Dependence Of Mobility Research Articles

Causal pathways of potential factors affecting participation level of individuals with unilateral cerebral palsy

Introduction: Although most children with unilateral cerebral palsy can achieve independent mobility levels with or without assistive devices, they remain susceptible to decreased participation. This study aimed to explore the potential factors affecting participation of children with unilateral cerebral palsy. Method: Fifty children with unilateral cerebral palsy were enrolled. The degree of spasticity in the upper limb muscles was assessed using the Modified Ashworth Scale, active range of motion of the upper limb joints was assessed using a universal goniometer, and activity performance was measured using the ABILHAND-Kids and Gross Motor Function Measure. Environmental factors and mental health were evaluated using the European Child Environment Questionnaire and Strength and Difficulties Questionnaire. The Child and Adolescent Scale of Participation was used to assess participation. Results: Path analysis showed that upper limb impairment had both direct (β = −0.41; p < 0.05) and indirect (β = 0.64; p < 0.001) effects on participation. Most importantly, it was found that the participation of children with unilateral cerebral palsy was notably influenced by environmental factors and mental health (β2 = −0.42; p < 0.05, and β2 = −0.36; p < 0.05). Conclusion: Participation of children with unilateral cerebral palsy is affected by a combination of functioning and contextual factors.

Predicting sit-to-stand motions with a deep reinforcement learning based controller under idealized exoskeleton assistance

AbstractMaintaining the capacity for sit-to-stand transitions is paramount for preserving functional independence and overall mobility in older adults and individuals with musculoskeletal conditions. Lower limb exoskeletons have the potential to play a significant role in supporting this crucial ability. In this investigation, a deep reinforcement learning (DRL) based sit-to-stand (STS) controller is developed to study the biomechanics of STS under both exoskeleton assisted and unassisted scenarios. Three distinct conditions are explored: 1) Hip joint assistance (H-Exo), 2) Knee joint assistance (K-Exo), and 3) Hip-knee joint assistance (H+K-Exo). By utilizing a generic musculoskeletal model, the STS joint trajectories generated under these scenarios align with unassisted experimental observations. We observe substantial reductions in muscle activations during the STS cycle, with an average decrease of 68.63% and 73.23% in the primary hip extensor (gluteus maximus) and primary knee extensor (vasti) muscle activations, respectively, under H+K-Exo assistance compared to the unassisted STS scenario. However, the H-Exo and K-Exo scenarios reveal unexpected increases in muscle activations in the hamstring and gastrocnemius muscles, potentially indicating a compensatory mechanism for stability. In contrast, the combined H+K-Exo assistance demonstrates a noticeable reduction in the activation of these muscles. These findings underscore the potential of sit-to-stand assistance, particularly in the combined hip-knee exoskeleton scenario, and contribute valuable insights for the development of robust DRL-based controllers for assistive devices to improve functional outcomes.

Transient electrophoresis of colloidal particles in a salt-free medium

A general theory is developed for the time dependent transient electrophoretic mobility of spherical colloidal particles in a salt-free liquid medium containing only counterions when a step external electric field is suddenly applied to the colloidal suspension. It is found that as in the case of the steady electrophoretic mobility in a salt-free medium, there is a certain critical value of the particle surface charge separating two cases, that is, the low-surface-charge case and the high-surface-charge case. In the latter case the counterion condensation takes place near the particle surface. For the low-surface charge case, the transient electrophoretic mobility agrees with that of a sphere in an electrolyte solution in the limit of very low electrolyte concentrations. For the high-surface-charge case, however, the transient mobility becomes independent of the particle surface charge because of the counterion condensation effects. A simple expression is derived for the ratio of the transient electrophoretic mobility to the steady electrophoretic mobility, which is found to take the same form irrespective of the magnitude of the particle surface charge. Using this equation, it is now possible to predict how the system will approach its final steady state.

