Fourier-based integration of quasi-periodic gait accelerations for drift-free displacement estimation using inertial sensors

Validation of inertial measurement units based on waveform similarity assessment against a photogrammetry system for gait kinematic analysis

When assessing gait analysis outcomes for clinical use, it is indispensable to use an accurate system ensuring a minimal measurement error. Inertial Measurement Units (IMUs) are a versatile motion capture system to evaluate gait kinematics during out-of-lab activities and technology-assisted rehabilitation therapies. However, IMUs are susceptible to distortions, offset and drifting. Therefore, it is important to have a validated instrumentation and recording protocol to ensure the reliability of the measurements, to differentiate therapy effects from system-induced errors. A protocol was carried out to validate the accuracy of gait kinematic assessment with IMUs based on the similarity of the waveform of concurrent signals captured by this system and by a photogrammetry reference system. A gait database of 32 healthy subjects was registered synchronously with both devices. The validation process involved two steps: 1) a preliminary similarity assessment using the Pearson correlation coefficient, and 2) a similarity assessment in terms of correlation, displacement and gain by estimating the offset between signals, the difference between the registered range of motion (∆ROM), the root mean square error (RMSE) and the interprotocol coefficient of multiple correlation (CMCP). Besides, the CMCP was recomputed after removing the offset between signals (CMCPoff). The correlation was strong (r > 0.75) for both limbs for hip flexion/extension, hip adduction/abduction, knee flexion/extension and ankle dorsal/plantar flexion. These joint movements were studied in the second part of the analysis. The ∆ROM values obtained were smaller than 6°, being negligible relative to the minimally clinically important difference (MCID) estimated for unaffected limbs, and the RMSE values were under 10°. The offset for hips and ankles in the sagittal plane reached -9° and -8°, respectively, whereas hips adduction/abduction and knees flexion/extension were around 1°. According to the CMCP, the kinematic pattern of hip flexion/extension (CMCP > 0.90) and adduction/abduction (CMCP > 0.75), knee flexion/extension (CMCP > 0.95) and ankle dorsi/plantar flexion (CMCP > 0.90) were equivalent when captured by each system synchronously. However, after offset correction, only hip flexion/extension (CMCPoff = 1), hip adduction/abduction (CMCPoff > 0.85) and knee flexion/extension (CMCPoff > 0.95) satisfied the conditions to be considered similar.

Gait Monitoring and Analysis: A Mathematical Approach

Gait abnormalities are common in the elderly and individuals diagnosed with Parkinson's, often leading to reduced mobility and increased fall risk. Monitoring and assessing gait patterns in these populations play a crucial role in understanding disease progression, early detection of motor impairments, and developing personalized rehabilitation strategies. In particular, by identifying gait irregularities at an early stage, healthcare professionals can implement timely interventions and personalized therapeutic approaches, potentially delaying the onset of severe motor symptoms and improving overall patient outcomes. In this paper, we studied older adults affected by chronic diseases and/or Parkinson's disease by monitoring their gait due to wearable devices that can accurately detect a person's movements. In our study, about 50 people were involved in the trial (20 with Parkinson's disease and 30 people with chronic diseases) who have worn our device for at least 6 months. During the experimentation, each device collected 25 samples from the accelerometer sensor for each second. By analyzing those data, we propose a metric for the "gait quality" based on the measure of entropy obtained by applying the Fourier transform.

Drift-Free 3D Orientation and Displacement Estimation for Quasi-Cyclical Movements Using One Inertial Measurement Unit: Application to Running

