Ambulatory system for the quantitative and qualitative analysis of gait and posture in chronic pain patients treated with spinal cord stimulation

The physical activity in normal daily life is determined to a large extent by the functional ability of a subject. As a result, the measurement of the physical activity that a subject performs spontaneously could be a useful and objective measurement of disability, particularly in patients with disease-related functional impairment. The aim of this study is to provide an accurate method for the measurement and analysis of the physical activity under normal life conditions. Using three kinematical sensors strapped to the body, both the posture and the gait parameters can be assessed qualitatively and quantitatively. A detailed description of the algorithms used to analyse both the posture and the gait are presented in this paper. Two methods, based on different sensor configurations and signal processing, are proposed for the detection of sitting and standing postures (Methods P1 and P2). Two other methods are used for the quantitative assessment of walking (Methods W1 and W2). The performance of the algorithms (expressed in terms of sensitivity, specificity and error) is based on the comparison of data recorded simultaneously by a non-interfering observer (reference data) with the data provided by the recording system (21 patients, 61 h). Sensitivity and specificity are respectively 98.2% and 98.8% (P1), 97.8% and 98.1% (P2) for sitting; 98.0% and 98.5% (P1), 97.4% and 97.8% (P2) for standing; 97.1% and 97.9% (W1), 92.4% and 94.9% (W2) for walking; and finally, 99.2% and 98.6% for lying. Overall detection errors (as a percent of range) are as follows: 1.15% (P1) and 1.20% (P2) for sitting, 1.36% (P1) and 1.40% (P2) for standing, 1.20% (W1) and 1.60% (W2) for walking and 0.40% for lying. The error for the estimated walking distance and the speed is 6.8% and 9.6%, respectively. We conclude that both methods can be used for the accurate measurement of the basic physical activity in normal daily life. Measurements performed before and after the delivery of a treatment can therefore provide information of unprecedented accuracy and objectivity on the ability of a procedure, in this case spinal cord stimulation, to restore functional capabilities. (C) 2003 Elsevier B.V. All rights reserved.