Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.295
Filtrar
1.
Sensors (Basel) ; 21(1)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33379174

RESUMO

Freezing of Gait (FoG) is a common symptom in Parkinson's Disease (PD) occurring with significant variability and severity and is associated with increased risk of falls. FoG detection in everyday life is not trivial, particularly in patients manifesting the symptom only in specific conditions. Various wearable devices have been proposed to detect PD symptoms, primarily based on inertial sensors. We here report the results of the validation of a novel system based on a pair of pressure insoles equipped with a 3D accelerometer to detect FoG episodes. Twenty PD patients attended a motor assessment protocol organized into eight multiple video recorded sessions, both in clinical and ecological settings and both in the ON and OFF state. We compared the FoG episodes detected using the processed data gathered from the insoles with those tagged by a clinician on video recordings. The algorithm correctly detected 90% of the episodes. The false positive rate was 6% and the false negative rate 4%. The algorithm reliably detects freezing of gait in clinical settings while performing ecological tasks. This result is promising for freezing of gait detection in everyday life via wearable instrumented insoles that can be integrated into a more complex system for comprehensive motor symptom monitoring in PD.


Assuntos
Transtornos Neurológicos da Marcha , Doença de Parkinson , Dispositivos Eletrônicos Vestíveis , , Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Humanos , Doença de Parkinson/diagnóstico
2.
Sensors (Basel) ; 20(24)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33371295

RESUMO

This study describe the characteristics of hemiplegic stroke gait with principal component analysis (PCA) of trunk movement (TM) and gait event (GE) parameters by the inertial measurement unit (IMU) sensors: (1) Background: This process can determine dominant variables through multivariate examination to identify the affected, unaffected, and healthy lower-limb sides; (2) Methods: The study monitored forty patients with stroke and twenty-eight healthy individuals comprising the control group for comparison. The IMU sensors were attached to each subject while performing a 6 m walking test. Sixteen variables extracted from the measured data were divided into 7 GE and 9 TM variables explaining pelvis tilt, oblique, and rotation. (3) Results: The tilt range variables of the trunk movement on the affected and unaffected sides were lower than those of the healthy side; this showed between-group differences in various GE variables. For the healthy and affected sides, 80% of variances were explained with 2 or 3 PCs involving only a few dominant variables; and (4) Conclusions: The difference between each side leg should be considered during the development of a diagnosis method. This research can be utilized to develop functional assessment tools for personalized treatment and to design appropriate training protocols.


Assuntos
Análise da Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Hemiplegia/diagnóstico , Monitorização Fisiológica/instrumentação , Acidente Vascular Cerebral , Tronco , Idoso , Fenômenos Biomecânicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pelve , Análise de Componente Principal , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 847-850, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018117

RESUMO

Parkinson's disease (PD) patients with freezing of gait (FOG) can suddenly lose their forward moving ability leading to unexpected falls. To overcome FOG and avoid the falls, a real-time accurate FOG detection or prediction system is desirable to trigger on-demand cues. In this study, we designed and implemented an in-place movement experiment for PD patients to provoke FOG and meanwhile acquired multimodal physiological signals, such as electroencephalography (EEG) and accelerometer signals. A multimodal model using brain activity from EEG and motion data from accelerometers was developed to improve FOG detection performance. In the detection of over 700 FOG episodes observed in the experiments, the multimodal model achieved 0.211 measured by Matthews Correlation Coefficient (MCC) compared with the single-modal models (0.127 or 0.139).Clinical Relevance- This is the first study to use multimodal: EEG and accelerometer signal analysis in FOG detection, and an improvement was achieved.


