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LaCroix K, Horelka L, Hung C, Brown DA. Estimating highest capacity propulsion performance using backward-directed force during walking evaluation for individuals with acquired brain injury. J Neuroeng Rehabil 2024; 21:134. [PMID: 39103946 DOI: 10.1186/s12984-024-01428-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/17/2024] [Indexed: 08/07/2024] Open
Abstract
There are over 5.3 million Americans who face acquired brain injury (ABI)-related disability as well as almost 800,000 who suffer from stroke each year. To improve mobility and quality of life, rehabilitation professionals often focus on walking recovery soon after hospital discharge for ABI. Reduced propulsion capacity (force output of the lower limbs to counteract ground reaction forces) negatively impacts walking ability and complicates recovery during rehabilitation for brain injured people. We describe a method, using backward-directed resistance (BDR) in a robotic-based treadmill device, to allow measurement of maximum walking propulsion force (MWPF) that is not otherwise possible during overground walking assessment. Our objective was to test the construct validity of a maximum walking propulsion force (MWPF) measure that reflects a person's propulsive strength against applied BDR, while walking on a robotic treadmill-based device for participants with acquired brain injury (ABI). Our study enrolled 14 participants with ABI at an in inpatient rehabilitation in Galveston, TX from 8/1/21 - 4/31/22. The range of weight-adjusted MWPF was 2.6-27.1% body weight (%BW), mean 16.5 ± 8.4%BW, reflecting a wide range of propulsive force capability. The strongest correlation with overground tests was between the 6-minute walk test (6-MWT) distance and the MWPF values (r = 0.83, p < 0.001) with moderate correlations between the 10-meter walk tests at comfortable (CWS) and fast speeds (FWS). The Five Times Sit-to-Stand (used as a standard clinical measure of functional lower extremity strength) and MWPF tests were poorly correlated (r = 0.26, p = 0.4). Forward model selection included 6-MWT distance, age, and overground CWS as significant partial predictors of MWPF. We conclude that this novel MWPF measure is a valid representation of maximum propulsive force effort during walking for people post-ABI. Additional research could help determine the impact of interventions designed to increase propulsive force generation during rehabilitation training to improve overground walking performance.
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Affiliation(s)
- Kelli LaCroix
- MD-PhD Combined Degree Program, Department of Rehabilitation Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, USA.
- , Galveston, USA.
| | - Lauren Horelka
- Moody Neurorehabilitation Institute at Galveston, 1528 Post Office St, Galveston, TX, USA
| | - Clif Hung
- Moody Neurorehabilitation Institute at Galveston, 1528 Post Office St, Galveston, TX, USA
| | - David A Brown
- School of Health Professions, University of Texas Medical Branch, 301 University Blvd, Galveston, TX, USA
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Graham L, Powell D, Campbell KR, Morris R, Vitorio R, Parrington L, Antonellis P, Godfrey A, King LA, Stuart S. iVOMS: Instrumented Vestibular / Ocular motor screen in healthy controls and mild traumatic brain injury. Med Eng Phys 2024; 129:104180. [PMID: 38906567 DOI: 10.1016/j.medengphy.2024.104180] [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: 10/19/2023] [Revised: 04/12/2024] [Accepted: 05/06/2024] [Indexed: 06/23/2024]
Abstract
Objective Vestibular/ocular deficits occur with mild traumatic brain injury (mTBI). The vestibular/ocular motor screening (VOMS) tool is used to assess individuals post-mTBI, which primarily relies upon subjective self-reported symptoms. Instrumenting the VOMS (iVOMS) with technology may allow for more objective assessment post-mTBI, which reflects actual task performance. This study aimed to validate the iVOMS analytically and clinically in mTBI and controls. Methods Seventy-nine people with sub-acute mTBI (<12 weeks post-injury) and forty-four healthy control participants performed the VOMS whilst wearing a mobile eye-tracking on a one-off visit. People with mTBI were included if they were within 12 weeks of a physician diagnosis. Participants were excluded if they had any musculoskeletal, neurological or sensory deficits which could explain dysfunction. A series of custom-made eye tracking algorithms were used to assess recorded eye-movements. Results The iVOMS was analytically valid compared to the reference (ICC2,1 0.85-0.99) in mTBI and controls. The iVOMS outcomes were clinically valid as there were significant differences between groups for convergence, vertical saccades, smooth pursuit, vestibular ocular reflex and visual motion sensitivity outcomes. However, there was no significant relationship between iVOMS outcomes and self-reported symptoms. Conclusion The iVOMS is analytically and clinically valid in mTBI and controls, but further work is required to examine the sensitivity of iVOMS outcomes across the mTBI spectrum. Findings also highlighted that symptom and physiological issue resolution post-mTBI may not coincide and relationships need further examination.
