Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Τρίτη 9 Μαΐου 2017
Heavy mite exposure in the environment can induce allergic systemic reactions.
http://alexsfakianakis.blogspot.com/2017/05/mite-hypersensitivity.html
Anaphylaxis
Anaphylaxis is an acute emergency that is potentially fatal and commonly related to an allergic and immunologic trigger requiring immediate effective life-saving treatment [151]. Heavy mite exposure in the environment can induce allergic systemic reactions. More recently, the induction of anaphylaxis through ingestion of mite-contaminated foods has been described [152].
Pancake anaphylaxis, also called oral mite anaphylaxis (OMA), is a relatively new syndrome characterized by severe allergic symptoms occurring immediately after eating foods, especially containing flours, contaminated with mites. These cooked foods contain thermoresistant mite allergens and contaminated wheat flour used to make pancakes is its most common presentation [152]. A variant clinical picture is provoked by physical exercise and is called dust mite ingestion-associated exercise-induced anaphylaxis [153]. OMA is more prevalent in tropical and subtropical areas of the globe where mites grow easily in their warm and humid environments [154]. There are reports in the literature of two fatalities associated with the ingestion of foods contaminated with mites [155, 156]. Mites responsible for OMA include domestic and storage species and can be present in any type of flours. There is an intriguing association of OMA and hypersensitivity to aspirin and nonsteroidal anti-inflammatory drugs (NSAIDS) for which there is no good explanation yet and it is more prevalent in patients with house dust mite allergic rhinitis and/or asthma [157]. The higher the contaminated mite ingestion the greater the risk for anaphylaxis. OMA confirmation requires the microscopic documentation and identification of mites in the suspected flour. Alternatively the immunoassay for demonstration of the presence of mite allergens in the suspected flour can be used. It is imperative to try to prevent the worldwide OMA delineating predisposing genetic factors and determining if mite immunotherapy might be efficacious modifying the clinical course of this important variety of food anaphylaxis [152, 158].
Co-sensitization to cockroaches, some crustaceans (shrimp, crab, lobster), shellfish (clams, mussels), and mollusks (snails) is often described and likely due to the presence of allergens in the tropomyosins family, present in some crustaceans (major allergen of shrimp: Pen 1), insects (some flies, mosquitoes, cockroaches), gastropods and mites (Der f 10) [122].
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Prevention of Dust Mite and Dust Mite Allergen Exposure
Justification for Dust Mite Exposure Control
The decision to initiate environmental controls to reduce dust mite exposure can be complex. Total prevention of exposure to mite allergenic material to prevent IgE sensitization to mite allergens in genetically susceptible individuals requires strict, continuous avoidance of mite exposure, which is practically all but impossible [199]. Furthermore, to curtail development of all cross-reacting specific IgE, avoidance of all arthropods would probably be required [200]. The majority of the world's population lives on seacoasts [201] or along rivers [202] and these areas typically have adequate humidity to support growth of dust mites and storage mites during all parts of the year.
Much research has been conducted to determine if it is possible to reduce development of mite-specific IgE-mediated sensitization (primary prevention). Several studies comparing dust mite sensitization rates in children from areas endemically low and areas endemically high in dust mite allergen indicated that the prevalence and degree of sensitization to dust mite was strongly associated with the amount of exposure to mite allergens [203, 204]. A prospective study of mite allergen avoidance in Manchester, UK, [205, 206] using a combination of interventions, decreased Der p 1 from mattresses by 97% to the nanogram range during pregnancy and 12 months after birth in the active group [205]. However, with all possible dust mite exposures at homes of friends and family, on public transportation and in public places and at schools and day care centers, primary prevention of dust mite sensitization by mite allergen avoidance may not be possible [207, 208, 209].
Secondary prevention, or the attempt to reduce the risk of asthma in dust mite sensitized children has also received much attention. The link between asthma and dust mite exposure is one of the most extensively studied relationships between environmental exposure and disease development [210, 211, 212, 213]. In all climates conducive to the growth of dust mites, mite exposure may be one of the factors contributing to the development of asthma [112, 214]. Secondary prevention has also been the goal for many children with allergic rhinitis who are at risk of the subsequent development of asthma. However, to date there is no evidence-based information as to whether mite avoidance may be effective as a secondary preventive measure to prevent/delay asthma development among mite-sensitized individuals, or those with allergic rhinitis.
The relation of dust mite allergen exposure and the worsening of allergic respiratory symptoms is well documented [215]. In one study of 311 subjects both sensitized and exposed to high levels of indoor allergen including dust mite allergen there was significantly lower FEV1% predicted values (mean, 83.7% vs 89.3%; mean difference, 5.6%; 95% CI, 0.6%-10.6%; P = .03), higher eNO values (geometric mean [GM], 12.8 vs 8.7 ppb; GM ratio, 0.7; 95% CI, 0.5-0.8; P = .001), and more severe airways reactivity (PD20 GM, 0.25 vs 0.73 mg; GM ratio, 2.9; 95% CI, 1.6-5.0; P < .001) as compared with subjects not sensitized and exposed [216]. Adults in a 4-year study who were both sensitized and exposed to high levels of dust mite allergens had increased bronchial hyper-responsiveness [217]. Many additional links between dust mite exposure and allergic disease are documented in the recent environmental practice parameter on dust mites [198]. A reduction in the symptoms experienced by those with atopic dermatitis has also been linked to house dust-mite allergen avoidance [218].
Facilitative factors and Allergen Reservoirs
Controlling factors that facilitate the growth and reproduction of dust mites has been an often sought goal in exposure control. The dependence of dust mites on the water content of the air has been extensively documented [219, 220]. Arid climates have an intrinsically low abundance of dust mites, and the most effective method of controlling dust mite exposure is to live in a very dry climate such as the high desert of New Mexico in the US or the Altiplano or Bolivian Plateau, in west-central South America [202]. Since this is not a practical solution, mimicking these conditions in the home environment as much as possible provides an opportunity to control mite population growth.
Humidity control should be the mainstay of any mite control efforts. The most important factor facilitating dust mite growth, reproduction and allergen production is the availability of water in the surrounding environment [220]. Mites absorb moisture directly from their surroundings under conditions of high moisture and lose water when moisture is low. The mite moisture equilibrium therefore is not directly relative humidity dependent. It is instead dependent of the moisture situation of the local microenvironment and the moisture retention ability of the mite's immediate surroundings such as carpet dust reservoirs or bedding. A simple measurement of relative humidity may not assure an environment free of dust mite activity. Microenvironments that exist in bedding, in carpet next to concrete or in pet lounging areas may provide adequate moisture for mite survival in climates not expected to have a mite presence. A mite surrounded by a hygroscopic microenvironment as moist bedding can survive much dryer conditions than would be expected. Of note, exposure to a moisture rich environment for only a short period can provide enough moisture for growth and metabolism [221].
Although directly linked to water content of the air in the calculation of relative humidity, temperature is also a factor in dust mite survival. Conditions at the extreme ends of the temperature spectrum, either to cold or to hot can impact mite survival although elevated temperature conditions tend to be more lethal than freezing. Mites and their eggs survive poorly when exposed to hot water and clothes dryers but survive during short periods of freezing conditions. The exposure to direct sunlight is an often forgotten factor in the destruction of dust mites [222].
It is not enough to address mite factors facilitating mite population growth. Reservoirs of mite allergen must also be eliminated. House dust mites can be found in any area of the home, however they are most often associated with certain indoor environments including the bedroom carpet, mattresses and bedding, frequently occupied upholstered furniture and in pet lounging areas [223, 224]. Recent investigations have questioned the traditional concepts of the location of dust mite reservoirs indicating that significant exposure can occur in public transportation conveyances and associated with work environments as well as clothing [207].
