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Raza A, Sekiguchi Y, Yaguchi H, Honda K, Fukushi K, Huang C, Ihara K, Nozaki Y, Nakahara K, Izumi SI, Ebihara S. Gait classification of knee osteoarthritis patients using shoe-embedded internal measurement units sensor. Clin Biomech (Bristol, Avon) 2024; 117:106285. [PMID: 38901396 DOI: 10.1016/j.clinbiomech.2024.106285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/14/2024] [Accepted: 06/03/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Knee osteoarthritis negatively affects the gait of patients, especially that of elderly people. However, the assessment of wearable sensors in knee osteoarthritis patients has been under-researched. During clinical assessments, patients may change their gait patterns under the placebo effect, whereas wearable sensors can be used in any environment. METHODS Sixty patients with knee osteoarthritis and 20 control subjects were included in the study. Wearing shoes with an IMU sensor embedded in the insoles, the participants were required to walk along a walkway. The sensor data were collected during the gait. To discriminate between healthy and knee osteoarthritis patients and to classify different subgroups of knee osteoarthritis patients (patients scheduled for surgery vs. patients not scheduled for surgery; bilateral knee osteoarthritis diagnosis vs. unilateral knee osteoarthritis diagnosis), we used a machine learning approach called the support vector machine. A total of 88 features were extracted and used for classification. FINDINGS The patients vs. healthy participants were classified with 71% accuracy, 85% sensitivity, and 56% specificity. The "patients scheduled for surgery" vs. "patients not scheduled for surgery" were classified with 83% accuracy, 83% sensitivity, and 81% specificity. The bilateral knee osteoarthritis diagnosis vs. unilateral knee osteoarthritis diagnosis was classified with 81% accuracy, 75% sensitivity, and 79% specificity. INTERPRETATION Gait analysis using wearable sensors and machine learning can discriminate between healthy and knee osteoarthritis patients and classify different subgroups with reasonable accuracy, sensitivity, and specificity. The proposed approach requires no complex gait factors and is not limited to controlled laboratory settings.
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Affiliation(s)
- Ahmed Raza
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | - Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan.
| | - Haruki Yaguchi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Keita Honda
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Kenichiro Fukushi
- Biometrics Research Labs, NEC Corporation, Hinode 1131, Abiko, Chiba 270-1174, Japan
| | - Chenhui Huang
- Biometrics Research Labs, NEC Corporation, Hinode 1131, Abiko, Chiba 270-1174, Japan
| | - Kazuki Ihara
- Biometrics Research Labs, NEC Corporation, Hinode 1131, Abiko, Chiba 270-1174, Japan
| | - Yoshitaka Nozaki
- Biometrics Research Labs, NEC Corporation, Hinode 1131, Abiko, Chiba 270-1174, Japan
| | - Kentaro Nakahara
- Biometrics Research Labs, NEC Corporation, Hinode 1131, Abiko, Chiba 270-1174, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan; Graduate School of Biomedical Engineering, Tohoku University, 2-1, Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
| | - Satoru Ebihara
- Department of Internal Medicine & Rehabilitation Science, Disability Sciences, Tohoku University Graduate School of Medicine,1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan
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Oliveira LKR, Marques AP, Andrade KFA, Assis JCSD, Brito AL, Souza GS, Callegari B. Virtual Reality in Improving Anticipatory Postural Adjustments to Step Initiation in Individuals with Knee Osteoarthritis: A Randomized Controlled Trial. Games Health J 2024; 13:100-108. [PMID: 38436585 DOI: 10.1089/g4h.2023.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Background: Virtual reality (VR) has been suggested as a new therapeutic approach in various sectors of rehabilitation, including the treatment of patients with knee osteoarthritis (OA), and one of its treatment goals is to improve the gait pattern and walking ability of patients. Objective: This study aimed to evaluate if VR, along with conventional physiotherapy treatment (CT), has superior effects to kinesiotherapy alone on pain, physical capacity, balance, and the parameters of anticipatory postural adjustments (APAs) in patients with knee OA. Design: This study is a single-blind randomized controlled trial. Setting: Secondary care at Hospital SARAH Network of Rehabilitation Hospitals, Brazil. Participants: Forty participants (31 women and 9 men) with knee OA in at least one knee and able to ambulate independently. Intervention: A rehabilitation program (8 consecutive weeks, 50-minute session, twice a week). Patients were randomized into the intervention groups CT or VR. Main Outcome Measures: Primary-latency of APA, amplitude of APA, and time to reach the maximum acceleration amplitude. Secondary-balance control by Mini-Balance Evaluation Systems Test, pain, and physical capacity by Western Ontario and McMaster Universities Arthritis Index. Results: The results of the study showed that conventional treatment significantly improved pain intensity, physical capacity, and balance in individuals with knee OA; however, only the group that used VR showed improvement in the APA parameters. Conclusion: This study demonstrated that VR associated with conventional treatment improved APAs in patients with knee OA.
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Affiliation(s)
- Luana Karine Resende Oliveira
- Laboratório de Estudos da Motricidade Humana, Belém, Pará, Brazil
- SARAH Network of Rehabilitation Hospitals, Brasília, Distrito Federal, Brazil
- Programa de Pós Graduação em Ciências do Movimento, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Amélia Pasqual Marques
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo, São Paulo, Brazil
| | | | - Jéssica Cristina Santos de Assis
- Laboratório de Estudos da Motricidade Humana, Belém, Pará, Brazil
- Programa de Pós Graduação em Ciências do Movimento, Universidade Federal do Pará, Belém, Pará, Brazil
- Programa de Pós Graduação em Neurociências e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Aymee Lobato Brito
- Laboratório de Estudos da Motricidade Humana, Belém, Pará, Brazil
- Programa de Pós Graduação em Neurociências e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Givago Silva Souza
- Programa de Pós Graduação em Neurociências e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil
- Programa de Pós Graduação em Doenças Tropicais, Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Pará, Brazil
| | - Bianca Callegari
- Laboratório de Estudos da Motricidade Humana, Belém, Pará, Brazil
- Programa de Pós Graduação em Ciências do Movimento, Universidade Federal do Pará, Belém, Pará, Brazil
- Programa de Pós Graduação em Neurociências e Biologia Celular, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Pará, Brazil
- Programa de Pós Graduação em Doenças Tropicais, Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Pará, Brazil
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Hommen JM, Batista JP, Bollheimer LC, Hildebrand F, Laurentius T, Siebers HL. Movement patterns during gait initiation in older adults with various stages of frailty: a biomechanical analysis. Eur Rev Aging Phys Act 2024; 21:1. [PMID: 38218828 PMCID: PMC10787464 DOI: 10.1186/s11556-024-00335-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND Gait initiation is challenging for older individuals with poor physical function, particularly for those with frailty. Frailty is a geriatric syndrome associated with increased risk of illness, falls, and functional decline. This study examines whether spatial and temporal parameters of gait initiation differ between groups of older adults with different levels of frailty, and whether fear of falling, and balance ability are correlated with the height of lifting the food during gait initiation. METHODS Sixty-one individuals aged > 65 years, classified by Fried frailty phenotype, performed five self-paced gait initiation trials. Data was collected using a three-dimensional passive optical motion capture system, consisting of 10 cameras with the ability to perceive reflective markers, and two force plates. The total duration of gait initiation and the duration of its four sub-phases, the first step length, and the maximum foot clearance during the first step were derived, and compared statistically between groups. Additionally, an association analysis was conducted between foot clearance and fear of falling, and confidence in balance in older individuals. RESULTS Frail individuals had significantly longer unloading durations, and total durations of gait initiation compared to non-frail older adults. Additionally, they had shorter first step lengths compared to non-frail older adults. Pre-frail older adults also showed shorter steps compared to the non-frail group. However, there were no significant differences between groups for the maximum foot clearance during the first step. Nevertheless, the maximum foot clearance of older individuals correlated significantly with their fear of falling and confidence in balance. CONCLUSION Older adults with reduced physical function and signs of frailty mainly display longer duration of gait initiation and decreased first step length compared to non-frail older adults. The release phase is decreased as the double support phase is prolonged in frail patients. This information can guide the development of specialized exercise programs to improve mobility in this challenging motion between static and dynamic balance.
