Prediction of conversion to dementia disorders based on timed up and go dual-task test verbal and motor outcomes: a five-year prospective memory-clinic-based study.

BACKGROUND: While assessment tools can increase the detection of cognitive impairment, there is currently insufficient evidence regarding clinical outcomes based on screening for cognitive impairment in older adults. METHODS: The study purpose was to investigate whether Timed Up and Go dual-task test (TUGdt) results, based on TUG combined with two different verbal tasks (name different animals, TUGdt-NA, and recite months in reverse order, TUGdt-MB), predicted dementia incidence over a period of five years among patients (N = 186, mean = 70.7 years; 45.7% female) diagnosed with Subjective Cognitive Impairment (SCI) and Mild Cognitive Impairment (MCI) following assessment at two memory clinics. Associations between TUG parameters and dementia incidence were examined in Cox regression models. RESULTS: During follow-up time (median (range) 3.7 (0.1-6.1) years) 98 participants converted to dementia. Novel findings indicated that the TUGdt parameter words/time, after adjustment for age, gender, and education, can be used for the prediction of conversion to dementia in participants with SCI or MCI over a period of five years. Among the TUG-related parameters investigated, words/time showed the best predictive capacity, while time scores of TUG and TUGdt as well as TUGdt cost did not produce significant predictive results. Results further showed that the step parameter step length during TUGdt predicts conversion to dementia before adjustment for age, gender, and education. Optimal TUGdt cutoffs for predicting dementia at 2- and 4-year follow-up based on words/time were calculated. The sensitivity of the TUGdt cutoffs was high at 2-year follow-up: TUGdt-NA words/time, 0.79; TUGdt-MB words/time, 0.71; reducing respectively to 0.64 and 0.65 at 4-year follow-up. CONCLUSIONS: TUGdt words/time parameters have potential as cost-efficient tools for conversion-to-dementia risk assessment, useful for research and clinical purposes. These parameters may be able to bridge the gap of insufficient evidence for such clinical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05893524: https://www. CLINICALTRIALS: gov/study/NCT05893524?id=NCT05893524&rank=1 .

Dual-Task Interference of Gait Parameters During Different Conditions of the Timed Up-and-Go Test Performed by Community-Dwelling Older Adults.

The Timed Up-and-Go (TUG) test has been combined with different verbal/cognitive tasks (i.e., TUG dual task [TUGdt]) as a form of motor-cognitive testing. However, it is still unclear how different TUGdt conditions affect gait among older adults. Thirty community-dwelling older adults, with mean age of 73 years, participated in the study. Data were collected using marker-free video recordings. Gait parameters were extracted using a semiautomatic deep learning system. Comparisons of execution time and gait parameter outcomes were made under TUG and three types of TUGdt test conditions: TUGdt-naming animals, TUGdt-months backwards, and TUGdt-serial 7s. Statistical analyses were based on mean values of the gait parameters for each participant and TUG condition, including TUGdt gait cost, that is, the relative difference between TUGdt and TUG. All the investigated TUGdt conditions resulted in varying degrees of gait parameter changes. Under TUGdt conditions, participants took shorter and slower steps, with TUGdt-serial 7s causing the largest interference.

Robust Plug-and-Play Joint Axis Estimation Using Inertial Sensors.

Inertial motion capture relies on accurate sensor-to-segment calibration. When two segments are connected by a hinge joint, for example in human knee or finger joints as well as in many robotic limbs, then the joint axis vector must be identified in the intrinsic sensor coordinate systems. Methods for estimating the joint axis using accelerations and angular rates of arbitrary motion have been proposed, but the user must perform sufficiently informative motion in a predefined initial time window to accomplish complete identifiability. Another drawback of state of the art methods is that the user has no way of knowing if the calibration was successful or not. To achieve plug-and-play calibration, it is therefore important that 1) sufficiently informative data can be extracted even if large portions of the data set consist of non-informative motions, and 2) the user knows when the calibration has reached a sufficient level of accuracy. In the current paper, we propose a novel method that achieves both of these goals. The method combines acceleration- and angular rate information and finds a globally optimal estimate of the joint axis. Methods for sample selection, that overcome the limitation of a dedicated initial calibration time window, are proposed. The sample selection allows estimation to be performed using only a small subset of samples from a larger data set as it deselects non-informative and redundant measurements. Finally, an uncertainty quantification method that assures validity of the estimated joint axis parameters, is proposed. Experimental validation of the method is provided using a mechanical joint performing a large range of motions. Angular errors in the order of 2 ∘ were achieved using 125-1000 selected samples. The proposed method is the first truly plug-and-play method that overcome the need for a specific calibration phase and, regardless of the user's motions, it provides an accurate estimate of the joint axis as soon as possible.