Climate Factors
Although residents of cold and arid climates are less likely to be exposed to house dust mites, the large majority of the world population is exposed to house dust mites. Nearly half of the people in the world live within 200 km of the coast where humidity levels are typically higher. The rate of population growth in coastal areas is accelerating. In China alone over 400 million live in coastal cities. Dust mite exposures and the allergic problems related to those exposures are likely to increase [201].
Although many climates are naturally conducive to mite growth and allergen production, the artificial control of indoor climates is increasing. Even though it is energy intensive, the use of forced air heating and air conditioning is growing around the world and especially in more affluent economies. Dust mite allergen exposure control is therefore a viable option for large numbers of persons. In many areas seasonal heating requirements result in very dry indoor environments and subsequently dust mite exposure is a seasonal phenomenon. Low humidity conditions can also be obtained through use of air conditioning and dehumidification. Yet, in many areas of the world ambient humidity levels are high enough that producing low humidity levels sufficient to preclude dust mite growth is not practically achievable. The recent Cochrane study on dehumidification alone indicates that evidence of clinical benefits of dehumidification using mechanical ventilation with dehumidifiers is scanty [225]. Indeed, the meta-analysis of multiple dust mite control studies would lead the reader to believe that there is nothing that can be physically done to control dust mites and improve health. Yet, this conclusion is disputed by many experts in the field of allergy [226]. Furthermore, the nature of single source exposure control studies may preclude successful clinical improvement because allergen sensitization is typically to multiple agents.
A significant amount of work has been done on removal of mites and mite allergens through cleaning. It goes without saying that efforts to control mite infestations of the skin and remove mite infestations from clothing are essential in the maintenance of overall health [227]. Humans have been living with dust mites for generations and they might even be described as among our "old friends" [228]. But no physician would advocate for wearing mite infested clothing or sleeping in mite infested bedding. Mite sensitization is likely to occur in genetically susceptible individuals, therefore efforts to reduce instances of elevated mite exposure and thus reduce allergic symptoms are only prudent [229].
Since mite allergens are located in known areas of a typical house [229, 230] removing mite allergen reservoirs is a very effective way to reduce mite allergen exposure. Efforts to remove carpets, drapes, upholstered furniture and any other fabric covered objects from the living environment can effectively reduce mite allergen exposure. The extent to which these items are removed will ultimately be a matter of personal preference. Since mite allergens are known to be heavy and not aerodynamically suited for airborne disbursal [34] and high humidity microenvironments are known to exist in bedding it is logical to focus dust mite reduction efforts on bedding. Efforts to enclose mattresses, box springs and pillows in mite-impermeable covers are known to be very effective [231]. However, it is important to mention that the efficacy of allergen avoidance in patients with already established rhinitis or asthma is a matter of debate [232, 233, 234, 235].
Washing bedding in hot water and even with bleach and drying bedding in very hot conditions or even in direct sunlight are known to reduce both the presence of mite allergen and the mites themselves [236, 237]. Washing bedding and clothing removes mite allergens and kills mites. Most of the killing is through drowning, although washing in hotter water kills more mites. The temperature used to wash bedding has become an issue. Elevated temperatures are more energy intensive and hotter water is a scalding hazard. Experts agree that washing is better than not washing and washing with water that is 48° Celsius provides optimum mite killing and home safety [199].
Heat treatment can be effective in killing mites and their eggs. Treatment of cloth at 95° Celsius killed all mites present [238]. However, treatment at 40 °C under dry and wet conditions allowed approximately 80% of all mite eggs to survive. Under dry heat at 50 °C, the thermal death point of dust mite eggs occurred at 5 h and at 60 °C death occurred almost instantaneously [239]. Presumably the eggs survive heat better than the mites themselves. Homes treated with heat-steam over a period of months showed a sustained reduction of Der p 1 and Der p 2 compared to sham treated homes [240] However, mite allergens have been demonstrated to be stable even at elevated temperatures [241].
Although the practice has fallen into senescence in the modern world of appliances, there was a time when frequently placing bedding in direct sunlight for several hours was practiced in many cultures. It has been demonstrated that ultraviolet irradiation is lethal to many organisms including dust mites [242, 243].
Many harsh chemicals are known to kill dust mites or denature mite allergens in industrial and household settings. Agents like tannic acid, Benzyl benzoate, Disodium octaborate tetrahydrate, tri-n-butyl tin maleate, pirimiphos methyl and even "essential oils" like methyl eugenol have been described in the literature to effectively kill mites [244, 245, 246, 247, 248]. However, they are all dangerous at some concentration and cannot be recommended for use by patients or homeowners [199].
It has been suggested that freezing can be effective in killing dust mites and the recommendation to place small cloth items like stuffed animals in the freezer compartment of house hold refrigerators has been frequently given out by allergists. However, there is little evidence that this is effective. There may be some mite death due to desiccation in the dry environment of a household freezer. But, dust mite eggs have been shown to resist freezing at temperatures above −70° Celsius [222]. And, freezing is not effective in removing dust mite allergen from reservoirs because dust mite allergen is stable at low temperatures for extended periods of time [239].
Air conditioning would have a twofold impact on dust mite populations. The cool temperatures will slow mite metabolism and reproduction and reduce moisture need for mite survival. Microenvironments or increased humidity can be reduced using a dehumidifier and/or air conditioning. The absence of air conditioning has been shown to be a factor contributing to increased mite allergen levels in US homes [249]. Air conditioners must be operated for a long time to remove sufficient moisture from the air to effectively decrease room humidity. Mechanical ventilation heat pump recovery units in the UK failed to achieve the desired mite reduction results [250].
Evidence on clinical benefits of dehumidification using mechanical ventilation with dehumidifiers remains scanty [225]. Although dehumidification and air conditioning doubtlessly reduce overall dust mite exposure [251], the difficulty in using dehumidification alone in damp environments to decrease dust mite antigen exposure has been described in a recent Cochrane review [225].
Summary of current recommendations
Most publications on allergy and dust mite control would agree that a comprehensive program of personal hygiene, bed hygiene, properly fitted allergen-impermeable covers, cleaning, dehumidification or air conditioning and appropriate food storage in very damp climates can reduce exposure to house dust mite allergens. It is a stretch further to conclude that the above steps can improve symptoms in those already allergic to dust mites. However, depending on the sensitivity and life style of the allergic person, prudent efforts over an extended period of time are likely to result in gradual improvement in health. The fact that current studies do not provide sufficient evidence for critical reviews to conclude there is unequivocal benefit is no reason to abandon logical and prudent efforts to reduce mite exposure.
