Optimal degrees of freedom of the lower extremities for human walking and running.

Determining the degrees of freedom (DOF) of the linked rigid-body model, representing a multi-body motion of the human lower extremity, is one of the most important procedures in locomotion analysis. However, a trade-off exists between the quality of data fitting and the generalizability of the model. This study aimed to determine the optimal DOF of the model for the lower extremities that balance the goodness-of-fit and generalizability of the model during walking and running using Akaike's information criterion (AIC). Empirically obtained kinematic data for the lower extremities during walking and running were fitted by models with 9, 18, or 22 DOF. The relative quality of these models was assessed using their bias-corrected AIC (cAIC) value. A significant simple main effect of the model was found on the cAIC value for both walking and running conditions. Pairwise comparisons revealed that the cAIC value of the 18-DOF model was significantly smaller than that of the 9-DOF (walking: p < 0.001, running: p = 0.010) and 22-DOF (walking: p < 0.001, running: p < 0.001) models. These findings suggest that the 18-DOF model is optimal for representing the lower extremities during walking and running, in terms of goodness-of-fit and generalizability.

Effect of auditory deprivation on adaptive locomotion: Interaction with lower visual field occlusion.

Auditory stimuli have been suggested to play a role in adequately controlling movement; however, their influence is not fully understood, particularly regarding dynamic behaviors, such as adaptive locomotion. This study aimed to investigate whether auditory deprivation affects adaptive locomotion. In particular, we aimed to elucidate the role of the auditory sense in obstacle avoidance by manipulating the visual field, which provides crucial sensory information for movement control. Sixteen participants approached a 15-cm obstacle located 6 m away and stepped over it under four different conditions that combined two factors: the hearing condition controlled by wearing earmuffs with and without holes, and the lower visual field condition controlled by carrying opaque white and transparent boards. Spatiotemporal variables during the approach to the obstacle were measured using an electronic walkway, whereas foot clearance over the obstacle was assessed using a motion-capture system. Participants who experienced auditory deprivation and lower visual field occlusion demonstrated greater variability in step length when approaching the obstacle compared with the other conditions. The leading and trailing foot clearances were higher under lower visual field occlusion conditions. Furthermore, when participants were under conditions of auditory deprivation, greater variability was observed in the clearance of the leading foot. These results suggest that auditory information contributes to movement stabilization during adaptive locomotion. Our findings provide evidence that auditory and visual senses complement each other during motor actions, indicating that adaptive locomotion can be influenced by the integration of multiple sensory inputs.

Preparatory knee flexion movement facilitates faster sideways jumping execution in male collegiate soccer goalkeepers.

Preparatory lower-limb loading conditions may affect the jump-to-reach performance of soccer goalkeepers. This study investigated the effect of pre-jump lower-limb loading/unloading during bilateral knee flexion-extension movements on sideways jump-to-reach performance in 18 male collegiate soccer goalkeepers. Participants performed the two-choice (high and low targets) reaction-time single-leg jump-to-reach task under two conditions: without preparatory movements (no-prep) and with continuous alternating knee extension and flexion movements (prep). The 'go' cue was provided with different preparatory loading conditions during the pre-jump knee extension and flexion phases. Performance was assessed using three-dimensional kinematic data and ground reaction forces. A significant main effect of the preparatory condition was observed for the jump take-off time. Pairwise comparisons revealed that the jump take-off time was 3.4-4.4% faster when initiated during the knee flexion phase than the no-prep condition and the extension phase (p ≤ .028). Increasing lower-limb loading and downward body movement with knee flexion appeared to facilitate effective loading to take-off to reach the high target and faster downward-directed take-off to reach the low target, respectively. Pre-jump knee flexion movement could be utilised by soccer goalkeepers to facilitate faster take-off to maximise their chances of saving shots within the reach of single-leg side-jumping.

Identification of characteristics of foot position and angle during swing phase in fallers using principal component analysis.

