Disturbances of automatic gait control mechanisms in higher level gait disorder

Gait Training of Healthy Older Adults in a Sitting Position using the Wearable Robot to Assist Arm-swing Rhythm, WALK-MATE ROBOT

Although various walking training robots have been developed and their effectiveness has been recognised, operating these robots requires the implementation of safety measures to avoid the risk of falling. This study aimed to confirm whether arm swing rhythm training in the sitting position using an arm swing rhythm-assisted robot, WMR, improved subsequent walking. Healthy older adults (N = 20) performed arm swing rhythm training in a sitting position for 1 min × three times while being presented with tactile stimulation synchronised with the arm swing rhythm from a robot. An increase in walking performance was observed with increases in stride length and speed. In addition, the stabilisation of the gait pattern was observed, with a decrease in the proportion of the double-foot support phase and an increase in the proportion of the swing phase in one gait cycle. These results suggest that arm swing rhythm training in a sitting position using WMR improves gait in older adults. This will lead to the realisation of safe and low-cost robot-based walking training in sitting position.

Vestibular perceptual learning improves self-motion perception, posture, and gait in older adults

Vestibular motion perception declines with age, increasing the risk of falling substantially. We performed a two-week perceptual learning intervention using a self-motion direction discrimination task (2800 training trials per person) on a 6 degrees of freedom motion platform in healthy older adults (n = 40, aged 70-88 yr). Linear inter-aural and angular roll tilt vestibular thresholds improved with training (95% credible interval for pre/post difference), suggesting altered sensitivity post-training. Moreover, improved perceptual abilities transfer to actual posture (reduced sway) and gait parameters. Passive self-motion discrimination training provides a new and promising way to counteract age-related sensory decline. It can reduce the risk of falling, and thereby maintain individual autonomy and quality of life.

Fall Prevalence and Associated Risk Factors Among the Elderly Population in Tabuk City, Saudi Arabia: A Cross-Sectional Study 2023

Background Falls are common among older adults, and they constitute a major public health issue with high morbidity and mortality. Aim This study aimed to estimate the prevalence of falls and investigate the contributing risk factors among the elderly population in Tabuk City, Saudi Arabia. Methods This cross-sectional study recruited a random representative sample of the elderly aged ≥ 60 years. We collected data by interviewing the participants using a structured, Arabic-language questionnaire. It included personal information, a history of falls in the past three and 12 months, comorbidities, and environmental factors. The main outcome was a history of falls in the preceding year. Multivariable logistic regression was used to evaluate the association between potential risk factors and falls. Results The study included 296 participants. Most participants were female (66.9%), aged 60-69 years (68.2%), and married (68.9%). The self-reported prevalence of falls over the preceding 12 months was 25.3% (95% confidence interval (CI): 20.6-30.5). Older people with depressive symptoms had significantly increased vulnerability to falls (adjusted odds ratio (AOR): 0.452, 95% CI: 0.239-0.854). Environmental factors were associated with a 1.799 times (95% CI: 1.041-3.109) increased likelihood of fall, and gait impairment was the strongest risk factor (AOR: 2.775, 95% CI: 1.558-4.942). Conclusions Falls are common among the elderly population in Tabuk City, Saudi Arabia. Gait impairment, the presence of depressive symptoms, and environmental hazards were substantially associated with falls, suggesting that most falls are preventable.

Neurophysiology of cerebellar ataxias and gait disorders

There are numerous forms of cerebellar disorders from sporadic to genetic diseases. The aim of this chapter is to provide an overview of the advances and emerging techniques during these last 2 decades in the neurophysiological tests useful in cerebellar patients for clinical and research purposes. Clinically, patients exhibit various combinations of a vestibulocerebellar syndrome, a cerebellar cognitive affective syndrome and a cerebellar motor syndrome which will be discussed throughout this chapter. Cerebellar patients show abnormal Bereitschaftpotentials (BPs) and mismatch negativity. Cerebellar EEG is now being applied in cerebellar disorders to unravel impaired electrophysiological patterns associated within disorders of the cerebellar cortex. Eyeblink conditioning is significantly impaired in cerebellar disorders: the ability to acquire conditioned eyeblink responses is reduced in hereditary ataxias, in cerebellar stroke and after tumor surgery of the cerebellum. Furthermore, impaired eyeblink conditioning is an early marker of cerebellar degenerative disease. General rules of motor control suggest that optimal strategies are needed to execute voluntary movements in the complex environment of daily life. A high degree of adaptability is required for learning procedures underlying motor control as sensorimotor adaptation is essential to perform accurate goal-directed movements. Cerebellar patients show impairments during online visuomotor adaptation tasks. Cerebellum-motor cortex inhibition (CBI) is a neurophysiological biomarker showing an inverse association between cerebellothalamocortical tract integrity and ataxia severity. Ataxic gait is characterized by increased step width, reduced ankle joint range of motion, increased gait variability, lack of intra-limb inter-joint and inter-segmental coordination, impaired foot ground placement and loss of trunk control. Taken together, these techniques provide a neurophysiological framework for a better appraisal of cerebellar disorders.

