Effects of slouched sitting posture on clavicular and scapular orientations and movements in individuals with neck pain with scapular dysfunction.

BACKGROUND: It has been suggested that sitting posture affects clavicular, scapular and spinal kinematics, however its effects in people with neck pain and scapular dysfunction remain unknown. The study aimed to determine the clavicular and scapular kinematics in different sitting postures in patients with neck pain and scapular dysfunction. METHODS: Thirty-four participants with neck pain and scapular dysfunction were recruited into the study. Kinematics of the clavicle and scapula were recorded using motion analysis at rest and during arm elevation (at 30, 60, 90, and 120 degrees) in a slouched and upright sitting posture. RESULTS: Compared to the upright sitting posture, the slouched sitting posture had increased clavicular protraction and elevation as well as scapular internal rotation and anterior tilt at rest and during the arm raising and lowering phases (at 30, 60, 90, and 120 degrees) (p < 0.05). The slouched sitting also had increased scapular upward rotation in the lowering phase at all angles (p < 0.05). SIGNIFICANCE: The slouched sitting posture has a significant influence on clavicular and scapular kinematics. Awareness of good sitting posture should be encouraged in patients with neck pain and scapular dysfunction.

Gait smoothness during high-demand motor walking tasks in older adults with mild cognitive impairment.

Early signs of Mild Cognitive Impairment (MCI)-related gait deficits may be detected through the performance of complex walking tasks that require high gait control. Gait smoothness is a robust metric of overall body stability during walking. This study aimed to explore gait smoothness during complex walking tasks in older adults with and without MCI. Participants were 18 older adults with MCI (mean age = 67.89 ± 4.64 years) and 18 cognitively intact controls (mean age = 67.72 ± 4.63 years). Gait assessment was conducted under four complex walking tasks: walking a narrow path, walking around an obstacle, horizontal head turns while walking, and vertical head turns while walking. The index of harmonicity (IH), representing gait smoothness associated with overall body stability, was measured in anteroposterior, mediolateral, and vertical directions. A multivariate analysis was employed to compare the differences in IH between groups for each complex walking task. The MCI group demonstrated a reduction of IH in the mediolateral direction during the horizontal head turns than the control group (MCI group = 0.64 ± 0.16, Control group = 0.74 ± 0.12, p = 0.04). No significant differences between groups were found for the IH in other directions or walking conditions. These preliminary findings indicate that older adults with MCI have a decline in step regularity in the mediolateral direction during walking with horizontal head turns. Assessment of the smoothness of walking during head turns may be a useful approach to identifying subtle gait alterations in older adults with MCI, which may facilitate timely gait intervention.

Feasibility of Internet-Based Physical-Cognitive Exercise for Health Benefits of Middle-Aged Obese Women.

INTRODUCTION: Obesity in middle-aged women markedly increases the risk for non-communicable diseases, neurodegenerative diseases, and physical and cognitive problems. Exercise, particularly combined physical-cognitive exercise, has been demonstrated to have beneficial effects on both physical and cognitive health. However, middle-aged women often face barriers to engaging in exercise, which include time constraints, lack of motivation, and enjoyment. Incorporating an exercise program into a technology-based intervention in the home environment may help overcome these barriers and promote health benefits. Therefore, this study aimed to assess the feasibility of home-based, physical-cognitive internet-based exercise for middle-aged obese women. METHODS: A total of 33 middle-aged obese women were enrolled in the study. Participants performed an intervention for 60 min/day, 3 days/week for 3 months. Feasibility outcomes (adherence, adverse events, physical performances, obesity parameters, and enjoyment of the program) were measured. RESULTS: Average exercise adherence was 91.67%, and no adverse events were reported in this feasibility study. At the end of the training period, body weight and BMI were significantly decreased compared to baseline. As for physical performances, both cardiorespiratory fitness and lower limb muscle power were significantly improved at post-training when compared to baseline. Furthermore, the participants experienced a high level of exercise enjoyment, and it was maintained over the 3-month training period. CONCLUSION: These findings suggest that home-based, internet-based physical-cognitive exercise was safe and feasible for reducing obesity parameters, improving physical function, maintaining enjoyment over the course of training, and facilitating adherence to exercise in middle-aged obese women.

Conventional video-based system for measuring the subtask speed of the Timed Up and Go Test in older adults: Validity and reliability study.

