Validity and Reliability of a Smartphone App for Gait and Balance Assessment

Advances in technology provide an opportunity to enhance the accuracy of gait and balance assessment, improving the diagnosis and rehabilitation processes for people with acute or chronic health conditions. This study investigated the validity and reliability of a smartphone-based application to measure postural stability and spatiotemporal aspects of gait during four static balance and two gait tasks. Thirty healthy participants (aged 20–69 years) performed the following tasks: (1) standing on a firm surface with eyes opened, (2) standing on a firm surface with eyes closed, (3) standing on a compliant surface with eyes open, (4) standing on a compliant surface with eyes closed, (5) walking in a straight line, and (6) walking in a straight line while turning their head from side to side. During these tasks, the app quantified the participants’ postural stability and spatiotemporal gait parameters. The concurrent validity of the smartphone app with respect to a 3D motion capture system was evaluated using partial Pearson’s correlations (rp) and limits of the agreement (LoA%). The within-session test–retest reliability over three repeated measures was assessed with the intraclass correlation coefficient (ICC) and the standard error of measurement (SEM). One-way repeated measures analyses of variance (ANOVAs) were used to evaluate responsiveness to differences across tasks and repetitions. Periodicity index, step length, step time, and walking speed during the gait tasks and postural stability outcomes during the static tasks showed moderate-to-excellent validity (0.55 ≤ rp ≤ 0.98; 3% ≤ LoA% ≤ 12%) and reliability scores (0.52 ≤ ICC ≤ 0.92; 1% ≤ SEM% ≤ 6%) when the repetition effect was removed. Conversely, step variability and asymmetry parameters during both gait tasks generally showed poor validity and reliability except step length asymmetry, which showed moderate reliability (0.53 ≤ ICC ≤ 0.62) in both tasks when the repetition effect was removed. Postural stability and spatiotemporal gait parameters were found responsive (p < 0.05) to differences across tasks and test repetitions. Along with sound clinical judgement, the app can potentially be used in clinical practice to detect gait and balance impairments and track the effectiveness of rehabilitation programs. Further evaluation and refinement of the app in people with significant gait and balance deficits is needed.

Download Full-text

Gender Differences in Postural Stability Among Children

Journal of Human Kinetics ◽

10.2478/v10078-012-0041-5 ◽

2012 ◽

Vol 33 (1) ◽

pp. 25-32 ◽

Cited By ~ 36

Author(s):

Andrew Smith ◽

Franciska Ulmer ◽

Del Wong

Keyword(s):

Gender Differences ◽

Repeated Measures ◽

Postural Stability ◽

Sensory Input ◽

Stability Control ◽

Activity Level ◽

Medium Effect ◽

Eyes Closed ◽

Stability Performance ◽

Eyes Open

Gender Differences in Postural Stability Among ChildrenThis study aimed to examine the gender differences in postural stability among 8-12 year-old children. Twenty-six children participated in this repeated measures study to measure the centre of pressure (COP) under one normal condition (CONTROL: hard surface, eyes open, and looking straight ahead) and two challenging sensory conditions (ECHB: eyes closed and head back; and EOCS: eyes open and compliant surface) in randomized order. Girls had significantly lower COP path velocity (COP-PV, p < 0.05, medium effect), smaller radial displacement (COP-RD, p < 0.05, medium effect), and lower area velocity (COP-AV, p < 0.05, medium effect) as compared to boys when the three conditions were pooled. Gender differences were found in the percentage changes in COP-RD during ECHB (p < 0.05, large effect) and EOCS (p < 0.05, medium effect), and in COP-AV during both ECHB and EOCS conditions (p < 0.05, medium effect). Postural stability performance of girls had higher correlations with age (-0.62 vs. -0.40), body mass (-0.60 vs. -0.42), foot length (-0.68 vs. -0.45), and physical activity level (-0.45 vs. 0.02), as compared to boys. Girls had better postural stability than boys but were more affected by altered sensory input information. Girls are more capable of integrating their sensory inputs, whereas boys treat each sensory input somewhat separately and rely more on somatosensory feedback. Exercises such as standing on unstable surfaces with eyes open instead of eye closed and head back are more beneficial to children's postural stability control system.

Download Full-text

S267 – Analysis of Balance and Gait Parameters in Healthy Subjects

Otolaryngology ◽

10.1016/j.otohns.2008.05.443 ◽

2008 ◽

Vol 139 (2_suppl) ◽

pp. P164-P164

Author(s):

Lorena Echeverria ◽

Manuel Rodriguez Paradinas ◽

Luis Gómez Pellico ◽

Teresa Rivera ◽

Asuncion Bosch Martin ◽

...

