Automated detection of near falls: algorithm development and preliminary results

<p>Abstract</p> <p>Background</p> <p>Falls are a major source of morbidity and mortality among older adults. Unfortunately, self-report is, to a large degree, the gold-standard method for characterizing and quantifying fall frequency. A number of studies have demonstrated that near falls predict falls and that near falls may occur more frequently than falls. These studies suggest that near falls might be an appropriate fall risk measure. However, to date, such investigations have also relied on self-report. The purpose of the present study was to develop a method for automatic detection of near falls, potentially a sensitive, objectivemarker of fall risk and to demonstrate the ability to detect near falls using this approach.</p> <p>Findings</p> <p>15 healthy subjects wore a tri-axial accelerometer on the pelvis as they walked on a treadmill under different conditions. Near falls were induced by placing obstacles on the treadmill and were defined using observational analysis. Acceleration-derived parameters were examined as potential indicators of near falls, alone and in various combinations. 21 near falls were observed and compared to 668 "non-near falls" segments, consisting of normal and abnormal (but not near falls) gait. The best single method was based on the maximum peak-to-peak vertical acceleration derivative, with detection rates better than 85% sensitivity and specificity.</p> <p>Conclusions</p> <p>These findings suggest that tri-axial accelerometers may be used to successfully distinguish near falls from other gait patterns observed in the gait laboratory and may have the potential for improving the objective evaluation of fall risk, perhaps both in the lab and in at home-settings.</p

Design and Implementation of an Instrumented Cane for Gait Recognition

Independent mobility is an important aspect of an individual's life and must sometimes be augmented by use of an assistive device such as a wheeled walker or cane following a fall, injury, or functional decline. Physical therapists perform functional gait assessments to gauge the probability of an individual experiencing a fall and often recommend use of a walker, cane, or walking stick to decrease fall risk. Our team has developed a clinical assessment tool centered on a standard walking cane embedded system that can enhance a therapist's observation-based gait assessment with use of additional objective and quantitative data. This system can be utilized to detect timing and speed of cane placement, angular acceleration of the cane, and amounts of weight borne on the cane. This system is designed to assist physical therapists at the basic level in collection of objective data during gait analysis, to facilitate appropriate assistive gait device prescription, to provide patients and therapists feedback during gait training, and to reduce wrist and shoulder injuries with cane usage. However, more importantly, using the plethora of objective data that can be obtained from this cane, automated gait analysis and gait pattern classification can be performed to understand a patient's walking performance

A smartphone-based online system for fall detection with alert notifications and contextual information of real-life falls

This article presents the results of a prospective study investigating a proof-of-concept, smartphone-based, online system for fall detection and notification. Apart from functioning as a practical fall monitoring instrument, this system may serve as a valuable research tool, enable future studies to scale their ability to capture fall-related data, and help researchers and clinicians to investigate real-falls

