Contextualizing remote fall risk: Video data capture and implementing ethical AI.

Wearable inertial measurement units (IMUs) are being used to quantify gait characteristics that are associated with increased fall risk, but the current limitation is the lack of contextual information that would clarify IMU data. Use of wearable video-based cameras would provide a comprehensive understanding of an individual's habitual fall risk, adding context to clarify abnormal IMU data. Generally, there is taboo when suggesting the use of wearable cameras to capture real-world video, clinical and patient apprehension due to ethical and privacy concerns. This perspective proposes that routine use of wearable cameras could be realized within digital medicine through AI-based computer vision models to obfuscate/blur/shade sensitive information while preserving helpful contextual information for a comprehensive patient assessment. Specifically, no person sees the raw video data to understand context, rather AI interprets the raw video data first to blur sensitive objects and uphold privacy. That may be more routinely achieved than one imagines as contemporary resources exist. Here, to showcase/display the potential an exemplar model is suggested via off-the-shelf methods to detect and blur sensitive objects (e.g., people) with an accuracy of 88%. Here, the benefit of the proposed approach includes a more comprehensive understanding of an individual's free-living fall risk (from free-living IMU-based gait) without compromising privacy. More generally, the video and AI approach could be used beyond fall risk to better inform habitual experiences and challenges across a range of clinical cohorts. Medicine is becoming more receptive to wearables as a helpful toolbox, camera-based devices should be plausible instruments.

Driving following a diagnosis of dementia: Exploring the views and experiences of people with dementia-A UK survey.

BACKGROUND: Driving cessation can be one of the adjustments made following a diagnosis of dementia. Little is known about the views and opinions of people living with dementia about this. The study aimed to gather a broad idea of the expectations, impacts and the process of driving cessation from the perspective of those living with dementia. METHODS: 138 people with dementia and 91 relatives/friends (on behalf of an individual with dementia) took part in an online questionnaire. RESULTS: People living with dementia reported stopping driving following diagnosis can have negative psychological impacts particularly in relation to; feelings of isolation, depression, loss of freedom and feeling life isn't worth living. Age, gender and choice in the driving cessation process were related to the degree of negative experiences. CONCLUSIONS: The difficulties reported by people with dementia suggest a need to provide more structured post diagnostic support to aid decision making of driving continuation or cessation; with the view to reducing associated distress and enabling people with dementia to continue to live a meaningful life.

Sonification for Personalised Gait Intervention.

Mobility challenges threaten physical independence and good quality of life. Often, mobility can be improved through gait rehabilitation and specifically the use of cueing through prescribed auditory, visual, and/or tactile cues. Each has shown use to rectify abnormal gait patterns, improving mobility. Yet, a limitation remains, i.e., long-term engagement with cueing modalities. A paradigm shift towards personalised cueing approaches, considering an individual's unique physiological condition, may bring a contemporary approach to ensure longitudinal and continuous engagement. Sonification could be a useful auditory cueing technique when integrated within personalised approaches to gait rehabilitation systems. Previously, sonification demonstrated encouraging results, notably in reducing freezing-of-gait, mitigating spatial variability, and bolstering gait consistency in people with Parkinson's disease (PD). Specifically, sonification through the manipulation of acoustic features paired with the application of advanced audio processing techniques (e.g., time-stretching) enable auditory cueing interventions to be tailored and enhanced. These methods used in conjunction optimize gait characteristics and subsequently improve mobility, enhancing the effectiveness of the intervention. The aim of this narrative review is to further understand and unlock the potential of sonification as a pivotal tool in auditory cueing for gait rehabilitation, while highlighting that continued clinical research is needed to ensure comfort and desirability of use.

Evidence for motor learning in Parkinson's disease: acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues.

