A wearable system for pre-impact fall detection

Unique features of body segment kinematics in falls and activities of daily living (ADL) are applied to make automatic detection of a fall in its descending phase, prior to impact, possible. Fall-related injuries can thus be prevented or reduced by deploying fall impact reduction systems, such as an inflatable airbag for hip protection, before the impact. In this application, the authors propose the following hypothesis: “Thigh segments normally do not exceed a certain threshold angle to the side and forward directions in ADL, whereas this abnormal behavior occurs during a fall activity”. Torso and thigh wearable inertial sensors (3D accelerometer and 2D gyroscope) are used and the whole system is based on a body area network (BAN) for the comfort of the wearer during a long term application. The hypothesis was validated in an experiment with 21 young healthy volunteers performing both normal ADL and fall activities. Results show that falls could be detected with an average lead-time of 700 ms before the impact occurs, with no false alarms (100% specificity), a sensitivity of 95.2%. This is the longest lead-time achieved so far in pre-impact fall detection.     

Effect of pre-impact movement strategies on the impact forces resulting from a lateral fall

Approximately 90% of hip fractures in older adults result from falls, mostly from landing on or near the hip. A three-dimensional, 11-segment, forward dynamic biomechanical model was developed to investigate whether segment movement strategies prior to impact can affect the impact forces resulting from a lateral fall. Four different pre-impact movement strategies, with and without using the ipsilateral arm to break the fall, were implemented using paired actuators representing the agonist and antagonist muscles acting about each joint. Proportional-derivative feedback controller controlled joint angles and velocities so as to minimize risk of fracture at any of the impact sites. It was hypothesized that (a) the use of active knee, hip and arm joint torques during the pre-contact phase affects neither the whole body kinetic energy at impact nor the peak impact forces on the knee, hip or shoulder and (b) muscle strength and reaction time do not substantially affect peak impact forces. The results demonstrate that, compared with falling laterally as a rigid body, an arrest strategy that combines flexion of the lower extremities, ground contact with the side of the lower leg along with an axial rotation to progressively present the posterolateral aspects of the thigh, pelvis and then torso, can reduce the peak hip impact force by up to 56%. A 30% decline in muscle strength did not markedly affect the effectiveness of that fall strategy. However, a 300-ms delay in implementing the movement strategy inevitably caused hip impact forces consistent with fracture unless the arm was used to break the fall prior to the hip impact.     

Automatic individual calibration in fall detection – an integrative ambulatory measurement framework

The objective of the current study was to demonstrate the utility of a new integrative ambulatory measurement (IAM) framework by developing and evaluating an individual calibration function in fall detection application. Ten healthy elderly persons were involved in a laboratory study and tested in a protocol comprising various types of activities of daily living and slip-induced backward falls. Inertial measurement units attached to the trunk and thigh segments were used to measure trunk angular kinematics and thigh accelerations. The effect of individual calibration was evaluated with previously developed fall detection algorithm. The results indicated that with individual calibration, the fall detection performance achieved approximately the same level of sensitivity (100% vs. 100%) and specificity (95.25% vs. 95.65%); however, response time was significantly lower than without (249 ms vs. 255 ms). It was concluded that the automatic individual calibration using the IAM framework improves the performance of fall detection, which has a greater implication in preventing/minimising injuries associated with fall accidents.     

Biomechanical simulations of forward fall arrests: effects of upper extremity arrest strategy,gender and aging-related declines in muscle strength

Computer simulation was used to predict the extent to which age-related muscle atrophy may adversely affect the safe arrest of a forward fall onto the arms. The biomechanical factors affecting the separate risks for wrist fracture or head impact were examined using a two-dimensional, 5-link, forward dynamic model. The hypothesis was tested in older females that age-related loss in muscular strength renders the use of the arms ineffective in arresting a forward fall without either a torso impact exceeding 0.5m/s or distal forearm loads sufficient to fracture the wrist. The results demonstrate that typical age-related decline in arm muscle strength substantially reduces the ability to arrest a forward fall without the elbows buckling and, therefore, a risk of torso and/or head impact. The model predicted that older women with below-average bone strength risk a Colles fracture when arresting typical falls, particularly with an extended arm.     

