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1.
Medicine (Baltimore) ; 98(45): e17874, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702655

RESUMO

BACKGROUND: Stepping in place (SIP) is a useful locomotor training intervention. The purpose of this study was to investigate the effects of single auditory-cued SIP training on cortical excitability, rhythmic movements and walking ability in patients with Parkinson's disease(PD). METHODS: Cross-over randomized control trial. Each participant completed two interventions with at least one-week washout period in between: (1) SIP with concurrent auditory cues (AC condition) and (2) SIP without auditory cues (NC condition). RESULTS: In the primary outcome, the cortical silent period (CSP) duration increased (P = .005), whereas short intracortical inhibition (SICI) decreased after training (P = .001). Freezers demonstrated enhanced inhibition in the resting motor threshold and CSP duration. SICI and intracortical facilitation were modulated in both groups under the AC condition. In the secondary outcomes, the stepping variability decreased significantly (AC: P = .033; NC: P = .009), whereas walking cadence increased after training (AC: P = .019; NC: P = .0023). CONCLUSIONS: Auditory-cued SIP training improved the lower-limb movement variability and modulated the cortical excitability in patients with PD. Freezers may benefit more from this training than nonfreezers.


Assuntos
Estimulação Acústica/métodos , Sinais (Psicologia) , Transtornos Neurológicos da Marcha/terapia , Estimulação Magnética Transcraniana/métodos , Idoso , Estudos Cross-Over , Potenciais Evocados Auditivos/fisiologia , Transtornos Neurológicos da Marcha/etiologia , Humanos , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Desempenho Físico Funcional , Modalidades de Fisioterapia , Caminhada/fisiologia
2.
J Frailty Aging ; 8(4): 205-209, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637407

RESUMO

BACKGROUND: Sedentary lifestyle leads to worse health outcomes with aging, including frailty. Older adults can benefit from regular physical activity, but exercise promotion in the clinical setting is challenging. OBJECTIVES: The objective of this clinical demonstration project was to implement a Geriatric Walking Clinic for older adults and determine whether this clinical program can lead to improvements in characteristics of frailty. DESIGN: This was a clinical demonstration project/quality improvement project. SETTING: Outpatient geriatrics clinic at the South Texas Veterans Health Care System (STVHCS). PARTICIPANTS: Older Veterans, aged ≥60 years. INTERVENTION: A 6-week structured walking program, delivered by a registered nurse and geriatrician. Patients received a pedometer and a comprehensive safety evaluation at an initial face-to-face visit. They were subsequently followed with weekly phone calls and participated in a final face-to-face follow-up visit at 6 weeks. MEASUREMENTS: Grip strength (handheld dynamometer), gait speed (10-ft walk), Timed Up and Go (TUG), and body mass index (BMI) were assessed at baseline and follow-up. Frailty status for gait speed was assessed using Fried criteria. RESULTS: One hundred eighty five patients completed the program (mean age: 68.4 ±7 years, 88% male). Improvements from baseline to follow-up were observed in average steps/day, gait speed, TUG, and BMI. Improvement in gait speed (1.13 ±0.20 vs. 1.24 ± 0.23 meter/second, p<0.0001) resulted in reduced odds of meeting frailty criteria for slow gait at follow-up compared to the baseline examination (odds ratio = 0.31, 95% confidence interval: 0.13-0.72, p = 0.01). CONCLUSIONS: Our findings demonstrate that a short duration, low-intensity walking intervention improves gait speed and TUG. This new clinical model may be useful for the promotion of physical activity, and for the prevention or amelioration of frailty characteristics in older adults.


Assuntos
Terapia por Exercício/métodos , Fragilidade/prevenção & controle , Veteranos/estatística & dados numéricos , Caminhada/fisiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Velocidade de Caminhada/fisiologia
3.
Ideggyogy Sz ; 72(9-10): 317-323, 2019 Sep 30.
Artigo em Húngaro | MEDLINE | ID: mdl-31625698

RESUMO

Gait disturbance is a major symptom in patients with multiple sclerosis. The Expanded Disability Status Scale (EDSS) was first used in clinical trials of multiple sclerosis for the assessment of disability, however it has become more and more widely used in clinical practice as well. Nowadays its use is essential in application of the new diagnostic criteria, the new clinical form classification and in monitoring the efficacy of therapies. EDSS is based on a standardised neurological examination, but focuses on those symptoms that are frequent in multiple sclerosis. Based on the examination it assesses seven functional systems: visual, brainstem, pyramidal, cerebellar, sensory, bowel-bladder and cerebral functions. EDSS scores can be determined based on the scores given in the functional systems and on testing the walking distance. In newer versions the "Ambulation score" has been added. This chapter clarifies the scores based on the maximal walking distance and the need for a walking aid to walk this distance. The Neurostatus/EDSS training method improves the reproducibility of the standardised neurological examination that forms the basis of the EDSS scoring. Of the tests assessing walking, the Timed-25 Foot Walk Test and the self-administered 12-Item Multiple Sclerosis Walking Scale are suitable for routine evaluation of walking performance. An increase of more than 20% in the Timed-25 Foot Walk may be considered a significant change in gait.


