Functional calibration procedure for 3D knee joint angle description using inertial sensors

Measurement of three-dimensional (3D) knee joint angle outside a laboratory is of benefit in clinical examination and therapeutic treatment comparison. Although several motion capture devices exist, there is a need for an ambulatory system that could be used in routine practice. Up-to-date, inertial measurement units (IMUs) have proven to be suitable for unconstrained measurement of knee joint differential orientation. Nevertheless, this differential orientation should be converted into three reliable and clinically interpretable angles. Thus, the aim of this study was to propose a new calibration procedure adapted for the joint coordinate system (JCS), which required only IMUs data. The repeatability of the calibration procedure, as well as the errors in the measurement of 3D knee angle during gait in comparison to a reference system were assessed on eight healthy subjects. The new procedure relying on active and passive movements reported a high repeatability of the mean values (offset<1°) and angular patterns (SD<0.3° and CMC>0.9). In comparison to the reference system, this functional procedure showed high precision (SD<2° and CC>0.75) and moderate accuracy (between 4.0° and 8.1°) for the three knee angle. The combination of the inertial-based system with the functional calibration procedure proposed here resulted in a promising tool for the measurement of 3D knee joint angle. Moreover, this method could be adapted to measure other complex joint, such as ankle or elbow.     

Quantification of gait parameters with inertial sensors and inverse kinematics

Measuring human gait is important in medicine to obtain outcome parameter for therapy, for instance in Parkinson’s disease. Recently, small inertial sensors became available which allow for the registration of limb-position outside of the limited space of gait laboratories. The computation of gait parameters based on such recordings has been the subject of many scientific papers. We want to add to this knowledge by presenting a 4-segment leg model which is based on inverse kinematic and Kalman filtering of data from inertial sensors. To evaluate the model, data from four leg segments (shanks and thighs) were recorded synchronously with accelerometers and gyroscopes and a 3D motion capture system while subjects (n = 12) walked at three different velocities on a treadmill. Angular position of leg segments was computed from accelerometers and gyroscopes by Kalman filtering and compared to data from the motion capture system. The four-segment leg model takes the stance foot as a pivotal point and computes the position of the remaining segments as a kinematic chain (inverse kinematics). Second, we evaluated the contribution of pelvic movements to the model and evaluated a five segment model (shanks, thighs and pelvis) against ground-truth data from the motion capture system and the path of the treadmill.ResultsWe found the precision of the Kalman filtered angular position is in the range of 2–6° (RMS error). The 4-segment leg model computed stride length and length of gait path with a constant undershoot of 3% for slow and 7% for fast gait. The integration of a 5th segment (pelvis) into the model increased its precision. The advantages of this model and ideas for further improvements are discussed.     

Ambulatory estimation of foot placement during walking using inertial sensors

This study proposes a method to assess foot placement during walking using an ambulatory measurement system consisting of orthopaedic sandals equipped with force/moment sensors and inertial sensors (accelerometers and gyroscopes). Two parameters, lateral foot placement (LFP) and stride length (SL), were estimated for each foot separately during walking with eyes open (EO), and with eyes closed (EC) to analyze if the ambulatory system was able to discriminate between different walking conditions. For validation, the ambulatory measurement system was compared to a reference optical position measurement system (Optotrak). LFP and SL were obtained by integration of inertial sensor signals. To reduce the drift caused by integration, LFP and SL were defined with respect to an average walking path using a predefined number of strides. By varying this number of strides, it was shown that LFP and SL could be best estimated using three consecutive strides. LFP and SL estimated from the instrumented shoe signals and with the reference system showed good correspondence as indicated by the RMS difference between both measurement systems being 6.5±1.0 mm (mean ±standard deviation) for LFP, and 34.1±2.7 mm for SL. Additionally, a statistical analysis revealed that the ambulatory system was able to discriminate between the EO and EC condition, like the reference system. It is concluded that the ambulatory measurement system was able to reliably estimate foot placement during walking.     

Sit-to-stand motor strategies investigated in able-bodied young and elderly subjects

