The protocol follows the guidelines of the local human Ethics Committee in Zurich (KEK Zurich).
1. Hardware Installation (Figure 1)
<ol>
	<li>Use two 10-m sets of floor-based bars and place them parallel to each other (and to the line of progression) to create a corridor with an inter-set distance of approximately 1 m. 
	NOTE: This distance can be increased up to 8 m. Each bar has a length of 1 m&#160;and consists of 96 light diodes.</li>
	<li>Make a distinction between light-transmitting (T) and light-receiving (R) units for the installation of the bars by placing the light-transmitting (T) units on the right side and the light-receiving (R) units on the left side with respect to the walking direction. 
	NOTE: The first meter bars (both T and R) have silver drums. The T and R bars disposed on the remaining 9 m&#160;are all equal and interchangeable.</li>
	<li>Connect all bars of a row with caps (wireless). Use 2&#160;power supplies: one for each set of bars (T and R).</li>
	<li>Connect the first R bar to the laptop with a USB cable.</li>
	<li>Position the camera next to the first bar for offline verifications (e.g., starting foot), and connect it to the laptop with a USB cable.</li>
	<li>Put a mark 2 m before and after the beginning and end of the track.</li>
	<li>Switch on the photoelectric device using the on-off switch of the first R and T bar.</li>
	<li>Check that the control LEDs&#160;located on all R bars are green. 
	NOTE: If so, the system is correctly positioned and testing can start; however, if one or more of the control LEDs are red the system is not correctly positioned and/or connected. Control all caps by checking that they are completely clicked into place and then turn the system off and on again.</li>
</ol>
<img alt="Figure 1" src="/files/ftp_upload/51878/51878fig1.jpg" /> 
Figure 1.&#160;The photoelectric system consists of light-transmitting (T) and light-receiving (R) units that are placed parallel to each other with a distance of approximately 1 m. The camera is installed close to the start area for control purposes. The laptop is connected with USB cables to the first R bar and to the camera. <a href="https://www.jove.com/files/ftp_upload/51878/51878fig1highres.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
2. Software Installation and Preparation of a Test
<ol>
	<li>Load the software operating the photoelectric system from www.optogait.com/Support/Downloads. Note: This protocol is described by using the 1.8.1 version.</li>
	<li>If the software is used for the first time for gait analysis create a new test as follows (otherwise proceed to step 2.3):
	<ol>
		<li>Select Test then click on Define / Modify tests. Now&#160;click on Gait test and then select Duplicate test. Click on Confirm in the pop-up window so that the test is duplicated.</li>
		<li>Double click on the duplicated test to modify the name (e.g., Gait Test 10 bars) and select 10 for the number of bars. Use the standard parameters for the gait test, which are presented in Figure 2. Finally, select Save to save all modifications.</li>
	</ol>
	</li>
	<li>Add a new patient to the database. Select Patients, click on Insert / Modify patient, and then click on New patient to enter the data. Then Save the data.</li>
</ol>
<img alt="Figure 2" src="/files/ftp_upload/51878/51878fig2.jpg" /> 
Figure 2.&#160;Standard settings for a gait test with 10 bars, as described in the present protocol. These settings have to be defined when the photoelectric system is used for the first time. In this protocol the starting foot is not defined. The system starts measuring when the patient enters the recording area and stops measuring when the patient leaves the measuring units. <a href="https://www.jove.com/files/ftp_upload/51878/51878fig2highres.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
3. Testing Procedures
<ol>
	<li>Always give the same instructions to the patient13.
	<ol>
		<li>Instruct the patient to walk with flat-soled shoes along the 10-m walkway at two different velocities: normal (&#8220;walk at a pace that is comfortable for you&#8221;), and faster than normal (&#8220;walk at a pace that is faster than you would normally walk&#8221;).</li>
		<li>Ask the patient to look straight ahead during the walking trials.</li>
