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

Auditory cue based on the golden ratio can improve gait patterns in people with parkinson’s disease

The harmonic structure of walking relies on an irrational number called the golden ratio (φ): in healthy subjects, it coincides with the stride-to-stance ratio, and it is associated with a smooth gait modality. This smoothness is lost in people with Parkinson’s disease (PD), due to deficiencies in the execution of movements. However, external auditory cues seem to facilitate movement, by enabling the timing of muscle activation, and helping in initiating and modulating motor output. Based on a harmonic fractal structure of gait, can the administration of an auditory cue based on individual’s φ-rhythm improve, in acute, gait patterns in people with PD? A total of 20 participants (16 males, age 70.9 ± 8.4 years, Hoehn and Yahr stage-II) were assessed through stereophotogrammetry: gait spatio-temporal parameters, and stride-to-stance ratio were computed before, during, and after the φ-rhythm administration. Results show improvements in terms of stride length (p = 0.018), walking speed (p = 0.014), and toe clearance (p = 0.013) when comparing gait patterns before and after the stimulus. Furthermore, the stride-to-stance ratio seems to correlate with almost all spatio-temporal parameters, but it shows the main changes in the before–during rhythm comparison. In conclusion, φ-rhythm seems an effective cue able to compensate for defective internal rhythm of the basal ganglia in PD

Vestibular rehabilitation training in patients with subacute stroke: a preliminary randomized controlled trial

Background: Vestibular rehabilitation (VR) consists in a customized exercise program patient-centred that includes a combination of different exercise components with the aim to promote gaze stability, improve balance and gait, and facilitate somatosensory integration. OBJECTIVE: The aim of this study was to investigate the effect of customized vestibular rehabilitation training on gait stability of patients with subacute stroke. METHODS: Twenty-five inpatients (12 M, age: 64.1±12.1 years) with diagnosis of subacute stroke were enrolled and randomized in two groups. All patients were evaluated before and after 4 weeks of training sessions. An instrumented 10-Meter Walk Test together with traditional clinical scales were used to assess VR effects. To investigate if any fall event occurred after patients' dismissal, they were followed-up at three and twelve months after dismissal. RESULTS: Higher values of walking speed and stride length were observed in the VR group. Conversely, no significant difference was found in terms of trunk stability. The results of between-group comparison highlight significant differences between the two groups for different clinical scale scores. CONCLUSION: VR could be included into a rehabilitation program for patients with stroke for improving their gait and dynamic balance acting on their vestibular system as facilitator of recovery

Multilevel upper body movement control during gait in children with cerebral palsy

Upper body movements during walking provide information about balance control and gait stability. Typically developing (TD) children normally present a progressive decrease of accelerations from the pelvis to the head, whereas children with cerebral palsy (CP) exhibit a general increase of upper body accelerations. However, the literature describing how they are transmitted from the pelvis to the head is lacking. This study proposes a multilevel motion sensor approach to characterize upper body accelerations and how they propagate from pelvis to head in children with CP, comparing with their TD peers. Two age-and gender-matched groups of 20 children performed a 10m walking test at self-selected speed while wearing three magneto-inertial sensors located at pelvis, sternum, and head levels. The root mean square value of the accelerations at each level was computed in a local anatomical frame and its variation from lower to upper levels was described using attenuation coefficients. Between-group differences were assessed performing an ANCOVA, while the mutual dependence between acceleration components and the relationship between biomechanical parameters and typical clinical scores were investigated using Regression Analysis and Spearman's Correlation, respectively (alpha = 0.05). New insights were obtained on how the CP group managed the transmission of accelerations through the upper body. Despite a significant reduction of the acceleration from pelvis to sternum, children with CP do not compensate for large accelerations, which are greater than in TD children. Furthermore, those with CP showed negative sternum-to-head attenuations, in agreement with the documented rigidity of the head-trunk system observed in this population. In addition, the estimated parameters proved to correlate with the scores used in daily clinical practice. The proposed multilevel approach was fruitful in highlighting CP-TD gait differences, supported the in-field quantitative gait assessment in children with CP and might prove beneficial to designing innovative intervention protocols based on pelvis stabilization