Detecting Falls as Novelties in Acceleration Patterns Acquired with Smartphones

Despite being a major public health problem, falls in the elderly cannot be detected efficiently yet. Many studies have used acceleration as the main input to discriminate between falls and activities of daily living (ADL). In recent years, there has been an increasing interest in using smartphones for fall detection. The most promising results have been obtained by supervised Machine Learning algorithms. However, a drawback of these approaches is that they rely on falls simulated by young or mature people, which might not represent every possible fall situation and might be different from older people''s falls. Thus, we propose to tackle the problem of fall detection by applying a kind of novelty detection methods which rely only on true ADL. In this way, a fall is any abnormal movement with respect to ADL. A system based on these methods could easily adapt itself to new situations since new ADL could be recorded continuously and the system could be re-trained on the fly. The goal of this work is to explore the use of such novelty detectors by selecting one of them and by comparing it with a state-of-the-art traditional supervised method under different conditions. The data sets we have collected were recorded with smartphones. Ten volunteers simulated eight type of falls, whereas ADL were recorded while they carried the phone in their real life. Even though we have not collected data from the elderly, the data sets were suitable to check the adaptability of novelty detectors. They have been made publicly available to improve the reproducibility of our results. We have studied several novelty detection methods, selecting the nearest neighbour-based technique (NN) as the most suitable. Then, we have compared NN with the Support Vector Machine (SVM). In most situations a generic SVM outperformed an adapted NN.     

基于三轴加速度传感器的跌倒检测研究

本文基于MMA7260QT加速度传感器获取的人体运动加速度信号,采用人体加速度向量幅值(SVM)和人体加速度向量区域值(SMA)描述了老年人的运动状态,检测人体跌倒,具有良好的准确性和实时性。采用bior3.3小波分析,在轮廓的基础上,最大程度上保留了细节,有效的去除噪声对特征量的干扰。本文提出了人体跌倒检测算法,大大降低了误判率和漏判率。首先,检测人体SVM是否超过阈值进行第一级跌倒检测,区别出人体日常活动(ADL)和跌倒;其次在此基础上,检测第一级各个跌倒的SMA值,是否超过阈值,判断跌倒和疑似跌倒。当两次判断都检测到跌倒发生时,报警。     

Distinguishing fall activities from normal activities by velocity characteristics

The purpose of this study was to identify unique features of the velocity profile during normal and abnormal (i.e., fall) activities so as to make the automatic detection of falls during the descending phase of a fall possible. Normal activities included walking, rising from a chair and sitting down, descending stairs, picking up an object from the floor, transferring in and out of a tub, and lying down on a bed. The fall activities included tripping, forward and backward falls from standing. The horizontal and vertical velocities (V(h) and V(v)) at various locations of the trunk was measured. It was found that the V(h) and V(v) of the trunk during normal activities were within a well-controlled range, and that when the velocity in one direction increased, the velocity in the other direction usually did not. In contrast, the V(h) and V(v) demonstrated two different characteristics for the fall movement. Firstly, the magnitude of both V(h) and V(v) of the trunk increased dramatically during the falling phase, reaching up to 2-3 times that of normal velocities. Secondly, the increase of V(h) and V(v) magnitude usually occurred simultaneously, and usually about 300-400 ms before the end of the fall. These two velocity characteristics, that is, the magnitude change and the timing of the magnitude change of both V(h) and V(v), could be used to distinguish fall movements from normal activities during the descending phase of the fall. It is hoped that the application of these two velocity characteristics could lead to potentially preventing or degrading fall-related injuries in the elderly population when connected with other devices.     

Reliability of impact forces, hip angles and velocities during simulated forward falls using a novel Propelled Upper Limb fall ARrest Impact System (PULARIS)

