Gait Assessment Research Articles

Abstract TMP34: Lower Limb Motor Performance is Proportional to Corticospinal Tract Integrity in Chronic Stroke

Introduction: Gait is a complex behavior characterized by an array of measures, each contributing to our understanding of gait performance. To improve gait recovery after stroke, we need to connect complex clinical function and brain structure. Here, our purpose is to evaluate the relationship between lower limb performance and structural integrity of corticospinal tract (CST) in ambulatory chronic stroke survivors. Methods: Diffusion weighted images (DWIs) and lower limb performance measures were acquired from 36 chronic (>6 months) stroke survivors with lower limb deficits. Clinical measures included Fugl-Meyer(FM), Gait Assessment and Intervention Tool (GAIT), timed-up-and-go (TUG) and fastest gait speed (GS). Lesions were manually outlined on the MRIs, and left hemisphere lesions were flipped. DWIs were preprocessed using standard denoising techniques before calculating fractional anisotropy (FA), mean diffusivity (MD) and radial diffusivity (RD). Tract-based spatial statistics (TBSS) was used to normalize all data to MNI space and project it onto a skeleton of white matter tracts. CSTs were isolated. Voxel-wise analysis was performed with permutation testing (5000 permutations). A regression model was created for each clinical variable using lesion masks as a regressor. Results: Participants were 64±8.9 y/o, 83% male and 53% left hemisphere lesion. FM was 24.1±4.1. Mild correlations were present for FM with GAIT (Pearson, r = -0.33, p = 0.045) and GS (r = 0.34, p = 0.038), and GS with GAIT (r = -0.35, p = 0.036). TUG was highly correlated with GS (r = -0.93, p = 0.000). In exploratory analysis, findings for ipsilesional CST were as follows: 1) better FM was associated with higher FA, MD and RD, p = 0.001, 0.002 and 0.006 respectively; 2) better GS with higher FA, p = 0.034,3) better TUG scores with lower RD, p = 0.041 and 4) a trend of GAIT with RD, p=0.054. Location of statistically significant voxels varied for different clinical measures. No associations were found for contralesional CST. Conclusion: Structural correlates of lower limb performance can be detected using diffusion weighted tractography. FM, an impairment measure of paretic limb, has a stronger association with CST integrity than the measures of global gait function (TUG and GS).

Improving Gait Analysis Techniques with Markerless Pose Estimation Based on Smartphone Location.

Marker-based 3D motion capture systems, widely used for gait analysis, are accurate but have disadvantages such as cost and accessibility. Whereas markerless pose estimation has emerged as a convenient and cost-effective alternative for gait analysis, challenges remain in achieving optimal accuracy. Given the limited research on the effects of camera location and orientation on data collection accuracy, this study investigates how camera placement affects gait assessment accuracy utilizing five smartphones. This study aimed to explore the differences in data collection accuracy between marker-based systems and pose estimation, as well as to assess the impact of camera location and orientation on accuracy in pose estimation. The results showed that the differences in joint angles between pose estimation and marker-based systems are below 5°, an acceptable level for gait analysis, with a strong correlation between the two datasets supporting the effectiveness of pose estimation in gait analysis. In addition, hip and knee angles were accurately measured at the front diagonal of the subject and ankle angle at the lateral side. This research highlights the significance of careful camera placement for reliable gait analysis using pose estimation, serving as a concise reference to guide future efforts in enhancing the quantitative accuracy of gait analysis.

Functional evaluation of physical performance, gait, balance and activities of daily living in older individuals with long COVID syndrome.

