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Brauner FDO, Oliveira M, Hausen DO, Schiavo A, Balbinot G, Mestriner RG. Association Between Depressive Symptoms, Cognitive Status, and the Dual-Task Performance Index in Older Adults: A Cross-Sectional Study. J Aging Phys Act 2024:1-9. [PMID: 38729617 DOI: 10.1123/japa.2023-0152] [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: 05/02/2023] [Revised: 02/03/2024] [Accepted: 03/19/2024] [Indexed: 05/12/2024]
Abstract
The Performance Index (P-Index) is a measure for evaluating mobility-related dual-task performance in older adults. The identification of specific clinicodemographic factors predictive of P-Index scores, however, remains unclear. This cross-sectional study analyzed data from 120 community-dwelling older adults (average age 71.3 ± 11.23 years) to explore clinicodemographic variables that influence P-Index scores during the instrumented timed up and go test. Unadjusted analyses suggested several factors, including age, gender, body mass index, Mini-Mental Status Examination scores, functional reach test performance, history of falls, ethnicity, Geriatric Depression Scale scores, alcohol consumption, and educational levels, as potential predictors of P-Index. However, adjusted multinomial multiple regression analysis revealed Geriatric Depression Scale and Mini-Mental Status Examination scores as the exclusive independent predictors of P-Index classifications, segmented into high, intermediate, or low (percentiles ≤ 25, 26-74, or ≥ 75, respectively). A significant association was observed between the manifestation of depressive symptoms, lower Mini-Mental Status Examination scores, and reduced cognitive-motor performance. The findings implicate depressive symptoms and low cognitive performance as substantial impediments to optimal dual-task mobility within this cohort. Further studies are warranted to examine the efficacy of cognitive stimulation and antidepressant therapy, in augmenting mobility-related dual-task performance among older adults.
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Affiliation(s)
- Fabiane de Oliveira Brauner
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), PUCRS, Porto Alegre, RS, Brazil
| | - Mariana Oliveira
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), PUCRS, Porto Alegre, RS, Brazil
| | - Daiane Oliveira Hausen
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), PUCRS, Porto Alegre, RS, Brazil
| | - Aniuska Schiavo
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), PUCRS, Porto Alegre, RS, Brazil
| | - Gustavo Balbinot
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Régis Gemerasca Mestriner
- Biomedical Gerontology Program of the School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), PUCRS, Porto Alegre, RS, Brazil
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Voisard C, de l'Escalopier N, Vienne-Jumeau A, Moreau A, Quijoux F, Bompaire F, Sallansonnet M, Brechemier ML, Taifas I, Tafani C, Drouard E, Vayatis N, Ricard D, Oudre L. Innovative multidimensional gait evaluation using IMU in multiple sclerosis: introducing the semiogram. Front Neurol 2023; 14:1237162. [PMID: 37780706 PMCID: PMC10540441 DOI: 10.3389/fneur.2023.1237162] [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: 06/08/2023] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Background Quantifying gait using inertial measurement units has gained increasing interest in recent years. Highly degraded gaits, especially in neurological impaired patients, challenge gait detection algorithms and require specific segmentation and analysis tools. Thus, the outcomes of these devices must be rigorously tested for both robustness and relevancy in order to recommend their routine use. In this study, we propose a multidimensional score to quantify and visualize gait, which can be used in neurological routine follow-up. We assessed the reliability and clinical coherence of this method in a group of severely disabled patients with progressive multiple sclerosis (pMS), who display highly degraded gait patterns, as well as in an age-matched healthy subjects (HS) group. Methods Twenty-two participants with pMS and nineteen HS were included in this 18-month longitudinal follow-up study. During the follow-up period, all participants completed a 10-meter walk test with a U-turn and back, twice at M0, M6, M12, and M18. Average speed and seven clinical criteria (sturdiness, springiness, steadiness, stability, smoothness, synchronization, and symmetry) were evaluated using 17 gait parameters selected from the literature. The variation of these parameters from HS values was combined to generate a multidimensional visual tool, referred to as a semiogram. Results For both cohorts, all criteria showed moderate to very high test-retest reliability for intra-session measurements. Inter-session quantification was also moderate to highly reliable for all criteria except smoothness, which was not reliable for HS participants. All partial scores, except for the stability score, differed between the two populations. All partial scores were correlated with an objective but not subjective quantification of gait severity in the pMS population. A deficit in the pyramidal tract was associated with altered scores in all criteria, whereas deficits in cerebellar, sensitive, bulbar, and cognitive deficits were associated with decreased scores in only a subset of gait criteria. Conclusions The proposed multidimensional gait quantification represents an innovative approach to monitoring gait disorders. It provides a reliable and informative biomarker for assessing the severity of gait impairments in individuals with pMS. Additionally, it holds the potential for discriminating between various underlying causes of gait alterations in pMS.
