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Knee osteoarthritis (OA) is commonly combined with the presentation of a coronal deformity of the knee. The bony origin of the knee varus deformity can be classified as tibial origin, femoral origin, or a combination of tibial and femoral causes. Deformities of tibial origin are mostly common clinically, while patients with knee OA with femoral varus deformity are less common. Do hip, knee and ankle kinematics and spatiotemporal parameters differ between patients with knee OA with femoral varus deformity and healthy subjects? Twenty-five patients (14 females and 11 males) with knee OA and femoral varus deformity and 20 healthy subjects (12 males and 8 females) as control group were included in this study. The kinematic parameters of the hip-knee-ankle joint and spatiotemporal gait parameters were included in the study. This study found that the step speed and step length of the knee OA with femoral varus (KOAF) group were smaller than those of the control group, while double support period percentage was greater in the KOAF group. Significant differences were found in the maximum knee extension angle, maximum knee flexion angle, knee flexion range of motion, maximum hip flexion angle, maximum hip extension angle, and hip flexion range of motion between the two groups. After comparing the ankle motion between the two groups, significant differences were found in the maximum eversion angle, inversion range of motion, maximum ankle abduction angle, and abduction range of motion. Knee OA with femoral varus deformity causes adaptive changes in the kinematic parameters of hip, knee and ankle joints and spatiotemporal gait parameters to alleviate symptoms and maintain normal activity. • Abnormal gait characteristics exist in femoral knee varus deformity. • Femoral knee varus deformity demonstrates abnormal spatiotemporal parameter changes. • Femoral varus deformity exhibits adaptive gait changes in the hip-knee-ankle joint. [ABSTRACT FROM AUTHOR]

Introduction: Gait disorders are common in patients with Parkinson's disease (PD), and objective, quantifiable, and portable evaluation methods are needed in clinical practice. We assessed the differences in gait characteristics between patients with PD and healthy controls (HCs) using two-dimensional (2D) video and explored the diagnostic value of 2D video for early-stage PD.Methods: Sixty-eight patients with PD and 48 HCs were recruited. All participants walked a standard 5-m track while recorded using mobile phones. The differences in gait characteristics between the groups and gait parameters of patients with early-stage PD were analyzed. Receiver operating characteristic analysis was used to evaluate the discrimination activity of gait parameters.Results: Compared with HCs, patients with PD had shorter step length (S/M, p < 0.001/0.001), faster cadence (p = 0.044), slower walking speed (p < 0.001), smaller arm-swing angle (S/M, p < 0.001/0.001), slower arm-swing velocity (S/M, p < 0.001/0.001), and greater variability and asymmetry. The patients with early-stage PD had similar characteristics. After combined step length and variability and asymmetry of arm-swing angle, diagnostic sensitivity and specificity reached 84.6% and 89.6%, respectively, and an area under the curve of 0.91 (0.84-0.97).Conclusion: We proposed a new method to improve the sensitivity of early-stage PD diagnosis using 2D video, which, as a portable and objective method, could be used to evaluate gait disorders in PD, including in early-stage PD. Combined diagnostic analysis of step length and variability and asymmetry of arm-swing angle could improve the sensitivity of PD diagnosis and was helpful in distinguishing patients with early-stage PD from HCs. [ABSTRACT FROM AUTHOR]

Niemann-Pick type C (NPC) is a rare but treatable lysosomal disorder with heterogeneous clinical presentations including cognitive impairment, movement disorders and vertical gaze palsy. We illustrate five cases of genetically confirmed NPC and highlight backward leaning during gait as a relevant clinical sign and a useful diagnostic clue. [ABSTRACT FROM AUTHOR]

We describe an elderly woman meeting criteria for vascular parkinsonism/dementia associated with a likely pathogenic variant in the COL22A1 gene, supported by functional experiments in a zebrafish model. We suggest that white matter hyperintensities may not represent small-vessel ischemic disease and that, if confirmed by further observations, COL22A1 may be included among the adult-onset leukoencephalopathies mislabeled as "vascular parkinsonism." [ABSTRACT FROM AUTHOR]

