SAGA: Stability-Aware Gait Analysis in constraint-free environments.

BACKGROUND: Gait abnormality detection is a challenging task in clinical practice. The majority of the current frameworks for gait abnormality detection involve the individual processes of segmentation, feature estimation, feature learning, and similarity assessment. Since each component of these modules is fixed and they are mutually independent, their performance under difficult circumstances is not ideal. We combine those processes into a single framework, a gait abnormality detection system with an end-to-end network. METHODS: It is made up of convolutional neural networks and Deep-Q-learning methods: one for coordinate estimation and the other for classification. In a single joint learning technique that may be trained together, the two networks are modeled. This method is significantly more efficient for use in real life since it drastically simplifies the conventional step-by-step approach. RESULTS: The proposed model is experimented on MATLAB R2020a. While considering into consideration the stability factor, our proposed model attained an average case accuracy of 95.3%, a sensitivity of 96.4%, and a specificity of 94.1%. SIGNIFICANCE: Our paradigm for quantifying gait analysis using commodity equipment will improve access to quantitative gait analysis in medical facilities and rehabilitation centers while also allowing academics to conduct large-scale investigations for gait-related disorders. Numerous experimental findings demonstrate the effectiveness of the proposed strategy and its ability to provide cutting-edge outcomes.

Increased trailing limb angle in hemiplegic patients after training with a knee orthosis: A randomized controlled trial.

BACKGROUND: Stroke often induces gait abnormality, such as buckling knee pattern, compromising walking ability. Previous studies indicated that an adequate trailing limb angle (TLA) is critical for recovering walking ability. OBJECTIVE: We hypothesized that correcting gait abnormality by immobilizing the knee joint using a knee orthosis (KO) would improve walking patterns and increase the TLA, and investigated whether walking training using a KO would increase the TLA in post-stroke patients. METHODS: In a randomized controlled trial, thirty-four participants were assigned to KO (walking training using a KO) and non-KO (without using a KO) groups. Twenty-nine completed the three-week gait training protocol. TLA was measured at baseline and after training. A two-way repeated ANOVA was performed to evaluate TLA increases with training type and time as test factors. A t-test compared TLA changes (ΔTLA) between the two groups. RESULTS: ANOVA showed a main effect for time (F = 64.5, p < 0.01) and interaction (F = 15.4, p < 0.01). ΔTLA was significantly higher in the KO group (14.6±5.8) than in the non-KO group (5.0±7.0, p < 0.001). CONCLUSION: Walking training using a KO may be practical and effective for increasing TLA in post-stroke patients.

Multimodal Gait Abnormality Recognition Using a Convolutional Neural Network-Bidirectional Long Short-Term Memory (CNN-BiLSTM) Network Based on Multi-Sensor Data Fusion.

Global aging leads to a surge in neurological diseases. Quantitative gait analysis for the early detection of neurological diseases can effectively reduce the impact of the diseases. Recently, extensive research has focused on gait-abnormality-recognition algorithms using a single type of portable sensor. However, these studies are limited by the sensor's type and the task specificity, constraining the widespread application of quantitative gait recognition. In this study, we propose a multimodal gait-abnormality-recognition framework based on a Convolutional Neural Network-Bidirectional Long Short-Term Memory (CNN-BiLSTM) network. The as-established framework effectively addresses the challenges arising from smooth data interference and lengthy time series by employing an adaptive sliding window technique. Then, we convert the time series into time-frequency plots to capture the characteristic variations in different abnormality gaits and achieve a unified representation of the multiple data types. This makes our signal processing method adaptable to several types of sensors. Additionally, we use a pre-trained Deep Convolutional Neural Network (DCNN) for feature extraction, and the consequently established CNN-BiLSTM network can achieve high-accuracy recognition by fusing and classifying the multi-sensor input data. To validate the proposed method, we conducted diversified experiments to recognize the gait abnormalities caused by different neuropathic diseases, such as amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD), and Huntington's disease (HD). In the PDgait dataset, the framework achieved an accuracy of 98.89% in the classification of Parkinson's disease severity, surpassing DCLSTM's 96.71%. Moreover, the recognition accuracy of ALS, PD, and HD on the PDgait dataset was 100%, 96.97%, and 95.43% respectively, surpassing the majority of previously reported methods. These experimental results strongly demonstrate the potential of the proposed multimodal framework for gait abnormality identification. Due to the advantages of the framework, such as its suitability for different types of sensors and fewer training parameters, it is more suitable for gait monitoring in daily life and the customization of medical rehabilitation schedules, which will help more patients alleviate the harm caused by their diseases.

