Parameterization and reliability of single-leg balance test assessed with inertial sensors in stroke survivors: a cross-sectional study

Iliotibial band tightness and internal rotation of the tibia in the stance phase of running associated with patella instability

Management of patellar instability is still a clinical challenge, especially in pediatric and adolescent athletes. The purpose of the study was to check the association between the positive apprehension test (which is a sign of patellar instability) and positive Ober's test [which is a sign of a tight iliotibial band (ITB)] and the lower degree of internal rotation of the tibia in young athletes determined by inertial sensors. The participants of this observational case-control study were 56 young athletes aged 10-15. The moving patellar apprehension test for lateral patellar instability and Ober's test for assessing the flexibility of the ITB were performed on all participants. There were 32 sides with positive apprehension tests (cases) and 80 with negative apprehension tests (controls). The degree of internal rotation of the tibia was determined with an inertial sensor. Internal rotation of the tibia in the stance phase of running was lower in the case group than in the control group. Logistic regression analysis showed that the degree of internal rotation of the tibia in the stance phase of running was a good predictor of patellar instability. Our study illustrates that wearable devices can be valuable in determining possible initial patellar instability. Using inertial sensors, a strong association between patellar instability, ITB tightness, and lower internal rotation of the tibia in the stance phase of running was determined. The significance of this study might be the possibility of preventing damage or dislocations of the patella by improving the elasticity of the ITB, which is particularly relevant since patellar instability is common among adolescents.

Accelerometry in the Functional Assessment of Balance in People with Stroke: A Systematic Review

Balance disturbances in people with lived experience of stroke affect activities of daily living and social participation, so assessing them is essential to know the level of functional independence. Accelerometers are electronic devices that allow kinematic variables of balance to be recorded and are a tool of great interest in the assessment of functional balance. To determine the validity and reliability of, as well as the most performed protocols using accelerometers in the functional assessment of balance in people with experience of stroke, a systematic search of articles published in the electronic databases PubMed, Scopus, the Web of Science, the Cochrane Library, the PEDro and the Virtual Health Library from Spain was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We used QUADAS-2 to assess the quality of the included studies. Eight studies met the inclusion criteria, two studied reliability and validity, two studied reliability and four studied the validity of accelerometers in the assessment of balance in people with stroke. All studies indicated the kind of accelerometer, localization on the body, tests and outcome variables. The results indicate that accelerometers show excellent reliability values in the assessment of balance in people who had a prior stroke and disparate results in terms of validity. Triaxial accelerometers were most used, and the 4th and 5th lumbar and 1st and 2nd sacral vertebrae were the body areas most used for their placement.

Effects of Virtual Reality on Transtibial Amputation Rehabilitation Outcomes: A Randomized Study

Purpose: Virtual reality is widely used in patients with chronic musculoskeletal problems. However, the short-term effects on individuals with transtibial (TT) amputation during this process remain unclear. This study aimed at investigating the effects of virtual reality on rehabilitation outcomes in TT amputees. Methods: The study included 20 TT amputees who were using TT prostheses. The participants were divided into two groups randomly as follows: physiotherapy (PT) and virtual reality (VR). Participants were treated 3 days a week, for 4 weeks, and evaluations were made before and after treatment; a 6-minute walk test was used for performance, a single-leg balance test for balance, Trinity Amputation Prosthesis Experience Scale for prosthesis satisfaction, a 10-meter walking test for gait speed, and a wearable smart t-shirt to determine cadence. Results: It was found that there was a statistically significant difference in performance, balance, prosthesis satisfaction, cadence, and gait speed before and after PT (P < 0.05). There were differences in terms of performance, prosthesis satisfaction, balance, cadence, and gait speed before and after VR (P < 0.05). There was no statistically significant difference between PT and VR (P > 0.05). Conclusion: The 4 weeks of VR training improved performance, prosthesis satisfaction, balance, cadence, and gait speed in TT amputation rehabilitation similar to physiotherapy methods. The addition of VR training to amputation rehabilitation will bring improvements since it is a fun and safe intervention. Clinical Trial Registration: The trial is registered at Clinical Trials.gov, Trial No: NCT03872193.

