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Jor A, Lau NWK, Daryabor A, Kobayashi T. Effects of ankle-foot orthoses on step activities in the community: a systematic review. Disabil Rehabil 2024; 46:464-477. [PMID: 36710007 DOI: 10.1080/09638288.2023.2169774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 01/13/2023] [Indexed: 01/31/2023]
Abstract
PURPOSE To determine the effects of ankle-foot orthoses (AFO) on step-based physical activities in individuals with neurological, orthopaedic, or cardiovascular disorders. METHODS Electronic searches of databases such as Scopus, PubMed, Web of Science, Embase, ProQuest, Cochrane Library, and EBSCO were conducted. Two evaluators independently searched with keywords focusing on step-based physical activities, and either articulated or non-articulated AFO. Study quality was assessed using a modified Downs and Black quality scale. RESULTS Eleven studies that met the inclusion criteria were selected, including four being classified as good, four as fair, and three as poor in quality. The majority of these trials found no significant effects of AFO on step activities. Only a few studies reported improvements in step counts and active times in step activity with a limited to moderate level of evidence. Subjective evaluations such as user satisfaction, and physical functionality during step activity, on the other hand, showed substantial changes with the use of AFO interventions, although there was no evidence of improvement in the quality of life. CONCLUSIONS Although the AFO did not seem to have a substantial effect on step activity, it appeared to play a vital role in improving the patient satisfaction level of step activity.IMPLICATIONS FOR REHABILITATIONAnkle-foot orthoses (AFO) may not significantly affect the step activity of individuals with impaired ankle-foot complex.AFO may enhance patient-reported satisfaction, physical functioning, participation, and fatigue level during step activity.The patient's perception that the AFO is beneficial is in contrast to objective data showing no significant increase in real-world activity.
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Affiliation(s)
- Abu Jor
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Leather Engineering, Faculty of Mechanical Engineering, Khulna University of Engineering & Technology, Khulna, Bangladesh
| | - Noelle W K Lau
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - Aliyeh Daryabor
- Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Korkusuz S, Seçkinoğulları B, Yürük ZÖ, Uluğ N, Kibar S. Balance and gait in individuals with diabetic peripheral neuropathy. Neurol Res 2024; 46:14-22. [PMID: 37712608 DOI: 10.1080/01616412.2023.2257445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/09/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Diabetic Peripheral Neuropathy (DPN) causes various physical problems such as the increased risk of falling, loss of balance and coordination while standing or walking, susceptibility to injuries due to sensory loss. AIMS The aim of the study was to evaluate and compare the effects of neuropathic pain (NP) in individuals with DPN on balance and gait. METHODS This prospective controlled study was conducted on 42 adults aged between 40-65 years. The participants were divided into three groups; individuals with DPN and NP (DPN+NP/n = 14), individuals with DPN without NP (DPN-NP/n = 14), and the control group (n = 14), respectively. The Force Plate system and Core Balance System measured static and dynamic postural balance and stability limits. Gait and dynamic plantar pressure distribution analyses were performed with a computerized gait evaluation system. RESULTS The score of LANSS, and VAS during gait were higher in DPN+NP group than in DPN-NP (p < 0.05). No significant difference was observed between the groups in balance parameters (p > 0.05). The right-left heel maximum forces were lower in both groups with DPN compared to the control group (p < 0.05). In terms of spatiotemporal parameters of the gait, there was a difference between the groups only in step width and left single support line parameters (p < 0.05). CONCLUSIONS The results of this study indicate that the individuals with DPN have an increased step width, their left single support line was shortened, and the maximum force on the heel decreased. The NP did not cause any change in balance and gait parameters.
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Affiliation(s)
- Süleyman Korkusuz
- Atılım University, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Büşra Seçkinoğulları
- Hacettepe University, Institute of Health Sciences, Neurology Physiotherapy Doctorate Program, Ankara, Turkey
| | - Zeliha Özlem Yürük
- Baskent University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Naime Uluğ
- Atılım University, Department of Physiotherapy and Rehabilitation, Ankara, Turkey
| | - Sibel Kibar
- Atılım University, Vocational School of Health Services, Department of Therapy and Rehabilitation, Ankara, Turkey
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Baseman C, Fayfman M, Schechter MC, Ostadabbas S, Santamarina G, Ploetz T, Arriaga RI. Intelligent Care Management for Diabetic Foot Ulcers: A Scoping Review of Computer Vision and Machine Learning Techniques and Applications. J Diabetes Sci Technol 2023:19322968231213378. [PMID: 37953531 DOI: 10.1177/19322968231213378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Ten percent of adults in the United States have a diagnosis of diabetes and up to a third of these individuals will develop a diabetic foot ulcer (DFU) in their lifetime. Of those who develop a DFU, a fifth will ultimately require amputation with a mortality rate of up to 70% within five years. The human suffering, economic burden, and disproportionate impact of diabetes on communities of color has led to increasing interest in the use of computer vision (CV) and machine learning (ML) techniques to aid the detection, characterization, monitoring, and even prediction of DFUs. Remote monitoring and automated classification are expected to revolutionize wound care by allowing patients to self-monitor their wound pathology, assist in the remote triaging of patients by clinicians, and allow for more immediate interventions when necessary. This scoping review provides an overview of applicable CV and ML techniques. This includes automated CV methods developed for remote assessment of wound photographs, as well as predictive ML algorithms that leverage heterogeneous data streams. We discuss the benefits of such applications and the role they may play in diabetic foot care moving forward. We highlight both the need for, and possibilities of, computational sensing systems to improve diabetic foot care and bring greater knowledge to patients in need.
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Affiliation(s)
- Cynthia Baseman
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Maya Fayfman
- Grady Health System, Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Marcos C Schechter
- Grady Health System, Division of Infectious Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Sarah Ostadabbas
- Department of Electrical & Computer Engineering, Northeastern University, Boston, MA, USA
| | - Gabriel Santamarina
- Department of Medicine and Orthopaedics, School of Medicine, Emory University, Atlanta, GA, USA
| | - Thomas Ploetz
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
| | - Rosa I Arriaga
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, USA
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Roberts LJ, Szmulewicz DJ. A patient with neuropathy and ataxia: what do I have to consider? Curr Opin Neurol 2023; 36:382-387. [PMID: 37639448 DOI: 10.1097/wco.0000000000001200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW An increasing number of peripheral neuro(no)pathies are identified as involving other components of the neurological system, particularly those that further impair balance. Here we aim to outline an evidence-based approach to the diagnosis of patients who present with a somatosensory disorder which also involves at least one other area of neurological impairment such as the vestibular, auditory, or cerebellar systems. RECENT FINDINGS Detailed objective investigation of patients who present with sensory impairment, particularly where the degree of imbalance is greater than would be expected, aids the accurate diagnosis of genetic, autoimmune, metabolic, and toxic neurological disease. SUMMARY Diagnosis and management of complex somatosensory disorders benefit from investigation which extends beyond the presenting sensory impairment.
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Affiliation(s)
- Leslie J Roberts
- Neurophysiology Department, Department of Neurology & Neurological Research, St Vincent's Hospital, Department of Medicine, the University of Melbourne
| | - David J Szmulewicz
- Balance Disorders and Ataxia Service, Eye and Ear Hospital
- Bionics Institute, 384-388 Albert Street, East Melbourne, Victoria, Australia
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Sempere‐Bigorra M, Brognara L, Julian‐Rochina I, Mazzotti A, Cauli O. Relationship between deep and superficial sensitivity assessments and gait analysis in diabetic foot patients. Int Wound J 2023; 20:3023-3034. [PMID: 37057818 PMCID: PMC10502296 DOI: 10.1111/iwj.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/27/2023] [Indexed: 04/15/2023] Open
Abstract
Peripheral neuropathy is a prevalent complication of diabetes that can lead to gait impairment and its adverse consequences. This study explored the potential utility of different parameters of gait analysis using a single sensor unit as a simple tool to detect peripheral neuropathy in 85 diabetic patients (DP) with diabetic foot in whom different somato-sensitivity tests in the feet were performed. Gait spatiotemporal parameters were examined by sensor inertial measurement placed in the lumbar area, while the superficial sensitivity pathway was assessed by nociception tests and deep sensitivity was examined by light touch-pressure and vibration sensitivity tests. Correlations between each sensory test and gait parameters were analysed in a logistic regression model in order to assess if gait parameters are associated with two different sensory pathways. Impaired deep sensory pathways were significantly (P < .05) correlated with lower gait speed, reduced cadence, smaller stride length, longer stance periods, and a higher risk of falling on the Tinetti Scale, while all gait parameters were significantly (P < .01) correlated with the superficial sensory pathway. Type 2 diabetics have significantly (P < .05) higher impairment in vibratory sensitivity than type 1 diabetics, and the years with diabetes mellitus (DM) diagnosis have a significant (P < .05) association with reduced vibration sensitivity. These findings indicate relationships between the deep sensory pathway and gait impairments in DP measured by inertial sensors, which could be a useful tool to diagnose gait alterations in DP and to evaluate the effect of treatments to improve gait and thus the risk of falls in diabetic patients.
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Affiliation(s)
- Mar Sempere‐Bigorra
- Nursing Department, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
| | - Lorenzo Brognara
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Iván Julian‐Rochina
- Nursing Department, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
- Frailty Research Organized Group, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
| | - Antonio Mazzotti
- Department of Biomedical and Neuromotor Sciences (DIBINEM)Alma Mater Studiorum University of BolognaBolognaItaly
| | - Omar Cauli
- Nursing Department, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
- Frailty Research Organized Group, Faculty of Nursing and PodiatryUniversity of ValenciaValenciaSpain
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Walz ID, Waibel S, Lippi V, Kammermeier S, Gollhofer A, Maurer C. "PNP slows down" - linearly-reduced whole body joint velocities and altered gait patterns in polyneuropathy. Front Hum Neurosci 2023; 17:1229440. [PMID: 37780958 PMCID: PMC10534044 DOI: 10.3389/fnhum.2023.1229440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Gait disturbances are a common consequence of polyneuropathy (PNP) and a major factor in patients' reduced quality of life. Less is known about the underlying mechanisms of PNP-related altered motor behavior and its distribution across the body. We aimed to capture whole body movements in PNP during a clinically relevant mobility test, i.e., the Timed Up and Go (TUG). We hypothesize that joint velocity profiles across the entire body would enable a deeper understanding of PNP-related movement alterations. This may yield insights into motor control mechanisms responsible for altered gait in PNP. Methods 20 PNP patients (61 ± 14 years) and a matched healthy control group (CG, 60 ± 15 years) performed TUG at (i) preferred and (ii) fast movement speed, and (iii) while counting backward (dual-task). We recorded TUG duration (s) and extracted gait-related parameters [step time (s), step length (cm), and width (cm)] during the walking sequences of TUG and calculated center of mass (COM) velocity [represents gait speed (cm/s)] and joint velocities (cm/s) (ankles, knees, hips, shoulders, elbows, wrists) with respect to body coordinates during walking; we then derived mean joint velocities and ratios between groups. Results Across all TUG conditions, PNP patients moved significantly slower (TUG time, gait speed) with prolonged step time and shorter steps compared to CG. Velocity profiles depend significantly on group designation, TUG condition, and joint. Correlation analysis revealed that joint velocities and gait speed are closely interrelated in individual subjects, with a 0.87 mean velocity ratio between groups. Discussion We confirmed a PNP-related slowed gait pattern. Interestingly, joint velocities in the rest of the body measured in body coordinates were in a linear relationship to each other and to COM velocity in space coordinates, despite PNP. Across the whole body, PNP patients reduce, on average, their joint velocities with a factor of 0.87 compared to CG and thus maintain movement patterns in terms of velocity distributions across joints similarly to healthy individuals. This down-scaling of mean absolute joint velocities may be the main source for the altered motor behavior of PNP patients during gait and is due to the poorer quality of their somatosensory information. Clinical Trial Registration https://drks.de/search/de, identifier DRKS00016999.
