Gait-modifying effects of augmented-reality cueing in people with Parkinson's disease.

Introduction: External cueing can improve gait in people with Parkinson's disease (PD), but there is a need for wearable, personalized and flexible cueing techniques that can exploit the power of action-relevant visual cues. Augmented Reality (AR) involving headsets or glasses represents a promising technology in those regards. This study examines the gait-modifying effects of real-world and AR cueing in people with PD. Methods: 21 people with PD performed walking tasks augmented with either real-world or AR cues, imposing changes in gait speed, step length, crossing step length, and step height. Two different AR headsets, differing in AR field of view (AR-FOV) size, were used to evaluate potential AR-FOV-size effects on the gait-modifying effects of AR cues as well as on the head orientation required for interacting with them. Results: Participants modified their gait speed, step length, and crossing step length significantly to changes in both real-world and AR cues, with step lengths also being statistically equivalent to those imposed. Due to technical issues, step-height modulation could not be analyzed. AR-FOV size had no significant effect on gait modifications, although small differences in head orientation were observed when interacting with nearby objects between AR headsets. Conclusion: People with PD can modify their gait to AR cues as effectively as to real-world cues with state-of-the-art AR headsets, for which AR-FOV size is no longer a limiting factor. Future studies are warranted to explore the merit of a library of cue modalities and individually-tailored AR cueing for facilitating gait in real-world environments.

Effects of motor imagery training on gait performance in individuals after stroke: a systematic review and meta-analysis.

PURPOSE: This review systematically explores and summarise the effects of motor imagery training (MIT) compared to conventional therapy on gait performance in individuals after stroke. MATERIALS AND METHODS: Randomised controlled trials (RCTs) were systematically searched in five electronic databases (PubMed, EMBASE, PsycINFO, OVID Nursing and CINAHL) from inception to 30 December 2022. Studies investigating MITs, targeted at individuals after stroke were eligible. Data were extracted related to study and intervention characteristics. RESULTS: Sixteen studies were included. Compared with 'routine methods of treatment or training', the meta-analyses showed that MIT was more effective in improving cadence immediately post intervention (SMD: 1.22, 95% CI: 0.59, 1.85, p = 0.0001, I2 = 25%) and at 1- or 2-months post intervention (SMD: 0.78, 95% CI: 0.35, 1.20, p = 0.0004, I2 = 46%). The results also showed that MIT improves the step length of the affected side and the unaffected side at 1- or 2-months post intervention. Separate meta-analyses were also conducted on different tests of walking endurance (assessed by the 6-Minute Walk Test) and functional mobility (assessed by the Timed-Up-and-Go test). CONCLUSIONS: MIT effectively improved gait performance. The findings in individuals after stroke remain inconclusive due to significant heterogeneity in included studies.

Restoring gait performance and daily functional abilities is an important goal of post-stroke rehabilitation.Motor imagery training (MIT) may be a promising method to improve gait restoration and is expected to provide another option for the effective rehabilitation of stroke patients.This review highlights the limited research on MIT and thus the limited evidence to guide clinical rehabilitation.In the stroke rehabilitation, clinical specialists may consider incorporating MIT into the treatment programme to improve patients' gait performance and ensure effective early lower limb rehabilitation.

Accuracy, concurrent validity, and test-retest reliability of pressure-based insoles for gait measurement in chronic stroke patients.

Introduction: Wearables are potentially valuable tools for understanding mobility behavior in individuals with neurological disorders and how it changes depending on health status, such as after rehabilitation. However, the accurate detection of gait events, which are crucial for the evaluation of gait performance and quality, is challenging due to highly individual-specific patterns that also vary greatly in movement and speed, especially after stroke. Therefore, the purpose of this study was to assess the accuracy, concurrent validity, and test-retest reliability of a commercially available insole system in the detection of gait events and the calculation of stance duration in individuals with chronic stroke. Methods: Pressure insole data were collected from 17 individuals with chronic stroke during two measurement blocks, each comprising three 10-min walking tests conducted in a clinical setting. The gait assessments were recorded with a video camera that served as a ground truth, and pressure insoles as an experimental system. We compared the number of gait events and stance durations between systems. Results and discussion: Over all 3,820 gait events, 90.86% were correctly identified by the insole system. Recall values ranged from 0.994 to 1, with a precision of 1 for all measurements. The F1 score ranged from 0.997 to 1. Excellent absolute agreement (Intraclass correlation coefficient, ICC = 0.874) was observed for the calculation of the stance duration, with a slightly longer stance duration recorded by the insole system (difference of -0.01 s). Bland-Altmann analysis indicated limits of agreement of 0.33 s that were robust to changes in walking speed. This consistency makes the system well-suited for individuals post-stroke. The test-retest reliability between measurement timepoints T1 and T2 was excellent (ICC = 0.928). The mean difference in stance duration between T1 and T2 was 0.03 s. We conclude that the insole system is valid for use in a clinical setting to quantitatively assess continuous walking in individuals with stroke.