Machine Learning Approaches for Dementia Detection Through Speech and Gait Analysis: A Systematic Literature Review.

Background: Dementia is a general term for several progressive neurodegenerative disorders including Alzheimer's disease. Timely and accurate detection is crucial for early intervention. Advancements in artificial intelligence present significant potential for using machine learning to aid in early detection. Objective: Summarize the state-of-the-art machine learning-based approaches for dementia prediction, focusing on non-invasive methods, as the burden on the patients is lower. Specifically, the analysis of gait and speech performance can offer insights into cognitive health through clinically cost-effective screening methods. Methods: A systematic literature review was conducted following the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The search was performed on three electronic databases (Scopus, Web of Science, and PubMed) to identify the relevant studies published between 2017 to 2022. A total of 40 papers were selected for review. Results: The most common machine learning methods employed were support vector machine followed by deep learning. Studies suggested the use of multimodal approaches as they can provide comprehensive and better prediction performance. Deep learning application in gait studies is still in the early stages as few studies have applied it. Moreover, including features of whole body movement contribute to better classification accuracy. Regarding speech studies, the combination of different parameters (acoustic, linguistic, cognitive testing) produced better results. Conclusions: The review highlights the potential of machine learning, particularly non-invasive approaches, in the early prediction of dementia. The comparable prediction accuracies of manual and automatic speech analysis indicate an imminent fully automated approach for dementia detection.

Kinematic, kinetic and electromyographic adaptation to speed and resistance in double poling cross country skiing.

This study incorporated variations in speed and the horizontal resistance acting upon elite female skiers during double poling (DP) on a treadmill and specifically analyzed biomechanical adaptations to these variations. Whole body kinematics and pole force data were recorded and used to calculate the moment of force acting on the shoulder and elbow joints. Data were obtained with a 3D optoelectronic system using reflective markers at given anatomical landmarks. Forces along the long axis of the right pole were measured with a piezoelectric force transducer. Surface electrodes were used to record EMG activity in the rectus femoris, rectus abdominis, latissimus dorsi and triceps brachii muscles. In a first set of recordings, the participants double poled with zero elevation at five different speeds from 8 to 17 km h(-1). In a second set of recordings, horizontal resistance was added by weights (0.4-1.9 kg) attached to a pulley system pulling the skier posteriorly during DP at 14 km h(-1). Results showed increasing relative duration of the thrust phase with increasing resistance, but not with speed. Significant kinematic differences occurred with increase in both speed and resistance. The mean (±SD) horizontal force components ranged between 1.7 (±1.3) and 2.8 (±1.1) percent (%) bodyweight (BW) in the speed adaptation and 3.1 (±0.6) and 4.0 (±1.3) % BW in the adaptation to horizontal resistance. Peak muscle activity showed a central to peripheral (proximo-distal) activation sequence. The temporal cycle phase pattern in the adaptation to speed and horizontal resistance differed.

Neuromuscular Controller Models for Quantifying Standing Balance in Older People: A Systematic Review.

