Search Results (2,249)

Background: Frailty in older adults is linked to adverse cardiovascular outcomes, but its relationship with echocardiographic markers of diastolic function remains unclear. We examined associations between frailty measures and indices of diastolic function in community-dwelling older adults. Methods: This cross-sectional study included 537 adults aged ≥65 years from a multidisciplinary outpatient clinic. Frailty was assessed using the Fried phenotype, Clinical Frailty Scale (CFS), gait speed, and handgrip strength. Associations with diastolic indices were analyzed using multivariable regression with sequential adjustment. Sensitivity analysis was performed via matching. Results: According to the Fried phenotype, 30.8% of participants were robust, 59.7% pre-frail, and 9.5% frail. Indexed left atrial dimension (LAi) was consistently higher in frail individuals. Frailty was also associated with higher odds of elevated right ventricular systolic pressure (>35 mmHg) in unadjusted analyses. Using the CFS, individuals with a score higher than 3 had significantly higher NT-proBNP levels compared to those with a score of 1–2. Higher gait speed and handgrip strength were associated with more favorable cardiac structure, including smaller left heart chamber sizes, and lower natriuretic peptide levels. Conclusions: Frailty was independently associated with structural and functional markers of diastolic dysfunction in older adults, particularly left atrial enlargement (as captured in Fried) and NT-proBNP elevation (as captured in CFS), supporting the integration of frailty assessment into cardiovascular risk evaluation. Full article

Background/Objectives: The relationship between psychotropic medication use, prescribing appropriateness, and fall-related risk factors remains incompletely characterised. Gait speed is a key predictor of falls. We aimed to examine whether gait speed is associated with appropriately versus inappropriately prescribed psychotropic medication use among relatively healthy older adults. Methods: We conducted an observational cross-sectional study of 119 community-dwelling adults aged ≥ 70 years with low comorbidity burden (Charlson Comorbidity Index < 2) and preserved functional status (Barthel Index > 85). Gait speed was assessed over 6 metres. Psychotropic medication use was recorded and prescribing appropriateness was evaluated using STOPP/START and Beers criteria, supplemented by geriatric pharmacological considerations. Multivariable linear regression analyses adjusted for age, sex, waist-to-height ratio, and frailty status. Results: In the fully adjusted model, inappropriate psychotropic medication use was associated with significantly slower gait speed compared with no use (B = −0.109 m/s; p = 0.026). In contrast, appropriately prescribed psychotropic medication use was not associated with gait speed (B = −0.018 m/s; p = 0.699). Conclusions: In this cross-sectional sample of relatively healthy older adults, appropriate psychotropic medication use was not associated with gait speed impairment, whereas inappropriate use was associated with slower gait. Although causal inference is not supported, these findings may inform prescribing quality and fall-risk assessment in older populations. Full article

This study investigated whether baseline sleep quality influences the effects of a 12-week multicomponent exercise program on sleep quality and physical function in community-dwelling older adults. Twenty-five older adults were classified according to baseline sleep quality using the Pittsburgh Sleep Quality Index into a Good Sleep (GS, n = 8) group and a Poor Sleep (PS, n = 17) group. The exercise program was performed three times per week for 12 weeks, with each 60 min session consisting of warm-up, multicomponent exercise, and cool-down. Outcome measures included sleep quality (PSQI), physical performance assessed by the Short Physical Performance Battery, and health-related fitness tests. A significant group × time interaction was observed for PSQI total score (p = 0.035). The PS group showed a significant reduction in PSQI score (−1.71 points, p < 0.01), indicating improved sleep quality, with favorable changes in subjective sleep quality, sleep latency, use of sleeping medication, and daytime dysfunction. However, the PS group demonstrated significant improvements in gait speed, grip strength, and 2 min walking performance. A significant group × time interaction was observed for the 30 s chair stand test (p = 0.011), with the GS group showing greater improvements in lower-extremity muscular endurance. Baseline sleep quality was associated with the pattern of adaptation to multicomponent exercise. Older adults with poor sleep quality experienced meaningful improvements in sleep, whereas those with good sleep quality showed greater gains in muscular endurance. These findings support the inclusion of sleep assessment when designing individualized exercise interventions for older adults. Full article