Markerless gait analysis through a single camera and computer vision.

The assessment of gait performance using quantitative measures can yield crucial insights into an individual's health status. Recently, computer vision-based human pose estimation has emerged as a promising solution for markerless gait analysis, as it allows for the direct extraction of gait parameters from videos. This study aimed to compare the lower extremity kinematics and spatiotemporal gait parameters obtained from a single-camera-based markerless method with those acquired from a marker-based motion tracking system across a healthy population. Additionally, we investigated the impact of camera viewing angles and distances on the accuracy of the markerless method. Our findings demonstrated a robust correlation and agreement (Rxy > 0.75, Rc > 0.7) between the markerless and marker-based methods for most spatiotemporal gait parameters. We also observed strong correlations (Rxy > 0.8) between the two methods for hip flexion/extension, knee flexion/extension, hip abduction/adduction, and hip internal/external rotation. Statistical tests revealed significant effects of viewing angles and distances on the accuracy of the identified gait parameters. While the markerless method offers an alternative for general gait analysis, particularly when marker use is impractical, its accuracy for clinical applications remains insufficient and requires substantial improvement. Future investigations should explore the potential of the markerless system to measure gait parameters in pathological gaits.

Accuracy of unilateral and bilateral gait assessment using a mobile gait analysis system at different walking speeds.

BACKGROUND: Previous research on the accuracy of mobile measurement systems has focused on parameters related to the whole gait cycle. Specifically, bilateral gait characteristics were primarily used as outcome measures. RESEARCH QUESTION: How accurate are unilateral gait characteristics detected using a mobile system at various fixed walking speeds? METHODS: Gait analysis during treadmill walking at velocities (VEL) of 2.5 (v1), 4.5 (v2) and 6.5 km/h (v3) was performed in a population of 47 healthy young adults, consisting of 27 females (age: 23 ± 2 years, BMI: 21.4 ± 2.2 kg/m²) and 20 males (age: 22 ± 1 years, BMI: 23.3 ± 3.4 kg/m²). Spatiotemporal gait data were simultaneously determined using an instrumented treadmill (gaitway 3D) and a mobile gait analysis system (RehaGait). Besides VEL, bilateral (stride length [SL], cadence [CAD]) and unilateral (contact duration [CON], single [SS] and double support duration [DS]) outcomes were validated. RESULTS: Across the three VEL investigated, the correlations between both measurement systems were almost perfect in SL and CAD (r > 0.97). In addition, SL significantly differed (p < 0.01) with moderate to large effects, whereby the root mean squared error (RMSE) did not exceed 1.8 cm. RMSE in CAD was not higher than 0.33 spm and statistically significant differences were only present at v1 (d = 0.63). DS was the most erroneous unilateral parameter with values for %RMSE ranging from 9% at v1 to 14% at v3. In CON and SS %RMSE was in a magnitude of 2-4% across all VEL. Furthermore, VEL affected measurement accuracy in unilateral outcomes with moderate to large effects (F (2, 45) > 6.0, p < 0.01, ηp2 > 0.11) with consistently higher differences at lower velocities. SIGNIFICANCE: Based on the results presented the validity of the mobile gait analysis system investigated to detect gait asymmetries must be questioned.

Effect of Novel Laser Shoe Photobiomodulation on Neuropathic Pain and Plantar Pressure Profile in Type 2 Diabetes Mellitus with Peripheral Neuropathy.

