Age-Related Adaptations of Lower Limb Intersegmental Coordination During Walking

The correlation of gait and muscle activation characteristics with locomotion dysfunction grade in elderly individuals

Objective

To investigate the differences and regularity of gait and muscle activation characteristics parameters in the Locomotion Dysfunction Grade (LDG) scale assessment in elderly individuals, and analyse the correlation between objective parameters and scale grading. Thus, to propose a novel detection mode for elderly individuals, which combined the LDG scale with objective detection. It can not only provide quantitative data for intelligent evaluation and rehabilitation, but also provided more accurate reference for the classification of care levels in elderly care policies.

Methods

Elderly individuals (n = 159) who underwent gait analysis and sEMG at the Chinese Rehabilitation Research Center from January 2019 to September 2023 were included. According to the LDG scale, the elderly individuals were divided into four groups, namely, the LDG4, LDG5, LDG6 groups and the healthy control group. Four indicators, namely, spatiotemporal, kinematic, dynamic gait parameters and muscle activation characteristics data, were collected. Changes in these characteristics of elderly individuals with lower extremity motor dysfunction were evaluated and analysed statistically.

Results

The spatiotemporal gait parameters were significantly lower in the LDG4, LDG5, LDG6 groups than in the healthy control group. The double support phase was positively correlated with the LDG, while the swing phase, step length and velocity were negatively correlated (P < 0.05). The movement angles of both hips, knees and ankles were significantly limited and negatively correlated with the LDG (P < 0.05). Compared with those in the healthy control group, the centre of pressure (COP) path length were greater, and the average COP velocity was significantly lower (P < 0.05) in the LDG4, LDG5, LDG6 groups. The regularity of muscle activation clearly changed. The root mean square of the gastrocnemius medialis was positively correlated with LDG (P < 0.05), while the tibialis anterior showed no regularity.

Conclusion

As the LDG increased, the differences in spatiotemporal, kinematic and dynamic gait parameters between elderly individuals with motor dysfunction and the healthy individuals gradually increased. The muscle activation characteristics parameters showed an abnormal activation pattern. These parameters were correlated with the LDG, providing a more comprehensive and objective assessment of lower extremity motor function in elderly individuals, improve assessment accuracy, and help accurate rehabilitation.

Investigation of intersegmental coordination patterns in human walking

BACKGROUND

Intersegmental coordination between thigh, shank, and foot plays a crucial role in human gait, facilitating stable and efficient human walking. Limb elevation angles during the gait cycle form a planar manifold describes the by the planar covariation law, a recognized fundamental aspect of human locomotion.

RESEARCH QUESTION

How does the walking speed, age, BMI, and height, affect the size and orientation of the intersegmental coordination manifold and covariation plane?

METHODS

This study introduces novel metrics for quantifying intersegmental coordination, including the mean radius of the manifold, rotation of the manifold about the origin, and the orientation of the plane with respect to the coordinate planes. A statistical investigation is conducted on a publicly available human walking dataset for subjects aged 19-67 years, walking at speeds between 0.18 and 2.3 m s-1 to determine correlations of the proposed quantities. We used two sample t-test and ANOVA to find statistical significance of changes in the metrics with respect to gender and walking speed, respectively. Regression analysis was used to establish relationships between the introduced metrics and walking speed.

RESULTS

High correlations are observed between walking speed and the computed metrics, highlighting the sensitivity of these metrics to gait characteristics. Conversely, negligible correlations are found for demographic parameters like age, body mass index (BMI), and height. Male and female groups exhibit no practically significant differences in any of the considered metrics. Additionally, metrics tend to increase in magnitude as walking speed increases.

SIGNIFICANCE

This study contributes numerical metrics to characterize ISC of lower limbs with respect to walking speed along with regression models to estimate these metrics and related kinematic quantities. These findings hold significance for enhancing clinical gait analysis, generating optimal walking trajectories for assistive devices, prosthetics, or rehabilitation, aiming to replicate natural gaits and improve the functionality of biomechanical devices.

