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Arippa F, Pau M, Marcello R, Atzeni L, Simone Vullo S, Monticone M. An integrated approach to the assessment of balance and functional mobility in individuals with history of severe traumatic brain injury. Heliyon 2024; 10:e30665. [PMID: 38765073 PMCID: PMC11098832 DOI: 10.1016/j.heliyon.2024.e30665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/11/2024] [Accepted: 05/01/2024] [Indexed: 05/21/2024] Open
Abstract
Individuals who experienced severe Traumatic Brain Injury (sTBI) are often characterized by relevant motor dysfunctions which are likely to negatively affect activities of daily living and quality of life and often persist for years. However, detailed objective information about their magnitude are scarce. The aim of this study was to quantitatively assess the extent of motor deficits in terms of postural control effectiveness under static and dynamic conditions and to investigate the existence of possible correlations between the results of clinical tests and instrumental measures. Postural sway and functional mobility (i.e., instrumented Timed Up and Go test, iTUG) were objectively measured in 18 individuals with sTBI and 18 healthy controls using a pressure plate and a wearable inertial sensor. Additionally, participants with history of sTBI completed the Rivermead Mobility Index (RMI). One-way ANOVA and Spearman's rank correlation analysis were employed to examine differences between the two groups and determine potential correlations between the instrumental tests and clinical scales. The results show that people with sTBI were characterized by larger sway area and longer iTUG walking sub-phase. Significant correlations were also detected between RMI scores and iTUG total duration, as well as the walking phase. Taken together, these findings suggest that, even years after the initial injury, individuals with sTBI appear characterized by impaired postural control and functional mobility, which appears correlated with the RMI score. The integration of instrumental measures with clinical scales in the routine assessment and treatment of individuals with sTBI would result in more comprehensive, objective, and sensitive evaluations, thus improving precision in treatment planning, enabling ongoing progress monitoring, and highlighting the presence of motor deficits even years after the initial injury. Such integration is of importance for enhancing the long-term quality of life for individuals with sTBI.
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Affiliation(s)
- Federico Arippa
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Rosa Marcello
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS G. Brotzu Hospital, Cagliari, Italy
| | - Laura Atzeni
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS G. Brotzu Hospital, Cagliari, Italy
| | - Salvatore Simone Vullo
- Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, ARNAS G. Brotzu Hospital, Cagliari, Italy
| | - Marco Monticone
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Martiš P, Košutzká Z, Kranzl A. A Step Forward Understanding Directional Limitations in Markerless Smartphone-Based Gait Analysis: A Pilot Study. SENSORS (BASEL, SWITZERLAND) 2024; 24:3091. [PMID: 38793945 PMCID: PMC11125344 DOI: 10.3390/s24103091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/02/2024] [Accepted: 05/10/2024] [Indexed: 05/26/2024]
Abstract
The progress in markerless technologies is providing clinicians with tools to shorten the time of assessment rapidly, but raises questions about the potential trade-off in accuracy compared to traditional marker-based systems. This study evaluated the OpenCap system against a traditional marker-based system-Vicon. Our focus was on its performance in capturing walking both toward and away from two iPhone cameras in the same setting, which allowed capturing the Timed Up and Go (TUG) test. The performance of the OpenCap system was compared to that of a standard marker-based system by comparing spatial-temporal and kinematic parameters in 10 participants. The study focused on identifying potential discrepancies in accuracy and comparing results using correlation analysis. Case examples further explored our results. The OpenCap system demonstrated good accuracy in spatial-temporal parameters but faced challenges in accurately capturing kinematic parameters, especially in the walking direction facing away from the cameras. Notably, the two walking directions observed significant differences in pelvic obliquity, hip abduction, and ankle flexion. Our findings suggest areas for improvement in markerless technologies, highlighting their potential in clinical settings.
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Affiliation(s)
- Pavol Martiš
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, 833 05 Bratislava, Slovakia;
| | - Zuzana Košutzká
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, 833 05 Bratislava, Slovakia;
| | - Andreas Kranzl
- Laboratory for Gait and Movement Analysis, Orthopedic Hospital Speising, 1130 Vienna, Austria
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Abdollahi M, Kuber PM, Rashedi E. Dual Tasking Affects the Outcomes of Instrumented Timed up and Go, Sit-to-Stand, Balance, and 10-Meter Walk Tests in Stroke Survivors. SENSORS (BASEL, SWITZERLAND) 2024; 24:2996. [PMID: 38793850 PMCID: PMC11125653 DOI: 10.3390/s24102996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024]
Abstract
Stroke can impair mobility, with deficits more pronounced while simultaneously performing multiple activities. In this study, common clinical tests were instrumented with wearable motion sensors to study motor-cognitive interference effects in stroke survivors (SS). A total of 21 SS and 20 healthy controls performed the Timed Up and Go (TUG), Sit-to-Stand (STS), balance, and 10-Meter Walk (10MWT) tests under single and dual-task (counting backward) conditions. Calculated measures included total time and gait measures for TUG, STS, and 10MWT. Balance tests for both open and closed eyes conditions were assessed using sway, measured using the linear acceleration of the thorax, pelvis, and thighs. SS exhibited poorer performance with slower TUG (16.15 s vs. 13.34 s, single-task p < 0.001), greater sway in the eyes open balance test (0.1 m/s2 vs. 0.08 m/s2, p = 0.035), and slower 10MWT (12.94 s vs. 10.98 s p = 0.01) compared to the controls. Dual tasking increased the TUG time (~14%, p < 0.001), balance thorax sway (~64%, p < 0.001), and 10MWT time (~17%, p < 0.001) in the SS group. Interaction effects were minimal, suggesting similar dual-task costs. The findings demonstrate exaggerated mobility deficits in SS during dual-task clinical testing. Dual-task assessments may be more effective in revealing impairments. Integrating cognitive challenges into evaluation can optimize the identification of fall risks and personalize interventions targeting identified cognitive-motor limitations post stroke.
