Reliable and robust detection of freezing of gait episodes with wearable electronic devices

A wearable wireless sensing system for assisting patients affected by Parkinson's disease is proposed. It uses integrated micro-electro-mechanical inertial sensors able to recognize the episodes of involuntary gait freezing. The system operates in real time and is designed for outdoor and indoor applications. Standard tests were performed on a noticeable number of patients and healthy persons and the algorithm demonstrated its reliability and robustness respect to individual specific gait and postural behaviors. The overall performances of the system are excellent with a specificity higher than 97%

Continuous home monitoring of Parkinson's disease using inertial sensors: A systematic review.

Parkinson's disease (PD) is a progressive neurological disorder of the central nervous system that deteriorates motor functions, while it is also accompanied by a large diversity of non-motor symptoms such as cognitive impairment and mood changes, hallucinations, and sleep disturbance. Parkinsonism is evaluated during clinical examinations and appropriate medical treatments are directed towards alleviating symptoms. Tri-axial accelerometers, gyroscopes, and magnetometers could be adopted to support clinicians in the decision-making process by objectively quantifying the patient's condition. In this context, at-home data collections aim to capture motor function during daily living and unobstructedly assess the patients' status and the disease's symptoms for prolonged time periods. This review aims to collate existing literature on PD monitoring using inertial sensors while it focuses on papers with at least one free-living data capture unsupervised either directly or via videotapes. Twenty-four papers were selected at the end of the process: fourteen investigated gait impairments, eight of which focused on walking, three on turning, two on falls, and one on physical activity; ten articles on the other hand examined symptoms, including bradykinesia, tremor, dyskinesia, and motor state fluctuations in the on/off phenomenon. In summary, inertial sensors are capable of gathering data over a long period of time and have the potential to facilitate the monitoring of people with Parkinson's, providing relevant information about their motor status. Concerning gait impairments, kinematic parameters (such as duration of gait cycle, step length, and velocity) were typically used to discern PD from healthy subjects, whereas for symptoms' assessment, researchers were capable of achieving accuracies of over 90% in a free-living environment. Further investigations should be focused on the development of ad-hoc hardware and software capable of providing real-time feedback to clinicians and patients. In addition, features such as the wearability of the system and user comfort, set-up process, and instructions for use, need to be strongly considered in the development of wearable sensors for PD monitoring

Optimizing Clinical Assessments in Parkinson's Disease Through the Use of Wearable Sensors and Data Driven Modeling

The emergence of motion sensors as a tool that provides objective motor performance data on individuals afflicted with Parkinson's disease offers an opportunity to expand the horizon of clinical care for this neurodegenerative condition. Subjective clinical scales and patient based motor diaries have limited clinometric properties and produce a glimpse rather than continuous real time perspective into motor disability. Furthermore, the expansion of machine learn algorithms is yielding novel classification and probabilistic clinical models that stand to change existing treatment paradigms, refine the application of advance therapeutics, and may facilitate the development and testing of disease modifying agents for this disease. We review the use of inertial sensors and machine learning algorithms in Parkinson's disease

Using 3D sensing and projecting technology to improve the mobility of Parkinson's disease patients

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonParkinson’s is a neurological condition in which parts of the brain responsible for movements becomes incapacitated over time due to the abnormal dopamine equilibrium. Freezing of Gait (FOG) is one of the main Parkinson’s Disease (PD) symptoms that affects patients not only physically but also psychologically as it prevents them from fulfilling simple tasks such as standing up or walking. Different auditory and visual cues have been proven to be very effective in improving the mobility of People with Parkinson’s (PwP). Nonetheless, many of the available methods require user intervention or devices to be worn, charged, etc. to activate the cues. This research suggests a system that can provide an unobtrusive facility to detect FOG and falling in PwP as well as monitoring and improving their mobility using laser-based visual cues casted by an automated laser system. It proposes a new indoor method for casting a set of two parallel laser lines as a dynamic visual cue in front of a subject’s feet based on the subject’s head direction and 3D location in a room. The proposed system controls the movement of a set of pan/tilt servo motors and laser pointers using a microcontroller based on the real-time skeletal information acquired from a Kinect v2 sensor. A Graphical User Interface (GUI) is created that enables users to control and adjust the settings based on the user preferences. The system was tested and trained by 12 healthy participants and reviewed by 15 PwP who suffer from frequent FOG episodes. The results showed the possibility of employing the system as an indoor and on-demand visual cue system for PwP that does not rely on the subject’s input or introduce any additional complexities to operate. Despite limitations regarding its outdoor use, feedback was very positive in terms of domestic usability and convenience, where 12/15 PwP showed interest in installing and using the system at their homes

