Trunk and foot acceleration variability during walking relates to fall history and clinical disability in persons with multiple sclerosis

Decision making influences movement variability and performance of high-level female football players in an elastic resistance task

Introduction

The inclusion of sport-specific constraints in resistance training promotes the development of player abilities in an integrated way, which maximises the effectiveness of player adaptations induced by training. Considering that perceptual-cognitive abilities play a fundamental role in football, decision making could be introduced to enhance the cognitive similarity of resistance tasks to sport actions. However, it is unknown how decision making as a constraint could affect the player during an elastic resistance task. Therefore, the aim of this study was to investigate the effects of decision making of high-level female football players on movement variability and performance during an elastic band resistance task.

Methods

Twenty-three high-level female football players performed the elastic resistance task with a ball, both as attackers and as defenders without decision making (NDM) and with decision making (DM). The movement variability was quantified using the sample entropy derived from the acceleration recorded with an accelerometer placed at the lower back of each player. The passing accuracy of the attacker was quantified using a scoring scale.

Results

Results revealed that adding decision making to an elastic resistance task increased the movement variability of the defender but did not affect the movement variability of the attacker. In contrast, the passing accuracy of the attacker was reduced. Overall, the attacker had a higher movement variability compared to the defender.

Discussion

These findings suggest that decision making, as a football-specific constraint, can enhance the potential of an elastic resistance task in training. This is due to the fact that it reduces control and regularity of movement for the defensive role player and increases technical difficulty for the attacking role player. Furthermore, these effects are beneficial, as they can promote the adaptive processes necessary to optimise the performance of the players.

Wearable Sensor Technologies to Assess Motor Functions in People With Multiple Sclerosis: Systematic Scoping Review and Perspective

BACKGROUND

Wearable sensor technologies have the potential to improve monitoring in people with multiple sclerosis (MS) and inform timely disease management decisions. Evidence of the utility of wearable sensor technologies in people with MS is accumulating but is generally limited to specific subgroups of patients, clinical or laboratory settings, and functional domains.

OBJECTIVE

This review aims to provide a comprehensive overview of all studies that have used wearable sensors to assess, monitor, and quantify motor function in people with MS during daily activities or in a controlled laboratory setting and to shed light on the technological advances over the past decades.

METHODS

We systematically reviewed studies on wearable sensors to assess the motor performance of people with MS. We scanned PubMed, Scopus, Embase, and Web of Science databases until December 31, 2022, considering search terms "multiple sclerosis" and those associated with wearable technologies and included all studies assessing motor functions. The types of results from relevant studies were systematically mapped into 9 predefined categories (association with clinical scores or other measures; test-retest reliability; group differences, 3 types; responsiveness to change or intervention; and acceptability to study participants), and the reporting quality was determined through 9 questions. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines.

RESULTS

Of the 1251 identified publications, 308 were included: 176 (57.1%) in a real-world context, 107 (34.7%) in a laboratory context, and 25 (8.1%) in a mixed context. Most publications studied physical activity (196/308, 63.6%), followed by gait (81/308, 26.3%), dexterity or tremor (38/308, 12.3%), and balance (34/308, 11%). In the laboratory setting, outcome measures included (in addition to clinical severity scores) 2- and 6-minute walking tests, timed 25-foot walking test, timed up and go, stair climbing, balance tests, and finger-to-nose test, among others. The most popular anatomical landmarks for wearable placement were the waist, wrist, and lower back. Triaxial accelerometers were most commonly used (229/308, 74.4%). A surge in the number of sensors embedded in smartphones and smartwatches has been observed. Overall, the reporting quality was good.

CONCLUSIONS

Continuous monitoring with wearable sensors could optimize the management of people with MS, but some hurdles still exist to full clinical adoption of digital monitoring. Despite a possible publication bias and vast heterogeneity in the outcomes reported, our review provides an overview of the current literature on wearable sensor technologies used for people with MS and highlights shortcomings, such as the lack of harmonization, transparency in reporting methods and results, and limited data availability for the research community. These limitations need to be addressed for the growing implementation of wearable sensor technologies in clinical routine and clinical trials, which is of utmost importance for further progress in clinical research and daily management of people with MS.