		<li>Ask the patient to initiate the first step with the same foot to better standardize the test conditions.</li>
		<li>Ask the patient to start walking 2 m&#160;before the first photoelectric bar and to conclude each trial 2 m&#160;after the last bar in order to maintain constant gait velocity13.</li>
	</ol>
	</li>
	<li>Demonstrate one trial at normal velocity to the patient.</li>
	<li>Request the patient to perform three familiarization trials followed by one experimental trial at each velocity. Always complete normal velocity trials first.</li>
	<li>To get ready with the software, click on Test and then Execute to start the measurements with the created test.
	<ol>
		<li>Select the patient by clicking on Select, choosing the patient and then clicking on Confirm.</li>
		<li>Select the test by clicking on Select, and choosing the test e.g., Gait Test 10 bars. Check that only this test is selected for the measurement.</li>
		<li>Place the camera&#160;so that it can record the entire walk. Change the position of the camera while checking the live picture on the screen of your laptop.</li>
		<li>Finally, click on Execute again. 
		NOTE: Now the software is ready to measure. As soon as the patient enters the bars, the system starts to measure and a pop-up window appears asking for the starting foot.</li>
	</ol>
	</li>
	<li>Click on the appropriate foot so that the gait parameters will be correctly calculated. 
	NOTE: The camera records automatically once the test is started.</li>
	<li>Save the test.</li>
</ol>
4. Data Analysis
<ol>
	<li>Click on Results to display the completed trials. Then click on the arrow next to the test of interest to transfer the test from the Test list to the Test analysis section. Now click on View to display the selected test. Refer to the Results section for all tests performed in this study. 
	NOTE: A window with all test data appears (Figure 3). On the left side of the window there are some command buttons for activating various functions. The other part of the window presents 4 types of information regarding the current test. Each set of information can be shown/hidden using the configuration commands. From top to bottom the items are the following: video, charts displaying the results, table with numerical data, and photoelectric bars.</li>
	<li>Click on Gait data to display a gait report (Figure 3).</li>
	<li>Click on Print (a window with the report appears) to print out the report. 
	NOTE: The report can be printed as it is or can be modified. For the different spatiotemporal parameters, the following results are presented in the report: mean values &#177; standard deviation (SD) of the left and right side, coefficients of variation (CV) expressing gait variability14,15, and percent difference between the left and the right side (asymmetry).
	<ol>
		<li>If required, modify the report as follows: open the report as described above (step 4.3). Click on the buttons Show or Hide on the left side of the screen to adapt the presented data and charts of the report.</li>
		<li>To change the logo and/or the footer on the report, click on the respective button (Change logo or Change footer) to modify these parameters.</li>
	</ol>
	</li>
	<li>To compare two or more tests performed on different occasions, e.g., before and after an intervention, select the different tests in the results section by clicking on the arrow next to the tests and then click on the Compare button. 
	NOTE: A report with the direct comparison of all parameters of the different tests is displayed.</li>
</ol>
<img alt="Figure 3" src="/files/ftp_upload/51878/51878fig3.jpg" /> 
Figure 3.&#160;Screenshot of all test data. The command buttons appear on the left side of the window (e.g., by clicking on Print a report is generated, which can be eventually modified). The other part of the window presents the following information regarding the current test, from top to bottom: video, charts displaying the results, table with numerical data, and photoelectric bars. These details can be shown/hidden using the Configure button on the right side. The actual view of the data can be changed by clicking on Gait data or Gait report, respectively. <a href="https://www.jove.com/files/ftp_upload/51878/51878fig3highres.jpg" target="_blank">Please click here to view a larger version of this figure.</a>

