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Background: We aimed to evaluate the effectiveness of the combination of protein supplementation and resistance training (RT), compared with RT alone or combined with a placebo, in improving gait speed. Methods: We searched PubMed, Web of Science, Cochrane Library, and SPORTDiscus databases, and 18 randomized controlled trials with 1,147 older participants were included for meta-analysis. Data were pooled as the effect sizes (Hedges' g) with 95% confidence interval (CI) of the gait speed (in meters per second). The random-effect meta-analysis, subgroup analyses, meta-regression, and sensitivity analysis were conducted. Results: The combination of protein supplementation and RT significantly improved gait speed (Hedges' g: 0.52 m/s, 95% confidence interval [0.17, 0.86], p =.005; I2 = 86.5%) compared with the RT alone. The subgroup analyses revealed that the significant improvement in gait speed postprotein intervention plus RT was observed only in participants who consumed protein after RT (Hedges' g: 0.90 m/s, 95% confidence interval [0.46, 1.33], p =.001; I2 = 79.6%). The pooled result did not significantly change after excluding any single study at one time or excluding smaller studies with large effect sizes. Conclusions: Protein supplementation combined with RT could significantly improve the gait speed of older adults compared with RT alone. This positive effect is more pronounced in people who consume protein after RT. [ABSTRACT FROM AUTHOR]

Musculoskeletal modeling, typically implemented using marker-based systems in laboratory environments, is commonly used for noninvasive estimations of loads. Inertial measurement units (IMUs) have become an alternative for the evaluation of kinematics. However, estimates of spine joint contact forces using IMUs have yet to be thoroughly evaluated. Dynamics tasks and static postures from activities of daily living were captured on 11 healthy subjects using both systems simultaneously. Spine kinematics obtained from IMU- and marker-based systems and L4–L5 joint contact forces were compared. Lateral bending resulted in a weak agreement with significant differences between the 2 systems (P =.02, average root mean-squared error = 4.81), whereas flexion–extension and axial rotation exhibited the highest agreement with no significant differences (P <.05, average root mean-squared error = 5.51 and P <.31, average root mean-squared error = 5.08, respectively). All tasks showed excellent correlations (R2 =.76–.99) in estimated loads between systems. Differences in predicted loads at the L4–L5 were only observed during flexion–extension (1041 N vs 947 N, P =.0004) and walking with weights (814 N vs 727 N, P =.004). Different joint reaction force outcomes were obtained in 2 of the 8 tasks between systems, suggesting that IMUs can be robust tools allowing for convenient and less expensive evaluations and for longitudinal assessments inside and outside the laboratory setting. [ABSTRACT FROM AUTHOR]

The purpose was to examine (1) the effect of measurement position and sex on femoral cartilage outcomes, and (2) the association between gait biomechanics and cartilage outcomes. Fifty individuals participated (25 males and 25 females; age = 20.62 [1.80] y). Ultrasound measured femoral cartilage thickness and echo-intensity at 90°, 115°, and 140° of knee flexion. Gait outcomes included the external knee adduction and knee flexion moments. Cartilage outcomes were compared using 2 (sex) × 3 (position) repeated-measures analysis of variance. Gait and cartilage associations were assessed using stepwise regression. Medial cartilage was thicker when measured at 90° compared with 115° (P =.02) and 140° (P <.01), and 115° compared with 140°, (P <.01) in males but not in females. Cartilage was thicker at 90° compared with 140° across both sexes within all regions (P <.01). Males had thicker cartilage than females in all positions (P <.01). Echo-intensity was lower at 90° than 115° (P <.01) and 140° (P =.01) in the central and lower at 90° than at 115° (P <.01) and 140° (P =.03) in lateral regions. No association was found between gait and cartilage outcomes. Ultrasound imaging position effects cartilage features more in males compared with females. Imaging position and sex influence cartilage outcomes and should be considered in study designs and clinical evaluation. [ABSTRACT FROM AUTHOR]

Context: Dual-task (simultaneous cognitive–motor activities) assessments have been adapted into reliable and valid clinical concussion measures. However, abundant motor and cognitive variations leave researchers and clinicians uncertain about which combinations elicit the intended dual-task effect. Our objective was to examine differences between commonly employed dual-task motor and cognitive combinations among healthy, college-aged individuals. Design: Cross-sectional laboratory study. Methods: Twenty participants (age: 21.3 [2.4] y; height: 176.0 [9.1] cm; mass: 76.0 [16.4] kg; 20% with concussion history) completed 4 motor tasks (gait, tandem gait, single-leg balance, and tandem balance) under 5 cognitive conditions (single task, subtraction, month reversal, spelling backward, and visual Stroop) in a research laboratory. The motor performance outcomes were spatiotemporal variables for gait and tandem gait and center of pressure path length (in centimeters) for single-leg and tandem balance. Cognitive outcomes were response rate (responses/second) and cognitive accuracy. We used separate repeated-measures analyses of variance for each motor and cognitive outcome with post hoc Tukey t tests. Results: Gait velocity, gait stride length, and tandem gait velocity demonstrated significant cognitive–motor interactions (P's <.001) such that all dual-task conditions resulted in varyingly slower or shorter movement than single task. Conversely, single-leg balance (P =.627) and tandem balance (P =.434) center of pressure path length did not significantly differ among the dual-task cognitive conditions or relative to single task. Statistically significant cognitive–motor interactions were observed only for spelling backward accuracy (P =.004) and response rates for spelling backward, month reversal, and visual Stroop (P's <.001) such that worse accuracy, but faster response rates, occurred during motor tasks. Conclusions: Gait and tandem gait motor tasks accompanied with spelling backward or subtraction cognitive tasks demonstrated consistently strong dual-task effects and, therefore, may be the best suited for clinical and research use following concussion. [ABSTRACT FROM AUTHOR]

Time series biomechanical data inform our understanding of normal gait mechanics and pathomechanics. This study examines the utility of different quantitative methods to distinguish vertical ground reaction forces (VGRFs) from experimentally distinct gait strategies. The goals of this study are to compare measures of VGRF data—using the shape factor method and a Fourier series-based analysis—to (1) describe how these methods reflect and distinguish gait patterns and (2) determine which Fourier series coefficients discriminate normal walking, with a relatively stiff-legged gait, from compliant walking, using deep knee flexion and limited vertical oscillation. This study includes a reanalysis of previously presented VGRF data. We applied the shape factor method and fit 3- to 8-term Fourier series to zero-padded VGRF data. We compared VGRF renderings using Euclidean L2 distances and correlations stratified by gait strategy. Euclidean L2 distances improved with additional harmonics, with limited improvement after the seventh term. Euclidean L2 distances were greater in shape factor versus Fourier series renderings. In the 8 harmonic model, amplitudes of 9 Fourier coefficients—which contribute to VGRF features including peak and local minimum amplitudes and limb loading rates—were different between normal and compliant walking. The results suggest that Fourier series-based methods distinguish between gait strategies. [ABSTRACT FROM AUTHOR]

Postpartum mothers are susceptible to lumbopelvic pain which may be exacerbated by loading, like carrying their infant in arms and with baby carriers. Nulliparous women carrying infant mannequins may biomechanically mimic mother–infant dyad, but this has not been studied. The purpose of our study was to investigate biomechanical differences of 10 mothers carrying their infants and 10 nulliparous women carrying infant mannequins under 3 gait conditions: carrying nothing, carrying in arms, and carrying in a baby carrier (babywearing). Spatiotemporal gait parameters, peak ground reaction forces and impulses, and lower extremity and trunk kinematics were collected using motion capture and force plates and compared using a mixed 2 × 3 (parity × condition) analysis of variance (α ≤.05). The largest differences occurred between carrying conditions: carrying in arms or babywearing increased vertical and anteroposterior ground reaction forces, trunk extension, ankle dorsiflexion, and hip and knee flexion. Kinematic differences were identified between arms and babywearing conditions. Together this suggests alterations in joint loading for both groups. Our study also contributes a novel understanding of postpartum health by demonstrating alterations in step time, anterior forces, and ankle and knee mechanics, suggesting that during gait, mothers carrying their own infants choose different propulsive strategies than nulliparous women carrying mannequins. [ABSTRACT FROM AUTHOR]

