Dynamic Stability and Risk of Tripping during the Timed Up and Go Test in Hemiparetic and Healthy Subjects

Background

The Timed Up and Go (TUG) test is often used to estimate risk of falls. Foot clearance and displacement of the center of mass (COM), which are related to risk of tripping and dynamic stability have never been evaluated during the TUG. Accurate assessment of these parameters using instrumented measurements would provide a comprehensive assessment of risk of falls in hemiparetic patients. The aims of this study were to analyze correlations between TUG performance time and displacement of the COM and foot clearance in patients with stroke-related hemiparesis and healthy subjects during the walking and turning sub-tasks of the TUG and to compare these parameters between fallers and non-fallers.

Methods

29 hemiparetic patients and 25 healthy subjects underwent three-dimensional gait analysis during the TUG test. COM and foot clearance were analyzed during the walking and turning sub-tasks of the TUG.

Results

Lateral displacement of the COM was greater and faster during the walking sub-tasks and vertical displacement of the COM was greater during the turn in the patients compared to the healthy subjects (respectively p<0.01 and p<0.05). Paretic foot clearance was greater during walking and displacement of the COM was slower during the turn in the patients (p<0.01). COM displacement and velocity during the turn were correlated with TUG performance in the patients, however, vertical COM displacement was not. These correlations were significant in the healthy subjects. There were no differences between COM parameters or foot clearance in fallers and non-fallers.

Discussion and Conclusion

Hemiparetic patients are less stable than healthy subjects, but compensate with a cautious gait to avoid tripping. Instrumented analysis of the TUG test appears relevant for the assessment of dynamic stability in hemiparetic patients, providing more information than straight-line gait.     

Responsiveness to rehabilitation of balance and gait impairment in elderly with peripheral neuropathy

Elderly people with peripheral neuropathy of the lower limbs (PNLL) demonstrate a typical balance and gait impairment because of sensory ataxia. There is evidence that rehabilitation produces important gains on balance and gait. However, responsiveness to rehabilitation of balance and gait measures is unknown in PNLL. Aim of the current work is to evaluate the responsiveness to rehabilitation of balance, gait and sensory ataxia measures in elderly with PNLL.Twenty-five elderly with PNLL attending physiotherapy and occupational therapy during inpatient rehabilitation were recruited. Balance and gait measures (including static posturography, TUG test and the 10 m walking test) were administered on admission and discharge. An accelerometer secured to the trunk was used for TUG recording and static balance assessment. Static balance was tested with open and closed eyes, so as to assess sensory ataxia.Following rehabilitation, patients improved gait [admission vs discharge, mean(SD): 0.86(0.33) vs 0.98(0.32) m/s], TUG [18.7(7.8) vs 15.1(5.2) s] and turning [46.2(15.3) vs 53.3(15.3) °/s]. However, none of 12 static balance parameters derived from trunk acceleration significantly changed. Principal component analysis showed that before training, eyes closed and eyes open balance correlated with orthogonal components (one and two vs. three and four). After training, eyes open and eyes closed balance were more similar to each other being both correlated with component one.Responsiveness to rehabilitation is larger for gait than static balance measured by trunk acceleration. However, exercise can also have a beneficial effect on sensory ataxia by making eyes closed balance more similar to eyes open balance.     

Extended Timed Up & Go test: Is walking forward and returning back to the chair equivalent gait?

The Timed Up & Go test (TUG) is functional test and is a part of routine clinical examinations. The instrumented Timed Up & Go test enables its segmentation to sub-tasks: sit-to-stand, walking forward, turning, walking back, stand-to-sit, and consequently the computation of task-specific parameters and sub-tasks separately. However, there are no data on whether walking forward parameters differ from the walking back parameters. This study tested the differences between walking forward and walking back in the TUG extended to 10 m for 17 spatio-temporal gait parameters. All parameters were obtained from a GAITRite® pressure sensitive walkway (CIR Systems, Inc.). The differences were assessed for healthy controls and Parkinson's disease (PD) patients. None of investigated parameters exhibited a difference between both gait subtasks for healthy subjects group. Five parameters of interest, namely velocity, step length, stride length, stride velocity, and the proportion of the double support phase with respect to gait cycle duration, showed a statistically significant difference between gait for walking forward and walking back in PD patients. Therefore, we recommend a separate assessment for walking forward and walking back rather than averaging both gaits together.     

