Detection of Fall Risk in Multiple Sclerosis by Gait Analysis-An Innovative Approach Using Feature Selection Ensemble and Machine Learning Algorithms.

One of the common causes of falls in people with Multiple Sclerosis (pwMS) is walking impairment. Therefore, assessment of gait is of importance in MS. Gait analysis and fall detection can take place in the clinical context using a wide variety of available methods. However, combining these methods while using machine learning algorithms for detecting falls has not been performed. Our objective was to determine the most relevant method for determining fall risk by analyzing eleven different gait data sets with machine learning algorithms. In addition, we examined the most important features of fall detection. A new feature selection ensemble (FS-Ensemble) and four classification models (Gaussian Naive Bayes, Decision Tree, k-Nearest Neighbor, Support Vector Machine) were used. The FS-Ensemble consisted of four filter methods: Chi-square test, information gain, Minimum Redundancy Maximum Relevance and RelieF. Various thresholds (50%, 25% and 10%) and combination methods (Union, Union 2, Union 3 and Intersection) were examined. Patient-reported outcomes using specialized walking questionnaires such as the 12-item Multiple Sclerosis Walking Scale (MSWS-12) and the Early Mobility Impairment Questionnaire (EMIQ) achieved the best performances with an F1 score of 0.54 for detecting falls. A combination of selected features of MSWS-12 and EMIQ, including the estimation of walking, running and stair climbing ability, the subjective effort as well as necessary concentration and walking fluency during walking, the frequency of stumbling and the indication of avoidance of social activity achieved the best recall of 75%. The Gaussian Naive Bayes was the best classification model for detecting falls with almost all data sets. FS-Ensemble improved the classification models and is an appropriate technique for reducing data sets with a large number of features. Future research on other risk factors, such as fear of falling, could provide further insights.

Effect of Thoracic Kyphosis and Lumbar Lordosis on the Distribution of Ground Reaction Forces on the Feet.

Introduction: In clinical practice, foot load receptors are very important in shaping the correct vertical posture and optimal equilibrium reactions. They are so important that stimulating them gives measurable effects in improving both balance and posture. Plantar pressure distribution is an important parameter that provides information on changes in a person's posture, also during gait. Aim: The aim of the work is to assess the effect of thoracic kyphosis and lumbar lordosis on the distribution of ground reaction forces on the feet. Materials and Methods: A total of 211 subjects aged 8-12 were examined. Body posture and distribution of ground reaction forces on the feet were assessed using the following parameters: thoracic kyphosis angle, lumbar lordosis angle, maximum pressure (static), average pressure (static), foot surface, distribution of foot pressure, maximum pressure (dynamic), time load (dynamic). DIERS formetric and DIERS pedoscan methods were used to measure the parameters. Results: The level of the kyphosis angle correlated positively with the percentage distribution of forefoot load in static conditions. The level of lordosis angle correlated positively with the foot surface and forefoot load. Positive correlation of the lordosis angle is also related to its connection with the difference in leg load during gait. A broader cause and effect view of body posture defects and the distribution of ground reaction forces on the feet can affect a more complete assessment of the correlation between these variables, contributing to more effective treatment of any disorders of the described phenomena. Conclusion: The size of thoracic kyphosis and lumbar lordosis affects the distribution of ground reaction forces on the feet. The effect of lumbar lordosis has a linear value in relation to percentage distribution of forefoot and heel loads.

The Relationship Between the Shape of the Spine and the Width of Linea Alba in Children Aged 6-9 Years. Case-Control Study.

Introduction: Civilization development coupled with contemporary lifestyle leads to a systematic increase in postural disorders. An analysis of factors that may provoke postural disorders indicates that such a stimulus may be the diastasis of the rectus abdominis muscles. Moreover, abnormal activity of the rectus abdominis muscles may affect balance disorders through reduced spinal stabilization and disturbed body statics. There is an increase in body posture abnormalities between the ages of 6 and 9 related to new school duties. Purpose of the Study: The purpose of the study was to evaluate the relationship between the shape of the spine and the width of the linea alba in children aged 6-9 years. Material and Method: The study was designed to evaluate parameters determining the shape of the spine, and the width of the linea alba in healthy children aged 6-9 years. The study participants were divided into two groups based on the width of the linea alba. The study group with the width of the linea alba >10 mm and the control group with the width of the linea alba ≤ 10 mm. The study group were included 37 children and the control group 24 children. The examination of the linea alba width was performed by a radiology specialist using a linear transducer and SAOTE- My Lab Classc-type ultrasound at rest and during contraction of the rectus abdominis muscles. Parameters describing the shape of the spine were measured using the Diers Formetric 4D system: trunk inclination, trunk imbalance, pelvis tilt, pelvic torsion, kyphotic apex, lordotic apex, kyphotic angle, lordotic angle, rotation angle, trunk torsion, lateral deviation. The obtained results were statistically analyzed using a Paired t test for comparison of differences between the results in the study and control groups and Pearson's test to assess the correlation between the width of the linea alba and parameters describing spinal alignment. Results: In both groups, the parameters describing the shape of the spine did not differ from the norms accepted as typical for the age norm. The only statistically significant difference between the study and control group concerned the trunk inclination, which was negative in the study group, signifying a shift of the entire spine axis backwards beyond the vertical. Conclusions: There is a correlation between the shape of spine and the width of the linea alba in terms of selected parameters determining the body posture in the sagittal plane, which concern: the position of the lumbar lordotic apex, trunk inclination and the depth of the lumbar lordotic angle. The width of the linea alba is not explicitly related to abnormalities of pelvic and spinal alignment in the frontal and transverse planes.

