Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 47
Filtrar
1.
NPJ Parkinsons Dis ; 6(1): 31, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33298934

RESUMO

Few exercise interventions practice both gait and balance tasks with cognitive tasks to improve functional mobility in people with PD. We aimed to investigate whether the Agility Boot Camp with Cognitive Challenge (ABC-C), that simultaneously targets both mobility and cognitive function, improves dynamic balance and dual-task gait in individuals with Parkinson's disease (PD). We used a cross-over, single-blind, randomized controlled trial to determine efficacy of the exercise intervention. Eighty-six people with idiopathic PD were randomized into either an exercise (ABC-C)-first or an active, placebo, education-first intervention and then crossed over to the other intervention. Both interventions were carried out in small groups led by a certified exercise trainer (90-min sessions, 3 times a week, for 6 weeks). Outcome measures were assessed Off levodopa at baseline and after the first and second interventions. A linear mixed-effects model tested the treatment effects on the Mini-BESTest for balance, dual-task cost on gait speed, SCOPA-COG, the UPDRS Parts II and III and the PDQ-39. Although no significant treatment effects were observed for the Mini-BESTest, SCOPA-COG or MDS-UPDRS Part III, the ABC-C intervention significantly improved the following outcomes: anticipatory postural adjustment sub-score of the Mini-BESTest (p = 0.004), dual-task cost on gait speed (p = 0.001), MDS-UPDRS Part II score (p = 0.01), PIGD sub-score of MDS-UPDRS Part III (p = 0.02), and the activities of daily living domain of the PDQ-39 (p = 0.003). Participants with more severe motor impairment or more severe cognitive dysfunction improved their total Mini-BESTest scores after exercise. The ABC-C exercise intervention can improve specific balance deficits, cognitive-gait interference, and perceived functional independence and quality of life, especially in participants with more severe PD, but a longer period of intervention may be required to improve global cognitive and motor function.

2.
PLoS One ; 15(12): e0244583, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33370408

RESUMO

Augmented sensory biofeedback training is often used to improve postural control. Our previous study showed that continuous auditory biofeedback was more effective than continuous visual biofeedback to improve postural sway while standing. However, it has also been reported that both discrete visual and auditory biofeedback training, presented intermittently, improves bimanual task performance more than continuous visual biofeedback training. Therefore, this study aimed to investigate the relative effectiveness of discrete visual biofeedback versus discrete auditory biofeedback to improve postural control. Twenty-two healthy young adults were randomly assigned to either a visual or auditory biofeedback group. Participants were asked to shift their center of pressure (COP) by voluntary postural sway forward and backward in line with a hidden target, which moved in a sinusoidal manner and was displayed intermittently. Participants were asked to decrease the diameter of a visual circle (visual biofeedback) or the volume of a sound (auditory biofeedback) based on the distance between the COP and the target in the training session. The feedback and the target were given only when the target reached the inflection points of the sine curves. In addition, the perceptual magnitudes of visual and auditory biofeedback were equalized using Stevens' power law. Results showed that the mean and standard deviation of the distance between COP and the target were reduced int the test session, removing the augmented sensory biofeedback, in both biofeedback training groups. However, the temporal domain of the performance improved in the test session in the auditory biofeedback training group, but not in the visual biofeedback training group. In conclusion, discrete auditory biofeedback training was more effective for the motor learning of voluntarily postural swaying compared to discrete visual biofeedback training, especially in the temporal domain.

3.
J Biomech ; 112: 110045, 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33011672

RESUMO

Increased postural sway is often observed in people with mild traumatic brain injury (mTBI), but our understanding of how individuals with mTBI control their head during stance is limited. The purpose of this study was to determine if people with mTBI exhibit increased sway at the head compared with healthy controls. People with persisting symptoms after mTBI (n = 59, 41 women) and control participants (n = 63, 38 women) stood quietly for one minute in four conditions: eyes open on a firm surface (EO-firm), eyes closed on a firm surface (EC-firm), eyes open on a foam pad (EO-foam), and eyes closed on foam (EC-foam). Inertial sensors at the head, sternum, and lumbar region collected tri-axial accelerations. Root-mean-square (RMS) accelerations in anteroposterior (AP) and mediolateral (ML) directions and sway ratios between the head and sternum, head and lumbar, and sternum and lumbar region were compared between groups. Temporal coupling of anti-phase motion between the upper and lower body angular accelerations was assessed with magnitude squared coherence and cross-spectral phase angles. People with mTBI demonstrated greater sway than controls across conditions and directions. During foam-surface conditions, the control group, but not the mTBI group, reduced ML sway at their head and trunk relative to their lumbar by increasing the expression of an anti-phase hip strategy within the frontal plane. These results are consistent with suggestions of inflexible or inappropriate postural control in people with mTBI.

