Movement as a Gateway to Participation for Individuals With Neuromotor Conditions: A Scoping Review.

PURPOSE: The purpose of this scoping review was to examine and analyze the developmental and rehabilitation literature related to movement and participation at key points of transition for individuals with neuromotor conditions. METHODS: Arksey and O'Malley's scoping review protocol was applied, and 37 articles were included. Extracted data included population, developmental transition points, movement opportunity, type of participation, and outcome measures. RESULTS: Most studies covered developmental transition points; none examined transitions as a variable for participation outcomes. Physical activity/exercise was the most common movement opportunity. Most publications used formal outcome measures of participation; others used observation or interviews. CONCLUSION: No publications adequately addressed the effect of movement opportunities on participation during developmental transition points.

A Fall Prevention Feasibility Trial for People With HIV and Alcohol Use.

Alcohol contributes to higher fall risk in people living with HIV (PLWH), yet fall prevention trials for PWH with alcohol use are lacking. To assess the feasibility of conducting a randomized controlled trial of a 10-week online fall prevention intervention tailored for PLWH with alcohol use. The intervention consisted of weekly virtual group discussions, individual phone check-ins, and home exercises. Of those eligible, 53.5% (23/43) enrolled (12 to the intervention and 11 to control). Mean age was 58 years; 82.6% had a past 6-month fall; 65.2% had alcohol use disorder; and 95.7% completed postintervention assessments. The intervention was highly rated (Client Satisfaction Questionnaire-8 score M = 30.4, SD = 1.6) with a wide range of group and individual phone session attendance. Preliminary analyses suggest the intervention may reduce the odds of falling and alcohol use frequency. Findings support the feasibility of a larger randomized trial. ClinicalTrials.gov Identifier: NCT04804579.

A fall prevention feasibility trial for people with HIV and alcohol useAlcohol contributes to higher fall risk in people living with HIV (PLWH), yet fall prevention studies for PLWH with alcohol use are lacking. We conducted a 10-week online fall prevention intervention for PLWH (n = 23) with recent alcohol use to assess if the intervention was feasible and acceptable for PLWH. The intervention consisted of weekly virtual group discussions and individual phone check-ins with an occupational therapist and a customized home exercise program. The mean age was 58 years. Almost all fell in the past 6 months (82.6%), had impaired physical functioning (91.3%), and had alcohol use disorder (65.2%). Participants reported high intervention satisfaction. Preliminary analyses suggest that the intervention may reduce the odds of falling and alcohol use frequency. Findings support the feasibility of an online fall prevention intervention study for PLWH.

Factors Mediating or Moderating the Effects of Obesity on Walking: Targeting Areas for Rehabilitation.

Increased physical activity, such as walking, is often prescribed to address obesity. Several factors that may influence the connection between obesity and walking include the biomechanics of gait, pain, depressive symptoms, physical health, and activity. The objective of this study was to assess the moderation and mediation effects of knee pain and buckling, depressive symptoms, physical activity, and physical health on spatiotemporal gait parameters in individuals with obesity. Forty participants with obesity performed a task in which they walked on flat ground and crossed an obstacle. Measures of knee pain and buckling, depressive symptoms, physical activity, and physical health were collected. We conducted mediation analyses with knee buckling and pain as mediators of the effect of the BMI on spatiotemporal gait parameters. Moderation analyses were performed with depressive symptoms, physical activity, and physical health as moderators of the effect of BMI on spatiotemporal gait parameters. We found that depressive symptoms and physical health moderated the relationship between BMI and Step Width in people with obesity. These effects were pronounced when participants crossed an obstacle. In conclusion, depressed mood and physical health influence the relationship between obesity and walking. These factors present potential avenues for rehabilitation interventions to aid individuals with obesity.

Factors contributing to whether or not people with obesity undergo bariatric surgery.

