A single Inertial Measurement Unit on the shank to assess the Shank-to-Vertical Angle

A novel method for accurate division of the gait cycle into seven phases using shank angular velocity

BACKGROUND

Accurate detection of gait events is crucial for gait analysis, enabling the assessment of gait patterns and abnormalities. Inertial measurement unit (IMU) sensors have gained traction for event detection, mainly focusing on initial contact (IC) and toe-off (TO) events. However, effective detection of other key events such as heel rise (HR), feet adjacent (FA), and tibia vertical (TBV) is essential for comprehensive gait analysis.

RESEARCH QUESTION

Can a novel IMU-based method accurately detect HR, TO, FA, and TBV events, and how does its performance compare with existing methods?

METHODS

We developed and validated an IMU-based method using cumulative mediolateral shank angular velocity (CSAV) for event detection. A dataset of nearly 25,000 gait cycles from healthy adults walking at varying speeds and footwear conditions was used for validation. The method's accuracy was assessed against force plate and motion capture data and compared with existing TO detection methods.

RESULTS

The CSAV method demonstrated high accuracy in detecting TO, FA, and TBV events and moderate accuracy in HR event detection. Comparisons with existing TO detection methods showcased superior performance. The method's stability across speed and shoe variations underscored its robustness.

SIGNIFICANCE

This study introduces a highly accurate IMU-based method for detecting gait events needed to divide the gait cycle into seven phases. The effectiveness of the CSAV method in capturing essential events across different scenarios emphasizes its potential applications. Although HR event detection can be further improved, the precision of the CSAV method in TO, FA, and TBV detection advance the field. This study bridges a critical gap in IMU-based gait event detection by introducing a method for subdividing the swing phase into its subphases. Further research can focus on refining HR detection and expanding the method's utility across diverse gait contexts, thereby enhancing its clinical and scientific significance.

Assessment of Foot Strike Angle and Forward Propulsion with Wearable Sensors in People with Stroke

Effective retraining of foot elevation and forward propulsion is a critical aspect of gait rehabilitation therapy after stroke, but valuable feedback to enhance these functions is often absent during home-based training. To enable feedback at home, this study assesses the validity of an inertial measurement unit (IMU) to measure the foot strike angle (FSA), and explores eight different kinematic parameters as potential indicators for forward propulsion. Twelve people with stroke performed walking trials while equipped with five IMUs and markers for optical motion analysis (the gold standard). The validity of the IMU-based FSA was assessed via Bland-Altman analysis, ICC, and the repeatability coefficient. Eight different kinematic parameters were compared to the forward propulsion via Pearson correlation. Analyses were performed on a stride-by-stride level and within-subject level. On a stride-by-stride level, the mean difference between the IMU-based FSA and OMCS-based FSA was 1.4 (95% confidence: -3.0; 5.9) degrees, with ICC = 0.97, and a repeatability coefficient of 5.3 degrees. The mean difference for the within-subject analysis was 1.5 (95% confidence: -1.0; 3.9) degrees, with a mean repeatability coefficient of 3.1 (SD: 2.0) degrees. Pearson's r value for all the studied parameters with forward propulsion were below 0.75 for the within-subject analysis, while on a stride-by-stride level the foot angle upon terminal contact and maximum foot angular velocity could be indicative for the peak forward propulsion. In conclusion, the FSA can accurately be assessed with an IMU on the foot in people with stroke during regular walking. However, no suitable kinematic indicator for forward propulsion was identified based on foot and shank movement that could be used for feedback in people with stroke.

Inertial measurement data from loose clothing worn on the lower body during everyday activities

Embedding sensors into clothing is promising as a way for people to wear multiple sensors easily, for applications such as long-term activity monitoring. To our knowledge, this is the first published dataset collected from sensors in loose clothing. 6 Inertial Measurement Units (IMUs) were configured as a 'sensor string' and attached to casual trousers such that there were three sensors on each leg near the waist, thigh, and ankle/lower-shank. Participants also wore an Actigraph accelerometer on their dominant wrist. The dataset consists of 15 participant-days worth of data collected from 5 healthy adults (age range: 28-48 years, 3 males and 2 females). Each participant wore the clothes with sensors for between 1 and 4 days for 5-8 hours per day. Each day, data were collected while participants completed a fixed circuit of activities (with a video ground truth) as well as during free day-to-day activities (with a diary). This dataset can be used to analyse human movements, transitional movements, and postural changes based on a range of features.