Assuntos
Transtornos Neurológicos da Marcha , Doença de Parkinson , Acelerometria , Eletroencefalografia , Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Humanos , Doença de Parkinson/diagnóstico
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4034-4037, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018884

RESUMO

Freezing of gait (FOG) is a major hindrance to daily mobility and can lead to falling in people with Parkinson's disease. While wearable accelerometers and gyroscopes have been commonly used for FOG detection, foot plantar pressure distribution could also be considered for this application, given its usefulness in previous gait-based classification. This research examined 325 plantar-pressure based features and 132 acceleration-based features extracted from the walking data of five males with Parkinson's disease who experienced FOG. A set of 61 features calculated from the time domain, Fast Fourier transform (FFT), and wavelet transform (WT) were extracted from multiple input signals; including, total ground reaction force, foot centre of pressure (COP) position, COP velocity, COP acceleration, and 3D ankle acceleration. Minimum-redundancy maximum relevance (mRMR) feature selection was used to rank all features. Plantar-pressure based features accounted for 4 of the top 5 features (ranks 2, 3, 4, 5); the remaining feature was an ankle acceleration based feature (rank 1). The three highest ranked features were the freeze index (calculated from ankle acceleration), total power in the frequency domain (calculated using the FFT from COP velocity), and mean of the WT detail coefficients (calculated from COP velocity). This preliminary analysis demonstrated that features calculated from plantar pressure, specifically COP velocity, performed comparably to ankle acceleration features. Thus, feature sets for FOG detection may benefit from plantar-pressure based features.


Assuntos
Transtornos Neurológicos da Marcha , Doença de Parkinson , Aceleração , Tornozelo , Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Humanos , Masculino , Doença de Parkinson/diagnóstico
5.
Sensors (Basel) ; 20(18)2020 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-32899946

RESUMO

Gait deterioration caused by prolonged walking represents one of the main consequences of multiple sclerosis (MS). This study aims at proposing quantitative indices to measure the gait deterioration effects. The experimental protocol consisted in a 6-min walking test and it involved nine patients with MS and twenty-six healthy subjects. Pathology severity was assessed through the Expanded Disability Status Scale. Seven inertial units were used to gather lower limb kinematics. Gait variability and asymmetry were assessed by coefficient of variation (CoV) and symmetry index (SI), respectively. The evolution of ROM (range of motion), CoV, and SI was computed analyzing data divided into six 60-s subgroups. Maximum difference among subgroups and the difference between the first minute and the remaining five were computed. The indices were analyzed for intra- and inter-day reliability and repeatability. Correlation with clinical scores was also evaluated. Good to excellent reliability was found for all indices. The computed standard deviations allowed us to affirm the good repeatability of the indices. The outcomes suggested walking-related fatigue leads to an always more variable kinematics in MS, in terms of changes in ROM, increase of variability and asymmetry. The hip asymmetry strongly correlated with the clinical disability.


Assuntos
Fadiga/fisiopatologia , Transtornos Neurológicos da Marcha/diagnóstico , Marcha/fisiologia , Esclerose Múltipla/diagnóstico , Índice de Gravidade de Doença , Caminhada/fisiologia , Adulto , Idoso , Fenômenos Biomecânicos/fisiologia , Estudos de Casos e Controles , Avaliação da Deficiência , Progressão da Doença , Teste de Esforço/métodos , Feminino , Transtornos Neurológicos da Marcha/etiologia , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/patologia , Esclerose Múltipla/fisiopatologia , Reprodutibilidade dos Testes , Projetos de Pesquisa , Fatores de Tempo
6.
J Stroke Cerebrovasc Dis ; 29(9): 105035, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807447

RESUMO

BACKGROUND AND PURPOSE: Stiff-knee gait, which is a gait abnormality observed after stroke, is characterized by decreased knee flexion angles during the swing phase, and it contributes to a decline in gait ability. This study aimed to identify the immediate effects of pedaling exercises on stiff-knee gait from a kinesiophysiological perspective. METHODS: Twenty-one patients with chronic post-stroke hemiparesis and stiff-knee gait were randomly assigned to a pedaling group and a walking group. An ergometer was set at a load of 5 Nm and rotation speed of 40 rpm, and gait was performed at a comfortable speed; both the groups performed the intervention for 10 min. Kinematic and electromyographical data while walking on flat surfaces were immediately measured before and after the intervention. RESULTS: In the pedaling group, activity of the rectus femoris significantly decreased from the pre-swing phase to the early swing phase during gait after the intervention. Flexion angles and flexion angular velocities of the knee and hip joints significantly increased during the same period. The pedaling group showed increased step length on the paralyzed side and gait velocity. CONCLUSIONS: Pedaling increases knee flexion during the swing phase in hemiparetic patients with stiff-knee gait and improves gait ability.