Disruptions in gait function are common after concussion in adolescents; however, the neuromotor control deficits driving these gait disruptions are not well known. Fifteen concussed (age mean [SD]): 17.4 [0.6], 13 females, days since injury: 26.3 [9.9]) and 17 uninjured (age: 18.0 [0.7], 10 females) adolescents completed 3 trials each of single-task gait and dual-task gait (DT). During DT, participants simultaneously walked while completing a serial subtraction task. Gait metrics and variability in instantaneous mean frequency in lower extremity muscles were captured by inertial sensors and surface electromyography, respectively. A 2-way analysis of covariance was used to compare gait metrics across groups and conditions. Functional principal components analysis was used to identify regions of variability in instantaneous mean frequency curves. Functional principal component scores were compared across groups using a Welch statistic. Both groups displayed worse performance on gait metrics during DT condition compared to single-task, with no differences between groups (P <.001). Concussed adolescents displayed significantly greater instantaneous mean frequency, indicated by functional principal component 1, in the tibialis anterior, biceps femoris, and semitendinosus (P <.05) during single-task and DT compared with uninjured adolescents. Our observations suggest that concussed adolescents display inefficient motor unit recruitment lasting longer than 2 weeks following injury, regardless of the addition of a secondary task. [ABSTRACT FROM AUTHOR]

Purpose: There are important methodological considerations for translating wearable-based gait-monitoring data to field settings. This study investigated different devices' sampling rates, signal lengths, and testing frequencies for athlete monitoring using dynamical systems variables. Methods: Secondary analysis of previous wearables data (N = 10 runners) from a 5-week intensive training intervention investigated impacts of sampling rate (100–2000 Hz) and signal length (100–300 strides) on detection of gait changes caused by intensive training. Primary analysis of data from 13 separate runners during 1 week of field-based testing determined day-to-day stability of outcomes using single-session data and mean data from 2 sessions. Stride-interval long-range correlation coefficient α from detrended fluctuation analysis was the gait outcome variable. Results: Stride-interval α reduced at 100- and 200- versus 300- to 2000-Hz sampling rates (mean difference: −.02 to −.08; P ≤.045) and at 100- compared to 200- to 300-stride signal lengths (mean difference: −.05 to −.07; P <.010). Effects of intensive training were detected at 100, 200, and 400 to 2000 Hz (P ≤.043) but not 300 Hz (P =.069). Within-athlete α variability was lower using 2-session mean versus single-session data (smallest detectable change:.13 and.22, respectively). Conclusions: Detecting altered gait following intensive training was possible using 200 to 300 strides and a 100-Hz sampling rate, although 100 and 200 Hz underestimated α compared to higher rates. Using 2-session mean data lowers smallest detectable change values by nearly half compared to single-session data. Coaches, runners, and researchers can use these findings to integrate wearable-device gait monitoring into practice using dynamic systems variables. [ABSTRACT FROM AUTHOR]

Gait asymmetry is a predictor of fall risk and may contribute to increased falls during pregnancy. Previous work indicates that pregnant women experience asymmetric joint laxity and pelvic tilt during standing and asymmetric joint moments and angles during walking. How these changes translate to other measures of gait asymmetry remains unclear. Thus, the purpose of this case study was to determine the relationships between pregnancy progression, subsequent pregnancies, and gait asymmetry. Walking data were collected from an individual during 2 consecutive pregnancies during the second and third trimesters and 6 months postpartum of her first pregnancy and the first, second, and third trimesters and 6 months postpartum of her second pregnancy. Existing asymmetries in step length, anterior–posterior (AP) impulses, AP peak ground reaction forces, lateral impulses, and joint work systematically increased as her pregnancy progressed. These changes in asymmetry may be attributed to pelvic asymmetry, leading to asymmetric hip flexor and extensor length, or due to asymmetric plantar flexor strength, as suggested by her ankle work asymmetry. Relative to her first pregnancy, she had greater asymmetry in step length, step width, braking AP impulse, propulsive AP impulse, and peak braking AP ground reaction force during her second pregnancy, which may have resulted from increased joint laxity. [ABSTRACT FROM AUTHOR]

It is not currently possible to directly and noninvasively measure in vivo patellofemoral joint contact force during dynamic movement; therefore, indirect methods are required. Simple models may be inaccurate because patellofemoral contact forces vary for the same knee flexion angle, and the patellofemoral joint has substantial out-of-plane motion. More sophisticated models use 3-dimensional kinematics and kinetics coupled to a subject-specific anatomical model to predict contact forces; however, these models are time consuming and expensive. We applied a principal component analysis prediction and regression method to predict patellofemoral joint contact forces derived from a robust musculoskeletal model using exclusively optical motion capture kinematics (external approach), and with both patellofemoral and optical motion capture kinematics (internal approach). We tested this on a heterogeneous population of asymptomatic subjects (n = 8) during ground-level walking (n = 12). We developed equations that successfully capture subject-specific gait characteristics with the internal approach outperforming the external. These approaches were compared with a knee-flexion based model in literature (Brechter model). Both outperformed the Brechter model in interquartile range, limits of agreement, and the coefficient of determination. The equations generated by these approaches are less computationally demanding than a musculoskeletal model and may act as an effective tool in future rapid gait analysis and biofeedback applications. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the interlimb coordination, asymmetry, and variability between older adults who participated in sports (n = 25; age = 72.6 ± 6.46 years) and sedentary older adults (n = 20; age = 70.85 ± 3.82 years). The sport participants were selected from tennis and badminton clubs, whereas the sedentary participants were recruited from local community centers. The participants walked at their preferred speed in a 10-m walkway for 2 min. The interlimb coordination was measured by the phase coordination index. Other walking metrics were speed, cadence, swing time, stance time, double-support time, stride time, and swing time asymmetry. The results showed that the sport participants relative to the sedentary group had better interlimb coordination, higher walking speed and cadence, and less swing time variability. Young older adults also had a better interlimb coordination. In conclusion, the findings of this study showed that long-term participation in sports has some antiaging benefits on gait coordination and symmetry in older adults. [ABSTRACT FROM AUTHOR]

Prior work, primarily focusing on habitual gait velocity, has demonstrated a cost while walking when coupled with a cognitive task. The cost of dual-task walking is exacerbated with age and complexity of the cognitive or motor task. However, few studies have examined the dual-task cost associated with maximal gait velocity. Thus, this cross-sectional study examined age-related changes in dual-task (serial subtraction) walking at two velocities. Participants were classified by age: young-old (45–64 years), middle-old (65–79 years), and oldest-old (≥80 years). They completed single- and dual-task walking trials for each velocity: habitual (N = 217) and maximal (N = 194). While no significant Group × Condition interactions existed for habitual or maximal gait velocities, the main effects for both condition and age groups were significant (p <.01). Maximal dual-task cost (p =.01) was significantly greater in the oldest-old group. With age, both dual-task velocities decreased. Maximal dual-task cost was greatest for the oldest-old group. [ABSTRACT FROM AUTHOR]

Context: Single- and dual-task walking gait assessments have been used to identify persistent movement and cognitive dysfunction among athletes with concussions. However, it is unclear whether previous ankle sprain injuries confound these outcomes during baseline testing. The purpose of this study was to determine the effects of (1) ankle sprain history and (2) time since prior ankle sprain injury on single- and dual-task spatiotemporal gait outcomes and cognitive measures. Design: Cross- sectional study. Methods: We assessed 60 college Division-I athletes (31 with ankle sprain history; 13 females and 18 males, 19.3 [0.8] y; 29 with no ankle sprain history, 14 females and 15 males, 19.7 [0.9] y) who completed injury history forms and underwent concussion baseline testing. Athletes completed single- and dual-task gait assessments by walking back and forth along an 8-m walkway for 40 seconds. Athletes wore a smartphone with an associated mobile application on their lumbar spine to record spatiotemporal gait parameters and dual-task cognitive performance. Separate multivariate analyses of variance were used to assess the effects of ankle sprain injury history on spatiotemporal measures, gait variability, and cognitive performance. We performed a multivariate regression subanalysis on athletes who reported time since injury (n = 23) to assess temporal effects on gait and cognitive performance. Results: Athletes with and without a histoiy of ankle sprains had comparable spatiotemporal and gait variability outcomes during single- (P = .42; P = .13) and dual-task (P = .75; P = .55) conditions. Additionally, ankle sprain injury history did not significantly influence cognitive performance (P = .35). Finally, time since ankle sprain did not significantly affect single- (P = .75) and dual-task gait (P = .69), nor cognitive performance (P = 19). Conclusions: Ankle sprain injury history did not significantly alter spatiotemporal gait outcomes nor cognitive performance during this common clinical assessment. Future studies may consider including athletes with ankle sprain injury history during concussion assessments. [ABSTRACT FROM AUTHOR]

