Measuring center of pressure signals to quantify human balance using multivariate multiscale entropy by designing a force platform

Predicting balance impairments in older adults: a wavelet-based center of pressure classification approach

BACKGROUND

Aging is associated with a decline in postural control and an increased risk of falls. The Center of Pressure (CoP) trajectory analysis is a commonly used method to assess balance. In this study, we proposed a new method to identify balance impairments in older adults by analyzing their CoP trajectory frequency components, sensory inputs, reaction time, motor functions, and Fall-related Concerns (FrC).

METHODS

The study includes 45 older adults aged [Formula: see text] years who were assessed for sensory and motor functions. FrC and postural control in a quiet stance with open and closed eyes on stable and unstable surfaces. A Discrete Wavelet Transform (DWT) was used to detect features in frequency scales, followed by the K-means algorithm to detect different clusters. The multinomial logistic model was used to identify and predict the association of each group with the sensorimotor tests and FrC.

RESULTS

The study results showed that by DWT, three distinct groups of subjects could be revealed. Group 2 exhibited the broadest use of frequency scales, less decline in sensorimotor functions, and lowest FrC. The study also found that a decline in sensorimotor functions and fall-related concern may cause individuals to rely on either very low-frequency scales (group 1) or higher-frequency scales (group 3) and that those who use lower-frequency scales (group 1) can manage their balance more successfully than group 3.

CONCLUSIONS

Our study provides a new, cost-effective method for detecting balance impairments in older adults. This method can be used to identify people at risk and develop interventions and rehabilitation strategies to prevent falls in this population.

Measuring the Reliability of Postural Sway Measurements for a Static Standing Task: The Effect of Age

Background: A force plate is used to determine the ability to balance ability. However, only some medical centers or laboratories are equipped with force plates because they are costly so a low-cost force plate is required for home care or health care institutes. Few studies compare the reliability of postural sway measurements in terms of age. This study proposes a low-cost force plate to select reliable parameters to evaluate postural sway.

Objectives: To determine the intra-rater reliability of a novel force plate and the effect of age difference on the intra-rater test-retest reliability for the center of pressure (COP).

Methods: Forty participants were enrolled for this study: 20 youths and 20 older adults. Participants stood on a custom-made and low-cost force plate with eyes opened and eyes closed to measure COP-related parameters. The within-day test-retest reliability was measured at two sessions on the same day and the between-days reliability was measured on two different days. The COP-related parameters include the average velocity of COP, the average velocity in the antero-posterior and medio-lateral directions, the mean distance of COP and the mean distance in the antero-posterior and medio-lateral directions. An intra-class correlation coefficient test with one-way random model was performed to determine the reliability of different variables within-days and between-days. The results were presented in single measurement of intraclass correlation coefficient (ICC), the standard error of measurements, and the minimal detectable changes of each COP-related parameters.

Results: The novel low-cost force plate demonstrates excellent reliability in terms of the COP velocity related parameters for within- and between-day measurements. The ICC of COP distance related parameters were good to excellent reliability for between-day measurements (range: 0.43–0.84). Older adults demonstrated excellent reliability in terms of the mean distance for antero-posterior and the results were better than those for younger participants for the eyes-opened and eyes-closed conditions. The reliability in terms of the mean distance for medio-lateral was poor to good for older adults (range: 0.38–0.55), and excellent for younger participants.

Conclusion: The novel and low-cost force plate reliably measured balance and age affects the reliability of different COP variables, so the results of this study were pertinent to the selection of COP measures.

