Forward Masking in Cochlear Implant Users: Electrophysiological and Psychophysical Data Using Pulse Train Maskers

Abstract

Electrical stimulation of auditory nerve fibers using cochlear implants (CI) shows psychophysical forward masking (pFM) up to several hundreds of milliseconds. By contrast, recovery of electrically evoked compound action potentials (eCAPs) from forward masking (eFM) was shown to be more rapid, with time constants no greater than a few milliseconds. These discrepancies suggested two main contributors to pFM: a rapid-recovery process due to refractory properties of the auditory nerve and a slow-recovery process arising from more central structures. In the present study, we investigate whether the use of different maskers between eCAP and psychophysical measures, specifically single-pulse versus pulse train maskers, may have been a source of confound.

In experiment 1, we measured eFM using the following: a single-pulse masker, a 300-ms low-rate pulse train masker (LTM, 250 pps), and a 300-ms high-rate pulse train masker (HTM, 5000 pps). The maskers were presented either at same physical current (Φ) or at same perceptual (Ψ) level corresponding to comfortable loudness. Responses to a single-pulse probe were measured for masker-probe intervals ranging from 1 to 512 ms. Recovery from masking was much slower for pulse trains than for the single-pulse masker. When presented at Φ level, HTM produced more and longer-lasting masking than LTM. However, results were inconsistent when LTM and HTM were compared at Ψ level. In experiment 2, masked detection thresholds of single-pulse probes were measured using the same pulse train masker conditions. In line with our eFM findings, masked thresholds for HTM were higher than those for LTM at Φ level. However, the opposite result was found when the pulse trains were presented at Ψ level.

Our results confirm the presence of slow-recovery phenomena at the level of the auditory nerve in CI users, as previously shown in animal studies. Inconsistencies between eFM and pFM results, despite using the same masking conditions, further underline the importance of comparing electrophysiological and psychophysical measures with identical stimulation paradigms.

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Assessment and Outcome in Non-Traditional Cochlear Implant Candidates

The objectives of this study were to assess: (i) patient expectations met as a measure of outcome in early-deafened, late-implanted (non-traditional) cochlear implant recipients and (ii) pre-implantation predictive factors for postoperative speech perception. The notes of 13 recipients were retrospectively reviewed. The mean age at onset of profound deafness was 1.5 years (range 0-6). The mean age at implantation was 37 years (range 22-51 years). Patient expectations were assessed pre-operatively and 1 year after implantation. They were met or exceeded in 129/140 (92%) domains overall. A higher Speech Intelligibility Rating and audiovisual City University of New York sentence score before implantation were found to be positive predictive factors for improved speech discrimination after cochlear implantation.
Audiol Neurotol 2016;21:383-390

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Comparison of Acyclovir and Famciclovir for Ramsay Hunt Syndrome.

Objective: Although antiviral agents are widely used to treat Ramsay hunt syndrome (RHS), their relative effectiveness has not been assessed. This study retrospectively compared clinical outcomes in patients with RHS treated with the antiviral agents acyclovir and famciclovir. Patients and Methods: This study involved 227 patients diagnosed with RHS from 2003 to 2015. Patients were treated with prednisolone plus acyclovir (n = 102) or famciclovir (n = 125). Patient outcomes were measured using the House-Brackmann scale according to age, initial severity of disease, electroneurography, and underlying disease. Results: Based on complications (p = 0.019) and disease severity (p = 0.013), the overall complete recovery rate was significantly higher with famciclovir than with acyclovir, whereas rates of recovery in patients with severe (p = 0.111) and initially moderate (grades III-IV; p = 0.070) facial palsy were similar. Electroneurography also showed no difference in remission rate between the two groups (p = 0.692). Complete recovery rates in patients with hypertension and/or diabetes mellitus were similar in the two groups. However, the complete recovery rate of patients without hypertension and diabetes was significantly higher in patients treated with famciclovir than acyclovir (p = 0.018). Conclusion: Recovery rates in patients with RHS were higher following treatment with steroid plus famciclovir than with steroid plus acyclovir, especially in patients without hypertension and diabetes mellitus. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Association of TagSNP in lncRNA HOTAIR with susceptibility to noise-induced hearing loss in a Chinese population

