Search Results (179)

Children with cerebral palsy (CP) exhibit head instability during simple overground walking, which may comprise sensory input and reduce stepping accuracy. Investigations of head stability during more challenging tasks, where fall risk may be increased, are limited. This study explored differences in head stability between ambulatory children with hemiplegic CP (N = 9) and diplegia (N = 9) (GMFCS I and II) and typically developing (TD) children (N = 8) during a targeted stepping task. All children completed five trials stepping into two successive rectangular floor-based targets whilst walking along an 8 m walkway. Three-dimensional motion capture enabled calculation of head stability and foot placement within and before each target. A two-way mixed-design ANOVA compared differences between all groups and target approach. Children with diplegic CP showed greater sagittal, frontal, and resultant head-to-laboratory and head-to-trunk head instability compared to children with hemiplegic CP and TD children. Anteroposterior foot placement error was significantly greater in children with hemiplegic CP (8.5 ± 5.0 cm) compared to TD children (3.8 ± 1.5 cm). Group differences in head instability were not consistent with group differences in foot placement error. To better understand how head instability might affect fall risk in children with CP, more challenging environments should be tested in future. Full article

So far, there have been no high-quality studies examining the efficacy of outpatient biofeedback devices in cases of prescribed partial weight-bearing, such as after surgery on the lower limbs. This study aimed to assess whether a biofeedback device is more effective than using a personal scale. Two groups of healthy individuals wearing an insole orthosis were trained to achieve partial loading in a three-point gait within a target zone of 15–30 kg during overground walking and going up and down stairs. The treatment group (20 women and 22 men) received continuous biofeedback, while the control group (26 women and 16 men) received no information. Findings were compared in a randomized controlled trial. Compliance with partial loading without biofeedback was poor; on level ground and stairs, only one in two steps fell within the target area, and overloading occurred on at least one in three steps. The treatment group reduced the percentage of steps taken in the overload zone to ≤8.4% (p < 0.001 across all three courses) and achieved more than two-thirds of their steps within the target zone (p < 0.001 on level ground, p = 0.008 upstairs, and p = 0.028 downstairs). In contrast, the control group did not demonstrate any significant differences in the target zone (p = 0.571 on level ground, p = 0.332 upstairs, and p = 0.392 downstairs). In terms of maintaining partial load, outpatient biofeedback systems outperform bathroom scales. Full article

Triterpenoid saponins from the Astragalus species possess valuable effects (cytotoxic, adjuvant, hepatoprotective, neuroprotective, antiviral, etc.). Some also have immunomodulatory activities. Astragalus glycyphyllos is distributed in Bulgaria and mainly accumulates cycloartane saponins. From the overground parts of the species, a triterpenoid cyloartane-type saponin (AGOS3) was isolated by different chromatographic techniques. A quantitative LC-MS method for the determination of the saponin was developed and validated. Further, the saponin was loaded in copolymeric micelles based on triblock copolymers of polyethylene oxide and polypropylene oxide (Pluronics). The LC-MS method was applied on the developed micelles to determine their loading degrees. Afterwards, the possible pharmacological effects of free and encapsulated in polymeric nanoparticles of triterpenoid saponin (1, 5, 10, 25, 50, and 100 µg/mL) were evaluated in isolated murine macrophages and lymphocytes in vitro. Free AGOS3 stimulated proliferation only at the highest tested concentrations (50–100 µg/mL), and the effect was more evident in isolated macrophages. Interestingly, AGOS3-loaded polymeric micelles caused concentration dependency and statistically significant increases in the proliferation of both isolated lymphocytes and macrophages, even at a lower concentration (10 µg/mL). These results could serve as the basis for further research on the immunomodulatory effect of this saponin. Full article