SYME’S OPERATION IN THE TREATMENT OF GUNSHOT INJURIES OF THE FOOT

Symeʼs operation for gunshot injuries of the foot may be a viable alternative to transtibial amputation. Objective. To analyze the results of the use of Symeʼs operation in patients with gunshot injuries of the foot, to highlight the important points of surgical technique, rehabilitation and prosthetics. Methods.The results of treatment of 12 men with gunshot wounds to the foot aged 23–54 years (mean age (36.1 ± 2.7) years) who underwent Syme surgery were analyzed. All patients were military personnel at the time of injury. Clinical, instrumental and microbiological examinations were used. The severity of the injury and the prospects of reconstructive treatment were assessed by the Hannover Fracture Score (HFS-97), the anatomic defect present and the severity of static-dynamic disorders. The results were evaluated according to VAS (pain) and ALAC (prosthesis using). Results. Healing of postoperative wounds in all cases occurred without complications. The observation period was from 8 months. up to 7 years (3.5 years on average). All 10 prosthetic patients use a prosthesis: 1 — walking on a prosthesis outside the home (ALAC IV), 5 — independent mobility (ALAC V), 4 — mobility does not differ from the norm (ALAC VI). In two cases (15,4 %) due to pain syndrome (7,3 and 6,8 according to VAS) prosthetics was impossible — reamputation at the level of the leg. Conclusions. Syme’s operation provides a good functional result of prosthetics in case of gunshot injuries of the foot, is a real alternative to transtibial amputation in cases with preserved hindfoot.

Reimagining Accessibility: Leveraging Deep Learning in Smartphone Applications to Assist Visually Impaired People Indoor Object Distance Estimation

Every other aspect of life is organized around the sight. A person with vision impairment suffers severely from independent mobility and quality of life. The proposed framework combines mobile deep learning with distance estimation algorithms to detect and classify indoor objects with estimated distance in real-time during indoor navigation. The user, wearing the device with a lanyard or holding it in a way that positions the camera forward, identifies in real-time surroundings indoor objects with estimated distance and voice commentary. Moreover, the mobile framework provides an estimated distance to the obstacles and suggests a safe navigational path through voice-guided feedback. By harnessing the power of deep learning in a mobile setting, this framework aims to improve the independence of visually impaired individuals by facilitating them a higher degree of independence in indoor navigation. This study's proposed mobile object detection and distance estimation framework achieved 99.75% accuracy. This research contributes by leveraging mobile deep learning with identifying objects in real-time, classification and distance estimation, a state-of-the-art approach to use the latest technologies to enhance indoor mobility challenges faced by visually impaired people.

The whole journey chain with public transport for people with autism spectrum disorder and attention deficit hyperactivity disorder – a scoping review

ABSTRACT Independent transport mobility is an important contributor to health, well-being, and participation. Several skills and competences are required for a person to use the transport system. The characteristics of cognitive disorders, such as Autism Spectrum Disorder (ASD) and Attention deficit/hyperactivity disorder (ADHD), may pose barriers to independent travel. Methods The study’s aim was to synthesise knowledge on the use of public transport among individuals with ASD or ADHD using the whole journey chain perspective. A scoping review using the PRISMA ScR framework was conducted, and included articles published between January 2012 and June 2022. A total of 11 studies from four countries were included in the analysis. Results This study complements the whole journey chain perspective with a phase that takes place long before the journey begins, and which concerns planning and preparation. Confident travellers could easily learn new routes, while those lacking confidence faced challenges, especially with unexpected route changes or cancellations. Conclusions There is a great need for emphasis on the design of public transport facilities and public spaces to increase the sense of safety for travellers with ASD, and to assist them with information-seeking, comprehension, and recovery between journeys.

Predicting Driving Cessation Among Cognitively Normal Older Drivers: The Role of Alzheimer Disease Biomarkers and Clinical Assessments.

