Evaluation of gait cycle time variability in patients with knee osteoarthritis using a triaxial accelerometer

Knee osteoarthritis can alter gait variability. However, few studies have compared the temporal factors of the gait cycle between patients with knee osteoarthritis and healthy subjects. Furthermore, no studies have investigated the relationship between gait variability and potential contributing factors (knee joint functions such as muscle strength) in knee osteoarthritis. The first objective of this study was to compare gait cycle variability between female patients with knee osteoarthritis and healthy elderly women to determine gait characteristics in patients with knee osteoarthritis. The second objective was to examine whether gait cycle variability in knee osteoarthritis is associated with potential contributing factors. Twenty-four female patients diagnosed with knee osteoarthritis and 12 healthy elderly women participated. Gait cycle variability (coefficient of variation of gait cycle time), knee extension range of motion, knee extension strength, 5-meter walk test, Timed Up & Go Test, and Western Ontario and McMaster Universities Osteoarthritis Index were measured. All assessment results were compared between the knee osteoarthritis and healthy groups. Gait cycle variability was significantly higher in the knee osteoarthritis group (3.2%) compared to the healthy group (2.1%). A significant positive correlation was found between the gait cycle variability and 5-meter walk test (r=0.46) and Western Ontario and McMaster Universities Osteoarthritis Index (r=0.43). The gait of patients with knee osteoarthritis may be more unstable than that of healthy individuals. In addition, unstable gait may be associated with gait speed and quality of life. Therefore, we believe that rehabilitation to improve unstable gait can enhance the quality of life of patients with knee osteoarthritis.

Clinical outcomes and prognostic factors for cavernous hemangiomas of the spinal cord: a retrospective cohort study

OBJECTIVEIntramedullary cavernous hemangioma (CH) is a rare vascular lesion that is mainly characterized by the sudden onset of hemorrhage in young, asymptomatic patients, who then experience serious neurological deterioration. Despite the severity of this condition, the therapeutic approach and timing of intervention for CH remain matters of debate. The aim of this study was to evaluate the clinical characteristics of CH patients before and after surgery and to identify prognostic indicators that affect neurological function in these patients.METHODSThis single-center retrospective study included 66 patients who were treated for intramedullary CH. Among them, 57 underwent surgery and 9 patients received conservative treatment. The authors collected demographic, symptomology, imaging, neurological, and surgical data. Univariate and multivariate logistic regression analyses were performed to identify the prognostic indicators for neurological function.RESULTSWhen comparing patients with stable and unstable gait prior to surgery, patients with unstable gait had a higher frequency of hemorrhagic episodes (52.4% vs 19.4%, p = 0.010), as assessed by the modified McCormick Scale. The lesion was significantly smaller in patients who underwent conservative treatment compared with surgery (2.5 ± 1.5 mm vs 5.9 ± 4.1 mm, respectively; p = 0.024). Overall, the patients experienced significant neurological recovery after surgery, but a worse preoperative neurological status was identified as an indicator affecting surgical outcomes by multivariate analysis (OR 10.77, 95% CI 2.88–40.36, p < 0.001). In addition, a larger lesion size was significantly associated with poor functional recovery in patients who had an unstable gait prior to surgery (8.6 ± 4.5 mm vs 3.5 ± 1.6 mm, p = 0.011).CONCLUSIONSOnce a hemorrhage occurs, surgical intervention should be considered to avoid recurrence of the bleeding and further neurological injury. In contrast, if the patients with larger lesion presented with worse preoperative functional status, surgical intervention could have a risk for aggravating the functional deficiencies by damaging the thinning cord parenchyma. Conservative treatment may be selected if the lesion is small, but regular neurological examination by MRI is needed for assessment of a change in lesion size and for detection of functional deterioration.

