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Wiles TM, Mangalam M, Sommerfeld JH, Kim SK, Brink KJ, Charles AE, Grunkemeyer A, Kalaitzi Manifrenti M, Mastorakis S, Stergiou N, Likens AD. NONAN GaitPrint: An IMU gait database of healthy young adults. Sci Data 2023; 10:867. [PMID: 38052819 PMCID: PMC10698035 DOI: 10.1038/s41597-023-02704-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
An ongoing thrust of research focused on human gait pertains to identifying individuals based on gait patterns. However, no existing gait database supports modeling efforts to assess gait patterns unique to individuals. Hence, we introduce the Nonlinear Analysis Core (NONAN) GaitPrint database containing whole body kinematics and foot placement during self-paced overground walking on a 200-meter looping indoor track. Noraxon Ultium MotionTM inertial measurement unit (IMU) sensors sampled the motion of 35 healthy young adults (19-35 years old; 18 men and 17 women; mean ± 1 s.d. age: 24.6 ± 2.7 years; height: 1.73 ± 0.78 m; body mass: 72.44 ± 15.04 kg) over 18 4-min trials across two days. Continuous variables include acceleration, velocity, position, and the acceleration, velocity, position, orientation, and rotational velocity of each corresponding body segment, and the angle of each respective joint. The discrete variables include an exhaustive set of gait parameters derived from the spatiotemporal dynamics of foot placement. We technically validate our data using continuous relative phase, Lyapunov exponent, and Hurst exponent-nonlinear metrics quantifying different aspects of healthy human gait.
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Affiliation(s)
- Tyler M Wiles
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Madhur Mangalam
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Joel H Sommerfeld
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Seung Kyeom Kim
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Kolby J Brink
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Anaelle Emeline Charles
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Alli Grunkemeyer
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Marilena Kalaitzi Manifrenti
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Spyridon Mastorakis
- College of Information Science and Technology, University of Nebraska at Omaha, Omaha, NE, 68182, USA
| | - Nick Stergiou
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA
- Department of Physical Education and Sport Science, Aristotle University, Thessaloniki, Greece
| | - Aaron D Likens
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, Omaha, NE, 68182, USA.
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Gregg E, Beggs C, Bissas A, Nicholson G. A machine learning approach to identify important variables for distinguishing between fallers and non-fallers in older women. PLoS One 2023; 18:e0293729. [PMID: 37906588 PMCID: PMC10617741 DOI: 10.1371/journal.pone.0293729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
Falls are a significant ongoing public health concern for older adults. At present, few studies have concurrently explored the influence of multiple measures when seeking to determine which variables are most predictive of fall risks. As such, this cross-sectional study aimed to identify those functional variables (i.e. balance, gait and clinical measures) and physical characteristics (i.e. strength and body composition) that could best distinguish between older female fallers and non-fallers, using a machine learning approach. Overall, 60 community-dwelling older women (≥65 years), retrospectively classified as fallers (n = 21) or non-fallers (n = 39), attended three data collection sessions. Data (281 variables) collected from tests in five separate domains (balance, gait, clinical measures, strength and body composition) were analysed using random forest (RF) and leave-one-variable-out partial least squares correlation analysis (LOVO PLSCA) to assess variable importance. The strongest discriminators from each domain were then aggregated into a multi-domain dataset, and RF, LOVO PLSCA, and logistic regression models were constructed to identify the important variables in distinguishing between fallers and non-fallers. These models were used to classify participants as either fallers or non-fallers, with their performance evaluated using receiver operating characteristic (ROC) analysis. The study found that it is possible to classify fallers and non-fallers with a high degree of accuracy (e.g. logistic regression: sensitivity = 90%; specificity = 87%; AUC = 0.92; leave-one-out cross-validation accuracy = 63%) using a combination of 18 variables from four domains, with the gait and strength domains being particularly informative for screening programmes aimed at assessing falls risk.
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Affiliation(s)
- Emily Gregg
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Clive Beggs
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Department of Medicine for the Elderly, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Athanassios Bissas
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Gareth Nicholson
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
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Chan LLY, Arbona CH, Brodie MA, Lord SR. Prediction of injurious falls in older adults using digital gait biomarkers extracted from large-scale wrist sensor data. Age Ageing 2023; 52:afad179. [PMID: 37738170 DOI: 10.1093/ageing/afad179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVES To determine whether digital gait biomarkers captured by a wrist-worn device can predict injurious falls in older people and to develop a multivariable injurious fall prediction model. DESIGN Population-based longitudinal cohort study. SETTING AND PARTICIPANTS Community-dwelling participants of the UK Biobank study aged 65 and older (n = 32,619) in the United Kingdom. METHODS Participants were assessed at baseline on daily-life walking speed, quality, quantity and distribution using wrist-worn accelerometers for up to 7 days. Univariable and multivariable Cox proportional hazard regression models were used to analyse the associations between these parameters and injurious falls for up to 9 years. RESULTS Five percent of the participants (n = 1,627) experienced at least one fall requiring medical attention over a mean of 7.0 ± 1.1 years. Daily-life walking speed, gait quality, quantity of walking and distribution of daily walking were all significantly associated with the incidence of injurious falls (P < 0.05). After adjusting for sociodemographics, lifestyle factors, comorbidities, handgrip strength and reaction time; running duration, total step counts and usual walking speed were identified as independent and significant predictors of falls (P < 0.01). These associations were consistent in those without a history of previous fall injuries. In contrast, step regularity was the only risk factor for those with a previous fall history after adjusting for covariates. CONCLUSIONS Daily-life gait speed, quantity and quality, derived from wrist-worn sensors, are significant predictors of injurious falls in older people. These digital gait biomarkers could potentially be used to identify fall risk in screening programs and integrated into fall prevention strategies.
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Affiliation(s)
- Lloyd L Y Chan
- Neuroscience Research Australia, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Carmen Herrera Arbona
- Neuroscience Research Australia, Sydney, Australia
- Getafe University Hospital, Madrid, Spain
| | - Matthew A Brodie
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, Australia
| | - Stephen R Lord
- Neuroscience Research Australia, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
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Mangalam M, Skiadopoulos A, Siu KC, Mukherjee M, Likens A, Stergiou N. Leveraging a virtual alley with continuously varying width modulates step width variability during self-paced treadmill walking. Neurosci Lett 2023; 793:136966. [PMID: 36379391 PMCID: PMC10171215 DOI: 10.1016/j.neulet.2022.136966] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
Increased fall risk in older adults and clinical populations is linked with increased amount and altered temporal structure of step width variability. One approach to rehabilitation seeks to reduce fall risk in older adults by reducing the amount of step width variability and restoring the temporal structure characteristic of healthy young adults. The success of such a program depends on our ability to modulate step width variability effectively. To this end, we investigated how manipulation of the visual walking space in a virtual environment could modulate the amount and temporal structure of step width variability. Nine healthy adults performed self-paced treadmill walking in a virtual alley in a fixed-width Control condition (1.91 m) and two conditions in which the alley's width oscillated sinusoidally at 0.03 Hz: between 0.38 and 1.14 m and 0.38-2.67 m in Narrow and Wide conditions, respectively. The step width time series from each condition was evaluated using: (i) the standard deviation to identify changes in the amount of variability and (ii) the fractal scaling exponent estimated using detrended fluctuation analysis (DFA) to identify changes in the temporal structure of variability in terms of persistence in fluctuations. The Wide condition neither affected the standard deviation nor the fractal scaling exponent of step width time series. The Narrow condition did not affect the standard deviation of step width time series compared to the Control condition but significantly increased its fractal scaling exponent compared to the Control and Wide conditions, suggestive of more persistent fluctuations characteristic of a healthy gait. These results show that virtual reality based rehabilitative intervention can modulate step width variability to potentially reduce fall risk in older adults and clinical populations.