BACKGROUND: Photobiomodulation (PBM) or Low-level laser is used to treat diabetic foot complications. The existing method of laser application to the foot did not cover the foot's entire area to improve the foot's microcirculation. Therefore, we have developed a cost-effective Special LASER Shoe device, focusing exclusively on the entire foot region to manage neuropathic pain and other symptoms in individuals with type 2 diabetes mellitus. OBJECTIVE: The main objective of the present study was to evaluate the effect of this newly developed special laser shoe PBM on neuropathic pain and plantar pressure profile in individuals with type 2 diabetes mellitus with neuropathy. METHODS: We included 60 participants with diabetic peripheral neuropathy of both genders and age more than 20 years. Participants were treated with PBM by a specially designed novel Laser Shoe. Outcomes were clinical variables like Vibration Perception Threshold (VPT), Visual Analogue Scale (VAS), Michigan neuropathy screening instrument A&B, Ankle-Brachial Index (ABI), and Static dynamic gait parameters. RESULTS: Participants were with an average age of 62, and the average duration of diabetes was 11 years. Analysis showed a significant difference in VPT, VAS, Michigan neuropathic screening inventory, and ankle-brachial index. (P < 0.05). CONCLUSION: We conclude that Novel laser shoe photobiomodulation using 'Laser Shoe' effectively reduces peripheral neuropathic pain. It is also effective in reducing average and maximum plantar pressure. Reduction in neuropathic pain and improvement in plantar pressure distribution can reduce further complications.

Estimation of Gait Parameters for Adults with Surface Electromyogram Based on Machine Learning Models.

Gait analysis has been studied over the last few decades as the best way to objectively assess the technical outcome of a procedure designed to improve gait. The treating physician can understand the type of gait problem, gain insight into the etiology, and find the best treatment with gait analysis. The gait parameters are the kinematics, including the temporal and spatial parameters, and lack the activity information of skeletal muscles. Thus, the gait analysis measures not only the three-dimensional temporal and spatial graphs of kinematics but also the surface electromyograms (sEMGs) of the lower limbs. Now, the shoe-worn GaitUp Physilog® wearable inertial sensors can easily measure the gait parameters when subjects are walking on the general ground. However, it cannot measure muscle activity. The aim of this study is to measure the gait parameters using the sEMGs of the lower limbs. A self-made wireless device was used to measure the sEMGs from the vastus lateralis and gastrocnemius muscles of the left and right feet. Twenty young female subjects with a skeletal muscle index (SMI) below 5.7 kg/m2 were recruited for this study and examined by the InBody 270 instrument. Four parameters of sEMG were used to estimate 23 gait parameters. They were measured using the GaitUp Physilog® wearable inertial sensors with three machine learning models, including random forest (RF), decision tree (DT), and XGBoost. The results show that 14 gait parameters could be well-estimated, and their correlation coefficients are above 0.800. This study signifies a step towards a more comprehensive analysis of gait with only sEMGs.

Determination of Gait Events and Temporal Gait Parameters for Persons with a Knee-Ankle-Foot Orthosis.

Gait event detection is essential for controlling an orthosis and assessing the patient's gait. In this study, patients wearing an electromechanical (EM) knee-ankle-foot orthosis (KAFO) with a single IMU embedded in the thigh were subjected to gait event detection. The algorithm detected four essential gait events (initial contact (IC), toe off (TO), opposite initial contact (OIC), and opposite toe off (OTO)) and determined important temporal gait parameters such as stance/swing time, symmetry, and single/double limb support. These gait events were evaluated through gait experiments using four force plates on healthy adults and a hemiplegic patient who wore a one-way clutch KAFO and a pneumatic cylinder KAFO. Results showed that the smallest error in gait event detection was found at IC, and the largest error rate was observed at opposite toe off (OTO) with an error rate of -2.8 ± 1.5% in the patient group. Errors in OTO detection resulted in the largest error in determining the single limb support of the patient with an error of 5.0 ± 1.5%. The present study would be beneficial for the real-time continuous monitoring of gait events and temporal gait parameters for persons with an EM KAFO.

Association Between Baseline Gait Parameters and Future Fall Risk in Patients With De Novo Parkinson's Disease: Forward Versus Backward Gait.

