th
THE 9 INTERNATION
NAL SYMPOSIUM ON ADVANCED TOPICS IN ELECT
May 7-9, 2015
Bucharest, Romania
Wearable Systtem for Gait Assessmennt during
Physicaal Rehabilitation Process
Octavian Postolache1, Senior
S Member IEEE, Pedro Silva Girão2, Senior Mem mber IEEE,
3
José M. D. Pereira
P , Senior Member IEEE, Gabriela Postolache4
1
Instituto de
d Telecomunicações/ISCTE-IUL, Lisboa, Portugal
2
Instituto dee Telecomunicações/DEEC-IST, UL, Lisboa, Portugal
3
Institutoo de Telecomunicações/EST/IPS Setúbal, Portugal
4
Insttituto de Medicina Molecular, Lisboa, Portugal
opostolache@lx.it.pt, joseper@est.ips.pt, psgirao@ist.utl.pt, gpostolache@
Abstract- A system for gait assessment baseed on smart insoles
instrumented with flexible sensors as part of ZigBee network
nodes and Bluetooth inertial measurement nodes is presented.
The system was developed to objectively reecord and measure
ground reaction force, acceleration and direcction of feet in order
to provide information to physiotherap pists for objective
evaluation of rehabilitation effectiveness. Gaait characterization
is made using time domain and time-frequen ncy domain analysis
of the signals. A small, light and portab ble wireless sensor
network for quantitative gait impairment measurements in a
more natural environment was designed.
work, piezoresistive
Keywords: wearable wireless sensor netw
sensors, gait analysis.
INTRODUCTION
Gait analysis is mainly carried out by visual observation
or using laboratory-based instruments suuch as laboratory
video/optical cameras, floor sensors, senssors placed on the
body or integration of these technologies. Such technologies
are designed mainly for hospital and laborratory research and
are expensive both in equipment and personnel p support.
Moreover, these gait lab technologies have h limitation of
exploring the impact of type of surface onn gait alteration or
examining gait on ample walking distancees. It is also known
that when a patient is examined in a specially arranged
environment the motor performance may not n be the same as
that in a more natural environment such as home or daily
environments. Evidence on gait patterrn changes when
subjects walk outside a gait laboratory environment was
published [1]. It is the gait in everyday lifee that matters most
to evaluate whether a treatment is eff ffective or not in
improving patients' movements. Thus, it is definitely
desirable the usage of technologies foor long term gait
monitoring able: to identify adverse rehabbilitation outcomes,
as well as risk factors associated with poor outcome; to
provide and share information for indiividuals with gait
impairments, their family and friends, andd physiotherapists;
to allow in-home physiotherapy tailored specifically to the
patients’ needs, functioning and disabbility; to increase
effectiveness of various interventionns provided by
physiotherapists.
Recently, technology development haas produce motion
and position sensors small in size and low weight, with
wireless communication suitable for easyy and reliable gait
assessment and monitoring of subjects outside a gait lab.
E
978-1-4799-7514-3/15/$31.00 ©2015 IEEE 321
TRICAL ENGINEERING
@fm.ul.pt
New systems and algorithhm based on accelerometers
[2,3,4], gyroscopes [5,6], inertial measurement units
[7,8,9,10], force sensors [11, 122], GPS [13], smartphone apps
[14], Kinect [15,16], TelosB seensor motes [17], cardioid and
omni-directional microphones attached
a in pairs to walls [18],
radar [19,20] or laser technollogy [21] were designed and
presented for gait analysis. Thhe challenge is multiple. An
easy-to-use system for out of the lab or clinics gait
monitoring should: be simple and a quite often limited in the
number of sensors for monitoriing of various gait parameters;
include signal acquisition and processing for elimination or
interference reduction of environmental and
psychophysiological variablees on gait parameters
measurement; provide understtandable presentation of the
data. Wearable sensor systemss need to be easy to put on
without feeling cumbersome duuring activities nor sensitive to
likely variations on daily wearinng after taking off frequently -
a video based system often posses intrusion on privacy and is
difficult to install to monitor vaariety of activities in different
locations. Safety use and meeasurements, the cost of the
system and technology accessibbility are also issues that must
be addressed.
This paper presents the initial design of a low cost
hardware and software plaatform developed with the
integration of a user-friendly graphical
g user interface (GUI)
which facilitates the real time acquisition
a of ground reaction
force, acceleration and directtion of feet, and automatic
detection representation of gaiit impairments. The paper is
organized as follows: Sections II I and III present the hardware
and the software parts of the meeasurement system; Section IV
describes the experimental testss performed; Section V and VI
present several experimental ressults and conclusions.
SYSTEM HARDWARE
A
Fig. 1 shows the system impplemented for gait monitoring.
Each insole includes three flexible piezorezistive force
(FlexF) sensors, a resistance to voltage converter and an
Atmel microcontroller platform m having a 10 bits analog to
digital converter. Two requirem ments were considered when
FlexF sensors were disposed on the insole: extraction of
meaningful values of forces associated
a with gait, and gait
information representation usinng a reduced number of forces
sensors.

