Search

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]

Both navigation abilities and gait can be affected by the atrophy in the medial temporal cortex. This study aimed to determine whether navigation abilities could differentiate seniors with and without medial temporal lobe atrophy who complained about their cognitive status. The participants, classified to either the medial temporal atrophy group (n = 23) or the control group (n = 22) underwent neuropsychological assessment and performed a spatial navigation task while their gait parameters were recorded. The study showed no significant differences between the two groups in memory, fluency, and semantic knowledge or typical measures of navigating abilities. However, gait parameters, particularly the propulsion index during certain phases of the navigation task, distinguished between seniors with and without medial temporal lobe lesions. These findings suggest that the gait parameters in the navigation task may be a valuable tool for identifying seniors with cognitive complaints and subtle medial temporal atrophy. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the United States, there are over seven million stroke survivors, with many facing gait impairments due to foot drop. This restricts their community ambulation and hinders functional independence, leading to several long-term health complications. Despite the best available physical therapy, gait function is incompletely recovered, and this occurs mainly during the acute phase post-stroke. Therapeutic options are limited currently. Novel therapies based on neurobiological principles have the potential to lead to long-term functional improvements. The Brain-Computer Interface (BCI) controlled Functional Electrical Stimulation (FES) system is one such strategy. It is based on Hebbian principles and has shown promise in early feasibility studies. The current study describes the BCI-FES clinical trial, which examines the safety and efficacy of this system, compared to conventional physical therapy (PT), to improve gait velocity for those with chronic gait impairment post-stroke. The trial also aims to find other secondary factors that may impact or accompany these improvements and establish the potential of Hebbian-based rehabilitation therapies. METHODS: This Phase II clinical trial is a two-arm, randomized, controlled, longitudinal study with 66 stroke participants in the chronic (> 6 months) stage of gait impairment. The participants undergo either BCI-FES paired with PT or dose-matched PT sessions (three times weekly for four weeks). The primary outcome is gait velocity (10-meter walk test), and secondary outcomes include gait endurance, range of motion, strength, sensation, quality of life, and neurophysiological biomarkers. These measures are acquired longitudinally. DISCUSSION: BCI-FES holds promise for gait velocity improvements in stroke patients. This clinical trial will evaluate the safety and efficacy of BCI-FES therapy when compared to dose-matched conventional therapy. The success of this trial will inform the potential utility of a Phase III efficacy trial. TRIAL REGISTRATION: The trial was registered as BCI-FES Therapy for Stroke Rehabilitation on February 19, 2020, at clinicaltrials.gov with the identifier NCT04279067.

We aimed to investigate the effects of delivering 3 gait retraining interventions (toe-in, toe-out, and placebo gait) on proxy measures of medial knee load (early- and late-stance peak knee adduction moment [KAM], KAM impulse, and varus thrust) in people with knee osteoarthritis, using a hybrid model of face-to-face and telehealth-delivered sessions over 5 months. This was an originally planned 3-arm randomized placebo-controlled clinical trial. However, during the 2021 COVID-19 outbreak and lockdown in Sydney, Australia, the study became a pilot randomized controlled trial with the remainder of interventions delivered via telehealth. Nine individuals with symptomatic medial knee osteoarthritis were allocated to receive either a toe-in, toe-out, or posture re-education (placebo) gait retraining intervention. Primary outcomes of early- and late-stance peak KAM, KAM impulse, and varus thrust were assessed at baseline and follow-up. Eight participants returned for their follow-up gait assessment. Participants in both active intervention groups (toe-in and toe-out) achieved foot progression angle changes at follow-up. Overall, knee biomechanics in the placebo group did not change at follow-up. It is possible to achieve biomechanical changes in individuals with medial knee osteoarthritis when delivering gait retraining interventions via a hybrid model of face-to-face and telehealth. [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]

This study aimed to observe the characteristics of foot posture asymmetry and abnormal gait in patients with unilateral and bilateral knee osteoarthritis (KOA) and to explore the association between foot posture asymmetry, abnormal gait and the clinical symptoms and severity of KOA. Sixty patients with KOA were allocated as follows: unilateral group (UG; n = 30) and bilateral group (BG; n = 30). We accessed foot posture, foot posture asymmetry, gait and plantar pressure parameters and symmetry index, clinical symptom-related scores and disease severity, and investigated the relationship between these variables. The results showed that the overall percentage of asymmetry and severe asymmetry in foot posture were lower in BG than in UG. There was substantial asymmetry in many gait indicators within the two groups, but no significant differences were observed between the two groups. Moreover, foot posture asymmetry, multiple gait and plantar pressure parameters and symmetry indices were closely related to clinical symptoms and disease severity. In conclusion, both unilateral and bilateral KOA patients have foot posture asymmetry and gait asymmetry, but the foot posture asymmetry of the former is more severe than that of the latter. Intervention for this population should treat simultaneously both knee joints. The evaluation and monitoring of foot posture asymmetry, gait and plantar pressure parameters and symmetry indices can provide a more comprehensive and scientific basis for the prevention and treatment of KOA. [ABSTRACT FROM AUTHOR]

Background and objective: There are multiple pharmacological treatment options for motor symptoms of Parkinson's disease (PD). These comprise multiple drug classes which are approved for the condition, including levodopa, dopamine agonists, COMT inhibitors, MAO-B inhibitors, NMDA-receptor antagonists, anticholinergics, and others. Some of the drugs are approved for monotherapy and combination therapy while others are only approved as adjunctive therapy to levodopa. Furthermore, treatment for special treatment situations, e.g., rescue medication for off-phases, for tremor, treatment during pregnancy and breast feeding is discussed and recommendations are given with further details. Methods: The recommendations were based on systematic literature reviews, drafted by expert teams, consented in online polls followed by online consensus meetings of the whole German Parkinson's Guideline Group, and publicly released in November 2023. Results: In the new S2k (i.e., consensus-based) guidelines, the pharmacotherapy of the motor symptoms of PD is discussed in five chapters. These comprise "Parkinson medication", "Initial monotherapy", "Early combination therapy", "Fluctuations and dyskinesia", and "Parkinsonian tremor". Furthermore, there is a chapter for special treatment situations, including perioperative management, freezing of gait, and pregnancy and breastfeeding. Conclusion: The recommendations for the pharmacotherapy of motor symptoms of PD have been updated. Newly available drugs have been added, while other drugs (e.g., ergoline dopamine agonists, anticholinergics, budipine) have been removed from the recommendations. [ABSTRACT FROM AUTHOR]

Freezing of gait (FOG) is a disabling motor symptom prevalent in patients with Parkinson's disease (PD); however, its pathophysiological mechanisms are poorly understood. This study aimed to investigate whole‐brain functional connectivity (FC) pattern alterations in PD patients with FOG. A total of 18 PD patients, 10 with FOG (PD‐FOG) and 8 without FOG (PD‐nFOG), and 10 healthy controls were enrolled. High‐resolution 3D T1‐weighted and resting‐state functional MRI (rs‐fMRI) data were obtained from all participants. The groups' internetwork connectivity differences were explored with rs‐fMRI FC using seed‐based analysis and graph theory. Multiple linear regression analysis estimated the relationship between FC changes and clinical measurements. Rs‐fMRI analysis demonstrated alterations in FC in various brain regions between the three groups. Freezing of Gait Questionnaire severity was correlated with decreased brain functional connection between Vermis12 and the left temporal occipital fusiform cortex (r = −0.82, P <.001). Graph theory topological metrics indicated a decreased clustering coefficient in the right superior temporal gyrus in the PD‐nFOG group. PD‐FOG patients exhibited a compensatory increase in connectivity between the left inferior frontal gyrus language network and the postcentral gyrus compared to PD‐nFOG patients. Further, the decreased connection between Vermis 12 and the left temporal occipital fusiform cortex may serve as a potential neuroimaging biomarker for tracking PD‐FOG and distinguishing between PD subtypes. [ABSTRACT FROM AUTHOR]

