Early diagnosis of frailty: Technological and non-intrusive devices for clinical detection

This work analyses different concepts for frailty diagnosis based on affordable standard technology such as smartphones or wearable devices. The goal is to provide ideas that go beyond classical diagnostic tools such as magnetic resonance imaging or tomography, thus changing the paradigm; enabling the detection of frailty without expensive facilities, in an ecological way for both patients and medical staff and even with continuous monitoring. Fried's five-point phenotype model of frailty along with a model based on trials and several classical physical tests were used for device classification. This work provides a starting point for future researchers who will have to try to bridge the gap separating elderly people from technology and medical tests in order to provide feasible, accurate and affordable tools for frailty monitoring for a wide range of users.This work was sponsored by the Spanish Ministry of Science, Innovation and Universities and the European Regional Development Fund (ERDF) across projects RTC-2017-6321-1 AEI/FEDER, UE, TEC2016-76021-C2-2-R AEI/FEDER, UE and PID2019-107270RB-C21/AEI/10.13039/501100011033, UE

Older adults with weaker muscle strength stand up from a sitting position with more dynamic trunk use

The ability to stand up from a sitting position is essential for older adults to live independently. Body-fixed inertial sensors may provide an approach for quantifying the sit-to-stand (STS) in clinical settings. The aim of this study was to determine whether measurements of STS movements using body-fixed sensors yield parameters that are informative regarding changes in STS performance in older adults with reduced muscle strength. In twenty-seven healthy older adults, handgrip strength was assessed as a proxy for overall muscle strength. Subjects were asked to stand up from a chair placed at three heights. Trunk movements were measured using an inertial sensor fixed to the back. Duration, angular range, and maximum angular velocity of STS phases, as well as the vertical velocity of the extension phase, were calculated. Backwards elimination using Generalized Estimating Equations was used to determine if handgrip strength predicted the STS durations and trunk kinematics. Weaker subjects (i.e., with lower handgrip strength) were slower during the STS and showed a larger flexion angular range and a larger extension angular range. In addition, weaker subjects showed a greater maximum angular velocity, which increased with lower seat heights. Measurements with a single inertial sensor did reveal that older adults with lower handgrip strength employed a different strategy to stand up from a sitting position, involving more dynamic use of the trunk. This effect was greatest when elevating body mass. Trunk kinematic parameters were more sensitive to reduced muscle strength than durations

A review of activity trackers for senior citizens: research perspectives, commercial landscape and the role of the insurance industry

The objective assessment of physical activity levels through wearable inertial-based motion detectors for the automatic, continuous and long-term monitoring of people in free-living environments is a well-known research area in the literature. However, their application to older adults can present particular constraints. This paper reviews the adoption of wearable devices in senior citizens by describing various researches for monitoring physical activity indicators, such as energy expenditure, posture transitions, activity classification, fall detection and prediction, gait and balance analysis, also by adopting consumer-grade fitness trackers with the associated limitations regarding acceptability. This review also describes and compares existing commercial products encompassing activity trackers tailored for older adults, thus providing a comprehensive outlook of the status of commercially available motion tracking systems. Finally, the impact of wearable devices on life and health insurance companies, with a description of the potential benefits for the industry and the wearables market, was analyzed as an example of the potential emerging market drivers for such technology in the future

Validation, optimization and exploitation of orientation measurements issued from inertial systems for clinical biomechanics