Spatiotemporal and Kinematic Parameters Relating to Oriented Gait and Turn Performance in Patients with Chronic Stroke

Background

The timed up and go test (TUG) is a functional test which is increasingly used to evaluate patients with stroke. The outcome measured is usually global TUG performance-time. Assessment of spatiotemporal and kinematic parameters during the Oriented gait and Turn sub-tasks of the TUG would provide a better understanding of the mechanisms underlying patients’ performance and therefore may help to guide rehabilitation. The aim of this study was thus to determine the spatiotemporal and kinematic parameters which were most related to the walking and turning sub-tasks of TUG performance in stroke patients.

Methods

29 stroke patients carried out the TUG test which was recorded using an optoelectronic system in two conditions: spontaneous and standardized condition (standardized foot position and instructed to turn towards the paretic side). They also underwent a clinical assessment. Stepwise regression was used to determine the parameters most related to Oriented gait and Turn sub-tasks. Relationships between explanatory parameters of Oriented gait and Turn performance and clinical scales were evaluated using Spearman correlations.

Results

Step length and cadence explained 82% to 95% of the variance for the walking sub-tasks in both conditions. Percentage single support phase and contralateral swing phase (depending on the condition) respectively explained 27% and 56% of the variance during the turning sub-task in the spontaneous and standardized conditions.

Discussion and Conclusion

Step length, cadence, percentage of paretic single support phase and non-paretic swing phase, as well as dynamic stability were the main parameters related to TUG performance and they should be targeted in rehabilitation.     

Estimation of minimum ground clearance (MGC) using body-worn inertial sensors

Objective assessment of balance and mobility in elderly populations using body-worn sensors has recently become a prevalent theme in falls-related research. Recent research by the authors identified mean absolute-valued vertical angular velocity measured using shank mounted inertial sensors during a timed-up-and-go test as having a strong association with falls history in a group of elderly adults. This study aimed to investigate the clinical relevance of this parameter by exploring the relationship between it and minimum ground clearance (MGC) measured with an optical motion capture system. MGC is an important variable when considering trip-related falls risk. This paper also presents a method of estimating properties of MGC during walking, across a range of speeds and gait patterns, using body-worn inertial sensors. We found that mean MGC and coefficient of variation (CV) MGC are correlated with mean absolute-valued vertical angular velocity and acceleration as measured by shank or foot mounted inertial sensors. Regression models generated using inertial sensor derived variables were used to robustly estimate the mean MGC and CV MGC measured by an optical marker-tracking system. Foot-mounted sensors were found to yield slightly better results than sensors on the shank. Different walking speeds and gait patterns were not found to influence the accuracy of the models. We conclude that these findings have the potential to evaluate a walking trial using body-worn inertial sensors, which could then be used to identify individuals with increased risk of unprovoked collisions with the ground during locomotion.     

Locomotor Trajectories of Stroke Patients during Oriented Gait and Turning

Background

The Timed Up and Go (TUG) test is widely used to assess locomotion in patients with stroke and is considered to predict the risk of falls. The analysis of locomotor trajectories during the TUG appears pertinent in stroke patients. The aims of this study were i) to analyze locomotor trajectories in patients with stroke during the walking and turning sub-tasks of the TUG, and to compare them with healthy subjects, ii) to determine whether trajectory parameters provide additional information to that provided by the conventional measure (performance time), iii) to compare the trajectory parameters of fallers and non-fallers with stroke and of patients with right and left hemisphere stroke, and iv) to evaluate correlations between trajectory parameters and Berg Balance Scale scores.

