Minimum Foot Clearance Prediction in Stroke Survivors: A Transformer-Based Approach.

Minimum foot clearance (MFC) is defined as the minimum vertical distance between the lowest point of the swing foot or shoe and the walking surface in gait, which is now considered as a critical gait parameter for predicting trip-related fall risks. Different MFC methods have been used to assess fall risks by tripping, with the analytical method proposed by Begg et al. being the most widely used one. Since this method is based on assumption of a 2D triangular geometric model of the foot, the effects of out-of-plane rotations of the foot/shoe on MFC were not completely known. Furthermore, the accuracy of the MFC maybe influenced by factors such as shoe type, limiting its potential applications in clinical scenarios. Thus, this study proposes a novel method to calculate MFC parameter (called 3D-MFC) based on 3D modeling of the “virtual” markers of the shoe. By using a dynamic point-tracking technology, the 3D-MFC can automatically extract the MFC height while subject walking. From the Bland-Altman analysis, it was shown the 3D-MFC agreed well with that of the Begg's 2D-Geometric method. However, the mean absolute error (MSE) and root mean square error (RMSE) of the 3D-MFC method were less than 1 mm, which significantly outperformed the 2D-Geometric method, especially for subjects using rocker-bottom shoe. It is suggested that the 3D-MFC has potential to be an effective solution for identifying the MFC parameters and is expected to be used for biomechanical assessment of trip-related fall risks in the elderly.

Over half of older adult falls are caused by tripping. Many of these trips are likely due to obstacles present on walkways that put older adults or other individuals with low foot clearance at risk. Yet, Minimum Foot Clearance (MFC) values have not been measured in real-world settings and existing methods make it difficult to do so. In this paper, we present the Minimum Foot Clearance Estimation (MFCE) system that includes a device for collecting calibrated video data from pedestrians on outdoor walkways and a computer vision algorithm for estimating MFC values for these individuals. This system is designed to be positioned at ground level next to a walkway to efficiently collect sagittal plane videos of many pedestrians’ feet, which is then processed offline to obtain MFC estimates. Five-hundred frames of video data collected from 50 different pedestrians was used to train (370 frames) and test (130 frames) a convolutional neural network. Finally, data from 10 pedestrians was analyzed manually by three raters and compared to the results of the network. The footwear detection network had an Intersection over Union of 85% and was able to find the bottom of a segmented shoe with a 3-pixel average error. Root Mean Squared (RMS) errors for the manual and automated methods for estimating MFC values were 2.32 mm, and 3.70 mm, respectively. Future work will compare the accuracy of the MFCE system to a gold standard motion capture system and the system will be used to estimate the distribution of MFC values for the population.

A systematic review of the effect of ageing and falls history on minimum foot clearance characteristics during level walking

Background: Falls are a major health concern, with one in three adults over the age of 65 falling each year. A key gait parameter that is indicative of tripping is minimum foot clearance (MFC), which occurs during the mid-swing phase of gait. This is the second of a two-part scoping review on MFC literature. The aim of this paper is to identify vulnerable populations and conditions that impact MFC mean or median relative to controls. This information will inform future design/maintenance standards and outdoor built environment guidelines. Methods: Four electronic databases were searched to identify journal articles and conference papers that report level-ground MFC characteristics. Two independent reviewers screened papers for inclusion. Results: Out of 1571 papers, 43 relevant papers were included in this review. Twenty-eight conditions have been studied for effects on MFC. Eleven of the 28 conditions led to a decrease in mean or median MFC including dual-task walking in older adults, fallers with multiple sclerosis, and treadmill walking. All studies were conducted indoors. Conclusions: The lack of standardized research methods and covariates such as gait speed made it difficult to compare MFC values between studies for the purpose of defining design and maintenance standards for the outdoor built environment. Standardized methods for defining MFC and an emphasis on outdoor trials are needed in future studies.

