Clinical Balance Research Articles

Prenatal or postnatal corticosteroids favor clinical, respiratory, metabolic outcomes and oxidative balance of preterm lambs corticotherapy for premature neonatal lambs

Challenges of the extrauterine environment can be life threatening for a premature fetus with inadequate fetal maturity. Maternal corticosteroids therapy is widely employed to induce fetal pulmonary maturation. Nevertheless, whenever therapeutic pregnancy interruption has to be performed in a time manner insufficient to treat the dam, postnatal corticotherapy can be considered an alternative. However, it is not known if antenatal and postnatal corticotherapy can improve similarly neonatal outcomes and pulmonary function. This research aimed to analyze antenatal and postnatal corticotherapy on premature lambs vitality, pulmonary functioning, metabolic and oxidative status. Lambs were evaluated according to the mode of treatment: Prenatal Corticosteroid Group (8 lambs born after maternal betamethasone treatment 48 h prior to birth), Postnatal Corticosteroid Group (9 lambs subjected to betamethasone treatment 10 min after birth) and Control Group (5 lambs remained untreated). Lambs were medically followed-up from birth to 72 h thereafter through a complete physical examination, as well as lactatemia, glycaemia, blood acid-base balance and antioxidant status. Treated lambs had higher vitality score than the Control Group. Heart rate was higher in postnatal therapy compared to prenatal treatment. Respiratory rate and rectal temperature were higher in treated groups. Treated lambs had hyperglycemia, while the Postnatal Group had higher lactatemia than the Control Group. The Prenatal Group had lower and normal pCO2 from 60 min onwards. The Postnatal Group had higher superoxide dismutase activity than untreated lambs. In conclusion, prenatal and postnatal betamethasone treatments favor neonatal clinical outcome, respiratory function, glucose homeostasis and oxidative balance.

Lithium treatment in children and adolescents with anorexia nervosa: clinical use, side effects and tolerability.

Current guidelines, due to potential toxicity and lack of clinical evidence, do not recommend the use of lithium in the treatment of Anorexia Nervosa (AN). Scarce evidence is available on the use, side effects, and tolerability of this drug in children and adolescents with AN, a population characterized by specific clinical, metabolic, and hydro-electrolytic balance features. Here we report a case series of children and adolescents hospitalized for AN and treated with lithium. Case series reporting the use of lithium in 7 female young patients with AN. Reasons for introduction, dosages, formulation, plas-ma levels, adverse drug reactions (ADR) and modifi-cations of electrocardiogram (EKG) and plasma levels of glucose, cholesterol, creatinine, urea, sodium, and thyroid-stimulating hormone (TSH) were assessed. Re-sults. Reasons for the introduction of lithium included unstable mood, insufficient compliance with nutri-tional programs, and psychomotor agitation. In all of the patients an improvement on target symptoms was observed. Lithium was started at 171.4 (+/-56.7) mg/day, up to 600.0 (+/-173.2) mg/day. The most frequent scheme was three times daily. The mean plasmatic concentration was 0.6 (+/-0.3) mmol/L at one month. One pa-tient experienced polyuria, polydipsia and dry mouth, and another showed increased creatinine kinase. No major modifications of EKG, glucose, cholesterol, cre-atinine, urea, sodium emerged. In this sample of children and adolescents hospitalized for AN, lithium was administered to improve psychiatric symptoms impairing compliance. All the patients experienced an improvement on these symptoms after being admin-istered lithium. ADR were reported in 2 cases. These data should be investigated in wider populations and controlled studies.

Possibilities of life quality correction of patients with chronic pancreatitis in postoperative hypothyroidis

