Design and Accuracy of an Instrumented Insole Using Pressure Sensors for Step Count

Accuracy, concurrent validity, and test-retest reliability of pressure-based insoles for gait measurement in chronic stroke patients

Introduction

Wearables are potentially valuable tools for understanding mobility behavior in individuals with neurological disorders and how it changes depending on health status, such as after rehabilitation. However, the accurate detection of gait events, which are crucial for the evaluation of gait performance and quality, is challenging due to highly individual-specific patterns that also vary greatly in movement and speed, especially after stroke. Therefore, the purpose of this study was to assess the accuracy, concurrent validity, and test-retest reliability of a commercially available insole system in the detection of gait events and the calculation of stance duration in individuals with chronic stroke.

Methods

Pressure insole data were collected from 17 individuals with chronic stroke during two measurement blocks, each comprising three 10-min walking tests conducted in a clinical setting. The gait assessments were recorded with a video camera that served as a ground truth, and pressure insoles as an experimental system. We compared the number of gait events and stance durations between systems.

Results and discussion

Over all 3,820 gait events, 90.86% were correctly identified by the insole system. Recall values ranged from 0.994 to 1, with a precision of 1 for all measurements. The F1 score ranged from 0.997 to 1. Excellent absolute agreement (Intraclass correlation coefficient, ICC = 0.874) was observed for the calculation of the stance duration, with a slightly longer stance duration recorded by the insole system (difference of -0.01 s). Bland-Altmann analysis indicated limits of agreement of 0.33 s that were robust to changes in walking speed. This consistency makes the system well-suited for individuals post-stroke. The test-retest reliability between measurement timepoints T1 and T2 was excellent (ICC = 0.928). The mean difference in stance duration between T1 and T2 was 0.03 s. We conclude that the insole system is valid for use in a clinical setting to quantitatively assess continuous walking in individuals with stroke.

Smartwatch-Based Prediction of Single-Stride and Stride-to-Stride Gait Outcomes Using Regression-Based Machine Learning

Spatiotemporal variability during gait is linked to fall risk and could be monitored using wearable sensors. Although many users prefer wrist-worn sensors, most applications position at other sites. We developed and evaluated an application using a consumer-grade smartwatch inertial measurement unit (IMU). Young adults (n = 41) completed seven-minute conditions of treadmill gait at three speeds. Single-stride outcomes (stride time, length, width, and speed) and spatiotemporal variability (coefficient of variation of each single-stride outcome) were recorded using an optoelectronic system, while 232 single- and multi-stride IMU metrics were recorded using an Apple Watch Series 5. These metrics were input to train linear, ridge, support vector machine (SVM), random forest, and extreme gradient boosting (xGB) models of each spatiotemporal outcome. We conducted Model × Condition ANOVAs to explore model sensitivity to speed-related responses. xGB models were best for single-stride outcomes [relative mean absolute error (% error): 7-11%; intraclass correlation coefficient (ICC2,1) 0.60-0.86], and SVM models were best for spatiotemporal variability (% error: 18-22%; ICC2,1 = 0.47-0.64). Spatiotemporal changes with speed were captured by these models (Condition: p < 0.00625). Results support the feasibility of monitoring single-stride and multi-stride spatiotemporal parameters using a smartwatch IMU and machine learning.

Optimal locations and computational frameworks of FSR and IMU sensors for measuring gait abnormalities