Location of minimum foot clearance on the shoe and with respect to the obstacle changes with locomotor task

Tripping is the largest cause of falls, and low swing foot ground clearance during the mid-swing phase, particularly at the critical gait event known as Minimum Foot Clearance (MFC), is the major risk factor for tripping-related falls. Intervention strategies to increase MFC height can be effective if applied in real-time based on feed-forward prediction. The current study investigated the capability of machine learning models to classify the MFC into various categories using toe-off kinematics data. Specifically, three MFC sub-categories (less than 1.5 cm, between 1.5 and 2.0 cm, and higher than 2.0 cm) were predicted to apply machine learning approaches. A total of 18,490 swing phase gait cycles’ data were extracted from six healthy young adults, each walking for 5 min at a constant speed of 4 km/h on a motorized treadmill. K-Nearest Neighbor (KNN), Random Forest, and XGBoost were utilized for prediction based on the data from toe-off for five consecutive frames (0.025 s duration). Foot kinematics data were obtained from an inertial measurement unit attached to the mid-foot, recording tri-axial linear accelerations and angular velocities of the local coordinate. KNN, Random Forest, and XGBoost achieved 84%, 86%, and 75% accuracy, respectively, in classifying MFC into the three sub-categories with run times of 0.39 s, 13.98 s, and 170.98 s, respectively. The KNN-based model was found to be more effective if incorporated into an active exoskeleton as the intelligent system to control MFC based on the preceding gait event, i.e., toe-off, due to its quicker computation time. The machine learning-based prediction model shows promise for the prediction of critical MFC data, indicating higher tripping risk.

Foot-ground clearance characteristics in women: A comparison across different ages

Falls prevention is important for older individuals to maintain healthy lifestyles and is an essential challenge in sustaining the socioeconomic structure of many advanced nations. Tripping has been recognized as the largest cause of falls and accordingly, understanding tripping-induced anterior balance loss is necessary in reducing the overall frequency of falls among older adults. Hazardous anterior balance loss due to tripping can be attributed to the mid-swing phase event, minimum foot clearance (MFC). The mechanism of tripping-induced anterior balance loss can be described as anterior movement of the center of mass (CoM) passing the frontal boundary of the supporting base between the swing and stance toes. The first aim of the current study was to establish a computational method for determining available response time (ART) to anterior balance loss due to tripping at MFC, in other words, the time taken for CoM to reach the anterior boundary and therefore, the time limit for balance recovery. Kinematic information of CoM and both toes in addition to simulated impact force due to tripping at MFC were used to estimate ART. The second aim was to apply correlation analysis to a range of gait parameters to identify the factors influencing ART. ART for balance loss in the forward direction due to tripping was on average. 0.11s for both the dominant and non-dominant limbs' simulated tripping at MFC. Correlation analysis revealed five factors at MFC that prolong ART including: 1) greater fore-aft distance from CoM to stance toe, 2) greater sideway distance from CoM to swing toe, 3) longer distance from CoM to the frontal boundary of the supporting base, 4) slower CoM forward velocity and 5) slower horizontal toe velocity. The established ART computation method can be utilized to examine the effects of ageing and various gait tasks on the likelihood of tripping-induced anterior balance loss and associated falls.

