An evaluation of the 30-s chair stand test in older adults: frailty detection based on kinematic parameters from a single inertial unit

Background: A growing interest in frailty syndrome exists because it is regarded as a major predictor of co-morbidities and mortality in older populations. Nevertheless, frailty assessment has been controversial, particularly when identifying this syndrome in a community setting. Performance tests such as the 30-second chair stand test (30-s CST) are a cornerstone for detecting early declines in functional independence. Additionally, recent advances in body-fixed sensors have enhanced the sensors’ ability to automatically and accurately evaluate kinematic parameters related to a specific movement performance. The purpose of this study is to use this new technology to obtain kinematic parameters that can identify frailty in an aged population through the performance the 30-s CST. Methods: Eighteen adults with a mean age of 54 years, as well as sixteen pre-frail and thirteen frail patients with mean ages of 78 and 85 years, respectively, performed the 30-s CST while threir trunk movements were measured by a sensor-unit at vertebra L3. Sit-stand-sit cycles were determined using both acceleration and orientation information to detect failed attempts. Movement-related phases (i.e. impulse, stand-up, and sit-down) were differentiated based on seat off and seat on events. Finally, the kinematic parameters of the impulse, stand-up and sit-down phases were obtained to identify potential differences across the three frailty groups. Results: For the stand-up and sit-down phases, velocity peaks and “modified impulse” parameters clearly differentiated subjects with different frailty levels (p < 0.001). The trunk orientation range during the impulse phase was also able to classify a subject according to his frail syndrome (p < 0.001). Furthermore, these parameters derived from the inertial units (IUs) are sensitive enough to detect frailty differences not registered by the number of completed cycles which is the standard test outcome. Conclusions: This study shows that IUs can enhance the information gained from tests currently used in clinical practice, such as the 30-s CST. Parameters such as velocity peaks, impulse, and orientation range are able to differentiate between adults and older populations with different frailty levels. This study indicates that early frailty detection could be possible in clinical environments, and the subsequent interventions to correct these disabilities could be prescribed before further degradation occurs.The authors are indebted to the Spanish Department of Health and Institute Carlos III of the Government of Spain [Spanish Net on Aging and frailty; (RETICEF)], Department of Health of the Government of Navarre and Economy and Competitivity Department of the Government of Spain, for financing this research with grants numbered RD12/0043/0022, 87/2010, and DEP2011-24105 respectively

Frailty assessment based on trunk kinematic parameters during walking

Background: Physical frailty has become the center of attention of basic, clinical and demographic research due to its incidence level and gravity of adverse outcomes with age. Frailty syndrome is estimated to affect 20 % of the population older than 75 years. Thus, one of the greatest current challenges in this field is to identify parameters that can discriminate between vulnerable and robust subjects. Gait analysis has been widely used to predict frailty. The aim of the present study was to investigate whether a collection of parameters extracted from the trunk acceleration signals could provide additional accurate information about frailty syndrome. Methods: A total of 718 subjects from an elderly population (319 males, 399 females; age: 75.4 ± 6.1 years, mass: 71.8 ± 12.4 kg, height: 158 ± 6 cm) volunteered to participate in this study. The subjects completed a 3-m walk test at their own gait velocity. Kinematic data were acquired from a tri-axial inertial orientation tracker. Findings: The spatio-temporal and frequency parameters measured in this study with an inertial sensor are related to gait disorders and showed significant differences among groups (frail, pre-frail and robust). A selection of those parameters improves frailty classification obtained to gait velocity, compared to classification model based on gait velocity solely. Interpretation: Gait parameters simultaneously used with gait velocity are able to provide useful information for a more accurate frailty classification. Moreover, this technique could improve the early detection of pre-frail status, allowing clinicians to perform measurements outside of a laboratory environment with the potential to prescribe a treatment for reversing their physical decline.This work was supported in part by the Spanish Department of Health and Institute Carlos III of the Government of Spain [Spanish Net on Aging and frailty; (RETICEF)], and Economy and Competitivity Department of the Government of Spain, under grants numbered RD12/043/0002, and DEP2011-24105, respectively

Evaluation de l'utilité et de l'utilisabilité des capteurs dans un habitat intelligente pour la santé

Ingeniería de TelecomunicaciónTelekomunikazio Ingeniaritz

Frailty assessment based on the instrumented version on the 30-s chair stand test

El objetivo de esta tesis es mejorar la evaluación de la capacidad funcional usando nuevos parámetros cinemáticos. Así, el personal clínico dispondrá de una serie de medidas objetivas y cuantificables para realizar sus diagnósticos. El movimiento que se ha analizado en este trabajo es el relativo al test de treinta segundos de la silla, y el instrumento de medida utilizado ha sido una única unidad inercial. La mayor parte de esta Tesis Doctoral está dedicada al análisis de las señales de aceleración y velocidad angular, que nos proporciona la unidad inercial, durante la ejecución del 30-s CST. En base a este análisis se obtienen parámetros significativos, capaces de distinguir diferentes niveles de fragilidad. Todo este trabajo ha sido publicado en revistas de impacto del JCR y aparece recogido en los capítulos dos, tres, cuatro y cinco. En el primero de ellos se realizó una revisión sistemática de la literatura correspondiente al análisis de la señal de los test relacionados con el movimiento de sentarse y levantarse de una silla, indicando también nuestras aportaciones. A continuación se desarrolló un algoritmo para la corrección del error de deriva que se produce al tratar de obtener la señal de posición vertical a partir de la aceleración en este eje que nos proporciona el sensor inercial. En el siguiente artículo se evaluó un modo de análisis, basado en parámetros cinemáticos, en un grupo de personas pre-frágiles. Y, finalmente, se escribió un último trabajo con el análisis final para obtener aquellos parámetros cinemáticos que son capaces de distinguir entre sujetos con distinto grado de fragilidad

