CurrOpinNeurol.AuthormanuscriptavailableinPMC2014Dec1.

Publishedinfinaleditedformas:

PMCID:PMC4035103
NIHMSID:NIHMS568974

CurrOpinNeurol.2013Dec26(6):602608.
doi:10.1097/WCO.0000000000000026

Wearablemotionsensorstocontinuouslymeasurerealworldphysical
activities
BruceH.Dobkin,MD
BruceH.Dobkin,ProfessorofNeurology,UniversityofCaliforniaLosAngeles,GeffenUCLASchoolofMedicine,710WestwoodPlaza,Los
Angeles,CA90095,3102066500
BruceH.Dobkin:bdobkin@mednet.ucla.edu
CopyrightnoticeandDisclaimer

Abstract
Purposeofreview

Rehabilitationforsensorimotorimpairmentsaimstoimprovedailyactivities,walking,exercise,andmotor
skills.Monitoringofpracticeandmeasuringoutcomes,however,isusuallyrestrictedtolaboratorybased
proceduresandselfreports.Mobilehealthdevicesmayreversetheseconfoundersofdailycareand
researchtrials.
Recentfindings

Wearable,wirelessmotionsensordata,analyzedbyactivitypatternrecognitionalgorithms,candescribe
thetype,quantity,andqualityofmobilityrelatedactivitiesinthecommunity.Datatransmissionfrom
sensorstothecellphoneandInternetenablecontinuousmonitoring.Remoteaccesstolaboratoryquality
dataaboutwalkingspeed,durationanddistance,gaitasymmetryandsmoothnessofmovements,aswellas
cycling,exercise,andskillspractice,opensnewopportunitiestoengagepatientsinprogressive,
personalizedtherapieswithfeedbackaboutperformance.Clinicaltrialdesignswillbeabletoinclude
remoteverificationoftheintegrityofcomplexphysicalinterventionsandcompliancewithpractice,as
wellascapturerepeated,ecologicallysound,ratioscaleoutcomemeasures.
Summary

Giventheprogressivelyfallingcostofminiaturizedwearablegyroscopes,accelerometers,andother
physiologicsensors,aswellasinexpensivedatatransmission,sensingsystemsmaybecomeasubiquitous
ascellphonesforhealthcare.Neurorehabilitationcandevelopthesemobilehealthplatformsfordailycare
andclinicaltrialstoimproveexerciseandfitness,skillslearning,andphysicalfunctioning.
Keywords:mobilehealth,strokerehabilitation,outcomeassessment,physicalactivity,accelerometer,
gyroscope,activitymonitor,signalprocessing,telemedicine
Introduction
MobilehealthormHealthisagrowingendeavortoimprovehealthcareservicesviamobilecommunication
devices.1ThecellphoneenablescontinuousaccesstotheInternetoverbroadbandandWiFifordata

