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Woelfle T, Bourguignon L, Lorscheider J, Kappos L, Naegelin Y, Jutzeler CR. Wearable Sensor Technologies to Assess Motor Functions in People With Multiple Sclerosis: Systematic Scoping Review and Perspective. J Med Internet Res 2023; 25:e44428. [PMID: 37498655 PMCID: PMC10415952 DOI: 10.2196/44428] [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] [Received: 11/18/2022] [Revised: 12/19/2022] [Accepted: 05/04/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Wearable sensor technologies have the potential to improve monitoring in people with multiple sclerosis (MS) and inform timely disease management decisions. Evidence of the utility of wearable sensor technologies in people with MS is accumulating but is generally limited to specific subgroups of patients, clinical or laboratory settings, and functional domains. OBJECTIVE This review aims to provide a comprehensive overview of all studies that have used wearable sensors to assess, monitor, and quantify motor function in people with MS during daily activities or in a controlled laboratory setting and to shed light on the technological advances over the past decades. METHODS We systematically reviewed studies on wearable sensors to assess the motor performance of people with MS. We scanned PubMed, Scopus, Embase, and Web of Science databases until December 31, 2022, considering search terms "multiple sclerosis" and those associated with wearable technologies and included all studies assessing motor functions. The types of results from relevant studies were systematically mapped into 9 predefined categories (association with clinical scores or other measures; test-retest reliability; group differences, 3 types; responsiveness to change or intervention; and acceptability to study participants), and the reporting quality was determined through 9 questions. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. RESULTS Of the 1251 identified publications, 308 were included: 176 (57.1%) in a real-world context, 107 (34.7%) in a laboratory context, and 25 (8.1%) in a mixed context. Most publications studied physical activity (196/308, 63.6%), followed by gait (81/308, 26.3%), dexterity or tremor (38/308, 12.3%), and balance (34/308, 11%). In the laboratory setting, outcome measures included (in addition to clinical severity scores) 2- and 6-minute walking tests, timed 25-foot walking test, timed up and go, stair climbing, balance tests, and finger-to-nose test, among others. The most popular anatomical landmarks for wearable placement were the waist, wrist, and lower back. Triaxial accelerometers were most commonly used (229/308, 74.4%). A surge in the number of sensors embedded in smartphones and smartwatches has been observed. Overall, the reporting quality was good. CONCLUSIONS Continuous monitoring with wearable sensors could optimize the management of people with MS, but some hurdles still exist to full clinical adoption of digital monitoring. Despite a possible publication bias and vast heterogeneity in the outcomes reported, our review provides an overview of the current literature on wearable sensor technologies used for people with MS and highlights shortcomings, such as the lack of harmonization, transparency in reporting methods and results, and limited data availability for the research community. These limitations need to be addressed for the growing implementation of wearable sensor technologies in clinical routine and clinical trials, which is of utmost importance for further progress in clinical research and daily management of people with MS. TRIAL REGISTRATION PROSPERO CRD42021243249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=243249.
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Affiliation(s)
- Tim Woelfle
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Lucie Bourguignon
- Department of Health Sciences and Technology, ETH Zurich, Zürich, Switzerland
| | - Johannes Lorscheider
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Yvonne Naegelin
- Research Center for Clinical Neuroimmunology and Neuroscience Basel, University Hospital and University of Basel, Basel, Switzerland
- Department of Neurology, University Hospital Basel, Basel, Switzerland
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Subtask Segmentation Methods of the Timed Up and Go Test and L Test Using Inertial Measurement Units—A Scoping Review. INFORMATION 2023. [DOI: 10.3390/info14020127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
The Timed Up and Go test (TUG) and L Test are functional mobility tests that allow healthcare providers to assess a person’s balance and fall risk. Segmenting these mobility tests into their respective subtasks, using sensors, can provide further and more precise information on mobility status. To identify and compare current methods for subtask segmentation using inertial sensor data, a scoping review of the literature was conducted using PubMed, Scopus, and Google Scholar. Articles were identified that described subtask segmentation methods for the TUG and L Test using only inertial sensor data. The filtering method, ground truth estimation device, demographic, and algorithm type were compared. One article segmenting the L Test and 24 articles segmenting the TUG met the criteria. The articles were published between 2008 and 2022. Five studies used a mobile smart device’s inertial measurement system, while 20 studies used a varying number of external inertial measurement units. Healthy adults, people with Parkinson’s Disease, and the elderly were the most common demographics. A universally accepted method for segmenting the TUG test and the L Test has yet to be published. Angular velocity in the vertical and mediolateral directions were common signals for subtask differentiation. Increasing sample sizes and furthering the comparison of segmentation methods with the same test sets will allow us to expand the knowledge generated from these clinically accessible tests.