4.
Front Neurol ; 11: 940, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33101161

RESUMO

Background: Balance deficits in people with Parkinson's disease (PD) are often not helped by pharmacological or surgical treatment. Although balance exercise intervention has been shown to improve clinical measures of balance, the efficacy of exercise on different, objective balance domains is still unknown. Objective: To compare the sensitivity to change in objective and clinical measures of several different domains of balance and gait following an Agility Boot Camp with Cognitive Challenges (ABC-C) intervention. Methods: In this cross-over, randomized design, 86 individuals with PD participated in 6-week (3×/week) ABC-C exercise classes and 6-week education classes, consisting of 3-6 individuals. Blinded examiners tested people in their practical off state. Objective outcome measures from wearable sensors quantified four domains of balance: sway in standing balance, anticipatory postural adjustments (APAs) during step initiation, postural responses to the push-and-release test, and a 2-min natural speed walk with and without a cognitive task. Clinical outcome measures included the Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III, the Mini Balance Evaluation Systems Test (Mini-BESTest), the Activities of Balance Confidence (ABC), and the Parkinson's Disease Questionnaire (PDQ-39). The standardized response means (SRM) of the differences between before and after each intervention compared responsiveness of outcomes to intervention. A linear mixed model compared effects of exercise with the active control-education intervention. Results: The most responsive outcome measures to exercise intervention with an SRM > 0.5 were objective measures of gait and APAs, specifically arm range of motion, gait speed during a dual-task walk, trunk coronal range of motion, foot strike angle, and first-step length at step initiation. The most responsive clinical outcome measure was the patient-reported PDQ-39 activities daily living subscore, but all clinical measures had SRMs <0.5. Conclusions: The objective measures were more sensitive to change after exercise intervention compared to the clinical measures. Spatiotemporal parameters of gait, including gait speed with a dual task, and APAs were the most sensitive objective measures, and perceived functional independence was the most sensitive clinical measure to change after the ABC-C exercise intervention. Future exercise intervention to improve gait and balance in PD should include objective outcome measures.

5.
J Neurotrauma ; 2020 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-32495691

RESUMO

There is a dearth of knowledge about how symptom severity affects gait in the chronic (>3 months) mild traumatic brain injury (mTBI) population despite up to 53% of people reporting persisting symptoms after mTBI. The aim of this investigation was to determine whether gait is affected in a symptomatic, chronic mTBI group and to assess the relationship between gait performance and symptom severity on the Neurobehavioral Symptom Inventory (NSI). Gait was assessed under single- and dual-task conditions using five inertial sensors in 57 control subjects and 65 persons with chronic mTBI (1.0 year from mTBI). The single- and dual-task gait domains of Pace, Rhythm, Variability, and Turning were calculated from individual gait characteristics. Dual-task cost (DTC) was calculated for each domain. The mTBI group walked (domain z-score mean difference, single-task = 0.70; dual-task = 0.71) and turned (z-score mean difference, single-task = 0.69; dual-task = 0.70) slower (p < 0.001) under both gait conditions, with less rhythm under dual-task gait (z-score difference = 0.21; p = 0.001). DTC was not different between groups. Higher NSI somatic subscore was related to higher single- and dual-task gait variability as well as slower dual-task pace and turning (p < 0.01). Persons with chronic mTBI and persistent symptoms exhibited altered gait, particularly under dual-task, and worse gait performance related to greater symptom severity. Future gait research in chronic mTBI should assess the possible underlying physiological mechanisms for persistent symptoms and gait deficits.

