Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined.

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Monitoring gait quality in daily activities through wearable sensors has the potential to improve medical assessment in Parkinson’s Disease (PD). In this study, four gait partitioning methods, two based on thresholds and two based on a machine learning approach, considering the four-phase model, were compared. The methods were tested on 26 PD patients, both in OFF and ON levodopa conditions, and 11 healthy subjects, during walking tasks. All subjects were equipped with inertial sensors placed on feet. Force resistive sensors were used to assess reference time sequence of gait phases. Goodness Index (G) was evaluated to assess accuracy in gait phases estimation. A novel synthetic index called Gait Phase Quality Index (GPQI) was proposed for gait quality assessment. Results revealed optimum performance (G < 0.25) for three tested methods and good performance (0.25 < G < 0.70) for one threshold method. The GPQI resulted significantly higher in PD patients than in healthy subjects, showing a moderate correlation with clinical scales score. Furthermore, in patients with severe gait impairment, GPQI was found higher in OFF than in ON state. Our results unveil the possibility of monitoring gait quality in PD through real-time gait partitioning based on wearable sensors.

Ergonomics evaluation through measurements of biomechanical parameters in real time has a great potential in reducing non-fatal occupational injuries, such as work-related musculoskeletal disorders. Assuming a correct posture guarantees the avoidance of high stress on the back and on the lower extremities, while an incorrect posture increases spinal stress. Here, we propose a solution for the recognition of postural patterns through wearable sensors and machine-learning algorithms fed with kinematic data. Twenty-six healthy subjects equipped with eight wireless inertial measurement units (IMUs) performed manual material handling tasks, such as lifting and releasing small loads, with two postural patterns: correctly and incorrectly. Measurements of kinematic parameters, such as the range of motion of lower limb and lumbosacral joints, along with the displacement of the trunk with respect to the pelvis, were estimated from IMU measurements through a biomechanical model. Statistical differences were found for all kinematic parameters between the correct and the incorrect postures (p < 0.01). Moreover, with the weight increase of load in the lifting task, changes in hip and trunk kinematics were observed (p < 0.01). To automatically identify the two postures, a supervised machine-learning algorithm, a support vector machine, was trained, and an accuracy of 99.4% (specificity of 100%) was reached by using the measurements of all kinematic parameters as features. Meanwhile, an accuracy of 76.9% (specificity of 76.9%) was reached by using the measurements of kinematic parameters related to the trunk body segment.

The use of motorized treadmills as convenient tools for the study of locomotion has been in vogue for many decades. However, despite the widespread presence of these devices in many scientific and clinical environments, a full consensus on their validity to faithfully substitute free overground locomotion is still missing. Specifically, little information is available on whether and how the neural control of movement is affected when humans walk and run on a treadmill as compared to overground. Here, we made use of linear and non-linear analysis tools to extract information from electromyographic recordings during walking and running overground, and on an instrumented treadmill. We extracted synergistic activation patterns from the muscles of the lower limb via non-negative matrix factorization. We then investigated how the motor modules (or time-invariant muscle weightings) were used in the two locomotion environments. Subsequently, we examined the timing of motor primitives (or time-dependent coefficients of muscle synergies) by calculating their duration, the time of main activation, and their Hurst exponent, a non-linear metric derived from fractal analysis. We found that motor modules were not influenced by the locomotion environment, while motor primitives were overall more regular in treadmill than in overground locomotion, with the main activity of the primitive for propulsion shifted earlier in time. Our results suggest that the spatial and sensory constraints imposed by the treadmill environment might have forced the central nervous system to adopt a different neural control strategy than that used for free overground locomotion, a data-driven indication that treadmills could induce perturbations to the neural control of locomotion.

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Maintaining balance stability while turning in a quasi-static stance and/or in dynamic motion requires proper recovery mechanisms to manage sudden center-of-mass displacement. Furthermore, falls during turning are among the main concerns of community-dwelling elderly population. This study investigates the effect of aging on reactive postural responses to continuous yaw perturbations on a cohort of 10 young adults (mean age 28 ± 3 years old) and 10 older adults (mean age 61 ± 4 years old). Subjects underwent external continuous yaw perturbations provided by the RotoBit 1D platform. Different conditions of visual feedback (eyes opened and eyes closed) and perturbation intensity, i.e., sinusoidal rotations on the horizontal plane at different frequencies (0.2 Hz and 0.3 Hz), were applied. Kinematics of axial body segments was gathered using three inertial measurement units. In order to measure reactive postural responses, we measured body-absolute and joint absolute rotations, center-of-mass displacement, body sway, and inter-joint coordination. Older adults showed significant reduction in horizontal rotations of body segments and joints, as well as in center-of-mass displacement. Furthermore, older adults manifested a greater variability in reactive postural responses than younger adults. The abnormal reactive postural responses observed in older adults might contribute to the well-known age-related difficulty in dealing with balance control during turning.

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