Comprehensive Genetic Analysis of Japanese Autosomal Dominant Sensorineural Hearing Loss Patients

by Yoh-ichiro Iwasa, Shin-ya Nishio, Shin-ichi Usami

Background

In general, autosomal dominant inherited hearing loss does not have a founder mutation, with the causative mutation different in each family. For this reason, there has been a strong need for efficient diagnosis methods for autosomal dominant sensorineural hearing loss (ADSNHL) patients. This study sought to verify the effectiveness of our analysis algorithm for the screening of ADSNHL patients as well as the usefulness of the massively parallel DNA sequencing (MPS).

Subjects and Methods

Seventy-five Japanese ADSNHL patients from 53 ENT departments nationwide participated in this study. We conducted genetic analysis of 75 ADSNHL patients using the Invader assay, TaqMan genotyping assay and MPS-based genetic screening.

Results

A total of 46 (61.3%) ADSNHL patients were found to have at least one candidate gene variant.

Conclusion

We were able to achieve a high mutation detection rate through the combination of the Invader assay, TaqMan genotyping assay and MPS. MPS could be used to successfully identify mutations in rare deafness genes.

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Tip Fold-over in Cochlear Implantation: Case Series.

Objective: To describe the incidence, clinical presentation, and performance of cochlear implant (CI) recipients with tip fold-over. Study Design: Retrospective case series. Setting: Tertiary referral center. Patients: CI recipients who underwent postoperative computed tomography (CT) scanning. Intervention(s): Tip fold-over was identified tomographically using previously validated software that identifies the electrode array. Electrophysiologic testing including spread of excitation or electric field imaging (EFI) was measured on those with fold-over. Main Outcome Measure(s): Location of the fold-over; audiological performance pre and postselective deactivation of fold-over electrodes. Results: Three hundred three ears of 235 CI recipients had postoperative CTs available for review. Six (1.98%) had tip fold-over with 5/6 right-sided ears. Tip fold-over occurred predominantly at 270 degrees and was associated with precurved electrodes (5/6). Patients did not report audiological complaints during initial activation. In one patient, the electrode array remained within the scala tympani with preserved residual hearing despite the fold-over. Spread of excitation supported tip fold-over, but the predictive value was not clear. EFI predicted location of the fold-over with clear predictive value in one patient. At an average follow-up of 11 months, three subjects underwent deactivation of the overlapping electrodes with two of them showing marked audiological improvement. Conclusion: In a large academic center with experienced surgeons, tip fold-over occurred at a rate of 1.98% but was not immediately identifiable clinically. CT imaging definitively showed tip fold-over. Deactivating involved electrodes may improve performance possibly avoiding revision surgery. EFI may be highly predictive of tip fold-over and can be run intraoperatively, potentially obviating the need for intraop fluoroscopy. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Letter to the Editor-Response Regarding Combined Transmastoid and Middle Fossa Approach.

No abstract available

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Sudden Hearing Loss Due to Anterior Inferior Cerebellar Artery Infarction.

No abstract available

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Oculographic, Clinical Test of Sensory Integration and Balance and Computerized Dynamic Posturography Findings in Patients With Psoriatic Arthritis.

Objective: To assess the frequency and characteristics of the oculographic findings and the usefulness of the clinical test of sensory integration and balance (CTSIB) for the evaluation of balance in patients with psoriatic arthritis (PsA) by comparing this test with the computerized dynamic posturography (CDP). Study Design: A series of consecutive patients that fulfilled the Moll and Wright criteria for PsA and matched controls were studied. Setting: The study was performed at the Otolaryngology Division of a tertiary reference center. Intervention: Vestibular evaluation including CTSIB followed by CDP was performed to all patients and age, sex, and ethnically frequency-matched controls. Main Outcome Measure: Patterns of CTSIB and CDP (gold standard) were assessed and compared. Patients: Sixty PsA patients (63.3% women) and 60 matched controls. Results: PsA patients had higher frequency of abnormal oculocephalic response (13.3%) and abnormal caloric test (26.7%) than controls (0% in both cases) (p = 0.006 and p

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Intracranial Complications From Temporal Bone Cystic Angiomatosis.

No abstract available

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What can Long-Term Attendance at Programming Appointments Tell us About Pediatric Cochlear Implant Recipients?.

