StepSensor - can a sensor-based insole system detect changes in step quality associated with acquired brain injury?

Foot-drop after an acquired brain injury is a frequent challenge often associated with severe injury and affecting up to 30% of stroke patients (Peishun et al. 2021). Relating to biomechanical function of the foot, impeding walking and slowing gait, it results in reduced foot-clearance from the floor during walking, increasing the risk of a fall (Burpee and Lewik 2015). Almost 40% of stroke patients will fall within 1 year of being discharged from hospital (Nyberg et al. 1995). Not only do falls have devastating effects at the time, but can have substantial psychological impact. Indeed, "fear of falling" is the greatest indicator in the stroke population of a higher falls risk (Goh et al. 2016). Falls cost the NHS £2.3bn a year, with this figure expected to rise with an ageing population (NICE, 2015). Through a recent Innovate UK SMART grant, the University of Sheffield has been collaborating with Walk With Path to evaluate the function of a wearable sensor-based system, consisting of smart insoles, a patient facing app and a clinician facing dashboard. The system enables remote monitoring of activity, through the use of accelerometers, gyroscopes and plantar pressure sensors, and empowers individuals to engage with rehabilitation and suggested activity levels. In the current study (n>70; 18-80 yrs, healthy volunteers), we have compared the insole with laboratory-based biomechanical analysis of several activities of daily living including walking, rising from a chair, sitting and carrying a load (Table 1) and have demonstrated the system is capable of detecting key spatiotemporal parameters such as cadence, walking speed and stride length, as well as identifying changes in pressure associated with lifting weight (Fig 2). However, we have not yet used the insole with a patient population, nor have we explored the sensitivity of the insole to detect changes in step quality. Table 1: Accuracy compared with gold standard Fig 1: Pressure interface We aim to contribute to the ongoing rehabilitation and monitoring of patients with acquired brain injury, cutting across both clinical and community environments, aligning with the FAST area of interest Enabling rehabilitation, support and continuing care after brain injury, including return to normal life . The insole system is currently at TRL 4, having been validated in the lab, and this project will bring it to TRL 6, by validating the insole in the select patient group. Walk With Path has carried out iterative testing throughout their development, and have followed co-design processes with over 20 people as part of projects involving both the healthy elderly and people with chronic conditions such as diabetes. Patients have shown a strong willingness to share data with a clinician, when the aim is to improve health and care. The Innovate UK study is currently consulting with public members to explore their perspectives on the use of the insole, including factors such as comfort and frequency of use - and this has contributed to the development of work package 2 in exploring the ease of use, and shoe type for the specific patient group.