Comparison of Two Therapeutic Approaches of Cerebellar Transcranial Direct Current Stimulation in a Sardinian Family Affected by Spinocerebellar Ataxia 38: a Clinical and Computerized 3D Gait Analysis Study

Spinocerebellar ataxia 38 (SCA 38) is a very rare autosomal dominant inherited disorder caused by a mutation in ELOV5 gene, specifically expressed in cerebellar Purkinje cells, encoding an enzyme involved in the synthesis of fatty acids. Seven symptomatic SCA 38 patients of a Sardinian family were administered 15 sessions of cerebellar anodal transcranial direct current stimulation (tDCS) in a cross-over study, employing deltoid cerebellar-only (C-tDCS) and cerebello-spinal (CS-tDCS) cathodal montage. Clinical evaluation was performed at baseline (T0), after 15 sessions of tDCS (T1) and after 1 month of follow-up (T2). Modified International Cooperative Ataxia Rating Scale (MICARS) and the Robertson dysarthria profile were used to rate ataxic and dysarthric symptoms, respectively. Alertness and split attention tests from Zimmermann test battery for attentional performance were employed to rate attentive functions. Moreover, 3D computerized gait analysis was employed to obtain a quantitative measure of efficacy of tDCS on motor symptoms. While clinical data showed that both CS and C-tDCS improved motor, dysarthric, and cognitive scores, the quantitative analysis of gait revealed significant improvement in spatio-temporal parameters only for C-tDCS treatment. Present findings, yet preliminary and limited by the small size of the tested sample, confirm the therapeutic potential of cerebellar tDCS in improving motor and cognitive symptoms in spinocerebellar ataxias and underline the need to obtain quantitative and objective measures to monitor the efficacy of a therapeutic treatment and to design tailored rehabilitative interventions. ClinicalTrials.gov identifier: NCT05951010.

Cybersickness in People with Multiple Sclerosis Exposed to Immersive Virtual Reality

Together with the wide range of possible benefits for the rehabilitation/training of people with multiple sclerosis (pwMS) and other neurologic conditions, exposure to immersive virtual reality (VR) has often been associated with unpleasant symptoms, such as transient dizziness, headache, nausea, disorientation and impaired postural control (i.e., cybersickness). Since these symptoms can significantly impact the safety and tolerability of the treatment, it appears important to correctly estimate their presence and magnitude. Given the existing data scarcity, this study aims to assess the existence and severity of possible adverse effects associated with exposure to immersive VR in a cohort of pwMS using both objective measurements of postural control effectiveness and subjective evaluations of perceived symptoms. To this aim, postural sway under upright quiet posture (in the presence and absence of visual input) of 56 pwMS with an Expanded Disability Status Scale score (EDSS) in the range of 0-6.5 (mean EDSS 2.3) and 33 unaffected individuals was measured before and after a 10-min immersive VR session and at 10 min follow-up on the basis of center of pressure (COP) trajectories. The severity of cybersickness symptoms associated with VR exposure was also self-rated by the participants using the Italian version of the Simulator Sickness Questionnaire (SSQ). Temporary impairments of postural control in terms of significantly increased sway area were observed after the VR session only in pwMS with mild-moderate disability (i.e., EDSS in the range of 2.5-6.5) in the presence of visual input. No changes were observed in pwMS with low disability (EDSS 0-2) and unaffected individuals. In contrast, when the visual input was removed, there was a decrease in sway area (pwMS with mild-moderate disability) and COP path length relating to the use of VR (pwMS with mild-moderate disability and unaffected individuals), thus suggesting a sort of "balance training effect". Even in this case, the baseline values were restored at follow-up. All participants, regardless of their status, experienced significant post-VR side effects, especially in terms of blurred vision and nausea. Taken together, the findings of the present study suggest that a short immersive VR session negatively (eyes open) and positively (eyes closed) impacts the postural control of pwMS and causes significant disorientation. However, such effects are of limited duration. While it is reasonable to state that immersive VR is sufficiently safe and tolerable to not be contraindicated in the rehabilitation/training of pwMS, in order to reduce possible negative effects and maximize the efficacy, safety and comfort of the treatment, it appears necessary to develop specific guidelines that consider important factors like individual susceptibility, maximum exposure time according to the specific features of the simulation, posture to adopt and protocols to assess objective and perceived effects on participants.

Quantitative Characterization of Gait Patterns in Individuals with Spinocerebellar Ataxia 38

Spinocerebellar ataxia 38 (SCA 38) is a rare autosomal neurological disease whose clinical features include, among others, severe gait disturbances that have not yet been fully characterized. In this study, we employed a computerized 3D gait analysis to obtain spatio-temporal parameters of gait and the kinematics in the sagittal plane in the hip, knee, and ankle joints of seven individuals with SCA 38, which were then compared with those of twenty unaffected individuals matched for age, sex, and anthropometric features. The results show that, in comparison with unaffected individuals, those with SCA 38 are characterized by a significantly reduced speed, stride length, and duration of the swing phase, as well as an increased step width and stance and double support phase durations. The point-by-point comparison of the angular trends at the hip, knee, and ankle joints revealed significant alterations during most part of the stance phase for hip joint and at pre-swing/swing phases for knee and ankle joints. For these latter joints, a significantly reduced dynamic range of motion was also found. Such findings provide some new insights into hip and knee kinematics for this specific form of ataxia and may be useful for monitoring the disease's progression and designing specific, tailored rehabilitative interventions.

Motor and cognitive skills implicated in the Motor Observation Questionnaire for Teachers (MOQ-T): A multidisciplinary approach

This study was designed to determine the relationship between an observational measure of motor skills for teachers (i.e., MOQ-T), age, and some objectively assessed cognitive and motor indices. Two further goals were to examine which motor and cognitive factors predicted MOQ-T scores and to explore whether pupils with very low motor skills identified through MOQ-T also exhibited lower scores on objectively assessed motor and visuo-spatial tasks. A sample of 156 pupils aged 8.4 years-11.3 years and attending Italian primary school completed a battery of tests assessing writing speed, visuo-spatial abstract reasoning, fluency, and static balance abilities objectively assessed by measuring postural sway. Small to medium associations were found between MOQ-T scores and age, motor, and cognitive parameters, respectively. Moreover, approximately 26% of the variance in MOQ-T was predicted by sway area in the eyes-open condition, visuo-spatial fluency, and writing speed. Finally, pupils at risk of developmental coordination disorder exhibited poorer writing speed, and motor and higher-order visuo-spatial deficits. In conclusion, the synergistic use of objective measures of motor and cognitive functioning and observational screening questionnaires such as MOQ-T should be encouraged at school to identify pupils at risk of developmental coordination disorder.

Characterization of upper limb use in health care workers during regular shifts: A quantitative approach based on wrist-worn accelerometers

Despite the high prevalence of upper limb (UL) work-related musculoskeletal disorders (WRMSD) among health care workers (HCWs), little is known about their relationship with exposure to biomechanical risk factors. This study aimed to assess UL activity features under actual working conditions using two wrist-worn accelerometers. Accelerometric data were processed to obtain duration, intensity, and asymmetry of UL use in 32 HCWs during the execution of commonly performed tasks (e.g., patient hygiene, transfer, and meal distribution) within a regular shift. The results show that such tasks are characterized by significantly different patterns of UL use, in particular, higher intensities and larger asymmetries were observed respectively for patient hygiene and meal distribution. The proposed approach appears, thus, suitable to discriminate tasks characterized by different UL motion patterns. Future studies could benefit from the integration of such measures with self-reported workers' perception to elucidate the relationship between dynamic UL movements and WRMSD.

