Analyzing the Use of Accelerometers as a Method of Early Diagnosis of Alterations in Balance in Elderly People: A Systematic Review

Validation of the Equidyn protocol for evaluation of dynamic balance in older adults through a smartphone application

BACKGROUND

Different tasks and proxy measurements have been employed to evaluate dynamic balance in older individuals. However, due to inherent limitations, results from most evaluations could hardly be taken as valid measurements of dynamic balance.

RESEARCH QUESTION

Is the Equidyn smartphone application-based protocol valid and sensitive for assessment of dynamic balance in older adults?

METHODS

Dynamic balance was evaluated in 52 physically active individuals, age range 60-80 years (M = 69.36). The dynamic tasks were one-leg sway either in the mediolateral (ML) or anteroposterior (AP) direction while supported on the contralateral leg, and cyclic sit-to-stand with a narrow support base. These tasks were performed under standardized movement amplitude and rhythm. Outcomes were correlated with unipedal quiet standing. A smartphone was attached to the trunk backside, and a custom-made application (Equidyn) was employed to provide guidance throughout evaluation, timed beeps to pace the movements, and three-dimensional trunk acceleration measurement for balance evaluation.

RESULTS

Our data showed (a) that both ML and AP leg sway tasks were sensitive to aging and to direction of leg sway movements; (b) referenced to quiet unipedal stance, moderate/strong correlations for the ML/AP leg sway tasks and moderate correlations for the sit-to-stand task; and (c) moderate/strong correlations between the ML and AP leg sway tasks, and moderate correlations between the sit-to-stand and the two unipedal dynamic tasks in the ML acceleration direction.

SIGNIFICANCE

The current results support the conclusion that the Equidyn protocol is a sensitive and valid tool to evaluate dynamic balance in healthy older individuals. The protocol tasks standardized in amplitude and rhythm favor their reproducibility and trunk acceleration data interpretation. As the whole assessment is made through a smartphone application, this dynamic balance evaluation could be made in a low-cost simple way both in the laboratory and clinical settings.

Symmetric unipedal balance in quiet stance and dynamic tasks in older individuals

Previous evidence of increased difference of muscular strength between the dominant and non-dominant legs in older adults suggests the possibility of dissimilar balance control between the legs (between-leg asymmetry) associated with aging. In the current investigation, we evaluated between-leg asymmetries in older adults when performing quiet and dynamic balance tasks. Fifty-two physically active and healthy older adults within the age range of 60 to 80 years were recruited. Participants performed balance tasks in unipedal stance, including quiet standing and cyclic sway (rhythmic oscillation) of the non-supporting leg in the anteroposterior or mediolateral directions, producing foot displacements with amplitudes of 20 cm paced in 1 Hz through a metronome. Body balance was evaluated through trunk accelerometry, by using the sensors embedded into a smartphone fixed at the height of the 10th-12th thoracic spines. Analysis revealed lack of significant differences in balance control between the legs either when comparing the right versus left or the preferred versus non-preferred legs, regardless of whether they were performing quiet stance or dynamic tasks. Further examination of the data showed high between-leg correlation coefficients (rs range: 0.71-0.84) across all tasks. Then, our results indicated symmetric and associated between-leg balance control in the examined older adults.

The Applications of Artificial Intelligence for Assessing Fall Risk: Systematic Review

BACKGROUND

Falls and their consequences are a serious public health problem worldwide. Each year, 37.3 million falls requiring medical attention occur. Therefore, the analysis of fall risk is of great importance for prevention. Artificial intelligence (AI) represents an innovative tool for creating predictive statistical models of fall risk through data analysis.

OBJECTIVE

The aim of this review was to analyze the available evidence on the applications of AI in the analysis of data related to postural control and fall risk.

METHODS

A literature search was conducted in 6 databases with the following inclusion criteria: the articles had to be published within the last 5 years (from 2018 to 2024), they had to apply some method of AI, AI analyses had to be applied to data from samples consisting of humans, and the analyzed sample had to consist of individuals with independent walking with or without the assistance of external orthopedic devices.

RESULTS

We obtained a total of 3858 articles, of which 22 were finally selected. Data extraction for subsequent analysis varied in the different studies: 82% (18/22) of them extracted data through tests or functional assessments, and the remaining 18% (4/22) of them extracted through existing medical records. Different AI techniques were used throughout the articles. All the research included in the review obtained accuracy values of >70% in the predictive models obtained through AI.

CONCLUSIONS

The use of AI proves to be a valuable tool for creating predictive models of fall risk. The use of this tool could have a significant socioeconomic impact as it enables the development of low-cost predictive models with a high level of accuracy.

TRIAL REGISTRATION

PROSPERO CRD42023443277; https://tinyurl.com/4sb72ssv.

Kinesiophobia, limits of stability, and functional balance assessment in geriatric patients with chronic low back pain and osteoporosis: a comprehensive study

Background

The significance of studying Kinesiophobia, Limits of Stability (LOS), and functional balance in geriatric patients with CLBP and osteoporosis lies in their profound impact on rehabilitation outcomes and fall risk, ultimately affecting patients' quality of life. This study aimed to examine LOS and functional balance in the geriatric population concurrently experiencing Chronic Low Back Pain (CLBP) and osteoporosis, in comparison to age-matched healthy controls; to assess the correlations between Kinesiophobia, LOS, and functional balance assessments; and to evaluate the mediating influence of Kinesiophobia on the association between LOS and functional balance tests.

