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Zhang J, Veltink PH, van Asseldonk EHF. Reframing Whole-Body Angular Momentum: Exploring the Impact of Low-Pass Filtered Dynamic Local Reference Frames During Straight-Line and Turning Gaits. IEEE Trans Neural Syst Rehabil Eng 2024; 32:3167-3178. [PMID: 39186427 DOI: 10.1109/tnsre.2024.3449706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
Accurately estimating whole-body angular momentum (WBAM) during daily activities may benefit from choosing a locally-defined reference frame aligned with anatomical axes, particularly during activities involving body turns. Local reference frames, potentially defined by pelvis heading angles, horizontal center of mass velocity (vCoM), or average angular velocity ( Aω ), can be utilized. To minimize the impact of inherent mediolateral oscillations of these frames, such as those caused by pelvis or vCoM rotation in the transverse plane, a low-pass filter is recommended. This study investigates how differences among global, local reference frames pre- and post-filtering affect WBAM component distribution across anatomical axes during straight-line walking and various turning tasks, which is lacking in the literature. Results highlighted significant effects of reference frame choice on WBAM distribution in the anteroposterior (AP) and mediolateral (ML) axes in all tasks. Specifically, expressing WBAM in the vCoM-oriented local reference frame yielded significantly lower (or higher) WBAM in the AP (or ML) axes compared to pelvis-oriented and Aω -oriented frames. However, these significant differences disappeared after employing a low-pass filter to local reference frames. Therefore, employing low-pass filtered local reference frames is crucial to enhance their applicability in both straight-line and turning tasks, ensuring more precise WBAM estimates. In applications that require expressing anatomical axes-dependent biomechanical parameters in a local reference frame, pelvis- and vCoM-oriented frames are more practical compared to the A ω -oriented frame, as they can be determined by a reduced optical marker set or inertial sensors in future applications when the whole-body kinematics is not available.
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Reddy NA, Clements RG, Brooks JCW, Bright MG. Simultaneous cortical, subcortical, and brainstem mapping of sensory activation. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.11.589099. [PMID: 38659741 PMCID: PMC11042175 DOI: 10.1101/2024.04.11.589099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Non-painful tactile sensory stimuli are processed in the cortex, subcortex, and brainstem. Recent functional magnetic resonance imaging (fMRI) studies have highlighted the value of whole-brain, systems-level investigation for examining pain processing. However, whole-brain fMRI studies are uncommon, in part due to challenges with signal to noise when studying the brainstem. Furthermore, the differentiation of small sensory brainstem structures such as the cuneate and gracile nuclei necessitates high resolution imaging. To address this gap in systems-level sensory investigation, we employed a whole-brain, multi-echo fMRI acquisition at 3T with multi-echo independent component analysis (ME-ICA) denoising and brainstem-specific modeling to enable detection of activation across the entire sensory system. In healthy participants, we examined patterns of activity in response to non-painful brushing of the right hand, left hand, and right foot, and found the expected lateralization, with distinct cortical and subcortical responses for upper and lower limb stimulation. At the brainstem level, we were able to differentiate the small, adjacent cuneate and gracile nuclei, corresponding to hand and foot stimulation respectively. Our findings demonstrate that simultaneous cortical, subcortical, and brainstem mapping at 3T could be a key tool to understand the sensory system in both healthy individuals and clinical cohorts with sensory deficits.
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Affiliation(s)
- Neha A. Reddy
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, United States
| | - Rebecca G. Clements
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, United States
| | | | - Molly G. Bright
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Department of Biomedical Engineering, McCormick School of Engineering and Applied Sciences, Northwestern University, Evanston, IL, United States
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Bode T, Zoroofchi S, Vettorazzi E, Droste JN, Welsch GH, Schwesig R, Marshall RP. Functional analysis of postural spinal and pelvic parameters using static and dynamic spinometry. Heliyon 2024; 10:e29239. [PMID: 38633646 PMCID: PMC11021985 DOI: 10.1016/j.heliyon.2024.e29239] [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: 09/13/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024] Open
Abstract
Background Spinometry is a radiation-free method to three-dimensional spine imaging that provides additional information about the functional gait patterns related to the pelvis and lower extremities. This radiation-free technology uses the surface topography of the trunk to analyze surface asymmetry and identify bony landmarks, thereby aiding the assessment of spinal deformity and supporting long-term treatment regimes. Especially reliable dynamic spinometric data for spine and pelvis are necessary to evaluate the management of non-specific back pain. Research aim This study aims to generate reliable dynamic spinometric data for spine and pelvis parameters that can serve as reference data for future studies and clinical practice. Methods This study assessed 366 subjects (185 females) under static and 360 subjects (181 females) under dynamic (walking on a treadmill at 3 km/h and 5 km/h) conditions. The DIERS Formetric 4Dmotion® system uses stripes of light to detect the surface topography of the spine and pelvis and identifies specific landmarks to analyze the spine during standing and walking. Results Relevant gender effects were calculated for lordotic angle (ηp2 = 0.22) and pelvic inclination (ηp2 = 0.26). Under static conditions, female subjects showed larger values for both parameters (lordotic angle: 41.6 ± 8.60°; pelvic inclination: 25.5 ± 7.49°). Regarding speed effects, three relevant changes were observed (sagittal imbalance: ηp2 = 0.74, kyphotic angle: ηp2 = 0.13, apical deviation: ηp2 = 0.11). The most considerable changes were observed between static condition and 3 km/h, especially for sagittal imbalance and lordotic angle. For these parameters, relevant effect sizes (d > 0.8) were calculated between static and 3 km/h for males and females. Concerning clinical vertebral parameters, only lordotic angle and pelvic inclination were correlated with each other (r = 0.722). Conclusion This study generated a gender-specific reference database of asymptomatic individuals for static and dynamic spinometry. It demonstrated that the DIERS Formetric 4Dmotion® system could capture natural changes in static and dynamic situations and catalogue functional adaptations of spino-pelvic statics at different speeds. The lordotic angle is an indirect marker of pelvic inclination, allowing spinometry to identify individuals at risk even under dynamic conditions.
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Affiliation(s)
- Tobias Bode
- Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Schima Zoroofchi
- Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Eik Vettorazzi
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jan-Niklas Droste
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- BG Klinikum Hamburg-Boberg, Bergedorfer Str. 10, 21033, Hamburg, Germany
| | - Götz H. Welsch
- Athleticum, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - René Schwesig
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Robert Percy Marshall
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
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Aysha T, Zaki S, Alam MF, Sharma S, Alnasser SM, Alqahatn AS, Mujaddadi A, Raza A, Nuhmani S. Effectiveness of backward gait training on body composition, cardiopulmonary fitness, inflammation, and metabolic marker in adults: A systematic review and meta-analysis. Int J Crit Illn Inj Sci 2024; 14:101-111. [PMID: 39005976 PMCID: PMC11245139 DOI: 10.4103/ijciis.ijciis_74_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 07/16/2024] Open
Abstract
Walking is a fundamental physical activity with significant health implications. Backward gait training (BGT) has emerged as a novel approach with potential benefits, yet its effects in comparison to traditional forward gait training (FGT) remain uncertain. This systematic review and meta-analysis aimed to evaluate the effects of BGT on body composition, cardiopulmonary fitness, and inflammatory and metabolic markers in adults. A comprehensive search across electronic databases was conducted following the Preferred Publishing Items for Systematic Reviews and Meta-Analyses guidelines. Randomized clinical trials (RCTs) comparing BGT with FGT in adults were included. Methodological quality was assessed using the Cochrane risk-of-bias tool. The certainty of evidence was evaluated using the Grading of Recommendation, Assessment, Development, and Evaluation approach. The analysis included a total of 379 male participants across the studies. The meta-analysis demonstrated significant changes in body composition and inflammatory marker outcomes, which included waist-to-height ratio (standardized mean difference [SMD]-1.18, 95% confidence interval [CI]-1.89-0.48, I2 = 83%, P < 0.01), body mass index (SMD-0.55, 95% CI-0.77-0.32, I2= 0%, P < 0.01), and C-reactive protein (SMD-0.98, 95% CI-1.28-0.70, I2= 0%, P < 0.01). In addition, the qualitative review revealed potential enhancements in cardiopulmonary fitness and metabolic markers following BGT. While the results suggest potential benefits of BGT on body composition and inflammatory markers, the evidence remains limited and heterogeneous. Further robust research with diverse populations, longer intervention periods, and comprehensive outcome assessments is essential to elucidate the true impact of BGT and its utility for promoting overall health and well-being in adults.
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Affiliation(s)
- Tuba Aysha
- Centre for Physiotherapy and Rehabilitation Sciences, New Delhi, India
| | - Saima Zaki
- Centre for Physiotherapy and Rehabilitation Sciences, New Delhi, India
| | - Md Farhan Alam
- Centre for Physiotherapy and Rehabilitation Sciences, New Delhi, India
| | - Saurabh Sharma
- Centre for Physiotherapy and Rehabilitation Sciences, New Delhi, India
| | - Saeed Mufleh Alnasser
- Rehabilitation Health Service, Armed Forces Hospital - Southern Region, Khamis Mushait, Saudi Arabia
| | - Abdulkarim Saeed Alqahatn
- Rehabilitation Health Service, Armed Forces Hospital - Southern Region, Khamis Mushait, Saudi Arabia
| | - Aqsa Mujaddadi
- Centre for Physiotherapy and Rehabilitation Sciences, New Delhi, India
| | - Ahmar Raza
- Centre for Physiotherapy and Rehabilitation Sciences, New Delhi, India
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Fiori L, Castiglia SF, Chini G, Draicchio F, Sacco F, Serrao M, Tatarelli A, Varrecchia T, Ranavolo A. The Lower Limb Muscle Co-Activation Map during Human Locomotion: From Slow Walking to Running. Bioengineering (Basel) 2024; 11:288. [PMID: 38534562 DOI: 10.3390/bioengineering11030288] [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: 01/16/2024] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
The central nervous system (CNS) controls movements and regulates joint stiffness with muscle co-activation, but until now, few studies have examined muscle pairs during running. This study aims to investigate differences in lower limb muscle coactivation during gait at different speeds, from walking to running. Nineteen healthy runners walked and ran at speeds ranging from 0.8 km/h to 9.3 km/h. Twelve lower limb muscles' co-activation was calculated using the time-varying multi-muscle co-activation function (TMCf) with global, flexor-extension, and rostro-caudal approaches. Spatiotemporal and kinematic parameters were also measured. We found that TMCf, spatiotemporal, and kinematic parameters were significantly affected by gait speed for all approaches. Significant differences were observed in the main parameters of each co-activation approach and in the spatiotemporal and kinematic parameters at the transition between walking and running. In particular, significant differences were observed in the global co-activation (CIglob, main effect F(1,17) = 641.04, p < 0.001; at the transition p < 0.001), the stride length (main effect F(1,17) = 253.03, p < 0.001; at the transition p < 0.001), the stride frequency (main effect F(1,17) = 714.22, p < 0.001; at the transition p < 0.001) and the Center of Mass displacement in the vertical (CoMy, main effect F(1,17) = 426.2, p < 0.001; at the transition p < 0.001) and medial-lateral (CoMz, main effect F(1,17) = 120.29 p < 0.001; at the transition p < 0.001) directions. Regarding the correlation analysis, the CoMy was positively correlated with a higher CIglob (r = 0.88, p < 0.001) and negatively correlated with Full Width at Half Maximum (FWHMglob, r = -0.83, p < 0.001), whereas the CoMz was positively correlated with the global Center of Activity (CoAglob, r = 0.97, p < 0.001). Positive and negative strong correlations were found between global co-activation parameters and center of mass displacements, as well as some spatiotemporal parameters, regardless of gait speed. Our findings suggest that walking and running have different co-activation patterns and kinematic characteristics, with the whole-limb stiffness exerted more synchronously and stably during running. The co-activation indexes and kinematic parameters could be the result of global co-activation, which is a sensory-control integration process used by the CNS to deal with more demanding and potentially unstable tasks like running.
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Affiliation(s)
- Lorenzo Fiori
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
- Behavioral Neuroscience PhD Program, Department of Physiology and Pharmacology, Sapienza University, Viale dell'Università 30, 00185 Rome, Italy
| | - Stefano Filippo Castiglia
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100 Latina, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Via Bassi 21, 27100 Pavia, Italy
| | - Giorgia Chini
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Francesco Draicchio
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Floriana Sacco
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Mariano Serrao
- Department of Medical and Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Via Franco Faggiana 1668, 04100 Latina, Italy
| | - Antonella Tatarelli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Tiwana Varrecchia
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
| | - Alberto Ranavolo
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, INAIL, Via Fontana Candida 1, Monte Porzio Catone, 00078 Rome, Italy
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Toussaint TD, Schepens B. Biomechanical behavior of the lower limbs and of the joints when landing from different heights. J Biomech 2024; 165:112014. [PMID: 38422773 DOI: 10.1016/j.jbiomech.2024.112014] [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: 09/05/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
Landing from a jump is a challenging task as the energy accumulated during the aerial phase of the jump must be fully dissipated by the lower limbs during landing; the higher the jump height, the greater the amount of energy to be dissipated. In the present study, we aim to understand (1) how the biomechanical behavior is tuned as a function of the mechanical demand, and (2) the relationship between the self-selected landing strategy and the behavior of the joints. Fourteen subjects were asked to drop off a box of 10 to 60 cm height and land on the ground. The ground reaction forces and the kinematics were recorded using force plates and a motion capture system. A model was used to estimate the properties, i.e. stiffness and damping, of the lower limbs and of the joints. Our results show that, whatever the amount of energy to be dissipated (i.e. height of the jump), the lower limbs and the anke and knee joints behave first as a spring, then as a spring-damper system. However each joint plays a specific role: during the spring phase, the behaviour of the lower limb is associated with the stiffness of the ankle and with the landing constraints (i.e. force peak and loading rate), while during the spring-damper phase, it is associated with the stiffness of the knee and with the amount of energy to be dissipated. Our findings suggest that constraints and performance result from a distinct control of biomechanical parameters at the joints.