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Mite Allergy Research The authors view the following as currently unmet needs in mite allergy research: Since mites constitute the most important allergen source worldwide the information contained in this document needs to be disseminated to all ranks of the medical establishment for educational purposes and to stimulate research Increased knowledge on the cellular basis of the immune responses to mites A better understanding of the link between mite sensitization and allergic diseases Better insights into the genetic influences controlling IgE responses to mite allergens. Effects of epigenetic factors Improved mite allergen standardization Development of purified mite allergens with defined clinically relevant epitopes for molecular diagnosis and evaluation of the response to immunotherapy Development of objective methods to assess allergen exposure and environmental control outcomes Better strategies for immunotherapy and immunoprophylaxis of mite allergy: recombinant allergens, h
http://alexsfakianakis.blogspot.com/2017/05/mite-hypersensitivity.html
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Rick factors for medical and allergic events during air travel An increase of passenger’s age Flight stress and anxiety, including increased security procedures Disruption of routine Changes in the cabin environment (temperature, humidity, air pressure) Decreased seat space Flight delays Alcohol/drug intake Longer flights Altered circadian rhythm Jet lag Pre-existing medical conditions
http://alexsfakianakis.blogspot.com/2017/05/in-flight-allergic-emergencies.html
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
In-flight treatment of allergic emergencies and asthma Treating medical emergencies during flight is a major challenge and air travel is an important concern for subjects with asthma and a history of a SAR. The resources to treat allergic emergencies are somewhat limited. In the United States, the Federal Aviation Administration requires the inclusion of epinephrine in medical kits carried on board [18]. These emergency medical kits typically contain the following medications [19]: Aqueous epinephrine (adrenaline) 1:10000 and 1:1000 dilution. Albuterol (salbutamol) for nebulization. Bronchodilator aerosol inhaler. Cortisol (hydrocortisone). Antihistamines tablets and injectable (commonly diphenhydramine). A recommendation from this World Allergy Organization (WAO) expert group for in-flight treatment of a SAR and AE is: a) For AE, inhaled bronchodilator and oxygen. Consider an oral, intramuscular or intravenous corticosteroid for moderate to severe symptoms and intramuscular epinephr
http://alexsfakianakis.blogspot.com/2017/05/in-flight-allergic-emergencies.html
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Measures that reduce the risk of an in-flight reaction to peanut and tree nuts 1. Passengers requesting any kind of special accommodation (e.g., peanut/tree nut snacks not be distributed, announcement to not eat items with peanut/tree nut, request special peanut/tree nut-free meal, buffer zone, pre-board, request to sit in a certain seat/zone). 2. Peanut/tree nut-free meals. 3. Wiping of tray tables 4. Avoidance of airline pillows or blankets 5. Buffer zones around which peanut or nut products cannot be consumed 6. Request other passengers not to consume peanut/tree nut-containing products 7. Announcement that passengers do not eat peanut/tree nut containing goods 8. Not consuming airline-provided food
http://alexsfakianakis.blogspot.com/2017/05/in-flight-allergic-emergencies.html
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Recommendations to prevent and manage in-flight allergic events • Promote the prevention of allergic diseases via passenger education • Medical consultation for high-risk passengers before traveling • Train and re-train aircrews • Promote general preventive measures during the flight: hydration, food allergen avoidance (especially peanuts, tree nuts, other foods, as necessary) • Provide an appropriate place for furry pets away from subjects with pet allergy • Provide for sufficient quantities of appropriate medications: epinephrine (adrenaline), β2 agonists for inhalation and nebulization, oral and injectable corticosteroids and antihistamines • Oxygen
Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480
Turkish Standardized Reading Passage for the Evaluation of Hard Glottal Attack Occurrence Frequency
Source:Journal of Voice
Author(s): Melek Nur Uygun, Fatma Esen Aydınlı, Songül Aksoy, Esra Özcebe
ObjectiveThis study aimed to develop a Turkish reading passage that can be used in evaluating the frequency of hard glottal attack (HGA) and to assess its reliability.Study DesignThis is a prospective case-control study.MethodsThe Towne-Heuer reading passage is a valuable tool that can be used for the auditory-perceptual assessment of voice. The characteristics of the first four paragraphs of the reading passage were analyzed by a linguist. Then, a Turkish reading passage with similar characteristics was developed. The control group (n = 21) consisted of individuals with no voice disorder. The study group consisted of two subgroups that were diagnosed as having vocal fold nodules (n = 11) and muscle tension dysphonia (n = 10). A total of three listeners were evaluated for the frequency of HGAs. One of the listeners was a master's student, whereas the other two listeners were speech-language pathologists. Consistency between the listeners was evaluated by using the percent agreement and the kappa statistics. Intrarater reliability was assessed by the Wilcoxon sign test. The t test was used to evaluate potential differences between the groups. The results were considered as significant if the P value was <0.05.ResultsThe average attack number in the study group was found to be significantly higher than the controls (P < 0.05). No significant difference could be discerned between the muscle tension dysphonia and vocal nodule subgroups (P > 0.05).ConclusionsFindings confirmed that HGAs are clearly related to the vocal hyperfunction; however, the mechanism of action needs more research. In addition, the relationship between syllable stress and HGA should be further researched to clarify the cause of the attack number differences between English and Turkish languages.
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Objective assessment of movement competence in children using wearable sensors: An instrumented version of the TGMD-2 locomotor subtest
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Maria Cristina Bisi, G. Pacini Panebianco, R. Polman, R. Stagni
Movement competence (MC) is defined as the development of sufficient skill to assure successful performance in different physical activities. Monitoring children MC during maturation is fundamental to detect early minor delays and define effective intervention. To this purpose, several MC assessment batteries are available. When evaluating movement strategies, with the aim of identifying specific skill components that may need improving, widespread MC assessment is limited by high time consumption for scoring and the need for trained operators to ensure reliability. This work aims to facilitate and support the assessment by designing, implementing and validating an instrumented version of the TGMD-2 locomotor subtest based on Inertial Measurement Units (IMUs) to quantify MC in children rapidly and objectively. 45 typically developing children, aged 6–10, performed the TGMD-2 locomotor subtest (six skills). During the tests, children wore five IMUs mounted on lower back, on ankles and on wrists. Sensor and video recordings of the tests were collected. Three expert evaluators performed the standard assessment of TGMD-2. Using theoretical and modelling approaches, algorithms were implemented to automatically score children tests based on IMUs’ data. The automatic assessment, compared to the standard one, showed an agreement higher than 87% on average on the entire group for each skill and a reduction of time for scoring from 15 to 2min per participant. Results support the use of IMUs for MC assessment: this approach will allow improving the usability of MC assessment, supporting objectively evaluator decisions and reducing time requirement for the evaluation of large groups.
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Source:Gait & Posture, Volume 56
Author(s): Maria Cristina Bisi, G. Pacini Panebianco, R. Polman, R. Stagni
Movement competence (MC) is defined as the development of sufficient skill to assure successful performance in different physical activities. Monitoring children MC during maturation is fundamental to detect early minor delays and define effective intervention. To this purpose, several MC assessment batteries are available. When evaluating movement strategies, with the aim of identifying specific skill components that may need improving, widespread MC assessment is limited by high time consumption for scoring and the need for trained operators to ensure reliability. This work aims to facilitate and support the assessment by designing, implementing and validating an instrumented version of the TGMD-2 locomotor subtest based on Inertial Measurement Units (IMUs) to quantify MC in children rapidly and objectively. 45 typically developing children, aged 6–10, performed the TGMD-2 locomotor subtest (six skills). During the tests, children wore five IMUs mounted on lower back, on ankles and on wrists. Sensor and video recordings of the tests were collected. Three expert evaluators performed the standard assessment of TGMD-2. Using theoretical and modelling approaches, algorithms were implemented to automatically score children tests based on IMUs’ data. The automatic assessment, compared to the standard one, showed an agreement higher than 87% on average on the entire group for each skill and a reduction of time for scoring from 15 to 2min per participant. Results support the use of IMUs for MC assessment: this approach will allow improving the usability of MC assessment, supporting objectively evaluator decisions and reducing time requirement for the evaluation of large groups.