With the aging US population and increasing incidence of Alzheimer disease (AD), understanding factors contributing to driving cessation among older adults is crucial for clinicians. Driving is integral for maintaining independence and functional mobility, but the risk factors for driving cessation, particularly in the context of normal aging and preclinical AD, are not well understood. We studied a well-characterized community cohort to examine factors associated with driving cessation. This prospective, longitudinal observation study enrolled participants from the Knight Alzheimer Disease Research Center and The DRIVES Project. Participants were enrolled if they were aged 65 years or older, drove weekly, and were cognitively normal (Clinical Dementia Rating [CDR] = 0) at baseline. Participants underwent annual clinical, neurologic, and neuropsychological assessments, including β-amyloid PET imaging and CSF (Aβ42, total tau [t-Tau], and phosphorylated tau [p-Tau]) collection every 2-3 years. The primary outcome was time from baseline visit to driving cessation, accounting for death as a competing risk. The cumulative incidence function of driving cessation was estimated for each biomarker. The Fine and Gray subdistribution hazard model was used to examine the association between time to driving cessation and biomarkers adjusting for clinical and demographic covariates. Among the 283 participants included in this study, there was a mean follow-up of 5.62 years. Driving cessation (8%) was associated with older age, female sex, progression to symptomatic AD (CDR ≥0.5), and poorer performance on a preclinical Alzheimer cognitive composite (PACC) score. Aβ PET imaging did not independently predict driving cessation, whereas CSF biomarkers, specifically t-Tau/Aβ42 (hazard ratio [HR] 2.82, 95% CI 1.23-6.44, p = 0.014) and p-Tau/Aβ42 (HR 2.91, 95% CI 1.28-6.59, p = 0.012) ratios, were independent predictors in the simple model adjusting for age, education, and sex. However, in the full model, progression to cognitive impairment based on the CDR and PACC score across each model was associated with a higher risk of driving cessation, whereas AD biomarkers were not statistically significant. Female sex, CDR progression, and neuropsychological measures of cognitive functioning obtained in the clinic were strongly associated with future driving cessation. The results emphasize the need for early planning and conversations about driving retirement in the context of cognitive decline and the immense value of clinical measures in determining functional outcomes.

After-School Activities of Japanese Elementary School Children: Comparison of Children Who Attend Lessons and Cram Schools With Those Who Do Not.

This study examined the after-school activities of Japanese elementary school children in which little information is available for understanding the process by which participation in organized activities leads to the decrease in children's independent mobility. One thousand eight hundred and twenty-four mothers of elementary school children participated in an online survey. The mothers responded to the questions on the number of lessons (or cram schools) their children attended weekdays, as well as their children's behavior after classes, and parents providing transportation when their children go out to play. The proportion of children attending lessons and/or cram schools increased as their grades progressed. A significant interaction existed between the degree of parental transportation and grade in terms of whether or not the children attended lessons and/or cram schools. Parental involvement included pick up or drop-off for a large percentage of younger children without lessons, whereas the degree of parental involvement was greater for older children attending lessons. In other words, parents of children without attending lessons or cram schools tended to allow children to engage in independent activities when they reached the higher grades, whereas parents of children who frequently attended lessons and cram schools tended to remain involved in transporting their children, even when they reached the higher grades. The results suggested that the participation of children in organized activities leads to a routine of parental pickup and/or drop-off, which renders difficult the facilitation of opportunities for children to independently participate in play activities.

Gait Features in Different Environments Contributing to Participation in Outdoor Activities in Old Age (GaitAge): Protocol for an Observational Cross-Sectional Study.

