Mobile Quantification and Therapy Course Tracking for Gait Rehabilitation

This paper presents a novel autonomous quality metric to quantify the rehabilitations progress of subjects with knee/hip operations. The presented method supports digital analysis of human gait patterns using smartphones. The algorithm related to the autonomous metric utilizes calibrated acceleration, gyroscope and magnetometer signals from seven Inertial Measurement Unit attached on the lower body in order to classify and generate the grading system values. The developed Android application connects the seven Inertial Measurement Units via Bluetooth and performs the data acquisition and processing in real-time. In total nine features per acceleration direction and lower body joint angle are calculated and extracted in real-time to achieve a fast feedback to the user. We compare the classification accuracy and quantification capabilities of Linear Discriminant Analysis, Principal Component Analysis and Naive Bayes algorithms. The presented system is able to classify patients and control subjects with an accuracy of up to 100\%. The outcomes can be saved on the device or transmitted to treating physicians for later control of the subject's improvements and the efficiency of physiotherapy treatments in motor rehabilitation. The proposed autonomous quality metric solution bears great potential to be used and deployed to support digital healthcare and therapy.Comment: 5 Page

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program

Trainer in a pocket - proof-of-concept of mobile, real-time, foot kinematics feedback for gait pattern normalization in individuals after stroke, incomplete spinal cord injury and elderly patients

Background: Walking disabilities negatively affect inclusion in society and quality of life and increase the risk for secondary complications. It has been shown that external feedback applied by therapists and/or robotic training devices enables individuals with gait abnormalities to consciously normalize their gait pattern. However, little is known about the effects of a technically-assisted over ground feedback therapy. The aim of this study was to assess whether automatic real-time feedback provided by a shoe-mounted inertial-sensor-based gait therapy system is feasible in individuals with gait impairments after incomplete spinal cord injury (iSCI), stroke and in the elderly. Methods: In a non-controlled proof-of-concept study, feedback by tablet computer-generated verbalized instructions was given to individuals with iSCI, stroke and old age for normalization of an individually selected gait parameter (stride length, stance or swing duration, or foot-to-ground angle). The training phase consisted of 3 consecutive visits. Four weeks post training a follow-up visit was performed. Visits started with an initial gait analysis (iGA) without feedback, followed by 5 feedback training sessions of 2–3 min and a gait analysis at the end. A universal evaluation and FB scheme based on equidistant levels of deviations from the mean normal value (1 level = 1 standard deviation (SD) of the physiological reference for the feedback parameter) was used for assessment of gait quality as well as for automated adaptation of training difficulty. Overall changes in level over iGAs were detected using a Friedman’s Test. Post-hoc testing was achieved with paired Wilcoxon Tests. The users’ satisfaction was assessed by a customized questionnaire. Results: Fifteen individuals with iSCI, 11 after stroke and 15 elderly completed the training. The average level at iGA significantly decreased over the visits in all groups (Friedman’s test, p < 0.0001), with the biggest decrease between the first and second training visit (4.78 ± 2.84 to 3.02 ± 2.43, p < 0.0001, paired Wilcoxon test). Overall, users rated the system’s usability and its therapeutic effect as positive. Conclusions: Mobile, real-time, verbalized feedback is feasible and results in a normalization of the feedback gait parameter. The results form a first basis for using real-time feedback in task-specific motor rehabilitation programs. Trial registration: DRKS00011853 , retrospectively registered on 2017/03/23

Intelligent signal processing for digital healthcare monitoring

Ein gesunder Gang ist ein komplexer Prozess und erfordert ein Gleichgewicht zwischen verschiedenen neurophysiologischen Systemen im Körper und gilt als wesentlicher Indikator für den physischen und kognitiven Gesundheitszustand einer Person. Folglich würden Anwendungen im Bereich der Bioinformatik und des Gesundheitswesens erheblich von den Informationen profitieren, die sich aus einer längeren oder ständigen Überwachung des Gangs, der Gewohnheiten und des Verhaltens von Personen unter ihren natürlichen Lebensbedingungen und bei ihren täglichen Aktivitäten mit Hilfe intelligenter Geräte ergeben. Vergleicht man Trägheitsmess- und stationäre Sensorsysteme, so bieten erstere hervorragende Möglichkeiten für Ganganalyseanwendungen und bieten mehrere Vorteile wie geringe Größe, niedriger Preis, Mobilität und sind leicht in tragbare Systeme zu integrieren. Die zweiten gelten als der Goldstandard, sind aber teuer und für Messungen im Freien ungeeignet. Diese Arbeit konzentriert sich auf die Verbesserung der Zeit und Qualität der Gangrehabilitation nach einer Operation unter Verwendung von Inertialmessgeräten, indem sie eine neuartige Metrik zur objektiven Bewertung des Fortschritts der Gangrehabilitation in realen Umgebungen liefert und die Anzahl der verwendeten Sensoren für praktische, reale Szenarien reduziert. Daher wurden die experimentellen Messungen für eine solche Analyse in einer stark kontrollierten Umgebung durchgeführt, um die Datenqualität zu gewährleisten. In dieser Arbeit wird eine neue Gangmetrik vorgestellt, die den Rehabilitationsfortschritt anhand kinematischer Gangdaten von Aktivitäten in Innen- und Außenbereichen quantifiziert und verfolgt. In dieser Arbeit wird untersucht, wie Signalverarbeitung und maschinelles Lernen formuliert und genutzt werden können, um robuste Methoden zur Bewältigung von Herausforderungen im realen Leben zu entwickeln. Es wird gezeigt, dass der vorgeschlagene Ansatz personalisiert werden kann, um den Fortschritt der Gangrehabilitation zu verfolgen. Ein weiteres Thema dieser Arbeit ist die erfolgreiche Anwendung von Methoden des maschinellen Lernens auf die Ganganalyse aufgrund der großen Datenmenge, die von den tragbaren Sensorsystemen erzeugt wird. In dieser Arbeit wird das neuartige Konzept des ``digitalen Zwillings'' vorgestellt, das die Anzahl der verwendeten Wearable-Sensoren in einem System oder im Falle eines Sensorausfalls reduziert. Die Evaluierung der vorgeschlagenen Metrik mit gesunden Teilnehmern und Patienten unter Verwendung statistischer Signalverarbeitungs- und maschineller Lernmethoden hat gezeigt, dass die Einbeziehung der extrahierten Signalmerkmale in realen Szenarien robust ist, insbesondere für das Szenario mit Rehabilitations-Gehübungen in Innenräumen. Die Methodik wurde auch in einer klinischen Studie evaluiert und lieferte eine gute Leistung bei der Überwachung des Rehabilitationsfortschritts verschiedener Patienten. In dieser Arbeit wird ein Prototyp einer mobilen Anwendung zur objektiven Bewertung des Rehabilitationsfortschritts in realen Umgebungen vorgestellt