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Affiliation(s)
- Lisa Graham
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Dylan Powell
- Department of Computer and Information Science, Northumbria University, Newcastle, UK
| | - Kody R Campbell
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Rosie Morris
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK; Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Rodrigo Vitorio
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK; Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Lucy Parrington
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA; Department of Sport, Exercise and Nutrition Sciences, La Trobe University, Victoria, Australia
| | - Prokopios Antonellis
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Alan Godfrey
- Department of Computer and Information Science, Northumbria University, Newcastle, UK
| | - Laurie A King
- Department of Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK; Department of Neurology, Oregon Health and Science University, Portland, OR, USA; Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
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de Aquino Costa Sousa T, Gagnon IJ, Li KZH, McFadyen BJ, Lamontagne A. Exploring the challenges of avoiding collisions with virtual pedestrians using a dual-task paradigm in individuals with chronic moderate to severe traumatic brain injury. J Neuroeng Rehabil 2024; 21:80. [PMID: 38755606 PMCID: PMC11097498 DOI: 10.1186/s12984-024-01378-x] [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: 03/01/2024] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Individuals with a moderate-to-severe traumatic brain injury (m/sTBI), despite experiencing good locomotor recovery six months post-injury, face challenges in adapting their locomotion to the environment. They also present with altered cognitive functions, which may impact dual-task walking abilities. Whether they present collision avoidance strategies with moving pedestrians that are altered under dual-task conditions, however, remains unclear. This study aimed to compare between individuals with m/sTBI and age-matched control individuals: (1), the locomotor and cognitive costs associated with the concurrent performance of circumventing approaching virtual pedestrians (VRPs) while attending to an auditory-based cognitive task and; (2) gaze behaviour associated with the VRP circumvention task in single and dual-task conditions. METHODOLOGY Twelve individuals with m/sTBI (age = 43.3 ± 9.5 yrs; >6 mo. post injury) and 12 healthy controls (CTLs) (age = 41.8 ± 8.3 yrs) were assessed while walking in a virtual subway station viewed in a head-mounted display. They performed a collision avoidance task with VRPs, as well as auditory-based cognitive tasks (pitch discrimination and auditory Stroop), both under single and dual-task conditions. Dual-task cost (DTC) for onset distance of trajectory deviation, minimum distance from the VRP, maximum lateral deviation, walking speed, gaze fixations and cognitive task accuracy were contrasted between groups using generalized estimating equations. RESULTS In contrast to CTLs who showed locomotor DTCs only, individuals with m/sTBI displayed both locomotor and cognitive DTCs. While both groups walked slower under dual-task conditions, only individuals with m/sTBI failed to modify their onset distance of trajectory deviation and maintained smaller minimum distances and smaller maximum lateral deviation compared to single-task walking. Both groups showed shorter gaze fixations on the approaching VRP under dual-task conditions, but this reduction was less pronounced in the individuals with m/sTBI. A reduction in cognitive task accuracy under dual-task conditions was found in the m/sTBI group only. CONCLUSION Individuals with m/sTBI present altered locomotor and gaze behaviours, as well as altered cognitive performances, when executing a collision avoidance task involving moving pedestrians in dual-task conditions. Potential mechanisms explaining those alterations are discussed. Present findings highlight the compromised complex walking abilities in individuals with m/sTBI who otherwise present a good locomotor recovery.
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Affiliation(s)
- Thiago de Aquino Costa Sousa
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada.
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital - CISSS Laval, Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 3205 Place Alton-Goldbloom, Laval, QC, H7V 1R2, Canada.
| | - Isabelle J Gagnon
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
- Trauma/Child Development, Montreal Children's Hospital, Montreal, QC, Canada
| | - Karen Z H Li
- Department of Psychology, Concordia University, Montreal, QC, Canada
- Centre for Research in Human Development, Concordia University, Montreal, QC, Canada
- PERFORM Centre, Concordia University, Montreal, QC, Canada
| | - Bradford J McFadyen
- School of Rehabilitation Sciences, Université Laval, Quebec City, QC, Canada
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS Capitale Nationale, Quebec City, QC, Canada
| | - Anouk Lamontagne
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
- Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital - CISSS Laval, Site of the Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), 3205 Place Alton-Goldbloom, Laval, QC, H7V 1R2, Canada
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Tramontano M, Orejel Bustos AS, Montemurro R, Vasta S, Marangon G, Belluscio V, Morone G, Modugno N, Buzzi MG, Formisano R, Bergamini E, Vannozzi G. Dynamic Stability, Symmetry, and Smoothness of Gait in People with Neurological Health Conditions. SENSORS (BASEL, SWITZERLAND) 2024; 24:2451. [PMID: 38676068 PMCID: PMC11053882 DOI: 10.3390/s24082451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024]
Abstract
Neurological disorders such as stroke, Parkinson's disease (PD), and severe traumatic brain injury (sTBI) are leading global causes of disability and mortality. This study aimed to assess the ability to walk of patients with sTBI, stroke, and PD, identifying the differences in dynamic postural stability, symmetry, and smoothness during various dynamic motor tasks. Sixty people with neurological disorders and 20 healthy participants were recruited. Inertial measurement unit (IMU) sensors were employed to measure spatiotemporal parameters and gait quality indices during different motor tasks. The Mini-BESTest, Berg Balance Scale, and Dynamic Gait Index Scoring were also used to evaluate balance and gait. People with stroke exhibited the most compromised biomechanical patterns, with lower walking speed, increased stride duration, and decreased stride frequency. They also showed higher upper body instability and greater variability in gait stability indices, as well as less gait symmetry and smoothness. PD and sTBI patients displayed significantly different temporal parameters and differences in stability parameters only at the pelvis level and in the smoothness index during both linear and curved paths. This study provides a biomechanical characterization of dynamic stability, symmetry, and smoothness in people with stroke, sTBI, and PD using an IMU-based ecological assessment.
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Affiliation(s)
- Marco Tramontano
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater University of Bologna, 40138 Bologna, Italy;
- Unit of Occupational Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Amaranta Soledad Orejel Bustos
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
| | - Rebecca Montemurro
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Simona Vasta
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Gabriele Marangon
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, 66100 Chieti, Italy
| | - Valeria Belluscio
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
| | - Giovanni Morone
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy;
- San Raffaele Institute of Sulmona, 67039 Sulmona, Italy
| | | | - Maria Gabriella Buzzi
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Rita Formisano
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
| | - Elena Bergamini
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
- Department of Management, Information and Production Engineering, University of Bergamo, Via Pasubio 7b, 24044 Dalmine, BG, Italy
| | - Giuseppe Vannozzi
- Santa Lucia Foundation IRCCS (Institute for Research and Health Care), 00179 Rome, Italy; (A.S.O.B.); (V.B.); (M.G.B.); (R.F.)