BACKGROUND AND PURPOSE: Falls are not uncommon even in patients with early stages of Parkinson's disease (PD). The aims of this study were to determine the relationships between gait parameters and falls and identify crucial gait parameters for predicting future falls in patients with de novo PD. METHODS: We prospectively recruited patients with de novo PD, and evaluated their baseline demographics, global cognitive function on the Montreal Cognitive Assessment test, and parkinsonian motor symptoms including their subtypes. Both forward gait (FG) and backward gait (BG) were measured using the GAITRite system. The history of falls in consecutive patients with de novo PD was examined along with 1 year of follow-up data. RESULTS: Among the 76 patients with de novo PD finally included in the study, 16 (21.1%) were classified as fallers. Fallers had slower gait and shorter stride for FG and BG parameters than did non-fallers, while stride-time variability was greater in fallers but only for BG. Multivariable logistic regression analysis revealed that slow gait was an independent risk factor in BG. CONCLUSIONS: Among the patients with de novo PD, gait speed and stride length were more impaired for both FG and BG in fallers than in non-fallers. It was particularly notable that slow BG was significantly associated with future fall risk, indicating that BG speed is a potential biomarker for predicting future falls in patients with early-stage PD.

Step length is associated with comprehensive frailty status in community-dwelling older people.

AIM: To examine spatial-temporal gait parameters associated with comprehensive frailty status in community-dwelling, independent older people. METHODS: This cross-sectional study included 225 older people (≥65 years) living independently in the community. The Kihon Checklist was used to assess comprehensive frailty status, and participants were classified as robust, pre-frailty, or frailty. A sheet-type plantar pressure sensor was used to evaluate the following gait parameters, which were extracted at the usual and fast pace: gait speed, cadence, stride time, step length-to-height ratio (step length/height), step width, stance duration, double-support time, and variability of each gait parameter. Ordinal logistic regression analysis adjusted for confounding factors was performed to determine the association between gait parameters and frailty status. In addition, the ability to discriminate frailty status was evaluated by receiver operating characteristic (ROC) curve analysis for gait parameters that were significantly associated with frailty status. RESULTS: Frailty status was pre-frailty in 79 (35.1%) and frailty in 30 (13.3%) participants. Ordinal logistic regression analysis showed a significant association of step length/height (%) at both usual and fast pace with frailty status, even after adjustment for confounding factors (usual pace: odds ratio [OR] = 0.93 [95% confidence interval, CI: 0.86-0.99]; fast pace: OR = 0.93 [95% CI: 0.87-0.99]). ROC curve analysis identified step length/height at fast pace in women as the best discriminator between frailty and non-frailty (area under the curve 0.69, cut-off value 43.4%, sensitivity 50%, specificity 82%). CONCLUSIONS: Step length appears to be a useful gait parameter for discriminating frailty status in community-dwelling, independent older people. Geriatr Gerontol Int 2024; 24: 18-24.

Changes in Gait Parameters and the Podal System Depending on the Presence of a Specific Malocclusion Type in School-Age Children.

BACKGROUND: The correspondence between various aspects of human postural parameters and the spatial relation of the jaws is of increasing interest among scientists. Emerging research suggests that the stomatognathic system and posture play, in a broad sense, significant roles. OBJECTIVES: The aim of the study was to analyze the relationship between various malocclusion types and gait parameters, the distribution of foot pressure on the ground, and body balance. METHODS: The study involved 155 patients aged 12-16. The subjects were divided into groups according to their malocclusion-Angle's class II (n = 32), Canine class II (n = 31), and Overbite (n = 46). The control group (n = 46) comprised children not demonstrating any defects. The study data were collected by direct observation of the oral cavity. Gait analysis was carried out using the Wiva® Science sensor, and the distribution of foot forces on the ground and body balance was determined via the E.P.S R/1 pedobarographic mat. The non-parametric Mann-Whitney U test was applied for statistical analysis. RESULTS: Analysis of the results obtained showed statistically significant differences in left step duration (p = 0.042) and the duration of the right step (p = 0.021), as well as the projection of the body's center of gravity on the left foot (p = 0.027). CONCLUSIONS: Distoocclusion in the anterior part of the mandible may cause different positioning of the head and neck, as well as varying tension of the muscles, further leading to balance disorders while walking.