Publication date: Available online 20 February 2017
Source:Hearing Research
Author(s): Boshen Wang, Enmin Ding, Huanxi Shen, Jianfeng Wang, Kai Sun, Shi Chen, Lei Han, Hengdong Zhang, Baoli Zhu, Ming Xu
BackgroundNoise-induced hearing loss (NIHL) is a multifactorial disease, and dysregulation of oxidative stress is universally acknowledged as one crucial pathogenic factor for this disease. Recently studies have found the LncRNA HOTAIR is involved in the alteration of oxidative stress level, cell proliferation, cell cycle progression, and apoptosis. Considering the effects of lncRNA HOTAIR in cellular oxidative stress, we sought to investigate the influence of lncRNA HOTAIR variants on the risk of NIHL.MethodsTo explore the effects of HOTAIR polymorphisms on individual susceptibility to NIHL, We performed genotyping of three tagSNPs (rs874945, rs4759314 and rs7958904) in HOTAIR gene in a Chinese population which consists of 570 NIHL cases and 570 controls. The luciferase assays were further performed to investigate the regulatory function of HOTAIR tagSNPs.ResultsOur results revealed individuals with the G allele of HOTAIR tagSNP rs4759314 and the haplotype (rs874945, rs4759314 and rs7958904) are associated with an increased risk of NIHL in a Chinese population. Meanwhile, the rs4759314 G allele could significantly increase the expression of lncRNA HOTAIR.ConclusionsThe genetic polymorphism within HOTAIR gene may play a crucial role in the occurrence and development of NIHL.



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Association of TagSNP in lncRNA HOTAIR with susceptibility to noise-induced hearing loss in a Chinese population

Publication date: Available online 20 February 2017
Source:Hearing Research
Author(s): Boshen Wang, Enmin Ding, Huanxi Shen, Jianfeng Wang, Kai Sun, Shi Chen, Lei Han, Hengdong Zhang, Baoli Zhu, Ming Xu
BackgroundNoise-induced hearing loss (NIHL) is a multifactorial disease, and dysregulation of oxidative stress is universally acknowledged as one crucial pathogenic factor for this disease. Recently studies have found the LncRNA HOTAIR is involved in the alteration of oxidative stress level, cell proliferation, cell cycle progression, and apoptosis. Considering the effects of lncRNA HOTAIR in cellular oxidative stress, we sought to investigate the influence of lncRNA HOTAIR variants on the risk of NIHL.MethodsTo explore the effects of HOTAIR polymorphisms on individual susceptibility to NIHL, We performed genotyping of three tagSNPs (rs874945, rs4759314 and rs7958904) in HOTAIR gene in a Chinese population which consists of 570 NIHL cases and 570 controls. The luciferase assays were further performed to investigate the regulatory function of HOTAIR tagSNPs.ResultsOur results revealed individuals with the G allele of HOTAIR tagSNP rs4759314 and the haplotype (rs874945, rs4759314 and rs7958904) are associated with an increased risk of NIHL in a Chinese population. Meanwhile, the rs4759314 G allele could significantly increase the expression of lncRNA HOTAIR.ConclusionsThe genetic polymorphism within HOTAIR gene may play a crucial role in the occurrence and development of NIHL.



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Association of TagSNP in lncRNA HOTAIR with susceptibility to noise-induced hearing loss in a Chinese population

Publication date: Available online 20 February 2017
Source:Hearing Research
Author(s): Boshen Wang, Enmin Ding, Huanxi Shen, Jianfeng Wang, Kai Sun, Shi Chen, Lei Han, Hengdong Zhang, Baoli Zhu, Ming Xu
BackgroundNoise-induced hearing loss (NIHL) is a multifactorial disease, and dysregulation of oxidative stress is universally acknowledged as one crucial pathogenic factor for this disease. Recently studies have found the LncRNA HOTAIR is involved in the alteration of oxidative stress level, cell proliferation, cell cycle progression, and apoptosis. Considering the effects of lncRNA HOTAIR in cellular oxidative stress, we sought to investigate the influence of lncRNA HOTAIR variants on the risk of NIHL.MethodsTo explore the effects of HOTAIR polymorphisms on individual susceptibility to NIHL, We performed genotyping of three tagSNPs (rs874945, rs4759314 and rs7958904) in HOTAIR gene in a Chinese population which consists of 570 NIHL cases and 570 controls. The luciferase assays were further performed to investigate the regulatory function of HOTAIR tagSNPs.ResultsOur results revealed individuals with the G allele of HOTAIR tagSNP rs4759314 and the haplotype (rs874945, rs4759314 and rs7958904) are associated with an increased risk of NIHL in a Chinese population. Meanwhile, the rs4759314 G allele could significantly increase the expression of lncRNA HOTAIR.ConclusionsThe genetic polymorphism within HOTAIR gene may play a crucial role in the occurrence and development of NIHL.



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Understanding Differences at Del Mar Heights Elementary School

In collaboration with Del Mar Heights Elementary School, the Student Academy of Audiology – San Diego coordinated the participation of AuD students in an award-winning disability awareness program, Understanding Differences. The program was established in 2005 to foster empathy and teach understanding through science lessons, interactive simulations, and guest speakers. Alongside Deaf Community Service, the SDSU/UCSD AuD students created and led hearing loss simulator, tuning fork hearing screening, and hearing aid technology stations during the culminating event to conclude the month-long exploration of hearing impairment and Deaf culture. 

