Three-Dimensional Lower-Limb Kinematics from Accelerometers and Gyroscopes with Simple and Minimal Functional Calibration Tasks: Validation on Asymptomatic Participants.

The use of inertial measurement units (IMUs) to compute gait outputs, such as the 3D lower-limb kinematics is of huge potential, but no consensus on the procedures and algorithms exists. This study aimed at evaluating the validity of a 7-IMUs system against the optoelectronic system. Ten asymptomatic subjects were included. They wore IMUs on their feet, shanks, thighs and pelvis. The IMUs were embedded in clusters with reflective markers. Reference kinematics was computed from anatomical markers. Gait kinematics was obtained from accelerometer and gyroscope data after sensor orientation estimation and sensor-to-segment (S2S) calibration steps. The S2S calibration steps were also applied to the cluster data. IMU-based and cluster-based kinematics were compared to the reference through root mean square errors (RMSEs), centered RMSEs (after mean removal), correlation coefficients (CCs) and differences in amplitude. The mean RMSE and centered RMSE were, respectively, 7.5° and 4.0° for IMU-kinematics, and 7.9° and 3.8° for cluster-kinematics. Very good CCs were found in the sagittal plane for both IMUs and cluster-based kinematics at the hip, knee and ankle levels (CCs > 0.85). The overall mean amplitude difference was about 7°. These results reflected good accordance in our system with the reference, especially in the sagittal plane, but the presence of offsets requires caution for clinical use.

SmartSwim, a Novel IMU-Based Coaching Assistance.

Swimming coaches provide regular timed and technical feedback to swimmers and guide them efficiently in training sessions. Due to the complexity of swimmers' performance, which is not visible in qualitative observation, quantitative and objective performance evaluation can better assist the coach in this regard. Inertial measurement units (IMUs) are used in swimming for objective performance evaluation. In this study, we propose a new performance evaluation feedback (SmartSwim) using IMU and investigate its effects on the swimmer's weekly progress. Measurements were conducted each week with 15 competitive swimmers for 10 weeks using a Sacrum IMU. The SmartSwim report included a comprehensive representation of performance based on goal metrics of each phase extracted from the IMU signals. The swimmers were divided into two groups: the experimental and control groups. The SmartSwim report for each swimmer in the experimental group was given to the coach, who used it to adjust the training accordingly. The results showed that the experimental group outperformed the control group when comparing each swimmer, each session and the whole sessions. At the level of each individual, more members of the experimental group showed significant downward trend of average lap time (Mann-Kendall trend test, 95% confidence level). While comparing the sessions, the experimental group showed significantly lower lap time than the control group from the sixth session onwards (p-value < 0.05 from t-test). Considering all sessions, the experimental group showed significantly higher progress, lower average lap time, and more consistent records (Mann-Whitney U test at 95% confidence level) than the control group. This study demonstrated that SmartSwim can assist coaching by quantitatively assessing swimmers' performance, leading to more efficient training.

Measuring upper limb function in children with hemiparesis with 3D inertial sensors.

PURPOSE: Upper limb assessments in children with hemiparesis rely on clinical measurements, which despite standardization are prone to error. Recently, 3D movement analysis using optoelectronic setups has been used to measure upper limb movement, but generalization is hindered by time and cost. Body worn inertial sensors may provide a simple, cost-effective alternative. METHODS: We instrumented a subset of 30 participants in a mirror therapy clinical trial at baseline, post-treatment, and follow-up clinical assessments, with wireless inertial sensors positioned on the arms and trunk to monitor motion during reaching tasks. RESULTS: Inertial sensor measurements distinguished paretic and non-paretic limbs with significant differences (P < 0.01) in movement duration, power, range of angular velocity, elevation, and smoothness (normalized jerk index and spectral arc length). Inertial sensor measurements correlated with functional clinical tests (Melbourne Assessment 2); movement duration and complexity (Higuchi fractal dimension) showed moderate to strong negative correlations with clinical measures of amplitude, accuracy, and fluency. CONCLUSION: Inertial sensor measurements reliably identify paresis and correlate with clinical measurements; they can therefore provide a complementary dimension of assessment in clinical practice and during clinical trials aimed at improving upper limb function.

