Hemodialysis Impact on Motor Function beyond Aging and Diabetes—Objectively Assessing Gait and Balance by Wearable Technology

Motor functions are deteriorated by aging. Some conditions may magnify this deterioration. This study examined whether hemodialysis (HD) process would negatively impact gait and balance beyond diabetes condition among mid-age adults (48–64 years) and older adults (65+ years). One hundred and ninety-six subjects (age = 66.2 ± 9.1 years, body-mass-index = 30.1 ± 6.4 kg/m2, female = 56%) in 5 groups were recruited: mid-age adults with diabetes undergoing HD (Mid-age HD+, n = 38) and without HD (Mid-age HD−, n = 40); older adults with diabetes undergoing HD (Older HD+, n = 36) and without HD (Older HD−, n = 37); and non-diabetic older adults (Older DM−, n = 45). Gait parameters (stride velocity, stride length, gait cycle time, and double support) and balance parameters (ankle, hip, and center of mass sways) were quantified using validated wearable platforms. Groups with diabetes had overall poorer gait and balance compared to the non-diabetic group (p < 0.050). Among people with diabetes, HD+ had significantly worsened gait and balance when comparing to HD− (Cohen’s effect size d = 0.63–2.32, p < 0.050). Between-group difference was more pronounced among older adults with the largest effect size observed for stride length (d = 2.32, p < 0.001). Results suggested that deterioration in normalized gait speed among HD+ was negatively correlated with age (r = −0.404, p < 0.001), while this correlation was diminished among HD−. Interestingly, results also suggested that poor gait among Older HD− is related to poor ankle stability, while no correlation was observed between poor ankle stability and poor gait among Older HD+. Using objective assessments, results confirmed that the presence of diabetes can deteriorate gait and balance, and this deterioration can be magnified by HD process. Among HD− people with diabetes, poor ankle stability described poor gait. However, among people with diabetes undergoing HD, age was a dominate factor describing poor gait irrespective of static balance. Results also suggested feasibility of using wearable platforms to quantify motor performance during routine dialysis clinic visit. These objective assessments may assist in identifying early deterioration in motor function, which in turn may promote timely intervention.

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Hemodialysis Impact on Motor Function Beyond Aging and Diabetes – Objectively Assessing Gait and Balance by Wearable Technology

10.20944/preprints201809.0529.v1 ◽

2018 ◽

Author(s):

He Zhou ◽

Fadwa Al-Ali ◽

Hadi Rahemi ◽

Nishat Kulkarni ◽

Abdullah Hamad ◽

...

Keyword(s):

Older Adults ◽

Motor Function ◽

Effect Size ◽

Motor Performance ◽

Stride Length ◽

Gait Cycle ◽

Center Of Mass ◽

Static Balance ◽

Double Support ◽

Gait Parameters

Motor functions are deteriorated by aging. Some conditions may magnify this deterioration. To examine whether hemodialysis (HD) process would negatively impact gait and balance beyond diabetes condition among mid-age adults (48-64 years) and older adults (65+ years). One hundred and ninety-six subjects (age=66.2±9.1 years, body-mass-index=30.1±6.4 kg/m2, female=56%) in 5 groups were recruited: mid-age adults with diabetes undergoing HD (Mid-age HD+, n=38) and without HD (Mid-age HD-, n=40); older adults with diabetes undergoing HD (Older HD+, n=36) and without HD (Older HD-, n=37); and non-diabetic older adults (Older DM-, n=45). Gait parameters (stride velocity, stride length, gait cycle time, and double support) and balance parameters (ankle, hip, and center of mass sways) were quantified using validated wearable platforms. Groups with diabetes had overall poorer gait and balance compared to the non-diabetic group (p<0.050). Among people with diabetes, the HD+ had significantly worsened gait and balance when comparing to the HD- (Cohen’s effect size d=0.63-2.32, p<0.050). Between-group difference was more pronounced among older adults with the largest effect size observed for stride length (d=2.32, p<0.001). Results suggested that deterioration in gait speed among the HD+ was correlated with age (r=-0.440, p<0.001), while this correlation was diminished among the HD-. Interestingly, results also suggested that poor gait in the Older HD- related to poor balance, while no correlation was observed between poor balance and poor gait among the Older HD+. Using objective assessments, results confirmed that the presence of diabetes can deteriorate gait and balance, and this deterioration can be magnified by HD process. Among non-HD people with diabetes, poor static balance described poor gait. However, among people with diabetes undergoing HD, age was a dominate factor describing poor gait irrespective of static balance. Results also suggested feasibility of using wearable platforms to quantify motor performance during routine dialysis clinic visits. These objective assessments may assist in identifying early deterioration in motor function, which in turn may promote timely intervention.