An Immersive Virtual Kitchen Training System for People with Multiple Sclerosis: A Development and Validation Study

Rehabilitation via virtual reality (VR) training tools allows repetitive, intensive, and task-specific practice in a controlled and safe environment. Our goal was to develop and validate a novel immersive VR system based on the practice of real-life activities in a kitchen environment in people with multiple sclerosis (pwMS) with upper-limb dysfunction. The novel immersive VR kitchen application includes several tasks, i.e., tidying up the kitchen, preparing a hamburger and soup meal, and dish washing. Following the development phase, the system was tested for an 8-week intervention period on a small sample of pwMS suffering from upper-limb dysfunction. The Suitability Evaluation Questionnaire for VR systems served as the primary outcome. The scores for enjoyment, sense of comfort with the system, feelings of success and control, realism, easy-to-understand instructions, assists in rehabilitation therapy, were between 4.0 and 4.6, indicating a high satisfaction. The scores for eye discomfort, dizziness, nausea, and disorientation during practice were between 2.8 and 1.3, indicating a low-to-moderate interference of the system. The virtual kitchen training system is feasible and safe for upper-limb training in pwMS and paves the way for future RCTs to examine the benefits of the system compared with standard care, thus improving the functionality of the upper limbs in pwMS.

Smoothness of Gait in Overweight (But Not Obese) Children Aged 6–10

Excessive body mass represents a serious threat to the optimal psychophysical development of children, and it is known to be able to significantly affect their locomotor capabilities, making them more prone to the development of musculoskeletal disorders. However, despite the relevant number of existing studies, a clear gait pattern of overweight children has not been defined yet, particularly in the case of a mass excess that is relatively small (i.e., in those not obese). In the present study, we employed a wearable inertial measurement unit placed on the low back to derive spatio-temporal parameters and quantify the smoothness of gait (by means of harmonic ratio) from trunk accelerations acquired during gait trials carried out by 108 children aged 6–10 (46% males), stratified into two groups according to their body mass index (normal weight, n = 69 and overweight, n = 39). The results show that while gait speed, stride length, cadence and double support duration were found to be almost identical in the two groups, significant differences were observed in terms of harmonic ratio. In particular, overweight children exhibited a reduced harmonic ratio in the antero-posterior direction and higher harmonic ratio in the medio-lateral direction. While the significantly lower harmonic ratio in the antero-posterior direction is likely to be indicative of a loss of smoothness in the walking direction, probably due to a combination of factors associated with the altered movement biomechanics, the higher harmonic ratio in the medio-lateral direction might be associated with specific strategies adopted to increase lateral stability. Although further studies are necessary to elucidate the specific mechanisms that influence the smoothness of gait, it is noteworthy that harmonic ratios appear sensitive even to subtle change in locomotor control in overweight children characterized by apparently regular spatio-temporal parameters of gait and might be employed to assess the effectiveness of interventions designed to improve mobility functions.

Change in upper limb function in people with multiple sclerosis treated with nabiximols: a quantitative kinematic pilot study

OBJECTIVES

Nabiximols represents an increasingly employed add-on treatment option for spasticity in people with multiple sclerosis (PwMS) who either were unresponsive or reported excessive adverse reactions to other therapies. While several studies performed in the last decade demonstrated its effectiveness, safety, and tolerability, few quantitative data are available on the impact on motor dysfunctions. In this open-label, not concurrently controlled study, we aimed to assess the impact of a 4-week treatment with nabiximols on upper limb functionality.

METHODS

Thirteen PwMS (9 female, 4 male) with moderate-severe spasticity underwent a combination of clinical tests (i.e., Box and Block, BBT and Nine-Hole Peg test, 9HPT) and instrumental kinematic analysis of the "hand to mouth" (HTM) movement by means of optical motion capture system.

RESULTS

After the treatment, improvements in gross and fine dexterity were found (BBT + 3 blocks/min, 9HPT - 2.9 s, p < 0.05 for both cases). The kinematic analysis indicated that HTM movement was faster (1.69 vs. 1.83 s, p = 0.05), smoother, and more stable. A significant reduction of the severity of spasticity, as indicated by the 0-10 numerical rating scale (4.2 vs. 6.3, p < 0.001), was also observed.

CONCLUSION

The findings from the present pilot study suggest that a 4-week treatment with nabiximols ameliorates the spasticity symptoms and the overall motor function of upper limb in PwMS with moderate-severe spasticity. The use of quantitative techniques for human movement analysis may provide valuable information about changes originated by the treatment in realistic upper limb motor tasks involved in activities of daily living.

Effect of immersive virtual reality training on hand-to-mouth task performance in people with Multiple Sclerosis: A quantitative kinematic study

BACKGROUND

Although the use of Virtual Reality (VR) has received increasing interest as an add-on treatment in neurorehabilitation programs in the last fifteen years, there is scarce information about the effectiveness of fully immersive VR-based treatments on upper limb (UL) motor function in people with Multiple Sclerosis (PwMS).

METHODS

In this bicentric 2-period interventional crossover study, 19 PwMS with moderate to severe disability (mean EDSS score 5.5) and relevant UL impairment underwent 12 immersive-VR sessions over a period of 4 weeks, using commercially available VR platform (Oculus Quest) and games (Fruit Ninja, Beat Saber and Creed - Rise to Glory). Possible changes associated with the treatment were objectively assessed through instrumental kinematic analysis of the "hand-to-mouth" (HTM) movement by means of optical motion capture system. Clinical tests to assess gross and fine manual dexterity (i.e., the Box and Blocks and Nine Hole Peg Test) were also administered.

RESULTS

The results of the kinematic analysis suggest that the VR training positively impacted the ability of the tested PwMS to perform the HTM task. In particular, a significant reduction of the overall time required to complete the task of approximately 20% for both most and least affected limb, and an improved degree of precision and stability of the movement, as indicated by the reduced value of adjusting sway, especially for the most affected limb (-60%).

CONCLUSION

Based on the results of the quantitative analysis, a 4-week treatment with immersive VR is able to improve speed and stability of the HTM movement in PwMS. This suggests that such an approach might be considered suitable to facilitate an immediate transfer of the possible positive effects associated with the training to common activities of daily living.

Continuous assessment of trunk posture in healthcare workers assigned to wards with different MAPO index

Healthcare professionals generally experience an above-average incidence of low back disorders (LBDs) compared with workers of other professions, and its level of risk is commonly assessed using observational methods such as the MAPO method (Movement and Assistance of Hospital Patients). In this study, we continuously monitored the trunk posture of 30 healthcare workers using a single inertial sensor to: (1) understand whether the MAPO classification is effective in adequately discriminating the risk associated with the time spent in non-neutral trunk postures and (2) characterise the variability of biomechanical exposure among workers employed in wards with the same MAPO index. The results substantially confirm the validity of the MAPO approach in discriminating among wards characterised by different levels of biomechanical exposure associated with the risk of developing LBDs. However, they also highlight the need to assess workers' exposure on an individual basis due to the high intra-group variability.Practitioner summary: Employing a quantitative measurement setup to monitor trunk posture along with an observational method (ie MAPO) can identify the existence of criticalities or the poor application of ergonomic recommendations given during the training of healthcare workers even in hospital wards characterised by little or no risk of developing low back disorders.