Objectives: To determine the prevalence of vascular parkinsonism (VasP) in a stroke prevention clinic (SPC).Background: VasP can be defined by an onset of parkinsonism with prominent gait problems occurring within 1 year of stroke.Methods: We created a screening strategy based on the Tanner Questionnaire (TQ), a validated scale for parkinsonism, and the creation of a 4-point Five-Minute Assessment Scale (FMAS) operationalizing Zijlmans' criteria for the diagnosis of VasP. Consecutive stroke patients were screened over a 12-month period using the TQ and the FMAS. SAS statistical software was used.Results: Two hundred forty patients (52.5% females) were screened (mean age of 65 years, standard deviation, 14.5). Twenty-five percent of patients had a TQ score ≥ 4 with a median FMAS of 2. In this group, 32.6% (15/46) were found to have parkinsonism. Seventeen percent (8/46) were diagnosed with VasP having an FMAS of 4. Seventy-five of the participants obtained a TQ ≤ 3, with a median FMAS of 1. Only 1 patient in this group had parkinsonism (1.9%; 1/194). Using a cutoff of 4 points in the TQ resulted in a sensitivity of 93.8%, a specificity of 86.2% for parkinsonism, and a sensitivity of 100% with a specificity of 83% for VasP. Patients with FMAS = 4 (VasP) attained higher scores in the TQ with a median of 5 (Spearman rank correlation coefficient for the TQ and the FMAS (rs) = .447, P < .0005).Conclusions: We documented a prevalence of 3% (8/240) for VasP in an SPC. We propose a new, easier, and unified 2-step TQ-FMAS screening strategy for this condition. [ABSTRACT FROM AUTHOR]

Abstract Background and purpose Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) diagnosis is based on the presence of three main clinical features: 1) ataxia, 2) pyramidal involvement, and 3) axonal neuropathy. This study aimed to explore, among a cohort of adults with ARSACS, the prevalence of other signs and symptoms than those commonly describe in this disease and compare their prevalence between younger (<40 years) and older (≥40 years) participants. Methods A clinical interview based on a standardized questionnaire was conducted. It included the following items: memory and concentration problems, hearing impairment, epilepsy, spasms, choreathetosis, neuropathic pain, cramps and fecal incontinence. Results A total of 43 participants were interviewed, with a mean age of 38.9 years and 51.2% were men. Spasms (55.8%), cramps (53.5%), and concentration problems (39.5%) were the most frequent manifestations. Except for choreathetosis, which was present in only one participant, all other signs and symptoms were present in 9.3% to 29.3% of participants. Conclusions People with ARSACS may experience many other clinical manifestations than the most commonly described. This study is a preliminary step toward the development of a comprehensive evidence-based clinical care guideline for this population. Highlights • Spasms, cramps, concentration problems, and fecal incontinence were often present. • Lower limb neuropathic pain is more frequent than in the Canadian population. • Prevalence of epilepsy is also much higher than in the Canadian population. [ABSTRACT FROM AUTHOR]

The underlying mechanisms responsible for the gait changes in frontal gait disorder (FGD), a form of higher level gait disorders, are poorly understood. We investigated the relationship between stride length and cadence (SLCrel) in people with FGD (n=15) in comparison to healthy older adults (n=21) to improve our understanding of the changes to gait in FGD. Gait data was captured using an electronic walkway system as participants walked at five self-selected speed conditions: preferred, very slow, slow, fast and very fast. Linear regression was used to determine the strength of the relationship (R(2)), slope and intercept. In the FGD group 9 participants had a strong SLCrel (linear group) (R(2)>0.8) and 6 a weak relationship (R(2)<0.8) (nonlinear group). The linear FGD group did not differ to healthy control for slope (p>0.05) but did have a lower intercept (p<0.001). The linear FGD group modulated gait speed by adjusting stride length and cadence similar to controls whereas the nonlinear FGD participants adjusted stride length but not cadence similar to controls. The non-linear FGD group had greater disturbance to their gait, poorer postural control and greater fear of falling compared to the linear FGD group. Investigation of the SLCrel resulted in new insights into the underlying mechanisms responsible for the gait changes found in FGD. The findings suggest stride length regulation was disrupted in milder FGD but as the disorder worsened, cadence control also became disordered resulting in a break down in the relationship between stride length and cadence. [ABSTRACT FROM AUTHOR]