Analysis of Movement Variability in Cycling: An Exploratory Study

The purpose of this study was to determine the test-retest repeatability of Blue Trident inertial measurement units (IMUs) and VICON Nexus kinematic modelling in analysing the Lyapunov Exponent (LyE) during a maximal effort 4000 m cycling bout in different body segments/joints. An additional aim was to determine if changes in the LyE existed across a trial. Twelve novice cyclists completed four sessions of cycling; one was a familiarisation session to determine a bike fit and become better accustomed to the time trial position and pacing of a 4000 m effort. IMUs were attached to the head, thorax, pelvis and left and right shanks to analyse segment accelerations, respectively, and reflective markers were attached to the participant to analyse neck, thorax, pelvis, hip, knee and ankle segment/joint angular kinematics, respectively. Both the IMU and VICON Nexus test-retest repeatability ranged from poor to excellent at the different sites. In each session, the head and thorax IMU acceleration LyE increased across the bout, whilst pelvic and shank acceleration remained consistent. Differences across sessions were evident in VICON Nexus segment/joint angular kinematics, but no consistent trend existed. The improved reliability and the ability to identify a consistent trend in performance, combined with their improved portability and reduced cost, advocate for the use of IMUs in analysing movement variability in cycling. However, additional research is required to determine the applicability of analysing movement variability during cycling.

How does a systematic tuning protocol for ankle foot orthosis-footwear combinations affect gait in children in cerebral palsy?

PURPOSE

To investigate the effects of a systematic tuning protocol for ankle foot orthosis footwear combinations (AFO-FC) using incrementing heel height on gait in children with cerebral palsy (CP).

METHODS

Eighteen children with CP (10.8 ± 3 years, Gross Motor Function Classification System (GMFCS) I-II) underwent 3D gait analysis on a treadmill, while the AFO heel surface was systematically incremented with wedges. Children were subdivided based on their gait pattern, i.e., knee hyperextension (EXT) and excessive knee flexion (FLEX). Outcome measures included sagittal hip and knee angles and moments, shank to vertical angle (SVA), foot to horizontal angle, and gait profile score (GPS).

RESULTS

For both groups, incrementing heel height resulted in increased knee flexion, more inclined SVA, and increased knee extension moments. This resulted in gait improvements for some children of the EXT-group, but not in FLEX. High variation was found between individuals and within-subject effects were not always consistent for kinematic and kinetics.

CONCLUSIONS

A systematic AFO-FC tuning protocol using incremented heel height can be effective to improve gait in children with CP walking with EXT. The current results emphasise the importance of including kinematics as well as kinetics of multiple instances throughout the gait cycle for reliable interpretation of the effect of AFO tuning on gait.Implications for rehabilitationA systematic ankle foot orthosis footwear combinations (AFO-FC) tuning protocol using incremented heel height can improve gait in children walking with knee hyperextension.Tuning results in changes throughout the gait cycle.Little evidence is found for an optimal SVA of 10-12° at midstance.For clinical interpretation, both joint kinematic and kinetic parameters should be considered throughout the gait cycle and evaluation should not be based on SVA only.

