A new ambulatory system for comparative evaluation of the three-dimensional knee kinematics, applied to anterior cruciate ligament injuries

The aim of this study was to develop an ambulatory system for the three-dimensional (3D) knee kinematics evaluation, which can be used outside a laboratory during long-term monitoring. In order to show the efficacy of this ambulatory system, knee function was analysed using this system, after an anterior cruciate ligament (ACL) lesion, and after reconstructive surgery. The proposed system was composed of two 3D gyroscopes, fixed on the shank and on the thigh, and a portable data logger for signal recording. The measured parameters were the 3D mean range of motion (ROM) and the healthy knee was used as control. The precision of this system was first assessed using an ultrasound reference system. The repeatability was also estimated. A clinical study was then performed on five unilateral ACL-deficient men (range: 19-36 years) prior to, and a year after the surgery. The patients were evaluated with the IKDC score and the kinematics measurements were carried out on a 30 m walking trial. The precision in comparison with the reference system was 4.4 degrees, 2.7 degrees and 4.2 degrees for flexion-extension, internal-external rotation, and abduction-adduction, respectively. The repeatability of the results for the three directions was 0.8 degrees, 0.7 degrees and 1.8 degrees. The averaged ROM of the five patients' healthy knee were 70.1 degrees [standard deviation (SD) 5.8 degrees], 24.0 degrees (SD 3.0 degrees) and 12.0 degrees (SD 6.3 degrees) for flexion-extension, internal-external rotation and abduction-adduction before surgery, and 76.5 degrees (SD 4.1 degrees), 21.7 degrees (SD 4.9 degrees) and 10.2 degrees (SD 4.6 degrees) 1 year following the reconstruction. The results for the pathologic knee were 64.5 degrees (SD 6.9 degrees), 20.6 degrees (SD 4.0 degrees) and 19.7 degrees (8.2 degrees) during the first evaluation, and 72.3 degrees (SD 2.4 degrees), 25.8 degrees (SD 6.4 degrees) and 12.4 degrees (SD 2.3 degrees) during the second one. The performance of the system enabled us to detect knee function modifications in the sagittal and transverse plane. Prior to the reconstruction, the ROM of the injured knee was lower in flexion-extension and internal-external rotation in comparison with the controlateral knee. One year after the surgery, four patients were classified normal (A) and one almost normal (B), according to the IKDC score, and changes in the kinematics of the five patients remained: lower flexion-extension ROM and higher internal-external rotation ROM in comparison with the controlateral knee. The 3D kinematics was changed after an ACL lesion and remained altered one year after the surgery.

Stair climbing detection during daily physical activity using a miniature gyroscope

Kamiar Aminian, Brian Coley, Anisoara Ionescu, Bijan Najafi

A new method of monitoring physical activity that is able to detect walking upstairs using a miniature gyroscope attached to the shank is presented. Wavelet transformation, in conjunction with a simple kinematics model, was used to detect toe-off, heel-strike and foot-flat, as well cycles corresponding to stair ascent. To evaluate the system, three studies were performed. The method was first tested on 10 healthy young volunteer subjects in a gait laboratory where an ultrasonic motion system was used as a reference system. In the second study, the system was tested on three hospitalized elderly people to classify walking upstairs from walking downstairs and flat walking. In the third study, monitoring was performed on seven patients with peripheral vascular disease for 60 min during their daily physical activity. The first study revealed a close relationship between the ambulatory and the reference systems. Compared to the reference system, the ambulatory system had an overall sensitivity and specificity of 98% and 97%, respectively. In the second study, the ambulatory system also showed a very high sensitivity (> 94%) in identifying a 50 stairs ascent from walking on the flat and walking downstairs. Finally, compared with visual surveillance, we observed a relatively high accuracy in identifying 196 walking upstairs cycles through daily physical activity in the third study. Our results demonstrated a reliable technique of measuring walking upstairs during physical activity. (c) 2004 Elsevier B.V. All rights reserved.

