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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]

Sex differences in epidemiology, clinical features, and therapeutical responses are emerging in several movement disorders, even though they are still not widely recognized. Parkinson's disease (PD) is not an exception: men and women suffering from PD have different levels of disability. Research has been performed using multiple databases and scientific journals; this review summarizes the available evidence on sex differences in PD regarding epidemiology, risk factors, genetics, clinical phenotype, social impact, and therapeutic management. The role of hormones in determining such differences is also briefly discussed. The results confirm the existence of differences between men and women in PD; women have a higher risk of developing disabling motor complications and non-motor fluctuations compared to men, while men have a higher risk of developing cognitive impairment, postural instability, and gait disorders. Improving our knowledge in these differences may result in the implementation of strategies for disease-tailored treatment and management. [ABSTRACT FROM AUTHOR]

Pregnant people experience many physical changes which might affect their walking pattern. Waddling gait is a common gait pattern pregnant individuals adopt. It is unknown whether waddling gait is a sign of poor balance or a protective mechanism against loss of balance, so the aim of this study was to understand why some pregnant individuals adopt this gait pattern. We assessed twenty-three pregnant individuals longitudinally in 4-week intervals between 18 and 34 weeks of gestation. Participants completed a quiet standing balance trial and a walking trial. We measured spatiotemporal variables and body center of mass motion, from which we derived measures of balance and gait energetics. Forward-step multiple linear regression analyses were used to explore the correlation between step width (as a measure of waddling) and the other variables. We found a positive correlation between change in step width average and change in lateral motion of the center of mass during walking (R2=0.624, P<0.001) and change in step width standard deviation and change in minimum center of gravity distance to the lateral border (R2=0.339, p=0.004), suggesting wider steps help recapture balance during pregnancy. Surprisingly, no significant relationship was found between change in step width and changes in energy recovery (p=0.341) or mechanical work (p=0.482), indicating that taking wider steps is not inefficient. A negative correlation between change in step width and change in standing anteroposterior center of mass motion (R2=0.315, p=0.005) suggests better balance control among people that adopt a waddling gait pattern. This study suggests that waddling gait is a protective mechanism during pregnancy. Clinicians and prosthetists can use this insight to promote step width during walking among pregnant individuals to increase their safety. • Waddling gait during pregnancy correlates with better balance control, not worse. • There was no change in energy cost with adopting a waddling gait. • Waddling is an efficient movement pattern that should be promoted. [ABSTRACT FROM AUTHOR]

Body weight support (BWS) technologies offer effective gait training for individuals with neurological gait impairments. However, varying dynamic BWS levels may impact specific gait kinematics, potentially introducing maladaptive movement patterns. To investigate the acute impact of different levels of dynamically modulated BWS during overground walking at a self-selected speed on gait quality, kinematic gait patterns, and self-reported gait comfort in young adults with gait impairments. Three-dimensional gait analysis was conducted on 18 individuals with neurological gait impairments during overground walking with 0, 10, 20, 30, 40, and 50 % BWS using a novel robotic unloading device. Gait quality, expressed as Gait Deviation Index (GDI), lower limb joint kinematics, and spatiotemporal parameters were obtained for one representative stride per participant at each BWS level. Gait comfort was reported on a visual analogue scale (VAS) for each unload level. Time-continuous data were analysed using statistical parametric mapping; discrete data were compared between BWS levels using paired t-tests. Compared with habitual gait (0 % BWS), GDI was unaltered with increasing BWS. The relative shapes of kinematic trajectories were largely unaffected, with minor reductions in amplitude and a limited impact on temporal effects with increasing BWS. Most spatiotemporal parameters were unaltered by changes in BWS, although negative impacts on walking speed, cadence, and step length emerged at 40 % BWS, with a more pronounced impact at 50 % BWS. Gait comfort improved at 20–30 % BWS by up to 20 mm on a 0–100 mm VAS. Participants maintained habitual (0 % BWS) biomechanical gait patterns with 10–30 % BWS, experiencing increased gait comfort at 20–30 % BWS. Dynamically modulated BWS can be applied in task-specific gait training to offer vertical body support and increased comfort with little to no impact on biomechanical movement patterns. • Gait quality was unaffected by body weight support. • Habitual gait patterns were maintained at 10–30 % body weight support. • Kinematic trajectories were largely preserved, with some changes in amplitude. • Perceived gait comfort increased at 20–30 % body weight support. [ABSTRACT FROM AUTHOR]

In human gait, leg progression into the swing phase involves two primary strategies: ankle plantar flexion and hip flexion. These strategies are believed to exhibit a trade-off relationship; however, it is unclear whether this relationship holds for normal gait and the role of the medial longitudinal arch (MLA) in shaping these strategies. Does a trade-off relationship exist between ankle plantar flexion and hip flexion strategies during normal gait in young healthy adults? Do the kinematics of MLA during gait influence the strategies during leg progression into the swing phase? Data from 36 young healthy adults were analyzed. Gait speed and peak moment, angular impulse, peak power and joint work at ankle plantar flexion and hip flexion were assessed within the context of the normal gait task. The parameters were also assessed using ankle-to-hip joint ratios (ankle/hip indices). Kinematics of MLA, including peak MLA angle, amount of descent, and amount of elevation during gait, were also measured. To exclude the effect of gait speed, partial correlation coefficients were employed to explore the relationship between ankle and hip variables as well as the ratio of ankle/hip indices and MLA kinematics. A significant negative correlation between ankle plantar flexion work and hip flexion work was detected. Moreover, a positive correlation between the ankle plantar flexion work to hip flexion work ratio and MLA elevation was detected. A trade-off relationship between ankle plantar flexion and hip flexion strategies during normal gait in young healthy adults was confirmed, suggesting that these parameters are fundamental to normal gait. Additionally, the MLA elevation during late stance may influence the establishment of ankle plantar flexion and hip flexion strategies. These findings enhance our understanding of gait mechanisms and highlight the role of MLA kinematics in shaping gait strategies. • The relationship between ankle and hip movement strategies in gait was examined. • The role of the medial longitudinal arch (MLA) in gait strategies was investigated. • Ankle plantar flexion work negatively correlated with hip flexion work. • MLA elevation was associated with gait strategies. • Ankle-hip trade-off is fundamental to gait and may be affected by MLA elevation. [ABSTRACT FROM AUTHOR]

Gait disturbance is one of the most common symptoms in patients with Parkinson's disease (PD) that is closely associated with poor clinical outcomes. Recently, video-based human pose estimation (HPE) technology has attracted attention as a cheaper and simpler method for performing gait analysis than marker-based 3D motion capture systems. However, it remains unclear whether video-based HPE is a feasible method for measuring temporospatial and kinematic gait parameters in patients with PD and how this function varies with camera position. In this study, treadmill and overground walking in 24 patients with early PD was measured using a motion capture system and two smartphone cameras placed on the near-frontal and lateral sides of the subjects. We compared the differences in temporospatial gait parameters and kinematic characteristics between joint position data obtained from the 3D motion capture system and the markerless HPE. Our results confirm the feasibility of analyzing gait in patients with PD using HPE. Although the near-frontal view, where the heel and toe are clearly visible, is effective for estimating temporal gait parameters, the lateral view is particularly well-suited for assessing spatial gait parameters and joint angles. However, in clinical settings where lateral recordings are not feasible, near-frontal view recordings can still serve as a practical alternative to motion capture systems. [ABSTRACT FROM AUTHOR]

