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Machine learning methods have been widely used for gait assessment through the estimation of spatio-temporal parameters. As a further step, the objective of this work is to propose and validate a general probabilistic modeling approach for the classification of different pathological gaits. Specifically, the presented methodology was tested on gait data recorded on two pathological populations (Huntington’s disease and post-stroke subjects) and healthy elderly controls using data from inertial measurement units placed at shank and waist. By extracting features from group-specific Hidden Markov Models (HMMs) and signal information in time and frequency domain, a Support Vector Machines classifier (SVM) was designed and validated. The 90.5% of subjects was assigned to the right group after leave-one-subject–out cross validation and majority voting. The long-term goal we point to is the gait assessment in everyday life to early detect gait alterations.

Gait symmetry is one of the most informative aspects describing the quality of gait. Many indices have been proposed to quantify gait symmetry. Among them, indices focusing on the comparison of the two body sides (e.g., Symmetry Angle, SA) and indices based on the analysis of the locomotor act as a whole, dealing with the body center of mass (e.g., Symmetry Index, SI BCoM ) or lower trunk accelerometry (e.g., improved Harmonic Ratio, iHR) have been proposed. Remarkably, the relationship between these indices has received little attention so far, as well as the influence of gait speed on their values. The aim of this study is to investigate this relationship by comparing the SA, SI BCoM , and iHR, and to explore the effect of walking speed on these indices. Ten healthy adults walked for 60 s on a treadmill at seven different speeds (from 0.28 to 1.95 m s −1 ) and simulate an asymmetric gait (ASYM) at 0.83 m s −1 . Marker-based trajectories were recorded, and the body center of mass 3D trajectory was obtained. Simultaneously, lower trunk 3D linear accelerations were collected using a triaxial accelerometer. SI BCoM , iHR, and SA were calculated for each stride, each anatomical direction, and each condition. Perfect symmetry was never displayed in any axes and any indices. Significant differences existed between SI BCoM , and iHR in all anatomical directions (p < 0.0001). The walking speed significantly affected SI BCoM and iHR values in anteroposterior and craniocaudal directions, but not in mediolateral. Conversely, no walking speed effect was found for SA (p = 0.28). All three indices significantly discriminated between ASYM and the corresponding walking condition (p < 0.05). Gait symmetry may differ significantly according to the data source, mathematical approach, and walking speed. Healthy individuals display an asymmetrical gait and acknowledging this aspect is crucial when establishing rehabilitation objectives and assessing the quality of gait in the clinical setting.

The International Society of Biomechanics (ISB) has charged this committee with development of a standard similar in scope to the kinematic standard proposed in Wu et al. (2002) and Wu et al. (2005). Given the variety of purposes for which intersegmental forces and moments are used in biomechanical research, it is not possible to recommend a particular set of analysis standards that will be acceptable in all applications. Instead, it is the purpose of this paper to recommend a set of reporting standards that will result in an understanding of the differences between investigations and the ability to reproduce the research. The end products of this standard are (1) a critical checklist that can be used during submission of manuscripts and abstracts to insure adequate description of methods, and (2) a web based visualization tool that can be used to alter the coordinate system, normalization technique and internal/external perspective of intersegmental forces and moments during walking and running so that the shape and magnitude of the curves can be compared to one’s own data.

The orientation of a magneto and inertial measurement unit (MIMU) is estimated by means of sensor fusion algorithms (SFAs) thus enabling human motion tracking. However, despite several SFAs implementations proposed over the last decades, there is still a lack of consensus about the best performing SFAs and their accuracy. As suggested by recent literature, the filter parameters play a central role in determining the orientation errors. The aim of this work is to analyze the accuracy of ten SFAs while running under the best possible conditions (i.e., their parameter values are set using the orientation reference) in nine experimental scenarios including three rotation rates and three commercial products. The main finding is that parameter values must be specific for each SFA according to the experimental scenario to avoid errors comparable to those obtained when the default parameter values are used. Overall, when optimally tuned, no statistically significant differences are observed among the different SFAs in all tested experimental scenarios and the absolute errors are included between 3.8 deg and 7.1 deg. Increasing the rotation rate generally leads to a significant performance worsening. Errors are also influenced by the MIMU commercial model. SFA MATLAB implementations have been made available online.