Postural instability is a key feature of Parkinson Disease that is associated with falls and morbidity. We designed a pull apparatus to quantitatively measure the force needed to pull subjects off-balance. Thirteen Controls and eight individuals with Parkinson Disease (PD) were evaluated. All individuals with PD reported subjective symptoms of postural instability and were symptomatic for approximately 9.4 years when tested. No significant differences were found between Controls and PD subjects in the magnitude of force required to pull them off-balance. None of the Controls fell and all took a step into the direction of pull to maintain their balance. 59% of the time PD subjects fell because they did not take a step in the direction of pull to maintain their center of mass (COM) over their feet, thus indicating a deficiency in postural reflexes. If they fell on the first pull, PD subjects did not show a learning effect when pulled multiple times in the same direction. The utility of the Pull Test to detect postural instability is related to the subject's behavioral response, not the force needed to pull them off balance. Our findings may also help explain certain features of the PD gait as an attempt by subjects to avoid postural instability by not placing their COM in gravitationally unstable positions. [ABSTRACT FROM AUTHOR]

Highlights: [•] We identify causal factors for gait changes in patients with peripheral neuropathy. [•] Changes in the mean walking pattern are mainly due to a slowing of walking speed. [•] Peripheral sensory loss has a direct effect on gait variability. [•] This effect depends on the walking speed and occurs predominantly for slow walking. [•] Gait variability while slow walking is associated to the fall status of patients. [Copyright &y& Elsevier]

Highlights: [•] It is not known if obstacle crossing following stroke improves over time. [•] Obstacle crossing performance was examined over a one month time period. [•] Crossing speed increased when the unaffected limb led, but not the affected limb. [•] Change in obstacle crossing speed was not associated with change in level over-ground speed. [•] Training to improve obstacle crossing following stroke may be required. [ABSTRACT FROM AUTHOR]

Abstract: Background: There have been no previous diffusion tensor imaging (DTI) studies comparing Parkinson's disease (PD) with postural instability and gait disorder (PIGD) parkinsonism. Objective: Utilizing DTI with 2-region tractography, we conducted a case control study to determine if different brain regions representing the neural network of the motor system are differentially affected in PIGD compared to PD and controls. Methods: On a 3 T MR machine, using manual ROI (regions of interest) we determined the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values on DTI in anatomical brain regions representing the extrapyramidal, pyramidal, and transcallosal tracts, aided by 2-region tractography. FA and ADC were correlated with the Tinetti score (measure of gait and balance). Results: Sixty-five subjects (21 PD, 25 PIGD, 19 controls) were included in the analysis. We demonstrated greater ADC abnormalities in the extrapyramidal, pyramidal and transcallosal motor systems in PIGD compared to controls. Multivariate analysis taking into consideration various clinical variables showed that the FA (p = 0.02) and ADC (p = 0.001) values in the corpus callosum body differentiated PIGD from PD. PIGD with low Tinetti score had a lower FA (p = 0.02) and a higher ADC value (corpus callosum body) (p = 0.03) compared to those with a high score. Conclusions: We demonstrated for the first time that DTI abnormalities along the transcallosal motor tract in the body of the corpus callosum, but not the substantia nigra, differentiated PIGD from PD, and the degree of corpus callosum body abnormality correlated with the Tinetti score (a measure of risk of falls). [Copyright &y& Elsevier]

Abstract: In this study, we present a model for the gait of normal and Parkinson''s disease (PD) persons. Gait is semi-periodic and has fractal properties. Sine circle map (SCM) relation has a sinusoidal term and can show chaotic behaviour. Therefore, we used SCM as a basis for our model structure. Moreover, some similarities exist between the parameters of this relation and basal ganglia (BG) structure. This relation can explain the complex behaviours and the complex structure of BG. The presented model can simulate the BG behaviour globally. A model parameter, Ω, has a key role in the model response. We showed that when Ω is between 0.6 and 0.8, the model simulates the behaviour of normal persons; the amounts greater or less than this range correspond to PD persons. Our statistical tests show that there is a significant difference between the Ω of normal and PD patients. We conclude that Ω can be introduced as a parameter to distinguish normal and PD persons. Additionally, our results showed that Spearman correlation between the Ω and the severity of PD is 0.586. This parameter may be a good index of PD severity. [Copyright &y& Elsevier]

