACT The turning metrics are related to impairment and mobility in chronic stroke patients; hence they are important to include during clinical evaluation and may assist in creating a customized strategy, assess potential treatments, and effectively organize recovery.
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Affiliation(s)
- Stefania Spina
- Section of Physical Medicine and Rehabilitation, Spasticity and Movement Disorders "ReSTaRt" Unit, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Salvatore Facciorusso
- Villa Beretta Rehabilitation Center, Valduce Hospital, Costa Masnaga, Lecco, Italy -
| | - Milena C D'Ascanio
- Section of Physical Medicine and Rehabilitation, Spasticity and Movement Disorders "ReSTaRt" Unit, Policlinico Riuniti, University of Foggia, Foggia, Italy
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
- San Raffaele Institute of Sulmona, Sulmona, L'Aquila, Italy
| | - Alessio Baricich
- Physical Medicine and Rehabilitation Unit, University Hospital "Maggiore della Carità", Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
| | - Pietro Fiore
- Neurorehabilitation Unit, Istituti Clinici Scientifici Maugeri, IRCCS, Institute of Bari, Bari, Italy
| | - Andrea Santamato
- Section of Physical Medicine and Rehabilitation, Spasticity and Movement Disorders "ReSTaRt" Unit, Policlinico Riuniti, University of Foggia, Foggia, Italy
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Mathunny JJ, Karthik V, Devaraj A, Jacob J. A scoping review on recent trends in wearable sensors to analyze gait in people with stroke: From sensor placement to validation against gold-standard equipment. Proc Inst Mech Eng H 2023; 237:309-326. [PMID: 36704959 DOI: 10.1177/09544119221142327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of the review is to evaluate wearable sensor placement, their impact and validation of wearable sensors on analyzing gait, primarily the postural instability in people with stroke. Databases, namely PubMed, Cochrane, SpringerLink, and IEEE Xplore were searched to identify related articles published since January 2005. The authors have selected the articles by considering patient characteristics, intervention details, and outcome measurements by following the priorly set inclusion and exclusion criteria. From a total of 1077 articles, 142 were included in this study and classified into functional fields, namely postural stability (PS) assessments, physical activity monitoring (PA), gait pattern classification (GPC), and foot drop correction (FDC). The review covers the types of wearable sensors, their placement, and their performance in terms of reliability and validity. When employing a single wearable sensor, the pelvis and foot were the most used locations for detecting gait asymmetry and kinetic parameters, respectively. Multiple Inertial Measurement Units placed at different body parts were effectively used to estimate postural stability and gait pattern. This review article has compared results of placement of sensors at different locations helping researchers and clinicians to identify the best possible placement for sensors to measure specific kinematic and kinetic parameters in persons with stroke.
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Affiliation(s)
- Jaison Jacob Mathunny
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - Varshini Karthik
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - Ashokkumar Devaraj
- Department of Biomedical Engineering, SRM Institute of Science and Technology, Chennai, India
| | - James Jacob
- Department of Physical Therapy, Kindred Healthcare, Munster, IN, USA
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Schwarz A, Al-Haj Husain A, Einaudi L, Thürlimann E, Läderach J, Awai Easthope C, Held JPO, Luft AR. Reliability and Validity of a Wearable Sensing System and Online Gait Analysis Report in Persons after Stroke. SENSORS (BASEL, SWITZERLAND) 2023; 23:624. [PMID: 36679424 PMCID: PMC9862973 DOI: 10.3390/s23020624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
The restoration of gait and mobility after stroke is an important and challenging therapy goal due to the complexity of the potentially impaired functions. As a result, precise and clinically feasible assessment methods are required for personalized gait rehabilitation after stroke. The aim of this study is to investigate the reliability and validity of a sensor-based gait analysis system in stroke survivors with different severities of gait deficits. For this purpose, 28 chronic stroke survivors (9 women, ages: 62.04 ± 11.68 years) with mild to moderate walking impairments performed a set of ambulatory assessments (3× 10MWT, 1× 6MWT per session) twice while being equipped with a sensor suit. The derived gait reports provided information about speed, step length, step width, swing and stance phases, as well as joint angles of the hip, knee, and ankle, which we analyzed for test-retest reliability and hypothesis testing. Further, test-retest reliability resulted in a mean ICC of 0.78 (range: 0.46-0.88) for walking 10 m and a mean ICC of 0.90 (range: 0.63-0.99) for walking 6 min. Additionally, all gait parameters showed moderate-to-strong correlations with clinical scales reflecting lower limb function. These results support the applicability of this sensor-based gait analysis system for individuals with stroke-related walking impairments.
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Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Adib Al-Haj Husain
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Lorenzo Einaudi
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Eva Thürlimann
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Julia Läderach
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354 Vitznau, Switzerland
| | - Chris Awai Easthope
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354 Vitznau, Switzerland
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
- Rehabilitation Center Triemli Zurich, Valens Clinics, 8063 Zurich, Switzerland
| | - Andreas R. Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, 6354 Vitznau, Switzerland
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11
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Zeng Z, Liu Y, Hu X, Tang M, Wang L. Validity and Reliability of Inertial Measurement Units on Lower Extremity Kinematics During Running: A Systematic Review and Meta-Analysis. SPORTS MEDICINE - OPEN 2022; 8:86. [PMID: 35759130 PMCID: PMC9237201 DOI: 10.1186/s40798-022-00477-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/11/2022] [Indexed: 11/13/2022]
Abstract
Background Inertial measurement units (IMUs) are useful in monitoring running and alerting running-related injuries in various sports settings. However, the quantitative summaries of the validity and reliability of the measurements from IMUs during running are still lacking. The purpose of this review was to investigate the concurrent validity and test–retest reliability of IMUs for measuring gait spatiotemporal outcomes and lower extremity kinematics of health adults during running. Methods PubMed, CINAHL, Embase, Scopus and Web of Science electronic databases were searched from inception until September 2021. The inclusion criteria were as follows: (1) evaluated the validity or reliability of measurements from IMUs, (2) measured specific kinematic outcomes, (3) compared measurements using IMUs with those obtained using reference systems, (4) collected data during running, (5) assessed human beings and (6) were published in English. Eligible articles were reviewed using a modified quality assessment. A meta-analysis was performed to assess the pooled correlation coefficients of validity and reliability. Results Twenty-five articles were included in the systematic review, and data from 12 were pooled for meta-analysis. The methodological quality of studies ranged from low to moderate. Concurrent validity is excellent for stride length (intraclass correlation coefficient (ICC) (95% confidence interval (CI)) = 0.937 (0.859, 0.972), p < 0.001), step frequency (ICC (95% CI) = 0.926 (0.896, 0.948), r (95% CI) = 0.989 (0.957, 0.997), p < 0.001) and ankle angle in the sagittal plane (r (95% CI) = 0.939 (0.544, 0.993), p = 0.002), moderate to excellent for stance time (ICC (95% CI) = 0.664 (0.354, 0.845), r (95% CI) = 0.811 (0.701, 0.881), p < 0.001) and good for running speed (ICC (95% CI) = 0.848 (0.523, 0.958), p = 0.0003). The summary Fisher's Z value of flight time was not statistically significant (p = 0.13). Similarly, the stance time showed excellent test–retest reliability (ICC (95% CI) = 0.954 (0.903, 0.978), p < 0.001) and step frequency showed good test–retest reliability (ICC (95% CI) = 0.896 (0.837, 0.933), p < 0.001). Conclusions Findings in the current review support IMUs measurement of running gait spatiotemporal parameters, but IMUs measurement of running kinematics on lower extremity joints needs to be reported with caution in healthy adults. Trial Registration: PROSPERO Registration Number: CRD42021279395. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-022-00477-0.
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12
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O’Brien MK, Shin SY, Khazanchi R, Fanton M, Lieber RL, Ghaffari R, Rogers JA, Jayaraman A. Wearable Sensors Improve Prediction of Post-Stroke Walking Function Following Inpatient Rehabilitation. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2022; 10:2100711. [PMID: 36304845 PMCID: PMC9592048 DOI: 10.1109/jtehm.2022.3208585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/31/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE A primary goal of acute stroke rehabilitation is to maximize functional recovery and help patients reintegrate safely in the home and community. However, not all patients have the same potential for recovery, making it difficult to set realistic therapy goals and to anticipate future needs for short- or long-term care. The objective of this study was to test the value of high-resolution data from wireless, wearable motion sensors to predict post-stroke ambulation function following inpatient stroke rehabilitation. METHOD Supervised machine learning algorithms were trained to classify patients as either household or community ambulators at discharge based on information collected upon admission to the inpatient facility (N=33-35). Inertial measurement unit (IMU) sensor data recorded from the ankles and the pelvis during a brief walking bout at admission (10 meters, or 60 seconds walking) improved the prediction of discharge ambulation ability over a traditional prediction model based on patient demographics, clinical information, and performance on standardized clinical assessments. RESULTS Models incorporating IMU data were more sensitive to patients who changed ambulation category, improving the recall of community ambulators at discharge from 85% to 89-93%. CONCLUSIONS This approach demonstrates significant potential for the early prediction of post-rehabilitation walking outcomes in patients with stroke using small amounts of data from three wearable motion sensors. CLINICAL IMPACT Accurately predicting a patient's functional recovery early in the rehabilitation process would transform our ability to design personalized care strategies in the clinic and beyond. This work contributes to the development of low-cost, clinically-implementable prognostic tools for data-driven stroke treatment.
