Walking Problems Research Articles

Fall risk factors and prevention among older adults in primary care in Belgium, 2019-2021

Abstract Background Falls are a major public health problem and ageing populations further increase the burden of fall-induced injuries. Falling among older persons is a multifactorial health condition needing multifactorial care. General practitioners (GPs) are well placed to implement a multifactorial management. A surveillance study of accidental falls studied characteristics of falls, risk groups and fall risk factors as well as fall prevention by GPs. Methods A 3-year retrospective population-based study by the Belgian network of Sentinel General Practitioners (SGP) on all patients aged ≥ 65 years consulting their GP for new fall-related injuries. Descriptive statistics were used to characterize falls, fallers, fall risks and preventive measures. Logistic regression analyses were performed to identify factors associated with a multifactorial fall risk profile. Results During 2019-21, 1138 accidental falls were registered. Medical and/or nursing intervention was required for 24% and 22% had a severe injury. During consult, 30% was referred to hospital. 61% of patients showed at least one of the four most prevalent fall risks, i.e. deficits of mobility or balance, polypharmacy, cognitive impairment or psychotropic medication. A multifactorial fall risk profile was observed in 45% of fallers and was associated with recurrent falling (p < 0.001), fall location (p < 0.05), activity when falling (p < 0.01) and pandemic year 2020 (p < 0.05). Addressing surrounding and walking problems were the most frequently delivered preventive measures. For 28% of patients, other primary care providers (mainly nurse and physiotherapist) were involved in preventive care. Conclusions This study highlights the importance of identifying fall risk factors among fallers in primary care. Preventive fall measures, taken in about one in four general practice patients in collaboration with other healthcare providers, are crucial for preventing accidental falls in older persons in Belgium. Key messages • A multifactorial management of fall risk factors by GPs is crucial for preventing accidental falls in older primary care patients. • Strengthening collaboration between primary healthcare professionals is needed for improving fall prevention in Belgium.

“Efficacy of Rehabilitation Exercises in Patients with Parkinson's Disease”

Introduction: Parkinson’s disease (PD) is a progressive neurodegenerative disease caused by a deficiency in the neurotransmitter dopamine in the basal ganglia. The gradual debilitating nature of PD makes it extremely difficult to function daily and interact with others. Rehabilitation has recently been suggested as an efficient and supplemental treatment for Parkinson's disease. Therefore, this study aimed to evaluate the efficacy of rehabilitation exercises for PD patients. Methods: This prospective study was conducted in the Department of Physical Medicine & Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July'2022 to June'2023. In our study, we included 60 patients diagnosed with Parkinson’s disease based on clinical indication and proper investigation. Patients were divided into two groups – Group A (Patients who received rehabilitation therapy) & Group B (Patients who received no intervention). Result: The MDS-UPDRS III scores were significantly lower in the rehabilitation group compared to the no -intervention group (P-value <0.001). The rehabilitation group also performed significantly better in the M-PAS (p<0.001). In terms of gait speed, the rehabilitation group showed higher comfort and faster gait speeds than the no-intervention group. The current study revealed that the majority of patients in the rehabilitation group (43%) mildly improved, with the maximum number (57%) of patients in the group experiencing an efficacy duration of three months. Conclusion: Our findings show that MS, walking problems, balance, and postural control dysfunction can all be improved in PD patients with 4 weeks of rehabilitation treatment therapy, compared to patients who did not undergo rehabilitation treatment.

Recreating evolutions of human walking gesture by spring-mass walking model

The evolution of human walking gestures is the evolution to adapt to new environments. Evolutionary adaptations in humans, including longer, straighter legs and increased average BMI, were examined using a spring-mass walking model to analyze their impact on locomotion efficiency. Spring-mass model considers walking problems in mechenics dimension. The simulation seperates variations that affects human walking to four independent parameters: mass, touch-down degree, leg length and leg stiffness. Simulation results demonstrated that model has lighter mass, which walks in smaller touch-down degrees gaits by lengthened, robust legs improved walking efficiency. By comparing CM displacement, research also addressed discrepancies between flat and normal gaits. Flat walking compensates its forward moving efficiency and distance per step to gain smaller vertical CM amplitude, accompanied by larger vertical CM amplitude and slower walking speed. Stronger legs and a curved, large-step gait reduced knee and waist pressure in individuals with higher BMI. The study highlights the adaptive significance of human physiological evolution in relation to locomotion efficiency. The study will provide insights into bipedal explanation for evolution tendency and existing problems.

