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Bergamini E, Cereatti A, Pavei G. Walking symmetry is speed and index dependent. Sci Rep 2024; 14:19548. [PMID: 39174605 PMCID: PMC11341956 DOI: 10.1038/s41598-024-69461-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024] Open
Abstract
Gait symmetry is one of the most informative aspects describing the quality of gait. Many indices have been proposed to quantify gait symmetry. Among them, indices focusing on the comparison of the two body sides (e.g., Symmetry Angle, SA) and indices based on the analysis of the locomotor act as a whole, dealing with the body center of mass (e.g., Symmetry Index, SIBCoM) or lower trunk accelerometry (e.g., improved Harmonic Ratio, iHR) have been proposed. Remarkably, the relationship between these indices has received little attention so far, as well as the influence of gait speed on their values. The aim of this study is to investigate this relationship by comparing the SA, SIBCoM, and iHR, and to explore the effect of walking speed on these indices. Ten healthy adults walked for 60 s on a treadmill at seven different speeds (from 0.28 to 1.95 m s-1) and simulate an asymmetric gait (ASYM) at 0.83 m s-1. Marker-based trajectories were recorded, and the body center of mass 3D trajectory was obtained. Simultaneously, lower trunk 3D linear accelerations were collected using a triaxial accelerometer. SIBCoM, iHR, and SA were calculated for each stride, each anatomical direction, and each condition. Perfect symmetry was never displayed in any axes and any indices. Significant differences existed between SIBCoM, and iHR in all anatomical directions (p < 0.0001). The walking speed significantly affected SIBCoM and iHR values in anteroposterior and craniocaudal directions, but not in mediolateral. Conversely, no walking speed effect was found for SA (p = 0.28). All three indices significantly discriminated between ASYM and the corresponding walking condition (p < 0.05). Gait symmetry may differ significantly according to the data source, mathematical approach, and walking speed. Healthy individuals display an asymmetrical gait and acknowledging this aspect is crucial when establishing rehabilitation objectives and assessing the quality of gait in the clinical setting.
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Affiliation(s)
- Elena Bergamini
- Department of Management, Information and Production Engineering, University of Bergamo, Via Marconi 4, 24044, Dalmine, Bergamo, Italy.
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis 15, 00135, Rome, Italy.
| | - Andrea Cereatti
- Department of Electronics and Telecommunications, Politecnico di Torino, Corso Castelfidardo, 39, 10129, Turin, Italy
| | - Gaspare Pavei
- Laboratory of Physiomechanics of Locomotion, Department of Pathophysiology and Transplantation, University of Milan, Via Luigi Mangiagalli 32, 20133, Milan, Italy
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Inai T, Kudo S, Tsuchida W, Fujimoto M. Knee sleeves improve gait symmetry during fast walking in older adults. Front Bioeng Biotechnol 2024; 12:1394314. [PMID: 39086498 PMCID: PMC11288883 DOI: 10.3389/fbioe.2024.1394314] [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: 03/01/2024] [Accepted: 06/19/2024] [Indexed: 08/02/2024] Open
Abstract
Knee sleeves are commonly used to address knee-related concerns, particularly in older individuals. Although previous studies have demonstrated their efficacy in improving gait and functional outcomes in knees with pathological conditions, the effectiveness of knee sleeves for improving gait characteristics in healthy older adults remains unclear. The harmonic ratio (HR), an index for assessing gait symmetry commonly used to discriminate between individuals with different functional levels, can be used to detect alterations in gait characteristics. This study investigated the effects of knee sleeves on gait symmetry in healthy older adults. Sixteen healthy community-dwelling older adults walked barefoot with and without knee sleeves at normal and fast speeds. Gait symmetry indices (HR and improved HR [iHR]) and spatiotemporal gait parameters were compared under different conditions. A significant interaction between knee condition and walking speed was observed for mean iHR in the anteroposterior direction (p = 0.006). A significant simple main effect of knee condition was found during fast walking, with a larger iHR with knee sleeves than without (p = 0.002). In the condition without knee sleeves, the iHR was significantly lower during fast walking than during normal walking (p = 0.035). Furthermore, a significant main effect of knee condition was observed for the variability of iHR in the anteroposterior direction, with a smaller variability when walking with knee sleeves than when walking without (p = 0.006). These results suggest that knee sleeves may enhance gait symmetry along the anteroposterior direction, particularly during fast walking, where symmetry disruption is more likely than walking at a comfortable pace. A significant reduction in gait symmetry variability also suggests a stabilizing effect on gait dynamics. These findings provide the first evidence supporting the efficacy of knee sleeves for improving gait symmetry. The use of knee sleeves could be a valuable option for restoring disrupted gait symmetry during fast walking, with potential implications for reducing the risk of falls.
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Affiliation(s)
| | | | | | - Masahiro Fujimoto
- Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Takamatsu, Kagawa, Japan
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Gan X, Liu X, Cai D, Zhang R, Li F, Fang H, Huang J, Qiu C, Zhan H. Wearable accelerometers reveal objective assessment of walking symmetry and regularity in idiopathic scoliosis patients. PeerJ 2024; 12:e17739. [PMID: 39035168 PMCID: PMC11259127 DOI: 10.7717/peerj.17739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/23/2024] [Indexed: 07/23/2024] Open
Abstract
Background Scoliosis is a multifaceted three-dimensional deformity that significantly affects patients' balance function and walking process. While existing research primarily focuses on spatial and temporal parameters of walking and trunk/pelvic kinematics asymmetry, there remains controversy regarding the symmetry and regularity of bilateral lower limb gait. This study aims to investigate the symmetry and regularity of bilateral lower limb gait and examine the balance control strategy of the head during walking in patients with idiopathic scoliosis. Methods The study involved 17 patients with idiopathic scoliosis of Lenke 1 and Lenke 5 classifications, along with 17 healthy subjects for comparison. Three-dimensional accelerometers were attached to the head and L5 spinous process of each participant, and three-dimensional motion acceleration signals were collected during a 10-meter walking test. Analysis of the collected acceleration signals involved calculating five variables related to the symmetry and regularity of walking: root mean square (RMS) of the acceleration signal, harmonic ratio (HR), step regularity, stride regularity, and gait symmetry. Results Our analysis reveals that, during the walking process, the three-dimensional motion acceleration signals acquired from the lumbar region of patients diagnosed with idiopathic scoliosis exhibit noteworthy disparities in the RMS of the vertical axis (RMS-VT) and the HR of the vertical axis (HR-VT) when compared to the corresponding values in the healthy control (RMS-VT: 1.6 ± 0.41 vs. 3 ± 0.47, P < 0.05; HR-VT: 3 ± 0.72 vs. 3.9 ± 0.71, P < 0.05). Additionally, the motion acceleration signals of the head in three-dimensional space, including the RMS in the anterior-posterior and vertical axis, the HR-VT, and the values of step regularity in both anterior-posterior and vertical axis, as well as the values of stride regularity in all three axes, are all significantly lower than those in the healthy control group (P < 0.05). Conclusion The findings of the analysis suggest that the application of three-dimensional accelerometer sensors proves efficacious and convenient for scrutinizing the symmetry and regularity of walking in individuals with idiopathic scoliosis. Distinctive irregularities in gait symmetry and regularity manifest in patients with idiopathic scoliosis, particularly within the antero-posterior and vertical direction. Moreover, the dynamic balance control strategy of the head in three-dimensional space among patients with idiopathic scoliosis exhibits a relatively conservative nature when compared to healthy individuals.
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Affiliation(s)
- Xiaopeng Gan
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Xin Liu
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Danxian Cai
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Rongbin Zhang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Fanqiang Li
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Haohuang Fang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Jingrou Huang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Chenguang Qiu
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Hongrui Zhan
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
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Pau M, Cerfoglio S, Capodaglio P, Marrone F, Grugni G, Porta M, Leban B, Galli M, Cimolin V. Cyclogram-based evaluation of inter-limb gait symmetry in Prader-Willi Syndrome. Gait Posture 2024; 112:167-172. [PMID: 38805861 DOI: 10.1016/j.gaitpost.2024.05.026] [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: 04/21/2023] [Revised: 07/13/2023] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is characterized by a complex clinical condition, whose typical features lead to impaired motor and functional skills. To date, limited data is available as regards symmetry of gait in PWS. RESEARCH QUESTION The aim of this study was to characterize lower-limb asymmetry during gait in a group of Prader-Willi Syndrome (PWS) individuals by using the synchronized cyclograms and to compare it with those of two different control groups, a normal-weight group and an obese group. METHODS A total of 18 PWS, 30 normal weight (NW) and 28 obese individuals (OG) matched for age, sex and height were assessed via 3D gait analysis. Gait spatio-temporal parameters were computed together with angle-angle diagrams, characterized in terms of their geometric features (i.e. area, orientation, and trend symmetry index). RESULTS Individuals with PWS exhibit reduced speed, stride length and cadence and increased duration of both stance and double support phase than the other groups. OG was characterized by the same pattern when compared to NW. With respect to inter-limb symmetry, individuals with PWS exhibited significantly larger cyclogram areas at hip joint with respect to the other two groups (203.32 degrees2 vs. 130.73 degrees2 vs. 111.59 degrees2) and significantly higher orientation angle (4.17° vs. 2.11° vs. 1.22°) and Trend Symmetry (3.72 vs. 2.02 vs. 1.21) with respect to the other two groups at knee joint; no differences were found at ankle joint. Both individuals with PWS and those of OG exhibited reduced ROM at knee and ankle joints with respect with normal weight, but no statistically significant differences were observed between PWS and OG. SIGNIFICANCE The obtained results may provide novel and useful insights to understand better the impairments in motor control associated with this pathological state, supporting clinics in the identification of the best rehabilitation program for this rare pathological state, aimed to improve stability and motor control.
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Affiliation(s)
- Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari 09123, Italy
| | - Serena Cerfoglio
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy; Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, Strada Luigi Cadorna 90, Piancavallo 28824, Italy
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, Strada Luigi Cadorna 90, Piancavallo 28824, Italy; Department of Surgical Sciences, Physical Medicine and Rehabilitation, University of Turin, Turin 10126 , Italy
| | - Flavia Marrone
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy; Department of of Mechanical Engineering, Politecnico di Milano, via La Masa 1, Milano 20156, Italy
| | - Graziano Grugni
- Unit of Auxology, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, Strada Luigi Cadorna 90, Piancavallo 28824, Italy
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari 09123, Italy
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari 09123, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano 20133, Italy; Orthopaedic Rehabilitation Unit and Research Laboratory in Biomechanics, Rehabilitation and Ergonomics, San Giuseppe Hospital, IRCCS Istituto Auxologico Italiano, Strada Luigi Cadorna 90, Piancavallo 28824, Italy.
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Rasouli Kahaki Z, Choobineh A, Razeghi M, Karimi MT, Safarpour AR. Dynamic stability evaluation of trunk accelerations during walking in blind and sighted individuals. BMC Ophthalmol 2024; 24:127. [PMID: 38515065 PMCID: PMC10958951 DOI: 10.1186/s12886-024-03394-w] [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: 07/15/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Dynamic stability is a fundamental goal in standing activities. In this regard, monitoring, analysis, and interventions made to improve stability is a research topic investigated in the biomechanics of human movements. Vision has a major role to play in controlling human movement. Nonetheless, little is known about the effects of visual deprivation, especially from birth on dynamic gait stability. METHODS The current study was conducted on 20 congenital blind and 10 sighted people (15-38 years). To evaluate the dynamic stability, descriptive data, harmonic ratio (HR), improved harmonic ratio (iHR), and root mean square (RMS), based on trunk acceleration data were measured in three axes: anteroposterior (AP), vertical (V), and mediolateral (ML) while participants walked an eight-meter straight path. RESULTS In the comparison of blind and sighted people (eyes open), standard deviation, HR, iHR, and RMS indices were found to be significantly different in both AP and V directions. All the mentioned parameters were significantly lower in blind than in sighted participants. In the comparison of blind people and sighted ones with closed eyes, changes were observed in the maximum, range, standard deviation, and RMS only in the AP axis. In the comparison between eyes open and closed in sighted people, a significant difference was found only in the harmonic ratio of the vertical axis. CONCLUSION Visual deprivation led to a decrease in dynamic stability parameters in the AP and V axes. Even the movement of sighted people in unchallenged conditions is dependent on visual information.
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Affiliation(s)
- Zeinab Rasouli Kahaki
- Student Research Committee, Department of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Choobineh
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Department of physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Taghi Karimi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Clarke LM, Jones RM, Hiremath SV, Franklin C, Wright WG, Tucker CA. The Effects of Age and Height on Gait Smoothness in Adolescent Athletes. CHILDREN (BASEL, SWITZERLAND) 2024; 11:223. [PMID: 38397335 PMCID: PMC10887815 DOI: 10.3390/children11020223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
(1) Background: Despite evidence of increased rates of sports injury during the years surrounding peak growth in adolescents, little is known regarding the relationship between adolescent growth and gait stability. The aim of this study was to gain a better understanding of how chronological age and height relate to gait stability in both male and female adolescents. (2) Methods: Participants (N = 67; females: n = 34, ages 8.7-15.9 years; males: n = 33, ages 10.0-16.7 years) completed two trials of treadmill walking at varying speeds: the preferred walking speed and 30% above and below. Trials were separated by a bout of fatiguing exercises. HarmonicRatios of the trunk, calculated from acceleration signals taken during walking, were used to quantify gait stability. Data were separated by sex and relationships between height and chronological age, and HarmonicRatios were assessed using multiple linear regression. (3) Results: Females' HarmonicRatios improved with chronological age both before and after fatigue. Males' HarmonicRatios increased with chronological age before fatigue; however, this effect was eliminated post-fatigue. Females' height was negatively associated with HarmonicRatios post-fatigue. Males' height was positively associated with HarmonicRatios pre-fatigue. (4) Conclusions: The study findings suggest sex differences in the effects of fatigue on gait stability during adolescence. In both sexes, HarmonicRatios increased with chronological age. These improvements were eliminated for males and altered for females with fatigue. The results of this study indicate the need for the reevaluation of sports progression based on chronological age in adolescents.
