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Office management of gait disorders in the elderly

Office management of gait disorders in the elderly

Main message Gait and balance disorders in the elderly are difficult to recognize and diagnose in the family practice setting because they initially present with subtle undifferentiated manifestations, and because causes are usually multifactorial, with multiple diseases developing simultaneously. To further complicate the issue, these manifestations can be camouflaged in elderly patients by the physiologic changes associated with normal aging. A classification of gait disorders based on sensorimotor levels can be useful in the approach to management of this problem. Gait disorders in patients presenting to family physicians in the primary care setting are often related to joint and skeletal problems (lowest-level disturbances), as opposed to patients referred to neurology specialty clinics with sensory ataxia, myelopathy, multiple strokes, and parkinsonism (lowest-, middle-, and highest-level disturbances). The difficulty in diagnosing gait disorders stems from the challenge of addressing early undifferentiated disease caused by multiple disease processes involving all sensorimotor levels. Patients might present with a nonspecific “cautious” gait that is simply an adaptation of the body to disease limitations. This cautious gait has a mildly flexed posture with reduced arm swing and a broadening of the base of support. This article reviews the focused history (including medication review), practical physical examination, investigations, and treatments that are key to office management of gait disorders.
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Gait disorders in the elderly and dual task gait analysis: a new approach for identifying motor phenotypes

Gait disorders in the elderly and dual task gait analysis: a new approach for identifying motor phenotypes

Abnormal gait resulting from neurological conditions was largely predominant as shown by other studies [40]. The differences according to sex were mainly due to the higher prevalence of osteoarthritis in female patients, which is consistent with the literature [41]. White matter lesions were found in some of the patients having gait disorders, in the absence of underlying neurological pathology [42]. Parkinson’s disease and dizziness were responsible for gait disorders in only 3 and 6 patients, respectively, despite the high frequency of these two conditions in gait disorders. This can be explained by the fact that patients with Parkinson’s disease are usually referred to neurologists, and those suffering from dizzi- ness are referred to ENT specialists. Surprisingly, the diagnosis of fear of falling, which is a prime concern of many elderly patients with unstable gait [43] was identi- fied as the main cause of gait disorders in only one pa- tient. Nevertheless, fear of falling may be present in a larger number of patients but may remain hidden by an- other cause of gait disorders such as MCI. Finally, no etiology was identified for gait disorders in 8 patients. The main causes of gait disorders were similar through the four clinical subgroups (C = 0.85). This finding high- lights the importance of cognitive and motor interac- tions in elderly subjects, the relevance of gait analysis under single and dual-task conditions in the assessment of gait disorders in elderly people, and the great clinical value of gait instability as a symptom.
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The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review

The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review

There is weak and inconsistent evidence that RAGT may hold benefits for children with gait disorders, par- ticularly those with CP, who wish to improve their walk- ing speed or standing ability. In the absence of clear evidence for training prescription and delivery, clinicians using RAGT should apply clinical judgement and moni- tor individual client progress closely with appropriate mobility measures. Further research is required using higher level trial design, and increased numbers to con- firm effectiveness, across a broad range of outcomes in- cluding adverse events, and to clarify training schedules and evidence in different populations, domains or ages.
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Gait disorders are associated with non-cardiovascular falls in elderly people: a preliminary study

Gait disorders are associated with non-cardiovascular falls in elderly people: a preliminary study

Since a cardiovascular mediated cause of fall has been described in up to 20 percent of unexplained elderly fall- ers, and in view of the associated morbidity, mortality and the availability of treatment, careful consideration should be given when assessing patients with unexplained falls [9,10]. As well, falls related to a neurally mediated cardio- vascular event could be expressed acutely and intermit- tently without chronically affecting gait performance, providing a potential explanation for the absence of gait disorders in these participants. As gait performance can be assessed directly, thus avoiding reporting bias, this approach could be applied even in absence of a detailed description of the episode. Finally, the simplicity of the proposed gait assessment makes it easy to perform and accessible for general clinicians and other health profes- sionals.
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Reliability of timed walking tests and temporo-spatial gait parameters in youths with neurological gait disorders

