Minding your steps: a cross-sectional pilot study using foot-worn inertial sensors and dual-task gait analysis to assess the cognitive status of older adults with mobility limitations.

BACKGROUND: Cognitive impairment is a critical aspect of our aging society. Yet, it receives inadequate intervention due to delayed or missed detection. Dual-task gait analysis is currently considered a solution to improve the early detection of cognitive impairment in clinical settings. Recently, our group proposed a new approach for the gait analysis resorting to inertial sensors placed on the shoes. This pilot study aimed to investigate the potential of this system to capture and differentiate gait performance in the presence of cognitive impairment based on single- and dual-task gait assessments. METHODS: We analyzed demographic and medical data, cognitive tests scores, physical tests scores, and gait metrics acquired from 29 older adults with mobility limitations. Gait metrics were extracted using the newly developed gait analysis approach and recorded in single- and dual-task conditions. Participants were stratified into two groups based on their Montreal Cognitive Assessment (MoCA) global cognitive scores. Statistical analysis was performed to assess differences between groups, discrimination ability, and association of gait metrics with cognitive performance. RESULTS: The addition of the cognitive task influenced gait performance of both groups, but the effect was higher in the group with cognitive impairment. Multiple dual-task costs, dual-task variability, and dual-task asymmetry metrics presented significant differences between groups. Also, several of these metrics provided acceptable discrimination ability and had a significant association with MoCA scores. The dual-task effect on gait speed explained the highest percentage of the variance in MoCA scores. None of the single-task gait metrics presented significant differences between groups. CONCLUSIONS: Our preliminary results show that the newly developed gait analysis solution based on foot-worn inertial sensors is a pertinent tool to evaluate gait metrics affected by the cognitive status of older adults relying on single- and dual-task gait assessments. Further evaluation with a larger and more diverse group is required to establish system feasibility and reliability in clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov (identifier: NCT04587895).

Using shoe-mounted inertial sensors and stepping exergames to assess the motor-cognitive status of older adults: A correlational study.

Objective: Stepping exergames designed to stimulate physical and cognitive skills can provide important information concerning individuals' performance. In this study, we investigated the potential of stepping and gameplay metrics to assess the motor-cognitive status of older adults. Methods: Stepping and gameplay metrics were recorded in a longitudinal study involving 13 older adults with mobility limitations. Game parameters included games' scores and reaction times. Stepping parameters included length, height, speed, and duration, measured by inertial sensors placed on the shoes while interacting with the exergames. Parameters measured on the first gameplay were correlated against standard cognitive and mobility assessments, including the Montreal Cognitive Assessment (MoCA), gait speed, and the Short Physical Performance Battery. Based on MoCA scores, patients were then stratified into two groups: cognitively impaired and healthy controls. The differences between the two groups were visually inspected, considering their within-game progression over the training period. Results: Stepping and gameplay metrics had moderate-to-strong correlations with cognitive and mobility performance indicators: faster, longer, and higher steps were associated with better mobility scores; better cognitive games' scores and reaction times, and longer and faster steps were associated with better cognitive performance. The preliminary visual analysis revealed that the group with cognitive impairment required more time to advance to the next difficulty level, also presenting slower reaction times and stepping speeds when compared to the healthy control group. Conclusion: Stepping exergames may be useful for assessing the cognitive and motor status of older adults, potentially allowing assessments to be more frequent, affordable, and enjoyable. Further research is required to confirm results in the long term using a larger and more diverse sample.

The feasibility of a stepping exergame prototype for older adults with major neurocognitive disorder residing in a long-term care facility: a mixed methods pilot study.

PURPOSE: To explore the feasibility of an exergame prototype in residential individuals with major neurocognitive disorder (MNCD). MATERIALS AND METHODS: Participants were randomly assigned to a 12-week stepping exergame training or traditional exercise (active control group). Semi-structured interviews were conducted after six and 12 weeks of exergaming. Qualitative data were thematically analysed using NVivo 12. The Short Physical Performance Battery, one minute sit-to-stand test, Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory, Cornell Scale for Depression in Dementia, and Dementia Quality of Life were assessed at baseline and post intervention using a Quade's ANCOVA. RESULTS: Seven older adults with MNCD in the exergame and 11 in the active control group completed the study [mean age = 83.2 ± 6.5 years; 94.4% female; SPPB score = 7.3 ± 2.4]. Results indicated that the VITAAL exergame prototype was experienced as enjoyable and beneficial. The post-MMSE score was higher (η2=.02, p = 0.01, F = 8.1) following exergaming versus traditional exercise. CONCLUSIONS: The findings suggest that the exergame prototype is accepted by individuals with MNCD residing in a long-term care facility when they are able to participate and under the condition that they are extensively guided. The preliminary efficacy results revealed higher post-MMSE scores after exergaming versus traditional exercise. Future trials should confirm or refute these findings. TRIAL REGISTRATION: The trial was registered in ClinicalTrials.gov (Identifier: NCT04436315)Implications for rehabilitationThe VITAAL exergame prototype is accepted by individuals with MNCD residing in a long-term care facility who are able to participate.Supervision of exergaming by health professionals is essential for successful implementation.The VITAAL exergame prototype might maintain cognitive levels in major neurocognitive disorder longer than walking combined with standardised squatting and stepping exercises.