Background: The "gold standard" marker for freezing of gait severity is percentage of time spent with freezing observed through video analysis. Objective: This study examined inter- and intra-rater reliability and variability of physiotherapists rating freezing of gait severity through video analysis and explored the effects of experience. Methods: Thirty physiotherapists rated 14 videos of Timed Up and Go performance by people with Parkinson's and gait freezing. Ten videos were unique, while four were repeated. Freezing frequency, total duration, and percentage of time spent with freezing were computed. Reliability and variability were estimated using ICC (2,1) and mean absolute differences. Between-group differences were calculated with the one-way ANOVA. Results: Inter- and intra-rater reliability ranged from moderate to good (ICC: inter-rater frequency = 0.63, duration = 0.78, percentage = 0.50; intra-rater frequency = 0.84, duration = 0.89, percentage = 0.50). Variability for freezing frequency was two episodes. Inter- and intra-rater variability for total freezing duration was 18.8 and 12.3 seconds, respectively. For percentage of time spent with freezing, this was 15.2% and 13.5%. Physiotherapy experience had no effect. Conclusion: Physiotherapists demonstrated sufficient reliability, but variability was large enough to cause changes in severity classifications on existing rating scales. Percentage of time spent with freezing was the least reliable marker, supporting the use of freezing frequency or total duration instead. [ABSTRACT FROM AUTHOR]

This study aimed to assess the effectiveness and safety of botulinum toxin (BTX) injections for managing motor disorders in patients with Parkinson's disease (PD). An electronic search was conducted based on Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Data from available randomized controlled trials (RCTs) assessing BTX injections for motor disorders in PD patients were extracted for meta‐analysis. Ultimately, 215 patients from eight RCTs were enrolled. Pooled analyses indicated that BTX was more effective than placebo in improving tremor (standardized mean difference [SMD] = 0.96, 95% CI [0.34, 1.58], p < 0.01), whereas no notable differences were observed between BTX and placebo regarding freezing of gait (SMD = 0.66, 95% CI [−0.26, 1.58], p = 0.162), United Parkinson's Disease Rate Scale (UPDRS) III score (SMD = −0.20, 95% CI [−1.17, 0.76], p = 0.68) and clinical global impression (CGI) score (SMD = 0.84, 95% CI [−0.74, 2.42], p = 0.298). Adverse events related to BTX injections were comparable to placebo (OR = 1.74, 95% CI [0.59, 5.14], p = 0.32). The current evidence suggests that BTX is effective and safe in treating PD tremor but fails to provide therapeutic benefits for freezing of gait and motor functional scores in PD patients. Furthermore, the limited number of included studies and heterogeneity in BTX intervention protocols suggest more research is needed, with additional standardized RCTs, to better understand and optimize BTX injections for motor disorders in PD. [ABSTRACT FROM AUTHOR]

Background: Postural instability and gait disorder and cognitive dysfunction are common symptoms of Parkinson’s disease (PD). Scale assessment is frequently used in the clinic to evaluate PD, but this technique is limited by its lack of sensitivity to changes in disease progression and its difficulty in capturing subtle movements and changes in cognitive function. It is currently believed that high-frequency repetitive transcranial magnetic stimulation (rTMS) can improve motor and cognitive dysfunction in patients with PD, though it remains controversial. Therefore, it is imperative to monitor and dynamically identify changes in postural instability and gait disorder, as well as those in cognitive dysfunction, in PD to develop targeted interventions. In this study, we observed the effect of high-frequency rTMS on gait disorders and cognitive functions in patients with PD by comparing data from wearable devices and eye-tracking devices before and after treatment. Methods: A total of 159 patients with PD were included in this study. A GYENNO MATRIX wearable gait analyzer was used to monitor the objective gait data (including the timed up-and-go, narrow-track, and turning tests), the Eyeknow eye-tracking evaluation system was used to monitor the patient’s eye movement cognition data (including the smooth pursuit, pro-saccade, and anti-saccade tests), and gait and cognitive function–related scales, including the Tinetti Balance Scale, Tinetti Gait Scale, Berg Balance Scale, Mini-Mental State Examination, and Montreal Cognitive Assessment (MoCA), were evaluated at the same time before and after high-frequency rTMS treatment. Results: The mean step length, mean stride velocity, stride length, and mean step frequency of patients with PD in the timed up-and-go test all increased compared with those before rTMS treatment, whereas the mean stride time and double support decreased. In the narrow-track test, the mean stride velocity increased and the mean stride time decreased. In the turning test, the turning left duration, turning right duration, mean duration, mean number of steps, and average step duration decreased, while the mean angular velocity increased after rTMS treatment. Compared with those before rTMS treatment, the latency period of patients with PD in overlapping saccades decreased, the completion time of overlapping saccades decreased, and the average saccade speed increased. In the anti-saccade test, the completion time decreased and the average saccade speed increased after rTMS treatment. Compared with those before rTMS treatment, the Tinetti Balance Scale, Tinetti Gait Scale, Berg Balance Scale, Mini-Mental State Examination, and MoCA scores increased, and the MoCA sub-items improved in terms of visual–spatial and executive function, language, abstraction, delayed recall, and orientation after rTMS treatment. Conclusion: High-frequency rTMS may be an effective therapy for improving gait disorders and cognitive functions in patients with PD. [ABSTRACT FROM AUTHOR]

Introduction: Profuse diarrhea and abdominal discomfort are well-documented symptoms of patients with known colorectal cancer. It is much less common for these patients to present with a chief complaint of gait disturbance and rhabdomyolysis. We present a case of incidentally discovered colorectal carcinoma in a patient who was initially evaluated for progressive weakness and recurrent falls. Case Presentation: A 51-year-old man was admitted to our department for management of rhabdomyolysis in the setting of progressive lower extremity weakness and mechanical falls. He developed abdominal discomfort and bowel changes during his admission, and after further investigation, he was found to have a rectal polyp positive for invasive adenocarcinoma, as well as multiple gluteal abscesses. Workup for metastasis, mutations, and oncogenic biomarkers was unremarkable. Conclusion: This case is a demonstration of a medically complex patient presentation compounded by multifactorial processes. Future providers may take note that an initial absence of classic gastrointestinal (GI) symptoms does not necessarily rule out underlying GI cancer. Instead, the initial presentation of colorectal adenocarcinoma may manifest with paraneoplastic versus incidental progressive proximal limb weakness prior to GI symptoms such as diarrhea. Additionally, our report demonstrates a case of possible paraneoplastic gluteal abscesses, which may have further contributed to the patient’s gait disturbance. However, it is unclear as to whether our patient’s various symptoms were directly linked to one another, or if they were incidental co-presentations. [ABSTRACT FROM AUTHOR]