Assuntos
Pessoas com Deficiência , Marcha , Esclerose Múltipla/diagnóstico , Caminhada/fisiologia , Avaliação da Deficiência , Marcha/fisiologia , Humanos , Esclerose Múltipla/complicações , Reprodutibilidade dos Testes
4.
J Appl Biomech ; 35(5): 320-326, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31541067

RESUMO

The authors tested 4 young healthy subjects walking with a powered knee exoskeleton to determine if it could reduce the metabolic cost of locomotion. Subjects walked with a backpack loaded and unloaded, on a treadmill with inclinations of 0° and 15°, and outdoors with varied natural terrain. Participants walked at a self-selected speed (average 1.0 m/s) for all conditions, except incline treadmill walking (average 0.5 m/s). The authors hypothesized that the knee exoskeleton would reduce the metabolic cost of walking uphill and with a load compared with walking without the exoskeleton. The knee exoskeleton reduced metabolic cost by 4.2% in the 15° incline with the backpack load. All other conditions had an increase in metabolic cost when using the knee exoskeleton compared with not using the exoskeleton. There was more variation in metabolic cost over the outdoor walking course with the knee exoskeleton than without it. Our findings indicate that powered assistance at the knee is more likely to decrease the metabolic cost of walking in uphill conditions and during loaded walking rather than in level conditions without a backpack load. Differences in positive mechanical work demand at the knee for varying conditions may explain the differences in metabolic benefit from the exoskeleton.


Assuntos
Metabolismo Energético , Exoesqueleto Energizado , Joelho , Músculo Esquelético/metabolismo , Caminhada/fisiologia , Adulto , Teste de Esforço , Humanos , Masculino , Consumo de Oxigênio , Suporte de Carga
5.
BMJ ; 366: l5101, 2019 09 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533934

RESUMO

OBJECTIVE: To determine the safety and efficacy of aerobic exercise on activities of daily living in the subacute phase after stroke. DESIGN: Multicentre, randomised controlled, endpoint blinded trial. SETTING: Seven inpatient rehabilitation sites in Germany (2013-17). PARTICIPANTS: 200 adults with subacute stroke (days 5-45 after stroke) with a median National Institutes of Health stroke scale (NIHSS, range 0-42 points, higher values indicating more severe strokes) score of 8 (interquartile range 5-12) were randomly assigned (1:1) to aerobic physical fitness training (n=105) or relaxation sessions (n=95, control group) in addition to standard care. INTERVENTION: Participants received either aerobic, bodyweight supported, treadmill based physical fitness training or relaxation sessions, each for 25 minutes, five times weekly for four weeks, in addition to standard rehabilitation therapy. Investigators and endpoint assessors were masked to treatment assignment. MAIN OUTCOME MEASURES: The primary outcomes were change in maximal walking speed (m/s) in the 10 m walking test and change in Barthel index scores (range 0-100 points, higher scores indicating less disability) three months after stroke compared with baseline. Safety outcomes were recurrent cardiovascular events, including stroke, hospital readmissions, and death within three months after stroke. Efficacy was tested with analysis of covariance for each primary outcome in the full analysis set. Multiple imputation was used to account for missing values. RESULTS: Compared with relaxation, aerobic physical fitness training did not result in a significantly higher mean change in maximal walking speed (adjusted treatment effect 0.1 m/s (95% confidence interval 0.0 to 0.2 m/s), P=0.23) or mean change in Barthel index score (0 (-5 to 5), P=0.99) at three months after stroke. A higher rate of serious adverse events was observed in the aerobic group compared with relaxation group (incidence rate ratio 1.81, 95% confidence interval 0.97 to 3.36). CONCLUSIONS: Among moderately to severely affected adults with subacute stroke, aerobic bodyweight supported, treadmill based physical fitness training was not superior to relaxation sessions for maximal walking speed and Barthel index score but did suggest higher rates of adverse events. These results do not appear to support the use of aerobic bodyweight supported fitness training in people with subacute stroke to improve activities of daily living or maximal walking speed and should be considered in future guidelines. TRIAL REGISTRATION: ClinicalTrials.gov NCT01953549.


