Background/Objectives: First responders frequently encounter high-stress environments that challenge physiological resilience and autonomic regulation. Heart rate variability (HRV) complexity is a critical marker of adaptive capacity and stress regulation. This study assessed the impact of a wearable-based mindfulness intervention on HRV complexity among first responders using a smartwatch. Methods: A total of 87 first responders participated in a one-month wearable-based intervention. Participants wore Garmin Vivosmart 5 devices to continuously collect PPG data (photoplethysmogram), focusing on beat-to-beat intervals (BBIs). The intervention involved daily Ecological Momentary Assessments (EMAs) and individual randomization to either a mindfulness message, a prompt to access an audio exercise, or no-treatment/control; interventions were delivered via the MYAPT.MIND mobile application. HRV metrics, including Sample Entropy, Multiscale Entropy (MSE), Recurrence Rate (RR), and Determinism (Det), were analyzed pre- and post-intervention/control using paired-samples t-tests. Results: Significant improvements were observed in HRV complexity metrics post-intervention. Sample Entropy increased (M = 1.42, SD = 0.11) compared to pre-intervention (M = 1.39, SD = 0.10; p = 0.007). MSE also showed significant gains (p = 0.038), particularly at lower scales, indicating enhanced short-term autonomic flexibility. Reductions were noted in RR (p = 0.025) and Det (p = 0.018), suggesting improved cardiovascular adaptability and reduced physiological rigidity. Other traditional time-domain metrics, such as Mean HR, SDNN, and RMSSD, did not exhibit significant changes. Conclusions: The wearable-based intervention significantly enhanced HRV complexity, reflecting improved autonomic regulation and adaptive capacity in first responders. These findings support the integration of digital mindfulness strategies for stress management in high-risk occupations. Future research should explore the longitudinal effects and mechanisms mediating these autonomic adaptations.

Falls are among the most common cause of decreased mobility and independence in older adults and rank as one of the most severe public health problems with frequent fatal consequences. In the present study, gait characteristics from 171 community-dwelling older adults were evaluated to determine their predictive ability for future falls using a wearable system. Participants wore a wearable sensor (inertial measurement unit, IMU) affixed to the sternum and performed a 10-m walking test. Measures of gait variability, complexity, and smoothness were extracted from each participant, and prospective fall incidence was evaluated over the following 6-months. Gait parameters were refined to better represent features for a random forest classifier for the fall-risk classification utilizing three experiments. The results show that the best-trained model for faller classification used both linear and nonlinear gait parameters and achieved an overall 81.6 ± 0.7% accuracy, 86.7 ± 0.5% sensitivity, 80.3 ± 0.2% specificity in the blind test. These findings augment the wearable sensor's potential as an ambulatory fall risk identification tool in community-dwelling settings. Furthermore, they highlight the importance of gait features that rely less on event detection methods, and more on time series analysis techniques. Fall prevention is a critical component in older individuals’ healthcare, and simple models based on gait-related tasks and a wearable IMU sensor can determine the risk of future falls.

Falls are the leading cause of disability in older adults with a third of adults over the age of 65 falling every year. Quantitative fall risk assessments using inertial measurement units and local dynamics stability (LDS) have shown that it is possible to identify at-risk persons. However, there are inconsistencies in the literature on how to calculate LDS and how much data is required for a reliable result. This study investigates the reliability and minimum required strides for 6 algorithm-normalization method combinations when computing LDS using young healthy and community dwelling elderly individuals. Participants wore an accelerometer at the lower lumbar while they walked for three minutes up and down a long hallway. This study concluded that the Rosenstein et al. algorithm was successfully and reliably able to differentiate between both populations using only 50 strides. It was also found normalizing the gait time series data by either truncating the data using a fixed number of strides or using a fixed number of strides and normalizing the entire time series to a fixed number of data points performed better when using the Rosenstein et al. algorithm.

