Limited Walking Research Articles

Continuous Gait Phase Estimation for Multi-Locomotion Tasks Using Ground Reaction Force Data.

Existing studies on gait phase estimation generally involve walking experiments using inertial measurement units under limited walking conditions (WCs). In this study, a gait phase estimation algorithm is proposed that uses data from force sensing resistors (FSRs) and a Bi-LSTM model. The proposed algorithm estimates gait phases in real time under various WCs, e.g., walking on paved/unpaved roads, ascending and descending stairs, and ascending or descending on ramps. The performance of the proposed algorithm is evaluated by performing walking experiments on ten healthy adult participants. An average gait estimation accuracy exceeding 90% is observed with a small error (root mean square error = 0.794, R2 score = 0.906) across various WCs. These results demonstrate the wide applicability of the proposed gait phase estimation algorithm using various insole devices, e.g., in walking aid control, gait disturbance diagnosis in daily life, and motor ability analysis.

Predicting Steady-State Metabolic Power in Cerebral Palsy, Stroke, and the Elderly During Walking With and Without Assistive Devices.

Individuals with walking impairment, such as those with cerebral palsy, often face challenges in leading physically active lives due to the high energy cost of movement. Assistive devices like powered exoskeletons aim to alleviate this burden and improve mobility. Traditionally, optimizing the effectiveness of such devices has relied on time-consuming laboratory-based measurements of energy expenditure, which may not be feasible for some patient populations. To address this, our study aimed to enhance the state-of-the-art predictive model for estimating steady-state metabolic rate from 2-min walking trials to include individuals with and without walking disabilities and for a variety of terrains and wearable device conditions. Using over 200 walking trials collected from eight prior exoskeleton-related studies, we trained a simple linear machine learning model to predict metabolic power at steady state based on condition-specific factors, such as whether the trial was conducted on a treadmill (level or incline) or outdoors, as well as demographic information, such as the participant's weight or presence of walking impairment, and 2 minutes of metabolic data. We demonstrated the ability to predict steady-state metabolic rate to within an accuracy of 4.71 ± 2.7% on averageacross allwalking conditionsand patient populations, including with assistive devices andondifferent terrains. This work seeks to unlock the use of in-the-loop optimization of wearable assistive devices in individuals with limited walking capacity. A freely available MATLAB application allows other researchers to easily apply our model.

Real-world gait and turning in individuals scheduled for total knee arthroplasty

BackgroundImproving mobility – specifically walking – is an important treatment goal of total knee arthroplasty. Objective indicators for mobility, however, are lacking in clinical evaluations. This study aimed to compare real-world gait and turning between individuals scheduled for total knee arthroplasty and healthy controls, using continuous monitoring with inertial measurement units. MethodsReal-world gait and turning data were collected for 5–7 days in individuals scheduled for total knee arthroplasty (n = 34) and healthy controls (n = 32) using inertial measurement units on the feet and lower back. Gait and turning parameters were compared between groups using a linear regression model. Data was further analyzed by stratification of gait bouts based on bout length, and turns based on turning angle and turning direction. FindingsDominant real-world gait speed was 0.21 m/s lower in individuals scheduled for total knee arthroplasty compared to healthy controls. Stride time was 0.05 s higher in individuals scheduled for total knee arthroplasty. Step time asymmetry was not different between the groups. Regarding walking activity, individuals scheduled for total knee arthroplasty walked 72 strides/h less than healthy controls, and maximum bout length was 316 strides shorter. Irrespective of the size of the turn, turning velocity was lower in individuals scheduled for total knee arthroplasty. InterpretationIndividuals scheduled for total knee arthroplasty showed specific walking and turning limitations in the real-world. Parameters derived from inertial measurement units reflected a rich profile of real-world mobility measures indicative of walking limitation of individuals scheduled for total knee arthroplasty, which may provide a relevant outcome dimension for future studies.

Leaning-Based Interfaces Improve Simultaneous Locomotion and Object Interaction in VR Compared to the Handheld Controller.