High cadence cycling not high work rate, increases gait velocity post-exercise

Gait velocity, or walking speed, has been referred to as the sixth vital sign, and research suggests that it is highly sensitive to change. Previous research has demonstrated the utility of cycling to improve gait parameters and in particular gait velocity in a variety of populations. However, it is unclear if the benefits from cycling to gait velocity stem from increased cadence, increased work rate, or the interaction between them. Therefore, the objective of the current research was to explicitly test the relationship between cycling work rate, cycling cadence, and gait velocity. 45 recreationally active young adults were randomly assigned to cycle at a normalised cadence and work rate, a higher cadence, or a higher work rate (CONTROL, FAST, HARD). All participants completed two ten-metre walk tests (10 MWT) pre- and post-cycling intervention. There was a significant interaction between group and time and post hoc comparisons showed that the FAST group walked significantly faster than the HARD group post-cycling. These results support the hypothesis that cycling at a cadence greater than the comfortable walking cadence, and not cycling at an increased work rate, increased gait velocity post-exercise for all members of our sample of healthy young adults.

Human arm redundancy: a new approach for the inverse kinematics problem

The inverse kinematics (IK) problem addresses how both humans and robotic systems coordinate movement to resolve redundancy, as in the case of arm reaching where more degrees of freedom are available at the joint versus hand level. This work focuses on which coordinate frames best represent human movements, enabling the motor system to solve the IK problem in the presence of kinematic redundancies. We used a multi-dimensional sparse source separation method to derive sets of basis (or source) functions for both the task and joint spaces, with joint space represented by either absolute or anatomical joint angles. We assessed the similarities between joint and task sources in each of these joint representations, finding that the time-dependent profiles of the absolute reference frame's sources show greater similarity to corresponding sources in the task space. This result was found to be statistically significant. Our analysis suggests that the nervous system represents multi-joint arm movements using a limited number of basis functions, allowing for simple transformations between task and joint spaces. Additionally, joint space seems to be represented in an absolute reference frame to simplify the IK transformations, given redundancies. Further studies will assess this finding's generalizability and implications for neural control of movement.

Comparison of mechanical energy transfer during right-forward lunge between female amateur and professional badminton players

BACKGROUND

Regarding their skill levels, badminton players present different movement patterns during front and right lunging. The main objective of this study was to compare the mechanical energy transfers attributable to right-forward lunges between amateur and professional badminton players to study variations in mechanical efficiency at various skill levels.

METHOD

In this cross-sectional study, twenty female badminton players were recruited (Professional group n = 10 and Amateur group n = 10). The kinematics and kinetics of the lower extremities were recorded while performing right-forward lunges using Vicon motion capture and Kistler force plates. Mechanical energy expenditures (MEE) were extracted in eccentric transfer, concentric transfer, and no-transfer phases for the hip, knee, and ankle joints. At each joint, mechanical energy compensations (MEC) were also determined. Independent samples t-tests were used to analyze data at a significance level of α = 0.05.

RESULT

Regards to mechanical energy expenditures at the initial heel contact phase, the professional players demonstrated statistically significant more ankle no-transfer (p < 0.003), less knee concentric transfer (p < 0.026), more knee eccentric transfer (p < 0.001), and less hip no-transfer (p < 0.001). At the same time, the amateur athletes showed significantly more ankle eccentric transfer (p < 0.042) at maximal knee flexion angle time point. Analyzing mechanical energy compensation coefficients showed that the professional athletes had significantly less ankle concentric transfer (p < 0.001), more knee concentric transfer (p < 0.001), more knee eccentric transfer (p < 0.001), and more hip eccentric transfer (p < 0.001) at initial contact phase. While they found to have significantly more ankle eccentric transfer (p < 0.007), less knee concentric transfer (p < 0.001), less knee eccentric transfer (p < 0.001), more hip concentric transfer (p < 0.001), and more hip eccentric transfer (p < 0.001) at maximal knee flexion angle.

CONCLUSION

it is shown that the mechanical energy efficiency of the right-forward lunge is skill-related. It seems that altered lunge landing biomechanics may increase the risk of ankle and knee injuries and muscular damages in amateur athletes. It is recommended for amateur players to follow a injury prevention training program that promotes proper lunging technique.

