Wiebren Zijlstra

Assessment of spatio-temporal gait parameters from trunk accelerations during human walking

This paper studies the feasibility of an analysis of spatio-temporal gait parameters based upon accelerometry. To this purpose, acceleration patterns of the trunk and their relationships with spatio-temporal gait parameters were analysed in healthy subjects. Based on model predictions of the bodys centre of mass trajectory during walking, algorithms were developed to determine spatio-temporal gait parameters from trunk acceleration data. In a first experiment, predicted gait parameters were compared with gait parameters determined from ground reaction forces measured by a treadmill. In a second experiment, spatio-temporal gait parameters were determined during overground walking. From the results of these experiments, it is concluded that, in healthy subjects, the duration of subsequent stride cycles and left/right steps, and estimations of step length and walking speed can be obtained from lower trunk accelerations. The possibility to identify subsequent stride cycles can be the basis for an analysis of other signals (e.g. kinematic or muscle activity) within the stride cycle.

Evaluation of Accelerometer-Based Fall Detection Algorithms on Real-World Falls

Despite extensive preventive efforts, falls continue to be a major source of morbidity and mortality among elderly. Real-time detection of falls and their urgent communication to a telecare center may enable rapid medical assistance, thus increasing the sense of security of the elderly and reducing some of the negative consequences of falls. Many different approaches have been explored to automatically detect a fall using inertial sensors. Although previously published algorithms report high sensitivity (SE) and high specificity (SP), they have usually been tested on simulated falls performed by healthy volunteers. We recently collected acceleration data during a number of real-world falls among a patient population with a high-fall-risk as part of the SensAction-AAL European project. The aim of the present study is to benchmark the performance of thirteen published fall-detection algorithms when they are applied to the database of 29 real-world falls. To the best of our knowledge, this is the first systematic comparison of fall detection algorithms tested on real-world falls. We found that the SP average of the thirteen algorithms, was (mean±std) 83.0%±30.3% (maximum value = 98%). The SE was considerably lower (SE = 57.0%±27.3%, maximum value = 82.8%), much lower than the values obtained on simulated falls. The number of false alarms generated by the algorithms during 1-day monitoring of three representative fallers ranged from 3 to 85. The factors that affect the performance of the published algorithms, when they are applied to the real-world falls, are also discussed. These findings indicate the importance of testing fall-detection algorithms in real-life conditions in order to produce more effective automated alarm systems with higher acceptance. Further, the present results support the idea that a large, shared real-world fall database could, potentially, provide an enhanced understanding of the fall process and the information needed to design and evaluate a high-performance fall detector.

Assessment of spatio-temporal parameters during unconstrained walking

This paper presents an analysis of spatio-temporal gait parameters during overground walking based upon a method that needs only lower trunk accelerations. Twenty-six healthy young subjects and 15 healthy elderly subjects participated in an experiment where overground walking was studied at different speeds. Accelerations of the lower trunk were measured by a tri-axial accelerometer connected to a portable data logger carried on the body. An analysis of trunk acceleration data produced temporal gait parameters (duration of subsequent stride cycles and left/right steps) and convincing estimations of spatial parameters (step length and walking speed). Typical differences in spatio-temporal gait parameters between young and elderly subjects could be demonstrated, i.e. a limited range of walking speeds, smaller step lengths, and a somewhat higher variability of temporal parameters in elderly subjects. It is concluded from these results that essential spatio-temporal gait parameters can be determined during overground walking using only one tri-axial accelerometer. The method is easy-to-use and does not interfere with regular walking patterns. Both the accelerometer and the data logger can be miniaturised to one small instrument that can be carried on the trunk during hours of walking. Thus, the method can easily be incorporated in current activity monitors so that 24-h monitoring of postures and activities can be combined with assessment of gait characteristics during these monitoring periods. In addition, the presented method can be a basis for more sophisticated gait analyses during overground walking, e.g. an analysis of kinematic signals or muscle activity within subsequent stride cycles.

Human neuronal interlimb coordination during split-belt locomotion

Human interlimb coordination and the adaptations in leg muscle activity were studied during walking on a treadmill with split belts. Four different belt speeds (0.5, 1.0, 1.5, 2.0 m/s) were offered in all possible combinations for the left and right leg. Subjects adapted automatically to a difference in belt speed within 10–20 stride cycles.This adaptation was achieved by a reorganization of the stride cycle with a relative shortening of the duration of the support and lengthening of the swing phase of the “fast” leg and, vice versa, in support and swing duration on the “slow” leg. The electromyogram EMG patterns were characterized by two basic observations: (1) onset and timing of EMG activity were influenced by biomechanical constraints. A shortening of the support phase on the faster side was related to an earlier onset and increase in gastrocnemius activity, while a coactivation pattern in the antagonistic leg muscles was predominant during a prolonged support phase on the slower side. (2) A differential modulation of the antagonistic leg muscles took place. An increase in ipsilateral belt speed in combination with a constant contralateral belt speed was associated with an almost linear increase in ipsilateral gastrocnemius and contralateral tibialis anterior EMG activity, while the contralateral gastrocnemius and ipsilateral tibialis anterior EMG activity were little affected. It is concluded that a modifiable timing within the stride cycle takes place with a coupling between ipsilateral support and contralateral swing phase. The neuronal control of this coupling is obviously based on ipsilateral modulation of leg extensor EMG by proprioceptive feedback and an appropriate central (e.g. spinal) modulation of contralateral tibialis anterior EMG activity.