Physical walking is often considered the gold standard for VR travel whenever feasible. However, limited free-space walking areas in the real-world do not allow exploring larger-scale virtual environments by actual walking. Therefore, users often require handheld controllers for navigation, which can reduce believability, interfere with simultaneous interaction tasks, and exacerbate adverse effects such as motion sickness and disorientation. To investigate alternative locomotion options, we compared handheld Controller (thumbstick-based) and physical walking versus a seated (HeadJoystick) and standing/stepping (NaviBoard) leaning-based locomotion interface, where seated/standing users travel by moving their head toward the target direction. Rotations were always physically performed. To compare these interfaces, we designed a novel simultaneous locomotion and object interaction task, where users needed to keep touching the center of upward moving target balloons with their virtual lightsaber, while simultaneously staying inside a horizontally moving enclosure. Walking resulted in the best locomotion, interaction, and combined performances while the controller performed worst. Leaning-based interfaces improved user experience and performance compared to Controller, especially when standing/stepping using NaviBoard, but did not reach walking performance. That is, leaning-based interfaces HeadJoystick (sitting) and NaviBoard (standing) that provided additional physical self-motion cues compared to controller improved enjoyment, preference, spatial presence, vection intensity, motion sickness, as well as performance for locomotion, object interaction, and combined locomotion and object interaction. Our results also showed that less embodied interfaces (and in particular the controller) caused a more pronounced performance deterioration when increasing locomotion speed. Moreover, observed differences between our interfaces were not affected by repeated interface usage.

Robotic technologies for in-orbit assembly of a large aperture space telescope: A review

Space telescopes have been instrumental in enlightening our understanding of the universe, from the iconic Hubble Space Telescope to specialized instruments like Chandra and Kepler. Pushing the frontiers of cosmic exploration, the future of space exploration hinges on modular Large Aperture Space Telescopes (LAST), much larger than the recently launched 6.5 m James Webb Space Telescope, necessitating robotic assembly in orbit. This paper introduces a paradigm shift in astronomical observation by featuring robotic in-orbit assembly of a large aperture space telescope. This review paper starts by tracing the evolution of telescopes and presents a comprehensive overview of the state-of-the-art space telescopes. This paper then reinforces the need for LAST to address the constant clamour for higher-resolution astronomy. While current semi-autonomous robotic manipulators operate from the International Space Station, their limited walking capabilities constrain their workspace, making them unsuitable for the LAST mission. This paper presents a detailed trade-off analysis of the challenges associated with the in-orbit assembly of LAST using candidate robots to understand the technological gaps. Further, the evolution of space robotic manipulators is presented, highlighting design features, advantages, and drawbacks for in-orbit spacecraft servicing and assembly missions. To tackle design and modelling challenges for robotic systems in space, amidst the various perturbations in the extreme space environment, linear and non-linear control systems necessary for achieving ultra-high precision performance are also discussed. This paper advances the walking space manipulator technology by introducing the next generation of walking space manipulators – the End-Over-End Walking Robot (E-Walker). The dexterous and modular design of the E-Walker makes it an ideal candidate for missions involving assembly, manufacturing, servicing, and maintenance.

Activity limitations, use of assistive devices, and mortality and clinical events in 25 high-income, middle-income, and low-income countries: an analysis of the PURE study

