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1.
Phys Ther ; 101(1)2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-33395476

RESUMEN

OBJECTIVE: Mobilization while receiving life support interventions, including mechanical ventilation and extracorporeal membrane oxygenation (ECMO), is a recommended intensive care unit (ICU) intervention to maintain physical function. The purpose of this case report is to describe a novel approach to implementing early mobility interventions for a patient who was pregnant and receiving ECMO while continuing necessary infectious disease precautions because of diagnosed coronavirus disease-19 (COVID-19). METHODS: A 27-year-old woman who was pregnant was admitted to the ICU with COVID-19 and rapidly developed acute respiratory failure requiring 9 days of ECMO support. After a physical therapist consultation, the patient was standing at the bedside by hospital day 5 and ambulating by hospital day 9. RESULTS: The patient safely participated in physical therapy during ICU admission and was discharged to home with outpatient physical therapy follow-up after 14 days of hospitalization. CONCLUSION: Early mobility is feasible during ECMO with COVID-19, and active participation in physical therapy, including in-room ambulation, may facilitate discharge to home. Innovative strategies to facilitate routine activity in a patient who is critically ill with COVID-19 require an established and highly trained team with a focus on maintaining function. IMPACT: Early mobility while intubated, on ECMO, and infected with COVID-19 is feasible while adhering to infectious disease precautions when it is performed by an experienced interdisciplinary team.


Asunto(s)
/terapia , Oxigenación por Membrana Extracorpórea , Modalidades de Fisioterapia , Complicaciones Infecciosas del Embarazo/terapia , Caminata/fisiología , Adulto , Femenino , Humanos , Embarazo
2.
Phys Ther ; 101(1)2021 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-32986836

RESUMEN

OBJECTIVE: For patients diagnosed with the novel coronavirus, COVID-19, evidence is needed to understand the effect of treatment by physical therapists in the acute hospital on patient outcomes. The primary aims of this study were to examine the relationship of physical therapy visit frequency and duration in the hospital with patients' mobility status at discharge and probability of discharging home. METHODS: This retrospective study included patients with COVID-19 admitted to any of 11 hospitals in 1 health system. The primary outcome was mobility status at discharge, measured using the Activity Measure for Post-Acute Care 6-Clicks basic mobility (6-Clicks mobility) and the Johns Hopkins Highest Level of Mobility scales. Discharge to home versus to a facility was a secondary outcome. Associations between these outcomes and physical therapy visit frequency or mean duration were tested using multiple linear or modified Poisson regression. Potential moderation of these relationships by particular patient characteristics was examined using interaction terms in subsequent regression models. RESULTS: For the 312 patients included, increased physical therapy visit frequency was associated with higher 6-Clicks mobility (b = 3.63; 95% CI, 1.54-5.71) and Johns Hopkins Highest Level of Mobility scores (b = 1.15; 95% CI, 0.37-1.93) at hospital discharge and with increased probability of discharging home (adjusted relative risk = 1.82; 95% CI, 1.25-2.63). Longer mean visit duration was also associated with improved mobility at discharge and the probability of discharging home, though the effects were less pronounced. Few moderation effects were observed. CONCLUSION: Patients with COVID-19 demonstrated improved mobility at hospital discharge and higher probability of discharging home with increased frequency and longer mean duration of physical therapy visits. These associations were not generally moderated by patient characteristics. IMPACT: Physical therapy should be an integral component of care for patients hospitalized due to COVID-19. Providing sufficient physical therapist interventions to improve outcomes must be balanced against protection from viral spread. LAY SUMMARY: Patients with COVID-19 can benefit from more frequent and longer physical therapy visits in the hospital.


Asunto(s)
/fisiopatología , Alta del Paciente , Modalidades de Fisioterapia , Caminata/fisiología , Actividades Cotidianas , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Factores de Tiempo
3.
Nat Commun ; 11(1): 6166, 2020 12 02.
Artículo en Inglés | MEDLINE | ID: mdl-33268800

RESUMEN

How do descending inputs from the brain control leg motor circuits to change how an animal walks? Conceptually, descending neurons are thought to function either as command-type neurons, in which a single type of descending neuron exerts a high-level control to elicit a coordinated change in motor output, or through a population coding mechanism, whereby a group of neurons, each with local effects, act in combination to elicit a global motor response. The Drosophila Moonwalker Descending Neurons (MDNs), which alter leg motor circuit dynamics so that the fly walks backwards, exemplify the command-type mechanism. Here, we identify several dozen MDN target neurons within the leg motor circuits, and show that two of them mediate distinct and highly-specific changes in leg muscle activity during backward walking: LBL40 neurons provide the hindleg power stroke during stance phase; LUL130 neurons lift the legs at the end of stance to initiate swing. Through these two effector neurons, MDN directly controls both the stance and swing phases of the backward stepping cycle. These findings suggest that command-type descending neurons can also operate through the distributed control of local motor circuits.


