Association between upper limb clinical tests and accelerometry metrics for arm use in daily life in children with unilateral cerebral palsy.

PURPOSE: To evaluate the association between upper-limb (UL) clinical tests and UL accelerometry-derived metrics in children with unilateral Cerebral Palsy (CP). METHODS: In this cross-sectional study, twenty children with unilateral CP and Manual Ability Classification System level I-III were included. Outcomes of the Assisting Hand Assessment, Box and Block-Test and accelerometry metrics were collected in the clinical setting and in daily life. UL asymmetry index (i.e., the ratio between the well-functioning UL and the affected UL use) was evaluated in different physical activity levels and relative use of UL was evaluated during daily living. Spearman's correlation was used to determine the association between UL clinical tests and accelerometry metrics in a clinical setting and in daily life. RESULTS: The strongest negative association was between the Assisting Hand Assessment units and accelerometry metrics during the sedentary time in daily life (rs = -0.64). The asymmetries between ULs were highest during the child's sedentary time (asymmetry index: 45.15) compared to when the child was in light (asymmetry index: 23.97) or higher intensity physical activity (asymmetry index: 13.39). The children used both ULs simultaneously for 44% of the time during daily life. CONCLUSION: Accelerometry metrics may provide additional objective information to clinical tests by quantifying the amount of UL movements and the amount of asymmetry between the upper limbs in daily life.

Accelerometer-based metrics of the upper limbs offer additional information about the quantity of upper limb asymmetry and relative use in children and adolescents with unilateral Cerebral Palsy.Accelerometer-based metrics of upper limb asymmetry in sedentary time and different physical activity intensities in daily life can be a complement to clinical tests among children and adolescents with unilateral Cerebral Palsy.

Individually tailored exercise in patients with postural orthostatic tachycardia syndrome related to post-COVID-19 condition - a feasibility study.

Postural orthostatic tachycardia syndrome (POTS) occurs in approximately 30% of people with highly symptomatic post-COVID-19 condition (PCC). It involves several symptoms that limit physical and psychological functions and cause reduced quality of life. Evidence for different treatments of POTS and PCC is limited, and this study aimed to evaluate the feasibility of individually tailored physical exercise. The secondary aim of the study was to evaluate the preliminary effectiveness of this intervention. Twenty-six participants (81% female, median age 41 years) were enrolled and performed individually tailored endurance and strength training, with progression, for twelve weeks. During the intervention period, the participants had weekly support from a physiotherapist. Feasibility was evaluated with good compliance, with 76% adherence to exercise prescription and 96% completing the study protocol. The treatment was safe, and the evaluation methods (questionnaires, physical assessments, and accelerometer monitoring) were judged to be feasible. After the intervention, improvements in symptom burden as well as in psychological and physical functions were observed. In conclusion, future randomized controlled trials can be performed with only minor adjustments and could include questionnaires, physical assessment and accelerometer monitoring, which were demonstrated as feasible by this study.

Validation of fNIRS measurement of executive demand during walking with and without dual-task in younger and older adults and people with Parkinson's disease.

BACKGROUND: Walking with a concurrent cognitive task (dual-task walking) can pose a challenge to some populations due to aging or neurodegenerative disease. These tasks require cognitive resources involving the prefrontal cortex and can be studied using functional near-infrared spectroscopy (fNIRS). An important step in understanding fNIRS measures during such walking tasks is validating that measures reflect the demands of the tasks and not confounding sources or movement artifacts. AIM: This study aimed to investigate the validity of fNIRS measures of prefrontal cortex activity as an indicator of executive demand during usual walking (single-task) and dual-task walking against clinical and objective measures of motor behavior in young adults, older adults, and people with Parkinson's disease (PD), by evaluating several validation hypotheses. METHODS: In total, 133 participants were recruited from younger adults (18-50 years, n = 42), older adults (≥60 years, n = 49) and people with PD (≥60 years, n = 42). Activity in the prefrontal cortex during walking with and without an auditory Stroop task was measured with fNIRS. A combined hemoglobin measure (correlation-based signal improvement, CBSI) was calculated for use in a region of interest analysis in the dorsolateral prefrontal cortex (dlPFC). Pre-registered hypotheses regarding convergent validity, discriminant validity and known group validity were tested. An exploratory analysis of different hemoglobin measures was also performed. RESULTS: Increases in dlPFC activity were found from single- to dual-task walking in the younger adults group and from rest to single-task walking in the older adults and PD groups. In line with hypotheses, a positive relationship was found between between dlPFC activity during dual-task walking and dual-task cost in the younger adults group, as well as a positive relationship to step time variability during single-task walking and a negative relationship to walking speed during single-task walking in the PD group. However, several clinical and gait measures lacked a relationship with dlPFC activity. CONCLUSION: The fNIRS results point towards the CBSI measure of dlPFC activity being a valid measure of executive demand during both single and dual-task walking. Some relationships between clinical and gait measures and brain activity during walking need further investigation.