Previous forward fall simulation methods have provided good kinematic and kinetic data, but are limited in that they have started the falls from a stationary position and have primarily simulated uni-directional motion. Therefore, a novel Propelled Upper Limb fall ARest Impact System (PULARIS) was designed to address these issues during assessments of a variety of fall scenarios. The purpose of this study was to present PULARIS and evaluate its ability to impact the upper extremities of participants with repeatable velocities, hand forces and hip angles in postures and with vertical and horizontal motion consistent with forward fall arrest. PULARIS consists of four steel tubing crossbars in a scissor-like arrangement that ride on metal trolleys within c-channel tracks in the ceiling. Participants are suspended beneath PULARIS by the legs and torso in a prone position and propelled horizontally via a motor and chain drive until they are quick released, and then impact floor-mounted force platforms with both hands. PULARIS velocity, hip angles and velocities and impact hand forces of ten participants (five male, five female) were collected during three fall types (straight-arm, self-selected and bent-arm) and two fall heights (0.05 m and 0.10 m) to assess the reliability of the impact conditions provided by the system. PULARIS and participant hip velocities were found to be quite repeatable (mean ICC?=?0.81) with small between trial errors (mean?=?0.03 m/s). The ratio of horizontal to vertical hip velocity components (~0.75) agreed well with previously reported data (0.70-0.80). Peak vertical hand impact forces were also found to be relatively consistent between trials with a mean ICC of 0.73 and mean between trial error of 13.4 N. Up to 83% of the horizontal hand impact forces displayed good to excellent reliability (ICC?>?0.6) with small between trial differences. Finally, the ICCs for between trial hip angles were all classified as good to excellent. Overall, PULARIS is a reliable method and is appropriate for studying the response of the distal upper extremity to impact loading during non-stationary, multi-directional movements indicative of a forward fall. This system performed well at different fall heights, and allows for a variety of upper and lower extremity, and hip postures to be tested successfully in different landing scenarios consistent with elderly and sport-related falls.     

Automatic Fall Detection System Based on the Combined Use of a Smartphone and a Smartwatch

Due to their widespread popularity, decreasing costs, built-in sensors, computing power and communication capabilities, Android-based personal devices are being seen as an appealing technology for the deployment of wearable fall detection systems. In contrast with previous solutions in the existing literature, which are based on the performance of a single element (a smartphone), this paper proposes and evaluates a fall detection system that benefits from the detection performed by two popular personal devices: a smartphone and a smartwatch (both provided with an embedded accelerometer and a gyroscope). In the proposed architecture, a specific application in each component permanently tracks and analyses the patient’s movements. Diverse fall detection algorithms (commonly employed in the literature) were implemented in the developed Android apps to discriminate falls from the conventional activities of daily living of the patient. As a novelty, a fall is only assumed to have occurred if it is simultaneously and independently detected by the two Android devices (which can interact via Bluetooth communication). The system was systematically evaluated in an experimental testbed with actual test subjects simulating a set of falls and conventional movements associated with activities of daily living. The tests were repeated by varying the detection algorithm as well as the pre-defined mobility patterns executed by the subjects (i.e., the typology of the falls and non-fall movements). The proposed system was compared with the cases where only one device (the smartphone or the smartwatch) is considered to recognize and discriminate the falls. The obtained results show that the joint use of the two detection devices clearly increases the system’s capability to avoid false alarms or ‘false positives’ (those conventional movements misidentified as falls) while maintaining the effectiveness of the detection decisions (that is to say, without increasing the ratio of ‘false negatives’ or actual falls that remain undetected).     

Dynamic stability of superior vs. inferior body segments in individuals with transtibial amputation walking in destabilizing environments

Interestingly, young and highly active people with lower limb amputation appear to maintain a similar trunk and upper body stability during walking as able-bodied individuals. Understanding the mechanisms underlying how this stability is achieved after lower-leg amputation is important to improve training regimens for improving walking function in these patients. This study quantified how superior (i.e., head, trunk, and pelvis) and inferior (i.e., thigh, shank, and feet) segments of the body respond to continuous visual or mechanical perturbations during walking. Nine persons with transtibial amputation (TTA) and 12 able-bodied controls (AB) walked on a 2 m×3 m treadmill in a Computer Assisted Rehabilitation Environment (CAREN). Subjects were perturbed by continuous pseudo-random mediolateral movements of either the treadmill platform or the visual scene. TTA maintained a similar local and orbital stability in their superior body segments as AB throughout both perturbation types. However, for their inferior body segments, TTA subjects exhibited greater dynamic instability during perturbed walking. In TTA subjects, these increases in instability were even more pronounced in their prosthetic limb compared to their intact leg. These findings demonstrate that persons with unilateral lower leg amputation maintain upper body stability in spite of increased dynamic instability in their impaired lower leg. Thus, transtibial amputation does significantly impair sensorimotor function, leading to substantially altered dynamic movements of their lower limb segments. However, otherwise relatively healthy patients with unilateral transtibial amputation appear to retain sufficient remaining sensorimotor function in their proximal and contralateral limbs to adequately compensate for their impairment.     