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Digital Biomarkers of Cognitive Frailty: The Value of Detailed Gait Assessment Beyond Gait Speed

Gerontology ◽

10.1159/000515939 ◽

2021 ◽

pp. 1-10

Author(s):

He Zhou ◽

Catherine Park ◽

Mohammad Shahbazi ◽

Michele K. York ◽

Mark E. Kunik ◽

...

Keyword(s):

Older Adults ◽

Steady State ◽

Dual Task ◽

Gait Speed ◽

Stride Length ◽

Cognitive Frailty ◽

Single Task ◽

Double Support ◽

Gait Parameters ◽

Digital Biomarkers

Background: Cognitive frailty (CF), defined as the simultaneous presence of cognitive impairment and physical frailty, is a clinical symptom in early-stage dementia with promise in assessing the risk of dementia. The purpose of this study was to use wearables to determine the most sensitive digital gait biomarkers to identify CF. Methods: Of 121 older adults (age = 78.9 ± 8.2 years, body mass index = 26.6 ± 5.5 kg/m2) who were evaluated with a comprehensive neurological exam and the Fried frailty criteria, 41 participants (34%) were identified with CF and 80 participants (66%) were identified without CF. Gait performance of participants was assessed under single task (walking without cognitive distraction) and dual task (walking while counting backward from a random number) using a validated wearable platform. Participants walked at habitual speed over a distance of 10 m. A validated algorithm was used to determine steady-state walking. Gait parameters of interest include steady-state gait speed, stride length, gait cycle time, double support, and gait unsteadiness. In addition, speed and stride length were normalized by height. Results: Our results suggest that compared to the group without CF, the CF group had deteriorated gait performances in both single-task and dual-task walking (Cohen’s effect size d = 0.42–0.97, p < 0.050). The largest effect size was observed in normalized dual-task gait speed (d = 0.97, p < 0.001). The use of dual-task gait speed improved the area under the curve (AUC) to distinguish CF cases to 0.76 from 0.73 observed for the single-task gait speed. Adding both single-task and dual-task gait speeds did not noticeably change AUC. However, when additional gait parameters such as gait unsteadiness, stride length, and double support were included in the model, AUC was improved to 0.87. Conclusions: This study suggests that gait performances measured by wearable sensors are potential digital biomarkers of CF among older adults. Dual-task gait and other detailed gait metrics provide value for identifying CF above gait speed alone. Future studies need to examine the potential benefits of gait performances for early diagnosis of CF and/or tracking its severity over time.

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Gait Abnormalities and the Risk of Falls in CKD

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.13871118 ◽

2019 ◽

Vol 14 (7) ◽

pp. 983-993 ◽

Cited By ~ 6

Author(s):

Jeannie Tran ◽

Emmeline Ayers ◽

Joe Verghese ◽

Matthew K. Abramowitz

Keyword(s):