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Affiliation(s)
- Isabelle D. Walz
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Sarah Waibel
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Vittorio Lippi
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Faculty of Medicine Freiburg, Institute of Digitalization in Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | | | - Albert Gollhofer
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Christoph Maurer
- Department of Neurology and Neuroscience, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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Mari S, Lecomte CG, Merlet AN, Audet J, Harnie J, Rybak IA, Prilutsky BI, Frigon A. A sensory signal related to left-right symmetry modulates intra- and interlimb cutaneous reflexes during locomotion in intact cats. Front Syst Neurosci 2023; 17:1199079. [PMID: 37360774 PMCID: PMC10288215 DOI: 10.3389/fnsys.2023.1199079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction During locomotion, cutaneous reflexes play an essential role in rapidly responding to an external perturbation, for example, to prevent a fall when the foot contacts an obstacle. In cats and humans, cutaneous reflexes involve all four limbs and are task- and phase modulated to generate functionally appropriate whole-body responses. Methods To assess task-dependent modulation of cutaneous interlimb reflexes, we electrically stimulated the superficial radial or superficial peroneal nerves in adult cats and recorded muscle activity in the four limbs during tied-belt (equal left-right speeds) and split-belt (different left-right speeds) locomotion. Results We show that the pattern of intra- and interlimb cutaneous reflexes in fore- and hindlimbs muscles and their phase-dependent modulation were conserved during tied-belt and split-belt locomotion. Short-latency cutaneous reflex responses to muscles of the stimulated limb were more likely to be evoked and phase-modulated when compared to muscles in the other limbs. In some muscles, the degree of reflex modulation was significantly reduced during split-belt locomotion compared to tied-belt conditions. Split-belt locomotion increased the step-by-step variability of left-right symmetry, particularly spatially. Discussion These results suggest that sensory signals related to left-right symmetry reduce cutaneous reflex modulation, potentially to avoid destabilizing an unstable pattern.
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Affiliation(s)
- Stephen Mari
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Charly G. Lecomte
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Angèle N. Merlet
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Johannie Audet
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jonathan Harnie
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Ilya A. Rybak
- Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Boris I. Prilutsky
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States
| | - Alain Frigon
- Department of Pharmacology-Physiology, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
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Cleland LD, Rowland HM, Mazzà C, Saal HP. Complexity of spatio-temporal plantar pressure patterns during everyday behaviours. J R Soc Interface 2023; 20:20230052. [PMID: 37376872 DOI: 10.1098/rsif.2023.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
The human foot sole is the primary interface with the external world during balance and walking, and also provides important tactile information on the state of contact. However, prior studies on plantar pressure have focused mostly on summary metrics such as overall force or centre of pressure under limited conditions. Here, we recorded spatio-temporal plantar pressure patterns with high spatial resolution while participants completed a wide range of daily activities, including balancing, locomotion and jumping tasks. Contact area differed across task categories, but was only moderately correlated with the overall force experienced by the foot sole. The centre of pressure was often located outside the contact area or in locations experiencing relatively low pressure, and therefore a result of disparate contact regions spread widely across the foot. Non-negative matrix factorization revealed low-dimensional spatial complexity that increased during interaction with unstable surfaces. Additionally, pressure patterns at the heel and metatarsals decomposed into separately located and robustly identifiable components, jointly capturing most variance in the signal. These results suggest optimal sensor placements to capture task-relevant spatial information and provide insight into how pressure varies spatially on the foot sole during a wide variety of natural behaviours.
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Affiliation(s)
- Luke D Cleland
- Active Touch Laboratory, Department of Psychology, University of Sheffield, Sheffield, UK
- Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Holly M Rowland
- Active Touch Laboratory, Department of Psychology, University of Sheffield, Sheffield, UK
- Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
| | - Claudia Mazzà
- Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
| | - Hannes P Saal
- Active Touch Laboratory, Department of Psychology, University of Sheffield, Sheffield, UK
- Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
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Jones SL, van Emmerik REA. Impaired foot vibration sensitivity is related to altered plantar pressures during walking in people with multiple sclerosis. Mult Scler Relat Disord 2023; 75:104767. [PMID: 37216882 DOI: 10.1016/j.msard.2023.104767] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 04/05/2023] [Accepted: 05/15/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Balance and mobility impairment are two of the most common and debilitating symptoms among people with multiple sclerosis (MS). Somatosensory symptoms, including reduced plantar cutaneous sensation, have been identified in this cohort. Given the importance of the somatosensory system in gait, it is likely that impaired plantar sensation may play a role in the walking adaptations commonly observed in people with MS, including decreased stride length and increased stride width and dual support time, often described as a cautious gait strategy. Understanding the contributions of plantar sensation to these alterations may provide targets for interventions that seek to improve sensory feedback and normalize gait patterns. This cross-sectional study determined whether individuals with MS who demonstrate reduced sensitivity of the plantar surfaces also demonstrate altered plantar pressure distributions during walking compared to a control cohort. METHODS Twenty individuals with MS and twenty age- and sex-matched control participants walked barefoot at preferred and three matched speeds. Participants walked across a walkway with an embedded pressure plate used to quantify pressures within ten plantar zones. In addition, vibration perception thresholds were assessed at four sites on the plantar surface. RESULTS Individuals with MS demonstrated increased peak total plantar pressures compared to control participants, that increased with walking speed. For the MS group, plantar pressures were higher on the less sensitive foot, although pressures on both feet exceeded those of the control cohort. Positive correlations between vibration perception threshold and peak total pressure were evident, although generally stronger in the MS cohort. CONCLUSION A relationship between plantar vibration sensitivity and pressure could indicate that individuals with MS seek to increase plantar sensory feedback during walking. However, because proprioception may also be impaired, increased plantar pressure could result from inaccurate foot placement. Interventions targeting improved somatosensation may have the potential to normalize gait patterns and should be investigated.
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Affiliation(s)
- Stephanie L Jones
- Department of Kinesiology, 110 Totman Building, School of Public Health and Health Sciences, University of Massachusetts Amherst, 30 Eastman Lane, Amherst, MA 01003-9258, USA; Department of Exercise and Sport Studies, 410 Scott Gym, Smith College, 102 Lower College Lane, Northampton, MA 01063, USA.
| | - Richard E A van Emmerik
- Department of Kinesiology, 110 Totman Building, School of Public Health and Health Sciences, University of Massachusetts Amherst, 30 Eastman Lane, Amherst, MA 01003-9258, USA
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Beauchesne N, Wagenaar-Tison A, Brousseau-Foley M, Moisan G, Cantin V, Blanchette V. Using a contralateral shoe lift to reduce gait deterioration during an offloading fast-walk setting in diabetic peripheral neuropathy: A comparative feasibility study. Diabetes Res Clin Pract 2023; 199:110647. [PMID: 37003479 DOI: 10.1016/j.diabres.2023.110647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/10/2023] [Accepted: 03/24/2023] [Indexed: 04/01/2023]
Abstract
AIMS Diabetic peripheral neuropathy (DPN) is a predictor of foot ulcers and leads to sedentary behaviour. This comparative study evaluated gait and feasibility of a 20-minute fast walk, at 40-60% of cardiopulmonary capacity, in individuals with DPN wearing an offloading boot and a contralateral shoe balancer. METHODS Gait parameters were measured with inertial sensors on 32 individuals (group with DPN [n = 16], group with diabetes but without DPN [n = 9], and a group without diabetes/DPN [n = 7]). Feasibility was assessed by feedback on perceived effort and adverse events. Gait outcomes were compared between groups with or without a shoe balancer using one-way ANOVAs. RESULTS The three groups were equivalent in terms of activity level and age and gender except for the body mass index. Both groups with diabetes exhibited minimal decreased gait speed (p > 0.005) and the DPN group exhibited increased double-support percentage (+4.6%, p = 0.01) while walking with an offloading boot and contralateral shoe balancer. The use of a contralateral shoe balancer reduced gait asymmetry. Lower physical activity level was associated with further gait deterioration in all groups. Few adverse events were reported, and 91% of participants reported that the proposed activity would be feasible daily. CONCLUSIONS The offloading boot deteriorated gait function, but a contralateral shoe balancer minimized its impact, especially in the context of physical activity in people with diabetes and DPN.
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Affiliation(s)
- Nikolas Beauchesne
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7, Canada
| | | | - Magali Brousseau-Foley
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7, Canada; Centre intégré universitaire de santé et de services sociaux de la Mauricie et du Centre-du-Québec (CIUSSS-MCQ) affiliated to Université de Montréal, Faculty of Medicine, Trois-Rivières Family Medicine University Clinic, 731, rue Ste-Julie, 2nd Floor, Trois- Rivières G9A 1X9, Canada
| | - Gabriel Moisan
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7, Canada
| | - Vincent Cantin
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7, Canada
| | - Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7, Canada; Centre de recherche du Centre intégré de santé et services sociaux de Chaudière-Appalaches (CISSS-CA), 143 rue Wolfe, Lévis G6V 3Z1, Canada; VITAM - Sustainable Health Research Centre, 2480, Rue de la Carnardière, Québec G1J 2G1, Canada.
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Peterka RJ, Gruber-Fox A, Heeke PK. Asymmetry measures for quantification of mechanisms contributing to dynamic stability during stepping-in-place gait. Front Neurol 2023; 14:1145283. [PMID: 37153656 PMCID: PMC10157157 DOI: 10.3389/fneur.2023.1145283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/28/2023] [Indexed: 05/10/2023] Open
Abstract
The goal of this study is to introduce and to motivate the use of new quantitative methods to improve our understanding of mechanisms that contribute to the control of dynamic balance during gait. Dynamic balance refers to the ability to maintain a continuous, oscillating center-of-mass (CoM) motion of the body during gait even though the CoM frequently moves outside of the base of support. We focus on dynamic balance control in the frontal plane or medial-lateral (ML) direction because it is known that active, neurally-mediated control mechanisms are necessary to maintain ML stability. Mechanisms that regulate foot placement on each step and that generate corrective ankle torque during the stance phase of gait are both known to contribute to the generation of corrective actions that contribute to ML stability. Less appreciated is the potential role played by adjustments in step timing when the duration of the stance and/or swing phases of gait can be shortened or lengthened to allow torque due to gravity to act on the body CoM over a shorter or longer time to generate corrective actions. We introduce and define four asymmetry measures that provide normalized indications of the contribution of these different mechanisms to gait stability. These measures are 'step width asymmetry', 'ankle torque asymmetry', 'stance duration asymmetry', and 'swing duration asymmetry'. Asymmetry values are calculated by comparing corresponding biomechanical or temporal gait parameters from adjacent steps. A time of occurrence is assigned to each asymmetry value. An indication that a mechanism is contributing to ML control is obtained by comparing asymmetry values to the ML body motion (CoM angular position and velocity) at the time points associated with the asymmetry measures. Example results are demonstrated with measures obtained during a stepping-in-place (SiP) gait performed on a stance surface that either remained fixed and level or was pseudorandomly tilted to disturb balance in the ML direction. We also demonstrate that the variability of asymmetry measures obtained from 40 individuals during unperturbed, self-paced SiP were highly correlated with corresponding coefficient of variation measures that have previously been shown to be associated with poor balance and fall risk.
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Affiliation(s)
- Robert J. Peterka
- Department of Veterans Affairs, National Center for Rehabilitative Auditory Research, Portland, OR, United States
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- *Correspondence: Robert J. Peterka,
| | - Apollonia Gruber-Fox
- Department of Veterans Affairs, National Center for Rehabilitative Auditory Research, Portland, OR, United States
| | - Paige K. Heeke
- Department of Veterans Affairs, National Center for Rehabilitative Auditory Research, Portland, OR, United States
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Milne SC, Kim SH, Murphy A, Larkindale J, Farmer J, Malapira R, Danoudis M, Shaw J, Ramakrishnan T, Rasouli F, Yiu EM, Georgiou-Karistianis N, Tai G, Zesiewicz T, Delatycki MB, Corben LA. The Responsiveness of Gait and Balance Outcomes to Disease Progression in Friedreich Ataxia. CEREBELLUM (LONDON, ENGLAND) 2022; 21:963-975. [PMID: 34855135 DOI: 10.1007/s12311-021-01348-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 06/13/2023]
Abstract
To identify gait and balance measures that are responsive to change during the timeline of a clinical trial in Friedreich ataxia (FRDA), we administered a battery of potential measures three times over a 12-month period. Sixty-one ambulant individuals with FRDA underwent assessment of gait and balance at baseline, 6 months and 12 months. Outcomes included GAITRite® spatiotemporal gait parameters; Biodex Balance System Postural Stability Test (PST) and Limits of Stability; Berg Balance Scale (BBS); Timed 25-Foot Walk Test; Dynamic Gait Index (DGI); SenseWear MF Armband step and energy activity; and the Friedreich Ataxia Rating Scale Upright Stability Subscale (FARS USS). The standardised response mean (SRM) or correlation coefficients were reported as effect size indices for comparison of internal responsiveness. Internal responsiveness was also analysed in subgroups. SenseWear Armband daily step count had the largest effect size of all the variables over 6 months (SRM = -0.615), while the PST medial-lateral index had the largest effect size (SRM = 0.829) over 12 months. The FARS USS (SRM = 0.824) and BBS (SRM = -0.720) were the only outcomes able to detect change over 12 months in all subgroups. The DGI was the most responsive outcome in children, detecting a mean change of -2.59 (95% CI -3.52 to -1.66, p < 0.001, SRM = -1.429). In conclusion, the FARS USS and BBS are highly responsive and can detect change in a wide range of ambulant individuals with FRDA. However, therapeutic effects in children may be best measured by the DGI.
