Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): Christian Vassallo, Anne-Hélène Olivier, Philippe Souères, Armel Crétual, Olivier Stasse, Julien Pettré
Robots and Humans have to share the same environment more and more often. In the aim of steering robots in a safe and convenient manner among humans it is required to understand how humans interact with them. This work focuses on collision avoidance between a human and a robot during locomotion. Having in mind previous results on human obstacle avoidance, as well as the description of the main principles which guide collision avoidance strategies, we observe how humans adapt a goal-directed locomotion task when they have to interfere with a mobile robot. Our results show differences in the strategy set by humans to avoid a robot in comparison with avoiding another human. Humans prefer to give the way to the robot even when they are likely to pass first at the beginning of the interaction.
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Τρίτη 27 Σεπτεμβρίου 2016
Gait deficits in people with Multiple Sclerosis: A systematic review and meta-analysis
Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): Laura Comber, Rose Galvin, Susan Coote
BackgroundMultiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls.ObjectiveThis systematic review and meta-analysis aims to quantify the effect of MS on gait to inform the development of falls prevention interventions.MethodsA systematic literature search identified case-control studies investigating differences in gait variables between people with MS and healthy controls. Meta-analysis examined the effect of MS on gait under normal and fast paced conditions.ResultsForty-one studies of people with Expanded Disability Status Scale (EDSS) 1.8 to 4.5 were included, of which 32 contributed to meta-analysis. A large effect of MS was found on stride length (Standardised Mean Difference, SMD=1.27, 95% CI{0.93, 1.61}), velocity (SMD=1.12, 95% CI{0.85, 1.39}), double support duration (SMD=0.85, 95% CI{0.51, 1.2}), step length (SMD=1.15, 95% CI{0.75, 1.5})and swing phase duration (SMD=1.23, 95% CI{0.06, 2.41}). A moderate effect was found on step width and stride time with the smallest effect found on cadence (SMD=0.43, 95% CI{0.14, 0.72}). All effect sizes increased for variables investigated under a fast walking pace condition (for example the effect on cadence increased to SMD=1.15, 95% CI{0.42, 1.88}).ConclusionsMS has a significant effect on gait even for those with relatively low EDSS. This effect is amplified when walking at faster speeds suggesting this condition may be more beneficial for assessment and treatment. No studies investigated the association between these deficits and falls. Further investigation relating to the predictive or protective nature of these deficits in relation to falls is warranted.
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Source:Gait & Posture
Author(s): Laura Comber, Rose Galvin, Susan Coote
BackgroundMultiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls.ObjectiveThis systematic review and meta-analysis aims to quantify the effect of MS on gait to inform the development of falls prevention interventions.MethodsA systematic literature search identified case-control studies investigating differences in gait variables between people with MS and healthy controls. Meta-analysis examined the effect of MS on gait under normal and fast paced conditions.ResultsForty-one studies of people with Expanded Disability Status Scale (EDSS) 1.8 to 4.5 were included, of which 32 contributed to meta-analysis. A large effect of MS was found on stride length (Standardised Mean Difference, SMD=1.27, 95% CI{0.93, 1.61}), velocity (SMD=1.12, 95% CI{0.85, 1.39}), double support duration (SMD=0.85, 95% CI{0.51, 1.2}), step length (SMD=1.15, 95% CI{0.75, 1.5})and swing phase duration (SMD=1.23, 95% CI{0.06, 2.41}). A moderate effect was found on step width and stride time with the smallest effect found on cadence (SMD=0.43, 95% CI{0.14, 0.72}). All effect sizes increased for variables investigated under a fast walking pace condition (for example the effect on cadence increased to SMD=1.15, 95% CI{0.42, 1.88}).ConclusionsMS has a significant effect on gait even for those with relatively low EDSS. This effect is amplified when walking at faster speeds suggesting this condition may be more beneficial for assessment and treatment. No studies investigated the association between these deficits and falls. Further investigation relating to the predictive or protective nature of these deficits in relation to falls is warranted.
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Residual Standard Deviation: Validation of a New Measure of Dual-Task Cost in Below-Knee Prosthesis Users
Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): Charla L. Howard, Chris Wallace, James Abbas, Dobrivoje S. Stokic
We developed and evaluated properties of a new measure of variability in stride length and cadence, termed residual standard deviation (RSD). To calculate RSD, stride length and cadence are regressed against velocity to derive the best fit line from which the variability (SD) of the distance between the actual and predicted data points is calculated. We examined construct, concurrent, and discriminative validity of RSD using dual-task paradigm in 14 below-knee prosthesis users and 13 age- and education-matched controls. Subjects walked first over an electronic walkway while performing separately a serial subtraction and backwards spelling task, and then at self-selected slow, normal, and fast speeds used to derive the best fit line for stride length and cadence against velocity. Construct validity was demonstrated by significantly greater increase in RSD during dual-task gait in prosthesis users than controls (group-by-condition interaction, stride length p=0.0006, cadence p=0.009). Concurrent validity was established against coefficient of variation (CV) by moderate-to-high correlations (r=0.50-0.87) between dual-task cost RSD and dual-task cost CV for both stride length and cadence in prosthesis users and controls. Discriminative validity was documented by the ability of dual-task cost calculated from RSD to effectively differentiate prosthesis users from controls (area under the receiver operating characteristic curve, stride length 0.863, p=0.001, cadence 0.808, p=0.007), which was better than the ability of dual-task cost CV (0.692, 0.648, respectively, not significant). These results validate RSD as a new measure of variability in below-knee prosthesis users. Future studies should include larger cohorts and other populations to ascertain its generalizability.
