{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T10:04:50Z","timestamp":1764842690553,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T00:00:00Z","timestamp":1673395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"EIT Health European network","award":["19260","20686","PR20\/0028-01","PR21\/0039-01"],"award-info":[{"award-number":["19260","20686","PR20\/0028-01","PR21\/0039-01"]}]},{"name":"public agency ACCI\u00d3 (PRIV)","award":["19260","20686","PR20\/0028-01","PR21\/0039-01"],"award-info":[{"award-number":["19260","20686","PR20\/0028-01","PR21\/0039-01"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>(1) Background: Duchenne (DMD) is a rare neuromuscular disease that progressively weakens muscles, which severely impairs gait capacity. The Six Minute-Walk Test (6MWT), which is commonly used to evaluate and monitor the disease\u2019s evolution, presents significant variability due to extrinsic factors such as patient motivation, fatigue, and learning effects. Therefore, there is a clear need for the establishment of precise clinical endpoints to measure patient mobility. (2) Methods: A novel score (6M+ and 2M+) is proposed, which is derived from the use of a new portable monitoring system capable of carrying out a complete gait analysis. The system includes several biomechanical sensors: a heart rate band, inertial measurement units, electromyography shorts, and plantar pressure insoles. The scores were obtained by processing the sensor signals and via gaussian-mixture clustering. (3) Results: The 6M+ and 2M+ scores were evaluated against the North Star Ambulatory Assessment (NSAA), the gold-standard for measuring DMD, and six- and two-minute distances. The 6M+ and 2M+ tests led to superior distances when tested against the NSAA. The 6M+ test and the 2M+ test in particular were the most correlated with age, suggesting that these scores better characterize the gait regressions in DMD. Additionally, the 2M+ test demonstrated an accuracy and stability similar to the 6M+ test. (4) Conclusions: The novel monitoring system described herein exhibited good usability with respect to functional testing in a clinical environment and demonstrated an improvement in the objectivity and reliability of monitoring the evolution of neuromuscular diseases.<\/jats:p>","DOI":"10.3390\/s23020831","type":"journal-article","created":{"date-parts":[[2023,1,11]],"date-time":"2023-01-11T04:59:58Z","timestamp":1673413198000},"page":"831","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Multidimensional Biomechanics-Based Score to Assess Disease Progression in Duchenne Muscular Dystrophy"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2781-8841","authenticated-orcid":false,"given":"Carolina","family":"Migliorelli","sequence":"first","affiliation":[{"name":"Unit of Digital Health, Eurecat, Centre Tecnol\u00f2gic de Catalunya, 08005 Barcelona, Spain"}]},{"given":"Meritxell","family":"G\u00f3mez-Martinez","sequence":"additional","affiliation":[{"name":"Unit of Digital Health, Eurecat, Centre Tecnol\u00f2gic de Catalunya, 08005 Barcelona, Spain"}]},{"given":"Paula","family":"Sub\u00edas-Beltr\u00e1n","sequence":"additional","affiliation":[{"name":"Unit of Digital Health, Eurecat, Centre Tecnol\u00f2gic de Catalunya, 08005 Barcelona, Spain"}]},{"given":"Mireia","family":"Claramunt-Molet","sequence":"additional","affiliation":[{"name":"Unit of Digital Health, Eurecat, Centre Tecnol\u00f2gic de Catalunya, 08005 Barcelona, Spain"},{"name":"Ephion Health, 08005 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3721-2774","authenticated-orcid":false,"given":"Sebastian","family":"Idelsohn-Zielonka","sequence":"additional","affiliation":[{"name":"Unit of Digital Health, Eurecat, Centre Tecnol\u00f2gic de Catalunya, 08005 Barcelona, Spain"},{"name":"Ephion Health, 08005 Barcelona, Spain"}]},{"given":"Eudald","family":"Mas-Hurtado","sequence":"additional","affiliation":[{"name":"Unit of Digital Health, Eurecat, Centre Tecnol\u00f2gic de Catalunya, 08005 Barcelona, Spain"}]},{"given":"Felip","family":"Miralles","sequence":"additional","affiliation":[{"name":"Unit of Digital Health, Eurecat, Centre Tecnol\u00f2gic de Catalunya, 08005 Barcelona, Spain"},{"name":"Ephion Health, 08005 Barcelona, Spain"}]},{"given":"Marisol","family":"Montolio","sequence":"additional","affiliation":[{"name":"Duchenne Parent Project, 28032 Madrid, Spain"},{"name":"Department of Cell Biology, Fisiology and Immunology, Faculty of Biology, University of Barcelona, 08007 Barcelona, Spain"}]},{"given":"Marina","family":"Rosell\u00f3-Ruano","sequence":"additional","affiliation":[{"name":"Duchenne Parent Project, 28032 Madrid, Spain"},{"name":"Department of Cell Biology, Fisiology and Immunology, Faculty of Biology, University of Barcelona, 08007 Barcelona, Spain"}]},{"given":"Julita","family":"Medina-Cantillo","sequence":"additional","affiliation":[{"name":"Unidad de Patolog\u00eda Neuromuscular, Servicio de Rehabilitaci\u00f3n, Hospital Sant Joan de D\u00e9u Barcelona, Passeig Sant Joan de D\u00e9u, 2, 08950 Esplugues de Llobregat, Spain"},{"name":"Investigaci\u00f3n Aplicada en Enfermedades Neuromusculares, Institut de Recerca Sant Joan de D\u00e9u, Santa Rosa 39-57, 08950 Esplugues de Llobregat, Spain"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1002\/ana.23528","article-title":"Evidence-based path to newborn screening for duchenne muscular dystrophy","volume":"71","author":"Mendell","year":"2012","journal-title":"Ann. