Creation and Validation of Chronojump-Boscosystem: A Free Tool to Measure Vertical Jumps



Measuring the height of the vertical jump is an indicator of the strength and power of the lower body.The technological tools available to measure the vertical jump are black boxes and are not open tothird-party verification or adaptation. We propose the creation of a measurement system calledChronojump-Boscosystem, consisting of open hardware and free software. Methods: A microcontrollerwas created and validated using a square wave generator and an oscilloscope. Two types of contactplatforms were developed using different materials. These platforms were validated by the minimumpressure required for activation at different points by a strain gauge, together with the on/off time ofour platforms in respect of the Ergojump-Boscosystem platform by a sample of 8 subjects performingsubmaximal jumps with one foot on each platform. Agile methodologies were used to develop and vali-date the software. Results: All the tools fall under the free software / open hardware guidelines andare, in that sense, free. The microcontroller margin of error is 0.1%. The validity of the fiberglass plat-form is 0.95 (ICC). The management software contains nearly 113.000 lines of code and is available in 7 languages.

The effect of extra-load conditioning on muscle performance in athletes

Bosco C, Rusko H, Hirvonen J


Fourteen sprinters were assigned to an experimental group (N = 7) and a control group (N = 7) in order to study the effects of 3 wk of extra-load conditioning. The extra-load conditioning was achieved by the athletes wearing special vests containing weights (7-8% body mass). The vests were used from morning to evening and during 3-5 training sessions/wk for 3 wk. No changes in the ordinary training regime were allowed, except the use of the vest by the experimental group. A jumping test battery and short running test on a treadmill were utilized to measure explosive power characteristics and the anaerobic performance of the subjects. While the control group showed no changes in any of the variables studied, the experimental subjects significantly improved their jumping heights in squat jumps with and without extra loads; their jumping heights in drop jumps and mechanical power output in 15 s of jumps. No changes in lactate levels or in running times to exhaustion were observed in response to the extra-load conditioning. The improvement of jumping performances could be due to a fast neurogenic adaptation to the new requirements.

Effects of inclined treadmill walking training with rhythmic auditory stimulation on balance and gait in stroke patients

Yoon SK, Kang SH


[Purpose] The purpose of this study was to determine if an inclined treadmill with rhythmic auditory stimulation gait training can improve balance and gait ability in stroke patients. [Subjects and Methods] Thirty participants were randomly divided into three groups: inclined treadmill with rhythmic auditory stimulation training group (n=10), inclined treadmill training group (n=10), and treadmill training group (n=10). For all groups, the training was conducted for 4 weeks, 30 minutes per session, 5 times per week. Two subjects dropped out before study completion. [Results] All variables of balance and gait, except for the timed up and go test in the treadmill group, significantly improved in all groups. Moreover, all variables showed a more significant improvement in the inclined treadmill with rhythmic auditory stimulation group when compared with the other groups. Timed up and go test, Berg balance scale, 6 m walking test, walking speed, and symmetric index were significantly improved in the inclined treadmill group when compared with the treadmill group. [Conclusion] Thus, for stroke patients receiving gait training, inclined treadmill with rhythmic auditory stimulation training was more effective in maintaining balance and gait than inclined treadmill without rhythmic auditory stimulation or only treadmill training.

Mobility-related function in older adults: assessment with a 6-minute walk test

Harada ND, Chiu V, Stewart AL


To determine the usefulness of the 6-minute walk test as an integrated measure of mobility in older adults.

Observational study.

Community centers and retirement homes in the Los Angeles area.

Eighty-six older adults without significant disease.


Main outcome measures:
Assessments included the 6-minute walk, chair stands, standing balance, gait speed, body mass index, and self-reported physical functioning and general health perceptions.

One-week test-retest reliability of the 6-minute walk was .95. As hypothesized, the 6-minute walk distance was significantly greater for active than for inactive older adults (p < .0001), moderately correlated with chair stands (r = .67), standing balance (r = .52), and gait speed (r = -.73). It had a low correlation with body mass index (r = -.07). The correlation of the 6-minute walk with self-reported physical functioning was .55, and its correlation with general health perceptions was .39. Self-report and performance measures explained 69% of the variance in 6-minute walk scores.

