On the reliability of single-camera markerless systems for overground gait monitoring.

BACKGROUND AND OBJECTIVE: Motion analysis is crucial for effective and timely rehabilitative interventions on people with motor disorders. Conventional marker-based (MB) gait analysis is highly time-consuming and calls for expensive equipment, dedicated facilities and personnel. Markerless (ML) systems may pave the way to less demanding gait monitoring, also in unsupervised environments (i.e., in telemedicine). However,scepticism on clinical usability of relevant outcome measures has hampered its use. ML is normally used to analyse treadmill walking, which is significantly different from the more physiological overground walking. This study aims to provide end-users with instructions on using a single-camera markerless system to obtain reliable motion data from overground walking, while clinicians will be instructed on the reliability of obtained quantities. METHODS: The study compares kinematics obtained from ML systems to those concurrently obtained from marker-based systems, considering different stride counts and subject positioning within the capture volume. RESULTS: The findings suggest that five straight walking trials are sufficient for collecting reliable kinematics with ML systems. Precision on joint kinematics decreased at the boundary of the capture volume. Excellent correlation was found between ML and MB systems for hip and knee angles (0.92

Postural stability assessment in expert versus amateur basketball players during optic flow stimulation.

We evaluated the role of visual stimulation on postural muscles and the changes in the center of pressure (CoP) during standing posture in expert and amateur basketball players. Participants were instructed to look at a fixation point presented on a screen during foveal, peripheral, and full field optic flow stimuli. Postural mechanisms and motor strategies were assessed by simultaneous recordings of stabilometric, oculomotor, and electromyographic data during visual stimulation. We found significant differences between experts and amateurs in the orientation of visual attention. Experts oriented attention to the right of their visual field, while amateurs to the bottom-right. The displacement in the CoP mediolateral direction showed that experts had a greater postural sway of the right leg, while amateurs on the left leg. The entropy-based data analysis of the CoP mediolateral direction exhibited a greater value in amateurs than in experts. The root-mean-square and the coactivation index analysis showed that experts activated mainly the right leg while amateurs the left leg. In conclusion, playing sports for years seems to have induced some strong differences in the standing posture between the right and left sides. Even during non-ecological visual stimulation, athletes maintain postural adaptations to counteract the body oscillation.

The mechanisms underpinning the slow component of [Formula: see text] in humans.

PURPOSE: When exercising above the lactic threshold (LT), the slow component of oxygen uptake ([Formula: see text]) appears, mainly ascribed to the progressive recruitment of Type II fibers. However, also the progressive decay of the economy of contraction may contribute to it. We investigated oxygen uptake ([Formula: see text]) during isometric contractions clamping torque (T) or muscular activation to quantify the contributions of the two mechanisms. METHODS: We assessed for 7 min T of the leg extensors, net oxygen uptake ([Formula: see text]) and root mean square (RMS) from vastus lateralis (VL) in 11 volunteers (21 ± 2 yy; 1.73 ± 0.11 m; 67 ± 14 kg) during cyclic isometric contractions (contraction/relaxation 5 s/5 s): (i) at 65% of maximal voluntary contraction (MVC) (FB-Torque) and; (ii) keeping the level of RMS equal to that at 65% of MVC (FB-EMG). RESULTS: [Formula: see text] after the third minute in FB-Torque increased with time ([Formula: see text] = 94 × t + 564; R2 = 0.99; P = 0.001), but not during FB-EMG. [Formula: see text]/T increased only during FB-Torque ([Formula: see text]/T = 1.10 × t + 0.57; R2 = 0.99; P = 0.001). RMS was larger in FB-Torque than in FB-EMG and significantly increased in the first three minutes of exercise to stabilize till the end of the trial, indicating that the pool of recruited MUs remained constant despite [Formula: see text]. CONCLUSION: The analysis of the RMS, [Formula: see text] and T during FB-Torque suggests that the intrinsic mechanism attributable to the decay of contraction efficiency was responsible for an increase of [Formula: see text] equal to 18% of the total [Formula: see text].

Postural adjustments to self-triggered perturbations under conditions of changes in body orientation.