Methods

This cross-sectional study included a total of 86 participants in each group. Kinesiophobia was assessed using the Tampa Scale of Kinesiophobia (TSK). LOS variables were evaluated with a computerized Iso-free platform in eight different directions. Functional balance was measured using the Timed Up and Go (TUG) test and the Berg Balance Scale (BBS).

Results

Patients with CLBP and osteoporosis showed significantly lower LOS percentages (45.78 ± 6.92) and impaired Functional Balance, reflected in a TUG Score (10.45 ± 2.23), compared to asymptomatic controls (LOS: 76.95 ± 8.21; TUG: 8.73 ± 1.90). Kinesiophobia showed a significant moderate negative correlation with LOS, indicated by r = -0.362 (p < 0.01). Additionally, Kinesiophobia was found to correlate with functional balance tests. Specifically, there was a moderate positive correlation with the TUG Score (r = 0.322, p < 0.01), indicating that higher Kinesiophobia is associated with slower TUG performance. Conversely, a stronger moderate negative correlation was observed with the Berg Balance Scale (BBS) Score (r = -0.436, p < 0.001), suggesting that increased Kinesiophobia is associated with lower BBS scores, indicating poorer balance performance. Mediation analysis revealed that Kinesiophobia significantly influences LOS and Functional Balance. For LOS and the TUG score, Kinesiophobia showed a direct effect (B = 0.24), an indirect effect (B = 0.09), and a total effect (B = 0.13). Similarly, for LOS and the BBS score, the direct effect of Kinesiophobia was B = 0.38, with an indirect effect of B = 0.10 and a total effect of B = 0.20.

Conclusion

This study underscores the substantial impact of Kinesiophobia on both stability and functional balance in individuals coping with CLBP and osteoporosis. The findings emphasize the clinical relevance of addressing Kinesiophobia as a potential target for interventions aimed at improving LOS and functional balance in this specific patient population.

Accelerometry in the Functional Assessment of Balance in People with Stroke: A Systematic Review

Balance disturbances in people with lived experience of stroke affect activities of daily living and social participation, so assessing them is essential to know the level of functional independence. Accelerometers are electronic devices that allow kinematic variables of balance to be recorded and are a tool of great interest in the assessment of functional balance. To determine the validity and reliability of, as well as the most performed protocols using accelerometers in the functional assessment of balance in people with experience of stroke, a systematic search of articles published in the electronic databases PubMed, Scopus, the Web of Science, the Cochrane Library, the PEDro and the Virtual Health Library from Spain was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We used QUADAS-2 to assess the quality of the included studies. Eight studies met the inclusion criteria, two studied reliability and validity, two studied reliability and four studied the validity of accelerometers in the assessment of balance in people with stroke. All studies indicated the kind of accelerometer, localization on the body, tests and outcome variables. The results indicate that accelerometers show excellent reliability values in the assessment of balance in people who had a prior stroke and disparate results in terms of validity. Triaxial accelerometers were most used, and the 4th and 5th lumbar and 1st and 2nd sacral vertebrae were the body areas most used for their placement.

Multisensory System for Long-Term Activity Monitoring to Facilitate Aging-in-Place

Demographic changes and an ageing population require more effective methods to confront the increased prevalence of chronic diseases which generate dependence in older adults as well as an important rise in social expenditure. The challenge is not only to increase life expectancy, but also to ensure that the older adults can fully enjoy that moment in their lives, living where they wish to (private home, nursing home, …). Physical activity (PA) is a representative parameter of a person's state of health, especially when we are getting older, because it plays an important role in the prevention of diseases, and that is the reason why it is promoted in older adults. One of the goals of this work is to assess the feasibility of objectively measuring the PA levels of older adults wherever they live. In addition, this work proposes long-term monitoring that helps to gather daily activity patterns. We fuse inertial measurements with other technologies (WiFi- and ultrasonic-based location) in order to provide not only PA, but also information about the place where the activities are carried out, including both room-level location and precise positioning (depending on the technology used). With this information, we would be able to generate information about the person's daily routines which can be very useful for the early detection of physical or cognitive impairment.

Accelerometry applications and methods to assess standing balance in older adults and mobility-limited patient populations: a narrative review

Accelerometers provide an opportunity to expand standing balance assessments outside of the laboratory. The purpose of this narrative review is to show that accelerometers are accurate, objective, and accessible tools for balance assessment. Accelerometry has been validated against current gold standard technology, such as optical motion capture systems and force plates. Many studies have been conducted to show how accelerometers can be useful for clinical examinations. Recent studies have begun to apply classification algorithms to accelerometry balance measures to discriminate populations at risk for falls. In addition to healthy older adults, accelerometry can monitor balance in patient populations such as Parkinson's disease, multiple sclerosis, and traumatic brain injury. The lack of software packages or easy-to-use applications have hindered the shift into the clinical space. Lack of consensus on outcome metrics has also slowed the clinical adoption of accelerometer-based balance assessments. Future studies should focus on metrics that are most helpful to evaluate balance in specific populations and protocols that are clinically efficacious.

Static and dynamic postural control assessment in schoolchildren: Reliability and reference values of the Modified Flamingo Test and Bar Test

INTRODUCTION

Single-leg stance tests have been widely used to evaluate static balance, like the Modified Flamingo Test. The evaluation of dynamic balance on small support surfaces is the objective of some tests like the Bar Test.

RESEARCH QUESTION

How is the performance of postural control during the performance of these tests in schoolchildren between 6 and 11 years of age in both sexes? What are the reference values of these tests in this population?

METHOD

A cross-sectional study in which a total of 282 children. The evaluation included both tests.

