Gait Changes Research Articles

Specific Gait Changes in Prodromal Hereditary Spastic Paraplegia Type 4: preSPG4 Study.

In hereditary spastic paraplegia type 4 (SPG4), subclinical gait changes might occur years before patients realize gait disturbances. The prodromal phase of neurodegenerative disease is of particular interest to halt disease progression by future interventions before impairment has manifested. The objective of this study was to identify specific movement abnormalities before the manifestation of gait impairment and quantify disease progression in the prodromal phase. Seventy subjects participated in gait assessment, including 30 prodromal SPAST pathogenic variant carriers, 17 patients with mild-to-moderate manifest SPG4, and 23 healthy control subjects. An infrared-camera-based motion capture system assessed gait to analyze features such as range of motion and continuous angle trajectories. Those features were correlated with disease severity as assessed by the Spastic Paraplegia Rating Scale, neurofilament light chain as a fluid biomarker indicating neurodegeneration, and motor-evoked potentials. Compared with healthy control subjects, we found an altered gait pattern in prodromal pathogenic variant carriers during the swing phase in the segmental angle of the foot (Dunn's post hoc test, q=3.1) and heel ground clearance (q=2.8). Furthermore, range of motion of segmental angle was reduced for the foot (q=3.3). These changes occurred in prodromal pathogenic variant carriers without quantified leg spasticity in clinical examination. Gait features correlated with neurofilament light chain levels, central motor conduction times of motor-evoked potentials, and Spastic Paraplegia Rating Scale score. Gait analysis can quantify changes in prodromal and mild-to-moderate manifest SPG4 patients. Thus, gait features constitute promising motor biomarkers characterizing the subclinical progression of spastic gait and might help to evaluate interventions in early disease stages. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Associations between driving rein tensions and drivers’ reports of the behaviour and driveability of Standardbred trotters

Effective communication between driver and horse through the reins is essential in harness racing to promote safety and optimise performance. Yet, the magnitudes of rein tension applied to driven horses, particularly Standardbred trotters (ST) are currently poorly understood. This is surprising given the number of reports that speak of mouth lesions after competition and equipment use that give raise to horse welfare concerns. Combining rein tension measurements with behavioural parameters has the potential to characterize “driveability” (as compared to “rideability”, the equivalent industry term for riding horses). Thus, the aims of the current study were: (i) identify how drivers perceive ST’s behavioural reactions in response to rein signals when driven on a racetrack, (ii) investigate whether drivers’ subjective appraisals of horses’ behavioural responses align with measured rein tensions (RT), (iii) relate these appraisals to the horses’ perceived driveability (score 1 = poor, 10 = excellent), and (iv) assess whether drivers differ in their scoring of horses’ driveability. Nine ST (5 geldings, 7.8 mean ± 2.1 SE years; 4 mares, 6.8 ± 0.5) were driven by 11 drivers (7 females; 4 males) all of whom were experienced in driving ST. Nine drivers tested three different horses each, and two drivers drove two of the horses. This resulted in 31 test drives involving several segments, each comprising a series of changes of gait and direction of travel. Rein tension meters were used throughout. After each test, drivers were asked to report on their experience of each horse they had just driven and to estimate RT (continuous rating scale from 0 to 50 kg) while driving that horse. Overall, segment had a significant effect on median RT (P < 0.001), with RT rising significantly in racing trot (average 59 N; Trot Left/Trot Right) than trotting on a circle (23 N; Circle Left/Circle Right) and walking (8 N), and was higher in counter-clockwise than in clockwise direction in racing trot (P = 0.058). Furthermore, there was an alignment between recorded RT and drivers’ estimates of perceived RT (P < 0.001), and driveability scores increased when estimated RT increased. The current study has confirmed that rein tensiometry may have a place in providing an evidence-base for consistent rein use, especially when horses are driven by multiple drivers. Whether or not soft tissue damage after competitive racing is correlated to higher peak RT, caused by the use of harsher equipment, or a combination of both, merits further investigation.

Update on an Observational, Clinically Useful Gait Coordination Measure: The Gait Assessment and Intervention Tool (G.A.I.T.).