<ol>
	<li>Chow, J. W., Yablon, S. A., Horn, T. S., Stokic, D. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Temporospatial+characteristics+of+gait+in+patients+with+lower+limb+muscle+hypertonia+after+traumatic+brain+injury.">Temporospatial characteristics of gait in patients with lower limb muscle hypertonia after traumatic brain injury.</a> Brain. Inj. 24, 1575-1584 (2010).</li><li>Esser, P., Dawes, H., Collett, J., Feltham, M. G., Howells, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+of+spatio-temporal+gait+parameters+using+inertial+measurement+units+in+neurological+populations.">Assessment of spatio-temporal gait parameters using inertial measurement units in neurological populations.</a> Gait Posture. 34, 558-560 (2011).</li><li>Maffiuletti, N. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spatiotemporal+parameters+of+gait+after+total+hip+replacement:+anterior+versus+posterior+approach.">Spatiotemporal parameters of gait after total hip replacement: anterior versus posterior approach.</a> Orthop. Clin. North Am. 40, 407-415 (2009).</li><li>Webster, K. E., Wittwer, J. E., Feller, J. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+gait+analysis+after+medial+unicompartmental+knee+arthroplasty+for+osteoarthritis.">Quantitative gait analysis after medial unicompartmental knee arthroplasty for osteoarthritis.</a> J. Arthroplasty. 18, 751-759 (2003).</li><li>Chui, K. K., Lusardi, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Spatial+and+temporal+parameters+of+self-selected+and+fast+walking+speeds+in+healthy+community-living+adults+aged+72-98+years.">Spatial and temporal parameters of self-selected and fast walking speeds in healthy community-living adults aged 72-98 years.</a> J. Geriatr. Phys. Ther. 33, 173-183 (2010).</li><li>Hollman, J. H., McDade, E. M., Petersen, R. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Normative+spatiotemporal+gait+parameters+in+older+adults.">Normative spatiotemporal gait parameters in older adults.</a> Gait Posture. 34, 111-118 (2011).</li><li>Lienhard, K., Schneider, D., Maffiuletti, N. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validity+of+the+Optogait+photoelectric+system+for+the+assessment+of+spatiotemporal+gait+parameters.">Validity of the Optogait photoelectric system for the assessment of spatiotemporal gait parameters.</a> Med. Eng. Phys. 35, 500-504 (2013).</li><li>Perry, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+analysis,+normal+and+pathological+function.">Gait analysis, normal and pathological function.</a> First edn, Slack Inc. , (1992).</li><li>Lee, M. M., Song, C. H., Lee, K. J., Jung, S. W., Shin, D. C., Shin, S. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concurrent+validity+and+test-retest+reliability+of+the+OPTOGait+photoelectric+cell+system+for+the+assessment+of+spatio-temporal+parameters+of+the+gait+of+young+adults.">Concurrent validity and test-retest reliability of the OPTOGait photoelectric cell system for the assessment of spatio-temporal parameters of the gait of young adults.</a> J. Phys. Ther. Sci. 26, 81-85 (2014).</li><li>Item-Glatthorn, J. F., Casartelli, N. C., Petrich-Munzinger, J., Munzinger, U. K., Maffiuletti, N. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validity+of+the+intelligent+device+for+energy+expenditure+and+activity+accelerometry+system+for+quantitative+gait+analysis+in+patients+with+hip+osteoarthritis.">Validity of the intelligent device for energy expenditure and activity accelerometry system for quantitative gait analysis in patients with hip osteoarthritis.</a> Arch. Phys. Med. Rehabil. 93, 2090-2093 (2012).</li><li>Maffiuletti, N. A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Concurrent+validity+and+intrasession+reliability+of+the+IDEEA+accelerometry+system+for+the+quantification+of+spatiotemporal+gait+parameters.">Concurrent validity and intrasession reliability of the IDEEA accelerometry system for the quantification of spatiotemporal gait parameters.</a> Gait Posture. 27, 160-163 (2008).</li><li>Reed, L. F., Urry, S. R., Wearing, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reliability+of+spatiotemporal+and+kinetic+gait+parameters+determined+by+a+new+instrumented+treadmill+system.">Reliability of spatiotemporal and kinetic gait parameters determined by a new instrumented treadmill system.</a> BMC Musculoskelet. Disord. 14, 249 (2013).</li><li>Kressig, R. W., Beauchet, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+clinical+applications+of+spatio-temporal+gait+analysis+in+older+adults.">Guidelines for clinical applications of spatio-temporal gait analysis in older adults.</a> Aging Clin. Exp. Res. 18, 174-176 (2006).</li><li>Dubost, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Relationships+between+dual-task+related+changes+in+stride+velocity+and+stride+time+variability+in+healthy+older+adults.">Relationships between dual-task related changes in stride velocity and stride time variability in healthy older adults.</a> Hum. Mov. Sci. 25, 372-382 (2006).</li><li>Hausdorff, J. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+variability:+methods,+modeling+and+meaning.">Gait variability: methods, modeling and meaning.</a> J. Neuroeng. Rehabil. 2, (2005).</li><li>Blin, O., Ferrandez, A. M., Serratrice, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Quantitative+analysis+of+gait+in+Parkinson+patients:+increased+variability+of+stride+length.">Quantitative analysis of gait in Parkinson patients: increased variability of stride length.</a> J. Neurol. Sci. 98, 91-97 (1990).</li><li>Webster, K. E., Merory, J. R., Wittwer, J. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gait+variability+in+community+dwelling+adults+with+Alzheimer+disease.">Gait variability in community dwelling adults with Alzheimer disease.</a> Alzheimer. Dis. Assoc. Disord. 20, 37-40 (2006).</li><li>Bejek, Z., Paroczai, R., Illyes, A., Kiss, R. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+influence+of+walking+speed+on+gait+parameters+in+healthy+people+and+in+patients+with+osteoarthritis.">The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis.</a> Knee Surg. Sports Traumatol. Arthrosc. 14, 612-622 (2006).</li></ol>