Assuntos
Terapia por Exercício/métodos , Aptidão Física/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Atividades Cotidianas , Adulto , Idoso , Avaliação da Deficiência , Teste de Esforço , Terapia por Exercício/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Terapia de Relaxamento , Índice de Gravidade de Doença , Método Simples-Cego , Acidente Vascular Cerebral/fisiopatologia , Reabilitação do Acidente Vascular Cerebral/efeitos adversos , Resultado do Tratamento , Caminhada/fisiologia
6.
J Pediatr Orthop ; 39(8): 429-435, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393305

RESUMO

BACKGROUND: Children's ability to control the speed of gait is important for a wide range of activities. It is thought that the ability to increase the speed of gait for children with cerebral palsy (CP) is common. This study considered 3 hypotheses: (1) most ambulatory children with CP can increase gait speed, (2) the characteristics of free (self-selected) and fast walking are related to motor impairment level, and (3) the strategies used to increase gait speed are distinct among these levels. METHODS: A retrospective review of time-distance parameters (TDPs) for 212 subjects with CP and 34 typically developing subjects walking at free and fast speeds was performed. Only children who could increase their gait speed above the minimal clinically important difference were defined as having a fast walk. Analysis of variance was used to compare TDPs of children with CP, among Gross Motor Function Classification System (GMFCS) levels, and children in typically developing group. RESULTS: Eight-five percent of the CP group (GMFCS I, II, III; 96%, 99%, and 34%, respectively) could increase gait speed on demand. At free speed, children at GMFCS I and II were significantly faster than children at GMFCS level III. At free speed, children at GMFCS I and II had significantly greater stride length than those at GMFCS levels III. At free speed, children at GMFCS level III had significantly lower cadence than those at GMFCS I and II. There were no significant differences in cadence among GMFCS levels at fast speeds. There were no significant differences among GMFCS levels for percent change in any TDP between free and fast walking. DISCUSSION: Almost all children with CP at GMFCS levels I and II can control the speed of gait, however, only one-third at GMFCS III level have this ability. This study suggests that children at GMFCS III level can be divided into 2 groups based on their ability to control gait speed; however, the prognostic significance of such categorization remains to be determined. LEVEL OF EVIDENCE: Diagnostic level II.


Assuntos
Paralisia Cerebral/fisiopatologia , Velocidade de Caminhada , Criança , Feminino , Marcha/fisiologia , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Caminhada/fisiologia
7.
NeuroRehabilitation ; 44(4): 587-597, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256089

RESUMO

BACKGROUND: Downslope walking (DSW) is an eccentric-based exercise intervention that promotes neuroplasticity of spinal reflex circuitry by inducing depression of Soleus Hoffman (H)-reflexes in young, neurologically unimpaired adults. OBJECTIVE: The objective of the study was to evaluate the effects of DSW on spinal excitability (SE) and walking function (WF) in people with multiple sclerosis (PwMS). METHODS: Our study comprised two experiments on 12 PwMS (11 women; 45.3±11.8 years). Experiment 1 evaluated acute effects of a single 20-minute session of treadmill walking at three different walking grades on SE, 0% or level walking (LW), - 7.5% DSW, and - 15% DSW. Experiment 2 evaluated the effects of 6 sessions of DSW, at - 7.5% DSW (with second session being - 15% DSW) on SE and WF. RESULTS: Experiment 1 showed significantly greater acute % H-reflex depression following - 15% DSW compared to LW (p = 0.02) and - 7.5% DSW (p = 0.05). Experiment 2 demonstrated significant improvements in WF. PwMS who showed greater acute H-reflex depression during the - 15% DSW session also demonstrated greater physical activity, long-distance WF, and the ability to have greater H-reflex depression after DSW training. Significant changes were not observed in regards to SE. CONCLUSIONS: Though significant changes were not observed in SE after DSW training, we observed an improvement in WF which merits further investigation of DSW in PwMS.


Assuntos
Teste de Esforço/métodos , Reflexo H/fisiologia , Esclerose Múltipla/fisiopatologia , Esclerose Múltipla/terapia , Caminhada/fisiologia , Adulto , Idoso , Eletromiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/diagnóstico , Músculo Esquelético/fisiopatologia , Plasticidade Neuronal/fisiologia , Resultado do Tratamento , Adulto Jovem
8.
Int J Sports Med ; 40(9): 585-591, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31272111

RESUMO

The aim of this study was to investigate the effects of walking training with and without blood flow restriction (BFR) on heart rate (HR) and heart rate variability (HRV) kinetics and HRV recovery. Twenty-one men (53.5±3.2 years; 82.4±13.5 kg; 168.5±7.2 cm) were randomly assigned to two training groups: walk training group with (BFR-W; n=11) and without (NOR-W; n=10) BFR. Before and after training, all subjects underwent body composition evaluation, incremental test, and one constant load test. Walking training was performed 3 times/week, during 6 weeks. Each session was composed by 5 sets of 3-min walking and 1-min rest between the sets. All parameters of HR on- and off-kinetics and RMSSD15 0 parameter of HRV on-kinetics were improved for BFR-W group after training (p<0.05), with an interaction effect for HR on-kinetics parameters and RMSSD15 0 parameter (p<0.05). Also, parameters of time and frequency domain of HRV recovery were also improved in BFR-W after training (p<0.05), with no interaction effect (p>0.05). Additionally, in BFR-W group, RMSSD60s values were improved in some moments after training (p<0.05). Therefore, this study demonstrates that a 6-week walking training with BFR improved cardiac autonomic responses on the onset and recovery of exercise.


