A Review of Accelerometry-Based Wearable Motion Detectors for Physical Activity Monitoring

Characteristics of physical activity are indicative of one’s mobility level, latent chronic diseases and aging process. Accelerometers have been widely accepted as useful and practical sensors for wearable devices to measure and assess physical activity. This paper reviews the development of wearable accelerometry-based motion detectors. The principle of accelerometry measurement, sensor properties and sensor placements are first introduced. Various research using accelerometry-based wearable motion detectors for physical activity monitoring and assessment, including posture and movement classification, estimation of energy expenditure, fall detection and balance control evaluation, are also reviewed. Finally this paper reviews and compares existing commercial products to provide a comprehensive outlook of current development status and possible emerging technologies

Gait symmetry and regularity in transfemoral amputees assessed by trunk accelerations

<p>Abstract</p> <p>Background</p> <p>The aim of this study was to evaluate a method based on a single accelerometer for the assessment of gait symmetry and regularity in subjects wearing lower limb prostheses.</p> <p>Methods</p> <p>Ten transfemoral amputees and ten healthy control subjects were studied. For the purpose of this study, subjects wore a triaxial accelerometer on their thorax, and foot insoles. Subjects were asked to walk straight ahead for 70 m at their natural speed, and at a lower and faster speed. Indices of step and stride regularity (Ad1 and Ad2, respectively) were obtained by the autocorrelation coefficients computed from the three acceleration components. Step and stride durations were calculated from the plantar pressure data and were used to compute two reference indices (SI1 and SI2) for step and stride regularity.</p> <p>Results</p> <p>Regression analysis showed that both Ad1 well correlates with SI1 (<it>R</it>²up to 0.74), and Ad2 well correlates with SI2 (<it>R</it>²up to 0.52). A ROC analysis showed that Ad1 and Ad2 has generally a good sensitivity and specificity in classifying amputee's walking trial, as having a normal or a pathologic step or stride regularity as defined by means of the reference indices SI1 and SI2. In particular, the antero-posterior component of Ad1 and the vertical component of Ad2 had a sensitivity of 90.6% and 87.2%, and a specificity of 92.3% and 81.8%, respectively.</p> <p>Conclusions</p> <p>The use of a simple accelerometer, whose components can be analyzed by the autocorrelation function method, is adequate for the assessment of gait symmetry and regularity in transfemoral amputees.</p

Rehabilitation Engineering in Parkinson's disease

Impairment of postural control is a common consequence of Parkinson's disease (PD) that becomes more and more critical with the progression of the disease, in spite of the available medications. Postural instability is one of the most disabling features of PD and induces difficulties with postural transitions, initiation of movements, gait disorders, inability to live independently at home, and is the major cause of falls. Falls are frequent (with over 38% falling each year) and may induce adverse consequences like soft tissue injuries, hip fractures, and immobility due to fear of falling. As the disease progresses, both postural instability and fear of falling worsen, which leads patients with PD to become increasingly immobilized. The main aims of this dissertation are to: 1) detect and assess, in a quantitative way, impairments of postural control in PD subjects, investigate the central mechanisms that control such motor performance, and how these mechanism are affected by levodopa; 2) develop and validate a protocol, using wearable inertial sensors, to measure postural sway and postural transitions prior to step initiation; 3) find quantitative measures sensitive to impairments of postural control in early stages of PD and quantitative biomarkers of disease progression; and 4) test the feasibility and effects of a recently-developed audio-biofeedback system in maintaining balance in subjects with PD. In the first set of studies, we showed how PD reduces functional limits of stability as well as the magnitude and velocity of postural preparation during voluntary, forward and backward leaning while standing. Levodopa improves the limits of stability but not the postural strategies used to achieve the leaning. Further, we found a strong relationship between backward voluntary limits of stability and size of automatic postural response to backward perturbations in control subjects and in PD subjects ON medication. Such relation might suggest that the central nervous system presets postural response parameters based on perceived maximum limits and this presetting is absent in PD patients OFF medication but restored with levodopa replacement. Furthermore, we investigated how the size of preparatory postural adjustments (APAs) prior to step initiation depend on initial stance width. We found that patients with PD did not scale up the size of their APA with stance width as much as control subjects so they had much more difficulty initiating a step from a wide stance than from a narrow stance. This results supports the hypothesis that subjects with PD maintain a narrow stance as a compensation for their inability to sufficiently increase the size of their lateral APA to allow speedy step initiation in wide stance. In the second set of studies, we demonstrated that it is possible to use wearable accelerometers to quantify postural performance during quiet stance and step initiation balance tasks in healthy subjects. We used a model to predict center of pressure displacements associated with accelerations at the upper and lower back and thigh. This approach allows the measurement of balance control without the use of a force platform outside the laboratory environment. We used wearable accelerometers on a population of early, untreated PD patients, and found that postural control in stance and postural preparation prior to a step are impaired early in the disease when the typical balance and gait intiation symptoms are not yet clearly manifested. These novel results suggest that technological measures of postural control can be more sensitive than clinical measures. Furthermore, we assessed spontaneous sway and step initiation longitudinally across 1 year in patients with early, untreated PD. We found that changes in trunk sway, and especially movement smoothness, measured as Jerk, could be used as an objective measure of PD and its progression. In the third set of studies, we studied the feasibility of adapting an existing audio-biofeedback device to improve balance control in patients with PD. Preliminary results showed that PD subjects found the system easy-to-use and helpful, and they were able to correctly follow the audio information when available. Audiobiofeedback improved the properties of trunk sway during quiet stance. Our results have many implications for i) the understanding the central mechanisms that control postural motor performance, and how these mechanisms are affected by levodopa; ii) the design of innovative protocols for measuring and remote monitoring of motor performance in the elderly or subjects with PD; and iii) the development of technologies for improving balance, mobility, and consequently quality of life in patients with balance disorders, such as PD patients with augmented biofeedback paradigms