Assuntos
Acidentes por Quedas/prevenção & controle , Ciclismo , Terapia por Exercício , Transtornos Neurológicos da Marcha/reabilitação , Marcha , Articulação do Joelho/fisiopatologia , Paresia/reabilitação , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Adulto , Idoso , Fenômenos Biomecânicos , Feminino , Análise da Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/etiologia , Paresia/fisiopatologia , Projetos Piloto , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Método Simples-Cego , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
7.
Neurology ; 94(24): 1093-1099, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32482839

RESUMO

Functional gait disorders are common in clinical practice. They are also usually disabling for affected individuals. The diagnosis is challenging because no single walking pattern is pathognomonic for a functional gait disorder. Establishing a diagnosis is based not primarily on excluding organic gait disorders but instead predominantly on recognizing positive clinical features of functional gait disorders, such as an antalgic, a buckling, or a waddling gait. However, these features can resemble and overlap with organic gait disorders. It is therefore necessary to also look for inconsistency (variations in clinical presentation that cannot be reconciled with an organic lesion) and incongruity (combination of symptoms and signs that is not seen with organic lesions). Yet, these features also have potential pitfalls as inconsistency can occur in patients with dystonic gait or those with freezing of gait. Similarly, patients with dystonia or chorea can present with bizarre gait patterns that may falsely be interpreted as incongruity. A further complicating factor is that functional and organic gait disorders may coexist within the same patient. To improve the diagnostic process, we present a sign-based approach-supported by videos-that incorporates the diverse clinical spectrum of functional gait disorders. We identify 7 groups of supportive gait signs that can signal the presence of functional gait disorders. For each group of signs, we highlight how specific clinical tests can bring out the inconsistencies and incongruencies that further point to a functional gait disorder.


Assuntos
Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/terapia , Humanos , Caminhada
8.
J Clin Neurosci ; 78: 301-306, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32389546

RESUMO

Patients with stroke (PwS) demonstrate impaired gait and balance, and asymmetric gait, placing them at high risk of falls. We aimed to investigate the effects of a single training session that included mechanical external perturbation which resists forward movement of the paretic leg during its swing phase of walking on gait and balance in PwS. In a pre-post pilot study, gait asymmetry and balance function were assessed in 22 first-event chronic PwS (i.e., unilateral hemiparesis). PwS underwent tests during baseline and one week later, after participating in a single training session that resisted forward stepping during the swing phase of walking with a device secured around the patient's waist and connected diagonally to the patient's foot by a tension cord. Ground reaction forces and center of pressure were sampled during treadmill gait to assess step length asymmetry. Performance-oriented mobility assessment (POMA), a two-minute walk test (2MWT), and the voluntary step execution test were also measured. We found no significant improvement in step length asymmetry. However, POMA scores, as well as voluntary step execution tests improved with a moderate effect size. It seems that applying diagonal resistance force to the swinging leg resulted in insufficient horizontal force. However, the improvement in the preparation phase, i.e., better weight-bearing abilities during the voluntary stepping, may be due to the compression force applied to the lower limb joints thus providing proprioceptive training. This suggests that proprioceptive training may improve gait performance in stroke patients in a very short training period.


Assuntos
Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/reabilitação , Marcha/fisiologia , Paresia/reabilitação , Equilíbrio Postural/fisiologia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidentes por Quedas/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Teste de Esforço/métodos , Terapia por Exercício/métodos , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/diagnóstico , Paresia/fisiopatologia , Projetos Piloto , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
9.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32144121

RESUMO

A previously healthy 9-year-old immigrant girl from Mexico was evaluated in the emergency department (ED) with one week of fatigue, fevers, rhinorrhea, and cough. She initially presented to her primary pediatrician, where a complete blood count revealed neutropenia, prompting referral to the ED. In the ED, she was found to be influenza A-positive. Because of dehydration, she received intravenous fluids and was admitted to the pediatric hospital medicine service. After 2 days, influenza symptoms improved, and oral intake increased. However, she was noted to have decreased bilateral lower-extremity strength, absent Achilles reflexes, decreased lower-extremity sensation and proprioception, a positive result on the Romberg sign, and abnormal heel-to-shin testing results. These findings prompted an urgent neurology consultation. After extensive imaging, laboratory evaluation, and further consultations, a diagnosis was established.