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Affiliation(s)
- Thibaut D Toussaint
- Laboratoire de Physiologie et Biomécanique de la Locomotion, Insitute of NeuroScience, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Bénédicte Schepens
- Laboratoire de Physiologie et Biomécanique de la Locomotion, Insitute of NeuroScience, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
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Vanneau T, Quiquempoix M, Erkel MC, Drogou C, Trignol A, Sauvet F, Léger D, Gomez-Merino D, Chennaoui M. Beneficial Effects of Photoperiod Lengthening on Sleep Characteristics and Mechanical Hyperalgesia in Injured Rats. eNeuro 2024; 11:ENEURO.0433-23.2023. [PMID: 38212115 PMCID: PMC10921263 DOI: 10.1523/eneuro.0433-23.2023] [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: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 01/13/2024] Open
Abstract
Sleep and muscle injury-related pain are in negative relationship, and sleep extension may be a favorable countermeasure. In response to muscle injury, an adaptive sleep response has been described in rats, characterized by an increase in total sleep time (TST) and nonrapid eye movement (NREM) sleep. This study examined the effects of photoperiod lengthening (a model of sleep prolongation in rats) on the sleep characteristics of muscle-injured rats and whether this lengthening could benefit injury-induced mechanical hyperalgesia using the Von Frey test. Switching from the conventional 12:12 light/dark (LD) photoperiod (light on: 08:00-20:00) to LD 16:8 (light extended to 24:00) gives rats an extra window of sleep. Our results show higher TST and NREM sleep times in LD 16:8 versus LD 12:12 injured rats during 4 h of light lengthening for 7 d postinjury, showing the efficiency of photoperiod lengthening to increase sleep time in injured rats. In addition, a cumulative effect with the adaptive sleep response to muscle injury occurred with higher TST and NREM sleep times in LD 16:8 injured versus noninjured rats during the dark period, reflecting the high need for sleep after the injury. Greater stability and higher relative delta power of NREM sleep during the extended light period were also observed in injured rats. Finally, the extended photoperiod limits the muscle injury-induced mechanical hyperalgesia for 13 d and allows faster recovery of the baseline mechanical threshold. This is associated with reduced pro-inflammatory cytokines levels in the hippocampus, a brain structure involved in pain processing.
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Affiliation(s)
- T Vanneau
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge 91223, France
- VIFASOM (URP 7330 Vigilance, Fatigue, Sommeil et Santé Publique), Université Paris Cité, Paris 75001, France
| | - M Quiquempoix
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge 91223, France
- VIFASOM (URP 7330 Vigilance, Fatigue, Sommeil et Santé Publique), Université Paris Cité, Paris 75001, France
| | - M-C Erkel
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge 91223, France
- VIFASOM (URP 7330 Vigilance, Fatigue, Sommeil et Santé Publique), Université Paris Cité, Paris 75001, France
| | - C Drogou
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge 91223, France
- VIFASOM (URP 7330 Vigilance, Fatigue, Sommeil et Santé Publique), Université Paris Cité, Paris 75001, France
| | - A Trignol
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge 91223, France
- VIFASOM (URP 7330 Vigilance, Fatigue, Sommeil et Santé Publique), Université Paris Cité, Paris 75001, France
| | - F Sauvet
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge 91223, France
- VIFASOM (URP 7330 Vigilance, Fatigue, Sommeil et Santé Publique), Université Paris Cité, Paris 75001, France
| | - D Léger
- VIFASOM (URP 7330 Vigilance, Fatigue, Sommeil et Santé Publique), Université Paris Cité, Paris 75001, France
- APHP, APHP-Centre Université de Paris, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris 75001, France
| | - D Gomez-Merino
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge 91223, France
- VIFASOM (URP 7330 Vigilance, Fatigue, Sommeil et Santé Publique), Université Paris Cité, Paris 75001, France
| | - M Chennaoui
- French Armed Forces Biomedical Research Institute (IRBA), Brétigny-sur-Orge 91223, France
- VIFASOM (URP 7330 Vigilance, Fatigue, Sommeil et Santé Publique), Université Paris Cité, Paris 75001, France
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Perucca L, Scarano S, Russo G, Robecchi Majnardi A, Caronni A. Fatigue may improve equally after balance and endurance training in multiple sclerosis: a randomised, crossover clinical trial. Front Neurol 2024; 15:1274809. [PMID: 38385033 PMCID: PMC10880192 DOI: 10.3389/fneur.2024.1274809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/02/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Fatigue and poor balance are frequent and severe problems in multiple sclerosis (MS) that may interact. Endurance training is known to be effective on fatigue. This study aims to test if balance training is more effective against MS fatigue. Methods A randomised crossover trial was run, recruiting 31 MS people (21 women; median age: 46 years, range: 30-64; median EDSS: 4, range: 2.5-5). Participants received balance and endurance training alternately (15 one-to-one sessions, 5 days/week) and were assessed before (T0), after (T1), and 30 days after treatment ended (T2). The Modified Fatigue Impact Scale (MFIS) with scores linearised through Rasch analysis was the primary outcome (the lower the measure, the better the condition, i.e., the lower the fatigue symptoms). The Equiscale balance scale and posturography (EquiTest) were used to assess balance. Linear mixed-effects models with ANOVA were used for significance testing. Results Thirteen participants had no carryover effect and were included in the primary analysis. Fatigue significantly changed across the three time points (F2,58 = 16.0; p < 0.001), but no difference across treatments was found. Altogether, both treatments significantly improved the MFIS measure at T1 (95%CI: -1.24 logits; mean: -1.67 to -0.81 logits) and T2 (95%CI: -1.04; mean: -1.49 to -0.60) compared to T0 (95%CI: -0.51; mean: -0.95 to -0.08; p ≤ 0.001). Equiscale and posturography highlighted balance improvement after balance training but not after endurance training. Conclusion Balance and endurance training could similarly reduce fatigue in MS patients in the short term. However, only balance training also improved balance in MS.
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Affiliation(s)
- Laura Perucca
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Scarano
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Giovanna Russo
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
| | - Antonio Robecchi Majnardi
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
| | - Antonio Caronni
- IRCCS Istituto Auxologico Italiano, Department of Neurorehabilitation Sciences, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Labrozzi GC, Warner H, Makowski NS, Audu ML, Triolo RJ. Center of Mass Estimation for Impaired Gait Assessment Using Inertial Measurement Units. IEEE Trans Neural Syst Rehabil Eng 2024; 32:12-22. [PMID: 38090847 PMCID: PMC10849874 DOI: 10.1109/tnsre.2023.3341436] [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] [Indexed: 01/14/2024]
Abstract
Injury or disease often compromise walking dynamics and negatively impact quality of life and independence. Assessing methods to restore or improve pathological gait can be expedited by examining a global parameter that reflects overall musculoskeletal control. Center of mass (CoM) kinematics follow well-defined trajectories during unimpaired gait, and change predictably with various gait pathologies. We propose a method to estimate CoM trajectories from inertial measurement units (IMUs) using a bidirectional Long Short-Term Memory neural network to evaluate rehabilitation interventions and outcomes. Five non-disabled volunteers participated in a single session of various dynamic walking trials with IMUs mounted on various body segments. A neural network trained with data from four of the five volunteers through a leave-one-subject out cross validation estimated the CoM with average root mean square errors (RMSEs) of 1.44cm, 1.15cm, and 0.40cm in the mediolateral (ML), anteroposterior (AP), and inferior/superior (IS) directions respectively. The impact of number and location of IMUs on network prediction accuracy was determined via principal component analysis. Comparing across all configurations, three to five IMUs located on the legs and medial trunk were the most promising reduced sensor sets for achieving CoM estimates suitable for outcome assessment. Lastly, the networks were tested on data from an individual with hemiparesis with the greatest error increase in the ML direction, which could stem from asymmetric gait. These results provide a framework for assessing gait deviations after disease or injury and evaluating rehabilitation interventions intended to normalize gait pathologies.
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Takiyama K, Yokoyama H. Speed-dependent modulations of asymmetric center of body mass trajectory in the gait of above-knee amputee subjects. Front Sports Act Living 2024; 5:1304141. [PMID: 38239891 PMCID: PMC10794564 DOI: 10.3389/fspor.2023.1304141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
How to achieve stable locomotion while overcoming various instabilities is an ongoing research topic. One essential factor for achieving a stable gait is controlling the center of body mass (CoM). The CoM yields more instability in the mediolateral direction. Examining speed-dependent modulations of the CoM trajectories in the frontal plane can provide insight into control policies for achieving stable locomotion. Although these modulations have been studied while assuming symmetric CoM trajectories, this assumption is generally incorrect. For example, amputee subjects demonstrate asymmetric CoM trajectories. Here, we investigated speed-dependent modulations of asymmetric CoM trajectories in above-knee amputee subjects using Fourier series expansion. Despite the asymmetric CoM trajectories in amputee subjects, the framework of Fourier series expansion clarified that amputee subjects showed the same speed-dependent modulations as non-amputee subjects whose CoM trajectories were symmetric. Specifically, CoM trajectories became narrower in the mediolateral direction and broader in the superoinferior direction as walking speed increased. The speed-dependent modulations of CoM trajectories had a functional role in improving dynamic stability, and faster walking speeds provided greater dynamic stability on both prosthetic and non-prosthetic sides. Although the asymmetry of foot contact duration and CoM trajectory decreased as walking speed increased, step width and the asymmetry of dynamic stability between prosthetic and non-prosthetic sides remained constant across the walking speed, which corresponded to the predictions by our framework. These findings could offer a better strategy for achieving stable walking for amputee subjects.
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Affiliation(s)
- Ken Takiyama
- Department of Electrical Engineering and Computer Science, Tokyo University of Agriculture and Technology, Koganei, Japan
| | - Hikaru Yokoyama
- Division of Advanced Health Science, Tokyo University of Agriculture and Technology, Koganei, Japan
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11
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Zhang H, Shen Q, Zheng P, Wang H, Zou R, Zhang Z, Pan Y, Zhi JY, Xiang ZR. Harvesting Inertial Energy and Powering Wearable Devices: A Review. SMALL METHODS 2024; 8:e2300771. [PMID: 37853661 DOI: 10.1002/smtd.202300771] [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: 06/22/2023] [Revised: 09/13/2023] [Indexed: 10/20/2023]
Abstract
Amidst the swift progression of microelectronics and Internet of Things technology, wearable devices are gradually gaining ground in the domains of human health monitoring. Recently, human bioenergy harvesting has emerged as a plausible alternative to batteries. This paper delves into harvesting human inertial energy that stimulates inertial masses through human motion and then transmutes the motion of the inertial masses into electrical energy. The inertial energy harvester is better suited for low-frequency and irregular human motion. This review first identifies the sources of human motion excitation that are compatible with inertial energy harvesters and then provides a summary of the operating principles and the comparisons of the commonly used energy conversion mechanisms, including electromagnetic, piezoelectric, and triboelectric transducers. The review thoroughly summarizes the latest advancements in human inertial energy-harvesting technology that are categorized and grouped based on their excitation sources and mechanical modulation methods. In addition, the review outlines the applications of inertial energy harvesters in powering wearable devices, medical health monitoring, and as mobile power sources. Finally, the challenges faced by inertial energy-harvesting technologies are discussed, and the review provides a perspective on the potential developments in the field.
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Affiliation(s)
- Hexiang Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, P. R. China
- Yibin Research Institute, Southwest Jiaotong University, Yibin, 64000, P. R. China
| | - Qianhui Shen
- School of Design, Southwest Jiaotong University, Chengdu, 610031, P. R. China
| | - Peng Zheng
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, P. R. China
- Yibin Research Institute, Southwest Jiaotong University, Yibin, 64000, P. R. China
| | - Hao Wang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, P. R. China
- Yibin Research Institute, Southwest Jiaotong University, Yibin, 64000, P. R. China
| | - Rui Zou
- School of Design, Southwest Jiaotong University, Chengdu, 610031, P. R. China
| | - Zutao Zhang
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, P. R. China
| | - Yajia Pan
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, 610031, P. R. China
| | - Jin-Yi Zhi
- School of Design, Southwest Jiaotong University, Chengdu, 610031, P. R. China
| | - Ze-Rui Xiang
- School of Design, Southwest Jiaotong University, Chengdu, 610031, P. R. China
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12
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Crystal O, Maralani PJ, Black S, Fischer C, Moody AR, Khademi A. Brain Age Estimation on a Dementia Cohort Using FLAIR MRI Biomarkers. AJNR Am J Neuroradiol 2023; 44:1384-1390. [PMID: 38050032 PMCID: PMC10714845 DOI: 10.3174/ajnr.a8059] [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: 05/26/2023] [Accepted: 10/13/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND AND PURPOSE The prodromal stage of Alzheimer's disease presents an imperative intervention window. This work focuses on using brain age prediction models and biomarkers from FLAIR MR imaging to identify subjects who progress to Alzheimer's disease (converting mild cognitive impairment) or those who remain stable (stable mild cognitive impairment). MATERIALS AND METHODS A machine learning model was trained to predict the age of normal control subjects on the basis of volume, intensity, and texture features from 3239 FLAIR MRI volumes. The brain age gap estimation (BrainAGE) was computed as the difference between the predicted and true age, and it was used as a biomarker for both cross-sectional and longitudinal analyses. Differences in biomarker means, slopes, and intercepts were investigated using ANOVA and Tukey post hoc test. Correlation analysis was performed between brain age gap estimation and established Alzheimer's disease indicators. RESULTS The brain age prediction model showed accurate results (mean absolute error = 2.46 years) when testing on held out normal control data. The computed BrainAGE metric showed significant differences between the stable mild cognitive impairment and converting mild cognitive impairment groups in cross-sectional and longitudinal analyses, most notably showing significant differences up to 4 years before conversion to Alzheimer's disease. A significant correlation was found between BrainAGE and previously established Alzheimer's disease conversion biomarkers. CONCLUSIONS The BrainAGE metric can allow clinicians to consider a single explainable value that summarizes all the biomarkers because it considers many dimensions of disease and can determine whether the subject has normal aging patterns or if he or she is trending into a high-risk category using a single value.
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Affiliation(s)
- Owen Crystal
- From the Department of Electrical, Computer and Biomedical Engineering (O.C., A.K.), Toronto Metropolitan University, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, Science and Technology (O.C., A.K.), Toronto, Ontario, Canada
| | - Pejman J Maralani
- Department of Medical Imaging (P.J.M., A.R.M., A.K.), University of Toronto, Toronto, Ontario, Canada
| | - Sandra Black
- Institute of Medical Science (S.B., C.F.), University of Toronto, Toronto, Ontario, Canada
- Department of Neurology (S.B.), University of Toronto, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Research Program (S.B.), Sunnybrook Research Institute, Toronto, Ontario, Canada
- Division of Neurology (S.B.), Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- L.C. Campbell Cognitive Neurology Research Unit (S.B.), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Corinne Fischer
- Institute of Medical Science (S.B., C.F.), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry (C.F.), St. Michael's Hospital, Toronto, Ontario, Canada
- Keenan Research Center (C.F., A.K.), St. Michael's Hospital, Toronto, Ontario, Canada
| | - Alan R Moody
- Department of Medical Imaging (P.J.M., A.R.M., A.K.), University of Toronto, Toronto, Ontario, Canada
| | - April Khademi
- From the Department of Electrical, Computer and Biomedical Engineering (O.C., A.K.), Toronto Metropolitan University, Toronto, Ontario, Canada
- Department of Medical Imaging (P.J.M., A.R.M., A.K.), University of Toronto, Toronto, Ontario, Canada
- Keenan Research Center (C.F., A.K.), St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Biomedical Engineering, Science and Technology (O.C., A.K.), Toronto, Ontario, Canada
- Vector Institute for Artificial Intelligence (A.K.), Toronto, Ontario, Canada
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13
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Dussault-Picard C, Cherni Y, Ferron A, Robert MT, Dixon PC. The effect of uneven surfaces on inter-joint coordination during walking in children with cerebral palsy. Sci Rep 2023; 13:21779. [PMID: 38066308 PMCID: PMC10709314 DOI: 10.1038/s41598-023-49196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
Clinical gait analysis on uneven surfaces contributes to the ecological assessment of gait deviations of children with spastic cerebral palsy (CP). Walking on uneven surfaces requires specific motor strategies, which can be assessed by lower-limb kinematic and inter-joint coordination analyses. This study aimed to assess and compare kinematics and inter-joint coordination between children with CP and their typically developing (TD) peers when walking on even and two levels of uneven surfaces (medium and high). A total of 17 children with CP and 17 TD children (11.5 ± 3.5 and 10.4 ± 4.5 years old, respectively) were asked to complete 6-8 gait trials on a 4-m walkway of each surface (n = 3) in randomized blocks while fit with retro-reflective markers on their lower-limbs. Children with CP showed proximal gait adaptations (i.e., hip and knee) on uneven surfaces. Compared with the TD group, the CP group showed decreased hip extension during late stance (49-63%, d = 0.549, p < 0.001), and a more in-phase knee-hip coordination strategy during swing phase (75-84% of gait cycle, d = 1.035, p = 0.029 and 92-100%, d = 1.091, p = 0.030) when walking on an uneven (high), compared to even surface. This study provides a better understanding of kinematic strategies employed by children with spastic CP when facing typical daily life gait challenges. Further studies are needed to evaluate the benefits of integrating uneven surfaces in rehabilitation care.
