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Sterke B, Jabeen S, Baines P, Vallery H, Ribbers G, Heijenbrok-Kal M. Direct biomechanical manipulation of human gait stability: A systematic review. PLoS One 2024; 19:e0305564. [PMID: 38990959 PMCID: PMC11239080 DOI: 10.1371/journal.pone.0305564] [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: 03/03/2023] [Accepted: 05/31/2024] [Indexed: 07/13/2024] Open
Abstract
People fall more often when their gait stability is reduced. Gait stability can be directly manipulated by exerting forces or moments onto a person, ranging from simple walking sticks to complex wearable robotics. A systematic review of the literature was performed to determine: What is the level of evidence for different types of mechanical manipulations on improving gait stability? The study was registered at PROSPERO (CRD42020180631). Databases Embase, Medline All, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, and Google Scholar were searched. The final search was conducted on the 1st of December, 2022. The included studies contained mechanical devices that influence gait stability for both impaired and non-impaired subjects. Studies performed with prosthetic devices, passive orthoses, and analysing post-training effects were excluded. An adapted NIH quality assessment tool was used to assess the study quality and risk of bias. Studies were grouped based on the type of device, point of application, and direction of forces and moments. For each device type, a best-evidence synthesis was performed to quantify the level of evidence based on the type of validity of the reported outcome measures and the study quality assessment score. Impaired and non-impaired study participants were considered separately. From a total of 4701 papers, 53 were included in our analysis. For impaired subjects, indicative evidence was found for medio-lateral pelvis stabilisation for improving gait stability, while limited evidence was found for hip joint assistance and canes. For non-impaired subjects, moderate evidence was found for medio-lateral pelvis stabilisation and limited evidence for body weight support. For all other device types, either indicative or insufficient evidence was found for improving gait stability. Our findings also highlight the lack of consensus on outcome measures amongst studies of devices focused on manipulating gait.
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Affiliation(s)
- Bram Sterke
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Saher Jabeen
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Patricia Baines
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Heike Vallery
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Biomechanical Engineering, Technical University of Delft, Delft, The Netherlands
| | - Gerard Ribbers
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
| | - Majanka Heijenbrok-Kal
- Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Rijndam Rehabilitation Center, Rotterdam, The Netherlands
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2
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Lin MIB, Wu B, Cheng SW. Changes in Navigation Controls and Field-of-View Modes Affect Cybersickness Severity and Spatiotemporal Gait Patterns After Exposure to Virtual Environments. HUMAN FACTORS 2024; 66:1942-1960. [PMID: 37501376 DOI: 10.1177/00187208231190982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE To examine the effects of navigation controls and field-of-view modes on cybersickness severity and gait dynamics after cessation of exposure to a virtual environment (VE). BACKGROUND The applications of virtual reality are increasing in various fields; however, whether changes in interaction techniques and visual contents could mitigate the potential gait disturbance following VE exposure remains unclear. METHOD Thirty healthy adults wore a head-mounted display to complete six sessions of 12-min run-and-gun tasks using different navigation controls (gamepad, head, natural) and field-of-view modes (full, restricted). Forward and backward walking tasks were performed before and after VE exposure. The degrees of cybersickness and presence were evaluated using questionnaires, along with the in-session task performance. Spatiotemporal gait measures and their variabilities were calculated for each walking task. RESULTS The participants experienced less cybersickness with the head and natural controls than with the gamepad. Natural control, based on matching body movements, was associated with the highest degree of presence and best performance. VE navigation using the gamepad showed reduced cadences and increased stride times during postexposure forward-walking tasks. When the VE was presented via the restricted field-of-view mode, increased gait variabilities were observed from backward-walking tasks after VE exposure. CONCLUSION Body movement-based navigation controls may alleviate cybersickness. We observed gait adaptation during both ambulation tasks, which was influenced by the navigation control method and field-of-view mode. APPLICATION This study provides the first evidence for gait adaptation during balance-demanding tasks after VE exposure, which is valuable for designing guidelines for virtual reality interactions.
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Affiliation(s)
- Ming-I Brandon Lin
- Department of Industrial and Information Management, National Cheng Kung University, Tainan, Taiwan
- Institute of Information Management, National Cheng Kung University, Tainan, Taiwan
| | - Bonnie Wu
- Department of Industrial and Information Management, National Cheng Kung University, Tainan, Taiwan
| | - Shun-Wen Cheng
- Institute of Information Management, National Cheng Kung University, Tainan, Taiwan
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3
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Zhang Y, Weijer RHA, van Schooten KS, Bruijn SM, Pijnappels M. External Validation and Further Exploration of Fall Prediction Models Based on Questionnaires and Daily-Life Trunk Accelerometry. J Am Med Dir Assoc 2024; 25:105107. [PMID: 38917964 DOI: 10.1016/j.jamda.2024.105107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 05/13/2024] [Accepted: 05/17/2024] [Indexed: 06/27/2024]
Abstract
Ambulatory measurements of trunk accelerations can provide valuable insight into the amount and quality of daily life activities. Such information has been used to create models to identify individuals at high risk of falls. However, external validation of such prediction models is lacking, yet crucial for clinical implementation. We externally validated 3 previously described fall prediction models. Complete questionnaires and 1-week trunk acceleration data were obtained from 263 community-dwelling people (mean age 71.8 years, 68.1% female). To validate models, we first used the coefficients and optimal cutoffs from the original cohort, then recalibrated the original models, as well as optimized parameters based on our new cohort. Among all participants, 39.9% experienced falls during a 6-month follow-up. All models showed poor precision (0.20-0.49), poor sensitivity (0.32-0.58), and good specificity (0.45-0.89). Calibration of the original models had limited effect on model performance. Using coefficients and cutoffs optimized on the external cohort also had limited benefits. Lastly, the odds ratios in our cohort were different from those in the original cohort, which indicated that gait characteristics, except for the index of harmonicity ML (medial-lateral direction), were not statistically associated with falls. Fall risk prediction in our cohort was not as effective as in the original cohort. Recalibration as well as optimized model parameters resulted in a limited increase in accuracy. Fall prediction models are highly specific to the cohort studied. This highlights the need for large representative cohorts, preferably with an external validation cohort.
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Affiliation(s)
- Yuge Zhang
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel H A Weijer
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Kimberley S van Schooten
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Population Health, University of New South Wales, Sydney, Australia
| | - Sjoerd M Bruijn
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Institute of Brain and Behavior Amsterdam, Amsterdam, the Netherlands
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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Koren Y, Barzel O, Shmuelof L, Handelzalts S. Spatiotemporal variability after stroke reflects more than just slow walking velocity. Gait Posture 2024; 110:59-64. [PMID: 38493556 DOI: 10.1016/j.gaitpost.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/27/2023] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Increased spatiotemporal gait variability is considered a clinical biomarker of ageing and pathology, and a predictor of future falls. Nevertheless, it is unclear whether the increased spatiotemporal variability observed in persons with stroke is directly related to the pathology or simply reflects their choice of walking velocity. RESEARCH QUESTION Does increased spatiotemporal gait variability directly relate to motor coordination deficits after stroke? METHODS Forty persons with stroke participated in this cross-sectional study. Participants performed the lower-extremity motor coordination test (LEMOCOT) on an electronic mat equipped with force sensors. Then, participants walked for 120 s on a computerized treadmill at their comfortable walking velocity. For the LEMOCOT we used the traditional score of in-target touch count and computed the absolute and variable error around the targets. For gait variability, we extracted the standard deviation of step time, step length, step velocity, and step width. Using linear modeling, we tested the correlations of gait variability with the outcome measures from the LEMOCOT, after controlling for walking velocity. RESULTS The variability in step time, step length and step width correlated with walking velocity, while the variability in step velocity did not. After controlling for walking velocity, we observed that the LEMOCOT score correlated with the variance in step time, and the variable error in the LEMOCOT correlated with the variance in step length, in step width, and in step velocity. No significant correlation with any of the velocity-controlled step parameters was found for the absolute error in the LEMOCOT. SIGNIFICANCE Decreased performance in the LEMOCOT was associated with increased spatiotemporal variability in persons with stroke, regardless of their walking velocity. Our results demonstrate the connection between lower-extremity coordination impairments and deficits in gait function.
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Affiliation(s)
- Yogev Koren
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Translational Neurorehabilitation Laboratory, Adi-Negev Nahalat Eran Rehabilitation Center, Ofakim, Israel
| | - Oren Barzel
- Sheba Medical Center, Ramat Gan, Israel; Adi-Negev Rehabilitation Center, Nahalat Eran, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Ono Academic College, Kiryat Ono, Israel
| | - Lior Shmuelof
- The Translational Neurorehabilitation Laboratory, Adi-Negev Nahalat Eran Rehabilitation Center, Ofakim, Israel; Department of Cognitive and Brain Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shirley Handelzalts
- Department of Physical Therapy, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; The Translational Neurorehabilitation Laboratory, Adi-Negev Nahalat Eran Rehabilitation Center, Ofakim, Israel; Department of Physical Therapy, Loewenstein Rehabilitation Medical Center, Raanana, Israel.
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Tramontano M, Orejel Bustos AS, Montemurro R, Vasta S, Marangon G, Belluscio V, Morone G, Modugno N, Buzzi MG, Formisano R, Bergamini E, Vannozzi G. Dynamic Stability, Symmetry, and Smoothness of Gait in People with Neurological Health Conditions. SENSORS (BASEL, SWITZERLAND) 2024; 24:2451. [PMID: 38676068 PMCID: PMC11053882 DOI: 10.3390/s24082451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
Neurological disorders such as stroke, Parkinson's disease (PD), and severe traumatic brain injury (sTBI) are leading global causes of disability and mortality. This study aimed to assess the ability to walk of patients with sTBI, stroke, and PD, identifying the differences in dynamic postural stability, symmetry, and smoothness during various dynamic motor tasks. Sixty people with neurological disorders and 20 healthy participants were recruited. Inertial measurement unit (IMU) sensors were employed to measure spatiotemporal parameters and gait quality indices during different motor tasks. The Mini-BESTest, Berg Balance Scale, and Dynamic Gait Index Scoring were also used to evaluate balance and gait. People with stroke exhibited the most compromised biomechanical patterns, with lower walking speed, increased stride duration, and decreased stride frequency. They also showed higher upper body instability and greater variability in gait stability indices, as well as less gait symmetry and smoothness. PD and sTBI patients displayed significantly different temporal parameters and differences in stability parameters only at the pelvis level and in the smoothness index during both linear and curved paths. This study provides a biomechanical characterization of dynamic stability, symmetry, and smoothness in people with stroke, sTBI, and PD using an IMU-based ecological assessment.
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Affiliation(s)
- Marco Tramontano
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, 40138 Bologna, Italy;
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Amaranta Soledad Orejel Bustos
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
| | - Rebecca Montemurro
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Simona Vasta
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Gabriele Marangon
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Valeria Belluscio
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- San Raffaele Institute of Sulmona, 67039 Sulmona, Italy
| | | | - Maria Gabriella Buzzi
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Rita Formisano
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Elena Bergamini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
- Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio 7b, 24044 Dalmine, BG, Italy
| | - Giuseppe Vannozzi
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
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6
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Freitas M, Pinho F, Pinho L, Silva S, Figueira V, Vilas-Boas JP, Silva A. Biomechanical Assessment Methods Used in Chronic Stroke: A Scoping Review of Non-Linear Approaches. SENSORS (BASEL, SWITZERLAND) 2024; 24:2338. [PMID: 38610549 PMCID: PMC11014015 DOI: 10.3390/s24072338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 03/22/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
Non-linear and dynamic systems analysis of human movement has recently become increasingly widespread with the intention of better reflecting how complexity affects the adaptability of motor systems, especially after a stroke. The main objective of this scoping review was to summarize the non-linear measures used in the analysis of kinetic, kinematic, and EMG data of human movement after stroke. PRISMA-ScR guidelines were followed, establishing the eligibility criteria, the population, the concept, and the contextual framework. The examined studies were published between 1 January 2013 and 12 April 2023, in English or Portuguese, and were indexed in the databases selected for this research: PubMed®, Web of Science®, Institute of Electrical and Electronics Engineers®, Science Direct® and Google Scholar®. In total, 14 of the 763 articles met the inclusion criteria. The non-linear measures identified included entropy (n = 11), fractal analysis (n = 1), the short-term local divergence exponent (n = 1), the maximum Floquet multiplier (n = 1), and the Lyapunov exponent (n = 1). These studies focused on different motor tasks: reaching to grasp (n = 2), reaching to point (n = 1), arm tracking (n = 2), elbow flexion (n = 5), elbow extension (n = 1), wrist and finger extension upward (lifting) (n = 1), knee extension (n = 1), and walking (n = 4). When studying the complexity of human movement in chronic post-stroke adults, entropy measures, particularly sample entropy, were preferred. Kinematic assessment was mainly performed using motion capture systems, with a focus on joint angles of the upper limbs.