For the execution of a certain motor task, a motor strategy is chosen by each individual among those that are consistent with the structural and functional constraints of his/her locomotor system, and that tends to maximise the effectiveness of the motor act. The identification of this strategy allows for the assessment of the individual's functional status. This study aimed at identifying the motor strategies adopted for the execution of the sit-to-stand motor task, at different speeds and initial postures, in a sample of 35 community-dwelling elders and in a sample of 16 young able-bodied individuals. This was done using a method, least perceivable to the test subject and "economical" for the experimenter, which entailed the recording of external forces only. A musculo-skeletal system model, based on a telescopic inverted-pendulum (TIP) moved by a linear and two rotational muscle-equivalent actuators, was then used. Parameters describing the kinematics and dynamics of these actuators were extracted and submitted to statistical analysis. Different motor strategies were identified in the two age groups, as well as associated with both a different initial posture (ankle dorsiflexion angle) and speed of execution of the motor task. In particular, the elder group, as compared with the young group, prior to seat-off tended to flex the trunk more, thus bringing the CM closer to the base of support, and at a higher velocity, thus gaining a higher momentum. After seat-off, elders rotated the body forward and, only after having brought their CM over the base of support, effectively started elevation. Both global muscular effort and coordination effort associated with the achievement of balance and raising were lower. However, maximal speed was also lower. The above results indicated that the elders could count on a lower functional reserve than the young individuals and, from the methodological viewpoint, that the TIP approach is a good candidate for subject-specific functional evaluation in a clinical context.     

Haemodynamic response to exercise in healthy young and elderly subjects

Whereas with advancing age, peak heart rate (HR) and cardiac index (CI) are clearly reduced, peak stroke index (SI) may decrease, remain constant or even increase. The aim of this study was to describe the patterns of HR, SI, CI, arteriovenous difference in oxygen concentration (C _a-vO₂), mean arterial pressure (MAP), systemic vascular resistance index (SVRI), stroke work index (SWI) and mean systolic ejection rate index (MSERI) in two age groups (A: 20–30 years, n = 20; B: 50–60 years n = 20. After determination of pulmonary function, an incremental bicycle exercise test was performed, with standard gas-exchange measurements and SI assessment using electrical impedance cardiography. The following age-related changes were found: similar submaximal HR response to exercise in both groups and a higher peak HR in A than in B[185 (SD 9) vs 167 (SD 14) beats · min⁻¹, P < 0.0005]; increase in SI with exercise up to 60–90 W and subsequent stabilization in both groups. As SI decreased towards the end of exercise in B, a higher peak SI was found in A [57.5 (SD 14.0) vs 43.6 (SD 7.7) ml · m⁻², P < 0.0005]; similar submaximal CI response to exercise, higher peak CI in A [10.6 (SD 2.5) vs 7.2 (SD 1.3) l · min⁻¹ · m⁻², P < 0.0005]; no differences in C _a-vO₂ during exercise; higher MAP at all levels of exercise in B; higher SVRI at all levels of exercise in B; lower SWI in B after recovery; higher MSERI at all levels of exercise in A. The decrease in SI with advancing age would seem to be related to a decrease in myocardial contractility, which can no longer be compensated for by an increase in preload (as during submaximal exercise). Increases in systemic blood pressure may also compromise ventricular function but would seem to be of minor importance. Accepted: 24 September 1996     

High efficiency electrochemical immuno sensors using 3D comb electrodes

To realize highly sensitive electrochemical immunoassays, a micro-fabricated three-dimensional (3D) electrode was fabricated and applied to enzyme immuno assay based on production of a redox species. The dimensions of the electrodes are 10 microm in width and 30 microm in height, with 20 microm spacing in between, and the 30 pairs of anode and cathode electrodes made up a single sensor. This structure lead to enhancement of the electrochemical reaction, nearly 100% of trap ratio of redox species. It can be applied to highly sensitive enzyme immuno sensing based on p-aminophenylphosphate (PAPP). Applicability of this technique to the immuno assay for one of the clinical diagnostic marker proteins (alpha-fetoprotein; AFP) from 6 to 500 ng/mL was demonstrated.     

Strategy quantification using body worn inertial sensors in a reactive agility task

Agility performance is often evaluated using time-based metrics, which provide little information about which factors aid or limit success. The objective of this study was to better understand agility strategy by identifying biomechanical metrics that were sensitive to performance speed, which were calculated with data from an array of body-worn inertial sensors. Five metrics were defined (normalized number of foot contacts, stride length variance, arm swing variance, mean normalized stride frequency, and number of body rotations) that corresponded to agility terms defined by experts working in athletic, clinical, and military environments. Eighteen participants donned 13 sensors to complete a reactive agility task, which involved navigating a set of cones in response to a vocal cue. Participants were grouped into fast, medium, and slow performance based on their completion time. Participants in the fast group had the smallest number of foot contacts (normalizing by height), highest stride length variance (normalizing by height), highest forearm angular velocity variance, and highest stride frequency (normalizing by height). The number of body rotations was not sensitive to speed and may have been determined by hand and foot dominance while completing the agility task. The results of this study have the potential to inform the development of a composite agility score constructed from the list of significant metrics. By quantifying the agility terms previously defined by expert evaluators through an agility score, this study can assist in strategy development for training and rehabilitation across athletic, clinical, and military domains.     