BackgroundTrip-related falls which is a major problem in the elderly population, might be linked to declines in the balance control function due to ageing. Minimum foot clearance (MFC) which provides a more sensitive measure of the motor function of the locomotor system, has been identified as a potential gait parameter associated with trip-related falls in older population. This paper proposes nonlinear indexes (approximate entropy (ApEn) and Poincaré plot indexes) of MFC variability and investigates the relationship of MFC with derived indexes of elderly gait patterns. The main aim is to find MFC variability indexes that well correlate with balance impairments.MethodsMFC data during treadmill walking for 14 healthy elderly and 10 elderly participants with balance problems and a history of falls (falls risk) were analysed using a PEAK-2D motion analysis system. ApEn and Poincaré plot indexes of all MFC data sets were calculated and compared.ResultsSignificant relationships of mean MFC with Poincaré plot indexes (SD1, SD2) and ApEn (r = 0.70, p < 0.05; r = 0.86, p < 0.01; r = 0.74, p < 0.05) were found in the falls-risk elderly group. On the other hand, such relationships were absent in the healthy elderly group. In contrast, the ApEn values of MFC data series were significantly (p < 0.05) correlated with Poincaré plot indexes of MFC in the healthy elderly group, whereas correlations were absent in the falls-risk group. The ApEn values in the falls-risk group (mean ApEn = 0.18 ± 0.03) was significantly (p < 0.05) higher than that in the healthy group (mean ApEn = 0.13 ± 0.13). The higher ApEn values in the falls-risk group might indicate increased irregularities and randomness in their gait patterns and an indication of loss of gait control mechanism. ApEn values of randomly shuffled MFC data of falls risk subjects did not show any significant relationship with mean MFC.ConclusionResults have implication for quantifying gait dynamics in normal and pathological conditions, thus could be useful for the early diagnosis of at-risk gait. Further research should provide important information on whether falls prevention intervention can improve the gait performance of falls risk elderly by monitoring the change in MFC variability indexes.

Efficient, adaptive, locomotor function is critically important for maintaining our health and independence, but falls-related injuries when walking are a significant risk factor, particularly for more vulnerable populations such as older people and post-stroke individuals. Tripping is the leading cause of falls, and the swing-phase event Minimum Foot Clearance (MFC) is recognised as the key biomechanical determinant of tripping probability. MFC is defined as the minimum swing foot clearance, which is seen approximately mid-swing, and it is routinely measured in gait biomechanics laboratories using precise, high-speed, camera-based 3D motion capture systems. For practical intervention strategies designed to predict, and possibly assist, swing foot trajectory to prevent tripping, identification of the MFC event is essential; however, no technique is currently available to determine MFC timing in real-life settings outside the laboratory. One strategy has been to use wearable sensors, such as Inertial Measurement Units (IMUs), but these data are limited to primarily providing only tri-axial linear acceleration and angular velocity. The aim of this study was to develop Machine Learning (ML) algorithms to predict MFC timing based on the preceding toe-off gait event. The ML algorithms were trained using 13 young adults’ foot trajectory data recorded from an Optotrak 3D motion capture system. A Deep Learning configuration was developed based on a Recurrent Neural Network with a Long Short-Term Memory (LSTM) architecture and Huber loss-functions to minimise MFC-timing prediction error. We succeeded in predicting MFC timing from toe-off characteristics with a mean absolute error of 0.07 s. Although further algorithm training using population-specific inputs are needed. The ML algorithms designed here can be used for real-time actuation of wearable active devices to increase foot clearance at critical MFC and reduce devastating tripping falls. Further developments in ML-guided actuation for active exoskeletons could prove highly effective in developing technologies to reduce tripping-related falls across a range of gait impaired populations.

Soldier-relevant body borne load impacts minimum foot clearance during obstacle negotiation

Because falls among the elderly can cause serious injury leading to a bedridden state, methods to maintain motor function in the elderly and prevent falls are important. Among falls by the elderly are tripping falls, in which the forefoot gets caught on the floor to cause the fall. Minimum foot clearance (MFC), the smallest distance between the floor and the foot during the swing phase of gait, has been given attention as a cause of tripping falls, as elderly people at risk of falling have been reported to have low MFC. No research has been done, however, to examine what geriatric factors determine MFC. In this study, various measurements were taken on muscle strength, joint angles, and other characteristics as factors possibly influencing the height of MFC, a multiple regression analysis was performed with MFC as the dependent variable, and those factors with high degrees of influence were extracted. The results revealed that the height of MFC is highly influenced by strength of the hip flexors and angle of ankle dorsiflexion. The results of this study should be taken into consideration when having elderly people do fall prevention training.