2005

Shoulder function and outcome evaluation after surgery using 3D inertial sensors

Brian Coley

The importance of outcome evaluation of a medical treatment in orthopedics is currently recognized. In shoulder disease, a large variety of evaluation tools is employed to assess the results of the surgery. However, even if the majority of these evaluations are largely widespread, none was accepted as a universal standard. Since 1990, few researchers have been evaluating the assumption that the movement analysis (with camera-based or electromagnetic systems) is likely to provide objective results. In clinical practice, these techniques are not always applicable for outcome evaluation of a treatment. The surgeons lack a convenient and simple method of evaluating in an objective way a patient's activity and quality of life after a surgery of the shoulder. This project provides a new tool for the objective functional evaluation of shoulder pathologies, a tool that can be easily used by a doctor at a hospital and by the patient at home. It allows the measurement of the biodynamic changes as well as 3D kinematics of the treated shoulder by noting the effects of these changes on clinical results and on the patient's daily activity. The project was split in four complementary studies. In the first study, a new ambulatory device allowing long-term monitoring of the shoulder movement using several inertial sensors (3D gyroscopes, 3D accelerometers) attached on the trunk, the humerus and the scapula's spine was designed. By combining acceleration and angular velocity features of the both humerus during 9 tests, three kinematic scores for the functional assessment of the shoulder were presented to evaluate the shoulder function in patient before and after surgery. The kinematic scores objectively showed the shoulder improvement after surgery. In the second study, a new method was proposed to detect and quantify the dominant upper-limb segment during daily activity. The method was tested on healthy subjects (N=31) and a patient group (N=10, at baseline, 3, 6 and 12 months after surgery) while carrying the system during 8 hours of their daily life. The results showed the dominance of the arm during standing, sitting and walking periods for healthy subjects and the quantification of the shoulder improvement after surgery, by taking into account the presence of the disease in the dominant or the non dominant arm. In the third study, 3D gyroscopes attached on the humerus were used to identify the movements of flexion-extension, abduction-adduction and internal/external rotation of the humerus and to identify the rates of adjunct (deliberate rotation) and conjunct rotations (inherent or automatic rotation) within each movement. The frequencies of each movement (number/hour) for the different ranges of the arm speed, as well as the rate of adjunct and conjunct rotations for each movement were estimated during daily activity in healthy and patient groups. The results provided the values of frequency of each movement and adjunct/conjunct rate based on the data obtained from the healthy group. In the pathological case, we found that the painful dominant shoulder of the patients lost its predominance in favor of the healthy shoulder, the non dominant shoulder. Patients had less pure internal/external rotations and performed less fast movements while after surgery these parameters presented no significant differences with the healthy group. In the fourth study, a new method of detecting the working level of the shoulder was presented. By measuring the arm elevation during motionless periods, we proposed a new score to evaluate the ability of working at a specific level for a definite duration. We showed that this score had an average of 100% (±31%) for healthy subjects while the working level of the painful shoulder was lower than the healthy shoulder and improved significantly after surgery (up to 87% at 6 months). This study provides preliminary evidence of the effectiveness of the proposed system in clinical practice and objectively assesses upper-limb activity during daily activity.

EPFL2007

Orientation of body segments in ski jumps using wearable sensors: Analysis of relevant parameters during stable flight phase

Kamiar Aminian, Julien Chardonnens, Julien Favre

3D kinematic and dynamic analysis is highly required in ski jumping. Current recording techniques (e.g. camera systems) suffered from limitations, such as volume capture or complexity of use and processing. This study proposed a new 3D approach based on inertial sensors to calculate automatically the whole body segments orientation of the entire jump during in-field measurements. Combination of accelerometers and gyroscopes allowed devising a functional calibration procedure adapted to ski jumping activity. Then, segments orientation was obtained based on strapdown integration of gyroscopes. Finally, accelerometers were used to define in-run initial orientations and to improve segments orientations during stable flight. In order to show the efficacy of the proposed system, relevant 3D parameters of stable flight phase (V-and attack ski angles, joint angles, drag and lift forces) were extracted from 86 jumps of 34 jumpers. Combination of these parameters expressed 55% of whole variance of distance score.

2010

Shoulder function and outcome evaluation after surgery using 3D inertial sensors

Brian Coley

EPFL2007