Unraveling age-related impairment of the neuromuscular system: exploring biomechanical and neurophysiological perspectives

With extended life expectancy, the quality of life of elders is a priority. Loss of mobility, increased morbidity and risks of falls have dramatic individual and societal impacts. Here we consider the age-related modifications of gait, from a biomechanical and neurophysiological perspective. Among the many factors of frailty involved (e.g., metabolic, hormonal, immunological), loss of muscle strength and neurodegenerative changes inducing slower muscle contraction may play a key role. We highlight that the impact of the multifactorial age-related changes in the neuromuscular systems results in common features of gait in the immature gait of infants and older adults. Besides, we also consider the reversibility of age-related neuromuscular deterioration by, on the one hand, exercise training, and the other hand, novel techniques such as direct spinal stimulation (tsDCS).

Muscle activation patterns and muscle synergies reflect different modes of coordination during upper extremity movement

A core issue in motor control is how the central nervous system generates and selects the muscle activation patterns necessary to achieve a variety of behaviors and movements. Extensive studies have verified that it is the foundation to induce a complex movement by the modular combinations of several muscles with a synergetic relationship. However, a few studies focus on the synergetic similarity and dissimilarity among different types of movements, especially for the upper extremity movements. In this study, we introduced the non-negative matrix factorization (NMF) method to explore the muscle activation patterns and synergy structure under 6 types of movements, involving the hand open (HO), hand close (HC), wrist flexion (WF), wrist extension (WE), supination (SU), and pronation (PR). For this, we enrolled 10 healthy subjects to record the electromyography signal for NMF calculation. The results showed a highly modular similarity of the muscle synergy among subjects under the same movement. Furthermore, Spearman's correlation analysis indicated significant similarities among HO-WE, HO-SU, and WE-SU (p < 0.001). Additionally, we also found shared synergy and special synergy in activation patterns among different movements. This study confirmed the theory of modular structure in the central nervous system, which yields a stable synergetic pattern under the same movement. Our findings on muscle synergy will be of great significance to motor control and even to clinical assessment techniques.

Use of planar covariation in lower limb kinematics to characterize adaptations of running after cycling in elite triathletes

Purpose

To characterize alterations of lower limb intersegmental coordination during the acute phase of running after cycling among highly trained triathletes using an analysis of planar covariation.

Methods

Nine highly trained triathletes completed a control run (CR) and a run after transitioning from cycling exercise (transition run, or TR condition) on a motorized treadmill at a self-selected pace. Sagittal plane kinematics were recorded using a 3D Vicon motion capture system. Intersegmental coordination of the thigh, shank and foot segments of the right lower limb and run loop planarity were calculated during running before cycling and at four different times after the end of cycling.

Results

PCA showed a significant within-subject phase shift of the run loop planarity (F = 6.66, P = 0.01). Post hoc analysis showed significance median differences increase for u _3t parameter between CR_SS vs. TR₃₀ (P = 0.01), TR_t1/2 (P = 0.01) and TR_MRT (P = 0.01). No difference for u _3t parameter existed between CR_SS vs. TR_SS.

Conclusion

Prior variable-cadence, moderate intensity cycling has a significant effect on run loop planarity and therefore intersegmental coordination during the acute transition phase among highly trained triathletes. However, alterations to lower limb coordination are corrected by the 3rd minute after the beginning of the post cycle run. We suggest that planar covariation can be used as a more sensitive measure of cycling-induced variations in running to characterize adaptation in elite and importantly, developing athletes.

Effects of exercise habituation and aging on the intersegmental coordination of lower limbs during walking with sinusoidal speed change

Background

The time courses of the joint elevation angles of the thigh, shank, and foot in one stride during walking can be well approximated by a “plane” in a triaxial space. This intersegmental coordination (IC) of the lower limb elevation angles is referred to as the planar covariation law. We examined the effects of exercise habituation and aging on the thickness of the IC plane of the lower limbs under sinusoidal speed changing conditions.

Methods

Seventeen sedentary young (SY), 16 active young (AY), and 16 active elderly (AE) adults walked on a treadmill in accordance with a sinusoidal speed changing protocol at 120, 60, and 30 s periods with an amplitude of ± 0.56 m·s⁻¹. Motion of the lower limbs from the sagittal direction was recorded to calculate the elevation angles of the lower limbs. When the best-fit IC plane was determined, the smallest standard deviation of the IC plane was considered as the anteroposterior gait variability of the lower limbs. The coefficient of variance of the step width was also quantified to evaluate the lateral step variability (CV_SW).