Methods

29 patients with stroke (mean age 54.2±12.2 years, 18 men, 8 fallers) and 25 healthy subjects (mean age 51.6±8.7 years, 11 men) underwent three-dimensional analysis of the TUG. The trajectory of the center of mass was analyzed by calculation of the global trajectory length, Hausdorff distance and Dynamic Time Warping. The parameters were compared with a reference trajectory during the total task and each sub-task (Go, Turn, Return) of the TUG.

Results

Values of trajectory parameters were significantly higher for the stroke group during the total TUG and the Go and Turn sub-tasks (p<0.05). Moreover, logistic regression indicated that these parameters better discriminated stroke patients and healthy subjects than the conventional timed performance during the Go sub-task. In addition, fallers were distinguished by higher Dynamic Time Warping during the Go (p<0.05). There were no differences between patients with right and left hemisphere stroke.

Discussion and Conclusion

The trajectories of the stroke patients were longer and more deviated during the turn and the preceding phase. Trajectory parameters provided additional information to timed performance of this locomotor task. Focusing rehabilitation programs on lead-up to turn and turning could be relevant for stroke patients since the Turn was related to the balance and the phase preceding the turn seemed to distinguish fallers.     

Spatio-temporal parameters of gait measured by an ambulatory system using miniature gyroscopes

In this study we describe an ambulatory system for estimation of spatio-temporal parameters during long periods of walking. This original method based on wavelet analysis is proposed to compute the values of temporal gait parameters from the angular velocity of lower limbs. Based on a mechanical model, the medio-lateral rotation of the lower limbs during stance and swing, the stride length and velocity are estimated by integration of the angular velocity. Measurement's accuracy was assessed using as a criterion standard the information provided by foot pressure sensors. To assess the accuracy of the method on a broad range of performance for each gait parameter, we gathered data from young and elderly subjects. No significant error was observed for toe-off detection, while a slight systematic delay (10 ms on average) existed between heelstrike obtained from gyroscopes and footswitch. There was no significant difference between actual spatial parameters (stride length and velocity) and their estimated values. Errors for velocity and stride length estimations were 0.06 m/s and 0.07 m, respectively. This system is light, portable, inexpensive and does not provoke any discomfort to subjects. It can be carried for long periods of time, thus providing new longitudinal information such as stride-to-stride variability of gait. Several clinical applications can be proposed such as outcome evaluation after total knee or hip replacement, external prosthesis adjustment for amputees, monitoring of rehabilitation progress, gait analysis in neurological diseases, and fall risk estimation in elderly.     

Intra-Rater,Inter-Rater and Test-Retest Reliability of an Instrumented Timed Up and Go (iTUG) Test in Patients with Parkinson’s Disease

Background

The “Timed Up and Go” (TUG) is a widely used measure of physical functioning in older people and in neurological populations, including Parkinson’s Disease. When using an inertial sensor measurement system (instrumented TUG [iTUG]), the individual components of the iTUG and the trunk kinematics can be measured separately, which may provide relevant additional information.

Objective

The aim of this study was to determine intra-rater, inter-rater and test-retest reliability of the iTUG in patients with Parkinson’s Disease.

Methods

Twenty eight PD patients, aged 50 years or older, were included. For the iTUG the DynaPort Hybrid (McRoberts, The Hague, The Netherlands) was worn at the lower back. The device measured acceleration and angular velocity in three directions at a rate of 100 samples/s. Patients performed the iTUG five times on two consecutive days. Repeated measurements by the same rater on the same day were used to calculate intra-rater reliability. Repeated measurements by different raters on the same day were used to calculate intra-rater and inter-rater reliability. Repeated measurements by the same rater on different days were used to calculate test-retest reliability.

