1
|
Lozano-Garcia M, Doheny EP, Mann E, Morgan-Jones P, Drew C, Busse-Morris M, Lowery MM. Estimation of Gait Parameters in Huntington's Disease Using Wearable Sensors in the Clinic and Free-living Conditions. IEEE Trans Neural Syst Rehabil Eng 2024; 32:2239-2249. [PMID: 38819972 DOI: 10.1109/tnsre.2024.3407887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
In Huntington's disease (HD), wearable inertial sensors could capture subtle changes in motor function. However, disease-specific validation of methods is necessary. This study presents an algorithm for walking bout and gait event detection in HD using a leg-worn accelerometer, validated only in the clinic and deployed in free-living conditions. Seventeen HD participants wore shank- and thigh-worn tri-axial accelerometers, and a wrist-worn device during two-minute walk tests in the clinic, with video reference data for validation. Thirteen participants wore one of the thigh-worn tri-axial accelerometers (AP: ActivPAL4) and the wrist-worn device for 7 days under free-living conditions, with proprietary AP data used as reference. Gait events were detected from shank and thigh acceleration using the Teager-Kaiser energy operator combined with unsupervised clustering. Estimated step count (SC) and temporal gait parameters were compared with reference data. In the clinic, low mean absolute percentage errors were observed for stride (shank/thigh: 0.6/0.9%) and stance (shank/thigh: 3.3/7.1%) times, and SC (shank/thigh: 3.1%). Similar errors were observed for proprietary AP SC (3.2%), with higher errors observed for the wrist-worn device (10.9%). At home, excellent agreement was observed between the proposed algorithm and AP software for SC and time spent walking (ICC [Formula: see text]). The wrist-worn device overestimated SC by 34.2%. The presented algorithm additionally allowed stride and stance time estimation, whose variability correlated significantly with clinical motor scores. The results demonstrate a new method for accurate estimation of HD gait parameters in the clinic and free-living conditions, using a single accelerometer worn on either the thigh or shank.
Collapse
|
2
|
Emmerzaal J, Vets N, Devoogdt N, Smeets A, De Groef A, De Baets L. Upper-Limb Movement Quality before and after Surgery in Women with Breast Cancer: An Exploratory Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:3472. [PMID: 38894264 PMCID: PMC11175096 DOI: 10.3390/s24113472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024]
Abstract
(1) Background: This study aimed to describe upper-limb (UL) movement quality parameters in women after breast cancer surgery and to explore their clinical relevance in relation to post-surgical pain and disability. (2) Methods: UL movement quality was assessed in 30 women before and 3 weeks after surgery for breast cancer. Via accelerometer data captured from a sensor located at the distal end of the forearm on the operated side, various movement quality parameters (local dynamic stability, movement predictability, movement smoothness, movement symmetry, and movement variability) were investigated while women performed a cyclic, weighted reaching task. At both test moments, the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire was filled out to assess UL disability and pain severity. (3) Results: No significant differences in movement quality parameters were found between the pre-surgical and post-surgical time points. No significant correlations between post-operative UL disability or pain severity and movement quality were found. (4) Conclusions: From this study sample, no apparent clinically relevant movement quality parameters could be derived for a cyclic, weighted reaching task. This suggests that the search for an easy-to-use, quantitative analysis tool for UL qualitative functioning to be used in research and clinical practice should continue.
Collapse
Affiliation(s)
- Jill Emmerzaal
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (J.E.)
| | - Nieke Vets
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (J.E.)
- CarEdOn Research Group, 3000 Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (J.E.)
- CarEdOn Research Group, 3000 Leuven, Belgium
- Department of Vascular Surgery and Department of Physical Medicine and Rehabilitation, Centre for Lymphoedema, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Ann Smeets
- Department of Oncology, KU Leuven, 3000 Leuven, Belgium
- Department of Surgical Oncology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven, 3000 Leuven, Belgium; (J.E.)
- CarEdOn Research Group, 3000 Leuven, Belgium
- MOVANT Research Group, Department of Rehabilitation Sciences, University of Antwerp, 2000 Antwerp, Belgium
- Pain in Motion International Research Group, 1090 Brussels, Belgium
| | - Liesbet De Baets
- Pain in Motion International Research Group, 1090 Brussels, Belgium
- Pain in Motion (PAIN) Research Group, Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
- Chronic Pain Rehabilitation, Department of Physical Medicine and Physiotherapy, University Hospital Brussels, 1090 Brussels, Belgium
| |
Collapse
|
3
|
Mao Q, Zheng W, Shi M, Yang F. Scientometric Research and Critical Analysis of Gait and Balance in Older Adults. SENSORS (BASEL, SWITZERLAND) 2024; 24:3199. [PMID: 38794055 PMCID: PMC11125350 DOI: 10.3390/s24103199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
Gait and balance have emerged as a critical area of research in health technology. Gait and balance studies have been affected by the researchers' slow follow-up of research advances due to the absence of visual inspection of the study literature across decades. This study uses advanced search methods to analyse the literature on gait and balance in older adults from 1993 to 2022 in the Web of Science (WoS) database to gain a better understanding of the current status and trends in the field for the first time. The study analysed 4484 academic publications including journal articles and conference proceedings on gait and balance in older adults. Bibliometric analysis methods were applied to examine the publication year, number of publications, discipline distribution, journal distribution, research institutions, application fields, test methods, analysis theories, and influencing factors in the field of gait and balance. The results indicate that the publication of relevant research documents has been steadily increasing from 1993 to 2022. The United States (US) exhibits the highest number of publications with 1742 articles. The keyword "elderly person" exhibits a strong citation burst strength of 18.04, indicating a significant focus on research related to the health of older adults. With a burst factor of 20.46, Harvard University has made impressive strides in the subject. The University of Pittsburgh displayed high research skills in the area of gait and balance with a burst factor of 7.7 and a publication count of 103. The research on gait and balance mainly focuses on physical performance evaluation approaches, and the primary study methods include experimental investigations, computational modelling, and observational studies. The field of gait and balance research is increasingly intertwined with computer science and artificial intelligence (AI), paving the way for intelligent monitoring of gait and balance in the elderly. Moving forward, the future of gait and balance research is anticipated to highlight the importance of multidisciplinary collaboration, intelligence-driven approaches, and advanced visualization techniques.
Collapse
Affiliation(s)
- Qian Mao
- School of Design, The Hong Kong Polytechnic University, Hong Kong
| | - Wei Zheng
- Department of Computer Science and Technology, Tsinghua University, Beijing 100190, China
| | - Menghan Shi
- Lancaster Imagination Lab, Lancashire, Lancaster LA1 4YD, UK
| | - Fan Yang
- Electrical and Electronic Engineering Department, The Hong Kong Polytechnic University, Hong Kong
| |
Collapse
|
4
|
Reilly PT, van Eps A, Stefanovski D, Pfau T. The influence of different horseshoes and ground substrates on mid-stance hoof orientation at the walk. Equine Vet J 2024; 56:598-606. [PMID: 37589397 DOI: 10.1111/evj.13990] [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: 01/09/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Horseshoes with modified contact surfaces combined with deformable ground substrates are used to change hoof orientation during mid-stance, for example, for therapeutic reasons. OBJECTIVES To measure the effect of horseshoes and ground substrates on sagittal and transverse plane hoof orientation at mid-stance using a dorsal hoof wall mounted triaxial accelerometer. STUDY DESIGN In vivo experiment, randomised crossover design. METHODS Differences in sagittal and transverse plane angles between standing and mid-stance of the left front hoof of six horses walking with regular horseshoes, egg bar, toe-wide, medial-wide, lateral-wide and three-degree egg bar shoes on turf, sand and hard ground substrates were assessed with linear mixed models with horseshoe and substrate type as fixed factors (p < 0.05) for each animal. RESULTS Hoof angles were significantly affected by horseshoe (p < 0.001), surface (p < 0.001) and the combination (p < 0.001). The sagittal plane angle increased in deformable ground substrates at walk-in mid-stance on turf [mean (±standard deviation): 2.6° (±3.8°)] and on sand [2.6° (±4.1°)] across all shoes. The greatest increase was observed with egg bar shoes [turf: 4.37° (±3.82°); sand 4.69° (±3.83°)]. There was a tendency for the hoof to sink laterally into deformable ground substrates among all shoes [turf: 1.11° (±1.49°); sand: 0.93° (±1.93°)]. Medial-wide shoes increased the lateral sinking [turf: 2.00° (±1.63°); sand: 1.79° (±1.58°)]. Lateral-wide shoes reduced the lateral sinking on turf [0.62° (±1.26°)] and induced a marginal medial sinking on sand [-0.007° (±2.03°)]. MAIN LIMITATIONS The substrate properties were not quantitatively assessed, and observations were limited to front hooves at the walk. A larger sample size would be preferable. CONCLUSIONS Mid-stance hoof orientation changes with specific combinations of shoes and ground substrates in the walking horse.
Collapse
Affiliation(s)
- Patrick T Reilly
- Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett \Square, Pennsylvania, USA
| | - Andrew van Eps
- Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett \Square, Pennsylvania, USA
| | - Darko Stefanovski
- Department of Clinical Sciences, New Bolton Center, University of Pennsylvania, Kennett \Square, Pennsylvania, USA
| | - Thilo Pfau
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
- Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
5
|
Noamani A, Riahi N, Vette AH, Rouhani H. Clinical Static Balance Assessment: A Narrative Review of Traditional and IMU-Based Posturography in Older Adults and Individuals with Incomplete Spinal Cord Injury. SENSORS (BASEL, SWITZERLAND) 2023; 23:8881. [PMID: 37960580 PMCID: PMC10650039 DOI: 10.3390/s23218881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023]
Abstract
Maintaining a stable upright posture is essential for performing activities of daily living, and impaired standing balance may impact an individual's quality of life. Therefore, accurate and sensitive methods for assessing static balance are crucial for identifying balance impairments, understanding the underlying mechanisms of the balance deficiencies, and developing targeted interventions to improve standing balance and prevent falls. This review paper first explores the methods to quantify standing balance. Then, it reviews traditional posturography and recent advancements in using wearable inertial measurement units (IMUs) to assess static balance in two populations: older adults and those with incomplete spinal cord injury (iSCI). The inclusion of these two groups is supported by their large representation among individuals with balance impairments. Also, each group exhibits distinct aspects in balance assessment due to diverse underlying causes associated with aging and neurological impairment. Given the high vulnerability of both demographics to balance impairments and falls, the significance of targeted interventions to improve standing balance and mitigate fall risk becomes apparent. Overall, this review highlights the importance of static balance assessment and the potential of emerging methods and technologies to improve our understanding of postural control in different populations.
Collapse
Affiliation(s)
- Alireza Noamani
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada; (A.N.); (N.R.); (A.H.V.)
| | - Negar Riahi
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada; (A.N.); (N.R.); (A.H.V.)
| | - Albert H. Vette
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada; (A.N.); (N.R.); (A.H.V.)
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB T5G 0B7, Canada
| | - Hossein Rouhani
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada; (A.N.); (N.R.); (A.H.V.)
