Search

Background Functional motor disorders (FMDs) are highly disabling conditions associated with long-term disability, poor quality of life, and economic burden on health and social care. While multidisciplinary 5-days rehabilitation programs have been shown to reduce motor and non-motor symptoms, long-term management and monitoring in FMDs remain an unmet need. Aim To compare a 12-weeks telemedicine program against a 12-weeks self-management program after a 5-days rehabilitation program for improving motor, non-motor symptoms, quality of life, and perception of change in patients with FMDs. Methods The study population was 64 consecutive patients with a definite diagnosis of FMDs who underwent a 5-days in-person rehabilitation program followed by either a self-management (the first 32 patients) or a telemedicine program (the latter 32 patients). Validated measures of motor and non-motor symptoms such as fatigue and pain, quality of life, perception of change, gait, and postural control were recorded before (T0), after completion of rehabilitation (T1), and then again at 3 months (T2). Results Improvement at 3-month follow-up assessment of motor symptoms (p p = 0.028), and self-rated change perception (p = 0.043) was greater in the telemedicine group. No different between-groups effect was found on other dimensions of fatigue, pain, physical and mental health, and gait and postural control. Conclusions Long-term management and expert monitoring of patients with FMDs via telemedicine may enhance long-term outcomes in motor symptoms and physical fatigue, with a positive long-term impact on self-rated health perception of change.

Contains fulltext : 291411.pdf (Publisher’s version ) (Open Access) Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need. 28 maart 2023 7 p.

Spastic cerebral palsy is the most common childhood developmental disorder. The symptoms of spastic cerebral palsy frequently lead to immobility. In the lower body, this presents as a result of insufficient push off strength or insufficient gait swing clearance causing tripping and falling. A common tool in the rehabilitation of spastic cerebral palsy is cueing, or a physical prompting of proper function. In 2021 and 2022, teams created a device that uses a vibration stimulus to cue. Working with the Stanford Department of Orthopedics, our team believes we can improve upon the existing proof of concept to create a useful research instrument. Our final prototype utilizes a custom printed circuit board (PCB) and battery secured inside of polycarbonate protective casings. The cases are secured in a hand-sewn neoprene brace for variable tightness. Both the total weight and casing footprint from the previous prototype were by 50% respectively. Test results confirmed that the casing takes no damage when dropped, and that the casing can sustain a 125 kg sustained load without deformation. Additionally, in an experiment with seven participants, that brace and vibration were comfortable. In the future, the PCB could be further miniaturized through removing prebuilt modules, the brace could be outsourced for professional construction, and the casing injection molded. The device would become cheaper, smaller, and more robust through these actions.

In individuals with Parkinson's disease (PD), the medication induces different and inconsistent results in the spatiotemporal parameters of gait, making it difficult to understand its effects on gait. As spatiotemporal gait parameters have been reported to be affected by gait speed, it is essential to consider the gait speed when studying walking biomechanics to interpret the results better when comparing the gait pattern of different conditions. Since the medication alters the self-selected gait speed of individuals with PD, this study analysed whether the change in gait speed can explain the selective effects of l-DOPA on the spatiotemporal parameters of gait in individuals with PD. We analysed the spatiotemporal gait parameters at the self-selected speed of 22 individuals with PD under ON and OFF states of l-DOPA medication. Bayesian mediation analysis evaluated which gait variables were affected by the medication state and checked if those effects were mediated by speed changes induced by medication. The gait speed was significantly higher among ON compared with OFF medication. All the spatiotemporal parameters of the gait were mediated by speed, with proportions of mediation close to 1 (effect entirely explained by speed changes). Our results show that a change in gait speed better explains the changes in the spatiotemporal gait parameters than the ON-OFF phenomenon. As an implication for rehabilitation, our results suggest that it is possible to assess the effect of l-DOPA on improving motor symptoms related to gait disorders by measuring gait speed.

Was ist neu? Zusammenhang von Harninkontinenz und Mobilitätsstörungen Harninkontinenz und eine Störung der Mobilität – 2 geriatrische Syndrome – haben eine hohe Korrelation und beeinflussen sich gegenseitig negativ. Das Neuauftreten einer Harninkontinenz sollte ein Alarmsignal sein, weil sich die Mobilitätsparameter korrelierend negativ entwickeln. Erkennen der Assoziation von Harninkontinenz und Mobilitätsstörungen im klinischen Alltag Wo das eine Syndrom (Harninkontinenz oder Mobilitätsstörung) auftritt, sollte man das andere im Blick haben (Mobilitätsstörung oder Harninkontinenz). Dies gelingt mit einem Harninkontinenz-Assessment. Korrelation der Harninkontinenz mit Stürzen und Frakturen Harninkontinenz führt zu gehäuften Stürzen, der Einfluss auf Verletzungen, insbesondere Frakturen, bleibt unklar. Gegenseitiger Einfluss von körperlicher Fitness und Inkontinenz Kombinierte, die Inkontinenz und die körperliche Fitness beeinflussende Interventionen haben einen positiven Effekt auf beide geriatrische Syndrome. Studien weisen darauf hin, dass reines Kontinenzmanagement einen Einfluss z. B. auf Stürze hat, und umgekehrt eine körperliche Aktivierung sich positiv auf die Inkontinenz auswirkt.

ZusammenfassungStörungen des Gehens, der Mobilität und Stürze sind häufige Gesundheitsprobleme von Patienten mit chronischen, neurologischen Erkrankungen. Daher ist es wichtig, neben der Behandlung der neurologischen Grunderkrankung auch symptomatische Therapieoptionen mit dem Ziel der Verbesserung des Gehens einzusetzen.Mittels einer selektiven Literaturrecherche von Studien mit expliziter Untersuchung der Gehfähigkeit wurden symptomatische Therapiemöglichkeiten in den folgenden klinischen Entscheidungsfeldern identifiziert und diskutiert: (1) hypokinetische Gangstörung (z.B. bei M. Parkinson, Normaldruckhydrocephalus und vaskulärer Enzephalopathie), (2) Gangunsicherheit mit Ataxie (sensorisch und zerebellär) und (3) spastisch-paretische Gangstörung (bei Multipler Sklerose). Es werden medikamentöse und nicht-medikamentöse Therapieoptionen analysiert, speziell zu den Funktionsbereichen „Lokomotion“, „posturale Kontrolle“, „Modulation“ und „Adaptionsfähigkeit“. Die medikamentösen Behandlungskonzepte orientieren sich vorwiegend an den pathophysiologischen Veränderungen der Grunderkrankungen. Physikalisch-medizinische Basistherapien sowie Gang- und Bewegungstherapien erweitern das therapeutische Spektrum. Zudem können geh-relevante Einzelsymptome effizient mittels physikalisch-medizinischer oder pharmakologischer Therapien verbessert werden.Die Behandlungsoptionen neurologischer Gangstörungen sind gut und systematisch untersucht und ermöglichen eine individuelle Anpassung an die zugrundeliegende neurologische Erkrankung, an die Funktionsdefizite der individuellen Gangstörung sowie an relevante Einzelsymptome, welche das Gehen nochmals verschlechtern.