The Timed Up and Go Test (TUG) is a simple fall risk screening test that covers basic functional movement; thus, quantifying the subtask movement ability may provide a clinical utility. The video-based system allows individual's movement characteristics assessment. This study aimed to investigate the concurrent validity and test-retest reliability of the video-based system for assessing the movement speed of TUG subtasks among older adults. Twenty older adults participated in the validity study, whilst ten older adults participated in the reliability study. Participant's movement speed in each subtask of the TUG under comfortable and fast speed conditions over two sessions was measured. Pearson correlation coefficient was used to identify the validity of the video-based system compared to the motion analysis system. Intraclass correlation coefficient (ICC3,2) was used to determine the reliability of the video-based system. The Bland-Altman plots were used to quantify the agreement between the two measurement systems and two repeatable sessions. The validity analysis demonstrated a moderate to very high relationship in all TUG subtask movement speeds between the two systems under the comfortable speed (r = 0.672-0.906, p < 0.05) and a moderate to high relationship under the fast speed (r = 0.681-0.876, p < 0.05). The reliability of the video-based system was good to excellent for all subtask movement speeds in both the comfortable speed (ICCs = 0.851-0.967, p < 0.05) and fast speed (ICCs = 0.720-0.979, p < 0.05). The Bland-Altman analyses showed that almost all mean differences of the subtask speed of the TUG were close to zero, within 95% limits of agreement, and symmetrical distribution of scatter plots. The video-based system was a valid and reliable tool that may be useful in measuring the subtask movement speed of TUG among healthy older adults.

1D Barcode Detection: Novel Benchmark Datasets and Comprehensive Comparison of Deep Convolutional Neural Network Approaches.

Recent advancement in Deep Learning-based Convolutional Neural Networks (D-CNNs) has led research to improve the efficiency and performance of barcode recognition in Supply Chain Management (SCM). D-CNNs required real-world images embedded with ground truth data, which is often not readily available in the case of SCM barcode recognition. This study introduces two invented barcode datasets: InventBar and ParcelBar. The datasets contain labeled barcode images with 527 consumer goods and 844 post boxes in the indoor environment. To explore the influential capability of the datasets that affect recognition process, five existing D-CNN algorithms were applied and compared over a set of recently available barcode datasets. To confirm the model's performance and accuracy, runtime and Mean Average Precision (mAP) were examined based on different IoU thresholds and image transformation settings. The results show that YOLO v5 works best for the ParcelBar in terms of speed and accuracy. The situation is different for the InventBar since Faster R-CNN could allow the model to learn faster with a small drop in accuracy. It is proven that the proposed datasets can be practically utilized for the mainstream D-CNN frameworks. Both are available for developing barcode recognition models and positively affect comparative studies.

Gait variability during abrupt slow and fast speed transitions in older adults with mild cognitive impairment.

Gait speed modulation, including abruptly decreasing or increasing gait speed, is a challenging task and prerequisite for safe mobility in the community. Older adults with Mild Cognitive Impairment (MCI) exhibit gait deficits under challenging walking conditions which may increase their risk of falls. The purpose of this study was to investigate spatiotemporal variability during slow and fast speed transitions in older adults with and without MCI. Twenty-five older adults with MCI (mean age = 68.56 ± 3.79 years) and 25 cognitively intact controls (mean age = 68.72 ± 4.67 years) participated. Gait performance during gait speed transitions was measured in two walking conditions: 1) a slow to fast speed transition in response to a randomly presented cue, and 2) a fast to slow speed condition in response to a randomly presented cue. Means and variability of spatiotemporal parameters during the transitions were measured and mixed model repeated measures ANOVAs were used to assess interaction and main effects. The older adults with MCI exhibited greater variability of step length (MCI = 13.93 ± 5.38, Control = 11.12 ± 3.15, p = 0.03) and swing time (MCI = 13.35 ± 6.01, Control = 10.43 ± 2.87, p = 0.03) than the controls during the fast to slow speed transitions. No other between-group differences were evident for the gait parameters across the two walking conditions. The findings suggest that older adults with MCI have reduced ability to adapt their gait during transitions from fast to slow walking speeds. This impairment may indicate a decline in automated regular rhythmic gait control and explain in part why this group is at increased risk of falls. Slow speed transition task might be incorporated as a fall risk screening in older adults with MCI.

3D measurement of clavicular and scapular orientations: The association with clinical characteristics and responsiveness to scapular repositioning in patients with neck pain.