Purpose: Examine the reliability of field-based fitness assessments in school-aged children with emotional or behavioral difficulties (EBD). Understanding the impact of fitness on physical activity participation for children with EBD is limited by our ability to reliably measure it. Methods: Fifteen children aged 7–12 years with EBD completed 7 assessments—standing broad jump, overhead throw, grip strength, isometric plank hold, isometric wall squat, unilateral heel raise, and modified 6-minute walk test—in a random order on 2 separate occasions. Intraclass correlation coefficients (ICCs) were computed to evaluate reliability. Results: ICCs ranged from.65 to.99 representing moderate to excellent reliability for all assessments. Shorter assessments requiring less attention and behavior regulation tended to demonstrate higher ICC values while assessments with greater attention or behavioral regulation demands tended to have lower ICC values. Conclusion: Results demonstrate varied reliability for fitness tests in children with EBD. Practitioners can use grip strength and standing broad jump assessments with confidence. Other assessments have good reliability but greater variability indicating they may be a challenge for some children with EBD. [ABSTRACT FROM AUTHOR]

The Timed Up-and-Go (TUG) test has been combined with different verbal/cognitive tasks (i.e., TUG dual task [TUGdt]) as a form of motor-cognitive testing. However, it is still unclear how different TUGdt conditions affect gait among older adults. Thirty community-dwelling older adults, with mean age of 73 years, participated in the study. Data were collected using marker-free video recordings. Gait parameters were extracted using a semiautomatic deep learning system. Comparisons of execution time and gait parameter outcomes were made under TUG and three types of TUGdt test conditions: TUGdt-naming animals, TUGdt-months backwards, and TUGdt-serial 7s. Statistical analyses were based on mean values of the gait parameters for each participant and TUG condition, including TUGdt gait cost, that is, the relative difference between TUGdt and TUG. All the investigated TUGdt conditions resulted in varying degrees of gait parameter changes. Under TUGdt conditions, participants took shorter and slower steps, with TUGdt-serial 7s causing the largest interference. [ABSTRACT FROM AUTHOR]

Older adults must have the ability to walk at variable speeds/distances to meet community demands. This single group pre–post test study's purposes were to examine if actual cadences after 7 weeks of rhythmic auditory stimulation gait training matched target cadences, improved walking distance, duration, velocity, maximum cadence, balance, enjoyment, and/or changed spatial/temporal gait parameters. Fourteen female adults (72.6 ± 4.4 years) participated in 14 sessions, while variable cadences were progressively introduced. Eleven older adult responders walked faster (3.8 steps/min) than one target cadence (−10% pace) while matching the target cadences for the other paces when walking with rhythmic auditory stimulation. Two nonresponders walked near their baseline cadence with little variability while one walked at faster cadences; all three did not appear to adjust to the beat of the music. After training, participants increased their walking distance, 90.8 ± 46.5 m; t(1, 13) = −7.3; p ≤.005, velocity, 0.36 ± 0.15 m/s; t(1, 40) = −15.4; p <.001, and maximum cadence, 20.6 ± 9.1 steps/min; t(1, 40) = −14.6; p <.001; changes exceeded minimal clinically important differences. Twelve of 14 expressed enjoyment. Walk with rhythmic auditory stimulation training is a promising activity for older adults, which may translate to an individual's ability to adapt walking speeds to various community demands. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of multimodal features based on gait analysis and eye tracking for elderly people screening with subjective cognitive decline in the community. Methods: In the study, 412 cognitively normal older adults aged over 65 years were included. Among them, 230 individuals were diagnosed with nonsubjective cognitive decline and 182 with subjective cognitive decline. All participants underwent assessments using three screening tools: the traditional SCD9 scale, gait analysis, and eye tracking. The gait analysis involved three tasks: the single task, the counting backwards dual task, and the naming animals dual task. Eye tracking included six paradigms: smooth pursuit, median fixation, lateral fixation, overlap saccade, gap saccade, and anti-saccade tasks. Using the XGBoost machine learning algorithm, several models were developed based on gait analysis and eye tracking to classify subjective cognitive decline. Results: A total of 161 gait and eye-tracking features were measured. 22 parameters, including 9 gait and 13 eye-tracking features, showed significant differences between the two groups (p < 0.05). The top three eye-tracking paradigms were anti-saccade, gap saccade, and median fixation, with AUCs of 0.911, 0.904, and 0.891, respectively. The gait analysis features had an AUC of 0.862, indicating better discriminatory efficacy compared to the SCD9 scale, which had an AUC of 0.762. The model based on single and dual task gait, antisaccade, gap saccade, and median fixation achieved the best efficacy in SCD screening (AUC = 0.969). Conclusion: The gait analysis, eye-tracking multimodal assessment tool is an objective and accurate screening method that showed better detection of subjective cognitive decline. This finding provides another option for early identification of subjective cognitive decline in the community. [ABSTRACT FROM AUTHOR]

Frailty, a geriatric syndrome, is assessed using the frailty phenotype (FP) and frailty index (FI). While these approaches have been applied to aging mice, their effectiveness in prematurely aging mouse models such as PolgAD257A/D257A (PolgA) has not been completely explored. We demonstrated that frailty became evident in PolgA mice around 40 weeks, validated through body weight loss, reduced walking speed, decreased physical activity, and weaker grip strength. Moreover, we also identified sex differences in these mice with females exhibiting slightly more physical decline compared to males. Frailty prevalence in PolgA mice at 40 weeks parallels that observed in naturally aging mice at 27 months and aging humans at 65-70 years. These findings contribute to understanding frailty onset and sex-specific patterns in this prematurely aging mouse model, emphasizing the significance of the PolgA mouse model in investigating aging and related disorders. [ABSTRACT FROM AUTHOR]

Background: A higher difference in estimated glomerular filtration rate by cystatin C versus creatinine (eGFRDiff = eGFRCys – eGFRCreat) is associated with decreased frailty risk. Since eGFRCreat is influenced by muscle more than eGFRCys, muscle mass may explain this association. Previous work could not account for this when considering regional muscle measures by imaging. Deuterated creatine (D3Cr) dilution measures whole body muscle mass (kilograms). We aimed to determine whether eGFRDiff is associated with D3Cr muscle mass and whether muscle mass explains the association between eGFRDiff and frailty. Methods: Cross‐sectional analysis within the multicenter MrOS Study at Year 14 (visit 4). 490 men of the original cohort of 5994 MrOS participants (aged ≥65 at enrollment) were included. Exposure was eGFRDiff (= eGFRCys – eGFRCreat), calculated using CKD‐EPI equations 2012/2021. Primary outcome was D3Cr muscle mass. Secondary outcome was phenotypic pre‐frailty (one or two criteria) and frailty (≥three criteria) including the following: weight loss, weakness, slow gait, physical activity, poor energy. The association of eGFRDiff with D3Cr muscle mass was examined by linear regression, that with prefrailty / frailty by multinomial logistic regression. Results: Mean ± SD age was 84 ± 4 years, eGFRCreat 68 ± 16, eGFRCys 52 ± 16, eGFRDiff −15 ± 12 mL/min/1.73 m2 and D3Cr muscle mass 24 ± 4 kg. For each SD increment in eGFRDiff, D3Cr muscle mass was 1.4 kg higher on average, p < 0.0001 (fully adjusted). Higher eGFRDiff was associated with lower odds of frailty (OR = 0.63 95% CI [0.45;0.89]), but this was partially attenuated and insignificant after additionally adjusting for D3Cr muscle mass (OR = 0.85 95% CI [0.58; 1.24]). Conclusions: Higher eGFRDiff is associated with lower odds of frailty among late‐life men. D3Cr muscle mass accounts for some of this association. This suggests that non‐GFR determinants of creatinine and cystatin C, such as muscle mass, play a role in explaining the association of eGFRDiff with frailty. Future studies are needed to confirm. [ABSTRACT FROM AUTHOR]

Background: Many previous studies reported that mobility did not recover to the preoperative level even several months after total knee arthroplasty (TKA). However, recent studies indicate that the time required for recovery may have been shortened. The correct information regarding the mobility improvement is very helpful in assessing a patients' progress in rehabilitation. Therefore, we evaluated the mobility early after TKA. Materials and Methods: One hundred seventy patients participated. We measured gait speed and the Timed Up and Go test (TUG) as mobility at pre-operatively and post-operatively at one, two, and three weeks. Results: Gait speed at 1 and 2 weeks after TKA was significantly lower than the preoperative value, but no significant difference was observed at 3 weeks. TUG at 1 week after surgery was significantly slower than the preoperative value, but no difference at 2 weeks, and faster than the preoperative value at 3 weeks. Approximately half of the patients (gait speed, 50%; TUG, 55%) demonstrated improvements exceeding their preoperative values. Conclusions: Our findings suggest that achieving preoperative mobility within 3 weeks after TKA may serve as a target for assessing early postoperative recovery progress. [ABSTRACT FROM AUTHOR]

The article focuses on an 11-year-old boy presenting with slurred speech and involuntary movements, later diagnosed with a neurological disorder. Topics include his clinical symptoms such as dysarthria and abnormal involuntary movements, his physical exam findings including hyperreflexia and abnormal gait, and the absence of significant prior medical or family history.

