Role of body-worn movement monitor technology for balance and gait rehabilitation.
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ABSTRACT:
SUBMITTER: Horak F
PROVIDER: S-EPMC4348720 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:While balance and gait limitations are hallmarks of multiple sclerosis (MS), standard stopwatch-timed measures practical for use in the clinic are insensitive in minimally affected patients. This prevents early detection and intervention for mobility problems. The study sought to determine if body-worn sensors could detect differences in balance and gait between people with MS with normal walking speeds and healthy controls. Thirty-one MS and twenty-eight age- and sex-matched control subjects were tested using body-worn sensors both during quiet stance and gait (Timed Up and Go test, TUG). Results were compared to stopwatch-timed measures. Stopwatch durations of the TUG and Timed 25 Foot Walk tests were not significantly different between groups. However, during quiet stance with eyes closed, people with MS had significantly greater sway acceleration amplitude than controls (p=0.02). During gait, people with MS had greater trunk angular range of motion in roll (medio-lateral flexion, p=0.017) and yaw (axial rotation, p=0.026) planes. Turning duration through 180° was also longer in MS (p=0.031). Thus, body-worn motion sensors detected mobility differences between MS and healthy controls when traditional timed tests could not. This portable technology provides objective and quantitative mobility data previously not obtainable in the clinic, and may prove a useful outcome measure for early mobility changes in MS.
| S-EPMC3614340 | biostudies-literature
Project description:Ataxia is an impairment of the coordination of movement or the interaction of associated muscles, accompanied by a disturbance of the gait pattern. Diagnosis of this clinical sign, and evaluation of its severity is usually done using subjective scales during neurological examination. In this exploratory study we investigated if inertial sensors in a smart phone (3 axes of accelerometer and 3 axes of gyroscope) can be used to detect ataxia. The setting involved inertial sensor data collected by smartphone placed on the dog's back while walking in a straight line. A total of 770 walking sessions were evaluated comparing the gait of 55 healthy dogs to the one of 23 dogs with ataxia. Different machine learning techniques were used with the K-nearest neighbors technique reaching 95% accuracy in discriminating between a healthy control group and ataxic dogs, indicating potential use for smartphone apps for canine ataxia diagnosis and monitoring of treatment effect.
| S-EPMC9386067 | biostudies-literature
Project description:BackgroundImpaired balance regulation after stroke puts patients and therapists at risk of injury during rehabilitation. Body weight support systems (BWSSs) minimize this risk and allow patients to safely practice balance activities during therapy. Treadmill-based balance perturbation systems with BWSSs are known to improve balance in patients with age- or disease-related impairments. However, these stationary systems are unable to accommodate complex exercises that require more freedom of movement.ObjectiveThis study aims to evaluate the effect of a new balance perturbation module, which is directly integrated into a track-mounted BWSS, on balance impairments secondary to acute stroke.MethodsThis unblinded quasi-randomized controlled preliminary study was conducted in a rehabilitation-focused long-term acute care hospital. Participants were recruited from stroke rehabilitation inpatients with an admission Berg Balance Scale (BBS) score of 21 (out of 56) or greater. Over a 2-week period, consented participants completed 8 BWSS or BWSS with perturbation (BWSS-P) treatment sessions; study activities were incorporated into regular treatment to avoid disruption of their normal care. Although both groups conducted the same balance and gait activities during their treatment sessions, the BWSS-P sessions included lateral, anterior, and posterior balance perturbations. Pre- and postintervention BBS and Activities-Specific Balance Confidence (ABC) assessments were the primary outcome measures collected. Institutional BBS data from the year before installation of the track-mounted BWSS were retrospectively included as a post hoc historical standard of care comparison.ResultsThe improved postintervention BBS and ABC assessment scores showed that all participants benefited from therapy (P<.001 for all pre- and postintervention comparisons). The average BBS percent change for the BWSS-P sample (n=14) was 66.95% (SD 43.78%) and that for the BWSS control sample (n=15) was 53.29% (SD 24.13%). These values were greater than those for the standard of care group (n=30; mean 28.31%, SD 17.25%; P=.02 and P=.005 respectively), with no difference among the BWSS groups (P=.67). ABC score changes were also similar among the preintervention and postintervention BWSS groups (P=.94 and P=.92, respectively).ConclusionsBoth BWSS groups demonstrated similar BBS and ABC score improvements, indicating that balance perturbations were not detrimental to postacute stroke rehabilitation and were safe to use. These data provide strong rationale and baseline data for conducting a larger follow-up study to further assess if this new perturbation system provides additional benefit to the rehabilitation of gait and balance impairments following stroke.Trial registrationClinicalTrials.gov NCT04919161; https://clinicaltrials.gov/ct2/show/NCT04919161.