Results

The standard deviation of the IC plane was significantly greater in the order of SY, AY, and AE, regardless of the sinusoidal wave periods of the changing speed. The CV_SW was not significantly different among the three groups.

Conclusions

Exercise habituation influences anteroposterior gait variability of the lower limbs, but not lateral step variability, even in young adults. Given these, gait adaptability for sinusoidal speed changes does not always decline with aging.

Trial registration

UMIN000031456 (R000035911; registered February 23, 2018).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40101-022-00298-w.

An Analysis of Lower Limb Coordination Variability in Unilateral Tasks in Healthy Adults: A Possible Prognostic Tool

Interlimb coordination variability analysis can shed light into the dynamics of higher order coordination and motor control. However, it is not clear how the interlimb coordination of people with no known injuries change in similar activities with increasing difficulty. This study aimed to ascertain if the interlimb coordination variability range and patterns of healthy participants change in different unilateral functional tasks with increasing complexity and whether leg dominance affects the interlimb coordination variability. In this cross-sectional study fourteen younger participants with no known injuries completed three repeated unilateral sit-to-stands (UniSTS), step-ups (SUs), and continuous-hops (Hops). Using four inertial sensors mounted on the lower legs and thighs, angular rotation of thighs and shanks were recorded. Using Hilbert transform, the phase angle of each segment and then the continuous relative phase (CRP) of the two segments were measured. The CRP is indicative of the interlimb coordination. Finally, the linear and the nonlinear shank-thigh coordination variability of each participant in each task was calculated. The results show that the linear shank-thigh coordination variability was significantly smaller in the SUs compared to both UniSTS and Hops in both legs. There were no significant differences found between the latter two tests in their linear coordination variability. However, Hops were found to have significantly larger nonlinear shank-thigh coordination variability compared to the SUs and the UniSTS. This can be due to larger vertical and horizontal forces required for the task and can reveal inadequate motor control during the movement. The combination of nonlinear and linear interlimb coordination variability can provide more insight into human movement as they measure different aspects of coordination variability. It was also seen that leg dominance does not affect the lower limb coordination variability in participants with no known injuries. The results should be tested in participants recovering from lower limb injuries.

Relation between Step-To-Step Transition Strategies and Walking Pattern in Older Adults

In older adults, two different modes of step-to-step transition have been observed: an anticipated mode when the redirection of the centre of mass of the body (COM) begins before double stance and another when the transition begins during double stance. However, the impact of transition mode on gait kinetics and kinematics has not been investigated. Age and step-to-step-transition-related differences in intersegmental coordination and in the COM trajectory during walking were identified. Fifteen young (24.1 ± 0.7 y.o.) and thirty-six older adults (74.5 ± 5.0 y.o.) walked on a treadmill at 1.11 m s−1 and 1.67 m s−1. Lower-limb motion and ground reaction force were recorded. The COM dynamics were evaluated by measuring the pendulum-like exchange of the COM energies. While all young adults and 21 of the older adults used an anticipated transition, 15 older adults presented a non-anticipated transition. Previously documented changes of intersegmental coordination with age were accentuated in older adults with non-anticipated transition (p < 0.001). Moreover, older adults with non-anticipated transition had a smaller pendulum-like energy exchange than older adults with anticipated transition (p = 0.03). The timing of COM redirection is linked to kinematic and mechanic modification of gait and could potentially be used as a quantitative assessment of age-related decline in gait.

Early strong predictors of decline in instrumental activities of daily living in community-dwelling older Japanese people

Objective

Our aim is to determine the strong predictors of the onset of instrumental activities of daily living (IADL) decline in community-dwelling older people.

Design

A prospective cohort study with a two-year follow-up.

Setting

Kashiwa City, Chiba Prefecture, Japan and Toshima Ward, Tokyo Metropolitan, Japan.

Participants

The data were acquired from two cohorts. The final sample comprised 1,523 community-dwelling older people aged 65–94 years (681 men, 842 women). They were individuals who were independent in IADL at baseline and participated in follow-up IADL assessments two years later.

