Use of inertial sensors to measure upper limb motion: application in stroke rehabilitation

Stroke is the largest cause of severe adult complex disability, caused when the blood supply to the brain is interrupted, either by a clot or a burst blood vessel. It is characterised by deficiencies in movement and balance, changes in sensation, impaired motor control and muscle tone, and bone deformity. Clinically applied stroke management relies heavily on the observational opinion of healthcare workers. Despite the proven validity of a few clinical outcome measures, they remain subjective and inconsistent, and suffer from a lack of standardisation. Motion capture of the upper limb has also been used in specialised laboratories to obtain accurate and objective information, and monitor progress in rehabilitation. However, it is unsuitable in environments that are accessible to stroke patients (for example at patients’ homes or stroke clubs), due to the high cost, special set-up and calibration requirements. The aim of this research project was to validate and assess the sensitivity of a relatively low cost, wearable, compact and easy-to-use monitoring system, which uses inertial sensors in order to obtain detailed analysis of the forearm during simple functional exercises, typically used in rehabilitation. Forearm linear and rotational motion were characterised for certain movements on four healthy subjects and a stroke patient using a motion capture system. This provided accuracy and sensitivity specifications for the wearable monitoring system. With basic signal pre-processing, the wearable system was found to report reliably on acceleration, angular velocity and orientation, with varying degrees of confidence. Integration drift errors in the estimation of linear velocity were unresolved. These errors were not straightforward to eliminate due to the varying position of the sensor accelerometer relative to gravity over time. The cyclic nature of rehabilitation exercises was exploited to improve the reliability of velocity estimation with model-based Kalman filtering, and least squares optimisation techniques. Both signal processing methods resulted in an encouraging reduction of the integration drift in velocity. Improved sensor information could provide a visual display of the movement, or determine kinematic quantities relevant to the exercise performance. Hence, the system could potentially be used to objectively inform patients and physiotherapists about progress, increasing patient motivation and improving consistency in assessment and reporting of outcomes.