The 6-minute walk test is reliable and is valid in relation to the performance and self-reported indicators of physical functioning tested in this study. It could serve as a useful integrated measure of mobility.

Are the 10 Meter and 6 Minute Walk Tests Redundant in Patients with Spinal Cord Injury?

Gail F. Forrest, Karen Hutchinson, Douglas J. Lorenz, Jeffrey J. Buehner, Leslie R. VanHiel, Sue Ann Sisto, D. Michele Basso



To evaluate the relationship and redundancy between gait speeds measured by the 10 Meter Walk Test (10MWT) and 6 Minute Walk Test (6MWT) after motor incomplete spinal cord injury (iSCI). To identify gait speed thresholds supporting functional ambulation as measured with the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI).


Prospective observational cohort.


Seven outpatient rehabilitation centers from the Christopher and Dana Reeve Foundation NeuroRecovery Network (NRN).


249 NRN patients with American Spinal Injury Association Impairment Scale (AIS) level C (n = 20), D (n = 179) and (n = 50) iSCI not AIS evaluated, from February 2008 through April 2011.


Locomotor training using body weight support and walking on a treadmill, overground and home/community practice.

Main Outcome Measure(s)

10MWT and 6MWT collected at enrollment, approximately every 20 sessions, and upon discharge.


The 10MWT and 6MWT speeds were highly correlated and the 10MWT speeds were generally faster. However, the predicted 6MWT gait speed from the 10MWT, revealed increasing error with increased gait speed. Regression lines remained significantly different from lines of agreement, when the group was divided into fast (≥0.44 m/s) and slow walkers (<0.44 m/s). Significant differences between 6MWT and 10MWT gait speeds were observed across SCI-FAI walking mobility categories (Wilcoxon sign rank test p<.001), and mean speed thresholds for limited community ambulation differed for each measure. The smallest real difference for the 6MWT and 10MWT, as well as the minimally clinically important difference (MCID) values, were also distinct for the two tests.


While the speeds were correlated between the 6MWT and 10MWT, redundancy in the tests using predictive modeling was not observed. Different speed thresholds and separate MCIDs were defined for community ambulation for each test.

Guidelines for the Six-Minute Walk Test

American Thoracic Society 


This statement provides practical guidelines for the 6-minutewalk test (6MWT). Specifically, it reviews indications, detailsfactors that influence results, presents a brief step-by-step pro-tocol, outlines safety measures, describes proper patient prep-aration and procedures, and offers guidelines for clinical inter-pretation of results. These recommendations are not intendedto limit the use of alternative protocols for research studies.We do not discuss the general topic of clinical exercise testing.As with other American Thoracic Society statements onpulmonary function testing, these guidelines come out of aconsensus conference. Drafts were prepared by two members(P.L.E. and R.J.Z.) and were based on a comprehensive Med-line literature search from 1970 through 2001, augmented bysuggestions from other committee members. Each draft re- sponded to comments from the working committee. The guide-lines follow previously published methods as closely as possi-ble and provide a rationale for each specific recommendation.The final recommendations represent a consensus of the com-mittee. The committee recommends that these guidelines bereviewed in five years and in the meantime encourages furtherresearch in areas of controversy.