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1038\/ejhg.2012.301","article-title":"Newborn bloodspot screening for Duchenne Muscular Dystrophy: 21 years experience in Wales (UK)","volume":"21","author":"Moat","year":"2013","journal-title":"Eur. J. Hum. Genet."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s10654-020-00613-8","article-title":"Life expectancy at birth in Duchenne muscular dystrophy: A systematic review and meta-analysis","volume":"35","author":"Landfeldt","year":"2020","journal-title":"Eur. J. Epidemiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1212\/WNL.0000000000002891","article-title":"DMD genotypes and loss of ambulation in the CINRG Duchenne Natural History Study","volume":"87","author":"Bello","year":"2016","journal-title":"Neurology"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pires, I.M., Denysyuk, H.V., Villasana, M.V., S\u00e1, J., Marques, D.L., Morgado, J.F., Albuquerque, C., and Zdravevski, E. (2022). Development Technologies for the Monitoring of Six-Minute Walk Test: A Systematic Review. Sensors, 22.","DOI":"10.3390\/s22020581"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1002\/mus.23902","article-title":"THE 6-minute walk test and other endpoints in Duchenne muscular dystrophy: Longitudinal natural history observations over 48 weeks from a multicenter study","volume":"48","author":"McDonald","year":"2013","journal-title":"Muscle Nerve"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1002\/mus.21544","article-title":"The 6-minute walk test as a new outcome measure in Duchenne muscular dystrophy","volume":"41","author":"McDonald","year":"2009","journal-title":"Muscle Nerve"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Prahm, K.P., Witting, N., and Vissing, J. (2014). Decreased Variability of the 6-Minute Walk Test by Heart Rate Correction in Patients with Neuromuscular Disease. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0114273"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1016\/j.nmd.2014.06.224","article-title":"TP 1: Pilot study evaluating motivation on the performance of timed walking in boys with Duchenne muscular dystrophy","volume":"24","author":"Alfano","year":"2014","journal-title":"Neuromuscul. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1164\/rccm.201012-2079ED","article-title":"Strengths and limitations of the six-minute-walk test: A model biomarker study in idiopathic pulmonary fibrosis","volume":"183","author":"Heresi","year":"2011","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"529","DOI":"10.2522\/ptj.20120210","article-title":"The Six-Minute Walk Test in Chronic Pediatric Conditions: A Systematic Review of Measurement Properties","volume":"93","author":"Bartels","year":"2013","journal-title":"Phys. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"362","DOI":"10.2340\/16501977-2222","article-title":"Reliability of the 2- and 6-minute walk tests in neuromuscular diseases","volume":"49","author":"Knak","year":"2017","journal-title":"J. Rehabil. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.ejpn.2018.10.001","article-title":"Two-minute versus 6-minute walk distances during 6-minute walk test in neuromuscular disease: Is the 2-minute walk test an effective alternative to a 6-minute walk test?","volume":"23","author":"Witherspoon","year":"2018","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1016\/j.ejpn.2015.08.002","article-title":"Six-minute walk test versus two-minute walk test in children with Duchenne muscular dystrophy: Is more time more information?","volume":"19","author":"Vill","year":"2015","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.drudis.2018.07.001","article-title":"How soon will digital endpoints become a cornerstone for future drug development?","volume":"24","author":"Boehme","year":"2018","journal-title":"Drug Discov. Today"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1124\/pr.120.000028","article-title":"Development of Novel, Value-Based, Digital Endpoints for Clinical Trials: A Structured Approach Toward Fit-for-Purpose Validation","volume":"72","author":"Kruizinga","year":"2020","journal-title":"Pharmacol. Rev."