RESULTS

The relative reliability was excellent (Intraclass Correlation Coefficient = 0.84-0.98), and the absolute reliability ranged between 4.5% and 7.1% for coefficient variation and between 0.5 and 1.5 for the standard error of measurement. The average results were 3.8 ± 2.7 floor touches for the Modified Flamingo Test and 5 ± 3.5 m for the Bar Test. The results of both tests improve progressively with the increase of age.

DISCUSSION

It can be asserted that children of different ages, as well as boys and girls of the same age, perform differently in these tests. Particularly, according to the analysis based on age subgroups, there were greater improvements in the performance of both tests between 8 and 11 years of age.

CONCLUSIONS

The girls obtained in both tests better results, although between 6 and 7 years of age the differences between sexes are not significant.

Development and Application of a Stability Index Estimation Algorithm Based on Machine Learning for Elderly Balance Ability Diagnosis in Daily Life

BACKGROUND

The stability index estimation algorithm was derived and applied to develop and implement a balance ability diagnosis system that can be used in daily life.

METHODS

The system integrated an approach based on sensory function interaction, called the clinical test of sensory interaction with balance. A capacitance and resistance sensing type force mat was fabricated, and a stability index prediction algorithm was developed and applied using the center of pressure variables. The stability index prediction algorithm derived a center of pressure variable for 103 elderly people by Nintendo Wii Balance Board to predict the stability index of the balance system (Biodex SD), and the accuracy of this approach was confirmed.

RESULTS

As a result of testing with the test set, the linear regression model confirmed that the r-value ranged between 0.943 and 0.983. To confirm the similarity between the WBB and the flexible force mat, each measured center of pressure value was inputted and calculated in the developed regression model, and the result of the correlation coefficient validation confirmed an r-value of 0.96.

CONCLUSION

The system developed in this study will be applicable to daily life in the home in the form of a floor mat.

Testing the validity and reliability of a new android application-based accelerometer balance assessment tool for community-dwelling older adults

BACKGROUND

Postural instability is a risk factor for falls in older adults. It is possible to detect postural stability using an integrated accelerometer (ACC) sensor in a smartphone. Therefore, a novel ACC-based smartphone application running on the Android operating system called BalanceLab was created and tested.

PURPOSE

This study aimed to determine the validity and reliability of a novel ACC-based Android smartphone application for assessing balance in older adults.

METHODS

Using BalanceLab, 20 older adults completed three balance assessments: the Modified Clinical Test of Sensory Interaction in Balance (MCTSIB), a single-leg stance test (SLST), and a limit of stability test (LOS). The validity of this mobile application was investigated using a three-dimensional (3D) motion analysis system and the Fullerton Advanced Balance (FAB) scale. The test-retest reliability of this mobile application was determined on two separate occasions within one day, at least two hours apart.

RESULTS

The two static balance assessments (the MCTSIB and SLST) demonstrated moderate to excellent correlation with the 3D motion analysis system (r = 0.70-0.91) and the FAB scale (r = 0.67-0.80). However, the majority of the dynamic balance tests (the LOS tests) did not demonstrate any correlation with the 3D motion analysis system or the FAB scale. This novel ACC-based application demonstrated good to excellent test-retest reliability (ICC = 0.76-0.91).

CONCLUSION

A static, but not dynamic, balance assessment tool that uses a novel ACC-based application for Android can be used to measure balance in older adults. This application has moderate to excellent validity and test-retest reliability.

Instrumental and Non-Instrumental Measurements in Patients with Peripheral Vestibular Dysfunctions

Vestibular dysfunction is a disturbance of the body's balance system. The control of balance and gait has a particular influence on the quality of life. Currently, assessing patients with these problems is mainly subjective. New assessment options using wearables may provide complementary and more objective information. Posturography makes it possible to determine the extent and type of posture dysfunction, which makes it possible to plan and monitor the effectiveness of physical rehabilitation therapy. This study evaluates the effectiveness of non-instrumental clinical tests and the instrumental mobile posturography MediPost device for patients with unilateral vestibular disorders. The study group included 40 patients. A subjective description of the symptoms was evaluated using a questionnaire about the intensity of dizziness using the Dizziness Handicap Inventory (DHI) and Vertigo Syndrome Scale-short form (VSS-sf). The clinical protocol contained clinical tests and MediPost measurements using a Modified Clinical Test of Sensory Interaction on Balance. All patients underwent vestibular rehabilitation therapy (VRT) for four weeks. The non-instrumental measurement results were statistically significant, and the best was in the Timed Up and Go test (TUG). In MediPost, condition 4 was the most valuable. This research demonstrated the possibilities of using an instrumental test (MediPost) as an alternative method to assess balance.

Effects of Load Carriage on Postural Sway and Relative Ground Reaction Forces in Special Police Officers: A Cross-Sectional Study

Although excessive load carriage results in biomechanical gait changes, little evidence has been provided regarding its impact on postural sway. Therefore, the main purpose of this study was to determine whether heavier loads have effects on changing foot stability and postural sway in special police officers. Thirty male special police officers (age = 40 ± 6 years, height = 180 ± 5 cm, weight = 89 ± 8 kg) were assessed in four conditions: (1) carrying no load, (2) carrying a 5 kg load, (3) carrying a 25 kg load, and (4) carrying a 45 kg load. Foot characteristics during standing were assessed with Zebris pedobarographic pressure platform. Heavier loads increased the center of pressure (COP) path length and average velocity, length of minor and major axis, and 95% confidence ellipse area, while a decrease in angle between Y and major axis was observed. Relative forces beneath the left forefoot and right backfoot regions decreased and an increase in relative forces beneath the left backfoot and right forefoot was observed. When carrying heavy loads, static foot parameters rapidly changed, especially in COP path length and average velocity.