With discoveries of brain and spinal cord mechanisms that control gait, and disrupt gait coordination after disease or injury, and that respond to motor training for those with neurological disease or injury, there is greater ability to construct more efficacious gait coordination training paradigms. Therefore, it is critical in these contemporary times, to use the most precise, sensitive, homogeneous (i.e., domain-specific), and comprehensive measures available to assess gait coordination, dyscoordination, and changes in response to treatment. Gait coordination is defined as the simultaneous performance of the spatial and temporal components of gait. While kinematic gait measures are considered the gold standard, the equipment and analysis cost and time preclude their use in most clinics. At the same time, observational gait coordination scales can be considered. Two independent groups identified the Gait Assessment and Intervention Tool (G.A.I.T.) as the most suitable scale for both research and clinical practice, compared to other observational gait scales, since it has been proven to be valid, reliable, sensitive to change, homogeneous, and comprehensive. The G.A.I.T. has shown strong reliability, validity, and sensitive precision for those with stroke or multiple sclerosis (MS). The G.A.I.T. has been translated into four languages (English, Spanish, Taiwanese, and Portuguese (translation is complete, but not yet published)), and is in use in at least 10 countries. As a contribution to the field, and in view of the evidence for continued usefulness and international use for the G.A.I.T. measure, we have provided this update, as well as an open access copy of the measure for use in clinical practice and research, as well as directions for administering the G.A.I.T.

Alcoholic neuropathy associated with chronic alcohol intake

Alcoholic neuropathy (AN), a debilitating condition that mainly affects chronic alcohol drinkers, is thought to cause lesions in the peripheral nervous system leading to sensory, autonomic, and motor dysfunctions. Despite many studies, the pathogenesis of these lesions is still not completely understood. We investigated few aspects on the development of alcohol-induced peripheral neuropathy, by assessing sensory, motor and autonomic functions, as well as stereological analysis of axonal fibers and myelin sheath of the sciatic nerve. Twelve male Wistar rats were divided into Control group and Alcohol group that was submitted to Two Bottle-Choice Paradigm of intermittent and voluntary alcohol solution intake (20%; v/v) during eight weeks. At the end of treatment, three different sensorium-motor tests were applied - Tactile Sensitivity, Thermal Sensitivity, and Functional Observational Battery (FOB). Quantitative morphometric analysis of sciatic nerve structures was performed by stereological method. Alcohol concentration in the blood was measured to analyze possible correlation between availability of alcohol in the blood and the magnitude of the peripheral nerve lesion. Our data showed a peripheral effect of chronic alcohol intake associated with hyperalgesia and a process of demyelination with a strong correlation with alcohol consumption. This process was associated with increased tactile sensitivity, with behavioral reflexes such as locomotor hyperactivity, changes in gait and balance, and autonomic reflexes such as piloerection.

A Novel Criticality Analysis Technique for Detecting Dynamic Disturbances in Human Gait

The application of machine learning (ML) has made an unprecedented change in the field of medicine, showing a significant potential to automate tasks and to achieve objectives that are closer to human cognitive capabilities. Human gait, in particular, is a series of continuous metabolic interactions specific for humans. The need for an intelligent recognition of dynamic changes of gait enables physicians in clinical practice to early identify impaired gait and to reach proper decision making. Because of the underlying complexity of the biological system, it can be difficult to create an accurate detection and analysis of imbalanced gait. This paper proposes a novel Criticality Analysis (CA) methodology as a feasible method to extract the dynamic interactions involved in human gait. This allows a useful scale-free representation of multivariate dynamic data in a nonlinear representation space. To quantify the effectiveness of the CA methodology, a Support Vector Machine (SVM) algorithm is implemented in order to identify the nonlinear relationships and high-order interactions between multiple gait data variables. The gait features extracted from the CA method were used for training and testing the SVM algorithm. The simulation results of this paper show that the implemented SVM model with the support of the CA method increases the accuracy and enhances the efficiency of gait analysis to extremely high levels. Therefore, it can perform as a robust classification tool for detection of dynamic disturbances of biological data patterns and creates a tremendous opportunity for clinical diagnosis and rehabilitation.