Purpose: This pilot study assessed the safety and effects of progressive functional high-intensity training in a group setting for adolescents with unilateral cerebral palsy (CP) on daily function indicators. Methods: Nine adolescents (mean age 16.9 years, GMFCS levels I–II) participated in 12 weeks of training (2x/week). Evaluations included 3D gait analysis, the 6-min walking test (6MWT), clinical exams, and the Gross Motor Function Measure-66 (GMFM-66). Results: No adverse events occurred, and GMFM-66 scores significantly improved (p =.031, Δ = 2.19%). Although increases in 6MWT (p =.09, Δ = 29.8 m) performance and propulsion ratio (p =.067, Δ = 5.4%) for the affected leg were observed, they were not statistically significant. Discussion: The study suggests that this training is safe and may enhance gross motor function, endurance, and gait asymmetry in unilateral CP. Future research should include upper limb evaluations and out-of-clinic motion analysis with wearable inertial measurement units (IMUs) to provide a more comprehensive assessment of functional movements. [ABSTRACT FROM AUTHOR]

The analysis of gait is an important tool for evaluating postoperative outcomes of a Total Knee Replacement (TKR). There are few studies which have evaluated the gait parameters of a Kinematic retaining (Kr) prosthesis. This study therefore aims to investigate the kinetic and kinematic differences of running and walking, in the ankle, knee and hip joints in patients who underwent a Kr TKR. This study assessed the gait of 12 patients with physica lima Kr TKRs at 1 year follow up and 8 healthy controls using 3D video analysis. Data was collected on the kinetics and kinematics of walking and running at the ankle, knee and hip. Comparison was made between the operated and non-operated limbs of the patients, and between the operated and control limbs. Gait analysis showed no statistically significant difference in the hip, ankle and knee angles or moments between the non-operated and operated legs during walking and running. However, there was a statistically significant difference between the knee angles of initial contact, maximum flexion during stance and swing in the TKR knees vs controls in walking and running. Similarly, there was also a statistically significantly higher max knee flexion moment between operated knees and controls in both walking and running. This study has shown that a quadriceps avoidance gait persists in patients after TKR, and that there was symmetry and reciprocated gait parameters in non-operated limbs. These findings suggest that Kr TKRs could be capable of replicating normal knee kinematics when running and walking. [ABSTRACT FROM AUTHOR]

Background: Total knee replacement (TKA) is a frequent modality performed in patients with knee osteoarthritis (OA). The aim of this study was to perform a meta-analysis and systematic review to evaluate the efficacy after TKA by gait analysis in patients with OA. Methods: PubMed, EMBASE, the Cochrane library, and Web of Science were searched for relevant studies from inception to July 2024. STATA SE 14.0 software was used for statistical analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guideline. Results: A total of 2525 reports were identified with 24 studies meeting pre-designed inclusion criteria. Several gait parameters were investigated. In patients with knee OA after TKA, there existed an increase in the Max knee flexion (WMD, 3.12; 95% CI, 0.93 to 5.32; I2 = 73.9%, P < 0.001), the Cadence (WMD, 4.05; 95% CI, 2.28 to 5.82; I2 = 48.9%, P = 0.068), the stride length (WMD, 0.05; 95% CI, 0.01 to 0.09; I2 = 77.1%, P < 0.001), the walking speed (WMD, 0.08; 95% CI, 0.02 to 0.14; I2 = 93.3%, P < 0.001), and the step length (WMD, 0.04; 95% CI, 0.00 to 0.07; I2 = 89.3%, P < 0.001) while a decrease in the double support time (WMD, -0.04; 95% CI, − 0.08 to -0.01; I2 = 0.0%, P = 0.585). Besides, no statistically significant differences were observed in the Knee range of motion (ROM), the Max knee rotation at stance phase, the Max knee extension, the step width, the stride time and the step time. Sensitivity analysis showed that all the results were robust. Conclusions: In summary, the study found that, in patients with knee OA undergoing TKA may have great effects on improving gait parameters. If there are more high-quality studies in the future, we should make a more comprehensive evaluation of walking function by gait analysis together with other evaluation systems such as muscle strength and proprioception measurement. [ABSTRACT FROM AUTHOR]

Background: Plantar fasciitis (PF) is the most common cause of heel pain affecting both young active patients and older sedentary individuals. It most often arises as a result of degenerative changes in the proximal plantar fascia. Aim: The purpose of this study was to investigate the effect of extracorporeal shockwave on gait parameters in patients with plantar fasciitis. Design: A randomized controlled clinical trial. Setting: The outpatient physiotherapy clinic of the teaching hospital Shibin El Kom. Methods: Participants were randomly divided into two equal groups. Group (A) (study group): received extracorporeal shockwave therapy one session per week and traditional treatment (ultrasound, stretching exercises, and strengthening exercises) three sessions per week for 4 weeks. Group (B)(the control group): received traditional treatment (ultrasound, stretching exercises, and strengthening exercises) 3 sessions per week for 4 weeks. The pre- and post-treatment development of the patients was evaluated by visual analog scale (VAS) to measure pain, foot function index (FFI) to measure foot function, and Kinovea software to analyze gait parameters (stride length, stride time, walking speed, and cadence). Results: Both groups showed improvement in all study variables, but the study group showed more improvement. There was a statistically significant decrease in VAS (p = 0.001), a significant decrease in FFI (p = 0.001), a significant increase in stride length (p = 0.001), a significant decrease in stride time (p = 0.001), a significant increase in walking speed (p = 0.001), and a significant increase in cadence (p = 0.01) post-treatment compared to group (B). Conclusion: Extracorporeal shockwave treatment is regarded as a useful treatment for improving gait parameters in patients with plantar fasciitis. Clinical rehabilitation impact: Extracorporeal shockwave therapy improved gait parameters in patients with plantar fasciitis as it increases stride length, walking speed, cadence, and decreases stride time. So, it is recommended to be included in the rehabilitation program for patients with plantar fasciitis and gait disabilities. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effectiveness of radial extracorporeal shock wave therapy (r ESWT) as an additional treatment modality for spastic equinus deformity in chronic hemiplegic patients. Methods: 100 eligible stroke patients with calf muscles spasticity were randomized into 2 groups. Group I: 50 patients exposed to rESWT 1.500 pulses, 0.10 mJ to 0.3mJ/mm2, with a frequency 4 Hz once weekly for one month. Group II: 50 patients exposed to Sham rESWT once weekly for one month. Clinical, electrophysiological & musculoskeletal ultrasound assessments were done for all patients. Results: After controlling baseline as covariate, the trend for modified Ashworth scale (MAS), Passive ankle dorsiflexion motion (PADFM), 10 meters walk test (10-MWT), and Ratio of maximum H reflex to maximum M response (H/M ratio) after one & two months was significantly different between the two groups, with improvement of all clinical and electrophysiological parameters in group I. Conclusion: ESWT represents a useful non-invasive, additional modality for the reduction of foot spasticity and equinus deformity in stroke patients. Implications for Rehabilitation: Extracorporeal shock wave therapy represents a useful non-invasive, additional modality for reduction of foot spasticity and equinus deformity in chronic stroke patients. The application of such a modality improves limb posture, range of motion, and muscle extensibility. Early extracorporeal shock wave rehabilitative intervention in stroke patients reduces fat infiltration and fibrosis replacement of spastic muscle. [ABSTRACT FROM AUTHOR]

