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This is a unique clinical case of a spontaneous non-traumatic hip dislocation in a patient with stroke with a hip and knee flexion pattern. This case highlights the role of spasticity as a cause of hip dislocation and the need to combine focal spasticity treatment and surgery to restore ambulation.

An elderly man in his early 80s presented with a 6-month history of worsening lower limb weakness on a background of a longer-standing waddling gait. Examination revealed bilateral scapular winging, and weakness in his proximal and distal lower limbs. Electromyography showed widespread chronic partial denervation changes, while sensory and motor nerve conduction parameters were preserved. After little progression over the course of 18 months, motor neuron disease was deemed less likely. Genetic testing revealed BICD2-related spinal muscular atrophy with lower extremity dominance (SMALED2), a disease that is usually of earlier onset. He is the oldest patient in the literature to be diagnosed with SMALED2 while maintaining ambulation, suggesting the milder spectrum of BICD2-related disease.

This article examines the place of Beckett’s work amongst recent artworks sited at the Northern Irish border/ north of Ireland border. Using Dylan Quinn’s Fulcrum, the Happy Days Enniskillen International Beckett Festival’s Walking for Waiting for Godot, and the collaborative community project Across and In-Between as key examples, I explore how Beckett’s work has become absorbed into the kinds of wider arts and political discourses—and indeed crises—that this border-site reflects. These projects share a concern for placing bodies at the border, asking us to see from the situation of the border, to trace its often-impalpable contours with the frail tools of words and bodies.

Background: Performing cognitive–motor dual tasks (DTs) may result in reduced walking speed and cognitive performance. The effect in persons with progressive multiple sclerosis (pwPMS) having cognitive dysfunction is unknown. Objective: To profile DT-performance during walking in cognitively impaired pwPMS and examine DT-performance by disability level. Methods: Secondary analyses were conducted on baseline data from the CogEx-study. Participants, enrolled with Symbol Digit Modalities Test 1.282 standard deviations below normative value, performed a cognitive single task ([ST], alternating alphabet), motor ST (walking) and DT (both). Outcomes were number of correct answers on the alternating alphabet task, walking speed, and DT-cost (DTC: decline in performance relative to the ST). Outcomes were compared between EDSS subgroups (≤ 4, 4.5–5.5, ≥ 6). Spearman correlations were conducted between the DTCmotor with clinical measures. Adjusted significance level was 0.01. Results: Overall, participants (n = 307) walked slower and had fewer correct answers on the DT versus ST (both p < 0.001), with a DTCmotor of 15.8% and DTCcognitive of 2.7%. All three subgroups walked slower during the DT versus ST, with DTCmotor different from zero (p’s < 0.001). Only the EDSS ≥ 6 group had fewer correct answers on the DT versus ST (p < 0.001), but the DTCcognitive did not differ from zero for any of the groups (p ≥ 0.039). Conclusion: Dual tasking substantially affects walking performance in cognitively impaired pwPMS, to a similar degree for EDSS subgroups.

A quantitative analysis of human gait patterns in space–time provides an opportunity to observe variability within and across individuals of varying motor capabilities. Impaired gait significantly affects independence and quality of life, and thus a large part of clinical research is dedicated to improving gait through rehabilitative therapies. Evaluation of these paradigms relies on understanding the characteristic differences in the kinematics and underlying biomechanics of impaired and unimpaired locomotion, which has motivated quantitative measurement and analysis of the gait cycle. Previous analysis has largely been limited to a statistical comparison of manually selected pointwise metrics identified through expert knowledge. Here, we use a recent statistical-geometric framework, elastic functional data analysis (FDA), to decompose kinematic data into continuous ‘amplitude’ (spatial) and ‘phase’ (temporal) components, which can then be integrated with established dimensionality reduction techniques. We demonstrate the utility of elastic FDA through two unsupervised applications to post-stroke gait datasets. First, we distinguish between unimpaired, paretic and non-paretic gait presentations. Then, we use FDA to reveal robust, interpretable groups of differential response to exosuit assistance. The proposed methods aim to benefit clinical practice for post-stroke gait rehabilitation, and more broadly, to automate the quantitative analysis of motion.

The aim of this investigation was to determine if meeting the 2018 physical activity (PA) time-intensity guidelines was associated with better ambulatory function, health-related quality of life (HRQoL), vascular function, and inflammation than failing to meet the guidelines in patients with peripheral artery disease and claudication. Second, we determined the optimal number of total steps/d and steps taken at moderate cadence needed to meet the PA time-intensity guidelines.Five hundred seventy-two patients were assessed on daily ambulatory activity for 1 wk with a step activity monitor, and were grouped according to whether they achievedlt;150 min/wk of moderate-intensity PA (group 1 = do not meet guidelines; n = 397) or whether they were above this threshold (group 2 = meet guidelines; n = 175).Treadmill peak walking time (mean ± SD) was higher ( Plt; .001) in group 2 (709 ± 359 sec) than in group 1 (427 ± 281 sec). The physical function HRQoL score was higher ( Plt; .001) in group 2 (61 ± 22%) than in group 1 (44 ± 21%). High-sensitivity C-reactive protein was lower ( Plt; .001) in group 2 (3.6 ± 4.5 mg/L) than in group 1 (5.9 ± 6.1 mg/L). Finally, ≥7675 total steps/d and ≥1660 steps/d at moderate cadence were optimal thresholds associated with meeting PA guidelines.Patients with claudication who meet the 2018 PA time-intensity guidelines for US adults had better ambulation, HRQoL, and vascular outcomes than those who failed to meet the PA guidelines. Patients with claudication best achieved the PA time-intensity guidelines by taking ≥7675 total steps/d, and ≥1660 steps/d at a moderate cadence.

Efforts to study performance fatigability have been limited because of measurement constrains. Accelerometry and advanced statistical methods may enable us to quantify performance fatigability more granularly via objective detection of performance decline. Thus, we developed the Pittsburgh Performance Fatigability Index (PPFI) using triaxial raw accelerations from wrist-worn accelerometer from two in-laboratory 400-m walks.Sixty-three older adults from our cross-sectional study (mean age, 78 yr; 56% women; 88% White) completed fast-paced ( n = 59) and/or usual-paced 400-m walks ( n = 56) with valid accelerometer data. Participants wore ActiGraph GT3X+ accelerometers (The ActiGraph LLC, Pensacola, FL) on nondominant wrist during the walking task. Triaxial raw accelerations from accelerometers were used to compute PPFI, which quantifies percentage of area under the observed gait cadence-versus-time trajectory during a 400-m walk to a hypothetical area that would be produced if the participant sustained maximal cadence throughout the entire walk.Higher PPFI scores (higher score = greater fatigability) correlated with worse physical function, slower chair stands speed and gait speed, worse cardiorespiratory fitness and mobility, and lower leg peak power (| ρ | = 0.36-0.61 from fast-paced and | ρ | = 0.28-0.67 from usual-paced walks, all P0.05). PPFI scores from both walks remained associated with chair stands speed, gait speed, fitness, and mobility, after adjustment for sex, age, race, weight, height, and smoking status; PPFI scores from the fast-paced walk were associated with leg peak power.Our findings revealed that the objective PPFI is a sensitive measure of performance fatigability for older adults and can serve as a risk assessment tool or outcome measure in future studies and clinical practice.

Individual differences in brain structure and function in older adults are potential proxies of brain reserve or maintenance and may provide mechanistic predictions of adherence to exercise. We hypothesized that multimodal neuroimaging features would predict adherence to a 6-month randomized controlled trial of exercise in 131 older adults (age, 65.79 ± 4.65 yr, 63% female), alone and in combination with psychosocial, cognitive, and health measures.Regularized elastic net regression within a nested cross-validation framework was applied to predict adherence to the intervention in three separate models (brain structure and function only; psychosocial, health, and demographic data only; and a multimodal model).Higher cortical thickness in somatosensory and inferior frontal regions and less surface area in primary visual and inferior frontal regions predicted adherence. Higher nodal functional connectivity (degree count) in default, frontoparietal, and attentional networks and less nodal strength in primary visual and temporoparietal networks predicted exercise adherence ( r = 0.24, P = 0.004). Survey and clinical measures of gait and walking self-efficacy, biological sex, and perceived stress also predicted adherence ( r = 0.17, P = 0.056); however, this prediction was not significant when tested against a null test statistic. A combined multimodal model achieved the highest predictive strength ( r = 0.28, P = 0.001).Our results suggest that there is a substantial utility of using brain-based measures in future research into precision and individualized exercise interventions older adults.