The focus of most epidemiological studies has been mortality or clinical events, with less information on activity limitations related to basic daily functions and their consequences. Standardised data from multiple countries at different economic levels in different regions of the world on activity limitations and their associations with clinical outcomes are sparse. We aimed to quantify the prevalence of activity limitations and use of assistive devices and the association of limitations with adverse outcomes in 25 countries grouped by different economic levels. In this analysis, we obtained data from individuals in 25 high-income, middle-income, and low-income countries from the Prospective Urban Rural Epidemiological (PURE) study (175 660 participants). In the PURE study, individuals aged 35-70 years who intended to continue living in their current home for a further 4 years were invited to complete a questionnaire on activity limitations. Participant follow-up was planned once every 3 years either by telephone or in person. The activity limitation screen consisted of questions on self-reported difficulty with walking, grasping, bending, seeing close, seeing far, speaking, hearing, and use of assistive devices (gait, vision, and hearing aids). We estimated crude prevalence of self-reported activity limitations and use of assistive devices, and prevalence standardised by age and sex. We used logistic regression to additionally adjust prevalence for education and socioeconomic factors and to estimate the probability of activity limitations and assistive devices by age, sex, and country income. We used Cox frailty models to evaluate the association between each activity limitation with mortality and clinical events (cardiovascular disease, heart failure, pneumonia, falls, and cancer). The PURE study is registered with ClinicalTrials.gov, NCT03225586. Between Jan 12, 2001, and May 6, 2019, 175 584 individuals completed at least one question on the activity limitation questionnaire (mean age 50·6 years [SD 9·8]; 103 625 [59%] women). Of the individuals who completed all questions, mean follow-up was 10·7 years (SD 4·4). The most common self-reported activity limitations were difficulty with bending (23 921 [13·6%] of 175 515 participants), seeing close (22 532 [13·4%] of 167 801 participants), and walking (22 805 [13·0%] of 175 554 participants); prevalence of limitations was higher with older age and among women. The prevalence of all limitations standardised by age and sex, with the exception of hearing, was highest in low-income countries and middle-income countries, and this remained consistent after adjustment for socioeconomic factors. The use of gait, visual, and hearing aids was lowest in low-income countries and middle-income countries, particularly among women. The prevalence of seeing close limitation was four times higher (6257 [16·5%] of 37 926 participants vs 717 [4·0%] of 18 039 participants) and the prevalence of seeing far limitation was five times higher (4003 [10·6%] of 37 923 participants vs 391 [2·2%] of 18 038 participants) in low-income countries than in high-income countries, but the prevalence of glasses use in low-income countries was half that in high-income countries. Walking limitation was most strongly associated with mortality (adjusted hazard ratio 1·32 [95% CI 1·25-1·39]) and most consistently associated with other clinical events, with other notable associations observed between seeing far limitation and mortality, grasping limitation and cardiovascular disease, bending limitation and falls, and between speaking limitation and stroke. The global prevalence of activity limitations is substantially higher in women than men and in low-income countries and middle-income countries compared with high-income countries, coupled with a much lower use of gait, visual, and hearing aids. Strategies are needed to prevent and mitigate activity limitations globally, with particular emphasis on low-income countries and women. Funding sources are listed at the end of the Article.

Effect of Arm-Ergometry Versus Treadmill Supervised Exercise on Cardiorespiratory Fitness and Walking Distances in Patients With Peripheral Artery Disease: The ARMEX Randomized Clinical Trial.

To compare arm-ergometry and treadmill supervised exercise training on cardiorespiratory fitness and walking distances in patients with peripheral artery disease (PAD). ARMEX was a single-center, single-blinded, parallel group, non-inferiority trial enrolling symptomatic patients with PAD. Patients were randomized (1:1 ratio) to a 12-wk arm-ergometry (AEx) or standard treadmill (TEx) supervised exercise training protocol. The powered primary end point was the change in peak oxygen uptake (VO 2 ) at 12 wk, measured on a treadmill cardiopulmonary exercise test (CPX). Secondary outcomes included changes in VO 2 at the first ventilatory threshold (VT-1), ventilatory efficiency (ratio of minute ventilation [VE] to carbon dioxide production [VCO 2 ], VE/VCO 2 ), walking distances by CPX and 6-min walking test (6MWT), and self-reported walking limitations. Fifty-six patients (66±8yr; 88% male) were randomized (AEx, n =28; TEx, n =28). At 12 wk, VO 2peak change was not significantly different between groups (0.75 mL/kg/min; 95% CI, -0.94 to 2.44; P =.378), despite a significant increase only in AEx. VO 2 at VT-1 improved in both groups without between-group differences, and VE/VCO 2 slope improved more in AEx. The TEx attained greater improvements in walking distance by CPX (121.08 m; 95% CI, 24.49-217.66; P =.015) and 6MWT (25.08 m; 95% CI, 5.87-44.29; P =.012) and self-perceived walking distance. Arm-ergometry was noninferior to standard treadmill training for VO 2peak , and treadmill training was associated with greater improvements in walking distance. Our data support the use of treadmill as a first-line choice in patients with PAD to enhance walking capacity, but arm-ergometry could be an option in selected patients.