- Department of Biomedical Engineering, University of Alberta, Edmonton, AB T6G 1H9, Canada
- Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB T5G 0B7, Canada
| |
Collapse
|
6
|
Browning S, Holland S, Wellwood I, Bilney B. Spatiotemporal Gait Parameters in Adults With Premanifest and Manifest Huntington's Disease: A Systematic Review. J Mov Disord 2023; 16:307-320. [PMID: 37558234 PMCID: PMC10548085 DOI: 10.14802/jmd.23111] [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: 06/03/2023] [Revised: 07/15/2023] [Accepted: 08/09/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE To systematically review and critically evaluate literature on spatiotemporal gait deviations in individuals with premanifest and manifest Huntington's Disease (HD) in comparison with healthy cohorts. METHODS We conducted a systematic review, guided by the Joanna Briggs Institute's Manual for Evidence Synthesis and pre-registered with the International Prospective Register of Systematic Reviews. Eight electronic databases were searched. Studies comparing spatiotemporal footstep parameters in adults with premanifest and manifest HD to healthy controls were screened, included and critically appraised by independent reviewers. Data on spatiotemporal gait changes and variability were extracted and synthesised. Meta-analysis was performed on gait speed, cadence, stride length and stride length variability measures. RESULTS We screened 2,721 studies, identified 1,245 studies and included 25 studies (total 1,088 participants). Sample sizes ranged from 14 to 96. Overall, the quality of the studies was assessed as good, but reporting of confounding factors was often unclear. Meta-analysis found spatiotemporal gait deviations in participants with HD compared to healthy controls, commencing in the premanifest stage. Individuals with premanifest HD walk significantly slower (-0.17 m/s; 95% confidence interval [CI] [-0.22, -0.13]), with reduced cadence (-6.63 steps/min; 95% CI [-10.62, -2.65]) and stride length (-0.09 m; 95% CI [-0.13, -0.05]). Stride length variability was also increased in premanifest cohorts by 2.18% (95% CI [0.69, 3.68]), with these changes exacerbated in participants with manifest disease. CONCLUSION Findings suggest individuals with premanifest and manifest HD display significant spatiotemporal footstep deviations. Clinicians could monitor individuals in the premanifest stage of disease for gait changes to identify the onset of Huntington's symptoms.
Collapse
Affiliation(s)
- Sasha Browning
- Faculty of Health Sciences, Australian Catholic University, Ballarat, Australia
| | - Stephanie Holland
- Faculty of Health Sciences, Australian Catholic University, Ballarat, Australia
| | - Ian Wellwood
- Faculty of Health Sciences, Australian Catholic University, Ballarat, Australia
| | - Belinda Bilney
- Faculty of Health Sciences, Australian Catholic University, Ballarat, Australia
| |
Collapse
|
7
|
Poleur M, Markati T, Servais L. The use of digital outcome measures in clinical trials in rare neurological diseases: a systematic literature review. Orphanet J Rare Dis 2023; 18:224. [PMID: 37533072 PMCID: PMC10398976 DOI: 10.1186/s13023-023-02813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/07/2023] [Indexed: 08/04/2023] Open
Abstract
Developing drugs for rare diseases is challenging, and the precision and objectivity of outcome measures is critical to this process. In recent years, a number of technologies have increasingly been used for remote monitoring of patient health. We report a systematic literature review that aims to summarize the current state of progress with regard to the use of digital outcome measures for real-life motor function assessment of patients with rare neurological diseases. Our search of published literature identified 3826 records, of which 139 were included across 27 different diseases. This review shows that use of digital outcome measures for motor function outside a clinical setting is feasible and employed in a broad range of diseases, although we found few outcome measures that have been robustly validated and adopted as endpoints in clinical trials. Future research should focus on validation of devices, variables, and algorithms to allow for regulatory qualification and widespread adoption.
Collapse
Affiliation(s)
- Margaux Poleur
- Department of Neurology, Liege University Hospital Center, Liège, Belgium.
- Neuromuscular Reference Center, Division of Paediatrics University, Hospital University of Liège, Liège, Belgium.
- Centre de Référence des Maladies Neuromusculaires, Centre Hospitalier Régional de la Citadelle, Boulevard du 12eme de Ligne 1, 4000, Liège, Belgium.
| | - Theodora Markati
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Laurent Servais
- MDUK Oxford Neuromuscular Centre and NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
- Neuromuscular Reference Center, Division of Paediatrics University, Hospital University of Liège, Liège, Belgium
| |
Collapse
|
8
|
Vezočnik M, Juric MB. Adaptive Inertial Sensor-Based Step Length Estimation Model. SENSORS (BASEL, SWITZERLAND) 2022; 22:9452. [PMID: 36502153 PMCID: PMC9739942 DOI: 10.3390/s22239452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Pedestrian dead reckoning (PDR) using inertial sensors has paved the way for developing several approaches to step length estimation. In particular, emerging step length estimation models are readily available to be utilized on smartphones, yet they are seldom formulated considering the kinematics of the human body during walking in combination with measured step lengths. We present a new step length estimation model based on the acceleration magnitude and step frequency inputs herein. Spatial positions of anatomical landmarks on the human body during walking, tracked by an optical measurement system, were utilized in the derivation process. We evaluated the performance of the proposed model using our publicly available dataset that includes measurements collected for two types of walking modes, i.e., walking on a treadmill and rectangular-shaped test polygon. The proposed model achieved an overall mean absolute error (MAE) of 5.64 cm on the treadmill and an overall mean walked distance error of 4.55% on the test polygon, outperforming all the models selected for the comparison. The proposed model was also least affected by walking speed and is unaffected by smartphone orientation. Due to its promising results and favorable characteristics, it could present an appealing alternative for step length estimation in PDR-based approaches.
Collapse
|
9
|
Desai R, Blacutt M, Youdan G, Fritz NE, Muratori LM, Hausdorff JM, Busse M, Quinn L. Postural control and gait measures derived from wearable inertial measurement unit devices in Huntington's disease: Recommendations for clinical outcomes. Clin Biomech (Bristol, Avon) 2022; 96:105658. [PMID: 35588586 DOI: 10.1016/j.clinbiomech.2022.105658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 04/13/2022] [Accepted: 04/22/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postural control impairments begin early in Huntington's disease yet measures most sensitive to progression have not been identified. The aims of this study were to: 1) evaluate postural control and gait in people with and without Huntington's disease using wearable sensors; and 2) identify measures related to diagnosis and clinical severity. METHODS 43 individuals with Huntington's disease and 15 age-matched peers performed standing with feet together and feet apart, sitting, and walking with wearable inertial sensors. One-way analysis of variance determined differences in measures of postural control and gait between early and mid-disease stage, and non-Huntington's disease peers. A random forest analysis identified feature importance for Huntington's disease diagnosis. Stepwise and ordinal regressions were used to determine predictors of clinical chorea and tandem walking scores respectively. FINDINGS There was a significant main effect for all postural control and gait measures comparing early stage, mid stage and non-Huntington's disease peers, except for gait cycle duration and step duration. Total sway, root mean square and mean velocity during sitting, as well as gait speed had the greatest importance in classifying disease status. Stepwise regression showed that root mean square during standing with feet apart significantly predicted clinical measure of chorea, and ordinal regression model showed that root mean square and total sway standing feet together significantly predicted clinical measure of tandem walking. INTERPRETATIONS Root mean square measures obtained in sitting and standing using wearable sensors have the potential to serve as biomarkers of postural control impairments in Huntington's disease.
Collapse
Affiliation(s)
- Radhika Desai
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
| | - Miguel Blacutt
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
| | - Gregory Youdan
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.
| | - Nora E Fritz
- Wayne State University, Departments of Health Care Sciences and Neurology, Detroit, MI, USA.
| | - Lisa M Muratori
- Department Physical Therapy, Stony Brook University, New York, USA.
| | - Jeffrey M Hausdorff
- Center for the Study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA; Centre for Trials Research, Cardiff University, Cardiff, UK.
| |
Collapse
|
10
|
Movement Quality Parameters during Gait Assessed by a Single Accelerometer in Subjects with Osteoarthritis and Following Total Joint Arthroplasty. SENSORS 2022; 22:s22082955. [PMID: 35458937 PMCID: PMC9029923 DOI: 10.3390/s22082955] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 01/13/2023]
Abstract
This study’s aim is threefold: (I) Evaluate movement quality parameters of gait in people with hip or knee osteoarthritis (OA) compared to asymptomatic controls from a single trunk-worn 3D accelerometer. (II) Evaluate the sensitivity of these parameters to capture changes at 6-weeks, 3-, 6-, and 12-months following total knee arthroplasty (TKA). (III) Investigate whether observed changes in movement quality from 6-weeks and 12-months post-TKA relates to changes in patient-reported outcome measures (PROMs). We invited 20 asymptomatic controls, 20 people with hip OA, 18 people pre- and post-TKA to our movement lap. They wore a single trunk-worn accelerometer and walked at a self-selected speed. Movement quality parameters (symmetry, complexity, smoothness, and dynamic stability) were calculated from the 3D acceleration signal. Between groups and between timepoints comparisons were made, and changes in movement quality were correlated with PROMs. We found significant differences in symmetry and stability in both OA groups. Post-TKA, most parameters reflected an initial decrease in movement quality at 6-weeks post-TKA, which mostly normalised 6-months post-TKA. Finally, improved movement quality relates to improvements in PROMs. Thus, a single accelerometer can characterise movement quality in both OA groups and post-TKA. The correlation shows the potential to monitor movement quality in a clinical setting to inform objective, data-driven personalised rehabilitation.
Collapse
|
11
|
Mobbs RJ, Perring J, Raj SM, Maharaj M, Yoong NKM, Sy LW, Fonseka RD, Natarajan P, Choy WJ. Gait metrics analysis utilizing single-point inertial measurement units: a systematic review. Mhealth 2022; 8:9. [PMID: 35178440 PMCID: PMC8800203 DOI: 10.21037/mhealth-21-17] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 08/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Wearable sensors, particularly accelerometers alone or combined with gyroscopes and magnetometers in an inertial measurement unit (IMU), are a logical alternative for gait analysis. While issues with intrusive and complex sensor placement limit practicality of multi-point IMU systems, single-point IMUs could potentially maximize patient compliance and allow inconspicuous monitoring in daily-living. Therefore, this review aimed to examine the validity of single-point IMUs for gait metrics analysis and identify studies employing them for clinical applications. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Guidelines (PRISMA) were followed utilizing the following databases: PubMed; MEDLINE; EMBASE and Cochrane. Four databases were systematically searched to obtain relevant journal articles focusing on the measurement of gait metrics using single-point IMU sensors. RESULTS A total of 90 articles were selected for inclusion. Critical analysis of studies was conducted, and data collected included: sensor type(s); sensor placement; study aim(s); study conclusion(s); gait metrics and methods; and clinical application. Validation research primarily focuses on lower trunk sensors in healthy cohorts. Clinical applications focus on diagnosis and severity assessment, rehabilitation and intervention efficacy and delineating pathological subjects from healthy controls. DISCUSSION This review has demonstrated the validity of single-point IMUs for gait metrics analysis and their ability to assist in clinical scenarios. Further validation for continuous monitoring in daily living scenarios and performance in pathological cohorts is required before commercial and clinical uptake can be expected.
