Claudia Mazzà

Control of the upper body accelerations in young and elderly women during level walking

BackgroundThe control of the head movements during walking allows for the stabilisation of the optic flow, for a more effective processing of the vestibular system signals, and for the consequent control of equilibrium.In young individuals, the oscillations of the upper body during level walking are characterised by an attenuation of the linear acceleration going from pelvis to head level. In elderly subjects the ability to implement this motor strategy is reduced. The aim of this paper is to go deeper into the mechanisms through which the head accelerations are controlled during level walking, in both young and elderly women specifically.MethodsA stereophotogrammetric system was used to reconstruct the displacement of markers located at head, shoulder, and pelvis level while 16 young (age: 24 ± 4 years) and 20 older (age: 72 ± 4 years) female volunteers walked at comfortable and fast speed along a linear pathway. The harmonic coefficients of the displacements in the medio-lateral (ML), antero-posterior (AP), and vertical (V) directions were calculated via discrete Fourier transform, and relevant accelerations were computed by analytical double differentiation. The root mean square of the accelerations were used to define three coefficients for quantifying the attenuations of the accelerations from pelvis to head, from pelvis to shoulder, and from shoulder to head.ResultsThe coefficients of attenuation were shown to be independent from the walking speed, and hence suitable for group and subject comparison.The acceleration in the AP direction was attenuated by the two groups both from pelvis to shoulder and from shoulder to head. The reduction of the shoulder to head acceleration, however, was less effective in older women, suggesting that the ability to exploit the cervical hinge to attenuate the AP acceleration is challenged in this population. Young women managed to exploit a pelvis to shoulder attenuation strategy also in the ML direction, whereas in the elderly group the head acceleration was even larger than the pelvis acceleration.ConclusionThe control of the head acceleration is fundamental when implementing a locomotor strategy and its loss could be one of the causes for walking instability in elderly women.

Step detection and activity recognition accuracy of seven physical activity monitors.

The aim of this study was to compare the seven following commercially available activity monitors in terms of step count detection accuracy: Movemonitor (Mc Roberts), Up (Jawbone), One (Fitbit), ActivPAL (PAL Technologies Ltd.), Nike+ Fuelband (Nike Inc.), Tractivity (Kineteks Corp.) and Sensewear Armband Mini (Bodymedia). Sixteen healthy adults consented to take part in the study. The experimental protocol included walking along an indoor straight walkway, descending and ascending 24 steps, free outdoor walking and free indoor walking. These tasks were repeated at three self-selected walking speeds. Angular velocity signals collected at both shanks using two wireless inertial measurement units (OPAL, ADPM Inc) were used as a reference for the step count, computed using previously validated algorithms. Step detection accuracy was assessed using the mean absolute percentage error computed for each sensor. The Movemonitor and the ActivPAL were also tested within a nine-minute activity recognition protocol, during which the participants performed a set of complex tasks. Posture classifications were obtained from the two monitors and expressed as a percentage of the total task duration. The Movemonitor, One, ActivPAL, Nike+ Fuelband and Sensewear Armband Mini underestimated the number of steps in all the observed walking speeds, whereas the Tractivity significantly overestimated step count. The Movemonitor was the best performing sensor, with an error lower than 2% at all speeds and the smallest error obtained in the outdoor walking. The activity recognition protocol showed that the Movemonitor performed best in the walking recognition, but had difficulty in discriminating between standing and sitting. Results of this study can be used to inform choice of a monitor for specific applications.

Exercise induced muscle damage and recovery assessed by means of linear and non-linear sEMG analysis and ultrasonography