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Affiliation(s)
| | | | - Ehsan Rashedi
- Industrial and Systems Engineering Department, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.)
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Abdollahi M, Rashedi E, Kuber PM, Jahangiri S, Kazempour B, Dombovy M, Azadeh-Fard N. Post-Stroke Functional Changes: In-Depth Analysis of Clinical Tests and Motor-Cognitive Dual-Tasking Using Wearable Sensors. Bioengineering (Basel) 2024; 11:349. [PMID: 38671771 PMCID: PMC11048064 DOI: 10.3390/bioengineering11040349] [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: 03/04/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Clinical tests like Timed Up and Go (TUG) facilitate the assessment of post-stroke mobility, but they lack detailed measures. In this study, 21 stroke survivors and 20 control participants underwent TUG, sit-to-stand (STS), and the 10 Meter Walk Test (10MWT). Tests incorporated single tasks (STs) and motor-cognitive dual-task (DTs) involving reverse counting from 200 in decrements of 10. Eight wearable motion sensors were placed on feet, shanks, thighs, sacrum, and sternum to record kinematic data. These data were analyzed to investigate the effects of stroke and DT conditions on the extracted features across segmented portions of the tests. The findings showed that stroke survivors (SS) took 23% longer for total TUG (p < 0.001), with 31% longer turn time (p = 0.035). TUG time increased by 20% (p < 0.001) from STs to DTs. In DTs, turning time increased by 31% (p = 0.005). Specifically, SS showed 20% lower trunk angular velocity in sit-to-stand (p = 0.003), 21% longer 10-Meter Walk time (p = 0.010), and 18% slower gait speed (p = 0.012). As expected, turning was especially challenging and worsened with divided attention. The outcomes of our study demonstrate the benefits of instrumented clinical tests and DTs in effectively identifying motor deficits post-stroke across sitting, standing, walking, and turning activities, thereby indicating that quantitative motion analysis can optimize rehabilitation procedures.
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Affiliation(s)
- Masoud Abdollahi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Ehsan Rashedi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Pranav Madhav Kuber
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Sonia Jahangiri
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Behnam Kazempour
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
| | - Mary Dombovy
- Department of Rehabilitation and Neurology, Unity Hospital, Rochester, NY 14626, USA;
| | - Nasibeh Azadeh-Fard
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.); (S.J.); (B.K.); (N.A.-F.)
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Peters J, Abou L, Wong E, Dossou MS, Sosnoff JJ, Rice LA. Smartphone-based gait and balance assessment in survivors of stroke: a systematic review. Disabil Rehabil Assist Technol 2024; 19:177-187. [PMID: 35584288 DOI: 10.1080/17483107.2022.2072527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/21/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Gait and balance impairments are associated with falls and reduced quality of life among survivors of stroke (SS). Effective methods to assess these impairments at-home and in-clinic can help reduce fall risks and improve functional outcomes. Smartphone technology may be able to evaluate these impairments. This review aims to summarize the validity, reliability, sensitivity, and specificity of smartphone applications for determining gait and balance disorders in SS. METHOD Database search through PubMed, Web of Science, Scopus, CINAHL, and SportDiscuss was conducted to retrieve studies that explored the use of smartphone-based applications for assessing gait and balance disorders in SS. Two independent reviewers screened potential articles to determine eligibility for inclusion. Eligible studies were summarized for participant and study characteristics, validity, reliability, sensitivity, and specificity of smartphone assessments. Methodological quality assessment of studies was performed using the NIH Quality Assessment Tool. RESULTS Seven cross-sectional studies were included in the review. Quality assessment revealed all studies had low risk of bias. Three of the included studies examined the validity, four examined the reliability, and two examined the specificity and sensitivity of smartphone-based application assessments of gait and balance in SS. Studies revealed that smartphones were valid, reliable, specific, and sensitive. Six of the seven included studies intended their use for SS and one study for clinicians. CONCLUSION Preliminary evidence supports that smartphone-based gait and balance assessments are valid, reliable, sensitive, and specific in SS in laboratory settings. Future research is needed to test smartphone-based gait and balance assessments in home settings and determine optimal wear sites for assessments.IMPLICATIONS FOR REHABILITATIONSmartphone-based gait and balance assessments are feasible, valid and reliable for survivors of strokeThe findings may guide future research to standardize the use of smartphone to assess gait and balance in this population.The remote use of smartphone-based assessments to predict fall risk in survivors of stroke needs to be explored.
