Fall Prediction and Prevention Systems: Recent Trends, Challenges, and Future Research Directions.

Fall prediction is a multifaceted problem that involves complex interactions between physiological, behavioral, and environmental factors. Existing fall detection and prediction systems mainly focus on physiological factors such as gait, vision, and cognition, and do not address the multifactorial nature of falls. In addition, these systems lack efficient user interfaces and feedback for preventing future falls. Recent advances in internet of things (IoT) and mobile technologies offer ample opportunities for integrating contextual information about patient behavior and environment along with physiological health data for predicting falls. This article reviews the state-of-the-art in fall detection and prediction systems. It also describes the challenges, limitations, and future directions in the design and implementation of effective fall prediction and prevention systems

Is the timed-up and go test feasible in mobile devices? A systematic review

The number of older adults is increasing worldwide, and it is expected that by 2050 over 2 billion individuals will be more than 60 years old. Older adults are exposed to numerous pathological problems such as Parkinson’s disease, amyotrophic lateral sclerosis, post-stroke, and orthopedic disturbances. Several physiotherapy methods that involve measurement of movements, such as the Timed-Up and Go test, can be done to support efficient and effective evaluation of pathological symptoms and promotion of health and well-being. In this systematic review, the authors aim to determine how the inertial sensors embedded in mobile devices are employed for the measurement of the different parameters involved in the Timed-Up and Go test. The main contribution of this paper consists of the identification of the different studies that utilize the sensors available in mobile devices for the measurement of the results of the Timed-Up and Go test. The results show that mobile devices embedded motion sensors can be used for these types of studies and the most commonly used sensors are the magnetometer, accelerometer, and gyroscope available in off-the-shelf smartphones. The features analyzed in this paper are categorized as quantitative, quantitative + statistic, dynamic balance, gait properties, state transitions, and raw statistics. These features utilize the accelerometer and gyroscope sensors and facilitate recognition of daily activities, accidents such as falling, some diseases, as well as the measurement of the subject's performance during the test execution.info:eu-repo/semantics/publishedVersio

Home detection of freezing of gait using Support Vector Machines through a single waist-worn triaxial accelerometer

Among Parkinson’s disease (PD) symptoms, freezing of gait (FoG) is one of the most debilitating. To assess FoG, current clinical practice mostly employs repeated evaluations over weeks and months based on questionnaires, which may not accurately map the severity of this symptom. The use of a non-invasive system to monitor the activities of daily living (ADL) and the PD symptoms experienced by patients throughout the day could provide a more accurate and objective evaluation of FoG in order to better understand the evolution of the disease and allow for a more informed decision-making process in making adjustments to the patient’s treatment plan. This paper presents a new algorithm to detect FoG with a machine learning approach based on Support Vector Machines (SVM) and a single tri-axial accelerometer worn at the waist. The method is evaluated through the acceleration signals in an outpatient setting gathered from 21 PD patients at their home and evaluated under two different conditions: first, a generic model is tested by using a leave-one-out approach and, second, a personalised model that also uses part of the dataset from each patient. Results show a significant improvement in the accuracy of the personalised model compared to the generic model, showing enhancement in the specificity and sensitivity geometric mean (GM) of 7.2%. Furthermore, the SVM approach adopted has been compared to the most comprehensive FoG detection method currently in use (referred to as MBFA in this paper). Results of our novel generic method provide an enhancement of 11.2% in the GM compared to the MBFA generic model and, in the case of the personalised model, a 10% of improvement with respect to the MBFA personalised model. Thus, our results show that a machine learning approach can be used to monitor FoG during the daily life of PD patients and, furthermore, personalised models for FoG detection can be used to improve monitoring accuracy.Peer ReviewedPostprint (published version

Mobile Phone Sensors Can Discern Medication-related Gait Quality Changes in Parkinson\u27s Patients in the Home Environment