Asunto(s)
Encéfalo/fisiología , Drosophila melanogaster/fisiología , Neuronas Motoras/fisiología , Red Nerviosa/fisiología , Caminata/fisiología , Animales , Fenómenos Biomecánicos , Encéfalo/citología , Drosophila melanogaster/citología , Femenino , Neuronas Motoras/citología , Músculos/inervación , Músculos/fisiología
4.
PLoS One ; 15(11): e0241187, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33151936

RESUMEN

OBJECTIVE: We sought to identify seasonal variation in physical activity that different physical activity measurement tools can capture in children with congenital heart disease. METHODS: Data were collected as part of a prospective cohort study at BC Children's Hospital, Vancouver, Canada. Daily step counts of children aged 9-16 years with moderate-to-severe CHD were assessed continuously for 1-year via a commercial activity tracker (Fitbit Charge 2™). Physical activity levels were also assessed conventionally at one time-point via accelerometers (ActiGraph) and physical activity questionnaires. RESULTS: 156 children (mean age 12.7±2.4 years; 42% female) participated in the study. Fitbit data (n = 96) over a 1-year period clearly illustrated seasonal peaks (late spring and autumn) and dips (winter and summer school holidays) in physical activity levels, with group mean values being below 12,000 steps per day throughout the year. According to conventional accelerometry data (n = 142), 26% met guidelines, which tended to differ according to season of measurement (spring: 39%, summer: 11%, fall: 20%, winter: 39%; p-value = 0.053). Questionnaire data (n = 134) identified that the most widely reported activities were walking (81%) and running (78%) with walking being the highest in summer and fall and running in winter and spring. Furthermore, regardless of overall activity levels the children exhibit similar seasonal variation. CONCLUSIONS: We demonstrated that physical activity level changes across seasons in children with CHD. It is important to be aware of these fluctuations when assessing and interpreting physical activity levels. Season specific counselling for physical activity may be beneficial in a clinical setting.


Asunto(s)
Ejercicio Físico/fisiología , Cardiopatías Congénitas/fisiopatología , Acelerometría/métodos , Adolescente , Canadá , Niño , Clima , Femenino , Monitores de Ejercicio , Humanos , Masculino , Actividad Motora/fisiología , Estudios Prospectivos , Instituciones Académicas , Estaciones del Año , Encuestas y Cuestionarios , Caminata/fisiología
5.
Medicine (Baltimore) ; 99(47): e22735, 2020 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-33217794

RESUMEN

INTRODUCTION: Hyperglycemia is closely associated with the occurrence of diabetic complications, especially for patients with type 2 diabetes mellitus. Clinical trials indicated that walking exercise could improve glycemic control in patients with type 2 diabetes mellitus, but it is difficult to draw definitive and reliable conclusions due to the small sample size and possible exaggerated efficacy of various individual clinical trials. Therefore, we will conduct systematic review and meta-analysis to assess the current evidence for the efficacy of walking on glycemic control. METHODS AND ANALYSIS: The databases of PubMed, EMBASE, Web of Science and Cochrane Library will be searched for this review. Cochrane risk-of-bias assessment tool will be applied to assess the risk of bias of included studies. A meta-analysis will be performed according to the Cochrane Handbook for Systematic Reviews of Interventions by using RevMan 5.3 and STATA/SE 14.0 software. Subgroup analysis will be conducted to investigate the sources of heterogeneity. Sensitivity analysis will be performed to assess the reliability and stability of the meta-analysis. Publication bias and small-study effects will be evaluated by a funnel plot and Eggers test if there are at least 10 studies. Additionally, the quality of evidence for this review will be assessed by Grades of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: This systematic review and meta-analysis will be to assess the efficacy of walking exercise on glycemic control. CONCLUSION: We will provide strong evidence to determine whether walking can improve glycemic control in patients with type 2 diabetes mellitus. This study is supposed to provide references for clinical trials and patients with type 2 diabetes mellitus. ETHICS AND DISSEMINATION: This study does not require ethical approval. The results of this review will be published in a peer reviewed journal. INPLASY REGISTRATION NUMBER: INPLASY202090046.


Asunto(s)
Glucemia/análisis , Diabetes Mellitus Tipo 2/terapia , Proyectos de Investigación , Caminata/fisiología , Estudios Cruzados , Humanos , Metaanálisis como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Revisiones Sistemáticas como Asunto
6.
PLoS One ; 15(11): e0242000, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33170866

