Validity and reliability of smartphone orientation measurement to quantify dynamic balance function

Objective: Postural control is frequently compromised after sub-concussive and concussive head trauma, and balance testing is an integral part of neuromotor assessment and management. The main objective of this paper is to develop a novel smartphone-based neuromotor assessment protocol for screening of dynamic balance decrements stemming from head trauma. Approach: Experiments 1 and 2 compared Android smartphone orientation detection algorithms to a biomechanics laboratory motion capture system using a pendulum (i.e. non-biological movement) and a human stepping task (i.e. biological movement). Experiment 3 examined the test-retest reliability of a stepping-in-place protocol in three different sensory conditions (eyes open, no-vision, head shake) using temporal and spatial variability metrics extracted from thigh orientation signal in a sample of healthy young adults. Main results: Smartphone sensors provided valid measurements of movement timing and amplitude variables. However, sensor firmware version and Android OS version significantly affected quality of measurement. High test-retest reliability was shown for the temporal and spatial variables of interest during the stepping-in-place task. Significance: Collectively, these experiments show that our smartphone application is a valid and reliable way to measure leg movement characteristics (mean stride time and its variability (CV), Peak Thigh SD, Thigh ROM, and Peak Return Velocity) during dynamic balance activity, which could provide an objective way to assess neuromotor function after head trauma and in other populations with balance dysfunction

Wearable Sensors in the Evaluation of Gait and Balance in Neurological Disorders

The aging population and the increased prevalence of neurological diseases have raised the issue of gait and balance disorders as a major public concern worldwide. Indeed, gait and balance disorders are responsible for a high healthcare and economic burden on society, thus, requiring new solutions to prevent harmful consequences. Recently, wearable sensors have provided new challenges and opportunities to address this issue through innovative diagnostic and therapeutic strategies. Accordingly, the book “Wearable Sensors in the Evaluation of Gait and Balance in Neurological Disorders” collects the most up-to-date information about the objective evaluation of gait and balance disorders, by means of wearable biosensors, in patients with various types of neurological diseases, including Parkinson’s disease, multiple sclerosis, stroke, traumatic brain injury, and cerebellar ataxia. By adopting wearable technologies, the sixteen original research articles and reviews included in this book offer an updated overview of the most recent approaches for the objective evaluation of gait and balance disorders

Wearable inertial sensors for human movement analysis

Introduction: The present review aims to provide an overview of the most common uses of wearable inertial sensors in the field of clinical human movement analysis.Areas covered: Six main areas of application are analysed: gait analysis, stabilometry, instrumented clinical tests, upper body mobility assessment, daily-life activity monitoring and tremor assessment. Each area is analyzed both from a methodological and applicative point of view. The focus on the methodological approaches is meant to provide an idea of the computational complexity behind a variable/parameter/index of interest so that the reader is aware of the reliability of the approach. The focus on the application is meant to provide a practical guide for advising clinicians on how inertial sensors can help them in their clinical practice.Expert commentary: Less expensive and more easy to use than other systems used in human movement analysis, wearable sensors have evolved to the point that they can be considered ready for being part of routine clinical routine