Usability Study of a Multicomponent Exergame Training for Older Adults with Mobility Limitations.

The global population aged 60 years and over rises due to increasing life expectancy. More older adults suffer from "geriatric giants". Mobility limitations, including immobility and instability, are usually accompanied by physical and cognitive decline, and can be further associated with gait changes. Improvements in physical and cognitive functions can be achieved with virtual reality exergame environments. This study investigated the usability of the newly developed VITAAL exergame in mobility-impaired older adults aged 60 years and older. Usability was evaluated with a mixed-methods approach including a usability protocol, the System Usability Scale, and a guideline-based interview. Thirteen participants (9 female, 80.5 ± 4.9 years, range: 71-89) tested the exergame and completed the measurement. The System Usability Scale was rated in a marginal acceptability range (58.3 ± 16.5, range: 30-85). The usability protocol and the guideline-based interview revealed general positive usability. The VITAAL exergame prototype received positive feedback and can be considered usable by older adults with mobility limitations. However, minor improvements to the system in terms of design, instructions, and technical aspects should be taken into account. The results warrant testing of the feasibility of the adapted multicomponent VITAAL exergame, and its effects on physical and cognitive functions, in comparison with conventional training, should be studied.

A Deep Learning Approach for Foot Trajectory Estimation in Gait Analysis Using Inertial Sensors.

Gait performance is an important marker of motor and cognitive decline in older adults. An instrumented gait analysis resorting to inertial sensors allows the complete evaluation of spatiotemporal gait parameters, offering an alternative to laboratory-based assessments. To estimate gait parameters, foot trajectories are typically obtained by integrating acceleration two times. However, to deal with cumulative integration errors, additional error handling strategies are required. In this study, we propose an alternative approach based on a deep recurrent neural network to estimate heel and toe trajectories. We propose a coordinate frame transformation for stride trajectories that eliminates the dependency from previous strides and external inputs. Predicted trajectories are used to estimate an extensive set of spatiotemporal gait parameters. We evaluate the results in a dataset comprising foot-worn inertial sensor data acquired from a group of young adults, using an optical motion capture system as a reference. Heel and toe trajectories are predicted with low errors, in line with reference trajectories. A good agreement is also achieved between the reference and estimated gait parameters, in particular when turning strides are excluded from the analysis. The performance of the method is shown to be robust to imperfect sensor-foot alignment conditions.

The VITAAL Stepping Exergame Prototype for Older Adults With Major Neurocognitive Disorder: A Usability Study.

Purpose: This study investigates the usability of a stepping exergame in older adults with major neurocognitive disorder (MNCD) residing in a long-term care facility. Materials and Methods: A mixed methods study was conducted. Participants played exergames for 30 min on one try-out session. During the exergames, the think aloud method was used, and field notes were taken by the facilitator. Following the exergames, participants completed the System Usability Scale (SUS) and a semi-structured in-depth interview about usability including their personal experiences. Audio files were transcribed and a thematic content analysis of the think aloud data, field notes and interviews were performed using NVivo 12. Results: Twenty-two participants with MNCD were included [mean age = 84.3 ± 5.5 (70-95) years; 81.8% women; Short Physical Performance Battery score = 7.5 ± 3.2 (1-12), Montreal Cognitive Assessment score = 11.9 ± 4.4 (2-19)]. System usability was rated "ok to good" with a mean SUS score of 57.8 (SD = 12.3) with scores ranging from 37.5 to 90.0. Five main themes emerged from the thematic content analysis: (1) perceived user friendliness and acceptability of the exergames; (2) interactional experience; (3) motivational factors; (4) training modalities; and (5) risks. There were no adverse events nor dropouts. Conclusion: Participants evaluated the usability of the exergames positively. The results indicate that the stepping exergame is usable in older adults with MNCD.

