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Instrumented insole for weight measurement of frail people

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 Instrumented insole for weight measurement of frail
people
Eric Campo Yoann Charlon
CNRS, LAAS, 7 avenue du Colonel CNRS, LAAS, 7 avenue du Colonel
Roche, F-31400 Toulouse, France Roche, F-31400 Toulouse, France
Université de Toulouse, UT2J, LAAS, +33 561336426
F-31100 Toulouse, France charlon@laas.fr
+33 561337961
campo@laas.fr
ABSTRACT
In this paper, we describe an instrumented shoe insole designed to
collect the weight data of a person during his or her daily
activities. This research is within a more global project about new
wearable systems for monitoring human health status. The work
presented compares two solutions: one based on a force-sensing
resistor and another one on a pressure sensor. This paper
describes the insole device that integrates specific sensors to get
weight data and the test bench developed to characterize their
performances. The first results show that a 1kg weight change can
be obtained which is perfectly meets the needs of healthcare
professionals.
Categories and Subject Descriptors
J.2 [Physical Sciences and Engineering]: Electronics
General Terms
Design, Experimentation.
Keywords
Frail people, weight measurement, smart insole, electronic design,
wearable systems, force sensor resistor, pressure sensor.
1. INTRODUCTION
Measuring and monitoring one’s own personal data has become
more and more essential for people. Indeed, with the rapid
development of connected objects and smartphones, everyone can
analyze their gait, weight, sleep or health data for rehabilitations,
sports and daily behavior monitoring [1]. In the context of
population aging [2], the possibilities provided by the information
and communication technology, especially by the connected
objects, are numerous and give good perspectives for improving
the quality of care and for giving better autonomy to the elderly
[3]. Helping frail people to stay at home in safe conditions is an
identified target in the current health policy of modern societies,
which tends to detect or prevent the loss of autonomy. Frailty [4]
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requires prior specific permission and/or a fee. Permissions@acm.org.
Petra’15, July 01 – 03, 2015, Corfu, Greece
© 2015 ACM. ISBN 978-1-4503-3452-5/15/07…$15.00
DOI: http://dx.doi.org/10.1145/2769493.2769525
Damien Brulin
CNRS, LAAS, 7 avenue du Colonel
Roche, F-31400 Toulouse, France
Université de Toulouse, UT2J, LAAS,
F-31100 Toulouse, France
+33 561337960
brulin@laas.fr
is a syndrome demonstrated by a higher vulnerability to stressors
and is responsible for an increased risk of major negative health-
related events, including disability. Numerous factors link the
concept of frailty to physiological and clinical indicators (e.g.,
gait speed, physical activity, loss of weight, etc.). Appropriate
technological solutions such as devices worn by the people
directly on their own body or integrated on a garment or clothes
could allow a precise measurement of physiological parameters.
Therefore, the design of a wearable device must meet certain
requirements, such as low intrusiveness, high energy
independence, the reliability of measurements during activity and
a good acceptance by the user [5]. These systems must be well
designed to fit the needs and requirements of health professionals
and users [3]. Here we are interested in one of the five criteria
proposed by Fried [4] to follow frailty: the measure of weight
change. Among the different possible sensors, we have compared
two solutions: one based on a force-sensing resistor and another
one on a pressure sensor through a specially designed test bench.
The object used to implement the electronic device is an insole.
The paper is organized as follows: Section 2 describes the
different devices that currently exist or are being researched for
measuring plantar pressure. Section 3 gives a description of the
two solutions retained. Section 4 shows the test bench and
comparative results. Section 5 ends the paper with a conclusion
and gives some perspectives.
2. PLANTAR PRESSURE SENSORS
2.1 Devices proposed in literature
This section intends to present and compare various mobile
systems for measuring plantar pressure with pressure-force
sensors in order to justify our sensor choices for the insole
development. Plantar pressure systems can be classified into two
types of systems. One is incorporated into shoes or insoles that
contain sensors that read how well a person is balancing (F-
Scan® Tekscan, Moticon or iShoe systems) to gather information
for doctors and get people to a specialist before they fall. The
other is a platform system used for both static and dynamic studies
that integrates a pressure-sensor array that covers more- or less-
extended surfaces (Pedar© Novel or Parotec® Paromed systems)
[6]. The sensors are often flexible and are incorporated into the
shoe so that the measurements reflect the contact between the foot
and the shoe. These systems are highly recommended in orthotics
studies and shoe designs, but there is the risk that the sensor could
slide. Sensors should be fixed appropriately to prevent slippage
and ensure reliable results. Another limitation is that the spatial
resolution of the data is low compared to plantar pressure-
measurement platforms, due to the reduced number of sensors. 2.2 Pressure sensors
Most of these systems are often divided into two parts: an
integrated part in the shoe or sole that contains the pressure 2.2.1 Resistive sensors (FSR)
sensors and an external module that processes, stores or transmits FSR sensors behave like a resistor whose value varies with the
the data with a wire or wireless connection. The most common force being applied to its surface. Several technologies can be
applications of this type of system are as follows: Podiatry, gait used, and sensors are widespread in the industry. The most current
analysis, stabilometry, medical monitoring of athletes, FSRs are those based on conductive polymers [10], but there are
rehabilitation, advice on the choice of shoes, support for the also FSRs using piezoresistive materials [11] and FSRs based on
