857 research outputs found

    A novel behavioural paradigm for characterising anticipatory postural adjustments in mice

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    Daily we use purposeful, voluntary movements to interact with our environment. These movements demand and cause our body to experience a weight redistribution, i.e., anticipatory postural adjustments (APAs), and it’s the appropriate employment of these APAs that allows us to complete said voluntary movements without falling over or losing our equilibrium. The literature suggests that for humans, monkeys, and several quadrupeds, APAs are crucial at initiation and during movement. However, research has been somewhat limited due to the lack of behavioural paradigms that would allow for a better understanding into the neural circuitry involved with APAs. Given the widespread availability of genetic tools and advanced viral techniques in mice I focused my efforts in developing a novel behavioral paradigm for this species. The first chapters detail the reasoning behind the development of this novel behavioural paradigm while also providing a complete description of the different components and their functions. Later chapters use the custom-designed setup to characterise mouse APAs, incorporating various recording approaches designed to quantify APAs and compare them to those described in prior work, highlighting possible interspecifies similarities and differences. Additionally, I briefly discuss the potential neural circuitry of APAs informed by my own data and research that has been done in different animals, providing a comprehensive overview of APAs in mice

    Assisting walking balance using a bio-inspired exoskeleton controller

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    Background: Balance control is important for mobility, yet exoskeleton research has mainly focused on improving metabolic energy efficiency. Here we present a biomimetic exoskeleton controller that supports walking balance and reduces muscle activity. Methods: Humans restore balance after a perturbation by adjusting activity of the muscles actuating the ankle in proportion to deviations from steady-state center of mass kinematics. We designed a controller that mimics the neural control of steady-state walking and the balance recovery responses to perturbations. This controller uses both feedback from ankle kinematics in accordance with an existing model and feedback from the center of mass velocity. Control parameters were estimated by fitting the experimental relation between kinematics and ankle moments observed in humans that were walking while being perturbed by push and pull perturbations. This identified model was implemented on a bilateral ankle exoskeleton. Results: Across twelve subjects, exoskeleton support reduced calf muscle activity in steady-state walking by 19% with respect to a minimal impedance controller (p < 0.001). Proportional feedback of the center of mass velocity improved balance support after perturbation. Muscle activity is reduced in response to push and pull perturbations by 10% (p = 0.006) and 16% (p < 0.001) and center of mass deviations by 9% (p = 0.026) and 18% (p = 0.002) with respect to the same controller without center of mass feedback. Conclusion: Our control approach implemented on bilateral ankle exoskeletons can thus effectively support steady-state walking and balance control and therefore has the potential to improve mobility in balance-impaired individuals.Support Biomechanical Engineerin