Objective: This study sought to understand factors linked to long-term engagement with available post-implant "mapping" review services for individuals who received cochlear implants (CI)(s) as children. Study Design: Demographics, communication outcomes, and appointment attendance records from an unselected group of 400 participants who received CI(s) between 1985 and 2009 were analyzed. Results: After 5 years post-implant, 85.75% (n = 343) of participants attended the clinic for "mapping" appointments between March 2011 and March 2014, but 14.25% (n = 57) had not attended "mapping" for more than 3 years before March 2014. Findings showed that participants who did attend routine follow-up "mapping" appointments received their first implants at a significantly younger age (mean, 3.73 yr; standard deviation [SD], 3.39) and demonstrated better receptive language performance (mean standard score, 72; SD, 21.2) and better speech perception scores (mean open-set words, 54.1%; SD, 24.4; phonemes, 77.5%; SD, 15.8) suggesting they derived greater benefit from the technology than participants who did not attend (mean age at implant, 6.38 yr; SD, 4.85; mean receptive language standard score, 58.6; SD, 25.6; mean open-set-words, 34.5%; SD, 24.5; phonemes, 62.7.4%; SD, 23.4). Conclusions: The present study identified a profile of pediatric CI recipients who continue to attend follow-up review appointments after 5 years of device experience. Individuals who were non-attenders tended to include part-time and non-users of the technology. This could be due to a range of factors including the use of past speech processor technology (at first 12 months after switch-on), less overall benefit, and the presence of additional special needs. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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"Long-term Outcomes After Middle Fossa Approach for Traumatic Facial Nerve Paralysis. Otology & Neurotology 2016;37: 799-804".

No abstract available

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Cellular mechanisms of noise-induced hearing loss

Publication date: Available online 2 December 2016
Source:Hearing Research
Author(s): Arwa Kurabi, Elizabeth M. Keithley, Gary D. Housley, Allen F. Ryan, Ann C-Y. Wong
Exposure to intense sound or noise can result in purely temporary threshold shift (TTS), or leave a residual permanent threshold shift (PTS) along with alterations in growth functions of auditory nerve output. Recent research has revealed a number of mechanisms that contribute to noise-induced hearing loss (NIHL). The principle cause of NIHL is damage to cochlear hair cells and associated synaptopathy. Contributions to TTS include reversible damage to hair cell (HC) stereocilia or synapses, while moderate TTS reflects protective purinergic hearing adaptation. PTS represents permanent damage to or loss of HCs and synapses. While the substrates of HC damage are complex, they include the accumulation of reactive oxygen species and the active stimulation of intracellular stress pathways, leading to programmed and/or necrotic cell death. Permanent damage to cochlear neurons can also contribute to the effects of NIHL, in addition to HC damage. These mechanisms have translational potential for pharmacological intervention and provide multiple opportunities to prevent HC damage or to rescue HCs and spiral ganglion neurons that have suffered injury. This paper reviews advances in our understanding of cellular mechanisms that contribute to NIHL and their potential for therapeutic manipulation.



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Cellular mechanisms of noise-induced hearing loss

Publication date: Available online 2 December 2016
Source:Hearing Research
Author(s): Arwa Kurabi, Elizabeth M. Keithley, Gary D. Housley, Allen F. Ryan, Ann C-Y. Wong
Exposure to intense sound or noise can result in purely temporary threshold shift (TTS), or leave a residual permanent threshold shift (PTS) along with alterations in growth functions of auditory nerve output. Recent research has revealed a number of mechanisms that contribute to noise-induced hearing loss (NIHL). The principle cause of NIHL is damage to cochlear hair cells and associated synaptopathy. Contributions to TTS include reversible damage to hair cell (HC) stereocilia or synapses, while moderate TTS reflects protective purinergic hearing adaptation. PTS represents permanent damage to or loss of HCs and synapses. While the substrates of HC damage are complex, they include the accumulation of reactive oxygen species and the active stimulation of intracellular stress pathways, leading to programmed and/or necrotic cell death. Permanent damage to cochlear neurons can also contribute to the effects of NIHL, in addition to HC damage. These mechanisms have translational potential for pharmacological intervention and provide multiple opportunities to prevent HC damage or to rescue HCs and spiral ganglion neurons that have suffered injury. This paper reviews advances in our understanding of cellular mechanisms that contribute to NIHL and their potential for therapeutic manipulation.



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Cellular mechanisms of noise-induced hearing loss

Publication date: Available online 2 December 2016
Source:Hearing Research
Author(s): Arwa Kurabi, Elizabeth M. Keithley, Gary D. Housley, Allen F. Ryan, Ann C-Y. Wong
Exposure to intense sound or noise can result in purely temporary threshold shift (TTS), or leave a residual permanent threshold shift (PTS) along with alterations in growth functions of auditory nerve output. Recent research has revealed a number of mechanisms that contribute to noise-induced hearing loss (NIHL). The principle cause of NIHL is damage to cochlear hair cells and associated synaptopathy. Contributions to TTS include reversible damage to hair cell (HC) stereocilia or synapses, while moderate TTS reflects protective purinergic hearing adaptation. PTS represents permanent damage to or loss of HCs and synapses. While the substrates of HC damage are complex, they include the accumulation of reactive oxygen species and the active stimulation of intracellular stress pathways, leading to programmed and/or necrotic cell death. Permanent damage to cochlear neurons can also contribute to the effects of NIHL, in addition to HC damage. These mechanisms have translational potential for pharmacological intervention and provide multiple opportunities to prevent HC damage or to rescue HCs and spiral ganglion neurons that have suffered injury. This paper reviews advances in our understanding of cellular mechanisms that contribute to NIHL and their potential for therapeutic manipulation.