Assuntos
Constrição , Frequência Cardíaca , Caminhada/fisiologia , Teste de Esforço , Humanos , Cinética , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Esfigmomanômetros , Coxa da Perna
9.
Int J Sports Med ; 40(8): 498-502, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31288288

RESUMO

Footpod monitors are wearable devices attaching to the shoe with the ability to sense oscillations in leg movement; however, few studies provide reliability. The purpose was to provide reliability data for outdoor tasks as measured by the Stryd Power Meter, which is a footpod monitor. Young healthy individuals (N=20, male n=12, female n=8) completed two 5-min self-paced walks along a trail, and two 5-min trail runs. Reliability of the tasks was determined using Coefficient of Variation (CV), Intraclass Correlation (ICC), and 95% confidence intervals (CI). Measures during trail running that returned a CV less than 10%, met the ICC threshold of 0.70, and displayed good to excellent 95% CI included pace, average elapsed power, average elapsed form power, average elapsed leg spring, and vertical oscillation. The only variable during walking to meet these criteria was maximal power (CV=4.02%, ICC=0.968, CI=0.902, 0.989). Running tasks completed on a trail generally return more consistent measures for variables that can be obtained from the Stryd footpod device than walking tasks.


Assuntos
Monitores de Aptidão Física/normas , Corrida/fisiologia , Caminhada/fisiologia , Desenho de Equipamento , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Análise e Desempenho de Tarefas , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-31343373

RESUMO

The resuspension of indoor particulate matters caused by people indoor walking could affect indoor air quality and human health. Therefore, it is particularly important to study the resuspension rules of the particulate matters in different indoor environments. The influence of the ground material and the relative humidity on resuspension of the particulate matters were investigated under three kinds of ground materials and three different relative humidity. Results showed that different relative humidity and different ground materials had different effects on the mass concentration of the particulate matters. In addition, different particle sizes had diverse influence on the mass concentration. Compared with low-level loop pile carpet and shaggy carpet, hardwood floor was more conductive to human health which was less likely to cause the resuspension of the particulate matters. At the same time, relative humidity had a great influence on the resuspension of the particulate matters. With the increase of relative humidity, the resuspension rate of fine particulate matters decreased.


Assuntos
Poluição do Ar em Ambientes Fechados/análise , Pisos e Cobertura de Pisos , Umidade , Material Particulado/análise , Caminhada/fisiologia , Monitoramento Ambiental , Poluição Ambiental/análise , Humanos , Tamanho da Partícula
11.
Phys Ther ; 99(6): 711-720, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31155663

RESUMO

BACKGROUND: People with cerebral palsy (CP) experience increased muscle stiffness, muscle weakness, and reduced joint range of motion. This can lead to an abnormal pattern of gait, which can increase the energy cost of walking and contribute to reduced participation in physical activity. OBJECTIVE: The aim of the study was to examine associations between lower-body joint angles, moments, power, and walking efficiency in adolescents with CP. DESIGN: This was a cross-sectional study. METHODS: Sixty-four adolescents aged 10 to 19 years with CP were recruited. Walking efficiency was measured as the net nondimensional oxygen cost (NNcost) during 6 minutes of overground walking at self-selected speed. Lower-body kinematics and kinetics during walking were collected with 3-dimensional motion analysis, synchronized with a treadmill with integrated force plates. The associations between the kinematics, kinetics, and NNcost were examined with multivariable linear regression. RESULTS: After adjusting for age, sex, and Gross Motor Function Classification System level, maximum knee extension angle (ß = -0.006), hip angle at midstance (ß = -0.007), and maximum hip extension (ß = -0.008) were associated with NNcost. Age was a significant modifier of the association between the NNcost and a number of kinematic variables. LIMITATIONS: This study examined kinetic and kinematic variables in the sagittal plane only. A high interindividual variation in gait pattern could have influenced the results. CONCLUSIONS: Reduced knee and hip joint extension are associated with gait inefficiency in adolescents with CP. Age is a significant factor influencing associations between ankle, knee, and hip joint kinematics and gait efficiency. Therapeutic interventions should investigate ways to increase knee and hip joint extension in adolescents with CP.


