Postural Patterns Research Articles

Motor Function and Perception of Health in Women with Provoked Vestibulodynia

BackgroundProvoked vestibulodynia (PVD) is a prevalent and disabling condition in women that may be associated with reduced quality of life and impairment of physical functioning. AimTo investigate whether women with PVD have different motor functions, posture and breathing patterns, and whether they perceive their physical health differently, compared with asymptomatic controls. Methods and Main Outcome MeasureThe Standardized Mensendieck Test (SMT) and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) were used to assess differences between 35 women with PVD and 35 healthy controls. ResultsThere were no statistically significant differences in any of the 5 motor domains of the SMT between the women with PVD and those without PVD: standing posture, 4.0 (0.6) vs 5.0 (0.6); gait, 4.7 (0.6) vs 4.8 (0.6); movement, 4.8 (0.8) vs 5.1 (0.6); sitting posture, 4.7 (1.0) vs 4.9 (0.8); respiration, 4.7 (1.0) vs 4.7 (0.9). Women with PVD scored significantly lower in all domains on the SF-36 (adjusted Bonferroni P = .002) except physical functioning. Clinical ImplicationsGiven the lack of difference in the SF-36 physical functioning domain and in all 5 domains of the SMT between women with PVD and those without PVD, the value of interventions focusing on general physical function is unclear. Strengths & LimitationsA study strength is the use of an assessor-blinded case-control design, trained physiotherapists to conduct the tests, and valid and reliable outcome measures. A limitation is the homogeneity of the sample of young nulliparous women, which limits the generalizability of our findings to other study populations. ConclusionYoung nulliparous women with PVD did not score differently from a group of healthy controls on assessment of overall physical functioning or on standing posture, gait, movement, sitting posture, and respiration. However, the score for perception of general health was lower in the women with PVD compared with controls.I. Næss, H.C. Frawley, K. Bø. Motor Function and Perception of Health in Women with Provoked Vestibulodynia. J Sex Med 2019;16:1060–1067.

Dynamics of postural control in individuals with ankle instability: Effect of visual input and orthotic use

The present study investigated the effect of visual deprivation and the use of an ankle orthosis on the dynamics of center of pressure (COP) trajectories during unilateral stance in individuals with ankle instability (AI). Sixteen individuals with AI and nine healthy individuals performed four trials of 30s unilateral stance on a force platform with 1) eyes open wearing no orthosis, 2) eyes closed wearing no orthosis, 3) eyes open wearing orthosis, and 4) eyes closed wearing orthosis. The anterior-posterior and mediolateral COP trajectory were extracted. Regularity was quantified by sample entropy, dimensionality was quantified by correlation dimension and level of time dependency was quantified by entropic half-life. The AI individuals had lower sample entropy and longer entropic half-life in their COP trajectories. The effect of visual deprivation did not differ between groups. Wearing an ankle orthosis increased the sample entropy in the anterior-posterior direction and decreased the correlation dimension in the mediolateral direction for the AI group only. Individuals with AI have higher COP trajectory regularity and higher level of time dependency compared to healthy individuals. Additionally, individuals with AI do not alter the dynamics of their postural control during unilateral stance with visual deprivation compared to healthy individuals. This suggests that alterations in visual or somatosensory information differently affect the executed postural movement pattern. Finally, wearing an orthosis significantly alters the COP dynamics of individuals with AI.

Postural patterns in the first year of life: contributions of maternal physical activity in the pregnancy period

Postural patterns in the first year of life: contributions of maternal physical activity in the pregnancy period

Erkennung und Klassifikation von Haltungs- und Gangmustern am Rollator durch Abstandsmessungen – ein Vergleich zwischen klinischer Beurteilung und maschineller Klassifikation