implementation of an orthopedic insole and biomechanics. carbon nanotubes [12]. Most research projects using FSR sensors
Advanced research projects include the PIMU system [7], which use a Flexiforce sensor from Tekscan [8] or from Interlink
combines a pressure sensor with a high spatial resolution (1248 Electronics [10] [13]. An FSR requires a relatively simple
hotspots) and an IMU (inertial measurement unit). The IMU interface and can operate satisfactorily in moderately hostile
combines an accelerometer, a gyroscope and a magnetometer environments. The advantages of FSRs are their size (the
which samples the three spatial dimensions up to 512 Hz. The thickness is typically less than 0.5 mm), low price and good
pressure sensor combines approximately 1.300 FSR (Flexible resistance to shocks. They are more suited to natural walking
Sensor Resistance) in a matrix array manufactured by Tekscan [8]. (thin, light and flexible) [6]. However, the FSR is damaged if
This system facilitates the detection of many situations in real pressure is applied for a long time (several hours). Other
time with an accuracy higher than 99%: the difference between disadvantages are their low accuracy (up to 10% or more) and the
sitting and standing, walking and climbing stairs, etc. It has an non-linearity of the resistance; although simple electronic circuits
autonomy range of up to 14 hours. Another interesting system is could allow for a linear output.
SmartInsole [9]. This is a wireless system for measuring physical
activity and gait that is integrated inside a sole. It uses FSR 2.2.2 Piezoelectric sensors
pressure sensors and an accelerometer to monitor the movements This type of sensor produces a voltage in response to pressure.
of the wearer. Five pressure sensors are positioned at key contact Piezoelectric devices have a high impedance and are therefore
points to measure the forces applied to these points. The susceptible to electrical interference, which leads to a poor signal-
accelerometer is used to measure the dynamic acceleration to-noise ratio. The most suitable material for clinical applications
resulting from movement. When all the values from the sensors for measuring body pressure is PolyVinyliDene Fluoride (PVDF),
are zero for a fixed period of time (set to five minutes), the because it is flexible, thin and deformable [14]. Sensors of this
SmartInsole is inactive and the system is in power-saving mode. type presented in the literature show good repeatability and good
Finally, in-shoe sensors are better for ensuring a natural gait linearity with a sufficient measuring range (680 kPa and 450 kPa).
compared to platform systems. Table 1 shows the recent industrial
or research systems for the plantar pressure measurement related 2.2.3 Capacitive sensors
to the technology used. These systems utilize capacitive, resistive, These are capacitors whose capacitance varies with the applied
piezoelectric or piezoresistive sensors. These sensors provide an force. A change in capacitance can be induced by a change of the
electrical signal output (either voltage or current) that is permittivity of the environment between the plates, the variation
proportional to the measured pressure. of the distance between the plates or the surface variation. They
are adapted to natural walking (thin, light and flexible) and are
Table 1. Technology used for measuring plantar pressure. inexpensive. Electronic implementation is simple; it is a passive
component to be integrated into an electronic board without the
Number Sample Measure
Device Type of Technology frequency range need to compensate for temperature drifts. However, some
sensors (Hz) (KPa) limitations have been noted in publications in terms of lifespan
Pedar Novel Shoe 99 Capacitive / 1200 and the difficulty of calibrating the sensors. In addition, certain
performance criteria need further improvement, including non-
Parotec Insole 24 Hydrocells 250 625 linearity, repeatability and low load detection [14].
F-Scan Shoe 960 FSR/PZR 500 1034
2.2.4 Textile sensors
Moticon Insole 13 / 100 400 These are conductive materials sewn onto a fabric. They measure
the change in resistance or capacity of the conductive mesh during
iShoe Insole 6 FSR/PZR / 1642
deformation to calculate the strength. Many types of textile
3-axis force Under sensors can be found in the literature [15]. Textile sensors use a
1 Optical / /
sensor shoes
In-Sole
mesh coated with silicon containing carbon as a strain-sensing
Insole / MEMS 1024 103 element [6] [16]. Advanced features are good durability (100,000
MEMS
PIMU Insole 1300 FSR 120 /
cycles and over), a pressure range compatible with walking (10 to
800 kPa), good accuracy, repeatability and reasonable deviations
SMART (below 5%). However, the measurements are non-linear and the
Insole 5 FSR / /
INSOLE
hysteresis is significant.
PZR/ITRI Insole 83 FSR/PZR / 2540
Flexible
Insole 64 FSR/PZR 2000 2000 2.2.5 MEMS sensors
insole
There are several sensors in the literature [6] [17] for measuring
Textile Insole 6 Textile 100 800 weight with high measurement ranges and good linearity.
i-SMART Moreover, they are easy to implement in a sole. MEMS pressure
Shoe 3 Piezoceramic / /
ShoE II sensors have many advantages, such as easy communication with
the electric elements in semiconductor chips, small size, low We can therefore consider that the pressure should not exceed 20
power consumption, low cost, high reliability and greater mbar in a tube of 2 mm. An absolute resolution of 100 g seems to
precision. be acceptable to detect a relative variation of 1 kg of weight of the
person on a small area (heel). Figures 1 and 2 present the sensor
2.2.6 Optical sensors integration in a sole.
These sensors measure the intensity of light between two points
when a force is applied. The path of light is modified, and we can
measure the value of the force from the change in light intensity.
Articles [18] [19] in which the sensors are presented do not
exhibit the characteristics of interest. We can see that they are still
somewhat linear and accept a small measuring range (<50 N). In
addition, they have a low life duration and are quite cumbersome.