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Affiliation(s)
- Cyril Voisard
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Nicolas de l'Escalopier
- Université Paris Cité, Université Paris Saclay, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Paris, France
- Service de Chirurgie Orthopédique, Traumatologique et Réparatrice des Membres, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Aliénor Vienne-Jumeau
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Albane Moreau
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Flavien Quijoux
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Flavie Bompaire
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
- Université Paris Cité, Université Paris Saclay, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Paris, France
| | - Magali Sallansonnet
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Marie-Laure Brechemier
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Irina Taifas
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Camille Tafani
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Eve Drouard
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
| | - Nicolas Vayatis
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
| | - Damien Ricard
- Service de Neurologie, Service de Santé des Armées, Hôpital d'Instruction des Armées Percy, Clamart, France
- Université Paris Cité, Université Paris Saclay, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Paris, France
- Ecole du Val-de-Grâce, Service de Santé des Armées, Paris, France
| | - Laurent Oudre
- Université Paris Saclay, Université Paris Cité, Ecole Normale Supérieure Paris Saclay, Centre National de la Recherche Scientifique, Service de Santé des Armées, Institut National de la Santé et de la Recherche Médicale, Centre Borelli, Gif-sur-Yvette, France
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Caronni A, Picardi M, Scarano S, Malloggi C, Tropea P, Gilardone G, Aristidou E, Pintavalle G, Redaelli V, Antoniotti P, Corbo M. Pay attention: you can fall! The Mini-BESTest scale and the turning duration of the TUG test provide valid balance measures in neurological patients: a prospective study with falls as the balance criterion. Front Neurol 2023; 14:1228302. [PMID: 37745667 PMCID: PMC10516579 DOI: 10.3389/fneur.2023.1228302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background Balance, i.e., the ability not to fall, is often poor in neurological patients and this impairment increases their risk of falling. The Mini-Balance Evaluation System Test (Mini-BESTest), a rating scale, the Timed Up and Go (TUG) test, and gait measures are commonly used to quantify balance. This study assesses the criterion validity of these measures as balance measures. Methods The probability of being a faller within nine months was used as the balance criterion. The Mini-BESTest, TUG (instrumented with inertial sensors), and walking test were administered before and after inpatient rehabilitation. Multiple and LASSO logistic regressions were used for the analysis. The diagnostic accuracy of the model was assessed with the area under the curve (AUC) of the receiver operating characteristic curve. Mobility measure validity was compared with the Akaike Information Criterion (AIC). Results Two hundred and fourteen neurological patients (stroke, peripheral neuropathy, or parkinsonism) were recruited. In total, 82 patients fell at least once in the nine-month follow-up. The Mini-BESTest (AUC = 0.69; 95%CI: 0.62-0.76), the duration of the TUG turning phase (AUC = 0.69; 0.62-0.76), and other TUG measures were significant faller predictors in regression models. However, only the turning duration (AIC = 274.0) and Mini-BESTest (AIC = 276.1) substantially improved the prediction of a baseline model, which only included fall risk factors from the medical history (AIC = 281.7). The LASSO procedure selected gender, disease chronicity, urinary incontinence, the Mini-BESTest, and turning duration as optimal faller predictors. Conclusion The TUG turning duration and the Mini-BESTest predict the chance of being a faller. Their criterion validity as balance measures in neurological patients is substantial.
