Proceedings of ASME 2012 International Mechanical Engineering Congress & Exposition

IMECE12
November 9-15, 2012, Houston, Texas, USA

IMECE2012-87809
WIRELESS MULTI-SENSOR INTEGRATION FOR ACL REHABILITATION USING BIOFEEDBACK
MECHANISM

SMN Arosha Senanayake

Department of Computer Science,
University of Brunei
Jalan Tungku Link, Gadong BE1410,
Brunei
arosha.senanayake@ubd.edu.bn

Owais Ahmed Malik

Department of Computer Science,
University of Brunei
Jalan Tungku Link, Gadong BE1410,
Brunei
11H1202@ubd.edu.bn

Pg. Mohammad Iskandar

Department of Applied Physics,
University of Brunei
Jalan Tungku Link, Gadong BE1410,
Brunei
iskandar.petra@ubd.edu.bn
assessment of the kinematics and neuromuscular changes
occurring after ACL reconstruction in an athlete.

ABSTRACT
The objective of this study is to propose an integrated
motion analysis system for monitoring and assisting the
rehabilitation process for athletes based on biofeedback
mechanism, particularly for human subjects already undergone
Anterior Cruciate Ligament (ACL) injury operations and thus
about to start the rehabilitation process. For this purpose,
different types of parameters (kinematics and neuromuscular
signals) from multi-sensors integration are combined to
analyze the motion of affected athletes. Signals acquired from
sensors are pre-processed in order to prepare the pattern set for
intelligent algorithms to be integrated for possible
implementation of effective assistive rehabilitation processing
tools for athletes and sports orthopedic surgeons. Based on the
characteristics of different signals invoked during the
rehabilitation process, two different intelligent approaches
(Elman RNN and Fuzzy Logic) have been tested. The newly
introduced integrated multi-sensors approach will assist in
identifying the clinical stage of the recovery process of
athletes after ACL repair and will facilitate clinical decisionmaking during the rehabilitation process. The use of wearable
wireless miniature sensors will provide an un-obstructive

INTRODUCTION
Human motion analysis is an active research area due
to its importance and applications in different fields including
pathology identification [1,2], elderly fall prevention[3],
rehabilitation of patients[4,5] and sports [6]. In the area of
sports medicine, motion analysis has been used for helping in
recovery from injuries, designing new products and improving
the skills of athletes. Motion analysis can help in designing
rehabilitation techniques for athletes suffering from lower
limb injuries.
One of the most common lower limb injuries that
may adversely affect the motion and thus career of an athlete
is the knee injury due to Anterior Cruciate Ligament (ACL)
rupture. The data on surgical reconstruction in sporting
population revealed varying estimated incidence of ACL [7,
8]. There are different causes of ACL injury in sports
including sudden stops during running, quick change of
direction, pivoting, incorrect landing and direct blow to knee
are some of the important causes of ACL sprain or tears.

Copyright 2012 by ASME

0.07

0.06

0.05

0.04

0.03

0.02

0.01

0
3. 8

3. 9

4. 1

4.2

4. 3

4.4

4. 5

4.6

4. 7
4

x 10

400

300

200

100

-100

-200

-300
50
3.7

3. 8

3.9

4.1

4.2

4. 3

4.4

4.5

4. 6

4.7

4.8
4

x 10
40

30

20

10

-10

-20

-30

-40
3.7

3. 8

3.9

4.1

4.2

4. 3

4.4

4.5

4. 6

4.7

4.8
4

x 10

FIGURE 1: A GENERAL FRAMEWORK FOR MOTION ANALYSIS USING INTEGRATED SENSORS

The high incidence of ACL injuries has been reported in

young athletes (aged 14-20 years) [7]. Although the recovery
for ACL injury varies from athlete to athlete but recent studies
support a return to full sports competition after 6 months of
ACL reconstruction [9].

examination and intervention. These sensors provide

kinematics of the motion and assist in recovery process.
The aim of this study is to investigate for an objective
rehabilitation monitoring system for ACL injury which can
assist the clinicians and athletes in examining and observing
the overall progress of the reconstruction and knee changes
(kinematics and neuromuscular) occurring during the recovery
period. This can help in intervening the rehabilitation process
at any particular/required time where the improvement is slow
or not advancing in the appropriate direction.

