Gait Quality Research Articles

Functional trajectories during innate spinal cord repair.

Adult zebrafish are capable of anatomical and functional recovery following severe spinal cord injury. Axon growth, glial bridging and adult neurogenesis are hallmarks of cellular regeneration during spinal cord repair. However, the correlation between these cellular regenerative processes and functional recovery remains to be elucidated. Whereas the majority of established functional regeneration metrics measure swim capacity, we hypothesize that gait quality is more directly related to neurological health. Here, we performed a longitudinal swim tracking study for 60 individual zebrafish spanning 8 weeks of spinal cord regeneration. Multiple swim parameters as well as axonal and glial bridging were integrated. We established rostral compensation as a new gait quality metric that highly correlates with functional recovery. Tensor component analysis of longitudinal data supports a correspondence between functional recovery trajectories and neurological outcomes. Moreover, our studies predicted and validated that a subset of functional regeneration parameters measured 1 to 2 weeks post-injury is sufficient to predict the regenerative outcomes of individual animals at 8 weeks post-injury. Our findings established new functional regeneration parameters and generated a comprehensive correlative database between various functional and cellular regeneration outputs.

Instrumental assessment of dynamic postural stability in patients with unilateral vestibular hypofunction during straight, curved, and blindfolded gait.

To characterise dynamic postural stability of gait in patients with vestibular hypofunction (PwVH) using a sensor-based assessment while performing dynamic tasks and to correlate the results of this evaluation with clinical scales. This cross-sectional study involved 22 adults between 18 and 70years old from a healthcare hospital centre. Eleven patients suffering from chronic vestibular hypofunction (PwVH) and eleven healthy controls (HC) were evaluated through a combined inertial sensor-based and clinical scale assessment. Participants were equipped with five synchronised inertial measurement units (IMUs) (128Hz, Opal, APDM, Portland, OR, USA): three IMUs were located on the occipital cranium bone, near the lambdoid suture of the head, at the centre of the sternum, and at L4/L5 level, just above the pelvis, and were used to quantify gait quality parameters, while the other two were located slightly above lateral malleoli and used to perform stride and step segmentation. Three different motor tasks were performed in a randomized order: the 10-m Walk Test (10mWT), the Figure of Eight Walk Test (Fo8WT) and the Fukuda Stepping Test (FST). A set of gait quality parameters related to stability, symmetry and smoothness of gait were extracted from IMU data and correlated with the clinical scale scores. PwVH and HC results were compared to test for significant between-group differences. Significant differences were found for the three motor tasks (10mWT, Fo8WT and FST) when comparing PwVH and HC groups. For the 10mWT and the Fo8WT, significant differences between the PwVH and HC groups were found for the stability indexes. Considering the FST, significant differences between the PwVH and HC groups were also found in the stability and symmetry of gait. A significant correlation was found between the Dizziness Handicap Inventory and gait indices during the Fo8WT. In this study, we characterized the dynamic postural stability alterations during linear, curved, and blindfolded walking/stepping in PwVH combining an instrumental IMU-based with traditional clinical scales approach. Combining instrumental and clinical evaluation for dynamic stability of gait alterations in PwVH is useful in thoroughly evaluating the effects of unilateral vestibular hypofunction.

A randomized, triple-blinded controlled clinical study with a novel disease-modifying drug combination in equine lameness-associated osteoarthritis