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Source:Gait & Posture
Author(s): Charla L. Howard, Chris Wallace, James Abbas, Dobrivoje S. Stokic
We developed and evaluated properties of a new measure of variability in stride length and cadence, termed residual standard deviation (RSD). To calculate RSD, stride length and cadence are regressed against velocity to derive the best fit line from which the variability (SD) of the distance between the actual and predicted data points is calculated. We examined construct, concurrent, and discriminative validity of RSD using dual-task paradigm in 14 below-knee prosthesis users and 13 age- and education-matched controls. Subjects walked first over an electronic walkway while performing separately a serial subtraction and backwards spelling task, and then at self-selected slow, normal, and fast speeds used to derive the best fit line for stride length and cadence against velocity. Construct validity was demonstrated by significantly greater increase in RSD during dual-task gait in prosthesis users than controls (group-by-condition interaction, stride length p=0.0006, cadence p=0.009). Concurrent validity was established against coefficient of variation (CV) by moderate-to-high correlations (r=0.50-0.87) between dual-task cost RSD and dual-task cost CV for both stride length and cadence in prosthesis users and controls. Discriminative validity was documented by the ability of dual-task cost calculated from RSD to effectively differentiate prosthesis users from controls (area under the receiver operating characteristic curve, stride length 0.863, p=0.001, cadence 0.808, p=0.007), which was better than the ability of dual-task cost CV (0.692, 0.648, respectively, not significant). These results validate RSD as a new measure of variability in below-knee prosthesis users. Future studies should include larger cohorts and other populations to ascertain its generalizability.
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Medial-lateral centre of mass displacement and base of support are equally good predictors of metabolic cost in amputee walking
Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): R.A. Weinert-Aplin, M. Twiste, H.L. Jarvis, A.N. Bennett, R.J. Baker
Amputees are known to walk with greater metabolic cost than able-bodied individuals and establishing predictors of metabolic cost from kinematic measures, such as centre of mass (CoM) motion, during walking are important from a rehabilitative perspective, as they can provide quantifiable measures to target during gait rehabilitation in amputees. While it is known that vertical CoM motion poorly predicts metabolic cost, CoM motion in the medial-lateral (ML) and anterior-posterior directions have not been investigated in the context of gait efficiency in the amputee population. Therefore, the aims of this study were to investigate the relationship between CoM motion in all three directions of motion, base of support and walking speed, and the metabolic cost of walking in both able-bodied individuals and different levels of lower limb amputee. 37 individuals were recruited to form groups of controls, unilateral above- and below-knee, and bilateral above-knee amputees respectively. Full-body optical motion and oxygen consumption data were collected during walking at a self-selected speed. CoM position was taken as the mass-weighted average of all body segments and compared to each individual’s net non-dimensional metabolic cost. Base of support and ML CoM displacement were the strongest correlates to metabolic cost and the positive correlations suggest increased ML CoM displacement or Base of support will reduce walking efficiency. Rehabilitation protocols which indirectly reduce these indicators, rather than vertical CoM displacement will likely show improvements in amputee walking efficiency.
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Source:Gait & Posture
Author(s): R.A. Weinert-Aplin, M. Twiste, H.L. Jarvis, A.N. Bennett, R.J. Baker
Amputees are known to walk with greater metabolic cost than able-bodied individuals and establishing predictors of metabolic cost from kinematic measures, such as centre of mass (CoM) motion, during walking are important from a rehabilitative perspective, as they can provide quantifiable measures to target during gait rehabilitation in amputees. While it is known that vertical CoM motion poorly predicts metabolic cost, CoM motion in the medial-lateral (ML) and anterior-posterior directions have not been investigated in the context of gait efficiency in the amputee population. Therefore, the aims of this study were to investigate the relationship between CoM motion in all three directions of motion, base of support and walking speed, and the metabolic cost of walking in both able-bodied individuals and different levels of lower limb amputee. 37 individuals were recruited to form groups of controls, unilateral above- and below-knee, and bilateral above-knee amputees respectively. Full-body optical motion and oxygen consumption data were collected during walking at a self-selected speed. CoM position was taken as the mass-weighted average of all body segments and compared to each individual’s net non-dimensional metabolic cost. Base of support and ML CoM displacement were the strongest correlates to metabolic cost and the positive correlations suggest increased ML CoM displacement or Base of support will reduce walking efficiency. Rehabilitation protocols which indirectly reduce these indicators, rather than vertical CoM displacement will likely show improvements in amputee walking efficiency.
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How do walkers avoid a mobile robot crossing their way?
Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): Christian Vassallo, Anne-Hélène Olivier, Philippe Souères, Armel Crétual, Olivier Stasse, Julien Pettré
Robots and Humans have to share the same environment more and more often. In the aim of steering robots in a safe and convenient manner among humans it is required to understand how humans interact with them. This work focuses on collision avoidance between a human and a robot during locomotion. Having in mind previous results on human obstacle avoidance, as well as the description of the main principles which guide collision avoidance strategies, we observe how humans adapt a goal-directed locomotion task when they have to interfere with a mobile robot. Our results show differences in the strategy set by humans to avoid a robot in comparison with avoiding another human. Humans prefer to give the way to the robot even when they are likely to pass first at the beginning of the interaction.
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Source:Gait & Posture
Author(s): Christian Vassallo, Anne-Hélène Olivier, Philippe Souères, Armel Crétual, Olivier Stasse, Julien Pettré
Robots and Humans have to share the same environment more and more often. In the aim of steering robots in a safe and convenient manner among humans it is required to understand how humans interact with them. This work focuses on collision avoidance between a human and a robot during locomotion. Having in mind previous results on human obstacle avoidance, as well as the description of the main principles which guide collision avoidance strategies, we observe how humans adapt a goal-directed locomotion task when they have to interfere with a mobile robot. Our results show differences in the strategy set by humans to avoid a robot in comparison with avoiding another human. Humans prefer to give the way to the robot even when they are likely to pass first at the beginning of the interaction.
