Search Results (9)

Background/Objectives: Low back pain is one of the most prevalent pathologies. Several studies relate its chronification to certain psycho-emotional characteristics, such as self-efficacy or the patient’s lack of confidence in the ability to move. Determine the reliability and validity of the OPTIMAL-confidence scale in people with chronic low back pain and describe the confidence in the movement capacity of this population. Methods: Design: A validation study was designed to evaluate the psychometric properties of the OPTIMAL-Confidence Questionnaire in a population with chronic low back pain. A descriptive observational study in a population with chronic low back pain and a healthy population was designed to describe the confidence in the movement capacity of the population with chronic low back pain. Settings: Health centers of primary care from a region of northwestern Spain. Participants: The final sample was 122 patients diagnosed with chronic low back pain. The sampling was completed with 30 additional healthy subjects. Instruments: OPTIMAL-confidence questionnaire, Numerical Pain Rating Scale, Chronic Pain Self-efficacy Scale, and ad hoc questionnaire to collect socio-demographic and clinical variables. Results: Cronbach’s alpha for the OPTIMAL-confidence questionnaire was 0.91. The association of OPTIMAL-confidence with the self-efficacy, pain intensity, and movement ability scales was moderate and significant (p < 0.001). Regarding the low back pain population, significant differences were observed in confidence levels according to age and the need for walking aids (p < 0.009). The OPTIMAL-confidence questionnaire also showed significant discrimination between the low back pain group and the no back pain group (p < 0.001). The confidence interval was 95%. Conclusions: The population with low back pain shows less confidence in their ability to perform movements, compared to the general population. OPTIMAL is an instrument that can discriminate between patients who present chronic low back pain and those who do not. Full article

The use of crutches is a common method of assisting people during recovery from musculoskeletal injuries in the lower limbs. There are several different ways to walk with crutches depending on the patient’s needs. The structure of crutch gaits or crutch gait patterns varies based on the delay between the aid and foot placement, the number of concurrent points of contact, and laterality. In a rehabilitation process, the prescribed pattern may differ according to the injury, the treatment and the individual’s condition. Clinicians may improve diagnosis, assessment, training, and treatment by monitoring and analyzing gait patterns. This study aimed to assess and characterize four crutch walking patterns using spatial and temporal parameters obtained from the instrumented crutches. For this purpose, 27 healthy users performed four different gait patterns over multiple trials. Each trial was recorded using a portable system integrated into the crutches, which measured force, position, and acceleration. Based on the data angle, an algorithm was developed to segment the trials into gait cycles and identify gait phases. The next step was to determine the most appropriate metrics to describe each gait pattern. Several metrics were used to analyze the collected data, including force, acceleration, angle, and stride time. Among 27 participants, significant differences were found between crutch gait patterns. Through the use of these spatial and temporal parameters, promising results were obtained for monitoring assisted gait with crutches. Furthermore, the results demonstrated the possibility of using instrumented crutches as a clinical tool. Full article

Assessing motor competence is essential for evaluating the effectiveness of physical activity interventions that aim to maintain or improve older adults’ function. However, assessing motor competence in older adults who have difficulties walking or standing is challenging, because few instruments or guidelines are appropriate for these frail older adults. This article aims to describe challenges in evaluating motor function among frail older adults, discuss strategies for adapting motor function assessments to their home settings, and provide recommendations for future clinical trials so that older adults with ambulatory difficulties can benefit from motor function assessment and physical activity programs. Data came from the baseline assessment of 116 participants of an ongoing clinical trial, “Promoting Seniors’ Health with Home Care Aides (Pro-Home)”. Our results demonstrated that the Pro-Home study involved participants who would be typically excluded from clinical trials and that the two instruments selected or developed for Pro-Home (Short Physical Performance Battery, Pro-Home Ankle Range of Motion Measure) captured a wide range of lower extremity motor competence with no or few missing data. Recommendations for future studies include knowing the target population thoroughly, developing trust and rapport with all parties involved, and continuously collaborating with interviewers who conduct assessments. Full article

Hereditary spastic paraplegia (HSP) is characterised by progressive lower-limb spasticity and weakness resulting in ambulation difficulties. During clinical practice, walking is observed and/or assessed by timed 10-metre walk tests; time, feasibility, and methodological reliability are barriers to detailed characterisation of patients’ walking abilities when instrumenting this test. Wearable sensors have the potential to overcome such drawbacks once a validated approach is available for patients with HSP. Therefore, while limiting patients’ and assessors’ burdens, this study aims to validate the adoption of a single lower-back wearable inertial sensor approach for step detection in HSP patients; this is the first essential algorithmic step in quantifying most gait temporal metrics. After filtering the 3D acceleration signal based on its smoothness and enhancing the step-related peaks, initial contacts (ICs) were identified as positive zero-crossings of the processed signal. The proposed approach was validated on thirteen individuals with HSP while they performed three 10-metre tests and wore pressure insoles used as a gold standard. Overall, the single-sensor approach detected 794 ICs (87% correctly identified) with high accuracy (median absolute errors (mae): 0.05 s) and excellent reliability (ICC = 1.00). Although about 12% of the ICs were missed and the use of walking aids introduced extra ICs, a minor impact was observed on the step time quantifications (mae 0.03 s (5.1%), ICC = 0.89); the use of walking aids caused no significant differences in the average step time quantifications. Therefore, the proposed single-sensor approach provides a reliable methodology for step identification in HSP, augmenting the gait information that can be accurately and objectively extracted from patients with HSP during their clinical assessment. Full article

