Inertial Sensors Reveal Subtle Motor Deficits When Walking With Horizontal Head Turns After Concussion

Fino, Peter C.; Wilhelm, Jennifer; Parrington, Lucy; Stuart, Samuel; Chesnutt, J. C.; King, Laurie A.

doi:10.1097/htr.0000000000000418

Cited by 17 publications

(13 citation statements)

References 37 publications

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“…Automatically characterizing head and trunk movements during routinely prescribed vestibular exercises using IMUs is an innovative approach that will allow a more sensitive and objective analysis of progression during vestibular rehabilitation. In people with mTBI, smaller and slower head movements during performance tasks have been reported [5] but such movements are not easily quantified with the naked eye and may not be perceived by the patient performing the exercise. Quantifying such information with IMUs could inform both the treating physical therapist and, with time, the patient themselves by providing immediate feedback on velocity and quality of performance.…”

Section: Discussionmentioning

confidence: 99%

“…Consequently, avoidance behavior and maladaptive strategies, such as limiting the head ROM and rotational velocity, may be used in an effort to minimize symptoms [4]. These subtle impaired movements, such as head and trunk velocity, are often not detected visually [5], and have the potential to interfere with successful rehabilitation. Thus, the ability to quantify and track these movements both within the clinic and during a home exercise program may be highly beneficial.…”

Section: Introductionmentioning

confidence: 99%

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Validation of an Inertial Sensor Algorithm to Quantify Head and Trunk Movement in Healthy Young Adults and Individuals with Mild Traumatic Brain Injury

Parrington

Jehu

Fino

et al. 2018

Sensors

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Wearable inertial measurement units (IMUs) may provide useful, objective information to clinicians interested in quantifying head movements as patients’ progress through vestibular rehabilitation. The purpose of this study was to validate an IMU-based algorithm against criterion data (motion capture) to estimate average head and trunk range of motion (ROM) and average peak velocity. Ten participants completed two trials of standing and walking tasks while moving the head with and without moving the trunk. Validity was assessed using a combination of Intra-class Correlation Coefficients (ICC), root mean square error (RMSE), and percent error. Bland-Altman plots were used to assess bias. Excellent agreement was found between the IMU and criterion data for head ROM and peak rotational velocity (average ICC > 0.9). The trunk showed good agreement for most conditions (average ICC > 0.8). Average RMSE for both ROM (head = 2.64°; trunk = 2.48°) and peak rotational velocity (head = 11.76 °/s; trunk = 7.37 °/s) was low. The average percent error was below 5% for head and trunk ROM and peak rotational velocity. No clear pattern of bias was found for any measure across conditions. Findings suggest IMUs may provide a promising solution for estimating head and trunk movement, and a practical solution for tracking progression throughout rehabilitation or home exercise monitoring.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validation of an Inertial Sensor Algorithm to Quantify Head and Trunk Movement in Healthy Young Adults and Individuals with Mild Traumatic Brain Injury

Parrington

Jehu

Fino

et al. 2018

Sensors

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“…Tests of physical function, such as the FGA and HiMAT, assess global performance during these complex tasks, but lack objectivity and nuanced measurement scales ( 12 ) that limit the tests' sensitivities ( 93 , 94 ). However, recent advances in wearable technologies have enabled objective, sensitive assessments of subtle motor deficits during common clinical tests ( 8 , 9 , 95 ). By leveraging wearable sensors to quantify turning, an ecologically relevant and complex task, we hope to improve clinical decision-making after mTBI.…”

Section: Discussionmentioning

confidence: 99%

“…Quantifying turning performance has traditionally been difficult in clinical settings, but recent advances in wearable sensors have enabled objective, robust, reliable, and sensitive assessments of turning performance in other clinical populations ( 45 , 55 – 59 ). This project is designed to transition our previous research findings ( 8 , 9 , 21 , 45 , 55 – 59 ) into clinical settings for improved assessments after mTBI by evaluating objective dual-task (DT) turning measures for use as rehabilitative outcomes and as tools for RTD assessments. Therefore, the first goal of this study is to assess diagnostic accuracy—the added value of objective DT turning measures over standard clinical assessments.…”

