The effect of assistive devices on gait patterns in Parkinson’s disease: preliminary results

Poster presented at the First international Congress of CiiEM “From Basic Sciences to Clinical Research”, 27-28 November 2015, Egas Moniz, Caparica, Portugal.

Metodologia para avaliação e monitorização da marcha espástica em pacientes pós-AVC

O trabalho que se apresenta nesta dissertação pretende ser uma contribuição para o desenvolvimento de métodos de avaliação da recuperação da marcha em pacientes pós acidente vascular cerebral (AVC), envolvidos em programas de reabilitação e que sejam utilizadores de ortóteses tornozelo-pé (AFO – Ankle Foot Orthosis). A metodologia desenvolvida considera uma AFO em polipropileno (PP), que é instrumentada com uma unidade de medição inercial (UMI) e oito extensómetros elétricos de resistência. A UMI é fixa com uma tira elástica na posição do retro pé. Os dados recolhidos a partir da instrumentação são utilizados para monitorizar a marcha de doentes pós AVC, a partir do qual podem ser estimados diversos parâmetros espácio-temporais. Os sinais recolhidos nos extensómetros permitem a identificação dos eventos da marcha, necessários para a segmentação do sinal da aceleração, enquanto o sinal da aceleração do eixo horizontal da UMI, no plano sagital, garante a identificação da velocidade da marcha, tempo de apoio e comprimento do ciclo da marcha. Nos testes ao método desenvolvido foram utilizados dois voluntários: um indivíduo saudável e um paciente em recuperação pós AVC, tendo sido definido um protocolo de marcha com dez metros (10 MWT). Os dados recolhidos no indivíduo saudável foram enquadrados no padrão de referência. O paciente executou o protocolo antes e após tratamento com toxina botulínica (TB). Este estudo propõe a definição de um novo parâmetro, o índice de confiança ic, que avalia a confiança do sujeito espástico durante a marcha, com base na transferência do centro da gravidade do corpo na fase do balanço. O método Bland –Altman foi aplicado para validar o método da UMI de medição da velocidade de marcha, comparando com um método de referencia que utiliza medição temporal com cronómetro. A média das diferenças entre os dois métodos foi determinada junto aos limites de concordância. O t Student test permitiu a validação dos dados utilizados no cálculo do índice de confiança. A correlação forte entre as velocidades da marcha e os tempos de apoio e a cadência, fortalece a confiabilidade dos dados obtidos e dos parâmetros calculados utilizando os métodos desenvolvidos neste trabalho. Os resultados obtidos com a metodologia desenvolvida, que apresenta uma estratégia inovadora que recorre aos ângulos da orientação de uma UMI no plano sagital mostraram que é possível monitorizar a evolução dos doentes pós-AVC com recurso a uma AFO.

Description and Prediction of Freezing of Gait in Parkinson's Disease from Wearable Inertial Measurements Units

Parkinson's disease (PD) is a neuro-degenerative disorder, the second most common after Alzheimer's disease. After diagnosis, treatments can help to relieve the symptoms, but there is no known cure for PD. PD is characterized by a combination of motor and no-motor dysfunctions. Among the motor symptoms there is the so called Freezing of Gait (FoG). The FoG is a phenomenon in PD patients in which the feet stock to the floor and is difficult for the patient to initiate movement. FoG is a severe problem, since it is associated with falls, anxiety, loss of mobility, accidents, mortality and it has substantial clinical and social consequences decreasing the quality of life in PD patients. Medicine can be very successful in controlling movements disorders and dealing with some of the PD symptoms. However, the relationship between medication and the development of FoG remains unclear. Several studies have demonstrated that visual or auditory rhythmical cuing allows PD patients to improve their motor abilities. Rhythmic auditory stimulation (RAS) was shown to be particularly effective at improving gait, specially with patients that manifest FoG. While RAS allows to reduce the time and the effects of FoGs occurrence in PD patients after the FoG is detected, it can not avoid the episode due to the latency of detection. An improvement of the system would be the prediction of the FoG. This thesis was developed following two main objectives: (1) the finding of specifics properties during pre FoG periods different from normal walking context and other walking events like turns and stops using the information provided by the inertial measurements units (IMUs) and (2) the formulation of a model for automatically detect the pre FoG patterns in order to completely avoid the upcoming freezing event in PD patients. The first part focuses on the analysis of different methods for feature extraction which might lead in the FoG occurrence.

