Design of SmartWalk for Estimating Implication of Pathway With Turn and Task Condition on Postural and Gait Indices: Relevance to Fear of Fall.

Fear of Fall (FoF) is often associated with postural and gait abnormalities leading to decreased mobility in individuals with Parkinson's Disease (PD). The variability in knee flexion (postural index) during heel-strike and toe-off events while walking can be related to one's FoF. Depending on the progression of the disease, gait abnormality can be manifested as start/turn/stop hesitation, etc. adversely affecting one's cadence along with an inability to transfer weight from one leg to the other. Also, task demands can have implications on one's gait and posture. Given that individuals with PD often suffer from FoF and their dynamic balance is affected by task conditions and pathways, in- depth investigation is warranted to understand the implications of task condition and pathways on one's gait and posture. This necessitates use of portable, wearable device that can capture one's gait-related indices and knee flexion in free-living conditions. Here, we have designed a portable, wearable and cost-effective device (SmartWalk) comprising of instrumented Shoes integrated with knee flexion recorder units. Results of our study with age-matched groups of healthy individuals (GrpH) and those with PD (GrpPD) showed the potential of SmartWalk to estimate the implication of task condition, pathways (with and without turn) and pathway segments (straight and turn) on one's knee flexion and gait with relevance to FoF. The knee flexion and gait-related indices were found to strongly corroborate with clinical measure related to FoF, particularly for GrpPD, serving as pre-clinical inputs for clinicians.

The Implication of Pathway Turn and Task Condition on Gait Quantified Using SmartWalk: Changes With Age and Parkinson's Disease With Relevance to Postural Strategy and Risk of Fall.

One's gait can be affected by aging, pathway with turns, task demands, etc., causing changes in gait-related indices and knee flexion (influencing posture). Walking on pathways with turns threatens stability, affecting one's gait-related indices and posture. The ability to overcome such deficits is compromised with age and neurological disorders, e.g., Parkinson's Disease (PD) leading to falls. Also, task demands imposed by single and dual-task (e.g., counting backward while walking) conditions affect the gait of individuals using different postural strategies varying with age and neurological disorder. Existing research has investigated either the effect of the pathway with turn or task condition on one's gait. However, none (to our knowledge) have explored the differentiated implications of the pathway with turn and task conditions on one's gait-related indices and knee flexion while walking. Our study had two phases with 30 participants. Phase 1 had healthy adults (young and old) and Phase 2 had age and gender-matched healthy elderly and individuals with Parkinson's disease (PD) who walked on pathways having turns under single and dual-task conditions. We analysed gait in terms of (i) gait-related indices (Phases 1 and 2) and (ii) knee flexion (Phase 2). Also, we analysed one's counting performance during dual task. One's gait-related indices and knee flexion were measured using a portable gait quantifier. The aim was to (i)understand whether both pathways with turn and task conditions are equally effective in affecting the gait of (a)individuals of varying ages and (b) gender-matched healthy older adults and individuals with PD, (ii)study variations of knee joint angles while walking on pathways having turns (under different task conditions) in terms of its clinical relevance, and (iii) explore the implication of pathway with turn on counting performance (with relevance to postural strategy) with varying age and PD. Results indicated that for the younger group, the task condition caused statistical variations in gait-related indices. For the older group, both pathways with turn and task conditions had statistical implications on gait-related indices. Additionally, individuals with PD demonstrated a higher variation in knee flexion than their healthy counterparts. Again, pathways with varying turns elicited variations in counting performance indicating different postural strategies being employed by the three groups.

Validation of Gujarati Version of ABILOCO-Kids Questionnaire.

