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Lo CWT, Brodie MA, Tsang WWN, Lord SR, Yan CH, Wong AYL. Pain, balance, and mobility in people 1 year after total knee arthroplasty: a non-randomized cross-sectional pilot study contrasting posterior-stabilized and medial-pivot designs. Pilot Feasibility Stud 2022; 8:131. [PMID: 35765113 PMCID: PMC9238077 DOI: 10.1186/s40814-022-01094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a common treatment for severe knee osteoarthritis. Medial-pivot TKA systems (MP-TKA) are theoretically better than posterior-stabilized TKA systems (PS-TKA) in improving static and dynamic balance of patients although it is difficult to objectively quantify these balance parameters in a clinical setting. Therefore, this pilot study aimed to evaluate the feasibility of using wearable devices in a clinical setting to examine whether people with MP-TKA have better postoperative outcomes than PS-TKA, and their balance control is more akin to age-matched asymptomatic controls. METHODS The current cross-sectional pilot study recruited 57 participants with 2 different prosthesis designs (20 PS-TKA, 18 MP-TKA) and 19 asymptomatic controls. At 1-year post-TKA, pain, knee stiffness, and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Static balance, mobility, and gait stability of the participants were evaluated based on data collected from wearable motion sensors during the near tandem stance, timed-up-and-go, and 6-min walk tests. RESULTS Compared to asymptomatic controls, both TKA groups reported significantly more pain and stiffness and demonstrated reduced functional mobility, increased stride-time-variability, and impaired balance. After Bonferroni adjustment, no significant differences in pain, balance, and mobility performance were observed between PS-TKA and MP-TKA participants 1 year after surgery. However, there was a trend for increased anteroposterior sway of the lumbar and head regions in the MP-TKA participants when undertaking the near tandem stance test. The wearable motion sensors were easy to use without any adverse effects. CONCLUSIONS It is feasible to use wearable motion sensors in a clinical setting to compare balance and mobility performance of patients with different TKA prothesis designs. Since this was a pilot study and no definite conclusions could be drawn, future clinical trials should determine the impacts of different TKA prosthesis designs on post-operative outcomes over a longer follow-up period.
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Affiliation(s)
- Cathy W T Lo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Matthew A Brodie
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - William W N Tsang
- Department of Physiotherapy, School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR, China
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Chun-Hoi Yan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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2
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Mobbs RJ, Natarajan P, Fonseka RD, Betteridge C, Ho D, Mobbs R, Sy L, Maharaj M. Walking orientation randomness metric (WORM) score: pilot study of a novel gait parameter to assess walking stability and discriminate fallers from non-fallers using wearable sensors. BMC Musculoskelet Disord 2022; 23:304. [PMID: 35351090 PMCID: PMC8966274 DOI: 10.1186/s12891-022-05211-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/04/2022] [Indexed: 05/31/2023] Open
Abstract
Background Musculoskeletal disorders can contribute to injurious falls and incur significant societal and healthcare burdens. Identification of fallers from non-fallers through wearable-based gait analysis can facilitate timely intervention to assist mobility and prevent falls whilst improving care and attention for high fall-risk patients. In this study, we use wearable sensor-based gait analysis to introduce a novel variable to assess walking stability in fallers and non-fallers – the Walking Orientation Randomness Metric. The WORM score quantifies the stability, or ‘figure-of-eight’ motion of a subject’s trunk during walking as an indicator of a falls-predictive (pathological) gait. Methods WORM is calculated as the ‘figure-of-eight’ oscillation mapped out in the transverse-plane by the upper body’s centre-point during a walking bout. A sample of patients presenting to the Prince of Wales Hospital (Sydney, Australia) with a primary diagnosis of “falls for investigation” and age-matched healthy controls (non-fallers) from the community were recruited. Participants were fitted at the sternal angle with the wearable accelerometer, MetaMotionC (Mbientlab Inc., USA) and walked unobserved (at self-selected pace) for 5-50 m along an obstacle-free, carpeted hospital corridor. Results Participants comprised of 16 fallers (mean age: 70 + 17) and 16 non-fallers (mean age: 70 + 9) based on a recent fall(s) history. The (median) WORM score was 17-fold higher (p < 0.001) in fallers (3.64 cm) compared to non-fallers (0.21 cm). ROC curve analyses demonstrate WORM can discriminate fallers from non-fallers (AUC = 0.97). Diagnostic analyses (cut-off > 0.51 cm) show high sensitivity (88%) and specificity (94%). Conclusion In this pilot study we have introduced the WORM score, demonstrating its discriminative performance in a preliminary sample size of 16 fallers. WORM is a novel gait metric assessing walking stability as measured by truncal way during ambulation and shows promise for objective and clinical evaluation of fallers. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05211-1.