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Affiliation(s)
- Joseph Peters
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Libak Abou
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Ellyce Wong
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Jacob J Sosnoff
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA
- Illinois Multiple Sclerosis Research Collaborative, University of Illinois at Urbana Champaign, Urbana, IL, USA
| | - Laura A Rice
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Illinois Multiple Sclerosis Research Collaborative, University of Illinois at Urbana Champaign, Urbana, IL, USA
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Bibi R, Yan Z, Ilyas M, Shaheen M, Singh SN, Zeb A. Assessment of fall-associated risk factors in the Muslim community-dwelling older adults of Peshawar, Khyber Pakhtunkhwa, Pakistan. BMC Geriatr 2023; 23:623. [PMID: 37794341 PMCID: PMC10552376 DOI: 10.1186/s12877-023-04322-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/15/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Falls are the third-leading cause of disability among the elderly population worldwide. It is multifactorial, and the occurrence of falls depends on different factors, which can be different from context to context, and individual to individual. Therefore, regular assessment of fall risk factors is required to develop a strategy for fall prevention. The study aimed to identify fall-related risk factors in Pakistani healthy older adults at risk of developing physical disabilities. It also aimed to create a risk-predictive model for fall occurrence, offering evidence for preventive strategies. METHODS Data were collected from 140 Muslim older adults from two residential areas of Peshawar, Khyber Pakhtunkhwa, from July 2022 to August 25, 2022, after obtaining permission from the Zhengzhou University Ethical Review Board (ZZUIRB #202,254), and the District Health Department Office (DHO #14,207). Participants were informed, and consent was obtained before data collection. Data were collected using the Time Up and Go Test (TUGT) checklist, the Cognitive Screening Scores (CS-10) checklist, interviews regarding the prayer practice, fall history in the last six months, visual equity questions, and demographic variables. RESULTS Factors associated with falls were; age, gender, education, cognitive status, poor walking speed, lack of physical activity, poor vision, and history of falls in the last six months, with a significant P value of (P. < 0.05) in the Pearson correlation coefficient test. Poor cognition, low visual equity, poor walking speed, and lack of exercise increase the risk of falling in the future, with a prediction value of (P < 0.005) in Omnibus, Lemeshow score of (0.77). CONCLUSION Hence, our study provides a road map for future risk assessment of falls by adding the four mentioned risk factors in the proposed model to facilitate timely action to prevent fall-related infirmities in Pakistani healthy older adults.
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Affiliation(s)
- Rashida Bibi
- Institution of Nursing and Health Sciences, Zhengzhou University, Zhengzhou, Henan, China.
| | - Zhang Yan
- Institution of Nursing and Health Sciences, Zhengzhou University, Zhengzhou, Henan, China.
| | - Muhammad Ilyas
- School of Nursing, Iqra National University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Mussarat Shaheen
- Government Nursing College Abbottabad, Khyber Pakhtunkhwa, Pakistan
| | | | - Akhter Zeb
- Ismail College of Nursing Sawat, Khyber Pakhtunkhwa, Pakistan
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Zhu W, Deng S, Jiang H, Zhang J, Li B, Jia Q, Meng Z. Assessment of corticospinal tract remodeling based on diffusion tensor imaging in the treatment of motor dysfunction after ischemic stroke by acupuncture: A meta-analysis. Medicine (Baltimore) 2023; 102:e34618. [PMID: 37565876 PMCID: PMC10419801 DOI: 10.1097/md.0000000000034618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/14/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND To investigate the efficacy of acupuncture in improving motor dysfunction after ischemic stroke (IS) and to investigate the effect of acupuncture on corticospinal tract (CST) remodeling using diffusion tensor imaging. METHODS Published literature on the effect of acupuncture on CST remodeling after IS using diffusion tensor imaging in the form of randomized controlled trials (RCTs) were systematically retrieved and screened from Cochrane Library, Web of Science, PubMed, Embase, CNKI, CBM, VIP, and Wanfang databases from inception to December 2022. The methodological quality of the included studies was critically and independently evaluated by 2 reviewers using the Cochrane Risk of Bias Assessment Tool for RCTs. The correlated data were extracted using the pre-designed form, and all analyses were performed using Reviewer Manager version 5.4. RESULTS Eleven eligible RCTs involving 459 patients were eventually included. The combined evidence results showed that the acupuncture group significantly improved patients' National Institute of Health stroke scale, Fugl-Meyer Assessment Scale, and Barthel index compared with conventional medical treatment. The acupuncture group significantly promoted remodeling of the CST, as reflected by an increase in fractional anisotropy (FA) throughout the CST [MD = 0.04, 95% CI (0.02, 0.07), P = .001], and in addition, subgroup analysis showed that the acupuncture group significantly improved FA in the infarct area compared with conventional medical treatment at around 4 weeks [MD = 0.04, 95% CI (0.02, 0.06), P = .0002] and FA of the affected cerebral peduncle [MD = 0.03, 95% CI (0.00, 0.07), P = .02]. Also, compared with conventional medical treatment, the acupuncture group significantly increased average diffusion coefficient of the affected cerebral peduncle [MD = -0.21, 95% CI (-0.28, -0.13), P < .00001]. CONCLUSION The results of the meta-analysis suggest that acupuncture therapy can improve the clinical manifestations of motor dysfunction in patients after IS and advance a possibly beneficial effect on CST remodeling. However, due to the number and quality of eligible studies, these findings need to be further validated in more standardized, rigorous, high-quality clinical trials.