People with Parkinson's disease (PD) have difficulty learning new motor skills. Evidence suggests external stimuli (cues) may enhance learning; however, this may be specific to cued rather than non-cued performance. We aimed to test effects of cued training on motor learning in PD. We defined motor learning as acquisition (single task), automaticity (dual task) and retention of single- and dual-task performance (follow-up). 153 subjects with PD received 3 weeks cued gait training as part of a randomised trial (the RESCUE trial). We measured changes in cued gait performance with three external rhythmical cues (ERC) (auditory, visual and somatosensory) during single and dual tasks after training and 6 weeks follow-up. Gait was tested without cues to compare specificity of learning (transfer). Subjects were 'on' medication and were cued at preferred step frequency during assessment. Accelerometers recorded gait and walking speed, step length and step frequency were determined from raw data. Data were analysed with SAS using linear regression models. Walking speed and step length significantly increased with all cues after training during both single- and dual-task gait and these effects were retained. Training effects were not specific to cued gait and were observed in dual-task step length, and walking speed however was more limited in single-task non-cued gait. These results support the use of ERC to enhance motor learning in PD as defined by increased acquisition, automaticity and retention. They also highlight the potential for sustained improvement in walking and complex task performance.

Is impact of fatigue an independent factor associated with physical activity in patients with idiopathic Parkinson's disease?

To investigate the longitudinal association between fatigue and physical activity in Parkinson's disease (PD) and determine whether this association is distorted by potential confounders. Data from baseline, 3, 6, and 12 week assessments in a single blind randomized clinical trial with cross-over design were used (N = 153). The Multidimensional Fatigue Inventory (MFI) was used to assess fatigue and an activity monitor to measure amount of physical activity (defined as % dynamic activity during each monitoring session). Time-independent and time-dependent factors were investigated for their possible univariate association with dynamic activity. Random coefficient analysis was applied. Candidate confounders were successively added to the longitudinal association model to determine if the association between dynamic activity and fatigue was distorted. A proportional change beyond 15% was considered to be significant. Fatigue was significantly associated with physical activity (beta = -0.099, SE = 0.032, P = 0.002). This association was not significantly distorted by type of intervention, age, gender, social support, disease duration, disease severity, motor impairment, cognition, anxiety, or medication intake. Depression caused proportional change of 22.2% in the regression coefficient of MFI. After controlling for depression, a significant association between MFI and dynamic activity remained (beta = -0.121, SE = 0.036, P = 0.000). The association found between fatigue and dynamic activity suggests that patients who experience higher levels of fatigue are less physically active. However, the total explained variance of dynamic activity by fatigue alone was small, suggesting that fatigue is only a minor factor in the complex of behavioral aspects that affect the amount of physical activity in patients with PD.

Walking speed during single and dual tasks in Parkinson's disease: which characteristics are important?

The impact of dual tasks on gait in Parkinson's disease (PD) reveals lack of automaticity and increased cognitive demands. We explored which characteristics explained walking speed with and without dual task interference and if they reflected the cognitive demands of the task. In 130 people with PD, gait performance was quantified in the home using accelerometers allowing estimates of single and dual task walking speed and interference (difference between dual and single task). Multiple regression analysis was used to explore the effect of 12 characteristics representing four domains (personal, motor symptoms, cognitive, affective) on gait outcomes. Thirty-seven percent of variance in single task speed was explained by increased fear of falling, sex, age, disease severity, and depression; 34% of variance in dual task speed was explained by increased fear of falling, disease severity, medication, and depression; 12% of variance in interference scores was explained by greater disease severity and impaired executive function. Personal, motor, affective, and cognitive characteristics contribute to walking speed and interference, highlighting the multifactorial nature of gait. Different patterns of characteristics for each outcome indicates the impact of cognitive demand and task complexity, providing cautious support for dual task speed and interference as valid proxy measures of cognitive demand in PD gait.

Gait and gait-related activities and fatigue in Parkinson's disease: what is the relationship?