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Affiliation(s)
- C Dussault-Picard
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, University of Montreal, Montreal, Canada.
- Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Montreal, Canada.
| | - Y Cherni
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, University of Montreal, Montreal, Canada
- Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Montreal, Canada
- Institute of Biomedical Engineering, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - A Ferron
- Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Montreal, Canada
- Department of Biology, University of Quebec in Montreal, Montreal, Canada
| | - M T Robert
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Canada
| | - P C Dixon
- Faculty of Medicine, School of Kinesiology and Physical Activity Sciences, University of Montreal, Montreal, Canada
- Research Center of the Sainte-Justine University Hospital (CRCHUSJ), Montreal, Canada
- Institute of Biomedical Engineering, Faculty of Medicine, University of Montreal, Montreal, Canada
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14
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Beauchamp JA, Hassan AS, McPherson LM, Negro F, Pearcey GEP, Cummings M, Heckman CJ, Dewald JPA. Motor unit firing rate modulation is more impaired during flexion synergy-driven contractions of the biceps brachii in chronic stroke. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.22.23298905. [PMID: 38045404 PMCID: PMC10690344 DOI: 10.1101/2023.11.22.23298905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Following a hemiparetic stroke, individuals exhibit altered motor unit firing patterns during voluntary muscle contractions, including impairments in firing rate modulation and recruitment. These individuals also exhibit abnormal muscle coactivation through multi-joint synergies (e.g., flexion synergy). Here, we investigate whether motor unit firing activity during flexion synergy-driven contractions of the paretic biceps brachii differs from that of voluntary contractions and use these differences to predict changes in descending motor commands. To accomplish this, we characterized motor unit firing patterns of the biceps brachii in individuals with chronic hemiparetic stroke during voluntary isometric elbow flexion contractions in the paretic and non-paretic limbs, as well as during contractions driven by voluntary effort and by flexion synergy expression in the paretic limb. We observed significant reductions in motor unit firing rate modulation from the non-paretic to paretic limb (non-paretic - paretic: 0.14 pps/%MVT, 95% CI: [0.09 0.19]) that were further reduced during synergy-driven contractions (voluntary paretic - synergy driven: 0.19 pps/%MVT, 95% CI: [0.14 0.25]). Moreover, using recently developed metrics, we evaluated how a stroke-induced reliance on indirect motor pathways alters the inputs that motor units receive and revealed progressive increases in neuromodulatory and inhibitory drive to the motor pool in the paretic limb, with the changes greatest during synergy-driven contractions. These findings suggest that an interplay between heightened neuromodulatory drive and alterations in inhibitory command structure may account for the observed motor unit impairments, further illuminating underlying neural mechanisms involved in the flexion synergy and its impact on motor unit firing patterns post-stroke.
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15
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Amrani El Yaakoubi N, McDonald C, Lennon O. Prediction of Gait Kinematics and Kinetics: A Systematic Review of EMG and EEG Signal Use and Their Contribution to Prediction Accuracy. Bioengineering (Basel) 2023; 10:1162. [PMID: 37892892 PMCID: PMC10604078 DOI: 10.3390/bioengineering10101162] [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: 08/28/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
Human-machine interfaces hold promise in enhancing rehabilitation by predicting and responding to subjects' movement intent. In gait rehabilitation, neural network architectures utilize lower-limb muscle and brain activity to predict continuous kinematics and kinetics during stepping and walking. This systematic review, spanning five databases, assessed 16 papers meeting inclusion criteria. Studies predicted lower-limb kinematics and kinetics using electroencephalograms (EEGs), electromyograms (EMGs), or a combination with kinematic data and anthropological parameters. Long short-term memory (LSTM) and convolutional neural network (CNN) tools demonstrated highest accuracies. EEG focused on joint angles, while EMG predicted moments and torque joints. Useful EEG electrode locations included C3, C4, Cz, P3, F4, and F8. Vastus Lateralis, Rectus Femoris, and Gastrocnemius were the most commonly accessed muscles for kinematic and kinetic prediction using EMGs. No studies combining EEGs and EMGs to predict lower-limb kinematics and kinetics during stepping or walking were found, suggesting a potential avenue for future development in this technology.
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Affiliation(s)
| | | | - Olive Lennon
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, D04 V1W8 Dublin, Ireland; (N.A.E.Y.)
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16
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Jeon W, Ramadan A, Whitall J, Alissa N, Westlake K. Age-related differences in lower limb muscle activation patterns and balance control strategies while walking over a compliant surface. Sci Rep 2023; 13:16555. [PMID: 37783842 PMCID: PMC10545684 DOI: 10.1038/s41598-023-43728-0] [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: 06/22/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023] Open
Abstract
Substantial evidence demonstrates that falls in older adults are leading causes of fatal and non-fatal injuries and lead to negative impacts on the quality of life in the aging population. Most falls in older fallers result from unrecoverable limb collapse during falling momentum control in the single limb support (SLS) phase. To understand why older adults are more likely to fall than younger adults, we investigated age-related differences in knee extensor eccentric control, lower limb muscle activation patterns, and their relation to balance control. Ten older and ten younger healthy adults were compared during balance control while walking on a compliant surface. There was a positive correlation between knee extensor eccentric work in the perturbed leg and the swinging leg's speed and margin of stability. In comparison to younger adults, older adults demonstrated (1) less eccentric work, reduced eccentric electromyography burst duration in the perturbed leg, (2) higher postural sway during SLS, and (3) impaired swinging leg balance control. The group-specific muscle synergy showed that older adults had a prominent ankle muscle activation, while younger adults exhibited a more prominent hip muscle activation. These findings provide insight into targeted balance rehabilitation directions to improve postural stability and reduce falls in older adults.
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Affiliation(s)
- Woohyoung Jeon
- Department of Health and Kinesiology, University of Texas at Tyler, Tyler, TX, USA.
| | - Ahmed Ramadan
- Department of Biomedical Engineering, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Jill Whitall
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nesreen Alissa
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kelly Westlake
- Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD, USA.
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Akiyama R, Ishii A, Kikuchi T, Okawa M, Yamao Y, Abekura Y, Ono I, Sasaki N, Tsuji H, Imamura H, Hatano T, Sakai N, Miyamoto S. Onset-to-treatment time and aneurysmal regression predict improvement of cranial neuropathy after flow diversion treatment in patients with symptomatic internal carotid artery aneurysms. J Neurointerv Surg 2023; 15:886-891. [PMID: 35853697 PMCID: PMC10447392 DOI: 10.1136/jnis-2022-019202] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although flow diversion plays a pivotal role in treating internal carotid artery aneurysms presenting with cranial neuropathy, predictors of symptom improvement have not been established. OBJECTIVE To investigate improvement of symptoms after flow diversion treatment in patients with internal carotid artery aneurysms causing cranial neuropathy, with sufficient follow-up period. Additionally, to examine factors associated with improvement of symptoms. METHODS This retrospective multicenter study examined patients with unruptured internal carotid artery aneurysms presenting with cranial neuropathy who were treated using flow diversion and followed up for at least 12 months. Study outcomes were transient worsening of symptoms and symptom status 12 months after treatment. Patient and aneurysm characteristics were statistically analyzed. RESULTS Seventy-seven patients were included. Data needed for outcome analysis were available for 66 patients. At the 1-, 3-, 6-, 12-month, and last follow-ups, the proportion of patients with resolved or improved symptoms was 26% (20/77), 51% (39/77), 74% (57/77), 83% (64/77), and 79%(62/77), respectively. Symptom onset-to-treatment time <6 months (OR=24.2; 95% CI 3.09 to 188.84; p=0.002) and aneurysmal regression (OR=23.1; 95% CI 1.97 to 271.75; p=0.012) were significantly associated with symptom improvement. Transient symptom worsening and worse symptoms at 12 months occurred in 19/77 (25%) and 2/77 (3%) patients, respectively. CONCLUSIONS The rate of cranial neuropathy symptom improvement after flow diversion increased over the first 12 months after treatment, but not thereafter. Treatment within 6 months of symptom onset and aneurysmal regression were predictors of symptom improvement.
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Affiliation(s)
- Ryo Akiyama
- Department of Neurosurgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Kyoto, Japan
| | - Akira Ishii
- Department of Neurosurgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Kyoto, Japan
| | - Takayuki Kikuchi
- Department of Neurosurgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Kyoto, Japan
| | - Masakazu Okawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Kyoto, Japan
| | - Yukihiro Yamao
- Department of Neurosurgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Kyoto, Japan
| | - Yu Abekura
- Department of Neurosurgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Kyoto, Japan
| | - Isao Ono
- Department of Neurosurgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Kyoto, Japan
| | - Natsuhi Sasaki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Kyoto, Japan
| | - Hirofumi Tsuji
- Department of Neurosurgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Kyoto, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Taketo Hatano
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Kyoto, Japan
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18
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Carse B, Hebenton J, Brady L, Davie-Smith F. Absent loading response knee flexion: The impact on gait kinetics and centre of mass motion in individuals with unilateral transfemoral amputation, and the effect of microprocessor controlled knee provision. Clin Biomech (Bristol, Avon) 2023; 108:106061. [PMID: 37556922 DOI: 10.1016/j.clinbiomech.2023.106061] [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: 01/16/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Individuals with unilateral transfemoral amputation walk with increased levels of asymmetry, and this is associated with reduced gait efficiency, back pain and overuse of the intact limb. This study investigated the effect of walking with a unilateral absence of loading response knee flexion on the symmetry of anterior-posterior kinetics and centre of mass accelerations. METHODS A retrospective cohort study design was used, assessing three-dimensional gait data from individuals with unilateral transfemoral amputation (n = 56). The anterior-posterior gait variables analysed included; peak ground reaction forces, impulse, centre of mass acceleration, as well as rate of vertical ground reaction force increase in early stance. With respect to these variables, this study assessed the symmetry between intact and prosthetic limbs, compared intact limbs against a healthy unimpaired control group, and evaluated effect on symmetry of microprocessor controlled knee provision. FINDINGS Significant between-limb asymmetries were found between intact and prosthetic limbs across all variables (p < 0.0001). Intact limbs showed excessive loading when compared with control group limbs after speed normalisation across all variables (p < 0.0001). No improvement in kinetic symmetry following microprocessor controlled knee provision was found. INTERPRETATION The gait asymmetries for individuals with transfemoral amputation identified in this study suggest that more should be done by developers to address the resultant overloading of the intact limb, as this is thought to have negative long-term effects. The provision of microprocessor controlled knees did not appear to improve the asymmetries faced by individuals with transfemoral amputation, and clinicians should be aware of this when managing patient expectations.
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Affiliation(s)
- Bruce Carse
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, UK.
| | - Joanne Hebenton
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Laura Brady
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, UK
| | - Fiona Davie-Smith
- West of Scotland Rehabilitation and Mobility Centre, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow G51 4TF, UK
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19
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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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20
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Gudmundson AT, Koo A, Virovka A, Amirault AL, Soo M, Cho JH, Oeltzschner G, Edden RA, Stark C. Meta-analysis and Open-source Database for In Vivo Brain Magnetic Resonance Spectroscopy in Health and Disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.02.10.528046. [PMID: 37205343 PMCID: PMC10187197 DOI: 10.1101/2023.02.10.528046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Proton ( 1 H) Magnetic Resonance Spectroscopy (MRS) is a non-invasive tool capable of quantifying brain metabolite concentrations in vivo . Prioritization of standardization and accessibility in the field has led to the development of universal pulse sequences, methodological consensus recommendations, and the development of open-source analysis software packages. One on-going challenge is methodological validation with ground-truth data. As ground-truths are rarely available for in vivo measurements, data simulations have become an important tool. The diverse literature of metabolite measurements has made it challenging to define ranges to be used within simulations. Especially for the development of deep learning and machine learning algorithms, simulations must be able to produce accurate spectra capturing all the nuances of in vivo data. Therefore, we sought to determine the physiological ranges and relaxation rates of brain metabolites which can be used both in data simulations and as reference estimates. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we've identified relevant MRS research articles and created an open-source database containing methods, results, and other article information as a resource. Using this database, expectation values and ranges for metabolite concentrations and T 2 relaxation times are established based upon a meta-analyses of healthy and diseased brains.
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Affiliation(s)
- Aaron T. Gudmundson
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Annie Koo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Anna Virovka
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Alyssa L. Amirault
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Madelene Soo
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Jocelyn H. Cho
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
| | - Georg Oeltzschner
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Richard A.E. Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD
| | - Craig Stark
- Department of Neurobiology and Behavior, University of California, Irvine, Irvine, CA
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Liss DJ, Carey HD, Allen JL. Young adults use whole-body feedback and ankle proprioception to perceive small locomotor disturbances. Hum Mov Sci 2023; 89:103084. [PMID: 36989968 DOI: 10.1016/j.humov.2023.103084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/29/2023]
Abstract
To prevent a fall when a disturbance to walking is encountered requires sensory information about the disturbance to be sensed, integrated, and then used to generate an appropriate corrective motor response. Prior research has shown that feedback of whole-body motion (e.g., center-of-mass kinematics) drives this corrective response. Here, we hypothesized that young adults also use whole-body motion to perceive locomotor disturbances. 15 subjects performed a locomotor discrimination task in which the supporting leg was slowed during stance every 8-12 steps to emulate subtle slips. The perception threshold of these disturbances was determined using a psychometrics approach and found to be 0.08 ± 0.03 m/s. Whole-body feedback was examined through center-of-mass (CoM) kinematics and whole-body angular momentum (WBAM). Perturbation-induced deviations of CoM and WBAM were calculated in response to the two perturbation levels nearest each subject's perception threshold. Consistent with our hypothesis, we identified significantly higher perturbation induced deviations for perceived perturbations in sagittal-plane WBAM, anteroposterior CoM velocity, and vertical CoM velocity and acceleration. Because whole body motion is not sensed directly but instead arises from the integration of various sensory feedback signals, we also explored local sensory feedback contributions to the perception of locomotor disturbances. Local sensory feedback was estimated through kinematic analogues of vision (head angle), vestibular (head angular velocity), proprioception (i.e., sagittal hip, knee, and ankle angles), and somatosensation (i.e., anterior-posterior & mediolateral center-of-pressure, COP). We identified significantly higher perturbation induced deviations for perceived perturbations in sagittal-plane ankle angle. These results provide evidence for both whole-body feedback and ankle proprioception as important for the perception of subtle slip-like locomotor disturbances in young adults. Our interpretation is ankle proprioception is a dominant contributor to estimates of whole-body motion to perceive locomotor disturbances.