Assuntos
Anemia/etiologia , Transtornos Neurológicos da Marcha/etiologia , Influenza Humana/complicações , Debilidade Muscular/etiologia , Neutropenia/etiologia , Deficiência de Vitamina B 12/diagnóstico , Antivirais/uso terapêutico , Criança , Diagnóstico Diferencial , Fadiga/etiologia , Feminino , Febre/etiologia , Transtornos Neurológicos da Marcha/diagnóstico , Humanos , Influenza Humana/tratamento farmacológico , Oseltamivir/uso terapêutico , Doenças da Medula Espinal/complicações , Doenças da Medula Espinal/diagnóstico , Deficiência de Vitamina B 12/complicações , Vômito/etiologia
10.
Dev Med Child Neurol ; 62(7): 868-873, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32162342

RESUMO

AIM: To explore how patients with cerebral palsy (CP) perceive their gait and evaluate associations between subjective gait perception and: objective gait parameters, endurance, pain, and fatigue. METHOD: Sixty-two patients (21 females and 41 males; mean [SD] age 20y [5y 1mo], range 15-29y) performed a clinical gait analysis. Self-selected walking speed, Gait Profile Score, and Gait Variable Score were calculated. Subjective gait perception was assessed with a visual analogue scale using the question: 'On a scale from 0 (worst) to 10 (optimal), how would you describe your walking today?'. A 6-minute walk test (6MWT) measured endurance; the 36-Item Short Form Health Survey (SF-36) evaluated quality of life. T-tests, Pearson correlations, and univariate and multiple linear regression models were used to compare and find associations between the data. RESULTS: Overall mean (SD) subjective gait perception was 7.5 (1.8) and was significantly higher for patients in Gross Motor Function Classification System (GMFCS) level I (7.9 [1.5]) than for patients in GMFCS levels II and III (5.9 [2.0]). Positive correlations were found between subjective gait perception and gait scores, walking speed, 6MWT distance, and SF-36 score. Only walking speed was a significant predictor of subjective gait perception. INTERPRETATION: Subjective gait perception was influenced by GMFCS level and linked partially with the walking speed. The gait quality did not explain subjective gait perception. It is important to combine subjective and objective gait scores to develop personalized therapeutic goals. WHAT THIS PAPER ADDS: Subjective gait perception is influenced by the physical impairment levels of patients with cerebral palsy. Subjective gait perception and objective gait scores are associated. Walking speed is the only predictor of gait perception.


Assuntos
Paralisia Cerebral/fisiopatologia , Autoavaliação Diagnóstica , Transtornos Neurológicos da Marcha/fisiopatologia , Índice de Gravidade de Doença , Velocidade de Caminhada , Adolescente , Adulto , Paralisia Cerebral/complicações , Teste de Esforço , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Adulto Jovem
12.
Gait Posture ; 77: 75-82, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32004949