RESUMEN

We studied the use of powered ankle-foot orthoses (PAFOs) and walking stability of the wearers, focusing on the ankle joint, which is known to play a critical role in gait stability. Recognizing that the subtalar joint is an important modulator of walking stability, we conducted the walking experiment on a treadmill by applying varying assistance techniques to the 2-degree-of-freedom (DOF) PAFO, which has the subtalar joint as the rotating axis, and the commonly used 1-DOF PAFO. The participants were 8 healthy men (mean±SD: height, 174.8±7.1 cm; weight, 69.8±6.5 kg; and age, 29.1±4.8 years) with no history of gait abnormality. Center of pressure (COP) was measured with an in-shoe pressure sensor, and stability was estimated on the basis of the angular acceleration measured with the inertial measurement unit attached to the trunk. The experimental results of the 2-DOF PAFO, with or without assistance, showed a significantly higher stability than those of the 1-DOF PAFO (up to 23.78%, p<0.0326). With the 1-DOF PAFO, the stability deteriorated with the increase in the degree of assistance provided. With the 2-DOF PAFO, this tendency was not observed. Thus, the importance of the subtalar joint was proven using PAFOs. The mean position analysis of the COP during the stance phase confirmed that the COP highly correlated with stability (Pearson correlation coefficient: -0.6607). Thus, we conclude that only the 2-DOF PAFO can maintain walking stability, regardless of the assistance characteristics, by preserving the COP in the medial position through eversion. Awareness regarding the role of the subtalar joint is necessary during the manufacture or use of PAFOs, as lack of awareness could lead to the degradation of the wearer's gait stability, regardless of effective assistance, and deteriorate the fundamental functionality of PAFO.


Asunto(s)
Articulación del Tobillo/fisiología , Diseño de Equipo/métodos , Marcha/fisiología , Adulto , Tobillo/fisiología , Fenómenos Biomecánicos , Dispositivo Exoesqueleto/tendencias , Pie/fisiología , Ortesis del Pié/tendencias , Humanos , Masculino , Zapatos , Caminata/fisiología
7.
PLoS Biol ; 18(11): e3000738, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33186352

RESUMEN

The central pattern generator (CPG) for locomotion is a set of pacemaker neurons endowed with inherent bursting driven by the persistent sodium current (INaP). How they proceed to regulate the locomotor rhythm remained unknown. Here, in neonatal rodents, we identified a persistent potassium current critical in regulating pacemakers and locomotion speed. This current recapitulates features of the M-current (IM): a subthreshold noninactivating outward current blocked by 10,10-bis(4-pyridinylmethyl)-9(10H)-anthracenone dihydrochloride (XE991) and enhanced by N-(2-chloro-5-pyrimidinyl)-3,4-difluorobenzamide (ICA73). Immunostaining and mutant mice highlight an important role of Kv7.2-containing channels in mediating IM. Pharmacological modulation of IM regulates the emergence and the frequency regime of both pacemaker and CPG activities and controls the speed of locomotion. Computational models captured these results and showed how an interplay between IM and INaP endows the locomotor CPG with rhythmogenic properties. Overall, this study provides fundamental insights into how IM and INaP work in tandem to set the speed of locomotion.


Asunto(s)
Generadores de Patrones Centrales/metabolismo , Canal de Potasio KCNQ2/metabolismo , Locomoción/fisiología , Animales , Animales Recién Nacidos/metabolismo , Animales Recién Nacidos/fisiología , Antracenos/farmacología , Generadores de Patrones Centrales/fisiología , Canal de Potasio KCNQ2/genética , Masculino , Ratones Endogámicos C57BL , Neuronas Motoras/metabolismo , Neuronas Motoras/fisiología , Neuronas/fisiología , Potasio/metabolismo , Canales de Potasio/metabolismo , Ratas , Ratas Wistar , Sodio/metabolismo , Canales de Sodio/metabolismo , Canales de Sodio/fisiología , Médula Espinal/fisiología , Caminata/fisiología
8.
PLoS One ; 15(11): e0242369, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33216780

RESUMEN

China General Administration of Sport has published and adopted the National Physical Fitness Measurement (NPFM-preschool children version) since 2000. However, studies on intraday reliability, sensitivity, and minimum detectable change (MDC) are lacking. This study aimed to investigate and compare the reliability, sensitivity, and MDC values of NPFM in preschool children between the ages of 3.5 to 6 years. Six items of NPFM including 10-m shuttle run, standing long jump, balance beam walking, sit-and-reach, tennis throwing, and double-leg timed hop, were tested for 209 Chinese kindergarten children in Beijing in the morning. Intraday relative reliability was tested using intraclass correlation coefficient (ICC3,1) with a 95% confidence interval while absolute reliability was expressed in standard error of measurement (SEM) and percentage of coefficient of variation (CV%). Test sensitivity was assessed by comparing the smallest worthwhile change (SWC) with SEM, while MDC values with 95% confidence interval (MDC95) were established. Measurements in most groups, except 10-m shuttle run test (ICC3,1: 0.56 to 0.74 [moderate]) in the 3.5 to 5.5-year-old groups, balance beam test in 4- and 5-year-old (ICC3,1: 0.33 to 0.35 [poor]) and 5.5-year-old (ICC3,1 = 0.68 [moderate]) groups, and double-leg timed hop test (ICC3,1 = 0.67 [moderate]) in the 4.5-year-old group, demonstrated good to excellent relative reliability (ICC3,1: 0.77 to 0.97). The balance beam walking test showed poor absolute reliability in all the groups (SEM%: 11.76 to 22.28 and CV%: 15.40 to 24.78). Both standing long jump and sit-and-reach tests demonstrated good sensitivity (SWC > SEM) in all subjects group, boys, and girls. Pairwise comparison revealed systematic bias with significantly better performance in the second trial (p<0.01) of all the tests with moderate to large effect size.