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

How Does Technology Development Influence the Assessment of Parkinson’s Disease? A Systematic Review

abstract: Parkinson’s disease (PD) is a neurological disorder with complicated and disabling motor and non-motor symptoms. The pathology for PD is difficult and expensive. Furthermore, it depends on patient diaries and the neurologist’s subjective assessment of clinical scales. Objective, accurate, and continuous patient monitoring have become possible with the advancement in mobile and portable equipment. Consequently, a significant amount of work has been done to explore new cost-effective and subjective assessment methods or PD symptoms. For example, smart technologies, such as wearable sensors and optical motion capturing systems, have been used to analyze the symptoms of a PD patient to assess their disease progression and even to detect signs in their nascent stage for early diagnosis of PD. This review focuses on the use of modern equipment for PD applications that were developed in the last decade. Four significant fields of research were identified: Assistance diagnosis, Prognosis or Monitoring of Symptoms and their Severity, Predicting Response to Treatment, and Assistance to Therapy or Rehabilitation. This study reviews the papers published between January 2008 and December 2018 in the following four databases: Pubmed Central, Science Direct, IEEE Xplore and MDPI. After removing unrelated articles, ones published in languages other than English, duplicate entries and other articles that did not fulfill the selection criteria, 778 papers were manually investigated and included in this review. A general overview of PD applications, devices used and aspects monitored for PD management is provided in this systematic review.Dissertation/ThesisMasters Thesis Computer Engineering 201

Digital innovation in Multiple Sclerosis Management

Due to innovation in technology, a new type of patient has been created, the e-patient, characterized by the use of electronic communication tools and commitment to participate in their own care. The extent to which the world of digital health has changed during the COVID-19 pandemic has been widely recognized. Remote medicine has become part of the new normal for patients and clinicians, introducing innovative care delivery models that are likely to endure even if the pendulum swings back to some degree in a post-COVID age. The development of digital applications and remote communication technologies for patients with multiple sclerosis has increased rapidly in recent years. For patients, eHealth apps have been shown to improve outcomes and increase access to care, disease information, and support. For HCPs, eHealth technology may facilitate the assessment of clinical disability, analysis of lab and imaging data, and remote monitoring of patient symptoms, adverse events, and outcomes. It may allow time optimization and more timely intervention than is possible with scheduled face-to-face visits. The way we measure the impact of MS on daily life has remained relatively unchanged for decades, and is heavily reliant on clinic visits that may only occur once or twice each year.These benefits are important because multiple sclerosis requires ongoing monitoring, assessment, and management.The aim of this Special Issue is to cover the state of knowledge and expertise in the field of eHealth technology applied to multiple sclerosis, from clinical evaluation to patient education

An Overview of Smart Shoes in the Internet of Health Things: Gait and Mobility Assessment in Health Promotion and Disease Monitoring

New smart technologies and the internet of things increasingly play a key role in healthcare and wellness, contributing to the development of novel healthcare concepts. These technologies enable a comprehensive view of an individual’s movement and mobility, potentially supporting healthy living as well as complementing medical diagnostics and the monitoring of therapeutic outcomes. This overview article specifically addresses smart shoes, which are becoming one such smart technology within the future internet of health things, since the ability to walk defines large aspects of quality of life in a wide range of health and disease conditions. Smart shoes offer the possibility to support prevention, diagnostic work-up, therapeutic decisions, and individual disease monitoring with a continuous assessment of gait and mobility. This overview article provides the technological as well as medical aspects of smart shoes within this rising area of digital health applications, and is designed especially for the novel reader in this specific field. It also stresses the need for closer interdisciplinary interactions between technological and medical experts to bridge the gap between research and practice. Smart shoes can be envisioned to serve as pervasive wearable computing systems that enable innovative solutions and services for the promotion of healthy living and the transformation of health care