The 6-min walking distance: long-term follow up in patients with COPD

C. Casanova, C. G. Cote, J. M. Marin, J. P. de Torres, A. Aguirre-Jaime, R. Mendez, L. Dordelly, B. R. Celli


The 6-min walking distance (6MWD) test is used in clinical practice and research into patients with chronic obstructive pulmonary disease (COPD). However, little is known about natural long-term change in this parameter. The 6MWD was measured at baseline and then annually for 5 yrs in 294 patients with COPD and its annual rate of decline was determined. Forced expiratory volume in one second (FEV1) was also measured and the relationship between changes in both markers was explored. At baseline, the median 6MWD was 380 m (range 160-600 m). It declined by 19% (16 m.yr(-1)) over the 5 yrs compared with baseline in patients with American Thoracic Society/European Respiratory Society stage III COPD (FEV1 30-50% predicted) and by 26% (15 m.yr(-1)) in patients with stage IV COPD (FEV1 <30% pred). Over the 5-yr follow-up, the proportion of patients with a minimal clinically significant decline of 54 m increased with the severity of the disease. It was 24% in stage II, 45% in stage III, and 63% in stage IV disease. In contrast, the rate of decline of FEV1 was greater in patients with milder airflow obstruction and lesser in patients with lower absolute FEV1 values. In conclusion, the 6-min walking distance test provides increasingly useful information as the severity of chronic obstructive pulmonary disease increases.

Are static and functional balance abilities related in individuals with Multiple Sclerosis?

Massimiliano ,Micaela Porta, Giancarlo Coghe, Federica Corona, Giuseppina Pilloni, Lorena Lorefice, Maria Giovanna Marrosu, Eleonora Cocco



In people with Multiple Sclerosis (pwMS), balance assessment is essential in estimating the risk of falls, monitoring disease progression and verifying the effectiveness of rehabilitative treatment. Clinical tools and instrumental techniques are available for testing static and dynamic balance, but the relationship between such abilities is still not clear. Having information about this link would be important in properly planning the type and number of tests to administer.


One hundred and six pwMS (Expanded Disability Status Scale, EDSS 0−6.5) stratified in three sub-groups (Class 1 EDSS 0–1.5, Class 2 EDSS 2–4 and Class 3 EDSS 4.5–6.5) and 42 healthy controls (HC) participated in the study. All underwent static posturography and instrumented Timed-Up-and-Go (TUG) performed using a wearable inertial sensor. Raw data were processed to extract postural sway features, overall duration of TUG and its main sub-phases (i.e. sit-to-stand, 180° turns and stand-to-sit).


All sway parameters of pwMS of Classes 2 and 3, as well as total TUG duration and time necessary to perform 180° turns, were found significantly higher than HC and Class 1 participants. However, poor correlations were found between sway and TUG parameters. When pwMS are grouped, small/moderate correlations (in the range 0.20–0.41) were found between all sway parameters and total TUG duration.


Static and dynamic balance in pwMS appear scarcely correlated, although both worsen as disability increases. This implies that they should be separately assessed using specific tests to have a complete view of postural control performance in MS.

Use of Wearable Inertial Sensor in the Assessment of Timed-Up-and-Go Test: Influence of Device Placement on Temporal Variable Estimation

Stefano Negrini, Mauro Serpelloni, Cinzia Amici, Massimiliano Gobbo, Clara Silvestro, Riccardo Buraschi, Alberto Borboni, Diego Crovato5, Nicola Francesco Lopomo


The “Timed Up and Go” (TUG) test is widely used in various disorders to evaluate subject’s mobility, usually evaluating only time execution. TUG test specificity could be improved by using instrumented assessment based on inertial sensors. Position of the sensor is critical. This study aimed to assess the reliability and validity of an inertial sensor placed in three different positions to correctly segment the different phases in the TUG test. Finding demonstrated good reliability of the proposed methodology compared to the gold standard motion analysis approach based on surface markers and an optoelectronic system. Placing the sensor just beneath the lumbar-sacral joint reported the lower values of deviation with respect to the gold standard. Optimized position can extend the proposed methodology from the clinical context towards ubiquitous solutions in an ecological approach.

The sensitivity and specificity of the Timed "Up & Go" and the Dynamic Gait Index for selfreported falls in persons with vestibular disorders

Whitney, S. L., Marchetti, G. F., et al.