Background: Three-dimensional motion analysis using optoelectronic cameras and force platforms is typically used to quantify gait disorders. However, these systems have various limitations, particularly when assessing patients in an ecological environment. To address these limitations, several wearable devices have been developed. However, few studies have reported metrological information regarding their repeatability and sensitivity to change. Methods: A healthy adult performed 6 min walking tests with FeetMe^® system insoles under different walking conditions overground and on a treadmill. The standard error of measurement (SEM), the minimum detectable differences (MDDs), and the effect size (ES) were calculated for spatio-temporal parameters, and the ground reaction force was calculated from the 16,000 steps recorded. Results: SEM values were below 3.9% for the ground reaction force and below 6.8% for spatio-temporal parameters. ES values were predominantly high, with 72.9% of cases between overground and treadmill conditions with induced asymmetry, and 64.5% of cases between treadmill conditions with and without induced asymmetry exhibiting an ES greater than 1.2. The minimum detectable differences ranged from 4.5% to 10.7% for ground reaction forces and 2.1% to 18.9% for spatio-temporal parameters. Conclusion: Our study demonstrated that the FeetMe^® system is a reliable solution. The sensitivity to change showed that these instrumented insoles can effectively reflect patient asymmetry and progress. Full article

Relearning to walk requires progressive training in real scenarios—overground—along with assistance in basic tasks, such as balancing. In addition, user ability must be maximized through compliant robotic assistance as needed. Despite decades of research, gait rehabilitation robotic devices yield controversial results. This article presents the conceptual design of a novel walking assistance and rehabilitation robot, the NIMBLE robot, aimed at providing ambulatory, bodyweight-supported gait training, assisting the user’s center of mass trajectory to aid weight transfer and dynamic balance during walking. NIMBLE consists of a robotic mobile frame, a partial bodyweight support (PBWS) system, an ambulatory lower-limb exoskeleton (Exo-H3) and a cable-driven pelvis-assisting robot. Designed as a modular structure, it differentiates hierarchical communication levels through a Robot Operating System (ROS) 2 network. We present the mechatronic design and experimental results assessing the impact of the mechatronic coupling between the robotic modules on the walking kinematics and the frame movement control performance. The robotic frame hardly affects the walking kinematics up to 2 degrees in both the sagittal and frontal planes, making it feasible for lateral balance and weight translation training. Moreover, it successfully tracks and follows user trajectories. The NIMBLE robotic frame assessment shows promising results for ambulatory gait rehabilitation. Full article

Running is the basis of many sports and has highly beneficial effects on health. To increase the understanding of running, DSPro^® insoles were developed to collect running parameters during tasks. However, no validation has been carried out for running gait analysis. The aims of this study were to assess the test–retest reliability and criterion validity of running gait parameters from DSPro^® insoles compared to a motion-capture system. Equipped with DSPro^® insoles, a running gait analysis was performed on 30 healthy participants during overground and treadmill running using a motion-capture system. Using an intraclass correlation coefficient (ICC), the criterion validity and test–retest reliability of spatiotemporal parameters were calculated. The test–retest reliability shows moderate to excellent ICC values (ICC > 0.50) except for propulsion time during overground running at a fast speed with the motion-capture system. The criterion validity highlights a validation of running parameters regardless of speeds (ICC > 0.70). This present study validates the good criterion validity and test–retest reliability of DSPro^® insoles for measuring spatiotemporal running gait parameters. Without the constraints of a 3D motion-capture system, such insoles seem to be helpful and relevant for improving the care management of active patients or following running performance in sports contexts. Full article