A Drift-Free 3D Orientation and Displacement estimation method (DFOD) based on a single inertial measurement unit (IMU) is proposed and validated. Typically, body segment orientation and displacement methods rely on a constant- or zero-velocity point to correct for drift. Therefore, they are not easily applicable to more proximal segments than the foot. DFOD uses an alternative single sensor drift reduction strategy based on the quasi-cyclical nature of many human movements. DFOD assumes that the quasi-cyclical movement occurs in a quasi-2D plane and with an approximately constant cycle average velocity. DFOD is independent of a constant- or zero-velocity point, a biomechanical model, Kalman filtering or a magnetometer. DFOD reduces orientation drift by assuming a cyclical movement, and by defining a functional coordinate system with two functional axes. These axes are based on the mean acceleration and rotation axes over multiple complete gait cycles. Using this drift-free orientation estimate, the displacement of the sensor is computed by again assuming a cyclical movement. Drift in displacement is reduced by subtracting the mean value over five gait cycle from the free acceleration, velocity, and displacement. Estimated 3D sensor orientation and displacement for an IMU on the lower leg were validated with an optical motion capture system (OMCS) in four runners during constant velocity treadmill running. Root mean square errors for sensor orientation differences between DFOD and OMCS were 3.1 ± 0.4° (sagittal plane), 5.3 ± 1.1° (frontal plane), and 5.0 ± 2.1° (transversal plane). Sensor displacement differences had a root mean square error of 1.6 ± 0.2 cm (forward axis), 1.7 ± 0.6 cm (mediolateral axis), and 1.6 ± 0.2 cm (vertical axis). Hence, DFOD is a promising 3D drift-free orientation and displacement estimation method based on a single IMU in quasi-cyclical movements with many advantages over current methods.

Calibration-Free Gait Assessment by Foot-Worn Inertial Sensors

Walking is a central activity of daily life, and there is an increasing demand for objective measurement-based gait assessment. In contrast to stationary systems, wearable inertial measurement units (IMUs) have the potential to enable non-restrictive and accurate gait assessment in daily life. We propose a set of algorithms that uses the measurements of two foot-worn IMUs to determine major spatiotemporal gait parameters that are essential for clinical gait assessment: durations of five gait phases for each side as well as stride length, walking speed, and cadence. Compared to many existing methods, the proposed algorithms neither require magnetometers nor a precise mounting of the sensor or dedicated calibration movements. They are therefore suitable for unsupervised use by non-experts in indoor as well as outdoor environments. While previously proposed methods are rarely validated in pathological gait, we evaluate the accuracy of the proposed algorithms on a very broad dataset consisting of 215 trials and three different subject groups walking on a treadmill: healthy subjects (n = 39), walking at three different speeds, as well as orthopedic (n = 62) and neurological (n = 36) patients, walking at a self-selected speed. The results show a very strong correlation of all gait parameters (Pearson's r between 0.83 and 0.99, p < 0.01) between the IMU system and the reference system. The mean absolute difference (MAD) is 1.4 % for the gait phase durations, 1.7 cm for the stride length, 0.04 km/h for the walking speed, and 0.7 steps/min for the cadence. We show that the proposed methods achieve high accuracy not only for a large range of walking speeds but also in pathological gait as it occurs in orthopedic and neurological diseases. In contrast to all previous research, we present calibration-free methods for the estimation of gait phases and spatiotemporal parameters and validate them in a large number of patients with different pathologies. The proposed methods lay the foundation for ubiquitous unsupervised gait assessment in daily-life environments.

Sparse Visual-Inertial Measurement Units Placement for Gait Kinematics Assessment

This study investigates the possibility of estimating lower-limb joint kinematics and meaningful performance indexes for physiotherapists, during gait on a treadmill based on data collected from a sparse placement of new Visual Inertial Measurement Units (VIMU) and the use of an Extended Kalman Filter (EKF). The proposed EKF takes advantage of the biomechanics of the human body and of the investigated task to reduce sensor inaccuracies. Two state-vector formulations, one based on the use of constant acceleration model and one based on Fourier series, and the tuning of their corresponding parameters were analyzed. The constant acceleration model, due to its inherent inconsistency for human motion, required a cumbersome optimisation process and needed the a-priori knowledge of reference joint trajectories for EKF parameters tuning. On the other hand, the Fourier series formulation could be used without a specific parameters tuning process. In both cases, the average root mean square difference and correlation coefficient between the estimated joint angles and those reconstructed with a reference stereophotogrammetric system was 3.5deg and 0.70, respectively. Moreover, the stride lengths were estimated with a normalized root mean square difference inferior to 2% when using the forward kinematics model receiving as input the estimated joint angles. The popular gait deviation index was also estimated and showed similar results very close to 100, using both the proposed method and the reference stereophotogrammetric system. Such consistency was obtained using only three wireless and affordable VIMU located at the pelvis and both heels and tracked using two affordable RGB cameras. Being further easy-to-use and suitable for applications taking place outside of the laboratory, the proposed method thus represents a good compromise between accurate reference stereophotogrammetric systems and markerless ones for which accuracy is still under debate.