Abstract: A 73-year-old man had episodic encephalopathy, ataxia and neuropathy. Symptoms largely resolved but adenopathy later lead to the diagnosis of a low-grade follicular lymphoma. The neurological symptoms soon recurred with new pontine calcifications identified by computed tomography. Brain biopsy revealed microvascular endothelial cell nuclear changes. Electron microscopy identified small polymorphic bacteria without a cell wall and with terminal and attachment organelles within endothelial cells and clustered in some microvascular lumina. Immunostaining was positive for Mycoplasma pneumoniae and convalescent serum enzyme immunoassay was positive for M. pneumoniae IgG. The patient again recovered and he was neurologically stable 33months after the initial episode. The ultrastructural findings of the bacterial cells are distinctive of some mycoplasmal species when compared to other small bacteria. Mycoplasma-like organisms are reported in four autopsied patients who had chronic encephalopathy, movement disorders, and some of the same light- and electron-microscopic findings in the brain as our patient. Direct neuroinvasion by Mycoplasma species has been suggested, while anatomic observations in our patient and in the four autopsy cases show microvascular invasion but not parenchymal invasion. Most mycoplasmal encephalitis may be immune-mediated. The frequency of neurovascular invasion is not known. It may be rare and it may persist. [Copyright &y& Elsevier]

Abstract: Objective: Aortoenteric fistula is a rare and serious pathology with a high mortality rate (around 50%). The surgery''s neurological complications are also rare (around 0.25% of reconstructive interventions); two-thirds are spinal cord infarcts, with the remaining one-third corresponding to cases of ischemic polyradiculopathy. The latter condition is rarely described and appears to have a better functional prognosis. Methodology: We report a patient case with aortoduodenal fistula complicated, first by acute haemorrhage and then, by polyradicular damage and a sensorimotor impairment in both legs. Results: EMG revealed bilateral damage to the lumbosacral plexus but NMR did not detect any abnormalities. The motor impairment in the legs was linked to sensory damage. We monitored the patient for two years. The initial functional disability score was 68 but it worsened steadily to a maximum value of 126 two years later. Conclusion: The paraclinical data (EMG, NMR) and the functional worsening strengthened our diagnosis of bilateral lumbosacral plexus ischemia, which is rarely described. However, the prognosis appears to be better than for infarction of the conus medullaris, the principal differential diagnosis. [Copyright &y& Elsevier]

Abstract: Gait disorders in people with dementia have been documented in a number of studies. There is some preliminary evidence suggesting there may be a relationship between dementia type and gait abnormality. Quantitative gait analysis has not previously been reported for people diagnosed with dementia with Lewy bodies (DLB). Therefore, this study aimed to quantify gait patterns of people with DLB and compare them with those of people with Alzheimer''s disease (AD) and control subjects. Two groups of 10 subjects divided according to a diagnosis of DLB and AD, and 10 control subjects underwent gait analysis using an electronic walkway. Participants were required to walk at self-selected slow, preferred and fast speeds. There were no differences between the DLB and AD patient groups for any of the measured gait variables. Velocity and stride length values were significantly reduced in both patient groups compared to the control group at all speeds and percentage of time spent in double limb support was significantly increased in both patient groups compared to the control group at all walking speeds. Significant correlations were found between gait speeds and gait outcome variables. Spatiotemporal gait characteristics of people with AD and DLB are similar, but significantly different from the normal population. [Copyright &y& Elsevier]

Abstract: Parkinsonism can be psychogenic, and psychogenic parkinsonism is about 10% of psychogenic movement disorder patients. Patients can present with any feature or combination of features of organic Parkinson''s disease. There are clinical clues that can lead to the correct diagnosis, and laboratory testing with clinical neurophysiology or DAT (dopamine transporter) scanning can be helpful as well. Patients may have both organic Parkinson''s disease and psychogenic parkinsonism, and this might be considered a psychologically induced aggravation of the organic disorder. [Copyright &y& Elsevier]