ObjectiveThis study aimed to test a novel treatment combination (TC) (equivalent to sildenafil, mepivacaine, and glucose) with disease-modifying properties compared to Celestone® bifas® (CB) in a randomized triple-blinded phase III clinical study in horses with mild osteoarthritis (OA). Joint biomarkers (reflecting the articular cartilage and subchondral bone remodelling) and clinical lameness were used as readouts to evaluate the treatment efficacy. MethodsTwenty horses with OA-associated lameness in the carpal joint were included in the study and received either TC (n = 10) or CB (n = 10) drug intra-articularly-twice in the middle carpal joint with an interval of 2 weeks (visit 1 & 2). Clinical lameness was assessed both objectively (Lameness locator) and subjectively (visually). Synovial fluid and serum were sampled for quantification of the extracellular matrix (ECM) neo-epitope joint biomarkers represented by biglycan (BGN262) and cartilage oligomeric matrix protein (COMP156). Another two weeks later clinical lameness was recorded, and serum was collected for biomarkers analysis. The overall health status was compared pre and post-intervention by interviewing the trainer. ResultsPost-intervention, SF BGN262 levels significantly declined in TC (P = 0.002) and COMP156 levels significantly increased in CB (P = 0.002). The flexion test scores improved in the TC compared to CB (P =0.033) and also had an improved trotting gait quality (P =0.044). No adverse events were reported. ConclusionThis is the first clinical study presenting companion diagnostics assisting in identifying OA phenotype and evaluating the efficacy and safety of a novel disease-modifying osteoarthritic drug.

Stepping beyond Counts in Recovery of Total Knee Arthroplasty: A Prospective Study on Passively Collected Gait Metrics

Advances in algorithms developed from sensor-based technology data allow for the passive collection of qualitative gait metrics beyond step counts. The purpose of this study was to evaluate pre- and post-operative gait quality data to assess recovery following primary total knee arthroplasty. This was a multicenter, prospective cohort study. From 6 weeks pre-operative through to 24 weeks post-operative, 686 patients used a digital care management application to collect gait metrics. Average weekly walking speed, step length, timing asymmetry, and double limb support percentage pre- and post-operative values were compared with a paired-samples t-test. Recovery was operationally defined as when the respective weekly average gait metric was no longer statistically different than pre-operative. Walking speed and step length were lowest, and timing asymmetry and double support percentage were greatest at week two post-operative (p < 0.0001). Walking speed recovered at 21 weeks (1.00 m/s, p = 0.063) and double support percentage recovered at week 24 (32%, p = 0.089). Asymmetry percentage was recovered at 13 weeks (14.0%, p = 0.23) and was consistently superior to pre-operative values at week 19 (11.1% vs. 12.5%, p < 0.001). Step length did not recover during the 24-week period (0.60 m vs. 0.59 m, p = 0.004); however, this difference is not likely clinically relevant. The data suggests that gait quality metrics are most negatively affected two weeks post-operatively, recover within the first 24-weeks following TKA, and follow a slower trajectory compared to previously reported step count recoveries. The ability to capture new objective measures of recovery is evident. As more gait quality data is accrued, physicians may be able to use passively collected gait quality data to help direct post-operative recovery using sensor-based care pathways.

Application of the Ridden Horse Pain Ethogram to 150 Horses with Musculoskeletal Pain before and after Diagnostic Anaesthesia.

The Ridden Horse Pain Ethogram (RHpE) was developed to facilitate the recognition of musculoskeletal pain. The aim of this study was to document changes in RHpE scores before and after diagnostic anaesthesia was performed to alleviate pain ± when the saddle was changed. One hundred and fifty horses underwent ridden exercise as part of an investigation of poor performance. The RHpE was applied before and after the interventions. Fifty-two (34.7%) horses exhibited a bilaterally symmetrical short step length and/or restricted hindlimb impulsion and engagement. Fifty-three (35.3%) horses had episodic lameness; only forty-five (30.0%) horses were continuously lame. The median maximum lameness grade when ridden was 2/8 (interquartile range [IQR]: 0-3; range: 0-4). Fifty-six (37.3%) horses had an ill-fitting saddle, which was considered likely to influence performance. The median RHpE scores after the interventions (2/24 [IQR: 1-3, range: 0-12]) were significantly lower than before the interventions (9/24 [IQR: 8-11, range: 2-15]) (Wilcoxon signed-rank z = 10.6, p < 0.001). There was no correlation between the RHpE score and maximum lameness grade before diagnostic anaesthesia (Spearman's rho = 0.09, p = 0.262). It was concluded that the absence of overt lameness does not preclude primary musculoskeletal pain. Gait quality and performance can be improved by diagnostic anaesthesia, with substantial reductions in RHpE scores.