PyTHang: an open-source wearable sensor system for real-time monitoring of head-torso angle for ambulatory applications

This article presents the realization of a low-cost wearable sensor system and its Python-based software that can measure and record relative head-torso angle, especially in sagittal plane. The system is mainly developed to track head-torso angle during walk in a clinical study. The open-hardware part of the system is composed of a pair of triaxial digital accelerometers, a microprocessor, a Bluetooth module and a rechargeable battery unit. The reception of the transmitted acceleration data, visualization, interactive sensor alignment, angle estimation and data-logging are realized by the developed open-source graphical user interface. The system is tested on a tripod for verification and on a subject for practical demonstration. Developed system can be constructed and used for ambulatory monitoring and analysis of relative head-torso angle. Open-source user interface can be downloaded and developed for further (different) algorithms and device hardware.

Robust Step Detection from Different Waist-Worn Sensor Positions: Implications for Clinical Studies

Analyzing human gait with inertial sensors provides valuable insights into a wide range of health impairments, including many musculoskeletal and neurological diseases. A representative and reliable assessment of gait requires continuous monitoring over long periods and ideally takes place in the subjects' habitual environment (real-world). An inconsistent sensor wearing position can affect gait characterization and influence clinical study results, thus clinical study protocols are typically highly proscriptive, instructing all participants to wear the sensor in a uniform manner. This restrictive approach improves data quality but reduces overall adherence. In this work, we analyze the impact of altering the sensor wearing position around the waist on sensor signal and step detection. We demonstrate that an asymmetrically worn sensor leads to additional odd-harmonic frequency components in the frequency spectrum. We propose a robust solution for step detection based on autocorrelation to overcome sensor position variation (sensitivity = 0.99, precision = 0.99). The proposed solution reduces the impact of inconsistent sensor positioning on gait characterization in clinical studies, thus providing more flexibility to protocol implementation and more freedom to participants to wear the sensor in the position most comfortable to them. This work is a first step towards truly position-agnostic gait assessment in clinical settings.

Validity and reliability of wearable inertial sensors in healthy adult walking: a systematic review and meta-analysis

BACKGROUND

Inertial measurement units (IMUs) offer the ability to measure walking gait through a variety of biomechanical outcomes (e.g., spatiotemporal, kinematics, other). Although many studies have assessed their validity and reliability, there remains no quantitive summary of this vast body of literature. Therefore, we aimed to conduct a systematic review and meta-analysis to determine the i) concurrent validity and ii) test-retest reliability of IMUs for measuring biomechanical gait outcomes during level walking in healthy adults.

METHODS

Five electronic databases were searched for journal articles assessing the validity or reliability of IMUs during healthy adult walking. Two reviewers screened titles, abstracts, and full texts for studies to be included, before two reviewers examined the methodological quality of all included studies. When sufficient data were present for a given biomechanical outcome, data were meta-analyzed on Pearson correlation coefficients (r) or intraclass correlation coefficients (ICC) for validity and reliability, respectively. Alternatively, qualitative summaries of outcomes were conducted on those that could not be meta-analyzed.

RESULTS

A total of 82 articles, assessing the validity or reliability of over 100 outcomes, were included in this review. Seventeen biomechanical outcomes, primarily spatiotemporal parameters, were meta-analyzed. The validity and reliability of step and stride times were found to be excellent. Similarly, the validity and reliability of step and stride length, as well as swing and stance time, were found to be good to excellent. Alternatively, spatiotemporal parameter variability and symmetry displayed poor to moderate validity and reliability. IMUs were also found to display moderate reliability for the assessment of local dynamic stability during walking. The remaining biomechanical outcomes were qualitatively summarized to provide a variety of recommendations for future IMU research.

