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Antonellis P, Weightman MM, Fino PC, Chen S, Lester ME, Hoppes CW, Dibble LE, King LA. Relation Between Cognitive Assessment and Clinical Physical Performance Measures After Mild Traumatic Brain Injury. Arch Phys Med Rehabil 2024; 105:868-875. [PMID: 37931890 DOI: 10.1016/j.apmr.2023.10.013] [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: 07/05/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVES To investigate the relation between cognitive and motor performance in individuals with mild traumatic brain injury (mTBI) and examine differences in both cognitive and motor performance between adults after mTBI and healthy controls. DESIGN Multi-center, cross-sectional study. SETTING Three institutional sites (Courage Kenny Research Center, Minneapolis, MN, Oregon Health & Science University, Portland, OR, and University of Utah, Salt Lake City, UT). PARTICIPANTS Data were collected from 110 participants (N=110), including those with mTBI and healthy controls, who completed cognitive and physical performance assessments. INTERVENTIONS Not applicable. OUTCOME MEASURES Cognitive assessments involved the Automated Neuropsychological Assessment Metrics to evaluate domains of attention, memory, reaction time, processing speed, and executive function. Physical performance was evaluated through clinical performance assessments, such as the 1-min walk test, the modified Illinois Agility Test, the Functional Gait Assessment Tool, the High-Level Mobility Assessment Tool, a complex turning course, and a 4-Item Hybrid Assessment of Mobility for mTBI. Participants also completed additional trials of the 1-min walk test, modified Illinois Agility Test, and complex turning course with a simultaneous cognitive task. RESULTS Individuals with mTBI performed worse on cognitive assessments, as well as several of the physical performance assessments compared with healthy controls. Complex tasks were more strongly related to cognitive assessments compared with simple walking tasks. CONCLUSIONS Combining complex motor tasks with cognitive demands may better demonstrate functional performance in individuals recovering from mTBI. By understanding the relation between cognitive and physical performance in individuals recovering from mTBI, clinicians may be able to improve clinical care and assist in return to activity decision-making.
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Affiliation(s)
| | | | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT
| | - Siting Chen
- School of Public Health, Oregon Health & Science University, Portland, OR
| | - Mark E Lester
- Department of Physical Therapy, University of Texas Rio Grande Valley, Harlingen, TX
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR
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Kaya RD, Hastilow K, Owen KM, Zimmerman EM, Rosenfeldt AB, Alberts JL. An Augmented Reality Rifle Qualification Test for Return-to-Duty Assessment in Service Members. Mil Med 2024:usae028. [PMID: 38422491 DOI: 10.1093/milmed/usae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/18/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Variability in return-to-duty (RTD) decision-making following mild traumatic brain injury (mTBI) is a threat to troop readiness. Current RTD assessments lack military-specific tasks and quantitative outcomes to inform stakeholders of a service member's (SM) capacity to successfully perform military duties. Augmented reality (AR), which places digital assets in a user's physical environment, provides a technological vehicle to deliver military-relevant tasks to a SM to be used in the RTD decision-making process. In addition to delivering digital content, AR headsets provide biomechanical data that can be used to assess the integrity of the central nervous system in movement control following mTBI. The objective of this study was to quantify cognitive and motor performance on an AR rifle qualification test (RQT) in a group of neurologically healthy military SMs. MATERIALS AND METHODS Data were collected from 111 healthy SMs who completed a basic (single-task) and complex (dual-task) RQT with a simulated M4 rifle. The complex scenario required the SM to perform the RQT while simultaneously answering arithmetic problems. Position data from the AR headset were used to capture postural sway, and the built-in microphone gathered responses to the arithmetic problems. RESULTS There were no differences in the number of targets hit, trigger pull reaction time, and transition time from kneeling to standing between the basic and complex scenarios. A significant worsening in postural sway following kneel-to-stand transition was observed in the complex scenario. The average reaction time to answer the arithmetic problems was nearly 2 times slower than the average reaction time to pull the trigger to a displayed target in the complex scenario. CONCLUSION The complex scenario provoked dual-task interference in SMs as evidenced by worsening postural sway and reaction time differences between the cognitive and motor tasks. An AR RQT provides objective and quantitative outcomes during a military-specific task. Greater precision in evaluating cognitive and motor performance during a military-relevant task has the potential to aid in the detection and management of SMs and their RTD following MTBI.
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Affiliation(s)
- Ryan D Kaya
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH 44195, USA
| | - Karissa Hastilow
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH 44195, USA
| | - Kelsey M Owen
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH 44195, USA
| | - Eric M Zimmerman
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH 44195, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH 44195, USA
| | - Jay L Alberts
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH 44195, USA
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH 44195, USA
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Cecchini AS, McCulloch K, Harrison C, Favorov O, Davila M, Zhang W, Prim J, Krok CDRM. Expanding capabilities to evaluate readiness for return to duty after mTBI: The CAMP study protocol. PLoS One 2024; 19:e0270076. [PMID: 38285693 PMCID: PMC10824418 DOI: 10.1371/journal.pone.0270076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 03/22/2023] [Indexed: 01/31/2024] Open
Abstract
Physical Therapists affiliated with Intrepid Spirit Centers evaluate and treat Active Duty Service Members (ADSM) who have duty-limiting post-concussion symptoms to improve the ability to perform challenging tasks associated with military service. The Complex Assessment of Military Performance (CAMP) is a test battery that more closely approximates the occupational demands of ADSM without specific adherence to a particular branch of service or military occupational specialty. Subtasks were developed with military collaborators to include high level skills that all service members must be able to perform such as reacting quickly, maintaining visual stability while moving and changing positions, and scanning for, noting, and/or remembering operationally relevant information under conditions of physical exertion. OBJECTIVE The purpose of this observational longitudinal study is to: 1- establish typical performance parameters for ADSM on the CAMP test battery 2- determine the element of the CAMP battery that demonstrate the greatest differences from standard performance and serve as predictors for successful return to duty and 3- develop clinician-facing feedback algorithms and displays and 4-develop materials for clinical dissemination. This ongoing multi-site study is currently funded through the CDMRP and has been approved by the Naval Medical Center Portsmouth IRB. METHODS ADSM undergoing post-concussion rehabilitation at the Intrepid Spirit Centers will be tested within one week of their initial Physical Therapy evaluation and after completing Physical Therapy. Control participants will include males, females, and ADSM from the Special Operations community. Participants will complete an intake form that includes questions about demographics, military service, deployment and concussion history, and profile and duty status. Other measures include those that explore concussion symptoms, sleep quality, post-traumatic stress, and perceptions of resilience. The CAMP includes three separate 10-15 minute tasks. Movement is recorded by wearable inertial sensors and heart rate variability is recorded with a POLAR10 monitor. The "Run-Roll" task requires rapid position changes, combat rolls and quick running forwards and backwards while carrying a simulated weapon. Visual stability before and after the task is also performed. The "Dual-Task Agility" task includes rapid running with and without a weighted vest and a working memory task. The "Patrol Exertion" task requires repeated stepping onto an exercise step while watching a virtual patrol video. Additional tasks include monitoring direction of travel, observing for signs of enemy presence, and reacting to multiple auditory signals embedded in the video. DISCUSSION Measures that evaluate relevant skills are vital to support safe return to duty for ADSM who may be exposed to imminent danger as part of training or mission demands. The CAMP is designed to be an ecologically valid and clinically feasible assessment that may be more sensitive to capturing subtle impairments that impact duty performance as test skills are integrated into dual and multi-tasks that reflect occupational demands. Assessment results may serve as a more robust indicator of readiness for full return to duty after concussion.
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Affiliation(s)
- Amy Seal Cecchini
- The Geneva Foundation, Womack Army Medical Center, Ft. Bragg, NC, United States of America
| | - Karen McCulloch
- Department of Human Movement Science, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Courtney Harrison
- Department of Human Movement Science, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Oleg Favorov
- Department of Biomedical Engineering, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Maria Davila
- Research Triangle Institue, Research Triangle Park, NC, United States of America
| | - Wanqing Zhang
- Department of Human Movement Science, Division of Physical Therapy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Julianna Prim
- Department of Psychiatry, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - C. D. R. Michael Krok
- Womack Army Medical Center Intrepid Spirit Clinic, Ft. Bragg, NC, United States of America
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Miller Koop M, Rosenfeldt AB, Owen K, Zimmerman E, Johnston J, Streicher MC, Albright A, Penko AL, Alberts JL. The Microsoft HoloLens 2 Provides Accurate Biomechanical Measures of Performance During Military-Relevant Activities in Healthy Adults. Mil Med 2023; 188:92-101. [PMID: 37948237 DOI: 10.1093/milmed/usad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/17/2023] [Accepted: 02/06/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Augmented reality systems, like the HoloLens 2 (HL2), have the potential to provide accurate assessments of mild traumatic brain injury (mTBI) symptoms in military personnel by simulating complex military scenarios while objectively measuring the user's movements with embedded motion sensors. The aim of this project was to determine if biomechanical measures of marching and squatting, derived from the HL2 motion sensors, were statistically equivalent, within 5%, to metrics derived from the gold-standard three-dimensional motion capture (MoCap) system. MATERIALS AND METHODS Sixty-four adults (18-45 years; 34 males) completed a squatting and a marching task under single- (motor) and dual-task (motor + cognitive) conditions. Positional data from the HL2 and MoCap were simultaneously collected during the tasks and used to calculate and compare biomechanical outcomes. The HL2's augmented reality capabilities were utilized to deliver the cognitive component of the marching dual task. RESULTS Equivalence testing indicated the HL2 and MoCap measures were within 5% in all squatting metrics-trial time, squat duration, squat velocity, squat depth, and dwell time. Marching metrics, including trial time, step count, stepping rate, and step interval, were also equivalent between the two systems. The mean reaction time for responses during the Stroop test was 810 (125) milliseconds per response. CONCLUSIONS Biomechanical outcomes characterizing performance during two common military movements, squatting and marching, were equivalent between the HL2 and MoCap systems in healthy adults. Squatting and marching are two military-relevant tasks that require strength, motor coordination, and balance to perform, all of which are known to be affected by mTBI. Taken together, the data provide support for using the HL2 platform to deliver military-specific assessment scenarios and accurately measure performance during these activities. Utilizing objective and quantitative measures of motor function may enhance the management of military mTBI and reduce unnecessary risk to service members.
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Affiliation(s)
- Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Kelsey Owen
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Eric Zimmerman
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Joshua Johnston
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Matthew C Streicher
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Alec Albright
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Amanda L Penko
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH 44195, USA
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH 44195, USA
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Rosenfeldt AB, Kaya RD, Owen K, Hastilow K, Scelina K, Scelina L, Miller Koop M, Zimmerman E, Alberts JL. Development of the Troop Readiness Evaluation With Augmented Reality Return-to-Duty (Troop READY) Platform to Aid in the Detection and Treatment of Military Mild Traumatic Brain Injury. Mil Med 2023; 188:67-74. [PMID: 37948246 DOI: 10.1093/milmed/usad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/12/2023] [Accepted: 01/25/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Mild traumatic brain injury (mTBI) is prevalent in service members (SMs); however, there is a lack of consensus on the appropriate approach to return to duty (RTD). Head-mounted augmented reality technology, such as the HoloLens 2, can create immersive, salient environments to more effectively evaluate relevant military task performance. The Troop Readiness Evaluation with Augmented Reality Return-to-Duty (READY) platform was developed to objectively quantify cognitive and motor performance during military-specific activities to create a comprehensive approach to aid in mTBI detection and facilitate appropriate RTD. The aim of this project was to detail the technical development of the Troop READY platform, the outcomes, and its potential role in the aiding detection and RTD decision-making post mTBI. The secondary aim included evaluating the safety, feasibility, and SM usability of the Troop READY platform. MATERIALS AND METHODS The Troop READY platform comprises three assessment modules of progressing complexity: (1) Static and Dynamic Mobility, (2) Rifle Qualification Test, and (3) Small Unit Operations Capacity-Room Breach/Clearing Exercise. The modules were completed by 137 active duty SMs. Safety was assessed through monitoring of adverse events. Feasibility was assessed using the self-directed module completion rate. Usability was measured using the Systems Usability Scale. RESULTS No adverse events occurred. Completion rates of the three modules ranged from 98 to 100%. In terms of usability, the mean Systems Usability Scale score of all participants was 83.92 (13.95), placing the Troop READY platform in the good-to-excellent category. Objective motor and cognitive outcomes were generated for each module. CONCLUSION The Troop READY platform delivers self-directed, salient assessment modules to quantify single-task, dual-task, and unit-based performance in SMs. The resultant data provide insight into SM performance through objective outcomes and identify specific areas of executive or motor function that may be slow to recover following mTBI.
