Dr Patrick Esser

Objective: It is still unclear how the abnormal foot sensation influences the gait during walking in type 2 diabetes mellitus (T2DM). For the purpose of gaining a better insight into the alterations of detailed gait parameters and figuring out the important aspect in the gait indexes by peripheral neuropathy in elder T2DM patients, we compared the gait features in participants with normal glucose tolerance (NGT) controls, as well as diabetic individuals complicated with and without peripheral neuropathy.
Subjects and Methods: Gait parameters was observed during the 10-m walk on the flat land among different conditions of diabetes in 1741 participants from three clinical centers. Subjects were divided into 4 groups: persons with NGT were taken as control groups, patients with T2DM including 3 subgroups: DM control (no chronic complications), DM-DPN (DM complicated only with peripheral neuropathy), and DM-DPN+LEAD (DM complicated with both neuropathy and artery disease). The clinical characteristics
and gait parameters were assessed and compared among these four groups. Analyses of variance were employed to verify possible differences of gait parameters between groups and conditions. Stepwise multivariate regression analysis was performed to reveal possible predictors of gait deficits. ROC curve analysis was employed to find any discriminatory power of DPN for the step time.
Results: In participants burdened with DPN, whether complicated with LEAD or not, step time increased sharply (pAUC value was 0.608 (95% CI: 0.562-0.654, p Conclusions: In addition to sex, age and leg length, VPT was a distinct factors that associated with altered gait parameters. Diabetic peripheral neuropathy is associated with increased step time and the step time increases with the worse VPT in type 2 diabetes.

Background: Developmental coordination disorder affects approximately 6% of children, interfering with participation in physical activity and can persist through adulthood. However, no studies have investigated the neuromotor mechanisms of learning of a novel task with rhythmic cueing.

Methods: Movement Assessment Battery for Children-2nd edition was used to identify 48 children with probable developmental coordination disorder (13.9±0.05 yrs, 27% male) and 37 typically developed (13.9±0.10 yrs, 54% male). While instrumented with an inertial measurement unit, both groups performed a novel rhythmic stepping task and with a concurrent auditory stroop test (dual-task), underwent seven weeks of intervention with step training with rhythmic cuing and were tested for retention five weeks post-intervention.

Findings: Initially, the group with probable developmental coordination disorder had a higher variability of step timing (coefficient of variation: 0.08±0.003-typically developed – 0.09±0.004-probable developmental coordination disorder, ppppppp

Interpretation: Rhythmic cueing shows strong promise for enhancing motor learning in children with probable developmental coordination disorder.

Trial registration: Retrospectively registered on ClinicalTrials.gov with reference: NCT03150784

Keywords: Developmental Coordination Disorder, stepping, motor learning, intervention, rhythmic cueing.

Managing the health and wellbeing of full-time professional athletes is a multifaceted task. In elite high-performance environments, medical staff and strength training coaches attempt to identify improved methods to monitor player health. Monitoring player health could indicate potential injury risk and assist in adjustments to training and workload management. Measuring fatigue is a notable component of monitoring player readiness before and after training sessions, and after competitive fixtures.

In the present study, a novel method of gathering non-invasive player data was investigated by utilising the Omegawave (OW) to monitor direct current (DC) potential brainwave activity. This method allowed for non-invasive data gathering to assess recovery, player readiness and indicators of workload that may affect optimal performance. DC potential is based on recording low electrical frequencies (>0.5 Hz) that is derived from 1) Stabilization point of DC potential (mV), 2) Stabilization time (1.0‐7.0) and 3) Curve shape (1.0‐7.0). These measures evaluate the athlete’s internal stress, readiness to perform, and neurological function through DC potential brain wave activity and heart rate variability (HRV) assessments. The primary aim of this case series was to compare the efficacy of objective DC potential brainwave activity measurements (neurological function) with neuromuscular fatigue data using reactive strength index modified (RSImod) and profile of mood states (POMS) questionnaires to assess a player’s state of readiness to train.