This article describes the development of an add-on module for wheeled walkers dedicated to sensor-based posture and gait pattern recognition with the goal to develop an everyday aid for fall prevention. The core contribution is aclinical study that compared single gait parameter assessments coming from medical staff to those obtained from an automatic classification algorithm, i. e. the Mahalanobis distance over time series of sensor measurements. The walker-module described here extends an off-the-shelf wheeled walker by two depth cameras that observe the torso, pelvic, region and legs of the user. From the stream of depth images, distance measurements to eight relevant feature points on the body surface (shoulders, iliac crests, upper and lower legs) are combined to time series that describe the individual gait cycles. For automatic classification of gait cycle descriptions 14 safety-relevant gait parameters (gait width, height, length, symmetry, variability; flection of torso, knees (l/r), hips (l/r); position, distance to walker; 2‑value, 5‑value gait patterns [While the two-value gait pattern differentiates agait cycle into physiological and pathological, the five-value gait pattern distinguishes between antalgic, atactic, paretic, protective, and physiological gait]), single classifier algorithms were trained using machine learning techniques based on the mathematical concept of the Mahalanobis distance (distance of individual gait cycles to class averages and corresponding covariance matrices). For this purpose, training and test datasets were gathered in aclinical setting from 29subjects. Here, the assessment of gait properties given by medical experts served for the labelling of sensorial gait cycle descriptions of the training and test datasets. In order to evaluate the quality of the automated classification in the add-on module afinal comparison between human and automatic gait parameter assessment is given. The gait assessment conducted by trained medical staff served as acomparator for the machine learning gait assessment and showed arelatively uniform class distribution of gait parameters over the group of probands, e. g. 57% showed an increased and 43% anormal distance to the walker. Of the subjects 51% positioned themselves central to the walker, while 41% took aleft deviating, and 8% aright deviating position. A further 12 gait parameters were differentiated and evaluated in 2-5 classes. In the following, single gait cycle descriptions of each subject were assessed by trained classification algorithms. The best automatic classification rates over all subjects were given by the distance to walker (99.4%), and the 2-value gait pattern (99.2%). Gait variability (94.6%) and position to walker (94.2%) showed the poorest classification rates. Over all gait parameters and subjects, 96.9% of all gait cycle descriptions were correctly classified. With an average classification rate of 96.9%, the described gait classification approach is well suited for apatient-oriented training correction system that informs the user about false posture during every day walker use. Asecond application scenario is the use in aclinical setting for objectifying the gait assessment of patients. To reach these ambitious goals requires more future research. It includes the replacement of depth cameras by small size distance sensors (1D Lidar), the design and implementation of asuitable walker-user interface, and the evaluation of the proposed classification algorithm by contrasting it to results of modern deep convolutional neural network output.

Postural stability pattern as an important safety factor of firefighters.

Firefighting is a hazardous profession that involves high fall risk and is crucial component for the safety of people. The aim of this study was to identify factors that impact on postural stability patterns of firefighters. The study examined 177 Polish firefighters from the National Firefighting and Rescue System (NFRS) aged 31.9±10.1 years, with body height of 179.6±5.93, body mass of 83.9±11.0 and BMI of 26.0±3.03. Postural stability was evaluated by means of the Balance System SD (Biodex USA) set at the level 12 of instability, in a sportswear, bunker gear, with and without visual input. The fall risk test (FRI) was also performed. Four indices were analysed: overall stability index (OSI), anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and fall risk index (FRI). Mean results for fall risk index (FRI) were in the normal range for all age groups regardless of the type of clothing the firefighters were wearing. Individual results obtained in the fall risk test, 128 firefighters were in the normal range for their age, furthermore, 10 firefighters obtained better results than the normal range, 34 firefighters had worse results and 5 people failed to complete the test. Postural stability with eyes closed was found to decline with age. Wearing bunker gear did not have an effect on postural stability. Balance tests should be integrated into the firefighting training routines in order to improve balance and support fall prevention. Exercises with reduced visual input should also be incorporated into the training methodology.

Gait Pattern Differences Among Children With Bilateral Cerebral Palsy.