Assessment of postural control in children

The relevance of the study is due to the high incidence of postural control impairment in patients with neurological diseases and lack of common approaches to their diagnosing in children. In this article we show the main stages in the formation of postural control and mechanisms of balance maintaining in childhood. We assessed the information content of existing clinical scales used to study components of postural balance in children in clinical practice. Also, we studied the diagnostic significance of functional methods for assessing postural control. Particular attention we paid to the study of the diagnostic significance of computer posturography (stabilometry) and accelerometry. We identified the main clinical and functional diagnostic markers of postural imbalance in children of different age and nosological groups. Further research in this area will make it possible to develop the most objective criteria for impaired postural control in childhood, which will increase the effectiveness of treatment and rehabilitation measures. 

Mapping features and patterns of accelerometry data on human movement in different age groups and associated health problems: A cross-sectional study

PURPOSE

Human movement is considered one of the important factors for maintaining an independent life. Individuals in different age groups have different characteristics of locomotion patterns and some health conditions can affect or be affected by mobility changes. Few studies clarify or present data about the influence of different ages and biopsychosocial factors on accelerometry features. The aim of this study was to identify characteristics and variables in the frequency signals for different age groups and their relationship with associated health conditions in raw accelerometry data obtained from the use of a triaxial accelerometer during 7 days of activities of daily living.

METHOD

A cross-sectional study was conducted based on the database of the first evaluations of the Epidemiological Study of Movement (EPIMOV) cohort. Frequency, signal amplitude, and entropy accelerometry features of EPIMOV participants who used a triaxial accelerometer for 7 days were extracted. Sociodemographic, clinical, anthropometric and physical activity assessments were also performed. Two-way ANOVA was performed to compare accelerometry features within different age groups. A series of stepwise multiple regressions were performed on accelerometry variables to analyze their relationships with demographic, anthropometric and cardiovascular risk variables.

RESULTS

The sample consisted mostly of female, white, and high school graduates. The most prevalent cardiovascular risk factors were sedentary behavior and obesity. When analyzing the accelerometry variables, it was possible to observe that the entropy feature, and the counts, decrease in the group of older adults, while the feature of harmonic components of gait (frequency × amplitude) increases in the group of older adults. Regarding the amplitude feature, there were no significant differences between the groups. Through stepwise multiple linear regression, it was possible to observe that demographic, anthropometric and cardiovascular risk factors are associated with most accelerometry variables.

CONCLUSION

The results confirm that human movement can be influenced by different ages, sex, demographic, anthropometric and cardiovascular risk factors. Future studies and clinical analyzes can use the methods proposed in this research to adjust movement patterns for sex and different age groups, thus obtaining new interpretations about human movement.

A Comparison among Different Strategies to Detect Potential Unstable Behaviors in Postural Sway

Assistive Technology helps to assess the daily living and safety of frail people, with particular regards to the detection and prevention of falls. In this paper, a comparison is provided among different strategies to analyze postural sway, with the aim of detecting unstable postural status in standing condition as precursors of potential falls. Three approaches are considered: (i) a time-based features threshold algorithm, (ii) a time-based features Neuro-Fuzzy inference system, and (iii) a Neuro-Fuzzy inference fed by Discrete-Wavelet-Transform-based features. The analysis was performed across a wide dataset and exploited performance indexes aimed at assessing the accuracy and the reliability of predictions provided by the above-mentioned strategies. The results obtained demonstrate valuable performances of the three considered strategies in correctly distinguishing among stable and unstable postural status. However, the analysis of robustness against noisy data highlights better performance of Neuro-Fuzzy inference systems with respect to the threshold-based algorithm.

Use of interventions involving virtual reality tasks during the climacteric: a systematic review

Technological advances have been impacting health care worldwide. Our study aimed to research the literature systematically to determine the impact of technological treatments versus conventional treatments on the quality of life of climacteric women. The study was registered on PROSPERO (CRD42021241638). We searched seven databases, including PRISMA, using mesh terms. After screening for eligibility, we selected five clinical trials, and applying the snowball technique we were able to include four more articles, totaling nine articles that used technology-based interventions (virtual reality games) during the climacteric. The total study population consisted of 298 climacteric women. Two studies evaluated a technology-based treatment for pelvic floor, one for urinary incontinence symptoms, three for postural balance, one for cardiorespiratory capacity, one for osteoporosis and one study for lower back pain. The studies showed that the technological treatments improved pelvic floor strength, balance, cardiorespiratory fitness and bone mineral density when compared to conventional treatments. Improvement was linked to adherence to training and a high level of satisfaction during the training sessions. Technology-based treatments appear to be a viable alternative to conventional treatments in improving the quality of health, with benefits for the cardiovascular, genitourinary and skeletal systems, and ultimately for the overall quality of life.

A Digital Health Service for Elderly People with Balance Disorders and Risk of Falling: A Design Science Approach

In this study, a design science research methodology was used aiming at designing, implementing and evaluating a digital health service to complement the provision of healthcare for elderly people with balance disorders and risk of falling. An explanatory sequential mixed methods study allowed to identify and explore the dissatisfaction with electronic medical records and the opportunity for using digital health solutions. The suggested recommendations helped to elaborate and develop “BALANCE”, a digital service implemented on the METHIS platform, which was recently validated for remote monitoring of chronic patients in primary healthcare. “BALANCE” provides clinical and interactive data, questionnaire pre and post-balance rehabilitation, tutorial videos with balance exercises and patient-recorded videos of the exercises. This digital service was demonstrated, including five elderly patients with clinical recommendations for balance rehabilitation at home. Finally, the authors conducted two focus groups with the participants and their caregivers as well as with physicians. The focus groups aimed at exploring their satisfaction level, needs of adjustment in the “BALANCE” service and strategies for applicability. The digital healthcare service evaluation revealed a significant potential for clinical applicability of this digital solution for elderly people with balance disorders and risk of falling.

