Digital health technologies that quantify mobility in unsupervised, daily-living environments are emerging as a complementary evaluation approach in neurology. Data collected in these ecologically valid, patient-relevant settings can overcome significant limitations of conventional clinical assessments. Unsupervised assessments can capture fluctuating and rare events and have the promise of supporting clinical decision-making and serving as outcomes in clinical trials. However, studies that directly compared assessments made in unsupervised and supervised (i.e. in the lab or clinical) settings point to large disparities, even in the same parameters of mobility (up to 180% difference). These differences appear to be influenced by psychological, physiological, cognitive, environmental, and technical factors and by the specific aspect of mobility and diagnosis. To facilitate the successful adaptation of the unsupervised assessment of mobility in the clinic and in clinical trials, clinicians and future work should take into account these disparities and the multiple factors that contribute to them.

Gait speed often referred as the sixth vital sign is the most powerful biomarker of mobility. While a clinical setting allows the estimation of gait speed under controlled conditions that present functional capacity, gait speed in real-life conditions provides the actual performance of the patient. The goal of this study was to investigate objectively under what conditions during daily activities, patients perform as well as or better than in the clinic. To this end, we recruited 27 Parkinson’s disease (PD) patients and measured their gait speed by inertial measurement units through several walking tests in the clinic as well as their daily activities at home. By fitting a bimodal Gaussian model to their gait speed distribution, we found that on average, patients had similar modes in the clinic and during daily activities. Furthermore, we observed that the number of medication doses taken throughout the day had a moderate correlation with the difference between clinic and home. Performing a cycle-by-cycle analysis on gait speed during the home assessment, overall only about 3% of the strides had equal or greater gait speeds than the patients’ capacity in the clinic. These strides were during long walking bouts (>1 min) and happened before noon, around 26 min after medication intake, reaching their maximum occurrence probability 3 h after Levodopa intake. These results open the possibility of better control of medication intake in PD by considering both functional capacity and continuous monitoring of gait speed during real-life conditions.

Background: Sit-to-stand and stand-to-sit transitions are frequent daily functional tasks indicative of muscle power and balance performance. Monitoring these postural transitions with inertial sensors provides an objective tool to assess mobility in both the laboratory and home environment. While the measurement depends on the sensor location, the clinical and everyday use requires high compliance and subject adherence. The objective of this study was to propose a sit-to-stand and stand-to-sit transition detection algorithm that works independently of the sensor location. Methods: For a location-independent algorithm, the vertical acceleration of the lower back in the global frame was used to detect the postural transitions in daily activities. The detection performance of the algorithm was validated against video observations. To investigate the effect of the location on the kinematic parameters, these parameters were extracted during a five-time sit-to-stand test and were compared for different locations of the sensor on the trunk and lower back. Results: The proposed detection method demonstrates high accuracy in different populations with a mean positive predictive value (and mean sensitivity) of 98% (95%) for healthy individuals and 89% (89%) for participants with diseases. Conclusions: The sensor location around the waist did not affect the performance of the algorithm in detecting the sit-to-stand and stand-to-sit transitions. However, regarding the accuracy of the kinematic parameters, the sensors located on the sternum and L5 vertebrae demonstrated the highest reliability.

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Due to various applications of human motion capture techniques, developing low-cost methods that would be applicable in nonlaboratory environments is under consideration. MEMS inertial sensors and Kinect are two low-cost devices that can be utilized in home-based motion capture systems, e.g., home-based rehabilitation. In this work, an unscented Kalman filter approach was developed based on the complementary properties of Kinect and the inertial sensors to fuse the orientation data of these two devices for human arm motion tracking during both stationary shoulder joint position and human body movement. A new measurement model of the fusion algorithm was obtained that can compensate for the inertial sensors drift problem in high dynamic motions and also joints occlusion in Kinect. The efficiency of the proposed algorithm was evaluated by an optical motion tracker system. The errors were reduced by almost 50% compared to cases when either inertial sensor or Kinect measurements were utilized.