BACKGROUND: Bariatric surgery has been suggested as a safe and effective way to treat obesity by facilitating weight loss, but factors that predict the likelihood of bariatric surgery are unknown. The objective of this study was to describe factors associated with individuals with obesity that influence their decision to undergo bariatric surgery. SUBJECTS AND METHODS: The study design was a cross-sectional study and participants were recruited via a survey link posted on the Obesity Action Coalition website. Demographic data, medical data, weight loss program data, and reports of personal experiences were gathered via an online survey. A multivariate logistic regression model was conducted to examine predictors associated with bariatric surgery (N = 4192). RESULTS: Participants who took phentermine (OR=2.983), Phentermine-topiramate (Qsymia) (OR=2.863), Naltrexone-bupropion (Contrave) (OR=3.246), or Liraglutide (Saxenda) (OR=2.144) had a higher likelihood of undergoing bariatric surgery for weight loss. Participants with type 2 diabetes (OR=1.728), post-traumatic stress disorder (PTSD) (OR=1.489), or COVID-19 (OR=3.852) had a higher likelihood of undergoing bariatric surgery while sleep apnea (OR=0.760) was associated with a lower likelihood of receiving surgery. Those who used MyFitnessPal™ (OR=2.232), Noom™ (OR=1.400), Jenny Craig™ (OR=1.533), or Keto (OR=1.664) for weight loss had a higher likelihood of obtaining bariatric surgery. Personal trauma experiences of sexual abuse (OR=1.982) and physical abuse (OR=1.490) were more associated with participants who underwent surgery. CONCLUSIONS: A variety of characteristics were associated with decisions to undergo bariatric surgery. These findings may help to determine ways to support individuals who are considering bariatric surgery.

Oromotor skills in autism spectrum disorder: A scoping review.

Oromotor functioning plays a foundational role in spoken communication and feeding, two areas of significant difficulty for many autistic individuals. However, despite years of research and established differences in gross and fine motor skills in this population, there is currently no clear consensus regarding the presence or nature of oral motor control deficits in autistic individuals. In this scoping review, we summarize research published between 1994 and 2022 to answer the following research questions: (1) What methods have been used to investigate oromotor functioning in autistic individuals? (2) Which oromotor behaviors have been investigated in this population? and (3) What conclusions can be drawn regarding oromotor skills in this population? Seven online databases were searched resulting in 107 studies meeting our inclusion criteria. Included studies varied widely in sample characteristics, behaviors analyzed, and research methodology. The large majority (81%) of included studies report a significant oromotor abnormality related to speech production, nonspeech oromotor skills, or feeding within a sample of autistic individuals based on age norms or in comparison to a control group. We examine these findings to identify trends, address methodological aspects hindering cross-study synthesis and generalization, and provide suggestions for future research.

The effect of trunk and shank position on the hip-to-knee moment ratio in a bilateral squat.

OBJECTIVES: The effect of knee position on joint moments during squats has been studied; however, the effect of trunk angle has been less well investigated. This study evaluated the effect of both trunk and knee sagittal plane position on the distribution of moments between the hip and knee extensors during the bilateral squat. DESIGN: Observational study. SETTING: Biomechanics laboratory. PARTICIPANTS: One hundred individuals performed bilateral squats. MAIN OUTCOME MEASURES: Motion and force data were collected using motion capture and force plates. Trunk and shank angles and hip and knee moments were calculated. A linear regression was used to associate the ratio between the hip and knee moments (hip-to-knee moment ratio) with the sagittal plane trunk and shank angles, while accounting for six squat depths (between 60° and 110° of knee flexion) and side. RESULTS: Trunk angle and shank angle each contributed to the hip-to-knee moment ratio (P < .001) with trunk accounting for a higher proportion of variance than the other variables. The hip-to-knee moment ratio increased with increasing trunk angle and with decreasing shank angle. CONCLUSIONS: This large cohort study supports the use of trunk position to instruct squat technique with the goal of modifying hip and knee moments.

Study Protocol for a Pilot Randomized Trial of a Virtual Occupational Therapy Fall Prevention Intervention for People With HIV and Alcohol Use.