Fig. 1. Gait Assessment System Block Diagram: FleexF SensM - Flexiforce
sensing module; F_AcqC - force acquisition and coommunication module;
Shim3IMU - Shimmer 3 inertial measurement unit; FAss Coord - Force
Assessment Network Coordinator; end nodes of the network - Fright node
and Fleft node.
The human gait involves unique paatterns called gait
phases, namely stance and swing phase ussually divided into
eight functional patterns developed by the Rancho Los
Amigos gait analysis committee, as:
1) Stance phase: initial contact, loading ressponse, mid stance,
terminal stance, pre swing;
2) Swing phase: initial swing, mid swing, teerminal swing.
The FlexF sensors were placed underneatth the calcaneus, the
head of the 1st metatarsal and the head of the 4tth metatarsal. During
3D gyroscopes, and 3D magnetom meters. The Shimmer module is
based on a 24MHz MSP430 CPU C and includes a Bluetooth
transceiver, being the overall pow
wer consumption of the module
very low.
A. Insole Sensing Module
The implemented smart insooles include sets of ultra-thin,
flexible, 445N measuremennt range Flexiforce A201
piezorezistive sensors. Metrollogical characteristics of the
used FlexF sensors are: lineariity error ±3%; repeatability
±2.5% of full scale; hysteresis < 4.5 % of full scale. Before
the implementation of the insole sensing module, tests were
done for static and dynamic chharacterization of the sensors.
Tests were performed usingg a pneumatic cylinder, a
pneumatic tester with accuracy of about 0.7 kPa (0.1 psi) for
a measuring range between 0 annd over 200 kPa (30 psi), and a
precision balance with 20 g accuracy. The pressure was
applied over the FlexF sensor using
u a double acting compact
cylinder operating in a pressuree range between 100 and 1000
kPa. A static characteristic of thhe FlexF sensor experimentally
obtained is presented in Fig. 3.
It is important to underline that during calibration a thin
elastomer was inserted betweenn the sensing area of the FlexF
sensor and the pneumatic cyllinder piston rod in order to
provide a uniform pressure distrribution over the sensitive part
of the sensor. In Fig. 4 is represented the dynamic response of
FlexF sensor when 2 differentt thicknesses of polyurethane
rubber were applied over the FlexF F sensing area. From the
curves that are represented in Fig.
F 4, it can be concluded that
even if an excessive polyurethhane rubber thickness is used
(e=3 mm), the time constantt (τ) associated with FlexF
resistance variations does noot impose significant delays
relatively to the dynamic variations of the kinematic
parameters that are associatedd with walking. Contact force
variation during gait is exppressed by the variation of
resistance of the FlexF sensors. Taking into account the
necessity to convert this variaation into voltage variation to
be acquired by the F_AcqC nodes n attached to each leg, a
three channel resistance--to-voltage converter was
implemented.

