Walking Performance Research Articles

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Background. Virtual reality and balancing beam are widely acknowledged as a highly successful approach for improving balance as well as walking performance among children suffering from hemiplegic cerebral palsy (CP). Purpose. The aim of this study was to compare between the impact of virtual reality and balance beam on walking performance (balance and functional walking capacity) in children with hemiplegic CP. Subjects and methods. A total of seventy-five children with hemiplegic CP, comprising 31 boys and 44 girls, aged between 7 and 11 years of both genders, were included in this study. The participants were allocated randomly into three groups (n = 25), A (control group) and B, C (study groups). All children received designed physical therapy programs based on neurodevelopmental technique, in addition to balance and gait training exercises for control group A, virtual reality training for group B and balance beam training for group C. The treatment program was administered to each group three times weekly for three consecutive months, lasting one hour each session. All children were examined clinically pre- and post-treatment using HUMAC balance and tilt system, and 6- minutes walking test (6mWT) to assess balance, walking functional capacity respectively. Results. There was a significant improvement in balance and 6MWT of three groups post treatment when contrasted with that pretreatment (p < 0.001). Furthermore, group B and C's measured variables showed a substantial improvement over group A's when compared (p < 0.01), while group B and C did not differ significantly (p > 0.05). Conclusions. Virtual reality and balance beam training have an effective influence on the improvement of balance and walking performance.

The measurement of fatigability severity in individuals with multiple sclerosis and healthy controls

BackgroundMultiple Sclerosis (MS) is a chronic disease that substantially diminishes one's ability to undertake daily living activities. Fatigue has been reported by at least 80 % of persons with MS (PwMS). Yet, little is known concerning the quantification of fatigability using prolonged walking tests. ObjectivesTo compare fatigability severity measures using the 10-minute walk test for PwMS against age- and gender-matched healthy controls (HCs). MethodsParticipants included 53 ambulatory PwMS and 49 HCs. Perceived fatigability was measured by dividing a participant's change in self-reported tiredness by the number of meters walked. Performance fatigability was calculated by dividing the change in walking speed (at 2.5 and 10 min) by the total distance walked in meters. ResultsThere was a significant difference in perceived fatigability between PwMS and HCs (mean difference: 2.73 ± 0.83; p = 0.001) and in performance fatigability (mean difference: 0.24 ± 0.11; p = 0.01). Moreover, there were significant differences in speed and distance at all time points (p ≤ 0.05) between PwMS and HCs. ConclusionsPwMS have significant walking deficits as reflected by greater fatigability in both perceived and performance measures. These methods can enhance therapeutic strategies that improve the walking performances of PwMS.

Visuospatial cognition predicts performance on an obstructed vision obstacle walking task in older adults

Walking performance and cognitive function demonstrate strong associations in older adults, with both declining with advancing age. Walking requires the use of cognitive resources, particularly in complex environments like stepping over obstacles. A commonly implemented approach for measuring the cognitive control of walking is a dual-task walking assessment, in which walking is combined with a second task. However, dual-task assessments have shortcomings, including issues with scaling the task difficulty and controlling for task prioritization. Here we present a new assessment designed to be less susceptible to these shortcomings while still challenging cognitive control of walking: the Obstructed Vision Obstacle (OBVIO) task. During the task, participants hold a lightweight tray at waist level obstructing their view of upcoming foam blocks, which are intermittently spaced along a 10 m walkway. This forces the participants to use cognitive resources (e.g., attention and working memory) to remember the exact placement of upcoming obstacles to facilitate successful crossing. The results demonstrate that adding the obstructed vision board significantly slowed walking speed by an average of 0.26 m/s and increased the number of obstacle strikes by 8-fold in healthy older adults (n = 74). Additionally, OBVIO walking performance (a score based on both speed and number of obstacle strikes) significantly correlated with computer-based assessments of visuospatial working memory, attention, and verbal working memory. These results provide initial support that the OBVIO task is a feasible walking test that demands cognitive resources. This study lays the groundwork for using the OBVIO task in future assessment and intervention studies.

Normative values in healthy adults for the 6-minute and 2-minute walk tests in Belgium and Vietnam: implications for clinical practice.