Measurements

At baseline, comprehensive assessments were performed including: health interview, gait function, hand-grip strength, skeletal muscle mass, balance function, oral function, dietary lifestyle, cognitive function, quality of life, mental status, and social network. When the two-year follow-up was performed, IADL declines were observed in 53 out of 1,523 people. The association of each Z-transformed parameter with the occurrence of IADL decline was examined by employing a binominal logistic regression model adjusting for age, gender, body weight, body height, and medical history. An odds ratio (OR) and a 95% confidence interval were calculated and compared between different parameters.

Results

A decrease in walking speed and one-legged stance time, whereas an increased timed up & go test time was associated with significant ORs for the occurrence of IADL decline.

Conclusion

Gait-related parameters appear to be the strong predictors of the onset of IADL decline in community-dwelling older people.

Characterization and Categorization of Various Human Lower Limb Movements Based on Kinematic Synergies

A proper movement categorization reduces the complexity of understanding or reproducing human movements in fields such as physiology, rehabilitation, and robotics, through partitioning a wide variety of human movements into representative sub-motion groups. However, how to establish a categorization (especially a quantitative categorization) for various human lower limb movements is rarely investigated in literature and remains challenging due to the diversity and complexity of the lower limb movements (diverse gait modes and interaction styles with the environment). Here we present a quantitative categorization for the various lower limb movements. To this end, a similarity measure between movements was first built based on limb kinematic synergies that provide a unified and physiologically meaningful framework for evaluating the similarities among different types of movements. Then, a categorization was established via hierarchical cluster analysis for thirty-four lower limb movements, including walking, running, hopping, sitting-down-standing-up, and turning in different environmental conditions. According to the movement similarities, the various movements could be divided into three distinct clusters (cluster 1: walking, running, and sitting-down-standing-up; cluster 2: hopping; cluster 3: turning). In each cluster, cluster-specific movement synergies were required. Besides the uniqueness of each cluster, similarities were also found among part of the synergies employed by these different clusters, perhaps related to common behavioral goals in these clusters. The mix of synergies shared across the clusters and synergies for specific clusters thus suggests the coexistence of the conservation and augmentation of the kinematic synergies underlying the construction of the diverse and complex motor behaviors. Overall, the categorization presented here yields a quantitative and hierarchical representation of the various lower limb movements, which can serve as a basis for the understanding of the formation mechanisms of human locomotion and motor function assessment and reproduction in related fields.

Prevalence, awareness, and associated factors of high blood pressure among female migrant workers in Central South China

BACKGROUND

Although many young Chinese women migrate to urban regions for better opportunities, little is known about the prevalence and awareness of having high blood pressure (HBP) in this population. This study investigated the prevalence, awareness, and factors associated with HBP among young female migrant workers in Central South China.

METHODS

We conducted a cross-sectional study to identify HBP (2017 ACC/AHA guidelines) among female migrant workers aged 18-45 years in Central South China. Demographics, anthropometric measurements, hypertension-related lifestyle, awareness of HBP, and blood pressure were recorded. Logistic regression analysis was used to identify the factors associated with HBP (blood pressure ≥ 130/80 mmHg).

RESULTS

Overall, 232 female migrants participated in the study (mean age 34.4; standard deviation: 6.4 years). The prevalence of HBP was 27.2% (95% CI [21.6-33.2]), and 88.9% of the participants were unaware of their HBP status. Having rural medical insurance (odds ratio [OR] = 20.7; 95% confidence interval 95% CI [2.1-204.8]), awareness of having HBP (OR = 5.1; 95% CI [1.4-18.5]), physical inactivity (OR = 2.9; 95% CI [1.1-7.9]), and being overweight/obese (OR = 2.7; 95% CI [1.3-6.1]) were independently associated with HBP.

CONCLUSIONS

This study revealed a high prevalence of HBP among young Chinese female migrant workers, as well as a high frequency of being unaware of their condition and some associated factors (rural medical insurance, awareness of having HBP, physical inactivity, and overweight/obesity). The uncontrolled HBP among young Chinese female migrant workers suggested that health education needs further promotion in such a population.