Virtual Reality Impact on Fatigue, Quality of Life, Gait and Balance in Patients with Multiple Sclerosis: A Narrative Review

Virtual Reality Impact on Fatigue, Quality of Life, Gait and Balance in Patients with Multiple Sclerosis: A Narrative Review

Gait quality after robot therapy compared with physiotherapy in the patient with incomplete spinal cord injured: A systematic review.

Spinal cord injury results in the interruption of neuronal conduction in the spinal cord, a condition that occurs in 0.1% of the world's population. This results in severe limitations in autonomy including locomotor function. Its recovery can be pursued through conventional isolated physiotherapeutic rehabilitation (overground walking training - OGT) or associated with Robot-assisted gait training - RAGT (e.g.: Lokomat ®). The aim of this review is to compare the effectiveness of RAGT combined with conventional physiotherapy. The databases consulted, from March 2022 to November 2022, were PubMed, PEDro, Cochrane Central Register of Controlled Trials (Cochrane Library) and CINAHL. RCT studies of people with incomplete spinal cord injuries treated with RAGT and/or OGT with the aim of improving walking were analysed. Among the 84 RCTs identified, 4 were included in the synthesis, with a total of 258 participants. The outcomes analysed concerned both locomotor function through lower limb muscle strength and the need for assistance in walking, using the WISCI-II scale and the LEMS. Robotic treatment stimulated the greatest improvements in the four studies; however, they were not always statistically significant. A rehabilitation protocol combining RAGT with conventional physiotherapy is more effective than isolated OGT in improving ambulation in the subacute phase.

Short and Middle Functional Outcome in the Static vs. Dynamic Fixation of Syndesmotic Injuries in Ankle Fractures: A Retrospective Case Series Study.

Syndesmotic injuries are common lesions associated with ankle fractures. Static and dynamic fixation are frequently used in syndesmotic injury-associated ankle fractures. The purpose of this study is to compare short- and mid-term quality of life, clinical outcomes, and gait after static stabilization with a trans-syndesmotic screw or dynamic stabilization with a suture button device. Here, 230 patients were enrolled in a retrospective observational study. They were divided in two groups according to the fixation procedure (Arthrex TightRope®, Munich, Germany) synthesis vs. osteosynthesis with a 3.5 mm trans-syndesmotic tricortical screw). They then underwent clinical assessment using the American Foot and Ankle Score (AOFAS) at 1, 2, 6, 12, and 24 months after surgery. Quality of life was assessed according to the EuroQol-5 Dimension (EQ-5D) at 2 and 24 months after surgery in the follow-up; gait analysis was performed 2 and 24 months postoperatively. Significant differences were found at a two-month follow-up according to the AOFAS (p = 0.0001) and EQ-5D (p = 0.0208) scores. No differences were noted in the other follow-ups (p > 0.05) or gait analysis. The dynamic and static fixation of syndesmotic injuries in ankle fracture are both efficacious and valid procedures for avoiding ankle instability. The suture button device was comparable to the screw fixation according to functional outcomes and gait analysis.