A scoping review on recent trends in wearable sensors to analyze gait in people with stroke: From sensor placement to validation against gold-standard equipment

The purpose of the review is to evaluate wearable sensor placement, their impact and validation of wearable sensors on analyzing gait, primarily the postural instability in people with stroke. Databases, namely PubMed, Cochrane, SpringerLink, and IEEE Xplore were searched to identify related articles published since January 2005. The authors have selected the articles by considering patient characteristics, intervention details, and outcome measurements by following the priorly set inclusion and exclusion criteria. From a total of 1077 articles, 142 were included in this study and classified into functional fields, namely postural stability (PS) assessments, physical activity monitoring (PA), gait pattern classification (GPC), and foot drop correction (FDC). The review covers the types of wearable sensors, their placement, and their performance in terms of reliability and validity. When employing a single wearable sensor, the pelvis and foot were the most used locations for detecting gait asymmetry and kinetic parameters, respectively. Multiple Inertial Measurement Units placed at different body parts were effectively used to estimate postural stability and gait pattern. This review article has compared results of placement of sensors at different locations helping researchers and clinicians to identify the best possible placement for sensors to measure specific kinematic and kinetic parameters in persons with stroke.

Potential of Whole-Body Vibration in Parkinson’s Disease: A Systematic Review and Meta-Analysis of Human and Animal Studies

Simple Summary

Exercise has shown to have a positive impact on both motor and non-motor functions in Parkinson’s Disease patients. However, particularly in later stages of the disease, reduced cognitive function and motor capacity may lead to an inability to stay physically active. Therefore, alternative strategies for patients with Parkinson’s Disease are necessary to minimize burden for patients, their families and public health care. Whole-Body Vibration could be such an alternative. Whole-Body Vibration is an exercise or treatment method in which subjects are exposed to a mechanical vibration while sitting, standing or exercising on a vibrating platform. Whole-Body Vibration is currently used for physiotherapy, sports and rehabilitation purposes. Whole-Body Vibration treatment is interesting because it affects both the body and brain. The potential of Whole-Body Vibration for, specifically, Parkinson’s Disease patients should be clarified for further application. For this purpose, we conducted an extensive systematic review of the articles investigating the effects of Whole-Body Vibrations (1) on animals and humans with Parkinson’s Disease and (2) on neuropathological Parkinson’s Disease mechanisms. The results show some potential of Whole-Body Vibration for Parkinson’s Disease patients. The recommendations provided by this review can be used by researchers and rehabilitative practitioners implementing Whole-Body Vibration as a treatment for Parkinson’s Disease patients.

Abstract

(1) Background: When the severity of Parkinson’s Disease (PD) increases, patients often have difficulties in performing exercises. Whole-Body Vibration (WBV) may be a suitable alternative. This systematic review aims to clarify if WBV shows potential as rehabilitative therapy for PD patients. (2) Methods: We searched several databases for controlled trials investigating the effects of WBV (1) on PD populations and (2) PD neuropathological mechanisms. We included both human and animal studies and performed meta-analyses. (3) Results: The studies on PD populations (14 studies) show an overall significant, but small, effect in favor of WBV (Hedges’ g = 0.28), for which the effects on stability (Hedges’ g = 0.39) and balance (Hedges’ g = 0.30) are the most prominent. The studies on the neuropathological mechanisms (18 studies) show WBV effects on neuroinflammation (Hedges’ g = –1.12) and several specific WBV effects on neurotransmitter systems, growth factors, neurogenesis, synaptic plasticity and oxidative stress. (4) Conclusions: The effects of WBV on human PD patients remains inconclusive. Nevertheless, WBV protocols with sufficient duration (≥3 weeks), session frequency (≥3 sessions/week) and vibration frequency (≥20 Hz) show potential as a treatment method, especially for motor function. The potential of WBV for PD patients is confirmed by the effects on the neuropathological mechanisms in mostly non-PD populations. We recommend high-quality future studies on both PD patients and PD mouse models to optimize WBV protocols and to examine the neuropathological mechanisms in PD populations.

Best Quantitative Tools for Assessing Static and Dynamic Standing Balance after Stroke: A Systematic Review

Purpose: Our objective was to examine the psychometric qualities (reliability and validity) and clinical utility of quantitative tools in measuring the static and dynamic standing balance of individuals after stroke. Method: We searched four databases (PubMed/MEDLINE, PEDro, Embase, and CINAHL) for studies published from January 2018 through September 2019 and included those that assessed the psychometric properties of standing balance tests with an adult stroke population. We evaluated the quality of the studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist and assessed each test on a utility assessment scale. Results: A total of 22 studies met the inclusion criteria, and 18 quantitative tools for assessing static or dynamic standing balance of individuals with stroke were analyzed. Findings support good or excellent reliability for all tests, whereas correlations for validity ranged from weak to strong. Study quality was variable. Dynamic balance tests had better clinical utility scores than static ones. Five tests had complete psychometric analyses: quiet standing on a force platform, five-step test, sideways step, step length, and turn tests.