This is the first sham-controlled trial to examine the effects of home-based leg heat therapy (HT) on walking performance in patients with peripheral artery disease (PAD). We demonstrate that unsupervised HT using water-circulating trousers is safe, well-tolerated, and elicits meaningful changes in walking ability in patients with symptomatic PAD. This home-based treatment option is practical, painless, and may be a feasible adjunctive therapy to counteract the decline in lower extremity physical function in patients with PAD.

The aim of this study was to compare the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) with equal energy expenditure on glycaemic and cardiometabolic risk factors in people with Type 2 Diabetes Mellitus (T2DM) when compared to the control. Sixty-three people with T2DM were randomly assigned to HIIT, MICT, or non-exercising controls. Individuals were trained with HIIT at 90 and 30% of their VO(2)peak (1:2 min ratio) starting from 8 up to 16 intervals and MICT at 50% of VO(2)peak, on a cycle ergometer, 3 times/week for 12 weeks under supervision. The primary outcome measure was the change in HbA1c. Aerobic capacity, cardiovascular responses, anthropometric measures, body composition, glycaemic, and cardiometabolic risk factors were measured at the beginning and the end of the 12-week training period. There was no significant difference between HIIT and MICT or when compared to the control for HbA1c, glucose, insulin resistance, blood lipids, cardiovascular responses, anthropometric measures, body composition, and abdominal and visceral fat (p(adj )> 0.05). HIIT and MICT increased VO(2)peak significantly compared to controls (p < 0.05) but not to each other (p > 0.05). Both HIIT and MICT improved VO(2)peak and HbA1c after 12 weeks of training compared to their baseline, furthermore, only MICT caused additional improvements in cardiovascular responses, anthropometric measures, and abdominal fat compared to baseline (p < 0.05). As a conclusion, isoenergetic HIIT or MICT did not improve HbA1c. The two protocols were equally efficient for improvement in aerobic capacity but had little effect on other cardiometabolic factors.

Cutaneous feedback from feet is involved in regulation of muscle activity during locomotion, and the lack of this feedback results in motor deficits. We tested the hypothesis that locomotor changes caused by local unilateral anesthesia of paw pads in the cat could be reduced/reversed by electrical stimulation of cutaneous and proprioceptive afferents in the distal tibial nerve during stance. Several split-belt conditions were investigated in four adult female cats. In addition, we investigated the effects of similar distal tibial nerve stimulation on overground walking of one male cat that had a transtibial, bone-anchored prosthesis for 29 months and, thus, had no cutaneous/proprioceptive feedback from the foot. In all treadmill conditions, cats walked with intact cutaneous feedback (control), with right fore- and hindpaw pads anesthetized by lidocaine injections, and with a combination of anesthesia and electrical stimulation of the ipsilateral distal tibial nerve during the stance phase at 1.2× threshold of afferent activation. Electrical stimulation of the distal tibial nerve during the stance phase of walking with anesthetized ipsilateral paw pads reversed or significantly reduced the effects of paw pad anesthesia on several kinematic variables, including lateral center of mass shift, cycle and swing durations, and duty factor. We also found that stimulation of the residual distal tibial nerve in the prosthetic hindlimb often had different effects on kinematics compared with stimulation of the intact hindlimb with paw anesthetized. We suggest that stimulation of cutaneous and proprioceptive afferents in the distal tibial nerve provides functionally meaningful motion-dependent sensory feedback, and stimulation responses depend on limb conditions.

To prospectively analyze the associations with coronary heart disease (CHD) risk of reallocating time from sedentary behavior to various physical activities using the isotemporal substitution model, particularly according to whether the participants meet the recommended physical activity level.We included 455,298 UK Biobank participants free of CHD at baseline (March 13, 2006, to October 10, 2010). Sedentary behavior time was quantified by summing up the time spent on television watching, computer (not at work), and driving. Physical activities were categorized as daily-life activities (walking for pleasure, light do-it-yourself, and heavy do-it-yourself) and structured exercise (strenuous sports and other exercise).During a median follow-up of 11 years, 20,162 incident CHD cases were documented. Sedentary behavior time was significantly associated with a higher risk of CHD, independent of physical activity. Replacing 30 min/d of sedentary behavior with an equal time of various physical activities was associated with a 3% to 12% risk reduction of CHD. Replacing 1 h/d of sedentary behavior with different types of physical activities was associated with a 6% to 23% risk reduction of CHD. Sedentary behavior to strenuous sports reallocations showed the largest benefit. Reallocations of sedentary behavior to various physical activities showed particularly greater benefits among those who did not meet the physical activity recommendations.Replacing sedentary behavior time with various daily-life activities or structured exercise is associated with significant reductions in CHD risk.

Bu çalışma, COVID-19 salgını süresince sıklıkla başvurulan sokağa çıkma yasakları dönemlerinde araç kullanımının kısıtlanması nedeniyle yahut kent kullanıcılarının bulaş riskini azaltmak için kendi iradeleriyle toplu taşıma araçlarından kaçınmaları dolayısıyla kentle yeniden ilişkilenmelerini sağlayan yürüme pratiğini, İstanbul gibi yayaların ulaşım hakkının oldukça sınırlı olduğu bir ölçekten ele almayı amaçlamaktadır. Çalışma, yaya olmanın kentsel bir deneyim olarak tarihsel ve felsefi veçhelerini tartışmaya açtıktan sonra, hızlı ve kesintisiz bir hareketlilik (mobilite) üzerine kurulu neoliberal kentte yürümenin nasıl unutulduğuna ve COVID-19 salgını “sayesinde” nasıl yeniden hatırlandığına yoğunlaşmaktadır. Araştırmada amaçlı ve kartopu örnekleme yoluyla “üniversite eğitimli çalışanlara” ulaşılmıştır. Araştırmaya katılmaya gönüllü olmuş 46 katılımcı, İstanbul’un merkez ve periferisi denebilecek 23 farklı ilçesinde ikamet etmektedir. Çalışmada, toplu taşım kullanımındaki değişime dair sosyo-demografik bulguların ötesinde, niteliksel analiz bulgularına göre katılımcıların algı, değerlendirme ve deneyimlerinde çeşitli temalara ulaşılmıştır: Arzulanan bir edim olarak yürümek, olumlu duygulanım pahasıyla ulaşılan bir edim olarak yürümek, salgın günleriyle başa çıkma yolu ve kenti evcilleştirme pratiği olarak yürümek, sosyalleşme biçimi olarak yürümek, politik bir edim olarak yürümek temaları kent tarihi, kent sosyolojisi, sosyal psikoloji ve çevre psikolojisi literatürleri ekseninde tartışılmıştır. Araştırma, COVID-19 salgın günlerinde İstanbul’da yaşayan üniversite eğitimli çalışanlara odaklanmasıyla, giderek artan İstanbul Çalışmaları yazınına katkı sunmaktadır., This study examines the walking practice, which provides re-engagement with the city during the curfews in the COVID-19 pandemic. Restricting the use of vehicles or city users’ voluntarily avoidance of public transportation to reduce the transmission risk refers to Istanbul’s quite limited transportation opportunities during the pandemic. After discussing the historical/philosophical dimensions of being on foot as an urban experience, the study focuses on how walking in the neoliberal city built on fast/uninterrupted mobility is remembered “thanks to” the pandemic. In the research, “university graduate employees” were reached through purposeful/snowball sampling. Forty-six individuals who participated voluntarily reside in Istanbul’s twenty-three districts from centre and periphery. In the study, beyond the socio-demographic findings on the change in public transport usage, various themes were reached in the participants’ perceptions, evaluations, and experiences according to the qualitative analysis findings. The themes discussed regarding “walking” within the scope of urban history/sociology and social/environmental psychology are as follows: the desired performance, the performance achieved as positive affect, a way of coping with pandemic days and taming the city, as a socialization method, and a political act. The research contributes to the “Istanbul Studies”, focusing on university graduate employees living in Istanbul during the pandemic days.