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Affiliation(s)
- Jana Maria Hommen
- Department of Cardiology, St. Vinzenz-Hospital, Cologne, Germany.
- Department of Geriatric Medicine, Uniklinik RWTH Aachen, Aachen, Germany.
| | - João P Batista
- Chair for Physiotherapy, SRH University of Health, Leverkusen, Germany
| | | | - Frank Hildebrand
- Department of Orthopedic, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, Aachen, Germany
| | - Thea Laurentius
- Department of Geriatric Medicine, Uniklinik RWTH Aachen, Aachen, Germany
| | - Hannah Lena Siebers
- Department of Orthopedic, Trauma and Reconstructive Surgery, Uniklinik RWTH Aachen, Aachen, Germany
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Ting KC, Lin YC, Chan CT, Tu TY, Shih CC, Liu KC, Tsao Y. Inertial Measurement Unit-Based Romberg Test for Assessing Adults With Vestibular Hypofunction. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2023; 12:245-255. [PMID: 38196821 PMCID: PMC10776102 DOI: 10.1109/jtehm.2023.3334238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 08/22/2023] [Accepted: 10/18/2023] [Indexed: 01/11/2024]
Abstract
This work aims to explore the utility of wearable inertial measurement units (IMUs) for quantifying movement in Romberg tests and investigate the extent of movement in adults with vestibular hypofunction (VH). A cross-sectional study was conducted at an academic tertiary medical center between March 2021 and April 2022. Adults diagnosed with unilateral vestibular hypofunction (UVH) or bilateral vestibular hypofunction (BVH) were enrolled in the VH group. Healthy controls (HCs) were recruited from community or outpatient clinics. The IMU-based instrumented Romberg and tandem Romberg tests on the floor were applied to both groups. The primary outcomes were kinematic body metrics (maximum acceleration [ACC], mean ACC, root mean square [RMS] of ACC, and mean sway velocity [MV]) along the medio-lateral (ML), cranio-caudal (CC), and antero-posterior (AP) axes. A total of 31 VH participants (mean age, 33.48 [SD 7.68] years; 19 [61%] female) and 31 HCs (mean age, 30.65 [SD 5.89] years; 18 [58%] female) were recruited. During the eyes-closed portion of the Romberg test, VH participants demonstrated significantly higher maximum ACC and increased RMS of ACC in head movement, as well as higher maximum ACC in pelvic movement along the ML axis. In the same test condition, individuals with BVH exhibited notably higher maximum ACC and RMS of ACC along the ML axis in head and pelvic movements compared with HCs. Additionally, BVH participants exhibited markedly increased maximum ACC along the ML axis in head movement during the eyes-open portion of the tandem Romberg test. Conversely, no significant differences were found between UVH participants and HCs in the assessed parameters. The instrumented Romberg and tandem Romberg tests characterized the kinematic differences in head, pelvis, and ankle movement between VH and healthy adults. The findings suggest that these kinematic body metrics can be useful for screening BVH and can provide goals for vestibular rehabilitation.
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Affiliation(s)
- Kuan-Chung Ting
- Department of Otolaryngology-Head and Neck SurgeryTaipei Veterans General HospitalTaipei11217Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung UniversityTaipei11221Taiwan
- School of MedicineNational Yang Ming Chiao Tung UniversityTaipei11221Taiwan
| | - Yu-Chieh Lin
- Department of Biomedical EngineeringNational Yang Ming Chiao Tung UniversityTaipei11221Taiwan
| | - Chia-Tai Chan
- Department of Biomedical EngineeringNational Yang Ming Chiao Tung UniversityTaipei11221Taiwan
| | - Tzong-Yang Tu
- Department of Otolaryngology-Head and Neck SurgeryTaipei Veterans General HospitalTaipei11217Taiwan
| | - Chun-Che Shih
- Institute of Clinical Medicine, National Yang Ming Chiao Tung UniversityTaipei11221Taiwan
- Division of Cardiovascular SurgeryTaipei Municipal Wanfang HospitalTaipei11608Taiwan
- Taipei Heart Institute, Taipei Medical UniversityTaipei11013Taiwan
| | - Kai-Chun Liu
- Research Center for Information Technology InnovationAcademia SinicaTaipei11529Taiwan
| | - Yu Tsao
- Research Center for Information Technology InnovationAcademia SinicaTaipei11529Taiwan
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Antunes da Costa Moraes A, Brito Duarte M, Veloso Ferreira E, Cristina da Silva Almeida G, dos Santos Cabral A, de Athayde Costa e Silva A, Rosa Garcez D, Silva Souza G, Callegari B. Comparison of inertial records during anticipatory postural adjustments obtained with devices of different masses. PeerJ 2023; 11:e15627. [PMID: 37456867 PMCID: PMC10349560 DOI: 10.7717/peerj.15627] [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: 02/22/2023] [Accepted: 06/02/2023] [Indexed: 07/18/2023] Open
Abstract
Background Step initiation involves anticipatory postural adjustments (APAs) that can be measured using inertial measurement units (IMUs) such as accelerometers. However, previous research has shown heterogeneity in terms of the population studied, sensors used, and methods employed. Validity against gold standard measurements was only found in some studies, and the weight of the sensors varied from 10 to 110 g. The weight of the device is a crucial factor to consider when assessing APAs, as APAs exhibit significantly lower magnitudes and are characterized by discrete oscillations in acceleration paths. Objective This study aims to validate the performance of a commercially available ultra-light sensor weighing only 5.6 g compared to a 168-g smartphone for measuring APAs during step initiation, using a video capture kinematics system as the gold standard. The hypothesis is that APA oscillation measurements obtained with the ultra-light sensor will exhibit greater similarity to those acquired using video capture than those obtained using a smartphone. Materials and Methods Twenty subjects were evaluated using a commercial lightweight MetaMotionC accelerometer, a smartphone and a system of cameras-kinematics with a reflective marker on lumbar vertebrae. The subjects initiated 10 trials of gait after a randomized command from the experimenter and APA variables were extracted: APAonset, APAamp, PEAKtime. A repeated measures ANOVA with post-hoc test analyzed the effect of device on APA measurements. Bland-Altman plots were used to evaluate agreement between MetaMotionC, smartphone, and kinematics measurements. Pearson's correlation coefficients were used to assess device correlation. Percentage error was calculated for each inertial sensor against kinematics. A paired Student's t-test compared th devices percentage error. Results The study found no significant difference in temporal variables APAonset and PEAKtime between MetaMotionC, smartphone, and kinematic instruments, but a significant difference for variable APAamp, with MetaMotionC yielding smaller measurements. The MetaMotionC had a near-perfect correlation with kinematic data in APAonset and APAamp, while the smartphone had a very large correlation in APAamp and a near-perfect correlation in APAonset and PEAKtime. Bland-Altman plots showed non-significant bias between smartphone and kinematics for all variables, while there was a significant bias between MetaMotionC and kinematics for APAamp. The percentage of relative error was not significantly different between the smartphone and MetaMotionC. Conclusions The temporal analysis can be assessed using ultralight sensors and smartphones, as MetaMotionC and smartphone-based measurements have been found to be valid compared to kinematics. However, caution should be exercised when using ultralight sensors for amplitude measurements, as additional research is necessary to determine their effectiveness in this regard.
