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Objective: To explore the impact on risk factors for recurrent stroke after gait training among persons restricted in walking in the chronic phase after stroke. Methods: In this randomized controlled trial, two groups performed gait training, 1 session/day, 3 days/week for 6 weeks, including electromechanically assisted gait training on a treadmill (EAGT) (n=12) or variable conventional gait training only (n=15); a control group (n=11) continued as usual. Endurance assessed with the 6-minute walk test, blood pressure, weight and blood samples were collected at baseline and after 6 weeks. Total Cholesterol, High Density Lipoprotein Cholesterol, and Triglycerides in plasma, and HbA1c in blood (reflecting glucose levels) were analysed. Results: The EAGT group walked more than twice the distance compared to the Conventional training group while the effective training time was similar. Endurance in walking increased most in the Conventional group while the Control group declined. Systolic blood pressure decreased most in the Conventional group, with a moderate effect size (ŋp2) of 0.0921 (95% confidence interval (CI)0.0012-0.2598). Body weight decreased most in the EAGT group with a large effect size (ŋp2) of 0.1406 (95% CI0.0047-0.3452). Lipid levels exhibited non-conclusive changes and HbA1c did not change significantly in any group. Conclusions: Results indicate that six weeks of gait training may change risk factors for recurrent stroke even in persons restricted in mobility and that different training methods may have differential effects. These findings are in agreement with previous studies in less severely disabled persons and should encourage further studies in the current subgroup. [ABSTRACT FROM AUTHOR]

In subacute, non-ambulatory individuals after stroke, does mechanically assisted walking with body weight support result in more independent walking or better walking ability than usual walking training in the short term? Are any benefits maintained in the longer term? Is it detrimental to walking in terms of walking speed? A systematic review with meta-analysis of randomised studies with a Physiotherapy Evidence Database (PEDro) score > 4. Non-ambulatory adults ≤ 12 weeks after stroke. Any type of mechanically assisted walking with body weight support. Independent walking (ie, proportion of independent walkers), walking ability (eg, 0 to 5 Functional Ambulation Category, FAC) and walking speed. Fifteen studies involving 1,014 participants (mean PEDro score 6.4) were included. In the short term, mechanically assisted walking with body weight support resulted in more independent walking (RD 0.19, 95% CI 0.11 to 0.26) and better walking ability (MD 0.8 on the FAC, 95% CI 0.5 to 1.0) compared with the same amount of usual walking training. In the longer term, it resulted in better walking ability (MD 0.6 on the FAC, 95% CI 0.2 to 1.1). Mechanically assisted walking with body weight support does not appear to be detrimental to walking speed in the short term (MD 0.13 m/s, 95% CI 0.03 to 0.22) or longer term (MD 0.11 m/s, 95% CI 0.00 to 0.22). This review provides high-certainty evidence that mechanically assisted walking with body weight support results in more independent walking and better walking ability in individuals with stroke who are non-ambulatory subacutely compared with usual walking training. Given the importance of achieving walking in the short term, clinicians are encouraged to use this intervention. PROSPERO CRD42024549678 [ABSTRACT FROM AUTHOR]

The gait cycle involves a repeated sequence of tasks that result in walking. The cycle is divided into two phases: the stance and swing phase. Both phases have further sub-phases. The stance phase may be considered from the perspective of the three functional foot-ankle fulcrums or 'rockers'. Gait analysis is defined as the assessment of gait and identification of abnormalities. The different classes of gait data include temporal-spatial parameters, kinematics, and kinetics. Instrumented gait analysis uses motion capture systems and instrumented walkways to record gait data in these various classes. Evolving technologies for gait analysis include two–dimensional camera systems and wearable devices. Inertial measuring units are small electronic wearable devices containing sensors, which record temporal-spatial gait parameters. There is potential to use inertial measuring units in conjunction with machine learning to estimate more detailed gait data. The identification of abnormal gait patterns in patients with certain neurological disorders helps guide clinical decision-making. Pattern recognition and kinematic data have been used to develop a classification system for sagittal plane gait deviations in the spastic diplegic variant of cerebral palsy. Five common patterns are recognized. These are equinus, jump, apparent equinus, crouch and asymmetric gait patterns. Orthotics are important non-operative management devices. Surgery may be used to address specific primary or secondary pathology. [ABSTRACT FROM AUTHOR]

Introduction and Purpose: Knee osteoarthritis (OA) is a common condition that limits function and reduces quality of life. Total knee arthroplasty (TKA) is a surgical procedure that replaces the joint surfaces to address anatomical changes due to knee OA. While TKA improves symptoms and function, postoperative impairments are common, including reduced quadriceps strength. Blood flow restriction (BFR) may be a viable option for patients following TKA, as it can improve strength with a minimal amount of joint loading compared to traditional strength training. The purpose of this case report is to describe the impact of BFR use in an individual after TKA, employing pain measurements, quantitative sensory testing, patient-reported outcome measures, physical performance tests, and muscle strength and power testing to explore potential treatment effects and identify potential predictors of response for future studies. Case Description: A 49-year-old former female triathlete with a history of knee injury and arthroscopic surgery underwent a right TKA and sought physical therapy (PT) due to pain, limited range of motion (ROM), and knee instability during weight bearing activity. PT interventions included manual therapy, gait training, and a home program. Despite participating in supervised PT, she had persistent pain, ROM deficits, and muscle weakness 16 weeks following TKA. BFR was incorporated into her home program, 16-weeks postoperatively. The Short Form McGill Pain Questionnaire-2 (SF-MPQ-2) and Numeric Pain Rating Scale (NPRS) were used to measure pain. Quantitative sensory testing included pressure pain threshold (PPT) and two-point discrimination (TPD) to measure change in sensory perception. Patient-reported outcome measures to assess perceived physical function were the Knee injury and Osteoarthritis Outcome Score (KOOS) and the KOOS- Joint Replacement (KOOS-JR). Physical performance was measured through the 30-second fast walk test (30SFW), timed stair climb test (SCT), 30-second chair standing test (CST), and the timed up and go (TUG). Knee ROM was assessed through standard goniometry. Knee extensor and flexor muscle strength and power were measured with an instrumented dynamometer for isokinetic and isometric testing, generating a limb symmetry index (LSI). Outcomes: Pain and quantitative sensory testing achieved clinically meaningful improvement suggesting reduced sensitivity during and after BFR utilization. Perceived physical function and symptoms significantly improved, particularly in sports and recreation activities, and were best captured in the KOOS, not the KOOS-JR. Physical performance reached clinically meaningful improvement in walking speed, chair stand repetitions, and timed stair climb tests after BFR. Isokinetic and isometric strength and power in knee extensors and flexors increased significantly after BFR compared to the uninvolved leg as determined by LSI. Discussion: In this case, BFR appeared to be a safe and well-tolerated intervention. The results suggest potential benefits in terms of increased function, strength, power, and reduced pain in this specific person after TKA. Comprehensive pain and sensory assessments alongside clinical measures may help identify suitable patients for BFR after TKA. The KOOS-Sport & Recreation subscale may be more responsive to monitor functional recovery compared to the KOOS-JR, possibly due to the subject's athletic background. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

