Application of motion analysis system in pre-impact fall detection

The purpose of this study is to investigate unique features of body segments in fall and activities of daily living (ADL) to make automatic detection of fall in its descending phase before the impact. Thus, fall-related injuries can be prevented or reduced by deploying feedback systems before the impact. In this study, the authors propose the following hypothesis: (1) thigh segment normally does not go beyond certain threshold angle to forward and sideways directions in ADL and (2) even if it does, the angular characteristics measured at torso and thigh differ from one another in ADL whereas in the case of fall, they become congruent. These two factors can be used to distinguish fall from ADL in its inception. Vicon 3-D motion analysis system was used in this study. High level of correlation between thigh and torso segments (corr > 0.99) was found for fall activities and low correlation coefficients (mean corr for lateral movements is 0.2338 and for sagittal movements is -0.665) were observed in ADL. By applying the hypothesis, all simulated falls could be detected with no false alarms and around 700ms lead-time before the impact was achieved in pre-impact fall detection. It is the longest lead-time obtained so far in pre-impact fall detection.     

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。     

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.     

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).     

Vestibular dysfunction in vitamin D receptor mutant mice

The vitamin D endocrine system is essential for calcium and bone homeostasis. Vitamin D deficits are associated with muscle weakness and osteoporosis, whereas vitamin D supplementation may improve muscle function, body sway and frequency of falls, growth and mineral homeostasis of bones. The loss of muscle strength and mass, as well as deficits in bone formation, lead to poor balance. Poor balance is one of the main causes of falls, and may lead to dangerous injuries. Here we examine balance functions in vitamin D receptor deficient (VDR−/−) mice, an animal model of vitamin D-dependent rickets type II, and in 1α-hydroxylase deficient (1α-OHase−/−) mice, an animal model of pseudovitamin D-deficiency rickets. Recently developed methods (tilting box, rotating tube test), swim test, and modified accelerating rotarod protocol were used to examine whether the absence of functional VDR, or the lack of a key vitamin D-activating enzyme, could lead to mouse vestibular dysfunctions. Overall, VDR−/− mice, but not 1α-OHase−/− mice, showed shorter latency to fall from the rotarod, smaller fall angle in the tilting box test, and aberrant poor swimming. These data suggest that VDR deficiency in mice is associated with decreased balance function, and may be relevant to poorer balance/posture control in humans with low levels of vitamin D.     

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.     

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.     

Can martial arts techniques reduce fall severity? An in vivo study of femoral loading configurations in sideways falls

Sideways falls onto the hip are a major cause of femoral fractures in the elderly. Martial arts (MA) fall techniques decrease hip impact forces in sideways falls. The femoral fracture risk, however, also depends on the femoral loading configuration (direction and point of application of the force). The purpose of this study was to determine the effect of fall techniques, landing surface and fall height on the impact force and the loading configuration in sideways falls. Twelve experienced judokas performed sideways MA and Block ('natural') falls on a force plate, both with and without a judo mat on top. Kinematic and force data were analysed to determine the hip impact force and the loading configuration. In falls from a kneeling position, the MA technique reduced the impact force by 27%, but did not change the loading configuration. The use of the mat did not change the loading configuration. Falling from a standing changed the force direction. In all conditions, the point of application was distal and posterior to the greater trochanter, but it was less distal and more posterior in falls from standing than from kneeling position. The present decrease in hip impact force with an unchanged loading configuration indicates the potential protective effect of the MA technique on the femoral fracture risk. The change in loading configuration with an increased fall height warrant further studies to examine the effect of MA techniques on fall severity under more natural fall circumstances.     

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.     

Automated remote fall detection using impact features from video and audio

Elderly people and people with epilepsy may need assistance after falling, but may be unable to summon help due to injuries or impairment of consciousness. Several wearable fall detection devices have been developed, but these are not used by all people at risk. We present an automated analysis algorithm for remote detection of high impact falls, based on a physical model of a fall, aiming at universality and robustness. Candidate events are automatically detected and event features are used as classifier input. The algorithm uses vertical velocity and acceleration features from optical flow outputs, corrected for distance from the camera using moving object size estimation. A sound amplitude feature is used to increase detector specificity. We tested the performance and robustness of our trained algorithm using acted data from a public database and real life data with falls resulting from epilepsy and with daily life activities. Applying the trained algorithm to the acted dataset resulted in 90% sensitivity for detection of falls, with 92% specificity. In the real life data, six/nine falls were detected with a specificity of 99.7%; there is a plausible explanation for not detecting each of the falls missed. These results reflect the algorithm’s robustness and confirms the feasibility of detecting falls using this algorithm.     

The relation between hip impact velocity and hip impact force differs between sideways fall techniques.