Background: People living with HIV (PLWH) are at risk for falls due to polypharmacy, unhealthy substance (risky alcohol and/or illicit drug) use, low physical activity, and frailty combined with typical age-related physical changes. Fall prevention is needed to reduce the morbidity related to falls and fractures, however, there is a paucity of data on the design of a fall prevention intervention and whether it can be delivered virtually. We describe the protocol of a pilot randomized trial of a virtual occupational therapy fall prevention intervention for people with HIV at high risk for falls and recent alcohol and/or drug use. Method: PLWH will be recruited from the Boston ARCH 4F Cohort study, an observational study of PLWH to examine the impact of alcohol on falls. Trial participants will be randomized to either an occupational therapy-led fall prevention intervention or provided with written education about fall prevention and alcohol use (control). The 10-week fall prevention intervention was based upon results from qualitative interviews with PLWH about falls and will consist of weekly virtual group sessions, home exercises and phone-check-ins, delivered by occupational therapists. The primary outcome measures will be number of groups attended and a participant-completed satisfaction survey. Change in number of falls, alcohol and other drug use, and physical functioning will be examined. Discussion: A virtual occupational therapy fall prevention intervention addresses the emerging concern of fall risk in PLWH and alcohol use. This pilot study will provide preliminary estimates of fall-related outcomes as well as feasibility of study procedures for a larger trial. ClinicalTrialsgov Identifier: NCT04804579. Boston University Protocol Record H-41041.

Changes in dynamic balance control in adults with obesity across walking speeds.

Adults with obesity have gait instability, leading to increased fall risks and decreased physical activity. Whole-body angular momentum (WBAM) is regulated over a gait cycle, essential to avoid a fall. However, how obese adults regulate WBAM during walking is unknown. The current study investigated changes in WBAM about the body's center of mass (COM) during walking in obese and non-obese adults across different walking speeds. Twenty-eight young adults with obesity and normal weight walked barefoot at a fixed walking speed (FWS, 1.25 m/s) and at five different speeds based on their preferred walking speed (PWS): 50, 75, 100, 125, and 150 % of PWS. Adults with obesity walked slower with shorter step length, wider step width, and longer double support time (p < 0.01). The ranges of frontal- and transverse-plane WBAM were greater in obese adults (p < 0.01). We also found that the range of frontal-plane WBAM did not significantly change with walking speed (p > 0.05), while the range of transverse-plane WBAM increased with walking speed (p < 0.01). The ranges of frontal- and transverse-plane WBAM increased with the mediolateral ground reaction force and mediolateral moment arm (p < 0.01), which may be most affected by lateral foot placement relative to the body's COM. Our findings suggest that controlling mediolateral stability during walking is more challenging in obese adults, independent of their slow walking speed. Understanding whole-body rotational dynamics observed in obese walking provides an insight into the biomechanical link between obesity and gait instability, which may help find a way to reduce fall risks and increase physical activity.

Changes in Gait Self-Efficacy, Fear of Falls, and Gait Four and Eight Months after Bariatric Surgery.

After bariatric surgery, individuals improve walking characteristics related to fall risk. However, little is known about psychosocial factors, such as gait self-efficacy and fear of falling, after surgery. Our objectives were to (1) examine how weight loss affects psychosocial factors and gait four and eight months after bariatric surgery, as well as (2) determine if there is a relationship between gait self-efficacy and fear of falling. Fourteen adults scheduled to undergo bariatric surgery completed three visits: before surgery, four and eight months after surgery. Gait self-efficacy was measured with the Modified Gait Efficacy Scale, and fear of falls was measured with the Tinetti Falls Efficacy Scale. Gait measures were collected during five conditions: initial baseline and final baseline on flat ground, and crossing obstacles of three heights. Gait self-efficacy or fear of falling did not change after surgery. However, both four and eight months after surgery, higher gait self-efficacy and lower fear of falling were correlated with longer and faster steps during all conditions (all ps < 0.05). Focusing interventions on psychosocial measures related to gait may yield longer lasting improvements in walking after surgery, ultimately resulting in a decreased fall risk and higher quality of life.

Neuroimaging Techniques as Descriptive and Diagnostic Tools for Infants at Risk for Autism Spectrum Disorder: A Systematic Review.

