Download Automated Detection of Gait and Balance Disturbances

Automated Detection of Gait and Balance Disturbances
in the Home-Setting: A "holter" monitor for Gait and Fall Risk
Inventors: Prof. Jeffrey M. Hausdorff, Prof. Nir Giladi
Abstract
Falls are a significant cause of morbidity and mortality, especially among older adults and
many patient populations. In June of 2009, research on falls among the elderly was listed as
the 3rd item in the top priority group in the Institute of Medicine's report to Congress on
national priorities for the United States. Much effort has been devoted to the development of
methods for evaluating fall risk, but the most common means of quantifying falls remain selfreport. Despite its widespread use, this method has three key limitations: 1) it is subjective in
nature, relying on subjects' motivation and memory (which can be problematic in its own
right), 2) it requires a long observation period (e.g., typically six months or a year), and 3)
sensitivity if often lacking (e.g., subjects are typically classified as fallers and non-fallers, but
the absence of a more refined scale may limits sensitivity and the ability to evaluate
intervention efficacy).
We envision an ambulatory, wearable system that can be used for automatic identification
and quantification of gait and balance disturbances in the home-setting. This holter-like
device will be capable of detecting and monitoring near falls and other transient losses of
balance and documentation of any changes in the walking pattern. It should, a priori, provide
objective quantification of a sensitive marker of fall risk and gait impairment, based on realworld performance over relatively short observation time periods.
Experience and Expertise
Professors Hausdorff and Giladi have extensive experience in the study of gait, falls, and
ambulatory monitoring and have been leading investigations in this field for more than
almost two decades. They have published numerous papers and given many invited talks on
this topic. Research in Tel Aviv Sourasky Medical Center's Laboratory for Gait and
Neurodynamics has been funded by a number of sources including the Michael J Fox
Foundation, the National Parkinson Foundation, the National Institutes of Health (US), the
European Commission, and the Israel Science Foundation.
Applications
The envisioned system could be used by geriatricians, neurologists, movement disorders
specialists, physical therapists, orthopedics, and internists to document and objectively
quantify and track gait and balance disturbances in the home-setting. The system could be
applied to help assess fall risk and other transient gait and balance disturbances, to inform
decisions related to the need for intervention (e.g., walking aid, drug, nursing home
admission, 24/7 caregiver), and to assist in evaluating the efficacy of therapeutic
interventions. It might also be used as a personnel health-device to enable older adults and
certain patient groups to keep track of their gait and fall risk. In addition to its use by
clinicians, patients and perhaps insurance providers, the system could be an invaluable tool in
the hands of researchers who are investigating the effects of novel therapies (e.g., drug
effects) on gait, balance and fall risk.
Advantages
The advantages of the envisioned approach include: a) objective measurement; b) no need to
rely on self-report for the assessment of relatively rare events (e.g., near falls, falls) that have
huge clinical ramifications; c) low-cost compared to kinematic and kinetic assessment; d) an
evaluation that is based on actual everyday performance, and not biased by white-coat
syndrome, motivation, memory or its absence; e) the possibility of using a similar device /
approach in the clinic to augment and enhance the clinical assessment.
Publications
Automated Detection of Near Falls: Algorithm Development and Preliminary Results
(submitted).
Abstract presented at the Proceedings of the International Conference on Ambulatory
Monitoring of Physical Activity and Movement, the Netherlands, May 2008
Can an accelerometer enhance the utility of the Timed-up & go test when evaluating patients
with Parkinson's disease? Medical Engineering & Physics (in press).