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Constituent Lower Extremity Work (CLEW) approach: A novel tool to visualize joint and segment work
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Anahid Ebrahimi, Saryn R. Goldberg, Jason M. Wilken, Steven J. Stanhope
Work can reveal the mechanism by which movements occur. However, work is less physically intuitive than more common clinical variables such as joint angles, and are scalar quantities which do not have a direction. Therefore, there is a need for a clearly reported and comprehensively calculated approach to easily visualize and facilitate the interpretation of work variables in a clinical setting. We propose the Constituent Lower Extremity Work (CLEW) approach, a general methodology to visualize and interpret cyclic tasks performed by the lower limbs. Using six degree-of-freedom power calculations, we calculated the relative work of the four lower limb constituents (hip, knee, ankle, and distal foot). In a single pie chart, the CLEW approach details the mechanical cost-of-transport, the percentage of positive and negative work performed in stance phase and swing phase, and the individual contributions of positive and negative work from each constituent. This approach can be used to compare the constituent-level adaptations occurring between limbs of individuals with impairments, or within a limb at different gait intensities. In this article, we outline how to generate and interpret the CLEW pie charts in a clinical report. As an example of the utility of the approach, we created a CLEW report using average reference data from eight unimpaired adult subjects walking on a treadmill at 0.8 statures/s (1.4m/s) compared with data from the intact and prosthetic limbs of an individual with a unilateral amputation walking with an above-knee passive prosthesis.
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Source:Gait & Posture, Volume 56
Author(s): Anahid Ebrahimi, Saryn R. Goldberg, Jason M. Wilken, Steven J. Stanhope
Work can reveal the mechanism by which movements occur. However, work is less physically intuitive than more common clinical variables such as joint angles, and are scalar quantities which do not have a direction. Therefore, there is a need for a clearly reported and comprehensively calculated approach to easily visualize and facilitate the interpretation of work variables in a clinical setting. We propose the Constituent Lower Extremity Work (CLEW) approach, a general methodology to visualize and interpret cyclic tasks performed by the lower limbs. Using six degree-of-freedom power calculations, we calculated the relative work of the four lower limb constituents (hip, knee, ankle, and distal foot). In a single pie chart, the CLEW approach details the mechanical cost-of-transport, the percentage of positive and negative work performed in stance phase and swing phase, and the individual contributions of positive and negative work from each constituent. This approach can be used to compare the constituent-level adaptations occurring between limbs of individuals with impairments, or within a limb at different gait intensities. In this article, we outline how to generate and interpret the CLEW pie charts in a clinical report. As an example of the utility of the approach, we created a CLEW report using average reference data from eight unimpaired adult subjects walking on a treadmill at 0.8 statures/s (1.4m/s) compared with data from the intact and prosthetic limbs of an individual with a unilateral amputation walking with an above-knee passive prosthesis.
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Title: Gait patterns of children and adolescents with Charcot-Marie-Tooth disease
Publication date: Available online 8 May 2017
Source:Gait & Posture
Author(s): Elizabeth Wojciechowski, Amy Sman, Kayla Cornett, Jacqueline Raymond, Kathryn Refshauge, Manoj P. Menezes, Joshua Burns
Gait abnormalities reported in childhood Charcot-Marie-Tooth disease (CMT) include foot-drop, reduced ankle power at push-off and increased knee and hip flexion for swing clearance (‘steppage-gait’). The purpose of this study was to describe the gait patterns of 60 children aged 6-17 years with CMT (CMTall) and distinguish differences based on functional weakness using the CMT Pediatric Scale (CMTPedS). Data were captured using Vicon Nexus system and compared to 50 healthy norms. Data were subdivided into three groups denoting increasing severity of dorsiflexion and plantarflexion weakness from the CMTPedS: no difficulty heel or toe walking (CMTND), difficulty heel walking (CMTDH), difficulty toe and heel walking (CMTDTH). Compared to healthy norms, CMTall demonstrated significantly worse gait profile score, reduced ankle dorsiflexion during swing (foot-drop), reduced ankle dorsiflexor moment in loading response and reduced external thigh-foot angle. Contrary to previous studies there were no signs of reduced ankle power or compensation through ‘steppage gait’ in this mild-moderately affected population. Instead, CMTall demonstrated reduced internal hip rotation and reduced hip abductor moment. When data were sub-grouped and compared to healthy norms, three different gait patterns at the ankle emerged: CMTND had a near-normal gait pattern, CMTDH presented with foot-drop, and CMTDTH had increased peak dorsiflexion and reduced ankle power generation. Several distinct and abnormal gait patterns were identified in children with CMT, with increasing gait abnormalities in more functionally severe cases. Classifying gait patterns based on disease severity might be a valuable tool in clinical decision making, assessing disease progression and phenotype-genotype correlation studies.
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Source:Gait & Posture
Author(s): Elizabeth Wojciechowski, Amy Sman, Kayla Cornett, Jacqueline Raymond, Kathryn Refshauge, Manoj P. Menezes, Joshua Burns
Gait abnormalities reported in childhood Charcot-Marie-Tooth disease (CMT) include foot-drop, reduced ankle power at push-off and increased knee and hip flexion for swing clearance (‘steppage-gait’). The purpose of this study was to describe the gait patterns of 60 children aged 6-17 years with CMT (CMTall) and distinguish differences based on functional weakness using the CMT Pediatric Scale (CMTPedS). Data were captured using Vicon Nexus system and compared to 50 healthy norms. Data were subdivided into three groups denoting increasing severity of dorsiflexion and plantarflexion weakness from the CMTPedS: no difficulty heel or toe walking (CMTND), difficulty heel walking (CMTDH), difficulty toe and heel walking (CMTDTH). Compared to healthy norms, CMTall demonstrated significantly worse gait profile score, reduced ankle dorsiflexion during swing (foot-drop), reduced ankle dorsiflexor moment in loading response and reduced external thigh-foot angle. Contrary to previous studies there were no signs of reduced ankle power or compensation through ‘steppage gait’ in this mild-moderately affected population. Instead, CMTall demonstrated reduced internal hip rotation and reduced hip abductor moment. When data were sub-grouped and compared to healthy norms, three different gait patterns at the ankle emerged: CMTND had a near-normal gait pattern, CMTDH presented with foot-drop, and CMTDTH had increased peak dorsiflexion and reduced ankle power generation. Several distinct and abnormal gait patterns were identified in children with CMT, with increasing gait abnormalities in more functionally severe cases. Classifying gait patterns based on disease severity might be a valuable tool in clinical decision making, assessing disease progression and phenotype-genotype correlation studies.
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Gait Characteristics of Children and Youth With Chemotherapy Induced Peripheral Neuropathy Following Treatment for Acute Lymphoblastic Leukemia
Publication date: Available online 9 May 2017
Source:Gait & Posture
Author(s): Marilyn J. Wright, Donna M. Twose, Jan Willem Gorter
Sensory changes and muscle weakness attributable to chemotherapy induced peripheral neuropathy (CIPN) are possible sequela of treatment for acute lymphoblastic leukemia (ALL) which can result in long-lasting difficulties with walking. The purpose of this study was to describe the gait characteristics of children and youth treated for ALL who exhibited CIPN compared to typically developing children and youth using 3D motion analyses and electromyography (EMG). Temporal-spatial, kinematic, kinetic, and electromyographic (EMG) data were collected from 17 youth (mean age 11.2 (5.7) years) with CIPN and compared to data from 10 typically developing youth. Although the gait of the CIPN group was heterogeneous between and within participants, the CIPN group demonstrated primary deviations attributable to CIPN and secondary deviations, both passive effects and active compensatory mechanisms. They had significantly less peak hip extension, knee flexion in loading, dorsiflexion at initial contact, plantarflexion at pre-swing, and dorsiflexion in swing, shorter step lengths, and lower ankle moments and powers than the comparison participants. EMG data from the gastrocnemius and tibialis anterior muscles showed excessive co-activation and atypical firing including out of phase firing of the gastrocnemius in late swing and loading and premature firing of the tibialis anterior in terminal stance. This study, using 3D motion analysis and EMG in youth with CIPN, showed variability in gait suggesting that clinical decision-making should be based on a detailed understanding of individual impairments and associated gait abnormalities.