Improving activity recognition using a wearable barometric pressure sensor in mobility-impaired stroke patients.

BACKGROUND: Stroke survivors often suffer from mobility deficits. Current clinical evaluation methods, including questionnaires and motor function tests, cannot provide an objective measure of the patients' mobility in daily life. Physical activity performance in daily-life can be assessed using unobtrusive monitoring, for example with a single sensor module fixed on the trunk. Existing approaches based on inertial sensors have limited performance, particularly in detecting transitions between different activities and postures, due to the inherent inter-patient variability of kinematic patterns. To overcome these limitations, one possibility is to use additional information from a barometric pressure (BP) sensor. METHODS: Our study aims at integrating BP and inertial sensor data into an activity classifier in order to improve the activity (sitting, standing, walking, lying) recognition and the corresponding body elevation (during climbing stairs or when taking an elevator). Taking into account the trunk elevation changes during postural transitions (sit-to-stand, stand-to-sit), we devised an event-driven activity classifier based on fuzzy-logic. Data were acquired from 12 stroke patients with impaired mobility, using a trunk-worn inertial and BP sensor. Events, including walking and lying periods and potential postural transitions, were first extracted. These events were then fed into a double-stage hierarchical Fuzzy Inference System (H-FIS). The first stage processed the events to infer activities and the second stage improved activity recognition by applying behavioral constraints. Finally, the body elevation was estimated using a pattern-enhancing algorithm applied on BP. The patients were videotaped for reference. The performance of the algorithm was estimated using the Correct Classification Rate (CCR) and F-score. The BP-based classification approach was benchmarked against a previously-published fuzzy-logic classifier (FIS-IMU) and a conventional epoch-based classifier (EPOCH). RESULTS: The algorithm performance for posture/activity detection, in terms of CCR was 90.4 %, with 3.3 % and 5.6 % improvements against FIS-IMU and EPOCH, respectively. The proposed classifier essentially benefits from a better recognition of standing activity (70.3 % versus 61.5 % [FIS-IMU] and 42.5 % [EPOCH]) with 98.2 % CCR for body elevation estimation. CONCLUSION: The monitoring and recognition of daily activities in mobility-impaired stoke patients can be significantly improved using a trunk-fixed sensor that integrates BP, inertial sensors, and an event-based activity classifier.

Monitoring weekly progress of front crawl swimmers using IMU-based performance evaluation goal metrics.

Technical evaluation of swimming performance is an essential factor in preparing elite swimmers for their competitions. Inertial measurement units (IMUs) have attracted much attention recently because they can provide coaches with a detailed analysis of swimmers' performance during training. A coach can obtain a quantitative and objective evaluation from IMU. The purpose of this study was to validate the use of a new phase-based performance assessment with a single IMU worn on the sacrum during training sessions. Sixteen competitive swimmers performed five one-way front crawl trials at their maximum speed wearing an IMU on the sacrum. The coach recorded the lap time for each trial, as it remains the gold standard for swimmer's performance in competition. The measurement was carried out once a week for 10 consecutive weeks to monitor the improvement in the swimmers' performance. Meaningful progress was defined as a time decrease of at least 0.5 s over a 25 m lap. Using validated algorithms, we estimated five goal metrics from the IMU signals representing the swimmer's performance in the swimming phases (wall push-off, glide, stroke preparation, free-swimming) and in the entire lap. The results showed that the goal metrics for free-swimming phase and the entire lap predicted the swimmer's progress well (e.g., accuracy, precision, sensitivity, and specificity of 0.91, 0.89, 0.94, and 0.95 for the lap goal metric, respectively). As the goal metrics for initial phases (wall push-off, glide, stroke preparation) achieved high precision and specificity (≥0.79) in progress detection, the coach can use them for swimmers with satisfactory free-swimming phase performance and make further improvements in initial phases. Changes in the values of the goal metrics have been shown to be correlated with changes in lap time when there is meaningful progress. The results of this study show that goal metrics provided by the phase-based performance evaluation with a single IMU can help monitoring swimming progress. Average velocity of the lap can replace traditional lap time measurement, while phase-based goal metrics provide more information about the swimmer's performance in each phase. This evaluation can help the coach quantitatively monitor the swimmer's performance and train them more efficiently.