ACL injury results in changes in kinematics, kinetics

and neuromuscular activity of the subjects. Motion analysis of
an ACL injured athlete enables detection of subtle kinetic and
kinematic changes. In order to evaluate the athletes natural
course, useful information can be gained with a better
understanding of kinetic and kinematic changes and their
effect on the menisci and cartilage [7]. Additionally, it has
also been observed that the ACL deficiency can cause
reorganization of the central nervous system [10]. This
observation intimates that such an injury may not be
considered a simple peripheral musculoskeletal injury but it
might be regarded as a neurophysiologic dysfunction [10].
Different devices such as optical motion capture system, force
plates and inertial sensors have been used to analyze human
motion and thus to assist knee injury recovery process [11-13].
The optical motion capture systems (reflective markers e.g.
Vicon or active markers e.g. Optotrak) are assumed to be a
gold standard in human motion analysis. However, the
utilization of wireless inertial sensors has also proved to be an
effective mechanism for gait analysis and dynamic stability
assessment [12-15]. These miniature wearable inertial sensors
offer a great prospect in acquiring human motion in both
indoor and outdoor environment. Such wearable sensors can
be very useful in monitoring the recovery from knee
injury/surgery and in identifying patients who do not improve
as expected and thus make possible an early clinical

METHODOLOGY
General System Architecture
The
proposed
Hardware/Software
co-design
architecture for monitoring and assisting the ACL injury
rehabilitation process is illustrated in Fig. 1. The functionality
of each component related to this study is described as
follows.
Hardware Components: The system hardware includes the
following major components:
Wireless Microelectromechanical Systems (MEMS)
Sensors: These body mounted miniature sensors are used
to measure and record the athlete lower extremity motion,
particularly knee activities during motion, in terms of
angular rate and linear acceleration. The small size and
light-weight sensors do not provide any obstruction in the
human motion.
2

Copyright 2012 by ASME

FIGURE 2: PROCESSING AND SYNCHRONIZATION OF KINEMATICS AND EMG SIGNALS

Wireless EMG Capturing System: The electromyography

signals from knee flexors and extensors are captured using
BioCapture system for monitoring the neuromuscular
activity during rehabilitation process. Additionally,
electroencephalography signals may also be monitored to
study the role/activity of brain during the motor control.

Recovery
Monitoring/Biofeedback
Interface:
A
biofeedback system will provide monitoring of the
recovery progress based on the intelligent algorithms to
clinicians and athletes as well.
Knowledge Base (KB): The knowledge base is used to
store the data/signals at different stages and in different
formats for processing and classification. It will also
contain the information from training model which will be
updated based on new results produced by the intelligent
data analyzer. This will help the system in learning from
previous experiences and reacting appropriately in the new
situations.

Video Camera: The video camera provides visual

monitoring of the rehabilitation process. The video signals
may be synchronized with other sensors to analyze the
athlete performance and to estimate different recovery
phases during experiments.
Software Components: The system software includes the
following major components:

The current study focuses on implementation of the signal

acquisition, processing, synchronization and motion
classification part of the proposed architecture (Fig. 2).

Signal Acquisition Layer (SAL): This layer acquires the

signals in raw form from different sensors (motion and
EMG sensors) and stores them in the database for
processing by next layer.

Participants
In order to analyze data, both healthy and ACLreconstructed subjects were included in this study. There were
5 healthy male and 5 (3 females and 2 males) unilateral ACL
reconstructed subjects recruited for monitoring kinematics and
muscular activities during the gait cycle. The healthy subjects
were having a mean age of 23.5 years, mean height 163 cm,
and mean weight 65 kg. For ACL reconstructed male subjects,
the mean age, mean height and mean weight were 25 years, 80
Kg and 178 cm respectively. For ACL reconstructed female
subjects, the mean age, mean height and mean weight were
28.5 years, 61 Kg and 164.6 cm respectively. The participants
were recruited from University of Brunei, Ministry of Defense
and Ministry of Sports in Brunei. Ethical procedures were
carried out according to the guidelines approved by University
of Brunei Graduate Research Office and Ethics Committee.