Understanding Differences was recognized by the North Coastal Council PTA with a Program Award of Excellence and has been awarded the California School Boards Association Golden Bell Award. 

See the photos!

[See image gallery at slhs.sdsu.edu]

 

 

 

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CDC Releases New Report, Raises Concern About Noise-Induced Hearing Loss

​A Morbidity and Mortality Weekly Report recently released by the Centers for Disease Control and Prevention shows nearly one in four adults aged 20 to 69 has audiometric notches, indicating a high prevalence of noise-induced hearing loss.

The CDC analyzed the most recent available data from the 2011-2012 National Health and Nutrition Examination Survey to determine the presence of audiometric notches among the U.S. adult population. The prevalence of both unilateral and bilateral notches was consistently higher in men than women for both reported work exposure to noise and no reported work exposure to noise. The presence of noise-induced hearing loss increased from one in five among young adults aged 20 to 29 to one in four among adults aged 50 to 59. Close to 24 percent of people who self-reported excellent or good hearing regardless of noise exposure reported had bilateral or unilateral notches, indicating that this is a significant but often unrecognized problem. 

Published: 2/21/2017 8:52:00 AM

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Understanding Differences at Del Mar Heights Elementary School

In collaboration with Del Mar Heights Elementary School, the Student Academy of Audiology – San Diego coordinated the participation of AuD students in an award-winning disability awareness program, Understanding Differences. The program was established in 2005 to foster empathy and teach understanding through science lessons, interactive simulations, and guest speakers. Alongside Deaf Community Service, the SDSU/UCSD AuD students created and led hearing loss simulator, tuning fork hearing screening, and hearing aid technology stations during the culminating event to conclude the month-long exploration of hearing impairment and Deaf culture. 

Understanding Differences was recognized by the North Coastal Council PTA with a Program Award of Excellence and has been awarded the California School Boards Association Golden Bell Award. 

See the photos!

[See image gallery at slhs.sdsu.edu]

 

 

 

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CDC Releases New Report, Raises Concern About Noise-Induced Hearing Loss

​A Morbidity and Mortality Weekly Report recently released by the Centers for Disease Control and Prevention shows nearly one in four adults aged 20 to 69 has audiometric notches, indicating a high prevalence of noise-induced hearing loss.

The CDC analyzed the most recent available data from the 2011-2012 National Health and Nutrition Examination Survey to determine the presence of audiometric notches among the U.S. adult population. The prevalence of both unilateral and bilateral notches was consistently higher in men than women for both reported work exposure to noise and no reported work exposure to noise. The presence of noise-induced hearing loss increased from one in five among young adults aged 20 to 29 to one in four among adults aged 50 to 59. Close to 24 percent of people who self-reported excellent or good hearing regardless of noise exposure reported had bilateral or unilateral notches, indicating that this is a significant but often unrecognized problem. 

Published: 2/21/2017 8:52:00 AM

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Understanding Differences at Del Mar Heights Elementary School

In collaboration with Del Mar Heights Elementary School, the Student Academy of Audiology – San Diego coordinated the participation of AuD students in an award-winning disability awareness program, Understanding Differences. The program was established in 2005 to foster empathy and teach understanding through science lessons, interactive simulations, and guest speakers. Alongside Deaf Community Service, the SDSU/UCSD AuD students created and led hearing loss simulator, tuning fork hearing screening, and hearing aid technology stations during the culminating event to conclude the month-long exploration of hearing impairment and Deaf culture. 

Understanding Differences was recognized by the North Coastal Council PTA with a Program Award of Excellence and has been awarded the California School Boards Association Golden Bell Award. 

See the photos!

[See image gallery at slhs.sdsu.edu]

 

 

 

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CDC Releases New Report, Raises Concern About Noise-Induced Hearing Loss

​A Morbidity and Mortality Weekly Report recently released by the Centers for Disease Control and Prevention shows nearly one in four adults aged 20 to 69 has audiometric notches, indicating a high prevalence of noise-induced hearing loss.

The CDC analyzed the most recent available data from the 2011-2012 National Health and Nutrition Examination Survey to determine the presence of audiometric notches among the U.S. adult population. The prevalence of both unilateral and bilateral notches was consistently higher in men than women for both reported work exposure to noise and no reported work exposure to noise. The presence of noise-induced hearing loss increased from one in five among young adults aged 20 to 29 to one in four among adults aged 50 to 59. Close to 24 percent of people who self-reported excellent or good hearing regardless of noise exposure reported had bilateral or unilateral notches, indicating that this is a significant but often unrecognized problem. 

Published: 2/21/2017 8:52:00 AM

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A systematic review of stimulus parameters for eliciting distortion product otoacoustic emissions from adult humans

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Hearing aid fine-tuning based on Dutch descriptions

.


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A systematic review of stimulus parameters for eliciting distortion product otoacoustic emissions from adult humans

.