The participants in this study were eleven male senior professional rugby union players with a mean stature (±SD) of 185.2 ± 8.6 cm, mass of 101.1 ± 12.9 kg, and age of 27.1 ± 2.1 years. All players were tested three days per week over a six-week mid-season period. Results from this case study suggest that DC potentials could be used as an objective measure to indicate player readiness and managing individual player workload The final analyses identified a weak negative correlation (r = -0.17) between the RSImod data and the DC potential data was observed. DC potential brainwave activity data could be used in conjunction with subjective measures such as POMS, RSImod and reported injury status to adjust player daily activity.

Background: Despite extensive literature regarding laboratory-based balance perturbations, there is no up-to-date systematic review of methods. This systematic review aimed to assess current perturbation methods, and outcome variables used to report participant biomechanical responses during walking.
​​​​​​​Methods: Web of Science, CINAHL and PubMed online databases were searched, for records from 2015, the last search was on 30th of May 2022. Studies were included where participants were 18+ years, with or without clinical conditions, conducted in non-hospital settings. Reviews were excluded. Participant descriptive, perturbation method, outcome variables and results were extracted and summarised. Bias was assessed using the Appraisal tool for Cross-sectional Studies risk of bias assessment tool. Qualitative analysis was performed as the review aimed to investigate methods used to apply perturbations.
Results: 644 records were identified and 33 studies were included, totaling 779 participants. The most frequent method of balance perturbation during gait was by means of a treadmill translation. The most frequent outcome variable collected was participant step width, closely followed by step length. Most studies reported at least one spatiotemporal outcome variable. All included studies showed some risk of bias, generally related to reporting of sampling approaches. Large variation in perturbation type, duration and intensity and outcome variables were reported.
Conclusions: This review shows the wide variety of published laboratory perturbation methods. Also demonstrating the significant impact on outcome measures of a study based on the type of perturbation used.
Registration: PROSPERO ID: CRD42020211876

Until recently, neural assessments of gross motor coordination could not reliably handle active tasks, particularly in realistic environments, and offered a narrow understanding of motor-cognition.  By applying a comprehensive neuroergonomic approach using optical mobile neuroimaging, we probed the neural correlates of motor functioning in young people with Developmental Coordination Disorder (DCD), a motor-learning deficit affecting 5-6% of children with lifelong complications. Neural recordings using fNIRS were collected during active ambulatory behavioral task execution from 37 Typically Developed and 48 DCD Children who performed cognitive and physical tasks in both single and dual conditions. This is the first of its kind study targeting regions of prefrontal cortical dysfunction for identification of neuropathophysiology for DCD during realistic motor tasks and is one of the largest neuroimaging study (across all modalities) involving DCD.

We demonstrated that DCD is a motor-cognitive disability, as gross motor /complex tasks revealed neuro-hemodynamic deficits and dysfunction within the right middle and superior frontal gyri of the prefrontal cortex through functional near infrared spectroscopy. Furthermore, by incorporating behavioral performance, decreased neural efficiency in these regions were revealed in children with DCD, specifically during motor tasks. Lastly, we provide a framework, evaluating disorder impact in ecologically valid contexts to identify when and for whom interventional approaches are most needed and open the door for precision therapies.

Objective: Experimental studies show small to moderate effects of both acute and regular physical activity on executive functions, these being strongly associated with academic performance at school. In order to understand the naturally occurring associations between primary school-aged children’s working memory (WM), selfreported concentration, and physical activity (PA), 35 children (M age = 9.8 years, range = 7.6-11.4 years old) in Years 3-6 of primary school took part in a two-week long intraindividual study. Method: Participants wore an accelerometer wristband throughout the study, and carried out a working memory task (digit recall) and completed a sustained attention measure each morning and afternoon, giving 517 time-points nested in 4-10 schooldays (M obs = 15.8 situations, n obs = 4-18). Results: Using multilevel structural equation models (MSEM) we found that working memory was stable across time (within-person b = 0.29) and trait-like ( ICC s = 0.58). Across situations, state working memory was higher later in the calendar week. Acute moderate to vigorous physical activity (MVPA) was not associated with stateworking memory, but exertion of a higher level of MVPA than usual the previous day was associated with lower state-working memory the following day. Trait-sustained attention (across the two weeks) predicted higher trait-working memory and older students outperformed younger students. Conclusions: Implications for timing and intensity of students’ physical activity in educational settings is discussed.

