Balance impairment is a major mechanism behind falling along with environmental hazards. Under physiological conditions, ageing leads to a progressive decline in balance control per se. Moreover, various neurological disorders further increase the risk of falls by deteriorating specific nervous system functions contributing to balance. Over the last 15 years, significant advancements in technology have provided wearable solutions for balance evaluation and the management of postural instability in patients with neurological disorders. This narrative review aims to address the topic of balance and wireless sensors in several neurological disorders, including Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, and other neurodegenerative and acute clinical syndromes. The review discusses the physiological and pathophysiological bases of balance in neurological disorders as well as the traditional and innovative instruments currently available for balance assessment. The technical and clinical perspectives of wearable technologies, as well as current challenges in the field of teleneurology, are also examined.

We propose an unobtrusive, wearable, and wireless system for the pre-screening and follow-up in the domestic environment of specific sleep-related breathing disorders. This group of diseases manifests with episodes of apnea and hypopnea of central or obstructive origin, and it can be disabling, with several drawbacks that interfere in the daily patient life. The gold standard for their diagnosis and grading is polysomnography, which is a time-consuming, scarcely available test with many wired electrodes disseminated on the body, requiring hospitalization and long waiting times. It is limited by the night-by-night variability of sleep disorders, while inevitably causing sleep alteration and fragmentation itself. For these reasons, only a small percentage of patients achieve a definitive diagnosis and are followed-up. Our device integrates photoplethysmography, an accelerometer, a microcontroller, and a bluetooth transmission unit. It acquires data during the whole night and transmits to a PC for off-line processing. It is positioned on the nasal septum and detects apnea episodes using the modulation of the photoplethysmography signal during the breath. In those time intervals where the photoplethysmography is detecting an apnea, the accelerometer discriminates obstructive from central type thanks to its excellent sensitivity to thoraco-abdominal movements. Tests were performed on a hospitalized patient wearing our integrated system and the type III home sleep apnea testing recommended by The American Academy of Sleep Medicine. Results are encouraging: sensitivity and precision around 90% were achieved in detecting more than 500 apnea episodes. Least thoraco-abdominal movements and body position were successfully classified in lying down control subjects, paving the way toward apnea type classification.

In Parkinson’s disease (PD), abnormal movements consisting of hypokinetic and hyperkinetic manifestations commonly lead to nocturnal distress and sleep impairment, which significantly impact quality of life. In PD patients, these nocturnal disturbances can reflect disease-related complications (e.g., nocturnal akinesia), primary sleep disorders (e.g., rapid eye movement behaviour disorder), or both, thus requiring different therapeutic approaches. Wearable technologies based on actigraphy and innovative sensors have been proposed as feasible solutions to identify and monitor the various types of abnormal nocturnal movements in PD. This narrative review addresses the topic of abnormal nocturnal movements in PD and discusses how wearable technologies could help identify and assess these disturbances. We first examine the pathophysiology of abnormal nocturnal movements and the main clinical and instrumental tools for the evaluation of these disturbances in PD. We then report and discuss findings from previous studies assessing nocturnal movements in PD using actigraphy and innovative wearable sensors. Finally, we discuss clinical and technical prospects supporting the use of wearable technologies for the evaluation of nocturnal movements.

In this work, we propose a wireless wearable system for the acquisition of multiple biopotentials through charge transfer electrostatic sensors realized in MEMS technology. The system is designed for low power consumption and low invasiveness, and thus candidates for long-time monitoring in free-living conditions, with data recording on an SD or wireless transmission to an external elaborator. Thanks to the wide horizon of applications, research is very active in this field, and in the last few years, some devices have been introduced on the market. The main problem with those devices is that their operation is time-limited, so they do not match the growing demand for long monitoring, which is a must-have feature in diagnosing specific diseases. Furthermore, their versatility is hampered by the fact that they have been designed to record just one type of signal. Using ST-Qvar sensors, we acquired an electrocardiogram trace and single-channel scalp electroencephalogram from the frontal lobes, together with an electrooculogram. Excellent results from all three types of acquisition tests were obtained. The power consumption is very low, demonstrating that, thanks to the MEMS technology, a continuous acquisition is feasible for several days.

Myotonic dystrophy type 1 (DM1) is a genetic inherited autosomal dominant disease characterized by multisystem involvement, including muscle, heart, brain, eye, and endocrine system. Although several methods are available to evaluate muscle strength, endurance, and dexterity, there are no validated outcome measures aimed at objectively evaluating qualitative and quantitative gait alterations. Advantageously, wearable sensing technology has been successfully adopted in objectifying the assessment of motor disabilities in different medical occurrences, so that here we consider the adoption of such technology specifically for DM1. In particular, we measured motor tasks through inertial measurement units on a cohort of 13 DM1 patients and 11 healthy control counterparts. The motor tasks consisted of 16 meters of walking both at a comfortable speed and fast pace. Measured data consisted of plantar-flexion and dorsi-flexion angles assumed by both ankles, so to objectively evidence the footdrop behavior of the DM1 disease, and to define a novel severity index, termed SI-Norm2, to rate the grade of walking impairments. According to the obtained results, our approach could be useful for a more precise stratification of DM1 patients, providing a new tool for a personalized rehabilitation approach.