The aim of our study was to evaluate the physical performance, balance, gait and activities of daily living (ADL) of older individuals with long COVID syndrome (LCS). A total of 124 individuals (49% women) with a mean age of 71.8 ± 5.8 years were included in the study. Participants were divided into two groups, older individuals with LCS in the LCS group and older individuals who were not diagnosed with COVID-19 in the CON (control) group. Physical performance of participants was evaluated with the Alusti Test, balance and gait assessment was evaluated with the Tinetti Balance and Gait Assessment (TBGA), and ADL were evaluated with the Barthel Index (BI). In the evaluations between groups, the mean score of active muscular mobility of right and left upper extremities, transfer supine position to sitting, trunk in sitting position and standing, which are among the subparameters of the Alusti Test, were statistically significantly lower in LCS compared to CON (p < .05). TBGA total score and gait section mean score of TBGA were statistically significantly lower in LCS than in CON (p < .05). There was no significant difference between the groups in the balance section of the TBGA and the mean BI scores (p > .05). It was concluded that physical performance parameters related to active muscular mobility of the upper extremity, transfer supine position to sitting, trunk in sitting position and walking in LCS were negatively affected by the disease, but this did not affect the level of balance and independence in ADL.

Effects of a Powered Ankle-Foot Prosthesis and Physical Therapy on Function for Individuals With Transfemoral Limb Loss: Rationale, Design, and Protocol for a Multisite Clinical Trial.

Powered ankle-foot prosthetic devices can generate net positive mechanical work during gait, which mimics the physiological ankle. However, gait deviations can persist in individuals with transfemoral limb loss because of habit or lack of rehabilitation. Prosthetic research efforts favor the design or evaluation of prosthetic componentry and rarely incorporate any type of rehabilitation, despite evidence suggesting that it is critical for minimizing gait imbalances. Given the accelerated rate of innovation in prosthetics, there is a fundamental knowledge gap concerning how individuals with transfemoral limb loss should learn to correctly use powered ankle-foot devices for maximum functional benefit. Because of the recent advances in prosthetic technology, there is also a critical unmet need to develop guidelines for the prescription of advanced prosthetic devices that incorporate both physical and psychological components to identify appropriate candidates for advanced technology. The primary goal of this investigation is to examine the roles of advanced prosthetic technology and a device-specific rehabilitative intervention on gait biomechanics, functional efficacy, and pain in individuals with transfemoral limb loss. The secondary goal is to develop preliminary rehabilitation guidelines for advanced lower limb prosthetic devices to minimize gait imbalances and maximize function and to establish preliminary guidelines for powered ankle-foot prosthetic prescription. This prospective, multisite study will enroll 30 individuals with unilateral transfemoral limb loss. At baseline, participants will undergo a full gait analysis and assessment of function, neurocognition, cognitive load, subjective preferences, and pain using their current passive prosthesis. The participants will then be fitted with a powered ankle-foot device and randomized into 2 equal groups: a powered device with a device-specific rehabilitation intervention (group A) or a powered device with the current standard of practice (group B). Group A will undergo 4 weeks of device-specific rehabilitation. Group B will receive the current standard of practice, which includes basic device education but no further device-specific rehabilitation. Data collection procedures will then be repeated after 4 weeks and 8 weeks of powered ankle use. This study was funded in September 2017. Enrollment began in September 2018. Data collection will conclude by March 2024. The initial dissemination of results is expected in August 2024. The projected trends indicate that the number of individuals with limb loss will dramatically increase in the United States. The absence of effective, evidence-based interventions may make individuals with transfemoral limb loss more susceptible to increased secondary physical conditions and degenerative changes. With this expected growth, considerable resources will be required for prosthetic and rehabilitation services. Identifying potential mechanisms for correcting gait asymmetries, either through advanced prosthetic technology or rehabilitative interventions, can provide a benchmark for understanding the optimal treatment strategies for individuals with transfemoral limb loss. ClinicalTrials.gov NCT03625921; https://clinicaltrials.gov/study/NCT03625921. DERR1-10.2196/53412.

