scholarly journals Diagnostic usefulness of 10-step tandem gait test for the patient with degenerative cervical myelopathy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dallah Yoo ◽  
Kyung-Chung Kang ◽  
Jung-Hee Lee ◽  
Ki Young Lee ◽  
In-Uk Hwang
Keyword(s):  
Cervical Myelopathy ◽  
Screening Tools ◽  
Control Group ◽  
Japanese Orthopedic Association ◽  
Gait Abnormality ◽  
Abnormal Gait ◽  
Diagnostic Usefulness ◽  
Gait Abnormalities ◽  
Degenerative Cervical Myelopathy ◽  
Tandem Gait

AbstractTandem gait is considered one of the most useful screening tools for gait impairment. The aim of this study is to evaluate diagnostic usefulness of 10-step tandem gait test for the patients with degenerative cervical myelopathy (DCM). Sixty-two DCM patients were compared to 55 persons without gait abnormalities as control. We counted the number of consecutive steps and graded into five according the number of steps and stability. Five grades of tandem gait were investigated for association with clinical parameters including qualitative Japanese orthopedic association (JOA) sub-score for lower extremities and Nurick scale and quantitative balance and gait assessments. The number of tandem steps were reduced and the grades of tandem gait were differently distributed in the DCM patients compared to controls (steps, 7.1 ± 3.6 versus 9.9 ± 0.4, p < 0.001; grades of 0/1/2/3/4/5, 1/13/14/15/19 versus 0/0/2/15/38, p < 0.001 in patients with DCM and control respectively). Patients with DCM showed more unstable balance and abnormal gait features including slower velocity, shorter strides, wider bases with increased stance phase of a gait cycle compared to the control group. The grades of tandem gait were correlated with JOA sub-score (r = 0.553, p < 0.001) and the Nurick scale (r = − 0.652, p < 0.001) as well as both balance and gait parameters. In DCM patients, tandem gait was impaired and correlated with severity of gait abnormality. The authors believe that 10-step tandem gait test is an objective and useful screening test for evaluating gait disturbance in patients with DCM.

scholarly journals A Clinical Practice Guideline for the Management of Degenerative Cervical Myelopathy: Introduction, Rationale, and Scope

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 21S-27S ◽  
Author(s):  
Michael G. Fehlings ◽  
Lindsay A. Tetreault ◽  
K. Daniel Riew ◽  
James W. Middleton ◽  
Jeffrey C. Wang
Keyword(s):  
Cervical Myelopathy ◽  
Primary Care Physicians ◽  
Treatment Strategies ◽  
Signs And Symptoms ◽  
Operative Management ◽  
Cord Compression ◽  
Neurological Dysfunction ◽  
Japanese Orthopedic Association ◽  
Abnormal Gait ◽  
Degenerative Cervical Myelopathy

Degenerative cervical myelopathy (DCM) is a progressive spine disease and the most common cause of spinal cord dysfunction in adults worldwide. Patients with DCM may present with common signs and symptoms of neurological dysfunction, such as paresthesia, abnormal gait, decreased hand dexterity, hyperreflexia, increased tone, and sensory dysfunction. Clinicians across several specialties encounter patients with DCM, including primary care physicians, rehabilitation specialists, therapists, rheumatologists, neurologists, and spinal surgeons. Currently, there are no guidelines that outline how to best manage patients with mild (defined as a modified Japanese Orthopedic Association (mJOA) score of 15-17), moderate (mJOA = 12-14), or severe (mJOA ≤ 11) myelopathy, or nonmyelopathic patients with evidence of cord compression. This guideline provides evidence-based recommendations to specify appropriate treatment strategies for these populations. The intent of our recommendations is to (1) help identify patients at high risk of neurological deterioration, (2) define the role of nonoperative and operative management in each patient population, and (3) determine which patients are most likely to benefit from surgical intervention. The ultimate goal of these guidelines is to improve outcomes and reduce morbidity in patients with DCM by promoting standardization of care and encouraging clinicians to make evidence-informed decisions.

