Present and future of gait assessment in clinical practice: Towards the application of novel trends and technologies

BackgroundDespite being available for more than three decades, quantitative gait analysis remains largely associated with research institutions and not well leveraged in clinical settings. This is mostly due to the high cost/cumbersome equipment and complex protocols and data management/analysis associated with traditional gait labs, as well as the diverse training/experience and preference of clinical teams. Observational gait and qualitative scales continue to be predominantly used in clinics despite evidence of less efficacy of quantifying gait.Research objectiveThis study provides a scoping review of the status of clinical gait assessment, including shedding light on common gait pathologies, clinical parameters, indices, and scales. We also highlight novel state-of-the-art gait characterization and analysis approaches and the integration of commercially available wearable tools and technology and AI-driven computational platforms.MethodsA comprehensive literature search was conducted within PubMed, Web of Science, Medline, and ScienceDirect for all articles published until December 2021 using a set of keywords, including normal and pathological gait, gait parameters, gait assessment, gait analysis, wearable systems, inertial measurement units, accelerometer, gyroscope, magnetometer, insole sensors, electromyography sensors. Original articles that met the selection criteria were included.Results and significanceClinical gait analysis remains highly observational and is hence subjective and largely influenced by the observer's background and experience. Quantitative Instrumented gait analysis (IGA) has the capability of providing clinicians with accurate and reliable gait data for diagnosis and monitoring but is limited in clinical applicability mainly due to logistics. Rapidly emerging smart wearable technology, multi-modality, and sensor fusion approaches, as well as AI-driven computational platforms are increasingly commanding greater attention in gait assessment. These tools promise a paradigm shift in the quantification of gait in the clinic and beyond. On the other hand, standardization of clinical protocols and ensuring their feasibility to map the complex features of human gait and represent them meaningfully remain critical challenges

Predictive Modeling for Obesity and Overweight in Adolescents, Current Status and Application to the MENA Region

Obesity is a public health burden that impacts more than two billion people (30% of the world’s population) and approximately 340 million children and adolescents. Adolescent obesity has become a concern in most developing and developed countries, including Arab countries within the Middle East and North Africa (MENA) regions. These countries are at greater risk due to recent urbanization, westernization, and socioeconomic development that has led to changes in dietary habits, lifestyle, and rapid nutrition transition, especially in the second half of the twentieth century. Addressing childhood and adolescent obesity is considered central to tackling obesity. Recent systematic reviews of obesity prevalence among adolescents in the MENA are scarce and old. This chapter highlights the multifactorial aspects of adolescent and childhood obesity and the associated prediction models within the MENA region. It also proposes an obesity prediction model based on a list of potential risk factors for suitable future implementation and validation. The search engines Google Scholar, Scopus, Web of Science, and PubMed were used to retrieve literature about adolescent obesity and predictive algorithms/ models between the years 2015 and 2020 in MENA adolescent populations and propose a list of potential predictors/risk factors for suitable future implementation and validation. The results demonstrated the lack of accurate population-based predictive algorithms for obesity for this target group. Based on a holistic approach of integrating relevant main risk factors, we proposed an obesity predictive model that could be valuable for informing policy-makers in the region and helping them set up effective national and regional surveillance systems

An insight into the paradigms of osteoporosis: From genetics to biomechanics

© 2019 The Authors Considered as one of the major epidemics of the 21st century, osteoporosis affects approximately 200 million people globally, with significant worldwide impact on rates of morbidity and mortality and massive socioeconomic burdens. Mainly characterized by decreased bone mineral density (BMD) and increased risk of bone fragility/deterioration, this devastating silent epidemic typically has no symptoms until a fracture occurs. The multifactorial disease, osteoporosis is instigated by complex interactions between genetic, metabolic and environmental factors, with severe impact on the biomechanics of the musculoskeletal system. This article provides a review of the epidemiology, genetic and biomechanical aspects of primary osteoporosis. The review begins with a summary of the epidemiology and global prevalence of osteoporosis. Sections 1 and 2 discuss the genetic associations and molecular signaling pathways involved in normal and pathological osteogenesis while Section 3 explores the biomechanics of osteoporosis and its quantitative damaging effects on critical bone mechanical properties, and associated bone remodeling. Overall, this review summarizes the recent findings about osteoporosis and emphasizes the importance of an integrative holistic approach in investigating osteoporosis towards providing better informed, more effective preventive and treatment modalities. Importantly, this work also explores the limited available literature on the various aspects of osteoporosis in the United Arab Emirates (UAE), Gulf Cooperation Council (GCC), and Middle East despite its alarming prevalence in the region, and highlights the need for further research and studies taking into consideration the importance of the vitamin D receptor (VDR) gene influencing the development of osteoporosis

Effects of Kinesiology Tape on Non-linear Center of Mass Dispersion During the Y Balance Test

