Direct and indirect effects of attention and visual function on gait impairment in Parkinson’s disease: influence of task and turning

Gait impairment is a core feature of Parkinson’s disease (PD) which has been linked to cognitive and visual deficits, but interactions between these features are poorly understood. Monitoring saccades allows investigation of real-time cognitive and visual processes and their impact on gait when walking. This study explored; 1) saccade frequency when walking under different attentional manipulations of turning and dual-task; and 2) direct and indirect relationships between saccades, gait impairment, vision and attention. Saccade frequency (number of fast eye-movements per-second) was measured during gait in 60 PD and 40 age-matched control participants using a mobile eye-tracker. Saccade frequency was significantly reduced in PD compared to controls during all conditions. However, saccade frequency increased with a turn and decreased under dual-task for both groups. Poorer attention directly related to saccade frequency, visual function and gait impairment in PD, but not controls. Saccade frequency did not directly relate to gait in PD, but did in controls. Instead, saccade frequency and visual function deficit indirectly impacted gait impairment in PD, which was underpinned by their relationship with attention. In conclusion, our results suggest a vital role for attention with direct and indirect influences on gait impairment in PD. Attention directly impacted saccade frequency, visual function and gait impairment in PD, with connotations for falls. It also underpinned indirect impact of visual and saccadic impairment on gait. Attention therefore represents a key therapeutic target that should be considered in future research

Feasibility of using low-cost markerless motion capture for assessing functional outcomes after lower extremity musculoskeletal cancer surgery

\ua9 2024 Furtado et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Physical limitations are frequent and debilitating after sarcoma treatment. Markerless motion capture (MMC) could measure these limitations. Historically expensive cumbersome systems have posed barriers to clinical translation. Research question Can inexpensive MMC [using Microsoft KinectTM] assess functional outcomes after sarcoma surgery, discriminate between tumour sub-groups and agree with existing assessments? Methods Walking, unilateral stance and kneeling were measured in a cross-sectional study of patients with lower extremity sarcomas using MMC and standard video. Summary measures of temporal, balance, gait and movement velocity were derived. Feasibility and early indicators of validity of MMC were explored by comparing MMC measures i) between tumour sub-groups; ii) against video and iii) with established sarcoma tools [Toronto Extremity Salvage Score (TESS)), Musculoskeletal Tumour Rating System (MSTS), Quality of lifecancer survivors (QoL-CS)]. Statistical analysis was conducted using SPSS v19. Tumour sub-groups were compared using Mann-Whitney U tests, MMC was compared to existing sarcoma measures using correlations and with video using Intraclass correlation coefficient agreement. Results Thirty-four adults of mean age 43 (minimum value—maximum value 19–89) years with musculoskeletal tumours in the femur (19), pelvis/hip (3), tibia (9), or ankle/foot (3) participated; 27 had limb sparing surgery and 7 amputation. MMC was well-tolerated and feasible to deliver. MMC discriminated between surgery groups for balance (p<0.05*), agreed with video for kneeling times [ICC = 0.742; p = 0.001*] and showed moderate relationships between MSTS and gait (p = 0.022*, r = -0.416); TESS and temporal outcomes (p = 0.016* and r = -0.0557*), movement velocity (p = 0.021*, r = -0.541); QoL-CS and balance (p = 0.027*, r = 0.441) [* = statistical significance]. As MMC uncovered important relationships between outcomes, it gave an insight into how functional impairments, balance, gait, disabilities and quality of life (QoL) are associated with each other. This gives an insight into mechanisms of poor outcomes, producing clinically useful data i.e. data which can inform clinical practice and guide the delivery of targeted rehabilitation. For example, patients presenting with poor balance in various activities can be prescribed with balance rehabilitation and those with difficulty in movements or activity transitions can be managed with exercises and training to improve the quality and efficiency of the movement. Significance In this first study world-wide, investigating the use of MMC after sarcoma surgery, MMC was found to be acceptable and feasible to assess functional outcomes in this cancer population. MMC demonstrated early indicators of validity and also provided new knowledge that functional impairments are related to balance during unilateral stance and kneeling, gait and movement velocity during kneeling and these outcomes in turn are related to disabilities and QoL. This highlighted important relationships between different functional outcomes and QoL, providing valuable information for delivering personalised rehabilitation. After completing future validation work in a larger study, this approach can offer promise in clinical settings. Low-cost MMC shows promise in assessing patient’s impairments in the hospitals or their homes and guiding clinical management and targeted rehabilitation based on novel MMC outcomes affected, therefore providing an opportunity for delivering personalised exercise programmes and physiotherapy care delivery for this rare cancer

Balance and coordination after viewing stereoscopic 3D television.