Accelerometric assessment of different dimensions of natural walking during the first year after stroke

Objectives: To describe the course of walking behaviour over a period of 1 year after stroke, using accelerometry, and to compare 1-year data with those from a healthy group. Design: One-year follow-up cohort study. Subjects: Twenty-three stroke patients and 20 age-matched healthy subjects. Methods: Accelerometer assessments were made in the participants' daily environment for 8 h/day during the 1st (T1), 12th (T2) and 48th (T3) weeks after stroke, and at one timepoint in healthy subjects. Primary outcomes were: percentage of time walking and upright (amount); mean duration and number of walking periods (distribution); step regularity and gait symmetry (quality); and walking speed. Results: Time walking, time upright, and number of walking bouts increased during T1 and T2 (p 0.30). Mean duration of walking periods showed no significant improvements (p > 0.30) during all phases. Step regularity, gait symmetry and gait speed showed a tendency to increase consistently from T1 to T3. At T3, amount and distribution variables reached the level of the healthy group, but significant differences remained (p < 0.02) in step regularity and gait speed. Conclusion: In this cohort, different outcomes of walking behaviour showed different patterns and levels of recovery, which supports the multi-dimensional character of gait

Calibrating accelerometer tags with oxygen consumption rate of rainbow trout (Oncorhynchus mykiss) and their use in aquaculture facility: A case study

SIMPLE SUMMARY: Measuring metabolic rates in free-swimming fish would provide valuable insights about the energetic costs of different life activities this is challenging to implement in the field due to the difficulty of performing such measurements. Thus, the calibration of acoustic transmitters with the oxygen consumption rate (MO(2)) could be promising to counter the limitations observed in the field. In this study, calibrations were performed in rainbow trout (Oncorhynchus mykiss), and a subsample of fish was implanted with such a transmitter and then followed under aquaculture conditions. The use of acoustic transmitters calibrated with MO(2) appeared to be a promising tool to estimate energetic costs in free-swimming rainbow trout, and for welfare assessment in the aquaculture industry. ABSTRACT: Metabolic rates are linked to the energetic costs of different activities of an animal’s life. However, measuring the metabolic rate in free-swimming fish remains challenging due to the lack of possibilities to perform these direct measurements in the field. Thus, the calibration of acoustic transmitters with the oxygen consumption rate (MO(2)) could be promising to counter these limitations. In this study, rainbow trout (Oncorhynchus mykiss Walbaum, 1792; n = 40) were challenged in a critical swimming test (U(crit)) to (1) obtain insights about the aerobic and anaerobic metabolism throughout electromyograms; and (2) calibrate acoustic transmitters’ signal with the MO(2) to be later used as a proxy of energetic costs. After this calibration, the fish (n = 12) were implanted with the transmitter and were followed during ~50 days in an aquaculture facility, as a case study, to evaluate the potential of such calibration. Accelerometer data gathered from tags over a long time period were converted to estimate the MO(2). The MO(2) values indicated that all fish were reared under conditions that did not impact their health and welfare. In addition, a diurnal pattern with higher MO(2) was observed for the majority of implanted trout. In conclusion, this study provides (1) biological information about the muscular activation pattern of both red and white muscle; and (2) useful tools to estimate the energetic costs in free-ranging rainbow trout. The use of acoustic transmitters calibrated with MO(2), as a proxy of energy expenditure, could be promising for welfare assessment in the aquaculture industry