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Affiliation(s)
- Sarah C Milne
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia.
- Physiotherapy Department, Monash Health, Melbourne, Australia.
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Australia.
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia.
| | | | - Anna Murphy
- MonARC, Monash Health, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Mary Danoudis
- MonARC, Monash Health, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | | | | | | | - Eppie M Yiu
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Department of Neurology, The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Nellie Georgiou-Karistianis
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Geneieve Tai
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
| | | | - Martin B Delatycki
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- Victorian Clinical Genetics Services, Melbourne, Australia
| | - Louise A Corben
- Bruce Lefroy Centre, Murdoch Children's Research Institute, Melbourne,, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
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13
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Luo Y, Lu X, Grimaldi NS, Ahrentzen S, Hu B. Salient Targets and Fear of Falling Changed the Gait Pattern and Joint Kinematic of Older Adults. SENSORS (BASEL, SWITZERLAND) 2022; 22:9352. [PMID: 36502056 PMCID: PMC9740332 DOI: 10.3390/s22239352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Fear of falling and environmental barriers in the home are two major factors that cause the incidence of falling. Poor visibility at night is one of the key environmental barriers that contribute to falls among older adult residents. Ensuring their visual perception of the surroundings, therefore, becomes vital to prevent falling injuries. However, there are limited works in the literature investigating the impact of the visibility of the target on older adults' walking destinations and how that impact differs across them with different levels of fear of falling. OBJECTIVE The purpose of the study was to examine the effects of target salience on older adults' walking performance and investigate whether older adults with varying levels of fear of falling behave differently. METHODS The salient target was constructed with LED strips around the destination of walking. Fifteen older adults (aged 75 years old and above), seven with low fear of falling and eight with high fear of falling, volunteered for the study. Participants walked from the designated origin (i.e., near their beds) to the destination (i.e., near the bathroom entrance), with the target turned on or off around the destination of the walking trials. Spatiotemporal gait variables and lower-body kinematics were recorded by inertial sensors and compared by using analysis of variance methods. RESULTS Data from inertial sensors showed that a more salient target at the destination increased older adults' gait speed and improved their walking stability. These changes were accompanied by less hip flexion at heel strikes and toe offs during walking. In addition, older adults with low fear of falling showed more substantial lower-body posture adjustments with the salient target presented in the environment. CONCLUSIONS Older adults with a low fear of falling can potentially benefit from a more salient target at their walking destination, whereas those with a high fear of falling were advised to implement a more straightforward falling intervention in their living areas.
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Affiliation(s)
- Yue Luo
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Xiaojie Lu
- Shimberg Center for Housing Studies, University of Florida, Gainesville, FL 32611, USA
- Microelectronics Thrust, Function Hub, The Hong Kong University of Science and Technology (Guangzhou), Guangzhou 511453, China
| | - Nicolas S. Grimaldi
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, USA
| | - Sherry Ahrentzen
- Shimberg Center for Housing Studies, University of Florida, Gainesville, FL 32611, USA
| | - Boyi Hu
- Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL 32611, USA
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14
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Davidson I, Parker ZJ. Falls in people post-Guillain-Barré syndrome in the United Kingdom: A national cross-sectional survey of community based adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2590-e2603. [PMID: 35015326 PMCID: PMC9546005 DOI: 10.1111/hsc.13703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/08/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
Guillain-Barré syndrome (GBS) has several enduring effects that can lead to further harm and/or lower quality of life. These effects include falling and body pain, neither of which have been fully explored. This study aims to examine the risk factors associated with falling and potential causes of body pain in a post-GBS population. A cross-sectional survey of 216 participants was conducted using an electronic questionnaire that included. Self-report measures for: overall health, balance, anxiety and depression levels, body pain and demographics related to GBS experience and falls. A large proportion of individuals post-GBS experience ongoing problems beyond those expected with ageing. Comparative tests indicated that people reporting falls in the previous 12 months had: poorer levels of mobility, poorer F-scores, higher levels of body pain, poorer balance, poorer anxiety and depression scores and higher levels of fatigue. Gender did not appear to contribute to falls. Injuries following falls were associated with a lack of physiotherapy postdischarge and time since GBS. In a regression analysis of the identified and expected key variables, age and body pain statistically predicted falls. In over a quarter of cases reported here, respondents did not receive community physiotherapy following hospital discharge. In the midst and aftermath of COVID-19, provision of rehabilitation needs to be recalibrated, not just for COVID patients, but the wider community with ongoing needs. Issues around well-being and quality of life in the post-GBS community also need further consideration.
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Affiliation(s)
- Ian Davidson
- Department of Health ProfessionalsManchester Metropolitan UniversityManchesterUK
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15
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Corrà MF, Vila-Chã N, Sardoeira A, Hansen C, Sousa AP, Reis I, Sambayeta F, Damásio J, Calejo M, Schicketmueller A, Laranjinha I, Salgado P, Taipa R, Magalhães R, Correia M, Maetzler W, Maia LF. Peripheral neuropathy in Parkinson's disease: prevalence and functional impact on gait and balance. Brain 2022; 146:225-236. [PMID: 35088837 PMCID: PMC9825570 DOI: 10.1093/brain/awac026] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/03/2021] [Accepted: 12/21/2021] [Indexed: 01/12/2023] Open
Abstract
Peripheral neuropathy is a common problem in patients with Parkinson's disease. Peripheral neuropathy's prevalence in Parkinson's disease varies between 4.8-55%, compared with 9% in the general population. It remains unclear whether peripheral neuropathy leads to decreased motor performance in Parkinson's disease, resulting in impaired mobility and increased balance deficits. We aimed to determine the prevalence and type of peripheral neuropathy in Parkinson's disease patients and evaluate its functional impact on gait and balance. A cohort of consecutive Parkinson's disease patients assessed by movement disorders specialists based on the UK Brain Bank criteria underwent clinical, neurophysiological (nerve conduction studies and quantitative sensory testing) and neuropathological (intraepidermal nerve fibre density in skin biopsy punches) evaluation to characterize the peripheral neuropathy type and aetiology using a cross-sectional design. Gait and balance were characterized using wearable health-technology in OFF and ON medication states, and the main parameters were extracted using validated algorithms. A total of 99 Parkinson's disease participants with a mean age of 67.2 (±10) years and mean disease duration of 6.5 (±5) years were assessed. Based on a comprehensive clinical, neurophysiological and neuropathological evaluation, we found that 40.4% of Parkinson's disease patients presented peripheral neuropathy, with a predominance of small fibre neuropathy (70% of the group). In the OFF state, the presence of peripheral neuropathy was significantly associated with shorter stride length (P = 0.029), slower gait speed (P = 0.005) and smaller toe-off angles (P = 0.002) during straight walking; significantly slower speed (P = 0.019) and smaller toe-off angles (P = 0.007) were also observed during circular walking. In the ON state, the above effects remained, albeit moderately reduced. With regard to balance, significant differences between Parkinson's disease patients with and without peripheral neuropathy were observed in the OFF medication state during stance with closed eyes on a foam surface. In the ON states, these differences were no longer observable. We showed that peripheral neuropathy is common in Parkinson's disease and influences gait and balance parameters, as measured with mobile health-technology. Our study supports that peripheral neuropathy recognition and directed treatment should be pursued in order to improve gait in Parkinson's disease patients and minimize balance-related disability, targeting individualized medical care.
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Affiliation(s)
- Marta Francisca Corrà
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, 4050-313 Porto, Portugal,Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal,Institute for Research and Innovation in Health (i3s), University of Porto, 4200-135 Porto, Portugal
| | - Nuno Vila-Chã
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Ana Sardoeira
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Clint Hansen
- Department of Neurology, Kiel University, 24118 Kiel, Germany
| | - Ana Paula Sousa
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Inês Reis
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Firmina Sambayeta
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Joana Damásio
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Margarida Calejo
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Andreas Schicketmueller
- Institute for Medical Engineering and Research Campus STIMULATE, University of Magdeburg, 39106 Magdeburg, Germany,HASOMED GmbH, 39114 Magdeburg, Germany
| | - Inês Laranjinha
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Paula Salgado
- Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Ricardo Taipa
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, 4050-313 Porto, Portugal,Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, 4050-313 Porto, Portugal,Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Manuel Correia
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), University of Porto, 4050-313 Porto, Portugal,Centro Hospitalar Universitário do Porto (CHUPorto), 4099-001 Porto, Portugal
| | - Walter Maetzler
- Department of Neurology, Kiel University, 24118 Kiel, Germany
| | - Luís F Maia
- Correspondence to: Luís F. Maia Department of Neurology Centro Hospitalar Universitario do Porto (CHUPorto) Largo do Prof. Abel Salazar, 4099-001 Porto, Portugal E-mail:
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16
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Lee Y, Shin S. Improvement of Gait in Patients with Stroke Using Rhythmic Sensory Stimulation: A Case-Control Study. J Clin Med 2022; 11:jcm11020425. [PMID: 35054122 PMCID: PMC8780685 DOI: 10.3390/jcm11020425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/03/2022] [Accepted: 01/11/2022] [Indexed: 12/14/2022] Open
Abstract
Patients with stroke suffer from impaired locomotion, exhibiting unstable walking with increased gait variability. Effects of rhythmic sensory stimulation on unstable gait of patients with chronic stroke are unclear. This study aims to determine the effects of rhythmic sensory stimulation on the gait of patients with chronic stroke. Twenty older adults with stroke and twenty age- and gender-matched healthy controls walked 60 m under four conditions: normal walking with no stimulation, walking with rhythmic auditory stimulation (RAS) through an earphone in the ear, walking with rhythmic somatosensory stimulation (RSS) through a haptic device on the wrist of each participant, and walking with rhythmic combined stimulation (RCS: RAS + RSS). Gait performance in the stroke group significantly improved during walking with RAS, RSS, and RCS compared to that during normal walking (p < 0.008). Gait variability significantly decreased under the RAS, RSS, and RCS conditions compared to that during normal walking (p < 0.008). Rhythmic sensory stimulation is effective in improving the gait of patients with chronic stroke, regardless of the type of rhythmic stimuli, compared to healthy controls. The effect was greater in patients with reduced mobility, assessed by the Rivermead Mobility Index (RMI).