Neuromuscular diseases cause abnormal joint movements and drastically alter gait patterns in patients. The analysis of abnormal gait patterns can provide clinicians with an in-depth insight into implementing appropriate rehabilitation therapies. Wearable sensors are used to measure the gait patterns of neuromuscular patients due to their non-invasive and cost-efficient characteristics. FSR and IMU sensors are the most popular and efficient options. When assessing abnormal gait patterns, it is important to determine the optimal locations of FSRs and IMUs on the human body, along with their computational framework. The gait abnormalities of different types and the gait analysis systems based on IMUs and FSRs have therefore been investigated. After studying a variety of research articles, the optimal locations of the FSR and IMU sensors were determined by analysing the main pressure points under the feet and prime anatomical locations on the human body. A total of seven locations (the big toe, heel, first, third, and fifth metatarsals, as well as two close to the medial arch) can be used to measure gate cycles for normal and flat feet. It has been found that IMU sensors can be placed in four standard anatomical locations (the feet, shank, thigh, and pelvis). A section on computational analysis is included to illustrate how data from the FSR and IMU sensors are processed. Sensor data is typically sampled at 100 Hz, and wireless systems use a range of microcontrollers to capture and transmit the signals. The findings reported in this article are expected to help develop efficient and cost-effective gait analysis systems by using an optimal number of FSRs and IMUs.

Semiactive Knee Orthotic Using a MR Damper and a Smart Insole to Control the Damping Force Sensing the Plantar Pressure

This work presents the development of semiactive knee orthosis prototype that focus to absorb the forces and impacts in this joint during the human gait. This prototype consists of three subsystems: the first is a wireless and portable system capable of measuring the ground reaction forces in the stance phase of the gait cycle, by means of an instrumented insole with force sensing resistors strategically placed on the sole of the foot, an electronic device allows processing and transmit this information via Bluetooth to the control system. The second is a semiactive actuator, which has inside a magnetorheological fluid, highlighting its ability to modify its damping force depending on the intensity of the magnetic field that circulates through the MR fluid. It is regulated by a Proportional Derivative (PD) controller system according to the values of plantar pressure measured by the insole. The third component is a mechanical structure manufactured by 3D printing, which adapts to the morphology of the human leg. This exoskeleton is designed to support the forces on the knee controlling the action of the magnetorheological actuator by ground reaction forces. The purpose of this assistance system is to reduce the forces applied to the knee during the gait cycle, providing support and stability to this joint. The obtained experimental results indicate that the device fulfills the function by reducing 12 % of the impact forces on the user's knee.

Carrying Position-Independent Ensemble Machine Learning Step-Counting Algorithm for Smartphones

Current step-count estimation techniques use either an accelerometer or gyroscope sensors to calculate the number of steps. However, because of smartphones unfixed placement and direction, their accuracy is insufficient. It is necessary to consider the impact of the carrying position on the accuracy of the pedometer algorithm, because of people carry their smartphones in various positions. Therefore, this study proposes a carrying-position independent ensemble step-counting algorithm suitable for unconstrained smartphones in different carrying positions. The proposed ensemble algorithm comprises a classification algorithm that identifies the carrying position of the smartphone, and a regression algorithm that considers the identified carrying position and calculates the number of steps. Furthermore, a data acquisition system that collects (i) label data in the form of the number of steps estimated from the Force Sensitive Resistor (FSR) sensors, and (ii) input data in the form of the three-axis acceleration data obtained from the smartphones is also proposed. The obtained data were used to allow the machine learning algorithms to fit the signal features of the different carrying positions. The reliability of the proposed ensemble algorithms, comprising a random forest classifier and a regression model, was comparatively evaluated with a commercial pedometer application. The results indicated that the proposed ensemble algorithm provides higher accuracy, ranging from 98.1% to 98.8%, at self-paced walking speed than the commercial pedometer application, and the machine learning-based ensemble algorithms can effectively and accurately predict step counts under different smart phone carrying positions.

Benefits to Performance and Well-Being of Nature-Based Exercise: A Critical Systematic Review and Meta-Analysis

