DIFFERENCES IN HIP MUSCLE STRENGTH AND STATIC BALANCE IN PATIENTS WITH TRANSFEMORAL AMPUTATIONS CLASSIFIED AT DIFFERENT K-LEVELS: A PRELIMINARY CROSS-SECTIONAL STUDY

BACKGROUND: Following amputation, patients with lower limb amputations (LLA) are classified into different functional mobility levels (K-levels) ranging from K0 (lowest) to K4 (highest). However, K-level classification is often based on subjective criteria. Objective measures that are able to differentiate between K-levels can help to enhance the objectivity of K-level classification. OBJECTIVE(S): The goal of this preliminary cross-sectional study was to investigate whether differences in hip muscle strength and balance parameters exist among patients with transfemoral amputations (TFA) assigned to different K-levels. METHODOLOGY: Twenty-two participants with unilateral TFA were recruited for this study, with four participants assigned to K1 or K2, six assigned to K3 and twelve assigned to K4. Maximum isometric hip strength of the residual limb was assessed in hip flexion, abduction, extension, and adduction using a custom-made diagnostic device. Static balance was investigated in the bipedal stance on a force plate in eyes open (EO) and eyes closed (EC) conditions. Kruskal-Wallis tests were used to evaluate differences between K-level groups. FINDINGS: Statistical analyses revealed no significant differences in the parameters between the three K-level groups (p>0.05). Descriptive analysis showed that all hip strength parameters differed among K-level groups showing an increase in maximum hip torque from K1/2-classified participants to those classified as K4. Group differences were also present in all balance parameters. Increased sway was observed in the K1/2 group compared to the K4 group, especially for the EC condition. CONCLUSION: Although not statistically significant, the magnitude of the differences indicates a distinction between K-level groups. These results suggest that residual limb strength and balance parameters may have the potential to be used as objective measures to assist K-level assignment for patients with TFA. This potential needs to be confirmed in future studies with a larger number of participants. Layman's Abstract Patients with lower limb amputation (LLA) are classified into different mobility levels, so-called K-levels, which are ranging from K0 (lowest) to K4 (highest). K-level classification is relevant for the patients as it determines the type of prosthetic components available. However, K-level can vary greatly based on the clinician or orthopedic technician individual assessment. Objective data from physical performance tests can help to improve K-level classification. Therefore, muscle strength tests of the amputation stump as well as balance tests were performed in this study to determine whether these parameters have the potential to support K-level classification. Twenty-two participants with a thigh amputation participated in the study (four K1/2-, six K3- and twelve K4-participants). Hip muscle strength on the amputation side was assessed as well as static balance in the double leg stance with eyes open and eyes closed. Analysis of the data showed that all hip strength parameters differed between the K-level groups, with maximum strength increasing from the K1/2 group to the K4 group. Group differences were also seen in the balance parameters with greater body sway for the K1/2 group when compared to the K4 group, especially when participants had their eyes closed. These results show that muscle strength tests of the residual limb and static balance tests may serve as additional measures to improve K-level assignment for patients with LLA. This was only an initial study and further studies with a larger number of participants are required to confirm these results. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/37456/28905 How To Cite: John S, Orlowski K, Mrkor K.U, Edelmann-Nusser J, Witte K. Differences in hip muscle strength and static balance in patients with transfemoral amputations classified at different K-levels: A preliminary cross-sectional study. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 1, No.5. https://doi.org/10.33137/cpoj.v5i1.37456 Corresponding Author: Stefanie John,Department of Sports Science, Faculty of Humanities, Otto von Guericke University, Magdeburg, Germany.E-Mail: [email protected] ID: https://orcid.org/0000-0001-6722-7195

Magnetoencephalography resting-state correlates of executive and language components of verbal fluency

Verbal fluency (VF) is a heterogeneous cognitive function that requires executive as well as language abilities. The purpose of this study was to elucidate the specificity of the resting state MEG correlates of the executive and language components. To this end, we administered a VF test, another verbal test (Vocabulary), and another executive test (Trail Making Test), and we recorded 5-min eyes-open resting-state MEG data in 28 healthy participants. We used source-reconstructed spectral power estimates to compute correlation/anticorrelation MEG clusters with the performance at each test, as well as with the advantage in performance between tests, across individuals using cluster-level statistics in the standard frequency bands. By obtaining conjunction clusters between verbal fluency scores and factor loading obtained for verbal fluency and each of the two other tests, we showed a core of slow clusters (delta to beta) localized in the right hemisphere, in adjacent parts of the premotor, pre-central and post-central cortex in the mid-lateral regions related to executive monitoring. We also found slow parietal clusters bilaterally and a cluster in the gamma 2 and 3 bands in the left inferior frontal gyrus likely associated with phonological processing involved in verbal fluency.