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Hearing aid fine-tuning based on Dutch descriptions

.


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A systematic review of stimulus parameters for eliciting distortion product otoacoustic emissions from adult humans

.


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Hearing aid fine-tuning based on Dutch descriptions

.


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Inertial and Time-of-Arrival Ranging Sensor Fusion

Publication date: Available online 20 February 2017
Source:Gait & Posture
Author(s): Paul Vasilyev, Sean Pearson, Mahmoud El-Gohary, Mateo Aboy, James McNames
Wearable devices with embedded kinematic sensors including triaxial accelerometers, gyroscopes, and magnetometers are becoming widely used in applications for tracking human movement in domains that include sports, motion gaming, medicine, and wellness. The kinematic sensors can be used to estimate orientation, but can only estimate changes in position over short periods of time. We developed a prototype sensor that includes ultra wideband ranging sensors and kinematic sensors to determine the feasibility of fusing the two sensor technologies to estimate both orientation and position. We used a state space model and applied the unscented Kalman filter to fuse the sensor information. Our results demonstrate that it is possible to estimate orientation and position with less error than is possible with either sensor technology alone. In our experiment we obtained a position root mean square error of 5.2cm and orientation error of 4.8° over a 15 minute recording.



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Transfer effects of step training on stepping performance in untrained directions in older adults: A randomised controlled trial

Publication date: Available online 21 February 2017
Source:Gait & Posture
Author(s): Yoshiro Okubo, Jasmine Menant, Manasa Udyavar, Matthew A Brodie, Benjamin K Barry, Stephen R Lord, Daina Sturnieks
BackgroundAlthough step training improves the ability of quick stepping, some home-based step training systems train limited stepping directions and may cause harm by reducing stepping performance in untrained directions. This study examines the possible transfer effects of step training on stepping performance in untrained directions in older people.MethodsFifty four older adults were randomized into: forward step training (FT); lateral plus forward step training (FLT); or no training (NT) groups. FT and FLT participants undertook a 15-minute training session involving 200 step repetitions. Prior to and post training, choice stepping reaction time and stepping kinematics in untrained, diagonal and lateral directions were assessed.ResultsSignificant interactions of group and time (pre/post-assessment) were evident for the first step after training indicating negative (delayed response time) and positive (faster peak stepping speed) transfer effects in the diagonal direction in the FT group. However, when the second to the fifth steps after training were included in the analysis, there were no significant interactions of group and time for measures in the diagonal stepping direction.ConclusionsStep training only in the forward direction improved stepping speed but may acutely slow response times in the untrained diagonal direction. However, this acute effect appears to dissipate after a few repeated step trials. Step training in both forward and lateral directions appears to induce no negative transfer effects in diagonal stepping. These findings suggest home-based step training systems present low risk of harm through negative transfer effects in untrained stepping directions.Trial registration: ANZCTR 369066.



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Predictors for anterior pelvic tilt following surgical correction of flexed knee gait including patellar tendon shortening in children with cerebral palsy

Publication date: Available online 21 February 2017
Source:Gait & Posture
Author(s): Harald Böhm, Matthias Hösl, Leonhard Döderlein
IntroductionPatellar tendon shortening procedure within single event multilevel surgeries was shown to improve crouch gait in Cerebral Palsy (CP) patients. However, one of the drawbacks associated to the correction of flexed knee gait may be increased pelvic anterior tilt with compensatory lumbar lordosis.Research questionWhich CP patients are at risk for excessive anterior pelvic tilt following correction of flexed knee gait including patellar tendon shortening?Methods32 patients with CP between 8-18 years GMFCS I&II were included. They received patellar tendon shortenings within multilevel surgery. Patients with concomitant knee flexor lengthening were excluded. Gait analysis and clinical testing was performed pre- and 24.1 (SD=1.9)months postoperatively. Patients were subdivided into more/less than 5° increase in anterior pelvic tilt. Preoperative measures indicating m. rectus and m. psoas shortness, knee flexor over-length, hip extensor and abdominal muscle weakness and equinus gait were compared between groups. Stepwise multilinear regression of the response value increase in pelvic tilt during stance phase was performed from parameters that were significantly different between groups.Results34% of patients showed more than 5° increased pelvic anterior tilt postoperatively. Best predictors for anterior pelvic tilt from preoperative measures were increased m. rectus tone and reduced hip extension during walking that explained together 39% of the variance in increase of anterior pelvic tilt.Discussionevery third patient showed considerable increased pelvic tilt following surgery of flexed knee gait. In particular patients with preoperative higher muscle tone in m. rectus and lower hip extension during walking were at risk and both features need to be addressed in the therapy.