Assessment of Body Posture of Children With Chest Pain.

Objective: An increase in the appearance of chest pain among children is observed globally. The authors present various reasons for their appearance. As can be seen from numerous observations, the majority of cases are not related to the pathology of the circulatory system. Increasingly, studies on the causes of chest pain in children show their association with musculoskeletal disorders. Aim: of the work was assessment of body posture in children with chest pain using the Diers Formetric 4D system. Methods: The study involved a group of 184 female and male children, aged 7-12 years. The study group consisted of 64 patients with chest pain. The children from this group were diagnosed with functional chest pain by a cardiologist. The control group consisted of 120 patients without chest pain. The study included the assessment of body posture using the DIERS Formetric system. Results: The analysis of the results obtained during the study showed that among the children with chest pain, there are statistically significant irregularities in the parameters determining body posture compared to the control group. Comparing the study group with the control group, there is a statistically significant difference in the lateral deviation of VPDM (rms) (mm) (p = 0.001). Both children from the test group aged 9-10 and 11-12 obtained higher results than their peers from the control group. In the group of the youngest children in terms of the lateral deviation of VPDM (rms) (mm), increasing the number of children under study would contribute to significant differences in this variable. In the study group, among children aged 9-10 years, there were also statistically significant abnormalities regarding trunk imbalance and pelvic skewness compared to the children of the same age in the control group. Conclusions: Irregularities in the parameters determining body posture may cause chest pain in children.

Using Machine Learning Algorithms for Identifying Gait Parameters Suitable to Evaluate Subtle Changes in Gait in People with Multiple Sclerosis.

In multiple sclerosis (MS), gait impairment is one of the most prominent symptoms. For a sensitive assessment of pathological gait patterns, a comprehensive analysis and processing of several gait analysis systems is necessary. The objective of this work was to determine the best diagnostic gait system (DIERS pedogait, GAITRite system, and Mobility Lab) using six machine learning algorithms for the differentiation between people with multiple sclerosis (pwMS) and healthy controls, between pwMS with and without fatigue and between pwMS with mild and moderate impairment. The data of the three gait systems were assessed on 54 pwMS and 38 healthy controls. Gaussian Naive Bayes, Decision Tree, k-Nearest Neighbor, and Support Vector Machines (SVM) with linear, radial basis function (rbf) and polynomial kernel were applied for the detection of subtle walking changes. The best performance for a healthy-sick classification was achieved on the DIERS data with a SVM rbf kernel (κ = 0.49 ± 0.11). For differentiating between pwMS with mild and moderate disability, the GAITRite data with the SVM linear kernel (κ = 0.61 ± 0.06) showed the best performance. This study demonstrates that machine learning methods are suitable for identifying pathologic gait patterns in early MS.

Effectiveness of physiotherapy interventions for injury in ballet dancers: A systematic review.

BACKGROUND: The unique repetitive nature of ballet dancing, which often involves transgressing endurance limits of anatomical structures, makes dancers prone to injury. The following systematic review aims to assess the effectiveness of physiotherapy interventions in the treatment of injuries in ballet dancers. METHODS: The review was performed in line with the PRISMA statement on preferred reporting items for systematic reviews and meta-analyses. Six electronic databases (PubMed, Ovid Embase, Cochrane, Medline, PEDro, Google Scholar) were queried. The study populations comprised active ballet dancers and/or ballet school attendees with acute and chronic injuries and those with persistent pain. There were no restrictions regarding age, sex, ethnicity or nationality. The Modified McMaster Critical Review Form for quantitative studies was used to assess the methodological quality of the studies reviewed in accordance with the relevant guidelines. RESULTS: Out of the total of 687 articles subjected to the review, 10 met the inclusion criteria. Diverse physiotherapeutic interventions were described and effectiveness was assessed using different parameters and measurements. Overall, the results indicate that physiotherapy interventions in ballet dancers exert a positive effect on a number of indices, including pain, ROM and functional status. CONCLUSIONS: Due to the small amount of evidence confirming the effectiveness of physiotherapeutic interventions in ballet dancers after injuries and methodological uncertainties, it is recommended to improve the quality of prospective studies.