Signal Processing Layer (SPL): This layer processes the

raw signals into required format for further processing by
the system (e.g. signal filtering, knee angle calculation,
signal rectification etc.)
Feature Extraction Layer (FEL): This layer will be used in
future to determine the most distinguishing components of
the EMG and other signals.
Signal Synchronization Layer (SSL): This layer
synchronizes the signals from different sensors in order to
analyze the overall performance about the knee joints and
muscles activities during rehabilitation.
Intelligent Data Analyzer (IDA): After transforming the
bio-signals into required format, intelligent algorithms are
used for motion pattern classification and prediction during
rehabilitation.

Experimental Setup
The experimental data was collected using two
sensing units namely KinetiSense (ClevMed, Inc.) and
BioCapture (ClevMed, Inc.). The KinetiSense is a bio-kinetic
analysis system consisting of a command module, wireless
transmission radio and sensor units. Each sensor unit (size:
2.2cm x 1.5cm x 1.25cm) contains a tri-axial MEMS
accelerometer and a tri-axial MEMS gyroscope to measure 3-

Training Model: A training model will assist the IDA in

classification and prediction during rehabilitation.

Copyright 2012 by ASME

D linear accelerations and 3-D angular velocities respectively.

The data from sensors is wirelessly transferred through USB
receiver to the computer where the KinetiSense software
records the readings for each experiment. The sampling rate of
motion sensors data was 128Hz. Each subject was setup with
four motion sensors attached to the his/her right thigh, right
shank, left thigh and left shank using flexible bulk and Velcro
straps to note the angular rate and accelerations of lower limb
extremities. This data was then exported to MatLab to
compute the knee angle and for other processing.

Knee Angle Computation and Signals Synchronization

The knee flexion/extension measurements were
obtained from each motion sensor unit placed on the thigh and
shank segments of both legs. The sensors were aligned to
provide knee angle about the sagittal plane using angular rate
about Z-axis (Fig. 3). The angular rate measurements obtained
from the motion sensors (MEMS gyroscopes) were low pass
filtered using 6th order Butterworth filter with 3 Hz cut-off
frequency before computing the orientations. With respect to
the placement of each motion sensor, measurements for zeroreferencing were obtained prior to starting the experiment
(actual motion) when the subjects were in upright position.
These measurements were then subtracted from each angular
rate during the experiment. Trapezoidal integration method
was
applied
on
angular
rates
( ,

 ,  and 
 ) of both lower limbs to
estimate the orientation ( , 
 ,  and 
 )
of lower extremity. The estimated orientation of thigh and
shank is computed using Eq. (1), where () is the estimated
orientation at time t, () is the angular rate of either thigh or
shank at time t and t is the sampling time.

The EMG signals were recorded using BioCapture

physiological monitoring system consisting of BioRadio and
USB receiver. The BioRadio records the EMG signals, does
initial processing and then wirelessly transmits them to the
computer using USB receiver. For our study, the sampling rate
to collect EMG signals was set to 960Hz at 12/16 bit A/D
conversion. In order to record surface EMG signals, foam snap
electrodes were placed on five different knee extensor and
flexor muscles including vastus medialis, vastus lateralis,
semitendinosis and biceps femoris/gastrocnemius medialis.
SENIAM EMG guidelines were followed for skin preparation
and electrodes placement [16]. The data recorded by
BioCapture was exported to MatLab for filtering and EMG
rectification.

() =

Data Collection

The EMG signals were recorded using surface EMG

electrodes placed at four muscles (knee flexors/extensors:
vastus medialis, vastus lateralis, semitendinosis and
gastrocnemius medialis or biceps femoris) on each leg. The
raw EMG data from BioCapture was high and low pass
filtered using 4th order Butterworth filter for generating EMG
envelops for each muscle.

Left

The synchronization of both systems was done using

re-sampling and gait cycle detection. An up-sampling was
done for motion data from KinetiSense to match with the
sampling rate of EMG recording from BioCapture. For motion
data, the heel strike (HS) was detected by using shank sagittal
angular velocity [2]. The HS was identified by examining the
timing character tics of the angular velocity and determining
the two minima on either side of a peak in velocity curve
where every second minimum indicates the HS event. The
anteroposterior acceleration from a 2-D accelerometer,
available in BioCapture, was used to identify heel strike event
in EMG data to mark the gait cycle and observe the
overlapping of knee kinematics and EMG signals of different
muscles [17].