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Uphill walking: Biomechanical demand on the lower extremities of obese adolescents

Publication date: Available online 20 February 2017
Source:Gait & Posture
Author(s): Gerda Strutzenberger, Nathalie Alexander, Dominik Bamboschek, Elisabeth Class, Helmut Langhof, Hermann Schwameder
The number of obesity prevalence in adolescents is still increasing. Obesity treatment programs typically include physical activity with walking being recommended as appropriate activity, but limited information exists on the demand uphill walking places on the joint loading and power of obese adolescents. Therefore, the purpose of this study was to investigate the effect of different inclinations on step characteristics, sagittal and frontal joint angles, joint moments and joint power of obese adolescents in comparison to their normal-weight peers. Eleven obese (14.5 ± 1.41 years, BMI: 31.1 ± 3.5 kg/m²) and eleven normal-weight adolescents (14.3 ± 1.86 years, BMI: 19.0 ± 1.7 kg/m²) walked with 1.11 m/s on a ramp with two imbedded force plates (AMTI, 1000 Hz) at three inclinations (level, 6°, 12°). Kinematic data were collected via an infrared-camera motion system (Vicon, 250Hz). The two-way (inclination, group) ANOVA indicated a significant effect of inclination on almost all variables analysed, with the hip joint being the most affected by inclination, followed by the knee and ankle joint. The obese participants additionally spent less time in swing phase, walked with an increased knee flexion and valgus angle and an increased peak hip flexion and adduction moment. Hip joint power of obese adolescents was especially in the steepest inclination significantly increased compared to their normal-weight peers. Obese adolescents demonstrate increased joint loading compared to their normal-weight peers and in combination with a musculoskeletal malalignment they might be prone to an increased overuse injury risk.



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Relationship between ambulatory physical activity assessed by activity trackers and physical frailty among nursing home residents.

Publication date: Available online 20 February 2017
Source:Gait & Posture
Author(s): F. Buckinx, A. Mouton, J.Y. Reginster, J.L. Croisier, N. Dardenne, C. Beaudart, J. Nelis, E. Lambert, G. Appelboom, O. O Bruyère
BackgroundsThe aim of this study was to assess the relationship between the level of ambulatory physical activity, measured by physical activity tracker, and the clinical components of physical frailty, among nursing home residents.MethodsWe proceeded in 3 steps: (1) Validation of the physical activity tracker (i.e. the Pebble): 24 volunteer adults walked on a treadmill. The number of steps recorded by the Pebble worn by the subjects was compared with the number of steps counted by the investigators, by means of the Intra-class correlation coefficients (ICC). (2) Measurement of ambulatory physical activity, using the Pebble trackers, over a 7-day period. (3) Relationship between the results obtained with the Pebble trackers (step 2) and subjects’ clinical characteristics, linked to physical frailty.ResultsICC data, showed that the reliability of the Pebble was better when it was worn at the foot level (ICC ranged from 0.60 to 0.93 depending on the tested speed). Gait speed is also an important determinant of the reliability, which is better for low gait speed. On average, the 27 nursing home residents included in the second step of this study walked 1678.4±1621 (median=1300) steps per day. Most physical components of frailty measured in this study were significantly different between subjects who walked less than 1300 steps per day and those who were more active.ConclusionThis study showed that nursing home residents have a poor ambulatory physical activity, assessed using a physical activity tracker, which is associated with poorer physical performances and higher disability.



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Inertial and Time-of-Arrival Ranging Sensor Fusion

Publication date: Available online 20 February 2017
Source:Gait & Posture
Author(s): Paul Vasilyev, Sean Pearson, Mahmoud El-Gohary, Mateo Aboy, James McNames
Wearable devices with embedded kinematic sensors including triaxial accelerometers, gyroscopes, and magnetometers are becoming widely used in applications for tracking human movement in domains that include sports, motion gaming, medicine, and wellness. The kinematic sensors can be used to estimate orientation, but can only estimate changes in position over short periods of time. We developed a prototype sensor that includes ultra wideband ranging sensors and kinematic sensors to determine the feasibility of fusing the two sensor technologies to estimate both orientation and position. We used a state space model and applied the unscented Kalman filter to fuse the sensor information. Our results demonstrate that it is possible to estimate orientation and position with less error than is possible with either sensor technology alone. In our experiment we obtained a position root mean square error of 5.2cm and orientation error of 4.8° over a 15 minute recording.