TRIAL REGISTRATION

PROSPERO CRD42021243249; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=243249.

Adding mechanical vibration to a half squat with different ballasts and rhythms increases movement variability

The aim of this study was to determine whether whole body vibration increases movement variability while performing a half squat with different ballasts and rhythms through entropy. A total of 12 male athletes (age: 21.24 ± 2.35 years, height: 176.83 ± 5.80 cm, body mass: 70.63 ± 8.58 kg) performed a half squat with weighted vest, dumbbells and bar with weights suspended with elastic bands, with and without vibration at the squat rhythm of 40 and 60 bpm. Each ballast corresponded to 15% of the body mass. The movement variability was analysed by calculating the sample entropy of the acceleration signal, recorded at the waist using an accelerometer. With vibration, differences were found between weighted vest and dumbbells (t(121) = -8.81, p < 0.001 at 40 bpm; t(121) = -8.18, p < 0.001 at 60 bpm) and between weighted vest and bar at both rhythms (t(121) = -8.96, p < 0.001 at 40 bpm; t(121) = -8.83, p < 0.001 at 60 bpm). Furthermore, a higher sample entropy was obtained at 40 bpm with all ballasts (t(121) = 5.65, p < 0.001 with weighted vest; t(121) = 6.27, p < 0.001 with dumbbells; t(121) = 5.78, p < 0.001 with bar). No differences were found without vibration. These findings reveal that adding mechanical vibration to a half squat produces a non-proportional increase in movement variability, being larger when the ballast is placed on the upper limbs and when performed at a slow rhythm.

Optimal sensor location and direction to accurately classify people with early-stage multiple sclerosis using gait stability

BACKGROUND

The local divergence exponent (LDE) has been used to assess gait stability in people with multiple sclerosis (pwMS). Although previous studies have consistently found that stability is lower in pwMS, inconsistent methodologies have been used to assess patients with a broad range of disability levels.

QUESTIONS

What sensor location and movement direction(s) are better able to classify pwMS at early stages of the disease?

METHODS

49 pwMS with EDSS ≤ 2.5 and 24 healthy controls walked overground for 5 min while 3D acceleration data was obtained from sensors placed at the sternum (STR) and lumbar (LUM) areas. Unidirectional (vertical [VT], mediolateral [ML], and anteroposterior [AP]) and 3-dimensional (3D) LDEs were calculated using STR and LUM data over 150 strides. ROC analyses were performed to assess classification models using single and combined LDEs, with and without velocity per lap (VEL_LAP) as a covariate.

RESULTS

Four models performed equally well by using combinations of VEL_LAP, LUM_3D, LUM_VT, LUM_ML, LUM_AP, STR_ML, and STR_AP (AUC = 0.879). The best model using single sensor LDEs included VEL_LAP, STR_3D, STR_ML, and STR_AP (AUC = 0.878), whereas using VEL_LAP + STR_VT (AUC = 0.869) or VEL_LAP + STR_3D (AUC=0.858) performed best using a single LDE.

SIGNIFICANCE

The LDE offers an alternative to currently insensitive tests of gait impairment in pwMS at early stages, when deterioration is not clinically evident. For clinical purposes, the implementation of this measure can be simplified using a single sensor at the sternum and a single LDE measure, but speed should be considered. Longitudinal studies to determine the predictive power and responsiveness of the LDE to MS progression are still needed.

