Suitability of visual cues for freezing of gait in patients with idiopathic Parkinson's disease: a case-control pilot study.

BACKGROUND: Freezing of gait (FOG) is one of the most debilitating symptoms in patients with idiopathic Parkinson's disease (IPD). Visual cues can relieve FOG symptoms. However, there is no consensus on patient characteristics that can benefit from visual cues. Therefore, we examined the differences in IPD patient characteristics according to the effectiveness of visual cueing. METHODS: Through gait experiments, we investigated the number of FOG occurrences, average FOG period per episode, proportion of FOG duration in the total gait cycles, and FOG-free period gait spatiotemporal parameters in ten participants diagnosed with FOG due to IPD. Subsequently, the differences between their clinical characteristics and striatal dopamine active transporter availability from six subregions of the striatum were compared by dividing them into two groups based on the three reduction rates: occurrence numbers, mean durations per episode, and proportion of FOG duration in the total gait cycles improved by visual cueing using laser shoes. The relationships among these three reduction rates and other FOG-related parameters were also investigated using Spearman correlation analyses. RESULTS: According to the three FOG-related reduction rates, the group assignments were the same, which was also related to the baseline self-reported FOG severity score (New Freezing of Gait Questionnaire): the more severe the FOG, the poorer the response to the visual cueing. By visual cueing, the better response group demonstrated the characteristics of lower new FOG questionnaire total scores, higher dopamine active transporter availability of the anterior and posterior putamen, and shorter mean duration of FOG per episode in the absence of cueing. These results were replicated using Spearman correlation analyses. CONCLUSIONS: For FOG symptoms following IPD, gait assistance by visual cueing may be more effective when the total NFOGQ score is lower and the DAT of putamen is higher. Through this study, we demonstrated clinical and striatal dopaminergic conditions to select patients who may be more likely to benefit from visual cueing with laser shoes, and these findings lead to the need for early diagnosis of FOG in patients with IPD. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05080413. Registered on September 14, 2021.

Microprocessor-Controlled Prostheses for a Bilateral Transtibial Amputee with Gait Analysis and Satisfaction: A 1-Year Followup Case Report.

Bilateral amputees are disadvantaged as they lack healthy leg support. We present the rare case of a bilateral transtibial amputee (BTA), in which we compared the first South Korean-made microprocessor-controlled prosthesis (MPA) to a conventional prosthetic ankle (CPA) with gait analysis and a patient questionnaire for long-term outcomes. A 70-year-old man presented with bilateral transtibial amputations from injury. Assessments were performed after wearing an MPA for 1 month and 1 year with three-dimensional gait analysis. Satisfaction, mobility, and pain were evaluated using the Korean version of the Prostheses Evaluation Questionnaire (K-PEQ). The spatiotemporal parameters of both sides showed increased stability from the CPA to 1 month (mMPA) and 1 year (yMPA). We observed an increased single support time, decreased step width, and almost normal stance-swing time ratio. In kinematic parameters, the ankle range of motion (ROM) was bilaterally increased at mMPA and yMPA. Unfortunately, the MPA gait showed insufficient ankle plantarflexion during the terminal stance that failed to generate push-up power. As the MPA adaptation time increased, the symmetry ratio improved to a balanced value. The questionnaire-based investigations of satisfaction, mobility, and pain revealed excellent results. The MPA proved helpful for ankle mobility in the BTA, and the questionnaire showed good satisfaction and mobility in varied terrain.

Customized Power Wheelchair Joysticks Made by Three-Dimensional Printing Technology: A Pilot Study on the Environmental Adaptation Effects for Severe Quadriplegia.

BACKGROUND: Power wheelchair joysticks are often available as standardized ready-made products for patients with severe hand dysfunction. However, standardized joysticks have limitations in accommodating the individualized features of hand dysfunctions. Three-dimensional (3D) printing technology has facilitated active research on the development of joysticks that can overcome such limitations. METHODS: Four subjects participated in the study to evaluate driving abilities and satisfaction after using the customized joystick for two weeks. Modified power-mobility indoor driving assessment (PIDA), National Aeronautics and Space Administration task load index (NASA-TLX), and psychosocial impact of assistive devices scale (PIADS; Korean version) were employed for evaluation. RESULTS: In patients 1-3, the modified PIDA scores had the highest values in the pre-test and post-test. In patient 4, the modified PIDA score had a higher value in the post-test (mean value = 4) compared to the pre-test (mean value = 3.33). In all patients, the modified PIDA time was lower in the post-test compared to the pre-test. The NASA-TLX and PIADS values indicate that greater satisfaction was achieved through the usage of customized joysticks in the post-test. CONCLUSIONS: All patients can improve their power wheelchair driving abilities and achieve greater satisfaction. CLINICAL RELEVANCE: Three-dimensional printed customized power wheelchair joysticks can offer enhanced driving abilities and satisfaction to patients with limited hand function owing to severe spinal cord injury.