Background and Study Aim. Cerebral palsy is a broad term for a variety of non-progressive, resulting in physical impairment, movement dysfunction, and poor posture. The purpose of the study was to compare the effectiveness in the Halliwick aquatic exercise versus conventional land-based therapy on gross motor function of children aged from 3 to 5 years with spastic cerebral palsy. Material and Methods. In this randomized controlled trial, (n=34) children diagnosed with spastic Cerebral palsy were randomly assigned into either the Halliwick concept group (n=17) or active control (conventional exercising group) (n=17). A physiotherapist performed the sessions with participants three times a week, 45 minutes duration over 12 weeks. An independent pediatric rehabilitation specialist assessed the children’s gross motor function using the gross motor function measures (sitting, crawling and kneeling, standing, walking, running, and jumping). Results. After the intervention, both Halliwick concept group and conventional exercising group significantly improved activities of sitting, crawling & kneeling, standing and walking, running and jumping. Besides, the estimate of the effect of the Halliwick exercises on sitting, standing and walking, running & jumping activities was more clinically significant than conventional exercises, with sitting; MD = -0.06 [95%, CI; -0.19 to 0.32], standing; MD = 0.14 [95%, CI; -0.15-0.31], and walking, running & jumping activities; MD = -0.09 [95%, CI; -0.11 to 0.20]. None of the between-group differences for any remaining outcomes was significant. Conclusion. Aquatic exercises based on the Halliwick concept are better than conventional exercises to improve sitting, standing and walking, running and jumping activities in children aged 3 to 5 years with spastic cerebral palsy., Передумови та мета дослідження. Церебральний параліч — це широкий термін для різноманітних непрогресуючих захворювань, що призводять до фізичних порушень, рухової дисфункції та неправильної постави. Мета дослідження полягала в тому, щоб порівняти ефективність водних вправ Halliwick із традиційною наземною терапією великої моторики функції дітей 3-5 років зі спастичним церебральним паралічем.Матеріал і методи. У цьому рандомізованому контрольованому дослідженні (n=34) діти з діагнозом спастичний церебральний параліч були випадковим чином розподілені або в групу концепції Halliwick (n=17), або в групу активного контролю (група звичайних вправ) (n=17). Фізіотерапевт проводив сеанси з учасниками тричі на тиждень тривалістю 45 хвилин протягом 12 тижнів. Незалежний фахівець з дитячої реабілітації оцінив загальну моторику дітей за допомогою показників загальної моторики (сидіння, повзання та стояння на колінах, стояння, ходьба, біг та стрибки).Результати. Після втручання як концептуальна група Halliwick, так і група звичайних вправ значно покращили такі види діяльності, як сидіти, повзати та стояти на колінах, стояти та ходити, бігати та стрибати. Крім того, оцінка ефекту вправ Halliwick на сидіння, стояння та ходьбу, біг і стрибки була більш клінічно значущою, ніж звичайні вправи, сидячи; MD = -0,06 [95%, ДІ; -0,19 до 0,32], стоячи; MD = 0,14 [95%, ДІ; -0,15-0,31], а також ходьба, біг і стрибки; MD = -0,09 [95%, ДІ; -0,11 до 0,20]. Жодна з відмінностей між групами для будь-яких інших результатів не була суттєвою.Висновок. Водні вправи, засновані на концепції Халлівіка, краще, ніж звичайні вправи, для покращення сидіння, стояння та ходьби, бігу та стрибків у дітей віком від 3 до 5 років зі спастичним церебральним паралічем.

Microprocessor-controlled prostheses are designed to improve mobility and quality of life through better balance and energy restoration in persons with transtibial amputation. Quasi-active microprocessor-controlled ankles (MPA) adapt to variable terrain by ankle angle adjustment.To compare energy expenditure, balance, quality of life, and satisfaction of Proprio-foot® (a quasi-active MPA model) with standard prescribed ankle prosthesis (prescribed ankle-foot units [PA]) (standard energy storage and return prosthesis).Multicenter, unblinded, randomized, controlled, cross-over study.Energy expenditure (primary outcome) was assessed by oxygen uptake (VO2) measured at the maximum level reached with the 2 prostheses during treadmill walking at progressively increasing incline and speed. Balance was assessed by stabilometry in different static positions. Quality of life and satisfaction were assessed by "Short Form 36" questionnaire (0-100) and by Evaluation de la Satisfaction envers une Aide Technique (0-5) questionnaires after wearing each of the 2 prostheses for 34 days.Forty-five patients tested the 2 prostheses. No statistical difference in VO2 was observed. Significant improvement of balance was observed both during standing on an incline or decline with MPA and PA (p0.01). Short Form 36 questionnaire physical scores and Short Form 36 questionnaire mental scores were 68.5 ± 19.5 vs. 62.1 ± 19.6 (p0.01) and 72.0 ± 20.8 vs. 66.2 ± 20.9 (p0.01) in MPA and PA, respectively. Evaluation de la Satisfaction envers une Aide Technique score on the device was not statistically significant between the 2 groups (MPA 4.4 ± 0.5 vs. PA 4.3 ± 0.5, p = 0.360).Proprio-foot® improved balance, quality of life, and patient satisfaction despite no reduction or increase in energy expenditure in comparison with standard energy storage and return prosthesis.

BackgroundWhile walking in nature has been shown to improve affect in adults from the community to a greater extent than walking in urban settings, it is unknown whether such findings can be generalized to individuals suffering from depression. Using a parallel group design, this randomized controlled trial examined the effects of a single walk in nature versus urban settings on negative and positive affect in adult psychiatric outpatients diagnosed with major depressive disorder (MDD).MethodParticipants recruited from a psychiatric outpatient clinic for adults with MDD were randomly assigned to a nature or urban walk condition. Thirty-seven adults (mean age=49 years) completed a single 60-minute walk. Negative and positive affect were assessed using The Positive and Negative Affect Schedule or PANAS at 6 time points: before the walk, halfway during the walk, immediately post-walk, at home before bedtime, 24 hours post-walk, and 48 hours post-walk.ResultsControlling for baseline levels of affect before the walk, individuals who walked in nature experienced overall lower levels of negative affect, F(1, 35.039)=4.239, p=.047, compared to those who walked in urban settings. Positive affect did not differ across walk conditions.LimitationsThe generalizability of results are limited by the small sample size and the presence of more female than male participants.ConclusionsWalking in nature might be a useful strategy to improve the affect of adults with MDD. Future research should investigate different ways to integrate the beneficial effects of nature exposure into existing treatment plans for psychiatric outpatients with MDD.

In addition to physical factors, psychological factors such as self-efficacy (SE) reportedly affect physical activity (PA) levels in individuals with knee osteoarthritis (OA). However, the relationship between PA and SE for walking tasks in patients with knee OA remains unclear. The present study aimed to investigate the direct and indirect pathways of SE for walking tasks and the influence of previously reported factors on PA level in individuals with knee OA.A cross-sectional design was employed. Eighty-five individuals with knee OA were enrolled. The daily step count (Steps) was considered an objective level of PA. The SE for the walking task was assessed using a modified Gait Efficacy Scale (mGES). Data on gait speed (GS), the visual analog scale (VAS) score for knee pain, Kellgren-Lawrence (K-L) grade of radiographic severity of knee OA, age, and body mass index were collected. Path analysis was performed to investigate the direct and indirect effects of these variables on Steps.After exclusion, 70 participants were included. The alternative model, which included Steps, mGES, GS, VAS, K-L grade, and age, showed a good fit. mGES and age had a direct effect on Steps (standardized path coefficients: 0.337 and -0.542, respectively), while the other variables had indirect effects.The SE for walking tasks was directly associated with Steps representative of the PA level. This finding suggests that SE for the walking task may be important in improving PA levels in individuals with knee OA.

