Older adults and balance dysfunction

Parkinson's disease diagnosis using deep learning: A bibliometric analysis and literature review

Parkinson's Disease (PD) is a progressive neurodegenerative illness triggered by decreased dopamine secretion. Deep Learning (DL) has gained substantial attention in PD diagnosis research, with an increase in the number of published papers in this discipline. PD detection using DL has presented more promising outcomes as compared with common machine learning approaches. This article aims to conduct a bibliometric analysis and a literature review focusing on the prominent developments taking place in this area. To achieve the target of the study, we retrieved and analyzed the available research papers in the Scopus database. Following that, we conducted a bibliometric analysis to inspect the structure of keywords, authors, and countries in the surveyed studies by providing visual representations of the bibliometric data using VOSviewer software. The study also provides an in-depth review of the literature focusing on different indicators of PD, deployed approaches, and performance metrics. The outcomes indicate the firm development of PD diagnosis using DL approaches over time and a large diversity of studies worldwide. Additionally, the literature review presented a research gap in DL approaches related to incremental learning, particularly in relation to big data analysis.

Chinese Version of the Vestibular Disorders Activities of Daily Living Scale

OBJECTIVES/HYPOTHESIS

To translate and cross-culturally adapt vestibular disorders activities of daily living (VADL) scale to Chinese population, and verify its psychometric characteristics.

STUDY DESIGN

A methodology study to translate, validate, and verify the reliability of the VADL scale.

METHODS

The translation of the VADL from English to Chinese was carried out in accordance with the recommendations proposed by the Process of Cross-Cultural Adaptation guideline. All 185 Subjects with chief complaints of dizziness or vertigo were continuously invited to the study from January 2021 to June 2021. Investigation using the Chinese version of VADL (VADL-C) was completed by all the participants. Complete data from all 124 participants were used for reliability and internal consistency analysis by using SPSS 22.0.

RESULTS

Through careful and complete translation and adaptation, the VADL-C was successfully created. The content validity of the VADL-C was 0.887, the internal consistency was 0.951, and the test-retest reliability was 0.989.

CONCLUSIONS

The VADL-C has an excellent internal consistency, test-retest reliability, and content validity. It will be a new tool to be used in China and for overseas Chinese speakers to explore the functional capacity of individuals with vestibular diseases and guide therapy planning, particularly in vestibular rehabilitation training program. Laryngoscope, 2021.

Capacidade, desempenho e confiança da marcha como preditores de quedas em indivíduos pós-acidente vascular encefálico

RESUMO O objetivo deste estudo foi avaliar a correlação entre capacidade, desempenho e confiança da marcha e número de quedas em indivíduos após sofrerem acidente vascular encefálico (AVE), além de investigar quais dessas variáveis relacionadas à marcha poderiam predizer as quedas nessa população. Foram avaliados 95 indivíduos pós-AVE, de acordo com número de quedas no último ano e capacidade de marcha (por meio de teste de caminhada de 10 metros), desempenho na marcha (pela aplicação do questionário ABILOCO-Brasil) e confiança na marcha (pela análise de modified gait efficacy scale). O coeficiente de correlação de Pearson foi utilizado para avaliar as correlações entre as variáveis. A regressão linear múltipla foi aplicada para avaliar se as variáveis relacionadas à marcha são capazes de predizer as quedas em indivíduos pós-AVE. Não foram encontradas correlações significativas entre capacidade (p=0,87) e performance na marcha (p=0,06) e número de quedas. Correlação significativa, negativa, de magnitude moderada, foi encontrada somente entre confiança na marcha e quedas (r=−0,43; p<0,01). Na análise de regressão, apenas a confiança na marcha permaneceu no modelo (p<0,01) como preditora do número de quedas em indivíduos pós-AVE, sendo capaz, sozinha, de explicar 18% (R2=0,18) dessa variável. Assim, os achados do estudo demonstraram que apenas a confiança na marcha está diretamente relacionada com o número de quedas em indivíduos pós-AVE, sendo essa também a única variável que pode ser considerada preditora desse evento nessa população.

