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Background: The neural mechanisms underlying freezing of gait (FOG) in Parkinson's disease (PD) have not been completely comprehended. Sensory-motor integration dysfunction was proposed as one of the contributing factors. Here, we investigated short-latency afferent inhibition (SAI) and long-latency afferent inhibition (LAI), and analyzed their association with gait performance in FOG PD patients, to further validate the role of sensorimotor integration in the occurrence of FOG in PD. Methods: Twenty-five levodopa responsive-FOG PD patients (LR-FOG), fifteen levodopa unresponsive-FOG PD patients (LUR-FOG), twenty-eight PD patients without FOG (NO-FOG PD) and twenty-two healthy controls (HC) were included in the study. Clinical features such as PD motor symptoms, FOG severity and cognitive abilities were evaluated using clinical scales in subjects with PD. All participants underwent paired associative stimulation (PAS) to evaluate SAI and LAI in addition to regular input-output curve by transcranial magnetic stimulation. The performances of gait were assessed using a portable gait analyzing system in 10-meter timed Up and Go task. The correlations between the gait spatiotemporal parameters or the scores of FOG scale and the magnitudes of SAI or LAI were analyzed. Results: Compared to HC and NO-FOG PD patients, SAI was decreased in FOG PD subgroups. LAI was also reduced in both LR-FOG PD and LUR-FOG PD in relative to HC; however, only LUR-FOG PD showed significant reduction of LAI in comparison to NO-FOG PD group. FOG PD patients showed poorer gait performance compared to HC and NO-FOG PD group. The reduction of SAI and LAI were correlated with the impaired gait spatiotemporal parameters or scores of FOG scale in PD with FOG. Conclusion: The SAI and LAI were attenuated in PD patients with FOG, and the reduction of SAI or LAI were correlated to disturbed gait performance, indicating that sensory-motor integration dysfunction played a role in the development of FOG in PD. [ABSTRACT FROM AUTHOR]

Background: Human immunodeficiency virus (HIV) is a retrovirus mainly infecting immune cells. Central nervous system diseases in HIV-infected patients can be caused by HIV or opportunistic infections. Neurological diseases associated with HIV have diverse manifestations and may occur in early or late stages. This article reports an HIV patient with myelopathy as initial symptom and negative spinal cord magnetic resonance imaging (MRI) and reviews common classifications of HIV-related spinal cord diseases. Case presentation: A 50-year-old male presented with weakness in both lower limbs and gait disorders for more than three months. Physical examination and various tests ruled out many possible causes. Given positive HIV and syphilis antibody in serological examination, normal spinal cord MRI and electromyogram, and after excluding other potential diagnoses through comprehensive analysis, the diagnosis of HIV-related myelopathy was established. Conclusions: Spinal cord lesions caused by HIV infection involve multiple aspects in terms of etiology and mechanism. HIV infection-related vacuolar myelopathy (HIV-VM) is the most common and typical spinal cord lesion. It usually appears at a relatively late stage of HIV infection, but it may also occur in the early stage and even serve as the initial manifestation of newly diagnosed HIV. The diagnosis of HIV myelopathy is usually exclusionary. In imaging, it often shows high T2 signal and spinal cord atrophy on spinal cord MRI, or it may also appear normal. Clinical Trial: Not applicable. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions Reduced step length is a hallmark of gait disturbance in people with Parkinson's disease (PD). Although treadmill training is effective for improving step length, the associated neural mechanisms have not been fully investigated. Moreover, exploring the baseline neurophysiological predictors for step length improvement after training could facilitate personalized gait rehabilitation for PD.The aim of this study was to investigate the neuroplastic changes in corticomotor excitability after treadmill training and to explore whether baseline neurophysiological measures could predict step length improvement in PD.Data from 61 participants with idiopathic PD who completed 12 treadmill training sessions were included. Gait performances and corticomotor excitability measured by transcranial magnetic stimulation (TMS) were obtained at baseline, postintervention, and 1‐month follow‐up. TMS outcomes included motor‐evoked potentials, cortical silent period (CSP), intracortical facilitation (ICF), and short‐interval intracortical inhibition (SICI). General estimating equation analysis and principal‐component analyses were used to determine the neuroplastic changes induced by training, and multiple linear regression analysis was performed to explore the baseline TMS predictors for step length improvement at 1‐month follow‐up.After treadmill training, SICI and CSP significantly increased and shared an emerging relationship. Regression analysis showed that female sex and greater baseline ICF and SICI were significant predictors of step length improvement at the follow‐up.This study advanced the understanding of neuroplastic changes induced by treadmill training in PD and showed that preserved SICI and ICF were predictors for lasting step length improvement after training. Future studies could investigate other influential factors for treadmill training in PD. © 2024 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Introduction: The wearable cyborg Hybrid Assistive Limb (HAL) is a therapeutic exoskeletal device that provides voluntary gait assistance using kinematic/kinetic gait data and bioelectrical signals. By utilizing the gait data automatically measured by HAL, we are developing a system to analyze the wearer's gait during the intervention, unlike conventional evaluations that compare pre- and post-treatment gait test results. Despite the potential use of the gait data from the HAL's sensor information, there is still a lack of analysis using such gait data and knowledge of gait patterns during HAL use. This study aimed to cluster gait patterns into subgroups based on the gait data that the HAL automatically collected during treatment and to investigate their characteristics. Methods: Gait data acquired by HAL, including ground reaction forces, joint angles, trunk angles, and HAL joint torques, were analyzed in individuals with progressive neuromuscular diseases. For each measured item, principal component analysis was applied to the gait time-series data to extract the features of the gait patterns, followed by hierarchical cluster analysis to generate subgroups based on the principal component scores. Bayesian regression analysis was conducted to identify the influence of the wearer's attributes on the clustered gait patterns. Results: The gait patterns of 13,710 gait cycles from 457 treatments among 48 individuals were divided into 5–10 clusters for each measured item. The clusters revealed a variety of gait patterns when wearing the HAL and identified the characteristics of multiple sub-group types. Bayesian regression models explained the influence of the wearer's disease type and gait ability on the distribution of gait patterns to subgroups. Discussion: These results revealed key differences in gait patterns related to the wearer's condition, demonstrating the importance of monitoring HAL-assisted walking to provide appropriate interventions. Furthermore, our approach highlights the usefulness of the gait data that HAL automatically measures during the intervention. We anticipate that the HAL, designed as a therapeutic device, will expand its role as a data measurement device for analysis and evaluation that provides gait data simultaneously with interventions, creating a novel cybernics treatment system that facilitates a multi-faceted understanding of the wearer's gait. [ABSTRACT FROM AUTHOR]

Background: Medroxyprogesterone acetate (MPA), a synthetic progestogen, is extensively used for the treatment of various conditions, including contraception, irregular menstruation, functional uterine bleeding, and endometriosis. However, like all pharmaceutical agents, MPA is associated with adverse drug reactions. This study aimed to evaluate the adverse events (AEs) associated with MPA in by analyzing real-world data from the U.S. Food and Drug Administration's Adverse Event Reporting System (FAERS). By providing a comprehensive assessment of the safety profile of MPA, this study seeks to support informed clinical decision-making. Methods: Data covering the period from the first quarter of 2004 to the first quarter of 2024 were collected from the FAERS database. Disproportionality analyses were conducted using several statistical methods, including reporting odds ratio (ROR), proportional reporting ratio (PRR), empirical Bayesian geometric mean (EBGM). Additionally, time-to-onset (TTO) analysis was employed to quantify the signals of the MPA-associated AEs. Results: A comprehensive dataset comprising 21,035,995 AE reports was compiled. Among these, 3,939 women reported using MPA as a contraceptive method. The reports covered 27 system organ classes (SOCs) and 25 high-frequency AE signals. Notably, significant AEs were identified, some of which were not previously detailed in the medication's prescribing information. Unforeseen significant AEs such as unintended pregnancy (n = 623; ROR, 6.65; ROR025, 6.1; χ2, 2,482.38; PRR, 6.41; EBGM, 5.69; EBGM05, 5.29), bone pain (n = 35; ROR, 13.78; ROR025, 9.4; χ2, 311.2; PRR, 13.75; EBGM, 10.59; EBGM05, 7.69), gait disturbance (n = 34; ROR, 2.82; ROR025, 1.99; χ2, 37.31; PRR, 2.88; EBGM, 2.7; EBGM05, 2.02), dental caries (n = 15; ROR, 23.16; ROR025, 12.32; χ2, 204.26; PRR, 23.14; EBGM, 15.23; EBGM05, 8.98), decrease in blood pressure (n = 15; ROR, 3.88; ROR025, 2.29; χ2, 29.35; PRR, 3.88; EBGM, 3.63; EBGM05, 2.33), and osteonecrosis (n = 9; ROR, 23.44; ROR025, 10.36; χ2, 123.67; PRR, 23.43; EBGM, 15.35; EBGM05, 7.75) were identified as AEs that were not previously outlined in the prescribing information of the medication. Conclusion: Our findings align with clinical observations, highlighting the emergence of previously unreported AE signals associated with MPA and their demographic and TTO characteristics. Further pharmaco-epidemiological studies are required to substantiate these observations. [ABSTRACT FROM AUTHOR]

