Brook Galna

Purpose
Conduct a systematic review aimed to identify and synthesise evidence describing how walking impairment impacts the way persons with multiple sclerosis (MS) participate in activities within their homes and communities. Further, we assessed the sensitivity of the International Classification of Functioning, Disability and Health (ICF) framework to the lived walking experience for persons with MS.

Methods
Seven electronic databases were searched for peer-reviewed articles on the walking experience of persons with MS. Qualitative articles were included if they included quotes from persons with MS regarding community walking. Qualitative data were synthesised using a hybrid inductive and deductive thematic analysis, guided by the ICF framework and quality was appraised using the CASP tool.

Results
We included 90 eligible studies (214 quotes, 1813 participants). Study quality was high in 54% of studies. Four themes were identified: (1) adapting to physical barriers; (2) navigating society; (3) emotion and mindset; and (4) personal relationships.

Conclusions
The impact of walking impairment on community participation is perceived by persons with MS as negative and the cause of disconnect from those around them. Barriers are largely perceived as extrinsic to the self. Caution should be exercised when conceptualising walking experiences with MS using the ICF framework alone.

Implications for rehabilitation
This study reinforces the understanding of walking with multiple sclerosis (MS) as dynamic and multifaceted, shaped by physical, societal, relational, and psychological factors.

There is a need for enhanced advocacy efforts that extend beyond infrastructure, targeting the immediate social networks and broader communities of individuals with MS.

Consumer and community co-designed research is pivotal in recognising emotion and mindset as central, not peripheral, to the walking experience for persons with MS.

When conducting a walking-related needs analysis for persons with MS, we recommend that clinicians integrate psychological and physical outcomes.

Background
This study aimed to determine the self-reported impacts of COVID-19 on healthcare disruption for persons with multiple sclerosis (MS) in Australia and the personal characteristics and service factors associated with disruption.

Methods
We used 2020 data from the Australian MS Longitudinal Study survey. We used univariate and backward-stepwise regression to explore the disease-related and demographic predictors of: i) the self-perceived influence of COVID-19 on medical care; and ii) the impact of reduced access to health services on health. We also quantified the cumulative impact reduced access to each health service had on the cohort, incorporating the volume and severity of the impact on health.

Results
Of the 1484 participants who provided data, 548 (36.9 %) participants reported the pandemic influenced their medical care. Participants who reported the pandemic influenced their medical care had a younger age, more comorbidities and more disability. 454 (30.6 %) participants reported that reduced access to health services impacted their health. Reduced access was most commonly reported for general practice (311, 21 %), neurology (246, 16.6 %) and physiotherapy (214, 14.4 %). Reduced access to physiotherapy had the greatest cumulative impact on health. The cumulative personal impact of reduced access across all health services was associated with several factors, including younger age, female sex and disability.

Conclusions
One-third of Australians with MS experienced healthcare disruptions during the first year of the COVID-19 pandemic, with the reduced access to physiotherapy most significantly impacting health. The study underscores the importance of continuity of healthcare services during future crises and underscores the need for robust strategies such as hybrid healthcare models and telehealth frameworks to guard against risks to service delivery in the future.

Background
Multiple sessions of walking with blood flow restriction (BFR) of the legs can improve cardiovascular fitness, muscle strength and hypertrophy in older adults. However, it is unclear whether BFR impairs walking balance acutely, potentially increasing falls risk during BFR training for this at-risk population.

Research Question
Does bilateral BFR of the legs acutely worsen walking balance of older adults?

Methods
Ten older adults (mean age: 73, SD: 3 y) walked for 10 min on a treadmill at 50 %, 60 % and 70 % of their fast walking speed, with 10 cm-wide cuffs on the proximal thigh of both legs inflated to 0 % (no cuff), 40 % or 60 % of arterial occlusion pressure. We measured four characteristics of walking balance which were selected a priori and combined into a gait quality index predictive of future falls in older adults: autocorrelation of vertical accelerations; magnitude and harmonicity of sideways accelerations; and magnitude of the dominant period of forwards accelerations.

Results
Walking balance worsened with BFR, independent of walking speed, for all outcomes except the magnitude of the dominant period of forwards accelerations, with worse balance observed with increasing cuff pressure. Compared to no BFR, gait quality declined 12 % when walking with 50 % occlusion and declined 20 % with 60 % occlusion (p < 0.001).

Significance
Our findings suggest that BFR results in poorer acute walking balance, with a dose-response relationship for cuff pressure. Supervised walking trials are warranted to further assess the safety of BFR training in community settings and whether these balance-related changes may stimulate beneficial chronic balance adaptations.

Background
Posterior cortical atrophy (PCA) is a dementia subgroup commonly misdiagnosed due to unusual presentation and limited clinical awareness. Previously, the GaitDem study provided proof-of-concept for the use of accelerometery-based walking assessment in clinical and real-world settings in supporting differentiation Lewy body disease (LBD) and Alzheimer's disease (AD). Real-world walking assessment also provides insights into the impact of disease on everyday behaviours. Here, we aimed to assess the feasibility of accelerometery-based real-world walking assessment of PCA and describe differences between PCA and more prevalent neurodegenerative dementia syndromes, AD and LBD.