Introduction/Background Patients with multiple sclerosis (PwMS) present cognitive and motor dysfunction. The Cognitive Motor Interference (CMI) could have a negative impact in PmMS’ daily-life activities especially in those situations when the concomitances of these two components are crucial (e.g., walking and talking with someone, cross a traffic light). CMI have been experimentally evaluated based on a dual task paradigm. Recent studies suggest that there is some inconsistence in the literature regarding whether dual task condition differs between PwMS and healthy peers. The objectives of this study were (i) to determine the impact of the CMI in the gait of PwMS by comparing with healthy peers and (ii) to determine which clinical, cognitive and motor, parameters were more associated with dual task gait. Material and method Forty-nine PwMS and 15 healthy peers participated in this study. The evaluations were composed by a current clinical evaluation, SDMT cognitive test, visual analogue scale of fatigue and gait evaluated at self-selected and dual task (arithmetic calculations) conditions. Afterward, the dual task cost (DTC), which is the ratio between the velocities of the 2 gait conditions, was calculated. Results Significant differences in the cognitive and motor performances were found between PwMS and healthy groups ( P = 10 −5 ). However, in terms of DTC, no significant difference was found between groups ( P = 0.12). EDSS score was the only significant parameter able to explain the DTC variance at 8%. The gait at self-selected condition could explain 92% of the variance of the gait at dual task condition. Conclusion The CMI occurs in the same proportion in both PwMS and healthy persons. Despite the preponderance of the motor component in the DTC and in gait dual task condition, a combined motor and cognitive rehabilitation approach may have better results than a rehabilitation programs based on separated components. [ABSTRACT FROM AUTHOR]

Objective Hereditary spastic paraplegia (HSP) designates a rare genetic disorder characterized by the existence of a pyramidal syndrome and/or paresis of the lower limbs, resulting in locomotor disorders. The objective of this study was to investigate the HSP patients walking characteristics during a comfortable walking speed, to determinate the most deleterious impairments and their evolutivity during a prolonged standardized walk. A second goal was to study the co-contraction of targeted muscles during these two walking conditions. Material/patients and methods In this prospective study, the spatio-temporal parameters (GAITRITE ® electronic walkway) and electromyographics (surface EMG) of twelve HSP patients were compared with those of nine matched subjects, for the walking conditions: « comfortable walk », « Six Minutes Walking Test » (SMWT). The perceived exertion was assessed by the Borg scale. HSP patients received a standardized interrogatory and neuro-orthopedic examination measuring angles joint values, spasticity (Tardieu scale) and muscle strength (MRC scale). For every subjects, muscle activations and co-contractions indices were analyzed for several muscles: semi-tendinosus (ST), rectus femoris (RF), gastrocnemius lateralis (GL) and tibialis anterior (TA) for all walking conditions. Results Median gait speed (0.85 m/s) and cadence (91 steps/min) were significantly lower in the HSP group compared with unaffected subjects. Walking speed was constant over the SMWT for a high level of exertion. Spasticity and weakness were greatest for the GL muscle that had a prolonged activation during the swing phase. Co-contraction indices in the GL/TA couple were significantly increased for the non-dominant lower-limb during swing phase. No significant differences were found for the RF/ST couple. The motor deficit was the only significant parameter correlate to walking speed. Discussion–conclusion HSP patients are characterized by a slow walk explained mainly by a motor deficit. Surface EMG seems to be an interesting tool in the therapeutic reflection to investigate walking disorders in HSP disease. [ABSTRACT FROM AUTHOR]

Functional or psychogenic movement disorders are common and disabling, and sometime difficult to diagnose. The history and physical exam can give positive features that will support the diagnosis, which should not be based solely on exclusion. Some clues in the history are sudden onset, intermittent time course, variability of manifestation over time, childhood trauma, history of other somatic symptom and secondary gain. Anxiety and depression are common, but not necessarily more than the general population. On examination, distraction and suggestibility may be present. There are specific signs that should be looked for with different types of movements. For example, with tremor, change in frequency over time and entrainment are common features. With myoclonus, the movements might be complex in type with long latencies to stimulus induced jerks. Gait disorders show good balance despite claims to the contrary. Functional dystonia still remains a challenging diagnosis in many circumstances, although fixed dystonia is one sign more likely to be functional. [ABSTRACT FROM AUTHOR]

Abstract: Freezing of gait (FoG) is one of the most troublesome symptoms associated with Parkinson disease (PD). This symptom usually does not respond to dopaminergic therapy, possibly because it is mediated via noradrenergic, rather than dopaminergic, deficiency. As atomoxetine enhances noradrenergic transmission we postulated that it may be effective in the treatment of FoG and enrolled 5 PD patients who had this gait abnormality, both when “on” or “off” levodopa, into a double-blind, randomized trial. Although an improvement in total Gait and Balance Scale (GABS) score was noted in patients treated with atomoxetine as compared to placebo, this did not reach statistical significance, possibly because of a small sample size. Further studies in a larger population of patients with FoG are needed to determine whether atomoxetine is a useful drug in the treatment of this, often disabling, feature of PD. [Copyright &y& Elsevier]