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Tendolkar P, Ibironke O, Marchesi G, De Luca A, Squeri V, Nolan KJ, Pilkar R, Karunakaran KK. Relationship between Timed Up and Go performance and quantitative biomechanical measures of balance. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1220427. [PMID: 38566622 PMCID: PMC10985617 DOI: 10.3389/fresc.2024.1220427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/01/2024] [Indexed: 04/04/2024]
Abstract
Traumatic brain injury (TBI) impairs sensory-motor functions, with debilitating consequences on postural control and balance, which persist during the chronic stages of recovery. The Timed Up and Go (TUG) test is a reliable, safe, time-efficient, and one of the most widely used clinical measures to assess gait, balance, and fall risk in TBI patients and is extensively used in inpatient and outpatient settings. Although the TUG test has been used extensively due to its ease of performance and excellent reliability, limited research has been published that investigates the relationship between TUG performance and quantitative biomechanical measures of balance. The objective of this paper was to quantify the relationship between biomechanical variables of balance and the TUG scores in individuals with chronic TBI. Regression models were constructed using six biomechanical variables to predict TUG scores. The model that conservatively removed gait speed (i.e., TUG-1/GS) gave the best results, achieving a root-mean-square error of ∼±2 s and explaining over 69% of the variability.
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Affiliation(s)
- Prasad Tendolkar
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | - Oluwaseun Ibironke
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
| | | | | | | | - Karen J. Nolan
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
| | - Rakesh Pilkar
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- ActiGraph, LLC, Pensacola, FL, United States
| | - Kiran K. Karunakaran
- Center for Mobility and Rehabilitation Engineering Research, Kessler Foundation, West Orange, NJ, United States
- Department of Physical Medicine and Rehabilitation, Rutgers—New Jersey Medical School, Newark, NJ, United States
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Basini G, Rambelli C, Galletti M, Zerbinati P, Prati P, Mascioli F, Masiero S, Mazzoli D, Merlo A. Short-term effects of foot surgery on walking-related pain, function, and satisfaction in patients with Charcot-Marie-Tooth disease: a prospective cohort study. Front Neurol 2024; 14:1304258. [PMID: 38269004 PMCID: PMC10807423 DOI: 10.3389/fneur.2023.1304258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/11/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Patients with Charcot-Marie-Tooth disease (CMT) often suffer from walking-related pain (WRP), muscle weakness, foot deformities, and reduced ankle dorsiflexion (DF), which affects their ability to walk and daily activities. Functional surgery (FS) can restore foot deviations, affecting the loading ability during gait. We assessed the short-term effects of FS in patients with CMT on WRP, foot and ankle structure, and function, along with patients' perceived improvement. Methods This is a prospective cohort study on CMT patients who had undergone FS and rehabilitation. We analyzed the changes after 1 month, focusing on WRP, DF, the center of pressure progression (COPP) during walking, and measures of walking ability. The non-parametric Wilcoxon test was used. Results Ten patients were included. One month after FS, WRP reduced from 5.5 (IQR = 3.5) to 2 (IQR = 3.5), p = 0.063, with an effect size of 0.615. The highest decrease was found in patients with very high pre-surgical pain levels. DF almost reached 10° for both active and passive movements (p < 0.05), and COPP improved from 44 to 60% (p = 0.009) of foot length. Gait speed, lower limb functioning, and balance did not change. More than half of the sample felt improved or much improved after FS. Conclusion FS can be effective in reducing WRP and restoring foot posture in CMT patients in the short-term, which allows them to wear shoes, and leads to a perceived improvement and satisfaction. Lack of improvement in functional skills may be due to muscle weakness typical of CMT. Studies with longer follow-ups may confirm these hypotheses.