Prior reviews point to the superior benefits of exercising in nature vs in conventional indoor venues, particularly in terms of well-being. However, physical exercise performance, neither in terms of efficacy nor efficiency, has not been sufficiently addressed by past reviews of this topic. Therefore, we conducted both a systematic review and meta-analysis of the experimental literature that relates to differences in exercise performance and well-being between exercising in nature and in conventional indoor venues. Forty-nine relevant studies─the outcome data of which were used for the systematic review─were located within the Web of Science, PubMed, and Scopus databases. The meta-analyses, using data from twenty-four of the relevant studies, revealed no significant overall environmental effect on task performance efficacy outcomes (p = 0.100). For nature-based exercise, however, marginally positive cognitive performance outcomes (p = 0.059), lower ratings of perceived exhaustion (p = 0.001), and higher levels of vigor (p = 0.017) were observed, indicating higher performance efficiency. As for the effects of environment on well-being, positive affect was significantly higher for nature-based exercise (p = 0.000), while perceived stress was significantly higher for indoor exercise (p = 0.032). These results must, however, be interpreted with caution. High levels of bias and between-study heterogeneity were observed. Nonetheless, given several noticeable trends in the results, it may be that exercising in nature enhances the efficiency of exercise task performance to a greater extent than does indoor exercise.

Technical validation of real-world monitoring of gait: a multicentric observational study

INTRODUCTION

Existing mobility endpoints based on functional performance, physical assessments and patient self-reporting are often affected by lack of sensitivity, limiting their utility in clinical practice. Wearable devices including inertial measurement units (IMUs) can overcome these limitations by quantifying digital mobility outcomes (DMOs) both during supervised structured assessments and in real-world conditions. The validity of IMU-based methods in the real-world, however, is still limited in patient populations. Rigorous validation procedures should cover the device metrological verification, the validation of the algorithms for the DMOs computation specifically for the population of interest and in daily life situations, and the users' perspective on the device.

METHODS AND ANALYSIS

This protocol was designed to establish the technical validity and patient acceptability of the approach used to quantify digital mobility in the real world by Mobilise-D, a consortium funded by the European Union (EU) as part of the Innovative Medicine Initiative, aiming at fostering regulatory approval and clinical adoption of DMOs.After defining the procedures for the metrological verification of an IMU-based device, the experimental procedures for the validation of algorithms used to calculate the DMOs are presented. These include laboratory and real-world assessment in 120 participants from five groups: healthy older adults; chronic obstructive pulmonary disease, Parkinson's disease, multiple sclerosis, proximal femoral fracture and congestive heart failure. DMOs extracted from the monitoring device will be compared with those from different reference systems, chosen according to the contexts of observation. Questionnaires and interviews will evaluate the users' perspective on the deployed technology and relevance of the mobility assessment.

ETHICS AND DISSEMINATION

The study has been granted ethics approval by the centre's committees (London-Bloomsbury Research Ethics committee; Helsinki Committee, Tel Aviv Sourasky Medical Centre; Medical Faculties of The University of Tübingen and of the University of Kiel). Data and algorithms will be made publicly available.

TRIAL REGISTRATION NUMBER

ISRCTN (12246987).

Deep Learning-Based Optimal Smart Shoes Sensor Selection for Energy Expenditure and Heart Rate Estimation

Wearable technologies are known to improve our quality of life. Among the various wearable devices, shoes are non-intrusive, lightweight, and can be used for outdoor activities. In this study, we estimated the energy consumption and heart rate in an environment (i.e., running on a treadmill) using smart shoes equipped with triaxial acceleration, triaxial gyroscope, and four-point pressure sensors. The proposed model uses the latest deep learning architecture which does not require any separate preprocessing. Moreover, it is possible to select the optimal sensor using a channel-wise attention mechanism to weigh the sensors depending on their contributions to the estimation of energy expenditure (EE) and heart rate (HR). The performance of the proposed model was evaluated using the root mean squared error (RMSE), mean absolute error (MAE), and coefficient of determination (R2). Moreover, the RMSE was 1.05 ± 0.15, MAE 0.83 ± 0.12 and R2 0.922 ± 0.005 in EE estimation. On the other hand, and RMSE was 7.87 ± 1.12, MAE 6.21 ± 0.86, and R2 0.897 ± 0.017 in HR estimation. In both estimations, the most effective sensor was the z axis of the accelerometer and gyroscope sensors. Through these results, it is demonstrated that the proposed model could contribute to the improvement of the performance of both EE and HR estimations by effectively selecting the optimal sensors during the active movements of participants.