The purpose of this study was to assess the biomechanical adaptations prompted by stationary cycling paired with visual feedback of vertical pedal reaction forces during both stationary cycling and overground walking for patients who underwent a total knee arthroplasty (TKA). Specifically, an emphasis on the inter-limb deficits in knee joint biomechanics were examined. Ten patients who underwent a TKA took part in an acute intervention with pre- and post-testing measurements of kinematics (240 Hz) and kinetics (1200 Hz) during stationary cycling and overground walking. The intervention phase consisted of six cycling sessions during which participants were provided with visual feedback of their bilateral peak vertical pedal reaction force, with instructions to maintain a symmetrical loading between limbs. A 2 × 2 (work rate/speed × time) repeated measures ANOVA (α = 0.05) was conducted on key outcome variables. Peak knee extension moment asymmetry during stationary cycling significantly improved (p = 0.038, η²_p = 0.610) following the acute intervention. Walking velocities for both preferred (p = 0.001, d = 0.583) and fast (p = 0.002, d = 0.613) walking speeds displayed improvements from pre- to post-testing. Significant improvements in the total score (p = 0.009, d = 0.492) and ADL subscale score (p = 0.041, d = 0.270) for the Knee Injury and Osteoarthritis Outcome Score were present following the acute intervention. Stationary cycling with visual feedback may be beneficial post-TKA; however, further investigation is merited. Full article

Objective: This study aimed to investigate the effects of overground robot exoskeleton gait training on gait outcomes, balance, and motor function in patients with stroke. Methods: Following the PRISMA guidelines, literature searches were performed in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, Ovid-LWW, and RISS databases. A total of 504 articles were identified, of which 19 were included for analysis after application of the inclusion and exclusion criteria. The included literature was qualitatively evaluated using the PEDro scale, while the Egger’s regression, funnel plot, and trim-and-fill methods were applied to assess and adjust for publication bias. Results: The averaged PEDro score was 6.21 points, indicating a high level of methodological quality. In the analysis based on dependent variables, higher effect sizes were observed in the following ascending order: gait speed (g = 0.26), motor function (g = 0.21), gait ability (g = 0.18), Timed Up and Go Test (g = −0.15), gait endurance (g = 0.11), and Berg Balance Scale (g = 0.05). Subgroup analyses further revealed significant differences in Asian populations (g = 0.26), sessions lasting longer than 30 min (g = 0.37), training frequency of three times per week or less (g = 0.38), and training duration of four weeks or less (g = 0.25). Overall, the results of this study indicate that overground robot exoskeleton gait training is effective at improving gait speed in patients with stroke, particularly when the sessions exceed 30 min, are conducted three times or less per week, and last for four weeks or less. Conclusion: our results suggest that training is an effective intervention for patients with stroke, provided that appropriate goal-setting and intensity and overground robot exoskeleton gait are applied. Full article

Overground rock is a prominent feature of rocky desertification landscape in karst farmland; however, people often pay attention to their adverse effects, leaving their positive effects on ecohydrological processes and plant growth as rarely studied and utilized. In this study, the effects of overground rock film mulching (ORFM) on soil water flow behavior, soil water content and temporal and spatial heterogeneity were investigated through a dye tracer test and soil moisture measurement. Moreover, the effects of this technology on the root characteristics of crops (maize and broad bean) were analyzed. The results showed that ORFM treatment significantly increased soil water content and its spatio-temporal heterogeneity by preventing preferential flow at the rock–soil interface. It suggested that this practice can provide a more favorable soil moisture environment for crop growth, which was confirmed by the differences in root characteristics of crops (maize and broad bean) under different treatments in this study. It was found that ORFM treatment reduced the root radial extent of crops but increased the root biomass and root bifurcation rate, which are widely considered to be key factors in improving the efficiency of fine root absorption. Therefore, we believe that ORFM has great potential to improve the effective use of soil water and agricultural water management in karst areas, which is essential for sustainable agricultural development in the region. Full article