Diet Quality Compared to the Nutritional Knowledge of Polish, German, and Slovakian University Students-Preliminary Research.

The eating habits of students differ significantly from those recommended by health practitioners. The aim of this study was to find differences related to diet quality and knowledge on nutrition among Polish, German, and Slovakian students as well as to examine which factors differentiate the diet quality of students from these three countries. The study was conducted on a group of 394 university students from Poland, Germany, and Slovakia. The assessment of diet quality and knowledge on food and nutrition was done with the use of the Dietary Habits and Nutrition Beliefs Questionnaire. The diet of German students was characterized by a significantly higher consumption of legume-based foods, vegetables, and fruit compared to Polish students and Slovakian participants (p < 0.001). The diet of the Poles was characterized by a high consumption of cured meat, smoked sausages, hot dogs, white bread and bakery products, butter, fried foods, and energy drinks. The most important factors significantly associated with diet quality involved the country, place of residence, Body Mass Index (BMI), physical activity, and time spent watching TV or using a computer. Polish students were characterized by the highest level of knowledge on food and nutrition (p < 0.001). However, it was not reflected in their diet. The authorities of universities should aim to provide students with access to canteens on campuses which would offer the possibility of consumption of both affordable and healthy meals.

Evaluation of the association between postural control and sagittal curvature of the spine.

INTRODUCTION: Balance is key to controlling body posture. Balance is typically assessed by measures of the body's vertical orientation, obtained by balancing out the forces acting on different body segments. The ability to maintain balance is assessed by evaluating centre of pressure (CoP) displacement; such assessments are typically used to evaluate responses to a treatment process. PURPOSE OF STUDY: This study evaluated the efficiency of compensatory reactions in children according to the extent of thoracic kyphosis and lumbar lordosis. MATERIALS AND METHOD: The study enrolled 312 children aged 8‒12 years, including 211 patients with postural disorders: thoracic kyphosis outside the 47‒50-degree range and lordosis outside the 38‒42-degree range (study group). A control group was also recruited and comprised 101 children without postural disorders. The DIERS formetric 4D system was used to assess posture and CoP displacement. RESULTS: Children in the study group showed a significantly greater range of CoP displacement than children in the control group. The kyphosis angle correlated with the maximum CoP displacement in the coronal plane and the maximum CoP displacement in the sagittal plane during gait. The kyphosis angle also correlated with the maximum CoP displacement back in the static test. The size of the lordosis angle correlated with the maximum displacement of CoP in the coronary plane during gait, and with the maximum displacement of CoP toward the left, forward, and backward in the static test. The correlation coefficient of the lordosis angle with displacement of the CoP in the sagittal plane was 0.999. CONCLUSIONS: We found an association between kyphosis and lordosis and the amplitude of CoP displacement, which may reflect the postural control system's response to biomechanical destabilisation caused by changes in kyphosis and lordosis.The lordosis angle correlation strength for displacement of CoP in sagittal plane is 0.999 and adopts a linear value.

The FED-Method (Fixation, Elongation, Derotation) - a Machine-supported Treatment Approach to Patients with Idiopathic Scoliosis - Systematic Review. / Die FED-Methode (Fixation, Elongation, Derotation) ­ ein gerätegestütztes Behandlungsverfahren zur Behandlung von Patienten mit idiopathischer Skoliose ­ systematisches Review.