To establish reference values for the 6-minute walk test (6MWT) and 2-minute walk test (2MWT) distances, to investigate the correlation between these 2 tests, and to establish prediction equations for these distances in healthy populations of Belgium and Vietnam. Cross-sectional study. The 6MWT and 2MWT were administered to a convenience sample of 239 Belgian and 303 Vietnamese participants between the ages of 18 and 80 years. The mean (standard deviation; SD) 2MWT distances were 215 (32.8) m for Belgian participants and 156 (25.5) m for Vietnamese participants. The mean (SD) 6MWT distances were 625 (90.7) m for Belgian participants and 449 (70.4) m for Vietnamese participants. The Pearson correlation coefficient between the 2 tests was 0.901 (p < 0.001) for Belgian participants and 0.871 (p < 0.001) for Vietnamese participants. Age and sex were the 2 most important predictors of walking distance, followed by body mass index for Belgium and height for Vietnam. The adjusted R² ranged from 0.31 to 0.49 across 4 predictive equations. These results can be used to determine the presence of walking performance deficits and to guide future studies. The 2MWT is suggested as a useful and convenient alternative to the 6MWT for assessing walking performance in clinical practice.

Abstract P285: Relationship Between Body Mass Index, Waist Measurement, Six-Minute Walk Performance and Whole-Body Strength in Adults With Cardiovascular Disease: Findings From the Lifestyle Heart Health Study

Introduction: Cardiovascular disease (CVD) is the leading cause of death, killing 17.9 million people annually worldwide. Key risk factors include physical inactivity, overweight/obesity, high blood pressure, high cholesterol which worsen with age, and smoking and excessive alcohol intake. Six-minute walk (6MW) performance and whole-body muscle strength are both related to cardiovascular mortality and also worsen with age, particularly in the absence of physical activity. The aims of this study were to understand levels of cardiovascular risk and compliance to usual medical treatment (medication, lifestyle modifications) in a high socioeconomic Australian population, and to identify relationships between key risk factors, 6MW and muscle strength. A secondary aim was to help inform development of the Lifestyle Heart Health Education Program. Methods: This was a cross-sectional study of 473 people with CVD in Sydney. Class was classified based on the Australian socioeconomic index for areas. Conditions were defined according to Australian national guidelines. Medical history, body mass index (BMI), waist measurement, whole-body muscle strength and 6MW measurements were assessed. Simple linear and stepwise regressions were used to assess potential relationships. Results: Mean age of the cohort was 66.8±11.6; range 21-94 yrs; 68.5% female; socioeconomic index was deemed high. All participants had CVD, of which 25% were on aspirin. Hypertension was prevalent in 65% (38% on anti-hypertensives); 65% had dyslipidaemia (40% on a statin); 91% had a BMI over 26.0; and 85% of males and 80% of females had a waist measurement over gender-specific heart health recommendations. Less than 3% of the cohort smoked, and less than 10% consumed alcohol at a level deemed high-risk. Almost 20% of the cohort were at risk of CV mortality according to 6MW performance with scores less than 350 metres. Waist measurement, BMI, and blood pressure were the greatest risk factors across the cohort. Muscle strength (r=-0.34; r 2 =0.17; p&lt;0.001) and 6MW performance (r=-0.37; r 2 =0.17; p&lt;0.001) both decreased with age. BMI and age were the most significant predictors of 6MW (r=-0.45; r 2 =0.20; p=0.004) and whole-body strength (r=0.49; r 2 =0.24; p&lt;0.001) in females; waist and age were the most significant predictors of 6MW (r=-0.38; r 2 =0.14; p=0.11) and whole-body strength (r=0.41; r 2 =0.17; p=0.04) in males. Conclusion: Whilst alcohol and smoking campaigns are working to reduce consumption of these harmful substances, low cardiorespiratory and muscular fitness and overweight/obesity remain highly prevalent. Population-level interventions such as the Lifestyle Heart Health Program that aim to reduce weight and waist and improve physical activity, walking ability and muscle strength are urgently needed to reduce cardiovascular risk and mortality.