Behavioral Study of Parkinson's Disease Rats Model with DigiGait&amp;lt;sup&amp;gt;TM&amp;lt;/sup&amp;gt; Imaging System

<bold>Objective</bold> To detect the feasibility of DigiGait^TM Imaging System in evaluating gait changes in rats model with Parkinson's disease (PD). <bold>Methods</bold> A total of 24 clean male SD rats were randomly divided into normal group, sham operation group and model group, with eight rats in each group. In the model group, 6-Hydroxydopamine (6-OHDA) was injected into the brain with unilateral 2-point method to establish PD rats model. The sham operation group was injected with 0.2% ascorbic acid solution with the same method, and the normal group did not receive any surgical treatment. After successful preparation of the model, DigiGait^TM Imaging System was used to analyze temporal subcomponent (swing duration, braking duration, stance duration, stance factor), spatial subcomponent (stride frequency, stride length, stance width, gait symmetry, paw overlap distance, paw placement positioning) and postural subcomponent (paw angle, step angle, paw area). <bold>Results</bold> 1) Temporal subcomponent: compared with the normal group, the swing duration, braking duration and stance duration of left front paw, left hind paw and right front paw in the model group were significantly prolonged (<italic>P</italic>&lt;0.05), and the braking duration and swing duration of right hind paw in the model group were significantly prolonged (<italic>P</italic>&lt;0.05). Compared with the sham operation group, the swing duration, braking duration and stance duration of left front paw, left hind paw and right front paw in the model group were significantly prolonged (<italic>P</italic>&lt;0.05), and the braking duration of right hind paw in the model group was significantly prolonged (<italic>P</italic>&lt;0.05). 2) Spatial subcomponent: compared with the normal group and the sham operation group, the front and hind limb stance width of the model group significantly increased (<italic>P</italic>&lt;0.05), step frequency of four paws, stride length of left paws and paw placement positioning and gait symmetry in the model group significantly decreased (<italic>P</italic>&lt;0.05). But stride length of right paws and overlap distance of left and right paws in the model group had no significant changes (<italic>P</italic>&gt;0.05). 3) Postural subcomponent: compared with the normal group and the sham operation group, the contact area of left front paw, left hind paw and right hind paw with running belt in the model group significantly decreased (<italic>P</italic>&lt;0.05), there was no significant difference in paw area, paw angle and gait angle between the right front paw and the running belt (<italic>P</italic>&gt;0.05). <bold>Conclusion</bold> DigiGait^TM Imaging System can objectively evaluate walking, balance and coordination functions of PD rats, which has the potential to be widely applied in PD related basic research.

Can preoperative brain imaging features predict shunt response in idiopathic normal pressure hydrocephalus? A PRISMA review.

This systematic literature review aimed to identify brain computed tomography (CT) and magnetic resonance imaging (MRI) features that could be used to discriminate idiopathic normal pressure hydrocephalus (iNPH) shunt responders from non-responders. PubMed, Embase, Web of Science, and Cochrane were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only original research articles reporting preoperative CT and/or MRI features and iNPH shunt response evaluated by changes in gait, dementia, and urinary incontinence were included. Title and abstract screening and full-text article evaluation were done by two authors. Data on patient demographics and inclusion criteria, brain image evaluation, shunting methods, and shunt response evaluation were recorded. The search resulted in 1274 studies after removing duplicates. Twenty-seven studies were chosen for final review. Both structural (i.e., callosal angle, disproportionately enlarged subarachnoid space hydrocephalus (DESH), and temporal horn diameter) and physiological brain imaging (including aqueductal flow measurement and brain perfusion) had been examined. Fourteen out of 27 studies found no difference in any assessed imaging parameters between responders and non-responders, and none of the examined imaging parameters was repeatedly and consistently reported as significantly different between the two groups. No brain imaging parameters were consistently and repeatedly reported as different between iNPH shunt responders and non-responders.

A Review of the Measurement of the Neurology of Gait in Cognitive Dysfunction or Dementia, Focusing on the Application of fNIRS during Dual-Task Gait Assessment

Poor motor function or physical performance is a predictor of cognitive decline. Additionally, slow gait speed is associated with poor cognitive performance, with gait disturbances being a risk factor for dementia. Parallel declines in muscular and cognitive performance (resulting in cognitive frailty) might be driven primarily by muscle deterioration, but bidirectional pathways involving muscle–brain crosstalk through the central and peripheral nervous systems are likely to exist. Following screening, early-stage parallel declines may be manageable and modifiable through simple interventions. Gait–brain relationships in dementia and the underlying mechanisms are not fully understood; therefore, the current authors critically reviewed the literature on the gait–brain relationship and the underlying mechanisms and the feasibility/accuracy of assessment tools in order to identify research gaps. The authors suggest that dual-task gait is involved in concurrent cognitive and motor activities, reflecting how the brain allocates resources when gait is challenged by an additional task and that poor performance on dual-task gait is a predictor of dementia onset. Thus, tools or protocols that allow the identification of subtle disease- or disorder-related changes in gait are highly desirable to improve diagnosis. Functional near-infrared spectroscopy (fNIRS) is a non-invasive, cost-effective, safe, simple, portable, and non-motion-sensitive neuroimaging technique, widely used in studies of clinical populations such as people suffering from Alzheimer’s disease, depression, and other chronic neurological disorders. If fNIRS can help researchers to better understand gait disturbance, then fNIRS could form the basis of a cost-effective means of identifying people at risk of cognitive dysfunction and dementia. The major research gap identified in this review relates to the role of the central/peripheral nervous system when performing dual tasks.

