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Sistema di misura per la valutazione del cammino

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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.

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Sistema di misura per la valutazione del cammino

  1. 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. 2. Step-by-step – objective 2 Design and development of a system able to: 1. provide an objective evaluation of motor performance
  3. 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. 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. 5. Why technology has not yet provided useful devices in rehabilitation? Step-by-step - Background
  6. 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. 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. 8. Step-by-step - Background Available since last 10-15 years, why aren’t they widespread yet?
  9. 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. 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. 11. Step-by-step - Solution Hardware: COMETA WaveTrack IMU
  12. 12. Step-by-step - Solution Hardware Software
  13. 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. 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. 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. 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. 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. 18. Step-by-step – Report Xlsx file with all gait the step-by-step gait spatio- temporal parameters
  19. 19. OBIETTIVO 2: FASE CRONICA riabilitazione «evidence-based» Validazione: dal laboratorio al contesto ambulatoriale

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