Objective Methods Results Interpretation To investigate the effects of directional subthalamic deep brain stimulation (STN‐dDBS) on gait and balance disorders, including freezing of gait (FOG), in patients with advanced Parkinson's disease (PD).We included 10 participants who underwent STN‐DBS and presented severe preoperative FOG, in a randomized, double‐blind, crossover study. We used segmented DBS electrodes to investigate whether directing the predicted volume of tissue activated (VTA) to overlap the central STN preferentially improved gait and balance disorders compared to directional DBS applied in the more posterior STN (sensorimotor). We also assessed non‐directional (ring‐mode) STN‐DBS. Our primary outcome was gait and balance control measured using instrumented gait recordings. Each patient had a pre‐operative structural and diffusion‐weighted imaging to model individual VTAs and to examine cortico‐subthalamic connectivity. We used linear mixed‐effects models to contrast the effects of central STN‐dDBS, posterior STN‐dDBS, and ring‐mode STN‐DBS.Central STN‐dDBS produced significantly better improvement in gait and balance control compared to posterior STN‐dDBS (p = 0.027), with fewer FOG episodes (p < 0.001). Conversely, ring‐mode STN‐DBS resulted in worsened postural control compared to central STN‐dDBS (p = 0.009). The cortico‐subthalamic connectivity with the STN VTAs involved mostly primary sensorimotor, premotor, and medial frontal cortices, with a higher overall cortico‐STN connectivity with ring‐mode STN‐DBS.Central STN‐dDBS represents the best option to improve gait and balance disorders in PD patients, including FOG. Our findings raise the possibility of reprogramming STN‐DBS toward the central area in selected patients with disabling FOG and/or postural instability after surgery. ANN NEUROL 2024 [ABSTRACT FROM AUTHOR]

Background: Freezing of gait (FOG) is an important milestone in the individual disease trajectory of people with Parkinson's disease (PD). Based on the cognitive model of FOG etiology, the mechanism behind FOG implies higher executive dysfunction in PDFOG+. To test this model, we investigated the FOGrelated phenotype and cognitive subdomains in idiopathic PD (iPD) patients without genetic variants linked to PD from the Luxembourg Parkinson's study. Methods: A cross-sectional analysis comparing iPDFOG+ (n = 118) and iPDFOG- (n = 378) individuals was performed, followed by the application of logistic regression models. Consequently, regression models were fitted for a subset of iPDFOG+ (n = 35) vs. iPDFOG- (n = 126), utilizing a detailed neuropsychological battery to assess the association between FOG and cognitive subdomains. Both regression models were adjusted for sociodemographic confounders and disease severity. Results: iPDFOG+ individuals presented with more motor complications (MDSUPDRS IV) compared to iPDFOG- individuals. Moreover, iPDFOG+ individuals exhibited a higher non-motor burden, including a higher frequency of hallucinations, higher MDS-UPDRS I scores, and more pronounced autonomic dysfunction as measured by the SCOPA-AUT. In addition, iPDFOG+ individuals showed lower sleep quality along with lower quality of life (measured by PDSS and PDQ-39, respectively). The cognitive subdomain analysis in iPDFOG+ vs. iPDFOG- indicated lower scores in Benton's Judgment of Line Orientation test and CERAD word recognition, reflecting higher impairment in visuospatial, executive function, and memory encoding. Conclusion: We determined a significant association between FOG and a clinical endophenotype of PD with higher non-motor burden. While our results supported the cognitive model of FOG, our findings point to a more widespread cortical impairment across cognitive subdomains beyond the executive domain in PDFOG+ with additional higher impairment in visuospatial function and memory encoding. [ABSTRACT FROM AUTHOR]

Striatum and its predominant input, motor cortex, are responsible for the selection and performance of purposive movement, but how their interaction guides these processes is not understood. To establish its neural and behavioral contributions, we bilaterally lesioned motor cortex and recorded striatal activity and reaching performance daily, capturing the lesion's direct ramifications within hours of the intervention. We observed reaching impairment and an absence of striatal motoric activity following lesion of motor cortex, but not parietal cortex control lesions. Although some aspects of performance began to recover after 8–10 days, striatal projection and interneuronal dynamics did not—eventually entering a non-motor encoding state that aligned with persisting kinematic control deficits. Lesioned mice also exhibited a profound inability to switch motor plans while locomoting, reminiscent of clinical freezing of gait (FOG). Our results demonstrate the necessity of motor cortex in generating trained and untrained actions as well as striatal motoric dynamics. [Display omitted] • Motor, but not parietal, cortex is necessary for performing goal-directed actions • Movement-related dynamics in the striatum are absent following lesions of M1 • Behavior and striatal activity partly recover but are not comparable to pre-lesion • M1 lesions cause freezing of gait, suggesting its role in motor-state regulation Nicholas and Yttri find that in the absence of motor cortex, the stratum alone is not capable of producing goal-directed behavior. Lesions of motor cortex also produce a freezing of gait-like behavior, implicating motor cortex in the setting and updating of motor state. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions In Parkinson's disease (PD), postural instability and gait disorder (PIGD) symptoms are associated with a worse prognosis for an unknown reason.The objective was to explore the relationship between cannabinoid receptor type 1 (CB1R) availability and motor symptoms in PD with [18F]FMPEP‐d2 positron emission tomography (PET).Fifteen individuals with PD underwent [18F]FMPEP‐d2 PET to measure cerebral CB1R availability. The Unified Parkinson's Disease Rating Scale motor part (UPDRS‐III) was used to evaluate the motor symptoms.A negative correlation was observed between [18F]FMPEP‐d2 VT and PIGD score (P = 0.002) as well as rigidity subscore (P < 0.001). Both clusters covered widespread areas of both hemispheres. In contrast, tremor or bradykinesia did not correlate to [18F]FMPEP‐d2 VT.Gait, postural instability, and rigidity in PD are associated with decreased CB1R availability, unlike tremor or bradykinesia, suggesting that the endocannabinoid system has a role in the pathophysiology of different motor symptoms in PD. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

The article discusses a case report of a female patient who developed Parkinsonism after receiving chimeric antigen receptor T-cell therapy targeting B-cell maturation antigen for multiple myeloma. The patient experienced movement and neurocognitive treatment-emergent adverse events, including bradykinesia, hypomimia, and cognitive dysfunction. Despite treatment with steroids and IVIg, the Parkinsonism did not improve, and the patient relied on caregivers for daily activities. The article highlights the challenges in treating CAR-T associated Parkinsonism and the need for further research in this area. [Extracted from the article]

In this study, we investigated the pathological effects of novel goose parvovirus (NGPV) infection on the skeletal muscle, brain, and intestine of naturally affected ducks suffering from locomotor dysfunction as a new approach for a deeper understanding of this clinical form. For this purpose, a total of 97 diseased ducks, representing 24 flocks of different duck breeds (14–75 days old), were clinically examined. In total, 72 tissue pools of intestine, brain, and skeletal muscle samples were submitted for molecular identification. Typical clinical signs among the examined ducks suggested parvovirus infection. Regarding postmortem examination, all examined ducks showed muscle emaciation (100%) either accompanied by congestion (34%) or paleness (66%). Slight congestion, either in the brain (82.5%) or intestine (75.25%), was predominantly detected. Based on molecular identification, the intestine had the highest percentage of positive detection (91.7%), followed by the skeletal muscle (70.8%), and the brain (20.8%). The main histopathological alterations were myofibre atrophy and degeneration, marked enteritis accompanied by lymphocytic infiltration in the lamina propria and submucosa, while the affected brains showed vasculitis, diffuse gliosis, and Purkinje cell degeneration in the cerebellum. Next-generation sequencing further confirmed the presence of a variant strain of goose parvovirus (vGPV) that is globally known as NGPV and closely related to Chinese NGPV isolates. Using immunohistochemistry, the NGPV antigen was positively detected in the muscle fibres, enterocytes, and Purkinje cells in the cerebellum. These findings provided proof of the involvement of virus replication in the locomotor disorders linked to NGPV infection in ducks. [ABSTRACT FROM AUTHOR]