Identifying the characteristics of fallers is important for preventing falls because such events may reduce quality of life. It has been reported that several variables related to foot positions and angles during gait (e.g., sagittal foot angle and minimum toe clearance) differ between fallers and non-fallers. However, examining such representative discrete variables may not be sufficient to detect crucial information, which may be contained in the large portions of unanalyzed data. Therefore, we aimed to identify the comprehensive characteristics of foot position and angle during the swing phase of gait in non-fallers and fallers using principal component analysis (PCA). Thirty non-fallers and 30 fallers were recruited for this study. We performed PCA to reduce the dimensions of foot positions and angles during the swing phase and obtained principal component scores (PCSs) for each principal component vector (PCV), which were then compared between groups. The results revealed that the PCS of PCV3 in fallers was significantly larger than that in non-fallers (p = 0.003, Cohen's d = 0.80). We reconstructed waveforms of foot positions and angles during the swing phase using PCV3 and our main findings can be summarized as follows. Compared to non-fallers, fallers have a 1) low average foot position in the z-axis (i.e., height) during the initial swing phase 2) small average foot angle in the x-axis (i.e., rotation in the sagittal plane), during the initial swing phase, and 3) large variability in foot position in the y-axis (i.e., anterior/posterior position) during the initial swing phase. We can conclude that these are characteristics of gait related to fallers. Therefore, our findings may be beneficial for evaluating fall risk during gait using a device such as a shoe- or insole-embedded inertial measurement unit.

Development of a data platform for monitoring personal health records in Japan: The Sustaining Health by Integrating Next-generation Ecosystems (SHINE) Study.

BACKGROUND: The Sustaining Health by Integrating Next-generation Ecosystems (SHINE) Study was developed as a data platform that incorporates personal health records (PHRs) into health-related data at the municipal level in Japan. This platform allows analyses of the associations between PHRs and future health statuses, and supports the production of evidence for developing preventive care interventions. Herein, we introduce the SHINE Study's profile and describe its use in preliminary analyses. METHODS: The SHINE Study involves the collection of participants' health measurements and their addition to various health-related data from the Longevity Improvement & Fair Evidence (LIFE) Study. With cooperation from municipal governments, measurements can be acquired from persons enrolled in government-led long-term care prevention classes and health checkups who consent to participate in the SHINE Study. For preliminary analyses, we collected salivary test measurements, lifelog measurements, and gait measurements; these were linked with the LIFE Study's database. We analyzed the correlations between these measurements and the previous year's health care expenditures. RESULTS: We successfully linked PHR data of 33 participants for salivary test measurements, 44 participants for lifelog measurements, and 32 participants for gait measurements. Only mean torso speed in the gait measurements was significantly correlated with health care expenditures (r = -0.387, P = 0.029). CONCLUSION: The SHINE Study was developed as a data platform to collect and link PHRs with the LIFE Study's database. The analyses undertaken with this platform are expected to contribute to the development of preventive care tools and promote health in Japan.

Scalable spin Seebeck thermoelectric generation using Fe-oxide nanoparticle assembled film on flexible substrate.

We fabricated Fe3O4 nanoparticle (NP)-assembled films on flexible polyimide sheets with Pt or Ta cap layer using a spin coating method and DC sputtering. The films were elaborated for spin Seebeck thermoelectric generator applications, and their spin Seebeck voltages were observed. We showed that the thermoelectric power of [Pt film/Fe3O4 NP]n multilayered films increases with increasing number of stacking n. Additionally, we prepared spin Seebeck thermopile devices in which the Fe3O4 NP-assembled films capped by Pt and Ta are connected alternately in series. We demonstrated that spin Seebeck voltages of the thermopile devices are larger than those of single [Pt or Ta film/Fe3O4 NP]n piece. Our results indicate that the spin Seebeck thermoelectric power of Fe3O4 NPs can be enhanced using a simple fabrication process without lithography technique.

Bilateral Orbital Inflammation as a Manifestation of Paraneoplastic Syndrome.