Keyword(s):

Reference Values ◽

Postural Stability ◽

Dynamic Balance ◽

Stability Index ◽

Gait Velocity ◽

P Value ◽

Second Phase ◽

Healthy Women ◽

Eyes Closed ◽

Gait Parameters

Objectives 1) Describe gait parameters in healthy women walking, eyes opened and eyes closed. 2) Describe normal values of static and dynamic balance under the same conditions. The purpose of this study is to get reference values in gait and balance. This objective is to compare (in the second phase) our results with the data of patients affected by vestibular hypofunction before and after rehabilitation. Methods We carried out a pilot study with 22 healthy women. 3-dimensional video motion analysis system and posturography was used to measure our parameters. Our subjects walked on an instrumented walkway, giving us information about kinetic and kinematic variables (overall cadence, gait velocity, foot progression angle, stride width, stride length, stance and swing ratio). We also had measured stability variables such as postural stability index in static and dynamic conditions (fall risk). Statistical analysis was performed using Student's t-test for matched pairs and Anova test. Results Overall cadence was greater on open eyes condition (x= 118,67 steps/minute; SD= 7,23) than on closed eyes condition (x= 115,93; SD=7,74). This difference was significant (p=0.019). Same result occurred in average gait velocity (p value less than 0.05). Postural stability index in open eyes conditions was significantly better than in closed eyes conditions (p value less than 0.05). The others variables measured were determined and no significant differences were found. Conclusions In this study we set up the reference values in gait and balance parameters in healthy women. Overall cadence, gait velocity, and postural stability index are decreased in closed eyes condition.

Download Full-text

POSTURAL STABILITY STRATEGIES IN TRANSTIBIAL AMPUTEES DURING QUIET STANDING IN ALTERED SENSORY CONDITIONS WEARING THREE TYPES OF PROSTHETIC FEET

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519419500714 ◽

2020 ◽

Vol 20 (02) ◽

pp. 1950071

Author(s):

NOORANIDA ARIFIN ◽

NOOR AZUAN ABU OSMAN ◽

SADEEQ ALI

Keyword(s):

Postural Stability ◽

Quiet Standing ◽

Lateral Direction ◽

Prosthetic Foot ◽

Compliant Surface ◽

Eyes Closed ◽

Strong Positive Relationship ◽

Movement Strategy ◽

Prosthetic Feet ◽

Transtibial Amputees

Individuals with transtibial amputation exhibit altered movement strategy to sustain stability during quiet standing due to reduced proprioception on the amputated limb. The aim of this study is to determine the movement strategies in anterior–posterior and medial–lateral directions in predicting the overall postural stability. In this crossover study, postural stability of ten transtibial amputees was assessed using computed posturography while wearing different prosthetic foot types: solid ankle cushion heel (SACH), single axis (SA) and energy storage and return (ESAR). Three stability indices were measured during four conditions: standing with eyes opened and closed, standing on compliant surface and standing with tilted head. From the standard multiple regression analysis, 63% to 99% of the OSI score in all sensory conditions were explained from the MLSI score, while 11% to 56% from the APSI score. The Pearson’s [Formula: see text] indicated significant strong positive relationship between OSI and MLSI [Formula: see text]–[Formula: see text] during all sensory conditions. The APSI score was significantly lower than OSI during eyes-closed and head extended conditions for all prosthetic feet [Formula: see text]. Adjustments in postural stability strategies in transtibial amputees mostly occurred in medial–lateral direction regardless of prosthetic feet types and altered sensory conditions.

Download Full-text

Postural balance assessment in children aged 7 to 9 years, as related to body weight, height, and physical activity

Biomedical Human Kinetics ◽

10.1515/bhk-2015-0020 ◽

2015 ◽

Vol 7 (1) ◽

Cited By ~ 1

Author(s):

Emilia Stanek ◽

Aleksandra Truszczyńska ◽

Justyna Drzał-Grabiec ◽

Adam Tarnowski

Keyword(s):

Physical Activity ◽

Body Weight ◽

Postural Stability ◽

Body Height ◽

Mean Amplitude ◽

Moderate Physical Activity ◽

Balance Assessment ◽

Eyes Closed ◽

Study Population ◽

Primary School Pupils

SummaryStudy aim: the aim of this study was to determine how body height, body weight, and moderate physical activity affected postural stability in young schoolchildren.Materials and methods: the study population consisted of 148 primary school pupils. To assess postural stability, we used the CQStab2P stabilometric equipment (the bi-platform version), and an assessment of physical activity was conducted via questionnaire.Results: the study revealed that both greater body weight and greater body height positively affected postural stability in the studied population. We found a low, yet significant correlation regarding postural stability in children who attended sports classes. In the cases of path length and mean amplitude of sway with eyes closed, the children who were more active in sports had better vertical postural stability. We did not find any relationships between static balance and the number of sports classes attended in a week, or with participating in extra academic classes.Conclusions: 1. Children’s postural stability improved with age. 2. Children who took part in sports classes had better body balance. 3. The number of sports classes attended did not correlate with better postural stability.

