Editorial: new advanced wireless technologies for objective monitoring of motor symptoms in Parkinson's disease

Nowadays, a growing number of researchers is using advanced wearable technologies with inertial measurement units (IMUs) to improve the evaluation of motor symptoms in patients with Parkinson’s Disease (PD). In this contest, wearable sensors are promising technologies possibly helpful for the overall clinical management of PD. The present Research Topic entitled “New Advanced Wireless Technologies for Objective Monitoring of Motor Symptoms in Parkinson's Disease” explores advances and perspectives of new wearable devices applied to patients with PD in order to support the clinical assessment with objective methods. The eleven manuscripts included in this Research Topic deal with the evaluation of a wide range of motor symptoms in patients with PD, including the classical cardinal signs such as bradykinesia, rigidity, tremor, postural instability and disabling gait disorders such as Freezing of Gait (FOG). FOG significantly increases the risk of falls in patients with PD, resulting in a negative impact on quality of life

New advanced wireless technologies for objective monitoring of motor symptoms in parkinson's disease

Edition of a Research topic of Frontiers in Neurology with 12 reviewed and accepted original papersPeer ReviewedPostprint (published version

Effects of hemodialysis therapy on sit-to-walk characteristics in end stage renal disease patients

Patients with end stage renal diseases (ESRD) undergoing hemodialysis (HD) have high morbidity and mortality due to multiple causes; one of which is dramatically higher fall rates than the general population. In spite of the multiple efforts aiming to decrease the high mortality and improve quality of life in ESRD patients, limited success has been achieved. If adequate interventions for fall prevention are to be achieved, the functional and mobility mechanisms consistent with falls in this population must be understood. Human movements such as sit-to-walk (STW) tasks are clinically significant, and analysis of these movements provides a meaningful evaluation of postural and locomotor performance in elderly patients with functional limitations indicative of fall risks. In order to assess the effects of HD therapy on fall risks, 22 sessions of both pre- and post-HD measurements were obtained in six ESRD patients utilizing customized inertial measurement units (IMU). IMU signals were denoised using ensemble empirical mode decomposition and Savistky-Golay filtering methods to detect relevant events for identification of STW phases. The results indicated that patients were slower to get out of the chair (as measured by trunk flexion angular accelerations, time to peak trunk flexion, and overall STW completion time) following the dialysis therapy session. STW is a frequent movement in activities of daily living, and HD therapy may influence the postural and locomotor control of these movements. The analysis of STW movement may assist in not only assessing a patient's physical status, but in identifying HD-related fall risk as well. This preliminary study presents a non-invasive method of kinematic measurement for early detection of increased fall risk in ESRD patients using portable inertial sensors for out-patient monitoring. This can be helpful in understanding the pathogenesis better, and improve awareness in health care providers in targeting interventions to identify individuals at risk for fall

Accuracy and repeatability of wrist joint angles in boxing using an electromagnetic tracking system

© 2019, The Author(s). The hand-wrist region is reported as the most common injury site in boxing. Boxers are at risk due to the amount of wrist motions when impacting training equipment or their opponents, yet we know relatively little about these motions. This paper describes a new method for quantifying wrist motion in boxing using an electromagnetic tracking system. Surrogate testing procedure utilising a polyamide hand and forearm shape, and in vivo testing procedure utilising 29 elite boxers, were used to assess the accuracy and repeatability of the system. 2D kinematic analysis was used to calculate wrist angles using photogrammetry, whilst the data from the electromagnetic tracking system was processed with visual 3D software. The electromagnetic tracking system agreed with the video-based system (paired t tests) in both the surrogate ( 0.9). In the punch testing, for both repeated jab and hook shots, the electromagnetic tracking system showed good reliability (ICCs > 0.8) and substantial reliability (ICCs > 0.6) for flexion–extension and radial-ulnar deviation angles, respectively. The results indicate that wrist kinematics during punching activities can be measured using an electromagnetic tracking system

The Use of Wearable Sensors for Preventing, Assessing, and Informing Recovery from Sport-Related Musculoskeletal Injuries: A Systematic Scoping Review

Wearable technologies are often indicated as tools that can enable the in-field collection of quantitative biomechanical data, unobtrusively, for extended periods of time, and with few spatial limitations. Despite many claims about their potential for impact in the area of injury prevention and management, there seems to be little attention to grounding this potential in biomechanical research linking quantities from wearables to musculoskeletal injuries, and to assessing the readiness of these biomechanical approaches for being implemented in real practice. We performed a systematic scoping review to characterise and critically analyse the state of the art of research using wearable technologies to study musculoskeletal injuries in sport from a biomechanical perspective. A total of 4952 articles were retrieved from the Web of Science, Scopus, and PubMed databases; 165 were included. Multiple study features—such as research design, scope, experimental settings, and applied context—were summarised and assessed. We also proposed an injury-research readiness classification tool to gauge the maturity of biomechanical approaches using wearables. Five main conclusions emerged from this review, which we used as a springboard to propose guidelines and good practices for future research and dissemination in the field