Quantifying physical functional trajectory in hospitalized older adults using body worn inertial sensors

Acute medical illness requiring hospitalization usually is a critical event in the trajectory leading to disability in older adults. Functional decline frequently occurs during hospitalization, resulting in a loss of Independence in activities of daily living after discharge. The aim of the study was to assess the functional decline in different ADLs of hospitalized elderly patients in an Acute Care for Elderly (ACE) unit incorporating a body-worn inertial sensor and accompanying custom algorithms. 38 hospitalized older adults (age ≥ 75) were included. The patients completed different functional tasks, including a balance test, Gait Velocity Test (GVT), verbal and arithmetic dual-task gait, and a sit-to-stand ability test at admission and discharge. Movement-related parameters were acquired from a unique tri-axial inertial sensor unit. Maximal muscle strength and muscle power output endpoints were also assessed. The results indicated that significant improvements (p < 0.05) were found at discharge compared with the admission values for gait variability and spatiotemporal parameters in the 4- and 6-meter GVT. These significant gains were also obtained in the verbal GVT. In contrast, a significant reduction was found in the functional status measured with the Barthel Index scale. Regarding to the sit-to-stand ability, lower peak power was observed in the sit-to-stand phase of the task at discharge. In conclusion, inertial sensor unit and our custom, validated, algorithms represent a feasible tool for measuring and monitoring functional trajectory during hospitalization in older adults and they are sensitive to detect differences in movement pattern parameters in different ADLs such as walking and the ability to stand from a seated position.     

Mild dehydration and atrial natriuretic peptide in young and elderly subjects.

The influence of mild dehydration on plasma levels of atrial natriuretic peptide (ANP) was studied in both young (aged 18 to 25 years) and elderly (aged 72 to 86 years) subjects. We expected that dehydration would lower ANP concentrations due to the ensuing volume contraction. A different response of the ANP hormonal system in the elderly might help to explain the observation that elderly subjects are more predisposed to dehydration as compared to young subjects. Dehydration was induced by restriction of fluid intake to 25% of normal for one day. During the study, urinary osmolality increased while osmolar clearance and body weight decreased. Basal ANP concentrations were higher in the elderly subjects. However, these levels did not change during the dehydration study neither in the young nor in the elderly subjects. This may be explained by the activation of counter-regulatory systems preventing a decrease in central blood volume and hence a decrease in ANP concentration.     

Ventilatory and arousal patterns during sleep in normal young and elderly subjects

Since elderly subjects have lower chemosensitivity, we postulated that ventilation might be more state dependent in the elderly. To address this we investigated the changes in ventilation, measured by respiratory inductive plethysmography, with sleep in 12 healthy young (19-29 yr) and 13 elderly (greater than 65 yr) subjects. Ventilation was measured in representative periods in each sleep state. These data showed that there is no difference between the elderly and the young either in mean ventilation or in the variability of ventilation awake or in the different states of sleep. In both groups ventilation was variable in stage 1-2 sleep and least variable in stage 3-4 sleep. The variability in stage 1-2 sleep was due to periodic breathing (cycle time approximately 45 s) in both age groups. Although within a sleep state no differences were observed, over the night of study the elderly behaved differently from the young. Apneas occurred more frequently in the elderly, and 5 of 13 elderly met the criteria for sleep apnea syndrome compared with 1 of 12 young subjects. Apneas tended to occur predominantly in stage 1-2 sleep and seem to be an exaggeration of the periodicity that is typical of this state. Four of the elderly with apnea remained in this stage of sleep throughout the night of study. The apneic episodes usually terminated with an electroencephalogram arousal that occurred prior to or simultaneously with the onset of ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)     

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.     

Dispersion of helical axes during shoulder movements in young and elderly subjects

The shoulder complex (SC) consists of joints with little congruence and its active and passive structures ensure its stability. Stability of the SC rotation centre during upper arm movements can be estimated through the analysis of Helical Axes (HAs) dispersion.The aim of this study was to describe shoulder HAs dispersion during upper limb movements performed with dominant and non-dominant arms by young and elderly subjects. Forty subjects participated in the study (20 young: age 24.8 ± 2.8 years and 20 elderly: age 71.7 ± 6.3 years). Subjects were asked to perform four cycles of 15 rotations, flexions, elevations and abductions with one arm at a time at constant speed. Reflective markers were placed on participants’ arms and trunk in order to detect movements and the HAs dispersion with an optoelectronic system. Mean Distance (MD) from the HAs barycenter and Mean Angle (MA) were used as HAs dispersion indexes. Young subjects showed significant lower MD compared to the elderly during all motion ranges of rotation, flexion and elevation (p < 0.001). Moreover, the MD was lower in the dominant arm compared to the contralateral for rotation (p = 0.049) and flexion (p = 0.019). The results may be due to joint degeneration described in elderly subjects and differences in neuromuscular control of SC stability.     