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Affiliation(s)
- Weiming Zhu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Shizhe Deng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hailun Jiang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jieying Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Boxuan Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qingqing Jia
- The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhihong Meng
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Chang JL, Chen HJ, Chen PY, Chou LW, Lai CH, Lu YH, Chiang SL, Lin CH, Wang XM, Lin CH. Validating stroke-induced bilateral ankle coordination deficits using bilateral ankle measure relationship with motor functions in lower limbs. J Neuroeng Rehabil 2023; 20:32. [PMID: 36932449 PMCID: PMC10022551 DOI: 10.1186/s12984-023-01157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 03/10/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Coordinated control between the bilateral ankle joints plays an important role in performing daily life functions, such as walking and running. However, few studies have explored the impact of stroke on movement disorders that decrease the coordination control of the bilateral extremities and may decrease daily activities that require coordination control of the bilateral ankles. This study aimed to investigate the coordination control of the bilateral ankles using a novel bilateral ankle measurement system and evaluate the relationship of bilateral movement coordination control deficits with motor and functional performances of the lower extremities in patients with stroke. METHODS Twenty-one healthy adults (36.5 ± 13.2 y/o) and 19 patients with chronic stroke (58.7 ± 10.5 y/o) were enrolled. A novel measurement device with embedded rotary potentiometers was used to evaluate bilateral ankle coordination control. Participants were asked to move their dominant (non-paretic) foot from dorsiflexion to plantarflexion position and non-dominant (paretic) foot from dorsiflexion to plantarflexion position (condition 1) simultaneously, and vice versa (condition 2). Alternating time and angle for coordination control with movements of both ankles were calculated for each condition. Motor and functional performance measurements of the lower extremities included the lower-extremity portion of the Fugl-Meyer assessment (FMA-LE), Berg Balance Test (BBS), Timed Up and Go Test (TUG), and Barthel Index (BI). RESULTS Compared with the healthy group, alternating time was shorter in the stroke group by 8.3% (p = 0.015), and the alternating angles of conditions 1 and 2 were significantly higher than those of the healthy group by 1.4° (p = 0.001) and 2.5° (p = 0.013), respectively. The alternating angle in condition 2 showed moderate correlations with TUG (r = 0.512; p = 0.025), 10-m walk (r = 0.747; p < 0.001), gait speed (r = - 0.497 to - 0.491; p < 0.05), length (r = - 0.518 to - 0.551; p < 0.05), and BI (r = - 0.457; p = 0.049). CONCLUSION Stroke decreases alternating time, increases alternating angle, and shows bilateral ankle coordination control deficits temporally and spatially. A higher alternating angle is moderately to highly associated with motor function and lower limb function in patients with stroke.
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Affiliation(s)
- Jia-Lan Chang
- grid.412955.e0000 0004 0419 7197Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, No. 291, Jhongjheng Rd., Jhonghe, New Taipei, 23561 Taiwan
- grid.412896.00000 0000 9337 0481Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
| | - Hung-Ju Chen
- grid.59784.370000000406229172National Center for Geriatrics and Welfare Research, National Health Research Institutes, 35 Keyan Rd., Zhunan Town, Miaoli County, 350 Taiwan (R.O.C.)
| | - Po-Yin Chen
- grid.412896.00000 0000 9337 0481Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
| | - Li-Wei Chou
- grid.260539.b0000 0001 2059 7017Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei, 112 Taiwan (R.O.C.)
| | - Chien-Hung Lai
- grid.412896.00000 0000 9337 0481Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
- grid.412897.10000 0004 0639 0994Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, No. 252 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
| | - Yueh-Hsun Lu
- Department of Radiology, Shuang-Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., New Taipei City, 235 Taiwan (R.O.C.)