Technologies and the elderly

Abstract Technological development and the increase in the elderly population are undoubtedly the two phenomena that have most characterized the last forty years. Although the elderly are credited with a certain resistance towards new things, in the last 20 years there has been a growing interest in the use of technological tools such as smartphones, PCs and tablets by the elderly population. This phenomenon has undergone a strong acceleration starting from the COVID-19 pandemic which has made technological tools indispensable in order to maintain virtual social and family relationships as it was not possible to meet people directly. Technologies promise undoubted advantages, especially for elderly people who are more easily subject to fatigue and walking problems and are more in need of constant monitoring of their health, but, at the same time, it exposes everyone, especially those over sixty-five, to collateral damage, such as reduction of in-person relationships and exposure to online scams. In this article we will try to identify the pros and cons of the diffusion of modern technological tools among the elderly.

Association between the Hopkins Falls grading scale and motor function tests in patients with multiple sclerosis.

One of the main complications of multiple sclerosis (MS) is imbalance and walking problems that can lead to falls. This study investigated the association between a fall measurement scale called the Hopkins Falls Grading Scale (HFGS) and motor function tests in patients with MS. This cross sectional study was conducted using convenience sampling on 85 patients referred to the MS Association of Mashhad, Iran, in 2023. The HFGS examined falls during the past year and divided them into 4 degrees, and the function test included the timed 25 foot walk (T25FW) test and the timed up and go (TUG) test. Kruskal-Wallis test and Spearman's correlation coefficient were used for data analysis. A statistically significant association was obtained between HFGS and functional tests (T25FW and TUG) (for both P < 0.0001). A significant association was observed between the variables of age (P = 0.006), duration of the disease (P = 0.03), the use of mobility devices (P = 0.05), and HFGS. Considering the association between HFGS and motor function tests in MS patients, clinical experts should pay attention to patients who have slower movement and evaluate them in terms of falling status when performing motor function tests.

Effects of Treatments Applied in Myasthenia Gravis on Gait: Review

Myasthenia Gravis (MG) is an autoimmune disease in which neuromuscular transmission is blocked and neuromuscular junction physiology is affected. The main feature in MG is altered muscle weakness and fatigue of muscle groups that worsens with exercise and improves with rest. With the emergence of muscle weakness in the following periods, walking is affected in MG. This causes balance and walking problems. Most of the patients have complaints of falling and fear of falling. While applying MG treatment, myasthenic symptoms should be reduced and a stable clinical picture should be obtained in which the daily activities of the person are relieved. The aim of this study is to understand the effect of rehabilitation practices on gait in MG and to determine which exercises are effective. As a result, physiotherapy and rehabilitation approaches can provide solutions to patients' complaints, albeit symptomatically. Active resistance exercises, aerobic exercises, balance strategy training, endurance exercises, posture exercises, stretching exercises and active–passive range of motion exercises should be performed in an exercise program. In addition, rhythmic auditory stimulation and pre-surgical respiratory physiotherapy also have positive effects on walking.

Assessment of frailty, daily life activities, and nutrition of elderly immigrants: A household based cross-sectional study.

With the global migrant population on the rise, it's imperative to focus on the health status of more vulnerable groups within these communities. The elderly immigrants face myriad physical and psychosocial challenges that significantly impact their health and quality of life. This study aims to investigate the nutrition, daily life activities, and clinical frailty status of elderly immigrants residing in Türkiye. A cross-sectional design was employed in the Sultanbeyli District, focusing on Syrian immigrants aged 65 and over. Participants were surveyed face-to-face by interpreters proficient in Arabic. The questionnaire comprised sociodemographic details, health status, and scales like Katz Daily Life Activities, Clinical Frailty, and Mini Nutritional Assessment. The data analysis was executed using SPSS 22. Continuous variables were presented as mean ± standard deviation (SD) and median, while categorical ones were expressed in numbers and percentages (%). A significance level of P < .05 was considered for the analyses. The average age of the participants was determined as 71.64 ± 6.20 years. In the study group, 49.7% were female, 75.5% were younger than 75 years old, 47.7% had less than primary school education, 56.3% were married, 42.4% had a low income level, and 56.9% lived in the same household with 5 or more people. Among the participants in the study group, 47% had walking and balance problems, 29.1% had a history of falls in the last year, 10.6% were disabled, 69.5% complained of pain, 82.8% had a chronic illness, and 43% had polypharmacy. The median value of the KATZ Daily Living Activities scale was 6, the mean score of the Clinical Frailty Score scale was 3.25 ± 1.25, and the mean score of the Mini Nutritional Assessment scale was 12.40 ± 2.15. Among immigrant elderly individuals, 88.1% were able to sustain their lives independently, 13.9% were clinically frail, and 3.3% were at risk of malnutrition. Factors such as age, level of education, socioeconomic status, marital status, number of cohabitants in the household, BMI, neurological problems, walking-balance disorders, disability, and presence of chronic diseases are associated with daily life activities, frailty, and malnutrition status. It is believed that broader field research with greater participation would be beneficial for evaluating the nutritional status of immigrant elderly individuals.