Asunto(s)
Prueba de Esfuerzo/métodos , Aptitud Física/fisiología , Beijing , Niño , Preescolar , China , Femenino , Humanos , Masculino , Equilibrio Postural/fisiología , Carrera/fisiología , Caminata/fisiología
9.
PLoS One ; 15(11): e0239787, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33237916

RESUMEN

This systematic review evaluated the literature pertaining to the effect of shoes on lower limb venous status in asymptomatic populations during gait or exercise. The review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed-NCBI, EBSCO Host, Cochrane Library and Science Direct databases were searched (March 2019) for words around two concepts: shoes and venous parameters. The inclusion criteria were as follows: (1) the manuscript had to be published in an English-language peer-reviewed journal and the study had to be observational or experimental and (2) the study had to suggest the analysis of many types of shoes or orthotics on venous parameters before, during and/or after exercise. Out of 366 articles, 60 duplications were identified, 306 articles were analyzed, and 13 articles met the eligibility criteria after screening and were included. This review including approximately 211 participants. The methodological rigor of these studies was evaluated with the modified Downs and Black quality index. Nine studies investigated the effect of shoes on blood flow parameters, two on venous pressure and two on lower limb circumferences with exercise. Evidence was found that unstable shoes or shoes with similar technology, sandals, athletic or soft shoes, and customized foot orthotics elicited more improvement in venous variables than high-heeled shoes, firm shoes, ankle joint immobilization and barefoot condition. These venous changes are probably related to the efficiency of muscle pumps in the lower limbs, which in turn seem to be dependent on shoe features associated with changes in the kinetics, kinematics and muscle activity variables in lower limbs during gait and exercise.


Asunto(s)
Ortesis del Pié/efectos adversos , Extremidad Inferior/irrigación sanguínea , Sistema Musculoesquelético/irrigación sanguínea , Flujo Sanguíneo Regional/fisiología , Zapatos/efectos adversos , Fenómenos Biomecánicos , Marcha/fisiología , Humanos , Fenómenos Fisiológicos Musculoesqueléticos , Rango del Movimiento Articular/fisiología , Caminata/fisiología
10.
Sci Rep ; 10(1): 17159, 2020 10 13.
Artículo en Inglés | MEDLINE | ID: mdl-33051502

RESUMEN

Most human movement research takes place within controlled laboratories where researchers observe participant movement. Because a majority of daily activity is performed without observation, we hypothesized movement within a laboratory would vary when there was a small, large or absence of research group. We also hypothesized that personality type would influence movement during observation. Participants completed a personality questionnaire, then walked in a laboratory during three different conditions: no research group (no researchers), small research group (2 researchers), and large research group (6-10 researchers). Results revealed spatiotemporal parameters were altered between conditions, however personality type did not influence changes in movement. As the number of researchers increased, gait speed, cadence, and stride length increased, and step duration decreased. Gait speed increased by .03 m/s from the no research group to the small research group, by .06 m/s from the no research group to the large research group, and by .03 m/s from the small to large research group (all p values < .001). Understanding how researcher observation modifies movement is important and affects the replicability of results, as well as the interpretation of laboratory-based movement studies to activities of daily living in real world settings.


Asunto(s)
Marcha/fisiología , Caminata/fisiología , Actividades Cotidianas , Adulto , Femenino , Humanos , Masculino , Velocidad al Caminar/fisiología , Adulto Joven
11.
PLoS One ; 15(10): e0240509, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33052969

RESUMEN

PURPOSE: To evaluate see-through Augmented Reality Digital spectacles (AR DSpecs) for improving the mobility of patients with peripheral visual field (VF) losses when tested on a walking track. DESIGN: Prospective Case Series. PARTICIPANTS: 21 patients with peripheral VF defects in both eyes, with the physical ability to walk without assistance. METHODS: We developed the AR DSpecs as a wearable VF aid with an augmented reality platform. Image remapping algorithms produced personalized visual augmentation in real time based on the measured binocular VF with the AR DSpecs calibration mode. We tested the device on a walking track to determine if patients could more accurately identify peripheral objects. MAIN OUTCOME MEASURES: We analyzed walking track scores (number of recognized/avoided objects) and eye tracking data (six gaze parameters) to measure changes in the kinematic and eye scanning behaviors while walking, and assessed a possible placebo effect by deactivating the AR DSpecs remapping algorithms in random trials. RESULTS: Performance, judged by the object detection scores, improved with the AR DSpecs (P<0.001, Wilcoxon rank sum test) with an average improvement rate of 18.81%. Two gaze parameters improved with the activated algorithm (P<0.01, paired t-test), indicating a more directed gaze on the central path with less eye scanning. Determination of the binocular integrated VF with the DSpecs correlated with the integrated standard automated perimetry (R = 0.86, P<0.001), mean sensitivity difference 0.8 ± 2.25 dB (Bland-Altman). CONCLUSIONS: AR DSpecs may improve walking maneuverability of patients with peripheral VF defects by enhancing detection of objects in a testing environment.