Y
Bio-Capture
X
Motion Sensors
X
Z

Z
z

z
X

Motion Sensors
X
Z

Z
z

z
X
Y

(1)

The gyroscope integration drift was corrected using

complementary filter by fusing orientation measurements from
gyroscope and accelerometer available in motion sensor. The
corrected angular measurements were used to compute the
knee angle.

Two sets of experiments were conducted in this

study. In the first set, healthy subjects were requested to walk
at 2, 3 and 4 km/hour for 15 seconds on treadmill. In the
second set, subjects with ACL-reconstruction were requested
to walk naturally and/or on a treadmill at a speed of 2, 3 and 4
km/hour. Both kinematics and EMG signals were recorded at
the same time during all experiments.

Right

() + ()

2

Motion Classification Using Intelligent Mechanisms

FIGURE 3: MOTION SENSORS PLACEMENT AND
COORDINATE SYSTEM

For classifying the motion of healthy and postoperated (ACL reconstructed) legs, the Elman recurrent neural
4

Copyright 2012 by ASME

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network (RNN) and fuzzy logic based classifier have been

used in this study [18,19]. The temporal nature of the gait
cycle parameters was taken into consideration while
implementing both techniques.

(2)

The ranges and cut-off values for these membership

functions were decided based on the average of the values
from the same input parameters of the healthy leg for each
subject during respective phase of a gait cycle. Figure 5 shows
an example of membership functions for one input
(Semitendinosis muscle) and output (recovery status). The ifthen rules were designed based on the healthy leg parameters
and standard data [16]. An example rule for load response
phase of a gait cycle is:

VL
VM
ST
MG
KA

FIGURE 4: ELMAN RNN FOR RECOVERY STATUS

CLASSIFICATION

A general architecture for Elman RNN is shown in

Fig. 4 for five input parameters and one output parameter. One
of the main advantages of the Elman RNN is its ability to
recognize and track the temporal patterns. Such temporal
patterns are present in each gait cycle which is divided into
number of phases and each phase has possible different values
of the input parameters. The input parameters were arranged
in a sequence for relevant phases of a gait cycle for giving as
training data set. The inputs to the network were the knee
angle and EMG signal values for four muscles: vastus lateralis
(VL), vastus medialis (VM), semitendinosis (ST) and
gastrocnemius medialis (MG). The network was trained based
on sequence of the above parameters for the healthy and postoperated leg of each subject and then tested on data from both
legs. The relevant phases for selected four muscles, considered
in this study, are load response, mid-stance, terminal stance
and terminal swing. Each of the networks was trained for 1500
epochs, with 5 inputs, 50 hidden layer tansig neurons and a
single logsig output layer with gradient descent backpropagation weight/bias learning function, for 40 gait cycle
sequences of healthy leg.

IF (VL is high) AND (VM is high) AND (ST is medium or low)

AND (MG is low) AND (KA is small) THEN (STATUS is
Good)

(A) Input: Semitendinosis

A two layered type-1 fuzzy rule-based classifier was

also designed to classify the current health condition of the
post-operated leg/knee. The first layer consists of six fuzzy
classifiers based on the six phases (Load Response, First half
of Mid-Stance, Second half of Mid-Stance, First half of
Terminal Stance, Second half of Terminal Stance and
Terminal Swing) of gait cycle to be monitored. These phases
have been chosen based on the selection of four knee
extensors/flexors. Each of these fuzzy classifiers has input
parameters from a set of five values: knee angle, vastus
lateralis, vastus medialis, semitendinosis and gastrocnemius
medialis and one output parameter (recovery status during
phase). The exact number of inputs to the fuzzy classifier
depends on the gait cycle phase to be monitored. Three
membership functions (High/Large, Medium and Low/Small)
for each input parameters were defined using trapezoidal
membership functions (MFs) defined in Eq. (2). Similarly
three membership functions (Good, Average and Poor) were
defined for one output parameter.

(B) Output: Recovery Status

FIGURE 5: TRAPEZOIDAL MEMBERSHIP FUNCTIONS
FOR INPUT AND OUTPUT PARAMETERS (A)
SEMITENDINOSIS (B) RECOVERY STATUS

The outputs of first stage were defuzzified and then

given as input to the second layer as input. These singleton
values were fuzzified based on the MFs of second layer and
the overall recovery status of the subject was calculated (Fig.
6). Three MFs (Good, Average and Poor) for input and output
variables were defined using trapezoidal function. The result
of the second layer is the recovery status of the post-operated
knee/leg based on the current input parameters.