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Transfer effects of step training on stepping performance in untrained directions in older adults: A randomised controlled trial

Publication date: Available online 21 February 2017
Source:Gait & Posture
Author(s): Yoshiro Okubo, Jasmine Menant, Manasa Udyavar, Matthew A Brodie, Benjamin K Barry, Stephen R Lord, Daina Sturnieks
BackgroundAlthough step training improves the ability of quick stepping, some home-based step training systems train limited stepping directions and may cause harm by reducing stepping performance in untrained directions. This study examines the possible transfer effects of step training on stepping performance in untrained directions in older people.MethodsFifty four older adults were randomized into: forward step training (FT); lateral plus forward step training (FLT); or no training (NT) groups. FT and FLT participants undertook a 15-minute training session involving 200 step repetitions. Prior to and post training, choice stepping reaction time and stepping kinematics in untrained, diagonal and lateral directions were assessed.ResultsSignificant interactions of group and time (pre/post-assessment) were evident for the first step after training indicating negative (delayed response time) and positive (faster peak stepping speed) transfer effects in the diagonal direction in the FT group. However, when the second to the fifth steps after training were included in the analysis, there were no significant interactions of group and time for measures in the diagonal stepping direction.ConclusionsStep training only in the forward direction improved stepping speed but may acutely slow response times in the untrained diagonal direction. However, this acute effect appears to dissipate after a few repeated step trials. Step training in both forward and lateral directions appears to induce no negative transfer effects in diagonal stepping. These findings suggest home-based step training systems present low risk of harm through negative transfer effects in untrained stepping directions.Trial registration: ANZCTR 369066.



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Predictors for anterior pelvic tilt following surgical correction of flexed knee gait including patellar tendon shortening in children with cerebral palsy

Publication date: Available online 21 February 2017
Source:Gait & Posture
Author(s): Harald Böhm, Matthias Hösl, Leonhard Döderlein
IntroductionPatellar tendon shortening procedure within single event multilevel surgeries was shown to improve crouch gait in Cerebral Palsy (CP) patients. However, one of the drawbacks associated to the correction of flexed knee gait may be increased pelvic anterior tilt with compensatory lumbar lordosis.Research questionWhich CP patients are at risk for excessive anterior pelvic tilt following correction of flexed knee gait including patellar tendon shortening?Methods32 patients with CP between 8-18 years GMFCS I&II were included. They received patellar tendon shortenings within multilevel surgery. Patients with concomitant knee flexor lengthening were excluded. Gait analysis and clinical testing was performed pre- and 24.1 (SD=1.9)months postoperatively. Patients were subdivided into more/less than 5° increase in anterior pelvic tilt. Preoperative measures indicating m. rectus and m. psoas shortness, knee flexor over-length, hip extensor and abdominal muscle weakness and equinus gait were compared between groups. Stepwise multilinear regression of the response value increase in pelvic tilt during stance phase was performed from parameters that were significantly different between groups.Results34% of patients showed more than 5° increased pelvic anterior tilt postoperatively. Best predictors for anterior pelvic tilt from preoperative measures were increased m. rectus tone and reduced hip extension during walking that explained together 39% of the variance in increase of anterior pelvic tilt.Discussionevery third patient showed considerable increased pelvic tilt following surgery of flexed knee gait. In particular patients with preoperative higher muscle tone in m. rectus and lower hip extension during walking were at risk and both features need to be addressed in the therapy.



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Uphill walking: Biomechanical demand on the lower extremities of obese adolescents

Publication date: Available online 20 February 2017
Source:Gait & Posture
Author(s): Gerda Strutzenberger, Nathalie Alexander, Dominik Bamboschek, Elisabeth Class, Helmut Langhof, Hermann Schwameder
The number of obesity prevalence in adolescents is still increasing. Obesity treatment programs typically include physical activity with walking being recommended as appropriate activity, but limited information exists on the demand uphill walking places on the joint loading and power of obese adolescents. Therefore, the purpose of this study was to investigate the effect of different inclinations on step characteristics, sagittal and frontal joint angles, joint moments and joint power of obese adolescents in comparison to their normal-weight peers. Eleven obese (14.5 ± 1.41 years, BMI: 31.1 ± 3.5 kg/m²) and eleven normal-weight adolescents (14.3 ± 1.86 years, BMI: 19.0 ± 1.7 kg/m²) walked with 1.11 m/s on a ramp with two imbedded force plates (AMTI, 1000 Hz) at three inclinations (level, 6°, 12°). Kinematic data were collected via an infrared-camera motion system (Vicon, 250Hz). The two-way (inclination, group) ANOVA indicated a significant effect of inclination on almost all variables analysed, with the hip joint being the most affected by inclination, followed by the knee and ankle joint. The obese participants additionally spent less time in swing phase, walked with an increased knee flexion and valgus angle and an increased peak hip flexion and adduction moment. Hip joint power of obese adolescents was especially in the steepest inclination significantly increased compared to their normal-weight peers. Obese adolescents demonstrate increased joint loading compared to their normal-weight peers and in combination with a musculoskeletal malalignment they might be prone to an increased overuse injury risk.



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Relationship between ambulatory physical activity assessed by activity trackers and physical frailty among nursing home residents.

