Ana Francisca Rozin Kleiner

We investigated the impact of visual impairment on balance control. We measured the center of pressure (COP) between the two feet and plantar surface pressures on each foot in 18 normal-sighted participants and compared their data with measures from 18 legally blind participants, either acquired or congenital. Pressures were measured in open- and closed-eye conditions using a baropodometric resistive plate. In the eyes-open condition, there were no differences between the sighted and legally blind groups in COP displacement. However, participants with visual loss had significantly increased pressures in two metatarsal regions (M1 and M2 zones) of the plantar surface in both viewing conditions (p < 0.05). The differences in pressure measures between the normally sighted and legally blind groups could be attributed mainly to the subgroup of subjects with acquired impairment. Our findings suggest that subjects with visual impairment present increased metatarsal pressures (i.e. forefoot), not yet associated to anterior displacement of COP or impaired balance control.

Objective Individuals with Parkinson’s Disease (PD) and freezing of gait (FOG) present peripheral and central sensitivity disturbances that impair motor performance. This study aimed to investigate long‐term effects of plantar sensory stimulation on brain activity, brain connectivity and gait velocity of subjects with PD and FOG. Methods Twenty‐five subjects were enrolled in this clinical trial (NCT02594540). Plantar sensory stimulation was delivered using the Automated Mechanical Peripheral Stimulation therapy (AMPS). Volunteers were randomly assigned to real or placebo AMPS groups and received eight sessions of treatment. The primary outcome was brain activity (task‐based fMRI – active ankle dorsi‐plantar flexion). Secondary outcomes were brain connectivity (resting‐state ‐ RS fMRI) and gait velocity. fMRI was investigated on the left, right and mid sensory‐motor regions, left and right basal ganglia. Results No changes in brain activity were observed when task‐based fMRI was analyzed. After real AMPS, RS functional connectivity between basal ganglia and sensory‐related brain areas increased (insular and somatosensory cortices). Gait velocity also increased after real AMPS. A positive correlation was found between gait velocity and the increased connectivity between sensory, motor and supplementary motor cortices. Conclusion Plantar sensory stimulation through AMPS was not able to modify brain activity. AMPS increased the RS brain connectivity mainly in areas related to sensory processing and sensorimotor integration. Plantar stimulation could be a way to improve plantar sensitivity and consequently ameliorate gait performance. However, the mechanisms behind the way AMPS influences brain pathways are still not completely known.

Impairments of functional mobility may affect locomotion and quality of life in subjects with Parkinson’s disease (PD). Movement smoothness measurements, such as the spectral arc length (SPARC), are novel approaches to quantify movement quality. Previous studies analyzed SPARC in simple walking conditions. However, SPARC outcomes during functional mobility tasks in subjects with PD and freezing of gait (FOG) were never investigated. This study aimed to analyze SPARC during the Timed Up and Go (TUG) test in individuals with PD and FOG. Thirty-one participants with PD and FOG and six healthy controls were included. SPARC during TUG test was calculated for linear and angular accelerations using an inertial measurement unit system. SPARC data were correlated with clinical parameters: motor section of the Unified Parkinson’s Disease Rating Scale, Hoehn & Yahr scale, Freezing of Gait Questionnaire, and TUG test. We reported lower SPARC values (reduced smoothness) during the entire TUG test, turn and stand to sit in subjects with PD and FOG, compared to healthy controls. Unlike healthy controls, individuals with PD and FOG displayed a broad spectral range that encompassed several dominant frequencies. SPARC metrics also correlated with all the above-mentioned clinical parameters. SPARC values provide valid and relevant clinical data about movement quality (e.g., smoothness) of subjects with PD and FOG during a functional mobility test.

This systematic review aimed to investigate emerging methods used to quantify gait parameters in children with cerebral palsy (CP) in everyday environments. The StArt computational tool automatically screened the following databases: ACM, Engineering Village, IEEE, PubMed, Scopus and Web of Science from inception to June 2018. Studies reporting the use of wearable sensors to assess gait in daily settings in children with CP were included. Data regarding 1563 studies were extracted, but only three studies could be included on the basis of the inclusion/exclusion criteria. These studies proposed wearable technologies based on the use of signals provided by triaxial accelerometers and force resistive pressure sensors. These are able to track levels of activity and detect falls, gait deviations and gait symmetry in children with CP in their daily environments. To date, only two types of sensors have been tested in this population and it remains to be clarified how wearable sensors, used to quantify activity level, might benefit children with CP.

BACKGROUND: The shuffling steps pattern is a typical feature of gait in patients affected by Parkinson's disease (PD), which progressively reduces their quality of life, being related to the risk of falls in this population. Recently, Automated Mechanical Peripheral Stimulation (AMPS) was presented as an integrative rehabilitative treatment based on peripheral stimulation able to improve the gait spatiotemporal parameters in PD patients. AIM: The aim of this study was to evaluate the effects of AMPS on shuffling steps pattern by analyzing the kinematic and spatio-temporal gait parameters. DESIGN: Double blind randomized longitudinal study. SETTING: Outpatients. POPULATION: PD patients. METIIODS: In this double blind randomized longitudinal study, 14 patients with PD were treated with effective-AMPS (AMPS group), while 14 PD patients were treated with placebo-AMPS (SHAM group); 32 healthy subjects were deemed the control group (CG). A dedicated medical device (Gondola (TM) Medical Technologies, Stabio, Switzerland) was used to deliver both stimulations. Each treatment session lasted about 15 minutes, including preparation (approx. 10 to 13 minutes) and stimulation (approx. 2 minutes). All PD patients were given six AMPS/SHAM treatments sessions, twice a week, delivered during the off-levodopa phase, having withdrawn from dopaminergic medication overnight. We evaluated spatio-temporal and kinematic variables of gait with quantitative 3D-gait analysis as follows: before and after the first intervention (acute phase), then after the sixth session (long term phase). RESULTS: We detected differences in all gait variables immediately after the first session of AMPS treatment and again after the sixth stimulation session. CONCLUSIONS: AMPS treatment changes the shuffling steps pattern that is typical of PD subjects, increasing the ROM of hip, knee and ankle joints during the gait cycle. CLINICAL REHABILITATION IMPACT: This data presents further evidence that a rehabilitative approach based on the AMPS treatment can induce improvements in the gait pattern of patients affected by PD.

Individuals with Parkinson's disease (PD) and freezing of gait (FOG) have impaired postural control. Recent studies using foot sensory stimulation delivered by means of automated mechanical peripheral stimulation (AMPS) have demonstrated improvements of gait in individuals with PD. This study aimed to investigate the effects of AMPS on postural control in individuals with PD and FOG. Thirty-three subjects participated in this randomized controlled trial. Participants were allocated to two groups: AMPS and AMPS SHAM. Subjects underwent eight sessions of real (AMPS) or placebo AMPS (AMPS SHAM) once every three/four days. Postural control was assessed by means of posturography before the first and after the eighth session of treatment. We did not find positive effects of AMPS on center of pressure parameters. Thus, it seems that AMPS has no positive effect in terms of improving static postural control in individuals with PD and FOG.