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Children require less gait kinematic adaptations to pull a trolley than to carry a backpack

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Eva Orantes-Gonzalez, Jose Heredia-Jimenez, George J. Beneck
To transport school materials, trolleys have been proposed for children as an alternative to carrying a backpack. However, there is limited evidence comparing the adaptations associated with carrying school trolley versus backpack. This study compared the effects of carrying a backpack and pulling a trolley on gait kinematics in children. Fifty-three students were evaluated. Children walked at self-selected speeds across a walkway with no bag (control), carrying a backpack with the 15% of child́s body weight (%BW) and pulling a trolley with the same load. Spatiotemporal gait parameters and 3D kinematics of lower extremities and thorax were computed. No significant differences were obtained in spatiotemporal parameters between pulling a trolley and control. Carrying a backpack resulted in larger kinematics gait alterations than pulling the trolley compared to control. In conclusion, pulling a school trolley (15%BW) was more similar to not carrying a bag than carrying a backpack of the same load during level walking.



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Subthalamic nucleus stimulation and gait in Parkinson’s Disease: a not always fruitful relationship

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Giovanni Cossu, Massimiliano Pau
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) provides efficient treatment for the alleviation of motor signs in patients with advanced Parkinson’s disease (PD), but its specific effects on gait is sometimes less successful as it may even lead to an aggravation of freezing of gait. To better understand when axial symptoms can be expected to improve and when they may worsen or be resistant to STN-DBS, we propose here a narrative review that considers the recent literature evidences based on instrumental gait analysis data. Our aim is to report about the efficacy of STN-DBS on PD gait, analyzing the clinical and procedural factors involved, and discussing the strategies for optimizing such effectiveness in patients with advanced PD.



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Exoskeleton plantarflexion assistance for elderly

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): S. Galle, W. Derave, F. Bossuyt, P. Calders, P. Malcolm, D. De Clercq
Elderly are confronted with reduced physical capabilities and increased metabolic energy cost of walking. Exoskeletons that assist walking have the potential to restore walking capacity by reducing the metabolic cost of walking. However, it is unclear if current exoskeletons can reduce energy cost in elderly. Our goal was to study the effect of an exoskeleton that assists plantarflexion during push-off on the metabolic energy cost of walking in physically active and healthy elderly. Seven elderly (age 69.3±3.5y) walked on treadmill (1.11ms²) with normal shoes and with the exoskeleton both powered (with assistance) and powered-off (without assistance). After 20min of habituation on a prior day and 5min on the test day, subjects were able to walk with the exoskeleton and assistance of the exoskeleton resulted in a reduction in metabolic cost of 12% versus walking with the exoskeleton powered-off. Walking with the exoskeleton was perceived less fatiguing for the muscles compared to normal walking. Assistance resulted in a statistically nonsignificant reduction in metabolic cost of 4% versus walking with normal shoes, likely due to the penalty of wearing the exoskeleton powered-off. Also, exoskeleton mechanical power was relatively low compared to previously identified optimal assistance magnitude in young adults. Future exoskeleton research should focus on further optimizing exoskeleton assistance for specific populations and on considerate integration of exoskeletons in rehabilitation or in daily life. As such, exoskeletons should allow people to walk longer or faster than without assistance and could result in an increase in physical activity and resulting health benefits.



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The relative and absolute reliability of center of pressure trajectory during gait initiation in older adults

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Roya Khanmohammadi, Saeed Talebian, Mohammad Reza Hadian, Gholamreza Olyaei, Hossein Bagheri
It has been thought that for scientific acceptance of a parameter, its psychometric properties such as reliability, validity and responsiveness have critical roles. Therefore, this study was conducted to estimate how many trials are required to obtain a reliable center of pressure (COP) parameter during gait initiation (GI) and to investigate the effect of number of trials on the relative and absolute reliability. Twenty older adults participated in the study. Subjects began stepping over the force platform in response to an auditory stimulus. Ten trials were collected in one session. The displacement, velocity, mean and median frequency of the COP in the mediolateral (ML) and anteroposterior (AP) directions were evaluated. Relative reliability was determined using the intraclass correlation coefficient (ICC), and absolute reliability was evaluated using the standard error of measurement (SEM) and minimal detectable change (MDC95). The results revealed with respect to parameter, one to five trials should be averaged to ensure excellent reliability. Moreover, ICC, SEM% and MDC95% values were between 0.39–0.89, 4.84–41.5% and 13.4–115% for single trial and 0.86–0.99, 1.74–19.7% and 4.83–54.7% for ten trials averaged, respectively. Moreover, the ML and AP COP displacement in locomotor phase had the most relative reliability as well as the ML and AP median frequency in locomotor phase had the most absolute reliability. In general, the results showed that the COP-related parameters in time and frequency domains, based on average of five trials, provide reliable outcome measures for evaluation of dynamic postural control in older adults.