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Affiliation(s)
- Megan K. O’Brien
- Max Nader Laboratory for Rehabilitation Technologies and Outcomes ResearchShirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationNorthwestern UniversityChicagoIL60611USA
| | | | | | | | - Richard L. Lieber
- Max Nader Laboratory for Rehabilitation Technologies and Outcomes ResearchShirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationNorthwestern UniversityChicagoIL60611USA
- Department of Biomedical EngineeringNorthwestern UniversityEvanstonIL60208USA
| | - Roozbeh Ghaffari
- Querrey Simpson Institute for Bioelectronics, Northwestern UniversityEvanstonIL60208USA
| | - John A. Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern UniversityEvanstonIL60208USA
- Department of Materials Science and EngineeringNorthwestern UniversityEvanstonIL60208USA
- Department of ChemistryNorthwestern UniversityEvanstonIL60208USA
- Department of Mechanical EngineeringNorthwestern UniversityEvanstonIL60208USA
- Department of Electrical Engineering and Computer ScienceNorthwestern UniversityEvanstonIL60208USA
| | - Arun Jayaraman
- Max Nader Laboratory for Rehabilitation Technologies and Outcomes ResearchShirley Ryan AbilityLabChicagoIL60611USA
- Department of Physical Medicine and RehabilitationNorthwestern UniversityChicagoIL60611USA
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13
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Buraschi R, Pollet J, Villafañe JH, Piovanelli B, Negrini S. Temporal and kinematic analyses of timed up and go test in chronic low back pain patients. Gait Posture 2022; 96:137-142. [PMID: 35635989 DOI: 10.1016/j.gaitpost.2022.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze temporal and kinematic parameters of chronic Low-Back Pain (cLBP) subjects compared to healthy subjects during Timed Up and Go Test (TUG) execution implemented with an Inertial Measurement Unit and to explore the correlations of those parameters with pain and disability. METHODS Observational cross-sectional study. Thirty-one subjects with cLBP [(19 females - 61%), mean age 61 ± 19] were allocated to the case group, and 14 healthy [(10 females - 71%), mean age 62 ± 6] subjects to the control group. Instrumented TUG was administered to both groups. The Roland Morris Disability Questionnaire and Numerical Pain Rating Scale (NPRS) were also administered for disability and pain assessment in the case group. RESULTS Mean TUG time to completion [12.2 ± 3.5 s for cLBP; 8.1 ± 0.9 s for healthy] and the most of sub-phases duration significantly differed between groups (p < 0.05). As for kinematic parameters, significant differences (p < 0.05) were mainly retrieved in acceleration components during the sit-to-stand and stand-to-sit phase, with the cLBP group showing lower accelerations. Significant correlation [from strong (ρ = 0.75 of time to completion) to moderate (ρ = 0.43 of sit-to-stand)] was observed between RMQD score and all temporal parameters and with most of the kinematic parameters. No correlation with NPRS score was found. CONCLUSIONS Instrumented TUG application into a cLBP population provides valuable information about movement behaviors with a deeper assessment of objective functional impairment and disability in respect of the classical stop-watch outcome of TUG, possibly allowing a better design of the rehabilitative intervention.
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Affiliation(s)
| | | | | | | | - Stefano Negrini
- Department of Biomedical, Surgical and Dental Sciences, University of Milan "La Statale", Italy; IRCCS Istituto Ortopedico Galeazzi, Italy.
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14
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Homan K, Yamamoto K, Kadoya K, Ishida N, Iwasaki N. Comprehensive validation of a wearable foot sensor system for estimating spatiotemporal gait parameters by simultaneous three-dimensional optical motion analysis. BMC Sports Sci Med Rehabil 2022; 14:71. [PMID: 35430808 PMCID: PMC9013462 DOI: 10.1186/s13102-022-00461-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Use of a wearable gait analysis system (WGAS) is becoming common when conducting gait analysis studies due to its versatility. At the same time, its versatility raises a concern about its accuracy, because its calculations rely on assumptions embedded in its algorithms. The purpose of the present study was to validate twenty spatiotemporal gait parameters calculated by the WGAS by comparison with simultaneous measurements taken with an optical motion capture system (OMCS). METHODS Ten young healthy volunteers wore two inertial sensors of the commercially available WGAS, Physilog®, on their feet and 23 markers for the OMCS on the lower part of the body. The participants performed at least three sets of 10-m walk tests at their self-paced speed in the laboratory equipped with 12 high-speed digital cameras with embedded force plates. To measure repeatability, all participants returned for a second day of testing within two weeks. RESULTS Twenty gait parameters calculated by the WGAS had a significant correlation with the ones determined by the OMCS. Bland and Altman analysis showed that the between-device agreement for twenty gait parameters was within clinically acceptable limits. The validity of the gait parameters generated by the WGAS was found to be excellent except for two parameters, swing width and maximal heel clearance. The repeatability of the WGAS was excellent when measured between sessions. CONCLUSION The present study showed that spatiotemporal gait parameters estimated by the WGAS were reasonably accurate and repeatable in healthy young adults, providing a scientific basis for applying this system to clinical studies.
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Affiliation(s)
- Kentaro Homan
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Keizo Yamamoto
- School of Lifelong Sport, Hokusho University, 23 Bunkyodai, Ebetsu, 069-8511, Japan
| | - Ken Kadoya
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Naoki Ishida
- Department of Orthopedic Surgery, Hokuto Medical Corporation Hokuto Hospital, Kisen 7-5 Inada-cho, Obihiro, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan
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15
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Lee Y, Shin S. Improvement of Gait in Patients with Stroke Using Rhythmic Sensory Stimulation: A Case-Control Study. J Clin Med 2022; 11:jcm11020425. [PMID: 35054122 PMCID: PMC8780685 DOI: 10.3390/jcm11020425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with stroke suffer from impaired locomotion, exhibiting unstable walking with increased gait variability. Effects of rhythmic sensory stimulation on unstable gait of patients with chronic stroke are unclear. This study aims to determine the effects of rhythmic sensory stimulation on the gait of patients with chronic stroke. Twenty older adults with stroke and twenty age- and gender-matched healthy controls walked 60 m under four conditions: normal walking with no stimulation, walking with rhythmic auditory stimulation (RAS) through an earphone in the ear, walking with rhythmic somatosensory stimulation (RSS) through a haptic device on the wrist of each participant, and walking with rhythmic combined stimulation (RCS: RAS + RSS). Gait performance in the stroke group significantly improved during walking with RAS, RSS, and RCS compared to that during normal walking (p < 0.008). Gait variability significantly decreased under the RAS, RSS, and RCS conditions compared to that during normal walking (p < 0.008). Rhythmic sensory stimulation is effective in improving the gait of patients with chronic stroke, regardless of the type of rhythmic stimuli, compared to healthy controls. The effect was greater in patients with reduced mobility, assessed by the Rivermead Mobility Index (RMI).
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Affiliation(s)
- Yungon Lee
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan-si 38541, Korea;
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan-si 38541, Korea
- School of Kinesiology, College of Human Ecology & Kinesiology, Yeungnam University, 221ho, 280 Daehak-ro, Gyeongsan-si 38541, Korea
| | - Sunghoon Shin
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan-si 38541, Korea;
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan-si 38541, Korea
- School of Kinesiology, College of Human Ecology & Kinesiology, Yeungnam University, 221ho, 280 Daehak-ro, Gyeongsan-si 38541, Korea
- Correspondence: ; Tel.: +82-10-8940-2406
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16
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Supervised Exercise Training Improves 6 min Walking Distance and Modifies Gait Pattern during Pain-Free Walking Condition in Patients with Symptomatic Lower Extremity Peripheral Artery Disease. SENSORS 2021; 21:s21237989. [PMID: 34883993 PMCID: PMC8659842 DOI: 10.3390/s21237989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 12/24/2022]
Abstract
This study aimed to investigate the effects of supervised exercise training (SET) on spatiotemporal gait and foot kinematics parameters in patients with symptomatic lower extremity peripheral artery disease (PAD) during a 6 min walk test. Symptomatic patients with chronic PAD (Fontaine stage II) following a 3 month SET program were included. Prior to and following SET, a 6 min walk test was performed to assess the 6 min walking distance (6MWD) of each patient. During this test, spatiotemporal gait and foot kinematics parameters were assessed during pain-free and painful walking conditions. Twenty-nine patients with PAD (65.4 ± 9.9 years.) were included. The 6MWD was significantly increased following SET (+10%; p ≤ 0.001). The walking speed (+8%) and stride frequency (+5%) were significantly increased after SET (p ≤ 0.026). The stride length was only significantly increased during the pain-free walking condition (+4%, p = 0.001), whereas no significant differences were observed during the condition of painful walking. Similarly, following SET, the relative duration of the loading response increased (+12%), the relative duration of the foot-flat phase decreased (−3%), and the toe-off pitch angle significantly increased (+3%) during the pain-free walking condition alone (p ≤ 0.05). A significant positive correlation was found between changes in the stride length (r = 0.497, p = 0.007) and stride frequency (r = 0.786, p ≤ 0.001) during pain-free walking condition and changes in the 6MWD. A significant negative correlation was found between changes in the foot-flat phase during pain-free walking condition and changes in the 6MWD (r = −0.567, p = 0.002). SET was found to modify the gait pattern of patients with symptomatic PAD, and many of these changes were found to occur during pain-free walking. The improvement in individuals’ functional 6 min walk test was related to changes in their gait pattern.