Patients with Parkinson\u27s Disease (PD) experience daytime symptom fluctuations, which result in small amplitude, slow and unstable walking during times when medication attenuates. The ability to identify dysfunctional gait patterns throughout the day from raw mobile phone acceleration and gyroscope signals would allow the development of applications to provide real-time interventions to facilitate walking performance by, for example, providing external rhythmic cues. Patients (n = 20, mean Hoehn and Yahr: 2.25) had their ambulatory data recorded and were directly observed twice during one day: once after medication abstention, (OFF) and once approximately 30 min after intake of their medication (ON). Regularized generalized linear models (RGLM), neural networks (NN), and random forest (RF) classification models were individually trained for each participant. Across all subjects, our best performing classifier on average achieved an accuracy of 92.5%. This study demonstrated that smartphone accelerometers and gyroscopes can be used to distinguish between ON versus OFF times, potentially making smartphones useful intervention tools

Home monitoring of motor fluctuations in Parkinson's disease patients

In Parkinson's disease, motor fluctuations (worsening of tremor, bradykinesia, freezing of gait, postural instability) affect up to 70% of patients within 9 years of \textsc {l}-dopa therapy. Nevertheless, the assessment of motor fluctuations is difficult in a medical office, and is commonly based on poorly reliable self-reports. Hence, the use of wearable sensors is desirable. In this preliminary trial, we have investigated bradykinesia and freezing of gait—FOG—symptoms by means of inertial measurement units. To this purpose, we have employed a single smartphone on the patient's waist for FOG experiment (38 patients), and on patient thigh for LA (93 subjects). Given the sound performance achieved in this trial (AUC = 0.97 for FOG and AUC = 0.92 for LA), motor fluctuations may be estimated in domestic environments. To this end, we plan to perform measures and data processing on SensorTile, a tiny IoT module including several sensors, a microcontroller, a BlueTooth low-energy interface and microSD card, implementing an electronic diary of motor fluctuations, posture and dyskinesia during activity of daily living

Towards a wearable system for predicting the freezing of gait in people affected by Parkinson's disease

Some wearable solutions exploiting on-body acceleration sensors have been proposed to recognize Freezing of Gait (FoG) in people affected by Parkinson Disease (PD). Once a FoG event is detected, these systems generate a sequence of rhythmic stimuli to allow the patient restarting the march. While these solutions are effective in detecting FoG events, they are unable to predict FoG to prevent its occurrence. This paper fills in the gap by presenting a machine learning-based approach that classifies accelerometer data from PD patients, recognizing a pre-FOG phase to further anticipate FoG occurrence in advance. Gait was monitored by three tri-axial accelerometer sensors worn on the back, hip and ankle. Gait features were then extracted from the accelerometer's raw data through data windowing and non-linear dimensionality reduction. A k-nearest neighbor algorithm (k-NN) was used to classify gait in three classes of events: pre-FoG, no-FoG and FoG. The accuracy of the proposed solution was compared to state of-the-art approaches. Our study showed that: (i) we achieved performances overcoming the state-of-the-art approaches in terms of FoG detection, (ii) we were able, for the very first time in the literature, to predict FoG by identifying the pre-FoG events with an average sensitivity and specificity of, respectively, 94.1% and 97.1%, and (iii) our algorithm can be executed on resource-constrained devices. Future applications include the implementation on a mobile device, and the administration of rhythmic stimuli by a wearable device to help the patient overcome the FoG

Reliable and robust detection of freezing of gait episodes with wearable electronic devices

A wearable wireless sensing system for assisting patients affected by Parkinson's disease is proposed. It uses integrated micro-electro-mechanical inertial sensors able to recognize the episodes of involuntary gait freezing. The system operates in real time and is designed for outdoor and indoor applications. Standard tests were performed on a noticeable number of patients and healthy persons and the algorithm demonstrated its reliability and robustness respect to individual specific gait and postural behaviors. The overall performances of the system are excellent with a specificity higher than 97%

