Acute Nanoparticle Exposure to Vocal Folds: A Laboratory Study

Publication date: Available online 21 April 2017
Source:Journal of Voice
Author(s): Xinxin Liu, Tanaya Walimbe, William Pierre Schrock, Wei Zheng, M. Preeti Sivasankar
ObjectivesAirway exposure to nanoparticles is common in occupational settings. Inhaled nanoparticles have toxic effects on respiratory tissue. Vocal folds are also at direct risk from inhaled nanoparticles. This study investigated the effects of single-walled carbon nanotubes (SWCNT), a type of nanoparticle, on vocal fold epithelium and fibroblasts. These cell types were selected for study as the epithelium is the outer layer of the vocal folds and fibroblasts are the most common cell type in connective tissue underlying the epithelium.MethodsNative porcine vocal fold epithelium and cultured human vocal fold fibroblasts were exposed to SWCNTs (100 ng/mL) and control (no SWCNT) in vitro. Epithelial and fibroblast viability was measured using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Epithelial barrier integrity was assessed with transepithelial resistance and sodium fluorescein permeability. Epithelial tight junctional protein occludin expression was measured with Western blot. Gene expressions of the fibroblast-specific protein 1 (FSP-1), α-smooth muscle actin (α-SMA), and collagen III (Col-III) were assessed using quantitative polymerase chain reaction.ResultsTranscriptional expression of genes encoding FSP-1 and Col-III was increased significantly following SWCNT exposure. There were no significant differences between control and SWCNT groups on any of the other measures.ConclusionsSWCNT exposure induces vocal fold fibroblasts to a fibrotic phenotype. These data help us understand vocal fold defense mechanisms and lay the groundwork for studying the physiological effects of nanoparticle exposure in vivo.



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Laryngopharyngeal Reflux and Voice Disorders: A Multifactorial Model of Etiology and Pathophysiology

Publication date: Available online 21 April 2017
Source:Journal of Voice
Author(s): Jerome R. Lechien, Sven Saussez, Bernard Harmegnies, Camille Finck, James A. Burns
ObjectiveThe aim of this paper is to shed light on the pathogenesis and pathophysiological mechanisms underlying the development of hoarseness related to laryngopharyngeal reflux disease (LPRD).Material and methodsPubMed, Embase, and The Cochrane Library were searched for the terms reflux, laryngopharyngeal, laryngitis, voice, and hoarseness. Experimental and clinical studies providing substantial information about the occurrence of voice disorders, laryngeal histologic changes, or any pathophysiological processes related to LPRD were included by two independent investigators.ResultsOf the 104 studies reviewed, 47 studies that met our inclusion criteria were analyzed. LPRD leads to significant macroscopic and microscopic histopathologic changes in the mucosa of the vibratory margin of the vocal folds. More and more studies suspect that epithelial cell dehiscence, microtraumas, inflammatory infiltrates, Reinke space dryness, mucosal drying, and epithelial thickening are probably responsible for the hoarseness related to reflux and the impairment of the subjective and objective voice quality evaluations.ConclusionFuture clinical studies examining the pathophysiology of hoarseness related to LPRD should take into consideration all potential mechanisms involved in the development of hoarseness.



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Estudio del lenguaje en las diferentes fases de la enfermedad de Alzheimer a través del Test de Boston