transmissionofphysiologicvariables,physicalactivity,bloodtests,images,socialinteractions,mental
states,andenvironmentalconditions.2Bysimultaneouslyassessingbehavioral,physiological,and
psychologicalstatesintherealworldandinrealtime,mHealthalsoaimstoquantifystatesofhealthand
wellbeing.Feedback,cues,andupdatedinstructionsviagraphicsandtextmessagescanbeprovidedin
realtimebasedontheflowofinformationfromandbacktoapatient.Theresultwillbehighthroughput,
multistreamed,longitudinaldatasetstofacilitatediseaseprevention,diagnostics,compliance,
personalizedmanagement,andbehavioralchange.3Aglobalaimistousethistechnologytoreduce
healthcaredisparities,especiallyforpatientswithchronicdiseases,andlowerthelongtermcostofmore
personalizedcare.Thislongtermmanagementcapabilityisespeciallyimportantinneurologic
rehabilitationafterdisablingspinalcordandtraumaticbraininjury,aswellasinstroke,multiplesclerosis,
andanyprogressiveorneurodegenerativedisease.Thus,therehabilitationteammayfindremarkable
opportunitiesinmHealth,justasithasforotherassistivetechnologies.
Mobilehealthsmartphoneappstakeadvantageofexternalsensorsandthecamera,microphone,GPS,and
accelerometerbuiltintothesecommunicationdevices.Thephonealreadyservesasatransmissionrelay
forBluetoothequippedweightscales,bloodpressureandheartratedevices,equipmentforexercise,and
mentalandsocialhealthstateassessments.Biomonitoringofbloodchemistries,embeddedlabonachip
sensors,andtelemonitoringforremotepersonalhealthadvicebyprofessionalsaremovingforwardas
well.Evidenceforefficacyisgrowing,ifslowly.4Forexample,thefirstmHealthCochraneanalysisof
randomizedclinicaltrials(RCTs)forselfmanagementoftype2diabetesfoundlargereffectsonglucose
andHgbA1Ccontrolforcellphonebasedinterventionscomparedtoconventionalinformationand
computeruse.5Studiesofefficacy,however,aresparse.Acrossallhealthconditionsattheendof2012,
176RCTsofmHealthtechnologieswerelistedatclinicaltrials.gov,6butfewhavebeenpublishedorrelate
toneurologicdisability.
Thisreviewdescribeseffortstobringwearable,wirelesssensornetworkstobearoncommunitybased
assessmentsandtreatmentstoimprovewalking,exercise,fitness,andothermobilityrelatedactivitiesafter
neurologicinjuriesanddiseases.Itaddressesthechallengeofawhitepaper7fromtheNationalInstituteof
ChildHealthandHumanDevelopment,whichconcluded,Advancedtechnology/sensorsmustbe
developedtoestablishbettertrackingofcomplianceandclinicaloutcomes,atseveralInternational
ClassificationofFunctioning,Disability,andHealthlevels.New,lowcost,portablesensorsmay
ultimatelyreplaceprevailingclinicalinstrumentsusedforoutcomeassessments.Inexpensive
smartphonesandtabletsareloweringthecomplexityofthischallengesincetheycancommunicatewith
multiplesensorsplacedonthebodyinitiate,storeortransmitdataforprocessingprovideavarietyofuser
interfacesdownloadinstructionsandremindersandremotelyupdateapplications.
SensorPlatforms
Awiderangeofwearablesensors(Table1)areavailablecommerciallythatprovidetherawdatato
describearm,trunk,andlowerextremityactionsoutsideofamotionanalysisgaitlaboratory.8Thechoice
ofsensors,number,andplacementwilldependontheactivityandmovementvariablestobeascertained.
Practicalsensorsystemsmustmeetmanycomplexdesignrequirements,fromcosmetic,privacyand
technologyacceptabilitybyuserstosignalprocessing,datatransmission,annotation,andscalabilityfor
easyuse(Table2).Especiallyimportantformotionsensingistheaccuracyandspeedoffeaturedetection
andclassifieralgorithmsthatturnasequenceofinertialsignalsintoarecognizablemovementpatternto
measureclinicallyimportantdetailsofgaitandotherpurposefulactivities.
Commercialdevices

Recently,fitness,exerciseandwellnessgadgetshavecometothesocialnetworkingmarket.Cantheybe