Inertial Sensor Gait Analysis of Trendelenburg Gait in Patients Who Have Hip Osteoarthritis

BackgroundGait abnormalities such as Trendelenburg gait (TG) in patients who have hip osteoarthritis (OA) have traditionally been evaluated using clinicians’ visual assessment. Recent advances in portable inertial gait sensors offer more sensitive, quantitative methods for gait assessment in clinical settings. This study sought to compare sensor-derived metrics in a cohort of hip OA patients when stratified by clinical TG severity. MethodsThere were 42 patients who had hip OA and were grouped by TG severity (mild, moderate, and severe) through visual assessment by a single arthroplasty surgeon who had > 30 years of experience. After informed consent, wireless inertial sensors placed at the midpoint of the intercristal line collected gait parameters including pelvic shift, support time, toe-off symmetry, impact, and cadence. Clinical data on hip strength, range of motion, and Kellgren-Lawrence grade were collected. ResultsWorsening TG severity had a higher mean Kellgren-Lawrence grade (2.5 versus 3.2 versus 3.4; P = .014) and reduced passive hip abduction (P = .004). Severe TG group demonstrated predominantly contralateral pelvic shift (n = 9 of 10, 90.0%), while ipsilateral shift was more frequently detected in moderate (n = 10 of 18, 55.6%) and mild groups (n = 9 of 14, 64.3%; P = .021). Contralateral single support time bias was greatest in severe TG (35.7% versus 50.0 versus 90.0%; P = .027). Asymmetric toe-off, impact, and support times were observed in all groups. ConclusionsTraditional understanding of TG is that truncal shift occurs to the ipsilateral side. Using sensor-based measurements, the present study demonstrates a shift of the weight-bearing axis toward the contralateral side with increasing TG severity, which has not been previously described. Inertial sensors are feasible, quantitative gait measuring tools, and may reveal subtle patterns not readily discernible by traditional methods.

Fear of Falling Avoidance Behavior, but Not Fall History, Is Associated with Balance and Dynamic Gait Performance in Community-Dwelling Older Adults: A Cross-Sectional Study

Purpose: The purpose of this study was to determine relationships among balance confidence, fear of falling (FoF) avoidance behaviour, and high-level balance performance in community-dwelling older adults. Method: Eighty-nine participants [76 ± 7 (mean ± standard deviation) years, 54 females] completed the Activities-specific Balance Confidence Scale, Fear of Falling Avoidance Behavior Questionnaire, Functional Gait Assessment (FGA), Community Balance and Mobility Scale (CB&amp;M), and falls experienced in the past 12 months for this cross-sectional study. Results: Outcome measure (OM) scores did not differ between people who reported a fall and those without a fall. Correlations between all OMs varied from 0.52 to 0.88. FoF avoidance behaviour, but not fall history, was associated with lower scores on all measures. There were no floor or ceiling effects for the performance-based OMs. Conclusion: FoF avoidance behaviour did not differ between community-dwelling older adults with and without a previous fall. Participants who reported FoF avoidance behaviour had poorer balance performance, suggesting clinicians should assess high-level balance performance in older adults who exhibit FoF activity avoidance. Patient-reported OMs may identify older adults who need an assessment of dynamic balance and gait. The CB&amp;M and FGA are appropriate to assess high-level balance in older adults.

Improving orientation with respect to gravity enhances balance and gait recovery after stroke: DOBRAS cohort

BackgroundLateropulsion is a deficit in body orientation with respect to gravity, frequent after stroke. Although it is a primary factor affecting mobility, the impact of its attenuation on balance and gait recovery has never been investigated. Moreover, most studies on the lateropulsion time-course focus on severe forms suspected to have a poor recovery, which is not proven. ObjectivesTo investigate lateropulsion attenuation and test 2 hypotheses: 1) lateropulsion attenuation greatly contributes to balance and gait recovery and 2) severe forms of lateropulsion recover slower than moderate forms. MethodsThis longitudinal study involved individuals included in the Determinants of Balance Recovery After Stroke (DOBRAS) cohort, after a first-ever hemispheric stroke, with data collected on day 30 (D30), D60 and D90 post-stroke. Body orientation with respect to gravity was assessed using the Scale for Contraversive Pushing (both scores and severity grouping), in parallel with balance (Postural Assessment Scale for Stroke) and gait (modified Fugl-Meyer Gait Assessment). ResultsAmong the 106 eligible individuals (mean age 66.5 [SD 9.7] years), on D30, 43 (41%) were considered upright and 63 (59%) showed lateropulsion: 30 (28%) moderate and 33 (31%) severe. Most individuals with lateropulsion (73%) improved their body orientation, progressing from severe to moderate lateropulsion, or becoming upright. However, half were still not upright on D90. The improvement in body orientation had a large impact on mobility, especially in individuals with severe lateropulsion, in whom it explained about 50% of balance and gait recovery between D30 and D60, then 20% (D60-D90). For moderate lateropulsion, its attenuation explained about 20% of balance and gait recovery until D90. Lateropulsion attenuation was not slower in individuals with severe forms. ConclusionsLateropulsion attenuation enhances balance and gait recovery in individuals after stroke suggesting that specific rehabilitation of body orientation with respect to gravity might help to recover mobility. RegistrationNCT03203109