The ability to walk is a key issue for independent old age. Optimizing older peoples' opportunities for an autonomous and active life and reducing health disparities requires a better understanding of how to support independent mobility in older people. With increasing age, changes in gait parameters such as step length and cadence are common and have been shown to increase the risk of mobility decline. However, gait assessments are typically based on laboratory measures, even though walking in a laboratory environment may be significantly different from walking in outdoor environments. This project will study alterations in biomechanical features of gait by comparing walking on a treadmill in a laboratory, level outdoor, and hilly outdoor environments. In addition, we will study the possible contribution of changes in gait between these environments to outdoor mobility among older people. Participants of the study were recruited through senior organizations of Central Finland and the University of the Third Age, Jyväskylä. Inclusion criteria were community-dwelling, aged 70 years and older, able to walk at least 1 km without assistive devices, able to communicate, and living in central Finland. Exclusion criteria were the use of mobility devices, severe sensory deficit (vision and hearing), memory impairment (Mini-Mental State Examination ≤23), and neurological conditions (eg, stroke, Parkinson disease, and multiple sclerosis). The study protocol included 2 research visits. First, indoor measurements were conducted, including interviews (participation, health, and demographics), physical performance tests (short physical performance battery and Timed Up and Go), and motion analysis on a treadmill in the laboratory (3D Vicon and next-generation inertial measurement units [NGIMUs]). Second, outdoor walking tests were conducted, including walking on level (sports track) and hilly (uphill and downhill) terrain, while movement was monitored via NGIMUs, pressure insoles, heart rate, and video data. A total of 40 people (n=26, 65% women; mean age 76.3, SD 5.45 years) met the inclusion criteria and took part in the study. Data collection took place between May and September 2022. The first result is expected to be published in the spring of 2024. This multidisciplinary study will provide new scientific knowledge about how gait biomechanics are altered in varied environments, and how this influences opportunities to participate in outdoor activities for older people. RR1-10.2196/52898.

Extremely preterm infants with severe intraventricular hemorrhage: neurological evolution and long term and educational status

To know the most frequent neurological pathologies associated with extensive IVH, to determine the functional outcomes of mobility in the motor area and intellectual capacity in the cognitive area, to analyze the association between both areas and to know the schooling achieved. Descriptive and longitudinal study in VPNB with extensive IVH born between 2001 and 2014. They underwent protocolized neurological follow-up until school age. The functional outcomes in mobility and intellectual capacity were categorized into 4 levels: level 1 corresponds to good functionality and autonomy; level 2, functionality that allows independence, with support in some tasks; level 3 requires constant external support; and level 4 where there is total dependence. The association was analyzed using Chi-square and Cramer's V coefficient. 74 children completed the follow-up; the most frequent associated neurological pathologies were neurodevelopmental disorders, hypertensive hydrocephalus, and epilepsy. Independent mobility (normal or with limitations) reached 74.4% while 24.3% used wheelchairs. 51.3% was categorized as normal to borderline intellectual range, 12.2% as mild intellectual disability (ID), 17.6% as moderate ID, and 19.9% as severe to profound ID. There was a strong statistical association between functional levels of mobility and intellectual capacity (p < 0.000 and V = 0.62). Schooling was proportional to intellectual capacity: 56.8% attended regular schools, 27.0% attended special schools, and 16.2% had no schooling. 2/3 VPNB with extensive IVH showed positive functional outcomes, from normal to mild limitations that allow an almost autonomous life; in 1/3 the outcomes were unfavorable in mobility and cognitive performance, and there was a strong statistical correlation between both areas studied. Schooling was consistent with the intellectual level.

Typological analysis of community participation for sustainable tourism in Sasak Ende Tourism Village

Purpose — The purpose of this study is to analyze community participation in Sasak Ende Tourism Village in managing and designing sustainable tourism development strategies based on the results of typological analysis of community participation.Method — This study employs qualitative methods utilizing primary and secondary data sources. Data were gathered through observation, interviews, and documentation. We interviewed informants from the Central Lombok Tourism Office, the Managing Secretary of Sasak Ende Tourism Village, and Pujut Regency. Furthermore, triangulation analysis techniques were utilized in this study to assess the validity of the data.Result — Based on the analysis, three levels of community participation were identified in Sasak Ende Tourism Village: material incentive participation, interactive participation, and independent mobilization. Community participation activities in Sasak Ende Tourism Village adhere to socio-cultural, economic, and environmentally sustainable tourism principles. The strategy employed focuses on developing human resources (HR) and preserving Sasak traditional houses. The analysis results in a sustainable tourism development strategy for Sasak Ende Tourism Village based on the typology of participation and the principles of sustainable tourism.Practical implications — This study suggests that fostering various levels of community participation and aligning tourism development strategies with socio-cultural, economic, and environmental sustainability principles can lead to the preservation of cultural heritage and sustainable growth in destinations like Sasak Ende Tourism Village.