An IoT based Virtual Coaching System (VSC) for Assisting Activities of Daily Life

Nowadays aging of the population is becoming one of the main concerns of theworld. It is estimated that the number of people aged over 65 will increase from 461million to 2 billion in 2050. This substantial increment in the elderly population willhave significant consequences in the social and health care system. Therefore, in thecontext of Ambient Intelligence (AmI), the Ambient Assisted Living (AAL) has beenemerging as a new research area to address problems related to the aging of the population. AAL technologies based on embedded devices have demonstrated to be effectivein alleviating the social- and health-care issues related to the continuous growing of theaverage age of the population. Many smart applications, devices and systems have beendeveloped to monitor the health status of elderly, substitute them in the accomplishment of activities of the daily life (especially in presence of some impairment or disability),alert their caregivers in case of necessity and help them in recognizing risky situations.Such assistive technologies basically rely on the communication and interaction be-tween body sensors, smart environments and smart devices. However, in such contextless effort has been spent in designing smart solutions for empowering and supportingthe self-efficacy of people with neurodegenerative diseases and elderly in general. Thisthesis fills in the gap by presenting a low-cost, non intrusive, and ubiquitous VirtualCoaching System (VCS) to support people in the acquisition of new behaviors (e.g.,taking pills, drinking water, finding the right key, avoiding motor blocks) necessary tocope with needs derived from a change in their health status and a degradation of theircognitive capabilities as they age. VCS is based on the concept of extended mind intro-duced by Clark and Chalmers in 1998. They proposed the idea that objects within theenvironment function as a part of the mind. In my revisiting of the concept of extendedmind, the VCS is composed of a set of smart objects that exploit the Internet of Things(IoT) technology and machine learning-based algorithms, in order to identify the needsof the users and react accordingly. In particular, the system exploits smart tags to trans-form objects commonly used by people (e.g., pillbox, bottle of water, keys) into smartobjects, it monitors their usage according to their needs, and it incrementally guidesthem in the acquisition of new behaviors related to their needs. To implement VCS, thisthesis explores different research directions and challenges. First of all, it addresses thedefinition of a ubiquitous, non-invasive and low-cost indoor monitoring architecture byexploiting the IoT paradigm. Secondly, it deals with the necessity of developing solu-tions for implementing coaching actions and consequently monitoring human activitiesby analyzing the interaction between people and smart objects. Finally, it focuses on the design of low-cost localization systems for indoor environment, since knowing theposition of a person provides VCS with essential information to acquire information onperformed activities and to prevent risky situations. In the end, the outcomes of theseresearch directions have been integrated into a healthcare application scenario to imple-ment a wearable system that prevents freezing of gait in people affected by Parkinson\u2019sDisease

Detection of Freezing of Gait using Unsupervised Convolutional Denoising Autoencoder

At the advanced stage of Parkinson’s disease, patients may suffer from ‘freezing of gait’ episodes: a debilitating condition wherein a patient’s “feet feel as though they are glued to the floor”. The objective, continuous monitoring of the gait of Parkinson’s disease patients with wearable devices has led to the development of many freezing of gait detection models involving the automatic cueing of a rhythmic auditory stimulus to shorten or prevent episodes. The use of thresholding and manually extracted features or feature engineering returned promising results. However, these approaches are subjective, time-consuming, and prone to error. Furthermore, their performance varied when faced with the different walking styles of Parkinson’s disease patients. Inspired by state-of-art deep learning techniques, this research aims to improve the detection model by proposing a feature learning deep denoising autoencoder to learn the salient characteristics of Parkinsonian gait data that is applicable to different walking styles for the elimination of manually handcrafted features. Even with the elimination of manually handcrafted features, a reduction in half of the data window sizes to 2s, and a significant dimensionality reduction of learned features, the detection model still managed to achieve 90.94% sensitivity and 67.04% specificity, which is comparable to the original Daphnet dataset research