Publication date: Available online 21 April 2017
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Lourdes Aranda, Macarena Gordillo-Villatoro, J. Miguel Enamorado, Miguel López-Zamora
IntroducciónEl incremento en la esperanza de vida en las sociedades desarrolladas ha provocado un aumento en la aparición de enfermedades que son desconocidas por el mundo médico y científico, y por tanto difíciles de abarcar por la comunidad terapéutica. El objetivo de este trabajo es el análisis exhaustivo del progreso en el deterioro de cada una de las áreas del lenguaje en las diferentes fases de la enfermedad de Alzheimer (EA). De esta forma, se podrá planificar la intervención del logopeda en estos pacientes en función de la fase en que se encuentren.MetodologíaPara ello se ha diseñado un estudio para evaluar distintos aspectos del proceso cognitivo del lenguaje mediante la utilización del Test de Boston. Esta investigación se ha llevado a cabo con 32 participantes, de los cuales 8 no estaban diagnosticados de EA, 8 estaban diagnosticados de EA en la fase leve, 8 estaban diagnosticados de EA en la fase moderada y, por último, 8 estaban diagnosticados con EA en la fase grave, con el fin de poder estudiar cómo se van alterando las habilidades lingüísticas en las diferentes fases de la enfermedad.ResultadosLos resultados muestran cómo a medida que progresa la enfermedad, el habla espontánea, la comprensión auditiva y la expresión oral van deteriorándose en los participantes diagnosticados de EA. Sin embargo, no en todas las áreas del lenguaje el deterioro avanza de igual forma; de hecho, en el área de habla espontánea los participantes en fase leve ya comienzan a mostrar un deterioro significativo con respecto al grupo control. Sin embargo, dentro del área de comprensión auditiva, los participantes diagnosticados de EA son capaces de realizar de forma satisfactoria la tarea de discriminación auditiva, incluso en fases avanzadas de la enfermedad.Discusión y conclusionesEn esta investigación se observa cómo el curso de la alteración de las capacidades comunicativas difiere a lo largo del curso de la EA. Por ello, resalta la necesidad de estudiar en profundidad sus áreas del lenguaje para así ayudar a la planificación de la intervención del logopeda en cada momento específico de la enfermedad.IntroductionThe increase in life expectancy in developed societies has led to an rise in the appearance of diseases that are unknown by the medical and scientific world and, therefore, are difficult to cover by the therapeutic community. The Alzheimer's disease (AD) is a neurodegenerative disease that has multiple cognitive disorders, being especially relevant the language impairment displayed by patients diagnosed with the disease. The objective of this research is the exhaustive analysis of the progress in the deterioration of each of the areas of language in the different phases of AD. Thus, the intervention of the speech therapist can be planned in these patients depending on the phase in which they are.MethodWe have designed a study to evaluate various aspects of the cognitive process of language using the Boston Test. We have worked with 32 individuals, eight of which were not diagnosed with AD, eight diagnosed with AD in mild stage, eight with AD in moderate stage and finally, eight were diagnosed with AD in advanced stage. We analysed how it is disrupting language abilities at different stages of the disease.ResultsThe results show how Spontaneous Speech, Listening Comprehension and Oral Expression will be deteriorate in these patients as the disease progresses. However, deterioration does not proceed in the same way in all areas of language. In the Spontaneous Speech area, participants in the mild stage already begin to show a significant deterioration with respect to the control group. On the other hand, within the area of Listening Comprehension, all participants diagnosed with AD successfully perform the auditory discrimination task, even in advanced stages of the disease.Discussion and conclusionsThis research shows how the course of the alteration of the communicative capacities differs along the course of AD. Therefore, it highlights the need to study in more depth the language of the AD to help planning a speech therapy intervention in each specific phase of the illness.



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Estudio del lenguaje en las diferentes fases de la enfermedad de Alzheimer a través del Test de Boston