Compared to their sedentary peers, older track athletes demonstrate a superior ability to negate the normal age-related changes in gait mechanics known to attenuate maximal walking speed performance with age. Sports-specific exercises commonly utilized to affect this end may be appropriately scaled to benefit a wider subset of older adults. Optimal dosing of resistance training to maximize gluteus maximus functional fitness, accompanied by gait reeducation to augment motor patterns facilitating optimal peak trailing leg extension and push-off intensity, create a redundancy in walking capacity likely to prolong functional independence for beneficiaries of this targeted intervention. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolism (VTE) is a well-known complication after spine surgery. As many cases of cervical spine disease result in severe gait disturbance due to myelopathy, it may harbor a higher risk of VTE than other spinal disorders. However, few studies have focused primarily on cervical spine surgery to date. This investigation sought to determine the prevalence of VTE after cervical spine surgery and identify patient-based risk factors. Methods: The medical data of 341 consecutive patients (240 men and 101 women; mean age, 68.1 years) who underwent cervical spine surgery were retrospectively examined. Logistic regression models were employed to examine the prevalence, characteristics, and risk factors of postoperative VTE. Results: In this study, 2.6% of cervical spine surgery patients experienced postoperative VTE. In comparisons of VTE and non-VTE groups, significant differences were found for age (79.6 years vs 67.7 years, P < 0.01), 1-week postoperative Ddimer level (10.6 μg/mL vs 2.7 μg/mL, P < 0.01), and cardiovascular disease (44.4% vs 11.1%, P = 0.011). Multivariate analysis identified elevated postoperative D-dimer level and cardiovascular disease as significantly associated with postsurgical VTE with respective odds ratios of 1.54 and 9.52. Conclusion: Postoperative VTE in cervical spine surgery was seen in 2.6% of cases. Patients with elevated postoperative D-dimer level and cardiovascular disease may be at increased risk of VTE and may require additional observation. Clinical Relevance: Spine surgeons should take into account that patients with elevated postoperative D-dimer levels and cardiovascular disease may be at increased risk for VTE. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of meta-analysis are to evaluate evidence about the effects of Rehabilitation Exercise Program on the balance of post-stroke patients, evaluated by the Berg Balance Scale (BBS). Methods: The search was conducted 'stroke,' 'rehabilitation,' 'dynamic balance,' 'Berg Balance Scale,' 'exercise' and 'randomized controlled trial'using MEDLINE (accessed by PubMed), Web of Science (WoS), ProQuest, and Google Scholar for journal studies published from January 2018 to October 2022. Two independent reviewers performed the article selection, data extraction, and methodological quality assessment. The main outcome was dynamic balance assessed by the Berg Balance scale. Results: The review included 30 papers and a total of 540 patients. The overall effect size was 0.550, a medium effect size according to the Cohen's standard. It was observed that gender has moderate effect size in male (0.551), female (0.458) and higher in male. Exercise type results showed large effect sizes in balance training (0.966), and aquatic activities (0.830), moderate effect sizes in virtual reality (0.762), moderate effect sizes in physically active (0.581), gait training (0.541), dual-task (0.478), trunk control (0.284), and small effect sizes in resistance training (0.128). Conclusions: Exercise programs are effective in improving dynamic balance in stroke patients. Especially, the meta-analysis showed higher Effect Size for balance training and virtual reality than for other programs making this relevant interventions for future head to head superiority studies that compare different balance interventions in stroke. [ABSTRACT FROM AUTHOR]

Background: Spinal arachnoid web (AW) is a very rare entity, with a limited number of cases documented in the literature. Our manuscript represented a comprehensive general review, encompassing various aspects of the subject matter without focusing on any single element. The objective of this systematic review was to describe and analyze reported cases of surgically proven spinal arachnoid webs (AWs) to elucidate their imaging and clinical features, pathophysiology, and optimal management strategies, and to determine the total number of documented cases in the literature. Patterns and commonalities across reported cases were identified to provide a clearer framework for diagnosing and treating this elusive condition. A search of Web of Science, PubMed, and Scopus, respecting PRISMA guidelines, was conducted to include reported cases of surgically proven spinal AW. Our surgically proven case was included as well. The search yielded 196 cases of surgically confirmed spinal AWs in the literature. Adding our case, the total is 197. They are seen commonly in middle-aged patients, slightly more prevalent in males, and often without an evident cause. Sensation disturbances were the most frequently found clinical signs, followed by gait difficulties, weakness, and pain. Symptoms were predominantly located in the lower limbs and trunk. On imaging, an indentation to the rear aspect of the spinal cord was most frequently found at the mid-thorax followed by the upper thorax, often associated with a syrinx or a hyperintense T2 cord signal, usually extending rostrally. Excision was the most efficient treatment. Short conclusion: The assessment found that AW cases are rare in the literature, indicating the disease's scarcity. It manifests insidiously, with the shortest latency reported being 2 weeks. Upper limb symptoms occur in a quarter of cases regardless of the AW's thoracic location, likely due to rostral syrinx and cerebrospinal fluid flow disturbances. Most pathology results revealed fibrous connective tissue, similar to findings in arachnoid cysts, suggesting that AW may result from a ruptured arachnoid cyst or its precursor. Using 3D SPACE STIR and CISS MRI sequences is recommended to visualize the arachnoid band directly. [ABSTRACT FROM AUTHOR]

Objectives: Erroneous perceptions about the cause of stroke may negatively impact survival during and after stroke occurrence. Patient health decisions may be influenced by various factors, such as advice, previous experience, beliefs and online information. Some patients of African descent maintain that stroke is caused by witchcraft and its related impairments can be permanently ameliorated by divination. Accordingly, seeking medical intervention is seen as a waste of resources and time, making it difficult for health professional to offer adequate care. This study explores the importance of patient education combined with physiotherapy intervention in the modulation of stroke-related impairment amid erroneous beliefs about the incidence and management of stroke. Case Presentation: This study is a case report of a 63 year-old Nigerian female with diabetes. She is a hypertensive stroke survivor with a complaint of inability to walk, weakness of muscle, and loss of functional movement in her right hand and leg from a year ago. She underwent 8 weeks of individualized home physiotherapy, such as progressive manual resistance exercise, transcutaneous electrical nerve stimulations (ENS), electrical muscle stimulation, task-oriented circuit training, peripheral neuromuscular stimulation, task-specific training, and gait/balance exercise, in addition, to the use of routine drugs and diet 2 h daily for 3 days a week using discrete practice. Discussion: There was an improvement in muscle strength, hand functional abilities, gait/balance, activities of daily living and a reduction in spasticity, glucose level, body adiposity (body fat percentage (%BF), visceral fat percentage (%VF) and body mass index [BMI]) and blood pressure/derived cardiovascular indices as per post-intervention scores. Many factors could influence the patient's decision and continuous education of the patient and informal caregivers may positively influence the patient's condition and ameliorate erroneous beliefs among stroke survivors. We also provide evidence to corroborate and strengthen existing evidence that stroke-related impairments, can be modulated with physiotherapy intervention. We recommend that physiotherapists should include interventions targeted at increasing muscle mass and reducing body fat when treating stroke survivors to ameliorate the negative impact of stroke on the musculoskeletal structure, stroke recurrence, and enhancement of functional performance in activities of daily living. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the effect of step training (ST) utilizing a multivisual-cue mat on gait performance in individuals diagnosed with Parkinson’s Disease (PD). Thirty-six patients with PD aged between 63.3 ± 7.91 and 68.8 ± 8.20 years, at Hoehn and Yahr (HY) stage 2–3, were included in the study and randomly allocated to either a ST Group (n = 18) or a Control Group (n = 18). The ST Group underwent movement strategy training incorporating a multi-visual-cue mat, while the Control Group maintained regular daily activities. Outcome gait measures were assessed using a two-way mixed-design ANOVA. The results revealed that the ST group had significant (P < 0.001) improvements in gait velocity, step length, stride length, and a significantly reduced number of steps and double support time, Unified PD Rating Scale (UPDRS) part III motor score, and a freezing of gait questionnaire (FOG-Q) score. However, cadence was not significantly different compared with the Control Group (P = 0.13). All measured outcomes in patients in the ST Group were improved. Step training using a multivisual-cue mat has potential therapeutic benefits for enhancing gait performance in patients with Parkinson’s Disease, and appears to be both feasible and safe. The multi-visual-cue mat presents a promising avenue for further exploration as a beneficial tool to improve gait parameters in patients with PD in home exercise settings. [ABSTRACT FROM AUTHOR]