[Clinical strategies to prevent falls]

With the aging of population structure, the age-related balance dysfunction increases gradually, and the injuries related fall are increasing, which cause a serious social and economic burden. In addition, dizziness or vertigo is very common clinically, and these patients also have a higher risk of falling. In order to reduce the incidence of falls, targeted prevention measures are urgently needed. In this paper, the risk assessment, preventive measures and rehabilitation strategies of falls are systematically expounded, it is hoped that it will be helpful for the prevention and treatment of falls.

Automatic Gait Phases Detection in Parkinson Disease: A Comparative Study

BACKGROUND

Parkinson's disease (PD) is a chronic condition that can be diagnosed and monitored by evaluating changes in the gait and arm movement parameters. In the gait movement, each cycle consists of two phases: stance and swing. Using gait analysis techniques, it is possible to get spatiotemporal variables derived from both phases.

OBJECTIVE

In this paper, we compared two techniques: wavelet and peak detection. Previously, the wavelet technique was assessed for the gait phases detection, and peak detection was evaluated for arm swing analysis. These methods were evaluated using a low-cost RGB-D camera as data input source. This comparison could provide a unified and integrated method to analyze gait and arm swing signals.

METHODS

Twenty-five PD patients and 25 age-matched, healthy subjects were included. Mann-Whitney U test was used to compare the continuous variables between groups. Hamming distances and Spearman rank correlation were used to evaluate the agreement between the signals and the spatiotemporal variables obtained by both methods.

RESULTS

PD group showed significant reductions in speed (wavelet p = 0.001, peak detection p <0.001) and significantly greater swing (wavelet p = 0.003, peak detection p =0.005) and stance times (wavelet p = 0.003, peak detection p =0.004). Hamming distances showed small differences between the signals obtained by both methods (16 to 18 signal points). A very strong correlation (Spearman rho > 0.8, p <0.05) was found between the spatiotemporal variables obtained by each signal processing technique.

CONCLUSION

Wavelet and peak detection techniques showed a high agreement in the signal obtained from gait data. The spatiotemporal variables obtained by both methods showed significant differences between the walking patterns of PD patients and healthy subjects. The peak detection technique can be used for integral motion analysis, providing the identification of the phases in the gait cycle, and arm swing parameters.Clinical Relevance- this establishes that peaks and wavelet techniques are comparable and may use it interchangeably to process signals from the gait of Parkinson's disease patients to support diagnosis and follow up made by a clinical expert.

Presbyvestibulopathy: Diagnostic criteria Consensus document of the classification committee of the Bárány Society

This paper describes the diagnostic criteria for presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. PVP is defined as a chronic vestibular syndrome characterized by unsteadiness, gait disturbance, and/or recurrent falls in the presence of mild bilateral vestibular deficits, with findings on laboratory tests that are between normal values and thresholds established for bilateral vestibulopathy.

The diagnosis of PVP is based on the patient history, bedside examination and laboratory evaluation. The diagnosis of PVP requires bilaterally reduced function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the VOR with the video-HIT (vHIT); for the middle frequency range with rotary chair testing; and for the low frequency range with caloric testing.

For the diagnosis of PVP, the horizontal angular VOR gain on both sides should be < 0.8 and > 0.6, and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side should be < 25°/s and > 6°/s, and/or the horizontal angular VOR gain should be > 0.1 and < 0.3 upon sinusoidal stimulation on a rotatory chair.

PVP typically occurs along with other age-related deficits of vision, proprioception, and/or cortical, cerebellar and extrapyramidal function which also contribute and might even be required for the manifestation of the symptoms of unsteadiness, gait disturbance, and falls. These criteria simply consider the presence of these symptoms, along with documented impairment of vestibular function, in older adults.

Virtual reality in vestibular rehabilitation: a pilot study

Background/Aims

We evaluated the efficacy of using virtual reality with specific games for vestibular rehabilitation to treat patients with benign paroxysmal positional vertigo.