Generalized Dystonia as Presenting Feature of Wilson Disease: A Case Report.

Wilson disease is a rare autosomal recessive genetic disease, caused by the mutation of the ATP7B gene leading to decreased secretion of serum ceruloplasmin in blood and decrease biliary excretion of copper leading to toxic level accumulation in the liver, brain, kidney, and cornea, resulting in development of characteristic liver disease and neuropsychiatric symptoms. Our case presented with mainly clumsiness and gait abnormality without any psychiatric component and any history of liver disease. A 13-year old male, born out of non-consanguineous marriage, presented with clumsy walking and slurring of speech. The child also complained of poor handwriting and slipping of slipper from foot, without any history of abnormal behavior and poor scholastic performance. On examination gait was abnormal with sidewise swaying, increased muscle tone with rigidity and bilateral flexor plantar reflex. Slit lamp examination of eyes revealed bilateral Kayser-Fleischer rings. Serum ceruloplasmin was low (0.03 g/L) and 24-hour urinary copper was high (119.64 µg/day). MRI brain showed B/L putamen hyperintensity and panda sign suggestive of Wilson disease. After the diagnosis of Wilson disease was made, patient was treated with penicillamine and zinc. Child was also followed-up and re-examination showed slight improvement. Though not rare, Wilson disease is an uncommon entity with varied presentations and disabling consequences. Hence high index of suspicion and clinical correlation is required to diagnose it. Early initiation of treatment and good compliance ensure a better outcome.

Prevalence and Factors Associated with Working Equid Lameness in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis.

Lameness is an important concern in working equids of low- and middle-income communities (LMICs) with significant One Welfare implications. This study aims to determine the prevalence and influencing factors of lameness in working equids of LMICs. A systematic review and meta-analysis were performed to investigate pooled outcome prevalence using a random intercept regression model. Subgroup and sensitivity analysis were performed through meta-regression. A meta-analysis of study factors for lameness prevalence was performed. Sixty-four studies were included in the review. The pooled prevalence of lameness was 29.9% (n = 42, 95% CI 17-47%), while the pooled prevalence of gait abnormality was 62.9% (n = 12; 95% CI 31-87%). When considering both outcomes together, the pooled prevalence was 38.4% (n = 46; 95% CI 23-57%) with a significant (p = 0.02) difference between lameness (29.5%; 95% CI 16-48%) and gait abnormality (78.8%; 95% CI 40-95%). Species, country income level, gait assessed, and risk of bias did not significantly affect the pooled prevalence. Lower body condition scores, unresponsive attitudes, and old age were the most frequently reported factors positively associated with lameness-related outcomes. Working 7 days per week was positively associated with lameness. The standardization of outcome terminology, grading systems, and study factor categorization is recommended to enable more accurate interpretation and comparison between studies.

Effects of Wii Fit exer-gaming on balance and gait in elderly population: A randomized control trial.

OBJECTIVE: To assess the effect of exer-gaming on balance and gait in the elderly. Methods: The randomised controlled trial was conducted at Kulsum International Hospital, Islamabad, Pakistan, from July to October 2018, and comprised physically independent subjects aged 60 years and above who were randomised into experimental and control groups using concealed envelope method. The cases received exer-gaming for 30 minutes twice a week for 8 weeks, while the controls received balance training exercises twice a week for 8 weeks. Assessment was done at baseline and after 8 weeks of intervention. Outcome measures were assessed with Berg balance scale and the gait abnormality rating scale modified. Data was analysed using SPSS 21. RESULTS: Of the 90 subjects, there were 45(50%) in each of the two groups. The intervention group had better outcome in terms of gait (p<0.05) except for foot contact and shoulder extension (p>0.05), while the difference related to balance was not significant (p>0.05). CONCLUSIONS: Exer-gaming was found to be effective in improving various components of gait in the elderly compared to exercises.

The Limping Child.