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Affiliation(s)
- Ralph Jasper Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia. .,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia. .,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia. .,Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia. .,Neuro Spine Clinic, Prince of Wales Private Hospital, 320-346 Barker St, Randwick, NSW, 2031, Australia.
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - R Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Callum Betteridge
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Daniel Ho
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Redmond Mobbs
- School of Mathematics and Computer Science, University of New South Wales (UNSW), Sydney, Australia
| | - Luke Sy
- School of Mathematics and Computer Science, University of New South Wales (UNSW), Sydney, Australia
| | - Monish Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia.,Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia.,Neuro Spine Clinic, Prince of Wales Private Hospital, 320-346 Barker St, Randwick, NSW, 2031, Australia
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3
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Hellec J, Chorin F, Castagnetti A, Guérin O, Colson SS. Smart Eyeglasses: A Valid and Reliable Device to Assess Spatiotemporal Parameters during Gait. SENSORS (BASEL, SWITZERLAND) 2022; 22:1196. [PMID: 35161941 PMCID: PMC8846265 DOI: 10.3390/s22031196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 12/14/2022]
Abstract
The study aims to determine the validity and reproducibility of step duration and step length parameters measured during walking in healthy participants using an accelerometer embedded in smart eyeglasses. Twenty young volunteers participated in two identical sessions comprising a 30 s gait assessment performed at three different treadmill speeds under two conditions (i.e., with and without a cervical collar). Spatiotemporal parameters (i.e., step duration and step length normalized by the lower limb length) were obtained with both the accelerometer embedded in smart eyeglasses and an optoelectronic system. The relative intra- and inter-session reliability of step duration and step length computed from the vertical acceleration data were excellent for all experimental conditions. An excellent absolute reliability was observed for the eyeglasses for all conditions and concurrent validity between systems was observed. An accelerometer incorporated in smart eyeglasses is accurate to measure step duration and step length during gait.
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Affiliation(s)
- Justine Hellec
- Université Côte d’Azur, LAMHESS, EUR HEALTHY, 06205 Nice, France; (F.C.); (S.S.C.)
- Ellcie Healthy, 06600 Antibes, France
| | - Frédéric Chorin
- Université Côte d’Azur, LAMHESS, EUR HEALTHY, 06205 Nice, France; (F.C.); (S.S.C.)
- Université Côte d’Azur, CHU, Cimiez, Plateforme Fragilité, 06000 Nice, France
| | | | | | - Serge S. Colson
- Université Côte d’Azur, LAMHESS, EUR HEALTHY, 06205 Nice, France; (F.C.); (S.S.C.)
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Sierra M SD, Garcia A DE, Otálora S, Arias-Castro MC, Gómez-Rodas A, Múnera M, Cifuentes CA. Assessment of a Robotic Walker in Older Adults With Parkinson's Disease in Daily Living Activities. Front Neurorobot 2022; 15:742281. [PMID: 34970132 PMCID: PMC8712754 DOI: 10.3389/fnbot.2021.742281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/09/2021] [Indexed: 11/23/2022] Open
Abstract
The constant growth of the population with mobility impairments, such as older adults and people suffering from neurological pathologies like Parkinson's disease (PD), has encouraged the development of multiple devices for gait assistance. Robotic walkers have emerged, improving physical stability and balance and providing cognitive aid in rehabilitation scenarios. Different studies evaluated human gait behavior with passive and active walkers to understand such rehabilitation processes. However, there is no evidence in the literature of studies with robotic walkers in daily living scenarios with older adults with Parkinson's disease. This study presents the assessment of the AGoRA Smart Walker using Ramps Tests and Timed Up and Go Test (TUGT). Ten older adults participated in the study, four had PD, and the remaining six had underlying conditions and fractures. Each of them underwent a physical assessment (i.e., Senior Fitness, hip, and knee strength tests) and then interacted with the AGoRA SW. Kinematic and physical interaction data were collected through the AGoRA walker's sensory interface. It was found that for lower limb strength tests, older adults with PD had increases of at least 15% in all parameters assessed. For the Sit to Stand Test, the Parkinson's group evidenced an increase of 23%, while for the Chair Sit and Reach Test (CSRT), this same group was only 0.04 m away from reaching the target. For the Ramp Up Test (RUT), the subjects had to make a greater effort, and significant differences (p-value = 0.04) were evidenced in the force they applied to the device. For the Ramp Down Test (RDT), the Parkinson's group exhibited a decrease in torque, and there were statistically significant differences (p-value = 0.01) due to the increase in the complexity of the task. In the Timed Up and Go Test (TUGT), the subjects presented significant differences in torque (p-value of 0.05) but not in force (p-value of 0.22) due to the effect of the admittance controller implemented in the study. Finally, the results suggested that the walker, represents a valuable tool for assisting people with gait motor deficits in tasks that demanded more physical effort adapting its behavior to the specific needs of each user.
