The Impact of Lameness on Dairy Cattle Welfare: Growing Need for Objective Methods of Detecting Lame Cows and Assessment of Associated Pain

Dairy cows are the major animals reared for milk production worldwide. Lameness is a manifestation of painful condition due to injury or disease in the foot, regarded as a major welfare problem in dairy cows. An effective lameness management requires prompt identification of lame cows. The objectives of this systematic review were to discuss the various techniques of detecting lameness, assessment of the associated pain, and the impact of lameness on dairy cow welfare. Results from the literature search yielded 534 papers, with 102 papers meeting the inclusion criteria. The eligible studies were discussed in two sections which were; (1) lameness detection systems and their application in pain assessment using four methods: gait and behavioral variables, physiological parameters, pressure nociceptive threshold and blood biomarkers; (2) impact of lameness on animal-based welfare measures. Despite the limitations in the use of automated locomotion scoring systems, results showed the technique remains a promising tool for the prompt detection of lame cows compared with manual systems (MLSS). More investigation of such systems could aid the validation of pain in cows with various degree of lameness. Further studies are required for early lameness detection and minimizing the welfare implications in dairy herds

Visual-Vestibular Integration During Self-Motion Perception in Younger and Older Adults

Younger adults integrate visual and vestibular cues to self-motion in a manner consistent with optimal integration; however, little is currently known about whether this process changes with older age. Our objective was to determine whether older adults, like younger adults, display evidence of optimal visual-vestibular integration, including reductions in bimodal variance (visual-vestibular) compared with unimodal variance (visual or vestibular alone), and reliability-based cue weighting. We used a motion simulator and a head-mounted display to introduce a 2-interval forced-choice heading estimation task. Older (65+ years) and younger adults (18–35 years) judged which of two movements was more rightward. Movements consisted of vestibular cues (passive movement in darkness), visual cues (optic flow), or both cues combined. The combined condition contained either congruent cues or incongruent cues (either a subtle 5° or larger 20° conflict). Results demonstrated that older adults had less reliable visual heading estimates than younger adults but comparable vestibular heading estimates. During combined, congruent conditions, both age groups exhibited reductions in combined variance, consistent with predicted optimal integration. During subtle cue conflicts, only younger adults exhibited combined variance consistent with predicted optimal integration, but both age groups displayed reliability-based cue weighting. During larger spatial conflicts, neither group demonstrated optimal reductions in variance. Younger adults displayed reliability-based cue weighting but older adults’ heading estimates were biased toward the less reliable visual estimate. Older adults’ tendency to incorporate spatially conflicting and unreliable visual cues into their self-motion percept may affect their performance on mobility-related tasks like walking and driving

The role of virtual reality in improving health outcomes for community-dwelling older adults : systematic review

Background: Virtual reality (VR) delivered through immersive headsets creates an opportunity to deliver interventions to improve physical, mental, and psychosocial health outcomes. VR app studies with older adults have primarily focused on rehabilitation and physical function including gait, balance, fall prevention, pain management, and cognition. Several systematic reviews have previously been conducted, but much of the extant literature is focused on rehabilitation or other institutional settings, and little is known about the effectiveness of VR apps using immersive headsets to target health outcomes among community-dwelling older adults. Objective: The objective of this review was to evaluate the effectiveness of VR apps delivered using commercially available immersive headsets to improve physical, mental, or psychosocial health outcomes in community-dwelling older adults. Methods: Peer-reviewed publications that included community-dwelling older adults aged ≥60 years residing in residential aged care settings and nursing homes were included. This systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness evidence. The title of this review was registered with JBI, and the systematic review protocol was registered with the International Prospective Register of Systematic Reviews. Results: In total, 7 studies that specifically included community-dwelling older adults were included in this review. VR apps using a head-mounted display led to improvements in a number of health outcomes, including pain management, posture, cognitive functioning specifically related to Alzheimer disease, and a decreased risk of falls. A total of 6 studies reported a statistically significant difference post VR intervention, and 1 study reported an improvement in cognitive function to reduce navigational errors. Only one study reported on the usability and acceptability of the interventions delivered through VR. While one study used a distraction mechanism for pain management, none of the studies used gaming technology to promote enjoyment. Conclusions: Interventions to improve health outcomes through VR have demonstrated potential; however, the ability to synthesize findings by primary outcome for the older adult population is not possible. A number of factors, especially related to frailty, usability, and acceptability, also need to be explored before more substantial recommendations on the effectiveness of VR interventions for older adults can be made

