Abstract

This PhD dissertation focuses on developing improved methods for assessing and reducing fall risk in stroke survivors. Falls are a major concern in this population as they occur more frequently and can lead to catastrophic injuries due to factors like hemiparesis, spasticity, impaired balance and cognitive deficits. The dissertation reviews fall risk factors (FRFs) identified in prior studies and finds balance, gait and mobility metrics to be most significant. It notes current assessment methods rely on subjective scales and lack detailed motion analysis. Dual-task testing is also overlooked despite revealing subtle deficits. To address these gaps, wearable sensors and machine learning are proposed to objectively quantify fall risk. The dissertation first compares outcomes of clinical tests like Timed Up and Go (TUG), Sit-to-Stand (STS), balance and 10 Meter Walk Test (10MWT) between stroke survivors and controls under single and dual-task conditions. Stroke survivors show impaired performance exacerbated by dual-tasking, indicating utility of this approach. The next study instruments the tests with inertial sensors to enable precise motion analysis. Key deficits in turning, transitions and gait are identified in stroke survivors using features like trunk sway and velocities. Dual-tasking disproportionately worsens their performance, stressing limited cognitive-motor resources. A machine learning model using a test battery of instrumented clinical tasks under single and dual-task conditions is then developed to classify fall risk. Random forest model with two features related to medio-lateral sway during dual-task balance and gait speed achieves 91% accuracy. Analysis of sensor configurations finds a single thorax sensor effectively captures fall risk biomechanics. The model could be applied to assess rehabilitation exercises, demonstrating feasibility of tracking risk over time. In conclusion, the dissertation presents wearable sensor-based movement analysis and machine learning models as a quantitative framework for objective fall risk assessment in stroke survivors. Dual-task testing enhances sensitivity. A single thorax sensor capturing key metrics during clinical tests can efficiently evaluate risk. This could assist clinicians in prescribing interventions and tracking rehabilitation progress. With further validation, the approach may be translated to point-of-care screening and remote monitoring to improve prevention and quality of life after stroke.

Library of Congress Subject Headings

Falls (Accidents)--Prevention; Cerebrovascular disease--Patients--Health and hygiene; Machine learning; Motion detectors

Publication Date

12-2023

Document Type

Dissertation

Student Type

Graduate

Degree Name

Mechanical and Industrial Engineering (Ph.D)

Department, Program, or Center

Mechanical Engineering

College

Kate Gleason College of Engineering

Advisor

Ehsan Rashedi

Advisor/Committee Member

Katie McConky

Advisor/Committee Member

Mary Dombovy

Campus

RIT – Main Campus

Plan Codes

MIE-PHD

Download

Share

COinS