The acute effects of a stretching and conditioning exercise protocol for the lower limbs on gait performance- a proof of concept and single-blind study.

Background: Due to improvement in movement performance, post-activation performance enhancement (PAPE) may open new possibilities to improve gait performance. However, no study has attempted to translate this phenomenon into walking. Therefore, the study aimed to test whether acute stretching followed by a conditioning exercise can improve subsequent gait performance in healthy adults. Research question: Can an exercise protocol subsequently improve gait performance? Methods: Sixteen individuals walked four 10-m trials (in each period) before and after 7 min of an exercise protocol composed of stretching (focusing on the lower limb) and a conditioning exercise (standing calf-raise wearing a vest of 20 kg). Gait spatialtemporal parameters and muscle activity of tibialis anterior and gastrocnemius medialis and lateralis muscles were obtained by a 3D-motion system and wireless electromyography, respectively. Before and after the exercise protocol, kinematic and muscle activity parameters were compared by a one-way ANOVA and the Wilcoxon signed-rank test, respectively. Results: After the exercise protocol, the participants walked with a faster step velocity (p < 0.018) and with a lower step duration (p < 0.025). Also, higher peak muscle activity (p < 0.008) and low-frequency (p < 0.034) activation of the anterior tibial muscle after the exercise protocol were observed. Significance: In conclusion, the protocol improves the stability and the muscles' efficiency during gait, contributing to a new approach to enhancing gait rehabilitation programs.

Dedifferentiated liposarcoma in the abdominal cavity: a case report.

Liposarcoma adherent to the mesentery is extremely rare and difficult to diagnose. A 70-year-old woman presented to the hospital with a right lower abdominal mass. After surgical resection, the patient was diagnosed with dedifferentiated liposarcoma of the transverse colon with a mesenteric origin, and chemotherapy was administered. Diagnosing dedifferentiated liposarcoma of the transverse mesocolon based on imaging findings alone is challenging. Surgical resection can aid diagnosis. Moreover, cancer-specific genetic testing was performed in this case because dedifferentiated liposarcoma is a disease for which novel therapeutic agents are expected to be developed.

Perception of COVID-19 Pandemic by Brazilian People With Parkinson's Disease and Multiple Sclerosis.

COVID-19 in Brazil is threatening, and it has forced the government to adopt partial lockdown as a strategy to stop the spread of the virus in the first wave of pandemic (March 2020). These preventive measures during the COVID-19 pandemic may affect the motor and non-motor symptoms in people with Parkinson's disease (PD) and Multiple sclerosis (MS). Thus, the purpose of this study was to investigate the perception during the first wave of COVID-19 pandemic lockdown on motor and non-motor symptoms, and also measure physical activity level, quality of life, and sleep quality in Brazilian people with PD and MS. One hundred and fifty-three participants (PD-97 and MS-56) answered an online survey to identify the perception of motor and non-motor symptoms, and characterize the physical activity level, and quality of life and sleep in these neurological Brazillian population. During the beginning of pandemic lockdown in Brazil, our results indicated that 69% of people with PD and 55% of people with MS reported worse on motor aspects and lower amount of physical activity performed. Also, 75.2% (PD) and 92.9% (MS) of our cohort were considered inactive or sedentary. Based on the perception and behavior of the population studied, people with PD and MS should be encouraged to perform more physical activity in order to reduce the effects of isolation in motor and non-motor aspects of the diseases. Teleinterventions, such as home-based exercise, should be included in the new routine of people with PD and MS to reduce the impacts of lockdown and to maintain quality of life at a good level.

Effects of automatic mechanical peripheral stimulation on gait biomechanics in older adults with Parkinson's disease: a randomized crossover clinical trial.

BACKGROUND: Automated mechanical peripheral stimulation (AMPS) is a rehabilitation technique suggested to correct gait abnormalities on Parkinson's disease. Although previous studies have suggested increments in functional performance and gait speed after AMPS intervention, little is known about its effect on gait biomechanics. OBJECTIVE: To analyze the effect of an AMPS session on functional performance and gait biomechanics in subjects with Parkinson's disease. METHODS: Twenty-eight subjects aged 67±3 years old participated in this study. Kinematics and muscle activation were recorded during walking at a preferred gait speed before and after AMPS and sham interventions. Footswitches sensors were used to record the kinematic parameters. Electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius lateralis (GL) were recorded. Timed up and go (TUG) test and Short Physical Performance Battery (SPPB) were performed to assess functional performance. RESULTS: GL activation increased after AMPS intervention before and after heel strike (p = 0.04; p < 0.01) and before and after toe-off (p = 0.013; p = 0.038). Also, after AMPS intervention, TA activation increased after heel strike (p = 0.007); and after sham intervention, TA activation reduced before and after heel strike (p = 0.038; and p = 0.007) and before toe-off (p = 0.013). The time of TUG test was shorter after AMPS intervention (p = 0.015). CONCLUSION: AMPS intervention changed the EMG activation of ankle muscles during walking and functional performance. However, AMPS intervention did not change gait kinematics.