Aim: to study the quality of life and the emotional state of patients with chronic pancreatitis on the background of postoperative hypothyroidism and the possibility of effective rehabilitation.Materials and methods. 270 patients with chronic pancreatitis were examined, among which 40 patients with primary postoperative hypothyroidism, who made up group 1, group 2 included 30 patients without thyroid pathology. Patients underwent a blood test according to the main biochemical parameters, hormonal blood count, ultrasound of the thyroid gland, hepatobiliary and duodenal zone. The study of quality of life and psychoemotional state by tests.Results In patients with chronic pacreatitis in combination with postoperative hypothyroidism among diseases of the hepatoduodenal zone, chronic non-calculous cholecystitis and non-alcoholic fatty liver disease were identified that are clinically characterized by abdominal pain syndrome according to the GSRS questionnaire. Patients revealed mild depressive state, high levels of personal and situational anxiety. The quality of life of patients was reduced both in physical and in psychological components, due to indicators of role-playing physical and emotional functioning. Against the background of treatment with a combination of succinate-containing drugs, the severity of depression, situational and personal anxiety decreased, and role functioning due to physical and emotional state, social functioning increased.Conclusions: The use of combination therapy with sodium levothyroxine and ethylmethylhydroxypyridine succinate in patients with comorbid pathology during postoperative hypothyroidism improves the clinical picture, psychoemotional balance and quality of life.

Correlation Analysis of Lower-Limb Muscle Function With Clinical Status, Balance Tests, and Quality of Life in People With Parkinson Disease

Aim: To investigate the correlation of lower-limb muscle function with clinical status, balance, and quality of life in individuals with Parkinson disease (PD). Methods: Twenty-five participants were included. Outcome measures were assessed through scales and questionnaires. Quadriceps muscle function was assessed through a maximal isometric voluntary contraction. Spearman's correlation coefficient (ρ) analysis was performed. Results: Quadriceps peak force was negatively correlated with scores of the Unified Parkinson's Disease Rating Scale (UPDRS) part III (ρ= 0.610) but positively correlated with scores of the Mini-BESTest (ρ= 0.484) and the Timed Up and Go test (ρ= 0.528). The rate of force development was negatively correlated with scores of the UPDRS II (ρ=−0.437) and III (ρ=−0.577). Force variability was positively correlated with the quality of life (Parkinson's Disease Questionnaire 39; ρ= 0.455). Conclusion: Better quadriceps muscle function is associated with better clinical status, balance, and quality of life in people with PD.

Analysis of postural control and muscle function performance of older adults participating in a multicomponent exercise program in primary health care

Objectives: This cross-sectional study aimed to investigate (1) postural control performance in different postural tasks and (2) muscle strength and power of the hip, knee, and ankle of active vs inactive older adults. Methods: The sample consisted of 61 healthy community-dwelling older adults, classified into 2 groups: active, consisting of participants of a multicomponent exercise program offered through the Exercise Orientation Service; and inactive. Participants were considered physically active/inactive in the past 3 months. Postural control was assessed using a force plate in 8 postural tasks. Muscle function was evaluated using an isokinetic dynamometer. T-tests were used to compare clinical characteristics between the groups. ANCOVA and MANCOVA were used to compare differences in variables of postural control and muscle function. Results: Active participants had higher levels of physical activity, clinical balance, and quality of life than inactive participants. The active group had lower values for area (center of pressure) than the inactive group under the following conditions: bipedal stance on an unstable surface with eyes open and with eyes closed, and semi-tandem stance on an unstable surface with eyes open. The active group showed greater muscle power, with higher mean power values for hip abduction and adduction, knee extension, and knee flexion and shorter time to peak torque for hip adduction and ankle dorsiflexion than the inactive group. Conclusions: Multicomponent exercise programs delivered in primary health care settings contributed to improving postural control and muscle power in this sample of older adults, which can potentially help prevent falls and improve quality of life.

Effect of smooth eye tracking in different patterns on results of the modified Clinical Balance Sensory Integration Test in healthy young adults

Purpose: The aim of the study was to determine whether eye tracking of a point moving in different directions influences balance test performance in young healthy subjects. Methods: The study enrolled 45 healthy young adults aged 19–26. Balance assessment was carried out according to the modified Clinical Balance Sensory Integration Test protocol using the Biodex Balance System with an additional 63” screen to present the eye-tracking task. Each participant repeated measurements in standing on a stable and foam surface in six test conditions: two without eye tracking with eyes open and eyes closed, and four with eye tracking: with vertical, horizontal, star, and circle moving point. Each trial lasted 30 sec. Results: Regression analysis for the Sway Index showed that there was no impact of eye tracking on test results (p = 0.4326), although detailed analysis showed a significant impact of tracking a point moving in a circle in standing on a foam surface (p < 0.001). Conclusions: The presented results show that eye-tracking does not influence the results of the balance test with exception of eye-tracking of the circle movement in standing on a foam surface. It suggests that eye movements may affect the test results when performing more difficult balance tests.

