Abstract
BackgroundQuantification of motor performance has a promising role in personalized medicine by diagnosing and monitoring, e.g. neurodegenerative diseases or health problems related to aging. New motion assessment technologies can evolve into patient-centered eHealth applications on a global scale to support personalized healthcare as well as treatment of disease. However, uncertainty remains on the limits of generalizability of such data, which is relevant specifically for preventive or predictive applications, using normative datasets to screen for incipient disease manifestations or indicators of individual risks.ObjectiveThis study explored differences between healthy German and Japanese adults in the performance of a short set of six motor tests.MethodsSix motor tasks related to gait and balance were recorded with a validated 3D camera system. Twenty-five healthy adults from Chiba, Japan, participated in this study and were matched for age, sex, and BMI to a sample of 25 healthy adults from Berlin, Germany. Recordings used the same technical setup and standard instructions and were supervised by the same experienced operator. Differences in motor performance were analyzed using multiple linear regressions models, adjusted for differences in body stature.ResultsFrom 23 presented parameters, five showed group-related differences after adjustment for height and weight (R2 between .19 and .46, p<.05). Japanese adults transitioned faster between sitting and standing and used a smaller range of hand motion. In stepping-in-place, cadence was similar in both groups, but Japanese adults showed higher knee movement amplitudes. Body height was identified as relevant confounder (standardized beta >.5) for performance of short comfortable and maximum speed walks. For results of posturography, regression models did not reveal effects of group or body stature.ConclusionsOur results support the existence of a population-specific bias in motor function patterns in young healthy adults. This needs to be considered when motor function is assessed and used for clinical decisions, especially for personalized predictive and preventive medical purposes. The bias affected only the performance of specific items and parameters and is not fully explained by population-specific ethnic differences in body stature. It may be partially explained as cultural bias related to motor habits. Observed effects were small but are expected to be larger in a non-controlled cross-cultural application of motion assessment technologies with relevance for related algorithms that are being developed and used for data processing. In sum, the interpretation of individual data should be related to appropriate population-specific or even better personalized normative values to yield its full potential and avoid misinterpretation.
Highlights
In recent years, questions on the limitations of current medical practices were raised regarding the individual needs of a patient
Motor function patterns are of value for risk assessment in neurological diseases Motor function impairment is a hallmark of many neurological disorders, with impact on mobility, functional independence, and well-being of the patient [2]
The highest coefficient of variation (CV) values were found in measurements of knee amplitude asymmetry while stepping in place (Japanese: .86; German: .90), variability of trunk sway (Japanese: .70; German: .47), and arm movement variability in short line walk (Japanese: .66; German: .65)
Summary
Questions on the limitations of current medical practices were raised regarding the individual needs of a patient. Higher than normal step variability has been shown to indicate carrier status in spinocerebellar ataxias [4, 5]—even before clinical manifestation—and lower than normal postural stability may predict future decline in gait functions or fall risk in multiple sclerosis [6,7,8,9], while a motor-cognitive risk syndrome has been defined as predictive of cognitive decline [10] It remains to be shown, if improvement of such predictive motor features by targeted intervention may prevent progression events. The dosing of therapy— from pharmacotherapy to settings of deep brain stimulation for movement disorders or settings of cerebroabdominal shunts in normal pressure hydrocephalus—is individually tailored to reach an optimum of balance between its beneficial effects on motor functions and immediate side effects or longterm complications of therapy [11] To date, such decision relies on observation by trained professionals and use of standardized assessments by clinical rating scales to document their findings. Uncertainty remains on the limits of generalizability of such data, which is relevant for preventive or predictive applications, using normative datasets to screen for incipient disease manifestations or indicators of individual risks
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