A Novel Approach for Fall Risk Prediction Using the Inertial Sensor Data From the Timed-Up-and-Go Test in a Community Setting

Post-stroke patients usually suffer from a higher fall risk. Identifying potential fallers and giving them proper attention could reduce their chance of a fall that results in severe injuries and decreased quality of life. In this study, we introduced a novel approach for fall risk prediction that evaluates Short-form Berg Balance Scale scores via inertial measurement unit data measured from a 3-meter timed-up-and-go test. This approach used sensor technology and was thus easy to implement, and allowed a quantitative analysis of both gait and balance. The results showed that elastic net logistic regression achieved the best performance with 85% accuracy and 88% area under the curve compared with support vector machine, least absolute shrinkage and selection operator (LASSO), and stepwise logistic regression. This paper provides a framework for using sensor-based features together with a feature-selection strategy for screening and predicting the fall risk of post-stroke patients in a convenient setup with high accuracy. The findings of this study will not only enable the assessment of fall risk among post-stroke patients in a cost-effective manner but also provide decision-making support for community care providers and medical professionals in the form of sensor-based data on gait performance.

[1]  M. Woollacott,et al.  Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. , 2000, Physical therapy.

[2]  Nigel H. Lovell,et al.  A wearable triaxial accelerometry system for longitudinal assessment of falls risk , 2008, 2008 30th Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[3]  S. Fritz,et al.  Walking speed: the functional vital sign. , 2015, Journal of aging and physical activity.

[4]  Wiebren Zijlstra,et al.  Sensitivity of sensor-based sit-to-stand peak power to the effects of training leg strength, leg power and balance in older adults. , 2014, Gait & posture.

[5]  Robert Teasell,et al.  The incidence and consequences of falls in stroke patients during inpatient rehabilitation: factors associated with high risk. , 2002, Archives of physical medicine and rehabilitation.

[6]  Cecilia Lundholm,et al.  Predicting accidental falls in people with multiple sclerosis — a longitudinal study , 2009, Clinical rehabilitation.

[7]  Brenda Brouwer,et al.  Validity of the Community Balance and Mobility Scale in community-dwelling persons after stroke. , 2010, Archives of physical medicine and rehabilitation.

[8]  Jeffrey M. Hausdorff,et al.  Can an accelerometer enhance the utility of the Timed Up & Go Test when evaluating patients with Parkinson's disease? , 2010, Medical engineering & physics.

[9]  Nigel H. Lovell,et al.  Spectral Analysis of Accelerometry Signals From a Directed-Routine for Falls-Risk Estimation , 2011, IEEE Transactions on Biomedical Engineering.

[10]  H. Zou,et al.  Regularization and variable selection via the elastic net , 2005 .

[11]  Jeffrey M. Hausdorff,et al.  Using a Body-Fixed Sensor to Identify Subclinical Gait Difficulties in Older Adults with IADL Disability: Maximizing the Output of the Timed Up and Go , 2013, PloS one.

[12]  P. Beek,et al.  Gait Coordination After Stroke: Benefits of Acoustically Paced Treadmill Walking , 2007, Physical Therapy.

[13]  Richard F. Gunst,et al.  Applied Regression Analysis , 1999, Technometrics.

[14]  Tom Fahey,et al.  Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta- analysis , 2014, BMC Geriatrics.

[15]  R. Tibshirani Regression Shrinkage and Selection via the Lasso , 1996 .

[16]  Emer P. Doheny,et al.  Evaluation of Falls Risk in Community-Dwelling Older Adults Using Body-Worn Sensors , 2012, Gerontology.

[17]  D Maquet,et al.  The value of instrumental gait analysis in elderly healthy, MCI or Alzheimer's disease subjects and a comparison with other clinical tests used in single and dual-task conditions. , 2009, Annals of physical and rehabilitation medicine.

[18]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[19]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[20]  Ching-Fan Sheu,et al.  Developing a short form of the Berg Balance Scale for people with stroke. , 2006, Physical therapy.

[21]  Rossana Castaldo,et al.  Wearable Inertial Sensors for Fall Risk Assessment and Prediction in Older Adults: A Systematic Review and Meta-Analysis , 2018, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[22]  Trevor Hastie,et al.  Regularization Paths for Cox's Proportional Hazards Model via Coordinate Descent. , 2011, Journal of statistical software.