Background: Visual dysfunction, including abnormal stereopsis, is a significant non-motor symptom in Parkinson's disease (PD) that can reduce quality of life and appears early in the disease. Abnormal stereopsis is associated with worsening of bradykinesia and freezing of gait, though the exact pathways linking stereopsis to motor symptoms remain unclear. Furthermore, in PD patients, the pedunculopontine nucleus and laterodorsal tegmental complex play an active role in sensorimotor control, and these areas provide cholinergic projections. Cholinergic degeneration may be associated with symptoms such as abnormal stereopsis, postural instability, gait disturbances and cognitive impairment. Therefore, in this study, we hypothesized that a high postural instability and gait disturbance score would increase the risk of abnormal stereopsis in PD. Methods: We designed a cross-sectional study and included 240 early PD patients without ophthalmologic problems other than abnormal stereopsis. To evaluate stereopsis, we used Titmus stereo test plates. Stereopsis testing was performed only once at the time of the patient's initial PD diagnosis. We collected data from medical history taking, scales, cognitive function tests, gait analysis, and tilt table tests. To analyze the potential risk factors for abnormal stereopsis in PD, we conducted a binary logistic stepwise selection analysis. Results: Among the total of 240 PD patients, 185 were in the normal stereopsis group and 55 were in the abnormal stereopsis group. In the analysis for risk factors related to abnormal stereopsis, the postural instability and gait difficulties (PIGD) subtype score was significantly associated with abnormal stereopsis. (95% confidence interval: 1.37–5.15). Conclusions: In PD, particularly in PIGD subtype patients, abnormal stereopsis can lead to a decrease in the quality of sensory information, potentially interfering with feedback and adaptation processes. This, in turn, can negatively affect posture and gait, creating a vicious cycle. [ABSTRACT FROM AUTHOR]

AbstractBackgroundObjectiveMethodsResultsDiscussionGait instability and falls significantly impact life quality and morbi-mortality in elderly populations. Early diagnosis of gait disorders is one of the most effective approaches to minimize severe injuries.To find a gait instability pattern in older adults through an image representation of data collected by a single sensor.A sample of 13 older adults (71-85 years old) with instability by vestibular hypofunction is compared to a sample of 19 adults (21-75 years old) without instability and normal vestibular function. Image representations of the gait signals acquired on a specific walk path were generated using a continuous wavelet transform and analyzed as a texture using grey level co-occurrence matrix metrics as features. A support vector machine (SVM) algorithm was used to discriminate subjects.First results show a good classification performance. According to analysis of extracted features, most information relevant to instability is concentrated in the medio-lateral acceleration (X axis) and the frontal plane angular rotation (Z axis gyroscope). Performing a ten-fold cross-validation through the first ten seconds of the sample dataset, the algorithm achieves a 92,3 F1 score corresponding to 12 true-positives, 1 false positive and 1 false negative.This preliminary report suggests that the method has potential use in assessing gait disorders in controlled and non-controlled environments. It suggests that deep learning methods could be explored given the availability of a larger population and data samples. [ABSTRACT FROM AUTHOR]

Background: Tai Chi (TC) is widely acknowledged for its positive impact on improving motor function in older adults. Nevertheless, limited research has directly compared the effects of different TC styles on older adults with functional impairments. Objective: This study aimed to assess the impact of different TC styles on motor function in older adults with functional impairments. Method: We searched five databases—PubMed, Scopus, Chinese National Knowledge Infrastructure (CNKI), Web of Science, and Wiley Online Library—including studies published up to September 2024. The selection of literature adhered to PRISMA guidelines, with quality assessment independently carried out by two researchers. Results: Fourteen studies met the inclusion criteria for this review. The analysis revealed that TC interventions for functionally impaired older adults primarily employed Yang-style, Sun-style, Chen-style, and simplified-style TC. The populations studied included individuals with mild cognitive impairment (MCI), nonspecific low back pain (NS-LBP), preclinical disabilities, chronic diseases, poor balance, osteoarthritis (OA), Parkinson's disease (PD), sarcopenia, and those at risk of falls. The findings indicated that motor function in functionally impaired older adults were closely linked to balance, gait, mobility, strength, and fall rates. Among the various TC styles, Yang-style was the most frequently utilised intervention. Conclusion: This review examined four types of TC interventions and found strong evidence supporting the effectiveness of Yang-style TC in improving motor function in older adults with functional impairments. Additionally, five assessment methods—Single-Leg Stance (SL), Six-Minute Walk Test (6MWT), Timed Up and Go Test (TUGT), Chair Stand Test (CST), and Fall Efficacy Scale (FES)—were identified as suitable for evaluating this population. Based on the findings, it is recommended that individuals with functional impairments engage in Yang-style 24-movement TC, with an intervention duration of 12 weeks, practicing two to five times a week for 60 min each session. [ABSTRACT FROM AUTHOR]

Introduction: Freezing of gait (FOG) is a disabling symptom for people with Parkinson's disease (PwPD). Turning on the spot for one minute in alternating directions (360 turn) while performing a cognitive dual-task (DT) is a fast and sensitive way to provoke FOG. The FOG-index is a widely used wearable sensor-based algorithm to quantify FOG severity during turning. Despite that, the FOG-index's classification performance and criterion validity is not tested against the gold standard (i.e., video-rated time spent freezing). Therefore, this study aimed to evaluate the FOG-index's classification performance and criterion validity to assess FOG severity during 360 turn. Additionally, we investigated the FOG-index's optimal cutoff values to differentiate between PwPD with and without FOG. Methods: 164 PwPD self-reported the presence of FOG on the New Freezing of Gait Questionnaire (NFOGQ) and performed the DT 360 turn in the ON medication state while being videoed and wearing five wearable sensors. Two independent clinical experts rated FOG on video. ROC-AUC values assessed the FOG-index's classification accuracy against self-reported FOG and expert ratings. Spearman-rho was used to evaluate the correlation between expert and FOG-index ratings of FOG severity. Results: Twenty-eight patients self-reported FOG, while 104 were classified as a freezer by the experts. The FOG-index had limited classification agreement with the NFOGQ (AUC = 0.60, p = 0.115, sensitivity 46.4%, specificity 72.8%) and the experts (AUC = 0.65, p < 0.001, sensitivity 68.3%, specificity 61.7%). Only weak correlations were found between the algorithm outputs and expert ratings for FOG severity (rho = 0.13–0.38). Conclusion: A surprisingly large discrepancy was found between self-reported and expert-rated FOG during the 360 turning task, indicating PwPD do not always notice FOG in daily life. The FOG-index achieved suboptimal classification performance and poor criterion validity to assess FOG severity. Regardless, 360 turning proved a sensitive task to elicit FOG. Further development of the FOG-index is warranted, and long-term follow-up studies are needed to assess the predictive value of the 360 turning task for classifying FOG conversion. [ABSTRACT FROM AUTHOR]

