Validation of ankle strength measurements by means of a hand-held dynamometer in adult healthy subjects

Uniaxial Hand-Held Dynamometer (HHD) is a low-cost device widely adopted in clinical practice to measure muscle force. HHD measurements depend on operator’s ability and joint movements. The aim of the work is to validate the use of a commercial HHD in both dorsiflexion and plantarflexion ankle strength measurements quantifying the effects of HHD misplacements and unwanted foot’s movements on the measurements. We used an optoelectronic system and a multicomponent load cell to quantify the sources of error in the manual assessment of the ankle strength due to both the operator’s ability to hold still the HHD and the transversal components of the exerted force that are usually neglected in clinical routine. Results showed that foot’s movements and angular misplacements of HHD on sagittal and horizontal planes were relevant sources of inaccuracy on the strength assessment. Moreover, ankle dorsiflexion and plantarflexion force measurements presented an inaccuracy less than 2% and higher than 10%, respectively. In conclusion, the manual use of a uniaxial HHD is not recommend ed for the assessment of ankle plantarflexion strength; on the contrary, it can be allowed asking the operator to pay strong attention to the HHD positioning in ankle dorsiflexion strength measurements

Analysis of knee strength measurements performed by a hand-held multicomponent dynamometer and optoelectronic system

The quantification of muscle weakness is useful to evaluate the health status and performance of patients and athletes. In this paper, we proposed a novel methodology to investigate and to quantify the effects induced by inaccuracy sources occurring when using a hand-held dynamometer (HHD) for knee strength measurements. The validation methodology is based on the comparison between the output of a one-component commercial HHD and the outputs of a six-component load cell, comparable in dimension and mass. An optoelectronic system was used to measure HHD positioning angles and displacements. The setup allowed to investigate the effects induced by: 1) the operator's ability to place and to hold still the HHD and 2) ignoring the transversal components of the force exchanged. The main finding was that the use of a single component HHD induced an overall inaccuracy of 5% in the strength measurements if the angular misplacements are kept within the values found in this paper (≤15°) and with a knee range of motion ≤22°. Extension trials were the most critical due to the higher force exerted, i.e., 249.4 ± 27.3 versus 146.4 ± 23.9 N of knee flexion. The most relevant source of inaccuracy was identified in the angular displacement on the horizontal plane

Stereophotogrammetry in human movement analysis: novel methods for the quality assurance, biomechanical analysis and clinical interpretation of gait analysis