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González-Alonso J, Oviedo-Pastor D, Aguado HJ, Díaz-Pernas FJ, González-Ortega D, Martínez-Zarzuela M. Custom IMU-Based Wearable System for Robust 2.4 GHz Wireless Human Body Parts Orientation Tracking and 3D Movement Visualization on an Avatar. SENSORS 2021; 21:s21196642. [PMID: 34640961 PMCID: PMC8512038 DOI: 10.3390/s21196642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023]
Abstract
Recent studies confirm the applicability of Inertial Measurement Unit (IMU)-based systems for human motion analysis. Notwithstanding, high-end IMU-based commercial solutions are yet too expensive and complex to democratize their use among a wide range of potential users. Less featured entry-level commercial solutions are being introduced in the market, trying to fill this gap, but still present some limitations that need to be overcome. At the same time, there is a growing number of scientific papers using not commercial, but custom do-it-yourself IMU-based systems in medical and sports applications. Even though these solutions can help to popularize the use of this technology, they have more limited features and the description on how to design and build them from scratch is yet too scarce in the literature. The aim of this work is two-fold: (1) Proving the feasibility of building an affordable custom solution aimed at simultaneous multiple body parts orientation tracking; while providing a detailed bottom-up description of the required hardware, tools, and mathematical operations to estimate and represent 3D movement in real-time. (2) Showing how the introduction of a custom 2.4 GHz communication protocol including a channel hopping strategy can address some of the current communication limitations of entry-level commercial solutions. The proposed system can be used for wireless real-time human body parts orientation tracking with up to 10 custom sensors, at least at 50 Hz. In addition, it provides a more reliable motion data acquisition in Bluetooth and Wi-Fi crowded environments, where the use of entry-level commercial solutions might be unfeasible. This system can be used as a groundwork for developing affordable human motion analysis solutions that do not require an accurate kinematic analysis.
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Affiliation(s)
- Javier González-Alonso
- Grupo de Telemática e Imagen, Universidad de Valladolid, 47011 Valladolid, Spain; (D.O.-P.); (F.J.D.-P.); (D.G.-O.)
- Correspondence: (J.G.-A.); (M.M.-Z.)
| | - David Oviedo-Pastor
- Grupo de Telemática e Imagen, Universidad de Valladolid, 47011 Valladolid, Spain; (D.O.-P.); (F.J.D.-P.); (D.G.-O.)
| | - Héctor J. Aguado
- Unidad de Traumatología, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
| | - Francisco J. Díaz-Pernas
- Grupo de Telemática e Imagen, Universidad de Valladolid, 47011 Valladolid, Spain; (D.O.-P.); (F.J.D.-P.); (D.G.-O.)
| | - David González-Ortega
- Grupo de Telemática e Imagen, Universidad de Valladolid, 47011 Valladolid, Spain; (D.O.-P.); (F.J.D.-P.); (D.G.-O.)
| | - Mario Martínez-Zarzuela
- Grupo de Telemática e Imagen, Universidad de Valladolid, 47011 Valladolid, Spain; (D.O.-P.); (F.J.D.-P.); (D.G.-O.)
- Correspondence: (J.G.-A.); (M.M.-Z.)
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Teo YX, Chan YS, Gouwanda D, Gopalai AA, Nurzaman SG, Thannirmalai S. Quantification of muscles activations and joints range of motions during oil palm fresh fruit bunch harvesting and loose fruit collection. Sci Rep 2021; 11:15020. [PMID: 34294775 PMCID: PMC8298511 DOI: 10.1038/s41598-021-94268-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/05/2021] [Indexed: 11/24/2022] Open
Abstract
Although global demand for palm oil has been increasing, most activities in the oil palm plantations still rely heavily on manual labour, which includes fresh fruit bunch (FFB) harvesting and loose fruit (LF) collection. As a result, harvesters and/or collectors face ergonomic risks resulting in musculoskeletal disorder (MSD) due to awkward, extreme and repetitive posture during their daily work routines. Traditionally, indirect approaches were adopted to assess these risks using a survey or manual visual observations. In this study, a direct measurement approach was performed using Inertial Measurement Units, and surface Electromyography sensors. The instruments were attached to different body parts of the plantation workers to quantify their muscle activities and assess the ergonomics risks during FFB harvesting and LF collection. The results revealed that the workers generally displayed poor and discomfort posture in both activities. Biceps, multifidus and longissimus muscles were found to be heavily used during FFB harvesting. Longissimus, iliocostalis, and multifidus muscles were the most used muscles during LF collection. These findings can be beneficial in the design of various assistive tools which could improve workers' posture, reduce the risk of injury and MSD, and potentially improve their overall productivity and quality of life.
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Affiliation(s)
- Yu Xuan Teo
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Yon Sin Chan
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Darwin Gouwanda
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Alpha Agape Gopalai
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Surya Girinatha Nurzaman
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
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The Contribution of Machine Learning in the Validation of Commercial Wearable Sensors for Gait Monitoring in Patients: A Systematic Review. SENSORS 2021; 21:s21144808. [PMID: 34300546 PMCID: PMC8309920 DOI: 10.3390/s21144808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 12/28/2022]
Abstract
Gait, balance, and coordination are important in the development of chronic disease, but the ability to accurately assess these in the daily lives of patients may be limited by traditional biased assessment tools. Wearable sensors offer the possibility of minimizing the main limitations of traditional assessment tools by generating quantitative data on a regular basis, which can greatly improve the home monitoring of patients. However, these commercial sensors must be validated in this context with rigorous validation methods. This scoping review summarizes the state-of-the-art between 2010 and 2020 in terms of the use of commercial wearable devices for gait monitoring in patients. For this specific period, 10 databases were searched and 564 records were retrieved from the associated search. This scoping review included 70 studies investigating one or more wearable sensors used to automatically track patient gait in the field. The majority of studies (95%) utilized accelerometers either by itself (N = 17 of 70) or embedded into a device (N = 57 of 70) and/or gyroscopes (51%) to automatically monitor gait via wearable sensors. All of the studies (N = 70) used one or more validation methods in which “ground truth” data were reported. Regarding the validation of wearable sensors, studies using machine learning have become more numerous since 2010, at 17% of included studies. This scoping review highlights the current state of the ability of commercial sensors to enhance traditional methods of gait assessment by passively monitoring gait in daily life, over long periods of time, and with minimal user interaction. Considering our review of the last 10 years in this field, machine learning approaches are algorithms to be considered for the future. These are in fact data-based approaches which, as long as the data collected are numerous, annotated, and representative, allow for the training of an effective model. In this context, commercial wearable sensors allowing for increased data collection and good patient adherence through efforts of miniaturization, energy consumption, and comfort will contribute to its future success.
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20
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Williams JM, Nyman SR. Age Moderates Differences in Performance on the Instrumented Timed Up and Go Test Between People With Dementia and Their Informal Caregivers. J Geriatr Phys Ther 2021; 44:E150-E157. [PMID: 32175993 PMCID: PMC7611094 DOI: 10.1519/jpt.0000000000000265] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The instrumented Timed Up and Go test (iTUG) affords quantification of the subelements of the Timed Up and Go test to assess fall risk and physical performance. A miniature sensor applied to the back is able to capture accelerations and velocities from which the subelements of the iTUG can be quantified. This study is the first to compare iTUG performance between people with dementia (PWD) and their age-matched caregivers. The aims of this study were to explore how age moderates the differences in performance on the iTUG between PWD and their informal caregivers. METHODS Eight-three community-dwelling older PWD and their informal caregivers were recruited for this cross-sectional, observational study. Participants were grouped by age: younger than 70 years, 70 to 79 years, and 80 years and older. Participants wore an inertial sensor while performing the iTUG in their home. The performance of the subelements sit-to-stand, walking, and turning were captured through an algorithm converting accelerations and velocities into performance metrics such as duration and peak velocity. Performance for PWD was compared with caregivers for each age-matched group, and multiple regression models incorporating age, gender, and presence or absence of dementia were computed. RESULTS People with dementia took longer to turn in the younger than 70-year group, suggesting this may be an early indicator of functional decline in this age group. People with dementia took longer to complete the whole iTUG compared with caregivers in the 70- to 79-year-old group. In the 80+-year-old group, PWD took longer to complete both walking phases, sit-to-stand, and the full iTUG along with displaying slower turning velocity. Multiple regression models illustrated that gender failed to contribute significantly to the model, but age and presence of dementia explained around 30% of the variance of time to complete walking phases, total iTUG, and turning velocity. CONCLUSIONS Differences were evident in performance of the iTUG between PWD and caregivers even after controlling for age. Age moderates the differences observed in performance.
