Techniques for measuring weight bearing during standing and walking

OBJECTIVE: To classify and assess techniques for measuring the amount of weight bearing during standing and walking.BACKGROUND: A large variety of weight bearing measuring techniques exists. This review describes their advantages and limitations to assist clinicians and researchers in selecting a technique for their specific application in measuring weight bearing.METHODS: A literature search was performed in Pubmed-Medline, CINAHL, and EMBASE. Measurement techniques were classified in 'clinical examination', 'scales', 'biofeedback systems', 'ambulatory devices' and 'platforms', and assessed on aspects of methodological quality, application, and feasibility.RESULTS: A total of 68 related articles was evaluated. The clinical examination technique is a crude method to estimate the amount of weight bearing. Scales are useful for static measurements to evaluate symmetry in weight bearing. Biofeedback systems give more reliable, accurate and objective data on weight bearing compared to clinical examination and scales, but the high costs could limit their use in physical therapy departments. The ambulatory devices can measure weight bearing with good accuracy and reliability in the hospital and at home. Platforms have the best methodological quality, but are mostly restricted to a gait laboratory, need trained personnel, and are expensive.CONCLUSIONS: The choice of a technique largely depends upon the criteria discussed in this review; however the clinical utilisation, the research question posed, and the available budget also play a role. The new developments seen in the field of 'ambulatory devices' are aimed at extending measuring time, and improved practicality in data collection and data analysis. For these latter devices, however, mainly preliminary studies have been published about devices that are not (yet) commercially available.</p

Commercially available pressure sensors for sport and health applications: A comparative review

Pressure measurement systems have numerous applications in healthcare and sport. The purpose of this review is to: (a) describe the brief history of the development of pressure sensors for clinical and sport applications, (b) discuss the design requirements for pressure measurement systems for different applications, (c) critique the suitability, reliability, and validity of commercial pressure measurement systems, and (d) suggest future directions for the development of pressure measurements systems in this area. Commercial pressure measurement systems generally use capacitive or resistive sensors, and typically capacitive sensors have been reported to be more valid and reliable than resistive sensors for prolonged use. It is important to acknowledge, however, that the selection of sensors is contingent upon the specific application requirements. Recent improvements in sensor and wireless technology and computational power have resulted in systems that have higher sensor density and sampling frequency with improved usability – thinner, lighter platforms, some of which are wireless, and reduced the obtrusiveness of in-shoe systems due to wireless data transmission and smaller data-logger and control units. Future developments of pressure sensors should focus on the design of systems that can measure or accurately predict shear stresses in conjunction with pressure, as it is thought the combination of both contributes to the development of pressure ulcers and diabetic plantar ulcers. The focus for the development of in-shoe pressure measurement systems is to minimise any potential interference to the patient or athlete, and to reduce power consumption of the wireless systems to improve the battery life, so these systems can be used to monitor daily activity. A potential solution to reduce the obtrusiveness of in-shoe systems include thin flexible pressure sensors which can be incorporated into socks. Although some experimental systems are available further work is needed to improve their validity and reliability

Wearable Sensors and Smart Devices to Monitor Rehabilitation Parameters and Sports Performance: An Overview

A quantitative evaluation of kinetic parameters, the joint’s range of motion, heart rate, and breathing rate, can be employed in sports performance tracking and rehabilitation monitoring following injuries or surgical operations. However, many of the current detection systems are expensive and designed for clinical use, requiring the presence of a physician and medical staff to assist users in the device’s positioning and measurements. The goal of wearable sensors is to overcome the limitations of current devices, enabling the acquisition of a user’s vital signs directly from the body in an accurate and non–invasive way. In sports activities, wearable sensors allow athletes to monitor performance and body movements objectively, going beyond the coach’s subjective evaluation limits. The main goal of this review paper is to provide a comprehensive overview of wearable technologies and sensing systems to detect and monitor the physiological parameters of patients during post–operative rehabilitation and athletes’ training, and to present evidence that supports the efficacy of this technology for healthcare applications. First, a classification of the human physiological parameters acquired from the human body by sensors attached to sensitive skin locations or worn as a part of garments is introduced, carrying important feedback on the user’s health status. Then, a detailed description of the electromechanical transduction mechanisms allows a comparison of the technologies used in wearable applications to monitor sports and rehabilitation activities. This paves the way for an analysis of wearable technologies, providing a comprehensive comparison of the current state of the art of available sensors and systems. Comparative and statistical analyses are provided to point out useful insights for defining the best technologies and solutions for monitoring body movements. Lastly, the presented review is compared with similar ones reported in the literature to highlight its strengths and novelties

Partial Weight Bearing: Long-term monitoring of load in patients with a total hip arthroplasty during postoperative recovery

Partial weight bearing (PWB) is a central aspect within the postoperative physical therapy of orthopedic and trauma patients with pathologies of the lower extremity. Restriction in weight bearing of the operated leg during standing and walking is needed to avoid complications during the postoperative recovery. The task of the physical therapist (PT) is to instruct the patient how to unload the lower extremity during recovery, so that the patient can safely and independently perform activities of daily living. Restriction of the amount of load on the operated leg not only has to take place during the relatively short supervision periods with the PT, but also during the longer and, therefore, more relevant recovery periods without supervision during the hospital stay as well as after discharge. Although PWB is commonly used, few data are available on the assessment of actual load on the operated leg of the patient during activities of daily living. One reason for this could be the lack of valid and reliable portable instruments which can objectively measure the amount of weight bearing over a period of several hours. In this thesis the PWB performance of total hip patients with a trochanteric osteotomy is evaluated during their postoperative recovery. For this, a portable insole pressure system was adapted and validated to measure the vertical ground reaction force both in and outside the hospital setting

Controlling a robotic hip exoskeleton with noncontact capacitive sensors

For partial lower-limb exoskeletons, an accurate real-time estimation of the gait phase is paramount to provide timely and well-tailored assistance during gait. To this end, dedicated wearable sensors separate from the exoskeletons mechanical structure may be preferable because they are typically isolated from movement artifacts that often result from the transient dynamics of the physical human-robot interaction. Moreover, wearable sensors that do not require time-consuming calibration procedures are more easily acceptable by users. In this study a robotic hip orthosis was controlled using capacitive sensors placed in orthopedic cuffs on the shanks. The capacitive signals are zeroed after donning the cuffs and do not require any further calibration. The capacitive sensing-based controller was designed to perform online estimation of the gait cycle phase via adaptive oscillators, and to provide a phase-locked assistive torque. Two experimental activities were carried out to validate the effectiveness of the proposed control strategy. Experiments conducted with seven healthy subjects walking on a treadmill at different speeds demonstrated that the controller can estimate the gait phase with an average error of 4%, while also providing hip flexion assistance. Moreover, experiments carried out with four healthy subjects showed that the capacitive sensing-based controller could reduce the metabolic expenditure of subjects compared to the unassisted condition (mean ± SEM, -3.2% ± 1.1)