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Affiliation(s)
- Madhur Mangalam
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, NE 68182, USA.
| | - Andreas Skiadopoulos
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, NE 68182, USA
| | - Ka-Chun Siu
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, NE 68182, USA; College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Mukul Mukherjee
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, NE 68182, USA
| | - Aaron Likens
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, NE 68182, USA
| | - Nick Stergiou
- Division of Biomechanics and Research Development, Department of Biomechanics, and Center for Research in Human Movement Variability, University of Nebraska at Omaha, NE 68182, USA.
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Andrews AW, Vallabhajosula S, Boise S, Bohannon RW. Normal gait speed varies by age and sex but not by geographical region: a systematic review. J Physiother 2023; 69:47-52. [PMID: 36528509 DOI: 10.1016/j.jphys.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/02/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
QUESTIONS What are comfortable gait speed values for apparently healthy adults? How do these differ by age group, sex and geographical region? DESIGN Systematic review of observational studies with meta-analysis. PARTICIPANTS Apparently healthy, community-dwelling adults who have undergone measurement of comfortable gait speed. SEARCH METHOD Potentially relevant studies were identified in four databases. Extracted data from studies that satisfied the eligibility criteria were added to a database containing the same information from a meta-analysis published a decade ago. OUTCOME MEASURES The weighted mean comfortable gait speed was calculated along with the 95% confidence interval for each stratum of age/sex using a random-effects model. Mean gait speeds were further stratified by the continent where the study took place. Tests of homogeneity included I2 and prediction intervals. RESULTS Meta-analysis of data from 51,248 apparently healthy adults was stratified by age (in decades) and sex. Male gait speed slowed beyond age 50 years whereas female gait speed slowed beyond age 30 years. The weighted mean gait speed ranged from 97 cm/s (females aged ≥ 80 years) to 140 cm/s (males aged 40 to 49 years). The I2 values ranged from 0 to 34.07; prediction interval ranges varied from a low of 30 (125 to 155 cm/s; males aged 40 to 49 years) to a high of 77 (83 to 160 cm/s; females aged 60 to 69 years). There was considerable overlap in confidence intervals between continents for each sex/age group. CONCLUSIONS Comfortable gait speed slowed through the adult years, but males maintained a faster walking speed than females. Further stratification of comfortable gait speed by geographical region is not warranted.
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Affiliation(s)
| | | | - Sarah Boise
- Department of Physical Therapy Education, Elon University, Elon, USA
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Abe D, Motoyama K, Tashiro T, Saito A, Horiuchi M. Effects of exercise habituation and aging on the intersegmental coordination of lower limbs during walking with sinusoidal speed change. J Physiol Anthropol 2022; 41:24. [PMID: 35676743 PMCID: PMC9175341 DOI: 10.1186/s40101-022-00298-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background The time courses of the joint elevation angles of the thigh, shank, and foot in one stride during walking can be well approximated by a “plane” in a triaxial space. This intersegmental coordination (IC) of the lower limb elevation angles is referred to as the planar covariation law. We examined the effects of exercise habituation and aging on the thickness of the IC plane of the lower limbs under sinusoidal speed changing conditions. Methods Seventeen sedentary young (SY), 16 active young (AY), and 16 active elderly (AE) adults walked on a treadmill in accordance with a sinusoidal speed changing protocol at 120, 60, and 30 s periods with an amplitude of ± 0.56 m·s−1. Motion of the lower limbs from the sagittal direction was recorded to calculate the elevation angles of the lower limbs. When the best-fit IC plane was determined, the smallest standard deviation of the IC plane was considered as the anteroposterior gait variability of the lower limbs. The coefficient of variance of the step width was also quantified to evaluate the lateral step variability (CVSW). Results The standard deviation of the IC plane was significantly greater in the order of SY, AY, and AE, regardless of the sinusoidal wave periods of the changing speed. The CVSW was not significantly different among the three groups. Conclusions Exercise habituation influences anteroposterior gait variability of the lower limbs, but not lateral step variability, even in young adults. Given these, gait adaptability for sinusoidal speed changes does not always decline with aging. Trial registration UMIN000031456 (R000035911; registered February 23, 2018). Supplementary Information The online version contains supplementary material available at 10.1186/s40101-022-00298-w.
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Random forest algorithms to classify frailty and falling history in seniors using plantar pressure measurement insoles: a large-scale feasibility study. BMC Geriatr 2022; 22:746. [PMID: 36096722 PMCID: PMC9469527 DOI: 10.1186/s12877-022-03425-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022] Open
Abstract
Background Frailty and falls are two adverse characteristics of aging that impair the quality of life of senior people and increase the burden on the healthcare system. Various methods exist to evaluate frailty, but none of them are considered the gold standard. Technological methods have also been proposed to assess the risk of falling in seniors. This study aims to propose an objective method for complementing existing methods used to identify the frail state and risk of falling in older adults. Method A total of 712 subjects (age: 71.3 ± 8.2 years, including 505 women and 207 men) were recruited from two Japanese cities. Two hundred and three people were classified as frail according to the Kihon Checklist. One hundred and forty-two people presented with a history of falling during the previous 12 months. The subjects performed a 45 s standing balance test and a 20 m round walking trial. The plantar pressure data were collected using a 7-sensor insole. One hundred and eighty-four data features were extracted. Automatic learning random forest algorithms were used to build the frailty and faller classifiers. The discrimination capabilities of the features in the classification models were explored. Results The overall balanced accuracy for the recognition of frail subjects was 0.75 ± 0.04 (F1-score: 0.77 ± 0.03). One sub-analysis using data collected for men aged > 65 years only revealed accuracies as high as 0.78 ± 0.07 (F1-score: 0.79 ± 0.05). The overall balanced accuracy for classifying subjects with a recent history of falling was 0.57 ± 0.05 (F1-score: 0.62 ± 0.04). The classification of subjects relative to their frailty state primarily relied on features extracted from the plantar pressure series collected during the walking test. Conclusion In the future, plantar pressures measured with smart insoles inserted in the shoes of senior people may be used to evaluate aspects of frailty related to the physical dimension (e.g., gait and balance alterations), thus allowing assisting clinicians in the early identification of frail individuals. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03425-5.