U-turn speed is a valid and reliable smartphone-based measure of multiple sclerosis-related gait and balance impairment

Background: People living with multiple sclerosis (MS) experience impairments in gait and mobility, that are not fully captured with manually timed walking tests or rating scales administered during periodic clinical visits. We have developed a smartphone-based assessment of ambulation performance, the 5 U-Turn Test (5UTT), a quantitative self-administered test of U-turn ability while walking, for people with MS (PwMS). Research question: What is the test-retest reliability and concurrent validity of U-turn speed, an unsupervised self-assessment of gait and balance impairment, measured using a body-worn smartphone during the 5UTT? Methods: 76 PwMS and 25 healthy controls (HCs) participated in a cross-sectional non-randomised interventional feasibility study. The 5UTT was self-administered daily and the median U-turn speed, measured during a 14-day session, was compared against existing validated in-clinic measures of MS-related disability. Results: U-turn speed, measured during a 14-day session from the 5UTT, demonstrated good-to-excellent test-retest reliability in PwMS alone and combined with HCs (intraclass correlation coefficient [ICC] = 0.87 [95 % CI: 0.80-0.92]) and moderate-to-excellent reliability in HCs alone (ICC = 0.88 [95 % CI: 0.69-0.96]). U-turn speed was significantly correlated with in-clinic measures of walking speed, physical fatigue, ambulation impairment, overall MS-related disability and patients' self-perception of quality of life, at baseline, Week 12 and Week 24. The minimal detectable change of the U-turn speed from the 5UTT was low (19.42 %) in PwMS and indicates a good precision of this measurement tool when compared with conventional in-clinic measures of walking performance. Significance: The frequent self-assessment of turn speed, as an outcome measure from a smartphone-based U-turn test, may represent an ecologically valid digital solution to remotely and reliably monitor gait and balance impairment in a home environment during MS clinical trials and practice

Agreement Level of Running Temporal Measurements, Kinetics, and Force-Time Curves Calculated from Inertial Measurement Units

Inertial measurement units (IMUs) and wearable sensors have enabled athlete monitoring and research to become more ecologically valid due to their small size and low cost. IMUs and accelerometers that are placed on the body close to the point of impact and that record at sufficiently high frequencies have demonstrated the highest validity when measuring temporal gait event moments such as ground contact time (GCT) and flight time (FT) as well as peak forces (PF) during upright running. While the use of IMUs has increased in the sport performance and athlete monitoring realm, the potential of the technology’s ability to estimate running force-time curves utilizing the two-mass model (TMM) remains unexplored. The purpose of this study was two-fold. First, was to determine the validity of measuring temporal gait events and peak forces utilizing a commercially available shank-mounted inertial measurement unit. Second, was to determine the validity of force-time curves generated from the TMM utilizing data from shank-mounted inertial measurement units. Ten subjects voluntarily completed submaximal treadmill tests equipped with a force plate while wearing shank-mounted IMUs on each leg. Using the raw data from the IMUs, GCT, FT, total step time (ST), PF, and two-mass model-based force-time (F-t) curves were generated for 25 steps at 8 different speeds. Paired sample T-tests were performed on the gait events and peak force between the IMU and treadmill with both individual step comparison and averages per each speed. 95% confidence intervals were calculated for each timepoint of the force time curves. No statistically significant differences (p \u3e 0.05) and nearly perfect relationships were observed for the step averages for each speed with FT, ST, and PF. Confidence intervals of the corrected mean difference suggest that F-t curves calculated from the TMM may not be valid when assessing the running population as a whole. When performing a sub-group analysis of skilled runners and recreational runners, F-t curves derived from shank-mounted IMUs may be more valid in skilled runners than recreational runners. In skilled runners, the 95% CI for the mean difference contained zero within the first 60% of the GCT duration, whereas the 95% CI recreational runners contained a zero-value in a smaller percentage of the GCT located only in the middle of the GCT at the curve peak height. The results of this study suggest that interchangeability between shank-mounted IMUs and force plates may be very limited when estimating temporal gait events and kinetics. While agreement was low between F-t curves after the peak in skilled runners, use of shank-mounted IMUs to estimate F-t curves may have several benefits still in skilled runners when assessing peak forces and force development from initial contact until peak force

Gait characterization using wearable inertial sensors in healthy and pathological populations

