Unbalanced Gait Research Articles

FRI494 Ischemic Stroke After Radioactive Iodine Therapy In Graves Disease

Abstract Disclosure: T. Rave: None. J. Giunta: None. Hyperthyroidism is defined as excess thyroid hormone, most commonly due to Graves Disease. Thiomides are first line therapy, however more definitive options are radioactive iodine (RAI) or thyroidectomy. RAI enters thyroid follicular cells and destroys the thyroid tissue with beta ray emissions. Patients with Graves disease, toxic multinodular goiter, and thyroid cancer can benefit from RAI, but it is contraindicated in pregnancy, breast feeding, and severely uncontrolled thyrotoxicosis. Early side effects are pancytopenia, thyrotoxicosis, and later complications are bone marrow suppression and cancer. There are several reports of cerebral vascular accidents (CVA) after RAI therapy, however, there is limited research demonstrating whether CVA is a direct consequence of RAI or secondary to thyrotoxicosis. This case describes a possible RAI-induced CVA. A 60-year-old female with a past medical history of type 2 Diabetes Mellitus, hypertension, obesity, and Graves disease presented with altered mental status and gait instability for 1 day. She received RAI therapy 1 day prior to symptom onset for uncontrolled Graves disease. She was previously on Methimazole and PTU, however, both were discontinued due to an intolerable rash. As a result, she was maintained on a beta blocker prior to RAI. On presentation, she was afebrile, normotensive with a heart rate of 79. She was oriented only to person and place and had an unbalanced gait. Her Burch-Wartofsky score was 30, which was concerning for thyrotoxicosis. Her TSH was undetectable and EKG showed normal sinus rhythm. She was placed on atenolol, PTU and hydrocortisone. Her CT head was negative for acute disease, however, her MRI brain diagnosed an acute ischemic stroke. During admission, she had episodes of atrial fibrillation with rapid ventricular response. This patient presented with thyrotoxicosis after RAI therapy complicated by a CVA. It is important to note that on presentation she was reliably taking a beta blocker outpatient and her EKG was normal sinus rhythm making atrial fibrillation a less likely culprit of her CVA. Research has found that hyperthyroidism alone can lead to a prothrombotic state, however, additional literature reports that both hyperthyroid and euthyroid patients have an increased risk of CVA following RAI. Whether a CVA is secondary to thyrotoxicosis or a direct effect of RAI, this potentially life-threatening complication should be discussed with patients prior to treatment. Presentation: Friday, June 16, 2023

Validation of Gait Measurements on Short-Distance Walkways Using Azure Kinect DK in Patients Receiving Chronic Hemodialysis.

Muscle dysfunction, skeletal muscle fibrosis, and disability are associated with weakness in patients with end-stage renal disease. The main purpose of this study was to validate the effectiveness of a proposed system for gait monitoring on short-distance 1.5 m walkways in a dialysis center. Gaits with reduced speed and stride length, long sit-to-stand time (SST), two forward angles, and two unbalanced gait regions are defined in the proposed Kinect v3 gait measurement and analysis system (K3S) and have been considered clinical features in end-stage renal disease (ESRD) associated with poor dialysis outcomes. The stride and pace calibrations of the Kinect v3 system are based on the Zeno Walkway. Its single rating intraclass correlation (ICC) for the stride is 0.990, and its single rating ICC for the pace is 0.920. The SST calibration of Kinect v3 is based on a pressure insole; its single rating ICC for the SST is 0.871. A total of 75 patients on chronic dialysis underwent gait measurement and analysis during walking and weighing actions. After dialysis, patients demonstrated a smaller stride (p < 0.001) and longer SST (p < 0.001). The results demonstrate that patients' physical fitness was greatly reduced after dialysis. This study ensures patients' adequate physical gait strength to cope with the dialysis-associated physical exhaustion risk by tracing gait outliers. As decreased stride and pace are associated with an increased risk of falls, further studies are warranted to evaluate the clinical benefits of monitoring gait with the proposed reliable and valid system in order to reduce fall risk in hemodialysis patients.