Results

Nineteen ICC values (15%) were ≥ 0.9 which is considered as excellent reliability. Sixty four ICC values (49%) were ≥ 0.70 and < 0.90 which is considered as good reliability. Thirty one ICC values (24%) were ≥ 0.50 and < 0.70, indicating moderate reliability. Sixteen ICC values (12%) were ≥ 0.30 and < 0.50 indicating poor reliability. Two ICT values (2%) were < 0.30 indicating very poor reliability.

Conclusions

In conclusion, in patients with Parkinson’s disease the intra-rater, inter-rater, and test-retest reliability of the individual components of the instrumented TUG (iTUG) was excellent to good for total duration and for turning durations, and good to low for the sub durations and for the kinematics of the SiSt and StSi. The results of this fully automated analysis of instrumented TUG movements demonstrate that several reliable TUG parameters can be identified that provide a basis for a more precise, quantitative use of the TUG test, in clinical practice.     

Analysis of pelvic movement in the elderly during walking using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope

The incidence of falls in the elderly is increasing with the aging of society and is becoming a major public health issue. From the viewpoint of prevention of falls, it is important to evaluate the stability of the gait in the elderly people. The pelvic movement, which is a critical factor for walking stability, was analyzed using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope. The subjects were 95 elderly people over 60 years of age. The criteria for instability were open-eye standing on one leg for 15s or less, and 11s or more on 3m timed up and go test. Forty subjects who did not meet both of these criteria comprised the stable group, and the remaining 55 subjects comprised the unstable group. Pelvic movement during walking was compared between the two groups. The angle, angular velocity, and acceleration were analyzed based on the wave shape derived from the device worn around the second sacral. The results indicated that pelvic movement was lower in all three directions in the unstable group compared to the stable group, and the changes in the pelvic movement during walking in unstable elderly people were also reduced. This report is the first to evaluate pelvic movement by both a triaxial accelerometer and a triaxial gyroscope simultaneously. The characteristics of pelvic movement during walking can be applied in screening to identify elderly people with instability, which is the main risk factor associated with falls.     

Isokinetic elbow flexion and coactivation following eccentric training.

The influence of an eccentric training on torque/angular velocity relationships and coactivation level during maximal voluntary isokinetic elbow flexion was examined. Seventeen subjects divided into two groups (Eccentric Group EG, n = 9 Control Group CG, n = 8) performed on an isokinetic dynamometer, before and after training, maximal isokinetic elbow flexions at eight angular velocities (from - 120 degrees s(-1) under eccentric conditions to 240 degrees s(-1) under concentric conditions), and held maximal and submaximal isometric actions. Under all conditions, the myoelectric activities (EMG) of the biceps and the triceps brachii muscles were recorded and quantified as the RMS value. Eccentric training of the EG consisted of 5x6 eccentric muscle actions at 100 and 120% of one maximal repetition (IRM) for 21 sessions and lasted 7 weeks. In the EG after training, torque was significantly increased at all angular velocities tested (ranging from 11.4% at 30 degrees (s-1) to 45.5% at - 120 degrees s(-1)) (p < 0.05). These changes were accompanied by an increase in the RMS activities of the BB muscle under eccentric conditions (from - 120 to - 30 degrees (s-1)) and at the highest concentric angular velocities (180 and 24 degrees s(-1)) (p < 0.05). The RMS activity of the TB muscle was not affected by the angular velocity in either group for all action modes. The influence of eccentric training on the torque gains under eccentric conditions and for the highest velocities was attributed essentially to neural adaptations.     