Exploring the use of wearables in the management of mild traumatic brain injury

a) Why is the subject of your thesis important? Every year more than 1 million people attend Accident and Emergency with mild traumatic brain injuries (mTBI), many of which arise from Sports Related Concussion (SRC). Despite the high incidence of such injuries, there is still no gold standard method to monitor the wide variety of impairments (cognitive, visual, motor symptom) accompanying mTBI. Accordingly, there is concern about the long-term effects of mTBI if diagnosis is delayed or missed entirely. Current reliance on subjective techniques such as symptoms are non-specific and an unreliable indicator of recovery, making it difficult to know when it is safe for players to return to play (RTP). This highlights the need for testing and validating the accuracy and applicability of objective tools to aid diagnosis, monitoring, and RTP protocols for individuals exposed to mTBI and SRC. b) How have you undertaken the research? I have taken a systematic approach to this problem-based research, starting by understanding the clinical challenges of mTBI from SRC where amateur rugby union is used as an exemplar for investigation throughout the thesis. Both mTBI and SRC is an under-researched area confounded by insufficient medical staff available to recognise SRC and monitor players within low resource (community) based settings. This may place these individuals at an increased risk of having a delayed diagnosis or it being missed entirely. My hypothesis tests if the use of digital technologies may enable affordable mTBI management, ensuring continuity and objective personalised assessment to support traditional approaches. Accordingly, my thesis broadly comprises of a literature examination and preliminary validation and testing, progressing to an in-depth exploration involving larger datasets and concluding with recommendations for clinical practice. c) What are your main research findings? My multidisciplinary approach reveals that focusing on one impairment in mTBI is unlikely to reveal meaningful insight to mTBI/SRC and RTP. Instead, multimodal digital technologies could enable affordable management, ensuring consistency and continuity (e.g., between assessors) while offering objective personalised data to better support traditional approaches. My results provide insight and identify the usefulness of instrumented walking (gait) as a digital (bio) marker for mTBI management. Based on receiver operating characteristics (ROC) and area under the curve (AUC) analyisis free-living step velocity (i.e., walking speed) was the most sensitive (>0.72) at distinguishing healthy from acute SRC and may be useful for continuous monitoring and therefore informing SRC RTP. In a purely computing science context, my findings have uncovered challenges and opportunities for further refinement. For example, there is still room for more ‘no code’ solutions in gait and algorithm analysis. Few clinicians would have the technical skillsets for completing free-living gait analysis. Therefore, validated algorithms within a "drag and drop", click and collect approach is needed to meet the recommend approach of remote, free-living monitoring of habitual behaviours. That is an important next step for the translation of academic research grade devices for broader deployment in clinical practice. d) Why do your research findings matter This thesis generally supports the suggested use of digital technologies as an affordable and objective method to support traditional approaches of assessment in mTBI/SRC. Passive and continuous monitoring solutions such as wearables are becoming ubiquitous in daily life. Moreover, the use of instrumented (lab) and free-living gait may fit that context with evidence of its use as a diagnostic tool. More work is needed to strengthen that claim as well as further investigate its use as a responsive tool. Identifying useful digital biomarkers in pathological cohorts such as mTBI may improve the detection of injuries and better inform safe (personalised) RTP guidelines. Identifying critical stages of recovery more accurately will also reduce the likelihood of premature return to play before full recovery, which is a necessary threshold in offering personalised care and rehabilitation. That is an important next step for the translation of academic research grade devices for broader deployment in clinical practice

Wearables for Movement Analysis in Healthcare

Quantitative movement analysis is widely used in clinical practice and research to investigate movement disorders objectively and in a complete way. Conventionally, body segment kinematic and kinetic parameters are measured in gait laboratories using marker-based optoelectronic systems, force plates, and electromyographic systems. Although movement analyses are considered accurate, the availability of specific laboratories, high costs, and dependency on trained users sometimes limit its use in clinical practice. A variety of compact wearable sensors are available today and have allowed researchers and clinicians to pursue applications in which individuals are monitored in their homes and in community settings within different fields of study, such movement analysis. Wearable sensors may thus contribute to the implementation of quantitative movement analyses even during out-patient use to reduce evaluation times and to provide objective, quantifiable data on the patients’ capabilities, unobtrusively and continuously, for clinical purposes

Proceedings XXII Congresso SIAMOC 2022

Il congresso annuale della Società Italiana di Analisi del Movimento in Clinica dà l’occasione a tutti i professionisti, dell’ambito clinico e ingegneristico, di incontrarsi, presentare le proprie ricerche e rimanere aggiornati sulle più recenti innovazioni nell’ambito dell’applicazione clinica dei metodi di analisi del movimento, al fine di promuoverne lo studio e le applicazioni cliniche per migliorare la valutazione dei disordini motori, aumentare l’efficacia dei trattamenti attraverso l’analisi quantitativa dei dati e una più focalizzata pianificazione dei trattamenti, ed inoltre per quantificare i risultati delle terapie correnti

Evaluating footwear “in the wild”: Examining wrap and lace trail shoe closures during trail running

Trail running participation has grown over the last two decades. As a result, there have been an increasing number of studies examining the sport. Despite these increases, there is a lack of understanding regarding the effects of footwear on trail running biomechanics in ecologically valid conditions. The purpose of our study was to evaluate how a Wrap vs. Lace closure (on the same shoe) impacts running biomechanics on a trail. Thirty subjects ran a trail loop in each shoe while wearing a global positioning system (GPS) watch, heart rate monitor, inertial measurement units (IMUs), and plantar pressure insoles. The Wrap closure reduced peak foot eversion velocity (measured via IMU), which has been associated with fit. The Wrap closure also increased heel contact area, which is also associated with fit. This increase may be associated with the subjective preference for the Wrap. Lastly, runners had a small but significant increase in running speed in the Wrap shoe with no differences in heart rate nor subjective exertion. In total, the Wrap closure fit better than the Lace closure on a variety of terrain. This study demonstrates the feasibility of detecting meaningful biomechanical differences between footwear features in the wild using statistical tools and study design. Evaluating footwear in ecologically valid environments often creates additional variance in the data. This variance should not be treated as noise; instead, it is critical to capture this additional variance and challenges of ecologically valid terrain if we hope to use biomechanics to impact the development of new products

