Analysis of localized muscle fatigue in elderly women with and without a history of falls using electromyographic signal frequency parameters

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

From inverted pendulum to N-link chain: inertial sensors-based assessment of movement kinematics and dynamics for functional evaluation and rehabilitation

Despite several clinical tests that have been developed to qualitatively describe complex motor tasks by functional testing, these methods often depend on clinicians' interpretation, experience and training, which make the assessment results inconsistent, without the precision required to objectively assess the effect of the rehabilitative intervention. A more detailed characterization is required to fully capture the various aspects of motor control and performance during complex movements of lower and upper limbs. The need for cost-effective and clinically applicable instrumented tests would enable quantitative assessment of performance on a subject-specific basis, overcoming the limitations due to the lack of objectiveness related to individual judgment, and possibly disclosing subtle alterations that are not clearly visible to the observer. Postural motion measurements at additional locations, such as lower and upper limbs and trunk, may be necessary in order to obtain information about the inter-segmental coordination during different functional tests involved in clinical practice. With these considerations in mind, this Thesis aims: i) to suggest a novel quantitative assessment tool for the kinematics and dynamics evaluation of a multi-link kinematic chain during several functional motor tasks (i.e. squat, sit-to-stand, postural sway), using one single-axis accelerometer per segment, ii) to present a novel quantitative technique for the upper limb joint kinematics estimation, considering a 3-link kinematic chain during the Fugl-Meyer Motor Assessment and using one inertial measurement unit per segment. The suggested methods could have several positive feedbacks from clinical practice. The use of objective biomechanical measurements, provided by inertial sensor-based technique, may help clinicians to: i) objectively track changes in motor ability, ii) provide timely feedback about the effectiveness of administered rehabilitation interventions, iii) enable intervention strategies to be modified or changed if found to be ineffective, and iv) speed up the experimental sessions when several subjects are asked to perform different functional tests.

Effect of chlorzoxazone in patients with downbeat nystagmus: A pilot trial

Objective: Downbeat nystagmus (DBN) is the most frequent form of acquired persisting fixation nystagmus with different symptoms such as unsteadiness of gait, postural instability, and blurred vision with reduced visual acuity (VA) and oscillopsia. However, different symptomatic therapeutic principles are required, such as 3,4-diaminopyridine and 4-aminopyridine, that effectively suppress DBN. Chlorzoxazone (CHZ) is a nonselective activator of small conductance calcium-activated potassium (SK) channels that modifies the activity of cerebellar Purkinje cells. We evaluated the effects of this agent on DBN in an observational proof-of-concept pilot study. Methods: Ten patients received CHZ 500 mg 3 times a day for 1 or 2 weeks. Slow-phase velocity of DBN, VA, postural sway, and the drug's side effects were evaluated. Recordings were conducted at baseline, 90 minutes after first administration, and after 1 or 2 weeks. Results: Mean slow-phase velocity significantly decreased from a baseline of 2.74°/s ± 2.00 to 2.29°/s ± 2.12 (mean ± SD) 90 minutes after first administration and to 2.04°/s ± 2.24 (p < 0.001; post hoc both p = 0.024) after long-term treatment. VA significantly increased and postural sway in posturography showed a tendency to decrease on medication. Fifty percent of patients did not report any side effects. The most common reported side effect was abdominal discomfort and dizziness. Conclusions: The treatment with the SK-channel activator CHZ is a potentially new therapeutic agent for the symptomatic treatment of DBN. Classification of evidence: This study provides Class IV evidence that CHZ 500 mg 3 times a day may improve eye movements and visual fixation in patients with DBN.

Reproducibilidad de la batería EPESE de desempeño físico en atención primaria

Objetivo. Estimar la reproducibilidad de tres medidas objetivas de desempeño físico de personas mayores en atención primaria. Diseño. Estudio descriptivo y prospectivo con observación directa de la función física por parte de profesionales de la salud de acuerdo a un protocolo estandarizado. Emplazamiento. Tres centros de atención primaria de las provincias de Alicante y Valencia. Participantes. Muestra de 66 personas de 70 y más años, evaluadas en dos ocasiones por el mismo profesional al objeto de replicar idénticas condiciones del estudio, en un intervalo temporal de dos semanas (mediana de 14 días). Mediciones principales. Se evaluó el funcionamiento físico a través de tres pruebas objetivas de desempeño: el test de equilibrio, el de velocidad de la marcha, y la capacidad para levantarse y sentarse de una silla. Estas medidas provienen de los estudios E PESE (Established Populations for Epidemiologic Studies of the Elderly). Se ha calculado la fiabilidad test-retest mediante el coeficiente de correlación intraclase. Resultados. Los coeficientes de correlación intraclase (CCI) fueron de 0,55 para el test de equilibrio, de 0,69 para el test de levantarse de la silla, y de O, 79 para el de velocidad de la marcha. El valor para la puntuación total de la batería EPESE fue de 0,80. Conclusiones. La reproducibilidad de estas medidas de desempeño es tan aceptable como las aportadas por la bibliografía de referencia. Estas pruebas de desempeño permiten evaluar con rigor cambios importantes en funcionamiento y salud que se producen con el tiempo.

