Effects of Therapeutic Intervention on Spatiotemporal Gait Parameters in Adults With Neurologic Disorder: Systematic Review and Meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to review and quantify the changes in gait parameters after therapeutic intervention in adults with neurologic disorders. DATA SOURCES: A keyword search was performed in 4 databases: PubMed, CINAHL, Scopus, and Web of Science (01/2000-12/2021). We performed the search algorithm including all possible combinations of keywords. Full-text articles were examined further using forward/backward search methods. STUDY SELECTION: Studies were thoroughly screened using the following inclusion criteria: Study design: randomized controlled trial; adults ≥55 years old with a neurologic disorder; therapeutic intervention; spatiotemporal gait characteristics; and language: English. DATA EXTRACTION: A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, and spatiotemporal gait parameters such as cadence, step length, step width, or double limb support. A meta-analysis was performed among trials presenting with similar characteristics, including study population and outcome measure. If heterogeneity was >50%, a random plot analysis was used; otherwise, a fixed plot analysis was done. DATA SYNTHESIS: We included 25 out of 34 studies in our meta-analysis that examined gait in adults with neurologic disorders. All analyses used effect sizes and standard error and a P<.05(denoted by *) threshold was considered statistically significant. Overall, we found that sensory (SS) and electrical stimulation (ES) had the most significant effect on step length (SS: z=5.44*, ES: z=2.42*) and gait speed (SS: z=6.19*, ES: z=7.38*) in adults with Parkinson disease (PD). Although balance or physical activity interventions were not found to be effective in modifying step length in adults with PD, they showed a significant effect on gait speed. Further, physical activity had the most significant effect on cadence in adults with PD (z=2.84*) relative to sensory stimulation effect on cadence (z=2.59*). For stroke, conventional physical therapy had the most significant effect on step length (z=3.12*) and cadence (z=3.57*). CONCLUSION: Sensory stimulation such as auditory and somatosensory stimulation while walking had the most significant effect on step length in adults with PD. We also found that conventional physical therapy did improve spatial gait parameters relative to other physical activity interventions in adults with PD and stroke.

Dual task walking costs in older adults with mild cognitive impairment: a systematic review and meta-analysis.

OBJECTIVE: The objective of this systematic review and meta-analysis (PROSPERO registration No CRD42020192121) is to review existing literature focusing on effects of different dual task paradigms on walking speed in older adults with and without Mild Cognitive Impairment. METHODS: (1) Data Sources: PubMEd, Cumulative Index of Nursing and Allied Health, Cochrane library, and Web of Science. (2) Study Selection: The key terms searched included those associated with dual task, walking speed, executive function, older adults, and MCI. (3) Data Extraction: The search yielded 140 results with 20 studies meeting the inclusion criteria, which were rated by two independent reviewers using the Quality Assessment Tool. Descriptions of each study including the single and dual task protocol, outcome measure, and final outcomes were extracted. Meta-analysis was performed to evaluate the dual task effects on walking costs in older adults with and without MCI. RESULTS: Meta-analysis revealed that there were significant differences in the dual task walking costs among older adults with or without MCI (p < .05). Pooled effect sizes of the serial subtraction (9.54; 95%CI, 3.93-15.15) and verbal fluency tasks (10.06; 95%CI, 6.26-15.65) showed that there are higher motor dual-task costs in older adults with MCI than age-matched controls. For quality assessment, all studies ranged from 12 to 16 in score, out of 18 (high quality). CONCLUSIONS: In the studies included in this review, mental tracking tasks, consisting of serial subtraction and verbal fluency, were found to be the most sensitive in detecting MCI-related changes in older adults, and could serve an important role as a target measure for evaluating the efficacy of interventions aimed at improving cognitive and motor function in older adults.

Characterization and Control of Dynamic Rearrangement in a Self-Assembled Antibody Carrier.

Thorough characterization of protein assemblies is required for the control of structure and robust performance in any given application, especially for the safety and stability of protein therapeutics. Here, we report the use of multiple, orthogonal characterization techniques to enable control over the structure of a multivalent antibody carrier for future use in drug delivery applications. The carrier, known as Hex, contains six antibody binding domains that bind the Fc region of antibodies. Using size exclusion chromatography, analytical ultracentrifugation, and dynamic light scattering, we identified the stoichiometry of assembled Hex-antibody complexes and observed changes in the stoichiometry of nanocarriers when incubated at higher temperatures over time. The characterization data informed the modification of Hex to achieve tighter control over the protein assembly structure for future therapeutic applications. This work demonstrates the importance of using orthogonal characterization techniques and observing protein assembly in different conditions over time to fully understand and control structure and dynamics.