Introduction: The rate of adjustment in a movement, driven by feedback error, is referred to as the adaptation rate, and the rate of recovery of a newly adapted movement to its unperturbed condition is called the de-adaptation rate. The rates of adaptation and de-adaptation are dependent on the training mechanism and intrinsic factors such as the participant’s sensorimotor abilities. This study investigated the facilitation of the motor adaptation and de-adaptation processes for spatiotemporal features of an asymmetric gait pattern by sequentially applying split-belt treadmill (SBT) and asymmetric rhythmic auditory cueing (ARAC). Methods: Two sessions tested the individual gait characteristics of SBT and ARAC, and the remaining four sessions consisted of applying the two interventions sequentially during training. The adjustment process to the second intervention is referred to as “re-adaptation” and is driven by feedback error associated with the second intervention. Results: Ten healthy individuals participated in the randomized six-session trial. Spatiotemporal asymmetries during the adaptation and post-adaptation (when intervention is removed) stages were fitted into a two-component exponential model that reflects the explicit and implicit adaptation processes. A double component was shown to fit better than a single-component model. The decay constants of the model were indicative of the corresponding timescales and compared between trials. Results revealed that the explicit (fast) component of adaptation to ARAC was reduced for step length and step time when applied after SBT. Contrarily, the explicit component of adaptation to SBT was increased when it was applied after ARAC for step length. Additionally, the implicit (slow) component of adaptation to SBT was inhibited when applied incongruently after ARAC for step time. Discussion: These outcomes show that the role of working motor memory as a translational tool between different gait interventions is dependent on (i) the adaptation mechanisms associated with the interventions, (ii) the targeted motor outcome of the interventions; the effects of factors (i) and (ii) are specific to the explicit and implicit components of the adaptation processes; these effects are unique to spatial and temporal gait characteristics. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) disorder is caused by the imbalance of inhibitory dopamine and excitatory acetylcholine neurotransmitters, which causes hindrance in locomotion. Freezing of gait (FOG), tremors, and bradykinesia are the most debilitating and disconcerting symptoms of Parkinson's Disease (PD). FOG episodes occur due to neurological control disorder and motorized impairments, which sternly hinder voluntary movement and forward locomotion. The computational intelligence techniques can effectively predict PD from the sensor data. To detect the FOG episodes often experienced by PD patients, this paper utilizes a 5G spectrum that operates at 4.8 GHz. The main idea of the proposed system is to extract the wireless channel characteristics information (containing amplitude variances) that can be integrated into a 5G communication system. This system collects data through wireless devices such as dipole antennas, network interface cards, and RF signal generators. Five human activities were performed: fast walking, slow walking, sitting on a chair, FOG episodes, and voluntary stopping. We proposed a novel deep dual self-attention and Bi-LSTM fusion architecture for PD prediction to train the collected dataset. Two architectures have been proposed, namely Deep Dual Attention Neural Network (D2ANN) and BiLSTM Neural Network (BNN), for the classification of PD using Chanel State Information (CSI) data. After that, the most prominent information is extracted using self-attention activation. A newly informed weighted fusion approach is proposed, and tree growth optimization is employed for the best feature selection. Finally, the selected features are classified using a multilayer full SoftMax neural network. The experimental process was conducted on FOG wireless sensor network data and obtained the highest accuracy of 98.66%. Compared to the results with state-of-the-art techniques, the proposed framework shows improved accuracy, recall, and precision rates. [ABSTRACT FROM AUTHOR]

Background: Gait disorder is a prominent motor symptom in Parkinson's disease (PD), objective and quantitative assessment of gait is essential for diagnosing and treating PD, particularly in its early stage. Methods: This study utilized a non-contact gait assessment system to investigate gait characteristics between individuals with PD and healthy controls, with a focus on early-stage PD. Additionally, we trained two machine learning models to differentiate early-stage PD patients from controls and to predict MDS-UPDRS III score. Results: Early-stage PD patients demonstrated reduced stride length, decreased gait speed, slower stride and swing speeds, extended turning time, and reduced cadence compared to controls. Our model, after an integrated analysis of gait parameters, accurately identified early-stage PD patients. Moreover, the model indicated that gait parameters could predict the MDS-UPDRS III score using a machine learning regression approach. Conclusion: The non-contact gait assessment system facilitates the objective and quantitative evaluation of gait disorder in PD patients, effectively distinguishing those in the early stage from healthy individuals. The system holds significant potential for the early detection of PD. It also harnesses gait parameters for a reasoned prediction of the MDS-UPDRS III score, thereby quantifying disease severity. Overall, gait assessment is a valuable method for the early identification and ongoing monitoring of PD. [ABSTRACT FROM AUTHOR]

We proposed a deep learning method using a convolutional neural network on time-series (TS) images to detect and differentiate affected body parts in people with Parkinson's disease (PD) and freezing of gait (FOG) during 360° turning tasks. The 360° turning task was performed by 90 participants (60 people with PD [30 freezers and 30 nonfreezers] and 30 age-matched older adults (controls) at their preferred speed. The position and acceleration underwent preprocessing. The analysis was expanded from temporal to visual data using TS imaging methods. According to the PD vs. controls classification, the right lower third of the lateral shank (RTIB) on the least affected side (LAS) and the right calcaneus (RHEE) on the LAS were the most relevant body segments in the position and acceleration TS images. The RHEE marker exhibited the highest accuracy in the acceleration TS images. The identified markers for the classification of freezers vs. nonfreezers vs. controls were the left lateral humeral epicondyle (LELB) on the more affected side and the left posterior superior iliac spine (LPSI). The LPSI marker in the acceleration TS images displayed the highest accuracy. This approach could be a useful supplementary tool for determining PD severity and FOG. [ABSTRACT FROM AUTHOR]

Ellis-van Creveld syndrome (EVC) is a rare disorder with marked valgus knee deformity, and orthopedic surgeons may experience challenges with lower limb treatment. Most previous reports have focused on EVC in childhood and few on its treatment in adulthood. Our patient was a 23-year-old woman with bilateral knee pain and gait abnormalities, with no history of orthopedic treatment. Valgus knee deformities with anterolateral depression of the lateral tibial plateaus and external rotation deformities of the lower legs were observed on radiography. We performed extra-articular osteotomy of the femurs and tibias and soft tissue release. Although the correction of each femur and tibia was good, mild valgus deformity of the lower limbs remained. This may be because the depression of the lateral tibial plateau was not repaired, and no postoperative remodeling was performed. However, 10 years post-surgery, no recurrence of the deformity was observed and walking was stable without pain. [ABSTRACT FROM AUTHOR]