Young adults with vision impairment in India: Loneliness and social networks.

To examine the prevalence of loneliness and associated factors in young adults with vision impairment (VI), including quality of life (QoL) in India. Two hundred and three VI young adults (18-35 years) and 219 age-matched non-VI (controls) adults completed the loneliness scale, WHOQOL-BREF, Social Network Index (SNI) (network diversity, people in network size and number of embedded network subscales) and questions regarding sociodemographic characteristics and independent mobility. Rasch analysis was used to validate the questionnaires and interval-level scores were generated. Generalised linear models were used to estimate independent associations of sociodemographic factors, VI characteristics, social networks and QoL with loneliness. The prevalence of moderate and severe loneliness in the VI group was 10% (95% CI: 6.5, 15.4) and 4.4% (95% CI: 2.0, 8.2), respectively, and higher than that of controls. The VI group had a worse loneliness score than controls (-1.66 ± 2.25 vs. -2.13 ± 1.85 logits; p = 0.03). Those with ≤12 years and >12 years of education had loneliness scores of -1.58 ± 2.45 and -1.82 ± 1.99 logits, respectively (p = 0.01). Compared with controls, the VI group reported fewer extended family members, neighbours and friends leading to significantly smaller networks and network diversity (all p < 0.001). Loneliness scores demonstrated a significant correlation with only two SNI subscales for both groups: people in network size (r = -0.28 for VI; r = -0.30 for non-VI; p < 0.001 for both) and number of embedded networks (r = -0.22 for VI; r = -0.21 for non-VI; p = 0.002 for both). Both education (β = 0.45; p = 0.04) and QoL (β = -0.27, p = 0.02) were predictors of loneliness. Loneliness was commonly experienced by young VI adults and was higher among those with lower levels of education. Loneliness decreased with the presence of a larger number of people in network, suggesting that interventions to increase social activity and participation may be valuable in young VI adults.

Quality of Life in Children with Cerebral Palsy: The Role of Having Access to Rehabilitation Services

Background: Cerebral palsy (CP) is a neurological motor disability, and children with CP should receive rehabilitation services to achieve their full potential. Objectives: The purpose of this study was to explore the quality of life (QOL) of children with CP across various domains and to assess the role of access to rehabilitation services on their QOL. Methods: We conducted a cross-sectional study involving all 126 children aged 4 - 12 with CP and their parents in Saqqez county, Kurdistan province, Iran. The "Physical Rehabilitation Accessibility Assessment Questionnaire" and the "Parental Proxy CP QOL-Child questionnaire" were used to measure the main variables. The analysis performed separately for two subpopulations: 27 children aged 4 - 6 years and 99 children older than six, using SPSS version 23. After prforming Kolmogorov-Smirnov test, the Spearman correlation coefficient was employed to identify correlations. Results: The average age of the participants was 8 ± 2.36 years, with 51 (40.5%) being girls. Of the 126 children with CP, 45 (35.7%) had independent mobility function (GMFCS levels I and II). The mean CP QOL-Child domain scores ranged from 35.3 ± 25.1 in the 'access to services' domain to 74.5 ± 16.1 in the 'Emotional well-being and self-esteem' domain. The average accessibility score was 53.8 ± 22.1. Among children older than 6 years, access to rehabilitation services showed a significant correlation with all CP QOL-Child domain scores (P &lt; 0.05), except for 'social well-being and acceptance.' In children aged 4 - 6 years, only the Family Health domain score was significantly correlated with access to rehabilitation services (r = 0.44, P = 0.021). Conclusions: Access to rehabilitation services is a significant predictor of QOL in children older than 6 years. Further experimental research is needed to examine changes in various aspects of QOL in children with CP following improved access to rehabilitation services.

