Gait Quality Assessment in Survivors from Severe Traumatic Brain Injury: An Instrumented Approach Based on Inertial Sensors (original) (raw)
Related papers
Gait & Posture, 2007
Postural stability may be compromised in patients who have sustained a traumatic brain injury (TBI). The purpose of the present study was to examine dynamic stability during gait by measuring spatial and temporal variability of foot placement, and to determine the effect of increased difficulty of the walking task on gait variability in patients with TBI. It was hypothesized that patients with TBI will show increased variability in step time, step length, and step width in comparison to healthy controls and that such differences would be accentuated by increased task difficulty. Participants (patients: n = 20, controls: n = 20) were asked to walk across a pressure sensitive mat at their preferred pace (PW), as fast as possible (FW), and with their eyes closed (EC). In accordance with the hypotheses, patients had significantly greater variability in step time and step length in comparison to healthy controls, and when the complexity of the gait task increased (FW and EC tasks). Although step width variability showed no significant difference between the groups, both control and patient groups had increased step width variability in the EC task. It is proposed that such increases in variability reflect greater challenges to maintaining dynamic stability during gait among individuals with TBI and when performing more difficult tasks. #
Observational gait analysis in traumatic brain injury: Accuracy of clinical judgment
Gait & Posture, 2009
Objective: To determine the accuracy of clinicians' visual observations of gait disorders following traumatic brain injury (TBI). Methods: 30 ambulant participants (sample of convenience) receiving physiotherapy for mobility limitations following TBI and 25 age, height, weight and sex matched healthy unimpaired controls (HC) were recruited. Kinematic and ground reaction force data during gait were captured and video recordings were concurrently collected. Participants with TBI walked at self-selected speed whilst HCs walked at preferred speed as well as the mean TBI speed for comparison. 40 doctors, experienced physiotherapists, new graduate physiotherapists and novices were observers. Each viewed and rated 36 gait variables for a randomized sub-sample of 10 participants with TBI. Observer inaccuracy was calculated for each gait variable. Results: Overall the accuracy of observational gait analysis was low and there was considerable variability in observations between clinicians. For most kinematic variables, observer inaccuracy ranged from 30% to 50%. Although experienced observers were generally more accurate, average inter-item correlations were low, indicating that experience did not consistently improve the accuracy of visual observations. Observational plane, gait variable type, the joint or the segment had little effect on accuracy of observations. Conclusions: Observational gait analysis for adults with TBI has relatively low accuracy. Some of the gait abnormalities evident from quantitative gait analysis were not detected by observational gait analysis. ß
Classification of Gait Disorders Following Traumatic Brain Injury
Journal of Head Trauma Rehabilitation, 2014
To determine the extent to which gait disorders associated with traumatic brain injury (TBI) are able to be classified into clinically relevant and distinct subgroups. Design: Cross-sectional cohort study comprising people with TBI receiving physiotherapy for mobility limitations. Participants: One hundred two people with TBI. Outcome Measures: The taxonomic framework for gait disorders following TBI was devised on the basis of a framework previously developed for people with cerebral palsy. Participants with TBI who were receiving therapy for mobility problems were assessed using 3-dimensional gait analysis. Pelvis and bilateral lower limb kinematic data were recorded using a VICON motion analysis system while each participant walked at a self-selected speed. Five trials of data were collected for each participant. Multiclass support vector machine models were developed to systematically and automatically ascertain the clinical classification. Results: The statistical features derived from the major joint angles from unaffected limbs contributed to the best classification accuracy of 82.35% (84 of the 102 subjects). Features from the affected limb resulted in a classification accuracy of 76.47% (78 of 102 subjects). Conclusions: Despite considerable variability in gait disorders following TBI, we were able to generate a clinical classification system on the basis of 6 distinct subgroups of gait deviations. Statistical features related to the motion of the pelvis, hip, knee, and ankle on the less affected leg were able to accurately classify 82% of people with TBI-related gait disorders using a multiclass support vector machine framework.
Sensors, 2020
Gait and balance assessment in the clinical context mainly focuses on straight walking. Despite that curved trajectories and turning are commonly faced in our everyday life and represent a challenge for people with gait disorders. The adoption of curvilinear trajectories in the rehabilitation practice could have important implications for the definition of protocols tailored on individual’s needs. The aim of this study was to contribute toward the quantitative characterization of straight versus curved walking using an ecological approach and focusing on healthy and neurological populations. Twenty healthy adults (control group (CG)) and 20 patients with Traumatic Brain Injury (TBI) (9 severe, sTBI-S, and 11 very severe, sTBI-VS) performed a 10 m and a Figure-of-8 Walk Test while wearing four inertial sensors that were located on both tibiae, sternum and pelvis. Spatiotemporal and gait quality indices that were related to locomotion stability, symmetry, and smoothness were obtained....