6.
Neurorehabil Neural Repair ; 34(5): 417-427, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32249668

RESUMO

Introduction. It is well documented that freezing of gait (FoG) episodes occur in situations that are mentally challenging, such as dual tasks, consistent with less automatic control of gait in people with Parkinson disease (PD) and FoG. However, most physical rehabilitation does not include such challenges. The purpose was to determine (1) feasibility of a cognitively challenging Agility Boot Camp-Cognitive (ABC-C) program and (2) effects of this intervention on FoG, dual-task cost, balance, executive function, and functional connectivity. Methods. A total of 46 people with PD and FoG enrolled in this randomized crossover trial. Each participant had 6 weeks of ABC-C and Education interventions. Outcome measures were the following: FoG, perceived and objective measures; dual-task cost on gait; balance; executive function; and right supplementary motor area (SMA)-pedunculopontine nucleus (PPN) functional connectivity. Effect sizes were calculated. Results. ABC-C had high compliance (90%), with a 24% dropout rate. Improvements after exercise, revealed by moderate and large effect sizes, were observed for subject perception of FoG after exercise, dual-task cost on gait speed, balance, cognition (Scales for Outcomes in Parkinson's disease-Cognition), and SMA-PPN connectivity. Conclusions. The ABC-C for people with PD and FoG is a feasible exercise program that has potential to improve FoG, balance, dual-task cost, executive function, and brain connectivity. The study provided effect sizes to help design future studies with more participants and longer duration to fully determine the potential to improve FoG.

7.
Phys Ther ; 100(4): 687-697, 2020 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-31951263

RESUMO

BACKGROUND: Clinical practice for rehabilitation after mild traumatic brain injury (mTBI) is variable, and guidance on when to initiate physical therapy is lacking. Wearable sensor technology may aid clinical assessment, performance monitoring, and exercise adherence, potentially improving rehabilitation outcomes during unsupervised home exercise programs. OBJECTIVE: The objectives of this study were to: (1) determine whether initiating rehabilitation earlier than typical will improve outcomes after mTBI, and (2) examine whether using wearable sensors during a home-exercise program will improve outcomes in participants with mTBI. DESIGN: This was a randomized controlled trial. SETTING: This study will take place within an academic hospital setting at Oregon Health & Science University and Veterans Affairs Portland Health Care System, and in the home environment. PARTICIPANTS: This study will include 160 individuals with mTBI. INTERVENTION: The early intervention group (n = 80) will receive one-on-one physical therapy 8 times over 6 weeks and complete daily home exercises. The standard care group (n = 80) will complete the same intervention after a 6- to 8-week wait period. One-half of each group will receive wearable sensors for therapist monitoring of patient adherence and quality of movements during their home exercise program. MEASUREMENTS: The primary outcome measure will be the Dizziness Handicap Inventory score. Secondary outcome measures will include symptomatology, static and dynamic postural control, central sensorimotor integration posturography, and vestibular-ocular-motor function. LIMITATIONS: Potential limitations include variable onset of care, a wide range of ages, possible low adherence and/or withdrawal from the study in the standard of care group, and low Dizziness Handicap Inventory scores effecting ceiling for change after rehabilitation. CONCLUSIONS: If initiating rehabilitation earlier improves primary and secondary outcomes post-mTBI, this could help shape current clinical care guidelines for rehabilitation. Additionally, using wearable sensors to monitor performance and adherence may improve home exercise outcomes.


Assuntos
Concussão Encefálica/reabilitação , Terapia por Exercício/métodos , Serviços de Assistência Domiciliar , Ensaios Clínicos Controlados Aleatórios como Assunto , Dispositivos Eletrônicos Vestíveis , Adulto , Assistência Ambulatorial/métodos , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Tamanho da Amostra , Fatores de Tempo , Resultado do Tratamento
8.
ACS Appl Mater Interfaces ; 12(5): 5901-5908, 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-31971770

