Lara Allet

Wearable Systems for Monitoring Mobility-Related Activities in Chronic Disease: A Systematic Review

The use of wearable motion sensing technology offers important advantages over conventional methods for obtaining measures of physical activity and/or physical functioning in individuals with chronic diseases. This review aims to identify the actual state of applying wearable systems for monitoring mobility-related activity in individuals with chronic disease conditions. In this review we focus on technologies and applications, feasibility and adherence aspects, and clinical relevance of wearable motion sensing technology. PubMed (Medline since 1990), PEdro, and reference lists of all relevant articles were searched. Two authors independently reviewed randomised trials systematically. The quality of selected articles was scored and study results were summarised and discussed. 163 abstracts were considered. After application of inclusion criteria and full text reading, 25 articles were taken into account in a full text review. Twelve of these papers evaluated walking with pedometers, seven used uniaxial accelerometers to assess physical activity, six used multiaxial accelerometers, and two papers used a combination approach of a pedometer and a multiaxial accelerometer for obtaining overall activity and energy expenditure measures. Seven studies mentioned feasibility and/or adherence aspects. The number of studies that use movement sensors for monitoring of activity patterns in chronic disease (postural transitions, time spent in certain positions or activities) is nonexistent on the RCT level of study design. Although feasible methods for monitoring human mobility are available, evidence-based clinical applications of these methods in individuals with chronic diseases are in need of further development.

The behavioral significance of coherent resting-state oscillations after stroke

Stroke lesions induce not only loss of local neural function, but disruptions in spatially distributed areas. However, it is unknown whether they affect the synchrony of electrical oscillations in neural networks and if changes in network coherence are associated with neurological deficits. This study assessed these questions in a population of patients with subacute, unilateral, ischemic stroke. Spontaneous cortical oscillations were reconstructed from high-resolution electroencephalograms (EEG) with adaptive spatial filters. Maps of functional connectivity (FC) between brain areas were created and correlated with patient performance in motor and cognitive scores. In comparison to age matched healthy controls, stroke patients showed a selective disruption of FC in the alpha frequency range. The spatial distribution of alpha band FC reflected the pattern of motor and cognitive deficits of the individual patient: network nodes that participate normally in the affected functions showed local decreases in FC with the rest of the brain. Interregional FC in the alpha band, but not in delta, theta, or beta frequencies, was highly correlated with motor and cognitive performance. In contrast, FC between contralesional areas and the rest of the brain was negatively associated with patient performance. Alpha oscillation synchrony at rest is a unique and specific marker of network function and linearly associated with behavioral performance. Maps of alpha synchrony computed from a single resting-state EEG recording provide a robust and convenient window into the functionality and organization of cortical networks with numerous potential applications.

Effects of obesity on functional capacity

To assess the relationships between BMI and walking speed, balance control, sit‐to‐stand performance (a measure of mass specific lower limb power), and endurance.

Investigation of standing balance in diabetic patients with and without peripheral neuropathy using accelerometers.

BACKGROUND Peripheral neuropathy is recognised to be the most symptomatic complication of diabetes and is also linked to postural instability. This study investigates balance instability in diabetic patients with and without peripheral neuropathy. METHODS Quiet standing balance was investigated using an accelerometric-based method in 24 diabetic patients (12 with and 12 without peripheral neuropathy) and compared with 12 control subjects. Accelerations were measured at lumbar and ankle levels using three accelerometers. Two standing conditions of 30s were evaluated (i.e., eyes opened, eyes closed). The range and root mean square values were calculated on the anterior posterior component of lumbar and ankle accelerations and for the medial lateral component of lumbar accelerations. Differences between parameters were compared between groups using ANOVA and post hoc comparisons. FINDINGS The diabetic patients with peripheral neuropathy show higher-range and root mean square values compared with those of control subjects and diabetic patients without peripheral neuropathy. Significant differences between groups have been detected for anterior posterior range of lumbar acceleration, which was significantly higher for diabetic patients with peripheral neuropathy, compared with those of others groups. Significant higher values for diabetic patients with peripheral neuropathy were also detected for anterior posterior range and root mean square of ankle accelerations compared with control subjects. Visual deprivation shows an increase in accelerometric parameters for each group. INTERPRETATION This study is the first to investigate the balance instability of diabetic patients using accelerometers. Results confirm that diabetic patients with peripheral neuropathy have greater postural instability with higher acceleration values than those of control group and diabetic patients without peripheral neuropathy.