Effects of aerobic fitness on cognitive motor interference during self-paced treadmill walking in older adults.

BACKGROUND: Older adults experience greater cognitive motor interference (CMI) due to declines in cognitive and physical function. Although aerobic fitness has beneficial effects on cognition, its association with CMI is not clear. AIMS: This study aims to investigate the effects of aerobic fitness on CMI during self-paced treadmill walking in older adults. METHODS: Thirty participants (67.6 ± 10.34 years, 21 females) were included in a 2-day cross-sectional design study. Aerobic fitness was assessed with the Rockport 1-mile test. The dual-task paradigm consisted of walking only, and dual-task standing and dual-task walking (i.e., standing/walking while performing the Modified Stroop color word test) on a treadmill. To assess CMI, gait speed and accuracy rate were measured to later calculate the dual-task cost for each parameter. RESULTS: Individuals with low aerobic fitness exhibited significantly greater gait speed dual-task cost than individuals with high aerobic fitness (p < 0.05). There were no significant findings for accuracy rate dual-task cost. DISCUSSION: These study findings are the first to demonstrate increases in CMI in relation to low aerobic fitness. Results can be attributed to the relationship between aerobic fitness and cognition as well as theories related to attentional capacity. CONCLUSION: Older adults with low aerobic fitness possess greater CMI when compared to older adults with high aerobic fitness. This provides a foundation of knowledge on how aerobic fitness in older adults may affect CMI which can lead researchers to examine the causal relationships between an aerobic exercise intervention program and CMI in older adults.

Frontal brain activation changes due to dual-tasking under partial body weight support conditions in older adults with multiple sclerosis.

BACKGROUND: Gait impairments present while dual-tasking in older adults with multiple sclerosis (MS) have been associated with an increased risk of falls. Prior studies have examined prefrontal cortex (PFC) activity using functional near infrared spectroscopy (fNIRS) while dual-tasking in older adults with and without cognitive impairment. While the benefits of partial body weight support (PBWS) on gait have been clearly outlined in the literature, the potential use of PBWS to improve the ability to dual task in older adults with and without MS has not been examined. The aim of this study was to examine the effects of PBWS on the PFC activation while dual-tasking in older adults with and without MS. METHODS: Ten individuals with MS (mean 56.2 ± 5.1 yrs., 8 females) and 12 healthy older adults (HOA) (mean 63.1 ± 4.4 yrs., 9 females) participated in this study. PFC activation (i.e., oxygenated hemoglobin-HbO2) was measured using fNIRS. Assessments were done under two treadmill walking conditions: no body weight support (NBWS) and PBWS. Under each condition, participants were asked to walk at a comfortable speed (W) or walk and talk (WT). Linear mixed models were used to test for differences between cohorts, conditions, and tasks. RESULTS: HbO2 levels differed significantly between task (p < .001), cohort (p < .001), and BWS (p = .02). HbO2 levels increased under higher cognitive demands (i.e., W vs WT), in individuals with MS, and under different conditions (i.e., NBWS vs PBWS). Post-hoc analysis demonstrated a significant difference between cohorts during the WT and NBWS condition (p = .05). When examining the relative change in HbO2 levels during each task, a significant interaction between task, BWS, and cohort across time was observed (p < 0.01). While HOA increased PFC activation across time, MS exhibited a maintenance of PFC activation patterns during the WT under PBWS condition. CONCLUSIONS: This study establishes the potential impact of PBWS on PFC activation patterns under dual-tasking conditions and sheds light on the ability for PBWS to be used as a therapeutic tool in individuals with neurological conditions to decrease cognitive demands while dual-tasking and thus decrease the risk of falls.

Preliminary Evidence For The Effects Of Aging And Multiple Sclerosis On Cognitive Performance: An Analysis Based On Effect Size Estimates.