Hemoglobin levels play an important role in oxygen delivery to skeletal muscle, and reduced levels may impair muscle function and contribute to sarcopenia, particularly in patients with cancer. The aim of the present study was to evaluate the influence of hemoglobin levels on muscle mass and function in patients with digestive tract cancer. Methods: Patients of both sexes aged up to seventy years with cancers of the digestive system undergoing surgical and clinical treatment at an oncology referral center were included. Hemoglobin levels were assessed using a blood count, and the risk of sarcopenia was estimated using the Mini Sarcopenia Risk Assessment (MSRA). A total of 82 patients were evaluated, with a mean age of 55.4 years. Colon cancer was the most prevalent (41.6%), followed by rectal (18.3%) and stomach (14.6%) cancers. The risk of sarcopenia was estimated at 85.4%, and the prevalence of low hemoglobin levels was 71.9%; 35.4% of patients presented moderate hemoglobin depletion. Hemoglobin levels showed a moderate correlation with gait speed and a slight correlation with calf circumference, handgrip strength, and MSRA score. In conclusion, the risk of sarcopenia and low hemoglobin levels are present in patients with digestive tract cancer. Additionally, hemoglobin levels positively correlate with indicators of muscle function and the risk of sarcopenia. Full article

Background: High-heeled footwear is widely used by women, yet its systemic influence on spatiotemporal gait parameters, pelvic kinematics, and propulsion across a range of heel heights remains incompletely characterised. This study aimed to quantify gait changes across four footwear conditions and assess the contribution of anthropometric characteristics to observed gait variability. Methods: A within-subject repeated-measures study was conducted with 75 healthy young adult women (mean age 24.3 years, BMI 21.3 kg/m²) assessed barefoot, in ballerina flats, 8 cm heels, and 12 cm heels using the G-WALK inertial measurement system (BTS Bioengineering). Thirty gait parameters were analysed using the Friedman test with Bonferroni-corrected Wilcoxon post hoc comparisons (α_adj = 0.0083), Spearman rank correlations, multiple linear regression, and Kruskal–Wallis tertile analysis. Results: Footwear significantly affected 22 of 30 parameters. Walking speed was higher in all shod conditions than barefoot (up to +9.2%), driven entirely by stride elongation with cadence unchanged, indicating a general effect of footwear rather than heel elevation specifically. Stride length peaked at 8 cm heel (+8.9% vs. barefoot) and declined at 12 cm. Gait symmetry decreased progressively with heel height. Ballerina shoes produced a distinctively dynamic temporal profile—shortest stance duration, lowest double support, and highest single support time—significantly different from both barefoot and heeled conditions. The propulsion index increased height-dependently with heel height, rising 23.3% from barefoot (8.20) to 12 cm heel (10.11; p < 0.001). Pelvic obliquity symmetry was disrupted at 12 cm heel, while tilt symmetry was unaffected. Anthropometric analysis identified 110/600 significant Spearman correlations (23 surviving Benjamini–Hochberg FDR correction) and 29/120 significant regression models (14 surviving FDR); age, body weight, and shoe size were the most consistent predictors, most reliably in the barefoot condition. Conclusions: Heel height exerts condition-specific effects on gait biomechanics. Ballerina shoes produce a gait pattern distinct from both barefoot and heeled walking. Propulsion demand increases height dependently with heel elevation. Because participants walked in their own footwear, the observed effects reflect the combined characteristics of each shoe type rather than heel elevation in isolation. Anthropometric characteristics—particularly age, body weight, and shoe size—are modestly associated with footwear–gait responses and may inform future biomechanical research, although clinical application requires confirmation in standardised-footwear studies and clinical populations. Full article

Background: Spatial cognition, a skill paramount to survival, is impaired in Parkinson’s disease (PD) but has been little researched. Spatial cognition is utilized during motor–cognitive integration, which impacts daily functioning and quality of life in PD. As PD is a unilateral-onset condition, spatial–cognitive and motor–cognitive ability may differ by side of onset. Spatial cognition is suggested to be modulated by the right hemisphere; thus, we hypothesize to observe worse spatial and motor–cognitive performance by people with left-onset PD (LOPD) than right-onset PD (ROPD). Methods: 216 participants with PD were recruited (LOPD = 107; M = 62; mean age = 69.80 ± 8.5). Spatial outcomes were collected via the body position spatial task (BPST), Reverse Corsi Blocks, and visuospatial items of the Montreal Cognitive Assessment (MoCA); motor–cognitive outcomes were collected by a Trails test, a Four Square Step Test (FSST), and a Timed Up and Go test. An independent t-test and the Mann–Whitney U test compared outcome variables between onset groups. Results: No significant differences were found between onset groups. Exploratory subgroup analyses revealed differences. Significantly worse performance by LOPD in single- and dual-task TUG was found within people with bilateral symptoms and postural instability (Hoehn & Yahr stage, >2; LOPD, N = 33; single, p = 0.001; dual, p = 0.021) and worse performance in single-task TUG in people with MoCA < 18 (LOPD, N = 5; single, p = 0.036) and people with freezing of gait (FOGQ, >0; LOPD, N = 14, p = 0.048). Significantly larger DTC by LOPD was found within frequent freezers (FOGQ, >3; LOPD, N = 9; p = 0.003). Conclusions: LOPD may tend to perform worse in motor–cognitive tasks among subgroups of those with more severe symptoms, i.e., those at later stages of disease. These findings may have implications for prognoses of those with LOPD versus ROPD and suggest that those with LOPD may have worse long-term outcomes in spatial cognition and motor–cognitive integration. Full article

