Using IMU-based kinematic markers to monitor dual-task gait balance control recovery in acutely concussed individuals

Pitt, Will; Chen, Szu-Hua; Chou, Li-Shan

doi:10.1016/j.clinbiomech.2020.105145

Cited by 10 publications

(10 citation statements)

References 28 publications

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“…Alternatively, IMUs have been suggested to overcome this challenge as they are easily implemented, low cost and portable [36], with excellent validity and reliability for gait assessment [37]. Progression to use of IMUs was seen in the majority of reviewed articles, as most used IMU's to measure gait in TBI [24,[30][31][32][33][34]38] which were reported to be a viable and reliable method of gait assessment. IMU's (and 3D motion capture) were shown to detect abnormalities in gait and provide an overall account as to an individual's gait cycle following a TBI, as all of the reviewed studies showed gait differences between those with TBI and healthy controls.…”

Section: Instrumentationmentioning

confidence: 99%

“…Pitt et al [34] Provide an objective description of angular velocity and acceleration profiles along orthogonal axes from one IMU situated on L5 vertebrae.…”

mentioning

confidence: 99%

“…Step Duration. [31] McFadyen et al [25] Oldham et al [30] Parker et al [21] Parrington et al [32] Pitt et al [34] Shan Chou et al [27] -obstacle crossing Vallée et al [23] -obstacle crossing Williams et al [22] A notable methodological limitation was found when considering gait impairment across the spectrum of TBI. Specifically, none of the reviewed studies examined gait deficits in TBI across the full spectrum of the injury (mTBI to sevTBI), with several studies combining TBI severities into a single TBI category rather than defining and assessing specific sub-groups.…”

mentioning

confidence: 99%

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Gait Impairment in Traumatic Brain Injury: A Systematic Review

Dever

Powell

Graham

et al. 2022

Sensors

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Introduction: Gait impairment occurs across the spectrum of traumatic brain injury (TBI); from mild (mTBI) to moderate (modTBI), to severe (sevTBI). Recent evidence suggests that objective gait assessment may be a surrogate marker for neurological impairment such as TBI. However, the most optimal method of objective gait assessment is still not well understood due to previous reliance on subjective assessment approaches. The purpose of this review was to examine objective assessment of gait impairments across the spectrum of TBI. Methods: PubMed, AMED, OVID and CINAHL databases were searched with a search strategy containing key search terms for TBI and gait. Original research articles reporting gait outcomes in adults with TBI (mTBI, modTBI, sevTBI) were included. Results: 156 citations were identified from the search, of these, 13 studies met the initial criteria and were included into the review. The findings from the reviewed studies suggest that gait is impaired in mTBI, modTBI and sevTBI (in acute and chronic stages), but methodological limitations were evident within all studies. Inertial measurement units were most used to assess gait, with single-task, dual-task and obstacle crossing conditions used. No studies examined gait across the full spectrum of TBI and all studies differed in their gait assessment protocols. Recommendations for future studies are provided. Conclusion: Gait was found to be impaired in TBI within the reviewed studies regardless of severity level (mTBI, modTBI, sevTBI), but methodological limitations of studies (transparency and reproducibility) limit clinical application. Further research is required to establish a standardised gait assessment procedure to fully determine gait impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols.

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Section: Instrumentationmentioning

confidence: 99%

“…Pitt et al [34] Provide an objective description of angular velocity and acceleration profiles along orthogonal axes from one IMU situated on L5 vertebrae.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

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Gait Impairment in Traumatic Brain Injury: A Systematic Review

Dever

Powell

Graham

et al. 2022

Sensors

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“…Use of (inertial-based) wearables within mTBI has shown considerable promise for measuring balance and gait impairments 53 , 63 , 77 – 79 . Yet the true utility of inertial technologies may be their use beyond the clinic with the provision of habitual balance and gait data 67 .…”