Methods
Fourteen participants with PCA (Age: 71 years (56-78); 57% female) wore an accelerometer (AX6, Axivity) affixed to their lower back for up to seven days. Using validated algorithms, real-world walking outcomes were derived including measures of walking quality (step velocity), volume (minutes spent walking, steps per day, bouts per day), pattern (mean bout duration) and variability (of bout durations). Data was compared to the GaitDem cohort, which included 36 people with AD (Age: 77 years (67-88); 58% female) and 46 with LBD (Age: 77 years (65-91); 17% female), following a similar protocol. Kruskal-Wallis Test assessed between-group differences with post-hoc Dunn tests. 26 controls (Age: 74(60-89), 58% female) were included for visual comparison (Figure 1).

Results
Twelve PCA participants completed seven days of real-world walking assessment; two completed 5-6 days. The PCA group walked faster, spent more minutes walking, took more steps and walking bouts per day (p <0.01 for all) than the LBD group; no significant differences were found for pattern and variability outcomes or between PCA and AD groups (p >0.05; Figure 1).

Conclusion
All PCA participants completed real-world walking assessment for the recommended period of >3 days, suggesting feasibility. Preliminary results suggest that the PCA group's real-world macro walking behaviours are more similar to AD than LBD. Despite a small sample, this novel data provides proof-of-concept. Only real-world macro walking outcomes are reported. Previously, clinic-based accelerometery outcomes relating to micro gait characteristics (e.g. spatiotemporal and signal-based features) were more sensitive to differences between LBD and AD; this will be further explored for PCA.

Objective
Wearable technology allows accurate measurement of turning while walking, with cross-sectional studies indicating that difficulty turning presents even in preclinical phases of Parkinson's disease. The aim of our study was to quantify rate of change of turning performance in a cohort of older adults, and test whether turning decline can predict future diagnosis of Parkinson's disease.

Methods
A total of 1,051 participants from the Tübingen Evaluation of Risk Factors for Early Detection of Neurodegeneration (TREND) study were included for a 5-visit analysis over 10 years, with development of clinically evident Parkinson's disease tracked. Participants walked a 20-m hallway for 1 minute at their preferred pace, with a wearable device on the lower back. Longitudinal trajectories of turning performance were modelled using random effects linear mixed models to establish the interval between initial turning changes and Parkinson's disease diagnosis. Cox regression assessed whether initial turning measures could predict time to Parkinson's disease onset, controlling for age and sex.

Results
Of all participants, 23 were diagnosed with Parkinson's disease an average of 5.3 years post-baseline. Slower peak angular velocity at baseline was associated with a higher hazard of Parkinson's disease diagnosis, with deviations from controls emerging approximately 8.8 years before diagnosis. Additional analysis with a machine learning model using baseline characteristics of age, sex and peak angular velocity, identified 60% of prediagnostic Parkinson's disease (sensitivity: 0.600) and 80.5% non-prediagnostic Parkinson's disease (specificity: 0.805), with an area under the curve of 80.5%.

Interpretation
Peak angular velocity during turning shows promise identifying and tracking motor progression in the pre-diagnostic phase of Parkinson's disease.

Creative participation may allow children involved in health research to better describe their experience. Using participatory methods, we co-produced a short film with children to express their experiences of the COVID-19 lockdowns and as participants in health research conducted around the pandemic. Thirteen children (10-11 years) from an area of deprivation in Newcastle-upon-Tyne, England, worked with theatre practitioners to develop their spoken and written reflections and memories into a script. The subsequent short film (https://tinyurl.com/YoungSciComms) was perceived by classmates as an accurate and entertaining representation of their experiences. Film-making with children can facilitate effective peer-led communication in public health research.

In this retrospective cohort study, we examined maximal intensity periods (MIPs) for a broad range of movement characteristics during international field hockey. Further, we examined the intensity of near-peak periods, and whether peak demands for different movement characteristics occurred simultaneously. Player movement data from 28 Australian elite male field hockey players were obtained via wearable tracking devices in four international tournaments over 13 months (n = 393 player-matches). MIPs were identified via the rolling-sum method for mean speed, high-speed distance (> 5 m·s
), accelerations (> 2.5 m·s
), decelerations (< - 2.5 m·s
) and high-speed cuts (45° change of direction and > 5 m·s
) across eight epochs (range: 5 s-5 min). Random effects linear mixed models were used to estimate means for each movement characteristic, with random intercepts fitted for players and matches. Mean speed was ∼80% higher during the 1 min MIP (210 m·min
) than the match average (116 m·min
) and players regularly reached high mean speeds (for instance, the 10th most intense minute was still ∼44% above match average). High-speed distance, accelerations and decelerations accumulated > 5x faster during the 1 min MIP for those variables than the match average and high-speed cuts occurred with ∼10x greater frequency. During the 1 min MIP for total distance, all other movement characteristics were less than 40% of the 1 min MIP for that variable (except high-speed distance: 76%). Match averages substantially underestimate the MIPs of elite field hockey. Practitioners should consider analysing the peak periods of matches, with a focus on high-intensity movements, to inform monitoring and prescription of team sport-specific training.