THE EFFECT OF PHYSICAL ACTIVITY ON THE PREVENTION AND NUMBER OF FALLS IN ELDERLY PEOPLE

Regular physical activity can bring significant health benefits to people of all ages, and the need for physical activity does not decrease with age, but it has been proven that it can prolong a healthier and more independent life, prevent disability and significantly contribute to improving the lives of the elderly. In addition to the fact that each type of physical activity to a certain extent improves motor skills (strength, coordination, balance, agility, ...), mental health (self-esteem, quality of life) and reduces the risk of cardiovascular and all other causes of death, regular participation in exercise promotes mobility and functional independence in adults. A fall is an event in which a participant without their own intention comes to a lying position on the ground or at a lower level. Regardless of the health status of the individual, falls are associated with insufficient movement, reduced opportunities to perform daily activities (dressing, bathing, housework, ...) and the risk of being admitted to institutions where the care of dependent persons is taken. Arthritis, depression, cognitive impairment, vision, problems with balance and unbalanced gait, decreased muscle mass, as well as excessive use of medication increase the risk of falling. The total volume and type of physical activity needed by the elderly is not very well defined. However, it can be concluded that the combination of physical activity (strength training, endurance training, exercises for the development of balance and mobility, ...) and adequate nutrition (sufficient intake of essential amino acids/protein sources) is of crucial importance for preserving physical condition, motor skills and the health status of persons of the third age, and thus also in the prevention of falls. The aim of this study is to describe and find the best training programs for the prevention of falls in the elderly.

A rare case of bilateral optic neuritis and acute disseminated encephalomyelitis post mycoplasma pneumoniae infection

A case of a 4-year-old boy who developed acute disseminated encephalomyelitis (ADEM) and optic neuritis (ON) following Mycoplasma pneumoniae infection is reported. His symptoms, including excessive sleepiness, frontal headache, bilateral vision impairment, retro-auricular pain and unbalanced gait, were resolved after methylprednisolone pulse therapy, intravenous immunoglobulin (IVIG) and ciprofloxacin. Cerebrospinal fluid myelin basic protein (MBP) and Mycoplasma serology IgM were detected in our patient. This is the first report of a child with ADEM and ON associated with mastoditis caused by M. pneumoniae infection. Combined immunomodulatory therapy (pulse steroids and immunoglobulin) with anti- mycoplasma microbial therapy resulted in favorable visual recovery. Bilateral isolated optic neuritis as the first presenting feature in childhood ADEM is rare and requires proper evaluation and early therapeutic management. This case highlights the need for physician awareness of the association of mycoplasma infection with optic neuritis and ADEM.

PSIII-37 Effects of supplemented trace mineral amino acid chelates in working Labrador Retrievers

Abstract Trace mineral amino acid chelates (TMAAC) maintain integrity prior to absorption without binding to or interacting with other minerals or chelating compounds. TMAACs are essential as prosthetic groups for activating important enzymes like superoxide dismutase (SOD), which is needed to rid the body of free radicals and reactive oxygen species. A 19-day trial utilizing 20 Labrador Retrievers (10m/10f) was set up to determine the effects of TMAAC tabs on performance, recovery, and exercise induced inflammatory response. Dogs were sorted into two treatment groups: the TMAAC group received three oral tablets per day and the CON group received none. Body weights were recorded weekly and feed consumption was recorded daily. All dogs participated in an 8.05 km endurance run on Day 18, inducing exercise stress. Blood draws for serum biomarker analyses and gait analyses were performed at baseline (prior to treatment), 1-hour post-run, and 24-hours post-run. A pressure sensing computerized mat (CIR Systems, Inc) was used to evaluate lameness based on temporal spatial gait parameters. Dogs were walked on the mat at each time point to obtain three valid walks for analysis. TMAAC male dogs had similar amounts of SOD at baseline (P = 0.63) but increased 0.38 ng/ml SOD from baseline to Post-1h, while CON males had a 0.46ng/ml significant decrease in SOD (P = 0.002). Positive antioxidant trends favored TMAAC dogs across biomarkers assayed (P = 0.06). Gait lameness scores (GLS) indicated TMAAC males had unbalanced gait at baseline but recovered their normal gait after being on the treatment (P = 0.02). Stride length evaluation found that after treatment, this characteristic remained constant for TMAAC dogs but became uneven Post-24h for CON dogs (P = 0.04). Data collected from this trial indicate some significant exercise recovery improvement in working Labrador Retrievers supplemented with trace mineral amino acid chelates.