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Affiliation(s)
- Yungon Lee
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan-si 38541, Korea;
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan-si 38541, Korea
- School of Kinesiology, College of Human Ecology & Kinesiology, Yeungnam University, 221ho, 280 Daehak-ro, Gyeongsan-si 38541, Korea
| | - Sunghoon Shin
- Research Institute of Human Ecology, Yeungnam University, Gyeongsan-si 38541, Korea;
- Neuromuscular Control Laboratory, Yeungnam University, Gyeongsan-si 38541, Korea
- School of Kinesiology, College of Human Ecology & Kinesiology, Yeungnam University, 221ho, 280 Daehak-ro, Gyeongsan-si 38541, Korea
- Correspondence: ; Tel.: +82-10-8940-2406
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17
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Ahmad I, Verma S, Noohu MM, Hussain ME. Effect of sensorimotor training on spatiotemporal parameters of gait among middle and older age adults with diabetic peripheral neuropathy. Somatosens Mot Res 2021; 38:230-240. [PMID: 34334087 DOI: 10.1080/08990220.2021.1955671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The study aimed to evaluate the effect of sensorimotor training on spatiotemporal parameters of gait among middle-aged and older adults with diabetic peripheral neuropathy (DPN). METHODS A randomised controlled study with four parallel arms (two intervention groups and two control groups) was conducted. Thirty-seven DPN patients were selected on the basis of inclusion and exclusion criteria. Of these, 16 middle-aged and 21 older adults were randomly allocated to the intervention and control groups. Participants in the intervention group were administered eight weeks (three days/week) of sensorimotor training along with diabetes and foot care education whereas participants in the control group received only diabetes and foot care education. Outcome measures involved spatiotemporal parameters of gait at self-paced and maximal-paced, measured before and after eight weeks. RESULTS Age difference was found to be significant in velocity (p ≤ 0.013) and stride length (p ≤ 0.017) at self-paced and maximal-paced walking. After the intervention, velocity was found to be a significant group effect and time × group interaction at self-paced (p = 0.003) and maximal-paced (p = 0.003) walking. Stride length (p = 0.006) was found to be a significant group effect and time × group interaction at self-paced only. Cadence (p = 0.041) and gait cycle (p = 0.05) were found to be significant time × group interaction only at maximal-paced walking. Stance (p ≤ 0.047) and double limb support (p ≤ 0.02) were found to be significant group effect and time × group interaction at self-paced and maximal-paced walking. CONCLUSION Sensorimotor training improves spatiotemporal parameters of gait after eight weeks in similar fashion in middle-aged and older age DPN patients, regardless of age.
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Affiliation(s)
- Irshad Ahmad
- Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India.,Department of Physiotherapy, Faculty of Allied Health Sciences, Manav Rachna International Institute of Research and Studies, Faridabad, Haryana, India
| | - Shalini Verma
- Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
| | - Majumi Mohamad Noohu
- Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India
| | - Mohd Ejaz Hussain
- Diabetes Research Group, Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia (A Central University), New Delhi, India.,Faculty of Allied Health Sciences and Physiotherapy, SGT University, GuruGram, Haryana, India
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18
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Tütün Yümin E, Şimşek TT, Bakar Y. PLANTAR SENSATION AND BALANCE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS WITH AND WITHOUT PERIPHERAL NEUROPATHY. Acta Clin Croat 2021; 60:191-200. [PMID: 34744268 PMCID: PMC8564854 DOI: 10.20471/acc.2021.60.02.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/23/2019] [Indexed: 12/02/2022] Open
Abstract
The aim of the study was to investigate the effect of diabetes on plantar sense and balance in patients with type 2 diabetes mellitus (T2DM). The study included 300 subjects divided into three groups: 100 T2DM patients with diabetic peripheral neuropathy (group 1); 100 T2DM patients without peripheral neuropathy (group 2); and 100 subjects without DM (group 3). Berg Balance Scale (BBS), Timed Up and Go test (TUG), single leg test with eyes open and closed, and plantar sensory tests were applied in the subjects. Study results showed significant differences in plantar sensory tests, BBS, TUG and single leg test among the three groups (p<0.05). In addition, duration of DM and medication were negatively correlated with single leg test both with eyes open and closed, but showed positive correlation with plantar sense and TUG test. Furthermore, the length of insulin therapy showed positive correlation with plantar sense and TUG test and negative correlation with BBS (p<0.05). In conclusion, DM has an effect on plantar sense and balance, and there is a relation between the duration of DM and balance problems. Balance problems are observed more often in patients with neuropathy.
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Affiliation(s)
| | - Tülay Tarsuslu Şimşek
- 1Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant İzzet Baysal University, Bolu, Turkey; 2School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey; 3Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İzmir Bakırçay University, İzmir, Turkey
| | - Yeşim Bakar
- 1Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bolu Abant İzzet Baysal University, Bolu, Turkey; 2School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey; 3Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, İzmir Bakırçay University, İzmir, Turkey
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19
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Herssens N, Dobbels B, Moyaert J, Van de Berg R, Saeys W, Hallemans A, Vereeck L, Van Rompaey V. Paving the Way Toward Distinguishing Fallers From Non-fallers in Bilateral Vestibulopathy: A Wide Pilot Observation. Front Neurol 2021; 12:611648. [PMID: 33732204 PMCID: PMC7957054 DOI: 10.3389/fneur.2021.611648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
Patients with bilateral vestibulopathy (BVP) present with unsteadiness during standing and walking, limiting their activities of daily life and, more importantly, resulting in an increased risk of falling. In BVP patients, falls are considered as one of the major complications, with patients having a 31-fold increased risk of falling compared to healthy subjects. Thus, highlighting objective measures that can easily and accurately assess the risk of falling in BVP patients is an important step in reducing the incidence of falls and the accompanying burdens. Therefore, this study investigated the interrelations between demographic characteristics, vestibular function, questionnaires on self-perceived handicap and balance confidence, clinical balance measures, gait variables, and fall status in 27 BVP patients. Based on the history of falls in the preceding 12 months, the patients were subdivided in a "faller" or "non-faller" group. Results on the different outcome measures were compared between the "faller" and "non-faller" subgroups using Pearson's chi-square test in the case of categorical data; for continuous data, Mann-Whitney U test was used. Performances on the clinical balance measures were comparable between fallers and non-fallers, indicating that, independent from fall status, the BVP patients present with an increased risk of falling. However, fallers tended to report a worse self-perceived handicap and confidence during performing activities of daily life. Spatiotemporal parameters of gait did not differ between fallers and non-fallers during walking at slow, preferred, or fast walking speed. These results may thus imply that, when aiming to distinguish fallers from non-fallers, the BVP patients' beliefs concerning their capabilities may be more important than the moderately or severely affected physical performance within a clinical setting. Outcome measures addressing the self-efficacy and fear of falling in BVP patients should therefore be incorporated in future research to investigate whether these are indeed able to distinguish fallers form non-fallers. Additionally, information regarding physical activity could provide valuable insights on the contextual information influencing behavior and falls in BVP.
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Affiliation(s)
- Nolan Herssens
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Bieke Dobbels
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Julie Moyaert
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Raymond Van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Health Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russia
| | - Wim Saeys
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- RevArte Rehabilitation Hospital, Edegem, Belgium
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Multidisciplinary Motor Centre Antwerp (MOCEAN), University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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20
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Wang AB, Housley SN, Flores AM, Kircher SM, Perreault EJ, Cope TC. A review of movement disorders in chemotherapy-induced neurotoxicity. J Neuroeng Rehabil 2021; 18:16. [PMID: 33494755 PMCID: PMC7836454 DOI: 10.1186/s12984-021-00818-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/12/2021] [Indexed: 02/06/2023] Open
Abstract
Chemotherapy agents used in the standard treatments for many types of cancer are neurotoxic and can lead to lasting sensory and motor symptoms that compromise day-to-day movement functions in cancer survivors. To date, the details of movement disorders associated with chemotherapy are known largely through self-reported symptoms and functional limitations. There are few quantitative studies of specific movement deficits, limiting our understanding of dysfunction, as well as effective assessments and interventions. The aim of this narrative review is to consolidate the current understanding of sensorimotor disabilities based on quantitative measures in cancer survivors who received chemotherapy. We performed literature searches on PubMed and found 32 relevant movement studies. We categorized these studies into three themes based on the movement deficits investigated: (1) balance and postural control; (2) gait function; (3) upper limb function. This literature suggests that cancer survivors have increased postural sway, more conservative gait patterns, and suboptimal hand function compared to healthy individuals. More studies are needed that use objective measures of sensorimotor function to better characterize movement disabilities and investigate the underlying causes, as required for developing targeted assessments and interventions. By updating our understanding of movement impairments in this population, we identify significant gaps in knowledge that will help guide the direction of future research.
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Affiliation(s)
- Allison B Wang
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA. .,Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA. .,Shirley Ryan AbilityLab, 355 E Erie St 21st Floor, Chicago, IL, 60611, USA.
| | - Stephen N Housley
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Ann Marie Flores
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.,Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.,Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Sheetal M Kircher
- Cancer Survivorship Institute, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA.,Department of Hematology and Oncology, Northwestern University, Chicago, IL, USA
| | - Eric J Perreault
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.,Shirley Ryan AbilityLab, 355 E Erie St 21st Floor, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, USA
| | - Timothy C Cope
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA.,W.H. Coulter, Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Georgia Institute of Technology, Atlanta, GA, USA.,Integrated Cancer Research Center, Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA
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21
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Felicetti G, Thoumie P, Do MC, Schieppati M. Cutaneous and muscular afferents from the foot and sensory fusion processing: Physiology and pathology in neuropathies. J Peripher Nerv Syst 2021; 26:17-34. [PMID: 33426723 DOI: 10.1111/jns.12429] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 12/16/2022]
Abstract
The foot-sole cutaneous receptors (section 2), their function in stance control (sway minimisation, exploratory role) (2.1), and the modulation of their effects by gait pattern and intended behaviour (2.2) are reviewed. Experimental manipulations (anaesthesia, temperature) (2.3 and 2.4) have shown that information from foot sole has widespread influence on balance. Foot-sole stimulation (2.5) appears to be a promising approach for rehabilitation. Proprioceptive information (3) has a pre-eminent role in balance and gait. Reflex responses to balance perturbations are produced by both leg and foot muscle stretch (3.1) and show complex interactions with skin input at both spinal and supra-spinal levels (3.2), where sensory feedback is modulated by posture, locomotion and vision. Other muscles, notably of neck and trunk, contribute to kinaesthesia and sense of orientation in space (3.3). The effects of age-related decline of afferent input are variable under different foot-contact and visual conditions (3.4). Muscle force diminishes with age and sarcopenia, affecting intrinsic foot muscles relaying relevant feedback (3.5). In neuropathy (4), reduction in cutaneous sensation accompanies the diminished density of viable receptors (4.1). Loss of foot-sole input goes along with large-fibre dysfunction in intrinsic foot muscles. Diabetic patients have an elevated risk of falling, and vision and vestibular compensation strategies may be inadequate (4.2). From Charcot-Marie-Tooth 1A disease (4.3) we have become aware of the role of spindle group II fibres and of the anatomical feet conditions in balance control. Lastly (5) we touch on the effects of nerve stimulation onto cortical and spinal excitability, which may participate in plasticity processes, and on exercise interventions to reduce the impact of neuropathy.
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Affiliation(s)
- Guido Felicetti
- Istituti Clinici Scientifici Maugeri IRCCS, Unit of Neuromotor Rehabilitation, Institute of Montescano, Pavia, Italy
| | - Philippe Thoumie
- Service de rééducation neuro-orthopédique, Hôpital Rothschild APHP, Université Sorbonne, Paris, France.,Agathe Lab ERL Inserm U-1150, Paris, France
| | - Manh-Cuong Do
- Université Paris-Saclay, CIAMS, Orsay, France.,Université d'Orléans, CIAMS, Orléans, France
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22
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Vilas-Boas MDC, Rocha AP, Cardoso MN, Fernandes JM, Coelho T, Cunha JPS. Clinical 3-D Gait Assessment of Patients With Polyneuropathy Associated With Hereditary Transthyretin Amyloidosis. Front Neurol 2020; 11:605282. [PMID: 33329366 PMCID: PMC7719818 DOI: 10.3389/fneur.2020.605282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
Abstract
Hereditary amyloidosis associated with transthyretin V30M (ATTRv V30M) is a rare and inherited multisystemic disease, with a variable presentation and a challenging diagnosis, follow-up and treatment. This condition entails a definitive and progressive motor impairment that compromises walking ability from near onset. The detection of the latter is key for the disease's diagnosis. The aim of this work is to perform quantitative 3-D gait analysis in ATTRv V30M patients, at different disease stages, and explore the potential of the obtained gait information for supporting early diagnosis and/or stage distinction during follow-up. Sixty-six subjects (25 healthy controls, 14 asymptomatic ATTRv V30M carriers, and 27 symptomatic patients) were included in this case-control study. All subjects were asked to walk back and forth for 2 min, in front of a Kinect v2 camera prepared for body motion tracking. We then used our own software to extract gait-related parameters from the camera's 3-D body data. For each parameter, the main subject groups and symptomatic patient subgroups were statistically compared. Most of the explored gait parameters can potentially be used to distinguish between the considered group pairs. Despite of statistically significant differences being found, most of them were undetected to the naked eye. Our Kinect camera-based system is easy to use in clinical settings and provides quantitative gait information that can be useful for supporting clinical assessment during ATTRv V30M onset detection and follow-up, as well as developing more objective and fine-grained rating scales to further support the clinical decisions.