This research paper aimed to validate two methods for measuring loads during walking with instrumented crutches: one method to estimate partial weight-bearing on the lower limbs and another to estimate shoulder joint reactions. Currently, gait laboratories, instrumented with high-end measurement systems, are used to extract kinematic and kinetic data, but such facilities are expensive and not accessible to all patients. The proposed method uses instrumented crutches to measure ground reaction forces and does not require any motion capture devices or force platforms. The load on the lower limbs is estimated by subtracting the forces measured by the crutches from the subject’s total weight. Since the model does not consider inertia contribution in dynamic conditions, the estimation improves with low walking cadence when walking with the two-point contralateral and the three-point partial weight-bearing patterns considered for the validation tests. The shoulder joint reactions are estimated using linear regression, providing accurate values for the forces but less accurate torque estimates. The crutches data are acquired and processed in real-time, allowing for immediate feedback, and the system can be used outdoors in real-world walking conditions. The validation of this method could lead to better monitoring of partial weight-bearing and shoulder joint reactions, which could improve patient outcomes and reduce complications. Full article

While walkers are used as mobility aids for different gait impairments, little is known about the factors that affect the performance of such aids. Therefore, we investigated the impact of arm-holding conditions on gait stability and muscle activation. We used surface electromyography (sEMG) sensors on specific arm and leg muscles while the users took laps with a robotic walker, the mobile Tethered Pelvic Assist Device (mTPAD), on an instrumented mat. Eleven participants without gait disorders walked with and without a 10% body weight (BW) force applied on the pelvis in the following three configurations: (i) while gripping the walker’s frame, (ii) while using an armrest with their arms at a 90${}^{\circ }$ angle, and (iii) while using an armrest with their arms at a 130${}^{\circ }$ angle for 5 min each. Our results showed that when applying a force, the users changed their gait to increase stability. We also discovered differences in muscle activation based on the user’s specific arm conditions. Specifically, the 130${}^{\circ }$ condition required the least muscle activation, while gripping the walker’s frame increased specific muscle activation compared to 90${}^{\circ }$ and 130${}^{\circ }$. This study is the first to evaluate how arm-holding and external loading conditions alter gait and muscle activations using the mTPAD. Full article

This paper reports the architecture of a low-cost smart crutches system for mobile health applications. The prototype is based on a set of sensorized crutches connected to a custom Android application. Crutches were instrumented with a 6-axis inertial measurement unit, a uniaxial load cell, WiFi connectivity, and a microcontroller for data collection and processing. Crutch orientation and applied force were calibrated with a motion capture system and a force platform. Data are processed and visualized in real-time on the Android smartphone and are stored on the local memory for further offline analysis. The prototype’s architecture is reported along with the post-calibration accuracy for estimating crutch orientation (5° RMSE in dynamic conditions) and applied force (10 N RMSE). The system is a mobile-health platform enabling the design and development of real-time biofeedback applications and continuity of care scenarios, such as telemonitoring and telerehabilitation. Full article

Assessment of touchscreen manipulation skills is essential for determining the abilities of older individuals and the extent to which they may benefit from this technology as a means to enhance participation, self-esteem, and quality of life. The aim of this study was to compare the touchscreen manipulation ability between community-dwelling older adults and middle-aged adults using a newly developed Touchscreen Assessment Tool (TATOO) and to determine the usability of this instrument. Convenience samples of two age groups were considered, one including 28 independent community-living older adults aged 81.9 ± 4.2 years with intact or corrected vision and with the abilities to walk independently with or without a walking aid and to understand and follow simple commands, and the other including 25 healthy middle-age adults aged 53.4 ± 5.9 years. The usability assessment was conducted during a single session using the System Usability Scale (SUS). Older adults demonstrated poorer touchscreen skills compared to middle-aged adults. Previous experience in manipulating a smartphone by the older adults did not affect their performance. The SUS results indicated good usability of the TATOO by both age groups. The TATOO shows promise as a user-friendly tool for assessing the specific skills needed to operate touchscreens. The outcomes of this study support the suitability of touchscreen devices and applications as well as the need for adapted accessibility for older adults. Researchers and clinicians will benefit from the availability of a rapid, low-cost, and objective tool to assess the skills required for touchscreen use. Full article

Massive efforts to build walking aid platforms for the disabled have been made in line with the needs of the aging society. One of the core technologies that make up these platforms is a realization of the skin-like electronic patch, which is capable of sensing electromyogram (EMG) and delivering feedback information to the soft, lightweight, and wearable exosuits, while maintaining high signal-to-noise ratio reliably in the long term. The main limitations of the conventional EMG sensing platforms include the need to apply foam tape or conductive gel on the surface of the device for adhesion and signal acquisition, and also the bulky size and weight of conventional measuring instruments for EMG, limiting practical use in daily life. Herein, we developed an epidermal EMG electrode integrated with a wireless measuring system. Such the stretchable platform was realized by transfer-printing of the as-prepared EMG electrodes on a SiO₂ wafer to a polydimethylsiloxane (PDMS) elastomer substrate. The epidermal EMG patch has skin-like properties owing to its unique mechanical characteristics: i) location on a neutral mechanical plane that enables high flexibility, ii) wavy design that allows for high stretchability. We demonstrated wireless EMG monitoring using our skin-attachable and stretchable EMG patch sensor integrated with the miniaturized wireless system modules. Full article