2° Presentazione del workshop finale del progetto Step-by-Step Obiettivo 2 - Fase Cronica: RIABILITAZIONE “EVIDENCE-BASED” Lo sviluppo e la validazione clinica di un sistema di misura in grado di offrire una valutazione del percorso riabilitativo basata sull’evidenza, integrando le scale cliniche esistenti con parametri affidabili e ripetibili di segnali di movimento, correlabili con i valori delle scale.

1. Alberto Ferrari
CIRI Health Sciences & Technologies
University of Bologna
OBIETTIVO 2:
FASE CRONICA riabilitazione «evidence-based»
Sistema di misura per la
valutazione del cammino

2. Step-by-step – objective 2
Design and development of a system able to:
1. provide an objective evaluation of motor performance

3. Step-by-step – objective 2
Design and development of a system able to:
1. provide an objective evaluation of motor performance
2. to assist the clinical decisions making
à to obtain a rapid and effective recovery of
the locomotor function and the
maximum possible autonomy

4. • Clinical scales are the state of the art in the aim of
measuring the effectiveness of the rehabilitation
programs, but they are:
– often insensible to the change in the autonomy level
– suffer of ceiling and floor effects
– qualitative
– subjective
Step-by-step – Objective 2

5. Why technology has not yet provided useful
devices in rehabilitation?
Step-by-step - Background

6. Step-by-step - Background
Commercial systems for gait analysis
Mat/optical
based Camera based
Insole based
not-portable
expensive
quick analysis
req. laboratory
expensive
time consuming
accurate
thorough
no step length
no speed
portable

7. Step-by-step - Background
Mat based
Camera based
Insole based
not-portable
expensive
quick analysis
req. laboratory
expensive
time consuming
accurate
thorough
no step length
no speed
portable
üLow dimension
üCost effective
üPortable (ubiquitous)
üAutomatic data processing
Inertial sensors based

8. Step-by-step - Background
Available since last 10-15 years,
why aren’t they widespread yet?

9. Step-by-step - Background
Available since last 10-15 years,
why aren’t they widespread yet?
1. Accuracy and ease of use reached appropriate levels for
clinical applications just in the last 3-5 years
2. Methods, such as ZUPT-aided INS were developed in the
last 3-5 years

10. Step-by-step - Challenge
Development of a device that:
1. provides quantitative information
2. allows accurate measurement of the gait pattern
3. Easily used directly by clinicians (user-friendliness)

11. Step-by-step - Solution
Hardware: COMETA WaveTrack IMU

12. Step-by-step - Solution
Hardware
Software

13. Step-by-step - algorithms
Identify temporal events
#FootContact
#FootOff
Ferrari et al. 2016 –
IEEE Transaction on
Neural system and
rehabilitation engineering
24-73.8 4 4.2 4.4 4.6 4.8 5 5.2 5.4 5.6
time [sec]
-5
-4
-3
-2
-1
0
1
2
3
4
5
MLangularvelocity[rad/s]
Medio-lateral angular velocity Right=green Left=red
1. Temporal Gait events

14. Step-by-step - algorithms
Intelligence of algorithms tuned on the base of hundreds
of pathologic gait pattern (Parkinson, SCI, PCI and major
neurological disorders)
Initial contact
Foot off
Angular velocity
Inertial
sensor
Accelerometer
Gyroscope
dt∫dt∫
dt∫
position
velocity
orientation
-g
Mechanization eq.
ZUPT K
Kalman filter
correction
Temporal gait params Spatial gait params
Step length errors < 4%