Methods

The Activity-Specific Balance Confidence Scale (ABC Scale), Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Berg Balance Scale, Balancim, Romberg and Dix-Hallpike tests were used to evaluate 10 participants (5 males and 5 females; mean age 38.5 ± 14.7 years) with benign paroxysmal positional vertigo, who played 3 specific games of Nintendo Wii console (Snowboard Slalom, Tightrope Walk, Rhythm Parade) for 10 minutes twice a week for 4 weeks.

Results

The intervention resulted in significant increases in Activity-Specific Balance Confidence Scale score (d de Cohen >0.50), decreases in Dizziness Handicap Inventory (P<0.05 in t test for all dimensions and total score) and Tinnitus Handicap Inventory (P<0.05 in Wilcoxon test for all dimensions and total score), and improvement in balance shown on Romberg test, Berg Balance Scale (P<0.05 in t test for all dimensions and total score) and Balancim (d de Cohen >0.80).

Conclusions

Virtual reality with the selected games seemed to be effective on benign paroxysmal positional vertigo treatment, improving scores of tests and scales used in the assessment.

A quantitative analysis of postural control in elderly patients with vestibular disorders using visual stimulation by virtual reality

Introduction

Postural instability is one the most common disabling features in vestibular disorders.

Objective

This study aimed to analyze the limit of stability and the influence of manipulation of visual, somatosensorial and visual–vestibular information on postural control in older adults with vestibular disorder, with and without a history of falls.

Methods

Cross-sectional study. Participants – 76 elderly patients with vestibular disorder (G1, without falls; G2, with falls) and 41 healthy elderly subjects (control group; CG). Using posturography, analyzed were limit of stability area, body center of pressure, and velocity of oscillation in the standing position in 10 conditions, including open/closed eyes, unstable surface with eyes closed, saccadic and optokinetic stimuli, and visual–vestibular interaction.

Results

Limit of stability area in CG was better compared with G1-2, and center of pressure values were worse in G1 than in CG. Center of pressure area in all conditions and velocity of oscillation in the following conditions: open/closed eyes, optokinetic stimulation, and visual–vestibular interaction showed worse values in G2 than in CG. Center of pressure area in the following conditions: open/closed eyes, saccadic and optokinetic stimuli, visual–vestibular interaction, and unstable surface with eyes closed showed worse values in G2 than in G1.

Conclusion

Older adults with vestibular disorder presented reduced limit of stability and increased postural sway in the following conditions: conflict between visual and somatosensory information and visual–vestibular interaction. Deterioration in postural control was significantly associated with history of falls.

The Vestibular System and Ageing

The world's population is ageing due to increased hygiene and improved medical care. Dizziness and imbalance frequently affect the elderly and is most common among individuals over the age of 60. In this age group approximately 30% of the population experience these debilitating symptoms at some point. They contribute to falls and frailty, which often result in hospitalization causing tremendous cost for the health care systems, and increased mortality. To make the matters worse balance disorders are often complex. Physicians face the difficulty of diagnosing the patient with the exact disorder especially since each disorder may manifest differently in each patient. In addition, several treatment options exist, however, with a low level of evidence. This chapter summarizes the underlying degenerative processes of the peripheral as well as the central vestibular system, diagnostic tools, the most common balance disorders in the elderly, and possible treatment options of these disorders.