Objectives The objective was to determine recent cross-sectional trends in health-related fitness (HRF) in secondary school students by studying the 13–14 years old age group repeatedly over 6 years, considering parallel national trends in physical education (PE).

Methods Height, weight, broad jump, grip strength, 20 m shuttle run and throwing and catching skills were measured by the same research team using standardised techniques from 2014 to 2019. Trends in these HRF measures were assessed by linear regression, adjusting for school, sex and height. Interactions with fitness and body mass index (BMI) were tested. The number of PE lessons reported in the UK Annual School Workforce Census between 2010 and 2019 for all state-funded secondary schools was analysed.

Results Grip strength (B=−0.60, 95% CI −0.78 to –0.41), broad jump (B=−1.16, 95% CI −1.99 to –0.34), 20 m shuttle run (B=−1.85, 95% CI −2.58 to –1.12) and throwing and catching skills (B=−0.12, 95% CI −0.15 to –0.08) declined significantly over the study period. There was a greater reduction in broad jump and grip strength in adolescents with low fitness and a greater reduction in fitness and motor competence in adolescents with normal BMI. These declines coincided with a 16% reduction nationally in secondary school PE between 2010 (333 800 hours) and 2019 (280 725 hours).

Conclusion Adolescent HRF has declined in recent years, in parallel with PE lessons. Declines were observed across all young people and particularly those of low fitness and normal BMI. To reach the majority of young people, policy makers could increase PE in schools to increase activity and prevent worsening fitness and health in future generations.

The purpose of this study was to determine how dual-task (DT) effect on gait differs among adolescents with different fitness and health profiles. The gait performances of 365 adolescents aged 13-14 years were assessed at single and DT walking. The proportional changes in gait parameters from single to dual were regressed against gender, body mass index (BMIz), three components of MABC-2 (balance, aiming &catching and manual dexterity), group (high vs low motor competence), body strength, physical fitness level using multiple regression analyses; and gender and four items of balance subtest of MABC-2 in the secondary analysis. The analyses showed that being female was associated with greater reduction in gait speed and stride length and an increase in double support time and step time; and having lower score in balance was related to greater reduction in gait speed, and cadence, and an increase in step time. Only zig-zag hopping item of the balance subtest was associated with DT effect on gait speed and stride length. No significant relationships were found between DT effect on gait and the rest of the predictors. Females and adolescents with lower level of balance function may be at higher risk of having DT deficit during walking.

Background. Pupils in secondary schools do not meet the targets for physical activity levels during physical education (PE) sessions, and there is a lack of data on the vigorous physical activity domain (VPA) in PE known to be positively associated with cardio metabolic health While PE session intensity depends on a variety of factors, the large majority of studies investigating these factors have not taken into account the nested structure of this type of data set. Therefore, the aim of this study was to investigate the relationship between various factors (gender, activity type, class location and class composition) and various activity levels during PE classes in secondary schools, using a multi-level statistical approach.

Methods. Year eight (12–13 years old) adolescents (201 boys and 106 girls) from six schools were fitted with accelerometers during one PE session each, to determine the percentage (%) of the PE session time spent in sedentary (SPA), light (LPA), moderate (MPA), vigorous (VPA) and moderate-to-vigorous (MVPA) intensity levels. Two- and three-level (pupils, n = 307; classes, n = 13, schools, n = 6) mixed-effect models were used to assess the relationship between accelerometer-measured physical activity levels (% of class time spent in various activity levels) and gender, activity type, class location and composition.

Results. Participants engaged in MVPA and VPA for 30.7 ± 1.2% and 11.5 ± 0.8% of PE classes, respectively. Overall, no significant association between gender or class composition and PA was shown. A significant relationship between activity type and PA was observed, with Artistic classes significantly less active than Fitness classes for VPA (5.4 ± 4.5 vs. 12.5 ± 7.1%, p = 0.043, d:1.19). We also found a significant association between class location and PA, with significantly less time spent in SPA (24.8 ± 4.8% vs. 30.0 ± 3.4%, p = 0.042, d:0.77) and significantly more time spent in VPA (12.4 ± 3.7% vs. 7.6 ± 2.0%, p = 0.022, d:1.93) and MVPA (32.3 ± 6.7% vs.24.8 ± 3.8%, p = 0.024, d:1.33) in outdoors vs. indoors classes.

