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

Wearables for independent living in older adults: Gait and falls

Solutions are needed to satisfy care demands of older adults to live independently. Wearable technology (wearables) is one approach that offers a viable means for ubiquitous, sustainable and scalable monitoring of the health of older adults in habitual free-living environments. Gait has been presented as a relevant (bio)marker in ageing and pathological studies, with objective assessment achievable by inertial-based wearables. Commercial wearables have struggled to provide accurate analytics and have been limited by non-clinically oriented gait outcomes. Moreover, some research-grade wearables also fail to provide transparent functionality due to limitations in proprietary software. Innovation within this field is often sporadic, with large heterogeneity of wearable types and algorithms for gait outcomes leading to a lack of pragmatic use. This review provides a summary of the recent literature on gait assessment through the use of wearables, focusing on the need for an algorithm fusion approach to measurement, culminating in the ability to better detect and classify falls. A brief presentation of wearables in one pathological group is presented, identifying appropriate work for researchers in other cohorts to utilise. Suggestions for how this domain needs to progress are also summarised

IMUs: validation, gait analysis and system’s implementation

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Eletrónica Médica)Falls are a prevalent problem in actual society. The number of falls has been increasing greatly in the last fifteen years. Some falls result in injuries and the cost associated with their treatment is high. However, this is a complex problem that requires several steps in order to be tackled. Namely, it is crucial to develop strategies that recognize the mode of locomotion, indicating the state of the subject in various situations, namely normal gait, step before fall (pre-fall) and fall situation. Thus, this thesis aims to develop a strategy capable of identifying these situations based on a wearable system that collects information and analyses the human gait. The strategy consists, essentially, in the construction and use of Associative Skill Memories (ASMs) as tools for recognizing the locomotion modes. Consequently, at an early stage, the capabilities of the ASMs for the different modes of locomotion were studied. Then, a classifier was developed based on a set of ASMs. Posteriorly, a neural network classifier based on deep learning was used to classify, in a similar way, the same modes of locomotion. Deep learning is a technique actually widely used in data classification. These classifiers were implemented and compared, providing for a tool with a good accuracy in recognizing the modes of locomotion. In order to implement this strategy, it was previously necessary to carry out extremely important support work. An inertial measurement units’ (IMUs) system was chosen due to its extreme potential to monitor outpatient activities in the home environment. This system, which combines inertial and magnetic sensors and is able to perform the monitoring of gait parameters in real time, was validated and calibrated. Posteriorly, this system was used to collect data from healthy subjects that mimicked Fs. Results have shown that the accuracy of the classifiers was quite acceptable, and the neural networks based classifier presented the best results with 92.71% of accuracy. As future work, it is proposed to apply these strategies in real time in order to avoid the occurrence of falls.As quedas são um problema predominante na sociedade atual. O número de quedas tem aumentado bastante nos últimos quinze anos. Algumas quedas resultam em lesões e o custo associado ao seu tratamento é alto. No entanto, trata-se de um problema complexo que requer várias etapas a serem abordadas. Ou seja, é crucial desenvolver estratégias que reconheçam o modo de locomoção, indicando o estado do sujeito em várias situações, nomeadamente, marcha normal, passo antes da queda (pré-queda) e situação de queda. Assim, esta tese tem como objetivo desenvolver uma estratégia capaz de identificar essas situações com base num sistema wearable que colete informações e analise a marcha humana. A estratégia consiste, essencialmente, na construção e utilização de Associative Skill Memories (ASMs) como ferramenta para reconhecimento dos modos de locomoção. Consequentemente, numa fase inicial, foram estudadas as capacidades das ASMs para os diferentes modos de locomoção. Depois, foi desenvolvido um classificador baseado em ASMs. Posteriormente, um classificador de redes neuronais baseado em deep learning foi utilizado para classificar, de forma semelhante, os mesmos modos de locomoção. Deep learning é uma técnica bastante utilizada em classificação de dados. Estes classificadores foram implementados e comparados, fornecendo a uma ferramenta com uma boa precisão no reconhecimento dos modos de locomoção. Para implementar esta estratégia, era necessário realizar previamente um trabalho de suporte extremamente importante. Um sistema de unidades de medição inercial (IMUs), foi escolhido devido ao seu potencial extremo para monitorizar as atividades ambulatórias no ambiente domiciliar. Este sistema que combina sensores inerciais e magnéticos e é capaz de efetuar a monitorização de parâmetros da marcha em tempo real, foi validado e calibrado. Posteriormente, este Sistema foi usado para adquirir dados da marcha de indivíduos saudáveis que imitiram quedas. Os resultados mostraram que a precisão dos classificadores foi bastante aceitável e o classificador baseado em redes neuronais apresentou os melhores resultados com 92.71% de precisão. Como trabalho futuro, propõe-se a aplicação destas estratégias em tempo real de forma a evitar a ocorrência de quedas