Assuntos
Paralisia Cerebral/fisiopatologia , Marcha/fisiologia , Instabilidade Articular/fisiopatologia , Caminhada/fisiologia , Adolescente , Fenômenos Biomecânicos , Criança , Estudos Transversais , Feminino , Análise da Marcha/métodos , Humanos , Masculino
12.
Phys Ther ; 99(6): 739-747, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31155665

RESUMO

BACKGROUND AND PURPOSE: Cerebral palsy (CP) is characterized by decreased passive joint range-of-motion and impaired walking, resulting in progressive loss of function. Typical gait training interventions for children with CP appear insufficient to mitigate these effects. The purpose of this case report is to describe the use of a new treadmill-based gait training intervention using active correction with functional electrical stimulation (FES) in 2 adolescents with CP. CASE DESCRIPTION: Two participants with CP (13-year-old girls, Gross Motor Function Classification System [GMFCS] level II and III) trained by walking on a treadmill, with FES assistance, for 30 minutes, 3 times per week, for 12 weeks. The intervention used a feedback control system to detect all 7 phases of gait in real time and triggered FES to the appropriate muscle groups (up to 5 bilaterally) based on the detected gait phase. Joint kinematics, step width, stride length, walking endurance, peak oxygen uptake ($\dot{v}^{o}_{2}$), and oxygen (O2) cost of walking were evaluated preintervention and postintervention. OUTCOMES: Both participants showed improved knee and ankle angles and step width relative to children who are typically developing, and both exhibited increased stride length. One participant (GMFCS III) improved peak $\dot{v}^{o}_{2}$and walking endurance but not O2 cost of walking at her original self-selected walking speed. The other participant (GMFCS II) improved O2 cost of walking but not peak $\dot{v}^{o}_{2}$ or walking endurance. These differences are partly explained by differences in gait type, functional abilities, and initial fitness levels. Most improvements persisted at follow-up, indicating short-term neurotherapeutic effects. DISCUSSION: Most improvements persisted at follow-up, suggesting short-term neurotherapeutic effects. This case series demonstrates the promising utility of FES-assisted gait-training interventions, tailored to target individual gait deviations, in improving walking performance.


Assuntos
Paralisia Cerebral/reabilitação , Terapia por Exercício/métodos , Marcha/fisiologia , Caminhada/fisiologia , Adolescente , Feminino , Análise da Marcha/métodos , Humanos , Músculo Esquelético/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Velocidade de Caminhada/fisiologia
13.
Sensors (Basel) ; 19(12)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31234414

RESUMO

The paper presents a stochastic methodology for the simultaneous floating-base estimation of the human whole-body kinematics and dynamics (i.e., joint torques, internal and external forces). The paper builds upon our former work where a fixed-base formulation had been developed for the human estimation problem. The presented approach is validated by presenting experimental results of a health subject equipped with a wearable motion tracking system and a pair of shoes sensorized with force/torque sensors while performing different motion tasks, e.g., walking on a treadmill. The results show that joint torque estimates obtained by using floating-base and fixed-base approaches match satisfactorily, thus validating the present approach.


Assuntos
Articulações/fisiologia , Modelos Biológicos , Monitorização Fisiológica/métodos , Caminhada/fisiologia , Fenômenos Biomecânicos , Humanos , Modelos Teóricos , Movimento (Física) , Sapatos , Torque , Dispositivos Eletrônicos Vestíveis
14.
Sensors (Basel) ; 19(12)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31234451

RESUMO

(1) Background: Ankle joint power, as an indicator of the ability to control lower limbs, is of great relevance for clinical diagnosis of gait impairment and control of lower limb prosthesis. However, the majority of available techniques for estimating joint power are based on inverse dynamics methods, which require performing a biomechanical analysis of the foot and using a highly instrumented environment to tune the parameters of the resulting biomechanical model. Such techniques are not generally applicable to real-world scenarios in which gait monitoring outside of the clinical setting is desired. This paper proposes a viable alternative to such techniques by using machine learning algorithms to estimate ankle joint power from data collected by two miniature inertial measurement units (IMUs) on the foot and shank, (2) Methods: Nine participants walked on a force-plate-instrumented treadmill wearing two IMUs. The data from the IMUs were processed to train and test a random forest model to estimate ankle joint power. The performance of the model was then evaluated by comparing the estimated power values to the reference values provided by the motion tracking system and the force-plate-instrumented treadmill. (3) Results: The proposed method achieved a high accuracy with the correlation coefficient, root mean square error, and normalized root mean square error of 0.98, 0.06 w/kg, and 1.05% in the intra-subject test, and 0.92, 0.13 w/kg, and 2.37% in inter-subject test, respectively. The difference between the predicted and true peak power values was 0.01 w/kg and 0.14 w/kg with a delay of 0.4% and 0.4% of gait cycle duration for the intra- and inter-subject testing, respectively. (4) Conclusions: The results of this study demonstrate the feasibility of using only two IMUs to estimate ankle joint power. The proposed technique provides a basis for developing a portable and compact gait monitoring system that can potentially offer monitoring and reporting on ankle joint power in real-time during activities of daily living.