Remote Healthcare for Elderly People Using Wearables: A Review

The growth of health care spending on older adults with chronic diseases faces major concerns that require effective measures to be adopted worldwide. Among the main concerns is whether recent technological advances now offer the possibility of providing remote health care for the aging population. The benefits of suitable prevention and adequate monitoring of chronic diseases by using emerging technological paradigms such as wearable devices and the Internet of Things (IoT) can increase the detection rates of health risks to raise the quality of life for the elderly. Specifically, on the subject of remote health monitoring in older adults, a first approach is required to review devices, sensors, and wearables that serve as tools for obtaining and measuring physiological parameters in order to identify progress, limitations, and areas of opportunity in the development of health monitoring schemes. For these reasons, a review of articles on wearable devices was presented in the first instance to identify whether the selected articles addressed the needs of aged adults. Subsequently, the direct review of commercial and prototype wearable devices with the capability to read physiological parameters was presented to identify whether they are optimal or usable for health monitoring in older adults.

How Can We Develop an Efficient eHealth Service for Provision of Care for Elderly People with Balance Disorders and Risk of Falling? A Mixed Methods Study

This study aimed to identify relevant topics for the development of an efficient eHealth service for elderly people with balance disorders and risk of falling, based on input from physicians providing healthcare to this patient group. In the quantitative part of the study, an open multiple-choice questionnaire was made available on the website of the Portuguese General Medical Council to assess the satisfaction with electronic medical records regarding clinical data available, the time needed to retrieve data and the usefulness of the data. Of the 118 participants, 55% were dissatisfied/very dissatisfied with data availability and 61% with the time spent to access and update data related to the focused patient group. Despite this negative experience, 76% considered future e-Health solutions as pertinent/very pertinent. Subsequently, these findings were further explored with eight semi-structured interviews. The physicians confirmed the reported dissatisfactions and pointed out the lack of comprehensive data and system interoperability as serious problems, causing inefficient health services with an overlap of emergency visits and uncoordinated diagnostics and treatment. In addition, they discussed the importance of camera and audio monitoring to add significant value. Our results indicate considerable potential for e-Health solutions, but substantial improvements are crucial to achieving such future solutions.

Feasibility of Sensor Technology for Balance Assessment in Home Rehabilitation Settings

The increased use of sensor technology has been crucial in releasing the potential for remote rehabilitation. However, it is vital that human factors, that have potential to affect real-world use, are fully considered before sensors are adopted into remote rehabilitation practice. The smart sensor devices for rehabilitation and connected health (SENDoc) project assesses the human factors associated with sensors for remote rehabilitation of elders in the Northern Periphery of Europe. This article conducts a literature review of human factors and puts forward an objective scoring system to evaluate the feasibility of balance assessment technology for adaption into remote rehabilitation settings. The main factors that must be considered are: Deployment constraints, usability, comfort and accuracy. This article shows that improving accuracy, reliability and validity is the main goal of research focusing on developing novel balance assessment technology. However, other aspects of usability related to human factors such as practicality, comfort and ease of use need further consideration by researchers to help advance the technology to a state where it can be applied in remote rehabilitation settings.

Relationship of the sacral slope with early gait derangements in robust older women

BACKGROUND

Trunk pelvic dissociation is fundamental to the compensatory mechanism for muscle weakness during body bending. We carried out an early investigation of gait changes in a sample of community-dwelling women ≥60 years without gait complaints. The primary objective was to correlate spine and pelvic angles with performance tests and accelerometry parameters. The secondary objective was to correlate performance tests with accelerometry.

METHODS

In this cross-sectional study, 54 community-dwelling women ≥60 years were subjected to Falls Efficacy Scale-International (FES-I), performance tests (Berg Balance Scale, Timed Up and Go, and Gait analysis), and radiographic analysis of sagittal alignment (Thoracic and Lumbar Cobb, Pelvic Incidence, Sacral Slope, and Pelvic Tilt angles). Gait speed was assessed in a 10-m comfortable walk, and accelerometry parameters were obtained in a 30-m walk distance.

RESULTS

The sample, aged 72 ± 6 years, exhibited moderate correlation between Sacral Slope and Step Length (+ 0.615). Sacral Slope weakly correlated with FES-I (- 0.339), Berg Balance Scale (+ 0.367), and with further accelerometry data in the AP plane: RMS, (+ 0.439) and Stride Regularity (+ 0.475), p < 0.05, all. Lumbar Cobb weakly correlated with the following accelerometry data in the AP plane: Step Length (+ 0.405), RMS, (+ 0.392), and Stride Regularity (+ 0.345), p < 0.05, all. Additionally, Stride Regularity in AP moderately correlated with FES-I (0,561, p < 0.05), among other weak correlations between performance tests and accelerometry data in AP.

CONCLUSIONS

Early alterations in Sacral Slope and gait abnormalities in the AP plane may provide understanding of the early gait changes in robust older women.