Effects of a Supplement Containing Cannabidiol (CBD) on Sedation and Ataxia Scores and Health

Supplements containing Cannabidiol (CBD) are available for horses, however, few studies have been published on their effects on behavior and health parameters. The purpose of this study was to determine if a daily oral supplement containing CBD would cause sedation, ataxia or alterations in other health parameters during administration for 56 days. Twenty clinically healthy adult Thoroughbred horses were housed in stalls. Before treatment was initiated, a complete physical examination, complete blood count (CBC) and biochemical panel were evaluated. In addition, horses were examined for sedation and ataxia using standard scoring systems. Horses were randomly divided into two treatment groups, treated (supplement pellets containing CBD as Hemp Extract, 150 mg) or control (supplement pellets without CBD). Horses were treated daily and sedation and ataxia scores were assigned by two masked observers once weekly for 56 days. Horses were monitored daily for clinical signs or adverse events and body weights were recorded weekly. A CBC and biochemical panel were repeated on days 28 and 56, two hours after administration of the supplement. The supplement was readily consumed by the horses and no adverse effects were seen over the treatment period. Sedation and ataxia scores ranged from zero to two for all horses during the weekly examinations and there was no statistical difference between treatment groups. There were no treatment effects on blood values, including indicators of anemia and blood proteins, liver enzymes, kidney values, electrolytes or calcium. Body weight significantly increased in all horses, by Day 56 compared to Day zero but no treatment by day effect was noted. The CBD supplement (150 mg) was readily consumed and safe and did not result in changes in mentation, gait, or other health parameters, and no adverse clinical signs were observed during 56 days of oral administration.

Effect of knee joint weight change on knee function recovery and gait after total knee arthroplasty

BackgroundKnee osteoarthritis (KOA) is a common disease based on degenerative pathological changes. Total knee arthroplasty (TKA) is an effective treatment for end-stage of KOA. However, only volume adaptation can be achieved with current knee prostheses, and it is difficult to achieve weight adaptation. This study focused on the weight difference of knee joints and initially explored the impact of this change on knee joint functional recovery and gait changes in patients after surgery.MethodsFrom October 2015 to June 2019, patients who underwent primary unilateral TKA were enrolled in this prospective cohort study with the same brand of knee prostheses. General data were collected from patients who met the criteria. The resected bone and soft tissues were collected and weighed precisely during TKA, and multivariate regression analysis was used to determine the factors affecting the weight of the removed knee tissues. We compared the weight of excised tissues and the total weight of the knee prosthesis, and the weight difference was defined as the increased weight of the knee joint (IWKJ). All patients were evaluated by HSS score, gait analysis, and affected side knee X-ray at two weeks, three months, and the last follow-up after the operation. To further determine the influence of IWKJ on postoperative functional recovery, the relationship between IWKJ, HSS score, and gait analysis was analyzed by univariate regression.ResultsIn total, 210 patients were eventually included in observation. All patients underwent postoperative follow-up for no less than two years. Multiple regression analysis showed that the course of the disease, body weight, and kellgren-Larencen stage(K-L stage)of the affected knee joint were independent factors affecting the weight of the removed knee tissues and were positively correlated with it. Univariate analysis showed that IWKJ was negatively correlated with HSS score at two weeks and three months after the operation. In addition, the values of spatiotemporal parameters and knee rotation ROM were negatively correlated with IWKJ two weeks after surgery, while outside food load response was positively correlated with IWKJ. Cadence, knee rotation ROM, and Ankle rotation ROM were negatively correlated with IWKJ, while outside food was positively correlated with IWKJ three months after surgery. At the last follow-up, only the hip rotation ROM was positively correlated with IWKJ.ConclusionsAll Patients underwent TKA had varying degrees of increased knee weight. The increased weight was 298.98 ± 63.77 g. Patients' body weight, K-L staging, and disease duration are important factors that cause differences in resected knee tissue. Three months after the operation, the changes in knee joint weight had a negative correlation with the HSS score, which at the same time, it had varying degrees of linearity with gait parameters. However, the influence of weight diminished over time.