Cognitive reserve (CR) seems to be an ability to adapt cognitive processes in response to brain disease and may influence rehabilitation outcomes. This is a secondary analysis of the “Robot-Assisted Gait Training versus conventional therapy on mobility in severely disabled progressive MultiplE sclerosis patients” (RAGTIME) trial to investigate the influence of CR on the outcomes after gait rehabilitation in people with multiple sclerosis (PwMS). We included 53 PwMS and severe gait disability (EDSS 6–7). The participants were randomized into two groups to receive either robot-assisted gait training or overground walking (three times/week over four weeks). CR was evaluated by the Cognitive Reserve Index questionnaire (CRIq), which encompasses three sections (CRI Education, CRI Working Activity, and CRI Leisure Time). We stratified the patients using the 115 cut-off CRIq total score of at least a medium-high CR. The outcome measures were Timed 25-Foot Walk, 6 min walking test, Berg Balance Scale, Multiple Sclerosis Impact Scale—29, Multiple Sclerosis Walking Scale—12, Patient Health Questionnaire—9, and Fatigue Severity Scale (FSS). After gait rehabilitation, the FSS was significantly improved in those patients with higher CR compared with the others (F = 4.757, p = 0.015). In our study, CR did not affect the gait, balance, disability perception, and depression. Conversely, it positively influenced the fatigue after gait rehabilitation. Full article

We aimed to evaluate the intra-session relative and absolute reliability of obstacle-crossing parameters during overground walking in young adults, and to determine the number of trials required to ensure reliable assessment. We analysed data from 43 young male adults who were instructed to walk at a self-selected velocity on a pathway and to step over an obstacle (height = 15 cm; width = 80 cm, thickness = 2 cm) three times. Spatial–temporal gait parameters of the approaching and crossing phases (i.e., before and after the obstacle) and obstacle clearance parameters (i.e., vertical and horizontal distance between the foot and the obstacle during crossing) were computed using a three-dimensional motion analysis system. Intraclass correlation coefficients were used to compute the relative reliability, while standard error of measurement and minimal detectable change were used to assess the absolute reliability for all possible combinations between trials. Results showed that most spatial–temporal gait parameters and obstacle clearance parameters are reliable using the average of three trials. However, the mean of the second and third trials ensures the best relative and absolute reliabilities of most obstacle-crossing parameters. Further works are needed to generalize these results in more realistic conditions and in other populations. Full article

Walking encompasses a complex interplay of neuromuscular coordination and cognitive processes. Disruptions in gait can impact personal independence and quality of life, especially among the elderly and neurodegenerative patients. While traditional biomechanical analyses and neuroimaging techniques have contributed to understanding gait control, they often lack the temporal resolution needed for rapid neural dynamics. This study employs a mobile brain/body imaging (MoBI) platform with high-density electroencephalography (hd-EEG) to explore event-related desynchronization and synchronization (ERD/ERS) during overground walking. Simultaneous to hdEEG, we recorded gait spatiotemporal parameters. Participants were asked to walk under usual walking and dual-task walking conditions. For data analysis, we extracted ERD/ERS in α, β, and γ bands from 17 selected regions of interest encompassing not only the sensorimotor cerebral network but also the cognitive and affective networks. A correlation analysis was performed between gait parameters and ERD/ERS intensities in different networks in the different phases of gait. Results showed that ERD/ERS modulations across gait phases in the α and β bands extended beyond the sensorimotor network, over the cognitive and limbic networks, and were more prominent in all networks during dual tasks with respect to usual walking. Correlation analyses showed that a stronger α ERS in the initial double-support phases correlates with shorter step length, emphasizing the role of attention in motor control. Additionally, β ERD/ERS in affective and cognitive networks during dual-task walking correlated with dual-task gait performance, suggesting compensatory mechanisms in complex tasks. This study advances our understanding of neural dynamics during overground walking, emphasizing the multidimensional nature of gait control involving cognitive and affective networks. Full article