Displacement of the pelvis during human walking: experimental data and model predictions

Abstract Displacements of the pelvis during treadmill walking were studied in dependence of walking speed, stride frequency and stride length. Displacement curves per stride cycle were described by means of harmonic analysis. Simple mechanical, or geometrical models of the bodys center of mass (COM) tajectory during walking were used to predict amplitude and timing of pelvic displacements. As predicted by inverted pendulum models, the amplitude of pelvic displacement in vertical direction depended on stride length. Anterior-posterior displacements were predicted by assuming equal maxima of potential and forward kinetic energy of the body. Predictions for left-right displacements were based upon a model that assumed a constant stride width and a sinusoidal movement pattern. In agreement with this model, the amplitude of pelvic displacement in left-right direction depended on stride frequency. The presented models give insight into mechanical mechanisms which determine the pelvic trajectory during walking. The presented data may be useful in the clinical evaluation of gait disturbances.

Mobility assessment in older people; new possibilities and challenges

A major challenge for researchers and clinicians who address health issues in the ageing population is to monitor functioning, and to timely initiate interventions that aim to prevent loss of functional abilities and to improve the quality of life of older people. With the progress of technologies in the last decades, methods have become available that use body fixed sensors (BFS) to measure aspects of human performance under real-life conditions. These methods are based on the use of miniaturised and integrated sensors in combination with lightweight, small measuring devices that both can be carried on the body without interfering with normal behaviour. This paper addresses the potential relevance of new technology for monitoring motor function in older people, thereby specifically focusing on mobility assessment. After a short introduction with background information about BFS based technology, this paper identifies areas of particular relevance, and discusses the application of ambulatory techniques for long-term monitoring of daily physical activity, fall detectors, fall risk evaluation, and assessment of motor performance such as gait and balance control. Examples are given how these techniques can become clinically relevant, particularly in the context of fall interventions for older people.

Wearable systems for monitoring mobility-related activities in older people: a systematic review:

Objective: The use of wearable motion-sensing technology offers important advantages over conventional methods for obtaining measures of physical activity and/or physical functioning in aged individuals. This review aims to identify the actual state of applying wearable systems for monitoring mobility-related activity in older populations. In this review we focus on technologies and applications, research designs, feasibility and adherence aspects, and clinical relevance of wearable motion-sensing technology. Data sources: PubMed (MEDLINE since 1990), Ovid (BIOSIS, CINAHL), and Cochrane (Central) and reference lists of all relevant articles were searched. Review methods: Two authors independently reviewed randomized and non-randomized trials on people above 65 years systematically. Quality of selected articles was scored and study results were summarised and discussed. Results: Two hundred and twenty-seven abstracts were considered. After application of inclusion criteria and full text reading, 42 articles were taken into account in a full text review. Twenty of these papers evaluated walking with step counters, other papers used varying accelerometry approaches for obtaining overall activity measures (n = 16), or for monitoring changes in body postures and activity patterns (n = 17). Seven studies explicitly mentioned feasibility and/or adherence aspects. Eight studies presented outcome evaluations of interventions. Eight articles were representing descriptive research designs, three articles were using mixed descriptive and exploratory research designs, 23 articles used exploratory research-type designs, and eight articles used experimental research designs. Conclusion: Although feasible methods for monitoring human mobility are available, evidence-based clinical applications of these methods in older populations are in need of further development.

Do Dual Tasks Have an Added Value Over Single Tasks for Balance Assessment in Fall Prevention Programs? A Mini-Review