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Spilz A, Munz M. Synchronisation of wearable inertial measurement units based on magnetometer data. BIOMED ENG-BIOMED TE 2023:bmt-2021-0329. [PMID: 36668676 DOI: 10.1515/bmt-2021-0329] [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: 10/06/2021] [Accepted: 12/27/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Synchronisation of wireless inertial measurement units in human movement analysis is often achieved using event-based synchronisation techniques. However, these techniques lack precise event generation and accuracy. An inaccurate synchronisation could lead to large errors in motion estimation and reconstruction and therefore wrong analysis outputs. METHODS We propose a novel event-based synchronisation technique based on a magnetic field, which allows sub-sample accuracy. A setup featuring Shimmer3 inertial measurement units is designed to test the approach. RESULTS The proposed technique shows to be able to synchronise with a maximum offset of below 2.6 ms with sensors measuring at 100 Hz. The investigated parameters suggest a required synchronisation time of 8 s. CONCLUSIONS The results indicate a reliable event generation and detection for synchronisation of wireless inertial measurement units. Further research should investigate the temperature changes that the sensors are exposed to during human motion analysis and their influence on the internal time measurement of the sensors. In addition, the approach should be tested using inertial measurement units from different manufacturers to investigate an identified constant offset in the accuracy measurements.
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Affiliation(s)
- Andreas Spilz
- Department of Mechatronics and Medical Engineering, Biomechatronics Research Group, University of Applied Sciences, Ulm, Germany
| | - Michael Munz
- Department of Mechatronics and Medical Engineering, Biomechatronics Research Group, University of Applied Sciences, Ulm, Germany
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Toscano S, Patti F, Chisari CG, Arena S, Finocchiaro C, Schillaci CE, Zappia M. Reliability of televisits for patients with mild relapsing–remitting multiple sclerosis in the COVID-19 era. Neurol Sci 2022; 43:2253-2261. [PMID: 35018548 PMCID: PMC8751468 DOI: 10.1007/s10072-022-05868-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
Abstract
Background
Evidence of the cost-effectiveness of telemedicine (TM) for the management of Multiple Sclerosis (MS) has been provided recently. However, some doubts persist about the accuracy of neurological examinations performed remotely.
Objectives
This study investigated the reliability of neurological evaluations performed through TM in mild MS patients as compared with standard in-person visits.
Methods
In total, 76 patients with relapsing–remitting MS and Expanded Disability Status Scale (EDSS) ≤ 3.5 were consecutively recruited. Of them, 40 patients (52.6%) accepted to undergo both in-person and TM evaluations with independent examiners within 48 h. We alternatively asked patients to assure or not the presence of a caregiver during TM visits. A satisfaction questionnaire was administered to all participants.
Results
The inter-rater agreement attributed by two independent neurologists during TM visit was high (κ > 0.80) for EDSS and Functional Systems (FS) scores. Moderate agreement between TM and in-person evaluations emerged for pyramidal (κ = 0.57; p < 0.001), brainstem (κ = 0.57; p < 0.001), bowel and bladder (κ = 0.54; p < 0.001) and sensory (κ = 0.51; p < 0.001) FS scores, higher in patients providing the support of a caregiver. A good reliability was reported for EDSS scores computed during remote and in-person visits (ICC = 0.83; 95% CI 0.70–0.91; p < 0.001).
Conclusions
Despite the complexity of neurological examination, TM could be useful in monitoring MS patients with low disability.
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Affiliation(s)
- Simona Toscano
- Department "G.F. Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Francesco Patti
- Department "G.F. Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
| | - Clara Grazia Chisari
- Department "G.F. Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Sebastiano Arena
- Department "G.F. Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Chiara Finocchiaro
- Department "G.F. Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | | | - Mario Zappia
- Department "G.F. Ingrassia", Section of Neurosciences, Neurology Clinic, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
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Rogers JL, De La Cruz Minyety J, Vera E, Acquaye AA, Payén SS, Weinberg JS, Armstrong TS, Weathers SPS. Assessing mobility in primary brain tumor patients: A descriptive feasibility study using two established mobility tests. Neurooncol Pract 2022; 9:219-228. [PMID: 35601968 PMCID: PMC9113321 DOI: 10.1093/nop/npac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Patients with primary brain tumors (PBT) face significant mobility issues related to their disease and/or treatment. Here, the authors describe the preliminary utility and feasibility of two established mobility measures, the Timed-Up-and-Go (TUG) and Five-Times Sit-to-Stand (TSS) tests, in quickly and objectively assessing the mobility status of PBT patients at a single institution's neuro-oncology clinic. Methods Adult patients undergoing routine PBT care completed the TUG/TSS tests and MD Anderson Symptom Inventory-Brain Tumor module (MDASI-BT), which assessed symptom burden and interference with daily life, during clinic visits over a 6-month period. Research staff assessed feasibility metrics, including test completion times/rates, and collected demographic, clinical, and treatment data. Mann-Whitney tests, Kruskal-Wallis tests, and Spearman's rho correlations were used to interrogate relationships between TUG/TSS test completion times and patient characteristics. Results The study cohort included 66 PBT patients, 59% male, with a median age of 47 years (range: 20-77). TUG/TSS tests were completed by 62 (94%) patients. Older patients (P < .001) and those who were newly diagnosed (P = .024), on corticosteroids (P = .025), or had poor (≤80) KPS (P < .01) took longer to complete the TUG/TSS tests. Worse activity-related (work, activity, and walking) interference was associated with longer TUG/TSS test completion times (P < .001). Conclusions The TUG/TSS tests are feasible for use among PBT patients and may aid in clinical care. Older age, being newly diagnosed, using corticosteroids, poor (≤80) KPS, and high activity-related interference were associated with significant mobility impairment, highlighting the tests' potential clinical utility. Future investigations are warranted to longitudinally explore feasibility and utility in other practice and disease settings.
