Clinical assessment of gait and functional mobility in Italian healthy and cognitively impaired older persons using wearable inertial sensors

Abstract

Aim The main purpose of the present study was to verify the feasibility of wearable inertial sensors (IMUs) in a clinical setting to screen gait and functional mobility in Italian older persons. In particular, we intended to verify the capability of IMUs to discriminate individuals with and without cognitive impairments and assess the existence of significant correlations between mobility parameters extracted by processing trunk accelerations and cognitive status. Methods This is a cross-sectional study performed on 213 adults aged over 65 years (mean age 77.0 ± 5.4; 62% female) who underwent cognitive assessment (through Addenbrooke’s Cognitive Examination Revised, ACE-R) instrumental gait analysis and the Timed Up and Go (TUG) test carried out using a wearable IMU located in the lower back. Results Individuals with cognitive impairments exhibit a peculiar gait pattern, characterized by significant reduction of speed (− 34% vs. healthy individuals), stride length (− 28%), cadence (− 9%), and increase in double support duration (+ 11%). Slight, but significant changes in stance and swing phase duration were also detected. Poorer performances in presence of cognitive impairment were observed in terms of functional mobility as overall and sub-phase TUG times resulted significantly higher with respect to healthy individuals (overall time, + 38%, sub-phases times ranging from + 22 to + 34%), although with some difference associated with age. The severity of mobility alterations was found moderately to strongly correlated with the ACE-R score (Spearman’s rho = 0.58 vs. gait speed, 0.54 vs. stride length, 0.66 vs. overall TUG time). Conclusion The findings obtained in the present study suggest that wearable IMUs appear to be an effective solution for the clinical assessment of mobility parameters of older persons screened for cognitive impairments within a clinical setting. They may represent a useful tool for the clinician in verifying the effectiveness of interventions to alleviate the impact of mobility limitations on daily life in cognitively impaired individuals.

The Impact of SARS-CoV-2 (COVID-19) and its Lockdown Measures on the Mental and Functional Health of Older Individuals

“…However, the current results also highlighted that the asymmetry in mobility performance that was found comparing the cognitively intact group with the cognitively impaired one at baseline was lost at follow-up, that is when outdoor motor activities were restricted due to the introduction of the COVID-19 lockdown measures. Therefore, extending the outcomes of a study recently performed on a larger sample of Italian adults [15], we found an overall worsening of our participant's gait performance, which can be considered an evident result of their physical inactivity [19] due to the lockdown restrictions. Indeed, during the nationwide quarantine in the winter-spring 2020, the Italian government established that citizens were prevented from performing any kind of physical activity, that is, for 68 days Italians limited their motricity to a short daily walk within 200 meters of distance from their home.…”

“…Gait was objectively assessed using a miniaturized wearable inertial sensor (G-Sensor®, BTS Bioengineering S.p.A., Italy) previously employed for similar investigations in older adults [ 15 ] and which was attached to the individual’s trunk at S1 vertebrae location. Participants were requested to walk along a 30-m hallway, following a straight trajectory at a self-selected speed and in the most natural manner.…”

A Pilot Study to Validate a Wearable Inertial Sensor for Gait Assessment in Older Adults with Falls

“…They can explain motor syndrome associated with mild cognitive impairment and dementia as described by other authors [ 40 , 44 , 45 ]. Recently Mulas et al [ 46 ] published the results of gait assessment in Italian cognitive impaired older adults using wearable inertial sensors finding a significant reduction of speed in these patients and other changes in gait parameters.…”

Wearable gait analysis systems: ready to be used by medical practitioners in geriatric wards?

“…For example, variability of stride length is related to future falls [10][11][12] and gait speed as well as variability of step time are related to cognitive decline [10,13]. In turn, detailed information about functional status and potentially about the impact of diseasemodifying treatments can be obtained [14][15][16]. Therefore, the assessment of gait variability is an important part of gait assessment, which can be performed with instrumented gait analysis (IGA), for example, using gait mats or wearable sensors [10,17].…”