Human Motion Analysis with Wearable Inertial Sensors

High-resolution, quantitative data obtained by a human motion capture system can be used to better understand the cause of many diseases for effective treatments. Talking about the daily care of the aging population, two issues are critical. One is to continuously track motions and position of aging people when they are at home, inside a building or in the unknown environment; the other is to monitor their health status in real time when they are in the free-living environment. Continuous monitoring of human movement in their natural living environment potentially provide more valuable feedback than these in laboratory settings. However, it has been extremely challenging to go beyond laboratory and obtain accurate measurements of human physical activity in free-living environments. Commercial motion capture systems produce excellent in-studio capture and reconstructions, but offer no comparable solution for acquisition in everyday environments. Therefore in this dissertation, a wearable human motion analysis system is developed for continuously tracking human motions, monitoring health status, positioning human location and recording the itinerary. In this dissertation, two systems are developed for seeking aforementioned two goals: tracking human body motions and positioning a human. Firstly, an inertial-based human body motion tracking system with our developed inertial measurement unit (IMU) is introduced. By arbitrarily attaching a wearable IMU to each segment, segment motions can be measured and translated into inertial data by IMUs. A human model can be reconstructed in real time based on the inertial data by applying high efficient twists and exponential maps techniques. Secondly, for validating the feasibility of developed tracking system in the practical application, model-based quantification approaches for resting tremor and lower extremity bradykinesia in Parkinson’s disease are proposed. By estimating all involved joint angles in PD symptoms based on reconstructed human model, angle characteristics with corresponding medical ratings are employed for training a HMM classifier for quantification. Besides, a pedestrian positioning system is developed for tracking user’s itinerary and positioning in the global frame. Corresponding tests have been carried out to assess the performance of each system

Ambulatory monitoring of motor functions in patients with Parkinson's disease using kinematic sensors

Parkinson's disease (PD) is the second most common neurodegenerative disease in the general population. Cardinal symptoms of Parkinson's disease are resting tremor, rigidity, akinesia and bradykinesia and in advanced stages, gait impairments, postural instability and complications of chronic treatment with levodopa such as motor dysfunctions and dyskinesia. Multitude and complexity of these motor symptoms and their variability over the time have made assessment of them a difficult task. Moreover, following the fluctuations of motor performance (ON/OFF fluctuations) of the PD patients throughout their daily activities by quantifying their motor symptoms is a major challenge. The aim of this thesis was to design and validate a portable ambulatory movement analysis system for long-term monitoring and qualitative and quantitative assessment of motor abnormalities of PD patients during daily activities. We have designed a new measurement system consisting of five independent, lightweight, autonomous sensing units based on kinematic sensors that can continuously record body movements during daily life. Using this system and by performing several clinical studies, both in controlled conditions and on free moving patients, we have prepared a database of different movement patterns of PD patients. This database was the basis to design several new algorithms for the analysis of tremor, bradykinesia, gait and posture. An accurate algorithm based on spectral estimation has been proposed to detect and quantify tremor during daily activities of PD patients with a resolution down to three seconds using gyroscopes attached to the forearms. By quantifying the speed, range and the frequency of the movements, we have proposed a new method to assess the bradykinesia and tested it both in controlled and free conditions. We found out that in the free moving patients, the outcomes of this algorithm show significant and good correlation to the established clinical scores. Regarding the detection and analysis of gait, we have developed and tested a method based on four sensors attached to the lower limbs that provided spatio-temporal parameters of gait with good accuracy. We further improved our method using a new biomechanical model that could predict the movements of thighs from the movements of shanks during walking. This way we could reduce the number of sensor sites on the body while keeping the same accuracy in estimation of the spatio-temporal parameters of gait. By combining a statistical classifier, to detect transitions between sitting and standing postures, and a fuzzy classifier, to detect the basic body postures, we have developed an algorithm to classify basic body posture allocations both in PD patients and aged matched healthy subjects. Finally, while currently no other objective ambulatory method exists to accurately detect the periods of ON and OFF in PD patients, by combining the outcomes of the above algorithms (tremor, gait, bradykinesia and posture) using a statistical approach, we have proposed a method to detect periods of these two states with a resolution of 10 minutes in free moving patients. We believe that the proposed system has a high potential both for the clinical applications and research purposes related to the patient with Parkinson's disease and possibly other neurological movement disorders

Wearable Sensors in the Evaluation of Gait and Balance in Neurological Disorders

The aging population and the increased prevalence of neurological diseases have raised the issue of gait and balance disorders as a major public concern worldwide. Indeed, gait and balance disorders are responsible for a high healthcare and economic burden on society, thus, requiring new solutions to prevent harmful consequences. Recently, wearable sensors have provided new challenges and opportunities to address this issue through innovative diagnostic and therapeutic strategies. Accordingly, the book “Wearable Sensors in the Evaluation of Gait and Balance in Neurological Disorders” collects the most up-to-date information about the objective evaluation of gait and balance disorders, by means of wearable biosensors, in patients with various types of neurological diseases, including Parkinson’s disease, multiple sclerosis, stroke, traumatic brain injury, and cerebellar ataxia. By adopting wearable technologies, the sixteen original research articles and reviews included in this book offer an updated overview of the most recent approaches for the objective evaluation of gait and balance disorders