BACKGROUND: Clavicular and scapular orientations vary between neck pain patients as do clinical features and responses (changes in pain and rotation range) to scapular repositioning. Associations between these factors are unknown. OBJECTIVES: To identify subgroups of neck pain patients based on three-dimensional (3D) measures of clavicular and scapular orientations and differences between subgroups in clinical characteristics and responses to scapular repositioning. DESIGN: Cross-sectional study. METHODS: Eligible participants were recruited as part of a larger study. The 3D clavicular and scapular orientations were analyzed on the more painful side of the neck using a hierarchical cluster analysis. Clinical characteristics were neck pain location, intensity, duration, disability and presence of headache. Responses to scapular repositioning were classified as "yes and no". RESULTS: Fifty-eight participants (29 responsive; 29 non-responsive to scapular repositioning) participated in the study. Analysis identified two distinct subgroups: subgroup1 had greater clavicular retraction and scapular downward rotation (n = 26) and subgroup2 had greater clavicular elevation and scapular internal rotation and anterior tilt (n = 32). Headache and dominant pain in the upper neck were more frequent in subgroup 1 while dominant pain in the lower neck was frequent in subgroup 2 (p < 0.01). Most participants who responded positively to scapular repositioning (88.5%) were in subgroup1 and most non-responsive participants (81.2%) in subgroup2. CONCLUSIONS: The 3D clavicular and scapular orientations identified two subgroups of neck pain patients. Participants with predominantly downward scapular rotation were distinguished by pain in the upper neck, presence of headache and a positive response to scapular repositioning.

Clavicular and scapular, but not spinal kinematics vary with scapular dyskinesis type during arm elevation and lowering in persons with neck pain.

BACKGROUND: Scapular dyskinesis is often observed in patients with neck pain. However, it is unknown whether clavicular, scapular and spinal kinematics vary with different types of scapular dyskinesis during arm movement. RESEARCH QUESTION: Are there differences in clavicular, scapular and spinal kinematics during unilateral arm elevation and lowering among neck pain patients presenting with (i) scapular winging, (ii) with dysrhythmia, (iii) with no scapular abnormality and (iv) healthy controls? METHODS: Sixty participants with neck pain (20 in each group) and 20 asymptomatic controls were recruited. The 3D kinematic data were measured during unilateral arm elevation and lowering at 30°, 60°, 90°, and 120° in the scapular plane. A three-way mixed-effects ANOVA was used to determine the main effects (group, phase and angle) and the interactions between three independent variables on the kinematic data. RESULTS: The neck pain group with scapular winging had decreased clavicular retraction and increased scapular internal rotation and anterior tilt compared to the other neck pain and control groups at all angles during both phases of arm movement (p < 0.01). The neck pain group with scapular dysrhythmia had decreased scapular upward rotation compared to all other groups (p < 0.01). Some alterations in the kinematics existed during the lowering phase compared to the raising phase for all groups (p < 0.05). Spinal kinematics were similar across all groups (p > 0.05). SIGNIFICANCE: Specific patterns of clavicular and scapular kinematics were identified during arm movement relevant to the type of observed scapular dyskinesis in patients with neck pain. Such findings stand to inform more precise and relevant motor training in rehabilitation and improve understanding of the association between altered scapular kinematics and neck pain.

Reliability and validity of the Swaymeter for measuring the trunk control in children with spastic cerebral palsy.

AIMS: To examine the reliability and validity of a simple device, the Swaymeter, for measuring trunk control in children with CP. METHODS: Twenty children with spastic CP participated in this study. Trunk sway was measured while quietly sitting for 30s. Children lean forward or backward as far as possible for measuring dynamic balance range. Test-retest reliability was conducted. The concurrent and construct validity of the Swaymeter was assessed by comparison to the motion capture system and gross motor function measure (GMFM). RESULTS: The reliability of the Swaymeter was moderate to excellent in measuring trunk sway and dynamic balance range (ICCs = 0.696-0.948). Concurrent validity showed good results (r = 0.818-0.997) and construct validity of dynamic balance in anterior direction showed moderate to high correlation with the GMFM (r = 0.599-0.849). CONCLUSION: Assessment of trunk control in a sitting position using the Swaymeter in this study was valid and reliable in children with CP.

An Interactive Physical-Cognitive Game-Based Training System Using Kinect for Older Adults: Development and Usability Study.