Fall techniques that reduce fall severity may decrease the risk of hip fractures. A fundamental variable for fall severity is impact force, but impact velocity is also used. The purpose of the study was to determine whether impact velocity is valid to determine differences in fall severity between different techniques. Five young adults with martial arts (MA) experience performed sideways falls from kneeling height using three techniques: Block with arm (Block) and MA techniques with and without use of the arm to break the fall. In addition, one subject also performed MA falls from standing height. Linear regression analysis showed a moderate relation between hip impact velocity and force, which was depended on technique. In falls with comparable impact velocities, forces in MA falls were lower than forces in Block falls. Hence, differences in impact force could not be predicted by velocity. In conclusion, hip impact velocity may be useful to make an approximate prediction of impact force within fall techniques. However, to determine differences between techniques it was not always a valid predictor. When direct impact force measurements are not possible, methods combining impact velocity with energy estimates before and after impact might be more valid.     

Active responses decrease impact forces at the hip and shoulder in falls to the side.

Active responses, such as using the arm to break the fall, may be an effective means of decreasing likelihood of injury in a fall and may help explain why only a small percentage of falls result in a fracture. We quantified the impact force at the hip and shoulder in falls to the side from a kneeling position under three conditions: (1) attempting to break the fall by using an arm; (2) falling with the body relaxed; and (3) falling with the body tensed. Subjects fell from a kneeling position onto a force platform array covered with foam padding and impact force data were recorded. The ground reaction force-time curve was generally bimodal due to sequential impacts of the hip and shoulder. Impact forces at the hip and shoulder were 12 and 16% less for the slap condition (p < 0.05) than for the tensed condition. The impact forces for the relaxed and tensed conditions were not significantly different, although impact forces tended to be less in the relaxed condition. We concluded that active responses reduce the impact forces experienced at the hip and shoulder in falls to the side. Decreased effectiveness of protective responses, due to increases in reaction time and decreases in strength with age, may help explain why so many hip fractures occur in the elderly but so few occur in younger people.     

Mechanography performance tests and their association with sarcopenia,falls and impairment in the activities of daily living – a pilot cross-sectional study in 293 older adults

Objectives:

Muscle mass and muscle power considerably decline with aging. The aim of the present study was to determine the association between muscular function using mechanography and sarcopenia, falls and impairment in the activities of daily living (ADL) in a sample of 293 community-dwelling women and men aged 60-85 years in Berlin, Germany.

Methods:

Muscle function was determined by muscle power per body mass in vertical countermovement jumps (2LJP_rel) and the chair rising test (CRTP_rel) on a force plate. Sarcopenia status was assessed by estimating appendicular muscle mass with dual-X-ray absorptiometry. Self-reported ADL impairment and falls in the last 12 months were determined.

Results:

ADL impairment was significantly correlated with all performance tests but not with muscle mass. The 2LJP_rel (OR 0.88, 95%-CI 0.79-0.98), the Esslinger Fitness Index (EFI) (OR 0.97, 95%-CI 0.94-1.00) and the maximal velocity of the CRT (OR 0.70, 95%-CI 0.53-0.93) remained significant correlates for sarcopenia independent of age in men but not in women. The EFI could differentiate female individuals who had past fall events (OR 0.96, 95%-CI 0.93-0.98).

Conclusion:

The results of the present study highlight the importance of assessing muscle power in older individuals as a relevant correlate for functional decline.     

Estimating severity of sideways fall using a generic multi linear regression model based on kinematic input variables

Many research groups have studied fall impact mechanics to understand how fall severity can be reduced to prevent hip fractures. Yet, direct impact force measurements with force plates are restricted to a very limited repertoire of experimental falls. The purpose of this study was to develop a generic model for estimating hip impact forces (i.e. fall severity) in in vivo sideways falls without the use of force plates.Twelve experienced judokas performed sideways Martial Arts (MA) and Block (‘natural’) falls on a force plate, both with and without a mat on top. Data were analyzed to determine the hip impact force and to derive 11 selected (subject-specific and kinematic) variables. Falls from kneeling height were used to perform a stepwise regression procedure to assess the effects of these input variables and build the model.The final model includes four input variables, involving one subject-specific measure and three kinematic variables: maximum upper body deceleration, body mass, shoulder angle at the instant of ‘maximum impact’ and maximum hip deceleration. The results showed that estimated and measured hip impact forces were linearly related (explained variances ranging from 46 to 63%). Hip impact forces of MA falls onto the mat from a standing position (3650 ± 916 N) estimated by the final model were comparable with measured values (3698 ± 689 N), even though these data were not used for training the model. In conclusion, a generic linear regression model was developed that enables the assessment of fall severity through kinematic measures of sideways falls, without using force plates.     

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.     

