Abstract
BackgroundFor optimal guidance of walking rehabilitation therapy of stroke patients in an in-home setting, a small and easy to use wearable system is needed. In this paper we present a new shoe-integrated system that quantifies walking balance during activities of daily living and is not restricted to a lab environment. Quantitative parameters were related to clinically assessed level of balance in order to assess the additional information they provide.MethodsData of 13 participants who suffered a stroke were recorded while walking 10 meter trials and wearing special instrumented shoes. The data from 3D force and torque sensors, 3D inertial sensors and ultrasound transducers were fused to estimate 3D (relative) position, velocity, orientation and ground reaction force of each foot. From these estimates, center of mass and base of support were derived together with a dynamic stability margin, which is the (velocity) extrapolated center of mass with respect to the front-line of the base of support in walking direction. Additionally, for each participant step lengths and stance times for both sides as well as asymmetries of these parameters were derived.ResultsUsing the proposed shoe-integrated system, a complete reconstruction of the kinematics and kinetics of both feet during walking can be made. Dynamic stability margin and step length symmetry were not significantly correlated with Berg Balance Scale (BBS) score, but participants with a BBS score below 45 showed a small-positive dynamic stability margin and more asymmetrical step lengths. More affected participants, having a lower BBS score, have a lower walking speed, make smaller steps, longer stance times and have more asymmetrical stance times.ConclusionsThe proposed shoe-integrated system and data analysis methods can be used to quantify daily-life walking performance and walking balance, in an ambulatory setting without the use of a lab restricted system. The presented system provides additional insight about the balance mechanism, via parameters describing walking patterns of an individual subject. This information can be used for patient specific and objective evaluation of walking balance and a better guidance of therapies during the rehabilitation.Trial registrationThe study protocol is a subset of a larger protocol and registered in the Netherlands Trial Registry, number NTR3636.
Highlights
For optimal guidance of walking rehabilitation therapy of stroke patients in an in-home setting, a small and easy to use wearable system is needed
The objective of this study is to develop a method to assess balance dynamics during gait in stroke patients in an ambulatory setting and to relate our balance metrics to standardized clinical stability parameters in order to assess the additional information they provide
BBSb vref v vn aParticipant identification number bBerg Balance Scale score (0-56 points). vref : velocity (m/s) calculated from the time to pass 10 meters, measured using a stopwatch. v : velocity during selected steps (m/s) estimated by the extended Kalman filter. vn : velocity v normalized to v0 = gl0
Summary
For optimal guidance of walking rehabilitation therapy of stroke patients in an in-home setting, a small and easy to use wearable system is needed. For a better guidance van Meulen et al Journal of NeuroEngineering and Rehabilitation (2016) 13:48 during the rehabilitation of walking in a daily life setting, a wearable sensing system that qualitatively evaluates walking balance is needed [4]. This system should quantitatively estimate parameters to describe the movements of the patients’ feet and body center of mass (CoM) during walking in a daily life setting [5, 6]. Such a system has small-embedded sensors which do not interfere with daily life body movements and behavior [7]
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