usedforpatientcare?Ingeneral,thesecosmeticallystrikingdevicesdetectsuccessivemovementsbya
singlebiaxialortriaxialaccelerometerplacedinapocketoronawristband(e.g.,FitBit,BodyMedia,
FuelBand).Resultsaresummarizedbydownloadingdatatoacomputerorsmartphoneusuallyvia
Bluetooth.Episodicandcyclicalbodymovementsarethencalculatedasactivityorstepcountsor
convertedintocaloriecounts.Eachswingofthearmorforwardpropulsionofthetrunkisinterpretedasa
strideduringrepetitiveexercise.Actionswithlowgravitationalforceorunusualcombinationsof
accelerationdecelerationofshortdurationmaybemisinterpreted,however.Adventitiousmovementsmay
beinterpretedasthemotionofinterest.Reliabilityandvalidityareuncertaininhealthypersonsinreal
worldsettingsandyettobestudiedindisabledpersons.Atbest,awristwornaccelerometermay
distinguishsedentary,household,walkingandrunningasdistinctactivitiesandcorrectlyclassifyintensity
ofactivity50%ofthetime.9Intheirpresentconfiguration,thesearenotsuitableforresearchonpatients
withneurologicimpairments.
Singleaccelerometerbasedstepcountershavebeenavailablefor2decadesforoutpatientuse(e.g.,
Actigraph,PensacolaFLStepWatchActivityMonitor,OklahomaCity,OK).10,11Theircountofsteps
overtimegenerallycorrelatewiththedegreeofwalkingimpairmentforpatientswithstroke(e.g.,slower
walkerstakefewersteps)12andotherneurologicaldiseases.Likeevenlesssophisticatedpedometers,they
maynotdetectallstepswhenthecadencefallsbelow50/minute,walkingspeedslowsbelow0.6m/s13or
thegaitpatternincludesirregularmovements.Nonemeasurewalkingspeedorhaveyetbeenenabledto
downloadtoasmartphone.Triaxialaccelerometersystemsplacedposteriorlyatthemidlineofthewaist
useproprietaryalgorithmstodetectthegaitcycleandwalkingspeed(e.g.,Actibelt,Munchen,Germany),
butsofar,tendtobelessaccurateinpatientswithgreaterimpairmentwhowalkslowly.1416Indeed,
multisensorsystemsaresignificantlymoreaccuratethananyofthesesingleaccelerometerstomeasure
activityandestimateenergyexpenditure.16
Researchdevices

Animportantgoalforrehabilitationistobeabletoremotelyclassifyhumanactivitiesandquantitatively
measurethequalityoftheircomponentmovementsoutsideofamotionanalysislaboratory.Wirelessgait
laboratorysystems(e.g.,APDM,Portland,OR)thatintegratefrom27accelerometersandgyroscopes
wornonthewrists,anklesandchestorwaist,plusadditionaltypesofsensing,aresaidtobeaccuratefor
revealingthegaitcycleandwalkingspeed.Combinationsofaccelerometersarealsosufficienttodetect
posturalimbalance,17andmayhelpdetectorpredictfalls.Wheelchairactivityandenergyconsumption
measurementalsorequiresmultiplesensors,oneacharmandthechair.18Thesesystems,duetocostand
complexitiesinmanagement,haveprimarilybeenusedincontrolledsettings,butnotforcontinuous
communityusageenabledbyautomaticdownloadingtoasmartphone.
Comfortable,userfriendlysensornetworkdesignscompatiblewiththenotionofmHealtharebecoming
available.19Inonestudy,lowcost,miniaturizedtriaxialaccelerometerswithelectroniccircuitswere
placedoverthetibiajustabovebothanklesinhealthyandhemiplegicparticipants.Atemplatewalkat
severalspeedsfor10mwasusedtohelptraintheactivitypatternrecognitionalgorithmforeach
subject.20Thesynchronousbilateralrawinertialsignalswereexaminedforfeaturesrelatedtothetiming
ofcomponentsofeachstride,includingheeloff,toeoff,peakswing,endofswing,andfootflat.A
machinelearning,Bayesianactivityrecognitionclassifierwasdevelopedthatgroupedactivitiesandsetthe
featuresthatdistinguishedthem.Thealgorithmthenrecognizedsubsequentboutsofwalkingacrossaday's
activityandcalculatedwalkingspeedsinthestrokepatientsaslowas0.1m/s,alongwithdistanceand
durationofeachbout,andlimbasymmetriesinstanceandswingtimes.Thisprotocolledtohigh
correlationwithgroundtruthmeasuresduringwalkinginthecommunity.20,21Thissensorandanalysis
systemwasthenusedtoprovidefeedbackovertheInternetaboutdailywalkingboutsintermsofspeed,
22