Download Full-text

Effects of Back Support Exoskeleton Use on Postural Stability

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181319631485 ◽

2019 ◽

Vol 63 (1) ◽

pp. 1088-1089

Author(s):

Jang-Ho Park ◽

Sunwook Kim ◽

Maury A. Nussbaum ◽

Divya Srinivasan

Keyword(s):

Repeated Measures ◽

Postural Balance ◽

Postural Stability ◽

Center Of Pressure ◽

Median Frequency ◽

Upright Stance ◽

Eyes Closed ◽

Unipedal Standing ◽

Eyes Open ◽

Interactive Dynamics

While occupational back support exoskeletons (BSEs) are being considered as a potential intervention to reduce physical demands in tasks such as repetitive lifting (e.g., Frost, Abdoli-E, & Stevenson, 2009; Koopman, Kingma, Faber, de Looze, & van Dieën, 2019), BSE use in practice may introduce some unexpected or unintended safety challenges (Baltrusch, van Dieën, van Bennekom, & Houdijk, 2018; de Looze, Bosch, Krause, Stadler, & O’Sullivan, 2016). One potential adverse effect is a decrease in postural balance and stability due to the extra weight and the rigid structure of a BSE. However, there is limited empirical evidence on how the use of a BSE affects postural balance and stability. In this study, we investigated the effects of using different BSEs on postural balance and stability during quiet upright stance. A total of 20, gender-balanced, healthy participants were included [males = 25.2 (3.8) years, 176.4 (7.4) cm, and 76.6 (8.8) kg; females = 27.5 (2.7) years, 166.5 (5.4) cm, and 61.2 (8.6) kg]. Each completed multiple trials of quiet upright stance at different levels of difficulty (i.e., bipedal and unipedal stance; each with eyes open and closed), while wearing two different BSEs (SuitX™ AC version, Laevo™ V2) and in a control (no-exoskeleton) condition. Respective masses of the SuitX™ and Laevo™ were 4.5 and 2.8 kg, and both devices were designed to provide external torque parallel to that created by the torso extensor muscles via three body contact points (i.e., thighs, pelvis, and chest). Center-of-pressure (COP) time series were measured using a force-plate during each trial, and traditional COP-based postural sway parameters were used as outcome measures: median frequency (MF), mean velocity (MV), root-mean-square distance (RMSD), and sway area. MF, MV, and RMSD values were obtained in both the anteroposterior (AP) and mediolateral (ML) directions. As MV, RMSD, and SwayAREA were significantly correlated with participant height, these measures were normalized using respective linear regression models to prevent undesired bias. Results from repeated measures analyses of variance indicated that wearing BSEs may adversely affect postural stability during bipedal stance. Compared to the control condition, wearing the Laevo™ increased MFAP by 50% ( p=0.015) with eyes open, and wearing the SuitX™ increased MVAP by 7% ( p=0.029) with eyes closed. However, specific to the unipedal standing with eyes closed, wearing the Laevo™ appeared to positively affect postural stability among males, whereas wearing the SuitX™ appeared to negatively affect postural stability among females. Specifically, males had a 24% decrease in RMSDAP ( p=0.003) and a 31% decrease in SwayAREA ( p=0.012) when wearing Laevo™, while females had a 15% increase in RMSDAP ( p=0.038) when wearing the SuitX™. In conclusion, we found evidence that wearing a BSE can affect postural balance and stability during quiet upright stance. More importantly, such effects appeared dependent on task conditions (i.e., bipedal and unipedal, and with eyes open/closed), and to be BSE-design and gender-dependent. Our findings may suggest complex interactive dynamics between a user and a BSE, potentially due to a change in total center of mass (i.e., body + BSE), restricted motion, and external supportive torques of the BSE. Furthermore, males and females may be differentially affected by such interactive dynamics, depending on the BSE, particularly in more challenging tasks. Future studies need to investigate the specificity of BSE effects on postural control while considering different demographic and individual factors, and also the effects of wearing BSEs on postural stability in dynamic conditions (e.g., walking, negotiating an obstacle, or recovering from an external perturbation).

