Trendelenburg gait after total hip arthroplasty due to reduced muscle contraction of the hip abductors and extensors.

Background: Despite experiencing pain relief and improved activities of daily living after total hip arthroplasty (THA) for osteoarthritis of the hip, a Trendelenburg gait may be observed in some patients. The concentric and eccentric contraction patterns of hip muscles in a Trendelenburg gait are not well understood. Methods: This study included 89 patients (28 males and 61 females, mean age 66.5 ± 8.4 years, mean postoperative period 1.3 ± 0.4 years) after unilateral THA without functional impairment on the contralateral side. Gait analysis utilized a three-dimensional motion capture system to assess pelvis and hip angles, hip moment, and hip power. A Trendelenburg gait was defined as positive when nonoperative pelvic descent occurred at 30 % of the gait cycle, equivalent to mid-stance. Patients were classified into Trendelenburg gait-positive and -negative groups for statistical analysis. Unpaired t-test and chi-square test were used to compare the two groups. Multiple regression analysis was conducted to identify factors associated with the presence of a Trendelenburg gait. Results: A Trendelenburg gait was observed in 24 patients (27 %). Multiple regression analysis indicated that abduction (p < 0.01) and extension (p = 0.03) of hip joint power were significant determining of a Trendelenburg gait. Patients with a Trendelenburg gait exhibited reduced eccentric contraction of the hip abductor muscles and decreased concentric contraction of hip extensor muscles during early to mid-stance of their gait. Conclusion: Centrifugal contraction of hip abductor muscles and diminished eccentric contractility of hip extensor muscles appear crucial for hip stabilization mechanisms during gait after THA.

Mecánica y energética durante la marcha en cinta caminadora en adultos uruguayos saludables: efecto del IMC y la edad / Mechanics and energy during treadmill walking in healthy uruguayan adults: effect of BMI and age / Mecânica e energia durante a caminhada em esteira em adultos uruguaios saudáveis: efeito do IMC e Idade

La evaluación de la marcha en cinta caminadora puede resultar relevante para la toma de decisiones clínicas. No obstante, factores demográficos como la edad y el IMC pueden alterar la interpretación de los resultados. Nuestro objetivo fue obtener variables espacio- temporales, energéticas y costo de transporte durante la velocidad autoseleccionada en cinta caminadora para una muestra representativa de adultos uruguayos (n=28) y evaluar si diferentes rangos de edades e IMC pueden ser factores a tener en cuenta en pruebas clínicas donde se consideren dichas variables. Participaron 17 hombres y 11 mujeres (39,3 ± 14,8 años, 75,9 ± 12,5 kg, 1,74 ± 0,09 m, IMC 25,2 ± 4,06). Se realizó una reconstrucción 3D del movimiento en forma sincronizada con el consumo energético. Se obtuvieron valores de referencia y luego de agrupar los participantes según su IMC y rango de edad se compararon los datos mediante test de t (p≤0.05). Los resultados revelaron discrepancias significativas en las medidas espacio-temporales y energéticas de los adultos uruguayos al caminar en cinta con respecto a la literatura. La marcha difiere entre adultos jóvenes y de mediana edad en su velocidad autoseleccionada (p=0,03), longitud de zancada (p=0,01), trabajo mecánico externo (<0,001) y recuperación de energía mecánica (0,009), destacando la importancia de considerar la edad en evaluaciones clínicas. El IMC no influyó significativamente en estas variables. Estos hallazgos subrayan la necesidad de ajustar las interpretaciones de las pruebas clínicas de la marcha sobre cinta caminadora en adultos uruguayos de mediana edad (45 a 65 años).