The authors have nothing to disclose.

The protocol presented here can be used to evaluate spatial and temporal gait parameters of patients (orthopedic, neurological, cardiorespiratory, etc.) and healthy older adults with a recently-introduced photoelectric system. The total length and width of the system can be modulated depending on the available space and budget. The estimated cost (in Europe) is approximately 2,800 USD per meter for a 10-meter&#160;system and the minimum recommended length is 3 meter&#160;for floor-based gait analysis. A new feature of th...

Walking is one of the most important physical activities in everyday life, and is a main determinant of the quality of life for elderly and patient populations who may present with gait deteriorations. Clinical evaluation of gait function is therefore important to reveal potential alterations induced by aging and/or neurological/orthopedic pathologies, but also to prove the functional benefits of a treatment. Different instruments have been developed for the quantitative assessment of gait parameters, e.g., force plates, video-based 3D motion analysis, body-mounted accelerometers10,11, and instrumented walkway mats or treadmills12. However, these systems are mainly used for research studies rather than for clinical purposes because they are complex to operate, have low accessibility, and fragile sensors.
A floor-based photoelectric system has recently been introduced, which is able to provide a valid calculation of temporal features and 1D spatial coordinates of walking steps. This measuring instrument has several advantages compared to pre-existing systems: it is easy to handle, data are collected very quickly, it is simple to create a detailed report and it is a modular system which means that the length of the system can be changed. Thus, it can be used with confidence to measure within-group changes in longitudinal assessments and between-group differences in cross-sectional comparisons. The goals of the described protocol are to focus on the equipment and its installation, and to objectively and straightforwardly describe the assessment procedures for evaluating spatiotemporal gait parameters in elderly and patient populations.

<table border="0" cellpadding="0" cellspacing="0" width="846">
	<tbody>
		<tr height="21">
			<td height="21" style="height:21px;width:325px;">Name of Equipment</td>
			<td style="width:169px;">Company</td>
			<td style="width:119px;">Catalog Number</td>
			<td style="width:233px;">Comments/Description</td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:325px;">-Optogait system (10 meters)</td>
			<td style="width:169px;">Microgate, Bolzano, Italy</td>
			<td style="width:119px;"></td>
			<td><a href="http://www.optogait.com/">www.optogait.com</a></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:325px;">-Optogait software</td>
			<td style="width:169px;"></td>
			<td style="width:119px;"></td>
			<td>www.optogait.com/Support/Downloads</td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:325px;">-Laptop</td>
			<td style="width:169px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:325px;"></td>
			<td style="width:169px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:325px;">The Optogait system contains the following equipment:</td>
			<td style="width:169px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:325px;">-10 light-transmitting (T) bars (1 as a first meter)</td>
			<td style="width:169px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:325px;">-10 light-receiving (R) bars (1 as a first meter)</td>
			<td style="width:169px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="63">
			<td height="63" style="height:63px;width:325px;">-18 caps to connect the bars within a set (9 for T and 9 for R bars) and 2 special caps for the last T and R bar</td>
			<td style="width:169px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:325px;">-1 camera with its tripod</td>
			<td style="width:169px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:22px;width:325px;">-1 cable for connecting the Optogait to the laptop</td>
			<td style="width:169px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="42">
			<td height="42" style="height:42px;width:325px;">-1 cable for connecting the camera to the laptop</td>
			<td style="width:169px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
		<tr height="21">
			<td height="21" style="height:21px;width:325px;">-2 power supplies (one for each set of bars)</td>
			<td style="width:169px;"></td>
			<td style="width:119px;"></td>
			<td></td>
		</tr>
	</tbody>
</table>

clinical assessment of spatiotemporal gait parameters in patients and older adults