- grid.412896.00000 0000 9337 0481Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
| | - Shang-Lin Chiang
- grid.278244.f0000 0004 0638 9360Department of Physical Medicine and Rehabilitation, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Taipei, 114 Taiwan (R.O.C.)
| | - Chia-Huei Lin
- grid.278244.f0000 0004 0638 9360Department of Nursing, Tri-Service General Hospital; School of Nursing, National Defense Medical Center, No. 325, Sec. 2, Chenggong Rd., Taipei, 114 Taiwan (R.O.C.)
| | - Xin-Miao Wang
- Faculty of Humanities, Zhejiang Dong Fang Polytechnic College, 47Th Floor, China Resources Building B 1366 Qianjiang Road, Hangzhou, China
| | - Chueh-Ho Lin
- grid.412896.00000 0000 9337 0481Master Program in Long-Term Care, College of Nursing, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
- grid.416930.90000 0004 0639 4389Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, No. 111, Sec. 3, Xinglong Rd., Taipei, 116 Taiwan (R.O.C.)
- grid.412896.00000 0000 9337 0481International Ph.D. Program in Gerontology and Long-Term Care, Taipei Medical University, No. 250 Wu-Xing Street, Taipei, 110 Taiwan (R.O.C.)
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Abdollahi M, Kuber PM, Shiraishi M, Soangra R, Rashedi E. Kinematic Analysis of 360° Turning in Stroke Survivors Using Wearable Motion Sensors. SENSORS 2022; 22:s22010385. [PMID: 35009931 PMCID: PMC8749703 DOI: 10.3390/s22010385] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 12/24/2021] [Accepted: 12/25/2021] [Indexed: 02/04/2023]
Abstract
Background: A stroke often bequeaths surviving patients with impaired neuromusculoskeletal systems subjecting them to increased risk of injury (e.g., due to falls) even during activities of daily living. The risk of injuries to such individuals can be related to alterations in their movement. Using inertial sensors to record the digital biomarkers during turning could reveal the relevant turning alterations. Objectives: In this study, movement alterations in stroke survivors (SS) were studied and compared to healthy individuals (HI) in the entire turning task due to its requirement of synergistic application of multiple bodily systems. Methods: The motion of 28 participants (14 SS, 14 HI) during turning was captured using a set of four Inertial Measurement Units, placed on their sternum, sacrum, and both shanks. The motion signals were segmented using the temporal and spatial segmentation of the data from the leading and trailing shanks. Several kinematic parameters, including the range of motion and angular velocity of the four body segments, turning time, the number of cycles involved in the turning task, and portion of the stance phase while turning, were extracted for each participant. Results: The results of temporal processing of the data and comparison between the SS and HI showed that SS had more cycles involved in turning, turn duration, stance phase, range of motion in flexion–extension, and lateral bending for sternum and sacrum (p-value < 0.035). However, HI exhibited larger angular velocity in flexion–extension for all four segments. The results of the spatial processing, in agreement with the prior method, showed no difference between the range of motion in flexion–extension of both shanks (p-value > 0.08). However, it revealed that the angular velocity of the shanks of leading and trailing legs in the direction of turn was more extensive in the HI (p-value < 0.01). Conclusions: The changes in upper/lower body segments of SS could be adequately identified and quantified by IMU sensors. The identified kinematic changes in SS, such as the lower flexion–extension angular velocity of the four body segments and larger lateral bending range of motion in sternum and sacrum compared to HI in turning, could be due to the lack of proper core stability and effect of turning on vestibular system of the participants. This research could facilitate the development of a targeted and efficient rehabilitation program focusing on the affected aspects of turning movement for the stroke community.
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Affiliation(s)
- Masoud Abdollahi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.)
| | - Pranav Madhav Kuber
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.)
| | - Michael Shiraishi
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (M.S.); (R.S.)
| | - Rahul Soangra
- Department of Physical Therapy, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA; (M.S.); (R.S.)
- Fowler School of Engineering, Chapman University, Orange, CA 92866, USA
| | - Ehsan Rashedi
- Department of Industrial and Systems Engineering, Rochester Institute of Technology, Rochester, NY 14623, USA; (M.A.); (P.M.K.)
- Correspondence: ; Tel.: +1-585-475-7260
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10
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Comparison of 360° Turn Cycles among Individuals after Stroke and Healthy Older Adults. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11073202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke survivors are at high risk of falling during turning. The kinematics of performing a 360° turn have not been fully analyzed among individuals after stroke. Quantitative differences in the parameters of turning between healthy older adults and those after stroke could provide detailed information on turning ability among these groups. The purpose of the current study was to characterize differences between healthy older adults and adults after stroke in 360° turn kinematics. Fourteen individuals with chronic stroke (mean age: 69 ± 8.4 years) and 14 healthy older adults (mean age: 74 ± 8.7 years) performed three trials of 360° turning. Kinematics data were collected using 26 reflective markers at several body landmarks. This new method for quantifying turning revealed that stroke significantly affected the number of turn cycles, number of single support (SS) critical phases, and critical time. In some cases, falls among individuals with stroke may be related to the combination of impaired movement patterns and the complexity of tasks such as turning. Understanding turning kinematics can inform clinical interventions targeting improvements in turning ability and consequently, fall risk reduction in individuals after stroke.
