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Published in: BMC Neurology 1/2018

Open Access 01-12-2018 | Research article

Wearables for gait and balance assessment in the neurological ward - study design and first results of a prospective cross-sectional feasibility study with 384 inpatients

Authors: Felix P. Bernhard, Jennifer Sartor, Kristina Bettecken, Markus A. Hobert, Carina Arnold, Yvonne G. Weber, Sven Poli, Nils G. Margraf, Christian Schlenstedt, Clint Hansen, Walter Maetzler

Published in: BMC Neurology | Issue 1/2018

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Abstract

Background

Deficits in gait and balance are common among neurological inpatients. Currently, assessment of these patients is mainly subjective. New assessment options using wearables may provide complementary and more objective information.

Methods

In this prospective cross-sectional feasibility study performed over a four-month period, all patients referred to a normal neurology ward of a university hospital and aged between 40 and 89 years were asked to participate. Gait and balance deficits were assessed with wearables at the ankles and the lower back. Frailty, sarcopenia, Parkinsonism, depression, quality of life, fall history, fear of falling, physical activity, and cognition were evaluated with questionnaires and surveys.

Results

Eighty-two percent (n = 384) of all eligible patients participated. Of those, 39% (n = 151) had no gait and balance deficit, 21% (n = 79) had gait deficits, 11% (n = 44) had balance deficits and 29% (n = 110) had gait and balance deficits. Parkinson’s disease, stroke, epilepsy, pain syndromes, and multiple sclerosis were the most common diseases. The assessment was well accepted.