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Affiliation(s)
- Sergio D Sierra M
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Daniel E Garcia A
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Sophia Otálora
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | | | - Alejandro Gómez-Rodas
- Programa de Fisioterapia, Fundación Universitaria del Área Andina, Pereira, Colombia.,Programa Ciencias del Deporte y la Recreación, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Marcela Múnera
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
| | - Carlos A Cifuentes
- Department of Biomedical Engineering, Colombian School of Engineering Julio Garavito, Bogotá, Colombia
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5
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Evaluation of Physical Interaction during Walker-Assisted Gait with the AGoRA Walker: Strategies Based on Virtual Mechanical Stiffness. SENSORS 2021; 21:s21093242. [PMID: 34067133 PMCID: PMC8125083 DOI: 10.3390/s21093242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/05/2021] [Accepted: 05/02/2021] [Indexed: 11/16/2022]
Abstract
Smart walkers are commonly used as potential gait assistance devices, to provide physical and cognitive assistance within rehabilitation and clinical scenarios. To understand such rehabilitation processes, several biomechanical studies have been conducted to assess human gait with passive and active walkers. Several sessions were conducted with 11 healthy volunteers to assess three interaction strategies based on passive, low and high mechanical stiffness values on the AGoRA Smart Walker. The trials were carried out in a motion analysis laboratory. Kinematic data were also collected from the smart walker sensory interface. The interaction force between users and the device was recorded. The force required under passive and low stiffness modes was 56.66% and 67.48% smaller than the high stiffness mode, respectively. An increase of 17.03% for the hip range of motion, as well as the highest trunk’s inclination, were obtained under the resistive mode, suggesting a compensating motion to exert a higher impulse force on the device. Kinematic and physical interaction data suggested that the high stiffness mode significantly affected the users’ gait pattern. Results suggested that users compensated their kinematics, tilting their trunk and lower limbs to exert higher impulse forces on the device.
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Betteridge CMW, Natarajan P, Fonseka RD, Ho D, Mobbs R, Choy WJ. Objective falls-risk prediction using wearable technologies amongst patients with and without neurogenic gait alterations: a narrative review of clinical feasibility. Mhealth 2021; 7:61. [PMID: 34805392 PMCID: PMC8572751 DOI: 10.21037/mhealth-21-7] [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: 02/16/2021] [Accepted: 06/12/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES The present narrative review aims to collate the literature regarding the current use of wearable gait measurement devices for falls-risk assessment in neurological and non-neurological populations. Thereby, this review seeks to determine the extent to which the aforementioned barriers inhibit clinical use. BACKGROUND Falls contribute a significant disease burden in most western countries, resulting in increased morbidity and mortality with substantial therapeutic costs. The recent development of gait analysis sensor technologies has enabled quantitative measurement of several gait features related to falls risk. However, three main barriers to implementation exist: accurately measuring gait-features associated with falls, differentiating between fallers and non-fallers using these gait features, and the accuracy of falls predictive algorithms developed using these gait measurements. METHODS Searches of Medline, PubMed, Embase and Scopus were screened to identify 46 articles relevant to the present study. Studies performing gait assessment using any wearable gait assessment device and analysing correlation with the occurrence of falls during a retrospective or prospective study period were included. Risk of Bias was assessed using the Centre for Evidence Based Medicine (CEBM) Criteria. CONCLUSIONS Falls prediction algorithms based entirely, or in-part, on gait data have shown comparable or greater success of predicting falls than existing stratification scoring systems such as the 10-meter walk test or timed-up-and-go. However, data is lacking regarding their accuracy in neurological patient populations. Inertial measurement units (IMU) have displayed competency in obtaining and interpreting gait metrics relevant to falls risk. They have the potential to enhance the accuracy and efficiency of falls risk assessment in inpatient and outpatient setting.
