Assessing Sit-to-Stand for Clinical Use

Dieen, J.H. van [Promotor]Beek, P.J. [Promotor

Estimating activity-related energy expenditure under sedentary conditions using a tri-axial seismic accelerometer.

Activity-related energy expenditure (AEE) is difficult to quantify, especially under sedentary conditions. Here, a model was developed using the detected type of physical activity (PA) and movement intensity (MI), based on a tri-axial seismic accelerometer (DynaPort MiniMod; McRoberts B.V., The Hague, the Netherlands), with energy expenditure for PA as a reference. The relation between AEE (J/min/kg), MI, and the type of PA was determined for standardized PAs as performed in a laboratory including: lying, sitting, standing, and walking. AEE (J/min/kg) was calculated from total energy expenditure (TEE) and sleeping metabolic rate (SMR) as assessed with indirect calorimetry ((TEE x 0.9) - SMR). Subsequently, the model was validated over 23-h intervals in a respiration chamber. Subjects were 15 healthy women (age: 22 +/- 2 years; BMI: 24.0 +/- 4.0 kg/m(2)). Predicted AEE in the chamber was significantly related to measured AEE both within (r(2) = 0.81 +/- 0.06, P < 0.00001) and between (r(2) = 0.70, P < 0.001) subjects. The explained variation in AEE by the model was higher than the explained variation by MI alone. This shows that a tri-axial seismic accelerometer is a valid tool for estimating AEE under sedentary conditions.Obesity (2009) doi:10.1038/oby.2009.55

Detection of static and dynamic activities using uniaxial accelerometers

Rehabilitation treatment may be improved by objective analysis of activities of daily living. For this reason, the feasibility of distinguishing several static and dynamic activities (standing, sitting, lying, walking, ascending stairs, descending stairs, cycling) using a small set of two or three uniaxial accelerometers mounted on the body was investigated. The accelerometer signals can be measured with a portable data acquisition system, which potentially makes it possible to perform online detection of static and dynamic activities in the home environment. However, the procedures described in this paper have yet to be evaluated in the home environment. Experiments were conducted on ten healthy subjects, with accelerometers mounted on several positions and orientations on the body, performing static and dynamic activities according to a fixed protocol. Specifically, accelerometers on the sternum and thigh were evaluated. These accelerometers were oriented in the sagittal plane, perpendicular to the long axis of the segment (tangential), or along this axis (radial). First, discrimination between the static or dynamic character of activities was investigated. This appeared to be feasible using an rms-detector applied on the signal of one sensor tangentially mounted on the thigh. Second, the distinction between static activities was investigated. Standing, sitting, lying supine, on a side and prone could be distinguished by observing the static signals of two accelerometers, one mounted tangentially on the thigh, and the second mounted radially on the sternum. Third, the distinction between the cyclical dynamic activities walking, stair ascent, stair descent and cycling was investigated. The discriminating potentials of several features of the accelerometer signals were assessed: the mean value, the standard deviation, the cycle time and the morphology. Signal morphology was expressed by the maximal cross-correlation coefficients with template signals for the different dynamic activities. The mean signal values and signal morphology of accelerometers mounted tangentially on the thigh and the sternum appeared to contribute to the discrimination of dynamic activities with varying detection performances. The standard deviation of the signal and the cycle time were primarily related to the speed of the dynamic activities, and did not contribute to the discrimination of the activities. Therefore, discrimination of dynamic activities on the basis of the combined evaluation of the mean signal value and signal morphology is propose

The feasibility of posture and movement detection by accelerometry

The discrimination of postures and movements using a minimal set of uniaxial accelerometers was investigated. Postures and movements were distinguished on the bitsis of the high-pm filtered, rectified and low pass filtered signal of one accelerometer. Postures were discriminated by combining the constant valued signals of the accelerometers, mounted on different segments of the body. One sensor mounted ndiully on the trunc and one mounted radially or tangentially on the upper leg appeared to be suficient to discriminate shnding, sitting and lying. Methods are proposed for the discrimination of different cyclical movements