Cooling different body surfaces during upper and lower body exercise

The effect of varying the body surface area being cooled by a liquid microclimate system was evaluated during exercise heat-stress conditions. Six male subjects performed a total of six exercise (O2 uptake = 1.2 l/min) tests in a hot environment (ambient temperature = 38 degrees C, relative humidity = 30%) while dressed in clothing having low moisture permeability and high insulation. Each subject completed two upper body exercise (U; arm crank) tests: 1) with only the torso surface (T) cooled; and 2) with the surfaces of both the torso and upper arms (TA) cooled [coolant temperature at the inlet (Ti) was 20 degrees C for all upper body tests]. Each subject also completed four lower body exercise (L; walking) tests: 1) with only the T cooled (Ti = 20 degrees C); 2) with only the T cooled (Ti = 26 degrees C); 3) with torso, upper arm, and thigh surface (TAT) cooled (Ti = 20 degrees C); and 4) with TAT cooled (Ti = 26 degrees C). During U exercise, TA cooling had no effects compared with cooling only T. During L exercise, sweat rates, heart rates, and rectal temperature (Tre) changes were less with TAT cooling compared with cooling only the T. Altering Ti had no effect on Tre changes, but higher heart rates were observed with 26 than with 20 degrees C. These data indicate that cooling arms during upper body exercise provides no thermoregulatory advantage, although cooling the thigh surfaces during lower body exercise does provide an advantage.     

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.     

Pre-impact lower extremity posture and brake pedal force predict foot and ankle forces during an automobile collision

BACKGROUND: The purpose of this study was to determine how a driver's foot and ankle forces during a frontal vehicle collision depend on initial lower extremity posture and brake pedal force. METHOD OF APPROACH: A 2D musculoskeletal model with seven segments and six right-side muscle groups was used. A simulation of a three-second braking task found 3647 sets of muscle activation levels that resulted in stable braking postures with realistic pedal force. These activation patterns were then used in impact simulations where vehicle deceleration was applied and driver movements and foot and ankle forces were simulated. Peak rearfoot ground reaction force (F(RF)), peak Achilles tendon force (FAT), peak calcaneal force (F(CF)) and peak ankle joint force (F(AJ)) were calculated. RESULTS: Peak forces during the impact simulation were 476 +/- 687 N (F(RF)), 2934 +/- 944 N (F(CF)) and 2449 +/- 918 N (F(AJ)). Many simulations resulted in force levels that could cause fractures. Multivariate quadratic regression determined that the pre-impact brake pedal force (PF), knee angle (KA) and heel distance (HD) explained 72% of the variance in peak FRF, 62% in peak F(CF) and 73% in peak F(AJ). CONCLUSIONS: Foot and ankle forces during a collision depend on initial posture and pedal force. Braking postures with increased knee flexion, while keeping the seat position fixed, are associated with higher foot and ankle forces during a collision.     

Kinematic characteristics of the voluntary cyclic trunk movements in patients at the early stage of Parkinson's disease

Patients with the initial stage of Parkinson disease (PD) and matched controls performed repetitive bendings and turnings in standing position. Tasks included trunk movements in each of the anatomical planes: sagittal, frontal and axial. Electromagnetic system Flock of Birds was used for movement registration. Sensors were fixed at different segments of subject's body. Joint angles in the ankle, hip and torso as well as coordinates of the center of pressure served as output parameters. The amplitudes of joint angles were found to be lower in PD patients. Performance of the axial rotation revealed most pronounced differences. Thus, the amplitudes of joint angles of trunk movements in different anatomical planes reliably discriminate between PD patients and healthy subjects.     

The effect of asymmetrical body orientation during simulated forward falls on the distal upper extremity impact response of healthy people

