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Clinics (Sao Paulo, Brazil) May 2024An accurate assessment of balance problems is critical for decreasing the risk of falling in patients with Parkinson's Disease (PD). Reliable diagnostic tools such as...
INTRODUCTION
An accurate assessment of balance problems is critical for decreasing the risk of falling in patients with Parkinson's Disease (PD). Reliable diagnostic tools such as Computerized Dynamic Posturography (CDP) are not feasible for the clinical setting. Therefore, the present study's aim was to assess the correlation between the clinical Balance Evaluation Systems Test (BESTest) and CDP.
METHODS
20 male older adults with Parkinson's Disease (PD) were included in this study. Participants first executed the Sit-To-Stand (STS), Step/Quick turn (SQT), and Step Up and Over (SUO) tests on a Balance Master® force platform, followed by a clinical balance evaluation using the BESTest.
RESULTS
Four outcomes of the CDP were negatively correlated with one or more BESTest domains or total BESTest score: STS sway velocity was negatively correlated with the anticipatory postural adjustment (p = 0.02) and sensory orientation (p = 0.01) domains. SQT turn time was negatively correlated with biomechanical restriction (for turns to the left, p = 0.01, and right, p = 0.03, respectively), postural response (p = 0.01, p = 0.01), dynamic balance during gait (p = 0.007, p = 0.001), and total score (p = 0.02, p = 0.01). Step over time to the right in SUP was negatively correlated with the limits of the stability domain (p = 0.002) and total BESTest score (p = 0.020). SUO impact index was negatively correlated with the anticipatory postural adjustment domain (p = 0.01).
CONCLUSION
This study shows that several BESTest domains are significantly correlated with CDP outcomes, demonstrating that the BESTest can be used as a more clinically feasible alternative for computerized posturography, without loss of information.
PubMed: 38759438
DOI: 10.1016/j.clinsp.2024.100382 -
PloS One 2024The global number of people with diabetes is estimated to reach 643 million by 2030 of whom 19-34% will present with diabetic foot ulceration. Insoles which offload...
The effect of calcaneus and metatarsal head offloading insoles on healthy subjects' gait kinematics, kinetics, asymmetry, and the implications for plantar pressure management: A pilot study.
BACKGROUND
The global number of people with diabetes is estimated to reach 643 million by 2030 of whom 19-34% will present with diabetic foot ulceration. Insoles which offload high-risk ulcerative regions on the foot, by removing insole material, are the main contemporary conservative treatment to maintain mobility and reduce the likelihood of ulceration. However, their effect on the rest of the foot and relationship with key gait propulsive and balance kinematics and kinetics has not been well researched.
PURPOSE
The aim of this study is to investigate the effect of offloading insoles on gait kinematics, kinetics, and plantar pressure throughout the gait cycle.
METHODS
10 healthy subjects were recruited for this experiment to walk in 6 different insole conditions. Subjects walked at three speeds on a treadmill for 10 minutes while both plantar pressure and gait kinematics, kinetics were measured using an in-shoe pressure measurement insole and motion capture system/force plates. Average peak plantar pressure, pressure time integrals, gait kinematics and centre of force were analysed.
RESULTS
The average peak plantar pressure and pressure time integrals changed by -30% (-68% to 3%) and -36% (-75% to -1%) at the region of interest when applying offloading insoles, whereas the heel strike and toe-off velocity changed by 15% (-6% to 32%) and 12% (-2% to 19%) whilst walking at three speeds.
CONCLUSION
The study found that offloading insoles reduced plantar pressure in the region of interest with loading transferred to surrounding regions increasing the risk of higher pressure time integrals in these locations. Heel strike and toe-off velocities were increased under certain configurations of offloading insoles which may explain the higher plantar pressures and supporting the potential of integrating kinematic gait variables within a more optimal therapeutic approach. However, there was inter-individual variability in responses for all variables measured supporting individualised prescription.
Topics: Humans; Gait; Biomechanical Phenomena; Pilot Projects; Male; Pressure; Female; Adult; Foot Orthoses; Calcaneus; Healthy Volunteers; Shoes; Kinetics; Walking; Metatarsus; Foot
PubMed: 38758937
DOI: 10.1371/journal.pone.0303826 -
PloS One 2024The practice of female genital mutilation is associated with harmful social norms promoting violence against girls and women. Various studies have been conducted to...
BACKGROUND
The practice of female genital mutilation is associated with harmful social norms promoting violence against girls and women. Various studies have been conducted to examine the prevalence of female genital mutilation and its associated factors. However, there has been limited studies conducted to assess the association between female genital mutilation and markers of women's autonomy, such as their ability to negotiate for safer sex. In this study, we examined the association between female genital mutilation and women's ability to negotiate for safer sex in sub-Saharan Africa (SSA).
