Leg movement tracking in automatic video-based one-leg stance evaluation.

Falls are a major risk in elder population. Early diagnosis is therefore an important step towards increasing the safety of elders. One of the common diagnostic tests is the Berg Balance Scale (BBS), consisting of 14 exercises arranged from the easiest (sitting-to-standing) to the most demanding (one-leg stance). In this study a novel approach to the automatic assessment of the time in which the patient can remain in the one-leg stance position without loosing balance is introduced. The data is collected using a regular video camera. No markers, special garments, or system calibration are required. Two groups are examined. The first group consists of 16 students: healthy, young adults (12 female, 4 male, avg. 20yrs±1). The second group consists of 50 elders (39 female, 11 male, avg. 78.8yrs±5.9). Data (short, one minute recordings) are collected in a controlled environment using a digital video recorder (50fps, 1920×1080) fixed to a tripod. Data are processed off-line. First, the region of interest is determined. Next, the Kanade-Lucas-Tomasi tracking is performed. Best tracks are selected based on the registered vertical movement and two tracks are obtained corresponding to the left and right leg movements. Tracks are later subjected to the sparse signal baseline estimation, denoising and thresholding to detect the raised leg. Results are compared frame-wise to the ground truth reference obtained in the manual processing procedure. Both legs are evaluated in the elder group (in all cases several attempts featuring both legs were registered), resulting in 89.18%±11.27% DICE, 93.07%±5.43% sensitivity and 96.94%±6.11% specificity values for both legs. The signal of a single leg is evaluated in the student group (in all cases only one attempt was needed to perform the full examination) resulting in 98.96%±1.2% DICE, 98.78%±1.65% sensitivity and 98.73%±2.69% specificity values. This is the first step towards a video-based system enabling the automatic assessment of the four last, most vital tasks of the Berg Balance Scale evaluation.

Frailty phenotype and the role of levodopa challenge test in geriatric inpatients with mild parkinsonian signs.

Deficiency in dopaminergic system function may be one of the hypothetical reasons of the frailty syndrome but its role still remains unclear. The aim of our study was to assess the frailty phenotype prevalence in geriatric inpatients with mild parkinsonian signs (MPS) and to investigate levodopa test in the frail patients with MPS. We examined 118 participants: 90 with MPS and 28 in control group (without MPS). The frailty syndrome presence was evaluated by the Fried criteria. Deficiency in dopaminergic system function was assessed by one of the modifications of an acute levodopa challenge test (LCT): in MPS group every patient was examined by performing Up and Go Test and also Step Test before and 3 h after taking 125 mg of Madopar (levodopa + benserazide). Sixty-nine study subjects (58%) met criteria for frailty. Fifty-five participants in MPS group (61.1% of MPS group) and fourteen (50%) in control group. All of the patients that scored positive in walk speed criterion of frailty were frail. When all MPS patients were considered, the number of components scored positive for frailty was directly related to the walk speed (r = -0.70, p < 0.0001). In MPS group LCT scores were significantly higher for frailty patients compared to non-frailty (p = 0.0027). When all MPS patients were considered, the number of components scored positive for frailty was directly related LCT score (r = 0.37, p = 0.0004). There was a relationship between LCT and walk speed (r = -0.31, p = 0.0032). Our observations provide new information about the relationship between frailty and MPS, suggest the need for increased awareness of frailty in MPS patients and conversely. Our study provides data for a discussion on pathophysiological background of the frailty syndrome (FS), emphasizing the theories of the important impact of dopaminergic system deficit and encourages further research on the role of LCT in measuring it.

Knowledge on cardiovascular risk factors improves the effectiveness of rehabilitation following acute coronary syndrome.

BACKGROUND: There is a clear association between knowledge on healthy lifestyle and intensity of healthy behaviours, especially among young people. AIM: We sought to verify this hypothesis among patients after acute coronary syndrome (ACS), who were subjected to early in-hospital complex cardiac rehabilitation (CCR), by assessing the relationship between initial knowledge on cardiovascular risk factors and efficiency of rehabilitation. METHODS: Two hundred and five consecutive patients (153 man; age 62 ± 9 years) hospitalised between May 2013 and April 2014 were prospectively enrolled. On admission, the knowledge on risk factors was assessed by questionnaire. At the beginning, in the second and in the third week of CCR the six-minute walk test (6MWT) was performed. Effectiveness of rehabilitation was assessed by the 6MWT in the third week. Distance, speed, and metabolic equivalents (METs) were consid-ered markers of improvement. RESULTS: The most common number of correct answers was 11 (out of 20 questions) about risk factors (on average 54 ± 18%). Knowledge on more than 10 items was found for 99 subjects (48%) (i.e. good level of knowledge). Improvement of haemodynamic parameters and CCR effectiveness was found ('0' vs. '3': distance [m]: 442.0 ± 102.2 vs. 485.2 ± 109.3, p < 0.01; speed [km/h]: 4.4 ± 1.0 vs. 4.8 ± 1.1, p < 0.01; METs: 3.1 ± 0.5 vs. 3.3 ± 0.5; p < 0.01). Significantly better indica-tors of CCR effectiveness characterised patients with better knowledge (good knowledge vs. bad knowledge: distance [m]: 500.5 ± 95.7 vs. 470.8 ± 119.4, p = 0.04; speed [km/h]: 5.0 ± 1.0 vs. 4.7 ± 1.2, p = 0.04; METs: 3.4 ± 0.5 vs. 3.2 ± 0.6, p = 0.04). There was correlation between the percentage of correct answers and distance in 6MWT (R = 0.374, p < 0.001). CONCLUSIONS: Knowledge on the cardiovascular risk factors improves rehabilitation effectiveness among patients after ACS.