Collapse
Affiliation(s)
- Ralph Jasper Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
- Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia
| | - Jordan Perring
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | | | - Monish Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Nicole Kah Mun Yoong
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Luke Wicent Sy
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Rannulu Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Wen Jie Choy
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| |
Collapse
|
12
|
Keren K, Busse M, Fritz NE, Muratori LM, Gazit E, Hillel I, Scheinowitz M, Gurevich T, Inbar N, Omer N, Hausdorff JM, Quinn L. Quantification of Daily-Living Gait Quantity and Quality Using a Wrist-Worn Accelerometer in Huntington's Disease. Front Neurol 2021; 12:719442. [PMID: 34777196 PMCID: PMC8579964 DOI: 10.3389/fneur.2021.719442] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Huntington's disease (HD) leads to altered gait patterns and reduced daily-living physical activity. Accurate measurement of daily-living walking that takes into account involuntary movements (e.g. chorea) is needed. Objective: To evaluate daily-living gait quantity and quality in HD, taking into account irregular movements. Methods: Forty-two individuals with HD and fourteen age-matched non-HD peers completed clinic-based assessments and a standardized laboratory-based circuit of functional activities, wearing inertial measurement units on the wrists, legs, and trunk. These activities were used to train and test an algorithm for the automated detection of walking. Subsequently, 29 HD participants and 22 age-matched non-HD peers wore a tri-axial accelerometer on their non-dominant wrist for 7 days. Measures included gait quantity (e.g., steps per day), gait quality (e.g., regularity) metrics, and percentage of walking bouts with irregular movements. Results: Measures of daily-living gait quantity including step counts, walking time and bouts per day were similar in HD participants and non-HD peers (p > 0.05). HD participants with higher clinician-rated upper body chorea had a greater percentage of walking bouts with irregular movements compared to those with lower chorea (p = 0.060) and non-HD peers (p < 0.001). Even after accounting for irregular movements, within-bout walking consistency was lower in HD participants compared to non-HD peers (p < 0.001), while across-bout variability of these measures was higher (p < 0.001). Many of the daily-living measures were associated with disease-specific measures of motor function. Conclusions: Results suggest that a wrist-worn accelerometer can be used to evaluate the quantity and quality of daily-living gait in people with HD, while accounting for the influence of irregular (choreic-like) movements, and that gait features related to within- and across-bout consistency markedly differ in individuals with HD and non-HD peers.
Collapse
Affiliation(s)
- Karin Keren
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Nora E. Fritz
- Departments of Health Care Sciences and Neurology, Wayne State University, Detroit, MI, United States
| | - Lisa M. Muratori
- Department of Physical Therapy, School of Health Technology and Management, Stony Brook University, Stony Brook, NY, United States
- George Huntington's Institute, Muenster, Germany
| | - Eran Gazit
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Inbar Hillel
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Micky Scheinowitz
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
- School of Public Health, Tel Aviv University, Tel Aviv, Israel
| | - Tanya Gurevich
- Movement Disorders Unit, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler School of Medicine and Sagol, School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Noit Inbar
- Movement Disorders Unit, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nurit Omer
- Movement Disorders Unit, Tel Aviv Medical Center, Tel Aviv, Israel
- Sackler School of Medicine and Sagol, School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M. Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler School of Medicine and Sagol, School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, United States
| | - Lori Quinn
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| |
Collapse
|
13
|
Zemková E, Ďurinová E, Džubera A, Chochol J, Koišová J, Šimonová M, Zapletalová L. Simultaneous measurement of centre of pressure and centre of mass in assessing postural sway in healthcare workers with non-specific back pain: protocol for a cross-sectional study. BMJ Open 2021; 11:e050014. [PMID: 34446494 PMCID: PMC8395266 DOI: 10.1136/bmjopen-2021-050014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Low back pain (LBP) is widely prevalent in healthcare workers. It is associated with impaired postural and core stability. So far, centre of pressure (CoP) measures have been commonly recorded through the use of a force plate in order to assess postural stability. However, this approach provides limited information about the centre of mass (CoM) movement in the lumbar region in individuals with LBP. Recent developments in sensor technology enable measurement of the trunk motion which could provide additional information on postural sway. However, the question remains as to whether CoM measures would be more sensitive in discriminating individuals with mild and moderate back pain than traditional CoP analyses. This study aims to investigate the sensitivity of CoP and CoM measures under varied stable, metastable and unstable testing conditions in healthcare workers, and their relationship with the level of subjective reported back pain. METHODS AND ANALYSIS This is a cross-sectional controlled laboratory study. A group of 90 healthcare professionals will be recruited from rehabilitation centres within local areas. Participants will complete the Oswestry Disability Questionnaire. The primary outcome will be the rate of their back pain on the 0-10 Low Back Pain Scale (1-3 mild pain and 4-6 moderate pain). Secondary outcomes will include variables of postural and core stability testing during bipedal and one-legged stance on a force plate, a foam mat placed on the force plate, and a spring-supported platform with either eyes open or eyes closed. Both CoP using the posturography system based on a force plate and CoM using the inertial sensor system placed on the trunk will be simultaneously measured. ETHICS AND DISSEMINATION Projects were approved by the ethics committee of the Faculty of Physical Education and Sport, Comenius University in Bratislava (Nos. 4/2017, 1/2020). Findings will be published in peer-reviewed journals and presented at conferences.
Collapse
Affiliation(s)
- Erika Zemková
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sport, Comenius University in Bratislava, Bratislava, Slovakia
| | - Eva Ďurinová
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
| | - Andrej Džubera
- Department of Neurosurgery, Slovak Medical University and University Hospital - St. Michael's Hospital, Bratislava, Slovakia
| | - Juraj Chochol
- Department of Neurosurgery, Slovak Medical University and University Hospital - St. Michael's Hospital, Bratislava, Slovakia
| | - Jana Koišová
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
| | - Michaela Šimonová
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
| | - Ludmila Zapletalová
- Faculty of Health Sciences, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
| |
Collapse
|
14
|
Baker N, Gough C, Gordon SJ. Inertial Sensor Reliability and Validity for Static and Dynamic Balance in Healthy Adults: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2021; 21:5167. [PMID: 34372404 PMCID: PMC8348903 DOI: 10.3390/s21155167] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 07/25/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022]
Abstract
Compared to laboratory equipment inertial sensors are inexpensive and portable, permitting the measurement of postural sway and balance to be conducted in any setting. This systematic review investigated the inter-sensor and test-retest reliability, and concurrent and discriminant validity to measure static and dynamic balance in healthy adults. Medline, PubMed, Embase, Scopus, CINAHL, and Web of Science were searched to January 2021. Nineteen studies met the inclusion criteria. Meta-analysis was possible for reliability studies only and it was found that inertial sensors are reliable to measure static standing eyes open. A synthesis of the included studies shows moderate to good reliability for dynamic balance. Concurrent validity is moderate for both static and dynamic balance. Sensors discriminate old from young adults by amplitude of mediolateral sway, gait velocity, step length, and turn speed. Fallers are discriminated from non-fallers by sensor measures during walking, stepping, and sit to stand. The accuracy of discrimination is unable to be determined conclusively. Using inertial sensors to measure postural sway in healthy adults provides real-time data collected in the natural environment and enables discrimination between fallers and non-fallers. The ability of inertial sensors to identify differences in postural sway components related to altered performance in clinical tests can inform targeted interventions for the prevention of falls and near falls.
Collapse
Affiliation(s)
- Nicky Baker
- Flinders Digital Health Research Centre, Flinders University, Adelaide, SA 5042, Australia; (C.G.); (S.J.G.)
| | | | | |
Collapse
|
15
|
Talman LS, Hiller AL. Approach to Posture and Gait in Huntington's Disease. Front Bioeng Biotechnol 2021; 9:668699. [PMID: 34386484 PMCID: PMC8353382 DOI: 10.3389/fbioe.2021.668699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/28/2021] [Indexed: 11/30/2022] Open
Abstract
Disturbances of gait occur in all stages of Huntington’s disease (HD) including the premanifest and prodromal stages. Individuals with HD demonstrate the slower speed of gait, shorter stride length, and increased variability of gait parameters as compared to controls; cognitive disturbances in HD often compound these differences. Abnormalities of gait and recurrent falls lead to decreased quality of life for individuals with HD throughout the disease. This scoping review aims to outline the cross-disciplinary approach to gait evaluation in HD and will highlight the utility of objective measures in defining gait abnormalities in this patient population.
Collapse
Affiliation(s)
- Lauren S Talman
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Amie L Hiller
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States.,Portland VA Healthcare System, Portland, OR, United States
| |
Collapse
|
16
|
Waddell EM, Dinesh K, Spear KL, Elson MJ, Wagner E, Curtis MJ, Mitten DJ, Tarolli CG, Sharma G, Dorsey ER, Adams JL. GEORGE®: A Pilot Study of a Smartphone Application for Huntington's Disease. J Huntingtons Dis 2021; 10:293-301. [PMID: 33814455 DOI: 10.3233/jhd-200452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Current Huntington's disease (HD) measures are limited to subjective, episodic assessments conducted in clinic. Smartphones can enable the collection of objective, real-world data but their use has not been extensively evaluated in HD. OBJECTIVE Develop and evaluate a smartphone application to assess feasibility of use and key features of HD in clinic and at home. METHODS We developed GEORGE®, an Android smartphone application for HD which assesses voice, chorea, balance, gait, and finger tapping speed. We then conducted an observational pilot study of individuals with manifest HD, prodromal HD, and without a movement disorder. In clinic, participants performed standard clinical assessments and a battery of active tasks in GEORGE. At home, participants were instructed to complete the activities thrice daily for one month. Sensor data were used to measure chorea, tap rate, and step count. Audio data was not analyzed. RESULTS Twenty-three participants (8 manifest HD, 5 prodromal HD, 10 controls) enrolled, and all but one completed the study. On average, participants used the application 2.1 times daily. We observed a significant difference in chorea score (HD: 19.5; prodromal HD: 4.5, p = 0.007; controls: 4.3, p = 0.001) and tap rate (HD: 2.5 taps/s; prodromal HD: 8.9 taps/s, p = 0.001; controls: 8.1 taps/s, p = 0.001) between individuals with and without manifest HD. Tap rate correlated strongly with the traditional UHDRS finger tapping score (left hand: r = -0.82, p = 0.022; right hand: r = -0.79, p = 0.03). CONCLUSION GEORGE is an acceptable and effective tool to differentiate individuals with and without manifest HD and measure key disease features. Refinement of the application's interface and activities will improve its usability and sensitivity and, ideally, make it useful for clinical care and research.
Collapse
Affiliation(s)
- Emma M Waddell
- Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Karthik Dinesh
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | - Kelsey L Spear
- Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Molly J Elson
- Emory University School of Medicine, Emory University, Atlanta, GA, USA
| | - Ellen Wagner
- Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael J Curtis
- UR Health Lab, University of Rochester Medical Center, Rochester, NY, USA
| | - David J Mitten
- UR Health Lab, University of Rochester Medical Center, Rochester, NY, USA
| | - Christopher G Tarolli
- Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | - E Ray Dorsey
- Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Jamie L Adams
- Center for Health+Technology, University of Rochester Medical Center, Rochester, NY, USA.,Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
17
|
Vezočnik M, Kamnik R, Juric MB. Inertial Sensor-Based Step Length Estimation Model by Means of Principal Component Analysis. SENSORS 2021; 21:s21103527. [PMID: 34069414 PMCID: PMC8159098 DOI: 10.3390/s21103527] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/07/2021] [Accepted: 05/14/2021] [Indexed: 11/16/2022]
Abstract
Inertial sensor-based step length estimation has become increasingly important with the emergence of pedestrian-dead-reckoning-based (PDR-based) indoor positioning. So far, many refined step length estimation models have been proposed to overcome the inaccuracy in estimating distance walked. Both the kinematics associated with the human body during walking and actual step lengths are rarely used in their derivation. Our paper presents a new step length estimation model that utilizes acceleration magnitude. To the best of our knowledge, we are the first to employ principal component analysis (PCA) to characterize the experimental data for the derivation of the model. These data were collected from anatomical landmarks on the human body during walking using a highly accurate optical measurement system. We evaluated the performance of the proposed model for four typical smartphone positions for long-term human walking and obtained promising results: the proposed model outperformed all acceleration-based models selected for the comparison producing an overall mean absolute stride length estimation error of 6.44 cm. The proposed model was also least affected by walking speed and smartphone position among acceleration-based models and is unaffected by smartphone orientation. Therefore, the proposed model can be used in the PDR-based indoor positioning with an important advantage that no special care regarding orientation is needed in attaching the smartphone to a particular body segment. All the sensory data acquired by smartphones that we utilized for evaluation are publicly available and include more than 10 h of walking measurements.
