Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined.

We propose a wearable sensor system for automatic, continuous and ubiquitous analysis of Freezing of Gait (FOG), in patients affected by Parkinson’s disease. FOG is an unpredictable gait disorder with different clinical manifestations, as the trembling and the shuffling-like phenotypes, whose underlying pathophysiology is not fully understood yet. Typical trembling-like subtype features are lack of postural adaptation and abrupt trunk inclination, which in general can increase the fall probability. The targets of this work are detecting the FOG episodes, distinguishing the phenotype and analyzing the muscle activity during and outside FOG, toward a deeper insight in the disorder pathophysiology and the assessment of the fall risk associated to the FOG subtype. To this aim, gyroscopes and surface electromyography integrated in wearable devices sense simultaneously movements and action potentials of antagonist leg muscles. Dedicated algorithms allow the timely detection of the FOG episode and, for the first time, the automatic distinction of the FOG phenotypes, which can enable associating a fall risk to the subtype. Thanks to the possibility of detecting muscles contractions and stretching exactly during FOG, a deeper insight into the pathophysiological underpinnings of the different phenotypes can be achieved, which is an innovative approach with respect to the state of art.

Freezing of gait (FOG) is one of the most troublesome symptoms of Parkinson’s disease, affecting more than 50% of patients in advanced stages of the disease. Wearable technology has been widely used for its automatic detection, and some papers have been recently published in the direction of its prediction. Such predictions may be used for the administration of cues, in order to prevent the occurrence of gait freezing. The aim of the present study was to propose a wearable system able to catch the typical degradation of the walking pattern preceding FOG episodes, to achieve reliable FOG prediction using machine learning algorithms and verify whether dopaminergic therapy affects the ability of our system to detect and predict FOG. Methods: A cohort of 11 Parkinson’s disease patients receiving (on) and not receiving (off) dopaminergic therapy was equipped with two inertial sensors placed on each shin, and asked to perform a timed up and go test. We performed a step-to-step segmentation of the angular velocity signals and subsequent feature extraction from both time and frequency domains. We employed a wrapper approach for feature selection and optimized different machine learning classifiers in order to catch FOG and pre-FOG episodes. Results: The implemented FOG detection algorithm achieved excellent performance in a leave-one-subject-out validation, in patients both on and off therapy. As for pre-FOG detection, the implemented classification algorithm achieved 84.1% (85.5%) sensitivity, 85.9% (86.3%) specificity and 85.5% (86.1%) accuracy in leave-one-subject-out validation, in patients on (off) therapy. When the classification model was trained with data from patients on (off) and tested on patients off (on), we found 84.0% (56.6%) sensitivity, 88.3% (92.5%) specificity and 87.4% (86.3%) accuracy. Conclusions: Machine learning models are capable of predicting FOG before its actual occurrence with adequate accuracy. The dopaminergic therapy affects pre-FOG gait patterns, thereby influencing the algorithm’s effectiveness.

Wearable technology is attracting most attention in healthcare for the acquisition of physiological signals. We propose a stand-alone wearable surface ElectroMyoGraphy (sEMG) system for monitoring the muscle activity in real time. With respect to other wearable sEMG devices, the proposed system includes circuits for detecting the muscle activation potentials and it embeds the complete real-time data processing, without using any external device. The system is optimized with respect to power consumption, with a measured battery life that allows for monitoring the activity during the day. Thanks to its compactness and energy autonomy, it can be used outdoor and it provides a pathway to valuable diagnostic data sets for patients during their own day-life. Our system has performances that are comparable to state-of-art wired equipment in the detection of muscle contractions with the advantage of being wearable, compact, and ubiquitous.

Background: Current telemedicine approaches lack standardised procedures for the remote assessment of axial impairment in Parkinson’s disease (PD). Unobtrusive wearable sensors may be a feasible tool to provide clinicians with practical medical indices reflecting axial dysfunction in PD. This study aims to predict the postural instability/gait difficulty (PIGD) score in PD patients by monitoring gait through a single inertial measurement unit (IMU) and machine-learning algorithms. Methods: Thirty-one PD patients underwent a 7-m timed-up-and-go test while monitored through an IMU placed on the thigh, both under (ON) and not under (OFF) dopaminergic therapy. After pre-processing procedures and feature selection, a support vector regression model was implemented to predict PIGD scores and to investigate the impact of L-Dopa and freezing of gait (FOG) on regression models. Results: Specific time- and frequency-domain features correlated with PIGD scores. After optimizing the dimensionality reduction methods and the model parameters, regression algorithms demonstrated different performance in the PIGD prediction in patients OFF and ON therapy (r = 0.79 and 0.75 and RMSE = 0.19 and 0.20, respectively). Similarly, regression models showed different performances in the PIGD prediction, in patients with FOG, ON and OFF therapy (r = 0.71 and RMSE = 0.27; r = 0.83 and RMSE = 0.22, respectively) and in those without FOG, ON and OFF therapy (r = 0.85 and RMSE = 0.19; r = 0.79 and RMSE = 0.21, respectively). Conclusions: Optimized support vector regression models have high feasibility in predicting PIGD scores in PD. L-Dopa and FOG affect regression model performances. Overall, a single inertial sensor may help to remotely assess axial motor impairment in PD patients.