Conclusions

Our study suggests that the use of wearables for the assessment of gait and balance features in a clinical setting is feasible. Moreover, preliminary results confirm previous epidemiological data about gait and balance deficits among neurological inpatients. Evaluation of neurological inpatients with novel wearable technology opens new opportunities for the assessment of predictive, progression and treatment response markers.
Literature
1.
go back to reference Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, et al. Movement Disorder Society-sponsored revision of the unified Parkinson’s disease rating scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008;23:2129–70.CrossRefPubMed Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, et al. Movement Disorder Society-sponsored revision of the unified Parkinson’s disease rating scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord. 2008;23:2129–70.CrossRefPubMed
2.
go back to reference Parry SW, Deary V, Finch T, Bamford C, Sabin N, McMeekin P, et al. The STRIDE (strategies to increase confidence, InDependence and energy) study: cognitive behavioural therapy-based intervention to reduce fear of falling in older fallers living in the community - study protocol for a randomised controlled trial. Trials. 2014;15:210.CrossRefPubMedPubMedCentral Parry SW, Deary V, Finch T, Bamford C, Sabin N, McMeekin P, et al. The STRIDE (strategies to increase confidence, InDependence and energy) study: cognitive behavioural therapy-based intervention to reduce fear of falling in older fallers living in the community - study protocol for a randomised controlled trial. Trials. 2014;15:210.CrossRefPubMedPubMedCentral
3.
go back to reference Canning C, Sherrington C, Lord S, Fung V, Close J, Latt M, et al. Exercise therapy for prevention of falls in people with Parkinson’s disease: a protocol for a randomised controlled trial and economic evaluation. BMC Neurol. 2009;9:4.CrossRefPubMedPubMedCentral Canning C, Sherrington C, Lord S, Fung V, Close J, Latt M, et al. Exercise therapy for prevention of falls in people with Parkinson’s disease: a protocol for a randomised controlled trial and economic evaluation. BMC Neurol. 2009;9:4.CrossRefPubMedPubMedCentral
4.
go back to reference Wong TH, Nguyen HV, Chiu MT, Chow KY, Ong MEH, Lim GH, et al. The low fall as a surrogate marker of frailty predicts long-term mortality in older trauma patients. PLoS One. 2015;10:1–14. Wong TH, Nguyen HV, Chiu MT, Chow KY, Ong MEH, Lim GH, et al. The low fall as a surrogate marker of frailty predicts long-term mortality in older trauma patients. PLoS One. 2015;10:1–14.
5.
go back to reference Veuas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry P. Fear of falling and restriction of mobility in elderly fallers. Age Ageing. 1997;26:189–93.CrossRef Veuas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry P. Fear of falling and restriction of mobility in elderly fallers. Age Ageing. 1997;26:189–93.CrossRef
11.
go back to reference Torous J, Firth J, Mueller N, Onnela JP, Baker JT. Methodology and reporting of mobile heath and smartphone application studies for schizophrenia. Harv Rev Psychiatry. 2017;25:146–54.CrossRefPubMedPubMedCentral Torous J, Firth J, Mueller N, Onnela JP, Baker JT. Methodology and reporting of mobile heath and smartphone application studies for schizophrenia. Harv Rev Psychiatry. 2017;25:146–54.CrossRefPubMedPubMedCentral
12.
go back to reference Pevnick JM, Birkeland K, Zimmer R, Elad Y, Kedan I. Wearable technology for cardiology: an update and framework for the future. Trends Cardiovasc Med. 2018;28:144–50.CrossRefPubMed Pevnick JM, Birkeland K, Zimmer R, Elad Y, Kedan I. Wearable technology for cardiology: an update and framework for the future. Trends Cardiovasc Med. 2018;28:144–50.CrossRefPubMed
13.
go back to reference Haghi M, Thurow K, Stoll R. Wearable devices in medical internet of things: scientific research and commercially available devices. Healthc Inform Res. 2017;23:4–15.CrossRefPubMedPubMedCentral Haghi M, Thurow K, Stoll R. Wearable devices in medical internet of things: scientific research and commercially available devices. Healthc Inform Res. 2017;23:4–15.CrossRefPubMedPubMedCentral
14.
go back to reference Cahn A, Akirov A, Raz I. Digital health technology and diabetes management. J Diabetes. 2018;10:10–7.CrossRefPubMed Cahn A, Akirov A, Raz I. Digital health technology and diabetes management. J Diabetes. 2018;10:10–7.CrossRefPubMed
15.
go back to reference Vienne A, Barrois RP, Buffat S, Ricard D, Vidal P-P. Inertial sensors to assess gait quality in patients with neurological disorders: a systematic review of technical and analytical challenges. Front Psychol. 2017;8:817.CrossRefPubMedPubMedCentral Vienne A, Barrois RP, Buffat S, Ricard D, Vidal P-P. Inertial sensors to assess gait quality in patients with neurological disorders: a systematic review of technical and analytical challenges. Front Psychol. 2017;8:817.CrossRefPubMedPubMedCentral