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11
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Evolving dynamic self-adaptation policies of mHealth systems for long-term monitoring. J Biomed Inform 2020; 108:103494. [PMID: 32629044 DOI: 10.1016/j.jbi.2020.103494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/08/2020] [Accepted: 06/21/2020] [Indexed: 10/23/2022]
Abstract
Tele-rehabilitation can complement traditional rehabilitation therapies by providing valuable information that can help in the evaluation, monitoring, and treatment of patients. Many patient tele-monitoring systems that integrate wearable technology are emerging as an effective tool for the long-term surveillance of rehabilitation progression, enabling continuous sampling of patient real-time movement in a non-invasive way, without affecting the normal daily activity of the outpatient, who, therefore, will not need to make frequent clinic visits. One of the main challenges of tele-rehabilitation systems is to pay special attention to the diversity of dysfunctions in patients by offering devices with customized behaviours adaptable to the physical conditions of each patient at the different stages of the rehabilitation therapy. Long-term monitoring systems need an adaptation policy to autonomously reconfigure their behaviour according to vital signs read during the physical activity of the patient, the remaining battery level, or the required accuracy of collected data. However, it would alsobe desirable to adjust such adaptation policies over time, according to the patient's evolution. This work presents a wearable patient-monitoring system for tele-rehabilitation that is able to dynamically self-configure its internal behaviour to the current context of the outpatient according to a set of adaptation policies that optimize battery consumption, taking into account other QoS parameters at the same time. Our system is also able to self-adapt its internal adaptation policies as a patient's condition improves, while maintaining the system's efficiency. We illustrate our proposal with a real mHealth case study. The results of the experiments show that the system updates the adaptation policies, taking into account specific indicators of the disease. The validation results show that the evolution of the self-adaptation policies correlates with the progression of different patients.
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12
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Ferrari A, Milletti D, Giannini G, Cevoli S, Oppi F, Palandri G, Albini-Riccioli L, Mantovani P, Anderlucci L, Cortelli P, Chiari L. The effects of cerebrospinal fluid tap-test on idiopathic normal pressure hydrocephalus: an inertial sensors based assessment. J Neuroeng Rehabil 2020; 17:7. [PMID: 31948485 PMCID: PMC6966881 DOI: 10.1186/s12984-019-0638-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 12/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background Gait disturbances are typical of persons with idiopathic normal pressure hydrocephalus (iNPH) without signs distinctive from other neurodegenerative and vascular conditions. Cerebrospinal fluid tap-test (CSF-TT) is expected to improve the motor performance of iNPH patients and is a prognostic indicator in their surgical management. This observational prospective study aims to determine which spatio-temporal gait parameter(s), measured during instrumented motor tests, and clinical scale(s) may provide a relevant contribution in the evaluation of motor performance pre vs. post CSF-TT on iNPH patients with and without important vascular encephalopathy. Methods Seventy-six patients (20 with an associated vascular encephalopathy) were assessed before, and 24 and 72 h after the CSF-TT by a timed up and go test (TUG) and an 18 m walking test (18 mW) instrumented using inertial sensors. Tinetti Gait, Tinetti Balance, Gait Status Scale, and Grading Scale were fulfilled before and 72 h after the CSF-TT. Stride length, cadence and total time were selected as the outcome measures. Statistical models with mixed effects were implemented to determine the relevant contribution to response variables of each quantitative gait parameter and clinical scales. Results and conclusion From baseline to 72 h post CSF-TT patients improved significantly by increasing cadence in 18 mW and TUG (on average of 1.7 and 2.4 strides/min respectively) and stride length in 18 mW (on average of 3.1 cm). A significant reduction of gait apraxia was reflected by modifications in double support duration and in coordination index. Tinetti Gait, Tinetti Balance and Gait Status Scale were able to explain part of the variability of response variables not covered by instrumental data, especially in TUG. Grading Scale revealed the highest affinity with TUG total time and cadence when considering clinical scales alone. Patients with iNPH and an associated vascular encephalopathy showed worst performances compared to pure iNPH but without statistical significance. Gait improvement following CSF-TT was comparable in the two groups. Overall these results suggest that, in order to augment CSF-TT accuracy, is key to assess the gait pattern by analyzing the main spatio-temporal parameters and set post evaluation at 72 h. Trial registration Approved by ethics committee: CE 14131 23/02/2015.