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Affiliation(s)
- Jonathan M Williams
- Department of Human Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, England
| | - Samuel R Nyman
- Department of Psychology and Ageing and Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, England
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Mohan DM, Khandoker AH, Wasti SA, Ismail Ibrahim Ismail Alali S, Jelinek HF, Khalaf K. Assessment Methods of Post-stroke Gait: A Scoping Review of Technology-Driven Approaches to Gait Characterization and Analysis. Front Neurol 2021; 12:650024. [PMID: 34168608 PMCID: PMC8217618 DOI: 10.3389/fneur.2021.650024] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Gait dysfunction or impairment is considered one of the most common and devastating physiological consequences of stroke, and achieving optimal gait is a key goal for stroke victims with gait disability along with their clinical teams. Many researchers have explored post stroke gait, including assessment tools and techniques, key gait parameters and significance on functional recovery, as well as data mining, modeling and analyses methods. Research Question: This study aimed to review and summarize research efforts applicable to quantification and analyses of post-stroke gait with focus on recent technology-driven gait characterization and analysis approaches, including the integration of smart low cost wearables and Artificial Intelligence (AI), as well as feasibility and potential value in clinical settings. Methods: A comprehensive literature search was conducted within Google Scholar, PubMed, and ScienceDirect using a set of keywords, including lower extremity, walking, post-stroke, and kinematics. Original articles that met the selection criteria were included. Results and Significance: This scoping review aimed to shed light on tools and technologies employed in post stroke gait assessment toward bridging the existing gap between the research and clinical communities. Conventional qualitative gait analysis, typically used in clinics is mainly based on observational gait and is hence subjective and largely impacted by the observer's experience. Quantitative gait analysis, however, provides measured parameters, with good accuracy and repeatability for the diagnosis and comparative assessment throughout rehabilitation. Rapidly emerging smart wearable technology and AI, including Machine Learning, Support Vector Machine, and Neural Network approaches, are increasingly commanding greater attention in gait research. Although their use in clinical settings are not yet well leveraged, these tools promise a paradigm shift in stroke gait quantification, as they provide means for acquiring, storing and analyzing multifactorial complex gait data, while capturing its non-linear dynamic variability and offering the invaluable benefits of predictive analytics.
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Affiliation(s)
- Dhanya Menoth Mohan
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Ahsan Habib Khandoker
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Sabahat Asim Wasti
- Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sarah Ismail Ibrahim Ismail Alali
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Herbert F Jelinek
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Kinda Khalaf
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
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Effects of using assistive devices on the components of the modified instrumented timed up and go test in healthy subjects. Heliyon 2021; 7:e06940. [PMID: 34007923 PMCID: PMC8111581 DOI: 10.1016/j.heliyon.2021.e06940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Evaluation of the changes in gait spatiotemporal parameters and functional mobility with using assistive devices (ADs) would provide useful information and mutual assistance when prescribing such ambulatory devices. This study aimed to investigate the spatiotemporal gait and functional mobility parameters in healthy adults when walking using different ADs. Methods A group of healthy subjects participated in the study. The instrumented modified Timed Up and Go test (iTUG) was used to investigate the impact of different types of ADs on spatiotemporal and functional mobility parameters. Results Subjects showed a significant difference in the gait task performance (P = .001) in stride velocity, stride length, and cadence when walking with and without ADs. A significant difference was also found in the performance of the turn-to-sit task (P = .001) in both velocity and duration when walking with and without ADs. The time to complete sit-to-stand was significantly slower when using a walker (98.3 ± 22.3°/sec, P = .004) and a cane (78.2 ± 21.9°/sec, P = .004) compared to walking without an AD (78.2 ± 21.8°/sec). No significant difference was found between walking with a cane group versus walking with a four-wheeled walker group (P = .94). Conclusion ADs altered gait and functional mobility parameters differently in healthy subjects. Using a four-wheeled walker showed a tendency to increase stride velocity, cadence, stride length, and slow sit-to-stand velocity compared to using a cane. The findings highlight using more caution clinically when prescribing ADs and providing gait training.
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Spatio-temporal gait parameters obtained from foot-worn inertial sensors are reliable in healthy adults in single- and dual-task conditions. Sci Rep 2021; 11:10229. [PMID: 33986307 PMCID: PMC8119721 DOI: 10.1038/s41598-021-88794-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 04/07/2021] [Indexed: 02/07/2023] Open
Abstract
Inertial measurement units (IMUs) are increasingly popular and may be usable in clinical routine to assess gait. However, assessing their intra-session reliability is crucial and has not been tested with foot-worn sensors in healthy participants. The aim of this study was to assess the intra-session reliability of foot-worn IMUs for measuring gait parameters in healthy adults. Twenty healthy participants were enrolled in the study and performed the 10-m walk test in single- and dual-task ('carrying a full cup of water') conditions, three trials per condition. IMUs were used to assess spatiotemporal gait parameters, gait symmetry parameters (symmetry index (SI) and symmetry ratio (SR)), and dual task effects parameters. The relative and the absolute reliability were calculated for each gait parameter. Results showed that spatiotemporal gait parameters measured with foot-worn inertial sensors were reliable; symmetry gait parameters relative reliability was low, and SR showed better absolute reliability than SI; dual task effects were poorly reliable, and taking the mean of the second and the third trials was the most reliable. Foot-worn IMUs are reliable to assess spatiotemporal and symmetry ratio gait parameters but symmetry index and DTE gait parameters reliabilities were low and need to be interpreted with cautious by clinicians and researchers.
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Posada-Ordax J, Cosin-Matamoros J, Losa-Iglesias ME, Becerro-de-Bengoa-Vallejo R, Esteban-Gonzalo L, Martin-Villa C, Calvo-Lobo C, Rodriguez-Sanz D. Accuracy and Repeatability of Spatiotemporal Gait Parameters Measured with an Inertial Measurement Unit. J Clin Med 2021; 10:jcm10091804. [PMID: 33919039 PMCID: PMC8122546 DOI: 10.3390/jcm10091804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/16/2022] Open
Abstract
In recent years, interest in finding alternatives for the evaluation of mobility has increased. Inertial measurement units (IMUs) stand out for their portability, size, and low price. The objective of this study was to examine the accuracy and repeatability of a commercially available IMU under controlled conditions in healthy subjects. A total of 36 subjects, including 17 males and 19 females were analyzed with a Wiva Science IMU in a corridor test while walking for 10 m and in a threadmill at 1.6 km/h, 2.4 km/h, 3.2 km/h, 4 km/h, and 4.8 km/h for one minute. We found no difference when we compared the variables at 4 km/h and 4.8 km/h. However, we found greater differences and errors at 1.6 km/h, 2.4 km/h and 3.2 km/h, and the latter one (1.6 km/h) generated more error. The main conclusion is that the Wiva Science IMU is reliable at high speeds but loses reliability at low speeds.
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Affiliation(s)
- Jorge Posada-Ordax
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (J.P.-O.); (M.E.L.-I.)
| | - Julia Cosin-Matamoros
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
- Correspondence:
| | - Marta Elena Losa-Iglesias
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (J.P.-O.); (M.E.L.-I.)
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
| | - Laura Esteban-Gonzalo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
| | - Carlos Martin-Villa
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
| | - David Rodriguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
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25
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Towards Human Motion Tracking Enhanced by Semi-Continuous Ultrasonic Time-of-Flight Measurements. SENSORS 2021; 21:s21072259. [PMID: 33804840 PMCID: PMC8037013 DOI: 10.3390/s21072259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/20/2021] [Indexed: 11/29/2022]
Abstract
Human motion analysis is a valuable tool for assessing disease progression in persons with conditions such as multiple sclerosis or Parkinson’s disease. Human motion tracking is also used extensively for sporting technique and performance analysis as well as for work life ergonomics evaluations. Wearable inertial sensors (e.g., accelerometers, gyroscopes and/or magnetometers) are frequently employed because they are easy to mount and can be used in real life, out-of-the-lab-settings, as opposed to video-based lab setups. These distributed sensors cannot, however, measure relative distances between sensors, and are also cumbersome when it comes to calibration and drift compensation. In this study, we tested an ultrasonic time-of-flight sensor for measuring relative limb-to-limb distance, and we developed a combined inertial sensor and ultrasonic time-of-flight wearable measurement system. The aim was to investigate if ultrasonic time-of-flight sensors can supplement inertial sensor-based motion tracking by providing relative distances between inertial sensor modules. We found that the ultrasonic time-of-flight measurements reflected expected walking motion patterns. The stride length estimates derived from ultrasonic time-of-flight measurements corresponded well with estimates from validated inertial sensors, indicating that the inclusion of ultrasonic time-of-flight measurements could be a feasible approach for improving inertial sensor-only systems. Our prototype was able to measure both inertial and time-of-flight measurements simultaneously and continuously, but more work is necessary to merge the complementary approaches to provide more accurate and more detailed human motion tracking.