Effect of Sitting Ba-Duan-Jin Exercises on Balance and Quality of Life Among Older Adults: A Preliminary Study

PURPOSE

The aim of this study was to ascertain whether ba-duan-jin (BDJ) can improve balance and enhance the quality of life among older adults.

DESIGN

This pilot study was designed as a single group pre-post comparison test.

METHODS

Sixteen older adults were qualified and recruited for this study at local retirement communities. Assessments for pre- and postintervention among the subjects included Single-Leg Stance, Chair Rising Test, Tinetti Balance Test, Modified Falls Efficacy Scale, and 12-Item Short Form Health Survey Questionnaire for quality of life.

FINDINGS

After 12 weeks of BDJ training, significant improvements were identified in Single-Leg Stance, Tinetti Balance Test, Modified Falls Efficacy Scale, and 12-Item Short Form Health Survey (all p < .01); however not for the Chair Rising Test (p > .05).

CONCLUSION

The results indicate that BDJ can improve balance, lower extremity strength, quality of life, and decrease fear of falling among older adults.

CLINICAL RELEVANCE

BDJ is an effective rehabilitation training method and can improve balance and motor function among older people. Rehabilitation nursing plays a key role in functional rehabilitation of older people.

Accuracy and Repeatability of Spatiotemporal Gait Parameters Measured with an Inertial Measurement Unit

In recent years, interest in finding alternatives for the evaluation of mobility has increased. Inertial measurement units (IMUs) stand out for their portability, size, and low price. The objective of this study was to examine the accuracy and repeatability of a commercially available IMU under controlled conditions in healthy subjects. A total of 36 subjects, including 17 males and 19 females were analyzed with a Wiva Science IMU in a corridor test while walking for 10 m and in a threadmill at 1.6 km/h, 2.4 km/h, 3.2 km/h, 4 km/h, and 4.8 km/h for one minute. We found no difference when we compared the variables at 4 km/h and 4.8 km/h. However, we found greater differences and errors at 1.6 km/h, 2.4 km/h and 3.2 km/h, and the latter one (1.6 km/h) generated more error. The main conclusion is that the Wiva Science IMU is reliable at high speeds but loses reliability at low speeds.

Fifteen Years of Wireless Sensors for Balance Assessment in Neurological Disorders

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.

Analyzing the Use of Accelerometers as a Method of Early Diagnosis of Alterations in Balance in Elderly People: A Systematic Review

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.

Positive verbal suggestion optimizes postural control

Balance is a very important function that allows maintaining a stable stance needed for many daily life activities and for preventing falls. We investigated whether balance control could be improved by a placebo procedure consisting of verbal suggestion. Thirty healthy volunteers were randomized in two groups (placebo and control) and asked to perform a single-leg stance task in which they had to stand as steadily as possible on the dominant leg. The task was repeated in three sessions (T0, T1, T2). At T1 and T2 an inert treatment was applied on the leg, by informing the placebo group that it was effective in improving balance. The control group was overtly told that treatment was inert. An accelerometer applied on participants’ leg allowed to measure body sways in different directions. Subjective parameters, like perception of stability, were also collected. Results showed that the placebo group had less body sways than the control group at T2, both in the three-dimensional space and in the anterior-posterior direction. Furthermore, the placebo group perceived to be more stable than the control group. This study represents the first evidence that placebo effect optimizes posture, with a potential translational impact in patients with postural and gait disturbances.

Sensory-motor impairments of ipsilesional extremities and its impact on activity limitations following stroke

Background/Aims

Stroke can result in various motor and sensory impairments on contralesional as well as ipsilesional limbs. This study examined the impact on activity limitations as a result of sensory and motor impairments of ipsilesional limbs following stroke.