Older Adults ◽

Gait Speed ◽

Fall Risk ◽

Stride Length ◽

Gait Cycle ◽

Hazard Ratio ◽

Double Support ◽

Lower Egfr ◽

Risk Of Falls ◽

Gait Abnormalities

Background and objectivesOlder adults with CKD are at high risk of falls and disability. It is not known whether gait abnormalities contribute to this risk.Design, setting, participants, & measurementsQuantitative and clinical gait assessments were performed in 330 nondisabled community-dwelling adults aged ≥65 years. CKD was defined as an eGFR <60 ml/min per 1.73 m2. Cox proportional hazards models were created to examine fall risk.ResultsA total of 41% (n=134) of participants had CKD. In addition to slower gait speed, participants with CKD had gait cycle abnormalities including shorter stride length and greater time in the stance and double-support phases. Among people with CKD, lower eGFR was independently associated with the severity of gait cycle abnormalities (per 10 ml/min per 1.73 m2 lower eGFR: 3.6 cm [95% confidence interval (95% CI), 1.4 to 5.8] shorter stride length; 0.7% [95% CI, 0.3 to 1.0] less time in swing phase; 1.1% [95% CI, 0.5 to 1.7] greater time in double-support phase); these abnormalities mediated the association of lower eGFR with slower gait speed. On clinical gait exam, consistent with the quantitative abnormalities, short steps and marked swaying or loss of balance were more common among participants with CKD, yet most had no identifiable gait phenotype. A gait phenotype defined by any of these abnormal signs was associated with higher risk of falls among participants with CKD: compared with people without CKD and without the gait phenotype, the adjusted hazard ratio was 1.72 (95% CI, 1.06 to 2.81) for those with CKD and the phenotype; in comparison, the adjusted hazard ratio was 0.71 (95% CI, 0.40 to 1.25) for people with CKD but without the phenotype (P value for interaction of CKD status and gait phenotype =0.01).ConclusionsCKD in older adults is associated with quantitative gait abnormalities, which clinically manifest in a gait phenotype that is associated with fall risk.

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The Feasibility and Effectiveness of Wearable Sensor Technology in the Management of Elderly Diabetics with Foot Ulcer Remission: A Proof-Of-Concept Pilot Study with Six Cases

Gerontology ◽

10.1159/000513729 ◽

2021 ◽

pp. 1-10

Author(s):

Chenzhen Du ◽

Hongyan Wang ◽

Heming Chen ◽

Xiaoyun Fan ◽

Dongliang Liu ◽

...

Keyword(s):

Odds Ratio ◽

Stride Length ◽

Wearable Sensors ◽

Foot Ulcer ◽

Wearable Devices ◽

Foot Ulcers ◽

Diabetic Patients ◽

Wearable Sensor ◽

Double Support ◽

Gait Parameters

Aims: Using specials wearable sensors, we explored changes in gait and balance parameters, over time, in elderly patients at high risk of diabetic foot, wearing different types of footwear. This assessed the relationship between gait and balance changes in elderly diabetic patients and the development of foot ulcers, in a bid to uncover potential benefits of wearable devices in the prognosis and management of the aforementioned complication. Methods: A wearable sensor-based monitoring system was used in middle-elderly patients with diabetes who recently recovered from neuropathic plantar foot ulcers. A total of 6 patients (age range: 55–80 years) were divided into 2 groups: the therapeutic footwear group (n = 3) and the regular footwear (n = 3) group. All subjects were assessed for gait and balance throughout the study period. Walking ability and gait pattern were assessed by allowing participants to walk normally for 1 min at habitual speed. The balance assessment program incorporated the “feet together” standing test and the instrumented modified Clinical Test of Sensory Integration and Balance. Biomechanical information was monitored at least 3 times. Results: We found significant differences in stride length (p < 0.0001), stride velocity (p < 0.0001), and double support (p < 0.0001) between the offloading footwear group (OG) and the regular footwear group on a group × time interaction. The balance test embracing eyes-open condition revealed a significant difference in Hip Sway (p = 0.004), COM Range ML (p = 0.008), and COM Position (p = 0.004) between the 2 groups. Longitudinally, the offloading group exhibited slight improvement in the performance of gait parameters over time. The stride length (odds ratio 3.54, 95% CI 1.34–9.34, p = 0.018) and velocity (odds ratio 3.13, 95% CI 1.19–8.19, p = 0.033) of OG patients increased, converse to the double-support period (odds ratio 6.20, 95% CI 1.97–19.55, p = 0.002), which decreased. Conclusions: Special wearable devices can accurately monitor gait and balance parameters in patients in real time. The finding reveals the feasibility and effectiveness of advanced wearable sensors in the prevention and management of diabetic foot ulcer and provides a solid background for future research. In addition, the development of foot ulcers in elderly diabetic patients may be associated with changes in gait parameters and the nature of footwear. Even so, larger follow-up studies are needed to validate our findings.