1964 Wearable devices to measure gait and balance remotely that could be used in Comprehensive Geriatric Assessment: A scoping review

Abstract Introduction Comprehensive Geriatric Assessment (CGA) is widely used in the management and assessment of older people living with frailty, however optimal ways of delivering CGA are not well understood. Gait and balance impairments, common in those living with frailty, are assessed in CGA. Advancements in digital technology provide opportunities to improve patient outcomes by digital monitoring, rather than observation-based assessments - which may be less accurate. As part of the Digital and Remote Enhancements for the Assessment and Management of older people living with frailty (DREAM) study, the aim of this review was to identify devices to assess gait and balance remotely, to enhance CGA. Methods Searches were conducted across six databases. Papers published since 2008 were included if: participants were over 65; evaluated gait or balance using wearable technology suitable for community use; presented data on validity, reliability, or acceptability of the device. Results Of 6,203 papers identified, 48 papers were included evaluating 49 devices. 35 evaluations assessed gait, 7 assessed balance, and 7 assessed gait and balance. The most common modality was a single sensor (n= 30) on a participants’ back (n=22). Seven studies assessed more than one aspect of validity, but the majority examined criterion validity (n=35) and reliability (n=12). Good-excellent agreement between the wearable and a comparable method of analysing gait/balance was found in 15 studies. Devices could distinguish between healthy populations and those with Parkinson’s disease (n=8), cognitive impairment (n=4), falls (n=4), mobility disability (n=3) and frailty (n=3). Conclusion Wearable technologies offer accurate and reliable assessment of gait and balance that could be used to enhance CGA. These tools could be applied remotely in domiciliary settings, freeing up healthcare professionals to focus on other components of CGA, such as ensuring the delivery of interventions to address identified gait and balance impairment.

Performance during attention-demanding walking conditions in older adults

BackgroundConventional balance and gait assessments for fall risk screening are often conducted under unperturbed conditions. However, older adults can allocate their attention to motor tasks (balance or walking) without revealing performance deficiencies, posing a challenge in identifying those with compromised gait and balance. Research questionsDo community-dwelling older adults exhibit greater changes in cognitive and/or walking performance under balance-challenging conditions compared to typical dual-task walking conditions? MethodsTwenty-nine healthy, community-dwelling older adults performed four cognitive tasks (visual and auditory Stroop tasks, Clock task, and Paced Auditory Serial Addition Test) while walking with and without lateral treadmill sways (Perturbed vs. Unperturbed) and during standing. We calculated dual-task costs (DTC) and walking perturbation effects (WPE) as the percentage of change in cognitive and walking performance between dual and single-task conditions and between Perturbed and Unperturbed conditions, respectively. ResultsOlder adults exhibited similar DTC and WPE on cognitive task performance. However, in walking performance, they demonstrated significantly greater WPE than DTC across all gait and stability measures (p < 0.01), including the mean and variability of stride and margins of stability (MOS) measures, the variability of trunk movement and lower-limb joint angles, and the local stability measures. Older adults took shorter but wider steps, exhibited shorter MOSAP but greater MOSML, and experienced increased movement variability and walking instability to a greater extent than during dual-task walking. Overall, changes in variability and stability measures were more pronounced than those in mean gait measures. SignificanceIntroducing destabilizing perturbations to increase the task demands of balance and gait assessments is a more effective method to challenge older adults compared to simply adding a concurrent cognitive task. Fall screening assessments for community-dwelling older adults should incorporate balance-challenging conditions, such as introducing gait perturbations.