ZusammenfassungDie quantitative Ganganalyse findet zunehmend Einsatz bei der Diagnose, Verlaufsbeurteilung und Risikostratifizierung von neurologischen Gangstörungen. Dabei bleibt oft unklar, welche Messtechnik, Untersuchungsbedingungen und Gangmerkmale geeignet sind, um bestimmte klinische Fragestellungen zu beantworten. Ziel dieses Überblicksartikels ist es, allgemein anwendbare Konzepte und Strategien für die Testung, Analyse und Interpretation der Gangfunktion im klinischen Kontext vorzustellen und ihre Anwendung nah an der klinischen Praxis zu illustrieren. Der erste Abschnitt des Artikels gibt einen Überblick über derzeit verfügbare stationäre und mobile Messtechnologien, die eine Testung von Gang im klinischen Bereich und eine kontinuierliche Erfassung von Mobilität im Alltag der Patienten ermöglichen. Zudem werden Strategien zur Auswahl geeigneter Untersuchungsprotokolle diskutiert und Konzepte vorgestellt, die die Parametrisierung von Gang vereinfachen. Die anschließenden Abschnitte widmen sich konkreten klinischen Anwendungsfeldern der quantitativen Ganganalyse: Anhand von Fallbeispielen aus der aktuellen Studienliteratur wird dargestellt, (1) wie spezifische Muster des Gangbefunds Orientierungspunkte für die Differenzialdiagnose bieten und (2) wie quantitative Gangmerkmale die Früherkennung, Verlaufsbeurteilung und das Therapiemonitoring bei neurologischen Gangstörungen unterstützen können. Abschließend wird (3) der Beitrag von stationärer Gangtestung und mobiler Mobilitätserfassung für die Sturzrisikoprognose bei Patienten mit neurologischen Gangstörungen diskutiert.

ZusammenfassungDie 8 häufigsten Schwindelsyndrome liegen über 70% aller Schwindelpräsentationen zugrunde. Bei den akuten (meist einzeitigen) Schwindelsyndromen sind die akute unilaterale Vestibulopathie und der vestibuläre Schlaganfall von besonderer Bedeutung, bei den episodischen Schwindelerkrankungen der gutartige Lagerungsschwindel, der Morbus Menière und die vestibuläre Migräne und bei chronischem Schwindel die bilaterale Vestibulopathie/Presbyvestibulopathie, der funktionelle Schwindel und der zerebelläre Schwindel. In der letzten Dekade wurden für die häufigsten Schwindelsyndrome international konsentierte diagnostische Kriterien und Krankheitsbezeichnungen erarbeitet, die einfach im klinischen Alltag angewendet werden können. Die diagnostischen Leitlinien beruhen überwiegend auf einer gezielten Anamnese (Beginn, Dauer, Verlauf, Trigger, Begleitsymptome), klinischen Untersuchung und wenigen apparativen Verfahren zur Diagnosesicherung (vor allem mittels Videookulographie und Audiometrie). Die Therapie der häufigen Schwindelsyndrome basiert in der Regel auf einer Kombination aus physikalischen Verfahren (Lagerungsmanöver, multimodales Gleichgewichtstraining) und pharmakologischen Prinzipien (u.a. Kortikosteroide, Antiepileptika, Antidepressiva, Kaliumkanalblockern, plastizitätsfördernde Medikamente). Allerdings fehlt meist eine hochwertige Evidenz aus prospektiven und kontrollierten Studien. In der klinischen Praxis lassen sich die häufigen Schwindelsyndrome oft effektiv behandeln, sodass eine Chronifizierung oder sekundäre Komorbidität (durch Immobilität, Stürze oder psychiatrische Erkrankungen wie Angst oder Depression) vermieden werden kann.

Background Current available therapies for Parkinson disease (PD) have strong limitations, and patients usually present with refractory symptoms despite all efforts. Deep brain stimulation (DBS), which has been used in PD patients for decades (since 1987), has best indications for symptoms like tremor, motor fluctuations, or dyskinesia. However, postural instability and gait disturbances (PIGD) have restricted benefits with DBS. In 2009, spinal cord stimulation (SCS), a well-established therapy for chronic pain, has emerged as a potential alternative therapy that may help control unresponsive symptoms such as bradykinesia, PIGD, and freezing of gait. Methods The main studies regarding SCS in PD are reviewed here from the first studies in animal models to the latest clinical trials. Conclusions Despite promising findings, the heterogeneity of methodologies used and small samples in human studies pose a challenging problem to be addressed in order to have robust clinical evidence to support SCS as a viable PD treatment

ZusammenfassungIn der Übersichtsarbeit wird der Hintergrund des Phänomens Freezing-of-Gait (FOG) beim Parkinson-Syndrom beleuchtet. Die Charakterisierung des Phänomens als Symptom und die unterschiedlich definierten Subtypen werden diskutiert. Dabei stellen die unterschiedlichen Ausprägungsformen eine erhebliche Herausforderung an die alltägliche Behandlung und auch an die einheitliche Diagnostik bei klinischen Studien dar. Die bisherigen, standardisierten Erfassungsmethoden mittels Fragebögen und semistandardisierten klinischen Untersuchungen werden in Relevanz zur patientenspezifischen Versorgung dargestellt. Bei den derzeitigen Therapieformen spielen neben der Optimierung der dopaminergen Medikation gezielte medikamentöse Optionen bislang keine wesentliche Rolle, was aber auch an der Trennschärfe der standardisierten Diagnostik liegen kann. Dadurch ist beim variantenreichen Phänomen FOG auch die Evidenzlage der Tiefen Hirnstimulation eingeschränkt. Im Alltag können hingegen Physiotherapie und Cueing-Strategien sehr gute Erfolge erzielen, auch wenn die Studienlage bzgl. höchster Evidenzklasse eher gering ist. Die Entwicklungen der Technologie scheinen sowohl die diagnostische Trennschärfe als auch das individualisierte „Cueing“-Angebot zu revolutionieren. Aber auch hier fehlen noch ausreichend große Studien, die diese Diagnostik- und Therapieformen hinterlegen. Trotzdem ist davon auszugehen, dass vielen Patienten diese „neuen Tools“ gerne nutzen werden und der Behandlungsalltag für Arzt und Physiotherapeuten entsprechend belebt wird.