Reliability of timed walking tests and temporo-spatial gait parameters in youths with neurological gait disorders

We assume that the quality of gait of the most severely affected youths was overestimated by the GAITRite, as, for those with poor walking ability, data of the walk re- quired considerable editing with the GAITRite software. By deleting unclear steps, the quality of the walk im- proved. Editing might also have introduced a higher sus- ceptibility to a bias of the investigator due to unclear decisions on when and how to edit data. Despite that dif- ferent people edited the walks, they all performed this ac- cording to internally formulated guidelines. However, as each walking pattern has its specific characteristics that cannot be described in such guidelines, editing remains to a certain extent subjective. This might have impacted our results (but also those of other GAITRite studies).
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Analysis of foot and ankle disorders and prediction of gait in multiple sclerosis rehabilitation

Analysis of foot and ankle disorders and prediction of gait in multiple sclerosis rehabilitation

Based on this aspect, all information can be useful for designing a rehabilitation programme, regarding foot and ankle load, motor control and the coordination of move- ment. By this evaluation we see that it is possible to record the distribution of pressure at the plantar region in relation to weight and force, which helps us obtain a fast analysis of foot movement from the beginning of the gait cycle. This explains why many MS patients have gait disorders be- cause of demylinisation, which involves neurologic disor- ders, and the impact under the proprioceptive system. Our observation is in accordance with Fjeldstad [22], who says that specific evaluation testing of foot balance allows an estimate of the proprioceptive system, which is the most affected in MS.
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Cholinergic mesencephalic neurons are involved in gait and postural disorders in Parkinson disease

Cholinergic mesencephalic neurons are involved in gait and postural disorders in Parkinson disease

modulated by the speed of imagined gait, with faster imagined gait activating a discrete cluster within the MLR. Furthermore, the presence of gait disorders in patients with PD and in aged monkeys rendered parkinsonian by MPTP intoxication correlated with loss of PPN cholinergic neurons. Bilateral lesioning of the cholinergic part of the PPN induced gait and postural deficits in nondopaminergic lesioned monkeys. Our data therefore reveal that the cholinergic neurons of the PPN play a central role in controlling gait and posture and represent a possible target for pharmacological treatment of gait disorders in PD.
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Sleep-related breathing disorders and gait variability: a cross-sectional preliminary study

Sleep-related breathing disorders and gait variability: a cross-sectional preliminary study

Our results did not confirm the hypothesis that SRBDs-related increase in STV is due to SRBDs-related dysexecutive function. The main explanation is related to the fact that all participants were cognitively healthy individuals with no significant between-group difference in terms of digit span score. Another explanation could be that increase in STV is not a consequence of dysexe- cutive function but rather a primary symptom of SRBDs. It has been previously reported that motor disorders, and more specifically gait disorders, may be the first symptom of neurodegenerative brain disease such as Alzheimer disease [21].
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<p>Reference values of gait parameters measured with a plantar pressure platform in community-dwelling older Japanese adults</p>

<p>Reference values of gait parameters measured with a plantar pressure platform in community-dwelling older Japanese adults</p>

Moreover, several studies have reported that gait speed and step length predict cognitive decline. 14–16 A recent study investigated the association between gait parameter and cognitive status with falls since falls are prevalent in individuals with cognitive decline. 17 Gait parameters are also utilized to assess frailty 18 and to evaluate effective- ness of physical improvement by exercise. 19 Reference values for gait parameters could be utilized by researchers to determine cut-off values when examining the impact of gait parameters on adverse health outcomes as described above. Additionally, these values may provide valuable assistance to clinicians to establish normal value ranges and for assessment of clinical intervention effects.
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Virtual-dynamics-based reference gait speed generator for limit-cycle-based bipedal gait

Virtual-dynamics-based reference gait speed generator for limit-cycle-based bipedal gait

