From fall-risk assessment to fall detection: inertial sensors in the clinical routine and daily life

Falls are caused by complex interaction between multiple risk factors which may be modified by age, disease and environment. A variety of methods and tools for fall risk assessment have been proposed, but none of which is universally accepted. Existing tools are generally not capable of providing a quantitative predictive assessment of fall risk. The need for objective, cost-effective and clinically applicable methods would enable quantitative assessment of fall risk on a subject-specific basis. Tracking objectively falls risk could provide timely feedback about the effectiveness of administered interventions enabling intervention strategies to be modified or changed if found to be ineffective. Moreover, some of the fundamental factors leading to falls and what actually happens during a fall remain unclear. Objectively documented and measured falls are needed to improve knowledge of fall in order to develop more effective prevention strategies and prolong independent living. In the last decade, several research groups have developed sensor-based automatic or semi-automatic fall risk assessment tools using wearable inertial sensors. This approach may also serve to detect falls. At the moment, i) several fall-risk assessment studies based on inertial sensors, even if promising, lack of a biomechanical model-based approach which could provide accurate and more detailed measurements of interests (e.g., joint moments, forces) and ii) the number of published real-world fall data of older people in a real-world environment is minimal since most authors have used simulations with healthy volunteers as a surrogate for real-world falls. With these limitations in mind, this thesis aims i) to suggest a novel method for the kinematics and dynamics evaluation of functional motor tasks, often used in clinics for the fall-risk evaluation, through a body sensor network and a biomechanical approach and ii) to define the guidelines for a fall detection algorithm based on a real-world fall database availability.

Evaluation of an intervention focusing on children to promote physical activity in the entire community: Feasibility, effectiveness and sustainability over time.

Regular physical activity (PA) during childhood is associated with physical, mental, emotional and social health benefits. The constant practice of PA is considered one of the best buys available in public health. The World Health Organization (WHO) recommends to perform at least 60 minutes per day of moderate to vigorous PA for children and adolescents in order to obtain health benefits. However, globally, this level of PA is hardly achieved. Children and adolescent who do not reach the recommended levels of PA are defined as physically inactive and nowadays physical inactivity constitutes a new type of pandemic. For this reason, the WHO launched a global action plan addressing physical activity with a goal of reducing physical inactivity in children and youth. The plan also included recommendation to improve individual and community health and contribute to the social, cultural and economic development of all nations. Worldwide, children and adolescents spend a significant amount of time in school and for this reason the school represents a fundamental educational setting that can play a pivotal role increasing students’ PA. Opportunities to be physically active should not be considered purely in relation to when children attend physical education classes but also making physical activity available during the school day, such as physically active lessons, and multicomponent PA interventions. Since school-based PA interventions are quite numerous, the present thesis focused on interventions delivered during school hours and that integrate small doses of PA as part of routine instruction. This type of intervention is called “Active Breaks.” Active Breaks consists of brief 5–15 minutes sessions of PA led by teachers who introduce short bursts of PA into the academic lesson. In light of this the present thesis aims to evaluate the feasibility, efficacy and sustainability of an Active Breaks intervention targeting children to promote PA.