Smart Technology for Telerehabilitation: A Smart Device Inertial-sensing Method for Gait Analysis

The aim of this work was to develop and validate an iPod Touch (4th generation) as a potential ambulatory monitoring system for clinical and non-clinical gait analysis. This thesis comprises four interrelated studies, the first overviews the current available literature on wearable accelerometry-based technology (AT) able to assess mobility-related functional activities in subjects with neurological conditions in home and community settings. The second study focuses on the detection of time-accurate and robust gait features from a single inertial measurement unit (IMU) on the lower back, establishing a reference framework in the process. The third study presents a simple step length algorithm for straight-line walking and the fourth and final study addresses the accuracy of an iPod’s inertial-sensing capabilities, more specifically, the validity of an inertial-sensing method (integrated in an iPod) to obtain time-accurate vertical lower trunk displacement measures. The systematic review revealed that present research primarily focuses on the development of accurate methods able to identify and distinguish different functional activities. While these are important aims, much of the conducted work remains in laboratory environments, with relatively little research moving from the “bench to the bedside.” This review only identified a few studies that explored AT’s potential outside of laboratory settings, indicating that clinical and real-world research significantly lags behind its engineering counterpart. In addition, AT methods are largely based on machine-learning algorithms that rely on a feature selection process. However, extracted features depend on the signal output being measured, which is seldom described. It is, therefore, difficult to determine the accuracy of AT methods without characterizing gait signals first. Furthermore, much variability exists among approaches (including the numbers of body-fixed sensors and sensor locations) to obtain useful data to analyze human movement. From an end-user’s perspective, reducing the amount of sensors to one instrument that is attached to a single location on the body would greatly simplify the design and use of the system. With this in mind, the accuracy of formerly identified or gait events from a single IMU attached to the lower trunk was explored. The study’s analysis of the trunk’s vertical and anterior-posterior acceleration pattern (and of their integrands) demonstrates, that a combination of both signals may provide more nuanced information regarding a person’s gait cycle, ultimately permitting more clinically relevant gait features to be extracted. Going one step further, a modified step length algorithm based on a pendulum model of the swing leg was proposed. By incorporating the trunk’s anterior-posterior displacement, more accurate predictions of mean step length can be made in healthy subjects at self-selected walking speeds. Experimental results indicate that the proposed algorithm estimates step length with errors less than 3% (mean error of 0.80 ± 2.01cm). The performance of this algorithm, however, still needs to be verified for those suffering from gait disturbances. Having established a referential framework for the extraction of temporal gait parameters as well as an algorithm for step length estimations from one instrument attached to the lower trunk, the fourth and final study explored the inertial-sensing capabilities of an iPod Touch. With the help of Dr. Ian Sheret and Oxford Brookes’ spin-off company ‘Wildknowledge’, a smart application for the iPod Touch was developed. The study results demonstrate that the proposed inertial-sensing method can reliably derive lower trunk vertical displacement (intraclass correlations ranging from .80 to .96) with similar agreement measurement levels to those gathered by a conventional inertial sensor (small systematic error of 2.2mm and a typical error of 3mm). By incorporating the aforementioned methods, an iPod Touch can potentially serve as a novel ambulatory monitor system capable of assessing gait in clinical and non-clinical environments

Motor Ability Assessment in Lower-Limb Amputees

This work investigates the necessary aspects for the motor ability assessment in persons with lower-limb amputation, following the evaluation approaches suggested by the World Health Organization. In the specific case of the lower-limb amputee patient, the assessement can be articulated on two different levels: a first general, concerning the motor ability and quality of life as a function of that (level of independence), and a second local one, concerning the specificity of each single prosthetic module which composes the entire prosthetic chain, in the relationship with the user's motor function. The general purpose is therefore to provide fact-finding and operational tools in order to identify an accurate and reliable methodology for the motor ability assessment of prosthetized lower-limb amputees, both during gait and stereotypic locomotor tasks. This methodology is intended to constitute a valid and conventionally recognized reference for the amputee rehabilitation team, both for the functional patient assessment and for the technical-clinical evaluation of the prosthetic modules used. The perspective purpose is to verify the extractability of parameters particulary sensitive to the variability of clinical aspects related to the the lower-limb amputee motor ability, that can therefore be measured by a simple, low cost, wearable instrumentation, making them intelligible and useful to the clinical team and exportable in a remote supervision context. The main aims of the present thesis can be summarized in: 1. Identification of parameters of evaluation sensitive to the motor ability changes in lower-limb amputee subjects; 2. Definition of experimental methodological protocols ad hoc for the functional evaluation of the subject and for the appropriateness of the single prosthetic components. The research activity of the present thesis has been oriented on different works, each of which presents various peculiar aspects for the identification of specific indices for the assessment of the lower-limb amputee’s motor ability