Copyright 2012 by ASME

VL

VM
ST
KA

MG

KA

ST

VL
VM

KA

MG

VL

ST

VM

KA

MG

VL

VM

KA

ST
MG

MG

KA

FIGURE 6: TWO LAYERED FUZZY CLASSIFIER FOR RECOVERY STATUS

The output of the implemented intelligent

mechanisms is used to provide a bio-feedback by storing the
results in the knowledge-base and later reuse them to retrain
the network or rules. The integration of two types of signals
gives feedback about the musculoskeletal activities of the
subjects and the intelligent techniques assist in prediction and
classification of their rehabilitation progress. This combined
approach not only provides the feedback for the current
recovery status but it may also generate new patterns for
predicting and comparing the output of the later stages of
recovery.

Bio-Signals Analysis for Healthy Subjects

For healthy subjects, the angular rate for thigh and
shank was measured to compute the knee angle during normal
walking. The activation timing, duration and strength of
different muscles during a gait cycle were recorded by
capturing EMG signals. The correlated knee angle and EMG
signals from vastus lateralis/medialis, biceps femoris and
semitendinosis muscles were recorded (Fig. 7). The activation
timings and duration properties of these muscles during
normal walking for healthy subjects coincide with the existing
literature [20].

RESULTS
60

50

Knee Angle

Knee Angle

0.055

VL EMG

VM EMG

50

40

0.045

0.035
0.03

20
0.025

0.04

0.035

EMG (mV)

0.04
30

30

Knee Flexion/Extension (degrees)

40

EMG (mV)

Knee Flexion/Extension (degrees)

0.05

20
0.03

0.025

10

0.02

0.02

10

0.015

0.015
0.01

17.5

18

18.5

19
Time (sec)

19.5

20

20.5

10

0.005
21

17

0.005

17.5

18

(A) Vastus Lateralis

19
Time (sec)

19.5

20

20.5

21

(B) Vastus Medialis

60

0.04
Knee Angle

Knee Angle
50

0.035

ST EMG

0.025

0.02
20

0.015

10

0.1

Knee Flexion/Extension (degrees)

0.03
40

30

BF EMG

50

EMG (mV)

Knee Flexion/Extension (degrees)

18.5

0.05

EMG (mV)

17

0.01

0.01
0
0.005

0
17

17.5

18

18.5

19
Time (sec)

19.5

20

20.5

21

17

(C) Semitendinosis

17.5

18

18.5

19
Time (sec)

19.5

20

20.5

0
21

(D) Bicep Femoris

FIGURE 7: OVERLAPPED KNEE ANGLE AND EMG SIGNALS FOR DIFFERENT MUSCLES FOR A HEALTHY SUBJECT AT A
SPEED OF 2 KM/HOUR (A-D)

Copyright 2012 by ASME

specificity and total classification accuracy by using Eq. (3),

Eq. (4) and Eq. (5).

Bio-Signals Analysis for ACL Reconstructed Subjects

ACL injury changes knee dynamics and generally a
subject takes few months to recover completely after ACL
reconstruction. Figure 8 shows the difference in knee angle,
and activation timings and strength of for a female athlete
after two months period of post-surgery. Figure 9 shows the
condition of knee angle and activation timings and strength of
vastus lateralis for a male subject after two years of surgery. It
is clear from these figures that the subject after two years of
surgery has recovered from the injury to quite an extent while
the other subject has not yet fully recovered. These differences
have been used in this study for classification of subjects at
different stages of recovery. The knee kinematics and EMG
signals for subjects with ACL reconstruction were analyzed
using recurrent neural network and a two layered fuzzy
classifier. The Elman RNNs were designed, trained and tested
for post-operated subjects for three different walking speeds (2
Km/h, 3 Km/h and 4 Km/h). The networks converge to an
error of 0.0746 on average (Fig. 10). The network, once
trained, classifies the given input (knee angle and muscle
conditions) as recovered or not recovered subject.