Publication date: Available online 21 April 2017
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Lourdes Aranda, Macarena Gordillo-Villatoro, J. Miguel Enamorado, Miguel López-Zamora
IntroducciónEl incremento en la esperanza de vida en las sociedades desarrolladas ha provocado un aumento en la aparición de enfermedades que son desconocidas por el mundo médico y científico, y por tanto difíciles de abarcar por la comunidad terapéutica. El objetivo de este trabajo es el análisis exhaustivo del progreso en el deterioro de cada una de las áreas del lenguaje en las diferentes fases de la enfermedad de Alzheimer (EA). De esta forma, se podrá planificar la intervención del logopeda en estos pacientes en función de la fase en que se encuentren.MetodologíaPara ello se ha diseñado un estudio para evaluar distintos aspectos del proceso cognitivo del lenguaje mediante la utilización del Test de Boston. Esta investigación se ha llevado a cabo con 32 participantes, de los cuales 8 no estaban diagnosticados de EA, 8 estaban diagnosticados de EA en la fase leve, 8 estaban diagnosticados de EA en la fase moderada y, por último, 8 estaban diagnosticados con EA en la fase grave, con el fin de poder estudiar cómo se van alterando las habilidades lingüísticas en las diferentes fases de la enfermedad.ResultadosLos resultados muestran cómo a medida que progresa la enfermedad, el habla espontánea, la comprensión auditiva y la expresión oral van deteriorándose en los participantes diagnosticados de EA. Sin embargo, no en todas las áreas del lenguaje el deterioro avanza de igual forma; de hecho, en el área de habla espontánea los participantes en fase leve ya comienzan a mostrar un deterioro significativo con respecto al grupo control. Sin embargo, dentro del área de comprensión auditiva, los participantes diagnosticados de EA son capaces de realizar de forma satisfactoria la tarea de discriminación auditiva, incluso en fases avanzadas de la enfermedad.Discusión y conclusionesEn esta investigación se observa cómo el curso de la alteración de las capacidades comunicativas difiere a lo largo del curso de la EA. Por ello, resalta la necesidad de estudiar en profundidad sus áreas del lenguaje para así ayudar a la planificación de la intervención del logopeda en cada momento específico de la enfermedad.IntroductionThe increase in life expectancy in developed societies has led to an rise in the appearance of diseases that are unknown by the medical and scientific world and, therefore, are difficult to cover by the therapeutic community. The Alzheimer's disease (AD) is a neurodegenerative disease that has multiple cognitive disorders, being especially relevant the language impairment displayed by patients diagnosed with the disease. The objective of this research is the exhaustive analysis of the progress in the deterioration of each of the areas of language in the different phases of AD. Thus, the intervention of the speech therapist can be planned in these patients depending on the phase in which they are.MethodWe have designed a study to evaluate various aspects of the cognitive process of language using the Boston Test. We have worked with 32 individuals, eight of which were not diagnosed with AD, eight diagnosed with AD in mild stage, eight with AD in moderate stage and finally, eight were diagnosed with AD in advanced stage. We analysed how it is disrupting language abilities at different stages of the disease.ResultsThe results show how Spontaneous Speech, Listening Comprehension and Oral Expression will be deteriorate in these patients as the disease progresses. However, deterioration does not proceed in the same way in all areas of language. In the Spontaneous Speech area, participants in the mild stage already begin to show a significant deterioration with respect to the control group. On the other hand, within the area of Listening Comprehension, all participants diagnosed with AD successfully perform the auditory discrimination task, even in advanced stages of the disease.Discussion and conclusionsThis research shows how the course of the alteration of the communicative capacities differs along the course of AD. Therefore, it highlights the need to study in more depth the language of the AD to help planning a speech therapy intervention in each specific phase of the illness.



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Estudio del lenguaje en las diferentes fases de la enfermedad de Alzheimer a través del Test de Boston