Ability of Wearable Accelerometers-Based Measures to Assess the Stability of Working Postures

With the rapid development and widespread application of wearable inertial sensors in the field of human motion capture, the low-cost and non-invasive accelerometer (ACC) based measures have been widely used for working postural stability assessment. This study systematically investigated the abilities of ACC-based measures to assess the stability of working postures in terms of the ability to detect the effects of work-related factors and the ability to classify stable and unstable working postures. Thirty young males participated in this study and performed twenty-four load-holding tasks (six working postures × two standing surfaces × two holding loads), and forty-three ACC-based measures were derived from the ACC data obtained by using a 17 inertial sensors-based motion capture system. ANOVAs, t-tests and machine learning (ML) methods were adopted to study the factors’ effects detection ability and the postural stability classification ability. The results show that almost all forty-three ACC-based measures could (p < 0.05) detect the main effects of Working Posture and Load Carriage, and their interaction effects. However, most of them failed in (p ≥ 0.05) detecting Standing Surface’s main or interaction effects. Five measures could detect both main and interaction effects of all the three factors, which are recommended for working postural stability assessment. The performance in postural stability classification based on ML was also good, and the feature set exerted a greater influence on the classification accuracy than sensor configuration (i.e., sensor placement locations). The results show that the pelvis and lower legs are recommended locations overall, in which the pelvis is the first choice. The findings of this study have proved that wearable ACC-based measures could assess the stability of working postures, including the work-related factors’ effects detection ability and stable-unstable working postures classification ability. However, researchers should pay more attention to the measure selection, sensors placement, feature selection and extraction in practical applications.

Effect of Walking Speeds on Complexity of Plantar Pressure Patterns

Various walking speeds may induce different responses on the plantar pressure patterns. Current methods used to analyze plantar pressure patterns are linear and ignore nonlinear features. The purpose of this study was to analyze the complexity of plantar pressure images after walking at various speeds using nonlinear bidimensional multiscale entropy (MSE2D). Twelve participants (age: 27.1 ± 5.8 years; height: 170.3 ± 10.0 cm; and weight: 63.5 ± 13.5 kg) were recruited for walking at three speeds (slow at 1.8 mph, moderate at 3.6 mph, and fast at 5.4 mph) for 20 minutes. A plantar pressure measurement system was used to measure plantar pressure patterns. Complexity index (CI), a summation of MSE2D from all time scales, was used to quantify the changes of complexity of plantar pressure images. The analysis of variance with repeated measures and Fisher’s least significant difference correction were used to examine the results of this study. The results showed that CI of plantar pressure images of 1.8 mph (1.780) was significantly lower compared with 3.6 (1.790) and 5.4 mph (1.792). The results also showed that CI significantly increased from the 1st min (1.780) to the 10th min (1.791) and 20th min (1.791) with slow walking (1.8 mph). Our results indicate that slow walking at 1.8 mph may not be good for postural control compared with moderate walking (3.6 mph) and fast walking (5.4 mph). This study demonstrates that bidimensional multiscale entropy is able to quantify complexity changes of plantar pressure images after different walking speeds.

Empirical Mode Decomposition-Derived Entropy Features Are Beneficial to Distinguish Elderly People with a Falling History on a Force Plate Signal

Fall risk prediction is an important issue for the elderly. A center of pressure signal, derived from a force plate, is useful for the estimation of body calibration. However, it is still difficult to distinguish elderly people’s fall history by using a force plate signal. In this study, older adults with and without a history of falls were recruited to stand still for 60 s on a force plate. Forces in the x, y and z directions (Fx, Fy, and Fz) and center of pressure in the anteroposterior (COPx) and mediolateral directions (COPy) were derived. There were 49 subjects in the non-fall group, with an average age of 71.67 (standard derivation: 6.56). There were also 27 subjects in the fall group, with an average age of 70.66 (standard derivation: 6.38). Five signal series—forces in x, y, z (Fx, Fy, Fz), COPX, and COPy directions—were used. These five signals were further decomposed with empirical mode decomposition (EMD) with seven intrinsic mode functions. Time domain features (mean, standard derivation and coefficient of variations) and entropy features (approximate entropy and sample entropy) of the original signals and EMD-derived signals were extracted. Results showed that features extracted from the raw COP data did not differ significantly between the fall and non-fall groups. There were 10 features extracted using EMD, with significant differences observed among fall and non-fall groups. These included four features from COPx and two features from COPy, Fx and Fz.