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Source:Gait & Posture
Author(s): Marilyn J. Wright, Donna M. Twose, Jan Willem Gorter
Sensory changes and muscle weakness attributable to chemotherapy induced peripheral neuropathy (CIPN) are possible sequela of treatment for acute lymphoblastic leukemia (ALL) which can result in long-lasting difficulties with walking. The purpose of this study was to describe the gait characteristics of children and youth treated for ALL who exhibited CIPN compared to typically developing children and youth using 3D motion analyses and electromyography (EMG). Temporal-spatial, kinematic, kinetic, and electromyographic (EMG) data were collected from 17 youth (mean age 11.2 (5.7) years) with CIPN and compared to data from 10 typically developing youth. Although the gait of the CIPN group was heterogeneous between and within participants, the CIPN group demonstrated primary deviations attributable to CIPN and secondary deviations, both passive effects and active compensatory mechanisms. They had significantly less peak hip extension, knee flexion in loading, dorsiflexion at initial contact, plantarflexion at pre-swing, and dorsiflexion in swing, shorter step lengths, and lower ankle moments and powers than the comparison participants. EMG data from the gastrocnemius and tibialis anterior muscles showed excessive co-activation and atypical firing including out of phase firing of the gastrocnemius in late swing and loading and premature firing of the tibialis anterior in terminal stance. This study, using 3D motion analysis and EMG in youth with CIPN, showed variability in gait suggesting that clinical decision-making should be based on a detailed understanding of individual impairments and associated gait abnormalities.
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Objective assessment of movement competence in children using wearable sensors: An instrumented version of the TGMD-2 locomotor subtest
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Maria Cristina Bisi, G. Pacini Panebianco, R. Polman, R. Stagni
Movement competence (MC) is defined as the development of sufficient skill to assure successful performance in different physical activities. Monitoring children MC during maturation is fundamental to detect early minor delays and define effective intervention. To this purpose, several MC assessment batteries are available. When evaluating movement strategies, with the aim of identifying specific skill components that may need improving, widespread MC assessment is limited by high time consumption for scoring and the need for trained operators to ensure reliability. This work aims to facilitate and support the assessment by designing, implementing and validating an instrumented version of the TGMD-2 locomotor subtest based on Inertial Measurement Units (IMUs) to quantify MC in children rapidly and objectively. 45 typically developing children, aged 6–10, performed the TGMD-2 locomotor subtest (six skills). During the tests, children wore five IMUs mounted on lower back, on ankles and on wrists. Sensor and video recordings of the tests were collected. Three expert evaluators performed the standard assessment of TGMD-2. Using theoretical and modelling approaches, algorithms were implemented to automatically score children tests based on IMUs’ data. The automatic assessment, compared to the standard one, showed an agreement higher than 87% on average on the entire group for each skill and a reduction of time for scoring from 15 to 2min per participant. Results support the use of IMUs for MC assessment: this approach will allow improving the usability of MC assessment, supporting objectively evaluator decisions and reducing time requirement for the evaluation of large groups.
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Source:Gait & Posture, Volume 56
Author(s): Maria Cristina Bisi, G. Pacini Panebianco, R. Polman, R. Stagni
Movement competence (MC) is defined as the development of sufficient skill to assure successful performance in different physical activities. Monitoring children MC during maturation is fundamental to detect early minor delays and define effective intervention. To this purpose, several MC assessment batteries are available. When evaluating movement strategies, with the aim of identifying specific skill components that may need improving, widespread MC assessment is limited by high time consumption for scoring and the need for trained operators to ensure reliability. This work aims to facilitate and support the assessment by designing, implementing and validating an instrumented version of the TGMD-2 locomotor subtest based on Inertial Measurement Units (IMUs) to quantify MC in children rapidly and objectively. 45 typically developing children, aged 6–10, performed the TGMD-2 locomotor subtest (six skills). During the tests, children wore five IMUs mounted on lower back, on ankles and on wrists. Sensor and video recordings of the tests were collected. Three expert evaluators performed the standard assessment of TGMD-2. Using theoretical and modelling approaches, algorithms were implemented to automatically score children tests based on IMUs’ data. The automatic assessment, compared to the standard one, showed an agreement higher than 87% on average on the entire group for each skill and a reduction of time for scoring from 15 to 2min per participant. Results support the use of IMUs for MC assessment: this approach will allow improving the usability of MC assessment, supporting objectively evaluator decisions and reducing time requirement for the evaluation of large groups.
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Constituent Lower Extremity Work (CLEW) approach: A novel tool to visualize joint and segment work
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Anahid Ebrahimi, Saryn R. Goldberg, Jason M. Wilken, Steven J. Stanhope
Work can reveal the mechanism by which movements occur. However, work is less physically intuitive than more common clinical variables such as joint angles, and are scalar quantities which do not have a direction. Therefore, there is a need for a clearly reported and comprehensively calculated approach to easily visualize and facilitate the interpretation of work variables in a clinical setting. We propose the Constituent Lower Extremity Work (CLEW) approach, a general methodology to visualize and interpret cyclic tasks performed by the lower limbs. Using six degree-of-freedom power calculations, we calculated the relative work of the four lower limb constituents (hip, knee, ankle, and distal foot). In a single pie chart, the CLEW approach details the mechanical cost-of-transport, the percentage of positive and negative work performed in stance phase and swing phase, and the individual contributions of positive and negative work from each constituent. This approach can be used to compare the constituent-level adaptations occurring between limbs of individuals with impairments, or within a limb at different gait intensities. In this article, we outline how to generate and interpret the CLEW pie charts in a clinical report. As an example of the utility of the approach, we created a CLEW report using average reference data from eight unimpaired adult subjects walking on a treadmill at 0.8 statures/s (1.4m/s) compared with data from the intact and prosthetic limbs of an individual with a unilateral amputation walking with an above-knee passive prosthesis.
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Source:Gait & Posture, Volume 56
Author(s): Anahid Ebrahimi, Saryn R. Goldberg, Jason M. Wilken, Steven J. Stanhope
Work can reveal the mechanism by which movements occur. However, work is less physically intuitive than more common clinical variables such as joint angles, and are scalar quantities which do not have a direction. Therefore, there is a need for a clearly reported and comprehensively calculated approach to easily visualize and facilitate the interpretation of work variables in a clinical setting. We propose the Constituent Lower Extremity Work (CLEW) approach, a general methodology to visualize and interpret cyclic tasks performed by the lower limbs. Using six degree-of-freedom power calculations, we calculated the relative work of the four lower limb constituents (hip, knee, ankle, and distal foot). In a single pie chart, the CLEW approach details the mechanical cost-of-transport, the percentage of positive and negative work performed in stance phase and swing phase, and the individual contributions of positive and negative work from each constituent. This approach can be used to compare the constituent-level adaptations occurring between limbs of individuals with impairments, or within a limb at different gait intensities. In this article, we outline how to generate and interpret the CLEW pie charts in a clinical report. As an example of the utility of the approach, we created a CLEW report using average reference data from eight unimpaired adult subjects walking on a treadmill at 0.8 statures/s (1.4m/s) compared with data from the intact and prosthetic limbs of an individual with a unilateral amputation walking with an above-knee passive prosthesis.