No marchamos solas, marchamos acompañadas. Crónica de la Segunda Marcha de Mujeres Originarias

Fil: Brown, Giselle. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

[La necesidad e importancia de los tratados internacionales y su influencia en la marcha progresiva de los pueblos] : discurso leído en la Universidad Central por...D. Agustín Leís y Cernadas, en el acto solemne de recibir la investidura de doctor en la facultad de jurisprudencia.

Tesis de la Universidad Central (Madrid), Facultad de Derecho, leída el 30-06-1859.

Provas da votiva acçaõ do primeiro monarca de Portugal, que na marcha para escalar santarem prometteo a Deos a fundaçaõ, e dote de hum mosteiro cisterciense, se pelas intercessões de S. Bernardo ficasse senhor da Fortaleza, que hia atacar.

Mode of access: Internet.

Cómo se construyó una marcha por seguridad y justicia en una ciudad del interior de la Provincia de Buenos Aires. Movilización colectiva, acción política y percepción del delito : El caso de Azul, 2007

Fil: Galar, Santiago. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

No marchamos solas, marchamos acompañadas. Crónica de la Segunda Marcha de Mujeres Originarias

Fil: Brown, Giselle. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

The diagnostic reliability of Internet-based observational kinematic gait analysis

We investigated the accuracy and reliability of observational kinematic gait assessments performed via a low-bandwidth Internet link (118 kbit/s) and a higher-speed Internet link (128 kbit/s). Twenty-four subjects were randomized to either bandwidth group. Gait was assessed with the Gait Assessment Rating Scale (GARS) in the traditional manner, which is from video-recordings, and with repeated measurements via the online method. Online assessment was found to provide as accurate a measure of gait performance as the traditional assessment (limits of agreement

Does the type of concurrent task affect preferred and cued gait in people with Parkinson's disease?

Difficulty performing more than one task at a time is common in people with Parkinson's disease, resulting in interference with one or both tasks. While studies have shown that greater interference in gait occurs with more complex concurrent tasks, the impact of the type of concurrent task is unclear in the Parkinson's population. Thus the first purpose of this study was to investigate the effect of the concurrent task (calculation, language, or motor) on gait in people with Parkinson's disease. As visual cues are commonly used to aid stride regulation in people with Parkinson's disease, the second purpose of this study was to determine whether this method of increasing stride length was still effective if other tasks were performed simultaneously. Sixteen patients with Parkinson's disease and 16 gender- and age-matched controls performed six cognitive and motor concurrent tasks when seated, walking 10 m, and walking over visual cues. Stride length decreased in people with Parkinson's disease when performing the concurrent calculation and language tasks, but not with the motor task. The language task was more complex than the calculation task, thus the effect was not due to task complexity alone. Visual cues were effective in improving stride length whist maintaining velocity in people with Parkinson's disease, even when performed under dual task conditions. These findings highlight the importance of the task when assessing and retraining dual tasking during gait, and suggest that retraining dual tasking can occur whilst simultaneously using visual aids to regulate stride length.

Guidelines for filming digital camera video clips for the assessment of gait and movement disorders by teleneurology

Digital still cameras capable of filming short video clips are readily available, but the quality of these recordings for telemedicine has not been reported. We performed a blinded study using four commonly available digital cameras. A simulated patient with a hemiplegic gait pattern was filmed by the same videographer in an identical, brightly lit indoor setting. Six neurologists viewed the blinded video clips on their PC and comparisons were made between cameras, between video clips recorded with and without a tripod, and between video clips filmed on high- or low-quality settings. Use of a tripod had a smaller effect than expected, while images taken on a high-quality setting were strongly preferred to those taken on a low-quality setting. Although there was some variability in video quality between selected cameras, all were of sufficient quality to identify physical signs such as gait and tremor. Adequate-quality video clips of movement disorders can be produced with low-cost cameras and transmitted by email for teleneurology purposes.