Publication date: Available online 20 February 2017
Source:Gait & Posture
Author(s): F. Buckinx, A. Mouton, J.Y. Reginster, J.L. Croisier, N. Dardenne, C. Beaudart, J. Nelis, E. Lambert, G. Appelboom, O. O Bruyère
BackgroundsThe aim of this study was to assess the relationship between the level of ambulatory physical activity, measured by physical activity tracker, and the clinical components of physical frailty, among nursing home residents.MethodsWe proceeded in 3 steps: (1) Validation of the physical activity tracker (i.e. the Pebble): 24 volunteer adults walked on a treadmill. The number of steps recorded by the Pebble worn by the subjects was compared with the number of steps counted by the investigators, by means of the Intra-class correlation coefficients (ICC). (2) Measurement of ambulatory physical activity, using the Pebble trackers, over a 7-day period. (3) Relationship between the results obtained with the Pebble trackers (step 2) and subjects’ clinical characteristics, linked to physical frailty.ResultsICC data, showed that the reliability of the Pebble was better when it was worn at the foot level (ICC ranged from 0.60 to 0.93 depending on the tested speed). Gait speed is also an important determinant of the reliability, which is better for low gait speed. On average, the 27 nursing home residents included in the second step of this study walked 1678.4±1621 (median=1300) steps per day. Most physical components of frailty measured in this study were significantly different between subjects who walked less than 1300 steps per day and those who were more active.ConclusionThis study showed that nursing home residents have a poor ambulatory physical activity, assessed using a physical activity tracker, which is associated with poorer physical performances and higher disability.



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Inertial and Time-of-Arrival Ranging Sensor Fusion

Publication date: Available online 20 February 2017
Source:Gait & Posture
Author(s): Paul Vasilyev, Sean Pearson, Mahmoud El-Gohary, Mateo Aboy, James McNames
Wearable devices with embedded kinematic sensors including triaxial accelerometers, gyroscopes, and magnetometers are becoming widely used in applications for tracking human movement in domains that include sports, motion gaming, medicine, and wellness. The kinematic sensors can be used to estimate orientation, but can only estimate changes in position over short periods of time. We developed a prototype sensor that includes ultra wideband ranging sensors and kinematic sensors to determine the feasibility of fusing the two sensor technologies to estimate both orientation and position. We used a state space model and applied the unscented Kalman filter to fuse the sensor information. Our results demonstrate that it is possible to estimate orientation and position with less error than is possible with either sensor technology alone. In our experiment we obtained a position root mean square error of 5.2cm and orientation error of 4.8° over a 15 minute recording.



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Transfer effects of step training on stepping performance in untrained directions in older adults: A randomised controlled trial

Publication date: Available online 21 February 2017
Source:Gait & Posture
Author(s): Yoshiro Okubo, Jasmine Menant, Manasa Udyavar, Matthew A Brodie, Benjamin K Barry, Stephen R Lord, Daina Sturnieks
BackgroundAlthough step training improves the ability of quick stepping, some home-based step training systems train limited stepping directions and may cause harm by reducing stepping performance in untrained directions. This study examines the possible transfer effects of step training on stepping performance in untrained directions in older people.MethodsFifty four older adults were randomized into: forward step training (FT); lateral plus forward step training (FLT); or no training (NT) groups. FT and FLT participants undertook a 15-minute training session involving 200 step repetitions. Prior to and post training, choice stepping reaction time and stepping kinematics in untrained, diagonal and lateral directions were assessed.ResultsSignificant interactions of group and time (pre/post-assessment) were evident for the first step after training indicating negative (delayed response time) and positive (faster peak stepping speed) transfer effects in the diagonal direction in the FT group. However, when the second to the fifth steps after training were included in the analysis, there were no significant interactions of group and time for measures in the diagonal stepping direction.ConclusionsStep training only in the forward direction improved stepping speed but may acutely slow response times in the untrained diagonal direction. However, this acute effect appears to dissipate after a few repeated step trials. Step training in both forward and lateral directions appears to induce no negative transfer effects in diagonal stepping. These findings suggest home-based step training systems present low risk of harm through negative transfer effects in untrained stepping directions.Trial registration: ANZCTR 369066.



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Predictors for anterior pelvic tilt following surgical correction of flexed knee gait including patellar tendon shortening in children with cerebral palsy