A limp is a common presentation to pediatricians, emergency centers, and orthopedists. A directed history and physical examination, and the development of a differential diagnosis based on limp type, patient's age, and the anatomic site that is most likely affected, provides a selective approach to diagnostic testing. Laboratory tests are indicated when infection, inflammatory arthritis, or a malignancy is considered. Imaging usually begins with plain radiography. Ultrasonography is valuable in assessing irritable hips. Advanced imaging is done in select cases. Prompt referral to an orthopedist is essential, especially if septic joint, vascular or compartment issues, or open fractures are suspected.

Single-Event Multilevel Surgery to Correct Movement Disorders in Children with Cerebral Palsy.

Cerebral palsy (CP) is a common motor disability that may be congenital or acquired. Children with CP often have gait, balance, and posture abnormalities, some of which may be severe enough to interfere with safe ambulation or other activities of daily living. Nonsurgical and surgical interventions are part of the management plan for children with CP. Historically, surgeons addressed gait deviations individually and sequentially with single-level surgeries. However, computerized motion analysis and advances in orthopedic internal fixation devices have improved the outcomes for patients undergoing single-event multilevel surgery. This article provides perioperative RNs with a basic understanding of movement disorders that can be corrected with single-event multilevel surgery, the role of computerized motion analysis in making treatment decisions for ambulatory pediatric orthopedic patients with CP, and various treatment options for the movement disorders of children with CP.

Gait Abnormality Predicts Falls in Women After Total Hip Arthroplasty.

BACKGROUND: Patients who undergo total hip arthroplasty (THA) have an increased risk of falls during the first year postoperatively. However, risk factors for falls after THA remain unclear. We investigated the relationship between gait abnormality and falls during the first year after THA. METHODS: We conducted a prospective cohort study of 286 patients with severe hip osteoarthritis who underwent THA and examined fall history during the first year postoperatively. Baseline characteristics including age, body mass index, number of prescribed medications, comorbidities, and history of falling in the past year were evaluated as covariates and determined using a self-administered questionnaire and interview preoperatively. We assessed functional outcomes, including passive range of motion of the hip joint (flexion, extension, abduction, and adduction), muscle strength (hip abduction and knee extension), gait velocity, and gait abnormality, at 3 weeks postoperatively. Cox proportional hazard regression models were used to analyze the relationship between the presence of gait abnormality and falls. RESULTS: One hundred sixty-two women were included. The incidence of at least 1 fall during the first year after THA was 31.5%. Cox proportional hazard regression models showed that the presence of gait abnormality (hazard ratio, 2.91; 95% confidence interval, 1.55-5.48; P < .001) was significantly associated with falls during the first year postoperatively. CONCLUSION: The presence of gait abnormality is a useful screening tool to predict future falls in women after THA. Clinicians should assess gait abnormality to identify patients who may require fall prevention measures and continuous rehabilitation to improve gait abnormality.

Four novel ARSA gene mutations with pathogenic impacts on metachromatic leukodystrophy: a bioinformatics approach to predict pathogenic mutations.

Metachromatic leukodystrophy (MLD) disorder is a rare lysosomal storage disorder that leads to severe neurological symptoms and an early death. MLD occurs due to the deficiency of enzyme arylsulfatase A (ARSA) in leukocytes, and patients with MLD excrete sulfatide in their urine. In this study, the ARSA gene in 12 non-consanguineous MLD patients and 40 healthy individuals was examined using polymerase chain reaction sequencing. Furthermore, the structural and functional effects of new mutations on ARSA were analyzed using SIFT (sorting intolerant from tolerant), I-Mutant 2, and PolyPhen bioinformatics software. Here, 4 new pathogenic homozygous mutations c.585G>T, c.661T>A, c.849C>G, and c.911A>G were detected. The consequence of this study has extended the genotypic spectrum of MLD patients, paving way to a more effective method for carrier detection and genetic counseling.

Uric acid levels correlate with the severity of diabetic sensorimotor polyneuropathy.