Orientation-Invariant Spatio-Temporal Gait Analysis Using Foot-Worn Inertial Sensors.

Inertial sensors can potentially assist clinical decision making in gait-related disorders. Methods for objective spatio-temporal gait analysis usually assume the careful alignment of the sensors on the body, so that sensor data can be evaluated using the body coordinate system. Some studies infer sensor orientation by exploring the cyclic characteristics of walking. In addition to being unrealistic to assume that the sensor can be aligned perfectly with the body, the robustness of gait analysis with respect to differences in sensor orientation has not yet been investigated-potentially hindering use in clinical settings. To address this gap in the literature, we introduce an orientation-invariant gait analysis approach and propose a method to quantitatively assess robustness to changes in sensor orientation. We validate our results in a group of young adults, using an optical motion capture system as reference. Overall, good agreement between systems is achieved considering an extensive set of gait metrics. Gait speed is evaluated with a relative error of -3.1±9.2 cm/s, but precision improves when turning strides are excluded from the analysis, resulting in a relative error of -3.4±6.9 cm/s. We demonstrate the invariance of our approach by simulating rotations of the sensor on the foot.

Detection and classification of multidirectional steps for motor-cognitive training in older adults using shoe-mounted inertial sensors.

Interactive games have the potential to mitigate or prevent gait impairments and cognitive decline in older adults. This study aimed at developing a novel real-time step detection and direction classification approach to be used in the evaluation of multidirectional steps and interaction while playing motor-cognitive games. Two shoe-mounted inertial sensors were used to capture foot motions, which were treated interchangeably after the application of a novel foot sagittal reflection method. A single multi-class classifier was able to distinguish step direction with an accuracy of 98.1%. Experimental results support the applicability of the solution in the context of interactive motor-cognitive training.

Effects of an In-home Multicomponent Exergame Training on Physical Functions, Cognition, and Brain Volume of Older Adults: A Randomized Controlled Trial.

Aging is associated with a decline in physical functions, cognition and brain structure. Considering that human life is based on an inseparable physical-cognitive interplay, combined physical-cognitive training through exergames is a promising approach to counteract age-related impairments. The aim of this study was to assess the effects of an in-home multicomponent exergame training on [i] physical and cognitive functions and [ii] brain volume of older adults compared to a usual care control group. Thirty-seven healthy and independently living older adults aged 65 years and older were randomly assigned to an intervention (exergame training) or a control (usual care) group. Over 16 weeks, the participants of the intervention group absolved three home-based exergame sessions per week (à 30-40 min) including Tai Chi-inspired exercises, dancing and step-based cognitive games. The control participants continued with their normal daily living. Pre- and post-measurements included assessments of physical (gait parameters, functional muscle strength, balance, aerobic endurance) and cognitive (processing speed, short-term attention span, working memory, inhibition, mental flexibility) functions. T1-weighted magnetic resonance imaging was conducted to assess brain volume. Thirty-one participants (mean age = 73.9 ± 6.4 years, range = 65-90 years, 16 female) completed the study. Inhibition and working memory significantly improved post-intervention in favor of the intervention group [inhibition: F (1) = 2.537, p = 0.046, n p 2 = 0.11, working memory: F (1) = 5.872, p = 0.015, n p 2 = 0.02]. Two measures of short-term attentional span showed improvements after training in favor of the control group [F(1) = 4.309, p = 0.038, n p 2 = 0.03, F (1) = 8.504, p = 0.004, n p 2 = 0.04]. No significant training effects were evident for physical functions or brain volume. Both groups exhibited a significant decrease in gray matter volume of frontal areas and the hippocampus over time. The findings indicate a positive influence of exergame training on executive functioning. No improvements in physical functions or brain volume were evident in this study. Better adapted individualized training challenge and a longer training period are suggested. Further studies are needed that assess training-related structural brain plasticity and its effect on performance, daily life functioning and healthy aging.

A double closed loop to enhance the quality of life of Parkinson's Disease patients: REMPARK system.

This paper presents REMPARK system, a novel approach to deal with Parkinson's Disease (PD). REMPARK system comprises two closed loops of actuation onto PD. The first loop consists in a wearable system that, based on a belt-worn movement sensor, detects movement alterations that activate an auditory cueing system controlled by a smartphone in order to improve patient's gait. The belt-worn sensor analyzes patient's movement through real-time learning algorithms that were developed on the basis of a database previously collected from 93 PD patients. The second loop consists in disease management based on the data collected during long periods and that enables neurologists to tailor medication of their PD patients and follow the disease evolution. REMPARK system is going to be tested in 40 PD patients in Spain, Ireland, Italy and Israel. This paper describes the approach followed to obtain this system, its components, functionalities and trials in which the system will be validated.