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and neurological patients1-4, but also in healthy older adults5,6. The quantitative gait analysis described in this protocol is performed with a recently-introduced photoelectric system (see&#160;Materials table) which has the potential to be used in the clinic because it is portable, easy to set up (no subject preparation is required before a test), and does not require maintenance and sensor calibration. The photoelectric system consists of series of high-density floor-based photoelectric cells with light-emitting and light-receiving diodes that are placed parallel to each other to create a corridor, and are oriented perpendicular to the line of progression7. The system simply detects interruptions in light signal, for instance due to the presence of feet within the recording area. Temporal gait parameters and 1D spatial coordinates of consecutive steps are subsequently calculated to provide common gait parameters such as step length, single limb support and walking velocity8, whose validity against a criterion instrument has recently been demonstrated7,9. The measurement procedures are very straightforward; a single patient can be tested in less than 5 min&#160;and a comprehensive report can be generated in less than 1&#160;min.

A recent study demonstrated the validity of the photoelectric system against a criterion instrument (a validated electronic walkway) for the assessment of spatiotemporal gait parameters in orthopedic patients and healthy elderly controls7. The same between-group differences in gait variables were detected by the two systems. Although concurrent validity was excellent, with intraclass correlation coefficients ranging between 0.933 and 0.999 (p &#60; 0.001), a systematic bias (p &#60; 0.001) was observed between...

Watch this Scientific Journal Video about Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults at JoVE.com

Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

This protocol is used to evaluate spatial and temporal gait variables of neurological/orthopedic patients and older persons by means of a recently-introduced floor-based photocell system.

Spatial and temporal characteristics of human walking are frequently evaluated to identify possible gait impairments, mainly in orthopedic and ...

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13.7K 조회수.  Schulthess Clinic. This protocol is used to evaluate spatial and temporal gait variables of neurological/orthopedic patients and older persons by means of a recently-introduced floor-based photocell system.

비디오: Clinical Assessment of Spatiotemporal Gait Parameters in Patients and Older Adults

Collecting Saliva and Measuring Salivary Cortisol and Alpha-amylase in Frail Community Residing Older Adults via Family Caregivers

Salivary measures have emerged in bio-behavioral research that are easy-to-collect, minimally invasive, and relatively inexpensive biologic markers of stress. This article we present the steps for collection and analysis of two salivary assays in research with frail, community residing older adults-salivary cortisol and salivary alpha amylase. The field of salivary bioscience is rapidly advancing and the purpose of this presentation is to provide an update on the developments for investigators interested in integrating these measures into research on aging. Strategies are presented for instructing family caregivers in collecting saliva in the home, and for conducting laboratory analyses of salivary analytes that have demonstrated feasibility, high compliance, and yield quality specimens. The protocol for sample collection includes: (1) consistent use of collection materials; (2) standardized methods that promote adherence and minimize subject burden; and (3) procedures for controlling certain confounding agents. We also provide strategies for laboratory analyses include: (1) saliva handling and processing; (2) salivary cortisol and salivary alpha amylase assay procedures; and (3) analytic considerations.

We demonstrate: (1) procedures for collection of salivary samples in cognitive impaired older adults by family caregivers in the home setting, (2) procedures for measuring stress activity via salivary cortisol and alpha amylase, and (3) representative profiles. Protocols that allow researchers to study stress-linked processes advance our understanding of biological sensitivity and susceptibility.

Salivary measures have emerged in bio-behavioral research  that are easy-to-collect, minimally invasive, and relatively inexpensive  biologic markers of ...

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this is only partially explained by traditional CVD risk factors. Vascular dysfunction is an important non-traditional risk factor, characterized by vascular endothelial dysfunction (most commonly assessed as impaired endothelium-dependent dilation [EDD]) and stiffening of the large elastic arteries. While various techniques exist to assess EDD and large elastic artery stiffness, the most commonly used are brachial artery flow-mediated dilation (FMDBA) and aortic pulse-wave velocity (aPWV), respectively. Both of these noninvasive measures of vascular dysfunction are independent predictors of future cardiovascular events in patients with and without kidney disease. Patients with CKD demonstrate both impaired FMDBA, and increased aPWV. While the exact mechanisms by which vascular dysfunction develops in CKD are incompletely understood, increased oxidative stress and a subsequent reduction in nitric oxide (NO) bioavailability are important contributors. Cellular changes in oxidative stress can be assessed by collecting vascular endothelial cells from the antecubital vein and measuring protein expression of markers of oxidative stress using immunofluorescence. We provide here a discussion of these methods to measure FMDBA, aPWV, and vascular endothelial cell protein expression.