INTRODUCTION: Diabetic sensorimotor polyneuropathy (DSP) is the most frequent complication in patients with diabetes mellitus (DM), and is associated with age, DM duration, and HbA1c levels. In addition, higher uric acid (UA) levels are reported in patients with DSP. OBJECTIVES: To explore whether UA levels correlate with DSP severity. METHODS: We extracted the demographic data, clinical history, neurological and electrophysiological examinations and laboratory findings of 115 patients diagnosed with DSP from January 2012 to December 2015. RESULTS: The mean age of the total cohort was 62±13years, with 61% men. A positive correlation was demonstrated between uric acid levels and increasing sensory symptoms, and more abnormal electrophysiological findings and vibration perception thresholds. In addition, correlations with gait abnormality, the presence of paraproteinemia and creatine kinase levels were found. DISCUSSION: Our study results show that uric acid levels correlate with clinical and electrophysiological severity of DSP, providing additional evidence for the relationship between the two, and a potential therapeutic target for DSP.

Timing of surgical treatment for idiopathic normal pressure hydrocephalus: association between treatment delay and reduced short-term benefit.

OBJECTIVE A growing body of evidence suggests that longer durations of preoperative symptoms may correlate with worse postoperative outcomes following cerebrospinal fluid (CSF) diversion for treatment of idiopathic normal pressure hydrocephalus (iNPH). The aim of this study is to determine whether the duration of preoperative symptoms alters postoperative outcomes in patients treated for iNPH. METHODS The authors conducted a retrospective review of 393 cases of iNPH involving patients treated with ventriculoperitoneal (VP) shunting. The duration of symptoms prior to the operative intervention was recorded. The following outcome variables were assessed at baseline, 6 months postoperatively, and at last follow-up: gait performance, urinary continence, and cognition. RESULTS The patients' median age at shunt placement was 74 years. Increased symptom duration was significantly associated with worse gait outcomes (relative risk (RR) 1.055 per year of symptoms, p = 0.037), and an overall absence of improvement in any of the classic triad symptomology (RR 1.053 per year of symptoms, p = 0.033) at 6 months postoperatively. Additionally, there were trends toward significance for symptom duration increasing the risk of having no 6-month postoperative improvement in urinary incontinence (RR 1.049 per year of symptoms, p = 0.069) or cognitive symptoms (RR 1.051 per year of symptoms, p = 0.069). However, no statistically significant differences were noted in these outcomes at last follow-up (median 31 months). Age stratification by decade revealed that prolonging symptom duration was significantly associated with lower Mini-Mental Status Examination scores in patients aged 60-70 years, and lack of cognitive improvement in patients aged 70-80 years. CONCLUSIONS Patients with iNPH with longer duration of preoperative symptoms may not receive the same short-term benefits of surgical intervention as patients with shorter duration of preoperative symptoms. However, with longer follow-up, the patients generally reached the same end point. Therefore, when managing patients with iNPH, it may take longer to see the benefits of CSF shunting when patients present with a longer duration of preoperative symptoms.

Saddle fit and management: An investigation of the association with equine thoracolumbar asymmetries, horse and rider health.

REASONS FOR PERFORMING STUDY: No previous studies have investigated interrelationships between saddle fit/management, equine thoracolumbar asymmetries, rider and horse health. OBJECTIVES: To assess associations between data obtained by clinical assessment and those provided by riders via a questionnaire. STUDY DESIGN: Clinical assessment of a convenience sample of horses and riders compared with a Web-based questionnaire survey (n = 205). METHODS: Horse thoracolumbar asymmetries at predetermined sites, the presence of lameness (in hand and/or ridden), saddle slip, saddle fit/management and rider straightness were assessed. Kappa statistics were used to assess the relationship between categorical clinical data and questionnaire data from riders. Spearman's correlation was used to investigate associations between outcomes from clinical assessment (horse, saddle and rider data) and information provided by riders. RESULTS: There was a 40.5% (205 of 506) questionnaire response rate. Thirty horses (14.6%) had saddle slip, which was significantly associated with hindlimb lameness or gait abnormalities (P<0.001), but only 2 riders had considered a link between saddle slip and lameness. Rider back pain was common (38.5%) and associated with ill-fitting saddles (P = 0.03) and either a quadrupedally reduced cranial phase of the step or a stiff, stilted canter (P = 0.006). Well-fitted saddles were associated with frequent saddle fit checks (P = 0.004). Minor thoracolumbar asymmetries (P = 0.04) were negatively associated with ill-fitting saddles and positively associated with rider skill level (P = 0.001). CONCLUSIONS: The interaction between the horse, saddle and rider is complex. Ill-fitting saddles and a stiff, stilted canter or quadrupedally reduced cranial phase of the step are associated with rider back pain. Equine back pain and minor thoracolumbar asymmetries are associated with ill-fitting saddles. Saddle fit should be checked more often than once yearly to lower the number of ill-fitting saddles. Riders, trainers and other professionals involved in equine care and performance need better education to recognise ill-fitting saddles, lameness, saddle slip and rider crookedness.