Objective quantification of the balancing mechanisms in humans is strongly needed in health care of older people, yet is largely missing among current clinical balance assessment methods. Hence, the main goal of this literature review is to identify methods that have the potential to meet that need. We searched in the PubMed and IEEE Xplore databases using predefined criteria, screened 1064 articles, and systematically reviewed and categorized methods from 73 studies that deal with identification of neuromuscular controller models of human upright standing from empirical data. These studies were then analyzed with the particular aim to understand to what degree such methods would be useful solutions for assessing the balance of older individuals aged above 60 years. The 16 studies that included an older subject population were especially examined with this in mind. The majority of the reviewed articles focused on research questions related to the general function of human balance control rather than clinical applicability. Further efforts need to be made to adapt these methods for more accessible and mobile technologies and to ensure that the outcomes are valid for balance assessment of a general older population.

Acute effects of reducing vertical displacement and step frequency on running economy.

This work studies the immediate effects of altering the vertical displacement of the center of mass (VD) and step frequency (SF) on the metabolic cost of level treadmill running at 16 km · h(-1) on 16 male runners. Alterations of VD, SF, and the product VD × SF was induced using a novel feedback system, which presents target and current values to the runner by visual or auditory display. Target values were set to 5 and 10% reductions from individual baseline values. The results were expressed as relative changes from baseline values. Alterations led to an increase in metabolic cost in most cases, measured as V(O2) uptake per minute and kilogram of body mass. Correlations were weak. Still, linear multiple regression revealed a positive coefficient (0.28) for the relationship between VD × SF and V(O2). Separate rank correlation tests showed negative correlation (τ = -0.19) between SF and V(O2) and positive correlation (τ = 0.16) between VD and V(O2). There is a coupling between VD and SF caused by the mechanics of running; hence, isolated reduction of either factor was hard to achieve. The linear model also showed a negative coefficient for the relationship between the height of the center of mass above the ground (CoMh) and V(O2). The effect size was small (multiple R(2) 0.07 and 0.12). Still the results indicate that reducing VD × SF by reducing the vertical displacement can have a positive effect on running economy, but a concurrent reduction in CoMh may diminish the positive effect. Midterm and long-term effects of altering the technique should also be studied.

Metabolic Demands and Kinematics During Level Walking in Darkness With No Vision or With Visual Aid.

INTRODUCTION: Uniformed services commonly perform foot-borne operations at night, while using visual aid in terms of night vision goggles (NVG). During slow-level walking, complete lack of visual input alters kinematics and markedly increases the metabolic demand, whereas the effect on kinematics and energy expenditure of restricting the peripheral visual field by wearing NVG is still unknown. The purpose was to evaluate whether metabolic demands and kinematics during level walking are affected by complete darkness with and without visual aid. MATERIALS AND METHODS: Eleven healthy men walked on a treadmill (inclination: +2.3°, velocity: 4 km/h) with full vision in a lighted laboratory (Light), and in complete darkness wearing either a blindfold (Dark), or restricting the visual field to about 40° by wearing monocular (Mono) or binocular (Bino) NVG. Oxygen uptake ($\dot{\text{V}}$O2) was measured to evaluate metabolic demands. Inertial measurement units were used to estimate kinematics, and the outcome was validated by using a motion capture system. Ratings of perceived exertion, discomfort, and mental stress were evaluated after each condition using a Borg ratio scale. Physiologic and kinematic variables were evaluated using repeated measures analysis of variance (ANOVA), whereas ratings were evaluated using non-parametric Friedman ANOVA. RESULTS: $\dot{\text{V}}$ O2 was 20% higher in the Dark (1.2 ± 0.2 L/min) than the Light (1.0 ± 0.2 L/min) condition. Nominally, $\dot{\text{V}}$O2 in the Mono (1.1 ± 0.2 L/min) and Bino (1.1 ± 0.2 L/min) conditions fell in between those in the Light and Dark conditions but was not statistically different from either the Light or the Dark condition. Step length was shorter in the Dark (-9%, 1.22 ± 0.16 m) and Mono (-6%, 1.27 ± 0.09 m) conditions than in the Light condition (1.35 ± 0.11 m), whereas the Bino (1.28 ± 0.08 m) condition was not statistically different from either the Light or the Dark condition. The three conditions with no or limited vision were perceived more physically demanding, more uncomfortable, and more mentally stressful than the Light condition, and the Dark condition was perceived more mentally stressful than both NVG conditions. CONCLUSIONS: The study confirms that complete lack of visual cues markedly reduces the mechanical efficiency during level walking, even under obstacle-free and highly predictable conditions. That $\dot{\text{V}}$O2 and step length values for the NVG conditions fell in between those of the Light and Dark conditions suggest that both foveal and peripheral vision may play important roles in optimizing the mechanical efficiency during level walking.