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Piazza Lauro de Bosis, 00135 Roma, Italy;
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Hunzinger KJ, Walter AE, Rosenthal KA, Windham BG, Palta P, Juraschek SP, Hicks CW, Gottesman RF, Schneider ALC. Associations Between Prior Head Injury, Physical Functioning, and Frailty in the Atherosclerosis Risk in Communities Study. J Gerontol A Biol Sci Med Sci 2024; 79:glae032. [PMID: 38284926 PMCID: PMC10972581 DOI: 10.1093/gerona/glae032] [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: 10/05/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Older adults have the highest rates of head injury and are at the greatest risk for subsequent dysfunction, yet research on subsequent physical decline is limited. We sought to examine cross-sectional and prospective associations of head injury with physical functioning and frailty among older adults. METHODS A total of 5 598 Atherosclerosis Risk in Communities Study participants from Visit 5 (2011-13) underwent assessments of physical functioning (Short Physical Performance Battery [SPPB], comprised of gait speed, chair stands, and balance) and frailty (defined using established criteria) were followed through Visit 7 (2018-19). Head injury was self-reported or based on ICD-9 codes. Adjusted linear and multinomial logistic regression models were used to estimate associations. Prospective models incorporated inverse probability of attrition weights to account for death or attrition. RESULTS Participants were a mean age of 75 years, 58% were women, 22% were Black, and 27% had a prior head injury. Compared to individuals without head injury, individuals with head injury had worse physical functioning (SPPB total score, β-coefficient = -0.22, 95% CI: -0.35 to -0.09) and were more likely to be pre-frail (OR = 1.19, 95% CI: 1.04 to 1.35) or frail (OR = 1.40, 95% CI: 1.08 to 1.80) compared to robust. Prospectively, head injury was associated with a 0.02 m/s greater decline (95% CI: -0.04 to -0.01) in gait speed over a median of 5 years. Among baseline robust individuals (n = 1 847), head injury was associated with increased odds of becoming pre-frail (OR = 1.32, 95% CI: 1.04 to 1.67) or frail (OR = 1.92, 95% CI: 1.05 to 3.51) compared to robust. CONCLUSIONS Older adults with prior head injury had worse physical functioning and greater frailty at baseline and were more likely to become frail and walk slower over time, compared to individuals without head injury.
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Affiliation(s)
- Katherine J Hunzinger
- Department of Exercise Science, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexa E Walter
- Department of Neurology, University of Pennsylvania-Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kimberly A Rosenthal
- Department of Physical Medicine and Rehabilitation, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - B Gwen Windham
- Memory Impairment and Neurodegenerative Dementia (MIND) Center, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Priya Palta
- Department of Neurology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen P Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Caitlin W Hicks
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, Bethesda, Maryland, USA
| | - Andrea L C Schneider
- Department of Neurology, University of Pennsylvania-Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania-Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Kadaba Sridhar S, Dysterheft Robb J, Gupta R, Cheong S, Kuang R, Samadani U. Structural neuroimaging markers of normal pressure hydrocephalus versus Alzheimer's dementia and Parkinson's disease, and hydrocephalus versus atrophy in chronic TBI-a narrative review. Front Neurol 2024; 15:1347200. [PMID: 38576534 PMCID: PMC10991762 DOI: 10.3389/fneur.2024.1347200] [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: 11/30/2023] [Accepted: 02/07/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Normal Pressure Hydrocephalus (NPH) is a prominent type of reversible dementia that may be treated with shunt surgery, and it is crucial to differentiate it from irreversible degeneration caused by its symptomatic mimics like Alzheimer's Dementia (AD) and Parkinson's Disease (PD). Similarly, it is important to distinguish between (normal pressure) hydrocephalus and irreversible atrophy/degeneration which are among the chronic effects of Traumatic Brain Injury (cTBI), as the former may be reversed through shunt placement. The purpose of this review is to elucidate the structural imaging markers which may be foundational to the development of accurate, noninvasive, and accessible solutions to this problem. Methods By searching the PubMed database for keywords related to NPH, AD, PD, and cTBI, we reviewed studies that examined the (1) distinct neuroanatomical markers of degeneration in NPH versus AD and PD, and atrophy versus hydrocephalus in cTBI and (2) computational methods for their (semi-) automatic assessment on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans. Results Structural markers of NPH and those that can distinguish it from AD have been well studied, but only a few studies have explored its structural distinction between PD. The structural implications of cTBI over time have been studied. But neuroanatomical markers that can predict shunt response in patients with either symptomatic idiopathic NPH or post-traumatic hydrocephalus have not been reliably established. MRI-based markers dominate this field of investigation as compared to CT, which is also reflected in the disproportionate number of MRI-based computational methods for their automatic assessment. Conclusion Along with an up-to-date literature review on the structural neurodegeneration due to NPH versus AD/PD, and hydrocephalus versus atrophy in cTBI, this article sheds light on the potential of structural imaging markers as (differential) diagnostic aids for the timely recognition of patients with reversible (normal pressure) hydrocephalus, and opportunities to develop computational tools for their objective assessment.