Effects of modern technology (exergame and virtual reality) assisted rehabilitation vs conventional rehabilitation in patients with Parkinson’s disease: a network meta-analysis of randomised controlled trials

BackgroundModern technological applications, including exergames and virtual technology-assisted rehabilitation (VTAR) programmes, are promising for Parkinson’s disease (PD) rehabilitation. However, evidence regarding their efficacy for rehabilitation is inconclusive. ObjectivesThis network meta-analysis (NMA) investigated the efficacy of exergames and VTAR on gait and balance outcomes and acceptability for patients with PD. Data sourcesClinicalKey, Cochrane CENTRAL, Embase, ProQuest, PubMed, ScienceDirect, Web of Science and ClinicalTrials.gov. Study selectionRandomised controlled trials (RCTs) investigating changes in gait or balance parameters were included in this study. Study appraisal and synthesis methodsIn the NMA, standardised mean differences with 95% confidence intervals were calculated using a frequentist model. GRADE ratings were used to evaluate the quality of evidence in this study. ResultsTwenty-three RCTs with 949 participants were included. Exergames and VTAR were associated with significantly better improvements in balance and gait outcomes than usual treatment and other active control interventions. However, exergames were not associated with changes in depressive symptoms. The evaluation of acceptability results indicated that all exergames and VTAR were adequately tolerated, as indicated by the low drop-out rates. LimitationsSmall sample sizes and heterogeneity were the key limitations of this study. Conclusion and implications of key findingsThis NMA confirmed that exergames are associated with more favourable gait and balance outcomes in patients with PD compared with usual treatment and other active control interventions. GRADE ratings revealed that most direct, indirect and overall network evidence was of low to medium quality. Larger-scale studies with longer follow-up periods are warranted.

Comparative Study of the Effects of Two Dietary Sources of Vitamin D on the Bone Metabolism, Welfare and Birth Progress of Sows Fed Protein- and Phosphorus-Reduced Diets.

Simple SummaryThe dietary supply of vitamin D3, which is carried out in indoor husbandry due to limited sunlight, often results in a vitamin D status that is lower than that observed in outdoor pig farming. Studies have shown that the use of the vitamin D metabolite 25-hydroxycholecalciferol leads to a more efficient increase in vitamin D status. However, when nutrient intake is adequate, the replacement of the vitamin D source appears to have no or only marginal effects on the performance and bone metabolism of sows. The objective of this study was to investigate the influence of both forms of vitamin D, vitamin D3 and 25-hydroxycholecalciferol, on the mineral homeostasis, bone metabolism, welfare and birth progress of sows fed protein- and phosphorus-reduced diets. Supplementation with 25-hydroxycholecalciferol instead of vitamin D3 improved vitamin D status and reduced gait changes. However, mineral homeostasis and bone metabolism were not affected by the replacement of the vitamin D form. In conclusion, under conditions of a dietary reduction in protein and phosphorus, the replacement of the vitamin D form seems to help to improve the locomotion of sows, although bone mineralization is probably not affected.To investigate the influence of two dietary sources of vitamin D on the vitamin D status, bone metabolism, welfare and birth progress of gestating and lactating sows, forty-nine multiparous sows were randomly assigned to one of two diets: “CON” (n = 25; 50 μg vitamin D3/kg feed) and “HYD” (n = 24; 50 μg 25-hydroxycholecalciferol/kg feed). The basal diets were protein- and phosphorus-reduced. The trial started on day 3 ante insemination of the sows and ended with weaning of the piglets on day 28 postpartum. Dietary supplementation of 25-hydroxycholecalciferol resulted in improved maternal vitamin D status (p < 0.001), fewer gait changes (p < 0.01) and longer standing time after feeding (day 5 ante partum; p < 0.05) compared to vitamin D3. However, the bone markers CrossLaps and osteocalcin were not affected. Overall, the present results suggest that sows fed 25-hydroxycholecalciferol instead of vitamin D3 showed improved locomotion and stance strength. However, this outcome is probably not related to altered bone metabolism. The underlying mechanisms must be investigated in further studies.