Gait analysis is emerging as an effective tool to detect an incipient neurodegenerative disease or to monitor its progression. It has been shown that gait disturbances are an early indicator for cognitive impairments and can predict progression to neurodegenerative diseases. Furthermore, gait performance is a predictor of fall status, morbidity and mortality. Instrumented gait analysis provides quantitative measures to support the investigation of gait pathologies and the definition of targeted rehabilitation programs. In this framework, technologies such as inertial sensors are well accepted, and increasingly employed, as tools to characterize locomotion patterns and their variability in research settings. The general aim of this thesis is the evaluation, comparison and refinement of methods for gait characterization using magneto-inertial measurement units (MIMUs), in order to contribute to the migration of instrumented gait analysis from state of the art to state of the science (i.e.: from research towards its application in standard clinical practice). At first, methods for the estimation of spatio-temporal parameters during straight gait were investigated. Such parameters are in fact generally recognized as key metrics for an objective evaluation of gait and a quantitative assessment of clinical outcomes. Although several methods for their estimate have been proposed, few provided a thorough validation. Therefore an error analysis across different pathologies, multiple clinical centers and large sample size was conducted to further validate a previously presented method (TEADRIP). Results confirmed the applicability and robustness of the TEADRIP method. The combination of good performance, reliability and range of usage indicate that the TEADRIP method can be effectively adopted for gait spatio-temporal parameter estimation in the routine clinical practice. However, while traditionally gait analysis is applied to straight walking, several clinical motor tests include turns between straight gait segments. Furthermore, turning is used to evaluate subjects’ motor ability in more challenging circumstances. The second part of the research therefore headed towards the application of gait analysis on turning, both to segment it (i.e.: distinguish turns and straight walking bouts) and to specifically characterize it. Methods for turn identification based on a single MIMU attached to the trunk were implemented and their performance across pathological populations was evaluated. Focusing on Parkinson’s Disease (PD) subjects, turn characterization was also addressed in terms of onset and duration, using MIMUs positioned both on the trunk and on the ankles. Results showed that in PD population turn characterization with the sensors at the ankles lacks of precision, but that a single MIMU positioned on the low back is functional for turn identification. The development and validation of the methods considered in these works allowed for their application to clinical studies, in particular supporting the spatio-temporal parameters analysis in a PD treatment assessment and the investigation of turning characteristic in PD subjects with Freezing of Gait. In the first application, comparing the pre and post parameters it was possible to objectively determine the effectiveness of a rehabilitation treatment. In the second application, quantitative measures confirmed that in PD subjects with Freezing of Gait turning 360° in place is further compromised (and requires additional cognitive effort) compared to turning 180° while walking

Thigh-Derived Inertial Sensor Metrics to Assess the Sit-to-Stand and Stand-to-Sit Transitions in the Timed Up and Go (TUG) Task for Quantifying Mobility Impairment in Multiple Sclerosis

INTRODUCTION: Inertial sensors generate objective and sensitive metrics of movement disability that may indicate fall risk in many clinical conditions including multiple sclerosis (MS). The Timed-Up-And-Go (TUG) task is used to assess patient mobility because it incorporates clinically-relevant submovements during standing. Most sensor-based TUG research has focused on the placement of sensors at the spine, hip or ankles; an examination of thigh activity in TUG in multiple sclerosis is wanting. METHODS: We used validated sensors (x-IMU by x-io) to derive transparent metrics for the sit-to-stand (SI-ST) transition and the stand-to-sit (ST-SI) transition of TUG, and compared effect sizes for metrics from inertial sensors on the thighs to effect sizes for metrics from a sensor placed at the L3 level of the lumbar spine. 23 healthy volunteers were compared to 17 ambulatory persons with MS (PwMS, HAI <= 2). RESULTS: During the SI-ST transition, the metric with the largest effect size comparing healthy volunteers to PwMS was the Area Under the Curve of the thigh angular velocity in the pitch direction -- representing both thigh and knee extension; the peak of the spine pitch angular velocity during SI-ST also had a large effect size, as did some temporal measures of duration of SI-ST, although less so. During the ST-SI transition the metric with the largest effect size in PwMS was the peak of the spine angular velocity curve in the roll direction. A regression was performed. DISCUSSION: We propose for PwMS that the diminished peak angular velocities during SI-ST directly represents extensor weakness, while the increased roll during ST-SI represents diminished postural control. CONCLUSIONS: During the SI-ST transition of TUG, angular velocities can discriminate between healthy volunteers and ambulatory PwMS better than temporal features. Sensor placement on the thighs provides additional discrimination compared to sensor placement at the lumbar spine

Analysis of the complexity and variability of fine and gross motor tasks in fibromyalgia patients: precision and retrospective cross-sectional studies