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Affiliation(s)
- Marta Freitas
- Escola Superior de Saúde do Vale do Ave, Cooperativa de Ensino Superior Politécnico e Universitário, Rua José António Vidal, 81, 4760-409 Vila Nova de Famalicão, Portugal; (F.P.); (L.P.); (S.S.); (V.F.)
- HM—Health and Human Movement Unit, Polytechnic University of Health, Cooperativa de Ensino Superior Politécnico e Universitário, CRL, 4760-409 Vila Nova de Famalicão, Portugal
- Center for Rehabilitation Research (CIR), R. Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal;
- Porto Biomechanics Laboratory (LABIOMEP), 4200-450 Porto, Portugal
| | - Francisco Pinho
- Escola Superior de Saúde do Vale do Ave, Cooperativa de Ensino Superior Politécnico e Universitário, Rua José António Vidal, 81, 4760-409 Vila Nova de Famalicão, Portugal; (F.P.); (L.P.); (S.S.); (V.F.)
- HM—Health and Human Movement Unit, Polytechnic University of Health, Cooperativa de Ensino Superior Politécnico e Universitário, CRL, 4760-409 Vila Nova de Famalicão, Portugal
| | - Liliana Pinho
- Escola Superior de Saúde do Vale do Ave, Cooperativa de Ensino Superior Politécnico e Universitário, Rua José António Vidal, 81, 4760-409 Vila Nova de Famalicão, Portugal; (F.P.); (L.P.); (S.S.); (V.F.)
- HM—Health and Human Movement Unit, Polytechnic University of Health, Cooperativa de Ensino Superior Politécnico e Universitário, CRL, 4760-409 Vila Nova de Famalicão, Portugal
- Center for Rehabilitation Research (CIR), R. Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal;
- Porto Biomechanics Laboratory (LABIOMEP), 4200-450 Porto, Portugal
| | - Sandra Silva
- Escola Superior de Saúde do Vale do Ave, Cooperativa de Ensino Superior Politécnico e Universitário, Rua José António Vidal, 81, 4760-409 Vila Nova de Famalicão, Portugal; (F.P.); (L.P.); (S.S.); (V.F.)
- HM—Health and Human Movement Unit, Polytechnic University of Health, Cooperativa de Ensino Superior Politécnico e Universitário, CRL, 4760-409 Vila Nova de Famalicão, Portugal
- Department of Medical Sciences, University of Aveiro, 3810-193 Aveiro, Portugal
- School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Vânia Figueira
- Escola Superior de Saúde do Vale do Ave, Cooperativa de Ensino Superior Politécnico e Universitário, Rua José António Vidal, 81, 4760-409 Vila Nova de Famalicão, Portugal; (F.P.); (L.P.); (S.S.); (V.F.)
- HM—Health and Human Movement Unit, Polytechnic University of Health, Cooperativa de Ensino Superior Politécnico e Universitário, CRL, 4760-409 Vila Nova de Famalicão, Portugal
- Porto Biomechanics Laboratory (LABIOMEP), 4200-450 Porto, Portugal
| | - João Paulo Vilas-Boas
- School of Health Sciences, University of Aveiro, 3810-193 Aveiro, Portugal;
- Centre for Research, Training, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, 4200-450 Porto, Portugal
| | - Augusta Silva
- Center for Rehabilitation Research (CIR), R. Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal;
- Department of Physiotherapy, School of Health, Polytechnic of Porto, 4200-072 Porto, Portugal
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Erdoğan MŞ, Arpak ES, Keles CSK, Villagra F, Işık EÖ, Afşar N, Yucesoy CA, Mur LAJ, Akanyeti O, Saybaşılı H. Biochemical, biomechanical and imaging biomarkers of ischemic stroke: Time for integrative thinking. Eur J Neurosci 2024; 59:1789-1818. [PMID: 38221768 DOI: 10.1111/ejn.16245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/12/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.
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Affiliation(s)
| | - Esra Sümer Arpak
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Cemre Su Kaya Keles
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
- Institute of Structural Mechanics and Dynamics in Aerospace Engineering, University of Stuttgart, Stuttgart, Germany
| | - Federico Villagra
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Esin Öztürk Işık
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Nazire Afşar
- Neurology, Acıbadem Mehmet Ali Aydınlar University, İstanbul, Turkey
| | - Can A Yucesoy
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Luis A J Mur
- Department of Life Sciences, Aberystwyth University, Aberystwyth, Wales, UK
| | - Otar Akanyeti
- Department of Computer Science, Llandinam Building, Aberystwyth University, Aberystwyth, UK
| | - Hale Saybaşılı
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
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8
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Cimorelli A, Patel A, Karakostas T, Cotton RJ. Validation of portable in-clinic video-based gait analysis for prosthesis users. Sci Rep 2024; 14:3840. [PMID: 38360820 PMCID: PMC10869722 DOI: 10.1038/s41598-024-53217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024] Open
Abstract
Despite the common focus of gait in rehabilitation, there are few tools that allow quantitatively characterizing gait in the clinic. We recently described an algorithm, trained on a large dataset from our clinical gait analysis laboratory, which produces accurate cycle-by-cycle estimates of spatiotemporal gait parameters including step timing and walking velocity. Here, we demonstrate this system generalizes well to clinical care with a validation study on prosthetic users seen in therapy and outpatient clinics. Specifically, estimated walking velocity was similar to annotated 10-m walking velocities, and cadence and foot contact times closely mirrored our wearable sensor measurements. Additionally, we found that a 2D keypoint detector pretrained on largely able-bodied individuals struggles to localize prosthetic joints, particularly for those individuals with more proximal or bilateral amputations, but after training a prosthetic-specific joint detector video-based gait analysis also works on these individuals. Further work is required to validate the other outputs from our algorithm including sagittal plane joint angles and step length. Code for the gait transformer and the trained weights are available at https://github.com/peabody124/GaitTransformer .
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Affiliation(s)
| | - Ankit Patel
- Department of Neuroscience, Baylor College of Medicine, Houston, USA
- Department of Electrical & Computer Engineering, Rice University, Houston, USA
| | - Tasos Karakostas
- Shirley Ryan AbilityLab, Chicago, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, USA
| | - R James Cotton
- Shirley Ryan AbilityLab, Chicago, USA.
- Department of Physical Medicine and Rehabilitation, Northwestern University, Evanston, USA.
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9
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Majed L, Ibrahim R, Lock MJ, Jabbour G. Walking around the preferred speed: examination of metabolic, perceptual, spatiotemporal and stability parameters. Front Physiol 2024; 15:1357172. [PMID: 38405123 PMCID: PMC10884095 DOI: 10.3389/fphys.2024.1357172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/30/2024] [Indexed: 02/27/2024] Open
Abstract
Walking is the most accessible and common type of physical activity. Exercising at one's self-selected intensity could provide long-term benefits as compared to following prescribed intensities. The aim of this study was to simultaneously examine metabolic, perceptual, spatiotemporal and stability parameters at an absolute 3 km·h-1 speed range around the individual preferred walking speed (PWS). Thirty-four young sedentary adults (18 women) volunteered to walk at seven speeds relative to their PWS in 3-min trials interspaced with 3-min rest intervals. Results indicated a significant main effect of speed on all studied variables. While metabolic, perceptual and spatiotemporal values were sensitive to the smallest change in speed (i.e., 0.5 km·h-1), a significant increase in the rate of carbohydrate oxidation and decrease in %fat oxidation were only observed at speeds above PWS. Results also revealed significantly higher coefficients of variation for stride characteristics at speeds below PWS only. Moreover, analyses of best fit models showed a quadratic relationship between most variables and speed, with the exceptions of metabolic cost of transport, rating of perceived exertion and stride duration that changed exponentially with speed. PWS coincided with optimized mechanical efficiency, fuel oxidation and gait stability. This indicated that walking below PWS decreased both mechanical efficiency and stability of gait, while walking above PWS increased carbohydrate oxidation. Those factors seem to play an important role as determinants of PWS. We suggest that walking at PWS may provide benefits in terms of fat oxidation while optimizing gait stability.
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Affiliation(s)
- Lina Majed
- Exercise Science, Health and Epidemiology Division, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Rony Ibrahim
- Physical Education Department, College of Education, Qatar University, Doha, Qatar
| | - Merilyn Jean Lock
- Exercise Science, Health and Epidemiology Division, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
| | - Georges Jabbour
- Physical Education Department, College of Education, Qatar University, Doha, Qatar
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10
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Promsri A, Deedphimai S, Promthep P, Champamuang C. Effects of Different Wearable Resistance Placements on Running Stability. Sports (Basel) 2024; 12:45. [PMID: 38393265 PMCID: PMC10892856 DOI: 10.3390/sports12020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/25/2024] Open
Abstract
Stability during running has been recognized as a crucial factor contributing to running performance. This study aimed to investigate the effects of wearable equipment containing external loads on different body parts on running stability. Fifteen recreational male runners (20.27 ± 1.23 years, age range 19-22 years) participated in five treadmill running conditions, including running without loads and running with loads equivalent to 10% of individual body weight placed on four different body positions: forearms, lower legs, trunk, and a combination of all three (forearms, lower legs, and trunk). A tri-axial accelerometer-based smartphone sensor was attached to the participants' lumbar spine (L5) to record body accelerations. The largest Lyapunov exponent (LyE) was applied to individual acceleration data as a measure of local dynamic stability, where higher LyE values suggest lower stability. The effects of load distribution appear in the mediolateral (ML) direction. Specifically, running with loads on the lower legs resulted in a lower LyE_ML value compared to running without loads (p = 0.001) and running with loads on the forearms (p < 0.001), trunk (p = 0.001), and combined segments (p = 0.005). These findings suggest that running with loads on the lower legs enhances side-to-side local dynamic stability, providing valuable insights for training.
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Affiliation(s)
- Arunee Promsri
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand; (S.D.); (P.P.); (C.C.)
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11
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Netukova S, Bizovska L, Krupicka R, Szabo Z. The relationship between the local dynamic stability of gait to cognitive and physical performance in older adults: A scoping review. Gait Posture 2024; 107:49-60. [PMID: 37734191 DOI: 10.1016/j.gaitpost.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 06/05/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Local dynamic stability (LDS) has become accepted as a gait stability indicator. The deterioration of gait stability is magnified in older adults. RESEARCH QUESTION What is the current state in the field regarding rthe relationship between LDS and cognitive and/or physical function in older adults? METHODS A scoping review design was used to search for peer-reviewed literature or conference proceedings published through May 2023 for an association between LDS and cognitive (e.g., Montreal Cognitive Assessment) or physical performance (e.g., Timed Up & Go Test) in older adults. Only studies investigating gait stability via LDS during controlled walking, when dealing with a subject group consisting of healthy older adults, and quantifying LDS relationship to cognitive and/or physical measure were included. We analysed data from the studies in a descriptive manner. RESULTS In total, 814 potentially relevant articles were selected, of which 15 met the inclusion criteria. We identified 37 LDS quantifiers employed in LDS-cognition and/or LDS-physical performance relationship assessment. Nine measures of cognitive and 20 measures of physical performance were analysed. Most studies estimated LDS quantities using triaxial acceleration data. However, there was a variance in sensor placement and signal direction. Out of the 56 studied relationships of LDS to physical performance measures, sixteen were found to be relevant. Out of 22 studied relationships between LDS and cognitive measures, only two were worthwhile. SIGNIFICANCE Considering the heterogeneity of the utilized LDS (caused by different sensors locations, signals, and signal directions as well as variety of computational approaches to estimate LDS) and cognitive/physical measures, the results of this scoping review does not indicate a current need for a systematic review with meta-analysis. To assess the overall utility of LDS to reveal a relationship between LDS to cognitive and physical performance measures, an analysis of other subject groups would be appropriate.