Falls are among the major causes of morbidity and mortality in the elderly. Well-known risk factors are reduced physical activity, obstacles in the environment, balance and gait disorders, depression and neurological diseases. The gravity of trauma related to falls has been studied extensively, the main predictors of a harmful development within 12 months of a fall being dementia, old age, the level of dependency and restricted mobility. Efficient prevention interventions do exist, especially exercise-based interventions and assessment and modification of the home environment. A shift in the trend of falls among the elderly has indeed been reported in several Western countries: since the 1990s, rates of fall-related injuries have declined in countries such as Finland, Sweden, Canada and Switzerland.

Lower limb exoskeletons are a recent intervention promoted to improve gait disorders. Available research has focused on clinical outcomes; however, little is known about therapists' experiences using the device in practice.We explored the implementation of an exoskeleton at a tertiary rehabilitation center.In this longitudinal qualitative study we conducted semi-structured interviews with 10 therapists. One group of therapists was formally trained using the device, whereas the other group only had clinical exposure to the device. The interviews were transcribed, coded, and analyzed for themes.Three main themes emerged: (1)The exoskeleton represents one of the most complicated and labor-intensive interventions provided by therapists. Implementation requires substantial resources, raising questions regarding its efficacy and cost-effectiveness relative to other approaches. Until more evidence becomes available around the use and effectiveness of this rapidly evolving technology, therapists must contend with a high degree of uncertainty.IMPLICATIONS FOR REHABILITATIONUsing a lower limb exoskeleton may reduce physical demands on therapists in high-intensity rehabilitation programs that involve repetitive, effortful movements.However, a number of potential barriers to implementing the exoskeleton into practice need to be taken into consideration, including calibration time, intensive training required to become qualified to administer the intervention, the cost of the device, and comfort and safety of the device affecting user acceptance and uptake.Therapists also need to manage patient expectations related to outcomes related to use of exoskeletons.

Psychogenic gait disorders in children and adolescents represent a unique neuropediatric and rehabilitative challenge. The inability to walk frequently strikes abruptly. Triggers are not easily identifiable. Patients are commonly admitted to the hospital in an emergency. In view of the dramatic clinical picture, parents are perturbed. They expect rapid diagnostic clarification and therapy. If physical, laboratory, and X-ray examinations do not disclose any significant pathological findings, parents generally insist on consulting diverse specialists and clinics. The pivotal point of the course of treatment is the parent–doctor–patient relationship. This is notably true when child psychologists or psychiatrists have to be consulted. Typical risks and decision conflicts of the rehabilitation dynamics are described – these are augmented by several case vignettes.

Background Given the prevalence of gait dysfunction following stroke, walking recovery is a primary goal of rehabilitation. However, current gait rehabilitation approaches fail to demonstrate consistent benefits. Gait asymmetry, prevalent among stroke survivors who regain the ability to walk, is associated with an increased energy cost of walking and is a significant predictor of falls post-stroke. Furthermore, differential patterns of gait asymmetry may respond differently to gait training parameters. Research question The purpose of this study was to determine whether differential responses to locomotor task condition occur on the basis of step length asymmetry pattern (Symmetrical, NPshort, Pshort) observed during overground walking. Methods Participants first walked overground at their self-selected walking speed. Overground data were compared against three task conditions all tested during treadmill walking: self-selected speed with 0% body weight support (TM); self-selected speed with 30 % body weight support (BWS); and fastest comfortable speed with 30 % body weight support and nonparetic leg guidance (GuidanceNP). Our primary metrics were: symmetry indices of step length, stride length, and single limb support duration. Results We identified differences in the response to locomotor task conditions for each step length asymmetry subgroup. GuidanceNP induced an acute spatial symmetry only in the NPshort group and temporal symmetry in the Symmetrical and Pshort groups. Importantly, we found the TM and BWS conditions were insufficient to impact either spatial or temporal gait symmetry. Significance Task conditions consistent with locomotor training do not produce uniform effects across subpatterns of gait asymmetry. We identified differential responses to locomotor task conditions between groups with distinct asymmetry patterns, suggesting these subgroups may require unique intervention strategies. Despite group differences in asymmetry characteristics, improvements in symmetry noted in each group were driven by changes in both the paretic and nonparetic limbs.

Gait disorders are predisposing factors for falls. They are accessible to rehabilitation and can be analyzed using tools that collect spatio-temporal parameters of walking, such as the GAITRite® mat. The objective of this retrospective study was to find differences between the spatio-temporal parameters in patients who had fallen compared to patients who did not fall in a population of older patients hospitalized in acute geriatrics department. Patients over 75 years were included. For each patient, spatio-temporal parameters were collected using the GAITRite® mat. The patients were divided into two groups according to whether they had a history of fall. The spatio-temporal parameters were compared between the two groups and in relation to the general population. Sixty-seven patients, with an average age of 85.9 ± 6 years, were included. The patients had comorbidities, cognitive impairment and were polymedicated. The mean walking speed was 51.4 cm/s in non-fallers group and 47.3 cm/s in fallers group (p = 0.539), indicating pathological walking in comparison with the general population of the same age (average 100 cm/s). No association was found between the spatio-temporal parameters and fall, probably linked to many confounding factors such as the pathogenicity of walking of our patients and their comorbidities.

The problem of discirculatory encephalopathy (DEP) is still relevant in modern medicine due to the high prevalence of this pathology. The symptoms of gait disturbance and postural instability, which are an additional factor of disability and a decrease in the quality of life in patients with DEP, are discussed in this article. Modern concepts of the pathogenesis and clinical picture of static-dynamic disorders are highlighted.

Artículo de revisión, Gait abnormalities are a hallmark of Parkinson’s disease and contribute to falling risk. As disease symptoms progress, assistive devices are often prescribed. However, there are no guidelines for choosing appropriate ambulatory devices for gait impairment., This work was supported by the project PI19/00670 of the Ministerio de Ciencia, Innovación y Universidades, Instituto de Salud Carlos III, Spain. The authors declare that there are no additional disclosures to report relevant to this work.

Background New therapeutic approaches in neurological disorders are progressing into clinical development. Past failures in translational research have underlined the critical importance of selecting appropriate inclusion criteria and primary outcomes. Narrow inclusion criteria provide sensitivity, but increase trial duration and cost to the point of infeasibility, while broader requirements amplify confounding, increasing the risk of trial failure. This dilemma is perhaps most pronounced in spinal cord injury (SCI), but applies to all neurological disorders with low frequency and/or heterogeneous clinical manifestations. Objective Stratification of homogeneous patient cohorts to enable the design of clinical trials with broad inclusion criteria. Methods Prospectively–gathered data from patients with acute cervical SCI were analysed using an unbiased recursive partitioning conditional inference tree (URP–CTREE) approach. Performance in the 6-minute walk test at 6 months after injury was classified based on standardized neurological assessments within the first 15 days of injury. Functional and neurological outcomes were tracked throughout rehabilitation up to 6 months after injury. Results URP–CTREE identified homogeneous outcome cohorts in a study group of 309 SCI patients. These cohorts were validated by an internal, yet independent, validation group of 172 patients. The study group cohorts identified demonstrated distinct recovery profiles throughout rehabilitation. The baseline characteristics of the analysed groups were compared to a reference group of 477 patients. Conclusion URP–CTREE enables inclusive trial design by revealing the distribution of outcome cohorts, discerning distinct recovery profiles and projecting potential patient enrolment by providing estimates of the relative frequencies of cohorts to improve the design of clinical trials in SCI and beyond., Neurorehabilitation and Neural Repair, 36 (4-5), ISSN:1545-9683, ISSN:0888-4390, ISSN:1552-6844