Conclusions. The results suggest that class location and activity type could be associated with the intensity of PA in PE. It is essential to take into account the clustered nature of this type of data in similar studies if the sample size allows it.

The interplay between gender, Physical Activity (PA), and Dual Tasking (DT) in older adults is unclear. This study aimed to address DT based on gender and PA level. One-hundred and twenty older adults (81 women and 39 men) participated. Timed up and go test and spatiotemporal gait measures were collected in single and DT conditions. Participants were grouped according to gender and PA level. Physical activity did not explain gender differences, women were slower and had shorter stride lengths when DT regardless of PA level. Findings indicate the necessity for tailored PA and functional interventions to improve women’s performance.

Objective: To investigate the effect of small needle-knife therapy in people with painful knee osteoarthritis.
Design Pilot randomised, controlled trial.
Setting. Rehabilitation hospital.
Subjects. In-patients with osteo-arthritis of the knee.
Interventions: Either 1-3 small needle-knife treatments over 7 days or oral Celecoxib. All patients stayed in hospital three weeks, receiving the same mobility-focused rehabilitation.
Measures. Oxford Knee Score (OKS), gait speed and kinematics were recorded at baseline, at 3 weeks (discharge) and at three-months (OKS only). Withdrawal from the study, and adverse events associated with the small needle knife therapy were recorded.
Results: 83 patients were randomized: 44 into the control group, of whom 10 were lost by 3 weeks and 12 at 3 months; 39 into the experimental group of whom 8 were lost at 3 weeks and 3 months. The mean (SE) OKS scores at baseline were Control 35.86 ( 1.05), Exp 38.38 ( 0.99); at three weeks 26.64 (0.97) and 21.94
(1.23); and at three months 25.83 (0.91) and 20.48 (1.14) The mean (SE) gait speed at baseline was 1.07 (0.03) m/sec (Control) and 0.98 (0,03), and at three weeks was 1.14 (0.03) and 1.12 (0.03) (p Conclusions: Small needle-knife therapy added to standard therapy for patients with knee osteoarthritis, was acceptable, safe, and reduced pain and improved global function on the Oxford Knee Score. Further research is warranted.

Purpose: The presentation of unhealthy psychological symptoms are rising sharply in adolescents. Detrimental lifestyle behaviours are proposed as both possible causes and consequences. This study set out to compare selected measures of quality and quantity of movement between adolescents with and without unhealthy psychological symptoms.  
Methods: Using a cross sectional design, 96 participants completed the study from a whole year group of 166, age (13.36 ± 0.48) male 50.6% from a secondary school in Oxfordshire, England as a part of a larger study (EPIC) between January and April 2017. Measures were taken of quality and quantity of movement: reaction/movement time, gait pattern & physical activity, alongside psychological symptoms. Differences in movement behaviour in relation to psychological symptom and emotional problem presentation were determined using ANOVA. In the event of a significant result for the main factor of each parameter, a Bonferroni -corrected post hoc test was conducted to show the difference between categories in each group. Results for both unhealthy psychological symptoms and emotional problems were grouped into four categories (‘Close to average’, ‘slightly raised’, ‘high’ and ‘very high’). 
Results: Early adolescents with very high unhealthy psychological symptoms had 16.79% slower reaction times (p = .003, ηp2 = .170), 13.43% smaller walk ratio (p = .007, ηp2 = .152), 7.13% faster cadence (p = .005, ηp2 = .149), 6.95% less step time (p = .007, ηp2 = .153) and 1.4% less vigorous physical activity (p = .04, ηp2 = .102) than children with close to average psychological symptoms. Early adolescents with very high emotional problems had 12.25% slower reaction times (p = .05, ηp2 = .081), 10.61% smaller walk ratio (p = .02, ηp2 = .108), 6.03% faster cadence (p = .01, ηp2 = .134), 6.07% shorter step time (p = .007, ηp2 = .141) and 1.78% less vigorous physical activity (p = .009, ηp2 = .136) than children with close to average emotional problems.   
Conclusions:  Different movement quality and quantity of was present in adolescents with unhealthy psychological symptoms and emotional problems. We propose movement may be used to both monitor symptoms, and as a novel therapeutic behavioural approach. Further studies are required to confirm our findings. 