Immediate effect of visual and auditory feedback to control the running mechanics of well-trained athletes.

The correlation between mechanical factors of running and running economy as measured by metabolic cost is a subject of much interest in the study of locomotion. However, no change in running technique has been shown to result in an immediate improvement in running economy on an intra-individual basis. To evaluate the effect of a modified running technique, it is probably necessary that the individual trains with the new technique for a longer period using a feedback system to control the new kinematics. In this study, we examine the feasibility of using visual and auditory feedback to adapt running technique according to a simplistic model of the mechanical cost of running. The model considers only the mechanical work against gravity, which is the product of the magnitude of the vertical displacement of the runner's centre of mass and the step-frequency. In the experiments reported here, 18 trained runners, running at 16 km · h(-1) on a treadmill, were given feedback on these parameters together with indicated target levels. In almost all cases, the runners were able to adjust their technique accordingly.

Extraction of gait parameters from marker-free video recordings of Timed Up-and-Go tests: Validity, inter- and intra-rater reliability.

BACKGROUND: We study dual-task performance with marker-free video recordings of Timed Up-and-Go tests (TUG) and TUG combined with a cognitive/verbal task (TUG dual-task, TUGdt). RESEARCH QUESTION: Can gait parameters be accurately estimated from video-recorded TUG tests by a new semi-automatic method aided by a technique for human 2D pose estimation based on deep learning? METHODS: Thirty persons aged 60-85 years participated in the study, conducted in a laboratory environment. Data were collected by two synchronous video-cameras and a marker-based optoelectronic motion capture system as gold standard, to evaluate the gait parameters step length (SL), step width (SW), step duration (SD), single-stance duration (SSD) and double-stance duration (DSD). For reliability evaluations, data processing aided by a deep neural network model, involved three raters who conducted three repetitions of identifying anatomical keypoints in recordings of one randomly selected step from each of the participants. Validity was analysed using 95 % confidence intervals (CI) and p-values for method differences and Bland-Altman plots with limits of agreement. Inter- and intra-rater reliability were calculated as intraclass correlation coefficients (ICC) and standard errors of measurement. Smallest detectable change was calculated for inter-rater reliability. RESULTS: Mean ddifferences between video and the motion capture system data for SW, DSD, and SSD were significant (p < 0.001). However, mean differences for all parameters were small (-6.4%-13.0% of motion capture system) indicating good validity. Concerning reliability, almost all 95 % CI of the ICC estimates exceeded 0.90, indicating excellent reliability. Only inter-rater reliability for SW (95 % CI = 0.892;0.973) and one rater's intra-rater reliability for SSD (95 % CI = 0.793;0.951) were lower, but still showed good to excellent reliability. SIGNIFICANCE: The presented method for extraction of gait parameters from video appears suitable for valid and reliable quantification of gait. This opens up for analyses that may contribute to the knowledge of cognitive-motor interference in dual-task testing.

Elite golfers' kinematic sequence in full-swing and partial-swing shots.

The aim of this study was to investigate whether kinematic proximal-to-distal sequencing (PDS) and speed-summation are common characteristics of both partial and full-swing shots in golf players of different skill levels and genders. A total of 45 golfers participated, 11 male tournament professionals, 21 male and 13 female elite amateurs. They performed partial shots with a wedge to targets at three submaximal distances, 40, 55 and 70 m, and full-swing shots with a 5 iron and a driver for maximal distance. Pelvis, upper torso and hand movements were recorded in 3D with an electromagnetic tracking system (Polhemus Liberty) at 240 Hz and the magnitude of the resultant angular velocity vector of each segment was computed. The results showed a significant proximal-to-distal temporal relationship and a concomitant successive increase in maximum (peak) segment angular speed in every shot condition for both genders and levels of expertise. A proximal-to-distal utilization of interaction torques is indicated. Using a common PDS movement strategy in partial and full-swing golf shots appears beneficial from mechanical and control points of view and could serve the purpose of providing both high speed and accuracy.