Background/Study Context: Although cognitive impairment is common in persons with multiple sclerosis (MS), there are limited data on older adults with MS. The current pilot study involved a preliminary examination of cognitive impairments across a comprehensive neuropsychological assessment in older adults with MS compared with older adults without MS. METHODS: Twenty older adults with MS and 20 older adults without MS (≥60 years of age) underwent cognitive assessments, including the Trail Making Test (TMT) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The primary analytical model involved independent-samples t tests on the TMT and RBANS scores. The analysis focused on ½ SD (i.e., Cohen's d of 0.5) for judging the differences as meaningful. RESULTS: Overall, the study hypotheses were supported such that older adults with MS demonstrated decreased cognitive performance that exceeded ½ SD compared with the older adults without MS. CONCLUSION: This preliminary study demonstrated moderate and meaningful differences in cognitive performance in older adults with MS compared with older adults without MS. This suggests a clear need for identifying strategies for alleviating cognitive impairment in older adults with MS.

Delay differential analysis of electroencephalographic data.

We propose a time-domain approach to detect frequencies, frequency couplings, and phases using nonlinear correlation functions. For frequency analysis, this approach is a multivariate extension of discrete Fourier transform, and for higher-order spectra, it is a linear and multivariate alternative to multidimensional fast Fourier transform of multidimensional correlations. This method can be applied to short and sparse time series and can be extended to cross-trial and cross-channel spectra (CTS) for electroencephalography data where multiple short data segments from multiple trials of the same experiment are available. There are two versions of CTS. The first one assumes some phase coherency across the trials, while the second one is independent of phase coherency. We demonstrate that the phase-dependent version is more consistent with event-related spectral perturbation analysis and traditional Morlet wavelet analysis. We show that CTS can be applied to short data windows and yields higher temporal resolution than traditional Morlet wavelet analysis. Furthermore, the CTS can be used to reconstruct the event-related potential using all linear components of the CTS.

Relationship between epicardial adipose tissue, coronary artery disease and adiponectin in a Mexican population.

BACKGROUND: The amount of epicardial adipose tissue (EAT) around the heart has been identified as an independent predictor of coronary artery disease (CAD), potentially through local release of inflammatory cytokines. Ethnic differences have been observed, but no studies have investigated this relationship in the Mexican population. The objective of the present study was to evaluate whether a relationship exist between EAT thickness assessed via echocardiography with CAD and adiponectin levels in a Mexican population. METHODS: We studied 153 consecutive patients who underwent coronary angiography and transthoracic echocardiography (TTE). EAT thickness on the free wall of the right ventricle was measured at the end of systole from parasternal long and short axis views of three consecutive cardiac cycles. Coronary angiograms were analyzed for the presence, extent and severity of CAD. Serum adiponectin, lipids, glucose, C-reactive protein and fibrinogen were determined. RESULTS: EAT thickness was greater in patients with CAD than in those without CAD from both parasternal long (5.39 ± 1.75 mm vs 4.00 ± 1.67 mm p<0.0001) and short-axis views (5.23 ± 1.67 vs 4.12 ± 1.77, p=0.001). EAT thickness measured from parasternal long and short-axis showed a statistically significant positive correlation with age (r=0.354, p<0.001; r=0.286, p<0.001 respectively), and waist circumference (r=0.189, p=0.019; r=0.217, p=0.007 respectively). A significant negative correlation between EAT thickness from the parasternal long axis with cholesterol-HDL was observed (r=-0.163, p=0.045). No significant correlation was found between epicardial fat thickness and serum adiponectin or with the severity of CAD. CONCLUSIONS: EAT thickness was greater in patients with CAD. However, no correlation was observed with the severity of the disease or with serum adiponectin levels. EAT thickness measured by echocardiography might provide additional information for risk assessment and prediction of CAD.

Initial validation of the university of Alabama Birmingham study of aging life-space assessment in older adults with multiple sclerosis.