Unveiling the influence of the extended online-to-offline food delivery service environment on urban residents' usage: A case study of Nanjing, China

Online-to-offline food delivery services (OFDS) platforms have reshaped the urban food landscape. However, existing studies do not reveal the relationship between the changes in the food environment under the influence of OFDS and residents' usage of OFDS. This study considers the impact of OFDS on the food environment and innovatively introduces the concept of extended OFDS food environment (OFDS-FE). Unlike traditional food environments that offer physical dining options within a limited walking distance, the OFDS-FE refers to the food environment formed by different types of restaurants that rely on OFDS platforms to provide online services within the delivery area. Combining questionnaire survey data and Meituan takeaway restaurant data in Nanjing, China, the empirical results suggest that higher online restaurant density, lower road network density, and lower online restaurant accessibility within the extended area are associated with higher OFDS usage by residents. These findings highlight the significance of OFDS-FE in explaining residents' use of OFDS, providing a new perspective for understanding the relationship between the food environment and residents' dining behaviors. These results also shed light on urban planning and design.

Reliability parameters of the Timed 25-Foot-Walk (T25FW) in patients with Multiple Sclerosis: Lower walking speed is associated with greater Smallest Detectable Change

BackgroundReliability parameters of clinical measures should be sufficient in order to adequately monitor disease course and evaluate treatment in patients with Multiple Sclerosis (MS). The aim of this study was to assess the reliability of the Timed 25-Foot-Walk (T25FW) in patients with MS. MethodsMS patients performed the T25FW twice with approximately one year in between. After the second measurement, they answered an anchor question using a three-point Likert scale. Taking the non-normal distribution of the T25FW into account, intraclass correlation coefficient (ICCagreement), standard error of the mean (SEMagreement) and smallest detectable change (SDC) were computed. Results118 MS patients (76.3 % females, mean age 48.2 years) were included. Of these patients, 73 reported no change on the anchor question. They completed the T25FW at baseline in 4.7s (IQR 4.3-5.4s, n = 72) and at follow-up in 4.9s (IQR 4.3-5.9s, n = 73). The ICCagreement was 0.895, the SEMagreement was 0.037. The SDC was higher for higher mean T25FW and can be computed for each mean T25FW by 0.23*mean T25FW. ConclusionOverall, in patients with MS, the T25FW has a sufficient reliability as measured with the ICC, however the SDC of the T25FW increased when patients perform worse on the T25FW (i.e. have a lower walking speed). Because this test is often used in MS patients with limited walking ability, these findings are important to keep in mind when interpreting the re-test scores of the T25FW.

Current Trends for Children With Spina Bifida: A Survey of Pediatric Physical Therapists.

To describe contemporary physical therapy practice and management of children with spina bifida (SB) in the context of the International Classification of Functioning, Disability, and Health (ICF) framework. A descriptive, cross-sectional electronic survey was sent to US pediatric physical therapy clinics and posted in the American Physical Therapy Association Pediatrics newsletter. Data were analyzed using content analysis. Codes were compared, refined, and condensed into categories. A total of 163 participants were included. Most assessments evaluated the ICF Activity component. Most frequently reported ICF components: impairments=decreased strength (17.9%), activity limitations=limited walking (22.5%), and participation restrictions=restricted socializing/playing with peers or siblings (22.6%). The most prevalent intervention was strength training. Physical therapists (PTs) in the United States are performing assessments and interventions supported by available evidence; however, knowledge translation and more research are needed to support best practices in PT management of children with SB.

Associations between walking limitations and reported activity destinations among older adults.