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Development of a novel virtual reality gait intervention

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Anna E. Boone, Matthew H. Foreman, Jack R. Engsberg
IntroductionImproving gait speed and kinematics can be a time consuming and tiresome process. We hypothesize that incorporating virtual reality videogame play into variable improvement goals will improve levels of enjoyment and motivation and lead to improved gait performance.PurposeTo develop a feasible, engaging, VR gait intervention for improving gait variables.MethodsCompleting this investigation involved four steps: 1) identify gait variables that could be manipulated to improve gait speed and kinematics using the Microsoft Kinect and free software, 2) identify free internet videogames that could successfully manipulate the chosen gait variables, 3) experimentally evaluate the ability of the videogames and software to manipulate the gait variables, and 4) evaluate the enjoyment and motivation from a small sample of persons without disability.ResultsThe Kinect sensor was able to detect stride length, cadence, and joint angles. FAAST software was able to identify predetermined gait variable thresholds and use the thresholds to play free online videogames. Videogames that involved continuous pressing of a keyboard key were found to be most appropriate for manipulating the gait variables. Five participants without disability evaluated the effectiveness for modifying the gait variables and enjoyment and motivation during play. Participants were able to modify gait variables to permit successful videogame play. Motivation and enjoyment were high.SummaryA clinically feasible and engaging virtual intervention for improving gait speed and kinematics has been developed and initially tested. It may provide an engaging avenue for achieving thousands of repetitions necessary for neural plastic changes and improved gait.



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Stability-maneuverability trade-offs during lateral steps

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Julian Acasio, Mengnan/Mary Wu, Nicholas P. Fey, Keith E. Gordon
Selecting a specific foot placement strategy to perform walking maneuvers requires the management of several competing factors, including: maintaining stability, positioning oneself to actively generate impulses, and minimizing mechanical energy requirements. These requirements are unlikely to be independent. Our purpose was to determine the impact of lateral foot placement on stability, maneuverability, and energetics during walking maneuvers. Ten able-bodied adults performed laterally-directed walking maneuvers. Mediolateral placement of the “Push-off” foot during the maneuvers was varied, ranging from a cross-over step to a side-step. We hypothesized that as mediolateral foot placement became wider, passive stability in the direction of the maneuver, the lateral impulse generated to create the maneuver, and mechanical energy cost would all increase. We also hypothesized that subjects would prefer an intermediate step width reflective of trade-offs between stability vs. both maneuverability and energy. In support of our first hypothesis, we found that as Push-off step width increased, lateral margin of stability, peak lateral impulse, and total joint work all increased. In support of our second hypothesis, we found that when subjects had no restrictions on their mediolateral foot placement, they chose a foot placement between the two extreme positions. We found a significant relationship (p<0.05) between lateral margin of stability and peak lateral impulse (r=0.773), indicating a trade-off between passive stability and the force input required to maneuver. These findings suggest that during anticipated maneuvers people select foot placement strategies that balance competing costs to maintain stability, actively generate impulses, and minimize mechanical energy costs.



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Are the average gait speeds during the 10meter and 6minute walk tests redundant in Parkinson disease?

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Ryan P. Duncan, Stephanie A. Combs-Miller, Marie E. McNeely, Abigail L. Leddy, James T. Cavanaugh, Leland E. Dibble, Terry D. Ellis, Matthew P. Ford, K. Bo Foreman, Gammon M. Earhart
We investigated the relationships between average gait speed collected with the 10Meter Walk Test (Comfortable and Fast) and 6Minute Walk Test (6MWT) in 346 people with Parkinson disease (PD) and how the relationships change with increasing disease severity. Pearson correlation and linear regression analyses determined relationships between 10Meter Walk Test and 6MWT gait speed values for the entire sample and for sub-samples stratified by Hoehn & Yahr (H&Y) stage I (n=53), II (n=141), III (n=135) and IV (n=17). We hypothesized that redundant tests would be highly and significantly correlated (i.e. r>0.70, p<0.05) and would have a linear regression model slope of 1 and intercept of 0. For the entire sample, 6MWT gait speed was significantly (p<0.001) related to the Comfortable 10 Meter Walk Test (r=0.75) and Fast 10Meter Walk Test (r=0.79) gait speed, with 56% and 62% of the variance in 6MWT gait speed explained, respectively. The regression model of 6MWT gait speed predicted by Comfortable 10 Meter Walk gait speed produced slope and intercept values near 1 and 0, respectively, especially for participants in H&Y stages II–IV. In contrast, slope and intercept values were further from 1 and 0, respectively, for the Fast 10Meter Walk Test. Comfortable 10 Meter Walk Test and 6MWT gait speeds appeared to be redundant in people with moderate to severe PD, suggesting the Comfortable 10 Meter Walk Test can be used to estimate 6MWT distance in this population.