Parkinson's disease: Diagnosis and appreciation of comorbidities

Parkinson's disease (PD) is a complex neuropsychiatric disorder that manifests with a variety of motor and nonmotor symptoms. Its incidence increases with age. It is important for clinicians to be able to distinguish symptoms of aging and other comorbidities from those of PD. The diagnosis of PD has traditionally been rendered using strict criteria that mainly rely on the cardinal motor symptoms of rest tremor, rigidity, and bradykinesia. However, newer diagnostic criteria proposed by the Movement Disorders Society for diagnosis of PD collectively reflect a greater appreciation for the nonmotor symptoms. The treatment of PD remains symptomatic and the most noticeable improvements have been documented in the motor symptoms. Levodopa remains the gold standard for therapy, however there are now many other potential medical and surgical treatment strategies. Nonmotor symptoms have been shown to affect quality of life more than the motor symptoms. There is ongoing research into symptomatic and disease modifying treatments. Given the multisystem involvement in PD, an interdisciplinary patient-centered approach is recommended by most experts. This chapter addresses first the diagnostic approach and the many geriatric considerations. This is followed by a review of the nonmotor symptoms. Finally, a summary of current treatment strategies in PD is presented along with potential treatment complications.

The influence of ageing and diabetic peripheral neuropathy on posture sway, tremor, and the time to achieve balance equilibrium

BACKGROUND

It is well recognized that ageing and diabetes are associated with reduced balance and impaired gait. However, one important factor may be not just balance, but how long it takes to achieve balance equilibrium after a balance challenge. This study examined the relationship between balance, tremor, and time to achieve balance after a challenge to stability in young and old individuals without and without diabetes.

METHODS

Twenty-four of the subjects were young controls, 22 were older controls, 23 were individuals with diabetes, and 21 were young people with diabetes. Posture sway, tremor, and time to achieve stability were assessed on a force plate during 8 progressively challenging balance tasks.

RESULTS

For postural sway, tremor and time to reach postural stability, there was a significant difference in all groups with the increased balance challenge of the 8 tests (P<0.01). However, ageing and diabetes made balance, tremor and time to reach stability worse. In general, the young group with diabetes, for example, had similar responses to the old group without diabetes.

CONCLUSIONS

In the subjects with diabetes, balance was poorer than the non-diabetes groups. The young subjects with diabetes showed similar results to the older subjects without diabetes. Diabetes subjects had more muscle tremor and a slower response time of the body to a balance challenge. This may account for increased falls in individuals with diabetes.

Age-Related Interference between the Selection of Input-Output Modality Mappings and Postural Control-a Pilot Study

Age-related decline in executive functions and postural control due to degenerative processes in the central nervous system have been related to increased fall-risk in old age. Many studies have shown cognitive-postural dual-task interference in old adults, but research on the role of specific executive functions in this context has just begun. In this study, we addressed the question whether postural control is impaired depending on the coordination of concurrent response-selection processes related to the compatibility of input and output modality mappings as compared to impairments related to working-memory load in the comparison of cognitive dual and single tasks. Specifically, we measured total center of pressure (CoP) displacements in healthy female participants aged 19–30 and 66–84 years while they performed different versions of a spatial one-back working memory task during semi-tandem stance on an unstable surface (i.e., balance pad) while standing on a force plate. The specific working-memory tasks comprised: (i) modality compatible single tasks (i.e., visual-manual or auditory-vocal tasks), (ii) modality compatible dual tasks (i.e., visual-manual and auditory-vocal tasks), (iii) modality incompatible single tasks (i.e., visual-vocal or auditory-manual tasks), and (iv) modality incompatible dual tasks (i.e., visual-vocal and auditory-manual tasks). In addition, participants performed the same tasks while sitting. As expected from previous research, old adults showed generally impaired performance under high working-memory load (i.e., dual vs. single one-back task). In addition, modality compatibility affected one-back performance in dual-task but not in single-task conditions with strikingly pronounced impairments in old adults. Notably, the modality incompatible dual task also resulted in a selective increase in total CoP displacements compared to the modality compatible dual task in the old but not in the young participants. These results suggest that in addition to effects of working-memory load, processes related to simultaneously overcoming special linkages between input- and output modalities interfere with postural control in old but not in young female adults. Our preliminary data provide further evidence for the involvement of cognitive control processes in postural tasks.