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Affiliation(s)
- James L Rogers
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA,Corresponding Author: James L. Rogers, BS, Cancer Research Training Award Fellow, Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 9030 Old Georgetown Rd., Bethesda, MD 20892, USA ()
| | - Julianie De La Cruz Minyety
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Alvina A Acquaye
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Samuel S Payén
- Center for Nursing Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shiao-Pei S Weathers
- Department of Neuro-Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Brauner FO, Balbinot G, Figueiredo AI, Hausen DO, Schiavo A, Mestriner RG. The Performance Index Identifies Changes Across the Dual Task Timed Up and Go Test Phases and Impacts Task-Cost Estimation in the Oldest-Old. Front Hum Neurosci 2021; 15:720719. [PMID: 34658817 PMCID: PMC8514992 DOI: 10.3389/fnhum.2021.720719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/23/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Dual tasking is common in activities of daily living (ADLs) and the ability to perform them usually declines with age. While cognitive aspects influence dual task (DT) performance, most DT-cost (DT-C) related metrics include only time- or speed- delta without weighting the accuracy of cognitive replies involved in the task. Objectives: The primary study goal was to weight the accuracy of cognitive replies as a contributing factor when estimating DT-C using a new index of DT-C that considers the accuracy of cognitive replies (P-index) in the instrumented timed up and go test (iTUG). Secondarily, to correlate the novel P-index with domains of the Mini-Mental State Examination (MMSE). Methods: Sixty-three participants (≥85 years old) took part in this study. The single task (ST) and DT iTUG tests were performed in a semi-random order. Both the time taken to complete the task measured utilizing an inertial measurement unit (IMU), and the accuracy of the cognitive replies were used to create the novel P-index. Clinical and sociodemographic data were collected. Results: The accuracy of the cognitive replies changed across the iTUG phases, particularly between the walk 1 and walk 2 phases. Moreover, weighting 0.6 for delta-time (W1) and 0.4 for cognitive replies (W2) into the P-index enhanced the prediction of the MMSE score. The novel P-index was able to explain 37% of the scores obtained by the fallers in the “spatial orientation” and “attention” domains of the MMSE. The ability of the P-index to predict MMSE scores was not significantly influenced by age, schooling, and number of medicines in use. The Bland-Altman analysis indicated a substantial difference between the time-delta-based DT-C and P-index methods, which was within the limits of agreement. Conclusions: The P-index incorporates the accuracy of cognitive replies when calculating the DT-C and better reflects the variance of the MMSE in comparison with the traditional time- or speed-delta approaches, thus providing an improved method to estimate the DT-C.
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Affiliation(s)
- Fabiane Oliveira Brauner
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Gustavo Balbinot
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Anelise Ineu Figueiredo
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Daiane Oliveira Hausen
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Aniuska Schiavo
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Régis Gemerasca Mestriner
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
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García-Muñoz C, Cortés-Vega MD, Hernández-Rodríguez JC, Fernández-Seguín LM, Escobio-Prieto I, Casuso-Holgado MJ. Immersive Virtual Reality and Vestibular Rehabilitation in Multiple Sclerosis: Case Report. JMIR Serious Games 2021; 10:e31020. [PMID: 34766551 PMCID: PMC8892276 DOI: 10.2196/31020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/07/2021] [Accepted: 10/12/2021] [Indexed: 02/06/2023] Open
Abstract
Background Dizziness and imbalance are common and disabling symptoms in patients with multiple sclerosis (MS) and are caused by a central, peripheral, or mixed vestibulopathy. Central vestibular disorder is the most frequently reported vestibular problem in the MS population due to demyelination. Vestibular rehabilitation ameliorates these symptoms and their repercussions and improves quality of life. Immersive virtual reality (VRi) is an emerging tool in this field; however, no previous research has been performed studying its effects in MS. Objective The aim of this study was to apply a VRi vestibular training protocol to a patient with MS and assess the effects induced by the experimental intervention. Methods This case study included a 54-year-old woman with relapsing-remitting MS. We developed a standardized VRi exercise protocol for vestibular rehabilitation based on the gold-standard Cawthorne-Cooksey vestibular training protocol. The 20-session intervention was made up of 10 initial sessions and 10 advanced sessions. Each 50-minute session was performed two to three times per week for 7 weeks. Four evaluations were carried out over the study period: at baseline (T0), between initial and advances phases (T1), postintervention (T2), and 1 month after the experimental procedure (T3). The research outcomes were dizziness, balance, gait, impact of fatigue, quality of life, repercussions in muscular tone, and usability of the head-mounted display device. Results After implementing the VRi vestibular protocol, improvements were seen in the following patient parameters: Dizziness Handicap Inventory score (62 points at T0; 4 points at T2); Berg Balance Scale score (47 points at T0; 54 points at T2); instrumented Timed Up and Go time (8.35 seconds at T0; 5.57 seconds at T2); muscular tone of the erector spinae, rectus femoris, and soleus; Modified Fatigue Impact Scale score (61 points at T0; 37 points at T2); and Multiple Sclerosis Quality of Life-54 values (67.16% in the physical health area at T2; 33.56% in the mental health area at T2). The patient rated the usability of the system as 90%, based on the System Usability Scale, and gave the system a grade of A. Conclusions Although further research is needed, this study provided initial evidence that the first VRi vestibular protocol for the MS population can improve dizziness, balance, gait, impact of fatigue, quality of life, and muscular tone through an exergame intervention. This study may help establish a standardized VRi protocol for vestibular rehabilitation.