This study was aimed at investigating the time-course and recovery from eccentric (EC) exercise induced muscle damage by means of surface electromyography (sEMG), ultrasonography (US), and blood enzymes. Five subjects (EC Group) performed two bouts of 35 EC maximum contractions with the biceps brachii of their non dominant arm, five subjects were tested without performing EC (Control Group: CNT). The maximal isometric force (MVC) was measured. Force and sEMG signals were recorded during 80% MVC isometric contractions. In EC and CNT subjects US assessment on non-dominant biceps brachii was performed; creatin kinase (CK) and lactic dehydrogenasis (LDH) plasma levels were also assessed. Force, sEMG and CK-LDH measurements were performed before EC and after it periodically for 4 weeks. The sEMG was analysed in time and frequency domains; a non-linear analysis (Lyapunov 1st exponent, L1) of sEMG was also performed. After EC, the MVC was reduced by 40% on average with respect to the pre-EC values. A significant decrease in the initial frequency content, and in the MDF and L1 decay (13-42% less than the pre-EC values, respectively) was also observed. The sEMG amplitude (Root Mean Square, RMS) was unchanged after EC. The US revealed an increase in muscle belly thickness and in local muscle blood flow after EC. A complete recovery of all the considered parameters was achieved in two weeks. In conclusion sEMG analysis was confirmed as an early indicator of muscle damage. Muscle recovery from damage is followed by both sEMG and US and this may have useful clinical implications. Non linear analysis (L1) was revealed to be sensitive to early sEMG modifications induced by EC as well as able to follow the post EC changes in the sEMG.

An enhanced estimate of initial contact and final contact instants of time using lower trunk inertial sensor data

This study introduces a new method of extracting initial and final contact gait time events from vertical acceleration, measured with one waist mounted inertial measurement unit, by means of continuous wavelet transforms. The method was validated on 18 young healthy subjects and compared to two others available in the literature. Of the three methods investigated, the new one was the most accurate at identifying the existence and timing of initial and final contacts with the ground, with an average error of 0.02±0.02 s and 0.03±0.03 s (approximately 2% and 3% of mean stride duration), respectively.

Free-living monitoring of Parkinson's disease: Lessons from the field.

Wearable technology comprises miniaturized sensors (eg, accelerometers) worn on the body and/or paired with mobile devices (eg, smart phones) allowing continuous patient monitoring in unsupervised, habitual environments (termed free‐living). Wearable technologies are revolutionizing approaches to health care as a result of their utility, accessibility, and affordability. They are positioned to transform Parkinsons disease (PD) management through the provision of individualized, comprehensive, and representative data. This is particularly relevant in PD where symptoms are often triggered by task and free‐living environmental challenges that cannot be replicated with sufficient veracity elsewhere. This review concerns use of wearable technology in free‐living environments for people with PD. It outlines the potential advantages of wearable technologies and evidence for these to accurately detect and measure clinically relevant features including motor symptoms, falls risk, freezing of gait, gait, functional mobility, and physical activity. Technological limitations and challenges are highlighted, and advances concerning broader aspects are discussed. Recommendations to overcome key challenges are made. To date there is no fully validated system to monitor clinical features or activities in free‐living environments. Robust accuracy and validity metrics for some features have been reported, and wearable technology may be used in these cases with a degree of confidence. Utility and acceptability appears reasonable, although testing has largely been informal. Key recommendations include adopting a multidisciplinary approach for standardizing definitions, protocols, and outcomes. Robust validation of developed algorithms and sensor‐based metrics is required along with testing of utility. These advances are required before widespread clinical adoption of wearable technology can be realized.

An optimized Kalman filter for the estimate of trunk orientation from inertial sensors data during treadmill walking

The aim of this study was the fine tuning of a Kalman filter with the intent to provide optimal estimates of lower trunk orientation in the frontal and sagittal planes during treadmill walking at different speeds using measured linear acceleration and angular velocity components represented in a local system of reference. Data were simultaneously collected using both an inertial measurement unit (IMU) and a stereophotogrammetric system from three healthy subjects walking on a treadmill at natural, slow and fast speeds. These data were used to estimate the parameters of the Kalman filter that minimized the difference between the trunk orientations provided by the filter and those obtained through stereophotogrammetry. The optimized parameters were then used to process the data collected from a further 15 healthy subjects of both genders and different anthropometry performing the same walking tasks with the aim of determining the robustness of the filter set up. The filter proved to be very robust. The root mean square values of the differences between the angles estimated through the IMU and through stereophotogrammetry were lower than 1.0° and the correlation coefficients between the corresponding curves were greater than 0.91. The proposed filter design can be used to reliably estimate trunk lateral and frontal bending during walking from inertial sensor data. Further studies are needed to determine the filter parameters that are most suitable for other motor tasks.

