Performance Index for in Home Assessment of Motion Abilities in Ataxia Telangiectasia: A Pilot Study

Round 1

Reviewer 1 Report

In this work, the authors reported an evaluation of motion abilities based on a wearable motion capture system. The report maked bitter reading. Some of the descriptions of performance are too exaggerated. In terms of format and description, this is not a normal scientific paper, but more like a news report. The novelty in the work is low. Only one suggestion is to reject this work.

Author Response

According to the Reviewer's comments, the readability of the paper has been largely improved. The whole paper is now written around its original contribution and its novelty has been highlighted. The structure of the paper along with its title and Abstract has been modified. Overemphasis on describing results has been removed. 

Reviewer 2 Report

In this paper, the authors investigated the application wearable sensor for in-home evaluation of motion abilities in ataxia telangiectasia. The topic is interesting, while the presentation need to be improved in the following ways to achieve publishable standards:

1. Abstract: Delete reference [39] and reorganize it in a structured way (background, aim, method, results, conclusion).
2. Introduction: Move the introduction of ataxia teleangectasia (5. Natural history of Ataxia Teleangectasia) to the first part of introduction, and summarize the gate features.
3. The is a lack of introduction on the latest technologies of detecting gait and body movement (Refer: https://0-doi-org.brum.beds.ac.uk/10.3390/s22030809 https://0-doi-org.brum.beds.ac.uk/10.1088/1361-6579/ab299e https://0-doi-org.brum.beds.ac.uk/10.3390/s21082727 ). The wearable sensor and wireless technologies have been widely applied in this area, which can achieve high accuracy in multiple subjects.
4. Methods and Results: The methods need to be clearly separated from results. The details of subjects (i.e., patients and healthy controls) can be summarized in a table, followed by subsections on data collection, signal processing, and data analysis.
5. In methodological subsections (2. Fibonacci sequences in [39], 3. F-bonacci gait number in [39]), the authors introduced the algorithms to get bonacci gait number. What are the measured parameters of the wearable sensor? A flow chart from the sensor measurement as the input of algorithm will be helpful for readers to understand the overall algorithm framework.
6. The results from Patient F is significantly different from all other cases. However, regarding other cases, are the results significantly different from normal subjects? A larger-scale study is needed for further validation.
7. Discussion: measurement site and posture (Refer: https://0-doi-org.brum.beds.ac.uk/10.3389/fphys.2020.00823) of accelerometers can influence the accuracy of body movement detection. The heterogeneity among patients is also a major limitation that deserves discussion.

Author Response

1. The abstract has been modified in accordance with the Reviewer's comments. Reference [39] has been removed from it and specific subsections (background, aim, method, results, conclusion) have been introduced. 
2. According to the Reviewer's comment, the Introduction has been rearranged to include - in its first part - the previous [5. Natural history of Ataxia Teleangectasia]. Gait involvements are also reported. 
3. According to the Reviewer's comment, the latest technologies to detect gait and body movements are now discussed in the revised version of the Introduction. As suggested by the Reviewer, the reader is referred to https://0-doi-org.brum.beds.ac.uk/10.3390/s22030809 https://0-doi-org.brum.beds.ac.uk/10.1088/1361-6579/ab299e https://0-doi-org.brum.beds.ac.uk/10.3390/s21082727.
4. In accordance with the Reviewer's comment, methods are now separated from results. The sections "Methods and clinical cases" and "Data Analysis and results" now explicitly appear as Sections 4 and 5, with subsections concerning clinical cases, data acquisition and signal processing being included in Section 4.  
5. In accordance with the Reviewer's comment, the required flow chart is now reported.
6. According to the Reviewer's comment, it is now explicitly specified in the related section that, despite a study on a wider sample is actually needed, the reported data are sufficient to find statistically significant differences between patients and healthy controls. The results of the most severe patient (F) show the highest value of the Phi-Bonacci gait index, confirming not only the accuracy of this index in differentiating patients with respect to healthy subjects but also to objectively quantify the deficit among patients. 
7. According to the Reviewer's comment, it is now explicitly specified in the paper that, advantageously (especially in the considered application requiring the computation of temporal gait quantities), it is not mandatory to establish an exact measurement site for the Movit devices, so that they can be located anywhere but within the same body district. The most significant criterion for sensor position is the symmetricity between the left and right half of the body (i.e., the sensors positioned on the right arm and forearm should be on the same line of sensors on the left arm and forearm, the same for sensors on the lower half of the body). This is in agreement with the findings obtained in [17]. Anyway, we now precisely report in the related section where the sensors were placed on the head, forearm, chest, etc.