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Affiliation(s)
- Slavka Netukova
- Faculty of Biomedical Engineering, Czech Technical University in Prague, nam Sitna 3105, Czech Republic.
| | - Lucia Bizovska
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Radim Krupicka
- Faculty of Biomedical Engineering, Czech Technical University in Prague, nam Sitna 3105, Czech Republic
| | - Zoltan Szabo
- Faculty of Biomedical Engineering, Czech Technical University in Prague, nam Sitna 3105, Czech Republic
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12
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Yamagata S, Yamaguchi T, Shinya M, Milosevic M, Masani K. Comparison of sensitivity among dynamic balance measures during walking with different tasks. ROYAL SOCIETY OPEN SCIENCE 2024; 11:230883. [PMID: 38298402 PMCID: PMC10827416 DOI: 10.1098/rsos.230883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
Although various measures have been proposed to evaluate dynamic balance during walking, it is currently unclear which measures are most sensitive to dynamic balance. We aimed to investigate which dynamic balance measure is most sensitive to detecting differences in dynamic balance during walking across various gait parameters, including short- and long-term Lyapunov exponents (λs and λl), margin of stability (MOS), distance between the desired and measured centre of pressure (dCOP-mCOP) and whole-body angular momentum (WBAM). A total of 10 healthy young adults were asked to walk on a treadmill under three different conditions (normal walking, dual-task walking with a Stroop task as an unstable walking condition, and arm-restricted walking with arms restricted in front of the chest as another unstable walking condition) that were expected to have different dynamic balance properties. Overall, we found that λs of the centre of mass velocity, λs of the trunk velocity, λs of the hip joint angle, and the magnitude of the mediolateral dCOP-mCOP at heel contact can identify differences between tasks with a high sensitivity. Our findings provide new insights into the selection of sensitive dynamic balance measures during human walking.
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Affiliation(s)
| | - Takeshi Yamaguchi
- Department of Finemechanics, Graduate School of Engineering, Tohoku University, 6-6-01 Aramaki-Aza-Aoba, Aoba-ku, Sendai, Miyagi 980-8579, Japan
- Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Masahiro Shinya
- Graduate School of Humanities and Social Sciences, Hiroshima University, Higashi-Hiroshima, Japan
| | - Matija Milosevic
- The Miami Project to Cure Paralysis, University of Miami, Miami, FL, USA
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
- Department of Biomedical Engineering, University of Miami, Miami, FL, USA
| | - Kei Masani
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
- KITE Research Institute, University Health Network, Toronto, Canada
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13
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Kim T, Yu X, Xiong S. A multifactorial fall risk assessment system for older people utilizing a low-cost, markerless Microsoft Kinect. ERGONOMICS 2024; 67:50-68. [PMID: 37079340 DOI: 10.1080/00140139.2023.2202845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
Falls among older people are a major health concern. This study aims to develop a multifactorial fall risk assessment system for older people using a low-cost, markerless Microsoft Kinect. A Kinect-based test battery was designed to comprehensively assess major fall risk factors. A follow-up experiment was conducted with 102 older participants to assess their fall risks. Participants were divided into high and low fall risk groups based on their prospective falls over a 6-month period. Results showed that the high fall risk group performed significantly worse on the Kinect-based test battery. The developed random forest classification model achieved an average classification accuracy of 84.7%. In addition, the individual's performance was computed as the percentile value of a normative database to visualise deficiencies and targets for intervention. These findings indicate that the developed system can not only screen out 'at risk' older individuals with good accuracy, but also identify potential fall risk factors for effective fall intervention.Practitioner summary: Falls are the leading cause of injuries in older people. We newly developed a multifactorial fall risk assessment system for older people utilising a low-cost, markerless Kinect. Results showed that the developed system can screen out 'at risk' individuals and identify potential risk factors for effective fall intervention.
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Affiliation(s)
- Taekyoung Kim
- Human Factors and Ergonomics Laboratory, Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejoen, Republic of Korea
- KT R&D Center, Seoul, Republic of Korea
| | - Xiaoqun Yu
- Human Factors and Ergonomics Laboratory, Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejoen, Republic of Korea
| | - Shuping Xiong
- Human Factors and Ergonomics Laboratory, Department of Industrial and Systems Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejoen, Republic of Korea
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14
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Sasaki A, Aisawa A, Takeuchi N. Transcranial direct current stimulation facilitates backward walking training. Exp Brain Res 2024; 242:67-77. [PMID: 37955707 DOI: 10.1007/s00221-023-06728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
Backward walking training presents a great challenge to the physical and neural systems, which may result in an improvement in gait performance. Transcranial direct current electrical stimulation (tDCS), which can non-invasively enhance cortical activity, has been reported to strengthen corticomotor plasticity. We investigated whether excitatory tDCS over the primary motor cortex (M1) or the dorsolateral prefrontal cortex (DLPFC) enhances the effects of backward walking training in healthy participants. Thirty-six healthy participants (16 men and 20 women, mean age 21.3 ± 1.4 years) participated in this study. The participants were randomly assigned to one of the three tDCS groups (M1, DLPFC, and sham). They performed 5 min of backward walking training during 15 min of tDCS. We evaluated dual-task forward and backward walking performance before and after training. Both tDCS groups increased walking speed in the backward condition, but the DLPFC group increased the dual-task backward walking speed more than the M1 group. The M1 group showed decreased gait variability in dual-task backward walking, whereas the DLPFC group showed increased gait variability. Backward walking training combined with M1 stimulation may increase the backward walking speed by reducing gait variability. Backward walking training combined with DLPFC stimulation may prioritize walking speed over gait stability. Our results indicate that backward walking training combined with tDCS may be extended to other rehabilitation methods to improve gait performance.
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Affiliation(s)
- Ayuka Sasaki
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Anri Aisawa
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - Naoyuki Takeuchi
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, 1-1-1 Hondo, Akita, 010-8543, Japan.
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15
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Sterke BT, Poggensee KL, Ribbers GM, Lemus D, Vallery H. Light-Weight Wearable Gyroscopic Actuators Can Modulate Balance Performance and Gait Characteristics: A Proof-of-Concept Study. Healthcare (Basel) 2023; 11:2841. [PMID: 37957986 PMCID: PMC10647239 DOI: 10.3390/healthcare11212841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Falling is a major cause of morbidity, and is often caused by a decrease in postural stability. A key component of postural stability is whole-body centroidal angular momentum, which can be influenced by control moment gyroscopes. In this proof-of-concept study, we explore the influence of our wearable robotic gyroscopic actuator "GyroPack" on the balance performance and gait characteristics of non-impaired individuals (seven female/eight male, 30 ± 7 years, 68.8 ± 8.4 kg). Participants performed a series of balance and walking tasks with and without wearing the GyroPack. The device displayed various control modes, which were hypothesised to positively, negatively, or neutrally impact postural control. When configured as a damper, the GyroPack increased mediolateral standing time and walking distance, on a balance beam, and decreased trunk angular velocity variability, while walking on a treadmill. When configured as a negative damper, both peak trunk angular rate and trunk angular velocity variability increased during treadmill walking. This exploratory study shows that gyroscopic actuators can influence balance and gait kinematics. Our results mirror the findings of our earlier studies; though, with more than 50% mass reduction of the device, practical and clinical applicability now appears within reach.
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Affiliation(s)
- Bram T. Sterke
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Katherine L. Poggensee
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Gerard M. Ribbers
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Rijndam Revalidatie, Westersingel 300, 3015 LJ Rotterdam, The Netherlands
| | - Daniel Lemus
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
| | - Heike Vallery
- Department of Rehabilitation Medicine, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands; (K.L.P.); (G.M.R.); (H.V.)
- Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Mekelweg 2, 2628 CD Delft, The Netherlands;
- Faculty of Mechanical Engineering, Rhine-Westphalia Technical University of Aachen, 52062 Aachen, Germany
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Dai J, Jin X, Ma JX, Wu YF, Lu B, Bai HH, Ma XL. Spatiotemporal and kinematic gait analysis in patients with knee osteoarthritis and femoral varus deformity. Gait Posture 2023; 105:158-162. [PMID: 37573760 DOI: 10.1016/j.gaitpost.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/24/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Knee osteoarthritis (OA) is commonly combined with the presentation of a coronal deformity of the knee. The bony origin of the knee varus deformity can be classified as tibial origin, femoral origin, or a combination of tibial and femoral causes. Deformities of tibial origin are mostly common clinically, while patients with knee OA with femoral varus deformity are less common. RESEARCH QUESTION Do hip, knee and ankle kinematics and spatiotemporal parameters differ between patients with knee OA with femoral varus deformity and healthy subjects? METHODS Twenty-five patients (14 females and 11 males) with knee OA and femoral varus deformity and 20 healthy subjects (12 males and 8 females) as control group were included in this study. The kinematic parameters of the hip-knee-ankle joint and spatiotemporal gait parameters were included in the study. RESULTS This study found that the step speed and step length of the knee OA with femoral varus (KOAF) group were smaller than those of the control group, while double support period percentage was greater in the KOAF group. Significant differences were found in the maximum knee extension angle, maximum knee flexion angle, knee flexion range of motion, maximum hip flexion angle, maximum hip extension angle, and hip flexion range of motion between the two groups. After comparing the ankle motion between the two groups, significant differences were found in the maximum eversion angle, inversion range of motion, maximum ankle abduction angle, and abduction range of motion. SIGNIFICANCE Knee OA with femoral varus deformity causes adaptive changes in the kinematic parameters of hip, knee and ankle joints and spatiotemporal gait parameters to alleviate symptoms and maintain normal activity.
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Affiliation(s)
- Jing Dai
- Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China; Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Xin Jin
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China; Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China
| | - Jian-Xiong Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China; Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China.
| | - Yan-Fei Wu
- Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China; Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China
| | - Bin Lu
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China; Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China
| | - Hao-Hao Bai
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China; Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China
| | - Xin-Long Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin University, Tianjin 300050, China; Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin 300050, China; Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China.
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Soangra R, Smith JA, Rajagopal S, Yedavalli SVR, Anirudh ER. Classifying Unstable and Stable Walking Patterns Using Electroencephalography Signals and Machine Learning Algorithms. SENSORS (BASEL, SWITZERLAND) 2023; 23:6005. [PMID: 37447852 DOI: 10.3390/s23136005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
Analyzing unstable gait patterns from Electroencephalography (EEG) signals is vital to develop real-time brain-computer interface (BCI) systems to prevent falls and associated injuries. This study investigates the feasibility of classification algorithms to detect walking instability utilizing EEG signals. A 64-channel Brain Vision EEG system was used to acquire EEG signals from 13 healthy adults. Participants performed walking trials for four different stable and unstable conditions: (i) normal walking, (ii) normal walking with medial-lateral perturbation (MLP), (iii) normal walking with dual-tasking (Stroop), (iv) normal walking with center of mass visual feedback. Digital biomarkers were extracted using wavelet energy and entropies from the EEG signals. Algorithms like the ChronoNet, SVM, Random Forest, gradient boosting and recurrent neural networks (LSTM) could classify with 67 to 82% accuracy. The classification results show that it is possible to accurately classify different gait patterns (from stable to unstable) using EEG-based digital biomarkers. This study develops various machine-learning-based classification models using EEG datasets with potential applications in detecting unsteady gait neural signals and intervening by preventing falls and injuries.