    Assessment of Physical Activity in Adults with Progressive Muscle Disease

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    Introduction: Insufficient physical activity is a major threat to global health. Physical activity benefits peoples’ physical and mental health. The general population, including people living with disabilities and muscle wasting conditions, are recommended to avoid excessive sedentary time and engage in daily activity. Adults with progressive muscle disease experience barriers to physical activity participation, including muscle weakness, fatigue, physical deconditioning, impairment, activity limitations and participation restrictions (including societal and environmental factors), and fear of symptom exacerbation. More research is required to understand the inter-relationship between health and physical activity for adults with progressive muscle disease, particularly non-ambulant people who are under-represented in the existing research literature. Accurate measurement of FITT (frequency, intensity, time, and type of physical activity) is vital for high-quality physical activity assessment. The aim of this thesis was to assess the physical activity of ambulant and non-ambulant adults with progressive muscle disease.Systematic review findings identified various measures used to assess physical activity in adults with muscular dystrophy, including accelerometers, direct observation, heart rate monitors, calorimetry, positioning systems, activity diaries, single scales, interviews and questionnaires. None of the measures identified in the systematic review had well established measurement properties for adults with muscular dystrophy.Patient and public involvement interviews highlighted the importance of inclusive, remote, and technology-facilitated research design, the potential intrusion of direct observations of physical activity, the familiarity of questionnaires for data collection, and practical considerations to ensure wearing an activity monitor was not too burdensome.A feasibility study using multiple methods in 20 ambulant and non-ambulant adults with progressive muscle disease revealed satisfactory acceptability, interpretability, and usability of Fitbit and activity questionnaires, in both paper and electronic formats. During supervised activity tasks, Fitbit was found to have satisfactory criterion validity, reliability, and responsiveness and measurement properties were strengthened using multisensory measurement.An observational, longitudinal study that included 111 ambulant and non-ambulant adults with progressive muscle disease showed that:Activity monitoring had satisfactory validity, reliability and responsiveness using Fitbit, but there was considerable measurement error between Fitbit and the research grade GENEActiv accelerometer. Fitbit thresholds and multiple metrics (including accelerometer and heart rate data extrapolations of FITT) were appropriate for physical activity assessment in ambulant and non-ambulant adults with progressive muscle disease.Activity self-report had unsatisfactory concurrent validity, test-retest reliability, and responsiveness with substantial activity overestimation using the modified International Physical Activity Questionnaire. However, self-report properties were improved when used concurrently with Fitbit.Observed physical activity in adults with progressive muscle disease was generally low with excessive daily sedentary time. Activity frequencies, intensities and durations were lower, and activity types were more domestic, for wheelchair users and during the COVID-19 lockdown. Lower physical activity was significantly associated with greater functional impairment, less cardiorespiratory fitness, worse metabolic health, and lower quality of life. Activity optimisation thresholds and minimal clinically important differences were established.Discussion: The implications of this thesis include guidance for selection of appropriate physical activity measures by clinicians and researchers working with adults with progressive muscle disease. Fitbit is suitable in clinical practice and research for interactive, weekly remote activity monitoring or to support activity self-management and may represent an appropriate compromise between potential underestimation by accelerometry alone, and overestimation by self-report alone. A draft conceptual framework for physical activity measurement was also proposed. It includes frequency, intensity, time, and type of physical activity, and incorporates wider aspects of the physical activity construct, including somatic factors (relating to progressive muscle disease and underlying fitness) and contextual factors (relating to personal, social, and environmental situations). Future research will build on the knowledge gained in this thesis, furthering understanding of the inter-relationships between physical activity, health and wider contexts. Implementation will include testing a remote physical activity optimisation intervention that is inclusive of ambulant and non-ambulant participants, featuring Fitbit self-monitoring with a focus on optimisation of daily activity frequency and regularly interrupting sedentary time.</div

    Out of sight, out of mind: accessibility for people with hidden disabilities in museums and heritage sites

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    As of 2020, an estimated 14.1 million residents of the United Kingdom reported a disability (DWP 2020). Within this population, approximately 6.1 million people have a hidden disability (Buhalis and Michopoulou 2011). These hidden disabilities range widely, from neurodiverse conditions like autism and dyslexia to long term chronic conditions such as fibromyalgia and arthritis. Due to the wide range of disabilities and their impact on a disabled person’s life, they have generally been underrepresented in accessibility studies. This thesis uncovers the accessibility needs of people with hidden disabilities, specifically in museums and heritage sites where they have heretofore mostly been overlooked. I utilise semi-structured interviews and correspondence with people with hidden disabilities, as well as participant-led experiences through three case study sites in Northern England, to understand the barriers they face. Their experiences help me expose the importance of passive accessibility – accessibility measures built directly into an exhibition design, such as adequate lighting and personal interpretation boards. Additionally, this thesis aims to understand the cultural forces that prevent or support accessibility-related improvements to such sites from taking place. By studying the cultural make-up of each case study organisation through ethnographic observations of the staff at these sites, institutional roadblocks to enacting accessibility-related adjustments are revealed. Specifically, the lack of communication at these sites presents a significant barrier to enacting accessibility suggestions from disabled visitors. Tying together the themes of active/passive accessibility and lack of communication is the theme of gaps in disability awareness, by which I mean that heritage organisations do not wilfully create these barriers to inclusion, and yet they create them still because they simply do not realise these things. Filling these gaps opens up countless possibilities for improving accessibility not only for people with hidden disabilities but for all visitors and staff at museums and heritage sites