Identification of Postconcussion Dual-Task Gait Abnormalities Using Normative Reference Values

2019 ◽  
Vol 35 (4) ◽  
pp. 290-296 ◽  
Author(s):  
David R. Howell ◽  
Thomas A. Buckley ◽  
Brant Berkstresser ◽  
Francis Wang ◽  
William P. Meehan
Keyword(s):  
Reference Values ◽  
Dual Task ◽  
Gait Speed ◽  
Step Length ◽  
Normative Values ◽  
Control Group ◽  
Single Task ◽  
Abnormal Gait ◽  
Confounding Variables ◽  
Gait Abnormalities

The purpose of this study was to identify the rate of abnormal single-task and dual-task gait performance following concussion compared to uninjured controls using previously established normative reference values. The authors examined athletes with a concussion (n = 54; mean age = 20.3 [1.1] y, 46% female, tested 2.9 [1.5] d postinjury), and healthy controls were tested during their preseason baseline examination (n = 60; mean age = 18.9 [0.7] y, 37% female). Participants completed an instrumented single-/dual-task gait evaluation. Outcome variables included average walking speed, cadence, and step length. A significantly greater number of those with concussion walked with abnormal dual-task gait speed compared with the control group (56% vs 30%,P = .01). After adjusting for potential confounding variables (age, concussion history, symptom severity, and sleep), concussion was associated with lower dual-task gait speed (β = −0.150; 95% confidence interval [CI] = −0.252 to −0.047), cadence (β = −8.179; 95% CI = −14.49 to −1.871), and stride length (β = −0.109; 95% CI = −0.204 to −0.014). Although group analyses indicated that those with a concussion performed worse on single-task and dual-task gait compared with controls, a higher rate of abnormal gait was detected for the concussion group compared with the control group for dual-task gait speed only. Dual-task gait speed, therefore, may be considered as a measure to compare against normative values to detect postconcussion impairments.

scholarly journals Degenerative Cervical Myelopathy: How to Identify the Best Responders to Surgery?

2020 ◽  
Vol 9 (3) ◽  
pp. 759 ◽  
Author(s):  
Rocco Severino ◽  
Aria Nouri ◽  
Enrico Tessitore
Keyword(s):  
Cervical Myelopathy ◽  
Diffusion Tensor ◽  
Inverse Correlation ◽  
Postoperative Outcome ◽  
Definitive Treatment ◽  
Conduction Time ◽  
Japanese Orthopedic Association ◽  
Conventional Mri ◽  
T2 Hyperintensity ◽  
Degenerative Cervical Myelopathy

Surgery is the only definitive treatment for degenerative cervical myelopathy (DCM), however, the degree of neurological recovery is often unpredictable. Here, we assess the utility of a multidimensional diagnostic approach, consisting of clinical, neurophysiological, and radiological parameters, to identify patients likely to benefit most from surgery. Thirty-six consecutive patients were prospectively analyzed using the modified Japanese Orthopedic Association (mJOA) score, MEPs/SSEPs and advance and conventional MRI parameters, at baseline, and 3- and 12-month postoperatively. Patients were subdivided into “normal” and “best” responders (<50%, ≥50% improvement in mJOA), and correlation between Diffusion Tensor Imaging (DTI) parameters, mJOA, and MEP/SSEP latencies were examined. Twenty patients were “best” responders and 16 were “normal responders”, but there were no statistical differences in age, T2 hyperintensity, and midsagittal diameter between them. There was a significant inverse correlation between the MEPs central conduction time and mJOA in the preoperative period (p = 0.0004), and a positive correlation between fractional anisotropy (FA) and mJOA during all the phases of the study, and statistically significant at 1-year (r = 0.66, p = 0.0005). FA was significantly higher amongst “best responders” compared to “normal responders” preoperatively and at 1-year (p = 0.02 and p = 0.009). A preoperative FA > 0.55 was predictor of a better postoperative outcome. Overall, these results support the concept of a multidisciplinary approach in the assessment and management of DCM.

scholarly journals P.222 Subjective pattern of postoperative neurological recovery in degenerative cervical myelopathy varies by preoperative severity of disease

2021 ◽  
Vol 48 (s3) ◽  
pp. S84-S84
Author(s):  
AC Friesen ◽  
SA Detombe ◽  
P Doyle-Pettypiece ◽  
W Ng ◽  
K Gurr ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Cord Compression ◽  
Patient Expectations ◽  
Postoperative Recovery ◽  
Neurological Deficits ◽  
Postoperative Patient ◽  
Japanese Orthopedic Association ◽  
Sphincter Function ◽  
Moderate Disease ◽  
Degenerative Cervical Myelopathy