BACKGROUND: ABILOCO-Kids is a measure of locomotion ability for children with cerebral palsy (CP) aged 6 to 15 years & is available in English & French. AIM: To validate the Gujarati version of ABILOCO-Kids questionnaire to be used in clinical research on Gujarati population. MATERIALS AND METHODS: ABILOCO-Kids questionnaire was translated into Gujarati from English using forward-backward-forward method. To ensure face & content validity of Gujarati version using group consensus method, each item was examined by group of experts having mean experience of 24.62 years in field of paediatric and paediatric physiotherapy. Each item was analysed for content, meaning, wording, format, ease of administration & scoring. Each item was scored by expert group as either accepted, rejected or accepted with modification. Procedure was continued until 80% of consensus for all items. Concurrent validity was examined on 55 children with Cerebral Palsy (6-15 years) of all Gross Motor Functional Classification System (GMFCS) level & all clinical types by correlating score of ABILOCO-Kids with Gross Motor Functional Measure & GMFCS. RESULT: In phase 1 of validation, 16 items were accepted as it is; 22 items accepted with modification & 3 items went for phase 2 validation. For concurrent validity, highly significant positive correlation was found between score of ABILOCO-Kids & total GMFM (r=0.713, p<0.005) & highly significant negative correlation with GMFCS (r= -0.778, p<0.005). CONCLUSION: Gujarati translated version of ABILOCO-Kids questionnaire has good face & content validity as well as concurrent validity which can be used to measure caregiver reported locomotion ability in children with CP.

Changes in Capacity and Performance in Mobility Across Different Environmental Settings in Children with Cerebral Palsy: An Exploratory Study.

BACKGROUND: Children with cerebral palsy, although having similar diagnosis, varies in their abilities & level of functioning within & across different environmental context e.g. home, school or community setting. Capacity (what a child can do in standardized, controlled environment) may or may not be the same as performance (what a child actually does do in her/her daily environment). MATERIALS AND METHODS: After getting approval from Institutional Ethic's Committee (IEC), 63 children with cerebral palsy (4-16 year, mean 7.4 year with SD 0.39) of all clinical types, Gross Motor Functional Classification System (GMFCS) level I-V were examined for mobility using Gross Motor Functional Measure 88 (GMFM). Motor capacity was assessed in clinical setting by highest of 3 GMFM items attained, i.e., crawling (44), walks with support (68) & walks without support (70). Motor performance was measured by Functional Mobility Scale version 2. RESULT: On analysis of motor capacity 42.85% children were walking without support, 15.87% were able to crawl & 26.98% were able walk with support in clinical setting. Spearman's Correlation was done between GMFM item 70 with FMS 5 (home setting) to check correlation of capacity with performance & was found to be significantly correlated (r=0.586, p=0.04). All three GMFM items were correlated with FMS 5, 50, 500 & found positively correlated. For community setting (FMS 500), 52.38% children were lifted by parents & only 6.34% were using wheel chair mobility. A total of 21.87% patients were able to walk with or without support & still lifted by parents in school or community setting. CONCLUSION: Change in capacity and performance of mobility exists mainly in school and community setting in studied population. Context should be given importance to prioritize rehabilitation process.

Prevalance of obesity in children with cerebral palsy.

INTRODUCTION: Obesity are epidemic among children and adolescents. There is worldwide tendency of increasing prevalence of obesity in children. Cerebral palsy (CP) is leading cause of childhood disability.studies have proposed mechanism of children with disability leading towards obesity and related health risks. So this study is aimed at determining whether such trend of obesity exists in children with CP in terms of BMI and WHR. STUDY DESIGN: Cross -sectional study. PARTICIPANTS: 40 children diagnosed as CP age 2-18 years, GMFCS I-IV. PROCEDURE: BMI; kg/m(2) was calculated from height and weight. WHR was calculated by measuring waist circumference and hip circumference. BMI percentiles were reported according to sex-specific age group standards for growth set by the WHO growth charts. RESULTS: Out of total CP subjects 40% were found to be underweight, 45%, 7.5% and 7.5% were found to be normal, overweight and obese respectively according to BMI. Whereas 20%, 20% 60% were found to be at high risk, moderate risk and high risk of obesity respectively according to WHR. CONCLUSION: In our patient population, analysis of BMI and WHR suggests that children with CP have a high rate of overweight and are at risk of overweight, particularly of central obesity.