Smart Shoe Insole Based on Polydimethylsiloxane Composite Capacitive Sensors

Nowadays, the study of the gait by analyzing the distribution of plantar pressure is a well-established technique. The use of intelligent insoles allows real-time monitoring of the user. Thus, collecting and analyzing information is a more accurate process than consultations in so-called gait laboratories. Most of the previous published studies consider the composition and operation of these insoles based on resistive sensors. However, the use of capacitive sensors could provide better results, in terms of linear behavior under the pressure exerted. This behavior depends on the properties of the dielectric used. In this work, the design and implementation of an intelligent plantar insole composed of capacitive sensors is proposed. The dielectric used is a polydimethylsiloxane (PDMS)-based composition. The sensorized plantar insole developed achieves its purpose as a tool for collecting pressure in different areas of the sole of the foot. The fundamentals and details of the composition, manufacture, and implementation of the insole and the system used to collect data, as well as the data samples, are shown. Finally, a comparison of the behavior of both insoles, resistive and capacitive sensor-equipped, is made. The prototype presented lays the foundation for the development of a tool to support the diagnosis of gait abnormalities.

Discussion of Research Priorities for Gait Disorders in Parkinson's Disease

Gait and balance abnormalities develop commonly in Parkinson's disease and are among the motor symptoms most disabling and refractory to dopaminergic or other treatments, including deep brain stimulation. Efforts to develop effective therapies are challenged by limited understanding of these complex disorders. There is a major need for novel and appropriately targeted research to expedite progress in this area. The Scientific Issues Committee of the International Parkinson and Movement Disorder Society has charged a panel of experts in the field to consider the current knowledge gaps and determine the research routes with highest potential to generate groundbreaking data. © 2021 International Parkinson and Movement Disorder Society.

Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates

BACKGROUND

Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses.

METHODS

We used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained.

RESULTS

There were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes 'excessive.' The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features.

CONCLUSIONS

The concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.

Design on the Winter Jujubes Harvesting and Sorting Device

According to the existing problems of winter jujube harvesting, such as the intensive labor of manual picking, damage to the surface of winter jujubes, a winter jujube harvesting and sorting device was developed. This device consisted of vibration mechanism, collection mechanism, and sorting mechanism. The eccentric vibration mechanism made the winter jujubes fall, and the umbrella collecting mechanism can collect winter jujube and avoid the impact of winter jujube on the ground, and the sorting mechanism removed jujube leaves and divided the jujube into two types, and the automatic leveling mechanism made the device run smoothly in the field. Through finite element analysis and BP (Back Propagation) neural network analysis, the results show that: The vibration displacement of jujube tree is related to the trunk diameter and vibration position; the impact force of winter jujubes falling is related to the elastic modulus of umbrella material; the collecting area can be increased four times for each additional step of the collection mechanism; jujube leaves can be effectively removed when blower wind speed reaches 45.64 m/s. According to the evaluation standard grades of the jujubes harvesting and sorting, the device has good effects and the excellent rate up to 90%, which has good practicability and economy.

Balance and gait in the elderly: A contemporary review

Background

The prevalence of balance and gait deficits increases with age and is associated with the increased incidence of falls seen in the elderly population; these falls are associated with significant morbidity and mortality.

Objectives

To review changes in gait and balance associated with aging and the effect of visual perturbations on gait and balance in the elderly to provide a basis for future research.

Methods

PubMed and Cochrane Library were searched for articles from 1980 to present pertaining to gait and balance in older adults (>60) and younger adults (<60). Search terms included balance, posture, gait, locomotion, gait variability, gait disorders, gait disturbance, elderly, aging, falls, vision, visual, vestibular, and virtual reality. The references section of queried articles was also used to find relevant studies. Studies were excluded if subjects had a diagnosed gait or balance disorder.

Results

Elderly adults show age-related decline in sensory systems and reduced ability to adapt to changes in their environment to maintain balance. Elderly adults are particularly dependent on vision to maintain postural stability. Distinct changes in spatiotemporal gait parameters are associated with aging, such as slower gait and increased gait variability, which are amplified with exposure to visual perturbations. Increased gait variability, specifically with mediolateral perturbations, poses a particular challenge for elderly adults and is linked to increased falls risk. Virtual reality training has shown promising effects on balance and gait.

Conclusion

Elderly adults show age-related decline in balance and gait with increased gait variability and an associated increased risk of falls.

Level of Evidence

5.

Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed

Background

Several patients with Parkinson´s disease (PD) can walk normally along straight trajectories, and impairment in their stride length and cadence may not be easily discernible. Do obvious abnormalities occur in these high-functioning patients when more challenging trajectories are travelled, such as circular paths, which normally implicate a graded modulation in the duration of the interlimb gait cycle phases?

Methods

We compared a cohort of well-treated mildly to moderately affected PD patients to a group of age-matched healthy subjects (HS), by deliberately including HS spontaneously walking at the same speed of the patients with PD. All participants performed, in random order: linear and circular walking (clockwise and counter-clockwise) at self-selected speed. By means of pressure-sensitive insoles, we recorded walking speed, cadence, duration of single support, double support, swing phase, and stride time. Stride length-cadence relationships were built for linear and curved walking. Stride-to-stride variability of temporal gait parameters was also estimated.

Results

Walking speed, cadence or stride length were not different between PD and HS during linear walking. Speed, cadence and stride length diminished during curved walking in both groups, stride length more in PD than HS. In PD compared to HS, the stride length-cadence relationship was altered during curved walking. Duration of the double-support phase was also increased during curved walking, as was variability of the single support, swing phase and double support phase.

Conclusion

The spatio-temporal gait pattern and variability are significantly modified in well-treated, high-functioning patients with PD walking along circular trajectories, even when they exhibit no changes in speed in straight-line walking. The increased variability of the gait phases during curved walking is an identifying characteristic of PD. We discuss our findings in term of interplay between control of balance and of locomotor progression: the former is challenged by curved trajectories even in high-functioning patients, while the latter may not be critically affected.