Multiple obstacle avoidance induces a higher potential of falls among older adults. This study attempted to add other important measurements by investigating the pressure-related gait parameters when stepping over multiple obstacles on a portable pressure-sensing walkway. Twenty-six young and 26 older participants were recruited in this study. A portable pressure-sensing Zeno walkway and cyclogram intersection point analysis method was introduced to collect both spatial–temporal and pressure-related gait parameters. Older adults significantly reduced foot integrated pressure of the leading leg when stepping over the second obstacle compared with young adults (p = .0078). A significantly larger cyclogram intersection point shift in medial–lateral direction was found in older adults than in young adults (p = .024) when stepping over the second obstacle, especially in the lateral direction. The results of this study showed that a pressure-sensing walking combined with cyclogram intersection point method could detect foot pressure distribution differences caused by aging.

Load carriage experiments are typically performed from a linear perspective that assumes that movement variability is equivalent to error or noise in the neuromuscular system. A complimentary, nonlinear perspective that treats variability as the object of study has generated important results in movement science outside load carriage settings. To date, no systematic review has yet been conducted to understand how load carriage dynamics change from a nonlinear perspective. The goal of this systematic review is to fill that need. Relevant literature was extracted and reviewed for general trends involving nonlinear perspectives on load carriage. Nonlinear analyses that were used in the reviewed studies included sample, multiscale, and approximate entropy; the Lyapunov exponent; fractal analysis; and relative phase. In general, nonlinear tools successfully distinguish between unloaded and loaded conditions in standing and walking, although not in a consistent manner. The Lyapunov exponent and entropy were the most used nonlinear methods. Two noteworthy findings are that entropy in quiet standing studies tends to decrease, whereas the Lyapunov exponent in walking studies tends to increase, both due to added load. Thus, nonlinear analyses reveal altered load carriage dynamics, demonstrating promise in applying a nonlinear perspective to load carriage while also underscoring the need for more research.

The study examined how clinically measured walking capacity contributes to real-world walking performance in persons with Parkinson's disease (PD).Cross-sectional baseline data (n = 82) from a PD clinical trial were analyzed. The 6-Minute Walk Test (6MWT) and 10-Meter Walk Test (10MWT) were used to generate capacity metrics of walking endurance and fast gait speed, respectively. An activity monitor worn for seven days was used to generate performance metrics of mean daily steps and weekly moderate intensity walking minutes. Univariate linear regression analyses were used to examine associations between each capacity and performance measure in the full sample and less and more active subgroups.Walking capacity significantly contributed to daily steps in the full sample (endurance: RWalking capacity contributed to, but explained a relatively small portion of the variance in, real-world walking performance. The contribution was somewhat greater in less active individuals. The study adds support to the idea that clinically measured walking capacity may have limited benefit for understanding real-world walking performance in PD. Factors beyond walking capacity may better account for actual walking behavior.

This narrative review aims to provide a general overview of the literature about frame running, which is a recent modality of Para-Athletics. Frame running is practiced by using a tricycle without pedals called PETRA RaceRunner, by people with moderate to severe cerebral palsy and other lower limb functional limitations. Briefly, the movement pattern is very similar to walking and running. This review includes studies from scientific databases and content of official sports web sites by using the keywords "framerunning," "racerunning," and "petra racerunning." According to our search, this narrative review highlighted three themes involving the practice of frame running, namely health and quality of life, sports classification, and training and testing in the frame running context.

Walkability scores have been developed to measure how well the characteristics of the physical environment support walking. However, because pedestrian safety is not taken into account, areas that have higher Walk Scores could be associated with more walking and also more pedestrian-related injury. We aimed to explore the association between Walk Score and pedestrian-related injury in Sydney.Pedestrian-related injuries from 2010 to 2018 in Sydney were identified in the New South Wales Combined Admitted Patient Epidemiology Data. Walk Score was used to measure area-level walkability in Sydney statistical division. Regression models were used to examine the association between Walk Score, pedestrian-related injury, length of hospital stay (LOS) and injury severity.Among people aged ≤64 years, there was no significant association between walkability score and pedestrian-related injury. Among people aged ≥ 65 years, walkability score was significantly positively associated with pedestrian-related injury, which peaked at Somewhat Walkable. For most disadvantaged areas, the risk of pedestrian-related injury was highest for areas that were classified as Somewhat Walkable. For moderately disadvantaged areas, the risk of pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas. For the least disadvantaged areas, there was no significant association between walkability score and pedestrian-related injury. For LOS among people aged ≥ 65 years or in the most disadvantaged areas, it peaked at Somewhat Walkable areas. For injury severity, the risk of serious pedestrian-related injury was highest at Very Walkable to Walker's Paradise areas among people aged 16-64 years.For the majority of the population, built environment characteristics that are considered to make walking attractive also make it safer, offsetting any exposure-related increase injury risk. However, this is not the case for people aged ≥ 19 years, and those living in socioeconomically disadvantaged areas. Incorporating measures of pedestrian safety in walkability scores may create an impetus to ensure that the built environment is designed to support the safety of pedestrians from these groups.

Intermittent claudication (IC) is the most common symptom of peripheral arterial disease (PAD) which presents as a consequence of muscle ischaemia resulting from the atherosclerotic obstruction to arterial flow. High-quality evidence (Lane et al., 2017) shows that exercise programmes provide important benefits compared with usual care in improving pain-free and maximum walking distance in people with IC, but do not improve ankle-brachial pressure index (ABPI).Retrospective data were analysed to examine walking and ABPI outcomes for participants who completed a 12-week course of supervised or home-based exercise. All participants had a history of IC.46 participants (mean age 69±11 years; 76% male; 29% current smokers) referred for exercise were assessed, completed a 12-week course of exercise (home-based or supervised) and subsequently attended for re-assessment. Claudication onset distance (COD) increased by 363% (mean improvement 344.7 ± 265.1m; p .001) and peak walking distance (PWD) by 324.4% in the supervised exercise group; COD increased by 30.6% (mean improvement 32.8 ± 57.2 m; p = 0.026) and PWD by 31.5% in the home-based exercise group. Resting ABPI for the total cohort significantly improved from 0.82 ± 0.25 at A1 to 0.88 ± 0.25 at A2 (p = 0.027).A 12-week course of supervised exercise results in significantly greater walking distance outcomes (COD and PWD) than unmonitored home-based exercise. In contrast with previous findings (Lane et al. 2017), this retrospective study demonstrated a significant improvement in resting ABPI with both supervised exercise as well as home-based exercise.A 12-week programme of exercise favourably influenced walking and ABPI outcomes for patients with IC. Both home-based exercise and supervised individualised exercise increased walking distances, but the magnitude of the improvement in walking outcomes was greater in individuals who attended supervised exercise therapy.

The aim of the study was to assess whether the level of physical activity in daily life in previously sedentary adults had been sustained 7 years beyond a 1-year supervised walking program. One hundred ten participants (63 females, 57.5 ± 8.4 years; 47 males, 66.4 ± 7.9 years) were recalled and assessed for physical activity in daily life, weight, body mass index, blood pressure, and walking speed. Fifty-nine percentage of the participants measured met and exceeded the World Health Organization physical activity guidelines (Group 1), while 41% did not (Group 2). In both groups, we observed a significant decrease of weight (72.0 ± 14.0 kg vs. 69.7 ± 14.0 kg in Group 1; 77.4 ± 19.5 kg vs. 75.4 ± 18.6 kg in Group 2) and body mass index (25.9 ± 3.7 vs. 25.1 ± 3.9 in Group 1; 27.9 ± 5.6 vs. 27.2 ± 5.4 in Group 2). Group 1 showed a significant increase in walking speed (5.8 ± 0.7 km/hr vs. 6.2 ± 0.8 km/hr), while systolic pressure did not change from the baseline. In Group 2, systolic pressure significantly increased (131.3 ± 13.5 mmHg vs. 138.0 ± 15.5 mmHg), while walking speed did not change. A guided walking program seems to have been effective in educating sedentary people to remain physically active over time.