Background/Aims: Gait training for patients with lateropulsion after stroke improves outcomes (eg reduced lateropulsion and improved function) but can be burdensome on the physical therapist. This study describes the physical therapist burden and performance of a patient with moderate lateropulsion during three gait training approaches during inpatient rehabilitation. Methods: A physical therapist delivered gait training (one session each of overground robotic exoskeleton, overground supported walking, and body weight-supported treadmill training) for a patient with lateropulsion (scoring 8 out of 17 on the Burke Lateropulsion Scale). Outcomes were physiological burden (heart rate, metabolic equivalents, respiratory exchange ratio and energy expenditure), which were measured via a wearable metabolic system and perceptual burden (National Aeronautics and Space Administration Task Load Index) on the physical therapist. Patient performance (step count, time walking, time spent upright and time in moderate-to-vigorous intensity) was recorded. Results: During overground robotic exoskeleton gait training, the physical therapist's physiological metrics included an average heart rate of 116 beats per minute (minimum–maximum: 98–127, time in moderate-to-vigorous intensity was 0%), average metabolic equivalents of 3.2 (minimum–maximum: 1.7–4.3), a respiratory exchange ratio of 0.79 (minimum–maximum: 0.70–0.93), an energy expenditure of 228 kcal/hour and a perceptual burden of 33.3. The patient walked 228 steps, spent 15.4 minutes upright, 8.7 minutes walking and achieved 0% in moderate-to-vigorous intensity. During overground supported walking, the physical therapist's metrics included an average heart rate of 145 beats per minute (minimum–maximum: 113–164, time in moderate-to-vigorous intensity was 87%), average metabolic equivalents of 4.7 (minimum–maximum: 2.7–6.0), a respiratory exchange ratio of 0.96 (minimum–maximum: 0.81–1.16), an energy expenditure of 343 kcal/hour and a perceptual burden of 60.8. The patient walked 588 steps, spent 19.6 minutes upright, 10.5 minutes walking and achieved 38% in moderate-to-vigorous intensity. During body weight-supported treadmill training, the physical therapist's metrics included an average heart rate of 112 beats per minute (minimum–maximum: 69–137, time in moderate-to-vigorous intensity was 34%), average metabolic equivalents of 3.9 (minimum–maximum: 3.2–4.4), a respiratory exchange ratio of 0.89 (minimum–maximum: 0.82–0.95), an energy expenditure of 281 kcal/hour and a perceptual burden of 32.5. The patient walked 682 steps, spent 16.0 minutes upright, 10.0 minutes walking and achieved 0% in moderate-to-vigorous intensity. Conclusions: As concordance between physical therapist burden and patient gait performance was low in this study, future efforts to identify gait training approaches that minimise therapist burden while maximising outcomes for the patient with lateropulsion are necessary for the health of both. Implications for practice: Physical therapists may consider advanced technology use such as overground robotic exoskeletons to reduce the burden during the provision of gait training for patients with lateropulsion. Gait training performance of patients with lateropulsion may vary across different gait training approaches with low correspondence to therapist burden. [ABSTRACT FROM AUTHOR]

In this editorial, Massimiliano Polastri discusses the potential of artificial intelligence in healthcare. [ABSTRACT FROM AUTHOR]

This paper presents a real-time wearable system designed to assist Parkinson's disease patients experiencing freezing of gait episodes. The system utilizes advanced machine learning models, including convolutional and recurrent neural networks, enhanced with past sample data preprocessing to achieve high accuracy, efficiency, and robustness. By continuously monitoring gait patterns, the system provides timely interventions, improving mobility and reducing the impact of freezing episodes. This paper explores the implementation of a CNN+RNN+PS machine learning model on a microcontroller-based device. The device operates at a real-time processing rate of 40 Hz and is deployed in practical settings to provide 'on demand' vibratory stimulation to patients. This paper examines the system's ability to operate with minimal latency, achieving an average detection delay of just 261 milliseconds and a freezing of gait detection accuracy of 95.1%. While patients received on-demand stimulation, the system's effectiveness was assessed by decreasing the average duration of freezing of gait episodes by 45%. These preliminarily results underscore the potential of personalized, real-time feedback systems in enhancing the quality of life and rehabilitation outcomes for patients with movement disorders. [ABSTRACT FROM AUTHOR]

Background: Effective rehabilitation following total knee arthroplasty (TKA) is crucial for enhancing both range of motion (ROM) and functional outcomes. While robotics has demonstrated its potential in various medical contexts, the evidence on its application in TKA rehabilitation is still scarce. The marsi active knee (MAK), a robotic device that has already proven to be safe and beneficial in people with neurological disease, has been tested to facilitate the rehabilitation of TKA patients. Objective: This study aims to evaluate the safety, patient satisfaction, and clinical impact of integrating the MAK into an early rehabilitation regimen for TKA patients. Methods: The intervention comprised 14 one‐hour sessions administered thrice a week, utilizing the MAK within 48 h post‐TKA surgery. The rehabilitation sessions incorporated exercises involving passive mobilizations, sit‐to‐stand transitions, and gait training. Comprehensive data encompassing safety parameters, patient satisfaction, and clinical outcomes were meticulously collected and analyzed. Results: Six participants successfully completed the rehabilitation protocol with the MAK device. Notably, no significant adverse events were documented. Application of the device corresponded to perceptible reductions in self‐reported pain levels. Vital signs remained within minimal variance pre‐ and post‐rehabilitation. Participants proficiently engaged in all assisted exercises facilitated by the device, culminating in a high overall satisfaction rating of 4.6 ± 0.5 out of 5. Conclusion: The findings indicate that the MAK device exhibits a commendable level of safety while obtaining considerable patient satisfaction during the early rehabilitation phase following TKA, suggesting this device may be a reliable adjunct to TKA protocols. [ABSTRACT FROM AUTHOR]

Introduction: People with multiple sclerosis and gait impairment are particularly susceptible to facing restrictions in their participation. This study aims to investigate (a) which contextual factors within the framework of the International Classification of Functioning, Disability and Health (ICF) are relevant for participation from the perspective of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices, and (b) how these contextual factors shape the subjective facets of participation, including a sense of connection, efficacy and meaning, based on the social identity approach to health and well‐being. Methods: We conducted a qualitative analysis on data gathered from four online focus group interviews, each involving four to six people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices (totalling N = 19), and 12 individual online interviews conducted with participants from the focus group interviews. The analysis followed the qualitative content analysis according to Kuckartz. Results: Mobility assistive devices such as walkers, manual wheelchairs and electric wheelchairs/scooters were seen as facilitators that enabled participation in various life situations and enhanced a sense of efficacy by promoting independence. Challenges were encountered in relation to architectural barriers, pathways, weather conditions, public transportation and the lack of integral accessibility to services and systems. Although instrumental support could ease participation, it was also associated with an impaired sense of efficacy. Attitudes, particularly developing an understanding of the experiences of people with multiple sclerosis and gait impairment from others' perspectives, were considered important but often lacking, and discriminatory attitudes were experienced. On the level of personal factors, acceptance of both the mobility assistive devices and the disease itself were seen as facilitators for maintaining involvement in life situations. Conclusions: This study extends the existing literature by shedding light on the interconnectedness of contextual factors within the ICF and various facets of perceived participation, including a sense of connection, efficacy and meaning. These findings provide valuable insights for stakeholders such as urban planners and policymakers in developing inclusive environments that enhance the overall quality of participation for people with multiple sclerosis and gait impairment. Patient or Public Contribution: This study reports on the lived experiences of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices. The research team stood in close exchange with project members of the German Multiple Sclerosis Society Lower Saxony, a group representing the interests of people with multiple sclerosis, to design and conduct the focus group interviews. The results from the focus group interviews were the basis for the design of a participatory future workshop in which people with multiple sclerosis and stakeholders involved in the healthcare process collaboratively developed recommendations for improving the provision of mobility assistive devices. Trial Registration: German Clinical Trials Register number: DRKS00025532. [ABSTRACT FROM AUTHOR]

Background: Multiple Sclerosis (MS) is the most prevalent autoimmune neurological condition in the world, leading to a wide variety of symptoms, including balance disorders. Objective: To evaluate the angular vestibulo–ocular reflex (aVOR) of all six semicircular canals (SCCs) through Head Impulse (HIMP) and Suppression HIMP (SHIMP) paradigms and any correlations with clinical balance scales. Methods: All participants were assessed using the Expanded Disability Status Scale (EDSS), Berg Balance Scale (BBS), and Mini-BESTest (MBT). Vestibular function was measured by video Head Impulse Test (vHIT), obtaining aVOR gain for each SSC. Results: Twenty-seven PwMS (mean age 47.93 ± 8.51 years old, 18 females) were recruited. Most of the patients (81.48%) presented abnormal aVOR gains for at least one SSC. A moderate to strong correlation between aVOR gains of the left anterior SSC and, respectively, the MBT and the BBS was found. The subgroup analysis, based on the EDSS class, confirmed the correlation with the BBS in the patients with the most significant disability. Conclusions: People with MS may present impairments of the aVOR in one or more semicircular canals. The aVOR gain impairment of the vertical semicircular canals correlates with balance and gait disorders identified through clinical scales in PwMS. [ABSTRACT FROM AUTHOR]

