Clint Hansen

Validation of a Step Detection Algorithm during Straight Walking and Turning in Patients with Parkinson’s Disease and Older Adults using an Inertial Measurement Unit at the Lower Back

Introduction Inertial measurement units (IMUs) positioned on various body locations allow detailed gait analysis even under unconstrained conditions. From a medical perspective, the assessment of vulnerable populations is of particular relevance, especially in the daily-life environment. Gait analysis algorithms need thorough validation, as many chronic diseases show specific and even unique gait patterns. The aim of this study was therefore to validate an acceleration-based step detection algorithm for patients with Parkinson’s disease (PD) and older adults in both a lab-based and home-like environment. Methods In this prospective observational study, data were captured from a single 6-degrees of freedom IMU (APDM) (3DOF accelerometer and 3DOF gyroscope) worn on the lower back. Detection of heel strike (HS) and toe off (TO) on a treadmill was validated against an optoelectronic system (Vicon) (11 PD patients and 12 older adults). A second independent validation study in the home-like environment was performed against video observation (20 PD patients and 12 older adults) and included step counting during turning and non-turning, defined with a previously published algorithm. Results A continuous wavelet transform (cwt)-based algorithm was developed for step detection with very high agreement with the optoelectronic system. HS detection in PD patients/older adults, respectively, reached 99/99% accuracy. Similar results were obtained for TO (99/100%). In HS detection, Bland–Altman plots showed a mean difference of 0.002u2009s [95% confidence interval (CI) −0.09 to 0.10] between the algorithm and the optoelectronic system. The Bland–Altman plot for TO detection showed mean differences of 0.00u2009s (95% CI −0.12 to 0.12). In the home-like assessment, the algorithm for detection of occurrence of steps during turning reached 90% (PD patients)/90% (older adults) sensitivity, 83/88% specificity, and 88/89% accuracy. The detection of steps during non-turning phases reached 91/91% sensitivity, 90/90% specificity, and 91/91% accuracy. Conclusion This cwt-based algorithm for step detection measured at the lower back is in high agreement with the optoelectronic system in both PD patients and older adults. This approach and algorithm thus could provide a valuable tool for future research on home-based gait analysis in these vulnerable cohorts.

Arm swing asymmetry in overground walking

Treadmill experiments suggest that left-dominant arm swing is common in healthy walking adults and is modulated by cognitive dual-tasking. Little is known about arm swing asymmetry in overground walking. We report directional (dASI) and non-directional arm swing symmetry indices (ndASI) from 334 adults (mean age 68.6u2009±u20095.9u2009y) walking overground at comfortable (NW) and fast (FW) speeds and while completing a serial subtraction task (DT). dASI and ndASI were calculated from sagittal shoulder range of motion data generated by inertial measurement units affixed to the wrist. Most (91%) participants were right-handed. Group mean arm swing amplitude was significantly larger on the left in all walking conditions. During NW, ndASI was 39.5u2009±u200921.8, with a dASI of 21.9u2009±u200939.5. Distribution of dASI was bimodal with an approximately 2:1 ratio of left:right-dominant arm swing. There were no differences in ndASI between conditions but dASI was smaller during DT compared to FW (15.2 vs 24.6; pu2009=u20090.009). Handedness was unrelated to ndASI, dASI or the change in ASI metrics under DT. Left-dominant arm swing is the norm in healthy human walking irrespective of walking condition or handedness. As disease markers, ndASI and dASI may have different and complementary roles.

Bedeutung der Mobilitätsmessung — Zukunftsmusik oder sinnvoll?

Tragbare Sensorsysteme erlauben es, Mobilität und Bewegungsmuster alltagsnah zu erfassen. Diese Daten können zusätzliche Informationen zur klinischen Untersuchung liefern. Für einige geriatrische Erkrankungen gibt es bereits validierte Erfassungsmöglichkeiten.

Validation of a Lower Back “Wearable”-Based Sit-to-Stand and Stand-to-Sit Algorithm for Patients With Parkinson's Disease and Older Adults in a Home-Like Environment