RESUMO

Silicon has shown promise for use as a small band gap (1.1 eV) absorber material in photoelectrochemical (PEC) water splitting. However, the limited stability of silicon in acidic electrolyte requires the use of protection strategies coupled with catalysts. Herein, spin coating is used as a versatile method to directly coat silicon photoanodes with an IrOx oxygen evolution reaction (OER) catalyst, reducing the processing complexity compared to conventional fabrication schemes. Biphasic strontium chloride/iridium oxide (SrCl2:IrOx) catalysts are also developed, and both catalysts form photoactive junctions with silicon and demonstrate high photoanode activity. The iridium oxide photoanode displays a photocurrent onset at 1.06 V vs reversible hydrogen electrode (RHE), while the SrCl2:IrOx photoanode onsets earlier at 0.96 V vs RHE. The differing potentials are consistent with the observed photovoltages of 0.43 and 0.53 V for the IrOx and SrCl2:IrOx, respectively. By measuring the oxidation of a reversible redox couple, Fe(CN)63-/4-, we compare the charge carrier extraction of the devices and show that the addition of SrCl2 to the IrOx catalyst improves the silicon-electrolyte interface compared to pure IrOx. However, the durability of the strontium-containing photoanode remains a challenge, with its photocurrent density decreasing by 90% over 4 h. The IrOx photoanode, on the other hand, maintained a stable photocurrent density over this timescale. Characterization of the as-prepared and post-tested material structure via Auger electron spectroscopy identifies catalyst film cracking and delamination as the primary failure modes. We propose that improvements to catalyst adhesion should further the viability of spin coating as a technique for photoanode preparation.

9.
J Neurotrauma ; 37(1): 139-145, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31354032

RESUMO

Balance and mobility issues are common non-resolving symptoms following mild traumatic brain injury (mTBI). Current approaches for evaluating balance and mobility following an mTBI can be subjective and suboptimal as they may not be sensitive to subtle deficits, particularly in those with chronic mTBI. Wearable inertial measurement units (IMU) allow objective quantification of continuous mobility outcomes in natural free-living environments. This study aimed to explore free-living mobility (physical activity and turning) of healthy and chronic mild traumatic brain injury (mTBI) participants using a single IMU. Free-living mobility was examined in 23 healthy control (48.56 ± 23.07 years) and 29 symptomatic mTBI (40.2 ± 12.1 years) participants (average 419 days post-injury, persistent balance complaints) over 1 week, using a single IMU placed at the waist. Free-living mobility was characterized in terms of macro (physical activity volume, pattern and variability) and micro-level (discrete measures of turning) features. Macro-level outcomes showed those with chronic mTBI had similar quantities of mobility compared with controls. Micro-level outcomes within walking bouts showed that chronic mTBI participants had impaired quality of mobility. Specifically, people with chronic mTBI made larger turns, had longer turning durations, slower average and peak velocities (all p < 0.001), and greater turn variability compared with controls. Results highlighted that the quality rather than quantity of mobility differentiated chronic mTBI from controls. Our findings support the use of free-living IMU continuous monitoring to enhance understanding of specific chronic mTBI-related mobility deficits. Future work is required to develop an optimal battery of free-living measures across the mTBI spectrum to aid application within clinical practice.

10.
Hum Mov Sci ; 69: 102557, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31783306

RESUMO

INTRODUCTION: Mild traumatic brain injury (mTBI) can impact gait, with deficits linked to underlying neural disturbances in cognitive, motor and sensory systems. Gait is complex as it is comprised of multiple characteristics that are sensitive to underlying neural deficits. However, there is currently no clear framework to guide selection of gait characteristics in mTBI. This study developed a model of gait in chronic mTBI and replicated this in a separate group of controls, to provide a comprehensive and structured methodology on which to base gait assessment and analysis. METHODS: Fifty-two people with chronic mTBI and 59 controls completed a controlled laboratory gait assessment; walking for two minutes back and forth over a 13 m distance while wearing five wirelessly synchronized inertial sensors. Thirteen gait characteristics derived from the inertial sensors were selected for entry into the principle component analysis based on previous literature, robustness and novelty. Principle component analysis was then used to derive domains (components) of gait. RESULTS: Four gait domains were derived for our chronic mTBI group (variability, rhythm, pace and turning) and this was replicated in a separate control cohort. Domains totaled 80.8% and 77.4% of variance in gait for chronic mTBI and controls, respectively. Gait characteristic loading was unambiguous for all features, with the exception of gait speed in controls that loaded on pace and rhythm domains. CONCLUSION: This study contributes a four component model of gait in chronic mTBI and controls that can be used to comprehensively assess and analyze gait and underlying mechanisms involved in impairment, or examine the influence of interventions.