Stimulation of CGRP-expressing neurons in the medial cerebellar nucleus induces light and touch sensitivity in mice

Calcitonin gene-related peptide (CGRP) is considered a major player in migraine pathophysiology. However, the location and mechanisms of CGRP actions in migraine are not clearly elucidated. One important question yet to be answered is: Does central CGRP signaling play a role in migraine? One candidate site is the cerebellum, which serves as a sensory and motor integration center and is activated in migraine patients. The cerebellum has the most CGRP binding sites in the central nervous system and a deep cerebellar nucleus, the medial nucleus (MN), expresses CGRP (MNCGRP). A previous study demonstrated that CGRP delivery into the cerebellum induced migraine-like behaviors. We hypothesized that stimulation of MNCGRP neurons might induce migraine-like behaviors. To test the hypothesis, we used an optogenetic strategy using CalcaCre/+ mice to drive Cre-dependent expression of channelrhodopsin-2 selectively in CGRP neurons in the cerebellar MN. A battery of behavioral tests was done to assess preclinical behaviors that are surrogates of migraine symptoms, including light aversion, cutaneous allodynia, and spontaneous pain when MNCGRP neurons were optically stimulated. Motor functions were also assessed. Optical stimulation of MNCGRP neurons decreased the time spent in the light, which was coupled to increased time spent resting in the dark, but not the light. These changes were only significant in female mice. Plantar tactile sensitivity was increased in the ipsilateral paws of both sexes, but contralateral paw data were less clear. There was no significant increase in anxiety-like behavior, spontaneous pain (squint), or changes in gait. These discoveries reveal that MNCGRP neurons may contribute to migraine-like sensory hypersensitivity to light and touch.

1062 GAIT SPEED AND EXECUTIVE PERFORMANCE IN PEOPLE WITH MILD COGNITIVE IMPAIRMENT

Abstract Introduction The Motoric Cognitive Risk Syndrome has highlighted the link between cognitive and motor performance, and the associated incremental higher risk of developing dementia. There is considerable debate regarding what aspects of cognition (working memory, executive function, attention) are most associated with gait changes. This study investigates the relationship between mobility scores and cognitive profiles in individuals with Mild Cognitive Impairment (MCI) specifically with regard to executive performance and amnestic/non-amnestic profiles. Method Participants diagnosed with MCI, (Clinical Dementia Rating scale global score of ≤0.5, sum of boxes score ≤ 4.0), attending a regional specialist memory service had a three-meter Timed Up and Go (TUG) gait assessment and multi-domain neuropsychiatric assessment undertaken. Amnestic neuropsychiatric profile was defined as Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) delayed memory subset score &amp;lt; 1SD i.e. ≤16th centile below norm for age/education. Executive function performance was assessed using the Executive Interview (EXIT-25) where higher scores reflect poorer executive performance. Results Data was reviewed for 161 patients with MCI; 53% (86/161) women. 80% (129/161) had an amnestic neuropsychiatric profile, mean age 73.8 ± 7.2 (51–94). 20% (32/161) had non-amnestic MCI, mean age 74 ± 7.07 (60–87). There was no significant difference in TUG results between amnestic and non-amnestic MCI patients (11.2 ± 3.3 vs 10.7 ± 3.1 p = NS). There was a significant increase in TUG values with worsening executive function performance [EXIT-25 score 0–9 (88/161) mean TUG = 10.5 ± 3.3 seconds vs EXIT-25 score 10–14 (43/161) mean TUG =11.9 ± 2.8 seconds vs EXIT-25 score 15–25 (30/161) mean TUG = 12.1 ± 3.9 seconds; p = 0.021] which persisted after controlling for age, gender and other relevant cofactors. Discussion Reflective of the importance of frontal lobe integration to the respective tasks, subtle differences in gait performance are associated with executive function performance regardless of predominant amnestic or non-amnestic MCI profile.

Effect of Wearing Running Shoes on Lower Limb Kinematics by Using OpenSim Simulation Software

(1) Flatfoot is a common malformation in both children and adults, in which a proper arch fails to develop. This study aimed to see how over-the-counter running shoes improved the gait patterns of flatfoot patients. (2) Methods: Three healthy flatfoot subjects were included in the study. Flatfoot was diagnosed by a lateral talometatarsal angle of more than 4 degrees and a talocalcaneal angle of more than 30 degrees. All the patient data were captured using Vicon motion caption cameras. The subjects were allowed to walk at self-selected speeds with and without running shoes. (3) Results: Significant differences in lower limb kinematics were observed between barefoot and running shoe gait. In addition, by wearing the running shoes, the center of mass and lower limb kinematics changed. (4) Conclusion: The improvement in balance and control was clearly indicated, and the change in gait on the entire lower limb influenced normalizing the stresses of the foot with running shoes. These valuable results can be used for rehabilitation programs.