Asunto(s)
Trastornos de la Visión/rehabilitación , Campos Visuales/fisiología , Caminata/fisiología , Algoritmos , Anteojos , Femenino , Humanos , Masculino , Estudios Prospectivos , Realidad Virtual , Trastornos de la Visión/fisiopatología , Pruebas del Campo Visual
12.
PLoS One ; 15(10): e0239203, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33112909

RESUMEN

BACKGROUND: There currently is no field test available for measuring maximal exercise capacity in people with stroke. OBJECTIVE: To determine the feasibility, reproducibility and validity of the Shuttle Test (ST) to measure exercise capacity in people with stroke. DESIGN: Longitudinal study design. SETTING: Rehabilitation department, day care centres from a nursing home and private practices specialized in neuro rehabilitation. SUBJECTS: People with subacute or chronic stroke. INTERVENTIONS: A standardized protocol was used to determine feasibility, reproducibility and validity of the 10-meter Shuttle Test (10mST). MAIN MEASURES: Number of shuttles completed, 1stVentilatory Threshold (1stVT). RESULTS: The associations of the number of shuttles completed and cardiopulmonary capacity as measured with a portable gas analyser were r > 0.7, confirming good convergent validity in subacute and chronic people with stroke. Criterion validity, however, indicates it is not a valid test for measuring maximal cardiopulmonary capacity (VO2max). Only 60% of participants were able to reach the 1stVT. Higher cardiopulmonary capacity and a higher total score of the lower extremity Motricity Index contributed significantly to a higher number of shuttles walked (p = 0.001). CONCLUSIONS: The Shuttle Test may be a safe and useful exercise test for people after stroke, but may not be appropriate for use with people who walk slower than 2 km/h or 0.56 m/s.


Asunto(s)
Prueba de Esfuerzo/métodos , Tolerancia al Ejercicio/fisiología , Accidente Cerebrovascular/fisiopatología , Anciano , Anciano de 80 o más Años , Umbral Anaerobio , Prueba de Esfuerzo/estadística & datos numéricos , Estudios de Factibilidad , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Países Bajos , Consumo de Oxígeno , Reproducibilidad de los Resultados , Rehabilitación de Accidente Cerebrovascular , Caminata/fisiología
13.
PLoS One ; 15(10): e0241339, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33095823

RESUMEN

Studies have shown that human gait entrains to rhythmic bursts of ankle torque for perturbation intervals both slightly shorter and slightly longer than the natural stride period while walking on a treadmill and during overground walking, with phase alignment such that the torque adds to ankle push-off. This study investigated whether human gait also entrains to align the phase of rhythmic electrical stimulation of the gastrocnemius muscle with the timing of ankle push-off. In addition, this study investigated the muscle response to electrical stimulation at different phases of the gait cycle. We found that for both treadmill and overground walking entrainment was observed with phasing that aligned the stimuli with ankle push-off or just before foot contact. Achilles tendon wave speed measurements showed a significant difference (increase) in tendon load when electrical stimulation was applied just after foot contact and during swing phase, with a greater increase for higher amplitudes of electrical stimulation. However, stimulation did not increase tendon load when the timing coincided with push-off. Stride period measurements also suggest the effect of electrical stimulation is sensitive to the gait phase it is applied. These results confirmed that timing aligned with push-off is an attractor for electrical stimulation-induced perturbations of the medial gastrocnemius, and that the muscle response to stimulation is sensitive to timing and amplitude. Future research should investigate other muscles and timings and separate sensory vs. motor contributions to these phenomena.


Asunto(s)
Marcha/fisiología , Voluntarios Sanos , Músculo Esquelético/fisiología , Tendón Calcáneo/fisiología , Fenómenos Biomecánicos , Estimulación Eléctrica , Femenino , Humanos , Caminata/fisiología
14.
PLoS One ; 15(10): e0240267, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33085673

RESUMEN

We propose a modular architecture for neuromorphic closed-loop control based on bistable relaxation oscillator modules consisting of three spiking neurons each. Like its biological prototypes, this basic component is robust to parameter variation but can be modulated by external inputs. By combining these modules, we can construct a neural state machine capable of generating the cyclic or repetitive behaviors necessary for legged locomotion. A concrete case study for the approach is provided by a modular robot constructed from flexible plastic volumetric pixels, in which we produce a forward crawling gait entrained to the natural frequency of the robot by a minimal system of twelve neurons organized into four modules.