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Affiliation(s)
- Cristina García-Muñoz
- Physiotherapy Department. Faculty of Nursing, Physiotherapy and Podiatry., University of Seville, C/ Avicena S/N, Seville, ES
| | - María-Dolores Cortés-Vega
- Physiotherapy Department. Faculty of Nursing, Physiotherapy and Podiatry., University of Seville, C/ Avicena S/N, Seville, ES
| | | | - Lourdes M Fernández-Seguín
- Physiotherapy Department. Faculty of Nursing, Physiotherapy and Podiatry., University of Seville, C/ Avicena S/N, Seville, ES
| | - Isabel Escobio-Prieto
- Physiotherapy Department. Faculty of Nursing, Physiotherapy and Podiatry., University of Seville, C/ Avicena S/N, Seville, ES
| | - María Jesús Casuso-Holgado
- Physiotherapy Department. Faculty of Nursing, Physiotherapy and Podiatry., University of Seville, C/ Avicena S/N, Seville, ES
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Alexander S, Peryer G, Gray E, Barkhof F, Chataway J. Wearable technologies to measure clinical outcomes in multiple sclerosis: A scoping review. Mult Scler 2021; 27:1643-1656. [PMID: 32749928 PMCID: PMC8474332 DOI: 10.1177/1352458520946005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/01/2020] [Accepted: 07/06/2020] [Indexed: 11/15/2022]
Abstract
Wearable technology refers to any sensor worn on the person, making continuous and remote monitoring available to many people with chronic disease, including multiple sclerosis (MS). Daily monitoring seems an ideal solution either as an outcome measure or as an adjunct to support rater-based monitoring in both clinical and research settings. There has been an increase in solutions that are available, yet there is little consensus on the most appropriate solution to use in either MS research or clinical practice. We completed a scoping review (using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines) to summarise the wearable solutions available in MS, to identify those approaches that could potentially be utilised in clinical trials, by evaluating the following: scalability, cost, patient adaptability and accuracy. We identified 35 unique products that measure gait, cognition, upper limb function, activity, mood and fatigue, with most of these solutions being phone applications.
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Affiliation(s)
- Sarah Alexander
- Queen Square MS Centre and Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK
| | - Guy Peryer
- School of Health Sciences, University of East
Anglia, Norwich, UK
| | - Emma Gray
- The Multiple Sclerosis Society, London, UK
| | - Frederik Barkhof
- Queen Square MS Centre and Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK/Centre for Medical Image
Computing (CMIC), Department of Medical Physics and Biomedical Engineering,
University College London, London, UK/National Institute for Health Research
(NIHR), Biomedical Research Centre, University College London Hospitals
(UCLH), London, UK/Department of Radiology and Nuclear Medicine, VU
University Medical Centre, Amsterdam, The Netherlands
| | - Jeremy Chataway
- Queen Square MS Centre and Department of
Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain
Sciences, University College London, London, UK/National Institute for
Health Research (NIHR), Biomedical Research Centre, University College
London Hospitals (UCLH), London, UK/MRC CTU at UCL, Institute of Clinical
Trials and Methodology, University College London, London, UK
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Validity of a New 3-D Motion Analysis Tool for the Assessment of Knee, Hip and Spine Joint Angles during the Single Leg Squat. SENSORS 2020; 20:s20164539. [PMID: 32823657 PMCID: PMC7472619 DOI: 10.3390/s20164539] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 01/10/2023]
Abstract
Aim: Study concurrent validity of a new sensor-based 3D motion capture (MoCap) tool to register knee, hip and spine joint angles during the single leg squat. Design: Cross-sectional. Setting: University laboratory. Participants: Forty-four physically active (Tegner ≥ 5) subjects (age 22.8 (±3.3)) Main outcome measures: Sagittal and frontal plane trunk, hip and knee angles at peak knee flexion. The sensor-based system consisted of 4 active (triaxial accelerometric, gyroscopic and geomagnetic) sensors wirelessly connected with an iPad. A conventional passive tracking 3D MoCap (OptiTrack) system served as gold standard. Results: All sagittal plane measurement correlations observed were very strong for the knee and hip (r = 0.929–0.988, p < 0.001). For sagittal plane spine assessment, the correlations were moderate (r = 0.708–0.728, p < 0.001). Frontal plane measurement correlations were moderate in size for the hip (ρ = 0.646–0.818, p < 0.001) and spine (ρ = 0.613–0.827, p < 0.001). Conclusions: The 3-D MoCap tool has good to excellent criterion validity for sagittal and frontal plane angles occurring in the knee, hip and spine during the single leg squat. This allows bringing this type of easily accessible MoCap technology outside laboratory settings.