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Affiliation(s)
- Antonio Caronni
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Michela Picardi
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Chiara Malloggi
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Ospedale San Luca, Milan, Italy
| | - Peppino Tropea
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Giulia Gilardone
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Evdoxia Aristidou
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | | | - Valentina Redaelli
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Paola Antoniotti
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milan, Italy
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Zucchelli A, Lucente D, Filippini C, Marengoni A, Lopomo NF. Instrumental evaluation of gait smoothness and history of falling in older persons: results from an exploratory case-control study. Aging Clin Exp Res 2023; 35:1357-1361. [PMID: 37071388 DOI: 10.1007/s40520-023-02403-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/28/2023] [Indexed: 04/19/2023]
Abstract
Gait smoothness, perceived when a person walks continuously and uninterruptedly, is associated with an undisrupted gait pattern, good sensorimotor control, and a lower risk of falling. The spectral arc length (SPARC) is a quantitative metric proposed for the evaluation of movement smoothness from the signal obtained by wearable sensors. In this small exploratory case-control study, older persons with and without a history of injurious falls underwent a turn-test while wearing an accelerometer: gait smoothness was estimated by calculating SPARC during the straight and turning phases. Cases seemed to exhibit lower SPARC values during the turning phase, in comparison with control.
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Affiliation(s)
- Alberto Zucchelli
- Department of Information Engineering, Università degli Studi di Brescia, Viale Branze 38, 25100, Brescia, Italy.
- Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Daniela Lucente
- Geriatric Medicine Residency School, Università degli Studi di Brescia, Brescia, Italy
| | - Chiara Filippini
- Geriatric Medicine Residency School, Università degli Studi di Brescia, Brescia, Italy
| | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical and Experimental Sciences, Università degli Studi di Brescia, Brescia, Italy
| | - Nicola Francesco Lopomo
- Department of Information Engineering, Università degli Studi di Brescia, Viale Branze 38, 25100, Brescia, Italy
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Ortega-Bastidas P, Gómez B, Aqueveque P, Luarte-Martínez S, Cano-de-la-Cuerda R. Instrumented Timed Up and Go Test (iTUG)-More Than Assessing Time to Predict Falls: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:3426. [PMID: 37050485 PMCID: PMC10098780 DOI: 10.3390/s23073426] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
The Timed Up and Go (TUG) test is a widely used tool for assessing the risk of falls in older adults. However, to increase the test's predictive value, the instrumented Timed Up and Go (iTUG) test has been developed, incorporating different technological approaches. This systematic review aims to explore the evidence of the technological proposal for the segmentation and analysis of iTUG in elderlies with or without pathologies. A search was conducted in five major databases, following PRISMA guidelines. The review included 40 studies that met the eligibility criteria. The most used technology was inertial sensors (75% of the studies), with healthy elderlies (35%) and elderlies with Parkinson's disease (32.5%) being the most analyzed participants. In total, 97.5% of the studies applied automatic segmentation using rule-based algorithms. The iTUG test offers an economical and accessible alternative to increase the predictive value of TUG, identifying different variables, and can be used in clinical, community, and home settings.
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Affiliation(s)
- Paulina Ortega-Bastidas
- Health Sciences PhD Programme, International Doctoral School, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Kinesiology Department, Faculty of Medicine, Universidad de Concepción, Concepción, 151 Janequeo St., Concepcion 4030000, Chile
| | - Britam Gómez
- Biomedical Engineering, Faculty of Engineering, Universidad de Santiago de Chile, Libertador Bernardo O’Higgins Av., Santiago 9170022, Chile
| | - Pablo Aqueveque
- Department of Electrical Engineering, Faculty of Engineering, Universidad de Concepción, 219 Edmundo Larenas St., Concepción 4030000, Chile