Abstract P256: Rationale, Development, and Implementation of a Multidisciplinary Digital Lifestyle Health Education Program for Older Adults With Cardiovascular Disease and Osteoarthritis

Introduction: Cardiovascular disease (CVD) is the leading cause of death worldwide. Globally, osteoarthritis (OA) affects 654 million. In 2018, of the 1.2 million Australians who had CVD, half also had arthritis, with the most common form in Australia being OA. Ongoing pain and physical limitations from OA can affect lifestyle choices, contributing to the shared risk factor profile of CVD and OA (physical inactivity, overweight/obesity, poor diet, high medication use). This contributes further to the burden of both diseases including reduced 6-minute walk (6MW) performance, which is directly related to increased CVD mortality. This project outlines the rationale for and development of a multidisciplinary digital lifestyle health education program for the treatment and secondary prevention of CVD and its common comorbidity of OA. Methods: This study is a cross-sectional analysis of older adults in Sydney. Class was classified based on the Australian socioeconomic index for areas. Conditions were defined according to Australian national guidelines. Medical history, body mass index (BMI), waist measurement, muscle strength, and 6MW measurements were assessed. Differences between those with and without OA were determined via one-way analysis of variance. Simple linear regressions assessed potential relationships. Results: In a cohort of 532 adults; n=341 (64.1%) had diagnosed CVD; 48.4% of which had OA (mean age 66±12 years; 73.3% female). Socioeconomic index was deemed high. In the OA cohort mean BMI and waist were above healthy heart recommendations according to the World Health Organisation. There were no significant differences between those with OA and those without for cardiovascular risk factors of body weight, BMI, waist measurement, blood pressure, 6MW, or muscle strength. However, in those with CVD and OA, the relationship between age and 6MW was stronger and age accounted for more of the variance in performance (r=-0.44; r 2 =0.19; p&lt;0.001) than those without OA (r=-0.37; r 2 =0.17; p&lt;0.001), indicating a greater reduction in walking ability in those with OA as they get older. Conclusion: With 6MW performance being related to CVD mortality, interventions are needed to improve health and fitness in this cohort. International guidelines for CVD and OA recommend treatment should prioritise lifestyle changes, including a healthy diet, regular physical activity, and interventions that address all risk factors. Lifestyle LIFEMAP will assess the efficacy of a widely translatable multidisciplinary digital evidence-based 10-module lifestyle, food, exercise, medication, and park prescription education program for adults with the comorbidity of CVD and OA. We expect this program to improve knowledge, and healthy lifestyle choices, thereby improving physical activity and health outcomes in this highly vulnerable population.

Walking performance in individuals with lumbar spinal stenosis—possible outcome measures and assessment of known-group validity

BACKGROUND CONTEXTOne of the primary goals of treatments received by individuals with lumbar spinal stenosis with neurogenic claudication is to improve walking ability. Thus, a thorough and valid assessment of walking ability in patients with lumbar spinal stenosis is needed. Duration of continuous walking and steps per day could be relevant when evaluating walking ability in daily living. PURPOSETo describe and evaluate a method for estimating continuous walking periods in daily living and to evaluate the known-group validity of steps per day in individuals with lumbar spinal stenosis. STUDY DESIGNThis is a cross-sectional observational study. PATIENT SAMPLEThe study contains three study groups: individuals with lumbar spinal stenosis, individuals with low back pain, and a background population from the Lolland-Falster Health Study (LOFUS). OUTCOME MEASURESParticipants in all three study groups wore an accelerometer on the thigh for seven days. METHODSAccelerometer data were processed to summarize the continuous walking periods according to their length: the number of short (4–9 seconds), moderate (10–89 seconds), and extended (≥90 seconds) continuous walking periods per day, and the number of steps per day. Results from the three groups were compared using negative binomial regression with lumbar spinal stenosis as the reference level. RESULTSContinuous walking periods of moderate length were observed 1.48 (95% CI 1.27, 1.72) times more often in individuals from the background population than in individuals with LSS. Continuous walking periods of extended length were observed 1.53 (95% CI 1.13, 2.06) times more often by individuals with low back pain and 1.60 (95% CI 1.29, 1.99) times more often by individuals from the background population. The number of steps per day was 1.22 (95% CI 1.03, 1.46) times larger in individuals with LBP and 1.35 (95% CI 1.20, 1.53) times larger in individuals from background population. CONCLUSIONSThe impact of neurogenic claudication on walking ability in daily living seems possible to describe by continuous walking periods along with steps per day. The results support known-group validity of steps per day. This is the next step toward a clinically relevant and comprehensive assessment of walking in daily living in individuals with lumbar spinal stenosis.

Spatiotemporal walking performance in different settings: effects of walking speed and sex.