15. Step-by-step – Report
1. All info in A4 size
2. Easily interpretable
3. Full description of
performance
Test 1
University of Bologna
Personal Health System Lab
Alberto Ferrari
Gait Analysis Report April 18, 2018 09:05
Clinical question
pre-treatment
post-treatment
Condition
barefoot
shoes w/ orthosis
canesfollow-up
Clinician
Unit
Institution
✓
✓
Notes
Walking test
10 meters
6 minutes✓
TUG
70
104
31
254
150
Gait Cycle
31.0%
Distance covered [m]
244.4
No. Right Steps 240
No. Left Steps 240
38.5%
31.0%Swing Phase[32-41]
[31-42]Single Support
Double Support [17-35]
26
normality values based on reference by Hollman et al. 2011
trajectory
start
end
[m]
[m]
u
n
Variability [pci] 3.8
[cm]
Stride Length
short long
Gait Speed
[cm/s]
slow fast
Swing Duration
[centisec]
allegro lento
PushOff vel
[°/s]
soft powered
Pitch @ctact
[°]
plantarflexed dorsiflexed
Stride Duration
[centisec]
allegro lento
normality values from Hollman et al. 2011; Gait Posture
normality values from Hollman et al. 2011; Gait Posture
normality values from Hollman et al. 2011; Gait Posture
normality from Awai et al. 2016; Neurorehab Neur Rep
normality values from Hollman et al. 2011; Gait Posture
normality values from Hollman et al. 2011; Gait Posture
File name: 6minutes.c3d
median
median
median
median
median
median

16. Step-by-step – Report
Test 1
University of Bologna
Personal Health System Lab
Alberto Ferrari
Gait Analysis Report April 18, 2018 09:05
Clinical question
pre-treatment
post-treatment
Condition
barefoot
shoes w/ orthosis
canesfollow-up
Clinician
Unit
Institution
✓
✓
Notes
Walking test
10 meters
6 minutes✓
TUG
70
104
31
254
150
Gait Cycle
31.0%
Distance covered [m]
244.4
No. Right Steps 240
No. Left Steps 240
38.5%
31.0%Swing Phase[32-41]
[31-42]Single Support
Double Support [17-35]
26
normality values based on reference by Hollman et al. 2011
trajectory
start
end
[m]
[m]
u
n
Variability [pci] 3.8
[cm]
Stride Length
short long
Gait Speed
[cm/s]
slow fast
Swing Duration
[centisec]
allegro lento
PushOff vel
[°/s]
soft powered
Pitch @ctact
[°]
plantarflexed dorsiflexed
Stride Duration
[centisec]
allegro lento
normality values from Hollman et al. 2011; Gait Posture
normality values from Hollman et al. 2011; Gait Posture
normality values from Hollman et al. 2011; Gait Posture
normality from Awai et al. 2016; Neurorehab Neur Rep
normality values from Hollman et al. 2011; Gait Posture
normality values from Hollman et al. 2011; Gait Posture
File name: 6minutes.c3d
median
median
median
median
median
median
User and trial details
Box plot
wrt
Normality
bands
Flag indicating
where median falls
Descriptive stats

17. Step-by-step – Report
Gait Analysis Report March 29, 2018 16:39
Clinical question
pre-treatment
post-treatment
Condition
barefoot
shoes w/ orthosis
canesfollow-up
Clinician
Unit
Institution
Notes
Walking test
10 meters
6 minutes
TUG
-6
-4
-1
-2
7
Gait Cycle
31%
Distance covered [m]
244.
4
No. Right Steps 240
No. Left Steps 240
38%
31%Swing Phase[32-41]
[31-42]Single Support
Double Support [17-35]
-2
normality values based on reference by Hollman et al. 2011
trajectory
start
end
[m]
[m]
u
n
Variability [pci] 3.8
[cm]
Stride Length
short long
Gait Speed
[cm/s]
slow fast
Swing Duration
[centisec]
allegro lento
PushOff vel
[°/s]
soft powered
Pitch @ctact
[°]
plantarflexed dorsiflexed
Stride Duration
[centisec]
allegro lento
normality values from Hollman et al. 2011; Gait Posture
normality values from Hollman et al. 2011; Gait Posture
normality values from Hollman et al. 2011; Gait Posture
normality from Awai et al. 2016; Neurorehab Neur Rep
normality values from Hollman et al. 2011; Gait Posture
normality values from Hollman et al. 2011; Gait Posture
File name: 6minutes.c3d vs 6minutes.c3d
272.7
255
255
4.2
difference
difference
difference
difference
difference
difference
-1%
+2%
-1%
1. Comparison tool
1. Pre- vs post- treatment
2. W/ shoes or orthosis

18. Step-by-step – Report
Xlsx file with all gait the step-by-step gait spatio-
temporal parameters

19. OBIETTIVO 2:
FASE CRONICA riabilitazione «evidence-based»
Validazione:
dal laboratorio al contesto ambulatoriale