Gait smoothness during high-demand motor walking tasks in older adults with mild cognitive impairment.

Early signs of Mild Cognitive Impairment (MCI)-related gait deficits may be detected through the performance of complex walking tasks that require high gait control. Gait smoothness is a robust metric of overall body stability during walking. This study aimed to explore gait smoothness during complex walking tasks in older adults with and without MCI. Participants were 18 older adults with MCI (mean age = 67.89 ± 4.64 years) and 18 cognitively intact controls (mean age = 67.72 ± 4.63 years). Gait assessment was conducted under four complex walking tasks: walking a narrow path, walking around an obstacle, horizontal head turns while walking, and vertical head turns while walking. The index of harmonicity (IH), representing gait smoothness associated with overall body stability, was measured in anteroposterior, mediolateral, and vertical directions. A multivariate analysis was employed to compare the differences in IH between groups for each complex walking task. The MCI group demonstrated a reduction of IH in the mediolateral direction during the horizontal head turns than the control group (MCI group = 0.64 ± 0.16, Control group = 0.74 ± 0.12, p = 0.04). No significant differences between groups were found for the IH in other directions or walking conditions. These preliminary findings indicate that older adults with MCI have a decline in step regularity in the mediolateral direction during walking with horizontal head turns. Assessment of the smoothness of walking during head turns may be a useful approach to identifying subtle gait alterations in older adults with MCI, which may facilitate timely gait intervention.

Relationships between mediolateral step modulation and clinical balance measures in people with chronic stroke

BackgroundMany people with chronic stroke (PwCS) exhibit walking balance deficits linked to increased fall risk and decreased balance confidence. One potential contributor to these balance deficits is a decreased ability to modulate mediolateral stepping behavior based on pelvis motion. This behavior, hereby termed mediolateral step modulation, is thought to be an important balance strategy but can be disrupted in PwCS. Research questionAre biomechanical metrics of mediolateral step modulation related to common clinical balance measures among PwCS? MethodsIn this cross-sectional study, 93 PwCS walked on a treadmill at their self-selected speed for 3-minutes. We quantified mediolateral step modulation for both paretic and non-paretic steps by calculating partial correlations between mediolateral pelvis displacement at the start of each step and step width (ρSW), mediolateral foot placement relative to the pelvis (ρFP), and final mediolateral location of the pelvis (ρPD) at the end of the step. We also assessed several common clinical balance measures (Functional Gait Assessment [FGA], Activities-specific Balance Confidence scale [ABC], self-reported fear of falling and fall history). We performed Spearman correlations to relate each biomechanical metric of step modulation to FGA and ABC scores. We performed Wilcoxon rank sum tests to compare each biomechanical metric between individuals with and without a fear of falling and a history of falls. ResultsOnly ρFP for paretic steps was significantly related to all four clinical balance measures; higher paretic ρFP values tended to be observed in participants with higher FGA scores, with higher ABC scores, without a fear of falling and without a history of falls. However, the strength of each of these relationships was only weak to moderate. SignificanceWhile the present results do not provide insight into causality, they justify future work investigating whether interventions designed to increase ρFP can improve clinical measures of post-stroke balance in parallel.

Insole Pressure Sensors to Assess Post-Stroke Gait.

To confirm that the simplified insole does not affect the gait speed and to identify objective sensor-based gait parameters that correlate strongly with existing clinical gait assessment scales. Ten participants with gait impairment due to hemiplegic stroke were enrolled in this study. Pairs of insoles with four pressure sensors on each side were manufactured and placed in each shoe. Data were extracted during the 10-Meter Walk Test. Several sensor-derived parameters (for example stance time, heel_on-to-toe_peak time, and toe_peak pressure) were calculated and correlated with gait speed and lower extremity Fugl-Meyer (F-M) score. The insole pressure sensor did not affect gait, as indicated by a strong correlation (ρ=0.988) and high agreement (ICC=0.924) between the gait speeds with and without the insole. The parameters that correlated most strongly with highest β coefficients against the clinical measures were stance time of the non-hemiplegic leg (β=-0.87 with F-M and β=-0.95 with gait speed) and heel_on-to-toe_peak time of the non-hemiplegic leg (β=-0.86 with F-M and -0.94 with gait speed). Stance time of the non-hemiparetic leg correlates most strongly with clinical measures and can be assessed using a non-obtrusive insole pressure sensor that does not affect gait function. These results suggest that an insole pressure sensor, which is applicable in a home environment, may be useful as a clinical endpoint in post-stroke gait therapy trials.

