Walking Impairment Research Articles

Efficacy of a personalised activity plan for BREAKing UP sitting time in patients with intermittent claudication (the BREAK UP study)

IntroductionThe aim of this study was to investigate the concept of an 8-week personalised activity plan, using short periods of physical activity to break up sitting time in people with Intermittent Claudication (IC), to improve walking ability, and reduce time spent sitting. MethodsThe study was designed as a single centre, single arm, before and after study and is registered with clinicaltrials.gov (NCT04572737). The co-primary outcomes are time spent sitting and walking ability measured via the walking impairment questionnaire. Normally distributed data was analysed using paired samples T-tests; non-normally distributed data was analysed using related-samples Wilcoxon signed rank tests. ResultsThere was a significant improvement in both co-primary outcomes: walking ability and time spent sitting, as well as the following secondary outcomes: total bouts and time spent in prolonged sitting, time spent standing and stepping, anxiety, depression, and activity levels reported on the vascular quality of life questionnaire. ConclusionAn 8-week personalised activity plan to break up sitting time shows promise as a treatment for people with IC, improving walking ability and reducing time spent sitting. This study supports the use of large randomised controlled trials to further develop this treatment in people with IC.

Home-Based Walking Exercise and Supervised Treadmill Exercise in Patients With Peripheral Artery Disease

Few people with lower extremity peripheral artery disease (PAD) participate in supervised treadmill exercise covered by the Center for Medicare and Medicaid Services. In people with PAD, the benefits of home-based walking exercise, relative to supervised exercise, remain unclear. To study whether home-based walking exercise improves 6-minute walk (6MW) more than supervised treadmill exercise in people with PAD (defined as Ankle Brachial Index ≤0.90). Data were combined from 5 randomized clinical trials of exercise therapy for PAD using individual participant data meta-analyses, published from 2009 to 2022. Of the 5 clinical trials, 3 clinical trials compared supervised treadmill exercise to nonexercise control (N = 370) and 2 clinical trials compared an effective home-based walking exercise intervention to nonexercise control (N = 349). Individual participant-level data from 5 randomized clinical trials led by 1 investigative team were combined. The 5 randomized clinical trials included 3 clinical trials of supervised treadmill exercise and 2 effective home-based walking exercise interventions. Change in 6MW distance, maximum treadmill walking distance, and Walking Impairment Questionnaire at 6-month follow-up. The supervised treadmill exercise intervention consisted of treadmill exercise in the presence of an exercise physiologist, conducted 3 days weekly for up to 50 minutes per session. Home-based walking exercise consisted of a behavioral intervention in which a coach helped participants walk for exercise in or around home for up to 5 days per week for 50 minutes per session. A total of 719 participants with PAD (mean [SD] age, 68.8 [9.5] years; 46.5% female) were included (349 in a home-based exercise clinical trial and 370 in a supervised exercise trial). Compared with nonexercise control, supervised treadmill exercise was associated with significantly improved 6MW by 32.9 m (95% CI, 20.6-45.6; P < .001) and home-based walking exercise was associated with significantly improved 6MW by 50.7 m (95% CI, 34.8-66.7; P < .001). Compared with supervised treadmill exercise, home-based walking exercise was associated with significantly greater improvement in 6MW distance (between-group difference: 23.8 m [95% CI, 3.6, 44.0; P = .02]) but significantly less improvement in maximum treadmill walking distance (between-group difference:-132.5 m [95% CI, -192.9 to -72.1; P < .001]). In this individual participant data meta-analyses, compared with supervised exercise, home-based walking exercise was associated with greater improvement in 6MW in people with PAD. These findings support home-based walking exercise as a first-line therapy for walking limitations in PAD.

