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Frailty assessment based on wavelet analysis during quiet standing balance test

BACKGROUND A standard phenotype of frailty was independently associated with an increased risk of adverse outcomes including comorbidity, disability and with increased risks of subsequent falls and fractures. Postural control deficit measurement during quiet standing has been often used to assess balance and fall risk in elderly frail population. Real time human motion tracking is an accurate, inexpensive and portable system to obtain kinematic and kinetic measurements. The aim of this study was to examine orientation and acceleration signals from a tri-axial inertial magnetic sensor during quiet standing balance tests using the wavelet transform in a frail, a prefail and a healthy population. METHODS Fourteen subjects from a frail population (79±4 years), eighteen subjects from a prefrail population (80±3 years) and twenty four subjects from a healthy population (40±3 years) volunteered to participate in this study. All signals were analyzed using time-frequency information based on wavelet decomposition and principal component analysis. FINDINGS The absolute sum of the coefficients of the wavelet details corresponding to the high frequencies component of orientation and acceleration signals were associated with frail syndrome. INTERPRETATION These parameters could be of great interest in clinical settings and improved rehabilitation therapies and in methods for identifying elderly population with frail syndrome.

Kinematic parameters to evaluate functional performance of sit-to-stand and stand-to-sit transitions using motion sensor devices: a systematic review.

Clinicians commonly use questionnaires and tests based on daily life activities to evaluate physical function. However, the outcomes are usually more qualitative than quantitative and subtle differences are not detectable. In this review, we aim to assess the role of body motion sensors in physical performance evaluation, especially for the sit-to-stand and stand-to-sit transitions. In total, 53 full papers and conference abstracts on related topics were included and 16 different parameters related to transition performance were identified as potentially meaningful to explain certain disabilities and impairments. Transition duration is the most used to evaluate chair-related tests in real clinical settings. High-fall-risk fallers and frail subjects presented longer and more variable transition duration. Other kinematic parameters have also been highlighted in the literature as potential means to detect age-related impairments. In particular, vertical linear velocity and trunk tilt range were able to differentiate between different frailty levels. Frequency domain measures such as spectral edge frequency were also higher for elderly fallers. Lastly, approximate entropy values were larger for subjects with Parkinsons disease and were significantly reduced after treatment. This information could help clinicians in their evaluations as well as in prescribing a physical fitness program to correct a specific deficit.

Wavelet analysis based on time–frequency information discriminate chronic ankle instability

BACKGROUND Ankle sprains are one of the most common lower extremity injuries. Real time human motion tracking is an accurate, inexpensive and portable system to obtain kinematic and kinetic measurements. The purpose of this study was to discriminate between subjects with chronic ankle instability and subjects with stable ankles through inertial tracking technology and force plates. METHODS Twelve subjects (mean (SD) 23.16 (5.32) years, 174.83 (8.78) cm, 73.58 (17.10) kg) with stable ankles and 13 (mean (SD) 24.69 (5.91) years, 173.31 (9.07) cm, 69.61 (15.32) kg) with chronic ankle instability performed the Star Excursion Balance Test. Time-frequency information based on wavelet decomposition was used for analysing all signals. FINDINGS Dynamic balance impairment associated with chronic ankle instability was observed in the peak amplitude in the wavelet approximation as well as the absolute sum of the coefficients of the wavelet details of the acceleration, orientation and force signals. These results were found despite Star Excursion Balance Test performance during anterior, posteromedial and posterolateral excursions lead to similar specific reach distances in both limbs in either the chronic ankle instability or stable ankle groups. INTERPRETATION These parameters could be of great interest in detecting dynamic balance impairment in individuals at risk of sprains that might otherwise go undetected by only reach distance assessment.

Automatic Evaluation of the 30-s Chair Stand Test Using Inertial/Magnetic-Based Technology in an Older Prefrail Population

The aim of this study was to evaluate the inertial measures of the 30-s chair stand test using modern body-fixed motion sensors. Polynomial data fitting was used to correct the drift effect in the position estimation. Thereafter, the three most important test cycles phases (“impulse,” “stand up,” and “sit down”) were characterized and automatically analyzed. Automated test control is provided, making it possible for researchers without engineering knowledge to run the test. A collection of meaningful data based on kinematic variables is selected for further research. The proposed methodology for data analysis is a feasible tool for use in clinical settings. This method may not only improve rehabilitation therapies but also identify people at risk for falls more accurately than simply evaluating the number of cycles.