Asunto(s)
Marcha/fisiología , Redes Neurales de la Computación , Robótica , Algoritmos , Animales , Humanos , Locomoción/fisiología , Modelos Neurológicos , Neuronas/citología , Neuronas/fisiología , Caminata/fisiología
15.
PLoS One ; 15(9): e0239162, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32956408

RESUMEN

Our primary aim was to explore the development of player load throughout match time (i.e., the pattern) using moving 5-min windows in an elite soccer team and our secondary aim was to compare player load patterns between different positions within the same team. The dataset included domestic home matches (n = 34) over three seasons for a Norwegian Elite League team. Player movements (mean ± SD age 25.5 ± 4.2 years, height 183.6 ± 6.6 cm, body mass 78.9 ± 7.4 kg) were recorded at 20 Hz using body-worn sensors. Data for each variable (player load, player load per meter, total distance, accelerations, decelerations, sprint distance, high-intensity running distance) were averaged within positions in each match, converted to z-scores and averaged across all matches, yielding one time series for each variable for each position. Pattern similarity between positions was assessed with cross-correlations. Overall, we observed a distinct pattern in player load throughout match time, which also occurred in the majority of individual matches. The pattern shows peaks at regular intervals (~15 min), each followed by a period of lower load, declining until the next peak. The same pattern was evident in player load per meter. The cross-correlation analyses support the visual evidence, with correlations ranging 0.88-0.97 (p < .001) in all position pairs. In contrast, no specific patterns were discernible in total distance, accelerations, decelerations, sprint distance and high-intensity running distance, with cross-correlations ranging 0.65-0.89 (p < .001), 0.32-0.64 (p < .005), 0.18-0.65 (p < .005 in nine position pairs), 0.02-0.38 (p < .05 in three pairs) and 0.01-0.52 (p < .05 in three pairs), respectively. This study demonstrated similarity in player load patterns between both matches and positions in elite soccer competition, which could indicate a physical "pacing pattern" employed by the team.


Asunto(s)
Atletas/estadística & datos numéricos , Carrera/estadística & datos numéricos , Fútbol/estadística & datos numéricos , Posición de Pie , Caminata/estadística & datos numéricos , Adulto , Rendimiento Atlético/fisiología , Rendimiento Atlético/estadística & datos numéricos , Conjuntos de Datos como Asunto , Humanos , Masculino , Noruega , Carrera/fisiología , Fútbol/fisiología , Caminata/fisiología , Adulto Joven
16.
J Pediatr Orthop ; 40(9): e818-e821, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32931689

RESUMEN

BACKGROUND: The 6-minute walk test (6MWT) is used to assess the function of cardiopulmonary and neuromuscular conditions in adults and children. The primary research question was to determine the relationship between 6MWT distance and forced vital capacity (FVC) and the major curve among children with congenital scoliosis with rib anomalies. METHODS: The authors recorded 6MWT distance in meters, FVC as a percentage of predicted normal value using arm span for height (FVC%), and Cobb angle in 20 children (13 girls; average age, 6.7±1.3 y) with congenital scoliosis before outpatient surgical treatment. The 6MWT uses a standardized protocol and measures distance traveled in 6 minutes on a flat surface. The authors then determined the correlation between these measures using linear regression analysis. RESULTS: The Cobb angle of the major curvature was 55.4±20.5 degrees. The type of vertebral anomaly was mixed in 17 cases, formation failure in 2 cases, and segmentation failure in 1 case. The range of rib anomalies was 3.4±3.9 levels; 15 and 5 patients, respectively, had unilateral and bilateral rib anomalies. FVC and FVC% were 0.7±0.2 L and 60%±19%, respectively. The ratio of forced expiratory volume at 1 second to FVC (FEV1/FVC), which indicates obstructive lung disease, was normal at 93%±7%. The 6MWT distance was 386.3±59.4 m, which was ≤10% of the predicted distance for normal children. No child was able to walk the normal distance on the basis of published norms. 6MWT distance was significantly correlated with arm span (ρ=0.46, P=0.04) and major curve (ρ=-0.61, P=0.004), but not with FVC% (ρ=0.17, P=0.49). CONCLUSIONS: The 6MWT distance is a feasible measure of function and is substantially reduced before surgery in children with thoracic congenital scoliosis with rib anomalies. The 6MWT distance was significantly correlated with a major curve but not with FVC%. 6MWT distance is not affected by moderate lung function impairment. LEVEL OF EVIDENCE: Level IV-retrospective cohort study.


