Enrica Papi

Use of wearable technology for performance assessment: A validation study

Highlights • We assessed three sensors in monitoring activity performance.• A novel flexible sensor system was validated.• A functional sensor placement is as valid as a more conventional one.• A frequency domain approach was successfully applied to evaluate outcome measures.

Analysis of gait within the uncontrolled manifold hypothesis: Stabilisation of the centre of mass during gait

This study investigated the feasibility of the uncontrolled manifold approach (UCM) to analyse gait data variability in relation to the control of the centre of mass (COM) in adults with and without neuropathology. The proposed method was applied to six able-bodied subjects to characterise mechanisms of normal postural control during stance phase. This approach was repeated on an early stroke patient, who attended the laboratory three times at three monthly intervals, to characterise the variability of COM movement during walking with and without an orthosis. Both able-bodied subjects and the stroke participant controlled COM movement during stance but utilized a different combination of lower limb joint kinematics to ensure that the COM trajectory was not compromised. Interestingly, the stroke subject, despite a higher variability in joint kinematics, was able to maintain a stable COM position throughout stance phase. The stabilisation of the COM decreased when the patient walked unaided without the prescribed orthosis but increased over the six months of study. The UCM analysis demonstrated how a stroke patient used a range of lower limb motion pattern to stabilise the COM trajectory. It is suggested that this analysis can be used to track changes in these movement patterns in response to rehabilitation. As such we propose that this approach could have clinical utility to evaluate and prescribe rehabilitation in stroke patients.

A knee monitoring device and the preferences of patients living with osteoarthritis: a qualitative study

Objectives To identify perspective of patients with osteoarthritis, in particular design requirements and mode of use, of wearable technology to support the rehabilitation pathway. This study is part of a user-centred design approach adopted to develop a rehabilitation tool for patients with osteoarthritis. Design Qualitative study using a focus group approach; data management via a thematic analysis of patients’ responses. Participants 21 patients with osteoarthritis (age range 45–65 years) participated in 1 of the 4 focus groups. Recruitment continued until data saturation. Setting The study was conducted in a university setting. Results Main determinants of user acceptance of a wearable technology were appearance and comfort during use. Patients were supportive of the use of wearable technologies during rehabilitation and could recognise their benefit as monitors for their progress, incentives to adhere to exercise, and tools for more informed interaction with clinicians. Conclusions This paper should encourage adoption and development of wearable technology to support rehabilitation of patients with osteoarthritis. It is pivotal that technological development takes into account patients’ views in that it should be small, light, discrete, not ‘appear medical’ or challenge the identity of the user. Derived data should be available to patients and clinicians. Furthermore, wearable technologies should be developed to operate in two modes: for exercise guidance and assessment only, and for unobtrusive everyday monitoring. The information obtained from this study should guide the design of new technologies and support their use in clinical practice.

Impact of wearable technology on psychosocial factors of osteoarthritis management: a qualitative study

Objectives To identify the impact the use of wearable technology could have in patients with osteoarthritis in terms of communication with healthcare providers and patients’ empowerment to manage their condition. Design Qualitative study using focus groups with patients with osteoarthritis; data from patients’ responses were analysed using Framework Methodology. Participants 21 patients with knee osteoarthritis from the London area (age range 45–65 years) participated in a total of four focus groups. Recruitment continued until data saturation. Setting The study was conducted in a university setting. Results Patients’ responses suggested a positive attitude on the impact wearable technology could have on the management of osteoarthritis. It was perceived that the use of wearable devices would benefit patients in terms of feeling in control of their condition, providing them with awareness of their progress, empowering in terms of self-management and improving communication with their clinician. Conclusions This paper suggests positive patient perspectives on the perceived benefits wearable technology could have on the management of osteoarthritis. The data that could be collected with the use of wearable technology could be beneficial both to patients and clinicians. The information obtained from this study suggests that introducing wearable technology into patient-centred care could enhance patient experience in the field of osteoarthritis and beyond.