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Children require less gait kinematic adaptations to pull a trolley than to carry a backpack

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Eva Orantes-Gonzalez, Jose Heredia-Jimenez, George J. Beneck
To transport school materials, trolleys have been proposed for children as an alternative to carrying a backpack. However, there is limited evidence comparing the adaptations associated with carrying school trolley versus backpack. This study compared the effects of carrying a backpack and pulling a trolley on gait kinematics in children. Fifty-three students were evaluated. Children walked at self-selected speeds across a walkway with no bag (control), carrying a backpack with the 15% of child́s body weight (%BW) and pulling a trolley with the same load. Spatiotemporal gait parameters and 3D kinematics of lower extremities and thorax were computed. No significant differences were obtained in spatiotemporal parameters between pulling a trolley and control. Carrying a backpack resulted in larger kinematics gait alterations than pulling the trolley compared to control. In conclusion, pulling a school trolley (15%BW) was more similar to not carrying a bag than carrying a backpack of the same load during level walking.



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Subthalamic nucleus stimulation and gait in Parkinson’s Disease: a not always fruitful relationship

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Giovanni Cossu, Massimiliano Pau
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) provides efficient treatment for the alleviation of motor signs in patients with advanced Parkinson’s disease (PD), but its specific effects on gait is sometimes less successful as it may even lead to an aggravation of freezing of gait. To better understand when axial symptoms can be expected to improve and when they may worsen or be resistant to STN-DBS, we propose here a narrative review that considers the recent literature evidences based on instrumental gait analysis data. Our aim is to report about the efficacy of STN-DBS on PD gait, analyzing the clinical and procedural factors involved, and discussing the strategies for optimizing such effectiveness in patients with advanced PD.



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Exoskeleton plantarflexion assistance for elderly

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): S. Galle, W. Derave, F. Bossuyt, P. Calders, P. Malcolm, D. De Clercq
Elderly are confronted with reduced physical capabilities and increased metabolic energy cost of walking. Exoskeletons that assist walking have the potential to restore walking capacity by reducing the metabolic cost of walking. However, it is unclear if current exoskeletons can reduce energy cost in elderly. Our goal was to study the effect of an exoskeleton that assists plantarflexion during push-off on the metabolic energy cost of walking in physically active and healthy elderly. Seven elderly (age 69.3±3.5y) walked on treadmill (1.11ms²) with normal shoes and with the exoskeleton both powered (with assistance) and powered-off (without assistance). After 20min of habituation on a prior day and 5min on the test day, subjects were able to walk with the exoskeleton and assistance of the exoskeleton resulted in a reduction in metabolic cost of 12% versus walking with the exoskeleton powered-off. Walking with the exoskeleton was perceived less fatiguing for the muscles compared to normal walking. Assistance resulted in a statistically nonsignificant reduction in metabolic cost of 4% versus walking with normal shoes, likely due to the penalty of wearing the exoskeleton powered-off. Also, exoskeleton mechanical power was relatively low compared to previously identified optimal assistance magnitude in young adults. Future exoskeleton research should focus on further optimizing exoskeleton assistance for specific populations and on considerate integration of exoskeletons in rehabilitation or in daily life. As such, exoskeletons should allow people to walk longer or faster than without assistance and could result in an increase in physical activity and resulting health benefits.



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The relative and absolute reliability of center of pressure trajectory during gait initiation in older adults

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Roya Khanmohammadi, Saeed Talebian, Mohammad Reza Hadian, Gholamreza Olyaei, Hossein Bagheri
It has been thought that for scientific acceptance of a parameter, its psychometric properties such as reliability, validity and responsiveness have critical roles. Therefore, this study was conducted to estimate how many trials are required to obtain a reliable center of pressure (COP) parameter during gait initiation (GI) and to investigate the effect of number of trials on the relative and absolute reliability. Twenty older adults participated in the study. Subjects began stepping over the force platform in response to an auditory stimulus. Ten trials were collected in one session. The displacement, velocity, mean and median frequency of the COP in the mediolateral (ML) and anteroposterior (AP) directions were evaluated. Relative reliability was determined using the intraclass correlation coefficient (ICC), and absolute reliability was evaluated using the standard error of measurement (SEM) and minimal detectable change (MDC95). The results revealed with respect to parameter, one to five trials should be averaged to ensure excellent reliability. Moreover, ICC, SEM% and MDC95% values were between 0.39–0.89, 4.84–41.5% and 13.4–115% for single trial and 0.86–0.99, 1.74–19.7% and 4.83–54.7% for ten trials averaged, respectively. Moreover, the ML and AP COP displacement in locomotor phase had the most relative reliability as well as the ML and AP median frequency in locomotor phase had the most absolute reliability. In general, the results showed that the COP-related parameters in time and frequency domains, based on average of five trials, provide reliable outcome measures for evaluation of dynamic postural control in older adults.



