Multi-sensor assessment of dynamic balance during gait in patients with subacute stroke

Bergamini, Elena; Iosa, Marco; Belluscio, Valeria; Morone, Giovanni; Tramontano, Marco; Vannozzi, Giuseppe

doi:10.1016/j.jbiomech.2017.07.034

Cited by 45 publications

(41 citation statements)

References 39 publications

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“…Multi-sensor approaches have been utilized to characterize the link between trunk accelerations and walking, and this approach have detected, e.g., the lack of pelvic accelerations and impaired head position or upper extremity function. Moreover, accelerometric analysis of trunk movements has been suitable for distinguishing stroke patients from healthy controls due to their trunk asymmetry and gait disturbance, with good correlations with clinical balance and mobility scores [ 11 , 13 , 15 , 16 , 17 , 18 , 19 , 20 ]. However, to date, there is no automated monitoring of position changes in early neurorehabilitation available, and accelerometric sensors have not been used to assess changes of body position in immobile patients during early neurorehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Accelerometric Trunk Sensors to Detect Changes of Body Positions in Immobile Patients

Rauen

Schaffrath

Pradhan

et al. 2018

Sensors

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Mobilization, verticalization and position change are mandatory for severely affected neurological patients in early neurorehabilitation in order to improve neurological status and prevent complications. However, with the exception of hospitals and rehabilitation facilities, this activity is not usually monitored and so far the automated monitoring of position changes in immobile patients has not been investigated. Therefore, we investigated whether accelerometers on the upper trunk could reliably detect body position changes in immobile patients. Thirty immobile patients in early neurorehabilitation (Barthel Index ≤ 30) were enrolled. Two tri-axial accelerometers were placed on the upper trunk and on the thigh. Information on the position and position changes of the subject were derived from accelerometer data and compared to standard written documentation in the hospital over 24 h. Frequency and duration of different body positions (supine, sidelying, sitting) were measured. Data are presented as mean ± SEM. Groups were compared using one-way ANOVA or Kruskal-Wallis-test. Differences were considered significant if p < 0.05. Trunk sensors detected 100% and thigh sensors 66% of position changes (p = 0.0004) compared to standard care documentation. Furthermore, trunk recording also detected additional spontaneous body position changes that were not documented in standard care (81.8 ± 4.4% of all position changes were documented in standard care documentation) (p < 0.0001). We found that accelerometric trunk sensors are suitable for recording position changes and mobilization of severely affected patients. Our findings suggest that using accelerometers for care documentation is useful for monitoring position changes and mobilization frequencies in and outside of hospital for severely affected neurological patients. Accelerometric sensors may be valuable in monitoring continuation of care plans after intensive neurorehabilitation.

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Section: Introductionmentioning

confidence: 99%

Accelerometric Trunk Sensors to Detect Changes of Body Positions in Immobile Patients

Rauen

Schaffrath

Pradhan

et al. 2018

Sensors

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“…Wearable monitoring systems based on inertial sensors provide an opportunity to complement the mDGI with quantitative digitally stored data, giving information on trunk movement, step regularity, and smoothness during dynamic balance tasks that are difficult to assess during clinical examination, as demonstrated in recent studies in the same pathologies recruited for the present study . These data can help to enhance clinical reasoning to improve rehabilitation efficacy .…”

Section: Introductionmentioning

confidence: 74%

Instrumented Version of the Modified Dynamic Gait Index in Patients With Neurologic Disorders