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26
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Gawronska A, Pajor A, Zamyslowska-Szmytke E, Rosiak O, Jozefowicz-Korczynska M. Usefulness of Mobile Devices in the Diagnosis and Rehabilitation of Patients with Dizziness and Balance Disorders: A State of the Art Review. Clin Interv Aging 2020; 15:2397-2406. [PMID: 33376315 PMCID: PMC7764625 DOI: 10.2147/cia.s289861] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The gold standard for objective body posture examination is posturography. Body movements are detected through the use of force platforms that assess static and dynamic balance (conventional posturography). In recent years, new technologies like wearable sensors (mobile posturography) have been applied during complex dynamic activities to diagnose and rehabilitate balance disorders. They are used in healthy people, especially in the aging population, for detecting falls in the older adults, in the rehabilitation of different neurological, osteoarticular, and muscular system diseases, and in vestibular disorders. Mobile devices are portable, lightweight, and less expensive than conventional posturography. The vibrotactile system can consist of an accelerometer (linear acceleration measurement), gyroscopes (angular acceleration measurement), and magnetometers (heading measurement, relative to the Earth’s magnetic field). The sensors may be mounted to the trunk (most often in the lumbar region of the spine, and the pelvis), wrists, arms, sternum, feet, or shins. Some static and dynamic clinical tests have been performed with the use of wearable sensors. Smartphones are widely used as a mobile computing platform and to evaluate the results or monitor the patient during the movement and rehabilitation. There are various mobile applications for smartphone-based balance systems. Future research should focus on validating the sensitivity and reliability of mobile device measurements compared to conventional posturography. Conclusion Smartphone based mobile devices are limited to one sensor lumbar level posturography and offer basic clinical evaluation. Single or multi sensor mobile posturography is available from different manufacturers and offers single to multi-level measurements, providing more data and in some instances even performing sophisticated clinical balance tests.
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Affiliation(s)
- Anna Gawronska
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Anna Pajor
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Ewa Zamyslowska-Szmytke
- Balance Disorders Unit, Department of Audiology and Phoniatrics, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Oskar Rosiak
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Magdalena Jozefowicz-Korczynska
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
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27
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Awad LN, Lewek MD, Kesar TM, Franz JR, Bowden MG. These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits. J Neuroeng Rehabil 2020; 17:139. [PMID: 33087137 PMCID: PMC7579929 DOI: 10.1186/s12984-020-00747-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/19/2020] [Indexed: 12/29/2022] Open
Abstract
Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired neuromotor injuries remains limited by the dearth of (i) diagnostic approaches that can identify the specific neuromuscular, biomechanical, and clinical deficits underlying impaired locomotion and (ii) evidence-based, targeted treatments. In particular, impaired propulsion by the paretic limb is a major contributor to walking-related disability after stroke; however, few interventions have been able to target deficits in propulsion effectively and in a manner that reduces walking disability. Indeed, the weakness and impaired control that is characteristic of post-stroke hemiparesis leads to heterogeneous deficits that impair paretic propulsion and contribute to a slow, metabolically-expensive, and unstable gait. Current rehabilitation paradigms emphasize the rapid attainment of walking independence, not the restoration of normal propulsion function. Although walking independence is an important goal for stroke survivors, independence achieved via compensatory strategies may prevent the recovery of propulsion needed for the fast, economical, and stable gait that is characteristic of healthy bipedal locomotion. We posit that post-stroke rehabilitation should aim to promote independent walking, in part, through the acquisition of enhanced propulsion. In this expert review, we present the biomechanical and functional consequences of post-stroke propulsion deficits, review advances in our understanding of the nature of post-stroke propulsion impairment, and discuss emerging diagnostic and treatment approaches that have the potential to facilitate new rehabilitation paradigms targeting propulsion restoration.
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Affiliation(s)
- Louis N Awad
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, MA, USA.
| | - Michael D Lewek
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Trisha M Kesar
- Division of Physical Therapy, Emory University, Atlanta, GA, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Mark G Bowden
- Division of Physical Therapy, Medical University of South Carolina, Charleston, SC, USA
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28
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Bourke AK, Scotland A, Lipsmeier F, Gossens C, Lindemann M. Gait Characteristics Harvested During a Smartphone-Based Self-Administered 2-Minute Walk Test in People with Multiple Sclerosis: Test-Retest Reliability and Minimum Detectable Change. SENSORS 2020; 20:s20205906. [PMID: 33086734 PMCID: PMC7589972 DOI: 10.3390/s20205906] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/09/2020] [Accepted: 10/13/2020] [Indexed: 01/26/2023]
Abstract
The measurement of gait characteristics during a self-administered 2-minute walk test (2MWT), in persons with multiple sclerosis (PwMS), using a single body-worn device, has the potential to provide high-density longitudinal information on disease progression, beyond what is currently measured in the clinician-administered 2MWT. The purpose of this study is to determine the test-retest reliability, standard error of measurement (SEM) and minimum detectable change (MDC) of features calculated on gait characteristics, harvested during a self-administered 2MWT in a home environment, in 51 PwMS and 11 healthy control (HC) subjects over 24 weeks, using a single waist-worn inertial sensor-based smartphone. Excellent, or good to excellent test-retest reliability were observed in 58 of the 92 temporal, spatial and spatiotemporal gait features in PwMS. However, these were less reliable for HCs. Low SEM% and MDC% values were observed for most of the distribution measures for all gait characteristics for PwMS and HCs. This study demonstrates the inter-session test-retest reliability and provides an indication of clinically important change estimates, for interpreting the outcomes of gait characteristics measured using a body-worn smartphone, during a self-administered 2MWT. This system thus provides a reliable measure of gait characteristics in PwMS, supporting its application for the longitudinal assessment of gait deficits in this population.
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Affiliation(s)
- Alan K. Bourke
- Roche Pharma Research and Early Development, pRED Informatics, Roche Innovation Center Basel, F Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland; (A.K.B.); (F.L.); (M.L.)
| | - Alf Scotland
- Inovigate, Aeschenvorstadt 55, 4051 Basel, Switzerland;
| | - Florian Lipsmeier
- Roche Pharma Research and Early Development, pRED Informatics, Roche Innovation Center Basel, F Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland; (A.K.B.); (F.L.); (M.L.)
| | - Christian Gossens
- Roche Pharma Research and Early Development, pRED Informatics, Roche Innovation Center Basel, F Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland; (A.K.B.); (F.L.); (M.L.)
- Correspondence: ; Tel.: +41-61-687-5113
| | - Michael Lindemann
- Roche Pharma Research and Early Development, pRED Informatics, Roche Innovation Center Basel, F Hoffmann–La Roche Ltd., Grenzacherstrasse 124, 4070 Basel, Switzerland; (A.K.B.); (F.L.); (M.L.)
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29
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Hutchinson K, Sloutsky R, Collimore A, Adams B, Harris B, Ellis TD, Awad LN. A Music-Based Digital Therapeutic: Proof-of-Concept Automation of a Progressive and Individualized Rhythm-Based Walking Training Program After Stroke. Neurorehabil Neural Repair 2020; 34:986-996. [PMID: 33040685 DOI: 10.1177/1545968320961114] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The rhythm of music can entrain neurons in motor cortex by way of direct connections between auditory and motor brain regions. OBJECTIVE We sought to automate an individualized and progressive music-based, walking rehabilitation program using real-time sensor data in combination with decision algorithms. METHODS A music-based digital therapeutic was developed to maintain high sound quality while modulating, in real-time, the tempo (ie, beats per minute, or bpm) of music based on a user's ability to entrain to the tempo and progress to faster walking cadences in-sync with the progression of the tempo. Eleven individuals with chronic hemiparesis completed one automated 30-minute training visit. Seven returned for 2 additional visits. Safety, feasibility, and rehabilitative potential (ie, changes in walking speed relative to clinically meaningful change scores) were evaluated. RESULTS A single, fully automated training visit resulted in increased usual (∆ 0.085 ± 0.027 m/s, P = .011) and fast (∆ 0.093 ± 0.032 m/s, P = .016) walking speeds. The 7 participants who completed additional training visits increased their usual walking speed by 0.12 ± 0.03 m/s after only 3 days of training. Changes in walking speed were highly related to changes in walking cadence (R2 > 0.70). No trips or falls were noted during training, all users reported that the device helped them walk faster, and 70% indicated that they would use it most or all of the time at home. CONCLUSIONS In this proof-of-concept study, we show that a sensor-automated, progressive, and individualized rhythmic locomotor training program can be implemented safely and effectively to train walking speed after stroke. Music-based digital therapeutics have the potential to facilitate salient, community-based rehabilitation.