Fuerza muscular y parámetros espaciotemporales de la marcha en personas con enfermedad de Parkinson. Un estudio piloto / Muscle strength and spatiotemporal gait parameters in people with Parkinson´s disease. A pilot study

Introducción: La debilidad muscular en personas con enfermedad de Parkinson (EP) ha sido frecuentemente reconocida como un síntoma inespecífico. En otras patologías neurológicas, la debilidad de las extremidades inferiores, específicamente la debilidad de los cuádriceps, es el factor que causa mayor incapacidad para caminar. Pocas investigaciones han evaluado la relación entre la fuerza muscular de los miembros inferiores, utilizando herramientas objetivas en personas con EP y el desempeño de la marcha. El objetivo de este estudio fue analizar la correlación entre la fuerza muscular de los miembros inferiores, utilizando un dinamómetro isocinético, y los parámetros espaciotemporales de la marcha en la EP, en comparación con controles sanos emparejados por edad y sexo. Sujetos y métodos: El estudio se llevó a cabo con siete personas con EP –Hoehn y Yahr (HY) entre II y III– y siete controles sanos. Se realizaron pruebas isocinéticas de rodilla y tobillo a 60 y 120°/s y la prueba de marcha de 10 metros, a velocidad de marcha cómoda y rápida, en todos los sujetos reclutados. Resultados: Se observaron diferencias significativas en las medidas relacionadas con la fuerza de las extremidades inferiores y en los parámetros de la marcha entre las personas con EP y los controles. Los parámetros de la marcha mostraron excelentes correlaciones (rho = 0,7) para ambas extremidades inferiores: trabajo de flexión plantar de tobillo/desgaste corporal a 180°/s con número de pasos (indirecto) y zancada (directa) a ambas velocidades, y entre pico de torsión de flexión plantar de tobillo/desgaste corporal a 180°/s con número de pasos (indirecto) y zancada (directa) a velocidad máxima; y entre trabajo de extensión de rodilla/desgaste corporal a 60°/s con zancada (directa) a velocidad autoseleccionada. Conclusiones: La fuerza muscular de las extremidades inferiores de las personas con EP (estadios de HY II-III) se...(AU)

Introduction: Muscle weakness in persons with Parkinson disease (PD) has been frequently recognized as a nonspecific symptom. In other neurological conditions, lower limb weakness, specifically quadriceps weakness, is the factor that causes greater gait disability. Little research has evaluated the relationship between lower limb muscle strength, using objective tools, in PD persons and gait performance. The aim of this study was to analyze the correlation between lower limb muscle strength, using an isokinetic dynamometer, and the spatiotemporal gait parameters in PD, compared with age- and sex- matched healthy controls. Subjects and methods: The study was conducted with 7 persons with PD –Hoehn and Yahr (HY) between II-III– and 7 healthy controls. Isokinetic knee and ankle tests at 60 and 120°/s and the 10-meter walking test at comfortable and fast walking speed, were performed on all recruited subjects. Results: Significant differences in lower limb strength-related measures and gait parameters were observed between persons with PD and controls. Gait parameters showed excellent correlations (rho ≥ 0.7) for both lower limb: ankle plantar flexion work/body wearing at 180°/s with number of steps (indirect) and stride (direct) at both speeds, and between the ankle plantar flexion peak torque/ body wearing at 180°/s with number of steps (indirect) and stride (direct) at maximum speed; and between knee extension work/body wearing at 60°/s) with stride (direct) at self-selected speed. Conclusions: Persons with PD (HY II-III stages) lower limb muscle strength correlates excellently with gait pattern, showing lower isokinetic strength than healthy subjects of the same age and sex. This protocol showed safety to be performed in a larger sample.(AU)

Does listening to audiobooks affect gait behavior?