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Relationships between the Perception of Footwear Comfort and the Fear of Falls in People at the Early Period of Old Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106267. [PMID: 35627804 PMCID: PMC9141443 DOI: 10.3390/ijerph19106267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/13/2022] [Accepted: 05/20/2022] [Indexed: 12/04/2022]
Abstract
Objective: The present study aimed to analyze the relationships between the perceptions of footwear comfort with fear of falls in younger-old women and men. Participants: the population sample involved 100 free-living community dwellers aged 65−74. Design: the Falls Efficacy Scale-International and a visual analogue scale to assess perception of footwear comfort were used as research tools. Results: there were statistically significant differences in the FES-I results in people who suffered a fall in the last year compared to those who did not experience a fall (p < 0.001), as well as in the subjective assessment of mediolateral control in people who have suffered and have not suffered a fall in the last year (p = 0.033). In women, statistically significant relationships were found in the subjective assessment of shoe comfort in terms of arch height (p = 0.025) and material properties of the footwear (p = 0.036) with the results of FES-I. Conclusions: People who have fallen show a higher level of fear of falling. The assessment of footwear comfort in terms of mediolateral control was lower in the younger-old who had experienced a fall in the last year. In women, a worse assessment of arch height and material properties of the footwear is accompanied by greater fear of falling.
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Kim HK, Dai X, Lu SH, Lu TW, Chou LS. Discriminating features of ground reaction forces in overweight old and young adults during walking using functional principal component analysis. Gait Posture 2022; 94:166-172. [PMID: 35339964 DOI: 10.1016/j.gaitpost.2022.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Limited attention has been paid to age- or body size-related changes in the ground reaction forces (GRF) during walking despite their strong associations with lower limb injuries and pathology. RESEARCH QUESTION Do the features of GRF during walking associate with age or body size? METHODS Fifty-four participants were subdivided into four groups according to their age and body size: overweight old (n = 12), non-overweight old (n = 13), overweight young (n = 13), and non-overweight young (n = 16). Participants were asked to walk at their self-selected speeds on level ground with force plates embedded in the center of walkway. Functional principal component analysis (FPCA) was performed to extract major modes of variation and functional principal component scores (FPCs) in three-dimensional GRFs. Analysis of variance models were employed to investigate the effect of age, body size, or their interactions on the FPCs of each component of the GRF, with the adjustment to gait speed. RESULTS Significant age and body size effects were observed in FPC1 across all three-dimensional GRF. Both overweight and older groups showed greater braking force after heel-strike and greater propulsive forces during pre-swing when compared to the non-overweight and younger groups, respectively. The overweight old group displayed greater medial forces during mid-stance and the overweight young group showed prominently larger medial forces during pre-swing, while non-overweight old showed a tendency of flatter medial-lateral GRF waveforms during the entire stance phase. FPC2 revealed that only body size had an effect on three-dimensional GRF with the highest FPC2 scores in the overweight old group. SIGNIFICANCE Three-dimensional GRF during walking could be altered by the body size and age, which were more pronounced in the overweight and older group. The more dynamic GRF pattern with greater and/or lower peaks could be contributing factors to the increased joint load and injury rates observed in overweight aged individuals.
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Affiliation(s)
- Hyun Kyung Kim
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Xiongtao Dai
- Department of Statistic, Iowa State University, Ames, IA, USA
| | - Shiuan-Huei Lu
- Department of Biomedical Engineering, National Taiwan University, Taiwan
| | - Tung-Wu Lu
- Department of Biomedical Engineering, National Taiwan University, Taiwan
| | - Li-Shan Chou
- Department of Kinesiology, Iowa State University, Ames, IA, USA.
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Mahmood I, Raza A, Dehghani-Sanij AA. Evaluation of an adjustable ankle-foot orthosis impact on walking stability during gait transitional phases. Med Eng Phys 2022; 100:103720. [DOI: 10.1016/j.medengphy.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 04/19/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
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Ouyang S, Zheng C, Lin Z, Zhang X, Li H, Fang Y, Hu Y, Yu H, Wu G. Risk factors of falls in elderly patients with visual impairment. Front Public Health 2022; 10:984199. [PMID: 36072374 PMCID: PMC9441862 DOI: 10.3389/fpubh.2022.984199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To examine the risk factors for falls in elderly patients with visual impairment (VI) and assess the predictive performance of these factors. METHODS Between January 2019 and March 2021, a total of 251 elderly patients aged 65-92 years with VI were enrolled and then prospectively followed up for 12 months to evaluate outcomes of accidental falls via telephone interviews. Information of demographics and lifestyle, gait and balance deficits, and ophthalmic and systemic conditions were collected during baseline visits. Forward stepwise multivariable logistic regression analysis was performed to identify independent risk factors of falls in elderly patients with VI, and a derived nomogram was constructed. RESULTS A total of 143 falls were reported in 251 elderly patients during follow-up, with an incidence of 56.97%. The risk factors for falls in elderly patients with VI identified by multivariable logistic regression were women [odds ratio (OR), 95% confidence interval (CI): 2.71, 1.40-5.27], smoking (3.57, 1.34-9.48), outdoor activities/3 months (1.31, 1.08-1.59), waking up frequently during the night (2.08, 1.15-3.79), disorders of balance and gait (2.60, 1.29-5.24), glaucoma (3.12, 1.15-8.44), other retinal degenerations (3.31, 1.16-9.43) and best-corrected visual acuity (BCVA) of the better eye (1.79, 1.10-2.91). A nomogram was developed based on the abovementioned multivariate analysis results. The area under receiver operating characteristic curve of the predictive model was 0.779. CONCLUSIONS Gender, smoking, outdoor activities, waking up at night, disorders of balance and gait, glaucoma, other retinal degeneration and BCVA of the better eye were independent risk factors for falls in elderly patients with VI. The predictive model and derived nomogram achieved a satisfying prediction of fall risk in these individuals.
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Affiliation(s)
- Shuyi Ouyang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chunwen Zheng
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Graduate School, Shantou University Medical College, Shantou, China
| | - Zhanjie Lin
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Graduate School, Shantou University Medical College, Shantou, China
| | - Xiaoni Zhang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Haojun Li
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Fang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yijun Hu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Yijun Hu
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Honghua Yu
| | - Guanrong Wu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
- Guanrong Wu
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Lower-Extremity Intra-Joint Coordination and Its Variability between Fallers and Non-Fallers during Gait. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11062840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Falling is one of the most common causes of hip fracture and death in older adults. A comparison of the biomechanics of the gait in fallers and non-fallers older adults, especially joint coordination and coordination variability, enables the understanding of mechanisms that underpin falling. Therefore, we compared lower-extremity intra-joint coordination and its variability between fallers and non-fallers older adults during gait. A total of 26 older adults, comprising 13 fallers, took part in this study. The participants walked barefoot at a self-selected speed on a 10-m walkway. Gait kinematics in the dominant leg during 10 cycles were captured with 10 motion tracking cameras at a sampling rate of 100 Hz. Spatiotemporal gait parameters, namely, cadence, walking speed, double support time, stride time, width, and length, as well as intra-joint coordination and coordination variability in the sagittal plane were compared between the two groups. Results showed that fallers walked with significant lower cadence, walking speed, and stride length but greater double support and stride time than non-fallers. Significant differences in the ankle-to-knee, knee-to-hip, and ankle-to-hip coordination patterns between fallers and non-fallers and less coordination variability in fallers compared to non-fallers in some instants of the gait cycles were observed. The differences in spatiotemporal gait parameters in fallers compared to non-fallers may indicate an adaptation resulting from decreased efficiency to decrease the risk of falling. Moreover, the differences in segment coordination and its variability may indicate an inconsistency in neuromuscular control. It may also indicate reduced ability to control the motion of the leg in preparation for foot contact with the ground and the knee and ankle motions during loading response. Finally, such differences may show less control in generating power during the push-off phase in fallers.