The Mediating Role of Vision in the Relationship between Proprioception and Postural Control in Older Adults, as Compared to Teenagers and Younger and Middle-Aged Adults

The aim of this study is to analyze the mediating role of vision in the relationship between conscious lower limb proprioception (dominant knee) and bipedal postural control (with eyes open and closed) in older adults, as compared with teenagers, younger adults and middle-aged adults. Methods: The sample consisted of 119 healthy, physically active participants. Postural control was assessed using the bipedal Romberg test with participants’ eyes open and closed on a force platform. Proprioception was measured through the ability to reposition the knee at 45°, measured with the Goniometer Pro application’s goniometer. Results: The results showed an indirect relationship between proprioception and postural control with closed eyes in all age groups; however, vision did not mediate this relationship. Conclusions: Older adults outperformed only teenagers on the balance test. The group of older adults was the only one that did not display differences with regard to certain variables when the test was done with open or closed eyes. It seems that age does not influence performance on proprioception tests. These findings help us to optimize the design of training programs for older adults and suggest that physical exercise is a protective factor against age-related decline.

Static Postural Control Deficits in Adults with Myotonic Dystrophy Type 1, Steinert Disease

Background: Myotonic dystrophy type 1 (DM1) is characterized by progressive and predominantly distal muscle atrophy and myotonia. Gait and balance impairments, resulting in falls, are frequently reported in this population. However, the extent to which individuals with DM1 rely more on a specific sensory system for balance than asymptomatic individuals (AI) is unknown. Objective: Evaluate postural control performance in individuals with DM1 and its dependence on vision compared to AI. Methods: 20 participants with DM1, divided into two groups based on their diagnosis, i.e. adult and congenital phenotype, and 12 AI participants were recruited. Quiet standing postural control was assessed in two visual conditions: eyes-open and eyes-closed. The outcomes measures were center of pressure (CoP) mean velocity, CoP range of displacement in anteroposterior and mediolateral axis, and the 95% confidence ellipse’s surface. Friedman and Kruskal-Wallis analysis of variance were used to compare outcomes between conditions and groups, respectively. Results: Significant group effect and condition effect were observed on postural control performance. No significant difference was observed between the two DM1 groups. The significant differences observed between the AI group and the two DM1 groups in the eyes-open condition were also observed in the eyes-closed condition. Conclusions: The result revealed poorer postural control performance in people with DM1 compared to AI. The DM1 group also showed similar decrease in performance than AI in eyes-closed condition, suggesting no excessive visual dependency.

The effects of ankle Kinesiotaping on postural control in healthy taekwondo athletes

Background and Study Aim. Although Kinesiotape is widely used by athletes, information about its effect is unclear. Its effect on postural control might directly affect an athlete's performance. In this study, it is aimed to find out whether ankle Kinesiotaping in taekwondo athletes affects postural control. Material and Methods. Twenty-four healthy university students – taekwondo athletes (12 females, 12 males) were included in the study voluntarily (Age 21.00 ± 1.53 years; height 173.33 ± 7.29 cm; body weight 63.41 ± 9.41 kg). Kinesiotape was carried out to the dominant ankle of the participants. Kinesiotape was applied supportively to peroneus longus, peroneus brevis, and tibiofibular ligament. All participants were taken to postural control measurements twice with Kinesiotape (KT) and without KT. Postural control was measured using the Biodex Balance System with eyes open (EO) and eyes closed (EC). Overall Stability Index (OSI), anterior-posterior sway (AP) and medio-lateral sway (ML) scores were used in the evaluation of postural control. Wilcoxon test was used to compare balance scores under EO condition, and the t-test was used for dependent groups to compare balance scores under EC condition. Results. In EO condition, no significant difference was found between OSI, AP, and ML scores of the taekwondo athletes with KT and without KT (p > 0.05). In EC condition, no significant difference was found between OSI, AP, and ML scores of male taekwondo athletes with KT and without KT (p > 0.05). It was found that Kinesiotape in EC condition decreased OSI and AP sway scores in female taekwondo athletes (p < 0.05). Conclusions. It was determined that ankle Kinesiotaping of taekwondo athletes did not change the postural balance in EO condition. In EC condition it did not change the postural sway of male taekwondo athletes, but it improved the postural control performances of female taekwondo athletes.