Introduction: Cerebral small vessel disease (CSVD) is a chronic systemic degenerative disease affecting small blood vessels in the brain, leading to cognitive impairments. Transcranial direct current stimulation (tDCS), a non-invasive brain stimulation technique that applies low electrical currents to the scalp, shows promise in treating cognitive and movement disorders. However, further clinical evaluation is required to assess the long-term effects of tDCS on neuroplasticity and gait in patients with CSVD. We investigated the effects of long-term, repeated tDCS on local brain perfusion, network connectivity, cognition, and gait in patients with CSVD and gait disorders (CSVD-GD). Methods: This prospective, single-blind, multicenter, randomized controlled study enrolled 66 patients with CSVD-GD, categorized into the tDCS and Sham groups. Imaging and gait characteristic data were collected over three periods using magnetic resonance imaging and a gait analyzer, along with neuropsychological assessments. Results: Among 156 volunteers with CSVD-GD, 66 participated in this study, with 60 completing the entire process. Compared to the Sham group, the tDCS group exhibited a more pronounced increase in the cerebral blood flow to the dural cerebrospinal fluid ratio in regions such as the orbitofrontal cortex and cingulate gyrus (P < 0.05, FDR corrected), along with significantly greater improvements in gait speed and stride length. Tolerance to tDCS was good, with no difference in adverse reactions between the groups, except for a scalp burning sensation reported during the 1st week (24.24% and 6.06% in the tDCS and Sham groups, respectively; P = 0.003). Discussion: Long-term tDCS is effective and safe for improving neuroplasticity and gait cognition in patients with CSVD. [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]

Brodalumab, a humanized monoclonal antibody that targets the interleukin-17 receptor A, is primarily used to manage moderate-to-severe plaque psoriasis. Although it has demonstrated favorable efficacy and safety in clinical trials, the strict inclusion and exclusion criteria may not fully reflect its safety profile in real-world settings. As its use becomes more widespread in clinical practice, understanding its safety in real-world applications is crucial. This study employed disproportionality analysis to assess the safety of brodalumab by examining all adverse event reports that identified brodalumab as the primary suspected drug in the FDA Adverse Event Reporting System database since 2017. Techniques such as the Reporting Odds Ratio, Proportional Reporting Ratio, Multi-item Gamma Poisson Shrinker, and Bayesian Confidence Propagation Neural Network were utilized to analyze the adverse events associated with brodalumab. Additionally, the Weibull distribution was used to model the temporal risk of adverse events. The study identified several adverse reactions already listed on the drug's label that showed positive signals, including arthralgia, headache, myalgia, suicidal ideation, oropharyngeal pain, injection site mass, and infections. Additionally, we found potential adverse reactions not noted on the drug's label that exhibited positive signals, including depression, increased blood pressure, peripheral swelling, gait disturbance, inability to walk, stress, myocardial infarction, sepsis, uveitis, nephrolithiasis, and interstitial lung disease. Moreover, this analysis highlighted the critical need for vigilant monitoring of adverse events, especially during the first month following the initiation of treatment. This study provides initial insights into the real-world safety of brodalumab, confirming known adverse reactions and uncovering additional potential risks. The results deliver vital information that can assist clinicians in making informed decisions when prescribing brodalumab for psoriasis treatment. [ABSTRACT FROM AUTHOR]

Walking ability is essential for human survival and health. Its basic rhythm is mainly generated by the central pattern generator of the spinal cord. The rhythmic stimulation of music to the auditory center affects the cerebral cortex and other higher nerve centers, and acts on the central pattern generator. By means of rhythm entrainment, the central pattern generator can produce walking rhythm synchronized with music rhythm, control muscle tension, and then regulate human gait. Basal ganglia dysfunction is the main cause of abnormal gait in patients with Parkinson's disease. Music therapy provides external rhythmic stimulation, recruits neural networks to bypass the basal ganglia and synchronizes gait with external rhythms in both time and space through auditory-motor neural networks, helping to promote the improvement of abnormal gait patterns in patients with Parkinson's disease. [ABSTRACT FROM AUTHOR]

Simple Summary: Over recent decades, the swine industry has achieved substantial productivity gains through advancements in genetics, nutrition, and management practices. However, at the same time, there has been a concerning rise in the number of sows being culled earlier than expected and an increase in sow mortality rates. The longevity of sows is crucial for sustainable pig production as it improves productivity and reduces costs. This early removal raises ethical and welfare concerns. Several factors influence sow longevity, making nutritional strategies critical for addressing these challenges and improving sow health and welfare. This article highlights key nutritional approaches to support sow development and longevity while identifying information gaps that warrant further research. For instance, young female pigs (gilts) should be fed separately from other pigs to ensure proper growth and bone development. Special diets are particularly important around the time sows give birth, as this is when they face the highest health risks. The use of fiber, probiotics or antioxidants can help improve the health and resilience of sows during these critical stages. These approaches are promising nutritional tools to improve sow health and welfare and can also benefit the industry's profitability. Modern hyperprolific sows are increasingly susceptible to health challenges. Their rapid growth rates predispose them to locomotor disorders, while high metabolic demands, reduced backfat thickness, and increased protein accretion heighten their vulnerability to heat stress and dystocia. Additionally, prolonged farrowing negatively affects the oxidative and inflammatory status of these females. Additionally, prevalent conditions such as gastric ulcers and cystitis raise ethical, welfare, and economic concerns. Despite the several studies related to sow nutrition, there are no studies which compile and extrapolate nutrition approaches from the rearing period and their impact on sows' health and longevity. Also, the aim of our review was to shed light on gaps that require further investigation. Controlling body condition scores is crucial for maximizing productivity in sows. During gestation, high-fiber diets help maintain optimal body condition and prevent constipation, particularly during the peripartum period. Antioxidants offer a range of beneficial effects during this critical phase. Additionally, probiotics and acidifiers can enhance gut health and lower the risk of genitourinary infections. On the day of farrowing, energy supplementation emerges as a promising strategy to reduce farrowing duration. Collectively, these strategies address major health challenges, enhancing welfare and promoting sow's longevity. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is characterized by a slow, short-stepping, shuffling gait pattern caused by a combination of motor control limitations due to a reduction in dopaminergic neurons. Gait disorders are indicators of global health, cognitive status, and risk of falls and increase with disease progression. Therefore, the use of quantitative information on the gait mechanisms of PD patients is a promising approach, particularly for monitoring gait disorders and potentially informing therapeutic interventions, though it is not yet a well-established tool for early diagnosis or direct assessment of disease progression. Over the years, many studies have investigated the spatiotemporal parameters that are altered in the PD gait pattern, while kinematic and kinetic gait parameters are more limited. A scoping review was performed according to the PRISMA guidelines. The Scopus and PubMed databases were searched between 1999 and 2023. A total of 29 articles were included that reported gait changes in PD patients under different gait conditions: single free walking, sequential motor task, and dual task. The main findings of our review highlighted the use of optoelectronic systems for recording kinematic parameters and force plates for measuring kinetic parameters, due to their high accuracy. Most gait analyses in PD patients have been conducted at self-selected walking speeds to capture natural movement, although studies have also examined gait under various conditions. The results of our review indicated that PD patients experience alterations in the range of motion of the hip, knee, and ankle joints, as well as a reduction in the power generated/absorbed and the extensor/flexor moments. These findings suggest that the PD gait pattern may be more effectively understood using kinematic and kinetic parameters. [ABSTRACT FROM AUTHOR]