Cerebral Palsy (CP) disorders are a group of muscular disabilities that affect more than 700,000 people in the United States. As there are no cures for CP, currently-available treatments like traditional physical therapy and surgery seek to address symptoms, such as mobility impairments. However, these approaches can be intrusive, expensive, and limited in effectiveness. In this report, we describe the invention of a wearable device that will serve as a testing bed for research in the use of vibration as an inexpensive and effective option for the treatment of CP-related mobility disorders. Specifically, the device will be used to evaluate whether vibration at the site of the soleus, a muscle that is activated during walking to prevent trips and falls, can improve a user’s gait. Our device includes three components: a wearable that attaches to the user’s leg which delivers vibration at the site of the soleus muscle, a script that interfaces with a gait analysis tool developed by our liaisons at Stanford Orthopedics to output vibration actuation during the midstance of the gait cycle when the soleus is engaged, and a menu which allows the user easily to adjust different vibration parameters wirelessly. The high priority requirements of the project stipulate that the device must accurately deliver vibrotactile stimulation and that it must be worn comfortably by the user. We ran several tests which showed that both of these requirements were met. The device will give practitioners and clinicians an easy-to-use tool to test different vibration parameters, like amplitude, frequency, and attachment location. Altogether, our work represents an important step in understanding the benefits of vibration for the rehabilitation of CP-related mobility disorders.

INTRODUCTION: There is growing evidence on the efficacy of gait robotic rehabilitation in patients with multiple sclerosis (MS), but most of the studies have focused on gait parameters. Moreover, clear indications on the clinical use of robotics still lack. As part of the CICERONE Italian Consensus on Robotic Rehabilitation, the aim of this systematic review was to investigate the existing evidence concerning the role of lower limb robotic rehabilitation in improving functional recovery in patients with MS. EVIDENCE ACQUISITION: We searched for and systematically reviewed evidence-based studies on gait robotic rehabilitation in MS, between January 1st, 2010 and December 31st, 2020, in the following databases: Cochrane Library, PEDro, PubMed and Google Scholar. The study quality was assessed by the 16-item assessment of multiple systematic reviews 2 (AMSTAR 2) and the 10-item PEDro scale for the other research studies. EVIDENCE SYNTHESIS: After an accurate screening, only 17 papers were included in the review, and most of them (13 RCT) had a level II evidence. Most of the studies used the Lokomat as a grounded robotic device, two investigated the efficacy of end-effectors and two powered exoskeletons. Generally speaking, robotic treatment has beneficial effects on gait speed, endurance and balance with comparable outcomes to those of conventional treatments. However, in more severe patients (EDSS >6), robotics leads to better functional outcomes. Notably, after gait training with robotics (especially when coupled to virtual reality) MS patients also reach better non-motor outcomes, including spasticity, fatigue, pain, psychological well-being and quality of life. Unfortunately, no clinical indications emerge on the treatment protocols. CONCLUSIONS: The present comprehensive systematic review highlights the potential beneficial role on functional outcomes of the lower limb robotic devices in people with MS. Future studies are warranted to evaluate the role of robotics not only for walking and balance outcomes, but also for other gait-training-related benefits, to identify appropriate outcome measures related to a specific subgroup of MS subjects' disease severity.

Background: Freezing of gait (FOG) in Parkinson's disease (PD) is a devastating clinical phenomenon that has a detrimental impact on patients. It tends to be triggered more often during turning (complex) than during forwarding straight (simple) walking. The neural mechanism underlying this phenomenon remains unclear and requires further elucidation.Objective: To investigate the differences in cerebral functional magnetic resonance imaging responses between PD patients with and without FOG during explicitly video-guided motor imagery (MI) of various complex (normal, freezing) and simple (normal, freezing) walking conditions.Methods: We recruited 34 PD patients, namely, 20 with FOG and 14 without FOG, and 15 normal controls. Participants underwent video-guided MI of turning and straight walking, with and without freezing, while their brain blood oxygen level-dependent (BOLD) activities were measured. Gait analysis was performed.Results: While comparing FOG turning with FOG straight walking, freezers showed higher activation of the superior occipital gyrus, left precentral gyrus, and right postcentral gyrus compared with non-freezers. Normal controls also manifest similar findings compared with non-freezers, except no difference was noted in occipital gyrus activity between the two groups. Freezers also displayed a higher effect size in the locomotor regions than non-freezers during imagery of normal turning.Conclusions: Our findings suggest that freezers require a higher drive of cortical and locomotion regions to overcome the overinhibition of the pathways in freezers than in non-freezers. Compared with simple walking, increased dorsal visual pathway and deep locomotion region activities might play pivotal roles in tackling FOG in freezers during complex walking.

This scientific commentary refers to ‘Dissociated motor learning and de-adaptation in patients with functional gait disorders’, by Lin etal. (doi:10.1093/brain/awaa190)

SUMMARYAgainst the backdrop of accelerated ageing around the globe, an increasing number of individuals suffer from hip motion disability and gait disorders. In this paper, the performance analysis of a novel parallel assistive mechanism with 2 DOF for hip adduction/abduction (AB/AD) and flexion/extension (FL/EX) assistance is completed and evaluated, particularly the velocity and force transfer features. The analysis shows that the assistive mechanism has advantages of fine motion assistive isotropy, high force transfer ratio and large force isotropic radius, which indicates that the parallel assistive mechanism is suitable for hip AB/AD and FL/EX assistance.

Late effects of poliomyelitis (LEoP) are characterized by new gait abnormalities that occur many years after the initial poliomyelitis illness. Currently, there is no consensus on the most appropriate evaluation to detect gait disorders following LEoP. This study aimed to assess and compare the effectivenes of the gait profile score with that of the symmetry index (SI) to charaterize gait abnormalities resulting from the LEOP. The SI for stance, swing, double-support duration and the step length, and gait profile score were computed from gait analysis of 12 poliomyelitis subjects and 12 healthy participants. Receiver operating characteristic analysis was used to measure the sensitivity and specificity of the SI and the gait profile score to discriminate patients with the LEoP and healthy participants. The area under the receiver operating characteristic curve was calculated for both gait the profile score and SI. With AUC values all above 0.83 (good discrimination), SI and GPS significantly discriminated the participants with the LEoP from the healthy participants (all p-values

Recent advances in low-cost wearable sensors with methodologies, have opened up a promising future for gait analysis. By providing patient analysis with gait disorders from clinics to common people the analysis requires some form of precised user input. The purpose of this study was to develop a computationally low-cost methodology that could evaluate the performance of different sensor configurations and to study the effect of locomotion mode for swing and stance using kinematic data from hip, knee and ankle extracted using mobile phone accelerometers. The method involved features translated as sum vectors and then using a simple neural network where gait data was normalized and classified the swing or stance. Sum-vector neural network-based method allowed a significantly higher test accuracy compared to the other machine learning algorithms. As an extended gait analysis model focusing predictive applications and implementations that need faster computations, the method could classify the gait kinetic and kinematics of human lower limb more optimally.