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Affiliation(s)
- Maria do Carmo Vilas-Boas
- INESC TEC, FEUP and LABIOMEP, University of Porto, Porto, Portugal.,Unidade Corino de Andrade and Neurophysiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Patrícia Rocha
- Institute of Electronics and Informatics Engineering of Aveiro (IEETA), Department of Electronics, Telecommunications and Informatics, University of Aveiro, Aveiro, Portugal
| | - Márcio Neves Cardoso
- Unidade Corino de Andrade and Neurophysiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - José Maria Fernandes
- Institute of Electronics and Informatics Engineering of Aveiro (IEETA), Department of Electronics, Telecommunications and Informatics, University of Aveiro, Aveiro, Portugal
| | - Teresa Coelho
- Unidade Corino de Andrade and Neurophysiology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
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23
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Wearable Health Technology to Quantify the Functional Impact of Peripheral Neuropathy on Mobility in Parkinson's Disease: A Systematic Review. SENSORS 2020; 20:s20226627. [PMID: 33228056 PMCID: PMC7699399 DOI: 10.3390/s20226627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022]
Abstract
The occurrence of peripheral neuropathy (PNP) is often observed in Parkinson’s disease (PD) patients with a prevalence up to 55%, leading to more prominent functional deficits. Motor assessment with mobile health technologies allows high sensitivity and accuracy and is widely adopted in PD, but scarcely used for PNP assessments. This review provides a comprehensive overview of the methodologies and the most relevant features to investigate PNP and PD motor deficits with wearables. Because of the lack of studies investigating motor impairments in this specific subset of PNP-PD patients, Pubmed, Scopus, and Web of Science electronic databases were used to summarize the state of the art on PNP motor assessment with wearable technology and compare it with the existing evidence on PD. A total of 24 papers on PNP and 13 on PD were selected for data extraction: The main characteristics were described, highlighting major findings, clinical applications, and the most relevant features. The information from both groups (PNP and PD) was merged for defining future directions for the assessment of PNP-PD patients with wearable technology. We established suggestions on the assessment protocol aiming at accurate patient monitoring, targeting personalized treatments and strategies to prevent falls and to investigate PD and PNP motor characteristics.
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24
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Abstract
Frailty is a common geriatric condition due to aging and defined as a decline in strength and a decrease in the physiologic ability to maintain the homeostasis. Vitamin B12 (B12), water-soluble vitamins, are a cofactor in DNA synthesis and involved in the metabolism of every cell in the human body, including the central nervous system. Demyelination neuromuscular symptoms observed in the peripheral nervous system, along with signs of significant damage to nerve fibers, often cause weakness, numbness in distal limbs, impaired balance, gait ataxia, and even physical frailty. In this cross-sectional study, we aimed to investigate the relationship between frailty and B12 level in community-dwelling Korean older adults.Using the data from the Korean Frailty and Aging Cohort Study, 2938 participants (1400 men and 1538 women) were recruited in this study. To evaluate frailty, we compared the frail group and not-frail group based on the modified Korean version of the cardiovascular health study frailty index developed by Fried. SARC-F is used to screen for sarcopenia. The short physical performance battery (SPPB) timed up and go (TUG) test and activities-specific balance confidence scale used to evaluate the physical function and fall risk of participants. B12 concentrations were classified into clinically relevant categories: insufficient (<350 pg/mL) and sufficient (≥350 pg/mL). Linear and logistic regression analyses were used to evaluate the relationship between frailty and B12 levels.The mean age of the frail group was 77.8 (standard deviation = 3.7) years, while that of the not-frail group was 76.7 (SD = 4.0); of which the frail group's mean age was significantly high. In the unadjusted model, frailty was highly prevalent in the B12 insufficient group (odds ratio = 1.298). In the model fully adjusted for demographic data and comorbidities, these associations were attenuated. The B12 sufficiency group showed better total SPPB and TUG test scores. However, they were not statistically significant in the fully adjusted model.In this cross-sectional study, low B12 increased the incidence of frailty and affected physical performance, but it does not increase the incidence of frailty when considering the confounding factors. Frailty is caused by several factors rather than 1 factor, and B12 is one of these factors.
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Affiliation(s)
- Yunsoo Soh
- Department of Physical Medicine and Rehabilitation
| | - Chang Won Won
- Department of Family Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
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25
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Ylitalo KR, Strotmeyer ES, Pettee Gabriel K, Lange-Maia BS, Avis NE, Karvonen-Gutierrez CA. Peripheral Nerve Impairment and Recurrent Falls Among Women: Results From the Study of Women's Health Across the Nation. J Gerontol A Biol Sci Med Sci 2020; 75:2020-2027. [PMID: 31549141 DOI: 10.1093/gerona/glz211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Falls and related injuries are important public health concerns yet underappreciated in early aging. This study examined the association of peripheral nerve impairment (PNI) with fall outcomes in early old aged women (60-72 years). METHODS Women (n = 1,725; mean age 65.1 ± 2.7 years) from the longitudinal cohort Study of Women's Health Across the Nation completed a PNI questionnaire on presence, frequency, and severity of symptoms, and 10- and 1.4-g monofilament testing in 2016-2017. PNI was defined as four or more self-reported symptoms or monofilament insensitivity. Recurrent falls (two or more) and recurrent fall injuries (two or more falls with one or more injuries) in the previous 12 months were assessed via questionnaire. Poisson regression was used to generate risk ratios (RRs) and corresponding 95% confidence intervals (CIs) for the fall outcomes, adjusting for covariates. RESULTS Approximately 12.3% of participants reported two ore more falls, 7.6% reported recurrent falls with injury, and 15.8% reported four or more PNI symptoms. Women with recurrent falls were more likely to report four or more PNI symptoms compared to women without recurrent falls (32.1% vs 13.5%; p < .001). One quarter (25.6%) of participants had four or more PNI symptoms or monofilament insensitivity; after adjusting for covariates, women with either symptoms or insensitivity were more likely to report recurrent falls compared to women with neither (RR = 1.64; 95% CI: 1.24, 2.17). CONCLUSIONS These findings suggest that PNI may identify those at high risk for falls, particularly among women during early late life. Neuropathy screening instruments such as symptom questionnaires or monofilament testing are easy to implement and may have utility for fall risk assessment.
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Affiliation(s)
- Kelly R Ylitalo
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, Texas
| | - Elsa S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania
| | - Kelley Pettee Gabriel
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health - Austin Campus, Texas.,Department of Women's Health, Dell Medical School, Chicago, Illinois.,Department of Kinesiology and Health Education, The University of Texas at Austin, Chicago, Illinois
| | - Brittney S Lange-Maia
- Department of Preventive Medicine, Center for Community Health Equity, Rush University Medical Center, Chicago, Illinois
| | - Nancy E Avis
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
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26
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Möhwald K, Wuehr M, Schenkel F, Feil K, Strupp M, Schniepp R. The gait disorder in primary orthostatic tremor. J Neurol 2020; 267:285-291. [PMID: 32915312 PMCID: PMC7718181 DOI: 10.1007/s00415-020-10177-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To uncover possible impairments of walking and dynamic postural stability in patients with primary orthostatic tremor (OT). METHODS Spatiotemporal gait characteristics were quantified in 18 patients with primary OT (mean age 70.5 ± 5.9 years, 10 females) and 18 age-matched healthy controls. One-third of patients reported disease-related fall events. Walking performance was assessed on a pressure-sensitive carpet under seven conditions: walking at preferred, slow, and maximal speed, with head reclination or eyes closed, and while performing a cognitive or motor dual-task paradigm. RESULTS Patients exhibited a significant gait impairment characterized by a broadened base of support (p = 0.018) with increased spatiotemporal gait variability (p = 0.010). Walking speed was moderately reduced (p = 0.026) with shortened stride length (p = 0.001) and increased periods of double support (p = 0.001). Gait dysfunction became more pronounced during slow walking (p < 0.001); this was not present during fast walking. Walking with eyes closed aggravated gait disability as did walking during cognitive dual task (p < 0.001). CONCLUSION OT is associated with a specific gait disorder with a staggering wide-based walking pattern indicative of a sensory and/or a cerebellar ataxic gait. The aggravation of gait instability during visual withdrawal and the normalization of walking with faster speeds further suggest a proprioceptive or vestibulo-cerebellar deficit as the primary source of gait disturbance in OT. In addition, the gait decline during cognitive dual task may imply cognitive processing deficits. In the end, OT is presumably a complex network disorder resulting in a specific spino-cerebello-frontocortical gait disorder that goes beyond mere tremor networks.
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Affiliation(s)
- Ken Möhwald
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany. .,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - Fabian Schenkel
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Feil
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Roman Schniepp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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27
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Schniepp R, Möhwald K, Wuehr M. Key gait findings for diagnosing three syndromic categories of dynamic instability in patients with balance disorders. J Neurol 2020; 267:301-308. [PMID: 32462346 PMCID: PMC7718186 DOI: 10.1007/s00415-020-09901-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 01/29/2023]
Abstract
With the emergence of affordable, clinical-orientated gait analysis techniques, clinicians may benefit from a general understanding of quantitative gait analysis procedures and their clinical applications. This article provides an overview of the potential of a quantitative gait analysis for decision support in three clinically relevant scenarios of early stage gait disorders: scenario I: gait ataxia and unsteadiness; scenario II: hypokinesia and slow gait; scenario III: apparently normal gait with a specific fall tendency in complex mobility situations. In a first part, we justify the advantages of standardized data collection and analysis procedures including data normalization and dimensionality reduction techniques that facilitate clinical interpretability of instrument-based gait profiles. We then outline typical patterns of pathological gait and their modulation during different walking conditions (variation of speed, sensory perturbation, and dual tasking) and highlight key aspects that are particularly helpful to support and guide clinical decision-making.
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Affiliation(s)
- Roman Schniepp
- Department of Neurology, Ludwig-Maximilian University of Munich, Munich, Bavaria, Germany. .,German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilian University of Munich, Munich, Bavaria, Germany.
| | - Ken Möhwald
- Department of Neurology, Ludwig-Maximilian University of Munich, Munich, Bavaria, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilian University of Munich, Munich, Bavaria, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), Ludwig-Maximilian University of Munich, Munich, Bavaria, Germany
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28
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Inter-joint coordination during obstacle crossing in people with diabetic neuropathy. J Biomech 2020; 105:109765. [PMID: 32307183 DOI: 10.1016/j.jbiomech.2020.109765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 01/16/2020] [Accepted: 03/24/2020] [Indexed: 11/22/2022]
Abstract
Sensori-motor deficit due to diabetic peripheral neuropathy (DPN) alters the quality of obstacle-crossing which may increase the risk of falling. The aim of this study was to compare inter-joint coordination (IJC) during obstacle-crossing between people with DPN and healthy controls. Fifteen DPN and 15 healthy people crossed over obstacles with heights of 10% and 20% of the subject's leg length. The mean absolute relative phase (MARP) and deviation phase (DP) of both leading and trailing limbs were used to calculate the phase dynamic and variability of IJC. Furthermore, correlation between Berg Balance Scale (BBS), Fall Efficacy Scale (FES-I), Timed Up and Go (TUG) and MARP, DP were assessed in DPN group. There was no significant interaction between group and obstacle height on measured variables. However, Group had significant main effect on DP of hip-knee in leading limb (p < 0.05). Additionally, the main effects of the obstacle's height were significant on MARP of hip-knee of trailing limb (p < 0.01) and knee-ankle in leading limb (p < 0.05). FES-I was significantly correlated to hip-knee and knee-ankle MARPs of leading limb for crossing over 20% and knee-ankle MARP for crossing over 10% height obstacle (r = 0.68, 0.69, 0.59, respectively, p < 0.05). This score was also significantly correlated with hip-knee DP of both trailing and leading limbs when crossing 10% obstacle (r = 0.59, 0.57, respectively, p < 0.05). In conclusion, IJC during obstacle-crossing was less variable and more out-of-phase, as a result of DPN and obstacle height, respectively. Moreover, when crossing over lower obstacles, fear of falling is related to IJC dynamics and variability of more proximal segment, especially in the leading limb.