Publication date: Available online 21 April 2017
Source:Revista de Logopedia, Foniatría y Audiología
Author(s): Lourdes Aranda, Macarena Gordillo-Villatoro, J. Miguel Enamorado, Miguel López-Zamora
IntroducciónEl incremento en la esperanza de vida en las sociedades desarrolladas ha provocado un aumento en la aparición de enfermedades que son desconocidas por el mundo médico y científico, y por tanto difíciles de abarcar por la comunidad terapéutica. El objetivo de este trabajo es el análisis exhaustivo del progreso en el deterioro de cada una de las áreas del lenguaje en las diferentes fases de la enfermedad de Alzheimer (EA). De esta forma, se podrá planificar la intervención del logopeda en estos pacientes en función de la fase en que se encuentren.MetodologíaPara ello se ha diseñado un estudio para evaluar distintos aspectos del proceso cognitivo del lenguaje mediante la utilización del Test de Boston. Esta investigación se ha llevado a cabo con 32 participantes, de los cuales 8 no estaban diagnosticados de EA, 8 estaban diagnosticados de EA en la fase leve, 8 estaban diagnosticados de EA en la fase moderada y, por último, 8 estaban diagnosticados con EA en la fase grave, con el fin de poder estudiar cómo se van alterando las habilidades lingüísticas en las diferentes fases de la enfermedad.ResultadosLos resultados muestran cómo a medida que progresa la enfermedad, el habla espontánea, la comprensión auditiva y la expresión oral van deteriorándose en los participantes diagnosticados de EA. Sin embargo, no en todas las áreas del lenguaje el deterioro avanza de igual forma; de hecho, en el área de habla espontánea los participantes en fase leve ya comienzan a mostrar un deterioro significativo con respecto al grupo control. Sin embargo, dentro del área de comprensión auditiva, los participantes diagnosticados de EA son capaces de realizar de forma satisfactoria la tarea de discriminación auditiva, incluso en fases avanzadas de la enfermedad.Discusión y conclusionesEn esta investigación se observa cómo el curso de la alteración de las capacidades comunicativas difiere a lo largo del curso de la EA. Por ello, resalta la necesidad de estudiar en profundidad sus áreas del lenguaje para así ayudar a la planificación de la intervención del logopeda en cada momento específico de la enfermedad.IntroductionThe increase in life expectancy in developed societies has led to an rise in the appearance of diseases that are unknown by the medical and scientific world and, therefore, are difficult to cover by the therapeutic community. The Alzheimer's disease (AD) is a neurodegenerative disease that has multiple cognitive disorders, being especially relevant the language impairment displayed by patients diagnosed with the disease. The objective of this research is the exhaustive analysis of the progress in the deterioration of each of the areas of language in the different phases of AD. Thus, the intervention of the speech therapist can be planned in these patients depending on the phase in which they are.MethodWe have designed a study to evaluate various aspects of the cognitive process of language using the Boston Test. We have worked with 32 individuals, eight of which were not diagnosed with AD, eight diagnosed with AD in mild stage, eight with AD in moderate stage and finally, eight were diagnosed with AD in advanced stage. We analysed how it is disrupting language abilities at different stages of the disease.ResultsThe results show how Spontaneous Speech, Listening Comprehension and Oral Expression will be deteriorate in these patients as the disease progresses. However, deterioration does not proceed in the same way in all areas of language. In the Spontaneous Speech area, participants in the mild stage already begin to show a significant deterioration with respect to the control group. On the other hand, within the area of Listening Comprehension, all participants diagnosed with AD successfully perform the auditory discrimination task, even in advanced stages of the disease.Discussion and conclusionsThis research shows how the course of the alteration of the communicative capacities differs along the course of AD. Therefore, it highlights the need to study in more depth the language of the AD to help planning a speech therapy intervention in each specific phase of the illness.



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Local dynamic stability and gait variability during attentional tasks in young adults

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Rina Márcia Magnani, Georgia Cristina Lehnen, Fábio Barbosa Rodrigues, Gustavo Souto de Sá e Souza, Adriano de Oliveira Andrade, Marcus Fraga Vieira
Cell phone use while walking may be a cognitive distraction and reduce visual and motor attention. Thus, the aim of this study was to verify the effects of attentional dual-tasks while using a cell phone in different conditions. Stability, regularity, and linear variability of trunk kinematics, and gait spatiotemporal parameters in young adults were measured. Twenty young subjects of both genders were asked to walk on a treadmill for 4min under the following conditions: (a) looking forward at a fixed target 2.5m away (walking); (b) talking on a cell phone with unilateral handling (talking); (c) texting messages on a cell phone with unilateral handling (texting); and (d) looking forward at the aforementioned target while listening to music without handling the phone (listening). Local dynamic stability measured in terms of the largest Lyapunov exponent decreased while handling a cell phone (talking and texting). Gait variability and regularity increased when talking on a cell phone, but no variable changed in the listening condition. Under all dual-task conditions, there were significant increases in stride width and its variability. We conclude that young adults who use a cell phone when walking adapt their gait pattern conservatively, which can be because of increased attentional demand during cell phone use.