Examining links between cognitive markers, movement initiation and change, and pedestrian safety in older adults

Objective: The purpose of this study was to determine the extent to which mobility indices (such as walking speed and postural sway), motor initiation, and cognitive function, specifically executive functions, including spatial planning, visual attention, and within participant variability, differentially predicted collisions in the near and far sides of the road with increasing age. Methods: Adults aged over 45 years participated in cognitive tests measuring executive function and visual attention (using Useful Field of View; UFoV®), mobility assessments (walking speed, sit-to-stand, self-reported mobility, and postural sway assessed using motion capture cameras), and gave road crossing choices in a two-way filmed real traffic pedestrian simulation. Results: A stepwise regression model of walking speed, start-up delay variability, and processing speed) explained 49.4% of the variance in near-side crossing errors. Walking speed, start-up delay measures (average & variability), and spatial planning explained 54.8% of the variance in far-side unsafe crossing errors. Start-up delay was predicted by walking speed only (explained 30.5%). Conclusion: Walking speed and start-up delay measures were consistent predictors of unsafe crossing behaviours. Cognitive measures, however, differentially predicted near-side errors (processing speed), and far-side errors (spatial planning). These findings offer potential contributions for identifying and rehabilitating at-risk older pedestrians.

High accuracy discrimination of Parkinson's disease participants from healthy controls using smartphones

The aim of this study is to accurately distinguish Parkinson's disease (PD) participants from healthy controls using self-administered tests of gait and postural sway. Using consumer-grade smartphones with in-built accelerometers, we objectively measure and quantify key movement severity symptoms of Parkinson's disease. Specifically, we record tri-axial accelerations, and extract a range of different features based on the time and frequency-domain properties of the acceleration time series. The features quantify key characteristics of the acceleration time series, and enhance the underlying differences in the gait and postural sway accelerations between PD participants and controls. Using a random forest classifier, we demonstrate an average sensitivity of 98.5% and average specificity of 97.5% in discriminating PD participants from controls. © 2014 IEEE.

High-accuracy discrimination of Parkinson’s Disease participants from healthy controls using smartphones

Objective: To test the practicality and effectiveness of cheap, ubiquitous, consumer-grade smartphones to discriminate Parkinson’s disease (PD) subjects from healthy controls, using self-administered tests of gait and postural sway. Background: Existing tests for the diagnosis of PD are based on subjective neurological examinations, performed in-clinic. Objective movement symptom severity data, collected using widely-accessible technologies such as smartphones, would enable the remote characterization of PD symptoms based on self-administered, behavioral tests. Smartphones, when backed up by interviews using web-based videoconferencing, could make it feasible for expert neurologists to perform diagnostic testing on large numbers of individuals at low cost. However, to date, the compliance rate of testing using smart-phones has not been assessed. Methods: We conducted a one-month controlled study with twenty participants, comprising 10 PD subjects and 10 controls. All participants were provided identical LG Optimus S smartphones, capable of recording tri-axial acceleration. Using these smartphones, patients conducted self-administered, short (less than 5 minute) controlled gait and postural sway tests. We analyzed a wide range of summary measures of gait and postural sway from the accelerometry data. Using statistical machine learning techniques, we identified discriminating patterns in the summary measures in order to distinguish PD subjects from controls. Results: Compliance was high all 20 participants performed an average of 3.1 tests per day for the duration of the study. Using this test data, we demonstrated cross-validated sensitivity of 98% and specificity of 98% in discriminating PD subjects from healthy controls. Conclusions: Using consumer-grade smartphone accelerometers, it is possible to distinguish PD from healthy controls with high accuracy. Since these smartphones are inexpensive (around $30 each) and easily available, and the tests are highly non-invasive and objective, we envisage that this kind of smartphone-based testing could radically increase the reach and effectiveness of experts in diagnosing PD.

Leisure sports and postural control:Can a black belt protect your balance from aging?