Background: Vibrotactile stimulation has been studied in its efficacy of reducing freezing of gait (FOG) in patients with Parkinson's disease (PD). However, the results are still controversial. We evaluated the efficacy of a newly developed vibrotactile foot device on freezing severity and gait measures in PD patients with FOG. Objective: To evaluate the efficacy of vibrotactile foot device on PD patients with FOG. Methods: Thirty‐three PD patients with FOG were examined during their "off" medication state. The efficacy of the vibrotactile foot device was evaluated using a gait protocol comprising walking trials with vibrotactile stimulation "off" and "on." Walking trials were videotaped for the offline rating by two movement disorder specialists. The Opal inertial sensor unit (128 Hz; Mobility Lab; APDM Inc., Portland, OR, USA) was used for quantitative gait analysis. Results: The results demonstrated 33.1% reduction in number of FOG episodes (P < 0.001) and 32.6% reduction of freezing episodes (P < 0.001). Quantitative gait analysis showed a significant increase in step length (P = 0.033). A moderate negative correlation was observed between the change of percent time frozen and age (r = −0.415, P = 0.016). 73% of participants reported minimal to substantial improvement in walking with this vibrating stimulation delivered by the vibrotactile foot device. Conclusions: The vibrotactile foot device is an efficient device that could significantly reduce freezing severity and provide gait regulation to patients with PD experiencing frequent freezing. It could potentially be used in the home environment for improving the quality of life. [ABSTRACT FROM AUTHOR]

Purpose: Pelvic osteotomies present a surgical option to restore pelvic alignment, improve function and pain in sequelae of pelvic ring fractures. Understanding the three-dimensional deformity is a crucial step within preoperative planning; furthermore, accurate intraoperative execution of the planning can be challenging. In recent years, patient-specific guides and 3D modeling have emerged as promising technologies in orthopedic and trauma surgery to enhance surgical precision and facilitate intraoperative decision-making. Methods: We present the case of a 41-year-old male patient with a pelvic malunion, resulting from a vertical shear fracture occurring 8 years prior. The patient presented with a 4-cm cranial displacement of the right hemipelvis, accompanied by pubic symphysis disruption and fusion of S1 to L5 vertebra. Severely altered posture in the coronal and sagittal plane was associated with sitting imbalance, impaired gait, and chronic pain. Results: We analyzed the deformity and planned the surgical correction on a 3D interactive virtual model. Moreover, we developed 2 patient-specific cutting guides and one patient-specific reduction guide, allowing accurate bilateral pelvic osteotomies, subsequent realignment, and restoration of the pelvic anatomy. Conclusion: For the first time, 3D modeling and 3D-printed patient-specific guides were effectively employed in pelvic malunion surgery, enhancing the precision of preoperative planning, and providing valuable assistance during intraoperative procedures. [ABSTRACT FROM AUTHOR]

Idiopathic normal pressure hydrocephalus (iNPH) is a disease characterized by gait disturbance, cognitive impairment, and urinary incontinence. For those patients who do not respond to shunt surgery, it lacks objective radiologic findings for the diagnosis of shunt malfunction. Here we aimed to evaluate whether the Evans index and callosal angle change during a prospective long-term follow-up of patients with iNPH submitted to shunt surgery. Clinical (NPH Japanese Scale) and radiologic (Evans index and callosal angle) data were collected pre- and postoperatively (3, 6, 12 and months) in 19 patients with iNPH. Imaging tests were evaluated by the same neuroradiologist during the follow-up. Patients had lower scores on the NPH Japanese Scale over time (P < 0.001). There was no significant difference among Evans index values during the follow-up (P = 0.24). Preoperative average callosal angle was 72 ± 15, which increased to 91 ± 18 in 6 months (P = 0.003). In this sample, patients with iNPH submitted to a programmable valve shunt had an increase in callosal angle concomitant to neurologic improvement. The Evans index did not change during follow-up. [ABSTRACT FROM AUTHOR]

Mobile health technologies enable continuous, quantitative assessment of mobility and gait in real-world environments, facilitating early diagnoses of gait disorders, disease progression monitoring, and prediction of adverse events like falls. Traditionally, mobile gait assessment predominantly relied on body-fixed sensors positioned at the feet or lower trunk. Here, we investigate the potential of an algorithm utilizing an ear-worn motion sensor for spatiotemporal segmentation of gait patterns. We collected 3D acceleration profiles from the ear-worn sensor during varied walking speeds in 53 healthy adults. Temporal convolutional networks were trained to detect stepping sequences and predict spatial relations between steps. The resulting algorithm, mEar, accurately detects initial and final ground contacts (F1 score of 99% and 91%, respectively). It enables the determination of temporal and spatial gait cycle characteristics (among others, stride time and stride length) with good to excellent validity at a precision sufficient to monitor clinically relevant changes in walking speed, stride-to-stride variability, and side asymmetry. This study highlights the ear as a viable site for monitoring gait and proposes its potential integration with in-ear vital-sign monitoring. Such integration offers a practical approach to comprehensive health monitoring and telemedical applications, by integrating multiple sensors in a single anatomical location. [ABSTRACT FROM AUTHOR]

Existing studies on gait phase estimation generally involve walking experiments using inertial measurement units under limited walking conditions (WCs). In this study, a gait phase estimation algorithm is proposed that uses data from force sensing resistors (FSRs) and a Bi-LSTM model. The proposed algorithm estimates gait phases in real time under various WCs, e.g., walking on paved/unpaved roads, ascending and descending stairs, and ascending or descending on ramps. The performance of the proposed algorithm is evaluated by performing walking experiments on ten healthy adult participants. An average gait estimation accuracy exceeding 90% is observed with a small error (root mean square error = 0.794, R2 score = 0.906) across various WCs. These results demonstrate the wide applicability of the proposed gait phase estimation algorithm using various insole devices, e.g., in walking aid control, gait disturbance diagnosis in daily life, and motor ability analysis. [ABSTRACT FROM AUTHOR]

A 30-yr-old patient with Becker muscular dystrophy presented with stroke. Background issues of proximal weakness, dilated cardiomyopathy, and reduced endurance challenged the usual goalsetting and formulation of a stroke rehabilitation plan. We discuss the holistic rehabilitation program that this patient underwent, with a focus on the utilization of robot-assisted gait training that eventually led him to successfully regain mobility. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to evaluate how gait kinematics and muscle activity during robot-assisted gait training are affected by different combinations of parameter settings and a number of instruction types, ranging from no instructions to goal-specific instructions. Design: Robots for gait therapy provide a haptic guidance, but too much guidance can limit the active participation. Therapists can stimulate this active participation either with instructions or by adapting device parameters. How these two factors interact is still unknown. In the present study, we test the interaction of three different parameter settings and four instruction types in a cross-sectional study with 20 children and adolescents without impairment. Gait kinematics and surface electromyography were measured to evaluate the immediate effects. Results: We found that only goal-specific instructions in combination with a low guidance led to a moderate but significant change in gait kinematics. The muscle activity was altered by all instructions, but the biggest effect was found for goal-specific instructions with a 2.5 times higher surface electromyography amplitude compared to no instruction. Conclusions: Goal-specific instructions are a key element of robot assisted gait therapy interventions and device parameter adjustments may be used to modulate their effects. Therapists should pay close attention to how they instruct patients. [ABSTRACT FROM AUTHOR]

Cerclage wiring may be used to optimize the stability of intramedullary nail or plate fixations in comminuted proximal femoral fractures, periprosthetic fractures, and other selected cases. In this article, we presented a novel case of iatrogenic sciatic nerve entrapment from cerclage wiring used to supplement intramedullary nail fixation. We also illustrate and highlight the role of ultrasound in assessing the sciatic nerve to make a timely diagnosis. [ABSTRACT FROM AUTHOR]