Impacto en el personal sanitario de urgencias extrahospitalarias de las cargas elevadas en la movilización de pacientes con silla de transporte

Introduction. The objective of the study was to assess the physical effort made by hospital emergency personnel when transferring patients from their home to the ambulance. Material and methods. Cross-sectional observational study with a non-probabilistic sampling of convenience. Three groups are compared: firefighters, technical women in health emergencies (TES) and men TES, using inertial sensors with which we obtain relative data of the movement performed by 10 out-of-hospital health professionals (4 firefighters and 6 TES) when a patient goes down the stairs in conditions similar to an emergency. Result: The subjects who are in the top position in the displacement of the load have greater acceleration in the floor-ceiling plane and in the left leg. The female subject presents much greater acceleration in legs and arms than Impact of high loads during mobilization of patients with transport chairs among healthcare workers in the out-of-hospital emergency setting the rest, however, it is in the arms where it is significantly higher. When the subject who is in the position below in the displacement of the load, lowering the chair from behind, the acceleration of the legs is higher than when lowering it in the direction of travel. Conclusions. The subjects present greater acceleration in legs, being the place of the body that suffers the sum of the weight of the patient and the worker. Women present a greater acceleration so their physical effort is more pronounced. Lowering the chair in the direction of travel, decreases the acceleration in the legs so that this position is ergonomically better. The greater the stability when lowering the chair and the greater safety of the worker when performing this work, the acceleration decreases and therefore the physical effort that is made.Introducción. El objetivo del estudio es valorar el esfuerzo físico realizado por el personal de la urgencia extrahospitalaria al trasladar pacientes de su domicilio a la ambulancia.Material y métodos. Estudio observacional transversal con un muestreo no probabilístico de conveniencia. Se comparan tres grupos: bomberos, mujeres y hombres técnicos en emergencias sanitarias (TES), utilizando sensores inerciales con los que obtenemos datos relativos del movimiento que ejecutan 10 profesionales sanitarios del ámbito extrahospitalario (4 bomberos y 6 TES) al bajar un paciente por las escaleras en condiciones similares a una urgencia.Resultados. Los sujetos que se encuentran en la posición de arriba en el desplazamiento de la carga presentan mayor aceleración en el plano suelo-techo y en la pierna izquierda. La mujeres presentaron mayor aceleración en piernas y brazos que el resto, sin embargo, es en los brazos donde es significativamente superior. Cuando el sujeto que está en la posición de abajo en el desplazamiento de la carga, bajando la silla de espaldas, la aceleración de las piernas es superior que al bajarla en sentido de la marcha.Conclusiones. Los sujetos presentan mayor aceleración en piernas, siendo el lugar del cuerpo que sufre la suma del peso del paciente y del trabajador. Las mujeres presentan una mayor aceleración por lo que su esfuerzo físico es más acusado. Bajar la silla en sentido de la marcha, disminuye la aceleración en las piernas por lo que está posición es ergonómicamente mejor. Cuanto mayor es la estabilidad al bajar la silla y mayor seguridad del trabajador al desempeñar este trabajo, disminuye su aceleración y por lo tanto el esfuerzo físico que realiza

Multicomponent exercises including muscle power training enhance muscle mass, power output, and functional outcomes in institutionalized frail nonagenearians

Abstract This randomized controlled trial examined the effects of multicomponent training on muscle power output, muscle mass, and muscle tissue attenuation; the risk of falls; and functional outcomes in frail nonagenarians. Twenty-four elderly (91.9±4.1 years old) were randomized into intervention or control group. The intervention group performed a twice-weekly, 12-week multicomponent exercise program composed of muscle power training (8-10 repetitions, 40-60 % of the one-repetition maximum) combined with balance and gait retraining. Strength and power tests were performed on the upper and lower limbs. Gait velocity was assessed using the 5-m habitual gait and the timeup-and-go (TUG) tests with and without dual-task performance. Balance was assessed using the FICSIT-4 tests. The ability to rise from a chair test was assessed, and data on the incidence and risk of falls were assessed using questionnaires. Functional status was assessed before measurements with the Barthel Index. Midthigh lower extremity muscle mass and muscle fat infiltration were assessed using computed tomography. The intervention group showed significantly improved TUG with single and dual tasks, rise from a chair and balance performance (P&lt;0.01), and a reduced incidence of falls. In addition, the intervention group showed enhanced muscle power and strength (P&lt;0.01). Moreover, there were significant increases in the total and high-density muscle cross-sectional area in the intervention group. The control group significantly reduced strength and functional outcomes. Routine multicomponent exercise intervention should be prescribed to nonagenarians because overall physical outcomes are improved in this population