Introduction: Impaired sit-to-stand and stand-to-sit movements (postural transitions, PTs) in patients with Parkinsons disease (PD) and older adults (OA) are associated with risk of falling and reduced quality of life. Inertial measurement units (IMUs, also called “wearables”) are powerful tools to monitor PT kinematics. The purpose of this study was to develop and validate an algorithm, based on a single IMU positioned at the lower back, for PT detection and description in the above-mentioned groups in a home-like environment. Methods: Four PD patients (two with dyskinesia) and one OA served as algorithm training group, and 21 PD patients (16 without and 5 with dyskinesia) and 11 OA served as test group. All wore an IMU on the lower back and were videotaped while performing everyday activities for 90–180 min in a non-standardized home-like environment. Accelerometer and gyroscope signals were analyzed using discrete wavelet transformation (DWT), a six degrees-of-freedom (DOF) fusion algorithm and vertical displacement estimation. Results: From the test group, 1,001 PTs, defined by video reference, were analyzed. The accuracy of the algorithm for the detection of PTs against video observation was 82% for PD patients without dyskinesia, 47% for PD patients with dyskinesia and 85% for OA. The overall accuracy of the PT direction detection was comparable across groups and yielded 98%. Mean PT duration values were 1.96 s for PD patients and 1.74 s for OA based on the algorithm (p < 0.001) and 1.77 s for PD patients and 1.51 s for OA based on clinical observation (p < 0.001). Conclusion: Validation of the PT detection algorithm in a home-like environment shows acceptable accuracy against the video reference in PD patients without dyskinesia and controls. Current limitations are the PT detection in PD patients with dyskinesia and the use of video observation as the video reference. Potential reasons are discussed.

Clinical implications from daily physiotherapy examination of 131 acute hamstring injuries and their association with running speed and rehabilitation progression

Aim To investigate the association of daily clinical measures and the progression of rehabilitation and perceived running effort. Methods A cohort of 131 athletes with an MRI-confirmed acute hamstring injury underwent a standardised criteria-based rehabilitation protocol. Descriptive and inferential statistics were used to investigate the association between daily clinical subjective and objective measures and both the progression of rehabilitation and perceived running effort. These measures included different strength, palpation, flexibility and functional tests. Inter-rater and intrarater reliability and minimal detectable change were established for the clinical measures of strength and flexibility by examining measures taken on consecutive days for the uninjured leg. Results The progression of the daily measures was seen to be non-linear and varied according to the measure. Intra-rater reliability for the strength and flexibility measures were excellent (95%u2009CI ≥0.85 for all measures). Strength (in the outer range position) and flexibility (in maximum hip flexion with active knee extension (MHFAKE) in supine) were best associated with rehabilitation progression and perceived running effort. Additionally, length of pain on palpation was usefully associated with rehabilitation progression. At lower perceived running effort there was a large variation in actual running speed. Conclusion Daily physical measures of palpation pain, outer range strength, MHFAKE and reported pain during daily activity are useful to inform the progression of rehabilitation. Trial registration number NCT01812564 and NCT02104258.

Wearables for gait and balance assessment in the neurological ward - study design and first results of a prospective cross-sectional feasibility study with 384 inpatients

BackgroundDeficits in gait and balance are common among neurological inpatients. Currently, assessment of these patients is mainly subjective. New assessment options using wearables may provide complementary and more objective information.MethodsIn this prospective cross-sectional feasibility study performed over a four-month period, all patients referred to a normal neurology ward of a university hospital and aged between 40 and 89xa0years were asked to participate. Gait and balance deficits were assessed with wearables at the ankles and the lower back. Frailty, sarcopenia, Parkinsonism, depression, quality of life, fall history, fear of falling, physical activity, and cognition were evaluated with questionnaires and surveys.ResultsEighty-two percent (nu2009=u2009384) of all eligible patients participated. Of those, 39% (nu2009=u2009151) had no gait and balance deficit, 21% (nu2009=u200979) had gait deficits, 11% (nu2009=u200944) had balance deficits and 29% (nu2009=u2009110) had gait and balance deficits. Parkinson’s disease, stroke, epilepsy, pain syndromes, and multiple sclerosis were the most common diseases. The assessment was well accepted.ConclusionsOur study suggests that the use of wearables for the assessment of gait and balance features in a clinical setting is feasible. Moreover, preliminary results confirm previous epidemiological data about gait and balance deficits among neurological inpatients. Evaluation of neurological inpatients with novel wearable technology opens new opportunities for the assessment of predictive, progression and treatment response markers.

Sequence-dependent rotation axis changes in tennis

Abstract The purpose of this study was to evaluate the role of rotation axes during a tennis serve. A motion capture system was used to evaluate the contribution of the potential axes of rotation (minimum inertia axis, shoulder-centre of mass axis and the shoulder-elbow axis) during the four discrete tennis serve phases (loading, cocking, acceleration and follow through). Ten ranked athletes (International Tennis Number 1–3) repeatedly performed a flat service aiming at a target on the other side of the net. The four serve phases are distinct and thus, each movement phase seems to be organised around specific rotation axes. The results showed that the limbs’ rotational axis does not necessarily coincide with the minimum inertia axis across the cocking phase of the tennis serve. Even though individual serving strategies were exposed, all participants showed an effect due to the cocking phase and changed the rotation axis during the task. Taken together, the results showed that despite inter-individual differences, nine out of 10 participants changed the rotation axis towards the minimum inertia and/or the mass axis in an endeavour to maximise external rotation of the shoulder to optimally prepare for the acceleration phase.

