Publication date: Available online 4 April 2017
Source:Gait & Posture
Author(s): A.J. Metcalfe, C.J. Stewart, N.J. Postans, P.R. Biggs, G.M. Whatling, C.A. Holt, A.P. Roberts
Unilateral knee replacement is often followed by a contralateral replacement in time and the biomechanics of the other knee before and after knee replacement remains poorly understood. The aim of this paper is to distinguish the features of arthritic gait in the affected and unaffected legs relative to a normal population and to assess the objective recovery of gait function post-operatively, with the aim of defining patients at risk of poor post-operative function. Twenty patients with severe knee OA but no pain or deformity in any other lower limb joint were compared to twenty healthy subjects of the same age. Gait analysis was performed and quadriceps and hamstrings co-contraction was measured. Fifteen subjects returned 1year following knee arthroplasty. Moments and impulses were calculated, principal component analysis was used to analyse the waveforms and a classification technique (the Cardiff Classifier) was used to select the most discriminant data and define functional performance. Comparing pre-operative function to healthy function, classification accuracies for the affected and unaffected knees were 95% and 92.5% respectively. Post-operatively, the affected limb returned to the normal half of the classifier in 8 patients, and 7 of those patients returned to normal function in the unaffected limb. Recovery of normal gait could be correctly predicted 13 out of 15 times at the affected knee, and 12 out of 15 times at the unaffected knee based on pre-operative gait function. Focused rehabilitation prior to surgery may be beneficial to optimise outcomes and protect the other joints following knee arthroplasty.
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Τετάρτη 5 Απριλίου 2017
Concurrent validation of an index to estimate fall risk in community dwelling seniors through a wireless sensor insole system: a Pilot Study
Publication date: Available online 4 April 2017
Source:Gait & Posture
Author(s): Mirko Di Rosa, Jeff M. Hausdorff, Vera Stara, Lorena Rossi, Liam Glynn, Monica Casey, Stefan Burkard, Antonio Cherubini
Falls are a major health problem for older adults with immediate effects, such as fractures and head injuries, and longer term effects including fear of falling, loss of independence, and disability. The goals of the WIISEL project were to develop an unobtrusive, self-learning and wearable system aimed at assessing gait impairments and fall risk of older adults in the home setting; assessing activity and mobility in daily living conditions; identifying decline in mobility performance and detecting falls in the home setting. The WIISEL system was based on a pair of electronic insoles, able to transfer data to a commercially available smartphone, which was used to wirelessly collect data in real time from the insoles and transfer it to a backend computer server via mobile internet connection and then onwards to a gait analysis tool. Risk of falls was calculated by the system using a novel Fall Risk Index (FRI) based on multiple gait parameters and gait pattern recognition. The system was tested by twenty-nine older users and data collected by the insoles were compared with standardized functional tests with a concurrent validity approach. The results showed that the FRI captures the risk of falls with accuracy that is similar to that of conventional performance-based tests of fall risk. These preliminary findings support the idea that theWIISEL system can be a useful research tool and may have clinical utility for long-term monitoring of fall risk at home and in the community setting.
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Source:Gait & Posture
Author(s): Mirko Di Rosa, Jeff M. Hausdorff, Vera Stara, Lorena Rossi, Liam Glynn, Monica Casey, Stefan Burkard, Antonio Cherubini
Falls are a major health problem for older adults with immediate effects, such as fractures and head injuries, and longer term effects including fear of falling, loss of independence, and disability. The goals of the WIISEL project were to develop an unobtrusive, self-learning and wearable system aimed at assessing gait impairments and fall risk of older adults in the home setting; assessing activity and mobility in daily living conditions; identifying decline in mobility performance and detecting falls in the home setting. The WIISEL system was based on a pair of electronic insoles, able to transfer data to a commercially available smartphone, which was used to wirelessly collect data in real time from the insoles and transfer it to a backend computer server via mobile internet connection and then onwards to a gait analysis tool. Risk of falls was calculated by the system using a novel Fall Risk Index (FRI) based on multiple gait parameters and gait pattern recognition. The system was tested by twenty-nine older users and data collected by the insoles were compared with standardized functional tests with a concurrent validity approach. The results showed that the FRI captures the risk of falls with accuracy that is similar to that of conventional performance-based tests of fall risk. These preliminary findings support the idea that theWIISEL system can be a useful research tool and may have clinical utility for long-term monitoring of fall risk at home and in the community setting.