Early post-operative walking bouts are associated with improved gait speed and symmetry at 90 days

IntroductionThere is a paucity of literature on optimal patterns of daily walking following joint arthroplasty, which are now evaluated with consumer technologies like smartphones, and can enhance our understanding of post-operative mobility. When smartphone-recorded, daily walking patterns are captured, qualities of gait-recovery such as gait speed or symmetry can be analyzed in real-world environments. Research questionAre the daily distribution of walking bouts in the early post-operative period associated with 90-day gait quality measures following hip and knee arthroplasty? MethodsGait data was collected passively using a smartphone-based care management platform in patients undergoing hip and knee arthroplasty. As recorded via subjects’ free-living smartphone-collected gait bouts, data were investigated as a function of the walking session length and were used to create a ratio to the total time logging bouts, representing the fraction of walking performed during a single session per day (aggregation score). Quantile regression was performed to evaluate the association between early walking session lengths or aggregation score at 30 days post-operatively and the gait-sampled speed and asymmetry of walking at 90 days. ResultsIn total, 2255 patients provided evaluable data. The walking session length at 30 days was positively associated with 90-day mean gait speed across procedure types where quantile regression coefficients ranged from 0.11 to 0.17. In contrast, aggregation score was negatively associated with gait speed at 90 days, with coefficients ranging from −0.18 to −0.12. SignificanceThe duration and frequency of walking bouts was associated with recovery of gait speed and symmetry following lower limb arthroplasty. The findings may help clinicians design walking protocols that are associated with improved gait metrics at 3 months.

Selective Tibial Neurotomy Outcomes for Spastic Equinovarus Foot: Patient Expectations and Functional Assessment.

Spastic equinovarus foot (SEF) is a common dysfunctional foot posture after stroke that impairs balance and mobility. Selective tibial neurotomy (STN) is a simple but underutilized surgical option that can effectively address critical aspects of SEF and thereby provide enduring quality of life gains. There are few studies that examine both functional outcomes and patient satisfaction with this treatment option. To elucidate the patient goals that motivated their decision to undergo the procedure and compare subjective and objective changes in balance and functional mobility as a consequence of surgery. Thirteen patients with problematic SEF who had previously failed conservative measures were treated with STN. Preoperative and postoperative (on average 6 months) assessments evaluated gait quality and functional mobility. In addition, a custom survey was conducted to investigate patient perspectives on STN intervention. The survey showed that participants who opted for STN were dissatisfied with their previous spasticity management. The most common preoperative expectation for STN treatment was to improve walking, followed by improving balance, brace comfort, pain, and tone. Postoperatively, participants rated the improvement in their expectations and were, on average, 71 on a 100-point scale, indicating high satisfaction. The gait quality, assessed with the Gait Intervention and Assessment Tool, improved significantly between preoperative and postoperative assessment (M = -4.1, P = .01) with a higher average difference in stance of -3.3 than in swing -0.5. Improvement in both gait endurance (M = 36 m, P = .01) and self-selected gait speed (M = .12 m/s, P = .03) was statistically significant. Finally, static balance (M = 5.0, P = .03) and dynamic balance (M = 3.5, P = .02) were also significantly improved. STN improved gait quality and functional mobility and was associated with high satisfaction in patients with SEF.

37 Short-term effects of a single pulsed electromagnetic field therapy session on lameness, gait quality, and stress in moderately exercising horses

