A Compact Forearm Crutch Based on Force Sensors for Aided Gait: Reliability and Validity
<p>Comparison of GCH 1.0 and GCH 2.0.</p> "> Figure 2
<p>Individual walking while the quantity of the load exerted on the crutches is observed on the screen to improve its accuracy. The image on the board, which is different from the computer screen, is a specific chart for the patient.</p> "> Figure 3
<p>Individual performing aided gait in two stages along the walkway with direction signs and distracting effects so as to avoid him/her focusing on the platform.</p> "> Figure 4
<p>Box plot representing percentiles 25, 50 and 75 (<b>a</b>) and scatter plot (<b>b</b>) of the relationship between platform and GCH measurements.</p> "> Figure 5
<p>Bland-Altman Method representing the values differences (platform minus crutch) and GCH, versus the means (platform minus crutch) and GCH; for all the measurements (<b>a</b>), measurement requesting load on the crutches at 10% of body weight (<b>b</b>), 25% (<b>c</b>) and 50% (<b>d</b>).</p> "> Figure 6
<p>Dispersion graph. Ordenate axis: predicted values by the regression line. Abcissa axis: values recorded by the platform. Color increase in the representation indicates that there are higher values in those in which the variables coincide (0, 10, 20, 30, 40, 50, 60, 70).</p> ">
Abstract
:1. Introduction
2. Experimental Section
2.1. GCH System 2.0
Basic Functions of the GCH System 2.0
- Load control. The objective measurement of the loads applied to the crutches is the basis of the System. It shows the kilograms exerted on the crutches and the percentage of patient body weight (PPBW). This datum is the most relevant in the clinic, which always requires the subject’s current weight to be entered. The percentages allow researchers to compare intra-subject and inter-subject tests in order to establish treatment protocols.
- Feedback mechanism. The feedback information includes, individually, the ideal load exerted on the crutches (directly proportional to the unloading on the injured lower member), PPBW, according to the pathology and the treatment phase, introduced into the software as well as a percentage of error tolerated clinically due to excess or defect load. The fixed system alerts the subject of the mistakes made during gait for immediate self-correction (Figure 2). Acoustic signals, a continuous whistling, will be used if the recommended load is exceeded or discontinuous if it does not reach it; and visual, by using a projector. The portable system only uses an audible feedback. The fixed system shows only the feedback information useful for the patient’s training in the projector, and additional personalized clinical information (useful for the physiotherapist/researcher) on the computer screen.
2.2. Study Design
2.3. Study Variables
- Variable 1: GCH. Vertical reaction force of the Platform on the crutch (Z component) measured using our System. This variable is secreted in GCH_right and GCH_left, right and left crutches, respectively. The kg is used as a unit of measurement for GCH.
- Variable 2: Platform (kg). Vertical reaction force of the crutches on the Platform (Z component) calculated by the AMTI Platform. The unit of measurement was the kg.
2.4. Measurements and Participants
Inclusion Criteria
- healthy subjects between 18 and 60 years old with previous experience with crutches;
- presenting a normal gait, being asymptomatic on walking at free cadence;
- overcome a simple test of static equilibrium, consisting of keeping one’s balance on each foot for 30 s without great bodily movements [26].
Exclusion Criteria
- having an evident disorder of overall coordination and physical skill which could alter the aided gait.
2.5. Data Collection
2.6. Statistics
- t-test for related samples [30]: it compares the mean values of related samples when the values of the variables meet the normality criteria. This test was used to determine whether the two measurements can be considered similar. In addition, the study was performed based on the different ranges of weight loaded onto the crutches.
- Wilcoxon signed-rank test [30]: it compares the related sample distribution when the values of the variables do not meet the normality criteria.
3. Results
4. Discussion
Validity and Reliability
5. Conclusions
Acknowledgments
Author Contributions
Conflicts of Interest
Abbreviations
ANOVA | Analysis of Variance |
FS | Full Scale |
PCB | Printed Circuit Board |
PPBW | Percentage of Patient Body Weight |
SD | Standard Deviation |
SMD | Surface Mount Device |
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GCH 1.0. | GCH 2.0. |
---|---|
Distributed system | Compact system |
Patients have to carry an electronic box place on their belts. | Electronic component inside the crutch tube. |
External cables are necessary to connect the sensors to control box placed on the patient´s belt. | Internal cables. Patients do not have any contact with cables. |
External electronic components. | Internal miniature electronic components/ surface mount device (SMD). |