    Proceedings XXIII Congresso SIAMOC 2023

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    Il congresso annuale della Società Italiana di Analisi del Movimento in Clinica (SIAMOC), giunto quest’anno alla sua ventitreesima edizione, approda nuovamente a Roma. Il congresso SIAMOC, come ogni anno, è l’occasione per tutti i professionisti che operano nell’ambito dell’analisi del movimento di incontrarsi, presentare i risultati delle proprie ricerche e rimanere aggiornati sulle più recenti innovazioni riguardanti le procedure e le tecnologie per l’analisi del movimento nella pratica clinica. Il congresso SIAMOC 2023 di Roma si propone l’obiettivo di fornire ulteriore impulso ad una già eccellente attività di ricerca italiana nel settore dell’analisi del movimento e di conferirle ulteriore respiro ed impatto internazionale. Oltre ai qualificanti temi tradizionali che riguardano la ricerca di base e applicata in ambito clinico e sportivo, il congresso SIAMOC 2023 intende approfondire ulteriori tematiche di particolare interesse scientifico e di impatto sulla società. Tra questi temi anche quello dell’inserimento lavorativo di persone affette da disabilità anche grazie alla diffusione esponenziale in ambito clinico-occupazionale delle tecnologie robotiche collaborative e quello della protesica innovativa a supporto delle persone con amputazione. Verrà infine affrontato il tema dei nuovi algoritmi di intelligenza artificiale per l’ottimizzazione della classificazione in tempo reale dei pattern motori nei vari campi di applicazione

    Psychological and care impact of the daily use of a pediatric gait exoskeleton in children with spinal muscular atrophy

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    Introducción: La Atrofia Muscular Espinal Tipo II, es una enfermedad neurodegenerativa de origen genético que cursa con debilidad muscular y provoca deterioro motor e incapacidad para caminar en los niños. Se relaciona con graves problemas respiratorios, musculoesqueléticos, gastrointestinales y otros de salud y cuidado. Los exoesqueletos robóticos de miembros inferiores son dispositivos médicos que ayudan a la marcha de pacientes que no pueden caminar. Nuestro objetivo fue evaluar el impacto en la dimensión psicológica y de autocuidado derivado del uso del exoesqueleto ATLAS en el hogar en niños con Atrofia Muscular Espinal Tipo II. Metodología: tres niños con Atrofia Muscular Espinal Tipo II utilizaron el exoesqueleto en casa cinco días a la semana durante un período de dos meses para caminar y realizar actividades. Se realizó una evaluación del autocuidado de enfermería antes y durante el uso del dispositivo para evaluar los cambios en los resultados del autocuidado y los diagnósticos de enfermería. Se realizaron entrevistas en profundidad y semiestructuradas, además de la observación durante las sesiones, para evaluar el impacto de la experiencia en la dimensión psicológica de los participantes. Resultados: el uso del exoesqueleto produjo cambios en los condicionantes básicos de los niños y una mejora en los organismos de autocuidado. También aparecieron nuevas demandas de autocuidado. Tres de los diez diagnósticos de enfermería fueron resueltos. Asimismo, los niños mostraron una buena tolerancia a la actividad además de una mejora funcional evaluada en el tercer participante. Los niños y los cuidadores principales valoraron la experiencia como positiva y significativa. Los niños tenían una mayoría de emociones positivas, y se incrementó su autonomía y comportamiento social y exploratorio. Conclusiones: la tecnología del exoesqueleto podría considerarse como un nuevo recurso para el cuidado de niños con enfermedades neuromusculares. Su uso tuvo un impacto positivo tanto en las variables de autocuidado como en la dimensión psicológica de tres niños con atrofia muscular espinal tipo II. Aunque este estudio aporta ya evidencia, más estudios sobre el tema aportarían un mayor conocimiento