In old age, walking difficulty may reduce opportunities to reach valued activity destinations. Walking modifications, e.g., slower pace or using a walking aid, may enable individuals to continue going where they wish, and hence postpone the consequences of the onset of walking difficulties. We studied visited activity destinations (type, distance) among older people with varying degrees of walking limitations. Community-dwelling 75-85-year-old people living in Jyväskylä (N = 901) were asked to state whether they had no difficulty walking 2km, had modified their walking, or had difficulty walking. On a digital map, participants located physical exercise, attractive, and regular destinations they had visited during the past month. Destination counts and median distance to destinations from home were computed. Participants with intact walking reported higher counts of physical exercise (IRR = 1.45, 95% CI [1.31, 1.61]) and attractive destinations (IRR = 1.23, 95% CI [1.10, 1.40]) than those with walking difficulty and also visited these destinations further away from home than the others (b = 0.46, 95% CI [0.20, 0.71]). Those with walking modifications reported higher counts of physical exercise destinations than those with walking difficulty (IRR = 1.23, 95% CI [1.09, 1.40]). Counts of regular destinations and distance traveled were not associated with walking limitations. Walking modifications may help people with walking difficulty reach destinations further away from home, potentially contributing to their sense of autonomy. For those with walking difficulty, a low count of destinations other than regular destinations, e.g., shops or healthcare facilities, may signal their abandonment of recreational activities and a decrease in their life space, potentially leading to reduced well-being.

Accurate fall risk classification in elderly using one gait cycle data and machine learning

BackgroundFalls among the elderly are a major societal problem. While observations of medium-distance walking using inertial sensors identified potential fall predictors, classifying individuals at risk based on single gait cycles remains elusive. This challenge stems from individual variability and step-to-step fluctuations, making accurate classification difficult. MethodsWe recruited 44 participants, equally divided into high and low fall-risk groups. A smartphone secured on their second sacral spinous process recorded data during indoor walking. Features were extracted at each gait cycle from a 6-dimensional time series (tri-axial angular velocity and tri-axial acceleration) and classified using the gradient boosting decision tree algorithm. FindingsMean accuracy across five-fold cross-validation was 0.936. “Age” was the most influential individual feature, while features related to acceleration in the gait direction held the highest total relative importance when aggregated by axis (0.5365). InterpretationCombining acceleration, angular velocity data, and the gradient boosting decision tree algorithm enabled accurate fall risk classification in the elderly, previously challenging due to lack of discernible features. We reveal the first-ever identification of three-dimensional pelvic motion characteristics during single gait cycles in the high-risk group. This novel method, requiring only one gait cycle, is valuable for individuals with physical limitations hindering repetitive or long-distance walking or for use in spaces with limited walking areas. Additionally, utilizing readily available smartphones instead of dedicated equipment has potential to improve gait analysis accessibility.

Twenty-four hour physical activity, sedentary behaviour and sleep profiles in adults living with rheumatoid arthritis: a cross-sectional latent class analysis