Pulsed electromagnetic field (PEMF) therapy is applied to equids for a variety of preexisting conditions; however, research with its usage to enhance performance in the horse is limited. To test the hypothesis that a single PEMF therapy session improved stress, performance, and lameness parameters, 14 horses (11 ± 4.1 years) underwent a single 30-min whole body PEMF therapy session at 5 Hz and a single sham therapy session where horses were randomly assigned to a treatment order. A 2-week washout period was given between treatments. Resting heart rate, salivary cortisol, stride length, quality of movement, and lameness evaluation (fore limb vector sum, hip height difference, forehand stride rate, hind stride rate) on crushed gravel and loose sand surfaces were evaluated at 8 different time points: immediately before and after treatment, and at 2, 4, 8, 24, 48, and 72 h post treatment. Videos were assessed for stride length and were assessed by 3 blinded, carded judges for quality of movement. Mixed model analysis for crossover design with repeated measures was used to determine the effect of treatment, time, period, and all interactions. At 7.5 h post treatment, horses were subjected to a 30 min lunge to simulate a moderate exercise session. Post hoc multiple comparisons were performed with Tukey's adjustment (mean ± SE).Heart rate was lowered immediately following PEMF treatment (29 ± 1 BPM, P < 0.0001) when compared with all other sampling time points. For quality of movement (1 = poor, 10 = excellent), judges found walk quality to decrease immediately following PEMF treatment (5.68 ± 0.18) and at 4 h post (5.59 ± 0.16) when compared with 2 h sham (5.98 ± 0.1, P = 0.006) while trot quality did not differ. Walk stride length was affected by time but not treatment, increasing at 8 h (2.49 ± 0.03 m) post treatment when compared with pre-treatment sampling (2.43 ± 0.04 m, P = 0.03) but not the trot. Salivary cortisol concentration was unaffected by treatment but did have an effect of time (P < 0.0001) varying depending on the time of day of the sample. Forehand and hind stride rate were affected by surface (P = 0.004, P = 0.004) with sand having a slower rate than gravel and time (P < 0.0001, P < 0.0001) slowing stride rate as the day progressed. No differences were observed with fore limb vector sum and hip height difference. This study shows PEMF therapy has a relaxing effect evidenced by lowered heart rate immediately following treatment; however, more work is needed to determine the full effects of PEMF in performance horses.

Functional Bandaging in Children with Idiopathic Toe-Walking.

Idiopathic toe-walking (ITW) is a persistent gait pattern with no known etiology characterized as premature heel rise or no heel contact. We investigated the effects of functional bandaging in children with ITW on heel contact during stance phase and on gait quality. Nineteen children aged 4 to 16 years with ITW and ten age-matched healthy children were included in the study. Elastic adhesive bandages were applied to children with ITW to assist with dorsiflexion. Before bandaging (T0) and immediately (T1) and 1 week (T2) after initial bandaging, the initial contact, loading response, and midstance subphases of gait were analyzed using light pressure sensors and the Edinburgh Visual Gait Score (EVGS). Ten age-matched children with typical gait participated for comparison in T0. The data were analyzed with Friedman and Wilcoxon signed rank tests for within-group comparisons and Mann-Whitney U tests for between-group comparisons. In T0, for the ITW group, no heel contact was observed during stance. In T1, all of the participants achieved heel contact at initial contact and loading response and 56.8% at midstance. In T2, all of the heels continued contact at initial contact and loading response and 54.3% at midstance. The EVGS significantly improved. The Friedman test showed that there were noteworthy improvements between T0-T1 and T0-T2 in video-based observational gait analysis and EVGSs (P < .001), although no difference was found between T1-T2 in video-based observational gait analysis (P = .913) and EVGSs (P = .450). In children with ITW, dorsiflexion assistive functional bandaging was an effective tool to help achieve heel contact on the ground and improve walking quality for a short period after application. Further studies with longer follow-up and larger sample sizes are required to confirm the long-term therapeutic effects of this promising functional bandaging.

