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IRAF -Instrument for Movement Analysis of Person Transfer and Mobility in Daily Living

Authors:
Sofia Backåberg at Linnaeus University
Sofia Backåberg
Anna Kimming
Anna Kimming
Anna Kimming
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Peter Kraft
Peter Kraft
Peter Kraft
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Kicki Reifeldt
Kicki Reifeldt
Kicki Reifeldt
  • This person is not on ResearchGate, or hasn't claimed this research yet.
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Abstract

This paper describes the development, purpose and possible use of the IRAF Instrument with an example included.
IRAF Instrument for movement analysis of person transfer and mobili
ty.pdf
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All content in this area was uploaded by Sofia Backåberg on Sep 02, 2020
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IRAF Instrument for movement analysis of person transfer and mobili
ty.pdf
Content uploaded by Sofia Backåberg
Author content
All content in this area was uploaded by Sofia Backåberg on Sep 02, 2020
Content may be subject to copyright.
1
IRAF - Instrument for Movement Analysis of Person Transfer and
Mobility in Daily Living
In Swedish: IRAF - Instrument för RörelseAnalys vid Förflyttning
Introduction
IRAF is an instrument developed to support education, communication and assessment within the field
of safe and gentle person transfers. IRAF encompasses both the level of independence and the
qualitative aspects of the movement performance to clarify the individual’s need of support in daily life
transfers to guide how to provide safe and adequate support, i.e., in what way, how much and in what
stage of the transfer. Additionally, the aim is to create a common language for person transfers among
patients, healthcare providers, family care givers, and teachers within different contexts, such as
hospitals, rehabilitation centres, home care and educational institutions. The IRAF is today a paper-
based instrument and is currently under development in a digital format.
Purpose
The purpose of IRAF is to provide structure for and facilitate the analysis and assessment of an
individual’s mobility in physical activities in daily living to enhance understanding and communication of
an individual’s level of independence (LI) and the quality of movement performance (MP).
Basic ideas
- Contributing to safety and equal assessments of an individual’s mobility in daily living and
providing a specific and detailed overview of an individual’s need for support for person
transfers.
- Describing the most energy effective and gentle movements (“optimal” movements) in daily life
person transfers, which also provides the most efficient and safest support (manual support or
assistive devices).
- Choosing the movements described in the instrument based on a rehabilitative perspective to
enable as much activity by the individual as possible.
Examples of utility
- Providing a specific and structured analysis prior to a rehabilitation period, decision support for
training interventions and/or individual testing/adjustment/subscribing assistive devices.
- Offering a base for prescribing a certain way of person transfer.
- Evaluating the impact of an assistive device.
- Recommending a base for patient care planning.
- Supporting communication amongst health care staff, the patients and their significant
other/relatives to clarify the person’s current functional ability and motivate future goals.
- Offering educational support in teaching ergonomic skills and person transfer knowledge, for
example in Nursing education programs or for Health care staff.
- Providing a detailed and structured overview of an individual’s need for manual support and/or
assistive devices.
2
Development process
IRAF has been developed in collaboration with ORA Sweden (Observational movement analysis
association in Sweden) and HMC Sweden (Hjälpmedelcenter Sverige) by a group of experienced
physiotherapists and occupational therapists with extensive experience with person transfer, assistive
devices, patient rehabilitation, education and research in the field. IRAF has been developed and
evaluated iteratively in a cyclic process by clinically working physiotherapists and occupational
therapists. Currently we are involved in testing the reliability and validity of the instrument.
Pedagogical idea
When learning how to use IRAF the pedagogical idea is to use video feedback and different technical
movement analysis tools to gain awareness about one’s own movement with person transfers, but also
to learn and feel comfortable in using technical tools when using IRAF as support for the analysis. It is
also necessary to provide learning and communication support for the individual.
Description of IRAF
IRAF consists of one Overview and 17 Bases of Assessments (BoA) which provide detailed descriptions
for each of the person transfers. In the overview, only the key movements of the person transfers are
included, and it can be used directly or as a summary of all the 17 BoA. Each base of assessment can be
used separately depending on where assessment is needed. Appendix 1 shows an example (in Swedish)
of one of the BoA’s, the Sit to stand.
The Highest Level of Independence (Highest LI) is assessed in each of the 17 bases of assessment and/or
in the Overview. The Highest LI indicates the individual’s total level of needs for support and resources.
In clinical use of the IRAF, all assessments need not be accomplished at the same time. Sometimes
individuals cannot accomplish the full transfer independently, and then the assessment can be done
when an intervention is necessary, e.g. verbal guiding or use of an assistive device. It is therefore
important to note the date and time for the assessment and also the contextual factors in the note’s
field of the BoA’s and in the Overview.