Instrumented gait analysis is widely used in clinical settings for the early detection of neurological disorders, monitoring disease progression, and evaluating fall risk. However, the gold-standard marker-based 3D motion analysis is limited by high time and personnel demands. Advances in computer vision now enable markerless whole-body tracking with high accuracy. Here, we present vGait, a comprehensive 3D gait assessment method using a single RGB-D sensor and state-of-the-art pose-tracking algorithms. vGait was validated in healthy participants during frontal- and sagittal-perspective walking. Performance was comparable across perspectives, with vGait achieving high accuracy in detecting initial and final foot contacts (F1 scores > 95%) and reliably quantifying spatiotemporal gait parameters (e.g., stride time, stride length) and whole-body coordination metrics (e.g., arm swing and knee angle ROM) at different levels of granularity (mean, step-to-step variability, side asymmetry). The flexibility, accuracy, and minimal resource requirements of vGait make it a valuable tool for clinical and non-clinical applications, including outpatient clinics, medical practices, nursing homes, and community settings. By enabling efficient and scalable gait assessment, vGait has the potential to enhance diagnostic and therapeutic workflows and improve access to clinical mobility monitoring. [ABSTRACT FROM AUTHOR]

Purpose: Robotic and Exoskeleton Assisted Gait Training (REAGT) has become the mainstream gait training module. Studies are investigating the psychosocial effects of REAGT mostly as secondary outcomes. Our systematic review and meta-analysis aims to investigate the effects of REAGT in MS patients' mental health and fatigue. Materials and methods: We searched the electronic databases (Scopus, PubMed, Pedro, Cochrane Trials, Dare) for RCT studies fulfilling our inclusion criteria. A meta-analysis of available assessment tools was conducted calculating the summary mean differences in two different timepoints, before and after the intervention using random-effects models. Results: The systematic search of the electronic databases identified 302 studies. Seven RCT studies were considered eligible for data extraction and meta-analysis, according to our eligibility criteria. We were able to obtain adequate data to proceed with a quantitative synthesis for QoL SF36–MC (Mental Component), QoL SF-36 mental and psychosocial subscales, Multiple Sclerosis Quality of Life-54-Mental Health Composite (MSQoL-54-MHC), Patient's Health Questionnaire (PHQ-9) and Fatigue Severity Scale (FSS). Conclusions: Overall, REAGT seems to have a positive effect to Quality of Life, especially in MS patients' perspective of General and Mental Health and a slight positive effect in depression as measured by PHQ-9. Implications for rehabilitation: Multiple Sclerosis (MS) decreases physical and non-physical aspects of patients' quality of life perspective. Rehabilitation strategy must take into consideration the non-physical effects of a training intervention. Robotic and Exoskeleton Gait Training has a positive effect in MS patients' non-physical quality of life and a slight positive effect in depression. [ABSTRACT FROM AUTHOR]

Background: Virtual reality-based training has been widely used for post-stroke patients due to its positive effects on functional aspects by promoting brain plasticity. Objective: This study aimed to investigate the effectiveness of gait training with virtual reality-based real-time feedback on motor function, balance, and spatiotemporal gait parameters in post-stroke patients. Methods: Fifteen patients (n = 15) with chronic stroke were randomly assigned to either the virtual reality-based real-time feedback with treadmill gait training (experimental group n = 8) or the treadmill gait training (control group n = 7). For the experimental group that participated, a treadmill, an Oculus Rift VR device, and smart insoles were used for gait training with VR-based real-time feedback. Regarding gait training with VR-based real-time feedback, the patient wore an Oculus Rift and performed gait training on a treadmill for 30 min a day, three times a week, for 5 weeks. The control group participated in treadmill gait training for 30 min a day, three times a week, for 5 weeks. Motor function was measured using the Fugl-Meyer assessment. Balance was measured using the timed up and go test and Berg balance scale. Gait performance was measured using an Optogait. The normality test was performed using the Shapiro–Wilk test, the Wilcoxon signed-rank test was used for the within-group comparison, and the Mann–Whitney U test was used for the between-group comparison. Results: In the group analyses, both groups showed significant improvements in motor function balance and gait ability. According to the pre- and post-treatment results, greater improvement in the Fugl-Meyer assessment (experimental group: 4.75 vs. control group: 1.57) was observed in the experimental group compared with the control group (p < 0.05). In balance ability, greater improvement in the timed up and go test (experimental group: −3.10 vs. control group: −1.12) and Berg balance scale (experimental group: 3.00 vs. control group: 1.71) (p < 0.05). In the spatiotemporal gait parameters, greater improvement in affected step length (5.35 vs. 2.01), stride length (3.86 vs. 1.75), affected single support (2.61 vs. 1.22), and cadence (0.07 vs. 0.02) was observed in the experimental group compared with the control group (p < 0.05). Conclusions: This study suggested the positive effects of the virtual reality-based real-time feedback with treadmill gait training on motor function, balance, and gait performance. [ABSTRACT FROM AUTHOR]

Background/Objectives: Gait retraining is widely used in orthopedic rehabilitation to address abnormal movement patterns. However, retaining walking modifications can be challenging without guidance from physical therapists. Real-time auditory biofeedback can help patients learn and maintain gait alterations. This study piloted the feasibility of the musification of feedback to medialize the center of pressure (COP). Methods: To provide musical feedback, COP and plantar pressure were captured in real time at 100 Hz from a wireless 16-sensor pressure insole. Twenty healthy subjects (29 ± 5 years old, 75.9 ± 10.5 Kg, 1.73 ± 0.07 m) were recruited to walk using this system and were further analyzed via marker-based motion capture. A lowpass filter muffled a pre-selected music playlist when the real-time center of pressure exceeded a predetermined lateral threshold. The only instruction participants received was to adjust their walking to avoid the muffling of the music. Results: All participants significantly medialized their COP (−9.38% ± 4.37, range −2.3% to −19%), guided solely by musical feedback. Participants were still able to reproduce this new walking pattern when the musical feedback was removed. Importantly, no significant changes in cadence or walking speed were observed. The results from a survey showed that subjects enjoyed using the system and suggested that they would adopt such a system for rehabilitation. Conclusions: This study highlights the potential of musical feedback for orthopedic rehabilitation. In the future, a portable system will allow patients to train at home, while clinicians could track their progress remotely through cloud-enabled telemetric health data monitoring. [ABSTRACT FROM AUTHOR]

Objectives: Freezing of Gait (FOG) is one of the disabling symptoms in patients with Parkinson's Disease (PD). While it is difficult to early detect because of the sporadic occurrence of initial freezing events. Whether the characteristic of gait impairments in PD patients with FOG during the 'interictal' period is different from that in non-FOG patients is still unclear. Methods: The gait parameters were measured by wearable inertial sensors. Exploratory factor analysis was used to investigate the inherent structure of diverse univariate gait parameters, with the aim of identifying shared characteristics among the gait variables. Results: This cross-sectional study involved 68 controls and 245 PD patients (167 without FOG and 78 with FOG). The analysis yielded six distinct gait domains which were utilized to describe the impaired gait observed during the "interictal" period of FOG. Both PD-nFOG and PD-FOG groups exhibited significant impairments in the pace domain, kinematic domain, gait phase domain, and turning process domain compared to the healthy control. The gait phase domain was different in the PD-FOG group compared to the PD-nFOG group (p corrected = 0.004, Cohen's d = -0.46). And it was identified as independent risk factor for FOG (OR = 1.64, 95% CI = 1.05–2.55, p = 0.030), as well as other risk factors: gender (OR = 2.67, 95% CI = 1.19–5.99, p = 0.017), MDS-UPDRS IV score (OR = 1.23, 95% CI = 1.10–1.37, p < 0.001), and PIGD subscore (OR = 1.50, 95% CI = 1.30–1.73, p < 0.001). The model demonstrated a correct discrimination rate of 0.78 between PD-FOG and PD-nFOG, with an area under the receiver operating characteristic curve (AUC) of 0.87. Conclusions: FOG was found to be associated with abnormal alterations in the gait phase domain during the interictal period. Models constructed using gait phase domain, PIGD subscore, gender, and severity of motor complications can better differentiate freezers from no-freezers during 'interictal' period. [ABSTRACT FROM AUTHOR]