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Affiliation(s)
- Sharada Kadaba Sridhar
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Jen Dysterheft Robb
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Rishabh Gupta
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
- University of Minnesota Twin Cities Medical School, Minneapolis, MN, United States
| | - Scarlett Cheong
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Rui Kuang
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Uzma Samadani
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
- University of Minnesota Twin Cities Medical School, Minneapolis, MN, United States
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, United States
- Division of Neurosurgery, Department of Surgery, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
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Campbell KR, Wilhelm JL, Antonellis P, Scanlan KT, Pettigrew NC, Martini DN, Chesnutt JC, King LA. Assessing the Effects of Mild Traumatic Brain Injury on Vestibular Home Exercise Performance with Wearable Sensors. SENSORS (BASEL, SWITZERLAND) 2023; 23:9860. [PMID: 38139706 PMCID: PMC10748190 DOI: 10.3390/s23249860] [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: 11/07/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Abstract
After a mild traumatic brain injury (mTBI), dizziness and balance problems are frequently reported, affecting individuals' daily lives and functioning. Vestibular rehabilitation is a standard treatment approach for addressing these issues, but its efficacy in this population remains inconclusive. A potential reason for suboptimal outcomes is the lack of objective monitoring of exercise performance, which is crucial for therapeutic success. This study utilized wearable inertial measurement units (IMUs) to quantify exercise performance in individuals with mTBI during home-based vestibular rehabilitation exercises. Seventy-three people with mTBI and fifty healthy controls were enrolled. Vestibular exercises were performed, and IMUs measured forehead and sternum velocities and range of motions. The mTBI group demonstrated a slower forehead peak angular velocity in all exercises, which may be a compensatory strategy to manage balance issues or symptom exacerbation. Additionally, the mTBI group exhibited a larger forehead range of motion during specific exercises, potentially linked to proprioceptive deficits. These findings emphasize the usefulness of utilizing IMUs to monitor the quality of home-based vestibular exercises for individuals with mTBI and the potential for IMUs improving rehabilitation outcomes.
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Affiliation(s)
- Kody R. Campbell
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
| | - Jennifer L. Wilhelm
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
| | - Prokopios Antonellis
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
| | - Kathleen T. Scanlan
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
| | - Natalie C. Pettigrew
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
| | - Douglas N. Martini
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA 01060, USA
| | - James C. Chesnutt
- Department of Family Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Laurie A. King
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA; (J.L.W.); (P.A.); (L.A.K.)
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Wu P, He B, Li X, Zhang H. Roles of microRNA-124 in traumatic brain injury: a comprehensive review. Front Cell Neurosci 2023; 17:1298508. [PMID: 38034588 PMCID: PMC10687822 DOI: 10.3389/fncel.2023.1298508] [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: 09/21/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Traumatic brain injury (TBI) is a prominent global cause of mortality due to the limited availability of effective prevention and treatment strategies for this disorder. An effective molecular biomarker may contribute to determining the prognosis and promoting the therapeutic efficiency of TBI. MicroRNA-124 (miR-124) is most abundantly expressed in the brain and exerts different biological effects in a variety of diseases by regulating pathological processes of apoptosis and proliferation. Recently, increasing evidence has demonstrated the association between miR-124 and TBI, but there is still a lack of relevant literature to summarize the current evidence on this topic. Based on this review, we found that miR-124 was involved as a regulatory factor in cell apoptosis and proliferation, and was also strongly related with the pathophysiological development of TBI. MiR-124 played an essential role in TBI by interacting with multiple biomolecules and signaling pathways, such as JNK, VAMP-3, Rela/ApoE, PDE4B/mTOR, MDK/TLR4/NF-κB, DAPK1/NR2B, JAK/STAT3, PI3K/AKT, Ras/MEK/Erk. The potential benefits of upregulating miR-124 in facilitating TBI recovery have been identified. The advancement of miRNA nanocarrier system technology presents an opportunity for miR-124 to emerge as a novel therapeutic target for TBI. However, the specific mechanisms underlying the role of miR-124 in TBI necessitate further investigation. Additionally, comprehensive large-scale studies are required to evaluate the clinical significance of miR-124 as a therapeutic target for TBI.
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Affiliation(s)
- Panxing Wu
- Department of Neurosurgery, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Bao He
- Department of Neurosurgery, The First People’s hospital of Kunshan, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
| | - Xiaoliang Li
- Department of Neurosurgery, The First People’s hospital of Kunshan, Affiliated Kunshan Hospital of Jiangsu University, Suzhou, Jiangsu, China
- Suzhou Key Laboratory of Neuro-Oncology and Nano-Bionics, Suzhou, Jiangsu, China
| | - Hongwei Zhang
- Department of Emergency Medicine, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China
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9
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Mason R, Barry G, Robinson H, O'Callaghan B, Lennon O, Godfrey A, Stuart S. Validity and reliability of the DANU sports system for walking and running gait assessment. Physiol Meas 2023; 44:115001. [PMID: 37852268 DOI: 10.1088/1361-6579/ad04b4] [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: 07/04/2023] [Accepted: 10/18/2023] [Indexed: 10/20/2023]
Abstract
Objective. Gait assessments have traditionally been analysed in laboratory settings, but this may not reflect natural gait. Wearable technology may offer an alternative due to its versatility. The purpose of the study was to establish the validity and reliability of temporal gait outcomes calculated by the DANU sports system, against a 3D motion capture reference system.Approach. Forty-one healthy adults (26 M, 15 F, age 36.4 ± 11.8 years) completed a series of overground walking and jogging trials and 60 s treadmill walking and running trials at various speeds (8-14 km hr-1), participants returned for a second testing session to repeat the same testing.Main results. For validity, 1406 steps and 613 trials during overground and across all treadmill trials were analysed respectively. Temporal outcomes generated by the DANU sports system included ground contact time, swing time and stride time all demonstrated excellent agreement compared to the laboratory reference (intraclass correlation coefficient (ICC) > 0.900), aside from ground contact time during overground jogging which had good agreement (ICC = 0.778). For reliability, 666 overground and 511 treadmill trials across all speeds were examined. Test re-test agreement was excellent for all outcomes across treadmill trials (ICC > 0.900), except for swing time during treadmill walking which had good agreement (ICC = 0.886). Overground trials demonstrated moderate to good test re-test agreement (ICC = 0.672-0.750), which may be due to inherent variability of self-selected (rather than treadmill set) pacing between sessions.Significance. Overall, this study showed that temporal gait outcomes from the DANU Sports System had good to excellent validity and moderate to excellent reliability in healthy adults compared to an established laboratory reference.