Retrograde procedural memory is impaired in people with Parkinson's disease with freezing of gait.

Freezing of gait (FOG), is associated with impairment of different cognitive functions. Previous studies hypothesized that FOG may be due to a loss of automaticity. To explore whether FOG is associated with impairment in cognitive functions, focusing on retrograde procedural memory, the memory responsible for the automatic, implicit stored procedures that have been acquired in earlier life stages. In this cross-sectional, case-control study, 288 people with typical Parkinson's disease (PD) from the Luxembourg Parkinson's Study were assigned to Freezers (FOG+) and non-Freezers (FOG-) based on the MDS-UPDRS 2.13 (self-reported FOG episodes) and 3.11 (FOG evaluated by clinicians during gait assessment). Both groups were matched on age, sex and disease duration. Global cognition (MoCA), retrograde procedural memory and visuo-constructive abilities (CUPRO), psychomotor speed and mental flexibility (TMT) were assessed. Furthermore, we repeated our analyses by additionally controlling for depression (BDI-I). Besides lower global cognition (MoCA; p = 0.007) and mental flexibility (TMT-B and Delta-TMT; p < 0.001), FOG+ showed a lower performance in retrograde procedural memory (CUPRO-IS1; p < 0.001) compared to FOG-. After controlling additionally for depression, our main outcome variable CUPRO-IS1 remained significantly lower in FOG+ (p = 0.010). Our findings demonstrated that besides lower global cognition and mental flexibility scores, FOG+ showed lower performance in retrograde procedural memory compared to matched FOG-control patients, even when accounting for factors such as age, sex, disease duration or depression. In the context of limited treatment options, especially for non-invasive therapeutic approaches, these insights on procedural memory and FOG may lead to new hypotheses on FOG etiology and consequently the development of new treatment options.

Effects of device-performed and manual hip traction and vibration therapy in older adults with symptomatic hip osteoarthritis: A randomized single-blind controlled trial.

Traction-and-vibration-therapy (TVT) relieves pain in participants with hip osteoarthritis. Hip TVT is usually performed manually by the physiotherapist. A medical device was developed to perform hip-TVT in order to investigate effects on hip disability, pain intensity, recovery of balance and functional mobility in older adults with hip osteoarthritis and also to reduce physiotherapists' workload and help standardize treatment of hip TVT. In a block-randomized 3-month controlled trial involving 28 older adult participants with symptomatic primary hip osteoarthritis (SPHOA), one group (n= 10) received device-performed TVT, one (n= 10) manual TVT, and one (n= 8) sham/placebo therapy. Hip disability (Harris Hip Score), pain intensity (visual-analog-scale), recovery of balance and gait (Functional Gait Assessment) and functional mobility (Timed-Up-and-Go-test) were assessed at baseline, after 3 weeks without intervention, and after 3-month intervention. The Device TVT and Manual TVT groups exhibited superior outcomes compared to the Placebo group in terms of hip disability (p= 0.005 and p< 0.001, respectively), pain intensity (p= 0.002 and p< 0.001, respectively), and functional mobility (TUG) (p= 0.012 and p= 0.011, respectively). Furthermore, the recovery of balance and gait (FGA) showed a significant improvement in the Device TVT group when compared to the Placebo group (p= 0.043). The effect sizes ranged from 0.17 to 0.51, indicating moderate to large effects. Device-performed-TVT is comparable to manual hip-TVT for reducing pain and improving mobility in older adults with SPHOA, and may be beneficial in terms of reducing physiotherapists' workload and better therapy standardization.

American Geriatrics Society response to the World Falls Guidelines.