BACKGROUND: Older adults with multiple sclerosis (OAMS) have declines in walking and physical performance that may erode community mobility defined as the spatial extent of mobility in one's daily life and environment. OBJECTIVE: This study provided the first application and validation of the University of Alabama Birmingham Study of Aging Life-Space Assessment (UAB LSA) as a measure of community mobility in OAMS. METHODS: The sample included 97 OAMS and 108 healthy controls (HCs) who completed baseline assessments as part of an ongoing, longitudinal study. The primary assessments included the UAB LSA and timed 25-foot walk (T25FW), short physical performance battery (SPPB), global health score (GHS), and geriatric depression scale (GDS) in both OAMS and HCs, and patient determined disease steps (PDDS) scale in only OAMS. RESULTS: OAMS had significantly lower UAB LSA scores than HCs (p < .001). UAB LSA scores had strong correlations with T25FW(rs = -.641) and SPPB(rs = 0.507) in OAMS, and moderate correlations in HCs (rs = -.300 & rs = 0.384). The correlations between UAB LSA and GHS and GDS scores were significant, but small in OAMS (rs = -.239 & rs = -.231), and not statistically significant in HCs (rs = -.009 & rs = -.166). There was a strong correlation between UAB LSA and PDDS scores in the OAMS sample (rs = -.605). CONCLUSION: We provided initial evidence for UAB LSA scores as a measure of community mobility in OAMS.

Life space assessment and falls in older adults with multiple sclerosis.

BACKGROUND/OBJECTIVE: Falls research in older adults with MS (OAMS) is scarce, and no studies have reported on the association between life-space mobility and falls in this group. Herein, we hypothesized that higher baseline life-space scores would be associated with reduced odds of reporting falls during follow-up, and explored whether the association differed by MS subtype (progressive vs. relapsing-remitting). METHODS: OAMS (n = 91, mean age = 64.7 ± 4.3ys, %female = 66.9,%progressive MS = 30.7) completed the University of Alabama at Birmingham Life-Space-Assessment (UAB-LSA) scale and reported falls during a structured monthly telephone interview during follow-up (mean = 16.39 ± 11.44 months). General Estimated Equations (GEE) models were utilized to determine whether UAB-LSA scores predicted falls during follow-up. RESULTS: GEE models revealed that higher UAB-LSA scores were associated with a significant reduction in the odds of falling during follow-up (OR = 0.69, p = 0.012, 95 %CI = 0.51 to 0.92). Stratified analyses revealed that this association was significant in progressive (OR = 0.57, p = 0.004, 95 %CI = 0.39 to 0.84), but not relapsing-remitting (OR = 0.93, p = 0.779, 95 %CI = 0.57 to 1.53) MS. CONCLUSION: Higher life-space mobility was associated with lower odds of falling among OAMS with progressive subtype. The UAB-LSA may complement existing mobility measures for predicting fall risk.

Brain control of dual-task walking can be improved in aging and neurological disease.

The peak prevalence of multiple sclerosis has shifted into older age groups, but co-occurring and possibly synergistic motoric and cognitive declines in this patient population are poorly understood. Dual-task-walking performance, subserved by the prefrontal cortex, and compromised in multiple sclerosis and aging, predicts health outcomes. Whether acute practice can improve dual-task walking performance and prefrontal cortex hemodynamic response efficiency in multiple sclerosis has not been reported. To address this gap in the literature, the current study examined task- and practice-related effects on dual-task-walking and associated brain activation in older adults with multiple sclerosis and controls. Multiple sclerosis (n = 94, mean age = 64.76 ± 4.19 years) and control (n = 104, mean age = 68.18 ± 7.01 years) participants were tested under three experimental conditions (dual-task-walk, single-task-walk, and single-task-alpha) administered over three repeated counterbalanced trials. Functional near-infrared-spectroscopy was used to evaluate task- and practice-related changes in prefrontal cortex oxygenated hemoglobin. Gait and cognitive performances declined, and prefrontal cortex oxygenated hemoglobin was higher in dual compared to both single task conditions in both groups. Gait and cognitive performances improved over trials in both groups. There were greater declines over trials in oxygenated hemoglobin in dual-task-walk compared to single-task-walk in both groups. Among controls, but not multiple sclerosis participants, declines over trials in oxygenated hemoglobin were greater in dual-task-walk compared to single-task-alpha. Dual-task walking and associated prefrontal cortex activation efficiency improved during a single session, but improvement in neural resource utilization, although significant, was attenuated in multiple sclerosis participants. These findings suggest encouraging brain adaptability in aging and neurological disease.

Application of near-infrared spectroscopy to assess the effect of the cupping size on the spatial hemodynamic response from the area inside and outside the cup of the biceps.