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Affiliation(s)
| | | | | | | | - Brian Harris
- Sargent College, Boston University, Boston, MA, USA.,MedRhythms Inc, Portland, ME, USA
| | | | - Louis N Awad
- Sargent College, Boston University, Boston, MA, USA
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Fudickar S, Hellmers S, Lau S, Diekmann R, Bauer JM, Hein A. Measurement System for Unsupervised Standardized Assessment of Timed "Up & Go" and Five Times Sit to Stand Test in the Community-A Validity Study. SENSORS 2020; 20:s20102824. [PMID: 32429306 PMCID: PMC7287989 DOI: 10.3390/s20102824] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/07/2023]
Abstract
Comprehensive and repetitive assessments are needed to detect physical changes in an older population to prevent functional decline at the earliest possible stage and to initiate preventive interventions. Established instruments like the Timed “Up & Go” (TUG) Test and the Sit-to-Stand Test (SST) require a trained person (e.g., physiotherapist) to assess physical performance. More often, these tests are only applied to a selected group of persons already functionally impaired and not to those who are at potential risk of functional decline. The article introduces the Unsupervised Screening System (USS) for unsupervised self-assessments by older adults and evaluates its validity for the TUG and SST. The USS included ambient and wearable movement sensors to measure the user’s test performance. Sensor datasets of the USS’s light barriers and Inertial Measurement Units (IMU) were analyzed for 91 users aged 73 to 89 years compared to conventional stopwatch measurement. A significant correlation coefficient of 0.89 for the TUG test and of 0.73 for the SST were confirmed among USS’s light barriers. Correspondingly, for the inertial data-based measures, a high and significant correlation of 0.78 for the TUG test and of 0.87 for SST were also found. The USS was a validated and reliable tool to assess TUG and SST.
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Affiliation(s)
- Sebastian Fudickar
- Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (S.H.); (R.D.); (A.H.)
- Correspondence:
| | - Sandra Hellmers
- Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (S.H.); (R.D.); (A.H.)
| | - Sandra Lau
- Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University Heidelberg, 69117 Heidelberg, Germany; (S.L.); (J.M.B.)
| | - Rebecca Diekmann
- Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (S.H.); (R.D.); (A.H.)
| | - Jürgen M. Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, University Heidelberg, 69117 Heidelberg, Germany; (S.L.); (J.M.B.)
| | - Andreas Hein
- Assistance Systems and Medical Device Technology, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany; (S.H.); (R.D.); (A.H.)
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Zou TE, Liang PJ, Lee SC. Turning duration and steps predict future falls in poststroke hemiplegic individuals: A preliminary cohort study. Top Stroke Rehabil 2020; 28:33-41. [PMID: 32397952 DOI: 10.1080/10749357.2020.1760644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Turning was reported as one of the activities that most frequently leads to falling among stroke patients. This study investigated whether the duration and steps of a 180° turn while walking can distinguish retrospective fallers from non-fallers and predict future falls in a 1-year period in patients with poststroke hemiplegia. Methods: Thirty stroke patients were recruited. They were instructed to get up from a chair, walk straight 3 m, turn around, and return to seated position to assess the 180° walking-turn task. Turning performance was measured by two inertial sensor units of Physilog. Turn duration and steps were recorded for analysis. The numbers of retrospective and prospective falls were also obtained. Results: No significant difference was observed between retrospective stroke fallers and non-fallers in turn duration and steps. Turn duration and steps were significantly greater in prospective stroke fallers than in non-fallers. The cutoff turn duration of 4 s (area under the curve 0.75, 95% CI: 0.56-0.93, sensitivity 67%, specificity 80%, p =.04) and turn step of 7 steps (area under the curve 0.73, 95% CI: 0.51-0.94, sensitivity 56%, specificity 85%, p =.05) were found to most accurately predict prospective stroke fallers from non-fallers. Conclusions: Turn duration and steps were unable to discriminate between retrospective fallers and non-fallers but could predict prospective falls in patients with stroke. More than 4 s or 7 steps to complete a 180° turn while walking can be a predictor for patients with stroke at an increased risk of falling.
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Affiliation(s)
- Tian-En Zou
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation , New Taipei City, Taiwan
| | - Pei-Jung Liang
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation , New Taipei City, Taiwan
| | - Shu-Chun Lee
- School of Gerontology Health Management, College of Nursing, Taipei Medical University , Taipei City, Taiwan
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Serra-Añó P, Pedrero-Sánchez JF, Hurtado-Abellán J, Inglés M, Espí-López GV, López-Pascual J. Mobility assessment in people with Alzheimer disease using smartphone sensors. J Neuroeng Rehabil 2019; 16:103. [PMID: 31412893 PMCID: PMC6694667 DOI: 10.1186/s12984-019-0576-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/08/2019] [Indexed: 01/20/2023] Open
Abstract
Background Understanding the functional status of people with Alzheimer Disease (AD), both in a single (ST) and cognitive dual task (DT) activities is essential for identifying signs of early-stage neurodegeneration. This study aims to compare the performance quality of several tasks using sensors embedded in an Android device, among people at different stages of Alzheimer and people without dementia. The secondary aim is to analyze the effect of cognitive task performance on mobility tasks. Methods This is a cross-sectional study including 22 participants in the control group (CG), 18 in the group with mild AD and 22 in the group with moderate AD. They performed two mobility tests, under ST and DT conditions, which were registered using an Android device. Postural control was measured by medial-lateral and anterior-posterior displacements of the COM (MLDisp and APDisp, respectively) and gait, with the vertical and medial-lateral range of the COM (Vrange and MLrange). Further, the sit-to-stand (PStand) and turning and sit power (PTurnSit), the total time required to complete the test and the reaction time were measured. Results There were no differences between the two AD stages either for ST or DT in any of the variables (p > 0.05). Nevertheless, people at both stages showed significantly lower values of PStand and PTurnSit and larger Total time and Reaction time compared to CG (p < 0.05). Further, Vrange is also lower in CDR1G than in CG (p < 0.05). The DT had a significant deleterious effect on MLDisp in all groups (p < 0.05) and on APDisp only in moderate AD for DT. Conclusions Our findings indicate that AD patients present impairments in some key functional abilities, such as gait, turning and sitting, sit to stand, and reaction time, both in mild and moderate AD. Nevertheless, an exclusively cognitive task only influences the postural control in people with AD.
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Affiliation(s)
- Pilar Serra-Añó
- UBIC, Departament de Fisioteràpia de la Universitat de València, C/ Gascó Oliag, 5, 46010, Valencia, Spain
| | - José Francisco Pedrero-Sánchez
- Instituto de Biomecánica de Valencia, Universidad Politécnica de Valencia, Edificio 9C. Camino de Vera, s/n, 46022, Valencia, Spain
| | - Juan Hurtado-Abellán
- UBIC, Departament de Fisioteràpia de la Universitat de València, C/ Gascó Oliag, 5, 46010, Valencia, Spain
| | - Marta Inglés
- UBIC, Departament de Fisioteràpia de la Universitat de València, C/ Gascó Oliag, 5, 46010, Valencia, Spain
| | - Gemma Victoria Espí-López
- UBIC, Departament de Fisioteràpia de la Universitat de València, C/ Gascó Oliag, 5, 46010, Valencia, Spain
| | - Juan López-Pascual
- Instituto de Biomecánica de Valencia, Universidad Politécnica de Valencia, Edificio 9C. Camino de Vera, s/n, 46022, Valencia, Spain.
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Lefeber N, Degelaen M, Truyers C, Safin I, Beckwee D. Validity and Reproducibility of Inertial Physilog Sensors for Spatiotemporal Gait Analysis in Patients With Stroke. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1865-1874. [PMID: 31352347 DOI: 10.1109/tnsre.2019.2930751] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Spatiotemporal gait analysis can provide quantitative information to assess treatment outcomes in stroke survivors. Therefore, clinicians need a portable, easy-to-use and low-cost tool that accurately and reliably measures spatiotemporal gait parameters. This paper examined the concurrent validity and reproducibility of the Gait Up gait analysis package for the spatiotemporal gait analysis in subacute stroke survivors. Twenty-five subacute stroke survivors participated in two walking tests. Spatiotemporal gait parameters were synchronously measured by 2 foot-worn inertial sensors (Physilog) and three-dimensional motion capturing (Vicon). Intraclass correlation coefficients, standard errors of measurement, smallest detectable changes, limits of agreement, and the Bland-Altman plots were calculated for the paretic and non-paretic side. After removing a consistent outlier (i.e., data of the paretic side of subject 36 who dragged his foot), agreement between both devices was good to excellent for paretic and non-paretic gait cycle time, cadence, stride length, stride velocity, and double support and moderate for paretic and non-paretic stance and swing. The Bland-Altman plots supported these findings. Test-retest reliability was good to excellent for most parameters, except paretic stance and swing. In conclusion, the Gait Up gait analysis package is a valid and reliable tool to measure paretic and non-paretic gait cycle time, cadence, stride length, and stride velocity in subacute patients with stroke, who do not exhibit severe dragging of the paretic foot. However, the algorithm should be improved for the analysis of paretic stance and swing phase.
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Design and Accuracy of an Instrumented Insole Using Pressure Sensors for Step Count. SENSORS 2019; 19:s19050984. [PMID: 30813515 PMCID: PMC6427154 DOI: 10.3390/s19050984] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/16/2019] [Accepted: 02/21/2019] [Indexed: 12/28/2022]
Abstract
Despite the accessibility of several step count measurement systems, count accuracy in real environments remains a major challenge. Microelectromechanical systems and pressure sensors seem to present a potential solution for step count accuracy. The purpose of this study was to equip an insole with pressure sensors and to test a novel and potentially more accurate method of detecting steps. Methods: Five force-sensitive resistors (FSR) were integrated under the heel, the first, third, and fifth metatarsal heads and the great toe. This system was tested with twelve healthy participants at self-selected and maximal walking speeds in indoor and outdoor settings. Step counts were computed based on previously reported calculation methods, individual and averaged FSR-signals, and a new method: cumulative sum of all FSR-signals. These data were compared to a direct visual step count for accuracy analysis. Results: This system accurately detected steps with success rates ranging from 95.5 ± 3.5% to 98.5 ± 2.1% (indoor) and from 96.5 ± 3.9% to 98.0 ± 2.3% (outdoor) for self-selected walking speeds and from 98.1 ± 2.7% to 99.0 ± 0.7% (indoor) and 97.0 ± 6.2% to 99.4 ± 0.7% (outdoor) for maximal walking speeds. Cumulative sum of pressure signals during the stance phase showed high step detection accuracy (99.5 ± 0.7%–99.6 ± 0.4%) and appeared to be a valid method of step counting. Conclusions: The accuracy of step counts varied according to the calculation methods, with cumulative sum-based method being highly accurate.