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Affiliation(s)
| | - Manuela Brito Duarte
- Laboratory of Human Motricity Studies, Federal University of Para, Belém, PA, Brazil
| | | | | | | | | | - Daniela Rosa Garcez
- University Hospital Bettina Ferro de Souza, Federal University of Para, Belém, PA, Brazil
| | - Givago Silva Souza
- Nucleous of Tropical Medicine, Federal University of Para, Belém, PA, Brazil
- Institute of Biological Science, Federal University of Para, Belém, PA, Brazil
| | - Bianca Callegari
- Laboratory of Human Motricity Studies, Federal University of Para, Belém, PA, Brazil
- Post Graduation Program in Human Movement Sciences, Federal University of Para, Belém, PA, Brazil
- Nucleous of Tropical Medicine, Federal University of Para, Belém, PA, Brazil
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Rabuffetti M, De Giovannini E, Carpinella I, Lencioni T, Fornia L, Ferrarin M. Association of 7-Day Profiles of Motor Activity in Marital Dyads with One Component Affected by Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:1087. [PMID: 36772127 PMCID: PMC9921738 DOI: 10.3390/s23031087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/12/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: A noticeable association between the motor activity (MA) profiles of persons living together has been found in previous studies. Social actigraphy methods have shown that this association, in marital dyads composed of healthy individuals, is greater than that of a single person compared to itself. This study aims at verifying the association of MA profiles in dyads where one component is affected by Parkinson's disease (PD). (2) Methods: Using a wearable sensor-based social actigraphy approach, we continuously monitored, for 7 days, the activities of 27 marital dyads including one component with PD. (3) Results: The association of motor activity profiles within a marital dyad (cross-correlation coefficient 0.344) is comparable to the association of any participant with themselves (0.325). However, when considering the disease severity quantified by the UPDRS III score, it turns out that the less severe the symptoms, the more associated are the MA profiles. (4) Conclusions: Our findings suggest that PD treatment could be improved by leveraging the MA of the healthy spouse, thus promoting lifestyles also beneficial for the component affected by PD. The actigraphy approach provided valuable information on habitual functions and motor fluctuations, and could be useful in investigating the response to treatment.
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Affiliation(s)
| | - Ennio De Giovannini
- Centro Medico Riabilita Cooperativa Sociale Mano Amica Onlus, 36015 Schio, Italy
| | | | | | - Luca Fornia
- IRCCS Fondazione Don Carlo Gnocchi, 20148 Milano, Italy
- Department of Medical Biotechnology and Translational Medicine, Università degli Studi di Milano, 20133 Milano, Italy
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Fantozzi S, Borra D, Cortesi M, Ferrari A, Ciacci S, Chiari L, Baroncini I. Aquatic Therapy after Incomplete Spinal Cord Injury: Gait Initiation Analysis Using Inertial Sensors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811568. [PMID: 36141834 PMCID: PMC9517342 DOI: 10.3390/ijerph191811568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 05/16/2023]
Abstract
Populations with potential damage to somatosensory, vestibular, and visual systems or poor motor control are often studied during gait initiation. Aquatic activity has shown to benefit the functional capacity of incomplete spinal cord injury (iSCI) patients. The present study aimed to evaluate gait initiation in iSCI patients using an easy-to-use protocol employing four wearable inertial sensors. Temporal and acceleration-based anticipatory postural adjustment measures were computed and compared between dry-land and water immersion conditions in 10 iSCI patients. In the aquatic condition, an increased first step duration (median value of 1.44 s vs. 0.70 s in dry-land conditions) and decreased root mean squared accelerations for the upper trunk (0.39 m/s2 vs. 0.72 m/s2 in dry-land conditions) and lower trunk (0.41 m/s2 vs. 0.85 m/s2 in dry-land conditions) were found in the medio-lateral and antero-posterior direction, respectively. The estimation of these parameters, routinely during a therapy session, can provide important information regarding different control strategies adopted in different environments.
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Affiliation(s)
- Silvia Fantozzi
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
- Health Sciences and Technologies—Interdepartmental Centre for Industrial Research, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Davide Borra
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Matteo Cortesi
- Department for Life Quality Studies, University of Bologna, Via del Pilastro 8, 40126 Bologna, Italy
- Correspondence:
| | - Alberto Ferrari
- Health Sciences and Technologies—Interdepartmental Centre for Industrial Research, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Simone Ciacci
- Department Biomedical and Neuromotor Sciences, University of Bologna, Via del Pilastro 8, 40126 Bologna, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
- Health Sciences and Technologies—Interdepartmental Centre for Industrial Research, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Ilaria Baroncini
- Montecatone Rehabilitation Institute S.p.A., Via Montecatone 37, 40026 Imola, Italy
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Posada-Ordax J, Cosin-Matamoros J, Losa-Iglesias ME, Becerro-de-Bengoa-Vallejo R, Esteban-Gonzalo L, Martin-Villa C, Calvo-Lobo C, Rodriguez-Sanz D. Accuracy and Repeatability of Spatiotemporal Gait Parameters Measured with an Inertial Measurement Unit. J Clin Med 2021; 10:jcm10091804. [PMID: 33919039 PMCID: PMC8122546 DOI: 10.3390/jcm10091804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/16/2021] [Accepted: 04/18/2021] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Jorge Posada-Ordax
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (J.P.-O.); (M.E.L.-I.)
| | - Julia Cosin-Matamoros
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
- Correspondence:
| | - Marta Elena Losa-Iglesias
- Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (J.P.-O.); (M.E.L.-I.)
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
| | - Laura Esteban-Gonzalo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
| | - Carlos Martin-Villa
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
| | - David Rodriguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (L.E.-G.); (C.M.-V.); (C.C.-L.); (D.R.-S.)
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Park JH, Kia K, Srinivasan D, Kim JH. Postural balance effects from exposure to multi-axial whole-body vibration in mining vehicle operation. APPLIED ERGONOMICS 2021; 91:103307. [PMID: 33202332 DOI: 10.1016/j.apergo.2020.103307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 06/11/2023]
Abstract
Twenty participants (18 males and 2 females) completed postural stability assessments before and after 4-h exposure to whole body vibration (WBV) in four experimental conditions: (a) vertical-dominant WBV with vertical passive air suspension, (b) multi-axial WBV with vertical passive air suspension, (c) multi-axial WBV with multi-axial active suspension, and (d) no WBV condition. Center of pressure (COP)-based postural sway measures significantly increased following multi-axial WBV exposure. Increase in COP velocity and displacement following multi-axial WBV was significantly higher than the increase in all the other exposure conditions. However, no significant differences between the WBV conditions were observed in functional limits of stability and anticipatory postural adjustments. While our results show standing balance to be impaired following the multi-axial WBV exposure of off-road mining vehicles, dynamic stability across a broader range of conditions needs to be understood to causally link postural stability decrements to increased fall-risks associated with off-road vehicle operators.
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Affiliation(s)
- Jang-Ho Park
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Kiana Kia
- School of Mechanical, Industrial, and Manufacturing Engineering, Oregon State University, Corvallis, OR, USA
| | - Divya Srinivasan
- Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, VA, USA
| | - Jeong Ho Kim
- School of Biological and Population Health Sciences, Oregon State University, Corvallis, OR, USA.
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10
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Gawronska A, Pajor A, Zamyslowska-Szmytke E, Rosiak O, Jozefowicz-Korczynska M. Usefulness of Mobile Devices in the Diagnosis and Rehabilitation of Patients with Dizziness and Balance Disorders: A State of the Art Review. Clin Interv Aging 2020; 15:2397-2406. [PMID: 33376315 PMCID: PMC7764625 DOI: 10.2147/cia.s289861] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The gold standard for objective body posture examination is posturography. Body movements are detected through the use of force platforms that assess static and dynamic balance (conventional posturography). In recent years, new technologies like wearable sensors (mobile posturography) have been applied during complex dynamic activities to diagnose and rehabilitate balance disorders. They are used in healthy people, especially in the aging population, for detecting falls in the older adults, in the rehabilitation of different neurological, osteoarticular, and muscular system diseases, and in vestibular disorders. Mobile devices are portable, lightweight, and less expensive than conventional posturography. The vibrotactile system can consist of an accelerometer (linear acceleration measurement), gyroscopes (angular acceleration measurement), and magnetometers (heading measurement, relative to the Earth’s magnetic field). The sensors may be mounted to the trunk (most often in the lumbar region of the spine, and the pelvis), wrists, arms, sternum, feet, or shins. Some static and dynamic clinical tests have been performed with the use of wearable sensors. Smartphones are widely used as a mobile computing platform and to evaluate the results or monitor the patient during the movement and rehabilitation. There are various mobile applications for smartphone-based balance systems. Future research should focus on validating the sensitivity and reliability of mobile device measurements compared to conventional posturography. Conclusion Smartphone based mobile devices are limited to one sensor lumbar level posturography and offer basic clinical evaluation. Single or multi sensor mobile posturography is available from different manufacturers and offers single to multi-level measurements, providing more data and in some instances even performing sophisticated clinical balance tests.