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29
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Kyeong S, Kim SM, Jung S, Kim DH. Gait pattern analysis and clinical subgroup identification: a retrospective observational study. Medicine (Baltimore) 2020; 99:e19555. [PMID: 32282704 PMCID: PMC7440325 DOI: 10.1097/md.0000000000019555] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
To identify basic gait features and abnormal gait patterns that are common to different neurological or musculoskeletal conditions, such as cerebral stroke, Parkinsonian disorders, radiculopathy, and musculoskeletal pain.In this retrospective study, temporal-spatial, kinematic, and kinetic gait parameters were analyzed in 424 patients with hemiplegia after stroke, 205 patients with Parkinsonian disorders, 216 patients with radiculopathy, 167 patients with musculoskeletal pain, and 316 normal controls (total, 1328 subjects). We assessed differences according to the condition and used a community detection algorithm to identify subgroups within each condition. Additionally, we developed a prediction model for subgroup classification according to gait speed and maximal hip extension in the stance phase.The main findings can be summarized as follows. First, there was an asymmetric decrease of the knee/ankle flexion angles in hemiplegia and a marked reduction of the hip/knee range of motion with increased moment in Parkinsonian disorders. Second, three abnormal gait patterns, including fast gait speed with adequate maximal hip extension, fast gait speed with inadequate maximal hip extension, and slow gait speed, were found throughout the conditions examined. Third, our simple prediction model based on gait speed and maximal hip extension angle was characterized by a high degree of accuracy in predicting subgroups within a condition.Our findings suggest the existence of specific gait patterns within and across conditions. Our novel subgrouping algorithm can be employed in routine clinical settings to classify abnormal gait patterns in various neurological disorders and guide the therapeutic approach and monitoring.
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Affiliation(s)
- Sunghyon Kyeong
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine
| | | | - Suk Jung
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Republic of Korea
| | - Dae Hyun Kim
- Department of Physical Medicine and Rehabilitation, Veterans Health Service Medical Center, Seoul, Republic of Korea
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30
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Dietrich H, Heidger F, Schniepp R, MacNeilage PR, Glasauer S, Wuehr M. Head motion predictability explains activity-dependent suppression of vestibular balance control. Sci Rep 2020; 10:668. [PMID: 31959778 PMCID: PMC6971007 DOI: 10.1038/s41598-019-57400-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 12/21/2019] [Indexed: 11/25/2022] Open
Abstract
Vestibular balance control is dynamically weighted during locomotion. This might result from a selective suppression of vestibular inputs in favor of a feed-forward balance regulation based on locomotor efference copies. The feasibility of such a feed-forward mechanism should however critically depend on the predictability of head movements (HMP) during locomotion. To test this, we studied in 10 healthy subjects the differential impact of a stochastic vestibular stimulation (SVS) on body sway (center-of-pressure, COP) during standing and walking at different speeds and compared it to activity-dependent changes in HMP. SVS-COP coupling was determined by correlation analysis in frequency and time domains. HMP was quantified as the proportion of head motion variance that can be explained by the average head trajectory across the locomotor cycle. SVS-COP coupling decreased from standing to walking and further dropped with faster locomotion. Correspondingly, HMP increased with faster locomotion. Furthermore, SVS-COP coupling depended on the gait-cycle-phase with peaks corresponding to periods of least HMP. These findings support the assumption that during stereotyped human self-motion, locomotor efference copies selectively replace vestibular cues, similar to what was previously observed in animal models.
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Affiliation(s)
- H Dietrich
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany
| | - F Heidger
- Department of Neurology, University Hospital, LMU, Munich, Germany
| | - R Schniepp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany
- Department of Neurology, University Hospital, LMU, Munich, Germany
| | - P R MacNeilage
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany
- Department of Psychology, Cognitive and Brain Sciences, University of Nevada, Nevada, USA
| | - S Glasauer
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany
- Institute of Medical Technology, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - M Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital, LMU, Munich, Germany.
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31
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Richards TM, Sharma P, Kuang A, Whitty D, Ahmed Z, Shah PK. Novel Speed-Controlled Automated Ladder Walking Device Reveals Walking Speed as a Critical Determinant of Skilled Locomotion after a Spinal Cord Injury in Adult Rats. J Neurotrauma 2019; 36:2698-2721. [DOI: 10.1089/neu.2018.6152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Tiffany M. Richards
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York
| | - Pawan Sharma
- Department of Physical Therapy, Stony Brook University, Stony Brook, New York
| | - Aaron Kuang
- Department of Physical Therapy, Stony Brook University, Stony Brook, New York
| | - Douglas Whitty
- Department of Physical Therapy, Stony Brook University, Stony Brook, New York
| | - Zaghloul Ahmed
- Department of Physical Therapy, Center for Developmental Neuroscience, The College of Staten Island, Staten Island, New York
- Graduate Center, City University of New York, New York, New York
| | - Prithvi K. Shah
- Department of Neurobiology and Behavior, Stony Brook University, Stony Brook, New York
- Department of Physical Therapy, Stony Brook University, Stony Brook, New York
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32
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Coelho AR, Fontes RC, Moraes R, Barros CDGC, de Abreu DCC. Effects of the Use of Anchor Systems in the Rehabilitation of Dynamic Balance and Gait in Individuals With Chronic Dizziness of Peripheral Vestibular Origin: A Single-Blinded, Randomized, Controlled Clinical Trial. Arch Phys Med Rehabil 2019; 101:249-257. [PMID: 31465757 DOI: 10.1016/j.apmr.2019.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effectiveness of the anchors in the balance rehabilitation of participants with chronic peripheral vestibulopathy who failed to respond positively to conventional rehabilitation for dynamic balance and gait. DESIGN Assessor-blind, randomized controlled trial. SETTING Department of Otoneurology and Laboratory of Assessment and Rehabilitation of Equilibrium. PARTICIPANTS Women with chronic dizziness of peripheral vestibular origin (N=42), who continued to show otoneurologic symptoms for more than 6 months after starting classic vestibular rehabilitation, with no clinical improvement observed. INTERVENTIONS Participants were randomly assigned to receive a clinical intervention with the anchor system, a clinical intervention without the anchor system, or no intervention or anchor system. The intervention was based on multi-sensory exercises for 6 weeks, twice a week, totaling 12 sessions, in groups of up to 4 participants, with an average time of 40 minutes per session. MAIN OUTCOME MEASURES The primary outcome was functional balance as assessed by the short version of the Balance Evaluation Systems Test. The secondary outcomes were gait parameters of step width in meters, step length in meters, and gait speed in meters per second. The measures were assessed preintervention and postintervention, and after a 3-month follow-up period. RESULTS The proposed intervention was beneficial for dizziness, balance, and gait for both groups studied. At the 3-month follow-up, only the group that used anchors retained the benefits related to the physical aspects of dizziness, balance, and gait. CONCLUSIONS The present study found that the proposed intervention protocol, with or without the use of anchors, was beneficial for improving the dizziness, balance, and gait. However, retention of the benefits achieved through the exercise protocol was observed only for those using the anchor system, which promotes the use of haptic information. The use of anchors was effective, in short protocols (12wk), with maintenance of results after 3 months.
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Affiliation(s)
- Almir R Coelho
- Department of Health Sciences of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil; Department of Physiotherapy, University of Franca, Franca, Brazil.
| | - Rafaela C Fontes
- Department of Physiotherapy, University of Franca, Franca, Brazil
| | - Renato Moraes
- School of Physical Education and Sport of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | - Camila de G C Barros
- Department of Health Sciences of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Daniela C C de Abreu
- Department of Health Sciences of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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33
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Strategies for Gaze Stabilization Critically Depend on Locomotor Speed. Neuroscience 2019; 408:418-429. [DOI: 10.1016/j.neuroscience.2019.01.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 11/18/2022]
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Schniepp R, Möhwald K, Wuehr M. Clinical and automated gait analysis in patients with vestibular, cerebellar, and functional gait disorders: perspectives and limitations. J Neurol 2019; 266:118-122. [PMID: 31134375 DOI: 10.1007/s00415-019-09378-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 02/01/2023]
Abstract
This article outlines recent developments in the clinical and automated assessment of neurological gait disorders. With a primary focus on vestibular, cerebellar, and functional gait disorders, we discuss how instrumented gait examination may assist clinical decision making in these disorders with respect to the initial differential diagnosis and prognosis as well as the objective monitoring of disease progression and therapeutic interventions. We delineate strategies for data handling and analysis of quantitative gait examinations that can facilitate the clinical characterization and interpretation of walking impairments. These strategies include data normalization and dimensionality reduction procedures. We further emphasize the value of a comprehensive, standardized gait assessment protocol. Accordingly, the examination of walking conditions that challenge patients with respect to their biomechanical, sensory, or cognitive resources are particularly helpful to disclose and characterize the causes underlying their gait impairment. Finally, we provide a perspective on the emerging implementation of pattern recognition approaches within the framework of clinical management of gait disorders and discuss their potential to assist clinical decision making with respect to the differential diagnosis and the prognosis of fall risk in individual patients.
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Affiliation(s)
- Roman Schniepp
- Department of Neurology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany. .,German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Ken Möhwald
- Department of Neurology, University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Marchioninistrasse 15, 81377, Munich, Germany
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Dietrich H, Wuehr M. Selective suppression of the vestibulo-ocular reflex during human locomotion. J Neurol 2019; 266:101-107. [DOI: 10.1007/s00415-019-09352-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022]
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Kroneberg D, Elshehabi M, Meyer AC, Otte K, Doss S, Paul F, Nussbaum S, Berg D, Kühn AA, Maetzler W, Schmitz-Hübsch T. Less Is More - Estimation of the Number of Strides Required to Assess Gait Variability in Spatially Confined Settings. Front Aging Neurosci 2019; 10:435. [PMID: 30719002 PMCID: PMC6348278 DOI: 10.3389/fnagi.2018.00435] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 12/20/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Gait variability is an established marker of gait function that can be assessed using sensor-based approaches. In clinical settings, spatial constraints and patient condition impede the execution of longer distance walks for the recording of gait parameters. Turning paradigms are often used to overcome these constraints and commercial gait analysis systems algorithmically exclude turns for gait parameters calculations. We investigated the effect of turns in sensor-based assessment of gait variability. Methods: Continuous recordings from 31 patients with movement disorders (ataxia, essential tremor and Parkinson’s disease) and 162 healthy elderly (HE) performing level walks including 180° turns were obtained using an inertial sensor system. Accuracy of the manufacturer’s algorithm of turn-detection was verified by plotting stride time series. Strides before and after turn events were extracted and compared to respective average of all strides. Coefficient of variation (CoV) of stride length and stride time was calculated for entire set of strides, segments between turns and as cumulative values. Their variance and congruency was used to estimate the number of strides required to reliably assess the magnitude of stride variability. Results: Non-detection of turns in 5.8% of HE lead to falsely increased CoV for these individuals. Even after exclusion of these, strides before/after turns tended to be spatially shorter and temporally longer in all groups, contributing to an increase of CoV at group level and widening of confidence margins with increasing numbers of strides. This could be attenuated by a more generous turn excision as an alternative approach. Correlation analyses revealed excellent consistency for CoVs after at most 20 strides in all groups. Respective stride counts were even lower in patients using a more generous turn excision. Conclusion: Including turns to increase continuous walking distance in spatially confined settings does not necessarily improve the validity and reliability of gait variability measures. Specifically with gait pathology, perturbations of stride characteristics before/after algorithmically excised turns were observed that may increase gait variability with this paradigm. We conclude that shorter distance walks of around 15 strides suffice for reliable and valid recordings of gait variability in the groups studied here.