Melatonin protects against behavioural dysfunctions and dendritic spine damage in 3-nitropropionic acid-induced rat model of Huntington's disease.

Huntington's disease (HD), an autosomal dominant neurodegenerative movement disorder in which striatal and cortical neurons are mostly affected, has no effective cure existing. A fungal neurotoxin and a potent inhibitor of mitochondrial electron transport chain complex II inhibitor, 3-nitropropionic acid (3-NP) is known to cause HD pathology, including lesions in the striatum and the cortex, and several behavioural syndromes in experimental animals. In the present study we examined the effect of melatonin on motor activities, neuronal morphology as revealed by Nissl and rapid Golgi staining, as well as GABA, glutamate and biogenic amine neurotransmitter levels in 3-NP-induced HD in rats. We found that melatonin (10, 20mg/kg, i.p.) administered 1h prior to 3-NP dose (20mg/kg; daily for 4 days) restored motor coordination ability as shown in gait, beam balancing, swim ability and performance on rotarod. However it failed to reduce 3-NP-induced striatal lesion core area, neuronal damage and the elevated levels of striatal dopamine. Melatonin administration partially restored 3-NP-induced loss of dendritic spines in the striatum and the cortex, and the reduction in cerebellar granule cell, but not hippocampal CA1 neuronal arborization. These findings collectively suggest that melatonin offers beneficial effects in correction of learning related fine motor adjustments, but not in behaviours unrelated to learning, by the restoration of striatal and cortical spines, and cerebellar granule cell arborization.

The interrelationship of lameness, saddle slip and back shape in the general sports horse population.

REASONS FOR PERFORMING STUDY: Saddle slip is usually blamed on saddle fit, crooked riders or horse shape, but may reflect hindlimb lameness. There are no studies of the frequency of occurrence of saddle slip and risk factors within a tested sample population of the general sports horse population. OBJECTIVES: To quantify the frequency of saddle slip and to describe the association with lameness, thoracolumbar shape/symmetry, crooked riders and ill-fitting saddles. STUDY DESIGN: Nonrandom, cross-sectional survey using convenience sampling. METHODS: Five hundred and six sports horses in normal work were assessed prospectively. Thoracolumbar shape/symmetry were measured at predetermined sites; the presence of lameness (in hand and/or ridden) and saddle slip was recorded. Descriptive statistics, univariable and multiple logistic regression were performed to assess the relationship between horse-saddle-rider factors and saddle slip. RESULTS: The frequency of lameness, quadrilaterally reduced cranial phase of the stride or stiff, stilted canter was 45.7%, saddle slip 12.3%, left-right thoracolumbar shape asymmetries ≥ coefficient of variance of 8% (1.2 cm) 0.6%; and 103 of 276 riders (37.3%) sat crookedly. The saddle consistently slipped to one side in 24.4% of horses with hindlimb lameness alone, 45.5% of horses with concurrent hindlimb and forelimb lameness, compared with 5.4% with forelimb lameness, 17.4% with stiff, stilted canter, 20% with quadrilaterally reduced cranial phase of stride and 5.5% nonlame horses. Nineteen horses (30.6%) with saddle slip had no detectable hindlimb lameness; however, 14 had a gait abnormality, particularly in canter. Multivariable analysis revealed that saddle slip was significantly associated with hindlimb lameness and gait abnormalities (odds ratio [OR] = 52.62, 95% confidence interval [CI] 17.3-159.7), a saddle fitted with even contact and uniform flocking (OR = 15.49, 95% CI 1.9-125.5), riders sitting crookedly (OR = 6.32, 95% CI 2.9-13.7), a well-balanced saddle (OR = 3.05, 95% 1.4-6.9) and large back shape ratio at T18 (OR = 1.2, 95% 1.1-1.3). CONCLUSIONS: Many horses with hindlimb and/or forelimb lameness go unrecognised. Saddle slip may be a sign of hindlimb lameness. Education of the equestrian population to identify lameness and saddle slip is required. The Summary is available in Chinese - see Supporting information.