Preoperative Ambulatory Measurement of Asymmetric Leg Loading During Sit-to-Stand in Hip Arthroplasty Patients

Total hip arthroplasty (TGA) is a successful surgical procedure to treat patients with hip osteoarthritis. Clinicians use different questionnaires to evaluate these patients. Gait velocity and these questionnaires; usually show significant improvement after TGA . This clinical evaluation does, however, not provide objective, quantifiable information about the movement patterns underlying the functional capacity, which is clinically important and can currently only be obtained in a gait laboratory. There is a need to improve patient instructions and to quantify the rehabilitation process. The sit-to-stand (STS) movement is an objective performance-based task, whose assessment is related with the evaluation of functional recovery. Twenty two patients with hip osteoarthritis participated in this study. For each patient, validated questionnaires were administered and gait velocity was measured. Time, ground reaction forces, and lower limb asymmetry parameters were calculated using the instrumented force shoes (IFS) during STS movement with and without armrest. Significant inter-limb asymmetry was observed. No correlation was found between any parameter and gait velocity and questionnaires outcomes. Significant differences in time and force parameters between with/without armrest were found. Concluding, inter-limb asymmetry can be evaluated with the IFS supplying important additional information not represented by gait velocity and questionnaires usually used.

Frailty assessment based on trunk kinematic parameters during walking

BackgroundPhysical 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.MethodsA 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.FindingsThe 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.InterpretationGait 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.

Pre-operative ambulatory measurement of asymmetric lower limb loading during walking in total hip arthroplasty patients

BackgroundTotal hip arthroplasty is a successful surgical procedure to treat hip osteoarthritis. Clinicians use different questionnaires to assess the patient’s pain and functional capacity. Furthermore, they assess the quality of gait in a very global way.This clinical evaluation usually shows significant improvement after total hip arthroplasty, however, does not provide objective, quantifiable information about the movement patterns underlying the functional capacity, which can currently only be obtained in a gait laboratory. Instrumented force shoes can quantify gait velocity, ground reaction forces and the gait pattern easily in an outpatient setting.The main goal of this study was to investigate how mobility characteristics during walking, relate to gait velocity and questionnaire outcomes of patients with hip osteoarthritis in an outpatient setting.Methods22 patients with primary osteoarthritis of the hip selected for a total hip arthroplasty participated in this study. For each patient the Harris Hip Score, the Traditional Western Ontario and the McMaster Universities osteoarthritis index were administered. Subsequently, the patients were instructed to walk through the corridor while wearing instrumented shoes. The gait velocity estimated with the instrumented force shoes was validated measuring the time required to walk a distance of 10 m using a stopwatch and a measuring tape as a reference system. A regression analysis between spatial, temporal, ground reaction force parameters, including asymmetry, and the gait velocity and the questionnaires outcomes was performed.ResultsThe velocity estimated with the instrumented shoes did not differ significantly from the velocity measured independently. Although gait parameters correlated significantly with velocity, symmetry index parameters were not correlated with velocity. These symmetry index parameters show significant inter-limb asymmetry during walking. No correlation was found between any of the variables studied and questionnaires outcomes.ConclusionInter-limb asymmetry can be evaluated with the instrumented shoes supplying important additional information about the individual gait pattern, which is not represented by gait velocity and questionnaires usually used. Therefore, this new ambulatory measurement system is able to provide complementary information to gait velocity and questionnaires outcomes to assess the functional capacity of patients with hip osteoarthritis.