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Affiliation(s)
- Daniel Kroneberg
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany
| | - Morad Elshehabi
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Department of Neurodegenerative Diseases, Center for Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Anne-Christiane Meyer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany
| | - Karen Otte
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany
| | - Sarah Doss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany
| | - Friedemann Paul
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Nussbaum
- Department of Neurodegenerative Diseases, Center for Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Daniela Berg
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Department of Neurodegenerative Diseases, Center for Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Andrea A Kühn
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Walter Maetzler
- Department of Neurology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Department of Neurodegenerative Diseases, Center for Neurology, Hertie Institute for Clinical Brain Research, Tübingen, Germany
| | - Tanja Schmitz-Hübsch
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Neurocure Cluster of Excellence, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
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Lipsitz LA, Manor B, Habtemariam D, Iloputaife I, Zhou J, Travison TG. The pace and prognosis of peripheral sensory loss in advanced age: association with gait speed and falls. BMC Geriatr 2018; 18:274. [PMID: 30419857 PMCID: PMC6233369 DOI: 10.1186/s12877-018-0970-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 11/01/2018] [Indexed: 02/08/2023] Open
Abstract
Background Peripheral sensory loss is considered one of many risk factors for gait impairments and falls in older adults, yet no prospective studies have examined changes in touch sensation in the foot over time and their relationship to mobility and falls. Therefore, we aimed to determine the prevalence and progression of peripheral sensory deficits in the feet of older adults, and whether sensory changes are associated with the slowing of gait and development of falls over 5 years. Methods Using baseline, and 18 and 60 month followup data from the Maintenance Of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Study in Boston, MA, we determined changes in the ability to detect stimulation of the great toe with Semmes Weinstein monofilaments in 351 older adults. We used covariate-adjusted repeated measures analysis of variance to determine relationships between sensory changes and gait speed or fall rates. Results Subjects whose sensory function was consistently impaired over 5 years had a significantly steeper decline in gait speed (− 0.23 m/s; 95% CI: -0.28 to − 0.18) compared to those with consistently intact sensory function (− 0.12 m/s; 95% CI: -0.15 to − 0.08) and those progressing from intact to impaired sensory function (− 0.13 m/s; − 0.16 to − 0.10). Compared to subjects with consistently intact sensation, those whose sensory function progressed to impairment during followup had the greatest risk of falls (adjusted risk ratio = 1.57 (95% confidence interval = 1.12 to 2.22). Conclusions Our longitudinal results indicate that a progressive decline in peripheral touch sensation is a risk factor for mobility impairment and falls in older adults.
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Affiliation(s)
- Lewis A Lipsitz
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA. .,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Brad Manor
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Daniel Habtemariam
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA
| | - Ikechukwu Iloputaife
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA
| | - Junhong Zhou
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Thomas G Travison
- Hebrew SeniorLife Institute for Aging Research, 1200 Centre Street, Boston Roslindale, MA, 02131, USA.,Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Wuehr M, Schlick C, Möhwald K, Schniepp R. Walking in orthostatic tremor modulates tremor features and is characterized by impaired gait stability. Sci Rep 2018; 8:14152. [PMID: 30237442 PMCID: PMC6147915 DOI: 10.1038/s41598-018-32526-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/06/2018] [Indexed: 11/13/2022] Open
Abstract
Primary orthostatic tremor (OT) is characterized by high-frequency lower-limb muscle contractions and a disabling sense of unsteadiness while standing. Patients consistently report a relief of symptoms when starting to ambulate. Here, we systematically examined and linked tremor and gait characteristics in patients with OT. Tremor and gait features were examined in nine OT patients and controls on a pressure-sensitive treadmill for one minute of walking framed by two one-minute periods of standing. Tremor characteristics were assessed by time-frequency analysis of surface EMG-recordings from four leg muscles. High-frequency tremor during standing (15.29 ± 0.17 Hz) persisted while walking but was consistently reset to higher frequencies (16.34 ± 0.25 Hz; p < 0.001). Tremor intensity was phase-dependently modulated, being predominantly observable during stance phases (p < 0.001). Tremor intensity scaled with the force applied during stepping (p < 0.001) and was linked to specific gait alterations, i.e., wide base walking (p = 0.019) and increased stride-to-stride fluctuations (p = 0.002). OT during walking persists but is reset to higher frequencies, indicating the involvement of supraspinal locomotor centers in the generation of OT rhythm. Tremor intensity is modulated during the gait cycle, pointing at specific pathways mediating the peripheral manifestation of OT. Finally, OT during walking is linked to gait alterations resembling a cerebellar and/or sensory ataxic gait disorder.
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Affiliation(s)
- M Wuehr
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.
| | - C Schlick
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany
| | - K Möhwald
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - R Schniepp
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Munich, Germany
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Progression of Gait Ataxia in Patients with Degenerative Cerebellar Disorders: a 4-Year Follow-Up Study. THE CEREBELLUM 2018; 16:629-637. [PMID: 27924492 DOI: 10.1007/s12311-016-0837-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In the present study, the progression of gait impairment in a group of patients with primary degenerative cerebellar ataxias was observed over a period of 4 years. A total of 30 patients underwent an initial gait analysis study, and thereafter only 12 were evaluated because they completed the 2- and 4-year follow-up evaluations. Time-distance parameters, trunk and joint range of motion (RoM), and variability parameters (e.g., coefficients of variation) were measured at the baseline and at each follow-up evaluation. The scale for the assessment and rating of ataxia (SARA) was used to evaluate disease severity. We found a significant increase in the SARA score at both the 2- and 4-year follow-up evaluations. Almost all the gait variables changed significantly only at the 4-year follow-up. Particularly, we found a significant decrease in the step length and in the hip, knee, and ankle joint RoM values and noted a significant increase in the trunk rotation RoM and stride-to-stride and step length variability. Furthermore, a significant difference in ankle joint RoM was found between spinocerebellar ataxia and sporadic adult-onset ataxia patients, with the value being lower in the former group of patients. Our findings suggest that patients with degenerative cerebellar ataxias exhibit gait decline after 4 years from the baseline. Moreover, patients try to maintain an effective gait by adopting different compensatory mechanisms during the course of the disease in spite of disease progression.
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Fallahzadeh R, Ghasemzadeh H, Shahrokni A. Electronic Assessment of Physical Decline in Geriatric Cancer Patients. Curr Oncol Rep 2018; 20:26. [PMID: 29516212 PMCID: PMC7412116 DOI: 10.1007/s11912-018-0670-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to explore state-of-the-art remote monitoring and emerging new sensing technologies for in-home physical assessment and their application/potential in cancer care. In addition, we discuss the main functional and non-functional requirements and research challenges of employing such technologies in real-world settings. RECENT FINDINGS With rapid growth in aging population, effective and efficient patient care has become an important topic. Advances in remote monitoring and in its forefront in-home physical assessment technologies play a fundamental role in reducing the cost and improving the quality of care by complementing the traditional in-clinic healthcare. However, there is a gap in medical research community regarding the applicability and potential outcomes of such systems. While some studies reported positive outcomes using remote assessment technologies, such as web/smart phone-based self-reports and wearable sensors, the cancer research community is still lacking far behind. Thorough investigation of more advanced technologies in cancer care is warranted.
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Affiliation(s)
- Ramin Fallahzadeh
- School of Electrical Engineering and Computer Science, Washington State University, 305 NE Spokane Street, DANA 118A, Pullman, WA, 99164-2752, USA
| | - Hassan Ghasemzadeh
- School of Electrical Engineering and Computer Science, Washington State University, 355 Spokane Street, EME 131, Pullman, WA, 99164-2752, USA
| | - Armin Shahrokni
- Geriatric Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, Box 205, 1275 York Ave., New York, NY, 10065, USA.
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Neural correlates of obstacle negotiation in older adults: An fNIRS study. Gait Posture 2017; 58:130-135. [PMID: 28778021 PMCID: PMC5645241 DOI: 10.1016/j.gaitpost.2017.07.043] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 06/02/2017] [Accepted: 07/15/2017] [Indexed: 02/02/2023]
Abstract
Older adults are less efficient at avoiding obstacles compared to young adults, especially under attention-demanding conditions. Using functional near-infrared-spectroscopy (fNIRS), recent studies implicated the prefrontal cortex (PFC) in cognitive control of locomotion, notably under dual-task walking conditions. The neural substrates underlying Obstacle Negotiation (ON), however, have not been established. The current study determined the role of the PFC in ON during walking in seniors. Non-demented older adults (n=90; mean age=78.1±5.5years; %female=51) underwent fNIRS acquisition to assess changes in hemodynamic activity in the PFC during normal-walk [NW] and walk-while-talk [WWT] conditions with and without obstacles. Obstacles were presented as red elliptical shapes using advanced laser technology, which resemble potholes. Linear mixed effects models were used to determine differences in oxygenated hemoglobin (HbO2) levels among the four task conditions. The presence of slow gait, a risk factor for dementia and falls, served as a predictor hypothesized to moderate the effect of obstacles on PFC HbO2 levels. PFC HbO2 levels were significantly higher in WWT compared to NW (p<0.001) irrespective of ON. Slow gait moderated the effect of obstacles on HbO2 levels across task conditions. Specifically, compared to participants with normal gait, PFC HbO2 levels were significantly increased in ON-NW relative to NW (p=0.017) and ON-WWT relative to WWT (p<0.001) among individuals with slow gait. Consistent with Compensatory Reallocation, ON required greater PFC involvement among individuals with mobility limitations.
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Somatosensory impairment and its association with balance limitation in people with multiple sclerosis. Gait Posture 2017; 57:224-229. [PMID: 28667904 DOI: 10.1016/j.gaitpost.2017.06.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 06/04/2017] [Accepted: 06/22/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Somatosensory impairments are common in multiple sclerosis. However, little data are available to characterize the nature and frequency of these problems in people with multiple sclerosis. OBJECTIVE To investigate the frequency of somatosensory impairments and identify any association with balance limitations in people with multiple sclerosis. METHODS The design was a prospective cross-sectional study, involving 82 people with multiple sclerosis and 30 healthy controls. Tactile and proprioceptive sensory acuity were measured using the Rivermead Assessment of Somatosensory Performance. Vibration duration was assessed using a tuning fork. Duration for the Timed Up and Go Test and reaching distance of the Functional Reach Test were measured to assess balance limitations. The normative range of sensory modalities was defined using cut-off points in the healthy participants. The multivariate linear regression was used to identify the significant predictors of balance in people with multiple sclerosis. RESULTS Proprioceptive impairments (66.7%) were more common than tactile (60.8%) and vibration impairments (44.9%). Somatosensory impairments were more frequent in the lower limb (78.2%) than the upper limb (64.1%). All sensory modalities were significantly associated with the Timed Up and Go and Functional Reach tests (p<0.05). The Timed Up and Go test was independently predicted by the severity of the neurological lesion, Body Mass Index, ataxia, and tactile sensation (R2=0.58), whereas the Functional Reach test was predicted by the severity of the neurological lesion, lower limb strength, and vibration sense (R2=0.49). CONCLUSIONS Somatosensory impairments are very common in people with multiple sclerosis. These impairments are independent predictors of balance limitation.
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Oliveira AS, Schlink BR, Hairston WD, König P, Ferris DP. Restricted vision increases sensorimotor cortex involvement in human walking. J Neurophysiol 2017; 118:1943-1951. [PMID: 28679843 DOI: 10.1152/jn.00926.2016] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/28/2017] [Accepted: 07/04/2017] [Indexed: 11/22/2022] Open
Abstract
This study aimed to determine whether there is electrocortical evidence of augmented participation of sensory brain areas in walking modulation during walking with eyes closed. Healthy subjects (n = 10) walked on a treadmill at 1 m/s while alternating 5 min of walking with the eyes open or closed while we recorded ground reaction forces (GRFs) and high-density scalp electroencephalography (EEG). We applied independent component analysis to parse EEG signals into maximally independent component (IC) processes and then computed equivalent current dipoles for each IC. We clustered cortical source ICs and analyzed event-related spectral perturbations synchronized to gait events. Our results indicated that walking with eyes closed reduced the first peak of the vertical GRFs and induced shorter stride duration. Regarding the EEG, we found that walking with eyes closed induced significantly increased relative theta desynchronization in the frontal and premotor cortex during stance, as well as greater desynchronization from theta to beta bands during transition to single support for both left and right somatosensory cortex. These results suggest a phase-specific increased participation of brain areas dedicated to sensory processing and integration when vision is not available for locomotor guidance. Furthermore, the lack of vision demands higher neural processing related to motor planning and execution. Our findings provide evidence supporting the use of eyes-closed tasks in clinical practice, such as gait rehabilitation and improvements in balance control, as there is higher demand for additional sensory integration for achieving postural control.NEW & NOTEWORTHY We measured electrocortical dynamics in sighted individuals while walking with eyes open and eyes closed to induce the participation of other sensory systems in postural control. Our findings show that walking with visual restriction increases the participation of brain areas dedicated to sensory processing, motor planning, and execution. These results confirm the essential participation of supraspinal inputs to postural control in human locomotion, supporting the use of eyes-closed tasks in clinical practice.