The degree of vascular dysfunction and contributing physiological mechanisms can be assessed in patients with chronic kidney disease by measuring brachial artery flow-mediated dilation, aortic pulse-wave velocity, and vascular endothelial cell protein expression.

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this ...

A Detailed Protocol for Physiological Parameters Acquisition and Analysis in Neurosurgical Critical Patients

Intracranial pressure (ICP) monitoring is now widely used in neurosurgical critical patients. Besides mean ICP value, the ICP derived parameters such as ICP waveform, amplitude of pulse (AMP), the correlation of ICP amplitude and ICP mean (RAP), pressure reactivity index (PRx), ICP and arterial blood pressure (ABP) wave amplitude correlation (IAAC), and so on, can reflect intracranial status, predict prognosis, and can also be used as guidance of proper treatment. However, most of the clinicians focus only on the mean ICP value while ignoring these parameters because of the limitations of the current devices. We have recently developed a multimodality monitoring system to address these drawbacks. This portable, user-friendly system will use a data collecting and storing device to continuously acquire patients&#39; physiological parameters first, i.e., ABP, ICP, and oxygen saturation, and then analyze these physiological parameters. We hope that the multimodality monitoring system will be accepted as a key measure to monitor physiological parameters, to analyze the current clinical status, and to predict the prognosis of the neurosurgical critical patients.

Recently, we have developed a portable multimodality monitoring system for the monitoring of various physiological parameters in neurosurgical critical patients. Detailed protocols on how to use this multimodality monitoring system are presented here.

Intracranial pressure (ICP) monitoring is now widely used in neurosurgical critical patients. Besides mean ICP value, the ICP derived parameters such as ...

Severe Burn Injury in a Swine Model for Clinical Dressing Assessment

Wound healing is a dynamic repair process and is the most complex biological process in human life. In response to burn injury, alterations in biological pathways impair the inflammation response, resulting in delayed wound healing. Impaired wound healing frequently occurs in patients with diabetes leading to unfavorable outcomes such as amputation. Hence, dressings having beneficial effect in promoting burn wound repair are needed. However, studies on burn wound treatment are limited due to lack of proper animal models. Our previous study demonstrated wound-healing performance in rat and swine models using a minimally invasive surgical technique. This study aimed to demonstrate a swine model of severe burn injury that eliminates wound contraction and more closely approximates the human processes of re-epithelialization and new tissue formation. This protocol provides a detailed procedure for creating consistent burn wounds and examining the wound-healing performance under the treatment of an experimental dressing in a swine model. Six burn wounds were created symmetrically on the dorsum, which were covered with a clinical dressing composed of four layers: an inner contact layer of experimental materials, an inner intermediate layer of waterproof film, an outer intermediate layer of gauze, and an outer layer of adhesive plaster. Upon the completion of experiments, wound closure, wound area, and Vancouver Scar Scale score were examined. The samples of skin resected from each animal post-sacrifice were histologically prepared and stained using hematoxylin and eosin staining. Antibacterial activity of each dressing in the context of wound healing was also examined. The application of the clinical dressing to the wounds in swine model mimics the biological processes of human wound healing with respect to the processes of epithelialization, cellular proliferation, and angiogenesis. Therefore, this swine model provides an easy-to-learn, cost-effective, and robust method to assess the effect of clinical dressings in severe burn injury.

To closely mimic the mode of burn injuries requires the interplay between clinical observation and studies in animal models. In this study, a swine model of severe burn injury was established to assess an experimental dressing in physiological and pathophysiological settings.

Wound healing is a dynamic repair process and is the most complex biological process in human life. In response to burn injury, alterations in biological ...