Reviewer 3 Report

I don't know if it's the English or the fact that there are just several missing words in the manuscript, but this manuscript was very challenging to read. I struggled to read through the introduction having to read it multiple times and fill in missing words. The sentence structures seemed to be fine, but there were several words that just seemed to be missing. With that being said, below are my comments.

1. I struggled to read through the first two paragraphs about gait as there were several missing words, including author names and citations were included instead. Further, there were some citations that were superscripted while others not.
2. The AT paragraph had 0 citations. Please provide citations for that paragraph
3. It seems that there were some find and replace features used when talking about citation 39 because the same issue occurs in the Fibonacci sequence. I understand that the authors are self-citing however, just writing the name of the first author of citation 39 and perhaps saying "Verrelli and colleagues" or "Verrelli, et al"
4. Although the sentence structures seem to be fine, the tenses are all over the place throughout the manuscript
5. How were healthy controls matched?
6. Please identify where on the head, forearm, chest, etc the sensors were placed
7. You do a good job of presenting the results however, could you please provide a definition of some sort for the variables presented in the tables.

I believe that this manuscript has significant value and it is very much needed (I can see how this work would be applicable in other fields besides neurological diseases). However, the authors need to go back through and thoroughly proof-read this manuscript as the errors made it very challenging to read.

Author Response

1. Formatting issues have been solved. In accordance with the Reviewer's comment, the paper readability turns out to be greatly improved.
2. As required by the Reviewer, the discussion concerning AT (now appearing in the Introduction) is modified to include references. 
3. According to the Reviewer's comment, reference [48] now even reports "Verrelli et al." when appearing in the titles of sections.
4. The use of tenses has been accurately checked.
5. We now explicitly specify in the related section that, as controls, we have selected healthy subjects in the age range 20-30 years and without any neurological or orthopedic deficits because representative of the physiology and biomechanics of mature walking. 
 6. As required by the Reviewer, we now precisely report where the sensors were placed on the head, forearm, chest, etc.
7. In accordance with the Reviewer's comment, the Appendix now recalls the definitions of the quantities presented in the tables.  

Round 2

Reviewer 1 Report

The full text does not have any traces of modification with the symbols. I don't see what changes the authors have made. The seemingly earnest responses from the authors are not reflected in the draft. I wasn't persuaded to change my previous opinion.

Author Response

Since the paper was thoroughly modified, no trace of modification has been reported in the revised version of the paper. As the Reviewer can notice by reading the revised paper, all his/her comments have been taken into proper consideration and all the issues raised by him/her have been addressed.

Reviewer 2 Report

1. The introduction is too long. The pathology and comorbidity of AF do not need to be extended. Please largely simplify paragraphs 2-4, just briefly introduce the gait features of AF patients.
2. The normal structure of a research paper need to be followed. As mentioned in my earlier comment, three independent sections (i.e., methods, results, and discussion) are needed. 
3. Too many self-citations (Ref 18-26). Please deleted those not directly related to the current study.
4. The order of citations and references need to be renewed.

Author Response

1.  As required by the Reviewer, the Introduction has been shortened and several details that were out of the focus of the paper have been removed.
2. The structure of the paper has been modified in accordance with the Reviewer's comment. Three independent sections (Methods, Results, Discussion) now appear. 
3. The number of self-citations has been greatly reduced. The paper is now written around its original contribution.
4. In order to improve the readability of the paper, the references are now numbered in order of citation in the text.

Reviewer 3 Report

Thank you for addressing my concerns. This manuscript reads significantly better and can be replicated.

Author Response

The authors are indebted to the Reviewers for his/her valuable comments.