Wearable inertial sensors to measure gait and posture characteristic differences in older adult fallers and non-fallers: A scoping review

This is the final version. Available on open access from Elsevier via the DOI in this recordBackground Wearable inertial sensors have grown in popularity as a means of objectively assessing fall risk. This review aimed to identify gait and posture differences among older adult fallers and non-fallers which can be measured with the use of wearable inertial sensors. In addition to describing the number of sensors used to obtain measures, the concurrent anatomical locations, how these measures compare to current forms of clinical fall risk assessment tests and the setting of tests. Methods Following the development of a rigorous search strategy, MEDLINE, Web of Science, Cochrane, EMBASE, PEDro, and CINAHL were systematically searched for studies involving the use of wearable inertial sensors, to determine gait and postural based differences among fallers or those at high fall risk compared with non-fallers and low fall risk adults aged 60 years and older. Results Thirty five papers met the inclusion criteria. One hundred and forty nine gait and posture characteristic differences were identified using wearable inertial sensors. There were sensor derived measures which significantly and strongly correlated with traditional clinical tests. The use of a single wearable inertial sensor located at the lower posterior trunk, was most the most effective location and enough to ascertain multiple pertinent fall risk factors. Conclusion This review identified the capabilities of identifying fall risk factors among older adults with the use of wearable inertial sensors. The lightweight portable nature makes inertial sensors an effective tool to be implemented into clinical fall risk assessment and continuous unsupervised home monitoring, in addition to, outdoor testing.Engineering and Physical Sciences Research Council (EPSRC)National Institute for Health Research (NIHR

The use of wearable inertial measurement units to assess gait and balance outcomes related to fall risk among older adults

Due to the prevalence and associated health, social and economic costs of falls among older adults, this thesis originally aimed to identify a more robust and objective way of assessing fall risk factors with the use of wearable inertial measurement units (IMU). However, due to unforeseen circumstances, the direction of the thesis had to be changed. Therefore, the thesis aimed to investigate whether gait and balance outcomes related to fall risk, when measured with wearable IMUs are sensitive to conditions which may replicate clinical and habitual environments. In Study one, a systematic scoping review was conducted to identify characteristic differences between fallers and non-fallers with the use of IMUs. The lower trunk was the most common anatomical location, whilst walking a predetermined distance indoors was the most common test used with IMUs to distinguish between fallers and non-fallers. In Study two, seventeen older and seventeen younger adults performed multiple walking and standing tasks in a laboratory. Older adults had a lower root mean square of the IMU acceleration signal, harmonic ratio and greater step time asymmetry compared to younger adults. The use of a cognitive dual task caused gait to be slower and less symmetrical among older and younger adults. Trunk displacement to quantify trunk sway during quiet standing was greater among older adults and increased as standing conditions became more difficult. Older adults exhibited distinct differences in gait when walking indoors and outdoors. The results of Study two suggested that IMUs may identify differences between older and younger adults regarding walking speed and time to completion of clinical tests, even when a stopwatch could not. In Study three, twenty older and twenty younger adults had IMUs attached to different anatomical locations during waking hours. There were differences in all gait variables when walking supervised in the laboratory and unsupervised in habitual indoor environments for both older and younger adults. There were also large differences in gait variables when walking indoors and outdoors. These results suggest the need for future studies in continuous, outdoor and unsupervised free-living conditions, with regards to fall risk assessments. This thesis demonstrates that gait and balance outcomes related to fall risk, when measured using wearable IMUs, are sensitive to conditions resembling habitual and clinical environments among both older and younger adults. This could prove valuable for the enhancement of future fall risk research

Effects of Obesity and Fall Risk on Gait and Posture of Community-Dwelling Older Adults

Epidemiological studies link increased fall risk to obesity in older adults, but the mechanism through which obesity increases falls and fall risks is unknown. This study investigates if obesity (Body Mass Index: BMI\u3e30 kg/m2) influenced gait and standing postural characteristics of community dwelling older adults leading to increased risk of falls. One hundred healthy older adults (age 74.0±7.6 years, range of 56-90 years) living independently in a community participated in this study. Participants’ history of falls over the previous two years was recorded, with emphasis on frequency and characteristics of falls. Participants with at least two falls in the prior year were classified as fallers. Each individual was assessed for postural stability during quiet stance and gait stability during 10 meters walking. Fall risk parameters of postural sway (COP area, velocity, path-length) were measured utilizing a standard forceplate coupled with an accelerometer affixed at the sternum. Additionally, parameters of gait stability (walking velocity, double support time, and double support time variability) were assessed utilizing an accelerometer affixed at the participant’s sternum. Gait and postural stability analyses indicate that obese older adults who fell have significantly altered gait pattern (longer double support time and greater variability) exhibiting a loss of automaticity in walking and, postural instability as compared to their counterparts (i.e., higher sway area and path length, and higher sway velocity) further increasing the risk of a fall given a perturbation. Body weight/BMI is a risk factor for falls in older adults as measured by gait and postural stability parameters

The within-day and between-day reliability of using sacral accelerations to quantify balance performance.