A reliability assessment software using Kinect to complement the clinical evaluation of Parkinson's disease

Parkinson's disease is characterized by alterations in the gait pattern that may increase the risk of falls. Variations in the gait pattern cannot be objectively measured in clinical examination, so it is necessary to adapt devices to measure objectively, valid and replicable changes in gait patterns that are part of the evolution of the disease and / or pharmacotherapy. In an interdisciplinary effort, we developed the "e-Motion Capture System" software, which is able to calculate motor (cadence, stride and step length) and spatiotemporal (velocity and acceleration) parameters that affect quality of life in patients with Parkinson's disease. In this paper, we show results of the comparison between our e-Motion software and a benchmark reference, multiple-camera 3D motion capture system to track a gait pattern. This analysis was performed to compare the spatial locations of the ankles of a volunteer under indoor controlled conditions. Our results for the comparison between e-Motion and the 3D motion capture system show excellent agreement.

Prevalência de vestibulopatia em idosos institucionalizados de Natal - RN - Brasil

Resumo: OBJETIVO: aferir a prevalência de vestibulopatia e seus fatores associadosem idosos institucionalizados por meio do exame clínico de cabeceira. MÉTODOS: trata-se de um estudo transversal realizado nas 12 Instituições de longa permanência para idosos de Natal-Brasil, regulamentadas pela Vigilância Sanitária. Foram eleitos os idosos com bom nível cognitivo e capazes de deambular, totalizando 115 indivíduos. Os idosos foram questionados sobre a presença de tontura no último ano, e quando a resposta era positiva, eram submetidos a questionário e exame físico específico para diagnóstico de vestibulopatia, segundo o protocolo de Johnson e Lalwani (2004). Para a análise estatística, utilizou-se o teste do Qui-quadrado ou exato de Fisher para um nível de significância de 5% e cálculo da razão de prevalência. RESULTADOS: a prevalência de vestibulopatia foi de 10,56%e foram associados a osteoartrose e o etilismo. CONCLUSÃO: a vestibulopatia apresenta baixa prevalência nos idosos institucionalizados de Natal-Brasil.

Aging of the Human Vestibular System

Aging affects every sensory system in the body, including the vestibular system. Although its impact is often difficult to quantify, the deleterious impact of aging on the vestibular system is serious both medically and economically. The deterioration of the vestibular sensory end organs has been known since the 1970s; however, the measurable impact from these anatomical changes remains elusive. Tests of vestibular function either fall short in their ability to quantify such anatomical deterioration, or they are insensitive to the associated physiologic decline and/or central compensatory mechanisms that accompany the vestibular aging process. When compared with healthy younger individuals, a paucity of subtle differences in test results has been reported in the healthy older population, and those differences are often observed only in response to nontraditional and/or more robust stimuli. In addition, the reported differences are often clinically insignificant insomuch that the recorded physiologic responses from the elderly often fall within the wide normative response ranges identified for normal healthy adults. The damaging economic impact of such vestibular sensory decline manifests itself in an exponential increase in geriatric dizziness and a subsequent higher prevalence of injurious falls. An estimated $10 to $20 billion dollar annual cost has been reported to be associated with falls-related injuries and is the sixth leading cause of death in the elderly population, with a 20% mortality rate. With an estimated 115% increase in the geriatric population over 65 years of age by the year 2050, the number of balanced-disordered patients with a declining vestibular system is certain to reach near epidemic proportions. An understanding of the effects of age on the vestibular system is imperative if clinicians are to better manage elderly patients with balance disorders, dizziness, and vestibular disease.

Brazilian version of the Vestibular Disorders Activities of Daily Living Scale (VADL)

The Vestibular Disorders Activities of Daily Living Scale (VADL) assesses the impact of dizziness and body imbalance on the everyday activities of patients with vestibulopathy. The scale encompasses 28 activities divided into three sub-scales (functional, ambulation and instrumental).

OBJECTIVE

To translate and cross-culturally adapt the VADL to the Brazilian Portuguese language and verify its reliability.

METHOD

Questionnaire translation methodological research. Eighty elderly subjects (age > 65 years) with chronic dizziness arising from vestibular disorders were enrolled, of which 40 participated in the pre-testing stage and 40 in reliability analysis. Concordance Correlation Coefficient (CCC) analysis was used to assess reliability. Internal consistency was estimated using Cronbach's alpha (α).