Frontal plane hip and ankle sensorimotor function, not age, predicts unipedal stance time

Introduction: Changes occur in muscles and nerves with aging. In this study we explore the relationship between unipedal stance time (UST) and frontal plane hip and ankle sensorimotor function in subjects with diabetic neuropathy. Methods: UST, quantitative measures of frontal plane ankle proprioceptive thresholds, and ankle and hip motor function were tested in 41 subjects with a spectrum of lower limb sensorimotor function ranging from healthy to moderately severe diabetic neuropathy. Results: Frontal plane hip and ankle sensorimotor function demonstrated significant relationships with UST. Multivariate analysis identified only composite hip strength, ankle proprioceptive threshold, and age to be significant predictors of UST (R2 = 0.73), explaining 46%, 24%, and 3% of the variance, respectively. Conclusions: Frontal plane hip strength was the single best predictor of UST and appeared to compensate for less precise ankle proprioceptive thresholds. This finding is clinically relevant given the possibility of strengthening the hip, even in patients with significant peripheral neuropathy. Muscle Nerve, 2012

The influence of stride-length on plantar foot-pressures and joint moments.

PURPOSE Joint moments have been acknowledged as key factors in understanding gait abnormalities. Gait velocity is further known to affect joint moments and foot pressures. Keeping gait velocity constant is thus a strategy to cancel out the influence of different preferred gait speed between groups. But even if gait velocity is controlled, individuals can choose different stride length-stride frequency combinations to cope with an imposed gait velocity. SCOPE To understand the influence of stride frequency-stride length on joint moments and plantar pressures. METHODS Twenty healthy young adults had to cross an 8m walkway with a walking speed of 1.3ms(-1). The wooden walkway was equipped with a force and a pressure platform. While walking speed was kept constant each participant walked with five different imposed stride lengths (SL): preferred (SL0); with a decrease of 10% (SL-10); with a decrease of 20% (SL-20); with an increase of 10% (SL+10) and with an increase of 20% (SF+20). RESULTS Ankle and knee joint moments significantly decreased with a decrease in SL. A significant (p<.05) lower peak pressure was achieved with a decreased SL under the heel, toes and midfoot. DISCUSSION/CONCLUSION The results showed that a change in stride lengths alters both, joint moments and foot pressures with clinically interesting indications. Redistribution of joint moments in the elderly for example might rather result from decreased SL than from age.

Clinical factors associated with gait alterations in diabetic patients

Aim  To identify clinical factors associated with gait alterations in patients with Type 2 diabetes.

ICF: Clinical relevance for physiotherapy? A critical review

The International Classification of Functioning, Disability and Health (ICF) holds great promise for providing the rehabilitation disciplines with a universal language. However, the ICF is still highly complex and questions remain about its practicability. The aims of this review were to (i) identify how the ICF is integrated in the clinical activity of physiotherapists, (ii) discuss advantages and limits of the use of the ICF, and (iii) suggest further possibilities for implementing the ICF by physiotherapists. A literature search on Medline, Cochrane, CINAHL and PEDro (key words: ICF, physiotherapy, physical therapy, clinical application, clinical use) was carried out, together with a check for articles on Google Scholar. Of 155 identified articles, 22 were specific to physiotherapy. These articles described the utility of the ICF to facilitate decision-making for physiotherapists; to classify the evaluation of therapy outcomes; to ensure that all aspects of human functioning are represented while testing the effectiveness and the reliability of these outcomes; to structure the documentation of assessments and interventions, as well as to ameliorate the communication. ICF has a clinical relevance for physiotherapists, although the limited reliability of the qualifier system for the feasibility of its implementation was shown. The authors emphasize that the ICF is a tool that facilitates the decision of what to measure but not how to measure.

Hip strength: Ankle proprioceptive threshold ratio predicts falls and injury in diabetic neuropathy

Introduction: We determined lower limb neuromuscular capacities associated with falls and fall‐related injuries in older people with declining peripheral nerve function. Methods: Thirty‐two subjects (67.4 ± 13.4 years; 19 with type 2 diabetes), representing a spectrum of peripheral neurologic function, were evaluated with frontal plane proprioceptive thresholds at the ankle, frontal plane motor function at the ankle and hip, and prospective follow‐up for 1 year. Results: Falls and fall‐related injuries were reported by 20 (62.5%) and 14 (43.8%) subjects, respectively. The ratio of hip adductor rate of torque development to ankle proprioceptive threshold (HipSTR/AnkPRO) predicted falls (pseudo‐R2 = .726) and injury (pseudo‐R2 = .382). No other variable maintained significance in the presence of HipSTR/AnkPRO. Conclusions: Fall and injury risk in the population studied is related inversely to HipSTR/AnkPRO. Increasing rapidly available hip strength in patients with neuropathic ankle sensory impairment may decrease risk of falls and related injuries. Muscle Nerve 50: 437–442, 2014

Interest of dual-task-related gait changes in idiopathic normal pressure hydrocephalus

Background:  Gait disorders in patients with idiopathic normal pressure hydrocephalus (iNPH) share similar characteristics found in pathologies presenting with higher‐level gait disorders that have been specifically associated with gait changes during walking while simultaneously performing an attention‐demanding task (i.e. dual tasking). The current study assessed the effect of cerebrospinal fluid (CSF) tapping on quantitative gait modification during single and dual tasking in patients with a suspicion of iNPH.