Static taping of the ankle or knee joint is a common method of reducing risk of injury by providing mechanical stability. An alternative taping technique employs kinesiology tape, which has the additional benefit of improving functionality by stimulating proprioception. There is substantial disagreement whether kinesiology tape shows significant differences in proprioception and postural stability as compared to rigid/static tape when applied at the lower limb. The current study investigated the effects of kinesiology tape and static tape during a Y Balance Test on center of mass as an indicator for postural stability. Forty-one individuals, free of injury, performed the Y Balance Test under the three conditions; no tape, kinesiology tape, and static tape applied at the lower limb to the quadriceps, triceps surae and ankle joint. All participants completed the Y Balance Test to determine whether any significant differences could be observed using center of mass movement as a surrogate measure for balance and proprioception. The Minkowski-Bouligand and box-counting fractal dimension analyses were used as measures of the dynamic changes in the center of mass whilst undertaking the Y Balance Test. Statistical analyses included the Kruskal Wallis test to allow for non-normally distributed data and a Bonferroni corrected pairwise T-test as a post hoc test to ascertain pairwise differences between the three taping conditions. Significance was set at 0.05. The fractal analyses of the dynamic changes in center of mass showed significant differences between the control and both the static tape and kinesiology tape groups (p = 0.021 and 0.009, respectively). The current study developed a novel measure of dynamic changes in the center of mass during a set movement that indicated real-time processing effects during a balance task associated with the type of taping used to enhance postural stability

Genetics of diabetic kidney disease: A follow-up study in the Arab population of the United Arab Emirates

Background: Two genome-wide association studies in European and Japanese populations reported on new loci for diabetic kidney disease (DKD), including FTO. In this study, we have replicated these investigations on a cohort of 410 Type 2 diabetes mellitus (T2DM) patients of Arab origin from the United Arab Emirates (UAE). Methods and Results: The cohort included 145 diabetic patients diagnosed with DKD and 265 diabetics free of the disease. In general, we were able to confirm the association between the FTO locus and DKD, as reported in the Japanese population. Specifically, there were significant associations with two single nucleotide polymorphisms (SNPs), namely rs1421086 (p =.013, OR = 1.52 depending on allele G, 95% CI: 1.09–2.11) and rs17817449 (p =.0088, OR = 1.55 depending on allele C, 95% CI: 1.12–2.14) of the FTO locus. Both SNPs were in linkage disequilibrium with rs56094641, also as reported in the Japanese population. While the alleles of both SNPs, which increase the risk of DKD, were associated with higher Body Mass Index (BMI), their associations with DKD were independent of the BMI effects. Conclusions: This study confirms that FTO is a multiethnic locus for DKD which is independent from any influence of BMI and/or obesity

Clinical and genetic associations of renal function and diabetic kidney disease in the United Arab Emirates: A cross-sectional study

OBJECTIVES: Within the Emirati population, risk factors and genetic predisposition to diabetic kidney disease (DKD) have not yet been investigated. The aim of this research was to determine potential clinical, laboratory and reported genetic loci as risk factors for DKD. RESEARCH DESIGN AND METHODS: Four hundred and ninety unrelated Emirati nationals with type 2 diabetes mellitus (T2DM) were recruited with and without DKD, and clinical and laboratory data were obtained. Following adjustments for possible confounders, a logistic regression model was developed to test the associations of 63 single nucleotide polymorphisms (SNPs) in 43 genetic loci with DKD (145 patients with DKD and 265 without DKD). Linear regression models, adjusted for age and gender, were then used to study the genetic associations of five renal function traits, including 83 SNPs with albumin-to-creatinine ratio, 92 SNPs with vitamin D (25-OH cholecalciferol), 288 SNPs with estimated glomerular filtration rate (eGFR), 363 SNPs with serum creatinine and 73 SNPs with blood urea. RESULTS: Patients with DKD, as compared with those without the disease, were mostly men (52%vs38% for controls), older (67vs59 years) and had significant rates of hypertension and dyslipidaemia. Furthermore, patients with DKD had T2DM for a longer duration of time (16vs10 years), which in an additive manner was the single factor that significantly contributed to the development of DKD (p=0.02, OR=3.12, 95% CI 1.21 to 8.02). Among the replicated associations of the genetic loci with different renal function traits, the most notable included CONCLUSIONS: Associations were found between several genetic loci and risk markers for DKD, which may influence kidney function traits and DKD in a population of Arab ancestry

Automated Spatial Pattern Analysis for Identification of Foot Arch Height From 2D Foot Prints

Arch height is an important determinant for the risk of foot pathology, especially in an aging population. Current methods for analyzing footprints require substantial manual processing time. The current research investigated automated determination of foot type based on features derived from the Gabor wavelet utilizing digitized footprints to allow timely assessment of foot type and focused intervention. Two hundred and eighty footprints were collected, and area, perimeter, curvature, circularity, 2nd wavelet moment, mean bending energy (MBE), and entropy were determined using in house developed MATLAB codes. The results were compared to the gold standard using Spearman’s Correlation coefficient and multiple linear regression models with significance set at 0.05. The proposed approach found MBE combined with foot perimeter to give the best results as shown by ANOVA (F(2,211) = 10.18, p < 0.0001) with the mean ±SD of low, normal, and high arch being, respectively, 0.26 ± 0.025,.24 ± 0.021, and 0.23 ± 0.024. A clinical review of the new cut off values, as set by the first and the third quartiles of our sample, lead to reliability up to 87%. Our results suggest that automated wavelet-based foot type classification of 2D binary images of the plantar surface of the foot is comparable to current state-of-the-art methods providing a cost and time effective tool suitable for clinical diagnostics

