Alberts Et Al. - 2015 - Using Accelerometer and Gyroscopic Measures To Qua
Alberts Et Al. - 2015 - Using Accelerometer and Gyroscopic Measures To Qua
Alberts Et Al. - 2015 - Using Accelerometer and Gyroscopic Measures To Qua
doi: 10.4085/1062-6050-50.2.01
Ó by the National Athletic Trainers’ Association, Inc original research
www.natajournals.org
Context: Force platforms and 3-dimensional motion-capture to compare equilibrium scores produced by the NeuroCom and
systems provide an accurate method of quantifying postural iPad2 devices. Limits of agreement was defined as the mean
stability. Substantial cost, space, time to administer, and need bias (NeuroCom iPad) 6 2 standard deviations. Mean
for trained personnel limit widespread use of biomechanical absolute percentage error and median difference between the
techniques in the assessment of postural stability in clinical or NeuroCom and iPad2 measurements were used to evaluate
field environments. how closely the real-time COG sway measured by the 2 systems
Objective: To determine whether accelerometer and gyro- tracked each other.
scope data sampled from a consumer electronics device (iPad2)
Results: The limits between the 2 devices ranged from
provide sufficient resolution of center-of-gravity (COG) move-
ments to accurately quantify postural stability in healthy young 0.58 to 0.58 in SOT condition 1 to 2.98 to 1.38 in SOT condition
people. 5. The largest absolute value of the measurement error within
Design: Controlled laboratory study. the 95% confidence intervals for all conditions was 2.98. The
Setting: Research laboratory in an academic medical mean absolute percentage error analysis indicated that the
center. iPad2 tracked NeuroCom COG with an average error ranging
Patients or Other Participants: A total of 49 healthy from 5.87% to 10.42% of the NeuroCom measurement across
individuals (age ¼ 19.5 6 3.1 years, height ¼ 167.7 6 13.2 SOT conditions.
cm, mass ¼ 68.5 6 17.5 kg). Conclusions: The iPad2 hardware provided data of suffi-
Intervention(s): Participants completed the NeuroCom cient precision and accuracy to quantify postural stability.
Sensory Organization Test (SOT) with an iPad2 affixed at the Accuracy, portability, and affordability make using the iPad2 a
sacral level. reasonable approach for assessing postural stability in clinical
Main Outcome Measure(s): Primary outcomes were equi- and field environments.
librium scores from both systems and the time series of the
angular displacement of the anteroposterior COG sway during Key Words: concussions, motor function, motor control,
each trial. A Bland-Altman assessment for agreement was used biomechanics
Key Points
The accelerometer and gyroscope within the iPad2 provided data of sufficient quantity and quality to enable
accurate evaluation of postural stability.
The accuracy, portability, availability, and affordability of mobile devices can enable health care providers in various
clinical and field settings to evaluate postural stability in athletes.
To improve clinical outcomes, mobile devices can be a mechanism by which sophisticated biomechanical
algorithms are translated to the broader field of athletic trainers and clinical teams treating patients with concussions.
The accuracy and reliability of mobile devices must be validated before these systems are used to assess cognitive
or motor function.
M
aintenance of stable posture depends on the or mild traumatic brain injury (mTBI), has been well-
efficient processing and integration of informa- documented to adversely affect postural stability; however,
tion from the visual, somatosensory, and vestib- debate exists about the time course for resolution of balance
ular systems and the modulation of efferent responses by declines postconcussion.11–21 Often after concussion, static
the musculoskeletal system.1 A decline in postural stability postural-stability declines are most evident when visual and
is often a hallmark of advancing age2–4 and neurologic support-surface conditions are altered.20 Based on the
diseases, such as Parkinson disease5–7 and multiple frequency of postural-stability deficits postconcussion, the
sclerosis.8–10 In addition to neurologic disease, concussion, recent consensus statement on concussion in sport22 and the
Geneva, Switzerland), which has a range of 62.0g, computer; only 1 of 882 trials was discarded due to loss
resolution of 0.9 to 1.1 mg, and maximum sampling rate of more than 3 consecutive data points. The median number
of 100 Hz.42 Device-rotation rates were measured by the of lost individual data points was 1 per trial (0.05% of total
embedded 3-axis gyroscope (model L3G4200D; STMi- data points). The NeuroCom force plate measures COP in
croelectronics) with a range of 62508/s, resolution of 8.75 the 2-dimensional plane associated with AP and ML sway.