durationanddistanceinaRCTduringinpatientstrokerehabilitationat15sitesin12countries.22Over
2100hoursofactivitieswereidentifiedandquantifiedin140subjects,revealingtheprogressionof
walkingrelatedmeasuresandtheactualamountofphysicaltherapyprovidedformobility.ABluetooth
connectionfromthesensorscandownloadthedatatoasmartphoneaswell,thentoaremoteserverfor
algorithmprocessing.Anotherresearchgroupplacedbilateralaccelerometersatmidlegalongwitha
gyroscopetotrytoeliminatethetemplatewalk,buttheiralgorithmwasonlyaccuratewhenwalkingspeed
exceeded0.6m/s.23Othersensorplacementsandapproachestofeatureextractionfromtheaccelerometer
signalhavebeenreportedforsubacutestroke,24Parkinson's,25andmultiplesclerosis.17
Thus,muchprogressisbeingmadeforpersonalizedmotiontechnologies.Asmartphonewitha
continuouslyrunningsoftwareapplicationthatcompressesandtransmitsdatatoacentralservercanbean
effectivehubtomanagemultiplestreamsofsensorandotherphysiologicaldata.26Practicalsensingfor
thestudyofpatients,however,requirestechnicalandlogisticaldevelopmentandplanning.2Inadditionto
featureslistedinTable2,culturalacceptanceoftechnologiesmustevolvetooptimizeutilization.For
inexpensive,wideutilization,interoperabilityofsoftwareandcommunicationsystems,publiclyopen
standards,andqualitativeandquantitativeevidenceaboutwhatworksforwhatpopulationunderspecified
conditionsseemsessential.4,27Forneurologyandrehabilitation,efficacyandeffectivenesstrialsare
necessarybeforeafinaliterationofhardware,softwareandinfrastructureshouldbescaledforwideusage.
MotionSensingforDailyCare
Disabledpersons,suchasthoseafterstroke,takefarfewerstepsdaily,withfewerandshorterboutsof
walkingcomparedtohealthypeers.28Criticalresearchtounderstandhowtoreduceriskfactorsfor
vasculardisease,forexample,andtoreducedisabilityandincreasedailyparticipationwillbenefitfromthe
abilitytoquantifythetype,quantity,andqualityofdailyactivities.8Sensornetworksthatmonitorupper29
andlowerextremity20activitiesshouldfacilitateaccurateongoingassessmentduringcommunity
functioningandenablefrequentrecommendationsabouthowtoprogressexerciseandskillspracticefrom
remotelylocatedprofessionals.Sensors,then,mayalterbehaviorbyofferingfeedbackandpersonal
activityauditingthatencouragesselfefficacyintheformofgraphicsandinstructionfromanywherethe
Internetreaches.Whenparticularexercisesandskillspracticeareprescribedduringlongterm
rehabilitationefforts,bothpatientsandcaregiversmaybenefitfromremotesupervisionthataddressestheir
concernsaboutsafetyandhowbesttoworktoadvancethereacquisitionofskills.
Althoughthislevelofmonitoringcouldbeviewedasaninvasionofprivacy,disabledpersonsarelikelyto
applaudtheaccessibilityofrehabilitationsupervisioninthecontextoftheirhomeandcommunityatlow
cost.Teleneurology30andtelerehabilitation31couldinterfacewithwearablesensortechnologyto
complementhomebasedcareandcompliancewithmedicalrecommendations.
SensorsforClinicalTrials
Havinggroundtruthaboutactivitylevels,intermsoffrequency,duration,intensity,andenergy
consumption,willturnassumptionsaboutthequantityofexerciseandpracticeduringtrialsinto
certainties.Forexample,allofthelargerecentRCTsoftreadmillandrobotictrainingtoimprovewalking
afterstroke,12,3234spinalcordinjury,35,36Parkinson's,37,38andmultiplesclerosis39haveassigned
subjectsinthecontrolandexperimentalgroupstoaspecifiednumberofhoursofweeklytreatment.None
ofthestudies,however,canreportwithconfidencehowmuchwalkingandexerciseoccurredduring
plannedpracticesessionsorwhetherparticipantspracticedlocomotorskillsandexercisedoutsideof
formaltrainingtimes.40Exercisetrialsthattakeplaceinthecommunityareevenlesslikelytobeableto
capturethequantityofpractice.41,42Yetabiastowardhighorlowlevelsofpracticebeyondwhatthe
investigativeteamseesmayhaveaconfoundingimpactontheeffectsoftheexperimentaltherapy.For