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Development of a novel virtual reality gait intervention

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Anna E. Boone, Matthew H. Foreman, Jack R. Engsberg
IntroductionImproving gait speed and kinematics can be a time consuming and tiresome process. We hypothesize that incorporating virtual reality videogame play into variable improvement goals will improve levels of enjoyment and motivation and lead to improved gait performance.PurposeTo develop a feasible, engaging, VR gait intervention for improving gait variables.MethodsCompleting this investigation involved four steps: 1) identify gait variables that could be manipulated to improve gait speed and kinematics using the Microsoft Kinect and free software, 2) identify free internet videogames that could successfully manipulate the chosen gait variables, 3) experimentally evaluate the ability of the videogames and software to manipulate the gait variables, and 4) evaluate the enjoyment and motivation from a small sample of persons without disability.ResultsThe Kinect sensor was able to detect stride length, cadence, and joint angles. FAAST software was able to identify predetermined gait variable thresholds and use the thresholds to play free online videogames. Videogames that involved continuous pressing of a keyboard key were found to be most appropriate for manipulating the gait variables. Five participants without disability evaluated the effectiveness for modifying the gait variables and enjoyment and motivation during play. Participants were able to modify gait variables to permit successful videogame play. Motivation and enjoyment were high.SummaryA clinically feasible and engaging virtual intervention for improving gait speed and kinematics has been developed and initially tested. It may provide an engaging avenue for achieving thousands of repetitions necessary for neural plastic changes and improved gait.



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Stability-maneuverability trade-offs during lateral steps

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Julian Acasio, Mengnan/Mary Wu, Nicholas P. Fey, Keith E. Gordon
Selecting a specific foot placement strategy to perform walking maneuvers requires the management of several competing factors, including: maintaining stability, positioning oneself to actively generate impulses, and minimizing mechanical energy requirements. These requirements are unlikely to be independent. Our purpose was to determine the impact of lateral foot placement on stability, maneuverability, and energetics during walking maneuvers. Ten able-bodied adults performed laterally-directed walking maneuvers. Mediolateral placement of the “Push-off” foot during the maneuvers was varied, ranging from a cross-over step to a side-step. We hypothesized that as mediolateral foot placement became wider, passive stability in the direction of the maneuver, the lateral impulse generated to create the maneuver, and mechanical energy cost would all increase. We also hypothesized that subjects would prefer an intermediate step width reflective of trade-offs between stability vs. both maneuverability and energy. In support of our first hypothesis, we found that as Push-off step width increased, lateral margin of stability, peak lateral impulse, and total joint work all increased. In support of our second hypothesis, we found that when subjects had no restrictions on their mediolateral foot placement, they chose a foot placement between the two extreme positions. We found a significant relationship (p<0.05) between lateral margin of stability and peak lateral impulse (r=0.773), indicating a trade-off between passive stability and the force input required to maneuver. These findings suggest that during anticipated maneuvers people select foot placement strategies that balance competing costs to maintain stability, actively generate impulses, and minimize mechanical energy costs.



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Are the average gait speeds during the 10meter and 6minute walk tests redundant in Parkinson disease?

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Ryan P. Duncan, Stephanie A. Combs-Miller, Marie E. McNeely, Abigail L. Leddy, James T. Cavanaugh, Leland E. Dibble, Terry D. Ellis, Matthew P. Ford, K. Bo Foreman, Gammon M. Earhart
We investigated the relationships between average gait speed collected with the 10Meter Walk Test (Comfortable and Fast) and 6Minute Walk Test (6MWT) in 346 people with Parkinson disease (PD) and how the relationships change with increasing disease severity. Pearson correlation and linear regression analyses determined relationships between 10Meter Walk Test and 6MWT gait speed values for the entire sample and for sub-samples stratified by Hoehn & Yahr (H&Y) stage I (n=53), II (n=141), III (n=135) and IV (n=17). We hypothesized that redundant tests would be highly and significantly correlated (i.e. r>0.70, p<0.05) and would have a linear regression model slope of 1 and intercept of 0. For the entire sample, 6MWT gait speed was significantly (p<0.001) related to the Comfortable 10 Meter Walk Test (r=0.75) and Fast 10Meter Walk Test (r=0.79) gait speed, with 56% and 62% of the variance in 6MWT gait speed explained, respectively. The regression model of 6MWT gait speed predicted by Comfortable 10 Meter Walk gait speed produced slope and intercept values near 1 and 0, respectively, especially for participants in H&Y stages II–IV. In contrast, slope and intercept values were further from 1 and 0, respectively, for the Fast 10Meter Walk Test. Comfortable 10 Meter Walk Test and 6MWT gait speeds appeared to be redundant in people with moderate to severe PD, suggesting the Comfortable 10 Meter Walk Test can be used to estimate 6MWT distance in this population.



