Differences in Gait Stability and Acceleration Characteristics Between Healthy Young and Older Females

Our aim was to evaluate differences in gait acceleration intensity, variability, and stability of feet and trunk between older females (OF) and young females (YF) using inertial sensors. Twenty OF (mean age 68.4, SD 4.1 years) and 18 YF (mean age 22.3, SD 1.7 years) were asked to walk straight for 100 meters at their preferred speed, while wearing inertial sensors on their heels and lower back. We calculated spatiotemporal measures, foot and trunk acceleration characteristics, their variability, and trunk stability using the local divergence exponent (LDE). Two-way ANOVA (such as the factors foot and age), Student's t-test and Mann–Whitney U test were used to compare statistical differences of measures between groups. Cohen's d effects were calculated for each variable. Foot maximum vertical (VT) acceleration and amplitude, trunk-foot VT acceleration attenuation, and their variability were significantly smaller in OF than in YF. In contrast, trunk mediolateral (ML) acceleration amplitude, maximum VT acceleration, amplitude, and their variability were significantly larger in OF than in YF. Moreover, OF showed lower stability (i.e., higher LDE values) in ML acceleration, ML, and VT angular velocity of the trunk. Even though we measured healthy OF, these participants showed lower VT foot accelerations with higher VT trunk acceleration, lower trunk-foot VT acceleration attenuation, less gait stability, and more variability of the trunk, and hence, were more likely to fall. These findings suggest that instrumented gait measurements may help for early detection of changes or impairments in gait performance, even before this can be observed by clinical eye or gait speed.

A Robust Multi-Channel EMG System for Lower Back and Abdominal Muscles Training

EMG is an established method to acquire the action potentials of contracted muscles. Although commercial EMG systems are available and it is one of the most researched biosignals, it has never become widely used in rehabilitation or fitness training monitoring. The reasons are technical challenges of wearable EMG systems regarding electrode placement, motion artefacts and the complex connectivity of multi-channel EMG measurements. We address this problem for the lower back and abdominal musculature, through a novel dry electrodes belt, multi-channel high density EMG circuitry and problem-specific signal processing. The subject can easily strap the dry electrodes belt around himself which provides 16 EMG channels. Interferences from the ECG and motion artefacts are reduced by a stationary wavelet decomposition. Afterwards, an inter-channel filter is applied to increase the robustness of the signals. Subject measurements during different kinds of typical abdominal and lower back training exercises were performed wearing the novel dry electrodes belt. The results show the possibility of robust EMG measurements from the lower back and abdominal muscles by utilizing the gathered redundancy, appropriately. The additional information obtained via the multi-channel EMG circuitry and spatial oversampling can be used to address current problems of EMG applications. It combines the advantages of robustness and the capability of using comfortable dry electrodes. Therefore, the proposed measurement method for acquiring spatial information about the muscle contractions from the lower trunk can be used for rehabilitation or fitness training monitoring.

The association of lower trunk muscle strength with low back pain in elite lightweight judokas is dependent on lumber spine abnormalities

BACKGROUND: Lumbar radiological abnormalities (LRA) and trunk muscle weakness are major causes of the low back pain (LBP). We reported that the prevalence of LRA was approximately 90% in middle- and heavyweight-judokas, independent to the occurrence of LBP. However, the trunk muscle weakness, especially the rotators, plays a key role in occurrence of LBP in heavyweight judokas. OBJECTIVE: To examine the trunk muscle strength (TMS) and LRA impact on LBP occurrence in lightweight judokas. METHOD: The strength of the trunk extensors, flexors, and rotators was measured in 32 lightweight male judokas. LBP and LRA were identified using a questionnaire, X-ray, and MRI. RESULTS: The occurrence rate of LBP and LRA were 40.6% and 62.5%, respectively, without any significant correlation. Among judokas without LRA, TMS of those with LBP were significantly lower than those without LBP (P< 0.05, the extensor; 60∘/s: ES [d] = 1.38, 90∘/s: ES [d] = 0.78, and 120∘/s: ES [d] = 0.37, flexor; 60∘/s: ES [d] = 1.48, dominant rotator; 60∘/s: ES [d] = 1.66, and 90∘/s: ES [d] = 1.87, non-dominant rotator; 90∘/s: ES [d] = 0.17, and dominant/non-dominant rotator ratio; 90∘/s: ES [d] = 1.55). Moreover, there were significant negative correlations between LBP severity and TMS (P< 0.05, the extensor; 90∘/s: r=-0.63, dominant rotator; 90∘/s: r=-0.648, and dominant/non-dominant rotator ratio; 90∘/s: r=-0.621) in judokas without LRA. RESULTS: The occurrence rate of LBP and LRA were 40.6% and 62.5%, respectively, without any significant correlation. Among judokas without LRA, the extensor (60, 90, and 120∘/s), flexor (60∘/s), dominant rotator (60 and 90∘/s), non-dominant rotator (90∘/s), and dominant/non-dominant rotator ratio (90∘/s) of judokas with LBP were significantly lower than those of the judokas without LBP. Moreover, there were significant negative correlations (P< 0.05) between LBP severity and the extensor (90∘/s; r=-0.63) and dominant rotator (90∘/s; r=-0.648) strength, and dominant/non-dominant rotator ratio (90∘/s; r=-0.621) in judokas without LRA. CONCLUSION: Weak trunk musculature may be a co-factor in the occurrence of LBP in lightweight judokas without LRA.