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Affiliation(s)
- Rachel Mason
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Gillian Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | | | | | | | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcasle upon Tyne, United Kingdom
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States of America
- Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom
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10
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Stephens JA, Press D, Atkins J, Duffy JR, Thomas ML, Weaver JA, Schmid AA. Feasibility of Acquiring Neuroimaging Data from Adults with Acquired Brain Injuries before and after a Yoga Intervention. Brain Sci 2023; 13:1413. [PMID: 37891782 PMCID: PMC10605412 DOI: 10.3390/brainsci13101413] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND To date, no one has prospectively evaluated yoga intervention-induced changes in brain structure or function in adults with acquired brain injuries (ABI). Thus, this study was conducted to test the feasibility of acquiring neuroimaging data from adults with ABI before and after a yoga intervention. METHODS This was a single-arm intervention feasibility study that included 12 adults with chronic (i.e., greater than 6 months post-injury) ABI and self-reported limitations in balance. Neuroimaging data were acquired before and after yoga. The yoga intervention was completed once per week for eight weeks. Feasibility objectives and benchmarks were established a priori. RESULTS Most feasibility objectives and benchmarks were achieved. The goal of recruiting 12 participants was successfully achieved, and 75% of participants were retained throughout the study (goal of 80%). All imaging feasibility benchmarks were met; rs-fMRI and fNIRS data were acquired safely, data were of acceptable quality, and data pre-processing procedures were successful. Additionally, improvements were detected in balance after yoga, as group-level balance was significantly better post-yoga compared to pre-yoga, p = 0.043. CONCLUSIONS These findings indicate it is feasible to acquire neuroimaging data from adults with ABI before and after a yoga intervention. Thus, future prospective studies are warranted.
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Affiliation(s)
- Jaclyn A. Stephens
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80524, USA; (J.A.W.); (A.A.S.)
- Molecular, Cellular and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO 80521, USA (M.L.T.)
| | - Denny Press
- Molecular, Cellular and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO 80521, USA (M.L.T.)
| | | | - John R. Duffy
- Psychology Department, Colorado State University, Fort Collins, CO 80523, USA;
| | - Michael L. Thomas
- Molecular, Cellular and Integrative Neuroscience Program, Colorado State University, Fort Collins, CO 80521, USA (M.L.T.)
- Psychology Department, Colorado State University, Fort Collins, CO 80523, USA;
| | - Jennifer A. Weaver
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80524, USA; (J.A.W.); (A.A.S.)
| | - Arlene A. Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80524, USA; (J.A.W.); (A.A.S.)
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11
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Bonanno M, De Nunzio AM, Quartarone A, Militi A, Petralito F, Calabrò RS. Gait Analysis in Neurorehabilitation: From Research to Clinical Practice. Bioengineering (Basel) 2023; 10:785. [PMID: 37508812 PMCID: PMC10376523 DOI: 10.3390/bioengineering10070785] [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: 05/02/2023] [Revised: 06/16/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
When brain damage occurs, gait and balance are often impaired. Evaluation of the gait cycle, therefore, has a pivotal role during the rehabilitation path of subjects who suffer from neurological disorders. Gait analysis can be performed through laboratory systems, non-wearable sensors (NWS), and/or wearable sensors (WS). Using these tools, physiotherapists and neurologists have more objective measures of motion function and can plan tailored and specific gait and balance training early to achieve better outcomes and improve patients' quality of life. However, most of these innovative tools are used for research purposes (especially the laboratory systems and NWS), although they deserve more attention in the rehabilitation field, considering their potential in improving clinical practice. In this narrative review, we aimed to summarize the most used gait analysis systems in neurological patients, shedding some light on their clinical value and implications for neurorehabilitation practice.
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Affiliation(s)
- Mirjam Bonanno
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98123 Messina, Italy
| | - Alessandro Marco De Nunzio
- Department of Research and Development, LUNEX International University of Health, Exercise and Sports, Avenue du Parc des Sports, 50, 4671 Differdange, Luxembourg
| | - Angelo Quartarone
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98123 Messina, Italy
| | - Annalisa Militi
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98123 Messina, Italy
| | - Francesco Petralito
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98123 Messina, Italy
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi "Bonino-Pulejo", Via Palermo, SS 113, C. da Casazza, 98123 Messina, Italy
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12
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La Framboise NF, Rochat E, Diserens K. A Biopsychosocial Evaluation of Post-Acute Outcome of Patients with Severe Brain Lesions Recovering from Coma: An Exploratory Study. J Clin Med 2023; 12:jcm12103572. [PMID: 37240678 DOI: 10.3390/jcm12103572] [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: 03/29/2023] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Currently, very little is known about the holistic outcome of patients recovering from coma. The aim of this retrospective exploratory study was to evaluate the outcomes of patients recovering from coma after care in an acute neurorehabilitation unit with particular focus on their biopsychosocial and spiritual needs in the post-acute phase of recovery. We included 12 patients and evaluated clinical outcome evolution by comparing standard neurobehavioral scores from patient files measured in the acute and post-acute phases. We assessed patient needs using the Quality of Life after Brain Injury scale (QOLIBRI) and classified self-reported complaints mentioned in patient files according to the International Classification of Functioning, Disability and Health framework (ICF). Mean patient evolution was a Level of Cognitive Functioning Scale (LCF)-r increase of 3.33 levels (range = 2); a Disability Rating Scale score (DRS) of -3.27 points (SD = 3.78); a Functional Ambulation Classification (FAC) scale score of 1.83 (range = 5); and a Glasgow Outcome Scale (GOS) median = 0 (Interquartile range = 1). Main patient complaints concerned mental functioning (n = 7), sensory functioning and pain (n = 6), neuromusculoskeletal and movement problems (n = 5), and major life areas (n = 5). To conclude, a significant handicap that affects their daily life was present in the post-acute phase in most patients. Complaints involved biopsychosocial and spiritual elements. The neurobehavioral scale results do not necessarily correlate with the subjective representations patients had of their condition.