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Affiliation(s)
- Anson B Rosenfeldt
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH 44195, USA
| | - Ryan D Kaya
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH 44195, USA
| | - Kelsey Owen
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH 44195, USA
| | - Karissa Hastilow
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH 44195, USA
| | - Kathryn Scelina
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH 44195, USA
| | - Logan Scelina
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH 44195, USA
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH 44195, USA
| | - Eric Zimmerman
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH 44195, USA
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Lerner Research Institute, Cleveland, OH 44195, USA
- Center for Neurological Restoration, Cleveland Clinic, Neurological Institute, Cleveland, OH 44195, USA
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McLoughlin J. Concussion Rehabilitation and the Application of Ten Movement Training Principles. Cureus 2023; 15:e46520. [PMID: 37927640 PMCID: PMC10625311 DOI: 10.7759/cureus.46520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Concussion awareness continues to grow in all aspects of healthcare, including the areas of prevention, acute care, and ongoing rehabilitation. Most of the concussion research to date has focussed on the challenges around screening and diagnosing what can be a complex mix of brain impairments that overlay with additional pre-existing comorbidities. While we expect further progress in concussion diagnosis, progress also continues to be made around proactive rehabilitation, with the emergence of interventions that can enhance the recovery process, maximise function and independence with a return to study, work, and play. Traditionally, optimal multimodal assessments of concussion have treated the physical, cognitive, and psychological domains of brain injury separately, which supports diagnosis, and informs appropriate follow-up care. Due to the complex nature of brain injury, multimodal assessments direct care toward professionals from many different disciplines including medicine, physiotherapy, psychology, neuropsychology, ophthalmology, and exercise physiology. In addition, these professionals may work in different fields such as sports, neurorehabilitation, vestibular, musculoskeletal, community, vocational, and general practice clinical settings. Rehabilitation interventions for concussions employed in practice are also likely to use a blend of theoretical principles from motor control, cognitive, and psychological sciences. This scale of diversity can make information dissemination, collaboration, and innovation challenging. The Ten Movement Training Principles (MTPs) have been proposed as a usable and relevant concept to guide and support clinical reasoning in neurorehabilitation. When applied to concussion rehabilitation, these same 10 principles provide a comprehensive overview of key rehabilitation strategies for current and future practice. Future collaborations can use these training principles to support clinical and research innovations including the rapid rise of technologies in this growing field of rehabilitation practice.
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Affiliation(s)
- James McLoughlin
- College of Nursing and Health Sciences, Flinders University, Adelaide, AUS
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Manupibul U, Tanthuwapathom R, Jarumethitanont W, Kaimuk P, Limroongreungrat W, Charoensuk W. Integration of force and IMU sensors for developing low-cost portable gait measurement system in lower extremities. Sci Rep 2023; 13:10653. [PMID: 37391570 PMCID: PMC10313649 DOI: 10.1038/s41598-023-37761-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/27/2023] [Indexed: 07/02/2023] Open
Abstract
Gait analysis is the method to accumulate walking data. It is useful in diagnosing diseases, follow-up of symptoms, and rehabilitation post-treatment. Several techniques have been developed to assess human gait. In the laboratory, gait parameters are analyzed by using a camera capture and a force plate. However, there are several limitations, such as high operating costs, the need for a laboratory and a specialist to operate the system, and long preparation time. This paper presents the development of a low-cost portable gait measurement system by using the integration of flexible force sensors and IMU sensors in outdoor applications for early detection of abnormal gait in daily living. The developed device is designed to measure ground reaction force, acceleration, angular velocity, and joint angles of the lower extremities. The commercialized device, including the motion capture system (Motive-OptiTrack) and force platform (MatScan), is used as the reference system to validate the performance of the developed system. The results of the system show that it has high accuracy in measuring gait parameters such as ground reaction force and joint angles in lower limbs. The developed device has a strong correlation coefficient compared with the commercialized system. The percent error of the motion sensor is below 8%, and the force sensor is lower than 3%. The low-cost portable device with a user interface was successfully developed to measure gait parameters for non-laboratory applications to support healthcare applications.
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Affiliation(s)
- Udomporn Manupibul
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
| | - Ratikanlaya Tanthuwapathom
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
| | - Wimonrat Jarumethitanont
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
- Faculty of Physical Therapy, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
| | - Panya Kaimuk
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
| | - Weerawat Limroongreungrat
- College of Sports Science and Technology, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand
| | - Warakorn Charoensuk
- Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Phuttamonthon, Nakhon Pathom, Thailand.
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Liu R, Liu L, Ma G, Feng S, Mu Y, Meng D, Wang S, Cai E. Visual Gait Analysis Based on UE4. SENSORS (BASEL, SWITZERLAND) 2023; 23:5463. [PMID: 37420630 DOI: 10.3390/s23125463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 07/09/2023]
Abstract
With the development of artificial intelligence technology, virtual reality technology has been widely used in the medical and entertainment fields, as well as other fields. This study is supported by the 3D modeling platform in UE4 platform technology and designs a 3D pose model based on inertial sensors through blueprint language and C++ programming. It can vividly display changes in gait, as well as changes in angles and displacements of 12 parts such as the big and small legs and arms. It can be used to combine with the module of capturing motion which is based on inertial sensors to display the 3D posture of the human body in real-time and analyze the motion data. Each part of the model contains an independent coordinate system, which can analyze the angle and displacement changes of any part of the model. All joints of the model are interrelated, the motion data can be automatically calibrated and corrected, and errors measured by an inertial sensor can be compensated, so that each joint of the model will not separate from the whole model and there will not occur actions that against the human body's structures, improving the accuracy of the data. The 3D pose model designed in this study can correct motion data in real time and display the human body's motion posture, which has great application prospects in the field of gait analysis.
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Affiliation(s)
- Ruzhang Liu
- The School of Electronic Information, Qingdao University, Qingdao 266071, China
| | - Luyin Liu
- The School of Electronic Information, Qingdao University, Qingdao 266071, China
| | - Guochao Ma
- The School of Electronic Information, Qingdao University, Qingdao 266071, China
| | - Shanshan Feng
- The School of Electronic Information, Qingdao University, Qingdao 266071, China
| | - Yuanhui Mu
- The School of Electronic Information, Qingdao University, Qingdao 266071, China
| | - Dexi Meng
- The School of Electronic Information, Qingdao University, Qingdao 266071, China
| | - Shuying Wang
- The School of Electronic Information, Qingdao University, Qingdao 266071, China
| | - Enlin Cai
- The School of Electronic Information, Qingdao University, Qingdao 266071, China
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Nascimento MDM, Maduro PA, Rios PMB, Nascimento LDS, Silva CN, Kliegel M, Ihle A. The Effects of 12-Week Dual-Task Physical-Cognitive Training on Gait, Balance, Lower Extremity Muscle Strength, and Cognition in Older Adult Women: A Randomized Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085498. [PMID: 37107780 PMCID: PMC10139030 DOI: 10.3390/ijerph20085498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 05/11/2023]
Abstract
This study aims to investigate the effects of dual-task physical-cognitive the training on body balance (BB), gait performance (GP), lower limb muscle strength (LEMS), and cognitive performance (CP) in a group of cognitively normal older adult women (n = 44; 66.20 ± 4.05 years). Of these, 22 were randomly allocated to the dual-task training (DT) group, and 22 participated in the control group (CG). Assessments were performed at baseline, after 12 weeks of intervention, and at the end of 12 weeks of follow-up, using the following instruments: Timed Up & Go (TUG), Timed Up & Go manual (TUGm), Timed Up & Go cognitive (TUGc), Balance Test (TEC), sit-to-stand test (STS), and verbal fluency test (VF). After 12 weeks of DT training, participants showed a significant time × group interaction in all motor assessments (BB, GP, LEMS), as well as in three cognitive tests (VF-grouping, VF-exchange, VF-total). No time-group interaction effect was indicated for the VF-category test. At all evaluation times, CG members maintained constant physical and cognitive performance. We conclude that 12 weeks of physical-cognitive DT training was effective in promoting BB, GP, and LEMS, as well as CP in cognitively normal older adult women, with lasting effects up to 12 weeks after the intervention.
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Affiliation(s)
- Marcelo de Maio Nascimento
- Department of Physical Education, Federal University of Vale do São Francisco, Campus Petrolina 56304-917, Brazil
- Correspondence: ; Tel.: +55-(87)-21016856
| | - Paula Andreatta Maduro
- University Hospital of the Federal University of Vale do São Francisco, Campus Petrolina 56304-917, Brazil
| | - Pâmala Morais Bagano Rios
- Department of Psychology, Federal University of Vale do São Francisco, Campus Petrolina 56304-917, Brazil
| | - Lara dos Santos Nascimento
- Department of Physical Education, Federal University of Vale do São Francisco, Campus Petrolina 56304-917, Brazil
| | - Carolina Nascimento Silva
- Department of Psychology, Federal University of Vale do São Francisco, Campus Petrolina 56304-917, Brazil
| | - Matthias Kliegel
- Department of Psychology, University of Geneva, 1205 Geneva, Switzerland (A.I.)
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland
- Swiss National Centre of Competence in Research LIVES—Overcoming Vulnerability: Life Course Perspectives, 1015 Lausanne, Switzerland
| | - Andreas Ihle
- Department of Psychology, University of Geneva, 1205 Geneva, Switzerland (A.I.)
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland
- Swiss National Centre of Competence in Research LIVES—Overcoming Vulnerability: Life Course Perspectives, 1015 Lausanne, Switzerland
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10
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Cecchini AS, Prim J, Zhang W, Harrison CH, McCulloch KL. The Portable Warrior Test of Tactical Agility: A Novel Functional Assessment That Discriminates Service Members Diagnosed With Concussion From Controls. Mil Med 2023; 188:e703-e710. [PMID: 34414438 PMCID: PMC10026616 DOI: 10.1093/milmed/usab346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/23/2021] [Accepted: 08/06/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Return-to-duty (RTD) readiness assessment for service members (SM) following concussion requires complex clinical considerations. The Portable Warrior Test of Tactical Agility (POWAR-TOTAL) is a functional assessment which improves on previous laboratory-based RTD assessments. METHODS Sixty-four SM diagnosed with concussion and 60 healthy control (HC) SM participated in this study. Group differences were analyzed to validate the POWAR-TOTAL. The High-level Mobility Assessment Test (HiMAT) was used to examine concurrent construct validity. An exploratory logistic regression analysis examined predictive validity. RESULTS The groups were demographically well-matched except for educational level. POWAR-TOTAL measures were statistically significantly different between the groups with moderate to large effect sizes. Concussed participants were less likely to be able to complete all trials of the POWAR-TOTAL. Motor scores correlated highly with HiMAT scores. POWAR-TOTAL motor task performance and membership in the control group was significantly associated with self-reported physical readiness to deploy. CONCLUSION The POWAR-TOTAL is a clinically feasible, military relevant assessment that is sensitive to differences between concussed and HC SM. This analysis supports the discriminant and construct validity of the POWAR-TOTAL, and may be useful for medical providers evaluating RTD readiness for SM who have sustained a concussion.