Purpose: Soft robotic exoskeletons (SREs) are portable, lightweight assistive technology with therapeutic potential for improving lower limb motor function in children with cerebral palsy. To understand the effects of long-term SRE-assisted walking training on children with spastic cerebral palsy (SCP), we designed a study aiming to elucidate the effects of SRE-assisted walking training on lower limb motor function in this population. Methods: In this randomized, single-blinded (outcome assessor) controlled trial, forty children diagnosed with SCP were randomized into the routine rehabilitation (RR) group (N = 20) and the SRE group (N = 20) for comparison. The RR group received routine rehabilitation training, and the SRE group received routine rehabilitation training combined with SRE-assisted overground walking training. Assessments (without SRE) were conducted pre- and post-intervention (8 weeks after the intervention). The primary outcome measures included the 10 m walk test (10MWT) and the 6 min walk test (6MWT). Secondary outcome measures comprised the gross motor function measure-88, pediatric balance scale modified Ashworth scale, and physiological cost index. Results: Both groups showed significant improvements (p < 0.01) across all outcome measures after the 8-week intervention. Between-group comparisons using ANCOVA revealed that the SRE group demonstrated greater improvement in walking speed from the 10MWT (+6.78 m/min, 95% CI [5.74–7.83]; p < 0.001) and walking distance during the 6MWT (+34.42 m, 95% CI [28.84–39.99]; p < 0.001). The SRE group showed greater improvement in all secondary outcome measures (p < 0.001). Conclusions: The study findings suggested that the integration of SRE-assisted overground walking training with routine rehabilitation more effectively enhances lower limb motor function in children with SCP compared to routine rehabilitation alone. Full article

An evaluation of the possible hepatotoxicity/hepatoprotective effects of a defatted extract of the above ground parts of Phlomis russeliana was conducted in vitro and in vivo. The extract was tested in vitro on hepatocytes alone and in a carbon tetrachloride (CCl₄)-bioactivation model. The same toxic substance was used for the in vivo evaluation on old Wistar rats. The extract was standardised via high performance liquid chromatography (HPLC) by the quantification of total flavonoids and verbascoside. Gallic acid equivalents were used to express the content of total phenolic compounds. The identification of flavonoids in this species was undertaken for the first time. The extract was not statistically hepatotoxic in vitro on the isolated rat hepatocytes. In the CCl₄-induced hepatotoxicity model, the extract had a hepatoprotective effect, which was concentration-dependant (the highest at 50 µg/mL). An in vivo study on old rats confirmed the observed antioxidant and hepatoprotective effects. The histological findings were favourable for the rats, given the extract and CCl₄ in combination. They had an unchanged organ structure, which is commensurable with these animals, treated with a combination of CCl₄ and silymarin. Full article

The global aging population faces significant health challenges, including an increasing vulnerability to disability due to natural aging processes. Wearable lower limb exoskeletons (LLEs) have emerged as a promising solution to enhance physical function in older individuals. This systematic review synthesizes the use of LLEs in alignment with the WHO’s healthy aging vision, examining their impact on intrinsic capacities and functional abilities. We conducted a comprehensive literature search in six databases, yielding 36 relevant articles covering older adults (65+) with various health conditions, including sarcopenia, stroke, Parkinson’s Disease, osteoarthritis, and more. The interventions, spanning one to forty sessions, utilized a range of LLE technologies such as Ekso^®, HAL^®, Stride Management Assist^®, Honda Walking Assist^®, Lokomat^®, Walkbot^®, Healbot^®, Keeogo Rehab^®, EX1^®, overground wearable exoskeletons, Eksoband^®, powered ankle–foot orthoses, HAL^® lumbar type, Human Body Posturizer^®, Gait Enhancing and Motivation System^®, soft robotic suits, and active pelvis orthoses. The findings revealed substantial positive outcomes across diverse health conditions. LLE training led to improvements in key performance indicators, such as the 10 Meter Walk Test, Five Times Sit-to-Stand test, Timed Up and Go test, and more. Additionally, enhancements were observed in gait quality, joint mobility, muscle strength, and balance. These improvements were accompanied by reductions in sedentary behavior, pain perception, muscle exertion, and metabolic cost while walking. While longer intervention durations can aid in the rehabilitation of intrinsic capacities, even the instantaneous augmentation of functional abilities can be observed in a single session. In summary, this review demonstrates consistent and significant enhancements in critical parameters across a broad spectrum of health conditions following LLE interventions in older adults. These findings underscore the potential of LLE in promoting healthy aging and enhancing the well-being of older adults. Full article