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Gait deficits in people with Multiple Sclerosis: A systematic review and meta-analysis
Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): Laura Comber, Rose Galvin, Susan Coote
BackgroundMultiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls.ObjectiveThis systematic review and meta-analysis aims to quantify the effect of MS on gait to inform the development of falls prevention interventions.MethodsA systematic literature search identified case-control studies investigating differences in gait variables between people with MS and healthy controls. Meta-analysis examined the effect of MS on gait under normal and fast paced conditions.ResultsForty-one studies of people with Expanded Disability Status Scale (EDSS) 1.8 to 4.5 were included, of which 32 contributed to meta-analysis. A large effect of MS was found on stride length (Standardised Mean Difference, SMD=1.27, 95% CI{0.93, 1.61}), velocity (SMD=1.12, 95% CI{0.85, 1.39}), double support duration (SMD=0.85, 95% CI{0.51, 1.2}), step length (SMD=1.15, 95% CI{0.75, 1.5})and swing phase duration (SMD=1.23, 95% CI{0.06, 2.41}). A moderate effect was found on step width and stride time with the smallest effect found on cadence (SMD=0.43, 95% CI{0.14, 0.72}). All effect sizes increased for variables investigated under a fast walking pace condition (for example the effect on cadence increased to SMD=1.15, 95% CI{0.42, 1.88}).ConclusionsMS has a significant effect on gait even for those with relatively low EDSS. This effect is amplified when walking at faster speeds suggesting this condition may be more beneficial for assessment and treatment. No studies investigated the association between these deficits and falls. Further investigation relating to the predictive or protective nature of these deficits in relation to falls is warranted.
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Source:Gait & Posture
Author(s): Laura Comber, Rose Galvin, Susan Coote
BackgroundMultiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls.ObjectiveThis systematic review and meta-analysis aims to quantify the effect of MS on gait to inform the development of falls prevention interventions.MethodsA systematic literature search identified case-control studies investigating differences in gait variables between people with MS and healthy controls. Meta-analysis examined the effect of MS on gait under normal and fast paced conditions.ResultsForty-one studies of people with Expanded Disability Status Scale (EDSS) 1.8 to 4.5 were included, of which 32 contributed to meta-analysis. A large effect of MS was found on stride length (Standardised Mean Difference, SMD=1.27, 95% CI{0.93, 1.61}), velocity (SMD=1.12, 95% CI{0.85, 1.39}), double support duration (SMD=0.85, 95% CI{0.51, 1.2}), step length (SMD=1.15, 95% CI{0.75, 1.5})and swing phase duration (SMD=1.23, 95% CI{0.06, 2.41}). A moderate effect was found on step width and stride time with the smallest effect found on cadence (SMD=0.43, 95% CI{0.14, 0.72}). All effect sizes increased for variables investigated under a fast walking pace condition (for example the effect on cadence increased to SMD=1.15, 95% CI{0.42, 1.88}).ConclusionsMS has a significant effect on gait even for those with relatively low EDSS. This effect is amplified when walking at faster speeds suggesting this condition may be more beneficial for assessment and treatment. No studies investigated the association between these deficits and falls. Further investigation relating to the predictive or protective nature of these deficits in relation to falls is warranted.
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Residual Standard Deviation: Validation of a New Measure of Dual-Task Cost in Below-Knee Prosthesis Users
Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): Charla L. Howard, Chris Wallace, James Abbas, Dobrivoje S. Stokic
We developed and evaluated properties of a new measure of variability in stride length and cadence, termed residual standard deviation (RSD). To calculate RSD, stride length and cadence are regressed against velocity to derive the best fit line from which the variability (SD) of the distance between the actual and predicted data points is calculated. We examined construct, concurrent, and discriminative validity of RSD using dual-task paradigm in 14 below-knee prosthesis users and 13 age- and education-matched controls. Subjects walked first over an electronic walkway while performing separately a serial subtraction and backwards spelling task, and then at self-selected slow, normal, and fast speeds used to derive the best fit line for stride length and cadence against velocity. Construct validity was demonstrated by significantly greater increase in RSD during dual-task gait in prosthesis users than controls (group-by-condition interaction, stride length p=0.0006, cadence p=0.009). Concurrent validity was established against coefficient of variation (CV) by moderate-to-high correlations (r=0.50-0.87) between dual-task cost RSD and dual-task cost CV for both stride length and cadence in prosthesis users and controls. Discriminative validity was documented by the ability of dual-task cost calculated from RSD to effectively differentiate prosthesis users from controls (area under the receiver operating characteristic curve, stride length 0.863, p=0.001, cadence 0.808, p=0.007), which was better than the ability of dual-task cost CV (0.692, 0.648, respectively, not significant). These results validate RSD as a new measure of variability in below-knee prosthesis users. Future studies should include larger cohorts and other populations to ascertain its generalizability.
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Source:Gait & Posture
Author(s): Charla L. Howard, Chris Wallace, James Abbas, Dobrivoje S. Stokic
We developed and evaluated properties of a new measure of variability in stride length and cadence, termed residual standard deviation (RSD). To calculate RSD, stride length and cadence are regressed against velocity to derive the best fit line from which the variability (SD) of the distance between the actual and predicted data points is calculated. We examined construct, concurrent, and discriminative validity of RSD using dual-task paradigm in 14 below-knee prosthesis users and 13 age- and education-matched controls. Subjects walked first over an electronic walkway while performing separately a serial subtraction and backwards spelling task, and then at self-selected slow, normal, and fast speeds used to derive the best fit line for stride length and cadence against velocity. Construct validity was demonstrated by significantly greater increase in RSD during dual-task gait in prosthesis users than controls (group-by-condition interaction, stride length p=0.0006, cadence p=0.009). Concurrent validity was established against coefficient of variation (CV) by moderate-to-high correlations (r=0.50-0.87) between dual-task cost RSD and dual-task cost CV for both stride length and cadence in prosthesis users and controls. Discriminative validity was documented by the ability of dual-task cost calculated from RSD to effectively differentiate prosthesis users from controls (area under the receiver operating characteristic curve, stride length 0.863, p=0.001, cadence 0.808, p=0.007), which was better than the ability of dual-task cost CV (0.692, 0.648, respectively, not significant). These results validate RSD as a new measure of variability in below-knee prosthesis users. Future studies should include larger cohorts and other populations to ascertain its generalizability.