People living with neurological disorders frequently experience gait impairments that substantially reduce mobility, independence, and quality of life. This pilot study aimed to evaluate the feasibility, safety, and preliminary functional outcomes of integrating the EksoNR robotic exoskeleton (Ekso Bionics, San Rafael, CA, USA) into outpatient neurorehabilitation practice in individuals with chronic neurological impairments. Over an eight-month period, five participants with heterogeneous neurological conditions (two spinal cord injuries, one cerebellar ataxia, one ischemic stroke, and one spastic paraparesis) completed a four-week robotic gait training program consisting of 15 intervention sessions. Functional outcomes were assessed before and after the intervention using standardized clinical tests. Cardiovascular endurance was evaluated using the 6-Minute Walk Test (6MWT), while physical and psychological well-being were assessed with the Functional Independence Measure (FIM) and the Barthel Index, in addition to the WHO Quality of Life (WHOQOL) and EQ-5D-5L questionnaires. Mobility and balance were evaluated using the Timed Up and Go (TUG), Berg Balance Scale (BBS), Tinetti Performance-Oriented Mobility Assessment (POMA), and Walking Index for Spinal Cord Injury II (WISCI II), where applicable. In addition, device-recorded gait parameters, including step count, step length, walking distance, and walking duration, were analyzed. Significant improvements were observed in several device-derived gait parameters, including the number of steps performed with the exoskeleton (p < 0.001), step length (p = 0.003), walking distance (p = 0.002), and walking duration (p < 0.05). Significant improvements were also identified in balance performance (BBS: p = 0.006; Tinetti POMA: p = 0.001), cardiovascular endurance (6MWT: p = 0.017), and EQ-5D-5L scores (p = 0.038). Functional independence measures (FIM and BI), TUG performance, and WHOQOL domains did not demonstrate statistically significant changes. No serious adverse events or device-related injuries occurred during the intervention period. Due to the small and clinically heterogeneous sample, these findings should be interpreted as preliminary exploratory results. Nevertheless, the study supports the feasibility and potential clinical utility of EksoNR-assisted gait rehabilitation and provides a basis for larger controlled investigations. Full article

Gait is a behavioral biometric trait that enables non-invasive person recognition based on individual walking patterns. Camera-based gait acquisition is convenient, but silhouette sequences often contain substantial motion-irrelevant appearance information, such as body shape, clothing, and carried objects. To address this problem, a multi-scale time series differencer is proposed to acquire tensor difference data between adjacent frames, so as to extract dynamic feature information in motion gait image sequences. Experiments on the CASIA-B dataset show that the proposed method achieves Rank-1 accuracies of 97.7%, 94.6%, and 80.0% under NM, BG, and CL conditions, respectively. Ablation results further demonstrate that MTDU improves the mean accuracy from 84.7% to 90.8% compared with single-scale temporal differencing. The multi-scale time series differencer shows potential for fields including sports motion gait detection and recognition, surveillance security motion gait identity authentication, and medical motion gait recovery assessment for sports injuries, demonstrating practical application value. Full article

Neuropathic pain is a debilitating condition lacking objective and quantitative assessment tools, as current evaluations rely largely on subjective reports. Hyperspectral imaging (HSI) is a non-invasive technology that quantifies spatial and spectral tissue characteristics and has been applied in rheumatologic and metabolic disorders. This study investigated whether HSI-detected paw skin alterations correlate with graded nerve injury severity in a chronic constriction injury (CCI) model. Sprague–Dawley rats were assigned to sham or CCI groups with one to four sciatic nerve ligatures. Behavioral assessments (CatWalk XT gait analysis, thermal hyperalgesia, and mechanical allodynia) and paw HSI measurements were performed longitudinally. Histological and molecular analyses were conducted from paw skin to dorsal spinal cord tissues. At 1100 nm, HSI demonstrated progressive and significant spectral deviations proportional to injury severity across all CCI groups, whereas 1300 nm changes were only detected in severe injuries. Histology revealed increased fibrosis, NGF, TNF-α, synaptophysin, and microglial activation with greater injury severity, alongside reduced PGP9.5, neurofilament, AChR, Desmin, GAP-43, Pax3, and BDNF expression. These molecular findings were supported by electrophysiological and behavioral impairments, which correlated with injury grade by HSI. In conclusion, HSI at 1100 nm provides a sensitive and objective indicator of neuropathic pain severity and holds promise as a quantitative translational tool. Full article