Well-being at midlife: Correlates of mental health in ambulatory menopausal women with multiple sclerosis

Background: A majority of women with multiple sclerosis (MS) are diagnosed prior to menopause, yet their experiences during this transition are not well characterized. Objectives: To explore associations between mental health, sleep, and other quality of life metrics, and vasomotor symptoms (VMSs) in ambulatory, menopausal women with MS. Methods: A secondary analysis was performed of baseline data from two trials enrolling ambulatory peri/postmenopausal women with MS: NCT02710214 (N = 24, bothersome VMS) and NCT04002934 (ongoing, N = 35, myelin repair). Measures analyzed were 36-Item Short-Form Survey (SF-36) (primary scale: general mental health), subjective sleep quality (Pittsburg Sleep Quality Index), VMS (daily diary, interference), mood (Center for Epidemiologist Studies—Depression Scale (CES-D)), walking impairment (timed 25-foot walk (T25FW)), and global disability (Expanded Disability Status Scale (EDSS)). Results: Participants’ characteristics (N = 59) were: mean age 51.8 years (SD = 3.4), mean disease duration 11.3 years (SD = 7.6), median EDSS 3.0 (IQR = 2.0–4.0). Mental health was associated with better sleep quality (rho = −0.41, p = 0.019) and better mood (rho = −0.75, p < 0.001), but not with EDSS or T25FW (rho < 0.20, p > 0.10). Worse sleep quality also correlated with more frequent VMS (rho = 0.41, p = 0.02) and VMS interference (rho = 0.59, p < 0.001). Conclusions: Findings suggest that optimizing sleep quality, mood, and hot flash quantity/interference could substantially improve mental health in menopausal women with MS—and highlight an important care gap in this population.

O.4.1-4 Integrated geriatric care - a community approach to preventing falls and frailty of elderly Slovenian

Abstract Purpose The need for geriatric treatment is increasing with the aging of the population. Multimorbid patients with social care problems and increased need for rehabilitation and paliative care are more common. Mortality of the elderly, due to falls is 2.5 times higher in Slovenia than in the other EU countries. Until the national regulation of integrated geriatric care in Slovenian health system and in other relevant environments (community, long-term care, social care) and the establishment of appropriate, licensed postgraduate training for health professionals, it is necessary to start educating wider range of health and social care personnel, for most common geriatric syndromes such as frailty, falls and NCDs. Establishing a community approach to health is one effective way to address vulnerability of elderly population. Project description Project Integration of geriatric care for the elderly is implementing the existing commitment from WHO Decade of healthy ageing and the Slovenian Health Care Plan until 2025. With planned activities, it will ensure equal access to quality and safe health services, integrated and comprehensive treatment and will contribute to the deinstitutionalization of the Slovenian eldest population. It will develop a unified set of tools, for the systematic identification of elderly needs, new digital tools for optimization and better communication between different levels of providers and training a wider range of new and already employed health and social care personnel, for optimal health care. Evaluation of new competency models for health care personnel, training methods and proposed clinical pathways will be carried out at the end of the project. Based on final proposals, we will establish a new approach to the system level of integrated geriatric care and bring the treatment closer to the patient's home. Conclusions Project will also contribute to upgrading competences of physiotherapists, kinesiologists, standard health teams in Health Promotion Centers, community nurses, family medicine and internal medicine doctors and social care workers for the integrated geriatric care for the elderly. It will address especially treatment of the physical component in geriatric syndrome, such as decreased muscle strength, balance, impaired walking and frailty, at different levels of health care and communities.

Designing environments that contribute to a reduction in the progression of Parkinson's disease; a literature review.

Parkinson's Disease (PD), a prevalent neurological disorder, causes physical difficulties like stiffness and impaired walking and affects patients' emotional well-being. Regular exercise and exposure to enriched environments are crucial to managing these symptoms. This review aims to extract evidence from studies regarding built environments' impact on reducing the progression of PD. Keywords from 2005 to 2022 were used in five databases, including PubMed, Clarivate Web of Science, UGA Library, and Google Scholar. Many studies emphasized physiotherapy and training for physical enhancement, often utilizing virtual games and smart devices. Others highlighted the advantages of non-slip flooring and accessible outdoor spaces, with some based on universal design principles. Few studies considered the emotional impact of built environments, showing a considerable gap in the studies simultaneously evaluating psychological and physical perspectives of Parkinson-friendly environments. There needs to be more consistency when considering these aspects of planning. Our findings suggest future research modeling enriched environments and tracking their impact on patients via Virtual Reality to find a comprehensive guideline for the most effective PD management environments.