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Affiliation(s)
- Rahul Soangra
- Fowler School of Engineering, Chapman University, Orange, CA 92866, USA
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA
| | - Jo Armour Smith
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA
| | - Sivakumar Rajagopal
- School of Electronics Engineering, Vellore Institute of Technology, Vellore 632014, India
| | - Sai Viswanth Reddy Yedavalli
- School of Electronics Engineering, Vellore Institute of Technology, Vellore 632014, India
- School of Electrical and Computer Science, University of Ottawa, Ottawa, ON K1N 6N5, Canada
| | - Erandumveetil Ramadas Anirudh
- School of Electronics Engineering, Vellore Institute of Technology, Vellore 632014, India
- Department of Electrical and Computer Engineering, University of Windsor, Windsor, ON N9B 3P4, Canada
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18
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Wang S, Nguyen TK, Bhatt T. Trip-Related Fall Risk Prediction Based on Gait Pattern in Healthy Older Adults: A Machine-Learning Approach. SENSORS (BASEL, SWITZERLAND) 2023; 23:5536. [PMID: 37420703 DOI: 10.3390/s23125536] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 07/09/2023]
Abstract
Trip perturbations are proposed to be a leading cause of falls in older adults. To prevent trip-falls, trip-related fall risk should be assessed and subsequent task-specific interventions improving recovery skills from forward balance loss should be provided to the individuals at risk of trip-fall. Therefore, this study aimed to develop trip-related fall risk prediction models from one's regular gait pattern using machine-learning approaches. A total of 298 older adults (≥60 years) who experienced a novel obstacle-induced trip perturbation in the laboratory were included in this study. Their trip outcomes were classified into three classes: no-falls (n = 192), falls with lowering strategy (L-fall, n = 84), and falls with elevating strategy (E-fall, n = 22). A total of 40 gait characteristics, which could potentially affect trip outcomes, were calculated in the regular walking trial before the trip trial. The top 50% of features (n = 20) were selected to train the prediction models using a relief-based feature selection algorithm, and an ensemble classification model was selected and trained with different numbers of features (1-20). A ten-times five-fold stratified method was utilized for cross-validation. Our results suggested that the trained models with different feature numbers showed an overall accuracy between 67% and 89% at the default cutoff and between 70% and 94% at the optimal cutoff. The prediction accuracy roughly increased along with the number of features. Among all the models, the one with 17 features could be considered the best model with the highest AUC of 0.96, and the model with 8 features could be considered the optimal model, which had a comparable AUC of 0.93 and fewer features. This study revealed that gait characteristics in regular walking could accurately predict the trip-related fall risk for healthy older adults, and the developed models could be a helpful assessment tool to identify the individuals at risk of trip-falls.
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Affiliation(s)
- Shuaijie Wang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Tuan Khang Nguyen
- Department of Computer Science, University of Illinois at Chicago, Chicago, IL 60607, USA
| | - Tanvi Bhatt
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL 60612, USA
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Castiglia SF, Trabassi D, Conte C, Ranavolo A, Coppola G, Sebastianelli G, Abagnale C, Barone F, Bighiani F, De Icco R, Tassorelli C, Serrao M. Multiscale Entropy Algorithms to Analyze Complexity and Variability of Trunk Accelerations Time Series in Subjects with Parkinson's Disease. SENSORS (BASEL, SWITZERLAND) 2023; 23:4983. [PMID: 37430896 DOI: 10.3390/s23104983] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/14/2023] [Accepted: 05/16/2023] [Indexed: 07/12/2023]
Abstract
The aim of this study was to assess the ability of multiscale sample entropy (MSE), refined composite multiscale entropy (RCMSE), and complexity index (CI) to characterize gait complexity through trunk acceleration patterns in subjects with Parkinson's disease (swPD) and healthy subjects, regardless of age or gait speed. The trunk acceleration patterns of 51 swPD and 50 healthy subjects (HS) were acquired using a lumbar-mounted magneto-inertial measurement unit during their walking. MSE, RCMSE, and CI were calculated on 2000 data points, using scale factors (τ) 1-6. Differences between swPD and HS were calculated at each τ, and the area under the receiver operating characteristics, optimal cutoff points, post-test probabilities, and diagnostic odds ratios were calculated. MSE, RCMSE, and CIs showed to differentiate swPD from HS. MSE in the anteroposterior direction at τ4 and τ5, and MSE in the ML direction at τ4 showed to characterize the gait disorders of swPD with the best trade-off between positive and negative posttest probabilities and correlated with the motor disability, pelvic kinematics, and stance phase. Using a time series of 2000 data points, a scale factor of 4 or 5 in the MSE procedure can yield the best trade-off in terms of post-test probabilities when compared to other scale factors for detecting gait variability and complexity in swPD.
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Affiliation(s)
- Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, 00078 Monte Porzio Catone, Italy
| | - Dante Trabassi
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Carmela Conte
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Alberto Ranavolo
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Gianluca Coppola
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Gabriele Sebastianelli
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Chiara Abagnale
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Francesca Barone
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
| | - Federico Bighiani
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCSS Mondino Foundation, 27100 Pavia, Italy
| | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCSS Mondino Foundation, 27100 Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCSS Mondino Foundation, 27100 Pavia, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, 04100 Latina, Italy
- Movement Analysis Laboratory, Policlinico Italia, 00162 Rome, Italy
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20
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Promsri A, Cholamjiak P, Federolf P. Walking Stability and Risk of Falls. Bioengineering (Basel) 2023; 10:bioengineering10040471. [PMID: 37106658 PMCID: PMC10135799 DOI: 10.3390/bioengineering10040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Walking stability is considered a necessary physical performance for preserving independence and preventing falls. The current study investigated the correlation between walking stability and two clinical markers for falling risk. Principal component analysis (PCA) was applied to extract the three-dimensional (3D) lower-limb kinematic data of 43 healthy older adults (69.8 ± 8.5 years, 36 females) into a set of principal movements (PMs), showing different movement components/synergies working together to accomplish the walking task goal. Then, the largest Lyapunov exponent (LyE) was applied to the first five PMs as a measure of stability, with the interpretation that the higher the LyE, the lower the stability of individual movement components. Next, the fall risk was determined using two functional motor tests-a Short Physical Performance Battery (SPPB) and a Gait Subscale of Performance-Oriented Mobility Assessment (POMA-G)-of which the higher the test score, the better the performance. The main results show that SPPB and POMA-G scores negatively correlate with the LyE seen in specific PMs (p ≤ 0.009), indicating that increasing walking instability increases the fall risk. The current findings suggest that inherent walking instability should be considered when assessing and training the lower limbs to reduce the risk of falling.
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Affiliation(s)
- Arunee Promsri
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
| | - Prasit Cholamjiak
- Department of Mathematics, School of Sciences, University of Phayao, Phayao 56000, Thailand
| | - Peter Federolf
- Department of Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
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21
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Xuan C, Zhang B, Jia X. The Effect of Human Settlement Pedestrian Environment on Gait of Older People: An Umbrella Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1567. [PMID: 36674319 PMCID: PMC9865741 DOI: 10.3390/ijerph20021567] [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: 12/26/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 06/17/2023]
Abstract
Older people are limited by the pedestrian environment in human settlements and are prone to travel difficulties, falls, and stumbles. Furthermore, we still lack systematic knowledge of the pedestrian environment affecting the gait of older people. The purpose of this review is to synthesize current evidence of effective human settlement pedestrian environments interfering with gait in older people. The systematic effects of the human settlement pedestrian environment on gait in older people are discussed. Databases such as Web of Science, Medline (via PubMed), Scopus, and Embase were searched for relevant studies up to June 2022. The literature was screened to extract relevant evidence from the included literature, assess the quality of the evidence, and analyze the systematic effects of the pedestrian environment on gait in older people. From the 4297 studies identified in the initial search, 11 systematic reviews or meta-analysis studies were screened, from which 18 environmental factors and 60 gait changes were extracted. After removing duplicate elements and merging synonymous features, a total of 53 relationships between environmental factors and gait change in older people were extracted: the main human settlement pedestrian environmental factors affecting gait change in older people in existing studies were indoor and outdoor stairs/steps, uneven and irregular ground, obstacles, walking path turns, vibration interventions, mechanical perturbation during gait, and auditory sound cues. Under the influence of these factors, older people may experience changes in the degree of cautiousness and conservatism of gait and stability, and their body posture performance and control, and muscle activation may also be affected. Factors such as ground texture or material, mechanical perturbations during gait, and vibration interventions stimulate older people's understanding and perception of their environment, but there is controversy over the results of specific gait parameters. The results support that human settlements' pedestrian environment affects the gait changes of older people in a positive or negative way. This review may likely contribute evidence-based information to aid communication among practitioners in public health, healthcare, and environmental construction. The above findings are expected to provide useful preference for associated interdisciplinary researchers to understand the interactions among pedestrian environments, human behavior, and physiological characteristics.
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Affiliation(s)
- Changzheng Xuan
- Architecture College, Inner Mongolia University of Technology (IMUT), Hohhot 010051, China
- Inner Mongolia Key Laboratory of Green Building, Hohhot 010051, China
| | - Bo Zhang
- Architecture College, Inner Mongolia University of Technology (IMUT), Hohhot 010051, China
- Inner Mongolia Key Laboratory of Green Building, Hohhot 010051, China
| | - Xiaohu Jia
- Architecture College, Inner Mongolia University of Technology (IMUT), Hohhot 010051, China
- Inner Mongolia Key Laboratory of Green Building, Hohhot 010051, China
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22
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Williams D, Martin AE. Predicting fall risk using multiple mechanics-based metrics for a planar biped model. PLoS One 2023; 18:e0283466. [PMID: 36972264 PMCID: PMC10042378 DOI: 10.1371/journal.pone.0283466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023] Open
Abstract
For both humans and robots, falls are undesirable, motivating the development of fall prediction models. Many mechanics-based fall risk metrics have been proposed and validated to varying degrees, including the extrapolated center of mass, the foot rotation index, Lyapunov exponents, joint and spatiotemporal variability, and mean spatiotemporal parameters. To obtain a best-case estimate of how well these metrics can predict fall risk both individually and in combination, this work used a planar six-link hip-knee-ankle biped model with curved feet walking at speeds ranging from 0.8 m/s to 1.2 m/s. The true number of steps to fall was determined using the mean first passage times from a Markov chain describing the gaits. In addition, each metric was estimated using the Markov chain of the gait. Because calculating the fall risk metrics from the Markov chain had not been done before, the results were validated using brute force simulations. Except for the short-term Lyapunov exponents, the Markov chains could accurately calculate the metrics. Using the Markov chain data, quadratic fall prediction models were created and evaluated. The models were further evaluated using differing length brute force simulations. None of the 49 tested fall risk metrics could accurately predict the number of steps to fall by themselves. However, when all the fall risk metrics except the Lyapunov exponents were combined into a single model, the accuracy increased substantially. These results suggest that multiple fall risk metrics must be combined to obtain a useful measure of stability. As expected, as the number of steps used to calculate the fall risk metrics increased, the accuracy and precision increased. This led to a corresponding increase in the accuracy and precision of the combined fall risk model. 300 step simulations seemed to provide the best tradeoff between accuracy and using as few steps as possible.
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Affiliation(s)
- Daniel Williams
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
| | - Anne E Martin
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
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23
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Maulet T, Cattagni T, Dubois F, Roche N, Laforet P, Bonnyaud C. Determinants and Characterization of Locomotion in Adults with Late-Onset Pompe Disease: New Clinical Biomarkers. J Neuromuscul Dis 2023; 10:963-976. [PMID: 37545258 PMCID: PMC10578228 DOI: 10.3233/jnd-230060] [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] [Accepted: 07/22/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The late-onset form of Pompe disease (LOPD) is characterized by muscle weakness, locomotor limitations and a risk of falls. The mechanisms responsible for altered locomotion in adults with LOPD are unknown. The identification of clinical biomarkers is essential for clinical follow-up and research. OBJECTIVES To identify muscle determinants of impaired locomotor performance, gait stability and gait pattern, and biomechanical determinants of falls in adults with LOPD. METHODS In this cross-sectional, case-control study, LOPD and control participants underwent 3D gait analysis, locomotor performance tests and muscle strength measurements (isokinetic dynamometer). We explored the muscular determinants of locomotor performance (gait speed, 6-minute walk test distance and timed up and go test), gait stability (spatiotemporal gait variables) and the gait pattern. We also explored biomechanical gait determinants of falls. After intergroup comparisons, determinants were sought to use forward stepwise multiple regression. RESULTS Eighteen participants with LOPD and 20 control participants were included. Locomotor performance, gait stability, and the gait pattern were significantly altered in LOPD compared to control participants. Hip abductor strength was the main common determinant of locomotor performance, gait stability and pelvic instability. Hip flexor strength was the main determinant of abnormal gait kinematics at the hip and knee. Percentage duration of single support phase during the gait cycle was the main determinant of falls. CONCLUSIONS Hip abductor strength and percentage duration of single support during gait were the major determinants of locomotor performance, gait stability, falls and the gait pattern in LOPD. These new clinical biomarkers should therefore be systematically assessed using instrumented tools to improve the follow-up of adults with LOPD. They should also be considered in future studies to accurately assess the effects of new therapies. Hip abductor strength and single support phase should also be priority targets for rehabilitation.