To evaluate the evidence of high-intensity locomotor training on outcomes related to gait and balance for patients with stroke in inpatient rehabilitation. Four databases were searched (PubMed, CINAHL, Web of Science, and MedLINE) for articles published prior to 13 June 2023. Studies of adults (>18 years old) with a diagnosis of stroke who received a high-intensity locomotor intervention while admitted to an inpatient rehabilitation facility were included. A functional outcome in the domain of gait speed, gait endurance, or balance must have been reported. Following the screening of 1052 studies, 43 were selected for full-text review. Studies were assessed for risk of bias using the tool appropriate to the study type. Gait speed, gait endurance, and balance outcome data were extracted for further analysis. Eight studies were selected with risk of bias ratings as moderate (4), high (2), and low (2). Six studies were analyzed in the meta-analysis (N = 635). A random-effects model analyzed between-group differences. Standard mean differences demonstrated that high-intensity locomotor training produces a moderate effect on gait endurance (0.50) and gait speed (0.41) and a negligible effect on balance (0.08) compared with usual care. The meta-analysis supports the use of high-intensity locomotor training over usual care for improving gait speed and gait endurance during inpatient post-stroke. Future studies should investigate dose-response relationships of high-intensity locomotor training in this setting. #CRD42022341329 [ABSTRACT FROM AUTHOR]

Spinal muscular atrophy (SMA) with progressive myoclonic epilepsy (PME) affects the nervous system. Symptoms appear in early childhood and include muscle weakness, difficulty walking, seizures, and cognitive decline. Despite introducing various therapies to restore acid ceramidase function or reduce ceramide accumulation and gene therapy to correct genetic mutations, there are still unknown underlying molecular mechanisms related to this disorder. This article reports a novel variant c.118G>C in the ASAH1 gene. The patient presented with clinical manifestations such as progressive muscle weakness and myoclonic convulsions. Clinical features and electrophysiological investigations revealed a motor neuron disease and generalized epileptic discharge. A significant temporal interval was observed between the initial diagnosis of SMA and the subsequent manifestation of myoclonic seizures. The proband was genetically assessed through whole exome sequencing (WES) followed by variant confirmation and bioinformatics analysis. According to this article's findings and previous research, further diagnostic testing and management are needed to determine the severity and progression of the patient's condition. [ABSTRACT FROM AUTHOR]

Introduction: Ischemic stroke in younger adults has been increasing over the years. It is often challenging to identify the underlying etiology and pathogenesis of stroke in the young. Inherited thrombophilias contribute to about 1%–4% of ischemic strokes in the young. Of the inherited thrombophilias, isolated protein S deficiency is an important risk factor for the development of arterial ischemic strokes. It is commonly associated with venous thrombosis but it is rarely associated with arterial ischemic strokes, contributing to 4%–12% of young strokes. Case Description: We report the case of a 38-year-old female who presented with acute onset of weakness in her left upper and lower limbs, whose magnetic resonance imaging brain showed evidence of recurrent arterial ischemic strokes and was detected to have an isolated protein S deficiency. Conclusion: It is very important to identify the underlying etiology in a young patient with stroke. Although protein S deficiency is commonly associated with venous thrombosis, it can be rarely associated with arterial ischemic strokes; hence, thrombophilia workup should always be done in the evaluation of young stroke. [ABSTRACT FROM AUTHOR]

In this work, we present a system that detects Freezing of Gait Detection (FOG) that uses of a single wearable inertial sensor to automatically evaluate a Parkinson's patient's gait instability and detect FOG in real-time. A wearable vibrator is our cueing system which is triggered by the FOG detection whenever a FOG episode takes place. The vibration impulses help the patient to prevent FOG by switching to voluntarily movement execution. Sensor data were collected from nine patients with Parkinson's disease performing Unified Parkinson's Disease Rating Scale (UPDRS) test under the supervision of a clinical expert. Along with data recording, a video was taken from patient's parkour. The data were labeled through the recorded video of the patient's tests and FOG and non-FOG data were assigned. A machine learning model using a deep Long-Short-Term-Memory (LSTM) employ the accelerometer data from the sensor and the inference leads to a FOG or non-FOG classification. The FOG detection model is pruned, quantized and used for real-time inference on Google Coral board worn on the patient' body. The model deployed on a Google coral board sends a trigger to the cuing device right after the FOG detection and the patient get alert for the happening FOG. The individualized model for one-second windows applied in this work performed an average of 91.5% of sensitivity and 86.5% specificity for models running on PC and 91.7% of sensitivity and 86.7% of specificity for the models tested on Google coral with the latency of 50 millisecond on real-time testing. [ABSTRACT FROM AUTHOR]

Parkinson disease is a neurodegenerative disease present in approximately 2% of the population older than 65 years. Rhythmic auditory stimulation in the early 1990s aimed to improve individual mobility in terms of gait speed, stride length, and cadence. Our systematic review and meta-analysis aimed to summarize and evaluate the evidence of the effects of rhythmic auditory stimulation on gait speed, stride length, and cadence in patients with Parkinson disease. A systematic review and meta-analysis of randomized controlled trials was conducted to determine the efficacy of rhythmic auditory stimulation in patients with Parkinson disease. Five studies were included in the review (209 patients). Rhythmic auditory stimulation resulted, on average, a gait speed improvement of 0.53 standard deviation (SD) units (95% CI, 0.23 to 0.83; P =.0005), a stride length improvement of 0.51 SD units (95% CI, 0.18 to 0.84; P =.003) greater than that in the control group. All trials contained a risk of bias due to a lack of blinding. The quality of evidence was low. No adverse events were identified. Rhythmic auditory stimulation may have a beneficial effect on gait speed and stride length in patients with Parkinson disease. Future studies should consider a power analysis to recruit an adequate number of subjects and minimize the risk of sample bias. Further research should provide the additional results required for an acceptable estimate of the effects of rhythmic auditory stimulation on gait in patients with Parkinson disease. [ABSTRACT FROM AUTHOR]