The SARS-CoV-2 pandemic has limited objective physiologic assessments. A standardized remote alternative is not currently available. "Cardiac effort" (CE), that is, the total number of heart beats divided by the 6-min walk test (6MWT) distance (beats/m), has improved reproducibility in the 6MWT and correlated with right ventricular function in pulmonary arterial hypertension.Can a chest-based accelerometer estimate 6MWT distance remotely? Is remote cardiac effort more reproducible than 6MWT distance when compared with clinic assessment?This was a single-center, prospective observational study, with institutional review board approval, completed between October 2020 and April 2021. Group 1 subjects with pulmonary arterial hypertension, receiving stable therapy for90 days, completed four to six total 6MWTs during a 2-week period to assess reproducibility. The first and last 6MWTs were performed in the clinic; two to four remote 6MWTs were completed at each participant's discretion. Masks were not worn. BioStamp nPoint sensors (MC10) were worn on the chest to measure heart rate and accelerometry. Two blinded readers counted laps, using accelerometry data obtained on the clinic or user-defined course. Averages of clinic variables and remote variables were used for Wilcoxon matched-pairs signed rank tests, Bland-Altman plots, or Spearman correlation coefficients.Estimated 6MWT distance, using the MC10, correlated strongly with directly measured 6MWT distance (r = 0.99; P .0001; in 20 subjects). Remote 6MWT distances were shorter than clinic 6MWT distances: 405 m (330-464 m) vs 389 m (312-430 m) (P = .002). There was no difference between in-clinic and remote CE: 1.75 beats/m (1.48-2.20 beats/m) vs 1.86 beats/m (1.57-2.14 beats/m) (P = .14).Remote 6MWT was feasible on a user-defined course; 6MWT distance was shorter than clinic distance. CE calculated by chest heart rate and accelerometer-estimated distance provides a reproducible remote assessment of exercise tolerance, comparable to the clinic-measured value.

Force plates are considered the gold standard for kinetic gait analysis, benefiting from measuring three-dimensional ground reaction forces. Nevertheless, the major disadvantage is that many trials are required during overground locomotion to capture adequate single-limb contacts. Additionally, the dogs slightly change velocities during overground walking, influencing kinetic and kinematic gait parameters. An alternative is using an instrumented treadmill that benefits from capturing many steady-state gait cycles at a constant speed quickly. The goal of this study was (1) to compare overground with treadmill locomotion and (2) to compare the instrumented treadmill with force plates for dogs kinetics measurements. Twelve client-owned dogs were measured during treadmill trotting while the treadmill was placed on force plates. Additionally, the dogs were measured during trotting along an alley over eight force plates. Bland-Altman plots, Pearson's (r), and concordance correlation coefficients (r

Objectives. To investigate (i) the interrater and test-retest reliabilities of completion time and number of steps in the Narrow Corridor Walking Test (NCWT); (ii) the minimal detectable changes (MDCs) in NCWT results; (iii) the correlations between NCWT results and stroke-specific outcome measures; and (iv) the optimal cut-off values of NCWT results for discriminating the difference in advanced balance ability between people with stroke and healthy older adults. Design. Cross-sectional. Subjects. Thirty people with stroke and 30 healthy older adults. Methods. People with stroke completed the NCWT on two separate days with a 7- to 10-day interval. The Fugl-Meyer Assessment (FMA), ankle dorsiflexor and plantarflexor muscle strength, Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and the Chinese version of the Community Integration Measure (CIM) were used to assess. The healthy older adults completed the NCWT once. Results. The NCWT completion time and NCWT steps showed excellent interrater reliability and test-retest reliability and significant correlations with FMA, affected ankle dorsiflexor muscle strength, BBS score, and TUG completion time. A cut-off value of 7.40 s for NCWT completion time and 13.33 for the NCWT steps distinguished people with stroke from healthy older adults. The MDCs of the NCWT completion time and NCWT steps were 6.87 s and 5.50, respectively. Conclusion. The NCWT is a reliable clinical measurement tool for the assessment of advanced balance ability in people with stroke.

The majority of people with muscle weakness or paralysis lose their ability to walk and require various assistive devices like a walker to walk. Although various studies have examined the effect of different types of anterior and posterior walkers on different walking variables, so far no studies compare anterior versus posterior walker on forces and torques applied to the lower extremities. This paper presents a novel approach of using a passive saddle-assistive device (S-AD) to investigate the effect of this device on the torques of the joints. To measure the effectiveness of the device, a volunteer with spinal cord injury (SCI) participated to walk in four modes; including the use of a standard walker, anterior, and posterior mobility S-AD with and without body weight support, in the gait laboratory. The forces and torques applied to the lower and upper limbs were measured and examined. The result demonstrated a reduction in the vertical force on the lower limb in the anterior S-AD in supporting the patient’s weight compared to the standard walker up to 42.8% and to the posterior S-AD with weight support up to 12%. According to the results, the anterior S-AD has a greater effect compared to posterior S-AD and standard walkers on lower and upper limb torque and forces during walking of a SCI patient while using knee ankle-foot orthoses.

BACKGROUND: Spinal cord injury (SCI) results in neurological dysfunction of the spinal cord below the injury. OBJECTIVE: To explore the immediate and long-term effects of robotic-assisted gait training (RAGT) on the recovery of motor function and walking ability in children with thoracolumbar incomplete SCI. METHODS: Twenty-one children with thoracolumbar incomplete SCI were randomly divided into the experimental (n = 11) and control groups (n = 10). The control group received 60 min of conventional physical therapy, and the experimental group received 30 min of RAGT based on 30 minutes of conventional physical therapy. Changes in walking speed and distance, physiological cost index (PCI), lower extremity motor score (LEMS), SCI walking index and centre-of-pressure (COP) envelope area score were observed in both groups of children before and after eight weeks of training. The primary outcome measures were the 10-metre walk test (10MWT) and six-minute walk distance (6MWD) at preferred and maximal speeds. In addition, several other measures were assessed, such as postural control and balance, lower limb strength and energy expenditure. RESULTS: Compared with control group, the self-selected walk speed (SWS), maximum walking speed (MWS), 6MWD, PCI, LEMS, COP, and Walking Index for Spinal Cord injury II (WISCI II) of experimental group were improved after treatment. The 6MWD, PCI, COP, and WISCI II after eight weeks of treatment were improved in experimental group. All indicators were not identical at three different time points when compared between two groups. Pairwise comparisons in experimental group suggested that the SWS, MWS, 6MWD, PCI, LEMS, COP, and WISCI II after treatment were higher than those before treatment. The 6MWD, LEMS, COP, and WISCI II after treatment were higher than at the one-month follow-up appointment. The SWS, PCI, LEMS, COP, and WISCI II at the eight-week follow-up appointment were improved. CONCLUSION: Robotic-assisted gait training may significantly improve the immediate motor function and walking ability of children with thoracolumbar incomplete SCI.

BACKGROUND: To date little is known about factors affecting walking rehabilitation in Parkinson’s disease (PD) patients. OBJECTIVE: This prospective observational cohort study evaluated the walking distance covered in 6 minutes (6 MWD) before and after conventional rehabilitation and verified which among PD motor disorders was the most important determinant of walking distance in PD patients undergoing rehabilitation. METHODS: Data were collected from 55 PD patients, performing a conventional outpatient motor rehabilitation program. The 6MWD at the end of rehabilitation and gain in 6MWD were the outcome measures. The Unified Parkinson’s Disease Rating Scale, Hoehn and Yahr scale, Nine Hole Peg Test, Grip and Pinch test, ROM wrist motility, and Berg Balance Scale (BBS) were used to assess PD patients at admission and were considered as dependent variables. Backward multiple regression analyses identified the determinants of 6MWD outcomes. RESULTS: The 6MWD was 246.58±115 meters at admission and 286.90±116 at the end of rehabilitation. At end of rehabilitation, the 6MWD was 42.32±47 meters greater than admission (p

Backward walking (BW) has been recommended as a rehabilitation intervention to prevent, manage, or improve diseases. However, previous studies showed that BW significantly increased the first vertical ground reaction force (GRF) during gait, which might lead to higher loading at the knee. Published reports have not examined the effects of BW on medial compartment knee loading. The objective of this study was to investigate the effects of BW on external knee adduction moment (EKAM). Twenty-seven healthy adults participated in the present study. A sixteen-camera three-dimensional VICON gait analysis system, with two force platforms, was used to collect the EKAM, KAAI, and other biomechanical data during BW and forward walking (FW). The first ( P < 0.001 ) and second ( P < 0.001 ) EKAM peaks and KAAI ( P = 0.02 ) were significantly decreased during BW when compared with FW. The BW significantly decreased the lever arm length at the first EKAM peak ( P = 0.02 ) when compared with FW. In conclusion, BW was found to be a useful strategy for reducing the medial compartment knee loading even though the first peak ground reaction force was significantly increased.