RESUMO

BACKGROUND: Due to the high susceptivity of the walking pattern to be affected by several disorders, accurate analysis methods are necessary. Given the complexity and relevance of such assessment, the utilization of methods to facilitate it plays a significant role, provided that they do not compromise the outcomes. RESEARCH QUESTIONS: This paper aimed at identifying the standards for the application of adaptive predictive systems to gait analysis, given the extensive research on this field. Furthermore, we also intended to check whether such methods can effectively support clinicians in determining the number of physiotherapy sessions necessary to recover gait-related dysfunctions. METHODS: Through a screening process of scientific databases, we considered studies encompassed from 1968 to April 2019. Within these 50 years, we found 24 papers that met our inclusion criteria. They were analyzed according to their data acquisition and processing methods via ad hoc questionnaires. Additionally, we examined quantitatively the adaptive approaches. RESULTS: Concerning data acquisition, the included papers presented a mean score of 6.1 SD 1.0, most of them applying optoelectronic systems, and the ground reaction force (GRF) was the most used parameter. The AI quality assessment showed an above-average rate of 7.8 SD 1.0, and artificial neural networks (ANN) being the paradigm most frequently utilized. Our systematic review identified only one study that addressed therapeutics including a predictive method. SIGNIFICANCE: While much progress has been identified to predict assessment aspects, there is little effort to assist healthcare professionals in establishing the rehabilitation duration and prognostics. Therefore, future studies should focus on accomplishing the production of applications of predictive methods to therapeutics and prognosis, not lingering extremely on the analysis of gait features.


Assuntos
Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/fisiopatologia , Marcha/fisiologia , Doenças Musculoesqueléticas/fisiopatologia , Redes Neurais de Computação , Fenômenos Biomecânicos , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/reabilitação , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/reabilitação , Modalidades de Fisioterapia , Caminhada
13.
Sensors (Basel) ; 20(3)2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-32012930

RESUMO

Mobility across people with a large range of age was evaluated, for the first time, by using an instrumented timed up and go test (iTUG) based on signals acquired by a single wearable inertial sensor. Eighty healthy participants, from childhood to old age, performed the test, covering walking distances of 3 m and 7 m. Total time, temporal, and velocity parameters of linear and turning subcomponents of the test were quantified. While children, adults, and senior adults exhibited similar values for all the parameters, older adults showed increases in duration and reductions in velocity during the turning phases when compared with the other groups. an increase in velocity was observed during mid turning when the test was performed along the longer distance. Similarity across children, adults, and senior adults indicates that healthy individuals develop the abilities performed in the iTUG early, while the slowing down shown during the turning phases by the older adults may reflect the need to implement adaptive adjustments to face changes of direction. These results emphasize the idea that reducing equipment to a single sensor provides an appropriate quantification when the iTUG is used to investigate a broader age range or different levels of complexity.


Assuntos
Técnicas Biossensoriais , Transtornos Neurológicos da Marcha/fisiopatologia , Equilíbrio Postural/fisiologia , Amplitude de Movimento Articular/fisiologia , Acelerometria , Adolescente , Adulto , Idoso , Criança , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/fisiopatologia , Fatores de Tempo , Estudos de Tempo e Movimento , Adulto Jovem
14.
Neurology ; 94(13): e1395-e1406, 2020 03 31.
Artigo em Inglês | MEDLINE | ID: mdl-32102980

RESUMO

OBJECTIVE: To test the hypothesis that higher-challenge gait and balance tasks are more sensitive than traditional metrics to subtle patient-reported gait dysfunction and future fall risk in early multiple sclerosis (MS). METHODS: Persons with early MS (n = 185; ≤5 years diagnosed) reported gait function (MS Walking Scale) and underwent traditional disability metrics (Expanded Disability Status Scale [EDSS], Timed 25 Foot Walk). Patients and healthy controls (n = 50) completed clinically feasible challenge tasks of gait endurance (2-Minute Walk Test), standing balance (NIH Toolbox), and dynamic balance (balance boards; tandem walk on 2 ten-foot boards of different widths, 4.5 and 1.5 in). MRI assessed global and regional brain volumes, total T2 lesion volume (T2LV), infratentorial T2LVs and counts, and cervical cord lesion counts. Falls, near falls, and fall-related injuries were assessed after 1 year. We examined links between all tasks and patient-reported gait, MRI markers, and fall data. RESULTS: Patients performed worse on higher challenge balance, but not gait, tasks compared with healthy controls. Worse patient-reported gait disturbance was associated with worse performance on all tasks, but only dynamic balance was sensitive to mild patient-reported gait difficulty. Balance tasks were more correlated with MRI metrics than were walking tasks or EDSS score. Thirty percent of patients reported either a fall or near fall after 1 year, with poor dynamic balance as the only task independently predicting falls. CONCLUSIONS: Balance plays a leading role in gait dysfunction early in MS. Clinically feasible higher-challenge balance tasks were most sensitive to patient-reported gait, MRI disease markers, and risk of future falls, highlighting potential to advance functional outcomes in clinical practice and trials.