5
Conductance (uS)

Fig. 2. Fundamental gait phases. Top view: repressentation of leg and foot
position; bottom view: foot contact regions. 1

walking, the sensors signals peak in sequennce as the center of 0

0 2000 4000 6000
0 8000 10000 12000 14000
pressure in the foot moves from the heel to thhe toe, thus allowing Foorce (g)
identification of the sub-phases of stance. Two inertial
i measurement
units (IMUs) from Shimmer for acceleration and a direction sensing Fig. 3. FlexF sensor static characterisstic
were included in the system. The IMUs includee 3D accelerometers,

322

Fig. 4. FlexF sensor dynamic characteristic
Each converter is expressed by a resistive voltage divider
connected to a follower based on operational amplifier
(LM324) (Fig. 5).
B. Acquisition and Wireless Communication Module
Fig. 5. FlexF sensor conditioning circuit (Vref-3.3V provided by
microcontroller platform, FlexF-flexiforce sensor, Rref-reference
resistance).
In order to acquire and transmit the force variation during
the gait tests, an acquisition, primary processing and wireless
data communication module was designed and implemented.
An ATmega328P board (Arduino FIO) powered by a 3.7V
battery was used. The component of device for recording
ground reaction force during gait is shown in Fig. 6.
The used microcontroller ATmega328P is a high-
performance Atmel picoPower 8-bit AVR RISC-based
microcontroller characterized by 10 bits ADC and 8MHz
CPU clock. This device achieves throughputs approaching 1
MIPS per MHz, balancing power consumption and
Fig. 6. Force Sensing Insole connected to the conditioning circuit and the
acquisition and wireless communication module (Arduino FIO) powered
by a 3.7V battery.
323
processing speed. The module memory includes 1kB
EEPROM, 2kB SRAM and 32kB FLASH. In the considered
system two acquisition and wireless communication modules
were implemented each with three force measuring channels.
The communication between the network end nodes and
the coordinator is done through ZigBee wireless
communication protocol. Each end node includes an XBee®
802.15.4 module coupled to each Arduino FIO platform and
one XBee modem is connected to the Gait Assessment Base
Station through XBee to USB interface. In this case the base
station works as coordinator for the implemented ZigBee
wireless network. A remote control, data storage and
advanced processing software was developed in LabVIEW
and implemented at the base station level.
SYSTEM SOFTWARE
The data coming from the implemented star topology with
two end nodes and a coordinator characterized by XBee
wireless communication and USB port connected to a host
laptop computer is online processed to extract information on
normal and abnormal gait. Local processing of the acquired
data and wireless data communication are based on
IEEE802.15.4 protocol performed by XBee wireless modem.
The laptop software developed in LabVIEW includes ZigBee
(for communication with smart insole) and Bluetooth (for
communication with Shimmer module) data exchange
software modules that were developed using the Arduino and
Shimmer software drivers. In the ZigBee network, the
coordinator is USB connected to the base station that uses the
F_AcqC (node1 and node2) radio address to target messages
for delivery. It is responsible for administering address and
forming and managing the network that includes, in this case,
only two end nodes. The F_AcqC nodes search for the
coordinator and exchange handshake information at startup.
The configuration of the ZigBee network was done using X-
CTU software from Digi, an XBee – USB adapter being used
to configure the coordinator and XBee end-nodes radio
modem. Once configured, a firmware component was
developed and implemented at the end nodes level. The
voltages associated with the forces measuring channels
(F.Left1, F.Left2, F.Left3 and F.Right1, F.Right2 and
F.Right3) are acquired and the values delivered through
ZigBee to the network coordinator that assures the graphical
representation, processing and storage. The GUI includes
different tabs, one related to ZigBee-USB adapter setup and
data storage path configuration, save action setup, gait test
duration. A second tab is associated with on-line force data
visualization and on the third tab is included the visualization
of the stored data and off-line data processing.
For simultaneous force–acceleration tests a fourth tab for
acceleration and gyroscope data visualization was included.
The data is acquired using programmed Shimmer 3 IMUs that
deliver the values of acceleration through Bluetooth
connection. The graphical user interface developed in
LabVIEW is presented in Fig. 7. The LED buttons indicate
when force sensors are activated. Signal from each force
sensor are represented. Also, information on phase lag
between right and left stance phase are represented through
graphical representation of VFr1 and VFl1, VFr3 and VFl3.
Time domain and time-frequency domain signal processing