Fatigue, fear of being mobilized and residual limb pain limit independent basic mobility and physiotherapy for patients early after major dysvascular lower extremity amputation: A prospective cohort study.

Early mobilization of patients with a major lower extremity amputation (LEA) is often a challenge because of lack of compliance. Therefore, we investigated factors limiting independent mobility and physiotherapy on the first day with physiotherapy (PTDay1) and the following 2 days after LEA. A total of 60 consecutive patients, mean age 73.7 years (SD 12.1 years), undergoing LEA were included over a period of 7 months. The Basic Amputee Mobility Score was used to assess basic mobility. Predefined limitations for not achieving independent mobility or not completing physiotherapy were residual limb pain, pain elsewhere, fear of being mobilized, fatigue, nausea/vomiting, acute cognitive dysfunction or "other" factors reported on PTDay1 and the following 2 days after LEA. Fatigue and fear of being mobilized were the most frequent limitations for not achieving independent mobility on PTDay1 and the following 2 days after LEA. Patients (n = 55) who were not independent in the Basic Amputee Mobility Score activity transferring from bed to chair on PTDay1 were limited by fatigue (44%) and fear of being mobilized (33%). A total of 21 patients did not complete planned physiotherapy on PTDay1, and were limited by fatigue (38%), residual limb pain (24%) and "other" factors (24%). Fatigue and fear of being mobilized were the most frequent factors that limited independent mobility early after LEA. Fatigue, residual limb pain and "other" factors limited completion of physiotherapy. Geriatr Gerontol Int 2024; 24: 470-476.

Orphan GPCR GPRC5C Facilitates Angiotensin II-Induced Smooth Muscle Contraction.

GPCRs (G-protein-coupled receptors) play a central role in the regulation of smooth muscle cell (SMC) contractility, but the function of SMC-expressed orphan GPCR class C group 5 member C (GPRC5C) is unclear. The aim of this project is to define the role of GPRC5C in SMC in vitro and in vivo. We studied the role of GPRC5C in the regulation of SMC contractility and differentiation in human and murine SMC in vitro, as well as in tamoxifen-inducible, SMC-specific GPRC5C knockout mice under basal conditions and in vascular disease in vivo. Mesenteric arteries from tamoxifen-inducible, SMC-specific GPRC5C knockout mice showed ex vivo significantly reduced angiotensin II (Ang II)-dependent calcium mobilization and contraction, whereas responses to other relaxant or contractile factors were normal. In vitro, the knockdown of GPRC5C in human aortic SMC resulted in diminished Ang II-dependent inositol phosphate production and lower myosin light chain phosphorylation. In line with this, tamoxifen-inducible, SMC-specific GPRC5C knockout mice showed reduced Ang II-induced arterial hypertension, and acute inactivation of GPRC5C was able to ameliorate established arterial hypertension. Mechanistically, we show that GPRC5C and the Ang II receptor AT1 dimerize, and knockdown of GPRC5C resulted in reduced binding of Ang II to AT1 receptors in HEK293 cells, human and murine SMC, and arteries from tamoxifen-inducible, SMC-specific GPRC5C knockout mice. Our data show that GPRC5C regulates Ang II-dependent vascular contraction by facilitating AT1 receptor-ligand binding and signaling.

Walking net O2 rises with advancing age in older women: where to go from here?