[23]  Nigel H. Lovell,et al.  Classification between non-multiple fallers and multiple fallers using a triaxial accelerometry-based system , 2011, 2011 Annual International Conference of the IEEE Engineering in Medicine and Biology Society.

[24]  Tomokazu Nakamura,et al.  Analysis of pelvic movement in the elderly during walking using a posture monitoring system equipped with a triaxial accelerometer and a gyroscope. , 2011, Journal of biomechanics.

[25]  A. Ramnemark,et al.  Fractures after Stroke , 1998, Osteoporosis International.

[26]  R. Nakamura,et al.  The relationship between walking speed and muscle strength for knee extension in hemiparetic stroke patients: a follow-up study. , 1988, The Tohoku journal of experimental medicine.

[27]  Lisa C. Blum,et al.  Usefulness of the Berg Balance Scale in Stroke Rehabilitation: A Systematic Review , 2008, Physical Therapy.

[28]  R. Tibshirani,et al.  Least angle regression , 2004, math/0406456.

[29]  A. Bueno-Cavanillas,et al.  Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes , 2004, European Journal of Epidemiology.

[30]  Jeffrey M. Hausdorff,et al.  An instrumented timed up and go: the added value of an accelerometer for identifying fall risk in idiopathic fallers , 2011, Physiological measurement.

[31]  Martin Jaggi,et al.  An Equivalence between the Lasso and Support Vector Machines , 2013, ArXiv.

[32]  L. Nyberg,et al.  Patient falls in stroke rehabilitation. A challenge to rehabilitation strategies. , 1995, Stroke.

[33]  Kamiar Aminian,et al.  The instrumented timed up and go test: potential outcome measure for disease modifying therapies in Parkinson's disease , 2009, Journal of Neurology, Neurosurgery & Psychiatry.

[34]  S. Page,et al.  Balance Is Associated with Quality of Life in Chronic Stroke , 2013, Topics in stroke rehabilitation.

[35]  A. Biderman,et al.  Depression and falls among community dwelling elderly people: a search for common risk factors , 2002, Journal of epidemiology and community health.

[36]  Bart Jansen,et al.  Accelerometer based Gait Analysis - Multi Variate Assessment of Fall Risk with FD-NEAT , 2011, BIOSIGNALS.

[37]  Hylton B Menz,et al.  Acceleration patterns of the head and pelvis during gait in older people with Parkinson's disease: a comparison of fallers and nonfallers. , 2009, The journals of gerontology. Series A, Biological sciences and medical sciences.

[38]  Fear of falling, balance, and gait velocity in patients with stroke , 2005, Physiotherapy theory and practice.

[39]  Brian Caulfield,et al.  Quantitative falls risk estimation through multi-sensor assessment of standing balance , 2012, Physiological measurement.

[40]  M. Tinetti,et al.  Fall risk index for elderly patients based on number of chronic disabilities. , 1986, The American journal of medicine.

[41]  M. Fornage,et al.  Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association , 2017, Circulation.

[42]  P. Catlin,et al.  Establishing the reliability and validity of measurements of walking time using the Emory Functional Ambulation Profile. , 1999, Physical therapy.

[43]  S. J. Redmond,et al.  Sensors-Based Wearable Systems for Monitoring of Human Movement and Falls , 2012, IEEE Sensors Journal.

[44]  M. Sekine,et al.  Quantitative evaluation of movement using the timed up-and-go test , 2008, IEEE Engineering in Medicine and Biology Magazine.

[45]  Corinna Cortes,et al.  Support-Vector Networks , 1995, Machine Learning.

[46]  John W Krakauer,et al.  Agreed definitions and a shared vision for new standards in stroke recovery research: The Stroke Recovery and Rehabilitation Roundtable taskforce , 2017, International journal of stroke : official journal of the International Stroke Society.

[47]  F. Horak,et al.  Body-worn motion sensors detect balance and gait deficits in people with multiple sclerosis who have normal walking speed. , 2012, Gait & posture.

[48]  Kiseon Kim,et al.  Quantitative Assessment of Balance Impairment for Fall-Risk Estimation Using Wearable Triaxial Accelerometer , 2017, IEEE Sensors Journal.

[49]  Antonio I Cuesta-Vargas,et al.  Reliability and criterion-related validity with a smartphone used in timed-up-and-go test , 2014, Biomedical engineering online.

[50]  A. Forster,et al.  Incidence and consequences offalls due to stroke: a systematic inquiry , 1995, BMJ.