PURPOSE: To explore the relationship between gait and gait-related activities and fatigue in Parkinson's disease (PD). METHOD: Twenty people with idiopathic PD (12 male, 8 female; mean age 64.6 +/- 7.96) and 10 age, sex and education matched controls (6 male, 4 female; mean age 63.5 +/- 7.03) wore an activity monitor for approximately 24 h, from which the percentage time walking and standing, the number of periods of walking greater than 10 sec were derived. Prior to monitoring, levels of fatigue (Multi-dimensional Fatigue Index, MFI) were evaluated. RESULTS: Activity data related to gait were compared for the waking hours of the day, reflected by the period between 6 am and 10 pm. Overall, PD subjects demonstrated reduced activity compared to controls, however there was no significant difference between PD and controls for the percentage time spent walking (p = 0.149), standing (p = 1.0) or engaged in periods of walking that were greater than 10 sec (p = 0.059). Significantly greater levels of fatigue were experienced by PD subjects in all MFI domains compared to controls (physical p = 0.001; activity p = 0.001; general p = 0.001; mental p = 0.028; motivation p = 0.024). There was no clear association between activity and fatigue in PD subjects. CONCLUSIONS: Evidence of increased fatigue is not supported by evidence of significantly decreased levels of activity in PD subjects. The relationship between activity and fatigue therefore remains unclear, highlighting the complex nature of the relationship between these factors. Further work is required to increase our understanding of the impact of fatigue on gait and gait-related activity so that improved management can be explored.

The effect of external rhythmic cues (auditory and visual) on walking during a functional task in homes of people with Parkinson's disease.

OBJECTIVES: To evaluate (1) the influence of rhythmic cues on gait interference during a functional activity and (2) the relationship of clinical symptoms to gait interference. DESIGN: Repeated-measures study. SETTING: Participants' homes. PARTICIPANTS: Twenty subjects with idiopathic Parkinson's disease (PD) and a control group of 10 age-, sex-, and education-matched subjects. INTERVENTIONS: Subjects performed a simple functional task that included a walking component and a dual-motor task. The functional task was performed with and without external rhythmic (auditory and visual) cues. MAIN OUTCOME MEASURES: Walking speed, mean step length, and step frequency were compared during trials of the tasks. In addition, tests of cognitive executive function (Hayling and Brixton tests), anxiety and depression (Hospital Anxiety and Depression Scale), and fatigue (Multidimensional Fatigue Inventory) were undertaken. RESULTS: The use of auditory cues during a dual task involving gait reduced the interference effect on the task; significant increases in step length were observed in PD subjects ( P =.018), representing an increase of 19%. CONCLUSIONS: External auditory cues may be useful in reducing interference and maintaining gait performance during more complicated functional activities. Clinical symptoms, such as depression and fatigue, could influence the ability to focus attention and may increase gait interference during the performance of complex tasks, with subsequent implications for functional walking and safety.

Attending to the task: interference effects of functional tasks on walking in Parkinson's disease and the roles of cognition, depression, fatigue, and balance.

OBJECTIVE: To evaluate the interference effects on walking of functional activities in the home in people with Parkinson's disease (PD) and the contribution of clinical symptoms to disturbance of gait. DESIGN: A repeated-measures trial, using a dual-task paradigm to evaluate the attentional demands of functional activities. SETTING: Participants' homes and a clinic. PARTICIPANTS: Twenty subjects with idiopathic PD and 10 age-, sex-, and education-matched controls. INTERVENTIONS: Subjects performed a simple walking task, a dual-motor task, a dual-cognitive task, and a multiple task, all of which were real-world activities. Main outcome measures Walking speed, mean step length, and step frequency were compared across different tasks for each subject. A battery of clinical outcome measures hypothesized to compete for attention were also conducted: cognition (Hayling and Brixton tests), anxiety and depression (Hospital Anxiety and Depression test), fatigue (Multidimensional Fatigue Inventory), balance (Berg Balance Scale), and disease severity (Hoehn and Yahr score). RESULTS: PD subjects walked at a significantly slower speed (26.5%, P<.001) and reduced step length (23%, P<.001) than did the controls. Performance of a concurrent cognitive and multitask resulted in significantly slower gait speed (P=.022; P<.015) and reduced mean step length (P=.022; P=.001) in PD subjects. Cognitive function, depression, physical fatigue, and balance were significantly related to walking speed for the functional tasks. Multiple regression analysis showed that the Brixton test, physical fatigue, and depression accounted for up to 39% of the variation in walking speed during functional tasks in PD and control subjects and balance accounted for 54% of variance for walking in PD subjects. CONCLUSIONS: Competition for attention through additional activities, decreased executive function, depression, fatigue, and impaired balance will increase difficulty in walking for PD subjects. Evaluation of performance during complex functional activities in an appropriate environment should be a focus of therapeutic assessment. Furthermore, functional performance may be influenced by several other symptoms that should also be considered.