Description of the Method for Evaluating Digital Endpoints in Alzheimer Disease Study: Protocol for an Exploratory, Cross-sectional Study.

BACKGROUND: More sensitive and less burdensome efficacy end points are urgently needed to improve the effectiveness of clinical drug development for Alzheimer disease (AD). Although conventional end points lack sensitivity, digital technologies hold promise for amplifying the detection of treatment signals and capturing cognitive anomalies at earlier disease stages. Using digital technologies and combining several test modalities allow for the collection of richer information about cognitive and functional status, which is not ascertainable via conventional paper-and-pencil tests. OBJECTIVE: This study aimed to assess the psychometric properties, operational feasibility, and patient acceptance of 10 promising technologies that are to be used as efficacy end points to measure cognition in future clinical drug trials. METHODS: The Method for Evaluating Digital Endpoints in Alzheimer Disease study is an exploratory, cross-sectional, noninterventional study that will evaluate 10 digital technologies' ability to accurately classify participants into 4 cohorts according to the severity of cognitive impairment and dementia. Moreover, this study will assess the psychometric properties of each of the tested digital technologies, including the acceptable range to assess ceiling and floor effects, concurrent validity to correlate digital outcome measures to traditional paper-and-pencil tests in AD, reliability to compare test and retest, and responsiveness to evaluate the sensitivity to change in a mild cognitive challenge model. This study included 50 eligible male and female participants (aged between 60 and 80 years), of whom 13 (26%) were amyloid-negative, cognitively healthy participants (controls); 12 (24%) were amyloid-positive, cognitively healthy participants (presymptomatic); 13 (26%) had mild cognitive impairment (predementia); and 12 (24%) had mild AD (mild dementia). This study involved 4 in-clinic visits. During the initial visit, all participants completed all conventional paper-and-pencil assessments. During the following 3 visits, the participants underwent a series of novel digital assessments. RESULTS: Participant recruitment and data collection began in June 2020 and continued until June 2021. Hence, the data collection occurred during the COVID-19 pandemic (SARS-CoV-2 virus pandemic). Data were successfully collected from all digital technologies to evaluate statistical and operational performance and patient acceptance. This paper reports the baseline demographics and characteristics of the population studied as well as the study's progress during the pandemic. CONCLUSIONS: This study was designed to generate feasibility insights and validation data to help advance novel digital technologies in clinical drug development. The learnings from this study will help guide future methods for assessing novel digital technologies and inform clinical drug trials in early AD, aiming to enhance clinical end point strategies with digital technologies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35442.

Swimming Phase-Based Performance Evaluation Using a Single IMU in Main Swimming Techniques.

Comprehensive monitoring of performance is essential for swimmers and swimming coaches to optimize the training. Regardless of the swimming technique, the swimmer passes various swimming phases from wall to wall, including a dive into the water or wall push-off, then glide and strokes preparation and finally, swimming up to the turn. The coach focuses on improving the performance of the swimmer in each of these phases. The purpose of this study was to assess the potential of using a sacrum-worn inertial measurement unit (IMU) for performance evaluation in each swimming phase (wall push-off, glide, stroke preparation and swimming) of elite swimmers in four main swimming techniques (i.e. front crawl, breaststroke, butterfly and backstroke). Nineteen swimmers were asked to wear a sacrum IMU and swim four one-way 25 m trials in each technique, attached to a tethered speedometer and filmed by cameras in the whole lap as reference systems. Based on the literature, several goal metrics were extracted from the instantaneous velocity (e.g. average velocity per stroke cycle) and displacement (e.g. time to reach 15 m from the wall) data from a tethered speedometer for the swimming phases, each one representing the goodness of swimmer's performance. Following a novel approach, that starts from swimming bout detection and continues until detecting the swimming phases, the IMU kinematic variables in each swimming phase were extracted. The highly associated variables with the corresponding goal metrics were detected by LASSO (least absolute shrinkage and selection operator) variable selection and used for estimating the goal metrics with a linear regression model. The selected kinematic variables were relevant to the motion characteristics of each phase (e.g. selection of propulsion-related variables in wall push-off phase), providing more interpretability to the model. The estimation reached a determination coefficient (R2) value more than 0.75 and a relative RMSE less than 10% for most goal metrics in all swimming techniques. The results show that a single sacrum IMU can provide a wide range of performance-related swimming kinematic variables, useful for performance evaluation in four main swimming techniques.