First advances in near fall detection and prediction when using a walker

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Eletrónica Médica)Falls are a major concern to society. Several injuries associated with falls need medical care, and in the worst-case scenario, a fall can lead to death. These consequences have a high cost for the population. In order to overcome these problems, a diversity of approaches for detection, prediction, and prevention of falls have been tackled. Walkers are often prescribed to subjects who present a higher risk of falling. Thus, it is essential to develop strategies to enhance the user's safety in an imminent danger situation. In this sense, this dissertation aims to develop a strategy to detect a near fall (NF) and its direction as well as the detection of incipient near fall (INF) while the subject uses a walker. Furthermore, it has the purpose of detecting two gait events, the heel strike (HS) and the toe-off (TO). The strategies established, in this work, were based on the data gathered through an inertial sensor placed on the lower trunk and force sensors placed on the insoles. Following data collection, the methodology adopted to identify the situations aforementioned was based on machine learning algorithms. In order to reach the model with best performance, many combinations of different classifiers were tested with three feature selection methods. Regarding the detection of NF, the results achieved presented a Matthews Correlation Coefficient (MCC) of 79.99% being possible to detect a NF 1.76±0.76s before its end. With the implementation of the post-processing algorithm, a large part of the false positives was eliminated being able to detect all NF 1.48±0.68s before its end. Concerning the models built to distinguish the direction of the NF, the best model presented accuracy of 58.97% being unable to reliably distinguish the three fall directions. The methodology followed, in this work, was unsuccessful to detect an INF. The best model presented MCC=23.87%, in this case. Lastly, with respect to the detection of HS and TO events the best model reached MCC=86.94%. With the application of the post-processing algorithm, part of misclassified samples was eliminated, however, a delay in the detection of the HS and TO events was introduced. With the post-processing it was possible to reach MCC=88.82%, not including the imposed delay.As quedas representam uma grande preocupação para a sociedade. Várias lesões associadas às quedas necessitam de cuidados médicos e, no pior dos casos, uma queda pode levar à morte. Estas consequências traduzem-se em custos elevados para a população. A fim de ultrapassar estes problemas, várias abordagens têm sido endereçadas para deteção, previsão e prevenção das quedas. Os andarilhos são muitas vezes prescritos a sujeitos que apresentam um risco de queda maior. Desta forma, é essencial desenvolver estratégias para aumentar a segurança do utilizador perante uma situação de perigo iminente. Neste sentido, esta dissertação visa desenvolver uma estratégia que permita a deteção de uma quase queda (NF) e a sua direção, assim como a deteção incipiente de uma NF (INF). Para além disso, tem o objetivo de detetar dois eventos de marcha, o heel strike (HS) e o toe-off (TO). As estratégias definidas, neste trabalho, basearam-se nos dados recolhidos através de um sensor inercial posicionado no tronco inferior e de sensores de força colocados nas palmilhas. Após a aquisição dos dados, a metodologia adotada para identificar as situações anteriormente referidas foi baseada em algoritmos de machine learning. Com o intuito de obter o modelo com melhor desempenho, várias combinações de diferentes classificadores foram testadas com três métodos de seleção de features. No que concerne à deteção da NF, os resultados alcançados apresentaram um Matthews Correlation Coefficient (MCC) de 79.99% sendo possível detetar uma NF 1.76±0.76s antes do seu final. Com a implementação do algoritmo de pós-processamento, grande parte dos falsos positivos foram eliminados, sendo possível detetar todas as NF 1.48±0.68s antes do seu final. Em relação aos modelos construídos para distinguir a direção da NF, o melhor modelo apresentou uma precisão (ACC) de 59.97%. A metodologia seguida neste trabalho não foi bem sucedida na deteção INF. O melhor modelo apresentou um MCC=23.87%. Relativamente à deteção dos eventos, HS e TO, o melhor modelo atingiu um MCC=86.94%. Com a aplicação do algoritmo de pós-processamento parte das amostras mal classificadas foram eliminadas, no entanto, foi introduzido um atraso na deteção do HS e do TO. Com o pós-processamento foi possível obter um MCC=88.82%, não incluindo o atraso imposto pelo pós-processamento

Seizure Detection, Seizure Prediction, and Closed-Loop Warning Systems in Epilepsy

Nearly one-third of patients with epilepsy continue to have seizures despite optimal medication management. Systems employed to detect seizures may have the potential to improve outcomes in these patients by allowing more tailored therapies and might, additionally, have a role in accident and SUDEP prevention. Automated seizure detection and prediction require algorithms which employ feature computation and subsequent classification. Over the last few decades, methods have been developed to detect seizures utilizing scalp and intracranial EEG, electrocardiography, accelerometry and motion sensors, electrodermal activity, and audio/video captures. To date, it is unclear which combination of detection technologies yields the best results, and approaches may ultimately need to be individualized. This review presents an overview of seizure detection and related prediction methods and discusses their potential uses in closed-loop warning systems in epilepsy

A 'one-size-fits-most' walking recognition method for smartphones, smartwatches, and wearable accelerometers

The ubiquity of personal digital devices offers unprecedented opportunities to study human behavior. Current state-of-the-art methods quantify physical activity using 'activity counts,' a measure which overlooks specific types of physical activities. We proposed a walking recognition method for sub-second tri-axial accelerometer data, in which activity classification is based on the inherent features of walking: intensity, periodicity, and duration. We validated our method against 20 publicly available, annotated datasets on walking activity data collected at various body locations (thigh, waist, chest, arm, wrist). We demonstrated that our method can estimate walking periods with high sensitivity and specificity: average sensitivity ranged between 0.92 and 0.97 across various body locations, and average specificity for common daily activities was typically above 0.95. We also assessed the method's algorithmic fairness to demographic and anthropometric variables and measurement contexts (body location, environment). Finally, we have released our method as open-source software in MATLAB and Python.Comment: 39 pages, 4 figures (incl. 1 supplementary), and 5 tables (incl. 2 supplementary

Wearable Inertial Sensors to Assess Standing Balance: A Systematic Review

Wearable sensors are de facto revolutionizing the assessment of standing balance. The aim of this work is to review the state-of-the-art literature that adopts this new posturographic paradigm, i.e., to analyse human postural sway through inertial sensors directly worn on the subject body. After a systematic search on PubMed and Scopus databases, two raters evaluated the quality of 73 full-text articles, selecting 47 high-quality contributions. A good inter-rater reliability was obtained (Cohen’s kappa = 0.79). This selection of papers was used to summarize the available knowledge on the types of sensors used and their positioning, the data acquisition protocols and the main applications in this field (e.g., “active aging”, biofeedback-based rehabilitation for fall prevention, and the management of Parkinson’s disease and other balance-related pathologies), as well as the most adopted outcome measures. A critical discussion on the validation of wearable systems against gold standards is also presented