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Balance impairment in kidney transplant recipients without concurrent peripheral neuropathy

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): T. Zanotto, S. Gobbo, V. Bullo, B. Vendramin, F. Duregon, L. Cugusi, A. Di Blasio, L. Furian, C. Silvestre, D. Neunhaeuserer, M. Zaccaria, M. Bergamin, A. Ermolao
Kidney transplant recipients (KTRs) present with compromised functional capacity, low levels of physical activity, muscle atrophy, and peripheral nerve dysfunction that may result in high postural instability. This study aimed to compare the static balance control of 19 KTRs with 19 healthy adults (HA). All participants completed the Romberg test on a stabilometric platform with eyes open (EO), eyes closed (EC) and during a dual task (DT) condition. Centre of pressure (COP) measures (COP velocity (COPv) and sway area (SA)), as well as position-based outcomes such as anterior-posterior (AP) and medio-lateral (ML) ranges of COP displacements were recorded. Independent ANCOVA revealed an overall lower performance of KTRs compared to HA (p<0.05) with the EC condition exhibiting the worst relative performance for KTRs, suggesting a poorer capacity of relying on proprioceptive information when maintaining the upright posture. The addition of a cognitive task did not further worsen balance performance in KTRs. As impaired postural control is one of the main predictors of falls in elderly subjects, these data might also indicate that this constitutes an equivalent risk factor for falling in middle-aged KTRs.



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Correlation of technical surgical goals to the GDI and investigation of post-operative GDI change in children with cerebral palsy

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Christina Bickley, Judi Linton, Nancy Scarborough, Elroy Sullivan, Katy Mitchell, Douglas Barnes
AimThe purpose of this study was to introduce a standardized set of surgical technical achievement goals (TAGs) as part of a comprehensive outcome assessment model for children with spastic cerebral palsy (CP) undergoing orthopaedic surgical intervention to improve gait. Examination of relationships of these surgical goals to the Gait Deviation Index (GDI) and use of two assessments in tandem provided a thorough picture of technical surgical outcomes.This study also investigated changes in GDI in children with spastic CP after surgery.MethodsData from 269 participants with spastic CP, aged 4 to 19 years with Gross Motor Function Classification System (GMFCS) levels I, II, and III who underwent lower extremity orthopaedic surgical intervention to improve gait were retrospectively analyzed. Data were examined as one heterogeneous group and sub-grouped based on pattern of involvement and GMFCS level to determine change in GDI and relationships between GDI and TAGs.ResultsDifferences in TAG achievement and GDI change by GMFCS level suggest a pairing of GDI with another technical measure to be beneficial. Analysis of the outcome tools individually revealed a significant difference between the pre-operative GDI and post-operative GDI mean for the entire group, as well as each of the subgroups. A significant difference in TAG achievement by GMFCS level was also noted.ConclusionThis paper provides evidence that lower extremity orthopedic intervention for the ambulatory child with spastic diplegic or hemiplegic CP improves gait and that a pairing of the GDI and TAGs system is beneficial to capture an accurate technical outcome assessment in both higher and lower functioning patients.



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The effects of object height and visual information on the control of obstacle crossing during locomotion in healthy older adults

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Sho Kunimune, Shuichi Okada
In order to safely avoid obstacles, humans must rely on visual information regarding the position and shape of the object obtained in advance. The present study aimed to reveal the duration of obstacle visibility necessary for appropriate visuomotor control during obstacle avoidance in healthy older adults. Participants included 13 healthy young women (mean age: 21.5±1.4years) and 15 healthy older women (mean age: 68.5±3.5years) who were instructed to cross over an obstacle along a pressure-sensitive pathway at a self-selected pace while wearing liquid crystal shutter goggles. Participants were evaluated during three visual occlusion conditions: (i) full visibility, (ii) occlusion at T-1 step (T: time of obstacle crossing), and (iii) occlusion at T-2 steps. Toe clearances of both the lead and trail limb (LTC and TTC) were calculated. LTC in the occlusion at T-2 steps condition was significantly greater than that in other conditions. Furthermore, a significant correlation was observed between LTC and TTC in both groups, regardless of the condition or obstacle height. In the older adult group alone, step width in the occlusion at T-2 steps condition increased relative to that in full visibility conditions. The results of the present study suggest that there is no difference in the characteristics of visuomotor control for appropriate obstacle crossing based on age. However, older adults may exhibit increased dependence on visual information for postural stability; they may also need an increased step width when lacking information regarding their positional relationship to obstacles.