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Medial-lateral centre of mass displacement and base of support are equally good predictors of metabolic cost in amputee walking
Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): R.A. Weinert-Aplin, M. Twiste, H.L. Jarvis, A.N. Bennett, R.J. Baker
Amputees are known to walk with greater metabolic cost than able-bodied individuals and establishing predictors of metabolic cost from kinematic measures, such as centre of mass (CoM) motion, during walking are important from a rehabilitative perspective, as they can provide quantifiable measures to target during gait rehabilitation in amputees. While it is known that vertical CoM motion poorly predicts metabolic cost, CoM motion in the medial-lateral (ML) and anterior-posterior directions have not been investigated in the context of gait efficiency in the amputee population. Therefore, the aims of this study were to investigate the relationship between CoM motion in all three directions of motion, base of support and walking speed, and the metabolic cost of walking in both able-bodied individuals and different levels of lower limb amputee. 37 individuals were recruited to form groups of controls, unilateral above- and below-knee, and bilateral above-knee amputees respectively. Full-body optical motion and oxygen consumption data were collected during walking at a self-selected speed. CoM position was taken as the mass-weighted average of all body segments and compared to each individual’s net non-dimensional metabolic cost. Base of support and ML CoM displacement were the strongest correlates to metabolic cost and the positive correlations suggest increased ML CoM displacement or Base of support will reduce walking efficiency. Rehabilitation protocols which indirectly reduce these indicators, rather than vertical CoM displacement will likely show improvements in amputee walking efficiency.
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Source:Gait & Posture
Author(s): R.A. Weinert-Aplin, M. Twiste, H.L. Jarvis, A.N. Bennett, R.J. Baker
Amputees are known to walk with greater metabolic cost than able-bodied individuals and establishing predictors of metabolic cost from kinematic measures, such as centre of mass (CoM) motion, during walking are important from a rehabilitative perspective, as they can provide quantifiable measures to target during gait rehabilitation in amputees. While it is known that vertical CoM motion poorly predicts metabolic cost, CoM motion in the medial-lateral (ML) and anterior-posterior directions have not been investigated in the context of gait efficiency in the amputee population. Therefore, the aims of this study were to investigate the relationship between CoM motion in all three directions of motion, base of support and walking speed, and the metabolic cost of walking in both able-bodied individuals and different levels of lower limb amputee. 37 individuals were recruited to form groups of controls, unilateral above- and below-knee, and bilateral above-knee amputees respectively. Full-body optical motion and oxygen consumption data were collected during walking at a self-selected speed. CoM position was taken as the mass-weighted average of all body segments and compared to each individual’s net non-dimensional metabolic cost. Base of support and ML CoM displacement were the strongest correlates to metabolic cost and the positive correlations suggest increased ML CoM displacement or Base of support will reduce walking efficiency. Rehabilitation protocols which indirectly reduce these indicators, rather than vertical CoM displacement will likely show improvements in amputee walking efficiency.
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How do walkers avoid a mobile robot crossing their way?
Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): Christian Vassallo, Anne-Hélène Olivier, Philippe Souères, Armel Crétual, Olivier Stasse, Julien Pettré
Robots and Humans have to share the same environment more and more often. In the aim of steering robots in a safe and convenient manner among humans it is required to understand how humans interact with them. This work focuses on collision avoidance between a human and a robot during locomotion. Having in mind previous results on human obstacle avoidance, as well as the description of the main principles which guide collision avoidance strategies, we observe how humans adapt a goal-directed locomotion task when they have to interfere with a mobile robot. Our results show differences in the strategy set by humans to avoid a robot in comparison with avoiding another human. Humans prefer to give the way to the robot even when they are likely to pass first at the beginning of the interaction.
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Source:Gait & Posture
Author(s): Christian Vassallo, Anne-Hélène Olivier, Philippe Souères, Armel Crétual, Olivier Stasse, Julien Pettré
Robots and Humans have to share the same environment more and more often. In the aim of steering robots in a safe and convenient manner among humans it is required to understand how humans interact with them. This work focuses on collision avoidance between a human and a robot during locomotion. Having in mind previous results on human obstacle avoidance, as well as the description of the main principles which guide collision avoidance strategies, we observe how humans adapt a goal-directed locomotion task when they have to interfere with a mobile robot. Our results show differences in the strategy set by humans to avoid a robot in comparison with avoiding another human. Humans prefer to give the way to the robot even when they are likely to pass first at the beginning of the interaction.
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Gait deficits in people with Multiple Sclerosis: A systematic review and meta-analysis
Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): Laura Comber, Rose Galvin, Susan Coote
BackgroundMultiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls.ObjectiveThis systematic review and meta-analysis aims to quantify the effect of MS on gait to inform the development of falls prevention interventions.MethodsA systematic literature search identified case-control studies investigating differences in gait variables between people with MS and healthy controls. Meta-analysis examined the effect of MS on gait under normal and fast paced conditions.ResultsForty-one studies of people with Expanded Disability Status Scale (EDSS) 1.8 to 4.5 were included, of which 32 contributed to meta-analysis. A large effect of MS was found on stride length (Standardised Mean Difference, SMD=1.27, 95% CI{0.93, 1.61}), velocity (SMD=1.12, 95% CI{0.85, 1.39}), double support duration (SMD=0.85, 95% CI{0.51, 1.2}), step length (SMD=1.15, 95% CI{0.75, 1.5})and swing phase duration (SMD=1.23, 95% CI{0.06, 2.41}). A moderate effect was found on step width and stride time with the smallest effect found on cadence (SMD=0.43, 95% CI{0.14, 0.72}). All effect sizes increased for variables investigated under a fast walking pace condition (for example the effect on cadence increased to SMD=1.15, 95% CI{0.42, 1.88}).ConclusionsMS has a significant effect on gait even for those with relatively low EDSS. This effect is amplified when walking at faster speeds suggesting this condition may be more beneficial for assessment and treatment. No studies investigated the association between these deficits and falls. Further investigation relating to the predictive or protective nature of these deficits in relation to falls is warranted.