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Affiliation(s)
- Lindsay M. Clarke
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA 19122, USA; (S.V.H.); (W.G.W.)
| | - Resa M. Jones
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, PA 19122, USA;
- Fox Chase Cancer Center, Temple University Health, Philadelphia, PA 19140, USA
| | - Shivayogi V. Hiremath
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA 19122, USA; (S.V.H.); (W.G.W.)
| | - Corinna Franklin
- Department of Pediatric Orthopedic Surgery, Yale University School of Medicine, New Haven, CT 06520, USA;
| | - W. Geoffrey Wright
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, PA 19122, USA; (S.V.H.); (W.G.W.)
| | - Carole A. Tucker
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, School of Health Professions, University of Texas Medical Branch, Galveston, TX 77555, USA;
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Romano A, Liparoti M, Minino R, Polverino A, Cipriano L, Carotenuto A, Tafuri D, Sorrentino G, Sorrentino P, Troisi Lopez E. The effect of dopaminergic treatment on whole body kinematics explored through network theory. Sci Rep 2024; 14:1913. [PMID: 38253728 PMCID: PMC10803322 DOI: 10.1038/s41598-023-50546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
Three-dimensional motion analysis represents a quantitative approach to assess spatio-temporal and kinematic changes in health and disease. However, these parameters provide only segmental information, discarding minor changes of complex whole body kinematics characterizing physiological and/or pathological conditions. We aimed to assess how levodopa intake affects the whole body, analyzing the kinematic interactions during gait in Parkinson's disease (PD) through network theory which assess the relationships between elements of a system. To this end, we analysed gait data of 23 people with PD applying network theory to the acceleration kinematic data of 21 markers placed on participants' body landmarks. We obtained a matrix of kinematic interactions (i.e., the kinectome) for each participant, before and after the levodopa intake, we performed a topological analysis to evaluate the large-scale interactions among body elements, and a multilinear regression analysis to verify whether the kinectome's topology could predict the clinical variations induced by levodopa. We found that, following levodopa intake, patients with PD showed less trunk and head synchronization (p-head = 0.048; p-7th cervical vertebrae = 0.032; p-10th thoracic vertebrae = 0.006) and an improved upper-lower limbs synchronization (elbows right, p = 0.002; left, p = 0.005), (wrists right, p = 0.003; left, p = 0.002; knees right, p = 0.003; left, p = 0.039) proportional to the UPDRS-III scores. These results may be attributable to the reduction of rigidity, following pharmacological treatment.
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Affiliation(s)
- Antonella Romano
- Department of Medical, Motor and Wellness Sciences, University of Naples "Parthenope", Naples, Italy
| | - Marianna Liparoti
- Department of Philosophical, Pedagogical and Economic-Quantitative Sciences, University of Chieti-Pescara G. D'Annunzio, Chieti, Italy
| | - Roberta Minino
- Department of Medical, Motor and Wellness Sciences, University of Naples "Parthenope", Naples, Italy
| | - Arianna Polverino
- Institute of Diagnosis and Treatment Hermitage Capodimonte, Naples, Italy
| | - Lorenzo Cipriano
- Department of Medical, Motor and Wellness Sciences, University of Naples "Parthenope", Naples, Italy
| | | | - Domenico Tafuri
- Department of Medical, Motor and Wellness Sciences, University of Naples "Parthenope", Naples, Italy
| | - Giuseppe Sorrentino
- Department of Medical, Motor and Wellness Sciences, University of Naples "Parthenope", Naples, Italy
- Institute of Diagnosis and Treatment Hermitage Capodimonte, Naples, Italy
- Institute of Applied Sciences and Intelligent Systems of National Research Council, Pozzuoli, Italy
| | - Pierpaolo Sorrentino
- Institut de Neurosciences Des Systèmes, Inserm, INS, Aix-Marseille University, Marseille, France.
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
| | - Emahnuel Troisi Lopez
- Institute of Applied Sciences and Intelligent Systems of National Research Council, Pozzuoli, Italy
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Rekant J, Chambers A, Suri A, Hergenroeder A, Sejdic E, Brach J. Weekly minutes of moderate to vigorous physical activity is associated with movement quality in overweight and obese older adults, independent of age. Aging Clin Exp Res 2023; 35:2941-2950. [PMID: 37861959 PMCID: PMC10735209 DOI: 10.1007/s40520-023-02584-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Physical activity can improve function and decrease healthcare spending among overweight and obese older adults. Although unstructured physical activity has been related to cardiometabolic improvements, the relationship between unstructured activity and movement quality is unclear. AIMS This study aimed to evaluate the association of amount of unstructured free-living moderate-vigorous physical activity (MVPA) with measures of movement quality in overweight and obese older adults. METHODS The association of MVPA with movement quality was assessed in 165 overweight and obese older adults (Age: 77.0(8.0) years; Body mass index (BMI): 29.2(5.3) kg/m2). Participants performed overground walking, the Figure of 8 Walk test, and the Five-Times Sit to Stand. Weekly physical activity was measured using a waist-worn Actigraph activity monitor. RESULTS Movement quality during straight path [gait speed (ρ = 0.30, p < 0.01), stride length (ρ = 0.33, p < 0.01), double-limb support time (ρ = -0.26, p < 0.01), and gait symmetry (ρ = 0.17, p = 0.02)] and curved path [F8W time (ρ = -0.22, p < 0.01) and steps (ρ = -0.22, p < 0.01)] walking were associated with weekly minutes of MVPA after controlling for age. Five-Times Sit to Stand performance was not significantly associated with weekly minutes of MVPA (ρ = -0.10, p = 0.13). CONCLUSIONS Older adults with high BMIs who are less active also demonstrate poorer movement quality, independent of age. Physical activity engagement and task-specific training should be targeted in interventions to promote healthy aging, decrease falls, and delay disability development. Future work should consider the interconnected nature of movement quality with physical activity engagement and investigate if targeting one influences the other.
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Affiliation(s)
- Julie Rekant
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - April Chambers
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anisha Suri
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrea Hergenroeder
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ervin Sejdic
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jen Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Igarashi T, Tani Y, Takeda R, Asakura T. Minimal detectable change in inertial measurement unit-based trunk acceleration indices during gait in inpatients with subacute stroke. Sci Rep 2023; 13:19262. [PMID: 37935767 PMCID: PMC10630455 DOI: 10.1038/s41598-023-46725-5] [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: 07/17/2023] [Accepted: 11/04/2023] [Indexed: 11/09/2023] Open
Abstract
Gait analysis using inertial measurement units (IMU) provides a multifaceted assessment of gait characteristics, but minimal detectable changes (MDC), the true change beyond measurement error, during gait in patients hospitalized with subacute stroke has not been clarified. This study aimed to determine the MDC in IMU-based trunk acceleration indices during gait in patients hospitalized with subacute stroke. Nineteen patients with subacute stroke (mean ± SD, 75.4 ± 10.9 years; 13 males) who could understand instructions, had a pre-morbid modified Rankin Scale < 3 and could walk straight for 16 m under supervision were included. As trunk acceleration indices, Stride regularity, harmonic ratio (HR), and normalized root mean square (RMS) during gait were calculated on three axes: mediolateral (ML), vertical (VT), and anterior-posterior (AP). MDC was calculated from two measurements taken on the same day according to the following formula: MDC = standard error of measurement × 1.96 × 2. The MDCs for each trunk acceleration index were, in order of ML, VT, and AP: 0.175, 0.179, and 0.149 for stride regularity; 0.666, 0.741, and 0.864 for HR; 4.511, 2.288, and 2.680 for normalized RMS. This finding helps determine the effectiveness of rehabilitation interventions in the gait assessment of patients with stroke.
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Affiliation(s)
- Tatsuya Igarashi
- Physical Therapy Division, Department of Rehabilitation, Numata Neurosurgery and Cardiovascular Hospital, Numata, Gunma, Japan.
| | - Yuta Tani
- Physical Therapy Division, Department of Rehabilitation, Numata Neurosurgery and Cardiovascular Hospital, Numata, Gunma, Japan
- Department of Basic Rehabilitation, School of Health Sciences, Gunma University, Maebashi, Gunma, Japan
| | - Ren Takeda
- Physical Therapy Division, Department of Rehabilitation, Numata Neurosurgery and Cardiovascular Hospital, Numata, Gunma, Japan
| | - Tomoyuki Asakura
- Department of Basic Rehabilitation, School of Health Sciences, Gunma University, Maebashi, Gunma, Japan
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Shimizu K, Suzuki H, Isoyama N, Yanagihara Y, Minakuchi S. Influence of wearing complete dentures on control of head position during walking in edentulous older adults. J Oral Rehabil 2023; 50:1012-1019. [PMID: 37221662 DOI: 10.1111/joor.13516] [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: 11/30/2022] [Revised: 03/24/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Coordination between the trunk and head is considered important for walking stability. Recent studies have reported that wearing complete dentures could improve trunk stability during walking; however, its effect on the head has not been clarified. OBJECTIVE This study aimed to clarify the effect of complete dentures on head stability during walking in edentulous older adults. METHODS Twenty edentulous older adults (11 men and 9 women; mean age, 78.6 ± 5.8 years) who used complete dentures were included in the study. Acceleration and angle rate sensors were placed on the participants' brow, chin and waist, and they were asked to walk a 20-m passage under two conditions: with and without dentures. The outcomes used to assess head stability were the variance values of acceleration and angle rate, the peak-to-peak values, harmonic ratio, root mean square, integrated values of the difference and dynamic time warping data obtained from the sensors. The variance values of the brow acceleration were compared using a paired t-test, and other outcomes were compared using a Wilcoxon signed-rank test. All significance levels were set at 5%. RESULTS In acceleration without dentures, the variance values of the chin and the peak-to-peak values of the brow and chin were significantly larger than with dentures. Angle rate without dentures, the variance values and the peak-to-peak values of the brow and chin were also significantly larger than with dentures. CONCLUSION Wearing complete dentures while walking might improve head stability and contribute to walking stability in edentulous older adults.
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Affiliation(s)
- Kento Shimizu
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroyuki Suzuki
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Naoya Isoyama
- Faculty of Social Information Studies, Otsuma Women's University, Tokyo, Japan
| | - Yuiko Yanagihara
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shunsuke Minakuchi
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Shimamura T, Ishikawa H, Fujii H, Katoh H. Smoothness Evaluation Indices during Sit-to-Stand-to-Sit Motions in Healthy Older Females and after Hip Fracture Using an Accelerometer: A Pilot Study. Geriatrics (Basel) 2023; 8:98. [PMID: 37887971 PMCID: PMC10606243 DOI: 10.3390/geriatrics8050098] [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: 07/04/2023] [Revised: 08/27/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Studies that quantify the quality of sit-to-stand-to-sit (STS) motions, particularly in terms of smoothness, are limited. Thus, this study aimed to investigate the possibility and usefulness of quality evaluation during STS motions. METHODS This cross-sectional study enrolled 36 females aged >60 years, including 18 females each in the healthy and hip fracture groups. Measurements were performed at two different speeds: five STS as fast as possible (STSF) and two seconds for each motion (STS2s). Indices of smoothness, including harmonic ratio (HR) and power spectrum entropy (PSE), were calculated and compared from the measured data in each of the three axial directions. RESULTS HR in the vertical direction was significantly higher in the healthy group (STSF: 3.65 ± 1.74, STS2s: 3.42 ± 1.54) than in the hip fracture group (STSF: 2.67 ± 1.01, STS2s: 2.58 ± 0.83) for STSF and STS2s. Furthermore, PSE for all directions and triaxial composites were significantly lower for STS2s (the healthy group (mediolateral (ML): 7.63 ± 0.31, vertical (VT): 7.46 ± 0.22, anterior-posterior (AP): 7.47 ± 0.15, triaxial: 7.45 ± 0.25), the hip fracture group (ML: 7.82 ± 0.16, VT: 7.63 ± 0.16, AP: 7.61 ± 0.17, triaxial: 7.66 ± 0.17)). CONCLUSIONS This study suggests the usefulness of HR and PSE as quality evaluations for STS motions.
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Affiliation(s)
- Takeshi Shimamura
- Department of Rehabilitation, Kumamoto Health Science University, 325 Izumi-machi, Kita-ku, Kumamoto 861-5598, Japan
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata 990-2212, Japan
| | - Hitoshi Ishikawa
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata 990-2212, Japan
| | - Hiromi Fujii
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata 990-2212, Japan
| | - Hiroshi Katoh
- Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, 260 Kamiyanagi, Yamagata 990-2212, Japan
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12
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Voisard C, de l'Escalopier N, Vienne-Jumeau A, Moreau A, Quijoux F, Bompaire F, Sallansonnet M, Brechemier ML, Taifas I, Tafani C, Drouard E, Vayatis N, Ricard D, Oudre L. Innovative multidimensional gait evaluation using IMU in multiple sclerosis: introducing the semiogram. Front Neurol 2023; 14:1237162. [PMID: 37780706 PMCID: PMC10540441 DOI: 10.3389/fneur.2023.1237162] [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: 06/08/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Background Quantifying gait using inertial measurement units has gained increasing interest in recent years. Highly degraded gaits, especially in neurological impaired patients, challenge gait detection algorithms and require specific segmentation and analysis tools. Thus, the outcomes of these devices must be rigorously tested for both robustness and relevancy in order to recommend their routine use. In this study, we propose a multidimensional score to quantify and visualize gait, which can be used in neurological routine follow-up. We assessed the reliability and clinical coherence of this method in a group of severely disabled patients with progressive multiple sclerosis (pMS), who display highly degraded gait patterns, as well as in an age-matched healthy subjects (HS) group. Methods Twenty-two participants with pMS and nineteen HS were included in this 18-month longitudinal follow-up study. During the follow-up period, all participants completed a 10-meter walk test with a U-turn and back, twice at M0, M6, M12, and M18. Average speed and seven clinical criteria (sturdiness, springiness, steadiness, stability, smoothness, synchronization, and symmetry) were evaluated using 17 gait parameters selected from the literature. The variation of these parameters from HS values was combined to generate a multidimensional visual tool, referred to as a semiogram. Results For both cohorts, all criteria showed moderate to very high test-retest reliability for intra-session measurements. Inter-session quantification was also moderate to highly reliable for all criteria except smoothness, which was not reliable for HS participants. All partial scores, except for the stability score, differed between the two populations. All partial scores were correlated with an objective but not subjective quantification of gait severity in the pMS population. A deficit in the pyramidal tract was associated with altered scores in all criteria, whereas deficits in cerebellar, sensitive, bulbar, and cognitive deficits were associated with decreased scores in only a subset of gait criteria. Conclusions The proposed multidimensional gait quantification represents an innovative approach to monitoring gait disorders. It provides a reliable and informative biomarker for assessing the severity of gait impairments in individuals with pMS. Additionally, it holds the potential for discriminating between various underlying causes of gait alterations in pMS.