Human Gait Analysis using Spatiotemporal Data Obtained from Gait Videos

Mit der Entwicklung von Deep-Learning-Techniken sind Deep-acNN-basierte Methoden zum Standard für Bildverarbeitungsaufgaben geworden, wie z. B. die Verfolgung menschlicher Bewegungen und Posenschätzung, die Erkennung menschlicher Aktivitäten und die Erkennung von Gesichtern. Deep-Learning-Techniken haben den Entwurf, die Implementierung und den Einsatz komplexer und vielfältiger Anwendungen verbessert, die nun in einer Vielzahl von Bereichen, einschließlich der Biomedizintechnik, eingesetzt werden. Die Anwendung von Computer-Vision-Techniken auf die medizinische Bild- und Videoanalyse hat zu bemerkenswerten Ergebnissen bei der Erkennung von Ereignissen geführt. Die eingebaute Fähigkeit von convolutional neural network (CNN), Merkmale aus komplexen medizinischen Bildern zu extrahieren, hat in Verbindung mit der Fähigkeit von long short term memory network (LSTM), die zeitlichen Informationen zwischen Ereignissen zu erhalten, viele neue Horizonte für die medizinische Forschung geschaffen. Der Gang ist einer der kritischen physiologischen Bereiche, der viele Störungen im Zusammenhang mit Alterung und Neurodegeneration widerspiegeln kann. Eine umfassende und genaue Ganganalyse kann Einblicke in die physiologischen Bedingungen des Menschen geben. Bestehende Ganganalyseverfahren erfordern eine spezielle Umgebung, komplexe medizinische Geräte und geschultes Personal für die Erfassung der Gangdaten. Im Falle von tragbaren Systemen kann ein solches System die kognitiven Fähigkeiten beeinträchtigen und für die Patienten unangenehm sein. Außerdem wurde berichtet, dass die Patienten in der Regel versuchen, während des Labortests bessere Leistungen zu erbringen, was möglicherweise nicht ihrem tatsächlichen Gang entspricht. Trotz technologischer Fortschritte stoßen wir bei der Messung des menschlichen Gehens in klinischen und Laborumgebungen nach wie vor an Grenzen. Der Einsatz aktueller Ganganalyseverfahren ist nach wie vor teuer und zeitaufwändig und erschwert den Zugang zu Spezialgeräten und Fachwissen. Daher ist es zwingend erforderlich, über Methoden zu verfügen, die langfristige Daten über den Gesundheitszustand des Patienten liefern, ohne doppelte kognitive Aufgaben oder Unannehmlichkeiten bei der Verwendung tragbarer Sensoren. In dieser Arbeit wird daher eine einfache, leicht zu implementierende und kostengünstige Methode zur Erfassung von Gangdaten vorgeschlagen. Diese Methode basiert auf der Aufnahme von Gehvideos mit einer Smartphone-Kamera in einer häuslichen Umgebung unter freien Bedingungen. Deep neural network (NN) verarbeitet dann diese Videos, um die Gangereignisse zu extrahieren. Die erkannten Ereignisse werden dann weiter verwendet, um verschiedene räumlich-zeitliche Parameter des Gangs zu quantifizieren, die für jedes Ganganalysesystem wichtig sind. In dieser Arbeit wurden Gangvideos verwendet, die mit einer Smartphone-Kamera mit geringer Auflösung außerhalb der Laborumgebung aufgenommen wurden. Viele Deep- Learning-basierte NNs wurden implementiert, um die grundlegenden Gangereignisse wie die Fußposition in Bezug auf den Boden aus diesen Videos zu erkennen. In der ersten Studie wurde die Architektur von AlexNet verwendet, um das Modell anhand von Gehvideos und öffentlich verfügbaren Datensätzen von Grund auf zu trainieren. Mit diesem Modell wurde eine Gesamtgenauigkeit von 74% erreicht. Im nächsten Schritt wurde jedoch die LSTM-Schicht in dieselbe Architektur integriert. Die eingebaute Fähigkeit von LSTM in Bezug auf die zeitliche Information führte zu einer verbesserten Vorhersage der Etiketten für die Fußposition, und es wurde eine Genauigkeit von 91% erreicht. Allerdings gibt es Schwierigkeiten bei der Vorhersage der richtigen Bezeichnungen in der letzten Phase des Schwungs und der Standphase jedes Fußes. Im nächsten Schritt wird das Transfer-Lernen eingesetzt, um die Vorteile von bereits trainierten tiefen NNs zu nutzen, indem vortrainierte Gewichte verwendet werden. Zwei bekannte Modelle, inceptionresnetv2 (IRNV-2) und densenet201 (DN-201), wurden mit ihren gelernten Gewichten für das erneute Training des NN auf neuen Daten verwendet. Das auf Transfer-Lernen basierende vortrainierte NN verbesserte die Vorhersage von Kennzeichnungen für verschiedene Fußpositionen. Es reduzierte insbesondere die Schwankungen in den Vorhersagen in der letzten Phase des Gangschwungs und der Standphase. Bei der Vorhersage der Klassenbezeichnungen der Testdaten wurde eine Genauigkeit von 94% erreicht. Da die Abweichung bei der Vorhersage des wahren Labels hauptsächlich ein Bild betrug, konnte sie bei einer Bildrate von 30 Bildern pro Sekunde ignoriert werden. Die vorhergesagten Markierungen wurden verwendet, um verschiedene räumlich-zeitliche Parameter des Gangs zu extrahieren, die für jedes Ganganalysesystem entscheidend sind. Insgesamt wurden 12 Gangparameter quantifiziert und mit der durch Beobachtungsmethoden gewonnenen Grundwahrheit verglichen. Die NN-basierten räumlich-zeitlichen Parameter zeigten eine hohe Korrelation mit der Grundwahrheit, und in einigen Fällen wurde eine sehr hohe Korrelation erzielt. Die Ergebnisse belegen die Nützlichkeit der vorgeschlagenen Methode. DerWert des Parameters über die Zeit ergab eine Zeitreihe, eine langfristige Darstellung des Ganges. Diese Zeitreihe konnte mit verschiedenen mathematischen Methoden weiter analysiert werden. Als dritter Beitrag in dieser Dissertation wurden Verbesserungen an den bestehenden mathematischen Methoden der Zeitreihenanalyse von zeitlichen Gangdaten vorgeschlagen. Zu diesem Zweck werden zwei Verfeinerungen bestehender entropiebasierter Methoden zur Analyse von Schrittintervall-Zeitreihen vorgeschlagen. Diese Verfeinerungen wurden an Schrittintervall-Zeitseriendaten von normalen und neurodegenerativen Erkrankungen validiert, die aus der öffentlich zugänglichen Datenbank PhysioNet heruntergeladen wurden. Die Ergebnisse zeigten, dass die von uns vorgeschlagene Methode eine klare Trennung zwischen gesunden und kranken Gruppen ermöglicht. In Zukunft könnten fortschrittliche medizinische Unterstützungssysteme, die künstliche Intelligenz nutzen und von den hier vorgestellten Methoden abgeleitet sind, Ärzte bei der Diagnose und langfristigen Überwachung des Gangs von Patienten unterstützen und so die klinische Arbeitsbelastung verringern und die Patientensicherheit verbessern