Neuromuscular Age-Related Adjustment of Gait When Moving Upwards and Downwards

Locomotor movements are accommodated to various surface conditions by means of specific locomotor adjustments. This study examined underlying age-related differences in neuromuscular control during level walking and on a positive or negative slope, and during stepping upstairs and downstairs. Ten elderly and eight young adults walked on a treadmill at two different speeds and at three different inclinations (0°, +6°, and −6°). They were also asked to ascend and descend stairs at self-selected speeds. Full body kinematics and surface electromyography of 12 lower-limb muscles were recorded. We compared the intersegmental coordination, muscle activity, and corresponding modifications of spinal motoneuronal output in young and older adults. Despite great similarity between the neuromuscular control of young and older adults, our findings highlight subtle age-related differences in all conditions, potentially reflecting systematic age-related adjustments of the neuromuscular control of locomotion across various support surfaces. The main distinctive feature of walking in older adults is a significantly wider and earlier activation of muscles innervated by the sacral segments. These changes in neuromuscular control are reflected in a reduction or lack of propulsion observed at the end of stance in older adults at different slopes, with the result of a delay in the timing of redirection of the centre-of-mass velocity and of an unanticipated step-to-step transition strategy.

Gait Kinematic and Kinetic Characteristics of Older Adults With Mild Cognitive Impairment and Subjective Cognitive Decline: A Cross-Sectional Study

Background

Older adults with mild cognitive impairment (MCI) have slower gait speed and poor gait performance under dual-task conditions. However, gait kinematic and kinetic characteristics in older adults with MCI or subjective cognitive decline (SCD) remain unknown. This study was designed to explore the difference in gait kinematics and kinetics during level walking among older people with MCI, SCD, and normal cognition (NC).

Methods

This cross-sectional study recruited 181 participants from July to December 2019; only 82 met the inclusion criteria and consented to participate and only 79 completed gait analysis. Kinematic and kinetic data were obtained using three-dimensional motion capture system during level walking, and joint movements of the lower limbs in the sagittal plane were analyzed by Visual 3D software. Differences in gait kinematics and kinetics among the groups were analyzed using multivariate analysis of covariance (MANCOVA) with Bonferroni post-hoc analysis. After adjusting for multiple comparisons, the significance level was p < 0.002 for MANCOVA and p < 0.0008 for post-hoc analysis.

Results

Twenty-two participants were MCI [mean ± standard deviation (SD) age, 71.23 ± 6.65 years], 33 were SCD (age, 72.73 ± 5.25 years), and 24 were NC (age, 71.96 ± 5.30 years). MANCOVA adjusted for age, gender, body mass index (BMI), gait speed, years of education, diabetes mellitus, and Geriatric Depression Scale (GDS) revealed a significant multivariate effect of group in knee peak extension angle (F = 8.77, p < 0.0001) and knee heel strike angle (F = 8.07, p = 0.001) on the right side. Post-hoc comparisons with Bonferroni correction showed a significant increase of 5.91° in knee peak extension angle (p < 0.0001) and a noticeable decrease of 6.21°in knee heel strike angle (p = 0.001) in MCI compared with NC on the right side. However, no significant intergroup difference was found in gait kinetics, including dorsiflexion, plantar flexion, knee flexion, knee extension, hip flexion, and hip extension(p > 0.002).

Conclusion

An increase of right knee peak extension angle and a decrease of right knee heel strike angle during level walking were found among older adults with MCI compared to those with NC.

Dynamic global sagittal alignment in patients with lumbar spinal stenosis: Analysis of the effects of decompression surgery on gait adaptations

BACKGROUND

Lumbar spinal stenosis (LSS) leads patients to adapt their posture and walking parameters. Pelvic retroversion might be a compensation mechanism of pain. Pelvic and lower limbs compensations during gait are still not precisely understood, as well as the effect of a surgical decompression on them. These dynamic parameters can be studied through three-dimensional gait analysis.

RESEARCH QUESTION

Is the dynamic pelvic tilt modified after decompression surgery in LSS patients compared to asymptomatic subjects?