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Affiliation(s)
- Cyril Voisard
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Nicolas de l'Escalopier
- Université Paris Cité, Université Paris Saclay, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Paris, France
- Service de Chirurgie Orthopédique, Traumatologique et Réparatrice des Membres, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Aliénor Vienne-Jumeau
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Albane Moreau
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Flavien Quijoux
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Flavie Bompaire
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
- Université Paris Cité, Université Paris Saclay, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Paris, France
| | - Magali Sallansonnet
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Marie-Laure Brechemier
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Irina Taifas
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Camille Tafani
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Eve Drouard
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Nicolas Vayatis
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Damien Ricard
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
- Université Paris Cité, Université Paris Saclay, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Paris, France
- Ecole du Val-de-Grâce, Service de Santé des Armées, Paris, France
| | - Laurent Oudre
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
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Pelicioni PH, Chan LL, Shi S, Wong K, Kark L, Okubo Y, Brodie MA. Impact of mobile phone use on accidental falls risk in young adult pedestrians. Heliyon 2023; 9:e18366. [PMID: 37701410 PMCID: PMC10493431 DOI: 10.1016/j.heliyon.2023.e18366] [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: 02/16/2023] [Revised: 07/14/2023] [Accepted: 07/14/2023] [Indexed: 09/14/2023] Open
Abstract
Background Mobile phone use is known to be a distraction to pedestrians, increasing their likelihood of crossing into oncoming traffic or colliding with other people. However, the effect of using a mobile phone to text while walking on gait stability and accidental falls in young adults remains inconclusive. This study uses a 70 cm low friction slip hazard and the threat of hazard to investigate the effects of texting while walking on gait stability, the ability to recover balance after a slip hazard and accidental falls. Methods Fifty healthy young adults performed six walking tasks, and one seated texting task in random order. The walks were conducted over a 10-m walkway. Four progressive hazard levels were used: 1) Seated; 2) Normal Walk (walking across the walkway with no threat of a slip); 3) Threat (walking with the threat of a slip); and 4) Slip (walking with an actual 70 cm slip hazard). The three walking conditions were repeated twice with and without the mobile phone texting dual-task. Gait kinematics and trunk posture were recorded using wearable sensors attached to the head, trunk, pelvis and feet. Study outcomes were analyzed using repeated measures analysis of variance with significance set to P≤.05. Results Mobile phone use significantly impaired postural balance recovery when slipping, as demonstrated by increased trunk sway. Mobile phone use negatively impacted gait stability as demonstrated by increased step time variability and decreased harmonic ratios. Increased hazard levels also led to reduced texting accuracy. Conclusions Using a mobile phone to text while walking may compete with locomotor tasks, threat assessment and postural balance control mechanisms, which leads to an increased risk of accidental falls in young adults. Pedestrians should therefore be discouraged through new educational and technology-based initiatives (for example a "texting lock" on detection of walking) from texting while walking on roadside footpaths and other environments where substantial hazards to safety exist.
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Affiliation(s)
- Paulo H.S. Pelicioni
- School of Health Sciences, University of New South Wales, Kensington Campus, NSW 2052, Australia
- Neuroscience Research Australia, 139 Barker Street Randwick, NSW 2031, Australia
| | - Lloyd L.Y. Chan
- Neuroscience Research Australia, 139 Barker Street Randwick, NSW 2031, Australia
- School of Population Health, University of New South Wales, Sydney 2052, NSW, Australia
| | - Shuotong Shi
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington Campus, NSW 2052, Australia
| | - Kenny Wong
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington Campus, NSW 2052, Australia
| | - Lauren Kark
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington Campus, NSW 2052, Australia
| | - Yoshiro Okubo
- Neuroscience Research Australia, 139 Barker Street Randwick, NSW 2031, Australia
- School of Population Health, University of New South Wales, Sydney 2052, NSW, Australia
| | - Matthew A. Brodie
- Graduate School of Biomedical Engineering, University of New South Wales, Kensington Campus, NSW 2052, Australia
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14
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Rasouli Kahaki Z, Razeghi M, Karimi MT, Sanjari MA, Safarpour AR, Choobineh A. Assessment of the effects of white cane variables on step symmetry of blind individuals. Oman J Ophthalmol 2023; 16:298-304. [PMID: 37602151 PMCID: PMC10433056 DOI: 10.4103/ojo.ojo_359_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Step symmetry is an important feature of human gait and is often regarded as a key index of healthy individuals' walking. This study evaluated the effects of height, white cane technique, and cane tip on symmetrical gait in blind individuals. MATERIALS AND METHODS Twenty blind and ten sighted subjects, aged 15-38 years, participated in this study. The harmonic ratio (HR) and improved HR (iHR) were measured by trunk accelerometer as gait symmetry index in three axes: anteroposterior (AP), vertical, and mediolateral of the body. These parameters were measured in the sighted group in open-eye conditions and in the blind group in five experimental conditions with different two heights (standard and long), two tips (pencil and roller), and two techniques (two-point touch and constant contact) of white cane when they walked in the 6-m path. RESULTS There was a significant difference between HR and iHR of the blind and sighted group, which indicates a significant reduction of symmetry loss in the blind group. Among the five different conditions studied in the group of blind people, an increase was observed in the HR and the iHR on the AP axis during the application of a standard cane with a roller tip, which indicated an increase in symmetry. CONCLUSION Based on the results, a long cane with a pencil tip and a standard cane with a roller tip in the constant contact technique can increase step symmetry.
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Affiliation(s)
- Zeinab Rasouli Kahaki
- Department of Ergonomics, Student Research Committee, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Taghi Karimi
- Department of Orthotics and Prosthetics, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ali Sanjari
- Department of Basic Rehabilitation Sciences, Rehabilitation Research Center, Biomechanics Lab, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Choobineh
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Bailey CA, Graham RB, Nantel J. Joint behaviour during arm swing changes with gait speed and predicts spatiotemporal variability and dynamic stability in healthy young adults. Gait Posture 2023; 103:50-56. [PMID: 37104892 DOI: 10.1016/j.gaitpost.2023.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/27/2023] [Accepted: 04/22/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Arm swing is linked to gait stability. How this is accomplished is unclear as most investigations artificially manipulate arm swing amplitude and examine average patterns. Biomechanical evaluation of stride-to-stride upper limb behaviour across a range of gait speeds, where the arm swings as preferred, could clarify this link. RESEARCH QUESTION How do stride-to-stride arm swing behaviours change with gait speed and relate to stride-to-stride gait fluctuations? METHODS Young adults (n = 45, 25 females) completed treadmill gait at preferred, slow (70% of preferred), and fast speed (130% of preferred) while full-body kinematics were acquired with optoelectronic motion capture. Arm swing behaviour was quantified by shoulder, elbow, and wrist joint angle amplitude (range of motion [ROM]) and motor variability (e.g. mean standard deviation [meanSD], local divergence exponent [λmax]). Stride-to-stride gait fluctuation was quantified by spatiotemporal variability (e.g. stride time CV) and dynamic stability (i.e. trunk local dynamic stability [trunk λmax], centre-of-mass smoothness [COM HR]). Repeated measures ANOVAs tested for speed effects and step-wise linear regressions identified arm swing-based predictors of stride-to-stride gait fluctuation. RESULTS Speed decreased spatiotemporal variability and increased trunk λmax and COM HR in the anteroposterior and vertical axes. Adjustments in gait fluctuations occurred with increased upper limb ROM, particularly for elbow flexion, and increased meanSD and λmax of shoulder, elbow, and wrist angles. Models of upper limb measures predicted 49.9-55.5% of spatiotemporal variability and 17.7-46.4% of dynamic stability. For dynamic stability, wrist angle features were the best and most common independent predictors. SIGNIFICANCE Findings highlight that all upper limb joints, and not solely the shoulder, underlie changes in arm swing amplitude, and that arm swing strategies pair with the trunk and contrast with centre-of-mass and stride strategies. Findings suggest that young adults search for flexible arm swing motor strategies to help optimize stride consistency and gait smoothness.
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Affiliation(s)
| | - Ryan B Graham
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Julie Nantel
- School of Human Kinetics, University of Ottawa, Ottawa, Canada.
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16
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Hagoort I, Vuillerme N, Hortobágyi T, Lamoth CJC. Age and walking conditions differently affect domains of gait. Hum Mov Sci 2023; 89:103075. [PMID: 36940500 DOI: 10.1016/j.humov.2023.103075] [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: 07/14/2022] [Revised: 03/03/2023] [Accepted: 03/04/2023] [Indexed: 03/22/2023]
Abstract
INTRODUCTION Analysing gait in controlled conditions that resemble daily life walking could overcome the limitations associated with gait analysis in uncontrolled real-world conditions. Such analyses could potentially aid the identification of a walking condition that magnifies age-differences in gait. Therefore, the aim of the current study was to determine the effects of age and walking conditions on gait performance. METHODS Trunk accelerations of young (n = 27, age: 21.6) and older adults (n = 26, age: 68.9) were recorded for 3 min in four conditions: walking up and down a university hallway on a track of 10 m; walking on a specified path, including turns, in a university hallway; walking outside on a specified path on a pavement including turns; and walking on a treadmill. Factor analysis was used to reduce 27 computed gait measures to five independent gait domains. A multivariate analysis of variance was used to examine the effects of age and walking condition on these gait domains. RESULTS Factor analysis yielded 5 gait domains: variability, pace, stability, time & frequency, complexity, explaining 64% of the variance in 27 gait outcomes. Walking conditions affected all gait domains (p < 0.01) but age only affected the time & frequency domain (p < 0.05). Age and walking conditions differently affected the domains variability, stability, time & frequency. The largest age-differences occurred mainly during straight walking in a hallway (variability: 31% higher in older adults), or during treadmill walking (stability: 224% higher, time&frequency: 120% lower in older adults). CONCLUSION Walking conditions affect all domains of gait independent of age. Treadmill walking and walking on a straight path in a hallway, were the most constrained walking conditions in terms of limited possibilities to adjust step characteristics. The age by condition interaction suggests that for the gait domains variability, stability, and time & frequency, the most constrained walking conditions seem to magnify the age-differences in gait.
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Affiliation(s)
- Iris Hagoort
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; Université Grenoble-Alpes, AGEIS, Grenoble, France
| | - Nicolas Vuillerme
- Université Grenoble-Alpes, AGEIS, Grenoble, France; Institut Universitaire de France, Paris, France; LabCom Telecom4Health, Orange Labs & Univ. Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
| | - Tibor Hortobágyi
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany; Hungarian University of Sport Science, Department of Kinesiology, Budapest, Hungary
| | - Claudine J C Lamoth
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, the Netherlands.
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Khan Z, Jiao X, Hu T, Shao Q, Sun X, Zhao X, Gu D. Investigation of gait, balance and lower extremity muscle activity during walking in patients with cervical spondylotic myelopathy using wearable sensors. Spine J 2023:S1529-9430(23)00106-7. [PMID: 36934793 DOI: 10.1016/j.spinee.2023.03.004] [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: 10/31/2022] [Revised: 02/28/2023] [Accepted: 03/10/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND CONTEXT Cervical spondylotic myelopathy (CSM) is a degenerative disease caused by cervical cord compression and can lead to the significant impairment of motor function including gait and balance disturbances and changes in lower extremity muscle activity. PURPOSE This study aimed to characterize gait, balance and lower extremity muscle activity in patients with CSM compared to age-matched healthy controls (HCs) using wearable sensors in the clinical setting. STUDY DESIGN Non-Randomized, prospective cohort study. PATIENT SAMPLE 10 CSM patients and 10 age-matched HCs were recruited for this study. OUTCOME MEASURES Gait and balance function parameters contained spatial temporal parameters, step regularity (SR1), stride regularity (SR2) and harmonic ratio (HR). EMG muscle activity parameters included time to peak and peak value during loading, stance, and swing phase. METHODS In this study, parameters of gait and balance function were extracted using triaxial accelerometer attached to the spinous processes of Lumbar 5 while participants performed an overground walking at a self-preferred speed. Moreover, muscular activity was simultaneously recorded via sEMG sensors attached to tibialis anterior (TA), rectus femoris (RF), bicep femoris (BF) and gastrocnemius lateral (GL). Independent sample t-test was used to find the differences between CSM patients and HCs. RESULTS Gait analysis showed cadence, step length and walking speed were statistically significantly lower in CSM patients than HCs. Stride time was significantly higher for CSM patients in comparison to HCs. Lower root mean square ratio (RMSR) of acceleration in the mediolateral (ML) direction, HR in the anteroposterior (AP) direction, SR1 in the AP direction and SR2 in all three directions were observed in CSM patients. For muscle activity analysis, EMG RMS for TA and RF during loading phase and RMS for GL during midstance phase was significantly lower for CSM patients, while significantly higher value was observed for RF RMS during midstance phase and GL RMS during swing phase in CSM patients. CONCLUSION Our pilot study shows that wearable sensors are able to detect the changes of gait, balance and lower extremity muscle activities of CSM patients in the clinical setting. This pilot study sets the stage for future researches on the diagnosis and monitor progression of CSM disease using wearable technology.
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Affiliation(s)
- Zawar Khan
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Xin Jiao
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Tianyi Hu
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Qineng Shao
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China
| | - Xin Sun
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Xin Zhao
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China.
| | - Dongyun Gu
- Shanghai Key Laboratory of Orthopaedic Implants and Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai 200011, China; School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200030, China; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai 200030, China.