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Affiliation(s)
- Anna Gawronska
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Anna Pajor
- Department of Otolaryngology, Head and Neck Oncology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Ewa Zamyslowska-Szmytke
- Balance Disorders Unit, Department of Audiology and Phoniatrics, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Oskar Rosiak
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Magdalena Jozefowicz-Korczynska
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
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11
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Aharonson V, Seedat N, Israeli-Korn S, Hassin-Baer S, Postema M, Yahalom G. Automated Stage Discrimination of Parkinson’s Disease. BIO INTEGRATION 2020. [DOI: 10.15212/bioi-2020-0006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract Background: Treatment plans for Parkinson’s disease (PD) are based on a disease stage scale, which is generally determined using a manual, observational procedure. Automated, sensor-based discrimination saves labor and costs in clinical settings and
may offer augmented stage determination accuracy. Previous automated devices were either cumbersome or costly and were not suitable for individuals who cannot walk without support.Methods: Since 2017, a device has been available that successfully detects PD and operates for people
who cannot walk without support. In the present study, the suitability of this device for automated discrimination of PD stages was tested. The device consists of a walking frame fitted with sensors to simultaneously support walking and monitor patient gait. Sixty-five PD patients in Hoehn
and Yahr (HY) stages 1 to 4 and 24 healthy controls were subjected to supported Timed Up and Go (TUG) tests, while using the walking frame. The walking trajectory, velocity, acceleration and force were recorded by the device throughout the tests. These physical parameters were converted into
symptomatic spatiotemporal quantities that are conventionally used in PD gait assessment.Results: An analysis of variance (ANOVA) test extended by a confidence interval (CI) analysis indicated statistically significant separability between HY stages for the following spatiotemporal
quantities: TUG time (p < 0.001), straight line walking time (p < 0.001), turning time (p < 0.001), and step count (p < 0.001). A negative correlation was obtained for mean step velocity (p < 0.001) and mean step length (p < 0.001). Moreover, correlations were established
between these, as well as additional spatiotemporal quantities, and disease duration, L-dihydroxyphenylalanine-(L-DOPA) dose, motor fluctuation, dyskinesia and the mobile part of the Unified Parkinson Disease Rating Scale (UPDRS).Conclusions: We have proven that stage discrimination
of PD can be automated, even to patients who cannot support themselves. A similar method might be successfully applied to other gait disorders.
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Affiliation(s)
- Vered Aharonson
- School of Electrical and Information Engineering, University of the Witwatersrand, Johannesburg, South Africa
| | - Nabeel Seedat
- School of Electrical and Information Engineering, University of the Witwatersrand, Johannesburg, South Africa
| | - Simon Israeli-Korn
- The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Sharon Hassin-Baer
- The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Michiel Postema
- School of Electrical and Information Engineering, University of the Witwatersrand, Johannesburg, South Africa
| | - Gilad Yahalom
- The Movement Disorders Institute, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
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12
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Kamieniarz A, Michalska J, Marszałek W, Akbaş A, Słomka KJ, Krzak-Kubica A, Rudzińska-Bar M, Juras G. Transitional Locomotor Tasks in People With Mild to Moderate Parkinson's Disease. Front Neurol 2020; 11:405. [PMID: 32499752 PMCID: PMC7242736 DOI: 10.3389/fneur.2020.00405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/17/2020] [Indexed: 12/12/2022] Open
Abstract
Background: People with Parkinson's disease (PD) exhibit deficits in maintaining balance both during quiet standing and during walking, turning, standing up from sitting, and step initiation. Objective: The purpose of this study was to examine balance disorders during a transitional task under different conditions in participants with PD. Methods: The research was conducted on 15 PD-II (mild) and 15 PD-III (moderate) individuals (H&Y II-III stage) and 30 healthy elderly. The transitional task was measured on two force platforms (A and B). The procedure consisted of three phases: (1) quiet standing on platform A, (2) crossing to platform B, and (3) quiet standing on platform B, each until measurements were completed. There were four conditions: crossing without an obstacle, crossing with an obstacle, and walking up and down the step. Results: There were no significant differences between mild PD individuals and healthy elderly during quiet standing before the transitional task and after completing the task. The temporal aspects describing the different transitional tasks were comparable between mild PD and healthy subjects. Moderate PD participants presented a significantly higher COP velocity after the transitional task compared to the healthy older adults (p < 0.05). Additionally, the moderate PD group showed significantly higher values for transit time relative to healthy subjects during the transitional task in all conditions (p < 0.05). Conclusions: Disease severity affects the temporal aspects of different transitional tasks in people with PD. The procedure of completing a transitional task under different conditions allowed differences between moderate and mild PD stages and healthy subjects to be observed.
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Affiliation(s)
- Anna Kamieniarz
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Justyna Michalska
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Wojciech Marszałek
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Anna Akbaş
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Kajetan J. Słomka
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
| | - Agnieszka Krzak-Kubica
- Department of Neurology, Medical University of Silesia in Katowice, University Clinical Center, Katowice, Poland
| | - Monika Rudzińska-Bar
- Department of Neurology, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Grzegorz Juras
- Institute of Sport Sciences, Academy of Physical Education, Katowice, Poland
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13
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Spanish version of the mini-BESTest: a translation, transcultural adaptation and validation study in patients with Parkinson's disease. Int J Rehabil Res 2020; 43:129-134. [PMID: 32097139 DOI: 10.1097/mrr.0000000000000401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Balance is affected in numerous neurologic disorders, like stroke, multiple sclerosis and Parkinson's disease contributing to falls, and diminishing quality of life and functionality. The mini-BESTest is one of the most recommended scales to detect balance disorders in people with Parkinson's disease, which has solid psychometric properties. Unfortunately, this scale has not been validated in Chile and there are no other validated scales that can determine balance disorders in patients with Parkinson's disease to date. The study objective was to validate the mini-BESTest scale in Chilean Parkinson's disease patients. The translation and adaptation to Chilean Spanish of the mini-BESTest scale were made following a cross-cultural adaptation process, to then obtain face and content validity by an expert committee. Afterwards, the demographic data and psychometric properties of internal consistency and ceiling and floor effects were measured with a sample of 50 subjects with Parkinson's disease. Furthermore, 10 subjects of the sample were evaluated with the purpose of measuring inter rater reliability. The scale presented a good internal consistency (Cronbach's alpha = 0.845), and an excellent inter rater reliability (intraclass correlation coefficient = 0.97), no ceiling or floor effects were found. The results of the face and content validity and psychometric properties are adequate, achieving the validation of the mini-BESTest scale for balance in Chilean people with Parkinson's disease.