Purpose: Robotic-assisted gait training (RAGT) is suggested to improve walking ability after stroke. The purpose of this study was to describe experiences of robotic-assisted gait training as part of a gait training intervention among persons in the chronic phase after stroke. Materials and methods: Semi-structured interviews were performed with 13 participants after a 6-week intervention including treadmill gait training with the Hybrid Assistive Limb® (HAL) exoskeleton. Data were analysed using qualitative content analysis. Results: Four categories emerged: (1) A rare opportunity for potential improvements describes the mindset before the start of the intervention; (2) Being pushed to the limit represents the experience of engaging in intensive gait training; (3) Walking with both resistance and constraints reveals barriers and facilitators during HAL training; (4) Reaching the end and taking the next step alone illustrates feelings of confidence or concern as the intervention ended. Conclusions: The gait training intervention including RAGT was considered demanding but appreciated. Support and concrete, individual feedback was crucial for motivation, whilst the lack of variation was a barrier. Results encourage further development of exoskeletons that are comfortable to wear and stimulate active participation by enabling smoothly synchronised movements performed during task-specific activities in different environments. Originally included in thesis in manuscript form.

Single-cell protein analysis is very important for understanding cellular heterogeneity and single-cell biology. However, owing to the extremely low levels of some tumor-associated proteins in individual cells, the absolute quantification of such tumor-associated proteins in a single cell remains a challenge. Herein, an intracellular multicomponent synchronous DNA-walking strategy is proposed for the simultaneous quantification of multiple tumor-associated proteins in a single cell. In this strategy, a nanoprobe based on a DNA walker was designed for the simultaneous signal amplification of nucleolin (NCL) and thymidine kinase 1 (TK1) in a single cell. NCL and TK1 in single cells were simultaneously detected on a microchip platform with detection limits of 1.0 and 0.8 pM, respectively. The results obtained from 20 liver cancer cells (HepG2) and 20 normal hepatocytes (HL-7702) indicated that NCL and TK1 were overexpressed in liver cancer cells. However, the levels of NCL and TK1 in normal hepatocytes are only about one-tenth to one-sixth of those in hepatic carcinoma. Using different nucleic acid aptamers, the proposed strategy can be applied for the analysis of other single-cell proteins and in the early diagnosis of cancer.

Exercise, like daily walking, may improve overall health and impede progression of chronic kidney disease (CKD); however, no specific walking dose has been recommended for patients with CKD. We aimed to investigate the association between daily walking steps and health-related quality of life (HRQOL) in adults with CKD.The walking steps of patients with CKD were extracted from the We Run mobile application. Their average daily walking steps were calculated and subdivided into the low-, middle-, and high-level groups. HRQOL was assessed using the physical component summary (PCS) and mental component summary (MCS) of the MOS 36 Short Form Health Survey (SF-36).A total of 558 adults (50.5%, men) with an average age of 40.2 (±13.8) years were enrolled. The median daily step count was 7,404 steps. The daily walking step count demonstrated an inverse U-shaped relationship with the SF-36 and subscale scores. Participants with daily walking steps between 7,000 and 12,000 have the highest PCS (68.1 ± 12.2) and MCS scores (70.0 ± 19.5). The multiple linear regression model showed that compared with patients with a daily step count of 7,000 to 12,000, patients with a daily step count12,000 had a significantly lower MCS score (P .001), while patients with a daily step count7,000 had significantly lower PCS (P .001) and MCS scores (P = .034). Moreover, the multivariable logistic regression model showed that patients with a daily step count12,000 had significantly lower mental health-related quality (odds ratio [OR], 2.188; 95% confidence interval [CI], 1.079-1.439 for low MCS), while those with a daily step count7,000 had a significantly lower HRQOL than the 7,000 to 12,000 daily step count group (OR, 2.113; 95% CI, 1.203-3.711 for low PCS; OR, 2.099; 95% CI, 1.210-3.643 for low MCS).These findings suggest that daily walking steps between 7,000 and 12,000 are associated with high HRQOL in adults with CKD.

One of the major challenges in developing powered lower limb prostheses is emulating the behavior of an intact lower limb with different walking speeds over diverse terrains. Numerous studies have been conducted on control algorithms in the field of rehabilitation robotics to achieve this overarching goal. Recent studies on powered prostheses have frequently used a hierarchical control scheme consisting of three control levels. Most control structures have at least one element of discrete transition properties that requires numerous sensors to improve classification accuracy, consequently increasing computational load and costs. In this study, we proposed a user-independent and free-mode method for eliminating the need to switch among different controllers. We constructed a database by using four OPAL wearable devices (Mobility Lab, APDM Inc., USA) for seven able-bodied subjects. We recorded the gait of each subject at three ambulation speeds during ground-level walking to train a nonlinear autoregressive network with an exogenous input recurrent neural network (NARX RNN) to estimate foot orientation (angular position) in the sagittal plane using shank angular velocity as external input. The trained NARX RNN estimated the foot orientation of all the subjects at different walking speeds over flat terrain with an average root-mean-square error (RMSE) of 2.1° ± 1.7°. The minimum correlation between the estimated and measured values was 86%. Moreover, a t-test showed that the error was normally distributed with a high certainty level (0.88 minimum p -value).

The benefits of physical activity to health and obesity prevention are well established. However, attributes of the built environment influence participation in physical activity. The purpose of this study is to assess differences in perceptions of neighborhood walkability across demographic characteristics and social environment factors among rural residents. In a telephone survey, adult respondents ( N = 448) across nine rural counties in a southeastern state answered questions about perceived neighborhood walkability, demographic characteristics, and their neighborhood social environment. Study recruitment for a convenience sample occurred through collaborations with local community organizations. Prevalence of destinations and barriers were estimated according to demographic and neighborhood social environment characteristics. Multiple logistic regression models assessed the association of demographic and neighborhood social environment characteristics with neighborhood walkability and calculated adjusted prevalence. Relaxing places to walk were the most often reported destinations (62.0%), followed by retail destinations (45.7%), and communal destinations (42.6%). Traffic was the most reported barrier to safe walking (40.4%), followed by animals (37.5%), and crime (30.5%). Perceptions of retail and communal destinations varied by age and race. Perceptions of traffic and crime as barriers varied by race, weight status, and income. Community belonging and social cohesion were associated with lower perceptions of barriers. Study findings present demographic characteristics and social environment attributes as key factors that shape perceived neighborhood walkability. Findings can help inform programmatic efforts and environmental change strategies to improve walking in rural areas.

Investigate the effects of land-based exercise-therapy on physical activity in people with knee osteoarthritis (KOA).Systematic review and meta-analysis of randomised or quasi-randomised trials investigating land-based exercise-therapy on physical activity, fitness, and general health in people with KOA. We updated a 2013 Cochrane review search on exercise-therapy for KOA in April 2021 and applied the Cochrane Risk-of-Bias Tool 1.0 to included articles. Standardised mean differences (SMDs) and 95% confidence intervals (CI) were calculated. GRADE was used to assess certainty of the evidence.Twenty-eight randomised controlled trials (2,789 participants) evaluating the effects of resistance-training (n = 10), walking (n = 6) and mixed-exercise programs (n = 7) were identified. Low to moderate certainty evidence indicated small increases in physical activity for exercise-therapy compared to non-exercise interventions in the short-term (SMD, 95% CI = 0.29, 0.09 to 0.50), but not the medium- (0.03, -0.11 to 0.18) or long-term (-0.06, -0.34 to 0.22). Low certainty evidence indicated large increases in physical activity for walking programs (0.53, 0.11 to 0.95) and mixed-exercise programs (0.67, 0.37 to 0.97) compared to non-exercise interventions in the short-term. Low certainty evidence indicated moderate and small increases in physical activity for resistance-training combined with education focused on pain coping skills and self-efficacy compared to education alone at medium-term follow-up (0.45, 0.19 to 0.71).Walking and mixed-exercise, but not resistance-training, may improve physical activity in people with KOA in the short-term. Combining resistance-training with education may increase physical activity in the medium-, but not the long-term, highlighting the potential importance of developing more effective longer-term interventions for people with KOA. Future studies evaluating land-based exercise-therapy are encouraged to include physical activity outcomes and longer-term follow-up to increase the certainty of evidence.