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Title: Gait patterns of children and adolescents with Charcot-Marie-Tooth disease
Publication date: Available online 8 May 2017
Source:Gait & Posture
Author(s): Elizabeth Wojciechowski, Amy Sman, Kayla Cornett, Jacqueline Raymond, Kathryn Refshauge, Manoj P. Menezes, Joshua Burns
Gait abnormalities reported in childhood Charcot-Marie-Tooth disease (CMT) include foot-drop, reduced ankle power at push-off and increased knee and hip flexion for swing clearance (‘steppage-gait’). The purpose of this study was to describe the gait patterns of 60 children aged 6-17 years with CMT (CMTall) and distinguish differences based on functional weakness using the CMT Pediatric Scale (CMTPedS). Data were captured using Vicon Nexus system and compared to 50 healthy norms. Data were subdivided into three groups denoting increasing severity of dorsiflexion and plantarflexion weakness from the CMTPedS: no difficulty heel or toe walking (CMTND), difficulty heel walking (CMTDH), difficulty toe and heel walking (CMTDTH). Compared to healthy norms, CMTall demonstrated significantly worse gait profile score, reduced ankle dorsiflexion during swing (foot-drop), reduced ankle dorsiflexor moment in loading response and reduced external thigh-foot angle. Contrary to previous studies there were no signs of reduced ankle power or compensation through ‘steppage gait’ in this mild-moderately affected population. Instead, CMTall demonstrated reduced internal hip rotation and reduced hip abductor moment. When data were sub-grouped and compared to healthy norms, three different gait patterns at the ankle emerged: CMTND had a near-normal gait pattern, CMTDH presented with foot-drop, and CMTDTH had increased peak dorsiflexion and reduced ankle power generation. Several distinct and abnormal gait patterns were identified in children with CMT, with increasing gait abnormalities in more functionally severe cases. Classifying gait patterns based on disease severity might be a valuable tool in clinical decision making, assessing disease progression and phenotype-genotype correlation studies.
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Source:Gait & Posture
Author(s): Elizabeth Wojciechowski, Amy Sman, Kayla Cornett, Jacqueline Raymond, Kathryn Refshauge, Manoj P. Menezes, Joshua Burns
Gait abnormalities reported in childhood Charcot-Marie-Tooth disease (CMT) include foot-drop, reduced ankle power at push-off and increased knee and hip flexion for swing clearance (‘steppage-gait’). The purpose of this study was to describe the gait patterns of 60 children aged 6-17 years with CMT (CMTall) and distinguish differences based on functional weakness using the CMT Pediatric Scale (CMTPedS). Data were captured using Vicon Nexus system and compared to 50 healthy norms. Data were subdivided into three groups denoting increasing severity of dorsiflexion and plantarflexion weakness from the CMTPedS: no difficulty heel or toe walking (CMTND), difficulty heel walking (CMTDH), difficulty toe and heel walking (CMTDTH). Compared to healthy norms, CMTall demonstrated significantly worse gait profile score, reduced ankle dorsiflexion during swing (foot-drop), reduced ankle dorsiflexor moment in loading response and reduced external thigh-foot angle. Contrary to previous studies there were no signs of reduced ankle power or compensation through ‘steppage gait’ in this mild-moderately affected population. Instead, CMTall demonstrated reduced internal hip rotation and reduced hip abductor moment. When data were sub-grouped and compared to healthy norms, three different gait patterns at the ankle emerged: CMTND had a near-normal gait pattern, CMTDH presented with foot-drop, and CMTDTH had increased peak dorsiflexion and reduced ankle power generation. Several distinct and abnormal gait patterns were identified in children with CMT, with increasing gait abnormalities in more functionally severe cases. Classifying gait patterns based on disease severity might be a valuable tool in clinical decision making, assessing disease progression and phenotype-genotype correlation studies.
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Gait Characteristics of Children and Youth With Chemotherapy Induced Peripheral Neuropathy Following Treatment for Acute Lymphoblastic Leukemia
Publication date: Available online 9 May 2017
Source:Gait & Posture
Author(s): Marilyn J. Wright, Donna M. Twose, Jan Willem Gorter
Sensory changes and muscle weakness attributable to chemotherapy induced peripheral neuropathy (CIPN) are possible sequela of treatment for acute lymphoblastic leukemia (ALL) which can result in long-lasting difficulties with walking. The purpose of this study was to describe the gait characteristics of children and youth treated for ALL who exhibited CIPN compared to typically developing children and youth using 3D motion analyses and electromyography (EMG). Temporal-spatial, kinematic, kinetic, and electromyographic (EMG) data were collected from 17 youth (mean age 11.2 (5.7) years) with CIPN and compared to data from 10 typically developing youth. Although the gait of the CIPN group was heterogeneous between and within participants, the CIPN group demonstrated primary deviations attributable to CIPN and secondary deviations, both passive effects and active compensatory mechanisms. They had significantly less peak hip extension, knee flexion in loading, dorsiflexion at initial contact, plantarflexion at pre-swing, and dorsiflexion in swing, shorter step lengths, and lower ankle moments and powers than the comparison participants. EMG data from the gastrocnemius and tibialis anterior muscles showed excessive co-activation and atypical firing including out of phase firing of the gastrocnemius in late swing and loading and premature firing of the tibialis anterior in terminal stance. This study, using 3D motion analysis and EMG in youth with CIPN, showed variability in gait suggesting that clinical decision-making should be based on a detailed understanding of individual impairments and associated gait abnormalities.
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Source:Gait & Posture
Author(s): Marilyn J. Wright, Donna M. Twose, Jan Willem Gorter
Sensory changes and muscle weakness attributable to chemotherapy induced peripheral neuropathy (CIPN) are possible sequela of treatment for acute lymphoblastic leukemia (ALL) which can result in long-lasting difficulties with walking. The purpose of this study was to describe the gait characteristics of children and youth treated for ALL who exhibited CIPN compared to typically developing children and youth using 3D motion analyses and electromyography (EMG). Temporal-spatial, kinematic, kinetic, and electromyographic (EMG) data were collected from 17 youth (mean age 11.2 (5.7) years) with CIPN and compared to data from 10 typically developing youth. Although the gait of the CIPN group was heterogeneous between and within participants, the CIPN group demonstrated primary deviations attributable to CIPN and secondary deviations, both passive effects and active compensatory mechanisms. They had significantly less peak hip extension, knee flexion in loading, dorsiflexion at initial contact, plantarflexion at pre-swing, and dorsiflexion in swing, shorter step lengths, and lower ankle moments and powers than the comparison participants. EMG data from the gastrocnemius and tibialis anterior muscles showed excessive co-activation and atypical firing including out of phase firing of the gastrocnemius in late swing and loading and premature firing of the tibialis anterior in terminal stance. This study, using 3D motion analysis and EMG in youth with CIPN, showed variability in gait suggesting that clinical decision-making should be based on a detailed understanding of individual impairments and associated gait abnormalities.
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Objective assessment of movement competence in children using wearable sensors: An instrumented version of the TGMD-2 locomotor subtest
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Maria Cristina Bisi, G. Pacini Panebianco, R. Polman, R. Stagni
Movement competence (MC) is defined as the development of sufficient skill to assure successful performance in different physical activities. Monitoring children MC during maturation is fundamental to detect early minor delays and define effective intervention. To this purpose, several MC assessment batteries are available. When evaluating movement strategies, with the aim of identifying specific skill components that may need improving, widespread MC assessment is limited by high time consumption for scoring and the need for trained operators to ensure reliability. This work aims to facilitate and support the assessment by designing, implementing and validating an instrumented version of the TGMD-2 locomotor subtest based on Inertial Measurement Units (IMUs) to quantify MC in children rapidly and objectively. 45 typically developing children, aged 6–10, performed the TGMD-2 locomotor subtest (six skills). During the tests, children wore five IMUs mounted on lower back, on ankles and on wrists. Sensor and video recordings of the tests were collected. Three expert evaluators performed the standard assessment of TGMD-2. Using theoretical and modelling approaches, algorithms were implemented to automatically score children tests based on IMUs’ data. The automatic assessment, compared to the standard one, showed an agreement higher than 87% on average on the entire group for each skill and a reduction of time for scoring from 15 to 2min per participant. Results support the use of IMUs for MC assessment: this approach will allow improving the usability of MC assessment, supporting objectively evaluator decisions and reducing time requirement for the evaluation of large groups.