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14
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Kuhner A, Wiesmeier IK, Cenciarini M, Maier TL, Kammermeier S, Coenen VA, Burgard W, Maurer C. Motion Biomarkers Showing Maximum Contrast Between Healthy Subjects and Parkinson's Disease Patients Treated With Deep Brain Stimulation of the Subthalamic Nucleus. A Pilot Study. Front Neurosci 2020; 13:1450. [PMID: 32116488 PMCID: PMC7020741 DOI: 10.3389/fnins.2019.01450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 12/30/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Classic motion abnormalities in Parkinson's disease (PD), such as tremor, bradykinesia, or rigidity, are well-covered by standard clinical assessments such as the Unified Parkinson's Disease Rating Scale (UPDRS). However, PD includes motor abnormalities beyond the symptoms and signs as measured by UPDRS, such as the lack of anticipatory adjustments or compromised movement smoothness, which are difficult to assess clinically. Moreover, PD may entail motor abnormalities not yet known. All these abnormalities are quantifiable via motion capture and may serve as biomarkers to diagnose and monitor PD. Objective: In this pilot study, we attempted to identify motion features revealing maximum contrast between healthy subjects and PD patients with deep brain stimulation (DBS) of the nucleus subthalamicus (STN) switched off and on as the first step to develop biomarkers for detecting and monitoring PD patients' motor symptoms. Methods: We performed 3D gait analysis in 7 out of 26 PD patients with DBS switched off and on, and in 25 healthy control subjects. We computed feature values for each stride, related to 22 body segments, four time derivatives, left–right mean vs. difference, and mean vs. variance across stride time. We then ranked the feature values according to their distinguishing power between PD patients and healthy subjects. Results: The foot and lower leg segments proved better in classifying motor anomalies than any other segment. Higher degrees of time derivatives were superior to lower degrees (jerk > acceleration > velocity > displacement). The averaged movements across left and right demonstrated greater distinguishing power than left–right asymmetries. The variability of motion was superior to motion's absolute values. Conclusions: This small pilot study identified the variability of a smoothness measure, i.e., jerk of the foot, as the optimal signal to separate healthy subjects' from PD patients' gait. This biomarker is invisible to clinicians' naked eye and is therefore not included in current motor assessments such as the UPDRS. We therefore recommend that more extensive investigations be conducted to identify the most powerful biomarkers to characterize motor abnormalities in PD. Future studies may challenge the composition of traditional assessments such as the UPDRS.
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Affiliation(s)
- Andreas Kuhner
- Department of Computer Science, University of Freiburg, Freiburg im Breisgau, Germany.,BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany
| | - Isabella Katharina Wiesmeier
- BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Neurology and Neurophysiology, University Medical Center Freiburg, Medical Faculty, Freiburg im Breisgau, Germany
| | - Massimo Cenciarini
- BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Neurology and Neurophysiology, University Medical Center Freiburg, Medical Faculty, Freiburg im Breisgau, Germany
| | - Timo Leon Maier
- BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Neurology and Neurophysiology, University Medical Center Freiburg, Medical Faculty, Freiburg im Breisgau, Germany
| | - Stefan Kammermeier
- Klinikum der Universität München, Ludwig-Maximilians-Universität LMU, Neurologische Klinik und Poliklinik, Munich, Germany
| | - Volker Arnd Coenen
- BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Stereotactic and Functional Neurosurgery, University Medical Center Freiburg, Medical Faculty, Freiburg im Breisgau, Germany
| | - Wolfram Burgard
- Department of Computer Science, University of Freiburg, Freiburg im Breisgau, Germany.,BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christoph Maurer
- BrainLinks BrainTools, Cluster of Excellence, University of Freiburg, Freiburg im Breisgau, Germany.,Department of Neurology and Neurophysiology, University Medical Center Freiburg, Medical Faculty, Freiburg im Breisgau, Germany
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15
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Gazit E, Buchman AS, Dawe R, Curran TA, Mirelman A, Giladi N, Hausdorff JM. What happens before the first step? A New Approach to Quantifying Gait Initiation Using a Wearable Sensor. Gait Posture 2020; 76:128-135. [PMID: 31760316 PMCID: PMC7015786 DOI: 10.1016/j.gaitpost.2019.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walking is a volitional behavior that requires planning and initiation before a step is observed. Following a signal to begin walking, studies of gait initiation in specialized labs have identified three phases that occur during the transition from a standing position via anticipatory postural adjustment (APA) to the first step. Routine instrumented gait testing outside of the laboratory setting focuses on gait execution and does not include gait initiation measures. RESEARCH QUESTION Can a single IMU sensor be used for performing gait initiation evaluations outside the lab? METHODS We recorded walking in young (N = 41) and older (N = 26) adults using an instrumented gait mat while they were wearing a 3D accelerometer on their lower back. Subjects were instructed to begin walking following an auditory signal. An algorithm was developed to extract the following measures from the acceleration signal: gait initiation time, measured from the start of the auditory cue to begin walking and ends at the heel-strike of the swing leg, time-to-APA (reaction time), APA duration and swing time (execution of the first step). RESULTS Intraclass correlation coefficient analysis showed good to excellent agreement between gait initiation metrics obtained with the gait mat and the wearable sensor (mean 0.88, range [0.75-0.96]). Except for swing time, all measures were longer in the older subjects, compared to the young adults (p < 0.01). SIGNIFICANCE Extracting gait initiation measures from routine instrumented gait testing may facilitate studies that can better determine the extent to which impaired gait planning and execution contribute to mobility impairments.
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Affiliation(s)
- Eran Gazit
- Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel
| | - Aron S. Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago,Department of Neurological Sciences, Rush University Medical Center, Chicago
| | - Robert Dawe
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago,Department of Radiology, Rush University Medical Center, Chicago
| | - Thomas A. Curran
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago
| | - Anat Mirelman
- Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel,Sagol School of Neuroscience, Tel Aviv University, Israel,Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Israel
| | - Nir Giladi
- Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel,Sagol School of Neuroscience, Tel Aviv University, Israel,Department of Neurology and Neurosurgery, Sackler School of Medicine, Tel Aviv University, Israel
| | - Jeffrey M. Hausdorff
- Center for the study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Israel,Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago,Department of Orthopaedic Surgery, Rush University Medical Center, Chicago,Department of Physical Therapy, Sackler Faculty of Medicine, Israel
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16
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Accuracy and Reliability of Onset Detection Algorithms in Gait Initiation for Healthy Controls and Participants With Parkinson's Disease. J Appl Biomech 2019; 35:393–400. [PMID: 31629341 DOI: 10.1123/jab.2018-0431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/25/2019] [Accepted: 07/29/2019] [Indexed: 11/18/2022]
Abstract
Accurate and reliable detection of the onset of gait initiation is essential for the correct assessment of gait. Thus, this study was aimed at evaluation of the reliability and accuracy of 3 different center of pressure-based gait onset detection algorithms: A displacement baseline-based algorithm (method 1), a velocity baseline-based algorithm (method 2), and a velocity extrema-based algorithm (method 3). The center of pressure signal was obtained during 10 gait initiation trials from 16 healthy participants and 3 participants with Parkinson's disease. Intrasession and absolute reliability of each algorithm was assessed using the intraclass correlation coefficient and the coefficient of variation of center of pressure displacement during the postural phase of gait initiation. The accuracy was evaluated using the time error of the detected onset by each algorithm relative to that of visual inspection. The authors' results revealed that although all 3 algorithms had high to very high intrasession reliabilities in both healthy subjects and subjects with Parkinson's disease, methods 2 and 3 showed significantly better absolute reliability than method 1 in healthy controls (P = .001). Furthermore, method 2 outperformed the other 2 algorithms in both healthy subjects and subjects with Parkinson's disease with an overall accuracy of 0.80. Based on these results, the authors recommend using method 2 for accurate and reliable gait onset detection.