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Affiliation(s)
- Alberto Ferrari
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | - David Milletti
- Unit of Rehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giulia Giannini
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Sabina Cevoli
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Federico Oppi
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giorgio Palandri
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Albini-Riccioli
- Unit of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Mantovani
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Laura Anderlucci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Pietro Cortelli
- Unit of Neurology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Lorenzo Chiari
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), Alma Mater Studiorum - University of Bologna, Bologna, Italy.,Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
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13
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Rech KD, Salazar AP, Marchese RR, Schifino G, Cimolin V, Pagnussat AS. Fugl-Meyer Assessment Scores Are Related With Kinematic Measures in People with Chronic Hemiparesis after Stroke. J Stroke Cerebrovasc Dis 2019; 29:104463. [PMID: 31740027 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104463] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 10/02/2019] [Accepted: 10/07/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Stroke often results in motor impairment and limited functional capacity. This study aimed to verify the relationship between widely used clinical scales and instrumented measurements to evaluate poststroke individuals with mild, moderate, and severe motor impairment. METHODS This cross-sectional study included 34 participants with chronic hemiparesis after stroke. Fugl-Meyer Assessment and Modified Ashworth Scale were used to quantify upper and lower limb motor impairment and the resistance to passive movement (i.e., spasticity), respectively. Upper limb Motor performance (movement time and velocities) and movement quality (range of motion, smoothness and trunk displacement) were analyzed during a reaching forward task using an optoelectronic system (instrumented measurement). Lower limb motor performance (gait and functional mobility parameters) was assessed by using an inertial measurement unit system. FINDINGS Fugl-Meyer Assessment correlated with motor performance (upper and lower limbs) and with movement quality (upper limb). Modified Ashworth scale correlated with movement quality (upper limb). Cutoff values of 9.0 cm in trunk anterior displacement and .57 m/s in gait velocity were estimated to differentiate participants with mild/moderate and severe compromise according to the Fugl-Meyer Assessment. CONCLUSIONS These results suggest that the Fugl-Meyer Assessment can be used to infer about motor performance and movement quality in chronic poststroke individuals with different levels of impairment.
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Affiliation(s)
- Katia Daniele Rech
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre RS, Brazil
| | - Ana Paula Salazar
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre RS, Brazil
| | - Ritchele Redivo Marchese
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre RS, Brazil
| | - Giulia Schifino
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre RS, Brazil
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Aline Souza Pagnussat
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil; Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre RS, Brazil.
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14
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Kusumaningsih W, Triangto K, Salim H. Gait turning patterns in chronic ischemic stroke males and its relationship to recovery: A cross-sectional study. Medicine (Baltimore) 2019; 98:e17210. [PMID: 31567973 PMCID: PMC6756695 DOI: 10.1097/md.0000000000017210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 08/19/2019] [Accepted: 08/23/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Impaired turning patterns have been considered as 1 factor which potentially leads to disability in chronic stroke patients. Mobility comprises 80% of the chief disability, and would eventually lead to falls. Expanded Timed Up and Go (ETUG) is an effective mobility assessment method. It utilizes video recording to analyze the conventional Time Up and Go (TUG) Test components, which includes turning pattern analysis. METHODS Six healthy males without stroke history and 21 chronic ischemic stroke males (divided into subjects with or without the presence of flexor synergy pattern subgroups) capable of independent ambulation were recruited from Neurology and Medical Rehabilitation Department outpatient clinic. ETUG tests were recorded for each subject and were analyzed thoroughly using a computer program. RESULTS Timed Up and Go time was significantly different between the 3 groups (P = .001). As compared to control, and synergy absent group, median turning time was highest in chronic stroke patients with presence of flexor synergy by 2786 ms (P = .002), but was not significantly different in percentage ETUG (14%, P = .939). Further analysis revealed that Brunnstrom stage and number of steps taken for turning significantly affect TUG duration. Other factors such as hemiparetic side, or body height were not significantly associated. DISCUSSION The presence of flexor synergy would significantly affect turning time, this would then correlate to the disability of shifting body's center of gravity, as a part of the Stroke core set of International Classification of Functioning, Disability, and Health (ICF).Therefore, stroke patients need to have early ambulatory training regarding pivoting motion rather than solely focusing on straight walking. Instead of hemiparetic side, it is possible that overall turning time is affected by coordination and orientation capability, signifying the importance of cortical plasticity.
