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      Classifying Step and Spin Turns Using Wireless Gyroscopes and Implications for Fall Risk Assessments

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          Abstract

          Recent studies have reported a greater prevalence of spin turns, which are more unstable than step turns, in older adults compared to young adults in laboratory settings. Currently, turning strategies can only be identified through visual observation, either in-person or through video. This paper presents two unique methods and their combination to remotely monitor turning behavior using three uniaxial gyroscopes. Five young adults performed 90° turns at slow, normal, and fast walking speeds around a variety of obstacles while instrumented with three IMUs (attached on the trunk, left and right shank). Raw data from 360 trials were analyzed. Compared to visual classification, the two IMU methods’ sensitivity/specificity to detecting spin turns were 76.1%/76.7% and 76.1%/84.4%, respectively. When the two methods were combined, the IMU had an overall 86.8% sensitivity and 92.2% specificity, with 89.4%/100% sensitivity/specificity at slow speeds. This combined method can be implemented into wireless fall prevention systems and used to identify increased use of spin turns. This method allows for longitudinal monitoring of turning strategies and allows researchers to test for potential associations between the frequency of spin turns and clinically relevant outcomes (e.g., falls) in non-laboratory settings.

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          Most cited references20

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          Fall frequency and characteristics and the risk of hip fractures.

          The 2 objectives of this study were to investigate the association between history of falls and risk of hip fracture and to identify characteristics of falls that determine whether or not a hip fracture will occur. Population-based case-control study. Subjects were selected from the community and from nursing homes in Sydney, Australia. There were 412 subjects (205 cases, 207 controls) in the part of the study concerned with falls frequency and risk of hip fracture (age range 65-100 years). Differences between hip fracture-related falls and other falls were studied in 209 cognitively intact subjects: 84 controls who had fallen at least once in the previous 3 years and 125 cases. Data were collected with an interviewer-administered questionnaire. There was a strong relationship between reported number of falls in the past year and risk of hip fracture. This relationship was stronger among men than among women. There was only 1 statistically significant fall characteristic associated with risk of hip fracture; falling while turning was much more likely to lead to a hip fracture than falling when walking in one direction (age- and sex-adjusted odds ratio: 7.9, 95% confidence interval: 1.4-43.0). (1) Taking a simple falls history is a useful way of identifying elderly people, particularly men, at increased risk of hip fracture; (2) The direction of a fall is an important determinant of hip fracture occurrence.
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            Visual control of locomotion: strategies for changing direction and for going over obstacles.

            Dynamics of gait adjustments required to go over obstacles and to alter direction of locomotion when cued visually were assessed through the measurement of ground reaction forces, muscle activity, and kinematics. The time of appearance of obstacles of varying heights, their position within the step cycle, and cue lights for direction change were varied. Direction change must be planned in the previous step to reduce the acceleration of the body center of mass toward the landing foot to 0. The inability of steering within the step cycle is due to the incapacity of muscles to rotate the body and translate it along the mediolateral axes. For obstacle avoidance, Ss systematically manipulated the gait patterns as a function of obstacle height and position and the time available within the ongoing step. Greater supraspinal involvement in control of locomotion is found.
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              Turning strategies during human walking.

              The mechanisms involved in rapidly turning during human walking were studied. Subjects were asked to walk at a comfortable speed and to turn toward the instructed direction as soon as they felt an electrical stimulus to the superficial peroneal nerve. Stimuli were presented repeatedly at random over 10- to 15-min periods of walking for turning in both directions. Electromyograms (EMGs), joint angular movements of the right leg, and forces under both feet were recorded. The step cycle was divided into 16 parts, and the responses to stimuli in each part were analyzed separately. Two turning strategies were used, depending on which leg was placed in front for braking. For example, to turn to the right when the right foot was placed in front, subjects generally altered direction by spinning the body around the right foot (spin turn). To turn left when the right foot was in front, subjects shifted weight to the right leg, externally rotated the left hip, stepped onto the left leg, and continued turning until the right leg stepped in the new direction (step turn). The step turn is easy and stable because the base of support during the turn is much wider than in the spin turn, so some subjects used it in all parts of the cycle. Initially, the deceleration of walking is similar to a rapid stopping task, which has been previously examined. The deceleration mechanism involves a sequence of distal-to-proximal activation of muscles on one side of the body (soleus, biceps femoris, and erector spinae). This pattern is similar to the "ankle strategy" used in postural control during forward sway. The control of foot placement in the swing leg and muscle activities for rotating the trunk in the stance leg occurred within a step after the cue. The action of ankle inverters and elevation of the pelvis by activity of gluteus medius may contribute to the control of trunk rotation. This activity was closely related to the timing of the opposite foot strike, independent of the part of the step cycle when the stimulus was applied. In most subjects, the turn was completed without resetting the underlying walking rhythm. This first EMG analysis of rapid turning shows how common strategies for postural sway and stopping can be combined with one of two turning strategies. This simplifies the complex task of turning at a random time in the step cycle.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Sensors (Basel)
                Sensors (Basel)
                sensors
                Sensors (Basel, Switzerland)
                MDPI
                1424-8220
                06 May 2015
                May 2015
                : 15
                : 5
                : 10676-10685
                Affiliations
                [1 ]Department of Mechanical Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; E-Mail: fino@ 123456vt.edu
                [2 ]Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA; E-Mail: cframes5@ 123456vt.edu
                [3 ]School of Biological and Health Systems Engineering, Ira A. Fulton Schools of Engineering, Arizona State University, Tempe, AZ 85287, USA
                Author notes
                [* ]Author to whom correspondence should be addressed; E-Mail: Thurmon.lockhart@ 123456asu.edu ; Tel.: +1-480-965-1499; Fax: +1-480-727-7624.
                Article
                sensors-15-10676
                10.3390/s150510676
                4481922
                25954950
                1a3db1b8-f0f3-44cd-9d41-b193779074b2
                © 2015 by the authors; licensee MDPI, Basel, Switzerland.

                This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 23 March 2015
                : 27 April 2015
                Categories
                Article

                Biomedical engineering
                gait,turning,wireless sensors,imu,fall risk
                Biomedical engineering
                gait, turning, wireless sensors, imu, fall risk

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