Section: Introductionmentioning

confidence: 99%

Objective Dual-Task Turning Measures for Return-to-Duty Assessment After Mild Traumatic Brain Injury: The ReTURN Study Protocol

et al. 2021

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Determining readiness for duty after mild traumatic brain injury (mTBI) is essential for the safety of service members and their unit. Currently, these decisions are primarily based on self-reported symptoms, objective measures that assess a single system, or standardized physical or cognitive tests that may be insensitive or lack ecological validity for warrior tasks. While significant technological advancements have been made in a variety of assessments of these individual systems, assessments of isolated tasks are neither diagnostically accurate nor representative of the demands imposed by daily life and military activities. Emerging evidence suggests that complex tasks, such as dual-task paradigms or turning, have utility in probing functional deficits after mTBI. Objective measures from turning tasks in single- or dual-task conditions, therefore, may be highly valuable for clinical assessments and return-to-duty decisions after mTBI. The goals of this study are to assess the diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation of objective, dual-task turning measures within an mTBI population. These goals will be accomplished over two phases. Phase 1 will enroll civilians at three sites and active-duty service members at one site to examine the diagnostic accuracy and predictive capacity of dual-task turning outcomes. Phase 1 participants will complete a series of turning tasks while wearing inertial sensors and a battery of clinical questionnaires, neurocognitive testing, and standard clinical assessments of function. Phase 2 will enroll active-duty service members referred for rehabilitation from two military medical treatment facilities to investigate the responsiveness to rehabilitation of objective dual-task turning measures. Phase 2 participants will complete two assessments of turning while wearing inertial sensors: a baseline assessment prior to the first rehabilitation session and a post-rehabilitation assessment after the physical therapist determines the participant has completed his/her rehabilitation course. A variable selection procedure will then be implemented to determine the best task and outcome measure for return-to-duty decisions based on diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation. Overall, the results of this study will provide guidance and potential new tools for clinical decisions in individuals with mTBI.Clinical Trial Registration: clinicaltrials.gov, Identifier NCT03892291.

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“…They are crucial for mobility and functional movements that are required for personal independence and the majority of daily activities, such as personal cleanliness or home care [14][15][16]. Turning requires changes in the anteroposterior and mediolateral impulses to decrease the speed of locomotion along the sagittal plane and move the centre of mass towards the new direction of displacement [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Muscle Activation and Distribution during Four Test/Functional Tasks: A Comparison between Dry-Land and Aquatic Environments for Healthy Older and Young Adults

Cuesta‐Vargas

Martín-Martín

Pérez‐Cruzado

et al. 2020

IJERPH

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Background: The use of rehabilitation protocols carried out in water has been progressively increasing due to the favorable physical properties of the water. Electromyography allows one to register muscle activity even under water. Aim: To compare muscle activity between two groups (healthy young adults (HYA) and healthy older adults (HOA)) in two different environments (dry land and aquatic) using surface electromyography during the execution of four different test/functional movements. Methods: Analytical cross-sectional study. HYA and HOA carried out four functional tasks (Step Up and Down, Sit TO Stand test, Gait Initiation and Turns During Gait) in two different environments (dry land and aquatic). Absolute and relative muscle activation was compared between each group and between each environment. In addition, the stability of the measured was calculated through a test-retest (ICC 2:1). Results: Within the same environment there were significant differences between young and older adults in three of the four functional tasks. In contrast, in the gait initiation, hardly any significant differences were found between the two groups analysed, except for the soleus and the anterior tibial. Measurement stability ranged from good to excellent. Conclusions: Level of the musculature involvement presents an entirely different distribution when the test/functional task is performed on dry land or in water. There are differences both in the relative activation of the musculature and in the distribution of the partition of the muscles comparing older and young adults within the same environment.

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Inertial Sensors Reveal Subtle Motor Deficits When Walking With Horizontal Head Turns After Concussion

Abstract: Inertial sensors can improve traditional clinical assessments by quantifying subtle, nonobservable deficits in people following sports-related concussion.

Cited by 17 publications

References 37 publications

Validation of an Inertial Sensor Algorithm to Quantify Head and Trunk Movement in Healthy Young Adults and Individuals with Mild Traumatic Brain Injury

Validation of an Inertial Sensor Algorithm to Quantify Head and Trunk Movement in Healthy Young Adults and Individuals with Mild Traumatic Brain Injury

Objective Dual-Task Turning Measures for Return-to-Duty Assessment After Mild Traumatic Brain Injury: The ReTURN Study Protocol

Muscle Activation and Distribution during Four Test/Functional Tasks: A Comparison between Dry-Land and Aquatic Environments for Healthy Older and Young Adults

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