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Affiliation(s)
- Widjajalaksmi Kusumaningsih
- Department of Physical Medicine and Rehabilitation Cipto Mangunkusumo Hospital
- Neuroscience and Brain Development Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine, University of Indonesia Jakarta
| | - Kevin Triangto
- Department of Physical Medicine and Rehabilitation Cipto Mangunkusumo Hospital
| | - Harris Salim
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Beerse M, Lelko M, Wu J. Biomechanical analysis of the timed up-and-go (TUG) test in children with and without Down syndrome. Gait Posture 2019; 68:409-414. [PMID: 30594868 DOI: 10.1016/j.gaitpost.2018.12.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The timed up-and-go (TUG) test consists of multiple functional activities of daily living performed in a sequence, with the goal to complete the test as quickly as possible. Considering children with Down syndrome (DS) have been shown to take longer to complete the TUG test, it is imperative to identify which tasks are problematic for this population in order to individualize physical interventions. RESEARCH QUESTION Is the biomechanical pattern of each functional task during the TUG test different between children with DS and typically developing (TD) children? METHODS Thirteen children with DS and thirteen TD children aged 5-11 years old completed the TUG test. Kinematic data was captured using a Vicon motion capture system. We visually coded the TUG test into five phases: sit-to-stand, walk-out, turn-around, walk-in, and stand-to-sit. We focused on the center-of-mass (COM) movement in the sit-to-stand phase, spatiotemporal parameters in the walk-out phase, and intersegmental coordination in the turn-around phase. RESULTS AND SIGNIFICANCE Children with DS took longer to complete the entire test, as well as each of the five phases. During the sit-to-stand phase, children with DS produced smaller peak vertical COM velocity, medial-lateral COM excursion, and peak knee and hip extension velocity compared to TD peers. Children with DS walked at a slower velocity during the walk-out phase. Both groups demonstrated a similar intersegmental coordination pattern between the head, thorax, and pelvis during the turn-around phase although children with DS had slower average and peak angular velocity at the head, thorax, and pelvis. Our results suggest that children with DS were less able to anticipate transitioning between motor tasks and took longer to initiate motor tasks. Our TUG analysis provides the detailed insights to help evaluate individual motor tasks as well as the transition from one task to another for clinical populations.
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Affiliation(s)
- Matthew Beerse
- Department of Health and Sport Science, University of Dayton, Dayton, OH, United States
| | - Michael Lelko
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, United States
| | - Jianhua Wu
- Department of Kinesiology and Health, Georgia State University, Atlanta, GA, United States; Center for Movement and Rehabilitation Research, Georgia State University, Atlanta, GA, United States.
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Son H, Park C. Effect of turning direction on Timed Up and Go test results in stroke patients. Eur J Phys Rehabil Med 2019; 55:35-39. [DOI: 10.23736/s1973-9087.18.05202-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Klima D, Morgan L, Baylor M, Reilly C, Gladmon D, Davey A. Physical Performance and Fall Risk in Persons With Traumatic Brain Injury. Percept Mot Skills 2018; 126:50-69. [PMID: 30458668 DOI: 10.1177/0031512518809203] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Injuries sustained from traumatic brain injury (TBI) culminate in both cognitive and neuromuscular deficits. Patients often progress to higher functioning on the Rancho continuum even while mobility deficits persist. Although prior studies have examined physical performance among persons with chronic symptoms of TBI, less is known about the relatively acute phase of TBI as patients prepare for rehabilitation discharge. The aims of this cross-sectional study were to (a) compare balance and gait performance in 20 ambulant persons with moderate to severe TBI who were nearing rehabilitation discharge with their age-matched controls and (b) describe performance with thresholds for fall risk and community navigation. During a designed task circuit, 40 participants (20 persons with TBI and 20 controls) performed the Timed Up and Go (TUG), gait velocity, and Walking and Remembering tests. Balance testing included the Fullerton Advanced Balance Scale (FABS) and instrumented Modified Clinical Test for Sensory Interaction in Balance (MCTSIB). Statistical analyses included analysis of covariance for group comparisons and a multivariate analysis of covariance for MCTSIB sway velocities with anthropometric controls. The TBI group (mean [ M] age = 42, standard deviation [ SD] =19.5 years; 70% males) performed significantly more poorly on all mobility tests ( p < .05) and their scores reflected a potential fall risk. Gait velocity was significantly slower for the TBI versus control group ( M = .96, SD = 2.6 vs. M = 1.5, SD = 2.2 m/s; p < .001), including TUG times ( M = 13.5, SD = 4.9 vs. M = 7.7, SD = 1.4; p < .001). TBI participants also demonstrated significantly greater sway velocity on all MCTSIB conditions ( p < .01) and lower performance on the FABS ( p < .001). Performance indices indicate potential fall risk and community navigation compromise for individuals with moderate to severe TBI. Physical performance scores support the need for continued interventions to optimize functional mobility upon discharge.
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Affiliation(s)
- Dennis Klima
- 1 Department of Physical Therapy, University of Maryland Eastern Shore, Princess Anne, MD, USA
| | - Lindsay Morgan
- 2 Department of Rehabilitation, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Michelle Baylor
- 3 Rehabilitation Services, University of Maryland Rehabilitation and Orthopedic Institute, Baltimore, MD, USA
| | - Cordia Reilly
- 4 Rehabilitation Services, University of Maryland Shore Regional Health, Easton, MD, USA
| | - Daniel Gladmon
- 3 Rehabilitation Services, University of Maryland Rehabilitation and Orthopedic Institute, Baltimore, MD, USA
| | - Adam Davey
- 5 Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
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