Reliability of Precision in Motion Software

Background: There is a current lack of affordable 3-D motion analysis systems available to physical therapists for documenting objective data. Objective: Compare data from inexpensive 3-D motion capture system using the Kinect, to the Codamotion, a traditional active marker, motion analysis system. Determine data reliability. Design: Reliability-method comparison study Methods: Seventeen subjects (9 females, 8 males) were instructed to walk down marked runway, arms across chest while both systems recorded data. Data was collected with Kinect on the same and opposite side as the Coda. Kinect and Coda data were interpolated and normalized for comparison. A program for heel strike detection was written in R for both systems, which determined stride length and stride time. Interclass correlation coefficients (ICC 3,1) were calculated for stride length, stride time, and joint angles for all subjects. Results: All stride length ICC ≥ 0.70 shows acceptable clinical reliability. One of four stride time ICC \u3c 0.70 for opposite leg step 1 likely due to occlusion of test leg by other leg during step. Joint value comparisons show high variability in reliability of Kinect software. Seventy-seven % of the same side knee data and fifteen % of the hip same side data from Kinect is clinically reliable. Limitations: Kinect and Coda use different skeletal models. Conclusions: Kinect software updates are needed to improved accuracy. Kinect system was significantly easier to use than Coda and may eventually be a cheaper alternative to traditional motion analysis systems that could be used by clinicians to monitor patient progress

Classifying Toe Walking Gait Patterns Among Children Diagnosed With Idiopathic Toe Walking Using Wearable Sensors and Machine Learning Algorithms

Idiopathic toe walking (ITW) is a gait abnormality in which children’s toes touch at initial contact and demonstrate limited or no heel contact throughout the gait cycle. Toe walking results in poor balance, increased risk of falling, and developmental delays among children. Identifying toe walking steps during walking can facilitate targeted intervention among children diagnosed with ITW. With recent advances in wearable sensing, communication technologies, and machine learning, new avenues of managing toe walking behavior among children are feasible. In this study, we investigate the capabilities of Machine Learning (ML) algorithms in identifying initial foot contact (heel strike versus toe strike) utilizing wearable body sensors. Thirty-six children (Age 9.4±2.8 years) diagnosed with ITW participated in this study. Six ML algorithms, consisting of Support Vector Machines (SVM), decision tree (DT), random forest (RF), K-nearest neighbors (KNN), Multi-layer Perceptron (MLP), and Gaussian process (GP), could successfully classify initial contact walking patterns among ITW. We found that a simple KNN algorithm resulted in the highest accuracy of 92.92% and an F1-score of 93.20% to differentiate toe walking gait versus best heel strike when using all four body sensors. We also found that toe walking resulted in higher variability in the sacral vertical accelerations among children diagnosed with ITW. Accurate quantification of toe walking steps in clinical applications is critical for assessing rehabilitation progress and designing new interventions for children diagnosed with ITW

Risk Factors Associated With Low Back Pain in Golfers: A Systematic Review and Meta-analysis

Context: Low back pain is common in golfers. The risk factors for golf-related low back pain are unclear but may include individual demographic, anthropometric, and practice factors as well as movement characteristics of the golf swing. Objective: The aims of this systematic review were to summarize and synthesize evidence for factors associated with low back pain in recreational and professional golfers. Data Sources: A systematic literature search was conducted using the PubMed, CINAHL, and SPORTDiscus electronic databases through September 2017. Study Selection: Studies were included if they quantified demographic, anthropometric, biomechanical, or practice variables in individuals with and without golf-related low back pain. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 3. Data Extraction: Studies were independently reviewed for inclusion by 2 authors, and the following data were extracted: characterization of low back pain, participant demographics, anthropometrics, biomechanics, strength/flexibility, and practice characteristics. The methodological quality of studies was appraised by 3 authors using a previously published checklist. Where possible, individual and pooled effect sizes of select variables of interest were calculated for differences between golfers with and without pain. Results: The search retrieved 73 articles, 19 of which met the inclusion criteria (12 case-control studies, 5 cross-sectional studies, and 2 prospective longitudinal studies). Methodological quality scores ranged from 12.5% to 100.0%. Pooled analyses demonstrated a significant association between increased age and body mass and golf-related low back pain in cross-sectional/case-control studies. Prospective data indicated that previous history of back pain predicts future episodes of pain. Conclusion: Individual demographic and anthropometric characteristics may be associated with low back pain, but this does not support a relationship between swing characteristics and the development of golf-related pain. Additional high-quality prospective studies are needed to clarify risk factors for back pain in golfers