| | - Soledad Luarte-Martínez
- Kinesiology Department, Faculty of Medicine, Universidad de Concepción, Concepción, 151 Janequeo St., Concepcion 4030000, Chile
| | - Roberto Cano-de-la-Cuerda
- Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine Department, Universidad Rey Juan Carlos, 28922 Madrid, Spain
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Doğan M, Ayvat E, Kılınç M. Telerehabilitation versus virtual reality supported task-oriented circuit therapy on upper limbs and trunk functions in patients with multiple sclerosis: A randomized controlled study. Mult Scler Relat Disord 2023; 71:104558. [PMID: 36812718 DOI: 10.1016/j.msard.2023.104558] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/20/2023] [Accepted: 02/09/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION The purpose of this study was to investigate the effects of two different technology-supported rehabilitation approaches which are mobile application based telerehabilitation (TR) and virtual reality supported task oriented circuit therapy groups (V-TOCT) on the upper limb (UL), trunk function, and functional activity kinematics in patients with Multiple Sclerosis (PwMS). METHODS Thirty-four patients with PwMS were included in this study. The participants were evaluated at baseline and after eight weeks of treatment by an experienced physiotherapist using the Trunk Impairment Scale (TIS), kinetic function sub-parameter of the International Cooperative Ataxia Rating Scale (K-ICARS), ABILHAND, Minnesota Manual Dexterity tests (MMDT), and trunk and UL kinematics using inertial sensors. The participants were randomized into the TR and V-TOCT groups with a 1:1 allocation ratio. All participants received interventions for 1 hour per session, 3 sessions per week, for 8 weeks. RESULTS Trunk impairment, ataxia severity, UL, and hand function showed statistically significant improvement in both groups. The functional range of motion (FRoM) of shoulder and wrist increased transversal plane and the FRoM of shoulder increased on sagittal plane in V-TOCT. Log Dimensionless Jerk (LDJ) decreased on transversal plane in V-TOCT group. The FRoM of the trunk joints increased on the coronal plane and the FRoM of the trunk joints increased on the transversal plane in TR. Dynamic balance of the trunk and K-ICARS improved better in V-TOCT than in TR (p < 0,05). CONCLUSIONS V-TOCT and TR improved UL function, TIS, and ataxia severity in PwMS. The V-TOCT was more effective than the TR in terms of dynamic trunk control and kinetic function. The clinical results were confirmed using the kinematic metrics of motor control.
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Affiliation(s)
- Mert Doğan
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Ender Ayvat
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Muhammed Kılınç
- Department of Neurological Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Germanotta M, Iacovelli C, Aprile I. Evaluation of Gait Smoothness in Patients with Stroke Undergoing Rehabilitation: Comparison between Two Metrics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013440. [PMID: 36294017 PMCID: PMC9603299 DOI: 10.3390/ijerph192013440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 05/27/2023]
Abstract
The use of quantitative methods to analyze the loss in gait smoothness, an increase in movement intermittency which is a distinguishing hallmark of motor deficits in stroke patients, has gained considerable attention in recent years. In the literature, the spectral arc length (SPARC), as well as metrics based on the measurement of the jerk, such as the log dimensionless jerk (LDLJ), are currently employed to assess smoothness. However, the optimal measure for evaluating the smoothness of walking in stroke patients remains unknown. Here, we investigated the smoothness of the body's center of mass (BCoM) trajectory during gait, using an optoelectronic system, in twenty-two subacute and eight chronic patients before and after a two-month rehabilitation program. The two measures were evaluated for their discriminant validity (ability to differentiate the smoothness of the BCoM trajectory calculated on the cycle of the affected and unaffected limb, and between subacute and chronic patients), validity (correlation with clinical scales), and responsiveness to the intervention. According to our findings, the LDLJ outperformed the SPARC in terms of the examined qualities. Based on data gathered using an optoelectronic system, we recommend using the LDLJ rather than the SPARC to investigate the gait smoothness of stroke patients.