Interface entre as medidas de benefício após a reabilitação vestibular – relato de casos

ABSTRACT The purpose of this research is to characterize the vestibular rehabilitation (VR), vestibulo-ocular reflex (VOR) gain, the occurrence of compensatory saccades, the static and dynamic balance, and the impact on quality of life in three patients with peripheral vestibular hypofunction. This is a descriptive study, approved by the ethics in research committee, under number 4,462.519. Three female patients participated in the study, two aged 55 and one aged 67, with a medical diagnosis of peripheral vestibular dysfunction. The participants underwent anamnesis, Dizziness Handicap Inventory (DHI) questionnaire, clinical assessment of postural balance and Video Head Impulse Test (vHIT), pre and post VR. The VR was applied in a personalized manner, based on the Cawthorne and Cooksey protocol, associated with virtual reality stimuli. After VR, a reduction in the total score average of DHI was observed, suggesting a decrease in participation restriction. The clinical balance assessment results were within the normal range for the altered tests, pre VR. In the three evaluated cases, vHIT showed increased RVO gain for the previously affected semicircular ducts (SCDs), compatible with normality standards, and reduction or extinction in the occurrence of compensatory saccades. The increase in VOR gain and the reduction or suppression of compensatory saccades after VR are suggestive signs of vestibular compensation. These results were compatible with increased postural stability and less restricted quality of life. These findings demonstrate the benefit provided by VR in the three evaluated cases.

The Effect of Sex, Sport Participation, and Concussion History on Baseline Concussion Balance Test Performance in Division-I Collegiate Athletes

Explore the effect of baseline characteristics such as sex, sport, and concussion history on the Concussion Balance Test (COBALT) performance in collegiate athletes. The COBALT is a recently developed clinical balance assessment specifically for athletic populations following concussion. The task conditions of the COBALT are designed to challenge sensory integration and reweighting processing underlying postural control. It has been documented that balance performance is influenced by factors such as sex and sport in collegiate athletes. One-hundred twenty seven collegiate athletes (77 male, 50 female; age: 19.81 ± 1.39; height: 68.77 ± 5.57 in; mass: 80.98 ± 26.15 kg), who participated in Division-I football, soccer, or cheerleading were included. Participants completed the 4 baseline conditions (Condition 3, 4, 7, 8) of the COBALT. Condition 3 (C3) included a side-to-side headshake with eyes closed. For Condition 4 (C4) the participant stood with hands clasped, elbows extended, and thumbs up while rotating their trunk side-to-side, visually focusing on their thumbs. Conditions 7 (C7) and 8 (C8) repeated C3 and C4 on a foam surface. Two 20-second trials of each condition were completed on a forceplate and the mean angular sway velocity (°/s) were calculated and number of errors were counted. ANOVAs and ANCOVAs were used to assess the potential effects on COBALT performance. There were no significant differences in postural sway for any COBALT condition based on sex (p > 0.05). Females demonstrated more errors than males on C7 (p < 0.001). Cheerleaders had more balance errors compared to football athletes for C3 and C7 (p < 0.05) and soccer athletes for C7 (p < 0.05). Concussion history did not have an effect on COBALT performance (p > 0.05). Understanding factors that may influence COBALT performance at baseline may enhance concussion evaluation in collegiate athletes with suspected balance deficits following concussion. While concussion history had no effect, sex and sports participation may influence performance and should be considered when interpreting COBALT results post-concussion.

Chronic, Mild Vestibulopathy Leads to Deficits in Spatial Tasks that Rely on Vestibular Input While Leaving Other Cognitive Functions and Brain Volumes Intact.