CONCLUSIONS

The findings of this review demonstrate the excellent validity and reliability of IMUs for mean spatiotemporal parameters during walking, but caution the use of spatiotemporal variability and symmetry metrics without strict protocol. Further, this work tentatively supports the use of IMUs for joint angle measurement and other biomechanical outcomes such as stability, regularity, and segmental accelerations. Unfortunately, the strength of these recommendations are limited based on the lack of high-quality studies for each outcome, with underpowered and/or unjustified sample sizes (sample size median 12; range: 2-95) being the primary limitation.

Improving the Accuracy of Wearable Sensors for Human Locomotion Tracking Using Phase-Locked Regression Models

The trend toward soft wearable robotic systems creates a compelling need for new and reliable sensor systems that do not require a rigid mounting frame. Despite the growing use of inertial measurement units (IMUs) in motion tracking applications, sensor drift and IMU-to-segment misalignment still represent major problems in applications requiring high accuracy. This paper proposes a novel 2-step calibration method which takes advantage of the periodic nature of human locomotion to improve the accuracy of wearable inertial sensors in measuring lower-limb joint angles. Specifically, the method was applied to the determination of the hip joint angles during walking tasks. The accuracy and precision of the calibration method were accessed in a group of N =8 subjects who walked with a custom-designed inertial motion capture system at 85% and 115% of their comfortable pace, using an optical motion capture system as reference. In light of its low computational complexity and good accuracy, the proposed approach shows promise for embedded applications, including closed-loop control of soft wearable robotic systems.

Continuous Digital Monitoring of Walking Speed in Frail Elderly Patients: Noninterventional Validation Study and Longitudinal Clinical Trial

BACKGROUND

Digital technologies and advanced analytics have drastically improved our ability to capture and interpret health-relevant data from patients. However, only limited data and results have been published that demonstrate accuracy in target indications, real-world feasibility, or the validity and value of these novel approaches.

OBJECTIVE

This study aimed to establish accuracy, feasibility, and validity of continuous digital monitoring of walking speed in frail, elderly patients with sarcopenia and to create an open source repository of raw, derived, and reference data as a resource for the community.

METHODS

Data described here were collected as a part of 2 clinical studies: an independent, noninterventional validation study and a phase 2b interventional clinical trial in older adults with sarcopenia. In both studies, participants were monitored by using a waist-worn inertial sensor. The cross-sectional, independent validation study collected data at a single site from 26 naturally slow-walking elderly subjects during a parcours course through the clinic, designed to simulate a real-world environment. In the phase 2b interventional clinical trial, 217 patients with sarcopenia were recruited across 32 sites globally, where patients were monitored over 25 weeks, both during and between visits.

RESULTS

We have demonstrated that our approach can capture in-clinic gait speed in frail slow-walking adults with a residual standard error of 0.08 m per second in the independent validation study and 0.08, 0.09, and 0.07 m per second for the 4 m walk test (4mWT), 6-min walk test (6MWT), and 400 m walk test (400mWT) standard gait speed assessments, respectively, in the interventional clinical trial. We demonstrated the feasibility of our approach by capturing 9668 patient-days of real-world data from 192 patients and 32 sites, as part of the interventional clinical trial. We derived inferred contextual information describing the length of a given walking bout and uncovered positive associations between the short 4mWT gait speed assessment and gait speed in bouts between 5 and 20 steps (correlation of 0.23) and longer 6MWT and 400mWT assessments with bouts of 80 to 640 steps (correlations of 0.48 and 0.59, respectively).

CONCLUSIONS

This study showed, for the first time, accurate capture of real-world gait speed in slow-walking older adults with sarcopenia. We demonstrated the feasibility of long-term digital monitoring of mobility in geriatric populations, establishing that sufficient data can be collected to allow robust monitoring of gait behaviors outside the clinic, even in the absence of feedback or incentives. Using inferred context, we demonstrated the ecological validity of in-clinic gait assessments, describing positive associations between in-clinic performance and real-world walking behavior. We make all data available as an open source resource for the community, providing a basis for further study of the relationship between standardized physical performance assessment and real-world behavior and independence.