Effects of working posture, lifting load, and standing surface on postural instability during simulated lifting tasks in construction

Postural instability is a major contributor to fatal and nonfatal falls in the construction industry. This study investigated the effects of working posture, lifting load and standing surface on perceived postural instability. Thirty young males performed simulated lifting tasks in construction using six different postures under four experimental conditions (2 loads × 2 surfaces). Results showed working postures with bending at the waist and overhead carrying were associated with high postural instability. With lifting load and inclined standing surface both significantly increased postural instability for all working postures except the full squatting. Full squatting with lifting load was more stable than without load for the flat surface, but opposite for the inclined surface. These findings indicate three investigated factors had not only significant main effects, but also complicated interaction effects on postural instability, implying that all three factors should be considered simultaneously for the real practice on fall prevention in construction. Practitioner summary: The leading causes of worker deaths in the construction industry were falls. This study showed that working postures with waist bending and overhead carrying were associated with high postural instability. With lifting load and inclined standing surface both significantly increased postural instability for all working postures except the full squatting.

Portable electronic device to assess the human balance using a minimum number of sensors

OBJECTIVE

This paper presents the design and development of a new electronic portable device to assess the human balance of the human body during standing, using a minimal number of sensors and peripheral components. This device is aimed to evaluate human balance in environments outside of specialized laboratories, such as small clinics and therapy offices.

APPROACH

The design is based on previous designs using three or more resistive force sensors attached to the feet, however in the present work, the sensors were attached on an adjustable platform, to fit several sizes of feet. Furthermore, all the signal acquisition, process, storage and display are executed by an embedded electronic system, thus avoiding the use of computers and external peripherals. A new method to compute the CoP using only two sensors per foot was developed and tested in a group of 50 university students, (17 women and 33 men), 26.04 ± 4.94 years.

MAIN RESULTS

It was developed a portable electronic system to measure the trajectory of the CoP and to calculate the indexes values derived from it. The system is capable to discriminate between measuring situations (open and closed eyes), using only two sensors per foot (p < 0.0001). A comparison between the values obtained for young subjects using the proposed device, and the values reported in the literature showed a similar tendency.

SIGNIFICANCE

The results indicate that the proposed system is a good, low-cost, and easy-to-use alternative tool for researchers and clinicians interested in the evaluation of human balance, especially if the measurements must be done outside laboratories.

Complexity-Based Measures of Postural Sway during Walking at Different Speeds and Durations Using Multiscale Entropy

: Participation in various physical activities requires successful postural control in response to the changes in position of our body. It is important to assess postural control for early detection of falls and foot injuries. Walking at various speeds and for various durations is essential in daily physical activities. The purpose of this study was to evaluate the changes in complexity of the center of pressure (COP) during walking at different speeds and for different durations. In this study, a total of 12 participants were recruited for walking at two speeds (slow at 3 km/h and moderate at 6 km/h) for two durations (10 and 20 minutes). An insole-type plantar pressure measurement system was used to measure and calculate COP as participants walked on a treadmill. Multiscale entropy (MSE) was used to quantify the complexity of COP. Our results showed that the complexity of COP significantly decreased (p < 0.05) after 20 min of walking (complexity index, CI = −3.51) compared to 10 min of walking (CI = −3.20) while walking at 3 km/h, but not at 6 km/h. Our results also showed that the complexity index of COP indicated a significant difference (p < 0.05) between walking at speeds of 3 km/h (CI = −3.2) and 6 km/h (CI = −3.6) at the walking duration of 10 minutes, but not at 20 minutes. This study demonstrated an interaction between walking speeds and walking durations on the complexity of COP.

