Application of Wavelet in Quantitative Evaluation of Gait Events of Parkinson’s Disease

Motivation. In Parkinson’s disease, disturbances in gait initiation are of particular interest as they affect postural adjustments and movement disorders which may lead to falling. This falling down may be dangerous and at times life threatening, thus becoming a major concern for the patient and the clinician. These gait abnormalities are due to dependencies of movement on the motor system. Paroxysmal dyskinesia (commonly termed as freezing of gait) is one of the extreme cases of motor blocks. Since the last two decades, automated methods for monitoring motor activities, their data analysis, and algorithm techniques have been subjects of research for Parkinson’s disease (PD). This research will be of help to clinicians in prescribing a drug regimen. Problem Statement. Development of a system based on an algorithm for automatic detection of the freezing of gait (FOG) and other postural adjustments, with the help of wearable sensor’s data and to provide a quantitative approach for assessing the intensity of PD by analyzing frequency components associated with different motor movements and gait. Methodology. This paper presents a novel wavelet energy distribution approach to distinguish between walking, standing, and FOG. Data from the acceleration sensor is taken as input. After preprocessing, discrete wavelet transform (DWT) is applied on the data which shows its entire frequency spectrum. In the next step, energy is computed for the decomposed level of interest. Results. Systems detected FOG and other gait postures and showed time-frequency range by examining differentiated decomposed signals by DWT. Energy distribution and PSD graph proved the accuracy of the system. Validation is done by the LOSO method which shows 90% accuracy for the proposed method. Conclusion. Observations of the clinical trials validate the proposed technique. In comparison to the previous techniques reported in literature, it is seen that the proposed method shows improvement in time and frequency resolution as well as processing time.

Mielopathy related to copper deficiency after bariatric surgery: case report / Mielopatia relacionada à deficiência de cobre após cirurgia bariátrica: relato de caso

Copper is an essential enzymatic cofactor in many stages of normal functioning of human body, acting mainly in hematological, vascular and neurological functions. Its deficiency is linked to some conditions as highly isolated oral zinc intake, parenteral nutrition and after bariatric surgery. Neurological symptoms due copper deficiency include gait abnormalities, sensitive ataxia and sensitive neuropathic symptoms. We present a case of copper deficiency myelopathy after bariatric surgery. Copper deficiency myelopathy is poorly diagnosed, being imperative the early recognition of the condition aiming better outcomes and neurological recovery.

A Low-Cost, Autonomous Gait Detection and Estimation System for Analyzing Gait Impairments in Mice

With the advancement in imaging technology, many commercial systems have been developed for performing motion analysis in mice. However, available commercial systems are expensive and use proprietary software. In this paper, we describe a low-cost, camera-based design of an autonomous gait acquisition and analysis system for inspecting gait deficits in C57BL/6 mice. Our system includes video acquisition, autonomous gait-event detection, gait-parameter extraction, and result visualization. We provide a simple, user-friendly, step-by-step detailed methodology to apply well-known image processing techniques for detecting mice footfalls and calculating various gait parameters for analyzing gait abnormalities in healthy and neurotraumatic mice. The system was used in a live animal study for assessing recovery in a mouse model of Parkinson’s disease. Using the videos acquired in the study, we validate the performance of our system with receiver operating characteristic (ROC) and Hit : Miss : False (H : M : F) detection analyses. Our system correctly detected the mice footfalls with an average H : M : F score of 92.1 : 2.3 : 5.6. The values for the area under an ROC curve for all the ROC plots are above 0.95, which indicates an almost perfect detection model. The ROC and H : M : F analyses show that our system produces accurate gait detection. The results observed from the gait assessment study are in agreement with the known literature. This demonstrates the practical viability of our system as a gait analysis tool.

Clinical characteristics and outcome of hydrocephalus in neurosarcoidosis: a retrospective cohort study and review of the literature

Hydrocephalus is reported in approximately one-tenth of neurosarcoidosis patients. However, data on clinical characteristics and outcome are lacking. In this retrospective study, we present 11 patients with neurosarcoidosis and hydrocephalus on neuroimaging. Median age was 52 years and seven were female (64%). Presenting symptoms consisted of headache in 8 out of 11 (73%), vertigo in 5 (46%), gait abnormalities in 4 (36%), diplopia in 2 (18%) and decreased visual acuity in 1 (9%). Cranial imaging showed obstructive hydrocephalus in 10 (91%) and non-obstructive hydrocephalus in 1 (9%) out of 11, obstruction occurred at the level of the fourth ventricle in 6 out of 10 (60%). Treatment consisted of glucocorticoids in all the patients with additional methotrexate or azathioprine in 6 (55%) and infliximab in 1 (9%) patient. Neurosurgical intervention was performed in 10 out of 11 (91%) patients. Treatment led to remission, improvement or stabilization of disease in 9 out of 10 (90%) of patients. One patient died due to cerebral herniation despite neurosurgical decompression and CSF shunting. Median modified Rankin scale score at last follow-up was 2 (range 0–6). A systematic review and meta-analysis of studies on hydrocephalus due to neurosarcoidosis identified 36 patients that compared to our patients had a lower median age at onset and a higher mortality. Acute obstructive hydrocephalus due to neurosarcoidosis is a potentially fatal medical emergency requiring neurosurgical intervention and initiation of immunosuppressive therapy. If patients survive the initial phase, the outcome is generally favorable.