Objectives: In this study, based on the known vestibulo-hippocampal connections, we asked whether mild chronic vestibulopathy leads only to vestibular-related deficits or whether there are effects on hippocampal function, structure, and cognition in general. In more detail, we assessed whether chronic vestibulopathy leads to (a) deficits in vestibular tasks without cognitive demand (balancing), (b) deficits in spatial cognitive tasks that require vestibular input (path integration, rotational memory), (c) deficits in spatial cognitive tasks that do not rely on vestibular input, (d) deficits in general cognitive function, and (e) atrophy in the brain. Methods: A total of 15 patients with chronic uni- or bilateral vestibulopathy (56.8 ± 10.1 years; 4 females) were included in this study and were age- and gender-matched by the control participants (57.6 ± 10.5) in a pairwise manner. Given their clinical symptoms and their deficits of the vestibulo-ocular reflex (VOR) the patients could be classified as being mildly affected. All participants of the underwent the following tests: clinical balance (CBT), triangle completion (TCT) for path integration, rotational memory (RM), the visuo-spatial subset of the Berlin intelligence structure test (BIS-4) and d2-R for attention and concentration, and a structural MRI for gray matter analysis using voxel-based morphometry (VBM). Results: Compared to the healthy controls, the vestibulopathy patients performed significantly worse in terms of CBT, TCT, and RM but showed no differences in terms of the BIS-4 and d2-R. There were also no significant volumetric gray matter differences between the two groups. Conclusions: This study provides evidence that both non-cognitive and cognitive functions that rely on vestibular input (balancing, path integration, rotational memory) are impaired, even in mild chronic vestibulopathy, while other cognitive functions, which rely on visual input (visuo-spatial memory, attention), are unimpaired in this condition, together with an overall intact brain structure. These findings may reflect a segregation between vestibular- and visual-dependent processes in the medial temporal lobe on the one hand and a structure–function dissociation on the other.

Lower Cognitive Set Shifting Ability Is Associated With Stiffer Balance Recovery Behavior and Larger Perturbation-Evoked Cortical Responses in Older Adults.

The mechanisms underlying associations between cognitive set shifting impairments and balance dysfunction are unclear. Cognitive set shifting refers to the ability to flexibly adjust behavior to changes in task rules or contexts, which could be involved in flexibly adjusting balance recovery behavior to different contexts, such as the direction the body is falling. Prior studies found associations between cognitive set shifting impairments and severe balance dysfunction in populations experiencing frequent falls. The objective of this study was to test whether cognitive set shifting ability is expressed in successful balance recovery behavior in older adults with high clinical balance ability (N = 19, 71 ± 7 years, 6 female). We measured cognitive set shifting ability using the Trail Making Test and clinical balance ability using the miniBESTest. For most participants, cognitive set shifting performance (Trail Making Test B-A = 37 ± 20 s) was faster than normative averages (46 s for comparable age and education levels), and balance ability scores (miniBESTest = 25 ± 2/28) were above the threshold for fall risk (23 for people between 70 and 80 years). Reactive balance recovery in response to support-surface translations in anterior and posterior directions was assessed in terms of body motion, muscle activity, and brain activity. Across participants, lower cognitive set shifting ability was associated with smaller peak center of mass displacement during balance recovery, lower directional specificity of late phase balance-correcting muscle activity (i.e., greater antagonist muscle activity 200–300 ms after perturbation onset), and larger cortical N1 responses (100–200 ms). None of these measures were associated with clinical balance ability. Our results suggest that cognitive set shifting ability is expressed in balance recovery behavior even in the absence of profound clinical balance disability. Specifically, our results suggest that lower flexibility in cognitive task performance is associated with lower ability to incorporate the directional context into the cortically mediated later phase of the motor response. The resulting antagonist activity and stiffer balance behavior may help explain associations between cognitive set shifting impairments and frequent falls.

Gastrostomy and fundoplication in neurologically impaired children: A benefit-risks confrontation