Falls are a major cause of preventable death, injury, and reduced independence in adults aged 65 years and older. The American Geriatrics Society and British Geriatrics Society (AGS/BGS) published a guideline in 2001, revised in 2011, addressing common risk factors for falls and providing recommendations to reduce fall risk in community-dwelling older adults. In 2022, the World Falls Guidelines (WFG) Task Force created updated, globally oriented fall prevention risk stratification, assessment, management, and interventions for older adults. Our objective was to briefly summarize the new WFG, compare them to the AGS/BGS guideline, and offer suggestions for implementation in the United States. We reviewed 11 of the 12 WFG topics related to community-dwelling older adults and agree with several additions to the prior AGS/BGS guideline, including assessment and intervention for hearing impairment and concern for falling, assessment and individualized exercises for older adults with cognitive impairment, and performing a standardized assessment such as STOPPFall before prescribing a medication that couldpotentially increase fall risk. Notable areas of difference include: (1) AGS continues to recommend screening all patients aged 65+ annually for falls, rather than just those with a history of falls or through opportunistic case finding; (2) AGS recommends continued use of the Timed Up and Go as a gait assessment, rather than relying on gait speed; and (3) AGS recommends clinical judgment on whether or not to check an ECG for those at risk for falling. Our review and translation of the WFG for a US audience offers guidance for healthcare and other providers and teams to reduce fall risk in older adults.

Avaliação da eficácia clínica do uso de células-tronco mesenquimais alógenas derivadas de tecido adiposo no tratamento da osteoartrite secundária a displasia coxofemoral em cães

ABSTRACT: This study assessed the efficacy of an intra-articular injection of allogeneic adipose tissue-derived from mesenchymal stem cells (AD-MSCs) for the treatment of hip dysplasia in dogs. The study group included 12 otherwise healthy dogs of different breeds, ages, weights, and degrees of hip dysplasia diagnosed using radiography. An orthopedic assessment was performed on all dogs before and at 30, 60, and 90 days after infusion of AD-MSCs(2 × 106cells). On the same days, each dog’s owner answered a questionnaire based on theHelsinkiChronic Pain Index. The data were converted to ordinal data based on the score for each variable, and the Friedman test for multiple comparisons was used to verify the results. Compared with the corresponding values on day 0, orthopedic and gait assessments and owners’ reported pain indexes improved over the 90-day observation period. These results suggested that treatment with allogeneic AD-MSCs significantly reduced the clinical signs associated with hip dysplasia during the study period. However, long-term studies are needed to determine the optimal therapeutic protocol for routine clinical use of AD-MSCs in hip dysplasia.

The Effect of Short-Term Kinesiology Taping on Neuromuscular Controls in Hallux Valgus During Gait: A Study of Muscle and Kinematic Synergy.

To investigate the biomechanical mechanisms underlying the pathogenesis and explore the effects of kinesiology taping (KT) on neuromuscular control in HV patients. The study population consisted of 16 young controls (YC group) and 15 patients with hallux valgus (HV group). All subjects underwent a natural velocity gait assessment. Additionally, 11 patients from the HV group received KT intervention over a period of one month, consisting of 15 sessions administered every other day. After the one-month intervention, these patients underwent a gait assessment and were included in the HV-KT group. The electromyography (EMG) and joint motion were evaluated using non-negative matrix factorization (NNMF) to compare the difference in muscle and kinematic synergy among the three groups. The center of plantar pressure (COP) and ground reaction force (GRF) were measured by the force platform. The number of synergies did not differ within the three groups, but the structure of muscle synergies and kinematic synergies differed in the HV group. The KT intervention (HV-KT group) altered the structure of synergies. The correlation between kinematic synergies and muscular synergies was lower in the HV group than in the YC group, whereas the correlation between the two increased after the KT intervention in the HV group. During gait, the HV group tended to activate more muscles around foot joints to maintain body stability. The visual analogue scale (VAS) scores, hallux valgus angle (HVA), and COP were significantly decreased after the intervention ( [Formula: see text]). HV patients exhibited altered kinematic and muscular synergies structures as well as muscle activation. Also, it weakened the balance and athletic ability of HV patients. KT intervention improved neuromuscular control to provide a better gait performance.