The gaze and the head’s movement are important in all of the person transfers and the basic idea is that
the movement of the head follows the gaze. The gaze is described in IRAF when it is especially crucial for
the transfer, such as in the rising from lying in bed to bedside sitting.
The Flow in the movements is essential and when the flow is deficient this is to be noted in the Field
notes.
Assessment of Level of Independence (LI)
LI can imply both the assessment of the total level of independence for the whole transfer and different
parts/components.
0 = Independent
1 = Independent with assistive device/devices
2 = Actively with oral/manual guidance
3 = Actively with manual support
4 = Actively with manual support and assistive device/devices
5 = Passively with manual support with/without assistive devices.
- = Not accomplished by the time of assessment
x = N/A
3
Assessment of quality of Movement Performance (MP)
MP refers to the quality of the movement concerning the movement descriptions in the BoA’s.
0 = In accordance with the BoA description, this means that the person performs the movement or
component of the movement according to the description in the BoA and no auxiliary support is needed.
1 = Small deviant from the BoA description, this means that the movement or component of the
movement slightly deviates from the description in the BoA e.g. that there are things in the performance
that can be improved that will make the performance more effective/smooth.
2 = Large deviations from the BoA description, this means that the movement or component of the
movement greatly deviates from the description in the BoA. The performance is ineffective and can
imply a hazard/risk of harm.
Definition of terms
The following terms are used in IRAF and/or during the IRAF course and are defined below as they are
used and understood when using IRAF.
Assistive devices = Things added to enable the transfer. The armrests on a chair and the adjustments of
the bed are considered as assistive devices (e.g. raised head end). Hands that are used to push are not
considered as assistive devices.
Optimal movement/motor control (Optimal rörelse) = Involves coordinated activity in the whole
system; between global/superficial muscles and local/deep muscles (Paul Hodges PT, PhD, Professor).
Optimal movement/motor control is gentle for the body, enables effective force development and
allows for another person to support and facilitate the transfer adequately and gently.
Active push (Tryck) = Accomplished by muscle force against a surface. Force per unit area.
Active push direction (Tryckriktning) = The direction of the active push against the surface
accomplished by muscle force.
Force (Kraft) = The physical force that evolves by the push of a body part against a surface. “The force
has always size, direction, and center of pressure” (Helga Hirschfeld PhD, PT).
Movement direction (Kraftriktning) = The direction of the movement which is the opposite of the active
push direction.
Torso (bål) = Includes upper and lower back and pelvis.
Pushing foot (Frånskjutande fot) = The foot that actively pushes against the surface to transfer the
body’s center of gravity.
Receiving foot (Mottagande fot) = The foot that captures the movement/body’s center of gravity from
the pushing foot.
Synchronous movement (Likriktad rörelse) = When a body segment (e.g pelvis and femur) moves in the
same angular direction as another body segment (e.g. pelvis tilted backwards and femur in flexion in the
hip joint).
Asynchronous movement (Motriktad rörelse) = When a body segment (e.g. pelvis and femur) moves in
the opposite angular direction as another body segment (e.g. pelvis tilted forward and femur moves in
flexion in the hip joint).
Developers of IRAF
Sofia Backberg PhD, Physiotherapist, Senior Lecturer
Anna Kimming MSc, Physiotherapist,
Peter Kraft, Physiotherapist
Kicki Reifeldt, Occupational Therapist and Founder of HMC Sweden
4
Appendix 1
... An experienced physiotherapist performed the EA of the sitto-stand movement in this study, using a newly developed instrument for structured movement analysis of person transfer and mobility in physical activities of daily living (Backåberg et al., 2020). The instrument has been developed by an expert group of experienced physiotherapists, an occupational therapist, a researcher, and instructors within the field of safe person transfer and has been tested for face validity by a group of clinical physiotherapists. ...
... The results from the current study show that EAs of the sitto-stand movement (Backåberg et al., 2020) did not correlate well with the 30sCST, but could be predicted by the SAT. The reason for this is unknown, but it may indicate that there is a complex movement pattern that is not easily assessed and that there might be a non-linear association between EA and the sitto-stand movement. ...