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Affiliation(s)
- Anderson S Oliveira
- Human Neuromechanics Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan; .,Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - Bryan R Schlink
- Human Neuromechanics Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan
| | - W David Hairston
- Human Research and Engineering Directorate, U.S. Army Research Laboratory, Aberdeen Proving Ground, Maryland
| | - Peter König
- Institute of Cognitive Science, University of Osnabrück, Osnabrück, Germany; and.,Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel P Ferris
- Human Neuromechanics Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan
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Schniepp R, Möhwald K, Wuehr M. Gait ataxia in humans: vestibular and cerebellar control of dynamic stability. J Neurol 2017; 264:87-92. [PMID: 28397001 DOI: 10.1007/s00415-017-8482-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/31/2017] [Accepted: 04/01/2017] [Indexed: 01/15/2023]
Abstract
During human locomotion, vestibular feedback control is fundamental for maintaining dynamic stability and adapting the gait pattern to external circumstances. Within the supraspinal locomotor network, the cerebellum represents the key site for the integration of vestibular feedback information. The cerebellum is further important for the fine-tuning and coordination of limb movements during walking. The aim of this review article is to highlight the shared structural and functional sensorimotor principles in vestibular and cerebellar locomotion control. Vestibular feedback for the maintenance of dynamic stability is integrated into the locomotor pattern via midline, caudal cerebellar structures (vermis, flocculonodular lobe). Hemispheric regions of the cerebellum facilitate feed-forward control of multi-joint coordination and higher locomotor functions. Characteristic features of the gait disorder in patients with vestibular deficits or cerebellar ataxia are increased levels of spatiotemporal gait variability in the fore-aft and the medio-lateral gait dimension. In the fore-aft dimension, pathologic increases of gait fluctuations critically depend on the locomotion speed and predominantly manifest during slow walking velocities. This feature is associated with an increased risk of falls in both patients with vestibular hypofunction as well as patients with cerebellar ataxia. Pharmacological approaches for the treatment of vestibular or cerebellar gait ataxia are currently not available. However, new promising options are currently tested in randomized, controlled trials (fampridine/FACEG; acetyl-DL-leucine/ALCAT).
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Affiliation(s)
- Roman Schniepp
- Department of Neurology, University of Munich, Bavaria, Germany. .,German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Bavaria, Germany.
| | - Ken Möhwald
- German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Bavaria, Germany
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders (DSGZ), University of Munich, Bavaria, Germany
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Schniepp R, Schlick C, Schenkel F, Pradhan C, Jahn K, Brandt T, Wuehr M. Clinical and neurophysiological risk factors for falls in patients with bilateral vestibulopathy. J Neurol 2016; 264:277-283. [DOI: 10.1007/s00415-016-8342-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/07/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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Jahn K, Kressig RW, Bridenbaugh SA, Brandt T, Schniepp R. Dizziness and Unstable Gait in Old Age: Etiology, Diagnosis and Treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 112:387-93. [PMID: 26157011 DOI: 10.3238/arztebl.2015.0387] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/18/2015] [Accepted: 03/18/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Dizziness and unsteady gait are common in the elderly but are too often dismissed as supposedly nonspecific, inevitable accompaniments of normal aging. For many affected persons, the factors leading to dizziness and gait impairment in old age are never identified, yet some of these factors can be specifically detected and treated. METHODS This review is based on publications (2005-2014) retrieved by a selective search in PubMed on the terms "aging," "dizziness," "elderly," "gait," "gait disorder," "geriatric," "locomotion," and "vertigo." RESULTS Dizziness interferes with the everyday activities of 30% of persons over age 70 and is so severe that it constitutes a reason for consulting a physician. The more common causes of dizziness and unsteady gait in old age are sensory deficits, such as bilateral vestibular failure, polyneuropathy, and impaired visual acuity; benign paroxysmal positioning vertigo; and central disorders such as cerebellar ataxia and normal-pressure hydrocephalus. Further relevant factors include sedative or antihypertensive medication, loss of muscle mass (sarcopenia), and fear of falling. Many elderly persons have multiple factors at the same time. Benign paroxysmal positioning vertigo can be effectively treated with specific physical maneuvers. Sedating drugs are indicated only for the treatment of acute rotatory vertigo and are not suitable for long-term use. Sarcopenia can be treated with physical training. CONCLUSION If a specific cause can be identified, dizziness and gait unsteadiness in old age can often be successfully treated. The common causes can be revealed by systematic clinical examination. Controlled clinical trials on the efficacy of treatments for elderly persons are urgently needed.
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Affiliation(s)
- Klaus Jahn
- German Center for Vertigo and Balance Disorders, Großhadern Hospital, Ludwig-Maximilian-Universität, München, Schön Klinik Bad Aibling, Basel University and University Center for Geriatrics and Rehabilitation, Felix Platter Hospital, Basel, Switzerland, Institute for Clinical Neurosciences, Großhadern Hospital, Ludwig-Maximilian-Universität, Munich, Neurological Clinic and Policlinic, Großhadern Hospital, Ludwig-Maximilian-Universität Munich
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Pirker W, Katzenschlager R. Gait disorders in adults and the elderly : A clinical guide. Wien Klin Wochenschr 2016; 129:81-95. [PMID: 27770207 PMCID: PMC5318488 DOI: 10.1007/s00508-016-1096-4] [Citation(s) in RCA: 239] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 09/14/2016] [Indexed: 01/22/2023]
Abstract
Human gait depends on a complex interplay of major parts of the nervous, musculoskeletal and cardiorespiratory systems. The individual gait pattern is influenced by age, personality, mood and sociocultural factors. The preferred walking speed in older adults is a sensitive marker of general health and survival. Safe walking requires intact cognition and executive control. Gait disorders lead to a loss of personal freedom, falls and injuries and result in a marked reduction in the quality of life. Acute onset of a gait disorder may indicate a cerebrovascular or other acute lesion in the nervous system but also systemic diseases or adverse effects of medication, in particular polypharmacy including sedatives. The prevalence of gait disorders increases from 10 % in people aged 60–69 years to more than 60 % in community dwelling subjects aged over 80 years. Sensory ataxia due to polyneuropathy, parkinsonism and frontal gait disorders due to subcortical vascular encephalopathy or disorders associated with dementia are among the most common neurological causes. Hip and knee osteoarthritis are common non-neurological causes of gait disorders. With advancing age the proportion of patients with multiple causes or combinations of neurological and non-neurological gait disorders increases. Thorough clinical observation of gait, taking a focused patient history and physical, neurological and orthopedic examinations are basic steps in the categorization of gait disorders and serve as a guide for ancillary investigations and therapeutic interventions. This clinically oriented review provides an overview on the phenotypic spectrum, work-up and treatment of gait disorders.
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Affiliation(s)
- Walter Pirker
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Department of Neurology, Wilhelminenspital, Vienna, Austria.
| | - Regina Katzenschlager
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Conditions, Donauspital, Vienna, Austria
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Altered EMG patterns in diabetic neuropathic and not neuropathic patients during step ascending and descending. J Electromyogr Kinesiol 2016; 31:32-39. [PMID: 27632533 DOI: 10.1016/j.jelekin.2016.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/18/2016] [Accepted: 08/17/2016] [Indexed: 11/22/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) causes motor control alterations during daily life activities. Tripping during walking or stair climbing is the predominant cause of falls in the elderly subjects with DPN and without (NoDPN). Surface Electromyography (sEMG) has been shown to be a valid tool for detecting alterations of motor functions in subjects with DPN. This study aims at investigating the presence of functional alterations in diabetic subjects during stair climbing and at exploring the relationship between altered muscle activation and temporal parameter. Lower limb muscle activities, temporal parameters and speed were evaluated in 50 subjects (10 controls, 20 with DPN, 20 without DPN), while climbing up and down a stair, using sEMG, three-dimentional motion capture and force plates. Magnitude and timing of sEMG linear envelopes peaks were extracted. Level walking was used as reference condition for the comparison with step negotiation. sEMG, speed and temporal parameters revealed significant differences among all groups of patients. Results showed an association between earlier activation of lower limb muscles and reduced speed in subjects with DPN. Speed and temporal parameters significantly correlated with sEMG (p<0.05). The findings of this study are encouraging and could be used to improve rehabilitation programs aiming at reducing falls risk in diabetic subjects.
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Covill LG, Utley C, Hochstein C. Comparison of Ai Chi and Impairment-Based Aquatic Therapy for Older Adults With Balance Problems: A Clinical Study. J Geriatr Phys Ther 2016; 40:204-213. [PMID: 27490823 DOI: 10.1519/jpt.0000000000000100] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Older adults with balance deficits often fear falling and limit their mobility. Poor balance is multifactorial, influenced by medication interactions, musculoskeletal and sensory system changes, and poor neuromuscular response to changes in body positions. Aquatic physical therapy (APT) is an intervention used to improve balance and decrease falls. Ai Chi is a water-based exercise program. It incorporates slow movements of progressive difficulty utilizing the upper and lower extremities and trunk coordinated with deep breathing. It is used for relaxation, strengthening, and balance training. The purpose of this study was to determine whether Ai Chi provides better results than conventional impairment-based aquatic therapy (IBAT) for older adults with balance deficits. METHODS Thirty-two community-dwelling adults, 65 to 85 years old, were referred to 2 different community pools for APT. Fifteen participants received Ai Chi-based aquatic interventions and 17 participants received an IBAT program. Physical therapists trained in both programs completed interventions and determined discharge. Physical balance measures, which included the Berg Balance Scale (BBS) and Timed Up and Go (TUG), were collected pre- and posttherapy. Self-reported outcome measures, the Activities-Specific Balance Confidence Scale (ABC) and Numerical Pain Rating Scale (NPRS), were collected pre- and posttherapy and 3- and 6-month postdischarge. RESULTS A 2-way (group by time) mixed-model analysis of covariance with initial outcome scores as a covariate revealed no difference between groups in any of the outcome measures (BBS, P = .53; TUG, P = .39; ABC, P = .63; NPRS, P = .27). Repeated-measures analysis and dependent t tests showed significant improvements in the BBS (P = .00) and TUG (P = .03) after APT. The ABC and NPRS did not improve significantly (ABC, P = .27; NPRS, P = .77). CONCLUSIONS There were no significant differences found in balance measures, balance confidence, or pain levels for community-dwelling older adults between the Ai Chi and IBAT programs. Physical outcome measures improved with APT but patient-reported measures did not. Further study is indicated to determine the most effective treatment frequency and duration for this population.
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Affiliation(s)
- Laura G Covill
- 1Des Moines University, Des Moines, Iowa. 2Mercy Physical Therapy Clinics, Des Moines, Iowa
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Postural Control and Gait Performance in the Diabetic Peripheral Neuropathy: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9305025. [PMID: 27525281 PMCID: PMC4971307 DOI: 10.1155/2016/9305025] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/16/2016] [Accepted: 06/16/2016] [Indexed: 11/30/2022]
Abstract
Purpose. The aim of this paper is to review the published studies on the characteristics of impairments in the postural control and gait performance in diabetic peripheral neuropathy (DPN). Methods. A review was performed by obtaining publication of all papers reporting on the postural control and gait performance in DPN from Google Scholar, Ovid, SAGE, Springerlink, Science Direct (SD), EBSCO Discovery Service, and Web of Science databases. The keywords used for searching were “postural control,” “balance,” “gait performance,” “diabetes mellitus,” and “diabetic peripheral neuropathy.” Results. Total of 4,337 studies were hit in the search. 1,524 studies were screened on their titles and citations. Then, 79 studies were screened on their abstract. Only 38 studies were eligible to be selected: 17 studies on postural control and 21 studies on the gait performance. Most previous researches were found to have strong evidence of postural control impairments and noticeable gait deficits in DPN. Deterioration of somatosensory, visual, and vestibular systems with the pathologic condition of diabetes on cognitive impairment causes further instability of postural and gait performance in DPN. Conclusions. Postural instability and gait imbalance in DPN may contribute to high risk of fall incidence, especially in the geriatric population. Thus, further works are crucial to highlight this fact in the hospital based and community adults.
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