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Source:Gait & Posture
Author(s): Laura Comber, Rose Galvin, Susan Coote
BackgroundMultiple Sclerosis (MS) results in postural instability and gait abnormalities which are associated with accidental falls.ObjectiveThis systematic review and meta-analysis aims to quantify the effect of MS on gait to inform the development of falls prevention interventions.MethodsA systematic literature search identified case-control studies investigating differences in gait variables between people with MS and healthy controls. Meta-analysis examined the effect of MS on gait under normal and fast paced conditions.ResultsForty-one studies of people with Expanded Disability Status Scale (EDSS) 1.8 to 4.5 were included, of which 32 contributed to meta-analysis. A large effect of MS was found on stride length (Standardised Mean Difference, SMD=1.27, 95% CI{0.93, 1.61}), velocity (SMD=1.12, 95% CI{0.85, 1.39}), double support duration (SMD=0.85, 95% CI{0.51, 1.2}), step length (SMD=1.15, 95% CI{0.75, 1.5})and swing phase duration (SMD=1.23, 95% CI{0.06, 2.41}). A moderate effect was found on step width and stride time with the smallest effect found on cadence (SMD=0.43, 95% CI{0.14, 0.72}). All effect sizes increased for variables investigated under a fast walking pace condition (for example the effect on cadence increased to SMD=1.15, 95% CI{0.42, 1.88}).ConclusionsMS has a significant effect on gait even for those with relatively low EDSS. This effect is amplified when walking at faster speeds suggesting this condition may be more beneficial for assessment and treatment. No studies investigated the association between these deficits and falls. Further investigation relating to the predictive or protective nature of these deficits in relation to falls is warranted.
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Residual Standard Deviation: Validation of a New Measure of Dual-Task Cost in Below-Knee Prosthesis Users
Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): Charla L. Howard, Chris Wallace, James Abbas, Dobrivoje S. Stokic
We developed and evaluated properties of a new measure of variability in stride length and cadence, termed residual standard deviation (RSD). To calculate RSD, stride length and cadence are regressed against velocity to derive the best fit line from which the variability (SD) of the distance between the actual and predicted data points is calculated. We examined construct, concurrent, and discriminative validity of RSD using dual-task paradigm in 14 below-knee prosthesis users and 13 age- and education-matched controls. Subjects walked first over an electronic walkway while performing separately a serial subtraction and backwards spelling task, and then at self-selected slow, normal, and fast speeds used to derive the best fit line for stride length and cadence against velocity. Construct validity was demonstrated by significantly greater increase in RSD during dual-task gait in prosthesis users than controls (group-by-condition interaction, stride length p=0.0006, cadence p=0.009). Concurrent validity was established against coefficient of variation (CV) by moderate-to-high correlations (r=0.50-0.87) between dual-task cost RSD and dual-task cost CV for both stride length and cadence in prosthesis users and controls. Discriminative validity was documented by the ability of dual-task cost calculated from RSD to effectively differentiate prosthesis users from controls (area under the receiver operating characteristic curve, stride length 0.863, p=0.001, cadence 0.808, p=0.007), which was better than the ability of dual-task cost CV (0.692, 0.648, respectively, not significant). These results validate RSD as a new measure of variability in below-knee prosthesis users. Future studies should include larger cohorts and other populations to ascertain its generalizability.
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Source:Gait & Posture
Author(s): Charla L. Howard, Chris Wallace, James Abbas, Dobrivoje S. Stokic
We developed and evaluated properties of a new measure of variability in stride length and cadence, termed residual standard deviation (RSD). To calculate RSD, stride length and cadence are regressed against velocity to derive the best fit line from which the variability (SD) of the distance between the actual and predicted data points is calculated. We examined construct, concurrent, and discriminative validity of RSD using dual-task paradigm in 14 below-knee prosthesis users and 13 age- and education-matched controls. Subjects walked first over an electronic walkway while performing separately a serial subtraction and backwards spelling task, and then at self-selected slow, normal, and fast speeds used to derive the best fit line for stride length and cadence against velocity. Construct validity was demonstrated by significantly greater increase in RSD during dual-task gait in prosthesis users than controls (group-by-condition interaction, stride length p=0.0006, cadence p=0.009). Concurrent validity was established against coefficient of variation (CV) by moderate-to-high correlations (r=0.50-0.87) between dual-task cost RSD and dual-task cost CV for both stride length and cadence in prosthesis users and controls. Discriminative validity was documented by the ability of dual-task cost calculated from RSD to effectively differentiate prosthesis users from controls (area under the receiver operating characteristic curve, stride length 0.863, p=0.001, cadence 0.808, p=0.007), which was better than the ability of dual-task cost CV (0.692, 0.648, respectively, not significant). These results validate RSD as a new measure of variability in below-knee prosthesis users. Future studies should include larger cohorts and other populations to ascertain its generalizability.