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Voss S, Joyce J, Biskis A, Parulekar M, Armijo N, Zampieri C, Tracy R, Palmer S, Fefferman M, Ouyang B, Liu Y, Berry-Kravis E, O’Keefe JA. Normative database of spatiotemporal gait parameters using inertial sensors in typically developing children and young adults. Gait Posture 2020; 80:206-213. [PMID: 32531757 PMCID: PMC7388584 DOI: 10.1016/j.gaitpost.2020.05.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 04/20/2020] [Accepted: 05/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inertial sensors are increasingly useful to clinicians and researchers to detect gait deficits. Reference values are necessary for comparison to children with gait abnormalities. OBJECTIVE To present a normative database of spatiotemporal gait and turning parameters in 164 typically developing children and young adults ages 5-30 utilizing the APDM Mobility Lab® system. METHODS Participants completed the i-WALK test at both self-selected (SS) and fast as possible (FAP) walking speeds. Spatiotemporal gait and turning parameters included stride length, stride length variability, gait speed, cadence, stance, swing, and double support times, and foot strike, toe-off, and toe-out angles, turn duration, peak turn velocity and number of steps to turn. RESULTS Absolute stride length and gait speed increased with age. Normalized gait speed, absolute and normalized cadence, and stride length variability decreased with age. Normalized stride length and all parameters of gait cycle phase and foot position remained unaffected by age except for greater FSA in children 7-8. Foot position parameters in children 5-6 were excluded due to aberrant values and high standard deviations. Turns were faster in children ages 5-13 and 7-13 in the SS and FAP conditions, respectively. There were no differences in number of steps to turn. Similar trends were observed in the FAP condition except: normalized gait speed did not demonstrate a relationship with age and children ages 5-8 demonstrated increased stance and double support times and decreased swing time compared to children 11-13 and young adults (ages 5-6 only). Females ages 5-6 demonstrated increased stride length variability in the SS condition; males ages 7-8 and 14-30 ha d increased absolute stride length in the FAP condition. Similarities and differences were found between our values and previous literature. SIGNIFICANCE This normative database can be used by clinicians and researchers to compare abnormal gait patterns and responses to interventions.
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Affiliation(s)
- Stephanie Voss
- Department of Occupational Therapy, Rush University, Chicago, IL, United States
| | - Jessica Joyce
- Department of Cell & Molecular Medicine, Rush University, Chicago, IL, United States
| | - Alexandras Biskis
- Department of Cell & Molecular Medicine, Rush University, Chicago, IL, United States
| | - Medha Parulekar
- Rush Medical College, Rush University, Chicago, IL, United States
| | - Nicholas Armijo
- Department of Cell & Molecular Medicine, Rush University, Chicago, IL, United States
| | - Cris Zampieri
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Rachel Tracy
- Department of Occupational Therapy, Rush University, Chicago, IL, United States
| | - Sasha Palmer
- Department of Occupational Therapy, Rush University, Chicago, IL, United States
| | - Marie Fefferman
- Rush Medical College, Rush University, Chicago, IL, United States
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University, Chicago, IL, United States
| | - Yuanqing Liu
- Department of Neurological Sciences, Rush University, Chicago, IL, United States
| | - Elizabeth Berry-Kravis
- Department of Neurological Sciences, Rush University, Chicago, IL, United States,Department of Pediatrics, Rush University, Chicago, IL, United States
| | - Joan A. O’Keefe
- Department of Occupational Therapy, Rush University, Chicago, IL, United States,Department of Cell & Molecular Medicine, Rush University, Chicago, IL, United States,Department of Neurological Sciences, Rush University, Chicago, IL, United States,Corresponding author: Joan A. O’Keefe, PhD, PT, Departments of Cell & Molecular Medicine and Neurological Sciences, Rush University, 600 South Paulina Street, Suite 507 Armour Academic Center, Chicago, IL 60612,
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11
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Tulipani LJ, Meyer B, Larie D, Solomon AJ, McGinnis RS. Metrics extracted from a single wearable sensor during sit-stand transitions relate to mobility impairment and fall risk in people with multiple sclerosis. Gait Posture 2020; 80:361-366. [PMID: 32615409 PMCID: PMC7413823 DOI: 10.1016/j.gaitpost.2020.06.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Approximately half of the 2.3 million people with multiple sclerosis (PwMS) will fall in any three-month period. Currently clinicians rely on self-report measures or simple functional assessments, administered at discrete time points, to assess fall risk. Wearable inertial sensors are a promising technology for increasing the sensitivity of clinical assessments to accurately predict fall risk, but current accelerometer-based approaches are limited. RESEARCH QUESTION Will metrics derived from wearable accelerometers during a 30-second chair stand test (30CST) correlate with clinical measures of disease severity, balance confidence and fatigue in PwMS, and can these metrics be used to accurately discriminate fallers from non-fallers? METHODS Thirty-eight PwMS (21 fallers) completed self-report outcome measures then performed the 30CST while triaxial acceleration data were collected from inertial sensors adhered to the thigh and chest. Accelerometer metrics were derived for the sit-to-stand and stand-to-sit transitions and relationships with clinical metrics were assessed. Finally, the metrics were used to develop a logistic regression model to classify fall status. RESULTS Accelerometer-derived metrics were significantly associated with multiple clinical metrics that capture disease severity, balance confidence and fatigue. Performance of a logistic regression for classifying fall status was enhanced by including accelerometer features (accuracy 74%, AUC 0.78) compared to the standard of care (accuracy 68%, AUC 0.74) or patient reported outcomes (accuracy 71%, AUC 0.75). SIGNIFICANCE Accelerometer derived metrics were associated with clinically relevant measures of disease severity, fatigue and balance confidence during a balance challenging task. Inertial sensors could feasibly be utilized to enhance the accuracy of functional assessments to identify fall risk in PwMS. Simplicity of these accelerometer-based metrics could facilitate deployment for community-based monitoring.