VL EMG

Knee Extension/Flexion (degrees)

0.03

EMG (mV)

0.025

0.02

0.015
10
0.01
0

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(4)

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(5)

The fuzzy rule-based classifier performs very well in

classifying the recovery status of subjects as good, medium or
poor. The system was tested for given values of knee angle
and average muscle strength in each of the six phases
identified for four muscles used in this study. Table II shows
that the fuzzy rule-based system classifies all instances of the
recovery stages correctly when used for a subject at different
walking speeds. The system identifies the recovery status as a
high value in medium for all walking speeds which shows
that this subject is partially recovered after post-surgery.

40

20

(3)

Table II shows the values of above parameters for the

RNNs. It can be noticed that the overall accuracy of the Elman
RNN based classifier is greater than or equal to 85% which is
reasonable with small data set used for training.

Knee Angle

30

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60

50

123455657 =

0.005

10
25

25.5

26

26.5

27

27.5

Time (sec)

60
Knee Angle
VL EMG
0.04

60
Knee Angle

0.03

0.02

20

40

0.01
0.03

0.02
20

EMG (mV)

Knee Extension/Flexion (degrees)

VL EMG

40

EMG (mV)

Knee Flexion/Extension (degrees)

(A) Vastus Lateralis (Healthy Leg)

21

21.5

22

22.5

23

23.5

24

24.5

Time (sec)

0.01

24

24.5

25

25.5
Time (sec)

26

26.5

(A) Vastus Lateralis (Healthy Leg)

0.01
27

50
60
Knee Angle

(B) Vastus Lateralis (Post-operated Leg)

VL EMG

FIGURE 8: ACTIVATION TIMINGS AND STRENGTHS OF

VASTUS LATERALIS OF HEALTHY AND POSTOPERATED LEG AT 2 KM/H (A, B) OF FEMALE ATHLETE
AFTER 2 MONTHS OF SURGERY

0.06

EMG (mV)

Knee Flexion/Extesnsion (degrees)

0.08
40

20

0.04

0
0.02
0

19

19.5

20

20.5

21

21.5

22

22.5

Time (sec)

Table I shows the confusion matrix for the

classification accuracy of RNNs for a net-ball player walking
at three different speeds after 2 months of surgery for forty
tested gait cycles.

(B) Vastus Lateralis (Post-operated Leg)

FIGURE 9: ACTIVATION TIMINGS AND STRENGTHS OF
VASTUS LATERALIS OF HEALTHY AND POSTOPERATED LEG AT 2 KM/H (A, B) OF MALE ATHLETE
AFTER 2 YEARS OF SURGERY

The test performance of the Elman RNN classifier

was also determined by the computation of sensitivity,
7

Copyright 2012 by ASME

athletes rehabilitation process can be obtained by

combination of different types of bio-signals (knee kinematics
and neuromuscular signals) rather than relying only on
limited inputs.

Mean Square Error

10

The system has been tested for a small group of

healthy/ACL-reconstructed subjects and shows promising
results. Figure 7 illustrates that the results of the sensors
integration and fusion are consistent with the previous studies
which confirms the feasibility of the approach [20]. The
changes in knee angle and related muscles have also been
reported in literature [21, 22]. The results shown in Fig. 8 and
Fig. 9 conform to these studies. Figure 8 depicts that there is
an observable difference in the knee angle of a female subject
after two months of surgery. Moreover, the strength of vastus
lateralis muscle also varies in healthy and operated leg for this
athlete. On the other hand, there are minor differences in knee
angle for healthy and operated leg for the male athlete after
two years of surgery (Fig. 9). Although there is difference in
peak values for vastus lateralis of both healthy and postoperated legs, but the activation timings and shape of EMG
envelops match in both legs. Similar difference was noted for
strength of vastus medialis also but the hamstring muscles
have more or less similar strengths. This phenomenon is
consistent for all speeds (2 km/h, 3 km/h and 4 km/h) for this
subject. The increased muscle strength observed in postoperated leg is probably caused by the re-innervations of
muscle fibers following ACL reconstruction. The other
possible reasons could be leg dominance, muscle hyper-trophy
or hyper-reflexia or improper muscle strength training during
recovery process. Although this study shows a comparison of
kinematics and neuromuscular patterns between ACL intact
and ACL reconstructed leg, but generally after ACL injury
there are compensatory gait adaptations in the healthy (ACL
intact) leg due to abnormalities imposed by non-functional
limb. Hence, the prototype built is validated with athletes own
subjective data revealed during the experiments. For clinical
applications of the system, historical data of these parameters
must be present and stored in advance for athletes, particularly
for sports where ACL injuries are more common. Such
historical data may also be useful for injury prevention,
recovery classification and prediction.