Abnormal Gait Recognition Using 3D Joint information of Multiple Kinects System and RNN-LSTM.

Gait is an important indicator for specific diseases. Abnormal gait patterns are caused by various factors such as physical, neurological, and sensory problems. If it is possible to recognize abnormal gait patterns in the early stage of the related disease, patients can receive proper treatment early and prevent secondary accidents such as falls caused by unbalanced gait. In this paper, we propose a gait recognition system that can recognize 5 abnormal gait patterns. Our system using 3D joint information obtained by using multiple Kinect v2 sensors and RNN-LSTM. In particular, abnormal gaits caused by physical problems such as injury, weakness of muscle, and joint problems are targeted for recognition. The purpose of this paper is to find optimal condition for gait recognition when using the multiple Kinect v2 sensors. Experiments were conducted by comparing the test accuracies on 14 combinations of human joint. Through this experiment, we selected optimal joints to show outstanding results so that our gait recognition model performs optimally. Results show that Ankles, Wrists, and the Head are the most influential joints on RNN-LSTM model. We applied 25-joint information of the human body to recognize gait patterns and achieved an accuracy over 97%.

Gait Imbalance Determination Using Foot Plantar Pressure Measurement

The ability to walking is a basic component of human mobility, and gait, which is the pattern of walking, may help or harm human health depending on posture. Therefore, it is a part of smart health care to measure gait quality in real time and inform the user of the posture. This paper determines whether body balance is maintained during gait by using foot plantar pressure measurement among methods to determine the gait balance. Thus, it aims to investigate changes in body balance according to the weight of bags and the plantar pressure measurement system, and to implement a system that give a notice when an unbalanced gait occurs in the future study.

Receding horizon viability radius for stability of humanoid robot under external perturbation

In this paper, a new approach that uses the rate of change of the angular momentum about the center of mass (COM) to improve the balance of a humanoid robot is proposed. This approach is motivated by how humans balance themselves when standing, walking, and running by making use of their upper body and swinging legs. Human movements such as lunging forward or backward and rotating arms make use of angular momentum to maintain balance. As the external perturbation increases, a human instinctively decides when and where to take a step to avoid a fall. In the same manner, a humanoid robot subjected to an external perturbation can determine whether to remain standing or to take a step with a swinging leg to maintain balance using RHVR conditions obtained from the proposed linear inverted dumbbell model. The rotation of a dumbbell model with mass inertia is an easy expression of the angular momentum of an upper body, arms, and legs. A zero-moment point (ZMP) outside the support polygon indicates an unbalanced gait and cannot represent a physical point related to the sole of the robot foot, which is defined as pseudo-ZMP (PZMP) in this paper. PZMP located outside the support area provides useful information for balancing the gait. PZMP from the foot edge provides a measure of the unbalanced moment that tends to rotate the humanoid robot around the supporting foot and causes it to fall. It is shown that PZMP is determined by the Gauss’s principle within mechanical constraints of the rate of change of angular momentum about COM. In fact, the actual angular acceleration about COM is determined by the Gauss’s principle. Additionally, RHVRs is defined, that is, viability regions to keep the balance that indicate the essential range of stability implemented to a real system. RHVRs are divided into the real ZMP (RZMP), PZMP and stepping PZMP (SPZMP). Hence, the regions of RHVR and the actual angular acceleration about COM determine which of the three control strategies is used.