Treadmill gait assessment can be relevant for clinical decision-making. However, demographic factors such as age and BMI may alter result interpretation. Our aim was to obtain spatiotemporal, energetic, and cost of transport variables during self-selected treadmill walking speed for a representative sample of Uruguayan adults (n=28) and to assess if different age ranges and BMI could be factors to consider in clinical tests involving these variables. Seventeen men and eleven women participated (39.3 ± 14.8 years, 75.9 ± 12.5 kg, 1.74 ± 0.09 m, BMI 25.2 ± 4.06). A synchronized 3D motion reconstruction was performed with energy consumption. Reference values were obtained and data were compared using t-tests (p≤0.05), after grouping participants by BMI and age range. Results revealed significant discrepancies in spatiotemporal and energetic measures of Uruguayan adults walking on the treadmill, compared to the literature. Gait differed between young and middle-aged adults in their self-selected speed (p=0.03), stride length (p=0.01), external mechanical work (p<0.001), and mechanical energy recovery (0.009), emphasizing the importance of considering age in clinical evaluations. BMI did not significantly influence these variables. These findings underscore the need to adjust interpretations of treadmill gait clinical tests in middle-aged Uruguayan adults (45 to 65 years).

A avaliação da marcha na esteira pode ser relevante para a tomada de decisões clínicas. No entanto, fatores demográficos como idade e IMC podem alterar a interpretação dos resultados. Nosso objetivo foi obter variáveis espaço-temporais, energéticas e custo de transporte durante a velocidade de caminhada autoselecionada na esteira para uma amostra representativa de adultos uruguaios (n = 28) e avaliar se diferentes faixas etárias e IMC podem ser fatores a serem considerados em testes clínicos que envolvam essas variáveis. Dezessete homens e onze mulheres participaram (39,3 ± 14,8 anos, 75,9 ± 12,5 kg, 1,74 ± 0,09 m, IMC 25,2 ± 4,06). Foi realizada uma reconstrução tridimensional do movimento sincronizada com o consumo de energia. Foram obtidos valores de referência e os dados foram comparados usando testes t (p≤0,05), após agrupar os participantes por IMC e faixa etária. Os resultados revelaram discrepâncias significativas nas medidas espaço-temporais e energéticas dos adultos uruguaios ao caminhar na esteira, em comparação com a literatura. A marcha diferiu entre adultos jovens e de meia-idade em sua velocidade autoselecionada (p=0,03), comprimento da passada (p=0,01), trabalho mecânico externo (<0,001) e recuperação de energia mecânica (0,009), destacando a importância de considerar a idade em avaliações clínicas. O IMC não influenciou significativamente essas variáveis. Esses achados destacam a necessidade de ajustar as interpretações dos testes clínicos de marcha na esteira em adultos uruguaios de meia- idade (45 a 65 anos).

Comparative biomechanical analysis of a conventional/novel hip prosthetic socket.

The aim of this study was to investigate and compare the biomechanical properties of the conventional and novel hip prosthetic socket by using the finite element and gait analysis. According to the CT scan model of the subject's residual limb, the bones, soft tissues, and the socket model were reconstructed in three dimensions by using inverse modeling. The distribution of normal and shear stresses at the residual limb-socket interface under the standing condition was investigated using the finite element method and verified by designing a pressure acquisition module system. The gait experiment compared and analyzed the conventional and novel sockets. The results show that the simulation results are consistent with the experimental data. The novel socket exhibited superior stress performance and gait outcomes compared to the conventional design. Our findings provide a research basis for evaluating the comfort of the hip prosthetic socket, optimizing and designing the structure of the socket of the hip.

A multi-center, randomized, double-blind, sham-stimulation controlled study of transcranial magnetic stimulation with precision navigation for the treatment of multiple system atrophy.