Background: The positive findings from our previous studies, which revealed the link between postural and gait patterns in children with unilateral cerebral palsy (CP) were very encouraging for recognition this relationship in children with bilateral cerebral palsy (CP). Therefore, the objective of this study was to evaluate whether different gait patterns corresponding to postural patterns in children with bilateral CP could be statistically significant according to a cluster analysis.Methods: Fifty-eight participants with bilateral CP and 45 matched children with typical growth and development. The participants walked barefoot along a treadmill at their own pace. Three-dimensional kinematic data were collected using the Measuring System for Motion Analysis. To characterize gait patterns, the Gillette Gait Index (GGI) and its 16 distinct gait parameters were used. The participants were divided into four subgroups according to their postural patterns.Results: A cluster analysis revealed 4 gait patterns corresponding to postural patterns: (1) normal gait pattern corresponded to neutral posture; (2) balanced gait pattern corresponded to balanced posture; (3) lordotic gait pattern corresponded to lordotic postural pattern; (4) swayback gait pattern corresponded to backward-leaning posture. There were significant differences in mean GGI and various clusters in the 8 GGI gait parameters: cadence, mean pelvic tilt; mean pelvic rotation, minimum hip flexion, peak hip abduction in swing; knee flexion at initial contact, and peak dorsiflexion in stance.Conclusion: Our results showed that gait discrepancies among children with bilateral CP were not simply a result of lower limb kinematic deviations in the sagittal plane. Information on different gait patterns could improve early therapy in children with bilateral CP before abnormal gait patterns are fully established.

Design and Evaluation of a Soft Assistive Lower Limb Exoskeleton

SummaryWearable devices are fast evolving to address mobility and autonomy needs of elderly people who would benefit from physical assistance. Recent developments in soft robotics provide important opportunities to develop soft exoskeletons (also called exosuits) to enable both physical assistance and improved usability and acceptance for users. The XoSoft EU project has developed a modular soft lower limb exoskeleton to assist people with low mobility impairments. In this paper, we present the design of a soft modular lower limb exoskeleton to improve person’s mobility, contributing to independence and enhancing quality of life. The novelty of this work is the integration of quasi-passive elements in a soft exoskeleton. The exoskeleton provides mechanical assistance for subjects with low mobility impairments reducing energy requirements between 10% and 20%. Investigation of different control strategies based on gait segmentation and actuation elements is presented. A first hip–knee unilateral prototype is described, developed, and its performance assessed on a post-stroke patient for straight walking. The study presents an analysis of the human–exoskeleton energy patterns by way of the task-based biological power generation. The resultant assistance, in terms of power, was 10.9% ± 2.2% for hip actuation and 9.3% ± 3.5% for knee actuation. The control strategy improved the gait and postural patterns by increasing joint angles and foot clearance at specific phases of the walking cycle.

The effectiveness of transverse abdominis training on balance, postural sway and core muscle recruitment patterns: a pilot study comparison across age groups.

[Purpose] This pilot study aims to determine whether improvements in postural sway, particularly among older adults, can be augmented immediately after training participants to activate and isolate the transverse abdominis (TrA) muscle. [Participants and Methods] Fifty six participants (in three age groups) took part in a single session TrA training intervention. Aspects of postural sway, balance and muscle activation patterns were measured before and after training and compared. [Results] There was significant improvement across four of six postural sway variables for the combined sample of all age groups. Older adults improved more than younger and middle-age participants in two important postural sway variables. No marked differences were evident in static reach distance across all age groups. There were no differences between groups with regard to surface electromyography (sEMG) amplitudes despite the emergence of different activation patterns among age groups. [Conclusion] Immediate effects were induced in postural sway measures after the single session training intervention. By improving neuromuscular control of the TrA and maximizing the efficiency of related proximal core muscles center of pressure (COP) sway velocities decreased during single limb standing (SLS).