While many fall prevention strategies targeted against clinical risk factors have been tested, their success in reducing falls has been modest. Current falls research in aging is mostly focused on clinical predictors of falls. Hence, there is a knowledge gap regarding the underlying biological and neural mechanisms of falls. Emerging evidence from our and other studies implicates biological derangements in inflammation, oxidative stress, and vascular pathways in the occurrence of disorders of gait, balance, and cognition, which in turn are major risk factors for falls in older adults. A growing understanding of the relationship between cognitive and mobility processes in aging opens up the possibility of novel interventions to improve mobility and reduce risk of falls.

Genetic ataxias are associated with mutations in hundreds of genes with high phenotypic overlap complicating the clinical diagnosis. Whole-exome sequencing (WES) has increased the overall diagnostic rate considerably. However, the upper limit of this method remains ill-defined, hindering efforts to address the remaining diagnostic gap. To further assess the role of rare coding variation in ataxic disorders, we reanalyzed our previously published exome cohort of 76 predominantly adult and sporadic-onset patients, expanded the total number of cases to 260, and introduced analyses for copy number variation and repeat expansion in a representative subset. For new cases (n = 184), our resulting clinically relevant detection rate remained stable at 47% with 24% classified as pathogenic. Reanalysis of the previously sequenced 76 patients modestly improved the pathogenic rate by 7%. For the combined cohort (n = 260), the total observed clinical detection rate was 52% with 25% classified as pathogenic. Published studies of similar neurological phenotypes report comparable rates. This consistency across multiple cohorts suggests that, despite continued technical and analytical advancements, an approximately 50% diagnostic rate marks a relative ceiling for current WES-based methods and a more comprehensive genome-wide assessment is needed to identify the missing causative genetic etiologies for cerebellar ataxia and related neurodegenerative diseases.

Turning is impaired in people with Parkinson's Disease (PD) and it is a common trigger for freezing of gait (FoG). Recent evidence suggests that people with PD who freeze (PD+FoG) have worse turning performance than those who don't have freezing (non-freezers, PD-FoG), and the freezing episodes are exacerbated by increasing the turn angular amplitude.We investigated the difference between turning 180° while walking versus turning 360° in place, in both single- and dual-task conditions, by means of objective measures in people with PD with and without FoG.Twenty-four PD+FoG and eighteen PD-FoG performed 180° turns while walking and 360° turns in place during single- and dual-task conditions. Quantitative measures of turning and the dual-task cost were computed. Differences were investigated between groups and within turning types using ANOVA. Associations between turn measures and clinical scales were examined with Spearman correlations.Turn duration and the number of steps were greater, and peak angular velocity slower, in PD+FoG compared to PD-FoG (p 0.001). Dual-task costs were similar across groups, but turn duration showed significant interaction (p = 0.03). Posture Instability and Gait Disability (PIGD) subscore was associated with all turn measures in PD-FoG; whereas PIGD was mainly associated with turning while walking in PD+FoG.Objective measures of turning revealed differences between people with and without FoG, specifically, people with FoG showed more impairments in 360° turning in place compared to 180° turning while walking. However, as the turning challenges were increased by adding a dual-task, results from PD+FoG were similar to those from PD-FoG.

Assistive robots play an important role in improving the quality of life of patients at home. Among all the monitoring tasks, gait disorders are prevalent in elderly and people with neurological conditions and this increases the risk of fall. Therefore, the development of mobile systems for gait monitoring at home in normal living conditions is important. Here, we present a mobile system that is able to track humans and analyze their gait in canonical coordinates based on a single RGB-D camera. First, view-invariant three-dimensional (3-D) lower limb pose estimation is achieved by fusing information from depth images along with 2-D joints derived in RGB images. Next, both the 6-D camera pose and the 3-D lower limb skeleton are real-time tracked in a canonical coordinate system based on simultaneously localization and mapping (SLAM). A mask-based strategy is exploited to improve the re-localization of the SLAM in dynamic environments. Abnormal gait is detected by using the support vector machine and the bidirectional long-short term memory network with respect to a set of extracted gait features. To evaluate the robustness of the system, we collected multi-cameras, ground truth data from 16 healthy volunteers performing 6 gait patterns that mimic common gait abnormalities. The experiment results demonstrate that our proposed system can achieve good lower limb pose estimation and superior recognition accuracy compared to previous abnormal gait detection methods.

Background Antipsychotic medications are commonly used in the management of non-cognitive symptoms of dementia (also termed behavioural and psychological symptoms of dementia), such as agitation, calling out, hoarding, or aggression. This is despite increased recognition of adverse effects, including mortality, from these medications for people with dementia. The current aim was to review the most recent evidence for the efficacy and safety of antipsychotic medications in the management of non-cognitive symptoms in dementia. Methods Relevant studies published in English from March 2015 through to March 2018 were identified by searches of 5 databases: Medline, EBSCO, PsycINFO, Cochrane DARE, and Cochrane CENTRAL. Systematic reviews, meta-analyses, and controlled trials evaluating the safety of antipsychotic medication, or comparing the effectiveness of antipsychotic medication with placebo, another antipsychotic medication, or non-pharmacological intervention, were included. Independent article review and data extraction was performed by two reviewers. Study quality was appraised using the Joanna Briggs Institute critical appraisal tools. Results Thirteen studies were included. Benefits and harms vary among antipsychotic medications for people with dementia, however overall efficacy of antipsychotics remains modest at best. A significant number of side effects are associated with antipsychotics, not least cerebrovascular events, sedation, gait disturbances, falls, fractures, urinary tract infections, cognitive worsening, and mortality. Atypical antipsychotics have a more favourable safety profile in some respects. People with certain dementias, notably Lewy Body Dementia, may experience more severe side-effects. Conclusion The evidence reinforces caution when prescribing antipsychotic medications for people with dementia; these medications should only be considered when symptoms are severe or non-pharmacological interventions have failed. Clinicians should closely monitor people with dementia who are prescribed an antipsychotic for side effects, limiting use of these medications to short-term treatment if possible. The forthcoming national clinical guideline for appropriate prescribing of psychotropic medications for non-cognitive symptoms will support clinical decision-making in this regard.