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18
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Castiglia SF, Trabassi D, Tatarelli A, Ranavolo A, Varrecchia T, Fiori L, Di Lenola D, Cioffi E, Raju M, Coppola G, Caliandro P, Casali C, Serrao M. Identification of Gait Unbalance and Fallers Among Subjects with Cerebellar Ataxia by a Set of Trunk Acceleration-Derived Indices of Gait. CEREBELLUM (LONDON, ENGLAND) 2023; 22:46-58. [PMID: 35079958 DOI: 10.1007/s12311-021-01361-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 02/01/2023]
Abstract
This study aimed to assess the ability of 25 gait indices to characterize gait instability and recurrent fallers among persons with primary degenerative cerebellar ataxia (pwCA), regardless of gait speed, and investigate their correlation with clinical and kinematic variables. Trunk acceleration patterns were acquired during the gait of 34 pwCA, and 34 age- and speed-matched healthy subjects (HSmatched) using an inertial measurement unit. We calculated harmonic ratios (HR), percent recurrence, percent determinism, step length coefficient of variation, short-time largest Lyapunov exponent (sLLE), normalized jerk score, log-dimensionless jerk (LDLJ-A), root mean square (RMS), and root mean square ratio of accelerations (RMSR) in each spatial direction for each participant. Unpaired t-tests or Mann-Whitney tests were performed to identify significant differences between the pwCA and HSmatched groups. Receiver operating characteristics were plotted to assess the ability to characterize gait alterations in pwCA and fallers. Optimal cutoff points were identified, and post-test probabilities were calculated. The HRs showed to characterize gait instability and pwCA fallers with high probabilities. They were correlated with disease severity and stance, swing, and double support duration, regardless of gait speed. sLLEs, RMSs, RMSRs, and LDLJ-A were slightly able to characterize the gait of pwCA but failed to characterize fallers.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.
| | - Dante Trabassi
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy.,Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy
| | - Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, via Fontana Candida, 1, Monte Porzio Catone, 00078, Rome, Italy.,Department of Physiology and Pharmacology, Sapienza University of Rome, piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Davide Di Lenola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Ettore Cioffi
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.,Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Manikandan Raju
- Department of Human Neurosciences, Sapienza University of Rome, viale dell'Università 30, 00185, Rome, Italy
| | - Gianluca Coppola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Pietro Caliandro
- Unità Operativa Complessa Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli, 8, 00168, Rome, Italy
| | - Carlo Casali
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome-Polo Pontino, Corso della Repubblica 79, 04100, Latina, Italy.,Movement Analysis Laboratory, Policlinico Italia, Piazza del Campidano, 6, 00162, Rome, Italy
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19
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Ko JB, Hong JS, Shin YS, Kim KB. Machine Learning-Based Predicted Age of the Elderly on the Instrumented Timed Up and Go Test and Six-Minute Walk Test. SENSORS (BASEL, SWITZERLAND) 2022; 22:5957. [PMID: 36015714 PMCID: PMC9413258 DOI: 10.3390/s22165957] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/08/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
A decrease in dynamic balance ability (DBA) in the elderly is closely associated with aging. Various studies have investigated different methods to quantify the DBA in the elderly through DBA evaluation methods such as the timed up and go test (TUG) and the six-minute walk test (6MWT), applying the G-Walk wearable system. However, these methods have generally been difficult for the elderly to intuitively understand. The goal of this study was thus to generate a regression model based on machine learning (ML) to predict the age of the elderly as a familiar indicator. The model was based on inertial measurement unit (IMU) data as part of the DBA evaluation, and the performance of the model was comparatively analyzed with respect to age prediction based on the IMU data of the TUG test and the 6MWT. The DBA evaluation used the TUG test and the 6MWT performed by 136 elderly participants. When performing the TUG test and the 6MWT, a single IMU was attached to the second lumbar spine of the participant, and the three-dimensional linear acceleration and gyroscope data were collected. The features used in the ML-based regression model included the gait symmetry parameters and the harmonic ratio applied in quantifying the DBA, in addition to the features of description statistics for IMU signals. The feature set was differentiated between the TUG test and the 6MWT, and the performance of the regression model was comparatively analyzed based on the feature sets. The XGBoost algorithm was used to train the regression model. Comparison of the regression model performance according to the TUG test and 6MWT feature sets showed that the performance was best for the model using all features of the TUG test and the 6MWT. This indicated that the evaluation of DBA in the elderly should apply the TUG test and the 6MWT concomitantly for more accurate predictions. The findings in this study provide basic data for the development of a DBA monitoring system for the elderly.
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Affiliation(s)
| | | | | | - Kwang Bok Kim
- Correspondence: ; Tel.: +82-41-589-8465; Fax: +82-41-589-8640
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20
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Usefulness of gait parameters obtained from inertial sensors attached to the lower trunk and foot for assessment of gait performance in the early postoperative period after total knee arthroplasty. Knee 2022; 37:143-152. [PMID: 35779432 DOI: 10.1016/j.knee.2022.06.005] [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: 11/03/2021] [Revised: 04/01/2022] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study was performed to (i) compare gait parameters obtained from inertial sensors attached to the lower trunk and foot between patients in the early postoperative period after total knee arthroplasty (TKA) and healthy age- and sex-matched controls and (ii) elucidate the association between the gait parameters and patient-reported outcome measures (PROMs). METHOD The gait performance of 19 patients who had undergone TKA was assessed using inertial sensors and PROMs obtained from the Knee Injury and Osteoarthritis Outcome Score (KOOS) 1 week before hospital discharge. The patients walked along a 15-m walkway and we calculated the following gait parameters: walking speed, coefficient of variation (CV) of stride time, unbiased autocorrelation coefficient (AC), harmonic ratio (HR), and symmetry index (SI). The same gait parameter data from 19 age- and sex-matched healthy adults (controls) were obtained from our past study. RESULTS The TKA group demonstrated slower walking speed, larger CV of stride time, lower HR in all three directions, lower AC in the vertical direction, and higher SI in the vertical direction than the healthy control group (all p < 0.05). Correlation analysis revealed that the SI in the anteroposterior direction was significantly correlated with the KOOS symptoms subscore and ADL subscore (p < 0.05). CONCLUSIONS Patients in the early postoperative period after TKA exhibited worse gait performance as assessed by inertial sensors compared with healthy controls. Gait symmetry was correlated with PROMs. These results indicate the usefulness of assessing gait parameters after TKA.
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21
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Identifying the Effects of Age and Speed on Whole-Body Gait Symmetry by Using a Single Wearable Sensor. SENSORS 2022; 22:s22135001. [PMID: 35808494 PMCID: PMC9269851 DOI: 10.3390/s22135001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/26/2022] [Accepted: 06/29/2022] [Indexed: 01/27/2023]
Abstract
Studies on gait symmetry in healthy population have mainly been focused on small range of age categories, neglecting Teenagers (13–18 years old) and Middle-Aged persons (51–60 years old). Moreover, age-related effects on gait symmetry were found only when the symmetry evaluation was based on whole-body acceleration than on spatiotemporal parameters of the gait cycle. Here, we provide a more comprehensive analysis of this issue, using a Symmetry Index (SI) based on whole-body acceleration recorded on individuals aged 6 to 84 years old. Participants wore a single inertial sensor placed on the lower back and walked for 10 m at comfortable, slow and fast speeds. The SI was computed using the coefficient of correlation of whole-body acceleration measured at right and left gait cycles. Young Adults (19–35 years old) and Adults (36–50 years old) showed stable SI over the three speed conditions, while Children (6–12 years old), Teenagers (13–18 years old), Middle-Aged persons and Elderly (61–70 and 71–84 years old) exhibited lower SI values when walking at fast speed. Overall, this study confirms that whole-body gait symmetry is lower in Children and in Elderly persons over 60 years of age, showing, for the first time, that asymmetries appear also during teenage period and in Middle-Aged persons (51–60 years old).
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22
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Lo CWT, Brodie MA, Tsang WWN, Lord SR, Yan CH, Wong AYL. Pain, balance, and mobility in people 1 year after total knee arthroplasty: a non-randomized cross-sectional pilot study contrasting posterior-stabilized and medial-pivot designs. Pilot Feasibility Stud 2022; 8:131. [PMID: 35765113 PMCID: PMC9238077 DOI: 10.1186/s40814-022-01094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a common treatment for severe knee osteoarthritis. Medial-pivot TKA systems (MP-TKA) are theoretically better than posterior-stabilized TKA systems (PS-TKA) in improving static and dynamic balance of patients although it is difficult to objectively quantify these balance parameters in a clinical setting. Therefore, this pilot study aimed to evaluate the feasibility of using wearable devices in a clinical setting to examine whether people with MP-TKA have better postoperative outcomes than PS-TKA, and their balance control is more akin to age-matched asymptomatic controls. METHODS The current cross-sectional pilot study recruited 57 participants with 2 different prosthesis designs (20 PS-TKA, 18 MP-TKA) and 19 asymptomatic controls. At 1-year post-TKA, pain, knee stiffness, and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Static balance, mobility, and gait stability of the participants were evaluated based on data collected from wearable motion sensors during the near tandem stance, timed-up-and-go, and 6-min walk tests. RESULTS Compared to asymptomatic controls, both TKA groups reported significantly more pain and stiffness and demonstrated reduced functional mobility, increased stride-time-variability, and impaired balance. After Bonferroni adjustment, no significant differences in pain, balance, and mobility performance were observed between PS-TKA and MP-TKA participants 1 year after surgery. However, there was a trend for increased anteroposterior sway of the lumbar and head regions in the MP-TKA participants when undertaking the near tandem stance test. The wearable motion sensors were easy to use without any adverse effects. CONCLUSIONS It is feasible to use wearable motion sensors in a clinical setting to compare balance and mobility performance of patients with different TKA prothesis designs. Since this was a pilot study and no definite conclusions could be drawn, future clinical trials should determine the impacts of different TKA prosthesis designs on post-operative outcomes over a longer follow-up period.
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Affiliation(s)
- Cathy W T Lo
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Matthew A Brodie
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - William W N Tsang
- Department of Physiotherapy, School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong SAR, China
| | - Stephen R Lord
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia
| | - Chun-Hoi Yan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Arnold Y L Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
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23
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Troisi Lopez E, Minino R, Sorrentino P, Manzo V, Tafuri D, Sorrentino G, Liparoti M. Sensitivity to gait improvement after levodopa intake in Parkinson's disease: A comparison study among synthetic kinematic indices. PLoS One 2022; 17:e0268392. [PMID: 35551300 PMCID: PMC9098031 DOI: 10.1371/journal.pone.0268392] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 04/28/2022] [Indexed: 02/07/2023] Open
Abstract
The synthetic indices are widely used to describe balance and stability during gait. Some of these are employed to describe the gait features in Parkinson's disease (PD). However, the results are sometimes inconsistent, and the same indices are rarely used to compare the individuals affected by PD before and after levodopa intake (OFF and ON condition, respectively). Our aim was to investigate which synthetic measure among Harmonic Ratio, Jerk Ratio, Golden Ratio and Trunk Displacement Index is representative of gait stability and harmony, and which of these are more sensitive to the variations between OFF and ON condition. We found that all indices, except the Jerk Ratio, significantly improve after levodopa. Only the improvement of the Trunk Displacement Index showed a direct correlation with the motor improvement measured through the clinical scale UPDRS-III (Unified Parkinson's Disease Rating Scale-part III). In conclusion, we suggest that the synthetic indices can be useful to detect motor changes induced by, but not all of them clearly correlate with the clinical changes achieved with the levodopa administration. In our analysis, only the Trunk Displacement Index was able to show a clear relationship with the PD clinical motor improvement.
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Affiliation(s)
- Emahnuel Troisi Lopez
- Department of Motor Sciences and Wellness, University of Naples “Parthenope”, Naples, Italy
| | - Roberta Minino
- Department of Motor Sciences and Wellness, University of Naples “Parthenope”, Naples, Italy
| | - Pierpaolo Sorrentino
- Institut de Neuroscience des Systemès, Aix-Marseille University, Marseille, France
- Institute of Applied Sciences and Intelligent Systems, CNR, Pozzuoli (NA), Italy
| | - Valentino Manzo
- Alzheimer Unit and Movement Disorders Clinic, Department of Neurology, Cardarelli Hospital, Naples, Italy
| | - Domenico Tafuri
- Department of Motor Sciences and Wellness, University of Naples “Parthenope”, Naples, Italy
| | - Giuseppe Sorrentino
- Department of Motor Sciences and Wellness, University of Naples “Parthenope”, Naples, Italy
- Institute of Applied Sciences and Intelligent Systems, CNR, Pozzuoli (NA), Italy
- Institute for Diagnosis and Care, Hermitage Capodimonte, Naples, Italy
| | - Marianna Liparoti
- Department of Motor Sciences and Wellness, University of Naples “Parthenope”, Naples, Italy
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Bisi MC, Di Marco R, Ragona F, Darra F, Vecchi M, Masiero S, Del Felice A, Stagni R. Quantitative Characterization of Motor Control during Gait in Dravet Syndrome Using Wearable Sensors: A Preliminary Study. SENSORS (BASEL, SWITZERLAND) 2022; 22:2140. [PMID: 35336311 PMCID: PMC8952819 DOI: 10.3390/s22062140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/26/2022] [Accepted: 03/08/2022] [Indexed: 01/27/2023]
Abstract
Dravet syndrome (DS) is a rare and severe form of genetic epilepsy characterized by cognitive and behavioural impairments and progressive gait deterioration. The characterization of gait parameters in DS needs efficient, non-invasive quantification. The aim of the present study is to apply nonlinear indexes calculated from inertial measurements to describe the dynamics of DS gait. Twenty participants (7 M, age 9-33 years) diagnosed with DS were enrolled. Three wearable inertial measurement units (OPAL, Apdm, Portland, OR, USA; Miniwave, Cometa s.r.l., Italy) were attached to the lower back and ankles and 3D acceleration and angular velocity were acquired while participants walked back and forth along a straight path. Segmental kinematics were acquired by means of stereophotogrammetry (SMART, BTS). Community functioning data were collected using the functional independence measure (FIM). Mean velocity and step width were calculated from stereophotogrammetric data; fundamental frequency, harmonic ratio, recurrence quantification analysis, and multiscale entropy (τ = 1...6) indexes along anteroposterior (AP), mediolateral (ML), and vertical (V) axes were calculated from trunk acceleration. Results were compared to a reference age-matched control group (112 subjects, 6-25 years old). All nonlinear indexes show a disruption of the cyclic pattern of the centre of mass in the sagittal plane, quantitatively supporting the clinical observation of ataxic gait. Indexes in the ML direction were less altered, suggesting the efficacy of the compensatory strategy (widening the base of support). Nonlinear indexes correlated significantly with functional scores (i.e., FIM and speed), confirming their effectiveness in capturing clinically meaningful biomarkers of gait.
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Affiliation(s)
- Maria Cristina Bisi
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Viale del Risorgimento, 2, 40136 Bologna, Italy; (M.C.B.); (R.S.)