Weight: 1150 g. | Weight: 720 g. |
Non standard battery/rechargeable/700 mA. | Standard battery/AA/rechargeable/6000 mA. |
Zero is not automatic. | Offset process is automatically activated. |
Only for a patient walking with one or two crutches. | Several patients can use the System simultaneously, with one or two crutches. |
Discretized biofeedback. System informs if the load is wrong only with a binary signal. | The physiotherapist/patient can choose between continuous or discretized visual biofeedback. In the continuous mode, the patient receives information throughout the whole process [23]. |
Moteview 2.0. Generic software that shows: amount of load and a simple linear chart. This is visualized by the researcher. It is not useful for the patient. | GCH Control Software 1.0.: Specific program to control assisted gait. The load could be shown in percentages of the patient´s weight-bearing (data of clinic interest). It offers specific charts and data for researchers, physiotherapists and patients. It is adaptable to the kind of patient. (Figure 2). |
No database. | Patients’ clinical database. |
Data sampling frequency ≤10 Hz | Data sampling frequency ≤80 Hz |
The portable system. The physiotherapist selects the ideal load without percentages. It does not allow for comparisons and research. | The portable system (watch). The physiotherapists or researchers select the ideal load or the percentage of the patient’s weight-bearing (data of clinic interest). |
Load | N | Mean* | SD | Minimum | Maximum | Percentiles | ||||
---|---|---|---|---|---|---|---|---|---|---|
25 | 50 | 75 | ||||||||
Platform | Right crutch | 10 | 90 | 7.33 | 4.00 | 2.24 | 20.09 | 4.38 | 6.37 | 9.00 |
25 | 90 | 16.03 | 4.86 | 9.07 | 29.89 | 12.44 | 15.04 | 19.00 | ||
50 | 90 | 25.66 | 8.45 | 12.64 | 50.60 | 19.33 | 24.23 | 30.63 | ||
Left crutch | 10 | 90 | 7.76 | 4.30 | 2.13 | 23.15 | 4.58 | 6.73 | 9.33 | |
25 | 90 | 15.79 | 5.07 | 6.72 | 30.50 | 12.64 | 14.89 | 17.42 | ||
50 | 90 | 26.48 | 8.28 | 9.58 | 46.52 | 20.12 | 25.45 | 32.59 | ||
GCH | Right crutch | 10 | 90 | 7.31 | 3.97 | 2.20 | 19.65 | 4.40 | 6.30 | 9.07 |
25 | 90 | 15.93 | 4.82 | 8.99 | 29.73 | 12.42 | 14.95 | 18.90 | ||
50 | 90 | 25.46 | 8.38 | 12.70 | 50.06 | 19.02 | 24.38 | 30.40 | ||
Left crutch | 10 | 90 | 7.73 | 4.26 | 2.14 | 22.92 | 4.57 | 6.76 | 9.25 | |
25 | 90 | 15.69 | 5.02 | 6.70 | 30.19 | 12.56 | 14.77 | 17.32 | ||
50 | 90 | 26.27 | 8.22 | 9.58 | 46.02 | 19.88 | 25.23 | 32.17 |
Load | Intra-Class Correlation | Confidence Interval (95%) | p-Value | ||
---|---|---|---|---|---|
Lower Bound | Upper Bound | ||||
Right crutch | 10 | 0.99964 | 0.99946 | 0.99976 | <0.001 |
25 | 0.99937 | 0.99904 | 0.99958 | <0.001 | |
50 | 0.99985 | 0.99977 | 0.99990 | <0.001 | |
Left crutch | 10 | 0.99990 | 0.99985 | 0.99994 | <0.001 |
25 | 0.99993 | 0.99990 | 0.99996 | <0.001 | |
50 | 0.99995 | 0.99992 | 0.99996 | <0.001 | |
Global | 0.99992 | 0.99990 | 0.99993 | <0.001 |
Requested Load | Tolerance Level | n | % |
---|---|---|---|
10% | Tolerable | 178 | 98.9 |
Not tolerable | 2 | 1.1 | |
25% | Tolerable | 173 | 96.1 |
Not tolerable | 7 | 3.9 | |
50% | Tolerable | 169 | 93.9 |
Not tolerable | 11 | 6.1 | |
Global | Tolerable | 520 | 96.3 |
Not tolerable | 20 | 3.7 |
Right Crutch | Left Crutch | Global | |||||
---|---|---|---|---|---|---|---|
Load | 10 | 25 | 50 | 10 | 25 | 50 | |
Constant | −0.072 | −0.023 | −0.016 | −0.369 | −0.045 | 0.009 | −0.383 |
Constant Lower Bound | −0.167 | −0.198 | −0.146 | −0.598 | −0.093 | −0.066 | −0.519 |
Constant Upper Bound | 0.024 | 0.153 | 0.115 | −0.140 | 0.003 | 0.083 | −0.247 |
Constant p-value | 0.138 | 0.799 | 0.809 | 0.002 | 0.067 | 0.813 | <0.001 |
Slope | 1.014 | 1.008 | 1.009 | 1.062 | 1.009 | 1.008 | 1.036 |
Slope Lower Bound | 1.003 | 0.997 | 1.004 | 1.036 | 1.006 | 1.005 | 1.029 |
Slope Upper Bound | 1.026 | 1.018 | 1.013 | 1.089 | 1.012 | 1.010 | 1.044 |
Slope p-value | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 |
Adjusted Squared R | 0.997 | 0.998 | 0.999 | 0.986 | >0.999 | >0.999 | 0.993 |
Regression p-value | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 |
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Chamorro-Moriana, G.; Sevillano, J.L.; Ridao-Fernández, C. A Compact Forearm Crutch Based on Force Sensors for Aided Gait: Reliability and Validity. Sensors 2016, 16, 925. https://doi.org/10.3390/s16060925
Chamorro-Moriana G, Sevillano JL, Ridao-Fernández C. A Compact Forearm Crutch Based on Force Sensors for Aided Gait: Reliability and Validity. Sensors. 2016; 16(6):925. https://doi.org/10.3390/s16060925
Chicago/Turabian StyleChamorro-Moriana, Gema, José Luis Sevillano, and Carmen Ridao-Fernández. 2016. "A Compact Forearm Crutch Based on Force Sensors for Aided Gait: Reliability and Validity" Sensors 16, no. 6: 925. https://doi.org/10.3390/s16060925
APA StyleChamorro-Moriana, G., Sevillano, J. L., & Ridao-Fernández, C. (2016). A Compact Forearm Crutch Based on Force Sensors for Aided Gait: Reliability and Validity. Sensors, 16(6), 925. https://doi.org/10.3390/s16060925