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Affiliation(s)
- Noah F La Framboise
- Faculty of Biology and Medicine (FBM), Lausanne University, 1005 Lausanne, Switzerland
| | - Etienne Rochat
- Institute of Humanities in Medicine, Faculty of Biology and Medicine (FBM), Lausanne University, 1007 Lausanne, Switzerland
| | - Karin Diserens
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
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13
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Young F, Mason R, Morris RE, Stuart S, Godfrey A. IoT-Enabled Gait Assessment: The Next Step for Habitual Monitoring. SENSORS (BASEL, SWITZERLAND) 2023; 23:4100. [PMID: 37112441 PMCID: PMC10144082 DOI: 10.3390/s23084100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 06/19/2023]
Abstract
Walking/gait quality is a useful clinical tool to assess general health and is now broadly described as the sixth vital sign. This has been mediated by advances in sensing technology, including instrumented walkways and three-dimensional motion capture. However, it is wearable technology innovation that has spawned the highest growth in instrumented gait assessment due to the capabilities for monitoring within and beyond the laboratory. Specifically, instrumented gait assessment with wearable inertial measurement units (IMUs) has provided more readily deployable devices for use in any environment. Contemporary IMU-based gait assessment research has shown evidence of the robust quantifying of important clinical gait outcomes in, e.g., neurological disorders to gather more insightful habitual data in the home and community, given the relatively low cost and portability of IMUs. The aim of this narrative review is to describe the ongoing research regarding the need to move gait assessment out of bespoke settings into habitual environments and to consider the shortcomings and inefficiencies that are common within the field. Accordingly, we broadly explore how the Internet of Things (IoT) could better enable routine gait assessment beyond bespoke settings. As IMU-based wearables and algorithms mature in their corroboration with alternate technologies, such as computer vision, edge computing, and pose estimation, the role of IoT communication will enable new opportunities for remote gait assessment.
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Affiliation(s)
- Fraser Young
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne NE1 8ST, UK
| | - Rachel Mason
- Department of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne NE1 8ST, UK
| | - Rosie E. Morris
- Department of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne NE1 8ST, UK
| | - Samuel Stuart
- Department of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne NE1 8ST, UK
| | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcastle-upon-Tyne NE1 8ST, UK
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14
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Hsueh SC, Scerba MT, Tweedie D, Lecca D, Kim DS, Baig AM, Kim YK, Hwang I, Kim S, Selman WR, Hoffer BJ, Greig NH. Activity of a Novel Anti-Inflammatory Agent F-3,6'-dithiopomalidomide as a Treatment for Traumatic Brain Injury. Biomedicines 2022; 10:2449. [PMID: 36289711 PMCID: PMC9598880 DOI: 10.3390/biomedicines10102449] [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: 08/20/2022] [Revised: 09/01/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
Traumatic brain injury (TBI) is a major risk factor for several neurodegenerative disorders, including Parkinson's disease (PD) and Alzheimer's disease (AD). Neuroinflammation is a cause of later secondary cell death following TBI, has the potential to aggravate the initial impact, and provides a therapeutic target, albeit that has failed to translate into clinical trial success. Thalidomide-like compounds have neuroinflammation reduction properties across cellular and animal models of TBI and neurodegenerative disorders. They lower the generation of proinflammatory cytokines, particularly TNF-α which is pivotal in microglial cell activation. Unfortunately, thalidomide-like drugs possess adverse effects in humans before achieving anti-inflammatory drug levels. We developed F-3,6'-dithiopomalidomide (F-3,6'-DP) as a novel thalidomide-like compound to ameliorate inflammation. F-3,6'-DP binds to cereblon but does not efficiently trigger the degradation of the transcription factors (SALL4, Ikaros, and Aiolos) associated with the teratogenic and anti-proliferative responses of thalidomide-like drugs. We utilized a phenotypic drug discovery approach that employed cellular and animal models in the selection and development of F-3,6'-DP. F-3,6'-DP significantly mitigated LPS-induced inflammatory markers in RAW 264.7 cells, and lowered proinflammatory cytokine/chemokine levels in the plasma and brain of rats challenged with systemic LPS. We subsequently examined immunohistochemical, biochemical, and behavioral measures following controlled cortical impact (CCI) in mice, a model of moderate TBI known to induce inflammation. F-3,6'-DP decreased CCI-induced neuroinflammation, neuronal loss, and behavioral deficits when administered after TBI. F-3,6'-DP represents a novel class of thalidomide-like drugs that do not lower classical cereblon-associated transcription factors but retain anti-inflammatory actions and possess efficacy in the treatment of TBI and potentially longer-term neurodegenerative disorders.