},{"key":"ref_17","unstructured":"(2023, January 01). Ephion Health. Available online: www.ephion.heatlh."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/pri.520","article-title":"Development of a Functional Assessment Scale for Ambulatory Boys with Duchenne Muscular Dystrophy","volume":"17","author":"Scott","year":"2011","journal-title":"Physiother. Res. Int."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.nmd.2009.06.368","article-title":"Reliability of the North Star Ambulatory Assessment in a multicentric setting","volume":"19","author":"Mazzone","year":"2009","journal-title":"Neuromuscul. Disord."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1405","DOI":"10.1088\/0967-3334\/28\/11\/007","article-title":"Measurement of EMG activity with textile electrodes embedded into clothing","volume":"28","author":"Finni","year":"2007","journal-title":"Physiol. Meas."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Tikkanen, O., Haakana, P., Pesola, A.J., H\u00e4kkinen, K., Rantalainen, T., Havu, M., Pullinen, T., and Finni, T. (2013). Muscle Activity and Inactivity Periods during Normal Daily Life. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0052228"},{"key":"ref_22","first-page":"101","article-title":"Textile Electrodes Embedded in Clothing: A Practical Alternative to Traditional Surface Electromyography when Assessing Muscle Excitation during Functional Movements","volume":"17","author":"Colyer","year":"2018","journal-title":"J. Sports Sci. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Bengs, D., Jeglinsky, I., Surakka, J., Hellsten, T., Ring, J., and Kettunen, J. (2017). Reliability of Measuring Lower-Limb-Muscle Electromyography Activity Ratio in Activities of Daily Living With Electrodes Embedded in the Clothing. J. Sport Rehabil., 26.","DOI":"10.1123\/jsr.2017-0019"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kim, S., Lee, S., and Jeong, W. (2020). EMG Measurement with Textile-Based Electrodes in Different Electrode Sizes and Clothing Pressures for Smart Clothing Design Optimization. Polymers, 12.","DOI":"10.3390\/polym12102406"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1002\/mus.23905","article-title":"The 6-minute walk test and other clinical endpoints in duchenne muscular dystrophy: Reliability, concurrent validity, and minimal clinically important differences from a multicenter study","volume":"48","author":"McDonald","year":"2013","journal-title":"Muscle Nerve"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Anwary, A.R., Yu, H., and Vassallo, M. (2018). An Automatic Gait Feature Extraction Method for Identifying Gait Asymmetry Using Wearable Sensors. Sensors, 18.","DOI":"10.3390\/s18020676"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/S1350-4533(99)00030-2","article-title":"A practical gait analysis system using gyroscopes","volume":"21","author":"Tong","year":"1999","journal-title":"Med. Eng. Phys."},{"key":"ref_28","unstructured":"Zhang, Y., Wang, S., and Xia, D. (2010, January 20\u201323). EMD-based denoising methods in the MEMS gyroscope de-drift. Proceedings of the 2010 IEEE 5th International Conference on Nano\/Micro Engineered and Molecular Systems, Xiamen, China."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.infbeh.2014.04.006","article-title":"Coping with asymmetry: How infants and adults walk with one elongated leg","volume":"37","author":"Cole","year":"2014","journal-title":"Infant Behav. Dev."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1002\/wics.199","article-title":"The Bayesian information criterion: Background, derivation, and applications","volume":"4","author":"Neath","year":"2012","journal-title":"Wiley Interdiscip. Rev. Comput. Stat."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1103","DOI":"10.1177\/0883073810371002","article-title":"Classification of the Gait Patterns of Boys With Duchenne Muscular Dystrophy and Their Relationship to Function","volume":"25","author":"Thomas","year":"2010","journal-title":"J. Child Neurol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1111\/j.1469-8749.2011.03939.x","article-title":"Moving towards meaningful measurement: Rasch analysis of the North Star Ambulatory Assessment in Duchenne muscular dystrophy","volume":"53","author":"Mayhew","year":"2011","journal-title":"Dev. Med. Child Neurol."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/2\/831\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:06:49Z","timestamp":1760119609000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/2\/831"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,11]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["s23020831"],"URL":"https:\/\/doi.org\/10.3390\/s23020831","relation":{},"ISSN":["1424-8220"],"issn-type":[{"type":"electronic","value":"1424-8220"}],"subject":[],"published":{"date-parts":[[2023,1,11]]}}}