Background For children with neurological impairment (NI) and swallowing incoordination feeding gastrostomy is usually required. This procedure may cause or aggravate preexisting gastroesophageal reflux disease (GERD). Fundoplication has been advocated at the time of gastrostomy placement in these patients. The purpose of this study is to evaluate clinical impact and risk-benefit balance of fundoplication and gastrostomy tube placement in patients with NI due to cerebral palsy, Hypoxic ischemic encephalopathy, brain tumors, and Dandy-Walker syndrome. Methods This study is a ten-year retrospective analysis including 180 cases of gastric tube placement in neurologically impaired children performed in a single institution. Results One hundred eighty patients underwent gastrostomy tube (GT)placement (94 open versus 86 laparoscopic). Concomitant fundoplication was performed in 44 cases. Three different types of tube were used during the procedures. There were differences between the two groups in gender but not in age distribution or comorbidity. Fundoplication was laparoscopic in 29 cases (33.7%) and open in 15 (16.0%). Postoperative diarrhea was more frequently observed with the Mickey tube (p=0.008). the hospital stay was longer after Mic tube placement (p=001). Sequelae after gastrostomy tube placement were observed in 21 cases (p=0.015). five postoperative cases of death were noted (p=0.015). The recurrence rate of reflux was 71% and mortality rate was 63% on long term follow-up. Conclusions In this study on NI and swallowing disorder unresponsive to medical treatment, open or laparoscopic fundoplication and gastrostomy reduced nausea and pain after feeding, but not Apparent life-threatening event in infancy (ALTE). Potential increased risk of complications and the procedure results instability may indicate the implementation of new management guidelines. Key words Fundoplication; Gastrostomy; Neurological impairment; Children, Outcome.

Dynamic Visual Stimulations Produced in a Controlled Virtual Reality Environment Reveals Long-Lasting Postural Deficits in Children With Mild Traumatic Brain Injury.

Motor control deficits outlasting self-reported symptoms are often reported following mild traumatic brain injury (mTBI). The exact duration and nature of these deficits remains unknown. The current study aimed to compare postural responses to static or dynamic virtual visual inputs and during standard clinical tests of balance in 38 children between 9 and 18 years-of-age, at 2 weeks, 3 and 12 months post-concussion. Body sway amplitude (BSA) and postural instability (vRMS) were measured in a 3D virtual reality (VR) tunnel (i.e., optic flow) moving in the antero-posterior direction in different conditions. Measures derived from standard clinical balance evaluations (BOT-2, Timed tasks) and post-concussion symptoms (PCSS-R) were also assessed. Results were compared to those of 38 healthy non-injured children following a similar testing schedule and matched according to age, gender, and premorbid level of physical activity. Results highlighted greater postural response with BSA and vRMS measures at 3 months post-mTBI, but not at 12 months when compared to controls, whereas no differences were observed in post-concussion symptoms between mTBI and controls at 3 and 12 months. These deficits were specifically identified using measures of postural response in reaction to 3D dynamic visual inputs in the VR paradigm, while items from the BOT-2 and the 3 timed tasks did not reveal deficits at any of the test sessions. PCSS-R scores correlated between sessions and with the most challenging condition of the BOT-2 and as well as with the timed tasks, but not with BSA and vRMS. Scores obtained in the most challenging conditions of clinical balance tests also correlated weakly with BSA and vRMS measures in the dynamic conditions. These preliminary findings suggest that using 3D dynamic visual inputs such as optic flow in a controlled VR environment could help detect subtle postural impairments and inspire the development of clinical tools to guide rehabilitation and return to play recommendations.

Wearable IMU-Based Human Activity Recognition Algorithm for Clinical Balance Assessment Using 1D-CNN and GRU Ensemble Model.

In this study, a wearable inertial measurement unit system was introduced to assess patients via the Berg balance scale (BBS), a clinical test for balance assessment. For this purpose, an automatic scoring algorithm was developed. The principal aim of this study is to improve the performance of the machine-learning-based method by introducing a deep-learning algorithm. A one-dimensional (1D) convolutional neural network (CNN) and a gated recurrent unit (GRU) that shows good performance in multivariate time-series data were used as model components to find the optimal ensemble model. Various structures were tested, and a stacking ensemble model with a simple meta-learner after two 1D-CNN heads and one GRU head showed the best performance. Additionally, model performance was enhanced by improving the dataset via preprocessing. The data were down sampled, an appropriate sampling rate was found, and the training and evaluation times of the model were improved. Using an augmentation process, the data imbalance problem was solved, and model accuracy was improved. The maximum accuracy of 14 BBS tasks using the model was 98.4%, which is superior to the results of previous studies.