Understanding the factors that influence walking is important as quantitative walking assessments have potential to inform health risk assessments. Wearable technology innovation has enabled quantitative walking assessments to be conducted in different settings. Understanding how different settings influence quantitative walking performance is required to better utilize the health-related potential of quantitative walking assessments. How does spatiotemporal walking performance differ during walking in different settings at different speeds for young adults? Forty-two young adults [21 male (23 ± 4 years), 21 female (24 ± 5 years)] walked in two laboratory settings (overground, treadmill) and three non-laboratory settings (hallway, indoor open, outdoor pathway) at three self-selected speeds (slow, preferred, fast) following verbal instructions. Six walking trials of each condition (10 m in laboratory overground, 20 m in other settings) were completed. Participants wore 17 inertial sensors (Xsens Awinda, Movella, Henderson, NV) and spatiotemporal parameters were computed from sensor-derived kinematics. Setting × speed × sex repeated measures analysis of variance were used for statistical analysis. Regardless of the speed condition, participants walked faster overground when compared to while on the treadmill and walked faster in the indoor open and outdoor pathway settings when compared to the laboratory overground setting. At slow speeds, participants also walked faster in the hallway when compared to the laboratory overground setting. Females had greater cadence when compared to males, independent of settings and speed conditions. Particularly at slow speeds, spatiotemporal walking performance was different between the settings, suggesting that setting characteristics such as walkway boundary definition may significantly influence spatiotemporal walking performance.

Does backward gait require more proprioception and balance in older adults after total knee arthroplasty?

ObjectivesSome basic and instrumental daily living activities include backward gait. There is a need to clarify which parameters should be focused more on to improve backward gait in older individuals. This research investigated the proprioception, and balance in forward-backward gait of older individuals with total knee arthroplasty (TKA). MethodsA prospective cross-sectional research was conducted with 105 older adults with TKA. Individuals' forward and backward gait performance was assessed with the Timed Up & Go Test (TUG) and 3 Meter Walk Back Test (3MBWT), respectively. Proprioception was measured with a mobile application-based inclinometer. Berg Balance Scale (BBS) and Activity Specific Balance Confidence Scale (ABC) were used to assess balance and balance confidence levels, respectively. A single clinician evaluated the individuals. ResultsTUG was weakly and positively correlated with the Right and Left Leg Proprioception Test (RLPT and LLPT) (r1 = 0.386, r2 = 0.391, p < 0.01). Also, the 3MBWT was weakly and positively correlated with RLPT and LLPT, respectively (r1 = 0.293, r2 = 0.251, p < 0.01). In addition, TUG was strongly and negatively correlated with BBS and ABC, respectively (r1 = −0,693, r2 = −0.722, p < 0.01). Besides, 3MBWT was strongly and negatively correlated with BBS and ABC (r1 = −0.642, r2 = −0.645, p < 0.01). ConclusionThe study revealed that forward and backward walking were similarly associated with balance and proprioception in older adults with TKA. Clinicians should focus more on balance ability than proprioception to improve backward walking performance in older individuals with THA.

Evaluation of variability in performance and paw placement patterns by dogs completing the dog walk obstacle in an agility competition.

The objective of this study was to describe paw placement patterns for canine athletes completing the dog walk obstacle during canine agility trials. It was hypothesized that dogs would demonstrate defined sets of paw placement patterns as they complete the dog walk obstacle and that those could be classified based on end contact behavior. Videos of 296 dogs attempting the dog walk obstacle at the 2021 UK Agility International (UKI) US Open were reviewed online. Data observed from video evaluation included front and rear limb paw placement across the dog walk and time to complete the obstacle. Results showed a high variability in obstacle performance. Mean time to complete the entire obstacle was 2.26 seconds (sd = 1.03). Mean and median completion times were qualitatively similar across all height classes. A slight majority of dogs hit the up ramp with their right foot first indicating running on their left lead (n = 185, 63%) with some variation observed between heights. Likewise, a slight majority (58%) of dogs hit the down ramp with their right front foot first (151/262). Given the high variation in completion times and paw placements, we could not identify clear patterns of dog walk performance. The large amount of variation observed with the dog walk obstacle suggests a need for future studies to employ alternative methods for objective gait analysis and to strategically select dogs to reflect the large variety in obstacle performance observed here.

Neural Oscillations and Functional Significances for Prioritizing Dual-Task Walking in Parkinson's Disease.