Walking net O2 tends to increase with advancing age; however, factors contributing to this relationship have not been widely described. The implications of such findings could inform targeted strategies to promote independent mobility in older adults. Herein, we evaluated the relationship between net O2 and age at two submaximal workloads while exploring potential moderators of this relationship. Secondary analyses were performed on 35 older (65 ± 3years) women who completed a battery of physical assessments including fixed-speed, non-graded and graded (+ 2.5%) treadmill walking with indirect calorimetry to determine net O2. Maximal oxygen uptake ( O2max), knee extensor maximal isometric voluntary contraction (MVC), peak rate of torque development (RTD), and plantar flexor range-of-motion (PFROM) were also measured. Bivariate correlations showed non-graded (r = 0.403, p = 0.017) and graded (r = 0.413, p = 0.014) net O2 were positively related to age. Notably, these relationships strengthened after adjusting for O2max. Regression modeling showed age, RTD:MVC ratio (composite of muscle performance), and PFROM together explained 49% and 34% of the variance in non-graded and graded net O2, respectively. Further analyses suggested knee extensor MVC moderates the relationship between non-graded net O2 and age, accounting for 9% of the variance [ΔR2 = 0.090, F (1,31) = 4.13, p = 0.05]. These data support the premise that, in older women, walking net O2 rises with advancing age, and additionally, the RTD:MVC ratio and PFROM are independent correlates of non-graded net O2. Exercise interventions with a high degree of training specificity including explosive, velocity-based elements may promote independent mobility in older women.

A Review on Voice Navigation System for the Visually Impaired

A ground-breaking voice navigation system seems as a ray of light in a world where blind people must overcome enormous obstacles to navigate strange places. For those with vision impairments, safely and independently navigating in unfamiliar situations presents substantial obstacles. This system is a paradigm shift in providing safe and independent mobility assistance for the visually handicapped, as it makes use of cutting-edge technologies. The voice navigation system gives users the confidence to confidently navigate uncharted territory by seamlessly integrating computer vision and machine learning capabilities. With the use of real-time obstacle classification and recognition capabilities, the system can give users vital information about their surroundings, empowering them to make wise decisions while traveling. The system's smartphone-based platform, which provides an intuitive interface that can be accessed with voice commands, is its basis. By utilizing deep learning algorithms and pre-trained models, the system can precisely identify barriers and guide people across intricate environments. Precise positioning and route planning are made possible by the system's integration of GPS technology. Users receive up-to-date information on their location and the most efficient route to their destination via voice-activated instructions and advice. Individual user preferences are catered to by customizable options, which guarantee a tailored and user-friendly experience. A wider user base can utilize the system, democratizing access to necessary navigation tools, due to its affordability and interoperability with commonly available smartphone devices. The results of experimental tests highlight the effectiveness of the system, showing that it can reliably and accurately guide visually impaired people across a variety of surroundings. Through the promotion of increased autonomy and mobility, the voice navigation system enables users to move with unprecedented liberty and self-assurance, surmounting obstacles and opening up novel prospects. Key Words: : Voice navigation system, Machine learning, GPS technology, Deep learning algorithms, Navigation tools.

How parents' perception of the social norm is associated with their adolescent’s commuting behaviour to school

IntroductionActive commuting to school (ACS) and independent mobility (IM) are opportunities to increase physical activity among adolescents. Social norms might be related to these behaviours. The aim of this study was threefold, first to describe parents' perception of the social norm; second, to determine the associations between sociodemographic characteristics and parents' perception of the social norm; and third, to analyse the associations between parents' perception of the social norm and their adolescent’s commuting behaviour to and from school, according to the genders of parents and adolescents in Spain. MethodsData were collected through a questionnaire from 12 different public schools. The cross-sectional sample comprised 573 parents (61.8% mothers). The average age of adolescents was 13.2 years (SD = 2.21). ResultsParents' perception of the social norm were low but linear regression analysis showed that it was higher when the adolescents were younger and the distance to school were shorter. Mothers' perception of the social norm were higher when the educational level and family socioeconomic status were higher. Logistic regression analysis showed that a higher perception of the social norm among parents increased the odds of their adolescents commuting actively to (OR = 1.58; CI; 1.23, 2.02) and from (OR = 1.63; CI; 1.25, 2.10) school. However, in separate analyses, this did not apply for ACS among boys from school (OR = 1.23; CI; 0.84, 1.80). The odds of girls using IM to school increased when parents' perception of the social norm was higher (OR = 1.39; CI; 1.04, 1.86). ConclusionParents' perception of the social norm are relevant for ACS and IM during adolescence. The family sociodemographic characteristics influence the mothers' perception of the social norm. The importance of the social norm among parents differs between adolescent’s genders regarding their use of ACS and IM. To promote these behaviours, a social-norm approach is important targeting the visibility of ACS.