The occurrence of distal upper extremity injuries resulting from forward falls (approximately 165,000 per year) has remained relatively constant for over 20 years. Previous work has provided valuable insight into fall arrest strategies, but only symmetric falls in body postures that do not represent actual fall scenarios closely have been evaluated. This study quantified the effect of asymmetric loading and body postures on distal upper extremity response to simulated forward falls. Twenty participants were suspended from the Propelled Upper Limb fall ARest Impact System (PULARIS) in different torso and leg postures relative to the ground and to the sagittal plane (0°, 30° and 45°). When released from PULARIS (hands 10 cm above surface, velocity 1 m/s), participants landed on two force platforms, one for each hand. Right forearm impact response was measured with distal (radial styloid) and proximal (olecranon) tri-axial accelerometers and bipolar EMG from seven muscles. Overall, the relative height of the torso and legs had little effect on the forces, or forearm response variables. Muscle activation patterns consistently increased from the start to the peak activation levels after impact for all muscles, followed by a rapid decline after peak. The impact forces and accelerations suggest that the distal upper extremity is loaded more medial-laterally during asymmetric falls than symmetric falls. Altering the direction of the impact force in this way (volar-dorsal to medial-lateral) may help reduce distal extremity injuries caused when landing occurs symmetrically in the sagittal plane as it has been shown that volar-dorsal forces increase the risk of injury.     

Impact modeling of gymnastic back-handsprings and dive-rolls in children

This study was to determine estimates of the stiffness and damping properties of the wrist, and shoulder in children by examining wrist impacts on the outstretched hand in selected gymnastic activities. The influence of age, mass, and wrist and torso impact velocity on the stiffness and damping properties were also examined. Fourteen young gymnasts (ages 8 to 15 yrs) were videotaped while performing back-handspring trials or dive-rolls. Kinematic and ground reaction analysis provided input for computer simulation of the body as a rheological model with appropriate stiffness and damping. A significant positive linear relationship was obtained between wrist damping in dive rolls and age, mass, and wrist and torso impact velocity, while shoulder damping in the back-handsprings had a significant positive linear relationship with body mass. This new information on stiffness and damping at the shoulder and the wrist in children enables realistic mathematical modeling of children's physical responses to hand impact in falls. This is significant because modeling studies can now be used as an alternative to epidemiological studies to evaluate measures aimed at reducing injuries in gymnastics and other activities involving impact to the upper extremity.     

Strategy and synergy: two levels of equilibrium control during movement. Effects of the microgravity]

Equilibrium is ensured during forward or backward upper trunk movements by displacing the hip and knee simultaneously in opposite directions. When fast movements are performed, a muscle synergy characterized by the early activation of a set of trunk, thigh and leg muscles precedes the onset of the kinematic changes. The question which is addressed concerns the possibility that two levels of equilibrium control might exist during upper trunk movements: the strategy level, which is relatively invariant, is characterized by the displacement in opposite directions of the upper and low segments, and the muscle synergy level at which the strategy is implemented, which may be adaptable to the environmental constraints. When upper trunk movements are performed under microgravity with the subject's feet fixed to the floor of the space cabin, the displacement of upper and lower body segments in opposite directions still occurs, although this is no longer necessary to maintain the equilibrium. This kinematic strategy seems to be aimed at regulating the centre of inertia position with respect to the feet. The muscle synergies associated with these kinematic changes are modified, however, under microgravity. After returning to the ground, the previous synergies do not reappear immediately, but only after a few days. This suggests that a short period of learning is needed to change the synergy. These data are compatible with the hypothesis that two levels of equilibrium control actually exist during upper trunk movements, the strategy level, which is kinematic and invariant, and the synergy level, which is adaptable to the environmental constraints through a short learning process.     

Activities of Daily Living,Depression, and Quality of Life in Parkinson's Disease

This study examined whether activities of daily living (ADL) mediate the relationship between depression and health-related quality of life (HR-QOL) in people with Parkinson''s disease (PD). A cross-sectional, correlational research design examined data from 174 participants who completed the Geriatric Depression Scale (GDS-15), Parkinson''s Disease Questionnaire-39 (PDQ-39), and Unified Parkinson''s Disease Rating Scale-section 2 (UPDRS-section 2 [ADL]). Multiple Regression Analysis (MRA) was used to examine the mediator model. Depression and ADL significantly (p<.001) predicted HR-QOL, and depression significantly (p<.001) predicted ADL. Whilst ADL did not impact on the relationship between depression and HR-QOL, there was a significant (p<.001) indirect effect of depression on HR-QOL via ADL, suggesting both direct and indirect (via ADL) effects of depression on HR-QOL. The magnitude of this effect was moderate (R ² = .13). People with PD who report depression also experience greater difficulty completing ADL, which impacts upon their HR-QOL. It is recommended that clinicians adopt a multidisciplinary approach to care by combining pharmacological treatments with psycho/occupational therapy, thereby alleviating the heterogeneous impact of motor and non-motor symptoms on HR-QOL in people with PD.