Factors associated with the willingness to provide telerehabilitation by physiotherapists treating older adults or people with neurological diseases during the COVID-19 pandemic in Sweden.

BACKGROUND: While telerehabilitation is a promising alternative to traditional rehabilitation, previous studies suggest that it is still underutilised by physiotherapists. The purpose of this study was to identify factors associated with the willingness, and use of, telerehabilitation among physiotherapists. METHOD: An online survey, covering self-reported use of, and attitudes toward telerehabilitation during the COVID-19 pandemic, was distributed to physiotherapists who were members of the Swedish Association of Physiotherapists and working in geriatrics or neurology in Sweden. RESULTS: A total of 307 responding physiotherapists were included, most of whom were female (n = 277, 90.2%), working full-time (n = 225, 73.3%), had a bachelor's degree in physiotherapy as their highest education (n = 238, 77.8%) and working in community care settings (n = 131, 43.0%). Overall, 42.3% responded that they would be willing to work with telerehabilitation daily and 47% responded that they had previously worked with telerehabilitation to some degree during the COVID-19 pandemic. Logistic regression analysis revealed that feeling comfortable using digital tools (OR = 1.81, P = .043), believing that telerehabilitation increases the accessibility of rehabilitation (OR = 2.27, P = .009), and that patients will appreciate it (OR = 2.10, P = .025), were significantly associated with willingness to work daily with telerehabilitation. Working in primary care or rehabilitation centres (OR = 3.48, P < .012), having previously used telerehabilitation (OR = 55.86, P < .001), and perceiving the workplace reimbursement system as facilitating telerehabilitation (OR = 8.24, P = .003), were factors significantly associated with reported use of telerehabilitation during the COVID-19 pandemic. CONCLUSION: Among physiotherapists in Sweden, willingness to use telerehabilitation is largely associated with personal attitudes towards it, whereas reported use of telerehabilitation appears to be related to organisational factors. These findings could be used to shape future implementation of telerehabilitation practices in geriatric and neurorehabilitation in Sweden and contribute to the broader understanding of telerehabilitation among physiotherapists across different contexts.

Investigating underlying brain structures and influence of mild and subjective cognitive impairment on dual-task performance in people with Parkinson's disease.

Cognitive impairment can affect dual-task abilities in Parkinson's disease (PD), but it remains unclear whether this is also driven by gray matter alterations across different cognitive classifications. Therefore, we investigated associations between dual-task performance during gait and functional mobility and gray matter alterations and explored whether these associations differed according to the degree of cognitive impairment. Participants with PD were classified according to their cognitive function with 22 as mild cognitive impairment (PD-MCI), 14 as subjective cognitive impairment (PD-SCI), and 20 as normal cognition (PD-NC). Multiple regression models associated dual-task absolute and interference values of gait speed, step-time variability, and reaction time, as well as dual-task absolute and difference values for Timed Up and Go (TUG) with PD cognitive classification. We repeated these regressions including the nucleus basalis of Meynert, dorsolateral prefrontal cortex, and hippocampus. We additionally explored whole-brain regressions with dual-task measures to identify dual-task-related regions. There was a trend that cerebellar alterations were associated with worse TUG dual-task in PD-SCI, but also with higher dual-task gait speed and higher dual-task step-time variability in PD-NC. After multiple comparison corrections, no effects of interest were significant. In summary, no clear set of variables associated with dual-task performance was found that distinguished between PD cognitive classifications in our cohort. Promising but non-significant trends, in particular regarding the TUG dual-task, do however warrant further investigation in future large-scale studies.

Validation of algorithms for calculating spatiotemporal gait parameters during continuous turning using lumbar and foot mounted inertial measurement units.