Summary Gait impairments are among the most common and disabling symptoms of Parkinson's disease. Nonetheless, gait is not routinely assessed quantitatively but is described in general terms that are not sensitive to changes ensuing with disease progression. Quantifying multiple gait features (eg, speed, variability, and asymmetry) under natural and more challenging conditions (eg, dual-tasking, turning, and daily living) enhanced sensitivity of gait quantification. Studies of neural connectivity and structural network topology have provided information on the mechanisms of gait impairment. Advances in the understanding of the multifactorial origins of gait changes in patients with Parkinson's disease promoted the development of new intervention strategies, such as neurostimulation and virtual reality, aimed at alleviating gait impairments and enhancing functional mobility. For clinical applicability, it is important to establish clear links between specific gait impairments, their underlying mechanisms, and disease progression to foster the acceptance and usability of quantitative gait measures as outcomes in future disease-modifying clinical trials.

Objectives Disability prevention strategies are more achievable before osteoarthritis disease drives impairment. It is critical to identify high-risk groups, for strategy implementation and trial eligibility. An established measure, gait speed is associated with disability and mortality. We sought to develop and validate risk stratification trees for incident slow gait in persons at high risk for knee osteoarthritis, feasible in community and clinical settings. Methods Osteoarthritis Initiative (derivation cohort) and Multicenter Osteoarthritis Study (validation cohort) participants at high risk for knee osteoarthritis were included. Outcome was incident slow gait over up to 10-year follow-up. Derivation cohort classification and regression tree analysis identified predictors from easily assessed variables and developed risk stratification models, then applied to the validation cohort. Logistic regression compared risk group predictive values; area under the receiver operating characteristic curves (AUCs) summarised discrimination ability. Results 1870 (derivation) and 1279 (validation) persons were included. The most parsimonious tree identified three risk groups, from stratification based on age and WOMAC Function. A 7-risk-group tree also included education, strenuous sport/recreational activity, obesity and depressive symptoms; outcome occurred in 11%, varying 0%–29 % (derivation) and 2%–23 % (validation) depending on risk group. AUCs were comparable in the two cohorts (7-risk-group tree, 0.75, 95% CI 0.72 to 0.78 (derivation); 0.72, 95% CI 0.68 to 0.76 (validation)). Conclusions In persons at high risk for knee osteoarthritis, easily acquired data can be used to identify those at high risk of incident functional impairment. Outcome risk varied greatly depending on tree-based risk group membership. These trees can inform individual awareness of risk for impaired function and define eligibility for prevention trials.

Dieser Artikel beschreibt die Entwicklung eines Rollatormoduls zur sensorgestutzten Haltungs- und Gangmustererkennung mit dem Ziel, eine alltagstaugliche Hilfe zur Sturzpravention zu entwickeln. Kernbeitrag ist ein Vergleich zwischen der Beurteilung einzelner Gangparameter durch klinisches Personal und der im Rollatormodul verwendeten maschinellen Klassifikationsmethode, der Mahalanobis-Distanz uber Zeitreihen von Sensormesswerten. Das hier beschriebene Rollatormodul erweitert einen handelsublichen Rollator um zwei Tiefenbildkameras, die sowohl den Oberkorper als auch Beine und Becken des Benutzers beobachten. Aus dem Strom von Tiefenbildern werden Distanzmessungen zu 8 relevanten Punkten auf der Korperoberflache (Schultern, Beckenkamme, Oberschenkel, Schienbeine) zu Zeitreihen zusammengefasst, die einzelne Schrittzyklen beschreiben. Zur automatischen Klassifikation der Schrittzyklen im Hinblick auf 14 sicherheitsrelevante Gangparameter (Schrittbreite, -hohe, -lange, -symmetrie, -variabilitat; Flexion von Oberkorper, Knie (l/r) und Hufte (l/r); Position, Distanz zum Rollator; 2‑, 5‑wertiges Gangmuster. [Wahrend das 2‑wertige Gangmuster einen Schrittzyklus grob in pathologisch und physiologisch unterteilt, differenziert das 5‑wertige Gangmuster zwischen antalgischen, ataktischen, paretischen, protektiven und physiologischen Schrittzyklen.]), wurden jeweils einzelne Klassifikationsalgorithmen mit Techniken des maschinellen Lernens trainiert und dazu mathematisch die Mahalanobis-Distanz verwendet (Distanz einzelner Schrittzyklen zu Klassenmitteln und zugehorigen Kovarianzmatrizen). Sowohl Trainings- als auch Testdatensatze wurden dazu im klinischen Kontext mit 29 Probanden gewonnen. Dabei diente die durch klinische Experten vorgenommene Beurteilung des Gangbildes einer am Rollator gehenden Person sowohl zur Annotierung sensorischer Schrittzyklusbeschreibungen der Trainings- als auch der verwendeten Testdatensatze. Zur Bewertung der Qualitat der automatischen Klassifikation des Rollatormoduls wurde ein abschliesender Vergleich zwischen menschlicher und maschineller Beurteilung uber alle Gangparameter vorgenommen. Die fur den Vergleich mit dem maschinellen Lernverfahren herangezogene Gangbeurteilung durch medizinisches Personal zeigte uber das gesamte Patientenkollektiv eine relativ homogene Klassenverteilung in den einzelnen Gangparametern. So zeigten beispielsweise 57 % eine erhohte, und 43 % eine normale Distanz zum Rollator. Zentriert zum Rollator positionierten sich 51 % der Probanden, wahrend 41 % eine links abweichende und 8 % eine rechts abweichende Position einnahmen. Zwolf weitere Gangparameter wurden in 2 bis 5 Klassen unterteilt und beurteilt. Einzelne Schrittzyklen eines jeden Probanden wurden mithilfe der trainierten Klassifikationsalgorithmen beurteilt. Die besten maschinellen Klassifikationsraten uber alle Probanden ergaben sich fur die Parameter Distanz zum Rollator (99,4 %) und das 2-wertige Gangmuster (99,2 %). Die Schrittvariabilitat (94,6 %) und die Position zum Rollator (94,2 %) zeigten die schlechtesten Klassifikationsraten. Uber alle Gangparameter und Probanden wurden 96,9 % aller Schrittzyklusbeschreibungen korrekt klassifiziert. Mit einer durchschnittlichen Klassifikationsrate von 96,9 % eignet sich das beschriebene Gangklassifikationssystem sowohl fur den Einsatz in einem patientenorientierten Trainings‑/Korrektursystem, das auf Fehlhaltungen im Alltag hinweist, als auch fur ein potenzielles Diagnosesystem, das die Ganganalyse im klinischen Umfeld objektiviert. Vor dem Erreichen dieser Ziele konzentrieren sich aktuelle Arbeiten auf den Wechsel von tiefenbildkamerabasierter Distanzmessung zu kleinformatigen Distanzsensoren (1D Lidar) sowie das Design und die Implementierung einer geeigneten Rollatornutzerschnittstelle. Fur den eigentlichen Klassifikationsalgorithmus wird zudem an einem Vergleich der Ergebnisse mit denen von gefalteten neuronalen Netzwerken gearbeitet.