The assessment of center of mass and center of pressure during quiet stance: Current applications and future directions

This perspective article provides a brief review of our understanding of how center of pressure (CoP) and center of mass (CoM) are traditionally utilized to measure quiet standing and how technological advancements are allowing for measurements to be derived outside the confines of a laboratory setting. Furthermore, this viewpoint provides descriptions of what CoP and CoM outcomes may reflect, a discussion of recent developments in selected balance outcomes, the importance of measuring instantaneous balance outcomes, and directions for future questions/research. Considering the enormous number and cost of falls annually, conclusions drawn from this perspective underscore the need for more cohesive efforts to advance our understanding of balance performance. As we refine the technology and algorithms used to portably assess postural stability, the question of which measurement (i.e. CoP or CoM) to utilize seems to be highly dependent on the question being asked. Further, the complexity of the question appears to span multiple disciplines and cultivate exploration of the intrinsic mechanisms of stability. Recently developed multi-dimensional methods for assessing balance performance may provide additional insight into balance, improving our ability to predict balance impairments and falls outside the laboratory and in the clinic. However, additional work will be necessary to understand the clinical significance and predictive capacity of these outcomes in various fall-prone populations.

eHealth for Addressing Balance Disorders in the Elderly: Systematic Review

Background

The population is aging on a global scale, triggering vulnerability for chronic multimorbidity, balance disorders, and falls. Falls with injuries are the main cause of accidental death in the elderly population, representing a relevant public health problem. Balance disorder is a major risk factor for falling and represents one of the most frequent reasons for health care demand. The use of information and communication technologies to support distance healthcare (eHealth) represents an opportunity to improve the access and quality of health care services for the elderly. In recent years, several studies have addressed the potential of eHealth devices to assess the balance and risk of falling of elderly people. Remote rehabilitation has also been explored. However, the clinical applicability of these digital solutions for elderly people with balance disorders remains to be studied.

Objective

The aim of this review was to guide the clinical applicability of eHealth devices in providing the screening, assessment, and treatment of elderly people with balance disorders, but without neurological disease.

Methods

A systematic review was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. Data were obtained through searching the PubMed, Google Scholar, Embase, and SciELO databases. Only randomized controlled trials (RCTs) or quasiexperimental studies (QESs) published between January 2015 and December 2019 were included. The quality of the evidence to respond to the research question was assessed using Joanna Briggs Institute (JBI) Critical Appraisal for RCTs and the JBI Critical Appraisal Checklist for QESs. RCTs were assessed using the Cochrane risk of bias tool. We provide a narrative synthesis of the main outcomes from the included studies.

Results

Among 1030 unduplicated articles retrieved, 21 articles were included in this review. Twelve studies explored different technology devices to obtain data about balance and risk of falling. Nine studies focused on different types of balance exercise training. A wide range of clinical tests, functional scales, classifications of faller participants, sensor-based tasks, intervention protocols, and follow-up times were used. Only one study described the clinical conditions of the participants. Instrumental tests of the inner ear were neither used as the gold-standard test nor performed in pre and postrehabilitation assessments.

Conclusions

eHealth has potential for providing additional health care to elderly people with balance disorder and risk of falling. In the included literature, the heterogeneity of populations under study, methodologies, eHealth devices, and time of follow-up did not allow for clear comparison to guide proper clinical applicability. This suggests that more rigorous studies are needed.

Influence of Visual Information and Sex on Postural Control in Children Aged 6-12 Years Assessed with Accelerometric Technology

The performance of postural control is believed to be linked to how children use available sensory stimuli to produce adequate muscular activation. Therefore, the aim of the present study was to thoroughly explore postural stability under normal conditions and without visual information in postural control in children aged 6–12 years during static single-leg support. A descriptive cross-sectional study was conducted with 316 children (girls = 158). The analyzed variables were the mean and maximum values obtained in each of the three body axes and their root mean square during two static single-leg support tests: one with eyes open and one with eyes closed. Girls showed lower magnitudes in the recorded accelerations at all ages and in all the variables of both tests. Accelerations during the tests showed progressively lower values from 6 to 12 years of age. The sex had a significant influence on the magnitude obtained in the accelerations recorded during the tests. Improvements in balance with increasing age were greater with visual information than without visual information. The tests of single-leg support showed preferential sensorimotor strategies in boys and girls: boys tend to rely more on visual inputs, and girls process somesthetic information in a preferential way.

Effect of Progressive Step Marching Exercise on Balance Ability in the Elderly: A Cluster Randomized Clinical Trial

Exercise may reduce the risk of falls in the elderly. The objective of the study was to determine the effect of a progressive step marching exercise (PSME) program on balance ability, lower limb muscle strength, aerobic capacity, quality of life, and fear of falling in the elderly. A cluster randomized controlled trial was selected where 30 elderly participants (aged 69 ± 3 years) from a community were supervised while performing a PSME program and 30 (aged 70 ± 3 years) from another community were assigned to a control group. All participants in both groups underwent timed up and go test, one leg standing test, five time sit to stand test, two minutes step test, World Health Organization Quality of Life-Thai version, and fall efficacy scale Thai version at baseline, after exercise at 4 and 8 weeks. The PSME group underwent the program for 8 weeks while those in the control group were instructed to continue their normal activity. After training, the PSME showed significant improvement (p < 0.05) in all parameters except one leg standing and two minutes step test when compared to the control group (p < 0.05). In conclusion, the PSME program could improve balance ability, lower limb muscle strength, quality of life, and fear of falling in the elderly.