BackgroundRheumatoid Arthritis (RA), an autoimmune systemic inflammatory disease, affects more than 17 million people globally. People with RA have higher risk of premature mortality; often experience chronic fatigue, pain and disrupted sleep; and are less physically active and more sedentary than healthy counterparts. It remains unclear how people with RA may balance sleep and awake movement activities over 24-hours, or how differences in 24-hour behaviours may be associated with determinants of health, or alignment with published activity guidelines.MethodsCross-sectional exploration of objective measures of 24-hour sleep-wake activities in 203 people with RA. Latent Class Analysis (LCA) derived classes from time, by tertile, in six sleep-awake activities over 24 h. Comparisons of model fit statistics, class separation and interpretability defined best fit for number of classes. Variations in sleep-awake behaviour across classes and association of profile allocation with determinants of health, quality metrics for sleep, sitting and walking and alignment with published guidelines were explored. Multinomial logistic regression identified factors associated with likelihood of profile allocation.ResultsLCA identified 2 to 6 classes and a 4-class model was determined as best fit for 24-hour sleep-awake behaviour profiles. One profile (26%) presented with more balanced 24-hour sleep, sitting and walking behaviours. The other three profiles demonstrated progressively less balanced 24-hour behaviours including: having low (< 7 h), high (> 8 h), or recommended (7–8 h) sleep duration in respective combination with high sitting (> 10 h), limited walking (< 3 h) or both when awake. Age, existing sitting and walking habit strength and fatigue were associated with likelihood of belonging to different profiles. More balanced 24-hour behaviour was aligned with better quality metrics for sleep, sitting and walking and published guidelines.DiscussionFor people living with RA it is important to understand the ‘whole person’ and their ‘whole day’ to define who may benefit from support to modify 24-hour sleep-awake behaviours and which behaviours to modify. Supports should be informed by an understanding of personal or health-related factors that could act as barriers or facilitators for behavioural change, including exploring existing habitual sitting and walking behaviours.Trial registrationsClinicalTrials.gov ID: NCT02554474 (2015-09-16) and ClinicalTrials.gov ID: NCT03404245 (2018-01-11)

Satisfaction with social roles and activities across mobility status among persons with spinal cord injury.

Cross-sectional study. To examine the differences in satisfaction with social roles and activities among ambulatory individuals, manual wheelchair users, and power wheelchair users with spinal cord injuries (SCIs). Community setting. Participants completed surveys of their demographics and clinical data as well as the Spinal Cord Injury - Quality of Life Satisfaction with Social Roles and Activities- Short Form. Participants' mobility status was categorized into (1) ambulatory individuals, (2) independent manual wheelchair users, and (3) power wheelchair/scooter users. One-way ANOVA and ANCOVA were used, respectively, to examine unadjusted and adjusted differences in satisfaction with social roles and activities across mobility status. Adjustment covariates included age, sex, time since SCI, and SCI injury level. A total of 129 participants (mean age = 47.4 ± 13.6 years, 73% male) were included in the analyses. Unadjusted (F = 3.8, p = 0.03) and adjusted models (F = 3.4, p = 0.04) evidenced significant differences in satisfaction with social roles and activities according to mobility status. Pairwise Bonferroni Post-Hoc analysis indicated that manual wheelchair users were more satisfied with their social roles and activities when compared to ambulatory individuals (mean difference = 2.8, p < 0.05). Due to the current challenges associated with walking recovery after SCIs, clinicians may want to discuss the use of wheelchairs with individuals with limited walking ability when the goal is to improve participation and quality of life. Emphasizing alternative means of mobility may enhance satisfaction with social roles and activities.

Association between chronic disease, sensory impairment, walking limitation, and activities of daily living of community-dwelling older Indians.

Due to the paucity of existing evidence, this study aims to investigate the relationship between chronic disease, sensory impairment, walking limitation, and difficulty in activities of daily living (ADLs) in community-dwelling older Indians. This cross-sectional study included data from 31,394 individuals aged ≥ 60 years from the 2017 to 2018 Longitudinal Ageing Study in India. Participants were divided into 2 groups: 12,993 with chronic disease, sensory impairment, and a walking limitation, and 18,401 healthy individuals without such conditions. Participants with any chronic disease were further divided into 2 groups: sensory impairment (n = 12,462), and a walking limitation (n = 4745). Self-reported close-ended questionnaires with yes or no were used to assess each chronic disease (such as hypertension, diabetes, lung disorders, joint disorders, or heart disease), sensory impairment (vision or hearing), and walking limitation. A walking limitation was defined as being when a person could only walk at their usual pace for less than 500 meters on a flat surface. ADLs were assessed and classified as physical ADLs including basic physical requirements like dressing. Instrumental ADLs (IADLs) included more complicated community-based tasks like meal preparation. Findings showed that older Indians with chronic disease, sensory impairment, and a walking limitation were more likely to be significantly associated with physical ADLs (adjusted odds ratio [aOR] = 1.85, 95% confidence interval [CI] = 1.34-1.57, P < .0001) and IADLs (aOR = 1.45, 95% CI = 1.70-2.03, P < .0001) than those without such conditions. Among older Indians with chronic disease, sensory impairment was more likely associated with physical ADLs (aOR = 1.98, 95% CI = 1.82-2.16, P < .0001) and IADLs (aOR = 1.26, 95% CI = 1.15-1.37, P < .0001) followed by a walking limitation (aOR = 1.53, 95% CI = 1.42-1.65, P < .0001; aOR = 1.27, 95% CI = 1.17-1.38, P < .0001, respectively). These findings suggest that older Indians with chronic disease, sensory impairment, and walking limitation, can experience increased difficulty in overall and individual physical ADL and IADL than those without these conditions. Older Indians with any chronic condition who had sensory impairment or a walking limitation were also more likely to have difficulty with physical ADLs and IADLs.