Kinematic and plantar pressure analysis in Strumpell-Lorrain disease: A case report

BackgroundHereditary Spastic Paraparesis (HSP), also known as Strumpell-Lorrain disease, is a neurodegenerative disorder characterized by progressive muscle weakness, lower limb spasticity, and abnormal gait. It is a genetically inherited condition affecting the spinal cord. Currently, there is a lack of scientific literature on the evaluation of space-time parameters and plantar pressures in individuals with HSP. Therefore, the objective of this study is to assess spatial-temporal parameters and plantar pressures using motion sensors and a baropodometric platform. Case presentationA 50-year-old female patient with a body mass index (BMI) of 22.28 presented to our hospital with a 12-year history of Strumpell-Lorrain disease. She exhibited typical symptoms of the disease, including spastic paraparesis in the lower limbs, leading to difficulty in walking. The initial symptom of difficulty walking was diagnosed when she was 38 years old. Apart from walking impairments associated with spasticity and ataxia, the patient demonstrated paraparesis and weakness in the lower limbs, without any cognitive deficits. ConclusionsThis analysis elucidates the challenges faced by the patient with Strumpell-Lorrain disease in walking, particularly during the swing phase, resulting in a reliance on monopodal support. Additionally, the patient experiences difficulty in dorsiflexion of the ankle due to spasticity in the gastrocnemius muscle, leading to an increased load on the forefoot. These findings contribute to a better understanding of the specific gait abnormalities and biomechanical impairments associated with Strumpell-Lorrain disease.

Study Design, Rationale, and Methodology for Promote Weight Loss in Patients With Peripheral Artery Disease Who Also Have Obesity: The PROVE Trial.

Background Overweight and obesity are associated with adverse functional outcomes in people with peripheral artery disease (PAD). The effects of weight loss in people with overweight/obesity and PAD are unknown. Methods The PROVE (Promote Weight Loss in Obese PAD Patients to Prevent Mobility Loss) Trial is a multicentered randomized clinical trial with the primary aim of testing whether a behavioral intervention designed to help participants with PAD lose weight and walk for exercise improves 6-minute walk distance at 12-month follow-up, compared with walking exercise alone. A total of 212 participants with PAD and body mass index ≥25 kg/m2 will be randomized. Interventions are delivered using a Group Mediated Cognitive Behavioral intervention model, a smartphone application, and individual telephone coaching. The primary outcome is 12-month change in 6-minute walk distance. Secondary outcomes include total minutes of walking exercise/wk at 12-month follow-up and 12-month change in accelerometer-measured physical activity, the Walking Impairment Questionnaire distance score, and the Patient-Reported Outcomes Measurement Information System mobility questionnaire. Tertiary outcomes include 12-month changes in perceived exertional effort at the end of the 6-minute walk, diet quality, and the Short Physical Performance Battery. Exploratory outcomes include changes in gastrocnemius muscle biopsy measures of mitochondrial cytochrome C oxidase activity, mitochondrial biogenesis, capillary density, and inflammatory markers. Conclusions The PROVE randomized clinical trial will evaluate the effects of exercise with an intervention of coaching and a smartphone application designed to achieve weight loss, compared with exercise alone, on walking performance in people with PAD and overweight/obesity. Results will inform optimal treatment for the growing number of patients with PAD who have overweight/obesity. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04228978.

Experimental study on stabilometric complex for terrainkur in overweight people.