Healthy diet has been linked to better age-related physical functioning, but evidence on the relationship of overall diet quality in late midlife and clinically relevant measures of physical functioning in later life is limited. Research on potential sex differences in this relationship is scarce. The aim was to investigate the prospective association between overall diet quality, as assessed by the Healthy Eating Index-2015 at age 60-64y and measures of walking speed seven years later, among men and women from the Insight46, a neuroscience sub-study of the Medical Research Council National Survey of Health and Development. Diet was assessed at age 60-64y using five-day food diaries, from which total HEI-2015 was calculated. At age 69-71y, walking speed was estimated during four 10-meter walks at self-selected pace, using inertial measurement units. Multivariable linear regression models with sex as modifier, controlling for age, follow-up, lifestyle, health, social variables and physical performance were used. The final sample was 164 women and 167 men (n=331). Women had higher HEI-2015 scores and slower walking speed than men. A 10 point increase in HEI-2015 was associated with faster walking speed seven years later among women (B: 0.024, 95% CI: 0.006, 0.043), but not men. The association remained significant in the multivariable model (B: 0.021, 95% CI: 0.003, 0.040). In women in late midlife higher diet quality is associated with faster walking speed. A healthy diet in late midlife is likely to contribute towards better age-related physical capability and sex differences are likely to affect this relationship.

This study sought to select the most relevant test items from the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOTMP-2) and from a selection of health-related fitness tests for identifying school teenagers with poor motor coordination. The 241 participants in this study (144 boys, 97 girls aged 13–14 years old) were tested on the short form of the BOTMP-2 and on the following additional fitness tests: (a) seated medicine ball test, (b) broad jump, (c) handgrip strength, (d) alternate hand ball wall toss, (e) 10 × 5-meter agility shuttle run, and (f) Chester step test. We performed a factor analysis of participant scores on these various tasks and BOTMP-2 test items to reduce them to the least number of meaningful and useful items. Four factors explained 45% of the data variance: gross motor skills and power (including broad jump, hand ball toss, shuttle run, and sit-ups tests); fine motor skills (including copying star, following the maze and paper folding); core strength and balance (including push-ups, hopping, and balance beam); and general body strength (including medicine ball throw and handgrip). We conclude that an efficient school-based battery of test items to screen 13-14 year old adolescents for fitness and coordination should assess these four factors and might especially rely upon the broad jump, copying a star shape, hopping handgrip strength, aerobic fitness, and wall ball toss.

The names of the members of the IOPS MS study Group was inverted in the original paper and is now corrected in this article.

Objectives. To compare gait characteristics and functional balance abilities in men with LUTS secondary to BPH to those of matching controls under different conditions of increasing difficulties; single-task, dual-task motor, and dual-task cognitive.  Subjects and methods. In this cross-sectional experimental study we recruited a group of 43 men diagnosed with symptomatic BPH and control group of 38 older men. Participants performed the timed up and go (TUG) and 10-meter walking tests under different conditions of increasing difficulties. Namely, single task, dual-task motor, and dual-task cognitive. Time to complete the tests and spatial and temporal gait parameters were compared between groups and conditions via mixed-design ANOVA. Results. Under dual-task conditions, individuals in both groups performed significantly worse in a functional balance task and a simple walking to usual walking. However, as the complexity of the walking task increased, from dual-task motor to dual-task cognitive, significant differences between groups emerged. In particular, men with PBH performed worse than older adults in tasks demanding increased attentional control. Conclusion. Health care providers for men with LUTS due to BPH should assess for abnormal gait and maintain vigilant for balance problems that may lead to decreased mobility and falls. Dual task approach seems a feasible method to distinguish gait and balance impairments in men with BPH. 