Paraneoplastic neurologic syndromes (PNS) constitute a rare group of disorders whose optimal treatment is yet to be established. We report a patient with bilateral orbital inflammation associated with PNS, who responded well to surgical resection of the primary tumor. An 83-year-old woman was referred to our department for treatment of a progressive reduction in visual acuity and palpebral swelling in both eyes for the past 2 months. She was scheduled to undergo thoracic surgery for lung cancer. The best-corrected visual acuity (BCVA) in the right and left eye had worsened from 0.3 to 0.5 one month before she was referred to our department to 0.03 and 0.07, respectively. A slit-lamp examination revealed edema in both eyelids. Goldmann perimetry revealed several paracentral scotomas with constriction of the peripheral visual fields of both eyes, along with central absolute scotomas in V-4e isopter in the right eye. Magnetic resonance imaging revealed swelling of the bilateral extraocular muscles, which compressed the bilateral optic nerves at the orbital apex. Seven days after the resection of the lung cancer, the BCVA improved to 0.07 and 0.15 in the right and left eyes, respectively, without concomitant immunotherapy. Intravenous methylprednisolone (500 mg/day) was administered for 3 days to treat the residual orbital inflammation. Fourteen days after surgery, the BCVA further improved to 0.4 and 0.5 in the right and left eyes, respectively. Swelling of the bilateral extraocular muscles and the visual field abnormalities improved dramatically. Early diagnosis is crucial for the management of PNS.

Experimental Verification of Micro-Doppler Radar Measurements of Fall-Risk-Related Gait Differences for Community-Dwelling Elderly Adults.

In a previous study, we developed a classification model to detect fall risk for elderly adults with a history of falls (fallers) using micro-Doppler radar (MDR) gait measurements via simulation. The objective was to create daily monitoring systems that can identify elderly people with a high risk of falls. This study aimed to verify the effectiveness of our model by collecting actual MDR data from community-dwelling elderly people. First, MDR gait measurements were performed in a community setting, and the efficient gait parameters for the classification of fallers were extracted. Then, a support vector machine model that was trained and validated using the simulated MDR data was tested for the gait parameters extracted from the actual MDR data. A classification accuracy of 78.8% was achieved for the actual MDR data. The validity of the experimental results was confirmed based on a comparison with the results of our previous simulation study. Thus, the practicality of the faller classification model constructed using the simulated MDR data was verified for the actual MDR data.

Utilization of Micro-Doppler Radar to Classify Gait Patterns of Young and Elderly Adults: An Approach Using a Long Short-Term Memory Network.

To develop a daily monitoring system for early detection of fall risk of elderly people during walking, this study presents a highly accurate micro-Doppler radar (MDR)-based gait classification method for the young and elderly adults. Our method utilizes a time-series of velocity corresponding to leg motion during walking extracted from the MDR spectrogram (time-velocity distribution) in an experimental study involving 300 participants. The extracted time-series was inputted to a long short-term memory recurrent neural network to classify the gaits of young and elderly participant groups. We achieved a classification accuracy of 94.9%, which is significantly higher than that of a previously presented velocity-parameter-based classification method.

Preparatory Knee Flexion-Extension Movements Enhance Rapid Sidestepping Performance in Collegiate Basketball Players.

Lower-limb weight-bearing load distribution in stationary standing influences the timing of rapid first step initiation of importance for functional movement activities and agility performance in sports. This study investigated the effect of pre-step lower-limb loading and unloading with preparatory knee flexion-extension movements on sidestepping performance in fifteen male collegiate basketball players. Participants performed two-choice (step limb) reaction time sidestepping under two conditions: without preparatory movements before the go cue (no-prep-NP) and with continuous alternating knee extension and flexion movements (prep-P). The reaction signal was provided at the beginning of knee extension and flexion and during these movements which corresponded with the largest and smallest loading instants and the transition states between those instants. Sidestepping performance was assessed with three-dimensional kinematic data and ground reaction forces. Step initiation onset time was significantly faster by 13-15% than the NP condition when initiated in the knee flexion phase (p ≤ 0.028, r ≥ 0.70), whereas step-limb unloading interval from step initiation to step lift-off was significantly faster by 12-15% in the knee extension phase (p ≤ 0.01, r ≥ 0.74). The preparatory movements significantly shortened step lift-off by 10-12% (p ≤ 0.013, r ≥ 0.73) and step duration by 17-21% (p < 0.001, r ≥ 0.85) with 19-22% faster step velocity (p < 0.001, r ≥ 0.84), which resulted in 14-15% shorter overall time to step landing (p < 0.001, r ≥ 0.84), irrespective of the loading phases. These results indicated that lower-limb loading with pre-step knee flexion facilitated faster step initiation, while lower-limb unloading with knee extension facilitated faster step-limb unloading, both resulting in faster step lift-off. Bilateral knee flexion-extension movements as a preparatory action could be utilized by invasion sports players to facilitate reactive stepping performance for more effective movement initiation.