We studied anticipatory and compensatory postural adjustments (APAs and CPAs) associated with self-triggered postural perturbations in conditions with changes in the initial body orientation. In particular, we were testing hypotheses on adjustments in the reciprocal and coactivation commands, role of proximal vs. distal muscles, and correlations between changes in indices of APAs and CPAs. Healthy young participants stood on a board with full support or reduced support area and held a standard load in the extended arms. They released the load in a self-paced manned with a standard small-amplitude arm movement. Electromyograms of 12 muscles were recorded and used to compute reciprocal and coactivation indices between three muscle pairs on both sides of the body. The subject's body was oriented toward one of three targets: straight ahead, 60° to the left, and 60° to the right. Body orientation has stronger effects on proximal muscle pairs compared to distal muscles. It led to more consistent changes in the reciprocal command compared to the coactivation command. Indices of APAs and CPAs showed positive correlations across conditions. We conclude that the earlier suggested hierarchical relations between the reciprocal and coactivation command could be task-specific. Predominance of negative or positive correlations between APA and CPA indices could also be task-specific.

The Effects of Prolonged Vibrotactile EMG-Based Biofeedback on Ankle Joint Range of Motion During Gait in Children with Spastic Cerebral Palsy: A Case Series.

AIMS: The objective of this case series was to examine the feasibility of vibrotactile EMG-based biofeedback (BF) as a home-based intervention tool to enhance sensory information during everyday motor activities and to explore its effectiveness to induce changes in active ankle range of motion during gait in children with spastic cerebral palsy (CP). METHODS: Ten children ages 6 to 13 years with spastic CP were recruited. Participants wore two EMG-based vibro-tactile BF devices for at least 4 hours per day for 1-month on the ankle and knee joints muscles. The device computed the amplitude of the EMG signal of the target muscle and actuated a silent vibration motor proportional to the magnitude of the EMG. RESULTS: Our results demonstrated the feasibility of the augmented sensory information of muscle activity to induce changes of the active ankle range of motion during gait for 6 children with an increase ranging from 8.9 to 51.6% compared to a one-month period without treatment. CONCLUSIONS: Preliminary findings of this case series demonstrate the feasibility of vibrotactile EMG-based BF and suggest potential effectiveness to increase active ankle range of motion, therefore serving as a promising therapeutic tool to improve gait in children with spastic CP.

Preserving Data Privacy and Accuracy of Human Pose Estimation Software Based on CNN s for Remote Gait Analysis.

In the last years there have been significant improvements in the accuracy of real-time 3D skeletal data estimation software. These applications based on convolutional neural networks (CNNs) can playa key role in a variety of clinical scenarios, from gait analysis to medical diagnosis. One of the main challenges is to apply such intelligent video analytic at a distance, which requires the system to satisfy, beside accuracy, also data privacy. To satisfy privacy by default and by design, the software has to run on "edge" computing devices, by which the sensitive information (i.e., the video stream) is elaborated close to the camera while only the process results can be stored or sent over the communication network. In this paper we address such a challenge by evaluating the accuracy of the state-of-the-art software for human pose estimation when run "at the edge". We show how the most accurate platforms for pose estimation based on complex and deep neural networks can become inaccurate due to subs amp ling of the input video frames when run on the resource constrained edge devices. In contrast, we show that, starting from less accurate and "lighter" CNNs and enhancing the pose estimation software with filters and interpolation primitives, the platform achieves better real-time performance and higher accuracy with a deviation below the error tolerance of a marker-based motion capture system.

Synergies Stabilizing Vertical Posture in Spaces of Control Variables.