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Source:Gait & Posture, Volume 56
Author(s): Maria Cristina Bisi, G. Pacini Panebianco, R. Polman, R. Stagni
Movement competence (MC) is defined as the development of sufficient skill to assure successful performance in different physical activities. Monitoring children MC during maturation is fundamental to detect early minor delays and define effective intervention. To this purpose, several MC assessment batteries are available. When evaluating movement strategies, with the aim of identifying specific skill components that may need improving, widespread MC assessment is limited by high time consumption for scoring and the need for trained operators to ensure reliability. This work aims to facilitate and support the assessment by designing, implementing and validating an instrumented version of the TGMD-2 locomotor subtest based on Inertial Measurement Units (IMUs) to quantify MC in children rapidly and objectively. 45 typically developing children, aged 6–10, performed the TGMD-2 locomotor subtest (six skills). During the tests, children wore five IMUs mounted on lower back, on ankles and on wrists. Sensor and video recordings of the tests were collected. Three expert evaluators performed the standard assessment of TGMD-2. Using theoretical and modelling approaches, algorithms were implemented to automatically score children tests based on IMUs’ data. The automatic assessment, compared to the standard one, showed an agreement higher than 87% on average on the entire group for each skill and a reduction of time for scoring from 15 to 2min per participant. Results support the use of IMUs for MC assessment: this approach will allow improving the usability of MC assessment, supporting objectively evaluator decisions and reducing time requirement for the evaluation of large groups.
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Constituent Lower Extremity Work (CLEW) approach: A novel tool to visualize joint and segment work
Publication date: July 2017
Source:Gait & Posture, Volume 56
Author(s): Anahid Ebrahimi, Saryn R. Goldberg, Jason M. Wilken, Steven J. Stanhope
Work can reveal the mechanism by which movements occur. However, work is less physically intuitive than more common clinical variables such as joint angles, and are scalar quantities which do not have a direction. Therefore, there is a need for a clearly reported and comprehensively calculated approach to easily visualize and facilitate the interpretation of work variables in a clinical setting. We propose the Constituent Lower Extremity Work (CLEW) approach, a general methodology to visualize and interpret cyclic tasks performed by the lower limbs. Using six degree-of-freedom power calculations, we calculated the relative work of the four lower limb constituents (hip, knee, ankle, and distal foot). In a single pie chart, the CLEW approach details the mechanical cost-of-transport, the percentage of positive and negative work performed in stance phase and swing phase, and the individual contributions of positive and negative work from each constituent. This approach can be used to compare the constituent-level adaptations occurring between limbs of individuals with impairments, or within a limb at different gait intensities. In this article, we outline how to generate and interpret the CLEW pie charts in a clinical report. As an example of the utility of the approach, we created a CLEW report using average reference data from eight unimpaired adult subjects walking on a treadmill at 0.8 statures/s (1.4m/s) compared with data from the intact and prosthetic limbs of an individual with a unilateral amputation walking with an above-knee passive prosthesis.
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Source:Gait & Posture, Volume 56
Author(s): Anahid Ebrahimi, Saryn R. Goldberg, Jason M. Wilken, Steven J. Stanhope
Work can reveal the mechanism by which movements occur. However, work is less physically intuitive than more common clinical variables such as joint angles, and are scalar quantities which do not have a direction. Therefore, there is a need for a clearly reported and comprehensively calculated approach to easily visualize and facilitate the interpretation of work variables in a clinical setting. We propose the Constituent Lower Extremity Work (CLEW) approach, a general methodology to visualize and interpret cyclic tasks performed by the lower limbs. Using six degree-of-freedom power calculations, we calculated the relative work of the four lower limb constituents (hip, knee, ankle, and distal foot). In a single pie chart, the CLEW approach details the mechanical cost-of-transport, the percentage of positive and negative work performed in stance phase and swing phase, and the individual contributions of positive and negative work from each constituent. This approach can be used to compare the constituent-level adaptations occurring between limbs of individuals with impairments, or within a limb at different gait intensities. In this article, we outline how to generate and interpret the CLEW pie charts in a clinical report. As an example of the utility of the approach, we created a CLEW report using average reference data from eight unimpaired adult subjects walking on a treadmill at 0.8 statures/s (1.4m/s) compared with data from the intact and prosthetic limbs of an individual with a unilateral amputation walking with an above-knee passive prosthesis.
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Title: Gait patterns of children and adolescents with Charcot-Marie-Tooth disease
Publication date: Available online 8 May 2017
Source:Gait & Posture
Author(s): Elizabeth Wojciechowski, Amy Sman, Kayla Cornett, Jacqueline Raymond, Kathryn Refshauge, Manoj P. Menezes, Joshua Burns
Gait abnormalities reported in childhood Charcot-Marie-Tooth disease (CMT) include foot-drop, reduced ankle power at push-off and increased knee and hip flexion for swing clearance (‘steppage-gait’). The purpose of this study was to describe the gait patterns of 60 children aged 6-17 years with CMT (CMTall) and distinguish differences based on functional weakness using the CMT Pediatric Scale (CMTPedS). Data were captured using Vicon Nexus system and compared to 50 healthy norms. Data were subdivided into three groups denoting increasing severity of dorsiflexion and plantarflexion weakness from the CMTPedS: no difficulty heel or toe walking (CMTND), difficulty heel walking (CMTDH), difficulty toe and heel walking (CMTDTH). Compared to healthy norms, CMTall demonstrated significantly worse gait profile score, reduced ankle dorsiflexion during swing (foot-drop), reduced ankle dorsiflexor moment in loading response and reduced external thigh-foot angle. Contrary to previous studies there were no signs of reduced ankle power or compensation through ‘steppage gait’ in this mild-moderately affected population. Instead, CMTall demonstrated reduced internal hip rotation and reduced hip abductor moment. When data were sub-grouped and compared to healthy norms, three different gait patterns at the ankle emerged: CMTND had a near-normal gait pattern, CMTDH presented with foot-drop, and CMTDTH had increased peak dorsiflexion and reduced ankle power generation. Several distinct and abnormal gait patterns were identified in children with CMT, with increasing gait abnormalities in more functionally severe cases. Classifying gait patterns based on disease severity might be a valuable tool in clinical decision making, assessing disease progression and phenotype-genotype correlation studies.
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Source:Gait & Posture
Author(s): Elizabeth Wojciechowski, Amy Sman, Kayla Cornett, Jacqueline Raymond, Kathryn Refshauge, Manoj P. Menezes, Joshua Burns
Gait abnormalities reported in childhood Charcot-Marie-Tooth disease (CMT) include foot-drop, reduced ankle power at push-off and increased knee and hip flexion for swing clearance (‘steppage-gait’). The purpose of this study was to describe the gait patterns of 60 children aged 6-17 years with CMT (CMTall) and distinguish differences based on functional weakness using the CMT Pediatric Scale (CMTPedS). Data were captured using Vicon Nexus system and compared to 50 healthy norms. Data were subdivided into three groups denoting increasing severity of dorsiflexion and plantarflexion weakness from the CMTPedS: no difficulty heel or toe walking (CMTND), difficulty heel walking (CMTDH), difficulty toe and heel walking (CMTDTH). Compared to healthy norms, CMTall demonstrated significantly worse gait profile score, reduced ankle dorsiflexion during swing (foot-drop), reduced ankle dorsiflexor moment in loading response and reduced external thigh-foot angle. Contrary to previous studies there were no signs of reduced ankle power or compensation through ‘steppage gait’ in this mild-moderately affected population. Instead, CMTall demonstrated reduced internal hip rotation and reduced hip abductor moment. When data were sub-grouped and compared to healthy norms, three different gait patterns at the ankle emerged: CMTND had a near-normal gait pattern, CMTDH presented with foot-drop, and CMTDTH had increased peak dorsiflexion and reduced ankle power generation. Several distinct and abnormal gait patterns were identified in children with CMT, with increasing gait abnormalities in more functionally severe cases. Classifying gait patterns based on disease severity might be a valuable tool in clinical decision making, assessing disease progression and phenotype-genotype correlation studies.