Timed Up-and-Go Dual-Task Testing in the Assessment of Cognitive Function: A Mixed Methods Observational Study for Development of the UDDGait Protocol.

New methods to screen for and identify early-stage dementia disorders are highly sought after. The purpose of this pilot study is to develop a study protocol for a dual-task test aimed at aiding the early detection of dementia disorders. We used the Timed Up-and-Go (TUG) test, which is a mobility task involving starting in a sitting position, standing up, walking three meters to cross a line on the floor, turning around, walking back and sitting down again. We combined TUG with the verbal task of naming different animals. Pilot study participants were 43 individuals with and without established dementia diagnoses who attended a clinic for memory assessment. Video-recorded test performances were systematically analysed. Deviant test performances concerning the interplay between test administration and participants' responses to the assessment instructions were revealed and led to refinements being made to the final study protocol. Exploration of the dual-task test outcome measures in a sub-sample of 22 persons, ten with and twelve without dementia, indicated that step-length and number of named animals after the turning point of the dual-task test might constitute appropriate measures for examining this kind of sample. We concluded that the refined study protocol is feasible for testing individuals undergoing initial memory assessments and healthy controls. Follow-up studies with larger samples are being carried out and will bring new knowledge to this area of research. It may also provide an opportunity for further studies exploring possibilities for broad clinical implementation.

A method for determining minimal sets of markers for the estimation of center of mass, linear and angular momentum.

A new method is proposed for finding small sets of points on the body giving sufficient information for estimating the whole body center of mass (CoM), as well as the linear momenta (LM) and angular momenta (AM). In the underlying model each point (whose trajectory is tracked by a marker) is a point mass: Hence the body is represented by a simple system of point masses. The first step is to determine the appropriate set of points and the mass of each point, which is assumed to be specific for the movement performed. The distribution of the mass to each marker is determined from training data for which the true (or reference) trajectories of the CoM, LM or AM are known. This leads to a quadratic optimization problem with inequality constraints. The use of the method is demonstrated on data from discus throw. Results indicate reasonably small errors, considering the magnitude of other error sources, in CoM position (average magnitude of estimation error 1-2cm), and moderate errors in AM (13-20% of peak value).

Temporal coordination of the sit-to-walk task in subjects with stroke and in controls.

OBJECTIVES: To explore events and describe phases for temporal coordination of the sit-to-walk (STW) task, within a semistandardized set up, in subjects with stroke and matched controls. In addition, to assess variability of STW phase duration and to compare the relative duration of STW phases between the 2 groups. DESIGN: Cross-sectional. SETTING: Research laboratory. PARTICIPANTS: A convenience sample of persons with hemiparesis (n=10; age 50-67y) more than 6 months after stroke and 10 controls matched for sex, age, height, and body mass index. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Relative duration of STW phases, SE of measurement in percentage of the mean, and intraclass correlation coefficients (ICCs). RESULTS: Four STW phases were defined: rise preparation, transition, primary gait initiation, and secondary gait initiation. The subjects with stroke needed 54% more time to complete the STW task than the controls did. ICCs ranged from .38 to .66 and .22 to .57 in the stroke and control groups, respectively. SEs of measurement in percentage of the mean values were high, particularly in the transition phase: 54.1% (stroke) and 50.4% (controls). The generalized linear model demonstrated that the relative duration of the transition phase was significantly longer in the stroke group. CONCLUSIONS: The present results extend existing knowledge by presenting 4 new phases of temporal coordination of STW, within a semistandardized set-up, in persons with stroke and in controls. The high degree of variability regarding relative STW phase duration was probably a result of both the semistandardized set up and biological variability. The significant difference in the transition phase across the 2 groups requires further study.

Eccentric treatment for patellar tendinopathy: a prospective randomised short-term pilot study of two rehabilitation protocols.