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy
| | - Roberto Di Marco
- Department of Neuroscienc, University of Padova, Via Belzoni 160, 35121 Padova, Italy; (R.D.M.); (S.M.)
| | - Francesca Ragona
- Department of Paediatric Neuroscience, Euroepan Reference Network EpiCARE, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria, 11, 20133 Milano, Italy;
| | - Francesca Darra
- Pediatric Neurology, University Hospital of Verona, P.Le Stefani, 1, 37121 Verona, Italy;
| | - Marilena Vecchi
- Department of Women and Children Health, University of Padova, Via Nicolò Giustiniani, 3, 35128 Padova, Italy;
| | - Stefano Masiero
- Department of Neuroscienc, University of Padova, Via Belzoni 160, 35121 Padova, Italy; (R.D.M.); (S.M.)
- Padova Neuroscience Centre, University of Padova, Via Giuseppe Orus, 2, 35131 Padova, Italy
| | - Alessandra Del Felice
- Department of Neuroscienc, University of Padova, Via Belzoni 160, 35121 Padova, Italy; (R.D.M.); (S.M.)
- Padova Neuroscience Centre, University of Padova, Via Giuseppe Orus, 2, 35131 Padova, Italy
| | - Rita Stagni
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Viale del Risorgimento, 2, 40136 Bologna, Italy; (M.C.B.); (R.S.)
- Health Sciences and Technologies-Interdepartmental Center for Industrial Research, Via Tolara di Sopra, 50, Ozzano dell’Emilia, 40064 Bologna, Italy
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Association between Abnormal Gait Patterns and an Elevated Degree of Pain after Daily Walking: A Preliminary Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052842. [PMID: 35270535 PMCID: PMC8910192 DOI: 10.3390/ijerph19052842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to investigate whether abnormal gait patterns are associated with experiencing an elevated degree of pain after daily walking. In this preliminary, cross-sectional study, 223 community-dwelling older adults were assessed for pain experienced after daily walking using a simple question that involved asking the subject about their past experiences of an elevated degree of pain after walking for 400 m or more. Gait patterns were assessed using the Comprehensive Gait Assessment using InerTial Sensor score (C-GAITS score), derived from the data measured by Inertial sensors attached to the lower trunk and heel when subjects walked along a 15 m walkway at a self-selected preferred speed. The score was the sum of 10 gait parameter scores. The lower scores indicated more and worse abnormal gait patterns. In total, 24 older adults (10.8%) reported that they experienced pain after daily walking. According to the multiple logistic regression analyses, older adults with a lower total C-GAITS score had a significantly greater probability of having past experiences of pain after walking (odds ratio = 1.11, 95% confidence interval = 1.03–1.20). The findings of this study suggest that more and worse abnormal gait patterns among older adults in a clinical walking test are associated with an elevated degree of pain after daily walking.
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Hagoort I, Vuillerme N, Hortobágyi T, Lamoth CJ. Outcome-dependent effects of walking speed and age on quantitative and qualitative gait measures. Gait Posture 2022; 93:39-46. [PMID: 35063756 DOI: 10.1016/j.gaitpost.2022.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/19/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Walking speed predicts many clinical outcomes in old age. However, a comprehensive assessment of how walking speed affects accelerometer based quantitative and qualitative gait measures in younger and older adults is lacking. RESEARCH QUESTION What is the relationship between walking speed and quantitative and qualitative gait outcomes in younger and older adults? METHODS Younger (n = 27, age: 21.6) and older participants (n = 27, age: 69.5) completed 340 steps on a treadmill at speeds of 0.70 to a maximum of 1.75 m·s-1. We used generalized additive mixed models to determine the relationship between walking speed and quantitative (stride length, stride time, stride frequency and their variability) and qualitative (stride regularity, stability, smoothness, symmetry, synchronization, predictability) gait measures extracted from trunk accelerations. RESULTS The type of relationship between walking speed and the majority of gait measures (quantitative and qualitative) was characterized as logarithmic, with more prominent speed-effects at speeds below 1.20 m·s-1. Changes in quantitative measures included shorter strides, longer stride times, and a lower stride frequency, with more variability at lower speeds independent of age. For qualitative measures, we found a decrease in gait symmetry, stability and regularity in all directions with decreasing speeds, a decrease in gait predictability (Vertical, V, anterior-posterior, AP) and stronger gait synchronization (AP-mediolateral, ML, AP-V), and direction dependent effects of gait smoothness, which decreased in V direction, but increased in AP and ML directions with decreasing speeds. We found outcome-dependent effects of age on the quantitative and qualitative gait measures, with either no differences between age-groups, age-related differences that existed regardless of speed, and age-related differences in the type of relationship with walking speed. SIGNIFICANCE The relationship between walking speed and quantitative and qualitative gait measures, and the effects of age on this relationship, depends on the type of gait measure studied.
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Affiliation(s)
- Iris Hagoort
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, The Netherlands; Université Grenoble Alpes, AGEIS, Grenoble, France.
| | - Nicolas Vuillerme
- Université Grenoble Alpes, AGEIS, Grenoble, France; Institut Universitaire de France, Paris, France; LabCom Telecom4Health, Orange Labs & Univ. Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
| | - Tibor Hortobágyi
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, The Netherlands; Institute of Sport Sciences and Physical Education, Faculty of Sciences, University of Pécs, Pécs, Hungary; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
| | - Claudine Jc Lamoth
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, The Netherlands
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Felius RAW, Geerars M, Bruijn SM, van Dieën JH, Wouda NC, Punt M. Reliability of IMU-Based Gait Assessment in Clinical Stroke Rehabilitation. SENSORS 2022; 22:s22030908. [PMID: 35161654 PMCID: PMC8839370 DOI: 10.3390/s22030908] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023]
Abstract
Background: Gait is often impaired in people after stroke, restricting personal independence and affecting quality of life. During stroke rehabilitation, walking capacity is conventionally assessed by measuring walking distance and speed. Gait features, such as asymmetry and variability, are not routinely determined, but may provide more specific insights into the patient’s walking capacity. Inertial measurement units offer a feasible and promising tool to determine these gait features. Objective: We examined the test–retest reliability of inertial measurement units-based gait features measured in a two-minute walking assessment in people after stroke and while in clinical rehabilitation. Method: Thirty-one people after stroke performed two assessments with a test–retest interval of 24 h. Each assessment consisted of a two-minute walking test on a 14-m walking path. Participants were equipped with three inertial measurement units, placed at both feet and at the low back. In total, 166 gait features were calculated for each assessment, consisting of spatio-temporal (56), frequency (26), complexity (63), and asymmetry (14) features. The reliability was determined using the intraclass correlation coefficient. Additionally, the minimal detectable change and the relative minimal detectable change were computed. Results: Overall, 107 gait features had good–excellent reliability, consisting of 50 spatio-temporal, 8 frequency, 36 complexity, and 13 symmetry features. The relative minimal detectable change of these features ranged between 0.5 and 1.5 standard deviations. Conclusion: Gait can reliably be assessed in people after stroke in clinical stroke rehabilitation using three inertial measurement units.
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Affiliation(s)
- Richard A. W. Felius
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CS Utrecht, The Netherlands; (M.G.); (N.C.W.); (M.P.)
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (S.M.B.); (J.H.v.D.)
- Correspondence:
| | - Marieke Geerars
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CS Utrecht, The Netherlands; (M.G.); (N.C.W.); (M.P.)
- Physiotherapy Department Neurology, Rehabilitation Center de Parkgraaf, 3526 KJ Utrecht, The Netherlands
| | - Sjoerd M. Bruijn
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (S.M.B.); (J.H.v.D.)
| | - Jaap H. van Dieën
- Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (S.M.B.); (J.H.v.D.)
| | - Natasja C. Wouda
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CS Utrecht, The Netherlands; (M.G.); (N.C.W.); (M.P.)
- Physiotherapy Department Neurology, De Hoogstraat Revalidatie, 3583 TM Utrecht, The Netherlands
| | - Michiel Punt
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, 3584 CS Utrecht, The Netherlands; (M.G.); (N.C.W.); (M.P.)
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Mitsutake T, Nakazono H, Yoshizuka H, Taniguchi T, Sakamoto M. Increased Trailing Limb Angle is Associated with Regular and Stable Trunk Movements in Patients with Hemiplegia. J Stroke Cerebrovasc Dis 2021; 31:106242. [PMID: 34915305 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/17/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES In post-stroke patients, shifts in the center of gravity may affect joint movement patterns of the paraplegic lower limb during walking. The impact of changes in ankle dorsiflexion angle and trailing limb angle due to slight weight-shifting is unknown. This study aimed to investigate the effect of the abovementioned parameters on gait characteristics measured by trunk acceleration. MATERIALS AND METHODS During walking, the ankle dorsiflexion angle and trailing limb angle were assessed using two-dimensional motion analysis. Shifts in the center of gravity were assessed to evaluate symmetry, regularity, and sway of trunk movements by calculating the harmonic ratio, autocorrelation coefficient, and root mean square using a wearable trunk accelerometer. RESULTS Ankle dorsiflexion angle showed a significant negative correlation with the root mean square of the anteroposterior axis (r = -0.460, p = 0.005). Trailing limb angle was significantly correlated with the autocorrelation coefficient of the vertical axis (r = 0.585, p < 0.001) and root mean square of the vertical (r = -0.579, p < 0.001), mediolateral (r = -0.474, p = 0.004), and anteroposterior axes (r = -0.548, p = 0.001). Trailing limb angle was a significant predictor (autocorrelation coefficient vertical axis, p = 0.001; root mean square vertical axis, p = 0.001; mediolateral axis, p = 0.007; anteroposterior axis, p = 0.001). CONCLUSIONS Trailing limb angle can indicate the acquisition of forward propulsion during walking; an increase in it may contribute to improvements of the regular vertical movement ability and stability of the center of gravity sway.
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Affiliation(s)
- Tsubasa Mitsutake
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, 3-6-40 Momochihama, Sawara-ku, Fukuoka 814-0001, Japan.
| | - Hisato Nakazono
- Department of Occupational Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Hisayoshi Yoshizuka
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, 3-6-40 Momochihama, Sawara-ku, Fukuoka 814-0001, Japan
| | - Takanori Taniguchi
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, 3-6-40 Momochihama, Sawara-ku, Fukuoka 814-0001, Japan
| | - Maiko Sakamoto
- Education and Research Centre for Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Ko JB, Kim KB, Shin YS, Han H, Han SK, Jung DY, Hong JS. Predicting Sarcopenia of Female Elderly from Physical Activity Performance Measurement Using Machine Learning Classifiers. Clin Interv Aging 2021; 16:1723-1733. [PMID: 34611396 PMCID: PMC8485854 DOI: 10.2147/cia.s323761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Sarcopenia is a symptom in which muscle mass decreases due to decreasing in the number of muscle fibers and muscle cross-sectional area as aging. This study aimed to develop a machine learning classification model for predicting sarcopenia through a inertial measurement unit (IMU)-based physical performance measurement data of female elderly. Patients and Methods Seventy-eight female subjects from an elderly population (aged: 78.8±5.7 years) volunteered to participate in this study. To evaluate the physical performance of the elderly, the experiment conducted timed-up-and-go test (TUG) and 6-minute walk test (6mWT) with worn a single IMU. Based on literature review, 132 features were extracted from collected data. Feature selection was performed through the Kruskal–Wallis test, and features datasets were constructed according to feature selection. Three major machine learning-based classification algorithms classified the sarcopenia group in each dataset, and the performance of classification models was compared. Results As a result of comparing the classification model performance for sarcopenia prediction, the k-nearest neighborhood algorithm (kNN) classification model using 40 major features of TUG and 6mWT showed the best performance at 88%. Conclusion This study can be used as a basic research for the development of self-monitoring technology for sarcopenia.
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Affiliation(s)
- Jeong Bae Ko
- Digital Health Care R&D Department, Korea Institute of Industrial Technology, Cheonan, Chuncheongnam-do, South Korea
| | - Kwang Bok Kim
- Digital Health Care R&D Department, Korea Institute of Industrial Technology, Cheonan, Chuncheongnam-do, South Korea
| | - Young Sub Shin
- Digital Health Care R&D Department, Korea Institute of Industrial Technology, Cheonan, Chuncheongnam-do, South Korea
| | - Hun Han
- Digital Health Care R&D Department, Korea Institute of Industrial Technology, Cheonan, Chuncheongnam-do, South Korea
| | - Sang Kuy Han
- Robotics R&D Department, Korea Institute of Industrial Technology, Ansan, Gyeonggi-do, South Korea
| | - Duk Young Jung
- Seongnam Senior Experience Complex, Eulji University, Seongnam, Gyeonggi-do, South Korea
| | - Jae Soo Hong
- Digital Health Care R&D Department, Korea Institute of Industrial Technology, Cheonan, Chuncheongnam-do, South Korea
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The effects of different frequencies of rhythmic acoustic stimulation on gait stability in healthy elderly individuals: a pilot study. Sci Rep 2021; 11:19530. [PMID: 34593924 PMCID: PMC8484542 DOI: 10.1038/s41598-021-98953-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 09/13/2021] [Indexed: 02/04/2023] Open
Abstract
The efficacy of rhythmic acoustic stimulation (RAS) to improve gait and balance in healthy elderly individuals is controversial. Our aim was to investigate, through 3D gait analysis, the effect of different types of RAS (fixed frequency and based on subject-specific cadence), using conventional gait parameters and the trunk displacement as readouts. Walking at a fixed frequency of 80 bpm, the subjects showed extended duration of gait cycle and increased gait variability while the same individuals, walking at a fixed frequency of 120 bpm, showed reduced trunk sway and gait cycle duration. With regard to the RAS at subject-specific frequencies, walking at 90% of the subject-specific average cadence did not significantly modify the gait parameters, except for the speed, which was reduced. In contrast, walking at 100% and 110% of the mean cadence caused increased stride length and a slight reduction of temporal parameters and trunk sway. In conclusion, this pilot study shows that using RAS at fixed frequencies might be an inappropriate strategy, as it is not adjusted to individual gait characteristics. On the other hand, RAS frequencies equal to or slightly higher than each subject's natural cadence seem to be beneficial for gait and stability.