Comparing Loose Clothing-Mounted Sensors with Body-Mounted Sensors in the Analysis of Walking

A person's walking pattern can reveal important information about their health. Mounting multiple sensors onto loose clothing potentially offers a comfortable way of collecting data about walking and other human movement. This research investigates how well the data from three sensors mounted on the lateral side of clothing (on a pair of trousers near the waist, upper thigh and lower shank) correlate with the data from sensors mounted on the frontal side of the body. Data collected from three participants (two male, one female) for two days were analysed. Gait cycles were extracted based on features in the lower-shank accelerometry and analysed in terms of sensor-to-vertical angles (SVA). The correlations in SVA between the clothing- and body-mounted sensor pairs were analysed. Correlation coefficients above 0.76 were found for the waist sensor pairs, while the thigh and lower-shank sensor pairs had correlations above 0.90. The cyclical nature of gait cycles was evident in the clothing data, and it was possible to distinguish the stance and swing phases of walking based on features in the clothing data. Furthermore, simultaneously recording data from the waist, thigh, and shank was helpful in capturing the movement of the whole leg.

Assessment of the Shank-to-Vertical Angle While Changing Heel Heights Using a Single Inertial Measurement Unit in Individuals with Incomplete Spinal Cord Injury Wearing an Ankle-Foot-Orthosis

Previous research showed that an Inertial Measurement Unit (IMU) on the anterior side of the shank can accurately measure the Shank-to-Vertical Angle (SVA), which is a clinically-used parameter to guide tuning of ankle-foot orthoses (AFOs). However, in this context it is specifically important that differences in the SVA are detected during the tuning process, i.e., when adjusting heel height. This study investigated the validity of the SVA as measured by an IMU and its responsiveness to changes in AFO-footwear combination (AFO-FC) heel height in persons with incomplete spinal cord injury (iSCI). Additionally, the effect of heel height on knee flexion-extension angle and internal moment was evaluated. Twelve persons with an iSCI walked with their own AFO-FC in three different conditions: (1) without a heel wedge (refHH), (2) with 5 mm heel wedge (lowHH) and (3) with 10 mm heel wedge (highHH). Walking was recorded by a single IMU on the anterior side of the shank and a 3D gait analysis (3DGA) simultaneously. To estimate validity, a paired t-test and intraclass correlation coefficient (ICC) between the SVA_IMU and SVA_3DGA were calculated for the refHH. A repeated measures ANOVA was performed to evaluate the differences between the heel heights. A good validity with a mean difference smaller than 1 and an ICC above 0.9 was found for the SVA during midstance phase and at midstance. Significant differences between the heel heights were found for changes in SVA_IMU (p = 0.036) and knee moment (p = 0.020) during the midstance phase and in SVA_IMU (p = 0.042) and SVA_3DGA (p = 0.006) at midstance. Post-hoc analysis revealed a significant difference between the ref and high heel height condition for the SVA_IMU (p = 0.005) and knee moment (p = 0.006) during the midstance phase and for the SVA_IMU (p = 0.010) and SVA_3DGA (p = 0.006) at the instant of midstance. The SVA measured with an IMU is valid and responsive to changing heel heights and equivalent to the gold standard 3DGA. The knee joint angle and knee joint moment showed concomitant changes compared to SVA as a result of changing heel height.

The effects of ground-irregularity-cancelling prosthesis control on balance over uneven surfaces

Over half of individuals with a lower-limb amputation are unable to walk on uneven terrain. Using a prosthesis emulator system, we developed an irregularity-cancelling controller intended to reduce the effect of disturbances resulting from uneven surfaces. This controller functions by changing the neutral angles of two forefoot digits in response to local terrain heights. To isolate the effects of the controller, we also programmed a spring-like controller that maintained fixed neutral angles. Five participants with transtibial amputation walked on a treadmill with an uneven walking surface. Compared with the spring-like controller, the irregularity-cancelling controller reduced ankle torque variability by 41% in the sagittal plane and 64% in the frontal plane. However, user outcomes associated with balance were mostly unaffected; only trunk movement variability was reduced, whereas metabolic rate, mediolateral centre of mass motion, and variabilities in step width, step length and step time were unchanged. We conclude that reducing ankle torque variability of the affected limb is not sufficient for reducing the overall effect of disturbances due to uneven terrain. It is possible that other factors, such as changes in step height or disturbances to the intact limb, play a larger role in difficulty balancing while walking over uneven surfaces.