Laboratory-assessed gait cycle entropy for classifying walking limitations among community-dwelling older adults

Among older people, walking difficulty results from actual and perceived declines in physical capacities and environmental requirements for walking. We investigated whether the physiological complexity of the gait cycle covaries with experience of walking difficulty. Walking difficulty, gait speed, and gait cycle complexity were evaluated among 702 community-dwelling older people aged 75, 80, and 85 years who took part in the six-minute walking test in the research laboratory. Walking difficulty for 500 m was self-reported. Complexity was quantified as trunk acceleration multiscale entropy during the gait cycle. Complexity was then compared between those with no reported walking difficulty, walking with modifications but no difficulty, and those reporting walking difficulty. Higher entropy differentiated those reporting no difficulty walking from those reporting walking difficulties, while those reporting having modified their walking, but no difficulty formed an intermediate group that could not be clearly distinguished from the other categories. The higher complexity of the gait cycle is associated with slower gait speed and the presence of self-reported walking difficulty. Among older people, gait cycle complexity which primarily reflects the biomechanical dimensions of gait quality, could be a clinically meaningful measure reflecting specific features of the progression of walking decline. This encourages further investigation of the sensitivity of gait cycle complexity to detect early signs of gait deterioration and to support targeted interventions among older people.

Variability in Outcome After Bilateral, Fluoroquinolones-Associated Achilles Tendon Rupture: A Case Report

BACKGROUND: Achilles tendon rupture can be debilitating, and there is substantial variability in outcomes after Achilles tendon rupture. Patient- and tissue-level characteristics are beginning to emerge as healing indicators with the potential of identifying impaired healing earlier in recovery. CASE PRESENTATION: Patient with fluoroquinolone-induced, bilateral Achilles tendon rupture managed nonoperatively. OUTCOME AND FOLLOW-UP: Tendon tissue level outcomes on ultrasound, strength, range of motion, and patient-reported outcomes are reported. With similar treatment of bilateral tendons, the patient achieved good healing outcomes (evidenced by limited tendon elongation and walking capacity) on one side but had limited healing (evidenced by tendon retraction and need for bracing with walking) on the other side. DISCUSSION: The findings from this case report highlight the variability of patient outcomes after Achilles tendon rupture, even when treatment and the systemic healing environment is similar. This report also demonstrates the potential clinical utility of routine ultrasound imaging to assess early tendon healing before strength and other functional outcomes can be assessed. JOSPT Cases 2024;4(1):12-18. Epub 13 November 2023. doi:10.2519/josptcases.2023.12109

Patient Self-Assessment of Walking Ability and Fracture Risk in Older Australian Adults