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Local dynamic stability and gait variability during attentional tasks in young adults

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Rina Márcia Magnani, Georgia Cristina Lehnen, Fábio Barbosa Rodrigues, Gustavo Souto de Sá e Souza, Adriano de Oliveira Andrade, Marcus Fraga Vieira
Cell phone use while walking may be a cognitive distraction and reduce visual and motor attention. Thus, the aim of this study was to verify the effects of attentional dual-tasks while using a cell phone in different conditions. Stability, regularity, and linear variability of trunk kinematics, and gait spatiotemporal parameters in young adults were measured. Twenty young subjects of both genders were asked to walk on a treadmill for 4min under the following conditions: (a) looking forward at a fixed target 2.5m away (walking); (b) talking on a cell phone with unilateral handling (talking); (c) texting messages on a cell phone with unilateral handling (texting); and (d) looking forward at the aforementioned target while listening to music without handling the phone (listening). Local dynamic stability measured in terms of the largest Lyapunov exponent decreased while handling a cell phone (talking and texting). Gait variability and regularity increased when talking on a cell phone, but no variable changed in the listening condition. Under all dual-task conditions, there were significant increases in stride width and its variability. We conclude that young adults who use a cell phone when walking adapt their gait pattern conservatively, which can be because of increased attentional demand during cell phone use.



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Balance impairment in kidney transplant recipients without concurrent peripheral neuropathy

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): T. Zanotto, S. Gobbo, V. Bullo, B. Vendramin, F. Duregon, L. Cugusi, A. Di Blasio, L. Furian, C. Silvestre, D. Neunhaeuserer, M. Zaccaria, M. Bergamin, A. Ermolao
Kidney transplant recipients (KTRs) present with compromised functional capacity, low levels of physical activity, muscle atrophy, and peripheral nerve dysfunction that may result in high postural instability. This study aimed to compare the static balance control of 19 KTRs with 19 healthy adults (HA). All participants completed the Romberg test on a stabilometric platform with eyes open (EO), eyes closed (EC) and during a dual task (DT) condition. Centre of pressure (COP) measures (COP velocity (COPv) and sway area (SA)), as well as position-based outcomes such as anterior-posterior (AP) and medio-lateral (ML) ranges of COP displacements were recorded. Independent ANCOVA revealed an overall lower performance of KTRs compared to HA (p<0.05) with the EC condition exhibiting the worst relative performance for KTRs, suggesting a poorer capacity of relying on proprioceptive information when maintaining the upright posture. The addition of a cognitive task did not further worsen balance performance in KTRs. As impaired postural control is one of the main predictors of falls in elderly subjects, these data might also indicate that this constitutes an equivalent risk factor for falling in middle-aged KTRs.



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Correlation of technical surgical goals to the GDI and investigation of post-operative GDI change in children with cerebral palsy

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Christina Bickley, Judi Linton, Nancy Scarborough, Elroy Sullivan, Katy Mitchell, Douglas Barnes
AimThe purpose of this study was to introduce a standardized set of surgical technical achievement goals (TAGs) as part of a comprehensive outcome assessment model for children with spastic cerebral palsy (CP) undergoing orthopaedic surgical intervention to improve gait. Examination of relationships of these surgical goals to the Gait Deviation Index (GDI) and use of two assessments in tandem provided a thorough picture of technical surgical outcomes.This study also investigated changes in GDI in children with spastic CP after surgery.MethodsData from 269 participants with spastic CP, aged 4 to 19 years with Gross Motor Function Classification System (GMFCS) levels I, II, and III who underwent lower extremity orthopaedic surgical intervention to improve gait were retrospectively analyzed. Data were examined as one heterogeneous group and sub-grouped based on pattern of involvement and GMFCS level to determine change in GDI and relationships between GDI and TAGs.ResultsDifferences in TAG achievement and GDI change by GMFCS level suggest a pairing of GDI with another technical measure to be beneficial. Analysis of the outcome tools individually revealed a significant difference between the pre-operative GDI and post-operative GDI mean for the entire group, as well as each of the subgroups. A significant difference in TAG achievement by GMFCS level was also noted.ConclusionThis paper provides evidence that lower extremity orthopedic intervention for the ambulatory child with spastic diplegic or hemiplegic CP improves gait and that a pairing of the GDI and TAGs system is beneficial to capture an accurate technical outcome assessment in both higher and lower functioning patients.