BACKGROUND: The effect of listening to audiobooks, podcasts, and other audio files while walking on gait performance has not been well studied. Although the number of audio users is growing annually. Evidence suggests that a posture-first strategy contributes to gait stability in healthy individuals during dual-task conditions, but this effect may be diminished when the cognitive task is consciously prioritized. OBJECTIVES: To study the effect of listening to an audiobook while walking, as a daily life-like dual-task, on spatiotemporal gait parameters. METHODS: Forty young healthy (24.05 ± 3.66) subjects participated in the study. Spatiotemporal gait parameters were measured for 5 min on a treadmill once without (single-task) and once while listening to an audiobook through over-ear headphones (dual-task). Measured parameters included spatiotemporal parameters, gait phases, maximum pressure, and dual-task cost. Data were statistically analyzed using SPSS software. RESULTS: There were no significant differences in any of the studied parameters between the single- and dual-task conditions, even though the subjective cognitive load of listening to audiobooks while walking was high. However, participants with different habits had significant differences in gait phases and maximum pressure. Rare listeners had a shorter stance phase, a longer swing phase, and a higher maximum pressure on the dominant heel. They also had significant differences in dual-task costs. CONCLUSION: No differences in the spatiotemporal gait parameters for walking with and without listening to audiobooks, as a daily life-like dual-task, were observed. However, the difference between participants who listened rarely and participants who listened often may confirm the "posture first" strategy in young healthy people. TRIAL REGISTRATION: DRKS00025837, retrospectively registered on 23.11.2021.

Effectiveness of Neurodevelopmental Treatment and Sensory Integration Therapy on Gross Motor Function, Balance and Gait Parameters in Children With Spastic Diplegia.

Background Spastic diplegic cerebral palsy is the type that is most frequently seen in clinical settings. Spastic diplegic children have trouble maintaining their balance, gait, and gross motor function. This study investigated the effects of the Neurodevelopmental Technique (NDT) and Sensory Integration Technique (SIT) on balance, gross motor function, and gait characteristics in children with spastic diplegia. Method The study's participants were 8 to 12 years old, with spastic diplegia, categorized into stages I to III of the Gross Motor Function Classification System. While individuals in group B underwent sensory integration therapy, group A's subjects received NDT for 45 minutes. Both groups received traditional physiotherapy for 15 minutes. The protocol was given for five days a week, continuously for four weeks. All 40 subjects underwent pre- and post-treatment assessments using the Gross Motor Function Measure-88 (GMFM-88), Paediatric Balance Scale, Gait Parameters, and Gross Motor Function Classification System. Results The trial involved 40 children, divided into two groups of 20 each. Statistical analysis demonstrated a substantial improvement in group B post-intervention (P>0.0001). The study's findings were drawn using the Chi-Square test, paired and unpaired t-tests, and SPSS Statistics for Windows, version 27.0 (IBM Corp., Armonk, USA).A p<0.05 and the GraphPad Prism version 7.0 (GraphPad Software, Boston, USA) were used. A total of 40 children completed the entire duration of treatment for a month. 20 subjects participated in group A (age range 8-12 years; mean age 10.3 years) and 20 subjects in group B (age range 8-12 years; mean age 10.25 years). The GMFM-88, which assesses motor function, reveals that the between-group comparison indicates a substantial difference of 7.95 (6.04-9.86) in favor of Group B, with a p-value of 0.0001, signifying statistical significance. Similarly, the Pediatric Balance Scale (PBS) outcomes significantly enhanced in both groups post-intervention. The comparison between groups yields a difference of 1.85 (1.11-2.59) in favor of Group B, with a p-value of 0.0001. Conclusion The study concluded that SIT has a positive impact on gait metrics, balance, and gross motor function in children with spastic diplegia.

Spatiotemporal gait parameter fluctuations in older adults affected by mild cognitive impairment: comparisons among three cognitive dual-task tests.