In this research, paying particular attention to freezıng of gait (FOG), we aimed to investigate the associations between the clinical features and quality of lilfe (QOL) indexes comparatively in our PD subjects with and without STN-DBS therapy. All consecutive PD subjects with and without STN-DBS who applied to our movement disorders outpatient clinics between January/2022 and September/2022; and accepted to participate in the study were enrolled. The demographic data and clinical features were noted. Besides, the MDS-UPDRS, the FOG Questionnaire (FOGQ) and the Parkinson's Disease Questionnaire (PDQ-39) have also been performed on all individuals. Overall, 105 patients with PD participated in this study (34 patients with STN-DBS, 71 patients without STN-DBS). No difference was found in the PDQ-39 scores between patients with and without STN-DBS. The correlation analyses between the PQQ-39 scores and the clinical parameters revealed significant moderate correlations with the FOGQ score and low correlations with MDS-UPDRS scores. The analyses repeated in either patient group showed that there were no correlations between the MDS-UPDRS scores and PDQ-39 indexes in the DBS group. Besides, the correlations between the PDQ-39 scores and the FOG scores were more prominent in patients without DBS therapy. FOG was found to be associated with worse QOL status in both patients with and without STN-DBS therapy. However, the correlations analyses in either group showed that FOG was a more significant determinant in the QOL indexes in patients without DBS. Future studies evaluating the impact of other clinical features such as falls and gait impairment in QOL of patients with STN-DBS may provide contributions to the current evidence. [ABSTRACT FROM AUTHOR]

This study investigates the feasibility of utilizing non-invasive WiFi sensing using the 4.8 GHz operating frequency band of the 5 G spectrum, which is suitable for Internet of Things applications. We propose WiFOG : a WiFi CSI system for detecting FOG in PD leveraging deep learning and wireless channel characteristics collected by wireless devices such as a radio frequency signal generator, a network interface card, and dipole antennas. The raw data for several activities, including sitting, slow-walking, fast-walking, voluntary stopping, and FOG episodes, is collected. Regress feature engineering is performed in which discrete wavelet transforms is used for signal denoising and Hilbert-Huang transforms for feature extraction. Further, we propose hybrid feature selection techniques based on whale optimization, recursive feature elimination, and select form models for dimensionality reduction. Moreover, we propose a deep-gated recurrent network (DGRU) for activity classification and FOG detection and compared the results with the state-of-the-art approaches in the existing work. The results show our proposed scheme surpasses existing FOG detection with a total improvement of approximately 4 % in accuracy and a 29% reduction in training time. [ABSTRACT FROM AUTHOR]

Background Running is a common leisure physical activity that carries a risk for running related injury (RRI). Non-experienced runners are more likely to sustain RRIs. One form of gait retraining focuses on increasing cadence to improve running biomechanics related to RRI. Protocols for increasing cadence must be pragmatic to be implemented into clinical practice. Hypothesis/Purpose The purpose of this study was to determine if a pragmatic protocol including one instructional session, followed by independent gait retraining with metronome augmentation resulted in increased cadence and altered biomechanics in novice and recreational runners. Study Design Randomized Controlled Trial Methods Thirty-three novice or recreational adult runners completed a 12 Minute Cooper Run on an indoor track. Variables measured during the 12 Minute Cooper Run included distance, rate of perceived exertion (RPE), heart rate (HR), and 3-D biomechanics using inertial measurement units (IMUs). After baseline testing, the intervention group received instruction and five minutes of gait retraining at a cadence set 5-10% higher than baseline with metronome augmentation (Pro Metronome- Tempo, Beat; by Xiao Yixiang). They then ran two to three times a week for two weeks up to 30 minutes per session with the metronome set at the new cadence. After two weeks, repeat testing using the same protocol was completed. A Mann-Whitney U test analyzed differences between groups. Results Cadence at one minute (p = 0.037) and average cadence over the entire run (p=0.002) increased in the intervention group only with a large effect size (Cohens d = 0.837). No other group differences were found. Conclusion A pragmatic gait retraining protocol with metronome augmentation including one instructional and four to six independent sessions over a two-week duration increased cadence without negative effects on HR, RPE, distance. Biomechanics did not change with this intervention. Further research with pragmatic gait retraining protocols that increase cadence are needed with larger sample sizes, repeated measures over time, across runners of various abilities and experience levels. Level of Evidence Level 2 [ABSTRACT FROM AUTHOR]

The optimal surgical procedure for long-standing overt ventriculomegaly in adults (LOVA) remains controversial. A systematic search of three databases was performed for studies published between January 1999 and March 2022. This systematic review included 12 studies with a total of 318 patients with LOVA surgically treated. PRISMA guidelines were followed. Gait disturbance (74.8%) and headache (59.7%) were the most common clinical presentation. Overall, the rate of postoperative clinical improvement at the last follow-up was 83.6% (95% CI 78.1–86.1). A lower rate of postoperative clinical improvement or halt of progression of presenting symptoms was observed after ETV (211/257 = 82.1% 95% CI 76.2–85.1%) compared with VPS (55/61 = 90.2% 95% CI 80.3–96.1%). Overall, surgical and postoperative complications were reported in 22/297 patients (7.5% 95% CI 4.4–20%) (11 studies). A higher rate of surgical complications was observed in patients treated with VPS (19.7% 95 CI 5.9–46.7%), compared with patients treated with ETV (4.3% 95% CI 2.1–10.9%). The overall rate of second surgery due to failure of first surgical approach (ETV or VPS) was 46/275 (16.7%). This meta-analysis confirmed the efficacy of EVT and VPS in symptomatic patients with LOVA, reporting a roughly 84% of postoperative clinical improvement or halt of progression of symptoms. A higher rate of surgical complications was observed in patients treated with VPS compared with patients treated with ETV. In addition, roughly 18% of patients treated with ETV required a further VPS. These findings should be considered when advising LOVA patients regarding the management of hydrocephalus. [ABSTRACT FROM AUTHOR]

This study presents a markerless video-based human gait analysis system for automatic assessment of at-home rehabilitation. A marker-based MoCap system (Vicon) is used to evaluate the accuracy of the proposed approach. Additionally, a novel gait rehabilitation score based on the Dynamic Time Warping (DTW) algorithm is introduced, enabling quantification of rehabilitation progress. The accuracy of the proposed approach is assessed by comparing it to a marker-based MoCap system (Vicon), which is used to evaluate the proposed approach. This evaluation results in mean absolute errors (MAE) of 4.8° and 5.2° for the left knee, and 5.9° and 5.7° for the right knee, demonstrating an acceptable accuracy in knee angle measurements. The obtained scores effectively distinguish between normal and abnormal gait patterns. Subjects with normal gait exhibit scores around 97.5%, 98.8%, while those with abnormal gait display scores around 30%, 29%, respectively. Furthermore, a subject at an advanced stage of rehabilitation achieved a score of 65%. These scores provide valuable insights for patients, allowing them to assess their rehabilitation progress and distinguish between different levels of gait recovery. The proposed markerless approach demonstrates acceptable accuracy in measuring knee joint angles during a sagittal walk and provides a reliable rehabilitation score, making it a convenient and cost-effective alternative for automatic at-home rehabilitation monitoring. [ABSTRACT FROM AUTHOR]