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Affiliation(s)
- Lindsey J. Tulipani
- M-Sense Research Group, Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT
| | - Brett Meyer
- M-Sense Research Group, Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT
| | - Dale Larie
- M-Sense Research Group, Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT
| | - Andrew J. Solomon
- Department of Neurological Sciences, University of Vermont, Burlington, VT
| | - Ryan S. McGinnis
- M-Sense Research Group, Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT;,Corresponding Author: Dr. Ryan S. McGinnis (), Department of Electrical and Biomedical Engineering, 33 Colchester Avenue, Burlington, VT 05405
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12
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Fujita K, Iijima H, Eguchi R, Kuroiwa T, Sasaki T, Yokoyama Y, Koyama T, Nimura A, Kato R, Okawa A, Takahashi M. Gait analysis of patients with distal radius fracture by using a novel laser Timed Up-and-Go system. Gait Posture 2020; 80:223-227. [PMID: 32540778 DOI: 10.1016/j.gaitpost.2020.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/14/2020] [Accepted: 06/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Postmenopausal women are at risk of fall and fracture with the physical decline. Distal radius fracture (DRF) is considered as the primary fragility fracture, and women with this fracture showed poor results in the usual Timed Up-and-Go (TUG) test, indicating a decline in balance and physical ability. The detailed physical characteristics of female DRF patients have not been extensively examined. RESEARCH QUESTION Is the novel laser TUG system able to detect and analyze the detailed gait characteristics in patients with DRF whose physical ability has tended to decline? METHODS In this cross-sectional case control study, the gait characteristics of 32 female patients with DRF who had undergone surgery were evaluated at 2 weeks postoperatively with a laser TUG system to analyze the detailed leg motion during normal TUG test. Forty-three age- and sex-matched non-fractured women were evaluated by the laser TUG system as controls. Lifestyle and present illness were corrected at the time of TUG measurement. Detailed data during laser TUG in both groups were compared statistically, and odds ratio and thread shod of the fracture was elucidated through a logistic regression analysis. RESULTS DRF patients showed slower speed and had to do more steps to complete the TUG test. Furthermore, asymmetric trajectory and significantly further distance from the marker were observed. Thirteen steps to complete the TUG test was the thread shod of DRF. SIGNIFICANCE Detailed gait characteristics of patients with DRF were detected by the laser TUG system. The gait decline and abnormality could be one of the reasons of consecutive fragility fracture. To prevent secondary fragility fractures, this system can be useful for screening.
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Affiliation(s)
- Koji Fujita
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
| | - Hirotaka Iijima
- Department of System Design and Engineering, Faculty of Science and Technology, Keio University, Kanagawa, Japan
| | - Ryo Eguchi
- Department of System Design and Engineering, Faculty of Science and Technology, Keio University, Kanagawa, Japan
| | - Tomoyuki Kuroiwa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toru Sasaki
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yukihiro Yokoyama
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takafumi Koyama
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akimoto Nimura
- Department of Functional Joint Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Atsushi Okawa
- Department of Orthopaedic and Spinal Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Takahashi
- Department of System Design and Engineering, Faculty of Science and Technology, Keio University, Kanagawa, Japan
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13
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Brichetto G, Pedullà L, Podda J, Tacchino A. Beyond center-based testing: Understanding and improving functioning with wearable technology in MS. Mult Scler 2020; 25:1402-1411. [PMID: 31502913 DOI: 10.1177/1352458519857075] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Wearable sensors are designed to be worn on the body or embedded into portable devices (e.g. smartphones and smartwatches), allowing continuous patient-based monitoring, objective outcomes measuring, and feedback delivering on daily-life activities. Within the medicine domain, there has been a rapid increase in the development, testing, and use of wearable technologies especially in the context of neurological diseases. Although wearables represent promising tools also in multiple sclerosis (MS), the research on their application in MS is still ongoing, and further studies are required to assess their reliability and accuracy to monitor body functions and disability in people with MS (pwMS). Here, we provided a comprehensive overview of the opportunities, potential challenges, and limitations of the wearable technology use in MS. In particular, we classified previous findings within this field into macro-categories, considered crucial for disease management: assessment, monitoring, intervention, advice, and education. Given the increasing pivotal role played by wearables, current literature suggests that for pwMS, the time is right to shift from a center-based traditional therapeutic paradigm toward a personalized patient-based disease self-management. On this way, we present two ongoing initiatives aimed at implementing a continuous monitoring of pwMS and, consequently, providing timely and appropriate care interventions.
