Gait Quality Assessment in Survivors from Severe Traumatic Brain Injury: An Instrumented Approach Based on Inertial Sensors

Abstract

Despite existing evidence that gait disorders are a common consequence of severe traumatic brain injury (sTBI), the literature describing gait instability in sTBI survivors is scant. Thus, the present study aims at quantifying gait patterns in sTBI through wearable inertial sensors and investigating the association of sensor-based gait quality indices with the scores of commonly administered clinical scales. Twenty healthy adults (control group, CG) and 20 people who suffered from a sTBI were recruited. The Berg balance scale, community balance and mobility scale, and dynamic gait index (DGI) were administered to sTBI participants, who were further divided into two subgroups, severe and very severe, according to their score in the DGI. Participants performed the 10 m walk, the Figure-of-8 walk, and the Fukuda stepping tests, while wearing five inertial sensors. Significant differences were found among the three groups, discriminating not only between CG and sTBI, but also for walking ability levels. Several indices displayed a significant correlation with clinical scales scores, especially in the 10 m walking and Figure-of-8 walk tests. Results show that the use of wearable sensors allows the obtainment of quantitative information about a patient’s gait disorders and discrimination between different levels of walking abilities, supporting the rehabilitative staff in designing tailored therapeutic interventions.

Does Curved Walking Sharpen the Assessment of Gait Disorders? An Instrumented Approach Based on Wearable Inertial Sensors

“…In healthy subjects, the increase in sternum accelerations during curved walking determines a significant decrease of the attenuation coefficient (AC) from the pelvis to the sternum ( Figure 3 C). Because higher nRMS and decreased AC values have been widely associated with decreased stability [ 18 , 27 ], the results of the present study confirm that dynamic balance stability could be a critical aspect in curved trajectories, more than it is during straight walking. Indeed, the shifting of the body center of mass toward the inner part of the curve (generating a medio-lateral torque necessary to counteract the centrifugal acceleration and, thus, to avoid going off the tangent [ 34 ]), often flanked to a trunk tilt in the same direction, may contribute to jeopardizing the control of balance, particularly in patients with neurological disorders [ 8 , 10 ].…”

“…The results of the present study suggest that in very severe TBI patients, who have more impaired walking ability, straight walking-based tests may provide useful information about the patient’s impairment and its evolution, with no need of moving to more complex walking modalities. On the other hand, tests based only on straight paths may not be always adequate to reveal motor-related disorders in patients with good walking abilities, such as sTBI-S. Curved walking-based tests, like the F8WT, indeed have the potential to reveal changes due to diseases of the central or peripheral nervous system [ 10 , 18 ], to the evolution of walking disorders or to the administration of rehabilitation protocols. In addition, attention should be devoted to the rehabilitation of curved walking in high-functioning patients with neuro-motor deficits in order to improve their autonomy and quality of life.…”

“…Hence, in order to assess steady-state walking, only the middle 10 m (marked with tape on the floor) were considered for further analyses. For the F8WT, the participants were asked to walk a figure-of-8 shaped path ( Figure 1 ) marked with tape on the floor [ 18 ], consisting of two circles of 1.66 m (5.44 ft) of diameter each. The task was performed three times both clockwise and counterclockwise.…”

“…Curvilinear tests have been also used in people with Parkinson’s disease [ 8 , 9 ] and hemiparetic patients [ 10 ], highlighting gait abnormalities that were specifically related to the curved walking performance. However, the abovementioned literature mainly considered spatiotemporal parameters of gait (e.g., step count, stride length, mean velocity), without investigating the behavior of the upper-body, which is gaining interest among researchers and clinicians due to its fundamental role in the maintenance of up-right gait stability, symmetry, and smoothness of movement [ 18 , 19 ]. Furthermore, most of the studies focused on lab-based assessment, which lacks ecological validity and often entails cumbersome set up or limited acquisition volumes.…”

“…This is particularly true in those populations who commonly experience neuro-motor deficits. An example comes from people who suffered from a severe traumatic brain injury (sTBI), whose walking skills have been recently investigated using a wearable sensors-based approach in [ 18 ], highlighting that biomechanical parameters that are related to walking stability, symmetry, and smoothness are able to discriminate between different levels of severity within sTBI. Additionally, free-living mobility, thus both straight walking and turning, was investigated in people with mild TBI with wearable sensors [ 20 ].…”