Portable Electromyogram-sensitive System for Assessment of Fear of Fall: Relevance of Gait Phases for Post-Stroke Patients

Post-stroke patients often suffer from gait deficits along with Fear of Fall (FoF) that adversely affect their ambulation. The FoF has been reported to be negatively correlated with one's performance in daily life. Clinical scales, e.g., Falls Efficacy Scale are often used to assess one's FoF. Though powerful, it can suffer from subjectivity. Thus, it is important to have reliable assessment of FoF. Motivated by this, we used one's lower limb muscle activation during specific gait phases to assess one's FoF. For this, we developed a portable electromyogram-sensitive system that can synchronously measure one's muscle activation along with gait phases. We conducted an experimental study with post-stroke patients and age-matched healthy controls who walked under Dual-Task condition. We investigated the lower limb muscle (Gastrocnemius Lateralis (GM) and Tibialis Anterior (TA)) activation during Loading Response, Terminal Stance and Initial Swing phases of gait, associated with slips contributing to FoF. Results show that our system could quantify the disparity
$(\Delta)$
in muscle activation between the affected and unaffected sides of patients
$(\Delta=\sim84\%$
during Loading response for both GM and TA, ~32%for GM during Terminal Stance and TA during Initial Swing) which was considerably higher than that between dominant and non-dominant sides of healthy controls. This might infer reduced dynamic stability of patients leading to their FoF. Also, muscle activation could classify patients from healthy controls with 90% accuracy during Loading Response and Initial Swing phases with clinical relevance in diagnostics and monitoring rehabilitation outcomes. Clinical Relevance— This study indicated that our system has potential to be utilized as a tool for diagnostic and monitoring rehabilitation outcomes as it can quantify the residual muscle ability of the post-stroke patients during gait.