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Quantitative assessment of gait parameters in people with Parkinson's disease in laboratory and clinical setting: Are the measures interchangeable?

Neurology International ◽

10.4081/ni.2018.7729 ◽

2018 ◽

Vol 10 (2) ◽

Cited By ~ 4

Author(s):

Massimiliano Pau ◽

Federica Corona ◽

Roberta Pili ◽

Carlo Casula ◽

Marco Guicciardi ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Clinical Setting ◽

Stride Length ◽

Experimental Setting ◽

Optoelectronic System ◽

Double Support ◽

Gait Parameters ◽

Spatio Temporal ◽

Wearable Accelerometers

This study aimed to investigate possible differences in spatio-temporal gait parameters of people with Parkinson’s Disease (pwPD) when they are tested either in laboratory using 3D Gait Analysis or in a clinical setting using wearable accelerometers. The main spatio-temporal gait parameters (speed, cadence, stride length, stance, swing and double support duration) of 31 pwPD were acquired: i) using a wearable accelerometer in a clinical setting while wearing shoes (ISS); ii) same as condition 1, but barefoot (ISB); iii) using an optoelectronic system (OES) undressed and barefoot. While no significant differences were found for cadence, stance, swing and double support duration, the experimental setting affected speed and stride length that decreased (by 17% and 12% respectively, P<0.005) when passing from the clinical (ISS) to the laboratory (OES) setting. These results suggest that gait assessment should be always performed in the same conditions to avoid errors, which may lead to inaccurate patient’s evaluations.

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The Effects of Systematic Environmental Manipulation on Gait of Older Adults

Healthcare ◽

10.3390/healthcare8040386 ◽

2020 ◽

Vol 8 (4) ◽

pp. 386

Author(s):

Max Toepfer ◽

Alejandra Padilla ◽

Kevin Ponto ◽

Andrea H Mason ◽

Kristen A Pickett

Keyword(s):

Older Adults ◽

Repeated Measures ◽

Environmental Changes ◽

Small Scale ◽

Gait Patterns ◽

Double Support ◽

Single Dimension ◽

Adult Participants ◽

Gait Parameters ◽

Systematic Manipulation

Quantification of gait changes in response to altered environmental stimuli may allow for improved understanding of the mechanisms that influence gait changes and fall occurrence in older adults. This study explored how systematic manipulation of a single dimension of one’s environment affects spatiotemporal gait parameters. A total of 20 older adult participants walked at a self-selected pace in a constructed research hallway featuring a mobile wall, which allowed manipulation of the hallway width between three conditions: 1.14 m, 1.31 m, and 1.48 m. Spatiotemporal data from participants’ walks were captured using an instrumented GAITRite mat. A repeated measures ANOVA revealed older adults spent significantly more time in double support in the narrowest hallway width compared to the widest, but did not significantly alter other spatiotemporal measures. Small-scale manipulations of a single dimension of the environment led to subtle, yet in some cases significant changes in gait, suggesting that small or even imperceptible environmental changes may contribute to altered gait patterns for older adults.

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Transfer Effects of Fall Training on Balance Performance and Spatiotemporal Gait Parameters in Healthy Community-Dwelling Older Adults: A Pilot Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2013-0010 ◽

2014 ◽

Vol 22 (3) ◽

pp. 324-333 ◽

Cited By ~ 9

Author(s):

Lars Donath ◽

Oliver Faude ◽

Stephanie A. Bridenbaugh ◽

Ralf Roth ◽

Martin Soltermann ◽

...