Autism Spectrum Disorder (ASD) has traditionally been evaluated and diagnosed via behavioral assessments. However, increasing research suggests that neuroimaging as early as infancy can reliably identify structural and functional differences between autistic and non-autistic brains. The current review provides a systematic overview of imaging approaches used to identify differences between infants at familial risk and without risk and predictive biomarkers. Two primary themes emerged after reviewing the literature: (1) neuroimaging methods can be used to describe structural and functional differences between infants at risk and infants not at risk for ASD (descriptive), and (2) neuroimaging approaches can be used to predict ASD diagnosis among high-risk infants and developmental outcomes beyond infancy (predicting later diagnosis). Combined, the articles highlighted that several neuroimaging studies have identified a variety of neuroanatomical and neurological differences between infants at high and low risk for ASD, and among those who later receive an ASD diagnosis. Incorporating neuroimaging into ASD evaluations alongside traditional behavioral assessments can provide individuals with earlier diagnosis and earlier access to supportive resources.

The effect of obesity on whole-body angular momentum during steady-state walking.

BACKGROUND: Individuals with obesity demonstrate deficits in postural stability, leading to increased fall risks. Controlling whole-body angular momentum is essential for maintaining postural stability during walking and preventing falls. However, it is unknown how obesity impacts whole-body angular momentum during walking. RESEARCH PURPOSE: To investigate the change in angular momentum about the body's COM during walking in individuals with different degrees of obesity. METHODS: Thirty-eight young adults with different body mass index (BMI) scores walked barefoot at their preferred speed on a treadmill for 2 min. The whole-body angular momentum has been quantified from ground reaction force and moment data to capture the rotational behavior of walking in individuals with obesity without relying solely on placing markers on anatomical landmarks. RESULTS: We found that adults with higher BMI scores walked slower with shorter step length, wider step width, and longer double support time (ps<.01). Ranges of the frontal- and transverse-plane angular momentum were greater in adults with higher BMI scores (ps<.01), while no difference was observed between BMI groups in the total sum of changes in whole-body angular momentum in any plane (ps>.05). SIGNIFICANCE: Obesity not only decreased walking speed but also limited the ability to control mediolateral stability during walking. Investigating how obesity affects whole-body angular momentum may help better understand why adults with obesity have atypical gait with poor balance, address fall risk factors, and facilitate participation in physical activities.

Motor Skill, Motor Planning, and Motor Performance in Adults with Severe Mental Illnesses and Obesity.

Motor functioning in persons with serious mental illness (SMI) is not well studied. We assessed motor functioning in people with SMI (n = 15) vs. adults with obesity (n = 15) and healthy controls (n = 15). Motor skills were assessed using balance and coordination tests. Motor planning and performance were assessed in Obstacle and Metronome Walking Tasks. The SMI group scored lower on balance and coordination tests (all ps < 0.001), and took longer steps when approaching obstacles (all ps < 0.001), but had unimpaired motor performance on the Metronome Walking Task. In obesity, excess body mass impairs motor skills, which adversely impacts motor performance. In persons with SMI, motor performance was unimpaired, with cognitive and neuroanatomical abnormalities likely underlying balance, coordination, and motor skill challenges.

Footprint evidence of early hominin locomotor diversity at Laetoli, Tanzania.

Bipedal trackways discovered in 1978 at Laetoli site G, Tanzania and dated to 3.66 million years ago are widely accepted as the oldest unequivocal evidence of obligate bipedalism in the human lineage1-3. Another trackway discovered two years earlier at nearby site A was partially excavated and attributed to a hominin, but curious affinities with bears (ursids) marginalized its importance to the paleoanthropological community, and the location of these footprints fell into obscurity3-5. In 2019, we located, excavated and cleaned the site A trackway, producing a digital archive using 3D photogrammetry and laser scanning. Here we compare the footprints at this site with those of American black bears, chimpanzees and humans, and we show that they resemble those of hominins more than ursids. In fact, the narrow step width corroborates the original interpretation of a small, cross-stepping bipedal hominin. However, the inferred foot proportions, gait parameters and 3D morphologies of footprints at site A are readily distinguished from those at site G, indicating that a minimum of two hominin taxa with different feet and gaits coexisted at Laetoli.

Effects of obesity and foot arch height on gait mechanics: A cross-sectional study.