45 Quantifying gait quality changes in fragile foal syndrome carriers using artificial intelligence

The domestic horse has remarkable locomotor polymorphisms valuable to study of genetic musculoskeletal diseases and their effect on gait quality. Here we investigate a polymorphism in the PLOD1 gene, responsible for Fragile Foal Syndrome (FFS), as it impacts the organization of collagen fibers. We hypothesize that the changes in the biomechanical properties of tissues will result in change of locomotor phenotypes. We first addressed the need for a gait assessment tool that can accurately quantify various locomotor parameters. We created a pipeline built around the software package DeepLabCut (DLC), a user-friendly graphical user interface (GUI) written in Python, and a custom gait parameter calculator written in MatLab. DLC uses a pre-trained deep neural network model to apply 22 anatomical landmarks on jogging horses observed in video recordings. A custom GUI allows the user to perform error checks of the labels before the pipeline processes the raw marker coordinate files produced by DLC into geometric gait parameters. We then genotyped 138 horses in training for jumping competition by extracting DNA from the bulbs of pulled tail hair and running a PCR-RFLP test. We confirmed these genotypes via sanger sequencing. Of the 138 horses, 58 were purebred Thoroughbreds, 72 were warmbloods, and the remaining 8 were made up of stock horses. The carrier rate was n = 4 in Thoroughbreds, and n = 3in the warmbloods including an Irish Sport Horse, Sillia Argentina, and Holsteiner. We observed a FFS carrier frequency markedly higher in the Thoroughbred population than those reported in previous studies (6.9%, P = 0.015, Χ2 test). A Quadratic Discriminant Analysis then produced standardized coefficient scores for each of the 15 gait parameters to determine the best predictors of genotype within the model. The change in joint extension of both the hind and forelimb were the strongest predictors of genotype and indicated that FFS carriers had greater extension and swing of all 4 limbs. As a result, FFS carriers likely have an altered hoof flight path throughout the stride cycle. Future work will increase the sample size to capture more FFS carriers and will more precisely define the FFS locomotor phenotype. We will also apply this new phenotyping method to investigate changes in gait associated with other genetic variants for connective tissue disorders like HERDA and JEB. Improved quantification of gait parameters, and our understanding of the physiology of this and other known connective tissue disorders in the horse, will aid in future breeding and selection decisions to reduce injury risk and improve performance.

33 Assessing the effect of fatigue on stadium jumping penalty scores in elite three-day event horses utilizing artificial intelligence

Mandatory veterinary inspections assess lameness and fatigue to help predict the success of performance horses during competition. Horses competing at the international level in 3-d eventing must pass both mandatory inspections (pre-competition and post-cross country) to attempt the final phase: stadium jumping. With this in mind we hypothesize that quantifying the gait quality of horses for fatigue during the inspections will help predict if they will have faults in stadium jumping. However, these pass/fail exams are based on subjective and non-repeatable guidelines referencing the locomotor function of the horse, and do not have the ability to detect small gait changes over time. The development of artificial intelligence-based video analysis approaches allows for the objective production of quantitative scores which can be used to accurately assess the physical capability of the equine athlete. We quantified our custom gait parameter pipeline using the software package DeepLabCut (DLC) of horses at the trot during the veterinary inspections and analyzed 197 horses across 3 levels (CCI-2*, CCI-3*, and CCI-4*) and 5 venues. We used a Quadratic Discriminant Analysis to assign a standardized coefficient score, which we noted as a fatigue score, to all horses. Utilizing 3 common fatigueparameters in a multivariate model using the row-wise method we found stride length (P < 0.001) and speed (P < 0.001) had significant negative correlation probabilities, and stance time (P < 0.001) had a significant positive correlation probability with the fatigue scores. The significance supports the idea that a higher fatigue score is indicative of greater fatigue in the horse. We then applied a qualitative label to each horse, faults or no faults, where a horse with no faults had zero time and zero jump faults, and a horse with faults had any combination of the 2. Then we compared the horse's fatigue score to the qualitative label and found that horses with faults had a significantly higher (P = 0.0149, standard t-test) fatigue score suggesting that fatigue may impact stadium jumping performance more than previously appreciated. Further work investigating the impact of locomotor phenotypes and fatigue on competition performance will encourage the use of objective measures to protect sport horse welfare and improve training strategies, as well as providing the opportunity to add an objective tool to the procedures for mandatory veterinary inspections.

Evidence for the Efficacy of Commercially Available Wearable Biofeedback Gait Devices: Consumer-Centered Review.