Various factors are responsible for injuries that occur in the U.S. Army soldiers. In particular, rucksack load carriage equipment influences the stability of the lower extremities and possibly affects gait balance. The objective of this investigation was to assess the gait and local dynamic stability of the lower extremity of five subjects as they performed a simulated rucksack march on a treadmill. The Motek Gait Real-time Interactive Laboratory (GRAIL) was utilized to replicate the environment of the rucksack march. The first walking trial was without a rucksack and the second set was executed with the All-Purpose Lightweight Individual Carrying Equipment (ALICE), an older version of the rucksack, and the third set was executed with the newer rucksack version, Modular Lightweight Load Carrying Equipment (MOLLE). In this experiment, the Inertial Measurement Unit (IMU) system, Dynaport was used to measure the ambulatory data of the subject. This experiment required subjects to walk continuously for 200 seconds with a 20kg rucksack, which simulates the real rucksack march training. To determine the dynamic stability of different load carriage and normal walking condition, Local Dynamic Stability (LDS) was calculated to quantify its stability. The results presented that comparing Maximum Lyapunov Exponent (LyE) of normal walking was significantly lower compared to ALICE (P=0.000007) and MOLLE (P=0.00003), however, between ALICE and MOLLE rucksack walking showed no significant difference (P=0.441). The five subjects showed significantly improved dynamic stability when walking without a rucksack in comparison with wearing the equipment. In conclusion, we discovered wearing a rucksack result in a significant (P < 0.0001) reduction in dynamic stability.

Acute injury to aged individuals represents a significant challenge to the global healthcare community as these injuries are frequently treated in a reactive method due to the infeasibility of frequent visits to the hospital for biometric monitoring. However, there is potential to prevent a large number of these cases through passive, at-home monitoring of multiple physiological parameters related to various causes that are common to aged adults in general. This research strives to implement wearable devices, ambient “smart home” devices, and minimally invasive blood and urine analysis to test the feasibility of implementation of a multitude of research-level (i.e. not yet clinically validated) methods simultaneously in a “smart system”. The system comprises measures of balance, breathing, heart rate, metabolic rate, joint flexibility, hydration, and physical performance functions in addition to lab testing related to biological aging and mechanical cell strength. A proof-of-concept test is illustrated for two adult males of different ages: a 22-year-old and a 73-year-old matched in body mass index (BMI). The integrated system is test in this work, a pilot study, demonstrating functionality and age-related clinical relevance. The two subjects had physiological measurements taken in several settings during the pilot study: seated, biking, and lying down. Balance measurements indicated changes in sway area of 45.45% and 25.44%, respectively for before/after biking. The 22-year-old and the 73-year-old saw heart rate variabilities of 0.11 and 0.02 seconds at resting conditions, and metabolic rate changes of 277.38% and 222.23%, respectively, in comparison between the biking and seated conditions. A smart camera was used to assess biking speed and the 22- and 73-year-old subjects biked at 60 rpm and 28.5 rpm, respectively. The 22-year-old subject saw a 7 times greater electrical resistance change using a joint flexibility sensor inside of their index finger in comparison with the 73-year-old male. The 22 and 73-year-old males saw respective 28% and 48% increases in their urine ammonium concentration before/after the experiment. The average lengths of the telomere DNA from the two subjects were measured to be 12.1 kb (22-year-old) and 6.9 kb (73-year-old), consistent with their biological ages. The study probed feasibility of 1) multi-metric assessment under free living conditions, and 2) tracking of the various metrics over time.

OBJECTIVE: We sought to evaluate dynamic balance and postural stability in patients with adult spinal deformity (ASD) compared with published age-matched normative data. METHODS: Eleven patients with ASD were prospectively enrolled. Postural stability was tested using static and dynamic posturography; patients stood on a movable platform with an integrated force plate and performed standardized sensory organization testing (SOT), evaluating the influence of sensory processing on postural stability under 6 conditions, and motor control testing, assessing reflexive postural reactions to an external perturbation. Patient performance was compared with that of published age-matched controls. Quality of life metrics included scores on the Scoliosis Research Society-22 questionnaire, SF-36, and Morse Fall Scale. Correlations between postural stability and radiographic measurements were performed. RESULTS: ASD patients demonstrated significantly lower SOT scores (P <= 0.03) in 5 of 6 conditions tested and greater latency of limb movement during backward translation (P = 0.04) compared with controls. Lower SOT scores were associated with a history of falls. ASD patients who self-reported falling in the previous 6 months, when compared with nonfallers, demonstrated significantly lower SOT scores (P = 0.04) and significantly lower Scoliosis Research Society-22 self-image subscores (P = 0.003). Thoracic kyphosis and mediolateral sway (predictor of falls) were positively correlated in the eyesopen and eyes-closed conditions (P <= 0.04). CONCLUSIONS: ASD patients demonstrated impaired postural stability, diminished sensory integration, and delayed response to external perturbations compared with normal control data. Postural stability and quality of life metrics correlated with self-reported falls. These findings suggest that ASD patients have abnormal postural stability and may be at elevated risk of falls.