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Affiliation(s)
- Amy Seal Cecchini
- Geneva Foundation, Ft. Bragg Intrepid Spirit Center, Womack Army Medical Center, Fayetteville, NC 28310, USA
| | - Julianna Prim
- Division of Physical Therapy and Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine UNC-Chapel Hill, Chapel Hill, NC 27599-7135, USA
| | - Wanqing Zhang
- Office of Research, Department of Allied Health Sciences, School of Medicine UNC-Chapel Hill, Chapel Hill, NC 27599-7120, USA
| | - Courtney H Harrison
- Division of Physical Therapy and Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine UNC-Chapel Hill, Chapel Hill, NC 27599-7135, USA
| | - Karen L McCulloch
- Division of Physical Therapy and Curriculum in Human Movement Science, Department of Allied Health Sciences, School of Medicine UNC-Chapel Hill, Chapel Hill, NC 27599-7135, USA
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11
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Corbin-Berrigan LA, Teel E, Vinet SA, P De Koninck B, Guay S, Beaulieu C, De Beaumont L. The Use of Electroencephalography as an Informative Tool in Assisting Early Clinical Management after Sport-Related Concussion: a Systematic Review. Neuropsychol Rev 2023; 33:144-159. [PMID: 32577950 DOI: 10.1007/s11065-020-09442-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 06/07/2020] [Indexed: 12/21/2022]
Abstract
Sport-related concussion (SRC) is managed primarily through serial clinical evaluations throughout recovery. However, studies suggest that clinical measures may not be suitable to detect subtle alterations in functioning and are limited by numerous internal and external factors. Electroencephalography (EEG) has been used for over eight decades to discern altered function following illnesses and injuries, including traumatic brain injury. This study evaluated the associations between EEG measures and clinical presentation within three-months following SRC. A systematic review of the literature was performed in Medline, Embase, PsycINFO, CINAHL and Web of Science databases following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines, yielding a total of 13 peer-reviewed articles. Most studies showed low to moderate bias and moderate to high quality. The majority of the existing literature on the impact of concussion within the first 3 months post-injury suggests that individuals with concussion show altered brain function, with EEG abnormalities outlasting clinical dysfunction. Of all EEG biomarkers evaluated, P300 shows the most promise and should be explored further. Despite the relatively high quality of included articles, significant limitations are still present within this body of literature, including potential conflicts of interest and proprietary algorithms, making it difficult to draw strong and meaningful conclusions on the use of EEG in the early stages of SRC. Therefore, further exploration of the relationship between EEG measures and acute clinical presentation is warranted to determine if EEG provides additional benefits over current clinical assessments and is a feasible tool in clinical settings.
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Affiliation(s)
- Laurie-Ann Corbin-Berrigan
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.,Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | | | | | - Béatrice P De Koninck
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Université de Montréal, Montréal, Quebec, Canada
| | - Samuel Guay
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada.,Université de Montréal, Montréal, Quebec, Canada
| | | | - Louis De Beaumont
- Research Center, CIUSSS du Nord-de-l'Île-de-Montréal, Montréal, Quebec, Canada. .,Université de Montréal, Montréal, Quebec, Canada.
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12
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Powell D, Godfrey A, Parrington L, Campbell KR, King LA, Stuart S. Free-living gait does not differentiate chronic mTBI patients compared to healthy controls. J Neuroeng Rehabil 2022; 19:49. [PMID: 35619112 PMCID: PMC9137158 DOI: 10.1186/s12984-022-01030-6] [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: 07/21/2021] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Physical function remains a crucial component of mild traumatic brain injury (mTBI) assessment and recovery. Traditional approaches to assess mTBI lack sensitivity to detect subtle deficits post-injury, which can impact a patient’s quality of life, daily function and can lead to chronic issues. Inertial measurement units (IMU) provide an opportunity for objective assessment of physical function and can be used in any environment. A single waist worn IMU has the potential to provide broad/macro quantity characteristics to estimate gait mobility, as well as more high-resolution micro spatial or temporal gait characteristics (herein, we refer to these as measures of quality). Our recent work showed that quantity measures of mobility were less sensitive than measures of turning quality when comparing the free-living physical function of chronic mTBI patients and healthy controls. However, no studies have examined whether measures of gait quality in free-living conditions can differentiate chronic mTBI patients and healthy controls. This study aimed to determine whether measures of free-living gait quality can differentiate chronic mTBI patients from controls. Methods Thirty-two patients with chronic self-reported balance symptoms after mTBI (age: 40.88 ± 11.78 years, median days post-injury: 440.68 days) and 23 healthy controls (age: 48.56 ± 22.56 years) were assessed for ~ 7 days using a single IMU at the waist on a belt. Free-living gait quality metrics were evaluated for chronic mTBI patients and controls using multi-variate analysis. Receiver operating characteristics (ROC) and Area Under the Curve (AUC) analysis were used to determine outcome sensitivity to chronic mTBI. Results Free-living gait quality metrics were not different between chronic mTBI patients and controls (all p > 0.05) whilst controlling for age and sex. ROC and AUC analysis showed stride length (0.63) was the most sensitive measure for differentiating chronic mTBI patients from controls. Conclusions Our results show that gait quality metrics determined through a free-living assessment were not significantly different between chronic mTBI patients and controls. These results suggest that measures of free-living gait quality were not impaired in our chronic mTBI patients, and/or, that the metrics chosen were not sensitive enough to detect subtle impairments in our sample.
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Affiliation(s)
- Dylan Powell
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne, UK
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA.,Department of Dietetics, Human Nutrition and Sport, La Trobe University, Victoria, Australia
| | - Kody R Campbell
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Laurie A King
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Sam Stuart
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA. .,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, UK. .,North Tyneside Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
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13
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Nusbickel AJ, Vasilopoulos T, Zapf AD, Tripp BL, Herman DC. The effect of concussion on subsequent musculoskeletal injury risk in high school athletes. PM R 2022; 14:597-603. [PMID: 35488457 DOI: 10.1002/pmrj.12828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/14/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Studies have demonstrated an increased risk of musculoskeletal (MSK) injury after concussion in collegiate and professional athletes, but there has been relatively little study of this relationship in younger athletes. OBJECTIVE To determine the odds of experiencing a subsequent MSK injury after concussion in high school athletes. It was hypothesized that concussion would increase the risk of MSK injury within 365 days of the concussion event. DESIGN Retrospective observational study. SETTING Twelve high school sports programs. PARTICIPANTS Athletes (n = 14,461) from athletic training room records queried between 2010 and 2017. INDEPENDENT VARIABLES History of concussion and history of concussion and MSK injury in the year preceding MSK injury. MAIN OUTCOME MEASURES General estimating equation analyses were conducted to examine the odds of MSK injury related to (1) concussion within the preceding 365 days of injury; and (2) concussion and MSK injury within the preceding 365 days of concussion. RESULTS Respectively, 8% and 8.3% of athletes were identified with a concussion and MSK injury. After controlling for gender and sport, athletes with a concussion and prior MSK injury (odds ratio = 2.19, 95% confidence interval: 1.02-4.67) and athletes with a concussion alone (odds ratio = 1.67, 95% confidence interval: 1.15-2.44) both had higher odds of experiencing a subsequent MSK injury compared to athletes without prior concussion. CONCLUSIONS High school athletes who sustain a concussion have elevated odds of MSK injury at rates comparable to those for collegiate athletes. These findings support the use of neuromuscular-based rehabilitation and injury prevention protocols in the post-concussion period. These findings may also suggest exploring methods to modify concussion return-to-play criteria with the goal to reduce the risk of future MSK injury.
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Affiliation(s)
- Alex J Nusbickel
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Terrie Vasilopoulos
- Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, USA.,Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
| | - Ashley D Zapf
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
| | - Brady L Tripp
- Department of Applied Kinesiology and Physiology, University of Florida, Gainesville, Florida, USA
| | - Daniel C Herman
- Department of Physical Medicine and Rehabilitation, University of California at Davis, Sacramento, California, USA
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14
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Sethi D, Bharti S, Prakash C. A comprehensive survey on gait analysis: History, parameters, approaches, pose estimation, and future work. Artif Intell Med 2022; 129:102314. [DOI: 10.1016/j.artmed.2022.102314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 04/28/2022] [Accepted: 04/29/2022] [Indexed: 11/15/2022]
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15
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Glendon K, Desai A, Blenkinsop G, Belli A, Pain M. Recovery of symptoms, neurocognitive and vestibular-ocular-motor function and academic ability after sports-related concussion (SRC) in university-aged student-athletes: a systematic review. Brain Inj 2022; 36:455-468. [PMID: 35377822 DOI: 10.1080/02699052.2022.2051740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Physiological differences between a maturing and matured brain alters how Sports-Related Concussion (SRC) affects different age groups; therefore, a review specific to university-aged student-athletes is needed. OBJECTIVES Determine time to recovery for symptom burden, neurocognitive and Vestibular-Ocular-Motor (VOM) function and academic impact in university-aged student-athletes. METHODS Searches were conducted in PubMed, SpringerLink, PsycINFO, Science Direct, Scopus, Cochrane, Web of Science and EMBASE. Articles were included if they contained original data collected within 30 days in university-aged student-athletes, analysed SRC associated symptoms, neurocognitive or VOM function or academic ability and published in English. Two reviewers independently reviewed sources, using the Oxford Classification of Evidence-Based Medicine (CEBM) and the Downs and Black checklist, and independently extracting data before achieving consensus. RESULTS 58 articles met the inclusion criteria. Recovery of symptoms occurred by 7 and 3-5.3 days for neurocognition. The evidence base did not allow for a conclusion on recovery time for VOM function or academic ability. Few papers investigated recovery times at specified re-assessment time-points and have used vastly differing methodologies. CONCLUSIONS To fully understand the implication of SRC on the university-aged student-athlete' studies using a multi-faceted approach at specific re-assessments time points are required.Systematic review registration number: CRD42019130685.
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Affiliation(s)
- K Glendon
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Desai
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - G Blenkinsop
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - A Belli
- Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, UK
| | - M Pain
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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16
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Kieffer EE, Brolinson PG, Rowson S. Dual-Task Gait Performance Following Head Impact Exposure in Male and Female Collegiate Rugby Players. Int J Sports Phys Ther 2022; 17:355-365. [PMID: 35391870 PMCID: PMC8975566 DOI: 10.26603/001c.32591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Gait impairments have been well-studied in concussed athletes. However, the sex-specific effect of cumulative head impacts on gait is not well understood. When a cognitive task is added to a walking task, dual-task gait assessments can help amplify deficits in gait and are representative of tasks in everyday life. Dual-task cost is the difference in performance from walking (single-task) to walking with a cognitive load (dual-task). Purpose The objectives of this study were to explore the differences between sexes in 1) dual-task gait metrics, 2) gait metric changes from pre-season to post-concussion and post-season, and 3) the dual-task costs associated with gait metrics. Study Design Cross-sectional study. Methods Over two seasons, 77 female athlete-seasons and 64 male athlete-seasons from collegiate club rugby teams participated in this study. Subjects wore inertial sensors and completed walking trials with and without a cognitive test at pre-season, post-season, and post-concussion (if applicable). Results Females athletes showed improvement in cadence (mean = 2.7 step/min increase), double support time (mean = -0.8% gait cycle time decrease), gait speed (mean = 0.1 m/s increase), and stride length (mean = 0.2 m increase) in both task conditions over the course of the season (p < 0.030). Male athletes showed no differences in gait metrics over the course of the season, except for faster gait speeds and longer stride lengths in the dual-task condition (p < 0.034). In all four gait characteristics, at baseline and post-season, females had higher dual-task costs (mean difference = 4.4, p < 0.003) than the males. Conclusions This results of this study showed little evidence suggesting a relationship between repetitive head impact exposure and gait deficits. However, there are sex-specific differences that should be considered during the diagnosis and management of sports-related concussion. Level of Evidence Level 2b.
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17
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Salihu AT, Hill KD, Jaberzadeh S. Effect of cognitive task complexity on dual task postural stability: a systematic review and meta-analysis. Exp Brain Res 2022; 240:703-731. [PMID: 35034175 DOI: 10.1007/s00221-021-06299-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/21/2021] [Indexed: 01/01/2023]
Abstract
The dual task experimental paradigm is used to probe the attentional requirements of postural control. However, findings of dual task postural studies have been inconsistent with many studies even reporting improvement in postural stability during dual tasking and thus raising questions about cognitive involvement in postural control. A U-shaped non-linear relationship has been hypothesized between cognitive task complexity and dual task postural stability suggesting that the inconsistent results might have arisen from the use of cognitive tasks of varying complexities. To systematically review experimental studies that compared the effect of simple and complex cognitive tasks on postural stability during dual tasking, we searched seven electronic databases for relevant studies published between 1980 to September 2020. 33 studies involving a total of 1068 participants met the review's inclusion criteria, 17 of which were included in meta-analysis (healthy young adults: 15 studies, 281 participants; Stroke patients: 2 studies, 52 participants). Narrative synthesis of the findings in studies involving healthy old adults was carried out. Our result suggests that in healthy population, cognitive task complexity may not determine whether postural stability increases or decreases during dual tasking (effect of cognitive task complexity was not statistically significant; P > 0.1), and thus the U-shaped non-linear hypothesis is not supported. Rather, differential effect of dual tasking on postural stability was observed mainly based on the age of the participants and postural task challenge, implying that the involvement of cognitive resources or higher cortical functions in the control of postural stability may largely depends on these two factors.