Smart Sensing System for Combined Activity Classification and Estimation of Knee Range of Motion

This paper proposes a novel wearable system and assesses its reliability in monitoring sagittal knee movement, and discriminating between activities of daily living. The system consists of a flexible conductive polymer unit, embedded into a pair of leggings at the level of the knee, interfaced with a customized sensing node for wireless data acquisition. Design constraints included the need for the system to be unobtrusive, low cost, low power, and simple to use. The wearable system was evaluated through a series of trials conducted on healthy participants, tested on two different occasions, while walking, running, and going up and down a set of stairs. The waveforms of the sensor output resemble typical knee kinematics curves. An intraclass correlation coefficient greater than 0.8 was obtained for the output signal of the sensor from which, knee movement is derived for each of the different activities. Time and frequency domain features of the signal were used to discriminate between activities. Results show good discriminative capacity of selected parameters to an accuracy of 93% when employing a random forest analytical approach. These results suggest that the system can be used accurately to monitor both knee movement and activity performed in unconstrained environments, and thus suggesting its potential use to support knee rehabilitation.

Predicting knee osteoarthritis risk in injured populations

Background Individuals who suffered a lower limb injury have an increased risk of developing knee osteoarthritis. Early diagnosis of osteoarthritis and the ability to track its progression is challenging. This study aimed to explore links between self‐reported knee osteoarthritis outcome scores and biomechanical gait parameters, whether self‐reported outcome scores could predict gait abnormalities characteristic of knee osteoarthritis in injured populations and, whether scores and biomechanical outcomes were related to osteoarthritis severity via Spearmans correlation coefficient. Methods A cross‐sectional study was conducted with asymptomatic participants, participants with lower‐limb injury and those with medial knee osteoarthritis. Spearman rank determined relationships between knee injury and outcome scores and hip and knee kinetic/kinematic gait parameters. K‐Nearest Neighbour algorithm was used to determine which of the evaluated parameters created the strongest classifier model. Findings Differences in outcome scores were evident between groups, with knee quality of life correlated to first and second peak external knee adduction moment (0.47, 0.55). Combining hip and knee kinetics with quality of life outcome produced the strongest classifier (1.00) with the least prediction error (0.02), enabling classification of injured subjects gait as characteristic of either asymptomatic or knee osteoarthritis subjects. When correlating outcome scores and biomechanical outcomes with osteoarthritis severity only maximum external hip and knee abduction moment (0.62, 0.62) in addition to first peak hip adduction moment (0.47) displayed significant correlations. Interpretation The use of predictive models could enable clinicians to identify individuals at risk of knee osteoarthritis and be a cost‐effective method for osteoarthritis screening. HighlightsIndividuals with lower limb injury have increased a risk of early on‐set osteoarthritis.Current diagnosis techniques only identify established osteoarthritis.Biomechanical and self‐reported questionnaires may be strongly correlated in gait.Prediction models could aid clinicians identify risk of osteoarthritis during gait.Self‐reported questionnaires have low correlation to radiographic knee scans.

Wearable technology for spine movement assessment: A systematic review

Continuous monitoring of spine movement function could enhance our understanding of low back pain development. Wearable technologies have gained popularity as promising alternative to laboratory systems in allowing ambulatory movement analysis. This paper aims to review the state of art of current use of wearable technology to assess spine kinematics and kinetics. Four electronic databases and reference lists of relevant articles were searched to find studies employing wearable technologies to assess the spine in adults performing dynamic movements. Two reviewers independently identified relevant papers. Customised data extraction and quality appraisal form were developed to extrapolate key details and identify risk of biases of each study. Twenty-two articles were retrieved that met the inclusion criteria: 12 were deemed of medium quality (score 33.4–66.7%), and 10 of high quality (score >66.8%). The majority of articles (19/22) reported validation type studies. Only 6 reported data collection in real-life environments. Multiple sensors type were used: electrogoniometers (3/22), strain gauges based sensors (3/22), textile piezoresistive sensor (1/22) and accelerometers often used with gyroscopes and magnetometers (15/22). Two sensors units were mainly used and placing was commonly reported on the spine lumbar and sacral regions. The sensors were often wired to data transmitter/logger resulting in cumbersome systems. Outcomes were mostly reported relative to the lumbar segment and in the sagittal plane, including angles, range of motion, angular velocity, joint moments and forces. This review demonstrates the applicability of wearable technology to assess the spine, although this technique is still at an early stage of development.