Overweight and obesity is a multifactorial, multisystem disease declared a global epidemic by the World Health Organization (WHO) as early as in 1997. At least 30% of the working-age population in Russia is overweight. Only the use of physical activity as an integral (basic) part of obesity treatment and maintenance of the body weight achieved in the course of treatment can achieve durable and long-lasting treatment results as well as significant changes in the body structure (fat/non-fat body weight ratio). Terrainkur (therapeutic walking) is a method of spa treatment that combines climatotherapy and physical therapy. One of the problems in physical activity in obese people is the difficulty they experience in exercising due to the impaired walking pattern caused by imbalances in the muscle chains, including pelvic region, cervical region, which reduces endurance and commitment to physical activity. The study found that the exposure group (Terrainkur) showed lower values of "total fat", "metabolic age", "basic caloric value" compared to initial results and the control group; the exposure group (Terrainkur) showed a decrease in the deviation of the centre of body axis projection from the proper axis, the percentage of non-compliance with the proper fluctuations of the foot underextension. These changes contributed to the elimination of terrainkur restrictions and, as a result, improved the patient compliance during the terrainkur exercises.

Individuality of a group: detailed walking ability analysis of broiler flocks using optical flow approach

Impaired walking ability is one of the most important factors affecting broiler welfare. Routine monitoring of walking ability provides insights in the welfare status of a flock and assists farmers in taking remedial measures at an early stage. Several computer vision techniques have been developed for automated assessment of walking ability, providing an objective and biosecure alternative to the currently more subjective and time-consuming manual assessment of walking ability. However, these techniques mainly focus on assessment of averages at flock level using pixel movement. Therefore, the aim of this study was to investigate the potential of optical flow algorithms to identify flock activity, distribution and walking ability in a commercial setting on levels close to individual monitoring. We used a combination of chicken segmentation and optical flow methods, where chicken contours were first detected and were then used to identify activity, spatial distribution, and gait score distribution (i.e. walking ability) of the flock via optical flow. This is a step towards focusing more on individual chickens in an image and its pixel representation. In addition, we predicted the gait score distribution of the flock, which is a more detailed assessment of broiler walking ability compared to average gait score of the flock, as slight changes in walking ability are more likely to be detected when using the distribution compared to the average score. We found a strong correlation between predicted and observed gait scores (R2 = 0.97), with separate gait scores all having R2 > 0.85. Thus, the algorithm used in this study is a first step to measure broiler walking ability automatically in a commercial setting on a levels close to individual monitoring. These validation results of the developed automatic monitoring of flock activity, distribution and gait score are promising, but further validation is required (e.g. for chickens at a younger age, with very low and very high gait scores).

Accuracy and Reliability of a Suite of Digital Measures of Walking Generated Using a Wrist-Worn Sensor in Healthy Individuals: Performance Characterization Study.

Mobility is a meaningful aspect of an individual's health whose quantification can provide clinical insights. Wearable sensor technology can quantify walking behaviors (a key aspect of mobility) through continuous passive monitoring. Our objective was to characterize the analytical performance (accuracy and reliability) of a suite of digital measures of walking behaviors as critical aspects in the practical implementation of digital measures into clinical studies. We collected data from a wrist-worn device (the Verily Study Watch) worn for multiple days by a cohort of volunteer participants without a history of gait or walking impairment in a real-world setting. On the basis of step measurements computed in 10-second epochs from sensor data, we generated individual daily aggregates (participant-days) to derive a suite of measures of walking: step count, walking bout duration, number of total walking bouts, number of long walking bouts, number of short walking bouts, peak 30-minute walking cadence, and peak 30-minute walking pace. To characterize the accuracy of the measures, we examined agreement with truth labels generated by a concurrent, ankle-worn, reference device (Modus StepWatch 4) with known low error, calculating the following metrics: intraclass correlation coefficient (ICC), Pearson r coefficient, mean error, and mean absolute error. To characterize the reliability, we developed a novel approach to identify the time to reach a reliable readout (time to reliability) for each measure. This was accomplished by computing mean values over aggregation scopes ranging from 1 to 30 days and analyzing test-retest reliability based on ICCs between adjacent (nonoverlapping) time windows for each measure. In the accuracy characterization, we collected data for a total of 162 participant-days from a testing cohort (n=35 participants; median observation time 5 days). Agreement with the reference device-based readouts in the testing subcohort (n=35) for the 8 measurements under evaluation, as reflected by ICCs, ranged between 0.7 and 0.9; Pearson r values were all greater than 0.75, and all reached statistical significance (P<.001). For the time-to-reliability characterization, we collected data for a total of 15,120 participant-days (overall cohort N=234; median observation time 119 days). All digital measures achieved an ICC between adjacent readouts of >0.75 by 16 days of wear time. We characterized the accuracy and reliability of a suite of digital measures that provides comprehensive information about walking behaviors in real-world settings. These results, which report the level of agreement with high-accuracy reference labels and the time duration required to establish reliable measure readouts, can guide the practical implementation of these measures into clinical studies. Well-characterized tools to quantify walking behaviors in research contexts can provide valuable clinical information about general population cohorts and patients with specific conditions.