Validity and Reliability of a Customized Smartphone Application for Postural Sway Assessment

ObjectiveThe purpose of this study was to investigate the validity and reliability of a customized smartphone application (CSA) for postural sway (PS) assessment. MethodsThis validity and reliability study evaluated static balance by measuring PS in 29 healthy volunteers (15 women, 14 men, mean age 28 ± 5.11). Assessments included synchronized data collection using 3 systems: the CSA, a force plate, and the clinical modified balance error scoring system (mBESS). The experimental procedure included three 40-seconds long repetitions in 3 positions. Outcome measures included pathway and 95% ellipse area. Statistical analysis compared the developed application to both the force plate and the mBESS to test its validation and analyzed repeatability of the 3 experimental measurements. ResultsGood to strong correlations were found between the CSA and the force plate in double and tandem stance (pathway r = 0.81-0.91), and moderate to high reliability was found for the CSA (0.66-0.75) and for the force plate (0.69-0.77) pathway measurements. The similarity in reliability results of the 2 devices and the high correlation both support the validity of the CSA. Furthermore, a high correlation was demonstrated between the CSA and the mBESS (r = 0.80), higher than the force plate and the mBESS. ConclusionThe developed CSA was found valid and reliable in healthy young adults, and further research is needed to recommend it for clinical balance assessments. The CSA could therefore be considered for PS assessment in the clinical field.

Comparison of Immediate Impact of Massage and Foot Mobilization on Balance in Obese Women Nurses (35-45 Years Old) in Tehran University Hospitals

Background and Aims: Reduced balance and changes in posture are among the physical activity constraints in obese individuals. Devising techniques and methods for improving balance in obese women and preventing them from falling as well as its consequences are among the health system’s challenges. This article’s aim was to compare and evaluate the immediate effects of massage and mobilization of feet and ankles on balance among obese female nurses. Methods: The current study assessed 45 female nurses in Tehran University Hospitals (age range: 35-45 years and body mass index [BMI] over 30-40). They were randomly divided into three groups consisting of 15 people: The massage group (age: 38.73±3.39 years), (height: 154.67±5.55 cm), (weight: 79.50±8.63 kg), (BMI: 33.28±1.82 kg/m2), the mobilization group (age: 40.87±3.09 years), (height: 155.33±6.72 cm), (weight: 80.83±8.34 kg), (BMI: 33.60±1.88 kg/m2) and control group (age: 40.00±3.00 years), (height: 155.80±4.06 cm), (weight: 80.63±4.55 kg), (BMI: 33.28±1.24 kg/m2). The therapeutic protocol included 20 minutes of foot massage in the massage group and 20 minutes of mobilization on the feet and ankles in the mobilization group. In the control group, no treatment was performed. In this study, the subjects in the three groups were analyzed by two clinical balance tests: “One-Leg Standing (OLS) Test” and “Time Up &amp; Go Test (TUG)” Assessments were made before and immediately after the intervention. The data was statistically examined via Analysis of Covariance (ANCOVA) using SPSS software v. 21. Results: The analysis of Covariance findings indicated significant differences between the groups. Both massage and mobilization groups showed differences in the OLS scale score for both right and left legs and regarding the TUG test, significant differences were seen in the experimental groups compared to the control group (P=0/00). No significant differences were discovered between the efficacy of massage and balance mobilization (P≥0/05). Conclusion: According to the findings, feet plantar massage and mobilization can improve functional balance in obese female nurses and no differences were detected regarding their effect and utilization.

The administration of intravenous fluids to nulliparous women in labour: A retrospective clinical chart review and fluid balance documentation audit

BackgroundIn Australia, midwives are integral to providing safe and supportive care to women in labour. The administration of intravenous (IV) fluids is a frequent clinical intervention performed by midwives. At present, practices surrounding IV fluid administration to women during labour within Australia are largely undescribed and there is a limited amount of robust evidence available to guide practice. IV fluids do carry a risk of harm. To define and ensure safe IV fluid practices, research into practices surrounding the administration of IV fluids to women in labour is essential. AimsTo describe the current practice for registered midwives administering IV fluids to women during labour. DesignRetrospective clinical chart review and fluid balance documentation audit. MethodsA retrospective clinical chart review and audit of fluid balance documentation for 107 nulliparous women was conducted at a single metropolitan tertiary referral hospital in Sydney, New South Wales between 1 October 2016 and 22 March 2017. A 24-point tool was developed to audit fluid balance charts. ResultsEighty-eight percent of the 88 fluid balance charts available scored 50% or less using the 24-point fluid balance chart audit tool. Additionally, there was an estimated 18% completion rate for the NSW IV fluid order chart. ConclusionThis study found wide variation in clinical practice and incomplete fluid balance documentation at a single, metropolitan tertiary referral hospital. The findings highlight the difficulty of determining IV fluids practices in the context of incomplete fluid balance documentation. Additionally, there are patient safety and professional regulation concerns when fluid management documentation is missing and/or incomplete. Future research should examine barriers and facilitators for documentation.