To this end, we challenge this issue by designing vir- tual dynamics between the robot and the goal via a virtual leader point (see Fig. 1). This approach is a com- bination of an artificial potential field concept for mobile robots [14, 15] and a leader-follower formation for mul- tiple agents  [16, 17]. Seto and Sugihara have proposed the similar idea for smooth reaching movement [18], but in contrast, our proposal deals with the way to design parameters of the method and optimizes them in real time according to the surroundings. The virtual leader point is attracted to the goal and repulsed by other envi- ronment including obstacles instead of the robot, and consequently, a secure path from the start to the goal is planned autonomously. When the robot follows the leader point within a certain range, the robot reaches the goal while avoiding the obstacles. Such “indirect” interac- tion between the robot and surroundings restrains dras- tic change of the reference gait speeds, namely, they are likely to maintain stability of the current states.
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Fast Frontal View Gait Authentication Based on the Statistical Registration and Human Gait Modeling

Fast Frontal View Gait Authentication Based on the Statistical Registration and Human Gait Modeling

Abstract—We study the problem of analyzing and classifying frontal view gait video data. In this study, we suppose that frontal view gait data as a mixing of scale changing, human movements and speed changing parameters. We estimate these parameters using the statistical registration and modeling on a video data. To demonstrate the effectiveness of our method, we conducted experiment, assessing the proposed method for frontal view human gait authentication. We apply K-nearest- neighbor classifier, using the estimated parameters, to perform the human gait authentication, and present results from an experiment involving 120 subjects. As a result, our method shows high recognition rate and low calculation cost.
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Deep brain stimulation and its effects on Parkinson disease spatiotemporal gait parameters.

Deep brain stimulation and its effects on Parkinson disease spatiotemporal gait parameters.

organization of the STN is complex and its physiology was not a studied in the current study. However, the somatotopic organization of the STN implies precise electrode placement is important for proper response to STN-DBS. Granziera et al. (2008) found STN-DBS participants who developed gait difficulties immediately after surgery had improper electrode placement (Granziera et al., 2008). Furthermore, the MLE may spread to surrounding STN regions, impairing function. The lenticular fasciculus is a tract which houses peduncolopallidal fibers that connects the GPi with the PPN (Devos, Defebvre, & Bordet, 2010). The PPN is important in the initiation and modulation of gait (Pahapill & Lozano., 2000). It has been postulated that the MLE occurring within the STN causes a reduction in STN hyperactivity, contributed to improvement in appendicular symptoms. However, if the MLE spreads or occurs outside the STN it may interfere with other brain regions. Spread to the peduncolopallidal fiber tract may interfere with PPN activity, resulting in abnormal gait performance.
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Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis

Randomized controlled trial of robot-assisted gait training with dorsiflexion assistance on chronic stroke patients wearing ankle-foot-orthosis

Surprisingly from our results, gait analyses of Sham Group after long-term gait training reports reduction in affected ankle dorsiflexion and reduced knee flexion after subjects had taken off the passive AFO. These re- sponses are unexpected since they are against the main purpose of the passive AFO, which is to provide support in foot clearance [13, 14]. Although efforts have been made to minimize the weight of the unpowered AFO, which is relatively more lightweight comparing with ro- botic AFO design from other research groups, it should be noted that both intervention groups still had extra 0.5 kg loading on affected ankle with additional meta- bolic cost and mechanical constraints [46], which could be the cause of the reduction in affected side ROM and the negative foot tilting angle (dropped foot pointing downward) maintained after mid-swing (Fig. 4). 3.6 kg unilateral loading of the MIT Anklebot would reduce peak dorsiflexion angle by about 7° at terminal stance [47], and 4 kg load mass on foot segment would increase metabolic cost of walking by 48% [48]. Previous studies demonstrate adding 2.5 kg mass on leg for a short dur- ation did not alter lower-limb kinematics [46], yet our results suggest prolonged wearing 0.5 kg weight at af- fected ankle would still alter gait pattern even after the patients had taken off the device, which is an important limitation of the robot-assisted AFO. Moreover, partici- pants complained about occasional poor fitting and mis- alignment of the robot-assisted AFO that pressed on the leg, particularly for patients with extreme body sizes, ap- parently customized AFO should be considered in future studies. Other studies on powered AFO also highlighted the importance of custom-fit exoskeleton for better comfort, stability, and robustness [20]. Future design of robot-assisted AFO should take into considerations the potential drawback of added mass, external perturba- tions, and custom-fit orthosis on ankle joint.
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Multilevel Surgery for Children With Cerebral Palsy: A Meta-analysis