Validity of accelerometry in step detection and gait speed measurement in orthogeriatric patients

BACKGROUND

Mobile accelerometry is a powerful and promising option to capture long-term changes in gait in both clinical and real-world scenarios. Increasingly, gait parameters have demonstrated their value as clinical outcome parameters, but validation of these parameters in elderly patients is still limited.

OBJECTIVE

The aim of this study was to implement a validation framework appropriate for elderly patients and representative of real-world settings, and to use this framework to test and improve algorithms for mobile accelerometry data in an orthogeriatric population.

METHODS

Twenty elderly subjects wearing a 3D-accelerometer completed a parcours imitating a real-world scenario. High-definition video and mobile reference speed capture served to validate different algorithms.

RESULTS

Particularly at slow gait speeds, relevant improvements in accuracy have been achieved. Compared to the reference the deviation was less than 1% in step detection and less than 0.05 m/s in gait speed measurements, even for slow walking subjects (< 0.8 m/s).

CONCLUSION

With the described setup, algorithms for step and gait speed detection have successfully been validated in an elderly population and demonstrated to have improved performance versus previously published algorithms. These results are promising that long-term and/or real-world measurements are possible with an acceptable accuracy even in elderly frail patients with slow gait speeds.

Continuous Analysis of Running Mechanics by Means of an Integrated INS/GPS Device

This paper describes a single body-mounted sensor that integrates accelerometers, gyroscopes, compasses, barometers, a GPS receiver, and a methodology to process the data for biomechanical studies. The sensor and its data processing system can accurately compute the speed, acceleration, angular velocity, and angular orientation at an output rate of 400 Hz and has the ability to collect large volumes of ecologically-valid data. The system also segments steps and computes metrics for each step. We analyzed the sensitivity of these metrics to changing the start time of the gait cycle. Along with traditional metrics, such as cadence, speed, step length, and vertical oscillation, this system estimates ground contact time and ground reaction forces using machine learning techniques. This equipment is less expensive and cumbersome than the currently used alternatives: Optical tracking systems, in-shoe pressure measurement systems, and force plates. Another advantage, compared to existing methods, is that natural movement is not impeded at the expense of measurement accuracy. The proposed technology could be applied to different sports and activities, including walking, running, motion disorder diagnosis, and geriatric studies. In this paper, we present the results of tests in which the system performed real-time estimation of some parameters of walking and running which are relevant to biomechanical research. Contact time and ground reaction forces computed by the neural network were found to be as accurate as those obtained by an in-shoe pressure measurement system.

Estimation of spatio-temporal parameters of gait from magneto-inertial measurement units: multicenter validation among Parkinson, mildly cognitively impaired and healthy older adults

Background

The use of miniaturized magneto-inertial measurement units (MIMUs) allows for an objective evaluation of gait and a quantitative assessment of clinical outcomes. Spatial and temporal parameters are generally recognized as key metrics for characterizing gait. Although several methods for their estimate have been proposed, a thorough error analysis across different pathologies, multiple clinical centers and on large sample size is still missing. The aim of this study was to apply a previously presented method for the estimate of spatio-temporal parameters, named Trusted Events and Acceleration Direct and Reverse Integration along the direction of Progression (TEADRIP), on a large cohort (236 patients) including Parkinson, mildly cognitively impaired and healthy older adults collected in four clinical centers. Data were collected during straight-line gait, at normal and fast walking speed, by attaching two MIMUs just above the ankles. The parameters stride, step, stance and swing durations, as well as stride length and gait velocity, were estimated for each gait cycle. The TEADRIP performance was validated against data from an instrumented mat.

Results

Limits of agreements computed between the TEADRIP estimates and the reference values from the instrumented mat were − 27 to 27 ms for Stride Time, − 68 to 44 ms for Stance Time, − 31 to 31 ms for Step Time and − 67 to 52 mm for Stride Length. For each clinical center, the mean absolute errors averaged across subjects for the estimation of temporal parameters ranged between 1 and 4%, being on average less than 3% (< 30 ms). Stride length mean absolute errors were on average 2% (≈ 25 mm). Error comparisons across centers did not show any significant difference. Significant error differences were found exclusively for stride and step durations between healthy elderly and Parkinsonian subjects, and for the stride length between walking speeds.