Investigating health disparities in vestibular rehabilitation.

Health disparities (HD) impact care delivery and health outcomes in individuals with vestibular disorders (IVD). The purpose of this study is to identify whether health disparities (HD) exist in Vestibular Rehabilitation (VR) between individuals identifying as Caucasians or racial or ethnic minorities (REM). This study was a retrospective chart review of IVD who attended outpatient VR between 1/2014 and 9/2020. Data recorded included age, gender, race/ethnicity, vestibular diagnosis, VR interventions, and pre-post outcome measures such as Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC), Gait speed (GS), and Functional Gait Assessment (FGA). Chi-squared tests, one-tailed, and two-tailed t-tests (α= 0.05) were utilized to compare Caucasian and REM groups. Three hundred and forty-three charts (N = 343) met inclusion/exclusion criteria. REM demonstrated higher median DHI scores (46 vs. 38, p = 0.008) and lower ABC scores (53.10% vs. 66.30%, p < 0.001) at VR evaluation compared to Caucasians. There were no statistically significant differences in DHI, ABC, FGA, and GS scores between Caucasians and REM at discharge. VR was able to equalize HD in DHI and ABC which initially existed between REM and Caucasians. VR therapists should work with public health and policy researchers to improve access to VR.

BlazePose-Seq2Seq: Leveraging Regular RGB Cameras for Robust Gait Assessment.

Evaluation of human gait through smartphone-based pose estimation algorithms provides an attractive alternative to costly lab-bound instrumented assessment and offers a paradigm shift with real time gait capture for clinical assessment. Systems based on smart phones, such as OpenPose and BlazePose have demonstrated potential for virtual motion assessment but still lack the accuracy and repeatability standards required for clinical viability. Seq2seq architecture offers an alternative solution to conventional deep learning techniques for predicting joint kinematics during gait. This study introduces a novel enhancement to the low-powered BlazePose algorithm by incorporating a Seq2seq autoencoder deep learning model. To ensure data accuracy and reliability, synchronized motion capture involving an RGB camera and ten Vicon cameras were employed across three distinct self-selected walking speeds. This investigation presents a groundbreaking avenue for remote gait assessment, harnessing the potential of Seq2seq architectures inspired by natural language processing (NLP) to enhance pose estimation accuracy. When comparing BlazePose alone to the combination of BlazePose and 1D convolution Long Short-term Memory Network (1D-LSTM), Gated Recurrent Unit (GRU) and Long Short-Term Memory (LSTM), the average mean absolute errors decreased from 13.4° to 5.3° for fast gait, from 16.3° to 7.5° for normal gait, and from 15.5° to 7.5° for slow gait at the left ankle joint angle respectively. The strategic utilization of synchronized data and rigorous testing methodologies further bolsters the robustness and credibility of these findings.

A Quantitative Gait Assessment Approach Using a Wearable Device and Its Validation for Different Neurological Disorder Conditions

Improving independent mobility in people with various gait abnormalities is a major goal of rehabilitation therapy. While quantitative gait assessment is crucial to provide meaningful feedback on each treatment, many gait wearables have been validated with the standard method. However, none of the studies focused on validation of gait characterization in different classes of the pathological population compared with the control population. Hence, a novel wearable device called Gait Watch, worn on both the lower limbs, to estimate spatiotemporal and kinematic parameters of heterogeneous gait-impaired groups has been evaluated and its outcomes have been statistically analyzed. This article presents a statistical validation of gait dynamics of the control group and patients diagnosed with cerebral vascular accident, traumatic brain injury, peripheral nervous system, psychiatric issues, and seizures. Using the preliminary analysis results, a set of descriptive variables that allow for disease differentiation was selected to provide appropriate treatment to patients with various ailments and enhance their gait quality. The extraction of clinically significant gait parameters of interest using proposed Gait Watch would ascertain various neurological conditions as well as accurately quantify the extent of the difference in various gait parameters in subjects with different gait conditions when compared with the control group.