Multilevel Surgery for Children With Cerebral Palsy: A Meta-analysis

a classi fi cation system. We extracted data on gait speed and summary statistics of gait (ie, the Gait Deviation Index, Gait Pro fi le Score [GPS], or Gillette Gait Index). 10–12 When .1 summary score was reported in studies, we extracted data on the GPS. We chose to extract data on gait summary scores rather than individual kinematic or kinetic variables because authors of many studies reported a large number of variables obtained from three-dimensional gait analysis. In addition, we extracted data on participation, QoL, and satisfaction with surgery. Since the publication of the ICF, there has been a lack of consensus regarding measurement tools to assess participation. For the purpose of this review, we extracted data on measures that mapped to the recently developed family of participation-related constructs. 13 Finally, we extracted data on passive range of motion, muscle strength, and spasticity because these are commonly evaluated before and after MLS as part of a clinical examination and are used to inform clinical decision-making on surgery. We extracted data on passive knee extension and passive dorsi fl exion only because these were the most commonly reported joints. Because authors typically reported muscle strength and spasticity for .1 muscle group, we ranked muscle groups in order of frequency of reporting across all included studies. For each study, we then extracted data for strength and spasticity, respectively, for the most frequently reported muscle group. If data were not reported for the most frequently reported muscle group, we extracted data for the next most frequently reported muscle group, and so on. If data were reported on both limbs, data
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Performance Analysis of ANN based Gait Recognition

Performance Analysis of ANN based Gait Recognition

Interest in gait as a biometric has increased over the years, especially in the computer-vision arena. Niyogi and Adelson [7] and Guo et al. [8] were the first to announce gait analysis techniques capable of discriminating between individuals. The major single contributor to progress of automatic recognition by gait has been Defence Advanced Research Project's Agency (DARPA's) Human ID at a Distance research program. This program was established to improve security at United Sates embassies following some terrorists act in 1998. Mohamed Sayed (2018) states in the published work that It is crucial to find methods that analyze large amount of data captured by cameras and/or various sensors installed all around us. Machine learning becomes a prevailing tool in analyzing such data that signifies behavioral characteristics of human beings. Gait as an identifier for use in individual recognition systems has respective and almost certainly unique key features for each person including centroid, cycle length and step size. Gait is sometimes preeminent suited to recognition or surveillance scenarios. It might be used in the identification of females who are the yaring veils in some countries without critical social issues. The objective of this project is to predict accurately one-dimensional coordinates of normalized n -component vectors representing two dimensional silhouettes in order to identify individuals at a distance without any interaction and obtrusion. Varied algorithms are further incorporated into walk pattern analysis to adoptively improve gait recognitions and classification. The results are reported reasonable identification performance as compared to several machine learning methods [9].
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Interactive cueing with walk-Mate for Hemiparetic Stroke Rehabilitation

Interactive cueing with walk-Mate for Hemiparetic Stroke Rehabilitation

In each of the experiments subjects were equipped with a Walk-Mate transmitter, and walked at a steady speed in a normal manner around a 20 m circular track in a quiet room with the impaired side away from the center. If patients experienced fatigue during the experi- ment, reported physical unease or a desire to take a break, some minutes of rest were permitted. Behavior such as talking during the experiment was prohibited in advance, insofar as patients did not require to report physical unease, and in fact this did not occur during any of the experiments. Moreover, each of the subjects indicated that they themselves felt very comfortable with this form of walking. All of the sessions were conducted twice a day, and continuously for 5 days. For the first session on the first day of the experiment however, each patient performed only 300 seconds of walking inde- pendently in order to measure their initial gait condition. An identical 300-second evaluation of their walking was conducted on the day following the last day of experi- mentation, in order to evaluate the effectiveness of the training.
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The role of wearable devices and objective gait analysis for the assessment and monitoring of patients with lumbar spinal stenosis: systematic review