Clinical Application and Feasibility of Utilizing the PEDI-CAT to Assess Activity and Participation Among Children Receiving Physical Therapy Incorporating Hippotherapy

Background Hippotherapy (HPOT) is a physical therapy (PT) treatment tool using equine movement to improve mobility for children with movement impairments. Although research suggests HPOT improves body structure and function, there is limited evidence regarding its impact on activity and participation outcomes in a clinical setting. The Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) may be useful in HPOT settings to highlight changes in activity and participation. Purpose 1) Evaluate the PEDI-CAT’s sensitivity to changes in activity and participation among children receiving PT using HPOT; 2) determine feasibility of administering the PEDI-CAT in a HPOT setting; and 3) examine how PEDI-CAT scores influence clinical decision-making. Methods Participants (N = 34) were children who attended weekly PT using HPOT for 6 months. The PEDI-CAT was completed for all participants by a parent or caregiver at initial treatment (T1) and 6 months later (T2). A linear mixed effects model was used to evaluate changes in scores over time. Team meetings occurred monthly to discuss how PEDI-CAT scores impacted treatment. Results There were significant improvements across 3 PEDI-CAT domains between T1 and T2 for all children with small effect sizes and nonsignificant changes noted within two diagnostic subgroups with small-to-medium effect sizes. The PEDI-CAT was completed by all participants without interrupting treatment flow. PEDI-CAT score reports enriched therapist-client conversations increasing shared decision-making. Conclusion PTs who treat children using HPOT may feasibly use the PEDI-CAT to assess changes in activity level outcomes and to assist clinical decision-making

Dense & Attention Convolutional Neural Networks for Toe Walking Recognition

Idiopathic toe walking (ITW) is a gait disorder where children’s initial contacts show limited or no heel touch during the gait cycle. Toe walking can lead to poor balance, increased risk of falling or tripping, leg pain, and stunted growth in children. Early detection and identification can facilitate targeted interventions for children diagnosed with ITW. This study proposes a new one-dimensional (1D) Dense & Attention convolutional network architecture, which is termed as the DANet, to detect idiopathic toe walking. The dense block is integrated into the network to maximize information transfer and avoid missed features. Further, the attention modules are incorporated into the network to highlight useful features while suppressing unwanted noises. Also, the Focal Loss function is enhanced to alleviate the imbalance sample issue. The proposed approach outperforms other methods and obtains a superior performance. It achieves a test recall of 88.91% for recognizing idiopathic toe walking on the local dataset collected from real-world experimental scenarios. To ensure the scalability and generalizability of the proposed approach, the algorithm is further validated through the publicly available datasets, and the proposed approach achieves an average precision, recall, and F1-Score of 89.34%, 91.50%, and 92.04%, respectively. Experimental results present a competitive performance and demonstrate the validity and feasibility of the proposed approach

Development of Fetal Movement Between 26 and 36 Weeks’ Gestation in Response to Vibroacoustic Stimulation

BACKGROUND: Ultrasound observation of fetal movement has documented general trends in motor development and fetal age when motor response to stimulation is observed. Evaluation of fetal movement quality, in addition to specific motor activity, may improve documentation of motor development and highlight specific motor responses to stimulation. AIM: The aim of this investigation was to assess fetal movement at 26 and 36-weeks gestation during three conditions (baseline, immediate response to vibro-acoustic stimulation (VAS), and post-response). DESIGN: A prospective, longitudinal design was utilized. SUBJECTS: Twelve normally developing fetuses, eight females and four males, were examined with continuous ultrasound imaging. OUTCOME MEASURES: The fetal neurobehavioral coding system (FENS) was used to evaluate the quality of motor activity during 10-s epochs over the three conditions. RESULTS: Seventy-five percent of the fetuses at the 26-week assessment and 100% of the fetuses at the 36-week assessment responded with movement immediately following stimulation. Significant differences in head, fetal breathing, general, limb, and mouthing movements were detected between the 26 and 36-week assessments. Movement differences between conditions were detected in head, fetal breathing, limb, and mouthing movements. CONCLUSION: Smoother and more complex movement was observed with fetal maturation. Following VAS stimulation, an immediate increase of large, jerky movements suggests instability in fetal capabilities. Fetal movement quality changes over gestation may reflect sensorimotor synaptogenesis in the central nervous system, while observation of immature movement patterns following VAS stimulation may reflect movement pattern instability

Foot Contact Dynamics and Fall Risk Among Children Diagnosed With Idiopathic Toe Walking