Effects of footwear fixation on joint angle variability during straight gait in the elderly.

BACKGROUND: Various types of footwear fixation can dramatically alter gait characteristics, and could potentially contribute to an increased risk of falls in the elderly. However, no studies have been conducted to analyze the effects of footwear fixation on joint angle variabilities, particularly during the entire gait cycle. RESEARCH QUESTION: Does the fixation of footwear significantly affect the lower limb joint angle variabilities during the gait cycle? METHODS: Principal component analysis (PCA) was conducted on 20 healthy adults using 3D spatio-temporal data of the pelvis and lower limb joint angle that were collected during the entire gait cycle with the footwear in various conditions (well-fixated footwear, less-fixated footwear, slippers, and bare feet). Kinematic waveforms were reconstructed from the PCA data, which were used to determine the distinct differences in joint angle variabilities between footwear conditions. RESULTS: The results showed large variability in the knee- and ankle-joint angles on the sagittal plane when walking in the loose condition (less-fixated footwear, slippers, and bare feet) compared with those in the well-fixated footwear condition. SIGNIFICANCE: These results demonstrate the effect of footwear fixation on the joint angle variabilities of the elderly while walking. The increase in the knee- and ankle-joint angle variabilities when walking with less-fixated footwear could be a risk factor for falls.

Lateral Perturbation-Induced and Voluntary Stepping in Fallers and Nonfallers After Stroke.

OBJECTIVE: A loss of balance poststroke from externally induced perturbations or during voluntary movements is often recovered by stepping. The purpose of this study was to characterize stepping behavior during lateral induced waist-pull perturbations and voluntary steps in community-dwelling fallers and nonfallers with chronic stroke. METHODS: This study used a cohort design. Thirty participants >6 months poststroke were exposed to 24 externally triggered lateral waist-pull perturbations and 20 voluntary steps. Balance tolerance limit (BTL) (transition from single to multiple steps) and first step type were determined for the waist-pull perturbations. Step parameters of initiation time, velocity, first step length, and clearance were calculated at and above BTL and for the voluntary steps. Hip abductor/adductor torque, foot cutaneous sensation, and self-reported falls that occurred 6 months prior were evaluated. RESULTS: Twelve participants were classified retrospectively as fallers and 18 as nonfallers. Fallers had a reduced BTL and took more medial first steps than nonfallers. Above BTL, no between-group differences were found in medial steps. At BTL, the nonparetic step clearance was reduced in fallers. Above BTL, fallers took longer to initiate a paretic and nonparetic step and had a reduced nonparetic step length and clearance compared with nonfallers. There was a between-group difference in step initiation time for voluntary stepping with the paretic leg (P < .05). Fallers had a reduced paretic abductor torque and impaired paretic foot cutaneous sensation. CONCLUSION: A high fall rate poststroke necessitates effective fall prevention strategies. Given that more differences were found during perturbation-induced stepping between fallers and nonfallers, further research assessing perturbation-induced training on reducing falls is needed. IMPACT: Falls assessments should include both externally induced perturbations along with voluntary movements in determining the fall risk.

Adverse effects of the coexistence of locomotive syndrome and sarcopenia on the walking ability and performance of activities of daily living in Japanese elderly females: a cross-sectional study.

[Purpose] The aim of this study was to investigate whether the coexistence of locomotive syndrome and sarcopenia is associated with the risk of fall or performance of activities of daily living in elderly females. [Participants and Methods] We categorized 112 Japanese elderly female participants under three groups: control, locomotive syndrome, and locomotive syndrome and co-existing sarcopenia. We compared the groups based on the mean scores of anthropometric and physical function measurements, the Timed Up and Go test, and the Tokyo Metropolitan Institute of Gerontology Index of Competence to evaluate activities of daily living. [Results] The Timed Up and Go test score significantly differed among the groups. The score of the Timed Up and Go test significantly correlated with scores of the skeletal muscle mass index, skeletal muscle strength grading, and usual gait speed. The total score of the Tokyo Metropolitan Institute of Gerontology Index of Competence significantly decreased in all the groups. [Conclusion] The coexistence of locomotive syndrome and sarcopenia is associated with an increased risk of fall and worsened performance of activities of daily living. Further, the risk of fall is associated with the skeletal muscle mass, skeletal muscle strength, and gait speed. It seems likely that, compared to sarcopenia, locomotive syndrome is more sensitive to lower limb dysfunctions.