Task prioritization involves allocating brain resources in a dual-task scenario, but the mechanistic details of how prioritization strategies affect dual-task walking performance for Parkinson's disease (PD) are little understood. We investigated the performance benefits and corresponding neural signatures for people with PD during dual-task walking, using gait-prioritization (GP) and manual-prioritization (MP) strategies. Participants (N = 34) were asked to hold two inter-locking rings while walking and to prioritize either taking big steps (GP strategy) or separating the two rings (MP strategy). Gait parameters and ring-touch time were measured, and scalp electroencephalograph was performed. Compared with the MP strategy, the GP strategy yielded faster walking speed and longer step length, whereas ring-touch time did not significantly differ between the two strategies. The MP strategy led to higher alpha (8-12 Hz) power in the posterior cortex and beta (13-35 Hz) power in the left frontal-temporal area, but the GP strategy was associated with stronger network connectivity in the beta band. Changes in walking speed and step length because of prioritization negatively correlated with changes in alpha power. Prioritization-related changes in ring-touch time correlated negatively with changes in beta power but positively with changes in beta network connectivity. A GP strategy in dual-task walking for PD can enhance walking speed and step length without compromising performance in a secondary manual task. This strategy augments attentional focus and facilitates compensatory reinforcement of inter-regional information exchange.

Factors associated with changes in walking performance in individuals 3 months after stroke or TIA: secondary analyses from a randomised controlled trial of SMS-delivered training instructions in Sweden

ObjectivesThis study aimed to identify factors related to changes in walking performance in individuals 3 months after a stroke or TIA.DesignCross-sectional study with post hoc analysis of a randomised controlled...

Usage Frequency, Barriers, And Effectiveness of Functional Electrical Stimulation as An Intervention for Stroke Patients

Objective: To determine the frequency of Functional Electrical Stimulation (FES) use in stroke rehabilitation and to identify the barriers and effectiveness of its usage as an intervention for stroke patients. Materials &amp; Methods: This prospective observational study was performed in different clinics and hospitals in Hyderabad. Physical therapists actively practicing in healthcare facilities within Hyderabad, with a minimum of one year of clinical experience in stroke rehabilitation of either gender were included. A questionnaire was structured to collect data on the usage frequency, perceived barriers, and effectiveness related to the utilization of FES in stroke rehabilitation. Results: Most of the participants were using FES frequently and sometimes for shoulder subluxation, improving arm function, enhancing walking function, improving muscle strength and endurance, addressing hypertonia and spasticity, and improving sensation. Respondents when asked about having sufficient time to apply FES, lack of evidence justifying FES use, and regards to workplace support most of the cases &gt;50% agreed strongly agreed, while &lt;50% of study subjects’ believed that does not provide advantages for individuals having a chronic stroke. FES utilization among healthcare professionals in stroke patient rehabilitation, highlighting its potential benefits in improving arm function, shoulder subluxation, walking performance, and hemiplegic shoulder pain. However, there were no significant barriers identified. Conclusion: There was a significant use of FES by physical therapists in Hyderabad to address various aspects of stroke rehabilitation. The study overall highlights its potential for improving arm function, preventing shoulder subluxation, enhancing walking, and reducing hemiplegic shoulder pain, without significant identified barriers.

Cognitive function influences cognitive-motor interference during dual task walking in multiple sclerosis

BackgroundBoth physical and cognitive impairments are common in people with multiple sclerosis (PwMS). Performing a cognitive task while walking (i.e., dual-task walking) can introduce cognitive-motor interference (CMI), resulting in changes in walking performance. The association between the levels of cognitive impairment and of CMI in MS remains unclear. ObjectivesTo examine the association between cognitive functioning and differences in walking performance arise between single- and dual-task walking. MethodsNinety-five PwMS performed self-preferred pace walking and dual-task walking. The gait parameters recorded were used to compute dual task costs (DTC) as a metric of CMI. Cognitive functioning was assessed using Match, an unsupervised test developed based on the Symbol Digit Modalities Test. Participants were categorized as higher (HCF) and lower cognitive functioning (LCF) based on a Match z-score < −1.5. ResultsLCF group had elevated DTC for stride velocity, relative to the HCF group. Higher DTC for stride velocity was associated with lower cognition, as assessed by Match test. ConclusionThe findings support the hypothesis that CMI is associated with cognitive functioning in PwMS.