The purpose of this study was to determine the sensitivity and specificity of the Timed "Up & Go" (TUG) and Dynamic Gait Index in identifying self-reported fallers among persons with vestibular dysfunction. One hundred three patient charts were included from a tertiary vestibular physical therapy practice. The patients ranged in age from 14-90 years and had vestibular diagnoses, falls reported in the patient chart, and completed the TUG and/or the Dynamic Gait Index (DGI). Thirty-one persons reported falling one or more times in the previous 6 months during their initial assessment. Persons who took longer than 13.5 seconds to perform the TUG test were 3.7 times more likely to have reported a fall in the previous 6 months. Those persons with scores less than or equal to 18 on the DGI were 2.7 times (p = 0.03) more likely to have reported a fall in the previous 6 months. The sensitivity of the DGI at 18 or less was 70% and the specificity was 51%. People who scored greater than 11.1 seconds on the TUG were 5 times (p = 0.001) more likely to have reported a fall in the previous 6 months. Sensitivity (80%) and specificity (56%) were calculated for TUG scores of greater than 11.1 seconds. The TUG and the DGI appear to be helpful in identifying fall risk in persons with vestibular dysfunction. Slower scores on the TUG (> 11.1 seconds) and lower scores on the DGI (18) correlated with reports of falls in persons with vestibular dysfunction.

Using the Timed Up and Go Test in a Clinical Setting to Predict Falling in Parkinson’s Disease

Nocera, J., Stegemöller, E. L., et al.


Objective:To investigate the ability of the Timed Up & Go test to identify patients with Parkinson’s disease at risk for a fall.

Design:Cross-sectional cohort study.

Setting:Sixteen participating National Parkinson’s Foundation Centers of Excellence.

Participants:A query yielded a total of 2985 records (1828 men and 1157 women). From these, 884 were excluded because of a lack of crucial information (age, diagnosis, presence of deep brain stimulation, disease duration, inability of performing the Timed Up & Go test without assistance) at the time of testing, leaving 2097 patients included in the analysis.

Interventions:Not applicable.

Main Outcome Measures:The primary outcome measure for this study was falls. The chief independent variable was the Timed Up & Go test.

Results:The initial model examined the prediction of falls from the Timed Up & Go test, adjusting for all study covariates. The estimated models in the imputed data sets represented a significant improvement above chance (c2 range [dfZ17], 531.29e542.39, P<.001), suggesting that 74% of participants were accurately classified as a faller or nonfaller. The secondary model in which the question of whether the effect of Timed Up & Go test was invariant across disease severity demonstrated 75% of participants were accurately classified as a faller or nonfaller. Additional analysis revealed a proposed cut score of 11.5 seconds for discrimination of those who did or did not fall.

Conclusions:The findings suggest that the Timed Up & Go test may be an accurate assessment tool to identify those at risk for falls.

How to identify potential fallers in a stroke unit: validity indexes of 4 test methods

Andersson, A. G., Kamwendo, K., et al.


Objective: The aim of this study was to describe general characteristics of patients with stroke who have a tendency to fall and to determine whether certain test instruments can identify fallers.

Methods: Patients treated in a stroke unit during a 12-month period were included. At inclusion assessments were made with Berg Balance Scale Berg Balance Scale, Stops Walking When Talking, Timed Up & Go (TUG) and diffTUG. At follow-up 6 or 12 months later, patients who had fallen were identified.

Results: During the time from discharge to follow-up on 159 patients, 68 patients fell and 91 did not. Fallers fell more often during their initial hospital stay, used sedatives more often and were more visually impaired, compared with non-fallers. The Berg Balance Scale, Stops Walking When Talking and TUG results differed between fallers and non-fallers. The combined results of Berg Balance Scale and Stops Walking When Talking increased the possibility of identifying fallers.

Conclusion: Berg Balance Scale, Stops Walking When Talking and TUG can be used to evaluate which patients have a tendency to fall in order to carry out preventive measures. Berg Balance Scale can be used in all patients. Stops Walking When Talking can give additional information if the patient is able to walk. TUG is a possible choice, but fewer patients can perform it.

Clinical identification of multiple fall risk early after unilateral transtibial amputation

Dite, W., Connor, H. J., et al.


Objective: To examine if previously reported clinical tests of stepping and functional mobility could discriminate between multiple-falling and nonmultiple-falling people with unilateral transtibial amputations.

Design: Nonrandomized prospective cohort.

Setting: Rehabilitation hospital and general community.

Participants: Forty-seven subjects initially recruited and tested at discharge. Forty subjects were retested at 6 months postdischarge and grouped as either multiple fallers (n=13) or nonmultiple fallers (n=27).