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Affiliation(s)
| | - Chiara Iacovelli
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168 Rome, Italy
- Rehabilitation and Physical Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Irene Aprile
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
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Association between usual alcohol consumption and risk of falls in middle-aged and older Chinese adults. BMC Geriatr 2022; 22:750. [PMID: 36104686 PMCID: PMC9472419 DOI: 10.1186/s12877-022-03429-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background Previous studies exploring usual alcohol consumption and falls risk were scarce in China. In addition, the dose–response relationship has not been explored so far. This study aims to estimate the association between usual alcohol consumption and risk of falls among middle-aged and older Chinese adults based on data from the China Health and Retirement Longitudinal Study (CHARLS), which is representative of the population of the entire country. Methods Baseline survey data in 2015 and follow-up data in 2018 in CHARLS were utilized. Alcohol consumption was calculated in grams per day (gr/day) according to self-reported drinking data and categorized accordingly to The Dietary Guidelines for Chinese Residents (DGC) 2016. Fall was obtained from self-reported information. Multivariable logistic regression analyses were performed to estimate the association of usual alcohol consumption with risk of falling. The dose–response relationship was also explored using restricted cubic splines. Results A total of 12,910 middle-aged and older participants were included from the CHARLS 2015, of which 11,667 were followed up in 2018. We found that former, moderate, and excessive drinkers were at higher fall risk compared to never drinkers (former: OR, 1.24; 95% CI, 1.05–1.46; moderate: OR, 1.22; 95% CI, 1.06–1.41; excessive: OR, 1.36; 95% CI, 1.15–1.61) in the longitudinal analysis. Similarly, individuals with moderate and excessive alcohol consumption were at increased risk of falling in the cross-sectional analysis (moderate: OR, 1.18; 95% CI, 1.02–1.37; excessive: OR, 1.32; 95% CI, 1.11,1.57). No significant increased risk of falls was found for former drinkers (former: OR, 1.13; 95% CI, 0.96–1.34). We observed a significant non-linear relationship. Conclusions Our study suggests that usual alcohol consumption was associated with a higher risk of falls, highlighting the key role of alcohol intake on the fall risk, which needed consideration in developing intervention and prevention strategies for reducing falls among middle-aged and older Chinese adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03429-1.
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Figueiredo AI, Balbinot G, Brauner FO, Schiavo A, de Souza Urbanetto M, Mestriner RG. History of falls alters movement smoothness and time taken to complete a functional mobility task in the oldest-old: A case-control study. Exp Gerontol 2022; 167:111918. [DOI: 10.1016/j.exger.2022.111918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/11/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022]
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Abstract
Smoothness (i.e. non-intermittency) of movement is a clinically important property of the voluntary movement with accuracy and proper speed. Resting head position and head voluntary movements are impaired in cervical dystonia. The current work aims to evaluate if the smoothness of voluntary head rotations is reduced in this disease. Twenty-six cervical dystonia patients and 26 controls completed rightward and leftward head rotations. Patients’ movements were differentiated into “towards-dystonia” (rotation accentuated the torticollis) and “away-dystonia”. Smoothness was quantified by the angular jerk and arc length of the spectrum of angular speed (i.e. SPARC, arbitrary units). Movement amplitude (mean, 95% CI) on the horizontal plane was larger in controls (63.8°, 58.3°–69.2°) than patients when moving towards-dystonia (52.8°, 46.3°–59.4°; P = 0.006). Controls’ movements (49.4°/s, 41.9–56.9°/s) were faster than movements towards-dystonia (31.6°/s, 25.2–37.9°/s; P < 0.001) and away-dystonia (29.2°/s, 22.9–35.5°/s; P < 0.001). After taking into account the different amplitude and speed, SPARC-derived (but not jerk-derived) indices showed reduced smoothness in patients rotating away-dystonia (1.48, 1.35–1.61) compared to controls (1.88, 1.72–2.03; P < 0.001). Poor smoothness is a motor disturbance independent of movement amplitude and speed in cervical dystonia. Therefore, it should be assessed when evaluating this disease, its progression, and treatments.
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The 180° Turn Phase of the Timed Up and Go Test Better Predicts History of Falls in the Oldest-Old When Compared With the Full Test: A Case-Control Study. J Aging Phys Act 2022; 31:303-310. [PMID: 36216335 DOI: 10.1123/japa.2022-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/11/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
The 180° turn phase of the test may better differentiate the oldest-old regarding their history of falls. This is a case-control study designed to detect the ability of the 180° turn timed up and go (TUG) phase to detect a history of falls in the oldest-old. Sixty people aged 85 years and older were assessed in their homes. The single-task and dual-task TUG tests were performed using an inertial sensor (G-Walk). Sociodemographic data, physical activity levels, mental status, depressive symptoms, concern for falls occurrence, number of medicines in use, self-perception of balance, and the functional reach test were also assessed. The logistic regressions revealed the 180° turn phase of both the single-task and dual-task TUG was almost three times better than the full TUG test to detect a history of falls, thus providing insights that can be used to better assess functional mobility in the oldest-old.