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Medial-lateral centre of mass displacement and base of support are equally good predictors of metabolic cost in amputee walking
Publication date: Available online 26 September 2016
Source:Gait & Posture
Author(s): R.A. Weinert-Aplin, M. Twiste, H.L. Jarvis, A.N. Bennett, R.J. Baker
Amputees are known to walk with greater metabolic cost than able-bodied individuals and establishing predictors of metabolic cost from kinematic measures, such as centre of mass (CoM) motion, during walking are important from a rehabilitative perspective, as they can provide quantifiable measures to target during gait rehabilitation in amputees. While it is known that vertical CoM motion poorly predicts metabolic cost, CoM motion in the medial-lateral (ML) and anterior-posterior directions have not been investigated in the context of gait efficiency in the amputee population. Therefore, the aims of this study were to investigate the relationship between CoM motion in all three directions of motion, base of support and walking speed, and the metabolic cost of walking in both able-bodied individuals and different levels of lower limb amputee. 37 individuals were recruited to form groups of controls, unilateral above- and below-knee, and bilateral above-knee amputees respectively. Full-body optical motion and oxygen consumption data were collected during walking at a self-selected speed. CoM position was taken as the mass-weighted average of all body segments and compared to each individual’s net non-dimensional metabolic cost. Base of support and ML CoM displacement were the strongest correlates to metabolic cost and the positive correlations suggest increased ML CoM displacement or Base of support will reduce walking efficiency. Rehabilitation protocols which indirectly reduce these indicators, rather than vertical CoM displacement will likely show improvements in amputee walking efficiency.
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Source:Gait & Posture
Author(s): R.A. Weinert-Aplin, M. Twiste, H.L. Jarvis, A.N. Bennett, R.J. Baker
Amputees are known to walk with greater metabolic cost than able-bodied individuals and establishing predictors of metabolic cost from kinematic measures, such as centre of mass (CoM) motion, during walking are important from a rehabilitative perspective, as they can provide quantifiable measures to target during gait rehabilitation in amputees. While it is known that vertical CoM motion poorly predicts metabolic cost, CoM motion in the medial-lateral (ML) and anterior-posterior directions have not been investigated in the context of gait efficiency in the amputee population. Therefore, the aims of this study were to investigate the relationship between CoM motion in all three directions of motion, base of support and walking speed, and the metabolic cost of walking in both able-bodied individuals and different levels of lower limb amputee. 37 individuals were recruited to form groups of controls, unilateral above- and below-knee, and bilateral above-knee amputees respectively. Full-body optical motion and oxygen consumption data were collected during walking at a self-selected speed. CoM position was taken as the mass-weighted average of all body segments and compared to each individual’s net non-dimensional metabolic cost. Base of support and ML CoM displacement were the strongest correlates to metabolic cost and the positive correlations suggest increased ML CoM displacement or Base of support will reduce walking efficiency. Rehabilitation protocols which indirectly reduce these indicators, rather than vertical CoM displacement will likely show improvements in amputee walking efficiency.
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Non lethal Raine syndrome and differential diagnosis.
Non lethal Raine syndrome and differential diagnosis.
Eur J Med Genet. 2016 Sep 22;
Authors: Elalaoui SC, Al-Sheqaih N, Ratbi I, Urquhart JE, O'Sullivan J, Bhaskar S, Williams SS, Elalloussi M, Lyahyai J, Sbihi L, Cherkaoui Jaouad I, Sbihi A, Newman WG, Sefiani A
Abstract
Raine syndrome is a rare autosomal recessive bone dysplasia characterized by characteristic facial features with exophthalmos and generalized osteosclerosis. Amelogenesis imperfecta, hearing loss, seizures, and intracerebral calcification are apparent in some affected individuals. Originally, Raine syndrome was originally reported as a lethal syndrome. However, recently a milder phenotype, compatible with life, has been described. Biallelic variants inFAM20C, encoding aGolgi casein kinase involved in biomineralisation, have been identified in affected individuals. We report here a consanguineous Moroccan family with two affected siblingsa girl aged 18 and a boy of 15years. Clinical features, including learning disability, seizures and amelogenesis imperfecta, initially suggested a diagnosis of Kohlschutter-Tonz syndrome. However,a novel homozygous FAM20Cvariantc.676T > A, p.(Trp226Arg) was identified in the affected siblings. Our report reinforces that Raine syndrome is compatible with life, and that mild hypophosphatemia and amelogenesis imperfecta are key features of the attenuated form.
PMID: 27667191 [PubMed - as supplied by publisher]
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Children With Mild Bilateral and Unilateral Hearing Loss: Parents' Reflections on Experiences and Outcomes.
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Children With Mild Bilateral and Unilateral Hearing Loss: Parents' Reflections on Experiences and Outcomes.
J Deaf Stud Deaf Educ. 2016 Jan;21(1):34-43
Authors: Fitzpatrick E, Grandpierre V, Durieux-Smith A, Gaboury I, Coyle D, Na E, Sallam N
Abstract
Children with mild bilateral and unilateral hearing loss are now commonly identified early through newborn hearing screening initiatives. There remains considerable uncertainty about how to support parents and about which services to provide for children with mild bilateral and unilateral hearing loss. The goal of this study was to learn about parents' experiences and understand, from their perspectives, the impact of hearing loss in the mild range on the child's functioning. Parents of 20 children in Ontario, Canada, participated in the study. The median age of identification of hearing loss was 4.6 months (interquartile range: 3.6, 10.8). Parents appreciated learning early about hearing loss, but their experiences with the early process were mixed. Parents felt that professionals minimized the importance of milder hearing loss. There was substantial uncertainty about the need for hearing aids and the findings suggest that parents need specific guidance. Parents expressed concerns about the potential impact of hearing loss on their child's development, particularly at later ages.
PMID: 26433195 [PubMed - indexed for MEDLINE]
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Intersubjective Interaction Between Deaf Parents/Deaf Infants During the Infant's First 18 Months.
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Intersubjective Interaction Between Deaf Parents/Deaf Infants During the Infant's First 18 Months.