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Children require less gait kinematic adaptations to pull a trolley than to carry a backpack

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Eva Orantes-Gonzalez, Jose Heredia-Jimenez, George J. Beneck
To transport school materials, trolleys have been proposed for children as an alternative to carrying a backpack. However, there is limited evidence comparing the adaptations associated with carrying school trolley versus backpack. This study compared the effects of carrying a backpack and pulling a trolley on gait kinematics in children. Fifty-three students were evaluated. Children walked at self-selected speeds across a walkway with no bag (control), carrying a backpack with the 15% of child́s body weight (%BW) and pulling a trolley with the same load. Spatiotemporal gait parameters and 3D kinematics of lower extremities and thorax were computed. No significant differences were obtained in spatiotemporal parameters between pulling a trolley and control. Carrying a backpack resulted in larger kinematics gait alterations than pulling the trolley compared to control. In conclusion, pulling a school trolley (15%BW) was more similar to not carrying a bag than carrying a backpack of the same load during level walking.



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Subthalamic nucleus stimulation and gait in Parkinson’s Disease: a not always fruitful relationship

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Giovanni Cossu, Massimiliano Pau
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) provides efficient treatment for the alleviation of motor signs in patients with advanced Parkinson’s disease (PD), but its specific effects on gait is sometimes less successful as it may even lead to an aggravation of freezing of gait. To better understand when axial symptoms can be expected to improve and when they may worsen or be resistant to STN-DBS, we propose here a narrative review that considers the recent literature evidences based on instrumental gait analysis data. Our aim is to report about the efficacy of STN-DBS on PD gait, analyzing the clinical and procedural factors involved, and discussing the strategies for optimizing such effectiveness in patients with advanced PD.



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Exoskeleton plantarflexion assistance for elderly

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): S. Galle, W. Derave, F. Bossuyt, P. Calders, P. Malcolm, D. De Clercq
Elderly are confronted with reduced physical capabilities and increased metabolic energy cost of walking. Exoskeletons that assist walking have the potential to restore walking capacity by reducing the metabolic cost of walking. However, it is unclear if current exoskeletons can reduce energy cost in elderly. Our goal was to study the effect of an exoskeleton that assists plantarflexion during push-off on the metabolic energy cost of walking in physically active and healthy elderly. Seven elderly (age 69.3±3.5y) walked on treadmill (1.11ms²) with normal shoes and with the exoskeleton both powered (with assistance) and powered-off (without assistance). After 20min of habituation on a prior day and 5min on the test day, subjects were able to walk with the exoskeleton and assistance of the exoskeleton resulted in a reduction in metabolic cost of 12% versus walking with the exoskeleton powered-off. Walking with the exoskeleton was perceived less fatiguing for the muscles compared to normal walking. Assistance resulted in a statistically nonsignificant reduction in metabolic cost of 4% versus walking with normal shoes, likely due to the penalty of wearing the exoskeleton powered-off. Also, exoskeleton mechanical power was relatively low compared to previously identified optimal assistance magnitude in young adults. Future exoskeleton research should focus on further optimizing exoskeleton assistance for specific populations and on considerate integration of exoskeletons in rehabilitation or in daily life. As such, exoskeletons should allow people to walk longer or faster than without assistance and could result in an increase in physical activity and resulting health benefits.



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The relative and absolute reliability of center of pressure trajectory during gait initiation in older adults

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Roya Khanmohammadi, Saeed Talebian, Mohammad Reza Hadian, Gholamreza Olyaei, Hossein Bagheri
It has been thought that for scientific acceptance of a parameter, its psychometric properties such as reliability, validity and responsiveness have critical roles. Therefore, this study was conducted to estimate how many trials are required to obtain a reliable center of pressure (COP) parameter during gait initiation (GI) and to investigate the effect of number of trials on the relative and absolute reliability. Twenty older adults participated in the study. Subjects began stepping over the force platform in response to an auditory stimulus. Ten trials were collected in one session. The displacement, velocity, mean and median frequency of the COP in the mediolateral (ML) and anteroposterior (AP) directions were evaluated. Relative reliability was determined using the intraclass correlation coefficient (ICC), and absolute reliability was evaluated using the standard error of measurement (SEM) and minimal detectable change (MDC95). The results revealed with respect to parameter, one to five trials should be averaged to ensure excellent reliability. Moreover, ICC, SEM% and MDC95% values were between 0.39–0.89, 4.84–41.5% and 13.4–115% for single trial and 0.86–0.99, 1.74–19.7% and 4.83–54.7% for ten trials averaged, respectively. Moreover, the ML and AP COP displacement in locomotor phase had the most relative reliability as well as the ML and AP median frequency in locomotor phase had the most absolute reliability. In general, the results showed that the COP-related parameters in time and frequency domains, based on average of five trials, provide reliable outcome measures for evaluation of dynamic postural control in older adults.



