Obesity-related alterations in anticipatory postural mechanisms associated with gait initiation

A clinical application of gait quality patterns in osteoarthritis

AIM

To investigate whether a smartphone-based gait analysis tool can reliably output gait quality parameters that can be cross-analyzed to establish individual & disease-based changes in gait quality patterns.

METHODS

A cross-sectional study made up of a 48-patients undergoing disability certification at the "Dr. José Castro Villagrana" or the "Dr. David Fragoso Lizalde" Health Centers in Mexico City, Mexico. Their sensorimotor performance was evaluated through an in-house smartphone/IMU based digital tool. Gait was analyzed by means of frequency analysis of the acceleration of the body mass measured at the sternum. A composite gait quality score was determined through principal component analysis based primarily on the explainability and uniformity of gait. Quality independence against demographic variables (age & weight) was tested through ANCOVA. The association between gait quality and gait parameters was analyzed by using multiple linear regression.

RESULTS

A multiple regression model developed with a limited set of gait quality parameters successfully predicted gait smoothness with a 97.05 % accuracy with a mean square error of 0.085 between predicted and actual quality scores. The model demonstrates different predictive capacities across disease groups, with Osteoarthrosis + Osteoporosis having the highest R2 at 0.98 (p < 0.001) and Coxarthrosis having the lowest explained R2 at 0.79 (p < 0.001).

CONCLUSIONS

The assessment of gait quality, in family medicine, with low-cost digital tools is an area of opportunity yet to be explored. This tool can potentially disrupt the current disability workflow between primary and specialty care to have an objective method of assessing gait within a clinical consult. Individual patient-level benchmarking can give us insights into the patient's disease status, develop practical intervention strategies, and control the cost and quality of medical care by predicting an individualized course of disability or rehabilitation. Further studies are needed to validate digital gait assessments as clinical decision support tools for day-to-day clinical operations. MESH: Gait Analysis, Smartphone, Primary Health Care, Osteoarthrosis.

Towards a better understanding of anticipatory postural adjustments in people with Parkinson's disease

INTRODUCTION

Previous studies have shown that anticipatory postural adjustments (APAs) are altered in people with Parkinson's disease but its meaning for locomotion is less understood. This study aims to investigate the association between APAs and gait initiation, gait and freezing of gait and how a dynamic postural control challenging training may induce changes in these features.

METHODS

Gait initiation was quantified using wearable sensors and subsequent straight walking was assessed via marker-based motion capture. Additionally, turning and FOG-related outcomes were measured with wearable sensors. Assessments were conducted one week before (Pre), one week after (Post) and 4 weeks after (Follow-up) completion of a training intervention (split-belt treadmill training or regular treadmill training), under single task and dual task (DT) conditions. Statistical analysis included a linear mixed model for training effects and correlation analysis between APAs and the other outcomes for Pre and Post-Pre delta.

RESULTS

52 participants with Parkinson's disease (22 freezers) were assessed. We found that APA size in the medio-lateral direction during DT was positively associated with gait speed (p<0.001) and stride length (p<0.001) under DT conditions at Pre. The training effect was largest for first step range of motion and was similar for both training modes. For the associations between changes after the training (pooled sample) medio-lateral APA size showed a significant positive correlation with first step range of motion (p = 0.033) only in the DT condition and for the non-freezers only.

CONCLUSIONS

The findings of this work revealed new insights into how APAs were not associated with first step characteristics and freezing and only baseline APAs during DT were related with DT gait characteristics. Training-induced changes in the size of APAs were related to training benefits in the first step ROM only in non-freezers. Based on the presented results increasing APA size through interventions might not be the ideal target for overall improvement of locomotion.

Implications of obesity in patients with foot and ankle pathology

Obesity is a growing problem defined as a body mass index of greater than 30 kg/m². It is predicted that by 2030, 48.9% of adults will be classified as obese which expands surgical risk factors to a broad population while increasing healthcare costs at the same time in different socioeconomic groups. This specific population has been widely studied in multiple surgical fields and published studies have shown the implications in each of these fields. The impact of obesity on orthopedic surgical outcomes has been previously reported in several total hip and knee arthroscopy studies, with evidence indicating that obesity is strongly associated with an increased risk of post operative complications together with higher revision rates. In line with increasing interest on the impact of obesity in orthopedics, there has been a similar output of publications in the foot and ankle literature. This review article evaluates several foot and ankle pathologies, their risk factors associated with obesity and subsequent management. It provides an updated, comprehensive analysis of the effects of obesity on foot and ankle surgical outcomes, with the ultimate aim of educating both surgeons and allied health professionals about the risks, benefits, and modifiable factors of operating on obese patients.