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Affiliation(s)
- Giampaolo Brichetto
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy/Rehabilitation Center, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Ludovico Pedullà
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy/Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Jessica Podda
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy/Rehabilitation Center, Italian Multiple Sclerosis Society, Genoa, Italy
| | - Andrea Tacchino
- Scientific Research Area, Italian Multiple Sclerosis Foundation, Genoa, Italy
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14
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Brichetto G. We should monitor our patients with wearable technology instead of neurological examination - Commentary. Mult Scler 2020; 26:1028-1030. [PMID: 32669039 DOI: 10.1177/1352458520930985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giampaolo Brichetto
- Scientific Research Area, Italian MS Society Foundation, Genoa, Italy/AISM Rehabilitation Centers, Italian MS Society, Genoa, Italy
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15
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Figueiredo AI, Balbinot G, Brauner FO, Schiavo A, Baptista RR, Pagnussat AS, Hollands K, Mestriner RG. SPARC Metrics Provide Mobility Smoothness Assessment in Oldest-Old With and Without a History of Falls: A Case Control Study. Front Physiol 2020; 11:540. [PMID: 32587523 PMCID: PMC7298141 DOI: 10.3389/fphys.2020.00540] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/30/2020] [Indexed: 11/25/2022] Open
Abstract
Aging-related neuromuscular and neurocognitive decline induces unsmooth movements in daily functional mobility. Here, we used a robust analysis of linear and angular spectral arc length (SPARC) in the single and dual task instrumented timed up-and-go (iTUG) test to compare functional mobility smoothness in fallers and non-fallers aged 85 and older. 64 participants aged 85 and older took part in this case control study. The case group (fallers, n = 32) had experienced falls to the ground in the 6 months prior to the assessment. SPARC analyses were conducted in all phases of the single and dual task iTUGs. We also performed correlation mapping to test the relation of socio-demographic and clinical features on SPARC metrics. The magnitude of between-group differences was calculated using D-Cohen effect size (ES). SPARC was able to distinguish fallers during the single iTUG (ES ≈ 4.18). Turning while walking in the iTUG induced pronounced unsmooth movements in the fallers (SPARC ≈ −13; ES = 3.52) and was associated with the ability to maintain balance in the functional reach task. This information is of importance in the study of functional mobility in the oldest-old and to assess the efficacy of fall-prevention programs.
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Affiliation(s)
- Anelise Ineu Figueiredo
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Gustavo Balbinot
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Fabiane Oliveira Brauner
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aniuska Schiavo
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Reimann Baptista
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aline Souza Pagnussat
- Department of Physical Therapy, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Kristen Hollands
- School of Health Sciences, University of Salford Manchester, Salford, United Kingdom
| | - Régis Gemerasca Mestriner
- Biomedical Gerontology Program, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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16
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Fifteen Years of Wireless Sensors for Balance Assessment in Neurological Disorders. SENSORS 2020; 20:s20113247. [PMID: 32517315 PMCID: PMC7308812 DOI: 10.3390/s20113247] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/25/2020] [Accepted: 06/03/2020] [Indexed: 12/12/2022]
Abstract
Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined.
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17
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Wei H, Chopada P, Kehtarnavaz N. C-MHAD: Continuous Multimodal Human Action Dataset of Simultaneous Video and Inertial Sensing. SENSORS 2020; 20:s20102905. [PMID: 32443857 PMCID: PMC7287800 DOI: 10.3390/s20102905] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/15/2020] [Accepted: 05/18/2020] [Indexed: 12/01/2022]
Abstract
Existing public domain multi-modal datasets for human action recognition only include actions of interest that have already been segmented from action streams. These datasets cannot be used to study a more realistic action recognition scenario where actions of interest occur randomly and continuously among actions of non-interest or no actions. It is more challenging to recognize actions of interest in continuous action streams since the starts and ends of these actions are not known and need to be determined in an on-the-fly manner. Furthermore, there exists no public domain multi-modal dataset in which video and inertial data are captured simultaneously for continuous action streams. The main objective of this paper is to describe a dataset that is collected and made publicly available, named Continuous Multimodal Human Action Dataset (C-MHAD), in which video and inertial data stream are captured simultaneously in a continuous way. This dataset is then used in an example recognition technique and the results obtained indicate that the fusion of these two sensing modalities increases the F1 scores compared to using each sensing modality individually.
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18
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Flachenecker F, Gaßner H, Hannik J, Lee DH, Flachenecker P, Winkler J, Eskofier B, Linker RA, Klucken J. Objective sensor-based gait measures reflect motor impairment in multiple sclerosis patients: Reliability and clinical validation of a wearable sensor device. Mult Scler Relat Disord 2019; 39:101903. [PMID: 31927199 DOI: 10.1016/j.msard.2019.101903] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/11/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gait deficits are common in multiple sclerosis (MS) and contribute to disability but may not be easily detected in the early stages of the disease. OBJECTIVES We investigated whether sensor-based gait analysis is able to detect gait impairments in patients with MS (PwMS). METHODS A foot-worn sensor-based gait analysis system was used in 102 PwMS and 22 healthy controls (HC) that were asked to perform the 25-foot walking test (25FWT) two times in a self-selected speed (25FWT_pref), followed by two times in a speed as fast as possible (25FWT_fast). The Multiple Sclerosis Walking Scale (MSWS-12) was used as a subjective measure of patient mobility. Patients were divided into EDSS and functional system subgroups. RESULTS Datasets between two consecutive measurements (test-retest-reliability) were highly correlated in all analysed mean gait parameters (e.g. 25FWT_fast: stride length r = 0.955, gait speed r = 0.969) Subgroup analysis between HC and PwMS with lower (EDSS≤3.5) and higher (EDSS 4.0-7.0) disability showed significant differences in mean stride length, gait speed, toe off angle, stance time and swing time (e.g. stride length of EDSS subgroups 25FWT_fast p ≤ 0.001, 25FWT_pref p = 0.003). The differences between EDSS subgroups were more pronounced in fast than in self-selected gait speed (e.g. stride length 25FWT_fast 33.6 cm vs. 25FWT_pref 16.3 cm). Stride length (25FWT_fast) highly correlated to EDSS (r=-0.583) and MSWS-12 (r=-0.668). We observed significant differences between HC and PwMS with (FS 0-1) and without (FS≥2) pyramidal or cerebellar disability (e.g. gait speed of FS subgroups p ≤ 0.001). CONCLUSION Sensor-based gait analysis objectively supports the clinical assessment of gait abnormalities even in the lower stages of MS, especially when walking with fast speed. Stride length and gait speed where identified as the most clinically relevant gait measures. Thus, it may be used to support the assessment of PwMS with gait impairment in the future, e.g. for more objective classification of disability. Its role in home-monitoring scenarios need to be evaluated in further studies.