Wearable technologies in osteoarthritis: a qualitative study of clinicians’ preferences

Objective This study investigates clinicians’ views of health-related wearable technologies in the context of supporting osteoarthritis (OA) long-term management. Clinicians’ preferences are critical in identifying realistic implementation strategies for such technologies. Design Qualitative study incorporating an inductive thematic analysis applied to identify key themes from clinicians’ responses. Participants Clinicians, including 4 general practitioners, 4 physiotherapists and 5 orthopaedic surgeons were interviewed. Setting The study was conducted in a University setting. Results Participants all agreed wearable technologies could positively complement their role and enhance their relationship with patients. Perceived benefits of wearable technologies included monitoring patients’ progress, treatment evaluation, monitoring compliance and informing clinical decision-making. The device should be designed to provide objective data of patients’ locomotion capability in an easy and timely fashion via a simple interface. Data should be available to both clinicians and patients to provide them with the motivation to achieve clinical goals and allow them to take ownership of their treatment. The use of technology was also seen as a way to more effectively plan treatment and manage patients’ contact time saving time and cost. Conclusions Findings support the use of wearable technologies to enhance current OA management and suggest clinical uses. Adoption of technologies could have implications on the effectiveness of treatment provided overcoming current barriers, in particular compliance with treatment.

Determination of loads carried by polypropylene ankle-foot orthoses: a preliminary study.

Ankle–foot orthoses (AFOs) are prescribed for the management of gait-related problems. Prescription of AFOs is based on empirical techniques due to the low level of evidence-based research on their efficacy, but primarily poor understanding of their mechanical characteristics. This study aimed to establish a method that would allow the quantification of the contribution of AFOs in the control of the ankle joint during gait. A possible way of achieving this aim would be to measure strain on the AFO during walking by the use of strain gauges. Following successful experimentation with the application of strain gauges to polypropylene tensile specimens, an AFO was instrumented by attaching strain gauges to it so as to allow the moment generated on the AFO in the sagittal plane about the ankle to be measured. Walking trials using this AFO on an able-bodied subject indicated good step-to-step repeatability. The use of an instrumented AFO in conjunction with kinematic and kinetic data acquisition would allow the contribution of the AFO and the residual anatomical loads to be determined. The advantage of such procedure over previously reported ones resides on the use of the actual orthosis being worn by patients thereby conducting tests under real-life situations. It is believed that such analysis of the load actions of an orthosis, which may in future be carried out in three dimensions, would allow a better understanding of the interaction between the leg and the orthosis. This should ultimately enhance AFO prescription criteria and help in optimising patient/device matching.

Development of a wireless multi-functional body sensing platform for smart garment integration

This paper details the development of a multi-sensor platform designed to support functional monitoring and knee rehabilitation via its integration into a smart garment. The system incorporates flexible conductive polymer sensors, interfaced to a customized body sensor node with embedded accelerometer and gyroscope sensors. The body node was specifically developed for unobtrusive sensor data acquisition and the wireless transmission of data via a Bluetooth link. To demonstrate the system, a proof of concept investigation was conducted to assess its potential for functional monitoring in the context of daily activity discrimination. Preliminary results show that walking, running, stairs climbing and descending activities can be easily discriminated based on the data collected with the developed sensing platform. Moreover, simple clustering and discrimination of tThis paper details the development of a multi-sensor platform designed to support functional monitoring and knee rehabilitation via its integration into a smart garment. The system incorporates flexible conductive polymer sensors, interfaced to a customized body sensor node with embedded accelerometer and gyroscope sensors. The body node was specifically developed for unobtrusive sensor data acquisition and the wireless transmission of data via a Bluetooth link. To demonstrate the system, a proof of concept investigation was conducted to assess its potential for functional monitoring in the context of daily activity discrimination. Preliminary results show that walking, running, stairs climbing and descending activities can be easily discriminated based on the data collected with the developed sensing platform. Moreover, simple clustering and discrimination of the tested activities is shown to be feasible based on a single time domain signal power feature.he tested activities is shown to be feasible based on a single time domain signal power feature.