To determine potential benefits of intensive leisure sports for age-related changes in postural control, we tested 3 activity groups comprising 70 young (M = 21.67 years, SD = 2.80) and 73 older (M = 62.60 years, SD = 5.19) men. Activity groups were martial artists, who held at least 1st Dan (black belt), sportive individuals exercising sports without explicit balance components, and nonsportive controls. Martial artists had an advantage over sportive individuals in dynamic posture tasks (upright stance on a sway-referenced platform), and these 2 active groups showed better postural control than nonsportive participants. Age-related differences in postural control were larger in nonsportive men compared with the 2 active groups, who were similar in this respect. In contrast, negative age differences in other sensorimotor and cognitive functions did not differ between activity groups. We concluded that individuals engaging in intensive recreational sports have long-term advantages in postural control. However, even in older martial artists with years of practice in their sports, we observed considerable differences favoring the young. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Task prioritization in aging: effects of sensory information on concurrent posture and memory performance

In older adults, cognitive resources play a key role in maintaining postural stability. In the present study, we evaluated whether increasing postural instability using sway referencing induces changes in resource allocation in dual-task performance leading older adults to prioritize the more age-salient posture task over a cognitive task. Young and older adults participated in the study which comprised two sessions. In the first session, three posture tasks (stable, sway reference visual, sway reference somatosensory) and a working memory task (n-back) were examined. In the second session, single- and dual-task performance of posture and memory were assessed. Postural stability improved with session. Participants were more unstable in the sway reference conditions, and pronounced age differences were observed in the somatosensory sway reference condition. In dual-task performance on the stable surface, older adults showed an almost 40% increase in instability compared to single-task. However, in the sway reference somatosensory condition, stability was the same in single- and dual-task performance, whereas pronounced (15%) costs emerged for cognition. These results show that during dual-tasking while standing on a stable surface, older adults have the flexibility to allow an increase in instability to accommodate cognitive task performance. However, when instability increases by means of compromising somatosensory information, levels of postural control are kept similar in single- and dual-task, by utilizing resources otherwise allocated to the cognitive task. This evidence emphasizes the flexible nature of resource allocation, developed over the life-span to compensate for age-related decline in sensorimotor and cognitive processing.

A virtual reality approach to the study of visually driven postural control in developing and aging humans

L'être humain utilise trois systèmes sensoriels distincts pour réguler le maintien de la station debout: la somesthésie, le système vestibulaire, et le système visuel. Le rôle de la vision dans la régulation posturale demeure peu connu, notamment sa variabilité en fonction de l'âge, du type développemental, et des atteintes neurologiques. Dans notre travail, la régulation posturale induite visuellement a été évaluée chez des participants au développement et vieillissement normaux âgés de 5-85 ans, chez des individus autistes (développement atypique) âgés de 12-33 ans, ainsi que chez des enfants entre 9-18 ans ayant subi un TCC léger. À cet effet, la réactivité posturale des participants en réponse à un tunnel virtuel entièrement immersif, se mouvant à trois niveaux de vélocité, a été mesurée; des conditions contrôles, où le tunnel était statique ou absent, ont été incluses. Les résultats montrent que la réactivité (i.e. instabilité) posturale induite visuellement est plus élevée chez les jeunes enfants; ensuite, elle s'atténue pour rejoindre des valeurs adultes vers 16-19 ans et augmente de façon linéaire en fonction de l'âge après 45 ans jusqu'à redevenir élevée vers 60 ans. De plus, à la plus haute vélocité du tunnel, les plus jeunes participants autistes ont manifesté significativement moins de réactivité posturale comparativement à leurs contrôles; cette différence n'était pas présente chez des participants plus âgés (16-33 ans). Enfin, les enfants ayant subi un TCC léger, et qui étaient initialement modérément symptomatiques, ont montré un niveau plus élevé d'instabilité posturale induite visuellement que les contrôles, et ce jusqu'à 12 semaines post-trauma malgré le fait que la majorité d'entre eux (89%) n'étaient plus symptomatiques à ce stade. En somme, cela suggère la présence d'une importante période de transition dans la maturation des systèmes sous-tendant l'intégration sensorimotrice impliquée dans le contrôle postural vers l'âge de 16 ans, et d'autres changements sensorimoteurs vers l'âge de 60 ans; cette sur-dépendance visuelle pour la régulation posturale chez les enfants et les aînés pourrait guider l'aménagement d'espaces et l'élaboration d'activités ajustés à l'âge des individus. De plus, le fait que l'hypo-réactivité posturale aux informations visuelles chez les autistes dépende des caractéristiques de l'environnement visuel et de l'âge chronologique, affine notre compréhension des anomalies sensorielles propres à l'autisme. Par ailleurs, le fait que les enfants ayant subi un TCC léger montrent des anomalies posturales jusqu'à 3 mois post-trauma, malgré une diminution significative des symptômes rapportés, pourrait être relié à une altération du traitement de l'information visuelle dynamique et pourrait avoir des implications quant à la gestion clinique des patients aux prises avec un TCC léger, puisque la résolution des symptômes est actuellement le principal critère utilisé pour la prise de décision quant au retour aux activités. Enfin, les résultats obtenus chez une population à développement atypique (autisme) et une population avec atteinte neurologique dite transitoire (TCC léger), contribuent non seulement à une meilleure compréhension des mécanismes d'intégration sensorimotrice sous-tendant le contrôle postural mais pourraient aussi servir comme marqueurs sensibles et spécifiques de dysfonction chez ces populations. Mots-clés : posture, équilibre, vision, développement/vieillissement sensorimoteur, autisme, TCC léger symptomatique, réalité virtuelle.