Walking speed differentially affects lower extremity biomechanics in individuals with anterior cruciate ligament reconstruction compared to uninjured controls

BackgroundWalking biomechanics are commonly affected after anterior cruciate ligament reconstruction and differ compared to uninjured controls. Manipulating task difficulty has been shown to affect the magnitude of walking impairments in those early after knee surgery but it is unclear if patients in later phases post-op are similarly affected by differing task demands. Here, we evaluated the effects of manipulating walking speed on between-limb differences in ground reaction force and knee biomechanics in those with and without anterior cruciate ligament reconstruction. MethodsWe recruited 28 individuals with anterior cruciate ligament reconstruction and 20 uninjured control participants to undergo walking assessments at three speeds (self-selected, 120%, and 80% self-selected speed). Main outcomes included sagittal plane knee moments, angles, excursions, and ground reaction forces (vertical and anterior-posterior). FindingsWe observed walking speed differentially impacted force and knee-outcomes in those with anterior cruciate ligament reconstruction. Between-limb differences increased at fast and decreased at slow speeds in those with anterior cruciate ligament reconstruction while uninjured participants maintained between-limb differences regardless of speed (partial η2 = 0.13–0.33, p < 0.05). Anterior cruciate ligament reconstruction patients underloaded the surgical limb relative to both the contralateral, and uninjured controls in GRFs and sagittal plane knee moments (partial η2 range = 0.13–0.25, p < 0.05). InterpretationOverall, our findings highlight the persistence of walking impairments in those with anterior cruciate ligament reconstruction despite completing formal rehabilitation. Further research should consider determining if those displaying larger changes in gait asymmetries in response to fast walking also exhibit poorer strength and/or joint health outcomes.

Long-term trajectories of ambulatory impairment in multiple sclerosis.

Ambulatory impairment is a common and complex manifestation of multiple sclerosis (MS), and longitudinal patterns are not well understood. To characterize longitudinal walking speed trajectories in a general MS patient population and in those with early disease (⩽ 5 years from onset), identify subgroups with similar patterns, and examine associations with individual attributes. Using a retrospective cohort study design, latent class growth analysis was applied to longitudinal timed 25-foot walk (T25-FW) data from 7683 MS patients, to determine T25-FW trajectories. Associations were evaluated between trajectory assignment and individual attributes. Analyses were repeated for 2591 patients with early disease. In the general patient population, six trajectories were discerned, ranging from very minimal to very high impairment at baseline, with variability in impairment accrual. The clusters with moderate to very high walking impairment were associated with being female, older and Black American, longer symptom duration, progressive course, and depressive symptoms. In the early disease subset, eight trajectories were discerned that included two subgroups that rapidly accrued impairment. We identified novel subgroups of MS patients will distinct long-term T25-FW trajectories. These results underscore that socially disadvantaged and economically marginalized MS patients are the most vulnerable for severe ambulatory impairment.