METHODS
We pooled data from the most recent Demographic and Health Surveys (DHS) conducted from 2010 to 2020. Data from a sample of 50,337 currently married and cohabiting women from eleven sub-Saharan African countries were included in the study. A multilevel binary logistic regression analysis was used to examine the association between female genital mutilation and women's ability to refuse sex and ask their partners to use condom. Adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings of the logistic regression analysis. Statistical significance was set at p<0.05.
RESULTS
Female genital mutilation was performed on 56.1% of women included in our study. The highest and lowest prevalence of female genital mutilation were found among women from Guinea (96.3%) and Togo (6.9%), respectively. We found that women who had undergone female genital mutilation were less likely to refuse sex from their partners (aOR = 0.91, 95% CI = 0.86, 0.96) and ask their partners to use condoms (aOR = 0.82, 95% CI = 0.78, 0.86) compared to those who had not undergone female genital mutilation.
CONCLUSION
Female genital mutilation hinders women's ability to negotiate for safer sex. It is necessary to implement health education and promotion interventions (e.g., decision making skills) that assist women who have experienced female genital mutilation to negotiate for safer sex. These interventions are crucial to enhance sexual health outcomes for these women. Further, strict enforcement of policies and laws aimed at eradicating the practice of female genital mutilation are encouraged to help contribute to the improvement of women's reproductive health.
Topics: Humans; Female; Circumcision, Female; Africa South of the Sahara; Adult; Safe Sex; Young Adult; Adolescent; Middle Aged; Health Surveys; Negotiating; Sexual Partners; Condoms
PubMed: 38758930
DOI: 10.1371/journal.pone.0299034 -
PloS One 2024Walking on sloped surfaces is challenging for many lower limb prosthesis users, in part due to the limited ankle range of motion provided by typical prosthetic...
Walking on sloped surfaces is challenging for many lower limb prosthesis users, in part due to the limited ankle range of motion provided by typical prosthetic ankle-foot devices. Adding a toe joint could potentially benefit users by providing an additional degree of flexibility to adapt to sloped surfaces, but this remains untested. The objective of this study was to characterize the effect of a prosthesis with an articulating toe joint on the preferences and gait biomechanics of individuals with unilateral below-knee limb loss walking on slopes. Nine active prosthesis users walked on an instrumented treadmill at a +5° incline and -5° decline while wearing an experimental foot prosthesis in two configurations: a Flexible toe joint and a Locked-out toe joint. Three participants preferred the Flexible toe joint over the Locked-out toe joint for incline and decline walking. Eight of nine participants went on to participate in a biomechanical data collection. The Flexible toe joint decreased prosthesis Push-off work by 2 Joules during both incline (p = 0.008; g = -0.63) and decline (p = 0.008; g = -0.65) walking. During incline walking, prosthetic limb knee flexion at toe-off was 3° greater in the Flexible configuration compared to the Locked (p = 0.008; g = 0.42). Overall, these results indicate that adding a toe joint to a passive foot prosthesis has relatively small effects on joint kinematics and kinetics during sloped walking. This study is part of a larger body of work that also assessed the impact of a prosthetic toe joint for level and uneven terrain walking and stair ascent/descent. Collectively, toe joints do not appear to substantially or consistently alter lower limb mechanics for active unilateral below-knee prosthesis users. Our findings also demonstrate that user preference for passive prosthetic technology may be both subject-specific and task-specific. Future work could investigate the inter-individual preferences and potential benefits of a prosthetic toe joint for lower-mobility individuals.
Topics: Humans; Biomechanical Phenomena; Walking; Male; Artificial Limbs; Female; Middle Aged; Gait; Adult; Range of Motion, Articular; Toe Joint; Prosthesis Design; Foot; Aged
PubMed: 38758923
DOI: 10.1371/journal.pone.0295465 -
PloS One 2024The implantation of uncemented prostheses requires the application of sufficient forces to achieve a press-fit of the implant in the bone. Excessive forces have to be...