Reliability and Validity of the Six Spot Step Test in People with Intellectual Disability

Clinical tests for the evaluation of balance in people with intellectual disability that have been most commonly used depend on the subjective evaluation of the evaluator, easily reach the ceiling effect and are poorly sensitive to small changes; but new tests have been developed, such as the Six Spot Step Test. The aim of this study was to determine the validity and within-day and day-to-day test–retest reliability of the Six Spot Step Test in people with intellectual disability. A descriptive cross-sectional study was conducted with 18 people with intellectual disability. The participants conducted the Six Spot Step Test three times and a set of five clinical tests for the balance assessment. The relative reliability was excellent (Intraclass Correlation Coefficient (ICC) = 0.86 − 0.97), and the absolute reliability ranged between 4.7% and 7.3% for coefficient variation and between 0.6 and 1.2 for the standard error of measurement. Linear regression models showed that that test can explain the results of the Timed Up & Go, Four Square Step Test and the Berg Balance Scale. The Six Spot Step Test proved to be as valid and reliable for the evaluation of dynamic balance in people with intellectual disability as the most frequently used tests for the clinical evaluation of postural control.

Validity and Reliability of a Tool for Accelerometric Assessment of Balance in Scholar Children

In Pediatrics, balance is assessed through low-sensitivity clinical tests which identify developmental alterations at already advanced stages that cannot be detected at earlier stages. Therefore, the aim of this study was to develop an easily applicable quantitative tool that can be used to evaluate postural control. Consequently, a cross-sectional study was carried out with 91 healthy children. All of them performed a series of six accelerometric functional tests and four clinical tests of balance (Modified Flamingo Test, Bar Test, Babinski-Weil Test, and Fukuda Stepping Test). The Bar Test obtained mild inverse correlations with accelerations produced in the mediolateral axis and the root mean square of all the tests in monopodal support. The Flamingo Test obtained direct correlations with the root mean square of the tests in monopodal support and with the mediolateral axis of the monopodal tests and gait. The pediatric balance assessment scale consists of three factors and eleven items extracted from five accelerometric functional tests: the monopodal balance test with six items, normal gait test with three items, and bipodal balance test with two items. This tool is easy to apply and allows analysis in the evaluation of the balance state based on the accelerations of the center of mass.

Accelerometric Assessment of Postural Balance in Children: A Systematic Review

The correct development of postural control in children is fundamental to ensure that they fully reach their psychomotor capacities. However, this capacity is one of the least studied in the clinical and academic scope regarding children. The objective of this study was to analyze the degree of implementation of accelerometry as an evaluation technique for postural control in children and how it is being used.

METHODS

A systematic search was conducted in PubMed, SpringerLink, SportsDiscus, Medline, Scopus, and Web of Science with the following terms: balance, postural control, children, kids, accelerometry, and accelerometer.

RESULTS

The search generated a total of 18 articles. Two groups of studies were differentiated: those which exclusively included healthy individuals (n = 5) and those which included children with pathologies (n = 13). Accelerometry is being used in children mainly to assess the gait and static balance, as well as to identify the differences between healthy children and children with developmental disorders.

CONCLUSIONS

Accelerometry has a discrete degree of implementation as an evaluation tool to assess postural control. It is necessary to define a systematic method for the evaluation of postural control in pediatrics, in order to delve into the development of this capacity and its alterations in different neurodevelopmental disorders.

An IoT Smart Environment in Support of Disease Diagnosis Decentralization

The percentage of seniors in the global population is constantly growing and solutions in the field of fall detection and early detection of neuro-degenerative pathologies have a crucial role in order to increase life expectancy and quality of life. This study aims to extend fall detection and effective recognition of early signs of diseases to new smart environments, conceiving the decentralization of diagnostic monitoring in everyday life activities in a more pervasive paradigm. Inspiring to research outcomes, in this work an architecture is designed to detect falls in crowded indoor environments during events/exhibitions, for favoring a timely and effective intervention. It also foresees a continue monitoring of the gait for seniors during the visit, thus extracting key features which are stored on a dedicated database. The proposed solution allows third party researchers to perform analysis on the obtained gait datasets, through the adoption of advanced data-mining techniques for the detection of early signs of neuro-degenerative diseases and other pathologies. The architecture designed here aims to provide a step forward concerning the extension of smart monitoring environments for the detection of falls and early signs of pathologies in everyday life, in a more pervasive and decentralized paradigm.

Analysis of Postural Control in Sitting by Pressure Mapping in Patients with Multiple Sclerosis, Spinal Cord Injury and Friedreich's Ataxia: A Case Series Study

The postural control assessments in patients with neurological diseases lack reliability and sensitivity to small changes in patient functionality. The appearance of pressure mapping has allowed quantitative evaluation of postural control in sitting. This study was carried out to determine the evaluations in pressure mapping and verifying whether they are different between the three sample groups (multiple sclerosis, spinal cord injury and Friedreich’s ataxia), and to determine whether the variables extracted from the pressure mapping analysis are more sensitive than functional tests to evaluate the postural trunk control. A case series study was carried out in a sample of 10 adult patients with multiple sclerosis (n = 2), spinal cord injury (n = 4) and Friedreich’s ataxia (n = 4). The tests applied were: pressure mapping, seated Lateral Reach Test, seated Functional Reach Test, Berg Balance Scale, Posture and Postural Ability Scale, Function in Sitting Test, and Trunk Control Test. The participants with Friedreich’s ataxia showed a tendency to present a higher mean pressure on the seat of subject’s wheelchair compared to other groups. In parallel, users with spinal cord injury showed a tendency to present the highest values of maximum pressure and area of contact. People with different neurological pathologies and similar results in functional tests have very different results in the pressure mapping. Although it is not possible to establish a strong statistical correlation, the relationships between the pressure mapping variables and the functional tests seem to be numerous, especially in the multiple sclerosis group.