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The effects of object height and visual information on the control of obstacle crossing during locomotion in healthy older adults

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Sho Kunimune, Shuichi Okada
In order to safely avoid obstacles, humans must rely on visual information regarding the position and shape of the object obtained in advance. The present study aimed to reveal the duration of obstacle visibility necessary for appropriate visuomotor control during obstacle avoidance in healthy older adults. Participants included 13 healthy young women (mean age: 21.5±1.4years) and 15 healthy older women (mean age: 68.5±3.5years) who were instructed to cross over an obstacle along a pressure-sensitive pathway at a self-selected pace while wearing liquid crystal shutter goggles. Participants were evaluated during three visual occlusion conditions: (i) full visibility, (ii) occlusion at T-1 step (T: time of obstacle crossing), and (iii) occlusion at T-2 steps. Toe clearances of both the lead and trail limb (LTC and TTC) were calculated. LTC in the occlusion at T-2 steps condition was significantly greater than that in other conditions. Furthermore, a significant correlation was observed between LTC and TTC in both groups, regardless of the condition or obstacle height. In the older adult group alone, step width in the occlusion at T-2 steps condition increased relative to that in full visibility conditions. The results of the present study suggest that there is no difference in the characteristics of visuomotor control for appropriate obstacle crossing based on age. However, older adults may exhibit increased dependence on visual information for postural stability; they may also need an increased step width when lacking information regarding their positional relationship to obstacles.



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Local dynamic stability and gait variability during attentional tasks in young adults

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Rina Márcia Magnani, Georgia Cristina Lehnen, Fábio Barbosa Rodrigues, Gustavo Souto de Sá e Souza, Adriano de Oliveira Andrade, Marcus Fraga Vieira
Cell phone use while walking may be a cognitive distraction and reduce visual and motor attention. Thus, the aim of this study was to verify the effects of attentional dual-tasks while using a cell phone in different conditions. Stability, regularity, and linear variability of trunk kinematics, and gait spatiotemporal parameters in young adults were measured. Twenty young subjects of both genders were asked to walk on a treadmill for 4min under the following conditions: (a) looking forward at a fixed target 2.5m away (walking); (b) talking on a cell phone with unilateral handling (talking); (c) texting messages on a cell phone with unilateral handling (texting); and (d) looking forward at the aforementioned target while listening to music without handling the phone (listening). Local dynamic stability measured in terms of the largest Lyapunov exponent decreased while handling a cell phone (talking and texting). Gait variability and regularity increased when talking on a cell phone, but no variable changed in the listening condition. Under all dual-task conditions, there were significant increases in stride width and its variability. We conclude that young adults who use a cell phone when walking adapt their gait pattern conservatively, which can be because of increased attentional demand during cell phone use.