Effects of increased grazing intensity during the early and late grazing periods on the welfare of spring-calving, pasture-based dairy cows

The objective of this study was to identify potential effects of increased grazing intensity, characterized by differing pasture availability and stocking rate, on indicators of welfare during both early and late grazing periods. Seventy spring-calving, pasture-based Holstein-Friesian and cross-bred dairy cows, averaging 35 ± 16 d in milk on the first day of data collection, were assigned to 3 treatments (20-26 cows/treatment) representing a range in grazing intensity: LO (high pasture availability, 980 kg DM/ha opening cover, 2.75 cows/ha, 90:10% pasture:concentrate diet), MOD (medium pasture availability, 720 kg DM/ha opening cover, 2.75 cows/ha, 90:10% pasture:concentrate diet), and HI (low pasture availability, 570 kg DM/ha opening cover, 3.25 cows/ha, 80:20% pasture:concentrate diet); representative of current, best practice and proposed production levels respectively for this system. Welfare indicators were locomotion score, digital dermatitis and white line disease, rumen fill, ocular and nasal discharge, integument damage to the neck-back and hock regions, and lying time. Data were collected during a 5-wk early grazing period in spring (EG) and a 7-wk late grazing period in autumn (LG). Average daily lying time was recorded for 8 to 10 focal cows per treatment. Results demonstrated only minor treatment effects. Cows on MOD [odds ratio (OR) = 3.11] and HI (OR = 1.95) were more likely to display nasal discharge compared with LO. Cows on MOD tended to have more damage to the skin on the neck-back region than LO (OR = 4.26). Total locomotion score (maximum = 25) was greater on LOW (7.1 ± 0.20) compared with HI (6.5 ± 0.19). Average lame cow prevalence for EG and LG respectively was 15.3 ± 3.12% and 39.2 ± 3.00% (LO), 20.0 ± 2.58% and 24.2 ± 5.69% (MOD), and 14.9 ± 4.79% and 17.0 ± 3.44% (HI). Cows on HI were less likely to have impaired walking speed than either LO (OR = 0.24) or MOD (OR = 0.29). Cows on both HI (OR = 0.36) and MOD (OR = 0.40) were less likely to display impaired abduction or adduction compared with those on LO. An interaction between treatment and period revealed longer lying times for cows on LO (10.6 h/d ± 0.39) compared with both MOD and HI (8.7 ± 0.43 and 8.4 ± 0.41 h/d) during EG only. The greatest effects were across grazing periods, with all indicators except rumen fill and locomotion score demonstrating improvements from EG to LG. This suggests cows were able to cope well with increasing levels of grazing intensity, and that regardless of treatment, a greater number of days on pasture led to improvements in welfare indicators.

The impact of geriatric characteristics and comorbidities on distant metastases and other cause mortality in older women with non-metastatic breast cancer treated with primary endocrine therapy

IntroductionIn recent years, primary surgical treatment of older women with non-metastatic breast cancer has decreased in favor of primary endocrine therapy (PET). PET can be considered in women with a remaining life expectancy of less than five years. The aim of this study was to (1) assess the risk of distant metastases and other cause mortality over ten years in women aged 65 and older with stage I-III breast cancer treated with PET, (2) whether this was associated with geriatric characteristics and comorbidities and to (3) describe the reasons on which the choice for PET was made.MethodsWomen were included from the retrospective FOCUS cohort, which comprises all incident women diagnosed with breast cancer aged 65 or older between January 1997 and December 2004 in the Comprehensive Cancer Center Region West in the Netherlands. We selected women (N = 257) with stage I-III breast cancer and treated with PET from this cohort. Patient characteristics (including comorbidity, polypharmacy, walking, cognitive and sensory impairment), treatment and tumor characteristics were retrospectively extracted from charts. Outcomes were distant metastasis and other cause mortality. Cumulative incidences were calculated using the Cumulative Incidence for Competing Risks method (CICR); and subdistribution hazard ratios (SHR) were tested between groups based on age, geriatric characteristics and comorbidity with the Fine and Gray model.ResultsWomen treated with PET were on average 84 years old and 41% had one or more geriatric characteristics. Other cause mortality exceeded the cumulative incidence of distant metastasis over ten years (83 versus 5.6%). The risk of dying from another cause further increased in women with geriatric characteristics (SHR 2.06, p < 0.001) or two or more comorbidities (SHR 1.72, p < 0.001). Often the reason for omitting surgery was not recorded (52.9%), but if recorded surgery was omitted mainly at the patient’s request (18.7%).DiscussionThis study shows that the cumulative incidence of distant metastasis is much lower than other cause mortality in older women with breast cancer treated with PET, especially in the presence of geriatric characteristics or comorbidities. This confirms the importance of assessment of geriatric characteristics to aid counseling of older women.