Analogy Study of Center-Of-Pressure and Acceleration Measurement for Evaluating Human Body Balance via Segmentalized Principal Component Analysis

The purpose of this research is to investigate the feasibility of evaluating the human’s balancing ability by means of the human body’s swaying acceleration measurements instead of the traditional center-of-pressure (COP) measurement. The COP measurement has been used broadly for assessing the balance ability of patients in hospitals. However, the force plate system which is employed to measure the COP signals of the human body is generally restrictive due to the very high cost as well as the bulky portability. In this study, the balancing ability of the human body was evaluated through the measurements of a capacitive accelerometer. The segmentalized principal components analysis (sPCA) was employed to reduce the influence of the gravity component in acceleration measurement projected onto the horizontal components while the accelerometer inevitably tilts. The signal relationship between the COP and the acceleration was derived, so that the swaying acceleration measurements of human body can be utilized to evaluate the human body’s balancing ability.

Validating a low-cost, consumer force-measuring platform as an accessible alternative for measuring postural sway

The Zibrio SmartScale is a low-cost, portable force platform designed to perform an objective assessment of postural stability. The purpose of the present study was to validate the center of pressure (COP) measurements in the Zibrio SmartScale. Simultaneous COP data was collected by a Zibrio SmartScale and a laboratory-grade force platform (LFP) under the dynamic motion of an inverted pendulum device intended to mimic the sway of a standing human. The inverted pendulum was placed on the Zibrio SmartScale which was placed on the LFP. The pendulum was then displaced to angles of 3° and 5° in both the anterior-posterior (AP) and medial-lateral (ML) directions. The findings of this study show low mean average error (MAE) among the measures taken simultaneously upon the LFP and Zibrio SmartScale with no appreciable difference in error in either AP or ML COP directions. Averaged over repeated trials, the MAE did not surpass 0.5 mm. This represented 0.4% of the total range (±50 to 60 mm in 5° displacement trials) of simulated COP. The results of this study strongly indicate that the Zibrio SmartScale can perform adequately as a light-weight and low-cost alternative method of COP measurement in comparison to a traditional LFP.

Dynamic Balance Measurement and Quantitative Assessment Using Wearable Plantar-Pressure Insoles in a Pose-Sensed Virtual Environment

The center of plantar pressure (COP) reflects the dynamic balance of subjects to a certain extent. In this study, wearable pressure insoles are designed, body pose measure is detected by the Kinect sensor, and a balance evaluation system is formulated. With the designed games for the interactive actions, the Kinect sensor reads the skeletal poses to judge whether the desired action is performed, and the pressure insoles simultaneously collect the plantar pressure data. The COP displacement and its speed are calculated to determine the body sway and the ability of balance control. Significant differences in the dispersion of the COP distribution of the 12 subjects have been obtained, indicating different balancing abilities of the examined subjects. A novel assessment process is also proposed in the paper, in which a correlation analysis is made between the de facto sit-to-stand (STS) test and the proposed method; the Pearson and Spearman correlations are also conducted, which reveal a significant positive correlation. Finally, four undergraduate volunteers with a right leg sports injury participate in the experiments. The experimental results show that the normal side and abnormal side have significantly different characters, suggesting that our method is effective and robust for balance measurements.

Effects of Kinesiology Tape on Non-linear Center of Mass Dispersion During the Y Balance Test

Static taping of the ankle or knee joint is a common method of reducing risk of injury by providing mechanical stability. An alternative taping technique employs kinesiology tape, which has the additional benefit of improving functionality by stimulating proprioception. There is substantial disagreement whether kinesiology tape shows significant differences in proprioception and postural stability as compared to rigid/static tape when applied at the lower limb. The current study investigated the effects of kinesiology tape and static tape during a Y Balance Test on center of mass as an indicator for postural stability. Forty-one individuals, free of injury, performed the Y Balance Test under the three conditions; no tape, kinesiology tape, and static tape applied at the lower limb to the quadriceps, triceps surae and ankle joint. All participants completed the Y Balance Test to determine whether any significant differences could be observed using center of mass movement as a surrogate measure for balance and proprioception. The Minkowski-Bouligand and box-counting fractal dimension analyses were used as measures of the dynamic changes in the center of mass whilst undertaking the Y Balance Test. Statistical analyses included the Kruskal Wallis test to allow for non-normally distributed data and a Bonferroni corrected pairwise T-test as a post hoc test to ascertain pairwise differences between the three taping conditions. Significance was set at 0.05. The fractal analyses of the dynamic changes in center of mass showed significant differences between the control and both the static tape and kinesiology tape groups (p = 0.021 and 0.009, respectively). The current study developed a novel measure of dynamic changes in the center of mass during a set movement that indicated real-time processing effects during a balance task associated with the type of taping used to enhance postural stability.