2.2.7 Atmospheric pressure sensors Figure 1. Flexiforce sensor integrated in sole.

It seems possible to use air pressure sensors to measure several
parameters of walking, weight bearing, balancing and the phase of
walking for clinical rehabilitation applications. The measuring
unit is carried out using a winding of flexible silicone tubing that
has one end connected to an atmospheric pressure sensor. The
other end of the tube is sealed with an epoxy adhesive, thus
forming a closed circuit containing air. When the foot presses the
silicone coil, the deformation causes a variation in pressure in the
tube, which is measured by the sensor pressure [20].

2.2.8 Hydro-cell sensors Figure 2. Atmospheric sensor integrated in sole.

The hydro-cells (3D force sensors) of the Paromed company
(Gmbh, Germany) measure the vertical forces, shears and The position and the number of sensors to be placed in the sole
discharge of the foot (inverse of loading) for diabetic subjects. strongly depend on the application. Systems whose purpose is to
This piezoresistive sensor associated with a Wheatstone bridge is precisely monitor the distribution of plantar pressure use a
integrated in a capsule filled with an incompressible fluid. pressure-sensor network covering the entire sole so as to recover a
Whatever direction of action is forced on the hydro-cell, the plantar pressure map with good resolution. In our application, we
pressure generated in the aqueous medium is identical in each have instrumented the insole with only one sensor each to
point. This sensor has a high performance and preserves the compare the performance.
comfort of the sole (cell filled with liquid), but its high price
remains an obstacle (3,500 euros) [6]. 3.1.2 Electrical conditioner of sensors
Figure 3 gives the electrical scheme to increase the measurement
2.2.9 Sensor load cells range of the FSR sensor.
The miniature load cells seem to be an interesting alternative in
terms of robustness and performance [21]. Indeed, it is a strain
gauge associated with a Wheatstone bridge that is totally
encapsulated in a rugged, miniature metal package. These sensors
have a good linearity, drift and limited hysteresis (<5%).
Furthermore, they are robust. The major drawback is related to the
comfort of the shoe, because rigid elements need to be placed
around these cells. In addition, the height of the sensors is greater
than 3 mm. Moreover, the cost of a cell is relatively high (200 to
700 euros).
Figure 3. FSR sensor from Tekscan.
3. SENSOR CHOICE
Figure 4 gives the electrical scheme to get the output voltage for
3.1.1 Comparative analysis the atmospheric pressure sensor.
After a comparison of the different systems and types of sensors,
we have selected two sensors that we propose to compare: a
Flexiforce sensor from Tekscan (A401 FSR type) [8] (price of 20
euros) and an atmospheric sensor from Measurement Specialties
(MS4525-1PSI type) associated with a silicone tube [22] (price of
100 euros). The reason for choosing the atmospheric sensor is to
remain within the thickness of the sole, so the outer diameter of
the tube should be 2 mm. The pressure in this tube is 10 mbar for
68 KgF. We know the maximum forces that may occur during
walking (30 KgF/cm² or 140 kg distributed over 4.7 cm²) [14].
Figure 4. Electronic diagram for atmospheric sensor.
4. WEIGHING SYSTEMS COMPARISON

