Ambulatory Monitoring of Activities and Motor Symptoms in Parkinson's Disease

Ambulatory monitoring of motor symptoms in Parkinson's disease (PD) can improve our therapeutic strategies, especially in patients with motor fluctuations. Previously published monitors usually assess only one or a few basic aspects of the cardinal motor symptoms in a laboratory setting. We developed a novel ambulatory monitoring system that provides a complete motor assessment by simultaneously analyzing current motor activity of the patient (e.g., sitting, walking, etc.) and the severity of many aspects related to tremor, bradykinesia, and hypokinesia. The monitor consists of a set of four inertial sensors. Validity of our monitor was established in seven healthy controls and six PD patients treated with deep brain stimulation (DBS) of the subthalamic nucleus. The patients were tested at three different levels of DBS treatment. Subjects were monitored while performing different tasks, including motor tests of the Unified PD Rating Scale (UPDRS). Output of the monitor was compared to simultaneously recorded videos. The monitor proved very accurate in discriminating between several motor activities. Monitor output correlated well with blinded UPDRS ratings during different DBS levels. The combined analysis of motor activity and symptom severity by our PD monitor brings true ambulatory monitoring of a wide variety of motor symptoms one step close

Signal Quality and Compactness of a Dual-Accelerometer System for Gyro-Free Human Motion Analysis

There is a growing interest in measuring human activities via worn inertial sensors, and situating two accelerometers on a body segment allows accessing rotational kinematic information, at a significantly lower energy cost when compared with gyroscopes. However, the placement of sensors has not been widely considered in the literature. In practice, dual-accelerometer systems should be built as compact as possible to ensure long-term wearability. In this paper, the impact of sensor placement and nature of human activity on signal quality is quantified by individual and differential signal-to-noise ratios (SNRs). To do so, noise-free signals are described by a 2-D kinematic model of a body segment as a function of kinematic variables and sensor location on the segment. Measurements are modelled as kinematic signals disturbed by zero mean additive Gaussian noise. Depending on the accuracy needed, one can choose a minimal SNR to achieve, with such dual-accelerometer arrangement. We estimate SNR and minimal sensor separations for three data sets, two from the public domain and one collected for this paper. The data sets give arm motion profiles for reaching, inertial data collected during locomotion on a treadmill and during activities of daily life. With a dual-accelerometer arrangement, we show that it is possible to achieve a good differential SNR for the analysis of various human activities if the separation between the two sensors and their placement is well chosen

Moving On:Measuring Movement Remotely after Stroke

Most persons with stroke suffer from motor impairment, which restricts mobility on one side, and affects their independence in daily life activities. Measuring recovery is needed to develop individualized therapies. However, commonly used clinical outcomes suffer from low resolution and subjectivity. Therefore, objective biomechanical metrics should be identified to measure movement quality. However, non-portable laboratory setups are required in order to measure these metrics accurately. Alternatively, minimal wearable systems can be developed to simplify measurements performed at clinic or home to monitor recovery. Thus, the goal of the thesis was ‘To identify metrics that reflect movement quality of upper and lower extremities after stroke and develop wearable minimal systems for tracking the proposed metrics’. Section Upper Extremity First, we systematically reviewed literature ( Chapter II ) to identify metrics used to measure reaching recovery longitudinally post-stroke. Although several metrics were found, it was not clear how they differentiated recovery from compensation strategies. Future studies must address this gap in order to optimize stroke therapy. Next, we assessed a ‘valid’ measure for smoothness of upper paretic limb reaching ( Chapter III ), as this was commonly used to measure movement quality. After a systematic review and simulation analyses, we found that reaching smoothness is best measured using spectral arc length. The studies in this section offer us a better understanding of movement recovery in the upper extremity post-stroke. Section Lower Extremity Although metrics that reflect gait recovery are yet to be identified, in this section we focused on developing minimal solutions to measure gait quality. First, we showed the feasibility of 1D pressure insoles as a lightweight alternative for measuring 3D Ground Reaction Forces (GRF) ( Chapter IV ). In the following chapters, we developed a minimal system; the Portable Gait Lab (PGL) using only three Inertial Measurement Units (IMUs) (one per foot and one on the pelvis). We explored the Centroidal Moment Pivot (CMP) point ( Chapter V ) as a biomechanical constraint that can help with the reduction in sensors. Then, we showed the feasibility of the PGL to track 3D GRF ( Chapters VI-VII ) and relative foot and CoM kinematics ( Chapter VIII-IX ) during variable overground walking by healthy participants. Finally, we performed a limited validation study in persons with chronic stroke ( Chapter X ). This thesis offers knowledge and tools which can help clinicians and researchers understand movement quality and thereby develop individualized therapies post-stroke

Static and dynamic accuracy of an innovative miniaturized wearable platform for short range distance measurements for human movement applications