Design of a novel passive Binary-Controlled Variable Stiffness Joint (BpVSJ) towards passive haptic interface application

In this paper we present the design, development and experimental validation of a novel Binary-Controlled Variable Stiffness Joint (BpVSJ) towards haptic teleoperation and human interaction manipulators applications. The proposed actuator is a proof of concept of a passive revolute joint, where the working principle is based on the recruitment of series-parallel elastic elements. The novelty of the system lies in its design topology, including the capability to involve an (n) number of series-parallel elastic elements to achieve (2n) levels of stiffness, as compared to current approaches. Accordingly, the level of stiffness can be altered at any position without the need to revert to the initial equilibrium position. The BpVSJ has low energy consumption and short switching time, and is able to rotate freely at zero stiffness without limitations. Further smart features include scalability and relative compactness. This paper details the mathematical stiffness modeling of the proposed actuator mechanism, as well as the experimentally measured performance characteristics. The experimental results matched well with the physical-based modeling in terms of stiffness variation levels. Moreover, Psychophysical experiments were also conducted using (20) healthy subjects in order to evaluate the capability of the BpVSJ to display three different levels of stiffness that are cognitively realized by the users. The participants performed two tasks: a relative cognitive task and an absolute cognitive task. The results show that the BpVSJ is capable of rendering stiffness with high average relative accuracy (Relative Cognitive Task relative accuracy is 97.3%, and Absolute Cognitive Task relative accuracy is 83%)

Distinction of non-specific low back pain patients with proprioceptive disorders from healthy individuals by linear discriminant analysis

The central nervous system (CNS) dynamically employs a sophisticated weighting strategy of sensory input, including vision, vestibular and proprioception signals, towards attaining optimal postural control during different conditions. Non-specific low back pain (NSLBP) patients frequently demonstrate postural control deficiencies which are generally attributed to challenges in proprioceptive reweighting, where they often rely on an ankle strategy regardless of postural conditions. Such impairment could lead to potential loss of balance, increased risk of falling, and Low back pain recurrence. In this study, linear and non-linear indicators were extracted from center-of-pressure (COP) and trunk sagittal angle data based on 4 conditions of vibration positioning (vibration on the back, ankle, none or both), 2 surface conditions (foam or rigid), and 2 different groups (healthy and non-specific low back pain patients). Linear discriminant analysis (LDA) was performed on linear and non-linear indicators to identify the best sensory condition towards accurate distinction of non-specific low back pain patients from healthy controls. Two indicators: Phase Plane Portrait ML and Entropy ML with foam surface condition and both ankle and back vibration on, were able to completely differentiate the non-specific low back pain groups. The proposed methodology can help clinicians quantitatively assess the sensory status of non-specific low back pain patients at the initial phase of diagnosis and throughout treatment. Although the results demonstrated the potential effectiveness of our approach in Low back pain patient distinction, a larger and more diverse population is required for comprehensive validation

Genetic Associations With Diabetic Retinopathy and Coronary Artery Disease in Emirati Patients With Type-2 Diabetes Mellitus

Aim: Type 2 Diabetes Mellitus (T2DM) is associated with both microvascular complications such as diabetic retinopathy (DR), and macrovascular complications like coronary artery disease (CAD). Genetic risk factors have a role in the development of these complications. In the present case-control study, we investigated genetic variations associated with DR and CAD in T2DM patients from the United Arab Emirates.Methods: A total of 407 Emirati patients with T2DM were recruited. Categorization of the study population was performed based on the presence or absence of DR and CAD. Seventeen Single Nucleotide Polymorphisms (SNPs), were selected for association analyses through search of publicly available databases, namely GWAS catalog, infinome genome interpretation platform and GWAS Central database. A multivariate logistic regression test was performed to evaluate the association between the 17 SNPs and DR, CAD, or both. To account for multiple testing, significance was set at p < 0.00294 using the Bonferroni correction.Results: The SNPs rs9362054 near the CEP162 gene and rs4462262 near the UBE2D1 gene were associated with DR (OR = 1.66, p = 0.001; OR = 1.37, p = 0.031; respectively), and rs12219125 near the PLXDC2 gene was associated (suggestive) with CAD (OR = 2.26, p = 0.034). Furthermore, rs9362054 near the CEP162 gene was significantly associated with both complications (OR = 2.27, p = 0.0021). The susceptibility genes for CAD (PLXDC2) and DR (UBE2D1) have a role in angiogenesis and neovascularization. Moreover, association between the ciliary gene CEP162 and DR was established in terms of retinal neural processing, confirming previous reports.Conclusions: The present study reports associations of different genetic loci with DR and CAD. We report new associations between CAD and PLXDC2, and DR with UBE2D1 using data from T2DM Emirati patients