The number of wearable technological devices or sensors that are commercially available for gait training is increasing. These devices can fill a gap by extending therapy outside the clinical setting. This was shown to be important during the COVID-19 pandemic when people could not access one-on-one treatment. These devices vary widely in terms of mechanisms of therapeutic effect, as well as targeted gait parameters, availability, and strength of the evidence supporting the claims. This study aimed to create an inventory of devices targeting improvement in gait pattern and walking behavior and identify the strength of the evidence underlying the claims of effectiveness for devices that are commercially available to the public. As there is no systematic or reproducible way to identify gait training technologies available to the public, we used a pragmatic, iterative approach using both the gray and published literature. Four approaches were used: simple words, including some suggested by laypersons; devices endorsed by condition-specific organizations or charities; impairment-specific search terms; and systematic reviews. A findable list of technological devices targeting walking was extracted separately by 3 authors. For each device identified, the evidence for efficacy was extracted from material displayed on the websites, and full-text articles were obtained from the scientific databases PubMed, Ovid MEDLINE, Scopus, or Google Scholar. Additional information on the target population, mechanism of feedback, evidence for efficacy or effectiveness, and commercial availability was obtained from the published material or websites. A level of evidence was assigned to each study involving the device using the Oxford Centre for Evidence-Based Medicine classification. We also proposed reporting guidelines for the clinical appraisal of devices targeting movement and mobility. The search strategy for this consumer-centered review yielded 17 biofeedback devices that claim to target gait quality improvement through various sensory feedback mechanisms. Of these 17 devices, 11 (65%) are commercially available, and 6 (35%) are at various stages of research and development. Of the 11 commercially available devices, 4 (36%) had findable evidence for efficacy potential supporting the claims. Most of these devices were targeted to people living with Parkinson disease. The reporting of key information about the devices was inconsistent; in addition, there was no summary of research findings in layperson's language. The amount of information that is currently available to the general public to help them make an informed choice is insufficient, and, at times, the information presented is misleading. The evidence supporting the effectiveness does not cover all aspects of technology uptake. Commercially available technologies help to provide continuity of therapy outside the clinical setting, but there is a need to demonstrate effectiveness to support claims made by the technologies.

A robust walking detection algorithm using a single foot-worn inertial sensor: validation in real-life settings.

Walking activity and gait parameters are considered among the most relevant mobility-related parameters. Currently, gait assessments have been mainly analyzed in laboratory or hospital settings, which only partially reflect usual performance (i.e., real world behavior). In this study, we aim to validate a robust walking detection algorithm using a single foot-worn inertial measurement unit (IMU) in real-life settings. We used a challenging dataset including 18 individuals performing free-living activities. A multi-sensor wearable system including pressure insoles, multiple IMUs, and infrared distance sensors (INDIP) was used as reference. Accurate walking detection was obtained, with sensitivity and specificity of 98 and 91% respectively. As robust walking detection is needed for ambulatory monitoring to complete the processing pipeline from raw recorded data to walking/mobility outcomes, a validated algorithm would pave the way for assessing patient performance and gait quality in real-world conditions.

Recovery Curves for Patient Reported Outcomes and Physical Function After Total Hip Arthroplasty

BackgroundPatient-reported outcome measures (PROMs) are frequently used for evaluating patient satisfaction and function following total hip arthroplasty (THA). Functional measures along with chronologic modeling may help set expectations perioperatively. Our goal was to define the trajectory of recovery and function in the first year following THA. MethodsProspective data from 1,898 patients in a multicenter study was analyzed. The PROMs included the Hip disability and Osteoarthritis Score for Joint Replacement and EuroQol-5 dimension. Physical activity was recorded on a wearable technology. Data was collected preoperatively and at 1, 3, 6, and 12 months postoperatively. Generalized estimating equations were used to evaluate outcomes over time. ResultsSignificant improvement occurred between preoperative and postoperative time points for all PROMs. The PROMs showed the greatest proportional recovery within the first month postoperatively, each improving by at least 1 minimal clinically important difference (MCID). Daily steps and flights of stairs took longer to reach at least 1 MCID (3 months and 1 year, respectively). Gait speed and walking asymmetry returned to baseline by 3 months, but did not reach a MCID of improvement by 1 year. ConclusionPatients can be counseled that the greatest proportional improvement in PROMs is within 1 month after THA, while function surpasses preoperative baselines by 3 months, and gait quality may not improve until after 1 year. This can help set realistic expectations and target interventions toward patients deviating from the norm.