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17
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Carpinella I, Gervasoni E, Anastasi D, Lencioni T, Cattaneo D, Ferrarin M. Instrumental Assessment of Stair Ascent in People With Multiple Sclerosis, Stroke, and Parkinson's Disease: A Wearable-Sensor-Based Approach. IEEE Trans Neural Syst Rehabil Eng 2018; 26:2324-2332. [PMID: 30442611 DOI: 10.1109/tnsre.2018.2881324] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Stair ascent is a challenging daily-life activity highly related to independence. This task is usually assessed with clinical scales suffering from partial subjectivity and limited detail in evaluating different task aspects. In this paper, we instrumented the assessment of stair ascent in people with multiple sclerosis (MS), stroke (ST), and Parkinson's disease (PD) to analyze the validity of the proposed quantitative indexes and characterize subjects' performances. Participants climbed 10 steps wearing a magneto-inertial sensor [magneto-inertial measurement unit (MIMU)] at sternum level. Gait pattern features (step frequency, symmetry, regularity, and harmonic ratios), and upper trunk sway were computed from MIMU signals. Clinical modified dynamic gait index (mDGI) and mDGI-Item 8 "Up stairs" were administered. Significant correlations with clinical scores were found for gait pattern features ( ) and trunk pitch sway ( ) demonstrating their validity. Instrumental indexes showed alterations in the three pathological groups compared to healthy subjects and significant differences, not clinically detected, among MS, ST, and PD. MS showed the worst performance, with alterations of all gait pattern aspects and larger trunk pitch sway. ST showed worsening in gait pattern features but not in trunk motion. PD showed fewer alterations consisting in reduced step frequency and trunk yaw sway. These results suggest that the use of an MIMU provided valid objective indexes revealing between-group differences in stair ascent not detected by clinical scales. Importantly, the indexes include upper trunk measures, usually not present in clinical tests, and provide relevant hints for tailored rehabilitation.
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18
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Kim DS, Lee HJ, Lee SH, Chang WH, Jang J, Choi BO, Ryu GH, Kim YH. A wearable hip-assist robot reduces the cardiopulmonary metabolic energy expenditure during stair ascent in elderly adults: a pilot cross-sectional study. BMC Geriatr 2018; 18:230. [PMID: 30268096 PMCID: PMC6162880 DOI: 10.1186/s12877-018-0921-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/16/2018] [Indexed: 12/02/2022] Open
Abstract
Background Stair ascent is one of the most important and challenging activities of daily living to maintain mobility and independence in elderly adults. Recently, various types of wearable walking assist robots have been developed to improve gait function and metabolic efficiency for elderly adults. Several studies have shown that walking assist robots can improve cardiopulmonary metabolic efficiency during level walking in elderly. However, there is limited evidence demonstrating the effect of walking assist robots on cardiopulmonary metabolic efficiency during stair walking in elderly adults. Therefore, the aim of this study was to investigate the assistance effect of a newly developed wearable hip assist robot on cardiopulmonary metabolic efficiency during stair ascent in elderly adults. Methods Fifteen healthy elderly adults participated. The Gait Enhancing Mechatronic System (GEMS), developed by Samsung Electronics Co., Ltd., Korea, was used in the present study. The metabolic energy expenditure was measured using a K4b2 while participants performed randomly assigned two conditions consecutively: free ascending stairs without the GEMS or robot-assisted ascending stair with the GEMS. Results There were significant differences in the oxygen consumption per unit mass (ml/min/kg), metabolic power per unit mass (W/kg) and metabolic equivalents (METs) values between the GEMS and NoGEMS conditions. A statistically significant difference was found between the two conditions in net oxygen consumption and net metabolic power, with a reduction of 8.59% and 10.16% respectively in GEMS condition (p < 0.05). The gross oxygen consumption while climbing stairs under the GEMS and NoGEMS conditions was equivalent to 6.38 METs and 6.85 METs, respectively. Conclusion This study demonstrated that the GEMS was helpful for reducing cardiopulmonary metabolic energy expenditure during stair climbing in elderly adults. The use of the GEMS allows elderly adults to climb stairs with less metabolic energy, therefore, they may experience more endurance in stair climbing while using the GEMS. Trial registration NCT03389165, Registered 26 December 2017 - retrospectively registered
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Affiliation(s)
- Dong-Seok Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention & Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hwang-Jae Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention & Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Su-Hyun Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention & Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention & Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Junwon Jang
- Samsung Advanced Institute of Technology, Samsung Electronics, 130 Samsung-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16678, Republic of Korea
| | - Byung-Ok Choi
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Gyu-Ha Ryu
- Office of Biomechanical science, Research Center for Future Medicine, Samsung Medical Center, Sungkyunkwan University, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea.
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention & Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Irwon-ro 81, Gangnam-gu, Seoul, 06351, Republic of Korea.
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19
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Accelerometric Trunk Sensors to Detect Changes of Body Positions in Immobile Patients. SENSORS 2018; 18:s18103272. [PMID: 30274221 PMCID: PMC6210462 DOI: 10.3390/s18103272] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 11/17/2022]
Abstract
Mobilization, verticalization and position change are mandatory for severely affected neurological patients in early neurorehabilitation in order to improve neurological status and prevent complications. However, with the exception of hospitals and rehabilitation facilities, this activity is not usually monitored and so far the automated monitoring of position changes in immobile patients has not been investigated. Therefore, we investigated whether accelerometers on the upper trunk could reliably detect body position changes in immobile patients. Thirty immobile patients in early neurorehabilitation (Barthel Index ≤ 30) were enrolled. Two tri-axial accelerometers were placed on the upper trunk and on the thigh. Information on the position and position changes of the subject were derived from accelerometer data and compared to standard written documentation in the hospital over 24 h. Frequency and duration of different body positions (supine, sidelying, sitting) were measured. Data are presented as mean ± SEM. Groups were compared using one-way ANOVA or Kruskal-Wallis-test. Differences were considered significant if p < 0.05. Trunk sensors detected 100% and thigh sensors 66% of position changes (p = 0.0004) compared to standard care documentation. Furthermore, trunk recording also detected additional spontaneous body position changes that were not documented in standard care (81.8 ± 4.4% of all position changes were documented in standard care documentation) (p < 0.0001). We found that accelerometric trunk sensors are suitable for recording position changes and mobilization of severely affected patients. Our findings suggest that using accelerometers for care documentation is useful for monitoring position changes and mobilization frequencies in and outside of hospital for severely affected neurological patients. Accelerometric sensors may be valuable in monitoring continuation of care plans after intensive neurorehabilitation.
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20
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Carpinella I, Nardone A, Bonora G, Bowman T, Cattaneo D, Rabuffetti M, Ferrarin M. Counteracting Postural Perturbations Through Body Weight Shift: a Pilot Study Using a Robotic Platform in Subjects with Parkinson's Disease. IEEE Trans Neural Syst Rehabil Eng 2018; 26:1794-1802. [PMID: 30072335 DOI: 10.1109/tnsre.2018.2862463] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Abnormalities of body-weight transfer occur during several motor tasks in people with Parkinson's disease (PwPD). In this study, a novel robotic paradigm for assessment and training of dynamic balance was developed and applied to twelve healthy subjects (HS) and ten PwPD to verify its feasibility and to assess the capability of PwPD to counteract postural perturbations through body-weight shifts. At variance with other robotic paradigms, subjects had to react as fast as possible to the perturbation, bringing the platform back to the horizontal and keeping it until the end of the task. Four randomized perturbations, obtained varying the platform equilibrium angle from 0° to ±6° in sagittal (backward, forward) and frontal (right, left) planes, were repeated 3 times. Compared to HS, PwPD showed, in all perturbation directions, increased delay in counteraction phase onset (p<=0.01), prolonged time to stabilize the platform (p<=0.02), and higher deviation of the final plate inclination from the horizontal (p<=0.04), the deviation being larger during sagittal perturbations. PwPD showed also larger (p=0.01) postural sway around the stabilization angle following frontal perturbations. Results are in keeping with known hypo- and bradykinesia as well as proprioceptive and kinesthetic impairments in PD. We suggest that the proposed approach is feasible and might be included in balance evaluation and training in PD.