P300 in young and elderly subjects: Auditory frequency and intensity effects

Auditory event-related potentials (ERPs) were assessed in young and elderly subjects when stimulus intensity (40 vs. 60 dB SL) and standard/target tone frequency (250/500 Hz and 1000/2000 Hz) were manipulated to study the effects of these variables on the P3(00) and N1, P2 and N2 components. Auditory thresholds for each stimulus type were obtained, and the stimulus intensity was adjusted to effect perceptually equal intensities across conditions for each subject. Younger subjects demonstrated larger P3 amplitudes and shorter latencies than elderly subjects. The low frequency stimuli produced larger P3 amplitude and shorter latencies than the high frequency stimuli. Low intensity stimuli yielded somewhat smaller P3 amplitudes and longer peak latencies than high intensity stimulus tones. Although additional stimulus intensity and frequency effects were obtained for the N1, P2 and N2 components, these generally differed relatively little with subject age. The findings suggest that auditory stimulus parameters contribute to P3 measures, which are different for young compared to elderly subjects.     

Anaesthesiological risk assessment in young/adult and elderly dental patients

Objective: Analysing the differences in number of diseases reported, medicines taken and American Society of Anaesthesiologists (ASA) scores in young/adult and elderly dental patients. Subject: Forty‐seven young/adult and 47 elderly dental patients living in the community. Setting: Private dental practice. Main outcome measures: Age, number of systemic diseases reported during anamnesis, number of medicines taken, seriousness of pre‐existent diseases measured according to the ASA (American Society of Anaesthesiologist) scale. Study design: Analytical study. Results: The differences between young/adult and elderly dental patients as far as self‐reported medical conditions, medicines taken and ASA scores were statistically significant (p < 0.001). Conclusion: The number of elderly patients’ medical conditions are greater than young/adults’. It is therefore necessary to adequately assess the elderly patient before starting any dental treatment.     

Effect of concentration on taste-taste interactions in foods for elderly and young subjects

An increase in concentration of one of the tastants in a 'real food' might affect not only the perception of the taste quality of that manipulated tastant but also the other perceivable taste qualities. The influence of concentration increase of sodium or potassium chloride in tomato soup, sucrose or aspartame in iced tea, acetic or citric acid in mayonnaise, caffeine or quinine HCl in chocolate drink, monosodium glutamate (MSG) or inosine 5'-monophosphate (IMP) in broth on the other perceivable taste qualities in these foods was studied in 21 young subjects (19-33 years) and 21 older subjects (60-75 years). The results showed that for each of these tastants, except for the two acids, increasing the concentration provoked significant positive or negative interaction effects on the perception of one or more other taste qualities of the product. Especially in the young, olfaction plays a larger role in the assessment of taste intensity than has been hitherto assumed. The elderly are less able to discriminate between the taste qualities in a product, whereas the young are more able to do so.     

SWEET-HOME ICT technologies for the assessment of elderly subjects

Functional assessments are designed to ascertain a person's ability to perform activities of daily living (ADL) and provide valuable diagnostic as well as care-planning information. Currently, the gold standard for the assessment of functional ability involves clinical rating scales. However, scales are often limited in their ability to provide objective and sensitive information. In contrast, information and communication technologies (ICT) may overcome these limitations by capturing more fully the functional, as well as behavioral and cognitive disturbances associated with Alzheimer disease (AD). In this context, the ANR Tec San 2009 SWEET-HOME project aims at building an innovative framework for modeling ADL. The first result of the SWEET-HOME project has been the installation in a classical consultation setting of a specific room equipped with audio and video sensors. This leads to the following results: (1) physical activity recognition done by patients, (e.g., balance test, repeated transfers between sitting and standing): the monitoring system is able to detect the full set of activities with a detection rate varying from 96.9% to 100% (true positive rate); (2) activity of daily living: the monitoring system had an average sensitivity of 90% and an average precision of 83.51%. Using a functional score it is possible to differentiate AD patients from healthy controls; (3) acceptability of the system: results of the survey (all the 64 participants who accepted to be assessed using the system) indicated that the assessment has been perceived as pleasant (83%).     

Evoked cortical activity to sounds of differing signal meaning in young and elderly subjects

In elderly people, in comparison with the young ones, the latency of wave P300 is increased in response to all applied acoustic signals, the amplitude of P300 is lower only in response to significant stimuli. No age changes of the wave N150 parameters are noticed. P300 (or N150) wave amplitude depends on signal significance of the sound; it is the lowest in response to significant stimuli and the highest to the ignored ones. Possible reasons of this paradoxical phenomenon are discussed. Preferential participation of different stages of cortical information processing is determined by the difficulty of perceptive task solution. Cortical electrical reaction to separate stimuli is significantly determined by the context of the information perceived in the given period, creating psychological state of the personality.