Background and purpose: The co‐occurrence of amyloid‐β pathology in Parkinson's disease (PD) is common; however, the role of amyloid‐β deposition in motor prognosis remains elusive. This study aimed to investigate the association between striatal amyloid deposition, motor complications and motor prognosis in patients with PD. Methods: Ninety‐six patients with PD who underwent 18F florbetaben (FBB) positron emission tomography were retrospectively assessed. The ratio of the striatum to global (STG) FBB uptake was obtained for each individual, and patients were allotted into low and high STG groups according to the median value. The effect of STG group on regional amyloid deposition, the occurrence of motor complications and longitudinal change in levodopa equivalent dose (LED) requirement were investigated after controlling for age, sex, LED and disease duration at FBB scan. Results: The high STG group was associated with lower cortical FBB uptake in the parietal, occipital and posterior cingulate cortices and higher striatal FBB uptake compared to the low STG group. Patients in the high STG group had a higher risk of developing wearing off and levodopa‐induced dyskinesia than those in the low STG group, whereas the risk for freezing of gait was comparable between the two groups. The high STG group showed a more rapid increase in LED requirements over time than the low STG group. Conclusions: These findings suggest that relatively high striatal amyloid deposition is associated with poor motor outcomes in patients with PD. [ABSTRACT FROM AUTHOR]

Background: Epidermoid tumors of the cerebellopontine angle and posterior fossa account for approximately 1% of all intracranial tumors. Classifications that may guide surgical planning in the current neurosurgical practice are lacking. This study aimed to focus on the surgical outcome and suggest a classification system that may aid neurosurgeons in determining the goal of resection to minimize morbidity and mortality rates. Methods: The study population comprised patients who underwent surgery and follow-up for tissue-proven epidermoid tumors between 2015 and 2020. Patients' data, including demographic features, clinical symptomatology, the extent of surgical resection, and postoperative outcomes, were retrospectively evaluated. A new classification system was designed based on the anatomical–radiological findings and was evaluated in terms of clinical symptomatology, radiological features, surgical approach, and postoperative outcomes. Results: The patient population comprised 22 women (57.9%) and 16 men (42.1%), with a mean age of 34.9 years. A practical classification system based on the radiological–anatomical vertical (1, 2, and 3) and horizontal (a, b, and c) tumor extensions was designed. No significant differences were found in the patients in terms of sex/age. The most commonly observed symptom was gait disturbance (34.2%). The preoperative tumor diameter was significantly larger in the subtotal resection (STR) group than in the gross total resection (GTR) and near-total resection (NTR) groups. Significantly more cistern involvement was observed in the STR group than in the GTR group. The GTR, NTR, and STR rates were higher in grade 1, 3, and 2 cases, respectively. The subgroup 'a' was correlated with higher resection rates (GTR and NTR), whereas the subgroup 'b' was correlated with STR. Conclusions: Our suggested classification system represents a simple and practical model that may guide neurosurgeons in predicting the goal of resection during surgical planning and in minimizing potential morbidity. [ABSTRACT FROM AUTHOR]

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

Individuals diagnosed with Parkinson's disease (PD) have reported increased incidence rates of falling in comparison to undiagnosed peers. Falls in this population have been found to be related to increasing symptom intensity as well as decreases in overall quality of life. The following examines the effectiveness of balance-based Recreational Therapy within the community setting as part of a multidiscipline treatment team known as the Stillwater Communication, Arts, Nutrition, & Exercise program. A combination of previous data analysis from this longitudinal study have found that participants improved or maintained their physical functioning and reported less occurrences of falling. Treatment protocol focused on strength, balance, and gait-utilizing modalities such as exercise, obstacle courses, boxing training, and tai chi. Data collection of postural stability, or static balance, occurred throughout the 8-month treatment period on a monthly basis and the month 1 and month 8 mean differences were analyzed for statistical and clinical significance. Assessments revealed the successful increase and/or maintenance of overall postural stability through the 8-month treatment period. Results were not statistically significant, yet provide clinical evidence to the effectiveness of RT community- based balance training for individuals diagnosed with PD. The following study builds upon previous evidence that recreational therapy can be an effective treatment option for those who have been diagnosed with PD and potentially others who are experiencing issues with their balance. Implications for future studies and current practice are provided. [ABSTRACT FROM AUTHOR]

Background and objective: Stroke is one of the neurological disorders which is caused by disturbance in blood supply to the brain resulting in weakness in contralateral limbs and axial musculature. Stroke is the leading cause of physical impairment where the most prominent motor deficit is paresis of one side of body, which is contralateral to the event. This study was conducted with an aim to assess the effectiveness of bilateral upper extremity training on trunk performance, posture and gait in patients with subacute stroke. Method: 30 subjects with subacute stroke were selected for the study. Subjects were treated for 3 days/week for 12 sessions with 45 minutes of task oriented, strengthening training and PNF technique for bilateral upper extremity along with conventional training. The rehabilitation protocol consists of bilateral functional exercises, activity of daily living goal, exercises in multiple movement games, strengthening exercises for lower limb, controlled sitting training, sit to stand training, weight bearing and balance training Conclusion: Significant improvement in all items of TIS, PASS and DGI were observed after intervention (P< 0.001). The study concluded that bilateral upper extremity training is more effective in improving trunk control, posture and gait in subacute stroke patients. [ABSTRACT FROM AUTHOR]

Cerebral palsy (CP) is defined as a set of developmental illnesses that affect posture and mobility, causing activity restriction owing to abnormalities that are not progressive in the developing brain of the foetus or neonate. Children with cerebellar ataxic cerebral palsy often exhibit undeveloped or malformed cerebellar structures, resulting in challenges for the cerebellum to integrate the neural input required to control movement and balance smoothly. Patients with cerebellar ataxic cerebral palsy have difficulty in maintaining balance and trunk control which leads to difficulty in performing their activities of daily living and result in dependency. Thus, reporting cases like these is crucial to evaluate the impact of core stabilization intervention and treadmill walking on balance in a child having cerebellar ataxic cerebral palsy. A 7-year-old female child born at full term delivered via normal vaginal delivery with a birth weight of 2700 gm had no difficulties during antenatal, natal or postnatal phases. At the age of 6 years, mother noticed that the child had difficulty in standing and walking independently, she had difficulty in performing her activities of daily living independently. The patient underwent an 8 weeks intervention consisting of core stabilization exercise protocol and treadmill walking along with traditional physiotherapy intervention. The outcome measures included Paediatric Balance Scale for static balance and My Fitness Trainer (MFT)for dynamic balance. The patient showed significant improvement in both static as well as dynamic balance following the intervention. Thus, combined impact of core stabilization exercise protocol and treadmill walking can bring early effective changes on balance in a patient with cerebellar ataxic cerebral palsy. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis commonly develops between 20 to 40 years of age, however also seen in older populations. It is more common in females than in males. Fatigue, impaired coordination, pain, blurred vision, weakness in limbs are often the complaints. Objective: A case study is to provide evidence of the feasibility, acceptance and benefits of Cawthorne Cooksey exercise and strength training in gait and balance related impairments of a multiple sclerosis patient. Method: 58 years old multiple sclerosis patient was provided an individualised therapy for 3 weeks. Outcome measures included Tinetti Performance Oriented Mobility Assessment (Tinetti POMA) and Timed Up and Go (TUG). Result: Findings demonstrated the effectiveness of the cawthorne cooksey exercise and strength training for use by multiple sclerosis patient with gait and balance impairments. Conclusion: The Tinetti POMA Scale and TUG test scores suggested improved gait and balance. However the results were not clinically significant. [ABSTRACT FROM AUTHOR]