Section: Discussionmentioning

confidence: 99%

Sports related concussion: an emerging era in digital sports technology

2021

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Sports-related concussion (SRC) is defined as a mild traumatic brain injury (mTBI) leading to complex impairment(s) in neurological function with many seemingly hidden or difficult to measure impairments that can deteriorate rapidly without any prior indication. Growing numbers of SRCs in professional and amateur contact sports have prompted closer dialog regarding player safety and welfare. Greater emphasis on awareness and education has improved SRC management, but also highlighted the difficulties of diagnosing SRC in a timely manner, particularly during matches or immediately after competition. Therefore, challenges exist in off-field assessment and return to play (RTP) protocols, with current traditional (subjective) approaches largely based on infrequent snapshot assessments. Low-cost digital technologies may provide more objective, integrated and personalized SRC assessment to better inform RTP protocols whilst also enhancing the efficiency and precision of healthcare assessment. To fully realize the potential of digital technologies in the diagnosis and management of SRC will require a significant paradigm shift in clinical practice and mindset. Here, we provide insights into SRC clinical assessment methods and the translational utility of digital approaches, with a focus on off-field digital techniques to detect key SRC metrics/biomarkers. We also provide insights and recommendations to the common benefits and challenges facing digital approaches as they aim to transition from novel technologies to an efficient, valid, reliable, and integrated clinical assessment tool for SRC. Finally, we highlight future opportunities that digital approaches have in SRC assessment and management including digital twinning and the “digital athlete”.

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“…IMUs can estimate physical activity (e.g. steps per day) and balance, gait and turning impairments within any environment [2,14,[32][33][34][35]. Our recent work examined free-living physical activity and turning in chronic mTBI patients and controls, with turning metrics found to be more sensitive than physical activity metrics to differentiate groups [3].…”

Section: Introductionmentioning

confidence: 99%

Free-living Turning Rather Than Gait Differentiates People with Chronic Mild Traumatic Brain Injury from Controls

Powell¹,

Godfrey²,

Parrington³

et al. 2021

Preprint

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Background: Physical function remains a crucial component of mild traumatic brain injury (mTBI) assessment and recovery. Traditional approaches to assess mTBI lack sensitivity to subtle deficits post-injury, which can impact quality of life, daily function and can lead to chronic issues. Inertial measurement units (IMU) provide an objective alternative for measuring physical function of gait and turning and can be used in any environment. Our recent work has found that turning quality is more sensitive than the quantity of physical activity when comparing chronic mTBI and healthy controls. However, no studies have compared the quality of free-living gait and turning characteristics concurrently in chronic mTBI and healthy controls. This study aimed to determine whether free-living gait or turning is more sensitive in differentiating chronic mTBI from controls.Methods: Thirty-two people with chronic self-reported balance symptoms after mTBI (age: 40.88 ± 11.78 years, median days post injury: 440.68 days) and 23 healthy controls (age: 48.56 ± 22.56 years) were assessed for ~7 days using a single IMU at the waist on a belt. Free-living gait and turning characteristics were evaluated for chronic mTBI and controls using multi-variate analysis. Receiver operating characteristics (ROC) and Area Under the Curve (AUC) analysis were used to determine outcome sensitivity to chronic mTBI.Results: Free-living gait characteristics were not different in chronic mTBI and controls (all p>0.05). In contrast, all but two (number of turns and average velocity CV) free-living turning characteristics were significantly different between chronic mTBI and controls, whilst controlling for age and sex (Bonferroni adjusted p<0.002). The chronic mTBI group had larger turn angles and longer turn durations compared to controls. ROC and AUC analysis showed turn duration (AUC = 0.92) was the most sensitive measure for differentiating chronic mTBI from controls. Conclusions: Results show that turning rather than gait characteristics were significantly different between chronic mTBI and controls, with turn duration being the most sensitive measure. These results suggest turning is a suitable surrogate biomarker to assess and monitor chronic mTBI.

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Using IMU-based kinematic markers to monitor dual-task gait balance control recovery in acutely concussed individuals

Cited by 10 publications

References 28 publications

Gait Impairment in Traumatic Brain Injury: A Systematic Review

Gait Impairment in Traumatic Brain Injury: A Systematic Review

Sports related concussion: an emerging era in digital sports technology

Free-living Turning Rather Than Gait Differentiates People with Chronic Mild Traumatic Brain Injury from Controls

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