Assessing response, remission and treatment resistance in patients with Obsessive-Compulsive Disorder with and without Tic Disorders: results from a multicenter study

Introduction

Obsessive Compulsive Disorder (OCD) and Tic Disorder (TD) are two highly disabling, comorbid and difficult-to-treat conditions. DSM-5 acknowledged a new “tic-related” specifier for OCD, i.e., Obsessive-Compulsive Tic-related Disorder (OCTD), which may show poor treatment response.

Objectives

The aim of the present study was to evaluate rates and clinical correlates of response, remission and resistance to treatment in a large multicentre sample of OCD patients with versus without tics.

Methods

398 patients with a DSM-5 diagnosis of OCD with and without comorbid TD was assessed from ten psychiatric departments across Italy. Treatment response profiles in the whole sample were analysed comparing the rates of response, remission and treatment-resistance as well as related clinical features. Multivariate logistic regressions were performed to highlight possible treatment response related factors.

Results

Later ages of onset of TD and OCD were found in the remission group. Moreover, significantly higher rates of psychiatric comorbidities, TD, and lifetime suicidal ideation and attempts were associated to the treatment-resistant group, with larger degrees of perceived worsened quality of life and family involvement.

Conclusions

While remission was related to later ages of OCD and TD onset, specific clinical factors, such as early onset and presence of psychiatric comorbidities and concomitant TD, predicted a worse treatment response, with a significant impairment in quality of life for both patients and their caregivers. These findings suggest a worse profile of treatment response for patients with OCTD.

Disclosure

No significant relationships.

Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study

BACKGROUND

Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation.

AIM

We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project".

METHODS

We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale.

RESULTS

Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001).

CONCLUSION

This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.

Anomalous location of intracranial vessels in adults

Anomalous intracranial vessels are not uncommon, and this finding is not always associated with arteriovenous malformations. Other conditions such as anomalous connections between arteries or phlebitc patterns can also present as vessels with abnormal intracranial locations. Noninvasive diagnosis is important to determine whether to do more invasive tests such as cerebral digital subtraction angiography or to estimate the risk of bleeding in arteriovenous malformations and therefore to evaluate the need for endovascular/surgical treatment. In this paper, we present an algorithm for the differential diagnosis of anomalous intracranial vessels according to their location (intra/extra-axial) and function (whether the vessels are arterialized). Moreover, we analyze the important points of the angioarchitecture of the principal arteriovenous malformations with risk of intracranial bleeding, such as pial arteriovenous malformations and dural fistulas.

The association between low skeletal muscle mass and delirium: results from the nationwide multi-centre Italian Delirium Day 2017

Introduction

Delirium and sarcopenia are common, although underdiagnosed, geriatric syndromes. Several pathological mechanisms can link delirium and low skeletal muscle mass, but few studies have investigated their association. We aimed to investigate (1) the association between delirium and low skeletal muscle mass and (2) the possible role of calf circumference mass in finding cases with delirium.

Methods

The analyses were conducted employing the cross-sectional “Delirium Day” initiative, on patient 65 years and older admitted to acute hospital medical wards, emergency departments, rehabilitation wards, nursing homes and hospices in Italy in 2017. Delirium was diagnosed as a 4 + score at the 4-AT scale. Low skeletal muscle mass was operationally defined as calf circumference ≤ 34 cm in males and ≤ 33 cm in females. Logistic regression models were used to investigate the association between low skeletal muscle mass and delirium. The discriminative ability of calf circumference was evaluated using non-parametric ROC analyses.

Results

A sample of 1675 patients was analyzed. In total, 73.6% of participants had low skeletal muscle mass and 24.1% exhibited delirium. Low skeletal muscle mass and delirium showed an independent association (OR: 1.50; 95% CI 1.09–2.08). In the subsample of patients without a diagnosis of dementia, the inclusion of calf circumference in a model based on age and sex significantly improved its discriminative accuracy [area under the curve (AUC) 0.69 vs 0.57, p < 0.001].

Discussion and conclusion

Low muscle mass is independently associated with delirium. In patients without a previous diagnosis of dementia, calf circumference may help to better identify those who develop delirium.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-021-01950-8.

Use of wearable sensors to assess patterns of trunk flexion in young and old workers in the Metalworking Industry

Workers exposed to repeated trunk flexions are at risk of onset of low-back disorders and in individuals aged over 50 this issue is exacerbated by the physiologic decline of the musculoskeletal system and longer lifetime occupational exposure. In this study, we investigated the existence of possible age-related differences in patterns of trunk flexion of workers in the metalworking industry. Thirty-three subjects were monitored during an actual shift using a wearable Inertial Measurement Unit (IMU) to assess trunk flexion angles (i.e. between 30° and 60°, 60°-90° and > 90°). Results show that older workers spent less time with their trunk flexed, regardless of the class of flexion considered, with respect to their younger colleagues. Although further studies are necessary to clarify the existence of strategies aimed at optimising trunk movements during ageing, the IMU-based approach appears useful in highlighting potentially harmful conditions, especially in workers with marked signs of decline in their physical capacities. Practitioner summary: Wearable sensors, which are well tolerated and minimally intrusive, represent a valid option to continuously monitor trunk posture in workers employed in metalworking industry. The results of this study show that they provide valuable information about the patterns of flexion of young and old individuals engaged in physically demanding tasks.

Kinematics Adaptation and Inter-Limb Symmetry during Gait in Obese Adults

The main purpose of this study is to characterize lower limb joint kinematics during gait in obese individuals by analyzing inter-limb symmetry and angular trends of lower limb joints during walking. To this purpose, 26 obese individuals (mean age 28.5 years) and 26 normal-weight age- and sex-matched were tested using 3D gait analysis. Raw kinematic data were processed to derive joint-specific angle trends and angle-angle diagrams (synchronized cyclograms) which were characterized in terms of area, orientation and trend symmetry parameters. The results show that obese individuals exhibit a kinematic pattern which significantly differs from those of normal weight especially in the stance phase. In terms of inter-limb symmetry, higher values were found in obese individuals for all the considered parameters, even though the statistical significance was detected only in the case of trend symmetry index at ankle joint. The described alterations of gait kinematics in the obese individuals and especially the results on gait asymmetry are important, because the cyclic uneven movement repeated for hours daily can involve asymmetrical spine loading and cause lumbar pain and could be dangerous for overweight individuals.

Classifying diverse manual material handling tasks using a single wearable sensor

The use of inertial measurement units (IMUs) for monitoring and classifying physical activities has received substantial attention in recent years, both in occupational and non-occupational contexts. However, a "user-friendly" approach is needed to promote this approach to quantify physical demands in actual workplaces. We explored the use of a single IMU for extracting information about different manual material handling (MMH) tasks (i.e., specific type of task performed, and associated duration and frequency), using a bidirectional long short-term memory network for classification. Classification performance using single IMUs placed on several body parts was compared with performance using multiple IMU configurations (2, 3, and 17 IMUs). Overall, the use of a single sensor led to satisfactory results (e.g., median accuracy >97%) in classifying MMH tasks and estimating task duration and frequency. Limited benefits were obtained using additional sensors, and several sensor locations yielded similar outcomes. Classification performance, though, was relatively inferior for push/pull vs. other tasks.