BACKGROUND: Multiple system atrophy (MSA) is recognized as an atypical Parkinsonian syndrome, distinguished by a more rapid progression than that observed in Parkinson's disease. Unfortunately, the prognosis for MSA remains poor, with a notable absence of globally recognized effective treatments. Although preliminary studies suggest that transcranial magnetic stimulation (TMS) could potentially alleviate clinical symptoms in MSA patients, there is a significant gap in the literature regarding the optimal stimulation parameters. Furthermore, the field lacks consensus due to the paucity of robust, large-scale, multicenter trials. METHODS: This investigation is a multi-center, randomized, double-blind, sham-controlled trial. We aim to enroll 96 individuals diagnosed with MSA, categorized into Parkinsonian type (MSA-P) and cerebellar type (MSA-C) according to their predominant clinical features. Participants will be randomly allocated in a 1:1 ratio to either the TMS or sham stimulation group. Utilizing advanced navigation techniques, we will ensure precise targeting for the intervention, applying theta burst stimulation (TBS). To assess the efficacy of TBS on both motor and non-motor functions, a comprehensive evaluation will be conducted using internationally recognized clinical scales and gait analysis. To objectively assess changes in brain connectivity, functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) will be employed as sensitive indicators before and after the intervention. DISCUSSION: The primary aim of this study is to ascertain whether TBS can alleviate both motor and non-motor symptoms in patients with MSA. Additionally, a critical component of our research involves elucidating the underlying mechanisms through which TBS exerts its potential therapeutic effects. ETHICS AND DISSEMINATION: All study protocols have been reviewed and approved by the First Affiliated Medical Ethics Committee of the Air Force Military Medical University (KY20232118-F-1). TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2300072658. Registered on 20 June 2023.

An effective screening model for subjective cognitive decline in community-dwelling older adults based on gait analysis and eye tracking.

Objective: To evaluate the effectiveness of multimodal features based on gait analysis and eye tracking for elderly people screening with subjective cognitive decline in the community. Methods: In the study, 412 cognitively normal older adults aged over 65 years were included. Among them, 230 individuals were diagnosed with non-subjective cognitive decline and 182 with subjective cognitive decline. All participants underwent assessments using three screening tools: the traditional SCD9 scale, gait analysis, and eye tracking. The gait analysis involved three tasks: the single task, the counting backwards dual task, and the naming animals dual task. Eye tracking included six paradigms: smooth pursuit, median fixation, lateral fixation, overlap saccade, gap saccade, and anti-saccade tasks. Using the XGBoost machine learning algorithm, several models were developed based on gait analysis and eye tracking to classify subjective cognitive decline. Results: A total of 161 gait and eye-tracking features were measured. 22 parameters, including 9 gait and 13 eye-tracking features, showed significant differences between the two groups (p < 0.05). The top three eye-tracking paradigms were anti-saccade, gap saccade, and median fixation, with AUCs of 0.911, 0.904, and 0.891, respectively. The gait analysis features had an AUC of 0.862, indicating better discriminatory efficacy compared to the SCD9 scale, which had an AUC of 0.762. The model based on single and dual task gait, anti-saccade, gap saccade, and median fixation achieved the best efficacy in SCD screening (AUC = 0.969). Conclusion: The gait analysis, eye-tracking multimodal assessment tool is an objective and accurate screening method that showed better detection of subjective cognitive decline. This finding provides another option for early identification of subjective cognitive decline in the community.

Effect of femoral derotational osteotomy in patients with idiopathic increased femoral anteversion on joint loading and muscular demands.

Purpose: This study aimed to analyse the effect of the femoral derotational osteotomy (FDRO) on joint kinematics, kinetics, joint and muscle forces, and muscle moments in patients with idiopathic increased femoral anteversion compared with typically developing children (TDC). Methods: In this retrospective study, 17 patients (25 limbs, 13.2 ± 2.2 years, femoral anteversion = 49.0° ± 7.1°) were compared to nine TDC (9 limbs, 12.0 ± 3.0 years, femoral anteversion = 18.7° ± 4.1°). Gait analysis was performed 8.5 ± 7.2 months pre-surgery and 17.3 ± 5.5 months post-surgery. Joint angles, moments and forces as well as muscle forces and muscle contributions to joint moments were analysed using statistical parametric mapping. Results: Significant improvements in kinematics (hip rotation, foot progression, knee and hip flexion) were observed pre- to post-FDRO. Joint forces remained unaltered after surgery and did not differ from TDC. Gluteus minimus and deep external rotators muscle forces decreased in mid-stance, while adductor muscle forces increased during stance post-op compared to pre-op. Due to an improved knee extension postoperatively, the rectus femoris muscle force decreased to normal values during mid- and terminal stance. Postoperatively, only the deep external rotator muscle forces differed from TDC. Conclusions: This study showed that FDRO can restore muscle forces and muscle contributions to joint moments in addition to normal gait kinematics, while joint contact forces remain within normative ranges. This knowledge might also apply to other conditions in which pathological femoral anteversion is present.