Examining the Relationship Between a Neuromuscular Control Baseline Battery for Sport-Related Concussion and Anterior Cruciate Ligament Injury Risk

ObjectiveTo examine the relationship between the m-CTSIB and Landing Error Scoring System in a sample of collegiate female athletes.BackgroundRecent literature has linked concussion and neuromuscular deficits in the lower extremity after injury. Neuromuscular control is frequently assessed using balance measures for concussion, but also dynamically to identify anterior cruciate ligament injury (ACL) risk via jump-landing movement screening.Design/MethodsThirty-nine healthy, collegiate female soccer (n = 22) and volleyball (n = 17) athletes completed the modified-Clinical Test of Sensory Interaction of Balance (m-CTSIB) and the Landing Error Scoring System (LESS). Measures consisted of total m-CTSIB sway index scores on individual conditions (firm surface eyes open [condition 1] and eyes closed [2], foam surface eyes open [3] and eyes closed [4]), m-CTSIB overall score, and total LESS errors. LESS scores were also categorized into a low (0–4 errors) and high (5 + errors) risk to determine if athletes with worse neuromuscular control on the LESS has worse balance on the m-CTSIB. A Spearman's rank-order correlation was conducted to determine the strength of the relationship between LESS and m-CTSIB performance. A series of Mann-Whitney U test were performed to determine differences between low and high LESS performance on m-CTSIB performance.ResultsThere was a weak, negative correlation between LESS and m-CTSIB performance (rs(37) = −0.153, p = 0.35). Further, there were no differences between the low and high risk LESS groups on sway index scores on conditions 1 (U = 158.5, p = 0.39), 2 (U = 156.0, p = 0.36), 3 (U = 165.5, p = 0.51), or 4 (U = 128.5, p = 0.08), as well as overall m-CTSIB scores (U = 150.5, p = 0.28).ConclusionsThere appears to be a lack of relationship between the LESS and m-CTSIB tests, revealing the independence of static and dynamic lower extremity neuromuscular function. Athletes who may be more at risk for ACL injury due to abnormal jump-landing biomechanics, do not differ from low-risk athletes on baseline balance assessment.

A Wearable Head Mounted Display Bio-Signals Pad System for Emotion Recognition

Multimodal bio-signals acquisition based on wearable devices and using virtual reality (VR) as stimulus source are promising techniques in emotion recognition research field. Numerous studies have shown that emotional states can be better evoked through Immersive Virtual Environments (IVE). The main goal of this paper is to provide researchers with a system for emotion recognition in VR environments. In this paper, we present a wearable forehead bio-signals acquisition pad which is attached to Head-Mounted Displays (HMD), termed HMD Bio Pad. This system can simultaneously record emotion-related two-channel electroencephalography (EEG), one-channel electrodermal activity (EDA), photoplethysmograph (PPG) and skin temperature (SKT) signals. In addition, we develop a human-computer interaction (HCI) interface which researchers can carry out emotion recognition research using VR HMD as stimulus presentation device. To evaluate the performance of the proposed system, we conducted different experiments to validate the multimodal bio-signals quality, respectively. To validate EEG signal, we have assessed the performance in terms of EEG eyes-blink task and eyes-open and eyes-closed task. The EEG eyes-blink task indicates that the proposed system can achieve comparable EEG signal quality in comparison to the dedicated bio-signals measuring device. The eyes-open and eyes-closed task proves that the proposed system can efficiently record alpha rhythm. Then we used signal-to-noise ratio (SNR) and Skin Conductance Reaction (SCR) signal to validate the performance for EDA acquisition system. A filtered EDA signal, with a high mean SNR of 28.52 dB, is plotted on HCI interface. Moreover, the SCR signal related to stimulus response can be correctly extracted from EDA signal. The SKT acquisition system has been validated effectively by the temperature change experiment when subjects are in unpleasant emotion. The pulse rate (PR) estimated from PPG signal achieved the low mean average absolute error (AAE), which is 1.12 beats per minute (BPM) over 8 recordings. In summary, the proposed HMD Bio Pad offers a portable, comfortable and easy-to-wear device for recording bio-signals. The proposed system could contribute to emotion recognition research in VR environments.