Discovering user mobility and activity in smart lighting environments

"Smart lighting" environments seek to improve energy efficiency, human productivity and health by combining sensors, controls, and Internet-enabled lights with emerging “Internet-of-Things” technology. Interesting and potentially impactful applications involve adaptive lighting that responds to individual occupants' location, mobility and activity. In this dissertation, we focus on the recognition of user mobility and activity using sensing modalities and analytical techniques. This dissertation encompasses prior work using body-worn inertial sensors in one study, followed by smart-lighting inspired infrastructure sensors deployed with lights. The first approach employs wearable inertial sensors and body area networks that monitor human activities with a user's smart devices. Real-time algorithms are developed to (1) estimate angles of excess forward lean to prevent risk of falls, (2) identify functional activities, including postures, locomotion, and transitions, and (3) capture gait parameters. Two human activity datasets are collected from 10 healthy young adults and 297 elder subjects, respectively, for laboratory validation and real-world evaluation. Results show that these algorithms can identify all functional activities accurately with a sensitivity of 98.96% on the 10-subject dataset, and can detect walking activities and gait parameters consistently with high test-retest reliability (p-value < 0.001) on the 297-subject dataset. The second approach leverages pervasive "smart lighting" infrastructure to track human location and predict activities. A use case oriented design methodology is considered to guide the design of sensor operation parameters for localization performance metrics from a system perspective. Integrating a network of low-resolution time-of-flight sensors in ceiling fixtures, a recursive 3D location estimation formulation is established that links a physical indoor space to an analytical simulation framework. Based on indoor location information, a label-free clustering-based method is developed to learn user behaviors and activity patterns. Location datasets are collected when users are performing unconstrained and uninstructed activities in the smart lighting testbed under different layout configurations. Results show that the activity recognition performance measured in terms of CCR ranges from approximately 90% to 100% throughout a wide range of spatio-temporal resolutions on these location datasets, insensitive to the reconfiguration of environment layout and the presence of multiple users.2017-02-17T00:00:00