Measuring and managing foot muscle weakness

Foot muscle weakness is caused by disease, injury, inactivity and ageing, with disabling consequences. Exercise improves muscle weakness however, adherence to correct technique is challenging. Biofeedback may improve performance. Chapter One reviews the literature on small foot muscles, muscle function, measurement, causes and consequences of foot muscle weakness, and the role of exercise. Chapter Two is a systematic review on the relationship between foot pain, muscle strength and size. Eight studies were identified evaluating the relationship between foot pain and foot muscle strength or size, with a significant association between foot pain and muscle weakness when pain is of high intensity and weakness measured by toe flexion force. Chapter Three is a reliability study assessing size of abductor hallucis and medial belly flexor hallucis brevis muscles by ultrasound in 21 adults and identify their relationship with toe strength, foot morphology, balance. Intra-rater reliability was excellent. Significant associations were found between cross-sectional area of abductor hallucis with great toe flexion force, arch height sit and stand, truncated and full foot length, balance. Significant associations found between cross-sectional area of medial belly flexor hallucis brevis with Foot Posture Index, truncated and full foot length. After controlling for body size, cross-sectional area of abductor hallucis remained a significant correlate of great toe flexor strength. Chapter Four describes the development of the Archie biofeedback device. Device feasibility is evaluated in Chapter Five by repeat testing of 30 adults performing four foot exercises using Archie, with 89% of exercise and foot location variables collected consistently. Biofeedback significantly improved foot location for all exercises and 97% of participants reported biofeedback helped exercise performance. Archie appears to be a safe and feasible biofeedback device to assist participants perform exercise

The look of lameness - Behaviors and facial expressions associated with orthopedic pain in horses

There are increasing concerns about equine welfare in equestrian sports, where early detection of orthopedic pain remains a major challenge since reliable and valid pain assessment tools are lacking. Movement asymmetry may be present in horses perceived as free from lameness by their owners, as well as in horses with confirmed orthopedic pain. It is therefore important to differentiate movement asymmetry due to pain from that due to other reasons, which may be achievable by improving orthopedic pain assessment. The aim of this thesis was thus to identify body behaviors and changes in facial activity related to orthopedic pain and movement asymmetry in horses. Progression and regression of movement asymmetry after induced orthopedic pain was monitored and measured with gait analysis in eight horses. A number of behaviors including altered posture, head position, location in the box stall, focus and human interaction were found to be associated with orthopedic pain, as were facial expressions. Only one of four equine pain scales tested detected orthopedic pain reliably and accurately. Dynamic and diverse facial displays were identified in resting and moving horses during pain, illustrating that the concept of one prototypical pain face may be a simplification of the full pain-related facial repertoire. Horses trotted by hand showed a great inter-individual variation in facial expressiveness, highlighting the need for further analysis of facial activity during motion before its use for pain detection. The new knowledge on the relationship between pain and movement asymmetry provided in this thesis, can lead to improved pain assessments, pain management and equine welfare

A wearable biofeedback device to improve motor symptoms in Parkinson’s disease

Dissertação de mestrado em Engenharia BiomédicaThis dissertation presents the work done during the fifth year of the course Integrated Master’s in Biomedical Engineering, in Medical Electronics. This work was carried out in the Biomedical & Bioinspired Robotic Devices Lab (BiRD Lab) at the MicroElectroMechanics Center (CMEMS) established at the University of Minho. For validation purposes and data acquisition, it was developed a collaboration with the Clinical Academic Center (2CA), located at Braga Hospital. The knowledge acquired in the development of this master thesis is linked to the motor rehabilitation and assistance of abnormal gait caused by a neurological disease. Indeed, this dissertation has two main goals: (1) validate a wearable biofeedback system (WBS) used for Parkinson's disease patients (PD); and (2) develop a digital biomarker of PD based on kinematic-driven data acquired with the WBS. The first goal aims to study the effects of vibrotactile biofeedback to play an augmentative role to help PD patients mitigate gait-associated impairments, while the second goal seeks to bring a step advance in the use of front-end algorithms to develop a biomarker of PD based on inertial data acquired with wearable devices. Indeed, a WBS is intended to provide motor rehabilitation & assistance, but also to be used as a clinical decision support tool for the classification of the motor disability level. This system provides vibrotactile feedback to PD patients, so that they can integrate it into their normal physiological gait system, allowing them to overcome their gait difficulties related to the level/degree of the disease. The system is based on a user- centered design, considering the end-user driven, multitasking and less cognitive effort concepts. This manuscript presents all steps taken along this dissertation regarding: the literature review and respective critical analysis; implemented tech-based procedures; validation outcomes complemented with results discussion; and main conclusions and future challenges.Esta dissertação apresenta o trabalho realizado durante o quinto ano do curso Mestrado Integrado em Engenharia Biomédica, em Eletrónica Médica. Este trabalho foi realizado no Biomedical & Bioinspired Robotic Devices Lab (BiRD Lab) no MicroElectroMechanics Center (CMEMS) estabelecido na Universidade do Minho. Para efeitos de validação e aquisição de dados, foi desenvolvida uma colaboração com Clinical Academic Center (2CA), localizado no Hospital de Braga. Os conhecimentos adquiridos no desenvolvimento desta tese de mestrado estão ligados à reabilitação motora e assistência de marcha anormal causada por uma doença neurológica. De facto, esta dissertação tem dois objetivos principais: (1) validar um sistema de biofeedback vestível (WBS) utilizado por doentes com doença de Parkinson (DP); e (2) desenvolver um biomarcador digital de PD baseado em dados cinemáticos adquiridos com o WBS. O primeiro objetivo visa o estudo dos efeitos do biofeedback vibrotáctil para desempenhar um papel de reforço para ajudar os pacientes com PD a mitigar as deficiências associadas à marcha, enquanto o segundo objetivo procura trazer um avanço na utilização de algoritmos front-end para biomarcar PD baseado em dados inerciais adquiridos com o dispositivos vestível. De facto, a partir de um WBS pretende-se fornecer reabilitação motora e assistência, mas também utilizá-lo como ferramenta de apoio à decisão clínica para a classificação do nível de deficiência motora. Este sistema fornece feedback vibrotáctil aos pacientes com PD, para que possam integrá-lo no seu sistema de marcha fisiológica normal, permitindo-lhes ultrapassar as suas dificuldades de marcha relacionadas com o nível/grau da doença. O sistema baseia-se numa conceção centrada no utilizador, considerando o utilizador final, multitarefas e conceitos de esforço menos cognitivo. Portanto, este manuscrito apresenta todos os passos dados ao longo desta dissertação relativamente a: revisão da literatura e respetiva análise crítica; procedimentos de base tecnológica implementados; resultados de validação complementados com discussão de resultados; e principais conclusões e desafios futuros