Association between subject functional status, seat height, and movement strategy in sit-to-stand performance.

Objectives: To explore the association between an individuals functional status, movement task difficulty, and effectiveness of compensatory movement strategies within a sit‐to‐stand (STS) paradigm.

Real-time Estimate of Body Kinematics During a Planar Squat Task Using a Single Inertial Measurement Unit

This study aimed at the real-time estimation of the lower-limb joint and torso kinematics during a squat exercise, performed in the sagittal plane, using a single inertial measurement unit placed on the lower back. The human body was modeled with a 3-DOF planar chain. The planar IMU orientation and vertical displacement were estimated using one angular velocity and two acceleration components and a weighted Fourier linear combiner. The ankle, knee, and hip joint angles were thereafter obtained through a novel inverse kinematic module based on the use of a Jacobian pseudoinverse matrix and null-space decoupling. The aforementioned algorithms were validated on a humanoid robot for which the mechanical model used and the measured joint angles virtually exhibited no inaccuracies. Joint angles were estimated with a maximal error of 1.5°. The performance of the proposed analytical and experimental methodology was also assessed by conducting an experiment on human volunteers and by comparing the relevant results with those obtained through the more conventional photogrammetric approach. The joint angles provided by the two methods displayed differences equal to 3 ± 1°. These results, associated with the real-time capability of the method, open the door to future field applications in both rehabilitation and sport.

Control of the upper body movements during level walking in patients with facioscapulohumeral dystrophy

Facioscapulohumeral dystrophy (FSHD) is a muscular disease usually spreading from upper to lower body and characterised by asymmetric muscle weakness. Walking ability is compromised in these patients, with a consequent high risk of falls. A quantitative analysis of the upper body oscillations may unveil useful information about the capacity of these patients to stabilise the head, maintain balance, and compensate for lower limb muscle weakness during walking. This study involved 13 patients with FSHD and 13 healthy volunteers. The trajectories of three points located on the cranio-caudal axis, at head, shoulder, and pelvis levels, during level walking, were analysed. The range of motion of these three points and the attenuation of the relevant accelerations going from pelvis to head level were used to describe the upper body movements during walking. The patients had wider and less symmetrical oscillations than the healthy controls both in antero-posterior and medio-lateral directions. Furthermore, the capacity of the patients to attenuate the accelerations going from pelvis to head level was reduced. These features may be related not only to upper body muscle weakness, but also to a strategy functional to the compensation of proximal leg muscle weakness. In conclusion, this study highlighted that the control of upper body oscillations and of head stability is reduced in patients with FSHD, suggesting that the assessment of the upper body movements should be included in the treatment decision process.

A least-squares identification algorithm for estimating squat exercise mechanics using a single inertial measurement unit

This study investigated the possibility of estimating lower-limb joint kinematics during a squat exercise performed in the sagittal plane based on data collected from a single inertial measurement unit located on the lower trunk. The human body was modeled as a three-degrees-of-freedom planar chain and the relevant joint angles (ankle, knee, and hip) are represented by Fourier series. A least-squares approach based on the minimization of the difference between the measured and estimated linear accelerations and the angular velocity of the lower trunk was used to solve the related analytical problem. The approach was validated on ten healthy young volunteers (ten trials each) using a force plate and a stereophotogrammetric system to collect reference data. The root mean square differences between the estimated joint angles and those reconstructed with the stereophotogrammetric system were lower than 4° with correlation coefficients higher than 0.99. The ankle joint resultant vertical force component was estimated with an accuracy of about 3% and a high correlation coefficient of r=0.95, whereas much lower percentage accuracies were found for the horizontal force and couple components. The latter accuracies were similar to those affecting these force and couple components as estimated through inverse dynamics and the stereophotogrammetric data in conjunction with the same mechanical model, which suggests that only minor errors were introduced by the proposed algorithm and measurement tools.