Asunto(s)
Escoliosis/congénito , Prueba de Paso , Caminata/fisiología , Niño , Preescolar , Femenino , Volumen Espiratorio Forzado , Humanos , Modelos Lineales , Masculino , Periodo Preoperatorio , Radiografía , Estudios Retrospectivos , Escoliosis/diagnóstico por imagen , Escoliosis/fisiopatología , Escoliosis/cirugía , Capacidad Vital
17.
Stroke ; 51(10): 3074-3082, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32883192

RESUMEN

BACKGROUND AND PURPOSE: Previous data suggest patient demographics and clinical presentation are primary predictors of motor recovery poststroke, with minimal contributions of physical interventions. Other studies indicate consistent associations between the amount and intensity of stepping practice with locomotor outcomes. The goal of this study was to determine the relative contributions of these combined variables to locomotor outcomes poststroke across a range of patient demographics and baseline function. METHODS: Data were pooled from 3 separate trials evaluating the efficacy of high-intensity training, low-intensity training, and conventional interventions. Demographics, clinical characteristics, and training activities from 144 participants >1-month poststroke were included in stepwise regression analyses to determine their relative contributions to locomotor outcomes. Subsequent latent profile analyses evaluated differences in classes of participants based on their responses to interventions. RESULTS: Stepwise regressions indicate primary contributions of stepping activity on locomotor outcomes, with additional influences of age, duration poststroke, and baseline function. Latent profile analyses revealed 2 main classes of outcomes, with the largest gains in those who received high-intensity training and achieved the greatest amounts of stepping practice. Regression and latent profile analyses of only high-intensity training participants indicated age, baseline function, and training activities were primary determinants of locomotor gains. Participants with the smallest gains were older (≈60 years), presented with slower gait speeds (<0.40 m/s), and performed 600 to 1000 less steps/session. CONCLUSIONS: Regression and cluster analyses reveal primary contributions of training interventions on mobility outcomes in patients >1-month poststroke. Age, duration poststroke, and baseline impairments were secondary predictors. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02507466 and NCT01789853.


Asunto(s)
Terapia por Ejercicio , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/fisiopatología , Caminata/fisiología , Anciano , Prueba de Esfuerzo , Femenino , Marcha/fisiología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Resultado del Tratamiento
18.
PLoS Med ; 17(9): e1003222, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32956407

RESUMEN

BACKGROUND: Treatment with corticosteroids is recommended for Duchenne muscular dystrophy (DMD) patients to slow the progression of weakness. However, chronic corticosteroid treatment causes significant morbidities. Vamorolone is a first-in-class anti-inflammatory investigational drug that has shown evidence of efficacy in DMD after 24 weeks of treatment at 2.0 or 6.0 mg/kg/day. Here, open-label efficacy and safety experience of vamorolone was evaluated over a period of 18 months in trial participants with DMD. METHODS AND FINDINGS: A multicenter, open-label, 24-week trial (VBP15-003) with a 24-month long-term extension (VBP15-LTE) was conducted by the Cooperative International Neuromuscular Research Group (CINRG) and evaluated drug-related effects of vamorolone on motor outcomes and corticosteroid-associated safety concerns. The study was carried out in Canada, US, UK, Australia, Sweden, and Israel, from 2016 to 2019. This report covers the initial 24-week trial and the first 12 months of the VBP15-LTE trial (total treatment period 18 months). DMD trial participants (males, 4 to <7 years at entry) treated with 2.0 or 6.0 mg/kg/day vamorolone for the full 18-month period (n = 23) showed clinical improvement of all motor outcomes from baseline to month 18 (time to stand velocity, p = 0.012 [95% CI 0.010, 0.068 event/second]; run/walk 10 meters velocity, p < 0.001 [95% CI 0.220, 0.491 meters/second]; climb 4 stairs velocity, p = 0.001 [95% CI 0.034, 0.105 event/second]; 6-minute walk test, p = 0.001 [95% CI 31.14, 93.38 meters]; North Star Ambulatory Assessment, p < 0.001 [95% CI 2.702, 6.662 points]). Outcomes in vamorolone-treated DMD patients (n = 46) were compared to group-matched participants in the CINRG Duchenne Natural History Study (corticosteroid-naïve, n = 19; corticosteroid-treated, n = 68) over a similar 18-month period. Time to stand was not significantly different between vamorolone-treated and corticosteroid-naïve participants (p = 0.088; least squares [LS] mean 0.042 [95% CI -0.007, 0.091]), but vamorolone-treated participants showed significant improvement compared to group-matched corticosteroid-naïve participants for run/walk 10 meters velocity (p = 0.003; LS mean 0.286 [95% CI 0.104, 0.469]) and climb 4 stairs velocity (p = 0.027; LS mean 0.059 [95% CI 0.007, 0.111]). The vamorolone-related improvements were similar in magnitude to corticosteroid-related improvements. Corticosteroid-treated participants showed stunting of growth, whereas vamorolone-treated trial participants did not (p < 0.001; LS mean 15.86 [95% CI 8.51, 23.22]). Physician-reported incidences of adverse events (AEs) for Cushingoid appearance, hirsutism, weight gain, and behavior change were less for vamorolone than published incidences for prednisone and deflazacort. Key limitations to the study were the open-label design, and use of external comparators. CONCLUSIONS: We observed that vamorolone treatment was associated with improvements in some motor outcomes as compared with corticosteroid-naïve individuals over an 18-month treatment period. We found that fewer physician-reported AEs occurred with vamorolone than have been reported for treatment with prednisone and deflazacort, and that vamorolone treatment did not cause the stunting of growth seen with these corticosteroids. This Phase IIa study provides Class III evidence to support benefit of motor function in young boys with DMD treated with vamorolone 2.0 to 6.0 mg/kg/day, with a favorable safety profile. A Phase III RCT is underway to further investigate safety and efficacy. TRIAL REGISTRATION: Clinical trials were registered at www.clinicaltrials.gov, and the links to each trial are as follows (as provided in manuscript text): VBP15-002 [NCT02760264] VBP15-003 [NCT02760277] VBP15-LTE [NCT03038399].