Foot arch structure contributes to lower-limb joint mechanics and gait in adults with obesity. However, it is not well-known if excessive weight and arch height together affect gait mechanics compared to the effects of excessive weight and arch height alone. The purpose of this study was to determine the influences of arch height and obesity on gait mechanics in adults. In this study, 1) dynamic plantar pressure, 2) spatiotemporal gait parameters, 3) foot progression angle, and 4) ankle and knee joint angles and moments were collected in adults with normal weight with normal arch heights (n = 11), normal weight with lower arch heights (n = 10), obesity with normal arch heights (n = 8), and obesity with lower arch heights (n = 18) as they walked at their preferred speed and at a pedestrian standard walking speed, 1.25 m/s. Digital foot pressure data were used to compute a measure of arch height, the Chippaux-Smirak Index (CSI). Our results revealed that BMI and arch height were each associated with particular measures of ankle and knee joint mechanics during walking in healthy young adults: (i) a higher BMI with greater peak internal ankle plantar-flexion moment and (ii) a lower arch height with greater peak internal ankle eversion and abduction moments and peak internal knee abduction moment (i.e., external knee adduction moment). Our results have implications for understanding the role of arch height in reducing musculoskeletal injury risks, improving gait, and increasing physical activity for people living with obesity.

Association between the Functional Gait Assessment and spatiotemporal gait parameters in individuals with obesity compared to normal weight controls: A proof-of-concept study.

OBJECTIVES: Obesity is a significant global health concern that involves motor impairment, including deficits in gait and balance. A simple tool would be useful to capture gait and balance impairment in obesity. We assessed whether the Functional Gait Assessment (FGA) captures impairment in individuals with obese BMI (≥30 kg/m2) and whether impairment was related to spatiotemporal gait parameters. METHODS: Fourteen individuals with obese BMI and twenty individuals of normal weight underwent the FGA. Spatiotemporal gait parameters were collected while participants walked on a pressure sensitive walkway under five conditions: pre-baseline (flat ground walking), crossing small, medium, and high obstacles, and final-baseline (flat ground walking). RESULTS: Individuals with obesity had lower scores on the FGA (p≤0.001) and showed less efficient spatiotemporal gait parameters than healthy controls, particularly when crossing over obstacles (all ps≤0.05). For participants with obesity, lower FGA scores were associated with decreased gait velocity, but only during obstacle crossing (p≤0.05). CONCLUSIONS: The FGA may be a useful tool to capture gait impairment in populations with obesity. Obstacles may help reveal meaningful gait impairments. To our knowledge, this is the first study to examine the FGA in individuals with obesity, and represents a proof-of-concept that motivates further validation studies.

Temporal accuracy of gait after metronome practice.

Humans readily entrain their movements to a beat, including matching their gait to a prescribed tempo. Rhythmic auditory cueing tasks have been used to enhance stepping behavior in a variety of clinical populations. However, there is limited understanding of how temporal accuracy of gait changes over practice in healthy young adults. In this study, we examined how inter-step interval and cadence deviated from slow, medium, and fast tempos across steps within trials, across trials within blocks, and across two blocks that bookended a period of practice of walking to each tempo. Participants were accurate in matching the tempo at the slow and medium tempos, while they tended to lag behind the beat at the fast tempo. We also found that participants showed no substantial improvement across steps and trials, nor across blocks, suggesting that participants had a robust ability to entrain their gait to the specified metronome tempo. However, we did find that participants habituated to the prescribed tempo, showing self-paced gait that was faster than self-paced baseline gait after the fast tempo, and slower than self-paced baseline gait after the slow tempo. These findings might represent an "after-effect" in the temporal domain, akin to after-effects consistently shown in other sensorimotor tasks. This knowledge of how healthy participants entrain their gait to temporal cues may have important implications in understanding how clinical populations acquire and modify their gait in rhythmic auditory cueing tasks.

Pivoting in Context: Using the Forging Alliances in Interdisciplinary Rehabilitation Research Model to Collaborate During COVID-19.