Structural equation model of the effect of biological maturation on metabolic syndrome risk and C-reactive protein: effect of trunk fat and sports participation

Our aim was to analyze the association between somatic maturation and alterations in metabolic syndrome (METs) risk and C-reactive protein (CRP), focusing on the effect of changes in trunk fat and sports practice. This was a longitudinal study with a one-year follow-up. The sample was composed of 139 adolescents (46 without sports participation and 93 young athletes), aged 10–17 years. As outcomes, we adopted CRP and METs risk (triglycerides, HDL-c, fasting glucose, and mean blood pressure). Somatic maturation was estimated using Mirwald’s method. Structural equation models were used. Somatic maturation was not associated with sports practice, trunk fat, METs risk neither CRP. Sports practice was associated with a reduction in METs risk (β = −0.926; 95%CI:−1.773, −0.080) and reduction in trunk fat (−10.957; −19.630, −2.283), which was associated with increases in METs risk (0.020; 0.004, 0.036). In the CRP model, sports practice was associated with a reduction in trunk fat (−10.324; −18.637, −2.010), which in turn was associated with a reduction in CRP (0.007; 0.001, 0.013). Sports practice and lower trunk adiposity were associated with reductions in trunk fat, METs risk, and CRP through direct and indirect pathways. Our findings highlight the role of sports practice in attenuating the negative effect of trunk adiposity.

A Proposal for a Linear Calculation of Gait Asymmetry

Pathological gait is often associated with a lack of symmetry. A possible way to quantify this feature is to use acceleration data measured by a sensor located on the lower trunk. The most common approach calculates a symmetry index starting from the autocorrelation function, aiming to measure the divergence in motion of the left and right sides of the body. The various methods proposed to implement this approach are based on nonlinear and discontinuous functions, and the interpretation of their output is far from straightforward. The aim of this study was to propose a linear and easier to interpret quantification measure for gait asymmetry. The proposed measure was tested on data from healthy controls and from patients with Multiple Sclerosis and Parkinson’s Disease, and it was shown to negate the flaws present in previous methods and to provide more directly interpretable results.

Physical activity in stroke patients: A scoping review

Stroke is the second leading cause of disability and death worldwide with 5.9 million deaths annually. Stroke can be followed by various clinical problems. Impaired motoric function of the extremities is the most severe post stroke disorder experienced and impacts on limitations of daily activities. The main treatment is by doing regular physical activity exercises. This review was conducted to identify physical activities that can be performed by stroke patients. This scoping review was compiled using Arksey and O'Malley's five-stage framework. A total of three databases (i.e., Pubmed, Proquest, and DOAJ) was searched with relevant keyword "physical activity OR exercise AND stroke". The articles selected are published in the last 5 years, in English, and in full text. The literature search retrieved 164 studies to be screened based on the exclusion-inclusion criteria which finally resulted in the 11 studies included in the review. The remaining 11 studies were fully read and data were extracted regarding the type of physical activity, goals, settings and outcomes. Qualitative (i.e., theme analysis) methods have been used to synthesis the data. Based on the results of the review, there are several physical activities that stroke patients can do, such as progressive resistance and balance (PRB) exercises, locomotors exercises: (walking on a treadmill with body weight support and walking on the ground), selective movements of the upper and lower trunk body in the Supine and sit using a stable support / pad or unstable support (Swiss ball), core stability training, aerobic (AT) and resistance training (RT), aerobic training, walking exercises, and task-oriented training. Several physical exercises have been identified where each of these exercises has a purpose and benefit in the recovery of physical functional stroke patients. Physical activity should be done regularly and take into account the duration, intensity, and frequency of the exercise based on patient’s ability and stamina.

Gait Variability and Complexity during Single and Dual-Task Walking on Different Surfaces in Outdoor Environment

Nowadays, gait assessment in the real life environment is gaining more attention. Therefore, it is desirable to know how some factors, such as surfaces (natural, artificial) or dual-tasking, influence real life gait pattern. The aim of this study was to assess gait variability and gait complexity during single and dual-task walking on different surfaces in an outdoor environment. Twenty-nine healthy young adults aged 23.31 ± 2.26 years (18 females, 11 males) walked at their preferred walking speed on three different surfaces (asphalt, cobbles, grass) in single-task and in two dual-task conditions (manual task—carrying a cup filled with water, cognitive task—subtracting the number 7). A triaxial inertial sensor attached to the lower trunk was used to record trunk acceleration during gait. From 15 strides, sample entropy (SampEn) as an indicator of gait complexity and root mean square (RMS) as an indicator of gait variability were computed. The findings demonstrate that in an outdoor environment, the surfaces significantly impacted only gait variability, not complexity, and that the tasks affected both gait variability and complexity in young healthy adults.