BACKGROUND: The FED method (Fixation, Elongation, Derotation) is a treatment method approach to Patients with scoliosis. The FED method is especially established in Spain and Poland, whereby in Germany it is less well-known. Nevertheless the FED method is within the scope of a research project (Project Number: 19200 BR/3). The purpose of the paper is to characterize the FED method and to highlight the specificities in contrast to the Schroth method, which is international established and especially in Germany. METHODS: This systematic literature research was conducted in Nov 2017-Jan 2018. Therefore common medical and physiotherapeutic databases were used. Furthermore there was a hand search in selected scientific journals. Only a small number of relevant references were identified. That is why the respective authors were asked to provide the full-texts of their papers and to recommend further references. RESULTS: A total of 378 references were identified. After removing duplicates and the content-related selection, 19 references were deemed to be relevant. Based on the analysis of this relevant literature, the FED method was comprehensively characterized. First of all the general structure of the FED method and the scientific evidence for its effectiveness was described. And as a result of the literature research, the operating principles of the FED method were pointed out. Then these operating principles were discussed in comparison with the Schroth method. The Schroth method based on sensomotoric and kinesthetic principles and the correction of the pathologic posture was performed by selective muscle activation and breathing-pattern. Thus, the posture correction will be performed by the patients (auto correction). Compared to the Schroth method, the FED method implements the posture correction by the FED-device. This correction is influenced by mechanical forces with a comparatively high strength and intensity. The repetitive mechanical correction stimulates the sensomotoric system. And due to trophic/biochemical adaptations, the physiological bone growth will be stimulated. CONCLUSION: In total the authors want to clarify, that both treatment methods (Schroth method, FED method) supposed to be applied in consideration of the preconditions of the patients and the pursue of the different treatment goals. Thus, the implementation of treatment methods should be used according to the individual treatment demand and on different stages in the treatment process.

Hypermobility of joints in dancers.

OBJECTIVES: The current understanding of hypermobility and its diagnostic criteria is still insufficient to create a complete and systematic clinical presentation of the disorder. The objective of this study was to assess the prevalence of joint hypermobility syndrome (JHS) amongst a cohort of jazz dancers, by analyzing its presence in accordance with a number of diagnostic criteria, and to verify potential risk factors for joint hypermobility in jazz dancers. METHODS: 77 jazz dancers from the Polish Dance Theater were examined (58 female and 19 male). The prevalence of JHS was assessed using the following diagnostic tools: a structured interview, Beighton score, Grahame & Hakim questionnaire, and Sachse's criteria, in the modified version proposed by Kapandji. RESULTS: The prevalence of JHS in this cohort of jazz dancers differed significantly, depending on which criteria were adopted (p = 0.001) with Beighton score, Grahame & Hakim questionnaire, and Sachse's criteria identifying 64.9%, 74% and 59.7% of the sample as JHS respectively. Hypermobility was significantly more prevalent in women than men (p < 0.05). CONCLUSIONS: This study demonstrated a significant prevalence of joint hypermobility in jazz dancers and corroborates the findings of other researchers, indicating the need for unified diagnostic criteria for JHS in dancers.

Effect of physiotherapy on spinal alignment in children with postural defects.

OBJECTIVES: This paper assesses the effect of neurophysiological rehabilitation in children with postural defects on the depth of thoracic kyphosis, lateral spinal deviation and rotation of spinal motor segments. MATERIAL AND METHODS: A total of 201 patients aged 8-15 years old with a postural defect diagnosed by medical examination were enrolled. The analyzed parameters were determined using the DIERS system before the first therapeutic session and after 4 weeks of therapy. The angle of thoracic kyphosis, lateral deviation of the spine and spinal rotation were assessed. The therapy employed techniques associated with the proprioceptive neuromuscular facilitation (PNF) and Vojta's approaches. The results were analyzed separately for both sexes and for patients rehabilitated solely with Vojta's techniques vs. patients rehabilitated according to combined Vojta's and PNF techniques. The χ2 test was used for statistical analyses, at p < 0.05. RESULTS: There was improvement in the angle of thoracic kyphosis, ranging from 0.14 (among boys with kyphosis < 42°) to 5.47 (among girls with kyphosis ≥ 42°), spinal rotation, from 0.37 (among boys with kyphosis ≥ 42°) to 4.33 (among patients with kyphosis ≥ 42° rehabilitated solely according to Vojta's method), and lateral deviations, ranging from 1.32 mm (among boys with kyphosis < 42°) to 2.99 mm (among patients with kyphosis ≥ 42° rehabilitated solely according to Vojta's method). CONCLUSIONS: Neurophysiological rehabilitation of patients with postural defects produced positive effects by improving the angle of thoracic kyphosis, spinal rotation and lateral deviation of the spine. Children with reduced thoracic kyphosis achieved less improvement in the kyphosis angle, lateral spinal deviation and spinal rotation than children with kyphosis ≥ 42°. The DIERS Formetric System enables precise monitoring of therapeutic outcomes. Int J Occup Med Environ Health. 2019;32(1):25-32.

Efficacy of the use of the McKenzie and Vojta methods to treat discopathy-associated syndromes in the pediatric population.

