Introduction: Inertial sensors generate objective and sensitive metrics of movement disability that may indicate fall risk in many clinical conditions including multiple sclerosis (MS). The Timed-Up-And-Go (TUG) task is used to assess patient mobility because it incorporates clinically-relevant submovements during standing. Most sensor-based TUG research has focused on the placement of sensors at the spine, hip or ankles; an examination of thigh activity in TUG in multiple sclerosis is wanting.Methods: We used validated sensors (x-IMU by x-io) to derive transparent metrics for the sit-to-stand (SI-ST) transition and the stand-to-sit (ST-SI) transition of TUG, and compared effect sizes for metrics from inertial sensors on the thighs to effect sizes for metrics from a sensor placed at the L3 level of the lumbar spine. Twenty-three healthy volunteers were compared to 17 ambulatory persons with MS (PwMS, HAI ≤ 2).Results: During the SI-ST transition, the metric with the largest effect size comparing healthy volunteers to PwMS was the Area Under the Curve of the thigh angular velocity in the pitch direction–representing both thigh and knee extension; the peak of the spine pitch angular velocity during SI-ST also had a large effect size, as did some temporal measures of duration of SI-ST, although less so. During the ST-SI transition the metric with the largest effect size in PwMS was the peak of the spine angular velocity curve in the roll direction. A regression was performed.Discussion: We propose for PwMS that the diminished peak angular velocity during SI-ST directly represents extensor weakness, while the increased roll during ST-SI represents diminished postural control.Conclusions: During the SI-ST transition of TUG, angular velocities can discriminate between healthy volunteers and ambulatory PwMS better than temporal features. Sensor placement on the thighs provides additional discrimination compared to sensor placement at the lumbar spine.

The dual task paradigm (DTP), where performance of a walking task co-occurs with a cognitive task to assess performance decrement, has been controversially mooted as a more suitable task to test safety from falls in outdoor and urban environments than simple walking in a hospital corridor. There are a variety of different cognitive tasks that have been used in the DTP, and we wanted to assess the use of a secondary task that requires mental tracking (the alternate letter alphabet task) against a more automatic working memory task (counting backward by ones). In this study we validated the x-io x-IMU wearable inertial sensors, used them to record healthy walking, and then used dynamic time warping to assess the elements of the gait cycle. In the timed 25 foot walk (T25FW) the alternate letter alphabet task lengthened the stride time significantly compared to ordinary walking, while counting backward did not. We conclude that adding a mental tracking task in a DTP will elicit performance decrement in healthy volunteers.

INTRODUCTION Student self‐assessment using computer‐based quizzes has been shown to increase subject memory and engagement. Some types of self‐assessment quiz can be associated with a dilemma between 1) medical students who want the self‐assessment quiz to be clearly related to upcoming summative assessments or curated by the exam‐setters, and 2) university administrators and ethics committees who want clear guarantees that the self‐assessment quizzes are not based on the summative assessments or made by instructors familiar with the exam bank of items. One possible way past this apparent ethical impasse was to use a computer to design the self‐assessment questions, with the input to the algorithm being information that was freely available to the students in the course learning materials (i.e. criterion‐referenced from learning outcomes). Here we describe how a computer can formulate large numbers of these basic, rote‐memorization, MCQs; we further add a brief description of whether such questions were found to be satisfactory by students, and whether students engaged with our project METHODS An algorithm in Matlab was developed to formulate multiple choice questions for both ion transport proteins and pharmacology. A schematic of the Matlab process is shown in Figure 1. Matlab scripts and sample materials have been made available online for free (https://github.com/harry-witchel/Ion-Channel-MCQs and https://github.com/harrywitchel/Pharmacology-MCQs). Instructor‐verified question/items were uploaded to the Synap.ac online self‐quiz web platform, and 48 year 1 United Kingdom undergraduate medical students engaged with it for 3 weeks. Anonymized engagement statistics for students were provided by the Synap platform, and a paper‐based exit questionnaire with an 80% response rate (n = 44) measured satisfaction. RESULTS Four times as many students primarily accessed the quiz system via laptop compared to phone/tablet (Figure 2). Of 391 online questions/items, over 11,749 attempts were made. Data of usage showed that self‐assessment usage peaks occurred in days immediately before summative assessments and that troughs occurred on the days of assessments. Numerical subjective responses to the exit questionnaire were in a Likert format (1 = strongly disagree, 2 = disagree, 3 = neither agree nor disagree, 4 = agree, 5 = strongly agree). Greater than 80% of respondents agreed or strongly agreed with each of the positive statements ("I found the quiz software enjoyable to use", "I found it easy to use", "I engaged more with the study material because of the online quizzes", "I felt I learned more by using these quizzes"). The most positively answered numerical question was "I would like these kinds of quizzes to be extended to other modules", where 77% of the respondents strongly agreed. Subjective responses are shown in Figure 3. CONCLUSIONS Despite simplistic questions and rote‐memorization, the questions developed by this system were engaged with and received positively. Students strongly supported extending the system....

Article (Accepted Version) http://sro.sussex.ac.uk Witchel, Harry J, Guppy, Joseph H and Smith, Claire F (2018) The self-assessment dilemma: an open-source, ethical method using Matlab to formulate multiple-choice quiz questions for online reinforcement. Advances in Physiology Education, 42 (4). pp. 697-703.