Juvenile onset Huntington disease resulting from a very large maternal expansion

We report a 5(1/2)-year-old girl with a maternal family history of Huntington disease (HD), who presented clinically with unbalanced gait, impaired speech, and increasing difficulty with fine motor control. Onset of symptoms began at the age of 3(1/2) years. The suspected diagnosis of juvenile HD, based upon her family history, was confirmed by DNA analysis. At age 7, the patient died secondary to complications of her underlying disorder. Juvenile-onset Huntington disease is uncommon, predominantly transmitted by fathers and is always associated with very large expansions of the CAG repeat. Interestingly, this patient inherited a large CAG size expansion from her mother, who herself had symptoms of HD at the age of 18. Molecular analysis revealed that the mother had 70 CAG repeats whereas our patient had approximately 130 CAG repeats. This is the largest reported CAG expansion from a maternal transmission that has been confirmed molecularly and it demonstrates that very large expansions can also occur through the maternal lineage.

Acoustic neuroma and twin pregnancy

Though case reports of acoustic neuromas in pregnant patients are few, the signs and symptoms of these tumors can dramatically worsen during the last 3 or 4 months of pregnancy [l-3]. Advances in techniques of general anesthesia permit urgent operations on pregnant women with minimal risks to fetus and mother [1,2]. However, a woman with twin pregnancy and acoustic neuroma has not been reported. A 30-year-old woman (gravida two, para one) was transferred to the Veteran General Hospital-Taipei at the 30th week of pregnancy with the diagnosis of suspected brain tumor. Her first pregnancy had been uneventful. Prior to her transfer, she came to Tai-Ann Hospital during the 26th week of pregnancy because of hearing loss, tinnitus, diplopia, slurred speech and unbalanced gait. Before visiting doctors, she had the

Intrathecal Somatostatin in Cat and Mouse Studies on Pain, Motor Behavior, and Histopathology

Effects of intrathecal (i.t.) somatostatin (SST) on nociception, motor function, and spinal cord pathology were evaluated in cats and mice. Cats chronically implanted with i.t. lumbar catheters received either a single injection of 2 mg SST i.t. (group I, N = 4), four repetitive injections on consecutive days of 2 mg SST i.t. (group II, N = 4) or saline i.t. (group III, N = 2). No analgesic effects were observed following single or repeated SST injections as evaluated by the skin twitch response. However, significant impairment of hind leg motor function ranging from unbalanced gait to paralysis was observed following the first SST i.t. injection. Histological examination of spinal cords six days after the first SST injection in group II showed multiple pyknotic neurons in all cats. Some cats showed focal demyelination in the posterior column of the spinal cord white matter. Mice received a single percutaneous injection of 50 micrograms SST i.t. (group I, N = 7), 5 micrograms SST i.t. (group II, N = 3), or saline i.t., (group III, N = 5). No analgesic effects were observed in groups II and III as evaluated by the hot plate (HP) and tail flick (TF) tests. Injection of 50 micrograms SST i.t. (group I) caused reversible flaccid hind leg paralysis in all mice and concomitant increases in HP and TF latencies. Histologic examination revealed focal demyelination in the spinal cord in three out of seven mice in this group. Present data substantiate neurotoxic effects of i.t. SST and lack of behaviorally defined antinociception at innocuous dosages.

Wild life rabies in Nigeria: experimental infection and transmission studies with the shrew (Crocidura sp.).

Wild caught shrews were infected with rabies virus strains by the intramuscular, subcutaneous and oral routes. Inoculated animals became sick within four to seven days of inoculation with characteristic dumb rabies symptomatology. The significant symptom was a progressive loss of aggressiveness and an unbalanced gait. The course of illness was 36-48 hours. Transmission of rabies virus to susceptible laboratory mice was successful only with shrews which had been infected orally and allowed to bite adult mice soon after infection. This suggests a mechanical role in the transmission of rabies. Virus was isolated only from shrews infected with street or wild strains of rabies, but not with vaccine or fixed rabies strains.