BACKGROUND: Declines in physical and cognitive functions are recognized as important risk factors for falls in older adults. Promising evidence suggests that interactive game-based systems that allow simultaneous physical and cognitive exercise are a potential approach to enhance exercise adherence and reduce fall risk in older adults. However, a limited number of studies have reported the development of a combined physical-cognitive game-based training system for fall risk reduction in older adults. OBJECTIVE: The aim of this study is to develop and evaluate the usability of an interactive physical-cognitive game-based training system (game-based exercise) for older adults. METHODS: In the development phase (Part I), a game-based exercise prototype was created by integrating knowledge and a literature review as well as brainstorming with experts on effective fall prevention exercise for older adults. The output was a game-based exercise prototype that covers crucial physical and cognitive components related to falls. In the usability testing (Part II), 5 games (ie, Fruits Hunter, Where Am I?, Whack a Mole, Sky Falls, and Crossing Poison River) with three difficulty levels (ie, beginner, intermediate, and advanced levels) were tested in 5 older adults (mean age 70.40 years, SD 5.41 years). After completing the games, participants rated their enjoyment level while engaging with the games using the Physical Activity Enjoyment Scale (PACES) and commented on the games. Descriptive statistics were used to describe the participants' characteristics and PACES scores. RESULTS: The results showed that the average PACES score was 123 out of 126 points overall and between 6.66 and 7.00 for each item, indicating a high level of enjoyment. Positive feedback, such as praise for the well-designed interactions and user-friendly interfaces, was also provided. CONCLUSIONS: These findings suggest that it is promising to implement an interactive, physical-cognitive game-based exercise in older adults. The effectiveness of a game-based exercise program for fall risk reduction has yet to be determined.

Smartphone Monitoring of Gait and Balance During Irregular Surface Walking and Obstacle Crossing.

As gait adaptation is vital for successful locomotion, the development of field-based tools to quantify gait in challenging real-world environments are crucial. The aims of this study were to assess the reliability and validity of a smartphone-based gait and balance assessment while walking on unobstructed and obstructed terrains using two phone placements. Furthermore, age-related differences in smartphone-derived gait strategies when navigating different walking conditions and environments were evaluated. By providing a method for evaluating gait in the simulated free-living environment, results of this study can elucidate the strategies young and older adults utilize to navigate obstructed and unobstructed walking paths. A total of 24 young and older adults ambulated indoors and outdoors under three conditions: level walking, irregular surface walking, and obstacle crossing. Android smartphones placed on the body and in a bag computed spatiotemporal gait (i.e., velocity, step time, step length, and cadence) and balance (i.e., center of mass (COM) displacement), with motion capture and video used to validate parameters in the laboratory and free-living environments, respectively. Reliability was evaluated using the intraclass correlation coefficient and validity was evaluated using Pearson's correlation and Bland-Altman analysis. A three-way ANOVA was used to assess outcome measures across group, condition, and environment. Results showed that smartphones were reliable and valid for measuring gait across all conditions, phone placements, and environments (ICC2,1: 0.606-0.965; Pearson's r: 0.72-1.00). Although body and bag placement demonstrated similar results for spatiotemporal parameters, accurate vertical COM displacement could only be obtained from the body placement. Older adults demonstrated a longer step time and lower cadence only during obstacle crossing, when compared to young adults. Furthermore, environmental differences in walking strategy were observed only during irregular surface walking. In particular, participants utilized a faster gait speed and a longer step length in the free-living environment, compared to the laboratory environment. In conclusion, smartphones demonstrate the potential for remote patient monitoring and home health care. Along with being easy-to-use, inexpensive, and portable, smartphones can accurately evaluate gait during both unobstructed and obstructed walking, indoors and outdoors.

Beneficial Effects of Interactive Physical-Cognitive Game-Based Training on Fall Risk and Cognitive Performance of Older Adults.

Physical and cognitive declines are significant risk factors for falls. Promising evidence suggests that combined physical-cognitive training would be an effective fall risk reduction and cognitive improvement intervention. However, a limited number of studies have been conducted and findings have been inconclusive. This study investigated the effects of interactive physical-cognitive game-based training on the fall risk and cognitive performance of older adults. Forty participants were randomly allocated to the intervention (n = 20) and control (n = 20) groups. Participants in the intervention group performed a 1 h session, 3 times a week for 12 weeks of the interactive physical-cognitive game-based training program. Fall risk (Physiological Profile Assessment, PPA; and Timed Up and Go, TUG) and cognitive outcome (Montreal Cognitive Assessment, MoCA) were assessed at pre- and post-intervention. Thirty-nine participants (mean age = 69.81 ± 3.78 years) completed the study (97.5%). At the end of the trial, participants in the intervention group demonstrated significant improvement in the PPA fall risk score (p = 0.015), postural sway (p = 0.005), MoCA score (p = 0.001), and TUG-dual task (p = 0.045) compared to controls. In conclusion, the interactive physical-cognitive, game-based training was effective in reducing physiological fall risk and improving cognitive function in community-dwelling older adults.

Smartphone-Based Assessment of Gait During Straight Walking, Turning, and Walking Speed Modulation in Laboratory and Free-Living Environments.

