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Shah VV, Muzyka D, Jagodinsky A, McNames J, Casey H, El-Gohary M, Sowalsky K, Safarpour D, Carlson-Kuhta P, Schmahmann JD, Rosenthal LS, Perlman S, Horak FB, Gomez CM. Digital Measures of Postural Sway Quantify Balance Deficits in Spinocerebellar Ataxia. Mov Disord 2024; 39:663-673. [PMID: 38357985 DOI: 10.1002/mds.29742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/21/2023] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Maintaining balance is crucial for independence and quality of life. Loss of balance is a hallmark of spinocerebellar ataxia (SCA). OBJECTIVE The aim of this study was to identify which standing balance conditions and digital measures of body sway were most discriminative, reliable, and valid for quantifying balance in SCA. METHODS Fifty-three people with SCA (13 SCA1, 13 SCA2, 14 SCA3, and 13 SCA6) and Scale for Assessment and Rating of Ataxia (SARA) scores 9.28 ± 4.36 and 31 healthy controls were recruited. Subjects stood in six test conditions (natural stance, feet together and tandem, each with eyes open [EO] and eyes closed [EC]) with an inertial sensor on their lower back for 30 seconds (×2). We compared test completion rate, test-retest reliability, and areas under the receiver operating characteristic curve (AUC) for seven digital sway measures. Pearson's correlations related sway with the SARA and the Patient-Reported Outcome Measure of Ataxia (PROM ataxia). RESULTS Most individuals with SCA (85%-100%) could stand for 30 seconds with natural stance EO or EC, and with feet together EO. The most discriminative digital sway measures (path length, range, area, and root mean square) from the two most reliable and discriminative conditions (natural stance EC and feet together EO) showed intraclass correlation coefficients from 0.70 to 0.91 and AUCs from 0.83 to 0.93. Correlations of sway with SARA were significant (maximum r = 0.65 and 0.73). Correlations with PROM ataxia were mild to moderate (maximum r = 0.56 and 0.34). CONCLUSION Inertial sensor measures of extent of postural sway in conditions of natural stance EC and feet together stance EO were discriminative, reliable, and valid for monitoring SCA. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Vrutangkumar V Shah
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | - Daniel Muzyka
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
| | - Adam Jagodinsky
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
| | - James McNames
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
- Department of Electrical and Computer Engineering, Portland State University, Portland, Oregon, USA
| | - Hannah Casey
- Department of Neurology, The University of Chicago, Chicago, Illinois, USA
| | - Mahmoud El-Gohary
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
| | - Kristen Sowalsky
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
| | - Delaram Safarpour
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Jeremy D Schmahmann
- Ataxia Center, Laboratory for Neuroanatomy and Cerebellar Neurobiology, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Liana S Rosenthal
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Susan Perlman
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Fay B Horak
- Precision Motion, APDM Wearable Technologies-A Clario Company, Portland, Oregon, USA
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
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Shah VV, Jagodinsky A, McNames J, Carlson-Kuhta P, Nutt JG, El-Gohary M, Sowalsky K, Harker G, Mancini M, Horak FB. Gait and turning characteristics from daily life increase ability to predict future falls in people with Parkinson's disease. Front Neurol 2023; 14:1096401. [PMID: 36937534 PMCID: PMC10015637 DOI: 10.3389/fneur.2023.1096401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 02/02/2023] [Indexed: 03/05/2023] Open
Abstract
Objectives To investigate if digital measures of gait (walking and turning) collected passively over a week of daily activities in people with Parkinson's disease (PD) increases the discriminative ability to predict future falls compared to fall history alone. Methods We recruited 34 individuals with PD (17 with history of falls and 17 non-fallers), age: 68 ± 6 years, MDS-UPDRS III ON: 31 ± 9. Participants were classified as fallers (at least one fall) or non-fallers based on self-reported falls in past 6 months. Eighty digital measures of gait were derived from 3 inertial sensors (Opal® V2 System) placed on the feet and lower back for a week of passive gait monitoring. Logistic regression employing a "best subsets selection strategy" was used to find combinations of measures that discriminated future fallers from non-fallers, and the Area Under Curve (AUC). Participants were followed via email every 2 weeks over the year after the study for self-reported falls. Results Twenty-five subjects reported falls in the follow-up year. Quantity of gait and turning measures (e.g., number of gait bouts and turns per hour) were similar in future fallers and non-fallers. The AUC to discriminate future fallers from non-fallers using fall history alone was 0.77 (95% CI: [0.50-1.00]). In contrast, the highest AUC for gait and turning digital measures with 4 combinations was 0.94 [0.84-1.00]. From the top 10 models (all AUCs>0.90) via the best subsets strategy, the most consistently selected measures were variability of toe-out angle of the foot (9 out of 10), pitch angle of the foot during mid-swing (8 out of 10), and peak turn velocity (7 out of 10). Conclusions These findings highlight the importance of considering precise digital measures, captured via sensors strategically placed on the feet and low back, to quantify several different aspects of gait (walking and turning) during daily life to improve the classification of future fallers in PD.