Measurements of Motor Function and Other Clinical Outcome Parameters in Ambulant Children with Duchenne Muscular Dystrophy

While the number of new treatment options tested in patients with Duchenne muscular dystrophy (DMD) is increasing, there is still no defining of the most reliable assessments regarding therapeutic efficacy. We present clinical and radiological outcome measures used in ambulatory patients participating in our trial &#34;Treatment with L-citrulline and metformin in Duchenne muscular dystrophy&#34;. The motor function measure is a validated test in patients with neuromuscular disorders that consists of 32 items and assesses all three dimensions of motor performance including standing and transfer (D1 subscore), axial and proximal motor function (D2 subscore), and distal motor function (D3 subscore). The test shows high intra- and inter-rater variability but only when strictly following guidelines of the materials, examination steps, and calculation of scores. The 6-minute walk test, timed 10-meter walk/run test, and supine-up time are commonly used timed functional tests that also sufficiently monitor changes in muscle function; however, they strongly depend on patient collaboration. Quantitative MRI is an objective and sensitive biomarker to detect subclinical changes, though the examination costs may be a reason for its limited use. In this study, a high correlation between all clinical assessments and quantitative MRI scans was found. The combinational use of these methods provides a better understanding about disease progression; however, longitudinal studies are needed to validate their reliability.

The aim of this study is to present the most reliable clinical outcome measures and their correlations with quantitative muscle MRI in ambulant patients with Duchenne muscular dystrophy.

While the number of new treatment options tested in patients with Duchenne muscular dystrophy (DMD) is increasing, there is still no defining of the most ...

Multi-Modal Home Sleep Monitoring in Older Adults

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and research participants. Home sleep testing has gained momentum in the field of sleep medicine due to its convenience and lower cost, as well as being more naturalistic. The accuracy and quality of home sleep testing, however, may be variable because studies are not monitored by sleep technologists. There has been some success in improving the accuracy of home sleep studies by having trained sleep technicians assist participants inside their homes with putting on the devices, but this can be intrusive and time-consuming for those involved. In this protocol, participants undergo at-home sleep monitoring with multiple devices: 1) a single-channel EEG device; 2) a home sleep test for sleep-disordered breathing and periodic limb movements; 3) actigraphy; and 4) sleep logs. A major challenge of this study is obtaining high-quality sleep monitoring data on the first attempt in order to minimize participant burden. This protocol describes the implementation of educational manuals with step-by-step instructions and photos. The goal is to improve the quality of home sleep testing.

Here, we present a protocol to improve the quality of data from home sleep testing by providing a method to enhance instructions through a structured participant visit. This protocol includes the implementation of a step-by-step educational manual with photos to ensure proper placement of equipment.

The gold standard for sleep monitoring is attended in-lab polysomnography; however, this method may be cost-prohibitive and inconvenient for patients and ...

Evaluation of Patients' Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis

This protocol provides guidance on how to perform high resolution video rasterstereography and treadmill gait analysis on patients after lumbar fusion surgery to obtain results about altered variables of gait and posture. These observed changes can then be correlated with the patient-reported outcome measure of pain relief. The rasterstereographic device projects lines of parallel light onto the surface of the tested subject&#39;s back. The deformation of these lines is recognized by the device. From these data, a special software then generates a 3-D profile based on the principle of triangulation. With an inaccuracy of only 0.2 mm it can measure changes in posture at very high precision. Gait and stance parameters are recorded using a treadmill equipped with an electric sensor mat that contains 10,200 miniature force sensors in the registering zone under the belt. Initial walking speed on the treadmill is 0.5 km/h. Speed is then gradually increased by increments of 0.1 km/h until each subject reaches his or her individual maximum well tolerable walking speed. At this speed, parameters are recorded during a 20 s measurement interval. Subjects are tested barefoot and without holding a handrail. Among various other parameters, stride width, step length, stance phase and foot rotation are measured. Both methods used reportedly have a high intra- and inter-observer reliability. The advantage of these highly accurate techniques is that they offer an objective and very detailed perspective on changes in the patient&#39;s posture and gait. Due to the amount of data generated, these techniques are, however, not so much suitable for everyday routine use, but rather interesting to scientifically evaluate long term alterations in posture and gait in patients like for example after lumbar fusion surgery.

Evaluation of Patients&#039; Posture and Gait Profile After Lumbar Fusion Surgery by Video Rasterstereography and Treadmill Gait Analysis

Here, we present a protocol to analyze the posture and the gait of patients after lumbar fusion surgery by means of high-resolution video rasterstereography and a treadmill equipped with an integrated sensor mat. Allowing critical functional postoperative evaluation on a less subjective level may enhance accuracy and reliability of indication for surgery.