Fibromyalgia (FM) can be defined as a non-inflammatory chronic and widespread pain disease (Gentile et al., 2019) that present and series of other symptoms such as fatigue, Allodynia, Hyperalgesia, functional impairment, balance deficit, and others (ACSM, 2021; Rasouli et al., 2017). FM is considered to be a disease or syndrome that shows a central nervous system dysfunction in pain modulation (Gentile et al., 2019). This functional impairment in FM patients may be related to disturbances in motor functions, such as deficits in fine and gross motor control (Pérez-de-Heredia-Torres et al., 2013; Rasouli et al., 2017). Until today, it is still impossible to confirm the diagnosis of Fibromyalgia because no clinical tests are available for this purpose (ACSM, 2021). The present dissertation intends to verify if Inertial Measurement Units (IMU) are instruments that can facilitate the applicability (Study 1) of FTT; Analyze and interpret entropy values during fine and gross motor control tasks (Study 2), and assess the variability during the same fine and gross motor control tasks (Study 3) of individuals with FM diagnosis; and also to verify if the IMU with the non-linear analysis can characterize FM patients. The sample of 20 female subjects, 10 with FM and 10 without, with ages between 20 and 70 years old, was divided into experimental and control groups. Participants were asked to perform de finger tapping test with both hands, the gait task, and the sit and stand test. IMUs were used in all tasks to collect the required data for each study. Non linear measures of entropy and variability were used to allow a detailed and deeper motor control analysis, focusing on the process and on the quality of movement (Azami et al., 2017). The results showed that using inertial sensors may be of great applicability in the finger tapping test, and it could be a possible alternative to the traditional method. This method allows the tridimensional collection and analysis of other important information that we can only access by looking at the process and not just the results in a more practical, faster, and cheaper way. And the use of IMU, along with non-linear analysis in fine and gross motor control, could allow a better understanding and characterization of both groups, Fibromyalgia, and control, through the analysis of entropy and variability In conclusion, the use of inertial sensors to collect data from fine and gross motor has great potential and brings innovation to exercise researchers and professionals.A fibromialgia (FM) pode ser definida como uma doença não inflamatória com dor crónica generalizada (Gentile et al., 2019), e que apresenta uma série de outros sintomas como a fadiga, alodinia, hiperalgesia, comprometimento funcional, deficits de equilíbrio, entre outros (ACSM, 2021; Rasouli et al., 2017). A FM é considerada uma doença ou síndrome que apresenta uma disfunção por parte do sistema nervoso central no processamento e regulação da dor (Gentile et al., 2019). Esse comprometimento funcional em pacientes com FM pode estar relacionado com a presença de distúrbios motores, como deficits na motricidade fina e grossa (Pérez-de-Heredia-Torres et al., 2013; Rasouli et al., 2017). Até hoje ainda não é possível confirmar o diagnóstico de fibromialgia, pois não existem testes clínicos disponíveis para o efeito (ACSM, 2021). A presente dissertação pretende verificar se os sensores inerciais (IMUs) são instrumentos que podem facilitar a aplicação (Estudo 1) do FTT; analisar e interpretar valores de entropia durante a realização de tarefas de motricidade fina e grossa (Estudo 2) e, analisar a variabilidade durante a execução das mesmas tarefas de controlo motor fino e grosso de indivíduos com FM, e verificar se o IMU juntamente com a análise não linear, permite uma caracterização da fibromialgia. A amostra desta dissertação é constituída por 20 sujeitos do sexo feminino, 10 com FM e 10 sem FM, com idades compreendidas entre os 20 e os 70 anos, divididos em dois grupos, grupo experimental e grupo de controlo, respetivamente. Foi solicitado aos participantes que realizassem três tarefas motoras: o finger tapping test em ambas as mãos, a marcha e o teste de sentar-e-levantar. Os IMUs foram utilizados em todas as tarefas para recolher os dados necessários para cada estudo, de modo a serem aplicadas medidas de análise não-linear de entropia e variabilidade. Este tratamento de dados foi utilizado para permitir uma análise mais detalhada e profunda do controlo do movimento, com principal foco no processo e na qualidade do movimento (Azami et al., 2017). Os resultados desta dissertação mostraram que a utilização de sensores inerciais parece ter uma grande aplicabilidade no teste de finger tapping, e que o mesmo pode ser uma possível alternativa ao método validado. O IMU permite uma recolha e análise tridimensional, o qual possibilita entender o processo de controlo do movimento e não apenas o resultado, fazendo-o de forma mais prática, rápida e económica. O uso de IMUs juntamente com análises não-lineares na motricidade fina e grossa pode permitir uma melhor compreensão e caracterização de ambos os grupos, fibromialgia e controlo, através da análise da entropia e da variabilidade. Em conclusão, o uso de sensores inerciais apresenta um grande potencial e traz inovação para investigadores e profissionais do exercício.N/