Comparison of effectiveness of myofascial trigger point release with manual therapy and myofascial release in combination with self stretching in upper cross syndrome

Background: Upper cross syndrome is a common postural dysfunctional pattern that describes the dysfunctional tone of the musculature of shoulder girdle/cervicothoracic region of the body. In upper cross syndrome cervical flexors and rhomboid and lower trapezius become weak and pectorals and upper trapezius/elevator and sub occipital become tight. Overuse and tightness of these muscles results in trigger point (hyperirritable points/knots) formation in the belly of the muscles. Objective: To compare the effectiveness of myofascial trigger point release in upper cross syndrome versus myofascial trigger point release in combination with self-stretching treatment. Methodology: A total of 40 patients with upper cross syndrome were selected for study on the basis of inclusion criteria, randomly allocated in to two groups (each n=20). Group A was treated with myofascial trigger point release alone once a week and followed for 6 weeks, while group B was given the same treatment along with self-stretching home plan. Self-stretching include (chest stretch in sitting, upper trapezius stretch and sub occipital self-stretch include hold for 10-15 sec and release of 5-10 seconds). The pain, disability and Cervical ROM were assessed before and after treatment through Numeric Pain Rating Scale (NPRS), Neck Disability Index (NDI) and Goniometry respectively. Data was analyzed on SPSS 20. Results: The results shows that patients in Group B improve pain (mean NPRS from 5.40±0.50 to 2.50±0.52) and disability (mean NDI from 36.00±4.47 to 22.20±4.67) more than Group A with pain (mean NPRS from5.45±0.75 to 4.00±0.32) and disability (mean NDI from 31.25±6.85 to 23.20±7.40).Statistically significant results were found between the groups regarding NPRS, NDI and cervical ROM as p value was

The relationship between body composition and foot posture index in Special Olympics athletes

In Special Olympics, athletes' foot deformities, abnormal postural patterns and overweight and obesity were observed to be more common than in the general population. Therefore, the purpose of this study was to analyze the relationship between body composition and foot posture index. Additionally, the effect of gender and other factors on the body composition and foot posture index in athletes with intellectual disability (ID) were analyzed. 131 athletes with ID participated in this study: 36 table tennis players, 66 cross country skiers and 29 downhill skiers. Their body composition was assessed using the bioimpedance analysis InBody 230 (Biospace, Korea). The foot screening included the assessment of foot posture index, which evaluates the degree of pronated, supinated and neutral position of the foot, gait speed and the last part of the procedure consisted of a short questionnaire, providing the information about the type of housing, age, and the usage of orthotics. A low correlation between body composition and some of the foot posture index criteria was observed. The mean foot posture index score in athletes with ID was observed to be slightly pronated, as also described in the general population, with no statistically significant difference between female and male athletes. The gender differences were observed only in body composition. The high body weight and body fat percentage observed in this study highlight the need for healthy lifestyle education in athletes with ID.

Quality of body posture and postural stability in people with intellectual disability playing volleyball.

The quality of body posture and its balance depends on the efficiency of the receptors, the good work of the central nervous system integrating and coordinating the postural system and the effective musculoskeletal system. Physical activity of people with intellectual disability can stimulate the processes of improving the posture and its postural stability, improving the quality of life. The study was conducted in 2017. 20 randomly selected volleyball players with intellectual disabilities and 10 healthy players took part in it. Body posture was recorded using a photogrammetric system. To evaluate the use of the Frohner Posture Index and the Dolphens classification, stability of the posture was assessed on the Zebris FDM power plate, analyzing the basic stabilographic parameters sway path and sway area. Athletes with intellectual disabilities had significantly poorer posture and body balance than healthy players. There were no differences in postural stability between the groups studied. Some linear correlations were found between the quality of posture and balance and stabilographic variables. Incorrect postural patterns, observed in people with intellectual disabilities, require the development of special recovery programs. Qualified physical activity can help them improve their balance systems, reducing the risk of falls and injuries. The lack of the possibility of an unequivocal relationship between the quality of body posture and its stability requires research on a larger research material. New evaluation methods used (Frohner Posture index and Dolphens classification) confirmed their usefulness and gave new possibilities of application in postural research.

Role of positioning between trunk and pelvis in locomotor function of ambulant children with and without cerebral palsy.