Background: The Prevention of Falls Network Europe (ProFaNE) aims to bring together European researchers and clinicians to focus on the development of effective falls prevention programs for older people. One of the objectives is to identify suitable balance assessment tools. Assessment procedures that combine a balance task with a cognitive task may be relevant since part of all falls occurs during dual-task performance of walking or other balance activities. Objective: To evaluate whether dual-task balance assessments are more sensitive than single balance tasks in predicting falls and detecting changes in balance performance after fall interventions. Methods: A systematic literature search was performed in the databases PubMed, EMBASE, CINAHL, AMED, PsycINFO and Cochrane. Articles were selected according to the following inclusion criteria: (1) population: older adults (mean age ≧65 years), (2) assessment tool: dual task combining gait or other balance task with a cognitive task, (3) design: prospective or retrospective data collection of falls, or intervention study. Analysis of papers focused on measures of predictive ability or sensitivity-to-change for both tasks during dual-task performance as well as for the single balance and cognitive task. Results: Out of 114 dual-task studies in older people, 19 articles matched the inclusion criteria. Fourteen studies had sample sizes of 60 subjects or less; the studied populations, task combinations as well as other methodological aspects varied. None of the articles reported the same statistical measures for both tasks during dual-task performance as well as single balance and cognitive task. In two studies with prospective data collection of falls, higher odds ratios were found for the dual compared to the single balance task. Conclusions: Upon the available literature, conclusions for an added value of dual balance tasks for fall prediction or assessing fall intervention effects cannot be made due to incomplete comparisons of single and dual balance tasks. Nevertheless, two studies do provide an indication that dual balance tasks may have added value for fall prediction.

Adaptational and learning processes during human split-belt locomotion: interaction between central mechanisms and afferent input

Split-belt locomotion (i.e., walking with unequal leg speeds) requires a rapid adaptation of biome-chanical parameters and therefore of leg muscle electromyographic (EMG) activity. This adaptational process during the first strides of asymmetric gait as well as learning effects induced by repetition were studied in 11 healthy volunteers. Subjects were switched from slow (0.5 m/s) symmetric gait to split-belt locomotion with speeds of 0.5 m/s and 1.5 m/s, respectively. All subjects were observed to adapt in a similar way: (1) during the first trial, adaptation required about 12–15 strides. This was achieved by an increase in stride cycle duration, i.e., an increase in swing duration on the fast side and an increase in support duration on the slow side. (2) Adaptation of leg extensor and flexor EMG activity paralleled the changes of biomechanical parameters. During the first strides, muscle activity was enhanced with no increase in coactivity of antagonistic leg muscles. (3) A motor learning effect was seen when the same paradigm was repeated a few minutes later — interrupted by symmetric locomotion — as adaptation to the split-belt speeds was achieved within 1–3 strides. (4) This short-time learning effect did not occur in the “mirror” condition when the slow and fast sides were inverted. In this case adaptation again required 12–15 strides. A close link between central and proprioceptive mechanisms of interlimb coordination is suggested to underlie the adaptational processes during split-belt conditions. It can be assumed that, as in quadrupedal locomotion of the cat, human bipedal locomotion involves separate locomotor generators to provide the flexibility demanded. The present results suggest that side-specific proprioceptive information regarding the dynamics of the movement is necessary to adjust the centrally generated locomotor activity for both legs to the actual needs for controlled locomotion. Although the required pattern is quickly learned, this learning effect cannot be transferred to the contralateral side.

Biofeedback for training balance and mobility tasks in older populations : a systematic review

ContextAn effective application of biofeedback for interventions in older adults with balance and mobility disorders may be compromised due to co-morbidity.ObjectiveTo evaluate the feasibility and the effectiveness of biofeedback-based training of balance and/or mobility in older adults.Data SourcesPubMed (1950-2009), EMBASE (1988-2009), Web of Science (1945-2009), the Cochrane Controlled Trials Register (1960-2009), CINAHL (1982-2009) and PsycINFO (1840-2009). The search strategy was composed of terms referring to biofeedback, balance or mobility, and older adults. Additional studies were identified by scanning reference lists.Study SelectionFor evaluating effectiveness, 2 reviewers independently screened papers and included controlled studies in older adults (i.e. mean age equal to or greater than 60 years) if they applied biofeedback during repeated practice sessions, and if they used at least one objective outcome measure of a balance or mobility task.Data ExtractionRating of study quality, with use of the Physiotherapy Evidence Database rating scale (PEDro scale), was performed independently by the 2 reviewers. Indications for (non)effectiveness were identified if 2 or more similar studies reported a (non)significant effect for the same type of outcome. Effect sizes were calculated.Results and ConclusionsAlthough most available studies did not systematically evaluate feasibility aspects, reports of high participation rates, low drop-out rates, absence of adverse events and positive training experiences suggest that biofeedback methods can be applied in older adults. Effectiveness was evaluated based on 21 studies, mostly of moderate quality. An indication for effectiveness of visual feedback-based training of balance in (frail) older adults was identified for postural sway, weight-shifting and reaction time in standing, and for the Berg Balance Scale. Indications for added effectiveness of applying biofeedback during training of balance, gait, or sit-to-stand transfers in older patients post-stroke were identified for training-specific aspects. The same applies for auditory feedback-based training of gait in older patients with lower-limb surgery.ImplicationsFurther appropriate studies are needed in different populations of older adults to be able to make definitive statements regarding the (long-term) added effectiveness, particularly on measures of functioning.