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Affiliation(s)
- Shih Chang Hsueh
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program National Institute on Aging, NIH, Baltimore, MD 21224, USA
| | - Michael T. Scerba
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program National Institute on Aging, NIH, Baltimore, MD 21224, USA
| | - David Tweedie
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program National Institute on Aging, NIH, Baltimore, MD 21224, USA
| | - Daniela Lecca
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program National Institute on Aging, NIH, Baltimore, MD 21224, USA
| | - Dong Seok Kim
- AevisBio, Inc., Gaithersburg, MD 20878, USA
- Aevis Bio, Inc., Daejeon 34141, Korea
| | - Abdul Mannan Baig
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi 74800, Pakistan
| | | | | | - Sun Kim
- Aevis Bio, Inc., Daejeon 34141, Korea
| | - Warren R. Selman
- Department of Neurological Surgery, Case Western Reserve University and University Hospitals, Cleveland, OH 44106, USA
| | - Barry J. Hoffer
- Department of Neurological Surgery, Case Western Reserve University and University Hospitals, Cleveland, OH 44106, USA
| | - Nigel H. Greig
- Drug Design & Development Section, Translational Gerontology Branch, Intramural Research Program National Institute on Aging, NIH, Baltimore, MD 21224, USA
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15
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Development of a Nonmotorized Mechanism for Ankle Rehabilitation. IECMA 2022 2022. [DOI: 10.3390/iecma2022-12899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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The Effect of Dual-Task Motor-Cognitive Training in Adults with Neurological Diseases Who Are at Risk of Falling. Brain Sci 2022; 12:brainsci12091207. [PMID: 36138943 PMCID: PMC9497151 DOI: 10.3390/brainsci12091207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
Falls are common in patients with neurological diseases and can be very problematic. Recently, there has been an increase in fall prevention research in people with neurological diseases; however, these studies are usually condition-specific (e.g., only MS, PD or stroke). Here, our aim was to evaluate and compare the efficacy of an advanced and innovative dual-task, motor-cognitive rehabilitation program in individuals with different neurological diseases who are at risk of falling. We recruited 95 consecutive adults with neurological diseases who are at risk of falling and divided them into four groups: 31 with cerebrovascular disease (CVD), 20 with Parkinson’s disease (PD), 23 with traumatic brain injury (TBI) and 21 with other neurological diseases (OND). Each patient completed a dual-task, motor-cognitive training program and underwent two test evaluations to assess balance, gait, fear of falling and walking performance at the pre-and post-intervention. We found that our experimental motor-cognitive, dual-task rehabilitation program was an effective method for improving walking balance, gait, walking endurance and speed, and fear of falling, and that it reduced the risk of falls in patients with different neurological diseases. This study presents an alternative approach for people with chronic neurological diseases and provides innovative data for managing this population.
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17
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Akin FW, Murnane OD, Hall CD, Riska KM, Sears J. Vestibular and balance function in veterans with chronic dizziness associated with mild traumatic brain injury and blast exposure. Front Neurol 2022; 13:930389. [PMID: 36119708 PMCID: PMC9481418 DOI: 10.3389/fneur.2022.930389] [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: 04/27/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
The purpose of this study was to examine vestibular and balance function in individuals with chronic dizziness associated with mTBI/blast. A prospective case-control study design was used to examine ocular motor, vestibular function, and postural stability in veterans with symptoms of dizziness and/or imbalance following an mTBI or blast exposure (n = 77) and a healthy control group (n = 32). Significant group differences were observed for saccadic accuracy, VOR gain during slow harmonic acceleration at 0.01 Hz, cervical vestibular evoked myogenic potentials asymmetry ratio, composite equilibrium score on the sensory organization test, total Dynamic Gait Index score, and gait. The frequency of test abnormalities in participants with mTBI/blast ranged from 0 to 70% across vestibular, ocular motor, and balance/gait testing, with the most frequent abnormalities occurring on tests of balance and gait function. Seventy-two percent of the mTBI/blast participants had abnormal findings on one or more of the balance and gait tests. Vestibular test abnormalities occurred in ~34% of the individuals with chronic dizziness and mTBI/blast, and abnormalities occurred more frequently for measures of otolith organ function (25% for cVEMP and 18% for oVEMP) than for measures of hSCC function (8% for SHA and 6% for caloric test). Abnormal ocular motor function occurred in 18% of the mTBI/blast group. These findings support the need for comprehensive vestibular and balance assessment in individuals with dizziness following mTBI/blast-related injury.
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Affiliation(s)
- Faith W. Akin
- Mountain Home Hearing and Balance Research Program, James H. Quillen VA Medical Center, Mountain Home, TN, United States
- Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN, United States
- *Correspondence: Faith W. Akin
| | - Owen D. Murnane
- Mountain Home Hearing and Balance Research Program, James H. Quillen VA Medical Center, Mountain Home, TN, United States
- Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN, United States
| | - Courtney D. Hall
- Mountain Home Hearing and Balance Research Program, James H. Quillen VA Medical Center, Mountain Home, TN, United States
- Physical Therapy Program, Department of Rehabilitative Sciences, East Tennessee State University, Johnson City, TN, United States
| | - Kristal M. Riska
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Jennifer Sears
- Mountain Home Hearing and Balance Research Program, James H. Quillen VA Medical Center, Mountain Home, TN, United States
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18
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Bracali A, Baldanzini N. Estimation of Head Accelerations in Crashes Using Neural Networks and Sensors Embedded in the Protective Helmet. SENSORS (BASEL, SWITZERLAND) 2022; 22:5592. [PMID: 35898094 PMCID: PMC9371112 DOI: 10.3390/s22155592] [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: 05/30/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
Traumatic Brain Injuries (TBIs) are one of the most frequent and severe outcomes of a Powered Two-Wheeler (PTW) crash. Early diagnosis and treatment can greatly reduce permanent consequences. Despite the fact that devices to track head kinematics have been developed for sports applications, they all have limitations, which hamper their use in everyday road applications. In this study, a new technical solution based on accelerometers integrated in a motorcycle helmet is presented, and the related methodology to estimate linear and rotational acceleration of the head with deep Artificial Neural Networks (dANNs) is developed. A finite element model of helmet coupled with a Hybrid III head model was used to generate data needed for the neural network training. Input data to the dANN model were time signals of (virtual) accelerometers placed on the inner surface of the helmet shell, while the output data were the components of linear and rotational head accelerations. The network was capable of estimating, with good accuracy, time patterns of the acceleration components in all impact conditions that require medical treatment. The correlation between the reference and estimated values was high for all parameters and for both linear and rotational acceleration, with coefficients of determination (R2) ranging from 0.91 to 0.97.