Background: Peripheral neuropathies have a wide variety of causes and pathophysiologies. Assuming that there are local particularities in the Amazon region, the aim of this study was to describe the characteristics of patients by determining the factors associated with functional severity. Methods: This was a retrospective observational study at Cayenne Hospital between January 2015 and May 2023. We included patients from the French hospital activity monitoring database "Programme de médicalisation des systèmes d'information" by searching for the keywords "neuropathy" "Guillain-Barre syndrome"(GBS) "multineuritis" "polyneuritis". The Peripheral Neuropathy Disability (PND) score was determined to quantify the functional severity of patients. Results: A total of 754 patients were included, with a mean age of 60 years (SD = 14.6) and a predominance of women (53.6%). Gait disorders were present in 16.3% of patients (PND between 2 and 4). Mortality was 14.3% at 3 years. The most common causes of neuropathy were diabetes (58.2%), chemotherapy induced polyneuropathy toxicity (21.5%), Guillain-Barre syndrome (6.0%), unlabeled (3.2%), and infectious causes (2.0%). Infectious causes mainly included HIV in 13 patients (43.3%) and leprosy in 8 patients (26.7%). Only GBS was significantly associated with functional severity but all patients with a deficiency had a severe score. But, after excluding GBS, infectious causes were significantly associated with a severe PND score (aOR = 3.69 [1.18–11.58]). Discussion: The characteristics of French Guiana combine those found in developed and developing countries, with an over-representation of infections (notably HIV and leprosy), and diabetes. The causes often result from social inequalities in health. Conclusion: This is the first comprehensive study of the diverse causes of neuropathy in a territory undergoing epidemiologic transition in the Amazon region. [ABSTRACT FROM AUTHOR]

Recent research on ferroptosis and cuproptosis has underscored the crucial role of trace element regulation in osteoarthritis (OA) treatment. However, research systematically addressing the alterations in nutrient elements in OA cartilage is lacking. This study is initiated using clinical specimens to quantify metal element concentrations in both damaged and intact cartilage to identify deficient trace elements within the inflammatory and senescent microenvironments of OA. Based on the preliminary findings of selenium (Se) and gallium (Ga) deficiencies in OA cartilage, tailored nanoparticles based on Se and Ga are designed and validated for their antioxidant ability. GaSex nanoparticles demonstrated significant efficacy in mitigating chondrocyte degeneration and extracellular matrix degradation induced by inflammatory factors and in alleviating cartilage abrasion, hyperalgesia, and abnormal gait in a destabilization of the medial meniscus (DMM) mouse model. Mechanistically, GaSex nanoparticles activated the Nrf2 pathway and competitively inhibited the ubiquitin‐mediated degradation of Gpx4, thus inhibiting ferroptosis. This study systematically designed GaSex nanoparticles based on the imbalance of trace elements within the OA knee joint microenvironment and demonstrated robust antioxidant capabilities and remarkable competitive properties for ubiquitin, thereby providing a novel therapeutic solution for OA treatment. [ABSTRACT FROM AUTHOR]

Freezing of gait (FOG) is a walking disturbance that can lead to postural instability, falling, and decreased mobility in people with Parkinson's disease. This research used machine learning to predict and detect FOG episodes from plantar-pressure data and compared the performance of decision tree ensemble classifiers when trained on three different datasets. Dataset 1 (n = 11) was collected in a previous study. Dataset 2 (n = 10) included six new participants and four participants from Dataset 1 who were re-tested (approximately 2 years later), and Dataset 3 (n = 21) combined Datasets 1 and 2. The prediction model trained on Dataset 3 had a 2.28% higher sensitivity and 3.09% lower specificity compared to the models trained on Dataset 1. The model trained on Dataset 3 identified 86.84% of the total FOG episodes compared to 74.31% from the model trained on Dataset 1. Also, the model using Dataset 3 identified the FOG episodes 0.3 s earlier than the model developed with Dataset 1. The model trained using Dataset 3 showed improved performance in sensitivity, identification time, and FOG identification. The improvements using the expanded dataset (Dataset 3) in this study compared to the previous model reinforce the validity and generalizability of the original model. The model was able to predict and detect FOG well and is, therefore, ready to be implemented in a FOG prevention device. [ABSTRACT FROM AUTHOR]

Background: Irrespective of the severity, survival of a stroke has become commonplace, but many experience long-term physical, cognitive, and emotional difficulties, with walking difficulties being a frequent challenge. The community-based model of gait training is an innovative and holistic approach to neurorehabilitation that focuses on restoring mobility and enhancing the overall quality of life of stroke survivors. Aims: To assess the impact of community-based stroke rehabilitation programs from existing literatures. Objectives: To identify community-based stroke rehabilitation programs that are effective in improving function in stroke survivors. Methods: We conducted a scoping review of peer-reviewed articles to understand the impact of the community-based rehabilitation model of mobility training after stroke. We searched five different databases: PsycINFO, PubMed, CINAHL complete, Embase, and SCOPUS using topic-specific keywords. Only studies published in the English language from 2013 to 2023 were included. Results: Thirty-five articles met the inclusion criteria. Mobility training using either a treadmill or overground surfaces improved mobility. Orthotics use improved gait and balance among stroke survivors. Adapted video games for rehabilitation improved gait speed, balance, and mobility while the use of transcutaneous electrical nerve stimulation (TENS) aided functional recovery. The use of music or sound incorporated with exercises improved mobility, gait speed, and balance. Engaging in group exercises improved walking capacity, balance, walking speed, cardiovascular function, and community integration. Conclusion: Some community-based rehabilitation programs are effective in improving the physical and social recovery of stroke survivors. This concept can be considered when planning a recovery program for stroke survivors who do not have the ability to access a hospital rehabilitation setting. [ABSTRACT FROM AUTHOR]

Robot-assisted gait training (RAGT) is a promising technique for improving the gait ability of elderly adults and patients with gait disorders by enabling high-intensive and task-specific training. Gait functions involve multiple brain regions and networks. Therefore, RAGT is expected to affect not just gait performance but also neuroplasticity and cognitive ability. The purpose of this preliminary study was to verify the feasibility of the proposed RAGT design and to assess and compare the effect sizes of various measurement variables, including physical, cognitive, and neuroimaging induced by RAGT. Twelve healthy adults without any neurological or musculoskeletal disorders participated in this study. All participants wore a wearable exoskeleton robot and underwent 10 RAGT sessions. Functional data related to physical and cognitive abilities and neuroimaging data obtained from a magnetic resonance imaging (MRI) scanner and a functional near-infrared spectroscopy (fNIRS) device were acquired before and after the training sessions to assess the effect sizes of variables affected by RAGT. All participants underwent 10 sessions of RAGT without any adverse incidents, and the feasibility of the proposed RAGT design, consisting of preferred speed walking, fast speed walking, inclined walking, and squats, was validated. Variables related to physical and cognitive abilities significantly improved, but those related to neuroplasticity did not. The effect size of physical ability was "very large," whereas that of cognitive ability was "medium-to-large." The effect sizes of functional and structural neuroplasticity showed "medium" and "very small," respectively. The effect size of the RAGT varied depending on the measured variables, with the effect size being the greatest for physical ability, followed by cognitive ability, functional neuroplasticity, and structural neuroplasticity. The proposed RAGT design affects cognitive and neuroplastic effects beyond the physical effect directly affected by RAGT. This study highlights that while RAGT can positively influence cognitive outcomes beyond physical benefits, more intensive interventions may be required to elicit significant neuroplastic changes. This preliminary study offers useful information for researchers interested in designing robot-assisted training by investigating the potential extent of neuroplastic effects. Trial registration:KCT0006738. [ABSTRACT FROM AUTHOR]