The implantation of uncemented prostheses requires the application of sufficient forces to achieve a press-fit of the implant in the bone. Excessive forces have to be omitted to limit bone damage. Force measurements along the force transmission path between mallet and implant are frequently used to investigate this trade-off. Placing a load cell at a position of interest (PoI), which might be the implant bone interface or the head taper junction, is technically challenging or even impossible so that nearby positions are chosen. Thus, a certain inertia and stiffness remain between the PoI and the sensor, and consequently the measured dynamic forces differ from those at the PoI. This experimental and numerical study aimed to investigate the amount of force reduction along the transmission path while joining femoral heads to stem tapers. Forces were measured in vitro at the tip of the mallet, directly above the polymer tip of the impactor and below the stem taper. Springs and masses were used to represent the responding tissue of a patient. A semi-empirical numerical model of the force transmission path was developed and validated in order to simulate a larger range of responding tissue properties than experimentally possible and to investigate the influence of different surgical instruments. A distinct attenuation was observed since the peak forces at the impactor reached 35% of the applied peak forces and 21% at the stem taper, respectively. The force curves were replicated with a median root mean square error of 3.8% of the corresponding mallet blow for the impactor and 3.6% for the stem. The force measurement position and the used surgical instruments have a strong influence on the measured forces. Consequently, the exact measurement conditions with regard to sensor positioning and used surgical instruments have to be specified and hence only studies with similar setups should be compared to avoid misestimation of the forces at the PoI. The proposed dynamic numerical model is a useful tool to calculate the impact of the chosen or changed mechanical parameters prior to executing experiments and also to extrapolate the effect of changing the applied forces to the resulting forces at the PoI.
Topics: Humans; Hip Prosthesis; Stress, Mechanical; Biomechanical Phenomena; Femur Head; Models, Theoretical
PubMed: 38758920
DOI: 10.1371/journal.pone.0303682 -
Medicine May 2024The aim of this study was to compare the biomechanical performance of pedicle screw construction and locking compression plate fixation in posterior pelvic ring injuries...
BACKGROUND
The aim of this study was to compare the biomechanical performance of pedicle screw construction and locking compression plate fixation in posterior pelvic ring injuries analyzed by finite element method.
METHODS
A 3-dimensional finite element model of the spine-pelvis-femur complex with ligaments was reconstructed from computed tomography images. An unstable posterior pelvic ring injury was created, which was fixed with a pedicle screw construction or locking compression plate. A follower load of 400 N was applied to the upper surface of the vertebrae to simulate the upper body weight, while the ends of the proximal femurs were fixed. The construct stiffness, the maximum vertical displacement, the maximum posterior displacement, the maximum right displacement, and the overall maximum displacement of the sacrum, and stress distributions of the implants and pelvises were assessed.
RESULTS
The construct stiffness of the pedicle screw model (435.14 N/mm) was 2 times that of the plate model (217.01 N/mm). The maximum vertical displacement, the maximum posterior displacement, the maximum right displacement, and the overall maximum displacement of the sacrum in the pedicle screw model were smaller than those in the plate model (0.919, 1.299, 0.259, and 1.413 mm in the pedicle screw model, and 1.843, 2.300, 1.053, and 2.895 mm in the plate model, respectively). The peak stresses of the implant and pelvis in the pedicle screw model decreased by 80.4% and 25% when compared with the plate model (44.57 and 34.48 MPa in the pedicle screw model, and 227.47 and 45.97 MPa in the plate model, respectively).
CONCLUSION
The study suggested that the pedicle screw construction could provide better fixation stability than the locking compression plate and serves as the recommended fixation method for the treatment of posterior pelvic ring injuries.
Topics: Bone Plates; Humans; Finite Element Analysis; Pelvic Bones; Pedicle Screws; Biomechanical Phenomena; Fracture Fixation, Internal; Tomography, X-Ray Computed; Fractures, Bone
PubMed: 38758846
DOI: 10.1097/MD.0000000000038258 -
Bioinformatics and Biology Insights 2024Gait analysis serves as a critical diagnostic tool for identifying neurologic and musculoskeletal damage. Traditional manual analysis of motion data, however, is...
Gait analysis serves as a critical diagnostic tool for identifying neurologic and musculoskeletal damage. Traditional manual analysis of motion data, however, is labor-intensive and heavily reliant on the expertise and judgment of the therapist. This study introduces a binary classification method for the quantitative assessment of gait impairments, specifically focusing on Duchenne muscular dystrophy (DMD), a prevalent and fatal neuromuscular genetic disorder. The research compares spatiotemporal and sagittal kinematic gait features derived from 2D and 3D human pose estimation trajectories against concurrently recorded 3D motion capture (MoCap) data from healthy children. The proposed model leverages a novel benchmark dataset, collected from YouTube and publicly available datasets of their typically developed peers, to extract time-distance variables (e.g. speed, step length, stride time, and cadence) and sagittal joint angles of the lower extremity (e.g. hip, knee, and knee flexion angles). Machine learning and deep learning techniques are employed to discern patterns that can identify children exhibiting DMD gait disturbances. While the current model is capable of distinguishing between healthy subjects and those with DMD, it does not specifically differentiate between DMD patients and patients with other gait impairments. Experimental results validate the efficacy of our cost-effective method, which relies on recorded RGB video, in detecting gait abnormalities, achieving a prediction accuracy of 96.2% for Support Vector Machine (SVM) and 97% for the deep network.