Interventions: Not applicable.

Main outcome measures: Four Square Step Test (FSST), Timed Up & Go (TUG) test, 180 degrees turn test, and the Locomotor Capabilities Index (LCI) advanced score.

Results: Significant differences (P<.01) were found between the 2 groups for all of the main outcome measures. The test scores associated with an increased risk of having multiple falls were as follows: TUG test of 19 seconds or more (sensitivity, 85%; specificity, 74%), turn time of 3.7 seconds or more (sensitivity, 85%; specificity, 78%), turn steps 6 steps or more (sensitivity, 100%; specificity, 74%), FSST of 24 seconds or more (sensitivity, 92%; specificity, 93%), and LCI advanced score of 15 or less (sensitivity, 43%; specificity, 91%).

Conclusions: In this study, multiple-falling people with transtibial amputations displayed impaired mobility on the outcome measures reported. These measures offer valuable clinical tests of different and functionally relevant activities and provide good identification of multiple-falls risk.

A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients.

Thomas, J. I. and Lane, J. V.


Objectives: To test the hypothesis that scores on 4 falls risk measures will differ significantly in patients reporting recurrent falls compared with those who do not; and to explore the validity of each measure to predict such falls status.

Design: A convenience sample was tested to establish the sensitivity and specificity of the Functional Reach Test, Timed Up & Go test, one-leg stance test (OLST), and balance subsection of the Performance Oriented Mobility Assessment (B-POMA). A 12-month retrospective falls history was used to identify recurrent fallers.

Setting: A day hospital for the elderly.

Participants: Convenience sample of 30 day hospital patients. The inclusion criteria were: ability to rise from a chair and walk 6m; no severe cognitive impairment or blindness; age 65 years or older.

Interventions: Not applicable.

Main outcome measures: Scores on the 4 tests and retrospective falls histories.

Results: Scores on the B-POMA and OLST showed significant differences between fallers and nonfallers (P<.05). An OLST time of 1.02 seconds or less (odds ratio [OR]=15.2; 95% confidence interval [CI], 1.72-133.95) and B-POMA score of 11 or less (OR=18.5; 95% CI, 2.05-167.79) were predictive of day hospital patients having a history of recurrent falls.

Conclusions: OLST and B-POMA both have potential as screening tools for risk of falls, but this observation requires confirmation in a prospective study.

Clinical assessment of gait in individuals with multiple sclerosis using wearable inertial sensors: Comparison with patient-based measure

Massimiliano Pau, Silvia Caggiari, Alessandro Mura, Federica Corona, Bruno Leban, Giancarlo Coghe, Lorena Lorefice, Maria Giovanna Marrosu, Eleonora Cocco


Background: This study aims to verify the feasibility of use of wearable accelerometers in an ambulatory environment to assess spatiotemporal parameters of gait in people with Multiple Sclerosis (pwMS), as well as the correlation of objective data with patient-reported outcomes.

Methods: One hundred and five pwMS (Expanded Disability Status Scale, EDSS in the range 0–6.5) classified in three sub-groups (EDSS 0–1.5, EDSS 2–4, EDSS 4.5–6.5) and 47 healthy controls (HC) participated in the study. All the subjects were evaluated with the timed 25-foot walking test (T25FW) while wearing a commercially available accelerometer. PwMS also rated the impact of the disease on their walking abilities using the 12-item MS walking scale (MSWS-12).

Results: All parameters objectively measured, except stride length, were significantly modified in pwMS with higher EDSS, with respect to HC and lower disability participants. Moderate to high correlations (r =0.57–0.79) were observed between gait parameters and MSWS-12 for pwMS of higher EDSS. The correlation was found moderate for the intermediate EDSS category (r =0.42–0.62).

Conclusion: Wearable accelerometers are a useful tool for assessing gait performance for pwMS in a clinical setting, especially in cases of mild to moderate disability. Compared with other quantitative techniques, these devices allow patient testing under realistic conditions (i.e., fully dressed, with their usual shoes) using a simple procedure with immediate availability of data.

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