Detecting the symptoms of Parkinson's disease with non-standard video.

BACKGROUND: Neurodegenerative diseases, such as Parkinson's disease (PD), necessitate frequent clinical visits and monitoring to identify changes in motor symptoms and provide appropriate care. By applying machine learning techniques to video data, automated video analysis has emerged as a promising approach to track and analyze motor symptoms, which could facilitate more timely intervention. However, existing solutions often rely on specialized equipment and recording procedures, which limits their usability in unstructured settings like the home. In this study, we developed a method to detect PD symptoms from unstructured videos of clinical assessments, without the need for specialized equipment or recording procedures. METHODS: Twenty-eight individuals with Parkinson's disease completed a video-recorded motor examination that included the finger-to-nose and hand pronation-supination tasks. Clinical staff provided ground truth scores for the level of Parkinsonian symptoms present. For each video, we used a pre-existing model called PIXIE to measure the location of several joints on the person's body and quantify how they were moving. Features derived from the joint angles and trajectories, designed to be robust to recording angle, were then used to train two types of machine-learning classifiers (random forests and support vector machines) to detect the presence of PD symptoms. RESULTS: The support vector machine trained on the finger-to-nose task had an F1 score of 0.93 while the random forest trained on the same task yielded an F1 score of 0.85. The support vector machine and random forest trained on the hand pronation-supination task had F1 scores of 0.20 and 0.33, respectively. CONCLUSION: These results demonstrate the feasibility of developing video analysis tools to track motor symptoms across variable perspectives. These tools do not work equally well for all tasks, however. This technology has the potential to overcome barriers to access for many individuals with degenerative neurological diseases like PD, providing them with a more convenient and timely method to monitor symptom progression, without requiring a structured video recording procedure. Ultimately, more frequent and objective home assessments of motor function could enable more precise telehealth optimization of interventions to improve clinical outcomes inside and outside of the clinic.

Modular hip exoskeleton improves walking function and reduces sedentary time in community-dwelling older adults.

BACKGROUND: Despite the benefits of physical activity for healthy physical and cognitive aging, 35% of adults over the age of 75 in the United States are inactive. Robotic exoskeleton-based exercise studies have shown benefits in improving walking function, but most are conducted in clinical settings with a neurologically impaired population. Emerging technology is starting to enable easy-to-use, lightweight, wearable robots, but their impact in the otherwise healthy older adult population remains mostly unknown. For the first time, this study investigates the feasibility and efficacy of using a lightweight, modular hip exoskeleton for in-community gait training in the older adult population to improve walking function. METHODS: Twelve adults over the age of 65 were enrolled in a gait training intervention involving twelve 30-min sessions using the Gait Enhancing and Motivating System for Hip in their own senior living community. RESULTS: Performance-based outcome measures suggest clinically significant improvements in balance, gait speed, and endurance following the exoskeleton training, and the device was safe and well tolerated. Gait speed below 1.0 m/s is an indicator of fall risk, and two out of the four participants below this threshold increased their self-selected gait speed over 1.0 m/s after intervention. Time spent in sedentary behavior also decreased significantly. CONCLUSIONS: This intervention resulted in greater improvements in speed and endurance than traditional exercise programs, in significantly less time. Together, our results demonstrated that exoskeleton-based gait training is an effective intervention and novel approach to encouraging older adults to exercise and reduce sedentary time, while improving walking function. Future work will focus on whether the device can be used independently long-term by older adults as an everyday exercise and community-use personal mobility device. Trial registration This study was retrospectively registered with ClinicalTrials.gov (ID: NCT05197127).

Wearable airbag technology and machine learned models to mitigate falls after stroke.

BACKGROUND: Falls are a common complication experienced after a stroke and can cause serious detriments to physical health and social mobility, necessitating a dire need for intervention. Among recent advancements, wearable airbag technology has been designed to detect and mitigate fall impact. However, these devices have not been designed nor validated for the stroke population and thus, may inadequately detect falls in individuals with stroke-related motor impairments. To address this gap, we investigated whether population-specific training data and modeling parameters are required to pre-detect falls in a chronic stroke population. METHODS: We collected data from a wearable airbag's inertial measurement units (IMUs) from individuals with (n = 20 stroke) and without (n = 15 control) history of stroke while performing a series of falls (842 falls total) and non-falls (961 non-falls total) in a laboratory setting. A leave-one-subject-out crossvalidation was used to compare the performance of two identical machine learned models (adaptive boosting classifier) trained on cohort-dependent data (control or stroke) to pre-detect falls in the stroke cohort. RESULTS: The average performance of the model trained on stroke data (recall = 0.905, precision = 0.900) had statistically significantly better recall (P = 0.0035) than the model trained on control data (recall = 0.800, precision = 0.944), while precision was not statistically significantly different. Stratifying models trained on specific fall types revealed differences in pre-detecting anterior-posterior (AP) falls (stroke-trained model's F1-score was 35% higher, P = 0.019). Using activities of daily living as non-falls training data (compared to near-falls) significantly increased the AUC (Area under the receiver operating characteristic) for classifying AP falls for both models (P < 0.04). Preliminary analysis suggests that users with more severe stroke impairments benefit further from a stroke-trained model. The optimal lead time (time interval pre-impact to detect falls) differed between control- and stroke-trained models. CONCLUSIONS: These results demonstrate the importance of population sensitivity, non-falls data, and optimal lead time for machine learned pre-impact fall detection specific to stroke. Existing fall mitigation technologies should be challenged to include data of neurologically impaired individuals in model development to adequately detect falls in other high fall risk populations. Trial registration https://clinicaltrials.gov/ct2/show/NCT05076565 ; Unique Identifier: NCT05076565. Retrospectively registered on 13 October 2021.