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Pophal da Silva L, Boneti Moreira N, Barbosa de Freitas P, Pereira G, Rodacki ALF. Gait Parameters of Older Adults according to Their Fall History and Functional Capacity While Walking at Different Speeds. Gerontology 2021; 67:532-543. [PMID: 33677447 DOI: 10.1159/000513601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/07/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION It is believed that functional capacity and fall history are factors capable of influencing the gait parameters of older adults. Thus, the objective of this study was to verify whether gait parameters of community-dwelling older adults differ according to their functional capacity and fall history when walking at self-selected walking speed (SSWS) and fast walking speed (FWS) using principal component analysis (PCA). METHODS Two hundred ninety-five participants (82.3% women and 17.7% men) were allocated in four groups according to their fall history and functional capacity: non-fallers with higher functional capacity (NFHFC, n = 94; 69.3 ± 5.5 years), non-fallers with lower functional capacity (NFLFC, n = 114; 72.0 ± 8.1 years), fallers with higher functional capacity (FHFC, n = 29; 70.0 ± 6.0 years), and fallers with lower functional capacity (FLFC, n = 58; 72.5 ± 8.2 years). Fall history, anthropometric data, functional capacity by short physical performance battery and mobility by Timed Up and Go (TUG), and spatiotemporal gait parameters were evaluated. RESULTS Data analysis indicated that FLFC presented the lowest scores, especially in the Five Times Sit-to-Stand Test and TUG. The PCA showed that the first principal component (PC1) explained the most substantial amount of the data variability in both walking speeds (SSWS and FWS), predominantly including temporal parameters. PC2 composed by spatial outcomes (stride and step length and walking speed) showed the highest effect size. PC1 and PC2 were able to differentiate functional status, regardless of fall history. CONCLUSIONS Functional capacity showed great importance when analyzing gait parameters at different walking speeds (SSWS and FWS), regardless of fall history. Older adults with high functional capacity demonstrate better performance during gait. Besides, spatiotemporal parameters are the main factors explaining gait variability, both in SSWS and FWS.
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Affiliation(s)
- Letícia Pophal da Silva
- Department of Physical Education, Setor de Ciências Biológicas, Federal University of Paraná, Curitiba, Brazil,
| | - Natália Boneti Moreira
- Department of Physiotherapy, Setor de Ciências Biológicas, Federal University of Paraná, Curitiba, Brazil
| | - Paulo Barbosa de Freitas
- Interdisciplinary Graduate Program in Healthy Sciences, Cruzeiro do Sul University, São Paulo, Brazil
| | - Gleber Pereira
- Department of Physical Education, Setor de Ciências Biológicas, Federal University of Paraná, Curitiba, Brazil
| | - André Luiz Felix Rodacki
- Department of Physical Education, Setor de Ciências Biológicas, Federal University of Paraná, Curitiba, Brazil
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Quijoux F, Bertin-Hugault F, Zawieja P, Lefèvre M, Vidal PP, Ricard D. Postadychute-AG, Detection, and Prevention of the Risk of Falling Among Elderly People in Nursing Homes: Protocol of a Multicentre and Prospective Intervention Study. Front Digit Health 2021; 2:604552. [PMID: 34713067 PMCID: PMC8521935 DOI: 10.3389/fdgth.2020.604552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/15/2020] [Indexed: 12/02/2022] Open
Abstract
Introduction: While falls among the elderly is a public health issue, because of the social, medical, and economic burden they represent, the tools to predict falls are limited. Posturography has been developed to distinguish fallers from non-fallers, however, there is too little data to show how predictions change as older adults' physical abilities improve. The Postadychute-AG clinical trial aims to evaluate the evolution of posturographic parameters in relation to the improvement of balance through adapted physical activity (APA) programs. Methods: In this prospective, multicentre clinical trial, institutionalized seniors over 65 years of age will be followed for a period of 6 months through computer-assisted posturography and automatic gait analysis. During the entire duration of the follow-up, they will benefit from a monthly measurement of their postural and locomotion capacities through a recording of their static balance and gait thanks to a software developed for this purpose. The data gathered will be correlated with the daily record of falls in the institution. Static and dynamic balance measurements aim to extract biomechanical markers and compare them with functional assessments of motor skills (Berg Balance Scale and Mini Motor Test), expecting their superiority in predicting the number of falls. Participants will be followed for 3 months without APA and 3 months with APA in homogeneous group exercises. An analysis of variance will evaluate the variability of monthly measures of balance in order to record the minimum clinically detectable change (MDC) as participants improve their physical condition through APA. Discussion: Previous studies have stated the MDC through repeated measurements of balance but, to our knowledge, none appear to have implemented monthly measurements of balance and gait. Combined with a reliable measure of the number of falls per person, motor capacities and other precipitating factors, this study aims to provide biomechanical markers predictive of fall risk with their sensitivity to improvement in clinical status over the medium term. This trial could provide the basis for posturographic and gait variable values for these elderly people and provide a solution to distinguish those most at risk to be implemented in current practice in nursing homes. Trial Registration: ID-RCB 2017-A02545-48. Protocol Version: Version 4.2 dated January 8, 2020.
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Affiliation(s)
- Flavien Quijoux
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- ORPEA Group, Puteaux, France
| | | | | | | | - Pierre-Paul Vidal
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- Institute of Information and Control, Hangzhou Dianzi University, Hangzhou, China
| | - Damien Ricard
- Centre Borelli UMR 9010/Université Paris-Saclay, ENS Paris-Saclay, CNRS, SSA, Université de Paris, Inserm, Paris, France
- Service de Neurologie de l'Hôpital d'Instruction des Armées de Percy, Service de Santé des Armées, Clamart, France
- Ecole du Val-de-Grâce, Ecole de Santé des Armées, Paris, France
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15
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Hip Joint Abnormalities During Midstance in Osteoarthritic Patients. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:361-366. [PMID: 35003767 PMCID: PMC8679151 DOI: 10.12865/chsj.47.03.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022]
Abstract
Osteoarthritis is one of the most debilitating diseases in Europe affecting the lower limb joints, especially the hip and knee, having a bad influence on gait in the long run as well. Rehabilitation physicians use gait in order for the whole body to be seen in ensemble, and through midstance as moment of gait to also take predilection to falls into consideration. Goniometry is the quantifiable measure of a rehabilitation treatment by measuring the range of motion of each treated joint and studied during time. The patients that volunteered to be part of this study have been divided into four groups, depending on the level of osteoarthritis present at the lower limb joints: hip, knee, both hip and knee osteoarthritis or control group with no osteoarthritis, have been asked to walk for a few times and the video recordings were uploaded into the Angles App where we measured the lower limb joint angles during midstance. Patients with knee osteoarthritis present a more extended hip on both dominant and non-dominant sides compared to the ones with hip osteoarthritis, hip and knee osteoarthritis or control group. The results can be explained through the body's kinematic chains that link the knee and hip, hip and pelvis during the midstance phase in the sagittal plane. A physician can use a video goniometry app in order for him to thoroughly evaluate an osteoarthritic patient as well as follow him or her during the entire course of treatment.