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Okita S, De Lucena DS, Chan V, Reinkensmeyer DJ. Measuring Movement Quality of the Stroke-Impaired Upper Extremity with a Wearable Sensor: Toward a Smoothness Metric for Home Rehabilitation Exercise Programs. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:6691-6694. [PMID: 34892643 DOI: 10.1109/embc46164.2021.9629578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Remote patient monitoring systems show promise for assisting stroke patients in home exercise programs. While these systems typically measure exercise repetitions in order to monitor compliance, a key goal of therapists is to also monitor movement quality. Here we develop a measure of movement quality - Peak Intensity - that is a measure of movement smoothness that is implementable with a wrist-worn inertial measurement unit (IMU) in the context of performing repetitions of an upper extremity exercise. To calculate Peak Intensity, we assume we have an accurate count of the number of exercise repetitions in an exercise set, then calculate Peak Intensity as the total number of movement peaks from the continuous stream of IMU data generated across the set, divided by the number of repetitions. Using wrist-worn IMU measurements from 19 participants with chronic stroke performing a sample exercise in which they picked up and moved blocks across a divider (i.e. the Box and Blocks Test) we show that Peak Intensity is moderately correlated with a widely used measure of movement quality, the Quality of Movement score of the Motor Activity Log. Peak Intensity is also strongly correlated with a measure of hand function (the BBT score itself), but is more sensitive at greater levels of impairment. Finally, we show Peak Intensity can be validly derived from either wrist acceleration or angular velocity. These results suggest Peak Intensity could serve as an indicator of movement exercise quality for therapists monitoring home rehabilitation, and, potentially, as a means to provide augmented feedback to patients about their exercise quality.
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Brauner FO, Balbinot G, Figueiredo AI, Hausen DO, Schiavo A, Mestriner RG. The Performance Index Identifies Changes Across the Dual Task Timed Up and Go Test Phases and Impacts Task-Cost Estimation in the Oldest-Old. Front Hum Neurosci 2021; 15:720719. [PMID: 34658817 PMCID: PMC8514992 DOI: 10.3389/fnhum.2021.720719] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/23/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Dual tasking is common in activities of daily living (ADLs) and the ability to perform them usually declines with age. While cognitive aspects influence dual task (DT) performance, most DT-cost (DT-C) related metrics include only time- or speed- delta without weighting the accuracy of cognitive replies involved in the task. Objectives: The primary study goal was to weight the accuracy of cognitive replies as a contributing factor when estimating DT-C using a new index of DT-C that considers the accuracy of cognitive replies (P-index) in the instrumented timed up and go test (iTUG). Secondarily, to correlate the novel P-index with domains of the Mini-Mental State Examination (MMSE). Methods: Sixty-three participants (≥85 years old) took part in this study. The single task (ST) and DT iTUG tests were performed in a semi-random order. Both the time taken to complete the task measured utilizing an inertial measurement unit (IMU), and the accuracy of the cognitive replies were used to create the novel P-index. Clinical and sociodemographic data were collected. Results: The accuracy of the cognitive replies changed across the iTUG phases, particularly between the walk 1 and walk 2 phases. Moreover, weighting 0.6 for delta-time (W1) and 0.4 for cognitive replies (W2) into the P-index enhanced the prediction of the MMSE score. The novel P-index was able to explain 37% of the scores obtained by the fallers in the “spatial orientation” and “attention” domains of the MMSE. The ability of the P-index to predict MMSE scores was not significantly influenced by age, schooling, and number of medicines in use. The Bland-Altman analysis indicated a substantial difference between the time-delta-based DT-C and P-index methods, which was within the limits of agreement. Conclusions: The P-index incorporates the accuracy of cognitive replies when calculating the DT-C and better reflects the variance of the MMSE in comparison with the traditional time- or speed-delta approaches, thus providing an improved method to estimate the DT-C.