Les centrales inertielles (triade de capteurs inertiels dont la fusion des données permet l’estimation de l’orientation d’un corps rigide) sont de plus en plus populaires en biomécanique. Toutefois, les qualités métrologiques des centrales inertielles (CI) sont peu documentées et leur capacité à identifier des incapacités liées à la mobilité, sous-évaluée. Objectifs : (i) Caractériser la validité de la mesure d’orientation issue de CI ; (ii) Optimiser la justesse et la fidélité de ces mesures; et (iii) Proposer des métriques de mobilité basées sur les mesures d’orientation issues de CI. Méthodologie et résultats : La validité de la mesure d’orientation de différents types de CI a d’abord été évaluée en conditions contrôlées, à l’aide d’une table motorisée et d’une mesure étalon. Il a ainsi été démontré que les mesures d’orientation issues de CI ont une justesse acceptable lors de mouvements lents (justesse moyenne ≤ 3.1º), mais que cette justesse se dégrade avec l’augmentation de la vitesse de rotation. Afin d’évaluer l’impact de ces constatations en contexte clinique d’évaluation de la mobilité, 20 participants ont porté un vêtement incorporant 17 CI lors de la réalisation de diverses tâches de mobilité (transferts assis-debout, marche, retournements). La comparaison des mesures des CI avec celles d’un système étalon a permis de dresser un portrait descriptif des variations de justesse selon la tâche exécutée et le segment/l’articulation mesuré. À partir de ces constats, l’optimisation de la mesure d’orientation issue de CI est abordée d’un point de vue utilisateur, démontrant le potentiel d’un réseau de neurones artificiel comme outil de rétroaction autonome de la qualité de la mesure d’orientation (sensibilité et spécificité ≥ 83%). Afin d’améliorer la robustesse des mesures de cinématique articulaire aux variations environnementales, l’ajout d’une photo et d’un algorithme d’estimation de pose tridimensionnelle est proposé. Lors d’essais de marche (n=60), la justesse moyenne de l’orientation à la cheville a ainsi été améliorée de 6.7° à 2.8º. Finalement, la caractérisation de la signature de la cinématique tête-tronc pendant une tâche de retournement (variables : angle maximal tête-tronc, amplitude des commandes neuromusculaires) a démontré un bon pouvoir discriminant auprès de participants âgés sains (n=15) et de patients atteints de Parkinson (PD, n=15). Ces métriques ont également démontré une bonne sensibilité au changement, permettant l’identification des différents états de médication des participants PD. Conclusion : Les mesures d’orientation issues de CI ont leur place pour l’évaluation de la mobilité. Toutefois, la portée clinique réelle de ce type de système ne sera atteinte que lorsqu’il sera intégré et validé à même un outil de mesure clinique.Abstract : Inertial measurement of motion is emerging as an alternative to 3D motion capture systems in biomechanics. Inertial measurement units (IMUs) are composed of accelerometers, gyroscopes and magnetometers which data are fed into a fusion algorithm to determine the orientation of a rigid body in a global reference frame. Although IMUs offer advantages over traditional methods of motion capture, the value of their orientation measurement for biomechanics is not well documented. Objectives: (i) To characterize the validity of the orientation measurement issued from IMUs; (ii) To optimize the validity and the reliability of these measurements; and (iii) To propose mobility metrics based on the orientation measurement obtained from IMUs. Methods and results: The criterion of validity of multiple types of IMUs was characterized using a controlled bench test and a gold standard. Accuracy of orientation measurement was shown to be acceptable under slow conditions of motion (mean accuracy ≤ 3.1º), but it was also demonstrated that an increase in velocity worsens accuracy. The impact of those findings on clinical mobility evaluation was then assessed in the lab, with 20 participants wearing an inertial suit while performing typical mobility tasks (standing-up, walking, turning). Comparison of the assessed IMUs orientation measurements with those from an optical gold standard allowed to capture a portrait of the variation in accuracy across tasks, segments and joints. The optimization process was then approached from a user perspective, first demonstrating the capability of an artificial neural network to autonomously assess the quality of orientation data sequences (sensitivity and specificity ≥ 83%). The issue of joint orientation accuracy in magnetically perturbed environment was also specifically addressed, demonstrating the ability of a 2D photograph coupled with a 3D pose estimation algorithm to improve mean ankle orientation accuracy from 6.7° to 2.8º when walking (n=60 trials). Finally, characterization of the turn cranio-caudal kinematics signature (variables: maximum head to trunk angle and neuromuscular commands amplitude) has demonstrated a good ability to discriminate between healthy older adults (n=15) and early stages of Parkinson’s disease patients (PD, n=15). Metrics have also shown a good sensitivity to change, enabling to detect changes in PD medication states. Conclusion: IMUs offer a complementary solution for mobility assessment in clinical biomechanics. However, the full potential of this technology will only be reached when IMUs will be integrated and validated within a clinical tool

Estudio de la cinemática del miembro superior e inferior mediante sensores inerciales.