Lower Limb Kinematics in Individuals with Hip Osteoarthritis during Gait: A Focus on Adaptative Strategies and Interlimb Symmetry

Among the functional limitations associated with hip osteoarthritis (OA), the alteration of gait capabilities represents one of the most invalidating as it may seriously compromise the quality of life of the affected individual. The use of quantitative techniques for human movement analysis has been found valuable in providing accurate and objective measures of kinematics and kinetics of gait in individuals with hip OA, but few studies have reported in-depth analyses of lower limb joint kinematics during gait and, in particular, there is a scarcity of data on interlimb symmetry. Such aspects were investigated in the present study which tested 11 individuals with hip OA (mean age 68.3 years) and 11 healthy controls age- and sex-matched, using 3D computerized gait analysis to perform point-by-point comparisons of the joint angle trends of hip, knee, and ankle. Angle-angle diagrams (cyclograms) were also built to compute several parameters (i.e., cyclogram area and orientation and Trend Symmetry) from which to assess the degree of interlimb symmetry. The results show that individuals with hip OA exhibit peculiar gait patterns characterized by severe modifications of the physiologic trend at hip level even in the unaffected limb (especially during the stance phase), as well as minor (although significant) alterations at knee and ankle level. The symmetry analysis also revealed that the effect of the disease in terms of interlimb coordination is present at knee joint as well as hip, while the ankle joint appears relatively preserved from specific negative effects from this point of view. The availability of data on such kinematic adaptations may be useful in supporting the design of specific rehabilitative strategies during both preoperative and postoperative periods.

What gait features influence the amount and intensity of physical activity in people with multiple sclerosis?

Although the mutual relationship between ambulation and physical activity (PA) in people with multiple sclerosis (pwMS) has been described in several studies, there is still a lack of detailed information about the way in which specific aspects of the gait cycle are associated with amount and intensity of PA. This study aimed to verify the existence of possible relationships among PA parameters and the spatio-temporal parameters of gait when both are instrumentally assessed.Thirty-one pwMS (17F, 14 M, mean age 52.5, mean Expanded Disability Status Scale (EDSS) score 3.1) were requested to wear a tri-axial accelerometer 24 hours/day for 7 consecutive days and underwent an instrumental gait analysis, performed using an inertial sensor located on the low back, immediately before the PA assessment period. Main spatio-temporal parameters of gait (i.e., gait speed, stride length, cadence and duration of stance, swing, and double support phase) were extracted by processing trunk accelerations. PA was quantified using average number of daily steps and percentage of time spent at different PA intensity, the latter calculated using cut-point sets previously validated for MS. The existence of possible relationships between PA and gait parameters was assessed using Spearman rank correlation coefficient rho.Gait speed and stride length were the parameters with the highest number of significant correlations with PA features. In particular, they were found moderately to largely correlated with number of daily steps (rho 0.62, P< .001), percentage of sedentary activity (rho = -0.44, P < .001) and percentage of moderate-to-vigorous activity (rho = 0.48, P < .001). Small to moderate significant correlations were observed between PA intensity and duration of stance, swing and double support phases.The data obtained suggest that the most relevant determinants associated with higher and more intense levels of PA in free-living conditions are gait speed and stride length. The simultaneous quantitative assessment of gait parameters and PA levels might represent a useful support for physical therapists in tailoring optimized rehabilitative and training interventions.

Functional Electrical Stimulation for Foot Drop in Post-Stroke People: Quantitative Effects on Step-to-Step Symmetry of Gait Using a Wearable Inertial Sensor

The main purpose of the present study was to assess the effects of foot drop stimulators (FDS) in individuals with stroke by means of spatio-temporal and step-to-step symmetry, harmonic ratio (HR), parameters obtained from trunk accelerations acquired using a wearable inertial sensor. Thirty-two patients (age: 56.84 ± 9.10 years; 68.8% male) underwent an instrumental gait analysis, performed using a wearable inertial sensor before and a day after the 10-session treatment (PRE and POST sessions). The treatment consisted of 10 sessions of 20 min of walking on a treadmill while using the FDS device. The spatio-temporal parameters and the HR in the anteroposterior (AP), vertical (V), and mediolateral (ML) directions were computed from trunk acceleration data. The results showed that time had a significant effect on the spatio-temporal parameters; in particular, a significant increase in gait speed was detected. Regarding the HRs, the HR in the ML direction was found to have significantly increased (+20%), while those in the AP and V directions decreased (approximately 13%). Even if further studies are necessary, from these results, the HR seems to provide additional information on gait patterns with respect to the traditional spatio-temporal parameters, advancing the assessment of the effects of FDS devices in stroke patients.

Characterization of hand forces exerted during non-powered hospital bed pushing and pulling tasks

Accurate assessment of biomechanical risk associated with pushing/pulling tasks represents a challenging issue, especially in the health system where personnel are often required to maneuver beds and carts. Most studies in this field have been carried out in the laboratory, while few data have been collected under actual working conditions. This study aims to characterize the forces exerted during non-powered hospital bed maneuvering. Twenty participants were required to move a bed (equipped with a customized handlebar to measure exerted forces) along an actual hospital path including straight, turn and maneuver phases. The results show that higher forces are associated with the initial phase (peak and mean values 222 and 68 N) while the straight, turn and maneuvering phases required similar (lower) efforts. The combined effect of left, right and transversal forces suggests that the trunk of the operator might experience axial rotation, thus calling for further investigations of this aspect.

Does Multiple Sclerosis Differently Impact Physical Activity in Women and Man? A Quantitative Study Based on Wearable Accelerometers

In people with multiple sclerosis (pwMS), fatigue, weakness and spasticity may reduce mobility and promote sedentary behavior. However, little is known about the existence of possible differences in the way MS modifies the propensity to perform physical activity (PA) in men and women. The present study aimed to partly close this gap by means of quantitative analysis carried out using wearable sensors. Forty-five pwMS (23 F, 22 M, mean age 50.3) and 41 unaffected age- and sex-matched individuals wore a tri-axial accelerometer 24 h/day for 7 consecutive days. Raw data were processed to calculate average number of daily steps, vector magnitude (VM) counts, and percentage of time spent in sedentary behavior and in PA of different intensities (i.e., light and moderate-to-vigorous, MVPA). Women with MS spent more time in sedentary behavior and exhibited a reduced amount of light intensity activity with respect to men, while MVPA was similar across sexes. However, in comparison with unaffected individuals, the overall PA patterns appear significantly modified mostly in women who, in presence of the disease, present increased sedentary behavior, reduced MVPA, number of daily steps and VM counts. The findings of the present study highlight the urgency of including sex as variable in all studies on PA in pwMS.

Changes in symmetry during gait in adults with Prader-Willi syndrome

Most studies on locomotion of individuals with the Prader-Willi Syndrome (PWS) have been performed in a laboratory setting using quantitative motion analysis. Recently, wireless inertial sensors have been successfully employed for gait analysis in different pathological states with the advantages of reproducing a testing condition very close to those encountered in daily living. Using such devices, it is possible not only to characterize the conventional spatio-temporal parameters, but also extract information on further less conventional metrics, such as the harmonic ratio (HR), a measure of step-to-step symmetry based on trunk acceleration processing. In the present study, this technique was used to quantify gait parameters during level walking in 20 adults with PWS who were compared to 20 unaffected individuals. While no differences between the two groups were found in terms of spatio-temporal parameters, individuals with PWS exhibited significantly reduced values of HR in the antero-posterior and vertical directions. Such results, which indicate a poorer gait symmetry in PWS, suggest that upper body accelerations, as well as HR, provide novel information on gait in people with PWS that could not be extracted from spatio-temporal parameters only.