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Affiliation(s)
- Callum M. W. Betteridge
- Department of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpineClinic, Suite 7 Level 7, Prince of Wales Private Hospital, Randwick, Australia
- NeuroSpine Surgery Research Group, Sydney, Australia
- Wearables and Gait Assessment Group, Sydney, Australia
| | - Pragadesh Natarajan
- Department of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpineClinic, Suite 7 Level 7, Prince of Wales Private Hospital, Randwick, Australia
- NeuroSpine Surgery Research Group, Sydney, Australia
- Wearables and Gait Assessment Group, Sydney, Australia
| | - R. Dineth Fonseka
- Department of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpineClinic, Suite 7 Level 7, Prince of Wales Private Hospital, Randwick, Australia
- NeuroSpine Surgery Research Group, Sydney, Australia
- Wearables and Gait Assessment Group, Sydney, Australia
| | - Daniel Ho
- Department of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpineClinic, Suite 7 Level 7, Prince of Wales Private Hospital, Randwick, Australia
- NeuroSpine Surgery Research Group, Sydney, Australia
- Wearables and Gait Assessment Group, Sydney, Australia
| | - Ralph Mobbs
- Department of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpineClinic, Suite 7 Level 7, Prince of Wales Private Hospital, Randwick, Australia
- NeuroSpine Surgery Research Group, Sydney, Australia
- Wearables and Gait Assessment Group, Sydney, Australia
| | - Wen Jie Choy
- Department of Medicine, University of New South Wales, Sydney, Australia
- NeuroSpineClinic, Suite 7 Level 7, Prince of Wales Private Hospital, Randwick, Australia
- NeuroSpine Surgery Research Group, Sydney, Australia
- Wearables and Gait Assessment Group, Sydney, Australia
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7
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Motor adjustments during time-constrained sit-to-walk in people with Parkinson's disease. Exp Gerontol 2019; 124:110654. [DOI: 10.1016/j.exger.2019.110654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/30/2019] [Accepted: 07/05/2019] [Indexed: 11/22/2022]
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Dollack F, Perusquía-Hernández M, Kadone H, Suzuki K. Head Anticipation During Locomotion With Auditory Instruction in the Presence and Absence of Visual Input. Front Hum Neurosci 2019; 13:293. [PMID: 31555112 PMCID: PMC6724718 DOI: 10.3389/fnhum.2019.00293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 08/12/2019] [Indexed: 11/13/2022] Open
Abstract
Head direction has been identified to anticipate trajectory direction during human locomotion. Head anticipation has also been shown to persist in darkness. Arguably, the purpose for this anticipatory behavior is related to motor control and trajectory planning, independently of the visual condition. This implies that anticipation remains in the absence of visual input. However, experiments so far have only explored this phenomenon with visual instructions which intrinsically primes a visual representation to follow. The primary objective of this study is to describe head anticipation in auditory instructed locomotion, in the presence and absence of visual input. Auditory instructed locomotion trajectories were performed in two visual conditions: eyes open and eyes closed. First, 10 sighted participants localized static sound sources to ensure they could understand the sound cues provided. Afterwards, they listened to a moving sound source while actively following it. Later, participants were asked to reproduce the trajectory of the moving sound source without sound. Anticipatory head behavior was observed during trajectory reproduction in both eyes open and closed conditions. The results suggest that head anticipation is related to motor anticipation rather than mental simulation of the trajectory.
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Affiliation(s)
- Felix Dollack
- School of Integrative and Global Majors, University of Tsukuba, Tsukuba, Japan.,Artificial Intelligence Laboratory, University of Tsukuba, Tsukuba, Japan
| | | | - Hideki Kadone
- Artificial Intelligence Laboratory, University of Tsukuba, Tsukuba, Japan.,Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan.,Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Kenji Suzuki
- Artificial Intelligence Laboratory, University of Tsukuba, Tsukuba, Japan.,Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan.,Faculty of Engineering, Information and Systems, University of Tsukuba, Tsukuba, Japan
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9
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Multi-Functional Soft Strain Sensors for Wearable Physiological Monitoring. SENSORS 2018; 18:s18113822. [PMID: 30413011 PMCID: PMC6263389 DOI: 10.3390/s18113822] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/26/2018] [Accepted: 10/31/2018] [Indexed: 01/23/2023]
Abstract
Wearable devices which monitor physiological measurements are of significant research interest for a wide number of applications including medicine, entertainment, and wellness monitoring. However, many wearable sensing systems are highly rigid and thus restrict the movement of the wearer, and are not modular or customizable for a specific application. Typically, one sensor is designed to model one physiological indicator which is not a scalable approach. This work aims to address these limitations, by developing soft sensors and including conductive particles into a silicone matrix which allows sheets of soft strain sensors to be developed rapidly using a rapid manufacturing process. By varying the morphology of the sensor sheets and electrode placement the response can be varied. To demonstrate the versatility and range of sensitivity of this base sensing material, two wearable sensors have been developed which show the detection of different physiological parameters. These include a pressure-sensitive insole sensor which can detect ground reaction forces and a strain sensor which can be worn over clothes to allow the measurements of heart rate, breathing rate, and gait.