Epidemiological studies link increased fall risk to obesity in older adults, but the mechanism through which obesity increases falls and fall risks is unknown. This study investigates if obesity (Body Mass Index: BMI>30 kg/m2) influenced gait and standing postural characteristics of community dwelling older adults leading to increased risk of falls. One hundred healthy older adults (age 74.0±7.6 years, range of 56-90 years) living independently in a community participated in this study. Participants' history of falls over the previous two years was recorded, with emphasis on frequency and characteristics of falls. Participants with at least two falls in the prior year were classified as fallers. Each individual was assessed for postural stability during quiet stance and gait stability during 10 meters walking. Fall risk parameters of postural sway (COP area, velocity, path-length) were measured utilizing a standard forceplate coupled with an accelerometer affixed at the sternum. Additionally, parameters of gait stability (walking velocity, double support time, and double support time variability) were assessed utilizing an accelerometer affixed at the participant's sternum. Gait and postural stability analyses indicate that obese older adults who fell have significantly altered gait pattern (longer double support time and greater variability) exhibiting a loss of automaticity in walking and, postural instability as compared to their counterparts (i.e., higher sway area and path length, and higher sway velocity) further increasing the risk of a fall given a perturbation. Body weight/BMI is a risk factor for falls in older adults as measured by gait and postural stability parameters.

Our retrospective study of falls and resultant trauma in consecutive Parkinson disease (PD) patients seen in one year at the Muhammad Ali Parkinson Clinic found that multiple-fallers could be divided into patients who fell mainly when walking or those who fell mainly when standing. Patients who fell when walking were more likely to visit an emergency room or be admitted to a hospital. Of 455 consecutive patients who were evaluated over a one-year period, 51 were excluded because they had atypical Parkinson disorders, had multiple risk factors for falling, or were demented. Unified Parkinson Disease Rating Scales and Zeno Walkway results were compared among non-fallers, single-fallers, and multiple-fallers. Among multiple-fallers, comparisons were made between patients who fell mainly when standing and those who fell mainly when walking. Most patients (197, 49%) did not fall, 142 (35%) fell once, and 65 (16%) fell more than once. Multiple-fallers differed significantly from single-fallers and non-fallers: they had PD significantly longer (p<0.001), were more severely affected (p<0.001), and took shorter steps (p<0.001). Of 65 multiple-fallers, 26 (40%) fell mainly when standing, 28 (43%) fell mainly when walking, and 11 (17%) fell equally often when standing or walking. Falls when walking resulted in more severe injuries. Patients who fell mainly when standing did not realize they could fall when standing; engaged in inappropriate weight shifting, bending, reaching, and multitasking; and failed to use their assistive devices. Such patients would benefit from being counseled about falling when standing. Patients who fell mainly when walking were aware they could fall, despite using an assisted device, and were more likely to have freezing of gait (FOG). They were more likely to sustain a severe injury, and were more likely to be admitted to an emergency room or hospital. Such patients would benefit from reducing, if possible, FOG.