Background: Degenerative cervical myelopathy is a spinal disorder resulting in progressive spinal cord compression and consequent neurological deficits that can be assessed and tracked using the modified Japanese Orthopedic Association (mJOA) questionnaire. However, it is difficult to predict which patients will recover neurological function after surgery, making it difficult for clinicians to set reliable postoperative patient expectations. Methods: Sixty-eight operative myelopathy patients (50 male, 14 female) consented to complete the mJOA questionnaire both preoperatively and 6-months postoperatively. Fifteen of these patients had mild, twenty-three had moderate, and thirty had severe preoperative disease. Results: We found that in mild myelopathy, sensation and strength recover in similar proportions. In moderate myelopathy, a greater proportion of patients recover in each domain except for sensation. Recovery in severe myelopathy was comparable to moderate disease, but showed more dramatic recovery in sensation and sphincter function. Conclusions: This study shows that the severity of myelopathic disease influences the pattern of postoperative recovery. Though limited in sample size, the recovery patterns identified above are an important first step in recognizing myelopathy as a disease that patients experience heterogeneously both pre- and post-operatively. Our results will aid clinicians in goals-of-surgery discussions and assist with managing postoperative patient expectations.

scholarly journals Predictors associated with neurological recovery after anterior decompression with fusion for degenerative cervical myelopathy

2020 ◽  
Author(s):  
Hiroyuki Inose ◽  
Takashi Hirai ◽  
Toshitaka Yoshii ◽  
Atsushi Kimura ◽  
Katsushi Takeshita ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Recovery Rate ◽  
Neck Disability Index ◽  
Multiple Linear Regression Model ◽  
Vertical Axis ◽  
Neurological Recovery ◽  
Anterior Decompression ◽  
Sagittal Vertical Axis ◽  
Japanese Orthopedic Association ◽  
Degenerative Cervical Myelopathy

Abstract Background Anterior decompression with fusion (ADF) has often been performed for degenerative cervical myelopathy (DCM) in patients with poor cervical spine alignment and/or anterior cord compression. However, it is difficult to preoperatively predict the extent to which patients will experience postoperative neurological improvement. We aimed to identify predictors associated with neurological recovery after ADF in a retrospective study of prospectively collected data. Methods We prospectively enrolled patients who were scheduled for ADF for DCM. The associations of baseline variables with recovery rate were investigated using a multiple linear regression model. Results In total, 36 patients completed the 1-year follow-up. Regarding clinical outcomes, the Japanese Orthopedic Association score for the assessment of cervical myelopathy, European Quality of Life Five Dimensions Scale, Neck Disability Index, and Physical Component Summary of the SF-36 (PCS) scores improved postoperatively. The recovery rate was significantly correlated with the sagittal vertical axis (SVA) and T1 pelvic angle. Univariate regression analyses showed that the SVA and PCS score were significantly associated with recovery rate. Lastly, multiple regression analysis identified the independent predictors of recovery rate after ADF as thoracic kyphosis (TK), PCS, and SVA. According to this prediction model, the following equation was obtained: recovery rate = − 8.26 + 1.17 × (TK) – 0.45 × (SVA) + 0.85 × (PCS). Conclusion Patients with lower TK, lower PCS score, and higher SVA were more likely to have poor neurological recovery after ADF. Therefore, DCM patients with these predictors who undergo ADF might be cautioned about poor recovery and be required to provide adequate informed consent.

scholarly journals High prevalence of gait abnormalities in pugs

2018 ◽  
Vol 182 (6) ◽  
pp. 167-167 ◽  
Author(s):  
Cecilia Rohdin ◽  
Karin Hultin Jäderlund ◽  
Ingrid Ljungvall ◽  
Kerstin Lindblad-Toh ◽  
Jens Häggström
Keyword(s):  
Prospective Study ◽  
Kennel Club ◽  
Future Studies ◽  
Video Footage ◽  
Gait Abnormality ◽  
Abnormal Gait ◽  
High Prevalence ◽  
Associated Conditions ◽  
Health Disorders ◽  
Gait Abnormalities