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Affiliation(s)
- Felix Flachenecker
- Department of Neurology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen 91054, Germany
| | - Heiko Gaßner
- Department of Molecular Neurology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen 91054, Germany
| | - Julius Hannik
- Portabiles HealthCare Technologies GmbH, Erlangen 91054, Germany
| | - De-Hyung Lee
- Department of Neurology, University of Regensburg, Regensburg 93053, Germany
| | | | - Jürgen Winkler
- Department of Molecular Neurology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen 91054, Germany
| | - Bjoern Eskofier
- Machine Learning and Data Analytics Lab, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen 91054, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Regensburg 93053, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen 91054, Germany; Fraunhofer Institut für Integrierte Schaltungen, Erlangen, Germany.
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19
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Sikes EM, Cederberg KL, Sandroff BM, Bartolucci A, Motl RW. Quantitative Synthesis of Timed 25-Foot Walk Performance in Multiple Sclerosis. Arch Phys Med Rehabil 2019; 101:524-534. [PMID: 31669296 DOI: 10.1016/j.apmr.2019.08.488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/20/2019] [Accepted: 08/16/2019] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide a meta-analysis of articles that have included the timed 25-foot walk (T25FW) in persons with multiple sclerosis (MS), quantify differences in T25FW scores between those with MS and controls without MS, and quantify differences between categories of disability status and clinical disease courses within MS. DATA SOURCES The literature search was conducted using 4 databases (Google Scholar, PubMed, Cumulative Index to Nursing and Allied Health, EBSCO Host). We searched reference lists of published articles to identify additional articles. STUDY SELECTION A systematic literature search identified articles reporting average T25FW performance in seconds between those with MS and controls without MS, between those with MS who had mild and moderate and/or severe disability status, and between relapsing-remitting and progressive clinical courses of MS. DATA EXTRACTION Information was extracted and categorized based on reported data: comparisons of controls without MS and MS, comparisons of mild and moderate and/or severe MS based on study-defined Expanded Disability Status Scale groups, and comparisons of relapsing-remitting and progressive MS clinical courses. DATA SYNTHESIS We performed a random effects meta-analysis to quantify differences between groups as estimated by effect sizes (ESs). We expressed the differences in Cohen d as well as the original units of the T25FW (ie, seconds). CONCLUSIONS There was a large difference in T25FW performance in MS compared with controls without MS (ES=-0.93, mean difference=2.4s, P<.01). Persons with moderate and/or severe disability walked substantially slower compared with mild disability (ES=-1.02, mean difference=5.4s, P<.01), and persons with progressive courses of MS walked substantially slower than relapsing-remitting MS (ES=-1.4, mean difference=13.4s, P<.01).
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Affiliation(s)
- E Morghen Sikes
- School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Katie L Cederberg
- School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brian M Sandroff
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alfred Bartolucci
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Robert W Motl
- Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama
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20
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Klucken J, Gladow T, Hilgert JG, Stamminger M, Weigand C, Eskofier B. [Wearables in the treatment of neurological diseases-where do we stand today?]. DER NERVENARZT 2019; 90:787-795. [PMID: 31309270 DOI: 10.1007/s00115-019-0753-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Fitness and lifestyle trackers raise the awareness for wearable sensors in medical applications for clinical trials and healthcare. Various functional impairments of patients with neurological diseases are an ideal target to generate wearable-derived and patient-centered parameters that have the potential to support prevention, prediction, diagnostic procedures and therapy monitoring during the clinical work-up; however, substantial differences between clinical grade wearables and fitness trackers have to be acknowledged. For the application in clinical trials or individualized patient care distinct technical and clinical validation trials have to be conducted. The different test environments under laboratory conditions during standardized tests or under unsupervised home monitoring conditions have to be included in the algorithmic processing of sensor raw data in order to enable a clinical decision support under real-life conditions. This article presents the general understanding of the technical application for the most relevant functional impairments in neurology. While wearables used for sleep assessment have already reached a high level of technological readiness due to the defined test environment (bed, sleep), other wearable applications, e.g. for gait and mobility during home monitoring require further research in order to transfer the technical capabilities into real-life patient care.
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Affiliation(s)
- Jochen Klucken
- Molekulare Neurologie, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland. .,Medical Valley Digital Health Application Center, Bamberg, Deutschland. .,AG Digital Health Pathways, Fraunhofer IIS, Erlangen-Tennenlohe, Deutschland.
| | - Till Gladow
- Medical Valley Digital Health Application Center, Bamberg, Deutschland
| | | | - Marc Stamminger
- Graphische Datenverarbeitung, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Christian Weigand
- Medical Valley Digital Health Application Center, Bamberg, Deutschland.,Graphische Datenverarbeitung, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Björn Eskofier
- AG Mobile Health Lab, Fraunhofer IIS, Bamberg, Deutschland.,MaD Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
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