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10
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Psarakis M, Greene DA, Cole MH, Lord SR, Hoang P, Brodie M. Wearable technology reveals gait compensations, unstable walking patterns and fatigue in people with multiple sclerosis. Physiol Meas 2018; 39:075004. [PMID: 29701182 DOI: 10.1088/1361-6579/aac0a3] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE People with multiple sclerosis (PwMS) often experience a decline in gait performance, which can compromise their independence and increase falls. Ankle joint contractures in PwMS are common and often result in compensatory gait patterns to accommodate reduced ankle range of motion (ROM). APPROACH Using advances in wearable technology, the aim of this study was to quantify head and pelvis movement patterns that occur in PwMS with disability and determine how these secondary gait compensations impact on gait stability. Twelve healthy participants and 12 PwMS participated in the study. Head and pelvis movements were measured using two tri-axial accelerometers. Measures of gait compensation, mobility, variability, asymmetry, stability and fatigue were assessed during a 6 min walking test. MAIN RESULTS Compared to healthy controls, PwMS had greater vertical asymmetry in their head and pelvic movements (Cohen's d = 1.85 and 1.60). Lower harmonic ratios indicated that PwMS were more unstable than controls (Cohen's d = -1.61 to -3.06), even after adjusting for their slower walking speeds. In the PwMS, increased compensatory movements were correlated with reduced ankle active ROM (r = -0.71), higher disability (EDSS) scores (r = 0.58), unstable gait (r = -0.76), reduced mobility (r = -0.76) and increased variability (r = 0.83). SIGNIFICANCE Wearable device technology provides an efficient and reliable way to screen for excessive compensatory movements often present in PwMS and provides clinically important information that impacts on mobility, stride time variability and gait stability. This information may help clinicians identify PwMS at high risk of falling and develop better rehabilitation interventions that, in addition to improving mobility, may help target the underlying causes of unstable gait.
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Affiliation(s)
- Michael Psarakis
- Faculty of Health Sciences, Australian Catholic University, Australia
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11
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Bastas G, Fleck JJ, Peters RA, Zelik KE. IMU-based gait analysis in lower limb prosthesis users: Comparison of step demarcation algorithms. Gait Posture 2018; 64:30-37. [PMID: 29807270 PMCID: PMC6062463 DOI: 10.1016/j.gaitpost.2018.05.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/13/2018] [Accepted: 05/21/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inertial Measurement Unit (IMU)-based gait analysis algorithms have previously been validated in healthy controls. However, little is known about the efficacy, performance, and applicability of these algorithms in clinical populations with gait deviations such as lower limb prosthesis users (LLPUs). RESEARCH QUESTION To compare the performance of 3 different IMU-based algorithms to demarcate steps from LLPUs. METHODS We used a single IMU sensor affixed to the midline lumbopelvic region of 17 transtibial (TTA), 16 transfemoral (TFA) LLPUs, and 14 healthy controls (HC). We collected acceleration and angular velocity data during overground walking trials. Step demarcation was evaluated based on fore-aft acceleration, detecting either: (i) maximum acceleration peak, (ii) zero-crossing, or (iii) the peak immediately preceding a zero-crossing. We quantified and compared the variability (standard deviation) in acceleration waveforms from superposed step intervals, and variability in step duration, by each algorithm. RESULTS We found that the zero-crossing algorithm outperformed both peak detection algorithms in 65% of TTAs, 81% of TFAs, and 71% of HCs, as evidenced by lower standard deviations in acceleration, more consistent qualitative demarcation of steps, and more normally distributed step durations. SIGNIFICANCE The choice of feature-based algorithm with which to partition IMU waveforms into individual steps can affect the quality and interpretation of estimated gait spatiotemporal metrics in LLPUs. We conclude that the fore-aft acceleration zero-crossing serves as a more reliable feature for demarcating steps in the gait patterns of LLPUs.
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Affiliation(s)
- Gerasimos Bastas
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center
| | | | - Richard A. Peters
- Department of Electrical Engineering and Computer Science, Vanderbilt University
| | - Karl E. Zelik
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center,Department of Mechanical Engineering, Vanderbilt University,Department of Biomedical Engineering, Vanderbilt University
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12
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Symeonidou ER, Nordin AD, Hairston WD, Ferris DP. Effects of Cable Sway, Electrode Surface Area, and Electrode Mass on Electroencephalography Signal Quality during Motion. SENSORS 2018; 18:s18041073. [PMID: 29614020 PMCID: PMC5948545 DOI: 10.3390/s18041073] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/17/2022]
Abstract
More neuroscience researchers are using scalp electroencephalography (EEG) to measure electrocortical dynamics during human locomotion and other types of movement. Motion artifacts corrupt the EEG and mask underlying neural signals of interest. The cause of motion artifacts in EEG is often attributed to electrode motion relative to the skin, but few studies have examined EEG signals under head motion. In the current study, we tested how motion artifacts are affected by the overall mass and surface area of commercially available electrodes, as well as how cable sway contributes to motion artifacts. To provide a ground-truth signal, we used a gelatin head phantom with embedded antennas broadcasting electrical signals, and recorded EEG with a commercially available electrode system. A robotic platform moved the phantom head through sinusoidal displacements at different frequencies (0–2 Hz). Results showed that a larger electrode surface area can have a small but significant effect on improving EEG signal quality during motion and that cable sway is a major contributor to motion artifacts. These results have implications in the development of future hardware for mobile brain imaging with EEG.
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Affiliation(s)
- Evangelia-Regkina Symeonidou
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA.
- Max Planck Institute for Biological Cybernetics, 72076 Tübingen, Germany.