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Affiliation(s)
- Giacomo Basini
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
| | - Chiara Rambelli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padova, Italy
| | - Martina Galletti
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
| | - Paolo Zerbinati
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
- Neuro-Orthopedic Unit, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
| | - Paolo Prati
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
| | - Francesca Mascioli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padova, Italy
| | - Davide Mazzoli
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
| | - Andrea Merlo
- Gait and Motion Analysis Laboratory, Sol et Salus Hospital, Torre Pedrera di Rimini, Italy
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Lesch KJ, Hyrylä VV, Eronen T, Kupari S, Stenroth L, Venojärvi M, Tarvainen MP, Tikkanen HO. Young type 1 diabetes subjects sway more than healthy persons when somatosensory system is challenged in static standing postural stability tests. Clin Physiol Funct Imaging 2024; 44:56-62. [PMID: 37455246 DOI: 10.1111/cpf.12849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
In type 1 diabetes, it is important to prevent diabetes-related complications and postural instability may be one clinically observable manifestation early on. This study was set to investigate differences between type 1 diabetics and healthy controls in variables of instrumented posturography assessment to inform about the potential of the assessment in early detection of diabetes-related complications. Eighteen type 1 diabetics with no apparent complications (HbA1c = 58 ± 9 mmol/L, diabetes duration = 15 ± 7 years) and 35 healthy controls underwent six 1-min two feet standing postural stability tests on a force plate. Study groups were comparable in age and anthropometric and performed the test with eyes open, eyes closed (EC), and EC head up with and without unstable padding. Type 1 diabetics exhibited greater sway (path length, p = 0.044 and standard deviation of velocity, p = 0.039) during the EC test with the unstable pad. Also, power spectral density indicated greater relative power (p = 0.043) in the high-frequency band in the test with EC head up on the unstable pad and somatosensory activity increased more (p = 0.038) when the unstable pad was added to the EC test. Type 1 diabetes may induce subtle changes in postural control requiring more active balancing when stability is challenged. Postural assessment using a portable easy-to-use force plate shows promise in detecting a diabetes-related decline in postural control that may be used as a sensitive biomarker of early-phase diabetes-related complications.
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Affiliation(s)
- Kim J Lesch
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Vesa V Hyrylä
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Timo Eronen
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Saana Kupari
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Lauri Stenroth
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Mika Venojärvi
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mika P Tarvainen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Heikki O Tikkanen
- Institute of Biomedicine, Sports and Exercise Medicine, University of Eastern Finland, Kuopio, Finland
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Cudejko T, Button K, Al-Amri M. Wireless pressure insoles for measuring ground reaction forces and trajectories of the centre of pressure during functional activities. Sci Rep 2023; 13:14946. [PMID: 37696840 PMCID: PMC10495386 DOI: 10.1038/s41598-023-41622-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/29/2023] [Indexed: 09/13/2023] Open
Abstract
Wireless pressure insoles may enable the assessment of movement biomechanics in a real-world setting, and thus play an important role in the recommendation of clinical management, but they are not yet a gold standard due to the unknown accuracy and reliability with respect to different functional activities. Here, we compare novel wireless pressure insoles with force plates and examine the test-retest reliability of the insoles for measuring vertical ground reaction forces (vGRFs) and trajectories of the center of pressure (COP). In this observational study, healthy adults underwent two data collection sessions during one day. The Bland-Altman analysis was used to compare the outcomes measured with the two instruments during squats, jumps, and the sit-to-stand test. Test-retest reliability was assessed by the interclass correlation coefficient and the standard error of measurement for the outcomes during squats, jumps, walking, and stair ambulation. Trajectories of the COP in the anterior-posterior direction were comparable between the two systems during all activities. The insoles consistently measured shorter trajectories of the COP in the medial-lateral direction (except jumps) and lower vGRFs than the force plates. Test-retest reliability of the insoles was fair to high or excellent for all outcomes during all activities. In conclusion, the insoles provide reliable measures of vGRFs and trajectories of the COP during multiple functional activities in healthy adults. Although the insoles do not produce identical results to the force plate, the qualitative similarity and consistency between the two systems confirm the insoles can be used to measure these outcomes, based on the purpose and accuracy required.
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Affiliation(s)
- T Cudejko
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle Upon Tyne, NE1 8ST, UK
| | - K Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4EP, UK
| | - M Al-Amri
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, CF14 4EP, UK.