The objective of this prospective study was to determine the prevalence of gait abnormalities in a cohort of Swedish pugs by using an owner-based questionnaire targeting signs of gait abnormality and video footage showing the dog’s gait. This study also evaluated associated conditions of abnormal gait, including other health disorders prevalent in the breed. Five hundred and fifty (550) pugs registered in the Swedish Kennel Club, of one, five and eight years of age, in 2015 and 2016, were included in the study. Gait abnormalities were reported in 30.7 per cent of the responses. In the majority of cases, the character of the described gait indicated a neurological cause for the gait abnormality. An association was observed between abnormal gait and age, with gait abnormalities being significantly more common in older pugs (P=0.004). An association was also found between abnormal gait and dyspnoea, with dyspnoea being significantly more common in pugs with gait abnormalities (P<0.0001). This study demonstrated that the prevalence of gait abnormalities was high in the Swedish pug breed and increased with age. Future studies on the mechanisms behind these gait abnormalities are warranted.

scholarly journals Quantitative Assessment of Gait Characteristics in Degenerative Cervical Myelopathy: A Prospective Clinical Study

2020 ◽  
Vol 9 (3) ◽  
pp. 752 ◽  
Author(s):  
Sukhvinder Kalsi-Ryan ◽  
Anna C. Rienmueller ◽  
Lauren Riehm ◽  
Colin Chan ◽  
Daniel Jin ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Rank Correlation ◽  
Neurological Status ◽  
Therapeutic Interventions ◽  
Prospective Clinical Study ◽  
Early Presentation ◽  
Japanese Orthopedic Association ◽  
Gait Parameters ◽  
Degenerative Cervical Myelopathy ◽  
The Impact

It is challenging to discriminate the early presentation of Degenerative Cervical Myelopathy (DCM) as well as sensitively and accurately distinguishing between mild, moderate, and severe levels of impairment. As gait dysfunction is one of the cardinal symptoms of DCM, we hypothesized that spatiotemporal gait parameters, including the enhanced gait variability index (eGVI), could be used to sensitively discriminate between different severities of DCM. A total of 153 patients recently diagnosed with DCM were recruited and stratified on the basis of DCM severity grades, as measured using the modified Japanese Orthopedic Association (mJOA) scale. Demographic information and neurological status were collected. Gait assessments were performed using an 8 m walkway. Spearman rank correlation was used to identify relationships between gait parameters and mJOA values as well as the mJOA lower extremity (LE) subscore. Kruskal–Wallis H test was performed to evaluate differences between severity groups, as defined by mJOA classification. A significant and relatively strong correlation was found between the mJOA score and eGVI, as well as between the LE subscore of the mJOA and eGVI. Significant differences in the eGVI (X2(2, N = 153) = 55.04, p < 0.0001, ε2 = 0.36) were found between all groups of DCM severity, with a significant increase in the eGVI as DCM progressed from mild to moderate. The eGVI was the most discriminative gait parameter, which facilitated objective differentiation between varying severities of DCM. Quantitative gait assessments show promise as an accurate and objective tool to diagnose and classify DCM, as well as to potentially evaluate the impact of therapeutic interventions.

scholarly journals Management of degenerative cervical myelopathy – An update

2016 ◽  
Vol 62 (9) ◽  
pp. 886-894 ◽  
Author(s):  
ANDREI F. JOAQUIM ◽  
ENRICO GHIZONI ◽  
HELDER TEDESCHI ◽  
WELLINGTON K. HSU ◽  
ALPESH A. PATEL
Keyword(s):  
Spinal Cord ◽  
Cervical Myelopathy ◽  
Clinical Symptoms ◽  
Surgical Techniques ◽  
The Other ◽  
Surgical Approaches ◽  
Japanese Orthopedic Association ◽  
Advantages And Disadvantages ◽  
Clinical Magnetic Resonance Imaging ◽  
Degenerative Cervical Myelopathy

SUMMARY Introduction Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adult patients. Patients generally present with a slow, progressive neurological decline or a stepwise deterioration pattern. In this paper, we discuss the most important factors involved in the management of DCM, including a discussion about the surgical approaches. Method The authors performed an extensive review of the peer-reviewed literature addressing the aforementioned objectives. Results Although the diagnosis is clinical, magnetic resonance imaging (MRI) is the study of choice to confirm stenosis and also to exclude the differential diagnosis. The severity the clinical symptoms of DCM are evaluated by different scales, but the modified Japanese Orthopedic Association (mJOA) and the Nürick scale are probably the most commonly used. Spontaneous clinical improvement is rare and surgery is the main treatment form in an attempt to prevent further neurological deterioration and, potentially, to provide some improvement in symptoms and function. Anterior, posterior or combined cervical approaches are used to decompress the spinal cord, with adjunctive fusion being commonly performed. The choice of one approach over the other depends on patient characteristics (such as number of involved levels, site of compression, cervical alignment, previous surgeries, bone quality, presence of instability, among others) as well as surgeon preference and experience. Conclusion Spine surgeons must understand the advantages and disadvantages of all surgical techniques to choose the best procedure for their patients. Further comparative studies are necessary to establish the superiority of one approach over the other when multiple options are available.