mdeg/s, and maximum sampling rate of 100 Hz.43 The The ‘‘On’’ signal from the NeuroCom indicating the
Sensor Data iOS application (Sensor Data app by Wave- initiation of each trial was collected and processed through
front Labs; Apple Inc) was used to collect and transmit an analog-to-digital converter connected to the laptop
sensor data from the embedded accelerometer and gyro- computer and was used to mark the start of the 20-second
scope in the x-, y-, and z-directions to a laptop computer trial (Figure 1B). The COP data from the NeuroCom were
(Apple Inc). The coordinate system relative to the device is synchronized with iPad2 data in real time using the same
shown in Figure 1A. We were particularly interested in the LabView data-collection program. Individual trials were
x- and z-axes because they are in the direction of the eliminated if any of the following criteria were met: (1) the
mediolateral (ML) and AP movements, respectively, participant committed a testing error that normally would
associated with postural maintenance. The iPad2 data were invalidate the SOT, such as moving the feet midtrial or
sampled at 100 Hz, the same frequency as that of the falling (8 trials); (2) poor data integrity (1 trial); or (3) data-
NeuroCom system. transcription error, such that files with different data sets
Data were transmitted from the iPad2 with a user- were mistakenly labeled with the same name (18 trials).
datagram protocol over a WiFi connection to another The remaining 855 trials, representing 97% of collected
device. Before data collection, the WiFi connection was trials, were used in the analysis.
established between the iPad2 and a laptop computer, and
data were logged and saved continuously on the laptop
Data Analysis
computer during the trial using a customized LabView
data-collection program (National Instruments Corp, Aus- The AP COG angle was used for all outcome metrics.
tin, TX). This experimental setup minimized the latency of The NeuroCom system measures AP COP for position on
data transmission between the iPad2 and the laptop the force plate at each time point in a trial, converts it to AP
Additional inspection of the limits of agreement in the rapid movements (Figure 3A and B) and for large
Bland-Altman plots also revealed that 95% of the measure- movements (Figure 3C and D) in the time domain while
ment error between the 2 devices was from 3.8% to 4.0% or also capturing the extreme values within each trial. The
from 0.58 to 0.58 in the condition of best agreement (SOT-1) MAPE metric, which was used to quantify the goodness of
and from 23.1% to 10.7% or from 2.98 to 1.38 in the fit between the iPad2 and the NeuroCom COG time-series
condition with the poorest agreement (SOT-5; Table 3). data, was 7.93% for the entire cohort, signifying that the
Extrapolating from this result, the largest absolute value of COG value predicted with the iPad2 sensor data was similar
the measurement error within the 95% confidence intervals to the NeuroCom COG measurement across all trials.
for all conditions was 23% or 2.98. Further inspection of Furthermore, the model had a median difference of 0.018
Table 3 shows that for most conditions (SOT-1 through SOT- (first and third quartiles ¼ 0.278 and 0.248, respectively)
4) the largest absolute value of the measurement error in the between iPad2 and NeuroCom measures of COG sway.
95% confidence intervals was 11% or at most 1.48. Table 4 shows MAPE per condition for all analyzed trials.
Four representative trials with MAPE values ranging from The SOT-5 had the smallest MAPE value (5.87%),
0.68% to 4.53% are depicted in Figure 3. Visual inspection representing the lowest error and best fit between the iPad2
of Figure 3 indicates that the iPad2 measurements tracked and NeuroCom COG sway metrics despite having the largest
the NeuroCom COG measurement very closely for small, peak-to-peak movements (Table 3). The SOT-2 had the
80
largest MAPE value (10.42%) and, based on the equilibrium be quantified accurately in healthy adolescents and young
score metric (Table 3), the smallest sway range. adults using data from the accelerometer and gyroscope
embedded within the iPad2. The Bland-Altman analysis
DISCUSSION assessed the ability of the iPad2 to accurately capture the
peak-to-peak sway magnitude within a trial as quantified by
Comparison between the NeuroCom- and iPad2-generat- the equilibrium score. The SOT-1 had the smallest spread
ed equilibrium scores indicated that postural stability can between the 95% confidence intervals (mean bias ¼ 0.01%;
Figure 3. Example of real-time anteroposterior center-of-gravity sway data from NeuroCom (NeuroCom Smart Balance Master;
NeuroCom International Inc, Clackamas, OR) and iPad2 (Apple Inc, Cupertino, CA), with corresponding mean absolute percentage error
values for 4 randomly sampled trials: A, Sensory Organization Test (SOT) condition 1; B, SOT condition 4; C, SOT condition 5; and D, SOT
condition 6. Positive anteroposterior center-of-gravity sway values correspond to movements in the anterior direction and negative values
correspond to movements in the posterior direction relative to the center of gravity. The mean absolute percentage error values were used
to determine the goodness of fit for the iPad2 data relative to NeuroCom data and are provided for each condition in Table 4.
Address correspondence to Jay L. Alberts, PhD, Cleveland Clinic Concussion Center, Cleveland Clinic, 9500 Euclid Avenue,
Cleveland, OH 44195. Address e-mail to albertj@ccf.org.