Collapse
Affiliation(s)
- Melanija Vezočnik
- Faculty of Computer and Information Science, University of Ljubljana, Večna Pot 113, 1000 Ljubljana, Slovenia;
- Correspondence:
| | - Roman Kamnik
- Faculty of Electrical Engineering, University of Ljubljana, Tržaška Cesta 25, 1000 Ljubljana, Slovenia;
| | - Matjaz B. Juric
- Faculty of Computer and Information Science, University of Ljubljana, Večna Pot 113, 1000 Ljubljana, Slovenia;
| |
Collapse
|
18
|
Dasgupta P, VanSwearingen J, Godfrey A, Redfern M, Montero-Odasso M, Sejdic E. Acceleration Gait Measures as Proxies for Motor Skill of Walking: A Narrative Review. IEEE Trans Neural Syst Rehabil Eng 2021; 29:249-261. [PMID: 33315570 PMCID: PMC7995554 DOI: 10.1109/tnsre.2020.3044260] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In adults 65 years or older, falls or other neuromotor dysfunctions are often framed as walking-related declines in motor skill; the frequent occurrence of such decline in walking-related motor skill motivates the need for an improved understanding of the motor skill of walking. Simple gait measurements, such as speed, do not provide adequate information about the quality of the body motion's translation during walking. Gait measures from accelerometers can enrich measurements of walking and motor performance. This review article will categorize the aspects of the motor skill of walking and review how trunk-acceleration gait measures during walking can be mapped to motor skill aspects, satisfying a clinical need to understand how well accelerometer measures assess gait. We will clarify how to leverage more complicated acceleration measures to make accurate motor skill decline predictions, thus furthering fall research in older adults.
Collapse
|
19
|
Tortelli R, Rodrigues FB, Wild EJ. The use of wearable/portable digital sensors in Huntington's disease: A systematic review. Parkinsonism Relat Disord 2021; 83:93-104. [PMID: 33493786 PMCID: PMC7957324 DOI: 10.1016/j.parkreldis.2021.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/13/2020] [Accepted: 01/08/2021] [Indexed: 01/26/2023]
Abstract
In chronic neurological conditions, wearable/portable devices have potential as innovative tools to detect subtle early disease manifestations and disease fluctuations for the purpose of clinical diagnosis, care and therapeutic development. Huntington's disease (HD) has a unique combination of motor and non-motor features which, combined with recent and anticipated therapeutic progress, gives great potential for such devices to prove useful. The present work aims to provide a comprehensive account of the use of wearable/portable devices in HD and of what they have contributed so far. We conducted a systematic review searching MEDLINE, Embase, and IEEE Xplore. Thirty references were identified. Our results revealed large variability in the types of sensors used, study design, and the measured outcomes. Digital technologies show considerable promise for therapeutic research and clinical management of HD. However, more studies with standardized devices and harmonized protocols are needed to optimize the potential applicability of wearable/portable devices in HD. Wearable/portable sensors have been proposed to detect and quantify manifestations of many neurodegenerative diseases. No systematic review so far has examined their use in Huntington's disease (HD). This work draws a broad picture of the digital wearable-based landscape in HD. The utility of wearables in clinical practice and therapeutic research still needs to be proved. Collaborative efforts are needed to further investigate their clinical use in HD.
Collapse
Affiliation(s)
- Rosanna Tortelli
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Filipe B Rodrigues
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Edward J Wild
- UCL Huntington's Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, UK.
| |
Collapse
|
20
|
Celik Y, Stuart S, Woo WL, Godfrey A. Gait analysis in neurological populations: Progression in the use of wearables. Med Eng Phys 2020; 87:9-29. [PMID: 33461679 DOI: 10.1016/j.medengphy.2020.11.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
Gait assessment is an essential tool for clinical applications not only to diagnose different neurological conditions but also to monitor disease progression as it contributes to the understanding of underlying deficits. There are established methods and models for data collection and interpretation of gait assessment within different pathologies. This narrative review aims to depict the evolution of gait assessment from observation and rating scales to wearable sensors and laboratory technologies and provide limitations and possible future directions in the field of gait assessment. In this context, we first present an extensive review of current clinical outcomes and gait models. Then, we demonstrate commercially available wearable technologies with their technical capabilities along with their use in gait assessment studies for various neurological conditions. In the next sections, a descriptive knowledge for existing inertial and EMG based algorithms and a sign based guide that shows the outcomes of previous neurological gait assessment studies are presented. Finally, we state a discussion for the use of wearables in gait assessment and speculate the possible research directions by revealing the limitations and knowledge gaps in the literature.
Collapse
Affiliation(s)
- Y Celik
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - S Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - W L Woo
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - A Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK.
| |
Collapse
|
21
|
Chakraborty J, Nandy A. Discrete wavelet transform based data representation in deep neural network for gait abnormality detection. Biomed Signal Process Control 2020. [DOI: 10.1016/j.bspc.2020.102076] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Wristbands Containing Accelerometers for Objective Arm Swing Analysis in Patients with Parkinson's Disease. SENSORS 2020; 20:s20154339. [PMID: 32759667 PMCID: PMC7436032 DOI: 10.3390/s20154339] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/24/2022]
Abstract
In patients with Parkinson’s disease (PD), arm swing changes are common, even in the early stages, and these changes are usually evaluated subjectively by an expert. In this article, hypothesize that arm swing changes can be detected using a low-cost, cloud-based, wearable, sensor system that incorporates triaxial accelerometers. The aim of this work is to develop a low-cost, assistive diagnostic tool for use in quantifying the arm swing kinematics of patients with PD. Ten patients with PD and 11 age-matched, healthy subjects are included in the study. Four feature extraction techniques were applied: (i) Asymmetry estimation based on root mean square (RMS) differences between arm movements; (ii) posterior–anterior phase and cycle regularity through autocorrelation; (iii) tremor energy, established using Fourier transform analysis; and (iv) signal complexity through the fractal dimension by wavelet analysis. The PD group showed significant (p < 0.05) reductions in arm swing RMS values, higher arm swing asymmetry, higher anterior–posterior phase regularities, greater “high energy frequency” signals, and higher complexity in their XZ plane signals. Therefore, the novel, portable system provides a reliable means to support clinical practice in PD assessment.
Collapse
|
23
|
Porciuncula F, Wasserman P, Marder KS, Rao AK. Quantifying Postural Control in Premanifest and Manifest Huntington Disease Using Wearable Sensors. Neurorehabil Neural Repair 2020; 34:771-783. [PMID: 32672492 DOI: 10.1177/1545968320939560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Impairments in postural control in Huntington disease (HD) have important consequences for daily functioning. This observational study systematically examined baseline postural control and the effect of sensory attenuation and sensory enhancement on postural control across the spectrum of HD. Methods. Participants (n = 39) included healthy controls and individuals in premanifest (pHD) and manifest stages (mHD) of HD. Using wearable sensors, postural control was assessed according to (1) postural set (sit vs stand), (2) sensory attenuation using clinical test of sensory integration, and (3) sensory enhancement with gaze fixation. Outcomes included sway smoothness, amplitude, and frequency. Results. Based on postural set, pHD reduced postural sway in sitting relative to standing, whereas mHD had pronounced sway in standing and sitting, highlighting a baseline postural deficit. During sensory attenuation, postural control in pHD deteriorated relative to controls when proprioceptive demands were high (eyes closed on foam), whereas mHD had significant deterioration of postural control when proprioception was attenuated (eyes open and closed on foam). Finally, gaze fixation improved sway smoothness, amplitude, and frequency in pHD; however, no benefit was observed in mHD. Conclusions. Systematic examination of postural control revealed a fundamental postural deficit in mHD, which further deteriorates when proprioception is challenged. Meanwhile, postural deficits in pHD are detectable when proprioceptive challenge is high. Sensory enhancing strategies using gaze fixation to benefit posture may be useful when introduced well before motor diagnosis. These findings encourage further examination of wearable sensors as part of routine clinical assessments in HD.
Collapse
Affiliation(s)
- Franchino Porciuncula
- Paulson School of Engineering and Applied Sciences and Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, USA
| | - Paula Wasserman
- G.H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Karen S Marder
- G.H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Neurology, Psychiatry, G.H. Sergievsky Center and Taub Institute for Research on Alzheimer's Disease and the Aging Brain; Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ashwini K Rao
- G.H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Rehabilitation and Regenerative Medicine (Program in Physical Therapy), G.H. Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
24
|
Fifteen Years of Wireless Sensors for Balance Assessment in Neurological Disorders. SENSORS 2020; 20:s20113247. [PMID: 32517315 PMCID: PMC7308812 DOI: 10.3390/s20113247] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined.
Collapse
|
25
|
Trisno R, Nair P, Martin D, Baghini MS, Chung H, Pendharkar G, Kulkarni J. Using accelerometer as a diagnostic tool to detect drug-induced parkinsonism (DIP) secondary to first-generation anti-psychotic medications. Australas Psychiatry 2020; 28:348-353. [PMID: 32093499 DOI: 10.1177/1039856220901467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study is to examine the effectiveness of an accelerometer-based compact system in detecting and quantifying drug-induced parkinsonism (DIP) in patients with schizophrenia. METHOD A pilot study controlled clinical trial comprising 6 people with schizophrenia and 11 control subjects was conducted at Alfred Health, Melbourne. Participants had their movements assessed using Barnes Akathisia Rating Scale (BARS), Simpson Angus Scale (SAS) and Movement Disorder Society Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III) followed by an assessment of gait using three triaxial accelerometers. RESULTS Median BARS, SAS, MDS-UPDRS III and accelerometer scores were significantly higher for patients with schizophrenia than controls. Accelerometers detected three times more rest tremor than clinical rating scales. Patients with schizophrenia had 70% of their dynamic acceleration at frequencies between 4 and 10 Hz, which is almost twice that observed in the control population (38%). Accelerometer scores were significantly correlated with BARS scores. CONCLUSION Accelerometers were able to accurately detect patients with DIP better than some clinical rating scale including the SAS. Further larger-scale studies must be conducted to further demonstrate the accuracy of accelerometers in detecting DIP.