Anastasi

Carpinella

Gervasoni

et al. 2019

PM&R

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Background: Gait instability is common in adults with neurologic disorders and the modified Dynamic Gait Index (mDGI) was recently introduced to assess dynamic balance. However, instrumental assessment is needed to provide quantitative measures. Objective: To develop and validate an instrumented version of the mDGI. Design: Cross-sectional study. Setting: Clinical setting. Participants: Thirty adults with neurologic disorders (10 with multiple sclerosis, 10 with Parkinson disease, and 10 with stroke) and 20 healthy volunteers. Methods: Participants were assessed with the Timed Up and Go test (TUG) and with the mDGI. During the assessment of mDGI, data were collected by a single Inertial Measurement Unit (IMU) positioned on the sternum. Principal component analysis (PCA) was performed on the instrumented data extracting eight PC scores (ImPC) describing dynamic balance. The instrumented overall score (ImDGI) was then calculated as the sum of the mPCs. PCA revealed two components associated with stride features and regularity (ImDGI_Gait_Pattern) and trunk movements (ImDGI_Trunk_Sway). Spearman coefficients were calculated between mDGI and ImDGI, whereas Mann-Whitney (U) and Kruskal-Wallis (H) tests assessed differences between groups and neurologic conditions. Main Outcome Measurements: ImDGI. Results: ImDGI did not show ceiling effects, and good correlations were found between ImDGI and mDGI (r = .84), and TUG (r = .84) for people with neurologic disorders (P < .001). Significant differences among pathologies (H test (2) =12.5, P = .002) and between healthy participants and adults with neurologic disorders (U test = 47.0, P = .001) were found. ImDGI_Trunk_Sway discriminated between people using or not using walking aids and among the three pathologies (H (2) = 10.0, P = .007). Conclusions:The ImDGI test seems to provide valid measures to objectively assess dynamic balance in neurologic conditions and possibly quantify balance deficits also in adults with neurologic disorders.

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“…The clinical relevance of upright gait stability parameters is an important issue that deserves attention. A previous work of our research group [ 16 ] highlighted the importance of an instrumental MIMU assessment test in a sample of 45 patients with stroke, showing significant correlation with clinical scale scores. The change in pelvic-to-sternum accelerations differed significantly among the subgroups of patients divided according to ambulation ability, being able to identify patients at risk of fall.…”

Section: Resultsmentioning

confidence: 99%

“…Healthy subjects typically present a progressive reduction of the acceleration from pelvis to sternum and from sternum to head, that reflects the adoption of postural control strategies leading to a steady visual input and to a more effective processing of the vestibular system signals, thus improving the control of equilibrium [ 20 ]. This control is developed early in children, progressively lost with aging, and altered in the presence of a neurological deficit [ 15 , 16 , 18 , 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Usefulness of Magnetoinertial Wearable Devices in Neurorehabilitation of Children with Cerebral Palsy

Iosa

Sanctis

Summa

et al. 2018

Applied Bionics and Biomechanics

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Background Despite the increasing use of wearable magnetoinertial measurement units (MIMUs) for gait analysis, the efficacy of MIMU-based assessment for planning rehabilitation has not been adequately documented yet. Methods The usefulness of a MIMU-based assessment was evaluated comparing the data acquired by three MIMUs located at the pelvis, sternum, and head levels in 12 children with cerebral palsy (CP, age: 2–9 years) and 12 age-matched children with typical development (TD). Gait stability was quantified in terms of acceleration attenuation coefficients from pelvis to head, pelvis to sternum, and sternum to head. Children with CP were randomly divided in two groups: in the first group (CPI), MIMU-based parameters were used by therapists for planning patient-tailored rehabilitation programs, whereas in the second group (CPB), therapists were blind to the MIMU-based assessment results. Both CPI and CPB were tested before and after the relevant neurorehabilitation program. Ad hoc questionnaires were also administered to therapists of the CPI group to assess the degree of usefulness perceived about the information provided by the MIMU-based assessment. Results Significant differences were found between children with CP and those with TD for the acceleration attenuation coefficient from pelvis to head (p = 0.048) and from pelvis to sternum (p = 0.021). After neurorehabilitation, this last parameter increased more in CPI (35%) than in CPB (6%, p = 0.017 for the interaction group per time). The results of the questionnaires showed that therapists agreed with the usability (100% judged it as “easy to use”) and usefulness of the MIMU-based assessment in defining patient-oriented interventions (87%). Conclusions There is a large debate in literature about the efficacy of classical gait analysis that should be enlarged to new technological approaches, such as that based on MIMUs. This study is a first proof of concept about the efficacy of this approach for neurorehabilitation of children with CP.

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Multi-sensor assessment of dynamic balance during gait in patients with subacute stroke

Cited by 45 publications

References 39 publications

Accelerometric Trunk Sensors to Detect Changes of Body Positions in Immobile Patients

Accelerometric Trunk Sensors to Detect Changes of Body Positions in Immobile Patients

Instrumented Version of the Modified Dynamic Gait Index in Patients With Neurologic Disorders

Usefulness of Magnetoinertial Wearable Devices in Neurorehabilitation of Children with Cerebral Palsy

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