Investigating gait adaptations to split belt treadmill walking in healthy adults

Disability as a result of stroke is a major issue. Gait is a priority in rehabilitation, where asymmetry is a common and detrimental feature. Conventional treadmills are not able to treat this asymmetry. Recently the use of split belt (SB) treadmills has been suggested as a novel approach, SB allows each leg to travel at independent speeds. This study seeks to investigate the effects of SB gait on healthy young adults as a model for stroke patients. The study carried out motion analysis using the Motek CAREN. Subjects (n=10) were exposed to a total of 15 minutes SB in 5 and 10 minute blocks with a period of normal walking either side. Step length asymmetry and accommodation strategy was analysed. SB resulted in initial negative asymmetry, inferring a shortening of step of the leg on the fast belt (n=6) with some subjects showed a mirrored response (n=4). The asymmetry returns to baseline as subjects accommodate the novel condition. A distinct strategy was characterised, in which step length on fast belt was increased by delaying heel strike. When returned to normal walking conditions the initial asymmetry is reversed with a longer step on the fast leg. This is transient, after a short period normal walking there is a return to baseline asymmetry. Upon subsequent exposure to SB the adaption process is more rapid in adopting heel hang strategy (1st exposure 13 strides, 2nd exposure 3 strides), with significantly reduced asymmetry (p<0.001). The results show that young healthy adults can adapt to SB with distinct strategies. The improved adaption as a result of subsequent exposure suggests that there is some level of learned adaption. If applied to stroke patients, long term SB exposure may improve asymmetry and may be encouraged to adopt specific strategies to accommodate an increase in step length.Disability as a result of stroke is a major issue. Gait is a priority in rehabilitation, where asymmetry is a common and detrimental feature. Conventional treadmills are not able to treat this asymmetry. Recently the use of split belt (SB) treadmills has been suggested as a novel approach, SB allows each leg to travel at independent speeds. This study seeks to investigate the effects of SB gait on healthy young adults as a model for stroke patients. The study carried out motion analysis using the Motek CAREN. Subjects (n=10) were exposed to a total of 15 minutes SB in 5 and 10 minute blocks with a period of normal walking either side. Step length asymmetry and accommodation strategy was analysed. SB resulted in initial negative asymmetry, inferring a shortening of step of the leg on the fast belt (n=6) with some subjects showed a mirrored response (n=4). The asymmetry returns to baseline as subjects accommodate the novel condition. A distinct strategy was characterised, in which step length on fast belt was increased by delaying heel strike. When returned to normal walking conditions the initial asymmetry is reversed with a longer step on the fast leg. This is transient, after a short period normal walking there is a return to baseline asymmetry. Upon subsequent exposure to SB the adaption process is more rapid in adopting heel hang strategy (1st exposure 13 strides, 2nd exposure 3 strides), with significantly reduced asymmetry (p<0.001). The results show that young healthy adults can adapt to SB with distinct strategies. The improved adaption as a result of subsequent exposure suggests that there is some level of learned adaption. If applied to stroke patients, long term SB exposure may improve asymmetry and may be encouraged to adopt specific strategies to accommodate an increase in step length

A review of the effectiveness of lower limb orthoses used in cerebral palsy

To produce this review, a systematic literature search was conducted for relevant articles published in the period between the date of the previous ISPO consensus conference report on cerebral palsy (1994) and April 2008. The search terms were 'cerebral and pals* (palsy, palsies), 'hemiplegia', 'diplegia', 'orthos*' (orthoses, orthosis) orthot* (orthotic, orthotics), brace or AFO

Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability

Postural Instability (PI) is a core feature of Parkinson’s Disease (PD) and a major cause of falls and disabilities. Impairment of executive functions has been called as an aggravating factor on motor performances. Dance therapy has been shown effective for improving gait and has been suggested as an alternative rehabilitative method. To evaluate gait performance, spatial-temporal (S-T) gait parameters and cognitive performances in a cohort of patients with PD and PI modifications in balance after a cycle of dance therapy