In this study, we address the question: Can the central nervous system stabilize vertical posture in the abundant space of neural commands? We assume that the control of vertical posture is associated with setting spatial referent coordinates (RC) for the involved muscle groups, which translates into two basic commands, reciprocal and co-activation. We explored whether the two commands co-varied across trials to stabilize the initial postural state. Young, healthy participants stood quietly against an external horizontal load and were exposed to smooth unloading episodes. Linear regression between horizontal force and center of mass coordinate during the unloading phase was computed to define the intercept (RC) and slope (apparent stiffness, k). Hyperbolic regression between the intercept and slope across unloading episodes and randomization analysis both demonstrated high indexes of co-variation stabilizing horizontal force in the initial state. Higher co-variation indexes were associated with lower average k values across the participants suggesting destabilizing effects of muscle coactivation. Analysis of deviations in the {RC; k} space keeping the posture unchanged (motor equivalent) between two states separated by a voluntary quick body sway showed significantly larger motor equivalent deviations compared to non-motor equivalent ones. This is the first study demonstrating posture-stabilizing synergies in the space of neural control variables using various computational methods. It promises direct applications to studies of postural disorders and rehabilitation.

Enabling Gait Analysis in the Telemedicine Practice through Portable and Accurate 3D Human Pose Estimation.

Human pose estimation (HPE) through deep learning-based software applications is a trend topic for markerless motion analysis. Thanks to the accuracy of the state-of-the-art technology, HPE could enable gait analysis in the telemedicine practice. On the other hand, delivering such a service at a distance requires the system to satisfy multiple and different constraints like accuracy, portability, real-time, and privacy compliance at the same time. Existing solutions either guarantee accuracy and real-time (e.g., the widespread OpenPose software on well-equipped computing platforms) or portability and data privacy (e.g., light convolutional neural networks on mobile phones). We propose a portable and low-cost platform that implements real-time and accurate 3D HPE through an embedded software on a low-power off-the-shelf computing device that guarantees privacy by default and by design. We present an extended evaluation of both accuracy and performance of the proposed solution conducted with a marker-based motion capture system (i.e., Vicon) as ground truth. The results show that the platform achieves real-time performance and high-accuracy with a deviation below the error tolerance when compared to the marker-based motion capture system (e.g., less than an error of 5∘ on the estimated knee flexion difference on the entire gait cycle and correlation 0.91<ρ<0.99). We provide a proof-of-concept study, showing that such portable technology, considering the limited discrepancies with respect to the marker-based motion capture system and its working tolerance, could be used for gait analysis at a distance without leading to different clinical interpretation.

Transcranial direct current stimulation (tDCS) modulates motor execution in a limb reaching task.

The majority of human activities show a trade-off between movement speed and accuracy. Here we tested 16 participants in a quick pointing action after 20 minutes (2 mA) of transcranial direct current stimulation (tDCS) delivered at the supplementary motor area in a single-blind crossover design study for testing the feedforward components in the control of action. tDCS stimuli were delivered in three randomized sessions of stimulations as anodal, cathodal and sham as a control. The task performed pre- and post-tDCS stimulation, was to point as fast and as precise as possible with the big toe to targets having different sizes (2 and 8 cm; Width) and positioned at different distances (20 and 60 cm; Distance). An optoelectronic motion capture system was used to collect the kinematics of movement. The result indicates that individuals after receiving anodal stimulation decreased their movement time and increased their movement speed, while the opposite happened after receiving a cathodal stimulation. The scarcity of studies in this area invites us to plan a research that aims at the trade-off especially in the clinical settings.

Postural Threat Influences the Coupling Between Anticipatory and Compensatory Postural Adjustments in Response to an External Perturbation.

Fear of falling increases conscious control of balance and postural threat warrants accurate anticipatory motor commands for keeping a safe body posture. This study examines the anticipatory (APAs) and compensatory (CPAs) postural adjustments generated in response to an external perturbation while individuals are positioned at two different altitudes (2 cm and 80 cm) from the floor level. The main result indicates that due to the perceived emotional threat, different agonist and antagonist muscles synergies (R and C-Indexes) are manifested, particularly during the anticipatory phase. The results suggest that the CNS sends central commands for anticipating postural adjustments by adopting primarily a muscle reciprocal activation instead of a muscle co-activation strategy. Interestingly, the APAs strategies were modified under different postural threats by controlling the agonist-antagonist muscles at different joints of lower extremity. For CPAs the reciprocal activation was less applied compared to muscles co-activation to unsure larger margin for compensatory adjustments as needed and re-establish the postural stability. The results indicate that when facing to a postural threat, the CNS modulates the anticipatory and compensatory phases of postural adjustments to minimize the risk of falling.