Usefulness of magnetoinertial wearable devices in neurorehabilitation of children with cerebral palsy

Background. Despite the increasing use of wearable magnetoinertial measurement units (MIMUs) for gait analysis, the efficacy of MIMU-based assessment for planning rehabilitation has not been adequately documented yet. Methods. The usefulness of a MIMU-based assessment was evaluated comparing the data acquired by three MIMUs located at the pelvis, sternum, and head levels in 12 children with cerebral palsy (CP, age: 2-9 years) and 12 age-matched children with typical development (TD). Gait stability was quantified in terms of acceleration attenuation coefficients from pelvis to head, pelvis to sternum, and sternum to head. Children with CP were randomly divided in two groups: in the first group (CPI), MIMU-based parameters were used by therapists for planning patient-tailored rehabilitation programs, whereas in the second group (CPB), therapists were blind to the MIMU-based assessment results. Both CPI and CPB were tested before and after the relevant neurorehabilitation program. Ad hoc questionnaires were also administered to therapists of the CPI group to assess the degree of usefulness perceived about the information provided by the MIMU-based assessment. Results. Significant differences were found between children with CP and those with TD for the acceleration attenuation coefficient from pelvis to head (p = 0 048) and from pelvis to sternum (p = 0 021). After neurorehabilitation, this last parameter increased more in CPI (35%) than in CPB (6%, p = 0 017 for the interaction group per time). The results of the questionnaires showed that therapists agreed with the usability (100% judged it as "easy to use") and usefulness of the MIMU-based assessment in defining patient-oriented interventions (87%). Conclusions. There is a large debate in literature about the efficacy of classical gait analysis that should be enlarged to new technological approaches, such as that based on MIMUs. This study is a first proof of concept about the efficacy of this approach for neurorehabilitation of children with CP

The effect of vestibular stimulation on motor functions of children with cerebral palsy

Background: Cerebral palsy (CP) has been defined as a nonprogressive disease of movement and posture development. Physical therapy techniques use different forms of sensory stimulation to improve neuromotor development. Aim: The aim of this study was to assess the efficacy of a vestibular stimulation training in improving motor functions in cerebral palsy. Population: Fourteen children with CP were randomly separated into two different groups in a cross-over trial. Methods: Over a period of 10 weeks, each group performed 10 sessions of 50 min of neurodevelopmental treatment (NDT) and 10 sessions of vestibular training (VR). Children were evaluated with the Gross Motor Function Measurement-88 scale, the Goal Attainment Scale and the root mean square of head accelerations. Results: A significant improvement in the GAS-score (p =.003) was noted after NDT+VR. Conclusions: Vestibular stimulation integrated with NDT proved to be an effective complementary strategy for facilitating motor functioning

Overground walking training with the i-Walker, a robotic servo-assistive device, enhances balance in patients with subacute stroke: a randomized controlled trial

Background: Patients affected by mild stroke benefit more from physiological overground walking training than walking-like training performed in place using specific devices. The aim of the study was to evaluate the effects of overground robotic walking training performed with the servo-assistive robotic rollator (i-Walker) on walking, balance, gait stability and falls in a community setting in patients with mild subacute stroke. Methods: Forty-four patients were randomly assigned to two different groups that received the same therapy in two daily 40-min sessions 5 days a week for 4 weeks. Twenty sessions of standard therapy were performed by both groups. In the other 20 sessions the subjects enrolled in the i-Walker-Group (iWG) performed with the i-Walker and the Control-Group patients (CG) performed the same amount of conventional walking oriented therapy. Clinical and instrumented gait assessments were made pre- and post-treatment. The follow-up observation consisted of recording the number of fallers in the community setting after 6 months. Results: Treatment effectiveness was higher in the iWG group in terms of balance improvement (Tinetti: 68.4 +/- 27.6 % vs. 48.1 +/- 33.9 %, p = 0.033) and 10-m and 6-min timed walking tests (significant interaction between group and time: F(1,40) = 14.252, p = 0.001; and F(1,40) = 7.883, p = 0.008, respectively). When measured, latero-lateral upper body accelerations were reduced in iWG (F = 4.727, p = 0.036), suggesting increased gait stability, which was supported by a reduced number of falls at home. Conclusions: A robotic servo-assisted i-Walker improved walking performance and balance in patients affected by mild/moderate stroke, leading to increased gait stability and reduced falls in the community