10

10

500

1000

1500

1500 Epochs

FIGURE 10: THE CURVE OF NETWORK ERROR

CONVERGENCE

TABLE I: CONFUSION MATRIX FOR CLASSIFICATION BY

ELMAN RNN
Walking
Speed
2 Km/h
3 Km/h
4 Km/h

Actual Class\
Prediction

Healthy

Not-Recovered

Healthy

36.00

4.00

Not-Recovered

7.00

33.00

Healthy

34.00

6.00

Not-Recovered

3.00

37.00

Healthy

32.00

8.00

Not-Recovered

4.00

36.00

TABLE II: CLASSIFICATION COMPARISON OF ELMAN

RNN AND FUZZY RULE-BASED SYSTEM

Classifier
Elman
RNN

Fuzzy
Rule-Based

Walking
Speed

Sensitivity
(%)

Specificity
(%)

Accuracy
(%)

2 Km/h

90.00

82.50

86.25

3 Km/h

85.00

92.50

88.75

4 Km/h

80.00

90.00

85.00

2 Km/h

100.00

100.00

100.00

3 Km/h

100.00

100.00

100.00

4 Km/h

100.00

100.00

100.00

The use of intelligent techniques has also proved to

be helpful in classification of gait variations in normal and
operated legs. Although the convergence rate of RNN is not
up to the mark but the accuracy of the network can further be
improved by including large data set and using more features
from EMG signals. The fuzzy rule-based system has been
proved as a better option than recurrent neural network in this
initial investigation. Even though the classification results of
fuzzy logic based systems are more accurate but it is
cumbersome to design a comprehensive set of rules to include
all scenarios for all subjects. The fuzzy rule based system has
been designed and tested for individual athletes as per their
muscles strength which can be partially generalized by using
common features at different recovery stages. As the gait
patterns of individuals vary and designing a completely
autonomous system is far challenging with existing intelligent
mechanisms together with the state-of-the-art MEMS

DISCUSSION
The need for an objective recovery progression
during the convalescence after ACL injury is a crucial factor
in deciding the effectiveness of a rehabilitation program. This
preliminary study shows that the use of integrated signals and
intelligent techniques provides substantial assistance in
objective monitoring of rehabilitation and making informed
decisions about knee recovery progress. The methods used in
this study demonstrate that a more holistic picture about the
8

Copyright 2012 by ASME

technology so far available. This feasibility study advocates an

assistive tool for ACL rehabilitation where most common
features can be extracted from individual athlete's movements
and then used as training data. The inclusion of
visual/graphical system for the individuals' parameters can
provide more insight into the recovery progress and changes
occurring during different stages. A better option could be to
use neuro-fuzzy approach to learn the rules and membership
function also from the training data as the fuzzy logic
approach can handle uncertainty in data. The accuracy of the
results not only depends on the techniques used for data
processing but it also relies on the sensors' alignments and
placements in different body parts and muscles during
movement. A common source of error in all body mounted
sensors is soft tissue artifact (STA) that affects the
measurement accuracy [23,24]. An underestimated
flexion/extension has been observed due to sensors fixed on
thigh as the femur is surrounded by sizeable soft tissue
[25,26]. The STA has been minimized in our experiments by
placements of sensors using self-adjustable suite based on
human anthropometric data and adaptive filtering of the raw
data from motion sensors. A more comprehensive approach
will be considered to eliminate the error caused by STA in
future.

ACKNOWLEDGMENTS
This research is supported by the University Research
Council (URC) grant scheme at the University of Brunei under
the grant No: UBD/PNC2/2/RG/1(195) with the title
Integrated Motion Analysis System (IMAS). Authors also
appreciate Ministry of Sports and Ministry of Defense
providing Brunei national athletes as test subjects undergone
rehabilitation process due to ACL surgeries as well as healthy
test subjects involved for non-invasive rehabilitation
experiments. Further, authors also acknowledge the careful
monitoring by Mr. Illepurma Ranasinghe as the head coach of
sports, physical strength and conditioning during experiments
and the guidance provided by Dr. Shaheen Basheer from
RIPAS Hospital, Brunei Darussalam.
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