Methods

A cross-sectional study was used to assess 50 adults with stroke (acute: n=6, subacute: n=10, chronic: n=34) and 50 age- and gender-matched typically healthy adults. The Modified Ashworth Scale, the Brunnstrom Approach, Nottingham Sensory Assessment, Star Cancellation Test, Right-Left Orientation Test, Trunk Impairment Scale, Single Leg Stance Test, and the Fugl Mayer Assessment were used to measure outcomes for ipsilesional side impairments. Activity limitations were scored using the Wisconsin Gait Scale and the Motor Assessment Scale.

Results

A comparison of all impairments: tonal, voluntary control, sensation, perception, sitting and standing balance, and coordination of the ipsilesional extremity of persons with hemiparesis with corresponding extremity of typically healthy adults using unpaired t-test, showed significant impairment (P<0.05). Every participant with stroke had at least one impairment on their ipsilesional side, with 8% of participants having only one impairment, 36% had two impairments, 28% had three impairments, 18% had four impairments, 8% had five impairments and 2% had all six impairments on their ipsilesional side. The percentage of participants with stroke presenting with trunk impairment was highest (100%) and that of voluntary control impairment was lowest (24%) on their ipsilesional side. The relationship between identified impairments and activity limitations was calculated using Pearson’s correlation at 0.05 level, which showed a moderate negative correlation with the Wisconsin Gait Scale and a moderate positive correlation with the Motor Assessment Scale.

Conclusions

Ipsilesional impairments present in people with hemiparesis have a significant impact on the activity limitation; hence it is necessary to address ipsilesional impairments along with contralesional impairments.

Evaluating physical function and activity in the elderly patient using wearable motion sensors

Wearable sensors, in particular inertial measurement units (IMUs) allow the objective, valid, discriminative and responsive assessment of physical function during functional tests such as gait, stair climbing or sit-to-stand.

Applied to various body segments, precise capture of time-to-task achievement, spatiotemporal gait and kinematic parameters of demanding tests or specific to an affected limb are the most used measures.

In activity monitoring (AM), accelerometry has mainly been used to derive energy expenditure or general health related parameters such as total step counts.

In orthopaedics and the elderly, counting specific events such as stairs or high intensity activities were clinimetrically most powerful; as were qualitative parameters at the ‘micro-level’ of activity such as step frequency or sit-stand duration.

Low cost and ease of use allow routine clinical application but with many options for sensors, algorithms, test and parameter definitions, choice and comparability remain difficult, calling for consensus or standardisation.

Cite this article: Grimm B, Bolink S. Evaluating physical function and activity in the elderly patient using wearable motion sensors. EFORT Open Rev 2016;1:112–120. DOI: 10.1302/2058-5241.1.160022.

Experimental Validation of Depth Cameras for the Parameterization of Functional Balance of Patients in Clinical Tests

In clinical practice, patients’ balance can be assessed using standard scales. Two of the most validated clinical tests for measuring balance are the Timed Up and Go (TUG) test and the MultiDirectional Reach Test (MDRT). Nowadays, inertial sensors (IS) are employed for kinematic analysis of functional tests in the clinical setting, and have become an alternative to expensive, 3D optical motion capture systems. In daily clinical practice, however, IS-based setups are yet cumbersome and inconvenient to apply. Current depth cameras have the potential for such application, presenting many advantages as, for instance, being portable, low-cost and minimally-invasive. This paper aims at experimentally validating to what extent this technology can substitute IS for the parameterization and kinematic analysis of the TUG and the MDRT tests. Twenty healthy young adults were recruited as participants to perform five different balance tests while kinematic data from their movements were measured by both a depth camera and an inertial sensor placed on their trunk. The reliability of the camera’s measurements is examined through the Interclass Correlation Coefficient (ICC), whilst the Pearson Correlation Coefficient (r) is computed to evaluate the correlation between both sensor’s measurements, revealing excellent reliability and strong correlations in most cases.

Foot Dorsiflexion Velocity and Torque Variance Explained through Architectural and Electromyography Variables Comparing Elders and Stroke Survivors

OBJECTIVES

The objectives of this study are to analyze the relationship between electromyographic variables, tibialis anterior (TA) architecture, and functional variables (torque and kinematic variables) during maximal isometric and isotonic foot dorsiflexion (FD), and to compare the described relationship between stroke survivors (SS) and healthy elders (HE).