Background: Arachnoid cysts are extra parenchymal, intra-arachnoid fluid collections of unknown origin, similar in content to cerebrospinal fluid. Suprasellar arachnoid cysts are a rarer localization resulting from abnormalities of the Liliequist membrane or cystic dilatation of the interpeduncular cisterna. We aimed to contribute to the literature by presenting a series of suprasellar arachnoid cyst cases with endoscopic intervention and long-term results. Methods: This study analyzed radiographic data, clinical symptoms, surgical records, and videos of giant arachnoid cysts that underwent endoscopic surgery between 2013 and 2023. Cyst volumes and Evan's indexes were calculated both preoperatively and postoperatively. Results: The patient population consisted of 3 males (21.4%, 3/14 patients) and 11 females (78.5%, 11/14 patients). Their age at the time of surgery ranged from 1 year to 56 years (mean: 14.4 years). Of the total 14 patients, 4 (28.5%, 4/14 patients) were adults (age ≥ 18 years), and 10 (71.4%, 10/14 patients) were pediatric (age < 18 years). The most common presenting complaints were gait disturbance (21.4%, 3/14 patients), headache (21.4%, 3/14 patients), increased head circumference (14.2%, 2/14 patients), hormonal disorders (14.2%, 2/14 patients), seizures (14.2%, 2/14 patients), and forgetfulness (7.1%, 1/14 patients). Ventriculocystocisternostomy was performed in all patients. The most common perioperative complication was bleeding controlled by irrigation (28.5%, 4/14 patients). The mean follow-up period was 63.8 months (min:12 months-max:125 months). In the postoperative long-term follow-up, the preoperative neurologic examinations of the patients showed complete recovery, and hormonal problems returned to normal. Conclusions: Endoscopic options for the surgery of rare giant suprasellar arachnoid cysts, especially ventriculocisternostomy, are safe, less invasive, and successful, with fewer recurrences and the need for a second operation in the long-term results of patients who underwent ventriculocisternostomy according to our experience. [ABSTRACT FROM AUTHOR]

Background/Objective: Muscle synergy analysis based on machine learning has significantly advanced our understanding of the mechanisms underlying the central nervous system motor control of gait and has identified abnormal gait synergies in stroke patients through various analytical approaches. However, discrepancies in experimental conditions and computational methods have limited the clinical application of these findings. This review seeks to integrate the results of existing studies on the features of muscle synergies in stroke-related gait abnormalities and provide clinical and research insights into gait rehabilitation. Methods: A systematic search of Web of Science, PubMed, and Scopus was conducted, yielding 10 full-text articles for inclusion. Results: By comprehensively reviewing the consistencies and differences in the study outcomes, we emphasize the need to segment the gait cycle into specific phases (e.g., weight acceptance, push-off, foot clearance, and leg deceleration) during the treatment process of gait rehabilitation and to develop rehabilitation protocols aimed at restoring normal synergy patterns in each gait phase and fractionating reduced synergies. Conclusions: Future research should focus on validating these protocols to improve clinical outcomes and introducing indicators to assess abnormalities in the temporal features of muscle synergies. [ABSTRACT FROM AUTHOR]

Objective: Benign spinal intradural tumors are rare entities and there have been relatively few case series describing the epidemiology and characteristics of these tumors. Here, we evaluate the presentation, demographics, pathology and outcomes associated with the surgical management of spinal meningioma in our unit over a 6-year period. Results: A total of 68 cases presented to the operating surgeon during a 6-year period. Of these, over 80% (n = 55) were in females. Seventy-nine percent of the meningiomas were observed in the thoracic region (n = 54). Weakness and gait disturbance were the most common presenting complaints. Surgery significantly improved both motor outcome (p < 0.001) and health related qualities of life (SF36, p < 0.01). Seventeen percent of spinal meningioma cases (n = 12) had a preceding cancer diagnosis. Of these 75% (n = 9/12) were attributable to breast cancer. Overall, breast cancer preceded a diagnosis of a spinal meningioma in 16.4% of female cases (9/55). This is higher than expected number of breast cancer based on UK population and those reported in literature for breast cancer and intracranial meningioma. Conclusion: Spinal meningioma is disproportionately over-represented in females. Patients present with neurological deficits and surgery improved both neurology and patient reported quality of life. Relative to the known UK prevalence of breast cancer, there is a significantly higher than expected association between spinal meningioma and a preceding history of breast cancer. [ABSTRACT FROM AUTHOR]

Transarterial embolization (TAE) is generally the endovascular treatment of choice for tentorial dural arteriovenous fistula (dAVF). Although flow control of the feeder vessel has been reported to achieve complete shunt blockade, flow control in the absence of ischemia tolerance of internal carotid artery as a feeder has not been reported. We present a case in which treatment by Onyx TAE with intermittent flow control of the meningohypophyseal trunk as the feeder was successful for a tentorial dAVF presenting with myelopathy without tolerance of ischemia. The intermittent flow control is presented for a tentorial dAVF presenting with myelopathy without tolerance for ischemia. An inflation of the balloon in the internal carotid artery was set for 5 minutes, and the Onyx injection was repeated at intervals of at least 2 minutes. Injections and pauses were repeated to allow Onyx to reach the shunt pouch. The patient underwent successful TAE with intermittent flow control for a tentorial dAVF presenting with myelopathy. The disappearance of the shunt was confirmed with gait disturbance resolution postoperatively. Intermittent flow control of the meningohypophyseal trunk using a balloon may be safe and effective for cases showing no tolerance for ischemia. [ABSTRACT FROM AUTHOR]

Walking is fundamental to normal human life. However, many people suffer from walking impairments due to various diseases that may severely affect their daily activities. Early detection of an abnormal gait can aid subsequent treatment and rehabilitation. This paper proposes a novel abnormal gait recognition method based on a perceptual loss convolutional temporal autoencoder (PLCTAE) network. It comprises upstream and downstream tasks, both of which utilise radar micro‐Doppler spectrograms as inputs. The upstream task employs a convolutional autoencoder with the perceptual loss to encode and decode micro‐Doppler spectrograms, achieving unsupervised pretraining and obtaining the initial parameters for the convolutional part of the PLCTAE. The downstream task fine‐tunes the convolutional part of the PLCTAE through supervised training to extract spatial features from the micro‐Doppler spectrograms and incorporates a bidirectional long short‐term memory (BiLSTM) network to further extract temporal features, accomplishing the task of abnormal gait classification. The experimental results demonstrate that the proposed method achieves good classification performance on the self‐established dataset which is collected by Texas Instruments' IWR6843ISK millimetre‐wave radar and contains eight types of abnormal gaits. The generalisation performance is also validated on a public dataset from the University of Glasgow containing six types of human activities. [ABSTRACT FROM AUTHOR]

Background: Transcranial direct current stimulation (tDCS) is a therapeutic tool for improving post-stroke gait disturbances, with ongoing research focusing on specific protocols for its application. We evaluated the feasibility of a rehabilitation protocol that combines tDCS with conventional gait training. Methods: This was a randomized, double-blind, single-center pilot clinical trial. Patients with unilateral hemiplegia due to ischemic stroke were randomly assigned to either the tDCS with gait training group or the sham stimulation group. The anodal tDCS electrode was placed on the tibialis anterior area of the precentral gyrus while gait training proceeded. Interventions were administered 3 times weekly for 4 weeks. Outcome assessments, using the 10-meter walk test, Timed Up and Go test, Berg Balance Scale, Functional Ambulatory Scale, Modified Barthel Index, and European Quality of Life 5 Dimensions 3 Level Version, were conducted before and after the intervention and again at the 8-week mark following its completion. Repeated-measures analysis of variance (ANOVA) was used for comparisons between and within groups. Results: Twenty-six patients were assessed for eligibility, and 20 were enrolled and randomized. No significant differences were observed between the tDCS with gait training group and the sham stimulation group in gait speed after the intervention. However, the tDCS with gait training group showed significant improvement in balance performance in both within-group and between-group comparisons. In the subgroup analysis of patients with elicited motor-evoked potentials, comfortable pace gait speed improved in the tDCS with gait training group. No serious adverse events occurred throughout the study. Conclusions: Simultaneous anodal tDCS during gait training is a feasible rehabilitation protocol for chronic stroke patients with gait disturbances. [ABSTRACT FROM AUTHOR]