Background: Traditional gait assessments in adult degenerative scoliosis (ADS) often rely on prohibitively expensive, laboratory-bound optoelectronic systems that lack clinical accessibility. This research aims to independently evaluate both lower limbs using a wearable Inertial Measurement Unit (IMU) system, in contrast to studies that employ a unilateral reference, thereby elucidating the unique bilateral asymmetries and dynamic stability patterns exhibited in ADS. Methods: Gait patterns of 20 ADS patients and 15 healthy controls were analyzed using the Rokoko Smartsuit Pro. Segmental kinematic data were integrated with anthropometric mass distribution models to calculate the total body center of mass (CoM). Spatiotemporal parameters, joint range of motion (RoM), and CoM excursions in three planes were statistically compared between the groups. Results: ADS patients exhibited a cautious gait strategy characterized by significantly reduced step speed, shortened step lengths, and increased step width ($p<0.05$). Temporal analysis showed prolonged stride, stance, and double support time ($p<0.001$), while cadence remained comparable to healthy controls. A triple-joint deficit, including hip, knee, and ankle, was identified in the sagittal plane, especially with peak flexion reductions reaching up to 55% in the left knee and 38% in the right knee, highlighting profound functional asymmetry ($p<0.001$). Additionally, the CoM analysis reflected these stability restrictions, showing increased horizontal excursion and reduced vertical oscillation. Conclusions: Our findings suggest that ADS is associated with distinct, bilateral alterations in the lower limb kinematic chain and notable adaptations in dynamic balance parameters, characterized by a cautious gait strategy and profound sagittal triple-joint asymmetries. These findings highlight the feasibility of full-body wearable IMU technology in capturing objective, bilateral gait alterations, providing a foundational baseline that could complement standard static radiography in future clinical evaluations. Full article

Ankle dorsiflexion plays a vital role in ensuring safe and effective walking post-stroke, yet the best methods for assessing it and their clinical significance are still uncertain. This research compiles the existing sensor-based technologies used to measure ankle dorsiflexion in adults who have experienced a stroke and examines how these measurements correlate with walking performance. It also compares these findings with traditional clinical evaluation methods like manual muscle testing (MMT). We conducted a systematic search of PubMed, IEEE Xplore, and the Cochrane Library (2000–2025) for both observational and experimental studies that utilized sensor-based techniques (such as handheld or isokinetic dynamometry, load cells, and proprioceptive devices) to quantify ankle dorsiflexion and reported their relationship with gait outcomes. Additionally, studies employing conventional, non-instrumented clinical grading (e.g., ankle-dorsiflexor MMT) were included if they explored the connection between ankle function and gait, although these were not included in the quantitative analysis. Eighteen studies involving 783 stroke survivors met the inclusion criteria and were evaluated using the Newcastle–Ottawa Scale. Generally, individual studies found a positive association between ankle-dorsiflexor strength and both gait speed and endurance, although some negative correlations were noted. The strength and sometimes direction of these associations varied depending on the sensing technology, dorsiflexion index, gait outcome, and stroke chronicity. Overall, the current evidence indicates a generally positive but highly variable relationship between ankle dorsiflexion measurements and gait post-stroke, emphasizing the need to identify sources of variability and to create standardized, clinically applicable sensor-based assessment protocols. Full article

Background/Objectives: The suboccipital muscles (SOMs) are rich in muscle spindles and play a critical role in proprioceptive input and postural control. However, the relationship between SOM tone, head posture, and balance performance remains unclear. Therefore, this study aimed to investigate the association between SOM tone and postural balance, including the craniovertebral angle (CVA), static balance, and dynamic balance, in healthy adults. Methods: A total of 112 healthy adults participated in this study. SOM, cervical extensor muscle (CEM), and upper trapezius muscle (UTM) tones were assessed. Head posture was evaluated by measuring the CVA. Static balance was assessed through the trajectory of the center of pressure (COP), whereas dynamic balance was evaluated using gait parameters. Results: Participants with a higher SOM tone exhibited a significantly smaller CVA, increased COP path length and velocity, and narrower step width during walking than did those with a lower tone. The regression analysis showed that SOM tone was significantly associated with CVA (β = −0.219, p = 0.020), COP path length (β = 0.308, p = 0.001) and velocity (β = 0.296, p = 0.002), and step width (β = −0.242, p = 0.014), whereas CEM and UTM tone were not significantly associated with these variables. Conclusions: These findings suggest that SOM tone may be associated with postural control characteristics among healthy adults. Full article