To understand if children with and without cerebral palsy share the same lumbar postural control threshold on the sagittal plane for the transition between each walking locomotor stage. Observational analysis of sagittal trunk-pelvis kinematics of 97 children with cerebral palsy and 73 with typical development, according to their locomotor stage. Among children with typical development, all average and minimum measurements of the sagittal lumbar curve during the gait events were correlated with age and the locomotor stages of development. Among children with cerebral palsy, there were significant correlations between all average and minimum values of the sagittal lumbar curve and locomotor stages of development but not age. We conclude that, for the same locomotor level, there are no common postural patterns between children with typical development and those with spastic bilateral cerebral palsy for the position between trunk and pelvis in the sagittal plane. Maximal lordosis reduction between trunk and pelvis may change with age or even training, but does not make a positive effect on the locomotor level, while basal and maintenance capacities could explain locomotor function. Trials that failed to assess quality of movement may now have a better understanding of how different interventions improve posture towards the next functional level.

Women in motorsport: A case report of driving posture and performance after double mastectomy

IntroductionHere we report a case study of an experienced amateur female racing driver (age = 59) with self-reported fatigue of the muscles of the shoulder girdle post bilateral mastectomy and breast reconstruction. This case study describes how adjustment of her driving posture affected measures of muscle fatigue (sEMG) and driving performance (lap-time). MethodsBilateral surface electromyographic activity of sternocleidomastoid, cervical erector spinae, anterior deltoid and pectoralis major, angles of inclination of the cervical and lumbar spine in the sagittal plane and lap-times were measured at: 1) baseline, 2) after an initial adjustment of driving posture, and 3) after a readjustment of driving posture. Mean lap-times improved from 136.81 s (SD = 2.12) at baseline to 134.63 s (SD = 1.8) after readjustment. ResultsBoth sternocleidomastoid and left cervical erector spinae fatigued more slowly after readjustment but right cervical erector spinae fatigued more quickly. There was no change in the rates of fatigue of either pectoralis major or anterior deltoid. ConclusionThe improvement in her performance was associated with a change in the posture and movement pattern of her head rather than her shoulder girdle. It is likely that this improved her ability to visually perceive and steer the racing line.

Four weeks of training with simple postural instructions changes trunk posture and foot strike pattern in recreational runners

ObjectivesPrevious studies showed that adopting forward trunk lean and forefoot strike patterns may reduce risk of running-related knee injuries. However, the process of learning such forms is unclear. The purpose of the study was to investigate the effects of a 4-week training using simple postural instructions to elicit these changes. DesignLongitudinal intervention study. SettingA training included postural instructions: 1) lean your trunk forward, and 2) land on the front part of your feet. ParticipantsEighteen recreational runners. Main outcome measuresParticipants were assessed prior to training (PRE), immediately after the instructions (iPST), during training at 2 weeks (2WK) and 4 weeks (4WK), and 7–10 days after the conclusion of training (RET). Assessment consisted of running trials performed at self-selected and controlled speeds, during which the trunk and foot strike angles were assessed. ResultsComparing to PRE, forward trunk angle significantly increased by approximately 3.5° and foot strike angle by approximately 7° at 2WK, 4WK and RET. ConclusionsA 4-week training with simple postural instructions induced significant changes in trunk and foot strike patterns in recreational runners. Future study is needed to develop clinical therapeutic protocols for runners with and at risk of running-related knee injuries.