ACROMORFO study: gait analysis in a cohort of acromegalic patients

PurposeIn acromegaly, skeletal complications resulted to be associated with low quality of life (QoL) and high risk of falls. The aim of the present study was to perform a quantitative assessment of movement through gait analysis technique in patients with acromegaly.Study populationThirty-three acromegalic patients [9 with active disease (AD), 14 with controlled disease (CD) and 10 with disease remission (RD)] and 20 healthy subjects were enrolled for the study.MeasurementsKinetic and kinematic data were collected with 3D-gait analysis. Kinematic data were processed to compute the Gait Profile Score (GPS), a parameter that summarizes the overall deviation of kinematic gait data relative to unaffected population.ResultsThe acromegalic group showed longer stance phase duration (p < 0.0001) compared to controls. The GPS and several gait variable scores resulted to be statistically higher in the acromegalic group compared to healthy controls. GPS values were significantly higher in AD compared to CD (p < 0.05) and RD groups (p = 0.001). The AD group presented significantly higher values in terms of hip rotation and ankle dorsiflexion compared to CD and RD groups and with regard to the foot progression compared to RD. Interestingly, patients with RD exhibited a more physiological gait pattern.ConclusionAcromegalic patients showed quantitative alterations of gait pattern, suggesting instability and increased risk of falls. Arthropathy, along with its associated abnormal joint loading, proprioceptive impairment and hyperkyphosis could be contributing factors. Disease control and remission appear to improve postural balance. A better knowledge on walking performance in acromegaly would help to develop specific rehabilitation programmes to reduce falls’ risk and improve QoL.

Queer Street Scenes: Interruption, Exception, Orientation

How might we think queerly about the politics of performance in public space? Inspired by ‘queer’ as a straying from the straight-and-narrow and by the street as a site of chance meetings and awkward run-ins, I stage in this essay an encounter between two different approaches to thinking the politics of performance in public space. The first approach follows a familiar path: Bertolt Brecht's ‘street scene’ and Walter Benjamin's account of epic theatre. The second approach follows the walking performances of two queer migrant artists – South Korean-born Jisoo Yoo, now based in France, and Mozambican-born Jupiter Child, now based in Denmark – who interrogate the disorientation of the queer migrant body in Western European public space. Exploring the surprisingly busy intersection between the Brechtian street scene and the work of these two artists reveals a politics of performance in public space that favours orientation over rupture.

Gamification as a Tool for Promoting Physical Exercise and Healthy Eating Habits in Healthcare Worker Women: Effects on Cardiometabolic Health and Physical Fitness at Workplace.

To evaluate the effectiveness of gamified versus nongamified health promotion interventions on cardiometabolic health and fitness parameters in healthcare worker women. Randomized parallel group trial. A public outpatient health center in Brazil. Women employees (included: n = 29; lost to follow-up: n = 1; analyzed: n = 28). 8 weeks of gamified (n = 15) or nongamified (n = 13) interventions, consisting of health lectures, nutritional counseling, and supervised exercise training. The gamified group was divided into teams that received points based on completion of health goals/tasks. Anthropometric, cardiometabolic and physical fitness parameters. Two-way ANOVA with repeated measures (group vs. time), and Bonferroni post hoc tests. Body mass (-1.5 ± 1.5kg), waist circumference (-1.6 ± 3.0cm), HbA1C (-.2 ± .3%), triglycerides (-21.5 ± 48.2mg/dl), systolic (-11.1 ± 7.9 mmHg) and diastolic (-7.1 ± 5.8 mmHg) blood pressure, as well as sit and reach (3.9 ± 3.0cm) and six-minute walking (56 ± 37m) performance improved (P < .05) only after the gamified intervention. Sit-to-stand performance improved after both the gamified (-1.18 ± 1.24 s) and nongamified (-1.49 ± 1.87 s) interventions. The gamified intervention was more effective than the nongamified intervention for improving cardiometabolic and physical fitness parameters, suggesting that gamification may be an effective tool for promoting health in healthcare worker women.

Reliability and construct validity of the ACTIVLIM-Hemo and Haemophilia Activities List (HAL) questionnaires in individuals with haemophilia.