Assuntos
Articulação do Tornozelo/fisiologia , Técnicas Biossensoriais , Monitorização Fisiológica , Caminhada/fisiologia , Atividades Cotidianas , Algoritmos , Fenômenos Biomecânicos , Teste de Esforço , , Marcha/fisiologia , Análise da Marcha/métodos , Humanos , Extremidade Inferior/fisiologia , Tecnologia sem Fio
15.
PLoS Med ; 16(6): e1002836, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31237875

RESUMO

BACKGROUND: Data are lacking from physical activity (PA) trials with long-term follow-up of both objectively measured PA levels and robust health outcomes. Two primary care 12-week pedometer-based walking interventions in adults and older adults (PACE-UP and PACE-Lift) found sustained objectively measured PA increases at 3 and 4 years, respectively. We aimed to evaluate trial intervention effects on long-term health outcomes relevant to walking interventions, using routine primary care data. METHODS AND FINDINGS: Randomisation was from October 2012 to November 2013 for PACE-UP participants from seven general (family) practices and October 2011 to October 2012 for PACE-Lift participants from three practices. We downloaded primary care data, masked to intervention or control status, for 1,001 PACE-UP participants aged 45-75 years, 36% (361) male, and 296 PACE-Lift participants, aged 60-75 years, 46% (138) male, who gave written informed consent, for 4-year periods following randomisation. The following new events were counted for all participants, including those with preexisting diseases (apart from diabetes, for which existing cases were excluded): nonfatal cardiovascular, total cardiovascular (including fatal), incident diabetes, depression, fractures, and falls. Intervention effects on time to first event post-randomisation were modelled using Cox regression for all outcomes, except for falls, which used negative binomial regression to allow for multiple events, adjusting for age, sex, and study. Absolute risk reductions (ARRs) and numbers needed to treat (NNTs) were estimated. Data were downloaded for 1,297 (98%) of 1,321 trial participants. Event rates were low (<20 per group) for outcomes, apart from fractures and falls. Cox hazard ratios for time to first event post-randomisation for interventions versus controls were nonfatal cardiovascular 0.24 (95% confidence interval [CI] 0.07-0.77, p = 0.02), total cardiovascular 0.34 (95% CI 0.12-0.91, p = 0.03), diabetes 0.75 (95% CI 0.42-1.36, p = 0.34), depression 0.98 (95% CI 0.46-2.07, p = 0.96), and fractures 0.56 (95% CI 0.35-0.90, p = 0.02). Negative binomial incident rate ratio for falls was 1.07 (95% CI 0.78-1.46, p = 0.67). ARR and NNT for cardiovascular events were nonfatal 1.7% (95% CI 0.5%-2.1%), NNT = 59 (95% CI 48-194); total 1.6% (95% CI 0.2%-2.2%), NNT = 61 (95% CI 46-472); and for fractures 3.6% (95% CI 0.8%-5.4%), NNT = 28 (95% CI 19-125). Main limitations were that event rates were low and only events recorded in primary care records were counted; however, any underrecording would not have differed by intervention status and so should not have led to bias. CONCLUSIONS: Routine primary care data used to assess long-term trial outcomes demonstrated significantly fewer new cardiovascular events and fractures in intervention participants at 4 years. No statistically significant differences between intervention and control groups were demonstrated for other events. Short-term primary care pedometer-based walking interventions can produce long-term health benefits and should be more widely used to help address the public health inactivity challenge. TRIAL REGISTRATIONS: PACE-UP isrctn.com ISRCTN98538934; PACE-Lift isrctn.com ISRCTN42122561.


Assuntos
Actigrafia/tendências , Análise de Dados , Exercício/fisiologia , Atenção Primária à Saúde/tendências , Caminhada/fisiologia , Actigrafia/métodos , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Seguimentos , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Atenção Primária à Saúde/métodos , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento
16.
Sensors (Basel) ; 19(12)2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31212891

RESUMO

Recently, data from built-in sensors in smartphones have been readily available, and analyzing data for various types of health information from smartphone users has become a popular health care application area. Among relevant issues in the area, one of the most prominent topics is analyzing the characteristics of human movements. In this paper, we focus on characterizing the human movements of walking and running based on a novel machine learning approach. Since walking and running are human fundamental activities, analyzing their characteristics promptly and automatically during daily smartphone use is particularly valuable. In this paper, we propose a machine learning approach, referred to as 'two-stage latent dynamics modeling and filtering' (TS-LDMF) method, where we combine a latent space modeling stage with a nonlinear filtering stage, for characterizing individual dynamic walking and running patterns by analyzing smartphone sensor data. For the task of characterizing movements, the proposed method makes use of encoding the high-dimensional sequential data from movements into random variables in a low-dimensional latent space. The use of random variables in the latent space, often called latent variables, is particularly useful, because it is capable of conveying compressed information concerning movements and efficiently handling the uncertainty originating from high-dimensional sequential observation. Our experimental results show that the proposed use of two-stage latent dynamics modeling and filtering yields promising results for characterizing individual dynamic walking and running patterns.