Frontiers in Psychology
Gait disorders are major causes of falls in patients with neurological diseases. Understanding these disorders allows prevention and better insights into underlying diseases. InertiaLocoGraphy (ILG)-the quantification of gait by using inertial measurement units (IMUs)-shows great potential to address this public health challenge, but protocols vary widely and normative values of gait parameters are still unavailable. This systematic review critically compares ILG protocols, questions features extracted from inertial signals and proposes a semeiological analysis of clinimetric characteristics for use in neurological clinical routine. For this systematic review, PubMed, Cochrane and EMBASE were searched for articles assessing gait quality by using IMUs that were published from January 1, 2014 to August 31, 2016. ILG was used to assess gait in a wide range of neurological disorders-including Parkinson disease, mild cognitive impairment, Alzheimer disease, cerebral palsy, and cerebellar atrophyas well as in the faller or frail older population and in people presenting rheumatological pathologies. However, results have not yet been driving changes in clinical practice. One reason could be that studies mainly aimed at comparing pathological gait to healthy gait, but there is stronger need for semiological descriptions of gait perturbation, severity or prognostic assessment. Furthermore, protocols used to assess gait using IMUs are too many. Likely, outcomes are highly heterogeneous and difficult to compare across large panels of studies. Therefore, homogenization is needed to foster the use of ILG to assess gait quality in neurological routine practice. The pros and cons of each protocol are emphasized so that a compromise can be reached. As well, analysis of seven complementary clinical criteria (springiness, sturdiness, smoothness, steadiness, stability, symmetry, synchronization) is advocated.
Physiotherapy Canada, 2011
Purpose: To further investigate the construct validity of the Community Balance and Mobility Scale (CB&M), developed for ambulatory individuals with traumatic brain injury (TBI). Methods: A convenience sample of 35 patients with TBI (13 in-patients, 22 outpatients) was recruited. Analyses included a comparison of CB&M and Berg Balance Scale (BBS) admission and change scores and associations between the CB&M and measures of postural sway, gait, and dynamic stability; the Community Integration Questionnaire (CIQ); and the Activities-specific Balance Confidence (ABC) Scale. Results: Mean admission scores on the BBS and the CB&M were 53.6/56 (SD ¼ 4.3) and 57.8/96 (SD ¼ 23.3) respectively. Significant correlations were demonstrated between the CB&M and spatiotemporal measures of gait, including walking velocity, step length, step width, and step time; measures of dynamic stability, including variability in step length and step time; and the ABC (p < 0.05). Significant correlations between the CB&M and CIQ were revealed with a larger data set (n ¼ 47 outpatients) combined from previous phases of research. Conclusions: In patients with TBI, the CB&M is less susceptible to a ceiling effect than the BBS. The construct validity of the CB&M was supported, demonstrating associations with laboratory measures of dynamic stability, measures of community integration, and balance confidence.
Annals of Physical and Rehabilitation Medicine, 2018
• Individuals with traumatic brain injury (TBI) often present with balance problems associated with a decrease in their social participation. • An innovative approach consists in using perturbations on a split-belt treadmill to improve dynamic balance. • The aim of this study was to quantify the effects of a training program including perturbations on a split-belt treadmill on dynamic balance, walking speed, balance confidence and social participation in individuals with TBI at the social integration rehabilitation phase or at a chronic stage.
Physiotherapy Canada, 2011
Purpose: To further investigate the construct validity of the Community Balance and Mobility Scale (CB&M), developed for ambulatory individuals with traumatic brain injury (TBI). Methods: A convenience sample of 35 patients with TBI (13 in-patients, 22 outpatients) was recruited. Analyses included a comparison of CB&M and Berg Balance Scale (BBS) admission and change scores and associations between the CB&M and measures of postural sway, gait, and dynamic stability; the Community Integration Questionnaire (CIQ); and the Activities-specific Balance Confidence (ABC) Scale. Results: Mean admission scores on the BBS and the CB&M were 53.6/56 (SD ¼ 4.3) and 57.8/96 (SD ¼ 23.3) respectively. Significant correlations were demonstrated between the CB&M and spatiotemporal measures of gait, including walking velocity, step length, step width, and step time; measures of dynamic stability, including variability in step length and step time; and the ABC (p < 0.05). Significant correlations between the CB&M and CIQ were revealed with a larger data set (n ¼ 47 outpatients) combined from previous phases of research. Conclusions: In patients with TBI, the CB&M is less susceptible to a ceiling effect than the BBS. The construct validity of the CB&M was supported, demonstrating associations with laboratory measures of dynamic stability, measures of community integration, and balance confidence.