J Deaf Stud Deaf Educ. 2016 Jan;21(1):11-22
Authors: Roos C, Cramér-Wolrath E, Falkman KW
Abstract
This study is part of a larger longitudinal project with the aim of focusing early social interaction and development of mentalizing ability in 12 deaf infants, including the interaction between the infants and their deaf parents. The aim of the present paper is to describe early social interaction and moments of intersubjectivity between the deaf infants and their deaf parents during the first 18 months of the infant's life. The study is focused on the dyadic interaction rather than on the behaviors of the infant and the caregiver separately. In the analysis, the Intersubjective Developmental Theory Model (Loots, Devisé, & Sermijn, 2003) and the definitions of moments of intersubjectivity (Loots, Devisé, & Jacquet, 2005) were used. The findings show that the participating infants follow a typical developmental trajectory of intersubjectivity, both with regard to developmental stages and age. This development is supported by a visual, simultaneous way of communicating by gaze rather than having constant eye contact. Parents use complex visual communication skills in maintaining joint attention and also expect the infant to grasp the meaning of the interaction by use of gaze contact.
PMID: 26310457 [PubMed - indexed for MEDLINE]
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Outcomes After Cochlear Implantation in the Very Elderly.
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Outcomes After Cochlear Implantation in the Very Elderly.
Otol Neurotol. 2016 Jan;37(1):46-51
Authors: Wong DJ, Moran M, O'Leary SJ
Abstract
OBJECTIVE: To evaluate the outcomes after cochlear implantation (CI) in the elderly population, with a particular emphasis on perioperative complications, dizziness, and speech perception outcomes.
STUDY DESIGN: A retrospective cohort study of elderly cochlear implant patients.
SETTING: Tertiary referral center (Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, Melbourne).
PATIENTS: All patients aged 75 and above at the time of first cochlear implant (N = 150). Comparison was made between groups aged 85+ to 80-84, and 75-79.
INTERVENTIONS: All patients received Nucleus devices (either CI512 or CI24RE(CA)).
MAIN OUTCOME MEASURES: Speech recognition scores both pre- and postimplantation, symptomatic dizziness and effects upon independent living after surgery, and the incidence of perioperative medical and surgical complications. Complications were classified as major (intrinsic device failure, device migration, extracochlear insertion, meningitis, surgical site infection requiring reoperation, wound breakdown, permanent facial nerve paralysis) and minor (tinnitus, transient facial nerve palsy, facial nerve stimulation, taste disturbance, delayed wound healing).
RESULTS: All three cohorts had poor preoperative speech perception. There was significant improvement in postoperative word scores at 3 and 12 months across all groups. There was no statistically significant difference between the three cohorts in terms of speech recognition outcomes at 3 and 12 months. After surgery, more than 20% of patients at all ages experienced transient imbalance, although the incidence did not differ significantly between age groups (p = 0.71). In total, there were 13 major complications in 7 patients (4.7%), and 28 minor complications in 25 patients (16.7%).
CONCLUSION: Postoperative disequilibrium was commonly observed in this elderly population, yet patients still benefited with improved speech perception after cochlear implantation. Elderly patients can benefit from cochlear implantation, and age should not be a limitation for CI surgery. Cochlear implantation can be done safely and provides significant patient benefits.
PMID: 26649605 [PubMed - indexed for MEDLINE]
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Outcomes After Cochlear Implantation in the Very Elderly.
|
Related Articles |
Outcomes After Cochlear Implantation in the Very Elderly.
Otol Neurotol. 2016 Jan;37(1):46-51
Authors: Wong DJ, Moran M, O'Leary SJ
Abstract
OBJECTIVE: To evaluate the outcomes after cochlear implantation (CI) in the elderly population, with a particular emphasis on perioperative complications, dizziness, and speech perception outcomes.
STUDY DESIGN: A retrospective cohort study of elderly cochlear implant patients.
SETTING: Tertiary referral center (Cochlear Implant Clinic, Royal Victorian Eye and Ear Hospital, Melbourne).
PATIENTS: All patients aged 75 and above at the time of first cochlear implant (N = 150). Comparison was made between groups aged 85+ to 80-84, and 75-79.
INTERVENTIONS: All patients received Nucleus devices (either CI512 or CI24RE(CA)).
MAIN OUTCOME MEASURES: Speech recognition scores both pre- and postimplantation, symptomatic dizziness and effects upon independent living after surgery, and the incidence of perioperative medical and surgical complications. Complications were classified as major (intrinsic device failure, device migration, extracochlear insertion, meningitis, surgical site infection requiring reoperation, wound breakdown, permanent facial nerve paralysis) and minor (tinnitus, transient facial nerve palsy, facial nerve stimulation, taste disturbance, delayed wound healing).
RESULTS: All three cohorts had poor preoperative speech perception. There was significant improvement in postoperative word scores at 3 and 12 months across all groups. There was no statistically significant difference between the three cohorts in terms of speech recognition outcomes at 3 and 12 months. After surgery, more than 20% of patients at all ages experienced transient imbalance, although the incidence did not differ significantly between age groups (p = 0.71). In total, there were 13 major complications in 7 patients (4.7%), and 28 minor complications in 25 patients (16.7%).
CONCLUSION: Postoperative disequilibrium was commonly observed in this elderly population, yet patients still benefited with improved speech perception after cochlear implantation. Elderly patients can benefit from cochlear implantation, and age should not be a limitation for CI surgery. Cochlear implantation can be done safely and provides significant patient benefits.
PMID: 26649605 [PubMed - indexed for MEDLINE]
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Serial cVEMP Testing is Sensitive to Disease Progression in Meniere Patients.