Download Full-text

The Effects of Metronome Frequency Differentially Affects Gait on a Treadmill and Overground in People with Parkinson’s Disease

10.1101/19003251 ◽

2019 ◽

Author(s):

Madelon Wygand ◽

Guneet Chawla ◽

Nina Browner ◽

Michael D Lewek

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Gait Speed ◽

Repeated Measures ◽

Step Length ◽

Yahr Stage ◽

Gait Parameters ◽

Walking Environment ◽

Stage 1 ◽

Walking Speeds

AbstractObjectiveTo determine the effect of different metronome cue frequencies on spatiotemporal gait parameters when walking overground compared to walking on a treadmill in people with Parkinson’s diseaseDesignRepeated-measures, within-subject designSettingResearch laboratoryParticipantsTwenty-one people with Parkinson’s disease (Hoehn & Yahr stage 1-3)InterventionsParticipants walked overground and on a treadmill with and without metronome cues of 85%, 100%, and 115% of their baseline cadence for one minute each.Main Outcome MeasuresGait speed, step length, and cadenceResultsAn interaction effect between cue frequency and walking environment revealed that participants took longer steps during the 85% condition on the treadmill only. When walking overground, metronome cues of 85% and 115% of baseline cadence yielded decreases and increases, respectively, in both cadence and gait speed with no concomitant change in step length.ConclusionsThese data suggest that people with PD are able to alter spatiotemporal gait parameters immediately when provided the appropriate metronome cue and walking environment. We propose to target shortened step lengths by stepping to the beat of slow frequency auditory cues while walking on a treadmill, whereas the use of fast frequency cues during overground walking can facilitate faster walking speeds.

Download Full-text

Effects of Short-Term Dynamic Balance Training on Postural Stability in School-Aged Football Players and Gymnasts

Frontiers in Psychology ◽

10.3389/fpsyg.2021.767036 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rouven Kenville ◽

Tom Maudrich ◽

Sophie Körner ◽

Johannes Zimmer ◽

Patrick Ragert

Keyword(s):

Repeated Measures ◽

Dynamic Balance ◽

Training Session ◽

Balance Training ◽

Retention Rates ◽

Football Players ◽

Static Balance ◽

Balance Performance ◽

Balance Assessment ◽

Eyes Closed

Static and dynamic balance abilities enable simple and complex movements and are determinants of top athletic performance. Balance abilities and their proficiency differ fundamentally with respect to age, gender, type of balance intervention, and type of sport. With this study, we aim to investigate whether 4weeks of dynamic balance training (DBT) improves static balance performance in school-aged gymnasts and football players. For this purpose, young male gymnasts (n=21) and male football players (n=20) completed an initial static balance assessment consisting of two one-legged stance (left and right foot) and two two-legged stance (eyes open and eyes closed) tasks. Subsequently, all participants underwent a 4-week intervention. DBT consisting of nine individual tasks was performed two times per week. Another static balance assessment followed 1day after the last training session and retention was assessed 2weeks later. Dynamic balance scores and total path length were analyzed via rank-based repeated measures designs using ANOVA-type statistics. The influence of factors GROUP and TIME on the static and dynamic balance performance was examined. Prior to DBT, young gymnasts showed better static balance performance than football players. However, after intervention, both groups improved in both one-legged stance tasks and also had high retention rates in these tasks. No significant improvements were seen in either group in the two-legged balance tests. Both groups improved in the dynamic balance tasks, although no differences in learning rates were evident. Our findings imply an inter-relationship between both static and dynamic balance components. Consequently, training regimes should include both balance components to facilitate early development of balance ability.

Download Full-text

Gait Stability Measurement by Using Average Entropy

Entropy ◽

10.3390/e23040412 ◽

2021 ◽

Vol 23 (4) ◽

pp. 412

Author(s):

Han-Ping Huang ◽

Chang Francis Hsu ◽

Yi-Chih Mao ◽

Long Hsu ◽

Sien Chi

Keyword(s):