This study introduces BagStacking, an innovative ensemble learning framework designed to enhance the detection of freezing of gait (FOG) in Parkinson's disease (PD) using accelerometer data. By synergistically combining bagging's variance reduction with stacking's sophisticated blending mechanisms, BagStacking achieves superior predictive performance. Evaluated on a comprehensive PD dataset provided by the Michael J. Fox Foundation, BagStacking attained a mean average precision (MAP) of 0.306, surpassing standalone LightGBM and traditional stacking methods. Furthermore, BagStacking demonstrated superior area under the curve (AUC) metrics across key FOG event classes. Specifically, it achieved AUCs of 0.88 for start hesitation, 0.90 for turning, and 0.84 for walking events, outperforming multistrategy ensemble, regular stacking, and LightGBM baselines. Additionally, BagStacking exhibited reduced runtime compared to other ensemble approaches, making it suitable for real-time clinical monitoring. These results underscore BagStacking's effectiveness in addressing the variability inherent in FOG detection, thereby contributing to improved patient care in PD. [ABSTRACT FROM AUTHOR]

The neuromuscular circuit mechanisms of freezing of gait in Parkinson's disease have received little study. Technological progress enables researchers chronically to sense local field potential activity of the basal ganglia in patients while walking. To study subthalamic activity and the circuit processes of supraspinal contributions to spinal motor integration, we recorded local field potentials, surface EMG of antagonistic leg muscles and gait kinematics in patients while walking and freezing. To evaluate the specificity of our findings, we controlled our findings to internally generated volitional stops. We found specific activation–deactivation abnormalities of oscillatory activity of the subthalamic nucleus both before and during a freeze. Furthermore, we were able to show with synchronization analyses that subthalamo-spinal circuits entrain the spinal motor neurons to a defective timing and activation pattern. The main neuromuscular correlates when turning into freezing were as follows: (i) disturbed reciprocity between antagonistic muscles; (ii) increased co-contraction of the antagonists; (iii) defective activation and time pattern of the gastrocnemius muscle; and (iv) increased subthalamo-muscular coherence with the gastrocnemius muscles before the freeze. Beyond the pathophysiological insights into the supraspinal mechanisms contributing to freezing of gait, our findings have potential to inform the conceptualization of future neurorestorative therapies. [ABSTRACT FROM AUTHOR]

Objective The optimal approach for improving physical function following acute hospitalization is unknown. A recent clinical trial of home health physical therapy compared a high-intensity, progressive, multi-component (PMC) intervention to enhanced usual care (EUC). While both groups improved in physical function, no between-group differences were observed. However, the EUC group received care that differed from real world practice due to standardized treatments and a higher frequency of visits. This study compared a non-randomized true usual care (TUC) group to the EUC and PMC groups. Methods Participants in the parent trial were randomly assigned to the EUC group (n = 100) and PMC group (n = 100) following hospital discharge. A subset of eligible patients (n = 55) were concurrently enrolled in the TUC group. Both the PMC and EUC groups received strength, activities of daily living, and gait training that differed in intensity but were matched in frequency and duration. TUC group care was determined by the home health agency. The primary outcome at 60-days was the Short Physical Performance Battery (SPPB). Results In comparison to the TUC group, the EUC and PMC groups had significantly greater improvements in SPPB score (EUC: +1.04 points [CI = 0.18–1.90]; PMC: +1.12 points [CI = 0.23–2.00]). Conclusion While participants in the EUC and PMC groups experienced greater functional recovery compared to those in the TUC group, it cannot be determined whether these differences are due to the interventions received or confounding factors associated with the addition of a third, non-randomized, study group during the trial period. Impact This study illustrates the importance of design and interpretation of control groups for clinical trials. Further, the differences between the TUC group and the enhanced intervention groups warrant future research exploring whether increasing visits and standardizing care improve function in older adults receiving home health physical therapy after hospital associated deconditioning. Lay summary Participants in the intervention groups received standardized and more therapy than usual care, and experienced greater functional improvements. However, these differences may be due to factors associated with the addition of a non-randomized group during an ongoing clinical trial. [ABSTRACT FROM AUTHOR]

Objective: This pilot study aims to evaluate the combined impact of peripheral nerve mobilization (PNM) and virtual reality (VR) game-based gait training on gait parameters in chronic anterior cerebral artery (ACA) stroke patients. Methods: Eight chronic ACA stroke patients were randomized into experimental (PNM + VR) and control (conventional exercises) groups. Interventions were conducted for 45 min per session, five times a week, over 4 weeks. Gait parameters were measured using the OpenPose-based Markerless Gait Analysis System. Results: Both groups showed significant improvements in post-intervention measurements. The control group exhibited a mean increase in gait speed from 0.46 m/s to 0.62 m/s (p < 0.001), while the intervention group showed improvements from 0.41 m/s to 0.54 m/s (p < 0.001). Between-group analyses revealed significant differences in gait parameters post-intervention (p < 0.05). Conclusion: PNM and VR game-based gait training emerge as effective interventions for enhancing gait parameters in ACA stroke rehabilitation. [ABSTRACT FROM AUTHOR]

The article discusses the emergence of movement and neurocognitive treatment-emergent adverse events (MNT) associated with chimeric antigen receptor T-cell (CAR-T) therapy targeting B-cell maturation antigen (BCMA) in multiple myeloma patients. It highlights cases of parkinsonism and cognitive dysfunction following CAR-T therapy, with limited treatment options and unclear pathophysiology. The study emphasizes the need for movement disorders specialists to recognize and manage these dopamine-unresponsive adverse events to avoid unnecessary diagnostic testing and harmful treatments. [Extracted from the article]

Aim: To compare spatiotemporal parameters of asymmetry in gait between fallers and non-fallers in the age group of 50–79 years under the influence of different sensitisers. Settings and design: Convenience sampling. Cross-sectional observational study. Methods and material: A cross-sectional study was conducted on a cohort of seventy-two healthy adults within the age range of 50–79 years. The participants were segregated into two distinct groups: fallers, who had experienced falls within the past year and achieved a John Hopkins score exceeding 6, and non-fallers, characterised by an absence of falls in the preceding year and a John Hopkins score lower than 6. Gait analysis was performed using a pressure-sensitive walkway system known as GaitRite. Subjects were asked to walk two times on the walkway under five different conditions (slow walking, fast, walking, fixed gaze walking, dual-task walking, and walking with weights). Data were analysed. Results: A Mann–Whitney U Test was employed to statistically compare gait asymmetry between fallers and non-fallers, revealing a significant difference. This dissimilarity in gait asymmetry was further magnified under varying sensitising conditions. Temporal parameters demonstrated more pronounced asymmetry when compared to spatial parameters. Conclusions: The result shows that sensitisers influence the asymmetry in fallers more when compared to non-fallers. The sensitisers which increased asymmetry compared to non-fallers were slow walking, fast walking, fixed gaze, dual-task, and walking with weights. This study observed that all the temporal parameters are sensitive towards asymmetry when subjects were asked to walk under different sensitisers. [ABSTRACT FROM AUTHOR]

The article presents the case study of a 21-month-old boy who developed unsteady gait and bilateral leg weakness. Topics include the initial symptoms of ataxia and leg weakness following a recent Hepatitis A vaccination and minor gastrointestinal symptoms; the physical examination and imaging, which revealed acute spondylolysis and grade 1 spondylolisthesis; and the role of orthopedic consultation, which determined the spinal findings were likely acute on chronic in nature.