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Affiliation(s)
- Abubakar Tijjani Salihu
- Non-Invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston Victoria 319, P O Box 527, Melbourne, Australia.
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Shapour Jaberzadeh
- Non-Invasive Brain Stimulation and Neuroplasticity Laboratory, Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University, Frankston Victoria 319, P O Box 527, Melbourne, Australia
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18
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Narad ME, Epstein J, Peugh J, Barber Foss KD, Diekfuss JA, Bonnette S, Orban S, Yuan W, Dudley J, DiCesare CA, Reddington DL, Zhong W, Nissen KS, Shafer J, Avedesian JM, Slutsky-Ganesh AB, Lloyd RS, Howell D, Myer GD. The effect of subconcussive head impact exposure and jugular vein compression on behavioral and cognitive outcomes after a single season of high-school football: A prospective longitudinal trial. J Neurotrauma 2021; 39:49-57. [PMID: 34779241 DOI: 10.1089/neu.2021.0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This prospective longitudinal trial aimed to 1) determine the role of head impact exposure on behavioral/cognitive outcomes, and 2) assess the protective effect(s) of a jugular vein compression (JVC) collar on behavioral/cognitive outcomes following one season of high-school football. Participants included 284 male high-school football players aged 13-18 years enrolled from seven midwestern high-schools. Schools were allocated to the JVC collar intervention(four teams, 140 players) or non-collar/no intervention control (three teams, 144 players) condition. Head impact exposure was measured throughout the season using CSx accelerometers. Outcome measures included post season parent and adolescent report on Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN) and Post-Concussion Symptom Inventory (PCSI), as well as adolescent performance on Attention Network Task (ANT), digital Trail Making Task (dTMT), and Cued Switching task. No significant effect of head impact exposure or JVC collar use on post-season SWAN or PCSI scores or performance on dTMT and Cued Switching task were noted. There was no effect of head impact exposure on ANT performance; however, the JVC collar group had greater post-season Alerting network scores than the non-collar group (p=.026, d=.22). Findings provide preliminary evidence that the JVC collar may provide some protection to the alerting attention system. These findings should be interpreted cautiously as a greater understanding of the long-term sequalae of head impact exposure and the role of cumulative head impact exposure behavioral/cognitive outcomes is required.
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Affiliation(s)
- Megan E Narad
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine & Clinical Psychology, 3333 Burnet Ave, mlc 10006, Cincinnati, Ohio, United States, 45229;
| | - Jeffery Epstein
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati, Ohio, United States;
| | - James Peugh
- Cincinnati Children's Hospital Medical Center, 2518, Behavioral Medicine & Clinical Psychology, Cincinnati, Ohio, United States;
| | - Kim D Barber Foss
- Emory University, 1371, Emory Sport Performance and Research Center, Atlanta, Georgia, United States;
| | - Jed A Diekfuss
- Emory University, 1371, Emory Sport Performance and Research Center, Atlanta, Georgia, United States;
| | - Scott Bonnette
- Cincinnati Children's Hospital Medical Center, 2518, The SPORT Center, Division of Sports Medicine, Cincinnati, Ohio, United States;
| | - Sarah Orban
- University of Tampa, Department of psychology, Tampa, FL, United States;
| | - Weihong Yuan
- Cincinnati Children's Hospital Medical Center, 2518, 3333 Burnew Ave, Cincinnati, Ohio, United States, 45229-3026;
| | - Jonathan Dudley
- Cincinnati Children's Hospital Medical Center, 2518, 3333 Burnet Ave, Cincinnati, Ohio, United States, 45229-3026;
| | - Christopher A DiCesare
- University of Michigan, 1259, Department of Mechanical engineering, Ann Arbor, Michigan, United States;
| | - Danielle L Reddington
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | - Wen Zhong
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | | | - Jessica Shafer
- Cincinnati Children's Hospital Medical Center, 2518, Cincinnati, Ohio, United States;
| | | | - Alexis B Slutsky-Ganesh
- The University of North Carolina at Greensboro, Department of Kinesiology, Greensboro, North Carolina, United States;
| | - Rhodri S Lloyd
- Cardiff Metropolitan University, 11352, Cardiff, Cardiff, United Kingdom of Great Britain and Northern Ireland.,AUT University, Auckland, New Zealand.,Waikato Institute of Technology, 3715, Hamilton, New Zealand;
| | - David Howell
- University of Colorado Denver School of Medicine, 12225, Department of Orthopedics , Aurora, Colorado, United States;
| | - Greg D Myer
- Emory University School of Medicine, 12239, Atlanta, Georgia, United States.,the Micheli Center for Sports Injury Prevention, Waltham, Ma, United States;
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19
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Soulard J, Vaillant J, Baillet A, Gaudin P, Vuillerme N. The effects of a secondary task on gait in axial spondyloarthritis. Sci Rep 2021; 11:19537. [PMID: 34599222 PMCID: PMC8486771 DOI: 10.1038/s41598-021-98732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 08/27/2021] [Indexed: 02/08/2023] Open
Abstract
Studies on the effects of dual tasking in patients with chronic inflammatory rheumatic diseases are limited. The aim of this study was to assess dual tasking while walking in patients with axial spondyloarthritis (axSpA) in comparison to healthy controls. Thirty patients with axSpA and thirty healthy controls underwent a 10-m walk test at a self-selected comfortable walking speed in single- and dual-task conditions. Foot-worn inertial sensors were used to compute spatiotemporal gait parameters. Analysis of spatiotemporal gait parameters showed that the secondary manual task negatively affected walking performance in terms of significantly decreased mean speed (p < 0.001), stride length (p < 0.001) and swing time (p = 0.008) and increased double support (p = 0.002) and stance time (p = 0.008). No significant interaction of group and condition was observed. Both groups showed lower gait performance in dual task condition by reducing speed, swing time and stride length, and increasing double support and stance time. Patients with axSpA were not more affected by the dual task than matched healthy controls, suggesting that the secondary manual task did not require greater attention in patients with axSpA. Increasing the complexity of the walking and/or secondary task may increase the sensitivity of the dual-task design to axial spondyloarthritis.
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Affiliation(s)
- Julie Soulard
- University Grenoble Alpes, AGEIS, Grenoble, France.
- CHU Grenoble Alpes, Grenoble, France.
| | | | - Athan Baillet
- CHU Grenoble Alpes, Grenoble, France
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG UMR5525, Grenoble, France
| | - Philippe Gaudin
- CHU Grenoble Alpes, Grenoble, France
- University Grenoble Alpes, CNRS, CHU Grenoble Alpes, Grenoble INP, TIMC-IMAG UMR5525, Grenoble, France
| | - Nicolas Vuillerme
- University 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
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20
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Utility of a Postural Stability/Perceptual Inhibition Dual Task for Identifying Concussion in Adolescents. J Sport Rehabil 2021; 30:1191-1196. [PMID: 34525453 DOI: 10.1123/jsr.2021-0084] [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: 03/09/2021] [Revised: 05/24/2021] [Accepted: 06/16/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Research in the area of dual-task paradigms to assess sport-related concussion (SRC) status is growing, but additional assessment of this paradigm in adolescents is warranted. DESIGN This case-control study compared 49 adolescent athletes aged 12-20 years with diagnosed SRC to 49 age- and sex-matched controls on visual-spatial discrimination and perceptual inhibition (PIT) reaction time tasks performed while balancing on floor/foam pad conditions. METHODS The SRC group completed measures at a single time point between 1 and 10 days postinjury. Primary outcomes were dual-task reaction time, accuracy, and sway. General linear models evaluated differences between groups (P < .05). Logistic regression identified predictors of concussion from outcomes. Area under the curve evaluated discriminative ability of identifying SRC. RESULTS Results supported significantly higher anterior-posterior (AP) sway values in concussed participants for visual-spatial discrimination and PIT when balancing on the floor (P = .03) and foam pad (P = .03), as well as mediolateral sway values on the floor during visual-spatial discrimination (P = .01). Logistic regression analysis (R2 = .15; P = .001) of all dual-task outcomes identified AP postural sway during the PIT foam dual task as the only significant predictor of concussed status (ß = -2.4; P = .004). Total symptoms (area under the curve = 0.87; P < .001) and AP postural sway on foam (area under the curve = 0.70; P = .001) differentiated concussed from controls. CONCLUSION The AP postural sway on foam during a postural stability/PIT dual task can identify concussion in adolescents between 1 and 10 days from injury.
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21
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Chadwick L, Roth E, Minich NM, Taylor HG, Bigler ED, Cohen DM, Bacevice A, Mihalov LK, Bangert BA, Zumberge NA, Yeates KO. Cognitive Outcomes in Children with Mild Traumatic Brain Injury: An Examination Using the National Institutes of Health Toolbox Cognition Battery. J Neurotrauma 2021; 38:2590-2599. [PMID: 33906429 PMCID: PMC8403208 DOI: 10.1089/neu.2020.7513] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This study is the first to examine cognitive outcomes after pediatric mild TBI using the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB), a computerized cognitive test battery. The NIHTB-CB includes two complex measures of attention and executive function that allow differentiation of accuracy and response speed. We compared performance on the NIHTB-CB among children 8-16 years of age with mild TBI (n = 143) versus children with orthopedic injuries (OIs; n = 74) recruited in emergency departments and followed for 6 months post-injury. Mixed-model analyses showed that the mild TBI group showed significantly lower Fluid Cognition composite scores than the OI group at 10 days (group intercept, p = 0.018); the magnitude of group differences declined modestly over time (group × time interaction, p = 0.055). Effect sizes were d = 0.34 at 10 days post-injury, d = 0.27 at 3 months, and d = 0.10 at 6 months. No significant effects of group or time were found for the Crystallized Cognition composite. Analyses of Fluid Cognition subtests indicated that children with mild TBI displayed deficits for as long as 3 months on measures of attention and executive function (e.g., cognitive flexibility, inhibitory control), but not on measures of explicit memory, working memory, or processing speed. The poorer performance of the mild TBI group on measures of attention and executive function was attributable largely to slowed reaction time, not decreased accuracy. The findings suggest that children with mild TBI demonstrate persistent deficits in fluid cognition that are most apparent on tasks that combine demands for both speed and executive function.
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Affiliation(s)
- Leah Chadwick
- Department of Psychology and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Roth
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nori M. Minich
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
| | - H. Gerry Taylor
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Erin D. Bigler
- Departments of Psychology and Neuroscience, Brigham Young University, Provo, Utah, USA
| | - Daniel M. Cohen
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ann Bacevice
- Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio, USA
- Rainbow Babies and Children's Hospital, Cleveland, Ohio, USA
| | - Leslie K. Mihalov
- Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
- Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Barbara A. Bangert
- Departments of Radiology and Neurosurgery, University Hospitals Health System, Cleveland, Ohio, USA
| | | | - Keith Owen Yeates
- Department of Psychology and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Departments of Pediatrics and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Static and Dynamic Cognitive Performance in Youth and Collegiate Athletes With Concussion. Clin J Sport Med 2021; 31:442-447. [PMID: 31860545 DOI: 10.1097/jsm.0000000000000779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 06/19/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if individuals with a concussion demonstrate altered cognitive performance while standing still or while walking relative to uninjured controls. DESIGN Cross-sectional. SETTING Sports-medicine clinic. PARTICIPANTS Youth and collegiate athletes diagnosed with a concussion, assessed within 10 days of injury, and a group of uninjured control subjects. INDEPENDENT VARIABLES Concussion and control groups. MAIN OUTCOME MEASURES Participants stood still for 30 seconds while completing a cognitive task (spelling words backward, serial subtraction, or reverse month recitation) and completed a similar set of cognitive tasks while walking. Our primary outcome variables were (1) overall cognitive task performance (accuracy) and (2) the total number of task items completed during testing (completion rate) during standing and walking conditions. RESULTS One hundred ninety-one participants completed the study: 94 with concussion (tested mean = 5.1 ± 2.9 days postconcussion; 51% female; mean age = 17.1 ± 3.3 years) and 97 control subjects (40% female; mean age = 17.5 ± 2.1 years). The concussion group completed significantly fewer responses than the control group while standing still (37.3 ± 14.5 vs 45.1 ± 17.6 responses; P = 0.03) and while walking (22.7 ± 7.5 vs 33.6 ± 13.4 responses; P < 0.001). They were also significantly less accurate at spelling words backward (81.2 ± 28.6% correct vs 89.8 ± 15.0% correct; P = 0.049) and reciting months in reverse order (95.8 ± 10.4% correct vs 98.2 ± 4.2% correct; P = 0.034) while walking. CONCLUSIONS Athletes displayed lower cognitive task accuracy rates after concussion compared with control subjects during backward spelling and reverse month recitation tasks while walking but similar levels of accuracy while standing. Assessment of cognitive performance during dynamic tasks may be a clinically viable method to evaluate post-concussion deficits.