Quantitative gait analysis can provide a description of joint kinematics and dynamics, and it is recognized as a clinically useful tool for functional assessment, diagnosis and intervention planning. Clinically interpretable parameters are estimated from quantitative measures (i.e. ground reaction forces, skin marker trajectories, etc.) through biomechanical modelling. In particular, the estimation of joint moments during motion is grounded on several modelling assumptions: (1) body segmental and joint kinematics is derived from the trajectories of markers and by modelling the human body as a kinematic chain; (2) joint resultant (net) loads are, usually, derived from force plate measurements through a model of segmental dynamics. Therefore, both measurement errors and modelling assumptions can affect the results, to an extent that also depends on the characteristics of the motor task analysed (i.e. gait speed). Errors affecting the trajectories of joint centres, the orientation of joint functional axes, the joint angular velocities, the accuracy of inertial parameters and force measurements (concurring to the definition of the dynamic model), can weigh differently in the estimation of clinically interpretable joint moments. Numerous studies addressed all these methodological aspects separately, but a critical analysis of how these aspects may affect the clinical interpretation of joint dynamics is still missing. This article aims at filling this gap through a systematic review of the literature, conducted on Web of Science, Scopus and PubMed. The final objective is hence to provide clear take-home messages to guide laboratories in the estimation of joint moments for the clinical practice.

Background The step-by-step determination of the spatio-temporal parameters of gait is clinically relevant since it provides an estimation of the variability of specific gait patterns associated with frequent geriatric syndromes. In recent years, several methods, based on the use of magneto-inertial units (MIMUs), have been developed for the step-by-step estimation of the gait temporal parameters. However, most of them were applied to the gait of healthy subjects and/or of a single pathologic population. Moreover, spatial parameters in pathologic populations have been rarely estimated step-by-step using MIMUs. The validity of clinically suitable MIMU-based methods for the estimation of spatio-temporal parameters is therefore still an open issue. The aim of this study was to propose and validate a method for the determination of both temporal and spatial parameters that could be applied to normal and heavily compromised gait patterns. Methods Two MIMUs were attached above each subject’s ankles. An instrumented gait mat was used as gold standard. Gait data were acquired from ten hemiparetic subjects, ten choreic subjects, ten subjects with Parkinson’s disease and ten healthy older adults walking at two different gait speeds. The method detects gait events (GEs) taking advantage of the cyclic nature of gait and exploiting some lower limb invariant kinematic characteristics. A combination of a MIMU axes realignment along the direction of progression and of an optimally filtered direct and reverse integration is used to determine the stride length. Results Over the 4,514 gait cycles analyzed, neither missed nor extra GEs were generated. The errors in identifying both initial and final contact at comfortable speed ranged between 0 and 11 ms for the different groups analyzed. The stride length was estimated for all subjects with less than 3% error. Conclusions The proposed method is apparently extremely robust since gait speed did not substantially affect its performance and both missed and extra GEs were avoided. The spatio-temporal parameters estimates showed smaller errors than those reported in previous studies and a similar level of precision and accuracy for both healthy and pathologic gait patterns. The combination of robustness, precision and accuracy suggests that the proposed method is suitable for routine clinical use.