Fasting-Mimicking-Diet does not reduce skeletal muscle function in healthy young adults: a randomized control trial.

PURPOSE: The aim of this study was to evaluate the short- and long-term effects of the Fasting-Mimicking-Diet (FMD) intervention on neuromuscular parameters of force production in healthy young men. METHODS: Twenty-four physically active men completed the study. Participants were randomly assigned to Fasting-Mimicking (FMD) or Normal Diet (ND) and asked to follow three cycles of dietary intervention. Neuromuscular parameters of force production during maximal voluntary isometric contractions (MVCs) with the leg extensors muscles and anthropometrics were measured at baseline (T0), at the end of the first cycle (T1), and 7-10 days after the 3rd cycle of the nutritional intervention (T2). The study was registered on Clinicaltrials.gov (No. NCT04476615). RESULTS: There was a significant decrease in body mass at T1 for FMD (- 2.6 kg, ∆ from baseline, on average; p < 0.05) but not in ND (- 0.1 kg;). Neuromuscular parameters of force production, muscle volume, and MVC torque did not change or differ between groups across visits. Results were similar even when parameters were normalized by muscle volume. CONCLUSION: The consumption of FMD in a group of young healthy male subjects showed to be feasible, and it did not affect neuromuscular parameters of force production. The results suggest that FMD could be safely adopted by strength athletes without detrimental effects on force and muscle volume. Further research in clinical population at risk of muscle mass loss, such as elderly and obese subjects with sarcopenia, is warranted.

Energetics of walking in individuals with cerebral palsy and typical development, across severity and age: A systematic review and meta-analysis.

BACKGROUND: Individuals with cerebral palsy (CP) report physical fatigue as a main cause of limitation, deterioration and eventually cessation of their walking ability. A consequence of higher level of fatigue in individuals with CP leads to a less efficient and long-distance walking ability. RESEARCH QUESTION: This systematic review investigates the difference in 1) walking energy expenditure between individuals with CP and age-matched typically developing (TD) individuals; and 2) energetics of walking across Gross Motor Function Classification System (GMFCS) levels and age. METHODS: Five electronic databases (PubMed, Web of Science, CINAHL, ScienceDirect and Scopus) were searched using search terms related to CP and energetics of walking. RESULTS: Forty-one studies met inclusion criteria. Thirty-one studies compared energy expenditure between CP and age-matched controls. Twelve studies correlated energy expenditure and oxygen cost across GMFCS levels. Three studies investigated the walking efficiency across different ages or over a time period. A significant increase of energy expenditure and oxygen cost was found in individuals with CP compared to TD age-matched individuals, with a strong relationship across GMFCS levels. SIGNIFICANCE: Despite significant differences between individuals with CP compared to TD peers, variability in methods and testing protocols may play a confounding role. Analysis suggests oxygen cost being the preferred/unbiased physiological parameter to assess walking efficacy in CP. To date, there is a knowledge gap on age-related changes of walking efficiency across GMFCS levels and wider span of age ranges. Further systematic research looking at longitudinal age-related changes of energetics of walking in this population is warranted.

Muscle Belly Gearing Positively Affects the Force-Velocity and Power-Velocity Relationships During Explosive Dynamic Contractions.