Causal Effects of Motor Control on Gait Kinematics After Orthopedic Surgery in Cerebral Palsy: A Machine-Learning Approach.

BackgroundAltered motor control is common in cerebral palsy (CP). Understanding how altered motor control affects movement and treatment outcomes is important but challenging due to complex interactions with other neuromuscular impairments. While regression can be used to examine associations between impairments and movement, causal modeling provides a mathematical framework to specify assumed causal relationships, identify covariates that may introduce bias, and test model plausibility. The goal of this research was to quantify the causal effects of altered motor control and other impairments on gait, before and after single-event multi-level orthopedic surgery (SEMLS).MethodsWe evaluated the impact of SEMLS on change in Gait Deviation Index (ΔGDI) between gait analyses. We constructed our causal model with a Directed Acyclic Graph that included the assumed causal relationships between SEMLS, ΔGDI, baseline GDI (GDIpre), baseline neurologic and orthopedic impairments (Imppre), age, and surgical history. We identified the adjustment set to evaluate the causal effect of SEMLS on ΔGDI and the impact of Imppre on ΔGDI and GDIpre. We used Bayesian Additive Regression Trees (BART) and accumulated local effects to assess relative effects.ResultsWe prospectively recruited a cohort of children with bilateral CP undergoing SEMLS (N = 55, 35 males, age: 10.5 ± 3.1 years) and identified a control cohort with bilateral CP who did not undergo SEMLS (N = 55, 30 males, age: 10.0 ± 3.4 years). There was a small positive causal effect of SEMLS on ΔGDI (1.70 GDI points). Altered motor control (i.e., dynamic and static motor control) and strength had strong effects on GDIpre, but minimal effects on ΔGDI. Spasticity and orthopedic impairments had minimal effects on GDIpre or ΔGDI.ConclusionAltered motor control did have a strong effect on GDIpre, indicating that these impairments do have a causal effect on a child’s gait pattern, but minimal effect on expected changes in GDI after SEMLS. Heterogeneity in outcomes suggests there are other factors contributing to changes in gait. Identifying these factors and employing causal methods to examine the complex relationships between impairments and movement will be required to advance our understanding and care of children with CP.

Gait and Neuromuscular Changes Are Evident in Some Masters Club Level Runners 24-h After Interval Training Run.

PurposeTo examine the time course of recovery for gait and neuromuscular function immediately after and 24-h post interval training. In addition, this study compared the impact of different statistical approaches on detecting changes.MethodsTwenty (10F, 10M) healthy, recreational club runners performed a high-intensity interval training (HIIT) session consisting of six repetitions of 800 m. A 6-min medium intensity run was performed pre, post, and 24-h post HIIT to assess hip and knee kinematics and coordination variability. Voluntary activation and twitch force of the quadriceps, along with maximum isometric force were examined pre, post, and 24-h post significance HIIT. The time course of changes were examined using two different statistical approaches: traditional null hypothesis significance tests and “real” changes using minimum detectable change.ResultsImmediately following the run, there were significant (P < 0.05) increases in the hip frontal kinematics and coordination variability. The runners also experienced a loss of muscular strength and neuromuscular function immediately post HIIT (P < 0.05). Individual assessment, however, showed that not all runners experienced fatigue effects immediately post HIIT. Null hypothesis significance testing revealed a lack of recovery in hip frontal kinematics, coordination variability, muscle strength, and neuromuscular function at 24-h post, however, the use of minimum detectable change suggested that most runners had recovered.ConclusionHigh intensity interval training resulted in altered running kinematics along with central and peripheral decrements in neuromuscular function. Most runners had recovered within 24-h, although a minority still exhibited signs of fatigue. The runners that were not able to recover prior to their run at 24-h were identified to be at an increased risk of running-related injury.

Assessment of Brain Function in Patients With Cognitive Impairment Based on fNIRS and Gait Analysis.