example,participantswhopracticemoremaygainbetterskillsincorrectpracticecouldreducetheeffect
oftheformaltherapy.Thequantityandqualityofanexperimentalphysicalinterventionmayalsovary
acrossthemultiplesitesofanRCTorchangewhenanewtherapistreplacestheonewhowastrainedat
onsetofthetrial.Goodtrialdesignrecommendsthatextensivetraininginprovisionofacomplexphysical
interventiontakeplacebeforeanRCTstartsandthatvideotapingoftheinterventionorinperson,
intermittentmonitoringbepartoftheprotocolatsubsequentintervals.Theconventionalapproachtothese
monitoringneedsmaybelessreliableandcostmorethanintermittentremotesensormonitoringofactual
practice(howmuch,howwell)duringformaltrainingsessionsandinbetweentherapies.
Continuousmonitoringofwhatsubjectsactuallyperformenablesotherbenefitstotrialintegrityand
design.Serialsensormeasurescanprovidedoseresponseassessmentsorbeusedforimputationby
statisticianswhenaparticipantdropsout.Realworldsensingalsooffersecologicallysound,intervaland
ratioscaleassessmentstoaugmentquestionnairesandordinalscalesaboutdisability,participationin
fulfillingpersonalgoalsandroles,andphysicalfunctioning(Table3).Qualityoflifetoolsforthishave
becomearequirementasprimaryorsecondaryoutcomesinneurologictrials.Mostdiseaseshavetheir
owntool,oftenderivedfromquestionsdevelopedfortheMedicalOutcomesStudy'sSF36andnow
representedintheNIH'sNeuroQOLtoolbox.43TheseLikertscaledmeasuresofchangeindailyphysical
activityandratingsofdifficulty(climbingstairs,walking1block,etc),however,haveusuallynotbeen
confirmedbyrealtimestudiesoftheseactivities.Forexample,thereportedlevelofindependenceby
personswithSCIdifferedfromwhatcliniciansfoundontesting.44Wearablesensorscanprovidethat
groundtruth.
Justasselfreportingscalesstandasapartialsurrogateforactualactivityandparticipation,sodoother
commonlyusedwalkingrelatedoutcometools,suchasthetimedshortdistancewalk(615m)andthe
distancewalkedin26mininalaboratorysetting.Ingeneral,improvedeffectsonsurrogatesdonot
necessarilytransferintohealthbenefitsindeed,thesurrogatemayfailasaguidetothemostclinically
meaningfulandeffectivetherapies.45Inneurorehabilitationtrials,apretoposttestgainof>20%in10m
speedor6mindistanceoftenreachesstatisticalsignificanceandfavorsoneinterventionoveranother.The
clinicalmeaningfulnessofsuchchange,however,isuncertain.Thegainmaygenerallycorrelatewithself
reportedfunctionalmeasurementtools,46butoutliersarecommon,becausereliabilityofselfreportsare
uncertain.Theabilitytoseriallycapturewalkingrelatedvariablesinthehomeandcommunity,toexamine
changesinspeedandlegsymmetryonvariedsurfaces,andcapturechangesinexercisecapacity,for
exampleinrelationtopain,fatigueoradverseeffectsofmedications,shouldprovidegreaterinsightinto
theeffectivenessofnewtherapiesinallpatientsforwhomanevidencebasedtrialsuggestsefficacy.47,48
Thefrequencyatwhichpatientsmightbemonitoredbywearableactivitysensingnetworksdependsonthe
objectofthestudy.Levelsofwalkingactivityusingpedometersrequireabout7daysofdatacollectionto
obtainastableandrepresentativeaverageforhealthypersons49toaslittleas2daysforthosewith
incompleteSCI.50Foraclinicaltrialofawalkinginterventionof3monthsduration,aminimaldataset
mightinclude2weeksofdailymonitoringpriortostartingthecomparisontreatments,thenforoneweek
monthlyoratthetimeofscheduledoutcomemeasures.Foradrugtrial,activitymightbemeasured
continuouslyforatleastamonthtwoweekspriorandatleast2weeksafterinitiationtodetect
fluctuationsinresponsetomedications(e.g.,dyskinesiasorfreezingofgaitinParkinson'sdisease,leg
spasmsinSCI).Skillspracticeathomemightbeassessedfor12sessionsaweektomonitorqualityof
movements.Schedulesforfeedbackaboutperformancetomotivatecompliancewillhavetobeempirically
derived.
Conclusion
Wirelessremotesensingtomonitorthetype,quantity,andqualityofphysicalactivities,daily