- International Max Planck Research School for Cognitive and Systems Neuroscience, 72074 Tübingen, Germany.
| | - Andrew D Nordin
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA.
| | - W David Hairston
- U. S. Army Research Laboratory, Aberdeen Proving Ground, Aberdeen, MD 21005, USA.
| | - Daniel P Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA.
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Abstract
Postural control (PC) requires the interaction of the three sensory systems for a good maintenance of the balance, and in blind people, lack of visual input can harm your PC. Thus the objective is to perform a literature review concerning role of sight in the maintenance of PC and the adaptation of brain structures when vision is absent. Studies were searched from Pubmed, and EMBASE that included individuals with congenital blindness. Articles studying person with acquired blindness or low vision was excluded from this review. 26 out of 322 articles were selected for review, and we found that 1) blind individuals exhibit PC deficits and that is compensated by the intensification of the remaining systems; 2) Neuroplastic adaptation occurs throughout the entire cerebral cortex; and 3) Sensorimotor stimulation and transcranial direct current stimulation seem to be a rehabilitation strategy. According to this review, the findings suggest that improved remaining sensations in the presence of adaptations and neuroplasticity, does not translate into better postural control performance. Regarding rehabilitation strategies, more studies are needed to show which therapeutic modality best contributes to postural control.
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Brodie MA, Coppens MJ, Ejupi A, Gschwind YJ, Annegarn J, Schoene D, Wieching R, Lord SR, Delbaere K. Comparison between clinical gait and daily-life gait assessments of fall risk in older people. Geriatr Gerontol Int 2017; 17:2274-2282. [DOI: 10.1111/ggi.12979] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/19/2016] [Accepted: 11/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Milou J. Coppens
- Center for Human Movement Sciences, University Medical Center Groningen; University of Groningen; the Netherlands
| | - Andreas Ejupi
- Assistive Healthcare Information Technology Group; Austrian Institute of Technology; Vienna Austria
| | - Yves J. Gschwind
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
| | - Janneke Annegarn
- Department of Personal Health, Philips Research; High Tech Campus 34, 5656AE Eindhoven the Netherlands
| | - Daniel Schoene
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
- Institute for Biomedicine of Aging; Friedrich-Alexander University; Nuremberg Germany
| | - Rainer Wieching
- Institute for Information Systems; University Siegen; Siegen Germany
| | - Stephen R. Lord
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
| | - Kim Delbaere
- Neuroscience Research Australia; UNSW; Randwick, Sydney Australia
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15
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Buckley C, Galna B, Rochester L, Mazzà C. Quantification of upper body movements during gait in older adults and in those with Parkinson's disease: impact of acceleration realignment methodologies. Gait Posture 2017; 52:265-271. [PMID: 27992850 PMCID: PMC5343666 DOI: 10.1016/j.gaitpost.2016.11.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/21/2016] [Accepted: 11/29/2016] [Indexed: 02/02/2023]
Abstract
The upper body accelerations of people with Parkinson's disease (PD) measured by inertial measurement units (IMUs) may contribute towards diagnostic algorithms and help track disease progression. Before extracting variables related to upper body motion, acceleration signals require realignment to a global reference; however, the impact of these techniques on the resulting upper body variables is unclear. Therefore, the aim of this investigation was to examine the impact of four different realignment methods designed to correct acceleration signals on a range of upper body variables in older adults and in patients with PD. Two minutes of continuous gait were measured in 54 community-dwelling older adults (71.1±6.7 years) and 60 people with PD (age: 68.5±9.1 years). Three IMUs placed on the 5th lumbar vertebra, 7th cervical vertebra and the back of the head recorded the acceleration of the upper body. A selection of upper body variables sensitive to impaired upper body control in PD and four acceleration realignment methods were compared. A mixed-model ANOVA showed that the choice of realignment method significantly affected the values of upper body variables as well as their ability to discriminate between the PD and control group. Our findings indicate researchers and clinicians should be cautious when comparing upper body variables extracted from IMUs using different realignment methods, and consideration of realignment technique will be important when identifying the most sensitive markers of disease presence and progression. Therefore, it's strongly recommend that researchers consider and report their realignment methods when assessing upper body variables during gait.