The purpose of this quasiexperimental study was to test the effects of wearing the NewGait rehabilitative device on walking abilities in individuals with foot drop. The study involved 16 participants with foot drops caused by stroke (11 participants), multiple sclerosis (one participant), and peripheral neuropathies (four individuals). During a single testing session, participants walked 12 m at their self‐selected speed in four experimental conditions: walking without any orthotic device; walking while wearing a regular plastic posterior leaf ankle foot orthosis (AFO); walking with the NewGait device assisting ankle dorsiflexion only; and walking with the NewGait device assisting the hip, knee, and ankle joint motions. Body motions during walking were recorded using a 3D system for motion analysis and analyzed with a set of spatiotemporal and kinematic parameters and a gait decomposition index. The gait decomposition index indicated sagittal interjoint coordination in the three joint pairs (hip–knee, knee–ankle, and hip–ankle) of the paretic (foot drop) leg during walking and was validated in a previous study. Overall, wearing all three orthotic devices improved the gait velocity, ankle dorsiflexion, and foot clearance compared to gait trials in which no assistive devices were used. However, wearing the AFO significantly restricted the plantarflexion range of motion and decreased interjoint coordination as measured by joint decomposition. In contrast, the NewGait device altered the ankle plantarflexion motions but also increased coordinated movement (reduced the decomposition) in most lower‐extremity joint pairs and conditions. Therefore, the NewGait rehabilitative device can be considered superior to a regular AFO in correcting gait deviations caused by foot drop. [ABSTRACT FROM AUTHOR]

Background: Idiopathic normal pressure hydrocephalus (iNPH) is a prevalent neurological disorder, but its diagnosis remains challenging. Dual-task (DT) walking performance is a reliable indicator of iNPH but less is known about the role of cognitive reserve (CR) in predicting DT walking performance. Aims: The objective of this study was to evaluate the contribution of CR on DT walking in healthy controls (HC) and in iNPH patients (iNPH-P). Methods: 68 iNPH-P (77.2 +/- 6.7 years old) and 28 HC (74.5 +/- 5.7 years old) were evaluated on their single-task walking (Vsimple) and on 4 DT walking (walking and counting or counting backwards, naming animals, naming words beginning with the letter P) (Vcount, VcountB, Vanimals and Vletter respectively). The contribution of CR on the different DT walking speeds was compared between HC and iNPH-P. In iNPH-P, the contribution of CR on the walking speeds was compared with regard to other cognitive, functional, and socio-demographic variables. Results: Simple linear regression demonstrated a moderate influence of CR on single and DT walking speed in iNPH-P (β > 0.3, p <.001) but not in HC where the relation was not significant. In iNPH-P, results showed that CR played a major role in explaining each of the single and DT walking speeds with NPH-scale. Conclusion: As CR could be improved through the life cycle, these results support the idea of developing and supporting physical activity programs that will enrich social, physical, and cognitive resources to protect against age-related functional decline, especially in iNPH-P patients where the age-related deficits are greater. [ABSTRACT FROM AUTHOR]

Background: End-stage post-traumatic osteoarthritis of the ankle joint may require arthrodesis if conservative treatment fails and a decision against total ankle replacement is made. We aimed to compare the sex-specific differences in outcomes and objectify them using validated specific scores. Methods: Between 2010 and 2021, 221 patients underwent ankle arthrodesis at our institution, including 143 men (MAA) and 78 women (FAA). In addition to demographic data, the aetiology of osteoarthritis, the Foot Function Index (FFI-D), the Olerud-Molander Score (OMAS), and the Short Form-12 questionnaire (SF-12) were collected in this monocentric study. The mean follow-up time was 5.8 years. End-stage osteoarthritis was mostly due to ankle fractures as a result of sprains, falls, and road traffic accidents. Results: Post-operatively, the mean FFI-D for pain was 17.3 (MAA: 14.7; FAA 22.2) and 43.9 for function (MAA: 41.1; FAA 49.5); the mean OMAS was 58.2; and the mean SF-12 physical component score was 42.5. Women achieved significantly worse results in all scores; only the mental component summary of the SF-12 did not differ between the sexes (p > 0.05). Approximately 34% of women stated that the result in terms of gait pattern was worse than expected (MAA 16.1%; p < 0.05). Again, significantly more men stated that the result was better than expected (MAA: 48.3%; FAA: 31.5%, p < 0.05). Conclusions: The fact that the clinical results were significantly worse in women after ankle arthrodesis should be considered when determining the indication. However, the expectations of men and women also need to be individually adjusted. [ABSTRACT FROM AUTHOR]

Introduction: Perturbation walking (PW) has been shown to improve gait, however its effect on the cortical control of gait might provide insights on neural mechanisms underlying falls in adults with osteoarthritis. The objective of this study is to investigate the effect of PW on prefrontal cortical (PFC) activation in older women with (OA) and without osteoarthritis (HOA). We hypothesized that there would be an increase in PFC activation during PW relative to comfortable walking (CW) and higher increase in PFC activation during PW in HOA compared to OA. Methods: Twenty community-dwelling older women (66.7 ± 5.41 years old) walked on an instrumented treadmill that provided perturbations at pseudorandom intervals between 5-25 s using a counterbalanced design. Functional Near Infrared Spectroscopy was used to quantify PFC oxygenated hemoglobin (HbO2) and deoxyhemoglobin (Hb) levels, while standing prior to the task as a baseline. A linear mixed effects model was conducted to investigate the effects of cohort (HOA vs OA), task (PW vs CW), and their interaction on HbO2 (mM) and Hb (mM) levels. Results: HbO2 and Hb levels differed significantly between CW and PW tasks for both cohorts (P < 0.001) and demonstrated significant task by cohort interaction (P < 0.05). In addition, we found changes in walking performance (stride time, stride length, stride width and stance time) during and after PW. Spearman correlation demonstrated a strong association between increased stance time, increased body mass index and decreased PFC activation during PW. No other significant results were found. Discussion: This study found increase in PFC activation during PW and gait adaptation after a short bout of PW in HOA and OA. This increase in PFC activation was higher in HOA compared to OA, particularly during PW tasks, and was consistent with theory of limitations in mobility affecting neural activation in older adults. Further work remains to examine how pain, obesity, and mobility impacts cortical control in older adults with and without osteoarthritis. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) presents diverse symptoms and comorbidities, complicating its diagnosis and management. The primary objective of this cross-sectional, monocentric study was to assess digital gait sensor data's utility for monitoring and diagnosis of motor and gait impairment in PD. As a secondary objective, for the more challenging tasks of detecting comorbidities, non-motor outcomes, and disease progression subgroups, we evaluated for the first time the integration of digital markers with metabolomics and clinical data. Using shoe-attached digital sensors, we collected gait measurements from 162 patients and 129 controls in a single visit. Machine learning models showed significant diagnostic power, with AUC scores of 83–92% for PD vs. control and up to 75% for motor severity classification. Integrating gait data with metabolomics and clinical data improved predictions for challenging-to-detect comorbidities such as hallucinations. Overall, this approach using digital biomarkers and multimodal data integration can assist in objective disease monitoring, diagnosis, and comorbidity detection. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic osteoarthritis (PTOA) arises secondarily to joint trauma and is driven by catabolic inflammatory pathways. Alpha-2-macroglobulin (α2M) is a naturally occurring proteinase inhibitor found in human serum and synovial fluid that binds proteases as well as proinflammatory cytokines involved in the pathogenesis of PTOA. Purpose: (1) To investigate the therapeutic potential of intra-articular α2M injections during the acute stages of PTOA by inhibiting inflammatory pathways driven by the cytokines expressed by the synovium in a large preclinical Yucatan minipig model and (2) to determine if 3 intra-articular α2M injections have greater chondroprotective effects compared with 1 intra-articular injection. Study Design: Controlled laboratory study. Methods: A total of 48 Yucatan minipigs were randomized into 4 groups (n = 12 each): (1) modified intra-articular drilling (mIAD) and saline (mIAD + saline), (2) mIAD and 1 intra-articular α2M injection (mIAD +α2M-1), (3) mIAD and 3 α2M injections (mIAD +α2M-3), and (4) sham control. Surgical hindlimbs were harvested at 15 weeks after surgery. Cartilage degeneration, synovial changes, inflammatory gene expression, and matrix metalloproteinase levels were evaluated. Gait asymmetry was measured before and after surgery using a pressure-sensing walkway system. Results: Macroscopic lesion areas and microscopic cartilage degeneration scores were lower in the mIAD +α2M-1 and mIAD +α2M-3 groups compared with the mIAD + saline group (P <.05) and similar to those in the sham group (P >.05). Synovial membrane scores of the mIAD +α2M-1 and mIAD +α2M-3 groups were lower than that of the mIAD + saline group (P <.05) and higher than that of the sham group (P <.05). Interleukin-1 beta, nuclear factor kappa B, and tumor necrosis factor alpha mRNA expression in the synovium and matrix metalloproteinase-1 levels in synovial fluid were significantly lower in the mIAD +α2M-1 and mIAD +α2M-3 groups compared with the mIAD + saline group (P <.05). No significant differences were observed between the mIAD +α2M-1 and mIAD +α2M-3 groups for all measured outcomes. There were early changes in gait (P <.05) between preoperative and postoperative time points for the mIAD + saline, mIAD +α2M-1, and mIAD +α2M-3 groups that normalized by 15 weeks. Conclusion: Animals receiving early α2M treatment exhibited less cartilage damage, milder synovitis, and lower inflammation compared with animals with no α2M treatment. These results exemplify the early anti-inflammatory effects of α2M and provide evidence that intra-articular α2M injections may slow the progression of PTOA. Clinical Relevance: In patients presenting with an acute joint injury, an early intervention with α2M may have the potential to reduce cartilage degeneration from catabolic pathways and delay the development of PTOA. [ABSTRACT FROM AUTHOR]