PubMed: 38757143
DOI: 10.1177/11779322241231108 -
Heliyon May 2024This study aimed to explore the test-retest reliability of fNIRS in measuring frontal and parietal cortices activation during straight walking and turning walking in...
PURPOSE
This study aimed to explore the test-retest reliability of fNIRS in measuring frontal and parietal cortices activation during straight walking and turning walking in older adults, in order to provide a theoretical foundation for selecting assessment tools for clinical research on motor control and some diseases such as Parkinson's disease in older adults.
METHODS
18 healthy older participants (69.1 ± 0.7 years) were included in this study. The participants completed straight walking and figure-of-eight turning walking tasks at self-selected speeds. Intra-class correlation coefficients (ICCs) and Bland-Altman scatter plots were used to assess the test-retest reliability of oxyhemoglobin (HbO) changes derived from fNIRS. p < 0.05 was considered statistically significant.
RESULTS
The test-retest reliability of HbO in prefrontal cortex (ICC, 0.67-0.78) was good and excellent, in frontal motor cortex (ICC, 0.51-0.61) and parietal sensory cortex (ICC, 0.53-0.62) is fair and good when the older adults performed straight and turning walking tasks. Bland-Altman diagram shows that the data consistency is fair and good.
CONCLUSION
fNIRS can be used as a clinical measurement method to evaluate the brain activation of the older adults when walking in a straight line and turning, and the results are acceptable repeatability and consistency. However, it is necessary to strictly control the testing process and consider the possible changes in the repeated measurements.
PubMed: 38756562
DOI: 10.1016/j.heliyon.2024.e30197 -
Frontiers in Bioengineering and... 2024Articular cartilage injuries present a significant global challenge, particularly in the aging population. These injuries not only restrict movement due to primary... (Review)
Review
Strategies in product engineering of mesenchymal stem cell-derived exosomes: unveiling the mechanisms underpinning the promotive effects of mesenchymal stem cell-derived exosomes.
Articular cartilage injuries present a significant global challenge, particularly in the aging population. These injuries not only restrict movement due to primary damage but also exacerbate elderly degenerative lesions, leading to secondary cartilage injury and osteoarthritis. Addressing osteoarthritis and cartilage damage involves overcoming several technical challenges in biological treatment. The use of induced mesenchymal stem cells (iMSCs) with functional gene modifications emerges as a solution, providing a more stable and controllable source of Mesenchymal Stem Cells (MSCs) with reduced heterogeneity. Furthermore, In addition, this review encompasses strategies aimed at enhancing exosome efficacy, comprising the cultivation of MSCs in three-dimensional matrices, augmentation of functional constituents within MSC-derived exosomes, and modification of their surface characteristics. Finally, we delve into the mechanisms through which MSC-exosomes, sourced from diverse tissues, thwart osteoarthritis (OA) progression and facilitate cartilage repair. This review lays a foundational framework for engineering iMSC-exosomes treatment of patients suffering from osteoarthritis and articular cartilage injuries, highlighting cutting-edge research and potential therapeutic pathways.
PubMed: 38756412
DOI: 10.3389/fbioe.2024.1363780 -
Scientific Reports May 2024This technique-focused observational study explores the impact of a 6-week Nordic Walking (NW) program on physiological and biomechanical aspects in ischemic heart... (Observational Study)
Observational Study
This technique-focused observational study explores the impact of a 6-week Nordic Walking (NW) program on physiological and biomechanical aspects in ischemic heart disease (IHD) patients. Twelve male IHD patients (66.2 ± 5.2 years, 12.2 ± 7.5 years of disease duration) were evaluated pre- and post-training for (i) gait parameters, (ii) exercise tolerance using electrocardiographic (ECG) stress test, (iii) a 6-min walk test (6MWT). The NW training, adhering to IHD patient guidelines, involved a 100-m walk at a self-selected, preferred speed without sticks, with classic NW sticks and mechatronic sticks. A mechatronic measuring system, specifically engineered for measuring, diagnosing and monitoring the patient's gait, was integrated into mechatronic sticks. Post-training, significant enhancements were observed in ECG stress test duration, metabolic equivalency, and 6MWT distance, irrespective of the stick type. However, no significant changes were noted in spatiotemporal parameters concerning the measured side, stick utilisation, or type. The results suggest that NW training boosts exercise capacity and refines gait mechanics in male IHD patients. However, the improvement in exercise capacity was not linked to changes in gait mechanics from NW training but rather to the movement during NW gait. Hence, the key to enhancing exercise capacity in IHD patients is the movement during NW gait, not the quality of gait mechanics.
Topics: Humans; Male; Myocardial Ischemia; Gait; Aged; Walking; Exercise Tolerance; Middle Aged; Exercise Therapy; Electrocardiography; Walk Test; Exercise Test
PubMed: 38755348
DOI: 10.1038/s41598-024-62109-9