Gait monitoring: from the clinics to the daily life

Monitoring of gait in daily living allows a quantitative analysis of walking in unrestricted conditions, with many potential clinical applications. This thesis aims at addressing the limitations that still hinder the wider adoption of this approach in clinical practice, providing healthcare professionals and researchers new tools which may impact on current gait assessment procedures and improve the treatment of many diseases leading to – or generated by – mobility impairments. The thesis comprises four experimental sections:
Accuracy of commercially-available devices. Step detection accuracy in currently available physical activity monitors was assessed in healthy individuals. The best performing device was then tested in multiple sclerosis patients, showing reliability but highly speed-dependent accuracy. These findings suggest that a short set of tests performed in controlled conditions could inform researchers before starting unsupervised monitoring of gait in patients.
Differences between laboratory and free-living gait parameters. The study assessed the accuracy of two algorithms for gait event detection, and provided normative values of gait temporal parameters for healthy subjects in different environments and types of walking.
A pilot study toward clinical application. This pilot study compared laboratory based tests with daily living assessment of gait features in multiple sclerosis patients. Results provided clear evidence that in this population clinical gait tests might not represent typical gait patterns of daily living.
Analysis of free-living walking in patients with Diabetes. A systematic review is presented looking for evidence of the effectiveness of walking as physical activity to reduce inflammation. Then, cadence and step duration variability are examined during free-living walking in a group of patients with diabetes.
This thesis systematically highlighted potential and actual limitations in the use of wearable sensors for gait monitoring in daily life, providing clear practical indications and normative values which are essential for the widespread informed and effective clinical adoption of this technology.