The role of wearable devices and objective gait analysis for the assessment and monitoring of patients with lumbar spinal stenosis: systematic review

LSS is a disabling condition with significant economic, physical and psychological cost. It represents the most common indication for spine surgery in people older than 65 years. Most studies regarding LSS and outcomes of surgery are based on patient-reported information which may be subjective, inaccurate or incomplete [27, 28]. There is little objective data on functional changes following surgical intervention for LSS. The use of accel- erometers to evaluate activity post spinal surgery is a promising avenue to provide objective measurements as compared to self-completed questionnaires or formal laboratory-based gait assessment [29]. Based on the lim- ited data available from the 4 identified studies, we con- clude that the measurements of gait velocity, cadence, step length, number of steps and gait symmetry are use- ful in the assessment of decline and recovery in patients with LSS. The small number of studies and variation in methodology used indicate that further studies investi- gating the capacity of wearable gait metric measurement to provide reliable results are necessary.
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Nandukkal, a fossil crab used in Siddha Medicine and its therapeutic usage – a review

Nandukkal, a fossil crab used in Siddha Medicine and its therapeutic usage – a review

Nandukkal has been used in diversified diseases. It has been used for treating urinary disorders, mental disorders, Musculo skeletal disorders, dermatological disorders, gastro intestinal disorders, opthalmological disorders, veneral diseases, all kinds of toxic bites and all types of fever [12]. The therapeutic uses is listed in the Table 1.

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Human Gait Recognition Based on Multiview Gait Sequences

Human Gait Recognition Based on Multiview Gait Sequences

Although several approaches have been presented for the recognition of human gait, most of them limit their attention to the case in which only the side view is available since this viewing angle is considered to provide the richest informa- tion of the gait of the waking person [4–7]. In [8], an exper- iment was carried out using two views, namely, the frontal- parallel view and the side view, from which the silhouettes of the subjects in two walking stances were extracted. This ap- proach exhibited higher recognition accuracy for the frontal- parallel view than that of the side view. The side view was
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Gait phase classification for in-home gait assessment

Gait phase classification for in-home gait assessment

In [24], a Kinect-based gait assessment system is proposed for nor- mal/abnormal gait classification, where several high-level features are extracted from normal gait analysis and 360 ◦ turning analysis to perform statistic features thresholding classification. However, there is no numerical performance report. A point-of-care gait assess- ment framework that adopts dynamic time warping (DTW), prin- cipal component analysis (PCA) and linear discriminant analyses of gait indices is proposed in [25] to quantify gait abnormalities, evalu- ating limb impairment for patients with multiple sclerosis. However, there is no benchmarking system provided in the study. In [26], motion sequences are segmented into repetitive action sequences based on zero-velocity crossing of the selected representative kine- matic parameters that are extracted from a unified representation via a generic full-body kinematic model, unscented Kalman filter, frequency analysis and adaptive k-means clustering. Several filters are introduced in this unsupervised temporal segmentation method which need manual parameter tuning. Experiments are only con- ducted on easily-distinguishable full-body actions resulting in good performance. However, [26] is not practical for the gait phase seg- mentation task since it relies on high quality motion representation. A comparable camera-based gait phase classification system is pro- posed in [3], where the system adopts a single RGB camera to track 2D bull-eye paper markers attached on joints of interest and automat- ically labels a single frame when one of six gait events of interest occurs via a heuristic thresholding criteria. We have the following improvements: (1) 2D bull-eye paper markers [3] are replaced with retro-reflective ball markers to capture 3D joint location of interests using single depth camera, (2) comprehensive 3D gait parameters based on marker trajectories are defined to cover all possible high- level motion features of each gait phase, and most importantly, (3)
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