Introduction/Aims
Accurate measurement of knee-extensor strength in people with inclusion body myositis (IBM) is vital to track disease progression and provide a standardized outcome for clinical trials. Isokinetic dynamometers are the current gold standard tool for measuring knee-extensor strength. A less costly, more portable tool would have more widespread clinical and research applications. Current practice is to use handheld dynamometry, but there are concerns around the accuracy of this method as it relies on precise operator technique. This study investigates whether stabilization of the handheld dynamometer with a strap (SSHD) improves agreement with the isokinetic dynamometer (IKD) for measurement of knee-extensor strength in IBM participants compared to operator-stabilized handheld dynamometry (OSHD).

Methods
Fifteen IBM participants had bilateral knee-extensor force measured using three methods of dynamometry on the same day: the isokinetic dynamometer, operator-stabilized handheld dynamometry, and strap-stabilized handheld dynamometry. A crossover design was used to account for fatigue bias.

Results
Intraclass correlations (ICC) indicated poor absolute agreement of the IKD with OSHD (Strong leg = 0.240, Weak leg = 0.328), which was better for the SSHD method. Using the SSHD reduced the bias (i.e., there was less underestimation of force) between SSHD and the IKD compared to OSHD and the IKD (p < 0.05), indicating that strap-stabilized handheld dynamometry improved agreement and intraclass correlations with the IKD compared with operator-stabilized dynamometry.

Discussion
Strap-stabilized handheld dynamometry of knee extensor strength is feasible in IBM patients and may correlate better with isokinetic dynamometry than operator-stabilized handheld dynamometry, but larger studies are needed to confirm this finding.

A major challenge in capturing multi-segmental movements with unconnected inertial measurement units (IMUs) is synchronisation between IMUs. The aims of this study were to assess the reproducibility of desynchronisation rates between unconnected IMUs (Axivity, Ax6) commonly used in human movement studies and to determine the accuracy of predicted (corrected) clock differences under different conditions. In the first two experiments, we report that rates of desynchronisation between IMU pairs were linear, unique to each pair, and reproducible within and between sessions. The third experiment involved a cohort of active adults (n = 44) performing physical activity and resulted in predicted clock errors from −10.1 to 0.3 ms after 2 h. This level of synchronisation is acceptable for most human movement applications. The consistent and predictable desynchronisation rates found in these commonly used unconnected IMUs provides an opportunity for a simple, movement-independent, and adaptable techniques to extend synchronisation periods for many applications in human movement research. Further work to compensate for fluctuations in external and internal factors is warranted to extend synchronisation between unconnected IMUs for even longer duration.

Background
Digital mobility outcomes (DMOs) can be captured using body-worn inertial measurement units (IMUs) in lab-based and real-world environments. DMOs may support differential diagnosis of dementia; for example, Alzheimer’s disease (AD) and Lewy body disease (LBD) show unique signatures of gait impairment. Growing evidence suggests that turning impairments are related to cognitive decline. Turning outcomes can be captured via IMUs and may complement use of existing DMOs. This study aims to assess differences in turning outcomes between AD, LBD and older adult controls, and explore their clinical and cognitive correlations.

Method
Participants completed six intermittent 10-metre walks while wearing a IMU (APDM, Opal 128Hz) attached to their lower back. Following each walk, they made a 180degree turn. Two spatiotemporal (turn duration, angular velocity) and two acceleration-based (combined direction [anterior-posterior/medio-lateral/vertical] Root Mean Square (RMS) and Jerk RMS) turning outcomes were extracted using validated algorithms. Analysis of covariance assessed between-group differences in turning outcomes, controlling for age and sex. Tukey HSD tests for multiple comparisons determined where differences occurred. Correlations (Spearman’s rho) between significant turning outcomes and age, motor disease severity (MDS Unified Parkinson’s Disease Rating Scale III), global cognition (standardised Mini Mental State Examination; sMMSE), information processing (Trail Making Task A), and executive function (FAS Verbal Fluency Test) were assessed.

Results
98 eligible participants from the GaitDem study were included: 28 controls (Age (mean±SD):74±9 years, sMMSE:29±1), 35 AD (Age:77±6, sMMSE:23±4), and 35 LBD (Age:76±6, sMMSE:24±3). Both dementia disease subtypes demonstrated lower jerk RMS compared to controls (p<.05), while people with LBD also showed lower angular velocity, RMS and Jerk RMS (p<.05; Fig.1). For AD, turning impairments were associated with greater motor disease severity (Fig.2). For LBD, slower angular velocity was associated with greater motor disease severity, slower information processing and worse executive function (Fig.3).

Conclusions
Results suggest that dementia disease subtypes have significant turning impairments compared to normal ageing, but not compared to each other. However, turning impairments were related to discrete motor-cognitive profiles in dementia disease subtypes. Further work should explore other turning characteristics (i.e. related to turn phase, signal direction, turn strategy) as differential markers of dementia.