Virtual Art Therapy. Application of Michelangelo Effect to Neurorehabilitation of Patients with Stroke

In neurorehabilitation, some studies reported the effective use of art therapy for reducing psychological disorders and for enhancing physical functions and cognitive abilities. Neuroaesthetical studies showed that seeing an art masterpiece can spontaneously elicit a widespread brain arousal, also involving motor networks. To combine contemplative and performative benefits of art therapy protocols, we have developed an immersive virtual reality system, giving subjects the illusion that they are able to paint a copy of famous artistic paintings. We previously observed that during this virtual task, subjects perceived less fatigue and performed more accurate movements than when they were asked to color the virtual canvas. We named this upshot the Michelangelo effect. The aim of this study was to test the rehabilitative efficacy of our system. Ten patients with stroke in the subacute phase were enrolled and trained for one month with virtual art therapy (VAT) and physiotherapy. Their data were compared with those of ten patients matched for pathology, age and clinical parameters, trained only with conventional therapy for the same amount of time. The VAT group showed a significantly higher improvements in the Barthel Index score, a measure of independency in activities of daily living (66 ± 33% vs. 31 ± 28%, p = 0.021), and in pinching strength (66 ± 39% vs. 18 ± 33%, p = 0.008), with respect to the group treated with conventional rehabilitation

Post-stroke depression increases disability more than 15% in ischemic stroke survivors: a case-control study

We performed a retrospective, case-control study in consecutive ischemic stroke patients admitted to our stroke rehabilitation unit. Patients were matched for severity of neurological impairment (evaluated with the Canadian Neurological Scale, CNS), age (difference within 1 year), and onset admission interval (difference within 3 days). Participants were divided into two subgroups according to the presence or absence of PSD. Aim was to assess the specific influence of post-stroke depression (PSD) and antidepressant treatment on both basal functional status and rehabilitation outcomes. All PSD patients were treated primarily with serotoninergic antidepressants (AD). The final sample included 280 patients with depression (out of 320 found in a whole case series of 993 ischemic patients, i.e., 32.25%) and 280 without depression. Forty patients with depression were excluded because they had a history of severe psychiatric illness or aphasia, with a severe comprehension deficit. On one hand, PSD patients obtained lower Barthel Index (BI) and Rivermead Mobility Index (RMI) scores at both admission and discharge, with minor effectiveness of rehabilitative treatment and longer length of stay; on the other hand, this group had a lower percentage of dropouts. Lastly, PSD patients showed a different functional outcome, based on their response to antidepressant therapy, that was significantly better in responders than in non-responders (13.13%). Our results confirm the unfavorable influence of PSD on functional outcome, despite pharmacological treatment

Italian version of the pittsburgh rehabilitation participation scale: Psychometric analysis of validity and reliability

Patient’s active participation in therapy is a key component of successful rehabilitation. In fact, low participation has been shown to be a prognostic factor of poor outcome; however, participation is rarely assessed in clinical settings. The Pittsburgh Rehabilitation Participation Scale (PRPS) is a validated, quick, and accurate measure of participation, relying on clinicians’ observation, and not requiring any self-report by patients. The aim of this study was to validate an Italian version of the PRPS. Following forward and back-translation of PRPS into Italian, the translated version was validated in a total of 640 therapy sessions, related to a cohort of 32 patients admitted to an Italian hospital. It was tested for concurrent validity, finding significant correlations with Barthel Index (R > 0.58, p < 0.001) and SF-36 Physical and Mental Health (R > 0.4, p < 0.02), for predictive validity, finding significant correlation with the effectiveness of rehabilitation (R = 0.358, p = 0.045), and for inter-rater and intra-rater reliability, computing an Intra-class correlation coefficient (ICC = 0.926 and 0.756, respectively). These psychometric properties results were similar to those of the original version of this scale. The proposed PRPS can be helpful for Italian clinicians in the assessment of patient’s participation during rehabilitation