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Bonora G, Mancini M, Carpinella I, Chiari L, Ferrarin M, Nutt JG, Horak FB. Investigation of Anticipatory Postural Adjustments during One-Leg Stance Using Inertial Sensors: Evidence from Subjects with Parkinsonism. Front Neurol 2017; 8:361. [PMID: 28790972 PMCID: PMC5524831 DOI: 10.3389/fneur.2017.00361] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 07/07/2017] [Indexed: 11/22/2022] Open
Abstract
The One-Leg Stance (OLS) test is a widely adopted tool for the clinical assessment of balance in the elderly and in subjects with neurological disorders. It was previously showed that the ability to control anticipatory postural adjustments (APAs) prior to lifting one leg is significantly impaired by idiopathic Parkinson’s disease (iPD). However, it is not known how APAs are affected by other types of parkinsonism, such as frontal gait disorders (FGD). In this study, an instrumented OLS test based on wearable inertial sensors is proposed to investigate both the initial anticipatory phase and the subsequent unipedal balance. The sensitivity and the validity of the test have been evaluated. Twenty-five subjects with iPD presenting freezing of gait (FOG), 33 with iPD without FOG, 13 with FGD, and 32 healthy elderly controls were recruited. All subjects wore three inertial sensors positioned on the posterior trunk (L4–L5), and on the left and right frontal face of the tibias. Participants were asked to lift a foot and stand on a single leg as long as possible with eyes open, as proposed by the mini-BESTest. Temporal parameters and trunk acceleration were extracted from sensors and compared among groups. The results showed that, regarding the anticipatory phase, the peak of mediolateral trunk acceleration was significantly reduced compared to healthy controls (p < 0.05) in subjects with iPD with and without FOG, but not in FGD group (p = 0.151). Regarding the balance phase duration, a significant shortening was found in the three parkinsonian groups compared to controls (p < 0.001). Moreover, balance was significantly longer (p < 0.001) in iPD subjects without FOG compared to subjects with FGD and iPD subjects presenting FOG. Strong correlations between balance duration extracted by sensors and clinical mini-BESTest scores were found (ρ > 0.74), demonstrating the method’s validity. Our findings support the validity of the proposed method for assessing the OLS test and its sensitivity in distinguishing among the tested groups. The instrumented test discriminated between healthy controls and people with parkinsonism and among the three groups with parkinsonism. The objective characterization of the initial anticipatory phase represents an interesting improvement compared to most clinical OLS tests.
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Affiliation(s)
- Gianluca Bonora
- Biomedical Technology Department, IRCCS Foundation Don Gnocchi Onlus, Milan, Italy
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Ilaria Carpinella
- Biomedical Technology Department, IRCCS Foundation Don Gnocchi Onlus, Milan, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Maurizio Ferrarin
- Biomedical Technology Department, IRCCS Foundation Don Gnocchi Onlus, Milan, Italy
| | - John G Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Fay B Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States.,VA Portland Healthcare Systems, VAPORHCS, Portland, OR, United States
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Bonora G, Mancini M, Carpinella I, Chiari L, Horak FB, Ferrarin M. Gait initiation is impaired in subjects with Parkinson's disease in the OFF state: Evidence from the analysis of the anticipatory postural adjustments through wearable inertial sensors. Gait Posture 2017; 51:218-221. [PMID: 27816900 PMCID: PMC5140715 DOI: 10.1016/j.gaitpost.2016.10.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 10/04/2016] [Accepted: 10/23/2016] [Indexed: 02/02/2023]
Abstract
People with Parkinson's disease (PD) typically demonstrate impaired anticipatory postural adjustments (APAs) that shift the body center of mass forward (imbalance) and over the stance leg (unloading) prior to gait initiation. APAs are known to be smallest when people with PD are in their OFF-medication state compared to ON-medication or healthy controls. The aim of this pilot study is to validate a previously developed method for the assessment of gait initiation on PD patients in OFF state with body-worn, inertial sensors. Ten subjects with mild-to-moderate idiopathic PD and twelve healthy controls of similar age performed three gait initiation trials. The spatio-temporal parameters of APAs were extracted from three wearable sensors, placed on the shins and on the lower back, and validated with two force plates. Temporal parameters extracted from sensors and force plates, as well as the trunk medio-lateral acceleration and the correspondent displacement of the center of pressure, were significantly correlated. Subjects with PD showed hypometric adjustments in the medio-lateral direction (p-value<0.003) and increased duration of the unloading phase (p-value=0.04). The unloading phase was significantly longer than the imbalance (p-value=0.003) only in subjects with PD. The validity of the method of quantifying APAs from inertial sensors was confirmed in PD subjects by comparison with force plates. Sensitivity in discriminating PD patients from healthy controls was proven by both spatial and temporal parameters. Objective measures of gait initiation deficits with wearable technology provides valuable instrument for the assessment of gait initiation in clinical environments.
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Affiliation(s)
- Gianluca Bonora
- Biomedical Technology Department, IRCCS Foundation Don Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy
| | - Martina Mancini
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239-3098, USA
| | - Ilaria Carpinella
- Biomedical Technology Department, IRCCS Foundation Don Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Fay B Horak
- Department of Neurology, School of Medicine, Oregon Health & Science University, 3181 Sam Jackson Park Road, Portland, OR 97239-3098, USA,Department of Research, Portland VA Medical Center, 3710 SW US Veterans Hospital Road, Portland, OR 97239-9264, USA
| | - Maurizio Ferrarin
- Biomedical Technology Department, IRCCS Foundation Don Gnocchi Onlus, Via Capecelatro 66, 20148 Milan, Italy
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Carpinella I, Cattaneo D, Bonora G, Bowman T, Martina L, Montesano A, Ferrarin M. Wearable Sensor-Based Biofeedback Training for Balance and Gait in Parkinson Disease: A Pilot Randomized Controlled Trial. Arch Phys Med Rehabil 2016; 98:622-630.e3. [PMID: 27965005 DOI: 10.1016/j.apmr.2016.11.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To analyze the feasibility and efficacy of a novel system (Gamepad [GAMing Experience in PArkinson's Disease]) for biofeedback rehabilitation of balance and gait in Parkinson disease (PD). DESIGN Randomized controlled trial. SETTING Clinical rehabilitation gym. PARTICIPANTS Subjects with PD (N=42) were randomized into experimental and physiotherapy without biofeedback groups. INTERVENTIONS Both groups underwent 20 sessions of training for balance and gait. The experimental group performed tailored functional tasks using Gamepad. The system, based on wearable inertial sensors, provided users with real-time visual and acoustic feedback about their movement during the exercises. The physiotherapy group underwent individually structured physiotherapy without feedback. MAIN OUTCOME MEASURES Assessments were performed by a blinded examiner preintervention, postintervention, and at 1-month follow-up. Primary outcomes were the Berg Balance Scale (BBS) and 10-m walk test (10MWT). Secondary outcomes included instrumental stabilometric indexes and the Tele-healthcare Satisfaction Questionnaire. RESULTS Gamepad was well accepted by participants. Statistically significant between-group differences in BBS scores suggested better balance performances of the experimental group compared with the physiotherapy without biofeedback group both posttraining (experimental group-physiotherapy without biofeedback group: mean, 2.3±3.4 points; P=.047) and at follow-up (experimental group-physiotherapy without biofeedback group: mean, 2.7±3.3 points; P=.018). Posttraining stabilometric indexes showed that mediolateral body sway during upright stance was significantly reduced in the experimental group compared with the physiotherapy without biofeedback group (experimental group-physiotherapy without biofeedback group: -1.6±1.5mm; P=.003). No significant between-group differences were found in the other outcomes. CONCLUSIONS Gamepad-based training was feasible and superior to physiotherapy without feedback in improving BBS performance and retaining it for 1 month. After training, 10MWT data were comparable between groups. Further development of the system is warranted to allow the autonomous use of Gamepad outside clinical settings, to enhance gait improvements, and to increase transfer of training effects to real-life contexts.