Collapse
Affiliation(s)
- Roth Trisno
- Monash Alfred Psychiatry Research Centre (MAPrc), Australia; School of Medicine, Deakin University, Australia; and Department of Psychiatry, Barwon Health, Australia
| | - Parvathy Nair
- Department of Electrical and Computer Systems Engineering, Monash University, Australia; Department of Electrical Engineering, India Institute of Technology Bombay, India
| | - Daniel Martin
- Department of Electrical and Computer Systems Engineering, Monash University, Australia
| | - Maryam S Baghini
- Department of Electrical Engineering, India Institute of Technology Bombay, India
| | - Hoam Chung
- Department of Electrical and Computer Systems Engineering, Monash University, Australia
| | - Gita Pendharkar
- Department of Electrical and Computer Systems Engineering, Monash University, Australia
| | | |
Collapse
|
26
|
Kobsar D, Charlton JM, Tse CTF, Esculier JF, Graffos A, Krowchuk NM, Thatcher D, Hunt MA. Validity and reliability of wearable inertial sensors in healthy adult walking: a systematic review and meta-analysis. J Neuroeng Rehabil 2020; 17:62. [PMID: 32393301 PMCID: PMC7216606 DOI: 10.1186/s12984-020-00685-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 04/07/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Inertial measurement units (IMUs) offer the ability to measure walking gait through a variety of biomechanical outcomes (e.g., spatiotemporal, kinematics, other). Although many studies have assessed their validity and reliability, there remains no quantitive summary of this vast body of literature. Therefore, we aimed to conduct a systematic review and meta-analysis to determine the i) concurrent validity and ii) test-retest reliability of IMUs for measuring biomechanical gait outcomes during level walking in healthy adults. METHODS Five electronic databases were searched for journal articles assessing the validity or reliability of IMUs during healthy adult walking. Two reviewers screened titles, abstracts, and full texts for studies to be included, before two reviewers examined the methodological quality of all included studies. When sufficient data were present for a given biomechanical outcome, data were meta-analyzed on Pearson correlation coefficients (r) or intraclass correlation coefficients (ICC) for validity and reliability, respectively. Alternatively, qualitative summaries of outcomes were conducted on those that could not be meta-analyzed. RESULTS A total of 82 articles, assessing the validity or reliability of over 100 outcomes, were included in this review. Seventeen biomechanical outcomes, primarily spatiotemporal parameters, were meta-analyzed. The validity and reliability of step and stride times were found to be excellent. Similarly, the validity and reliability of step and stride length, as well as swing and stance time, were found to be good to excellent. Alternatively, spatiotemporal parameter variability and symmetry displayed poor to moderate validity and reliability. IMUs were also found to display moderate reliability for the assessment of local dynamic stability during walking. The remaining biomechanical outcomes were qualitatively summarized to provide a variety of recommendations for future IMU research. CONCLUSIONS The findings of this review demonstrate the excellent validity and reliability of IMUs for mean spatiotemporal parameters during walking, but caution the use of spatiotemporal variability and symmetry metrics without strict protocol. Further, this work tentatively supports the use of IMUs for joint angle measurement and other biomechanical outcomes such as stability, regularity, and segmental accelerations. Unfortunately, the strength of these recommendations are limited based on the lack of high-quality studies for each outcome, with underpowered and/or unjustified sample sizes (sample size median 12; range: 2-95) being the primary limitation.
Collapse
Affiliation(s)
- Dylan Kobsar
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada.,Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Jesse M Charlton
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Calvin T F Tse
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Francois Esculier
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,The Running Clinic, Lac Beauport, QC, Canada
| | - Angelo Graffos
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Natasha M Krowchuk
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Thatcher
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
27
|
Gaßner H, Jensen D, Marxreiter F, Kletsch A, Bohlen S, Schubert R, Muratori LM, Eskofier B, Klucken J, Winkler J, Reilmann R, Kohl Z. Gait variability as digital biomarker of disease severity in Huntington's disease. J Neurol 2020; 267:1594-1601. [PMID: 32048014 PMCID: PMC7293689 DOI: 10.1007/s00415-020-09725-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/20/2020] [Accepted: 01/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Impaired gait plays an important role for quality of life in patients with Huntington's disease (HD). Measuring objective gait parameters in HD might provide an unbiased assessment of motor deficits in order to determine potential beneficial effects of future treatments. OBJECTIVE To objectively identify characteristic features of gait in HD patients using sensor-based gait analysis. Particularly, gait parameters were correlated to the Unified Huntington's Disease Rating Scale, total motor score (TMS), and total functional capacity (TFC). METHODS Patients with manifest HD at two German sites (n = 43) were included and clinically assessed during their annual ENROLL-HD visit. In addition, patients with HD and a cohort of age- and gender-matched controls performed a defined gait test (4 × 10 m walk). Gait patterns were recorded by inertial sensors attached to both shoes. Machine learning algorithms were applied to calculate spatio-temporal gait parameters and gait variability expressed as coefficient of variance (CV). RESULTS Stride length (- 15%) and gait velocity (- 19%) were reduced, while stride (+ 7%) and stance time (+ 2%) were increased in patients with HD. However, parameters reflecting gait variability were substantially altered in HD patients (+ 17% stride length CV up to + 41% stride time CV with largest effect size) and showed strong correlations to TMS and TFC (0.416 ≤ rSp ≤ 0.690). Objective gait variability parameters correlated with disease stage based upon TFC. CONCLUSIONS Sensor-based gait variability parameters were identified as clinically most relevant digital biomarker for gait impairment in HD. Altered gait variability represents characteristic irregularity of gait in HD and reflects disease severity.
Collapse
Affiliation(s)
- Heiko Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Dennis Jensen
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - F Marxreiter
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Anja Kletsch
- George-Huntington Institute (GHI) GmbH, Münster, Germany
| | - Stefan Bohlen
- George-Huntington Institute (GHI) GmbH, Münster, Germany
| | - Robin Schubert
- George-Huntington Institute (GHI) GmbH, Münster, Germany
| | - Lisa M Muratori
- George-Huntington Institute (GHI) GmbH, Münster, Germany
- Rehabilitation Research and Movement Performance Laboratory (RRAMP Lab), Stony Brook University, Stony Brook, NY, USA
| | - Bjoern Eskofier
- Machine Learning and Data Analytics Lab, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
- Medical Valley-Digital Health Application Center GmbH, Bamberg, Germany
- Fraunhofer Institute for Integrated Circuits IIS, Erlangen, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Ralf Reilmann
- George-Huntington Institute (GHI) GmbH, Münster, Germany
- Department of Radiology, University of Muenster, Muenster, Germany
- Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | - Zacharias Kohl
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
- Center for Rare Diseases Erlangen, University Hospital Erlangen, Erlangen, Germany.
- Department of Neurology, University of Regensburg, Regensburg, Germany.
| |
Collapse
|
28
|
Leirós-Rodríguez R, García-Soidán JL, Romo-Pérez V. Analyzing the Use of Accelerometers as a Method of Early Diagnosis of Alterations in Balance in Elderly People: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2019; 19:E3883. [PMID: 31505828 PMCID: PMC6767154 DOI: 10.3390/s19183883] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022]
Abstract
Alterations of balance are a growing public health problem as they affect one in three adults over the age of 65, and one in two over the age of 80. Identifying the factors that affect postural stability is essential in designing specific interventions to maintain the independence and mobility of older people. The aim of this review was to understand the use of accelerometers in order to assess the balance in older people. Analyzing the most appropriate evaluation methodology and protocolizing it will optimize the processes of early identification of balance alterations. However, quantitative assessment methods of balance are usually limited to a laboratory environment, a factor that can be overcome by accelerometers. A systematic search was carried out across eight databases where accelerometers were employed to assess balance in older people. Articles were excluded if they focused on sensor design and did not measure balance or apply the technology on targeted participants. A total of 19 articles were included for full-text analysis, where participants took part in the balance evaluation monitored by accelerometers. The analysis of spatio-temporal parameters and the magnitude of the accelerations recorded by the devices were the most common study variables. Accelerometer usage has potential to positively influence interventions based on physical exercise to improve balance and prevent falls in older people.
Collapse
Affiliation(s)
- Raquel Leirós-Rodríguez
- Faculty of Physical Therapy, University of Vigo; Campus a Xunqueira, s/n, 36156 Pontevedra, Spain.
| | - Jose L García-Soidán
- Faculty of Education and Sport Sciences, University of Vigo; Campus a Xunqueira, s/n, 36156 Pontevedra, Spain.
| | - Vicente Romo-Pérez
- Faculty of Education and Sport Sciences, University of Vigo; Campus a Xunqueira, s/n, 36156 Pontevedra, Spain.
| |
Collapse
|
29
|
Reynard F, Christe D, Terrier P. Postural control in healthy adults: Determinants of trunk sway assessed with a chest-worn accelerometer in 12 quiet standing tasks. PLoS One 2019; 14:e0211051. [PMID: 30673753 PMCID: PMC6344019 DOI: 10.1371/journal.pone.0211051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/07/2019] [Indexed: 11/19/2022] Open
Abstract
Many diseases and conditions decrease the ability to control balance. In clinical settings, there is therefore a major interest in the assessment of postural control. Trunk accelerometry is an easy, low-cost method used for balance testing and constitutes an alternative method to the posturography using force platforms. The objective was to assess the responsiveness of accelerometry in a battery of 12 quiet standing tasks. We evaluated the balance of 100 healthy adults with an accelerometer fixed onto the sternum. We used the average amplitude of acceleration as an indirect measure of postural sways. The tasks of increased difficulty were realized with or without vision. The battery of tasks was repeated four times on two different days to assess reliability. We analyzed the extent to which the task difficulty and the absence of vision affected the trunk sway. The influence of individual characteristics (age, height, mass, sex, and physical activity level) was also assessed. The reliability analysis revealed that four repetitions of the battery of tasks are needed to reach a high accuracy level (mean ICC = 0.85). The results showed that task difficulty had a very large effect on trunk sways and that the removal of vision further increased sways. Concerning the effects of individual characteristics, we observed that women tended to oscillate more than men did in tasks of low difficulty. Age and physical activity level also had significant effects, whereas height and mass did not. In conclusion, age, sex, and physical fitness are confounders that should be considered when assessing patients’ balance. A battery of simple postural tasks measured by upper-trunk accelerometry can be a useful method for simple balance evaluation in clinical settings.
Collapse
Affiliation(s)
| | - David Christe
- Swiss federal institute of technology, Lausanne, Switzerland
| | | |
Collapse
|
30
|
Testa CM, Jankovic J. Huntington disease: A quarter century of progress since the gene discovery. J Neurol Sci 2019; 396:52-68. [DOI: 10.1016/j.jns.2018.09.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 01/21/2023]
|
31
|
Mobbs RJ, Katsinas CJ, Choy WJ, Rooke K, Maharaj M. Objective monitoring of activity and Gait Velocity using wearable accelerometer following lumbar microdiscectomy to detect recurrent disc herniation. JOURNAL OF SPINE SURGERY 2018; 4:792-797. [PMID: 30714012 DOI: 10.21037/jss.2018.12.02] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
We report a case of a 39-year-old male with sciatica who underwent an L5/S1 microdiscectomy with objective physical activity measurements performed preoperatively and continually postoperatively up to 3-month using wireless accelerometer technology linked to the surgical practice; collecting distance travelled, daily step count (DSC) and Gait Velocity (GV). Preoperative, the patient was walking with a GV of 0.97 m/s and a DSC of less than 2,500. After the first month following surgery, the patient had increased mobility, with a GV of 1.58 m/s, and taking an average of over 4,500 steps per day. At day 57 postop, the patient experienced a recurrence of pain with reduction of GV, DSC and walking distance. Magnetic resonance imaging (MRI) was performed and revealed a recurrent disc herniation with further surgery on day 63, with a rapid return of function post 2nd surgery. The use of wireless accelerometers is practical in obtaining objective physical activity measurements before and after lumbar microdiscectomy, and will assist the surgeon and rehabilitation provider to monitor outcomes, complications and assist in clinical decision making.