Video-Based Pose Estimation for Gait Analysis in Stroke Survivors during Clinical Assessments: A Proof-of-Concept Study.

Recent advancements in deep learning have produced significant progress in markerless human pose estimation, making it possible to estimate human kinematics from single camera videos without the need for reflective markers and specialized labs equipped with motion capture systems. Such algorithms have the potential to enable the quantification of clinical metrics from videos recorded with a handheld camera. Here we used DeepLabCut, an open-source framework for markerless pose estimation, to fine-tune a deep network to track 5 body keypoints (hip, knee, ankle, heel, and toe) in 82 below-waist videos of 8 patients with stroke performing overground walking during clinical assessments. We trained the pose estimation model by labeling the keypoints in 2 frames per video and then trained a convolutional neural network to estimate 5 clinically relevant gait parameters (cadence, double support time, swing time, stance time, and walking speed) from the trajectory of these keypoints. These results were then compared to those obtained from a clinical system for gait analysis (GAITRite®, CIR Systems). Absolute accuracy (mean error) and precision (standard deviation of error) for swing, stance, and double support time were within 0.04 ± 0.11 s; Pearson's correlation with the reference system was moderate for swing times (r = 0.4-0.66), but stronger for stance and double support time (r = 0.93-0.95). Cadence mean error was -0.25 steps/min ± 3.9 steps/min (r = 0.97), while walking speed mean error was -0.02 ± 0.11 m/s (r = 0.92). These preliminary results suggest that single camera videos and pose estimation models based on deep networks could be used to quantify clinically relevant gait metrics in individuals poststroke, even while using assistive devices in uncontrolled environments. Such development opens the door to applications for gait analysis both inside and outside of clinical settings, without the need of sophisticated equipment.

Lower-limb kinematics and kinetics during continuously varying human locomotion.

Human locomotion involves continuously variable activities including walking, running, and stair climbing over a range of speeds and inclinations as well as sit-stand, walk-run, and walk-stairs transitions. Understanding the kinematics and kinetics of the lower limbs during continuously varying locomotion is fundamental to developing robotic prostheses and exoskeletons that assist in community ambulation. However, available datasets on human locomotion neglect transitions between activities and/or continuous variations in speed and inclination during these activities. This data paper reports a new dataset that includes the lower-limb kinematics and kinetics of ten able-bodied participants walking at multiple inclines (±0°; 5° and 10°) and speeds (0.8 m/s; 1 m/s; 1.2 m/s), running at multiple speeds (1.8 m/s; 2 m/s; 2.2 m/s and 2.4 m/s), walking and running with constant acceleration (±0.2; 0.5), and stair ascent/descent with multiple stair inclines (20°; 25°; 30° and 35°). This dataset also includes sit-stand transitions, walk-run transitions, and walk-stairs transitions. Data were recorded by a Vicon motion capture system and, for applicable tasks, a Bertec instrumented treadmill.

Parameterizing Human Locomotion Across Quasi-Random Treadmill Perturbations and Inclines.

Previous work has shown that it is possible to use a mechanical phase variable to accurately quantify the progression through a human gait cycle, even in the presence of disturbances. However, mechanical phase variables are highly dependent on the behavior of the body segment from which they are measured, which can change with the human's task or in response to different disturbances. In this study, we compare kinematic parameterization methods based on time, thigh phase angle, and tibia phase angle with motion capture data obtained from ten able-bodied subjects walking at three inclines while experiencing phase-shifting perturbations from a split-belt instrumented treadmill. The belt, direction, and timings of perturbations were quasi-randomly selected to prevent anticipatory action by the subjects and sample different types of perturbations. Statistical analysis revealed that both phase parameterization methods are superior to time parameterization, with thigh phase angle also being superior to tibia phase angle in most cases.

Analysis of Continuously Varying Kinematics for Prosthetic Leg Control Applications.