BackgroundEarly detection of mild cognitive impairment is crucial in the prevention of Alzheimer’s disease (AD). This study aims to explore the changes in gait and brain co-functional connectivity between cognitively healthy and cognitively impaired groups under dual-task walking through the functional near-infrared spectroscopy (fNIRS) and gait analysis devices.MethodThis study used fNIRS device and gait analysis devices to collect the data of 54 older adults. According to the Mini-mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scales, the older adults were cognitively healthy (control group) and cognitively impaired (experimental group), of which 38 were in the control group and 16 were in the experimental group. The experiment was divided into a total of three sets of task experiments: a walking-only experiment, a dual-task walking-easy (DTW-easy) experiment, and a dual-task walking-difficult (DTW-difficult) experiment.Main ResultFor the cognitively impaired and cognitively healthy populations, there were no significant differences in overall functional connectivity, region of interest (ROI) connection strength, and gait performance during single-task walking between the two groups.Whereas the performances of DTW differed significantly from the single-task walking in terms of between-group variability of functional connectivity strength change values, and ROI connection strength change values in relation to the dual-task cost of gait. Finally, the cognitively impaired group was significantly more affected by DTW-difficult tasks than the cognitively healthy group.ConclusionThis study provides a new approach to assist in the diagnosis of people with cognitive impairment and provides a new research pathway for the identification of cognitive impairment.

Gait biomechanics phenotypes among total knee arthroplasty candidates by machine learning cluster analysis.

Knee osteoarthritis patient phenotyping is relevant to developing targeted treatments and assessing the treatment efficacy of total knee arthroplasty (TKA). This study aimed to identify clusters among TKA candidates based on demographic and knee mechanic features during gait, and compare gait changes between clusters postoperatively. TKA patients underwent 3D gait analysis 1-week pre (n = 134) and 1-year post-TKA (n = 105). Principal component analysis was applied to frontal and sagittal knee angle and moment waveforms, extracting major patterns of variability. Age, sex, body mass index, gait speed, and frontal and sagittal pre-TKA angle and moment PC scores previously identified as relevant to TKA outcomes were standardized (mean = 0, SD = 1, [134 × 15]). Multidimensional scaling and machine learning-based hierarchical clustering were applied. Final clusters were validated by examining intercluster differences pre-TKA and gait feature changes (PostPCscore - PrePCscore ) by k-way Χ2 and ANOVA tests. Four TKA candidate phenotypes yielded optimum clustering metrics, interpreted as higher and lower functioning clusters that were predominantly male and female. Higher functioning clusters pre-TKA (clusters 1 and 4) had more dynamic sagittal flexion moment (p < 0.001) and frontal plane adduction moment (p < 0.001) loading/un-loading patterns during stance. Post-TKA, higher functioning clusters demonstrated less knee mechanic improvements during gait (flexion angle p < 0.001; flexion moment p < 0.001).TKA candidates can be characterized by four clusters, predominately separated by sex and knee joint biomechanics. Post-TKA knee kinematics and kinetics improvements were cluster-specific; lower functioning clusters experienced more improvement. Cluster-based patient profiling may aid in triaging and developing OA management and surgical strategies meeting group-level function needs.

Age related changes in gait variability, asymmetry, and bilateral coordination – When does deterioration starts?

BackgroundGait pattern coordination is affected by several factors (e.g., neurodegeneration), while aging is known to have a significant negative impact. Various gait parameters, such as gait asymmetry (GA) and stride time coefficient of variation (CV), are widely used in both research and clinical settings in order to evaluate human locomotion. Another parameter is the phase coordination index (PCI), which specifically assesses bilateral coordination of gait (BCG), by quantifying the consistency and accuracy of the anti-phased stepping pattern. ObjectiveIn this study we hypothesized that there is a steady deterioration in the bilateral coordination of walking through ageing, and in gait rhythmicity, which would be evident by an increase in the values of the coordination parameters which are examined. MethodsWe analyzed gait cycles of 66 healthy participants in ages between 40 and 85 years which were divided into five age groups (40–44; 45–54; 55–64; 75 +). The participants performed corridor walking (i.e., back and forth) wearing a computerized motion sensor-based gait analysis system. PCI, CV and GA parameters were calculated for the straight-line walking segments. ResultsPCI values remained relatively stable between the ages of 40–75 (3.16 ± 1.11%), while in the age group of 75 + years old we observed a significant increase (i.e., deterioration in BCG) in PCI values (5.68 ± 2.01%, p < 0.047). Same pattern was seen for the CV parameter. However, GA was not statistically significantly different between all age groups. ConclusionIt appears that PCI and CV are more sensitive measures to detect changes in gait through the aging process. The results suggest that potential screening to detect salient gait deterioration should start from the age of 70. On the other hand, GA may be used to identify neurological impairments if found increased at any age.