An analytical comparison of datasets of Real-World and simulated falls intended for the evaluation of wearable fall alerting systems

Automatic fall detection is one of the most promising applications of wearables in the field of mobile health. The characterization of the effectiveness of wearable fall detectors is hampered by the inherent difficulty of testing these devices with real-world falls. In fact, practically all the proposals in the literature assess the detection algorithms with ‘scripted’ falls that are simulated in a controlled laboratory environment by a group of volunteers (normally young and healthy participants). Aiming at appraising the adequacy of this method, this work systematically compares the statistical characteristics of the acceleration signals from two databases with real falls and those computed from the simulated falls provided by 18 well-known repositories commonly employed by the related works. The results show noteworthy differences between the dynamics of emulated and real-life falls, which undermines the testing procedures followed to date and forces to rethink the strategies for evaluating wearable fall detectors.Funding for open access charge: Universidad de Málaga / CBUA. This research was funded by FEDER Funds (under grant UMA18-FEDERJA-022), Andalusian Regional Government (-Junta de Andalucía- grant PAIDI P18-RT-1652) and Universidad de Málaga, Campus de Excelencia Internacional Andalucia Tech

Exploring outcome measures for adults with myotonic dystrophy type 1

PhD ThesisMyotonic Dystrophy type 1 (DM1) is a multisystem progressive disorder with high heterogeneity. Novel emerging therapies require assessment tools that can effectively assess the effects of an intervention. The Outcome Measures in 5 Myotonic Dystrophy (OMMYD) Consortium has proposed a battery of functional outcome measures (FOM) identified as relevant for clinical trials in DM1. However, due to the variable nature of the disease and a scarcity of resources, there is a lack of systematic research that properly explores the use of these FOM. The current study examined three of these FOM and one extra related to 10 patients’ daily life performance. These are: (1) the ten-meters walk test; (2) the ten-meters walk/run test; (3) the 30-seconds sit and stand test; and, (4) a tri-axial accelerometer. By exploring the reliability, validity and responsiveness of these outcomes, we aimed to establish reference values and standard methodologies that could serve as guidance for clinical trials in DM1. A cohort of DM1 adults 15 screened for the two largest-to-date trials in DM1 (OPTIMSITIC and PHENO-DM1) were examined in relation to a set of pre-specified assessments and disease-burden scores. The results of this thesis supply disease-specific evidence of their validity, reliability and feasibility. The FOM, have shown to be psychometrically robust measures of functionality in DM1 and to be feasible for 20 clinical trials; they can provide a picture of patients’ muscle strength and perceived mobility and participation in life. The accelerometer can objectively quantify joints accelerations when walking at different speeds and summarise a DM1 patient’s habitual physical activity. The final choice of an outcome measure for a clinical trial in DM1 should be guided by disease domain that an intervention 25 is likely to impact on; but, a disease-specific study like this one will reduce the burden of protocol design whilst providing evidence supporting the decision-making process.the Medical Research Council Centre for Neuromuscular Diseases, Consejo Nacional de Ciencia y Tecnologia of Mexico and the Barbour Foundation.

Automated detection of missteps during community ambulation in patients with Parkinson’s disease: a new approach for quantifying fall risk in the community setting

Background: Falls are a leading cause of morbidity and mortality among older adults and patients with neurological disease like Parkinson’s disease (PD). Self-report of missteps, also referred to as near falls, has been related to fall risk in patients with PD. We developed an objective tool for detecting missteps under real-world, daily life conditions to enhance the evaluation of fall risk and applied this new method to 3 day continuous recordings. Methods: 40 patients with PD (mean age ± SD: 62.2 ± 10.0 yrs, disease duration: 5.3 ± 3.5 yrs) wore a small device that contained accelerometers and gyroscopes on the lower back while participating in a protocol designed to provoke missteps in the laboratory. Afterwards, the subjects wore the sensor for 3 days as they carried out their routine activities of daily living. An algorithm designed to automatically identify missteps was developed based on the laboratory data and was validated on the 3 days recordings. Results: In the laboratory, we recorded 29 missteps and more than 60 hours of data. When applied to this dataset, the algorithm achieved a 93.1% hit ratio and 98.6% specificity. When we applied this algorithm to the 3 days recordings, patients who reported two falls or more in the 6 months prior to the study (i.e., fallers) were significantly more likely to have a detected misstep during the 3 day recordings (p = 0.010) compared to the non-fallers. Conclusions: These findings suggest that this novel approach can be applied to detect missteps during daily life among patients with PD and will likely help in the longitudinal assessment of disease progression and fall risk