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Avedesian JM, Singh H, Diekfuss JA, Myer GD, Grooms DR. Loss of Motor Stability After Sports-Related Concussion: Opportunities for Motor Learning Strategies to Reduce Musculoskeletal Injury Risk. Sports Med 2021; 51:2299-2309. [PMID: 34339041 DOI: 10.1007/s40279-021-01527-5] [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] [Accepted: 07/19/2021] [Indexed: 11/26/2022]
Abstract
Current best practices to direct recovery after sports-related concussion (SRC) typically require asymptomatic presentation at both rest and during a graduated exercise progression, and cognitive performance resolution. However, this standard of care results in a significantly elevated risk for musculoskeletal (MSK) injury after return-to-sport (RTS). The elevated risk is likely secondary to, in part, residual neurophysiological and dual-task motor stability deficits that remain despite RTS. These deficits present as a loss of autonomous control of gait and posture and an increased need for cognition for motor stability. Thus, the incorporation of strategies that can enhance motor stability and restore autonomous control of gait and posture during SRC recovery and RTS progression may facilitate a reduction of the elevated risk of secondary MSK injury. We provide a theoretical framework for the application of motor learning principles to restore autonomous gait and postural stability after SRC via incorporation, or targeted manipulation, of external focus, enhanced expectations, autonomy support, practice schedule variability, and dual-task strategies during rehabilitation and RTS training.
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Affiliation(s)
- Jason M Avedesian
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA.
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA.
| | - Harjiv Singh
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Jed A Diekfuss
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | - Gregory D Myer
- Emory Sports Performance and Research Center, 4450 Falcon Pkwy, Flowery Branch, GA, USA
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
- Emory Sports Medicine Center, Atlanta, GA, USA
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
| | - Dustin R Grooms
- Ohio Musculoskeletal and Neurological Institute, Ohio University, Athens, OH, USA
- Division of Athletic Training, School of Applied Health Sciences and Wellness, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
- Division of Physical Therapy, School of Rehabilitation and Communication Sciences, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
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24
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Sanchez-Casanova J, Liu-Jimenez J, Tirado-Martin P, Sanchez-Reillo R. Unsupervised and scalable low train pathology detection system based on neural networks. Heliyon 2021; 7:e06270. [PMID: 33659760 PMCID: PMC7895758 DOI: 10.1016/j.heliyon.2021.e06270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/14/2020] [Accepted: 02/09/2021] [Indexed: 11/23/2022] Open
Abstract
Currently, there exist different technologies applied in the world of medicine dedicated to the detection of health problems such as cancer, heart diseases, etc. However, these technologies are not applied to the detection of lower body pathologies. In this article, a Neural Network (NN)-based system capable of classifying pathologies of the lower train by the way of walking in a non-controlled scenario, with the ability to add new users without retraining the system is presented. All the signals are filtered and processed in order to extract the Gait Cycles (GCs), and those cycles are used as input for the NN. To optimize the network a random search optimization process has been performed. To test the system a database with 51 users and 3 visits per user has been collected. After some improvements, the algorithm can correctly classify the 92% of the cases with 60% of training data. This algorithm is a first approach of creating a system to make a first stage pathology detection without the requirement to move to a specific place.
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Affiliation(s)
| | - Judith Liu-Jimenez
- University Group for ID technologies (GUTI), University Carlos III of Madrid, Spain
| | - Paloma Tirado-Martin
- University Group for ID technologies (GUTI), University Carlos III of Madrid, Spain
| | - Raul Sanchez-Reillo
- University Group for ID technologies (GUTI), University Carlos III of Madrid, Spain
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25
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Gagné MÈ, McFadyen BJ, Ouellet MC. Performance during dual-task walking in a corridor after mild traumatic brain injury: A potential functional marker to assist return-to-function decisions. Brain Inj 2021; 35:173-179. [PMID: 33455461 DOI: 10.1080/02699052.2020.1863467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: To compare the performance of participants with mTBI and healthy control on locomotor-cognitive dual-tasks in a corridor with limited technology.Design: Prospective study of twenty participants with mTBI (10 women; 22.10 ± 2.97 years; 70.9 ± 22.31 days post-injury), and 20 sex- and age-matched control participants (10 women; 22.55 ± 2.72 years).Methods: Participants performed six different dual-tasks combining locomotor tasks (level-walking, obstacle-crossing, and tandem gait) and cognitive tasks (counting backwards and verbal fluency). Symptoms and neuropsychological performance were also assessed.Results: No differences between groups were found for symptoms and neuropsychological measures. For gait speed, the group effect was not significant, but a significant group X cognitive task interaction was found, revealing a tendency toward slower gait speed in the mTBI group during dual-task conditions. A significantly greater dual-task cost for gait speed was found for the mTBI group. Although no statistically significant differences in cognitive performance were observed during dual-tasks, the mTBI group subjectively reported being significantly less concentrated.Conclusion: The present study revealed that in persons who seem to have well recovered after mTBI, on average 71 days post-injury, alterations in gait are detectable using a simple, "low-tech," corridor-based dual-task walking assessment.
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Affiliation(s)
- Marie-Ève Gagné
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), IRDPQ, Quebec, Canada.,School of Psychology, Faculty of Social Sciences, Université Laval, Quebec, Canada
| | - Bradford J McFadyen
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), IRDPQ, Quebec, Canada.,Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Marie-Christine Ouellet
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), IRDPQ, Quebec, Canada.,School of Psychology, Faculty of Social Sciences, Université Laval, Quebec, Canada
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26
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Fino PC, Weightman MM, Dibble LE, Lester ME, Hoppes CW, Parrington L, Arango J, Souvignier A, Roberts H, King LA. Objective Dual-Task Turning Measures for Return-to-Duty Assessment After Mild Traumatic Brain Injury: The ReTURN Study Protocol. Front Neurol 2021; 11:544812. [PMID: 33519659 PMCID: PMC7844093 DOI: 10.3389/fneur.2020.544812] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 12/07/2020] [Indexed: 02/05/2023] Open
Abstract
Determining readiness for duty after mild traumatic brain injury (mTBI) is essential for the safety of service members and their unit. Currently, these decisions are primarily based on self-reported symptoms, objective measures that assess a single system, or standardized physical or cognitive tests that may be insensitive or lack ecological validity for warrior tasks. While significant technological advancements have been made in a variety of assessments of these individual systems, assessments of isolated tasks are neither diagnostically accurate nor representative of the demands imposed by daily life and military activities. Emerging evidence suggests that complex tasks, such as dual-task paradigms or turning, have utility in probing functional deficits after mTBI. Objective measures from turning tasks in single- or dual-task conditions, therefore, may be highly valuable for clinical assessments and return-to-duty decisions after mTBI. The goals of this study are to assess the diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation of objective, dual-task turning measures within an mTBI population. These goals will be accomplished over two phases. Phase 1 will enroll civilians at three sites and active-duty service members at one site to examine the diagnostic accuracy and predictive capacity of dual-task turning outcomes. Phase 1 participants will complete a series of turning tasks while wearing inertial sensors and a battery of clinical questionnaires, neurocognitive testing, and standard clinical assessments of function. Phase 2 will enroll active-duty service members referred for rehabilitation from two military medical treatment facilities to investigate the responsiveness to rehabilitation of objective dual-task turning measures. Phase 2 participants will complete two assessments of turning while wearing inertial sensors: a baseline assessment prior to the first rehabilitation session and a post-rehabilitation assessment after the physical therapist determines the participant has completed his/her rehabilitation course. A variable selection procedure will then be implemented to determine the best task and outcome measure for return-to-duty decisions based on diagnostic accuracy, predictive capacity, and responsiveness to rehabilitation. Overall, the results of this study will provide guidance and potential new tools for clinical decisions in individuals with mTBI. Clinical Trial Registration: clinicaltrials.gov, Identifier NCT03892291.
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Affiliation(s)
- Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | | | - Leland E Dibble
- Department of Physical Therapy & Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Mark E Lester
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, United States.,Department of Physical Therapy, Texas State University, Round Rock, TX, United States
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, United States
| | - Lucy Parrington
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Jorge Arango
- Traumatic Brain Injury Center of Excellence, Fort Carson, CO, United States
| | | | - Holly Roberts
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA, United States
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
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Gait Assessment in College Athletes: Do Concussion History, Symptoms, Gender, and Type of Sport Matter? J Sport Rehabil 2021; 30:988-999. [PMID: 33418540 DOI: 10.1123/jsr.2019-0331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/20/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Though previous research has focused on examining the effects of concussion history using a dual-task paradigm, the influence of factors like symptoms (unrelated to concussion), gender, and type of sport on gait in college athletes is unknown. OBJECTIVE To examine the effect of concussion history, symptoms, gender, and type of sport (noncontact/limited contact/contact) individually on gait among college athletes. DESIGN Exploratory cross-sectional study. SETTING Laboratory. PARTICIPANTS In total, 98 varsity athletes (age, 18.3 [1.0] y; height, 1.79 [0.11] m; mass, 77.5 [19.2] kg; 27 with concussion history, 58 reported at least one symptom, 44 females; 8 played noncontact sports and 71 played contact sports) walked under single- and dual-task (walking while counting backward by 7) conditions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Dual-task cost (DTC; % difference between single task and dual task) of gait speed, cadence, step length and width, percentage of swing and double-support phases, symptom score, and total symptom severity score. Independent samples t tests and 1-way analysis of variance were conducted (α value = .05). RESULTS Self-reported concussion history resulted in no significant differences (P > .05). Those who reported symptoms at testing time showed significantly greater DTC of step length (mean difference [MD], 2.7%; 95% confidence interval [CI], 0.3% to 5.1%; P = .012), % of swing phase (MD, 1.0%; 95% CI, -0.2 to 2.1%; P = .042), and % of double-support phase (MD, 3.9%; 95% CI, 0.2% to 7.8%; P = .019). Females demonstrated significantly higher DTC of gait speed (MD, 5.3%; 95% CI, 1.3% to 9.3%; P = .005), cadence (MD, 4.0%; 95% CI, 1.4% to 6.5%; P = .002), % of swing phase (MD, 1.2%; 95% CI, 0.1% to 2.3%; P = .019), and % of double-support phase (MD, 4.1%; 95% CI, 0.4% to 7.9%; P = .018). Noncontact sports athletes had significantly greater step width DTC than contact sports athletes (MD, 14.2%; 95% CI, 0.9% to 27.6%; P = .032). CONCLUSIONS Reporting symptoms at testing time may influence gait under dual-task conditions. Additionally, female athletes showed more gait changes during a dual task. Sports medicine professionals should be aware that these variables, while unrelated to injury, may affect an athlete's gait upon analysis.
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DUAL-TASK ASSESSMENT IMPLICATIONS FOR ANTERIOR CRUCIATE LIGAMENT INJURY: A SYSTEMATIC REVIEW. Int J Sports Phys Ther 2020; 15:840-855. [PMID: 33344002 DOI: 10.26603/ijspt20200840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Several systematic reviews have evaluated the role of dual-task assessment in individuals with concussion. However, no systematic reviews to date have investigated dual-task protocols with implications for individuals with anterior cruciate ligament (ACL) injury or ACL reconstruction (ACLR). Purpose To systematically review the evidence on dual-task assessment practices applicable to those with ACL deficiency/ACLR, specifically with the aim to identify motor-cognitive performance costs. Study Design Systematic review. Methods A systematic literature review was undertaken on those with ACL-deficient or ACL-reconstructed knees performing dual-task activities. The following databases were searched from inception to June 8, 2018 including CINAHL, PsychInfo, PubMed, SPORTDiscus, Web of Science, and gray literature. Three primary search categories (knee, cognition, and motor task) were included. Only one reviewer independently performed the database search, data extraction, and scored each article for quality. All studies were assessed for quality and pertinent data were extracted, examined and synthesized. Results Ten studies were included for analysis, all of which were published within the prior ten years. Performance deficits were identified in those with either ACL deficiency or ACLR while dual-tasking, such as prioritization of postural control at the expense of cognitive performance, impaired postural control in single limb stance, greater number of cognitive errors, and increased step width coefficient of variation while walking. No studies examined those with prior ACL injury or ACLR during tasks that mimicked ACL injury mechanisms such as jump-landing or single-leg cutting. Conclusion The results of the current systematic review suggests that postural control, gait, and/or cognitive deficits exist when evaluated under a dual-task paradigm in those with ACL deficiency or ACLR. This systematic review highlights the need for future research on dual-task assessment for individuals who have sustained an ACL injury or undergone ACLR, specifically utilizing more difficult athletic movements. Level of Evidence Level 3a.