Cupping therapy is a popular intervention for improving muscle recovery after exercise although clinical evidence is weak. Previous studies demonstrated that cupping therapy may improve microcirculation of the soft tissue to accelerate tissue healing. However, it is unclear whether the cupping size could affect the spatial hemodynamic response of the treated muscle. The objective of this study was to use 8-channel near-infrared spectroscopy to assess this clinical question by assessing the effect of 3 cupping sizes (35, 40, and 45 mm in inner diameter of the circular cup) under -300 mmHg for 5 min on the muscle hemodynamic response from the area inside and outside the cup, including oxyhemoglobin and deoxy-hemoglobin in 18 healthy adults. Two-way factorial design was used to assess the interaction between the cupping size (35, 40, and 45 mm) and the location (inside and outside the cup) and the main effects of the cupping size and the location. The two-way repeated measures ANOVA demonstrated an interaction between the cupping size and the location in deoxy-hemoglobin (P = 0.039) but no interaction in oxyhemoglobin (P = 0.100), and a main effect of the cup size (P = 0.001) and location (P = 0.023) factors in oxyhemoglobin. For the cupping size factor, the 45-mm cup resulted in a significant increase in oxyhemoglobin (5.738±0.760 µM) compared to the 40-mm (2.095±0.312 µM, P<0.001) and 35-mm (3.134±0.515 µM, P<0.01) cup. Our findings demonstrate that the cupping size and location factors affect the muscle hemodynamic response, and the use of multi-channel near-infrared spectroscopy may help understand benefits of cupping therapy on managing musculoskeletal impairment.

Classification of fall risk across the lifespan using gait derived features from a wearable device.

Falls are one of the leading factors of injury and fatality in older adults. Given the importance of early detection of adults at higher risk of falls, we evaluated the ability of machine learning to classify fall risk in adults across the lifespan using wearable sensors embedded in a smartshirt. We evaluated the classification performance of binary and multiclass fall risk classifier models using SciKit Digital Health in adults across the lifespan. Using a k-fold and group k-fold cross-validation strategy, we demonstrate the feasibility of fall risk classification using accelerometer data from 10 second epochs of treadmill walking data from adults across the lifespan. We achieved an 88% accuracy in a binary clasifier of fallers vs. non-fallers, and an 86% accuracy in a multiclass classifier comparing non-fallers, fallers, and recurrent fallers using retrospective fall histories. Comparing group k-fold vs. k-fold cross-validation strategies, we find a 22-27% drop-off in accuracy performance. Furthering the evaluation framework presented in this study would be valuable to the development of more robust and clinically relevant models used in the prediction of fall risk. These models could one day be applied in clinical settings to help better diagnose and monitor fall risk among older adults, improving the care of at-risk individuals and reducing the injury and associated cost of falls.

Beta cortical oscillatory activities and their relationship to postural control in a standing balance demanding test: influence of aging.

Background: Age-related changes in the cortical control of standing balance may provide a modifiable mechanism underlying falls in older adults. Thus, this study examined the cortical response to sensory and mechanical perturbations in older adults while standing and examined the relationship between cortical activation and postural control. Methods: A cohort of community dwelling young (18-30 years, N = 10) and older adults (65-85 years, N = 11) performed the sensory organization test (SOT), motor control test (MCT), and adaptation test (ADT) while high-density electroencephalography (EEG) and center of pressure (COP) data were recorded in this cross-sectional study. Linear mixed models examined cohort differences for cortical activities, using relative beta power, and postural control performance, while Spearman correlations were used to investigate the relationship between relative beta power and COP indices in each test. Results: Under sensory manipulation, older adults demonstrated significantly higher relative beta power at all postural control-related cortical areas (p < 0.01), while under rapid mechanical perturbations, older adults demonstrated significantly higher relative beta power at central areas (p < 0.05). As task difficulty increased, young adults had increased relative beta band power while older adults demonstrated decreased relative beta power (p < 0.01). During sensory manipulation with mild mechanical perturbations, specifically in eyes open conditions, higher relative beta power at the parietal area in young adults was associated with worse postural control performance (p < 0.001). Under rapid mechanical perturbations, specifically in novel conditions, higher relative beta power at the central area in older adults was associated with longer movement latency (p < 0.05). However, poor reliability measures of cortical activity assessments were found during MCT and ADT, which limits the ability to interpret the reported results. Discussion: Cortical areas are increasingly recruited to maintain upright postural control, even though cortical resources may be limited, in older adults. Considering the limitation regarding mechanical perturbation reliability, future studies should include a larger number of repeated mechanical perturbation trials.