Utilising Xsens Gait Analysis to Improve Functional Outcomes in Chronic Ankle Instability: A Multifaceted Physiotherapy Approach.

Chronic ankle instability (CAI) is a common consequence of lateral ankle sprains, resulting in persistent pain, instability, and functional limitations. This case report investigates the effectiveness of a physiotherapy intervention for a 25-year-old female patient with CAI, marked by recurrent ankle sprains and persistent symptoms despite prior conservative treatments. The patient exhibited swelling, pain, and instability, with clinical assessment revealing significant ligament laxity and a high longitudinal arch in both feet. A comprehensive physiotherapy regimen focused on core, hip, and ankle muscle strength, dynamic balance, and proprioception was implemented, incorporating ankle stretches, joint mobilization, core strengthening, hip strengthening, and dynamic balance exercises on unstable surfaces. Pre-rehabilitation outcome measures included a numeric pain rating of 7/10, a Cumberland ankle instability tool (CAIT) score of 15/30, and a foot and ankle outcome score (FAOS) of 63%. Gait analysis revealed a speed of 0.79 m/s, a cadence of 99.24 steps/min, and a distance of 14.23 meters. Post-intervention, significant improvements were observed: pain reduced to 1/10, the CAIT score increased to 28/30, and the FAOS rose to 89%. Gait parameters also improved, with speed increasing to 0.90 m/s and distance to 15 meters. This case underscores the effectiveness of a targeted physiotherapy approach in managing CAI, highlighting the importance of a multi-dimensional rehabilitation strategy to enhance functional outcomes and reduce associated symptoms of CAI.

Manifestations of walking fatigability in people with multiple sclerosis based on gait quality and distance walked during the six minutes walking test.

BACKGROUND: Distance walking fatigability (DWF) in people with multiple sclerosis (pwMS) is defined as a decrease in the distance walking over time. However, declines in gait quality (i.e., gait quality fatigability- GQF) may occur independently or alongside DWF. OBJECTIVE: i) to investigate how walking fatigability manifests and its prevalence in pwMS; ii) to describe the temporal pattern of the changes of specific gait characteristics during the 6-minute walking test (6MWT) METHODS: Eighty-eight pwMS (EDSS 4[0-6.5], 49[21-70] years) and 47 healthy controls (HC- 46[25-60] years) performed the 6MWT wearing inertial measurement units. Gait characteristics (stride length, sensor-based gait speed, cadence, double support, step duration, stance phase, step duration asymmetry, step duration variability, foot-strike, toe-off, and leg circumduction) and walking distance were recorded in 1-minute intervals. A fatigability index was calculated by comparing the last and first minute of the 6MWT to identify abnormal worsening based on cutoff scores. The manifestation of walking fatigability was counted. The temporal pattern of worsening of gait characteristics during the 6MWT was examined in pwMS exceeding the cutoff values, compared to pwMS without abnormal changes and HC, using a two-way ANOVA (group vs. minutes) RESULTS: Thirty-five pwMS presented both DWF and GQF, 2 presented isolated DWF, 27 presented isolated GQF, and 24 presented non-walking fatigability. PwMS having GQF presented worsening in gait characteristics (cadence, step duration, step duration variability, or toe-off angle) from minute 2 onwards of the 6MWT, while HCs and pwMS without abnormal changes stabilized gait from minute 2 towards the end of the 6MWT. CONCLUSION: Walking fatigability in pwMS manifests not only as a decrease in walking distance but also as changes in gait quality. Understanding changes in gait characteristics during walking can help tailor rehabilitation interventions.