Assuntos
Técnicas Biossensoriais , Corrida/fisiologia , Smartphone , Caminhada/fisiologia , Acelerometria , Atividades Humanas , Humanos , Aprendizado de Máquina , Movimento/fisiologia
17.
Sensors (Basel) ; 19(11)2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31163585

RESUMO

Hemiparesis is one of the common sequelae of neurological diseases such as strokes, which can significantly change the gait behavior of patients and restrict their activities in daily life. The results of gait characteristic analysis can provide a reference for disease diagnosis and rehabilitation; however, gait correlation as a gait characteristic is less utilized currently. In this study, a new non-contact electrostatic field sensing method was used to obtain the electrostatic gait signals of hemiplegic patients and healthy control subjects, and an improved Detrended Cross-Correlation Analysis cross-correlation coefficient method was proposed to analyze the obtained electrostatic gait signals. The results show that the improved method can better obtain the dynamic changes of the scaling index under the multi-scale structure, which makes up for the shortcomings of the traditional Detrended Cross-Correlation Analysis cross-correlation coefficient method when calculating the electrostatic gait signal of the same kind of subjects, such as random and incomplete similarity in the trend of the scaling index spectrum change. At the same time, it can effectively quantify the correlation of electrostatic gait signals in subjects. The proposed method has the potential to be a powerful tool for extracting the gait correlation features and identifying the electrostatic gait of hemiplegic patients.


Assuntos
Fenômenos Biomecânicos , Transtornos Neurológicos da Marcha/fisiopatologia , Eletricidade Estática , Caminhada/fisiologia , Feminino , Marcha/fisiologia , Humanos , Masculino , Acidente Vascular Cerebral/fisiopatologia
18.
Int. j. morphol ; 37(2): 620-625, June 2019. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1002267

RESUMO

Determining kinematics of hindlimbs of theropod dinosaurs has been a challenge. Since cursorial birds are phylogenetically closest to theropod dinosaurs they are commonly used as a kinematic model of theropod dinosaur locomotion. Using a comparative biomechanical approach, we found that cursorial birds have a different morphology of legs than non avian theropodos and that appears to be that felines and ungulates share more morphological properties in the hindlimbs with theropod dinosaurs than cursorial birds. We calculated the ratio between the lower leg and the femur, and the relative length of the tibia and the metatarsus with respect to the length of the femur in cursorial birds, as well as felines, ungulates and non-avian theropods. We found that as the length of the femur increases, the length of the lower leg increases similarly in felines, ungulates and non-avian theropods. On the other hand, existing and extinct cursorial birds did not follow this pattern. This observation suggests that the hindlimb of cursorial birds are not well suited to serve as kinematic models for hindlimb of extinct theropod dinosaur locomotion.


Determinar la cinemática de los miembros pelvianos de los dinosaurios terópodos ha sido un desafío. Dado que las aves corredoras son filogenéticamente más cercanas a los dinosaurios terópodos, son comúnmente utilizadas como modelo cinemático de la locomoción del dinosaurio terópodo. Usando un enfoque biomecánico comparativo, encontramos que las aves corredoras tienen una morfología de pies diferente a la de los terópodos no aviares y parece ser que los felinos y los ungulados comparten más propiedades morfológicas en los pies con los dinosaurios terópodos que las aves corredoras. Calculamos la proporción entre la parte inferior de la pierna y el fémur, y la longitud relativa de la tibia y el metatarso con respecto a la longitud del fémur en aves corredoras, así como en los terópodos no aviares y ungulados. Encontramos que a medida que aumenta la longitud del fémur, la longitud de la parte inferior de la pierna aumenta de manera similar en los terópodos, los ungulados y los terópodos no aviares. Por otro lado, las aves corredoras existentes y extintas no siguieron este patrón. Esta observación sugiere que el miembro pelviano de las aves corredoras no es adecuada para servir como modelos cinemáticos de locomoción del miembro pelviano del dinosaurio terópodo extinto.


Assuntos
Animais , Fenômenos Biomecânicos/fisiologia , Aves/fisiologia , Dinossauros/fisiologia , Membro Posterior/fisiologia , Locomoção/fisiologia , Postura , Aves/anatomia & histologia , Caminhada/fisiologia , Dinossauros/anatomia & histologia , Membro Posterior/anatomia & histologia , Modelos Biológicos
19.
Fisioter. Pesqui. (Online) ; 26(2): 158-163, abr.-jun. 2019. tab
Artigo em Português | LILACS | ID: biblio-1012139