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Affiliation(s)
- Fabiane Oliveira Brauner
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Gustavo Balbinot
- KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Anelise Ineu Figueiredo
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Daiane Oliveira Hausen
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Aniuska Schiavo
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
| | - Régis Gemerasca Mestriner
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil.,Neuroplasticity and Neural Repair Research Group, Health and Life Sciences School, Pontifical Catholic University of Rio Grande do Sul, PUCRS, Porto Alegre, Brazil
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Garcia FDV, da Cunha MJ, Schuch CP, Schifino GP, Balbinot G, Pagnussat AS. Movement smoothness in chronic post-stroke individuals walking in an outdoor environment-A cross-sectional study using IMU sensors. PLoS One 2021; 16:e0250100. [PMID: 33886640 PMCID: PMC8061986 DOI: 10.1371/journal.pone.0250100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/30/2021] [Indexed: 12/28/2022] Open
Abstract
Background Walking speed is often used in the clinic to assess the level of gait impairment following stroke. Nonetheless, post-stroke individuals may employ the same walking speed but at a distinct movement quality. The main objective of this study was to explore a novel movement quality metric, the estimation of gait smoothness by the spectral arc length (SPARC), in individuals with a chronic stroke displaying mild/moderate or severe motor impairment while walking in an outdoor environment. Also, to quantify the correlation between SPARC, gait speed, motor impairment, and lower limb spasticity focused on understanding the relationship between the movement smoothness metric and common clinical assessments. Methods Thirty-two individuals with a chronic stroke and 32 control subjects participated in this study. The 10 meters walking test (10 MWT) was performed at the self-selected speed in an outdoor environment. The 10 MWT was instrumented with an inertial measurement unit system (IMU), which afforded the extraction of trunk angular velocities (yaw, roll, and pitch) and subsequent SPARC calculation. Results Movement smoothness was not influenced by gait speed in the control group, indicating that SPARC may constitute an additional and independent metric in the gait assessment. Individuals with a chronic stroke displayed reduced smoothness in the yaw and roll angular velocities (lower SPARC) compared with the control group. Also, severely impaired participants presented greater variability in smoothness along the 10 MWT. In the stroke group, a smoother gait in the pitch angular velocity was correlated with lower limb spasticity, likely indicating adaptive use of spasticity to maintain the pendular walking mechanics. Conversely, reduced smoothness in the roll angular velocity was related to pronounced spasticity. Conclusions Individuals with a chronic stroke displayed reduced smoothness in the yaw and roll angular velocities while walking in an outdoor environment. The quantification of gait smoothness using the SPARC metric may represent an additional outcome in clinical assessments of gait in individuals with a chronic stroke.
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Affiliation(s)
- Flora do Vale Garcia
- Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Movement Analysis and Rehabilitation Laboratory, UFCSPA, Porto Alegre, Brazil
| | - Maira Jaqueline da Cunha
- Movement Analysis and Rehabilitation Laboratory, UFCSPA, Porto Alegre, Brazil
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Clarissa Pedrini Schuch
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Giulia Palermo Schifino
- Movement Analysis and Rehabilitation Laboratory, UFCSPA, Porto Alegre, Brazil
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Gustavo Balbinot
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Aline Souza Pagnussat
- Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Movement Analysis and Rehabilitation Laboratory, UFCSPA, Porto Alegre, Brazil
- Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- Health Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
- * E-mail:
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Peric I, Spasic M, Novak D, Ostojic S, Sekulic D. Pre-Planned and Non-Planned Agility in Patients Ongoing Rehabilitation after Knee Surgery: Design, Reliability and Validity of the Newly Developed Testing Protocols. Diagnostics (Basel) 2021; 11:diagnostics11010146. [PMID: 33478145 PMCID: PMC7835766 DOI: 10.3390/diagnostics11010146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Due to its association with the risk of falling and consequent injury, the importance of agility is widely recognized, but no study so far has examined the different facets of agility in an untrained/clinical population. The aim of this study was to evaluate the reliability, validity, and correlates of newly developed tests of non-planned agility (NPA) and pre-planned agility (PPA) in an untrained/clinical sample. Methods: The sample comprised 38 participants older than 40 years (22 females, age: 56.1 ± 17.3 years, height: 170.4 ± 10.8 cm, mass: 82.54 ± 14.79 kg) who were involved in a rehabilitation program following total knee arthroplasty and knee arthroscopy. Variables included age, gender, type of surgery, history of fall, anthropometrics/body composition, and newly developed tests of NPA and PPA. Results: The results showed the high inter-testing- (ICC > 0.95, CV < 9%), and intra-testing-reliability (ICC > 0.96, CV < 9) of the newly developed tests. PPA and NPA were found to be valid in differentiation between age groups (>50 yrs. vs. <50 yrs.), and genders, with better performance in younger participants and males. Only NPA differentiated participants according to type of surgery, with better performance in those who had arthroscopic surgery, than those who had total knee arthroplasty. No differences in NPA and PPA were established between groups based on fall-history. In females, the body mass (Pearson’s r = 0.58 and 0.59, p < 0.001) and body fatness (Pearson’s r = 0.64 and 0.66, p < 0.001) were negatively correlated, while the lean body mass (Pearson’s r = 0.70 and 0.68, p < 0.001) was positively correlated with PPA and NPA. The NPA and PPA were highly correlated (Pearson’s r = 0.98, p < 0.001). Conclusions: We found that the proposed tests are reliable when evaluating agility characteristics in an untrained/clinical population after knee arthroplasty/arthroscopy. Further evaluation of the specific validity of the proposed tests in other specific subsamples is warranted.