Objective: Determine if NC001, an oral formulation of nicotine that reduces levodopa-induced dyskinesias (LIDs) in MPTP-Parkinson monkeys, could reduce falls, freezing of gait (FOG), and LIDs in Parkinson disease (PD) patients.Methods: Previously collected data from a study analyzing the effects of NC001 on LIDs in PD patients were reanalyzed. Because indirect-acting cholinergic drugs are sometimes helpful in reducing falls, we hypothesized that NC001, a direct-acting cholinergic agonist, could reduce falls in PD. The original 12-center, double-blind, randomized trial enrolled 65 PD patients. NC001 or placebo was administered 4 times per day for 10 weeks, beginning at 4 mg/day and escalating to 24 mg/day. Assessments included the Unified Dyskinesia Rating Scale (UDysRS) and Parts II-III of the original Unified Parkinson's Disease Rating Scale (UPDRS).Results: Randomization (1:1) resulted in 35 patients on NC001 and 30 on placebo at baseline. Thirty and 27 patients, respectively, had data available for an intent-to-treat analysis. NC001 was safe and well-tolerated. After 10 weeks, NC001 patients (14/30) had a significant reduction in falls vs. placebo patients (3/27) (p = 0.0041) as assessed by UPDRS Part II. NC001 patients (12/30) also had significantly reduced FOG vs. placebo patients (4/27) (p = 0.0043). NC001 patients, compared with placebo patients, had a significant improvement (p = 0.01) in UDysRS ambulation subtest (40% vs. 3%, respectively). Although NC001 patients had a greater reduction in dyskinesias on the UDysRS than placebo patients (30% vs. 19%, respectively), this was not significant (p = 0.09).Conclusions: NC001 significantly improved two refractory symptoms of PD, falls and FOG. The reduction in falls and FOG is attributed to selective stimulation of nicotinic receptors.Clinical Trial Registration: Conducted under IND 105, 268, serial number 0000. ClinicalTrials.gov identifier NCT00957918.

Postural control is a key aspect in preventing falls. The aim of this study was to determine if obesity affected balance in community-dwelling older adults and serve as an indicator of fall risk. The participants were randomly assigned to receive a comprehensive geriatric assessment followed by a longitudinal assessment of their fall history. The standing postural balance was measured for 98 participants with a Body Mass Index (BMI) ranging from 18 to 63 kg/m(2), using a force plate and an inertial measurement unit affixed at the sternum. Participants' fall history was recorded over 2 years and participants with at least one fall in the prior year were classified as fallers. The results suggest that body weight/BMI is an additional risk factor for falling in elderly persons and may be an important marker for fall risk. The linear variables of postural analysis suggest that the obese fallers have significantly higher sway area and sway ranges, along with higher root mean square and standard deviation of time series. Additionally, it was found that obese fallers have lower complexity of anterior-posterior center of pressure time series. Future studies should examine more closely the combined effect of aging and obesity on dynamic balance.

April 22, 2018April 10, 2018Free AccessNo Postural Stability Differences between Asymptomatic and Symptomatic Neurological Orthostatic Hypotension in Parkinson’s disease – A Pilot Study (P1.051)Victoria Smith, Christopher Frames, Markey Olson, Thurmon Lockhart, and Abraham LiebermanAuthors Info & AffiliationsApril 10, 2018 issue90 (15_supplement)https://doi.org/10.1212/WNL.90.15_supplement.P1.051 Letters to the Editor

ABSTRACT Purpose/Aim of the study: To study finger displacement in patients with Parkinson disease dementia (PDD) and in patients with Alzheimer disease (AD). Methods: We examined 56 patients with PDD and 35 with AD. Patients were examined during their regular outpatient clinic visit. Finger displacement was measured by observers not actively involved in the study using a creative grid ruler for all PDD and AD patients. Finger displacement was examined by asking patients to point their index fingers toward the grid ruler with the nails facing upward. Patients were asked to maintain the pointing position for 15 s. After 15 s, patients were asked to close their eyes for another 15 s while maintaining the same position. A positive result was downward index finger displacement of ≥5 cm within the 15-second time window with eyes closed. Results: Of the 56 PDD patients, 53 had bilateral finger displacement of >5 cm. In comparison, of the 35 AD patients, only 1 patient had minimal displacement. Conclusions: Results of the non-invasive finger displacement test may provide insight, on an outpatient basis, of the integrity of subcortical–cortical circuits. Downward finger displacement, especially bilateral downward displacement, may signal the extensive disruption of subcortical–cortical circuits that occurs in PDD patients. Abbreviations: AChE: acetylcholinesterase; AD: Alzheimer disease; DLB: dementia with Lewy bodies; ET: essential tremor; MDS-UPDRS: Movement Disorder Society–sponsored Unified Parkinson's Disease Rating Scale; MMSE: Mini-Mental State Examination; PD: Parkinson disease; PDD: Parkinson disease dementia