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Complexity of Gait Angle Measurements at the Ankle Joint During Midstance in Patients with Osteoarthritis. CURRENT HEALTH SCIENCES JOURNAL 2021; 47:398-404. [PMID: 35003772 PMCID: PMC8679145 DOI: 10.12865/chsj.47.03.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/15/2021] [Indexed: 11/25/2022]
Abstract
The evolution of rehabilitation treatments can be quantified through goniometric measurements. Thus, a video goniometer, and an app-based goniometry program can be both useful and a reliable method of obtaining a data base through which we can see if a certain rehabilitation treatment works out for our patients and during times such as the Covid-19 pandemic, a telemedicine approach can be done. Midstance is a sub-moment of the gait pattern, important in the stability of the lower limb, but that can also direct us towards a patient prone to falls. Osteoarthritis is a disease that causes high disability because of the cellular degradation that also affects normal gait. Four groups of subjects: subjects suffering from hip osteoarthritis, knee osteoarthritis, hip and knee osteoarthritis and control group, have been filmed and recorded their midstance joint range of motion in the Angles App. The dominant limb has been proven to have a more extended ankle in the hip osteoarthritis group, compared to knee osteoarthritis, hip and knee osteoarthritis or control group. Females have presented a more extended ankle, wearing high heels for a long period of time can be the cause of that. Subjects with knee osteoarthritis have presented a more flexed ankle in the dominant limb compared to the ones suffering from hip and knee osteoarthritis or control group. The ankle joint can also have its range of motion measured with a video goniometer, helping us compare results in between sessions of rehabilitation in osteoarthritic patients.
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Ehrhardt A, Hostettler P, Widmer L, Reuter K, Petersen JA, Straumann D, Filli L. Fall-related functional impairments in patients with neurological gait disorder. Sci Rep 2020; 10:21120. [PMID: 33273488 PMCID: PMC7712911 DOI: 10.1038/s41598-020-77973-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/17/2020] [Indexed: 11/08/2022] Open
Abstract
Falls are common in patients with neurological disorders and are a primary cause of injuries. Nonetheless, fall-associated gait characteristics are poorly understood in these patients. Objective, quantitative gait analysis is an important tool to identify the principal fall-related motor characteristics and to advance fall prevention in patients with neurological disorders. Fall incidence was assessed in 60 subjects with different neurological disorders. Patients underwent a comprehensive set of functional assessments including instrumented gait analysis, computerized postural assessments and clinical walking tests. Determinants of falls were assessed by binary logistic regression analysis and receiver operator characteristics (ROC). The best single determinant of fallers was a step length reduction at slow walking speed reaching an accuracy of 67.2% (ROC AUC: 0.669; p = 0.027). The combination of 4 spatio-temporal gait parameters including step length and parameters of variability and asymmetry were able to classify fallers and non-fallers with an accuracy of 81.0% (ROC AUC: 0.882; p < 0.001). These findings suggest significant differences in specific spatio-temporal gait parameters between fallers and non-fallers among neurological patients. Fall-related impairments were mainly identified for spatio-temporal gait characteristics, suggesting that instrumented, objective gait analysis is an important tool to estimate patients' fall risk. Our results highlight pivotal fall-related walking deficits that might be targeted by future rehabilitative interventions that aim at attenuating falls.
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Affiliation(s)
- Angela Ehrhardt
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Pascal Hostettler
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Lucas Widmer
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Katja Reuter
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Dominik Straumann
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Linard Filli
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
- Swiss Center for Clinical Movement Analysis (SCMA), Balgrist Campus AG, Zurich, Switzerland
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Mehdizadeh S, Van Ooteghem K, Gulka H, Nabavi H, Faieghi M, Taati B, Iaboni A. A systematic review of center of pressure measures to quantify gait changes in older adults. Exp Gerontol 2020; 143:111170. [PMID: 33238173 DOI: 10.1016/j.exger.2020.111170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/05/2020] [Accepted: 11/20/2020] [Indexed: 11/29/2022]
Abstract
Measures of gait center of pressure (COP) can be recorded using simple available technologies in clinical settings and thus can be used to characterize gait quality in older adults and its relationship to falls. The aim of this systematic review was to investigate the association between measures of gait COP and aging and falls. A comprehensive search of electronic databases including MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL (EBSCO), Ageline (EBSCO) and Scopus was performed. The initial search yielded 2809 papers. After removing duplicates and applying study inclusion/exclusion criteria, 34 papers were included in the review. Gait COP has been examined during three tasks: normal walking, gait initiation, and obstacle negotiation. The majority of studies examined mean COP position and velocity as outcome measures. Overall, gait in older adults was characterized by more medial COP trajectory in normal walking and lower average anterior-posterior and medio-lateral COP displacements and velocity in both gait initiation and obstacle crossing. Moreover, findings suggest that Tai chi training can enhance older adults' balance control during gait initiation as demonstrated by greater COP backward, medial and forward shift in all three phases of gait initiation. These findings should be interpreted cautiously due to inadequacy of evidence as well as methodological limitations of the studies such as small sample size, limited numbers of 'fallers', lack of a control group, and lack of interpretation of COP outcomes with respect to fall risk. COP measures can be adopted to assess fall-related gait changes in older adults but more complex measures of COP that reveal the dynamic nature of COP behavior in step-to-step variations are needed to adequately characterize gait changes in older adults.
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Affiliation(s)
- Sina Mehdizadeh
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Karen Van Ooteghem
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
| | - Heidi Gulka
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Hoda Nabavi
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Mohammadreza Faieghi
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Babak Taati
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada; Department of Computer Science, University of Toronto, Toronto, ON, Canada; Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Andrea Iaboni
- KITE- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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Blázquez-Carmona P, Mora-Macías J, Morgaz J, Fernández-Sarmiento JA, Domínguez J, Reina-Romo E. Mechanobiology of Bone Consolidation During Distraction Osteogenesis: Bone Lengthening Vs. Bone Transport. Ann Biomed Eng 2020; 49:1209-1221. [PMID: 33111968 DOI: 10.1007/s10439-020-02665-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/16/2020] [Indexed: 01/29/2023]
Abstract
Bone lengthening and bone transport are regeneration processes that commonly rely on distraction osteogenesis, a widely accepted surgical procedure to deal with numerous bony pathologies. Despite the extensive study in the literature of the influence of biomechanical factors, a lack of knowledge about their mechanobiological differences prevents a clinical particularization. Bone lengthening treatments were performed on sheep metatarsus by reproducing the surgical and biomechanical protocol of previous bone transport experiments. Several in vivo monitoring techniques were employed to build an exhaustive comparison: gait analysis, radiographic and CT assessment, force measures through the fixation, or mechanical characterization of the new tissue. A significant initial loss of the bearing capacity, quantified by the ground reaction forces and the limb contact time with the ground, is suffered by the bone lengthening specimens. The potential effects of this anomaly on the musculoskeletal force distribution and the evolution of the bone callus elastic modulus over time are also analyzed. Imaging techniques also seem to reveal lower bone volume in the bone lengthening callus than in the bone transport one, but an equivalent mineralization rate. The simultaneous quantification of biological and mechanical parameters provides valuable information for the daily clinical routine and numerical tools development.