Glial fibrillary acidic protein (GFAP) is an intermediate filament protein expressed mainly in astrocytes of the central nervous system (CNS), a potential biomarker of cognitive decline in Parkinson's disease (PD). The central motor subtypes of PD include tremor‐dominant (TD), postural instability and gait disorder (PIGD), and indeterminate subtypes, whose different course of disease requires the development of biomarkers that can predict progression based on motor subtypes. In this study, we aimed to assess the predictive value of cerebrospinal fluid (CSF) GFAP for PD motor subtypes in PD. Two hundred and sixteen PD patients were recruited in our study from the progression markers initiative. Patients were subgrouped into TD, PIGD, and indeterminate subtypes. Longitudinal relationships between baseline CSF GFAP and cognitive function and CSF biomarkers were assessed using linear mixed‐effects models. Cox regression was used to detect cognitive progression in TD patients. The baseline and longitudinal increases in CSF GFAP were associated with a greater decline in episodic memory, CSF α‐syn, and a greater increase of CSF NfL in TD and TD‐male subtypes. Cox regression showed that higher baseline CSF GFAP levels were corrected with a higher risk of developing mild cognitive impairment (MCI) over a 4‐year period in the PD with normal cognition (NC) group (adjusted HR = 1.607, 95% CI 1.907–2.354, p = 0.01). CSF GFAP might be a promising predictor of cognition decline in TD. [ABSTRACT FROM AUTHOR]

The article focuses on the integration of robot-assisted gait training into conventional rehabilitation for a patient with chronic neurological and functional impairments. Topics include the patient's medical history with toxoplasmic encephalitis, the implementation and outcomes of hybrid assistive limb therapy, and the potential benefits and limitations of robotic rehabilitation in enhancing neuroplasticity and functional recovery.

Objective: Interlimb coordination during walking is impaired after stroke, with unknown effects on walking function. This cross-sectional study determined associations of interlimb coordination and temporal symmetry with walking function and motor impairment. Design: During walking, participants wore wireless sensors to detect heel strikes. We calculated interlimb coordination as the phase coordination index and temporal symmetry as the ratio of contralesional (i.e., paretic) to ipsilesional (i.e., nonparetic) stance times. Associations with walking speed (10-meter walk test), walking endurance (6-min walk test), dynamic balance (Mini-Balance Evaluation Systems Test), and motor impairment (Fugl-Meyer Lower Extremity assessment) were assessed. Results: Fifty-six individuals with chronic stroke were tested. Worse interlimb coordination was correlated with slower comfortable (R = −0.38, P = 0.004) and maximal (R = −0.36, P = 0.006) walking speed and worse motor function (R = −0.45, P = 0.001). Worse temporal symmetry was correlated with worse motor function (R = 0.39, P = 0.004). Interlimb coordination had stronger associations than temporal symmetry with comfortable (R = −0.38 vs. 0.08) and maximal walking speeds (R = −0.36 vs. 0.12). Conclusions: Poor interlimb coordination was associated with slow walking and motor impairment and had stronger associations with walking speeds than temporal symmetry did. Interlimb coordination may provide unique insights into walking function and a target for walking rehabilitation after stroke. [ABSTRACT FROM AUTHOR]

Background& Objective: Giant axonal neuropathy (GAN) is a serious progressive neurodegenerative disease. The aim of this study is to evaluate the frequency and phenotypic-genotypic characteristics of GAN patients, which, like many rare diseases, is disguised under the name of polyneuropathy, and to present our experience. Methods: In this retrospective observational study, 105 pediatric patients with polyneuropathy were screened. Demographic characteristics and clinical diagnoses were reviewed. The mean age of the patients was 10.9 years (2-18), 59 were boys (56%) and 46 were girls (44%). GAN patients who were genetically diagnosed by single gene analysis were clinically evaluated in detail. Results: Regarding the etiology of polyneuropathy, 43% of patients had acquired and 57% had hereditary causes. Among hereditary cases, 29% had an unknown diagnosis, and 5% were diagnosed with GAN, presenting first with gait disturbance. These patients exhibited axonal sensorimotor polyneuropathy and diverse hair types (20% straight, 20% kinky, 40% curly, 20% slightly curly). Findings included carious teeth (40%), hyperplexia (20%), and apnea (20%). Disease progression included worsening scoliosis and limb deformities (pes cavus), with pathological cranial MRI findings. Literature identified 5 GAN patients with a homozygous deletion of GAN gene exon 2-5, classified as likely pathogenic (Class 4). Conclusion: This study highlights the frequency of GAN among undiagnosed polyneuropathies in childhood. Although the phenotype-genotype correlation for giant axonal neuropathy has not yet been determined, we hope that further studies in the field of molecular biology will increase the chances of a better quality of life. [ABSTRACT FROM AUTHOR]

An earlier observational study described selected patients with acute neck pain syndrome, who experienced short bursts of cervical vertigo elicited by rapid head movements. The current study on a larger cohort of 20 patients with chronic or frequently recurring neck pain syndrome and age-matched controls focused on two major questions: (1) Can head movements in subjects with exacerbations of neck pain and restrictions of neck mobility also elicit bursts of vertigo? (2) What is the impact on postural balance measured by analysis of body sway and locomotion? A detailed questionnaire was applied, posture and gait were evaluated by use of instrumented posturography—and gait analysis with and without slow or rapid horizontal head rotations in the yaw plane with and without sight/visual input. All patients reported some or frequent episodes of dizziness in the range of seconds only elicited by rapid, not by slow head movements. Postural sway in patients was unremarkable in undisturbed conditions without head movements, but specifically increased by rapid but not slow head turns. The latter is best explained by the lack of continuous control of velocity and amplitude of saccadic head movements. Gait analysis revealed a slowed and cautious gait pattern already at undisturbed condition that was even exaggerated during rapid head turns. These observations demonstrate that chronic or recurrent neck pain is associated with episodic experiences of dizziness and above results in both chronic and episodic alterations of stance and gait that resemble those described for patients with phobic postural vertigo/persistent postural perceptual dizziness, a functional gait disorder. [ABSTRACT FROM AUTHOR]

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

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

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Daytime sleepiness (DS) often accompanies obstructive sleep apnea (OSA), exacerbating its effects. DS can impair cognitive function, attention, reaction time, and motor coordination, increasing the risk of accidents. This study aimed to explore the relationship between DS, changes in gait and balance, and the occurrence of orofacial fractures. A narrative review was conducted using PubMed, Scopus, and Web of Science publications. The analysis revealed the impact of DS and OSA on gait and balance control in older individuals, emphasizing the need for interventions to address these issues and identify associated pathologies. Continuous Positive Airway Pressure (CPAP) therapy was recognized as a potential treatment, although further research is needed to understand DS triggers and treatment options in older populations. The study underscores the importance of analyzing interactions between the central nervous system, medications, balance, and mobility to prevent falls and related injuries. While the literature highlights the vulnerability of elderly individuals and those with OSA to falls, no established link between DS, gait, balance, and orofacial trauma necessitating medical and dental intervention was found. Thus, further research is warranted to address this gap and promote better understanding and management of these conditions. [ABSTRACT FROM AUTHOR]

Gait disorders are common in patients with subcortical ischemic vascular disease (SIVD). We aim to explore the impact of white matter (WM) damage on gait disorders in SIVD. 21 SIVD patients and 20 normal controls (NC) were included in the study. Montreal Cognitive Assessment (MoCA) was used to evaluate general cognition, while Speed-Accuracy Trade-Off (SAT) was used to assess executive function. Gait velocity, cadence, and stride length were measured. Diffusion Tensor Imaging (DTI) data were analyzed using Tract-Based Spatial Statistics (TBSS) and Peak Width of Skeletonized Mean Diffusivity (PSMD). The relationships among WM damage, gait disorders, and cognitive function were examined through mediation analysis. SIVD scored lower than NC in MoCA and SAT tests (P < 0.001). Gait velocity and stride length were decreased in SIVD. SIVD had lower PSMD (P < 0.001). PSMD correlated with gait parameters, which were totally mediated by MoCA and partially mediated by SAT. The fractional anisotropy (FA) and mean diffusivity (MD) of the genu of the corpus callosum (GCC) and body of CC (BCC) were correlated with gait parameters. The FA of the bilateral anterior corona radiata (ACR) was positively correlated with gait parameters, while the MD of the bilateral superior corona radiata (SCR), bilateral superior longitudinal fasciculus (SLF), and left external capsule (EC) were negatively correlated with them (P < 0.05). Gait impairments in SIVD were associated with cognitive deficits. Cognitive impairment mediated the WM damage and gait disorders. The microstructural alterations of CC, SLF, EC, and CR may be related to changes in gait. [ABSTRACT FROM AUTHOR]