RESUMO

RESUMO O objetivo do estudo foi verificar se existem diferenças na força muscular dos membros inferiores (MMII) e na habilidade de locomoção de indivíduos pós-acidente vascular encefálico (AVE) crônico, classificados como deambuladores comunitários ou não comunitários. Foi realizado um estudo transversal em 60 indivíduos pós-AVE crônico, divididos em deambuladores comunitários (n=33) e não comunitários (n=27) pela velocidade de marcha. A força muscular de sete grupos musculares bilaterais de MMII foi avaliada por meio do teste do esfigmomanômetro modificado e habilidade de locomoção pelo ABILOCO. Estatísticas descritivas foram utilizadas para caracterizar a amostra, e o teste t de Student para amostras independentes, a fim de comparar os dois grupos de indivíduos pós-AVE. Observou-se que os deambuladores comunitários apresentaram maiores valores de força muscular para a maioria dos grupos musculares de MMII (−0,973≥t≥−3,189; p≤0,04), e na habilidade de locomoção (t=−2,841; p=0,006). Os indivíduos pós-AVE crônico deambuladores comunitários possuem maior força muscular de MMII e mais habilidade de locomoção em comparação aos deambuladores não comunitários. Sugere-se que a avaliação fisioterapêutica de indivíduos pós-AVE inclua, além da mensuração da força muscular de MMII e seu tratamento, a mensuração da percepção da habilidade de locomoção, para análises da evolução do paciente e da eficácia da conduta terapêutica.


RESUMEN El objetivo del estudio fue verificar si existen diferencias en la fuerza muscular de los miembros inferiores (MMII) y en la habilidad de locomoción de individuos post-accidente cerebrovascular encefálico (ACV) crónico, clasificados como deambuladores comunitarios o no comunitarios. Se realizó un estudio transversal en 60 individuos post-ACV crónico, divididos en deambuladores comunitarios (n = 33) y no comunitarios (n = 27) por la velocidad de marcha. La fuerza muscular de siete grupos musculares bilaterales de MMII fue evaluada por medio de la prueba del esfigmomanómetro modificado, y la habilidad de locomoción por el ABILOCO. Las estadísticas descriptivas se utilizaron para caracterizar la muestra, y la prueba t de Student para muestras independientes con el fin de comparar los dos grupos de sujetos post-ACV. Se observó que los deambuladores comunitarios presentaron mayores valores de fuerza muscular para la mayoría de los grupos musculares de MMII (−0,973≥t≥−3,189; p≤0,04), y en la habilidad de locomoción (t=−2,841; p=0,006). Los individuos post-ACV crónico deambuladores comunitarios poseen mayor fuerza muscular de MMII y más habilidad de locomoción en comparación a los deambuladores no comunitarios. Se sugiere que la evaluación fisioterapéutica de individuos post-ACV incluya, además de la medición de la fuerza muscular de MMII y su tratamiento, la medición de la percepción de la habilidad de locomoción, para análisis de la evolución del paciente y de la eficacia de la conducta terapéutica.


ABSTRACT The objective of this study was to verify if there are differences in the lower-limb muscle strength (LL) and in the locomotion ability among post-stroke patients classified as community or non-community ambulators. A cross-sectional study was conducted in 60 post-chronic stroke subjects, divided into community (n=33) and non-community (n=27) ambulators by gait speed. The muscle strength of seven bilateral muscle groups of LL was evaluated through the modified sphygmomanometer test and locomotion ability through ABILOCO. Descriptive statistics were used to characterize the sample, and Student's t-test was used for independent samples to compare the two groups of post-stroke individuals. We observed that community ambulators had higher values of muscle strength for most muscle groups of LL (−0.973≥t≥3.189; p≤0.04), and in the locomotion ability (t=−2.841; p=0.006). Community ambulators showed higher LL muscle strength and better locomotion ability compared with non-community ambulators. Physiotherapeutic evaluation of post-stroke individuals should include, besides the measurement of LL muscle strength and its treatment, the measurement of the perception of locomotion ability to analyze the evolution of the patient and the efficacy of the therapeutic behavior.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Força Muscular/fisiologia , Locomoção/fisiologia , Estudos Transversais , Caminhada/fisiologia , Esfigmomanômetros , Extremidade Inferior/fisiopatologia , Marcha/fisiologia
20.
Sensors (Basel) ; 19(11)2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31146477

RESUMO

The Internet of Things is a rapidly growing paradigm for smart cities that provides a way of communication, identification, and sensing capabilities among physically distributed devices. With the evolution of the Internet of Things (IoTs), user dependence on smart systems and services, such as smart appliances, smartphone, security, and healthcare applications, has been increased. This demands secure authentication mechanisms to preserve the users' privacy when interacting with smart devices. This paper proposes a heterogeneous framework "ADLAuth" for passive and implicit authentication of the user using either a smartphone's built-in sensor or wearable sensors by analyzing the physical activity patterns of the users. Multiclass machine learning algorithms are applied to users' identity verification. Analyses are performed on three different datasets of heterogeneous sensors for a diverse number of activities. A series of experiments have been performed to test the effectiveness of the proposed framework. The results demonstrate the better performance of the proposed scheme compared to existing work for user authentication.


Assuntos
Atividades Cotidianas , Algoritmos , Cidades , Bases de Dados como Assunto , Árvores de Decisões , Exercício/fisiologia , Humanos , Smartphone , Máquina de Vetores de Suporte , Caminhada/fisiologia
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