Introduction: It has been shown that 45%–85% of patients with anterior cruciate ligament reconstruction (ACLR) will have early-onset arthritis within 10–12 years following surgery. Over the past two decades, the amount of literature regarding ACLR, gait maladaptations after ACLR and their potential link to early-onset arthritis, and rehabilitation techniques has grown exponentially; however, long-term patient outcomes remain modest. Methods: To evaluate current clinicians' attitudes, perspectives, and clinical practice approach for rehabilitation of patients following ACLR, a survey questionnaire was designed using the Delphi technique. Results: Of the 263 respondents, 84.4% (n = 226) reported that they believed gait training to be "Very" or "Extremely Important." However, only 35.7% (n = 94) reported objectively measuring gait during ACLR rehabilitation. Of the total respondents, only 6.8% (n = 18) assessed gait during rehabilitation using two-dimensional or three-dimensional motion capture technologies. Discussion: Our results suggest that while gait evaluation was perceived as important, most respondents did not objectively measure gait metrics as a clinical outcome during ACLR rehabilitation. These findings provide a prospective rehabilitation target to potentially mitigate a known risk factor of early-onset arthritis (gait maladaptations) in individuals following ACLR. [ABSTRACT FROM AUTHOR]

Purpose: High body mass index (BMI) is a strong predictor of posttraumatic osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR). Altered gait mechanics are independently affected by BMI and ACLR, and influence OA risk. Yet, evidence directly assessing the impact of high BMI on gait or cartilage characteristics after ACLR are limited. Here, we evaluated if high BMI moderates associations between gait and trochlear cartilage structure in individuals with ACLR. Methods: Treadmill walking biomechanics were evaluated in 40 normal BMI and 24 high BMI participants with ACLR at self-selected speeds. Normalized and absolute peak and cumulative loads (i.e., impulse) were extracted for peak knee flexion and adduction moments (KFM, KAM) and vertical ground reaction force (GRF).Medial and lateral femoral cartilage thickness and medial/lateral thickness ratios were assessed via ultrasound. Results: Those with ACLR and high BMI walked with reduced normalized peak vertical GRFs, and greater absolute peak and cumulative loads compared with normal BMI individuals with ACLR. Those with ACLR and high BMI also exhibited thinner cartilage and greater medial/lateral ratios in ACLR limbs compared with contralateral limbs whereas norma lBMI individuals with ACLR exhibited thicker ACLR limb cartilage. Lastly, greater peak KAM and KAM cumulative load were associated with thicker lateral cartilage and lesser medial/lateral thickness ratios, but only in the high BMI group. Conclusions: We observed those with high BMI after ACLR exhibited trochlear cartilage structural alterations not observed in normal BMI patients, whereas differential associations between loading outcomes and cartilage thickness in ACLR knees were observed between groups. Those with high BMI after ACLR may require different therapeutic strategies to optimize joint health in this subset of patients. [ABSTRACT FROM AUTHOR]

Strength is a primary and modifiable contributor to performance, injury risk, and rehabilitative success. The gold standard measure of strength is the isokinetic dynamometer, providing the clinician with the opportunity to manipulate contraction modality, range, and speed about a joint. However, criticism has highlighted a lack of functional relevance, with arbitrary selection of speed across the full range. To better understand function, biomechanical analysis of movement can inform a bespoke isokinetic data collection protocol. In this case, we use walking gait, a function goal for daily living and clinically assessed following knee replacement surgery for example. Concentric knee flexor and extensor demand was evident at an average angular velocity of 70°·s−1, whilst eccentric knee flexor and extensor demands were evident at speeds of 192°·s−1 and 165°·s−1, respectively. The efficacy of isokinetic dynamometry can be enhanced with bespoke data collection protocols, which better reflect the functional demands of the clinical movement objective. [ABSTRACT FROM AUTHOR]

To determine the relationship of dual-task-dynamic-balance with the risk-of-fall and gait-parameters in fallers and non-fallers elderly. After signing written informed consent, participants were assessed for dual-task-dynamic-balance [dual timed up and go (TUG) test (DTT)+ cognitive stops (CS) and DTT + CS + cognitive errors (CE)], risk-of-fall [berg balance scale], and gait-parameters [footprint method of gait analysis]. A significant difference was found between fallers and non-fallers for the variables falls in the previous 12 months, mini-mental state examination (MMSE), DTT + CS + CE, and walking speed. A significant moderate to strong negative correlation was found between dual task dynamic balance (DTT + CS and DTT + CS + CE), risk-of-fall and few gait-parameters in elderly fallers. The study emphasizes the importance of maintaining dynamic-balance and performing dual-tasks to prevent falls in elderly individuals, suggesting that interventions targeting both cognitive and motor aspects can be beneficial in reducing fall-risk. [ABSTRACT FROM AUTHOR]

Background: Limited research exists for use of transcutaneous spinal stimulation (TSS) in pediatric spinal cord injuries (SCI) to improve walking outcomes, especially in children diagnosed with SCI secondary to acute flaccid myelitis (AFM). Objective: This case series demonstrates the feasibility and efficacy of TSS paired with gait training in children diagnosed with AFM. Methods: A total of 4 participants diagnosed with incomplete SCI secondary to AFM completed 22, 2-h therapy sessions over 5–8 weeks. TSS paired with body weight-supported treadmill training (BWSTT) was provided for the first 30 min of each session. Changes in walking function were assessed through the 6 min walk test (6MWT), Timed Up and Go (TUG), 10 m walk test (10MWT), and walking index for spinal cord injury II (WISCI-II). To assess safety and feasibility, pain, adverse events, and participant and therapist exertion were monitored. Results: All participants tolerated the TSS intervention without pain or an adverse response. Changes in the 6MWT exceeded the minimal clinically important difference (MCID) for three participants and WISCI-II exceeding the minimal detectable change (MDC) for two of the participants. Conclusions: These results demonstrate that TSS is a safe and clinically feasible intervention for pediatric patients with AFM and may supplement gait-based interventions to facilitate improvements in walking function. [ABSTRACT FROM AUTHOR]