Keyword(s):

Older Adults ◽

Dual Task ◽

Stride Length ◽

Fear Of Falling ◽

Community Dwelling ◽

Stride Time ◽

Balance Performance ◽

Transfer Effects ◽

Gait Parameters ◽

Community Dwelling Older Adults

This study examined transfer effects of fall training on fear of falling (Falls Efficacy Scale—International [FES–I]), balance performance, and spatiotemporal gait characteristics in older adults. Eighteen community-dwelling older adults (ages 65–85) were randomly assigned to an intervention or control group. The intervention group completed 12 training sessions (60 min, 6 weeks). During pre- and posttesting, we measured FES–I, balance performance (double limb, closed eyes; single limb, open eyes; double limb, open eyes with motor-interfered task), and gait parameters (e.g., velocity; cadence; stride time, stride width, and stride length; variability of stride time and stride length) under single- and motor-interfered tasks. Dual tasks were applied to appraise improvements of cognitive processing during balance and gait. FES–I (p = .33) and postural sway did not significantly change (0.36 < p < .79). Trends toward significant interaction effects were found for step width during normal walking and stride length variability during the motor dual task (p = .05, ηp2 = .22). Fall training did not sufficiently improve fear of falling, balance, or gait performance under single- or dual-task conditions in healthy older adults.

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Effects of Postoperative Rehabilitation on Gait Parameters and Electromyography Variables in Acute and Chronic Anterior Cruciate Ligament Reconstruction Surgery in Football Players

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/9912795 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Gopal Nambi ◽

Walid Kamal Abdelbasset ◽

Anju Verma ◽

Shereen H. Elsayed ◽

Osama R. Aldhafian ◽

...

Keyword(s):

Stance Phase ◽

Gait Cycle ◽

Vastus Lateralis ◽

Cruciate Ligament ◽

Test Group ◽

Control Group ◽

Football Players ◽

Postoperative Rehabilitation ◽

Double Support ◽

Gait Parameters

Background and Objective. To date, there were no clinically proven and evident ACLR rehabilitation protocols developed exclusively for football players, also no comparative studies were conducted on kinematic, kinetic, and EMG parameters on postoperative rehabilitation protocol in acute and chronic ACLR. The objective of this study was to find and compare the kinematic, kinetic, and EMG effects of postoperative rehabilitation after acute and chronic ACLR surgeries in football players. Design and Setting. Using the convenience sampling method, eligible subjects were divided into three groups. The test group consisted of acute (n = 15) and chronic (n = 15) ACL injured subjects who underwent ACLR surgery and 8 weeks postoperative rehabilitation. The control group consists of (n = 15) healthy subjects. Kinematic (cadence (steps/min), step length (cm), step width (cm), double support (% of the gait cycle), and swing phase (% of the gait cycle)), kinetic (F1, early stance phase; F2, middle stance phase; and F3, late stance phase forces), and EMG data of the (biceps femoris, adductor longus, vastus medialis, and vastus lateralis) muscles were recorded and analyzed at baseline, 8 weeks, 6 months, and 12 months follow-up. Results. The results of the a-ACLR, c-ACLR, and control groups were compared. At 8 weeks following postoperative rehabilitation, the a-ACLR group shows more significant changes than the c-ACLR group ( p < 0.001 ). At 6 and 12 months, there are normal values of kinematic and kinetic values in a-ACLR compared with the results of the control group ( p < 0.001 ). Conclusion. The study showed that postoperative rehabilitation provides significant effects in the kinematic, kinetic, and EMG gait parameters in acute ACLR than chronic ACLR subjects. Early surgical intervention and postrehabilitation are mandatory to get the significant effects in the clinical parameters in acute and chronic ACL injury.

