By Patrick Roscher, MS, and Arnaud Gouelle, PhD
Throughout the COVID-19 pandemic, the use of telehealth visits has skyrocketed in an attempt to limit the spread of the virus. And due to its popularity, the continued use of telehealth is expected. However, while telehealth can be effective in many areas, there are limitations when it comes to characterizing changes in physical function such as gait. Methods traditionally used to quantify physical function and gait require trained personnel and often specialized equipment that is found within the clinic or laboratory setting. The objective measures on physical function gained from in-person testing are critical in determining the need of rehabilitation services and tracking changes in function over time. Currently, telemedicine relies heavily on self-reported outcomes that often lack sensitivity to subtle but clinically meaningful changes in patient function. This weakness in telemedicine and remote monitoring of patients is due to the limited availability of home-based tools to quantify physical function metrics (eg, stride velocity, double support time, and 3D joint angles) that are as accurate as the laboratory or clinical-based measures.
The COVID-19 pandemic led ProtoKinetics, as a company, to look at how we can lead the efforts behind a remote monitoring solution that will close the gap between the objective measures available within the laboratory or clinic setting and the limited measures available at home. We have identified our role in solving this problem in 2 ways. The first way is to use our system to validate wearable sensors. Our system provides objective data from direct measurement to quantify motion, making it a sensible validation tool for wearable sensors. To use wearable devices for data collection for the analysis of gait and other functional movements, the devices first must be validated for specific patient populations and testing protocols. Testing wearable sensors simultaneously with the Zeno Walkway System can contextualize the data from the wearables and validate the accuracy for a specific use. Researchers at universities such as Steven’s Institute of Technology and industry leaders such as Apple have already published studies using the Zeno Walkway System in this manner.1,2 The second way we are driving a solution is in developing a new product that can be used in the home setting for remote monitoring protocols. To meet this goal, a small, durable, and inexpensive sensor pad needs to be developed. Along with the sensor that can be sent to homes, we also need to develop meaningful protocols that are simple to follow than can be done on a smaller pad than our current system. The combination of these would create a solution allowing for a small battery of tests to be done on a small sensor in the home, with the data to be sent directly to the healthcare provider.
ProtoKinetics has been in contact with many research sites as we move forward with our 2-pronged approach to bringing objective gait and balance measures into the home. Among our numerous pursuits, we jumped at the opportunity to work with researchers at the University of Texas Medical Branch (UTMB) (Rachel Deer, PhD), Stevens Institute of Technology (Damiano Zanotto, PhD), and the University of Texas MD Anderson Cancer Center (Maria C. Swartz, PhD, MPH, RD, LD) on a project designed to use a smart insoles system in a telemedicine setting to assess effects and necessary rehabilitation for COVID-19 survivors. This study aimed to fill the need for accurate instrumented physical function measures in the home setting. We collaborated on designing a study to use smart insoles developed at Stevens’ Wearable Robotic Systems Laboratory and our newly developed ProtoKinetics pad to examine physical function longitudinal changes among COVID-19 survivors recruited from UTMB’s Post-COVID Recovery Clinic. The first step is to validate the insole system’s accuracy and confirm agreement between in-clinic and home testing outcomes. The ultimate goal is to be able to carry out the objective physical function tests using the insole system and ProtoKinetics pad in the homes of patients during telehealth visits. This ongoing study is a perfect example of how the Zeno Walkway System can be used to validate wearable systems so that reliable, objective data can be captured within a telehealth visit, thus closing the gap between obtainable data from in-person and remote healthcare visits.
Even pandemic disruption can lead to innovation.
While undoubtedly a disaster for public health, the pandemic disruption has led to accelerated innovation in the area of telemedicine. ProtoKinetics seeks to keep this innovation grounded in science.
Patrick Roscher, MS, and Arnaud Gouelle, PhD, provide customer support, project assistance, and educational content for ProtoKinetics clients using their backgrounds in research and clinical gait analysis. The educational content is produced within the Gait and Balance Academy and can be found at https://www.protokinetics.com/category/gait-and-balance-academy/.
- Duong TT H,et al., Validation of insole-based gait analysis system in young children with a neurodevelopmental disorder and autism traits, 2020 8th IEEE RAS/EMBS International Conference for Biomedical Robotics and Biomechatronics (BioRob), 2020, pp. 715-720, doi: 10.1109/BioRob49111.2020.9224273.
- Apple. Measuring walking quality through iPhone mobility metrics. www.apple.com/healthcare/docs/site/Measuring_Walking_Quality_Through_iPhone_Mobility_Metrics.pdf. May 2021