Automatic detection of disorientation among people with dementia

Ageing is characterized by decline in cognition including visuospatial function, necessary for independently executing instrumental activities of daily living. The onset of Alzheimer’s disease dementia exacerbates this decline, leading to major challenges for patients and increased burden for caregivers. An important function affected by this decline is spatial orientation. This work provides insight into substrates of real-world wayfinding challenges among older adults, with emphasis on viable features aiding the detection of spatial disorientation and design of possible interventions

Instrumentation of a cane to detect and prevent falls

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Eletrónica Médica)The number of falls is growing as the main cause of injuries and deaths in the geriatric community. As a result, the cost of treating the injuries associated with falls is also increasing. Thus, the development of fall-related strategies with the capability of real-time monitoring without user restriction is imperative. Due to their advantages, daily life accessories can be a solution to embed fall-related systems, and canes are no exception. Moreover, gait assessment might be capable of enhancing the capability of cane usage for older cane users. Therefore, reducing, even more, the possibility of possible falls amongst them. Summing up, it is crucial the development of strategies that recognize states of fall, the step before a fall (pre-fall step) and the different cane events continuously throughout a stride. This thesis aims to develop strategies capable of identifying these situations based on a cane system that collects both inertial and force information, the Assistive Smart Cane (ASCane). The strategy regarding the detection of falls consisted of testing the data acquired with the ASCane with three different fixed multi-threshold fall detection algorithms, one dynamic multi-threshold and machine learning methods from the literature. They were tested and modified to account the use of a cane. The best performance resulted in a sensitivity and specificity of 96.90% and 98.98%, respectively. For the detection of the different cane events in controlled and real-life situations, a state-of-the-art finite-state-machine gait event detector was modified to account the use of a cane and benchmarked against a ground truth system. Moreover, a machine learning study was completed involving eight feature selection methods and nine different machine learning classifiers. Results have shown that the accuracy of the classifiers was quite acceptable and presented the best results with 98.32% of overall accuracy for controlled situations and 94.82% in daily-life situations. Regarding pre-fall step detection, the same machine learning approach was accomplished. The models were very accurate (Accuracy = 98.15%) and with the implementation of an online post-processing filter, all the false positive detections were eliminated, and a fall was able to be detected 1.019s before the end of the corresponding pre-fall step and 2.009s before impact.O número de quedas tornou-se uma das principais causas de lesões e mortes na comunidade geriátrica. Como resultado, o custo do tratamento das lesões também aumenta. Portanto, é necessário o desenvolvimento de estratégias relacionadas com quedas e que exibam capacidade de monitorização em tempo real sem colocar restrições ao usuário. Devido às suas vantagens, os acessórios do dia-a-dia podem ser uma solução para incorporar sistemas relacionados com quedas, sendo que as bengalas não são exceção. Além disso, a avaliação da marcha pode ser capaz de aprimorar a capacidade de uso de uma bengala para usuários mais idosos. Desta forma, é crucial o desenvolvimento de estratégias que reconheçam estados de queda, do passo anterior a uma queda e dos diferentes eventos da marcha de uma bengala. Esta dissertação tem como objetivo desenvolver estratégias capazes de identificar as situações anteriormente descritas com base num sistema incorporado numa bengala que coleta informações inerciais e de força, a Assistive Smart Cane (ASCane). A estratégia referente à deteção de quedas consistiu em testar os dados adquiridos através da ASCane com três algoritmos de deteção de quedas (baseados em thresholds fixos), com um algoritmo de thresholds dinâmicos e diferentes classificadores de machine learning encontrados na literatura. Estes métodos foram testados e modificados para dar conta do uso de informação adquirida através de uma bengala. O melhor desempenho alcançado em termos de sensibilidade e especificidade foi de 96,90% e 98,98%, respetivamente. Relativamente à deteção dos diferentes eventos da ASCane em situações controladas e da vida real, um detetor de eventos da marcha foi e comparado com um sistema de ground truth. Além disso, foi também realizado um estudo de machine learning envolvendo oito métodos de seleção de features e nove classificadores diferentes de machine learning. Os resultados mostraram que a precisão dos classificadores foi bastante aceitável e apresentou, como melhores resultados, 98,32% de precisão para situações controladas e 94.82% para situações do dia-a-dia. No que concerne à deteção de passos pré-queda, a mesma abordagem de machine learning foi realizada. Os modelos foram precisos (precisão = 98,15%) e com a implementação de um filtro de pós-processamento, todas as deteções de falsos positivos foram eliminadas e uma queda foi passível de ser detetada 1,019s antes do final do respetivo passo de pré-queda e 2.009s antes do impacto