BACKGROUNDS: Gait disorder is associated with cognitive functional impairment, and this disturbance is more pronouncedly when performing additional cognitive tasks. Our study aimed to characterize gait disorders in mild cognitive impairment (MCI) under three dual tasks and determine the association between gait performance and cognitive function. METHODS: A total of 260 participants were enrolled in this cross-sectional study and divided into MCI and cognitively normal control. Spatiotemporal and kinematic gait parameters (31 items) in single task and three dual tasks (serial 100-7, naming animals and words recall) were measured using a wearable sensor. Baseline characteristics of the two groups were balanced using propensity score matching. Important gait features were filtered using random forest method and LASSO regression and further described using logistic analysis. RESULTS: After matching, 106 participants with MCI and 106 normal controls were recruited. Top 5 gait features in random forest and 4 ~ 6 important features in LASSO regression were selected. Robust variables associating with cognitive function were temporal gait parameters. Participants with MCI exhibited decreased swing time and terminal swing, increased mid stance and variability of stride length compared with normal control. Subjects walked slower when performing an extra dual cognitive task. In the three dual tasks, words recall test exhibited more pronounced impact on gait regularity, velocity, and dual task cost than the other two cognitive tests. CONCLUSION: Gait assessment under dual task conditions, particularly in words recall test, using portable sensors could be useful as a complementary strategy for early detection of MCI.

Safety and Feasibility Study of the Medical Care Pit Walking Support System for Rehabilitation of Acute Stroke Patients.

Stroke rehabilitation with mechanical assistance improves outcomes by facilitating repetition and relieving the care burden of therapy staff. Here, we tested the Medical Care Pit (MCP) walking assistance training device in the rehabilitation of eight acute stroke patients (median age 60.7 ± 16.3 years) who had recently suffered ischemic (three) or hemorrhagic (five) stroke (14.1 ± 6.5 days). Patients received standard rehabilitation approximately 5 days per week (weekdays only), plus MCP therapy twice a week, totaling four MCP sessions over 2 weeks. Fugl-Meyer Assessment-Lower Extremities (FMA-LE), Functional Ambulation Category (FAC), and other gait-associated parameters were measured. Over the 10.5 ± 1.6 days of therapy, MCP qualitatively assisted in gait analysis and real-time patient feedback while independent walking scores significantly improved (FAC 2.2 ± 0.8 to 3.1 ± 1.3, p = 0.020). FMA-LE scores also slightly improved but not to significance (p = 0.106). Objective burden on patients, as measured by modified Borg scale, was significantly improved (2.7 ± 1.6 to 2.0 ± 1.6, p = 0.014). In terms of questionnaires, anxiety scores for the physical therapist regarding gait training and falling with MCP significantly decreased (3.8 ± 2.3 to 1.0 ± 1.6; p = 0.027 and 3.1 ± 2.2 to 0.8 ± 1.3; p = 0.045) from the first to fourth sessions. Taken together, MCP, in addition to the usual rehabilitation program, was effective in gait rehabilitation for independent walking and relieved burdens on the patients. Such walking support systems may be an important part of acute stroke rehabilitation.

Effect of overground gait training with 'Mobility Assisted Robotic System-MARS' on gait parameters in patients with stroke: a pre-post study.

OBJECTIVE: To observe the effect of overground gait training with 'Mobility Assisted Robotic System-MARS' on gait parameters in patients with stroke. PATIENTS & METHODS: This prospective pre-post study was conducted in a tertiary teaching research hospital with 29 adult stroke patients, with age up to 65 years. Patients fulfilling the inclusion criteria were divided in 2 groups based on the duration of stroke (≤ 6 months-sub-acute & > 6 months-chronic stroke) and provided overground gait training with MARS robot for 12 sessions (1 h/session) over a period of 2-3 weeks. Primary outcome measures were; 10-Meter walk test-10MWT, 6-min' walk test-6MWT and Timed up & Go-TUG tests. Secondary outcome measures were Functional Ambulation Category-FAC, Modified Rankin Scale-MRS and Scandinavian Stroke Scale-SSS. RESULTS: No adverse events were reported. Twenty-five patients who were able to perform 10-MWT at the beginning of study were included in the final analysis with 12 in sub-acute and 13 in chronic stroke group. All primary and secondary outcome measures showed significant improvement in gait parameters at the end of the training (p < 0.05) barring 10-Meter walk test in sub-acute stroke group (p = 0.255). Chronic stroke group showed significant minimum clinically important difference-MCID difference in endurance (6MWT) at the end of the training and both groups showed better 'minimal detectable change-MDC' in balance (TUG) at the end of the training. CONCLUSIONS: Patients in both the groups showed significant improvement in walking speed, endurance, balance and independence at the end of the training with overground gait training with MARS Robot. CLINICAL TRIAL REGISTRY: National Clinical Trial Registry of India (CTRI/2021/08/035695,16/08/2021).