Muscle Activity and Gait Analysis of Assistive Device for Rehabilitation Gait Abnormalities Patient

Gait abnormality is a muscle disorder that disabling the patient to walk properly. This is caused by several factors including genetic influence, accident history, health issue, and others. Some suffered from this illness could be cured but some cases only could be helped by rehabilitation. This work is an original initiative in developing an assistive device as part of patient’s recovery and rehabilitation in helping the patient to regain muscle, as well assisting patient in performing their activities. However, the effectiveness on the device’s performance to serve its purpose has not yet been confirmed. Therefore, an electrical tool known as surface Electromyography (EMG) is being used to obtain the information required. This research is analysing the patient’s nerves system with and without the assistive device and demonstrate the effectiveness of the assistive device in reducing the muscle contraction, as well to increase the time-to-fatigue of the muscle. The findings of this research showed that the reduction in percent of average Root Mean Square (RMS) value of patient’s contraction muscle when using the device has increase the time-to-fatigue of the muscle. In conclusion, this assistive device assists the patient, minimise the muscle fatigue, and ease the patient in their daily chores.

Gait performance of adolescent mice assessed by the CatWalk XT depends on age, strain and sex and correlates with speed and body weight

The automatization of behavioral tests assessing motor activity in rodent models is important for providing robust and reproducible results and evaluating new therapeutics. The CatWalk system is an observer-independent, automated and computerized technique for the assessment of gait performance in rodents. This method has previously been used in adult rodent models of CNS-based movement disorders such as Parkinson’s and Huntington’s diseases. As motor and gait abnormalities in neuropsychiatric disorders are observed during infancy and adolescence, it became important to validate the CatWalk XT in the gait analysis of adolescent mice and unravel factors that may cause variations in gait performance. Three adolescent wild-type inbred mouse strains, C57BL/6N, DBA/2 and FVB/N, were tested using the CatWalk XT (Version 10.6) for suitable detection settings to characterize several gait parameters at P32 and P42. The same detection settings being suitable for C57BL/6N and DBA/2 mice allowed a direct comparison between the two strains. On the other hand, due to their increased body weight and size, FVB/N mice required different detection settings. The CatWalk XT reliably measured the temporal, spatial, and interlimb coordination parameters in the investigated strains during adolescence. Additionally, significant effects of sex, development, speed and body weight within each strain confirmed the sensitivity of motor and gait functions to these factors. The CatWalk gait analysis of rodents during adolescence, taking the effect of age, strain, sex, speed and body weight into consideration, will decrease intra-laboratory discrepancies and increase the face validity of rodent models of neuropsychiatric disorders.

Expanding the Phenotype of the FAM149B1-Related Ciliopathy and Identification of Three Neurogenetic Disorders in a Single Family

Biallelic truncating FAM149B1 variants result in cilia dysfunction and have been reported in four infants with Joubert syndrome and orofaciodigital syndrome type VI, respectively. We report here on three adult siblings, 18 to 40 years of age, homozygous for the known FAM149B1 c.354_357delinsCACTC (p.Gln118Hisfs*20) variant. Detailed clinical examinations were performed including ocular and gait analyses, skeletal- and neuroimaging. All three patients presented with neurological and oculomotor symptoms since birth and mild skeletal dysplasia in infancy resulting in characteristic gait abnormalities. We document mild skeletal dysplasia, abnormal gait with increased hip rotation and increased external foot rotation, ataxia, variable polydactyly, ocular Duane syndrome, progressive ophthalmoplegia, nystagmus, situs inversus of the retinal vessels, olfactory bulb aplasia, and corpus callosal dysgenesis as novel features in FAM149B1-ciliopathy. We show that intellectual disability is mild to moderate and retinal, renal and liver function is normal in these affected adults. Our study thus expands the FAM149B1-related Joubert syndrome to a mainly neurological and skeletal ciliopathy phenotype with predominant oculomotor dysfunction but otherwise stable outcome in adults. Diagnosis of FAM149B1-related disorder was impeded by segregation of multiple neurogenetic disorders in the same family, highlighting the importance of extended clinical and genetic studies in families with complex phenotypes.

Knotless Reconstruction of Chronic Achilles Tendon Ruptures With <3-cm Defects: Technique Tip

Chronic Achilles tendon ruptures can result in tendon lengthening and significant functional deficits including gait abnormalities and diminished push-off strength. Surgical intervention is typically required to restore Achilles tension and improve ankle plantarflexion strength. A variety of surgical reconstruction techniques exist depending on the size of the defect and amount of associated tendinosis. For smaller tendon defects 2 to 3 cm in size, primary end-to-end repair using an open incision and multiple locking sutures is an established technique. However, a longer skin incision and increased soft tissue dissection is required, and failure at the suture-tendon interface has been reported that can result in postoperative tendon elongation and persistent weakness. In this report, we describe a novel technique to reconstruct chronic midsubstance Achilles tendon ruptures using a small incision with knotless repair of the tendon secured directly to the calcaneus. This technique minimizes wound healing complications, increases construct fixation strength, and allows for early range of motion and rehabilitation. Level of Evidence: Level V, Expert Opinion.