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Affiliation(s)
- Vrutangkumar V. Shah
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
| | - Adam Jagodinsky
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
| | - James McNames
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
- Department of Electrical and Computer Engineering, Portland State University, Portland, OR, United States
| | - Patricia Carlson-Kuhta
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - John G. Nutt
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Mahmoud El-Gohary
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
| | - Kristen Sowalsky
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
| | - Graham Harker
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Martina Mancini
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
| | - Fay B. Horak
- Department of Neurology, Oregon Health & Science University, Portland, OR, United States
- APDM Wearable Technologies, A Clario Company, Portland, OR, United States
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Pigney KR, Torry M, Salvadore A, Jagodinsky A, Maeda GA. Loaded Hex Bar Jump Landing Does Not Increase Frontal Plane Knee Angles And Torques. Med Sci Sports Exerc 2021. [DOI: 10.1249/01.mss.0000760860.95802.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lopes Dos Santos M, Jagodinsky A, Lagally KM, Tricoli V, Berton R. Determining the Peak Power Output for Weightlifting Derivatives Using Body Mass Percentage: A Practical Approach. Front Sports Act Living 2021; 3:628068. [PMID: 33959705 PMCID: PMC8093619 DOI: 10.3389/fspor.2021.628068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/22/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- Marcel Lopes Dos Santos
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, United States.,School of Kinesiology, Applied Health and Recreation, Oklahoma State University, Stillwater, OK, United States
| | - Adam Jagodinsky
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, United States
| | - Kristen M Lagally
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, United States
| | - Valmor Tricoli
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Ricardo Berton
- School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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Thomas DQ, Jagodinsky A, Mahoney D, Schwerzler R, Gridley T, Guiffre C. Do GPS Capable Fitness Watches Accurately Measure Exercise Distances? Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000675260.10934.4d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lopes dos Santos M, Berton R, Jagodinsky A, Torry M, Lagally K. Optimal Load Based on Body Mass: A Pilot Study with The Hang Power Clean. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000560636.08627.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Holford KC, Torry M, Jagodinsky A, Cowley J, McCaw S. Saggital And Frontal Plane Knee Angles Between Pre-adolescencent Sexes Are Not Different During Jump-landing. Med Sci Sports Exerc 2018. [DOI: 10.1249/01.mss.0000538267.63590.4f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Morgan J, Hileman L, Pollalis S, Maeda A, Jagodinsky A, Torry M. Hip, Knee and Ankle Joint Power in Three Weighted Squat Jump Techniques. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000517176.21226.7e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jagodinsky A, Fox J, Decoux B, Weimar W, Liu W. Biomechanical comparison of frontal plane knee joint moment arms during normal and Tai Chi walking. J Phys Ther Sci 2015; 27:2959-61. [PMID: 26504334 PMCID: PMC4616135 DOI: 10.1589/jpts.27.2959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 06/18/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Medial knee osteoarthritis, a degenerative joint disease, affects adults. The
external knee adduction moment, a surrogate knee-loading measure, has clinical
implications for knee osteoarthritis patients. Tai Chi is a promising intervention for
pain alleviation in knee osteoarthritis; however, the characteristics of external knee
adduction moment during Tai Chi have not been established. [Subjects and Methods] During
normal and Tai Chi walking, a gait analysis was performed to compare the external knee
adduction moment moment-arm characteristics and paired t-tests to compare moment-arm
magnitudes. [Results] A significant difference was observed in the average lateral
direction of moment-arm magnitude during Tai Chi walking (−0.0239 ± 0.011 m) compared to
that during normal walking (−0.0057 ± 0.004 m). No significant difference was found
between conditions in average medial direction of moment-arm magnitude (normal walking:
0.0143 ± 0.010 m; Tai Chi walking: 0.0098 ± 0.014 m). [Conclusion] Tai Chi walking
produced a larger peak lateral moment-arm value than normal walking during the stance
phase, whereas Tai Chi walking and normal walking peak medial moment-arm values were
similar, suggesting that medial knee joint loading may be avoided during Tai Chi
walking.
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Affiliation(s)
| | - John Fox
- Doctor of Physical Therapy Program, Methodist University, USA
| | | | | | - Wei Liu
- School of Kinesiology, Auburn University, USA
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Romer B, Fox JW, Jagodinsky A, Weimar WH. Footwear effects on lower extremity coordination. Footwear Science 2015. [DOI: 10.1080/19424280.2015.1038621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Patel J, Fox J, Jagodinsky A, Rehm J, Weimar W. Effect of Arm Constraints on Gluteus Maximus EMG During Bipedal Acceleration. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000495985.04242.6c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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