As turns and walking speed modulation are crucial for functional mobility, development of a field-based tool to objectively evaluate non-steady-state gait is essential. This study aimed to quantify spatiotemporal gait using three Android smartphones during steady-state walking, turns, and gait speed modulation in laboratory and free-living environments. In total, 24 adults ambulated along a 10-m walkway in both environments under seven conditions: straight walking, 90° left or right turn, and modulating gait speed from usual-slow, usual-fast, slow-fast, and fast-slow. Two smartphones were attached to the body, with another phone placed in a shoulder bag. Gait velocity, step time, step length, cadence, and symmetry were computed from smartphone-based tri-axial accelerometers and validated with motion capture and video, in laboratory and free-living environments, respectively. Validity was assessed using Pearson's correlation and Bland-Altman analysis. Gait velocity results revealed moderate to very high validity across all walking conditions, smartphone models, smartphone locations, and environments. Correlations for gait velocity ranged between 0.87-0.91 and 0.79-0.83 for straight walking, 0.86-0.95 and 0.86-0.89 for turning, and 0.51-0.90 and 0.67-0.89 for speed modulation trials, in laboratory and free-living environments, respectively. Step time, step length, and cadence demonstrated high to very high correlations for straight walking and turns. However, symmetry results revealed high correlations only during straight walking in the laboratory. Conditions that included slow walking showed negligible to moderate validity with a high bias. In conclusion, smartphones can be employed as field-based devices to assess steady-state walking, turning, and speed modulation across environment, model, and placement when walking faster than 0.5 m/s.

Cognitive and visual demands, but not gross motor demand, of concurrent smartphone use affect laboratory and free-living gait among young and older adults.

BACKGROUND: As smartphones are an integral part of daily activities, understanding the underlying mechanism associated with concurrent cell phone use while walking may help reduce the risks of injury. RESEARCH QUESTION: This study examined the effect of cognitive, visual, and gross motor demands while using a phone during gait among young and older adults in the laboratory and free-living environments. METHODS: Twelve young and twelve older adults walked along a 10-m walkway under five conditions: single-task walking (Walk), walking and bi-manually holding a phone (Walk-Hold), walking while looking at a phone held in front of the participants (Walk-Look), walking while answering questions (Walk-Answer), and walking while texting (Walk-Text). All conditions were performed in laboratory and free-living environments. Gait velocity, step time, step length, and cadence were obtained using a smartphone with a built-in accelerometer attached to the body. The dual-task cost (DTC) was also assessed. A three-way ANOVA was utilized for all parameters. RESULTS: While no three-way interactions were found for any parameter, group × condition interactions were significant for gait velocity, step time, step length, cadence and their corresponding DTC. Decreased gait velocity, step length and cadence, with increased step time was demonstrated during Walk-Look, Walk-Answer, and Walk-Text, compared to Walk and Walk-Hold. While older adults markedly changed their gait during Walk-Answer and Walk-Text, these changes were less pronounced among young adults. SIGNIFICANCE: Visual and cognitive demand while concurrently using a phone influenced gait, especially among the elderly. Environment did not accentuate gait alterations during concurrent phone use. Therefore, smartphone technology should be developed to detect dual-task walking and temporarily modify functionality to reduce risk of injury from divided attention.

The validity and reliability of the Swaymeter for postural sway measurement in typically developing children aged between 7-12 years.

BACKGROUND: The Swaymeter is a simple devicefor measuring postural sway. It consists of a 40-cm-long rod with a vertically mounted pen at the end of the rod that measures the displacement of the body at waist level. RESEARCH QUESTION: This device could be an effective tool for measuring postural sway in children. However, the validity and reliability of the Swaymeter in children has not been evaluated. In this study, we aimed to evaluate the validity and reliability of the Swaymeter in typically developing children aged 7-12 years. METHOD: The Swaymeter procedure was randomly measured in quiet bipedal stance under 4 conditions: eyes open and eyes closed on the floor, eyes open and eyes closed on foam, 30 s were performed in each condition. There were 15 children participated in the validity study. The postural sway was measured concurrently with the motion capture system with two reflective markers on the top of the pen and 12th thoracic vertebra level in three trials with four testing conditions. Additionally, 36 children participated in test-retest reliability. Three measurements were performed on the same day and one week later. RESULTS: Swaymeter had a moderate to good correlation with motion capture system (r = 0.637-0.979). The test-retest reliability of the Swaymeter showed moderate to good reliability for immediate test-retest (ICC = 0.51-0.87). However, inter-session reliability revealed moderate to good reliability except for the AP variable that showed low reliability. Good to excellent reliability was found in sway area variable (ICCs between 0.74 and 0.92) for all measurements. SIGNIFICANCE: Postural sway measure by Swaymeter was valid and reliable in typically developing children aged 7-12 years and suitable for applying to assess postural sway in typically developing children.