The study of movement has always fascinated artists, photographers and researchers. Across the years, several attempts to capture, freeze, study and reproduce motion were made. Nowadays, motion capture plays an important role within many fields, from graphical animation, filmmaking, virtual reality, till medicine. In fact, movement analysis allows to measure kinematic and kinetic performance of the human body. The quantitative data obtained from measurements may support the diagnosis and treatment of many pathologies, allowing to take clinical decisions and supporting the follow-up of treatments or rehabilitation. This approach is nowadays named evidence based medicine. In this work, motion capture techniques and advanced signal processing techniques were exploited in order to: (i) develop a protocol for the validation and quality assurance of the clinical strength measurements, (ii) develop an algorithm for clinical gait analysis data interpretation and identification of pathological patterns, and (iii) design user-friendly software tools to help clinicians using the novel data processing algorithms and reporting the results of measurements. This work was divided into three sections: Part 1 contains a survey about the history of motion analysis and a review of the earliest experiments in biomechanics. The review covered the first historical attempts, that were mainly based on photography, till the state-of-the-art technology used today, i.e. the optoelectronic system. The working principle of optoelectronic system was reviewed as well as its applications and modern setups in the clinical practice. Some modern functional evaluation protocols, aimed to the quantitative evaluation of physical performance and clinical diagnosis of motor disorders, were also reviewed. Special attention was paid to the most common motion analysis exam that is nowadays worldwide standardized, i.e. the Gait Analysis. Examples of Gait Analysis studies on subjects with pathology and follow-up were reviewed. Part 2 concerns the design of an experimental setup, involving motion analysis, for the quality assurance of clinical strength measurements. Measurements of force are popular in the clinical practice as they allow to evaluate the muscle weakness, health status of patients and the effects of therapies. A variety of protocols was proposed to conduct such measurements, implying the acquisition of forces, angles and angular velocities when the maximum voluntary force is exerted. Hand held dynamometry (HHD), based on single component load cell, was extensively used in clinical practice; however, several shortcomings were identified. The most relevant were related to the operator’s ability. This work was aimed to investigate the inherent inaccuracy sources in knee strength measurements when are conducted by a single component load cell. The analysis was conducted by gathering the outputs of a compact six-component load cell, comparable in dimension and mass to clinical HHDs, and an optoelectronic system. Quality of measurements was investigated in terms of quantifying, by an ad-hoc metrics, the effects induced in the overall inaccuracy by: (i) the operator’s ability to place and to hold still the HHD and (ii) ignoring the transversal components of the force exchanged between the patient and the experimenter. The main finding was that the use of a single component HHD induced an overall inaccuracy of 5% in the strength measurements, when operated by a trained clinician and angular misplacements are kept within the values found in this work (≤15°) and with a knee ROM ≤ 22°. Even if the measurement outputs were reliable and accurate enough for both knee flexion and extension, extension trials were the most critical due to the higher force exerted, i.e. 249.4±27.3 N vs. 146.4±23.9 N of knee flexion. The most relevant source of inaccuracy was identified in the angular displacement of HHD on the horizontal plane. A dedicated software, with graphical user interface, was designed and implemented. The purposes of this software were to: (i) speed up data processing, (ii) allow user to select the proper processing workflow, and (iii) provide clinicians with a tool for quick data processing and reporting. Part 3 concerns the research study about gait analysis on subjects with pathology. Gait analysis is often used for the assessment of the gait abilities in children with cerebral palsy and to quantify improvements/variations after a treatment. To simplify GA interpretation and to quantify deviation from normality, some synthetic descriptors were developed in literature, such as the Movement Analysis Profile (MAP) and the Linear Fit Method (LFM). The aims of this work were: (i) to use synthetic descriptors in order to quantify gait variations in subjects with Cerebral Palsy that underwent surgery involving bone repositioning and muscle/tendon lengthening at the level of the femur and hamstring group (SEMLS); (ii) test the effectiveness of a recently proposed index, i.e. the LFM, on such patients; (iii) design and implement a novel index that may overcome the limitations of the previous methods. Gait Analysis exams of 10 children with Cerebral Palsy, pre and post treatment, were collected. Data were analysed by means of MAP and LFM indices. To overcome the limitations observed for the methods, another index was designed as a modified version of the MAP, namely the OC-MAP. It took into account the effect on deviation due to offset and allowed to compute the deviation from normality on tracks purified by the offset. An overall improvement of the gait pattern was observed for most of the subjects after surgery. The highest effect was observed for the knee flexion/extension angle. Patients who had initial high deviations also had the largest improvements. Worsening in the kinematics of the pelvis could be explained as a consequence of SEML involving a lengthening of hamstring group. Pre-post differences were higher than the Minimally Clinical Important Difference for all parameters, except hip flexion. An improvement towards normality was observed for all the parameters, with exception of pelvic tilt for which a worsening was observed. LFM provided results similar to OC-MAP offset analysis but could not be considered reliable due to intrinsic limitations. As offset in gait features played an important role in gait deviation, OC-MAP synthetic analysis is recommended to study gait pattern of subjects with Cerebral Palsy. A dedicated software, with graphical user interface, was designed and implemented. The purpose of this software was to compute the synthetic descriptors on a large amount of data, to speedup data processing and to provide clinicians with a quick access to the result

Accuracy of consumer-level and research-grade activity trackers in ambulatory settings in older adults

Wrist-worn activity trackers have experienced a tremendous growth lately and studies on the accuracy of mainstream trackers used by older adults are needed. This study explores the performance of six trackers (Fitbit Charge2, Garmin VivoSmart HR+, Philips Health Watch, Withings Pulse Ox, ActiGraph GT9X-BT, Omron HJ-72OITC) for estimating: steps, travelled distance, and heart-rate measurements for a cohort of older adults. Eighteen older adults completed a structured protocol involving walking tasks, simulated household activities, and sedentary activities. Less standardized activities were also included, such as: dusting, using a walking aid, or playing cards, in order to simulate real-life scenarios. Wrist-mounted and chest/waist-mounted devices were used. Gold-standards included treadmill, ECG-based chest strap, direct observation or video recording according to the activity and parameter. Every tracker showed a decreasing accuracy with slower walking speed, which resulted in a significant step under-counting. A large mean absolute percentage error (MAPE) was found for every monitor at slower walking speeds with the lowest reported MAPE at 2 km/h being 7.78%, increasing to 20.88% at 1.5 km/h, and 44.53% at 1 km/h. During household activities, the MAPE climbing up/down-stairs ranged from 8.38–19.3% and 10.06–19.01% (dominant and non-dominant arm), respectively. Waist-worn devices showed a more uniform performance. However, unstructured activities (e.g. dusting, playing cards), and using a walking aid represent a challenge for all wrist-worn trackers as evidenced by large MAPE (> 57.66% for dusting, > 67.32% when using a walking aid). Poor performance in travelled distance estimation was also evident during walking at low speeds and climbing up/down-stairs (MAPE > 71.44% and > 48.3%, respectively). Regarding heart-rate measurement, there was no significant difference (p-values > 0.05) in accuracy between trackers placed on the dominant or non-dominant arm. Concordant with existing literature, while the mean error was limited (between -3.57 bpm and 4.21 bpm), a single heart-rate measurement could be underestimated up to 30 beats-per-minute. This study showed a number of limitations of consumer-level wrist-based activity trackers for older adults. Therefore caution is required when used, in healthcare or in research settings, to measure activity in older adults

Validity evaluation of the Fitbit Charge2 and the Garmin vivosmart HR+ in free-living environments in an older adult cohort