METHODS

Twenty-eight participants (14 SS and 14 HE) over 65 years old performed 3 maximal isometric and isotonic FDs parameterized by ultrasound, electromyography (EMG), inertial sensor, and load cell. Common variables (TA) include muscle thickness, pennation angle, muscle activation, and EMG area under the curve. Specific variables include torque for isometric FD, and velocity and displacement for isotonic FD.

RESULTS

There are significant differences in all variables when comparing the 2 groups. Among these differences, all the outcome variables show higher values in the HE group than in the SS group. However, in the 2 dependent variables obtained during isometric FD (median and maximal torques), the independent variables can explain nearly 70% of the variability of the dependent variable, with values of 68.4%-71.9% for SS and 69.1%-70.2% for HE. Similar results were found during isotonic FD.

CONCLUSIONS

Even though the TA of the SS group is capable of generating less force (isometric FD) and is slower (isotonic FD) than that of the HE group, the contribution of the independent variables (muscle activation, pennation angle,and muscle thickness) can explain the same proportion of variability of the dependent variables.

Mobile Functional Reach Test in People Who Suffer Stroke: A Pilot Study

Background

Postural instability is one of the major complications found in people who survive a stroke. Parameterizing the Functional Reach Test (FRT) could be useful in clinical practice and basic research, as this test is a clinically accepted tool (for its simplicity, reliability, economy, and portability) to measure the semistatic balance of a subject.

Objective

The aim of this study is to analyze the reliability in the FRT parameterization using inertial sensor within mobile phones (mobile sensors) for recording kinematic variables in patients who have suffered a stroke. Our hypothesis is that the sensors in mobile phones will be reliable instruments for kinematic study of the FRT.

Methods

This is a cross-sectional study of 7 subjects over 65 years of age who suffered a stroke. During the execution of FRT, the subjects carried two mobile phones: one placed in the lumbar region and the other one on the trunk. After analyzing the data obtained in the kinematic registration by the mobile sensors, a number of direct and indirect variables were obtained. The variables extracted directly from FRT through the mobile sensors were distance, maximum angular lumbosacral/thoracic displacement, time for maximum angular lumbosacral/thoracic displacement, time of return to the initial position, and total time. Using these data, we calculated speed and acceleration of each. A descriptive analysis of all kinematic outcomes recorded by the two mobile sensors (trunk and lumbar) was developed and the average range achieved in the FRT. Reliability measures were calculated by analyzing the internal consistency of the measures with 95% confidence interval of each outcome variable. We calculated the reliability of mobile sensors in the measurement of the kinematic variables during the execution of the FRT.

Results

The values in the FRT obtained in this study (2.49 cm, SD 13.15) are similar to those found in other studies with this population and with the same age range. Intrasubject reliability values observed in the use of mobile phones are all located above 0.831, ranging from 0.831 (time B_C trunk area) and 0.894 (displacement A_B trunk area). Likewise, the observed intersubject values range from 0.835 (time B_C trunk area) and 0.882 (displacement A_C trunk area). On the other hand, the reliability of the FRT was 0.989 (0.981-0.996) and 0.978 (0.970-0.985), intrasubject and intersubject respectively.

Conclusions

We found that mobile sensors in mobile phones could be reliable tools in the parameterization of the Functional Reach Test in people who have had a stroke.

Comparison of kinematic variables obtained by inertial sensors among stroke survivors and healthy older adults in the Functional Reach Test: cross-sectional study

BACKGROUND

Balance dysfunction is one of the most common problems in people who suffer stroke. To parameterize functional tests standardized by inertial sensors have been promoted in applied medicine. The aim of this study was to compare the kinematic variables of the Functional Reach Test (FRT) obtained by two inertial sensors placed on the trunk and lumbar region between stroke survivors (SS) and healthy older adults (HOA) and to analyze the reliability of the kinematic measurements obtained.

METHODS

Cross-sectional study. Five SS and five HOA over 65. A descriptive analysis of the average range as well as all kinematic variables recorded was developed. The intrasubject and intersubject reliability of the measured variables was directly calculated.

RESULTS

In the same intervals, the angular displacement was greater in the HOA group; however, they were completed at similar times for both groups, and HOA conducted the test at a higher speed and greater acceleration in each of the intervals. The SS values were higher than HOA values in the maximum and minimum acceleration in the trunk and in the lumbar region.

CONCLUSIONS

The SS show less functional reach, a narrower, slower and less accelerated movement during the FRT execution, but with higher peaks of acceleration and speed when they are compared with HOA.