A Vision-Based Framework for Predicting Multiple Sclerosis and Parkinson's Disease Gait Dysfunctions-A Deep Learning Approach.

This study examined the effectiveness of a vision-based framework for multiple sclerosis (MS) and Parkinson's disease (PD) gait dysfunction prediction. We collected gait video data from multi-view digital cameras during self-paced walking from MS, PD patients and age, weight, height and gender-matched healthy older adults (HOA). We then extracted characteristic 3D joint keypoints from the collected videos. In this work, we proposed a data-driven methodology to classify strides in persons with MS (PwMS), persons with PD (PwPD) and HOA that may generalize across different walking tasks and subjects. We presented a comprehensive quantitative comparison of 16 diverse traditional machine and deep learning (DL) algorithms. When generalizing from comfortable walking (W) to walking-while-talking (WT), multi-scale residual neural network achieved perfect accuracy and AUC for classifying individuals with a given gait disorder; for subject generalization in W trials, residual neural network resulted in the highest accuracy and AUC of 78.1% and 0.87 (resp.), and 1D convolutional neural network (CNN) had highest accuracy of 75% in WT trials. Finally, when generalizing over new subjects in different tasks, again 1D CNN had the top classification accuracy and AUC of 79.3% and 0.93 (resp.). This work is the first attempt to apply and demonstrate the potential of DL with a multi-view digital camera-based gait analysis framework for neurological gait dysfunction prediction. This study suggests the viability of inexpensive vision-based systems for diagnosing certain neurological disorders.

Deep Learning for Multiple Sclerosis Differentiation Using Multi-Stride Dynamics in Gait.

OBJECTIVE: Multiple sclerosis (MS) is a chronic neurological condition of the central nervous system leading to various physical, mental and psychiatric complexities. Mobility limitations are amongst the most frequent and early markers of MS. We evaluated the effectiveness of a DeepMS2G (deep learning (DL) for MS differentiation using multistride dynamics in gait) framework, which is a DL-based methodology to classify multi-stride sequences of persons with MS (PwMS) from healthy controls (HC), in order to generalize over newer walking tasks and subjects. METHODS: We collected single-task Walking and dual-task Walking-while-Talking gait data using an instrumented treadmill from a balanced collection of 20 HC and 20 PwMS. We utilized domain knowledge-based spatiotemporal and kinetic gait features along with two normalization schemes, namely standard size-based and multiple regression normalization strategies. To differentiate between multi-stride sequences of HC and PwMS, we compared 16 traditional machine learning and DL algorithms. Further, we studied the interpretability of our highest-performing models; and discussed the association between the lower extremity function of participants and our model predictions. RESULTS: We observed that residual neural network (ResNet) based models with regression-based normalization were the top performers across both task and subject generalization classification designs. Considering regression-based normalization, a multi-scale ResNet attained a subject classification accuracy and F 1-score of 1.0 when generalizing from single-task Walking to dual-task Walking-while-Talking; and a ResNet resulted in the top subject-wise accuracy and F 1 of 0.83 and 0.81 (resp.), when generalizing over unseen participants. CONCLUSION: We used advanced DL and dynamics across domain knowledge-based spatiotemporal and kinetic gait parameters to successfully classify MS gait across distinct walking trials and unseen participants. SIGNIFICANCE: Our proposed DL algorithms might contribute to efforts to automate MS diagnoses.

A Deep Learning Approach for Grading of Motor Impairment Severity in Parkinson's Disease.

Objective and quantitative monitoring of movement impairments is crucial for detecting progression in neurological conditions such as Parkinson's disease (PD). This study examined the ability of deep learning approaches to grade motor impairment severity in a modified version of the Movement Disorders Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) using low-cost wearable sensors. A convolutional neural network architecture, XceptionTime, was used to classify lower and higher levels of motor impairment in persons with PD, across five distinct rhythmic tasks: finger tapping, hand movements, pronation-supination movements of the hands, toe tapping, and leg agility. In addition, an aggregate model was trained on data from all tasks together for evaluating bradykinesia symptom severity in PD. The model performance was highest in the hand movement tasks with an accuracy of 82.6% in the hold-out test dataset; the accuracy for the aggregate model was 79.7%, however, it demonstrated the lowest variability. Overall, these findings suggest the feasibility of integrating low-cost wearable technology and deep learning approaches to automatically and objectively quantify motor impairment in persons with PD. This approach may provide a viable solution for a widely deployable telemedicine solution.