RESULTS

Pre-test analysis revealed 15% of incomprehension on two activities; these items had to be adapted. The VADL-Brazil had similar levels of test-retest and inter-rater reliability for total score and presented substantial agreement (CCC = 0.79). Internal consistency was excellent for total score (α = 0.92), good for the functional (α = 0.89) and locomotion (α = 0.86) sub-scales, and poor for the instrumental subscale (α = 0.56).

CONCLUSION

The Brazilian version of the VADL was proven adequate, with good levels of reliability and internal consistency. It might be thus considered as an alternative to assess the functional capacity of vestibulopathy patients.

Effects of conventional versus multimodal vestibular rehabilitation on functional capacity and balance control in older people with chronic dizziness from vestibular disorders: design of a randomized clinical trial

BACKGROUND

There are several protocols designed to treat vestibular disorders that focus on habituation, substitution, adaptation, and compensation exercises. However, protocols that contemplate not only vestibular stimulation but also other components that are essential to the body balance control in older people are rare. This study aims to compare the effectiveness of two vestibular rehabilitation protocols (conventional versus multimodal) on the functional capacity and body balance control of older people with chronic dizziness due to vestibular disorders.

METHODS/DESIGN

A randomized, single-blind, controlled clinical trial with a 3 months follow-up period will be performed. The sample will be composed of older individuals with a clinical diagnosis of chronic dizziness resulting from vestibular disorders. The subjects will be evaluated at baseline, post-treatment and follow-up. Primary outcomes will be determined in accordance with the Dizziness Handicap Inventory (functional capacity) and the Dynamic Gait Index (body balance). Secondary outcomes include dizziness features, functional records, body balance control tests, and psychological information. The older individuals (minimum sample n = 68) will be randomized to either the conventional or multimodal Cawthorne&Cooksey protocols. The protocols will be performed during individual 50-minute sessions, twice a week, for 2 months (a total of 16 sessions). The outcomes of both protocols will be compared according to the intention-to-treat analysis.

DISCUSSION

Vestibular rehabilitation through the Cawthorne&Cooksey protocol has already proved to be effective. However, the addition of other components related to body balance control has been proposed to improve the rehabilitation of older people with chronic dizziness from vestibular disorders.

TRIAL REGISTRATION

ACTRN12610000018011.

A qualitative review of balance and strength performance in healthy older adults: impact for testing and training

A continuously greying society is confronted with specific age-related health problems (e.g., increased fall incidence/injury rate) that threaten both the quality of life of fall-prone individuals as well as the long-term sustainability of the public health care system due to high treatment costs of fall-related injuries (e.g., femoral neck fracture). Thus, intense research efforts are needed from interdisciplinary fields (e.g., geriatrics, neurology, and exercise science) to (a) elucidate neuromuscular fall-risk factors, (b) develop and apply adequate fall-risk assessment tools that can be administered in clinical practice, and (c) develop and design effective intervention programs that have the potential to counteract a large number of fall-risk factors by ultimately reducing the number of falls in the healthy elderly. This paper makes an effort to present the above-raised research topics in order to provide clinicians, therapists, and practitioners with the current state-of-the-art information.

Geriatric primer - common geriatric syndromes and special problems

Geriatric syndromes are common problems that affect older adults. They are often thought of as causes of morbidity in one or more functional domains, but they can simultaneously be a consequence of morbidity as well. This primer will cover 12 problems commonly considered to be geriatric syndromes and highlight the potential for outcomes in one area to affect those in another. The syndromes included are: losses in activities of daily living, cognitive dysfunction, delirium versus dementia, depression, dizziness, osteoporosis, falls, sensory loss, nutrition and weight loss, pain, substance abuse, urinary incontinence, and constipation. Each syndrome is briefly discussed, followed by strategies for assessment and intervention by the pharmacist in a community setting.