A través del conjunto de artículos recogidos en la presente Tesis se describe y analiza las variables relacionadas con el movimiento humano en distintas regiones corporales. Para el estudio del complejo articular del hombro, se eligió estudiar la abducción y flexión del hombro a través de los distintos segmentos corporales que lo conforman. Los dispositivos empleados para la medición de las variables cinemáticas fueron los sensores inerciales y el Smartphone. Por un lado, en el artículo I, se pudieron describir valores de referencia de movilidad en segmentos corporales y articulaciones en sujetos jóvenes sanos. En el artículo II, se pudieron observar diferencias entre sujetos sanos de distinto rango etario. Posteriormente el artículo III, con los sensores inerciales se pudo establecer diferencias cinemáticas entre sujetos asintomáticos y aquellos que presentan patología del hombro. En línea con el Smartphone, en el Artículo IV se obtuvieron valores descriptivos de la cinemática del húmero con el sensor embebido en un Smartphone. En el Artículo V, se validó una aplicación basada en imagen para medir el ángulo de abducción del brazo en sujetos sanos y patológicos, mostrando ser válida y fiable. La funcionalidad del complejo lumbo-pélvico-femoral se estudió a través de la prueba o Test “Sit-to-Stand” (STS), que representa el movimiento de levantarse de una silla. En el artículo VI, se profundizó en la actividad muscular y la fatiga durante la prueba STS a través de distintas variantes del test. Los resultados de este estudio permitieron establecer valores de referencia en sujetos sanos y analizar cómo varían las variables electromiográficas cuando se modifican las características de STS. Se demostró que la velocidad modifica la actividad muscular, y que se produce más fatiga a mayor número de repeticiones y velocidad. Por tanto, posteriormente los estudios se centraron en la variante más exigente de este test: 30-STS, levantarse tan rápido como sea posible el mayor número de veces durante 30 segundos. En el artículo VII, se buscó correlacionar la fatiga medida con electromiografía con la fatiga a través de la cinemática medida en el tronco con un Smartphone, no habiendo una correlación evidente. Posteriormente, en el artículo VIII, se decidió analizar la fatiga durante la prueba 30-STS a través de la aceleración como única variable proporcionada por un Smartphone situado en el esternón. Para ello, se analizaron esta vez los datos de aceleración, encontrándose un aumento del porcentaje de energía en el segundo 19 del test. Por tanto, de los resultados obtenidos en los estudios sobre el complejo articular del hombro y el complejo lumbopélvico-femoral en la presente Tesis se puede resumir que la cinemática del movimiento humano a través de variables inerciales ofrece al fisioterapeuta una potente herramienta aplicable al ámbito de evaluativo, diagnóstico y de tratamiento transferibles a la clínica a través de dispositivos de bajo coste como el Smartphone y, que, en conjunto con otras herramientas tales como cuestionarios auto-informados y electromiografía, permite abarcar más dimensiones dentro de la complejidad del movimiento humano

Prevention and Management of Frailty

It is important to prevent and manage the frailty of the elderly because their muscle strength and physical activity decrease in old age, making them prone to falling, depression, and social isolation. In the end, they need to be admitted to a hospital or a nursing home. When successful aging fails and motor ability declines due to illness, malnutrition, or reduced activity, frailty eventually occurs. Once frailty occurs, people with frailty do not have the power to exercise or the power to move. The functions of the heart and muscles are deteriorated more rapidly when they are not used. Consequently, frailty goes through a vicious cycle. As one’s physical fitness is deteriorated, the person has less power to exercise, poorer cognitive functions, and inferior nutrition intake. Consequently, the whole body of the person deteriorates. Therefore, in addition to observational studies to identify risk factors for preventing aging, various intervention studies have been conducted to develop exercise programs and apply them to communities, hospitals, and nursing homes for helping the elderly maintain healthy lives. Until now, most aging studies have focused on physical frailty. However, social frailty and cognitive frailty affect senile health negatively just as much as physical frailty. Nevertheless, little is known about social frailty and cognitive frailty. This special issue includes original experimental studies, reviews, systematic reviews, and meta-analysis studies on the prevention of senescence (physical senescence, cognitive senescence, social senescence), high-risk group detection, differentiation, and intervention

Smart Sensors for Healthcare and Medical Applications

This book focuses on new sensing technologies, measurement techniques, and their applications in medicine and healthcare. Specifically, the book briefly describes the potential of smart sensors in the aforementioned applications, collecting 24 articles selected and published in the Special Issue “Smart Sensors for Healthcare and Medical Applications”. We proposed this topic, being aware of the pivotal role that smart sensors can play in the improvement of healthcare services in both acute and chronic conditions as well as in prevention for a healthy life and active aging. The articles selected in this book cover a variety of topics related to the design, validation, and application of smart sensors to healthcare

Instrumented shoes for daily activity monitoring in healthy and at risk populations