Assuntos
Concussão Encefálica/fisiopatologia , Marcha , Velocidade de Caminhada , Adulto , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Nat Nanotechnol ; 14(11): 1071-1074, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31611657

RESUMO

We demonstrate the translation of a low-cost, non-precious metal cobalt phosphide (CoP) catalyst from 1 cm2 lab-scale experiments to a commercial-scale 86 cm2 polymer electrolyte membrane (PEM) electrolyser. A two-step bulk synthesis was adopted to produce CoP on a high-surface-area carbon support that was readily integrated into an industrial PEM electrolyser fabrication process. The performance of the CoP was compared head to head with a platinum-based PEM under the same operating conditions (400 psi, 50 °C). CoP was found to be active and stable, operating at 1.86 A cm-2 for >1,700 h of continuous hydrogen production while providing substantial material cost savings relative to platinum. This work illustrates a potential pathway for non-precious hydrogen evolution catalysts developed in past decades to translate to commercial applications.

12.
ACS Appl Mater Interfaces ; 11(37): 34059-34066, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31442022

RESUMO

Multimetallic Ir-based systems offer significant opportunities for enhanced oxygen evolution electrocatalysis by modifying the electronic and geometric properties of the active catalyst. Herein, a systematic investigation of bimetallic Ir-based thin films was performed to identify activity and stability trends across material systems for the oxygen evolution reaction (OER) in acidic media. Electron beam evaporation was used to co-deposit metallic films of Ir, IrSn2, IrCr, IrTi, and IrNi. The electrocatalytic activity of the electrochemically oxidized alloys was found to increase in the following order: IrTi < IrSn2 < Ir ∼ IrNi < IrCr. The IrCr system demonstrates two times the catalytic activity of Ir at 1.65 V versus RHE. Density functional theory calculations suggest that this enhancement is due to Cr active sites that have improved oxygen binding energetics compared to those of pure Ir oxide. This work identifies IrCr as a promising new catalyst system that facilitates reduced precious metal loadings for acid-based OER catalysis.

13.
ACS Appl Mater Interfaces ; 11(30): 26863-26871, 2019 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-31310093

RESUMO

With promising activity and stability for the oxygen reduction reaction (ORR), transition metal nitrides are an interesting class of non-platinum group catalysts for polymer electrolyte membrane fuel cells. Here, we report an active thin-film nickel nitride catalyst synthesized through a reactive sputtering method. In rotating disk electrode testing in a 0.1 M HClO4 electrolyte, the crystalline nickel nitride film achieved high activity and selectivity to four-electron ORR. It also exhibited good stability during 10 and 40 h chronoamperometry measurements in acid and alkaline electrolyte, respectively. A combined experiment-theory approach, with detailed ex situ materials characterization and density functional theory calculations, provides insight into the structure of the catalyst and its surface during catalysis. Design strategies for activity and stability improvement through alloying and nanostructuring are discussed.

14.
J Athl Train ; 54(4): 429-438, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30933608

RESUMO

CONTEXT: In longitudinal studies tracking recovery after concussion, researchers often have not considered the timing of return to play (RTP) as a factor in their designs, which can limit the understanding of how RTP may affect the analysis and resulting conclusions. OBJECTIVE: To evaluate the recovery of balance and gait in concussed athletes using a novel linear mixed-model design that allows an inflection point to account for changes in trend that may occur after RTP. DESIGN: Cohort study. SETTING: University athletics departments, applied field setting. PATIENTS OR OTHER PARTICIPANTS: Twenty-three concussed (5 women, 18 men; age = 20.1 ± 1.3 years) and 25 healthy control (6 women, 19 men; age = 20.9 ± 1.4 years) participants were studied. Participants were referred by their team athletic trainers. MAIN OUTCOME MEASURE(S): Measures consisted of the Balance Error Scoring System (BESS) total score, sway (instrumented root mean square of mediolateral sway), single-task gait speed, gait speed while simultaneously reading a handheld article (dual-task gait speed), dual-task cost of reading on gait speed, and dual-task cost of walking on reading. RESULTS: We observed no significant effects or interactions for the BESS. Instrumented sway was worse in concussed participants, and a change in the recovery trend occurred after RTP. We observed group and time effects and group × time and group × RTP change interactions (P ≤ .046). No initial between-groups differences were found for single-task or dual-task gait. Both groups increased gait speed initially and then leveled off after the average RTP date. We noted time and RTP change effects and positive group × time interactions for both conditions (P ≤ .042) and a group × RTP change interaction for single-task gait speed (P = .005). No significant effects or interactions were present for the dual-task cost of reading on gait speed or the dual-task cost of walking on reading. CONCLUSIONS: Changes in the rate of recovery were coincident with the timing of RTP. Although we cannot suggest these changes were a result of the athletes returning to play, these findings demonstrate the need for further research to evaluate the effects of RTP on concussion recovery.