Gait analysis using gravitational acceleration measured by wearable sensors

A novel method for measuring human gait posture using wearable sensor units is proposed. The sensor units consist of a tri-axial acceleration sensor and three gyro sensors aligned on three axes. The acceleration and angular velocity during walking were measured with seven sensor units worn on the abdomen and the lower limb segments (both thighs, shanks and feet). The three-dimensional positions of each joint are calculated from each segment length and joint angle. Joint angle can be estimated mechanically from the gravitational acceleration along the anterior axis of the segment. However, the acceleration data during walking includes three major components; translational acceleration, gravitational acceleration and external noise. Therefore, an optimization analysis was represented to separate only the gravitational acceleration from the acceleration data. Because the cyclic patterns of acceleration data can be found during constant walking, a FFT analysis was applied to obtain some characteristic frequencies in it. A pattern of gravitational acceleration was assumed using some parts of these characteristic frequencies. Every joint position was calculated from the pattern under the condition of physiological motion range of each joint. An optimized pattern of the gravitational acceleration was selected as a solution of an inverse problem. Gaits of three healthy volunteers were measured by walking for 20 s on a flat floor. As a result, the acceleration data of every segment was measured simultaneously. The characteristic three-dimensional walking could be shown by the expression using a stick figure model. In addition, the trajectories of the knee joint in the horizontal plane could be checked by visual imaging on a PC. Therefore, this method provides important quantitive information for gait diagnosis.     

Motion Control in Saccade and Smooth Pursuit for Bionic Eye Based on Three-dimensional Coordinates

Saccade and smooth pursuit are two important functions of human eye.In order to enable bionic eye to imitate the two functions,a control method that implements saccade and smooth pursuit based on the three-dimensional coordinates of target is proposed.An optimal observation position is defined for bionic eye based on three-dimensional coordinates.A kind of motion planning method with high accuracy is developed.The motion parameters of stepper motor consisting of angle acceleration and turning time are computed according to the position deviation,the target's angular velocity and the stepper motor's current angular velocity in motion planning.The motors are controlled with the motion parameters moving to given position with desired angular velocity in schedule time.The experimental results show that the bionic eye can move to optimal observation positions in 0.6 s from initial location and the accuracy of 3D coordinates is improved.In addition,the bionic eye can track a target within the error of less than 20 pixels based on three-dimensional coordinates.It is verified that saccade and smooth pursuit of bionic eye based on three-dimensional coordinates are feasible.     

The accuracy of measuring the kinematics of rising from a chair with accelerometers and gyroscopes

The purpose of this study was to assess the accuracy of measuring angle and angular velocity of the upper body and upper leg during rising from a chair with accelerometers, using low-pass filtering of the accelerometer signal. Also, the improvement in accuracy of the measurement with additional use of high-pass filtered gyroscopes was assessed. Two uni-axial accelerometers and one gyroscope (DynaPort) per segment were used to measure angles and angular velocities of upper body and upper leg. Calculated angles and angular velocities were compared to a high-quality optical motion analysis system (Optotrak), using root mean squared error (RMS) and correlation coefficient (r) as parameters. The results for the sensors showed that two uni-axial accelerometers give a reasonable accurate measurement of the kinematics of rising from a chair (RMS = 2.9, 3.5, and 2.6 degrees for angle and RMS = 9.4, 18.4, and 11.5 degrees /s for angular velocity for thorax, pelvis, and upper leg, respectively). Additional use of gyroscopes improved the accuracy significantly (RMS = 0.8, 1.1, and 1.7 degrees for angle and RMS = 2.6, 4.0 and 4.9 degrees /s for angular velocity for thorax, pelvis and upper leg, respectively). The low-pass Butterworth filter had optimal cut-off frequencies of 1.05, 1.3, and 1.05 for thorax, pelvis, and upper leg, respectively. For the combined signal, the optimal cut-off frequencies were 0.18, 0.2, and 0,38 for thorax, pelvis and upper leg, respectively. The filters showed no subject specificity. This study provides an accurate, inexpensive and simple method to measure the kinematics of movements similar to rising from a chair.     