The relationship between self-reported walking limitation, a proxy of muscle function, and fracture risk has not been investigated. To examine the association between a self-reported walking limitation of 1000 m or less and 5-year risk of fracture. This prospective cohort study compared individuals with various degrees of walking ability limitation at 1000 m (a little limitation and a lot of limitation) and those without limitation (no limitation) accounting for age, falls, prior fractures, and weight. Participants from the ongoing population-based Sax Institute 45 and Up Study were followed from recruitment (2005-2008) for 5 years (2010-2013). Data analysis was conducted from July 2020 to September 2023. Self-reported walking limitation. Incident fracture and site-specific fractures (hip, vertebral, and nonhip nonvertebral [NHNV] fractures). Among the 266 912 participants enrolled in the 45 and Up Study, 238 969 were included, with 126 015 (53%) women (mean [SD] age, 63 [11] years) and 112 954 (47%) men (mean [SD] age, 61 [11] years). Approximately 20% reported a degree of limitation in walking 1000 m or less at baseline (39 324 women [24%]; 23 191 men [21%]). During a mean (SD) follow-up of 4.1 (0.8) years, 7190 women and 4267 men experienced an incident fracture. Compared with participants who reported no walking limitations, a little limitation and a lot of limitation were associated with higher risk of fracture (a little limitation among women: hazard ratio [HR], 1.32; 95% CI, 1.23-1.41; a little limitation among men: HR, 1.46; 95% CI, 1.34-1.60; a lot of limitation among women: HR, 1.60; 95% CI, 1.49-1.71; a lot of limitation among men: HR, 2.03; 95% CI, 1.86-2.22). Approximately 60% of fractures were attributable to walking limitation. The association was significant for hip, vertebral, and NHNV fracture and ranged between a 21% increase to a greater than 219% increase. In this cohort study of 238 969 participants, self-reported walking limitations were associated with increased risk of fracture. These findings suggest that walking ability should be sought by clinicians to identify high-risk candidates for further assessment.

Feasibility of a Novel Geriatric Rehabilitation Program for People With COPD-induced Malnutrition and Muscle Wasting: A Qualitative Study.

Background and Purpose: Patients with COPD-induced malnutrition and muscle wasting are often frail. Consequently, traditional rehabilitation may be even counterproductive due to energy costs and there is a need for specialized rehabilitation programs, which are lacking for these patients. We developed such a program, which includes resistance training, following Nonlinear Periodized Exercise principles and physical energy management, in combination with a restriction of physical activities. The purpose of the study was to investigate the feasibility and the potential effects of this program. Methods: Patients who are eligible for the program are those with COPD gold III/IV and a fat free mass index below standard. We conducted a qualitative feasibility study and interviewed both patients and healthcare professionals (HCPs), using a deductive approach. The open interviews were qualitatively analyzed focussing on six areas of Bowens' feasibility model: acceptability, demand, implementation, practicality, limited efficacy, and integration. Results and discussions: Seven patients and seven HCPs were interviewed. For patients, key factors that helped to adhere to the program were knowledge about energy management, alternative skills to cope with COPD, and social support. They found the program beneficial. However, several patients considered a limitation of walking and ADL activities challenging. HCPs considered the program feasible and beneficial especially for those patients who accept they need a behavior change and who adhere to the program. For HCPs, key factors were the consistent approach and coaching skills of the multidisciplinary team members, and the monitoring role of the nurses. The limitation of physical activity and endurance training deviates from existing geriatric rehabilitation programs which propagate functional activity and training. Still, evidence from the current study suggests that our tailored approach for these patients might be more appropriate and also potentially effective without harm for physical function. Conclusions: Our novel, multidisciplinary rehabilitation program is considered feasible and clinically relevant by both patients and healthcare professionals. The next step is to explore its effects on muscle strength, physical functioning, and quality of life.

Miosite e rabdomiolisi da virus dell’influenza

Myositis during acute viral infections, also known as acute benign myositis of childhood (MBAI), is a clinical picture well described in the literature. Influenza virus (A and B) is one of the most common viral etiologies. The diagnosis is clinical, based on symptoms such as lower extremity pain with limitation of walking, and is combined with laboratory data such as elevation of blood creatine kinase (CK). Identifying patients who develop a myositis picture in the course of influenza infection is important not only for proper management of those, albeit rare, cases that may go on to complications, but also because of the need to reassure the family about the almost certainly benign evolution of the condition. During the 2023-2024 winter season, the association between influenza virus infection and myositis appeared particularly frequent; here we describe its clinical aspects and main pathogenetic hypotheses.