Multimodal Interaction Strategies for Walker-Assisted Gait: A Case Study for Rehabilitation in Post-Stroke Patients

Stroke has been considered the main cause of neuromuscular damages worldwide and one of the most common causes of walking disabilities, with approximately 60% of the individuals suffering from persistent problems in walking. These patients generally use technical aids for walking to achieve independent gait, however, when cognitive impairments are also present, conventional assistive devices such as walkers could be difficult to handle. By leveraging multimodal interfaces, smart walkers can offer natural and intuitive human-robot interaction. In this work, we present two multimodal interaction strategies for smart walkers focusing on guiding post-stroke patients through their environment. These strategies leverage different communication channels and provide distinct levels of guidance: one strategy uses haptic feedback and a visual interface to indicate the desired path to the user, while the other strategy uses haptic feedback and a virtual torque to maintain the user on path. We also present two case studies with post-stroke patients to preliminarily validate these interaction strategies with their target population and to collect valuable insight as to how multimodal strategies for smart walkers can be enhanced to deal with the characteristic asymmetries of post-stroke patients. Our results show that both strategies can guide the volunteers, however, the first one demands more effort from the volunteer and is more suited for patients with increased levels of independence. The second interaction strategy allows for higher linear velocity (Volunteer 1, 0.18\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{0.18}$$\\end{document}±0.026\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{\\pm 0.026}$$\\end{document}m/s\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{m/s}$$\\end{document}; Volunteer 2, 0.22\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{0.22}$$\\end{document}±0.0283\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{\\pm 0.0283}$$\\end{document}m/s\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{m/s}$$\\end{document}) than the first one (Volunteer 1, 0.10\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{0.10}$$\\end{document}±0.031\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{\\pm 0.031}$$\\end{document}m/s\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{m/s}$$\\end{document}; Volunteer 2, 0.20\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{0.20}$$\\end{document}±0.012\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{\\pm 0.012}$$\\end{document}m/s\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varvec{m/s}$$\\end{document}), suggesting improved guidance.

Predictive factors for foot pain in the adult population

BackgroundFoot pain has been associated to factors like: fat, body mass index, age increased, female gender and the presence of pathologies. Although evidence is limited. The purpose is to determine the predictive factors for foot pain in the adult population.MethodsFrom January to December 2021, 457 patients were > 18 years, gave signed informed consent to take part to this cross sectional study. All completed demographic data and various questionnaires related to pain: Foot Function Index, EuroQoL-5D and Visual Analogue Scale (foot pain). Anthropometric measurements were obtained using McPoil platform and foot posture was assessed by the Foot Posture Index (FPI). To determine whether a volume change is a predictive factor for foot pain, a parameter was established: the volumetric index for footwear (VIF). Factors linked to the presence of pain, including the considered VIF variables, were analyzed through multivariable logistic regression.ResultsAmong the study population, 40.7% were male and 59.3% female. The mean age of 39.06 years and a body mass index of 25.58 Kg/cm2. The logistic regression model had a classification capability of 72.4%, a sensitivity of 72.3% and a specificity of 73%, in which, the predictors considered were the variables found to have a significant association with FFI-pain > 45 points,, showed that younger women, with a higher BMI, higher values of right FPI (pronation), poorer overall perceived health and with problems in walking were more likely to experience foot pain.ConclusionPredictive factors for foot pain in the adult population include gender, age, Body Mass Index, FPI on the right foot, perceived health and mobility. Clinical implication, the presented measure aids physicians in assessing their patients´ foot pain likelihood.