A Low-Cost Calibration Method for Low-Cost MEMS Accelerometers Based on 3D Printing

A ubiquitous sensor in embedded systems is the accelerometer, as it enables a range of applications. However, accelerometers experience nonlinearities in their outputs caused by error terms and axes misalignment. These errors are a major concern because, in applications such as navigations systems, they accumulate over time, degrading the position accuracy. Through a calibration procedure, the errors can be modeled and compensated. Many methods have been proposed; however, they require sophisticated equipment available only in laboratories, which makes them complex and expensive. In this article, a simple, practical, and low-cost calibration method is proposed. It uses a 3D printed polyhedron, benefiting from the popularisation and low-cost of 3D printing in the present day. Additionally, each polyhedron could hold as much as 14 sensors, which can be calibrated simultaneously. The method was performed with a low-cost sensor and it significantly reduced the root-mean-square error (RMSE) of the sensor output. The RMSE was compared with the reported in similar proposals, and our method resulted in higher performance. The proposal enables accelerometer calibration at low-cost, and anywhere and anytime, not only by experts in laboratories. Compensating the sensor’s inherent errors thus increases the accuracy of its output.

Percentiles and Reference Values for Accelerometric Gait Assessment in Women Aged 50-80 Years

Background: The identification of factors that alter postural stability is fundamental in the design of interventions to maintain independence and mobility. This is especially important for women because of their longer life expectancy and higher incidence of falls than in men. We constructed the percentile box charts and determined the values of reference for the accelerometric assessment of the gait in women. Methods: We used a cross-sectional study with 1096 healthy adult women, who were asked to walk a distance of 20 m three times. Results: In all of the variables, a reduction in the magnitude of accelerations was detected as the age of the group advanced. The box charts show the amplitude of the interquartile ranges, which increases as the age of the participants advances. In addition, the interquartile ranges were greater in the variables that refer to the maximum values of the accelerations. Conclusions: The values obtained can be used to assess changes in gait due to aging, trauma and orthopaedic alterations that may alter postural stability and neurodegenerative processes that increase the risk of falling.

Physical Activity Practice and Optimal Development of Postural Control in School Children: Are They Related?

Background: This study aims to analyze the effect of physical activity practice on the postural control state of school children. If such an effect was detected, the second aim of the study was to identify which specific capacities of postural control benefited the most from physical activity. Methods: A cross-sectional study was performed using a convenience sample of 118 healthy children (54 girls) with a mean age of 10.3 ± 1.2 years. Their weight and height were measured. The accelerometric assessment of balance included four different tests in static balance and walking. Results: Physical activity habit prevalence was 38.9% in girls and 60.9% in boys, and its frequency was 2.3 days per week in girls and 2.8 days in boys. The active children obtained lower accelerations, but the active and sedentary girls showed lower accelerometric values than the active boys. The logistic regression analysis demonstrated the influence of sex on the accelerations of the body (p < 0.001), regardless of the habit of physical activity. Conclusions: Active children have better postural control than sedentary children, although sedentary girls have better balance than active boys. Therefore, physical activity practice seems to favor a more efficient development of postural control, but it cannot level or reverse the effect of the neurophysiological factors that are conditioned by sex.

Analysis of a Wearable Robotic System for Ankle Rehabilitation

As one of the most commonly injured joints of the human body, the ankle is often subject to sprains or fractures that require motion assistance to recover mobility. Whereas physiotherapists usually perform rehabilitation in one-on-one sessions with patients, several successful robotic rehabilitation solutions have been proposed in the last years. However, their design is usually bulky and requires the patient to sit or stand in a static position. A lightweight wearable device for ankle motion assistance, the CABLEankle, is here proposed for motion ankle exercising in rehabilitation and training. The CABLEankle is based on a cable-driven S-4SPS parallel architecture, which enables motion assistance over the large motion range of the human ankle in a walking gait. The proposed mechanism design is analyzed with kinematic and static models, and the force closure workspace of the mechanism is discussed with analytical results. Finally, the feasibility of the proposed design is investigated through numerical simulations over the ankle motion range as a characterization of the peculiar motion.

Reliability of accelerometric assessment of balance in children aged 6-12 years

BACKGROUND

Development and evaluation of an accelerometers technique for collecting data for asses balance had reported difficulty due to equilibrium reactions and continuous bursts. The aim of this study is to determine the reliability and internal consistency of accelerometric measurements, related to static equilibrium and gait in children aged 6 to 12 years.

METHODS

This descriptive and cross-sectional study involved 70 healthy children (50% girls) with a mean age of 9 years old. At the height of the 4th lumbar vertebra and directly on the skin, an accelerometer was placed on each participant. All of them had to complete four trials three times: balancing on one leg with eyes closed and eyes open, dynamic balancing on one leg on a foam mat, and normal gait.

RESULTS

Results show that tests performed in older children had higher internal consistency than those performed in younger children (vertical axis r = 0.82, sagittal axis r = 0.77, and perpendicular axis r = 0.74). Tests performed in children aged 8 years or older presented a strong correlation between trials (r > 0.71). The three static equilibrium tests obtained reliability values between 0.76 y 0.84. On the contrary, gait test obtained inferior and poorer results (0.6 < r < 0.71).

CONCLUSIONS

This method of assessment obtained positive results as an instrument for the quantitative assessment of balance in school-aged children. Values obtained for the three one-leg balance and static tests,were more strongly correlated than the normal gait test for all axes.