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Dusane S, Shafer A, Ochs WL, Cornwell T, Henderson H, Kim KYA, Gordon KE. Control of center of mass motion during walking correlates with gait and balance in people with incomplete spinal cord injury. Front Neurol 2023; 14:1146094. [PMID: 37325225 PMCID: PMC10262050 DOI: 10.3389/fneur.2023.1146094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Background There is evidence that ambulatory people with incomplete spinal cord injury (iSCI) have an impaired ability to control lateral motion of their whole-body center of mass (COM) during walking. This impairment is believed to contribute to functional deficits in gait and balance, however that relationship is unclear. Thus, this cross-sectional study examines the relationship between the ability to control lateral COM motion during walking and functional measures of gait and balance in people with iSCI. Methods We assessed the ability to control lateral COM motion during walking and conducted clinical gait and balance outcome measures on 20 ambulatory adults with chronic iSCI (C1-T10 injury, American Spinal Injury Association Impairment Scale C or D). To assess their ability to control lateral COM motion, participants performed three treadmill walking trials. During each trial, real-time lateral COM position and a target lane were projected on the treadmill. Participants were instructed to keep their lateral COM position within the lane. If successful, an automated control algorithm progressively reduced the lane width, making the task more challenging. If unsuccessful, the lane width increased. The adaptive lane width was designed to challenge each participant's maximum capacity to control lateral COM motion during walking. To quantify control of lateral COM motion, we calculated lateral COM excursion during each gait cycle and then identified the minimum lateral COM excursion occurring during five consecutive gait cycles. Our clinical outcome measures were Berg Balance Scale (BBS), Timed Up and Go test (TUG), 10-Meter Walk Test (10MWT) and Functional Gait Assessment (FGA). We used a Spearman correlation analysis (ρ) to examine the relationship between minimum lateral COM excursion and clinical measures. Results Minimum lateral COM excursion had significant moderate correlations with BBS (ρ = -0.54, p = 0.014), TUG (ρ = 0.59, p = 0.007), FGA (ρ = -0.59, p = 0.007), 10MWT-preferred (ρ = -0.59, p = 0.006) and 10MWT-fast (ρ = -0.68, p = 0.001). Conclusion Control of lateral COM motion during walking is associated with a wide range of clinical gait and balance measures in people with iSCI. This finding suggests the ability to control lateral COM motion during walking could be a contributing factor to gait and balance in people with iSCI.
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Affiliation(s)
- Shamali Dusane
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Anna Shafer
- Edward Hines Jr. VA Hospital, Hines, IL, United States
| | - Wendy L. Ochs
- Edward Hines Jr. VA Hospital, Hines, IL, United States
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Tara Cornwell
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Heather Henderson
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kwang-Youn A. Kim
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Keith E. Gordon
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Edward Hines Jr. VA Hospital, Hines, IL, United States
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Tesio L, Caronni A, Russo C, Felisari G, Banco E, Simone A, Scarano S, Bolognini N. Reversed Mirror Therapy (REMIT) after Stroke-A Proof-of-Concept Study. Brain Sci 2023; 13:847. [PMID: 37371327 DOI: 10.3390/brainsci13060847] [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: 04/27/2023] [Revised: 05/13/2023] [Accepted: 05/20/2023] [Indexed: 06/29/2023] Open
Abstract
In mirror training (MIT), stroke patients strive to move their hands while looking at the reflected image of the unaffected one. The recruitment of the mirror neurons and visual-proprioceptive conflict are expected to facilitate the paretic voluntary movement. Here, a reversed MIT (REMIT) is presented, which requires moving hands while looking at the reflected image of the paretic one, giving the illusion of being unable to move the unimpaired hand. This study compares MIT and REMIT on post-stroke upper-limb recovery to gain clues on the mechanism of action of mirror therapies. Eight chronic stroke patients underwent two weeks of MIT and REMIT (five sessions each) in a crossover design. Upper-limb Fugl-Meyer, Box and Block and handgrip strength tests were administered at baseline and treatments end. The strength of the mirror illusion was evaluated after each session. MIT induced a larger illusory effect. The Fugl-Meyer score improved to the same extent after both treatments. No changes occurred in the Box and Block and the handgrip tests. REMIT and MIT were equally effective on upper-limb dexterity, challenging the exclusive role of mirror neurons. Contrasting learned nonuse through an intersensory conflict might provide the rationale for both forms of mirror-based rehabilitation after stroke.
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Affiliation(s)
- Luigi Tesio
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milano, Italy
| | - Antonio Caronni
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milano, Italy
| | - Cristina Russo
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
| | - Giorgio Felisari
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
| | - Elisabetta Banco
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
| | - Anna Simone
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, Istituto Auxologico Italiano, IRCCS, Ospedale San Luca, 20149 Milano, Italy
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milano, Italy
| | - Nadia Bolognini
- Department of Psychology, University of Milano-Bicocca, 20126 Milano, Italy
- Neuropsychological Laboratory, Istituto Auxologico Italiano, IRCCS, 20122 Milano, Italy
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Boysen MD, Munk-Hansen M, Steffensen M, Holsgaard-Larsen A, Madeleine P. The biomechanical differences of wearing safety shoes compared with everyday shoes on dynamic balance when tripping over an obstacle. APPLIED ERGONOMICS 2023; 111:104040. [PMID: 37126881 DOI: 10.1016/j.apergo.2023.104040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
Safety shoes are known to challenge dynamic balance, but the interaction between footwear and trips has not been thoroughly explored. This study investigated the biomechanical differences on dynamic balance during unexpected trip perturbations between safety shoes and everyday shoes. The vertical position of the whole-body center of mass (CoM) and the linear momentum of the swing leg from seven females and sixteen males were analyzed in five subsequent gait cycles. Additionally, the recovery strategies (i.e., the displacement of the foot after tripping) were classified. Wearing safety shoes, the linear momentum of the foot and whole leg increased, and the vertical position of the whole-body CoM was lower after the perturbation. Additionally, the recovery strategy when wearing safety shoes demonstrated a lower displacement of the foot. In conclusion, wearing safety shoes was found to have negative biomechanical effects when having to circumvent a trip, and this potentially increased the risk of falling.
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Affiliation(s)
- Mads Daabeck Boysen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| | - Mathias Munk-Hansen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| | - Mike Steffensen
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
| | - Anders Holsgaard-Larsen
- Department of Clinical Research, University of Southern Denmark and Orthopedic Research Unit, Odense University Hospital, Odense, Denmark.
| | - Pascal Madeleine
- Sport Sciences - Performance and Technology, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.
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25
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Janse van Mantgem MR, van Rheenen W, Hackeng AV, van Es MA, Veldink JH, van den Berg LH, van Eijk RPA. Association Between Serum Lipids and Survival in Patients With Amyotrophic Lateral Sclerosis: A Meta-analysis and Population-Based Study. Neurology 2023; 100:e1062-e1071. [PMID: 36460467 PMCID: PMC9990853 DOI: 10.1212/wnl.0000000000201657] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 10/20/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVE To explore the association between lipids, polygenic profile scores (PPS) for biomarkers of lipid metabolism, markers of disease severity, and survival in patients with amyotrophic lateral sclerosis (ALS). METHODS We meta-analyzed the current literature on the prognostic value of lipids in patients with ALS. Subsequently, we evaluated the relationship between lipid levels at diagnosis, clinical disease stage, and survival in all consecutive patients diagnosed in the Netherlands. We determined the hazard ratio (HR) of each lipid for overall survival, defined as death from any cause. A subset of patients was matched to a previous genome-wide association study; data were used to calculate PPS for biomarkers of lipid metabolism and to determine the association between observed lipid levels at diagnosis and survival. RESULTS Meta-analysis of 4 studies indicated that none of the biomarkers of the lipid metabolism were statistically significantly associated with overall survival; there was, however, considerable heterogeneity between study results. Using individual patient data (N = 1,324), we found that increased high-density lipoprotein (HDL) cholesterol was associated with poorer survival (HR of 1.33 (95% CI 1.14-1.55, p < 0.001)). The correlation between BMI and HDL cholesterol (Pearson r -0.26, 95% CI -0.32 to -0.20) was negative and between BMI and triglycerides (TG) positive (Pearson r 0.18, 95% CI 0.12-0.24). Serum concentrations of total cholesterol and LDL cholesterol were lower in more advanced clinical stages (both p < 0.001). PPS for biomarkers of lipid metabolism explained 1.2%-13.1% of their variance at diagnosis. None of the PPS was significantly associated with survival (all p > 0.50). DISCUSSION Lipids may contain valuable information about disease severity and prognosis, but their main value may be driven as a consequence of disease progression. Our results underscore that gaining further insight into lipid metabolism and longitudinal data on serum concentrations of the lipid profile could improve the monitoring of patients and potentially further disentangle ALS pathogenesis.
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Affiliation(s)
- Mark R Janse van Mantgem
- From the Department of Neurology (M.R.J.M., W.R., A.V.H., M.A.E., J.H.V., L.H.B., R.P.A.E.), UMC Utrecht Brain Center, and Biostatistics & Research Support (R.P.A.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Wouter van Rheenen
- From the Department of Neurology (M.R.J.M., W.R., A.V.H., M.A.E., J.H.V., L.H.B., R.P.A.E.), UMC Utrecht Brain Center, and Biostatistics & Research Support (R.P.A.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Anemone V Hackeng
- From the Department of Neurology (M.R.J.M., W.R., A.V.H., M.A.E., J.H.V., L.H.B., R.P.A.E.), UMC Utrecht Brain Center, and Biostatistics & Research Support (R.P.A.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Michael A van Es
- From the Department of Neurology (M.R.J.M., W.R., A.V.H., M.A.E., J.H.V., L.H.B., R.P.A.E.), UMC Utrecht Brain Center, and Biostatistics & Research Support (R.P.A.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Jan H Veldink
- From the Department of Neurology (M.R.J.M., W.R., A.V.H., M.A.E., J.H.V., L.H.B., R.P.A.E.), UMC Utrecht Brain Center, and Biostatistics & Research Support (R.P.A.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Leonard H van den Berg
- From the Department of Neurology (M.R.J.M., W.R., A.V.H., M.A.E., J.H.V., L.H.B., R.P.A.E.), UMC Utrecht Brain Center, and Biostatistics & Research Support (R.P.A.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.
| | - Ruben P A van Eijk
- From the Department of Neurology (M.R.J.M., W.R., A.V.H., M.A.E., J.H.V., L.H.B., R.P.A.E.), UMC Utrecht Brain Center, and Biostatistics & Research Support (R.P.A.E.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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Cabanas-Valdés R, García-Rueda L, Salgueiro C, Pérez-Bellmunt A, Rodríguez-Sanz J, López-de-Celis C. Assessment of the 4-meter walk test test-retest reliability and concurrent validity and its correlation with the five sit-to-stand test in chronic ambulatory stroke survivors. Gait Posture 2023; 101:8-13. [PMID: 36696822 DOI: 10.1016/j.gaitpost.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/02/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND The 4-meter walk test (4-MWT) is a widely used measure to assess gait speed in the elderly but has not been validated for stroke survivors to date. OBJECTIVES To assess the test-retest reliability and concurrent validity of the 4-MWT compared to the 10-meter walk test (10-MWT) as a measure of gait speed in chronic post-stroke. SECONDARY OUTCOME MEASURE to assess the correlation of both gait measures with the 5 times sit-to-stand test (5TSTS). METHODS A cross-sectional observational study was conducted. Reliability was assessed by intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM) and minimal detectable change (MDC-95%). Bland & Altman analysis was used to quantify agreement between the 4-MWT and the 10-MWT. Two consecutive walking trials of the 4-MWT and 10-MWT followed by 5TSTS were performed all on the same day. A single researcher made all measurements. RESULTS Thirty-six chronic ambulatory post-stroke (average age 58.56 ± 11.28 years) were analyzed at their self-selected walking speed with a dynamic start. The 4-MWT showed excellent concurrent validity and test-retest reliability: ICC2.1 = 0.991 (95% CI: 0.983, 0.996); SEM= 0.032 and MDC- 95% = 0.090 m/second) with a strong positive correlation with the 10-MWT (r = 0.957, p < 0.001). The Bland & Altman analysis showed a concordance of -0.05 m/second bias (p = 0.039) (95% limits of agreement: 0.20 to -0.29 m/second). The paired t-test showed no statistically significant difference in the mean of both walking tests (p < 0.091). However, there was only moderate correlation between the two gait assessments and the 5TSTS. CONCLUSIONS This study indicates excellent test-retest reliability concurrent validity and strong correlation between 4-MWT and 10-MWT with a dynamic start at comfortable speed. The 4-MWT could be used as a measure of gait speed in both outpatients and home settings in chronic ambulatory stroke survivors.