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Affiliation(s)
- Christopher Buckley
- MRC-Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Pam Liversidge Building, University of Sheffield, Sheffield S1 3JD, UK; Department of Mechanical Engineering, University of Sheffield, Sir Frederick Mappin Building, Sheffield S1 3JD, UK; INSIGNEO Institute for in Silico Medicine, University of Sheffield, Pam Liversidge Building, Sheffield S1 3JD, UK.
| | - Brook Galna
- Institute of Neuroscience/Newcastle University Institute for Ageing, Newcastle University, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Lynn Rochester
- Institute of Neuroscience/Newcastle University Institute for Ageing, Newcastle University, Clinical Ageing Research Unit, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
| | - Claudia Mazzà
- Department of Mechanical Engineering, University of Sheffield, Sir Frederick Mappin Building, Sheffield S1 3JD, UK; INSIGNEO Institute for in Silico Medicine, University of Sheffield, Pam Liversidge Building, Sheffield S1 3JD, UK
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16
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Brodie MA, Okubo Y, Annegarn J, Wieching R, Lord SR, Delbaere K. Disentangling the health benefits of walking from increased exposure to falls in older people using remote gait monitoring and multi-dimensional analysis. Physiol Meas 2016; 38:45-62. [PMID: 27941237 DOI: 10.1088/1361-6579/38/1/45] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Falls and physical deconditioning are two major health problems for older people. Recent advances in remote physiological monitoring provide new opportunities to investigate why walking exercise, with its many health benefits, can both increase and decrease fall rates in older people. In this paper we combine remote wearable device monitoring of daily gait with non-linear multi-dimensional pattern recognition analysis; to disentangle the complex associations between walking, health and fall rates. One week of activities of daily living (ADL) were recorded with a wearable device in 96 independent living older people prior to completing 6 months of exergaming interventions. Using the wearable device data; the quantity, intensity, variability and distribution of daily walking patterns were assessed. At baseline, clinical assessments of health, falls, sensorimotor and physiological fall risks were completed. At 6 months, fall rates, sensorimotor and physiological fall risks were re-assessed. A non-linear multi-dimensional analysis was conducted to identify risk-groups according to their daily walking patterns. Four distinct risk-groups were identified: The Impaired (93% fallers), Restrained (8% fallers), Active (50% fallers) and Athletic (4% fallers). Walking was strongly associated with multiple health benefits and protective of falls for the top performing Athletic risk-group. However, in the middle of the spectrum, the Active risk-group, who were more active, younger and healthier were 6.25 times more likely to be fallers than their Restrained counterparts. Remote monitoring of daily walking patterns may provide a new way to distinguish Impaired people at risk of falling because of frailty from Active people at risk of falling from greater exposure to situations were falls could occur, but further validation is required. Wearable device risk-profiling could help in developing more personalised interventions for older people seeking the health benefits of walking without increasing their risk of falls.
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Affiliation(s)
- Matthew A Brodie
- Neuroscience Research Australia, UNSW, Randwick, Sydney, Australia
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17
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Rabuffetti M, Meriggi P, Pagliari C, Bartolomeo P, Ferrarin M. Differential actigraphy for monitoring asymmetry in upper limb motor activities. Physiol Meas 2016; 37:1798-1812. [DOI: 10.1088/0967-3334/37/10/1798] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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18
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Oliveira AS, Schlink BR, Hairston WD, König P, Ferris DP. Induction and separation of motion artifacts in EEG data using a mobile phantom head device. J Neural Eng 2016; 13:036014. [PMID: 27137818 DOI: 10.1088/1741-2560/13/3/036014] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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19
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Brodie MAD, Psarakis M, Hoang P. Gyroscopic corrections improve wearable sensor data prior to measuring dynamic sway in the gait of people with Multiple Sclerosis. Comput Methods Biomech Biomed Engin 2016; 19:1339-46. [PMID: 26866921 DOI: 10.1080/10255842.2016.1140747] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Accelerometers are incorporated into many consumer devices providing new ways to monitor gait, mobility, and fall risk. However, many health benefits have not been realised because of issues with data quality that results from gravitational 'cross-talk' when the wearable device is tilted. Here we present an adaptive filter designed to improve the quality of accelerometer data prior to measuring dynamic pelvic sway patterns during a six minute walk test in people with and without Multiple Sclerosis (MS). Optical motion capture was used as the gold standard. Improved wearable device accuracy (≤4.4% NRMSE) was achieved using gyroscopic corrections and scaling filter thresholds by step frequency. The people with MS presented significantly greater pelvis sway range to compensate for their lower limb weaknesses and joint contractures. The visualisation of asymmetric pelvic sway in people with MS illustrates the potential to better understand their mobility impairments for reducing fall risk.