Post-Stroke Spasticity (PSS) Setting Up a PSS Clinic: Experience and Results

Stroke is a leading cause of long-term disability. As a consequence of stroke and associated upper motor neuron (UMN) syndrome, stroke survivors are often left with muscle over activity, including spasticity. Spasticity is characterized by over- activity in muscles after injury to the central nervous system. When left untreated, post-stroke spasticity (PSS) can lead to contractures, pain and deformity, involuntary movement, and greater functional impairments (eg, reduced mobility, self-care and dressing). Spasticity is a common symptom after stroke, arising in about 30% of patients, and usually occurs within the first few days or weeks [1]. However, the onset of spasticity is highly variable and can occur in the short- medium or long-term post-stroke period [2]. Post-stroke hemiparesis, together with abnormal muscle tone, is a major cause of morbidity and disability. Patients with poststroke spasticity often demonstrate recognizable antigravity postural patterns (Fig 1) characterized by shoulder adduction, elbow and wrist flexion in the upper limb, hip adduction, knee extension and ankle plantar flexion in the lower limb. This “hemiplegic” posture, which is thought to result from increased motor neuron activity in antigravity muscles, significantly interferes with body image, balance and gait. BoNT-A, one of the most potent biologic toxins known to man acts by blocking neuromuscular transmission via inhibiting acetylcholine release [3]. BoNT-A treatment in post-stroke upper and lower limb spasticity is a safe and effective procedure to decrease muscle tone and increase the range of motion. More recent studies are demonstrating the importance for the rehabilitation therapist intervention to work alongside the physician to create more positive and significant effects on active function [4]. Daily stretching exercise is the key for the long-lasting benefits. BoNT-A Injections, Ultrasound guided technique, performed by a Physician in combination with physiotherapy and outcomes measurements are used to improve upper and lower limb function in stroke patients with spasticity in the clinical setting [5]. We would like to share our experience on the benefit of the ultrasound guided technique to target the muscles and our results in setting up a spasticity clinic for post-stroke patients.

Postural Patterns of the Subjects with Vergence Disorders: Impact of Orthoptic Re-education, a Pilot Study.

Aim:Vergence insufficiency is a common oculomotor disorder which causes visual but also general, and even postural symptoms. This study aimed to characterise postural control of subjects with isolated vergence disorder and assess whether orthoptic therapy affects it.Method:Vergence disorders were evaluated and treated by orthoptists. Postural control quality was measured before and after orthoptic therapy in different conditions to study the role of vision, fixating distance, binocular vision and ocular dominance.Results:Before orthoptic therapy, we recorded less body sway when subjects had their eyes closed than when they had their eyes open, and also less sway for the binocular condition when compared with monocular viewing conditions. This is opposite to well-known normal behaviour. Moreover, no distance or ocular dominance effect was found. After orthoptic therapy, our subject’s body sway was less when they had their eyes open than with their eyes closed and less when they looked at near fixation. No difference was found between monocular and binocular viewing conditions, but a small advantage of ocular dominance was found for one parameter.Conclusion:We conclude that subjects with vergence disorders show postural behaviour that is not characterized by the normal regularities observed in healthy subjects. Orthoptic re-education may have contributed to promoting such regularities. Further studies are needed to confirm these preliminary results.

Pattern Recognition of Human Postures Using the Data Density Functional Method

In this paper, we propose a new approach to recognize the motional patterns of human postures by introducing the data density functional method. Under the framework of the proposed method, sensed time signals will be mapped into specific physical spaces. The most probable cluster number within the specific physical space can be determined according to the principle of energy stability. Then, each corresponding cluster boundary can be measured by searching for the local lowest energy level. Finally, the configuration of the clusters in the space will characterize the most probable states of the motional patterns. The direction of state migration and the corresponding transition region between these states then constitute a significant motional feature in the specific space. Differing from conventional methods, only a single tri-axial gravitational sensor was employed for data acquirement in our hardware scheme. By combining the motional feature and the sensor architecture as prior information, experimental results verified that the most probable states of the motional patterns can be successfully classified into four common human postures of daily life. Furthermore, error motions and noise only offer insignificant influences. Eventually, the proposed approach was applied on a simulation of turning-over situations, and the results show its potential on the issue of elderly and infant turning-over monitoring.

Infant posture and movement analysis using a sensor-supported gym with toys.