Adaptive deep brain stimulation (DBS) provides individualized therapy for people with Parkinson's disease (PWP) by adjusting the stimulation in real-time using neural signals that reflect their motor state. Current algorithms, however, utilize condensed and manually selected neural features which may result in a less robust and biased therapy. In this study, we propose Neural-to-Gait Neural network (N2GNet), a novel deep learning-based regression model capable of tracking real-time gait performance from subthalamic nucleus local field potentials (STN LFPs). The LFP data were acquired when eighteen PWP performed stepping in place, and the ground reaction forces were measured to track their weight shifts representing gait performance. By exhibiting a stronger correlation with weight shifts compared to the higher-correlation beta power from the two leads and outperforming other evaluated model designs, N2GNet effectively leverages a comprehensive frequency band, not limited to the beta range, to track gait performance solely from STN LFPs. [ABSTRACT FROM AUTHOR]

In the medical field, there are several very different movement disorders, such as tremors, Parkinson's disease, or Huntington's disease. A wide range of motor and non-motor symptoms characterizes them. It is evident that in the modern era, the use of smart wrist devices, such as smartwatches, wristbands, and smart bracelets is spreading among all categories of people. This diffusion is justified by the limited costs, ease of use, and less invasiveness (and consequently greater acceptability) than other types of sensors used for health status monitoring. This systematic review aims to synthesize research studies using smart wrist devices for a specific class of movement disorders. Following PRISMA-S guidelines, 130 studies were selected and analyzed. For each selected study, information is provided relating to the smartwatch/wristband/bracelet model used (whether it is commercial or not), the number of end-users involved in the experimentation stage, and finally the characteristics of the benchmark dataset possibly used for testing. Moreover, some articles also reported the type of raw data extracted from the smart wrist device, the implemented designed algorithmic pipeline, and the data classification methodology. It turned out that most of the studies have been published in the last ten years, showing a growing interest in the scientific community. The selected articles mainly investigate the relationship between smart wrist devices and Parkinson's disease. Epilepsy and seizure detection are also research topics of interest, while there are few papers analyzing gait disorders, Huntington's Disease, ataxia, or Tourette Syndrome. However, the results of this review highlight the difficulties still present in the use of the smartwatch/wristband/bracelet for the identified categories of movement disorders, despite the advantages these technologies could bring in the dissemination of low-cost solutions usable directly within living environments and without the need for caregivers or medical personnel. [ABSTRACT FROM AUTHOR]

Abnormal locomotor patterns may occur in case of either motor damages or neurological conditions, thus potentially jeopardizing an individual's safety. Pathological gait recognition (PGR) is a research field that aims to discriminate among different walking patterns. A PGR-oriented system may benefit from the simulation of gait disorders by healthy subjects, since the acquisition of actual pathological gaits would require either a higher experimental time or a larger sample size. Only a few works have exploited abnormal walking patterns, emulated by unimpaired individuals, to perform PGR with Deep Learning-based models. In this article, the authors present a workflow based on convolutional neural networks to recognize normal and pathological locomotor behaviors by means of inertial data related to nineteen healthy subjects. Although this is a preliminary feasibility study, its promising performance in terms of accuracy and computational time pave the way for a more realistic validation on actual pathological data. In light of this, classification outcomes could support clinicians in the early detection of gait disorders and the tracking of rehabilitation advances in real time. [ABSTRACT FROM AUTHOR]

Freezing of gait (FOG) is a debilitating symptom of Parkinson disease (PD). It is episodic and variable in nature, making assessment difficult. Wearable sensors used in conjunction with specialized algorithms, such as our group's pFOG algorithm, provide objective data to better understand this phenomenon. While these methods are effective at detecting FOG retrospectively, more work is needed. The purpose of this paper is to explore how the existing pFOG algorithm can be refined to improve the detection and prediction of FOG. To accomplish this goal, previously collected data were utilized to assess the prediction ability of the current algorithm, the potency of each FOG assessment task(s) for eliciting FOG, and the maintenance of detection accuracy when modifying the sampling rate. Results illustrate that the algorithm was able to predict upcoming FOG episodes, but false positive rates were high. The Go Out and Turn-Dual Task was most potent for eliciting FOG, and the 360-Dual Task elicited the longest duration of FOG. The detection accuracy of the pFOG algorithm was maintained at a sampling rate of 60 Hz but significantly worse at 30 Hz. This work is an important step in refining the pFOG algorithm for improved clinical utility. [ABSTRACT FROM AUTHOR]

The diagnosis of Parkinson's disease (PD) is mainly based on the assessment of motor symptoms, although the influence of non-motor symptoms sometimes may be more significant on the patient's disability than the cardinal clinical signs of the disease. The predominant subtype of postural instability and gait disturbance is known to be associated with more severe non-motor symptoms of Parkinson's disease. Yet, the association between motor subtypes and specific mood symptoms remains understudied. The study aimed to analyze an association between sleep and chronotype signs, motor subtypes, with the severity of depressive symptoms in PD patients. We have included 64 patients in the clinical study. The studied population was divided into the following groups: PIGD group – patients with PD and dominance of postural instability and gait disorders; non-PIGD group – patients with PD and dominance of tremor or intermediate motor subtype. We used the Unified Parkinson's Disease Rating Scale, Beck Depression Inventory, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Munich Chronotype Questionnaire. Patients with the PIGD subtype have higher levels of depressive symptoms and excessive daytime sleepiness, poorer sleep quality, later sleep onset and mid-sleep, longer sleep latency, and sleep inertia. PIGD motor subtype (p < 0.001), poor sleep quality (p < 0.001), mid-sleep (p = 0.016), and sleep latency (p = 0.025) had a significant impact on the level of depression in univariate regression analysis. Still, only mid-sleep (p = 0.019) and poor sleep quality (p = 0.003) increased the probability of higher severity of depression in the multivariate model. Poor sleep quality and later mid-sleep may be predictors of more severe depressive symptoms in PD. • Patients with Parkinson's disease and PIGD subtype experience higher depressive symptoms. • Poor sleep quality and later mid-sleep are predictors of more severe depressive symptoms in PD patients. • PIGD patients report worse sleep quality, greater daytime sleepiness, and longer sleep latency compared to non-PIGD. • Study emphasizes the importance of assessing sleep and motor subtype to manage depression in PD patients effectively. [ABSTRACT FROM AUTHOR]