Background/Objectives: Rett syndrome is a rare neurodevelopmental disorder that can severely affect motor functioning, particularly walking. Previous training programs proposed treadmills as tools to increase walking endurance of patients with Rett syndrome, but these trainings did not include virtual reality (VR). The aim of this study was to assess the feasibility of a short treadmill training coupled to VR in girls with Rett syndrome. Methods: Nine patients with Rett syndrome underwent a 3-day treadmill walking program performed in semi-immersive VR. During the training, the happiness index and performance metrics were collected. At the end of the training parents filled out the Suitability Evaluation Questionnaire (SEQ) and, when feasible, patients underwent a gait assessment. Results: All the subjects recruited performed the three GRAIL sessions and parents showed a good satisfaction and considered the integration of treadmill and VR a good possibility for future rehabilitative programs. Participants showed greater satisfaction in environments requiring walking and their attention increased during training sessions, hypothesizing the feasibility of longer trainings with treadmill and VR. Data collected from gait analysis provided insights, although preliminary, concerning differences in gait pattern amongst the recruited subjects. Conclusions: Despite the small sample size and limited training duration, the paper suggests that a walking training with a treadmill combined with VR can represent a new strategy for Rett rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Gait ability can be objectively assessed using gait analysis. Three-dimensional gait analysis, the most commonly used analytical method, has limitations, such as a prolonged examination, high system costs, and inconsistently reported gait symmetry in patients with knee osteoarthritis (OA). Therefore, we aimed to evaluate the gait symmetry and changes before and after unilateral total knee arthroplasty (TKA) using the Walkway analyzer, a sheet-type gait analyzer. Methods: The healthy group included 38 participants from the Locomotor Frailty and Sarcopenia Registry study with lower limb pain or Kellgren–Lawrence classification grade 3 or 4 OA. The OA group included 34 participants from the registry study who underwent unilateral TKA. The walking speed, step length, step width, cadence, stride time, stance time, swing phase time, double-limb support phase time, stride, step length, and step width were analyzed per side using the Walkway gait analyzer. Results: No significant differences between the right and left sides were observed in the healthy group. In the OA group, the time indices and stance phase (p = 0.011) and the double-limb support phase time (p = 0.039) were longer on the contralateral side and the swing phase was longer on the affected side (p = 0.004) pre-operatively. However, these differences disappeared post-operatively. There were no significant differences in the spatial indices. Thus, this study revealed that patients undergoing unilateral TKA had an asymmetric gait pre-operatively, with a time index compensating for the painful side, and an improved symmetric gait post-operatively. Conclusions: The Walkway analyzer employs a simple test that requires only walking; hence, it is expected to be used for objective evaluation in actual clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Up to one-third of patients with fragility hip fractures are totally dependent in the year following the injury which leads to later morbidity and mortality. Understanding the related factors that affect patients' ambulation helps health care providers prepare for the treatment plans to improve their functional outcomes. This study aimed to evaluate the factors associated with independent walking disability in the early postoperative period after fragility hip fractures. Material and methods: This retrospective cohort study involved 394 patients with fragility hip fractures with either intertrochanteric, subtrochanteric, or femoral neck fractures from January 2018 to June 2023. The related factors including preoperative demographics, perioperative, and postoperative factors, were collected and analyzed. The endpoint was the independent walking disability of patients at 6 weeks after surgery. Results: 110 patients (27.9%) were disabled, whereas 284 patients (72.1%) could walk independently at postoperative 6 weeks. The multivariable risk ratio regression analysis showed that patients with age ≥80 years (RR 1.65; 95% CI 1.21-2.25; P = 0.001), pre-fracture walking with the gait aid (RR 2.03; 95% CI 1.53-2.69; P < 0.001), having ≥2 underlying comorbidities (RR 1.63; 95% CI 1.19-2.23; P = 0.002), preoperative hypoalbuminemia (RR 1.74; 95% CI 1.32-2.29; P < 0.001), and presence of the postoperative medical complication (RR 2.04; 95% CI 1.37-3.02; P < 0.001) were significantly associated with independent walking disability at the early postoperative period of 6 weeks. Conclusions: Post-hip fracture surgery patients with the presence of postoperative medical complication have the highest risk of independent walking disability. Health care providers should concentrate on high-risk patients, correct the modifiable factors, and minimize any postoperative complications to improve functional recovery and decrease morbidity related to non-ambulation after fragility hip fractures. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionTo reveal the discriminative value of gait parameters between Alzheimer’s disease (AD) and Parkinson’s disease (PD) subjects.We included all consecutive patients with newly diagnosed AD and those with a diagnosis of PD who applied to our polyclinic between March 2022 and June 2022. The demographic and clinical features were evaluated during interviews. The gait analyses were performed using a quantitative, smartphone-based gait analyses program. Using this program, the step time (ST), step length (SL), step number (SN), gait velocity (GV), and cadence were measured in all individuals.Overall, 31 patients with AD and 45 with PD were enrolled in the analyses. The mean age of the AD group was higher according to those with PD. As expected, the Mini-Mental State Examination (MMSE) values were lower in the AD group. The comparative analyses of the gait parameters between groups did not reveal differences in any of the measures. The correlation analyses to investigate the possible association between the disease severity and gait parameters revealed that the MDS-UPDRS showed low negative correlations with SL and GV.Our findings suggest that the evaluation of gait using the gait analyses program does not contribute to the discrimination between AD and PD in clinical practice. [ABSTRACT FROM AUTHOR]

Objective Total knee replacement (TKR) is a common solution for patients with advanced knee osteoarthritis (OA). Still, fall rates remain relatively high after surgery. TKR may alter pain and knee function, balance control, and proprioception. However, given the role of complex (dual-task) walking in fall prediction for older adults, it is unknown how TKR alters the attentional demand of walking in older adults. The goal of this study was to examine the effect of TKR on dual-task walking among older adults. Methods Participants were evaluated 1 month before surgery and 4.5 months after surgery. Participants walked along an instrumented 7-meter path for 1 minute with and without a cognitive task (serial-3 subtraction). Pain and knee function, knee proprioception, dynamic balance, and balance confidence, as well as dual-task costs (DTC) were compared before and after the surgery and factors associated with change in gait DTCs were assessed. Results Thirty-eight participants completed the study (age 72.6 years, SD = 4.9; 11 men). A significant decrease in pain was found following TKR, with no change in balance, balance confidence, or proprioception. There were no differences in gait DTCs before and after the surgery. However, change in dynamic balance, specifically reactive postural control and dynamic gait, predicted changes in gait speed and stride time DTCs. Conclusion The absence of an effect of TKR on gait DTCs can potentially underlie increased fall risk after TKR. Results from this study emphasize the significance of balance as a measure and focal point for rehabilitation after TKR. Impact This study contributes to our understanding of the attentional cost of walking in people before and after TKR, as well as to factors associated with it. Results from this work can assist formulation of rehabilitation programs for people with knee OA. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare reoperation rate and clinical outcomes between revision open reduction and internal fixation and hip arthroplasty following failed subtrochanteric fracture fixation. Methods: A retrospective review was conducted of patients > 50 years old treated for failed fixation of subtrochanteric fractures with revision ORIF or hip arthroplasty from 2003 to 2023. Primary outcomes included rate of fracture union and reoperations after initial salvage therapy. Secondary outcomes included complications (infection, dislocation, bursitis, implant prominence, implant failure, nonunion), pain, and gait-aid requirements by final follow-up. Results: Forty-four patients were identified: 34 treated with revision ORIF and 10 with hip arthroplasty. The arthroplasty cohort was older (75.4 vs. 66.0 years, p = 0.016) but did not differ from the ORIF cohort in sex, type of initial fixation, or reason for fixation failure. Patients treated with revision ORIF and patients treated with arthroplasty had similar rates of fracture union (85.3% vs. 80.0%, p = 0.772) and reoperation (35.3% vs. 30.0%, p = 0.710). There was no significant difference in rate of additional complications not requiring reoperation (0.0% vs. 40.0%, p = 0.071). The arthroplasty cohort achieved full weightbearing in significantly shorter time than the revision ORIF cohort (3.8 vs. 6.8 weeks, p = 0.005). Conclusion: Both revision ORIF and hip arthroplasty are acceptable options for salvage of failed subtrochanteric fracture fixation in patients greater than 50 years old, but patients should be counseled that although the rate of fracture union is high whether revision ORIF or hip arthroplasty is selected, the rate of reoperation can exceed 1-in-4 patients. Level of Evidence: Level III, Retrospective Comparative Study. [ABSTRACT FROM AUTHOR]

Amplitude-based exercise training has been shown to be effective in the motor performance of individuals with idiopathic Parkinson's disease, with limited research investigating its effects on Parkinson plus syndromes such as olivopontocerebellar atrophy (OPCA). The purpose of this clinical case report is to examine the effects of amplitude-based training exercises on an individual with OPCA. A 68-year-old man with a 14-month history of OPCA presented to physical therapy with bradykinesia, rigidity, and postural instability. The individual participated in 34 intervention sessions. Pre- and post-test measurements were collected for the following outcome measures: Five Times Sit to Stand (FTSTS); Functional Gait Assessment (FGA); Activities-Specific Balance Confidence Scale (ABC-6); 9 Hole Peg Test (9HPT); preferred and maximal gait speed. Improvements reaching Minimum Detectable Change (MDC) or Minimal Clinically Important Difference (MCID) were recorded with a pre (Week 1) and post (Week 20) intervention: FGA score (4-point improvement (MDC95 = 4 points), preferred gait speed (0.09 meters/second improvement (MCID = 0.05 meters/second)), FTSTS (6-second improvement (MDC95 = 2.3 seconds)), and 9HPT on the dominant hand (3-second improvement (MDC95 = 2.6 seconds)). Fluctuations during the plan of care were observed for these measures, and additional outcomes did not demonstrate a worsening of function. In an individual with OPCA, amplitude-based exercise training as a component of the plan of care increased dynamic balance in walking, gait speed, and hand dexterity. However, these results need to be validated on a larger sample of individuals with OPCA through randomized controlled trials. [ABSTRACT FROM AUTHOR]