Validation of seat-off and seat-on in repeated sit-to-stand movements using a single body fixed sensor

The identification of chair rise phases is a prerequisite for quantifying sit-to-stand movements. The aim of this study is to validate seat-off and seat-on detection using a single-body-fixed sensor against detection based on chair switches. A single sensor system with three accelerometers and three gyroscopes was fixed around the waist. Synchronized on-off switches were placed under the chair. Thirteen older adults were recruited from a residential care home and fifteen young adults were recruited among college students. Subjects were asked to complete two sets of five trials each. Six features of the trunk movement during seat-off and seat-on were calculated automatically, and a model was developed to predict the moment of seat-off and seat-on transitions. The predictions were validated with leave-one-out cross-validation. Feature extraction failed in two trials (0.7%). For the optimal combination of seat-off predictors, cross-validation yielded a mean error of 0ms and a mean absolute error of 51ms. For the best seat-on predictor, cross-validation yielded a mean error of -3ms and a mean absolute error of 127ms. The results of this study demonstrate that seat-off and seat-on in repeated sit-to-stand movements can be detected semi-automatically in young and older adults using a one-body-fixed sensor system with an accuracy of 51 and 127ms, respectively. The use of the ambulatory instrumentation is feasible for non-technically trained personnel. This is an important step in the development of an automated method for the quantification of sit-to-stand movements in clinical practice. © 2012 Institute of Physics and Engineering in Medicine

Geruisloos inwilligen : argumentatie en speelruimte in de Nederlandse asielprocedure, 1945-1994

Authorities in Western countries, like the Netherlands, believe that after thorough investigation it is possible to separate genuine refugees from non-genuine refugees. Members of the first group deserve admission, because they had a well-founded fear of persecution in their countries of origin. Non-genuine refugees, also called fortune hunters, were rejected, often because of credibility concerns. Individual case files of asylum seekers show which arguments were used to justify rejections or admissions. Case files contain a variety of letters and memos written by civil servants, neighbours, employers, relatives, friends, classmates of the children, churches, family doctors, refugee aid groups, lawyers, and scholars. All these insiders and outsiders explained why a particular asylum seeker deserved admission or not. This dissertation shows that civil servants were sensitive to the pressure of outsiders. In first instance, many asylum seekers were rejected, but if the asylum procedure dragged on, decisions were altered. This research displays the variety of arguments that were used in the period 1945-1994. Often arguments not related to the flight were decisive: humanitarian arguments, personal characteristics of the applicant (special skills), criticism on the asylum procedure (the asylum seeker waited too long) and being beneficial to the Dutch society.LEI Universiteit LeidenCities, Migration and Global Interdependenc

Physical performance and physical activity in older adults: associated but separate domains of physical function in old age.

Background: Physical Function Is A Crucial Factor In The Prevention And Treatment Of Health Conditions In Older Adults And Is Usually Measured Objectively With Physical Performance Tests And/or Physical Activity Monitoring. Objective: To Examine Whether 1) Physical Performance (PP) And Physical Activity (PA) Constitute Separate Domains Of Physical Function; 2) Differentiation Of PA Classes Is More Informative Than Overall PA. Design: Cross-Sectional Study To Explore The Relationships Within And Among PP And PA Measures. Methods In 49 Older Participants (83±7 Years; M±SD), Performance-based Tests Were Conducted And PA Was Measured For One Week. Activity Monitor Data Were Reduced In Terms Of Duration, Periods, And Mean Duration Of Periods Of Lying, Sitting, Standing And Locomotion. The Relation Between And Within PP Scores And PA Outcomes Were Analysed Using Rank Order Correlation And Factor Analysis. Results: Factor Structure After Varimax Rotation Revealed Two Orthogonal Factors Explaining 78% Of The Variance In The Data: One Comprising All PA Variables And One Comprising All PP Variables. PP Scores Correlated Moderately With PA In Daily Life. Differentiation Of Activity Types And Quantification Of Their Duration, Intensity And Frequency Of Occurrence Provided Stronger Associations With PP, As Compared To A Single Measure Of Acceleration Expressing Overall PA. Limitations: For Independent Validation, The Conclusions About The Validity Of The Presented Conceptual Framework And Its Clinical Implications Need To Be Confirmed In Other Studies. Conclusions: PP And PA Represent Associated But Separate Domains Of Physical Function, Suggesting That An Improvement Of PP Does Not Automatically Imply An Increase Of PA, I.e. A Change To A More Active Lifestyle. Differentiation Of Activity Classes In The Analysis Of PA Provides More Insights Into PA And Its Association With PP Than Using A Single Overall Measure Of Acceleration