Assuntos
Atletas , Concussão Encefálica/reabilitação , Terapia por Exercício/métodos , Marcha/fisiologia , Equilíbrio Postural/fisiologia , Volta ao Esporte , Caminhada/fisiologia , Concussão Encefálica/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Adulto Jovem
15.
Physiol Meas ; 40(4): 044006, 2019 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-30943463

RESUMO

OBJECTIVE: Saccadic (fast) eye movements are a routine aspect of neurological examination and are a potential biomarker of mild traumatic brain injury (mTBI). Objective measurement of saccades has become a prominent focus of mTBI research, as eye movements may be a useful assessment tool for deficits in neural structures or processes. However, saccadic measurement within mobile infra-red (IR) eye-tracker raw data requires a valid algorithm. The objective of this study was to validate a velocity-based algorithm for saccade detection in IR eye-tracking raw data during walking (straight ahead and while turning) in people with mTBI and healthy controls. APPROACH: Eye-tracking via a mobile IR Tobii Pro Glasses 2 eye-tracker (100 Hz) was performed in people with mTBI (n = 10) and healthy controls (n = 10). Participants completed two walking tasks: straight walking (walking back and forth for 1 min over a 10 m distance), and walking and turning (turns course included 45°, 90° and 135° turns). Five trials per subject, for one-hundred total trials, were completed. A previously reported velocity-based saccade detection algorithm was adapted and validated by assessing agreement between algorithm saccade detections and the number of correct saccade detections determined from manual video inspection (ground truth reference). MAIN RESULTS: Compared with video inspection, the IR algorithm detected ~97% (n = 4888) and ~95% (n = 3699) of saccades made by people with mTBI and controls, respectively, with excellent agreement to the ground truth (intra-class correlation coefficient2,1 = .979 to .999). SIGNIFICANCE: This study provides a simple yet highly robust algorithm for the processing of mobile eye-tracker raw data in mTBI and controls. Future studies may consider validating this algorithm with other IR eye-trackers and populations.


Assuntos
Algoritmos , Concussão Encefálica/fisiopatologia , Movimentos Sacádicos , Caminhada/fisiologia , Adulto , Estudos de Casos e Controles , Feminino , Fixação Ocular , Humanos , Masculino , Processamento de Sinais Assistido por Computador , Gravação em Vídeo
16.
J Head Trauma Rehabil ; 34(2): E74-E81, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30045224

RESUMO

OBJECTIVE: To examine whether horizontal head turns while seated or while walking, when instrumented with inertial sensors, were sensitive to the acute effects of concussion and whether horizontal head turns had utility for concussion management. SETTING: Applied field setting, athletic training room. PARTICIPANTS: Twenty-four collegiate athletes with sports-related concussion and 25 healthy control athletes. DESIGN: Case-control; longitudinal. MAIN MEASURES: Peak head angular velocity and peak head angle (range of motion) when performing head turns toward an auditory cue while seated or walking. Gait speed when walking with and without head turns. RESULTS: Athletes with acute sports-related concussion turned their head slower than healthy control subjects initially (group ß = -49.47; SE = 16.33; P = .003) and gradually recovered to healthy control levels within 10 days postconcussion (group × time ß = 4.80; SE = 1.41; P < .001). Peak head velocity had fair diagnostic accuracy in differentiating subjects with acute concussion compared with controls (areas under the receiver operating characteristic curve [AUC] = 0.71-0.73). Peak head angle (P = .17) and gait speed (P = .64) were not different between groups and showed poor diagnostic utility (AUC = 0.57-0.62). CONCLUSION: Inertial sensors can improve traditional clinical assessments by quantifying subtle, nonobservable deficits in people following sports-related concussion.