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31
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Comparing the Effects of Single-Task versus Dual-Task Balance Training on Gait Smoothness and Functional Balance in Community-Dwelling Older Adults: A Randomized Controlled Trial. J Aging Phys Act 2021; 30:308-315. [PMID: 34453027 DOI: 10.1123/japa.2020-0523] [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: 01/15/2021] [Revised: 04/26/2021] [Accepted: 05/31/2021] [Indexed: 11/18/2022]
Abstract
To compare the effects of single- versus dual-task balance training on the gait smoothness and balance of community-dwelling older adults, 69 volunteers were randomized to single-, dual-task training, and control (no intervention) groups. Exercises were received in 18 sessions through 6 weeks. The gait smoothness was measured by the harmonic ratio of trunk accelerations using a triaxial accelerometer. Balance performance was assessed through the Fullerton Advanced Balance scale, Timed Up and Go test, Activities-specific Balance Confidence, and gait speed. After the trial, all variables improved significantly in the training groups. Moreover, differences in the mean change of all variables, except the Timed Up and Go test, were statistically significant between the interventional groups and the control group, but no significant difference was reported between the two training groups. This study suggests that balance training can improve gait smoothness as well as balance status in healthy older adults.
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Conway ZJ, Silburn PA, Perera T, O'Maley K, Cole MH. Low-frequency STN-DBS provides acute gait improvements in Parkinson's disease: a double-blinded randomised cross-over feasibility trial. J Neuroeng Rehabil 2021; 18:125. [PMID: 34376190 PMCID: PMC8353795 DOI: 10.1186/s12984-021-00921-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/02/2021] [Indexed: 02/01/2023] Open
Abstract
Background Some people with Parkinson’s disease (PD) report poorer dynamic postural stability following high-frequency deep brain stimulation of the subthalamic nucleus (STN-DBS), which may contribute to an increased falls risk. However, some studies have shown low-frequency (60 Hz) STN-DBS improves clinical measures of postural stability, potentially providing support for this treatment. This double-blind randomised crossover study aimed to investigate the effects of low-frequency STN-DBS compared to high-frequency stimulation on objective measures of gait rhythmicity in people with PD. Methods During high- and low-frequency STN-DBS and while off-medication, participants completed assessments of symptom severity and walking (e.g., Timed Up-and-Go). During comfortable walking, the harmonic ratio, an objective measures of gait rhythmicity, was derived from head- and trunk-mounted accelerometers to provide insight in dynamic postural stability. Lower harmonic ratios represent less rhythmic walking and have discriminated people with PD who experience falls. Linear mixed model analyses were performed on fourteen participants. Results Low-frequency STN-DBS significantly improved medial–lateral and vertical trunk rhythmicity compared to high-frequency. Improvements were independent of electrode location and total electrical energy delivered. No differences were noted between stimulation conditions for temporal gait measures, clinical mobility measures, motor symptom severity or the presence of gait retropulsion. Conclusions This study provides evidence for the acute benefits of low-frequency stimulation for gait outcomes in STN-DBS PD patients, independent of electrode location. However, the perceived benefits of this therapy may be diminished for people who experienced significant tremor pre-operatively, as lower frequencies may cause these symptoms to re-emerge. Trial registration: This study was prospectively registered with the Australian and New Zealand Clinical Trials Registry on 5 June 2018 (ACTRN12618000944235). Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00921-4.
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Affiliation(s)
- Zachary J Conway
- School of Behavioural and Health Sciences, Australian Catholic University, P.O. Box 456, Brisbane, QLD, 4014, Australia.
| | - Peter A Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia.,Neurosciences Queensland, Brisbane, QLD, Australia
| | - Thushara Perera
- The Bionics Institute, East Melbourne, VIC, Australia.,Department of Medical Bionics, The University of Melbourne, Parkville, VIC, Australia
| | | | - Michael H Cole
- School of Behavioural and Health Sciences, Australian Catholic University, P.O. Box 456, Brisbane, QLD, 4014, Australia. .,Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia. .,Development and Disability over the Lifespan Program, Healthy Brain and Mind Research Centre, Australian Catholic University, Brisbane, Australia.
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Raykov YP, Evers LJW, Badawy R, Bloem BR, Heskes TM, Meinders MJ, Claes K, Little MA. Probabilistic Modelling of Gait for Robust Passive Monitoring in Daily Life. IEEE J Biomed Health Inform 2021; 25:2293-2304. [PMID: 33180738 DOI: 10.1109/jbhi.2020.3037857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Passive monitoring in daily life may provide valuable insights into a person's health throughout the day. Wearable sensor devices play a key role in enabling such monitoring in a non-obtrusive fashion. However, sensor data collected in daily life reflect multiple health and behavior-related factors together. This creates the need for a structured principled analysis to produce reliable and interpretable predictions that can be used to support clinical diagnosis and treatment. In this work we develop a principled modelling approach for free-living gait (walking) analysis. Gait is a promising target for non-obtrusive monitoring because it is common and indicative of many different movement disorders such as Parkinson's disease (PD), yet its analysis has largely been limited to experimentally controlled lab settings. To locate and characterize stationary gait segments in free-living using accelerometers, we present an unsupervised probabilistic framework designed to segment signals into differing gait and non-gait patterns. We evaluate the approach using a new video-referenced dataset including 25 PD patients with motor fluctuations and 25 age-matched controls, performing unscripted daily living activities in and around their own houses. Using this dataset, we demonstrate the framework's ability to detect gait and predict medication induced fluctuations in PD patients based on free-living gait. We show that our approach is robust to varying sensor locations, including the wrist, ankle, trouser pocket and lower back.
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Quantitative and Qualitative Running Gait Analysis through an Innovative Video-Based Approach. SENSORS 2021; 21:s21092977. [PMID: 33922801 PMCID: PMC8123008 DOI: 10.3390/s21092977] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 12/16/2022]
Abstract
Quantitative and qualitative running gait analysis allows the early identification and the longitudinal monitoring of gait abnormalities linked to running-related injuries. A promising calibration- and marker-less video sensor-based technology (i.e., Graal), recently validated for walking gait, may also offer a time- and cost-efficient alternative to the gold-standard methods for running. This study aim was to ascertain the validity of an improved version of Graal for quantitative and qualitative analysis of running. In 33 healthy recreational runners (mean age 41 years), treadmill running at self-selected submaximal speed was simultaneously evaluated by a validated photosensor system (i.e., Optogait—the reference methodology) and by the video analysis of a posterior 30-fps video of the runner through the optimized version of Graal. Graal is video analysis software that provides a spectral analysis of the brightness over time for each pixel of the video, in order to identify its frequency contents. The two main frequencies of variation of the pixel’s brightness (i.e., F1 and F2) correspond to the two most important frequencies of gait (i.e., stride frequency and cadence). The Optogait system recorded step length, cadence, and its variability (vCAD, a traditional index of gait quality). Graal provided a direct measurement of F2 (reflecting cadence), an indirect measure of step length, and two indexes of global gait quality (harmony and synchrony index). The correspondence between quantitative indexes (Cadence vs. F2 and step length vs. Graal step length) was tested via paired t-test, correlations, and Bland–Altman plots. The relationship between qualitative indexes (vCAD vs. Harmony and Synchrony Index) was investigated by correlation analysis. Cadence and step length were, respectively, not significantly different from and highly correlated with F2 (1.41 Hz ± 0.09 Hz vs. 1.42 Hz ± 0.08 Hz, p = 0.25, r2 = 0.81) and Graal step length (104.70 cm ± 013.27 cm vs. 107.56 cm ± 13.67 cm, p = 0.55, r2 = 0.98). Bland–Altman tests confirmed a non-significant bias and small imprecision between methods for both parameters. The vCAD was 1.84% ± 0.66%, and it was significantly correlated with neither the Harmony nor the Synchrony Index (0.21 ± 0.03, p = 0.92, r2 = 0.00038; 0.21 ± 0.96, p = 0.87, r2 = 0.00122). These findings confirm the validity of the optimized version of Graal for the measurement of quantitative indexes of gait. Hence, Graal constitutes an extremely time- and cost-efficient tool suitable for quantitative analysis of running. However, its validity for qualitative running gait analysis remains inconclusive and will require further evaluation in a wider range of absolute and relative running intensities in different individuals.
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Zhang Y, Wang H, Yao Y, Liu J, Sun X, Gu D. Walking stability in patients with benign paroxysmal positional vertigo: an objective assessment using wearable accelerometers and machine learning. J Neuroeng Rehabil 2021; 18:56. [PMID: 33789693 PMCID: PMC8011133 DOI: 10.1186/s12984-021-00854-y] [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: 10/12/2020] [Accepted: 03/17/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular disorders leading to balance difficulties and increased fall risks. This study aims to investigate the walking stability of BPPV patients in clinical settings and propose a machine-learning-based classification method for determining the severity of gait disturbances of BPPV. METHODS Twenty-seven BPPV outpatients and twenty-seven healthy subjects completed level walking trials at self-preferred speed in clinical settings while wearing two accelerometers on the head and lower trunk, respectively. Temporo-spatial variables and six walking stability related variables [root mean square (RMS), harmonic ratio (HR), gait variability, step/stride regularity, and gait symmetry] derived from the acceleration signals were analyzed. A support vector machine model (SVM) based on the gait variables of BPPV patients were developed to differentiate patients from healthy controls and classify the handicapping effects of dizziness imposed by BPPV. RESULTS The results showed that BPPV patients employed a conservative gait and significantly reduced walking stability compared to the healthy controls. Significant different mediolateral HR at the lower trunk and anteroposterior step regularity at the head were found in BPPV patients among mild, moderate, and severe DHI (dizziness handicap inventory) subgroups. SVM classification achieved promising accuracies with area under the curve (AUC) of 0.78, 0.83, 0.85 and 0.96 respectively for differentiating patients from healthy controls and classifying the three stages of DHI subgroups. Study results suggest that the proposed gait analysis that is based on the coupling of wearable accelerometers and machine learning provides an objective approach for assessing gait disturbances and handicapping effects of dizziness imposed by BPPV.
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Affiliation(s)
- Yuqian Zhang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.,School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, People's Republic of China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education of People's Republic China, Shanghai, 200030, People's Republic of China
| | - He Wang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, People's Republic of China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education of People's Republic China, Shanghai, 200030, People's Republic of China
| | - Yifei Yao
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, People's Republic of China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education of People's Republic China, Shanghai, 200030, People's Republic of China
| | - Jianren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China
| | - Xuhong Sun
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China.
| | - Dongyun Gu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, People's Republic of China. .,School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, 200030, People's Republic of China. .,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education of People's Republic China, Shanghai, 200030, People's Republic of China.
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Wang C, Patriquin M, Vaziri A, Najafi B. Mobility Performance in Community-Dwelling Older Adults: Potential Digital Biomarkers of Concern about Falling. Gerontology 2021; 67:365-373. [PMID: 33535225 DOI: 10.1159/000512977] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Concern about falling is a prevalent worry among community-dwelling older adults and may contribute to a decline in physical and mental health. This study aimed to examine the association between mobility performance and concern about falling. METHODS Older adults aged 65 years and older, with Mini-Mental State Examination score ≥24, and ambulatory (with or without the assistive device) were included. Concern about falling was evaluated with Falls Efficacy Scale-International (FES-I) scores. Participants with high concern about falling were identified using the cutoff of FES-I ≥23. Participants' motor capacity was assessed in standardized walking tests under single- and dual-task conditions. Participants' mobility performance was measured based on a 48-h trunk accelerometry signal from a wearable pendant sensor. RESULTS No significant differences were observed at participant characteristics across groups with different levels of concern about falling (low: N = 64, age = 76.3 ± 7.2 years, female = 46%; high: N = 59, age = 79.3 ± 9.1 years, female = 47%), after propensity matching with BMI, age, depression, and cognition. With adjustment of motor capacity (stride velocity and stride length under single- and dual-task walking conditions), participants with high concern about falling had significantly poorer mobility performance than those with low concern about falling, including lower walking quantity (walking bouts, steps and time per day, and walking bout average, walking bout variability, and longest walking bout, p ≤ 0.013), and poorer daily-life gait (stride velocity and gait variability, p ≤ 0.023), and poorer walking quality (frontal gait symmetry, and trunk acceleration and velocity intensity, p ≤ 0.041). The selected mobility performance metrics (daily steps and frontal gait symmetry) could significantly contribute to identifying older adults with high concern about falling (p ≤ 0.042), having better model performance (p = 0.036) than only walking quantity (daily steps) with adjustment of confounding effects from the motor capacity (stride length under dual-task walking condition). CONCLUSION There is an association between mobility performance and concern about falling in older adults. Mobility performance metrics can serve as predictors to identify older adults with high concern about falling, potentially providing digital biomarkers for clinicians to remotely track older adults' change of concern about falling via applications of remote patient monitoring.
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Affiliation(s)
- Changhong Wang
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Michelle Patriquin
- The Menniger Clinic, Houston, Texas, USA.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.,Michael E. Debakey VA Medical Center, Houston, Texas, USA
| | | | - Bijan Najafi
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA,
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The Effects of Combining Transcranial Direct Current Stimulation and Gait Training with Functional Electrical Stimulation on Trunk Acceleration During Walking in Patients with Subacute Stroke. J Stroke Cerebrovasc Dis 2021; 30:105635. [PMID: 33517032 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105635] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study aimed to investigate whether the combination of transcranial direct current stimulation (tDCS) and gait training with FES affected walking speed and trunk accelerometry-based gait characteristics in patients with subacute stroke, compared with FES or tDCS gait training only. MATERIALS AND METHODS Stroke patients (n = 34; female 15; mean age, 72.5 ± 11.2 years; mean days poststroke, 38.7) with resultant paresis in the lower extremity (mean Fugl-Meyer score, 25.5) were enrolled. Patients were randomly assigned to one of three groups: combined anodal tDCS and gait training with FES (tDCS+FES, n = 11), anodal tDCS with gait training (tDCS, n = 11), or combined sham tDCS and gait training with FES (FES, n = 12). Participants received the intervention for 20 minutes and a 40-minute conventional rehabilitative intervention daily for a week. Patients' walking ability was evaluated using walking speed, harmonic ratio (HR), autocorrelation coefficient (AC), and root mean square (RMS) along each axis using a wearable trunk accelerometer. RESULTS The tDCS+FES group had a significantly greater change in AC in the anteroposterior axis and mediolateral axis than the FES and tDCS groups and FES group, respectively. There were no significant effects on walking speed or other parameters (HR and RMS) among the groups. CONCLUSIONS The combination of anodal tDCS and gait training with FES improved the post-stroke patients' gait regularity than FES gait training intervention only. Thus, combined tDCS and FES gait training, as a novel intervention, could be an important therapeutic tool in improving walking performance.