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Affiliation(s)
- Théo Maulet
- Laboratory End: icap, Inserm Unit 1179, UVSQ, Université Paris-Saclay, France
- Research Unit ERPHAN, Université Paris-Saclay, France
- Movement Analysis Laboratory, Functional Exploration Unit, Raymond Poincaré Garches, G. H. U.Paris Saclay, APHP, France
| | - Thomas Cattagni
- Mouvement– Interactions – Performance, MIP, UR 4334, F-44000, Nantes University, Nantes, France
| | - Fabien Dubois
- Movement Analysis Laboratory, Functional Exploration Unit, Raymond Poincaré Garches, G. H. U.Paris Saclay, APHP, France
| | - Nicolas Roche
- Laboratory End: icap, Inserm Unit 1179, UVSQ, Université Paris-Saclay, France
- Movement Analysis Laboratory, Functional Exploration Unit, Raymond Poincaré Garches, G. H. U.Paris Saclay, APHP, France
| | - Pascal Laforet
- Laboratory End: icap, Inserm Unit 1179, UVSQ, Université Paris-Saclay, France
- Neurology Unit, Raymond Poincaré Garches, G.H. U. Paris Saclay, APHP, France
| | - Céline Bonnyaud
- Research Unit ERPHAN, Université Paris-Saclay, France
- Movement Analysis Laboratory, Functional Exploration Unit, Raymond Poincaré Garches, G. H. U.Paris Saclay, APHP, France
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24
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Tsuchida M, Takenaka Y, Kokue T, Suzuki T, Kurosawa C, Yokouchi Y, Kai Y, Sugawara K. Evaluating the immediate effect of the speed alteration task on walking stability using the Timed Up and Go test. J Phys Ther Sci 2023; 35:281-288. [PMID: 37020831 PMCID: PMC10067347 DOI: 10.1589/jpts.35.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/30/2022] [Indexed: 04/03/2023] Open
Abstract
[Purpose] This study aimed to investigate how the speed alteration task, which gradually increases or conversely decreases walking speed, affected walking stability. [Participants and Methods] Thirteen healthy young adults performed two walking tasks as follows: the speed alteration task, in which the walking speed was gradually increased or decreased, and the speed constant task, in which the walking speed was maintained at a comfortable level. Before and after each task, the Timed Up and Go test was performed to analyze time, walking speed, and trajectory. The overall score of the Timed Up and Go test, as well as the scores of the three major segments (i.e., forward, turning around, and return), and nine subsegments, were calculated and analyzed. [Results] During the speed alteration task, parameters including time and walking speed of the Timed Up and Go test were significantly improved. Also, the same parameters increased significantly in the forward and return segments. These increases were also observed in the first subsegment of the forward segment and the second subsegment of the return segment. [Conclusion] The speed alteration task improved walking stability, so it could be used in gait training to improve walking stability.
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25
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Rygelová M, Uchytil J, Torres IE, Janura M. Comparison of spatiotemporal gait parameters and their variability in typically developing children aged 2, 3, and 6 years. PLoS One 2023; 18:e0285558. [PMID: 37167236 PMCID: PMC10174554 DOI: 10.1371/journal.pone.0285558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
Independent walking is an important milestone in a child's development. The maturation of central nervous system, changes in body proportions, spatiotemporal parameters of gait and their variability change are dependent on age. The first aim of this study was to compare non-normalized and normalized spatiotemporal parameters and their variability in children. The second aim was to determine which spatiotemporal parameters are most affected by aging. Data from 64 typically developing children (age: 2.0-6.9 years), who walked at a self-selected speed along a 10m walkway, were collected with a motion capture system. Spatiotemporal parameters were normalized based on leg length. The main effect of the non-normalized walking speed revealed a moderate effect size (ES = 0.72) comparing 2- and 3-years-old, a large effect size comparing 2- and 6-years-old (ES = 1.77), and a large ES comparing 3- and 6-years-old (ES = 1.22). The normalized stride width parameter showed a statistically significant difference with large effect size between 2 vs 3 (ES = 1.00), 2 vs 6 (ES = 3.17), and 3 vs 6 (ES = 1.96). A statistically significant decrease in intra-individual gait variability with increasing age was observed in all parameters except for stride width. The variability of stride width may serve as a parameter in 2-year-olds to assess deviations from typically developing children. The assessment of effect size could be a useful indicator for clinical practice.
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Affiliation(s)
- Markéta Rygelová
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Jaroslav Uchytil
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Isaac Estevan Torres
- Department of Teaching Corporal Expression, University of Valencia, Valencia, Spain
| | - Miroslav Janura
- Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
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26
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Liu M, Naseri A, Lee IC, Hu X, Lewek MD, Huang H. A simplified model for whole-body angular momentum calculation. Med Eng Phys 2023; 111:103944. [PMID: 36792238 PMCID: PMC9970829 DOI: 10.1016/j.medengphy.2022.103944] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 11/28/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
The capability to monitor gait stability during everyday life could provide key information to guide clinical intervention to patients with lower limb disabilities. Whole body angular momentum (Lbody) is a convenient stability indicator for wearable motion capture systems. However, Lbody is costly to estimate, because it requires monitoring all major body segment using expensive sensor elements. In this study, we developed a simplified rigid body model by merging connected body segments to reduce the number of body segments, which need to be monitored. We demonstrated that the Lbody could be estimated by a seven-segment model accurately for both people with and without lower extremity amputation.
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Affiliation(s)
- Ming Liu
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, North Carolina, United States.
| | - Amirreza Naseri
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, North Carolina, United States
| | - I-Chieh Lee
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, North Carolina, United States
| | - Xiaogang Hu
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, North Carolina, United States
| | - Michael D Lewek
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, North Carolina, United States
| | - He Huang
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Raleigh, North Carolina, United States
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27
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Lee JY, Ryoo HW, Ahn SY, Bok SK. Can a Biomechanical Foot Orthosis Affect Gait in Patients With Hallux Valgus? A Pilot Study. Ann Rehabil Med 2022; 46:312-319. [PMID: 36588446 PMCID: PMC9810653 DOI: 10.5535/arm.22118] [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: 09/14/2022] [Accepted: 10/31/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To investigate the effects of customized biomechanical foot orthosis (BFO) on kinematic data during gait in patients with hallux valgus (HV) deformities and compare the results with those of a normal control group. METHODS Ten patients with HV deformities and 10 healthy volunteers were enrolled in this study. HV deformity was diagnosed using biomechanical and radiological assessments by a rehabilitation physician. Patients received the customized BFO manufactured at a commercial orthosis laboratory (Biomechanics, Goyang, South Korea) according to the strictly defined procedure by a single experienced technician. The spatiotemporal and kinematic data acquired by the Vicon 3D motion capture system (Oxford Metrics, Oxford, UK) were compared between the intervention groups (control vs. HV without orthosis) and between the HV groups (with vs. without orthosis). RESULTS The temporal-spatial and kinematic parameters of the HV group were significantly different from those of the control group. After applying BFO to the HV group, significantly increased ranges of plantar flexion motion and hindfoot inversion were observed. Furthermore, the HV group with BFO showed improved gait cadence, walking speed, and stride length, although the results were not statistically significant. CONCLUSION Our results suggest that it is imperative to understand the pathophysiology of HV, and the application of customized BFO can be useful for improving kinematics in HV deformities.
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Affiliation(s)
- Ji Young Lee
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyeon woo Ryoo
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - So Young Ahn
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Soo-Kyung Bok
- Department of Rehabilitation Medicine, College of Medicine, Chungnam National University, Daejeon, Korea,Corresponding author: Soo-Kyung Bok Department of Rehabilitation Medicine, School of Medicine, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon 35015, Korea. Tel: +82-42-338-2460, Fax: +82-42-338-2461, E-mail:
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28
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Möhwald K, Schniepp R. Konzepte der Sturzrisikoabschätzung bei neurogeriatrischen
Patienten. FORTSCHRITTE DER NEUROLOGIE · PSYCHIATRIE 2022; 90:589-599. [DOI: 10.1055/a-1801-3310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Neurogeriatrische Patienten sind sturzgefährdet. Dieser Beitrag
beschreibt allgemeine, klinische und mobilitätsbezogene
Sturzrisikofaktoren und gibt eine Übersicht zur Identifikation von
sturzgefährdeten Patienten sowie praxisbezogene Instruktionen zur
Durchführung eines strukturierten, multimodalen Sturzassessments. Die
Routinediagnostik wird dadurch um standardisierte klinische Untersuchungen sowie
apparative und mobile Bewegungsanalysen erweitert.
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29
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Potter MV, Cain SM, Ojeda LV, Gurchiek RD, McGinnis RS, Perkins NC. Evaluation of Error-State Kalman Filter Method for Estimating Human Lower-Limb Kinematics during Various Walking Gaits. SENSORS (BASEL, SWITZERLAND) 2022; 22:8398. [PMID: 36366096 PMCID: PMC9654083 DOI: 10.3390/s22218398] [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: 09/20/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Inertial measurement units (IMUs) offer an attractive way to study human lower-limb kinematics without traditional laboratory constraints. We present an error-state Kalman filter method to estimate 3D joint angles, joint angle ranges of motion, stride length, and step width using data from an array of seven body-worn IMUs. Importantly, this paper contributes a novel joint axis measurement correction that reduces joint angle drift errors without assumptions of strict hinge-like joint behaviors of the hip and knee. We evaluate the method compared to two optical motion capture methods on twenty human subjects performing six different types of walking gait consisting of forward walking (at three speeds), backward walking, and lateral walking (left and right). For all gaits, RMS differences in joint angle estimates generally remain below 5 degrees for all three ankle joint angles and for flexion/extension and abduction/adduction of the hips and knees when compared to estimates from reflective markers on the IMUs. Additionally, mean RMS differences in estimated stride length and step width remain below 0.13 m for all gait types, except stride length during slow walking. This study confirms the method's potential for non-laboratory based gait analysis, motivating further evaluation with IMU-only measurements and pathological gaits.
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Affiliation(s)
- Michael V. Potter
- Department of Physics and Engineering, Francis Marion University, Florence, SC 29506, USA
| | - Stephen M. Cain
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV 26506, USA
| | - Lauro V. Ojeda
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Reed D. Gurchiek
- Department of Bioengineering, Stanford University, Stanford, CA 94305, USA
| | - Ryan S. McGinnis
- Department of Electrical and Biomedical Engineering, University of Vermont, Burlington, VT 05405, USA
| | - Noel C. Perkins
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
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30
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Nascimento MDM, Gouveia ÉR, Gouveia BR, Marques A, Martins F, Przednowek K, França C, Peralta M, Ihle A. Associations of Gait Speed, Cadence, Gait Stability Ratio, and Body Balance with Falls in Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192113926. [PMID: 36360802 PMCID: PMC9655734 DOI: 10.3390/ijerph192113926] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/07/2023]
Abstract
To investigate the association between gait speed (GS), cadence (CAD), gait stability ratio (GSR), and body balance (BB) with falls in a large sample of older adults. The analysis included 619 individuals-305 men and 314 women (69.50 ± 5.62 years)-residing in the Autonomous Region of Madeira, Portugal. Mobility in GS, CAD, and GSR was assessed using the 50-foot walk test and BB by the Fullerton Advanced Balance scale. The frequency of falls was obtained by self-report. Linear regression analysis showed that higher performance in GS and BB was able to reduce the risk of falling by up to 0.34 and 0.44 times, respectively. An increase in the GSR value enhanced the risk of falling by up to 0.10 times. Multinomial analysis indicated that, in relation to the highest tertile (reference), older adults classified with GS and BB performance in the lowest tertile (lowest) had an increased chance (OR) of falling by up to 149.3% and 48.8%, respectively. Moreover, in relation to the highest tertile, the performance of the GSR classified in the lowest and medium tercile showed an increase in the chance of falling by up to 57.4% and 56.4%, respectively.
