An Automated Approach to Instrumenting the Up-on-the-Toes Test(s)

Abstract

Normal ankle function provides a key contribution to everyday activities, particularly step/stair ascent and descent, where many falls occur. The rising to up-on-the-toes (UTT) 30 second test (UTT-30) is used in the clinical assessment of ankle muscle strength/function and endurance and is typically assessed by an observer counting the UTT movement completed. The aims of this study are: (i) to determine whether inertial measurement units (IMUs) provide valid assessment of the UTT-30 by comparing IMU-derived metrics with those from a force-platform (FP), and (ii) to describe how IMUs can be used to provide valid assessment of the movement dynamics/stability when performing a single UTT movement that is held for 5 s (UTT-stand). Twenty adults (26.2 ± 7.7 years) performed a UTT-30 and a UTT-stand on a force-platform with IMUs attached to each foot and the lumbar spine. We evaluate the agreement/association between IMU measures and measures determined from the FP. For UTT-30, IMU analysis of peaks in plantarflexion velocity and in FP’s centre of pressure (CoP) velocity was used to identify each repeated UTT movement and provided an objective means to discount any UTT movements that were not completed ‘fully’. UTT movements that were deemed to have not been completed ‘fully’ were those that yielded peak plantarflexion and CoP velocity values during the period of rising to up-on-the-toes that were below 1 SD of each participant’s mean peak rising velocity across their repeated UTT. The number of UTT movements detected by the IMU approach (23.5) agreed with the number determined by the FP (23.6), and each approach determined the same number of ‘fully’ completed movements (IMU, 19.9; FP, 19.7). For UTT-stand, IMU-derived movement dynamics/postural stability were moderately-to-strongly correlated with measures derived from the FP. Our findings highlight that the use of IMUs can provide valid assessment of UTT test(s).