A Portable Robotic System for Ankle Joint Rehabilitation

The design of a new exoskeleton is presented based on four electric linear actuators for the flexion motion range of the ankle of a user. The exoskeleton system is designed to be easy to operate and fairly inexpensive so that it can be used as a tool for exercising and the rehabilitation of the ankle. A prototype of the ankle exoskeleton is presented with its electrical circuit and components, such as servomotors, microcontrollers, sensors, and power supplies. The prototype is distinguished by an innovative design, which uses linear electric actuators for angular-assisted motion, providing a controlled adaptive movement of the ankle joint in its basic movements, separately and combined. The key elements of the ankle exoskeleton prototype consist of a lower leg housing, front and rear servomotor mounts, and ball joints with the aim of mimicking and supporting the natural movements of the ankle for users with walking and mobility problems. The innovation of the proposed work can be recognized in the portable mechanical design with a proper mechatronic design with four actuators that control ankle motion in all its possibilities.

Quality of Life, Pedobarographic Parameters, and Foot Disorders in Patients with Extreme Obesity: Preliminary Results on Changes After Bariatric Surgery with Gastric Bypass

PurposeObesity is a growing health problem that affects a high percentage of the population. In podiatry context, few studies have addressed obesity because most pedobarographic systems are unable to bear the weight of patients with obesity, making it difficult to examine and manage these patients. The objective of this study was analyzed the sociodemographic characteristics, quality of life, foot disorders, and pedobarographic parameters of patients with extreme obesity who are candidates for bariatric surgery and determine the changes after weight loss post-surgery.Materials and MethodsWe conducted a foot examination, a pedobarographic study using a Podoprint® pressure platform, and a quality of life questionnaire (EQ-5D) on 23 patients with extreme obesity and analyzed the changes 12–18 months after surgery in 11 of them.ResultsWe observed foot disorders, high plantar pressure, greater rearfoot contact, flat footprint, asymmetries, and alterations in toe contact. Almost 73.9% of participants said they had foot pain, 56.5% said they had impaired mobility, and more than 40% said they had limitations in carrying out daily activities and suffered from anxiety. After weight loss, we observed improved quality of life; more foot disorders; changes in total contact area, plantar pressures, barycenter, contact time, and footprint; decreased pain perception, walking problems and anxiety situations. Moreover, medication decreased, but they need to take more vitamins and calcium.ConclusionWeight loss improved the quality of life of the participating patients but altered their foot disorders. All parameters need regular reassessment to detect changes and modify initially prescribed treatments.Graphical

Adaptive robust control for biped walking under uncertain external forces

Adaptability and robustness are important expressions of the intelligent walking ability of biped robots. This paper is concerned with the problem of dynamical biped walking and robust control of biped robots under external forces. Due to the characteristics of strong coupling and hybrid, the robotic system is modeled as a rigid kinematic chain with Lagrange equations. A novel adaptive feedback controller is proposed based on sliding mode control (SMC) and hybrid zero dynamics. The novelty of the proposed work lies in taking the uncertainty of upper-bound error into consideration. The hybrid robust control is mentioned to approximate unknown dynamic functions with the adaptive weight. The restricted Poincare return map is utilized to analyze the stability of a nonlinear impulsive system. It ensures that the flow of the continuous subsystem can pass through the impact cross section. Finally, the simulation results illustrate that the proposed adaptive SMC control system can favorably track the reference trajectories, even when a fault occurs, which verifies the effectiveness of the proposed method.

A Physical Rehabilitation Approach for Parkinson's Disease: A Systematic Literature Review.