Predicting the secondary structure of proteins using machine learning algorithms.

The functions of proteins in living organisms are related to their 3-D structure, which is known to be ultimately determined by their linear sequence of amino acids that together form these macromolecules. It is, therefore, of great importance to be able to understand and predict how the protein 3D-structure arises from a particular linear sequence of amino acids. In this paper we report the application of Machine Learning methods to predict, with high values of accuracy, the secondary structure of proteins, namely alpha-helices and beta-sheets, which are intermediate levels of the local structure.

Análise da viabilidade econômica da produção de leite a pasto e com suplementos na região dos Campos Gerais - Paraná / Evaluation of the economic viability of milk production on pasture and supplements in the region of Campos Gerais - Paraná, Brazil

Com o objetivo de avaliar a rentabilidade da produção de leite no sistema de produção integração lavoura-pecuária, foi conduzido um experimento, no período de julho de 2004 a abril de 2005, em Castro, Paraná. O delineamento utilizado foi de blocos ao acaso com quatro tratamentos e três repetições, com os tratamentos correspondendo a diferentes níveis de suplementação. Os tratamentos utilizados foram: 1 - pastagem + 20 por cento de suplementação, com Dieta Total Misturada (DTM), suficiente para mantença e produção de 28 litros vaca-1dia-1; 2 - pastagem + 45 por cento de suplementação; 3 - pastagem + 65 por cento de suplementação; e 4 - pastagem + 100 por cento de suplementação. A área experimental utilizada foi de 32,40ha, com 22,4ha no inverno, implantada com o consórcio azevém anual (Lolium multiflorum L.) e aveia preta (Avena strigosa Schreb.), dividida em 12 piquetes. No verão foi utilizada área de 10,0ha, com Quicuio (Pennisetum clandestinum), dividida também em 12 piquetes. Em cada repetição, foram utilizados quatro animais "testers", sendo três vacas da raça HPB e uma da raça Jérsei. O sistema de pastejo adotado foi o de lotação contínua, com carga variável. Foram utilizados animais reguladores para controlar a altura do pasto, mantida em torno de 20cm. Foram avaliadas, duas vezes por semana, a produção individual de leite das vacas, e a cada duas semanas a percentagem de gordura, a percentagem de proteína e a contagem de células somáticas no leite. A análise econômica foi realizada utilizando a metodologia proposta pelo Sistema de Acompanhamento do Custo de Produção de Leite no Paraná - FAEP. O tratamento 1, com 20 por cento de suplementação, apresentou o melhor resultado econômico, com custo operacional total de R$ 0,4635 litro-1, e margem líquida de R$ 0,13 litro-1.

Aiming to evaluate the profitability of milk production under an integrated dairy-crop system, on experiment was carried out at a commercial farm, of Paraná State, from July 2004 up to April 2005. A completely randomized block design, with four treatments, corresponding to different supplementation levels, with three replicates was applied. Treatments were pastures supplemented with 20 percent, 45 percent, 65 percent and 100 percent of supplementation (total diet calculated to give maintenance and milk production of 28kg/cow per day). The experimental area contained 32.4 hectares, being 22.4 hectares used during winter, composed of a mixture of annual ryegrass (Lolium multiflorum L.) and black oat (Avena strigosa Schreb), divided into twelve paddocks. During summer an area of 10 hectares was used, with Kikuyo (Pennisetum clandestinum) also divided in 12 paddocks. Three Holstein and one Jersey cows were used in each experimental unit as testers animals. The grazing system was continuous, with variable stocking. Put-and-take animals were used to control ward height, maintained around 20cm. Individual milk production was evaluated twice a week and percentage of fat, protein and somatic cell count were evaluated weekly. The economic analysis was proceeded using the methodology proposed by the Milk Cost Follow Up System of Paraná State. During the evaluation period, treatment 1 with 20 percent of supplementation showed the best results, with a total operational cost of R$ 0.4635 liter-1 and net income of R$ 0.13 liter-1.

Como nós tratamos as crianças no HIAS: rotinas médicas 1 / How we treat the childrens in HIAS

Publicaçäo sobre condultas médicas adotadas para as crianças internas no Hospital Infantil Albert Sabin. Tem como finalidade maior a uniformizaçäo das condutas, intentando contribuir para o melhor atendimento aos pequenos pacientes. É dirigido ao recem nascido e lacente até três meses de idade