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

Wearables for Movement Analysis in Healthcare

Quantitative movement analysis is widely used in clinical practice and research to investigate movement disorders objectively and in a complete way. Conventionally, body segment kinematic and kinetic parameters are measured in gait laboratories using marker-based optoelectronic systems, force plates, and electromyographic systems. Although movement analyses are considered accurate, the availability of specific laboratories, high costs, and dependency on trained users sometimes limit its use in clinical practice. A variety of compact wearable sensors are available today and have allowed researchers and clinicians to pursue applications in which individuals are monitored in their homes and in community settings within different fields of study, such movement analysis. Wearable sensors may thus contribute to the implementation of quantitative movement analyses even during out-patient use to reduce evaluation times and to provide objective, quantifiable data on the patients’ capabilities, unobtrusively and continuously, for clinical purposes

Human gait modelling with step estimation and phase classification utilising a single thigh mounted IMU for vision impaired indoor navigation

This research is focused on human gait modelling for infrastructure free inertial navigation for vision impaired. A pedometer based on a single thigh mounted gyroscope, an efficient algorithm to estimate thigh flexion and extension, gait models for level walking, a model to estimate step length and a technique to detect gait phases based on a single thigh mounted Inertial Measurement Unit (IMU) were developed and confirmed higher accuracies

Wearable Technology Supported Home Rehabilitation Services in Rural Areas:– Emphasis on Monitoring Structures and Activities of Functional Capacity Handbook

The sustainability of modern healthcare systems is under threat. – the ageing of the population, the prevalence of chronic disease and a need to focus on wellness and preventative health management, in parallel with the treatment of disease, pose significant social and economic challenges. The current economic situation has made these issues more acute. Across Europe, healthcare expenditure is expected to rice to almost 16% of GDP by 2020. (OECD Health Statistics 2018). Coupled with a shortage of qualified personnel, European nations are facing increasing challenges in their ability to provide better-integrated and sustainable health and social services. The focus is currently shifting from treatment in a care center to prevention and health promotion outside the care institute. Improvements in technology offers one solution to innovate health care and meet demand at a low cost. New technology has the potential to decrease the need for hospitals and health stations (Lankila et al., 2016. In the future the use of new technologies – including health technologies, sensor technologies, digital media, mobile technology etc. - and digital services will dramatically increase interaction between healthcare personnel and customers (Deloitte Center for Health Solutions, 2015a; Deloitte Center for Health Solutions 2015b). Introduction of technology is expected to drive a change in healthcare delivery models and the relationship between patients and healthcare providers. Applications of wearable sensors are the most promising technology to aid health and social care providers deliver safe, more efficient and cost-effective care as well as improving people’s ability to self-manage their health and wellbeing, alert healthcare professionals to changes in their condition and support adherence to prescribed interventions. (Tedesco et al., 2017; Majumder et al., 2017). While it is true that wearable technology can change how healthcare is monitored and delivered, it is necessary to consider a few things when working towards the successful implementation of this new shift in health care. It raises challenges for the healthcare systems in how to implement these new technologies, and how the growing amount of information in clinical practice, integrates into the clinical workflows of healthcare providers. Future challenges for healthcare include how to use the developing technology in a way that will bring added value to healthcare professionals, healthcare organizations and patients without increasing the workload and cost of the healthcare services. For wearable technology developers, the challenge will be to develop solutions that can be easily integrated and used by healthcare professionals considering the existing constraints. This handbook summarizes key findings from clinical and laboratory-controlled demonstrator trials regarding wearables to assist rehabilitation professionals, who are planning the use of wearable sensors in rehabilitation processes. The handbook can also be used by those developing wearable sensor systems for clinical work and especially for use in hometype environments with specific emphasis on elderly patients, who are our major health care consumers