Accuracy of Base of Support Using an Inertial Sensor Based Motion Capture System

The potential of miniature inertial sensors for human balance and gait analysis appears promising. Base of support (BOS), together with its interaction with center of mass, is a critical indicator in above mentioned research fields. This study aims to evaluate the accuracy of Xsens MVN BIOMECH, a commercial widely used inertial sensor-based motion capture system, for measuring static BOS and examine the effect of different task complexity on the accuracy. Eleven young males participated in this study and went through eleven different experimental tasks. Results showed there were considerable errors in estimating BOS area (error ranged from −12.6% to +64.6%) from Xsens MVN and a large error in foot separation distance when there was knee flexion. The estimated BOS area from MVN was smaller than the ground truth from footprint when there was no knee flexion, and larger when there was knee flexion, and it increased monotonically along with the knee flexion angles. Wrongly estimated foot separations, mainly caused by knee flexion, and the initial system estimation error on BOS, were two major reasons for error and instability of BOS estimation. The findings suggested that caution should be taken when using Xsens MVN BIOMECH to estimate BOS and foot position-related measurements, especially for postures/motions with knee flexion.

Design and Validation of a Low-Cost Portable Device to Quantify Postural Stability

Measurement of the displacement of the center-of-pressure (COP) is an important tool used in biomechanics to assess postural stability and human balance. The goal of this research was to design and validate a low-cost portable device that can offer a quick indication of the state of postural stability and human balance related conditions. Approximate entropy (ApEn) values reflecting the amount of irregularity hiding in COP oscillations were used to calculate the index. The prototype adopted a portable design using the measurements of the load cells located at the four corners of a low-cost force platform. The test subject was asked to stand on the device in a quiet, normal, upright stance for 30 s with eyes open and subsequently for 30 s with eyes closed. Based on the COP displacement signals, the ApEn values were calculated. The results indicated that the prototype device was capable of capturing the increase in regularity of postural control in the visual-deprivation conditions. It was also able to decipher the subtle postural control differences along anterior–posterior and medial–lateral directions. The data analysis demonstrated that the prototype would enable the quantification of postural stability and thus provide a low-cost portable device to assess many conditions related to postural stability and human balance such as aging and pathologies.

Evolution of a theory: how measurement has shaped Ayres Sensory Integration

This special issue of AJOT demonstrates the wide-reaching application of sensory integration concepts and provides multiple examples of the improvements in methodological rigor that occupational therapy researchers have brought to the study of Ayres Sensory Integration® theory.

Parameters Selection for Bivariate Multiscale Entropy Analysis of Postural Fluctuations in Fallers and Non-Fallers Older Adults

Entropy measures are often used to quantify the regularity of postural sway time series. Recent methodological developments provided both multivariate and multiscale approaches allowing the extraction of complexity features from physiological signals; see "Dynamical complexity of human responses: A multivariate data-adaptive framework," in Bulletin of Polish Academy of Science and Technology, vol. 60, p. 433, 2012. The resulting entropy measures are good candidates for the analysis of bivariate postural sway signals exhibiting nonstationarity and multiscale properties. These methods are dependant on several input parameters such as embedding parameters. Using two data sets collected from institutionalized frail older adults, we numerically investigate the behavior of a recent multivariate and multiscale entropy estimator; see "Multivariate multiscale entropy: A tool for complexity analysis of multichannel data," Physics Review E, vol. 84, p. 061918, 2011. We propose criteria for the selection of the input parameters. Using these optimal parameters, we statistically compare the multivariate and multiscale entropy values of postural sway data of non-faller subjects to those of fallers. These two groups are discriminated by the resulting measures over multiple time scales. We also demonstrate that the typical parameter settings proposed in the literature lead to entropy measures that do not distinguish the two groups. This last result confirms the importance of the selection of appropriate input parameters.