Infant posture and motor pattern development are normally analyzed by clinical assessment scales. Lately, this approach is combined with the use of sensor-supported systems, such as optical, inertial, and electromagnetic measurement systems, as well as novel assessment devices, such as CareToy. CareToy is a modular device for assessment and rehabilitation of preterm infants, comprising pressure mattresses, inertial and magnetic measurement units, and sensorized toys. Since such integrated sensor system combination is new to the field of sensor-supported infant behavior assessment and rehabilitation, dedicated methods for data analysis were developed and presented. These comprise trunk rotation, arm movement, forearm orientation, and head movement analysis, along with toy play and trunk posture stability evaluation. Methods were tested on case study data, evaluating suitability of developed algorithms for infant posture and activity analysis, regardless of behavioral responses. Obtained results demonstrate suitability of the proposed methods for successful use in studies of different motor pattern subfields. This represents an important step on the course towards objective, accurate, sensor-supported infant motor development assessment. Graphical abstract Posture and movement assessment of infants using analysis of sensory data, obtained with a dedicated sensorized gym with toys.

Early-onset of symptoms and clinical course of Pompe disease associated with the c.-32–13 T > G variant

BackgroundIndividuals with late-onset Pompe disease (LOPD) and the common c.-32–13 T > G variant are widely thought to have milder, adult-onset disease. This belief, and the consequent low suspicion of clinical involvement in children, has led to delays in diagnosis and treatment initiation in patients with early onset of symptoms. Previous reports of LOPD in children do not include description of the early-onset phenotype. This description of signs and symptoms, some of which are subtle and less known, is important to facilitate prompt identification and appropriate treatment in symptomatic children. MethodsRetrospective chart review of a cohort of 84 LOPD patients with the c.-32–13 T > G variant was conducted to identify patients diagnosed clinically (as opposed to through newborn screening) who had clinically documented symptom-onset within the first two years of life. ResultsFour patients had early onset of symptoms, with age at onset ranging from 10 days to 20 months. Initial symptoms included delay in achievement of gross motor milestones, signs of proximal muscle weakness, swallow and feeding difficulties, and sleep apnea. Early and characteristic alterations in posture and movement were identified in all patients. Age at diagnosis ranged from 10 months to 26 months. Median age at enzyme replacement therapy (ERT) initiation was 23.5 months. Despite ERT, progression of musculoskeletal involvement and residual muscle weakness was evident in all patients, as evidenced by ptosis, myopathic facies, scoliosis, lumbar lordosis, scapular winging, and trunk and lower extremity weakness. Standardized functional assessments showed gross motor function below age level as measured by the Alberta Infant Motor Scales, the Peabody Developmental Motor Scales-2, the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, and the six-minute walk test. ConclusionsOnset of symptoms including delay in achievement of gross motor milestones, signs of proximal muscle weakness, swallow and feeding difficulties, and sleep apnea in the first two years of life is not uncommon in individuals with LOPD and the c.-32–13 T > G variant. Patients with early-onset disease appear to have a more, rapid and severe progression of disease with persistent residual muscle deficits which partially improve with higher doses of ERT. Careful evaluation for specific and characteristic patterns of posture and movement in patients with this variant is necessary to identify those who have early onset of disease. Increased awareness of the early-onset signs and symptoms may also enable early identification of disease onset in children who are diagnosed through newborn screening.

Upper body position analysis of different experience level surgeons during laparoscopic suturing maneuvers using optical motion capture

BackgroundThis study aimed to analyze the posture patterns of surgeons with two different skill levels during laparoscopic surgery using an optical motion capture system. MethodsTwenty participants were divided into novice and expert groups. Their upper body motions during suturing tasks were captured, including average angle and angle variability (shoulder, elbow, wrist), joint fixation, head movement, and thoracolumbar flexion angle. ResultsOur analysis showed that (1) the arms of the expert surgeons were more loosely held at their sides by about 7°; (2) their elbows were more bent by about 10°; (3) they had a greater change in shoulder angle by about 1.4 times and a more fluid posture; (4) their heads were more stable, particularly in the longitudinal and vertical axes; and (5) their thoracolumbar flexion angle was smaller by about 10°. ConclusionsThe posture patterns of different technical level surgeons during laparoscopic suturing maneuvers revealed differences in limb positions. These results may provide new insights into the efficient acquisition of technical skills and reduced physical stress during laparoscopic surgery.