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Affiliation(s)
- Pablo Blázquez-Carmona
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Avenida Camino de los Descubrimientos s/n, 41092, Seville, Spain.
| | - Juan Mora-Macías
- Escuela Técnica Superior de Ingeniería, Universidad de Huelva, 21007, Huelva, Spain
| | - Juan Morgaz
- Departamento Medicina y Cirugía Animal, Ctra. Nacional IV-A, Campus Universitario de Rabanales, Km 396, 14014, Córdoba, Spain
| | - José Andrés Fernández-Sarmiento
- Departamento Medicina y Cirugía Animal, Ctra. Nacional IV-A, Campus Universitario de Rabanales, Km 396, 14014, Córdoba, Spain
| | - Jaime Domínguez
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Avenida Camino de los Descubrimientos s/n, 41092, Seville, Spain
| | - Esther Reina-Romo
- Escuela Técnica Superior de Ingeniería, Universidad de Sevilla, Avenida Camino de los Descubrimientos s/n, 41092, Seville, Spain
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20
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DeBerardinis J, Neilsen C, Lidstone DE, Dufek JS, Trabia MB. A comparison of two techniques for center of pressure measurements. J Rehabil Assist Technol Eng 2020; 7:2055668320921063. [PMID: 32670601 PMCID: PMC7338728 DOI: 10.1177/2055668320921063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 03/24/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Force platforms and pressure-measuring insoles are the most common tools used
for measuring center of pressure. Earlier studies to assess these
instruments suffered from limited sample sizes or an inadequate range of
participant foot sizes. The purpose of this study was to propose new methods
to extract and calculate comparably accurate center of pressure for the
Kistler® force platform and Medilogic® insoles. Methods Center of pressure data were collected from 65 participants wearing
pressure-measuring insoles (six different sizes). Participants walked over
consecutive force platforms for three trials while wearing
pressure-measuring insoles within socks. Onset force thresholds and center
of pressure segment length thresholds were used to determine accurate center
of pressure path length and width. A single step for each foot and trial was
extracted from both instruments. Results A strong correlation was observed between instruments in center of pressure
length (4.12 ± 6.72% difference, r = 0.74). Center of pressure width varied
and was weakly correlated (–7.04 ± 4.48% difference, r = 0.11). Conclusions The results indicate that both instruments can measure center of pressure
path length consistently and with comparable accuracy
(differences < 10%). There were differences between instruments in
measuring center of pressure path width, which were attributed to the
limited number of sensors across the width of the insoles.
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Affiliation(s)
- Jessica DeBerardinis
- Department of Mechanical Engineering, University of Nevada Las Vegas, Las Vegas, USA
| | - Conner Neilsen
- Department of Mechanical Engineering, University of Nevada Las Vegas, Las Vegas, USA
| | - Daniel E Lidstone
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, USA
| | - Janet S Dufek
- Department of Kinesiology and Nutrition Sciences, University of Nevada Las Vegas, Las Vegas, USA
| | - Mohamed B Trabia
- Department of Mechanical Engineering, University of Nevada Las Vegas, Las Vegas, USA
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Mahmood I, Martinez-Hernandez U, Dehghani-Sanij AA. Evaluation of gait transitional phases using neuromechanical outputs and somatosensory inputs in an overground walk. Hum Mov Sci 2020; 69:102558. [PMID: 31989950 DOI: 10.1016/j.humov.2019.102558] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 08/08/2019] [Accepted: 11/14/2019] [Indexed: 12/18/2022]
Abstract
In a bipedal walk, the human body experiences continuous changes in stability especially during weight loading and unloading transitions which are reported crucial to avoid fall. Prior stability assessment methods are unclear to quantify stabilities during these gait transitions due to methodological and/or measurement limitations. This study introduces Nyquist and Bode methods to quantify stability gait transitional stabilities using the neuromechanical output (CoP) and somatosensory input (GRF) responses. These methods are implemented for five different walking conditions grouped into walking speed and imitated rotational impairments. The trials were recorded with eleven healthy subjects using motion cameras and force platforms. The time rate of change in O/Is illustrated impulsive responses and modelled in the frequency domain. Nyquist and Bode stability methods are applied to quantify stability margins. Stability margins from outputs illustrated loading phases as stable and unloading phases as unstable in all walking conditions. There was a strong intralimb compensatory interaction (p < .001, Spearman correlation) found between opposite limbs. Overall, both walking groups illustrated a decrease (p < .05, Wilcoxon signed-rank test) in stability margins compared with normal/preferred speed walk. Further, stabilities quantified from outputs were found greater in magnitudes than the instability quantified from inputs illustrating the neuromotor balance control ability. These stability outcomes were also compared by applying extrapolated-CoM method. These methods of investigating gait dynamic stability are considered as having important implications for the assessment of ankle-foot impairments, rehabilitation effectiveness, and wearable orthoses.
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Affiliation(s)
- Imran Mahmood
- Institute of Design, Robotics, and Optimisation, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom.
| | | | - Abbas A Dehghani-Sanij
- Institute of Design, Robotics, and Optimisation, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom
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22
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Singer JC, Prentice SD, McIlroy WE. Exploring the role of applied force eccentricity after foot-contact in managing anterior instability among older adults during compensatory stepping responses. Gait Posture 2019; 73:161-167. [PMID: 31336331 DOI: 10.1016/j.gaitpost.2019.07.250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/21/2019] [Accepted: 07/17/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The specific mechanisms responsible for age-related decline in forward stability control remain unclear. Previous work has suggested reactive control of net ground reaction force (GRFnet) eccentricity may be responsible for age-related challenges in mediolateral stability control during the restabilisation phase of forward compensatory stepping responses. RESEARCH QUESTIONS Does reactive control of GRFnet eccentricity play a role in managing forward stability control during the restabilisation phase of a forward stepping response to external balance perturbation? METHODS Healthy younger (YA) (n = 20) and older adults (OA) (n = 20) were tethered to a rigid frame, via adjustable cable. Participants were released from a standardised initial forward lean and regained their balance using a single step. Whole-body motion analysis and four force platforms were utilised for data acquisition. Forward instability was quantified as centre of mass (COM) incongruity - the difference between the first local peak and final stable anterior COM positions. The extent of GRFnet eccentricity was quantified as the sagittal-plane angle of divergence of the line of action of the GRFnet relative to the COM. Two discrete points during restabilisation were examined (P1 and P2), which have been suggested to be indicative of proactive and reactive COM control, respectively. Age-related differences in magnitude, timing and trial-to-trial variability of kinematic and kinetic outcome variables were analysed using two-factor ANOVAs with repeated-measures. RESULTS OA exhibited greater COM incongruity magnitude and variability - both were reduced with trial-repetition. There were no age-related differences in the magnitude or timing of P2. Instead, OA exhibited a reduced magnitude of GRFnet eccentricity at P1. There was a positive correlation between AP COM incongruity magnitude and P1 magnitude. SIGNIFICANCE Different from mediolateral stability control, the present results suggest that OA may experience forward stability control challenges as a function of insufficient preparatory lower limb muscle activation prior to foot-contact.