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Balance impairment in kidney transplant recipients without concurrent peripheral neuropathy

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): T. Zanotto, S. Gobbo, V. Bullo, B. Vendramin, F. Duregon, L. Cugusi, A. Di Blasio, L. Furian, C. Silvestre, D. Neunhaeuserer, M. Zaccaria, M. Bergamin, A. Ermolao
Kidney transplant recipients (KTRs) present with compromised functional capacity, low levels of physical activity, muscle atrophy, and peripheral nerve dysfunction that may result in high postural instability. This study aimed to compare the static balance control of 19 KTRs with 19 healthy adults (HA). All participants completed the Romberg test on a stabilometric platform with eyes open (EO), eyes closed (EC) and during a dual task (DT) condition. Centre of pressure (COP) measures (COP velocity (COPv) and sway area (SA)), as well as position-based outcomes such as anterior-posterior (AP) and medio-lateral (ML) ranges of COP displacements were recorded. Independent ANCOVA revealed an overall lower performance of KTRs compared to HA (p<0.05) with the EC condition exhibiting the worst relative performance for KTRs, suggesting a poorer capacity of relying on proprioceptive information when maintaining the upright posture. The addition of a cognitive task did not further worsen balance performance in KTRs. As impaired postural control is one of the main predictors of falls in elderly subjects, these data might also indicate that this constitutes an equivalent risk factor for falling in middle-aged KTRs.



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Correlation of technical surgical goals to the GDI and investigation of post-operative GDI change in children with cerebral palsy

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Christina Bickley, Judi Linton, Nancy Scarborough, Elroy Sullivan, Katy Mitchell, Douglas Barnes
AimThe purpose of this study was to introduce a standardized set of surgical technical achievement goals (TAGs) as part of a comprehensive outcome assessment model for children with spastic cerebral palsy (CP) undergoing orthopaedic surgical intervention to improve gait. Examination of relationships of these surgical goals to the Gait Deviation Index (GDI) and use of two assessments in tandem provided a thorough picture of technical surgical outcomes.This study also investigated changes in GDI in children with spastic CP after surgery.MethodsData from 269 participants with spastic CP, aged 4 to 19 years with Gross Motor Function Classification System (GMFCS) levels I, II, and III who underwent lower extremity orthopaedic surgical intervention to improve gait were retrospectively analyzed. Data were examined as one heterogeneous group and sub-grouped based on pattern of involvement and GMFCS level to determine change in GDI and relationships between GDI and TAGs.ResultsDifferences in TAG achievement and GDI change by GMFCS level suggest a pairing of GDI with another technical measure to be beneficial. Analysis of the outcome tools individually revealed a significant difference between the pre-operative GDI and post-operative GDI mean for the entire group, as well as each of the subgroups. A significant difference in TAG achievement by GMFCS level was also noted.ConclusionThis paper provides evidence that lower extremity orthopedic intervention for the ambulatory child with spastic diplegic or hemiplegic CP improves gait and that a pairing of the GDI and TAGs system is beneficial to capture an accurate technical outcome assessment in both higher and lower functioning patients.



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The effects of object height and visual information on the control of obstacle crossing during locomotion in healthy older adults

Publication date: June 2017
Source:Gait & Posture, Volume 55
Author(s): Sho Kunimune, Shuichi Okada
In order to safely avoid obstacles, humans must rely on visual information regarding the position and shape of the object obtained in advance. The present study aimed to reveal the duration of obstacle visibility necessary for appropriate visuomotor control during obstacle avoidance in healthy older adults. Participants included 13 healthy young women (mean age: 21.5±1.4years) and 15 healthy older women (mean age: 68.5±3.5years) who were instructed to cross over an obstacle along a pressure-sensitive pathway at a self-selected pace while wearing liquid crystal shutter goggles. Participants were evaluated during three visual occlusion conditions: (i) full visibility, (ii) occlusion at T-1 step (T: time of obstacle crossing), and (iii) occlusion at T-2 steps. Toe clearances of both the lead and trail limb (LTC and TTC) were calculated. LTC in the occlusion at T-2 steps condition was significantly greater than that in other conditions. Furthermore, a significant correlation was observed between LTC and TTC in both groups, regardless of the condition or obstacle height. In the older adult group alone, step width in the occlusion at T-2 steps condition increased relative to that in full visibility conditions. The results of the present study suggest that there is no difference in the characteristics of visuomotor control for appropriate obstacle crossing based on age. However, older adults may exhibit increased dependence on visual information for postural stability; they may also need an increased step width when lacking information regarding their positional relationship to obstacles.



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