Background This study is focused on the investigation of advanced technology with potential involvement in the process of rehabilitation of working–age patients with orthopedic and neurologic disabilities. The main advantages of the use of advanced technology are related to decrease in recovery time and increase in return-to-work rate. This study addresses the biomechanics of walking and compares different gait sessions with RELIVE system. The purpose is to highlight the effect on the plantar pressure changes the system has during these sessions. Methods The study was realized on 15 healthy, disability-free subjects tested in 6 walking sessions. All the selected sessions were characterized by one particular characteristic, walking with hands on the handrail, and each participant had to perform three walks during each session. The F-Scan device from Tekscan (research software version), attached to the participants' belt was used to record the plantar pressure for each of the 18 walks. Results When walking with hands on the handrail, with 20% body weight offload, the average pressure values were lower with the alternator turned on compared to the seasons with the alternator turned off. Additionally, the body weight offloading of the participants determined by the body weight support subsystem resulted in decreased average pressure values with each percentage of unloaded body weight. Conclusion The unloading of the participants' weight was obtained by the body weight support subsystem. In all gait sessions studied, a drawback is represented by the interferences between the alternator and the body weight support subsystem. Therefore, is mandatory to find a solution for the interference between these two systems to assure a better gait training. Thus, a good alternative for conventional rehabilitation of working-age patients could be RELIVE system. [ABSTRACT FROM AUTHOR]

Many stroke patients develop ankle deformities due to neurological or non-neurological factors, resulting in abnormal gait patterns. While Ankle-Foot Orthoses (AFOs) are commonly used to address these issues, few are specifically designed for ankle varus. The Elastic Neutral Ankle-Foot Orthosis (EN-AFO) was developed for this purpose. This study aimed to analyze changes in kinematic and kinetic gait data in stroke patients with ankle varus, comparing those walking with and without EN-AFO in both AFO and No-AFO groups. Initially, 30 stroke patients with ankle varus were screened; after exclusions, 17 were included in the final analysis. In the No-AFO group, EN-AFO significantly improved maximal ankle inversion on the affected side during the swing phase (from 4.63 ± 13.26 to 10.56 ± 11.40, p = 0.025). Similarly, in the AFO group, EN-AFO led to a significant improvement in maximal ankle inversion on the less-affected side during the swing phase (from 7.95 ± 10.11 to 12.01 ± 8.64, p = 0.021). Additionally, ground reaction forces on the affected side of the AFO group significantly increased at both the forefoot (from 182.76 ± 61.45 to 211.55 ± 70.57, p = 0.038) and hindfoot (from 210.67 ± 107.88 to 231.85 ± 105.38, p = 0.038) with EN-AFO. Conversely, maximal and minimal thoracic axial rotation on the affected side improved significantly in the No-AFO group compared to the AFO group with EN-AFO, during both the stance and swing phases (stance phase: max improvement from −1.13 ± 1.80 to 4.83 ± 8.05, min improvement from −1.06 ± 2.45 to 5.89 ± 7.56; swing phase: max improvement from −1.33 ± 2.13 to 5.49 ± 7.82, min improvement from −1.24 ± 2.43 to 5.95 ± 7.12; max p = 0.034, min p = 0.016 during stance; max p = 0.027, min p = 0.012 during swing). Furthermore, both maximal and minimal thoracic axial rotation on the less-affected side during the swing phase improved significantly in the No-AFO group (max improvement from −2.09 ± 4.18 to 6.04 ± 6.90, min improvement from −0.47 ± 2.13 to 8.18 ± 10.45; max p = 0.027, min p = 0.012) compared with the AFO group. These findings suggest that EN-AFO may effectively improve gait in stroke patients with ankle varus in the No-AFO group. [ABSTRACT FROM AUTHOR]

Gait analysis plays a pivotal role in clinical diagnostics and aids in the detection and evaluation of various disorders and disabilities. Traditional methods often rely on intricate video systems or pressure mats to assess gait. Previous studies have demonstrated the potential of artificial intelligence (AI) in gait analysis using techniques, such as convolutional neural networks (CNN) and long short-term memory (LSTM) networks. However, these methods often encounter challenges related to high dimensionality, temporal dependencies, and variability in gait patterns, making accurate and efficient classification difficult. To address these challenges, this study introduces a simple one-dimensional (1D) CNN model designed to analyze ground reaction force (GRF) patterns and classify individuals as healthy or suffering from gait disorders. The model achieved a remarkable classification accuracy of 98.65% in distinguishing healthy individuals from those with gait disorders, demonstrating significant improvements over the existing models. This performance is bolstered by the attention mechanism and standardization techniques that enhance robustness and accuracy [ABSTRACT FROM AUTHOR]

Purpose: the purpose of this study was to evaluate the safety and usability of the ATLAS 2030 in children with Cerebral Palsy (CP) and Spinal Muscular Atrophy (SMA). Materials and Methods: the sample consisted of six children, three with CP and three with SMA, who received eight sessions of robot-assisted gait therapy. Safety was measured by the presence of adverse events. Usability was measured by spatiotemporal parameters, the Six-Minute Walking Test (6MWT), and the time needed for donning and doffing, as well as satisfaction questionnaires administered to therapists and patients. Results: no serious adverse events were reported. The average cadence and number of steps per session increased throughout sessions, as well as the distance covered in the 6MWT, both in participants with CP and SMA. The mean donning time at the end of the study was 4.6 ± 1.3 min, and only one therapist was necessary to carry out all of the sessions. Satisfaction was considered high by both children and therapists. Conclusions: the ATLAS 2030 was shown to be safe for children with CP and SMA. The usability of the device was good, since a progression in the spatiotemporal parameters was observed throughout the sessions, and patient and therapist satisfaction were high. [ABSTRACT FROM AUTHOR]

Background and Purpose: activities-based locomotor training (AB-LT) is a restorative therapeutic approach to the treatment of movement deficits in people with non-progressive neurological conditions, including cerebral palsy (CP). Transcutaneous spinal stimulation (TSS) is an emerging tool in the rehabilitation of individuals with sensorimotor deficits caused by neurological dysfunction. This non-invasive technique delivers electrical stimulation over the spinal cord, leading to the modulation of spinal sensorimotor networks. TSS has been used in combination with AB-LT and has been shown to improve muscle activation patterns and enhance motor recovery. However, there are no published studies comparing AB-LT + TSS to AB-LT alone in children with CP. The purpose of this case study was to compare the impact of AB-LT alone versus AB-LT combined with TSS on functional movement and quality of life in a child with CP. Methods: A 13-year-old male with quadriplegic CP participated in this pilot study. He was classified in the Gross Motor Function Classification System (GMFCS) at Level III. He completed 20 sessions of AB-LT (5x/week), then a 2-week washout period, followed by 20 sessions of body-AB-LT + TSS. Treatment sessions consisted of 1 h of locomotor training with body weight support and manual facilitation and 30 min of overground play-based activities. TSS was applied using the RTI Xcite®, with stimulation at the T11 and L1 vertebral levels. Assessments including the Gross Motor Function Measure (GMFM), 10-m walk test (10 MWT), and Pediatric Balance Scale (PBS) were performed, while spatiotemporal gait parameters were assessed using the Zeno Walkway®. All assessments were performed at three time points: before and after AB-LT, as well as after AB-LT + TSS. OUTCOMES: After 19/20 sessions of AB-LT alone, the participant showed modest improvements in the GMFM scores (from 86.32 to 88), 10 MWT speed (from 1.05 m/s to 1.1 m/s), and PBS scores (from 40 to 42). Following the AB-LT combined with TSS, scores improved to an even greater extent compared with AB-LT alone, with the GMFM increasing to 93.7, 10 MWT speed to 1.43 m/s, and PBS to 44. The most significant gains were observed in the GMFM and 10 MWT. Additionally, improvements were noted across all spatiotemporal gait parameters, particularly at faster walking speeds. Perhaps most notably, the child transitioned from the GMFCS level III to level II by the end of the study. Discussion: Higher frequency and intensity interventions aimed at promoting neuroplasticity to improve movement quality in children with CP are emerging as a promising alternative to traditional physical therapy approaches. This case study highlights the potential of TSS to augment neuroplasticity-driven treatment approaches, leading to improvements in neuromotor function in children with CP. These findings suggest that TSS could be a valuable addition to rehabilitation strategies, warranting further research to explore its efficacy in larger populations. [ABSTRACT FROM AUTHOR]

