Walking in daily life places high demands on the interplay between cognitive and motor functions. A well-functioning dual-tasking ability is thus essential for walking safely. The aims were to study longitudinal changes in gait function during single- and dual-tasking over a period of two years among people with initially mild AD (n=21). Data were collected on three occasions, twelve months apart. An optical motion capture system was used for three-dimensional gait analysis. Gait parameters were examined at comfortable gait speed during single-tasking, dual-tasking naming names, and naming animals. The dual-task cost for gait speed was pronounced at baseline (names 26%, animals 35%), and remained so during the study period. A significant (p<0.05) longitudinal decline in gait speed and step length during single- and dual-tasking was observed, whereas double support time, step width and step height showed inconsistent results. Systematic visual examination of the motion capture files revealed that dual-tasking frequently resulted in gait disturbances. Three main characteristics of such disturbances were identified: Temporal disturbance, Spatial disturbance and Instability in single stance. These aberrant gait performances may affect gait stability and increase the risk of falling. Furthermore, the observed gait disturbances can contribute to understanding and explaining previous reported gait variability among individuals with AD. However, the role that dual-task testing and aberrant dual-task gait performance play in the identification of individuals with early signs of cognitive impairment and in predicting fall risk in AD remains to be studied.

New methods to screen for and identify early-stage dementia disorders are highly sought after. The purpose of this pilot study is to develop a study protocol for a dual-task test aimed at aiding the early detection of dementia disorders. We used the Timed Up-and-Go (TUG) test, which is a mobility task involving starting in a sitting position, standing up, walking three meters to cross a line on the floor, turning around, walking back and sitting down again. We combined TUG with the verbal task of naming different animals. Pilot study participants were 43 individuals with and without established dementia diagnoses who attended a clinic for memory assessment. Video-recorded test performances were systematically analysed. Deviant test performances concerning the interplay between test administration and participants’ responses to the assessment instructions were revealed and led to refinements being made to the final study protocol. Exploration of the dual-task test outcome measures in a sub-sample of 22 persons, ten with and twelve without dementia, indicated that step-length and number of named animals after the turning point of the dual-task test might constitute appropriate measures for examining this kind of sample. We concluded that the refined study protocol is feasible for testing individuals undergoing initial memory assessments and healthy controls. Follow-up studies with larger samples are being carried out and will bring new knowledge to this area of research. It may also provide an opportunity for further studies exploring possibilities for broad clinical implementation.

Inertial motion capture relies on accurate sensor-to-segment calibration. When two segments are connected by a hinge joint, for example in human knee or finger joints as well as in many robotic limbs, then the joint axis vector must be identified in the intrinsic sensor coordinate systems. Methods for estimating the joint axis using accelerations and angular rates of arbitrary motion have been proposed, but the user must perform sufficiently informative motion in a predefined initial time window to accomplish complete identifiability. Another drawback of state of the art methods is that the user has no way of knowing if the calibration was successful or not. To achieve plug-and-play calibration, it is therefore important that 1) sufficiently informative data can be extracted even if large portions of the data set consist of non-informative motions, and 2) the user knows when the calibration has reached a sufficient level of accuracy. In the current paper, we propose a novel method that achieves both of these goals. The method combines acceleration- and angular rate information and finds a globally optimal estimate of the joint axis. Methods for sample selection, that overcome the limitation of a dedicated initial calibration time window, are proposed. The sample selection allows estimation to be performed using only a small subset of samples from a larger data set as it deselects non-informative and redundant measurements. Finally, an uncertainty quantification method that assures validity of the estimated joint axis parameters, is proposed. Experimental validation of the method is provided using a mechanical joint performing a large range of motions. Angular errors in the order of $2^{\circ }$ were achieved using 125–1000 selected samples. The proposed method is the first truly plug-and-play method that overcome the need for a specific calibration phase and, regardless of the user’s motions, it provides an accurate estimate of the joint axis as soon as possible.

Objective quantification of the balancing mechanisms in humans is strongly needed in health care of older people, yet is largely missing among current clinical balance assessment methods. Hence, the main goal of this literature review is to identify methods that have the potential to meet that need. We searched in the PubMed and IEEE Xplore databases using predefined criteria, screened 1064 articles, and systematically reviewed and categorized methods from 73 studies that deal with identification of neuromuscular controller models of human upright standing from empirical data. These studies were then analyzed with the particular aim to understand to what degree such methods would be useful solutions for assessing the balance of older individuals aged above 60 years. The 16 studies that included an older subject population were especially examined with this in mind. The majority of the reviewed articles focused on research questions related to the general function of human balance control rather than clinical applicability. Further efforts need to be made to adapt these methods for more accessible and mobile technologies and to ensure that the outcomes are valid for balance assessment of a general older population.

Sensor-to-segment calibration is a crucial step in inertial motion tracking. When two segments are connected by a hinge joint, for example in human knee and finger joints as well as in many robotic limbs, then the joint axis vector must be identified in the intrinsic sensor coordinate systems. There exist methods that identify these coordinates by solving an optimization problem that is based on kinematic joint constraints, which involve either the measured accelerations or the measured angular rates. In the current paper we demonstrate that using only one of these constraints leads to inaccurate estimates at either fast or slow motions. We propose a novel method based on a cost function that combines both constraints. The restrictive assumption of a homogeneous magnetic field is avoided by using only accelerometer and gyroscope readings. To combine the advantages of both sensor types, the residual weights are adjusted automatically based on the estimated signal variances and a nonlinear weighting of the acceleration norm difference. The method is evaluated using real data from nine different motions of an upper limb exoskeleton. Results show that, unlike previous approaches, the proposed method yields accurate joint axis estimation after only five seconds for all fast and slow motions.

The eBalance project is based on the idea that serious exergames—i.e., computer gaming systems with an interface that requires physical exertion to play—that are well adapted to users, can become a substantial part of a solution to recognized problems of insufficient engagement in fall-prevention exercise and the high levels of fall-related injuries among older people. This project is carried out as a collaboration between eight older people who have an interest in balance training and met the inclusion criteria of independence in personal activities of daily living, access to and basic knowledge of a computer, four staff working with the rehabilitation of older adults, and an interdisciplinary group of six research coordinators covering the areas of geriatric care and rehabilitation, as well as information technology and computer science. This paper describes the study protocol of the project’s initial phase which aims to develop a working partnership with potential users of fall-prevention exergames, including its conceptual underpinnings. The qualitative methodology was inspired by an ethnographical approach implying combining methods that allowed the design to evolve through the study based on the participants’ reflections. A participatory and appreciative action and reflection (PAAR) approach, accompanied by inquiries inspired by the Normalization Process Theory (NPT) was used in interactive workshops, including exergame testing, and between workshop activities. Data were collected through audio recordings, photos, and different types of written documentation. The findings provide a description of the methodology thus developed and applied. They display a methodology that can be useful for the design and development of care service and innovations for older persons where user participation is in focus.