Stroke rehabilitation interventions require multiple training sessions and repeated assessments to evaluate the improvements from training. Biofeedback-based treadmill training often involves 10 or more sessions to determine its effectiveness. The training and assessment process incurs time, labor, and cost to determine whether the training produces positive outcomes. Predicting the effectiveness of gait training based on baseline minimum foot clearance (MFC) data would be highly beneficial, potentially saving resources, costs, and patient time. This work proposes novel features using the Short-term Fourier Transform (STFT)-based magnitude spectrum of MFC data to predict the effectiveness of biofeedback training. This approach enables tracking non-stationary dynamics and capturing stride-to-stride MFC value fluctuations, providing a compact representation for efficient processing compared to time-domain analysis alone. The proposed STFT-based features outperform existing wavelet, histogram, and Poincaré-based features with a maximum accuracy of 95%, F1 score of 96%, sensitivity of 93.33% and specificity of 100%. The proposed features are also statistically significant (p0.001) compared to the descriptive statistical features extracted from the MFC series and the tone and entropy features extracted from the MFC percentage index series. The study found that short-term spectral components and the windowed mean value (DC value) possess predictive capabilities regarding the success of biofeedback training. The higher spectral amplitude and lower variance in the lower frequency zone indicate lower chances of improvement, while the lower spectral amplitude and higher variance indicate higher chances of improvement.

Background: Falls are a major public health issue and tripping is the most common self-reported cause of outdoor falls. Minimum foot clearance (MFC) is a key parameter for identifying the probability of tripping. Optical motion capture systems are commonly used to measure MFC values; however, there is a need to identify alternative modalities that are better suited to collecting data in real-world settings. Objective: This is the first of a two-part scoping review. The objective of this paper is to identify and evaluate alternative measurement modalities to optical motion capture systems for measuring level-ground MFC. A companion paper identifies conditions that impact MFC and the range of MFC values individuals that these conditions exhibit. Methods: We searched four electronic databases, where peer-reviewed journals and conference papers reporting level-ground MFC characteristics were identified. The papers were screened by two independent reviewers for inclusion. The reporting was done in keeping with the PRISMA-ScR reporting guidelines. Results: From an initial search of 1571 papers, 17 papers were included in this paper. The identified technologies were inertial measurement units (IMUs) (n = 10), ultrasonic sensors (n = 2), infrared sensors (IR) (n = 2), optical proximity sensors (OPS) (n = 1), laser ranging sensors (n = 1), and ultra-wideband sensors (n = 1). From the papers, we extracted the sensor type, the analysis methods, the properties of the proposed system, and its accuracy and validation methods. Conclusions: The two most commonly used alternative modalities were IMUs and OPS. There was a lack of standardization among studies utilizing the same measurement modalities, as well as discrepancies in the methods used to assess performance. We provide a list of recommendations for future work to allow for more meaningful comparison between modalities as well as future research directions.

Hemiplegic stroke often impairs gait and increases falls risk during rehabilitation. Tripping is the leading cause of falls, but the risk can be reduced by increasing vertical swing foot clearance, particularly at the mid-swing phase event, minimum foot clearance (MFC). Based on previous reports, real-time biofeedback training may increase MFC. Six post-stroke individuals undertook eight biofeedback training sessions over a month, in which an infrared marker attached to the front part of the shoe was tracked in real-time, showing vertical swing foot motion on a monitor installed in front of the subject during treadmill walking. A target increased MFC range was determined, and participants were instructed to control their MFC within the safe range. Gait assessment was conducted three times: Baseline, Post-training and one month from the final biofeedback training session. In addition to MFC, step length, step width, double support time and foot contact angle were measured. After biofeedback training, increased MFC with a trend of reduced step-to-step variability was observed. Correlation analysis revealed that MFC height of the unaffected limb had interlinks with step length and ankle angle. In contrast, for the affected limb, step width variability and MFC height were positively correlated. The current pilot-study suggested that biofeedback gait training may reduce tripping falls for post-stroke individuals.