Current gait control models suggest that independent locomotion depends on central and peripheral mechanisms. However, less information is available on the integration of these mechanisms for adaptive walking. In this cross-sectional study,  wWe investigated gait control mechanisms in people with Parkinson’s disease (PD) and healthy older (HO) adults: at self-selected walking speed (SSWS) and at fast walking speed (FWS). We measured effect of additional cognitive task (DT) and increased speed on prefrontal (PFC) and motor cortex (M1) activation, and Soleus H-reflex gain. Under DT-conditions we observed increased activation in PFC and M1.  Whilst H-reflex gain decreased with additional cognitive load for both groups and speeds, H-reflex gain was lower in PD compared to HO while walking under ST condition at SSWS. Attentional load in PFC excites M1, which in turn increases inhibition on H-reflex activity during walking and reduces activity and sensitivity of peripheral reflex during the stance phase of gait. Importantly this effect on sensitivity was greater in HO. We have previously observed that the PFC copes with increased attentional load in young adults with no impact on peripheral reflexes and we suggest that gait instability in PD may in part be due to altered sensorimotor functioning reducing the sensitivity of peripheral reflexes.

Background. We aimed to investigate the extent of the agreement on practices around brain death and postmortem organ donation. Methods. Investigators from 67 Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study centers completed several questionnaires (response rate: 99%). Results. Regarding practices around brain death, we found agreement on the clinical evaluation (prerequisites and neurological assessment) for brain death determination (BDD) in 100% of the centers. However, ancillary tests were required for BDD in 64% of the centers. BDD for nondonor patients was deemed mandatory in 18% of the centers before withdrawing life-sustaining measures (LSM). Also, practices around postmortem organ donation varied. Organ donation after circulatory arrest was forbidden in 45% of the centers. When withdrawal of LSM was contemplated, in 67% of centers the patients with a ventricular drain in situ had this removed, either sometimes or all of the time. Conclusions. This study showed both agreement and some regional differences regarding practices around brain death and postmortem organ donation. We hope our results help quantify and understand potential differences, and provide impetus for current dialogs toward further harmonization of practices around brain death and postmortem organ donation.

Background. The majority of stroke patients are inactive outside formal therapy sessions. Tailored activity feedback via a Smartwatch has the potential to increase inpatient activity. Objective. to identify the challenges and support needed by ward staff and researchers and to examine the feasibility of conducting a randomised controlled trial (RCT) using Smartwatch activity monitors in research naive rehabilitation wards. Objectives (Phase 1 and 2) were to report any challenges and support needed and determine the recruitment and retention rate, completion of outcome measures, Smartwatch adherence rate (Phase 2 only) readiness to randomise, adherence to protocol (intervention fidelity) and potential for effect. Methods. First admission, stroke patients (onset

Symptoms of Parkinson’s can result in low physical activity and poor sleep patterns which can have a detrimental effect on a person’s quality of life. To date, studies looking into exercise interventions for people with Parkinson’s (PwP) for symptom management are promising but inconclusive. The aim of this study is to estimate the effect of a clearly defined exercise prescription on general physical activity levels, fatigue, sleep, and quality of life in PwP. Method. PwP randomised into either an exercise group (29; 16 males, 13 females; mean age 67 years (7.12)) or a control handwriting group (36; 19 males; 17 females; mean age 67 years (5.88)) as part of a larger trial were included in this substudy if they had completed a 6-month weekly exercise programme (intervention group) and had complete objective physical activity data (intervention and control group). Sleep and fatigue were recorded from self-reported measures, and physical activity levels measured through the use of accelerometers worn 24 hours/day over a seven-day testing period at baseline and following the 24-week intervention. A Wilcoxon’s test followed by a Mann–Whitney post hoc analysis was used, and effect sizes were calculated. Results. Participants showed a significant increase in time spent in sedentary and light activities during the overnight period postintervention in both exercise and handwriting groups (p

To assess the feasibility of Zumba Gold® in people with PD, and to investigate the effects of dance styles and number of sessions on activity levels and physiological load.

Design

Repeated measure uncontrolled (single group) feasibility study.

Setting

Eleven participants (age: 64.0 ± 8.1 years) with mild-to-moderate idiopathic PD (Hoehn & Yahr stage < 3.0) took part in a screening session, followed by six Zumba Gold® workouts each separated by one week, and a follow-up interview six months later.

Main outcome measures

The main feasibility parameters measured were retention, compliance, and adverse events. Furthermore, during each Zumba Gold® session, physical activity levels were measured using tri-axial accelerometers, while physiological load was assessed by average heart rate (HRmean). A two-way ANOVA with repeated measures assessed the effects of dance styles and session number on activity level and HR.