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29
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Morris A, Cassidy B, Pelo R, Fino NF, Presson AP, Cushman DM, Monson NE, Dibble LE, Fino PC. Reactive Postural Responses After Mild Traumatic Brain Injury and Their Association With Musculoskeletal Injury Risk in Collegiate Athletes: A Study Protocol. Front Sports Act Living 2020; 2:574848. [PMID: 33345138 PMCID: PMC7739642 DOI: 10.3389/fspor.2020.574848] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Deficits in neuromuscular control are widely reported after mild traumatic brain injury (mTBI). These deficits are speculated to contribute to the increased rate of musculoskeletal injuries after mTBI. However, a concrete mechanistic connection between post-mTBI deficits and musculoskeletal injuries has yet to be established. While impairments in some domains of balance control have been linked to musculoskeletal injuries, reactive balance control has received little attention in the mTBI literature, despite the inherent demand of balance recovery in athletics. Our central hypothesis is that the high rate of musculoskeletal injuries after mTBI is in part due to impaired reactive balance control necessary for balance recovery. The purpose of this study is to (1) characterize reactive postural responses to recover balance in athletes with recent mTBI compared to healthy control subjects, (2) determine the extent to which reactive postural responses remain impaired in athletes with recent mTBI who have been cleared to return to play, and (3) determine the relationship between reactive postural responses and acute lower extremity musculoskeletal injuries in a general sample of healthy collegiate athletes. Methods: This two-phase study will take place at the University of Utah in coordination with the University of Utah Athletics Department. Phase 1 will evaluate student-athletes who have sustained mTBI and teammate-matched controls who meet all the inclusion criteria. The participants will be assessed at multiple time points along the return-to-play progress of the athlete with mTBI. The primary outcome will be measures of reactive postural response derived from wearable sensors during the Push and Release (P&R) test. In phase 2, student-athletes will undergo a baseline assessment of postural responses. Acute lower extremity musculoskeletal injuries for each participant will be prospectively tracked for 1 year from the date of first team activity. The primary outcomes will be the measures of reactive postural responses and the time from first team activity to lower extremity injury. Discussion: Results from this study will further our understanding of changes in balance control, across all domains, after mTBI and identify the extent to which postural responses can be used to assess injury risk in collegiate athletes.
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Affiliation(s)
- Amanda Morris
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Benjamin Cassidy
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
| | - Ryan Pelo
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States.,Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Nora F Fino
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, United States
| | - Daniel M Cushman
- Division of Physical Medicine and Rehabilitation, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Nicholas E Monson
- Department of Orthopaedic Surgery Operations, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT, United States
| | - Peter C Fino
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, United States
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Aumen AM, Oberg KJ, Mingils SM, Berkner CB, Tracy BL, Stephens JA. Revised and Neuroimaging-Compatible Versions of the Dual Task Screen. J Vis Exp 2020. [PMID: 33074251 DOI: 10.3791/61678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Dual task paradigms simultaneously assess motor and cognitive abilities, and they can detect subtle, residual impairments in athletes with recent mild traumatic brain injury (mTBI). However, past dual task paradigms have focused solely on lower extremity skills and have relied on cumbersome, expensive laboratory equipment - thus limiting their practicality for everyday mTBI evaluation. Subsequently, we developed the Dual Task Screen (DTS), which takes <10 minutes to administer and score, uses low-cost portable equipment, and includes lower extremity (LE) and upper extremity (UE) subtasks. The purpose of this manuscript was twofold. First, we describe the administration protocol for the revised DTS, which we revised to address the limitations of the original DTS. Specifically, the revisions included additions of smart devices to acquire more detailed gait data and inclusion of single cognitive conditions to test for disrupted cognitive performance under dual task conditions. Importantly, the revised DTS is a measure intended for future clinical use, and we present representative results from three male athletes to illustrate the type of clinical data that can be acquired from the measure. Importantly, we have yet to evaluate the sensitivity and specificity of the revised DTS in athletes with mTBI, which is the next research initiative. The second purpose of this manuscript is to describe a neuroimaging-compatible version of the DTS. We developed this version so we could evaluate the neural underpinnings of single and dual task performance, for a better empirical understanding of the behavioral deficits associated with mTBI. Thus, this manuscript also describes the steps we took to enable simultaneous functional near-infrared spectroscopy (fNIRS) measurement during the DTS, along with how we acquired and completed first-level processing of the fNIRS data.
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Affiliation(s)
- Allan M Aumen
- Molecular Cellular and Integrative Neuroscience Program, Colorado State University
| | - Kelly J Oberg
- Molecular Cellular and Integrative Neuroscience Program, Colorado State University
| | | | | | - Brian L Tracy
- Dept. of Health and Exercise Science, Colorado State University
| | - Jaclyn A Stephens
- Molecular Cellular and Integrative Neuroscience Program, Colorado State University; Dept. of Occupational Therapy, Colorado State University;
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Manaseer TS, Gross DP, Dennett L, Schneider K, Whittaker JL. Gait Deviations Associated With Concussion: A Systematic Review. Clin J Sport Med 2020; 30 Suppl 1:S11-S28. [PMID: 32132473 DOI: 10.1097/jsm.0000000000000537] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait deviations resulting from concussion are important to consider in the diagnosis, treatment progression, and return to activity after a concussion. OBJECTIVE To identify quantifiable gait deviations associated with concussion across populations and time since injury. METHODS AND MATERIALS Six electronic databases were systematically searched from January 1974 to September 2016. Studies selected included original data, had an analytic design, and reported a quantifiable gait parameter in individuals who had sustained a concussion as defined by the American Congress of Rehabilitation Medicine or related definitions. Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines were followed. Two independent authors assessed study quality [Downs and Black (DB) criteria] and level of evidence (Oxford Center of Evidence-Based Medicine Model). RESULTS Of 2650 potentially relevant articles, 21 level 4 studies were included. The median DB score was 12/33 (range 10-16). Heterogeneity in gait parameters and timing of postconcussion testing precluded meta-analysis. There is consistent level 4 evidence of increased medial-lateral center-of-mass displacement, and inconsistent level 4 evidence of decreased gait velocity after concussion. Further, there is preliminary level 4 evidence that gait deficits may exist beyond the typical 10-day recovery period and return to activity. CONCLUSION These findings suggest that individuals who have suffered a concussion may sway more in the frontal plane, and walk slower compared to healthy controls. Consensus about the most important gait parameters for concussion diagnosis and clinical management are lacking. Further, high-quality prospective cohort studies evaluating changes in gait from time of concussion to return to activity, sport, recreation and/or work are needed.
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Affiliation(s)
- Thaer S Manaseer
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Douglas P Gross
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- John Walter Scott Library, University of Alberta, Edmonton, AB, Canada
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; and
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
- Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, AB, Canada
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Pitt W, Chou LS. A case-control study of gait balance control in veterans with chronic symptoms following mTBI. Gait Posture 2020; 76:188-192. [PMID: 31862668 DOI: 10.1016/j.gaitpost.2019.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/27/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Numerous investigations suggest mild traumatic brain injury (mTBI) may result in persistent gait balance control deficits. Furthermore, military Veterans with symptoms of chronic mTBI often present with physical symptoms that may be associated with impaired gait balance control which may lead to prolonged recovery, difficulty performing activities of daily living, and increased disability. It is therefore important to objectively quantify gait balance deficits in Veterans with chronic mTBI. RESEARCH QUESTION Is gait balance control impaired in a group of Veterans with chronic symptoms of mTBI when compared to healthy matched Veterans? METHODS Eight Veterans with symptoms of chronic mTBI (1 F/7 M) and eight healthy matched Veterans (1 F/7 M) completed a gait balance assessment under single- (ST) and dual-task (DT) conditions. Gait balance control was quantified with whole body center of mass (COM) total medial-lateral (ML) displacement and peak ML velocity, which were calculated from camera-based motion capture. RESULTS Veterans with chronic mTBI walked with greater ML COM displacement (approximately 25 % increase) in both ST and DT walking (main effect of group, p = 0.018) when compared to healthy Veterans. The peak ML COM velocity was affected for both groups by performing a concurrent cognitive task (interaction effect, p = .012). Slower ML COM velocities in healthy Veterans suggest the adoption of a conservative balance control strategy, while faster ML COM velocities for Veterans with chronic mTBI may indicate a diminished ability to control ML momentum. SIGNIFICANCE Increased frontal plane COM motion under both ST and DT walking was observed in Veterans with chronic mTBI symptoms many years after injury. This suggests gait balance control may be adversely affected during divided attention gait and highlights the need for comprehensive gait analysis in the management of these individuals.
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Affiliation(s)
- Will Pitt
- Motion Analysis Laboratory, Department of Human Physiology, University of Oregon, Eugene, OR 97403, USA; Baylor University - Keller Army Community Hospital Division 1 Sports Physical Therapy Fellowship, United States Military Academy, West Point, NY, 10966, USA
| | - Li-Shan Chou
- Motion Analysis Laboratory, Department of Human Physiology, University of Oregon, Eugene, OR 97403, USA; Department of Kinesiology, Iowa State University, Ames, IA 50011, USA.
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Stuart S, Parrington L, Morris R, Martini DN, Fino PC, King LA. Gait measurement in chronic mild traumatic brain injury: A model approach. Hum Mov Sci 2020; 69:102557. [DOI: 10.1016/j.humov.2019.102557] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 01/04/2023]
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Maclean LM, McSkimming P, McMillan TM. The association between dual-task walking and counting responses and cognitive function and disability after severe head injury: A preliminary study. Neuropsychol Rehabil 2020; 31:570-582. [PMID: 31989869 DOI: 10.1080/09602011.2020.1716812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Adverse outcomes after severe head injury (SHI) can be difficult to detect in primary care and other settings where there is not specialist expertise for interpretation. Walking and counting dual-task (DT) measures are strongly associated with cognitive impairment and dementia and this preliminary study investigates whether performance on DT walking and counting tasks are associated with cognitive function and disability in 125 participants who sustained a SHI on average 26 years before. Single Task (ST) walking (speed over 6 metres) and ST counting (Serial 3s) and DT performance of concurrent walking and Serial 3s were compared with neuropsychological, wellbeing and disability tests for strength of association. The strongest correlations were between ST Correct Cognitive Responses (CCRs) and MMSE (rho = 0.435), DT CCRs and Short-term Memory Binding Tests (STMBT) binding accuracy (rho = 0,409) and DT CCRs and STROOP (rho = 0.420), but associations were less strong with disability. Developing this test, as a cost-efficient screening tool for triage to onward referral for neuropsychological assessment, holds promise, but requires further research.
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Affiliation(s)
- Linda M Maclean
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Paula McSkimming
- Robertson Centre of Biostatistics, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
| | - Tom M McMillan
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland
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McGrath MK, Linder SM, Koop MM, Zimmerman N, Ballantyne MAJ, Ahrendt DM, Alberts JL. Military-Specific Normative Data for Cognitive and Motor Single- and Dual-Task Assessments for Use in Mild Traumatic Brain Injury Assessment. Mil Med 2020; 185:176-183. [PMID: 32074318 DOI: 10.1093/milmed/usz261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Military personnel and civilian athletes are both at risk for mild traumatic brain injury. However, these groups are unique in their training and typical daily activities. A fundamental gap in the evaluation of military personnel following mild traumatic brain injury is the lack of military-specific normative reference data. This project aimed to determine if a separate normative sample should be used for military personnel on their performance of the Cleveland Clinic Concussion application and a recently developed dual-task module. METHODS Data were collected from healthy military personnel (n = 305) and civilians (n = 281) 18 to 30 years of age. Participants completed the following assessments: simple and choice reaction time, Trail Making tests A&B, processing speed test, single-task postural stability, single-task cognitive assessment, and dual-task assessment. RESULTS Civilian participants outperformed military service members on all cognitive tasks under single- and dual-task conditions (P ≤ 0.04). The military group outperformed civilians on all postural stability tasks under single- and dual-task conditions (P ≤ 0.01). CONCLUSION Differences in cognitive performance and postural stability measures may be influenced by demographic differences between military and civilian cohorts. Thus, military-specific normative datasets must be established to optimize clinical interpretation of Cleveland Clinic Concussion assessments.
