Low bone mineral density is associated with balance and hearing impairments

PurposeBone demineralization affects the skeletal system, including the temporal bone, which contains the cochlea and the vestibular labyrinth. However, research on the association of bone mineral density (BMD) with balance and hearing sensitivity is limited with conflicting results. Therefore, we examined the relationship in a population representative sample.MethodsWe analyzed 8863 participants to the National Health and Nutrition Examination Survey (1999–2004) aged 40 years and older. Total and head BMD were measured by dual energy x-ray absorptiometry. Balance was evaluated using the Romberg Test of Standing Balance on Firm and Compliant Support Surfaces condition 4, also indicative of vestibular dysfunction. Hearing condition was self-reported. The associations of total and head BMD with balance and hearing were assessed using multiple and multinomial logistic regressions adjusting for covariates.ResultsOn multiple logistic regression, low total BMD was associated with balance impairment (odds ratio [OR], 2.21; 95% confidence interval [CI], 1.43–4.75), especially in older adults (≥65 years old; OR, 3.72; 95% CI, 1.07–12.85). In multinomial regression, low total BMD was associated with report of significant hearing impairment in older adults (OR, 5.30; 95% CI, 1.20–23.26).ConclusionsLow BMD is associated with balance and hearing impairments, especially in older adults.     

Alterations of lower extremity function,health-related quality of life,and spatiotemporal gait parameters among individuals with chronic ankle instability

ObjectiveTo identify differences in patient-reported outcome questionnaires and spatiotemporal gait parameters during walking between individuals with and without chronic ankle instability (CAI) and to identify relationships between patient-oriented outcome and spatiotemporal gait parameters.ParticipantsTwenty-four individuals with CAI and 24 controls were included in this study.Main outcome measuresAll participants completed the Foot and Ankle Ability Measure including the Activities of Daily Living and Sport Subscales, the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), the Lower Extremity Functional Scale, and the Korean version of the EuroQol 5-Dimension (KEQ-5D). Participants walked in a laboratory setting to collect spatiotemporal gait parameter data.ResultsAll questionnaire scores from the male CAI group were lower than those from the control group. The female group yielded lower questionnaire scores than the controls, with an exception for KEQ-5D. The differences between the female CAI and female control groups in temporal gait parameters were significant. Correlations were observed between the WOMAC scores of the male participants and spatiotemporal gait parameters. In females, there were correlations between the patient-reported outcomes and spatiotemporal gait parameters.ConclusionsCAI patients need treatment not only for ankle function but also lower extremity function and gait performance.     

The relationship between the anteroposterior and mediolateral margins of stability in able-bodied human walking

BackgroundControl of dynamic balance in human walking is essential to remain stable and can be parameterized by the margins of stability. While frontal and sagittal plane margins of stability are often studied in parallel, they may covary, where increased stability in one plane could lead to decreased stability in the other. Hypothetically, this negative covariation may lead to critically low lateral stability during step lengthening.Research questionIs there a relationship between frontal and sagittal plane margins of stability in able-bodied humans, during normal walking and imposed step lengthening?MethodsFifteen able-bodied adults walked on an instrumented treadmill in a normal walking and a step lengthening condition. During step lengthening, stepping targets were projected onto the treadmill in front of the participant to impose longer step lengths. Covariation between frontal and sagittal plane margins of stability was assessed with linear mixed-effects models for normal walking and step lengthening separately.ResultsWe found a negative covariation between frontal and sagittal plane margins of stability during normal walking, but not during step lengthening.SignificanceThese results indicate that while a decrease in anterior instability may lead to a decrease in lateral stability during normal walking, able-bodied humans can prevent lateral instability due to this covariation in critical situations, such as step lengthening. These findings improve our understanding of adaptive dynamic balance control during walking in able-bodied humans and may be utilized in further research on gait stability in pathological and aging populations.     

Hybrid Assistive Limb® for sporadic inclusion body myositis: A case series

We evaluated the efficacy of rehabilitation therapy with Hybrid Assistive Limb® (HAL; hereafter HAL therapy) in three patients diagnosed with sporadic inclusion body myositis (sIBM) who were hospitalized to undergo HAL therapy. Among them, one patient participated in eight courses and the other two in two courses of HAL therapy between 2017 and 2020. We determined the mean rate of improvement in two-minute walking distance and 6 m walking speed at the time of hospital discharge. After HAL therapy, we confirmed the patients’ desire to continue the use of HAL. In one patient, we observed improvements of 146.0% and 120.0% in two-minute walk and 6 m walking speed, respectively, after the first course of HAL therapy; these values are 133.7% and 130% after the eighth course of HAL therapy. These values exceeded 90% in the other two patients after the second course of HAL therapy. HAL therapy maintained both quantity and quality of ambulation and showed positive psychological effects on patient conditions because it reduces exercise load and facilitates safety. While HAL therapy might be effective in maintaining and improving ambulation in patients with sIBM, we should consider to discontinue HAL therapy as it increased risk of falling.     