Does variability in motor output at individual joints predict stride time variability in gait? Influences of age, sex, and plane of motion

Old age is associated with variability in gait motor output, particularly in females, and is linked to fall risk. However, little is known about how older age and sex affect variability in the outputs of individual joints, and how these variabilities contribute to the collective gait output. Healthy adults aged 18-99 years (N = 102, 57 females) completed six trials of straight walking at self-selected speed. Stride time variability (coefficient of variation) and variabilities of lower limb tridimensional joint angles (standard deviations: SD) were calculated. Age * Sex (A * S) mixed models were conducted on all measures and year-by-year rates of change were subsequently estimated. Correlations and stepwise linear regression analyses were computed between joint angular variabilities and stride time variability. Each year of age was associated with 0.022% higher stride time variability (A: p = .002), 0.07° lower variability in peak ankle dorsiflexion (A: p = .004), 0.002-0.098° higher variability in mean ankle inversion/eversion, mean pelvic obliquity, and pelvic rotation range of motion (A: p < .05), and 0.024° higher variability in knee flexion/extension range of motion in males (A * S: p = .003). Higher variability in mean ankle and hip flexion/extension and in mean ankle inversion/eversion correlated with (ρ = 0.211-0.336; ps < 0.05) and independently predicted higher stride time variability (ps < 0.05), together explaining 21.9% of variance. Results suggest that higher stride time variability with older age may be produced by a shift from sagittal plane variability to frontal plane variability at the ankle.

Age-Related Changes in Smoothness of Gait of Healthy Children and Early Adolescents

In this study, we acquired and processed trunk accelerations during level walking in 85 children aged 8-13 years to calculate spatio-temporal parameters and Harmonic Ratio (HR), which is a metrics representative of gait smoothness and step-to-step symmetry. The results show that while spatio-temporal parameters remain unchanged once normalized considering individuals' anthropometry, significantly higher values of HR for both the antero-posterior and vertical directions were found in participants aged 12-13 with respect to those of 8-9. This indicates an improvement of gait symmetry, which suggests that the gait maturation process is still ongoing for the age ranges tested here.

Memory, Subjective Memory and Motor Functioning in Non-Demented Elders With and Without Parkinson's Disease

Parkinson's Disease (PD) is a progressive neurological condition characterized by motor and non-motor symptoms impacting life quality. The main aim of the current study was to investigate the effect of PD on objective (i.e., working memory and semantic memory) and subjective memory (i.e., self-reported seriousness of forgetting, mnemonic usage and actual memory efficiency) controlling for the effect of depressive symptomatology. The relationship of working memory performance to gait and mobility indices was also examined, as well as the factors predicting subjective memory were explored. Fifty-four community-dwelling adults (mean age = 72.3 years, SD = 8.8) were recruited in Sardinia, an Italian island located in the Mediterranean Sea. Specifically, 27 non-demented adults with mild, early-stage PD were matched for years of education, age, and gender with a sample of healthy individuals. Participants completed a test battery assessing objective memory, subjective memory, and depressive symptoms, and an instrumental analysis of gait and functional mobility was performed. Participants with PD had poorer objective memory across all indices measured and displayed a restricted set of gait and posture impairments. Working memory performance was selectively related to gait and posture measures. Moreover, participants with PD had lower trust in their memory efficiency relative to the past than the control healthy group. Finally, 22% of the variance in seriousness of the consequences of forgetting was predicted by education and general cognitive efficiency. Overall, the present findings confirm the presence of changes in both objective and subjective memory in PD, independent from depressive symptoms.

Similarities and Differences of Gait Patterns in Women and Men With Parkinson Disease With Mild Disability

OBJECTIVE

This study aimed to quantitatively investigate the existence of differences in spatiotemporal and kinematic parameters of gait in men and women with Parkinson disease (PD) using computerized 3-dimensional gait analysis.

DESIGN

Retrospective cohort study.

SETTING

Laboratory of Biomechanics.

PARTICIPANTS

Individuals with PD (N=35; 17 female, 18 male) of mean age 70.7 years characterized by mild disability (Hoehn and Yahr ≤2.5) who were tested in On medication state approximately 60 to 90 minutes after intake of the usual morning Levodopa dose.

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Spatiotemporal parameters of gait (speed, stride length, cadence, step width, duration of stance, swing, double support phases) and kinematics of hip, knee, and ankle joints in the sagittal plane.

RESULTS

Men and women exhibit similar spatiotemporal parameters, except for step width (wider in men). In contrast, relevant differences were found in terms of ankle kinematics. In particular, women presented increased ankle dorsiflexion through all the stance phase and mid to late swing phase, and reduced plantarflexion at the stance-swing phase transition.

CONCLUSIONS

Gait patterns of men and women with PD with mild disability are similar in terms of spatiotemporal parameters but characterized by marked differences regarding the ankle kinematics on the sagittal plane. The findings of the present study support the concept that investigations seeking to clarify the complex pathophysiology of PD-related gait disturbances should consider the role played by an individual's sex, thereby achieving more effective designing of physical and rehabilitative treatments.

Self-reported physical and mental health and motor functioning in elders with and without Parkinson's disease

Parkinson's Disease (PD) is a neurological disorder characterized by motor symptoms and other clinical conditions, such as cognitive impairment, negative mood, anxiety. The present study explored the impact of PD on self-reported physical and mental health, objective cognition and postural control. The relationship among these variables was examined in order to understand the impact on quality of life. Fifty-four participants, 27 with and 27 without PD, were recruited in Sardinia - an area with an atypical prevalence of PD and psychological characteristics that might mitigate the impact of PD on life quality. Participants completed objective tests of cognitive ability and postural control and self-report measures of physical and mental health. The detrimental effect of PD was evident across all outcomes. Self-reported physical and mental health were both related to postural control. Variance in perceived physical health was explained, not only by PD itself and postural control but also by participation in leisure activities. Self-report outcomes related to life quality are related not only by motor disturbances associated with PD but also with lifestyle activities. In conclusion, social contexts promoting socially-oriented activities, such as that found in Sardinia, may, therefore, mitigate some of the detrimental consequences of PD.

Circulating plasma phospholipid fatty acids and risk of pancreatic cancer in a large European cohort

There are both limited and conflicting data on the role of dietary fat and specific fatty acids in the development of pancreatic cancer. In this study, we investigated the association between plasma phospholipid fatty acids and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The fatty acid composition was measured by gas chromatography in plasma samples collected at recruitment from375 incident pancreatic cancer cases and375 matched controls. Associations of specific fatty acids with pancreatic cancer risk were evaluated using multivariable conditional logistic regression models with adjustment for established pancreatic cancer risk factors. Statistically significant inverse associations were found between pancreatic cancer incidence and levels of heptadecanoic acid (ORT3-T1 [odds ratio for highest versus lowest tertile] =0.63; 95%CI[confidence interval] = 0.41-0.98; ptrend = 0.036), n-3 polyunsaturated α-linolenic acid (ORT3-T1 = 0.60; 95%CI = 0.39-0.92; ptrend = 0.02) and docosapentaenoic acid (ORT3-T1 = 0.52; 95%CI = 0.32-0.85; ptrend = 0.008). Industrial trans-fatty acids were positively associated with pancreatic cancer risk among men (ORT3-T1 = 3.00; 95%CI = 1.13-7.99; ptrend = 0.029), while conjugated linoleic acids were inversely related to pancreatic cancer among women only (ORT3-T1 = 0.37; 95%CI = 0.17-0.81; ptrend = 0.008). Among current smokers, the long-chain n-6/n-3 polyunsaturated fatty acids ratio was positively associated with pancreatic cancer risk (ORT3-T1 = 3.40; 95%CI = 1.39-8.34; ptrend = 0.007). Results were robust to a range of sensitivity analyses. Our findings suggest that higher circulating levels of saturated fatty acids with an odd number of carbon atoms and n-3 polyunsaturated fatty acids may be related to lower risk of pancreatic cancer. The influence of some fatty acids on the development of pancreatic cancer may be sex-specific and modulated by smoking.