Spatiotemporal gait parameters such as step time and walking speed can be used to quantify gait performance and determine physical function. Inertial measurement units (IMUs) allow for the measurement of spatiotemporal gait parameters in unconstrained environments but must be validated against a gold standard. While many IMU systems and algorithms have been validated during treadmill walking and overground walking in a straight line, fewer studies have validated algorithms during more complex walking conditions such as continuous turning in different directions. This study explored the concurrent validity in a population of healthy adults (range 26-52 years) of three different algorithms using lumbar and foot mounted IMUs to calculate spatiotemporal gait parameters: two methods utilizing an inverted pendulum model, and one method based on strapdown integration. IMU data was compared to a Vicon twelve-camera optoelectronic system, using data collected from 9 participants performing straight walking and continuous walking trials at different speeds, resulting in 162 walking trials in total. Intraclass correlation coefficients (ICCA,1) for absolute agreement were calculated between the algorithm outputs and Vicon output. Temporal parameters were comparable in all methods and ranged from moderate to excellent, except double support time which was poor. Strapdown integration performed better for estimating spatial parameters than pendulum models during straight walking, but worse during turning. Selecting the most appropriate model should take into consideration both speed and walking condition.

The Role of Environmental Factors on Health Conditions, General Health and Quality of Life in Persons with Spinal Cord Injuries in South Africa.

OBJECTIVE: The objective was to describe the individual items of the environmental factors and to investigate the relationship between the environmental factors to health conditions, general health and quality of life in people with SCI in South Africa. METHODS: Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury (InSCI) Community Survey. Four major domains, environmental factors, health conditions, general health and quality of life of the survey questionnaire responses, were used for the analysis. Regression models were used to determine the association between the independent variable, which consisted of the specific environmental factors items, and the dependent variables comprising health conditions, general health and quality of life. RESULTS: The commonly reported environmental barriers were public access, lack of short- and long-distance transport and finances. Environmental factors such as public access (p < 0.001), short- (p < 0.001) and long-distance transport (p = 0.001), and friends' (p = 0.003) and colleagues' (p < 0.001) attitudes and communication (p = 0.042) were significantly associated with the presence of secondary health conditions. Finances (p = 0.026), family attitudes (p = 0.037) and communication (p = 0.039) had a significant association with worsened mental health. Services (p = 0.022) and communication (p = 0.042) were also significantly associated with decreased general health. CONCLUSION: The results provide insight into modifiable environmental factors policymakers need to consider or adapt to improve the lives of people with SCI in South Africa with respect to health (secondary health conditions), as well as general and mental health.

Mobile health to promote physical activity in people post stroke or transient ischemic attack - study protocol for a feasibility randomised controlled trial.

BACKGROUND: Physical activity is essential to improve health and reduce the risk of recurrence of stroke or transient ischemic attack (TIA). Still, people post stroke or TIA are often physically inactive and the availability of physical activity promotion services are often limited. This study builds on an existing Australian telehealth-delivered programme (i-REBOUND- Let's get moving) which provides support for home-based physical activity for people post stroke or TIA. The aim of this study is to test the feasibility, acceptability, and preliminary effects of a mobile Health (mHealth) version of the i-REBOUND programme for the promotion of physical activity in people post stroke or TIA living in Sweden. METHODS: One hundred and twenty participants with stroke or TIA will be recruited via advertisement. A parallel-group feasibility randomised controlled trial design with a 1:1 allocation ratio to 1) i-REBOUND programme receiving physical exercise and support for sustained engagement in physical activity through behavioural change techniques, or 2) behavioural change techniques for physical activity. Both interventions will proceed for six months and be delivered digitally through a mobile app. The feasibility outcomes (i.e., reach, adherence, safety and fidelity) will be monitored throughout the study. Acceptability will be assessed using the Telehealth Usability Questionnaire and further explored through qualitative interviews with a subset of both study participants and the physiotherapists delivering the intervention. Clinical outcomes on preliminary effects of the intervention will include blood pressure, engagement in physical activity, self-perceived exercise self-efficacy, fatigue, depression, anxiety, stress and health-related quality of life and will be measured at baseline and at 3, 6 and 12 months after the baseline assessments. DISCUSSION: We hypothesise that the mHealth delivery of the i-REBOUND programme will be feasible and acceptable in people post stroke/TIA living in rural and urban regions of Sweden. The results of this feasibility trial will inform the development of full-scale and appropriately powered trial to test the effects and costs of mHealth delivered physical activity for people after stroke or TIA. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05111951. Registered November 8, 2021.