OBJECTIVES: This paper evaluates the efficacy of using the McKenzie and Vojta methods for patients with low back pain and the use of the DIERS Formetric 4D system as an objective diagnostic tool. MATERIAL AND METHODS: The study enrolled 28 patients aged 15-17 years old. The patients were hospitalized at the Department of Orthopedics and Traumatology of the Swietokrzyskie Center for Pediatrics in Kielce with a diagnosis of back pain associated with a discopathy. The patients were rehabilitated according to the McKenzie and Vojta methods. Assessment by means of the DIERS Formetric system had taken place before the first therapy session and on the day that pain was eliminated to evaluate trunk inclination, angle of thoracic kyphosis, angle of lumbar lordosis, lateral deviation, trunk torsion, surface rotation and pelvic obliquity. Pain intensity and change in pain intensity over time were assessed by means of a numerical rating scale. RESULTS: Pain intensity was reduced to 0 over 3-12 days. The study participants demonstrated reduction in anterior trunk inclination of the mean value at 1.83°. The angle of thoracic kyphosis was also reduced by 7.95°. The angle of lordosis increased by 7.6°. The lateral spinal curvature was reduced by 8.92 mm. There was a reduction of 4.64° in trunk torsion. Surface rotation was reduced by 1.61° and pelvic obliquity was reduced by 3.78°. CONCLUSIONS: In discopathic patients, postural parameters comprising trunk inclination, angle of thoracic kyphosis, angle of lumbar lordosis, lateral deviation, trunk torsion, vertebral rotation and pelvic obliquity fail to reach Hartzmann's physiological reference ranges. A therapeutic intervention based on the Vojta and McKenzie methods may normalize the posture to physiological reference ranges and is effective in the treatment of patients with back pain. The DIERS system is an objective tool for tracing the effects of therapy in patients with back pain. Int J Occup Med Environ Health. 2019;32(1):33-41.

[The influence of pain aliments and vertebral mobility in patients after whole body cryotherapy].

INTRODUCTION: The motive efficiency depends from many factors, in this currently also form the state of health. The change in grounds of vertebral column causing the limitations of mobility and pain can significance worsen the functional state, motive efficiency and quality of patient's life. The leadership of active mode of life complying to recommendations the preventive style of life as well as the using with interventions of physical medicine influences on improvement significance the state of health. MATERIAL AND METHODS: It the examination groups were 42 patients (21 women and 21 men) in age from 45-65 years with low back pain about different etiology. All studied were thirty interventions of whole body cryotherapy and then practices kinesitherapy exercises by 30 minutes subjected on gymnastic room. To evaluation of stepping pain ailments was the scale VAS executed, mobility of lumbar spine with help of Schober test as well as was executed. All results were statistical analysis subjected. RESULTS: After whole body cryotherapy the pain ailments in scale VAS were statistical significant in men group. The decrease of pain ailments influenced on improvement column mobility vertebral spine with use a Schober test (p<0,05). The statistical analysis were not significant in women group of pain ailments and the opinion of mobility of vertebral column spine (p > 0,05). CONCLUSIONS: Whole body cryotherapy reduced significance pain ailments and mobility of lumbar spine in men group. In women group the got results were not statistical significant.

Indocyanine green R15 ratio depends directly on liver perfusion flow rate.

BACKGROUND: Indocyanine green (ICG) is a synthetic dye that is widely used to evaluate liver function in critically ill patients, before liver resection or after liver transplantation. Controversy still exists about the impact exerted on the ICG ratio after 15 min (ICG R15) by differences in liver perfusion rates, hyperdynamic states, or patient cardiac output. We studied the role of different liver perfusion rates on the ICG R15 ratio in a normothermic extracorporeal liver perfusion system under standardized conditions. METHODS: Livers from landrace pigs (40-50 kg) were perfused with fresh porcine blood. Normal and high perfusion rates were defined as 1 ml and 2 ml/g liver/min, respectively. Perfusate pressure of the hepatic artery and portal vein were within the physiological range in both groups. According to manufacturer's instructions, 0.5 mg of ICG per kg was applied and the ICG R15 was calculated. Calculations were based on fifteen experiments in five liver perfusions. Bile production, liver function and histology were analyzed. RESULTS: All perfusions were characterized by physiological bile production, lack of hepatocellular damage and normal histology. ICG R15 ratio in group I, perfused with 1 ml/g liver, was 18.9 +/- 6%. In group II, perfused with 2 ml/g liver, the ICG R15 ratio was 7.2 +/- 3%. The difference between groups 1 and 2 was statistically significant (p < 0.05). CONCLUSION: ICG R15 is reliable within one group at defined perfusion rates. Doubled perfusion rates contribute to higher ICG clearance. For clinical application we would like to suggest considering cardiac output of the patient for interpretation of ICG ratios.