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Affiliation(s)
- Jonathan C Singer
- Faculty of Kinesiology and Recreation Management, University of Manitoba, 66 Chancellors Cir., Winnipeg, MB, R3T 2N2, Canada.
| | - Stephen D Prentice
- Department of Kinesiology, University of Waterloo, 200 University Avenue, West, Waterloo, ON, N2L 3G1, Canada
| | - William E McIlroy
- Department of Kinesiology, University of Waterloo, 200 University Avenue, West, Waterloo, ON, N2L 3G1, Canada
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23
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Conceição NRD, Nóbrega de Sousa P, Pereira MP, Gobbi LTB, Vitório R. Utility of center of pressure measures during obstacle crossing in prediction of fall risk in people with Parkinson’s disease. Hum Mov Sci 2019; 66:1-8. [PMID: 30889495 DOI: 10.1016/j.humov.2019.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Postural instability during walking and tripping over obstacles are the main causes of falls in people with Parkinson's disease (PD). Preliminary limited evidence suggests that the length of the prospective follow-up period affects falls prediction in PD, with shorter periods leading to more accurate prediction. Thus, the primary aim of the present study was to test the performance of center of pressure (CoP) variables during obstacle crossing to predict fall risk in people with PD during subsequent periods of four, six, and 12 months. We also compared CoP variables during obstacle crossing between fallers and non-fallers. METHODS Forty-two individuals with PD, in mild to moderate stages, completed the baseline obstacle crossing assessment and reported falls for 12 months. Participants walked at their self-selected pace and were instructed to cross an obstacle (half knee height) positioned in the middle of an 8-m long pathway. A force platform was used to analyze CoP parameters of the stance phase of the trailing limb (most affected limb). The ability of each outcome measure to predict fall risk at four, six, and 12 months was assessed using receiver operating characteristic curve analyses. RESULTS Ten individuals (23.8%) were considered fallers at four months, twelve individuals (28.5%) at six months, and twenty-one individuals (50%) at 12 months. CoP amplitude and CoP velocity in the mediolateral direction significantly predicted fall risk at four, six, and 12 months. As judged by the area under the curve, mediolateral CoP velocity showed the best performance at four months, while mediolateral CoP amplitude showed the best performance at six months. Fallers presented greater values of mediolateral CoP velocity and amplitude than non-fallers. CONCLUSION These findings suggest that mediolateral CoP velocity and amplitude during obstacle crossing might be useful to predict fall risk in people with PD. Therefore, larger studies are encouraged.
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Lewis MJ, Williams KD, Langley T, Jarvis LM, Sawicki GS, Olby NJ. Development of a Novel Gait Analysis Tool Measuring Center of Pressure for Evaluation of Canine Chronic Thoracolumbar Spinal Cord Injury. J Neurotrauma 2019; 36:3018-3025. [PMID: 31044646 DOI: 10.1089/neu.2019.6479] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Gait evaluation after spinal cord injury (SCI) is an important component of determining functional status. Analysis of center of pressure (COP) provides a dynamic reflection of global locomotion and postural control and has been used to quantify various gait abnormalities. We hypothesized that COP variability would be greater for SCI versus normal dogs and that COP would be able to differentiate varying injury severity. Our objective was to investigate COP, COP variability, and body weight support percentage in dogs with chronic SCI. Eleven chronically non-ambulatory dogs after acute severe thoracolumbar SCI were enrolled. COP measurements in x (right-to-left, COPx) and y (craniocaudal, COPy) directions were captured while dogs walked on a pressure-sensitive treadmill with pelvic limb sling support. Root mean square values (RMS_COPx and RMS_COPy) were calculated to assess variability in COP. Body weight support percentage was measured using a load cell. Gait also was quantified using an open field scale (OFS) and treadmill-based stepping and coordination scores (SS, RI). Mean COPx, COPy, RMS_COPx, and RMS_COPy were compared between dogs with SCI and previously evaluated healthy controls. RMS measurements and support percentage were compared with standard gait scales (OFS, SS, RI). Mean COPy was more cranial and RMS_COPx and RMS_COPy were greater in SCI versus normal dogs (p < 0.001). Support percentage moderately correlated with SS (p = 0.019; R2 = 0.47). COP analysis and body weight support measurements offer information about post-injury locomotion. Further development is needed before consideration as an outcome measure to complement validated gait analysis methods in dogs with SCI.
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Affiliation(s)
- Melissa J Lewis
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
| | | | - Taylor Langley
- Campbell University Norman Adrian Wiggins School of Law, Raleigh, North Carolina
| | | | - Gregory S Sawicki
- George W. Woodruff School of Mechanical Engineering and School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia
| | - Natasha J Olby
- Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
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25
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Thompson JD, Plummer P, Franz JR. Age and falls history effects on antagonist leg muscle coactivation during walking with balance perturbations. Clin Biomech (Bristol, Avon) 2018; 59:94-100. [PMID: 30216784 PMCID: PMC6282179 DOI: 10.1016/j.clinbiomech.2018.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 09/06/2018] [Accepted: 09/07/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inspired by a reliance on visual feedback for movement control in older age, optical flow perturbations provide a unique opportunity to study the neuromuscular mechanisms involved in walking balance control, including aging and falls history effects on the response to environmental balance challenges. Specifically, antagonist leg muscle coactivation, which increases with age during walking, is considered a neuromuscular defense against age-associated deficits in balance control. The purpose of this study was to investigate the effects of age and falls history on antagonist leg muscle coactivation during walking with and without optical flow perturbations of different amplitudes. METHODS Eleven young adults [mean (standard deviation) age: 24.8 (4.8) years], eleven older non-fallers [75.3 (5.4) years] and eleven older fallers [age: 78 (7.6) years] participated in this study. Participants completed 2-minute walking trials while watching a speed-matched virtual hallway that, in some conditions, included mediolateral optical flow perturbations designed to elicit the visual perception of imbalance. FINDINGS We first found that lower leg antagonist muscle coactivation during normal walking increased with age, independent of falls history. We also found that older but not young adults increased antagonist leg muscle coactivation in the presence of optical flow perturbations, with more pervasive effects in older adults with a history of falls. INTERPRETATION Our findings allude to a greater susceptibility to optical flow perturbations in older fallers during walking, which points to a higher potential for risk of instability in more complex and dynamic everyday environments. These findings may also have broader impacts related to the design of innovative training paradigms and neuromuscular targets for falls prevention.