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Schifino G, Cimolin V, Pau M, da Cunha MJ, Leban B, Porta M, Galli M, Souza Pagnussat A. Functional Electrical Stimulation for Foot Drop in Post-Stroke People: Quantitative Effects on Step-to-Step Symmetry of Gait Using a Wearable Inertial Sensor. SENSORS 2021; 21:s21030921. [PMID: 33573046 PMCID: PMC7866372 DOI: 10.3390/s21030921] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/25/2022]
Abstract
The main purpose of the present study was to assess the effects of foot drop stimulators (FDS) in individuals with stroke by means of spatio-temporal and step-to-step symmetry, harmonic ratio (HR), parameters obtained from trunk accelerations acquired using a wearable inertial sensor. Thirty-two patients (age: 56.84 ± 9.10 years; 68.8% male) underwent an instrumental gait analysis, performed using a wearable inertial sensor before and a day after the 10-session treatment (PRE and POST sessions). The treatment consisted of 10 sessions of 20 min of walking on a treadmill while using the FDS device. The spatio-temporal parameters and the HR in the anteroposterior (AP), vertical (V), and mediolateral (ML) directions were computed from trunk acceleration data. The results showed that time had a significant effect on the spatio-temporal parameters; in particular, a significant increase in gait speed was detected. Regarding the HRs, the HR in the ML direction was found to have significantly increased (+20%), while those in the AP and V directions decreased (approximately 13%). Even if further studies are necessary, from these results, the HR seems to provide additional information on gait patterns with respect to the traditional spatio-temporal parameters, advancing the assessment of the effects of FDS devices in stroke patients.
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Affiliation(s)
- Giulia Schifino
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil; (G.S.); (M.J.d.C.); (A.S.P.)
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy;
- Correspondence: ; Tel.: +39-02-2399-3359; Fax: +39-02-2399-3360
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d’Armi, 09123 Cagliari, Italy; (M.P.); (B.L.); (M.P.)
| | - Maira Jaqueline da Cunha
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil; (G.S.); (M.J.d.C.); (A.S.P.)
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d’Armi, 09123 Cagliari, Italy; (M.P.); (B.L.); (M.P.)
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Piazza d’Armi, 09123 Cagliari, Italy; (M.P.); (B.L.); (M.P.)
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano, Italy;
| | - Aline Souza Pagnussat
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil; (G.S.); (M.J.d.C.); (A.S.P.)
- Movement Analysis and Rehabilitation Laboratory, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
- Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 900050-170, Brazil
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Piitulainen H, Kulmala JP, Mäenpää H, Rantalainen T. The gait is less stable in children with cerebral palsy in normal and dual-task gait compared to typically developed peers. J Biomech 2021; 117:110244. [PMID: 33493716 DOI: 10.1016/j.jbiomech.2021.110244] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/21/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
There is limited evidence about gait stability and its alteration by concurrent motor and cognitive tasks in children with cerebral palsy (CP). We examined gait stability and how it is altered by constrained cognitive or motor task in CP and their typically developed (TD) controls. Gait kinematics were recorded using inertial-measurement units (IMU) from 18 patients with hemiplegia (13.5 ± 2.4 years), 12 with diplegia (13.0 ± 2.1 years), and 31 TD controls (13.5 ± 2.2 years) during unconstrained gait, and motor (carrying a tray) and cognitive (word naming) task constrained gait at preferred speed (~400 steps/task). Step duration, its standard deviation and refined-compound-multiscale entropy (RCME) were computed independently for vertical and resultant horizontal accelerations. Gait complexity was higher for patients with CP than TD in all tasks and directions (p < 0.001-0.01), being pronounced in vertical direction, cognitive task and for diplegic patients (p < 0.05-0.001). The gait complexity increased more (i.e. higher dual-task cost) from the unconstrained to the constrained gait in CP compared to TD (p < 0.05). Step duration was similar in all groups (p > 0.586), but its variation was higher in CP than TD (p < 0.001-0.05), and during the constrained than unconstrained gait in all groups (p < 0.01-0.001). The gait in children with CP was more complex and the dual-task cost was higher primarily for children with diplegic CP than TD during cognitive task, indicating that attentional load hinders their gait more. This raises the hypothesis that more attention and cortical resources are needed to compensate for the impaired gait in children with CP.
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Affiliation(s)
- Harri Piitulainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Motion Analysis Laboratory, Helsinki University Hospital and University of Helsinki, Children and Adolescents, Helsinki, Finland.
| | - Juha-Pekka Kulmala
- Motion Analysis Laboratory, Helsinki University Hospital and University of Helsinki, Children and Adolescents, Helsinki, Finland
| | - Helena Mäenpää
- Motion Analysis Laboratory, Helsinki University Hospital and University of Helsinki, Children and Adolescents, Helsinki, Finland
| | - Timo Rantalainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Argunsah Bayram H, Yalcin B. The influence of biofeedback on physiological and kinematic variables of treadmill running. INT J PERF ANAL SPOR 2020. [DOI: 10.1080/24748668.2020.1861898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Begum Yalcin
- Department of Medical Engineering, Faculty of Engineering, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Abel B, Bongartz M, Eckert T, Ullrich P, Beurskens R, Mellone S, Bauer JM, Lamb SE, Hauer K. Will We Do If We Can? Habitual Qualitative and Quantitative Physical Activity in Multi-Morbid, Older Persons with Cognitive Impairment. SENSORS 2020; 20:s20247208. [PMID: 33339293 PMCID: PMC7766414 DOI: 10.3390/s20247208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022]
Abstract
This study aimed to identify determinants of quantitative dimensions of physical activity (PA; duration, frequency, and intensity) in community-dwelling, multi-morbid, older persons with cognitive impairment (CI). In addition, qualitative and quantitative aspects of habitual PA have been described. Quantitative PA and qualitative gait characteristics while walking straight and while walking turns were documented by a validated, sensor-based activity monitor. Univariate and multiple linear regression analyses were performed to delineate associations of quantitative PA dimensions with qualitative characteristics of gait performance and further potential influencing factors (motor capacity measures, demographic, and health-related parameters). In 94 multi-morbid, older adults (82.3 ± 5.9 years) with CI (Mini-Mental State Examination score: 23.3 ± 2.4), analyses of quantitative and qualitative PA documented highly inactive behavior (89.6% inactivity) and a high incidence of gait deficits, respectively. The multiple regression models (adjusted R2 = 0.395–0.679, all p < 0.001) identified specific qualitative gait characteristics as independent determinants for all quantitative PA dimensions, whereas motor capacity was an independent determinant only for the PA dimension duration. Demographic and health-related parameters were not identified as independent determinants. High associations between innovative, qualitative, and established, quantitative PA performances may suggest gait quality as a potential target to increase quantity of PA in multi-morbid, older persons.
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Affiliation(s)
- Bastian Abel
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, 69126 Heidelberg, Germany; (B.A.); (M.B.); (T.E.); (P.U.); (R.B.); (J.M.B.)
- Center for Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany
| | - Martin Bongartz
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, 69126 Heidelberg, Germany; (B.A.); (M.B.); (T.E.); (P.U.); (R.B.); (J.M.B.)
- Network Aging Research (NAR), Heidelberg University, 69115 Heidelberg, Germany
| | - Tobias Eckert
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, 69126 Heidelberg, Germany; (B.A.); (M.B.); (T.E.); (P.U.); (R.B.); (J.M.B.)
- Department for Social and Health Sciences in Sport, Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany
| | - Phoebe Ullrich
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, 69126 Heidelberg, Germany; (B.A.); (M.B.); (T.E.); (P.U.); (R.B.); (J.M.B.)
| | - Rainer Beurskens
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, 69126 Heidelberg, Germany; (B.A.); (M.B.); (T.E.); (P.U.); (R.B.); (J.M.B.)
- Department of Health and Social Affairs, FHM Bielefeld, University of Applied Sciences, 33602 Bielefeld, Germany
| | - Sabato Mellone
- Department of Electrical, Electronic, and Information Engineering, University of Bologna, 40136 Bologna, Italy;
| | - Jürgen M. Bauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, 69126 Heidelberg, Germany; (B.A.); (M.B.); (T.E.); (P.U.); (R.B.); (J.M.B.)
- Center for Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany
| | - Sallie E. Lamb
- Institute of Health Research, University of Exeter, South Cloisters, St. Luke’s Campus, Exeter EX1 2LU, UK;
| | - Klaus Hauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the University of Heidelberg, 69126 Heidelberg, Germany; (B.A.); (M.B.); (T.E.); (P.U.); (R.B.); (J.M.B.)
- Correspondence: ; Tel.: +49-6221-319-1532
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Tietsch M, Muaremi A, Clay I, Kluge F, Hoefling H, Ullrich M, Küderle A, Eskofier BM, Müller A. Robust Step Detection from Different Waist-Worn Sensor Positions: Implications for Clinical Studies. Digit Biomark 2020; 4:50-58. [PMID: 33442580 PMCID: PMC7768099 DOI: 10.1159/000511611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022] Open
Abstract
Analyzing human gait with inertial sensors provides valuable insights into a wide range of health impairments, including many musculoskeletal and neurological diseases. A representative and reliable assessment of gait requires continuous monitoring over long periods and ideally takes place in the subjects' habitual environment (real-world). An inconsistent sensor wearing position can affect gait characterization and influence clinical study results, thus clinical study protocols are typically highly proscriptive, instructing all participants to wear the sensor in a uniform manner. This restrictive approach improves data quality but reduces overall adherence. In this work, we analyze the impact of altering the sensor wearing position around the waist on sensor signal and step detection. We demonstrate that an asymmetrically worn sensor leads to additional odd-harmonic frequency components in the frequency spectrum. We propose a robust solution for step detection based on autocorrelation to overcome sensor position variation (sensitivity = 0.99, precision = 0.99). The proposed solution reduces the impact of inconsistent sensor positioning on gait characterization in clinical studies, thus providing more flexibility to protocol implementation and more freedom to participants to wear the sensor in the position most comfortable to them. This work is a first step towards truly position-agnostic gait assessment in clinical settings.
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Affiliation(s)
- Matthias Tietsch
- Novartis Institutes of Biomedical Research, Novartis Pharma AG, Basel, Switzerland
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany
| | - Amir Muaremi
- Novartis Institutes of Biomedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Ieuan Clay
- Evidation Health Inc., San Mateo, California, USA
| | - Felix Kluge
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany
| | - Holger Hoefling
- Novartis Institutes of Biomedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Martin Ullrich
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany
| | - Arne Küderle
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany
| | - Bjoern M. Eskofier
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander University Erlangen-Nürnberg, Nürnberg, Germany
| | - Arne Müller
- Novartis Institutes of Biomedical Research, Novartis Pharma AG, Basel, Switzerland
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Simoni L, Scarton A, Gerli F, Macchi C, Gori F, Pasquini G, Pogliaghi S. Testing the Performance of an Innovative Markerless Technique for Quantitative and Qualitative Gait Analysis. SENSORS 2020; 20:s20226654. [PMID: 33233799 PMCID: PMC7699971 DOI: 10.3390/s20226654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022]
Abstract
Gait abnormalities such as high stride and step frequency/cadence (SF-stride/second, CAD-step/second), stride variability (SV) and low harmony may increase the risk of injuries and be a sentinel of medical conditions. This research aims to present a new markerless video-based technology for quantitative and qualitative gait analysis. 86 healthy individuals (mead age 32 years) performed a 90 s test on treadmill at self-selected walking speed. We measured SF and CAD by a photoelectric sensors system; then, we calculated average ± standard deviation (SD) and within-subject coefficient of variation (CV) of SF as an index of SV. We also recorded a 60 fps video of the patient. With a custom-designed web-based video analysis software, we performed a spectral analysis of the brightness over time for each pixel of the image, that reinstituted the frequency contents of the videos. The two main frequency contents (F1 and F2) from this analysis should reflect the forcing/dominant variables, i.e., SF and CAD. Then, a harmony index (HI) was calculated, that should reflect the proportion of the pixels of the image that move consistently with F1 or its supraharmonics. The higher the HI value, the less variable the gait. The correspondence SF-F1 and CAD-F2 was evaluated with both paired t-Test and correlation and the relationship between SV and HI with correlation. SF and CAD were not significantly different from and highly correlated with F1 (0.893 ± 0.080 Hz vs. 0.895 ± 0.084 Hz, p < 0.001, r2 = 0.99) and F2 (1.787 ± 0.163 Hz vs. 1.791 ± 0.165 Hz, p < 0.001, r2 = 0.97). The SV was 1.84% ± 0.66% and it was significantly and moderately correlated with HI (0.082 ± 0.028, p < 0.001, r2 = 0.13). The innovative video-based technique of global, markerless gait analysis proposed in our study accurately identifies the main frequency contents and the variability of gait in healthy individuals, thus providing a time-efficient, low-cost means to quantitatively and qualitatively study human locomotion.
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Affiliation(s)
- Laura Simoni
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy;
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (F.G.); (C.M.); (G.P.)
| | | | - Filippo Gerli
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (F.G.); (C.M.); (G.P.)
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (F.G.); (C.M.); (G.P.)
| | | | - Guido Pasquini
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy; (F.G.); (C.M.); (G.P.)
| | - Silvia Pogliaghi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, 37129 Verona, Italy;
- Correspondence:
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Ngo T, Pathirana PN, Horne MK, Power L, Szmulewicz DJ, Milne SC, Corben LA, Roberts M, Delatycki MB. Balance Deficits due to Cerebellar Ataxia: A Machine Learning and Cloud-Based Approach. IEEE Trans Biomed Eng 2020; 68:1507-1517. [PMID: 33044924 DOI: 10.1109/tbme.2020.3030077] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cerebellar ataxia (CA) refers to the disordered movement that occurs when the cerebellum is injured or affected by disease. It manifests as uncoordinated movement of the limbs, speech, and balance. This study is aimed at the formation of a simple, objective framework for the quantitative assessment of CA based on motion data. We adopted the Recurrence Quantification Analysis concept in identifying features of significance for the diagnosis. Eighty-six subjects were observed undertaking three standard neurological tests (Romberg's, Heel-shin and Truncal ataxia) to capture 213 time series inertial measurements each. The feature selection was based on engaging six different common techniques to distinguish feature subset for diagnosis and severity assessment separately. The Gaussian Naive Bayes classifier performed best in diagnosing CA with an average double cross-validation accuracy, sensitivity, and specificity of 88.24%, 85.89%, and 92.31%, respectively. Regarding severity assessment, the voting regression model exhibited a significant correlation (0.72 Pearson) with the clinical scores in the case of the Romberg's test. The Heel-shin and Truncal tests were considered for diagnosis and assessment of severity concerning subjects who were unable to stand. The underlying approach proposes a reliable, comprehensive framework for the assessment of postural stability due to cerebellar dysfunction using a single inertial measurement unit.