Conclusions

The TEADRIP method was effectively validated on a large number of healthy and pathological subjects recorded in four different clinical centers. Results showed that the spatio-temporal parameters estimation errors were consistent with those previously found on smaller population samples in a single center. The combination of robustness and range of applicability suggests the use of the TEADRIP as a suitable MIMU-based method for gait spatio-temporal parameter estimate in the routine clinical use. The present paper was awarded the “SIAMOC Best Methodological Paper 2017”.

Benchmarking Foot Trajectory Estimation Methods for Mobile Gait Analysis

Mobile gait analysis systems based on inertial sensing on the shoe are applied in a wide range of applications. Especially for medical applications, they can give new insights into motor impairment in, e.g., neurodegenerative disease and help objectify patient assessment. One key component in these systems is the reconstruction of the foot trajectories from inertial data. In literature, various methods for this task have been proposed. However, performance is evaluated on a variety of datasets due to the lack of large, generally accepted benchmark datasets. This hinders a fair comparison of methods. In this work, we implement three orientation estimation and three double integration schemes for use in a foot trajectory estimation pipeline. All methods are drawn from literature and evaluated against a marker-based motion capture reference. We provide a fair comparison on the same dataset consisting of 735 strides from 16 healthy subjects. As a result, the implemented methods are ranked and we identify the most suitable processing pipeline for foot trajectory estimation in the context of mobile gait analysis.

Joint Inertial Sensor Orientation Drift Reduction for Highly Dynamic Movements

Inertial sensor drift is usually corrected on a single-sensor unit level. When multiple sensor units are used, mutual information from different units can be exploited for drift correction. This study introduces a method for a drift-reduced estimation of three dimensional (3-D) segment orientations and joint angles for motion capture of highly dynamic movements as present in many sports. 3-D acceleration measured on two adjacent segments is mapped to the connecting joint. Drift is estimated and reduced based on the mapped accelerations' vector orientation differences in the global frame. Algorithm validity is assessed on the example of alpine ski racing. Shank, thigh, and trunk inclination as well as knee and hip flexion were compared to a multicamera-based reference system. For specific leg angles and trunk segment inclination mean accuracy and precision were below 3.9° and 6.0°, respectively. The errors were similar to errors reported in other studies for lower dynamic movements. Drift increased axis misalignment and mainly affected joint and segment angles of highly flexed joints such as the knee or hip during a ski turn.

Ambulatory Assessment of Instantaneous Velocity during Walking Using Inertial Sensor Measurements

A novel approach for estimating the instantaneous velocity of the pelvis during walking was developed based on Inertial Measurement Units (IMUs). The instantaneous velocity was modeled by the sum of a cyclical component, decomposed in the Medio-Lateral (ML), VerTical (VT) and Antero-Posterior (AP) directions, and the Average Progression Velocity (APV) over each gait cycle. The proposed method required the availability of two IMUs, attached to the pelvis and one shank. Gait cycles were identified from the shank angular velocity; for each cycle, the Fourier series coefficients of the pelvis and shank acceleration signals were computed. The cyclical component was estimated by Fourier-based time-integration of the pelvis acceleration. A Bayesian Linear Regression (BLR) with Automatic Relevance Determination (ARD) predicted the APV from the stride time, the stance duration, and the Fourier series coefficients of the shank acceleration. Healthy subjects performed tasks of Treadmill Walking (TW) and Overground Walking (OW), and an optical motion capture system (OMCS) was used as reference for algorithm performance assessment. The widths of the limits of agreements (±1.96 standard deviation) were computed between the proposed method and the reference OMCS, yielding, for the cyclical component in the different directions: ML: ±0.07 m/s (±0.10 m/s); VT: ±0.03 m/s (±0.05 m/s); AP: ±0.06 m/s (±0.10 m/s), in TW (OW) conditions. The ARD-BLR achieved an APV root mean square error of 0.06 m/s (0.07 m/s) in the same conditions.