Collapse
Affiliation(s)
- Ralph J Mobbs
- University of New South Wales, Sydney, Australia.,NeuroSpineClinic, Prince of Wales Private Hospital, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Department of Spine Surgery, Prince of Wales Hospital, Sydney, Australia
| | - Christopher J Katsinas
- University of New South Wales, Sydney, Australia.,NeuroSpineClinic, Prince of Wales Private Hospital, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Wen Jie Choy
- University of New South Wales, Sydney, Australia.,NeuroSpineClinic, Prince of Wales Private Hospital, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Kaitlin Rooke
- NeuroSpineClinic, Prince of Wales Private Hospital, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Monish Maharaj
- University of New South Wales, Sydney, Australia.,NeuroSpineClinic, Prince of Wales Private Hospital, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| |
Collapse
|
32
|
Computerised Dynamic Posturography in Premanifest and Manifest individuals with Huntington's Disease. Sci Rep 2018; 8:14615. [PMID: 30279429 PMCID: PMC6168504 DOI: 10.1038/s41598-018-32924-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/18/2018] [Indexed: 11/25/2022] Open
Abstract
Evidence from small-scale studies indicates that impairments in postural stability are an early and disabling feature of Huntington’s disease (HD) and may be a useful clinical endpoint for disease modifying trials. Larger studies are needed to confirm these preliminary findings and the suitability of postural stability outcomes as clinical endpoints. Static and dynamic postural stability were evaluated in 54 premanifest HD, 36 manifest HD and 45 healthy individuals using the Sensory Organization Test (SOT) and Limits of Stability (LOS) test. Manifest HD displayed significantly lower scores on all SOT conditions and on the SOT composite score and had more falls than healthy and premanifest HD (p < 0.05). Premanifest and manifest HD demonstrated significantly lower endpoint excursion (p < 0.001), maximum excursion (p ≤ 0.001), and directional control (p ≤ 0.004) values than healthy individuals on the LOS test. Deficits in LOS were found to manifest on the left side of premanifest HD. Significant but low associations were observed between UHDRS-TMS, disease burden score, diagnostic confidence level, SOT conditions and SOT composite score. We confirm here that individuals with premanifest and manifest HD display significant impairments in static and dynamic postural stability. Dynamic posturography assessments should be considered as clinical endpoints for future disease modifying trials.
Collapse
|
33
|
Hu B, Kim C, Ning X, Xu X. Using a deep learning network to recognise low back pain in static standing. ERGONOMICS 2018; 61:1374-1381. [PMID: 29792576 DOI: 10.1080/00140139.2018.1481230] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 05/11/2018] [Indexed: 06/08/2023]
Abstract
Low back pain (LBP) remains one of the most prevalent musculoskeletal disorders, while algorithms that able to recognise LBP patients from healthy population using balance performance data are rarely seen. In this study, human balance and body sway performance during standing trials were utilised to recognise chronic LBP populations using deep neural networks. To be specific, 44 chronic LBP and healthy individuals performed static standing tasks, while their spine kinematics and centre of pressure were recorded. A deep learning network with long short-term memory units was used for training, prediction and implementation. The performance of the model was evaluated by: (a) overall accuracy, (b) precision, (c) recall, (d) F1 measure, (e) receiver-operating characteristic and (f) area under the curve. Results indicated that deep neural networks could recognise LBP populations with precision up to 97.2% and recall up to 97.2%. Meanwhile, the results showed that the model with the C7 sensor output performed the best. Practitioner summary: Low back pain (LBP) remains the most common musculoskeletal disorder. In this study, we investigated the feasibility of applying artificial intelligent deep neural network in detecting LBP population from healthy controls with their kinematics data. Results showed a deep learning network can solve the above classification problem with both promising precision and recall performance.
Collapse
Affiliation(s)
- Boyi Hu
- a Department of Environmental Health , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Chong Kim
- b Department of Neurosurgery - Pain Division, School of Medicine , West Virginia University , Morgantown , WV , USA
| | - Xiaopeng Ning
- c The Ergonomics Laboratory, Department of Industrial and Management Systems Engineering , West Virginia University , Morgantown , WV , USA
| | - Xu Xu
- d Edward P. Fitts Department of Industrial and Systems Engineering , North Carolina State University , Raleigh , NC , USA
| |
Collapse
|
34
|
Clinch SP, Busse M, Lelos MJ, Rosser AE. Rethinking Functional Outcome Measures: The Development of a Novel Upper Limb Token Transfer Test to Assess Basal Ganglia Dysfunction. Front Neurosci 2018; 12:366. [PMID: 29899687 PMCID: PMC5988893 DOI: 10.3389/fnins.2018.00366] [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] [Received: 12/06/2017] [Accepted: 05/11/2018] [Indexed: 01/27/2023] Open
Abstract
The basal ganglia are implicated in a wide range of motor, cognitive and behavioral activities required for normal function. This region is predominantly affected in Huntington's disease (HD), meaning that functional ability progressively worsens. However, functional outcome measures for HD, particularly those for the upper limb, are limited meaning there is an imperative for well-defined, quantitative measures. Here we describe the development and evaluation of the Moneybox test (MBT). This novel, functional upper limb assessment was developed in accordance with translational neuroscience and physiological principles for people with a broad disease manifestation, such as HD. Participants with HD (n = 64) and healthy controls (n = 21) performed the MBT, which required subjects to transfer tokens into a container in order of size (Baseline Transfer), value (Complex Transfer) with and without reciting the alphabet (Dual Transfer). Disease specific measures of motor, cognition, behavior, and function were collected. HD patients were grouped into disease stage, from which, discriminative and convergent validity was assessed using Analysis of Variance and Pearson's correlation respectively. Manifest HD participants were slower than pre-manifest and control participants, and achieved significantly lower MBT total scores. Performance in the Complex Transfer and Dual Transfer tasks were significantly different between pre-manifest and stage 1 HD. All MBT performance variables significantly correlated with routinely used measures of motor, cognition, behavior, and function. The MBT provides a valid, sensitive, and affordable functional outcome measure. Unlike current assessments, MBT performance significantly distinguished the subtle differences between the earliest disease stages of HD, which are the populations typically targeted in clinical trials.
Collapse
Affiliation(s)
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Mariah J. Lelos
- School of Biosciences, Cardiff University, Cardiff, United Kingdom
| | - Anne E. Rosser
- School of Biosciences, Cardiff University, Cardiff, United Kingdom
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|
35
|
Jarchi D, Pope J, Lee TKM, Tamjidi L, Mirzaei A, Sanei S. A Review on Accelerometry-Based Gait Analysis and Emerging Clinical Applications. IEEE Rev Biomed Eng 2018; 11:177-194. [PMID: 29994786 DOI: 10.1109/rbme.2018.2807182] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gait analysis continues to be an important technique for many clinical applications to diagnose and monitor certain diseases. Many mental and physical abnormalities cause measurable differences in a person's gait. Gait analysis has applications in sport, computer games, physical rehabilitation, clinical assessment, surveillance, human recognition, modeling, and many other fields. There are established methods using various sensors for gait analysis, of which accelerometers are one of the most often employed. Accelerometer sensors are generally more user friendly and less invasive. In this paper, we review research regarding accelerometer sensors used for gait analysis with particular focus on clinical applications. We provide a brief introduction to accelerometer theory followed by other popular sensing technologies. Commonly used gait phases and parameters are enumerated. The details of selecting the papers for review are provided. We also review several gait analysis software. Then we provide an extensive report of accelerometry-based gait analysis systems and applications, with additional emphasis on trunk accelerometry. We conclude this review with future research directions.
Collapse
|
36
|
Buckley E, Mazzà C, McNeill A. A systematic review of the gait characteristics associated with Cerebellar Ataxia. Gait Posture 2018; 60:154-163. [PMID: 29220753 DOI: 10.1016/j.gaitpost.2017.11.024] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/07/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cerebellar Ataxias are a group of gait disorders resulting from dysfunction of the cerebellum, commonly characterised by slowly progressing incoordination that manifests as problems with balance and walking leading to considerable disability. There is increasing acceptance of gait analysis techniques to quantify subtle gait characteristics that are unmeasurable by current clinical methods This systematic review aims to identify the gait characteristics able to differentiate between Cerebellar Ataxia and healthy controls. METHODS Following systematic search and critical appraisal of the literature, gait data relating to preferred paced walking in Cerebellar Ataxia was extracted from 21 studies. A random-effect model meta-analysis was performed for 14 spatiotemporal parameters. Quality assessment was completed to detect risk of bias. RESULTS There is strong evidence that compared with healthy controls, Cerebellar Ataxia patients walk with a reduced walking speed and cadence, reduced step length, stride length, and swing phase, increased walking base width, stride time, step time, stance phase and double limb support phase with increased variability of step length, stride length, and stride time. CONCLUSION The consensus description provided here, clarifies the gait pattern associated with ataxic gait disturbance in a large cohort of participants. High quality research and reporting is needed to explore specific genetic diagnoses and identify biomarkers for disease progression in order to develop well-evidenced clinical guidelines and interventions for Cerebellar Ataxia.
Collapse
Affiliation(s)
- Ellen Buckley
- Department of Neuroscience, University of Sheffield, UK.
| | - Claudia Mazzà
- Department of Mechanical Engineering, University of Sheffield, UK; INSIGNEO Institute for In Silico Medicine, University of Sheffield, UK.
| | - Alisdair McNeill
- Department of Neuroscience, University of Sheffield, UK; INSIGNEO Institute for In Silico Medicine, University of Sheffield, UK; Sheffield Children's Hospital, UK.
| |
Collapse
|
37
|
Avila-Luna A, Gálvez-Rosas A, Durand-Rivera A, Ramos-Languren LE, Ríos C, Arias-Montaño JA, Bueno-Nava A. Dopamine D 1 receptor activation maintains motor coordination and balance in rats. Metab Brain Dis 2018; 33:99-105. [PMID: 29052075 DOI: 10.1007/s11011-017-0126-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 10/09/2017] [Indexed: 10/18/2022]
Abstract
Dopamine (DA) modulates motor coordination, and its depletion, as in Parkinson's disease, produces motor impairment. The basal ganglia, cerebellum and cerebral cortex are interconnected, have functional roles in motor coordination, and possess dopamine D1 receptors (D1Rs), which are expressed at a particularly high density in the basal ganglia. In this study, we examined whether the activation of D1Rs modulates motor coordination and balance in the rat using a beam-walking test that has previously been used to detect motor coordination deficits. The systemic administration of the D1R agonist SKF-38393 at 2, 3, or 4 mg/kg did not alter the beam-walking scores, but the subsequent administration of the D1R antagonist SCH-23390 at 1 mg/kg did produce deficits in motor coordination, which were reversed by the full agonist SKF-82958. The co-administration of SKF-38393 and SCH-23390 did not alter the beam-walking scores compared with the control group, but significantly prevented the increase in beam-walking scores induced by SCH-23390. The effect of the D1R agonist to prevent and reverse the effect of the D1R antagonist in beam-walking scores is an indicator that the function of D1Rs is necessary to maintain motor coordination and balance in rats. Our results support that D1Rs mediate the SCH-23390-induced deficit in motor coordination.