Distal tibial valgus deformity, though common in various medical conditions, has not been extensively studied in idiopathic flatfoot. It clinically presents as hindfoot valgus, mimicking flatfoot deformity, and requires X-rays for detection. Severity is quantified using resting calcaneal angle and standing tibio-calcaneal angles (STCA), but their prognostic value for identifying distal tibial valgus deformity remains unclear. The use of routine invasive radiographs in idiopathic flatfoot is controversial as instrumented non-invasive gait analysis gains popularity for investigative purposes. This study aimed to determine the prevalence of distal tibial valgus deformity in children and adolescents with idiopathic flatfoot using radiography and to identify parameters assessed during standing or walking that predict this deformity. A retrospective study included outpatients aged 7–17 years with idiopathic flatfeet. Participants underwent clinical examination, foot and ankle X-rays, and instrumented 3-dimensional gait analysis. A lateral distal tibia angle (LDTA) < 86° indicated valgus deformity, with LDTA 86–92° considered normal. Two groups were analysed: ankle valgus (LDTA < 86°) and normal ankle (86–92°). STCA, ankle tilt, intermalleolar height difference (IMHD), and eight kinematic parameters were correlated with LDTA. The study included 136 patients (mean age 11.5 years, SD=2.2). Sixty-three patients had ankle valgus (LDTA 83.8°, SD=1.7°), and 73 had normal ankles (LDTA 88.8°, SD=1.3°), showing a significant difference between groups (p < 0.001). STCA during standing was the best predictor, though it explained only 9 % of variance, limiting robust prediction. The prevalence of distal tibial valgus deformity was 42 % in idiopathic flatfoot cases, highlighting the necessity for routine ankle radiographs due to the inability to clinically suspect this deformity. Further studies should explore the biomechanical effects and their clinical implications for management. • Distal tibial valgus deformity was found in 42 % of idiopathic flatfoot cases. • The tibio-calcaneal angle during standing (STCA) was the best predictor but only explained 9 % of the variance. • The standing and gait analysis data does not provide any indication of an underlying distal tibial valgus deformity. [ABSTRACT FROM AUTHOR]

The possibilities of out-of-lab gait analysis are ever increasing, with a recent development from Protokinetics movement analysis software (PKMAS) which, among other parameters, proposes an estimation of centre of mass (COMe) displacement. This measure can be useful in both clinical and sports performance environments. Does PKMAS provide an accurate estimation of the COM displacement and velocity? Fifteen participants completed 10 walking trials over the Zeno™ Walkway while simultaneously being equipped with a full-body marker set for VICON analysis. The antero-posterior and medio-lateral COMe displacement components from PKMAS were compared with the projected 3D COM obtained from marker tracking using Bland-Altman analyses and Lin's concordance coefficient. COM velocity was also calculated from the estimated displacement data from PKMAS. Results demonstrated a high mean bias in both the anteroposterior (AP) and mediolateral (ML) directions for COMe displacement. COMe velocity showed low mean bias but high limits of agreement and low precision. Lin's concordance correlation coefficient showed good to excellent agreement in the AP direction for velocity and displacement, respectively; poor agreement was seen in the ML direction. Based on these observations, the COMe proposed by the Protokinetics software does not produce accurate results and is to be used with caution in healthy subjects; it is not recommended for subjects presenting pathological gait. • The PKMAS provides estimations of COM displacement components. • Antero-posterior COMe displacement presents a good concordance against reference. • Medio-lateral COMe displacement and velocity components are considered inaccurate. • COMe displacements should be treated with caution before use for diagnosis. [ABSTRACT FROM AUTHOR]

The Dual-task Augmented Reality Treatment (DART) trial recently established that dual-task training (DTT) delivered by a physical therapist or the augmented reality DART platform was effective in improving spatiotemporal gait parameters under single- and dual-task conditions in individuals with Parkinson's disease (PD). Data regarding postural stability were not reported in the primary outcome manuscript. The aim of this secondary analysis was to compare the effects of a Traditional DTT intervention delivered by a physical therapist and DTT delivered by the DART platform on postural stability, functional mobility, and turning in individuals with PD. It was hypothesized that both groups would experience similar improvements. Forty-seven individuals with PD were randomized to an 8-week (16 sessions) Traditional DTT or DART intervention. The limits of stability test and the instrumented Timed Up and Go (TUG) under single- and dual-task conditions were gathered at Baseline, End of Treatment (EOT), and 8-weeks after EOT. At EOT, the Traditional DTT and DART groups experienced a 9 % and 14 % improvement in maximal excursion area and a 7 % and 12 % improvement in total TUG time under dual-task conditions, respectively (p<0.05). Turn duration and average and peak turn velocity during the TUG improved for both groups under single- and dual-task conditions at EOT. Improvements in turn duration (dual-task) and average turn velocity (single- and dual-task) persisted 8-weeks after intervention cessation. Improvements in postural stability, functional mobility, and turning under single- and dual-task conditions following traditional and DART DTT in individuals with PD indicate that cognitive-motor training can be used to effectively treat postural instability in this population. Improvements in the DART group were similar to traditional DTT, supporting our previous data demontrating that DART is an effective digital therapeutic to improve gait and postural instability in individuals with PD. • Dual-task training (DTT) improves postural stability in Parkinson's disease (PD). • Improvements were present in the traditional and augmented reality (AR) training groups. • DTT delivered via AR technology addresses several key barriers to clinical adoption. • The AR platform is a tool for therapist to treat PD and increase accessibility to care. [ABSTRACT FROM AUTHOR]

Falls in older adults increase the risk of mobility loss. Proper understanding of gait mechanisms related to falls may provide novel solutions for maintaining mobility in older adults. Identify fall-related gait patterns through analyzing alterations in gait parameters to walk faster than usual pace in older adults. A Total of 519 participants (mean age = 73.12 years; 51.05 % female), including non-fallers (n = 396) and fallers (n = 123), aged 60–96 years were assessed in the Baltimore Longitudinal Study of Aging. Participants completed gait assessments at both usual and fast paces. Range of motions (ROM) for the hip, knee, and ankle joint in the sagittal plane and hip abductor ROM during normal and fast pace gait were measured by 3D motion capture system (Vicon 612). For all gait variables, percentage-changes (PC; (((fast-walking_parameter – usual-walking_parameter) /usual-walking_parameter)*100)) was calculated. Associations of PC for gait speed and PC for other gait parameters were compared between fallers and non-fallers. Compared to non-fallers, fallers walked with shorter stride, elongated double support time and shorter knee ROM in the faster pace walk (p = 0.044, p = 0.019, and p = 0.036, respectively). PCs of all gait related variables were significantly associated with PC of gait speed in non-fallers (ps < 0.005), while in the fallers, only PC for stride length, cadence, and hip ROM were associated with PC for gait speed (ps < 0.001). Among non-fallers related PC for gait speed was associated with PC across gait parameters suggesting the use of similar biomechanical approaches in usual and fast gait. Compared to non-fallers, fallers demonstrated different mechanisms of transition from usual to fast gait. Evaluating speed-up strategies could provide insight into subtle yet important gait modifications in apparently well-functioning older adults that would help identify individuals at high risk of falling. • Fallers have unique speed-up mechanism in the normal gait. • Identifying gait changes in faller's is necessary for maintaining healthy gait. • Fall related functional declines in the range of motion are found. [ABSTRACT FROM AUTHOR]