Ten year outcomes after non-fixation of the smaller posterior malleolar fragment: A retrospective cohort study

IntroductionTreatment of posterior malleolar (PM) ankle fractures remains controversial. Despite increasing recommendation for small PM fragment fixation, high quality evidence demonstrating improved clinical outcomes over the unfixated PM is limited. We describe the long term clinical and radiographical outcomes in younger adult patients with PM ankle fractures managed without PM fragment fixation. Material and methodsA retrospective cohort study was performed on PM ankle fracture patients aged 18–55 years old admitted under our orthopaedic unit between 1st of April 2009 and 31st of October 2013. Inclusion criteria were ASA 1 and 2, independent mobility pre-trauma, no pre-existing ankle pathologies, with satisfactory bimalleolar and syndesmotic stabilisation. Open fractures, talar fractures, calcaneal fractures, pilon fractures, subsequent re-injury and major complications were excluded. All PM fragments were unfixated. Clinical outcomes were evaluated using visual analogue scale (VAS) for pain, Foot and Ankle Ability Measure (FAAM) with activities of daily living (ADL) and sports subscale for function, and patient satisfaction ratings. Osteoarthritis was assessed using modified Kellgren-Lawrence scale on follow-up weightbearing ankle radiographs. ResultsSixty-one participants were included. Mean follow-up was 10.26 years. Average PM size was 16.2 ± 7.39%. All participants were evaluated for clinical outcomes. Mean score of FAAM-ADL was 95.5 ± 7.13, FAAM-Sports 86.4 ± 15.5, patient satisfaction 86.2 ± 14.4% and pain score 1.13 ± 1.65. Radiographical outcomes were evaluated in 52 participants, showing no-to-minimal osteoarthritis in 36/52 (69%), mild osteoarthritis in 14/52 (27%) and moderate osteoarthritis in 2/52 (4%). Pain and functional scores were independent of PM fragment size, post-reduction step-off, dislocation, malleoli fractured or syndesmotic injury. PM step-off more than 1 mm and traumatic dislocation/subluxation were associated with worse radiographical osteoarthritis. ConclusionAfter controlling for confounders, the unfixated smaller posterior malleolus fragment at 10-year follow-up demonstrated largely satisfactory clinical outcomes with some radiographical progression of osteoarthritis. Level of evidenceLevel III – Retrospective cohort study

An autonomous wheelchair with health monitoring system based on Internet of Thing

Assistive powered wheelchairs will bring patients and elderly the ability of remain mobile without the direct intervention from caregivers. Vital signs from users can be collected and analyzed remotely to allow better disease prevention and proactive management of health and chronic conditions. This research proposes an autonomous wheelchair prototype system integrated with biophysical sensors based on Internet of Thing (IoT). A powered wheelchair system was developed with three biophysical sensors to collect, transmit and analysis users’ four vital signs to provide real-time feedback to users and clinicians. A user interface software embedded with the cloud artificial intelligence (AI) algorithms was developed for the data visualization and analysis. An improved data compression algorithm Minimalist, Adaptive and Streaming R-bit (O-MAS-R) was proposed to achieve a higher compression ratio with minimum 7.1%, maximum 45.25% compared with MAS algorithm during the data transmission. At the same time, the prototype wheelchair, accompanied with a smart-chair app, assimilates data from the onboard sensors and characteristics features within the surroundings in real-time to achieve the functions including obstruct laser scanning, autonomous localization, and point-to-point route planning and moving within a predefined area. In conclusion, the wheelchair prototype uses AI algorithms and navigation technology to help patients and elderly maintain their independent mobility and monitor their healthcare information in real-time.