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Thomas NDA, Gardiner JD, Crompton RH, Lawson R. Keep your head down: Maintaining gait stability in challenging conditions. Hum Mov Sci 2020; 73:102676. [PMID: 32956985 DOI: 10.1016/j.humov.2020.102676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Peripheral vision often deteriorates with age, disrupting our ability to maintain normal locomotion. Laboratory based studies have shown that lower visual field loss, in particular, is associated with changes in gaze and gait behaviour whilst walking and this, in turn, increases the risk of falling in the elderly. Separately, gaze and gait behaviours change and fall risk increases when walking over complex surfaces. It seems probable, but has not yet been established, that these challenges to stability interact. RESEARCH QUESTION How does loss of the lower visual field affect gaze and gait behaviour whilst walking on a variety of complex surfaces outside of the laboratory? Specifically, is there a synergistic interaction between the effects on behaviour of blocking the lower visual field and increased surface complexity? METHODS We compared how full vision versus simulated lower visual field loss affected a diverse range of behavioural measures (head pitch angle, eye angle, muscle coactivation, gait speed and walking smoothness as measured by harmonic ratios) in young participants. Participants walked over a range of surfaces of different complexity, including pavements, grass, steps and pebbles. RESULTS In both full vision and blocked lower visual field conditions, surface complexity influenced gaze and gait behaviour. For example, more complex surfaces were shown to be associated with lowered head pitch angles, increased leg muscle coactivation, reduced gait speed and decreased walking smoothness. Relative to full vision, blocking the lower visual field caused a lowering of head pitch, especially for more complex surfaces. However, crucially, muscle coactivation, gait speed and walking smoothness did not show a significant change between full vision and blocked lower visual field conditions. Finally, head pitch angle, muscle coactivation, gait speed and walking smoothness were all correlated highly with each other. SIGNIFICANCE Our study showed that blocking the lower visual field did not significantly change muscle coactivation, gait speed or walking smoothness. This suggests that young people cope well when walking with a blocked lower visual field, making minimal behavioural changes. Surface complexity had a greater effect on gaze and gait behaviour than blocking the lower visual field. Finally, head pitch angle was the only measure that showed a significant synergistic interaction between surface complexity and blocking the lower visual field. Together our results indicate that, first, a range of changes occur across the body when people walk over more complex surfaces and, second, that a relatively simple behavioural change (to gaze) suffices to maintain normal gait when the lower visual field is blocked, even in more challenging environments. Future research should assess whether young people cope as effectively when several impairments are simulated, representative of the comorbidities found with age.
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Affiliation(s)
- Nicholas D A Thomas
- Institute of Population Health, University of Liverpool, Liverpool L69 7ZA, UK; Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK.
| | - James D Gardiner
- Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Robin H Crompton
- Institute of Life Course & Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Rebecca Lawson
- Institute of Population Health, University of Liverpool, Liverpool L69 7ZA, UK
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Soleimanifar M, Mazaheri M, van Schooten KS, Asgari M, Mosallanezhad Z, Salavati M, Sedaghat-Nejad E, Parnianpour M. Magnitude, symmetry and attenuation of upper body accelerations during walking in women: The role of age, fall history and walking surface. Maturitas 2020; 139:49-56. [PMID: 32747040 DOI: 10.1016/j.maturitas.2020.05.016] [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: 01/10/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The present experiment examined the role of age and fall history in upper body accelerations when walking on an even and on an uneven surface. STUDY DESIGN An observational cross-sectional study. MAIN OUTCOME MEASURES The magnitude (root mean square [RMS]), symmetry (harmonic ratio) and attenuation (attenuation coefficient) of upper body accelerations were quantified as primary outcomes; gait spatiotemporal parameters were measured as secondary outcomes. METHODS Twenty young adults (mean ± SD age: 29.00 ± 4.51 yrs), 20 older non-fallers (66.60 ± 5.43 yrs) and 20 older fallers (68.55 ± 4.86 yrs) walked on an even and on an uneven surface, while wearing four accelerometers attached to the forehead, pelvis, right and left shanks. RESULTS Older fallers exhibited increased RMS acceleration in the mediolateral direction at the pelvis level compared with young adults when walking on the even surface (0.18 ± 0.04 vs. 0.14 ± 0.02, respectively), whereas walking on an uneven surface was associated with reduced magnitude of acceleration in older fallers (0.19 ± 0.04) compared with non-fallers (0.23 ± 0.04) and young adults (0.22 ± 0.03). Among other changes, walking on the uneven surface diminished pelvis-to-head attenuation in the mediolateral direction in older fallers (38.07 ± 14.51) compared with non-fallers (50.96 ± 11.03) and young adults (62.62 ± 8.21; all ps<0.05). CONCLUSIONS Reduced mediolateral accelerations in older fallers when walking on the uneven surface can be interpreted as a compensatory mechanism to preserve stability through increased body stiffness. Reduced postural flexibility in the frontal plane compromises the central role of the trunk in minimizing the impact of gait-related oscillations to the head, as evidenced by reduced mediolateral attenuation in older fallers.
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Affiliation(s)
- Manijeh Soleimanifar
- Lifestyle and Health Management Research Group, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
| | - Masood Mazaheri
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, College of Life and Environmental Sciences, University of Birmingham, UK.
| | - Kimberley S van Schooten
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Morteza Asgari
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Zahra Mosallanezhad
- Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mahyar Salavati
- Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ehsan Sedaghat-Nejad
- Laboratory for Computational Motor Control, Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
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Cimolin V, Pau M, Cau N, Leban B, Porta M, Capodaglio P, Sartorio A, Grugni G, Galli M. Changes in symmetry during gait in adults with Prader-Willi syndrome. Comput Methods Biomech Biomed Engin 2020; 23:1094-1101. [PMID: 32619156 DOI: 10.1080/10255842.2020.1787999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Most studies on locomotion of individuals with the Prader-Willi Syndrome (PWS) have been performed in a laboratory setting using quantitative motion analysis. Recently, wireless inertial sensors have been successfully employed for gait analysis in different pathological states with the advantages of reproducing a testing condition very close to those encountered in daily living. Using such devices, it is possible not only to characterize the conventional spatio-temporal parameters, but also extract information on further less conventional metrics, such as the harmonic ratio (HR), a measure of step-to-step symmetry based on trunk acceleration processing. In the present study, this technique was used to quantify gait parameters during level walking in 20 adults with PWS who were compared to 20 unaffected individuals. While no differences between the two groups were found in terms of spatio-temporal parameters, individuals with PWS exhibited significantly reduced values of HR in the antero-posterior and vertical directions. Such results, which indicate a poorer gait symmetry in PWS, suggest that upper body accelerations, as well as HR, provide novel information on gait in people with PWS that could not be extracted from spatio-temporal parameters only.
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Affiliation(s)
- Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Nicola Cau
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Ospedale San Giuseppe, Istituto Auxologico Italiano, IRCCS, Italy Piancavallo di Oggebbio (Verbania)
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Ospedale San Giuseppe, Istituto Auxologico Italiano, IRCCS, Italy Piancavallo di Oggebbio (Verbania)
| | - Alessandro Sartorio
- Division of Auxology and Experimental Laboratory for Auxo-endocrinological Research, Ospedale S. Giuseppe, Istituto Auxologico Italiano, IRCCS, Piancavallo di Oggebbio (Verbania), Italy
| | - Graziano Grugni
- Division of Auxology and Experimental Laboratory for Auxo-endocrinological Research, Ospedale S. Giuseppe, Istituto Auxologico Italiano, IRCCS, Piancavallo di Oggebbio (Verbania), Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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Ilg W, Seemann J, Giese M, Traschütz A, Schöls L, Timmann D, Synofzik M. Real-life gait assessment in degenerative cerebellar ataxia. Neurology 2020; 95:e1199-e1210. [DOI: 10.1212/wnl.0000000000010176] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/02/2020] [Indexed: 01/01/2023] Open
Abstract
ObjectivesWith disease-modifying drugs on the horizon for degenerative ataxias, ecologically valid motor biomarkers are highly warranted. In this observational study, we aimed to unravel and validate markers of ataxic gait in real life by using wearable sensors.MethodsWe assessed gait characteristics of 43 patients with degenerative cerebellar disease (Scale for the Assessment and Rating of Ataxia [SARA] 9.4 ± 3.9) compared with 35 controls by 3 body-worn inertial sensors in 3 conditions: (1) laboratory-based walking; (2) supervised free walking; (3) real-life walking during everyday living (subgroup n = 21). Movement analysis focused on measures of spatiotemporal step variability and movement smoothness.ResultsA set of gait variability measures was identified that allowed us to consistently identify ataxic gait changes in all 3 conditions. Lateral step deviation and a compound measure of spatial step variability categorized patients vs controls with a discrimination accuracy of 0.86 in real life. Both were highly correlated with clinical ataxia severity (effect size ρ = 0.76). These measures allowed detecting group differences even for patients who differed only 1 point in the clinical SARAposture&gait subscore, with highest effect sizes for real-life walking (d = 0.67).ConclusionsWe identified measures of ataxic gait that allowed us not only to capture the gait variability inherent in ataxic gait in real life, but also to demonstrate high sensitivity to small differences in disease severity, with the highest effect sizes in real-life walking. They thus represent promising candidates for motor markers for natural history and treatment trials in ecologically valid contexts.Classification of evidenceThis study provides Class I evidence that a set of gait variability measures, even if accessed in real life, correlated with the clinical severity of ataxia in patients with degenerative cerebellar disease.
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Pau M, Mulas I, Putzu V, Asoni G, Viale D, Mameli I, Leban B, Allali G. Smoothness of Gait in Healthy and Cognitively Impaired Individuals: A Study on Italian Elderly Using Wearable Inertial Sensor. SENSORS 2020; 20:s20123577. [PMID: 32599872 PMCID: PMC7348719 DOI: 10.3390/s20123577] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022]
Abstract
The main purpose of the present study was to compare the smoothness of gait in older adults with and without cognitive impairments, using the harmonic ratio (HR), a metric derived from trunk accelerations. Ninety older adults aged over 65 (age: 78.9 ± 4.8 years; 62% female) underwent instrumental gait analysis, performed using a wearable inertial sensor and cognitive assessment with the Mini Mental State Examination (MMSE) and Addenbrooke’s Cognitive Examination Revised (ACE-R). They were stratified into three groups based on their MMSE performance: healthy controls (HC), early and advanced cognitive decline (ECD, ACD). The spatio-temporal and smoothness of gait parameters, the latter expressed through HR in anteroposterior (AP), vertical (V) and mediolateral (ML) directions, were derived from trunk acceleration data. The existence of a relationship between gait parameters and degree of cognitive impairment was also explored. The results show that individuals with ECD and ACD exhibited significantly slower speed and shorter stride length, as well as reduced values of HR in the AP and V directions compared to HC, while no significant differences were found between ECD and ACD in any of the investigated parameters. Gait speed, stride length and HR in all directions were found to be moderately correlated with both MMSE and ACE-R scores. Such findings suggest that, in addition to the known changes in gait speed and stride length, important reductions in smoothness of gait are likely to occur in older adults, owing to early/prodromal stages of cognitive impairment. Given the peculiar nature of these metrics, which refers to overall body stability during gait, the calculation of HR may result in being useful in improving the characterization of gait patterns in older adults with cognitive impairments.
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Affiliation(s)
- Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, Piazza d’Armi, 09123 Cagliari, Italy; (I.M.); (B.L.)
- Correspondence: ; Tel.: +39-070-6753264
| | - Ilaria Mulas
- Department of Mechanical, Chemical and Materials Engineering, Piazza d’Armi, 09123 Cagliari, Italy; (I.M.); (B.L.)
| | - Valeria Putzu
- Center for Cognitive Disorders and Dementia, Geriatric Unit SS. Trinità Hospital, Via Romagna 16, 09127 Cagliari, Italy; (V.P.); (G.A.); (D.V.); (I.M.)
| | - Gesuina Asoni
- Center for Cognitive Disorders and Dementia, Geriatric Unit SS. Trinità Hospital, Via Romagna 16, 09127 Cagliari, Italy; (V.P.); (G.A.); (D.V.); (I.M.)
| | - Daniela Viale
- Center for Cognitive Disorders and Dementia, Geriatric Unit SS. Trinità Hospital, Via Romagna 16, 09127 Cagliari, Italy; (V.P.); (G.A.); (D.V.); (I.M.)
| | - Irene Mameli
- Center for Cognitive Disorders and Dementia, Geriatric Unit SS. Trinità Hospital, Via Romagna 16, 09127 Cagliari, Italy; (V.P.); (G.A.); (D.V.); (I.M.)
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, Piazza d’Armi, 09123 Cagliari, Italy; (I.M.); (B.L.)
| | - Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland;
- Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461, USA
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Storm FA, Cesareo A, Reni G, Biffi E. Wearable Inertial Sensors to Assess Gait during the 6-Minute Walk Test: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2020; 20:E2660. [PMID: 32384806 PMCID: PMC7249076 DOI: 10.3390/s20092660] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/23/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
Abstract
Wearable sensors are becoming increasingly popular for complementing classical clinical assessments of gait deficits. The aim of this review is to examine the existing knowledge by systematically reviewing a large number of papers focusing on the use of wearable inertial sensors for the assessment of gait during the 6-minute walk test (6MWT), a widely recognized, simple, non-invasive, low-cost and reproducible exercise test. After a systematic search on PubMed and Scopus databases, two raters evaluated the quality of 28 full-text articles. Then, the available knowledge was summarized regarding study design, subjects enrolled (number of patients and pathological condition, if any, age, male/female ratio), sensor characteristics (type, number, sampling frequency, range) and body placement, 6MWT protocol and extracted parameters. Results were critically discussed to suggest future directions for the use of inertial sensor devices in the clinics.
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Affiliation(s)
- Fabio Alexander Storm
- Scientific Institute, IRCCS “E. Medea”, Bioengineering Lab, 23842 Bosisio Parini, Lecco, Italy; (A.C.); (G.R.); (E.B.)
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