Magneto-inertial measurement units (MIMU) are a suitable solution to assess human motor performance both indoors and outdoors. However, relevant quantities such as step width and base of support, which play an important role in gait stability, cannot be directly measured using MIMU alone. To overcome this limitation, we developed a wearable platform specifically designed for human movement analysis applications, which integrates a MIMU and an Infrared Time-of-Flight proximity sensor (IR-ToF), allowing for the estimate of inter-object distance. We proposed a thorough testing protocol for evaluating the IR-ToF sensor performances under experimental conditions resembling those encountered during gait. In particular, we tested the sensor performance for different (i) target colors; (ii) sensor-target distances (up to 200 mm) and (iii) sensor-target angles of incidence (AoI) (up to 60°). Both static and dynamic conditions were analyzed. A pendulum, simulating the oscillation of a human leg, was used to generate highly repeatable oscillations with a maximum angular velocity of 6 rad/s. Results showed that the IR-ToF proximity sensor was not sensitive to variations of both distance and target color (except for black). Conversely, a relationship between error magnitude and AoI values was found. For AoI equal to 0°, the IR-ToF sensor performed equally well both in static and dynamic acquisitions with a distance mean absolute error <1.5 mm. Errors increased up to 3.6 mm (static) and 11.9 mm (dynamic) for AoI equal to ±30°, and up to 7.8 mm (static) and 25.6 mm (dynamic) for AoI equal to ±60°. In addition, the wearable platform was used during a preliminary experiment for the estimation of the inter-foot distance on a single healthy subject while walking. In conclusion, the combination of magneto-inertial unit and IR-ToF technology represents a valuable alternative solution in terms of accuracy, sampling frequency, dimension and power consumption, compared to existing technologies

The Use Of Inertial Measurement Units To Perform Kinetic Analyses Of Sprint Acceleration And Change Of Direction Tasks

Inertial measurement units (IMUs) are becoming more popular for field-based human movement analysis. However, their ability to track kinetic (i.e., 3-dimensional ground reaction force, F) and kinematic parameters used to evaluate sprint performance has not been assessed. Thus, the purpose of this thesis was three-fold. First was to assess the criterion validity of IMU estimates of the magnitude and direction of F during accelerative running tasks by comparison to a force plate. The second was to determine the concurrent validity of a novel IMU-based sprint velocity estimation algorithm. The third was to determine the concurrent validity of IMU estimates of kinetic determinates of sprint acceleration performance. For the first study, IMU estimates of continuous, step-average, and peak F while subjects performed linear sprint start and change of direction tasks were compared to the same measured by a force plate. For the second and third studies, a recently validated position-time method was used as the reference to which IMU estimates of continuous, average interval, and peak velocity as well as other performance variables (e.g., power, ratio of force, etc.) were compared. The results of these studies suggest the potential use of IMUs to assess sprint performance in the field

Implementation and validation of a stride length estimation algorithm, using a single basic inertial sensor on healthy subjects and patients suffering from Parkinson’s disease

As low cost and highly portable sensors, inertial measurements units (IMU) have become increasingly used in gait analysis, embodying an efficient alternative to motion capture systems. Meanwhile, being able to compute reliably accurate spatial gait parameters using few sensors remains a relatively complex problematic. Providing a clinical oriented solution, our study presents a gyrometer and accelerometer based algorithm for stride length estimation. Compared to most of the numerous existing works where only an averaged stride length is computed from several IMU, or where the use of the magnetometer is incompatible with everyday use, our challenge here has been to extract each individual stride length in an easy-to-use algorithm requiring only one inertial sensor attached to the subject shank. Our results were validated on healthy subjects and patients suffering from Parkinson’s disease (PD). Estimated stride lengths were compared to GAITRite© walkway system data: the mean error over all the strides was less than 6% for healthy group and 10.3% for PD group. This method provides a reliable portable solution for monitoring the instantaneous stride length and opens the way to promising applications

Analyzing human gait and posture by combining feature selection and kernel methods

This paper evaluates a set of computational algorithms for the automatic estimation of human postures and gait properties from signals provided by an inertial body sensor. The use of a single sensor device imposes limitations for the automatic estimation of relevant properties, like step length and gait velocity, as well as for the detection of standard postures like sitting or standing. Moreover, the exact location and orientation of the sensor is also a common restriction that is relaxed in this study. Based on accelerations provided by a sensor, known as the `9 2', three approaches are presented extracting kinematic information from the user motion and posture. Firstly, a two-phases procedure implementing feature extraction and Support Vector Machine based classi cation for daily living activity monitoring is presented. Secondly, Support Vector Regression is applied on heuristically extracted features for the automatic computation of spatiotemporal properties during gait. Finally, sensor information is interpreted as an observation of a particular trajectory of the human gait dynamical system, from which a reconstruction space is obtained, and then transformed using standard principal components analysis, nally Support Vector Regression is used for prediction. Daily living Activities are detected and spatiotemporal parameters of human gait are estimated using methods sharing a common structure based on feature extraction and kernel methods. The approaches presented are susceptible to be used for medical purposes.Peer ReviewedPreprin