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Williams JM, Nyman SR. Association between the instrumented timed up and go test and cognitive function, fear of falling and quality of life in community dwelling people with dementia. J Frailty Sarcopenia Falls 2018; 3:185-193. [PMID: 32300707 PMCID: PMC7155353 DOI: 10.22540/jfsf-03-185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore relationships between the instrumented timed up and go test (iTUG) and the following risk factors for falls: cognitive functioning, fear of falling (FoF), and quality of life (QoL) in people with dementia. METHODS 83 community-dwelling older adults with dementia (mean±sd age 78.00±7.96 years; 60.2% male) completed an interview to capture global cognition (Mini-Addenbrooke's Cognitive Evaluation), FoF (Iconographical Falls Efficacy Scale) and QoL (ICEpopCAPability measure for Older people). Participants completed an iTUG whilst wearing an inertial sensor on their trunk. Linear accelerations and rotational velocities demarcated sub-phases of the iTUG. Relationships were explored through correlations and regression modelling. RESULTS Cognition was related to duration of walking sub-phases and total time to complete iTUG (r=0.25-0.28) suggesting gait speed was related to cognition. FoF was most strongly related to turning velocity (r=0.39-0.44), but also to sit-to-stand, gait sub-phases and total time to complete iTUG. Sub-phases explained 27% of the variance in FoF. There were no correlations between iTUG and QoL. CONCLUSIONS Cognition and FoF were related to time to complete walking sub-phases but FoF was more closely related to turning velocity and standing acceleration. iTUG may offer unique insights into motor behaviour in people with dementia.
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Affiliation(s)
- Jonathan M. Williams
- Department of Human Sciences and Public Health, Faculty of Health and Social Sciences, Bournemouth University, UK
| | - Samuel R. Nyman
- Department of Psychology and Ageing & Dementia Research Centre, Faculty of Science and Technology, Bournemouth University, UK
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Zhang W, Smuck M, Legault C, Ith MA, Muaremi A, Aminian K. Simple Gait Symmetry Measures Based on Foot Angular Velocity: Analysis in Post Stroke Patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:5442-5445. [PMID: 30441568 DOI: 10.1109/embc.2018.8513585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this paper, we propose symmetry measures for post stroke assessment based on gait signal profiles from inertial sensors. Ten healthy controls and eight post stroke patients performed 6-Minute Walk Tests while wearing an inertial sensor on top of each shoe. Symmetry measures based on the linear correlation and the normalized sample distance between left and right foot pitch angular velocity showed high discriminating power to differentiate post stroke gait from healthy controls (Cliff's D = 0.95, Wilcoxon test p<0.001). The proposed symmetry measures are simple to estimate and do not require spatiotemporal gait parameters while they provide comparable discriminating power than symmetry measures based on spatiotemporal gait characteristics such as maximum angular velocity and stance ratio of each cycle. The proposed symmetry measures have the potential for generalization in wearable sensor based gait symmetry assessment.
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Guarnieri R, Crocetta TB, Massetti T, Barbosa RTDA, Antão JYFDL, Antunes TPC, Hounsell MDS, Monteiro CBDM, Oliveira ASB, Abreu LCD. Test-Retest Reliability and Clinical Feasibility of a Motion-Controlled Game to Enhance the Literacy and Numeracy Skills of Young Individuals with Intellectual Disability. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2018; 22:111-121. [PMID: 30346804 DOI: 10.1089/cyber.2017.0534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Games using motion capture from web cameras have become increasingly popular. However, there are no games specifically designed to teach literacy to individuals with intellectual disabilities (ID). The aim of this study was to investigate the feasibility of introducing young individuals with ID to a new augmented reality game, the MoviLetrando, and establish its test-retest reliability to determine its usefulness in teaching the alphabet and motor control skills. The performance of a sample of 88 ID participants (52 males, 36 females, mean ± standard deviation age, 11.2 ± 2.6 years) was measured on two different testing sessions. Five dependent variables (total points, number of correct vowels/numbers, number of mistakes, number of omissions, and average time to reach symbols) were used for data analysis. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), Cronbach's alpha, and Bland-Altman plots were used to estimate the test-retest reliability and measurement precision. Feasibility was assessed by examining recruitment, adherence, and acceptability in both phases of the game. The dependent variables identified in the MoviLetrando demonstrated an ICC of 0.44 to 0.82, suggesting acceptable/good test-retest reliability, respectively. The internal consistency was satisfactory. The small SEM, as well as the narrow width of the 95 percent limits of agreement in the Bland-Altman plots, implied that measurements of these dependent variables were precise and accurate on both the occasions. Excellent test-retest reliability for performance measurement was demonstrated in the ID participants, indicating that the MoviLetrando could be used as an outcome measure for this population.
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Affiliation(s)
- Regiani Guarnieri
- 1 Faculdade de Medicina do ABC-FMABC, Departamento de Saúde das Coletividades, Santo André, São Paulo, Brasil
| | - Tânia Brusque Crocetta
- 1 Faculdade de Medicina do ABC-FMABC, Departamento de Saúde das Coletividades, Santo André, São Paulo, Brasil
| | - Thaís Massetti
- 2 Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brasil
| | | | | | | | - Marcelo da Silva Hounsell
- 3 Universidade do Estado de Santa Catarina-UDESC, Departamento de Ciência da Computação, Joinville, Brasil
| | - Carlos Bandeira de Mello Monteiro
- 1 Faculdade de Medicina do ABC-FMABC, Departamento de Saúde das Coletividades, Santo André, São Paulo, Brasil.,2 Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, Brasil.,4 Escola de Artes, Ciências e Humanidades da Universidade de São Paulo (EACH-USP), Departamento de Pós-Graduação em Ciências da Reabilitação, São Paulo, Brasil
| | | | - Luiz Carlos de Abreu
- 1 Faculdade de Medicina do ABC-FMABC, Departamento de Saúde das Coletividades, Santo André, São Paulo, Brasil
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Zhang W, Smuck M, Legault C, Ith MA, Muaremi A, Aminian K. Gait Symmetry Assessment with a Low Back 3D Accelerometer in Post-Stroke Patients. SENSORS (BASEL, SWITZERLAND) 2018; 18:E3322. [PMID: 30282947 PMCID: PMC6209891 DOI: 10.3390/s18103322] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 09/15/2018] [Accepted: 09/29/2018] [Indexed: 11/17/2022]
Abstract
Gait asymmetry is an important marker of mobility impairment post stroke. This study proposes a new gait symmetry index (GSI) to quantify gait symmetry with one 3D accelerometer at L3 (GSIL3). GSIL3 was evaluated with 16 post stroke patients and nine healthy controls in the Six-Minute-Walk-Test (6-MWT). Discriminative power was evaluated with Wilcoxon test and the effect size (ES) was computed with Cliff's Delta. GSIL3 estimated during the entire 6-MWT and during a short segment straight walk (GSIL3straight) have comparable effect size to one another (ES = 0.89, p < 0.001) and to the symmetry indices derived from feet sensors (|ES| = [0.22, 0.89]). Furthermore, while none of the indices derived from feet sensors showed significant differences between post stroke patients walking with a cane compared to those able to walk without, GSIL3 was able to discriminate between these two groups with a significantly lower value in the group using a cane (ES = 0.70, p = 0.02). In addition, GSIL3 was strongly associated with several symmetry indices measured by feet sensors during the straight walking cycles (Spearman correlation: |ρ| = [0.82, 0.88], p < 0.05). The proposed index can be a reliable and cost-efficient post stroke gait symmetry assessment with implications for research and clinical practice.
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Affiliation(s)
- Wei Zhang
- Laboratory of Movement Analysis and Measurement Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.
| | - Matthew Smuck
- Wearable Health Lab, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA 94063, USA.
- Division of Physical Medicine & Rehabilitation, Stanford University, Palo Alto, CA 94304, USA.
| | - Catherine Legault
- Stanford Stroke Center, Stanford University, Palo Alto, CA 94304, USA.
| | - Ma A Ith
- Wearable Health Lab, Department of Orthopaedic Surgery, Stanford University, Redwood City, CA 94063, USA.
- Division of Physical Medicine & Rehabilitation, Stanford University, Palo Alto, CA 94304, USA.
| | - Amir Muaremi
- Novartis Institutes for BioMedical Research, 4056 Basel, Switzerland.
| | - Kamiar Aminian
- Laboratory of Movement Analysis and Measurement Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015 Lausanne, Switzerland.