Examining gender differences in gait parameters between non-smoker and smoker participants.

Smoking is one of the predictors of decreased cardiopulmonary endurance. Gait disturbance may be due to many reasons, including cardiovascular endurance. This study aimed to determine differences in gait parameters between non-smoker and smoker participants. A cross-sectional design was employed, involving thirty non-smokers and thirty-seven smokers as participants. Detailed interviews were conducted to gather information on smoking habits, status, and history. Gait parameters were measured using a high-quality 3D accelerometer, 3D gyroscope, and barometric pressure sensors (Physilog4 from GaitUp). Anthropometric characteristics were described, and mean values with standard deviations (SD) were calculated. An independent two-tailed t-test was conducted to compare gait parameters between non-smokers and smokers, with statistical significance set at p<0.05. The analysis revealed significant differences in various gait parameters between non-smokers and smokers. Specifically, significant differences were found in cadence (t=9.95, p=0.001), stride length (t=6.85, p=0.001), stride velocity (t=-6.58, p=0.001), stance (t=2.02, p=0.001), swing (t=3.46, p=0.001), foot flat (t=-8.94, p=0.001), pushing (t=3.53, p=0.001), and double support (t=-13.35, p=0.001). However, no significant difference was found between non-smokers and smokers in the loading phase (t=-1.57, p= 0.121). There were significant differences in general and temporal gait parameters between smokers and non-smokers. Gait parameters provide valuable insights for evaluating functional performance and providing objective and quantitative data to assess gait disorders. Future studies should include longitudinal studies with large sample sizes to explore the effects of potential confounders on gait parameters.

Automated Gait Analysis Based on a Marker-Free Pose Estimation Model.

Gait analysis is an essential tool for detecting biomechanical irregularities, designing personalized rehabilitation plans, and enhancing athletic performance. Currently, gait assessment depends on either visual observation, which lacks consistency between raters and requires clinical expertise, or instrumented evaluation, which is costly, invasive, time-consuming, and requires specialized equipment and trained personnel. Markerless gait analysis using 2D pose estimation techniques has emerged as a potential solution, but it still requires significant computational resources and human involvement, making it challenging to use. This research proposes an automated method for temporal gait analysis that employs the MediaPipe Pose, a low-computational-resource pose estimation model. The study validated this approach against the Vicon motion capture system to evaluate its reliability. The findings reveal that this approach demonstrates good (ICC(2,1) > 0.75) to excellent (ICC(2,1) > 0.90) agreement in all temporal gait parameters except for double support time (right leg switched to left leg) and swing time (right), which only exhibit a moderate (ICC(2,1) > 0.50) agreement. Additionally, this approach produces temporal gait parameters with low mean absolute error. It will be useful in monitoring changes in gait and evaluating the effectiveness of interventions such as rehabilitation or training programs in the community.

Relationship between gait parameter and spinal sagittal profiles in asymptomatic subjects.

BACKGROUND: To study the gait parameters in asymptomatic volunteers and investigate the correlation between the gait and several radiographic sagittal profiles. METHODS: Asymptomatic volunteers (20-50 years of age) were included and allocated into three subgroups depending on pelvic incidence (low, normal, and high). Standing whole spine radiographs and gait analysis data were obtained. The Pearson Coefficient Correlation was used to determine the relationship between the gait and radiographic profiles. RESULTS: A total of 55 volunteers (28 male and 27 females) were included. The mean age was 27.35 ± 6.37 years old. The average sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), and PI-LL mismatch (PI-LL) were 37.78 ± 6.59, 14.51 ± 9.19 degrees, and 52.29 ± 10.87 degrees and - 0.36 ± 11.41, respectively. The mean velocity and stride of all the volunteers were 119.00 ± 30.12 cm/s and 130.25 ± 7.72 cm, correspondingly. The correlation between each of the radiographical and gait parameters was low (ranging from - 0.24 to 0.26). CONCLUSION: Gait parameters were not differenced significantly between each of the PI subgroups in asymptomatic volunteers. Spinal sagittal parameters also showed a low correlation with gait parameters.