| S-EPMC8924779 | biostudies-literature
Project description:The aim of this study was to quantify the step-to-step variability (SSV) in speed-variant and speed-invariant movement components of the whole-body gait pattern during running. These separate aspects of variability can be used to gain insight into the neuromuscular control strategies that are engaged during running. Ten healthy, physically active, male recreational athletes performed five treadmill running trials at five different speeds (range: 1.3-4.9 m/sec). The whole-body movement was separated into principal movements (PM) using a principal component analysis. The PMs were split into two groups: a speed-variant group, where the range of motion (amplitude of PMs) changed with running speed; and a speed-invariant group, where the range of motion was constant across various speeds. The step-to-step variability (SSV) of the two groups was then quantified. The absolute SSV was the summed variability across all gait cycles, whereas the relative SSV was the summed variability divided by the magnitude of the movement. The absolute SSV of the speed-variant movements increased with running speed. By contrast, the relative SSV of the speed-variant group (as normalized to the PM amplitude) decreased asymptotically toward a minimal level as running speed increased. Both the absolute and relative SSV of the speed-invariant movements revealed a minimum at 3.1 m/sec. The whole-body gait pattern during running can be subdivided into speed-variant and speed-invariant movements. An interpretation of the SSV based on minimal intervention theory suggests that speed-variant movements are more tightly controlled, as evidenced by a lower degree of variability compared to the speed-invariant movements.
| S-EPMC3835005 | biostudies-literature
Project description:We hypothesised that rehabilitation specifically addressing balance in Parkinson's disease patients might improve not only balance but locomotion as well. Two balance-training protocols (standing on a moving platform and traditional balance exercises) were assessed by assigning patients to two groups (Platform, n = 15, and Exercises, n = 17). The platform moved periodically in the anteroposterior, laterolateral, and oblique direction, with and without vision in different trials. Balance exercises were based on the Otago Exercise Program. Both platform and exercise sessions were administered from easy to difficult. Outcome measures were (a) balancing behaviour, assessed by both Index of Stability (IS) on platform and Mini-BESTest, and (b) gait, assessed by both baropodometry and Timed Up and Go (TUG) test. Falls Efficacy Scale-International (FES-I) and Parkinson's Disease Questionnaire (PDQ-8) were administered. Both groups exhibited better balance control, as assessed both by IS and by Mini-BESTest. Gait speed at baropodometry also improved in both groups, while TUG was less sensitive to improvement. Scores of FES-I and PDQ-8 showed a marginal improvement. A four-week treatment featuring no gait training but focused on challenging balance tasks produces considerable gait enhancement in mildly to moderately affected patients. Walking problems in PD depend on postural instability and are successfully relieved by appropriate balance rehabilitation. This trial is registered with ClinicalTrials.gov NCT03314597.
| S-EPMC5863303 | biostudies-literature
Project description:BackgroundExtensive research shows that virtual reality (VR) enhances motor learning and has advantages in balance and gait rehabilitation of neurological patients. There is still uncertainty, however, as for the practicality and efficacy of VR in long-term clinical routine. The objective of this study was to report on 3 years of clinical practice conducting VR-based rehabilitation of balance and gait in a large medical center.MethodsThis retrospective study systematically analyzed clinical records of patients who received VR-based rehabilitation in a large rehabilitation center during 3 years. We evaluated the effect of VR-based rehabilitation treatments on balance and gait, cognitive dual-task load, patient's balance confidence (ABC-scale) and perception of suitability. Patients were either neurological patients, allocated to five groups: Parkinson's disease (PD), poststroke (PS), multiple sclerosis, traumatic brain injury, and 'other conditions', or non-neurological patients.ResultsRecords of 167 patients were analyzed. The availability of multiple VR systems and environments contributed to highly personalized interventions that tailored specific deficits with therapeutic goals. VR-based rehabilitation significantly improved balance and gait (measured by 10-Meter Walk Test, Timed-Up-and-Go, Berg Balance Scale, and Mini BESTest). Patients with PD and PS decreased dual-task cost while walking. Patients increased balance confidence and deemed VR suitable for rehabilitation.ConclusionsOur results suggest that VR-based rehabilitation is practicable and effective in clinical routine. Functional measures of balance and gait show significant improvements following VR-based interventions. Clinical approaches should exploit VR advantages for promoting motor learning and motivation. This study serves to aid transition to long-term clinical implementation of VR.
| S-EPMC6710712 | biostudies-literature
Project description: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 (? = 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.
| S-EPMC4801392 | biostudies-other
Project description:Wearable devices equipped with inertial sensors enable objective gait assessment for persons with multiple sclerosis (MS), with potential use in ambulatory care or home and community-based assessments. However, gait data collected in non-controlled settings are often fragmented and may not provide enough information for reliable measures. This paper evaluates a novel approach to (1) determine the effects of the length of the walking task on the reliability of calculated measures and (2) identify digital biomarkers for gait assessments from fragmented data. Thirty-seven participants (37) diagnosed with relapsing-remitting MS (EDSS range 0 to 4.5) executed two trials, walking 20 m each, with inertial sensors attached to their right and left shanks. Gait events were identified from the medio-lateral angular velocity, and short bouts of gait data were extracted from each trial, with lengths varying from 3 to 9 gait cycles. Intraclass correlation coefficients (ICCs) evaluate the degree of agreement between the two trials of each participant, according to the number of gait cycles included in the analysis. Results show that short bouts of gait data, including at least six gait cycles of bilateral data, can provide reliable gait measurements for persons with MS, opening new perspectives for gait assessment using fragmented data (e.g., wearable devices, community assessments). Stride time variability and asymmetry, as well as stride velocity variability and asymmetry, should be further explored as digital biomarkers to support the monitoring of symptoms of persons with neurological diseases.