The Gait Deviation Index (GDI) is a metric clinicians use to assess overall gait pathology in children with cerebral palsy (CP) by comparing kinematic data to a normative sample. The Gait Variability Index (GVI) is a related metric that quantifies the variability in spatio-temporal variables during gait. The GDI and GVI have been verified using marker-based motion capture approaches, but video-based markerless motion capture has not been compared using these tools in children with CP. Do GDI and GVI scores differ when measured using markerlessTheia3D and a marker-based approach between the more and less affected legs in children with CP? Fifteen children with CP (GMFCS levels I-IV) and 24 typically developing children aged 6–18 years were recruited for this study. Overground walking was performed at a self-selected pace while the pelvis and lower limb kinematics were simultaneously recorded using both motion capture systems. Differences in GDI and GVI scores when considering the effect of system and limb impairment were analyzed using two-way repeated-measures ANOVAs. GDI scores were 6.9 points lower (p < 0.05) when measured using Theia3D compared to the marker-based approach and 6.8 points lower (p < 0.05) in the more affected limbs than in the less affected limbs. These GDI score differences are considered clinically significant. No differences were identified in GVI scores between systems or limb impairment. Differences in kinematic measurements were found in children with CP, including pelvic tilt, hip flexion/extension, hip rotation, and foot progression angle, where root mean square differences between systems exceeded 10°. Theia3D can adequately measure variability in spatio-temporal gait parameters for quantifying GVI scores in children with CP compared to the marker-based approach. However, caution is needed when quantifying lower limb kinematics and interpreting GDI and GVI scores using Theia3D in children with CP. • Theia3D 2023 showed significantly lower GDI scores than the marker-based approach. • More affected limbs had lower GDI scores than less affected limbs. • GDI differences between systems and impairment levels were clinically significant. • No differences were found in GVI scores between systems or limb impairment. • Pelvic tilt, hip sagittal, and foot progression angles differed between systems. [ABSTRACT FROM AUTHOR]

The Gait Profile Score (GPS) and the Gait Variable Score (GVS) are summary measures used to assess the long-term effects of neuro-orthopedic surgery (NOS) in children with cerebral palsy (cwCP). What are the immediate changes after NOS as assessed by GPS and GVS, and how does GPS variation (ΔGPS) compare to the clinical opinion of the NOS outcome? Prospective single-arm cohort study. CwCP were assessed before NOS and after the first month of weight-bearing. Popliteal angle, ankle passive dorsiflexion (pDF), and spasticity were collected at the bedside. During walking, pain was assessed using NPRS, and speed was obtained from gait analysis data, as well as GPS and GVS. Longitudinal variations were analyzed using the Wilcoxon test. Children were classified as Improved (I), Stable (S), or Worsened (W) according to ΔGPS and the cut-off threshold recommended in literature. Two clinicians independently classified patients either as I, S, or W based on surgical outcome. Agreement between these two classifications was analyzed using Cohen's k. Twenty cwCP, 11.4 (3.4) years, were included. At the follow-up: the popliteal angle was reduced by 20° (p=0.015); pDF increased by 10° (p<0.001), and triceps surae spasticity decreased (p=0.008). Pain decreased in four children. GPS decreased from 12.7 (range 8.1–27.7) to 11.8 (7.6–17.6) (ES=0.514, p=0.046), despite a decrease in gait speed (p<0.001). GVS better highlighted the effect of NOS after single-level surgery. Clinically, 18/1/1 children were classified I/S/W. Based on ΔGPS, 9/8/3 children were classified I/S/W. Such disagreement (k=0.119, p=0.227) was mainly due to the different focus of the two assessments. Following NOS, immediate improvements in walking kinematics were observed. • Immediate variations following neuro-orthopedic surgery in cwCP were analyzed. • GPS significantly decreased in the sample at the one-month mark after surgery. • GVS provided details of specific kinematics improvements at a single-joint level. • GPS and GVS can ease the communication with non-expert clinicians. [ABSTRACT FROM AUTHOR]

Objective: 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). Methods: 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. Results: 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. Interpretation: 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 2025;97:149–162 [ABSTRACT FROM AUTHOR]

Background: Traditional surgery for degenerative thoracic disorder can be extremely invasive and accompanied by complications. Unilateral biportal endoscopy (UBE), a newly developed technique in the field of spin surgery, is minimally invasive and its popularity and indications have been increasing. In this study, we report three cases of different thoracic diseases treated using UBE. Methods: The first case was a 50-year-old male patient with lower extremity tingling sense and right thigh anterior aspect radiating pain. Bilateral decompression and removal of ossification of the ligamentum flavum (OFL) was done. The second case was a 75-year-old female who had symptoms of gait disturbance and motor weakness due to thoracic myelopathy in T12-L1. We performed canal decompression and discectomy using the far-lateral approach. The third case was a 69-year-old female with poor medical condition due to lymphoma who had symptoms of right intercostal pain that occurred after T12 acute compression fracture. UBE treatment was decided, and nerve decompression was performed. Results: In the first case, the tingling sense due to OYL improved three months after the surgery. In the second case, the right lower extremity radiating pain and gait disturbance showed improvement after surgery, but motor weakness continued until four months after surgery. In the third case, intercostal pain showed improvement immediately after surgery. Conclusion: Although UBE surgery is limited in completely replacing traditional treatments for degenerative thoracic disease, it offers the advantages of rapid rehabilitation and short-term hospitalization and can be a good surgical treatment option. [ABSTRACT FROM AUTHOR]

Introduction Foot-borne soldiers sometimes carry out nighttime operations. It has previously been reported an elevated metabolic demand and impaired walking economy during outdoor walking on a gravel road in darkness wearing night vision goggles (NVG), compared with wearing a headlamp. The aim of the present study was to evaluate the effect of wearing NVG while walking in a hilly forest terrain and compare the results between experienced and inexperienced NVG users. Materials and Methods At nighttime, two different groups, inexperienced (five men and six women) and experienced (nine men) NVG users, walked 1.1 km at a self-selected comfortable pace in a hilly forest. Part I was mainly uphill, and Part II was mainly downhill. Walks were performed wearing a headlamp (light), monocular NVG (mono), binocular NVG (bino), or mono with a 25 kg extra weight (backpack). Walking economy calculated from oxygen uptake in relation to body mass and covered distance (V̇O2 (mL/[kg · km])), heart rate, gait, and walking speed were measured. Results In both groups, walking economy was deteriorated in all three conditions with limited vision (mono, bino, and backpack) compared to the light condition, both during Part I (mono/bino, experienced: +26/+25%, inexperienced: +34/+28%) and Part II (mono/bino, experienced: +44/+46%, inexperienced: +63/+49%). In the backpack condition, the relative change of walking economy was greater for the inexperienced group than the experienced group: Part I (experienced: +46%, inexperienced: +70%), Part II (experienced: +71%, inexperienced: +111%). Concurrently, the step length was shorter in all three conditions with limited vision during Part I (mono/bino/backpack, experienced: −7/−7/−15%, inexperienced: −12/−12/−19%) and Part II (mono/bino/backpack; experienced: −8/−8/−14%, inexperienced: −17/−15/−24%) than in the light condition. The experienced NVG users walked faster during all conditions, but there was no difference in heart rate between groups. Conclusions Despite that foveal vision using NVG is adequate, it appears that the mechanical efficiency during nighttime walking in hilly terrain was markedly lower while wearing NVG than with full vision, regardless of whether the soldier was an experienced or inexperienced NVG user. Moreover, the walking economy was even more affected when adding the 25-kg extra weight. It is probable that the deteriorated mechanical efficiency was partly due to the shorter step length in all three conditions with limited vision. [ABSTRACT FROM AUTHOR]