Signal de sortie du capteur MS4525-1PSI (V)

0,9 0,9

Signal de sortie du système A401 (V)

0,8 0,8

4.1 Development of a test bench 0,7 0,7

We have developed a test bench (see Figure 5) composed of four 0,6 0,6

parts: 0,5 0,5

0,4 0,4

- A test column ES20 [23] that makes it possible to apply a force 0,3 0,3

on the sensor Force appliquée (kgF)

0,2

Force appliquée (kgF)

0,2

- A standard force-sensor calibrated through a conditioner [24]

(a) (b)
- A USB-6008 data acquisition card (National Instruments) [25]
- A computer with an acquisition application developed in Figure 6. Hysteresis tests: A401 FSR system (a); MS4525-1PSI
Labview system (b).

Signal de sortie du système MS4525-1PSI (V)

0,7 0,7

Signal de sortie du système A401 (V)

0,6 0,6

0,5 0,5

0,4 0,4

0,3 0,3

0,2 0,2

Temps (s) Temps (s)

(a) (b)

Figure 8. Repeatability tests: A401 FSR system (a); MS4525-

1PSI system (b).

Figure 5. Overview of the realized test bench. We note that the scales of the curves obtained for the two
The force shall be applied uniformly over the sensors to achieve a solutions are not identical (function "autoscale" enabled). The
measure of reliable strength in a static state. results obtained are as follows:
- Non-linearity: 1.5% for the A401 FSR system and 4% for the
4.2 Characterization tests system MS4525-1PSI
The tests are performed with the test column, the sampling - Hysteresis: 3% for the A401 FSR system and 10% for the
frequency of the data acquisition card is set to 100 Hz and the MS4525-1PSI system
supply voltage of the electronic assemblies is 3 V. Three tests - Repeatability: 97% for the A401 FSR system and 95% for the
were performed for each solution: MS4525-1PSI system
- Non-linearity tests (Figure 6): loading of 50 KgF in 10 sec and Overall, we observed that the two solutions work well with an
then measuring the maximum relative deviation (%) with respect advantage for the A401 FSR solution, especially for hysteresis.
to a linear response Hysteresis is related to the response time of the sensor. The slower
- Hysteresis tests (Figure 7): setting load of 50 KgF in 1 sec the sensor is, the more important the hysteresis is during a fast
(maximum speed of manual test column) and removing the charge load. Thus, we have measured the response time of two solutions
in 1 s, then measuring the maximum relative deviation (%) to a with an oscilloscope, which should be less than 100 ms [26]. The
linear response loading of the weighing system is performed instantaneously with
- Repeatability test (Figure 8): loading of 40 KgF for 10 sec 20 a calibrated weight of 5 kg (weight dropped). The result is 61 ms
times, then calculating the average of each maximum (10 sec) and for the A401 FSR system and 217 ms for the MS4525-1PSI
the maximum relative variation between the average maximum system, which confirms the hysteresis results. Following these
(%) tests, the solution we kept was the A401 FSR system, because this
solution seems more efficient with a low cost. Moreover, the
conditioning electronics are integrated into the thickness of a sole,
Signal de sortie du système MS4525-1PSI (V)

1,2 1,2

unlike the MS4525-1PSI sensor that has to be installed into the

Signal de sortie du système A401 (V)