Background The timed-up-and-go test (TUG) is a popular test for mobility, but it only measures the total time to complete tasks. Recent advances in smartphone technology enables measuring respective times of 6 components in the test (Stand, Go, Turn1, Come, Turns and Sit). We examined availability of these data for assessing different gait patterns. Methods This study enrolled 32 patients with probable idiopathic normal-pressure hydrocephalus and 87 age-matched active participants as controls. All the patients responded positively to cerebrospinal fluid (CSF) removal, among whom 19 underwent surgery with positive outcomes. The TUG was performed using a free smartphone application. The components were automatically detected, and their respective times were computed. Statistical analyses included item cluster analysis. Results In the control group, high correlations (r ≥ 0.7) were observed in two pairs of Go and Come, and Turn1 and Turn2, which reflect straight walk and turn. This pattern was lost in the baseline and after CSF removal in the hydrocephalus group. After surgery, the two pairs in the control group regained high correlations. The item cluster analysis showed the pattern changes more clearly. Conclusions A smartphone is useful for analyzing gait patterns in the TUG, which can be applicable for various gait disorders.

Gait disorders in the elderly may be based on a neurologic deficit at multiples levels, or may be secondary to nonneurologic causes. The physiology and pathophysiology of gait problems are reviewed and bedside examination and investigative tools are discussed. The reader will have an excellent working knowledge of the subject and will know how to diagnose and treat gait disorders and falls.

People with Parkinson disease suffer from a loss of dopaminergic neurons, which are involved in walking speed. Currently, virtual reality (VR) has emerged as a useful tool for the rehabilitation of people with neurological diseases, optimizing results in balance and gait. This review aimed to evaluate the effectiveness of VR or video games (through face-to-face sessions and not telerehabilitation) in improving walking speed and other spatio-temporal parameters of gait, balance, and quality of life in patients with Parkinson disease. A bibliographic search was carried out in the MEDLINE, Web of Science, Scopus, and PEDro databases. This systematic review adhered to the PRISMA guideline statement and was registered in PROSPERO (CRD42020180836). From a total of 119 records, 5 studies met the inclusion criteria for qualitative analysis, of which 3 contributed to the meta-analysis; inconclusive findings were found on gait speed, balance, and quality of life after the use of non-immersive VR systems face-to-face. A greater number of studies are necessary, with a greater number of participants, to differentiate between those VR specific systems (specifically designed for rehabilitation) from commercial video games, including immersive systems, and obtain more conclusive evidence. Furthermore, it would be interesting to compare the administration of this treatment in person versus its administration via telerehabilitation, which will help plan treatment programs., This work was supported by the Italian Ministry of Health (Ricerca Corrente).

Objective Parkinson’s disease is a common, age-related, neurodegenerative disease, affecting gait and other motor functions. Technological developments in consumer imaging are starting to provide high-quality, affordable tools for home-based diagnosis and monitoring. This pilot study aims to investigate whether a consumer depth camera can capture changes in gait features of Parkinson’s patients. The dataset consisted of 19 patients (tested in both a practically defined OFF phase and ON phase) and 8 controls, who performed the “Timed-Up-and-Go” test multiple times while being recorded with the Microsoft Kinect V2 sensor. Camera-derived features were step length, average walking speed and mediolateral sway. Motor signs were assessed clinically using the Movement Disorder Society Unified Parkinson’s Disease Rating Scale. Results We found significant group differences between patients and controls for step length and average walking speed, showing the ability to detect Parkinson’s features. However, there were no differences between the ON and OFF medication state, so further developments are needed to allow for detection of small intra-individual changes in symptom severity.

We aimed to investigate whether a newly defined distance in the lower limb can capture the characteristics of hemiplegic gait compared to healthy controls. Three-dimensional gait analyses were performed on 42 patients with chronic stroke and 10 age-matched controls. Pelvis-toe distance (PTD) was calculated as the absolute distance between an anterior superior iliac spine marker and a toe marker during gait normalized by PTD in the bipedal stance. The shortening peak during the swing phase was then quantified as PTDmin. The sagittal clearance angle, the frontal compensatory angle, gait speed, and the observational gait scale were also collected. PTDmin in the stroke group showed less shortening on the affected side and excessive shortening on the non-affected side compared to controls. PTDmin on the affected side correlated negatively with the sagittal clearance peak angle and positively with the frontal compensatory peak angle in the stroke group. PTDmin in stroke patients showed moderate to high correlations with gait speed and observational gait scale. PTDmin adequately reflected gait quality without being affected by apparent improvements due to frontal compensatory patterns. Our results showed that various impairments and compensations were included in the inability to shorten PTD, which can provide new perspectives on gait rehabilitation in stroke patients.

IntroductionFreezing of gait (FoG) is one of the most disabling yet poorly understood symptoms of Parkinson's disease (PD). FoG is an episodic gait pattern characterized by the inability to step that occurs on initiation or turning while walking, particularly with perception of tight surroundings. This phenomenon impairs balance, increases falls, and reduces the quality of life.Materials and methodsClinical-anatomical correlations, electrophysiology, and functional imaging have generated several mechanistic hypotheses, ranging from the most distal (abnormal central pattern generators of the spinal cord) to the most proximal (frontal executive dysfunction). Here, we review the neuroanatomy and pathophysiology of gait initiation in the context of FoG, and we discuss targets of central nervous system neuromodulation and their outcomes so far. The PubMed database was searched using these key words: neuromodulation, freezing of gait, Parkinson's disease, and gait disorders.ConclusionDespite these investigations, the pathogenesis of this process remains poorly understood. The evidence presented in this review suggests FoG to be a heterogenous phenomenon without a single unifying pathologic target. Future studies rigorously assessing targets as well as multimodal approaches will be essential to define the next generation of therapeutic treatments.

Virtual reality (VR) technology has emerged as a promising tool for studying and rehabilitating gait disturbances in different cohorts of patients (such as Parkinson's disease, post-stroke, or other neurological disorders) as it allows patients to be engaged in an immersive and artificial environment, which can be designed to address the particular needs of each individual. This review demonstrates the state of the art in applications of virtual walking techniques and related technologies for gait therapy and rehabilitation of people with movement disorders makes recommendations for future research and discusses the use of VR in the clinic. However, the potential for using these techniques in gait rehabilitation is to provide a more personalized approach by simulate the experience of natural walking, while patients with neurological disorders are maintained localized in the real world. The goal of our work is to investigate how the human nervous system controls movement in health and neurodegenerative disease.