Digital mobility assessment using wearable sensor systems has the potential to capture walking performance in a patient’s natural environment. It enables monitoring of health status and disease progression and evaluation of interventions in real-world situations. In contrast to laboratory settings, real-world walking occurs in non-conventional environments and under unconstrained and uncontrolled conditions. Despite the general understanding, there is a lack of agreed definitions about what constitutes real-world walking, impeding the comparison and interpretation of the acquired data across systems and studies. The goal of this study was to obtain expert-based consensus on specific aspects of real-world walking and to provide respective definitions in a common terminological framework. An adapted Delphi method was used to obtain agreed definitions related to real-world walking. In an online survey, 162 participants from a panel of academic, clinical and industrial experts with experience in the field of gait analysis were asked for agreement on previously specified definitions. Descriptive statistics was used to evaluate whether consent (> 75% agreement as defined a priori) was reached. Of 162 experts invited to participate, 51 completed all rounds (31.5% response rate). We obtained consensus on all definitions (“Walking” > 90%, “Purposeful” > 75%, “Real-world” > 90%, “Walking bout” > 80%, “Walking speed” > 75%, “Turning” > 90% agreement) after two rounds. The identification of a consented set of real-world walking definitions has important implications for the development of assessment and analysis protocols, as well as for the reporting and comparison of digital mobility outcomes across studies and systems. The definitions will serve as a common framework for implementing digital and mobile technologies for gait assessment and are an important link for the transition from supervised to unsupervised gait assessment.

The orientation of a magneto-inertial measurement unit can be estimated using a sensor fusion algorithm (SFA). However, orientation accuracy is greatly affected by the choice of the SFA parameter values which represents one of the most critical steps. A commonly adopted approach is to fine-tune parameter values to minimize the difference between estimated and true orientation. However, this can only be implemented within the laboratory setting by requiring the use of a concurrent gold-standard technology. To overcome this limitation, a Rigid-Constraint Method (RCM) was proposed to estimate suboptimal parameter values without relying on any orientation reference. The RCM method effectiveness was successfully tested on a single-parameter SFA, with an average error increase with respect to the optimal of 1.5 deg. In this work, the applicability of the RCM was evaluated on 10 popular SFAs with multiple parameters under different experimental scenarios. The average residual between the optimal and suboptimal errors amounted to 0.6 deg with a maximum of 3.7 deg. These encouraging results suggest the possibility to properly tune a generic SFA on different scenarios without using any reference. The synchronized dataset also including the optical data and the SFA codes are available online.

The aim of this contribution is to present a segmentation method for the identification of voluntary movements from inertial data acquired through a single inertial measurement unit placed on the subject’s wrist. Inertial data were recorded from 25 healthy subjects while performing 75 consecutive reach-to-grasp movements. The approach herein presented, called DynAMoS, is based on an adaptive thresholding step on the angular velocity norm, followed by a statistics-based post-processing on the movement duration distribution. Post-processing aims at reducing the number of erroneous transitions in the movement segmentation. We assessed the segmentation quality of this method using a stereophotogrammetric system as the gold standard. Two popular methods already presented in the literature were compared to DynAMoS in terms of the number of movements identified, onset and offset mean absolute errors, and movement duration. Moreover, we analyzed the sub-phase durations of the drinking movement to further characterize the task. The results show that the proposed method performs significantly better than the two state-of-the-art approaches (i.e., percentage of erroneous movements = 3%; onset and offset mean absolute error < 0.08 s), suggesting that DynAMoS could make more effective home monitoring applications for assessing the motion improvements of patients following domicile rehabilitation protocols.

Inertial measurement units (IMUs) enable orientation, velocity, and position estimation in several application domains ranging from robotics and autonomous vehicles to human motion capture and rehabilitation engineering. Errors in orientation estimation greatly affect any of those motion parameters. The present work explains the main challenges in inertial orientation estimation (IOE) and presents an extensive benchmark dataset that includes 3D inertial and magnetic data with synchronized optical marker-based ground truth measurements, the Berlin Robust Orientation Estimation Assessment Dataset (BROAD). The BROAD dataset consists of 39 trials that are conducted at different speeds and include various types of movement. Thereof, 23 trials are performed in an undisturbed indoor environment, and 16 trials are recorded with deliberate magnetometer and accelerometer disturbances. We furthermore propose error metrics that allow for IOE accuracy evaluation while separating the heading and inclination portions of the error and introduce well-defined benchmark metrics. Based on the proposed benchmark, we perform an exemplary case study on two widely used openly available IOE algorithms. Due to the broad range of motion and disturbance scenarios, the proposed benchmark is expected to provide valuable insight and useful tools for the assessment, selection, and further development of inertial sensor fusion methods and IMU-based application systems.