Robust Method for Mid-Activity Tracking and Evaluation of Ankle Health Post-Injury

Objective:
To present a robust methodology for evaluating ankle health during ambulation using a wearable device. 
Methods: 
We developed a novel data capture system that leverages changes within the ankle during ambulation for real-time tracking of bioimpedance. The novel analysis compares the range of reactance at 5 kHz to the range of reactance at 100 kHz; which removes the technique's previous reliance on a known baseline. To aid in interpretation of the measurements, we developed a quantitative simulation model based on a literature review of the effects on joint bioimpedance of variations in edematous fluid volume, muscle fiber tears, and blood flow changes. 
Results: 
The results of the simulation predicted a significant difference in the ratio of the range of the reactance from 5 kHz to 100 kHz between the healthy and injured ankles. These results were validated in 15 subjects - with 11 healthy ankles and 7 injured ankles measured. The injured subjects had lateral ankle sprains 2-4 weeks prior to the measurement. The analysis technique differentiated between the healthy and the injured population (p<<0.01), and a correlation (R = 0.8) with a static protocol previously validated for its sensitivity to edema. 
Conclusion: 
The technology presented can detect variations in ankle edema and structural integrity of ankles, and thus could provide valuable feedback to clinicians and patients during the rehabilitation of an ankle injury. 
Significance: 
This technology could lead to better-informed decision making regarding a patient's readiness to return to activity and / or tailoring rehabilitation activities to an individual's changing needs.