participation,andskillreacquisitionoffersgreatpotentialforneurologicandneurorehabilitationpatient
careandclinicaltrials.Progressivereductionsinthecost,sizeandenergyrequirementsofgyroscopes,
accelerometers,otherphysiologicsensorsanddatatransmissionovertheInternet,alongwithempirical
workonactivityrecognitionalgorithms,suggestthatwearablesystemsmaybecomeubiquitoustools.
Efficacyandeffectivenesstrialsarenecessary,however,beforeclinicianscanutilizesensordatafor
ecologicallysoundmonitoringandoutcomemeasures.
Acknowledgments
ThisreviewwaspartiallysupportedbygrantsfromtheDr.MiriamandSheldonG.AdelsonMedical
ResearchFoundationandNationalInstitutesofHealthR01HD071809.Facultyandstudentsfromthe
UCLAWirelessHealthInstitute,particularlyWilliamKaiser,PhD,MajidSerrafzadeh,PhD,XiaoyuXu,
PhD,AndrewDorsch,MD,andGreggPottie,PhDprovidedvaluableinsightsintomHealthsensing
networks.
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FiguresandTables
Table1

Typesofwearablesensorstoassessphysicalactivity
Triaxialaccelerometer:accelerations/decelerations,velocityanddisplacementofabodysegmentinx,y,zaxes.
Gyroscope:angularvelocityandrotation.
Globalpositioningsatellite(GPS)signal:locationprimarilyoutdoorsmaycalculatespeedanddistanceofcontinuous
walkingwithsmartphoneapp.
Magnetometer:directionalvectorsofspatialorientation.
Electromyography:dryelectrodesforsurfaceEMGoftimingandamountofmusclegroupactivation.
Goniometer:jointangularrangeofmotion.

Resistiveflexandpressuresensing:fiberopticordeformabletextileacrossajointdetectsangularchangepiezoelectrodefor
distributionofweightonsoletodefinestanceinthegaitcycle.
Environmentalcontext:ambientsound,light,motionactivatedphotoorvideo.