Impact of Body Mass Index on Static Postural Control in Adults With and Without Diabetes: A Cross-Sectional Study

AimThe objective of this research was to determine the static postural control differences measured from a force platform in Type 2 diabetes mellitus (T2DM) and healthy control groups with different levels of body mass index (BMI), and detect the static postural control difference between T2DM and healthy control groups stratified by different BMI category. This research also explored the relationship of BMI and static postural performance.MethodsWe recruited 706 participants with T2DM and 692 healthy controls who were sufficiently matched for age, gender, and BMI in this cross-sectional study. The participants were stratified into three groups by BMI: normal weight, overweight, and obesity. All participants performed two-legged static stance postural control assessment on a firm force platform. The Center of Pressure (CoP) parameters were collected under eyes-open and eyes-closed conditions. Mann–Whitney U test was used to compare the static postural control parameters within each BMI category in both groups. The static postural control parameters among different weight groups were compared by Kruskal–Wallis test, post hoc pair-wise comparison were conducted. Generalized linear model was conducted to examine the association between BMI and static postural control parameters while controlling for confounding factors.ResultsHealthy control group had statistical difference in most CoP parameters compared to T2DM group based on all BMI categories. Normal weight participants presented significant difference compared with overweight and/or obesity for total track length (TTL) and velocity of CoP displacements in Y direction (V-Y) under eyes-open condition, and for most CoP parameters under eyes-closed condition in both groups. There were statistically significant correlations between BMI and most static postural control parameters under only eyes-closed condition according to the result of generalized linear model.ConclusionT2DM patients had impaired static postural control performance compared to healthy controls at all BMI categories. The findings also indicated the association between BMI and static postural control, where higher BMI individuals showed more static postural instability in both T2DM and healthy controls.

A Randomized, Double-Blind, Placebo-Controlled Study of the Effects of Two Sequential Doses of NV-5138 SPN-820 on Quantitative Electroencephalography in Healthy Adult Males

NV-5138 (or SPN-820) is a novel small molecule activator of the mechanistic target of rapamycin complex 1 (mTORC1) currently under development for use in treatment- resistant depression. This phase I study evaluated the safety, tolerability, and pharmacodynamics (as measured by quantitative electroencephalography, qEEG) of two sequential oral doses of NV-5138 in healthy adult males. Twenty-five participants were randomly assigned to double-blind treatment with a single dose of placebo or 2400 mg NV-5138 on Day 1, and a second dose of the same treatment on Day 3. The two doses of NV-5138 were safe and well tolerated, with no deaths, serious adverse events, or discontinuations due to adverse events. Spectral band amplitudes, derived frequency measures, and magnitude squared coherences were computed from qEEG recordings during resting state eyes-open and eyes-closed conditions at multiple timepoints. In the NV-5138 group only, significant changes in qEEG measures occurred at 1 hour post-dose on both days (near NV-5138 T max ), including decreases in low-frequency band amplitudes (theta) and increases in high-frequency EEG band amplitudes (high beta and gamma). These effects were mirrored by a decrease in the theta/beta ratio, a measure negatively associated with arousal and cognitive processing capability. Significantly increased high beta and gamma band coherences were also detected at several specific electrode pairs in both eyes-open and eye-closed conditions. NV-5138 actively modulated functional brain parameters consistent with positive effects on mood, cognition, and arousal. These results indicate that qEEG measures may be useful biomarkers of NV-5138 target engagement and related changes in neural activity.

Deep brain stimulation in the subthalamic nuclei alters postural alignment and adaptation in Parkinson’s disease

Parkinson’s disease (PD) can produce postural abnormalities of the standing body position such as kyphosis. We investigated the effects of PD, deep brain stimulation (DBS) in the subthalamic nucleus (STN), vision and adaptation on body position in a well-defined group of patients with PD in quiet standing and during balance perturbations. Ten patients with PD and 25 young and 17 old control participants were recruited. Body position was measured with 3D motion tracking of the ankle, knee, hip, shoulder and head. By taking the ankle as reference, we mapped the position of the joints during quiet standing and balance perturbations through repeated calf muscle vibration. We did this to explore the effect of PD, DBS in the STN, and vision on the motor learning process of adaptation in response to the repeated stimulus. We found that patients with PD adopt a different body position with DBS ON vs. DBS OFF, to young and old controls, and with eyes open vs. eyes closed. There was an altered body position in PD with greater flexion of the head, shoulder and knee (p≤0.042) and a posterior position of the hip with DBS OFF (p≤0.014). With DBS ON, body position was brought more in line with the position taken by control participants but there was still evidence of greater flexion at the head, shoulder and knee. The amplitude of movement during the vibration period decreased in controls at all measured sites with eyes open and closed (except at the head in old controls with eyes open) showing adaptation which contrasted the weaker adaptive responses in patients with PD. Our findings suggest that alterations of posture and greater forward leaning with repeated calf vibration, are independent from reduced movement amplitude changes. DBS in the STN can significantly improve body position in PD although the effects are not completely reversed. Patients with PD maintain adaptive capabilities by leaning further forward and reducing movement amplitude despite their kyphotic posture.