Surrogates for rigidity and PIGD MDS-UPDRS subscores using wearable sensors

BackgroundTelemedicine has the advantage of expanding access to care for patients with Parkinson’s Disease (PD). However, rigidity and postural instability in PD are difficult to measure remotely, and are important measures of functional impairment and fall risk. Research questionCan measures from wearable sensors be used as future surrogates for the MDS-UPDRS rigidity and Postural Instability and Gait Difficulty (PIGD) subscores? MethodsThirty-one individuals with mild to moderate PD wore 3 inertial sensors at home for one week to measure quantity and quality of gait and turning in daily life. Separately, we performed a clinical assessment and balance characterization of postural sway with the same wearable sensors in the laboratory (On medication). We then first performed a traditional correlation analysis between clinical scores and objective measures of gait and balance followed by multivariable linear regression employing a best subset selection strategy. ResultsThe number of walking bouts and turns correlated significantly with the rigidity subscore, while the number of turns, foot pitch angle, and sway area while standing correlated significantly with the PIGD subscore (p < 0.05). The multivariable linear regression showed that rigidity subscore was best predicted by the number of walking bouts while the PIGD subscore was best predicted by a combination of number of walking bouts, gait speed, and postural sway. SignificanceThe correlation between objective sensor data and MDS-UPDRS rigidity and PIGD scores paves the way for future larger studies that evaluate use of objective sensor data to supplement remote MDS-UPDRS assessment.

The Function Assessment Scale for Spinal Deformity: Validity and Reliability of a New Clinical Scale.

Cross-sectional study. The aim of this study was to develop and validate the Function Assessment scale for Spinal Deformity (FASD). Spinal malalignment impacts daily functioning. Standard evaluation of adult spinal deformity (ASD) is based on static radiography and patient-reported scores, which fail to assess functional impairments. A clinical scale, quantifying function and balance of patients with ASD, could increase our insights on the impact of ASD on functioning. To develop the FASD, 70 ASD patients and 20 controls were measured to identify the most discriminating items of the Balance Evaluation Systems Test and Trunk Control Measurement Scale. Discussions between experts on the clinical relevance of selected items led to further item reduction. The FASD's discriminative ability was established between 43 patients and 19 controls, as well as between three deformity subgroups. For its responsiveness to treatment, 10 patients were reevaluated 6 months postoperatively. Concurrent validity was assessed through correlation analysis with radiographic parameters (pelvic tilt; sagittal vertical axis [SVA]; pelvic incidence minus lumbar lordosis [PI-LL]; coronal vertical axis) and patient-reported scores [Oswestry Disability Index]; Scoliosis Research Society outcome questionnaire; Falls Efficacy Scale-International). Test-retest and interrater reliability were tested on two groups of ten patients using intraclass correlation coefficients (ICC). Patients with ASD, mainly with sagittal malalignment, scored worse compared to controls on FASD (P < 0.001) and its subscales. No significant improvement was observed 6 months postoperatively (P = 0.758). FASD correlated significantly to all patient-reported scores and to SVA and PI-LL. Reliability between sessions (ICC = 0.97) and raters (ICC = 0.93) was excellent. Subscales also showed good to excellent reliability, except FASD 1 on "spinal mobility and balance" between sessions (ICC = 0.71). FASD proved to be a valid and reliable clinical scale for evaluation of functional impairments in ASD. Objective information on function and balance might ultimately guide physiotherapeutic treatment toward improved functioning.Level of Evidence: 2.