Objective: To assess the cervical vestibular evoked myogenic potentials (cVEMPs) ability to track disease progression in Meniere's disease patients over time and identify the most sensitive outcome measurement. Study Design: Retrospective. Setting: Large specialty hospital, department of otolaryngology. Subjects: Twenty nine Meniere's patients and seven migraine associated vertigo (MAV) patients. Intervention: All patients underwent two cervical vestibular evoked myogenic potential tests at 250, 500, 750, and 1000 Hz with a minimum test interval of 3 months. Main Outcome Measures: Threshold, peak-to-peak (PP) amplitude, interaural asymmetry ratio, and effect size. Results: In affected Meniere's ears all outcome measures were worse during the second test, for threshold this difference was statistically significant at 750 and 1000 Hz compared with the first test. Compared with young healthy ears the threshold was significantly worse at all frequencies. PP amplitude was significantly decreased at the second test at 750 Hz compared with the first test. In MAV no significant difference between tests was found at any frequency in PP amplitude or threshold. In Meniere's ears, threshold showed a higher first-to-second effect size at 500, 750, and 1000 Hz compared with PP amplitude. Conclusion: cVEMP is able to track progression in Meniere's disease over time. Thresholds were the most effective outcome measure to both track progression and to distinguish between MAV and Meniere's patients. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Minimally Invasive Surgery for the Treatment of Hyperacusis.
Objective: To evaluate the efficacy of a minimally invasive surgical procedure in patients with severe hyperacusis. Study Design: Prospective, longitudinal design. Setting: Tertiary referral center. Patients: Adult patients with history of severe hyperacusis. Intervention: Using a transcanal approach, the round and oval window was reinforced with temporalis fascia or tragal perichondrium in six subjects (nine ears) and was subdivided into two groups (unilateral or bilateral reinforcement procedure). Main Outcome Measures: Pre- and postoperative noise tolerance was measured using uncomfortable loudness level (ULL) test scores. In addition, a self-report hyperacusis questionnaire (HQ) was used to assess hypersensitivity to sound before and after the intervention. Results: Analysis of the data reveals improved postoperative mean ULL test scores of 14 dB (confidence interval [CI], 70-98 dB) in the unilateral group. For the bilateral group, improved mean scores were 13 dB (CI, 63-88 dB) in the first ear and 8 dB (CI, 71-86 dB) for the second ear. Further, a negative linear trend was observed in the mean subjective scores for the HQ when both groups measures were analyzed together decreasing from a mean score of 32.0 (standard deviation [SD] = 3.32) preoperative to a mean score of 11.5 (SD = 7.42) after surgery. Postoperatively, the patients reported no change in hearing and improved quality of life after the procedure. Conclusion: The results suggest that reinforcement of the round and oval window with temporalis fascia or tragal perichondrium may offer significant benefit for individuals with severe hyperacusis that has not responded to traditional therapy. ULL scores and self-report measures postoperatively demonstrate improved noise tolerance, high patient satisfaction, and enhanced quality of life. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://ift.tt/OBJ4xP Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Flat-Panel CT for Cochlear Implant Electrode Imaging: Comparison to Multi-Detector CT.
Hypothesis: Flat-panel computed tomography (FPCT) will allow more accurate localization of cochlear implants with decreased metallic artifact and decreased radiation dose when compared with multi-detector CT (MDCT). Background: The measurement of scalar location and intra-scalar position of cochlear implantation (CI) electrodes using computed tomography (CT) is complicated by metallic image artifact and insufficient scalar resolution. FPCT has been shown to improve upon the resolution of MDCT while reducing artifact. Previous studies of FPCT imaging employed isolated temporal bones and did not compare FPCT with MDCT. Methods: A total of 11 CI electrodes (Flex-24, MED-EL Corp, Innsbruck, Austria) were intentionally placed into either the scala tympani (ST) or scala vestibule (SV) in whole cadaver heads and imaged with MDCT and FPCT. The relative radiation dose was measured at the ocular lens for each modality. The implanted cochleae were then isolated and imaged with micro-CT which was used to assess electrode position. Images were reviewed and scored according to electrode array scalar compartment (ST, SV, scala media [SM]), intra-scalar position within each compartment (perimodiolar, mid modiolor, lateral wall) and for the presence of artifact by five readers blinded to the imaging method and approach for electrode insertion. Results: FPCT showed less metallic CI artifact (p = 0.002) and decreased radiation dosage when compared with MDCT. Reviewers were able to identify the scalar compartment and intra-scalar position of all electrodes more accurately with FPCT than with MDCT (p
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Single Institutional Experience With Observing 564 Vestibular Schwannomas: Factors Associated With Tumor Growth.
Objective: To characterize the risk and predictors of growth during observation of vestibular schwannomas (VS). Study Design: Retrospective case series. Setting: Single academic, tertiary care center. Patients: Five hundred sixty-four consecutive VS patients who underwent at least two magnetic resonance imaging (MRI) studies before intervention. Intervention(s): Serial MRI studies. Main Outcome Measure(s): Tumor growth, defined as a >=2 mm increase in the maximum tumor diameter between consecutive MRI studies, or between the first and last study. Results: A total of 1296 patients (1995-2015) with VS were identified. Of those, 564 patients (median age 59.2 years; 53.5% female) were initially observed and underwent multiple MRI studies (median follow-up 22.9 months, interquartile range [IQR] 11.7-42.7). The median maximum tumor diameter at presentation was 1.00 cm (IQR 0.6-1.51 cm). In all, 40.8% of tumors demonstrated growth and 32.1% underwent intervention (21.5% microsurgery, 10.5% radiation) during the surveillance period. Multivariable Cox regression analysis showed that for each tumor, the risk of growth or intervention was significantly increased for larger initial VS diameters (HR = 2.22; 95% CI: 1.90-2.61) and when disequilibrium was a presenting symptom (HR = 1.70; 95% CI: 1.30-2.23). Patient age, sex, aspirin use, and presenting symptoms of asymmetric hearing loss, tinnitus, and vertigo were not associated with tumor growth. Conclusion: To date, this is the largest series of observed VS reported in the literature. Risk of VS growth is significantly increased among patients who present with larger tumors and who have concomitant disequilibrium. IRB: 151481. Define Professional Practice Gap and Educational Need: No cohort with this sample size has assessed vestibular schwannoma growth rates in conjunction with this number of variables. Learning Objective: To characterize vestibular schwannoma growth rates and predictors of growth. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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