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Manupibul U, Tanthuwapathom R, Jarumethitanont W, Kaimuk P, Limroongreungrat W, Charoensuk W. Integration of force and IMU sensors for developing low-cost portable gait measurement system in lower extremities. Sci Rep 2023; 13:10653. [PMID: 37391570 PMCID: PMC10313649 DOI: 10.1038/s41598-023-37761-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/27/2023] [Indexed: 07/02/2023] Open
Abstract
Gait analysis is the method to accumulate walking data. It is useful in diagnosing diseases, follow-up of symptoms, and rehabilitation post-treatment. Several techniques have been developed to assess human gait. In the laboratory, gait parameters are analyzed by using a camera capture and a force plate. However, there are several limitations, such as high operating costs, the need for a laboratory and a specialist to operate the system, and long preparation time. This paper presents the development of a low-cost portable gait measurement system by using the integration of flexible force sensors and IMU sensors in outdoor applications for early detection of abnormal gait in daily living. The developed device is designed to measure ground reaction force, acceleration, angular velocity, and joint angles of the lower extremities. The commercialized device, including the motion capture system (Motive-OptiTrack) and force platform (MatScan), is used as the reference system to validate the performance of the developed system. The results of the system show that it has high accuracy in measuring gait parameters such as ground reaction force and joint angles in lower limbs. The developed device has a strong correlation coefficient compared with the commercialized system. The percent error of the motion sensor is below 8%, and the force sensor is lower than 3%. The low-cost portable device with a user interface was successfully developed to measure gait parameters for non-laboratory applications to support healthcare applications.
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Affiliation(s)
- Udomporn Manupibul
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
| | - Ratikanlaya Tanthuwapathom
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
| | - Wimonrat Jarumethitanont
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
- Faculty of Physical Therapy, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
| | - Panya Kaimuk
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
| | - Weerawat Limroongreungrat
- College of Sports Science and Technology, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
| | - Warakorn Charoensuk
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand.
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Nurse CA, Elstub LJ, Volgyesi P, Zelik KE. How Accurately Can Wearable Sensors Assess Low Back Disorder Risks during Material Handling? Exploring the Fundamental Capabilities and Limitations of Different Sensor Signals. SENSORS (BASEL, SWITZERLAND) 2023; 23:2064. [PMID: 36850663 PMCID: PMC9963039 DOI: 10.3390/s23042064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Low back disorders (LBDs) are a leading occupational health issue. Wearable sensors, such as inertial measurement units (IMUs) and/or pressure insoles, could automate and enhance the ergonomic assessment of LBD risks during material handling. However, much remains unknown about which sensor signals to use and how accurately sensors can estimate injury risk. The objective of this study was to address two open questions: (1) How accurately can we estimate LBD risk when combining trunk motion and under-the-foot force data (simulating a trunk IMU and pressure insoles used together)? (2) How much greater is this risk assessment accuracy than using only trunk motion (simulating a trunk IMU alone)? We developed a data-driven simulation using randomized lifting tasks, machine learning algorithms, and a validated ergonomic assessment tool. We found that trunk motion-based estimates of LBD risk were not strongly correlated (r range: 0.20-0.56) with ground truth LBD risk, but adding under-the-foot force data yielded strongly correlated LBD risk estimates (r range: 0.93-0.98). These results raise questions about the adequacy of a single IMU for LBD risk assessment during material handling but suggest that combining an IMU on the trunk and pressure insoles with trained algorithms may be able to accurately assess risks.