Case: Heterotopic ossification (HO) is a relatively rare but severe clinical finding around the hip joint, characterized by the formation of extraskeletal bone in soft tissue. We present the case of a 66-year-old man with a severe, painful gait disorder caused by extensive neurogenic bilateral HO. In this case, due to the medial HO localization, we performed a staged bilateral, combined HO resection and total hip arthroplasty using the single medial Ludloff approach. Conclusion: Our case highlights that, for combined hip osteoarthritis and medial HO, a Ludloff approach can be an effective option for achieving favorable surgical outcomes. [ABSTRACT FROM AUTHOR]

This article considers aspects of a development aid that provides medical support to strengthen pediatric orthopedics in Rwanda. We present part of the Afriquia foundation work, a nonprofit foundation from Poland involved in supporting the medical sector in Rwanda as a sign of global solidarity and the human right to health. The main foundation's activity is the treatment of orthopedic problems among Rwandan citizens. We present a case study of two children under the care of the Afiquia foundation. 11‐year‐old Seraphine treated due to the consequences of right tibia osteomyelitis and 11‐year‐old Lavi suffering from osteogenesis imperfecta. Both children were treated surgically in Poland due to Rwanda's lack of treatment possibilities. After the applied treatment, Seraphine walks correctly without crutches and can attend school and thrive among her peers. Lavi has not sustained any fragility fracture since the surgery in Poland. He is healthy and constantly ongoing his rehabilitation including gait training. The described cases initiated development aid in Rwanda, supplying hospitals with orthopedic implants and training medical staff. The growing number of humanitarian crises across the globe and the people affected requires increasing organizations involved in providing relief. The emphasis should be on global education, aiming to make the recipients reflect and prepare them to face humanitarian crises. [ABSTRACT FROM AUTHOR]

Functional gait disorders (FGDs) are a disabling subset of Functional Neurological Disorders in which presenting symptoms arise from altered high-level motor control. The dual-task paradigm can be used to investigate mechanisms of high-level gait control. The study aimed to determine the objective measures of gait that best discriminate between individuals with FGDs and healthy controls and the relationship with disease severity and duration. High-level spatiotemporal gait outcomes were analyzed in 87 patients with FGDs (79.3% women, average age 41.9±14.7 years) and 48 healthy controls (60.4% women, average age 41.9±15.7 years) on single and motor, cognitive, and visual-fixation dual tasks. The area under the curve (AUC) from the receiver operator characteristic plot and the dual-task effect (DTE) were calculated for each measure. Dual-task interference on the top single-task gait characteristics was determined by two-way repeated measures ANOVA. Stride time variability and its standard deviation (SD) failed to discriminate between the two groups in single and dual-task conditions (AUC<0.80 for all). Significant group x task interactions were observed for swing time SD and stride time on the cognitive dual tasks (p<0.035 for all). Longer disease duration was associated with poor gait performance and unsteadiness in motor and cognitive DTE (p<0.003) but improvement in stride length and swing time on the visual dual tasks (p<0.041). Our preliminary findings shed light on measures of gait automaticity as a diagnostic and prognostic gait biomarker and underline the importance of early diagnosis and management in individuals with FGDs. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact on risk factors for recurrent stroke after gait training among persons restricted in walking in the chronic phase after stroke. Methods: In this randomized controlled trial, two groups performed gait training, 1 session/day, 3 days/week for 6 weeks, including electromechanically assisted gait training on a treadmill (EAGT) (n=12) or variable conventional gait training only (n=15); a control group (n=11) continued as usual. Endurance assessed with the 6-minute walk test, blood pressure, weight and blood samples were collected at baseline and after 6 weeks. Total Cholesterol, High Density Lipoprotein Cholesterol, and Triglycerides in plasma, and HbA1c in blood (reflecting glucose levels) were analysed. Results: The EAGT group walked more than twice the distance compared to the Conventional training group while the effective training time was similar. Endurance in walking increased most in the Conventional group while the Control group declined. Systolic blood pressure decreased most in the Conventional group, with a moderate effect size (ŋp2) of 0.0921 (95% confidence interval (CI)0.0012-0.2598). Body weight decreased most in the EAGT group with a large effect size (ŋp2) of 0.1406 (95% CI0.0047-0.3452). Lipid levels exhibited non-conclusive changes and HbA1c did not change significantly in any group. Conclusions: Results indicate that six weeks of gait training may change risk factors for recurrent stroke even in persons restricted in mobility and that different training methods may have differential effects. These findings are in agreement with previous studies in less severely disabled persons and should encourage further studies in the current subgroup. [ABSTRACT FROM AUTHOR]

In subacute, non-ambulatory individuals after stroke, does mechanically assisted walking with body weight support result in more independent walking or better walking ability than usual walking training in the short term? Are any benefits maintained in the longer term? Is it detrimental to walking in terms of walking speed? A systematic review with meta-analysis of randomised studies with a Physiotherapy Evidence Database (PEDro) score > 4. Non-ambulatory adults ≤ 12 weeks after stroke. Any type of mechanically assisted walking with body weight support. Independent walking (ie, proportion of independent walkers), walking ability (eg, 0 to 5 Functional Ambulation Category, FAC) and walking speed. Fifteen studies involving 1,014 participants (mean PEDro score 6.4) were included. In the short term, mechanically assisted walking with body weight support resulted in more independent walking (RD 0.19, 95% CI 0.11 to 0.26) and better walking ability (MD 0.8 on the FAC, 95% CI 0.5 to 1.0) compared with the same amount of usual walking training. In the longer term, it resulted in better walking ability (MD 0.6 on the FAC, 95% CI 0.2 to 1.1). Mechanically assisted walking with body weight support does not appear to be detrimental to walking speed in the short term (MD 0.13 m/s, 95% CI 0.03 to 0.22) or longer term (MD 0.11 m/s, 95% CI 0.00 to 0.22). This review provides high-certainty evidence that mechanically assisted walking with body weight support results in more independent walking and better walking ability in individuals with stroke who are non-ambulatory subacutely compared with usual walking training. Given the importance of achieving walking in the short term, clinicians are encouraged to use this intervention. PROSPERO CRD42024549678 [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the effectiveness of personalized multifactorial fall risk assessment and intervention in reducing the incidence of recurrent falls after one year. Materials and Methods: This retrospective study reviewed medical records from the Geriatric Rehabilitation Clinic at Siriraj Hospital, including data from patients with a history of falls (fallers) or gait instability (non-fallers) between April 2016 and April 2021. Upon entering the clinic, older patients received personalized multifactorial fall risk assessment and intervention. Functional mobility was also evaluated using the Timed Up and Go (TUG) test, Functional Reach, and 30-second Chair Stand test. Fallers were followed for one year, and classified into recurrent fallers or zero-fallers based on whether they experienced at least one fall during the follow-up period. Results: Of the 134 patients initially reviewed, 105 met the criteria for analysis. The cohort was predominantly female (65.5%) with an average age of 81.5 years (SD 6.8). Common risk factors included hypertension, back/leg pain, and cognitive impairment. After 12 months, 27.4% of fallers experienced recurrent falls. Sedative medication use was significantly associated with increased fall risk (OR 4.15[1.5,11.44]; P < 0.05). Other risk factors were not statistically significant. The fall rate reduced from 80% to 27.4% following personalized intervention. Conclusion: Personalized multifactorial fall risk assessment and intervention significantly decreased the fall rate among older patients. Sedative medications were notably linked to increased fall risk, highlighting the need for careful medication management and targeted fall prevention strategies. [ABSTRACT FROM AUTHOR]

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]