Duplex ultrasound for surveillance of lower limb revascularisation.

Duplex ultrasound for surveillance of lower limb revascularisation.

Predictors of Sustained Physical Activity During the COVID-19 Pandemic in People With Parkinson Disease in Sweden.

During the first wave of the COVID-19 pandemic, people with Parkinson disease (PwPD) reported deterioration in health and physical activity. The aim of this study was to describe 1-year changes in physical activity and perceived health in PwPD during the COVID-19 pandemic and to identify predictors of sustained physical activity. This study compared perceived health and sensor-derived physical activity (Actigraph GT3x) in PwPD between the first (June to July 2020) and third waves (June to July 2021) of the pandemic. Multiple logistic regression analyses were used to predict sustained physical activity across the study period using personal factors, disease severity, and functioning as independent variables. Sixty-three PwPD (mean age 71.0 years, 41% females) completed both baseline and 1-year follow-up (26 lost to follow-up). PwPD showed a decrease in average number of steps per day (Δ415 steps, P = 0.048), moderate-to-vigorous-physical activity (Δ7 minutes, P = 0.007) and increase in sedentary time (Δ36 minutes, P <.001) between baseline and 1-year follow-up. While self-perceived walking impairments and depressive symptoms increased significantly, balance confidence decreased between baseline and 1-year follow-up, no significant changes occurred for self-rated health, quality of life, or anxiety. Significant predictors of sustained physical activity levels were 15 years or more of education (odds ratio [OR] = 7.38, P = 0.013) and higher perceived walking ability (OR = 0.18, P = 0.041). Among PwPD with mild to moderate disease severity living in Sweden, factors associated with reduced physical activity levels during the COVID-19 pandemic included older age, lower education levels, and greater perceived walking difficulties.

A dataset for the visually impaired walk on the road

As a special group, visually impaired people (VIP) find it difficult to access and use visual information in the same way as sighted individuals. In recent years, benefiting from the development of computer hardware and deep learning techniques, significant progress have been made in assisting VIP with visual perception. However, most existing datasets are annotated in single scenario and lack of sufficient annotations for diversity obstacles to meet the realistic needs of VIP. To address this issue, we propose a new dataset called Walk On The Road (WOTR), which has nearly 190 K objects, with approximately 13.6 objects per image. Specially, WOTR contains 15 categories of common obstacles and 5 categories of road judging objects, including multiple scenario of walking on sidewalks, tactile pavings, crossings, and other locations. Additionally, we offer a series of baselines by training several advanced object detectors on WOTR. Furthermore, we propose a simple but effective PC-YOLO to obtain excellent detection results on WOTR and PASCAL VOC datasets. The WOTR dataset is available at https://github.com/kxzr/WOTR

Impedance control and test of an automatic rotational orthosis for walking with arm swing