Associations among Bone Mineral Density, Physical Activity and Nutritional Intake in Middle-Aged Women with High Levels of Arterial Stiffness: A Pilot Study.

There is little consensus regarding the impacts of physical activity and nutrient intake on bone mineral density (BMD) in subjects with high or low levels of arterial stiffness. This study was performed to investigate whether physical activity and nutrient intake are associated with BMD in middle-aged women with high levels of arterial stiffness. The study population consisted of middle-aged women aged 40-64 years (n = 22). BMD was assessed by dual-energy X-ray absorptiometry. Carotid-femoral pulse wave velocity (cf-PWV) was used as an indicator of arterial stiffness. Subjects were divided into two groups by median cf-PWV. Physical activity in free-living conditions was evaluated using a triaxial accelerometer. Nutrient intake was also measured using the brief-type self-administered diet history questionnaire. In the High-PWV group, BMD showed a significant negative correlation with age. Using a partial correlation model, BMD was associated with the number of steps and unsaturated fatty acid intake in the High-PWV group. These results suggest that BMD in middle-aged women with high levels of arterial stiffness may be associated with both the number of steps and nutritional intake. Recommendations of physical activity and nutritional intake for the prevention of osteopenia should include consideration of arterial stiffness.

Determination of the optimal number of linked rigid-bodies of the trunk during walking and running based on Akaike's information criterion.

BACKGROUND: In the three-dimensional kinematic analysis of the trunk during human locomotion, a multi-segmental rigid-body model would be a better representation for the trunk compared with a single rigid-body model with regard to goodness-of-fit. However, there is a trade-off between data fitting and the simplicity of the model. RESEARCH QUESTION: This study aimed to determine the optimal number of rigid-body segments during walking and running using Akaike's information criterion (AIC), which determines the model that has goodness-of-fit and is generalizable. METHODS: Empirically obtained kinematic data for the trunk during walking and running were fitted by one-, two-, three-, and six-linked rigid-body models using a nonlinear optimization algorithm. The relative quality of these models was assessed using their bias-corrected AIC (AICc) value. RESULTS: The AICc values of two- and three-linked rigid-body models were significantly smaller than those of one- or six-segment models for the walking trial. For the running trial, the AICc values of two-, three-, and six-segment models were significantly smaller than that of the single rigid-body model. DISCUSSION: These results suggest that both two- and three-linked rigid-body models would be better than the one- and six-linked rigid-body representations for analyzing trunk movement during walking, whereas the two-, three-, and six-linked models would be comparably well-balanced models in terms of both the goodness-of-fit and generalizability for running analysis.

Evaluation of Higher-Level Instrumental Activities of Daily Living via Micro-Doppler Radar Sensing of Sit-to-Stand-to-Sit Movement.

This paper presents an evaluation technique for higher-level instrumental activities of daily living (HL-IADLs), which are defined as relatively complicated modern daily activities to perform independently, using micro-Doppler radar (MDR) signatures of sit-to-stand-to-sit (STSTS) movements. Because HL-IADLs are useful for evaluating the degree of disability and cognitive decline in daily life, this study aims to develop a system that enables the identification of individuals with HL-IADL impairments in an unconstrained manner. The study participants were elderly adults of age 65-74 years of rural communities in Japan, and their motion parameters in natural STSTS were extracted via a single 24-GHz MDR installed on the ceiling. Their HL-IADLs were evaluated using a questionnaire-based scale called the Japan Science and Technology Agency Index of Competence (JST-IC). The relationship between the HL-IADLs scaled with the JST-IC and the extracted STSTS parameters were statistically analyzed, and the results revealed that the extracted parameters were associated with the JST-IC score. Furthermore, an appropriately accurate screening method was verified for elderly adults with HL-IADL impairment using the extracted parameters.

Hyperreflective Foci in the Outer Retinal Layers as a Predictor of the Functional Efficacy of Ranibizumab for Diabetic Macular Edema.