To compare donor-site morbidity for alveolar bone grafting results following cartilage-preserving outer and inner cortico-cancellous iliac crest (OCIC and ICIC) bone block grafting in children. Patients were randomly divided into two groups and prospectively reviewed. In the OCIC and ICIC groups, cortico-cancellous bone blocks were harvested at outer and inner iliac crest respectively. Patient characteristics and surgical parameters were compared; pain intensity and duration, lateral femoral cutaneous nerve (LFCN) injury, gait disturbance, scar and contour satisfaction were analysed postoperatively. Forty-nine consecutive patients (OCIC, 24; ICIC, 25) were included. There were no significant differences in patient characteristics or donor-site surgical parameters. The mean pain score on the first post-operative day was significantly lower in the OCIC group (3.75±1.70) than in the ICIC group (5.20±2.08) (p=0.012). The pain duration was similar in the two groups (median: 5 days). Temporary LFCN injury only occurred in 3 patients in the ICIC group. Postoperatively, the duck and circle gaits were observed in the OCIC and ICIC groups, respectively. There were no significant differences in the claudication duration, scar and contour satisfaction between the groups. OCIC bone graft harvesting is marginally advantageous in children due to less early postoperative donor-site pain and a lower risk of nerve damage. [ABSTRACT FROM AUTHOR]

COVID-19 provided an opportunity to determine the effectiveness of telehealth physical therapy as part of a pro bono gait balance and mobility clinic. The aim of this case study is 2-folds--(1) to provide evidence for clinicians on telehealth physical therapy implementation while using mobile health platform and remote patient monitoring for a community-dwelling older adult with gait and balance disorder and (2) to provide evidence for clinical educators on telehealth-based teaching strategies to implement virtual clinical education for treating geriatric patient population. It is also important to note that this telehealth clinic model may be applicable outside of this patient population as well. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a typical, chronic neurodegenerative disease involving the concentration of dopamine, which can disrupt motor activity and cause different degrees of gait disturbance relevant to PD severity in patients. As current clinical PD diagnosis is a complex, time-consuming, and challenging task that relays on physicians' subjective evaluation of visual observations, gait disturbance has been extensively explored to make automatic detection of PD diagnosis and severity rating and provides auxiliary information for physicians' decisions using gait data from various acquisition devices. Among them, wearable sensors have the advantage of flexibility since they do not limit the wearers' activity sphere in this application scenario. In this paper, an attention-based temporal network (ATN) is designed for the time series structure of gait data (vertical ground reaction force signals) from foot sensor systems, to learn the discriminative differences related to PD severity levels hidden in sequential data. The structure of the proposed method is illuminated by Transformer Network for its success in excavating temporal information, containing three modules: a preprocessing module to map intra-moment features, a feature extractor computing complicated gait characteristic of the whole signal sequence in the temporal dimension, and a classifier for the final decision-making about PD severity assessment. The experiment is conducted on the public dataset PDgait of VGRF signals to verify the proposed model's validity and show promising classification performance compared with several existing methods. [ABSTRACT FROM AUTHOR]

We aimed to investigate the gait parameters in patients with subthalamic nucleus deep brain stimulation (STN-DBS) therapy using quantitative gait analyses and reveal the associated clinical features. Parkinson's disease (PD) subjects with STN-DBS who applied to our movement disorders outpatient clinics between December/2021 and March/2022 were enrolled. In addition to the evaluation of the demographic data and the clinical features; clinical scales measuring the freezing of gait (FOG), falls and quality of life were performed. A gait analyzer program was used to perform gait analysis. Thirty patients with a mean age of 59.4 ± 8.3 (F/M = 7/23) were enrolled. The comparative analyses between the tremor-dominant and akinetic-rigid (AR) subtype patients showed that the step time asymmetry measures were higher in the AR group. The comparative analyses according to the symptom onset side showed that the step length was smaller in those with left-side symptom onset. The correlation analyses showed that there were correlations between the quality-of-life indexes and FOG questionnaire and falls efficacy scale (FES) scores. Finally, the correlation analyses between clinical scales and gait parameters revealed that there were significant correlations between the FES scores and the step length asymmetry (SLA). We found a strong relationship between falls and quality of life indexes of our patients under STN-DBS therapy. In this patient group, particular evaluation of fallings and the follow-up of SLA in gait analysis may constitute important points during the evaluation of patients in routine clinical practice. [ABSTRACT FROM AUTHOR]

Objectives The SARS-CoV-2 pandemic is the most challenging crisis in the contemporary world. Besides severe pulmonary involvement, the disease also has several extrapulmonary manifestations, and new signs and symptoms are associated with it every dayThe present study aimed to inquire about the frequency of neurological manifestations and risk factors of COVID-19. Materials & Methods This retrospective, descriptive study included patients with neurological involvement admitted to the Alborz University of Medical Sciences academic hospitals from March 2020 to July 2020 with confirmed COVID-19 infection. The data included in the analysis were the patient's demographic information, underlying diseases, neurological manifestations, and laboratory findings. Results The study included ninety-five patients with a mean age of fiftynine. Neurological symptoms and signs were observed in 91.6% and 10.5% of the patients, respectively. The most frequently associated neurological symptoms of COVID-19 were fatigue (49.5%), headache (47.4%), and dizziness (45.3%). Furthermore, the most common neurological involvements included gait disorders (6.3%), cerebellar dysfunction (4.2%), and cerebrovascular accidents (3.15%). Positive troponin was shown to be the strongest predictor of neurological signs (OR=21, P=0.017), followed by WBC≥15,000 (OR = 20.75, P=0.018) and a history of respiratory disease (OR=7.42, P=0.007). Conclusion Neurological symptoms were observed in more than 91% of the patients, while neurological signs were present in 10.5% of the COVID-19 patients. Additionally, positive troponin, WBC≥15,000, and a history of respiratory disease were the strongest predictors of neurological signs. [ABSTRACT FROM AUTHOR]

We examined the effects of rhythmic finger movement training on freezing of gait (FOG) and electroencephalography (EEG) activity in 3 participants with Parkinson disease (PD). Participants underwent 3 minutes' rhythmic finger movement training twice daily for 4 weeks. We measured walking condition acceleration and EEG activity with and without a doorway, pre- and postintervention. Freezing index (FI), indicating FOG, was calculated from acceleration data. The high walking condition FI observed pretraining with a doorway decreased posttraining. The high pretraining frontal β-band activity decreased posttraining. Therefore, the participants' FOG and β-band activity decreased. Rhythmic finger movement training shows potential as an effective intervention for FOG; more study is needed. [ABSTRACT FROM AUTHOR]

Gerstmann-Sträussler-Scheinker (GSS) disease is a rare hereditary prion disease which is clinically characterized by a progressive cerebellar ataxia followed by cognitive impairment. We report a rare case of GSS disease in a 39-year-old male patient who complained of a progressive gait disturbance followed by dysarthria with cognitive impairment, after five months from the onset of initial symptom. His brain MRI scan revealed multifocal symmetric diffusion restricted lesions with T2/FLAIR hyperintensities in bilateral cerebral cortices, basal ganglia, and thalami. His family members also manifested similar symptoms in their 40-50s, suggesting the possibility of a genetic disease. Finally, he was genetically diagnosed with GSS disease by real-time quaking-induced conversion and prion protein (PRNP) gene sequencing test. [ABSTRACT FROM AUTHOR]