ABSTRACT: With the onset of the COVID-19 pandemic, researchers have been faced with challenges in maintaining interdisciplinary research collaborations. The purpose of this article is to apply and expand a previously introduced model to sustaining new interdisciplinary research collaborations: Forging Alliances in Interdisciplinary Rehabilitation Research (FAIRR). FAIRR is a logic model that can be used as a guide to create interdisciplinary rehabilitation research teams. In this article, the authors propose expanding FAIRR by including strategies for sustaining interdisciplinary rehabilitation research collaborations: modifying inputs (resources needed to assemble a team and to conduct research activities), shifting activities (steps taken to move the interdisciplinary collaboration forward), and examining what impacts the fit between inputs and activities. Two examples are used to highlight the application of the FAIRR model to interdisciplinary collaborations during COVID-19.

Effort-Based Decision-Making and Gross Motor Performance: Are They Linked?

The purpose of this study was to investigate the relationship between effort-based decision making and gross motor performance. Effort-based decision making was measured using a modified version of the Effort Expenditure for Rewards Task (EEfRT), in which participants pressed a button on a keyboard to fill a bar on a screen for monetary reward. Participants received monetary rewards that were commensurate with the level of effort that they were willing to expend. Gross motor performance was measured with a walking task, in which participants matched their steps to the beat of an audio metronome; they walked to metronome beats that were slower and also faster than their normal walking pace. We hypothesized that increased effort during the effort-based decision making task would be paired with an increase in steps taken per minute during the gross motor task. However, the results of this study indicated a lack of a statistically significant relationship between the effort-based decision making task and the gross motor task. Planning rather than decision-making may have been the cognitive construct that governed our gross motor task. These findings can be beneficial when thinking about potential interventions for populations who experience deficits in motor performance and cognition as well as for understanding the relationship between both cognitive and motor performance in healthy adults.

Changes in center of pressure velocities during obstacle crossing one year after bariatric surgery.

Adults with obesity have atypical gait with poor balance leading to an increase in fall risk. After massive weight loss, their gait improves. However, we know little about changes in postural stability after massive weight loss. The present study aimed to examine how massive weight loss after Roux-en-Y bariatric surgery affected adjustments in center of pressure (COP) velocities during flat ground walking and obstacle crossing. Before and one-year post-bariatric surgery, nineteen female adults walked under four conditions: baseline walking on flat ground and obstacle crossing with three different obstacle heights for a total of 20 trials. COP data were obtained from raw pressure time series data extracted from a gait carpet. Massive weight loss increased anteroposterior COP velocities under the midfoot of both trailing and leading legs (ps<.01) and decreased mediolateral COP velocities under the forefoot of trailing leg (p < .05). Decreased BMI from pre- to post-surgery was correlated with an increase in anterior-posterior and decrease in medial-lateral COP velocities and with increased velocity (ps<.05). Massive weight loss not only improved gait but also facilitated effective balance control strategies. Examining how massive weight loss affects adjustments in COP velocity may help create ways to better understand why individuals with obesity have atypical gait with poor balance and how we can facilitate participation in physical activities.

Effects of obesity class on flat ground walking and obstacle negotiation.

OBJECTIVES: Although much is known about the impact of obesity on gait, not much is understood about how classes of obesity affect movement. The purpose of this study was to examine the effects of weight classification on walking. METHODS: Sixty-seven women with normal BMI (n=13), overweight/Class I obesity (n=18), Class II obesity (n=16), and Class III obesity (n=20) participated. Gait parameters (velocity and percent of the gait cycle spent in swing and stance phases) were collected as participants walked on flat ground and crossed three obstacle heights. RESULTS: Adults with normal BMI had faster velocities (F(3,63)=12.60, p=.000017), shorter portions of the gait cycle spent in stance (F(3,62)=7.29, p=.00029), and a larger percent of the gait cycle spent in swing than those with higher BMI scores (F(3,62)=5.43, p=.002). Adults with overweight/Class I obesity had faster velocities than those with Class III obesity (p=.000082, d=1.20) as well as less variable velocities than those with Class II (p=.002, d=-.40) and Class III (p=.01, d=-1.0) obesity. No differences in velocity were found between those with Class II and Class III obesity (p=.12, d=.57). CONCLUSIONS: These results suggest the need to encourage adults to decrease overweight/Class I obesity but that an equally important goal is to prevent an increase in BMI leading to Class II obesity.