Dynamic postural stability, is associated with competitive level, in youth league soccer players

OBJECTIVES

To assess the effect of competitive level on dynamic postural stability in young elite and sub-elite soccer players.

DESIGN

Cross-sectional study.

SETTING

Laboratory.

PARTICIPANTS

Fifty-four male soccer players of Under 16 and Under 17 categories (mean age 15.9 ± 0.6), divided into two groups who regularly compete at national (n = 28) and regional (n = 26) levels.

MAIN OUTCOME MEASURES

Dynamic Postural Stability Index (DPSI) and vertical Time to Stabilization (vTTS) for a forward-jump landing. Static postural sway was calculated on the basis of center-of-pressure trajectories for a 20 s one-legged stance.

RESULTS

Players at national level exhibit better dynamic postural control than those at regional level, as indicated by the significantly lower DPSI (0.327 vs. 0.373, p < 0.001) and vTTS (0.887 vs. 1.158 s, p = 0.003). In contrast, no differences between groups were found in any of the postural sway parameters for the static test.

CONCLUSIONS

Young soccer players at national level are characterized by better balance performance in terms of faster and more efficient stabilization after a forward jump, while one-leg static standing tests appear not challenging enough to reveal differences in balance abilities associated with the combination of superior technical and physical features.

Quantifying gait impairment in individuals affected by Charcot-Marie-Tooth disease: the usefulness of gait profile score and gait variable score

Background: Gait analysis is a reliable tool to characterise ambulation in Charcot-Marie-Tooth, the obtained are complex data makes its use scarce in clinical practice. The use of synthetic measures may enable the clinician to easily interpret gait kinematics in Charcot-Marie-Tooth.Aims: To test the usefulness of Gait Profile Score as a method to quantify and monitor kinematic gait alterations in Charcot-Marie-Tooth.Methods: A group of patients with Charcot-Marie-Tooth and a control group underwent Gait Analysis. Neurological impairment was evaluated by means of the Charcot Marie Tooth neuropathy score in his original form and in the Rasch Analysis revised form. Differences in Kinematics scores induced by the pathology were assessed using the Mann-Whitney U test. The relationship between gait parameters and Charcot Marie Tooth neuropathy score was assessed by means of the Spearman correlation.Results: Twenty patients were enrolled. Mann-Whitney U test revealed a significant effect of the pathology on Gait Profile Score (p < 0.001). Charcot Marie Tooth neuropathy score was positively correlated with Gait Profile Score (Rho = 0.708, p = 0.001).Conclusion: Gait profile score can differentiate Charcot Marie Tooth from unaffected people and to quantify ambulation impairment, also identifying the joints more affected by the disease.Implications for rehabilitationPhysiotherapy and orthotics constitute the sole possible clinical approach for Charcot Marie Tooth, but the clinical scales are scarcely effective for assessing the rehabilitative outcome.Synthetic measures are able to summarize Charcot Marie tooth kinematics in a single score, and Gait Profile Score is able to differentiate patients with Charcot Marie tooth from healthy controls.Gait Profile Score is related to clinical disability as measured by the Charcot Marie tooth neuropathy score.

Texting While Walking Induces Gait Pattern Alterations in Healthy Older Adults

The use of a mobile phone for texting purposes results in distracted walking which may lead to injuries. In particular, texting while walking has been shown to induce significant alterations in gait patterns. This study aimed to assess whether changes in the main spatio-temporal parameters of gait when simultaneously engaged in texting on a smartphone and walking are different in older adults relative to young and middle- aged individuals. A total of 57 participants divided in three groups (19 older adults aged over 65, 19 young aged 20-40 and 19 middle-aged aged 41-64) were tested in two conditions: walking, and walking while texting on a smartphone. Spatio-temporal parameters of gait were assessed using a wearable accelerometer located on the lower back. The results show that texting induced similar reduction of gait speed, stride length and cadence in all groups. Slight (although significant) alterations of stance, swing and double support phases duration were found only for middle-aged participants. Such findings suggest that modifications of gait patterns due to texting seem unaffected by age, probably due to different perceptions of the cognitive complexity of the task and differential prioritization of its motor and cognitive aspects.

Quantitative assessment of upper limb functional impairments in people with Parkinson's disease

BACKGROUND

In clinical routine, upper limb motor disorders of people with Parkinson's disease are commonly assessed using scale- or timed tests, but such tools are not fully suitable for providing detailed information about their type and magnitude. To partly overcome these limitations, the present study aims to quantitatively investigate upper limb functional impairments through quantitative analysis of the "hand-to-mouth" task.

METHODS

Twenty-five individuals with Parkinson's disease and 20 age-matched healthy individuals underwent a kinematic analysis of the hand-to-mouth task from which spatio-temporal and kinematic measures, including summary measures (Arm Variable Score and Arm Profile Score), were calculated and correlated with clinical scores (Hoehn & Yahr, H&Y and the Unified Parkinson Disease Rating Scale, UPDRS).

FINDINGS

The "hand-to-mouth" movement is significantly altered in individuals with Parkinson's disease, especially in terms of reduced velocity, reduced range of motion of elbow flexion-extension and deviation from a physiologic pattern (Arm Profile Score 12.8° vs. 10.1° of unaffected, P = 0.002). Significant moderate correlations were found between movement duration and UPDRS-III (rho = 0.478, P = 0.001) and between the Arm Profile Score and H&Y (rho = 0.481, P = 0.024) and UPDRS-III (rho = 0.326, P = 0.001).

INTERPRETATION

On the basis of such findings, we can state that the kinematic analysis of "hand-to-mouth" movement, and in particular the summary indexes, are suitable for easily representing upper limb movement alterations in people with Parkinson's disease, thus allowing the monitoring either of disease progression or effectiveness of pharmacologic and rehabilitative treatments.

Association between brain atrophy and cognitive motor interference in multiple sclerosis

INTRODUCTION

Cognitive motor interference (CMI) is performance impairment due to simultaneuous task execution and is measured using the dual task cost (DTC). No pathological feature of MS has to date been associated with CMI.

AIM

To assess the relationship between brain volumes and CMI, as measured using the DTC, in a cross-sectional study.

METHODS

A group of persons with MS (pwMS) and an age- and sex-matched healthy control (HC) group underwent 3D gait analysis during using the dual task paradigm. Brain volumes were measured on T1-weighted gradient echo scans using SIENAX software. The relationships between brain volumes and the DTCs of spatial temporal parameters were evaluated using Pearson correlation. A multiple regression model was used to evaluate the ability to predict the DTC of cadence based on brain volume and grey matter (GM) volume.

RESULTS

Forty-four patients and 16 HCs underwent MRI and gait analysis. The mean expanded disability status scale (EDSS) was 2.4 ± 1.5. Significant relationships between brain volumes and DTC were found only in the pwMS group, with higher rho scores for the DTC of mean velocity, DTC of cadence, and DTC of stride time. A statistically significant regression equation with an R² value of 0.684 was found using GM and Z-score on the Stroop test as predictors of the DTC of cadence (p < 0.001).

CONCLUSION

Brain atrophy, especially than in the GM, is a major determinant of DTC, although other pathological markers also contribute to CMI in patients with MS.

Sex-dependent and sex-independent muscle activation patterns in adult gait as a function of age

INTRODUCTION

Aging leads to poorer neuromuscular control that may impact mobility. However, the specific decades when these changes occur, and whether these time-based changes are sex-specific, are unclear.