OBJECTIVE: To compare the efficacy and safety of two eccentric rehabilitation protocols for patients with symptomatic patellar tendinopathy. A new eccentric overload training device was compared with the present standard eccentric rehabilitation programme on a decline board. DESIGN: Prospective, randomised clinical trial. SETTING: Sports rehabilitation clinic, university sports laboratory, supplemented with home exercises. PATIENTS: 20 competitive and recreational athletes, all with clinical diagnosis of patellar tendinopathy, verified by MRI or ultrasound imaging. INTERVENTIONS: A 12-week rehabilitation period, either with bilateral eccentric overload strength training using the Bromsman device twice a week or with unilateral eccentric body load training using a decline board twice a week, supplemented with daily home exercises. OUTCOME MEASURES: The primary outcome was pain and function, assessed by the Swedish Victorian Institute of Sport Assessment for Patella (VISA-P) score. Secondary outcome measures were isokinetic muscle torque, dynamic function and muscle flexibility, as well as pain level estimations using visual analogue scale (VAS). Side effects were registered. RESULTS: Both treatment groups improved in the short term according to the VISA-P scores during the 12-week rehabilitation period. However, there were no significant differences between the groups in terms of pain and function. After a 3-month rehabilitation period, most patients could be regarded as improved enough to be able to return to training and sports. No serious side effects were detected in either group. CONCLUSION: In patients with patellar tendinopathy pain, two-legged eccentric overload training twice per week, using the new device (Bromsman), was as efficient and safe as the present standard daily eccentric one-legged rehabilitation-training regimen using a decline board.

A Study Protocol for Applying User Participation and Co-Learning-Lessons Learned from the eBalance Project.

The eBalance project is based on the idea that serious exergames-i.e., computer gaming systems with an interface that requires physical exertion to play-that are well adapted to users, can become a substantial part of a solution to recognized problems of insufficient engagement in fall-prevention exercise and the high levels of fall-related injuries among older people. This project is carried out as a collaboration between eight older people who have an interest in balance training and met the inclusion criteria of independence in personal activities of daily living, access to and basic knowledge of a computer, four staff working with the rehabilitation of older adults, and an interdisciplinary group of six research coordinators covering the areas of geriatric care and rehabilitation, as well as information technology and computer science. This paper describes the study protocol of the project's initial phase which aims to develop a working partnership with potential users of fall-prevention exergames, including its conceptual underpinnings. The qualitative methodology was inspired by an ethnographical approach implying combining methods that allowed the design to evolve through the study based on the participants' reflections. A participatory and appreciative action and reflection (PAAR) approach, accompanied by inquiries inspired by the Normalization Process Theory (NPT) was used in interactive workshops, including exergame testing, and between workshop activities. Data were collected through audio recordings, photos, and different types of written documentation. The findings provide a description of the methodology thus developed and applied. They display a methodology that can be useful for the design and development of care service and innovations for older persons where user participation is in focus.

Bias compensated least squares estimate of the center of rotation.

It is shown that a recently published least squares method for the estimation of the average center of rotation is biased. Consequently, a correction term is proposed, and an iterative algorithm is derived for finding a bias compensated solution to the least squares problem.The accuracy of the proposed bias compensated least squares method is compared to the previously proposed least squares method by Monte-Carlo simulations. The tests show that the new method gives a substantial improvement in accuracy.

The concept of mobility in single- and double handed manipulation.

The concept of mobility describes an important property of the human body when performing manipulation tasks. It describes, in a sense, how easy it is to accelerate a link or a point on the manipulator. Most often it is calculated for the end-link or end-point of the manipulator, since these are important for the control objective of the manipulator. Mobility is the inverse of the inertia experienced by a force acting on the end-point, or a combined force and torque acting on the end-link. The concept has been used in studies of reaching tasks with one arm, but thus far not for bi-manual manipulation. We present here the concept for both single-handed and double-handed manipulation, in a general manner which includes any type of grip of the hands on the object. The use of the concept is illustrated with data on the left and right arm in a golf swing.