Motor patterns evaluation of people with neuromuscular disorders for biomechanical risk management and job integration/reintegration

Neurological diseases are now the most common pathological condition and the leading cause of disability, progressively worsening the quality of life of those affected. Because of their high prevalence, they are also a social issue, burdening both the national health service and the working environment. It is therefore crucial to be able to characterize altered motor patterns in order to develop appropriate rehabilitation treatments with the primary goal of restoring patients' daily lives and optimizing their working abilities. In this thesis, I present a collection of published scientific articles I co-authored as well as two in progress in which we looked for appropriate indices for characterizing motor patterns of people with neuromuscular disorders that could be used to plan rehabilitation and job accommodation programs. We used instrumentation for motion analysis and wearable inertial sensors to compute kinematic, kinetic and electromyographic indices. These indices proved to be a useful tool for not only developing and validating a clinical and ergonomic rehabilitation pathway, but also for designing more ergonomic prosthetic and orthotic devices and controlling collaborative robots

Exploring Inertial-Based Wearable Technologies for Objective Monitoring in Sports-Related Concussion: a Single-Participant Report

Objective: Challenges remain in sports-related concussion (SRC) assessment to better inform return to play. Reliance on self-reported symptoms within the Sports Concussion Assessment Tool means that there are limited data on the effectiveness of novel methods to assess a player’s readiness to return to play. Digital methods such as wearable technologies may augment traditional SRC assessment and improve objectivity in making decisions regarding return to play. Methods: The participant was a male university athlete who had a recent history of SRC. The single-participant design consisted of baseline laboratory testing immediately after SRC, free-living monitoring, and follow-up supervised testing after 2 months. The primary outcome measures were from traditional assessment (eg, Sports Concussion Assessment Tool and 2-minute instrumented walk/gait test; secondary outcome measures were from remote (free-living) assessment with a single wearable inertial measurement unit (eg, for gait and sleep). Results: The university athlete (age = 20 years, height = 175 cm, weight = 77 kg [176.37 lb]) recovered and returned to play 20 days after SRC. Primary measures returned to baseline levels after 12 days. However, supervised (laboratory-based) wearable device assessment showed that gait impairments (increased step time) remained even after the athlete was cleared for return to play (2 months). Similarly, a 24-hour remote gait assessment showed changes in step time, step time variability, and step time asymmetry immediately after SRC and at return to play (1 month after SRC). Remote sleep analysis showed differences in sleep quality and disturbance (increased movement between immediately after SRC and once the athlete had returned to play [1 month after SRC]). Conclusion: The concern about missed or delayed SRC diagnosis is growing, but methods to objectively monitor return to play after concussion are still lacking. This report showed that wearable device assessment offers additional objective data for use in monitoring players who have SRC. This work could better inform SRC assessment and return-to-play protocols. Impact: Digital technologies such as wearable technologies can yield additional data that traditional self-report approaches cannot. Combining data from nondigital (traditional) and digital (wearable) methods may augment SRC assessment for improved return-to-play decisions

Sex Differences in Head Impact Magnitude, Neck and Head Size and Neck Strength in University Rugby Union

Concussion has consistently been reported as the most significant injury in rugby union and is an area of increasing concern. Female athletes are reported to suffer from a greater concussion incidence and worse outcomes than males. Increased neck strength has been associated with a reduction in concussion risk and requires further investigation. The aim of this thesis was to investigate sex differences which may affect brain injury susceptibility, primarily neck strength. The magnitude of head acceleration during impact events was recorded by instrumented mouthguards. University first team rugby players (31 male and 22 female) were measured university for 13 and seven competitive matches respectively. All impacts were video and waveform verified and impact kinematics classified. Anthropometrics and isometric neck strength were measured prior to the season beginning. Male players had significantly larger head, neck and shoulder anthropometrics than female players, as well as significantly greater neck strength in all four directions. Positional differences in size and strength were much more prominent in males than females. Head impact magnitude was found to be similar in both sexes, despite the significant differences in size and strength. Negative correlations for peak rotational head acceleration with neck flexion and extension strength, and for peak linear head acceleration with neck extension strength in the male players. Successful growth of female rugby requires a focus on female-derived data to develop laws, training techniques and coach education, rather than relying on the traditional androcentric data