modules were implemented in LabVIEW. Step length, stride
length, cadence, speed of gait were analyzed. Changes in gait
pattern are represented using Poincaré plot (where time
interval between two successive steps is plotted against next
time interval of two successive steps) and short time Fourier
spectrogram.
The gait pattern is visualized through the spectrogram of
the foot forces signals, where the spectrogram is performed
using short-time Fourier transform (STFT). STFT provides
time-frequency representation and is defined by:
ஶ signals were acquired at a rate of 20 S/s. Fig. 8 shows the
ܵܶ‫ݎܶܨ‬ሺ‫ݐ‬ǡ ݂ሻ ൌ ‫ି׬‬ஶ ‫݆ݏܨ‬ሺ‫ ݐ‬൅ ߬ሻ‫ݓ‬ሺ߬ሻ݁ ି௝ଶగ௙ఛ ݀߬
where t is time, f is frequency, Fsj is the acquired force signal
(s-foot id, l-left or r- right, j-insole force sensor order j=1..3,
Participants were asked to walk at their comfortable pace
along a pre-defined 10 meters path, in indoor conditions.
After confirming the comfort of the subjects, they were asked
to perform normal gait, and after this with left and right leg
dragging. Foot dragging can be caused by inadequate muscle
stimulation required for maximum knee flexion during swing
phase. Low knee flexion during swing phase results in foot
dragging on the ground when walking. Signal from force
sensors and from IMUs sensors were acquired, stored, and
displayed during gait (see Fig. 7).
A practical approach concerning the usage of different sliding
windows (e.g. Hanning, Hamming, Blackman) for gait
signature extraction through smart insole system was carried
out. Good results were obtained for the Hanning window.
EXPERIMENTAL TESTS
Several tests were done with the implemented system for
normal and abnormal gait with 6 healthy subjects.
Participants were asked to walk at their comfortable pace
along a pre-defined 10 meters path, in indoor conditions.
After confirming the comfort of the subjects, they were asked
Fig. 7. Gait Assessment GUI (F_r1, F_r2, F_r3, F_l1, F_l2, F_l3 – contact
force signaling LEDs; VFr1, VFr2, VFr3, VFl1, VFl2, VFl3 – voltage signals
associated with force variation at the foot-floor contact).
324
to perform normal gait and after this with left and right leg
dragging. Foot dragging can be caused by inadequate muscle
stimulation required for maximum knee flexion during swing
phase. Low knee flexion during swing phase results in foot
dragging on the ground when walking. Signal from force
sensors and from IMUs sensors were acquired, stored,
displayed during gait. Gait analysis using information on step
length, stride length, cadence, speed, Poincaré plot and short
time Fourier spectrogram was carried out.
RESULTS AND DISCUSSIONS
The force signals evolution during normal walking from right
and left foot force signals (VFr1, VFr3 – right foot forces;
VFl1, VFl3 - left foot forces) are represented in Fig. 8. The
(1) periodicity of the signals and their reduced variation
amplitudes, underlining the reduced variations of the contact
force and degree of symmetry between left and right foot
movement.
The change in pattern of force signal during abnormal gait
3
2,5
2
1,5
1
0,5
0
-0,5
20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
Time(s)
Fig. 8. The force voltage signals variation for normal gait from metatarsal
and calcaneus area (VFr1 – right force signal in purple , VFl1- left side force
signal in magenta, VFr3 – right force signal in orange, VFl3 – left force
signal in yellow).
can be observed in Fig.9, where Fig. 9a. represents the force
signal that resulted from right leg support and left leg
dragging while 9.b. corresponds to left leg support and right
leg dragging in simulated foot dragging. More time interval in
initial contact and stance phase knee flexion as well as more
amplitude of the signals from calcaneus region can be
observed in an example of right leg support and left leg
dragging represented in Fig. 9a. A higher variation in signals
amplitude can be observed when right foot was dragged.
The Poincaré plot is used to visualize the differences between
left and right movement of legs as well as to identify changes
between normal and abnormal gait. In Fig. 10 changes in
distribution of steps variation in normal (Fig. 10a) and left
foot dragging (Fig. 10b) are represented using Poincaré plot.
Less variation in foot step time intervals in the right foot and
in normal walking can be observed in comparison with left
foot in normal walking and left foot dragging walking.
The spectrogram signature of the left and right force signals
from left (Fl3) and right (Fr3) sensors are presented in Fig.
11. It can be observed that normal gait is characterized by less
time-frequency and energy variation in signals from
calcaneus areas than abnormal gait. The spectrograms show
 that the left leg dragging can be characterized by lower
frequencies values - lower step cycle and cadence- irregular
distribution of maximum spectral power and higher values of
spectrogram energy (orange-red represented) that reflect
lower speed walking and more time spent in support gait
phase.
2,5