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Affiliation(s)
- Matthew A D Brodie
- a Neuroscience Research Australia , University of New South Wales , Sydney , Australia
| | - Michael Psarakis
- b Faculty of Health Sciences , Australian Catholic University , Sydney , Australia
| | - Phu Hoang
- a Neuroscience Research Australia , University of New South Wales , Sydney , Australia
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Brodie MA, Lord SR, Coppens MJ, Annegarn J, Delbaere K. Eight-Week Remote Monitoring Using a Freely Worn Device Reveals Unstable Gait Patterns in Older Fallers. IEEE Trans Biomed Eng 2015; 62:2588-94. [PMID: 25993701 DOI: 10.1109/tbme.2015.2433935] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Develop algorithms to detect gait impairments remotely using data from freely worn devices during long-term monitoring. Identify statistical models that describe how gait performances are distributed over several weeks. Determine the data window required to reliably assess an increased propensity for falling. METHODS 1085 days of walking data were collected from eighteen independent-living older people (mean age 83 years) using a freely worn pendant sensor (housing a triaxial accelerometer and pressure sensor). Statistical distributions from several accelerometer-derived gait features (encompassing quantity, exposure, intensity, and quality) were compared for those with and without a history of falling. RESULTS Participants completed more short walks relative to long walks, as approximated by a power law. Walks less than 13.1 s comprised 50% of exposure to walking-related falls. Daily-life cadence was bimodal and step-time variability followed a log-normal distribution. Fallers took significantly fewer steps per walk and had relatively more exposure from short walks and greater mode of step-time variability. CONCLUSIONS Using a freely worn device and wavelet-based analysis tools allowed long-term monitoring of walks greater than or equal to three steps. In older people, short walks constitute a large proportion of exposure to falls. To identify fallers, mode of variability may be a better measure of central tendency than mean of variability. A week's monitoring is sufficient to reliably assess the long-term propensity for falling. SIGNIFICANCE Statistical distributions of gait performances provide a reference for future wearable device development and research into the complex relationships between daily-life walking patterns, morbidity, and falls.
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Brodie MA, Wang K, Delbaere K, Persiani M, Lovell NH, Redmond SJ, Del Rosario MB, Lord SR. New Methods to Monitor Stair Ascents Using a Wearable Pendant Device Reveal How Behavior, Fear, and Frailty Influence Falls in Octogenarians. IEEE Trans Biomed Eng 2015; 62:2595-601. [DOI: 10.1109/tbme.2015.2464689] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wearable pendant device monitoring using new wavelet-based methods shows daily life and laboratory gaits are different. Med Biol Eng Comput 2015; 54:663-74. [PMID: 26245255 DOI: 10.1007/s11517-015-1357-9] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
Abstract
Morbidity and falls are problematic for older people. Wearable devices are increasingly used to monitor daily activities. However, sensors often require rigid attachment to specific locations and shuffling or quiet standing may be confused with walking. Furthermore, it is unclear whether clinical gait assessments are correlated with how older people usually walk during daily life. Wavelet transformations of accelerometer and barometer data from a pendant device worn inside or outside clothing were used to identify walking (excluding shuffling or standing) by 51 older people (83 ± 4 years) during 25 min of 'free-living' activities. Accuracy was validated against annotated video. Training and testing were separated. Activities were only loosely structured including noisy data preceding pendant wearing. An electronic walkway was used for laboratory comparisons. Walking was classified (accuracy ≥97 %) with low false-positive errors (≤1.9%, κ ≥ 0.90). Median free-living cadence was lower than laboratory-assessed cadence (101 vs. 110 steps/min, p < 0.001) but correlated (r = 0.69). Free-living step time variability was significantly higher and uncorrelated with laboratory-assessed variability unless detrended. Remote gait impairment monitoring using wearable devices is feasible providing new ways to investigate morbidity and falls risk. Laboratory-assessed gait performances are correlated with free-living walks, but likely reflect the individual's 'best' performance.
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Brodie MAD, Canning CG, Beijer TR, Lord SR. Uncontrolled head oscillations in people with Parkinson's disease may reflect an inability to respond to perturbations while walking. Physiol Meas 2015; 36:873-81. [PMID: 25832116 DOI: 10.1088/0967-3334/36/5/873] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Fall injuries in people with Parkinson's disease (PD) are a major health problem. Increased sway while walking is a risk factor and further understanding of this destabilizing gait change may assist with rehabilitation and help prevent falls.Here, stride-to-stride head oscillations are used to help characterise different aspects of gait impairment in 10 people with PD on medication (67 years, SD 4), 10 healthy age-matched (HAM) participants (66 years, SD 7), and 10 young (30 years, SD 7). A wearable accelerometer was used to analyse head oscillations during five repeat 17 m walks by each participant.People with PD had significantly faster transverse plane head oscillations than the HAM or young groups; both along mediolateral (PD 47.2 cm s(-1), HAM 32.5 cm s(-1), and young 32.7 cm s(-1)) and anterioposterior axes (PD 33.3 cm s(-1), HAM 24.5 cm s(-1), and young 20.6 cm s(-1)). These differences were uncorrelated with reduced vertical oscillation velocity (PD 15.5 cm s(-1), HAM 18.8 cm s(-1), and young 20.1 cm s(-1)) and reduced walking speed (PD 1.2 m s(-1), HAM 1.4 m s(-1), and young 1.4 m s(-1)).Increased transverse plane head oscillations in people with PD may reflect motor impairment and the inability to respond sufficiently to perturbations while walking, which appears to be distinct from gait hyperkinesia, reduced vertical oscillations, step length, and walking speed.
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