Changes in muscle shape could play an important role during contraction allowing to circumvent some limits imposed by the fascicle force-velocity (F-V) and power-velocity (P-V) relationships. Indeed, during low-force high-velocity contractions, muscle belly shortening velocity could exceed muscle fascicles shortening velocity, allowing the muscles to operate at higher F-V and P-V potentials (i.e., at a higher fraction of maximal force/power in accordance to the F-V and P-V relationships). By using an ultrafast ultrasound, we investigated the role of muscle shape changes (vastus lateralis) in determining belly gearing (muscle belly velocity/fascicle velocity) and the explosive torque during explosive dynamic contractions (EDC) at angular accelerations ranging from 1000 to 4000°.s-2. By means of ultrasound and dynamometric data, the F-V and P-V relationships both for fascicles and for the muscle belly were assessed. During EDC, fascicle velocity, belly velocity, belly gearing, and knee extensors torque data were analysed from 0 to 150 ms after torque onset; the fascicles and belly F-V and P-V potentials were thus calculated for each EDC. Absolute torque decreased as a function of angular acceleration (from 80 to 71 Nm, for EDC at 1000 and 4000°.s-1, respectively), whereas fascicle velocity and belly velocity increased with angular acceleration (P < 0.001). Belly gearing increased from 1.11 to 1.23 (or EDC at 1000 and 4000°.s-1, respectively) and was positively corelated with the changes in muscle thickness and pennation angle (the changes in latter two equally contributing to belly gearing changes). For the same amount of muscle's mechanical output (force or power), the fascicles operated at higher F-V and P-V potential than the muscle belly (e.g., P-V potential from 0.70 to 0.56 for fascicles and from 0.65 to 0.41 for the muscle belly, respectively). The present results experimentally demonstrate that belly gearing could play an important role during explosive contractions, accommodating the largest part of changes in contraction velocity and allowing the fascicle to operate at higher F-V and P-V potentials.

Can spatial filtering separate voluntary and involuntary components in children with dyskinetic cerebral palsy?

The design of myocontrolled devices faces particular challenges in children with dyskinetic cerebral palsy because the electromyographic signal for control contains both voluntary and involuntary components. We hypothesized that voluntary and involuntary components of movements would be uncorrelated and thus detectable as different synergistic patterns of muscle activity, and that removal of the involuntary components would improve online EMG-based control. Therefore, we performed a synergy-based decomposition of EMG-guided movements, and evaluated which components were most controllable using a Fitts' Law task. Similarly, we also tested which muscles were most controllable. We then tested whether removing the uncontrollable components or muscles improved overall function in terms of movement time, success rate, and throughput. We found that removal of less controllable components or muscles did not improve EMG control performance, and in many cases worsened performance. These results suggest that abnormal movement in dyskinetic CP is consistent with a pervasive distortion of voluntary movement rather than a superposition of separable voluntary and involuntary components of movement.

Anticipatory and pre-planned actions: A comparison between young soccer players and swimmers.

The present study investigated whether a difference exists in reactive and proactive control for sport considered open or closed skills dominated. Sixteen young (11-12 years) athletes (eight soccer players and eight swimmers) were asked to be engaged into two games competitions that required either a reactive and a proactive type of control. By means of kinematic (i.e. movement time and duration) and dynamic analysis through the force platform (i.e. Anticipatory Postural Adjustments, APAs), we evaluated the level of ability and stability in reacting and anticipating actions. Results indicated that soccer players outperformed swimmers by showing higher stability and a smaller number of falls during the competition where proactive control was mainly required. Soccer players were able to reach that result by anticipating actions through well-modulated APAs. On the contrary, during the competition where reactive control was mainly required, performances were comparable between groups. Therefore, the development of specific action control is already established at 11-12 years of age and is enhanced by the training specificity.

Postural Adjustments during Interactions with an Active Partner.

Ensuring stability of the human vertical posture is a complex task requiring both anticipatory and compensatory postural strategies when a standing person performs fast actions and interacts with the environment, which can include other persons. How people adjust their preparatory and compensatory postural adjustments in situations when they interact with an active partner is still poorly understood. In this study we investigated the postural adjustments while two healthy persons played a traditional childhood game. While standing facing each other, they were asked to push with their hands against the hands of the opponent only, and to make the opponent to take a step. We explored strategies when pushing the opponent's hands generated perturbations to the posture of both players and when one of the players withdrew the arms to neutralize the opponent's pushing action. Electromyograms were recorded from the leg and trunk muscles and used to quantify early (EPAs), anticipatory (APAs) and compensatory (CPAs) postural adjustments, as well as the co-activation and reciprocal changes in the activity of agonist-antagonist pairs. Results showed higher indices of muscle co-activation during EPAs during the game compared to the control conditions. We found that postural preparation strategies defined whether a participant kept or lost balance during the game. Our results highlight the importance of muscle co-activation, the role of anticipation, and the difference in strategies while interacting with an active partner as compared to interactions with passive objects.

