Preliminary study for the assessment of physical activity using a triaxial accelerometer with a gyro sensor on the upper limbs of subjects with paraplegia driving a wheelchair on a treadmill

Abstract

Objective: This study aimed to examine whether, on the basis of the relationship between sensors attached on the upper limbs and energy expenditure (EE) at the time of wheelchair propulsion, there are differences in the measurement of EE depending on the sensor attachment site and whether addition of the angular velocity information to the acceleration value is advantageous. We also aimed to clarify the variables used to estimate EE as well as the estimated error. Setting: Laboratory of the National Hospital Organization Murayama Medical Center, Japan. Methods: Six male subjects with spinal cord injuries participated in the study. Each wore sensors at the wrist and the middle upper arm on both sides while driving a wheelchair on a treadmill at three levels: very, very light; very light; and fairly light. Triaxial acceleration, triaxial angular velocity and EE were measured during driving. We analyzed the correlation between EE and acceleration, angular velocity and synthesized values of acceleration and angular velocity at each location using regression, multiple regression and Bland-Altman analyses. INTRODUCTIONIndividuals with spinal cord injury (SCI) are prone to disuse syndrome due to their injury and limited movement. Compared with healthy people, people with SCI are at higher risk for lifestylerelated diseases and metabolic syndrome. 1 Thus, to improve and maintain health, a plan for managing physical activity is necessary. 2,3 A recent prospective cohort study showed that an increased physical activity level is associated with both improved physical fitness and a reduced risk of developing cardiovascular diseases. 3 Devices are needed to assess physical activity and evaluate the efficacy of health-promotion interventions.It is difficult to assess daily physical activity in community-dwelling people according to measurements of energy expenditure (EE) using criterion methods such as calorimetry or doubly labeled water techniques. Therefore, the development and validation of wearable monitors such as pedometers, load transducers/foot-contact monitors, accelerometers, heart rate monitors, combined accelerometer and heart rate monitors and multiple sensor systems that enable the evaluation of physical activity in healthy individuals are in progress. 4

Validity of activity monitors in wheelchair users: A systematic review

“…The mean difference represents the estimated bias, while the 95 percent limits of agreement provide an idea of how far apart two measures are likely to be for most individuals. Three studies constructed the Bland-Altman plots and reported the mean difference and the 95 percent limits of agreement (Tables 1-3) [29,35,50]. The ICC, on the other hand, is a reliability measure that considers the systematic differences in paired observations [54].…”

“…Two studies used doubly labeled water [24,35], and 14 studies used metabolic analysis systems such as Cosmed K4b2 or Quark b2 (COSMED; Rome, Italy), TrueOne 2400 computerized metabolic system (TrueOne; Salt Lake City, Utah), Oxycon mobile (Viasys Healthcare; Hochberg, Germany), gas analyzer (AR-1 type-4, Arco System; Chiba, Japan), and Metabolic Analysis System (Aerosport Inc; Ann Arbor, Michigan) as the criterion for measuring energy cost [27][28][29][30][31][32][33][34][37][38][39][40]42,50]. Other methods, including video analysis, observation, direct measurements, and motion capture systems, were used as reference comparisons for validating wheelchair and user movements [34,36,41,[43][44][45][46]49,[51][52].…”

“…The energy expenditure (EE), oxygen consumption, metabolic equivalent, and HR indexes were frequently reported outcome measures for quantifying the energy cost of PA. Of the 29 selected studies, 14 quantified PA in terms of energy cost [24][25][27][28][29][30][31][32][33][34][35][37][38]50]. Six of the studies reported distance traveled, speed (linear and/or angular), absolute angle of rotation, and number of wheel revolutions as measures of wheelchair movements [36,[44][45][46][48][49].…”

“…The specifications of each device are shown in Appendix 2. Of the 29 articles selected, 6 studies evaluated commercially available monitors with default algorithms for quantifying PA in MWUs [24][25][26][27][28][29] (Appendix 3), 15 evaluated commercially available monitors with custom algorithms [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] (Appendix 4), and 10 evaluated custom-made devices and algorithms [43][44][45][46][47][48][49][50][51][52] (Appendix 5). These activity monitors could be categorized into three types: accelerometer-based, multisensor-based, and others (gyroscope-or HR-based).…”

“…These activity monitors could be categorized into three types: accelerometer-based, multisensor-based, and others (gyroscope-or HR-based). Among the 29 articles, 14 investigated accelerometer-based monitors (1 uniaxial [38] and 13 triaxial [26,[32][33][39][40][41][42][46][47][48][49][50][51]), 9 evaluated multisensor-based devices [24][25][28][29]31,[34][35][36][37], 1 evaluated a gyroscope-based monitor [44], and 5 evaluated combinations of any 2 of the 3 types [27,30,43,45]. Among all articles, 19 included only MWUs with spinal cord injuries (SCIs) [24,[26][27][28][29]31,[33][34][35][36][37][40][41][43][44]46,[50][51][52]; 7 included MWUs with a mix of diagnoses, including ...…”