Assuntos
Concussão Encefálica/fisiopatologia , Movimentos da Cabeça/fisiologia , Transtornos dos Movimentos/fisiopatologia , Caminhada/fisiologia , Traumatismos em Atletas/fisiopatologia , Estudos de Casos e Controles , Sinais (Psicologia) , Feminino , Humanos , Masculino , Síndrome Pós-Concussão/diagnóstico , Velocidade de Caminhada/fisiologia , Dispositivos Eletrônicos Vestíveis , Adulto Jovem
17.
Sensors (Basel) ; 18(12)2018 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-30572640

RESUMO

Wearable inertial measurement units (IMUs) may provide useful, objective information to clinicians interested in quantifying head movements as patients' progress through vestibular rehabilitation. The purpose of this study was to validate an IMU-based algorithm against criterion data (motion capture) to estimate average head and trunk range of motion (ROM) and average peak velocity. Ten participants completed two trials of standing and walking tasks while moving the head with and without moving the trunk. Validity was assessed using a combination of Intra-class Correlation Coefficients (ICC), root mean square error (RMSE), and percent error. Bland-Altman plots were used to assess bias. Excellent agreement was found between the IMU and criterion data for head ROM and peak rotational velocity (average ICC > 0.9). The trunk showed good agreement for most conditions (average ICC > 0.8). Average RMSE for both ROM (head = 2.64°; trunk = 2.48°) and peak rotational velocity (head = 11.76 °/s; trunk = 7.37 °/s) was low. The average percent error was below 5% for head and trunk ROM and peak rotational velocity. No clear pattern of bias was found for any measure across conditions. Findings suggest IMUs may provide a promising solution for estimating head and trunk movement, and a practical solution for tracking progression throughout rehabilitation or home exercise monitoring.


Assuntos
Concussão Encefálica/fisiopatologia , Monitorização Fisiológica , Dispositivos Eletrônicos Vestíveis , Adulto , Algoritmos , Concussão Encefálica/reabilitação , Feminino , Cabeça/fisiologia , Humanos , Masculino , Movimento/fisiologia , Postura/fisiologia , Posição Ortostática , Testes de Função Vestibular/métodos , Caminhada/fisiologia
18.
Mil Med ; 183(suppl_1): 327-332, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29635623

RESUMO

Introduction: Optimal balance control requires a complex integration of sensory information from the visual, vestibular, and proprioceptive systems. The goal of this study is to determine if the instrumented modified Clinical Test of Sensory Integration and Balance (mCTSIB) was impaired acutely after mild traumatic brain injury (mTBI) when postural sway under varying sensory conditions was measured with a wearable inertial sensor. Materials and Methods: Postural sway was assessed in athletes who had sustained a mTBI within the past 2-3 d (n = 38) and control athletes (n = 81). Postural sway was quantified with a wearable inertial sensor (Opal; APDM, Inc.) during four varying sensory conditions of quiet stance: (1) eyes open (EO) firm surface, (2) eyes closed (EC) firm surface, (3) eyes open (EO) foam surface, and (4) eyes closed (EC) foam surface. Sensory reweighting deficits were computed by comparing the postural sway area in eyes closed versus eyes open conditions for firm and foam condition. Results: Postural sway was higher for mTBI compared with the control group during three of the four conditions of instrumented mCTSIB (EO firm, EC firm, and EC foam; p < 0.05). Sensory reweighting deficits were evident for mTBI individuals compared with control group on foam surface (EC firm vs EO firm; p < 0.05) and not on firm surface (EC firm vs EO firm; p = 0.63). Conclusions: The results from this study highlight the importance of detecting postural sway deficits during sensorimotor integration in mild TBI individuals.