Designing Ecological Auditory Feedback on Lower Limb Kinematics for Hemiparetic Gait Training.

Auditory feedback has earlier been explored as a tool to enhance patient awareness of gait kinematics during rehabilitation. In this study, we devised and tested a novel set of concurrent feedback paradigms on swing phase kinematics in hemiparetic gait training. We adopted a user-centered design approach, where kinematic data recorded from 15 hemiparetic patients was used to design three feedback algorithms (wading sounds, abstract, musical) based on filtered gyroscopic data from four inexpensive wireless inertial units. The algorithms were tested (hands-on) by a focus group of five physiotherapists. They recommended that the abstract and musical algorithms be discarded due to sound quality and informational ambiguity. After modifying the wading algorithm (as per their feedback), we conducted a feasibility test involving nine hemiparetic patients and seven physiotherapists, where variants of the algorithm were applied to a conventional overground training session. Most patients found the feedback meaningful, enjoyable to use, natural-sounding, and tolerable for the typical training duration. Three patients exhibited immediate improvements in gait quality when the feedback was applied. However, minor gait asymmetries were found to be difficult to perceive in the feedback, and there was variability in receptiveness and motor change among the patients. We believe that our findings can advance current research in inertial sensor-based auditory feedback for motor learning enhancement during neurorehabilitation.

Comparison of conventional socket attachment and bone-anchored prosthesis for persons living with transfemoral amputation - mobility and quality of life

BackgroundFor patients with transfemoral amputation experiencing issues with their sockets, bone-anchored prosthesis systems are an alternative and sometimes the only way to be mobile and independent. The present cross-sectional study aimed to investigate the gait performance and quality of life of a group of patients treated with bone-anchored systems compared to those of participants treated with a conventional socket-suspended prosthesis. MethodsA total of 17 participants with a socket-suspended and 20 with a bone-anchored prosthesis were included. Gait patterns were examined for symmetry, and performance was assessed using the six-minute walk test and the timed “Up & Go” test. Magnetic resonance imaging was performed to detect signs of osteoarthritis in both hips. Mobility in everyday life and quality of life were assessed using questionnaires. FindingsThere were no differences between the groups regarding the quality of life, daily mobility, and gait performance. The step width was significantly higher for the patients using socket-suspended prosthesis. The socket-suspended group showed a significant asymmetry regarding the step length. In the socket-suspended group, the prosthetic leg showed significantly higher cartilage abrasion than the contralateral leg did. InterpretationLarge differences in the measured outcomes in both groups illustrate the very different capabilities of the individual participants, which is apparently not primarily determined by the type of treatment. For patients who are satisfied with the socket treatment and perform well, bone-anchored prosthesis systems may not necessarily improve their functional capabilities and perceived quality of life.

Association Between Baby Walker Use and Infant Functional Motor Development.

The aim of this study was to determine the association between baby walker use and infant motor development, quality of gait, and potential development of lower extremity deformities. An anonymous survey was conducted among 6874 parents and legal guardians regarding the use of baby walkers, their children's development, and the occurrence of lower extremity deformities and gait disorders. A total of 969 questionnaires were returned. Baby walkers were used by 15.6% of children. A higher percentage of children who used baby walkers omitted crawling compared with the 10.7% of children who did not use baby walkers. Gait disorders occurred at a similar percentage in both groups. Use of baby walkers may be associated with infant motor development. Infants who used a baby walker were 3 times more likely to not have crawled for mobility than those who did not use a baby walker.