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Affiliation(s)
- Ivan Peric
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia;
| | - Miodrag Spasic
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia; (M.S.); (D.N.)
| | - Dario Novak
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia; (M.S.); (D.N.)
- Institute for Anthropological Research, 10000 Zagreb, Croatia
| | - Sergej Ostojic
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia;
| | - Damir Sekulic
- Faculty of Kinesiology, University of Split, 21000 Split, Croatia; (M.S.); (D.N.)
- Correspondence:
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Kozinc Ž, Löfler S, Hofer C, Carraro U, Šarabon N. Diagnostic Balance Tests for Assessing Risk of Falls and Distinguishing Older Adult Fallers and Non-Fallers: A Systematic Review with Meta-Analysis. Diagnostics (Basel) 2020; 10:E667. [PMID: 32899201 PMCID: PMC7554797 DOI: 10.3390/diagnostics10090667] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 01/02/2023] Open
Abstract
Falls are a major cause of injury and morbidity in older adults. To reduce the incidence of falls, a systematic assessment of the risk of falling is of paramount importance. The purpose of this systematic review was to provide a comprehensive comparison of the diagnostic balance tests used to predict falls and for distinguishing older adults with and without a history of falls. We conducted a systematic review of the studies in which instrumented (force plate body sway assessment) or other non-instrumented balance tests were used. We analyzed the data from 19 prospective and 48 retrospective/case-control studies. Among the non-instrumented tests, the single-leg stance test appears to be the most promising for discrimination between fallers and non-fallers. In terms of body sway measures, the center-of-pressure area was most consistently associated with falls. No evidence was found for increased benefit of the body sway test when cognitive tasks were added, or the vision was eliminated. While our analyses are limited due to the unbalanced representation of different test and outcome measures across studies, we can recommend the single-leg test for the assessment of the risk of falling, and the measurements of body sway for a more comprehensive assessment.
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Affiliation(s)
- Žiga Kozinc
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia;
- Andrej Marušič Institute, University of Primorska, Muzejski trg 2, SI-6000 Koper, Slovenia
| | - Stefan Löfler
- Physiko- & Rheumatherapie, Institute for Physical Medicine and Rehabilitation, 3100 St. Pölten, Austria;
- Centre of Active Ageing—Competence Centre for Health, Prevention and Active Ageing, 3100 St. Pölten, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, Neugebäudeplatz 1, 3100 St. Pölten, Austria;
| | - Christian Hofer
- Ludwig Boltzmann Institute for Rehabilitation Research, Neugebäudeplatz 1, 3100 St. Pölten, Austria;
| | - Ugo Carraro
- Department of Biomedical Sciences, University of Padova, Via Ugo Bassi, 58/B, 35131 Padova, Italy;
- Interdepartmental Research Center of Myology, University of Padova, Via Ugo Bassi, 58/B, 35131 Padova, Italy
- A&C M-C Foundation for Translational Myology, Padova, Galleria Duomo 5, 35141 Padova, Italy
| | - Nejc Šarabon
- Faculty of Health Sciences, University of Primorska, Polje 42, SI-6310 Izola, Slovenia;
- InnoRenew CoE, Livade 6, SI6310 Izola, Slovenia
- Laboratory for Motor Control and Motor Behavior, S2P, Science to Practice, Ltd., Tehnološki park 19, SI-1000 Ljubljana, Slovenia
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