The Effects of Auditory Feedback Gait Training Using Smart Insole on Stroke Patients

This study aimed to assess the effect of the auditory feedback gait training (AFGT) using smart insole on the gait variables, dynamic balance, and activities of daily living (ADL) of stroke patients. In this case, 45 chronic stroke patients who were diagnosed with a stroke before 6 months and could walk more than 10 m were included in this study. Participants were randomly allocated to the smart insole training group (n = 23), in which the AFGT system was used, or to the general gait training group (GGTG) (n = 22). Both groups completed conventional rehabilitation, including conventional physiotherapy and gait training, lasting 60 min per session, five times per week for 4 weeks. Instead of gait training, the smart insole training group received smart insole training twice per week for 4 weeks. Participants were assessed using the GAITRite for gait variables and Timed Up and Go test (TUG), Berg Balance Scale (BBS) for dynamic balance, and Modified Barthel Index (MBI) for ADL. The spatiotemporal gait parameters, symmetry of gait, TUG, BBS, and MBI in the smart insole training group were significantly improved compared to those in the GGTG (p < 0.05). The AFGT system approach is a helpful method for improving gait variables, dynamic balance, and ADL in chronic stroke patients.

A Soft Wearable and Fully-Textile Piezoresistive Sensor for Plantar Pressure Capturing

The trends of wearable health monitoring systems have led to growing demands for gait-capturing devices. However, comfortability and durability under repeated stress are still challenging to achieve in existing sensor-enabled footwear. Herein, a flexible textile piezoresistive sensor (TPRS) consisting of a reduced graphene oxide (rGO)-cotton) fabric electrode and an Ag fabric circuit electrode is proposed. Based on the mechanical and electrical properties of the two fabric electrodes, the TPRS exhibits superior sensing performance, with a high sensitivity of 3.96 kPa-1 in the lower pressure range of 0-36 kPa, wide force range (0-100 kPa), fast response time (170 ms), remarkable durability stability (1000 cycles) and detection ability in different pressures ranges. For the prac-tical application of capturing plantar pressure, six TPRSs were mounted on a flexible printed circuit board and integrated into an insole. The dynamic plantar pressure distribution during walking was derived in the form of pressure maps. The proposed fully-textile piezoresistive sensor is a strong candidate for next-generation plantar pressure wearable monitoring devices.

Evaluation and Application of a Customizable Wireless Platform: A Body Sensor Network for Unobtrusive Gait Analysis in Everyday Life

Body sensor networks (BSNs) represent an important research tool for exploring novel diagnostic or therapeutic approaches. They allow for integrating different measurement techniques into body-worn sensors organized in a network structure. In 2011, the first Integrated Posture and Activity Network by MedIT Aachen (IPANEMA) was introduced. In this work, we present a recently developed platform for a wireless body sensor network with customizable applications based on a proprietary 868MHz communication interface. In particular, we present a sensor setup for gait analysis during everyday life monitoring. The arrangement consists of three identical inertial measurement sensors attached at the wrist, thigh, and chest. We additionally introduce a force-sensitive resistor integrated insole for measurement of ground reaction forces (GRFs), to enhance the assessment possibilities and generate ground truth data for inertial measurement sensors. Since the 868MHz is not strongly represented in existing BSN implementations, we validate the proposed system concerning an application in gait analysis and use this as a representative demonstration of realizability. Hence, there are three key aspects of this project. The system is evaluated with respect to (I) accurate timing, (II) received signal quality, and (III) measurement capabilities of the insole pressure nodes. In addition to the demonstration of feasibility, we achieved promising results regarding the extractions of gait parameters (stride detection accuracy: 99.6±0.8%, Root-Mean-Square Deviation (RMSE) of mean stride time: 5ms, RMSE of percentage stance time: 2.3%). Conclusion: With the satisfactory technical performance in laboratory and application environment and the convincing accuracy of the gait parameter extraction, the presented system offers a solid basis for a gait monitoring system in everyday life.