Smartphone-based inertial sensors technology – Validation of a new application to measure spatiotemporal gait metrics

BackgroundSmartphones are increasingly recognized as the future technology for clinical gait assessment.ResearchQuestion: To determine the concurrent validity of gait parameters obtained using the smartphone technology and application in a group of patients with musculoskeletal pathologies.MethodsPatients with knee, lower back, hip, or ankle pain were included in the study (n = 72). Spatiotemporal outcomes were derived from the walkway and the smartphone simultaneously. Pearson’s correlations and limits of agreement (LoA) determined the association between the two methods.ResultsCadence and gait cycle time showed excellent correlation and agreement between the smartphone and the walkway (cadence: r = 0.997, LoA=1.4%, gait cycle time: r = 0.996, LoA = 1.6%). Gait speed, double-limb support and left and right step length demonstrated strong correlations and moderate agreement between methods (gait speed: r = 0.914, LoA=15.4%, left step length: r = 0.842, LoA = 17.0%, right step length: r = 0.800, LoA=16.4%). The left and right measures of single-limb support and stance percent showed a consistent 4% bias across instruments, yielding moderate correlation and very good agreement between the smartphone and the walkway (r = 0.532, LoA = 9% and r = 0.460, LoA=9.8% for left and right single-limb support; r = 0.463, LoA = 5.1% and r = 0.533, LoA = 4.4% for left and right stance).Significance: The examined application appears to be a valid tool for gait analysis, providing clinically significant metrics for the assessment of patients with musculoskeletal pathologies. However, additional studies should examine the technology amongst patients with severe gait abnormalities.     

Efficacy of comprehensive rehabilitation therapy for checkrein deformity: A case report

BACKGROUND In clinical practice, checkrein deformity is usually found in patients with calf injuries after ankle fracture or distal tibial fracture. The patients with checkrein deformity mainly report distending pain in toe tips, pain when walking or wearing shoes, and gait instability. Previous studies have mainly reported surgical treatments for checkrein deformity, while few studies have reported using comprehensive rehabilitation alone to improve the checkrein deformity.CASE SUMMARY A 28-year-old woman was admitted to the hospital due to unstable gait caused by pain in the right hallux, for which she was unable to stretch for over three months. The patient had undergone "resection of ameloblastoma at the right mandible, mandibulectomy, and autogenous right fibula grafting". The patient’s hallux toe, as well as the second and third toes of the right foot could not be stretched, with pain in all the toes during walking. Based on the medical records of the patient, as well as the results of physical and auxiliary examinations, the main diagnosis was checkrein deformity in the right foot. Since the patient refused surgical treatment, rehabilitation was the only treatment option. At discharge, the patient reported evident improvement in the pain in the toes, gait stability, as well as increased ability to climb up and downstairs.CONCLUSION Comprehensive rehabilitation therapy could effectively alleviate the manifestations of checkrein deformity and improve the walking ability of the patients.     

Impact of serial gait analyses on long-term outcome of hippotherapy in children and adolescents with cerebral palsy

The aim of this study was to obtain data of gait parameters on predicting long-term outcome of hippotherapy. In 20 participants (4–19 years; GMFCS levels I to III) with cerebral palsy (CP), gait and balance abilities were examined after 10-m walking test using a portable motion recorder. Hippotherapy was associated with increased Gross Motor Function Measure (GMFM)-66 at 1 year from the baseline (P < 0.001). Hippotherapy increased stride length, walking speed, and mean acceleration and decreased horizontal/vertical displacement ratio over time (P < 0.05). Stride length and mean acceleration at 6 weeks predicted the elevation of GMFM-66 score. These data suggest that 1-year outcome of hippotherapy on motor and balance functions can be assessed from the early phase by serial monitoring of the gait parameters.     

Musical enjoyment does not enhance walking speed in healthy adults during music-based auditory cueing

BackgroundRhythmic Auditory Stimulation (RAS) involves synchronizing footsteps to music or a metronome to improve gait speed and stability in patients with neurological disorders, such as Parkinson’s disease. However, responses to RAS vary across individuals, perhaps because of differences in enjoyment of the music or in musical abilities.Research questionIntuitively, musical enjoyment may influence gait responses to RAS, but enjoyment has not been systematically manipulated nor the effects empirically assessed. In addition, differences in beat perception ability are likely to influence gait responses to music, particularly when synchronizing to the beat. Therefore, we asked: how does music enjoyment alter gait, and do gait parameters differ between individuals with good versus poor beat perception ability, specifically when instructed to ‘walk freely’ versus ‘synchronize to the beat’?MethodYoung adults and older adults walked on a pressure sensor walkway in silence and to music that they had rated as either high or low in enjoyment, as well as a metronome. All stimuli were presented at 15 % faster than baseline cadence. Participants either walked freely to the music or synchronized to the beat.ResultsMusic enjoyment had no significant effects on gait in either younger or older adults. Compared to baseline, younger adults walked faster (by taking longer strides) to music than the metronome, whereas older adults walked faster (by taking more steps per minute) to the metronome than music. When instructed to synchronize vs. walk freely, young adults walked faster, but older adults walked slower. Finally, regardless of instruction type, young adults with poor beat perception took shorter and slower strides to the music, whereas older adults with poor beat perception took slower strides to the music.SignificanceBeat perception ability, instruction type, and age affect gait more than music enjoyment does, and thus should be considered when optimizing RAS outcomes.     

Effectiveness of Anma massage therapy in alleviating physical symptoms in outpatients with Parkinson's disease: A before-after study

We aimed to confirm the physical effects of a single Anma massage session and continuous Anma massage therapy for outpatients with Parkinson's disease (PD). Twenty-one PD outpatients (mean age, 64.43 ± 8.39 [SD] years; Hoehn and Yahr stage I–IV) received a single 40-min Anma massage session involving upper and lower limb exercises and some subsequently received seven weekly Anma massage sessions. After a single session, visual analogue scale scores were significantly lower for muscle stiffness, movement difficulties, pain, and fatigue; gait speed and pegboard test time were significantly shortened; stride length was significantly lengthened; and shoulder flexion and abduction were significantly improved. No significant changes occurred in controls. After continuous sessions, we found general improvements in the same outcomes. In conclusion, Anma massage might effectively alleviate various physical PD symptoms; furthermore, because it is given through clothing, Anma massage is accessible for PD patients with movement difficulties.