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.

Methods for the Quantification of Motor Stability for the Assessment of Fall Risk

The research field of the Thesis is the evaluation of motor variability and the analysis of motor stability for the assessment of fall risk. Since many falls occur during walking, a better understanding of motor stability could lead to the definition of a reliable fall risk index aiming at measuring and assessing the risk of fall in the elderly, in the attempt to prevent traumatic events. Several motor variability and stability measures are proposed in the literature, but still a proper methodological characterization is lacking. Moreover, the relationship between many of these measures and fall history or fall risk is still unknown, or not completely clear. The aim of this thesis is hence to: i) analyze the influence of experimental implementation parameters on variability/stability measures and understand how variations in these parameters affect the outputs; ii) assess the relationship between variability/stability measures and long- short-term fall history. Several implementation issues have been addressed. Following the need for a methodological standardization of gait variability/stability measures, highlighted in particular for orbital stability analysis through a systematic review, general indications about implementation of orbital stability analysis have been showed, together with an analysis of the number of strides and the test-retest reliability of several variability/stability numbers. Indications about the influence of directional changes on measures have been provided. The association between measures and long/short-term fall history has also been assessed. Of all the analyzed variability/stability measures, Multiscale entropy and Recurrence quantification analysis demonstrated particularly good results in terms of reliability, applicability and association with fall history. Therefore, these measures should be taken in consideration for the definition of a fall risk index.

Chemistry of aerosol particles and fog droplets during fall-winter season in the Po Valley

Air quality represents a key issue in the so-called pollution “hot spots”: environments in which anthropogenic sources are concentrated and dispersion of pollutants is limited. One of these environments, the Po Valley, normally experiences exceedances of PM10 and PM2.5 concentration limits, especially in winter when the ventilation of the lower layers of the atmosphere is reduced. This thesis provides a highlight of the chemical properties of particulate matter and fog droplets in the Po Valley during the cold season, when fog occurrence is very frequent. Fog-particles interactions were investigated with the aim to determine their impact on the regional air quality. Size-segregated aerosol samples were collected in Bologna, urban site, and San Pietro Capofiume (SPC), rural site, during two campaigns (November 2011; February 2013) in the frame of Supersito project. The comparison between particles size-distribution and chemical composition in both sites showed the relevant contribution of the regional background and secondary processes in determining the Po Valley aerosol concentration. Occurrence of fog in November 2011 campaign in SPC allowed to investigate the role of fog formation and fog chemistry in the formation, processing and deposition of PM10. Nucleation scavenging was investigated with relation to the size and the chemical composition of particles. We found that PM1 concentration is reduced up to 60% because of fog scavenging. Furthermore, aqueous-phase secondary aerosol formation mechanisms were investigated through time-resolved measurements. In SPC fog samples have been systematically collected and analysed since the nineties; a 20 years long database has been assembled. This thesis reports for the first time the results of this long time series of measurements, showing a decrease of sulphate and nitrate concentration and an increase of pH that reached values close to neutrality. A detailed discussion about the occurred changes in fog water composition over two decades is presented.