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Parkinsonian Signs are a Risk Factor for Falls
Publication date: Available online 4 April 2017
Source:Gait & Posture
Author(s): Nabila Dahodwala, Chinwe Nwadiogbu, Whitney Fitts, Helen Partridge, Jason Karlawish
BackgroundParkinsonian signs are common, non-specific findings in older adults and associated with increased rates of dementia and mortality. It is important to understand which motor outcomes are associated with parkinsonian signs.ObjectivesTo determine the role of parkinsonian signs on fall rates among older adults.MethodsWe conducted a longitudinal study of primary care patients from the University of Pennsylvania Health System. Adults over 55 years were assessed at baseline through surveys and a neurological examination. We recorded falls over the following 2 years. Parkinsonian signs were defined as the presence of 2 of 4 cardinal signs. Incident falls were compared between subjects with and without parkinsonian signs, and modified Poisson regression used to adjust for potential confounders in the relationship between parkinsonian signs and falls.Results982 subjects with a mean age of 68 (s.d. 8.8) years participated. 29% of participants fell and 12% exhibited parkinsonian signs at baseline. The unadjusted RR for falls among individuals with parkinsonian signs was 1.36 (95% CI 1.05-1.76, p=0.02). After adjusting for age, cognitive function, urinary incontinence, depression, diabetes, stroke and arthritis, individuals with parkinsonian signs were still 38% more likely to fall than those without parkinsonian signs (RR 1.38, 95% CI 1.04-1.82; p=0.03). Falls among those with parkinsonian signs were more likely to lead to injury (53% vs 37%; p=0.04).ConclusionsParkinsonian signs are a significant, independent risk factor for falls. Early detection of this clinical state is important in order to implement fall prevention programs among primary care patients.
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Source:Gait & Posture
Author(s): Nabila Dahodwala, Chinwe Nwadiogbu, Whitney Fitts, Helen Partridge, Jason Karlawish
BackgroundParkinsonian signs are common, non-specific findings in older adults and associated with increased rates of dementia and mortality. It is important to understand which motor outcomes are associated with parkinsonian signs.ObjectivesTo determine the role of parkinsonian signs on fall rates among older adults.MethodsWe conducted a longitudinal study of primary care patients from the University of Pennsylvania Health System. Adults over 55 years were assessed at baseline through surveys and a neurological examination. We recorded falls over the following 2 years. Parkinsonian signs were defined as the presence of 2 of 4 cardinal signs. Incident falls were compared between subjects with and without parkinsonian signs, and modified Poisson regression used to adjust for potential confounders in the relationship between parkinsonian signs and falls.Results982 subjects with a mean age of 68 (s.d. 8.8) years participated. 29% of participants fell and 12% exhibited parkinsonian signs at baseline. The unadjusted RR for falls among individuals with parkinsonian signs was 1.36 (95% CI 1.05-1.76, p=0.02). After adjusting for age, cognitive function, urinary incontinence, depression, diabetes, stroke and arthritis, individuals with parkinsonian signs were still 38% more likely to fall than those without parkinsonian signs (RR 1.38, 95% CI 1.04-1.82; p=0.03). Falls among those with parkinsonian signs were more likely to lead to injury (53% vs 37%; p=0.04).ConclusionsParkinsonian signs are a significant, independent risk factor for falls. Early detection of this clinical state is important in order to implement fall prevention programs among primary care patients.