Children that are diagnosed with Idiopathic Toe walking (cITW) are characterized by persistent toe-to-toe contacts. The objective of this study was to explore whether typical foot contact dynamics during walking predisposes cITW to a higher risk of falling. Twenty cITW and age-matched controls performed typical and toe walking trials. The gait parameters related to foot contact dynamics, vertical force impulses during stance, slip, and trip risk were compared for both groups. We found that cITW manifest less stable gait and produced significantly higher force impulses during push-off. Additionally, we found that cITW had a higher slip-initiation risk that was associated with higher foot contact horizontal and vertical velocities in addition to lower transitional acceleration of center of mass. We found that cITW exhibited a higher trip risk with toe clearance being significantly lower when compared to healthy counterparts. This study allowed for a quantitative description of foot contact dynamics and delineated typical from toe walking among cITW. Overall, the results indicate that cITW are less stable during typical walking and are prone to a higher risk of slip and trip-like falls

Gastrocnemius-Soleus Muscle Tendon Unit Changes Over the First 12 Weeks of Adjusted Age in Infants Born Preterm

Background and Purpose: Differences in the gastrocnemius-soleus muscle and tendon have been documented shortly after birth in infants born preterm compared with infants born at term. Knowledge of muscle tendon unit lengths at term age to 12 weeks of age in infants born preterm may be useful in understanding motor development. Participants and Method: Gastrocnemius-soleus muscle tendon unit lengths were compared at term age, at 6 weeks of age, and at 12 weeks of age (preterm adjusted age) in 20 infants born full term and 22 infants born preterm. Results: Significant differences were found between the 2 groups on taut tendon, relaxed muscle length (AO); taut tendon, stretched muscle length (AMax); and muscle stretch (AO to AMax). Infants born preterm demonstrated measures of AO and AMax in positions of greater plantar flexion compared with infants born full term. Significant differences in measurements of AO were found between term age and 12 weeks of age, indicating that the tendon lengthens during this period for both groups. Discussion and Conclusion: These results provide knowledge of musculoskeletal development of the gastrocnemius-soleus muscle and tendon. Differences in musculoskeletal measurements are consistent with uterine confinement in the last weeks of full-term gestation. These findings have implications when examining the musculoskeletal system in infants born preterm who are demonstrating functional changes

Lifelong Fitness in Ambulatory Children and Adolescents with Cerebral Palsy I: Key Ingredients for Bone and Muscle Health

Physical activity of a sufficient amount and intensity is essential to health and the prevention of a sedentary lifestyle in all children as they transition into adolescence and adulthood. While fostering a fit lifestyle in all children can be challenging, it may be even more so for those with cerebral palsy (CP). Evidence suggests that bone and muscle health can improve with targeted exercise programs for children with CP. Yet, it is not clear how musculoskeletal improvements are sustained into adulthood. In this perspective, we introduce key ingredients and guidelines to promote bone and muscle health in ambulatory children with CP (GMFCS I–III), which could lay the foundation for sustained fitness and musculoskeletal health as they transition from childhood to adolescence and adulthood. First, one must consider crucial characteristics of the skeletal and muscular systems as well as key factors to augment bone and muscle integrity. Second, to build a better foundation, we must consider critical time periods and essential ingredients for programming. Finally, to foster the sustainability of a fit lifestyle, we must encourage commitment and self-initiated action while ensuring the attainment of skill acquisition and function. Thus, the overall objective of this perspective paper is to guide exercise programming and community implementation to truly alter lifelong fitness in persons with CP

R Project in the Clinic

Background. The R project is a free online statistical environment which allows users to import, analyze, and produce visual representations for data. R may be useful in a busy clinical environment to provide objective evidence of progress in physical therapy for clients and payers. Objectives. Demonstrate how R can efficiently document physical therapy outcomes to justify treatment to patients and third party payers. Case Description. Case 1: Functional Independence Measures, collected once a day for 48 days, were used in inpatient rehabilitation to track progress of bed mobility, transfers, wheelchair mobility, gait, and stairs. Case 2: Alberta Infant Motor Scale, independent sitting and quadruped time recorded biweekly for 8 weeks utilized to tracking gross motor development in a typically developing infant. Case 3: Knee passive range of motion and hop tests recorded once a week, while Landing Error Scoring System and Knee Outcome Survey scored every 6 weeks, to track a male for 6 months after an ACL reconstruction and meniscal repair. Outcomes. For each case, R was used to create graphs that visually illustrate progress of each individual. These graphs include stacked line and scatter line plots to show change over time. Limitations. Basic statistical knowledge is a suggested prerequisite, however R is convenient once the program is downloaded and foundation in R basics is established. Conclusions. R was successfully used to track patient progress in various types of Physical Therapy settings. R was helpful in visually demonstrating objective patient progress over time