Differential Associations of Mobility With Fronto-Striatal Integrity and Lesion Load in Older Adults With and Without Multiple Sclerosis.

BACKGROUND: Mobility impairment is common in older persons with multiple sclerosis (MS), and further compounded by general age-related mobility decline but its underlying brain substrates are poorly understood. OBJECTIVE: Examine fronto-striatal white matter (WM) integrity and lesion load as imaging correlates of mobility outcomes in older persons with and without MS. METHODS: Fifty-one older MS patients (age 64.9 ± 3.7 years, 29 women) and 50 healthy, matched controls (66.2 ± 3.2 years, 24 women), participated in the study, which included physical and cognitive test batteries and 3T MRI imaging session. Primary imaging measures were fractional anisotropy (FA) and WM lesion load. The relationship between mobility impairment, defined using a validated short physical performance battery cutoff score, and neuroimaging measures was assessed with stratified logistic regression models. FA was extracted from six fronto-striatal circuits (left/right): dorsal striatum (dStr)-to-anterior dorsolateral prefrontal cortex (aDLPFC), dStr-to-posterior DLPFC, and ventral striatum (vStr)-to-ventromedial prefrontal cortex (VMPFC). RESULTS: Mobility impairment was significantly associated with lower FA in two circuits, left dStr-aDLPFC (P = .003) and left vStr-VMPFC (P = .004), in healthy controls but not in MS patients (P > .20), for fully adjusted regression models. Conversely, in MS patients but not in healthy controls, mobility impairment was significantly associated with greater lesion volume (P < .02). CONCLUSIONS: Comparing older persons with and without MS, we provide compelling evidence of a double dissociation between the presence of mobility impairment and two neuroimaging markers of white matter integrity, fronto-striatal fractional anisotropy, and whole brain lesion load.

Using cross-correlation analysis of multi-channel near infrared spectroscopy to assess the hemodynamic response to cupping therapy.

Cupping therapy is a common intervention for the management of musculoskeletal impairment. Previous studies have demonstrated that cupping therapy can improve muscle hemodynamic responses using single-channel near-infrared spectroscopy (NIRS). However, the effects of cupping therapy on spatial hemodynamic responses as well as the correlation between oxyhemoglobin and deoxy-hemoglobin are largely unknown. The cross-correlation function (CCF) algorithm was used to determine the correlation between time-series NIRS signals from inside and outside the cup as well as time-series oxyhemoglobin and deoxy-hemoglobin under 4 cupping intensities, including -225 and -300 mmHg for 5 and 10 min. The main finding was that the maximum CCF values of oxyhemoglobin was significantly higher than those in deoxy-hemoglobin (p < 0.05). Furthermore, it was found that there was a correlation between deoxy-hemoglobin with a longer duration and a larger magnitude of negative pressure. This is the first study investigating time-series hemodynamic responses after cupping therapy using cross-correlation function analysis of multi-channel NIRS signals.

Using near-infrared spectroscopy to investigate the effects of pressures and durations of cupping therapy on muscle blood volume and oxygenation.

Cupping therapy has been widely used to manage musculoskeletal impairment. However, the effects of pressure and duration of cupping therapy on the hemodynamic activity of the muscle have not been investigated. A 2 × 2 repeated measures factorial design was used to examine the main effect and interaction of pressure (-225 and -300 mmHg) and duration (5 and 10 min) on biceps muscle blood flow using near-infrared spectroscopy in 18 participants. The results showed that a significant interaction is between pressure and duration on deoxy-hemoglobin (p = 0.045). A significant main effect of pressure is on oxyhemoglobin (p = 0.005) and a significant main effect of duration is on oxyhemoglobin (p = 0.005). Cupping therapy at -300 mmHg for 10 min results in a higher oxyhemoglobin (6.75 ± 2.08 µM) and deoxy-hemoglobin (1.71 ± 0.78 µM) compared to other three combinations. Our study provides first evidence that the pressure and duration factors of cupping therapy can significantly affect muscle blood volume and oxygenation.