The aim of the study was to evaluate the effects of freezing of gait (FOG) on static and dynamic balance. Twenty patients with Parkinson's disease with and without FOG [PD+FOG (68,6±6,39 years) and PD-FOG group (70,6±4,57 years)] and 10 healthy individuals (68,4±4,92 years) with similar demographic characteristics were included in the study. Balance was compared between the three groups. Balance was evaluated with clinical tests Limits of stability (LoS) and body sway were measured using the E-LINK FP3 Force Plate and the Korebalance Balance Evaluation System, which measure the balance in static and dynamic conditions. Center of pressure (COP) change and average sway velocity were evaluated with the Zebris RehaWalk system. Total and subscale scores of the Unified Parkinson's Disease Rating Scale were significantly higher in the PD+FOG group (p<0.05). The balance test results for both groups were similar (p>0.05). The PD+FOG group performed worse on the computerized static balance tests, the COP analysis, and the dynamic balance total score than the other two groups (p<0.05). The PD+FOG group had significantly greater sustained weight deviation than the healthy controls (p<0.05). Patients with Parkinson's disease had a lower LoS in the posterior direction than healthy controls (p<0.05). FOG affects the dynamic balance more negatively than the static balance. In addition, FOG reduces LoS in the posterior direction and increases body sway in the anterior-posterior direction, which can lead to falls. Center of pressure, Freezing of gait, Limits of stability, Parkinson's disease, Postural Balance. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the relationship between phase angle and existence of locomotive syndrome, malnutrition, and sarcopenia alone or co-existence of locomotive syndrome, malnutrition, and sarcopenia and determine cut-off values of phase angle of these syndromes. Methods: Overall, 1,063 community-dwelling women aged ≥ 60 years underwent medical checkup. We assessed them for phase angle, locomotive syndrome risk tests, Mini Nutritional Assessment Short Form, grip strength, comfortable gait speed, and skeletal muscle mass index. Participants were classified into eight groups: robust; locomotive syndrome alone; malnutrition alone; sarcopenia alone; malnutrition and sarcopenia; locomotive syndrome and sarcopenia; locomotive syndrome and malnutrition; and co-existence of all syndromes. Results: The proportions of locomotive syndrome, sarcopenia, and malnutrition were 62.1%, 3.6%, and 36.9%, respectively. Since the prevalence of sarcopenia alone and malnutrition and sarcopenia were 0.0%, these groups were excluded from the analysis. Multinomial logistic regression analysis, adjusted for age and body mass index, showed the relationship between phase angle and locomotive syndrome, malnutrition, locomotive syndrome and sarcopenia, locomotive syndrome and malnutrition, and coexistence of the three syndromes. The phase angles for predicting locomotive syndrome, malnutrition, locomotive syndrome and sarcopenia, locomotive syndrome and malnutrition, and co-existence of the three syndromes were 5.4°, 5.4°, 5.0°, 5.2°, and 4.9°, respectively, all of which showed high predictive accuracy, 0.845, 0.845, 0.917, 0.906, and 0.956, respectively. Conclusion: The phase angle is a simple assessment of locomotive syndrome, malnutrition, and sarcopenia alone or co-existence, and it may be useful for the early detection of these syndromes in the community. [ABSTRACT FROM AUTHOR]

Forensic post-mortem examinations of animals are carried out on suspicion of violation of European and national legislation. In Denmark, and probably also in other countries with large-scale cattle production, cattle are regularly submitted for forensic assessment. Unfortunately, only few studies of forensic pathology in cattle are available. This paper presents a retrospective study of forensic case files on Danish cattle from January 2010 to December 2021. The case files were characterized with respect to types of lesion, age assessments of lesions and other parameters such as age and sex. A total of 118 forensic case files had been archived and related to 132 cattle (14 weeks–20 years of age; 68% female, 30% male and 2% unknown sex) with 228 lesions. Locomotor disorders constituted the majority of lesions. However, cachexia/emaciation, skin ulcerations and overgrowth of cornual horn were also frequent. Most lesions were chronic (91%) and age assessments for more than 2 weeks were stated for 79% of the lesions. This indicates that in Denmark at least, there is a need to consider how cattle with locomotor disorders are treated in a timely manner in order to avoid prolonged futile treatment and, thereby, suffering. Grossly visible reparative granulation tissue and new bone formation were present in lesions of 1–2 weeks and longer duration. However, all age assessments were stated in broad time intervals due to the lack of scientifically based forensic studies of age assessments of lesions in cattle. Therefore, to improve age assessments in forensic cattle cases, studies concerning the chronology of tissue reparation in cattle are warranted. We also present a guideline for the forensic examination of cattle. [ABSTRACT FROM AUTHOR]

Walking at fast speed is a gait training strategy post-stroke. It is unknown how faster-than-preferred pace impacts spatiotemporal gait characteristics in survivors with different functional abilities. To test the hypothesis that compared to high-functioning individuals, low-functioning individuals will be limited in modifying spatiotemporal gait parameters for walking at faster-than-preferred speed, and these limitations are associated with fear of falling. Forty-two adults, 17.6 ± 14.6 months post-stroke, traversed an instrumented walkway at preferred and fast speeds. Participants were categorized to a low-functioning group (LFG) (n = 20; <0.45 m/s) and high-functioning group (HFG) (n = 22; ≥0.45 m/s). Cadence, step length, stance time and spatiotemporal asymmetry measures were calculated. The Modified Falls-efficacy Scale examined fear of falling. Multivariate and correlational analysis tested hypotheses. Increased speed from preferred to fast pace was significantly greater for HFG (0.27 ± 0.03 m/s) than LFG (0.10 ± 0.02 m/s) (p ≤ 0.001). Cadence gain from preferred to fast pace did not differ between groups. However, HFG exhibited greater change in paretic (∆6.1 ± 1.37 cm; p <.001) and non-paretic step lengths (∆4.5 ± 1.37 cm; p =.003) than LFG. Spatiotemporal asymmetry did not change for either group. Fear of falling had moderately positive correlation with ∆paretic step length (r = 0.43; p =.004) and ∆non-paretic step length (r = 0.32; p =.035). While both low- and high-functioning individuals used a step-lengthening strategy to walk at faster-than-preferred speeds, the gain in step lengths was limited in low-functioning individuals and was partially explained by falls-efficacy. [ABSTRACT FROM AUTHOR]

This article describes the development process of the Safe Mobilisation Program to improve functional mobility and reduce fall risk in cognitively impaired older adults with gait disorders. We drew on a systematic review, informed by a theoretical paper and data collected during a feasibility study. Data collected were field notes of observation and participant feedback. Reflexive thematic analysis was undertaken. Home-based, one-on-one, low-intensity interventions are suitable designs. Key features of the tailored intervention to enhance participation include collaborative goal setting, individualized activities, rapport building, and carer training. Strategies targeting gait and cognitive deficits are integral to achieving optimal outcomes. [ABSTRACT FROM AUTHOR]