Parkinson's disease (PD) is one of the most common neurological ailments. With diverse motor affectations (postural instability, resting tremor, bradykinesia, and rigidity), people with Parkinson's disease (PwP) have a broad spectrum of non-motor symptoms. These include autonomic function changes, cognitive deterioration, neuropsychiatric difficulties, and sleep interruptions. Psychological disturbances, such as anxiety and sadness, are common among PwP. This discomfort is often accompanied by a decrease in general functioning, both at work and in social contacts. Furthermore, people who are experiencing psychological distress have a quick decrease in both physical and cognitive capacities. Furthermore, Pwp who also suffer from anxiety and depression are more likely to acquire dementia. It is worth noting that studies have shown good outcomes in the treatment of physical disabilities in PWP and the various therapeutics available for each affected body part, such as in the legs when they have walking problems, resting tremor in their hands, or micrography, which is a common symptom in these patients. The medical researchdatabases PubMed/Medline, Google Scholar, and the Cochrane Library were used to look for relevant materials. Upon meticulous scrutiny, a thorough investigation was conducted on the papers at hand. A total of 10 publications were meticulously selected based on stringent qualifying criteria. The present investigation examines various perspectives regarding the physical rehabilitation of individuals diagnosed with PD. The majority of therapeutic interventions employed revolve around cutting-edge technologies, such as virtual reality (VR), combined with exercise regimens. These interventions have demonstrated notable statistical significance in terms of enhancing various physical aspects, including endurance, performance, gait capacity, perception, and overall independence in daily life activities. One of the gathered studies makes use of the therapeutic benefits of yoga to help PwP deal with their anxiety and improve their mental health.Based on the aforementioned information, further investigation is required to ascertain the optimal approach for physical rehabilitation management and develop diverse strategies aimed at assisting individuals with PD in attaining physical autonomy.

The Strategy of Connotative Development of Higher Education in China: a Policy Mapping Scope

Abstract The history of higher education in China is considered as the history of continuously choosing a model of development. The higher education is always facing the problem of walking along the way of intension or extension at different stages of development. From the perspective of macro and micro, this study aims to explore the strategy of connotative development of higher education in China from a policy mapping scope. It plays a bigger and better function by adjusting or optimizing the structure, improving the level and quality under the background of keeping the scale of higher education system stable or growing slightly.

Syndrome postchute des sujets âgés et réhabilitation précoce à l’hôpital

While all people who fall are at risk for trauma, age, gender and health status can affect the type and severity of that trauma. It is important to stop trivializing falls in the elderly. Prevention of falls or relapses is essential. It is necessary to diagnose the first fall or if there are walking or balance problems with a risk of falling, or fear of falling.

Clinical Manifestations Associated with the Domain-Containing Protein 2 Gene Mutation in an Iranian Family with Spastic Paraplegia 54

Introduction: Spastic paraplegia type 54 (SPG54) is an autosomal recessive disorder caused by bi-allelic mutations in the DDHD-domain-containing protein 2 (DDHD2) gene. Worldwide, over 24 SPG54 families and 24 pathogenic variants have been reported. Our study aimed to describe the clinical and molecular findings of a pediatric patient from a consanguineous Iranian family with significant motor development delay, walking problems, paraplegia, and optic atrophy. Methods: The patient was a 7-year-old boy with severe neurodevelopmental and psychomotor problems. Neurological examinations, laboratory tests, electroencephalography, computed tomography scan, and brain magnetic resonance scan (MRI) were carried out for clinical evaluation. Whole-exome sequencing and in silico analysis were undertaken to identify the genetic cause of the disorder. Results: The neurological examination showed developmental delay, spasticity in the lower extremities, ataxia, foot contractures, and deep tendon reflexes in the extremities. The computed tomography scan was normal, but MRI revealed corpus callosum thinning with atrophic changes in the white matter. The genetic study reported a homozygous variant (c.856 C>T, p.Gln286Ter) in the DDHD2 gene. The homozygous state was confirmed by direct sequencing in the proband and his 5-year-old brother. This variant was not reported as a pathogenic variant in the literature or genetic databases and was predicted to affect the function of the DDHD2 protein. Conclusion: The clinical symptoms in our cases were similar to the previously reported phenotype of SPG54. Our results deepen the molecular and clinical spectrum of SPG54 to facilitate future diagnoses.