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Affiliation(s)
- Rosa Cabanas-Valdés
- Universitat Internacional de Catalunya, Physiotherapy Department, Faculty of Medicine and Health Sciences, Sant Cugat del Vallés, Barcelona, Spain.
| | - Laura García-Rueda
- Universitat Internacional de Catalunya, PhD Program, Sant Cugat del Vallés, Barcelona, Spain.
| | - Carina Salgueiro
- Universitat Internacional de Catalunya, Physiotherapy Department, Faculty of Medicine and Health Sciences, Sant Cugat del Vallés, Barcelona, Spain; Clínica de Neurorehabilitación, Sant Cugat del Vallés, Barcelona, Spain.
| | - Albert Pérez-Bellmunt
- Universitat Internacional de Catalunya, Campus Sant Cugat, Basic Sciences Department, Actium Functional Anatomy Research Group, Sant Cugat del Vallés, Barcelona, Spain.
| | - Jacobo Rodríguez-Sanz
- Universitat Internacional de Catalunya, Campus Sant Cugat, Basic Sciences Department, Actium Functional Anatomy Research Group, Sant Cugat del Vallés, Barcelona, Spain.
| | - Carlos López-de-Celis
- Universitat Internacional de Catalunya, Campus Sant Cugat, Basic Sciences Department, Actium Functional Anatomy Research Group, Sant Cugat del Vallés, Barcelona, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
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27
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Miyagishima S, Mani H, Sato Y, Inoue T, Asaka T, Kozuka N. Developmental changes in straight gait in childhood. PLoS One 2023; 18:e0281037. [PMID: 36758023 PMCID: PMC9910736 DOI: 10.1371/journal.pone.0281037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Understanding typical gait development is critical in developing suitable physical therapy methods for gait disorders. This study investigated the developmental changes and controlling mechanisms of straight gait. METHODS We conducted an experimental procedure among 90 participants, including 76 typically developing children and 14 healthy adults. The children were divided according to age into 3-4, 5-6, 7-8, and 9-10-year age groups. We created two indices to quantify straight gait using the extrapolated center of mass (XCOM; goal index, XCOMG and actual progress index, XCOMP), which were calculated and compared between the groups. Stepwise multiple regression was used to examine the effects of each gait variable on XCOMG and XCOMP. To eliminate the effects of multicollinearity, correlation coefficients were calculated for all gait variables. RESULTS Both XCOMG and XCOMP decreased gradually with age and were significantly larger in the 3-4 and 5-6 year groups than in the adult group. Multiple regression analysis showed that step velocity, step width, and the coefficiente of variation (CV) of the step width had independent coefficients of variation for the XCOMG, and the symmetry index of step time, step width, and the CV of the step width had independent CV for the XCOMP. These variables were selected as significant variables. The results showed that meandering gait was more pronounced at younger ages. Furthermore, straight gait observed in adulthood was achieved by the age of 7. CONCLUSION Pace (step velocity) and stability (step width and CV of step width) may contribute to XCOMG, which assesses the ability to proceed in the direction of the target. Stability and symmetry may contribute to XCOMP, which assesses the ability to walk straight in one's own direction of progress. Physical therapists could apply these indices in children to assess their ability to walk straight.
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Affiliation(s)
- Saori Miyagishima
- Division of Rehabilitation, Sapporo Medical University Hospital, Hokkaido, Japan
| | - Hiroki Mani
- Faculty of Welfare and Health Science, Oita University, Oita, Japan
- * E-mail:
| | - Yui Sato
- Division of Rehabilitation, Sapporo Medical University Hospital, Hokkaido, Japan
- Graduate School of Health Sciences, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Takahiro Inoue
- Department of System Pathology for Neurological Disorders, Brain Research Institute, Niigata University, Niigata, Japan
| | - Tadayoshi Asaka
- Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Naoki Kozuka
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Hokkaido, Japan
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Bucklin MA, Brown G, Gordon KE. People adapt a consistent center-of-mass trajectory in a novel force field. J Neurophysiol 2023; 129:298-306. [PMID: 36542421 PMCID: PMC9886345 DOI: 10.1152/jn.00391.2021] [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: 09/10/2021] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
During human walking the whole body center-of-mass (COM) trajectory may be a control objective, a goal the central nervous system uses to plan and regulate movement. Our previous observation, that after practice walking in a novel laterally directed force field people adapt a COM trajectory similar to their normal trajectory, supports this idea. However, our prior work only presented data demonstrating changes in COM trajectory in response to a single force field. To evaluate whether this phenomena is robust, in the present study we present new data demonstrating that people adapt their COM trajectory in a similar manner when the direction of the external force field is changed resulting in drastically different lower limb joint dynamics. Specifically, we applied a continuous, left-directed force field (in the previous experiment the force field was applied to the right) to the COM as participants performed repeated trials of a discrete walking task. We again hypothesized that with practice walking in the force field people would adapt a COM trajectory that was similar to their baseline performance and exhibit aftereffects, deviation of their COM trajectory in the opposite direction of force field, when the field was unexpectedly removed. These hypotheses were supported and suggest that participants formed an internal model to control their COM trajectory. Collectively these findings demonstrate that people adapt their gait patterns to anticipate consistent aspects of the external environment. These findings suggest that this response is robust to force fields applied in multiple directions that may require substantially different neural control.NEW & NOTEWORTHY With experience people adapted a predictive internal model to control their whole body center-of-mass walking trajectory that anticipated the disruptive laterally directed forces of a novel and consistent external environment. Collectively these findings demonstrate that adaptation of gait to anticipate consistent aspects of the external environment is a response that is robust to force fields in multiple directions that require substantially different lower limb dynamics and neural control.
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Affiliation(s)
- Mary A Bucklin
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Geoffrey Brown
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Keith E Gordon
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Research Service, Edward Hines, Jr. Department of Veterans Affairs Hospital, Hines, Illinois
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Sheeba S, Cavaleri R, Summers S, Browne C. Effectiveness of non-pharmacological treatments for vestibular and oculomotor dysfunction in patients with persistent post-concussive symptoms: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e066634. [PMID: 36609322 PMCID: PMC9827270 DOI: 10.1136/bmjopen-2022-066634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/12/2022] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Concussion is a form of mild traumatic brain injury that disrupts brain function. Although symptoms are mostly transient, recovery can be delayed and result in persistent postconcussive symptoms (PPCS). Vestibular and oculomotor dysfunction are among the most debilitating impairments associated with PPCS. However, pharmacological interventions for these impairments are associated with deleterious side effects. Accordingly, increasing research has examined the utility of non-pharmacological interventions for PPCS. The aim of this review is to synthesise and evaluate the effectiveness of non-pharmacological interventions for the treatment of vestibular and oculomotor dysfunction for patients with PPCS. METHODS AND ANALYSIS Systematic searches of MEDLINE, PubMed, Web of Science and Scopus will identify randomised controlled trials employing non-pharmacological treatments for vestibular and/or oculomotor dysfunction for PPCS. Such interventions may include, but are not limited to, vestibular rehabilitation, optokinetic stimulation and vestibulo-ocular reflex exercises. Assessments of oculomotor function will include versional eye movements, vergence eye movements, visual-fixation movements and accommodation response. Assessments of vestibular function will include the Fukuda Step test, functional balance tests, force displacement tests, and subjective reports of balance disruption or vertigo. Where appropriate, meta-analyses of standardised mean differences will be conducted using a random effects model for continuous outcomes. For dichotomous outcomes (improved vs not improved following treatment), effects will be expressed as relative risk. The impact of heterogeneity will be calculated using the I2 statistic. The Physiotherapy Evidence Database scale will be used to determine the methodological quality of individual studies and Grading of Recommendations, Assessment, Development and Evaluations used to assess the certainty and quality of evidence for each outcome. ETHICS AND DISSEMINATION Ethical approval is not required for this review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021254720.
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Affiliation(s)
- Stella Sheeba
- School of Science, Western Sydney University, Sydney, New South Wales, Australia
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Rocco Cavaleri
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Simon Summers
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Cherylea Browne
- School of Science, Western Sydney University, Sydney, New South Wales, Australia
- Brain Stimulation and Rehabilitation (BrainStAR) Lab, School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
- Translational Neuroscience Facility, UNSW Sydney, Sydney, New South Wales, Australia
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Martins VF, Tesio L, Simone A, Gonçalves AK, Peyré-Tartaruga LA. Determinants of age-related decline in walking speed in older women. PeerJ 2023; 11:e14728. [PMID: 36915651 PMCID: PMC10007973 DOI: 10.7717/peerj.14728] [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: 06/21/2022] [Accepted: 12/20/2022] [Indexed: 03/09/2023] Open
Abstract
Background Walking speed is reduced with aging. However, it is not certain whether the reduced walking speed is associated with physical and coordination fitness. This study explores the physical and coordination determinants of the walking speed decline in older women. Methods One-hundred-eighty-seven active older women (72.2 ± 6.8 years) were asked to perform a 10-m walk test (self-selected and maximal walking speed) and a battery of the Senior fitness test: lower body strength, lower body flexibility, agility/dynamic balance, and aerobic endurance. Two parameters characterized the walking performance: closeness to the modeled speed minimizing the energetic cost per unit distance (locomotor rehabilitation index, LRI), and the ratio of step length to step cadence (walk ratio, WR). For dependent variables (self-selected and maximal walking speeds), a recursive partitioning algorithm (classification and regression tree) was adopted, highlighting interactions across all the independent variables. Results Participants were aged from 60 to 88 years, and their self-selected and maximal speeds declined by 22% and 26% (p < 0.05), respectively. Similarly, all physical fitness variables worsened with aging (muscle strength: 33%; flexibility: 0 to -8 cm; balance: 22%; aerobic endurance: 12%; all p < 0.050). The predictors of maximal walking speed were only WR and balance. No meaningful predictions could be made using LRI and WR as dependent variables. Discussion The results suggest that at self-selected speed, the decrease in speed itself is sufficient to compensate for the age-related decline in the motor functions tested; by contrast, lowering the WR is required at maximal speed, presumably to prevent imbalance. Therefore, any excessive lowering of LRI and WR indicates loss of homeostasis of walking mechanics and invites diagnostic investigation.
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Affiliation(s)
- Valéria Feijó Martins
- LaBiodin Biodynamics Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Luigi Tesio
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Anna Simone
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Andréa Kruger Gonçalves
- LaBiodin Biodynamics Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Leonardo A Peyré-Tartaruga
- LaBiodin Biodynamics Laboratory, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Lecci L, Dugan K, Zeiger K, Keith J, Taravath S, Tseh W, Williams M. Validation of an accelerometer-based gait assessment: Establishing test-retest reliability, convergent validity, and predictive validity for concussion symptom endorsement. JOURNAL OF CONCUSSION 2023. [DOI: 10.1177/20597002231157947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Background Gait accelerometer (sensor) technology has proven effective in predicting several medical outcomes, but less is known regarding its prediction of concussion symptoms relative to conventional measures of gait and balance. Objective To establish the reliability and validity of gait accelerometer data. We first examine test-retest reliability and the impact of footwear and walking surfaces on gait. We then examine the convergent validity between gait accelerometer data and the NIH 4-meter gait test. Finally, we compare gait accelerometer data to gait speed and balance measures for predicting concussion symptoms. Methods Study 1 used a crossover study design with 60 participants to evaluate retest reliability and examine the effects of footwear (shoes/no-shoes) and walking surface (tile floor/grass) on gait accelerometer data. Study 2 employed a cross-sectional design with 1008 participants to assess gait accelerometer correlations with NIH 4-meter gait and the prediction of Centers for Disease Control and Prevention (CDC) concussion symptoms relative to previously validated gait and balance measures. Results Retest reliability (4-day average retest interval) for the no shoes/tile surface condition ranged from .72-.91 (mean = .80). Significant effects of footwear and especially walking surface revealed by Analysis of Variances (ANOVAs) on gait accelerometer data for the power, stride, balance, and symmetry domains indicate the need to standardize these variables. Gait accelerometer data correlates significantly with NIH 4-meter gait scores. Regression analyses found that gait accelerometer data predicts CDC concussion symptom endorsement, outperforming the BESS and NIH 4-meter gait at least three-fold. Conclusions When standardized on footwear and walking surface, gait accelerometers achieve strong test-retest reliability, converge with established measures of gait speed, and are superior to established measures of gait speed and balance when predicting concussion symptoms. Gait accelerometers represent a rapid tool for collecting additional gait information to quantify the behavioral sequelae of concussion and potentially inform return-to-play decision-making.
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Affiliation(s)
- Len Lecci
- Department of Psychology, University of North Carolina Wilmington (UNCW), Wilmington, USA
| | | | | | - Julian Keith
- Department of Psychology, University of North Carolina Wilmington (UNCW), Wilmington, USA
| | | | - Wayland Tseh
- Department of Psychology, University of North Carolina Wilmington (UNCW), Wilmington, USA
| | - Mark Williams
- New Hanover Regional Medical Center (now Novant), Wilmington, USA
- University of North Carolina Chapel Hill, Chapel Hill, USA
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Luecha T, Takesue S, Yeoh WL, Loh PY, Muraki S. Backward Walking Styles and Impact on Spatiotemporal Gait Characteristics. Healthcare (Basel) 2022; 10:healthcare10122487. [PMID: 36554011 PMCID: PMC9777745 DOI: 10.3390/healthcare10122487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/26/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022] Open
Abstract
Forward walking (FW) is a common balance assessment tool. However, its sensitivity is limited by the ceiling effect. Reverse gait, such as backward walking (BW), has been reported to have more advantages than FW for balance assessment. Three factors related to postural instability (i.e., increased speeds, restricted arm swing, and reduced visual feedback) during BW were investigated to determine BW conditions that have the potential to predict falls. Three-dimensional analyses were used to analyze seven walking conditions. FW and BW at self-selected and fast speeds were analyzed to identify the effects of speed. Walking with normal arm swings, crossed arms, and abducted arms during BW was tested to determine the effects of arm position. BW with closed and open eyes was compared to investigate the effects of visual feedback. BW had a significantly shorter step length than FW at high speeds. When the arms were abducted, the stance phase (%) was significantly lower compared to when arms were crossed during BW. Moreover, BW with closed eyes revealed significantly higher mediolateral center of mass (COM) displacements than with open eyes. We observed that BW with fast speeds, a crossed arm position, and closed eyes has the potential to help assess fall risk because it requires higher balance ability through spatiotemporal and COM adjustment.
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Affiliation(s)
- Teerapapa Luecha
- Department of Human Sciences, Graduate School of Design, Kyushu University, Fukuoka 815-8540, Japan
- Correspondence:
| | - Shin Takesue
- Department of Human Sciences, Graduate School of Design, Kyushu University, Fukuoka 815-8540, Japan
| | - Wen Liang Yeoh
- Faculty of Sciences and Engineering, Saga University, Saga 840-8502, Japan
| | - Ping Yeap Loh
- Department of Life Design and Science, Faculty of Design, Kyushu University, Fukuoka 815-8540, Japan
| | - Satoshi Muraki
- Department of Life Design and Science, Faculty of Design, Kyushu University, Fukuoka 815-8540, Japan
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Jeong S, Kim SH, Park KN. Is lumbopelvic motor control associated with dynamic stability during gait, strength, and endurance of core musculatures?: The STROBE study. Medicine (Baltimore) 2022; 101:e31025. [PMID: 36401395 PMCID: PMC9678604 DOI: 10.1097/md.0000000000031025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Core stability has been described as the product of motor control and muscular capacity of the lumbopelvic-hip complex. Because of the wide range of functions of the lumbopelvic-hip complex, the gold standard for evaluating core stability remains controversial. The Sahrmann core stability test (SCST), used in conjunction with the stabilizer pressure biofeedback unit (PBU), is widely applied to objectively evaluate core stability as this pertains lumbopelvic motor control. However, the association between such control and other elements of core stability including core strength, endurance, and dynamic stability during gait has not been well-studied. We investigated the relationships among the ability to control the lumbopelvic complex, core strength and endurance, and gait parameters. We compared lateral core endurance, hip strengths, and gait parameters (lateral oscillation of the center of mass (COM), the single support time, and the peak ground reaction force) between good and poor core stability groups, as determined by the SCST. In addition, logistic regression analysis was used to determine whether other core stability measures correlated with the core stability status defined by the SCST. Only lateral oscillation of the COM during walking differed significantly between the good and poor core stability groups and was a significant predictor of SCST core stability status. Lumbopelvic motor control, (as defined by the SCST), affects dynamic stability during gait, but not to the strength or endurance of the core musculatures.