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Falls in people with Parkinson’s disease: A prospective comparison of community and home-based falls
Publication date: Available online 4 April 2017
Source:Gait & Posture
Author(s): Robyn M. Lamont, Meg E. Morris, Hylton B. Menz, Jennifer L. McGinley, Sandra G. Brauer
BackgroundFalls are common and debilitating in people with Parkinson’s disease (PD) and restrict participation in daily activities. Understanding circumstances of falls in the community and at home may assist clinicians to target therapy more effectively.ObjectiveTo compare the characteristics of community and home fallers and the circumstances that contribute to falls in people living with PD.MethodsPeople with mild-moderately severe PD (n=196) used a daily falls diary and telephone hotline to report prospectively the occurrence, location and circumstances of falls over 14 months.Results62% of people with PD fell, with most falling at least once in the community. Compared to people who fell at home, the community-only fallers had shorter durations of PD (p=0.012), less severe disease (p=0.008) and reported fewer falls in the year prior to the study (p=0.003). Most falls occurred while people were ambulant, during postural transitions and when medication was working well. Community-based falls were frequently attributed to environmental factors such as challenging terrains (p < 0.001), high attention demands (p=0.029), busy or cluttered areas (p < 0.001) and tasks requiring speed (p=0.020). Physical loads were more often present in home than community-based falls (p=0.027).ConclusionFalls that occur in the community typically affect people with earlier PD and less severe disease than home-based falls. Individuals experiencing community-based falls may benefit from physiotherapy to manage challenging environments and high attention demands.
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Source:Gait & Posture
Author(s): Robyn M. Lamont, Meg E. Morris, Hylton B. Menz, Jennifer L. McGinley, Sandra G. Brauer
BackgroundFalls are common and debilitating in people with Parkinson’s disease (PD) and restrict participation in daily activities. Understanding circumstances of falls in the community and at home may assist clinicians to target therapy more effectively.ObjectiveTo compare the characteristics of community and home fallers and the circumstances that contribute to falls in people living with PD.MethodsPeople with mild-moderately severe PD (n=196) used a daily falls diary and telephone hotline to report prospectively the occurrence, location and circumstances of falls over 14 months.Results62% of people with PD fell, with most falling at least once in the community. Compared to people who fell at home, the community-only fallers had shorter durations of PD (p=0.012), less severe disease (p=0.008) and reported fewer falls in the year prior to the study (p=0.003). Most falls occurred while people were ambulant, during postural transitions and when medication was working well. Community-based falls were frequently attributed to environmental factors such as challenging terrains (p < 0.001), high attention demands (p=0.029), busy or cluttered areas (p < 0.001) and tasks requiring speed (p=0.020). Physical loads were more often present in home than community-based falls (p=0.027).ConclusionFalls that occur in the community typically affect people with earlier PD and less severe disease than home-based falls. Individuals experiencing community-based falls may benefit from physiotherapy to manage challenging environments and high attention demands.
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Letter to the editor on “Textured and stimulating insoles for balance and gait impairments in patients with multiple sclerosis and Parkinson’s disease: A systematic review and meta-analysis” by Martin Alfuth, Gait & Posture (2017) 51, 132–141
Publication date: Available online 4 April 2017
Source:Gait & Posture
Author(s): Ana Paula da Silva Salazar, Cinara Stein, Aline de Souza Pagnussat
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Source:Gait & Posture
Author(s): Ana Paula da Silva Salazar, Cinara Stein, Aline de Souza Pagnussat
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Audiological Results in SSD With an Active Transcutaneous Bone Conduction Implant at a Retrosigmoidal Position.
Objective: One option for patients with single sided deafness (SSD) who experience problems with insufficient hearing in different surroundings is the treatment with percutaneous bone-anchored hearing aids. Common medical problems associated to a skin penetrating abutment can be avoided by active transcutaneous bone conduction hearing implants. The purpose of our study was to evaluate the benefit of an active transcutaneous bone conduction hearing implant in patients with SSD. Patients and Methods: Patients suffering from SSD who are implanted with an active transcutaneous bone conduction hearing implant in retrosigmoidal position were audiologically analyzed. The audiological test battery included air and bone conduction thresholds, word recognition score (WRS) in quiet and speech intelligibility (Oldenburg Sentence Test [OLSA]) in noise. Patient satisfaction was evaluated with the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Bern-Benefit in Single-Sided Deafness (BBSS) questionnaire. Results: The monosyllable WRS and the signal-to-noise ratio (SNR) assessed by the OLSA was significantly better in all aided conditions. Also, the APHAB categories ease of communication and reverberation and the average benefit in the BBSS improved significantly if using the device. Conclusion: The Bonebridge is a transcutaneous alternative to the well-established percutaneous bone conducting devices in patients with single sided deafness. An improvement in hearing in noise and quiet as well as a decrease of the head shadow effect can be expected. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Cochlear Implantation in Cases of Unilateral Hearing Loss: Initial Localization Abilities.
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