Background: Few studies have investigated the validity of mainstream wrist-based activity trackers in healthy older adults in real life, as opposed to laboratory settings. Objective: This study explored the performance of two wrist-worn trackers (Fitbit Charge 2 and Garmin vivosmart HR+) in estimating steps, energy expenditure, moderate-to-vigorous physical activity (MVPA) levels, and sleep parameters (total sleep time [TST] and wake after sleep onset [WASO]) against gold-standard technologies in a cohort of healthy older adults in a free-living environment. Methods: Overall, 20 participants (>65 years) took part in the study. The devices were worn by the participants for 24 hours, and the results were compared against validated technology (ActiGraph and New-Lifestyles NL-2000i). Mean error, mean percentage error (MPE), mean absolute percentage error (MAPE), intraclass correlation (ICC), and Bland-Altman plots were computed for all the parameters considered. Results: For step counting, all trackers were highly correlated with one another (ICCs>0.89). Although the Fitbit tended to overcount steps (MPE=12.36%), the Garmin and ActiGraph undercounted (MPE 9.36% and 11.53%, respectively). The Garmin had poor ICC values when energy expenditure was compared against the criterion. The Fitbit had moderate-to-good ICCs in comparison to the other activity trackers, and showed the best results (MAPE=12.25%), although it underestimated calories burned. For MVPA levels estimation, the wristband trackers were highly correlated (ICC=0.96); however, they were moderately correlated against the criterion and they overestimated MVPA activity minutes. For the sleep parameters, the ICCs were poor for all cases, except when comparing the Fitbit with the criterion, which showed moderate agreement. The TST was slightly overestimated with the Fitbit, although it provided good results with an average MAPE equal to 10.13%. Conversely, WASO estimation was poorer and was overestimated by the Fitbit but underestimated by the Garmin. Again, the Fitbit was the most accurate, with an average MAPE of 49.7%. Conclusions: The tested well-known devices could be adopted to estimate steps, energy expenditure, and sleep duration with an acceptable level of accuracy in the population of interest, although clinicians should be cautious in considering other parameters for clinical and research purposes

Clinical gait analysis: do we need a big data approach?

Introduction and Tools. Panel “Big Data Era: challenges, tools and experiences in an interdisciplinary and dynamic world”. Knowledge representation, data integration and closure. Recent initiatives on Big Data of the ISTAT

Finite element analysis of the stress state produced by an orthodontic skeletal anchorage system based on miniscrews

Aims: The aim of this work is to produce detailed analysis and quantitative results of the stress state induced in an inferior first molar tooth by an orthodontic mesialization system based on a mini-screw, a bracket, and a rubber elastic string. Materials and Methods: The implant was modeled as a non-osteointegrated Ti-6Al-4V standard mini-screw, implanted in the anterior-buccal region of human jaw. 3D realistic models were constructed using data based on micro-computed tomography scans of human teeth as found in the literature. A couple of self-balanced forces of 4 N was applied and finite element method analysis was run and produced an approximate solution, which allowed to display stress distribution over the whole model. Materials' behavior was assumed elastic and linear. This approximation applies to the 1 st stage of the orthodontic treatments. Results: A detailed qualitative and quantitative analysis of the stress state is presented through images. Results in terms of stresses and displacements were studied to exclude any possibility of bracket debonding, bone failure, and loss of stability of the screw. Results were compared to the ultimate strengths of the bio-materials involved using engineering failure criteria. The actual stress state was found to be lower than the critical values. Conclusion: Results allows to qualitatively see the amount of bone, surronding the mini-screw, and the tooth, that undergoes stress. Furthermore, quantitative analysis of stress could exclude failure in alveolar bone and detachment at the enamel-bracket interface. The applied force and devices were proved to be safe to use for this kind of orthodontic facilities.Aims: The aim of this work is to produce detailed analysis and quantitative results of the stress state induced in an inferior first molar tooth by an orthodontic mesialization system based on a mini-screw, a bracket, and a rubber elastic string. Materials and Methods: The implant was modeled as a non-osteointegrated Ti-6Al-4V standard mini-screw, implanted in the anterior-buccal region of human jaw. 3D realistic models were constructed using data based on micro-computed tomography scans of human teeth as found in the literature. A couple of self-balanced forces of 4 N was applied and finite element method analysis was run and produced an approximate solution, which allowed to display stress distribution over the whole model. Materials' behavior was assumed elastic and linear. This approximation applies to the 1 st stage of the orthodontic treatments. Results: A detailed qualitative and quantitative analysis of the stress state is presented through images. Results in terms of stresses and displacements were studied to exclude any possibility of bracket debonding, bone failure, and loss of stability of the screw. Results were compared to the ultimate strengths of the bio-materials involved using engineering failure criteria. The actual stress state was found to be lower than the critical values. Conclusion: Results allows to qualitatively see the amount of bone, surronding the mini-screw, and the tooth, that undergoes stress. Furthermore, quantitative analysis of stress could exclude failure in alveolar bone and detachment at the enamel-bracket interface. The applied force and devices were proved to be safe to use for this kind of orthodontic facilities