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Affiliation(s)
- Marcelo de Maio Nascimento
- Department of Physical Education, Federal University of Vale do São Francisco, 56304-917 Petrolina, Brazil
| | - Élvio Rúbio Gouveia
- Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal
- LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland
| | - Bruna R. Gouveia
- LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland
- Regional Directorate of Health, Secretary of Health of the Autonomous Region of Madeira, 9004-515 Funchal, Portugal
- Saint Joseph of Cluny Higher School of Nursing, 9050-535 Funchal, Portugal
| | - Adilson Marques
- Faculty of Human Kinetics, University of Lisbon (CIPER), 1495-751 Lisbon, Portugal
- Faculty of Medicine, University of Lisbon (ISAMB), 1649-020 Lisbon, Portugal
| | - Francisco Martins
- Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal
- LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal
| | - Krzysztof Przednowek
- Institute of Physical Culture Sciences, Medical College, University of Rzeszów, 35-959 Rzeszów, Poland
| | - Cíntia França
- Department of Physical Education and Sport, University of Madeira, 9020-105 Funchal, Portugal
- LARSYS, Interactive Technologies Institute, 9020-105 Funchal, Portugal
| | - Miguel Peralta
- Faculty of Human Kinetics, University of Lisbon (CIPER), 1495-751 Lisbon, Portugal
- Faculty of Medicine, University of Lisbon (ISAMB), 1649-020 Lisbon, Portugal
| | - Andreas Ihle
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, 1205 Geneva, Switzerland
- Department of Psychology, 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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31
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Choi HS, Baek YS, In H. Ankle strategy assistance to improve gait stability using controllers based on in-shoe center of pressure in 2 degree-of-freedom powered ankle-foot orthoses: a clinical study. J Neuroeng Rehabil 2022; 19:114. [PMID: 36284358 PMCID: PMC9594937 DOI: 10.1186/s12984-022-01092-6] [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: 03/04/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Although the ankle strategy is important for achieving frontal plane stability during one-leg stance, previously developed powered ankle–foot orthoses (PAFOs) did not involve ankle strategies because of hardware limitations. Weakness of movement in frontal plane is a factor that deteriorates gait stability and increases fall risk so it should not be overlooked in rehabilitation. Therefore, we used PAFO with subtalar joint for frontal plane movement and tried to confirm that the existence of it is important in balancing through clinical experiments. Methods We developed a proportional CoP controller to assist ankle strategy or stabilizing moment and enhance eversion to compensate for the tilting moment with 2 dof PAFO. It was true experimental study, and we recruited seven healthy subjects (30 ± 4 years) who did not experience any gait abnormality participated in walking experiments for evaluating the immediate effect of subtalar joint of PAFO on their gait stability. They walked on the treadmill with several cases of controllers for data acquisitions. Indices of gait stability and electromyography for muscle activity were measured and Wilcoxon signed-rank tests were used to identify meaningful changes. Results We found that subjects were most stable during walking (in terms of largest Lyapunov exponents, p < 0.008) with the assistance of the PAFO when their electromyographic activity was the most reduced (p < 0.008), although postural sway increased when a proportional CoP controller was used to assist the ankle strategy (p < 0.008). Other indices of gait stability, kinematic variability, showed no difference between the powered and unpowered conditions (p > 0.008). The results of the correlation analysis indicate that the actuator of the PAFO enhanced eversion and preserved the location of the CoP in the medial direction so that gait stability was not negatively affected or improved. Conclusions We verified that the developed 2 dof PAFO assists the ankle strategy by compensating for the tilting moment with proportional CoP controller and that wearer can walk in a stable state when the orthosis provides power for reducing muscle activity. This result is meaningful because an ankle strategy should be considered in the development of PAFOs for enhancing or even rehabilitating proprioception. Trial registration 7001988-202003-HR-833-03
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Affiliation(s)
- Ho Seon Choi
- grid.35541.360000000121053345Center for Healthcare Robotics, Korea Institute of Science and Technology, Seoul, 03722 South Korea ,grid.15444.300000 0004 0470 5454School of Mechanical Engineering, Yonsei University, Seoul, 02792 South Korea
| | - Yoon Su Baek
- grid.15444.300000 0004 0470 5454School of Mechanical Engineering, Yonsei University, Seoul, 02792 South Korea
| | - Hyunki In
- grid.35541.360000000121053345Center for Healthcare Robotics, Korea Institute of Science and Technology, Seoul, 03722 South Korea
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32
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Promsri A. Assessing Walking Stability Based on Whole-Body Movement Derived from a Depth-Sensing Camera. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22197542. [PMID: 36236642 PMCID: PMC9571104 DOI: 10.3390/s22197542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/23/2022] [Accepted: 10/02/2022] [Indexed: 05/13/2023]
Abstract
Stability during walking is considered a crucial aspect of assessing gait ability. The current study aimed to assess walking stability by applying principal component analysis (PCA) to decompose three-dimensional (3D) whole-body kinematic data of 104 healthy young adults (21.9 ± 3.5 years, 54 females) derived from a depth-sensing camera into a set of movement components/synergies called "principal movements" (PMs), forming together to achieve the task goal. The effect of sex as the focus area was tested on three PCA-based variables computed for each PM: the relative explained variance (rVAR) as a measure of the composition of movement structures; the largest Lyapunov exponent (LyE) as a measure of variability; and the number of zero-crossings (N) as a measure of the tightness of neuromuscular control. The results show that the sex effects appear in the specific PMs. Specifically, in PM1, resembling the swing-phase movement, females have greater LyE (p = 0.013) and N (p = 0.017) values than males. Moreover, in PM3, representing the mid-stance-phase movement, females have smaller rVAR (p = 0.020) but greater N (p = 0.008) values than males. These empirical findings suggest that the inherent sex differences in walking stability should be considered in assessing and training locomotion.
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Affiliation(s)
- Arunee Promsri
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, 19 Moo 2, Maeka, Muang, Phayao 56000, Thailand;
- Unit of Excellence in Neuromechanics, School of Allied Health Sciences, University of Phayao, 19 Moo 2, Maeka, Muang, Phayao 56000, Thailand
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Promsri A. Sex Difference in Running Stability Analyzed Based on a Whole-Body Movement: A Pilot Study. Sports (Basel) 2022; 10:sports10090138. [PMID: 36136393 PMCID: PMC9506143 DOI: 10.3390/sports10090138] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
A sex-specific manner in running tasks is considered a potential internal injury risk factor in runners. The current study aimed to investigate the sex differences in running stability in recreational runners during self-preferred speed treadmill running by focusing on a whole-body movement. To this end, principal component analysis (PCA) was applied to kinematic marker data of 22 runners (25.7 ± 3.3 yrs.; 12 females) for decomposing the whole-body movements of all participants into a set of principal movements (PMs), representing different movement synergies forming together to achieve the task goal. Then, the sex effects were tested on three types of PCA-based variables computed for individual PMs: the largest Lyapunov exponent (LyE) as a measure of running variability; the relative standard deviation (rSTD) as a measure of movement structures; and the root mean square (RMS) as a measure of the magnitude of neuromuscular control. The results show that the sex effects are observed in the specific PMs. Specifically, female runners have lower stability (greater LyE) in the mid-stance-phase movements (PM4−5) and greater contribution and control (greater rSTD and RMS) in the swing-phase movement (PM1) than male runners. Knowledge of an inherent sex difference in running stability may benefit sports-related injury prevention and rehabilitation.
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Affiliation(s)
- Arunee Promsri
- Department of Physical Therapy, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand; ; Tel.: +66-54-466-666 (ext. 3817)
- Unit of Excellence in Neuromechanics, School of Allied Health Sciences, University of Phayao, Phayao 56000, Thailand
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Smith J, DiVito M, Fergus A. Reliability and discriminant validity of the quantitative timed up and go in typically developing children and children with cerebral palsy GMFCS levels I-II. J Pediatr Rehabil Med 2022; 16:25-35. [PMID: 36031915 DOI: 10.3233/prm-210034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the reliability, and discriminant validity of the Quantitative Timed up and Go (QTUG) in typically developing (TD) children and children with cerebral palsy (CP). METHODS Twenty-eight TD children and 8 with CP (GMFCS I-II) completed 3 TUG trials while wearing QTUG sensors. Test-retest reliability and discriminative ability were examined for the 57 constituent parameters of the TUG. Relationships between age and these parameters were also examined. RESULTS Forty-four of the parameters demonstrated moderate to excellent test-retest reliability, with measures of angular velocity being the most reliable. Twenty-six parameters were different between TD children and those with CP, and twenty-eight gait parameters demonstrated correlations with age, further supporting its discriminative ability. CONCLUSION The QTUG is a clinically feasible tool that is capable of both reliably measuring and discriminating many of the movement parameters with the TUG mobility task in TD children and those with CP GMFCS I-II. The results of the present study provide preliminary evidence that the QTUG can discriminate between children on several of the gait parameters within the TUG.
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Affiliation(s)
- Julianna Smith
- Shenandoah University Division of Physical Therapy Winchester, VA, USA
| | - Michelle DiVito
- Shenandoah University Division of Physical Therapy Winchester, VA, USA
| | - Andrea Fergus
- Shenandoah University Division of Physical Therapy Winchester, VA, USA
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Panday SB, Pathak P, Moon J, Koo D. Complexity of Running and Its Relationship with Joint Kinematics during a Prolonged Run. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9656. [PMID: 35955013 PMCID: PMC9368290 DOI: 10.3390/ijerph19159656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/30/2022] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
We investigated the effect of prolonged running on joint kinematics and its association with stride complexity between novice and elite runners. Ten elite marathoners and eleven healthy individuals took part in a 20 min submaximal prolonged running experiment at their preferred running speed (PRS). A three-dimensional motion capture system was utilized to capture and calculate the alpha exponent, stride-to-stride fluctuations (SSFs), and stride-to-stride variability (SSV) of spatiotemporal parameters and joint kinematics. In the results, the elite athletes ran at a considerably higher PRS than the novice runners, yet no significant differences were found in respiratory exchange ratio with increasing time intervals. For the spatiotemporal parameters, we observed a significant increase in the step width and length variability in novice runners with increasing time-interval (p < 0.05). However, we did not observe any differences in the alpha exponent of spatiotemporal parameters. Significant differences in SSF of joint kinematics were observed, particularly in the sagittal plane for ankle, knee, and hip at heel strike (p < 0.05). While in mid-stance, time-interval differences were observed in novices who ran with a lower knee flexion angle (p < 0.05). During toe-off, significantly higher SSV was observed, particularly in the hip and ankle for novices (p < 0.05). The correlation analysis of joint SSV revealed a distinct negative relationship with the alpha exponent of step-length and step-width for elite runners, while, for novices, a positive relation was observed only for the alpha exponent of step-width. In conclusion, our study shows that increased step-width variability seen in novices could be a compensatory mechanism to maintain performance and mitigate the loss of stability. On the other hand, elite runners showed a training-induced effective modulation of lower-limb kinematics to improve their running performance.
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Affiliation(s)
| | - Prabhat Pathak
- Department of Physical Education, Seoul National University, Seoul 08826, Korea
| | - Jeheon Moon
- Department of Physical Education, Korea National University of Education, Cheongju-si 28173, Korea
| | - Dohoon Koo
- Department of Exercise Prescription, College of Medical Science, Jeonju University, Jeonju 55069, Korea
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Effect of Different Ankle-Foot Immobility on Lateral Gait Stability in the Stance Phase. Appl Bionics Biomech 2022; 2022:7135040. [PMID: 35965839 PMCID: PMC9365579 DOI: 10.1155/2022/7135040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to investigate the effect of limited foot and ankle mobility on the lateral stability of gait through the observation of the mediolateral margin of stability and related kinematic parameters. Methods Thirty young, healthy participants walked at a fixed gait velocity on a level surface. Participants achieved different degrees of restricted mobility by wearing soft-soled shoes (S), an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion activity only (A), and an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion and adjustable horizontal rotation of the foot (OU/OR). Furthermore, the spatiotemporal parameters, mediolateral margin of stability, center of pressure, angle of the fore and hind foot relative to the tibia, and correlation coefficients of the factors were analyzed. Regression analysis was also performed. Results At right heel strike, group A had a significantly lower mediolateral margin of stability than group S and group OU. Meanwhile, forefoot adduction (0.2 < |r| <0.4) and plantarflexion (0.2 < |r| <0.4), as well as hindfoot internal rotation (0.2 < |r| <0.6) and inversion (0.2 < |r| <0.4), correlated negatively with lateral stability. Regression analysis revealed forefoot dorsiflexion and supination were the main independent variables for group A. At right heel off, groups OU and OR had a significantly lower mediolateral margin of stability than those in groups A and S. Forefoot adduction (0.2 < |r| <0.4) and dorsiflexion (0.4 < |r| <0.6) were correlated with lateral stability, as were hindfoot dorsiflexion (0.2 < |r| <0.4) and inversion (0.2 < |r| <0.4). Regression analysis revealed forefoot abduction and plantarflexion were the main independent variables for groups OU and OR. Conclusions The present study verified from gait data that forefoot dorsiflexion and supination at the initial contact of the stance phase were relevant factors for the differences in lateral gait stability, whereas abduction and plantar flexion of the forefoot at the terminal stance phase were the main influencing factors of lateral gait stability.