Table2

Technicalfeaturesforpracticalremotemotionsensingsystems
Sensors:
Type,numberandpositiondependonspecificbodymetricssought
Designe.g,piezoelectricorcapacitivemicroelectromechanicalsystemaccelerometer
Cosmeticacceptabilityeaseandreproducibilityofplacement.
Rawsignalstructureandsensitivitytoevents
Firmwareinstructionsfordevicecomponents
Partialdataprocessingonsensorchip
Platforms:
Interoperabilitybyusingcommonsoftware,communication,dataprocessingandconfidentialityprotocols
Opensource,publicallyavailablestandards
Endtoendsystemreliability
Datatransmission:
ChoiceofwirelessstandardsBluetooth,Zigbee,WiFi,voicechannels,ShortMessageService,UniversalMobile
TelecommunicationsSystems
Cost
Frequencyofdatasampling
Bandwidth
Powerconsumptionenergysource
Reliability
Datatimestamping
Errorcheck
Storagecapacity
Securedataateachstageofcollection,transfer,andstorage
Signalprocessing:
Temporallyfusedatasynchronouslyfrommultiplesensorsandbodysites
Analyticalgorithms
Featuresassessedincludemeanofsignal,peakfrequency,correlationofaxis,signalenergy,standarddeviation
ClassifiermodelsincludenaveBayes,supportvectormachine,decisiontree,hiddenMarkov,neuralnetworks,
spectrumanalysis,randomforest
Integratemultiplelayersoftheclassifier,e.g.,activity,context,sensorlocation
Artifactrecognitionexamineoutliers
Environmentalcontextofactivity
Speedofprocessing
Machinelearninganalysis

Resolutionofdata:
Softwaretointerpretdatafromsensorsandothersourcesofinformationtoprovidenewinsightsintohealthstates
Normalizedformatchedpopulationandsensitivetoindividual'sdailyfunctioningovertime
Discerntrajectoryofchangeandclinicallymeaningfulgainsanddeclines
Visualizedatausingcustomizabletoolsandreports
Annotation:
Describechangesinhealth,mood,behavior,socialcircumstances,environment
Ontologicalencodingofdataacrossstudies,e.g.,UnifiedMedicalLanguageSystemforstandarddescriptionofmedical
condition,treatments,responsesandcontexts
Methodstoscaleupapplications:
Simplifyinstructions,minimizetimeandeffortbyuserkeepcognitiveloadlow
Minimizestepsandincreaseautomaticityindataflowduringacquisition,processing,analysisandsearch
Conceptualizesummarydataforpracticaluses,suchasfeedback,monitoringandoutcometools
Dataaccessibilityincommondatabases:
NIHorResearchElectronicDataCapture(REDCap)databases
Annotatedrawdatarepositoryfordatamining
Dataprivacyandsecurity:
Encryption
HIPAArequirements

Table3

Comparisonofconventionalscalesandwireless,wearablesensorderivedtestsofmobilityrelated
functioning
DATA

USUALMETHOD

mHEALTHSENSORS

Typeofphysical

Selfreportdiaryorchecklistobserveinlab

Activitypatternrecognitionalgorithmswalk,

activity

videoshortdistancetimedwalkordistance

cycle,legexercisesidentifiablebysensordata

walkedin26min.

processing

Observationinertialmovement/stepcountsif

Directlymeasurewaveformsofindividual

Quantity

Frequency/duration accelerationshighenough
Quality

componentsandwholeactions

Laboratorymotionanalysisorpressurematsystem Compareeachlegduringstepcycleincontextof
environs

Locationof

Selfreportlab

activity
Reliability

Anywhereglobalpositioning&ambientcontext
sensingforsiteidentification

Interratertestretest

Groundtruthmeasurementv.sensorbased
algorithm

Validity

Content/constructforeachscale

Facevalidityresponsiveness

Statisticaltesting

Ordinalscalesofphysicalfunctioning

Interval/ratioscaledata

Dataentry

Computer

Smartphone,tablet

Humanfactors

Trainexaminersintestadministration

Trainparticipantsinacultureoftechnology

Regulation

LocalInstitutionalReviewBoardandHIPAA

LocalIRB&HIPAApossiblyFoodandDrug
Administration