METHODS

Adults aged 20-82 years (N = 93, 51 females) walked six gait trials at their preferred speed over a 10-m platform. Electromyography (EMG) of the rectus femoris (RF), tibialis anterior (TA), and gastrocnemius lateralis (GL) were measured using wireless surface sensors. Root mean square (RMS) and within-cycle coefficient of variation (CV) values were calculated for several phases of gait. Mixed effect models were conducted to test for Age, Sex, Muscle, and interaction effects, covarying for gait speed and stride length.

RESULTS

A significant Age × Sex × Muscle interaction on RMS at the mid-swing phase was found (p = .036), showing 4.2% higher RF RMS for males (β = 0.42, p = .008) and 3.3% higher GL RMS for females (β = 0.33, p = .038) with each of the three decades investigated. Significant Age × Muscle interactions on GL RMS were found at loading, mid-stance, and over the full gait cycle (ps < .05), with 2.0-4.3% higher values per decade (β = 0.20-0.43, ps < .05). There was generally higher CV with higher age at mid-swing and over the full gait cycle (significant Age effects, ps < .05). Females showed higher CV at loading, mid-stance, and terminal stance (significant Age × Sex effects, ps < .05).

DISCUSSION/CONCLUSION

Results suggest sex-dependent influences of age on muscle recruitment during a few specific phases of gait, and sex-independent influences of age on the recruitment of the ankle musculature, and on the overall gait cycle. These influences may help explain overall increased instability and fall risk in older adults.

Introduction to the Protocols on Screening and Treatment of Diabetic Retinopathy

Diabetes eye complications, and particularly diabetic retinopathy, are the major cause of blindness in the working age groups of industrialised countries. Laser photocoagulation has been proven to reduce blindness due to retinopathy by at least 60% but even more patients would benefit if treatment were delivered at an early enough stage. High risk retinopathy, though, does not cause visual symptoms and when the latter occur it is often too late to reverse them. Hence, a screening programme for diabetic retinopathy should aim at detecting patients at risk when they can still be effectively treated. This can be obtained by regularly checking the patients' eyes. Its target, as defined by the joint World Health Organisation/International Diabetes Federation Saint Vincent Declaration Working Group, is to reduce diabetes-related blindness by one third or more in the next 5 years. The number of persons to be screened is high, 30,000/million total population/year, but available data indicate that this is feasible and that the initial investments in professional and material resources are more than justified by the reduction of preventable blindness and of the financial burdens that go with it. Indeed, prevention of the major cause of blindness in the working age should rate the same priority as other widely deployed programmes, such as those to screen for cancer, neonatal hypothyroidism and phenylketonuria. The concerted action of government health departments, patients' and professional associations will be vital for the successful implementation of this programme. The texts of this document (a protocol for the screening of diabetic retinopathy and cataract), Appendix 1 (data collection card) and Appendix 2 (informative leaflet for the patients) were approved by 57 specialists, representing 30 diabetic and ophthalmic societies from 21 European countries, and endorsed for translation into all European languages and distribution at the appropriate levels.

A study of the Effects of Angiotensins 1, 2, 3 and Bradykinin on the Replication of Bovine Retinal Capillary Endothelial Cells and Pericytes

The renin-angiotensin system of the human eye may play a role in the regulation of retinal blood flow and the development of new vessels. We have investigated whether angiotensins 1, 2 and 3 or bradykinin, in concentrations ranging between 1 × 10–12 and 1 × 10–6, have any mitogenic activity on cultured bovine retinal endothelial cells (BREC) and pericytes (BRP). Cell replication was assessed by 3H-thymidine incorporation and, in the case of BREC and A T-2, also by cell counts. A T-2 was also tested on bovine aortic EC (BAEC). None of the substances elicited any response on BREC, BRP or BAEC. Whether angiotensin(s) induce angiogenesis in retinal vessels in vivo remains to be established but this does not appear to occur through direct stimulation of cell replication.

Diabetic Retinopathy and Metabolic Control

Retinopathy is probably the first long-term complication of diabetes mellitus to become clinically evident, possibly because the retina is the only microvascular bed that can be observed directly and repeatedly. This makes it a good model for studying the pathogenesis and natural history of diabetic microangiopathy. Most of the proposals to account for its pathogenesis invoke mechanisms that depend directly on the circulating and tissue levels of glucose: protein glycosylation, activation of the “polyol pathway”, abnormalities of vascular endothelium, altered capillary blood flow. Several population studies and clinical trials suggest that the degree of metabolic control maintained over the years influences the rates of appearance and progression of retinopathy. However, on an individual basis, factors independent of control may intervene, making some patients more or less prone to this complication. Animal models also suggest that the progression of retinopathy may become irreversible from its very early stages. From a clinical point of view, it is difficult to establish a satisfactory definition of “good” control and approaching it may increase the risk of dangerous hypoglycemia and weight gain. Diabetes and eye specialists are thus left to strive for the best possible, sensible, metabolic control but must also rely on early diagnosis and treatment for the sight-threatening complications of diabetes.

Trunk rotation alters postural sway but not gait in female children and early adolescents: Results from a school-based screening for scoliosis

OBJECTIVE

The purpose of this study was to assess the influence of trunk rotation (TR) on postural sway and spatial-temporal parameters of gait in children and early adolescents screened at school for the presence of scoliosis.

METHODS

Two hundred and fifty-five individuals aged 9-14 (141 boys, 114 girls) underwent trunk rotation (TR) assessment by means of angle of trunk rotation (ATR) measurements performed with Bunnell's scoliometer. Participants with ATR ≥ 5° formed the TR group whose data were compared with those of a control group (CON) composed of individuals with ATR < 5° matched for age and anthropometric features. Postural sway was calculated on the basis of center of pressure (COP) time series acquired using a pressure plate. Spatial-temporal parameters of gait were derived from trunk accelerations collected by a single inertial sensor located in the low-back region.

RESULTS

Sway area, sway path, COP velocities in medio-lateral (ML) and antero-posterior (AP) directions and COP displacements in ML direction were found significantly higher in girls with TR, while no differences between the TR and CON groups were detected in boys. Both boys and girls with TR exhibited gait patterns similar to those of their CON schoolmates.

CONCLUSIONS

These findings suggest that even mild levels of TR may influence balance of female children and early adolescents screened for scoliosis, and thus early interventions including selective and task-oriented exercises appear advisable. In contrast, TR does not appear to influence gait, but further investigations are required to clarify whether different ATR cut-offs may reveal alterations of spatial-temporal parameters.

Texting while walking differently alters gait patterns in people with multiple sclerosis and healthy individuals

BACKGROUND

In recent times, increasing safety concerns have been associated with the use of mobile phones by pedestrians. In particular, texting has been shown to significantly alter gait patterns. However, no specific investigations have been performed on people with Multiple Sclerosis (pwMS), who are already characterized by gait dysfunctions caused by the disease.

OBJECTIVE

To assess the existence of possible alterations in spatio-temporal parameters of gait in pwMS when simultaneously texting on a smartphone and walking.

METHODS

Fifty-four pwMS (mean age 40.5 ± 10.5) and 40 age-matched unaffected individuals were tested in two conditions: walking, and walking while texting on a smartphone. Spatio-temporal parameters of gait were assessed using a wearable accelerometer located on the lower back.

RESULTS

Texting induces reduction of gait speed, stride length and cadence in both groups, but such changes were smaller in magnitude in pwMS. An increase of stance and double support and reduction of swing phase were observed in pwMS only.