Impact of prior history of cancer in the outcomes of patients with atrial fibrillation

Abstract Introduction Atrial fibrillation (AF) is common among cancer survivors, but anticoagulant therapy in is particularly challenging in this population. Aim We analyzed how a previous diagnosis of cancer influences the embolic and hemorrhagic risk in AF patients in order to guide anticoagulant therapies. Methods We used a large retrospective and observational cohort of AF patients from Vigo, Spain (2014–2018). Primary endpoint were embolic and haemorrhagic events during follow-up. Secondary endpoints were all cause mortality, CV mortality, acute myocardial infarction (AMI) and heart failure (HF) admission. Results From the 16,056 included patients, 7.1% had a current/past diagnosis of cancer. Median follow-up was 4.9 years. The rate of anticoagulation therapy was similar in cancer and non-cancer patients (74.8% vs 75.8) although there was a higher prescription of heparin and a lower prescription of VKA in cancer group. Cancer patients had a higher embolic (CHA2DS2-VASC 3.5±1.5 vs 3.2±1.5; p&amp;lt;.001) and hemorrhagic risk (HASBLED 3.0±1.2 vs 2.6±1.2; p&amp;lt;.001). Embolic and hemorrhagic risk stratification with CHA2DS2-VASC and HASBLED scores was only accurate in patients with past (non-active) cancer (sHR CHA2DS2-VASC for embolic events: 1.26, 95% CI 1.02–1.54, P=.028 and sHR HASBLED for bleeding events 1.11, 95% CI 1.01–1.23, P=.029) but not in active-cancer patients (CHADS2-VASC sHR 1.14, 95% CI 0.98–1.32; p=.076 and HASBLED sHR 1.08, 95% CI 0.99–1.17; p=.070). After adjusting by age, sex, CHA2DS2-VASC, HASBLED, and anticoagulation therapy, cancer was not associated with higher risk of embolic events (sHR 0.73, 95% CI 0.41–1.26; p=.256), neither in anticoagulated nor in non-anticoagulated patients. However, cancer patients presented a higher bleeding risk (sHR 1.18, 95% CI 1.07–1.30; p=0.001), both in anticoagulated and non-anticoagulated patients. Anticoagulation therapy was associated with lower rate of embolic events and with higher rate of bleeding events in both groups of patients with and without cancer, although the embolic-hemorrhagic balance associated with anticoagulation was more favorable in cancer patients (for each avoided embolism with anticoagulation, 5.7 bleeding and 11.7 bleeding episodes occurred in cancer and non-cancer group respectively). We found no association between cancer and AMI or CV mortality rates. All-cause mortality was higher in cancer patients. For HF, only chemotherapy-treated patients presented higher risk (sHR1.54, 95% CI 1.10–2.16; p=0.012). Conclusion Patients with prior history of cancer have higher bleeding risk but similar embolic risk compared to patients without cancer history. Anticoagulation significantly reduced embolic events, with an increase in bleeding outcomes. However, the embolic-hemorrhagic profile of anticoagulation was more favorable in patients with cancer than without it. Funding Acknowledgement Type of funding sources: None. Scores performances by cancer activityEmbolic/bleeding net clinical balance

Discriminative Mobility Characteristics between Neurotypical Young, Middle-Aged, and Older Adults Using Wireless Inertial Sensors

Age-related mobility research often highlights significant mobility differences comparing neurotypical young and older adults, while neglecting to report mobility outcomes for middle-aged adults. Moreover, these analyses regularly do not determine which measures of mobility can discriminate groups into their age brackets. Thus, the current study aimed to provide a comprehensive analysis for commonly performed aspects of mobility (walking, turning, sit-to-stand, and balance) to determine which variables were significantly different and furthermore, able to discriminate between neurotypical young adults (YAs), middle-aged adults (MAAs), and older adults (OAs). This study recruited 20 YAs, 20 MAAs, and 20 OAs. Participants came into the laboratory and completed mobility testing while wearing wireless inertial sensors. Mobility tests assessed included three distinct two-minute walks, 360° turns, five times sit-to-stands, and a clinical balance test, capturing 99 distinct mobility metrics. Of the various mobility tests assessed, only 360° turning measures demonstrated significance between YAs and MAAs, although the capacity to discriminate between groups was achieved for gait and turning measures. A variety of mobility measures demonstrated significance between MAAs and OAs, and furthermore discrimination was achieved for each mobility test. These results indicate greater mobility differences between MAAs and OAs, although discrimination is achievable for both group comparisons.