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Affiliation(s)
- Siwoo Jeong
- Department of Physical Therapy, Jeonju University, Jeonju, Korea
| | - Si-Hyun Kim
- Department of Physical Therapy, Sangji University, Wonju, Korea
| | - Kyue-Nam Park
- Department of Physical Therapy, Jeonju University, Jeonju, Korea
- * Correspondence: Kyue-Nam Park, Department of Physical Therapy, 303, Cheonjam-ro, Wansan-gu, Jeonju-si, Jeollabuk-do, Korea (e-mail: )
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Dudoniene V, Balnytė M, Kuisma R. Comparison of static balance and gait between subjects with plantar fasciitis and age-matched controls. J Back Musculoskelet Rehabil 2022; 36:477-484. [PMID: 36404530 DOI: 10.3233/bmr-220092] [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: 11/16/2022]
Abstract
BACKGROUND Plantar fasciitis (PF) is a common condition amongst athletes as well as in non-sporting population. It is characterised by a sharp pain under the calcaneus during walking. The impact of pain due to PF on gait and static balance is examined in this observational study. OBJECTIVE To compare gait and balance between individuals with PF and age-matched controls without PF. METHOD A cross-sectional observational study was executed in an Outpatient Rehabilitation Centre. Twenty-nine participants were included, 14 with PF, and 15 age-matched healthy asymptomatic individuals. Main outcome measures were foot pain, foot function index (FFI), static balance measured with modified Romberg test, static balance measured on the TYMO® system, and gait with the G-Walk System. RESULTS Foot pain and FFI were adversely related to balance and gait parameters in subjects with PF. Static balance with eyes open and eyes closed on firm and soft surface measured on the TYMO® balance platform as well as gait parameters measured with the G-Walk system, were significantly lower in subjects with PF compared to age-matched healthy controls. CONCLUSION PF negatively affects parameters of static balance measured with TYMO® system and gait parameters measured with the G-Walk System. However, the Romberg balance test did not detect differences between subjects with PF and age-matched healthy controls.
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Affiliation(s)
| | | | - Raija Kuisma
- Karelia University of Applied Sciences, Joensuu, Finland
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Cheung D, Cheung J, Cheung V, Jin L. A New Quantitative Gait Analysis Method Based on Oscillatory Mechanical Energies Measured near Body Center of Mass. SENSORS (BASEL, SWITZERLAND) 2022; 22:8656. [PMID: 36433260 PMCID: PMC9698714 DOI: 10.3390/s22228656] [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: 10/09/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
Human locomotion involves the modulation of whole-body mechanical energy, which can be approximated by the motion dynamics at the body’s center of mass (BCOM). This study introduces a new method to measure gait efficiency based on BCOM oscillatory kinetic energy patterns using a single inertia measurement unit (IMU). Forty-seven participants completed an overground walk test at a self-selected speed. The average oscillatory energy (OE) at BCOM during walking was derived from measured acceleration data. The total OE showed a positive correlation with forward-walking velocity. The ratio of total OE to constant forward kinetic energy for healthy adults varied from ~1−5%, which can be considered the percent of oscillatory energy required to maintain gait posture for a given forward-walking velocity. Mathematically, this ratio is proportional to the square of the periodic peak-to-peak displacement of BCOM. Individuals with gait impairments exhibited a higher percentage of oscillatory energy, typically >6%. This wearable IMU-based method has the potential to be an effective tool for the rapid, quantitative assessment of gait efficiency in clinical and rehabilitation settings.
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Affiliation(s)
| | | | | | - Li Jin
- Biomechanics Research Laboratory, Department of Kinesiology, San José State University, San José, CA 95192, USA
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Buisseret F, Dehouck V, Boulanger N, Henry G, Piccinin F, White O, Dierick F. Adiabatic Invariant of Center-of-Mass Motion during Walking as a Dynamical Stability Constraint on Stride Interval Variability and Predictability. BIOLOGY 2022; 11:biology11091334. [PMID: 36138813 PMCID: PMC9495666 DOI: 10.3390/biology11091334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary Human walking exhibits properties of both stability and variability. On the one hand, the variability of the interval of time between heel strikes is autocorrelated, i.e., not randomly organized. On the other hand, walking is highly stereotyped and arguments from general mechanics suggest that the stability of gait can be assessed according to invariant properties. This study aims at proposing one of those invariants. Participants walked for 10 min at a natural pace, with and without a metronome indicating participants’ preferred step frequency. In both cases, we use different parameters to assess both the variability and stability of walking. We verify a known result: the metronome strongly alters the variability of the motion. However, despite the large variability changes, our proposed adiabatic invariant is preserved in both conditions, demonstrating the stability of gait. It appears as though our model reveals dynamical constraints that are “hidden” beyond apparent walking variability. Abstract Human walking exhibits properties of global stability, and local dynamic variability, predictability, and complexity. Global stability is typically assessed by quantifying the whole-body center-of-mass motion while local dynamic variability, predictability, and complexity are assessed using the stride interval. Recent arguments from general mechanics suggest that the global stability of gait can be assessed with adiabatic invariants, i.e., quantities that remain approximately constant, even under slow external changes. Twenty-five young healthy participants walked for 10 min at a comfortable pace, with and without a metronome indicating preferred step frequency. Stride interval variability was assessed by computing the coefficient of variation, predictability using the Hurst exponent, and complexity via the fractal dimension and sample entropy. Global stability of gait was assessed using the adiabatic invariant computed from averaged kinetic energy value related to whole-body center-of-mass vertical displacement. We show that the metronome alters the stride interval variability and predictability, from autocorrelated dynamics to almost random dynamics. However, despite these large local variability and predictability changes, the adiabatic invariant is preserved in both conditions, showing the global stability of gait. Thus, the adiabatic invariant theory reveals dynamical global stability constraints that are “hidden” behind apparent local walking variability and predictability.
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Affiliation(s)
- Fabien Buisseret
- CeREF-Technique, Chaussée de Binche 159, 7000 Mons, Belgium
- Forme and Fonctionnement Humain Laboratory, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, rue Trieu Kaisin 136, 6061 Montignies-sur-Sambre, Belgium
- Service de Physique Nucléaire et Subnucléaire, UMONS Research Institute for Complex Systems, Université de Mons, 20 Place du Parc, 7000 Mons, Belgium
- Correspondence:
| | - Victor Dehouck
- Service de Physique de l’Univers, Champs et Gravitation, UMONS Research Institute for Complex Systems, Université de Mons, 20 Place du Parc, 7000 Mons, Belgium
- Cognition, Action et Plasticité Sensorimotrice (CAPS), INSERM UMR1093, UFR STAPS, Université de Bourgogne Franche-Comté, BP 27877, 21078 Dijon, France
| | - Nicolas Boulanger
- Service de Physique de l’Univers, Champs et Gravitation, UMONS Research Institute for Complex Systems, Université de Mons, 20 Place du Parc, 7000 Mons, Belgium
| | - Guillaume Henry
- Forme and Fonctionnement Humain Laboratory, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, rue Trieu Kaisin 136, 6061 Montignies-sur-Sambre, Belgium
| | - Florence Piccinin
- Forme and Fonctionnement Humain Laboratory, Department of Physical Therapy, Haute Ecole Louvain en Hainaut, rue Trieu Kaisin 136, 6061 Montignies-sur-Sambre, Belgium
| | - Olivier White
- Cognition, Action et Plasticité Sensorimotrice (CAPS), INSERM UMR1093, UFR STAPS, Université de Bourgogne Franche-Comté, BP 27877, 21078 Dijon, France
| | - Frédéric Dierick
- CeREF-Technique, Chaussée de Binche 159, 7000 Mons, Belgium
- Laboratoire d’Analyse du Mouvement et de la Posture (LAMP), Centre National de Rééducation Fonctionnelle et de Réadaptation—Rehazenter, Rue André Vésale 1, 2674 Luxembourg, Luxembourg
- Faculté des Sciences de la Motricité, UCLouvain, Place Pierre de Coubertin 2, 1348 Louvain-la-Neuve, Belgium
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Thigh and Shank, Kinetic and Potential Energies during Gait Swing Phase in Healthy Adults and Stroke Survivors. Brain Sci 2022; 12:brainsci12081026. [PMID: 36009089 PMCID: PMC9405780 DOI: 10.3390/brainsci12081026] [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] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/10/2022] Open
Abstract
Background/Problem. Given the treatment-resistant gait deficits after stroke and known elevated energy cost of gait after stroke, it is important to study the patterns of mechanical energies of the lower limb segments. There is a dearth of information regarding mechanical energies specifically for the thigh and shank across the gait cycle. Therefore, the purpose of the current work was to characterize the following: (1) relative patterns of oscillation kinetic energy (KE) and potential energy (PE) within lower limb segments and across lower limb segments in healthy adults during the swing phase at chosen and slow gait speeds; (2) KE and PE swing phase patterns and values for stroke survivors versus healthy adults walking at slow speed; and (3) KE and PE patterns during the swing phase for two different compensatory gait strategies after stroke,. Methods. This was a gait characterization study, a two-group, parallel-cohort study of fourteen stroke survivors with gait deficits, walking at <0.4 m/s and eight adults with no gait deficits. For testing, the eight healthy adults walked at their chosen speed, and then at the imposed slow speed of <0.04 m/s. We used a standard motion capture system and calculation methods to acquire, calculate, and characterize oscillation patterns of KE and PE of the limb segments (thigh and shank) across the gait cycle. Results. In healthy adults, we identified key energy conservation mechanisms inherent in the interactions of KE and PE, both within the thigh and shank segments and across those limb segments, partially explaining the low cost of energy of the normal adult chosen speed gait pattern, and the underlying mechanism affording the known minimal set of activated muscles during walking, especially during the early swing phase. In contrast, KE was effectively absent for both healthy adults at imposed slow walking speed and stroke survivors at their very slow chosen speed, eliminating the normal conservation of energy between KE and PE within the thigh and across the thigh and shank. Moreover, and in comparison to healthy adult slow speed, stroke survivors exhibited greater abnormalities in mechanical energies patterns, reflected in either a compensatory stepping strategy (over-flexing the hip) or circumducting strategy (stiff-legged gait, with knee extended throughout the swing phase). Conclusions and contribution to the field. Taken together, these findings support targeted training to restore normal balance control and normal activation and de-activation coordination of hip, knee, and ankle muscles, respectively (agonist/antagonist at each joint), so as to eliminate the known post-stroke abnormal co-contractions; this motor training is critical in order to release the limb to swing normally in response to mechanical energies and afford the use of conservation of KE and PE energies within the thigh and across thigh and shank.
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Kelly DJ, Wensing PM. Optimizing Template Models to Quantifiably Assess Center of Mass Kinematic Reconstruction. IEEE Int Conf Rehabil Robot 2022; 2022:1-6. [PMID: 36176080 DOI: 10.1109/icorr55369.2022.9896496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The center of mass (COM) plays a fundamental role in human ambulation, but the redundant nature of the human body adds complexity to mathematically modeling its dynamics. Template models like the Bipedal Spring Loaded Inverted Pendulum (B-SLIP) and the Virtual Pivot Point (VPP) address this complexity by removing the redundancy while retaining desired salient characteristics, such as the COM evolution. However, template models for the COM during human walking have mostly been used for qualitative analysis due to issues such as overestimation of COM vertical displacement. This paper considers a quantifiable template-based analysis of human walking by using an optimization framework to set the model parameter values for matching both explicitly and implicitly considered gait characteristics. Furthermore, it is shown that allowing the leg stiffness of the B-SLIP and VPP model to vary throughout the gait cycle better matches vertical COM trajectories with 54%-63% error reduction. These optimized template models show promise in retaining ground reaction force (GRF) information, which is not explicitly considered during the optimization process. Future work looks to incorporate these optimized trajectories as a reference for control of a lower-limb knee-ankle prosthesis.
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Evans SA, James D, Rowlands D, Lee JB. Variability of the Center of Mass in Trained Triathletes in Running After Cycling: A Preliminary Study Conducted in a Real-Life Setting. Front Sports Act Living 2022; 4:852369. [PMID: 35734240 PMCID: PMC9207334 DOI: 10.3389/fspor.2022.852369] [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: 01/11/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
While the sport of short-distance (Sprint) triathlon provides an opportunity to research the effect of the center of mass (CoM) when cycling and running, much remains to be done. The literature has failed to consistently or adequately report how changes to hand position influence subsequent running as inferred by the magnitude of CoM acceleration. The demands of cycle training in a drops and aerodynamic position followed by running remain unquantified in Sprint Distance triathlon. Thus, far data collected indicate that the cycle to run transition (T2) is important for overall race success. While many age-groupers participate in Sprint Distance triathlon, the lack of T2 based research make comparisons between cycle hand position and ensuing running difficult. The motion of the human body when cycling and running in triathlon can be described by the motion of its CoM in a local coordinate system. Unobtrusive wearable sensors have proven to be an informative resource to monitor the magnitude of CoM accelerations in running. However, the extent to which they are used in cycling is unclear. Therefore, the aim of the present study was to analyse the temporal magnitudes of CoM acceleration when cycling position and cadence is changed and to analyse these effects on running after cycling. Ten recreational triathletes completed two 20 km cycling trials at varied cadence in a drops position (parts of the handlebars that curve outward, CycleDrops) and an aerodynamic position (arms bent, forearms parallel to the ground, CycleAero) immediately followed by a 5 km run at self-selected pace. Torso kinematics by way of CoM acceleration magnitude were captured in a typical training setting using a triaxial accelerometer. CoM acceleration was quantified in m/s2 and variability was measured by the coefficient of variation (CV) and root mean square (RMS). Results from CycleAero indicated that acceleration of the CoM in longitudinal (CV = 1%) and mediolateral directions (CV = 3%) was significantly reduced (p < 0.001) compared to CycleDrops. As for rate of perceived exertion (RPE), a significant difference was observed with triathletes reporting higher values in CycleAero alongside a greater CoM acceleration magnitude in the anteroposterior direction. The CoM varied significantly from RunAero with less longitudinal (CV = 0.2, p < 0.001) and mediolateral acceleration observed (CV = 7.5%, p < 0.001) compared to RunDrops. Although greater longitudinal acceleration was observed in the initial 1 km epoch of RunAero, triathletes then seemingly adjusted their CoM trajectory to record lower magnitudes until completion of the 5 km run, completing the run quicker compared to RunDrops (22.56 min1 ± 0.2, 23.34 min1 ± 0.5, p < 0.001, CV = 1.3%). Coaches may look to use triaxial accelerometers to monitor performance in both cycling and running after cycling.