Inertial measurement units to evaluate the efficacity of Equino Varus Foot surgery in post stroke hemiparetic patients: a feasibility study.

INTRODUCTION: This study evaluates the gait analysis obtained by Inetial Measurement Units (IMU) before and after surgical management of Spastic Equino Varus Foot (SEVF) in hemiplegic post-stroke patients and to compare it with the functional results obtained in a monocentric prospective cohort. METHODS: Patients with post-stroke SEVF, who underwent surgery in a single hospital between November 2019 and December 2021 were included. The follow-up duration was 6 months and included a functional analysis using Goal Attainment Scaling (GAS) and a Gait analysis using an innovative Multidimensional Gait Evaluation using IMU: the semiogram. RESULTS: 20 patients had a gait analysis preoperatively and at 6 months postoperatively. 90% (18/20) patients had a functional improvement (GAS T score ≥ 50) and 50% (10/20) had an improvement in walking technique as evidenced by the cessation of the use of a walking aid (WA). In patients with functional improvement and modification of WA the change in the semiogram area was + 9.5%, sd = 27.5%, and it was + 15.4%, sd = 28%. In the group with functional improvement without change of WA. For the 3 experiences (two patients) with unfavorable results, the area under the curve changed by + 2.3%, -10.2% and - 9.5%. The measurement of the semiogram area weighted by average speed demonstrated very good reproducibility (ICC(1, 3) = 0.80). DISCUSSION: IMUs appear to be a promising solution for the assessment of post-stroke hemiplegic patients who have undergone SEVF surgery. They can provide a quantified, objective, reliable in individual longitudinal follow up automated gait analysis solution for routine clinical use. Combined with a functional scale such as the GAS, they can provide a global analysis of the effect of surgery.

The Effect of Static Trial on Knee Adduction Moment During Walking.

Background and aim Sophisticated technologies in rehabilitation, such as three-dimensional gait analysis, allow for measuring kinematic and kinetic variables while performing activities. The first peak external knee adduction moment (EKAM) is considered an important outcome in individuals with knee osteoarthritis (OA) and has been shown to be affected by changes in foot position in static trials. The present study aimed to explore the variables in static trials that may lead to changes in the value of the EKAM while walking. Methods Twelve individuals participated in the current study and were asked to perform three static trials as follows: 20° toe-out, straight (0°), and 20° toe-in. The participants were asked to walk five trials (their own shoes and paces). The first peak EKAM was the main study outcome and was compared between conditions. Linear regression was used to investigate which variables in the static trials significantly predicted the magnitude of change in the EKAM while walking. Results The first peak EKAM significantly decreased by 8.2% while walking when changing the foot position in static trials from 20° toe-in to 20° toe-out. The magnitude of change in the EKAM was significantly (p<0.01) predicted by the magnitude of change in the knee joint frontal plane angle, shank transverse plane angle, ankle joint frontal plane angle, and hip joint frontal plane angle during static trials between 20° toe-in and 20° toe-out. The model was able to predict 94% of the variation in the EKAM due to changes in foot position during static trials. Conclusion Modifications in foot position during static trials led to a change in the first peak EKAM while walking. Researchers should focus on controlling the knee joint frontal plane angle, shank transverse plane angle, ankle joint frontal plane angle, and hip joint frontal plane angle during static trials when conducting longitudinal or crossover studies. Controlling these variables is necessary to reduce the likelihood of the EKAM being affected by static trials and to ensure that the EKAM changes in dynamic trials are not masked or increased by static trials.

Persistent deficits in knee joint kinematics and kinetics during gait following tibial plateau fractures - a longitudinal study.