| S-EPMC7558375 | biostudies-literature
Project description:BackgroundGait event detection is critical for remote gait analysis. Algorithms using a thigh-worn accelerometer for estimating spatiotemporal gait variables have demonstrated clinical utility in monitoring the gait of patients with gait and balance impairment. However, one may obtain accurate estimates of spatiotemporal variables, but with biased estimates of foot contact and foot off events. Some biomechanical analyses depend on accurate gait phase segmentation, but previous studies using a thigh-worn accelerometer have not quantified the error in estimating foot contact and foot off events.MethodsGait events and spatiotemporal gait variables were estimated using a thigh-worn accelerometer from 32 healthy subjects across a range of walking speeds (0.56-1.78 m/s). Ground truth estimates were obtained using vertical ground reaction forces measured using a pressure treadmill. Estimation performance was quantified using absolute error, root mean square error, and correlation analysis.ResultsAcross all strides (N = 3,898), the absolute error in estimating foot contact, foot off, stride time, stance time, and swing time was similar to other accelerometer-based techniques (39 ± 28 ms, 28 ± 28 ms, 11 ± 14 ms, 46 ± 31 ms, and 45 ± 30 ms, respectively). The correlation between reference measurements and estimates of bout-average stride time, stance time, and swing time were 1.00, 0.92, and 0.80, respectively. The (5th, 95th) percentiles of the foot contact and foot off estimation errors were (-91 ms, 51 ms) and (-70 ms, 60 ms), the largest of which amounts to about three samples using the 31.25 Hz sampling frequency used in this study.SignificanceUse of the proposed algorithm for estimating spatiotemporal gait variables is supported by the strong correlations with reference measurements. The gait event estimation error distributions provide bounds on the estimated gait events for enforcing gait phase-dependent task constraints for biomechanical analysis.
| S-EPMC7388785 | biostudies-literature
Project description:BackgroundAxial spondyloarthritis (axSpA) can lead to spinal mobility restrictions associated with restricted lower limb ranges of motion, thoracic kyphosis, spinopelvic ankylosis, or decrease in muscle strength. It is well known that these factors can have consequences on spatiotemporal gait parameters during walking. However, no study has assessed spatiotemporal gait parameters in patients with axSpA. Divergent results have been obtained in the studies assessing spatiotemporal gait parameters in ankylosing spondylitis, a subgroup of axSpA, which could be partly explained by self-reported pain intensity scores at time of assessment. Inertial measurement units (IMUs) are increasingly popular and may facilitate gait assessment in clinical practice.ObjectiveThis study compared spatiotemporal gait parameters assessed with foot-worn IMUs in patients with axSpA and matched healthy individuals without and with pain intensity score as a covariate.MethodsA total of 30 patients with axSpA and 30 age- and sex-matched healthy controls performed a 10-m walk test at comfortable speed. Various spatiotemporal gait parameters were computed from foot-worn inertial sensors including gait speed in ms-1 (mean walking velocity), cadence in steps/minute (number of steps in a minute), stride length in m (distance between 2 consecutive footprints of the same foot on the ground), swing time in percentage (portion of the cycle during which the foot is in the air), stance time in percentage (portion of the cycle during which part of the foot touches the ground), and double support time in percentage (portion of the cycle where both feet touch the ground).ResultsAge, height, and weight were not significantly different between groups. Self-reported pain intensity was significantly higher in patients with axSpA than healthy controls (P<.001). Independent sample t tests indicated that patients with axSpA presented lower gait speed (P<.001) and cadence (P=.004), shorter stride length (P<.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than healthy controls. When using pain intensity as a covariate, spatiotemporal gait parameters were still significant with patients with axSpA exhibiting lower gait speed (P<.001), shorter stride length (P=.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than matched healthy controls. Interestingly, there were no longer statistically significant between-group differences observed for the cadence (P=.17).ConclusionsGait was significantly altered in patients with axSpA with reduced speed, cadence, stride length, and swing time and increased double support and stance time. Taken together, these changes in spatiotemporal gait parameters could be interpreted as the adoption of a so-called cautious gait pattern in patients with axSpA. Among factors that may influence gait in patients with axSpA, patient self-reported pain intensity could play a role. Finally, IMUs allowed computation of spatiotemporal gait parameters and are usable to assess gait in patients with axSpA in clinical routine.Trial registrationClinicalTrials.gov NCT03761212; https://clinicaltrials.gov/ct2/show/NCT03761212.International registered report identifier (irrid)RR2-10.1007/s00296-019-04396-4.
| S-EPMC8663701 | biostudies-literature