1,5

0,5

-0,5
20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
Time(s)

a)
3

2,5

1,5

0,5

-0,5
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Time(s)

b)
Fig. 9. The force voltage signals from metatarsal and calcaneus area for
simulated foot dragging (VFr1 – right force signal in purple, VFl1- left force
signal in magenta, VFr3 – right force signal in orange, VFl3 – left force
signal in yellow): a) right leg dragging; b) left leg dragging

Fig.11. STFT spectrogram gait signature associated with Fr3 and Fl3 insole
sensors in normal (top) and abnormal (bottom) gait.

a) b)
3

2,5

1,5

0,5

-0,5
Fig.10. Pointcaré plots: normal gait (top), left leg dragging(bottom) 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
Time(s)

c)
During monitoring of feet force signals simultaneous Fig.12. Gait assessments based on Shimmer accelerometers and flexible force
acquisition of the accelerations were carried out. The sensors. a) left leg; b) right leg (ax – blue line, ay-red line, az-green line); c)
acquired x, y and z acceleration components are represented force voltage signals from right and left foots during the dragging test (VFr1,
VFl1,VFr3, VFl3 voltage signals associated with force measurement
in Fig. 12. Using the IMUs, information on acceleration, channels).
speed gait and direction can be obtained as well as
information on swing phase of gait whereas information on

325
stance phases of gait is directly obtained through force signal
acquisition. Thus, a thorough description of gait phases can
be obtained.
CONCLUSION
In the present work a set of wearable smart sensing nodes that
include flexible piezoresistive sensors with acquisition and
ZigBee wireless communication modules is presented. The
data from the sensing nodes are represented in time domain
and time-frequency domain for normal and abnormal gait
characterization. The results underscore the potential of the
designed and implemented system to objectively characterize
the gait changes during a rehabilitation process and for
monitoring user mobility activities in daily life. High gait
variability associated with gait impairments requires wearable
systems for analysis of a higher number of strides which may
provide a more stable estimation of mean values changes in
gait during physiotherapy.
ACKNOWLEDGMENT
This work was supported by the Instituto de Telecomunicações and
Fundação para a Ciência e Tecnologia - project EHR-Physio:
Electronic Health Records-Needs, Requirements and Barriers in
Physiotherapy, PTDC/DTP-DES/1661/2012. Additional support for
performed research was provided by IT-IUL/ISCTE-IUL.
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