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19
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Charalambous D, Strasser T, Tichy A, Bockstahler B. Ground Reaction Forces and Center of Pressure within the Paws When Stepping over Obstacles in Dogs. Animals (Basel) 2022; 12:ani12131702. [PMID: 35804600 PMCID: PMC9264929 DOI: 10.3390/ani12131702] [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: 05/27/2022] [Revised: 06/27/2022] [Accepted: 06/27/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Physical therapy and rehabilitation are emerging in veterinary medicine, and more research is needed to understand the effect of various exercises on kinematics and kinetics in animals. This will allow the animal physiotherapist to best utilize these exercises as a therapeutic and even diagnostic tool. Walking over obstacles is a typical canine physiotherapy exercise; however, no studies investigating the kinetics have been conducted. The present study showed significant changes in ground reaction forces and center of pressure in dogs walking over obstacles compared to normal walking. This can reflect a challenge that the animals have to overcome in order to perform this exercise. The data can be used for further studies in diseased animals or in the future as a diagnostic tool. Abstract Walking over obstacles is a widely used physiotherapy exercise in dogs. Current research is limited to the effect of this exercise in kinematics and muscle activation in dogs. The present study assessed the influence of walking over obstacles on the ground reaction forces (GRFs) and center of pressure (COP) in dogs. Data of dogs walking over one and two obstacles over a pressure platform were retrospectively analyzed and compared to normal walking. Walking over one obstacle did not affect the GRFs and COP of the forelimbs; however, significant changes were observed for the hindlimbs, especially the leading hindlimb. Walking over two obstacles caused significant changes to only one value at the forelimbs, whereas multiple significant changes in the GRFs and COP values were observed at the hindlimbs. Walking over obstacles seems to be challenging even for healthy adult dogs. Further studies are needed to investigate how different heights of obstacles and distances between them can further challenge the animals. The combination of kinetics and kinematics during walking over obstacles may be used in future as a diagnostic tool in geriatric and neurological patients in order to assess their proprioception awareness or to assess the improvement after an intervention, e.g., physiotherapy treatment.
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Affiliation(s)
- Danae Charalambous
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section for Physical Therapy, University of Veterinary Medicine, 1210 Vienna, Austria; (T.S.); (B.B.)
- Correspondence:
| | - Therese Strasser
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section for Physical Therapy, University of Veterinary Medicine, 1210 Vienna, Austria; (T.S.); (B.B.)
| | - Alexander Tichy
- Department of Biomedical Sciences, Platform for Bioinformatics and Biostatistics, University of Veterinary Medicine, 1210 Vienna, Austria;
| | - Barbara Bockstahler
- Department of Companion Animals and Horses, University Clinic for Small Animals, Small Animal Surgery, Section for Physical Therapy, University of Veterinary Medicine, 1210 Vienna, Austria; (T.S.); (B.B.)
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20
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Andersen MS, Güler DB, Larsen J, Rich KK, Svenningsen ÅF, Zhang M. The Development of Hindlimb Postural Asymmetry Induced by Focal Traumatic Brain Injury Is Not Related to Serotonin 2A/C Receptor Expression in the Spinal Cord. Int J Mol Sci 2022; 23:ijms23105358. [PMID: 35628167 PMCID: PMC9140651 DOI: 10.3390/ijms23105358] [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] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/16/2022] Open
Abstract
Brain injury and stroke are leading causes of adult disability. Motor deficits are common problems, and their underlying pathological mechanisms remain poorly understood. The serotoninergic system is implicated in both functional recovery from and the occurrence of spasticity after injuries to the central nervous system. This study, which was conducted on rats, investigated the development of limb postural changes and their relationship to the expression of serotonin (5-HT) 2A and 2C receptors in the spinal cord in the 4 weeks after focal traumatic brain injury (TBI) to the right hindlimb sensorimotor cortex. The limb motor deficits were assessed by measuring gait pattern changes during walking and hindlimb postural asymmetry at different time intervals (3−28 days) after surgery. The expressions of the 5-HT2A and 2C receptors in the lumbar spinal cord were investigated using immunohistochemistry. The results showed that all the rats with TBI, independently of the duration of the interval, displayed postural asymmetry with flexion on the contralateral (left) side (>2 mm), while the sham-operated rats showed no apparent postural asymmetry. The TBI rats also had longer stride lengths during walking in both their hindlimbs and their forelimbs compared with the sham rats. For both the TBI and the sham rats, the hind-paw placement angles were larger on the contralateral side in some of the groups. Compared to the sham-operated rats, the 5-HT2A and 2C receptor expression did not significantly change on either side of the lumbar spinal cords of the TBI rats in any of the groups. These results suggest that focal TBI can induce motor deficits lasting a relatively long time, and that these deficits are not related to the expression of the 5-HT2A and 2C receptors in the spinal cord.
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Affiliation(s)
- Marlene Storm Andersen
- Department of Molecular Medicine, University of Southern Denmark, DK-5000 Odense, Denmark; (M.S.A.); (D.B.G.); (J.L.); (K.K.R.); (Å.F.S.)
| | - Dilârâ Bedriye Güler
- Department of Molecular Medicine, University of Southern Denmark, DK-5000 Odense, Denmark; (M.S.A.); (D.B.G.); (J.L.); (K.K.R.); (Å.F.S.)
| | - Jonas Larsen
- Department of Molecular Medicine, University of Southern Denmark, DK-5000 Odense, Denmark; (M.S.A.); (D.B.G.); (J.L.); (K.K.R.); (Å.F.S.)
| | - Karen Kalhøj Rich
- Department of Molecular Medicine, University of Southern Denmark, DK-5000 Odense, Denmark; (M.S.A.); (D.B.G.); (J.L.); (K.K.R.); (Å.F.S.)
| | - Åsa Fex Svenningsen
- Department of Molecular Medicine, University of Southern Denmark, DK-5000 Odense, Denmark; (M.S.A.); (D.B.G.); (J.L.); (K.K.R.); (Å.F.S.)
- BRIDGE, University of Southern Denmark, DK-5000 Odense, Denmark
| | - Mengliang Zhang
- Department of Molecular Medicine, University of Southern Denmark, DK-5000 Odense, Denmark; (M.S.A.); (D.B.G.); (J.L.); (K.K.R.); (Å.F.S.)
- BRIDGE, University of Southern Denmark, DK-5000 Odense, Denmark
- Correspondence:
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