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Affiliation(s)
- Cameron A. Nurse
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Laura Jade Elstub
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Peter Volgyesi
- Institute for Software Integrated Systems, Vanderbilt University, Nashville, TN 37212, USA
| | - Karl E. Zelik
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37212, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN 37212, USA
- Department of Physical Medicine & Rehabilitation, Vanderbilt University, Nashville, TN 37212, USA
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Oubre B, Lane S, Holmes S, Boyer K, Lee SI. Estimating Ground Reaction Force and Center of Pressure using Low-Cost Wearable Devices. IEEE Trans Biomed Eng 2021; 69:1461-1468. [PMID: 34648428 DOI: 10.1109/tbme.2021.3120346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Ambulatory monitoring of ground reaction force (GRF) and center of pressure (CoP) could improve management of health conditions that impair mobility. Insoles instrumented with force-sensitive resistors (FSRs) are an unobtrusive, low-cost, and low-power technology for sampling GRF and CoP in real-world environments. However, FSRs have variable response characteristics that complicate estimation of GRF and CoP. This study introduces a unique data analytic pipeline that enables accurate estimation of GRF and CoP despite relatively inaccurate FSR responses. This paper also investigates whether inclusion of a complementary knee angle sensor improves estimation accuracy. METHODS Seventeen healthy subjects were equipped with an insole instrumented with six FSRs and a string-based knee angle sensor. Subjects walked in a straight line at self-selected slow, preferred, and fast speeds over an in-ground force platform. Twenty repetitions were performed for each speed. Supervised machine learning models estimated weight-normalized GRF and shoe size-normalized CoP, which were re-scaled to obtain GRF and CoP. RESULTS Anteroposterior GRF, Vertical GRF, and Anteroposterior CoP were estimated with a normalized root mean square error (NRMSE) of less than 5%. Mediolateral GRF and CoP were estimated with an NRMSE of 8.1% and 6.4%$ respectively. Knee angle-related features slightly improved GRF estimates. CONCLUSION Normalized models accurately estimated GRF and CoP despite deficiencies in FSR data. SIGNIFICANCE Ambulatory use of the proposed system could enable objective, longitudinal monitoring of severity and progression for a variety of health conditions.
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Ison C, Neilsen C, DeBerardinis J, Trabia MB, Dufek JS. Use of Pressure-Measuring Insoles to Characterize Gait Parameters in Simulated Reduced-Gravity Conditions. SENSORS 2021; 21:s21186244. [PMID: 34577451 PMCID: PMC8473299 DOI: 10.3390/s21186244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/28/2021] [Accepted: 09/14/2021] [Indexed: 11/16/2022]
Abstract
Prior researchers have observed the effect of simulated reduced-gravity exercise. However, the extent to which lower-body positive-pressure treadmill (LBPPT) walking alters kinematic gait characteristics is not well understood. The purpose of the study was to investigate the effect of LBPPT walking on selected gait parameters in simulated reduced-gravity conditions. Twenty-nine college-aged volunteers participated in this cross-sectional study. Participants wore pressure-measuring insoles (Medilogic GmBH, Schönefeld, Germany) and completed three 3.5-min walking trials on the LBPPT (AlterG, Inc., Fremont, CA, USA) at 100% (normal gravity) as well as reduced-gravity conditions of 40% and 20% body weight (BW). The resulting insole data were analyzed to calculate center of pressure (COP) variables: COP path length and width and stance time. The results showed that 100% BW condition was significantly different from both the 40% and 20% BW conditions, p < 0.05. There were no significant differences observed between the 40% and 20% BW conditions for COP path length and width. Conversely, stance time significantly differed between the 40% and 20% BW conditions. The findings of this study may prove beneficial for clinicians as they develop rehabilitation strategies to effectively unload the individual's body weight to perform safe exercises.
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Affiliation(s)
- Christian Ison
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA;
- Correspondence: ; Tel.: +1-626-824-4007
| | - Connor Neilsen
- Department of Mechanical Engineering, University of Nevada, Las Vegas, NV 89154, USA; (C.N.); (J.D.); (M.B.T.)
| | - Jessica DeBerardinis
- Department of Mechanical Engineering, University of Nevada, Las Vegas, NV 89154, USA; (C.N.); (J.D.); (M.B.T.)
| | - Mohamed B. Trabia
- Department of Mechanical Engineering, University of Nevada, Las Vegas, NV 89154, USA; (C.N.); (J.D.); (M.B.T.)
| | - Janet S. Dufek
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA;
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