Neurological damage after stroke and spinal cord injury often results in walking impairments. The theory of interlimb neural coupling implies that synchronized arm swing should be included during gait training to improve rehabilitation outcomes. We previously developed an automatic rotational orthosis for walking with arm swing (aROWAS), which produced coordinated interlimb movement when running in passive mode. The current case-series study had three aims: to develop impedance control algorithms for generating flexible movement in the aROWAS system, to validate its technical feasibility, and to investigate interlimb muscle activity when using it. A force-free controller was developed to compensate for gravity and friction, and an impedance controller was developed to produce a flexible movement pattern. Experiments were performed on three able-bodied volunteers to evaluate the feasibility of the flexible aROWAS system and muscle activity in their upper and lower limbs was recorded. In force-free mode, the leg rig was static but easily moved by small external forces, and the subjects reported very little resistance when attempting to walk synchronously in the aROWAS system. In impedance mode, the leg rig performed the pre-defined gait pattern, but the joint trajectories were adaptable to external forces. All participants produced earlier hip extension and greater knee flexion during active walking than during passive walking. Furthermore, the arm and lower limb muscles simultaneously produced higher electromyography activity. The control algorithms enabled the aROWAS system to produce walking-like coordinated joint performance in the upper and lower limbs, and also allowed for some degree of adjustment in response to voluntary input from the users. Stronger interlimb muscle activity was produced when participants walked actively in the system. This aROWAS system has the technical potential to serve as an effective tool for investigating interlimb neural coupling and as a novel testbed for walking rehabilitation with synchronized arm swing.

Mutant SPART causes defects in mitochondrial protein import and bioenergetics reversed by Coenzyme Q

Pathogenic variants in SPART cause Troyer syndrome, characterized by lower extremity spasticity and weakness, short stature and cognitive impairment, and a severe mitochondrial impairment. Herein, we report the identification of a role of Spartin in nuclear-encoded mitochondrial proteins. SPART biallelic missense variants were detected in a 5-year-old boy with short stature, developmental delay and muscle weakness with impaired walking distance. Patient-derived fibroblasts showed an altered mitochondrial network, decreased mitochondrial respiration, increased mitochondrial reactive oxygen species and altered Ca 2+ versus control cells. We investigated the mitochondrial import of nuclear-encoded proteins in these fibroblasts and in another cell model carrying a SPART loss-of-function mutation. In both cell models the mitochondrial import was impaired, leading to a significant decrease in different proteins, including two key enzymes involved in CoQ10 (CoQ) synthesis, COQ7 and COQ9, with a severe reduction in CoQ content, versus control cells. CoQ supplementation restored cellular ATP levels to the same extent shown by the re-expression of wild-type SPART, suggesting CoQ treatment as a promising therapeutic approach for patients carrying mutations in SPART .

Features of preoperative preparation in the treatment of the knee joint in patients with hemophilia

Hemophilia is considered a hematological-orthopedic disease that develops as a result of damage to various anatomical structures of the musculoskeletal system, among which the synovial joints (so-called "target joints") dominate in almost all patients with hemophilia. The purpose of the study was to develop and implement a modern preoperative preparation algorithm for surgical treatment of knee joint pathology in patients with hemophilia. In order to carry out our research, we analyzed 61 cases of hemophilia that were under inpatient and outpatient treatment at the "Kyiv City Clinical Hospital No.9" in the period from 2008 to 2022. Open or arthroscopic knee synovectomy was performed in 22 (36.1%) examined patients of our study. Indications for synovectomy were the presence of hemarthrosis 4–5 times a year or more, presence of deformity and pain syndrome. Total knee arthroplasty was performed in 39 (63.9%) patients. The indication for this operation was the presence of deforming arthrosis of the knee joint with impaired walking and standing function.The expanded algorithm of preoperative preparation included additional instrumental methods of research and calculation of the deficiency of blood coagulation factors, which made it possible to prevent hemorrhagic complications in this category of patients. Operations on patients with hereditary coagulation disorders should be performed under the supervision of hematologists specializing in coagulation disorders and preferably working in specialized centers that have all the necessary resources for the proper diagnosis and treatment of hemophilia. In order to minimize the risks of hemorrhagic complications, we strongly recommend treating such patients with the participation of a multidisciplinary team of specialists, drawing up an individual therapy plan before the operation, and conducting the operation in centers specializing in the treatment of patients with hemophilia. Keywords: orthopedics, hematological and orthopedic diseases, preoperative preparation algorithms.