A Case of Undetected Neuroborreliosis in a 75-Year-Old Chinese Male

Lyme disease is a multisystem infection caused by the spirochete Borrelia burgdorferi sensu stricto that manifests with characteristic symptoms in patients. Patients are identified based on their clinical symptoms and then diagnosed through enzyme-linked immunosorbent assay (ELISA), Western blot, and blood culture techniques. Here, we present the case of a 75-year-old, Northeast suburban resident complaining of unstable gait, high fevers, malaise, myalgia, and confusion. This patient’s symptoms were nonspecific, and his lab titers and blood cultures were repeatedly negative during his stay. It was only late in the course of his treatment that blood titers and cerebrospinal fluid analysis were positive for Lyme IgG and IgM. He was treated with intravenous doxycycline and prescribed oral doxycycline on discharge, resulting in a full recovery. We express the need for physicians to consider Lyme disease in endemic patients presenting with nonspecific systemic signs.

Predicting the minimum clinically important difference in patients undergoing surgery for the treatment of degenerative cervical myelopathy

OBJECTIVE The minimum clinically important difference (MCID) is defined as the minimum change in a measurement that a patient would identify as beneficial. Before undergoing surgery, patients are likely to inquire about the ultimate goals of the operation and of their chances of experiencing meaningful improvements. The objective of this study was to define significant predictors of achieving an MCID on the modified Japanese Orthopaedic Association (mJOA) scale at 2 years following surgery for the treatment of degenerative cervical myelopathy (DCM). METHODS Seven hundred fifty-seven patients were prospectively enrolled in either the AOSpine North America or International study at 26 global sites. Fourteen patients had a perfect preoperative mJOA score of 18 and were excluded from this analysis (n = 743). Data were collected for each participating subject, including demographic information, symptomatology, medical history, causative pathology, and functional impairment. Univariate log-binominal regression analyses were conducted to evaluate the association between preoperative clinical factors and achieving an MCID on the mJOA scale. Modified Poisson regression using robust error variances was used to create the final multivariate model and compute the relative risk for each predictor. RESULTS The sample consisted of 463 men (62.31%) and 280 women (37.69%), with an average age of 56.48 ± 11.85 years. At 2 years following surgery, patients exhibited a mean change in functional status of 2.71 ± 2.89 points on the mJOA scale. Of the 687 patients with available follow-up data, 481 (70.01%) exhibited meaningful gains on the mJOA scale, whereas 206 (29.98%) failed to achieve an MCID. Based on univariate analysis, significant predictors of achieving the MCID on the mJOA scale were younger age; female sex; shorter duration of symptoms; nonsmoking status; a lower comorbidity score and absence of cardiovascular disease; and absence of upgoing plantar responses, lower-limb spasticity, and broad-based unstable gait. The final model included age (relative risk [RR] 0.924, p < 0.0001), smoking status (RR 0.837, p = 0.0043), broad-based unstable gait (RR 0.869, p = 0.0036), and duration of symptoms (RR 0.943, p = 0.0003). CONCLUSIONS In this large multinational prospective cohort, 70% of patients treated surgically for DCM exhibited a meaningful functional gain on the mJOA scale. The key predictors of achieving an MCID on the mJOA scale were younger age, shorter duration of symptoms, nonsmoking status, and lack of significant gait impairment.

Design and Analysis of a Non-Vision-Based System for Detecting Unstable Gait

An unstable gait provides early warning of more serious conditions. In this study, we propose the use of pressure sensors embedded into a shoe pad along with a 3D accelerometer fastened to the knee. We have implemented a portable gait-measuring device integrated with a ZigBee wireless sensor network. Moreover, the step length, step speed, and step distance are easily calculated in the user interface. These data can then be used to distinguish the seven decision points of a complete gait cycle. Analysis of the gait cycle is done using fuzzy logic. The detected gait phases can be compared with standard gait parameters from the literature. Thus, the analyzed gait parameters can provide early detection of the emergence of an unstable gait. Finally, because our system measures knee flexion angle, it can detect the swing phase of the gait cycle.