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Koren Y, Rozenfeld E, Elefant I, Khir N, Glassberg E, Batcir S. Does cognitive loading interfere with walking control? Gait Posture 2022; 96:185-189. [PMID: 35696823 DOI: 10.1016/j.gaitpost.2022.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 05/19/2022] [Accepted: 05/25/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cognitive-motor interference is a common method used to investigate the cognitive demands of human walking. Using this methodology, consistent effects emerge: under cognitive load, walking velocity decreases, while spatio-temporal variability of walking increases. These effects are often interpreted as indicative of an interference in the ability to control gait. However, walking velocity is highly correlated with most gait parameters; thus, the increase in variability does not necessarily reflect reduced control, but rather a constant signal-to-noise ratio. METHODS To investigate the effect of cognitive loading on gait variability, we retrospectively analysed 3721 records of healthy young adults, walking with and without a concurrent cognitive task, on a treadmill. RESULTS Stride duration and length increased under cognitive load, while the variability of these parameters decreased. Further, these effects were different between participants starting to walk without cognitive loading and those starting to walk with cognitive loading. CONCLUSIONS Dual tasking is more likely to divert the focus of attention away from the walking task, causing a shift of balance between automatic and conscious control, as opposed to interference per-se.
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Affiliation(s)
- Yogev Koren
- Combatant Health Center, Medical corps, Israeli Defence Forces, Israel; Ben-Gurion University of The Negev, Faculty of Health Sciences, Israel.
| | - Evgeni Rozenfeld
- Combatant Health Center, Medical corps, Israeli Defence Forces, Israel; Ben-Gurion University of The Negev, Faculty of Health Sciences, Israel
| | - Itzik Elefant
- Combatant Health Center, Medical corps, Israeli Defence Forces, Israel
| | - Nabil Khir
- Combatant Health Center, Medical corps, Israeli Defence Forces, Israel
| | - Elon Glassberg
- Combatant Health Center, Medical corps, Israeli Defence Forces, Israel; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; The Uniform Services University of the Health sciences, Bethesda, Maryland, USA
| | - Shani Batcir
- Combatant Health Center, Medical corps, Israeli Defence Forces, Israel; Ben-Gurion University of The Negev, Faculty of Health Sciences, Israel
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Nonlinear Dynamic Measures of Walking in Healthy Older Adults: A Systematic Scoping Review. SENSORS 2022; 22:s22124408. [PMID: 35746188 PMCID: PMC9228430 DOI: 10.3390/s22124408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 02/01/2023]
Abstract
Background: Maintaining a healthy gait into old age is key to preserving the quality of life and reducing the risk of falling. Nonlinear dynamic analyses (NDAs) are a promising method of identifying characteristics of people who are at risk of falling based on their movement patterns. However, there is a range of NDA measures reported in the literature. The aim of this review was to summarise the variety, characteristics and range of the nonlinear dynamic measurements used to distinguish the gait kinematics of healthy older adults and older adults at risk of falling. Methods: Medline Ovid and Web of Science databases were searched. Forty-six papers were included for full-text review. Data extracted included participant and study design characteristics, fall risk assessment tools, analytical protocols and key results. Results: Among all nonlinear dynamic measures, Lyapunov Exponent (LyE) was most common, followed by entropy and then Fouquet Multipliers (FMs) measures. LyE and Multiscale Entropy (MSE) measures distinguished between older and younger adults and fall-prone versus non-fall-prone older adults. FMs were a less sensitive measure for studying changes in older adults’ gait. Methodology and data analysis procedures for estimating nonlinear dynamic measures differed greatly between studies and are a potential source of variability in cross-study comparisons and in generating reference values. Conclusion: Future studies should develop a standard procedure to apply and estimate LyE and entropy to quantify gait characteristics. This will enable the development of reference values in estimating the risk of falling.
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Hollander K, Petersen E, Zech A, Hamacher D. Effects of barefoot vs. shod walking during indoor and outdoor conditions in younger and older adults. Gait Posture 2022; 95:284-291. [PMID: 34020852 DOI: 10.1016/j.gaitpost.2021.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait stability and variability measures in barefoot and shod locomotion are frequently investigated in younger but rarely in older adults. Moreover, most studies examine gait measures in laboratory settings instead of real-life settings. RESEARCH QUESTIONS How are gait stability and variability parameters affected by footwear compared to barefoot walking in younger and older adults as well as under indoor vs. outdoor conditions? METHODS Healthy younger (<35 years) and older adults (>65 years) participated in the randomised within-subject study design. Participants conducted consecutive 25 m walking trials barefoot and with standardised footwear inside and outside. Inertial measurement units were mounted on the participant's foot and used to calculate local dynamic stability (LDS), velocity and minimal toe clearance (MTC), stride length and stride time, including variabilities for these parameters. Linear mixed models were calculated. RESULTS Data of 32 younger (17 female, 15 male, age: 30 ± 4 years) and 42 older participants (24 female, 18 male, age: 71 ± 4 years) were analysed. MTC variability was higher in shod conditions compared to barefoot (p = 0.048) and in outdoor conditions (p < 0.001). LDS was different between age groups (p < 0.001). Gait velocity and MTC were higher in shod and outdoor conditions (both p < 0.001). Stride length and time were higher in shod conditions (both p < 0.001) and different between outdoor vs. indoor (longer stride length and shorter stride time outdoor, both (p < 0.001) as well as age groups (shorter stride length (p < 0.021) and stride time in older adults (p < 0.001). SIGNIFICANCE Results suggest that gait stability and variability in older and younger adults are acutely affected by footwear vs. barefoot and indoor vs. outdoor walking conditions, indicating a high adaptiveness of these parameters to different experimental conditions. Consequently, future studies should be careful with generalising results obtained under certain conditions. Findings stress the clinical potential of barefoot walking.
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Affiliation(s)
| | - Evi Petersen
- Department of Sports, Physical Education and Outdoor Life, University of South-Eastern Norway, Norway.
| | - Astrid Zech
- Department of Sport Science, Friedrich Schiller University Jena, Germany
| | - Daniel Hamacher
- Department of Sport Science, Friedrich Schiller University Jena, Germany
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Indelicato E, Raccagni C, Runer S, Hannink J, Nachbauer W, Eigentler A, Amprosi M, Wenning G, Boesch S. Instrumented gait analysis defines the walking signature of CACNA1A disorders. J Neurol 2022; 269:2941-2947. [PMID: 34755206 PMCID: PMC9120104 DOI: 10.1007/s00415-021-10878-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Gait disturbances are a frequent symptom in CACNA1A disorders. Even though, data about their severity and progression are lacking and no CACNA1A-specific scale or assessment for gait is available. METHODS We applied a gait assessment protocol in 20 ambulatory patients with genetically confirmed CACNA1A disorders and 39 matched healthy controls. An instrumented gait analysis (IGA) was performed by means of wearable sensors in basal condition and after a treadmill/cycloergometer challenge in selected cases. RESULTS CACNA1A patients displayed lower gait speed, shorter steps with increased step length variability, a reduced landing acceleration as well as a reduced range of ankle motion compared to controls. Furthermore, gait-width in patients with episodic CACNA1A disorders was narrower as compared to controls. In one patient experiencing mild episodic symptoms after the treadmill challenge, the IGA was able to detect a deterioration over all gait parameters. CONCLUSIONS In CACNA1A patients, the IGA with wearable sensors unravels specific gait signatures which are not detectable at naked eye. These features (narrow-based gait, lower landing acceleration) distinguish these patients from other ataxic disorders and may be target of focused rehabilitative interventions. IGA can potentially be applied to monitor the neurological fluctuations associated with CACNA1A disorders.
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Affiliation(s)
- Elisabetta Indelicato
- Center for Rare Movement Disorders, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Cecilia Raccagni
- Neurobiology Division, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
- Department of Neurology, Regional General Hospital, Lorenz Boehler Strasse 5, 39100, Bolzano, Italy.
| | - Sarah Runer
- Center for Rare Movement Disorders, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Julius Hannink
- Portablies HealthCare Technologies GmbH, Henkestr. 91, 91052, Erlangen, Germany
| | - Wolfgang Nachbauer
- Center for Rare Movement Disorders, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Andreas Eigentler
- Center for Rare Movement Disorders, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Matthias Amprosi
- Center for Rare Movement Disorders, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Gregor Wenning
- Center for Rare Movement Disorders, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Neurobiology Division, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Sylvia Boesch
- Center for Rare Movement Disorders, Department of Neurology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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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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Vega D, Huang HJ, Arellano CJ. Step-to-step variability indicates disruption to balance control when linking the arms and legs during treadmill walking. PLoS One 2022; 17:e0265750. [PMID: 35320305 PMCID: PMC8942237 DOI: 10.1371/journal.pone.0265750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
We recently discovered that a rope-pulley system that mechanically coupling the arms, legs and treadmill during walking can assist with forward propulsion in healthy subjects, leading to significant reductions in metabolic cost. However, walking balance may have been compromised, which could hinder the potential use of this device for gait rehabilitation. We performed a secondary analysis by quantifying average step width, step length, and step time, and used their variability to reflect simple metrics of walking balance (n = 8). We predicted an increased variability in at least one of these metrics when using the device, which would indicate disruptions to walking balance. When walking with the device, subjects increased their average step width (p < 0.05), but variability in step width and step length remained similar (p’s > 0.05). However, the effect size for step length variability when compared to that of mechanical perturbation experiments suggest a minimal to moderate disruption in balance (Rosenthal ES = 0.385). The most notable decrement in walking balance was an increase in step time variability (p < 0.05; Cohen’s d = 1.286). Its effect size reveals a moderate disruption when compared to the effect sizes observed in those with balance deficits (effect sizes ranged between 0.486 to 1.509). Overall, we conclude that healthy subjects experienced minimal to moderate disruptions in walking balance when using with this device. These data indicate that in future clinical experiments, it will be important to not only consider the mechanical and metabolic effects of using such a device but also its potential to disrupt walking balance, which may be exacerbated in patients with poor balance control.