Using functional near-infrared spectroscopy to measure prefrontal cortex activity during dual-task walking and navigated walking: A feasibility study.

INTRODUCTION: While functional near-infrared spectroscopy (fNIRS) can provide insight into motor-cognitive deficits during ecologically valid gait conditions, the feasibility of using fNIRS during complex walking remains unknown. We tested the process and scientific feasibility of using an fNIRS device to measure cortical activity during complex walking tasks consisting of straight walking and navigated walking under single and dual-task (DT) conditions. METHODS: Nineteen healthy people from 18 to 64 years (mean age: 45.7 years) participated in this study which consisted of three complex walking protocols: (i) straight walking, DT walking (walking while performing an auditory Stroop task) and single-task auditory Stroop, (ii) straight and navigated walking, and (iii) navigated walking and navigated DT walking. A rest condition (standing still) was also included in each protocol. Process feasibility outcomes included evaluation of the test procedures and participant experience during and after each protocol. Scientific feasibility outcomes included signal quality measures, and the ability to measure changes in concentration of deoxygenated and oxygenated hemoglobin in the prefrontal cortex. RESULTS: All participants were able to complete the three protocols with most agreeing that the equipment was comfortable (57.9%) and that the testing duration was adequate (73.7%). Most participants did not feel tired (94.7%) with some experiencing pain (42.1%) during the protocols. The signal qualities were high for each protocol. Compared to the rest condition, there was an increase in oxygenated hemoglobin in the prefrontal cortex when performing dual-task walking and navigation. CONCLUSION: We showed that our experimental setup was feasible for assessing activity in the prefrontal cortex with fNIRS during complex walking. The experimental setup was deemed acceptable and practicable. Signal quality was good during complex walking conditions and findings suggest that the different tasks elicit a differential brain activity, supporting scientific feasibility.

Factors influencing employment among people with spinal cord injury in South Africa.

PURPOSE: The unemployment rate post spinal cord injury (SCI) in South Africa is high with limited knowledge of environmental factors outside the health services, especially in an unevenly developed resource setting like South Africa, affecting the employment rate in people with SCI. Our purpose was to investigate factors associated with employment in people with SCI in South Africa. METHODS: Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury Community Survey. Subsections of the questionnaire responses were used as explanatory variables to predict employment after SCI using logistic regression analysis. RESULTS: The response rate of the study was 54%. Of the 200 participants included, 61% reported being employed before SCI onset whereas only 25% reported being engaged in paid work at the time of this study. The logistic regression model showed not requiring physical assistance in the home environment (p = 0.016), the number of education years before SCI (p = 0.007), household income (p < 0.001), having worked before SCI onset (p = 0.041), and environmental factors (p = 0.029) to be factors associated with employment after SCI. CONCLUSION: The finding suggests multiple factors influence the employment rate, advocating for interdisciplinary rehabilitation approaches and social development interventions to address meaningful occupations in persons with SCI in South Africa.Implications for rehabilitationRehabilitation programs should be adapted and tailored to enhance physical independence.Public policies regarding environmental factors such as access to reliable transport, assistive devices, and public places for wheelchair users are important and could potentially support individuals with spinal cord injury (SCI) becoming employed/re-employed.For successful social/community/civic reintegration for individuals with SCI an intersectional collaboration (i.e., between policymakers, health professionals, and the labor market) needs to be considered to improve the employment opportunities post-SCI.

Cognitive-motor interference in people with mild to moderate multiple sclerosis, in comparison with healthy controls.