Assuntos
Acidentes por Quedas , Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Esclerose Múltipla Recidivante-Remitente/complicações , Adulto , Doenças Desmielinizantes/complicações , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Equilíbrio Postural/fisiologia
15.
J. negat. no posit. results ; 5(2): 212-217, feb. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-194010

RESUMO

INTRODUCCIÓN: La enfermedad de moyamoya es una enfermedad cerebrovascular que se caracteriza por la estenosis progresiva de las arterias del polígono de Willis, desarrollando una red vascular compensatoria anómala, denominada vasos moyamoya. Dichas áreas son más susceptibles de sufrir isquemia o hemorragia. CASO CLÍNICO: Varón de 47 años con clínica de debilidad en miembro superior izquierdo y torpeza en la marcha en miembro inferior izquierdo, de 5 días de evolución, en relación con consumo de cocaína. En arteriografía, red colateral compatible con patrón de moyamoya. DISCUSIÓN: El consumo crónico de cocaína produce aumento brusco de la presión arterial, vasoconstricción cerebral, vasculitis y trombosis aguda, con el consecuente desarrollo de vasos moyamoya como mecanismo fisiológico compensatorio


INTRODUCTION: Moyamoya disease is a cerebrovascular disease characterized by progressive stenosis of the arteries of the circle of Willis, conditioning the appearance of an anomalous compensatory vascular network, the moyamoya vessels. These areas are more susceptible to suffering ischemia or haemorrhage. CASE REPORT: A 47-year-old man with symptoms of weakness in the left upper limb and clumsy walk because of left leg, of 5 days' evolution, in relation to cocaine consumption. In arteriography, extensive collateral network compatible with the moyamoya pattern. DISCUSSION: The chronic consumption of cocaine produces abrupt increase in blood pressure, cerebral vasoconstriction, vasculitis and acute thrombosis, with the consequent development of moyamoya vessels as a compensatory physiological mechanism


Assuntos
Humanos , Transtornos Cerebrovasculares/induzido quimicamente , Doença de Moyamoya/induzido quimicamente , Transtornos Relacionados ao Uso de Cocaína/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Neurológicos da Marcha/diagnóstico , Infarto Cerebral/induzido quimicamente , Vasculite/induzido quimicamente
16.
J Neuroeng Rehabil ; 17(1): 7, 2020 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-31948485

RESUMO

BACKGROUND: Gait disturbances are typical of persons with idiopathic normal pressure hydrocephalus (iNPH) without signs distinctive from other neurodegenerative and vascular conditions. Cerebrospinal fluid tap-test (CSF-TT) is expected to improve the motor performance of iNPH patients and is a prognostic indicator in their surgical management. This observational prospective study aims to determine which spatio-temporal gait parameter(s), measured during instrumented motor tests, and clinical scale(s) may provide a relevant contribution in the evaluation of motor performance pre vs. post CSF-TT on iNPH patients with and without important vascular encephalopathy. METHODS: Seventy-six patients (20 with an associated vascular encephalopathy) were assessed before, and 24 and 72 h after the CSF-TT by a timed up and go test (TUG) and an 18 m walking test (18 mW) instrumented using inertial sensors. Tinetti Gait, Tinetti Balance, Gait Status Scale, and Grading Scale were fulfilled before and 72 h after the CSF-TT. Stride length, cadence and total time were selected as the outcome measures. Statistical models with mixed effects were implemented to determine the relevant contribution to response variables of each quantitative gait parameter and clinical scales. RESULTS AND CONCLUSION: From baseline to 72 h post CSF-TT patients improved significantly by increasing cadence in 18 mW and TUG (on average of 1.7 and 2.4 strides/min respectively) and stride length in 18 mW (on average of 3.1 cm). A significant reduction of gait apraxia was reflected by modifications in double support duration and in coordination index. Tinetti Gait, Tinetti Balance and Gait Status Scale were able to explain part of the variability of response variables not covered by instrumental data, especially in TUG. Grading Scale revealed the highest affinity with TUG total time and cadence when considering clinical scales alone. Patients with iNPH and an associated vascular encephalopathy showed worst performances compared to pure iNPH but without statistical significance. Gait improvement following CSF-TT was comparable in the two groups. Overall these results suggest that, in order to augment CSF-TT accuracy, is key to assess the gait pattern by analyzing the main spatio-temporal parameters and set post evaluation at 72 h. TRIAL REGISTRATION: Approved by ethics committee: CE 14131 23/02/2015.