This protocol provides guidance on how to perform high resolution video rasterstereography and treadmill gait analysis on patients after lumbar fusion ...

Invasive Hemodynamic Assessment for the Right Ventricular System and Hypoxia-Induced Pulmonary Arterial Hypertension in Mice

Pulmonary arterial hypertension (PAH) is a chronic and severe cardiopulmonary disorder. Mice are a popular animal model used to mimic this disease. However, the evaluation of right ventricular pressure (RVP) and pulmonary artery pressure (PAP) remains technically challenging in mice. RVP and PAP are more difficult to measure than left ventricular pressure because of the anatomical differences between the left and right heart systems. In this paper, we describe a stable right heart hemodynamic measurement method and its validation using healthy and PAH mice. This method is based on open-chest surgery and mechanical ventilation support. It is a complicated procedure compared to closed chest procedures. While a well-trained surgeon is required for this surgery, the advantage of this procedure is that it can generate both RVP and PAP parameters at the same time, so it is a preferable procedure for the evaluation of PAH models.

Here, we present a protocol to perform an invasive hemodynamic assessment of the right ventricle and pulmonary artery in mice using an open-chest surgery approach.

Pulmonary arterial hypertension (PAH) is a chronic and severe cardiopulmonary disorder. Mice are a popular animal model used to mimic this disease. ...

A Training Program Using an Agility Ladder for Community-Dwelling Older Adults

Aging impairs physical and cognitive functions and limits daily activities. Agility training can improve or maintain physical functioning in older people. The purpose of this study is to report the physical fitness benefits of a training program for independent community-dwelling older adults using an agility ladder. Each training session lasted approximately 30 minutes, and the benefits were achieved with two sessions per week for 14 weeks. Training was timed and involved four different drills and varying levels of difficulty through time. The exercises were performed at the School of Physical Education of the University of Campinas, S&#227;o Paulo state, Brazil. The study participants (n = 16; mean age of 66.9 &#177; 5.0 years) were instructed to perform the exercises as quickly as possible without making mistakes and were assisted by a physical trainer when they made mistakes. Assessments were performed both before and after training using five functional tests (i.e., Illinois agility, five times sit-to-stand, timed up-and-go, walking usual speed, and one-leg stand). Although the study sample was not compared with a control group, the results indicate that training protocols using an agility ladder are easy and practical and improve physical function performance in older adults.

The aim of this study is to present an agility training program for older people. The feasibility of this program is described, and the training protocol demonstrated by video imaging.

Aging impairs physical and cognitive functions and limits daily activities. Agility training can improve or maintain physical functioning in older people. ...

Oral Health Assessment by Lay Personnel for Older Adults

Oral health is an often-undervalued contributor to overall health. The literature, however, underscores the myriad of systemic diseases influenced by oral health, including type II diabetes, heart disease, and atherosclerosis. Thus, assessments of oral health, called oral screenings, have a significant role in assessing risk of disease, managing disease, and even improving disease by oral care. Here we present a method to assess oral health quickly and consistently across time. The protocol is simple enough for non-oral health professionals such as students, family, and caregivers. Useful for any age of patient, the method is particularly key for older individuals who are often at risk of inflammation and chronic disease. Components of the method include existing oral health assessment scales and inventories, which are combined to produce a comprehensive assessment of oral health. Thus, oral characteristics assessed include intraoral and extraoral structures, soft and hard tissues, natural and artificial teeth, plaque, oral functions such as swallowing, and the impact this oral health status has on the patient&#39;s quality of life. Advantages of this method include its inclusion of measures and perceptions of both the observer and patient, and its ability to track changes in oral health over time. Results acquired are quantitative totals of questionnaire and oral screening items, which can be summed for an oral health status score. The scores of successive oral screenings can be used to track the progression of oral health across time and guide recommendations for both oral and overall health care.

The goal of this protocol is to enable non-dental professionals to assess oral health status for research or health-screening purposes. Aspects assessed include lips, tongue, soft and hard tissues, natural and artificial teeth, oral cleanliness, plaque, swallowing, and impact of oral health on quality of life.

Oral health is an often-undervalued contributor to overall health. The literature, however, underscores the myriad of systemic diseases influenced by oral ...