In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than non-ballistic exercise rehabilitation for improving mobility, strength and balance? Does improved mobility translate to better health-related quality of life? A prospective, multicentre, randomised trial with concealed allocation, intention-to-treat analysis and blinded measurement. A total of 144 people with a neurological movement disorder affecting mobility as a result of traumatic brain injury. For 3 months, the experimental group had three 60-minute sessions of non-ballistic exercise rehabilitation per week replaced by ballistic resistance training. The control group had non-ballistic exercise rehabilitation of equivalent time. The non-ballistic exercise rehabilitation consisted of balance exercises, lower limb stretching, conventional strengthening exercises, cardiovascular fitness training and gait training. The primary outcome was mobility measured using the High-Level Mobility Assessment Tool (HiMAT). Secondary outcomes were walking speed, strength, balance and quality of life. They were measured at baseline (0 months), after completion of the 3-month intervention (3 months) and 3 months after cessation of intervention (6 months). After 3 months of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the 54-point HiMAT than the control group and remained 3 points (95% CI –1 to 6) higher at 6 months. Although there was a transient decrement in balance at 3 months in the experimental group, the interventions had similar effects on all secondary outcomes by 6 months. Participants with a baseline HiMAT < 27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT. This randomised trial shows that ballistic resistance training has a similar or better effect on mobility than non-ballistic training in people with traumatic brain injury. It may be better targeted towards those with more severe mobility limitations. ACTRN12611001098921. [ABSTRACT FROM AUTHOR]

Temporal gait asymmetry (TGA) affects 55% of people with stroke. This study investigated the effects of augmented feedback during overground gait training, on TGA. Eighteen people with chronic stroke were randomized to receive one of two feedback displays (A or B) and one of three feedback frequencies; no feedback (0%), after alternate walking trials (50%) or after every trial (100%). Display A depicted the TGA ratio as a vertical line along a horizontal axis with perfect symmetry in the middle. Display B depicted single limb stance duration of each leg as a bar graph. Participants completed 25 repetitions of 30 second trials with their assigned feedback (acquisition). Participants completed 10 repetitions of 30 second trials without feedback 24 hours later (retention). A pressure sensitive mat recorded TGA and speed. Changes in TGA and speed were investigated by plotting individual motor learning curves and fitting a curve with locally estimated scatterplot smoothing (LOESS) for each feedback group. An effect of feedback was defined a priori as a LOESS fitted curve with a decreasing slope from acquisition to retention. LOESS curve exhibited a decreasing slope for TGA in the 100B group only and for speed in the 50A and 0FB groups. This study provides preliminary evidence that visual feedback delivered at a high frequency during a single session of overground walking can change TGA post-stroke without reducing gait speed. An overground gait intervention with high frequency visual feedback to improve TGA post-stroke is worthwhile to investigate. [ABSTRACT FROM AUTHOR]

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Kinesiologia Slovenica is the property of Faculty of Sport and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper introduces a systematic classification of the facial nerve grading system using a comprehensive methodology using a pioneering Multi-Path Heterogeneous Neural Network (MPHNN) method designed for the accurate classification of exercise. It integrates four distinct Convolutional Neural Networks (CNNs) and Custom Feedforward Neural Networks (CFNNs) to enhance the precision of the classification. The CNNs are specifically tailored to scrutinize changes in the coordinates of facial landmarks over time, enabling the capture of both spatial information and temporal patterns in facial expressions during exercise. The CFNNs incorporate patient-specific variables and exercise statistics, including factors such as their surgical history, the type of exercise, its duration, and synthetic features like cumulative movement for each landmark. By leveraging this comprehensive framework, the proposed method offers a nuanced representation of the patient's exercise performance, thereby facilitating more precise outcomes of a classification. • Multi-Path Heterogeneous Neural Network method designed for accurate classification of exercises. • Convolutional Neural Networks and Custom Feedforward Neural Networks to enhance classification precision. • Facilitates more precise classification outcomes. [ABSTRACT FROM AUTHOR]

In immunocompromised conditions, latent syphilitic infection can lead to secondary syphilis. We present here a case of neurosyphilis(syphilitic meningomyelitis) in a kidney transplant recipient. Atypical presentation, the typical maculopapular rash, and a serological test all pointed to secondary syphilis. The scenario illustrates a crucial point: infections can go undetected, whereas a patient is on immunosuppressive therapy. [ABSTRACT FROM AUTHOR]

The article evaluates the benefits of high-intensity interval training (HIIT) compared to moderate-intensity locomotor training in improving walking capacity for individuals with chronic stroke.

Physical therapists use verbal cueing extensively during gait rehabilitation. Nevertheless, little is known about the ability of individuals post-stroke to make immediate changes to targeted spatiotemporal gait parameters from verbal commands. Additionally, adequate muscle strength may be necessary to promote positive alterations in gait. To determine the influence of targeted verbal cues on spatiotemporal gait parameters for individuals with chronic stroke. Further, we assessed the potential of a relationship between cue-induced gait modifications and paretic lower limb strength. Using a within-subjects design, twenty-seven adults with chronic stroke walked over a pressure mat with verbal cues to walk at (1) comfortable and (2) fast speeds, with increased (3) arm swing, (4) foot height, (5) step length, (6) push off, and (7) cadence. We also assessed lower extremity strength using a hand-held dynamometer. We measured gait speed, step length, stance time, and cadence for comparisons between conditions and performed correlational analyses to assess the influence of strength on gait alterations. Specific cues elicited increased walking speed, cadence, step lengths and paretic limb stance time. Only greater paretic hip and knee flexion strength was related to the ability to increase cadence when cued to do so (r > 0.41). With targeted verbal cueing, clinicians can improve step length, gait speed, stance time and cadence for individuals with chronic stroke. Lower extremity strength does not appear to be related to the ability to alter gait with verbal cueing in individuals with chronic stroke. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to compare morbidities at the donor site in autologous bone harvesting from an anterior iliac crest via the outer cortex, inner cortex and table splitting technique. Methods: The randomized, prospective and comparative study was conducted in 60 patients who were treated with bone grafting as a part of their treatment plan. Group A underwent the outer cortex technique (20 patients), Group B underwent the inner cortex technique (20 patients) and Group C underwent the table splitting technique (20 patients). The comparison of morbidities associated with various techniques of anterior iliac crest bone graft harvesting was done for a period of one year. Results: Most common morbidity observed was pain, measured by the visual analogue scale score (60/60, 100% of patients). The visual analogue scale score was significantly higher for the outer cortex group followed by the inner cortex group, and then the lowest score was for the table splitting group (p < 0.05). Followed by numbness (40/60, 66%), least in the table splitting group and maximum in the outer cortex group (p < 0.05). Next was abnormal gait, which was mostly seen in patients with the outer table method and least in the table split group (p < 0.05). Other complications were infections (4), itching at the surgical site (3) and hematoma (1). There were no significant difference regarding scar satisfaction among comparison groups. Conclusion: we conclude that few differences do exist in harvest-site morbidities between different techniques used in our study. Overall, the most common morbidity observed were pain, numbness and abnormal gait. However, the table splitting group has the lowest morbidity, therefore bone harvesting by the table splitting appears to be a very good option. [ABSTRACT FROM AUTHOR]