Background Mobility and cognitive impairments are often associated with increased fall risk among people with multiple sclerosis (PwMS). However, evidence on the concurrent assessment of gait or balance and cognitive tasks (dual-task) to predict falls appears to be inconsistent. Objective To summarize the ability of gait or balance dual-task testing to predict future falls among PwMS. Methods Seven databases including PubMed, Embase, Web of Science, Scopus, CINHAL, SPORTDiscuss, and PsycINFO were searched from inception to May 2022. Two independent reviewers identified studies that performed a dual-task testing among adults with multiple sclerosis and monitored falls prospectively for at least 3 months. Both reviewers also evaluated the quality assessment of the included studies. Results Eight studies with 484 participants were included in the review. Most studies (75%) indicated that dual-task testing and dual-task cost did not discriminate prospective fallers (⩾1 fall) and non-fallers (0 fall) and were not found as predictors of future falls. However, dual-task cost of walking velocity (OR = 1.23, 95% CI 0.98-4.45, P = .05) and dual-task of correct response rate of serial 7 subtraction (OR = 1.34, 95% CI 1.04-3.74, P = .02) were significantly associated with increased risk of recurrent falls (≥2 falls). Pattern of cognitive-motor interference was also associated with an increased risk of falling. All studies presented with strong quality. Conclusion The scarce evidence indicates that dual-task testing is not able to predict future falls among PwMS. Further research with more complex motor and cognitive tasks and longer-term fall monitoring is required before dual-task testing can be recommended as a predictor of future falls in this population.

Research on embodied decision-making only recently started to examine whether and how concurrent actions influence value-based decisions. For instance, during walking humans preferably make decisions that align with a turn toward the side of their current swing leg, sometimes resulting in unfavorable choices (e.g., less reward). It is suggested that concurrent movements influence decision-making by coincidental changes in motor costs. If this is true, systematic manipulations of motor costs should bias decisions. To test this, participants had to accumulate rewards (i.e., points) by walking and turning toward left and right targets displaying rewards across three experiments. In

To investigate the effect of aerobic exercise vs control (stretching/balance) on inflammatory and oxidative stress biomarkers in stroke survivors and whether these changes are associated with improvements in physical and metabolic health.Randomized controlled trial.The general communities of Baltimore, Maryland, and Atlanta, Georgia.Two hundred forty-six older (50 years), chronic (6 months) survivors of stroke (N=246) with hemiparetic gait were recruited, with 51 completing pre-intervention testing and 39 completing postintervention testing. Participants were required to have completed all conventional physical therapy and be capable of walking 3 minutes on a treadmill (N=246).Participants completed 6 months of 2 times/wk stretching or balance (ST; n=19) or 3 times/wk aerobic treadmill rehabilitation (TM; n=20;).Peak oxygen uptake rate (V̇oPhysical function and metabolic health parameters tended to improve after TM but not ST (ST vs TM: V̇oSix months of TM tends to be associated with increased functional capacity and reduced oxidative stress in chronic stroke survivors. Our findings identify potentially modifiable systemic markers of inflammation and oxidative stress important to stroke rehabilitation and provide potential targets for novel therapeutics in future studies.

This study aimed to investigate effect of a home-based stretching exercise program in individuals with plantar fasciitis (PF) and to compare its effect on ground reaction force (GRF)-time variables between mild, moderate, and severe pain subgroups and between before and after in each subgroup.A single cohort with pre-and post-test.Twenty individuals with PF received 3 weeks of home-based stretching exercise for calf and plantar fascia.GRF-time variables included force and time at; first peak (F1 and TF1), valley (F2 and TF2), second peak (F3 and TF3) in vertical, breaking (F4 and TF4) and propulsive (F5 and TF5) forces, first peak (F6 and TF6) and second peak lateral (F7 and TF7) forces. Additionally, worst pain was assessed at before and after exercise.Significant reductions were seen in F2, TF2, TF3, TF5 and worst pain after exercise (P 0.05) in individuals with PF. No differences were seen between three subgroups. For within subgroup analysis, only mild subgroup showed significant changes in F2, TF2, F4, TF6, and TF7 after exercise (P 0.05).A home-based stretching exercise was effective in reducing pain and some GRF-time variables, with the most noticeable response seen in mild subgroup.

Rapidly developing Redirected Walking (ROW) technologies have enabled VR applications to immerse users in large virtual environments (VE) while actually walking in relatively small physical environments (PE). When an unavoidable collision emerges in a PE, the ROW controller suspends the user's immersive experience and resets the user to a new direction in PE. Existing ROW methods mainly aim to reduce the number of resets. However, from the perspective of the user experience, when users are about to reach a point of interest (POI) in a VE, reset interruptions are more likely to have an impact on user experience. In this paper, we propose a new ROW method, aiming to keep resets occurring at a longer distance from the virtual target, as well as to reduce the number of resets. Simulation experiments and real user studies demonstrate that our method outperforms state-of-the-art ROW methods in the number of resets and dramatically increases the distance between the reset locations and the virtual targets.

To compare the metabolic demands of walking in individuals with lower limb injury with and without ankle-foot orthosis (AFO) use. A secondary aim was to compare these results with those from individuals with unilateral transtibial amputation (TTA) and able-bodied controls.Cross-sectional study.Two clinical research centers.Thirteen individuals (N=13) with lower limb injury who used a passive-dynamic AFO underwent metabolic analysis at 3 standardized speeds with and without their AFO. Results were compared with individuals with unilateral TTA who used a passive prosthetic foot and able-bodied controls with no musculoskeletal, neurologic, or cardiovascular deficits.Oxygen consumption, heart rate, and rating of perceived exertion.The use of the passive-dynamic AFO did not significantly change energetic demand (oxygen consumption, heart rate, perceived exertion) in participants with a lower limb [LL] injury. Heart rate (P.037) was significantly greater than able-bodied controls, but perceived exertion was significantly lower (P≤.031). There were no significant differences between participants with an LL injury (with or without the AFO) and individuals with TTA.Many individuals with LL injuries may expect to use passive-dynamic AFOs with little to no metabolic consequence. The stabilizing and assistive benefits of the AFO likely balance with its well-known range of motion limitations and power reductions. Passive-dynamic AFO use can sometimes be an alternative for individuals considering TTA. These results support that AFO users may be able to achieve similar energetic demands as those with amputation.