Optimization of the Position and Stiffness of Passive Walking Assistance Devices

Walking is a fundamental movement in daily life; however, many factors affect walking that may reduce the mobility of the people. Walking assistance devices can help with gaining mobility back for people who suffer from walking problems. In the present study, a computational method to determine the location and stiffness of the assistive walking systems was developed. The human walking model was created by using nine rigid bodies and eight revolute joints connecting them in the sagittal plane. The walking assistance system was considered as a tension spring with both ends attached to the human walking model. A coordinate system was defined along the distal–proximal direction of the human body. The position of the walking assistance system was determined by using four design variables, and the optimal position of the assistive walking system to reduce the total positive joint energy was found around the hip joint at a walking speed of 1.3 m/s. Hip joint moment and power were significantly affected by the walking assistance system, and the total positive joint energy was reduced by 8.8%. Because walking speed significantly affects walking kinematics and kinetics, the effect of walking speed on the optimal walking assistance device was investigated. The position of the device was kept the same, and the optimal stiffness and free length of the spring were found at different walking speeds. Two different cases were considered: a speed-specific design in which stiffness characteristics were separately optimized for each speed and a general design in which stiffness characteristics were optimized by considering all walking speeds. It was found that, in both cases, hip joint moment and power significantly reduced, and the speed-specific design produced a slightly larger reduction in total joint energy. The performance of the walking assistance systems in both cases were found to be higher at faster walking speeds.

Segmental Optic Atrophy with Adrenoleukodystrophy ABCD1 Gene Variant

We report a case of Adrenoleukodystrophy ABCD1 gene variant presenting with segmental optic atrophy in a 34-year-old male. The patient presented to our Neuro-Ophthalmology clinic with complaints of defective vision in both eyes, mild headache and gait disturbances. Ocular examination showed best corrected visual acuity of 6/24 in both eyes and fundus examination revealed temporal pallor of optic disc. Systemic examination revealed spastic paraparesis. Neuroimaging was advised which revealed well defined confluent symmetric bilateral T2/FLAIR hyperintense areas in parietal-occipital deep white matter and in the splenium of the corpus callosum, acoustic and optic radiations bilaterally. Genetic testing was positive for ABCD1 c.1966T&gt;C (p.Ser656Pro) gene variant. X-linked adrenoleukodystrophy (X-ALD) is a rare neurodegenerative disease characterized by genetic mutation of the ABCD1 gene, primarily affecting males. Our patient presented with defective vision and walking problem due to Adrenoleukodystrophy ABCD1 gene variant. Ocular symptoms often occur after the systemic abnormalities are noted.

Optimization of human gait using singular-value decomposition-based design variables

Age, walking speed, the presence of walking problems, the slope of the ground, and many other parameters affect human gait. Understanding gait variations and obtaining a reference behavior under different conditions is important for identifying abnormal walking behaviors and designing walking assistive devices, orthoses, and prostheses. Predictive dynamics can be used to determine a reference motion for a given task. In the predictive dynamics approach, the motion of a human is generated using design variables, and the equation of motion is considered a constraint. Several design variables were used to generate the motion, and the biological limits of the joints were considered additional constraints in previous studies. A foot-ground contact model was used to generate vertical and horizontal ground reaction forces using the nonlinear spring-damper model. This study proposed a singular value decomposition-based joint angle generation method to reduce the number of design variables and additional constraints. First, the joint angles were calculated using the motion capture data of 225 participants. Then, a joint angle matrix containing the joint angles of all participants in the experiments was created. The modes of the joint angles were extracted using singular-value decomposition. The joint angles were generated by summing the multiplication of the first nine modes of the joint angles and their corresponding design variables. Therefore, the number of design variables was significantly reduced. Moreover, the constraints related to the joint angle limits were intrinsically satisfied. Joint angles, moments, and power were obtained for the optimal energy and moment square cases at different walking speeds. The optimal results were found to be consistent with experimental results in the literature.

Problems with traditional rubber cane tips and cane tip design based on the human ankle–foot mechanism

Canes are mobility devices used by people who have some walking problems and want to move independently in areas where they cannot use wheelchairs easily. The traditional rubber tips are more prone to fall injuries. Few studies have concluded that using a cane can fall due to skidding or off–balancing. A cross-sectional survey was conducted among 45 users (who were the present user of a walking stick) to find the problems associated with traditional rubber tips and their relation with fall or skidding. To reduce the problem with traditional rubber tips, a newer design was proposed based on human ankle behavior to reduce falling/skidding and increase slip angle for independent walk on–ramp surface. The survey results show that traditional rubber tip (35%) was more prone to fall and skid accidents. People required more assistance on–ramp surface (38%) than a straight surface (35%). The mathematical model and simulation result shows that the new design mimics the mechanism of the normal human ankle. The findings showed that by using the human ankle mechanism, the functioning of canes on–ramp surfaces can be improved, and users' mobility needs may be better met.