A review of gait disorders in the elderly and neurological patients for robot-assisted training

Abstract

Purpose: Ambulation is an important objective for people with pathological gaits. Exoskeleton robots can assist these people to complete their activities of daily living. There are exoskeletons that have been presented in literature to assist the elderly and other pathological gait users. This article presents a review of the degree of support required in the elderly and neurological gait disorders found in the human population. This will help to advance the design of robot-assisted devices based on the needs of the end users.

Methods: The articles included in this review are collected from different databases including Science Direct, Springer Link, Web of Science, Medline and PubMed and with the purpose to investigate the gait parameters of elderly and neurological patients. Studies were included after considering the full texts and only those which focus on spatiotemporal, kinematic and kinetic gait parameters were selected as they are most relevant to the scope of this review. A systematic review and meta-analysis were conducted.

Results: The meta-analysis report on the spatiotemporal, kinematic and kinetic gait parameters of elderly and neurological patients revealed a significant difference based on the type and level of impairment. Healthy elderly population showed deviations in the gait parameters due to age, however, significant difference is observed in the gait parameters of the neurological patients.

Conclusion: A level of agreement was observed in most of the studies however the review also noticed some controversies among different studies in the same group. The review on the spatiotemporal, kinematics and kinetic gait parameters will provide a summary of the fundamental needs of the users for the future design and development of robotic assistive devices.

• Implications for rehabilitation

• The support requirements provide the foundation for designing assistive devices.

• The findings will be crucial in defining the design criteria for robot assistive devices.

     

Agomelatine for depression: expanding the horizons?

Introduction: Agomelatine is an antidepressant with unique pharmacological actions; it is both a melatonin agonist and selective serotonin antagonist. Both actions combined are necessary for antidepressant efficacy. Effects on melatonin receptors enable resynchronisation of disrupted circadian rhythms with beneficial effects on sleep patterns.

Areas covered: The issue of use of an antidepressant for depression co-morbid with somatic disorders is covered by the authors. A review of the literature from 2000 to August 2018 was undertaken using Scopus and Web of Science with the key words: agomelatine, depression, medical illness. Depression in Parkinson’s disease, cardiovascular illness and type II diabetes is reviewed with evidence of efficacy. Bipolar depression and seasonal affective disorder may also react favourably. Agomelatine may have specific efficacy on symptoms of anhedonia.

Expert opinion: Despite approval in some major jurisdictions, the drug has failed to gain registration in the United States. A defining issue may be questions about longer term efficacy: unequivocal effectiveness in placebo-controlled relapse prevention studies has not always been demonstrated. Continuation studies suggest maintenance of clinical responsiveness. A major disadvantage of the drug is its’ potential hepatotoxicity and the need for repeated clinical laboratory tests.     

L市社区老年人卫生服务利用情况及综合评价*

目的研究L市社区老年人的卫生服务利用情况,对不同社区进行综合评价,根据调查结果提出切实可行的对策和建议,为社区卫生服务中心针对老年人开展工作提供参考。方法对所调查老年人的基本情况进行描述性分析;采用logistic回归方法分析社区卫生服务利用的影响因素;采用TOPSIS法对不同社区卫生服务利用情况进行综合评价。结果被调查老年人的两周就诊率为29.7%,两周患者就诊率为68.5%,老年人过去一年住院率为28.3%;logistic回归分析结果显示,影响老年人两周就诊率和住院率的主要因素为是否患有慢性疾病(P0.05);Topsis评价结果显示,经济水平和文化程度高的被调查者社区卫生服务利用情况相对较好。结论 L市社区老年人卫生服务利用情况整体较好,但是不同社区之间存在差异,部分老年人认为社区医疗机构的医生技术能力较低。因此,要提高基层医务人员的能力,加快培养全科医生,从而提高社区卫生资源的利用。     

小切口阑尾手术治疗老年阑尾炎的临床效果分析

目的 研究在老年阑尾炎患者中采取小切口阑尾手术治疗的临床效果。方法 将本院收治的100例老年阑尾炎患者随机将其分为开放性阑尾手术治疗组和小切口阑尾手术治疗组各50例,比较2组患者并发症发生率、临床治疗有效率、VAS评分、术中出血量、切口长度、住院天数、排气时间、生活质量评分。结果 小切口阑尾手术治疗组老年阑尾炎患者临床治疗有效率、生活质量评分均高于开放性阑尾手术治疗组,术中出血量、切口长度、住院天数、排气时间少于或短于开放性阑尾手术治疗组,VAS评分、并发症发生率低于开放性阑尾手术治疗组,2组患者各项统计指标的差异均有统计学意义(P<0.05)。结论 将小切口阑尾手术治疗用于老年阑尾炎患者中具有临床显著价值,可降低并发症发生率,减少疼痛程度,提升治疗效果。     

老年中晚期原发性肝癌患者生活质量及其对生存期的影响

目的:观察老年中晚期原发性肝癌患者的生活质量状况及其对生存期的影响。方法:回顾性分析2014年01月至2016年12月我院收治的115例老年原发性肝癌患者，调查他们的生活质量指数（LQI），比较不同LQI水平原发性肝癌患者的生存情况，并分析影响预后的危险因素。结果:本组患者生活质量的总分是（118.72±34.26）分，LQI是0.59±0.13。参照患者1年生存状态，LQI的最佳临界值为0.63，曲线下面积为0.696。高LQI组的中位生存时间为16.5个月，显著高于低LQI组的12.4个月(P=0.037）。与低水平LQI组比较，高水平LQI组的年龄、谷丙转氨酶（ALT）、谷草转氨酶（AST）、凝血酶原时间（PT）、总胆红素（TBIL）和甲胎蛋白（AFP）水平以及门静脉癌栓发生率、保守治疗率更小或更低，白蛋白（ALB）水平和BCLC分期更高，差异均有统计学意义（P<0.05）。单因素分析结果显示，老年中晚期原发性肝癌的预后与ALB、AFP、Child-Pugh分级、门静脉癌栓、肝外转移、BCLC分期、药物保守治疗和LQI相关（P<0.05）。多因素分析结果显示，AFP≥400 ng/ml、BCLC C期和药物保守治疗是预后的独立危险因素（P<0.05），而非门静脉癌栓、非肝外转移、LQI≥0.63是其独立保护因素（P<0.05）。结论:老年中晚期原发性肝癌患者生活质量较低，生活质量越低，预后越差。