Parkinson’s disease (PD) can be divided into two subtypes based on clinical features—namely tremor dominant (TD) and postural instability and gait difficulty (PIGD). This categorization is important at the early stage of PD, since identifying the subtypes can help to predict the clinical progression of the disease. Accordingly, correctly diagnosing subtypes is critical in initiating appropriate early interventions and tracking the progression of the disease. However, as the disease progresses, it becomes increasingly difficult to further distinguish those attributes that are relevant to the subtypes. In this study, we investigated whether a method using the standing center of pressure (COP) time series data can separate two subtypes of PD by looking at the frequency component of COP (i.e., COP position and speed). Thirty-six participants diagnosed with PD were evaluated, with their bare feet on the force platform, and were instructed to stand upright with their arms by their sides for 20 s (with their eyes open and closed), which is consistent with the traditional COP measures. Fast Fourier transform (FFT) and wavelet transform (WT) were performed to distinguish between the motor subtypes using the COP measures. The TD group exhibited larger amplitudes at the frequency range of 3–7 Hz when compared to the PIGD group. Both the FFT and WT methods were able to differentiate the subtypes. COP time series information can be used to differentiate between the two motor subtypes of PD, using the frequency component of postural stability.

Objective: The incidence and circumstances of falls in patients with Parkinson’s disease was studied longitudinally in order to better characterize falls and educate patients. Background: Falls result in serious injuries in Parkinson disease (PD) patients and the elderly. In addition to recognizing fall risks, it is important to recognize fall types: falls when standing differ from falls when walking. These differences are important in educating and training patients and caregivers in fall prevention. Design/Methods: Data were analyzed for 404 idiopathic PD patients who were followed for one year. All patients were examined using MDS-UPDRS Part III and fall diaries. Patients were assessed for fall occurrence and fall types: standing or walking. Results: Of the 404 patients, 197 (49%) did not fall, 142 (35%) fell once, and 65 (16%) fell more than once (“multiple fallers”). Fallers and non-fallers had a similar duration and severity of PD. Multiple fallers, the focus of our study, differed significantly from single fallers and non-fallers; multiple fallers had longer disease duration (p Conclusions: Patients who fell when standing generally fell when shifting their weight, such as during bending, reaching, or stretching. Patients who fell when walking fell when turning, walking through a doorway, or walking on an uneven surface. This information can be utilized to educate and train PD patients on how to avoid falls. Disclosure: Dr. Lieberman has nothing to disclose. Dr. Lockhart has nothing to disclose. Dr. Olson has nothing to disclose. Dr. Smith has nothing to disclose. Dr. Frames has nothing to disclose.

April 24, 2018April 10, 2018Free AccessEffect of NP002, a centrally acting cholinergic agent, in reducing dyskinesia, freezing of gait, and falls in patients with Parkinson’s disease (S26.007)Abraham Lieberman, Thurmon Lockhart, Markey Olson, Victoria Smith, and Christopher FramesAuthors Info & AffiliationsApril 10, 2018 issue90 (15_supplement)https://doi.org/10.1212/WNL.90.15_supplement.S26.007 Letters to the Editor

Discriminating the two subtypes of tremor dominant (TD) and postural instability/gait difficulty (PIGD) in Parkinson's disease (PD) at early stage is highly valuable and crucial for progression treatment of disease for caregivers. However, there is no objective method or a subtype-specific biomarker yet available for identifying these two subtypes. A computational approach in frequency domain could be a good candidate to introduce biomarker since PD tremor had frequency range of 3-7 Hz. By using frequency component of the whole body Center Of Pressure (COP) signal, we propose a ratio between high and low frequency range. To evaluate this ratio, COP data of ten PD patients were utilized. The results suggest that identifying PD subtypes is attainable by using the frequency information of COP signals.