Impact of Multiple Sclerosis on Foot Health and Quality of Life: A Prospective Case-Control Investigation

Objectives: To assess quality of life or factors related to the foot and general health and to determine the impact taking into account foot health status in people with multiple sclerosis (MS). Methods: 50 subjects with MS and 50 healthy subjects were studied using the Foot Health Status Questionnaire, that is a validated and is reliable tool was used to assess foot health and quality of life. This instrument comprise four domains for evaluate the foot health (foot function, foot pain, footwear and general foot health) in the first section and for measure the general health comprise four domains (general health, physical activity, social capacity and vigor) for second section and was use for all participants. Results: In both groups of the sample, 50% (n = 15) were men and 50% (n = 35) women, and the mean age in the case group was 48.04 ± 10.49 and the control group was 48.04 ± 10.45 were recruited. A statistically significant difference (p < 0.05) was shown for foot function, general foot health, general health, physical activity and vigor domains, stating that people with MS have a lower related to foot health (lower FHSQ scores) compared to healthy subjects who have higher FHSQ scores. There were no statistically significant differences (p > 0.05) for the scores of the other domains of the FHSQ (foot pain, footwear and social capacity). Conclusion: Patients with MS suffer a negative impact on the quality of life related to foot health, which appears to be associated with the chronic disease.

Gait stability reflects motor tracts damage at early stages of multiple sclerosis

Background:

Gait in people with multiple sclerosis (PwMS) is affected even when no changes can be observed on clinical examination. A sensitive measure of gait deterioration is stability; however, its correlation with motor tract damage has not yet been established.

Objective:

To compare stability between PwMS and healthy controls (HCs) and determine associations between stability and diffusion magnetic resonance image (MRI) measures of axonal damage in selected sensorimotor tracts.

Methods:

Twenty-five PwMS (Expanded Disability Status Scale (EDSS) < 2.5) and 15 HCs walked on a treadmill. Stability from sacrum (LDESAC), shoulder (LDESHO) and cervical (LDECER) was calculated using the local divergence exponent (LDE). Participants underwent a 7T-MRI brain scan to obtain fibre-specific measures of axonal loss within the corticospinal tract (CST), interhemispheric sensorimotor tract (IHST) and cerebellothalamic tract (CTT). Correlation analyses between LDE and fibre density (FD) within tracts, fibre cross-section (FC) and FD modulated by FC (FDC) were conducted. Between-groups LDE differences were analysed using analysis of variance (ANOVA).

Results:

Correlations between all stability measures with CSTFD, between CSTFDC with LDESAC and LDECER, and LDECER with IHSTFD and IHSTFDC were significant yet moderate ( R < −0.4). Stability was significantly different between groups.

Conclusions:

Poorer gait stability is associated with corticospinal tract (CST) axonal loss in PwMS with no-to-low disability and is a sensitive indicator of neurodegeneration.

Changes in trunk and head acceleration during the 6-minute walk test and its relation to falls risk for adults with multiple sclerosis

For persons with multiple sclerosis (MS), the general decline in neuromuscular function underlies diminished balance, impaired gait and consequently, increased risk of falling. During gait, optimal control of head motion is an important feature which is achieved partly through control of the trunk-neck region to dampen gait-related oscillations. The primary aim of this study was to examine the effect performing a 6-minute walk test (6MWT) has on head, neck and trunk accelerations in individuals with MS. This was addressed using a repeated measures generalized linear model. We were also interested in assessing whether the 6MWT has an impact on a person's falls risk and specific physiological measures related to falls. Finally the relation between the amplitude (i.e., mean RMS) of head and trunk accelerations and falls risk was examined using linear regression. The main results were that over the course of the 6MWT, individuals progressively slowed down coupled with a concurrent increase in gait-related upper body accelerations (p's > 0.05). Despite the increased acceleration, no significant changes in attenuation from the trunk to the head were observed, indicating that persons were able to maintain an optimal level of control over these oscillations. Performing the 6MWT also had a negative impact on posture, with falls risk significantly increasing following this test (p > 0.05). Interestingly, the overall falls risk values were strongly linked with vertical accelerations about the trunk and head, but not average walking speed during the 6MWT. Overall, performing the 6MWT leads to changes in walking speed, upper body acceleration patterns and increases in overall falls risk.