Spasticity is a common impairment within pediatric neuromusculoskeletal disorders. How spasticity contributes to gait deviations is important for treatment selection. Our aim was to evaluate the pathophysiological mechanisms underlying gait deviations seen in children with spasticity, using predictive simulations. A cluster analysis was performed to extract distinct gait patterns from experimental gait data of 17 children with spasticity to be used as comparative validation data. A forward dynamic simulation framework was employed to predict gait with either velocity- or force-based hyperreflexia. This framework entailed a generic musculoskeletal model controlled by reflexes and supraspinal drive, governed by a multiobjective cost function. Hyperreflexia values were optimized to enable the simulated gait to best match experimental gait patterns. Three experimental gait patterns were extracted: (1) increased knee flexion, (2) increased ankle plantar flexion, and (3) increased knee flexion and ankle plantar flexion when compared with typical gait. Overall, velocity-based hyperreflexia outperformed force-based hyperreflexia. The first gait pattern could mostly be explained by rectus femoris and hamstrings velocity-based hyperreflexia, the second by gastrocnemius velocity-based hyperreflexia, and the third by gastrocnemius, soleus, and hamstrings velocity-based hyperreflexia. This study shows how velocity-based hyperreflexia from specific muscles contributes to different spastic gait patterns, which may help in providing targeted treatment. [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]

BACKGROUND: The plantarflexor weakness is a common muscle defect in patients with spastic cerebral palsy and Charcot-Marie-Tooth, which clinically manifests abnormal gaits, and the relationship between plantarflexor weakness and abnormal gaits is unclear. OBJECTIVE: To explore the biomechanical behavior of the lower limb under the action of a single factor of plantarflexor weakness to reveal the mechanism of abnormal gait induced by plantarflexor weakness and to provide guidance for the rehabilitation training of patients with plantarflexor weakness. METHODS: A predictive framework of musculoskeletal multibody dynamics in the sagittal plane was established based on OpenSim Moco to predict lower limb joint angles and muscle activation changes during walking in normal subjects. The validity of the framework was verified by combining the inverse kinematics and electromyogram activation time of the experimental data. Reduced isometric muscle forces were used to model plantarflexor weakness and to compare predicted lower extremity joint angles, joint moments, and muscle energy expenditure with normal subjects to analyze the effects of plantarflexor weakness on lower extremity biomechanics. RESULTS AND CONCLUSION: (1) The Moco-based prediction framework realistically predicted the biomechanical changes of the lower limbs during walking in normal subjects (joint angles: normalized correlation coefficient ≥ 0.73, root mean square error ≤ 7.10°). (2) The musculoskeletal model used a small stride support phase to increase the “heel-walking” gait during plantarflexor weakness. When the plantarflexor weakness reached 80%, the muscle energy expenditure was 5.691 4 J/kg/m, and the maximum activation levels of the gastrocnemius and soleus muscles were 0.72 and 0.53, which might cause the plantarflexor weakness patients to be more prone to fatigue when walking. (3) Muscle energy expenditure was significantly higher when the weakness of plantarflexors exceeded 40%, and the joint angles and moments of the lower limbs deteriorated significantly when the weakness of plantarflexors exceeded 60%, suggesting that there may be a “threshold” for the effect of plantarflexor weakness on gait, which may correspond to the point at which health care professionals should intervene in the clinical setting. [ABSTRACT FROM AUTHOR]

Context: Previous studies have found that instructions promoting an external focus (EF) tend to be more effective for movement pattern retraining compared to instructions promoting an internal focus (IF), for a variety of movement tasks. However, few studies have examined how different types of instructions affect running mechanics associated with running-related injury risk. Therefore, the purpose of this study was to compare the effects of instructions promoting different attentional foci on impact forces during running. Design: Cross-sectional study. Methods: Twenty uninjured female recreational runners ran at a self-selected speed with their typical pattern (no instructions condition) on an instrumented treadmill that measured ground reaction forces. Next, they were given 2 sets of instructions intended to alter their running pattern; one promoted an IF and the other promoted an EF. Repeated-measures analysis of variance was used to compare impact peaks and loading rates across the conditions (no instructions, IF, and EF), with post hoc tests conducted in the case of a significant omnibus test. Results: There were differences among the conditions in the impact peaks (P <.001) and loading rates (P <.001). Impact peaks were lower for the IF (P =.002) and EF (P <.001) conditions compared to the no instructions condition. Loading rates were lower for the EF condition compared to the no instructions (P <.001) and IF (P <.001) conditions; there was no difference between the IF and no instructions conditions (P =.24). Conclusions: Our findings indicate that instructions promoting an EF may be more effective at reducing loading rates during running compared to instructions promoting an IF. Clinicians should consider these findings when attempting to retrain a runner's running pattern. [ABSTRACT FROM AUTHOR]

Osmotic demyelination syndrome (ODS) is a rare complication associated with rapid sodium changes, typically encountered in patients with severe hyponatremia. ODS in patients with normonatremia (ODSIN) is less recognized. We describe a patient with MRI‐detected ODSIN following neurotrauma and reviewed the relevant literature. We present a 57‐year‐old female with subdural hematoma following ground‐level fall. Her initial sodium was 140 mEq/L but over 2 days, rose 17 mEq/L, peaking at 157 mEq/L. On exam, unexplainable, unexpected left‐sided hemiplegia with weakness sparing her face were noted; ODS was suspected. MRI revealed central pontine T2 hyperintensity, T1 hypointensity, and FLAIR hyperintensity. Treatment included gradual lowering of sodium with normal saline and free water. She was discharged to a skilled nursing facility (SNF) with sodium 138 mEq/L and upon 4‐year follow‐up had moderate disability and required some assistance to support activities of daily living. Our literature search yielded 23 cases (22 normonatremic; 1 where normonatremia progressed to hypernatremia). Common signs/symptoms were hyperreflexia, dysarthria, and gait disturbance. Common comorbidities were alcoholism, dialysis, and renal disease/failure. Cranial MRI confirmed all cases, frequently revealing central pontine T2 and FLAIR hyperintensity and T1 hypointensity. Our review further characterizes the diverse etiologies, clinical course, and radiographic features of ODSIN. Clinicians should consider this diagnosis when neurological symptoms occur even in the setting of normonatremia. [ABSTRACT FROM AUTHOR]

Objective: Cerebrospinal fluid (CSF) shunting has become the standard treatment for idiopathic normal pressure hydrocephalus (NPH). Nevertheless, there is still disagreement on diagnostic criteria for selecting patients for surgery and optimal shunt management. The primary aim of the present study was to provide an update on the status of best practice, the use of different diagnostic algorithms and therapeutic management of idiopathic NPH in an European country. Methods : A standardized questionnaire with sections on the assessment of clinical symptoms and signs of NPH, diagnostic work-up, therapeutic decision making, and operative techniques was sent to 135 neurosurgical clinics in Germany that regularly perform shunt surgeries. Results: Overall, responses were received from 114/135 (84.4%) clinics. Most responders considered gait disturbance to be the hallmark clinical sign of idiopathic NPH (96%). A lumbar tap test was utilized always/ mostly by 97 centers (86%). In 43% of the centers, 30–40 ml CSF were removed with the spinal tap test. Spinal dynamic CSF studies were used by 12 centers only occasionally, and only by 1 center always for diagnostic purposes. Ventriculo-peritoneal shunting was the most frequent type of CSF diversion (> 90%). Pressure-controlled valves were used by the majority of units (95%) Overall 102 centers (93%) always/mostly used adjustable valves, and antisiphon devices were used always/ mostly in 50% of units. Conclusion: The present survey demonstrates that there has been a remarkable change of practice and opinions on the diagnosis and treatment of idiopathic NPH over the past two decades in Germany. Remarkably, variabilities in practice among different centers are less common than previously and recommendations according to scientific publications and guidelines have been implemented more readily. [ABSTRACT FROM AUTHOR]