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Affiliation(s)
- Morgan K McGrath
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Susan M Linder
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Mandy Miller Koop
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Nicole Zimmerman
- Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
| | - Maj Aaron J Ballantyne
- Division of Adolescent and Young Adult Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Dale M Ahrendt
- Division of Adolescent and Young Adult Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234
| | - Jay L Alberts
- Department of Biomedical Engineering, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195
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Stuart S, Parrington L, Martini DN, Kreter N, Chesnutt JC, Fino PC, King LA. Analysis of Free-Living Mobility in People with Mild Traumatic Brain Injury and Healthy Controls: Quality over Quantity. J Neurotrauma 2020; 37:139-145. [DOI: 10.1089/neu.2019.6450] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Samuel Stuart
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Douglas N. Martini
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - Nicholas Kreter
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
| | - James C. Chesnutt
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
| | - Peter C. Fino
- Department of Health, Kinesiology, and Recreation, University of Utah, Salt Lake City, Utah
| | - Laurie A. King
- Department of Neurology, Oregon Health and Science University, Portland, Oregon
- Veterans Affairs Portland Health Care System, Portland, Oregon
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Effect of Single-Leg Squat Speed and Depth on Dynamic Postural Control Under Single-Task and Dual-Task Paradigms. J Appl Biomech 2019; 35:272-279. [PMID: 31034324 DOI: 10.1123/jab.2018-0327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although single-leg squats are a common dynamic balance clinical assessment, little is known about the relationship between parameters that influence squat movement and postural control performance. The objective of this study was to determine the relationships between squat parameters (speed and depth) and postural control under single task and dual task. A total of 30 healthy college students performed single-leg squats under single task and dual task with Stroop. Random-intercepts generalized linear mixed models determined the effect of squat parameters on center of pressure (CoP) parameters. For each 1-cm·s-1 increase in squat speed, sway range (mediolateral: β = -0.03; anteroposterior: β = -0.05) and area (β = -0.25) decreased, whereas sway speed (mediolateral: β = 0.05; anteroposterior: β = 0.29; total: β = 0.29) increased. For each 1-cm increase in squat depth, sway range (mediolateral: β = 0.05; anteroposterior: β = 0.20) and area (β = 0.72) increased, whereas sway speed (anteroposterior: β = -0.14; total: β = -0.14) decreased. Compared with single task, the association between total and anteroposterior sway speed and squat speed was stronger under dual task. Clinicians and researchers should consider monitoring squat speed and depth when assessing dynamic balance during single-leg squats, as these parameters influence postural control, especially under dual task.
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Manaseer TS, Gross DP, Mrazik M, Schneider K, Whittaker JL. Re-conceptualizing postural control assessment in sport-related concussion: Transitioning from the reflex/hierarchical model to the systems model. Physiother Theory Pract 2019; 37:763-774. [PMID: 31370724 DOI: 10.1080/09593985.2019.1648624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: While postural control impairment is common following sport-related concussion, few investigations have studied the physiological basis for this impairment. Both the Reflex/Hierarchical Model and the Systems Model are commonly used to characterize the physiological basis of postural control.Purpose: To discuss the physiological basis of postural control impairment resulting from sport-related concussion based on these models and suggest directions for future research.Methods: Narrative literature review.Findings: Postural control impairment seen with sport-related concussion is a multifaceted construct that can result from deficits in numerous systems that underlie postural control as described by the Systems Model, rather than a unidimensional construct that stems from the central nervous systems' inability to integrate sensory input to control posture as per the Reflex/Hierarchical Model.Conclusion: We recommend a transition away from the Hierarchical/Reflex Model of postural control towards the Systems Model in the conceptualization of sport-related concussion. Future research on postural control following sport-related concussion should account for the multifaceted nature of the resulting postural control impairment based on the Systems Model. Clinically, there is a need for a clinical postural control test that allows examination across the affected systems under single-task, dual-task, and sport-specific paradigms.
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Affiliation(s)
- Thaer S Manaseer
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Department of Sport Rehabilitation, Faculty of Physical Education and Sport Sciences, Hashemite University, Al Zarqa'a, Jordan
| | - Douglas P Gross
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Martin Mrazik
- Department of Educational Psychology, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Kathryn Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada.,Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
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Büttner F, Howell DR, Ardern CL, Doherty C, Blake C, Ryan J, Catena R, Chou LS, Fino P, Rochefort C, Sveistrup H, Parker T, Delahunt E. Concussed athletes walk slower than non-concussed athletes during cognitive-motor dual-task assessments but not during single-task assessments 2 months after sports concussion: a systematic review and meta-analysis using individual participant data. Br J Sports Med 2019; 54:94-101. [DOI: 10.1136/bjsports-2018-100164] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2019] [Indexed: 01/01/2023]
Abstract
ObjectivesTo determine whether individuals who sustained a sports concussion would exhibit persistent impairments in gait and quiet standing compared to non-injured controls during a dual-task assessment .DesignSystematic review and meta-analysis using individual participant data (IPD).Data sourcesThe search strategy was applied across seven electronic bibliographic and grey literature databases: MEDLINE, EMBASE, CINAHL, SportDISCUS, PsycINFO, PsycARTICLES and Web of Science, from database inception until June 2017.Eligibility criteria for study selectionStudies were included if; individuals with a sports concussion and non-injured controls were included as participants; a steady-state walking or static postural balance task was used as the primary motor task; dual-task performance was assessed with the addition of a secondary cognitive task; spatiotemporal, kinematic or kinetic outcome variables were reported, and; included studies comprised an observational study design with case–control matching.Data extraction and synthesisOur review is reported in line with the Preferred Reporting Items for Systematic review and Meta-Analyses-IPD Statement. We implemented the Risk of Bias Assessment tool for Non-randomised Studies to undertake an outcome-level risk of bias assessment using a domain-based tool. Study-level data were synthesised in one of three tiers depending on the availability and quality of data: (1) homogeneous IPD; (2) heterogeneous IPD and (3) aggregate data for inclusion in a descriptive synthesis. IPD were aggregated using a ‘one-stage’, random-effects model.Results26 studies were included. IPD were available for 20 included studies. Consistently high and unclear risk of bias was identified for selection, detection, attrition, and reporting biases across studies. Individuals with a recent sports concussion walked with slower average walking speed (χ2=51.7; df=4; p<0.001; mean difference=0.06 m/s; 95% CI: 0.004 to 0.11) and greater frontal plane centre of mass displacement (χ2=10.3; df=4; p=0.036; mean difference −0.0039 m; 95% CI: −0.0075 to −0.0004) than controls when evaluated using a dual-task assessment up to 2 months following concussion.Summary/conclusionsOur IPD evidence synthesis identifies that, when evaluated using a dual-task assessment, individuals who had incurred a sports concussion exhibited impairments in gait that persisted beyond reported standard clinical recovery timelines of 7–10 days. Dual-task assessment (with motion capture) may be a useful clinical assessment to evaluate recovery after sports concussion.Protocol pre-registrationThis systematic review was prospectively registered in PROSPERO CRD42017064861.
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Abstract
A complex diagnosis such as concussion requires a multidisciplinary patient-centered approach to maximize health outcomes. There is growing evidence to support the role of the Physical Therapist as a key member of the team of healthcare professionals managing children and adolescents with a protracted recovery following concussion. Symptoms such as headache, dizziness, neck pain, gaze instability, balance dysfunction, and fatigue can be addressed through a multimodel approach. This article provides an overview of the targeted pathways of examination and treatment of individuals with a concussion through vestibular rehabilitation, cervicogenic rehabilitation, exertional training, and patient education.
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Galea OA, Bristow HD, Chisholm SM, Mersch ME, Nullmeyer J, Reid CR, Treleaven JM. Single and dual tandem gait assessment post concussion: What performance time is clinically relevant across adult ages and what can influence results? Musculoskelet Sci Pract 2019; 42:166-172. [PMID: 31031162 DOI: 10.1016/j.msksp.2019.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/01/2019] [Accepted: 04/09/2019] [Indexed: 10/27/2022]
Abstract
AIM The three-metre tandem gait test (TG) is used to assess postural control during locomotion following sports concussion. However, values used to determine a pass/fail result are currently based on young athletic populations. Times for test completion may be influenced by several intrinsic or extrinsic factors. The aim of this study was to collate healthy individual single, dual task as well as dual task cost - motor TG times for a non-elite athlete population, across several age groups, and to investigate several potential influencing factors. METHODS Healthy individuals aged 18-55+, who had never experienced a concussion completed single and dual task TG following the SCAT5 protocol. A separate group (n = 20, age, foot length and body mass index matched) performed the tests with alternate instructions. RESULTS Mean best TG time for all participants were: single task 21.03 (±5.26s), dual task 29.59 (±9.84s) and DTC-motor 8.57 (±7.5s:41.7%). Age and foot length but not specificity of verbal instructions were related to TG times. Significantly slower single and dual task times were identified for the 55 + age group when compared to the three youngest groups (p < 0.01). No difference was seen for DTC-motor time or % between age groups (p > 0.05). CONCLUSION Healthy individual data collected exceeded previously reported average times. Faster times were evident in younger participants and those with longer foot length. Results from this study can be used as a reliable guideline to inform clinical decisions around the pass/fail result of TGT across age ranges in non-elite athlete populations post-concussion.
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Affiliation(s)
- Olivia A Galea
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia.
| | - Hayden D Bristow
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Scott M Chisholm
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Michaela E Mersch
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Jocelyn Nullmeyer
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Chantelle R Reid
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
| | - Julia M Treleaven
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, 4072, Australia
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Abstract
OBJECTIVES To (1) examine the association between a commonly used concussion test, tandem gait, in single/dual-task conditions with single-task and dual-task average walking speed, (2) characterize the prevalence of tandem gait false positives, and (3) develop a normative reference range of dual-task tandem gait times. DESIGN Cross-sectional study. SETTING Two NCAA collegiate athletic facilities. INDEPENDENT VARIABLES Athletes completed the tandem gait test and a gait evaluation in single/dual-task conditions during a preseason examination. MAIN OUTCOME MEASURES Associations between tandem gait times and average walking speeds were evaluated using multiple linear regression models. Various tandem gait test time pass/fail cutoffs were calculated to examine false-positive rates. RESULTS Among the 171 participants (103 men, 19.8 ± 1.2 years of age), dual-task tandem gait completion times were independently associated with dual-task average walking speed [β = -4.018; 95% confidence interval (CI), -7.153 to -0.883], but single-task associations were not found. Male gender was associated with faster tandem gait times in both single-task (β = -0.880, 95% CI, -1.731 to -0.029) and dual-task conditions (β = -2.225, 95% CI, -3.691 to -0.759). A pass/fail cutoff threshold of 14 seconds resulted in a 2% false-positive rate for single-task tandem gait, while it resulted in a 29% false-positive rate during dual-task tandem gait. CONCLUSIONS Average walking speed and dual-task tandem gait represent objective measures that are useful in concussion management. While a single-task tandem gait cutoff of 14 seconds seems appropriate for males, adjustments may be necessary based on sex and alternate pass/fail criteria may be appropriate for dual-task tandem gait.
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Linder SM, Koop MM, Ozinga S, Goldfarb Z, Alberts JL. A Mobile Device Dual-Task Paradigm for the Assessment of mTBI. Mil Med 2019; 184:174-180. [DOI: 10.1093/milmed/usy334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/15/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Research Objective
Dual-task performance, in which individuals complete two or more activities simultaneously, is impaired following mild traumatic brain injury. The aim of this project was to develop a dual-task paradigm that may be conducive to military utilization in evaluating cognitive-motor function in a standardized and scalable manner by leveraging mobile device technology.
Methods
Fifty healthy young adult civilians (18–24 years) completed four balance stances and a number discrimination task under single- and dual-task conditions. Postural stability was quantified using data gathered from iPad’s native accelerometer and gyroscope. Cognitive task difficulty was manipulated by presenting stimuli at 30, 60, or 90 per minute. Performance of cognitive and balance tasks was compared between single- and dual-task trials.