MATERIAL AND METHODS

50 asymptomatic subjects (C-group) and 37 patients operated on for lumbar decompression underwent a three-dimensional gait analysis one month before (M0) and six months after (M6) the surgery. 3D gait analysis was performed and hip and knee flexion, trunk kinematics, walking speed, stride length and pelvic tilt during gait or dynamic pelvic tilt (dPT) were recorded. Health-related quality of life (HRQL) scores (Oswestry Disability Index (ODI) and Visual Analogic Scales (VAS)) and radiological assessment were performed preoperatively and postoperatively.

RESULTS

Mean values of maximum and minimum dPT in the LSS-group preoperatively were significantly higher compared to the C-group (respectively 10.9 (6.2)° versus 7.3 (5.6)°, p = 0.003; 7.7 (6.1)° versus 4.8 (5.8)°, p = 0.011), and were significantly lowered at M6 (respectively 10.9 (6.2)° versus 8.1 (4.8)°, p = 0.0087; and 7.7 (6.1)° versus 5.1 (4.7)°, p = 0.012), and became similar to the C-group. The dPT range of motion at M0 and M6 were similar, and were both significantly higher than control values. Mean values of maximum and minimum hip flexion were significantly higher at M0 compared to the C-group, and were significantly lowered at M6. No difference was found between the pre- and postoperative radiographic pelvic tilt. The VAS for lumbar pain, the VAS for radicular pain and the ODI were significantly decreased at M6.

SIGNIFICANCE

Compared to asymptomatic people, LSS patients walked with a pelvic anteversion, a hip flessum and a knee flessum before surgery, which tended to disappear after the surgical decompression. These differences were not noticed on static radiographs.

Evaluation of Three Machine Learning Algorithms for the Automatic Classification of EMG Patterns in Gait Disorders

Gait disorders are common in neurodegenerative diseases and distinguishing between seemingly similar kinematic patterns associated with different pathological entities is a challenge even for the experienced clinician. Ultimately, muscle activity underlies the generation of kinematic patterns. Therefore, one possible way to address this problem may be to differentiate gait disorders by analyzing intrinsic features of muscle activations patterns. Here, we examined whether it is possible to differentiate electromyography (EMG) gait patterns of healthy subjects and patients with different gait disorders using machine learning techniques. Nineteen healthy volunteers (9 male, 10 female, age 28.2 ± 6.2 years) and 18 patients with gait disorders (10 male, 8 female, age 66.2 ± 14.7 years) resulting from different neurological diseases walked down a hallway 10 times at a convenient pace while their muscle activity was recorded via surface EMG electrodes attached to 5 muscles of each leg (10 channels in total). Gait disorders were classified as predominantly hypokinetic (n = 12) or ataxic (n = 6) gait by two experienced raters based on video recordings. Three different classification methods (Convolutional Neural Network-CNN, Support Vector Machine-SVM, K-Nearest Neighbors-KNN) were used to automatically classify EMG patterns according to the underlying gait disorder and differentiate patients and healthy participants. Using a leave-one-out approach for training and evaluating the classifiers, the automatic classification of normal and abnormal EMG patterns during gait (2 classes: "healthy" and "patient") was possible with a high degree of accuracy using CNN (accuracy 91.9%), but not SVM (accuracy 67.6%) or KNN (accuracy 48.7%). For classification of hypokinetic vs. ataxic vs. normal gait (3 classes) best results were again obtained for CNN (accuracy 83.8%) while SVM and KNN performed worse (accuracy SVM 51.4%, KNN 32.4%). These results suggest that machine learning methods are useful for distinguishing individuals with gait disorders from healthy controls and may help classification with respect to the underlying disorder even when classifiers are trained on comparably small cohorts. In our study, CNN achieved higher accuracy than SVM and KNN and may constitute a promising method for further investigation.

Risk factors leading to trabeculectomy surgery of glaucoma patient using Japanese nationwide administrative claims data: a retrospective non-interventional cohort study

BACKGROUND

Early recognition and management of baseline risk factors may play an important role in reducing glaucoma surgery burdens. However, no studies have investigated them using real-world data in Japan or other countries. This study aimed to clarify the risk factors leading to trabeculectomy surgery, which is the most common procedure of glaucoma surgery, of glaucoma patient using the Japanese nationwide administrative claims data associated with the diagnosis procedure combination (DPC) system.