Publication date: Available online 21 February 2017
Source:Gait & Posture
Author(s): Harald Böhm, Matthias Hösl, Leonhard Döderlein
IntroductionPatellar tendon shortening procedure within single event multilevel surgeries was shown to improve crouch gait in Cerebral Palsy (CP) patients. However, one of the drawbacks associated to the correction of flexed knee gait may be increased pelvic anterior tilt with compensatory lumbar lordosis.Research questionWhich CP patients are at risk for excessive anterior pelvic tilt following correction of flexed knee gait including patellar tendon shortening?Methods32 patients with CP between 8-18 years GMFCS I&II were included. They received patellar tendon shortenings within multilevel surgery. Patients with concomitant knee flexor lengthening were excluded. Gait analysis and clinical testing was performed pre- and 24.1 (SD=1.9)months postoperatively. Patients were subdivided into more/less than 5° increase in anterior pelvic tilt. Preoperative measures indicating m. rectus and m. psoas shortness, knee flexor over-length, hip extensor and abdominal muscle weakness and equinus gait were compared between groups. Stepwise multilinear regression of the response value increase in pelvic tilt during stance phase was performed from parameters that were significantly different between groups.Results34% of patients showed more than 5° increased pelvic anterior tilt postoperatively. Best predictors for anterior pelvic tilt from preoperative measures were increased m. rectus tone and reduced hip extension during walking that explained together 39% of the variance in increase of anterior pelvic tilt.Discussionevery third patient showed considerable increased pelvic tilt following surgery of flexed knee gait. In particular patients with preoperative higher muscle tone in m. rectus and lower hip extension during walking were at risk and both features need to be addressed in the therapy.



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Uphill walking: Biomechanical demand on the lower extremities of obese adolescents

Publication date: Available online 20 February 2017
Source:Gait & Posture
Author(s): Gerda Strutzenberger, Nathalie Alexander, Dominik Bamboschek, Elisabeth Class, Helmut Langhof, Hermann Schwameder
The number of obesity prevalence in adolescents is still increasing. Obesity treatment programs typically include physical activity with walking being recommended as appropriate activity, but limited information exists on the demand uphill walking places on the joint loading and power of obese adolescents. Therefore, the purpose of this study was to investigate the effect of different inclinations on step characteristics, sagittal and frontal joint angles, joint moments and joint power of obese adolescents in comparison to their normal-weight peers. Eleven obese (14.5 ± 1.41 years, BMI: 31.1 ± 3.5 kg/m²) and eleven normal-weight adolescents (14.3 ± 1.86 years, BMI: 19.0 ± 1.7 kg/m²) walked with 1.11 m/s on a ramp with two imbedded force plates (AMTI, 1000 Hz) at three inclinations (level, 6°, 12°). Kinematic data were collected via an infrared-camera motion system (Vicon, 250Hz). The two-way (inclination, group) ANOVA indicated a significant effect of inclination on almost all variables analysed, with the hip joint being the most affected by inclination, followed by the knee and ankle joint. The obese participants additionally spent less time in swing phase, walked with an increased knee flexion and valgus angle and an increased peak hip flexion and adduction moment. Hip joint power of obese adolescents was especially in the steepest inclination significantly increased compared to their normal-weight peers. Obese adolescents demonstrate increased joint loading compared to their normal-weight peers and in combination with a musculoskeletal malalignment they might be prone to an increased overuse injury risk.



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Relationship between ambulatory physical activity assessed by activity trackers and physical frailty among nursing home residents.

Publication date: Available online 20 February 2017
Source:Gait & Posture
Author(s): F. Buckinx, A. Mouton, J.Y. Reginster, J.L. Croisier, N. Dardenne, C. Beaudart, J. Nelis, E. Lambert, G. Appelboom, O. O Bruyère
BackgroundsThe aim of this study was to assess the relationship between the level of ambulatory physical activity, measured by physical activity tracker, and the clinical components of physical frailty, among nursing home residents.MethodsWe proceeded in 3 steps: (1) Validation of the physical activity tracker (i.e. the Pebble): 24 volunteer adults walked on a treadmill. The number of steps recorded by the Pebble worn by the subjects was compared with the number of steps counted by the investigators, by means of the Intra-class correlation coefficients (ICC). (2) Measurement of ambulatory physical activity, using the Pebble trackers, over a 7-day period. (3) Relationship between the results obtained with the Pebble trackers (step 2) and subjects’ clinical characteristics, linked to physical frailty.ResultsICC data, showed that the reliability of the Pebble was better when it was worn at the foot level (ICC ranged from 0.60 to 0.93 depending on the tested speed). Gait speed is also an important determinant of the reliability, which is better for low gait speed. On average, the 27 nursing home residents included in the second step of this study walked 1678.4±1621 (median=1300) steps per day. Most physical components of frailty measured in this study were significantly different between subjects who walked less than 1300 steps per day and those who were more active.ConclusionThis study showed that nursing home residents have a poor ambulatory physical activity, assessed using a physical activity tracker, which is associated with poorer physical performances and higher disability.



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Second cause of hidden hearing loss identified

Patients who complain they can't hear their friends at a noisy restaurant, but pass a hearing test in their doctor's office, may be describing hidden hearing loss.

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Second cause of hidden hearing loss identified

Patients who complain they can't hear their friends at a noisy restaurant, but pass a hearing test in their doctor's office, may be describing hidden hearing loss.

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Second cause of hidden hearing loss identified

Patients who complain they can't hear their friends at a noisy restaurant, but pass a hearing test in their doctor's office, may be describing hidden hearing loss.

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