Assuntos
Análise da Marcha/instrumentação , Transtornos Neurológicos da Marcha , Hidrocefalia de Pressão Normal/diagnóstico , Punção Espinal , Dispositivos Eletrônicos Vestíveis , Acelerometria/instrumentação , Idoso , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Hidrocefalia de Pressão Normal/complicações , Hidrocefalia de Pressão Normal/cirurgia , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Smartphone , Estudos de Tempo e Movimento
17.
Med Biol Eng Comput ; 58(2): 373-382, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31853775

RESUMO

Hemiplegia is a form of paralysis that typically has the symptom of dysbasia. In current clinical rehabilitations, to measure the level of hemiplegia gaits, clinicians often conduct subject evaluations through observations, which is unreliable and inaccurate. The Microsoft Kinect sensor (MS Kinect) is a widely used, low-cost depth sensor that can be used to detect human behaviors in real time. The purpose of this study is to investigate the usage of the Kinect data for the classification and analysis of hemiplegia gait. We first acquire the gait data by using a MS Kinect and extract a set of gait features including the stride length, gait speed, left/right moving distances, and up/down moving distances. With the gait data of 60 subjects including 20 hemiplegia patients and 40 healthy subjects, we employ a random forest-based classification approach to analyze the importances of different gait features for hemiplegia classification. Thanks to the over-fitting avoidance nature of the random forest approach, we do not need to have a careful control over the percentage of patients in the training data. In our experiments, our approach obtained the averaged classification accuracy of 90.65% among all the combinations of the gait features, which substantially outperformed state-of-the-art methods. The best classification accuracy of our approach is 95.45%, which is superior than all existing methods. Additionally, our approach also correctly reveals the importance of different gait features for hemiplegia classification. Our random forest-based approach outperforms support vector machine-based method and the Bayesian-based method, and can effectively extract gait features of subjects with hemiplegia for the classification and analysis of hemiplegia. Graphical Abstract Random Forest based Classsification and Analysis of Hemiplegia Gait using Low-cost Depth Cameras. Left: Motion capture with MS Kinect; Top-right: Random Forest Classsification based on the extracted gait features; Bottom-right: Sensitivity and specificity evaluation of the proposed classification approach.


Assuntos
Algoritmos , Custos e Análise de Custo , Transtornos Neurológicos da Marcha/diagnóstico por imagem , Transtornos Neurológicos da Marcha/diagnóstico , Hemiplegia/diagnóstico por imagem , Hemiplegia/fisiopatologia , Fotografação/economia , Fotografação/instrumentação , Feminino , Hemiplegia/economia , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC
18.
Gait Posture ; 76: 198-203, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31862670