Collapse
Affiliation(s)
- Alberto Avila-Luna
- División de Neurociencias, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, SSa, Calz México-Xochimilco 289, 14389, Ciudad de México, Mexico
| | - Arturo Gálvez-Rosas
- División de Neurociencias, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, SSa, Calz México-Xochimilco 289, 14389, Ciudad de México, Mexico
| | - Alfredo Durand-Rivera
- División de Neurociencias, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, SSa, Calz México-Xochimilco 289, 14389, Ciudad de México, Mexico
| | - Laura-Elisa Ramos-Languren
- Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, SSa, Insurgentes Sur 3877, 14269, Ciudad de México, Mexico
| | - Camilo Ríos
- Departamento de Neuroquímica, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, SSa, Insurgentes Sur 3877, 14269, Ciudad de México, Mexico
| | - José-Antonio Arias-Montaño
- Departamento de Fisiología, Biofísica y Neurociencias, Centro de Investigación y de Estudios Avanzados del IPN, Av. IPN 2508, 07360, Ciudad de México, Mexico
| | - Antonio Bueno-Nava
- División de Neurociencias, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, SSa, Calz México-Xochimilco 289, 14389, Ciudad de México, Mexico.
| |
Collapse
|
38
|
Macridis S, Johnston N, Johnson S, Vallance JK. Consumer physical activity tracking device ownership and use among a population-based sample of adults. PLoS One 2018; 13:e0189298. [PMID: 29293532 PMCID: PMC5749689 DOI: 10.1371/journal.pone.0189298] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 11/23/2017] [Indexed: 01/18/2023] Open
Abstract
Consumer physical activity tracking devices (PATs) have gained popularity to support individuals to be more active and less sedentary throughout the day. Wearable PATs provide real-time feedback of various fitness-related metrics such as tracking steps, sedentary time, and distance walked. The purpose of this study was to examine the prevalence and correlates of PAT ownership and use among a population-based sample of adults. A representative sample of adults ≥18 years (N = 1,215) from Alberta, Canada were recruited through random-digit dialing and responded to a questionnaire via computer-assisted telephone interviewing methods in summer 2016. Questionnaires assessed demographic and health behaviour variables, and items were designed to assess PAT ownership and usage. Logistic regression analysis (odds ratios) was used to assess correlates of PAT ownership and use. On average, participants (N = 1,215) were 53.9 (SD 16.7) years and 50.1% were female. Of the sample, 19.6% (n = 238) indicated they currently own and use a PAT. Participants who owned a PAT wore their device on average 23.2 days within the past month. Currently owning a PAT was significantly associated with being female (OR = 1.41, CI: 1.10 to 1.82), being <60 years of age (OR = 1.86, CI: 1.37 to 2.53), having at least some post secondary education (OR = 1.88, CI: 1.36 to 2.60), having a BMI ≥25 (OR = 1.52, CI: 1.16 to 1.99), and meeting physical activity guidelines (OR = 1.45, CI: 1.12 to 1.88). Similar correlates emerged for PAT use. Correlates significantly associated with PAT use and ownership included being female, being less than 60 years of age, having a post-secondary education, meeting physical activity guidelines, and being overweight/obese. This is the first study to examine characteristics of PAT ownership and use among Canadian adults.
Collapse
Affiliation(s)
- Soultana Macridis
- Alberta Centre for Active Living, Edmonton, Alberta, Canada
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - Nora Johnston
- Alberta Centre for Active Living, Edmonton, Alberta, Canada
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - Steven Johnson
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| | - Jeff K. Vallance
- Faculty of Health Disciplines, Athabasca University, Athabasca, Canada
| |
Collapse
|
39
|
Vuong K, Canning CG, Menant JC, Loy CT. Gait, balance, and falls in Huntington disease. HANDBOOK OF CLINICAL NEUROLOGY 2018; 159:251-260. [PMID: 30482318 DOI: 10.1016/b978-0-444-63916-5.00016-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Huntington disease (HD) is an autosomal-dominant, progressive, neurodegenerative disorder, characterized by involuntary movements and other motor impairments, cognitive/behavioral symptoms, and psychiatric disorders. Gait and balance impairments and falls greatly impact on the quality of life among people with HD, and being fall-prone is one of the strongest predictors of nursing-home placement. Gait impairment in HD is characterized by bradykinesia, reduced velocity, and increased variability in spatiotemporal features. Detrimental changes in symmetry, step length, stride time, balance measures, gait adaptability (external cues, dual tasking), and hypo/hyperkinesia have also been observed. Balance impairment is characterized by impairments of anticipatory balance without a change in base of support, anticipatory balance with a change in base of support, and reactive balance. In addition to gait and balance impairment, people with HD have a range of intrinsic and extrinsic factors that increase fall risk, including reduced cognitive reserve for dual tasking. Currently there is some evidence to suggest exercise interventions can address some HD-specific gait and balance deficits. However, no intervention studies to date have specifically targeted falls. Large, well-designed, randomized controlled trials are needed to guide future fall prevention interventions in people with HD.
Collapse
Affiliation(s)
- Kenny Vuong
- St. Joseph's Hospital, Auburn, Sydney, Australia
| | - Colleen G Canning
- Faculty of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Jasmine C Menant
- Neuroscience Research Australia, Randwick, Sydney, NSW, Australia
| | - Clement T Loy
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
40
|
Kobsar D, Osis ST, Boyd JE, Hettinga BA, Ferber R. Wearable sensors to predict improvement following an exercise intervention in patients with knee osteoarthritis. J Neuroeng Rehabil 2017; 14:94. [PMID: 28899433 PMCID: PMC5596963 DOI: 10.1186/s12984-017-0309-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 09/07/2017] [Indexed: 01/09/2023] Open
Abstract
Background Muscle strengthening exercises consistently demonstrate improvements in the pain and function of adults with knee osteoarthritis, but individual response rates can vary greatly. Identifying individuals who are more likely to respond is important in developing more efficient rehabilitation programs for knee osteoarthritis. Therefore, the purpose of this study was to determine if pre-intervention multi-sensor accelerometer data (e.g., back, thigh, shank, foot accelerometers) and patient reported outcome measures (e.g., pain, symptoms, function, quality of life) can retrospectively predict post-intervention response to a 6-week hip strengthening exercise intervention in a knee OA cohort. Methods Thirty-nine adults with knee osteoarthritis completed a 6-week hip strengthening exercise intervention and were sub-grouped as Non-Responders, Low-Responders, or High-Responders following the intervention based on their change in patient reported outcome measures. Pre-intervention multi-sensor accelerometer data recorded at the back, thigh, shank, and foot and Knee Injury and Osteoarthritis Outcome Score subscale data were used as potential predictors of response in a discriminant analysis of principal components. Results The thigh was the single best placement for classifying responder sub-groups (74.4%). Overall, the best combination of sensors was the back, thigh, and shank (81.7%), but a simplified two sensor solution using the back and thigh was not significantly different (80.0%; p = 0.27). Conclusions While three sensors were best able to identify responders, a simplified two sensor array at the back and thigh may be the most ideal configuration to provide clinicians with an efficient and relatively unobtrusive way to use to optimize treatment. Electronic supplementary material The online version of this article (10.1186/s12984-017-0309-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Dylan Kobsar
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.
| | - Sean T Osis
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,Running Injury Clinic, Calgary, AB, Canada
| | - Jeffrey E Boyd
- Department of Computer Science, University of Calgary, Calgary, AB, Canada
| | - Blayne A Hettinga
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Reed Ferber
- Faculty of Kinesiology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada.,Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Running Injury Clinic, Calgary, AB, Canada
| |
Collapse
|
41
|
Kegelmeyer DA, Kostyk SK, Fritz NE, Fiumedora MM, Chaudhari A, Palettas M, Young G, Kloos AD. Quantitative biomechanical assessment of trunk control in Huntington's disease reveals more impairment in static than dynamic tasks. J Neurol Sci 2017; 376:29-34. [PMID: 28431622 DOI: 10.1016/j.jns.2017.02.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 02/03/2017] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
Abstract
Postural instability is common in individuals with Huntington's disease (HD), yet little is known about control of the trunk during static and dynamic activities. We compared the trunk motion of 41 individuals with HD and 36 controls at thoracic and pelvic levels during sitting, standing, and walking using wearable iPod sensors. We also examined the ability of individuals with HD to respond to an auditory cue to modify trunk position when the pelvis moved >8° in sagittal or frontal planes during sitting using custom software. We found that amplitude of thoracic and pelvic trunk movements was significantly greater in participants with HD, and differences were more pronounced during static (i.e. sitting, standing) than dynamic (i.e. walking) tasks. In contrast to the slow, smooth sinusoidal trunk movements of controls, individuals with HD demonstrated rapid movements with varying amplitudes that continuously increased without stabilizing. Ninety-seven percent of participants with HD were able to modify their trunk position in response to auditory cues. Our results demonstrate that wearable iPod sensors are clinically useful for rehabilitation professionals to measure and monitor trunk stability in persons with HD. Additionally, auditory cueing holds potential as a useful training tool to improve trunk stability in HD.
Collapse
Affiliation(s)
- Deb A Kegelmeyer
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, 453 West 10th Ave, Columbus, OH 43210, United States.
| | - Sandra K Kostyk
- Movement Disorders Division, Department of Neurology, The Ohio State University, Columbus, OH, United States.
| | - Nora E Fritz
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, 453 West 10th Ave, Columbus, OH 43210, United States.
| | - Marianne M Fiumedora
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, 453 West 10th Ave, Columbus, OH 43210, United States.
| | - Ajit Chaudhari
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, 453 West 10th Ave, Columbus, OH 43210, United States.
| | - Marilly Palettas
- Center for Biostatistics, The Ohio State University, Columbus, OH, United States.
| | - Gregory Young
- Center for Biostatistics, The Ohio State University, Columbus, OH, United States.
| | - Anne D Kloos
- Physical Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University, 453 West 10th Ave, Columbus, OH 43210, United States.
| |
Collapse
|
42
|
Micó-Amigo ME, Kingma I, Ainsworth E, Walgaard S, Niessen M, van Lummel RC, van Dieën JH. A novel accelerometry-based algorithm for the detection of step durations over short episodes of gait in healthy elderly. J Neuroeng Rehabil 2016; 13:38. [PMID: 27093956 PMCID: PMC4837611 DOI: 10.1186/s12984-016-0145-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 04/03/2016] [Indexed: 11/17/2022] Open
Abstract
Background The assessment of short episodes of gait is clinically relevant and easily implemented, especially given limited space and time requirements. BFS (body-fixed-sensors) are small, lightweight and easy to wear sensors, which allow the assessment of gait at relative low cost and with low interference. Thus, the assessment with BFS of short episodes of gait, extracted from dailylife physical activity or measured in a standardised and supervised setting, may add value in the study of gait quality of the elderly. The aim of this study was to evaluate the accuracy of a novel algorithm based on acceleration signals recorded at different human locations (lower back and heels) for the detection of step durations over short episodes of gait in healthy elderly subjects. Methods Twenty healthy elderly subjects (73.7 ± 7.9 years old) walked twice a distance of 5 m, wearing a BFS on the lower back, and on the outside of each heel. Moreover, an optoelectronic three-dimensional (3D) motion tracking system was used to detect step durations. A novel algorithm is presented for the detection of step durations from low-back and heel acceleration signals separately. The accuracy of the algorithm was assessed by comparing absolute differences in step duration between the three methods: step detection from the optoelectronic 3D motion tracking system, step detection from the application of the novel algorithm to low-back accelerations, and step detection from the application of the novel algorithm to heel accelerations. Results The proposed algorithm successfully detected all the steps, without false positives and without false negatives. Absolute average differences in step duration within trials and across subjects were calculated for each comparison, between low-back accelerations and the optoelectronic system were on average 22.4 ± 7.6 ms (4.0 ± 1.3 % of average step duration), between heel accelerations and the optoelectronic system were on average 20.7 ± 11.8 ms (3.7 ± 1.9 %), and between low-back accelerations and heel accelerations were on average 27.8 ± 15.1 ms (4.9 ± 2.5 % of average step duration). Conclusions This study showed that the presented novel algorithm detects step durations over short episodes of gait in healthy elderly subjects with acceptable accuracy from low-back and heel accelerations, which provides opportunities to extract a range of gait parameters from short episodes of gait.