Foot Strike Angle Prediction and Pattern Classification Using LoadsolTM Wearable Sensors: A Comparison of Machine Learning Techniques

The foot strike pattern performed during running is an important variable for runners, performance practitioners, and industry specialists. Versatile, wearable sensors may provide foot strike information while encouraging the collection of diverse information during ecological running. The purpose of the current study was to predict foot strike angle and classify foot strike pattern from Loadsol^TM wearable pressure insoles using three machine learning techniques (multiple linear regression―MR, conditional inference tree―TREE, and random forest―FRST). Model performance was assessed using three-dimensional kinematics as a ground-truth measure. The prediction-model accuracy was similar for the regression, inference tree, and random forest models (RMSE: MR = 5.16°, TREE = 4.85°, FRST = 3.65°; MAPE: MR = 0.32°, TREE = 0.45°, FRST = 0.33°), though the regression and random forest models boasted lower maximum precision (13.75° and 14.3°, respectively) than the inference tree (19.02°). The classification performance was above 90% for all models (MR = 90.4%, TREE = 93.9%, and FRST = 94.1%). There was an increased tendency to misclassify mid foot strike patterns in all models, which may be improved with the inclusion of more mid foot steps during model training. Ultimately, wearable pressure insoles in combination with simple machine learning techniques can be used to predict and classify a runner’s foot strike with sufficient accuracy.

Accuracy of Mobile Applications versus Wearable Devices in Long-Term Step Measurements

Fitness sensors and health systems are paving the way toward improving the quality of medical care by exploiting the benefits of new technology. For example, the great amount of patient-generated health data available today gives new opportunities to measure life parameters in real time and create a revolution in communication for professionals and patients. In this work, we concentrated on the basic parameter typically measured by fitness applications and devices-the number of steps taken daily. In particular, the main goal of this study was to compare the accuracy and precision of smartphone applications versus those of wearable devices to give users an idea about what can be expected regarding the relative difference in measurements achieved using different system typologies. In particular, the data obtained showed a difference of approximately 30%, proving that smartphone applications provide inaccurate measurements in long-term analysis, while wearable devices are precise and accurate. Accordingly, we challenge the reliability of previous studies reporting data collected with phone-based applications, and besides discussing the current limitations, we support the use of wearable devices for mHealth.

Special Issue "Body Sensors Networks for E-Health Applications"

Body Sensor Networks (BSN) have emerged as a particularization of Wireless Sensor Networks (WSN) in the context of body monitoring environments, closely linked to healthcare applications. These networks are made up of smart biomedical sensors that allow the monitoring of physiological parameters and serve as the basis for e-Health applications. This Special Issue collects some of the latest developments in the field of BSN related to new developments in biomedical sensor technologies, the design and experimental characterization of on-body/in-body antennas and new communication protocols for BSN, including some review studies.

Use of Wearable Sensor Technology in Gait, Balance, and Range of Motion Analysis

More than 8.6 million people suffer from neurological disorders that affect their gait and balance. Physical therapists provide interventions to improve patient’s functional outcomes, yet balance and gait are often evaluated in a subjective and observational manner. The use of quantitative methods allows for assessment and tracking of patient progress during and after rehabilitation or for early diagnosis of movement disorders. This paper surveys the state-of-the-art in wearable sensor technology in gait, balance, and range of motion research. It serves as a point of reference for future research, describing current solutions and challenges in the field. A two-level taxonomy of rehabilitation assessment is introduced with evaluation metrics and common algorithms utilized in wearable sensor systems.