Orientador: Irenilza de Alencar Naas Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Engenharia Agrícola Resumo: O Brasil é hoje um dos maiores produtores e exportadores de carne de frango no mundo, mas para continuar nessa posição é necessário respeitar o bem-estar animal e manter baixos custos de produção. Problemas locomotores impedem que a ave se movimente livremente e, com isso, acesse os equipamentos necessários a sua sobrevivência: comedouro e bebedouro, prejudicando seu bem- estar e sua produtividade. A hipótese dessa pesquisa é que frangos de corte produzidos em condições de estresse apresentam problemas locomotores. O objetivo desse trabalho foi avaliar deficiências locomotoras em frangos de corte alojados em condições de estresse. Para tanto, foram realizados dois experimentos, sendo o primeiro a determinação da pressão plantar de aves de 28, 35, 42, e 49 dias, o qual foi realizado no Centro de Tecnologia da Universidade estadual de Campinas, São Paulo, Brasil. Essa medida foi determinada por sensores localizados sob uma esteira enquanto as aves caminhavam sobre ela, nesta ocasião também foi determinado o gait score dessas aves. As mais pesadas tiveram mais dificuldade de andar e tiveram maior valor de gait score. Não houve diferença significativa (p = 0,05) no pico da força das patas direito e esquerdo para aves com gait score 0 e 1; entretanto, para frangos mais pesados com gait score 2 houve desbalanço severo no pico das forças entre as patas. A força total expressa em porcentagem do peso vivo aumentou com a idade como esperado, mostrando uma correlação positiva com o gait score para as aves selecionadas. A deficiência de locomoção foi automaticamente detectada devido ao movimento desigual, como seu peso não foi distribuído igualmente nas patas durante caminhada. O segundo experimento constou de observação visual no campo, em granjas da região de Campinas-SP, com determinação do gait score em aves de 28, 35, e 42 dias. Neste experimento o gait score foi avaliado por três metodologias, aves estimuladas a andar, aves sem estímulo para andar e em 10 aves ao acaso dentro do galpão. Não foram encontradas evidências de interação entre os fatores Metodologia e Idade. Há influencia significativa da Metodologia sobre a determinação do gait score. A metodologia de 10 aves ao acaso foi a que se apresentou menos confiável. Os resultados de gait score foram menores na metodologia com estímulo para as aves andar. Entretanto nas três avaliações realizadas e em todas as idades, os resultados de gait score foram piores que o aceitável, sendo que a maior freqüência para gait score 0 (padrão normal) encontrada nesta pesquisa foi de 50%. Estes resultados poderiam ser atribuídos as condições de estresse ambiental inapropriadas em que os frangos foram produzidos. Abstract: Brazil is today one of the largest poultry meat producer and exporter of the world; however, in order to continue in this production level and quality it is needed to apply animal welfare principles maintaining the same production costs. Locomotors problems keep away the bird from moving freely and to access the needed equipments for its survival: feeder and drinker, reducing their welfare and productivity. The hypothesis of this research it is that Brazilian poultry production presents locomotors problems. The objective of this research was is to evaluate locomotors deficiencies in broiler chicken housed under stressful conditions. For that two experiment were done, the first was the determination of the feet pressure of broiler with the ages of 28, 35, 42 and 49 days. This first experiment was carried out at the Center for Technology, State University of Campinas, SP. The feet force measurement was determined by sensors over a mat while the birds walked over it, and at the same time the gait score was also determined. The heavier birds had more difficult in walking and presented higher gait score. No significant difference was found (p = 0.05) in the force peak of the right and left feet for the birds with gait score 0 and 1; however, older broilers with gait score 2 presented severe unbalance in the peak of force in both feet. The total force expressed as the percentage of the live weight increased with age as expected showing a positive correlation with the gait score of the tested broilers. The locomotion deficiency was automatic detected due to the unbalanced movement as the weight was not equally distributed in both legs during walking. The second experiment constituted of a visual observation in the field, in commercial broiler farms in the region of Campinas, SP, for determining the gait score of birds 28, 35 and 42 days old. In this trial the gait score was estimated in three ways, broilers stimulated to walking, birds without stimulus for walking and broilers chosen randomly inside the housing. No evidence of interaction between the factor Methodology and Age. Significant influence of Methodology over the determination of gait score was found. The methodology of chosen 10 bird at random was the one least reliable. The results of gait score were lower when using the methodology that stimulated the birds to waking. However, in the three evaluations and in all ages the results of gait score were worst than the acceptable, since the frequency of gait score 0 (normal pattern) found in this research was 50%. These results could be accredited to the inappropriate ambient harsh conditions the broilers were reared. Mestrado Construções Rurais e Ambiencia Mestre em Engenharia Agrícola

A Man with Depressed Mood, Unsteady Gait, and Urinary Incontinence A 70-year-old man with bipolar disorder was evaluated because of depressed mood, suicidal ideation, and gait disturbance. One mont...

The gait analysis is interpreted to include an overwhelming number of interrelated parameters, which, due to the high volume of data and their relationships and is difficult to implement. The integration of machine learning with biomechanics is a promising approach to simplify the evaluation. The aim of this paper is to educate readers about the key directions to implement the gait analysis with machine learning techniques. The detailed survey is based on review and implementation articles performed by numerous research scholars to detect neurological effects in gait, gait asymmetry, gait disorders, gait events, and gait activities by using supervised machine learning algorithms. This study paper also reveals the effectiveness of ML approaches for condition identification, forecasting recovery time and monitoring for clinical diagnostic instruments.

BackgroundReduced cortical sensorimotor inhibition is associated with mobility and cognitive impairments in people with Parkinson's disease (PD) and older adults (OAs). However, there is a lack of clarity regarding the relationships among sensorimotor, cognitive, and mobility impairments. The purpose of this study was to determine how cortical sensorimotor inhibition relates to impairments in mobility and cognition in people with PD and OAs.MethodCortical sensorimotor inhibition was characterized with short-latency afferent inhibition (SAI) in 81 people with PD and 69 OAs. Six inertial sensors recorded single- and dual-task gait and postural sway characteristics during a 2-minute walk and a 1-minute quiet stance. Cognition was assessed across the memory, visuospatial, executive function, attention, and language domains.ResultsSAI was significantly impaired in the PD compared to the OA group. The PD group preformed significantly worse across all gait and postural sway tasks. In PD, SAI significantly correlated with single-task foot strike angle and stride length variability, sway area, and jerkiness of sway in the coronal and sagittal planes. In OAs, SAI significantly related to single-task gait speed and stride length, dual-task stride length, and immediate recall (memory domain). No relationship among mobility, cognition, and SAI was observed.ConclusionsImpaired SAI related to slower gait in OA and to increased gait variability and postural sway in people with PD, all of which have been shown to be related to increased fall risk.