Physical Medicine and Rehabilitation, Nîmes University Hospital, 30240 Le Grau du Roi, France; Physical Medicine and Rehabilitation, Nîmes University Hospital, 30029 Nîmes, France; Euromov, IFRH, Montpellier University, Montpellier University Hospital, 34090 Montpellier, France.
INRIA, LIRMM, 34095 Montpellier, France.
Ann Phys Rehabil Med. 2020 May;63(3):195-201. doi: 10.1016/j.rehab.2019.03.007. Epub 2019 Apr 19.
Functional electrical stimulation (FES) can be used for compensation of foot-drop for post-stroke individuals by pre-programmed fixed stimulation; however, this stimulation seems no more effective than mechanical ankle foot orthoses.
We evaluated the metrological quality of inertial sensors for movement reconstruction as compared with the gold-standard motion capturing system, to couple FES with inertial sensors to improve dorsiflexion on the paretic side, by using an adaptive stimulation taking into account individuals' performance post-stroke.
Adults with ischemic or hemorrhagic stroke presenting foot-drop and able to walk 10m, were included from May 2016 to June 2017. Those with passive ankle dorsiflexion<0° with the knee stretched were excluded. Synchronous gait was analyzed with the VICON© system as the gold standard and inertial measurement units (IMUs) worn by participants. The main outcome was the dorsiflexion angle at the heel strike and mid-swing phase obtained from IMUs and the VICON system. Secondary outcomes were: stride length, walking speed, maximal ankle dorsiflexion velocity and fatigue detection.
We included 26 participants [18 males; mean age 58 (range 45-84) years]. During heel strike, the dorsiflexion angle measurements demonstrated a root mean square error (RMSE) of 5.5°; a mean average error (MAE) of 3.9°; Bland-Altman bias of -0.1° with limits of agreement -10.9° to+10.7° and good intra-class correlation coefficient (ICC) at 0.87 between the 2 techniques. During the mid-swing phase, the RMSE was 5.6; MAE 3.7°; Bland-Altman bias -0.9° with limits of agreement -11.7° to+9.8° and ICC 0.88. Good agreement was demonstrated for secondary outcomes and fatigue detection.
IMU-based reconstruction algorithms were effective in measuring ankle dorsiflexion with small biases and good ICCs in adults with ischemic or hemorrhagic stroke presenting foot-drop. The precision obtained is sufficient to observe the fatigue influence on the dorsiflexion and therefore to use IMUs to adapt FES.
功能性电刺激（FES）可以通过预编程的固定刺激来补偿中风后患者的足下垂；然而，这种刺激似乎并不比机械踝足矫形器更有效。
我们评估了惯性传感器在运动重建方面的计量质量，与运动捕捉系统这一黄金标准相比，我们使用了考虑到个体中风后表现的自适应刺激，将 FES 与惯性传感器结合起来，改善患侧的背屈。
2016 年 5 月至 2017 年 6 月期间，我们纳入了患有缺血性或出血性中风、出现足下垂且能行走 10 米的成年人。排除了被动背屈角度<0°且膝关节伸展的患者。同步步态通过黄金标准 VICON©系统和参与者佩戴的惯性测量单元（IMU）进行分析。主要结果是从 IMU 和 VICON 系统获得的足跟触地和中间摆动阶段的背屈角度。次要结果包括：步长、行走速度、最大踝关节背屈速度和疲劳检测。
我们纳入了 26 名参与者[18 名男性；平均年龄 58（45-84）岁]。在足跟触地时，背屈角度测量的均方根误差（RMSE）为 5.5°；平均绝对误差（MAE）为 3.9°；Bland-Altman 偏差为-0.1°，一致性界限为-10.9°至+10.7°，两种技术之间的组内相关系数（ICC）良好，为 0.87。在中间摆动阶段，RMSE 为 5.6；MAE 为 3.7°；Bland-Altman 偏差为-0.9°，一致性界限为-11.7°至+9.8°，ICC 为 0.88。对于次要结果和疲劳检测，结果显示出良好的一致性。
基于惯性测量单元的重建算法在测量缺血性或出血性中风后出现足下垂的成年人的踝关节背屈时效果良好，偏差小，ICC 高。所获得的精度足以观察到疲劳对背屈的影响，从而使用惯性测量单元来适应功能性电刺激。