Assessment of asymmetric leg loading before and after total hip arthroplasty using instrumented shoes

BackgroundTotal hip arthroplasty is a successful surgical treatment in patients with osteoarthritis of the hip. Different questionnaires are used by the clinicians to assess functional capacity and the patients pain, despite these questionnaires are known to be subjective. Furthermore, many studies agree that kinematic and kinetic parameters are crucial to evaluate and to provide useful information about the patient’s evolution for clinicians and rehabilitation specialists. However, these quantities can currently only be obtained in a fully equipped gait laboratory. Instrumented shoes can quantify gait velocity, kinetic, kinematic and symmetry parameters. The aim of this study was to investigate whether the instrumented shoes is a sufficiently sensitive instrument to show differences in mobility performance before and after total hip arthroplasty.MethodsIn this study, patients undergoing total hip arthroplasty were measured before and 6–8 months after total hip arthroplasty. Both measurement sessions include 2 functional mobility tasks while the subject was wearing instrumented shoes. Before each measurement the Harris Hip Score and the Traditional Western Ontario and McMaster Universities osteoarthritis index were administered as well.ResultsThe stance time and the average vertical ground reaction force measured with the instrumented shoes during walking, and their symmetry index, showed significant differences before and after total hip arthroplasty. However, the data obtained with the sit to stand test did not reveal this improvement after surgery.ConclusionsOur results show that inter-limb asymmetry during a walking activity can be evaluated with the instrumented shoes before and after total hip arthroplasty in an outpatient clinical setting.

Drift-Free Position Estimation for Periodic Movements Using Inertial Units

Latest advances in microelectromechanical systems have made inertial units (IUs) a powerful tool for human motion analysis. However, difficulties in handling their output signals must be overcome. The purpose of this study was to develop the novel “PB-algorithm” based on polynomial data fitting, splines interpolation, and the wavelet transform, one after the other, to cancel drift disturbances in position estimation for periodic movements. High-accuracy position measurements from an optical system (Vicon Nexus 1.0) were used to validate the proposed method and comparison with another drift-correction algorithm was provided. Results indicate the accuracy with respect to the Vicons reference signal (euclidean error lower than 54.62 × 10 -3 m and correlation coefficient higher than 0.968). A reduction of the root-mean-square error of 68.74% was obtained when the proposed two-step method was compared with a modified-band limited Fourier linear combiner. All methods were applied to data from the 30-s chair stand test, which is one of the most used clinical tests dealing with lower body strength assessment, falls prediction, and gait disorders in older adults. The relevance of this study is that after cancelling drift disturbances, and obtaining an accurate Z-position estimation, it is possible to evaluate the sit-to-stand and stand-to-sit transitions from the whole test.

Sprint mechanics evaluation using inertial sensor-based technology : A laboratory validation study

Advances in micro‐electromechanical systems have turned magnetic inertial measurement units (MIMUs) into a suitable tool for vertical jumping biomechanical evaluation. Thus, this study aimed to determine whether appropriate reliability and agreement reports could also be obtained when analyzing 20‐m sprint mechanics. Four bouts of 20‐m sprints were evaluated to determine whether the data provided by a MIMU placed at the lumbar spine could reliably assess sprint mechanics and to examine the validity of the MIMU sensor compared to force plate recordings. Maximal power (P0), force (F0), and velocity (V0), as well as other mechanical determinants of sprint performance associated with the force‐velocity, power‐velocity, and ratio of forces‐velocity, such as applied horizontal force loss (Sfv) and decrease in ratio of forces (Drf), were calculated and compared between instrumentations. Extremely large‐to‐very large correlation levels between MIMU sensor‐based sprint mechanics variables and force plate recordings were obtained (mean±SD, force plate vs MIMU; V0, 8.61±0.85 vs 8.42±0.69; F0, 383±110 vs 391±103; P0, 873±246 vs 799±241; Sfv, −44.6±12.7 vs −46.2±10.7), ranging from 0.88 to 0.94, except for Drf, which showed weak‐to‐moderate correlation level (r=.45; −6.32±1.08 vs −5.76±0.68). Step‐averaged force values measured with both systems were highly correlated (r=.88), with a regression slope close to the identity (1.01). Bland and Altman graphical representation showed a no random distribution of measured force values. Finally, very large‐to‐extremely large retest correlation coefficients were found for the intertrial reliability of MIMU measurements of sprint performance variables (r value ranging from .72 to .96). Therefore, MIMUs showed appropriate validity and reliability values for 20‐m sprint performance variables.