Powered prosthetic legs can improve the quality of life for people with transfemoral amputations by providing net positive work at the knee and ankle, reducing the effort required from the wearer, and making more tasks possible. However, the controllers for these devices use finite state machines that limit their use to a small set of pre-defined tasks that require many hours of tuning for each user. In previous work, we demonstrated that a continuous parameterization of joint kinematics over walking speeds and inclines provides more accurate predictions of reference kinematics for control than a finite state machine. However, our previous work did not account for measurement errors in gait phase, walking speed, and ground incline, nor subject-specific differences in reference kinematics, which occur in practice. In this work, we conduct a pilot experiment to characterize the accuracy of speed and incline measurements using sensors onboard our prototype prosthetic leg and simulate phase measurements on ten able-bodied subjects using archived motion capture data. Our analysis shows that given demonstrated accuracy for speed, incline, and phase estimation, a continuous parameterization provides statistically significantly better predictions of knee and ankle kinematics than a comparable finite state machine, but both methods' primary source of predictive error is subject deviation from average kinematics.

Phase-Variable Control of a Powered Knee-Ankle Prosthesis over Continuously Varying Speeds and Inclines.

Most controllers for lower-limb robotic prostheses require individually tuned parameter sets for every combination of speed and incline that the device is designed for. Because ambulation occurs over a continuum of speeds and inclines, this design paradigm requires tuning of a potentially prohibitively large number of parameters. This limitation motivates an alternative control framework that enables walking over a range of speeds and inclines while requiring only a limited number of tunable parameters. In this work, we present the implementation of a continuously varying kinematic controller on a custom powered knee-ankle prosthesis. The controller uses a phase variable derived from the residual thigh angle, along with real-time estimates of ground inclination and walking speed, to compute the appropriate knee and ankle joint angles from a continuous model of able-bodied kinematic data. We modify an existing phase variable architecture to allow for changes in speeds and inclines, quantify the closed-loop accuracy of the speed and incline estimation algorithms for various references, and experimentally validate the controller by observing that it replicates kinematic trends seen in able-bodied gait as speed and incline vary.

Predicting Individualized Joint Kinematics over a Continuous Range of Slopes and Speeds.

Individuality in clinical gait analysis is often quantified by an individual's kinematic deviation from the norm, but it is unclear how these deviations generalize across different walking speeds and ground slopes. Understanding individuality across tasks has important implications in the tuning of prosthetic legs, where clinicians have limited time and resources to personalize the kinematic motion of the leg to therapeutically enhance the wearer's gait. This study seeks to determine an efficient way to predictively model an individual's kinematics over a continuous range of slopes and speeds given only one personalized task at level ground. We were able to predict the kinematics of able-bodied individuals at a wide variety of conditions that were not specifically tuned. Applied to 10 human subjects, the individualization method reduced the RMSE between the model and subject's kinematics over all tasks by an average of 2% (max 52%) at the ankle, 27% (max 59%) at the knee, and 45% (max 83%) at the hip. Our results indicate that knowing how an individual subject differs from the average subject at level ground alone is enough information to improve kinematic predictions across all tasks. This research offers a new method for personalizing robotic prosthetic legs over a variety of tasks without the need of an engineer, which could make these complex devices more clinically viable.

Modeling the Kinematics of Human Locomotion Over Continuously Varying Speeds and Inclines.

Powered knee and ankle prostheses can perform a limited number of discrete ambulation tasks. This is largely due to their control architecture, which uses a finite-state machine to select among a set of task-specific controllers. A non-switching controller that supports a continuum of tasks is expected to better facilitate normative biomechanics. This paper introduces a predictive model that represents gait kinematics as a continuous function of gait cycle percentage, speed, and incline. The basis model consists of two parts: basis functions that produce kinematic trajectories over the gait cycle and task functions that smoothly alter the weight of basis functions in response to task. Kinematic data from 10 able-bodied subjects walking at 27 combinations of speed and incline generate training and validation data for this data-driven model. Convex optimization accurately fits the model to experimental data. Automated model order reduction improves predictive abilities by capturing only the most important kinematic changes due to walking tasks. Constraints on a range of motion and jerk ensure the safety and comfort of the user. This model produces a smooth continuum of trajectories over task, an impossibility for finite-state control algorithms. Random sub-sampling validation indicates that basis modeling predicts untrained kinematics more accurately than linear interpolation.

A Unified Parameterization of Human Gait Across Ambulation Modes.

This paper introduces a novel gait parameterization method that models gait kinematics as a continuous function of gait cycle phase, walking speed, and ground slope. Kinematic data was recorded from seven able-bodied subjects walking on a treadmill at twenty-seven combinations of walking speed and ground slope. Convex optimization was used to determine the parameters of a function of three variables that fits this experimental data. This function may be able to provide desired trajectories to a virtual constraint controller over a continuum of gait phases and ambulation modes. This could allow for a single, non-switching controller to control a prosthetic leg for a variety of tasks, avoiding many of the problems associated with the ubiquitous use of finite state machines in prosthesis control.