16.
go back to reference Maetzler W, Klucken J, Horne M. A clinical view on the development of technology-based tools in managing Parkinson’s disease. Mov Disord. 2016;31:1263–71.CrossRefPubMed Maetzler W, Klucken J, Horne M. A clinical view on the development of technology-based tools in managing Parkinson’s disease. Mov Disord. 2016;31:1263–71.CrossRefPubMed
17.
go back to reference Stolze H, Klebe S, Baecker C, Zechlin C, Friege L, Pohle S, et al. Prevalence of gait disorders in hospitalized neurological patients. Mov Disord. 2005;20:89–94.CrossRefPubMed Stolze H, Klebe S, Baecker C, Zechlin C, Friege L, Pohle S, et al. Prevalence of gait disorders in hospitalized neurological patients. Mov Disord. 2005;20:89–94.CrossRefPubMed
20.
go back to reference Pham MH, Elshehabi M, Haertner L, Din SD, Srulijes K, Heger T, et al. Validation of a step detection algorithm during straight walking and turning in patients with Parkinson’s disease and older adults using an inertial measurement unit at the lower back. Front Neurol. 2017;8:457.CrossRefPubMedPubMedCentral Pham MH, Elshehabi M, Haertner L, Din SD, Srulijes K, Heger T, et al. Validation of a step detection algorithm during straight walking and turning in patients with Parkinson’s disease and older adults using an inertial measurement unit at the lower back. Front Neurol. 2017;8:457.CrossRefPubMedPubMedCentral
21.
go back to reference Donath L, Faude O, Lichtenstein E, Nüesch C, Mündermann A. Validity and reliability of a portable gait analysis system for measuring spatiotemporal gait characteristics: comparison to an instrumented treadmill. J Neuroeng Rehabil. 2016;13:6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26790409. Donath L, Faude O, Lichtenstein E, Nüesch C, Mündermann A. Validity and reliability of a portable gait analysis system for measuring spatiotemporal gait characteristics: comparison to an instrumented treadmill. J Neuroeng Rehabil. 2016;13:6. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​26790409.
22.
go back to reference Hobert MA, Niebler R, Meyer SI, Brockmann K, Becker C, Huber H, et al. Poor Trail making test performance is directly associated with altered dual task prioritization in the elderly - baseline results from the TREND study. PLoS One. 2011;6:e27831.CrossRefPubMedPubMedCentral Hobert MA, Niebler R, Meyer SI, Brockmann K, Becker C, Huber H, et al. Poor Trail making test performance is directly associated with altered dual task prioritization in the elderly - baseline results from the TREND study. PLoS One. 2011;6:e27831.CrossRefPubMedPubMedCentral
23.
go back to reference Elshehabi M, Maier KS, Hasmann SE, Nussbaum S, Herbst H, Heger T, et al. Limited effect of dopaminergic medication on straight walking and turning in early to moderate Parkinson’s disease during single and dual tasking. Front Aging Neurosci. 2016;8:4. Elshehabi M, Maier KS, Hasmann SE, Nussbaum S, Herbst H, Heger T, et al. Limited effect of dopaminergic medication on straight walking and turning in early to moderate Parkinson’s disease during single and dual tasking. Front Aging Neurosci. 2016;8:4.
24.
go back to reference Maetzler W, Mancini M, Liepelt-Scarfone I, Müller K, Becker C, van Lummel RCRC, et al. Impaired trunk stability in individuals at high risk for Parkinson’s disease. PLoS One. 2012;7:e32240. 2012/03/30CrossRefPubMedPubMedCentral Maetzler W, Mancini M, Liepelt-Scarfone I, Müller K, Becker C, van Lummel RCRC, et al. Impaired trunk stability in individuals at high risk for Parkinson’s disease. PLoS One. 2012;7:e32240. 2012/03/30CrossRefPubMedPubMedCentral
25.
go back to reference Hasmann SE, Berg D, Hobert MA, Weiss D, Lindemann U, Streffer J, et al. Instrumented functional reach test differentiates individuals at high risk for Parkinson’s disease from controls. Front Aging Neurosci. 2014;6:286.CrossRefPubMedPubMedCentral Hasmann SE, Berg D, Hobert MA, Weiss D, Lindemann U, Streffer J, et al. Instrumented functional reach test differentiates individuals at high risk for Parkinson’s disease from controls. Front Aging Neurosci. 2014;6:286.CrossRefPubMedPubMedCentral
26.
go back to reference Podsiadlo D, Richardson S. The timed “up & go”: a test of basic functional mobility for frail elderly persons. 1991. Podsiadlo D, Richardson S. The timed “up & go”: a test of basic functional mobility for frail elderly persons. 1991.
27.
28.
go back to reference Weiss A, Herman T, Plotnik M, Brozgol M, Maidan I, Giladi N, et al. Can an accelerometer enhance the utility of the timed up & go test when evaluating patients with Parkinson’s disease? Med Eng Phys. 2010;32:119–25.CrossRefPubMed Weiss A, Herman T, Plotnik M, Brozgol M, Maidan I, Giladi N, et al. Can an accelerometer enhance the utility of the timed up & go test when evaluating patients with Parkinson’s disease? Med Eng Phys. 2010;32:119–25.CrossRefPubMed