Postural Stability ◽

Multiscale Entropy ◽

Gait Stability ◽

Eyes Closed ◽

Stride Interval ◽

Step Interval ◽

Stability Measurement ◽

Eyes Open ◽

Two Measures ◽

Better Than

Gait stability has been measured by using many entropy-based methods. However, the relation between the entropy values and gait stability is worth further investigation. A research reported that average entropy (AE), a measure of disorder, could measure the static standing postural stability better than multiscale entropy and entropy of entropy (EoE), two measures of complexity. This study tested the validity of AE in gait stability measurement from the viewpoint of the disorder. For comparison, another five disorders, the EoE, and two traditional metrics methods were, respectively, used to measure the degrees of disorder and complexity of 10 step interval (SPI) and 79 stride interval (SI) time series, individually. As a result, every one of the 10 participants exhibited a relatively high AE value of the SPI when walking with eyes closed and a relatively low AE value when walking with eyes open. Most of the AE values of the SI of the 53 diseased subjects were greater than those of the 26 healthy subjects. A maximal overall accuracy of AE in differentiating the healthy from the diseased was 91.1%. Similar features also exists on those 5 disorder measurements but do not exist on the EoE values. Nevertheless, the EoE versus AE plot of the SI also exhibits an inverted U relation, consistent with the hypothesis for physiologic signals.

Download Full-text

A Proposal of a Motion Measurement System to Support Visually Impaired People in Rehabilitation Using Low-Cost Inertial Sensors

Entropy ◽

10.3390/e23070848 ◽

2021 ◽

Vol 23 (7) ◽

pp. 848

Author(s):

Karla Miriam Reyes Leiva ◽

Milagros Jaén-Vargas ◽

Miguel Ángel Cuba ◽

Sergio Sánchez Lara ◽

José Javier Serrano Olmedo

Keyword(s):

Visually Impaired ◽

Inertial Sensors ◽

Personal Autonomy ◽

Low Cost ◽

Step Length ◽

Hand Position ◽

Visually Impaired People ◽

Gait Parameters ◽

Impaired Person ◽

Further Development

The rehabilitation of a visually impaired person (VIP) is a systematic process where the person is provided with tools that allow them to deal with the impairment to achieve personal autonomy and independence, such as training for the use of the long cane as a tool for orientation and mobility (O&M). This process must be trained personally by specialists, leading to a limitation of human, technological and structural resources in some regions, especially those with economical narrow circumstances. A system to obtain information about the motion of the long cane and the leg using low-cost inertial sensors was developed to provide an overview of quantitative parameters such as sweeping coverage and gait analysis, that are currently visually analyzed during rehabilitation. The system was tested with 10 blindfolded volunteers in laboratory conditions following constant contact, two points touch, and three points touch travel techniques. The results indicate that the quantification system is reliable for measuring grip rotation, safety zone, sweeping amplitude and hand position using orientation angles with an accuracy of around 97.62%. However, a new method or an improvement of hardware must be developed to improve gait parameters’ measurements, since the step length measurement presented a mean accuracy of 94.62%. The system requires further development to be used as an aid in the rehabilitation process of the VIP. Now, it is a simple and low-cost technological aid that has the potential to improve the current practice of O&M.

Download Full-text

Feasibility and Preliminary Efficacy of Gait Training Assisted by Multichannel Functional Electrical Stimulation in Early Stroke Rehabilitation: A Pilot Randomized Controlled Trial

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320981942 ◽

2021 ◽

Vol 35 (2) ◽

pp. 131-144

Author(s):

Maijke van Bloemendaal ◽

Sicco A. Bus ◽

Frans Nollet ◽

Alexander C. H. Geurts ◽

Anita Beelen

Keyword(s):

Electrical Stimulation ◽

Functional Electrical Stimulation ◽

Step Length ◽

Gait Training ◽

Control Group ◽

Significant Group ◽

Gait Symmetry ◽

Gait Parameters ◽

Walking Capacity ◽

Experimental Group

Background. Many stroke survivors suffer from leg muscle paresis, resulting in asymmetrical gait patterns, negatively affecting balance control and energy cost. Interventions targeting asymmetry early after stroke may enhance recovery of walking. Objective. To determine the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by multichannel functional electrical stimulation (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of gait symmetry and walking capacity in patients starting in the subacute phase after stroke. Methods. Forty inpatient participants (≤31 days after stroke) were randomized to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday. Feasibility was determined by adherence (≥75% sessions) and satisfaction with gait training (score ≥7 out of 10). Primary outcome for efficacy was step length symmetry. Secondary outcomes included other spatiotemporal gait parameters and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect postintervention and at 3-month follow-up. Results. Thirty-seven participants completed the study protocol (19 experimental group participants). Feasibility was confirmed by good adherence (90% of the participants) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome. Conclusions. MFES gait training is feasible early after stroke, but MFES efficacy for improving step length symmetry, other spatiotemporal gait parameters, or walking capacity could not be demonstrated. Trial Registration. Netherlands Trial Register (NTR4762).

Download Full-text