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Affiliation(s)
- Jessica D Thompson
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA
| | - Prudence Plummer
- Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason R Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC, USA.
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26
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Grabiner MD, Marone JR, Wyatt M, Sessoms P, Kaufman KR. Performance of an attention-demanding task during treadmill walking shifts the noise qualities of step-to-step variation in step width. Gait Posture 2018; 63:154-158. [PMID: 29738957 DOI: 10.1016/j.gaitpost.2018.04.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 04/24/2018] [Accepted: 04/25/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The fractal scaling evident in the step-to-step fluctuations of stepping-related time series reflects, to some degree, neuromotor noise. RESEARCH QUESTION The primary purpose of this study was to determine the extent to which the fractal scaling of step width, step width and step width variability are affected by performance of an attention-demanding task. We hypothesized that the attention-demanding task would shift the structure of the step width time series toward white, uncorrelated noise. METHODS Subjects performed two 10-min treadmill walking trials, a control trial of undisturbed walking and a trial during which they performed a mental arithmetic/texting task. Motion capture data was converted to step width time series, the fractal scaling of which were determined from their power spectra. RESULTS Fractal scaling decreased by 22% during the texting condition (p < 0.001) supporting the hypothesized shift toward white uncorrelated noise. Step width and step width variability increased 19% and five percent, respectively (p < 0.001). However, a stepwise discriminant analysis to which all three variables were input revealed that the control and dual task conditions were discriminated only by step width fractal scaling. SIGNIFICANCE The change of the fractal scaling of step width is consistent with increased cognitive demand and suggests a transition in the characteristics of the signal noise. This may reflect an important advance toward the understanding of the manner in which neuromotor noise contributes to some types of falls. However, further investigation of the repeatability of the results, the sensitivity of the results to progressive increases in cognitive load imposed by attention-demanding tasks, and the extent to which the results can be generalized to the gait of older adults seems warranted.
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Affiliation(s)
- Mark D Grabiner
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 1919 W. Taylor Street, Room 648, Chicago, IL 60612, United States.
| | - Jane R Marone
- University of Illinois at Chicago, Department of Kinesiology and Nutrition, 901 W. Roosevelt Rd, 336 PEB, Chicago, IL 60612, United States.
| | - Marilynn Wyatt
- Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States.
| | - Pinata Sessoms
- Naval Health Research Center, San Diego, 140 Sylvester Rd., San Diego, CA 92106-3521, United States.
| | - Kenton R Kaufman
- Motion Analysis Laboratory, Dan Abraham Health Living Center 4-214A, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, United States.
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27
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Turcato AM, Godi M, Giardini M, Arcolin I, Nardone A, Giordano A, Schieppati M. Abnormal gait pattern emerges during curved trajectories in high-functioning Parkinsonian patients walking in line at normal speed. PLoS One 2018; 13:e0197264. [PMID: 29750815 PMCID: PMC5947908 DOI: 10.1371/journal.pone.0197264] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/30/2018] [Indexed: 12/22/2022] Open
Abstract
Background Several patients with Parkinson´s disease (PD) can walk normally along straight trajectories, and impairment in their stride length and cadence may not be easily discernible. Do obvious abnormalities occur in these high-functioning patients when more challenging trajectories are travelled, such as circular paths, which normally implicate a graded modulation in the duration of the interlimb gait cycle phases? Methods We compared a cohort of well-treated mildly to moderately affected PD patients to a group of age-matched healthy subjects (HS), by deliberately including HS spontaneously walking at the same speed of the patients with PD. All participants performed, in random order: linear and circular walking (clockwise and counter-clockwise) at self-selected speed. By means of pressure-sensitive insoles, we recorded walking speed, cadence, duration of single support, double support, swing phase, and stride time. Stride length-cadence relationships were built for linear and curved walking. Stride-to-stride variability of temporal gait parameters was also estimated. Results Walking speed, cadence or stride length were not different between PD and HS during linear walking. Speed, cadence and stride length diminished during curved walking in both groups, stride length more in PD than HS. In PD compared to HS, the stride length-cadence relationship was altered during curved walking. Duration of the double-support phase was also increased during curved walking, as was variability of the single support, swing phase and double support phase. Conclusion The spatio-temporal gait pattern and variability are significantly modified in well-treated, high-functioning patients with PD walking along circular trajectories, even when they exhibit no changes in speed in straight-line walking. The increased variability of the gait phases during curved walking is an identifying characteristic of PD. We discuss our findings in term of interplay between control of balance and of locomotor progression: the former is challenged by curved trajectories even in high-functioning patients, while the latter may not be critically affected.
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Affiliation(s)
- Anna Maria Turcato
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Godi
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
- * E-mail:
| | - Marica Giardini
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Ilaria Arcolin
- Division of Physical Medicine and Rehabilitation, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Antonio Nardone
- Centro Studi Attività Motorie, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Neurorehabilitation and Spinal Units, ICS Maugeri SPA SB, Institute of Pavia, IRCCS, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Andrea Giordano
- Unit of Bioengineering, ICS Maugeri SPA SB, Institute of Veruno, IRCCS, Veruno, Novara, Italy
| | - Marco Schieppati
- Department of Exercise & Sports Science, International University of Health, Exercise and Sports, LUNEX University, Differdange, Luxembourg
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28
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Bizovska L, Svoboda Z, Janura M, Bisi MC, Vuillerme N. Local dynamic stability during gait for predicting falls in elderly people: A one-year prospective study. PLoS One 2018; 13:e0197091. [PMID: 29746520 PMCID: PMC5944953 DOI: 10.1371/journal.pone.0197091] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 04/26/2018] [Indexed: 11/25/2022] Open
Abstract
Computing the local dynamic stability using accelerometer data from inertial sensors has recently been proposed as a gait measure which may be able to identify elderly people at fall risk. However, the assumptions supporting this potential were concluded as most studies implement a retrospective fall history observation. The aim of this study was to evaluate the potential of local dynamic stability for fall risk prediction in a cohort of subjects over the age of 60 years using a prospective fall occurrence observation. A total of 131 elderly subjects voluntarily participated in this study. The baseline measurement included gait stability assessment using inertial sensors and clinical examination by Tinetti Balance Assessment Tool. After the baseline measurement, subjects were observed for a period of one year for fall occurrence. Our results demonstrated poor multiple falls predictive ability of trunk local dynamic stability (AUC = 0.673). The predictive ability improved when the local dynamic stability was combined with clinical measures, a combination of trunk medial-lateral local dynamic stability and Tinetti total score being the best predictor (AUC = 0.755). Together, the present findings suggest that the medial-lateral local dynamic stability during gait combined with a clinical score is a potential fall risk assessment measure in the elderly population.
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Affiliation(s)
- Lucia Bizovska
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
- * E-mail:
| | - Zdenek Svoboda
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Miroslav Janura
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacky University Olomouc, Olomouc, Czech Republic
| | - Maria Cristina Bisi
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi”, University of Bologna, Bologna, Italy
| | - Nicolas Vuillerme
- EA AGEIS, Universite Grenoble-Alpes, La Tronche, France
- Institut Universitaire de France, Paris, France
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