1 1

0,8 0,8
rear of the shoe.
0,6 0,6

0,4 0,4 Table 2 gives a comparative performance between the two

0,2 0,2
sensors.
0 0

Force appliquée (kgF) Force appliquée (kgF)

(a) (b)

Figure 5. Nonlinearity tests: A401 FSR system (a); MS4525-

1PSI system (b).
 Table 2. Comparative performance between FSR and
atmospheric sensors.
FSR sensor Atmospheric sensor
Linearity + +
Hysteresis + -
Repeatability + -
Integration + -
Cost + +
5. INSTRUMENTATION OF THE INSOLE
5.1 Device integration
The ultimate insole (see Figure 9) is composed of one electronic
device integrating a MC13213 SiP, an ADXL345 accelerometer, a
wireless communication device and the A401 Flexiforce sensor.
The conditioner has been developed with an LT6650 amplifier
connected in a non-inverter with a reference voltage of 0.4 V. The
system was designed to be integrated into the thickness of a
standard sole. The battery is a CR2320 type (135 mAh) that is
welded directly to side of the electronic module by means of two
contactors providing three months of autonomy. A specific
software was developed to store, manage and transmit all data to a
remote computer. The cost of the instrumented insole is estimated
at about 150 euros, less that all commercial systems.
Figure 9. Insole with electronic device and Flexiforce sensor.
This insole is the version selected to perform the tests with several
volunteers. We have embedded an algorithm for measuring the
weight change. The first results of this characterization are
presented in two steps:
- Characterization of the weighing system on a treadmill
- Characterization of the insole to assess its capacity to distinguish
several walking activities.
5.2 Characterization of the weighing system
on a treadmill
The objective of this characterization step is to verify that the
system is able to see a change in weight of 1 kg. The tests were
performed several times by a young man participant on a treadmill
at three walking speeds with a loaded backpack weighing from 0
to 10 kg using a calibrated weight of 1 kg. For these tests, the
device delivers the output voltage of the weighing system to 100
Hz. A Matlab program was used to analyze the raw data. In
established walking conditions, the variation in the voltage level
between each stride can reach up to 7%. To limit the variations,
the maximum has been averaged over 10 strides (variation of less
than 1%).
Figure 10. Characterization of the weighing system for
different gait speeds.
Figure 10 shows that the speed affects the pressures measured at
the heel. For a walking speed set by the treadmill, a pressure
increase is observed when the load in the backpack increases. It
seems possible to observe variations in the order of 1 kg by
placing the sensor in the heel under conditions set by averaging
the maximum of 10 successive steps.
This work in progress focuses on a learning phase of activity in
order to link the pressure measurements with the average walking
speed and stride length. The learning algorithms are based on
supervised or no supervised classification methods according to
the variables considered. The difficulty in ambulatory is to
accurately detect operating conditions to assess the change with
respect to pressures observed during the learning phase. The aim
is to make several statements a day to obtain a daily average. This
daily average could then be compared with the one obtained
during calibration to observe changes over time. A second
complementary track for the learning phase is to add an A401
Flexiforce sensor on the front of the sole for an additional
measuring point. Thus, it seems necessary to have an outpatient
activities-recognition algorithm to measure the weight change in
the best conditions--that is to say, to take the measurement at a
normal walking speed and on a flat surface.
6. CONCLUSION
The goal of this paper was to present the possibility of measuring
weight change with an instrumented shoe insole. We have studied
the main devices existing on the market and in literature, and we
have compared two pressure sensors: a Flexiforce sensor and an
atmospheric pressure sensor. A test bench was developed to
analyze the performance of these sensors. The FSR system seems
to give better results in terms of linearity, hysteresis and
repeatability. The ease of integration into a sole is also better At
the same time, we have developed a wireless electronic device to
control and manage the system. A complete integrated insole was
designed including an FSR sensor. The characterization on a
treadmill in the laboratory allows us to conclude that it is possible
to observe a change of weight up to 1 kg during a walking
activity. However, these results must be deepened. Ongoing works
concern the use of a rechargeable battery by induction and the
implementation of a walking-habits learning software. Subjects
are being recruited to assess the relevance of the sole device, the
 long-term technical reliability and the acceptability of the solution
for the users.
7. ACKNOWLEDGMENTS
The authors thanks the French regional Direccte agency for the
financial support in the Foot-Test project.
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