Rationale: Clinical practice guidelines support structured, progressive protocols for improving walking after stroke. Yet, practice is slow to change, evidenced by the little amount of walking activity in stroke rehabilitation units. Our recent study (n = 75) found that a structured, progressive protocol integrated with typical daily physical therapy improved walking and quality-of-life measures over usual care. Research therapists progressed the intensity of exercise by using heart rate and step counters worn by the participants with stroke during therapy. To have the greatest impact, our next step is to undertake an implementation trial to change practice across stroke units where we enable the entire unit to use the protocol as part of standard of care. Aims: What is the effect of introducing structured, progressive exercise (termed the Walk ’n Watch protocol) to the standard of care on the primary outcome of walking in adult participants with stroke over the hospital inpatient rehabilitation period? Secondary outcomes will be evaluated and include quality of life. Methods and sample size estimates: This national, multisite clinical trial will randomize 12 sites using a stepped-wedge design where each site will be randomized to deliver Usual Care initially for 4, 8, 12, or 16 months (three sites for each duration). Then, each site will switch to the Walk ’n Watch phase for the remaining duration of a total 20-month enrolment period. Each participant will be exposed to either Usual Care or Walk ’n Watch. The trial will enroll a total of 195 participants with stroke to achieve a power of 80% with a Type I error rate of 5%, allowing for 20% dropout. Participants will be medically stable adults post-stroke and able to take five steps with a maximum physical assistance from one therapist. The Walk ’n Watch protocol focuses on completing a minimum of 30 min of weight-bearing, walking-related activities (at the physical therapists’ discretion) that progressively increase in intensity informed by activity trackers measuring heart rate and step number. Study outcome(s): The primary outcome will be the change in walking endurance, measured by the 6-Minute Walk Test, from baseline (T1) to 4 weeks (T2). This change will be compared across Usual Care and Walk ’n Watch phases using a linear mixed-effects model. Additional physical, cognitive, and quality of life outcomes will be measured at T1, T2, and 12 months post-stroke (T3) by a blinded assessor. Discussion: The implementation of stepped-wedge cluster-randomized trial enables the protocol to be tested under real-world conditions, involving all clinicians on the unit. It will result in all sites and all clinicians on the unit to gain expertise in protocol delivery. Hence, a deliberate outcome of the trial is facilitating changes in best practice to improve outcomes for participants with stroke in the trial and for the many participants with stroke admitted after the trial ends.

Purpose Cases of pancreatic cancer are increasing, and the risk of developing this disease reportedly increases with age. In recent years, there has been an increasing number of reports on physical function in patients with pancreatic cancer. Methods such as the 6-min walk distance (6 MWD) should be established to evaluate physical function, as a decline in exercise capacity is an important index in these patients. Recently, the 6 MWD has also been used to evaluate physical function in patients with pancreatic cancer. In healthy older adults, a decrease in 6 MWD is reportedly associated with intrinsic capacity and health status. Such factors make assessing 6 MWD important. However, the measurement of 6 MWD requires a sizable measurement environment. The five times sit to stand (FTSTS) test is a simple method that can be performed using a chair. FTSTS is hypothesized to be a useful assessment scale in patients with pancreatic cancer because it is easy to estimate the decline in physical function in clinical practice if the decline in 6 MWD can be estimated by evaluating FTSTS. The study’s purpose was to clarify this hypothesis and ascertain the cutoff required to determine the decrease in 6 MWD in clinical practice. Methods Sixty consecutive patients with preoperative pancreatic cancer who were assessed for physical function were studied. 6 MWD ( Results Fifty-seven of the 60 patients were included in the analysis. Logistic regression analysis showed that FTSTS was a significant explanatory variable; ROC curve analysis showed an AUC of 0.872 and a cutoff value of 8.98 s. The sensitivity, specificity, PPV, and NPV were 82.4%, 80.0%, 63.6%, and 91.4%, respectively. Conclusions A decrease in 6 MWD in preoperative pancreatic cancer patients can be identified by performing FTSTS.

Aims The interplay between physical activity (PA) volume and intensity is poorly understood in relation to cardiovascular disease (CVD) risk. This study aimed to investigate the role of PA intensity, over and above volume, in relation to incident CVD. Methods and results Data were from 88 412 UK Biobank middle-aged adults (58% women) without prevalent CVD who wore accelerometers on their dominant wrist for 7 days, from which we estimated total PA energy expenditure (PAEE) using population-specific validation. Cox proportional hazards regressions modelled associations between PAEE (kJ/kg/day) and PA intensity (%MVPA; the fraction of PAEE accumulated from moderate-to-vigorous-intensity PA) with incident CVD (ischaemic heart disease or cerebrovascular disease), adjusted for potential confounders. There were 4068 CVD events during 584 568 person-years of follow-up (median 6.8 years). Higher PAEE and higher %MVPA (adjusted for PAEE) were associated with lower rates of incident CVD. In interaction analyses, CVD rates were 14% (95% confidence interval: 5–23%) lower when MVPA accounted for 20% rather than 10% of 15 kJ/kg/d PAEE; equivalent to converting a 14 min stroll into a brisk 7 min walk. CVD rates did not differ significantly between values of PAEE when the %MVPA was fixed at 10%. However, the lowest CVD rates were observed for combinations of both higher PAEE and %MVPA. Conclusion Reductions in CVD risk may be achievable through higher PA volume and intensity, with the role of moderately intense PA appearing particularly important. This supports multiple approaches or strategies to PA participation, some of which may be more practical or appealing to different individuals.

Predictive simulation of human walking has great potential in clinical motion analysis and rehabilitation engineering assessment, but large computational cost and reliance on measurement data to provide initial guess have limited its wide use. We developed a computationally efficient model combining optimization and inverse dynamics to predict three-dimensional whole-body motions and forces during human walking without relying on measurement data. Using the model, we explored two different optimization objectives, mechanical energy expenditure and the time integral of normalized joint torque. Of the two criteria, the sum of the time integrals of the normalized joint torques produced a more realistic walking gait. The reason for this difference is that most of the mechanical energy expenditure is in the sagittal plane (based on measurement data) and this leads to difficulty in prediction in the other two planes. We conclude that mechanical energy may only account for part of the complex performance criteria driving human walking in three dimensions.

This study aimed to ascertain the physical-fitness trends among community-dwelling older adults using performance testing. The results of the evaluation conducted during the COVID-19 pandemic were compared to data from the pre-pandemic period.A total of 240 community-dwelling older adults who participated in a health checkup program from 2016-2020 underwent the following tests: grip strength (upper limb muscle), single-leg balance with eyes open (static balance), sit-and-reach test (flexibility), timed up-and-go test (TUG, functional mobility), 5 meter habitual walk (walking ability), and hand working with pegboard (hand dexterity). Linear mixed effect models were applied to the hierarchical dataset: repeated data (Level 1), pre-pandemic (2016-2019), pandemic (2019-2020) (Level 2), and individuals (Level 3). Fixed effects and interactions were estimated for the survey year (Level 1), and between the survey year and pre- and post-pandemic (Level 2), with the range of decline set measured in terms of its standardized partial regression coefficient, "B," from 2019-2020.The items for which significant cross-level interactions were identified. In males, the following items showed significant cross-level interactions: sit and reach test (B=-2.56, 95% CI: -4.45--0.66 cm), TUG (+0.39, 0.21-0.56 sec) and 5 meter habitual walk (+0.15, 0.04-0.27 sec). In females items except single-leg balance with eyes open showed significant cross-level interactions: grip strength (-0.58, -1.11--0.05 kg), sit-and-reach test (-3.53, -5.11--1.95 cm), TUG (+0.15, 0.03-0.27 sec), for 5 meter habitual walk (+0.14, 0.04-0.24 sec), and hand working with pegboard (+0.89, 0.28-1.51 sec).In both males and females, a significant deterioration in flexibility and mobility movement ability was observed in 2019-2020. In addition, upper limb muscle strength and hand dexterity movement deteriorated in females.

The association between physical activity and human disease has not been examined using commercial devices linked to electronic health records. Using the electronic health records data from the All of Us Research Program, we show that step count volumes as captured by participants’ own Fitbit devices were associated with risk of chronic disease across the entire human phenome. Of the 6,042 participants included in the study, 73% were female, 84% were white and 71% had a college degree, and participants had a median age of 56.7 (interquartile range 41.5–67.6) years and body mass index of 28.1 (24.3–32.9) kg m–2. Participants walked a median of 7,731.3 (5,866.8–9,826.8) steps per day over the median activity monitoring period of 4.0 (2.2–5.6) years with a total of 5.9 million person-days of monitoring. The relationship between steps per day and incident disease was inverse and linear for obesity (n = 368), sleep apnea (n = 348), gastroesophageal reflux disease (n = 432) and major depressive disorder (n = 467), with values above 8,200 daily steps associated with protection from incident disease. The relationships with incident diabetes (n = 156) and hypertension (n = 482) were nonlinear with no further risk reduction above 8,000–9,000 steps. Although validation in a more diverse sample is needed, these findings provide a real-world evidence-base for clinical guidance regarding activity levels that are necessary to reduce disease risk.