scholarly journals Detection and Classification of Stroke Gaits by Deep Neural Networks Employing Inertial Measurement Units

Sensors ◽  
2021 ◽  
Vol 21 (5) ◽  
pp. 1864
Author(s):  
Fu-Cheng Wang ◽  
Szu-Fu Chen ◽  
Chin-Hsien Lin ◽  
Chih-Jen Shih ◽  
Ang-Chieh Lin ◽  
...  
Keyword(s):  
Stroke Patients ◽  
Gait Patterns ◽  
Gait Abnormality ◽  
Abnormal Gait ◽  
Average Accuracy ◽  
Targeted Treatments ◽  
Measurement Units ◽  
Gait Abnormalities ◽  
Rehabilitation Strategies

This paper develops Deep Neural Network (DNN) models that can recognize stroke gaits. Stroke patients usually suffer from partial disability and develop abnormal gaits that can vary widely and need targeted treatments. Evaluation of gait patterns is crucial for clinical experts to make decisions about the medication and rehabilitation strategies for the stroke patients. However, the evaluation is often subjective, and different clinicians might have different diagnoses of stroke gait patterns. In addition, some patients may present with mixed neurological gaits. Therefore, we apply artificial intelligence techniques to detect stroke gaits and to classify abnormal gait patterns. First, we collect clinical gait data from eight stroke patients and seven healthy subjects. We then apply these data to develop DNN models that can detect stroke gaits. Finally, we classify four common gait abnormalities seen in stroke patients. The developed models achieve an average accuracy of 99.35% in detecting the stroke gaits and an average accuracy of 97.31% in classifying the gait abnormality. Based on the results, the developed DNN models could help therapists or physicians to diagnose different abnormal gaits and to apply suitable rehabilitation strategies for stroke patients.

scholarly journals Predictors for quality of life improvement after surgery for degenerative cervical myelopathy: a prospective multi-center study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hiroyuki Inose ◽  
Takashi Hirai ◽  
Toshitaka Yoshii ◽  
Atsushi Kimura ◽  
Katsushi Takeshita ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cervical Myelopathy ◽  
Preoperative Assessment ◽  
Sacral Slope ◽  
Japanese Orthopedic Association ◽  
Life Improvement ◽  
Multi Center Study ◽  
Additional Support ◽  
Degenerative Cervical Myelopathy

Abstract Background Degenerative cervical myelopathy (DCM) can significantly impair a patient’s quality of life (QOL). In this study, we aimed to identify predictors associated with QOL improvement after surgery for DCM. Methods This study included 148 patients who underwent surgery for DCM. The European QOL-5 Dimension (EQ-5D) score, the Japanese Orthopedic Association for the assessment of cervical myelopathy (C-JOA) score, and the Nurick grade were used as outcome measures. Radiographic examinations were performed at enrollment. The associations of baseline variables with changes in EQ-5D scores from preoperative to 1-year postoperative assessment were investigated using a multivariable linear regression model. Results The EQ-5D and C-JOA scores and the Nurick grade improved after surgery (P < 0.001, P < 0.001, and P < 0.001, respectively). Univariable analysis revealed that preoperative EQ-5D and C-JOA scores were significantly associated with increased EQ-5D scores from preoperative assessment to 1 year after surgery (P < 0.0001 and P = 0.045). Multivariable regression analysis showed that the independent preoperative predictors of change in QOL were lumbar lordosis (LL), sacral slope (SS), and T1 pelvic angle (TPA). According to the prediction model, the increased EQ-5D score from preoperatively to 1 year after surgery = 0.308 − 0.493 × EQ-5D + 0.006 × LL − 0.008 × SS + 0.004 × TPA. Conclusions Preoperative LL, SS, and TPA significantly impacted the QOL of patients who underwent surgery for DCM. Less improvement in QOL after surgery was achieved in patients with smaller LL and TPA and larger SS values. Patients with these risk factors may therefore require additional support to experience adequate improvement in QOL.

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