Daily activity reflects the health status of an individual. Ageing and disease drastically affect all dimensions of mobility, from the number of active bouts to their duration and intensity. Performing less activity leads to muscle deterioration and further weakness that could lead to increased fall risk. Gait performance is also affected by ageing and could be detrimental for daily mobility. Therefore, activity monitoring in older adults and at risk persons is crucial to obtain relevant quantitative information about daily life performance. Activity evaluation has mainly been established through questionnaires or daily logs. These methods are simple but not sufficiently accurate and are prone to errors. With the advent of microelectromechanical systems (MEMS), the availability of wearable sensors has shifted activity analysis towards ambulatory monitoring. In particular, inertial measurement units consisting of accelerometers and gyroscopes have shown to be extremely relevant for characterizing human movement. However, monitoring daily activity requires comfortable and easy to use systems that are strategically placed on the body or integrated in clothing to avoid movement hindrance. Several research based systems have employed multiple sensors placed at different locations, capable of recognizing activity types with high accuracy, but not comfortable for daily use. Single sensor systems have also been used but revealed inaccuracies in activity recognition. To this end, we propose an instrumented shoe system consisting of an inertial measurement unit and a pressure sensing insole with all the sensors placed at the shoe/foot level. By measuring the foot movement and loading, the recognition of locomotion and load bearing activities would be appropriate for activity classification. Furthermore, inertial measurement units placed on the foot can perform detailed gait analysis, providing the possibility of characterizing locomotion. The system and dedicated activity classification algorithms were first designed, tested and validated during the first part of the thesis. Their application to clinical rehabilitation of at risk persons was demonstrated over the second part. In the first part of the thesis, the designed instrumented shoes system was tested in standardized conditions with healthy elderly subjects performing a sequence of structured activities. An algorithm based on movement biomechanics was built to identify each activity, namely sitting, standing, level walking, stairs, ramps, and elevators. The rich array of sensors present in the system included a 3D accelerometer, 3D gyroscope, 8 force sensors, and a barometer allowing the algorithm to reach a high accuracy in classifying different activity types. The tuning parameters of the algorithm were shown to be robust to small changes, demonstrating the suitability of the algorithm to activity classification in older adults. Next, the system was tested in daily life conditions on the same elderly participants. Using a wearable reference system, the concurrent validity of the instrumented shoes in classifying daily activity was shown. Additionally, daily gait metrics were obtained and compared to the literature. Further insight into the relationship between some gait parameters as well as a global activity metric, the activity âcomplexityâ, was discussed. Participants positively rated their comfort while using the system... (Please refer to thesis for full abstract

Desenvolvimento de protótipo de produto para testes de resistência, força e agilidade com aplicação no domínio da fisioterapia

Mestrado de dupla diplomação com a UTFPR - Universidade Tecnológica Federal do ParanáA utilização de testes de mobilidade, resistência e força em tratamentos fisioterapêu-ticos traz uma melhoria contínua das condições de mobilidade e força dos indivíduos. A correta execução destes testes e análise de seus resultados podem ser primordiais na recuperação de pacientes, para isso é necessário que se faça uso de equipamentos certi-ficados, calibrados e adequados. Esses testes podem ser realizados com um sistema de cadeira instrumentada, o Instituto Politécnico de Bragança possui um protótipoo da ca-deira instrumentada. O conceito de cadeira instrumentada varia de acordo com os tipos de testes que a mesma realiza, para esse trabalho a cadeira instrumentada realiza testes de mobilidade, força e resistência e tem o auxílio de sensores além de software para armazenamento de dados. A partir do exposto o objetivo desse trabalho é desenvolver o protótipo em estudo como produto de consumo com aplicação na fisioterapia. Foi reali-zada uma revisão sistemática na literatura sobre como esses testes são realizados, bem como os públicos-alvo e sua evolução. Além de propor melhorias mecânicas, visuais e ergonômicas ao sistema existente de cadeira instrumentada que é foco de uma análise SWOT realizada. A análise SWOT foi desenvolvida com base em pesquisa de opinião realizada através de um questionário, visando comparação com sistemas similares do mercado e a viabilidade do protótipo em estudo tornar-se produto de consumo. Com o levantamento bibliográfico, a realização da pesquisa de opinião e a análise SWOT, me-lhorias foram propostas para o protótipo. Conclui-se que as tecnologias, como sensores, são benéficas para a qualidade dos resultados dos testes, mas nem todas as alterações contribuem para o protótipo tornar-se produto de consumo.The use of mobility, resistance and strength tests in physiotherapy treatments brings a continuous improvement of the conditions of mobility and strength of the individuals. The correct execution of these tests and analysis of their results can be paramount in the recovery of patients, for this, it is necessary to make use of certified, calibrated and ade-quate equipment. These tests can be performed with an instrumented chair system, the Polytechnic Institute of Bragança has a prototype of the instrumented chair. The concept of instrumented chair varies according to the type of tests that it performs, for this work the instrumented chair performs tests of mobility, strength and resistance and has the aid of sensors as well as software for data storage. From the above, the objective of this work is to develop the prototype under study as a consumer product with application in physiotherapy. A systematic review was carried in the literature on how these tests are performed, as well as the target audiences and their evolution. In addition to propose mechanical, visual and ergonomic improvements to the existing system of instrumented chair that is the focus of SWOT analysis. The SWOT analysis was developed based on an opinion survey conducted through a questionnaire, aiming to compare with similar market systems and the possibility of the prototype under study becomes consumer product. With the bibliographical survey, the survey of opinion and the SWOT analysis, improvements were proposed for the prototype. It was concluded that technologies, such as sensors, are benefical to the quality of test results, but not all changes contribute to the prototype become a consumer product