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Gait Characteristics of Children and Youth With Chemotherapy Induced Peripheral Neuropathy Following Treatment for Acute Lymphoblastic Leukemia
Publication date: Available online 9 May 2017
Source:Gait & Posture
Author(s): Marilyn J. Wright, Donna M. Twose, Jan Willem Gorter
Sensory changes and muscle weakness attributable to chemotherapy induced peripheral neuropathy (CIPN) are possible sequela of treatment for acute lymphoblastic leukemia (ALL) which can result in long-lasting difficulties with walking. The purpose of this study was to describe the gait characteristics of children and youth treated for ALL who exhibited CIPN compared to typically developing children and youth using 3D motion analyses and electromyography (EMG). Temporal-spatial, kinematic, kinetic, and electromyographic (EMG) data were collected from 17 youth (mean age 11.2 (5.7) years) with CIPN and compared to data from 10 typically developing youth. Although the gait of the CIPN group was heterogeneous between and within participants, the CIPN group demonstrated primary deviations attributable to CIPN and secondary deviations, both passive effects and active compensatory mechanisms. They had significantly less peak hip extension, knee flexion in loading, dorsiflexion at initial contact, plantarflexion at pre-swing, and dorsiflexion in swing, shorter step lengths, and lower ankle moments and powers than the comparison participants. EMG data from the gastrocnemius and tibialis anterior muscles showed excessive co-activation and atypical firing including out of phase firing of the gastrocnemius in late swing and loading and premature firing of the tibialis anterior in terminal stance. This study, using 3D motion analysis and EMG in youth with CIPN, showed variability in gait suggesting that clinical decision-making should be based on a detailed understanding of individual impairments and associated gait abnormalities.
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Source:Gait & Posture
Author(s): Marilyn J. Wright, Donna M. Twose, Jan Willem Gorter
Sensory changes and muscle weakness attributable to chemotherapy induced peripheral neuropathy (CIPN) are possible sequela of treatment for acute lymphoblastic leukemia (ALL) which can result in long-lasting difficulties with walking. The purpose of this study was to describe the gait characteristics of children and youth treated for ALL who exhibited CIPN compared to typically developing children and youth using 3D motion analyses and electromyography (EMG). Temporal-spatial, kinematic, kinetic, and electromyographic (EMG) data were collected from 17 youth (mean age 11.2 (5.7) years) with CIPN and compared to data from 10 typically developing youth. Although the gait of the CIPN group was heterogeneous between and within participants, the CIPN group demonstrated primary deviations attributable to CIPN and secondary deviations, both passive effects and active compensatory mechanisms. They had significantly less peak hip extension, knee flexion in loading, dorsiflexion at initial contact, plantarflexion at pre-swing, and dorsiflexion in swing, shorter step lengths, and lower ankle moments and powers than the comparison participants. EMG data from the gastrocnemius and tibialis anterior muscles showed excessive co-activation and atypical firing including out of phase firing of the gastrocnemius in late swing and loading and premature firing of the tibialis anterior in terminal stance. This study, using 3D motion analysis and EMG in youth with CIPN, showed variability in gait suggesting that clinical decision-making should be based on a detailed understanding of individual impairments and associated gait abnormalities.
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Response to de Wit et al., 2016 “Characteristics of Auditory Processing Disorders: A Systematic Review”
Purpose
This letter to the editor is in response to a review by de Wit et al. (2016), “Characteristics of Auditory Processing Disorders: A Systematic Review,” published in April 2016 by Journal of Speech, Language, and Hearing Research.
Conclusion
The author argues that the conclusions in the de Wit et al. (2016) review are unfortunate in light of advances made in the clinical diagnosis and treatment of bottom-up auditory processing disorders in children.from #Audiology via ola Kala on Inoreader http://ift.tt/2qWPtr7
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Response to de Wit et al., 2016 “Characteristics of Auditory Processing Disorders: A Systematic Review”
Purpose
This letter to the editor is in response to a review by de Wit et al. (2016), “Characteristics of Auditory Processing Disorders: A Systematic Review,” published in April 2016 by Journal of Speech, Language, and Hearing Research.
Conclusion
The author argues that the conclusions in the de Wit et al. (2016) review are unfortunate in light of advances made in the clinical diagnosis and treatment of bottom-up auditory processing disorders in children.from #Audiology via ola Kala on Inoreader http://ift.tt/2qWPtr7
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Response to de Wit et al., 2016 “Characteristics of Auditory Processing Disorders: A Systematic Review”
Purpose
This letter to the editor is in response to a review by de Wit et al. (2016), “Characteristics of Auditory Processing Disorders: A Systematic Review,” published in April 2016 by Journal of Speech, Language, and Hearing Research.
Conclusion
The author argues that the conclusions in the de Wit et al. (2016) review are unfortunate in light of advances made in the clinical diagnosis and treatment of bottom-up auditory processing disorders in children.from #Audiology via xlomafota13 on Inoreader http://ift.tt/2qWPtr7
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Celebrities With Menieres
Meniere’s disease is a condition that can affect the inner ear. It causes vertigo, ear pressure and tinnitus. It was first discovered by a French physician in 1861. Meniere’s disease is a condition that can be difficult to live with. However, there are celebrities with Menieres who have thrilled.
Emily Dickinson
Emily Dickinson was a poet who had Meniere’s disease. Despite the fact that she had this disorder, she managed to write over 1,800 poems. She published about a dozen of those poems. Emily is still considered one of the greatest poets who ever lived.
Dana White
Dana White is a businessman and the president of the Ultimate Fighting Championship. He is also one of the celebrities with Menieres. In addition to managing his business, he also teaches aerobic classes. He revealed that he was diagnosed with Meniere’s disease in 2012.
Dana Davis
Dana Davis is a award-winning science fiction and fantasy writer. She was diagnosed with Meniere’s disease in 2003. The condition caused her to feel stressed out and exhausted. However, she has not let the disorder stop her from living her dreams. She still loves to write, read, run and travel.
Kristen Chenoweth
Kristen Chenoweth is another one of the celebrities with Menieres. She is a singer and actress. She is known for her roles in “You’re a Good Man, Charlie Brown” and “Wicked.” She was on stage when she started to experience Meniere’s symptoms for the first time. She wrote about her experience in her autobiography called “Fresh Air With Terry Gross.”
Katie LeClerc
Katie LeClerc is an actress who is known for her roles on “Switched at Birth” and “Veronica Mars.” She found out that she had Meniere’s disease while she was acting on “Switched at Birth.” The condition has affected her hearing, and she has to wear hearing aids.
Steve Francis
Steve Francis is a professional basketball player. He is known for his dribbling ability. He suffers from Meniere’s disease, which has also caused him to have debilitating headaches.
David Alstead
David Alstead is a skilled pianist. He had a surgery at the age of 19 that caused him to develop Meniere’s disease. He has also lost hearing in his left ear. Despite all of this, his career is taking off. He was named “Unsighed Artist of the Year” by “Keyboard Magazine”. He also won the Eric Stokes Song Contest. Additionally, he has performed at several musical theaters.
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