Asunto(s)
Actividad Motora/efectos de los fármacos , Distrofia Muscular de Duchenne/tratamiento farmacológico , Pregnadienodioles/uso terapéutico , Corticoesteroides/efectos adversos , Niño , Preescolar , Progresión de la Enfermedad , Glucocorticoides/efectos adversos , Humanos , Masculino , Prednisona/uso terapéutico , Pregnadienodioles/metabolismo , Resultado del Tratamiento , Caminata/fisiología
19.
Sensors (Basel) ; 20(18)2020 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-32899946

RESUMEN

Gait deterioration caused by prolonged walking represents one of the main consequences of multiple sclerosis (MS). This study aims at proposing quantitative indices to measure the gait deterioration effects. The experimental protocol consisted in a 6-min walking test and it involved nine patients with MS and twenty-six healthy subjects. Pathology severity was assessed through the Expanded Disability Status Scale. Seven inertial units were used to gather lower limb kinematics. Gait variability and asymmetry were assessed by coefficient of variation (CoV) and symmetry index (SI), respectively. The evolution of ROM (range of motion), CoV, and SI was computed analyzing data divided into six 60-s subgroups. Maximum difference among subgroups and the difference between the first minute and the remaining five were computed. The indices were analyzed for intra- and inter-day reliability and repeatability. Correlation with clinical scores was also evaluated. Good to excellent reliability was found for all indices. The computed standard deviations allowed us to affirm the good repeatability of the indices. The outcomes suggested walking-related fatigue leads to an always more variable kinematics in MS, in terms of changes in ROM, increase of variability and asymmetry. The hip asymmetry strongly correlated with the clinical disability.


Asunto(s)
Fatiga/fisiopatología , Trastornos Neurológicos de la Marcha/diagnóstico , Marcha/fisiología , Esclerosis Múltiple/diagnóstico , Índice de Severidad de la Enfermedad , Caminata/fisiología , Adulto , Anciano , Fenómenos Biomecánicos/fisiología , Estudios de Casos y Controles , Evaluación de la Discapacidad , Progresión de la Enfermedad , Prueba de Esfuerzo/métodos , Femenino , Trastornos Neurológicos de la Marcha/etiología , Indicadores de Salud , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/patología , Esclerosis Múltiple/fisiopatología , Reproducibilidad de los Resultados , Proyectos de Investigación , Factores de Tiempo
20.
Sci Rep ; 10(1): 15600, 2020 09 24.
Artículo en Inglés | MEDLINE | ID: mdl-32973244

RESUMEN

A consequence of a complete spinal cord injury (SCI) is the loss of gait capacity. Wearable exoskeletons for the lower extremity enable household and community ambulation in people with SCI. This study assessed the amount, purpose, and location of exoskeleton use in the home and community environment, without any restrictions. The number of steps taken was read from the exoskeleton software. Participants kept a daily logbook, and completed two user experience questionnaires (Quebec User Evaluation of Satisfaction with assistive Technology (D-QUEST) and System Usability Scale (SUS)). Fourteen people with a complete SCI used the ReWalk exoskeleton a median of 9 (range [1-15]) out of 16 ([12-21]) days, in which participants took a median of 3,226 ([330-28,882]) steps. The exoskeleton was mostly used for exercise purposes (74%) and social interaction (20%). The main location of use was outdoors (48%). Overall, participants were satisfied with the exoskeleton (D-QUEST 3.7 ± 0.4) and its usability (SUS 72.5 [52.5-95.0]). Participants with complete SCI report satisfaction with the exoskeleton for exercise and social interaction in the home and community, but report limitations as an assistive device during daily life.


Asunto(s)
Dispositivo Exoesqueleto/estadística & datos numéricos , Marcha/fisiología , Extremidad Inferior/fisiología , Satisfacción del Paciente , Traumatismos de la Médula Espinal/rehabilitación , Caminata/fisiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Características de la Residencia , Encuestas y Cuestionarios , Adulto Joven
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