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Quantifying Physical Activity Through Step Count Estimation Across Multiple Wearable Sensor Configurations: A

Louise Macq¹, Stéphanie Dehem^1,2, Thierry Lejeune^1,3

¹IREC, Institute of Experimental and Clinical Research, UCLouvain Bruxelles-Woluwe, Woluwe-St-Lambert, Belgium.

Neurorehabilitation

|July 8, 2026

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Pressure insoles and a custom ankle accelerometer algorithm offer the most accurate stride count measurements for both healthy and post-stroke individuals across various walking speeds.

Area of Science:

Biomechanics
Rehabilitation Technology
Wearable Sensors

Background:

Accurate stride count measurement is crucial for gait analysis in both healthy individuals and post-stroke patients.
Existing wearable sensor protocols for stride counting vary in accuracy and require validation against gold standards.

Purpose of the Study:

To determine the most accurate protocol for measuring stride count in post-stroke and healthy individuals.
To compare the accuracy of different wearable sensors, placements, and data processing algorithms against an instrumented treadmill.

Main Methods:

Eighteen post-stroke and 18 healthy adults walked at various speeds on an instrumented treadmill.
Participants wore six ActiGraph accelerometers (wrists, hips, ankles) and pressure insoles.

Keywords:

actigraphy gait physical activity rehabilitation stroke wearable electronic devices

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Stride counts were calculated using a custom peak-detection algorithm and the manufacturer's algorithm, then compared to the gold standard.

Main Results:

Stride count accuracy improved with gait velocity across all configurations.
Pressure-sensing insoles showed the highest accuracy (CCC=0.999 healthy, 0.996 post-stroke).
A custom algorithm with ankle accelerometers also yielded high accuracy (CCC=0.986 healthy, 0.990 post-stroke), outperforming the manufacturer's algorithm.

Conclusions:

Pressure insoles and a custom raw-acceleration algorithm for ankle-worn accelerometers provide the most accurate stride count measurements.
These methods are robust across different walking speeds and populations (healthy and post-stroke).
The manufacturer's algorithm demonstrated consistent inaccuracies in stride count estimation.