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Affiliation(s)
- Stuart A. Evans
- SABEL Labs, Charles Darwin University, College of Health and Human Science, Darwin, NT, Australia
- *Correspondence: Stuart A. Evans
| | - Daniel James
- School of Engineering, Griffith University, Nathan, QLD, Australia
| | - David Rowlands
- School of Engineering, Griffith University, Nathan, QLD, Australia
| | - James B. Lee
- SABEL Labs, Charles Darwin University, College of Health and Human Science, Darwin, NT, Australia
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Uniken Venema SM, Dankbaar JW, Wolff L, van Es ACGM, Sprengers M, van der Lugt A, Dippel DWJ, van der Worp HB. Collateral status and recanalization after endovascular treatment for acute ischemic stroke. J Neurointerv Surg 2022; 15:531-538. [PMID: 35584911 DOI: 10.1136/neurintsurg-2021-018545] [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: 12/14/2021] [Accepted: 05/02/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Successful recanalization and good collateral status are associated with good clinical outcomes after endovascular treatment (EVT) for acute ischemic stroke, but the relationships among them are unclear. OBJECTIVE To assess if collateral status is associated with recanalization after EVT and if collateral status modifies the association between successful recanalization and functional outcome. METHODS We retrospectively analyzed data from the MR CLEAN Registry, a multicenter prospective cohort study of patients with a proximal anterior occlusion who underwent EVT in the Netherlands. We determined collateral status with a previously validated four-point visual grading scale and defined successful recanalization as an extended Thrombolysis in Cerebral Infarction score ≥2B. Functional outcome was determined using the modified Rankin Scale score at 90 days. We assessed, with multivariable logistic regression models, the associations between (1) collateral status and successful recanalization, (2) successful recanalization and functional outcome, (3) collateral status and functional outcome. An interaction of collateral status and successful recanalization was assessed. Subgroup analyses were performed for patients treated with intravenous thrombolysis. RESULTS We included 2717 patients, of whom 1898 (70%) had successful recanalization. There was no relationship between collateral status and successful recanalization (adjusted common OR (95% CI) of grades 1, 2, and 3 vs 0: 1.19 (0.82 to 1.72), 1.20 (0.83 to 1.75), and 1.10 (0.74 to 1.63), respectively). Successful recanalization (acOR (95% CI): 2.15 (1.84 to 2.52)) and better collateral grades (acOR (95% CI) of grades 1, 2, and 3 vs 0: 2.12 (1.47 to 3.05), 3.46 (2.43 to 4.92), and 4.16 (2.89 to 5.99), respectively) were both associated with a shift towards better functional outcome, without an interaction between collateral status and successful recanalization. Results were similar for the subgroup of thrombolysed patients. CONCLUSIONS Collateral status is not associated with the probability of successful recanalization after EVT and does not modify the association between successful recanalization and functional outcome.
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Affiliation(s)
- Simone M Uniken Venema
- Department of Neurology and Neurosurgery, Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jan Willem Dankbaar
- Department of Radiology, University Medical Center Utrecht Imaging Division, Utrecht, The Netherlands
| | - Lennard Wolff
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Adriaan C G M van Es
- Department of Radiology, Leiden Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
| | - Marieke Sprengers
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Diederik W J Dippel
- Department of Neurology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center, University Medical Centre Utrecht, Utrecht, The Netherlands
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Machine Learning Strategies for Low-Cost Insole-Based Prediction of Center of Gravity during Gait in Healthy Males. SENSORS 2022; 22:s22093499. [PMID: 35591188 PMCID: PMC9100257 DOI: 10.3390/s22093499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 02/04/2023]
Abstract
Whole-body center of gravity (CG) movements in relation to the center of pressure (COP) offer insights into the balance control strategies of the human body. Existing CG measurement methods using expensive measurement equipment fixed in a laboratory environment are not intended for continuous monitoring. The development of wireless sensing technology makes it possible to expand the measurement in daily life. The insole system is a wearable device that can evaluate human balance ability by measuring pressure distribution on the ground. In this study, a novel protocol (data preparation and model training) for estimating the 3-axis CG trajectory from vertical plantar pressures was proposed and its performance was evaluated. Input and target data were obtained through gait experiments conducted on 15 adult and 15 elderly males using a self-made insole prototype and optical motion capture system. One gait cycle was divided into four semantic phases. Features specified for each phase were extracted and the CG trajectory was predicted using a bi-directional long short-term memory (Bi-LSTM) network. The performance of the proposed CG prediction model was evaluated by a comparative study with four prediction models having no gait phase segmentation. The CG trajectory calculated with the optoelectronic system was used as a golden standard. The relative root mean square error of the proposed model on the 3-axis of anterior/posterior, medial/lateral, and proximal/distal showed the best prediction performance, with 2.12%, 12.97%, and 12.47%. Biomechanical analysis of two healthy male groups was conducted. A statistically significant difference between CG trajectories of the two groups was shown in the proposed model. Large CG sway of the medial/lateral axis trajectory and CG fall of the proximal/distal axis trajectory is shown in the old group. The protocol proposed in this study is a basic step to have gait analysis in daily life. It is expected to be utilized as a key element for clinical applications.
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van den Bosch A, Fransen N, Mason M, Rozemuller AJ, Teunissen C, Smolders J, Huitinga I. Neurofilament Light Chain Levels in Multiple Sclerosis Correlate With Lesions Containing Foamy Macrophages and With Acute Axonal Damage. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/3/e1154. [PMID: 35241571 PMCID: PMC8893592 DOI: 10.1212/nxi.0000000000001154] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/03/2022] [Indexed: 12/18/2022]
Abstract
Background and Objectives To investigate whether white matter lesion activity, acute axonal damage, and axonal density in MS associate with CSF neurofilament light chain (NfL) levels. Methods Of 101 brain donors with MS (n = 92 progressive MS, n = 9 relapsing-remitting MS), ventricular CSF was collected, and NfL levels were measured. White matter lesions were classified as active, mixed, inactive, or remyelinated, and microglia/macrophage morphology in active and mixed lesions was classified as ramified, ameboid, or foamy. In addition, axonal density and acute axonal damage were assessed using Bielschowsky and amyloid precursor protein (APP) (immune)histochemistry. Results CSF NfL measurements of donors with recent (<1 year) or clinically silent stroke were excluded. CSF NfL levels correlated negatively with disease duration (p = 6.9e-3, r = 0.31). In donors without atrophy, CSF NfL levels correlated positively with the proportion of active and mixed lesions containing foamy microglia/macrophages (p = 9.85e-10 and p = 1.75e-3, respectively), but not with those containing ramified microglia. CSF NfL correlated negatively with proportions of inactive (p = 5.66e-3) and remyelinated lesions (p = 0.03). In the normal appearing pyramid tract, axonal density negatively correlated with CSF NfL levels (Bielschowsky, p = 0.02, r = −0.31), and the presence of acute axonal damage in lesions was related to higher NfL levels (APP, p = 1.17e-6). The amount of acute axonal damage was higher in active lesions with foamy microglia/macrophages and in the rim of mixed lesions with foamy microglia/macrophages when compared with active lesions containing ramified microglia/macrophages (p = 4.6e-3 and p = 0.02, respectively), the center and border of mixed lesions containing ramified microglia/macrophages (center: p = 4.6e-3, border, p = 4.6e-3, and n.s., p = 4.6e-3, respectively), the center of mixed lesions containing foamy microglia/macrophages (p = 4.6e-3 and p = 0.02, respectively), inactive lesions (p = 4.6e-3 and p = 4.6e-3, respectively), and remyelinated lesions (p = 0.03 and p = 0.04, respectively). Discussion Our results demonstrated that active and mixed white matter MS lesions with foamy microglia show high acute axonal damage and correlate with elevated CSF NfL levels. Our data support the use of this biomarker to monitor inflammatory demyelinating lesion activity with axonal damage in MS.
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Affiliation(s)
- Aletta van den Bosch
- From the Neuroimmunology Research Group (A.B., N.F., M.M., J.S., I.H.), Netherlands Institute for Neuroscience; Department Pathology (A.J.R.), Amsterdam UMC; Neurochemistry Lab (C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit; Department of Neurology and Immunology (J.S.), MS Center ErasMS, ErasmusMC, Rotterdam; and Swammerdam Institute for Life Sciences (I.H.), University of Amsterdam, the Netherlands.
| | - Nina Fransen
- From the Neuroimmunology Research Group (A.B., N.F., M.M., J.S., I.H.), Netherlands Institute for Neuroscience; Department Pathology (A.J.R.), Amsterdam UMC; Neurochemistry Lab (C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit; Department of Neurology and Immunology (J.S.), MS Center ErasMS, ErasmusMC, Rotterdam; and Swammerdam Institute for Life Sciences (I.H.), University of Amsterdam, the Netherlands
| | - Matthew Mason
- From the Neuroimmunology Research Group (A.B., N.F., M.M., J.S., I.H.), Netherlands Institute for Neuroscience; Department Pathology (A.J.R.), Amsterdam UMC; Neurochemistry Lab (C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit; Department of Neurology and Immunology (J.S.), MS Center ErasMS, ErasmusMC, Rotterdam; and Swammerdam Institute for Life Sciences (I.H.), University of Amsterdam, the Netherlands
| | - Annemieke Johanna Rozemuller
- From the Neuroimmunology Research Group (A.B., N.F., M.M., J.S., I.H.), Netherlands Institute for Neuroscience; Department Pathology (A.J.R.), Amsterdam UMC; Neurochemistry Lab (C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit; Department of Neurology and Immunology (J.S.), MS Center ErasMS, ErasmusMC, Rotterdam; and Swammerdam Institute for Life Sciences (I.H.), University of Amsterdam, the Netherlands
| | - Charlotte Teunissen
- From the Neuroimmunology Research Group (A.B., N.F., M.M., J.S., I.H.), Netherlands Institute for Neuroscience; Department Pathology (A.J.R.), Amsterdam UMC; Neurochemistry Lab (C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit; Department of Neurology and Immunology (J.S.), MS Center ErasMS, ErasmusMC, Rotterdam; and Swammerdam Institute for Life Sciences (I.H.), University of Amsterdam, the Netherlands
| | - Joost Smolders
- From the Neuroimmunology Research Group (A.B., N.F., M.M., J.S., I.H.), Netherlands Institute for Neuroscience; Department Pathology (A.J.R.), Amsterdam UMC; Neurochemistry Lab (C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit; Department of Neurology and Immunology (J.S.), MS Center ErasMS, ErasmusMC, Rotterdam; and Swammerdam Institute for Life Sciences (I.H.), University of Amsterdam, the Netherlands
| | - Inge Huitinga
- From the Neuroimmunology Research Group (A.B., N.F., M.M., J.S., I.H.), Netherlands Institute for Neuroscience; Department Pathology (A.J.R.), Amsterdam UMC; Neurochemistry Lab (C.T.), Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit; Department of Neurology and Immunology (J.S.), MS Center ErasMS, ErasmusMC, Rotterdam; and Swammerdam Institute for Life Sciences (I.H.), University of Amsterdam, the Netherlands
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Determination of the center of mass in a heterogeneous population of dogs. PLoS One 2022; 17:e0267361. [PMID: 35476847 PMCID: PMC9045670 DOI: 10.1371/journal.pone.0267361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/06/2022] [Indexed: 01/12/2023] Open
Abstract
The center of mass (CoM) is the location in a body where mass distribution is balanced. It has a fundamental role in balance and motion which has been poorly described in the dog. The objective of this study was to estimate the variance of the center of mass (CoM) in a heterogeneous population of client-owned dogs and to describe the relationship between CoM, subject morphometrics and an inertial measurement unit (IMU) box positioned ventrally on a neck collar. A single force platform and a reaction board were used to determine CoM in the transverse, sagittal and dorsal planes in thirty-one healthy adult dogs. A series of morphometric measurements were acquired with each dog standing, including distances relative to an IMU box positioned ventrally on a neck collar. Mean transverse plane CoM was 48% the distance from ischium to the IMU box, near the xiphoid process. Mean sagittal place CoM was 59% the width of the chest on the left side. Mean dorsal plane CoM was 41% the distance from the most dorsal to the most ventral aspect of the body. Dog length was the primary variable required to maximize the relationship between three-dimensional CoM and identifiable variables measured. A CoM based normalization procedure should be considered to normalize mass or motion based outcome measure output (e.g., ground reaction forces, vector acceleration) in a heterogeneous population of dogs. Future research will be needed to determine if CoM-based normalization procedures reduce variance in outcome measures affected by subject morphometrics.
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Beyeler M, Weber L, Kurmann CC, Piechowiak EII, Mosimann PJ, Zibold F, Meinel TR, Branca M, Goeldlin M, Pilgram-Pastor SM, Grunder L, Arnold M, Seiffge D, Meier R, Heldner MR, Dobrocky T, Mordasini P, Gralla J, Fischer U, Kaesmacher J. Association of reperfusion success and emboli in new territories with long term mortality after mechanical thrombectomy. J Neurointerv Surg 2022; 14:326-332. [PMID: 33911015 DOI: 10.1136/neurintsurg-2021-017422] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND The degree of reperfusion is the most important modifiable predictor of 3 month functional outcome and mortality in ischemic stroke patients treated with mechanical thrombectomy. Whether the beneficial effect of reperfusion also leads to a reduction in long term mortality is unknown. METHODS Patients undergoing mechanical thrombectomy between January 2010 and December 2018 were included. The post-thrombectomy degree of reperfusion and emboli in new territories were core laboratory adjudicated. Reperfusion was evaluated according to the expanded Thrombolysis in Cerebral Infarction (eTICI) scale. Vital status was obtained from the Swiss population register. Adjusted hazard ratios (aHRs) using time split Cox regression models were calculated. Subgroup analyses were performed in patients with borderline indications. RESULTS Our study included 1264 patients (median follow-up per patient 2.5 years). Patients with successful reperfusion had longer survival times, attributable to a lower hazard of death within 0-90 days and for >90 days to 2 years (aHR 0.34, 95% CI 0.26 to 0.46; aHR 0.37, 95% CI 0.22 to 0.62). This association was homogeneous across all predefined subgroups (p for interaction >0.05). Among patients with successful reperfusion, a significant difference in the hazard of death was observed between eTICI2b50 and eTICI3 (aHR 0.51, 95% CI 0.33 to 0.79). Emboli in new territories were present in 5% of patients, and were associated with increased mortality (aHR 2.3, 95% CI 1.11 to 4.86). CONCLUSION Successful, and ideally complete, reperfusion without emboli in new territories is associated with a reduction in long term mortality in patients treated with mechanical thrombectomy, and this was evident across several subgroups.