Results

73% retention and 81% compliance were achieved, and no adverse events were recorded. Participants’ enjoyment was high and 38% started Zumba Gold® classes in the community after intervention. HR values were similar between dance styles and within the American College of Sports Medicine (ACSM)’s recommendations in 50% of participants. Backwards steps reduced physiological load but improvements in activity levels between the first and last sessions show that steps could be learnt with time.

Conclusions

Zumba Gold® is safe and enjoyable for people with PD. The excellent compliance and positive participants’ feedback suggest the need for a larger-scale trial.

Determining fitness to drive is a major concern affecting aging and disabled populations, particularly concerning reduced cognitive functioning, functional limitations and reduced vision [1, 2]. The Royal Society for Prevention of Accidents encourages aging drivers to maintain their licence (for independence, mobility and quality of life), emphasising that prematurely removing someone’s driving licence negatively affects their quality of life - the consequences of which outweigh the chance of being involved in a collision, for both the driver and the remainder of society [3].

The gold standard test in the United Kingdom (UK) to determine the ability to drive is an on-road driving assessment, and clinicians have the opportunity to refer patients to an independent Mobility Centre (accredited by Driving Mobility) where an assessment will be performed based upon on-road driving experience as judged by a professional driving instructor and occupational therapist[4]. The assessment is resource expensive and only a limited number of individuals are referred. To date no screening test is clinically implemented in the UK which accurately determines fitness to drive[4].

This study sets out to evaluate the potential of the Montreal Cognitive Assessment (MOCA) as a screening tool, for people with concerns regarding cognitive capacity; to determine pass/fail cuts offs for on-road driving assessment.

Background

Integrating rehabilitation services through wearable systems has the potential to accurately assess the type, intensity, duration, and quality of movement necessary for procuring key outcome measures.

Objectives

This review aims to explore wearable accelerometry-based technology (ABT) capable of assessing mobility-related functional activities intended for rehabilitation purposes in community settings for neurological populations. In this review, we focus on the accuracy of ABT-based methods, types of outcome measures, and the implementation of ABT in non-clinical settings for rehabilitation purposes.

Data sources

Cochrane, PubMed, Web of Knowledge, EMBASE, and IEEE Xplore. The search strategy covered three main areas, namely wearable technology, rehabilitation, and setting.

Study selection

Potentially relevant studies were categorized as systems either evaluating methods or outcome parameters.

Methods

Methodological qualities of studies were assessed by two customized checklists, depending on their categorization and rated independently by three blinded reviewers.

Results

Twelve studies involving ABT met the eligibility criteria, of which three studies were identified as having implemented ABT for rehabilitation purposes in non-clinical settings. From the twelve studies, seven studies achieved high methodological quality scores. These studies were not only capable of assessing the type, quantity, and quality measures of functional activities, but could also distinguish healthy from non-healthy subjects and/or address disease severity levels.

Conclusion

While many studies support ABT’s potential for telerehabilitation, few actually utilized it to assess mobility-related functional activities outside laboratory settings. To generate more appropriate outcome measures, there is a clear need to translate research findings and novel methods into practice.

The purpose of this study was to establish and cross-validate a method for analyzing gait patterns determined by the center of mass (COM) through inertial sensors embedded in smart devices. The method employed an extended Kalman filter in conjunction with a quaternion rotation matrix approach to transform accelerations from the object onto the global frame. Derived by double integration, peak-to-trough changes in vertical COM position captured by a motion capture system, inertial measurement unit, and smart device were compared in terms of averaged and individual steps. The inter-rater reliability and levels of agreement for systems were discerned through intraclass correlation coefficients (ICC) and Bland–Altman plots. ICCs corresponding to inter-rater reliability were good-to-excellent for position data (ICCs,.80–.95) and acceleration data (ICCs,.54–.81). Levels of agreements were moderate for position data (LOA, 3.1–19.3%) and poor for acceleration data (LOA, 6.8%–17.8%). The Bland–Altman plots, however, revealed a small systematic error, in which peak-to-trough changes in vertical COM position were underestimated by 2.2 mm; the Kalman filter׳s accuracy requires further investigation to minimize this oversight. More importantly, however, the study׳s preliminary results indicate that the smart device allows for reliable COM measurements, opening up a cost-effective, user-friendly, and popular solution for remotely monitoring movement. The long-term impact of the smart device method on patient rehabilitation and therapy cannot be underestimated: not only could healthcare expenditures be curbed (smart devices being more affordable than today‘s motion sensors), but a more refined grasp of individual functioning, activity, and participation within everyday life could be attained.