Postural control in Down syndrome: the use of somatosensory and visual information to attenuate body sway

The purpose of this study was to examine the effects of visual and somatosensory information on body sway in individuals with Down syndrome (DS). Nine adults with DS (19-29 years old) and nine control subjects (CS) (19-29 years old) stood in the upright stance in four experimental conditions: no vision and no touch; vision and no touch; no vision and touch; and vision and touch. In the vision condition, participants looked at a target placed in front of them; in the no vision condition, participants wore a black cotton mask. In the touch condition, participants touched a stationary surface with their right index finger; in the no touch condition, participants kept their arms hanging alongside their bodies. A force plate was used to estimate center of pressure excursion for both anterior-posterior and medial-lateral directions. MANOVA revealed that both the individuals with DS and the control subjects used vision and touch to reduce overall body sway, although individuals with DS still oscillated more than did the CS. These results indicate that adults with DS are able to use sensory information to reduce body sway, and they demonstrate that there is no difference in sensory integration between the individuals with DS and the CS.

Postural control under visual and proprioceptive perturbations during double and single limb stances: Insights for balance training

Single Limb Stance under visual and proprioceptive disturbances is largely used in clinical settings in order to improve balance in a wide range of functional disabilities. However, the proper role of vision and proprioception in SLS is not completely understood. The objectives of this study were to test the hypotheses that when ankle proprioception is perturbed, the role of vision in postural control increases according to the difficulty of the standing task. And to test the effect of vision during postural adaptation after withdrawal of the somesthetic perturbation during double and single limb stance. Eleven males were submitted to double (DLS) and single limb (SLS) stances under conditions of normal or reduced vision, both with normal and perturbed proprioception. Center of pressure parameters were analyzed across conditions. Vision had a main effect in SLS, whereas proprioception perturbation showed effects only during DLS. Baseline stability was promptly achieved independently of visual input after proprioception reintegration. In conclusion, the role of vision increases in SLS. After proprioception reintegration, vision does not affect postural recovery. Balance training programs must take that into account. © 2011 Elsevier Ltd.

Efeitos de uma informação sensorial adicional no controle postural: envelhecimento e doença de Parkinson

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Influência de movimentos oculares sacádicos no equilíbrio postural de idosos praticantes de vôlei adaptado e idosos sedentários

Pós-graduação em Desenvolvimento Humano e Tecnologias - IBRC

The influence of anthropometric factors on postural balance: the relationship between body composition and posturographic measurements in young adults

OBJECTIVE: The aim of the present study was to evaluate the influence of anthropometric characteristics and gender on postural balance in adults. One hundred individuals were examined (50 males, 50 females; age range 20-40 years). METHODS: The following body composition measurements were collected (using bone densitometry measurements): fat percentage (% fat), tissue (g), fat (g), lean mass (g), bone mineral content (g), and bone mineral density (g/cm(2)). In addition, the following anthropometric measurements were collected: body mass (kg), height (cm), length of the trunk-cephalic region (cm), length of the lower limbs (cm) and length of the upper limbs (cm). The following indices were calculated: body mass index (kg/m(2)), waist-hip ratio and the support base (cm 2). Also, a postural balance test was performed using posturography variables with open and closed eyes. RESULTS: The analysis revealed poor correlations between postural balance and the anthropometric variables. A multiple linear regression analysis demonstrated that the whole group (female and male) height explained 12% of the medial-lateral displacement, 10% of the speed of oscillation, and 11% of the displacement area. The length of the trunk-cephalic length explained 6% of the displacement in the anteroposterior direction. With eyes closed, the support base and height explained 18% of the medial displacement, and the lateral height explained 10% of the displacement speed and 5% of the scroll area. CONCLUSION: Measured using posturography, the postural balance was only slightly influenced by the anthropometric variables, both with open and closed eyes. Height was the anthropometric variable that most influenced postural balance, both in the whole group and separately for each gender. Postural balance was more influenced by anthropometric factors in males than females.