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Porciuncula F, Roto AV, Kumar D, Davis I, Roy S, Walsh CJ, Awad LN. Wearable Movement Sensors for Rehabilitation: A Focused Review of Technological and Clinical Advances. PM R 2018; 10:S220-S232. [PMID: 30269807 PMCID: PMC6700726 DOI: 10.1016/j.pmrj.2018.06.013] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 01/01/2023]
Abstract
Recent technologic advancements have enabled the creation of portable, low-cost, and unobtrusive sensors with tremendous potential to alter the clinical practice of rehabilitation. The application of wearable sensors to track movement has emerged as a promising paradigm to enhance the care provided to patients with neurologic or musculoskeletal conditions. These sensors enable quantification of motor behavior across disparate patient populations and emerging research shows their potential for identifying motor biomarkers, differentiating between restitution and compensation motor recovery mechanisms, remote monitoring, telerehabilitation, and robotics. Moreover, the big data recorded across these applications serve as a pathway to personalized and precision medicine. This article presents state-of-the-art and next-generation wearable movement sensors, ranging from inertial measurement units to soft sensors. An overview of clinical applications is presented across a wide spectrum of conditions that have potential to benefit from wearable sensors, including stroke, movement disorders, knee osteoarthritis, and running injuries. Complementary applications enabled by next-generation sensors that will enable point-of-care monitoring of neural activity and muscle dynamics during movement also are discussed.
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Affiliation(s)
- Franchino Porciuncula
- Paulson School of Engineering and Applied Sciences and Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA(∗)
| | - Anna Virginia Roto
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA(†)
| | - Deepak Kumar
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA(‡)
| | - Irene Davis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA(§)
| | - Serge Roy
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA(¶)
| | - Conor J Walsh
- Paulson School of Engineering and Applied Sciences and Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA(#)
| | - Louis N Awad
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, Boston, MA; Paulson School of Engineering and Applied Sciences and Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA(∗∗).
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Newman MA, Hirsch MA, Peindl RD, Habet NA, Tsai TJ, Runyon MS, Huynh T, Zheng N. Reliability of the sub-components of the instrumented timed up and go test in ambulatory children with traumatic brain injury and typically developed controls. Gait Posture 2018; 63:248-253. [PMID: 29778065 DOI: 10.1016/j.gaitpost.2018.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/03/2018] [Accepted: 05/10/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Studies have evaluated the test-re-test reliability of subcomponents of the timed up and-go test in adults by using body-worn inertial sensors. However, studies in children have not been reported in the literature. RESEARCH QUESTION To evaluate the within-session reliability of subcomponents of a newly developed electronically augmented timed 'upand-go' test (EATUG) in ambulatory children with traumatic brain injury (TBI) and children with typical development (TD). METHOD The timed up and go test was administered to twelve consecutive ambulatory children with moderate to severe TBI (6 males and 6 females, age 10.5 ± 1.5 years, range 8-13 years, during inpatient rehabilitation at 27.0 ± 11.8 days following injury) and 10 TD age and sex-matched children (5 males and 5 females, 10.4 ± 1.3 years, range 8-11 years). Participants wore a single chest-mounted inertial measurement sensor package with custom software that measured angular and acceleration velocity and torso flexion and extension angles, while they performed 6 trials of the EATUG test. Measures were derived from the overall time to complete the TUG test, angular velocity and angular displacement data for torso flexion and extension during sit-to-stand and stand-to-sit segments and both mean and peak angular velocities for two turning segments (i.e. turning around a cone and turning-before-sitting). RESULTS Within-session reliability of the subcomponents of the TUG test for children with TBI assessed by the intra-class correlation coefficient was ICC (1,1) = 0.84, (range 0.82-0.96), and for TD children ICC (1,1) = 0.73, (range 0.53-0.89). Scores on Total Time, maximum torso flexion/extension angle and peak flexion angular velocity during sit-tostand, and peak turn angular velocity for both turns around the cone and turns before sitting were lower for children with TBI than for TD children (p ≤ 0.05). SIGNIFICANCE The EATUG test is a reliable measure of physical function in children with TBI who are being discharged from inpatient rehabilitation.
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Affiliation(s)
- Mark A Newman
- Carolinas Medical Center, Carolinas Rehabilitation, Department of Physical Medicine and Rehabilitation, 1100 Blythe Blvd., Charlotte, NC 28203, United States.
| | - Mark A Hirsch
- Carolinas Medical Center, Carolinas Rehabilitation, Department of Physical Medicine and Rehabilitation, 1100 Blythe Blvd., Charlotte, NC 28203, United States
| | - Richard D Peindl
- Atrium Health Musculoskeletal Institute, 1000 Blythe Blvd., Charlotte, NC 28203, United States
| | - Nahir A Habet
- Atrium Health Musculoskeletal Institute, 1000 Blythe Blvd., Charlotte, NC 28203, United States
| | - Tobias J Tsai
- Carolinas Medical Center, Carolinas Rehabilitation, Department of Physical Medicine and Rehabilitation, 1100 Blythe Blvd., Charlotte, NC 28203, United States
| | - Michael S Runyon
- Carolinas Medical Center, Department of Emergency Medicine, 1000 Blythe Blvd., Charlotte, NC 28203, United States
| | - Toan Huynh
- Carolinas Medical Center, Department of Surgery, Division of Acute Care Surgery, 1000 Blythe Blvd., Charlotte, NC 28203, United States
| | - Nigel Zheng
- Center for Biomedical Engineering and Science, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223, United States
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Burns A, Adeli H. Wearable technology for patients with brain and spinal cord injuries. Rev Neurosci 2017; 28:913-920. [DOI: 10.1515/revneuro-2017-0035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 07/14/2017] [Indexed: 11/15/2022]
Abstract
AbstractStudies have shown that patients who practice functional movements at home in conjunction with outpatient therapy show higher improvement in motor recovery. However, patients are not qualified to monitor or assess their own condition that must be reported back to the clinician. Therefore, there is a need to transmit physiological data to clinicians from patients in their home environment. This paper presents a review of wearable technology for in-home health monitoring, assessment, and rehabilitation of patients with brain and spinal cord injuries.
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Affiliation(s)
- Alexis Burns
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH 43210, USA
| | - Hojjat Adeli
- Departments of Biomedical Engineering, Biomedical Informatics, Civil, Environmental, and Geodetic Engineering, Neurology, and Neuroscience, and Biophysics Graduate Program, The Ohio State University, 470 Hitchcock Hall, 2070 Neil Avenue, Columbus, OH 43210, USA
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Beyea J, McGibbon CA, Sexton A, Noble J, O'Connell C. Convergent Validity of a Wearable Sensor System for Measuring Sub-Task Performance during the Timed Up-and-Go Test. SENSORS 2017; 17:s17040934. [PMID: 28441748 PMCID: PMC5426930 DOI: 10.3390/s17040934] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/29/2017] [Accepted: 04/10/2017] [Indexed: 01/30/2023]
Abstract
Background: The timed-up-and-go test (TUG) is one of the most commonly used tests of physical function in clinical practice and for research outcomes. Inertial sensors have been used to parse the TUG test into its composite phases (rising, walking, turning, etc.), but have not validated this approach against an optoelectronic gold-standard, and to our knowledge no studies have published the minimal detectable change of these measurements. Methods: Eleven adults performed the TUG three times each under normal and slow walking conditions, and 3 m and 5 m walking distances, in a 12-camera motion analysis laboratory. An inertial measurement unit (IMU) with tri-axial accelerometers and gyroscopes was worn on the upper-torso. Motion analysis marker data and IMU signals were analyzed separately to identify the six main TUG phases: sit-to-stand, 1st walk, 1st turn, 2nd walk, 2nd turn, and stand-to-sit, and the absolute agreement between two systems analyzed using intra-class correlation (ICC, model 2) analysis. The minimal detectable change (MDC) within subjects was also calculated for each TUG phase. Results: The overall difference between TUG sub-tasks determined using 3D motion capture data and the IMU sensor data was <0.5 s. For all TUG distances and speeds, the absolute agreement was high for total TUG time and walk times (ICC > 0.90), but less for chair activity (ICC range 0.5–0.9) and typically poor for the turn time (ICC < 0.4). MDC values for total TUG time ranged between 2–4 s or 12–22% of the TUG time measurement. MDC of the sub-task times were higher proportionally, being 20–60% of the sub-task duration. Conclusions: We conclude that a commercial IMU can be used for quantifying the TUG phases with accuracy sufficient for clinical applications; however, the MDC when using inertial sensors is not necessarily improved over less sophisticated measurement tools.
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Affiliation(s)
- James Beyea
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB E3B5A3, Canada.
| | - Chris A McGibbon
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB E3B5A3, Canada.
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB E3B5A3, Canada.
| | - Andrew Sexton
- Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB E3B5A3, Canada.
| | - Jeremy Noble
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB E3B5A3, Canada.
| | - Colleen O'Connell
- Faculty of Kinesiology, University of New Brunswick, Fredericton, NB E3B5A3, Canada.
- Stan Cassidy Centre for Rehabilitation, Fredericton, NB E3BOC7, Canada.
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