Non-fatal firearm injuries, Incidence and Circumstances: Presenting in DHQ Hospital Rawalpindi

Objective: To describe the incidence and manner of nonfatal firearm injuries in Rawalpindi District Study design: Observational retrospective study Place and Duration: District Head Quarters Hospital Rawalpindi. Duration of 6 months, from July 2020 to Dec 2020. Methodology: Total 82 patients with nonfatal firearm injuries were included. After approval from ERC committee of DHQ Hospital Rawalpindi, data was obtained from the duplicate copies of medicoleagal reports kept at the Forensic Medicine department t of IIMCT. These reports were carried out by cross ponding author and the demonstrators of Forensic Medicine department of IIMCT. The data was entered on a pre-designed Performa having variables such as demographics, time & place of death, region of body involved, weapon used & month of the year. Results: A total of 82 nonfatal firearm injuries were reported during these 6 months. 87% of the victims of were males encountering injuries 1 to 11 in number with an average of 3 injuries per person. 3o% of these injuries were received on the upper trunk, 32% on the lower trunk, 16% the lower limbs, 13% the upper limb, 3% the head and neck and 6% on the other regions. 68% of the injuries were lacerations, an exit wound was detected in 19% of cases and in 13% only entry wounds were found. Tattooing and burning of the adjacent skin were common in wounds on the upper and lower trunk while comminuted intra articular and shaft fractures were important varieties in the limbs. 86% of the victims were vitally stable, others being critically unstable with GCS ranging till 6/15. Conclusion: The public health issue of firearm-related injuries continues to be a concern. The necessity for a district-based, nationwide reporting system for fatal and nonfatal firearm-related injuries is critical. In Pakistan, these data could be used in the design, implementation, and assessment of preventative programs. Key words: Non fatal, Firearm injuries, Regional injuries

Can wood-decaying urban macrofungi be identified by using fuzzy interference system? An example in Central European Ganoderma species

Ganoderma is a cosmopolitan genus of wood-decaying basidiomycetous macrofungi that can rot the roots and/or lower trunk. Among the standing trees, their presence often indicates that a hazard assessment may be necessary. These bracket fungi are commonly known for the crust-like upper surfaces of their basidiocarps and formation of white rot. Six species occur in central European urban habitats. Several of them, such as Ganoderma adspersum, G. applanatum, G. resinaceum and G. pfeifferi, are most hazardous fungi causing extensive horizontal stem decay in urban trees. Therefore, their early identification is crucial for correct management of trees. In this paper, a fast technique is tested for the determination of phytopathologically important urban macrofungi using fuzzy interference system of Sugeno type based on 13 selected traits of 72 basidiocarps of six Ganoderma species and compared to the ITS sequence based determination. Basidiocarps features were processed for the following situations: At first, the FIS of Sugeno 2 type (without basidiospore sizes) was used and 57 Ganoderma basidiocarps (79.17%) were correctly determined. Determination success increased to 96.61% after selecting basidiocarps with critical values (15 basidiocarps). These undeterminable basidiocarps must be analyzed by molecular methods. In a case, that basidiospore sizes of some basidiocarps were known, a combination of Sugeno 1 (31 basidiocarps with known basidiospore size) and Sugeno 2 (41 basidiocarps with unknown basidiospore size) was used. 84.72% of Ganoderma basidiocarps were correctly identified. Determination success increased to 96.83% after selecting basidiocarps with critical values (11 basidiocarps).

Trends in Brachial Plexus Surgery: Characterizing Contemporary Practices for Exploration of Supraclavicular Plexus

Background There is variability in treatment strategies for patients with brachial plexus injury (BPI). We used qualitative research methods to better understand surgeons’ rationale for treatment approaches. We hypothesized that distal nerve transfers would be preferred over exploration and nerve grafting of the brachial plexus. Methods We conducted semi-structured interviews with BPI surgeons to discuss 3 case vignettes: pan-plexus injury, upper trunk injury, and lower trunk injury. The interview guide included questions regarding overall treatment strategy, indications and utility of brachial plexus exploration, and the role of nerve grafting and/or nerve transfers. Interview transcripts were coded by 2 researchers. We performed inductive thematic analysis to collate these codes into themes, focusing on the role of brachial plexus exploration in the treatment of BPI. Results Most surgeons routinely explore the supraclavicular brachial plexus in situations of pan-plexus and upper trunk injuries. Reasons to explore included the importance of obtaining a definitive root level diagnosis, perceived availability of donor nerve roots, timing of anticipated recovery, plans for distal reconstruction, and the potential for neurolysis. Very few explore lower trunk injuries, citing concern with technical difficulty and unfavorable risk-benefit profile. Conclusions Our analysis suggests that supraclavicular exploration remains a foundational component of surgical management of BPI, despite increasing utilization of distal nerve transfers. Availability of abundant donor axons and establishing an accurate diagnosis were cited as primary reasons in support of exploration. This analysis of surgeon interviews characterizes contemporary practices regarding the role of brachial plexus exploration in the treatment of BPI.