Foot Plantar Pressure Measurement System Using Highly Sensitive Crack-Based Sensor

Measuring the foot plantar pressure has the potential to be an important tool in many areas such as enhancing sports performance, diagnosing diseases, and rehabilitation. In general, the plantar pressure sensor should have robustness, durability, and high repeatability, as it should measure the pressure due to body weight. Here, we present a novel insole foot plantar pressure sensor using a highly sensitive crack-based strain sensor. The sensor is made of elastomer, stainless steel, a crack-based sensor, and a 3D-printed frame. Insoles are made of elastomer with Shore A 40, which is used as part of the sensor, to distribute the load to the sensor. The 3D-printed frame and stainless steel prevent breakage of the crack-based sensor and enable elastic behavior. The sensor response is highly repeatable and shows excellent durability even after 20,000 cycles. We show that the insole pressure sensor can be used as a real-time monitoring system using the pressure visualization program.

Smart Footwear Insole for Recognition of Foot Pronation and Supination Using Neural Networks

Abnormal foot postures during gait are common sources of pain and pathologies of the lower limbs. Measurements of foot plantar pressures in both dynamic and static conditions can detect these abnormal foot postures and prevent possible pathologies. In this work, a plantar pressure measurement system is developed to identify areas with higher or lower pressure load. This system is composed of an embedded system placed in the insole and a user application. The instrumented insole consists of a low-power microcontroller, seven pressure sensors and a low-energy bluetooth module. The user application receives and shows the insole pressure information in real-time and, finally, provides information about the foot posture. In order to identify the different pressure states and obtain the final information of the study with greater accuracy, a Deep Learning neural network system has been integrated into the user application. The neural network can be trained using a stored dataset in order to obtain the classification results in real-time. Results prove that this system provides an accuracy over 90% using a training dataset of 3000+ steps from 6 different users.

Preliminary Clinical Application of Textile Insole Sensor for Hemiparetic Gait Pattern Analysis

Post-stroke gait dysfunction occurs at a very high prevalence. A practical method to quantitatively analyze the characteristics of hemiparetic gait is needed in both clinical and community settings. This study developed a 10-channeled textile capacitive pressure sensing insole (TCPSI) with a real-time monitoring system and tested its performance through hemiparetic gait pattern analysis. Thirty-five subjects (18 hemiparetic, 17 healthy) walked down a 40-m long corridor at a comfortable speed while wearing TCPSI inside the shoe. For gait analysis, the percentage of the plantar pressure difference (PPD), the step count, the stride time, the coefficient of variation, and the phase coordination index (PCI) were used. The results of the stroke patients showed a threefold higher PPD, a higher step count (41.61 ± 10.7), a longer average stride time on the affected side, a lower mean plantar pressure on the affected side, higher plantar pressure in the toe area and the lateral side of the foot, and a threefold higher PCI (hemi: 19.50 ± 13.86%, healthy: 5.62 ± 5.05%) compared to healthy subjects. This study confirmed that TCPSI is a promising tool for distinguishing hemiparetic gait patterns and thus may be used as a wearable gait function evaluation tool, the external feedback gait training device, and a simple gait pattern analyzer for both hemiparetic patients and healthy individuals.

Validity of Instrumented Insoles for Step Counting, Posture and Activity Recognition: A Systematic Review

With the growing interest in daily activity monitoring, several insole designs have been developed to identify postures, detect activities, and count steps. However, the validity of these devices is not clearly established. The aim of this systematic review was to synthesize the available information on the criterion validity of instrumented insoles in detecting postures activities and steps. The literature search through six databases led to 33 articles that met inclusion criteria. These studies evaluated 17 different insole models and involved 290 participants from 16 to 75 years old. Criterion validity was assessed using six statistical indicators. For posture and activity recognition, accuracy varied from 75.0% to 100%, precision from 65.8% to 100%, specificity from 98.1% to 100%, sensitivity from 73.0% to 100%, and identification rate from 66.2% to 100%. For step counting, accuracies were very high (94.8% to 100%). Across studies, different postures and activities were assessed using different criterion validity indicators, leading to heterogeneous results. Instrumented insoles appeared to be highly accurate for steps counting. However, measurement properties were variable for posture and activity recognition. These findings call for a standardized methodology to investigate the measurement properties of such devices.