CONCLUSIONS

Texting alters gait patterns of pwMS differently from unaffected individuals, probably due to a different prioritization of the task, which appears to take into account the motor and sensory impairments associated with the disease by favoring the motor task.

Do gait patterns differ in men and women with multiple sclerosis?

BACKGROUND

Multiple Sclerosis (MS) affects men and women differently from several points of view: prevalence, severity of cognitive impairments and disability accumulation. However, it is unknown whether ambulatory dysfunctions are sex-related. This study investigated the existence of differences in spatio-temporal and kinematic parameters of gait in men and women with MS using 3D gait analysis.

METHODS

Gait patterns of 60 people with MS (pwMS, 32F, 28M) with low to moderate disability (average Expanded Disability Status Scale score 3, range 1-5.5) who underwent a gait analysis in the period 2014-2017 were retrospectively analyzed to calculate spatio-temporal parameters of gait and kinematics in the sagittal plane at hip, knee and ankle joints.

RESULTS

Significant differences between the groups were found in kinematics of gait. In particular, men exhibited reduced ankle plantar-flexion, increased knee flexion and hip flexion. In contrast, no differences were found in spatio-temporal parameters normalized by considering individuals' anthropometry.

CONCLUSIONS

The findings of the present study highlight the need to investigate gait dysfunctions in pwMS taking sex into consideration. Such an approach might be useful not only in better understanding the pathophysiology of gait disturbances originated by MS, but also in supporting a better orientation of rehabilitative treatments.

Smoothness of gait detects early alterations of walking in persons with multiple sclerosis without disability

In people with Multiple Sclerosis (pwMS) with little or no signs of disability, early detection of walking impairments represents a challenging issue, as simple gait metrics (e.g. speed, cadence, stride length, etc.) may not significantly differ from those of healthy individuals. In this study, we aimed to assess the existence of possible differences in spatial-temporal parameters and smoothness of gait measures (assessed through Harmonic Ratio, HR) obtained from trunk accelerations between 50pwMS without disability (Expanded Disability Status Scale score =1) and 50 age-matched healthy controls. The results show no differences in terms of gait velocity, stride length, stance/swing and double support phases duration, while HR in the direction of motion was significantly lower in pwMS (2.92 vs. 3.67, p<0.001), thus indicating a less smooth gait. The study of trunk accelerations through calculation of HR represents a fast, non-intrusive technique that allows early identification of anomalies in gait patterns of pwMS in absence of disability.

'Timed up and go' and brain atrophy: a preliminary MRI study to assess functional mobility performance in multiple sclerosis

Motor and cognitive disabilities are related to brain atrophy in multiple sclerosis (MS). 'Timed up and go' (TUG) has been recently tested in MS as functional mobility test, as it is able to evaluate ambulation/coordination-related tasks, as well as cognitive function related to mobility. The objective of this study is to evaluate the relationship between brain volumes and TUG performances. Inclusion criteria were a diagnosis of MS and the ability to walk at least 20 m. TUG was performed using a wearable inertial sensor. Times and velocities of TUG sub-phases were calculated by processing trunk acceleration data. Patients underwent to a brain MRI, and volumes of whole brain, white matter (WM), grey matter (GM), and cortical GM (C) were estimated with SIENAX. Sixty patients were enrolled. Mean age was 41.5 ± 11.6 years and mean EDSS 2.3 ± 1.2. Total TUG duration was correlated to lower WM (ρ = 0.358, p = 0.005) and GM (ρ = 0.309, p = 0.017) volumes. A stronger association with lower GM volume was observed for intermediate (ρ = 0.427, p = 0.001) and final turning (ρ = 0.390, p = 0.002). TUG is a useful tool in a clinical setting as it can not only evaluate patients' disability in terms of impaired functional mobility, but also estimate pathological features, such as grey atrophy.

Are static and functional balance abilities related in individuals with Multiple Sclerosis?

BACKGROUND

In people with Multiple Sclerosis (pwMS), balance assessment is essential in estimating the risk of falls, monitoring disease progression and verifying the effectiveness of rehabilitative treatment. Clinical tools and instrumental techniques are available for testing static and dynamic balance, but the relationship between such abilities is still not clear. Having information about this link would be important in properly planning the type and number of tests to administer.

METHODS

One hundred and six pwMS (Expanded Disability Status Scale, EDSS 0-6.5) stratified in three sub-groups (Class 1 EDSS 0-1.5, Class 2 EDSS 2-4 and Class 3 EDSS 4.5-6.5) and 42 healthy controls (HC) participated in the study. All underwent static posturography and instrumented Timed-Up-and-Go (TUG) performed using a wearable inertial sensor. Raw data were processed to extract postural sway features, overall duration of TUG and its main sub-phases (i.e. sit-to-stand, 180° turns and stand-to-sit).

RESULTS

All sway parameters of pwMS of Classes 2 and 3, as well as total TUG duration and time necessary to perform 180° turns, were found significantly higher than HC and Class 1 participants. However, poor correlations were found between sway and TUG parameters. When pwMS are grouped, small/moderate correlations (in the range 0.20-0.41) were found between all sway parameters and total TUG duration.

CONCLUSIONS

Static and dynamic balance in pwMS appear scarcely correlated, although both worsen as disability increases. This implies that they should be separately assessed using specific tests to have a complete view of postural control performance in MS.

Cochlear, auditory brainstem responses in Type 1 diabetes: relationship with metabolic variables and diabetic complications

AIMS

Few studies have analysed the presence of hearing abnormalities in diabetes. We assessed the presence of subclinical auditory alterations and their possible association with early vascular and neurological dysfunction in young adults with Type 1 diabetes of long duration.

METHODS

Thirty-one patients with Type 1 diabetes (mean age 33 ± 2.3 years, disease duration 25.7 ± 4.2 years) and 10 healthy controls underwent pure tone audiometry (PTA), distortion product otoacoustic emission (DPOAE) and auditory brainstem response (ABR) analyses. Associations with metabolic variables and chronic complications were explored.

RESULTS

Compared with healthy controls, patients with diabetes had significantly higher mean hearing thresholds, although still within the normoacusic range. DPOAE intensities at medium frequencies (2.8-4 kHz) were significantly lower in patients with diabetes. In ABR, in addition to waves I, III and V, we observed the appearance of a visible wave IV in patients with diabetes compared with controls (prevalence 61% vs. 10%, P < 0.05), and its appearance was related to a prolonged I-V interval (4.40 ± 0.62 ms vs. 4.19 ± 0.58 ms, P < 0.05). Diastolic blood pressure was higher in people with abnormal DPOAE (P < 0.05), whereas systolic blood pressure correlated with wave V and interpeak I-V interval latencies. A trend towards an association between evidence of wave IV and the presence of somatic neuropathy or abnormal cardiovascular autonomic tests was observed.

CONCLUSIONS

Young adults with long-term Type 1 diabetes have subclinical abnormalities in qualitative auditory perception, despite normal hearing thresholds, which might reflect neuropathic and/or vascular alterations.

La discectomia percutanea per aspirazione

Gli Autori riferiscono come il back pain tuttora presenti difficoltà sia diagnostiche che terapeutiche non risolte, verosimilmente per la complessità anatomo-funzionale delle strutture osteomio-legamentose che compongono la colonna vertebrale.

Fra le cause di lombalgia l'aumento della pressione intradiscale può rivestire un ruolo anche importante in considerazione delle diverse terminazioni sensitive situate sulla porzione esterna del disco. La nucleo-aspirazione secondo la tecnica di Onik rappresenta, in casi selezionati, un valido rimedio terapeutico.