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Affiliation(s)
- Daisey Vega
- Department of Health and Human Performance, Center for Neuromotor and Biomechanics Research Laboratory, University of Houston, Houston, Texas, United States of America
| | - Helen J. Huang
- Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, Florida, United States of America
- Disability, Aging, and Technology (DAT) Cluster, University of Central Florida, Orlando, Florida, United States of America
| | - Christopher J. Arellano
- Department of Health and Human Performance, Center for Neuromotor and Biomechanics Research Laboratory, University of Houston, Houston, Texas, United States of America
- * E-mail:
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Walha R, Gaudreault N, Dagenais P, Boissy P. Spatiotemporal parameters and gait variability in people with psoriatic arthritis (PsA): a cross-sectional study. J Foot Ankle Res 2022; 15:19. [PMID: 35246222 PMCID: PMC8895502 DOI: 10.1186/s13047-022-00521-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Foot involvement is a major manifestation of psoriatic arthritis (PsA) and can lead to severe levels of foot pain and disability and impaired functional mobility and quality of life. Gait spatiotemporal parameters (STPs) and gait variability, used as a clinical index of gait stability, have been associated with several adverse health outcomes, including risk of falling, functional decline, and mortality in a wide range of populations. Previous studies showed some alterations in STPs in people with PsA. However, gait variability and the relationships between STPs, gait variability and self-reported foot pain and disability have never been studied in these populations. Body-worn inertial measurement units (IMUs) are gaining interest in measuring gait parameters in clinical settings. Objectives To assess STPs and gait variability in people with PsA using IMUs, to explore their relationship with self-reported foot pain and function and to investigate the feasibility of using IMUs to discriminate patient groups based on gait speed-critical values. Methods Twenty-one participants with PsA (age: 53.9 ± 8.9 yrs.; median disease duration: 6 yrs) and 21 age- and sex-matched healthy participants (age 54.23 ± 9.3 yrs) were recruited. All the participants performed three 10-m walk test trials at their comfortable speed. STPs and gait variability were recorded and calculated using six body-worn IMUs and Mobility Lab software (APDM®). Foot pain and disability were assessed in participants with PsA using the foot function index (FFI). Results Cadence, gait speed, stride length, and swing phase were significantly lower, while double support was significantly higher, in the PsA group (p < 0.006). Strong correlations between STPs and the FFI total score were demonstrated (|r| > 0.57, p < 0.006). Gait variability was significantly increased in the PsA group, but it was not correlated with foot pain or function (p < 0.006). Using the IMUs, three subgroups of participants with PsA with clinically meaningful differences in self-reported foot pain and disability were discriminated. Conclusion STPs were significantly altered in participants with PsA, which could be associated with self-reported foot pain and disability. Future studies are required to confirm the increased gait variability highlighted in this study and its potential underlying causes. Using IMUs has been useful to objectively assess foot function in people with PsA. Trial registration ClinicalTrials.gov, NCT05075343, Retrospectively registered on 29 September 2021.
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Affiliation(s)
- Roua Walha
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nathaly Gaudreault
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pierre Dagenais
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Patrick Boissy
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada. .,Research Center on Aging, CIUSSS Estrie CHUS, Sherbrooke, QC, Canada.
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Are we missing parameters to early detect risk factors of falling in older adults? Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mitchell A, Martin AE. Quantifying the effect of sagittal plane joint angle variability on bipedal fall risk. PLoS One 2022; 17:e0262749. [PMID: 35081142 PMCID: PMC8791504 DOI: 10.1371/journal.pone.0262749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/04/2022] [Indexed: 11/19/2022] Open
Abstract
Falls are a major issue for bipeds. For elderly adults, falls can have a negative impact on their quality of life and lead to increased medical costs. Fortunately, interventional methods are effective at reducing falls assuming they are prescribed. For biped robots, falls prevent them from completing required tasks. Thus, it is important to understand what aspects of gait increase fall risk. Gait variability may be associated with increased fall risk; however, previous studies have not investigated the variation in the movement of the legs. The purpose of this study was to determine the effect of joint angle variability on falling to determine which component(s) of variability were statistically significant. In order to investigate joint angle variability, a physics-based simulation model that captured joint angle variability as a function of time through Fourier series was used. This allowed the magnitude, the frequency mean, and the frequency standard deviation of the variability to be altered. For the values tested, results indicated that the magnitude of the variability had the most significant impact on falling, and specifically that the stance knee flexion variability magnitude was the most significant factor. This suggests that increasing the joint variability magnitude may increase fall risk, particularly if the controller is not able to actively compensate. Altering the variability frequency had little to no effect on falling.
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Affiliation(s)
- Amy Mitchell
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
| | - Anne E. Martin
- Department of Mechanical Engineering, The Pennsylvania State University, University Park, PA, United States of America
- * E-mail:
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Karasawa S, Yamamoto M, Sakurai J, Kawasaki S, Kobayashi H. The Impact of Footwear on Posture, Gait and Balance. Health (London) 2022. [DOI: 10.4236/health.2022.142016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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47
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Fleps I, Pálsson H, Baker A, Enns-Bray W, Bahaloo H, Danner M, Singh NB, Taylor WR, Sigurdsson S, Gudnason V, Ferguson SJ, Helgason B. Finite element derived femoral strength is a better predictor of hip fracture risk than aBMD in the AGES Reykjavik study cohort. Bone 2022; 154:116219. [PMID: 34571206 DOI: 10.1016/j.bone.2021.116219] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 08/16/2021] [Accepted: 09/22/2021] [Indexed: 02/02/2023]
Abstract
Hip fractures associated with a high economic burden, loss of independence, and a high rate of post-fracture mortality, are a major health concern for modern societies. Areal bone mineral density is the current clinical metric of choice when assessing an individual's future risk of fracture. However, this metric has been shown to lack sensitivity and specificity in the targeted selection of individuals for preventive interventions. Although femoral strength derived from computed tomography based finite element models has been proposed as an alternative based on its superior femoral strength prediction ex vivo, such predictions have only shown marginal or no improvement for assessing hip fracture risk. This study compares finite element derived femoral strength to aBMD as a metric for hip fracture risk assessment in subjects (N = 601) from the AGES Reykjavik Study cohort and analyses the dependence of femoral strength predictions and classification accuracy on the material model and femoral loading alignment. We found hip fracture classification based on finite element derived femoral strength to be significantly improved compared to aBMD. Finite element models with non-linear material models performed better at classifying hip fractures compared to finite element models with linear material models and loading alignments with low internal rotation and adduction, which do not correspond to weak femur alignments, were found to be most suitable for hip fracture classification.
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Affiliation(s)
- Ingmar Fleps
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland.
| | - Halldór Pálsson
- Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | | | | | - Hassan Bahaloo
- Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Michael Danner
- Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, School of Engineering and Natural Sciences, University of Iceland, Reykjavik, Iceland
| | - Navrag B Singh
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland; Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - William R Taylor
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland; Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | | | | | - Stephen J Ferguson
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland; Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
| | - Benedikt Helgason
- Institute for Biomechanics, ETH Zürich, Zürich, Switzerland; Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore
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Rabuffetti M, Steinach M, Lichti J, Gunga HC, Balcerek B, Becker PN, Fähling M, Merati G, Maggioni MA. The Association of Fatigue With Decreasing Regularity of Locomotion During an Incremental Test in Trained and Untrained Healthy Adults. Front Bioeng Biotechnol 2021; 9:724791. [PMID: 34900952 PMCID: PMC8652249 DOI: 10.3389/fbioe.2021.724791] [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: 06/14/2021] [Accepted: 10/07/2021] [Indexed: 12/03/2022] Open
Abstract
Fatigue is a key factor that affects human motion and modulates physiology, biochemistry, and performance. Prolonged cyclic human movements (locomotion primarily) are characterized by a regular pattern, and this extended activity can induce fatigue. However, the relationship between fatigue and regularity has not yet been extensively studied. Wearable sensor methodologies can be used to monitor regularity during standardized treadmill tests (e.g., the widely used Bruce test) and to verify the effects of fatigue on locomotion regularity. Our study on 50 healthy adults [27 males and 23 females; <40 years; five dropouts; and 22 trained (T) and 23 untrained (U) subjects] showed how locomotion regularity follows a parabolic profile during the incremental test, without exception. At the beginning of the trial, increased walking speed in the absence of fatigue is associated with increased regularity (regularity index, RI, a. u., null/unity value for aperiodic/periodic patterns) up until a peak value (RI = 0.909 after 13.8 min for T and RI = 0.915 after 13.4 min for U subjects; median values, n. s.) and which is then generally followed (after 2.8 and 2.5 min, respectively, for T/U, n. s.) by the walk-to-run transition (at 12.1 min for both T and U, n. s.). Regularity then decreases with increased speed/slope/fatigue. The effect of being trained was associated with significantly higher initial regularity [0.845 (T) vs 0.810 (U), p < 0.05 corrected], longer test endurance [23.0 min (T) vs 18.6 min (U)], and prolonged decay of locomotor regularity [8.6 min (T) vs 6.5 min (U)]. In conclusion, the monitoring of locomotion regularity can be applied to the Bruce test, resulting in a consistent time profile. There is evidence of a progressive decrease in regularity following the walk-to-run transition, and these features unveil significant differences among healthy trained and untrained adult subjects.
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Affiliation(s)
| | - Mathias Steinach
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Julia Lichti
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Vegetative Physiology, Berlin, Germany
| | - Hanns-Christian Gunga
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany
| | - Björn Balcerek
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Vegetative Physiology, Berlin, Germany
| | - Philipp Nils Becker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Vegetative Physiology, Berlin, Germany
| | - Michael Fähling
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Vegetative Physiology, Berlin, Germany
| | - Giampiero Merati
- IRCCS Fondazione Don Carlo Gnocchi, Milano, Italy.,Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Martina Anna Maggioni
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Physiology, Center for Space Medicine and Extreme Environments Berlin, Berlin, Germany.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
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Gait changes over time in hospitalized older adults with advanced dementia: Predictors of mobility change. PLoS One 2021; 16:e0259975. [PMID: 34788342 PMCID: PMC8598066 DOI: 10.1371/journal.pone.0259975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 10/30/2021] [Indexed: 11/19/2022] Open
Abstract
People with dementia are at risk of mobility decline. In this study, we measured changes in quantitative gait measures over a maximum 10-week period during the course of a psychogeriatric admission in older adults with dementia, with the aims to describe mobility changes over the duration of the admission, and to determine which factors were associated with this change. Fifty-four individuals admitted to a specialized dementia inpatient unit participated in this study. A vision-based markerless motion capture system was used to record participants’ natural gait. Mixed effect models were developed with gait measures as the dependent variables and clinical and demographic variables as predictors. We found that gait stability, step time, and step length decreased, and step time variability and step length variability increased over 10 weeks. Gait stability of men decreased more than that of women, associated with an increased sacrum mediolateral range of motion over time. In addition, the sacrum mediolateral range of motion decreased in those with mild neuropsychiatric symptoms over 10 weeks, but increased in those with more severe neuropsychiatric symptoms. Our study provides evidence of worsening of gait mechanics and control over the course of a hospitalization in older adults with dementia. Quantitative gait monitoring in hospital environments may provide opportunities to intervene to prevent adverse events, decelerate mobility decline, and monitor rehabilitation outcomes.
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Zhang Y, Zhou X, Pijnappels M, Bruijn SM. Differences in Gait Stability and Acceleration Characteristics Between Healthy Young and Older Females. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:763309. [PMID: 36188861 PMCID: PMC9397671 DOI: 10.3389/fresc.2021.763309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022]
Abstract
Our aim was to evaluate differences in gait acceleration intensity, variability, and stability of feet and trunk between older females (OF) and young females (YF) using inertial sensors. Twenty OF (mean age 68.4, SD 4.1 years) and 18 YF (mean age 22.3, SD 1.7 years) were asked to walk straight for 100 meters at their preferred speed, while wearing inertial sensors on their heels and lower back. We calculated spatiotemporal measures, foot and trunk acceleration characteristics, their variability, and trunk stability using the local divergence exponent (LDE). Two-way ANOVA (such as the factors foot and age), Student's t-test and Mann–Whitney U test were used to compare statistical differences of measures between groups. Cohen's d effects were calculated for each variable. Foot maximum vertical (VT) acceleration and amplitude, trunk-foot VT acceleration attenuation, and their variability were significantly smaller in OF than in YF. In contrast, trunk mediolateral (ML) acceleration amplitude, maximum VT acceleration, amplitude, and their variability were significantly larger in OF than in YF. Moreover, OF showed lower stability (i.e., higher LDE values) in ML acceleration, ML, and VT angular velocity of the trunk. Even though we measured healthy OF, these participants showed lower VT foot accelerations with higher VT trunk acceleration, lower trunk-foot VT acceleration attenuation, less gait stability, and more variability of the trunk, and hence, were more likely to fall. These findings suggest that instrumented gait measurements may help for early detection of changes or impairments in gait performance, even before this can be observed by clinical eye or gait speed.
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Affiliation(s)
- Yuge Zhang
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Xinglong Zhou
- Sport Science College, Beijing Sport University, Beijing, China
| | - Mirjam Pijnappels
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Sjoerd M. Bruijn
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Institute of Brain and Behavior Amsterdam, Amsterdam, Netherlands
- Biomechanics Laboratory, Fujian Medical University, Quanzhou, China
- *Correspondence: Sjoerd M. Bruijn
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