Introduction: Despite using beta oscillations within the subthalamic nucleus as a biomarker of akinesia or rigidity in Parkinson's disease, a specific biomarker for freezing of gait (FOG) remains unclear. Recently, scalp phase-amplitude coupling (PAC) measured through scalp electroencephalography (EEG) has emerged as a promising tool for analyzing brain function. In this study, we examined whether PAC could be a biomarker for FOG. Methods: We enrolled 11 patients with Parkinson's disease and recorded scalp EEG in preparation for and during gait while simultaneously assessing motor function, including FOG. We investigated changes in cortical PAC during walking with and without FOG and examined its correlation with the postural instability and gait difficulty (PIGD) score. Results: Patient characteristics were as follows: mean age 59.1 ± 6.9 years, disease duration 13.9 ± 4.1 years, and seven men. Four trials were excluded from the analysis owing to artifacts. In the trials without FOG (n = 18), beta-gamma PAC in the sensorimotor area decreased during gait preparation (p = 0.011; linear mixed-effects model), which was not the case in trials with FOG (n = 6) (p = 0.64; linear mixed-effects model). Using a support vector machine, machine learning of PAC during preparation for walking predicted the presence of FOG with an accuracy of 71.2%. Conversely, PAC increased during walking in trials with FOG (p = 0.0042; linear mixed-effects model), and PAC 20 s after the start of walking was positively correlated with the PIGD score (correlation coefficient = 0.406, p = 0.032; Pearson's rank correlation). Conclusion: Beta-gamma PAC in the sensorimotor area during preparation for walking differs depending on the emergence of FOG. As gait symptoms worsened, beta-gamma PAC in the sensorimotor area during walking gradually increased. Cortical PAC may be a biomarker for FOG in Parkinson's disease and may lead to the development of strategies to prevent falls in the future. [ABSTRACT FROM AUTHOR]

Background: Over the past few years, the development of telerehabilitation has advanced rapidly. Patients with Parkinson's disease (PwPD) often have difficulty with mobility, making it challenging for them to perform centre-based exercise.This study aims to compare the effectiveness and adherence of home physical therapy (HPT) and telerehabilitation (TR) in mitigating motor symptoms and improving the quality of life in patients with mild to moderate Parkinson's disease. Methods: This randomized controlled trial included a total of 190 patients who underwent in-person eligibility assessment, with 100 allocated to the HPT group and 90 to the TR group. Both interventions consisted of home-based training sessions lasting 40–60 min and were conducted five times a week for 4 weeks. The primary outcome was the Unified Parkinson's Disease Rating Scale motor section (UPDRS3) score. Secondary outcomes included balance function, assessed using the Berg Balance Scale (BBS); risk of fall, evaluated through the Timed Up-and-Go test (TUG) and the Five Times Sit-to-Stand test (FTSST); gait, measured using the Freezing of Gait Questionnaire (FOGQ) and IDEEA activity monitor; muscle strength, evaluated using the isokinetic dynamometry; motor aspects of experiences of daily living (UPDRS2); and quality of life, assessed by Parkinson's Disease Questionnaire-39 (PDQ-39). Results: There was a significant difference in the UPDRS3, BBS, TUG, FTSST, FOGQ,step length, step velocity,preswing angle, UPDRS2 and PDQ-39 between baseline and 4 weeks in both groups. The decrease in the UPDRS3 score was significantly greater in the HPT group (-3.38 points) than in the RE group (-1.45 points) in the older age group (P = 0.021), but there was no significant between-group difference in the younger age group (P = 0.416). Similar changes favouring the HPT group were observed in the BBS, TUG, step velocity, and extension average torque. 7 (7%) patients in the HPT group and 12 (13%) patients in the TR group did not complete their daily exercise plan. Conclusions: Both HPT and TR have demonstrated effectiveness, safety, and feasibility in PwPD. However, the HPT program exhibited greater effectiveness among older patients and higher patient compliance compared to TR. Trial registration: Chictr.org.cn, ChiCTR2300071648. Registered on 22 May 2023—retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=196313. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is the second‐fastest growing neurodegenerative disease in the world. The major clinical symptoms rigor, tremor, and bradykinesia derive from the degeneration of the nigrostriatal pathway. However, PD is a multi‐system disease, and neurodegeneration extends beyond the degradation of the dopaminergic pathway. Symptoms such as postural instability, freezing of gait, falls, and cognitive decline are predominantly caused by alterations of transmitter systems outside the classical dopaminergic axis. While levodopa and deep brain stimulation (DBS) of the subthalamic nucleus or globus pallidus internus effectively address PD primary motor symptoms, they often fall short in mitigating axial symptoms and cognitive impairment. Along these lines, the cholinergic system is increasingly recognized to play a crucial role in governing locomotion, postural stability, and cognitive function. Thus, there is a growing interest in bolstering the cholinergic tone by DBS of cholinergic targets such as the pedunculopontine nucleus (PPN) and nucleus basalis of Meynert (NBM), aiming to alleviate these debilitating symptoms resistant to traditional treatment strategies targeting the dopaminergic network. This review offers a comprehensive overview of the role of cholinergic dysfunction in PD. We discuss the impact of PPN and NBM DBS on the management of symptoms not readily accessible to established DBS targets and pharmacotherapy in PD and seek to provide guidance on patient selection, surgical approach, and stimulation paradigms. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodsResultsConclusionVarus thrust (VT) is a frequently reported abnormal gait pattern in patients with medial knee osteoarthritis (KOA). VT is important to prevent KOA progression. However, there is no consensus on the relationship between VT and foot alignment and flexibility, although it has been reported that patients with KOA have pronated foot.In this study, we examined the relationship between VT, foot alignment, and flexibility in patients with KOA.Twenty patients with unilateral KOA were included in this study (mean age: 71.5 ± 4.7 years). KOA severity ranged from grade III (8 patients) to grade IV (12 patients) based on the Kellgren-Lawrence classification. Gait analysis using inertial sensors was performed to determine the difference between the VT of KOA side and the contralateral side without symptoms. The correlations between VT, foot alignment, and flexibility were also analyzed.VT was significantly greater on the side with KOA than on the contralateral side without KOA (d = 1.09, p = .002). VT was not significantly correlated with foot alignment but was significantly correlated with the arch stiffness index, which indicates foot flexibility (r = 0.642, p = .003).This study suggests that foot flexibility may play a more significant role than foot alignment in addressing VT in patients with KOA. When performing physical therapy for VT, evaluating foot flexibility in addition to foot alignment may help reduce this condition. Further studies with larger sample sizes and more detailed statistical analyses are needed to validate these findings. [ABSTRACT FROM AUTHOR]

Background/Objectives: This paper proposes a method for managing gait imbalances by integrating the Internet of Things (IoT) and machine learning technologies. Ankle–foot orthosis (AFO) devices are crucial medical braces that align the lower leg, ankle, and foot, offering essential support for individuals with gait imbalances by assisting weak or paralyzed muscles. This research aims to revolutionize medical orthotics through IoT and machine learning, providing a sophisticated solution for managing gait issues and enhancing patient care with personalized, data-driven insights. Methods: The smart ankle–foot orthosis (AFO) is equipped with a surface electromyography (sEMG) sensor to measure muscle activity and an Inertial Measurement Unit (IMU) sensor to monitor gait movements. Data from these sensors are transmitted to the cloud via fog computing for analysis, aiming to identify distinct walking phases, whether normal or aberrant. This involves preprocessing the data and analyzing it using various machine learning methods, such as Random Forest, Decision Tree, Support Vector Machine (SVM), Artificial Neural Network (ANN), Long Short-Term Memory (LSTM), and Transformer models. Results: The Transformer model demonstrates exceptional performance in classifying walking phases based on sensor data, achieving an accuracy of 98.97%. With this preprocessed data, the model can accurately predict and measure improvements in patients' walking patterns, highlighting its effectiveness in distinguishing between normal and aberrant phases during gait analysis. Conclusions: These predictive capabilities enable tailored recommendations regarding the duration and intensity of ankle–foot orthosis (AFO) usage based on individual recovery needs. The analysis results are sent to the physician's device for validation and regular monitoring. Upon approval, the comprehensive report is made accessible to the patient, ensuring continuous progress tracking and timely adjustments to the treatment plan. [ABSTRACT FROM AUTHOR]