Anti-VEGF drugs are as the first-line therapies for diabetic macular edema (DME). In this study, we investigated the association between hyperreflective foci in the outer retinal layers and functional efficacy in DME patients who received intravitreal ranibizumab (IVR) injections. We retrospectively reviewed 77 eyes of 71 patients with DME treated with pro re nata IVR injections for at least 12 months. We evaluated how baseline hyperreflective foci in the outer retinal layers on spectral domain optical coherence tomography images were associated with an improvement in logarithm of the minimum angle of resolution visual acuity (logMAR VA) at 12 months. Forty-three eyes with hyperreflective foci in the outer retinal layers had greater VA improvement than 34 eyes without such foci at 12 months. Multivariate analyses demonstrated that both logMAR VA and hyperreflective foci in the outer retinal layers at baseline were associated with VA improvement. Structural analyses revealed that the central subfield thickness was decreased and that the ellipsoid zone of photoreceptors was improved more significantly in eyes with hyperreflective foci in the outer layers than eyes without such lesions. Baseline hyperreflective foci in the outer retinal layers predict the functional efficacy of IVR injections for DME.

Disproportion of lamellar capillary non-perfusion in proliferative diabetic retinopathy on optical coherence tomography angiography.

PURPOSE: To characterise the non-perfused areas (NPAs) in the superficial and deep capillary layers (sNPAs and dNPAs, respectively) in the posterior pole in proliferative diabetic retinopathy (PDR) on wide-field optical coherence tomography angiography (OCTA) images. METHODS: We retrospectively reviewed 104 eyes of 70 patients with PDR from whom wide-field swept source OCTA images were acquired. sNPAs and dNPAs were manually measured in each quadrant of the inner (1-3 mm diameter), intermediate (3-6 mm), and outer (6-10 mm) rings centred on the fovea. Two qualitative findings, that is, segmented NPAs and periarteriolar NPAs, were also compared. RESULTS: The dNPAs were greater than the sNPAs (p<0.001) in each subfield. The outer ring had higher rates of deep NPAs than did the intermediate ring in the superior, inferior and temporal quadrants (p=0.010, p=0.004 and p<0.001, respectively), whereas no differences were detected in the nasal quadrant (p=1.000). Similarly, sNPA rates were higher in the outer ring than in the intermediate ring in the inferior and temporal subfields (p=0.003 and p<0.001, respectively). In 45 eyes with extensive NPAs, there were modest correlations between the dNPAs in the nasal and temporal quadrants in the intermediate (ρ=0.341, p=0.026) and outer (ρ=0324, p=0.032) rings, whereas sNPAs exhibited no associations. Segmented NPAs were delineated more frequently in the superficial layer than in the deep layer (p<0.001). Periarteriolar NPAs were more frequent in the deep layer (p<0.001). CONCLUSIONS: Three-dimensional assessment of wide-field OCTA promotes a better understanding of the enigmatic disproportion of lamellar NPAs in the posterior pole in PDR.

Predictor of Early Remission of Diabetic Macular Edema under As-Needed Intravitreal Ranibizumab.

The early remission of diabetic macular edema (DME) often occurs in eyes treated with anti-vascular endothelial growth factor (VEGF) treatment. We retrospectively reviewed and characterized eyes with early remission of DME at six months in 80 eyes under pro re nata (PRN) intravitreal ranibizumab (IVR) injections. The number of eyes without center-involved DME gradually increased and 14 and 20 eyes achieved remission of DME at 3 or 6 months, respectively, under the PRN regimen following three monthly loading doses. In particular, eyes with early remission at 6 months had smaller CSF thickness than those without the remission before and after the treatment except at the 1-month visit (P < 0.05); however, the changes in CSF thickness did not differ between them. VA and its changes were not different between eyes with and without remission. Multivariate analysis revealed that smaller CSF thickness at baseline predicted the early remission of DME under PRN IVR injections (odds ratio, 0.989; 95% confidence interval, 0.982-0.997; P = 0.008). These data elucidate the clinical characteristics of early remission of DME under PRN IVR injections and suggest that smaller CSF thickness at baseline is a novel predictor of early remission under PRN IVR injections for DME.