Effect of blood-flow restriction exercise on falls and fall related risk factors in older adults 60 years or above: a systematic review

This systematic review investigated the effect of low-load resistance training combined with blood-flow restriction (LL-BFR) on falls in older adults ≥60 years of age. The databases Embase, Medline, and Cochrane Library were searched from inception to October 1^st, 2019 and reference lists of retrieved publications. Main outcomes were fall rates or proportion of fallers. Additional outcomes were physical performance, lower extremity muscle strength or function, and balance. Mean difference ±SD on falls and fall related outcomes were reported and Cochrane Collaboration’s risk of bias tool was used to evaluate quality of evidence. Eight RCT-studies met the inclusion criteria. None reported falls data. Assessing physical performance tests (n=12), 8/12 of the LL-BFR groups showed a significant within-group improvement and 5/12 significant between-group effects comparing LL-BFR to respective controls. For muscle strength tests (n=16), 9/16 showed significant positive within-group improvement and 3/16 significant between-group effects. One study reported data on balance with conflicting results. In conclusion, LL-BFR might increase physical performance and muscle strength in older adults ≥60 years of age. None of the included studies investigated the effect on falls. Larger adequately powered studies are required before introducing LL-BFR as an alternative exercise modality to decrease fall risk.     

Wrist impact velocities are smaller in forward falls than backward falls from standing

The wrist is a common fracture site for both young and older adults. The purpose of this study was to compare wrist kinematics in backward and forward falls with different fall protective responses. We carried out within-subject comparison of impact velocities and maximum velocities during descent of the distal radius among three different fall configurations: (a) backward falls with knees flexed, (b) backward falls with knees extended and (c) forward falls with knees flexed. We also examined the effect of fall configuration on fall durations, elbow flexion, trunk flexion and forearm angles at impact. Forward falls resulted in smaller impact velocities of the distal radius, longer fall duration, longer braking duration, greater elbow flexion and more horizontal landing position of the forearm compared to backward falls. The distal radius impact velocity during forward falls (1.33 m/s) was significantly lower than in backward falls, and among the backward falls the impact velocity of the flexed knee strategy (2.01 m/s) was significantly lower than the extended knee strategy (2.27 m/s). These impact velocities were significantly reduced from the maximum velocities observed during descent (forward falls=3.57 m/s, backward falls with knee flexed=3.16 m/s, backward falls with knees extended=3.52 m/s). We conclude that (1) smaller impact velocities of the wrists in forward falls could imply a lower fracture risk compared to backward falls, and (2) fall protective responses reduced wrist impact velocities in all fall directions.     

Prediction of Falls and/or Near Falls in People with Mild Parkinson’s Disease

Objective

To determine factors associated with future falls and/or near falls in people with mild PD.

Methods

The study included 141 participants with PD. Mean (SD) age and PD-duration were 68 (9.7) and 4 years (3.9), respectively. Their median (q1–q3) UPDRS III score was 13 (8-18). Those >80 years of age, requiring support in standing or unable to understand instructions were excluded. Self-administered questionnaires targeted freezing of gait, turning hesitations, walking difficulties in daily life, fatigue, fear of falling, independence in activities of daily living, dyskinesia, demographics, falls/near falls history, balance problems while dual tasking and pain. Clinical assessments addressed functional balance performance, retropulsion, comfortable gait speed, motor symptoms and cognition. All falls and near falls were subsequently registered in a diary during a six-month period. Risk factors for prospective falls and/or near falls were determined using logistic regression.

Results

Sixty-three participants (45%) experienced ≥1 fall and/or near fall. Three factors were independent predictors of falls and/or near falls: fear of falling (OR = 1.032, p<0.001) history of near falls (OR = 3.475, p = 0.009) and retropulsion (OR = 2.813, p = 0.035). The strongest contributing factor was fear of falling, followed by a history of near falls and retropulsion.

Conclusions

Fear of falling seems to be an important issue to address already in mild PD as well as asking about prior near falls.     

The contribution of galactomannan detection in the diagnosis of invasive aspergillosis in bone marrow transplant recipients

Until recently, accurate microbiological diagnosis of invasive aspergillosis (IA) was seldom established in HSCT recipients. Blood samples are rarely positive for Aspergillus species, the reliability of the cultures depends of the specimen (if taken from a normally sterile site or not) and biopsy samples require invasive procedures, rarely recommended in patients with severe thrombocytopenia. Implementing the international consensus defining the microbiological criteria for the diagnosis of Aspergillus infection, we retrospectively evaluated the role of serum galactomannan (GM) detection by EIA to diagnose IA among HSCT patients with proven invasive fungal infection (IFI) and the impact of serum storage in GM concentrations. The EIA assay allowed categorizing as “probable” 5 of the 10 cases of “possible” aspergillosis (50%). Considering a lower cut-off level for the reaction (1.0), 80% of the cases could be categorized as “probable” aspergillosis. Positive or undetermined results were detected one to 4 months before the diagnosis of IA in eight of the 11 patients (72.7%) with proven IFI. Retesting the stored samples after a second storage for four years, we could observe lower reactivity in 20% of the samples. The detection of galactomannan by the EIA test represents a major advance in the diagnosis of IA in HSCT recipients at high risk of IA. A better understanding of the kinetics of the GM in different clinical situations is necessary to maximize the benefit of the test in Aspergillus surveillance.