The recovery process after tibial plateau fractures varies, with some patients experiencing persistent gait asymmetries for a long period of time. The aim of this study is to analyse knee joint kinematics and kinetics post-fracture using a linear mixed-effects model, assessing 26 participants over 24 months (aged 45, range 26-63), and an age-matched control group (aged 47, range 26-62). Participants underwent three-dimensional gait analysis at 6-, 12- and 24-months post-injury. Controls participated in the gait analysis on one occasion. Six gait variables related to knee joint kinematics and kinetics were analysed with a linear mixed-effects model. The model was constructed to determine if there was a differential improvement over time between the injured and the non-injured legs across the six variables, referred to as an interaction effect. If no interaction effect was observed, the model assessed whether there was a side difference between the legs and if there was any improvement over time in both legs. Additionally, non-parametric tests were performed to assess differences between the non-injured leg and the control group across the six variables 24 months after injury. The findings revealed an interaction effect in terms of cumulative absorbed power (p = 0.02, side difference p = 0.06). Other variables showed no interaction effects. Although a side difference between legs was observed for all variables (p < 0.001), only the variables regarding generated power exhibited improvements over time (p = 0.02 respectively). Minimal knee flexion, range of motion, and maximal extending knee joint moment showed no improvements over time. At the 24-month follow-up, the maximal extending knee joint moment was the only variable that differed between the non-injured leg and controls, with increased moment observed for the non-injured leg compared with the controls (p = 0.03). Taken together, two years post-fracture, patients demonstrated pronounced side differences between the injured and non-injured legs with worse ability to extend the knee joint and to generate power in the injured leg. While the kinetic variables improved over time, there were no improvements observed in kinematic variables. Moreover, the non-injured leg performed similarly to healthy controls in terms of minimal knee flexion, range of motion, and generated and absorbed power.

Multibody dynamics-based musculoskeletal modeling for gait analysis: a systematic review.

Beyond qualitative assessment, gait analysis involves the quantitative evaluation of various parameters such as joint kinematics, spatiotemporal metrics, external forces, and muscle activation patterns and forces. Utilizing multibody dynamics-based musculoskeletal (MSK) modeling provides a time and cost-effective non-invasive tool for the prediction of internal joint and muscle forces. Recent advancements in the development of biofidelic MSK models have facilitated their integration into clinical decision-making processes, including quantitative diagnostics, functional assessment of prosthesis and implants, and devising data-driven gait rehabilitation protocols. Through an extensive search and meta-analysis of over 116 studies, this PRISMA-based systematic review provides a comprehensive overview of different existing multibody MSK modeling platforms, including generic templates, methods for personalization to individual subjects, and the solutions used to address statically indeterminate problems. Additionally, it summarizes post-processing techniques and the practical applications of MSK modeling tools. In the field of biomechanics, MSK modeling provides an indispensable tool for simulating and understanding human movement dynamics. However, limitations which remain elusive include the absence of MSK modeling templates based on female anatomy underscores the need for further advancements in this area.

Case report: New perspectives on gait initiation strategies from a case of full toes amputation in a professional mountain climber.

Introduction: We studied the postural behaviour of a 52-year-old professional mountain climber who underwent bilateral amputation of all five toes after severe frostbite. Methods: Two tasks were examined: static posturography (SP) and gait initiation (GI), both performed barefoot and with prosthetic shoes. During SP, the participant kept the upright stance for 30 s while an optoelectronic system with reflective markers recorded feet position and body sway, and two force plates measured the Center of Pressure (CoP) displacement and Ground Reaction Force (GRF) of each foot. During GI, the participant stood on the force plates for at least 10 s and then spontaneously started walking, while optoelectronic system was used to monitor heel-off events; wireless EMG probes recorded the anticipatory postural adjustments (APAs) in trunk and lower limb muscles. Results: Compared to shod condition, during barefoot SP the participant showed a reduced anteroposterior (AP) and mediolateral (ML) extension of the Base of Support (BoS), and the whole-body CoP shifted about 7 mm more anteriorly, approaching the "safer" geometric center of the BoS. Despite this difference, the AP and ML ranges of CoP oscillations were similar in both conditions. In GI, the trunk dorsal muscles showed different APA patterns: when barefoot they were excitatory in the trailing and inhibitory in the leading side while they were bilaterally inhibitory when shod. Discussion: In parallel to CoP shift toward a "safer" position in SP, in barefoot GI the body rotation toward the trailing side may reveal a more "cautious" approach; this also shows that different postural strategies may be adopted in GI by one and the same individual.