Background: Deep angiomyxoma (DAM) is a slow-growing benign tumor with high risk of local recurrence after surgical resection. Although DAM in a lower extremity is extremely rare, clinicians must be aware of its possible occurrence. Suspicion can be made based on clinical examination and radiological imaging but final diagnosis is confirmed on histopathological examination and immunohistochemistry. We intend to present an extremely rare case of DAM in the knee, managed successfully with marginal excision. Case Presentation: A 4-year-old male child presented with the complains of a painless, progressively increasing, soft, non-tender, and fluctuant swelling in his right knee. The plain radiograph showed a non-calcified soft-tissue swelling and MRI revealed a multi-loculated cystic lesion with multiple septations. A pre-operative diagnosis of a benign cystic lesion was made. It was managed by marginal excision of the tumor and a histological diagnosis of DAM was made. IHC staining showed positivity for SMA, CD34 and vimentin were focally positive, while desmin and calponin were negative. At 12 months of follow-up, the patient had a normal painless gait and full knee ROM, without any local recurrence. Conclusion: DAM is a rare tumor which is often misdiagnosed. In this report, we present a rare case of benign cystic lesion which turned out to be DAM on HPE of resected specimen. Marginal excision of this lesion revealed good outcomes with no recurrence until 12 months of final follow-up. With this, we conclude that surgical excision should be the gold standard in cases of DAM. [ABSTRACT FROM AUTHOR]

Cerebellar impairment (CI) manifests from different etiologies resulting in a heterogenic clinical presentation affecting walking and mobility. Case-reports were reviewed to provide an analytical clinical picture of persons with CI (PwCI) to differentiate cerebellar and non-cerebellar impairments and to identify interventions and assessments used to quantify impact on walking and mobility according to the International Classification of Functioning, Disability and Health (ICF). Literature was searched in PubMed, Web Of Science and Scopus. Case-reports conducting physical rehabilitation and reporting at least one outcome measure of ataxia, gait pattern, walking or mobility were included. 28 articles with a total of 38 different patients were included. Etiologies were clustered to: spinocerebellar degenerations, traumatic brain injuries, cerebellar tumors, stroke and miscellaneous. The interventions applied were activity-based, including gait and balance training. Participation based activities such as tai chi, climbing and dance-based therapy had positive outcomes on mobility. Outcomes on body function such as ataxia and gait pattern were only reported in 22% of the patients. A comprehensive test battery to encompass the key features of a PwCI on different levels of the ICF is needed to manage heterogeneity. Measures on body function level should be included in interventions. This review reports on 38 cerebellar cases from 14 different aetiologies. Distinguishing cerebellar and non-cerebellar symptoms and categorising patients within the three cerebellar syndromes can assist with heterogeneity. Reporting of assessment on the body function level of ICF in terms of ataxia and gait pattern was only present in a minority of reports and thus increased reporting is encouraged. Multimodal and patient-tailored strategies are promising for targeting walking and mobility in persons with cerebellar impairment. [ABSTRACT FROM AUTHOR]

Some basic and instrumental daily living activities include backward gait. There is a need to clarify which parameters should be focused more on to improve backward gait in older individuals. This research investigated the proprioception, and balance in forward-backward gait of older individuals with total knee arthroplasty (TKA). A prospective cross-sectional research was conducted with 105 older adults with TKA. Individuals' forward and backward gait performance was assessed with the Timed Up & Go Test (TUG) and 3 Meter Walk Back Test (3MBWT), respectively. Proprioception was measured with a mobile application-based inclinometer. Berg Balance Scale (BBS) and Activity Specific Balance Confidence Scale (ABC) were used to assess balance and balance confidence levels, respectively. A single clinician evaluated the individuals. TUG was weakly and positively correlated with the Right and Left Leg Proprioception Test (RLPT and LLPT) (r 1 = 0.386, r 2 = 0.391, p < 0.01). Also, the 3MBWT was weakly and positively correlated with RLPT and LLPT, respectively (r 1 = 0.293, r 2 = 0.251, p < 0.01). In addition, TUG was strongly and negatively correlated with BBS and ABC, respectively (r 1 = −0,693, r 2 = −0.722, p < 0.01). Besides, 3MBWT was strongly and negatively correlated with BBS and ABC (r 1 = −0.642, r 2 = −0.645, p < 0.01). The study revealed that forward and backward walking were similarly associated with balance and proprioception in older adults with TKA. Clinicians should focus more on balance ability than proprioception to improve backward walking performance in older individuals with THA. [ABSTRACT FROM AUTHOR]

There is a paucity of research applying fully immersive virtual reality (VR) training to older adults with degenerative joint disease. This study investigated the effects of a training program utilizing fully immersive VR games on proprioception and gait ability in older patients with degenerative arthritis who had undergone total knee arthroplasty. This randomized controlled trial enrolled patients aged ≥65 years who were diagnosed with knee joint arthritis and had undergone knee arthroplasty followed by physical therapy. Participants were randomly assigned to an experimental group (receiving training using fully immersive VR games along with regular physical therapy) and a control group (receiving only regular physical therapy). The intervention was conducted five times a week for four weeks. Knee joint proprioception was measured using Biodex before and after the intervention. Spatial–temporal gait variables were collected using OptoGait for gait assessment. There was a significant decrease in the absolute error values of proprioception after the intervention in the experimental group, compared to before (p < 0.05), indicating improvement in proprioception. Gait speed, step count, and stride length improved significantly (p < 0.05, p < 0.01), demonstrating an enhancement in gait ability. The experimental group showed significantly greater improvements in gait speed, step count, and stride length than the control group (p < 0.01). Training using a fully immersive VR exercise program may have potential benefits for improving proprioception and gait parameters in patients who have undergone total knee arthroplasty. Fully immersive VR game-based training can be utilized as an effective rehabilitation intervention for patients undergoing knee arthroplasty in the future. [ABSTRACT FROM AUTHOR]

Spatiotemporal gait kinematics and their variability are commonly assessed in clinical and laboratory settings to quantify fall risk. Although the Hawthorne effect, or modifications in participant behavior due to knowledge of being observed, has the potential to impact such assessments, it has received minimal attention in the study of gait—particularly gait variability. The purpose of this study was to quantify the Hawthorne effect on variability and central tendency measures of fall-related spatiotemporal gait parameters. Seventeen healthy young adults walked on a treadmill at a self-selected velocity for 2 minutes under covert evaluation (ie, without awareness of being evaluated) and 2 minutes under overt evaluation. The movement was recorded using motion capture technology, from which we calculated mean value and step-to-step variability (using standard deviation and mean absolute deviation) of step length, step width, percent double support, percent stance phase, and stride time. Although central tendencies were unaffected by evaluation type, four-of-five measures of variability were significantly lower during overt evaluation for at least one-of-two metrics. Our results suggest a Hawthorne effect on locomotor control. Researchers should be aware of this phenomenon when designing research studies and interpreting gait assessments. [ABSTRACT FROM AUTHOR]

In-lab, marker-based gait analyses may not represent real-world gait. Real-world gait analyses may be feasible using inertial measurement units (IMUs) in combination with open-source data processing pipelines (OpenSense). Before using OpenSense to study real-world gait, we must determine whether these methods estimate joint kinematics similarly to traditional marker-based motion capture (MoCap) and differentiate groups with clinically different gait mechanics. Healthy young and older adults and older adults with knee osteoarthritis completed this study. We captured MoCap and IMU data during overground walking at 2 speeds. MoCap and IMU kinematics were computed with OpenSim workflows. We tested whether sagittal kinematics differed between MoCap and IMU, whether tools detected between-group differences similarly, and whether kinematics differed between tools by speed. MoCap showed more anterior pelvic tilt (0%–100% stride) and joint flexion than IMU (hip: 0%–38% and 61%–100% stride; knee: 0%–38%, 58%–89%, and 95%–99% stride; and ankle: 6%–99% stride). There were no significant tool-by-group interactions. We found significant tool-by-speed interactions for all angles. While MoCap- and IMU-derived kinematics differed, the lack of tool-by-group interactions suggests consistent tracking across clinical cohorts. Results of the current study suggest that IMU-derived kinematics with OpenSense may enable reliable evaluation of gait in real-world settings. [ABSTRACT FROM AUTHOR]