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Development of a novel virtual reality gait intervention

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Anna E. Boone, Matthew H. Foreman, Jack R. Engsberg
IntroductionImproving gait speed and kinematics can be a time consuming and tiresome process. We hypothesize that incorporating virtual reality videogame play into variable improvement goals will improve levels of enjoyment and motivation and lead to improved gait performance.PurposeTo develop a feasible, engaging, VR gait intervention for improving gait variables.MethodsCompleting this investigation involved four steps: 1) identify gait variables that could be manipulated to improve gait speed and kinematics using the Microsoft Kinect and free software, 2) identify free internet videogames that could successfully manipulate the chosen gait variables, 3) experimentally evaluate the ability of the videogames and software to manipulate the gait variables, and 4) evaluate the enjoyment and motivation from a small sample of persons without disability.ResultsThe Kinect sensor was able to detect stride length, cadence, and joint angles. FAAST software was able to identify predetermined gait variable thresholds and use the thresholds to play free online videogames. Videogames that involved continuous pressing of a keyboard key were found to be most appropriate for manipulating the gait variables. Five participants without disability evaluated the effectiveness for modifying the gait variables and enjoyment and motivation during play. Participants were able to modify gait variables to permit successful videogame play. Motivation and enjoyment were high.SummaryA clinically feasible and engaging virtual intervention for improving gait speed and kinematics has been developed and initially tested. It may provide an engaging avenue for achieving thousands of repetitions necessary for neural plastic changes and improved gait.



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Stability-maneuverability trade-offs during lateral steps

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Julian Acasio, Mengnan/Mary Wu, Nicholas P. Fey, Keith E. Gordon
Selecting a specific foot placement strategy to perform walking maneuvers requires the management of several competing factors, including: maintaining stability, positioning oneself to actively generate impulses, and minimizing mechanical energy requirements. These requirements are unlikely to be independent. Our purpose was to determine the impact of lateral foot placement on stability, maneuverability, and energetics during walking maneuvers. Ten able-bodied adults performed laterally-directed walking maneuvers. Mediolateral placement of the “Push-off” foot during the maneuvers was varied, ranging from a cross-over step to a side-step. We hypothesized that as mediolateral foot placement became wider, passive stability in the direction of the maneuver, the lateral impulse generated to create the maneuver, and mechanical energy cost would all increase. We also hypothesized that subjects would prefer an intermediate step width reflective of trade-offs between stability vs. both maneuverability and energy. In support of our first hypothesis, we found that as Push-off step width increased, lateral margin of stability, peak lateral impulse, and total joint work all increased. In support of our second hypothesis, we found that when subjects had no restrictions on their mediolateral foot placement, they chose a foot placement between the two extreme positions. We found a significant relationship (p<0.05) between lateral margin of stability and peak lateral impulse (r=0.773), indicating a trade-off between passive stability and the force input required to maneuver. These findings suggest that during anticipated maneuvers people select foot placement strategies that balance competing costs to maintain stability, actively generate impulses, and minimize mechanical energy costs.



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Are the average gait speeds during the 10meter and 6minute walk tests redundant in Parkinson disease?

Publication date: February 2017
Source:Gait & Posture, Volume 52
Author(s): Ryan P. Duncan, Stephanie A. Combs-Miller, Marie E. McNeely, Abigail L. Leddy, James T. Cavanaugh, Leland E. Dibble, Terry D. Ellis, Matthew P. Ford, K. Bo Foreman, Gammon M. Earhart
We investigated the relationships between average gait speed collected with the 10Meter Walk Test (Comfortable and Fast) and 6Minute Walk Test (6MWT) in 346 people with Parkinson disease (PD) and how the relationships change with increasing disease severity. Pearson correlation and linear regression analyses determined relationships between 10Meter Walk Test and 6MWT gait speed values for the entire sample and for sub-samples stratified by Hoehn & Yahr (H&Y) stage I (n=53), II (n=141), III (n=135) and IV (n=17). We hypothesized that redundant tests would be highly and significantly correlated (i.e. r>0.70, p<0.05) and would have a linear regression model slope of 1 and intercept of 0. For the entire sample, 6MWT gait speed was significantly (p<0.001) related to the Comfortable 10 Meter Walk Test (r=0.75) and Fast 10Meter Walk Test (r=0.79) gait speed, with 56% and 62% of the variance in 6MWT gait speed explained, respectively. The regression model of 6MWT gait speed predicted by Comfortable 10 Meter Walk gait speed produced slope and intercept values near 1 and 0, respectively, especially for participants in H&Y stages II–IV. In contrast, slope and intercept values were further from 1 and 0, respectively, for the Fast 10Meter Walk Test. Comfortable 10 Meter Walk Test and 6MWT gait speeds appeared to be redundant in people with moderate to severe PD, suggesting the Comfortable 10 Meter Walk Test can be used to estimate 6MWT distance in this population.



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