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Immediate effects of a novel walking assist device with auxiliary illuminator on patients after acute strokes

Hong Kong Physiotherapy Journal ◽

10.1142/s1013702519500100 ◽

2019 ◽

Vol 39 (02) ◽

pp. 115-124

Author(s):

Wan-Yun Huang ◽

Sheng-Hui Tuan ◽

Min-Hui Li ◽

Xin-Yu Liu ◽

Pei-Te Hsu

Keyword(s):

Gait Speed ◽

Stride Length ◽

Stance Phase ◽

Gait Cycle ◽

Swing Phase ◽

Heel Strike ◽

Assist Device ◽

Double Support ◽

Strike Angle ◽

Support Phase

Background: Many patients after acute stage of stroke are present with abnormal gait pattern due to weakness or hypertonicity of the affected limbs. Facilitation of normal gait is a primary goal of rehabilitation on these patients.Objective: We aimed to investigate whether walking assist device with auxiliary illuminator (quad-cane with laser) providing visual feedback during ambulation could improve parameters of gait cycle immediately among patients with subacute and chronic stroke.Methods: This was a cross-sectional study and 30 participants (male 23, female 7, group 1) with mean age [Formula: see text] years were recruited. Among them, 22 used ankle-foot orthosis [(AFO), group 2] and 8 did not use AFO (group 3) at usual walking. All the participants walked along a strait corridor with even surface for 20[Formula: see text]m without and with using a quad-cane with laser, respectively. A gait analyzer (Reha-Watch1 system) was used to measure the changes of the parameters of gait cycle, including stride length, cadence, gait speed, stance phase, swing phase, duration of single support and double support, the angle between toes and the ground at the time of toe-off (the toe-off angle) and the angle between calcaneus and the ground at the time of heel-strike (the heel-strike angle), before and with the use of a quad-cane with laser.Results: The increase in the heel-strike angle reached a significant difference in groups 1 2, and 3 ([Formula: see text], and [Formula: see text], respectively). However, the stride length, the gait speed, the cadence, percentage of the stance phase, swing phase, single-support phase, and double-support phase in a gait cycle, and the toe-off angle showed no significant change with the use of quad-cane with laser.Conclusion: Patients after acute stroke had an immediate and significant increase in the heel-stroke angle by using a quad-cane with laser during ambulation, which might help the patients to reduce knee hyperextension moment and lessen the pressure of heel at loading phase.

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Smoothness of Gait in Healthy and Cognitively Impaired Individuals: A Study on Italian Elderly Using Wearable Inertial Sensor

Sensors ◽

10.3390/s20123577 ◽

2020 ◽

Vol 20 (12) ◽

pp. 3577 ◽

Cited By ~ 1

Author(s):

Massimiliano Pau ◽

Ilaria Mulas ◽

Valeria Putzu ◽

Gesuina Asoni ◽

Daniela Viale ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Gait Speed ◽

Stride Length ◽

Inertial Sensor ◽

Cognitive Impairments ◽

Gait Parameters ◽

Acceleration Data ◽

Trunk Acceleration ◽

Spatio Temporal

The main purpose of the present study was to compare the smoothness of gait in older adults with and without cognitive impairments, using the harmonic ratio (HR), a metric derived from trunk accelerations. Ninety older adults aged over 65 (age: 78.9 ± 4.8 years; 62% female) underwent instrumental gait analysis, performed using a wearable inertial sensor and cognitive assessment with the Mini Mental State Examination (MMSE) and Addenbrooke’s Cognitive Examination Revised (ACE-R). They were stratified into three groups based on their MMSE performance: healthy controls (HC), early and advanced cognitive decline (ECD, ACD). The spatio-temporal and smoothness of gait parameters, the latter expressed through HR in anteroposterior (AP), vertical (V) and mediolateral (ML) directions, were derived from trunk acceleration data. The existence of a relationship between gait parameters and degree of cognitive impairment was also explored. The results show that individuals with ECD and ACD exhibited significantly slower speed and shorter stride length, as well as reduced values of HR in the AP and V directions compared to HC, while no significant differences were found between ECD and ACD in any of the investigated parameters. Gait speed, stride length and HR in all directions were found to be moderately correlated with both MMSE and ACE-R scores. Such findings suggest that, in addition to the known changes in gait speed and stride length, important reductions in smoothness of gait are likely to occur in older adults, owing to early/prodromal stages of cognitive impairment. Given the peculiar nature of these metrics, which refers to overall body stability during gait, the calculation of HR may result in being useful in improving the characterization of gait patterns in older adults with cognitive impairments.

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