Manufacturers and the media have raised the possibility that viewing stereoscopic 3D television (S3D TV) may cause temporary disruption to balance and visuomotor coordination. We looked for evidence of such effects in a laboratory-based study. Four hundred and thirty-three people aged 4-82 years old carried out tests of balance and coordination before and after viewing an 80 min movie in either conventional 2D or stereoscopic 3D, while wearing two triaxial accelerometers. Accelerometry produced little evidence of any change in body motion associated with S3D TV. We found no evidence that viewing the movie in S3D causes a detectable impairment in balance or in visuomotor coordination

Upper body accelerations as a biomarker of gait impairment in the early stages of Parkinson’s disease

Background Changes in upper body (UB) motion during gait may be a marker of incipient pathology, intervention response and disease progression in Parkinson’s disease (PD), which if independent from the lower body motion, might provide an improved assessment of gait. Research question This study aimed to test this hypothesis and establish whether variables calculated from accelerations measured on the UB are unique from spatiotemporal characteristics and can contribute to an improved classification of PD gait. Methods Data was obtained from 70 people with PD (69.2 ± 9.9 y.o., UPDRS III: 36.9 ± 12.3) and 64 age-matched controls (71.6 ± 6.8 y.o.). Spatiotemporal characteristics were measured using a pressure sensitive mat (GAITRite). Head and pelvis accelerations were synchronously measured with wearable inertial sensors (Opal, APDM). Pearson’s product-moment correlations were calculated between 49 selected variables from UB accelerations (representing magnitude, smoothness, regularity, symmetry and attenuation) and 16 traditional spatiotemporal characteristics (representing pace, variability, rhythm, asymmetry and postural control). Univariate and multivariate regression analysis was used to test the variables ability to classify PD gait. Results The variables were mostly unique from each other (67% of variables recorded an r < 0.3). Univariate and multivariate analysis showed that UB variables were moderately better at classifying PD gait than the spatiotemporal characteristics (Univariate: 0.70 to 0.81, Multivariate: 0.88 to 0.91 AUC). Significance This study showed for the first time that, if aiming at objective and optimal sensitive biomarkers for PD, UB variables should be measured in conjunction with spatiotemporal characteristics to obtain a more holistic assessment of PD gait for use in a clinical or free-living environment

Benchmark RGB-D Gait Datasets: A Systematic Review

Human motion analysis has proven to be a great source of information for a wide range of applications. Several approaches for a detailed and accurate motion analysis have been proposed in the literature, as well as an almost proportional number of dedicated datasets. The relatively recent arrival of depth sensors contributed to an increasing interest in this research area and also to the emergence of a new type of motion datasets. This work focuses on a systematic review of publicly available depth-based datasets, encompassing human gait data which is used for person recognition and/or classification purposes. We have conducted this systematic review using the Scopus database. The herein presented survey, which to the best of our knowledge is the first one dedicated to this type of datasets, is intended to inform and aid researchers on the selection of the most suitable datasets to develop, test and compare their algorithms. (c) Springer Nature Switzerland AG 2019

Sit-to-Stand Analysis in the Wild using Silhouettes for Longitudinal Health Monitoring

We present the first fully automated Sit-to-Stand or Stand-to-Sit (StS) analysis framework for long-term monitoring of patients in free-living environments using video silhouettes. Our method adopts a coarse-to-fine time localisation approach, where a deep learning classifier identifies possible StS sequences from silhouettes, and a smart peak detection stage provides fine localisation based on 3D bounding boxes. We tested our method on data from real homes of participants and monitored patients undergoing total hip or knee replacement. Our results show 94.4% overall accuracy in the coarse localisation and an error of 0.026 m/s in the speed of ascent measurement, highlighting important trends in the recuperation of patients who underwent surgery

Utilising the Intel RealSense camera for measuring health outcomes in clinical research

Applications utilising 3D Camera technologies for the measurement of health outcomes in the health and wellness sector continues to expand. The Intel® RealSense™ is one of the leading 3D depth sensing cameras currently available on the market and aligns itself for use in many applications, including robotics, automation, and medical systems. One of the most prominent areas is the production of interactive solutions for rehabilitation which includes gait analysis and facial tracking. Advancements in depth camera technology has resulted in a noticeable increase in the integration of these technologies into portable platforms, suggesting significant future potential for pervasive in-clinic and field based health assessment solutions. This paper reviews the Intel RealSense technology’s technical capabilities and discusses its application to clinical research and includes examples where the Intel RealSense camera range has been used for the measurement of health outcomes. This review supports the use of the technology to develop robust, objective movement and mobility-based endpoints to enable accurate tracking of the effects of treatment interventions in clinical trials

Aβ₄₂/Aβ₄₀ and Aβ₄₂/Aβ₃₈ Ratios Are Associated with Measures of Gait Variability and Activities of Daily Living in Mild Alzheimer’s Disease: A Pilot Study

Gait disturbances are some of the earliest changes in dementia and their monitoring presents an opportunity for early diagnosis. The exact relationship between gait and well-established biomarkers of Alzheimer’s disease (AD) remains to be clarified. In this study we compared gait-related measures with cerebrospinal fluid (CSF) markers of AD pathology. We recruited seventeen participants with mild AD in a multi-site study and performed gait assessment as well as lumbar punctures to obtain CSF. CSF Aβ₄₂/Aβ₄₀ and Aβ₄₂/Aβ₃₈ correlated positively with measures of variability (step time and step length) in the clinic-based assessments. This was driven by a negative relationship between gait variability and Aβ₄₀ and Aβ₃₈ but not Aβ₄₂. The amyloid ratios and gait variability measures were also associated with more severe functional impairment. We interpret these data as an indication that increasing amyloid production (i.e., increasing Aβ₄₀ and Aβ₃₈) is associated with diminishing cognitive-motor control of gait. These preliminary results suggest that the two amyloid ratios may be a marker of the earliest disturbances in the interplay between cognitive and motor control which characterize dementia