Collapse
Affiliation(s)
- M Encarna Micó-Amigo
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,McRoberts B. V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - Idsart Kingma
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Erik Ainsworth
- McRoberts B. V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - Stefan Walgaard
- McRoberts B. V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - Martijn Niessen
- McRoberts B. V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - Rob C van Lummel
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,McRoberts B. V., Raamweg 43, 2596 HN, The Hague, The Netherlands
| | - Jaap H van Dieën
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
43
|
Long-Term Objective Physical Activity Measurements using a Wireless Accelerometer Following Minimally Invasive Transforaminal Interbody Fusion Surgery. Asian Spine J 2016; 10:366-9. [PMID: 27114781 PMCID: PMC4843077 DOI: 10.4184/asj.2016.10.2.366] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/07/2015] [Accepted: 06/08/2015] [Indexed: 11/23/2022] Open
Abstract
We report on a case of a patient who underwent minimally invasive transforaminal lumbar interbody fusion (mi-TLIF) with objective physical activity measurements performed preoperatively and postoperatively at up to 12-months using wireless accelerometer technology. In the first postoperative month following surgery, the patient had reduced mobility, taking 2,397 steps over a distance of 1.8 km per day. However, the number of steps taken and distance travelled per day had returned to baseline levels by the second postoperative month. At one-year follow-up, the patient averaged 5,095 steps per day in the month over a distance of 3.8 km; this was a 60% improvement in both steps taken and distance travelled compared to the preoperative status. The use of wireless accelerometers is feasible in obtaining objective physical activity measurements before and after lumbar interbody fusion and may be applicable to other related spinal surgeries as well.
Collapse
|
44
|
Shin SS, An DH, Yoo WG. Effects of Balance Control Through Trunk Movement During Square and Semicircular Turns on Gait Velocity, Center of Mass Acceleration, and Energy Expenditure in Older Adults. PM R 2016; 8:953-961. [PMID: 26972362 DOI: 10.1016/j.pmrj.2016.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 02/24/2016] [Accepted: 03/02/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Turning during ambulation is a common movement in everyday life, but complex and challenging for older adults. Balance control through trunk movement provides a stable platform during walking, thus it is an essential component of safe and efficient turning during walking in elderly individuals. OBJECTIVES To investigate the effects of balance control during square turning (ST) and semicircular turning (SCT) on gait velocity, center of mass (COM) acceleration, and energy expenditure in elderly women. DESIGN Cross-sectional design. SETTING Village community center. PARTICIPANTS Twenty community-dwelling elderly women capable of independent walking were enrolled in the study. METHODS Participants walked at a self-selected speed along a marked path that included 2 types of turns (the path was divided into 3 segments: straight, turning, and straight return), while fitted with an accelerometer attached over the L3 spinous process. MAIN OUTCOME MEASUREMENTS Differences in gait velocity, normalized COM acceleration, and energy expenditure were analyzed using paired t-tests for comparisons between ST and SCT tasks and using a one-way repeated-measures analysis of variance for within tasks. RESULTS During the ST task, which was characterized by the use of a less-stable balance maintenance strategy, gait velocity and vertical COM acceleration were lower (P < .05), whereas greater medial-lateral COM acceleration (P < .05) and energy expenditure (P < .001) were observed during turning and return straight stages compared with the SCT task. For both tasks, velocity during turning stage was the slowest, among the 3 stages, the straight stage was the fastest (P < .05). For the SCT task, the anterior-posterior COM acceleration during the straight stage was significantly higher than during the turning stage, and the vertical COM acceleration during the straight stage was significantly lower than during the return-straight stage (P < .05). In both tasks, the energy expenditure of the turning stage was significantly higher than in the straight and return straight stage (P ≤ .001), and in the return straight stage was higher than the straight stage-only ST task (P < .05). CONCLUSIONS We suggest that elderly individuals participate in balance and gait training using a variety of turns, including turns requiring medial-lateral and vertical COM balance control, to prevent falls and to improve energy efficiency of walking. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Sun-Shil Shin
- Department of Rehabilitation and Science, Inje University, Gimhae, South Korea
| | - Duk-Hyun An
- Department of Physical Therapy, Inje University, Gimhae, South Korea
| | - Won-Gyu Yoo
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, 197 Inje-ro, Gimhae-si, Gyeongsangnam-do, South Korea, 621-749
| |
Collapse
|
45
|
Okuda S, Takano S, Ueno M, Hara Y, Chida Y, Ikkaku T, Kanda F, Toda T. Gait analysis of patients with Parkinson's disease using a portable triaxial accelerometer. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/ncn3.12043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shiho Okuda
- Department of Neurology Hyogo Rehabilitation Center Hospital Kobe Japan
| | - Shin Takano
- Department of Neurology Nishikobe Medical Center Kobe Japan
| | - Masao Ueno
- Department of Neurology Hyogo Rehabilitation Center Hospital Kobe Japan
| | - Yoshiaki Hara
- The Hyogo Institute of Assistive Technology Kobe Japan
| | - Yasushi Chida
- Bycen Business Incubate Center Kobe University Kobe Japan
| | - Tomoko Ikkaku
- Division of Neurology Kobe University Graduate School of Medicine Kobe Japan
| | - Fumio Kanda
- Division of Neurology Kobe University Graduate School of Medicine Kobe Japan
| | - Tatsushi Toda
- Division of Neurology Kobe University Graduate School of Medicine Kobe Japan
| |
Collapse
|
46
|
|
47
|
Mannini A, Trojaniello D, Cereatti A, Sabatini AM. A Machine Learning Framework for Gait Classification Using Inertial Sensors: Application to Elderly, Post-Stroke and Huntington's Disease Patients. SENSORS 2016; 16:s16010134. [PMID: 26805847 PMCID: PMC4732167 DOI: 10.3390/s16010134] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 01/16/2016] [Accepted: 01/18/2016] [Indexed: 11/17/2022]
Abstract
Machine learning methods have been widely used for gait assessment through the estimation of spatio-temporal parameters. As a further step, the objective of this work is to propose and validate a general probabilistic modeling approach for the classification of different pathological gaits. Specifically, the presented methodology was tested on gait data recorded on two pathological populations (Huntington’s disease and post-stroke subjects) and healthy elderly controls using data from inertial measurement units placed at shank and waist. By extracting features from group-specific Hidden Markov Models (HMMs) and signal information in time and frequency domain, a Support Vector Machines classifier (SVM) was designed and validated. The 90.5% of subjects was assigned to the right group after leave-one-subject–out cross validation and majority voting. The long-term goal we point to is the gait assessment in everyday life to early detect gait alterations.
Collapse
Affiliation(s)
- Andrea Mannini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa 56127, Italy.
| | - Diana Trojaniello
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari 07100, Italy.
| | - Andrea Cereatti
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari 07100, Italy.
| | - Angelo M Sabatini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa 56127, Italy.
| |
Collapse
|
48
|
Vilas-Boas MDC, Cunha JPS. Movement Quantification in Neurological Diseases: Methods and Applications. IEEE Rev Biomed Eng 2016; 9:15-31. [PMID: 27008673 DOI: 10.1109/rbme.2016.2543683] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
49
|
Trojaniello D, Ravaschio A, Hausdorff JM, Cereatti A. Comparative assessment of different methods for the estimation of gait temporal parameters using a single inertial sensor: application to elderly, post-stroke, Parkinson's disease and Huntington's disease subjects. Gait Posture 2015; 42:310-6. [PMID: 26163348 DOI: 10.1016/j.gaitpost.2015.06.008] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/25/2015] [Accepted: 06/16/2015] [Indexed: 02/02/2023]
Abstract
The estimation of gait temporal parameters with inertial measurement units (IMU) is a research topic of interest in clinical gait analysis. Several methods, based on the use of a single IMU mounted at waist level, have been proposed for the estimate of these parameters showing satisfactory performance when applied to the gait of healthy subjects. However, the above mentioned methods were developed and validated on healthy subjects and their applicability in pathological gait conditions was not systematically explored. We tested the three best performing methods found in a previous comparative study on data acquired from 10 older adults, 10 hemiparetic, 10 Parkinson's disease and 10 Huntington's disease subjects. An instrumented gait mat was used as gold standard. When pathological populations were analyzed, missed or extra events were found for all methods and a global decrease of their performance was observed to different extents depending on the specific group analyzed. The results revealed that none of the tested methods outperformed the others in terms of accuracy of the gait parameters determination for all the populations except the Parkinson's disease subjects group for which one of the methods performed better than others. The hemiparetic subjects group was the most critical group to analyze (stride duration errors between 4-5 % and step duration errors between 8-13 % of the actual values across methods). Only one method provides estimates of the stance and swing durations which however should be interpreted with caution in pathological populations (stance duration errors between 6-14 %, swing duration errors between 10-32 % of the actual values across populations).
Collapse
Affiliation(s)
- Diana Trojaniello
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy; Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy.
| | - Andrea Ravaschio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Jeffrey M Hausdorff
- Center for the study of Movement, Cognition and Mobility, Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel; Department of Physical Therapy, Sackler School of Medicine and Sagol School of Neuroscience, Tel Aviv University, Israel
| | - Andrea Cereatti
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy; Interuniversity Centre of Bioengineering of the Human Neuromusculoskeletal System, Sassari, Italy
| |
Collapse
|
50
|
Matsushima A, Yoshida K, Genno H, Murata A, Matsuzawa S, Nakamura K, Nakamura A, Ikeda SI. Clinical assessment of standing and gait in ataxic patients using a triaxial accelerometer. CEREBELLUM & ATAXIAS 2015; 2:9. [PMID: 26331052 PMCID: PMC4552446 DOI: 10.1186/s40673-015-0028-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 07/30/2015] [Indexed: 12/30/2022]
Abstract
Background The aim of this study was to investigate the usefulness of a triaxial accelerometer for the clinical assessment of standing and gait impairment in ataxic patients quantitatively. Fifty-one patients with spinocerebellar ataxia (SCA) or multiple system atrophy with predominant cerebellar ataxia (MSA-C) and 56 healthy control subjects were enrolled. The subjects, with a triaxial accelerometer on their back, were indicated to stand for 30 s in four different conditions (eyes opened or closed, and feet apart or together) and then to walk 10 m for a total of 12 times on a flat floor at their usual walking speed. In standing analysis, the degree of body sway was assessed. In gait analysis, gait velocity, cadence, step length, step regularity (auto-correlation coefficient: AC), step repeatability (cross-correlation coefficient) and the degree of body sway (The ratio of root mean square in each direction to the root mean square vector magnitude: RMSR) were evaluated. Results The degree of body sway in each standing condition and all parameters in gait showed a significant difference between the patients and control subjects. The AC and RMSR values, as well as the Scale for the Assessment and Rating of Ataxia score, showed a strong correlation with disease duration. Conclusions Various parameters obtained by a triaxial accelerometer can be sensitive and objective markers for the assessment and follow-up of standing and gait impairment in ataxic patients.
Collapse
Affiliation(s)
- Akira Matsushima
- Department of Neurology and Rheumatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan
| | - Kunihiro Yoshida
- Division of Neurogenetics, Department of Brain Disease Research, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan
| | - Hirokazu Genno
- Kissei Comtec Co., Ltd, 4010-10 Wada, Matsumoto, 390-1293 Japan
| | - Asuka Murata
- Kissei Comtec Co., Ltd, 4010-10 Wada, Matsumoto, 390-1293 Japan
| | | | - Katsuya Nakamura
- Division of Clinical and Molecular Genetics, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, 390-8621 Japan
| | - Akinori Nakamura
- Intractable Disease Care Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, 390-8621 Japan
| | - Shu-Ichi Ikeda
- Department of Neurology and Rheumatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621 Japan
| |
Collapse
|