30.
go back to reference Lachs MS, Becker M, Siegal AP, Miller RL, Tinetti ME. Delusions and behavioral disturbances in cognitively impaired elderly persons. J Am Geriatr Soc. 1992;40:768–73.CrossRefPubMed Lachs MS, Becker M, Siegal AP, Miller RL, Tinetti ME. Delusions and behavioral disturbances in cognitively impaired elderly persons. J Am Geriatr Soc. 1992;40:768–73.CrossRefPubMed
31.
go back to reference Kühner C, Bürger C, Keller F, Hautzinger M. Reliabilität und Validität des revidierten Beck-Depressionsinventars (BDI-II). Nervenarzt. 2007;78:651–6.CrossRefPubMed Kühner C, Bürger C, Keller F, Hautzinger M. Reliabilität und Validität des revidierten Beck-Depressionsinventars (BDI-II). Nervenarzt. 2007;78:651–6.CrossRefPubMed
34.
go back to reference Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.CrossRefPubMed Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.CrossRefPubMed
36.
go back to reference Bohannon RW, Williams AA. Normal walking speed: a descriptive meta-analysis. Physiotherapy. 2011;97:182–9.CrossRefPubMed Bohannon RW, Williams AA. Normal walking speed: a descriptive meta-analysis. Physiotherapy. 2011;97:182–9.CrossRefPubMed
38.
39.
go back to reference Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332:556–61.CrossRefPubMed Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332:556–61.CrossRefPubMed
40.
go back to reference Odenheimer G, Funkenstein HH, Beckett L, Chown M, Pilgrim D, Evans D, et al. Comparison of neurologic changes in “successfully aging” persons vs the Total aging population. Arch Neurol. 1994;51:573–80. American Medical AssociationCrossRefPubMed Odenheimer G, Funkenstein HH, Beckett L, Chown M, Pilgrim D, Evans D, et al. Comparison of neurologic changes in “successfully aging” persons vs the Total aging population. Arch Neurol. 1994;51:573–80. American Medical AssociationCrossRefPubMed
42.
go back to reference Verghese J, LeValley A, Hall CB, Katz MJ, Ambrose AF, Lipton RB. Epidemiology of gait disorders in community-residing older adults. J Am Geriatr Soc. 2006;54:255–61.CrossRefPubMedPubMedCentral Verghese J, LeValley A, Hall CB, Katz MJ, Ambrose AF, Lipton RB. Epidemiology of gait disorders in community-residing older adults. J Am Geriatr Soc. 2006;54:255–61.CrossRefPubMedPubMedCentral
43.
go back to reference Fitzpatrick AL, Buchanan CK, Nahin RL, Dekosky ST, Atkinson HH, Carlson MC, et al. Associations of gait speed and other measures of physical function with cognition in a healthy cohort of elderly persons. J Gerontol A Biol Sci Med Sci. 2007;62:1244–51. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18000144. Fitzpatrick AL, Buchanan CK, Nahin RL, Dekosky ST, Atkinson HH, Carlson MC, et al. Associations of gait speed and other measures of physical function with cognition in a healthy cohort of elderly persons. J Gerontol A Biol Sci Med Sci. 2007;62:1244–51. Available from: http://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​18000144.
48.
go back to reference Dadashi F, Mariani B, Rochat S, Büla CJ, Santos-Eggimann B, Aminian K. Gait and foot clearance parameters obtained using shoe-worn inertial sensors in a large-population sample of older adults. Sensors (Basel). 2013;14:443–57. Available from: http://www.mdpi.com/1424-8220/14/1/443. Dadashi F, Mariani B, Rochat S, Büla CJ, Santos-Eggimann B, Aminian K. Gait and foot clearance parameters obtained using shoe-worn inertial sensors in a large-population sample of older adults. Sensors (Basel). 2013;14:443–57. Available from: http://​www.​mdpi.​com/​1424-8220/​14/​1/​443.
49.
go back to reference Del Din S, Godfrey A, Rochester L. Validation of an accelerometer to quantify a comprehensive battery of gait characteristics in healthy older adults and Parkinson’s disease: toward clinical and at home use. IEEE J Biomed Heal Informatics. 2016;20:838–47.CrossRef Del Din S, Godfrey A, Rochester L. Validation of an accelerometer to quantify a comprehensive battery of gait characteristics in healthy older adults and Parkinson’s disease: toward clinical and at home use. IEEE J Biomed Heal Informatics. 2016;20:838–47.CrossRef
Metadata
Title
Wearables for gait and balance assessment in the neurological ward - study design and first results of a prospective cross-sectional feasibility study with 384 inpatients
Authors
Felix P. Bernhard
Jennifer Sartor
Kristina Bettecken
Markus A. Hobert
Carina Arnold
Yvonne G. Weber
Sven Poli
Nils G. Margraf
Christian Schlenstedt
Clint Hansen
Walter Maetzler
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2018
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-018-1111-7

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