Assuntos
Aceleração , Concussão Encefálica/complicações , Equilíbrio Postural/fisiologia , Atletas/estatística & dados numéricos , Concussão Encefálica/fisiopatologia , Estudos Transversais , Feminino , Humanos , Masculino , Universidades/organização & administração , Universidades/estatística & dados numéricos , Adulto Jovem
19.
Gait Posture ; 62: 157-166, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29550695

RESUMO

BACKGROUND: While a growing number of studies have investigated the effects of concussion or mild traumatic brain injury (mTBI) on gait, many studies use different experimental paradigms and outcome measures. The path for translating experimental studies for objective clinical assessments of gait is unclear. RESEARCH QUESTION: This review asked 2 questions: 1) is gait abnormal after concussion/mTBI, and 2) what gait paradigms (single-task, dual-task, complex gait) detect abnormalities after concussion. METHODS: Data sources included MEDLINE/PubMed, Scopus, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) accessed on March 14, 2017. Original research articles reporting gait outcomes in people with concussion or mTBI were included. Studies of moderate, severe, or unspecified TBI, and studies without a comparator were excluded. RESULTS: After screening 233 articles, 38 studies were included and assigned to one or more sections based on the protocol and reported outcomes. Twenty-six articles reported single-task simple gait outcomes, 24 reported dual-task simple gait outcomes, 21 reported single-task complex gait outcomes, and 10 reported dual-task complex gait outcomes. SIGNIFICANCE: Overall, this review provides evidence for two conclusions: 1) gait is abnormal acutely after concussion/mTBI but generally resolves over time; and 2) the inconsistency of findings, small sample sizes, and small number of studies examining homogenous measures at the same time-period post-concussion highlight the need for replication across independent populations and investigators. Future research should concentrate on dual-task and complex gait tasks, as they showed promise for detecting abnormal locomotor function outside of the acute timeframe. Additionally, studies should provide detailed demographic and clinical characteristics to enable more refined comparisons across studies.


Assuntos
Concussão Encefálica/complicações , Transtornos Neurológicos da Marcha/diagnóstico , Locomoção/fisiologia , Concussão Encefálica/fisiopatologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Transtornos dos Movimentos/fisiopatologia , Avaliação de Resultados em Cuidados de Saúde
20.
Front Neurol ; 9: 1045, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30619027

RESUMO

Balance during stance is regulated by active control mechanisms that continuously estimate body motion, via a "sensory integration" mechanism, and generate corrective actions, via a "sensory-to-motor transformation" mechanism. The balance control system can be modeled as a closed-loop feedback control system for which appropriate system identification methods are available to separately quantify the sensory integration and sensory-to-motor components of the system. A detailed, functionally meaningful characterization of balance control mechanisms has potential to improve clinical assessment and to provide useful tools for answering clinical research questions. However, many researchers and clinicians do not have the background to develop systems and methods appropriate for performing identification of balance control mechanisms. The purpose of this report is to provide detailed information on how to perform what we refer to as "central sensorimotor integration" (CSMI) tests on a commercially available balance test device (SMART EquiTest CRS, Natus Medical Inc, Seattle WA) and then to appropriately analyze and interpret results obtained from these tests. We describe methods to (1) generate pseudorandom stimuli that apply cyclically-repeated rotations of the stance surface and/or visual surround (2) measure and calibrate center-of-mass (CoM) body sway, (3) calculate frequency response functions (FRFs) that quantify the dynamic characteristics of stimulus-evoked CoM sway, (4) estimate balance control parameters that quantify sensory integration by measuring the relative contribution of different sensory systems to balance control (i.e., sensory weights), and (5) estimate balance control parameters that quantify sensory-to-motor transformation properties (i.e., feedback time delay and neural controller stiffness and damping parameters). Additionally, we present CSMI test results from 40 subjects (age range 21-59 years) with normal sensory function, 2 subjects with results illustrating deviations from normal balance function, and we summarize results from previous studies in subjects with vestibular deficits. A bootstrap analysis was used to characterize confidence limits on parameters from CSMI tests and to determine how test duration affected the confidence with which parameters can be measured. Finally, example results are presented that illustrate how various sensory and central balance deficits are revealed by CSMI testing.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...