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Affiliation(s)
- Ilaria Carpinella
- Biomedical Technology Department, Don Carlo Gnocchi Foundation, Milan, Italy
| | - Davide Cattaneo
- LaRiCE Lab, Department of Neurorehabilitation, Don Carlo Gnocchi Foundation, Milan, Italy.
| | - Gianluca Bonora
- Biomedical Technology Department, Don Carlo Gnocchi Foundation, Milan, Italy
| | - Thomas Bowman
- LaRiCE Lab, Department of Neurorehabilitation, Don Carlo Gnocchi Foundation, Milan, Italy
| | - Laura Martina
- LaRiCE Lab, Department of Neurorehabilitation, Don Carlo Gnocchi Foundation, Milan, Italy
| | - Angelo Montesano
- LaRiCE Lab, Department of Neurorehabilitation, Don Carlo Gnocchi Foundation, Milan, Italy
| | - Maurizio Ferrarin
- Biomedical Technology Department, Don Carlo Gnocchi Foundation, Milan, Italy
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Pal G, O'Keefe J, Robertson-Dick E, Bernard B, Anderson S, Hall D. Global cognitive function and processing speed are associated with gait and balance dysfunction in Parkinson's disease. J Neuroeng Rehabil 2016; 13:94. [PMID: 27793167 PMCID: PMC5084375 DOI: 10.1186/s12984-016-0205-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/25/2016] [Indexed: 12/25/2022] Open
Abstract
Background Our primary objective was to determine the relationship between global cognitive function and specific domains of gait and balance in a cohort of Parkinson’s disease (PD) subjects. In a secondary analysis, we determined whether specific cognitive domains correlated with gait and balance performance. Methods Fourteen PD subjects (mean age 61.1 ± 7.8 years) were recruited from the Rush University Medical Center Movement Disorders clinic. Subjects underwent clinical assessment using the motor subsection of the Unified Parkinson’s Disease Rating Scale (UPDRS) followed by quantitative gait and balance assessments using the APDM Mobility Lab™ system (Mobility Lab, APDM Inc., Portland, OR). Subjects completed global cognitive testing using the Mattis Dementia Rating Scale (MDRS) as well as domain specific cognitive measures. Spearman’s rho was used to assess correlations between cognitive measures and gait and balance function, with False Discovery Rate (FDR) correction for multiple comparisons. Results Global cognitive function had the strongest correlation with stride velocity (r = 0.816, p = 0.001), turn duration (r = −0.806, p = 0.001), number of steps to turn (r = −0.830, p = 0.001), and mean velocity of postural sway in the medio-lateral direction (r = −0.726, p = 0.005). A significant correlation was found between processing speed and two turning measures (turn duration, r = −0.884, p = 0.001; number of steps to turn, r = −0.954, p < 0.001), but no other associations were found between specific cognitive domains and gait domains. Conclusions This pilot study provides preliminary data regarding the association between global cognitive function and pace-related measures of gait, turning, and postural sway. Furthermore, reduced processing speed was found to be associated with difficulty in performing turns.
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Affiliation(s)
- Gian Pal
- Department of Neurological Sciences, Rush University, Chicago, IL, USA. .,Rush University Medical Center, 1725 West Harrison Street, Suite 755, Chicago, IL, 60612, USA.
| | - Joan O'Keefe
- Department of Neurological Sciences, Rush University, Chicago, IL, USA.,Department of Anatomy and Cell Biology, Rush University, Chicago, IL, USA
| | | | - Bryan Bernard
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - Sharlet Anderson
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
| | - Deborah Hall
- Department of Neurological Sciences, Rush University, Chicago, IL, USA
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Callisaya ML, Blizzard L, Martin K, Srikanth VK. Gait initiation time is associated with the risk of multiple falls-A population-based study. Gait Posture 2016; 49:19-24. [PMID: 27344449 DOI: 10.1016/j.gaitpost.2016.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 02/02/2023]
Abstract
AIMS In a population-based study of older people to examine whether 1) overall gait initiation (GI) time or its components are associated with falls and 2) GI under dual-task is a stronger predictor of falls risk than under single-task. METHODS Participants aged 60-85 years were randomly selected from the electoral roll. GI was obtained with a force platform under both single and dual-task conditions. Falls were ascertained prospectively over a 12-month period. Log multinomial regression was used to examine the association between GI time (total and its components) and risk of single and multiple falls. Age, sex and physiological and cognitive falls risk factors were considered as confounders. RESULTS The mean age of the sample (n=124) was 71.0 (SD 6.8) years and 58.9% (n=73) were male. Over 12 months 21.8% (n=27) of participants reported a single fall and 16.1% (n=20) reported multiple falls. Slower overall GI time under both single (RR all per 100ms 1.28, 95%CI 1.03, 1.58) and dual-task (RR 1.14, 95%CI 1.02, 1.27) was associated with increased risk of multiple, but not single falls (p<0.05). Multiple falls were also associated with slower time to first lateral movement under single-task (RR 1.90 95%CI 0.59, 1.51) and swing time under dual-task condition (RR 1.44 95%CI 1.08, 1.94). CONCLUSION Slower GI time is associated with the risk of multiple falls independent of other risk factors, suggesting it could be used as part of a comprehensive falls assessment. Time to the first lateral movement under single-task may be the best measures of this risk.
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Affiliation(s)
- Michele L Callisaya
- Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Southern Clinical School, Monash Medical Centre, Monash University, Clayton, Victoria, Australia.
| | - Leigh Blizzard
- Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
| | - Kara Martin
- Cancer Council Victoria, Cancer Epidemiology and Intelligence Division, Melbourne, Victoria, Australia.
| | - Velandai K Srikanth
- Southern Clinical School, Monash Medical Centre, Monash University, Clayton, Victoria, Australia; Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
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Weiss A, Brozgol M, Giladi N, Hausdorff JM. Can a single lower trunk body-fixed sensor differentiate between level-walking and stair descent and ascent in older adults? Preliminary findings. Med Eng Phys 2016; 38:1146-51. [PMID: 27527394 DOI: 10.1016/j.medengphy.2016.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/19/2016] [Accepted: 07/27/2016] [Indexed: 10/21/2022]
Abstract
Stair ascent and descent are common forms of ambulation that may be challenging to detect. Here, we propose the first step towards differentiating between stair negotiation and level-walking using a single body-fixed sensor. Seventeen healthy older adults (age: 79.3±4.2 years, 47% women) wore a body-fixed sensor on the lower-back while performing level-walking and stair negotiation. Measures derived from the 3D acceleration and angular-velocity signals included medians, ranges, step duration, step and stride regularity, filtered vertical to horizontal acceleration ratio (VAF/HAF), and wavelet-based features. Friedman's and Wilcoxon tests compared between conditions. Stepwise-binary logistic-regression evaluated classification accuracy. During level-walking, yaw range was lowest and anterior-posterior and vertical step and stride regularity were highest (p≤0.007). Anterior-posterior step regularity (p=0.003), VAF/HAF (p=0.094), and yaw range (p=0.105) identified level-walking (92.2% accuracy). During stair ascent, roll range, median anterior-posterior acceleration and anterior-posterior wavelet-coefficient were lowest (p≤0.006), while VAF/HAF was highest (p=0.0029). Anterior posterior wavelet coefficient (p=0.038) and VAF/HAF (p=0.018) identified stair ascent (94.3% accuracy). During stair descent, vertical and medio-lateral ranges were highest and medio-lateral stride regularity and VAF/HAF were lowest (p≤0.006). VAF/HAF (p=0.01), medio-lateral acceleration range (p=0.069), and medio-lateral stride regularity (p=0.072) identified stair descent (90.2% accuracy). These findings suggest that a single worn body-fixed sensor can be used to differentiate between level-walking and stair negotiation.
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Affiliation(s)
- Aner Weiss
- Center for the study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Marina Brozgol
- Center for the study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nir Giladi
- Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sieratzki Chair in Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Hausdorff
- Center for the study of Movement, Cognition, and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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