RESUMO

BACKGROUND: Quantitative gait analysis produces a vast amount of data, which can be difficult to analyze. Automated gait classification based on machine learning techniques bear the potential to support clinicians in comprehending these complex data. Even though these techniques are already frequently used in the scientific community, there is no clear consensus on how the data need to be preprocessed and arranged to assure optimal classification accuracy outcomes. RESEARCH QUESTION: Is there an optimal data aggregation and preprocessing workflow to optimize classification accuracy outcomes? METHODS: Based on our previous work on automated classification of ground reaction force (GRF) data, a sequential setup was followed: firstly, several aggregation methods - early fusion and late fusion - were compared, and secondly, based on the best aggregation method identified, the expressiveness of different combinations of signal representations was investigated. The employed dataset included data from 910 subjects, with four gait disorder classes and one healthy control group. The machine learning pipeline comprised principle component analysis (PCA), z-standardization and a support vector machine (SVM). RESULTS: The late fusion aggregation, i.e., utilizing majority voting on the classifier's predictions, performed best. In addition, the use of derived signal representations (relative changes and signal differences) seems to be advantageous as well. SIGNIFICANCE: Our results indicate that great caution is needed when data preprocessing and aggregation methods are selected, as these can have an impact on classification accuracies. These results shall serve future studies as a guideline for the choice of data aggregation and preprocessing techniques to be employed.


Assuntos
Análise da Marcha/métodos , Transtornos Neurológicos da Marcha/diagnóstico , Marcha/fisiologia , Máquina de Vetores de Suporte , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Análise de Componente Principal , Adulto Jovem
19.
IEEE Trans Neural Syst Rehabil Eng ; 28(1): 42-51, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31603824

RESUMO

It is well known that most patients with Parkinson's disease (PD) have different degree of movement disorders, such as shuffling, festination and akinetic episodes, which could degenerate the life quality of PD patients. Therefore, it is very useful to develop a computerized tool to provide an objective evaluation of PD patients' gait. In this study, we implemented a novel gait evaluating approach to provide not only a binary classification of PD gaits and normal walking, but also a quantification of the PD gaits to relate them to the PD severity level. The proposed system is a dual-modal deep-learning-based model, where left and right gait is modeled separately by a convolutional neural network (CNN) followed by an attention-enhanced long short-term memory (LSTM) network. The left and right samples for model training and testing were segmented sequentially from multiple 1D vertical ground reaction force (VGRF) signals according to the detected gait cycle. Experimental results indicate that our model can provide state-of-the-art performance in terms of classification accuracy. It is expected that the proposed model can be a useful gait assistance to provide a quantitative evaluation of PD gaits with high confidence and accuracy if trained suitably.


Assuntos
Atenção , Aprendizado Profundo , Redes Neurais de Computação , Doença de Parkinson/diagnóstico , Doença de Parkinson/psicologia , Idoso , Algoritmos , Simulação por Computador , Feminino , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Memória de Curto Prazo , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Caminhada
20.
Am J Phys Med Rehabil ; 99(1): 13-18, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31335341

RESUMO

PURPOSE: The aim of the study was to assess dual-task cost to spatio-temporal gait parameters in people with multiple sclerosis and a matched control group. METHOD: The multiple sclerosis group was composed of 17 participants with a diagnosis of multiple sclerosis and an Expanded Disability Status Scale score of less than 6. A total of 17 healthy participants were allocated to the control group by stratification. Controls were matched on the basis of age, sex, sociocultural habits, and body structure. Dual-task cost was determined by within-group repeated-measures analysis of variance. Participants were instructed to ambulate under normal conditions and perform a discrimination and decision-making task concurrently. Then, between-group analysis of variance was used to assess differences in mean dual-task cost between groups and determine dual-task cost differential. Testing was performed using three-dimensional photogrammetry and an electronic walkway. RESULTS: Based on dual-task cost differential, gait cycle time increase (-5.8%) and gait speed decrease (6.3%) because of multiple sclerosis-induced impairment. CONCLUSIONS: During single- and dual-task conditions, gait speed was lower in multiple sclerosis participants, because of a shorter step length and increased swing time. Increased gait time might be the result of compensatory mechanisms adopted to maintain stability while walking specially during the double-support phases.


Assuntos
Avaliação da Deficiência , Análise da Marcha , Transtornos Neurológicos da Marcha/diagnóstico , Limitação da Mobilidade , Esclerose Múltipla/fisiopatologia , Adulto , Análise de Variância , Estudos de Casos e Controles , Feminino , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Análise e Desempenho de Tarefas , Fatores de Tempo , Velocidade de Caminhada
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...