This case report delves into the case of a 56-year-old female patient presenting with progressive cephalalgia syndrome, nausea, vomiting, and gait disorders, diagnosed with a high-grade thalamic glioma. Glioma is the most common form of central nervous system (CNS) neoplasm that originates from glial cells. Gliomas are diffusely infiltrative tumors that affect the surrounding brain tissue. Glioblastoma is the most malignant type, while pilocytic astrocytomas are the least malignant brain tumors. In the past, these diffuse gliomas were classified into different subtypes and grades based on histopathologies such as a diffuse astrocytoma, oligodendrogliomas, or mixed gliomas/oligoastrocytomas. Currently, gliomas are classified based on molecular and genetic markers. After the gross total resection, a postoperative brain CT scan was conducted, which confirmed the quasi-complete resection of the tumor. The successful gross total resection of the tumor in this case, coupled with significant neurological improvement postoperatively, illustrates the potential benefits of aggressive surgical management for thalamic gliomas. This report advocates for further research to assess the efficacy of such interventions in malignant cases and to establish standardized treatment protocols, considering the heterogeneity in prognostic outcomes and the advancements in molecular diagnostics that offer deeper insights into glioma oncogenesis and progression. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease (PD) is often accompanied by gait disorders and freezing of gait (FoG), disabling symptoms that are resistant to conventional dopamine treatments. Given the cerebellum's connectivity with the motor cortex and basal ganglia, and its implication in PD, combining transcranial direct current stimulation targeting the cerebellum (ctDCS) with physical exercise might improve gait and balance. Objective: This study aimed to evaluate the effectiveness of a novel rehabilitation approach that combines noninvasive cerebellar stimulation with motor-cognitive training via an augmented reality treadmill (C-Mill VR+) in individuals with PD and FoG. Methods: Seventeen individuals with PD exhibiting FoG were enrolled in a randomized controlled trial. The participants were randomly assigned to a group receiving motor-cognitive training on the C-Mill VR+ with either ctDCS or sham ctDCS. Assessments were conducted pre-intervention (T0), post-intervention (T1) after 10 sessions, and at 4-week follow-up (T2), using various clinical scales. Additionally, C-Mill assessments of postural stability and gait were conducted at T0 and T1. Results: Although no significant time*group interactions were observed for any of the clinical variables measured, some were found in the C-Mill measures. Specifically, right lower limb sway in static conditions, both with eyes open (OAD) and eyes closed (OCD), significantly improved at T1 in the ctDCS group compared with the sham group. Conclusions: C-Mill outcomes indicate that the combined treatment may enhance motor control. Participants who received ctDCS along with augmented reality motor-cognitive training showed better postural stability. [ABSTRACT FROM AUTHOR]

Objective: Gait disturbance is one of the features of normal pressure hydrocephalus (NPH) and decompensated long-standing overt ventriculomegaly (LOVA). The timed-up-and-go (TUG) test and the timed-10-m-walking test (10MWT) are frequently used assessments tools for gait and balance disturbances in NPH and LOVA, as well as several other disorders. We aimed to make smart-phone apps which perform both the 10MWT and the TUG-test and record the results for individual patients, thus making it possible for patients to have an objective assessment of their progress. Patients with a suitable smart phone can perform repeat assessments in their home environment, providing a measure of progress for them and for their clinical team. Methods: 10MWT and TUG-test were performed by 50 healthy adults, 67 NPH and 10 LOVA patients, as well as 5 elderly patients as part of falls risk assessment using the Watkins2.0 app. The 10MWT was assessed with timed slow-pace and fast-pace. Statistical analysis used SPSS (version 25.0, IBM) by paired t-test, comparing the healthy and the NPH cohorts. Level of precision of the app as compared to a clinical observer using a stopwatch was evaluated using receiver operating characteristics curve. Results: As compared to a clinical observer using a stopwatch, in 10MWT the app showed 100% accuracy in the measure of time taken to cover distance in whole seconds, 95% accuracy in the number of steps taken with an error ± 1–3 steps, and 97% accuracy in the measure of total distance covered with error of ± 0.25–0.50 m. The TUG test has 100% accuracy in time taken to complete the test in whole seconds, 97% accuracy in the number of steps with an error of ± 1–2 steps and 87.5% accuracy in the distance covered with error of ± 0.50 m. In the measure of time, the app was found to have equal sensitivity as an observer. In measure of number of steps and distance, the app demonstrated high sensitivity and precision (AUC > 0.9). The app also showed significant level of discrimination between healthy and gait-impaired individuals. Conclusion: 'Watkins' and 'Watkins2.0' are efficient apps for objective performance of 10MWT and the TUG-test in NPH and LOVA patients and has application in several other pathologies characterised by gait and balance disturbance. [ABSTRACT FROM AUTHOR]

Objective: Among the disturbing motor symptoms in Parkinson's disease (PD), freezing of gait (FOG) stands out as one of the most severe challenges. It typically arises during the initiation of gait or when turning. This phenomenon not only impose a heavy burden on patients, but also on their families. We conduct a bibliometric analysis to summarize current research hotspots and trends concerning freezing of gait in Parkinson's disease (PD-FOG) over past two decades. Methods: We retrieved articles and reviews published in English about PDFOG in the Web of science Core Collection database from 2000 to 2023 on November 30,2023. The tools VOSviewer and CiteSpace facilitated a visual analysis covering various aspects such as publications, countries/regions, organizations, authors, journals, cited references, and keywords. Result: This study includes 1,340 articles from 64 countries/regions. There is a growth in publications related to PD-FOG over the past two decades, maintaining a stable high output since 2018, indicating a promising research landscape in the field of PD-FOG. The United States holds a leading position in this field, with Nieuwboer A and Giladi N being two of the most influential researchers. Over the past two decades, the research hotspots for PD-FOG have primarily encompassed the kinematic characteristics, diagnosis and detection, cognitive deficits and neural connectivity, as well as therapy and rehabilitation of PD-FOG. Topics including functional connectivity, virtual reality, deep learning and machine learning will be focal points of future research. Conclusion: This is the first bibliometric analysis of PD-FOG. We construct this study to summarize the research in this field over past two decades, visually show the current hotspots and trends, and offer scholars in this field concepts and strategies for subsequent studies. [ABSTRACT FROM AUTHOR]

Purpose: Idiopathic Normal Pressure Hydrocephalus (iNPH) is a neurological syndrome defined by gait disturbance, cognitive impairment and urinary incontinence. However, its clinical presentation can vary widely due to overlapping syndromes and common comorbidities in older adults. This study aims to provide practical guidance to aid in the clinical suspicion and support the diagnostic and therapeutic processes for these patients. Methods: Six quantitative variables regarding clinical, functional, and demographic aspects were considered for a large sample of patients with diagnosed iNPH. Principal component analysis (PCA) was adopted to define the main dimensions explaining the variability of the phenomenon. Then, two clusters of iNPH patients were described. Results: 178 patients were included in the analysis. The PCA produced two dimensions covering 61.8% of the total variability. The first one relied mainly on both clinical (mRS, iNPHGs) and functional (TUG, Tinetti) variables, while the second one was represented mainly on the demographic pattern (age and education). Cluster analysis depicted two main groups of patients. Cluster n.1 is composed of individuals who are older, more disabled, with poor functional performances, and highly symptomatic. Cluster n.2 patients are slightly younger, more educated, fitter, and with more nuanced clinical aspects. Conclusions: Profiling iNPH patients using quantitative variables and cluster analysis can help identify distinct characteristics of these patients, aiding in the guidance of both medical and surgical interventions. [ABSTRACT FROM AUTHOR]