BACKGROUND: Reduced motor and cognitive dual-task capacity is found to be more common among people with multiple sclerosis (MS), than among healthy populations. However, studies in larger samples of MS conducted using a more stringent methodology, which includes comparisons to healthy controls, are needed. Thus, the primary aim of this study was to explore the effects on motor and cognitive dual-tasking in people with mild to moderate overall MS-disability, in comparison to healthy controls. A second aim was to explore the differences in dual-task performance on a cognitive task between two motor tasks in people with mild to moderate MS and healthy controls. METHODS: This case-control study evaluated dual-task performance of the motor tasks standing with eyes closed (hereafter standing) and walking and a cognitive task assessing selective executive functions (auditory-Stroop test). Fifty-five people with MS (mild MS, n = 28; moderate MS, n = 27), and 30 healthy controls participated. Standing and walking were assessed using wireless inertial measurement unit sensors (APDM). Standing (three 30 s trials) was measured using sway area and root mean square sway, while walking (2 min) was measured using speed, stride length, and step time. Auditory-Stroop was measured using accuracy and response time. During dual-task assessments, each subject was instructed to pay equal attention to both tasks. Statistical significance was considered if p < .05. RESULTS: Instanding no significant within-group differences in the standing measures were found between single-task and dual-task performance. However, dual-task performance differed significantly between all groups (moderate MS > mild MS > healthy controls), except between mild and moderate MS in sway area. Inwalking, all groups slowed down speed and shortened stride length during dual-task condition compared to single-task condition. Moderate MS performed significantly poorer than mild MS and healthy controls in dual-task walking, but mild MS did not differ from healthy controls. In thecognitivetask only mild MS increased significantly in auditory-Stroop response time during walking. In healthy controls, the performance of auditory-Stroop was not affected by dual-tasking. Moderate MS had significantly longer response time in dual-task auditory-Stroop compared to the other groups, but no differences were observed between mild MS and healthy controls. Only mild MS had significantly longer response time during walking than during standing. CONCLUSION: This study showed that cognitive-motor interference in people with MS is present also in the early phases of the disease. This was shown during dual-tasking with slower walking and a longer response time in the cognitive task compared to healthy controls. Moderate MS performed poorer in almost every aspect of the motor and cognitive assessments in dual-task condition, compared to mild MS and healthy controls. Furthermore, during standing, people with MS performed poorer in standing measures compared to healthy controls. Additionally, healthy controls showed no cognitive interference during motor tasks. The results suggest that standardized regular assessment of dual-tasking in MS care might increase the individual's knowledge of dual-task capacity and contribute to understanding of possible related consequences. However, feasible assessment equipment and specific motor-cognitive dual-task training interventions for people with MS need to be developed.

Establishing Accelerometer Cut-Points to Classify Walking Speed in People Post Stroke.

While accelerometers could be used to monitor important domains of walking in daily living (e.g., walking speed), the interpretation of accelerometer data often relies on validation studies performed with healthy participants. The aim of this study was to develop cut-points for waist- and ankle-worn accelerometers to differentiate non-ambulation from walking and different walking speeds in people post stroke. Forty-two post-stroke persons wore waist and ankle accelerometers (ActiGraph GT3x+, AG) while performing three non-ambulation activities (i.e., sitting, setting the table and washing dishes) and while walking in self-selected and brisk speeds. Receiver operating characteristic (ROC) curve analysis was used to define AG cut-points for non-ambulation and different walking speeds (0.41−0.8 m/s, 0.81−1.2 m/s and >1.2 m/s) by considering sensor placement, axis, filter setting and epoch length. Optimal data input and sensor placements for measuring walking were a vector magnitude at 15 s epochs for waist- and ankle-worn AG accelerometers, respectively. Across all speed categories, cut-point classification accuracy was good-to-excellent for the ankle-worn AG accelerometer and fair-to-excellent for the waist-worn AG accelerometer, except for between 0.81 and 1.2 m/s. These cut-points can be used for investigating the link between walking and health outcomes in people post stroke.

Telerehabilitation during the COVID-19 pandemic in Sweden: a survey of use and perceptions among physiotherapists treating people with neurological diseases or older adults.

