Quantifying Variation in Gait Features from Wearable Inertial Sensors Using Mixed Effects Models

The emerging technology of wearable inertial sensors has shown its advantages in collecting continuous longitudinal gait data outside laboratories. This freedom also presents challenges in collecting high-fidelity gait data. In the free-living environment, without constant supervision from researchers, sensor-based gait features are susceptible to variation from confounding factors such as gait speed and mounting uncertainty, which are challenging to control or estimate. This paper is one of the first attempts in the field to tackle such challenges using statistical modeling. By accepting the uncertainties and variation associated with wearable sensor-based gait data, we shift our efforts from detecting and correcting those variations to modeling them statistically. From gait data collected on one healthy, non-elderly subject during 48 full-factorial trials, we identified four major sources of variation, and quantified their impact on one gait outcome—range per cycle—using a random effects model and a fixed effects model. The methodology developed in this paper lays the groundwork for a statistical framework to account for sources of variation in wearable gait data, thus facilitating informative statistical inference for free-living gait analysis

A wearable solution for accurate step detection based on the direct measurement of the inter-foot distance

Accurate step detection is crucial for the estimation of gait spatio-temporal parameters. Although several step detection methods based on the use of inertial measurement units (IMUs) have been successfully proposed, they may not perform adequately when the foot is dragged while walking, when walking aids are used, or when walking at low speed. The aim of this study was to test an original step-detection method, the inter-foot distance step counter (IFOD), based on the direct measurement of the distance between feet. Gait data were recorded using a wearable prototype system (SWING2DS), which integrates an IMU and two time-of-flight distance sensors (DSs). The system was attached to the medial side of the right foot with one DS positioned close to the forefoot (FOREDS) and the other close to the rearfoot (REARDS). Sixteen healthy adults were asked to walk over ground for two minutes along a loop, including both rectilinear and curvilinear portions, during two experimental sessions. The accuracy of the IFOD step counter was assessed using a stereo-photogrammetric system as gold standard. The best performance was obtained for REARDS with an accuracy higher than 99.8% for the instrumented foot step and 88.8% for the non-instrumented foot step during both rectilinear and curvilinear walks. Key features of the IFOD step counter are that it is possible to detect both right and left steps by instrumenting one foot only and that it does not rely on foot impact dynamics. The IFOD step counter can be combined with existing IMU-based methods for increasing step-detection accuracy

An objective assessment to investigate the impact of turning angle on freezing of gait in Parkinson's disease

Freezing of gait (FoG) is often described in subjects with Parkinson's disease (PD) as a sudden inability to continue the forward walking progression. FoG occurs most often during turning, especially at sharp angles. Here, we investigated 180 and 360 degrees turns in two groups: PD subjects reporting FoG (FoG+), and PD subjects without FoG (FoG-). Forty-three subjects (25 FoG+, 18 FoG-) wore an inertial sensor on their back while walking back and forth continuously for 2 min (reversing direction with a 180° turn), and while turning in place for 1 min (alternating 360° turning in opposite directions). Objective measures (turn duration, peak velocity, jerkiness and range of acceleration) were computed during the turns and compared across FoG+ and FoG-groups. Results showed that FoG+ compared to FoG-took significantly a longer time to complete 360° turns than 180° turns. A significant lower turn peak velocity, higher jerkiness and an increased range of medio-lateral acceleration was also found in FoG+. Significant differences between the two groups across the two turning tasks validated the hypothesis that sharper turns might cause higher instability in FoG+ compared to FoG-

Mechanical lifting energy consumption in work activities designed by means of the "revised NIOSH lifting equation"\u80\u9d