Comparison of the Effectiveness of Three Lumbosacral Orthoses on Early Spine Surgery Patients: A Prospective Cohort Study.

OBJECTIVE: To compare the convenience and effectiveness of the existing lumbosacral orthoses (LSO) (classic LSO and Cybertech) and a newly developed LSO (V-LSO) by analyzing postoperative data. METHODS: This prospective cohort study was performed from May 2019 to November 2019 and enrolled and analyzed 88 patients with degenerative lumbar spine disease scheduled for elective lumbar surgery. Three types of LSO that were provided according to the time of patient registration were applied for 6 weeks. Patients were randomized into the classic LSO group (n=31), Cybertech group (n=26), and V-LSO group (n=31). All patients were assessed using the Oswestry Disability Index (ODI) preoperatively and underwent plain lumbar radiography (anteroposterior and lateral views) 10 days postoperatively. Lumbar lordosis (LS angle) and frontal imbalance were measured with and without LSO. At the sixth postoperative week, a follow-up assessment with the ODI and orthosis questionnaire was conducted. RESULTS: No significant differences were found among the three groups in terms of the LS angle, frontal imbalance, ODI, and orthosis questionnaire results. When the change in the LS angle and frontal imbalance toward the reference value was defined as a positive change with and without LSO, the rate of positive change was significantly different in the V-LSO group (LS angle: 41.94% vs. 61.54% vs. 83.87%; p=0.003). CONCLUSION: The newly developed LSO showed no difference regarding its effectiveness and compliance when compared with the existing LSO, but it was more effective in correcting lumbar lordosis.

Differences in Gait Patterns of Unilateral Transtibial Amputees With Two Types of Energy Storing Prosthetic Feet.

OBJECTIVE: To evaluate if there is a difference in gait pattern when applying two different shapes of energy storing prosthetic feet for trainstibial amputation we conducted a comparative study. Energy storing prosthetic feet for transtibial amputation are increasing in use, but there are few studies that evaluate the effects of the shape of energy storing feet on gait patterns. METHODS: Ten unilateral transtibial amputees were recruited. Two different shapes of dynamic response feet were applied to each subject either 1C30 Trias or 1C60 Triton. The main differences between the two are a split forefoot and the presence of a heel wedge. Spatiotemporal, kinematic, and kinetic data was obtained through gait analysis. Differences between intact and prosthetic side and differences between the two prosthetics were assessed. RESULTS: On a side to side comparison, cadence asymmetry with 1C30 Trias was observed. Ankle plantarflexion at the end of stance and ankle supination at the onset of preswing was smaller with both prosthetic feet compared to the intact side. Other spatiotemporal, kinematic, and kinetic data showed no significant differences in a side to side comparison. In a comparison between the two prosthetics, stance and swing ratio and ankle dorsiflexion through mid-stance was closer to normal with 1C60 Triton than 1C30 Trias. Other spatiotemporal, kinematic, and kinetic data showed no statistically significant differences between prosthetics. CONCLUSION: Both energy storing feet implants showed symmetric gait in unilateral transtibial amputees who are functionally independent in daily living. And 1C60 Triton showed closer to normal gait patterns than 1C30 Trias in our study.

Effects of Lumbar Strengthening Exercise in Lower-Limb Amputees With Chronic Low Back Pain.

OBJECTIVE: To analyze the effect of lumbar strengthening exercise in lower-limb amputees with chronic low back pain. METHODS: We included in this prospective study 19 lower-limb amputees who had experienced low back pain for longer than 6 months. Participants were treated with 30-minute lumbar strengthening exercises, twice weekly, for 8 weeks. We used the visual analog scale (VAS), and Oswestry low back pain disability questionnaire, and measured parameters such as iliopsoas length, abdominal muscle strength, back extensor strength, and back extensor endurance. In addition, we assessed the isometric peak torque and total work of the trunk flexors and extensors using isokinetic dynamometer. The pre- and post-exercise measurements were compared. RESULTS: Compared with the baseline, abdominal muscle strength (from 4.4±0.7 to 4.8±0.6), back extensor strength (from 2.6±0.6 to 3.5±1.2), and back extensor endurance (from 22.3±10.7 to 46.8±35.1) improved significantly after 8 weeks. The VAS decreased significantly from 4.6±2.2 to 2.6±1.6 after treatment. Furthermore, the peak torque and total work of the trunk flexors and extensors increased significantly (p<0.05). CONCLUSION: Lumbar strengthening exercise in lower-limb amputees with chronic low back pain resulted in decreased pain and increased lumbar extensor strength. The lumbar strengthening exercise program is very effective for lower-limb amputees with chronic low back pain.