Head kinematics in mini-sled tests of foam padding: relevance of linear responses from free motion headform (FMH) testing to head angular responses

The revised Federal Motor Vehicle Safety Standard (FMVSS) No. 201 specifies that the safety performance of vehicle upper interiors is determined from the resultant linear acceleration response of a free motion headform (FMH) impacting the interior at 6.7 m/s. This study addresses whether linear output data from the FMH test can be used to select an upper interior padding that decreases the likelihood of rotationally induced brain injuries. Using an experimental setup consisting of a Hybrid III head-neck structure mounted on a mini-sled platform, sagittal plane linear and angular head accelerations were measured in frontal head impacts into foam samples of various stiffness and density with a constant thickness (51 mm) at low (approximately 5.0 m/s), intermediate (approximately 7.0 m/s), and high (approximately 9.6 m/s) impact speeds. Provided that the foam samples did not bottom out, recorded peak values of angular acceleration and change in angular velocity increased approximately linearly with increasing peak resultant linear acceleration and value of the Head Injury Criterion (HIC36). The results indicate that the padding that produces the lowest possible peak angular acceleration and peak change in angular velocity without causing high peak forces is the one that produces the lowest possible HIC36 without bottoming out in the FMH test.     

Computer-assisted evaluation of surface electromyograms of 8 different arm muscles]

The aim of the present study was, via digitization of the EMG signals and processing them in the computer, to make possible effective evaluation of electromyographically detectable modifications of the activity of the forearm muscles developing during wrist movements under defined conditions of loading. The search for the optimal measuring parameter was of particular importance. In groups of test subjects the electric voltage potentials generated by 8 arm muscles were measured simultaneously on the skin and evaluated using suitable variables (integral, RMS [root mean square] value, mean amplitude, summed amplitude, amplitude peak count [peaks], zero crossings) with the aid of a PC and a computer program specially developed for the task. On evaluation it was found that the parameters reacting sensitively mainly to amplitude size--integral, RMS value, mean amplitude height and summed amplitude--reflected, with gradually decreasing clarity, the activities of each muscle. The correlation among the first three parameters was almost linear. The parameters sensitive primarily to frequency modulations, such as peaks and number of zero crossings, yielded little information under the load applied. They did not adequately reflect the extension and flexion of the hand.     

Using a Body-Fixed Sensor to Identify Subclinical Gait Difficulties in Older Adults with IADL Disability: Maximizing the Output of the Timed Up and Go

Objective

The identification and documentation of subclinical gait impairments in older adults may facilitate the appropriate use of interventions for preventing or delaying mobility disability. We tested whether measures derived from a single body-fixed sensor worn during traditional Timed Up and Go (TUG) testing could identify subclinical gait impairments in community dwelling older adults without mobility disability.

Methods

We used data from 432 older adults without dementia (mean age 83.30±7.04 yrs, 76.62% female) participating in the Rush Memory and Aging Project. The traditional TUG was conducted while subjects wore a body-fixed sensor. We derived measures of overall TUG performance and different subtasks including transitions (sit-to-stand, stand-to-sit), walking, and turning. Multivariate analysis was used to compare persons with and without mobility disability and to compare individuals with and without Instrumental Activities of Daily Living disability (IADL-disability), all of whom did not have mobility disability.

Results

As expected, individuals with mobility disability performed worse on all TUG subtasks (p<0.03), compared to those who had no mobility disability. Individuals without mobility disability but with IADL disability had difficulties with turns, had lower yaw amplitude (p<0.004) during turns, were slower (p<0.001), and had less consistent gait (p<0.02).

Conclusions

A single body-worn sensor can be employed in the community-setting to complement conventional gait testing. It provides a wide range of quantitative gait measures that appear to help to identify subclinical gait impairments in older adults.     