Posture and Texting: Effect on Balance in Young Adults

Using a mobile phone while doing another activity is a common dual-task activity in our daily lives. This study examined the effect of texting on the postural stability of young adults. Twenty college students were asked to perform static and dynamic postural stability tasks. Traditional COP and multivariate multiscale entropy (MMSE) were used to assess the static postural stability and the Star Excursion Balance Test (SEBT) was used to assess the dynamic postural stability. Results showed that (1) texting impaired postural stability, (2) the complexity index did not change much although the task conditions changed, and (3) performing texting is perceived to be more difficult.

Operational safety assessment of turbo generators with wavelet Rényi entropy from sensor-dependent vibration signals

With the rapid development of sensor technology, various professional sensors are installed on modern machinery to monitor operational processes and assure operational safety, which play an important role in industry and society. In this work a new operational safety assessment approach with wavelet Rényi entropy utilizing sensor-dependent vibration signals is proposed. On the basis of a professional sensor and the corresponding system, sensor-dependent vibration signals are acquired and analyzed by a second generation wavelet package, which reflects time-varying operational characteristic of individual machinery. Derived from the sensor-dependent signals' wavelet energy distribution over the observed signal frequency range, wavelet Rényi entropy is defined to compute the operational uncertainty of a turbo generator, which is then associated with its operational safety degree. The proposed method is applied in a 50 MW turbo generator, whereupon it is proved to be reasonable and effective for operation and maintenance.

Sample entropy analysis of EEG signals via artificial neural networks to model patients' consciousness level based on anesthesiologists experience

Electroencephalogram (EEG) signals, as it can express the human brain's activities and reflect awareness, have been widely used in many research and medical equipment to build a noninvasive monitoring index to the depth of anesthesia (DOA). Bispectral (BIS) index monitor is one of the famous and important indicators for anesthesiologists primarily using EEG signals when assessing the DOA. In this study, an attempt is made to build a new indicator using EEG signals to provide a more valuable reference to the DOA for clinical researchers. The EEG signals are collected from patients under anesthetic surgery which are filtered using multivariate empirical mode decomposition (MEMD) method and analyzed using sample entropy (SampEn) analysis. The calculated signals from SampEn are utilized to train an artificial neural network (ANN) model through using expert assessment of consciousness level (EACL) which is assessed by experienced anesthesiologists as the target to train, validate, and test the ANN. The results that are achieved using the proposed system are compared to BIS index. The proposed system results show that it is not only having similar characteristic to BIS index but also more close to experienced anesthesiologists which illustrates the consciousness level and reflects the DOA successfully.

Applications of dynamical complexity theory in traditional Chinese medicine

Traditional Chinese medicine (TCM) has been gradually accepted by the world. Despite its widespread use in clinical settings, a major challenge in TCM is to study it scientifically. This difficulty arises from the fact that TCM views human body as a complex dynamical system, and focuses on the balance of the human body, both internally and with its external environment. As a result, conventional tools that are based on reductionist approach are not adequate. Methods that can quantify the dynamics of complex integrative systems may bring new insights and utilities about the clinical practice and evaluation of efficacy of TCM. The dynamical complexity theory recently proposed and its computational algorithm, Multiscale Entropy (MSE) analysis, are consistent with TCM concepts. This new system level analysis has been successfully applied to many health and disease related topics in medicine. We believe that there could be many promising applications of this dynamical complexity concept in TCM. In this article, we propose some promising applications and research areas that TCM practitioners and researchers can pursue.