Tuning of Standing Postural Responses to Instability and Cost Function.

Whole-body movements are performed daily, and humans must constantly take into account the inherent instability of a standing posture. At times these movements may be performed in risky environments and when facing different costs of failure. The aim of the study was to test the hypothesis that in upright stance participants continuously estimate both probability of failure and cost of failure such that their postural responses will be based on these estimates. We designed a snowboard riding simulation experiment where participants were asked to control the position of a moving snowboard within a snow track in a risky environment. Cost functions were provided by modifying the penalty of riding in the area adjacent to the snow track. Uncertainty was modified by changing the gain of postural responses while participants were standing on a rocker board. We demonstrated that participants continually evaluated the environmental cost function and compensated for additional risk with feedback-based postural changes, even when probability of failure was negligible. Results showed also that the participants' estimates of the probability of failure accounted for their own inherent instability. Moreover, participants showed a tendency to overweight large probabilities of failure with more biomechanically constrained standing postures that results in suboptimal estimates of risky environments. Overall, our results suggest that participants tune their standing postural responses by empirically estimating the cost of failure and the uncertainty level in order to minimize the risk of falling when cost is high.

A Model to Estimate the Optimal Layout for Assistive Communication Touchscreen Devices in Children With Dyskinetic Cerebral Palsy.

Excess involuntary movements and slowness of movement in children with dyskinetic cerebral palsy often result in the inability to properly interact with augmentative and alternative communication (AAC) devices. This significantly limits communication. It is, therefore, essential to know how to adjust the device layout in order to maximize each child's rate of communication. The aim of this paper was to develop a mathematical model to estimate the information rate in children with dyskinetic cerebral palsy and to determine the optimal AAC layout for a touchscreen tablet that results in enhanced speed of communication. The model predicts information rate based on button size, number, spacing between buttons, and the probability of making an error or missing target buttons. Estimation of the information rate confirmed our hypothesis of lower channel capacity in children with dyskinetic cerebral palsy compared with age-matched healthy children. Information rate increased when the AAC layout was customized based on the optimal parameters predicted by the model. In conclusion, this paper quantifies the effect of motor impairments on communication with assistive communication devices and shows that communication performance can be improved by optimally matching the parameters of the AAC touchscreen device to the abilities of the child.

Using the International Classification of Functioning, Disability, and Health Model to Gain Perspective of the Benefits of Yoga in Stroke, Multiple Sclerosis, and Children to Inform Practice for Children with Cerebral Palsy: A Meta-Analysis.

OBJECTIVE: Research pertaining to yoga and children with cerebral palsy (CP) is negligible. The primary purpose of this study was to determine the domains of the International Classification of Functioning, Disability, and Health (ICF) model and levels of evidence for yoga and adults with stroke and multiple sclerosis (MS), and children. A secondary purpose was to decide whether any inferences could be made for children with CP. DESIGN: This study included a meta-analysis. INTERVENTIONS: A systematic review was performed of yoga and said populations. Outcome measures were categorized according to the ICF model domains of body structures and function, activity, and quality of life. Effect sizes (ESs) were calculated by using Cohen's d. Since there were few commonalities among outcome measures and reporting of outcomes within and among diagnostic groups, direct comparisons of ESs were difficult. Hence, we chose to evaluate the impact of yoga as compared with the control group or other physical exercise by using a General Linear Mixed Model. RESULTS: There were 5 yoga studies with stroke, 15 with MS, and 12 with children. Studies with children used outcomes related to body structure and function, whereas those with stroke and MS used outcomes across all three domains of the ICF. ESs varied from negligible to medium for stroke, from negligible to large for MS and children. CONCLUSIONS: The findings of this meta-analysis indicate that yoga is no better or worse than other exercise modalities as a treatment intervention for adults with stroke and MS, and children. Group yoga classes are typically social environments that can contribute to increased physical progress and feelings that contribute to quality of life, which may benefit individuals with CP. More research on yoga and particularly in children and adults with CP would yield valuable information for creating effective and safe yoga programs with a rich array of benefits.