Effect of Gait Alteration on Fatigability during Walking in Adult Women with High Body Fat Composition

Background and Objective: The risk factors for injury due to alterations in gait efficiency and fatigability during walking are a rising concern. Therefore, the aims of this study were to characterize the changes in gait pattern and performance fatigability among adult women with a high body fat percentage and to study the association between the gait pattern and performance fatigability during walking. Materials and Methods: A total of 160 adult women were enrolled in the study and were divided into two groups: a high-body-fat percentage group (HBF; n = 80; fat% = 42.49 ± 3.51) and a comparison group with a normal body fat percentage (NBF; n = 80; fat% = 29.68 ± 4.30). The 10 min walking test (10-MWT) was used to measure performance fatigability. Treadmill-based gait analysis was used for the acquisition of gait parameters. The correlation between the variables was examined using Pearson’s correlation coefficient. Forward stepwise linear regression was carried out to examine the association between all independent variables, and performance fatigability was adjusted for age and height. The level of statistical significant was set at p-value < 0.05 in all analyses. Results: The mean performance fatigability during the 10-MWT was reported to be high (1.4 ± 0.13) among the participants with HBF, as compared with a fatigability of 1.25 ± 0.11 in the NBF group. The data analysis of the spatial parameters indicated that stride length and step length were statistically smaller in the participants with HBF, as compared with the NBF group. The effects of average maximum force, speed, cadence, step length, and stride length explained the variation in the performance fatigability by 61% (p = 0.007). Conclusion: The findings of this study showed that gait alteration due to excess body fat induced a reduction in performance, as reflected by the high fatigability performance during walking. The study demonstrated a significant association between the severity of performance fatigability and spatial gait parameters.

Orthostatic myoclonus - A retrospective study of Asian patients

BACKGROUND/PURPOSE

Orthostatic myoclonus (OM) is myoclonic jerks in both legs during standing. It may relate to gait unsteadiness and may be associated with various diagnoses, including neurodegenerative, systemic, and musculoskeletal diseases. Diagnosis is based on the surface electromyography (SEMG).

METHODS

From January 2016 to June 2020, we retrospectively reviewed 35 patients diagnosed with OM based on the SEMG criteria and analyzed the electrophysiological data.

RESULTS

The mean age was 75.3±8.9. Disease duration ranged from 2 days to several years. Genders were equally affected. The most common symptom was gait disturbance, and the next was leg tremulous sensation, followed by backward disequilibrium. 28.6% of our patients had falls. Electrophysiologically, bursting duration shorter than 100 ms supported the myoclonic origin from the cortex. The bursting activity occurred only on the upright and weight-bearing leg. The associated diagnoses included lumbosacral radiculopathy (28.6%), lumbosacral radiculopathy plus myasthenia gravis (2.9%), lumbosacral radiculopathy plus vascular parkinsonism (5.7%), diabetic polyneuropathy (5.7%), vascular parkinsonism (17.1%), Parkinson's disease (PD) (14.2%), normal pressure hydrocephalus (5.7%), medication-induced parkinsonism (2.9%), cervical myelopathy (2.9%), medication-related myoclonus (2.9%), and unknown (11.4%). In PD, OM was present before, along with, or after PD diagnosis. The myoclonic activity disrupted the parkinsonian tremor upon standing on SEMG.

CONCLUSION

OM is a syndrome instead of a diagnosis. It is more prevalent in the elderly with gait disturbance and patients will not necessarily fall. It is associated with central and peripheral nerve system disorders, systemic diseases, and medication use. We hypothesize that OM is a pathological disintegration of motor circuit.

Gait initiation differences between overweight and normal weight individuals

Accidental falls often occur during gait initiation. Excess body weight has been identified as a risk factor for accidental falls. This study aimed to examine the differences of gait initiation between overweight and normal-weight individuals. Fourteen overweight and 14 normal-weight young adults participated in the study. They were instructed to perform the gait initiation task under single-task and dual-task conditions. Dependent variables for the assessment of gait initiation included spatial-temporal measures and postural stability measures. The results showed that overweight could compromise postural stability during gait initiation, primarily by decreasing margin of stability in the anterior-posterior direction. Cognitive task interference with gait initiation was found to be similar between the overweight and normal weight groups. The findings from the present study can aid in better understanding the mechanisms associated with increased fall risks among overweight individuals. They also highlight the importance of overweight control in fall prevention. Practitioner summary: Overweight was found to compromise postural stability during gait initiation, primarily by decreasing margin of stability in the anterior-posterior direction. The findings highlight the importance of overweight control in fall prevention. Abbreviations: ANOVA: analyses of variance; AP: anterior-posterior; APA: anticipatory postural adjustment; BOS: base of support; BW: Body weight; COM: centre-of-mass; COP: center-of-pressure; CT: cognitive task; GI: Gait initiation; GRF: ground reaction force; HC: heel-contact; HO: heel-off; ML: medial-lateral; MOS: margin of stability; SD: standard deviation; SE: step execution; SL: step length; SW: step width; VEL_COM: velocity of the COM; XCOM: extrapolated center of mass.