Contribution of interaction torques during dart throwing: Differences between novices and experts

We examined if experts and novices show different utilization of the torque components impulses during dart throwing. Participants threw darts continuously at a dartboard aiming for the centre (target bulls eye). The upper-limb joint torque impulses were obtained through inverse dynamics with anthropometric and motion capture data as input. Depending on the joint degree of freedom (DOF) and movement phase (acceleration and follow-through), three main strategies of net torque (NET) impulse generation through joint muscle (MUS) and interaction (INT) torque impulses were highlighted. Firstly, our results showed that the elbow flexion-extension DOF leads the movement according to the joint leading hypothesis. Then, considering the acceleration phase, the analysis revealed differences in torque impulse decomposition between expert and novices. For the glenohumeral (GH) joint abduction-adduction and for wrist flexion, the INT torque impulse contributed positively to NET joint torque impulse in the group of experts unlike novices. This allowed to lower the necessary MUS torque impulse at these DOFs. Also, GH axial rotation was actively controlled by muscle torque impulse in the group of experts. During the follow-through, the experts used the INT torque impulse more proficiently than novices to break the elbow extension. The comparison between experts and novices through inverse dynamics document the link between the exploitation of interaction torques impulses and expertise in dart throwing for which the main objective is precision rather than velocity.

Hamstring and calf muscle activation as a function of bodyweight support during treadmill running in ACL reconstructed athletes

Rehabilitation after injury and reconstruction to the anterior cruciate ligament is thought to require a gradual reintroduction of loading, particularly during resumption of running. One strategy to achieve this is via the use of a reduced-gravity treadmill but it is unknown, if and how muscle activity varies in the reduced gravity conditions compared to regular treadmill running. Nineteen healthy participants and 18 male patients at the end of their rehabilitation (8 with a bone-patellar-bone graft, 10 with a hamstring graft) participated in this multi-muscle surface electromyography (sEMG) running study. The hamstrings and triceps surae were evaluated during a 16km/h running while at 6 different relative bodyweight conditions from 50% (half weight-bearing) to 100% (full weight-bearing). Muscle activation was examined individually as well as normalized to a composite entire activation and considered across the entire gait cycle using Statistical Parametric Mapping. The healthy participants showed differences between the 50-100% BW and 60-100% conditions and in the hamstring graft group for 60-100% and 80-100% conditions. No differences were seen comparing all loading conditions in the bone-patellar-bone graft group. For the hamstrings, from 70% BW and above, there appear to be no difference in activation patterns for any of the groups. The activation patterns of the hamstrings was essentially the same from 70% indicated bodyweight through to full weight bearing when running at 16km/h. Accordingly, when running at this relatively high speed, we do not expect any adverse effects in terms of altered motor patterns during rehabilitation of these muscles.

Performance analysis of male handball goalkeepers at the WorldHandball championship 2015

Goalkeepers have a very important role in handball. In coaching communities it is well recognized that goalkeepers’ performances can predict team ranking in major tournaments. Despite this, few studies have been conducted on elite goalkeepers participating in World Championships. Therefore, the purpose of this study was to analyse goalkeepers’ save performance during the 88 matches of the 2015 men’s World Championships tournament. Goalkeepers from 24 national teams were analysed using a tracking camera system and bespoke software (Prozone Handball V.1.2, Prozone, Leeds, UK). The purpose of this study was to examine time-motion performance parameters and to evaluate the save rates for each goalkeeper. The mean total distance covered in a game by the goalkeepers was 1634±999 m. Goalkeepers spent most of the time walking or standing. The total amount of shots to the goal was 6893, with a mean save percentage of 30% (2088 saves). A significant relationship was identified between the goalkeepers’ save statistics and the final team rankings. The save rate is important for teams to achieve a higher ranking, and therefore the selection and training of goalkeepers requires more than just assessing physical abilities. The throwing distribution and success/save rate during the Qatar 2015 Men Handball World Championships suggest strong and weak parts of the goal area, and coaches can use this information to adjust their training approaches for both goalkeepers and shooters.