    Balance control in people with multiple sclerosis : mechanisms, experiences, design and feasibility of an exercise trial

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    Background: Everyday living entails navigating complex environments and perform-ing activities often requiring simultaneous motor and cognitive actions/tasks (dual-tasking). Disease-related impairments in people with multiple sclerosis (MS) often impact sensorimotor and cognitive functions, both of which may contribute to a vicious cycle of decreased mobility, muscular weakness, impaired balance control, walking limitation, falls, and fall-related injuries. Reduced dual-task capacity is suggested to be more common among people with MS compared with healthy controls, which in turn might impact balance control. A more detailed understanding of the underlying mechanisms contributing to impaired balance control, as well as the experiences of how this affects activities and participation in people with MS’ everyday lives, is still lacking. Furthermore, balance training interventions with a gradual progression of difficulty and highly challenging tasks designed specifically for people with MS are rare. To develop a balance training intervention specifically targeting balance and walking problems for people with MS, both quantitative and qualitative preparatory studies are needed. Aim of thesis: To explore mechanisms, explore and describe experiences of balance control in people with MS, and furthermore to design and evaluate the feasibility of a highly challenging balance training intervention specific to MS. Methods: This thesis consists of four papers based on three data collections, including people with mild to moderate overall MS disability and healthy controls. Paper I was a test–retest reliability study of a balance assessment scale, the mini-BESTest, with repeated measurements one week apart; 54 people with MS were included. Paper II was a case-control study evaluating dual-task performances of the motor tasks standing with eyes closed and walking, and a cognitive task, auditory Stroop; 55 people with MS and 30 healthy controls were included. Paper III was a qualitative interview study exploring how impaired balance control affects participation in activities in people with MS’ everyday life; 16 people with MS were included. Paper IV was a single-group feasibility trial of a balance training intervention developed specifically for MS through a co-design workshop series with stakeholder involvement; 12 people with MS were included. Results: Paper I showed that the mini-BESTest total score is reliable for assessment of balance control in people with mild to moderate MS over time, and that section and item scores are useful for identification of specific aspects of balance impairment. Paper II demonstrated interference on walking during motor and cognitive dual-tasking both in people with MS and in healthy controls; but only people with mild MS displayed cognitive interference during walking. No dual-task effects were shown dur-ing standing. People with moderate MS performed worse in almost every aspect of dual-tasking compared to those with mild MS and healthy controls. The association between degree of motor–cognitive dual-task interference and an increased level of overall MS disability was evident. People with moderate MS differed significantly from the other groups in walking slower and using longer response time. In Paper III, people with MS described that balance impairment limited and affected performance and participation in everyday activities. The ability to be continuously active was often limited due to lack of energy and to day-to-day variation in capacity. Specific strategies were used when negotiating between capacity and ambition aiming to minimise the impact of balance impairment to keep up a good life. In Paper IV, most aspects of the developed balance training intervention were found to be feasible. However, some adaptations need to be considered to improve retention and training session attend-ance before embarking on a full-scale trial. Conclusion: The mini-BESTest demonstrated good to excellent test–retest reliability and small measurement errors, and is recommended for use in people with mild to moderate MS. Cognitive–motor interference was also present in people with mild MS. People with moderate MS performed worse than those with mild MS, and healthy controls in almost every aspect of the motor and cognitive dual-task assessments. Furthermore, people with mild to moderate MS perceived balance control as a skill, which, in contrast to their experiences prior to MS onset, has lost its automaticity and requires specific attention and awareness. To maintain everyday function and quality of life, they implement various compensatory strategies. Finally, despite some concerns regarding retention and attendance, the overall trial design and delivery of the designed intervention was found to be feasible for a full-scale trial
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