Older adults with weaker muscle strength stand up from a sitting position with more dynamic trunk use

The ability to stand up from a sitting position is essential for older adults to live independently. Body-fixed inertial sensors may provide an approach for quantifying the sit-to-stand (STS) in clinical settings. The aim of this study was to determine whether measurements of STS movements using body-fixed sensors yield parameters that are informative regarding changes in STS performance in older adults with reduced muscle strength. In twenty-seven healthy older adults, handgrip strength was assessed as a proxy for overall muscle strength. Subjects were asked to stand up from a chair placed at three heights. Trunk movements were measured using an inertial sensor fixed to the back. Duration, angular range, and maximum angular velocity of STS phases, as well as the vertical velocity of the extension phase, were calculated. Backwards elimination using Generalized Estimating Equations was used to determine if handgrip strength predicted the STS durations and trunk kinematics. Weaker subjects (i.e., with lower handgrip strength) were slower during the STS and showed a larger flexion angular range and a larger extension angular range. In addition, weaker subjects showed a greater maximum angular velocity, which increased with lower seat heights. Measurements with a single inertial sensor did reveal that older adults with lower handgrip strength employed a different strategy to stand up from a sitting position, involving more dynamic use of the trunk. This effect was greatest when elevating body mass. Trunk kinematic parameters were more sensitive to reduced muscle strength than durations

A novel accelerometry-based algorithm for the detection of step durations over short episodes of gait in healthy elderly.

Background: The assessment of short episodes of gait is clinically relevant and easily implemented, especially given limited space and time requirements. BFS (body-fixed-sensors) are small, lightweight and easy to wear sensors, which allow the assessment of gait at relative low cost and with low interference. Thus, the assessment with BFS of short episodes of gait, extracted from dailylife physical activity or measured in a standardised and supervised setting, may add value in the study of gait quality of the elderly. The aim of this study was to evaluate the accuracy of a novel algorithm based on acceleration signals recorded at different human locations (lower back and heels) for the detection of step durations over short episodes of gait in healthy elderly subjects.Methods: Twenty healthy elderly subjects (73.7 ± 7.9 years old) walked twice a distance of 5 m, wearing a BFS on the lower back, and on the outside of each heel. Moreover, an optoelectronic three-dimensional (3D) motion tracking system was used to detect step durations. A novel algorithm is presented for the detection of step durations from low-back and heel acceleration signals separately. The accuracy of the algorithm was assessed by comparing absolute differences in step duration between the three methods: step detection from the optoelectronic 3D motion tracking system, step detection from the application of the novel algorithm to low-back accelerations, and step detection from the application of the novel algorithm to heel accelerations.Results: The proposed algorithm successfully detected all the steps, without false positives and without false negatives. Absolute average differences in step duration within trials and across subjects were calculated for each comparison, between low-back accelerations and the optoelectronic system were on average 22.4 ± 7.6 ms (4.0 ± 1.3 % of average step duration), between heel accelerations and the optoelectronic system were on average 20.7 ± 11.8 ms (3.7 ± 1.9 %), and between low-back accelerations and heel accelerations were on average 27.8 ± 15.1 ms (4.9 ± 2.5 % of average step duration).Conclusions: This study showed that the presented novel algorithm detects step durations over short episodes of gait in healthy elderly subjects with acceptable accuracy from low-back and heel accelerations, which provides opportunities to extract a range of gait parameters from short episodes of gait