BACKGROUND : Telerehabilitation, i.e. rehabilitation at a distance using Information and Communication Technology (ICT), is a promising avenue for improving health among people with neurological diseases or older adults who often experience limited access to services. Still, little is known about physiotherapists' use, perceptions and needs with regards to telerehabilitation services. AIMS: To describe physiotherapists use and perceptions of, as well as needs for, telerehabilitation services for the rehabilitation of people with neurological diseases or older adults in Sweden. METHODS: In this cross-sectional study, an author-created survey was sent out to members of the Swedish Association of Physiotherapists including questions about the use and perceptions of existing telerehabilitation services (e.g. telephone, internet-based applications and mobile applications) as well as needs of future telerehabilitation services. The results were presented descriptively as numbers and percentages. RESULTS: Three hundred seven physiotherapists were included in this study with 139 (45%) treating people with neurological diseases and 168 (55%) treating older adults. Most respondents did not provide telerehabilitation before (74%) or during (51%) the COVID-19 pandemic. Telephone, which was predominantly used for administrative tasks, was the most frequent utilised ICT used by 68% of the physiotherapist using ICTs several days/week. Few respondents used internet-based applications (12%), mobile applications (3%) or SMS services (8%) and videoconferencing (3%). A majority of the respondents were interested in ICT (78%), felt comfortable using ICT (57%) and were interested in learning how ICT can be used in rehabilitation (92%). Still, few respondents perceived that people with neurological diseases or older adults can use existing ICTs for rehabilitation purposes (18%) and that existing reimbursement system within health care facilitates remote rehabilitation (16%). Important functionality of future ICT perceived by physiotherapists covered patient communication (e.g. chat, SMS and video), assessments (e.g. digital surveys and assessment of physical activity) and treatment (e.g. exercise prescription). CONCLUSION: While physiotherapists had an overall positive perception to use and willingness to learn about telerehabilitation, few used telerehabilitation services before nor during the COVID-19 pandemic and they also perceived multilevel barriers for implementation, ranging from patients ability to use ICT to existing reimbursement systems within health care. Our findings emphasize the need to strengthen the expertise regarding remote services among physiotherapists.

Accelerometer assessed upper limb activity in people with stroke: a validation study considering ambulatory and non-ambulatory activities.

PURPOSE: Accelerometry measurements are a promising method to provide quantitative information of upper limb function in daily life post stroke. Our purpose was to investigate i) the validity of accelerometer-based vector magnitude ratios (VMR) to distinguish upper limb function between individuals post-stroke and healthy controls during ambulatory and non-ambulatory activities and, ii) the association between the VMR and clinical assessment of upper limb function for individuals post-stroke. METHODS: Forty persons with stroke and 32 healthy controls wore wrist and hip accelerometers while performing three upper limb activities in a clinical setting and during three days in daily living. Clinical assessment of upper limb function was assessed with the Chedoke-McMaster Stroke Assessment measure and ABILHand. RESULTS: In the clinical setting and daily living, the VMR was significantly lower for individuals post-stroke compared to controls during non-ambulatory activities but not during ambulatory activities. There was a moderate to strong association between VMR and clinical assessment of upper limb function during all conditions, except for walking in the clinical setting. CONCLUSION: The VMR could be used as a sensitive objective marker to measure upper limb function post-stroke during ambulatory and non-ambulatory daily activities.Implications for rehabilitationAccelerometer-based assessment of upper limb function is a sensitive measure of upper limb function post stroke during different activity domains.Accelerometers-based assessment of arm function can detect differences in arm function outside the clinical setting (daily living) over a prolonged period that are not always identified by clinical assessment or perceived ability.

Validity of Hip and Ankle Worn Actigraph Accelerometers for Measuring Steps as a Function of Gait Speed during Steady State Walking and Continuous Turning.

This study aimed to investigate the accuracy and reliability of hip and ankle worn Actigraph GT3X+ (AG) accelerometers to measure steps as a function of gait speed. Additionally, the effect of the low frequency extension filter (LFEF) on the step accuracy was determined. Thirty healthy individuals walked straight and walked with continuous turns in different gait speeds. Number of steps were recorded with a hip and ankle worn AG, and with a Stepwatch (SW) activity monitor positioned around the right ankle, which was used as a reference for step count. The percentage agreement, interclass correlation coefficients and Bland-Altmann plots were determined between the AG and the reference SW across gait speeds for the two walking conditions. The ankle worn AG with the default filter was the most sensitive for step detection at >0.6 m/s, whilst accurate step detection for gait speeds < 0.6 m/s were only observed when applying the LFEF. The hip worn AG with the default filter showed poor accuracy (12-78%) at gait speeds < 1.0 m/s whereas the accuracy increased to >87% for gait speeds < 1.0 m/s when applying the LFEF. Ankle worn AG was the most sensitive to measure steps at a vast range of gait speeds. Our results suggest that sensor placement and filter settings need to be taken into account to provide accurate estimates of step counts.