Continuous Gait Phase Estimation for Multi-Locomotion Tasks Using Ground Reaction Force Data.

Existing studies on gait phase estimation generally involve walking experiments using inertial measurement units under limited walking conditions (WCs). In this study, a gait phase estimation algorithm is proposed that uses data from force sensing resistors (FSRs) and a Bi-LSTM model. The proposed algorithm estimates gait phases in real time under various WCs, e.g., walking on paved/unpaved roads, ascending and descending stairs, and ascending or descending on ramps. The performance of the proposed algorithm is evaluated by performing walking experiments on ten healthy adult participants. An average gait estimation accuracy exceeding 90% is observed with a small error (root mean square error = 0.794, R2 score = 0.906) across various WCs. These results demonstrate the wide applicability of the proposed gait phase estimation algorithm using various insole devices, e.g., in walking aid control, gait disturbance diagnosis in daily life, and motor ability analysis.

Comparison of Gait in Women with Degenerative Changes of the Hip Joint and Healthy Women Using the MoKA System-A Pilot Study.

Osteoarthritis (OA) is a global problem. There are few reports in the literature regarding the temporal and spatial parameters of gait in people with OA. The aim of this study was to determine spatiotemporal parameters for the pelvis and lower limbs during walking in women with OA and to compare these parameters with healthy people. For this purpose, a 6 min walking test (6MWT) was carried out. OA subjects had worse outcomes compared to the control group (p < 0.05). Data were collected using IMU sensors integrated into the MoKA system and mounted on indicator points on the body. Limited mobility of the pelvis in the frontal plane was observed in the study group, which influenced walking strategy. For the comparison with the control group at each minute, p < 0.05. IMU sensors attached to the body and integrated in one application provide extensive research and diagnostic capabilities.

Mobile Spatiotemporal Gait Segmentation Using an Ear-Worn Motion Sensor and Deep Learning.

Mobile health technologies enable continuous, quantitative assessment of mobility and gait in real-world environments, facilitating early diagnoses of gait disorders, disease progression monitoring, and prediction of adverse events like falls. Traditionally, mobile gait assessment predominantly relied on body-fixed sensors positioned at the feet or lower trunk. Here, we investigate the potential of an algorithm utilizing an ear-worn motion sensor for spatiotemporal segmentation of gait patterns. We collected 3D acceleration profiles from the ear-worn sensor during varied walking speeds in 53 healthy adults. Temporal convolutional networks were trained to detect stepping sequences and predict spatial relations between steps. The resulting algorithm, mEar, accurately detects initial and final ground contacts (F1 score of 99% and 91%, respectively). It enables the determination of temporal and spatial gait cycle characteristics (among others, stride time and stride length) with good to excellent validity at a precision sufficient to monitor clinically relevant changes in walking speed, stride-to-stride variability, and side asymmetry. This study highlights the ear as a viable site for monitoring gait and proposes its potential integration with in-ear vital-sign monitoring. Such integration offers a practical approach to comprehensive health monitoring and telemedical applications, by integrating multiple sensors in a single anatomical location.

The level of skills involved in an observation-based gait analysis.

This study aimed to determine the visual assessment skills during an observation-based gait analysis. Participants (N=40) included 20 physiotherapists (PTs) with>10 years of clinical experience (physiotherapists) and 20 physiotherapy students. Both groups watched a video of the gait of a subject with Guillain-Barré syndrome before and after being provided with information regarding other movements. Further, visual lines were measured using an EMR-8 eye mark recorder, and the results were compared between both groups. The average gaze duration was longer for students than for PTs (F1,79=53.3; p<0.01), whereas PTs gazed more often than the students (F1,79=87.6; p< 0.01). Furthermore, the PTs moved their eyes vertically more often than the students (F1,151=9.1; P< 0.01). We found that being able to discriminate the relative physical relationship of body locations by frequent and rapid vertical gazes could be an indication of the level of skills as an index to express the visual assessment skill in an observation-based gait analysis.