Fall risk characteristics of the elderly in an exercise class

The purpose of this study was to clarify the fall risk characteristics of the elderly participating in an exercise class.The subjects were comprised of 206 elderly Japanese aged 60 or older (37 males, 169 females) who participated in an exercise class, approved by the local government, once a week for 6 months. Physical fitness and ADL capability were evaluated by the physical fitness test of the Ministry of Education, Culture, Sports, Science and Technology. Fall risk was evaluated using the Fall Assessment Chart. Subjects were divided into two groups, high fall risk (total fall risk score > or =5) and low fall risk (total fall risk score <5), and the percentage of subjects in the high risk group was calculated.The percentage of subjects with a high fall risk was 15.8%, lower than the documented rate of the community-dwelling elderly in a previous study. Significant differences between fall risk groups were found in balance and ADL capabilities of walking, holding and changing posture and muscular strength. These functions also were significantly related to fall risk elements such as fall anxiety and slipping or stumbling at home in the partial correlation analyses.Improvement of these functions during exercise class may be useful in decreasing fall risk in the elderly.     

TURNING MANEUVERS IN STELLER SEA LIONS (EUMATOPIAS JUBATUS)

Steller sea lions are highly maneuverable marine mammals (expressed as minimum turning radius). Video recordings of turns ( n = 195) are analyzed from kinematic measurements for three captive animals. Speed-time plots of 180° turns have a typical "V-shape." The sea lions decelerated during the first half of the turn, reached a minimum speed in the middle of the curved trajectory and reaccelerated by adduction of the pectoral flippers. The initial deceleration was greater than that for passive gliding due to pectoral flipper braking and/or change in body contour from a stiff, straight streamlined form. Centripetal force and thrust were determined from the body acceleration. Most thrust was produced during the power phase of the pectoral flipper stroke cycle. Contrary to previous findings on otariids, little or no thrust was generated during initial abduction of the pectoral flippers and during the final drag-based paddling phase of the stroke cycle. Peak thrust force at the center of gravity occurs halfway through the power phase and the centripetal force is maximal at the beginning of the power stroke. Performance is modulated by changes in the duration and intensity of movements without changing their sequence. Turning radius, maximum velocity, maximum acceleration and turning duration were 0.3 body lengths, 3.5 m/s, 5 m/s², and 1.6 s, respectively. The relative maneuverability based on velocity and length specific minimum turning radius is comparable to other otariids, superior to cetaceans but inferior to many fish.     

Frailty assessment based on wavelet analysis during quiet standing balance test

BackgroundA 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.MethodsFourteen 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.FindingsThe 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.InterpretationThese parameters could be of great interest in clinical settings and improved rehabilitation therapies and in methods for identifying elderly population with frail syndrome.     

Driving a musculoskeletal model with inertial and magnetic measurement units

We developed and evaluated a new kinematic driver for musculoskeletal models using ambulatory inertial and magnetic measurement units (IMMUs). The new driver uses the orientation estimates based on sensor fusion of each individual IMMU and benefits from two important properties of musculoskeletal models. First, these models contain more complex, anatomical, kinematic models than those currently used for sensor fusion of multiple IMMUs and are continuously improved. Second, they allow movement between segment and measured sensor. For three different tasks, the new IMMU driver, (optical) marker drivers and a combination of both were used to reconstruct the motion. Maximal root mean square (RMS) joint angle differences with respect to the silver standard (combined IMMU/marker drivers) were found for the hip joint; 4°, 2° and 5° during squat, gait and slideboard tasks for IMMU-driven reconstructions, compared with 6°, 5° and 5° for marker-driven reconstructions, respectively. The measured angular velocities corresponded best to the IMMU-driven reconstructions, with a maximal RMS difference of 66°/s, compared with 108°/s and 91°/s for marker-driven reconstructions and silver standard. However, large oscillations in global accelerations occurred during IMMU-driven reconstructions resulting in a maximal RMS difference with respect to measured acceleration of 23 m/s², compared with 9 m/s² for reconstructions that included marker drivers. The new driver facilitates direct implementation of IMMU-based orientation estimates in currently available biomechanical models. As such, it can help in the rapid expansion of biomechanical analysis based on outdoor measurements.