OBJECTIVE: To study the effect of variable deep brain stimulation frequencies on balance and gait in patients with either bilateral Subthalamic nucleus(STN)or Globus pallidus internus (GPi)deep brain stimulator: A quantitative analysis. BACKGROUND:Gait and balance abnormalities are major contributor to falls in Parkinson Disease(PD)patients. Recent study indicates that low-frequency stimulation of STN or GPi improve gait in PD. In this study we quantitatively studied the effect of Low (LF-30Hz), intermediate (IF-80 HZ) and high frequency ( HF- clinically determined)DBS of STN and GPi METHODS: We tested 10 patients (5 STN and 5 GPi). Subjects were first tested in their usual HF DBS settings. They were reevaluated twice at IF, and LF conditions in off-medications state after random selection of the sequence. Minimum of 30-minute wait period was allowed before evaluation after changing stimulation frequency.Quantitative gait parameters were obtained using Mobilty Lab portable gait syatem sensors. Motor impairements were tested using Unified Parkinson9s Disease Rating scale (UPDRS). Gait measure include stride length, speed, cadence, step duration, double support. Arm swing velocity, number of steps and turning duration. Result:Stride length improved in 5 patients on IF, 4 patients on HF and 1 patient on LF. Double support duration improved in 4 patients on IF, 3 patients on HF and 3 patients on LF. Cadence improved in 4 patients on IF, 3 patients on HF and 3 patients in LF stimulation. Gait stride velocity improved in 4 patients on IF and 4 patients on HF and 2patients on LF stimulation. CONCLUSIONS:The motor performance including gait and Balance deteriorated when the frequency of stimulation was changed from high-frequency to Intermediate(80Hz)or low frequency (30HZ). This clearly indicated by increase in UPDRS motor score. With respect to gait measures, in general, the lower frequency (30Hz) stimulation worsened gait and turning easures more than intermediate frequency Disclosure: Dr. Deep has nothing to disclose. Dr. Lieberman has nothing to disclose. Dr. Dhall has received personal compensation for activities with Impax, Merz Pharma, Acadia, Medtronic, and IO Therapeutics as a consultant and for activities with Impax, UCB Pharma, Teva Neuroscience as a speaker. Dr. Shafer has nothing to disclose. Dr. Tateuchi has nothing to disclose. Dr. Simpson has nothing to disclose. Dr. Frames has nothing to disclose.

Objective: Why Do Patients with Parkinson Disease Fall? A Single Center Experience. Background: Falls are a major cause of disability in Parkinson disease (PD) patients. In this study, we investigated the risks associated with repeated falls in PD. Design/Methods: Data were collected from 404 PD patients followed for one year in an outpatient setting. Results: Of the 404 patients, 197 (49[percnt]) were non-fallers, 142 (35[percnt]) single fallers and 65 (16[percnt]) recurrent fallers. Single fallers(5.9 + 2.5 yrs., 19.7 + 8.3 UPDRS score) resembled non-fallers(5.4 + 2.2 yrs., 18.9 + 8.3 UPDRS score ) in duration and severity of PD. Recurrent fallers differed significantly from single and non-fallers, having longer disease duration (12.6 + 6.8 yrs., P <0.001) and greater disease severity (32.3 + 12.6 UPDRS score , P <0.001). Recurrent fallers differed significantly from single and non-fallers in postural stability: “pull test” (23 (12[percnt]) of non-fallers, 19 (13[percnt]) of single fallers and 31 (48[percnt]) of recurrent fallers scored abnormally on this test) and one-leg stance test (11 (6[percnt]) of non-fallers, 22 (16[percnt]) of single fallers and 43 (66[percnt]) of recurrent fallers were impaired on this test). Recurrent fallers differed from single and non-fallers with a higher prevalence of Freezing of Gait, “FOG” (12 (6[percnt]) non-fallers, 19 (13[percnt]) single fallers, and 31(48[percnt]) recurrent fallers received an abnormal score of greater than 1 on this test. The odds of obtaining an abnormal score on the FOG test were 2.4 times higher for single fallers in comparison to non-fallers, 5.9 times higher for recurrent fallers in comparison to single fallers, and 14.1 times higher for recurrent fallers in comparison to non-P <0.001). Conclusions: Among fallers, postural stability was more impaired than locomotion. Strategies that improve the evaluation and treatment of postural stability should be emphasized in PD patients who fall. Disclosure: Dr. Lieberman has nothing to disclose. Dr. Deep has nothing to disclose. Dr. Lockhart has nothing to disclose. Dr. Frames has nothing to disclose. Dr. Shafer has nothing to disclose. Dr. McCauley has nothing to disclose.