Dual tasking reduces gait asymmetry of trajectory deviation during obstacle circumvention in people with Parkinson's disease.

BACKGROUND: Certain aspects of gait may depend on cognition, and the effects of dual-tasking (DT) on gait asymmetry (GA) during obstacle circumvention in people with Parkinson's disease (pwPD) may be walking phase-dependent. While the approaching phase requires allocating significant cognitive resources to perform the task, outweighing the available resources may increase GA. During the avoiding phase, the obstacle could be used as an external cue, enhancing the attention to the obstacle and, consequently, improving gait control and regulating GA. OBJECTIVE: The study investigated the effects of obstacle circumvention during gait with DT on GA in pwPD, considering the circumvention phase. METHODS: Thirty participants, 15 pwPD and 15 neurologically healthy individuals, circumvented an obstacle 20 times (in total) according to side (right and left side) and DT (presence and absence). Spatial-temporal stride parameters, medial-lateral and horizontal trajectory deviations from the original path, strategy to obstacle circumvention (lead limb away from or close to the obstacle during the crossing step), and gaze parameters were calculated during the approaching and avoiding phases. The parameters were grouped considering the side that the obstacle was circumvented during each task, and the symmetry index was calculated. RESULTS: The results showed greater asymmetry of time of fixations, width, duration, and velocity during the approaching phase (p < 0.02), whereas the avoiding phase decreased asymmetry of medial-lateral and horizontal trajectory deviations parameters (p < 0.001) during obstacle circumvention with DT, in both pwPD and control group. CONCLUSIONS: The findings offer a basis for considering that goal-directed movement control may regulate GA in pwPD.

Cortical activity and gait parameter characteristics in people with multiple sclerosis during unobstructed gait and obstacle avoidance.

BACKGROUND: People with Multiple Sclerosis (PwMS) present higher cortical activity during walking. However, the cortical activity during gait while avoiding an obstacle is still not clear. OBJECTIVE: To investigate cortical activity and gait spatial-temporal parameters in PwMS during two different gait tasks (i.e., unobstructed and obstacle avoidance). METHOD: Fifteen PwMS and 15 healthy controls (CG) were recruited. Participants performed ten trials in each gait condition, wearing a 64-electrode cap electroencephalogram (EEG) at 1024 Hz. Kinematic data were obtained through 10 Vicon® cameras at 200 Hz. EEG was analyzed through four cortical areas (frontal, motor, parietal, and occipital cortex areas) and five frequency bands (delta, theta, alpha, beta, and gamma) obtained through the power spectral density. In addition, spatial-temporal gait parameters (e.g., step length and velocity) were measured. Two-way ANOVA (group x gait condition) and MANOVA (group x gait condition) were used to compare gait and EEG parameters, respectively. One-way ANOVA was used to compare groups in the crossing phase of the obstacle avoidance condition. RESULTS: PwMS presented lower step length and velocity, and higher cortical activity in frontal (beta and gamma) and parietal (gamma) cortical areas in both gait conditions compared to CG. Moreover, PwMS presented increased cortical activation (frontal and parietal) and decreased step length and velocity in obstacle avoidance compared with unobstructed gait. In addition, PwMS required more cortical resources (frontal and parietal) than CG to accomplish both gait conditions. During the obstacle avoidance task, it was further observed that PwMS positioned their feet closer to the obstacle, before and after the task, compared to CG. CONCLUSION: PwMS demand higher cortical resources to accomplish gait tasks, mainly when it is necessary to negotiate an obstacle in the pathway. This higher cortical activity may be a compensatory mechanism to deal with damage in subcortical structures caused by multiple sclerosis.

Is it possible to predict falls in older adults using gait kinematics?

BACKGROUND: Gait kinematic parameters have been reported as an important clinical tool to assess the risk of falls in older adults. However, the ability of these parameters to predict falls in the older population is still unclear. OBJECTIVE: To identify the ability that gait kinematic parameters present to predict fall in older adults. METHODS: Data from 102 older adults, who live in a community setting, were considered for this study. For data collection, older subjects had to walk on a 14 meter-walkway in their preferred gait speed. The incidence of falls was recorded at baseline together with gait kinematics and then every three months during the period of the study. The ability of gait kinematic parameters to predict falls was tested using the ROC curve. RESULTS: Stance time variability, swing time, and stride length presented a sensitivity to predict falls in older adults higher than 70%. CONCLUSION: Gait kinematic parameters, such as stance variability, swing time, and stride length may predict future falls in older adults.