Ability of Heart Rate Recovery and Gait Kinetics in a Single Wearable to Predict Frailty: Quasiexperimental Pilot Study.

BACKGROUND: Aging is a risk factor for falls, frailty, and disability. The utility of wearables to screen for physical performance and frailty at the population level is an emerging research area. To date, there is a limited number of devices that can measure frailty and physical performance simultaneously. OBJECTIVE: The aim of this study is to evaluate the accuracy and validity of a continuous digital monitoring wearable device incorporating gait mechanics and heart rate recovery measurements for detecting frailty, poor physical performance, and falls risk in older adults at risk of falls. METHODS: This is a substudy of 156 community-dwelling older adults ≥60 years old with falls or near falls in the past 12 months who were recruited for a fall prevention intervention study. Of the original participants, 22 participants agreed to wear wearables on their ankles. An interview questionnaire involving demographics, cognition, frailty (FRAIL), and physical function questions as well as the Falls Risk for Older People in the Community (FROP-Com) was administered. Physical performance comprised gait speed, timed up and go (TUG), and the Short Physical Performance Battery (SPPB) test. A gait analyzer was used to measure gait mechanics and steps (FRAIL-functional: fatigue, resistance, and aerobic), and a heart rate analyzer was used to measure heart rate recovery (FRAIL-nonfunctional: weight loss and chronic illness). RESULTS: The participants' mean age was 74.6 years. Of the 22 participants, 9 (41%) were robust, 10 (46%) were prefrail, and 3 (14%) were frail. In addition, 8 of 22 (36%) had at least one fall in the past year. Participants had a mean gait speed of 0.8 m/s, a mean SPPB score of 8.9, and mean TUG time of 13.8 seconds. The sensitivity, specificity, and area under the curve (AUC) for the gait analyzer against the functional domains were 1.00, 0.84, and 0.92, respectively, for SPPB (balance and gait); 0.38, 0.89, and 0.64, respectively, for FRAIL-functional; 0.45, 0.91, and 0.68, respectively, for FROP-Com; 0.60, 1.00, and 0.80, respectively, for gait speed; and 1.00, 0.94, and 0.97, respectively, for TUG. The heart rate analyzer demonstrated superior validity for the nonfunctional components of frailty, with a sensitivity of 1.00, specificity of 0.73, and AUC of 0.83. CONCLUSIONS: Agreement between the gait and heart rate analyzers and the functional components of the FRAIL scale, gait speed, and FROP-Com was significant. In addition, there was significant agreement between the heart rate analyzer and the nonfunctional components of the FRAIL scale. The gait and heart rate analyzers could be used in a screening test for frailty and falls in community-dwelling older adults but require further improvement and validation at the population level.

Hypoechoic ultrasonographic findings in the patellar ligaments are common in riding and trotting horses in training (116 cases).

Patellar ligament (PL) injuries are increasingly being reported in horses, but few studies have described the normal PL ultrasonographic appearance in horses. The aims of this prospective observational study were to describe the ultrasonographic appearance of the PLs and infrapatellar fat pad in a population of horses in training and to relate the ultrasonographic findings to objectively measured movement asymmetry. B-mode and color Doppler ultrasonographic examination of the PLs and infrapatellar fat pad in both hind limbs and objective gait analyses were performed on the 116 riding and trotting horses included in the study. The association between ultrasonographic findings, horse age, and movement asymmetry during the trot was then investigated. Distinct or diffuse hypoechoic regions were commonly found in the intermediate PL (24/116; 20.7%), especially in the caudal aspect of the mid-third of the ligament. The infrapatellar fat pad had a hypoechoic striated appearance in all horses except one, in which it was hyperechoic. No association was found between ultrasonographic findings in the PLs and infrapatellar fat pad and lameness. It is important to recognize that there is biological variation in PL appearance, which may or may not be associated with pain in this area, therefore emphasizing the use of local analgesia to determine the location of the lameness.