The aims of the present work were: to calculate lifting energy consumption (LEC) in work activities designed to have a growing lifting index (LI) by means of revised NIOSH lifting equation; to evaluate the relationship between LEC and forces at the L5-S1 joint. The kinematic and kinetic data of 20 workers were recorded during the execution of lifting tasks in three conditions. We computed kinetic, potential and mechanical energy and the corresponding LEC by considering three different centers of mass of: 1) the load (CoML); 2) the multi-segment upper body model and load together (CoMUpp+L); 3) the whole body and load together (CoMTot). We also estimated compression and shear forces. Results shows that LEC calculated for CoMUpp+L and CoMTot grew significantly with the LI and that all the lifting condition pairs are discriminated. The correlation analysis highlighted a relationship between LEC and forces that determine injuries at the L5-S1 joint

Kinematic discrimination of ataxia in horses is facilitated by blindfolding

BACKGROUND: Agreement among experienced clinicians is poor when assessing the presence and severity of ataxia, especially when signs are mild. Consequently, objective gait measurements might be beneficial for assessment of horses with neurological diseases. OBJECTIVES: To assess diagnostic criteria using motion capture to measure variability in spatial gait-characteristics and swing duration derived from ataxic and non-ataxic horses, and to assess if variability increases with blindfolding. STUDY DESIGN: Cross-sectional. METHODS: A total of 21 horses underwent measurements in a gait laboratory and live neurological grading by multiple raters. In the gait laboratory, the horses were made to walk across a runway surrounded by a 12-camera motion capture system with a sample frequency of 240 Hz. They were made to walk normally and with a blindfold in at least three trials each. Displacements of reflective markers on head, fetlock, hoof, fourth lumbar vertebra, tuber coxae and sacrum derived from three to four consecutive strides were processed and descriptive statistics, receiver operator characteristics (ROC) to determine the diagnostic sensitivity, specificity and area under the curve (AUC), and correlation between median ataxia grade and gait parameters were determined. RESULTS: For horses with a median ataxia grade ≥2, coefficient of variation for the location of maximum vertical displacement of pelvic and thoracic distal limbs generated good diagnostic yield. The hoofs of the thoracic limbs yielded an AUC of 0.81 with 64% sensitivity and 90% specificity. Blindfolding exacerbated the variation for ataxic horses compared to non-ataxic horses with the hoof marker having an AUC of 0.89 with 82% sensitivity and 90% specificity. MAIN LIMITATIONS: The low number of consecutive strides per horse obtained with motion capture could decrease diagnostic utility. CONCLUSIONS: Motion capture can objectively aid the assessment of horses with ataxia. Furthermore, blindfolding increases variation in distal pelvic limb kinematics making it a useful clinical tool

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

Empowering and assisting natural human mobility: The simbiosis walker

This paper presents the complete development of the Simbiosis Smart Walker. The device is equipped with a set of sensor subsystems to acquire user-machine interaction forces and the temporal evolution of user's feet during gait. The authors present an adaptive filtering technique used for the identification and separation of different components found on the human-machine interaction forces. This technique allowed isolating the components related with the navigational commands and developing a Fuzzy logic controller to guide the device. The Smart Walker was clinically validated at the Spinal Cord Injury Hospital of Toledo - Spain, presenting great acceptability by spinal chord injury patients and clinical staf

The use of wearable/portable digital sensors in Huntington’s disease: a systematic review

In chronic neurological conditions, wearable/portable devices have potential as innovative tools to detect subtle early disease manifestations and disease fluctuations for the purpose of clinical diagnosis, care and therapeutic development. Huntington’s disease (HD) has a unique combination of motor and non-motor features which, combined with recent and anticipated therapeutic progress, gives great potential for such devices to prove useful. The present work aims to provide a comprehensive account of the use of wearable/portable devices in HD and of what they have contributed so far. We conducted a systematic review searching MEDLINE, Embase, and IEEE Xplore. Thirty references were identified. Our results revealed large variability in the types of sensors used, study design, and the measured outcomes. Digital technologies show considerable promise for therapeutic research and clinical management of HD. However, more studies with standardized devices and harmonized protocols are needed to optimize the potential applicability of wearable/portable devices in HD