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Affiliation(s)
- Morin Beyeler
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Loris Weber
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Christoph C Kurmann
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Eike Immo I Piechowiak
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Pascal J Mosimann
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, Alfried-Krupp Krankenhaus, Essen, Nordrhein-Westfalen, Germany
| | - Felix Zibold
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Thomas Raphael Meinel
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Mattia Branca
- Institute of Social and Preventive Medicine, CTU Bern, University of Bern, Switzerland, Bern, Switzerland
| | - Martina Goeldlin
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Sara M Pilgram-Pastor
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Lorenz Grunder
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Marcel Arnold
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - David Seiffge
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Raphael Meier
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Support Center for Advanced Neuroimaging, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Mirjam R Heldner
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Tomas Dobrocky
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Jan Gralla
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Urs Fischer
- Department of Neurology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Johannes Kaesmacher
- Department of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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Mobbs RJ, Natarajan P, Fonseka RD, Betteridge C, Ho D, Mobbs R, Sy L, Maharaj M. Walking orientation randomness metric (WORM) score: pilot study of a novel gait parameter to assess walking stability and discriminate fallers from non-fallers using wearable sensors. BMC Musculoskelet Disord 2022; 23:304. [PMID: 35351090 PMCID: PMC8966274 DOI: 10.1186/s12891-022-05211-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/04/2022] [Indexed: 05/31/2023] Open
Abstract
Background Musculoskeletal disorders can contribute to injurious falls and incur significant societal and healthcare burdens. Identification of fallers from non-fallers through wearable-based gait analysis can facilitate timely intervention to assist mobility and prevent falls whilst improving care and attention for high fall-risk patients. In this study, we use wearable sensor-based gait analysis to introduce a novel variable to assess walking stability in fallers and non-fallers – the Walking Orientation Randomness Metric. The WORM score quantifies the stability, or ‘figure-of-eight’ motion of a subject’s trunk during walking as an indicator of a falls-predictive (pathological) gait. Methods WORM is calculated as the ‘figure-of-eight’ oscillation mapped out in the transverse-plane by the upper body’s centre-point during a walking bout. A sample of patients presenting to the Prince of Wales Hospital (Sydney, Australia) with a primary diagnosis of “falls for investigation” and age-matched healthy controls (non-fallers) from the community were recruited. Participants were fitted at the sternal angle with the wearable accelerometer, MetaMotionC (Mbientlab Inc., USA) and walked unobserved (at self-selected pace) for 5-50 m along an obstacle-free, carpeted hospital corridor. Results Participants comprised of 16 fallers (mean age: 70 + 17) and 16 non-fallers (mean age: 70 + 9) based on a recent fall(s) history. The (median) WORM score was 17-fold higher (p < 0.001) in fallers (3.64 cm) compared to non-fallers (0.21 cm). ROC curve analyses demonstrate WORM can discriminate fallers from non-fallers (AUC = 0.97). Diagnostic analyses (cut-off > 0.51 cm) show high sensitivity (88%) and specificity (94%). Conclusion In this pilot study we have introduced the WORM score, demonstrating its discriminative performance in a preliminary sample size of 16 fallers. WORM is a novel gait metric assessing walking stability as measured by truncal way during ambulation and shows promise for objective and clinical evaluation of fallers. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05211-1.
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Affiliation(s)
- Ralph Jasper Mobbs
- Faculty of Medicine, University of New South Wales, Sydney, Australia. .,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia. .,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia. .,Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia. .,Neuro Spine Clinic, Prince of Wales Private Hospital, 320-346 Barker St, Randwick, NSW, 2031, Australia.
| | - Pragadesh Natarajan
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - R Dineth Fonseka
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Callum Betteridge
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia
| | - Daniel Ho
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia
| | - Redmond Mobbs
- School of Mathematics and Computer Science, University of New South Wales (UNSW), Sydney, Australia
| | - Luke Sy
- School of Mathematics and Computer Science, University of New South Wales (UNSW), Sydney, Australia
| | - Monish Maharaj
- Faculty of Medicine, University of New South Wales, Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.,Wearables and Gait Analysis Research Group (WAGAR), Sydney, Australia.,Department of Neurosurgery, Prince of Wales Hospital, Sydney, Australia.,Neuro Spine Clinic, Prince of Wales Private Hospital, 320-346 Barker St, Randwick, NSW, 2031, Australia
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46
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Caruana G, Auger C, Pessini LM, Calderon W, de Barros A, Salerno A, Sastre-Garriga J, Montalban X, Rovira À. SWI as an Alternative to Contrast-Enhanced Imaging to Detect Acute MS Lesions. AJNR Am J Neuroradiol 2022; 43:534-539. [PMID: 35332015 PMCID: PMC8993188 DOI: 10.3174/ajnr.a7474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Acute inflammatory activity of MS lesions is traditionally assessed through contrast-enhanced T1-weighted MR images. The aim of our study was to determine whether a qualitative evaluation of non-contrast-enhanced SWI of new T2-hyperintense lesions might help distinguish acute and chronic lesions and whether it could be considered a possible alternative to gadolinium-based contrast agents for this purpose. MATERIALS AND METHODS Serial MR imaging studies from 55 patients with MS were reviewed to identify 169 new T2-hyperintense lesions. Two blinded neuroradiologists determined their signal pattern on SWI, considering 5 categories (hypointense rings, marked hypointensity, mild hypointensity, iso-/hyperintensity, indeterminate). Two different blinded neuroradiologists evaluated the presence or absence of enhancement in postcontrast T1-weighted images of the lesions. The Fisher exact test was used to determine whether each category of signal intensity on SWI was associated with gadolinium enhancement. RESULTS The presence of hypointense rings or marked hypointensity showed a strong association with the absence of gadolinium enhancement (P < .001), with a sensitivity of 93.0% and a specificity of 82.9%. The presence of mild hypointensity or isohyperintensity showed a strong association with the presence of gadolinium enhancement (P < .001), with a sensitivity of 68.3% and a specificity of 99.2%. CONCLUSIONS A qualitative analysis of the signal pattern on SWI of new T2-hyperintense MS lesions allows determining the likelihood that the lesions will enhance after administration of a gadolinium contrast agent, with high specificity albeit with a moderate sensitivity. While it cannot substitute for the use of contrast agent, it can be useful in some clinical settings in which the contrast agent cannot be administered.
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Affiliation(s)
- G Caruana
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - C Auger
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - L M Pessini
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - W Calderon
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - A de Barros
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - A Salerno
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - J Sastre-Garriga
- Department of Radiology, and Servei de Neurologia-Neuroimmunologia (J.S.-G., X.M.). Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- Department of Radiology, and Servei de Neurologia-Neuroimmunologia (J.S.-G., X.M.). Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - À Rovira
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
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Mohammadzada F, Zipser CM, Easthope CA, Halliday DM, Conway BA, Curt A, Schubert M. Mind your step: Target walking task reveals gait disturbance in individuals with incomplete spinal cord injury. J Neuroeng Rehabil 2022; 19:36. [PMID: 35337335 PMCID: PMC8957135 DOI: 10.1186/s12984-022-01013-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 03/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Walking over obstacles requires precise foot placement while maintaining balance control of the center of mass (CoM) and the flexibility to adapt the gait patterns. Most individuals with incomplete spinal cord injury (iSCI) are capable of overground walking on level ground; however, gait stability and adaptation may be compromised. CoM control was investigated during a challenging target walking (TW) task in individuals with iSCI compared to healthy controls. The hypothesis was that individuals with iSCI, when challenged with TW, show a lack of gait pattern adaptability which is reflected by an impaired adaptation of CoM movement compared to healthy controls. Methods A single-center controlled diagnostic clinical trial with thirteen participants with iSCI (0.3–24 years post injury; one subacute and twelve chronic) and twelve healthy controls was conducted where foot and pelvis kinematics were acquired during two conditions: normal treadmill walking (NW) and visually guided target walking (TW) with handrail support, during which participants stepped onto projected virtual targets synchronized with the moving treadmill surface. Approximated CoM was calculated from pelvis markers and used to calculate CoM trajectory length and mean CoM Euclidean distance TW-NW (primary outcome). Nonparametric statistics, including spearman rank correlations, were performed to evaluate the relationship between clinical parameter, outdoor mobility score, performance, and CoM parameters (secondary outcome). Results Healthy controls adapted to TW by decreasing anterior–posterior and vertical CoM trajectory length (p < 0.001), whereas participants with iSCI reduced CoM trajectory length only in the vertical direction (p = 0.002). Mean CoM Euclidean distance TW-NW correlated with participants’ neurological level of injury (R = 0.76, p = 0.002) and CoM trajectory length (during TW) correlated with outdoor mobility score (R = − 0.64, p = 0.026). Conclusions This study demonstrated that reduction of CoM movement is a common strategy to cope with TW challenge in controls, but it is impaired in individuals with iSCI. In the iSCI group, the ability to cope with gait challenges worsened the more rostral the level of injury. Thus, the TW task could be used as a gait challenge paradigm in ambulatory iSCI individuals. Trial registration Registry number/ ClinicalTrials.gov Identifier: NCT03343132, date of registration 2017/11/17. Supplementary Information The online version contains supplementary material available at 10.1186/s12984-022-01013-7.
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Affiliation(s)
- Freschta Mohammadzada
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Carl Moritz Zipser
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Chris A Easthope
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.,Cereneo Foundation, Center for Interdisciplinary Research, 6354, Vitznau, Switzerland
| | - David M Halliday
- Department of Electronic Engineering, University of York, York, YO10 5DD, UK.,York Biomedical Research Institute, University of York, York, UK
| | - Bernard A Conway
- Biomedical Engineering, University of Strathclyde, Glasgow, G4 0NW, UK
| | - Armin Curt
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Neurophysiology, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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Scarano S, Rota V, Tesio L, Perucca L, Robecchi Majnardi A, Caronni A. Balance Impairment in Fahr’s Disease: Mixed Signs of Parkinsonism and Cerebellar Disorder. A Case Study. Front Hum Neurosci 2022; 16:832170. [PMID: 35355583 PMCID: PMC8959384 DOI: 10.3389/fnhum.2022.832170] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/14/2022] [Indexed: 01/05/2023] Open
Abstract
Fahr’s disease is a rare idiopathic degenerative disease characterized by calcifications in the brain, and has also been associated with balance impairment. However, a detailed analysis of balance in these patients has not been performed. A 69-year-old woman with Fahr’s disease presented with a long-lasting subjective imbalance. Balance was analyzed using both clinical (EquiScale, Timed Up and Go test, and Dizziness Handicap Inventory-short form) and instrumented tests (the sway of the body center of mass during quiet, perturbed, and self-perturbed stance, and the peak curvature of the center of mass during single stance while walking on a force-treadmill). The patient’s balance was normal during clinical tests and walking. However, during standing, a striking impairment in vestibular control of balance emerged. The balance behavior displayed mixed parkinsonian (e.g., slowness and reduced amplitude of movement) and cerebellar (e.g., increased sway during standing in all conditions and decomposition of movement) features, with a discrepancy between the high severity of the static and the low severity of the dynamic balance impairment. The balance impairment characteristics outlined in this study could help neurologists and physiatrists detect, stage, and treat this rare condition.
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Affiliation(s)
- Stefano Scarano
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
- Department of Neurorehabilitation Sciences, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
- *Correspondence: Stefano Scarano,
| | - Viviana Rota
- Department of Neurorehabilitation Sciences, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Luigi Tesio
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
- Department of Neurorehabilitation Sciences, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Laura Perucca
- Department of Biomedical Sciences for Health, Università Degli Studi di Milano, Milan, Italy
- Department of Neurorehabilitation Sciences, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Antonio Robecchi Majnardi
- Department of Neurorehabilitation Sciences, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Antonio Caronni
- Department of Neurorehabilitation Sciences, Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy
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Khalaf A, Nadel H, Dahmoush H. Simultaneously Acquired MRI Arterial Spin-Labeling and Interictal FDG-PET Improves Diagnosis of Pediatric Temporal Lobe Epilepsy. AJNR Am J Neuroradiol 2022; 43:468-473. [PMID: 35210273 PMCID: PMC8910808 DOI: 10.3174/ajnr.a7421] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/06/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Interictal FDG-PET scans are a routine diagnostic technique for the identification of epileptogenic foci in the presurgical work-up of medically refractory pediatric epilepsy. With the advent of PET/MR imaging, it has become possible to simultaneously acquire FDG-PET and arterial spin-labeling perfusion data. The objective of this study was to evaluate whether the incorporation of arterial spin-labeling data with interictal FDG-PET could improve the diagnostic performance metrics of FDG-PET for identification of epileptogenic foci. MATERIALS AND METHODS Forty-five pediatric patients with a mean age of 10.8 years were retrospectively included in this study. These patients all underwent PET/MR imaging to diagnose suspected focal epilepsy. RESULTS When compared to interpretations of interictal FDG findings alone, FDG combined with arterial spin-labeling findings resulted in significantly decreased sensitivity (0.64 versus 0.52, P = .02), significantly increased specificity (0.50 versus 0.75, P = .04), and an increased positive predictive value (0.59 versus 0.75). The decreased sensitivity was found to be primarily driven by patients with extratemporal lobe epilepsy, as a subgroup analysis showed decreased sensitivity for patients with extratemporal epilepsy (0.52 versus 0.38, P = .04), but not for temporal epilepsy (0.83 versus 0.75, P = .16). Additionally, substantial agreement between focal FDG hypometabolism and arterial spin-labeling hypoperfusion was demonstrated with the Cohen κ (0.70, P < .01). CONCLUSIONS These findings suggest that simultaneously acquired interictal FDG-PET and arterial spin-labeling data can improve the diagnosis of epileptogenic foci, especially in the setting of temporal lobe epilepsy where they improve specificity and positive predictive value, with preservation of sensitivity.
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Affiliation(s)
- A.M. Khalaf
- From the Stanford University School of Medicine, Department of Radiology, Division of Nuclear Medicine & Molecular Imaging, Division of Pediatric Radiology, Division of Neuroimaging & Neurointervention, Stanford University, Stanford, California
| | - H.R. Nadel
- From the Stanford University School of Medicine, Department of Radiology, Division of Nuclear Medicine & Molecular Imaging, Division of Pediatric Radiology, Division of Neuroimaging & Neurointervention, Stanford University, Stanford, California
| | - H.M. Dahmoush
- From the Stanford University School of Medicine, Department of Radiology, Division of Nuclear Medicine & Molecular Imaging, Division of Pediatric Radiology, Division of Neuroimaging & Neurointervention, Stanford University, Stanford, California
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Muscle forces and power are significantly reduced during walking in patients with peripheral artery disease. J Biomech 2022; 135:111024. [PMID: 35248803 PMCID: PMC9064980 DOI: 10.1016/j.jbiomech.2022.111024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 11/21/2022]
Abstract
Patients with peripheral artery disease (PAD) have significantly reduced lower extremity muscle strength compared with healthy individuals as measured during isolated, single plane joint motion by isometric and isokinetic strength dynamometers. Alterations to the force contribution of muscles during walking caused by PAD are not well understood. Therefore, this study used simulations with PAD biomechanics data to understand lower extremity muscle functions in patients with PAD during walking and to compare that with healthy older individuals. A total of 12 patients with PAD and 10 age-matched healthy older controls walked across a 10-meter pathway with reflective markers on their lower limbs. Marker coordinates and ground reaction forces were recorded and exported to OpenSim software to perform gait simulations. Walking velocity, joint angles, muscle force, muscle power, and metabolic rate were calculated and compared between patients with PAD and healthy older controls. Our results suggest that patients with PAD walked slower with less hip extension during propulsion. Significant force and power reductions were observed in knee extensors during weight acceptance and in plantar flexors and hip flexors during propulsion in patients with PAD. The estimated metabolic rate of walking during stance was not different between patients with PAD and controls. This study is the first to analyze lower limb muscular responses during walking in patients with PAD using the OpenSim simulation software. The simulation results of this study identified important information about alterations to muscle force and power during walking in those with PAD.
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