Results
Cognitive performance from single- to dual-task paradigms showed no significant main effect of balance condition or the interaction of condition by frequency. From single- to dual-task conditions, a significant difference in postural control was revealed in only one stance: tandem with eyes closed, in which a slight improvement in postural stability was observed under dual-task conditions.
Conclusion
The optimal dual-task paradigm to evaluate cognitive-motor performance with minimal floor and ceiling effects consists of tandem stance with eyes closed while stimuli are presented at a rate of one per second.
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Affiliation(s)
- Susan M Linder
- Cleveland Clinic, Department of Biomedical Engineering, 9500 Euclid Avenue, Cleveland, OH
| | - Mandy Miller Koop
- Cleveland Clinic, Department of Biomedical Engineering, 9500 Euclid Avenue, Cleveland, OH
| | - Sarah Ozinga
- Cleveland Clinic, Department of Biomedical Engineering, 9500 Euclid Avenue, Cleveland, OH
| | - Zachary Goldfarb
- Cleveland Clinic, Department of Biomedical Engineering, 9500 Euclid Avenue, Cleveland, OH
| | - Jay L Alberts
- Cleveland Clinic, Department of Biomedical Engineering, 9500 Euclid Avenue, Cleveland, OH
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Cyber-Physical System Framework for Measurement and Analysis of Physical Activities. ELECTRONICS 2019. [DOI: 10.3390/electronics8020248] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several recent studies in Cyber-Physical Systems (CPS) focus on monitoring human movement and capturing data for further processing and analysis. However, there is a lack of studies that address the configurability and modularity of these systems, which is important for designing customized systems with customized devices. We propose a solution to solve this through a modular framework that automatically recognizes and configures new devices and provides real-time data wirelessly. The proposed framework creates a Digital Twin of the physical device and mirrors its attributes and sensory information into the cyber world so they can be used in real-time and post-routine analysis. As a proof of concept, a configurable CPS model for physical activities monitoring is designed and implemented. The designed gait monitoring and analysis system delivers spatiotemporal data from multiple multi-sensory devices to a central data handling and backup cloud server over conventional IEEE802.11 Wi-Fi. An experiment involving a young athlete examined whether or not the CPS components would recognize each other over foreign networks and communicate accurate information.
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Walters-Stewart C, Rochefort C, Longtin A, Zemek R, Sveistrup H. Centre of pressure during quiet stance and dual-task one month after mild traumatic brain injury: In adolescents. JOURNAL OF CONCUSSION 2018. [DOI: 10.1177/2059700218804917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Mild traumatic brain injury is a common neurological condition affecting adolescents in North America. In adults, symptoms related to balance are some of the most commonly reported. Methods The purpose of this study was to investigate the balance in adolescents with mild traumatic brain injury using linear and non-linear centre of pressure (COP) measures in quiet stance and during dual-task. Adolescents aged 13.00 to 17.99 years were tested once at one month following mild traumatic brain injury (n = 25), and healthy adolescents (n = 22) were tested once as controls in four conditions: standing with eyes open, standing with eyes closed, standing on a single leg and standing while performing a visual Stroop task. Results In general, compared to healthy adolescents, adolescents with mild traumatic brain injury demonstrated more variability ( p = 0.007, 95% CI (0.9, 5.4) and p = 0.049, 95% CI (0.009, 4.0), mediolateral and anteroposterior, respectively), showed more cumulative movement (path length, p = 0.016, 95% CI (1.3, 11.9)) and required greater speed of movement ( p = 0.012, 95% CI (0.99, 7.4) and p = 0.035, 95% CI (0.28, 7.5), mediolateral and anteroposterior, respectively) in maintaining balance, and in underlying temporal organization showed less local stability (mediolateral largest Lyapunov, p = 0.033, 95% CI (0.001, 0.027)), more short-term complexity anteroposteriorly ( p = 0.029, 95% CI (0.005, 0.099)) and less long-term complexity mediolaterally ( p = 0.001, 95% CI (0.015, 0.056)). Condition differences are additionally presented. Conclusions Findings suggest that, for adolescents with mild traumatic brain injury, when maintaining balance visual input is relied on differently, the effectiveness of control may be an issue during dual-task, and consequently, the challenge of dual-task may be on par with single leg stance.
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Affiliation(s)
- Coren Walters-Stewart
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Coralie Rochefort
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Andre Longtin
- Department of Physics, University of Ottawa, Ottawa, Canada
| | - Roger Zemek
- Division of Pediatric Emergency Medicine, Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Heidi Sveistrup
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Kinematic differences during a jump cut maneuver between individuals with and without a concussion history. Int J Psychophysiol 2018; 132:93-98. [DOI: 10.1016/j.ijpsycho.2017.08.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/23/2017] [Accepted: 08/12/2017] [Indexed: 11/18/2022]
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Working Memory Task Influence in Postural Stability and Cognitive Function in Adolescents. Motor Control 2018; 22:425-435. [PMID: 29486627 DOI: 10.1123/mc.2017-0063] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper describes a study on postural stability and cognitive function according to the difficulty increment of a working memory task (WMT) and age group in adolescents. One hundred and twenty-three participants (13-16 years) performed single and dual tasks in a bipedal standing position while barefoot. Four trials were conducted, consisting of single and dual tasks in three progressively difficult WMT conditions (i.e., 3-, 5-, and 7-digit sequences). Friedman's analysis of variance and Kruskal-Wallis tests were conducted to test the effect of the WMT and age group, respectively. Both the WMT and age were found to affect performance (p < .01). As the cognitive requirements increased, the adolescents were not able to maintain their performance in both balance and cognition, while postural control and cognition were found to evolve with age.
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Postigo-Alonso B, Galvao-Carmona A, Benítez I, Conde-Gavilán C, Jover A, Molina S, Peña-Toledo MA, Agüera E. Cognitive-motor interference during gait in patients with Multiple Sclerosis: a mixed methods Systematic Review. Neurosci Biobehav Rev 2018; 94:126-148. [PMID: 30189226 DOI: 10.1016/j.neubiorev.2018.08.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/28/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cognitive-motor interference (CMI) has been proposed as a valid marker of daily life impairment in Multiple Sclerosis (MS). The heterogeneity and scarce number of studies regarding CMI in MS has hampered the synthesis of the existing evidence. The present systematic review employed a mixed methods approach with the aim of identifying and describing variables under which CMI is particularly useful to assess patients with MS. RESULTS MS patients showed significant CMI. The motor variables that were most sensitive in detecting significant CMI were velocity (m/s), cadence (steps/min), and double support (% gait cycle), which was also specific for MS. Among the cognitive tasks, Alternate Alphabet and Serial Subtracting 7 s were sensitive, whereas Verbal Fluency were both sensitive and specific to CMI in MS. CONCLUSIONS CMI should be assessed in MS with a standardised dual task such as the Verbal Fluency task while walking, with measurements of the double support time and the effect on the cognitive task. The clinical usefulness of CMI in the assessment of patients with MS is discussed.
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Affiliation(s)
- B Postigo-Alonso
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain; Human Neuroscience Lab (HNL), Universidad Loyola Andalucía, Seville, Spain.
| | - A Galvao-Carmona
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain; Human Neuroscience Lab (HNL), Universidad Loyola Andalucía, Seville, Spain; Institute of Biomedical Sciences, Universidad Autónoma de Chile, Santiago, Chile
| | - I Benítez
- Department of Psychology, Universidad Loyola Andalucía, Seville, Spain
| | - C Conde-Gavilán
- Dementia and Multiple Sclerosis Unit, Neurology Service, Reina Sofía University Hospital, Córdoba, Spain
| | - A Jover
- Dementia and Multiple Sclerosis Unit, Neurology Service, Reina Sofía University Hospital, Córdoba, Spain
| | - S Molina
- Dementia and Multiple Sclerosis Unit, Neurology Service, Reina Sofía University Hospital, Córdoba, Spain
| | - M A Peña-Toledo
- Dementia and Multiple Sclerosis Unit, Neurology Service, Reina Sofía University Hospital, Córdoba, Spain
| | - E Agüera
- Dementia and Multiple Sclerosis Unit, Neurology Service, Reina Sofía University Hospital, Córdoba, Spain
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On-Field Signs Predict Future Acute Symptoms After Sport-Related Concussion: A Structural Equation Modeling Study. J Int Neuropsychol Soc 2018; 24:476-485. [PMID: 29307322 DOI: 10.1017/s1355617717001321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study investigated the relationship between on-field, objective signs immediately following sport-related concussion and self-reported symptom endorsement within 1 day post injury. METHODS A retrospective case series of 237 concussed high school athletes was performed. On-field signs were evaluated immediately post injury. Self-reported symptoms (2 clusters) were collected within 1 day post injury. A two-step structural equation model and follow-up bivariate regression analyses of significant on-field signs and symptom clusters were performed. RESULTS Signs of immediate memory, β=0.20, p=.04, and postural instability, β=0.19, p < .01, significantly predicted a greater likelihood of endorsing the cognitive-migraine-fatigue symptom cluster within 1 day post injury. Regarding signs correlated with specific symptoms, immediate memory was associated with symptoms of trouble remembering, χ 2 =37.92, p < .001, odds ratio (OR)=3.89 (95% confidence interval (CI) [2.47, 6.13]), and concentration difficulties, χ 2 =10.84, p=.001, OR=2.13 (95% CI [1.37, 3.30]). Postural instability was associated with symptom endorsement of trouble remembering, χ 2 =12.08, p < .001, OR=1.76 (95% CI [1.29, 2.40]). CONCLUSIONS Certain post-concussion on-field signs exhibited after injury were associated with specific symptom endorsement within 1 day post injury. Based on these associations, individualized education-based interventions and academic accommodations may help reduce unanticipated worry from parents, students, and teachers following a student-athlete's sport-related concussion, especially in cases of delayed onset symptoms. (JINS, 2018, 24, 476-485).
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Fino PC, Parrington L, Pitt W, Martini DN, Chesnutt JC, Chou LS, King LA. Detecting gait abnormalities after concussion or mild traumatic brain injury: A systematic review of single-task, dual-task, and complex gait. Gait Posture 2018; 62:157-166. [PMID: 29550695 DOI: 10.1016/j.gaitpost.2018.03.021] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 03/01/2018] [Accepted: 03/07/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND While a growing number of studies have investigated the effects of concussion or mild traumatic brain injury (mTBI) on gait, many studies use different experimental paradigms and outcome measures. The path for translating experimental studies for objective clinical assessments of gait is unclear. RESEARCH QUESTION This review asked 2 questions: 1) is gait abnormal after concussion/mTBI, and 2) what gait paradigms (single-task, dual-task, complex gait) detect abnormalities after concussion. METHODS Data sources included MEDLINE/PubMed, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) accessed on March 14, 2017. Original research articles reporting gait outcomes in people with concussion or mTBI were included. Studies of moderate, severe, or unspecified TBI, and studies without a comparator were excluded. RESULTS After screening 233 articles, 38 studies were included and assigned to one or more sections based on the protocol and reported outcomes. Twenty-six articles reported single-task simple gait outcomes, 24 reported dual-task simple gait outcomes, 21 reported single-task complex gait outcomes, and 10 reported dual-task complex gait outcomes. SIGNIFICANCE Overall, this review provides evidence for two conclusions: 1) gait is abnormal acutely after concussion/mTBI but generally resolves over time; and 2) the inconsistency of findings, small sample sizes, and small number of studies examining homogenous measures at the same time-period post-concussion highlight the need for replication across independent populations and investigators. Future research should concentrate on dual-task and complex gait tasks, as they showed promise for detecting abnormal locomotor function outside of the acute timeframe. Additionally, studies should provide detailed demographic and clinical characteristics to enable more refined comparisons across studies.
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Affiliation(s)
- Peter C Fino
- Department of Neurology, Oregon Health & Science University, United States; Veterans Affairs Portland Health Care System, United States.
| | - Lucy Parrington
- Department of Neurology, Oregon Health & Science University, United States
| | - Will Pitt
- Department of Human Physiology, University of Oregon, United States
| | - Douglas N Martini
- Department of Neurology, Oregon Health & Science University, United States; Veterans Affairs Portland Health Care System, United States
| | - James C Chesnutt
- Department of Orthopedics & Rehabilitation and Family Medicine, Oregon Health & Science University, United States
| | - Li-Shan Chou
- Department of Human Physiology, University of Oregon, United States
| | - Laurie A King
- Department of Neurology, Oregon Health & Science University, United States; National Center for Rehabilitative Auditory Research, Veterans Affairs Portland Health Care System, United States
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