METHODS

It was a retrospective, non-interventional cohort study. Data were collected from patients who were admitted to DPC participating hospitals, nationwide acute care hospitals and were diagnosed with glaucoma between 2012 to 2018. The primary outcome was the risk factors associated with trabeculectomy surgery. The association between baseline characteristics and trabeculectomy surgery was identified using multivariable logistic regression analysis by comparing patients with and without trabeculectomy surgery. Meanwhile, the secondary outcomes included the rate of comorbidities, the rate of concomitant drug use and the treatment patterns of glaucoma eye drops at the index admission. Among patients with trabeculectomy surgery, the risk factors leading to cataract surgery were also evaluated as subgroup analysis.

RESULTS

A total of 29,599 patients included in the analysis, 12,038 and 17,561 patients were in the glaucoma surgery and non-glaucoma surgery cohorts, respectively. The factors associated with the increase in trabeculectomy surgery were having allergies, taking concomitant drugs including cancer, depression, ischemic heart disease and peptic ulcer, being diagnosed with primary open-angle glaucoma and longer length of stay in hospital. In contrast, the factors associated with the decrease in trabeculectomy surgery were having hypertension, taking hypertension drug, age ≥ 80 and female.

CONCLUSIONS

Special focus on Japanese patients with glaucoma who have allergy-related comorbidities or take immune, nervous, circulatory or gastrointestinal system-related concomitant drugs seems to be desirable.

Age-related changes in the neuromuscular control of forward and backward locomotion

Previous studies found significant modification in spatiotemporal parameters of backward walking in healthy older adults, but the age-related changes in the neuromuscular control have been considered to a lesser extent. The present study compared the intersegmental coordination, muscle activity and corresponding modifications of spinal montoneuronal output during both forward and backward walking in young and older adults. Ten older and ten young adults walked forward and backward on a treadmill at different speeds. Gait kinematics and EMG activity of 14 unilateral lower-limb muscles were recorded. As compared to young adults, the older ones used shorter steps, a more in-phase shank and foot motion, and the activity profiles of muscles innervated from the sacral segments were significantly wider in each walking condition. These findings highlight age-related changes in the neuromuscular control of both forward and backward walking. A striking feature of backward walking was the differential organization of the spinal output as compared to forward gait. In addition, the resulting spatiotemporal map patterns also characterized age-related changes of gait. Finally, modifications of the intersegmental coordination with aging were greater during backward walking. On the whole, the assessment of backward walk in addition to routine forward walk may help identifying or unmasking neuromuscular adjustments of gait to aging.

Mental Health in Children in the Context of COVID-19: Focus on Discharged Children

Introduction: To date, the mental health consequences of children hospitalized with COVID-19 remain unclear. We aimed to assess mental health status in children in the context of COVID-19, with a focus on discharged children. Methods: We recruited discharged children who recovered from COVID-19 and healthy controls between July and September 2020 in Wuhan Children's Hospital. Post-traumatic stress disorder (PTSD), anxiety, depression, and sleep problems were assessed in these children using questionnaires. Univariable and multivariable logistic and linear regressions were conducted to identify risk factors. Results: Totally, there were 152 children (61 discharged children and 91 healthy controls) aged 7-18 years old in our study. An increasing trend in the prevalence of PTSD, anxiety, and depression was observed in the discharged children compared with healthy controls (PTSD: 8.20 vs. 2.20%, anxiety: 22.95 vs. 13.19%; depression: 47.54 vs. 32.97%). Discharged children tended to report more depressive symptoms (β = 0.39) and less sleep problems (β = -0.37). Discharged children who lived in nuclear families and had longer hospital stays were more likely to report depression [odds ratio (OR) = 3.68 and 1.14, respectively]. Anxiety symptoms and the severity of sleep problems of discharged children were positively associated with caregivers' depression and PTSD symptoms (OR = 21.88 and 31.09, respectively). Conclusion: In conclusion, PTSD, anxiety, and depression symptoms were common among recovered children 4 months after COVID-19 hospitalization. Children from nuclear family and those had longer hospital stays need special attention. In addition, parental mental health had a significant impact on their children's mental resilience and recovery.