Influence of an extended education program on the knowledge of cardiovascular risk factors among subjects undergoing rehabilitation following acute coronary syndrome.

INTRODUCTION: Health education is a component of complex cardiac rehabilitation (CCR). AIM: To evaluate the influence of an authorial extended educational program on the knowledge of cardiovascular risk factors among subjects undergoing early in-hospital rehabilitation following acute coronary syndrome treated with percutaneous intervention. MATERIAL AND METHODS: This prospective study covered 205 consecutive subjects (153 men and 52 women, aged 62 ±9 years) undergoing CCR. They were randomly allocated to the control group (105 patients receiving standard education during CCR) or the study group (100 patients participating in the extended education program). The extended education program was conducted in the 2nd and 3rd week of CCR and included a package of educational materials and additional lectures. RESULTS: Knowledge of basic rules for secondary cardiac prevention was better in the study group, both on admission and after CCR. Notwithstanding, a positive influence of the extended educational program was found with regard to awareness of recommended blood pressure levels and blood lipid profile (improvement of 15-20% in the study group). At baseline, the knowledge of risk factors was comparable between the groups (the percentage of correct questionnaire answers was 50 ±17% among the controls vs. 49 ±16% in the study group; p = 0.77), but improved significantly after education (52 ±17% among controls vs. 58 ±19% in the study group; p = 0.009) and remained better in the study group after a 3-month follow-up (56 ±19% among controls vs. 64 ±19% in the study group). CONCLUSIONS: Extended education during CCR significantly improves the knowledge of cardiovascular risk factors in patients after acute coronary syndrome.

Oxygen uptake during Nordic walking training in patients rehabilitated after coronary events.

BACKGROUND: Nordic walking (NW) is an effective form of endurance training in cardiac rehabilitation (CR). The key parameter for the safety and effectiveness of the training is its intensity. Training intensity may be directly measured by the volume of oxygen consumption (VO2), and indirectly by chronotropic cardiac response to exercise. No data have been published on the rates of VO2 during NW in field conditions among patients rehabilitated after coronary events. AIM: To assess the intensity of NW training in field conditions by measuring VO2, energy expenditure (EE), and heart rate (HR) in comparison with a treadmill cardiopulmonary exercise test (CPET) in a group of patients rehabilitated after coronary events. METHODS: Thirteen men after percutaneous coronary intervention due to an acute coronary syndrome (STEMI, NSTEMI, or UA), aged 53.2 ± 8.2 years, were evaluated and recruited for comprehensive CR at 30.3 ± 15.7 days after the incident. Left ventricular ejection fraction was evaluated and treadmill exercise test (ExT) using an individualised ramp protocol was performed during initial functional assessment. Following risk stratification, patients began training at 50% of HR reserve (HRR). Participants at low and moderate risk qualified for field NW training in the second week of CR. Treadmill CPET using a ramp protocol was performed after the patients had mastered the technique of walking with poles. Next day, HR, parameters of ventilation, and respiratory gas concentrations were measured during NW using a portable spiroergometry system. RESULTS: Exercise tolerance estimated during initial ExT was 9.1 ± 2.5 MET. Peak VO2 was 27.5 ± 5.4 mL/min/kg during CPET vs. 26.2 ± 7.7 mL/min/kg during NW (p < 0.447). Mean VO2 during NW was 17.5 ± 4.5 mL/min/kg, which amounted to 59.4 ± 18.6% of VO2 reserve in CPET. Mean HR during NW was 104.8 ± 9.8 bpm, amounting to 63.7 ± 28.7% of HRR, and peak HR was 128.4 ± 13.7 bpm vs. 131.1 ± 18.0 bpm during CPET (p < 0.628). EE during 24.7 ± 9.7 min of NW was 210.7 ± 149.0 kcal (8.1 ± 2.7 kcal/min). CONCLUSIONS: The intensity of NW training in field conditions in patients after coronary events was 59% of VO2 reserve, and its peak instantaneous intensity reached values obtained during CPET on a treadmill. EE during NW in the study group was 8.1 kcal/min. Chronotropic response during NW was 64% of HRR, and its instantaneous increase reached the maximum HR obtained during CPET.