Evaluation of the Skeleton Avatar Technique for Assessment of Mobility and Balance Among Older Adults
Article
Full-text available
  • Dec 2020
Background: Mobility and balance is essential for older adults' well-being and independence and the ability to maintain physically active. Early identification of functional impairment may enable early risk-of-fall assessments and preventive measures. There is a need to find new solutions to assess functional ability in easy, efficient, and accurate ways, which can be clinically used frequently and repetitively. Therefore, we need to understand how functional tests and expert assessments (EAs) correlate with new techniques. Objective: To explore whether the skeleton avatar technique (SAT) can predict the results of functional tests (FTs) of mobility and balance: Timed Up and Go (TUG), the 30-s chair stand test (30sCST), the 4-stage balance test (4SBT), and EA scoring of movement quality. Methods: Fifty-four older adults (+65 years) were recruited through pensioners' associations. The test procedure contained three standardized FTs: TUG, 30sCST, and 4SBT. The test performances were recorded using a three-dimensional SAT camera. EA scoring was performed based on the video recordings of the 30sCST. Functional ability scores were aggregated from balance and mobility scores. Probability theory-based statistical analyses were used on the data to aggregate sets of individual variables into scores, with correlation analysis used to assess the dependency between variables and between scores. Machine learning techniques were used to assess the appropriateness of easily observable variables/scores as predictors of the other variables included. Results: The results indicate that SAT data of the fourth 4SBT stage could be used to predict the aggregated results of all stages of 4SBT (with 7.82% mean absolute error), the results of the 30sCST (11.0%), the TUG test (8.03%), and the EA of the sit-to-stand movement (8.79%). There is a moderate (significant) correlation between the 30sCST and the 4SBT (0.31, p = 0.03), but not between the EA and the 30sCST. Conclusion: SAT can predict the results of the 4SBT, the 30sCST (moderate accuracy), and the TUG test and might add important qualitative information to the assessment of movement performance in active older adults. SAT might in the future provide the means for a simple, easy, and accessible assessment of functional ability among older adults.
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... In this study, we have used assessment and measurement results collected from our previous studies 1,6 as shown on Figure 1. It includes: three supervised FTs (TUG, 30sCST, and 4SBT) performed in a controlled environment, EA of the sit-to-stand movement performed on video recordings by an experienced physiotherapist using the Instrument for movement analysis of person transfer and mobility (IRAF) in daily living, 8 daily life PA collected by an ActivPAL device within 7 days, and completed SA questionnaire about daily life PA. The SA questionnaire contains questions about sitting and lying activities per day (in hours), the duration of physical activities per week (in minutes), exercises per week (in minutes), the duration of one exercise (in minutes), the frequency of exercising (e.g., few times per week, every day, sometimes per week, no training program), and the degree of strenuous of the exercising (not, little, moderate, very strenuous). ...
A comparative study of the 2D- and 3D-based skeleton avatar technology for assessing physical activity and functioning among healthy older adults
Article
Full-text available
Background: Maintaining physical activity (PA) and functioning (mobility, balance) is essential for older adults’ well-being and quality of life. However, current methods (functional tests, self-reports) and available techniques (accelerometers, sensors, advanced movement analysis systems) for assessing physical activity and functioning have shown to be less reliable, time- and resource-consuming with limited routine usage in clinical practice. There is a need to simplify the assessment of physical activity and functioning among older adults both in health care and clinical studies. This work presents a study on using Skeleton Avatar Technology (SAT) for this assessment. SAT analyzes human movement videos using artificial intelligence (AI). The study compares handy SAT based on 2D camera technology (2D SAT) with previously studied 3D SAT for assessing physical activity and functioning in older adults. Objective: To explore whether 2D SAT yields accurate results in physical activity and functioning assessment in healthy older adults, statistically compared to the accuracy of 3D SAT. Method: The mobile pose estimation model provided by Tensorflow was used to extract 2D skeletons from the video recordings of functional test movements. Deep neural networks were used to predict the outcomes of functional tests (FT), expert-based movement quality assessment (EA), accelerometer-based assessments (AC), and self-assessments of PA (SA). To compare the accuracy with 3D SAT models, statistical analysis was used to test whether the difference in the predictions between 2D and 3D models is significant or not. Results: Overall, the accuracy of 2D SAT is lower than 3D SAT in predicting FTs and EA. 2D SAT was able to predict AC with 7% Mean Absolute Error (MAE), and self-assessed PA (SA) with 16% MAE. On average MAE was 4% higher for 2D than for 3D SAT. There was no significant difference found between the 2D and the 3D model for AC and for two FTs (30 seconds chair stand test, 30sCST and Timed up and go, TUG). A significant difference was found for the 2D- and 3D-model of another FT (4-stage balance test, 4SBT). Conclusion: Altogether, the results show that handy 2D SAT might be used for assessing physical activity in older adults without a significant loss of accuracy compared to time-consuming standard tests and to bulky 3D SAT-based assessments. However, the accuracy of 2D SAT in assessing physical functioning should be improved. Taken together, this study shows promising results to use 2D SAT for assessing physical activity in healthy older adults in future clinical studies and clinical practice.
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