Wearable Barometric Pressure Sensor to Improve Postural Transition Recognition of Mobility-Impaired Stroke Patients.

Sit-to-stand and Stand-to-sit transfers (STS) provide relevant information regarding the functional limitation of mobility-impaired patients. The characterization of STS pattern using a single trunk fixed inertial sensor has been proposed as an objective tool to assess changes in functional ability and balance due to disease. Despite significant research efforts, STS quantification remains challenging due to the high inter- and between- subject variability of this motion pattern. The present study aims to improve the performance of STS detection and classification by fusing the information from barometric pressure (BP) and inertial sensors while keeping a single sensor located at the trunk. A total number of 345 STSs were recorded from 12 post-stroke patients monitored in a semi-structured conditioned protocol. Model-based features of BP signal were combined with kinematic parameters from accelerometer and/or gyroscope and used in a logistic regression-based classifier to detect STS and then identify their types. The correct classification rate was 90.6% with full sensor (BP and inertial) configuration and 75.4% with single inertial sensor. Receiver-Operating-Characteristics analysis was carried out to characterize the robustness of the models. The results demonstrate the potential of BP sensor to improve the detection and classification of STSs when monitoring is performed unobtrusively in every-day life.

Reliability and validity of the inertial sensor-based Timed "Up and Go" test in individuals affected by stroke.

The instrumented Timed "Up and Go" test (iTUG) has the potential for playing an important role in providing clinically useful information regarding an individual's balance and mobility that cannot be derived from the original single-outcome Timed "Up and Go" test protocol. The purpose of this study was to determine the reliability and validity of the iTUG using body-fixed inertial sensors in people affected by stroke. For test-retest reliability analysis, 14 individuals with stroke and 25 nondisabled elderly patients were assessed. For validity analysis, an age-matched comparison of 12 patients with stroke and 12 nondisabled controls was performed. Out of the 14 computed iTUG metrics, the majority showed excellent test-retest reliability expressed by high intraclass correlation coefficients (range 0.431-0.994) together with low standard error of measurement and smallest detectable difference values. Bland-Altman plots demonstrated good agreement between two repeated measurements. Significant differences between patients with stroke and nondisabled controls were found in 9 of 14 iTUG parameters analyzed. Consequently, these results warrant the future application of the inertial sensor-based iTUG test for the assessment of physical deficits poststroke in longitudinal study designs.

A lightweight security scheme for wireless body area networks: design, energy evaluation and proposed microprocessor design.

In order for wireless body area networks to meet widespread adoption, a number of security implications must be explored to promote and maintain fundamental medical ethical principles and social expectations. As a result, integration of security functionality to sensor nodes is required. Integrating security functionality to a wireless sensor node increases the size of the stored software program in program memory, the required time that the sensor's microprocessor needs to process the data and the wireless network traffic which is exchanged among sensors. This security overhead has dominant impact on the energy dissipation which is strongly related to the lifetime of the sensor, a critical aspect in wireless sensor network (WSN) technology. Strict definition of the security functionality, complete hardware model (microprocessor and radio), WBAN topology and the structure of the medium access control (MAC) frame are required for an accurate estimation of the energy that security introduces into the WBAN. In this work, we define a lightweight security scheme for WBAN, we estimate the additional energy consumption that the security scheme introduces to WBAN based on commercial available off-the-shelf hardware components (microprocessor and radio), the network topology and the MAC frame. Furthermore, we propose a new microcontroller design in order to reduce the energy consumption of the system. Experimental results and comparisons with other works are given.