• A novel mutation in the CYP27A1 gene has been identified. • Brain and spinal lesion were present. • A suspicion index proposed by Mignarri et al. (2014) facilitated the diagnosis. • Treatment improved biochemical and electrophysiological abnormalities. Cerebrotendinous xanthomatosis (CTX) is a rare inherited disorder of the alternative pathway of bile acid biosynthesis, due to mutation(s) of the gene CYP27A1, leading to sterol 27-hydroxylase deficiency. The latter results in a systematic deposition of cholestanol and cholesterol to the central nervous system and tendons, premature cataract, as well as the manifestation of systematic symptoms, such as chronic diarrhea, osteoporosis, and premature atherosclerosis. Due to its marked clinical heterogeneity, prompt diagnosis of this disorder is challenging. We present a case of a 38-year-old male with gait difficulty, a progressive deterioration in ambulation, several episodes of vertigo and episodic diarrhea. Clinical history revealed neonatal jaundice, juvenile bilateral cataracts, borderline intellectual capacity, hypothyroidism, testicular cancer. Magnetic resonance imaging demonstrated increased T2-weighted signal in internal capsules, midbrain, cerebellum, and spinal cord. Electrodiagnostic study showed mixed polyneuropathy. Genetic analysis revealed a novel, biallelic, most likely pathogenic mutation, in gene CYP2A1 (c.1410_1411del). Plasma sterol profiling confirmed the diagnosis of CTX. Our patient was treated with chenodeoxycholic acid and one year later, he shows a progressive improvement of gait, normalization of plasma sterol biochemistry and electrophysiological parameters. This case highlights the importance of maintaining a high index of suspicion as the key to an early diagnosis of CTX, taking into consideration its clinical variability and, if promptly identified, the good response to treatment. [ABSTRACT FROM AUTHOR]

We examined the clinical features and pathology, and identified the causative mutation, of osteogenesis imperfecta in a 2-mo-old kitten with growth retardation and abnormal gait. Blood and radiographic examinations were performed on presentation. Radiographs revealed decreased opacity of numerous bones. Fractures were observed in some long bones, including femur and tibia. Histologic examination of the tibia showed decreased osteoid and osteoblasts at the primary spongiosa extending from the growth plate. The periosteum was thickened, and cortical bone and osteoblasts were decreased. Consequently, osteogenesis imperfecta was diagnosed. Genomic DNA and total RNA were extracted from the skin and used for PCR. Whole-genome sequencing identified a 2-bp deletion (c.370_371delTG; p.C124fs), which resulted in a homozygous frameshift mutation on exon 3 of CREB3L1. This mutation introduced a premature stop codon, suggesting production of the truncated protein without a functional domain as a transcription factor for expression of COL1A1 mRNA. This error may have affected collagen fibril formation, leading to the development of osteogenesis imperfecta. [ABSTRACT FROM AUTHOR]

In people in the chronic phase of Guillain-Barré syndrome (GBS), how much more does a supervised, individualised exercise program improve functional independence with activities of daily living than a home-based exercise program? How do the two exercise programs compare regarding their effects on muscle strength, fatigue, pain and quality of life? Randomised controlled trial with concealed allocation, intention-to-treat analysis and blinding of outcome assessors. Sixteen adults with stable residual disability ≥ 6 months after the onset of GBS. Participants in the experimental group were allocated to 60-minute sessions of physiotherapist-supervised strengthening, endurance and breathing exercises, gait training and pain management, two to three sessions/week for 12 weeks. The control group was prescribed a home program of 30-minute sessions of maintenance exercises and education in self-management, two to three sessions/week for 12 weeks. Functional independence in activities of daily living on the 100-point Barthel Index (primary outcome), muscle strength on the 60-point Medical Research Council scale, fatigue on the 0-to-63 Fatigue Severity Scale, a visual analogue scale of pain severity, and quality of life, measured at baseline and months 6 and 12. At month 6, the median between-group difference was 5 (95% CI 0 to 20) for functional independence, 8 (95% CI 4 to 18) for strength, –13 (95% CI –28 to –1) for fatigue, and 12 (95% CI 3 to 13) for the environment domain of quality of life. Estimated effects at month 12 had a similar magnitude, but most of the CIs had greater uncertainty. Supervised, individualised exercise reduced fatigue and improved strength and quality of life more than unsupervised home exercise in people with chronic Guillain-Barré syndrome. CTRI/2016/08/007150. [ABSTRACT FROM AUTHOR]

The need to develop a more effective intervention to obtain a functional recovery of stroke patients who are unable to perform land-based treadmill gait training has been widely reported. Thus, this pilot study aimed to identify a gait training type that could lead to improved gait and respiratory functioning in adult patients with chronic severe hemiplegic stroke. To examine whether underwater treadmill or/and overground gait training could be more effective in stroke patients. In this single-blinded, randomized, controlled, comparative study, 22 patients with severe hemiplegic stroke in a rehabilitation hospital were randomly assigned to the experimental (underwater treadmill gait training) or control group (overground gait training). All participants performed a 60-min neurodevelopmental treatment (five times/week for 12 weeks). Each group performed 30-min underwater or overground gait training (two times/week for 12 weeks). Gait and respiratory function were measured before and after the 12-week training. For the walking variables, step-time difference changes post-training showed significant differences between the groups (−.06 vs. +.04 s, p <.05). Both groups showed significant increases in the maximal voluntary volume (MVV) at post compared to pre training (p <.05). The post-training MVV values were significantly different between the two groups (+23.35 vs. +4.76 L, p <.05). In severe stroke patients, underwater treadmill gait training can be more effective in improving gait and respiratory function than overground gait training and could be an effective clinical intervention tool for the training of such patients. [ABSTRACT FROM AUTHOR]

Normal healthy children vary in the pattern of their gait development. Deviation from parents' expectation and comparison with peers may lead to anxiety and medical consultation. It is essential to identify the important pathological diagnoses among the array of normal variants to facilitate early intervention and optimize outcomes. [ABSTRACT FROM AUTHOR]

Patients with progressive multifocal leukoencephalopathy (PML) in the context of human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) show a partial improvement following rehabilitation; however, this improvement is rapidly lost if the patient is not provided with intensive rehabilitation. A 42-year-old patient affected by HIV-AIDS had a clinical worsening within a few months following PML onset, despite being treated with antiretroviral drugs and conventional rehabilitation. He developed severe paraparesis and significant dependency in the activities of daily life. A first cycle of intensive rehabilitation provided the patient with some significant functional outcomes, although he experienced a worsening of the clinical condition after two months of rest, before admission to our rehabilitation unit. We thus sought to evaluate the effects of intensive robot-aided gait training (RAGT) coupled with transcranial direct current stimulation (tDCS). The patient significantly improved when provided with intensive RAGT coupled with tDCS (as per 10-meter Walk Test [10MWT] and 6-minute Walk Test [6MWT]), and the improvement was maintained at three-month follow-up. As this advanced approach was feasible, safe, and potentially effective, this case suggests that patients with PML-HIV require prolonged multidisciplinary rehabilitation treatment. We can speculate that individuals with PML should also be treated with innovative technology to improve their functional outcomes and therefore quality of life. [ABSTRACT FROM AUTHOR]