The objective of this study is to assess the reliability and construct validity of ACTIVLIM-Hemo, a newly developed Rasch-built questionnaire designed to evaluate activity limitations in people with haemophilia (PwH), in comparison with the Haemophilia Activities List (HAL), which was developed using Classical Test Theory. A total of 130 participants with haemophilia A or B were included. They underwent various assessments, including joint health scoring (HJHS), functional tests (TUG and 2MWT) and completed questionnaires such as the BPI, IPAQ, HAL and ACTIVLIM-Hemo. Reliability indices and the minimum detectable change (MDC95) were determined for ACTIVLIM-Hemo and for HAL. Construct validity was evaluated through correlations and multiple linear regression, considering demographic and clinical factors. Both ACTIVLIM-Hemo (Person Separation Index=0.92) and HAL (Cronbach's α=0.98) demonstrated high reliability. The MDC95 for ACTIVLIM-Hemo represented 11.6% of its measurement range, while for HAL, it amounted to 18/100 score points. Activity limitations measured by both instruments were significantly correlated with demographic and clinical factors. Joint health (HJHS), pain severity (BPI) and walking performance (2MWT) emerged as the main predictors of activity limitations, explaining 75% of the variance in ACTIVLIM-Hemo and 60% in HAL. ACTIVLIM-Hemo stands as a reliable and valid instrument for assessing activity limitations in PwH. Both instruments exhibited significant correlations with demographic and clinical factors, but ACTIVLIM-Hemo displayed a more homogeneous construct. Given its linear scale and lower MDC95 and better targeting, ACTIVLIM-Hemo shows promise as a patient-centric instrument for assessing responsiveness to treatment during individual follow-up.

High Dynamic Bipedal Robot with Underactuated Telescopic Straight Legs

Bipedal robots have long been a focal point of robotics research with an unwavering emphasis on platform stability. Achieving stability necessitates meticulous design considerations at every stage, encompassing resilience against environmental disturbances and the inevitable wear associated with various tasks. In pursuit of these objectives, here, the bipedal L04 Robot is introduced. The L04 Robot employs a groundbreaking approach by compactly enclosing the hip joints in all directions and employing a coupled joint design. This innovative approach allows the robot to attain the traditional 6 degrees of freedom in the hip joint while using only four motors. This design not only enhances energy efficiency and battery life but also safeguards all vulnerable motor reducers. Moreover, the double-slider leg design enables the robot to simulate knee bending and leg height adjustment through leg extension. This simulation can be mathematically modeled as a linear inverted pendulum (LIP), rendering the L04 Robot a versatile platform for research into bipedal robot motion control. A dynamic analysis of the bipedal robot based on this structural innovation is conducted accordingly. The design of motion control laws for forward, backward, and lateral movements are also presented. Both simulation and physical experiments corroborate the excellent bipedal walking performance, affirming the stability and superior walking capabilities of the L04 Robot.

Adaptive auditory assistance for stride length cadence modification in older adults and people with Parkinson's.

Gait rehabilitation using auditory cues can help older adults and people with Parkinson's improve walking performance. While auditory cues are convenient and can reliably modify gait cadence, it is not clear if auditory cues can reliably modify stride length (SL), another key gait performance metric. Existing algorithms also do not address habituation or fluctuation in motor capability, and have not been evaluated with target populations or under dual-task conditions. In this study, we develop an adaptive auditory cueing framework that aims to modulate SL and cadence. The framework monitors the gait parameters and learns a personalized cue-response model to relate the gait parameters to the input cues. The cue-response model is represented using a multi-output Gaussian Process (MOGP) and is used during optimization to select the cue to provide. The adaptive cueing approach is benchmarked against the fixed approach, where cues are provided at a fixed cadence. The two approaches are tested under single and dual-task conditions with 13 older adults (OA) and 8 people with Parkinson's (PwP). The results show that more than half of the OA and PwP in the study can change both SL and cadence using auditory cues. The fixed approach is best at changing people's gait without secondary task, however, the addition of the secondary task significantly degrades effectiveness at changing SL. The adaptive approach can maintain the same level of SL change regardless of the presence of the secondary task. A separate analysis is conducted to identify factors that influence the performance of the adaptive framework. Gait information from the previous time step, along with the previous input cue, can improve its prediction accuracy. More diversity in the initialization data can also improve the GP model. Finally, we did not find a strong correlation between stride length and cadence when the parameters are contingent upon input cues.