Background: Changes in the rearfoot calcaneal position affect the foot “arch structure” during the stance phase of gait and hence influence reactions in the plantar fascia thickness and stiffness during weight bearing. However, previous research has focused on the non-weight-bearing assessment of plantar fascia thickness (PFT) and stiffness (PFS) and has not linked these measurements to rearfoot position. Methods: This study aims to investigate if a change in the weight-bearing rearfoot position influences the PFT and PFS. A linear actuator-driven 3D-printed platform was utilised to reliably move the rearfoot through a range of frontal (F (4,12) = 19,585.8, p = 0.00) and sagittal plane angles (F (2,6) = 11,751.32, p = 0.00) whilst weight bearing. An ultrasound probe capable of shear wave elastography was incorporated into the platform for the closed-chain weight-bearing assessment of the PF. The PFT and PFS were collected for 13 (26 feet) participants (11 male, two female; age 35.62 ± 15.04; BMI: 30.31± 6.22 Kg/m²) from a convenience sample who met the inclusion criteria. Results: The data were subject to appropriate statistical, collective and cluster analysis. Individual participant data analysis showed a strong nonlinear correlation between PFT and PFS in the relaxed calcaneal position. The rearfoot sagittal plane cluster demonstrated an auxetic property in 54.3% of the group, where both the PFT and PFS increased. The frontal plane cluster demonstrated an auxetic property in 76% of the group, where the PFT increased as the PFS increased. Conclusions: The results suggest that the PF does have a specific response to changes in the rearfoot position for individuals, which, in some, can show an auxetic property. Full article

Background/Objectives: Normal pressure hydrocephalus (NPH) is a treatable cause of gait impairment and fall risk in older adults, yet it remains frequently underdiagnosed. This study aimed to validate an automated measurement of the callosal angle, a recognized imaging marker of NPH, adapted for use on routine head computed tomography (CT). Methods: We performed a retrospective analysis of 198 patients with probable NPH, confirmed by gait improvement following lumbar tap test, and 198 age- and sex-matched controls presenting with headache and negative head CT findings (mean age 74 ± 7 years; 60% male in both groups). Manual callosal angle measurements were independently obtained by trained residents and reviewed by neuroradiologists. Automated and manual measurements were compared using intraclass correlation, and diagnostic performance was assessed across threshold values. Results: Automated callosal angle measurements demonstrated strong agreement with manual measurements (ICC = 0.90). Using an automated callosal angle threshold of <90°, diagnostic accuracy was 84.1%, with sensitivity of 90.4% and specificity of 77.8%. Optimization to a 95° threshold yielded an accuracy of 85.9%, with both sensitivity and specificity of 85.9%. The area under the receiver operating characteristic curve was 0.915 (95% CI, 0.897–0.933). Conclusions: Automated callosal angle assessment on routine head CT provides reliable and scalable detection of NPH, supporting its use as a screening tool to facilitate earlier diagnosis and treatment of a potentially reversible cause of dementia. Full article

Magnetorheological (MR) dampers enable semi-active control in prosthetic knees by providing rapidly adjustable resistance with low mechanical complexity. This paper evaluates three torque level control methodologies for a transfemoral prosthetic leg incorporating an MR damper: a model-based feedforward strategy, an adaptive inverse-dynamics controller, and a robust inverse-dynamics controller. A Lagrange-based planar leg model with explicit force-to-torque mapping is formulated, and a reference knee trajectory is estimated from measurable gait variables using a cubic polynomial model whose order is selected through least-squares RMSE analysis. Each controller is assessed using knee-angle tracking accuracy and control effort to capture the practical trade-off between motion quality and energy demand. Results demonstrated that the adaptive inverse-dynamics controller has the smallest tracking error but requires the highest effort, whereas the robust inverse-dynamics approach realizes approximately the same tracking performance with reduced effort, thereby suggesting the best accuracy–effort compromise in the present work. Results, likewise, examined actuator feasibility by considering the MR damper as the primary dissipative element and the DC motor as a supplemental active actuator required when damping alone cannot satisfy the commanded knee torque. Full article