Walking models driven by centre of mass (CoM) data obtained from inertial measurement units (IMU) or optical motion capture systems (OMCS) can be used to objectively measure gait. However current models have only been validated within typical developed adults (TDA). The purpose of this study was to compare the projected CoM movement within Parkinson's disease (PD) measured by an IMU with data collected from an OMCS after which spatio-temporal gait measures were derived using an inverted pendulum model. The inter-rater reliability of spatio-temporal parameters was explored between expert researchers and clinicians using the IMU processed data. Participants walked 10 m with an IMU attached over their centre of mass which was simultaneously recorded by an OMCS. Data was collected on two occasions, each by an expert researcher and clinician. Ten people with PD showed no difference (p = 0.13) for vertical, translatory acceleration, velocity and relative position of the projected centre of mass between IMU and OMCS data. Furthermore no difference (p = 0.18) was found for the derived step time, stride length and walking speed for people with PD. Measurements of step time (p = 0.299), stride length (p = 0.883) and walking speed (p = 0.751) did not differ between experts and clinicians. There was good inter-rater reliability for these parameters (ICC3.1 = 0.979. ICC3.1 = 0.958 and ICC3.1 = 0.978, respectively). The findings are encouraging and support the use of IMUs by clinicians to measure CoM movement in people with PD.

Laboratory based gait analysis techniques are expensive, time consuming and require technical expertise. Inertial measurement units can directly measure temporal parameters and in combination with gait models may provide a solution to obtain spatial gait measurements within daily clinical assessments. However it is not known if a model and standard correction factor determined by Zijlstra and Hof [8] to estimate step and stride length parameters in typically developed adults (TDA) can be accurately used in neurologically impaired gaits.This research estimated the stride length over two 10 m walks at self selected walking speed in people with neurological conditions, using a previously established model and correction factor for TDA. The relation of the correction factor to walking speed was explored. We recruited TDA (n = 10) and participants with Parkinson's disease (PD; n = 24), muscular dystrophy (MD; n = 13), motor neuron disease (MND; n = 7) and stroke survivors (n = 18) for the study who twice walked 10 m at a self-selected pace. Stride length correction factors, for TDA (1.25 +/- 0.01), PD (1.25 +/- 0.03), and MD (1.21 +/- 0.08) (p = 0.833 and p = 0.242) were the same as previously reported in TDA (Zijlstra and Hof [8]). Correction factors for stroke (1.17 +/- 0.42) and MND (1.10 +/- 0.08) were different (p < 0.01 and p = 0.028 respectively). However there was a high level of variability for correction factors within groups, which did not relate to walking speed. Our findings support that correction factors should be determined for each individual to estimate average step/stride length in patients suffering from a neurological condition.

The purpose of this study was to use a quaternion rotation matrix in combination with an integration approach to transform translatory accelerations of the centre of mass (CoM) from an inertial measurement unit (IMU) during walking, from the object system onto the global frame. Second, this paper utilises double integration to determine the relative change in position of the CoM from the vertical acceleration data. Five participants were tested in which an IMU, consisting of accelerometers, gyroscopes and magnetometers was attached on the lower spine estimated centre of mass. Participants were asked to walk three timed through a calibrated volume at their self-selected walking speed. Synchronized data were collected by an IMU and an optical motion capture system (OMCS); both measured at 100 Hz. Accelerations of the IMU were transposed onto the global frame using a quaternion rotation matrix. Translatory acceleration, speed and relative change in position from the IMU were compared with the derived data from the OMCS. Peak acceleration in vertical axis showed no significant difference (p >= 0.05). Difference between peak and trough speed showed significant difference (p < 0.05) but relative peak-trough position between the IMU and OMCS did not show any significant difference (p >= 0.05). These results indicate that quaternions, in combination with Simpsons rule integration, can be used in transforming translatory acceleration from the object frame to the global frame and therefore obtain relative change in position, thus offering a solution for using accelerometers in accurate global frame kinematic gait analyses.