OBJECTIVES: To investigate the between-day and within-day reliability of a sacral mounted accelerometer to quantify balance performance and different balance metrics. DESIGN: Experimental, cross-sectional. SETTING: Laboratorial experiment. PARTICIPANTS: Thirty healthy volunteers. MAIN OUTCOME MEASURES: Balance tasks were double leg stance, tandem stance and single leg stance with eyes open and closed. Performance was measured by converting accelerations into path length (PL, length of the sway trace), jerk (jerkiness of sway trace) and root mean square (RMS) of the accelerations. RESULTS: Within-day ICC for PL were excellent (mean 0.78 95%CI 0.68-0.89), with Jerk and RMS demonstrating means of 0.60 and 0.47, respectively. The mean percentage minimal detectable change (MDC) within-day were small for PL (mean 6.7%, 95%CI 5.3-8.1). Between-day ICC were good for PL (mean 0.61, 95%CI 0.50-0.71), but more varied for Jerk and RMS. The mean percentage MDC was small for PL (mean 6.1%, 95%CI 5.0-7.2). No significant differences were determined for measurements between-days for any metric or task. PL had the highest discriminatory value between the 8 tasks. CONCLUSIONS: The sacral mounted accelerometer reliably measured balance performance within- and between-days. The PL is the recommended metric as it was the most reliable, most discriminatory and most sensitive to change

Understanding the determinants of independent mobility in older adults

As aging occurs, safely maintaining an active lifestyle is critical for health and independence. Independent mobility is influenced by one’s ability to perform three essential tasks of daily living: transitioning from a seated to standing posture, maintaining upright stance and walking. In spite of the apparent similarities in the predictive utility of these different tasks, there are few studies that have explored the specific relationship between these tasks that define independent mobility within individuals to determine if they reflect unique challenges to control. The thesis focused on two studies to advance understanding of the determinants of independent mobility in older adults. Study 1 explored the association between measures of standing, transitions and walking in 28 older adults. An important element was the assessment using portable low-cost measurement technology (Wii force boards and wearable accelerometers) so that testing could be done in the community. The results of this study revealed the potential importance of sit-to-stand performance as an independent measure of function in older adults. One important outcome was the need for a more detailed measurement of the sit-to-stand task, which is characterized by different phases that have unique control challenges. As a result, Study 2 was designed to evaluate different measurements of the sit-to-stand phases in order to provide a measurement tool that could be used in community and clinical testing. Ground reaction forces were found capable of identifying the different sit-to-stand phases and therefore afford the ability to quantify this behavior using portable technology. Identifying the underlying control mechanisms and relationships between these mechanisms allows clinicians to prescribe targeted and potentially more effective interventions focused on behavior specific control challenges

The effects of prolonged wear of textured shoe insoles on gait, foot sensation and proprioception in people with Multiple Sclerosis: protocol for a randomised controlled trial

Background: Many people with multiple sclerosis experience problems with walking, which can make daily activities difficult and often leads to falls. Foot sensation plays an important role in keeping the body balanced whilst walking; however, people with multiple sclerosis often have poor sensation on the soles of their feet. Wearing a specially designed shoe insole, which enhances plantar sensory information, could help people with multiple sclerosis to walk better. This study will explore whether long-term wear of a textured insole can improve walking in people with multiple sclerosis

Walking stability in young, old and neuropathic subjects

This thesis investigates walking patterns in healthy young people and in people with an increased risk of falling, and determines the physiological contributions to walking stability. First, a review of the relevant literature on techniques for assessing walking stability, age-related changes in balance and gait, and the contributions of vision, vestibular function, peripheral sensation and strength was undertaken. In response to a critical analysis of these findings, a new technique and protocol for the assessment of walking stability was developed. This involved measuring and analysing head and pelvis accelerations while subjects walked on a level surface and an irregular surface. Gait patterns were studied in 30 young healthy subjects and two groups known to be at increased risk of falling - 100 subjects over the age of 75, and 30 subjects with diabetic peripheral neuropathy. A series of vision, sensation, strength, reaction time and balance tests were also undertaken to identify subjects’ physiological abilities and risk of falls. Acceleration patterns of the head and pelvis differed according to physiological risk of falling, particularly when walking on the irregular surface. Those with a high risk of falling walked with a reduced velocity, cadence and step length, and exhibited less rhythmic acceleration patterns at the head and pelvis. Gait patterns were significantly associated with leg strength, peripheral sensation and reaction time. It is concluded that subjects with a high physiological risk of falling exhibit characteristic patterns of walking that indicate an impaired ability to control the movement of the pelvis and head, which may predispose to loss of balance