1
|
Tuijtelaars J, Brehm MA, Twisk JWR, Nollet F. Two-year course of walking adaptability in persons living with late effects of polio. J Rehabil Med 2024; 56:jrm14727. [PMID: 38497608 DOI: 10.2340/jrm.v56.14727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/23/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To evaluate the 2-year course of walking adaptability in persons with late effects of polio. DESIGN Prospective cohort study. PATIENTS A total of 48 persons with late effects of polio (69% female, mean age 63.1 years) with a fall history and/or fear of falling. METHODS Walking adaptability (i.e. variable target-stepping and reactive obstacle-avoidance) was assessed on an interactive treadmill at baseline, 1 year and 2 years. Further, leg-muscle strength and balance were assessed at baseline. The course of walking adaptability was analysed with linear mixed models. Based on median values, subgroups were defined for low vs high baseline walking-adaptability and for clinical characteristics. Tme by subgroup interactions were analysed. RESULTS Variable target-stepping and reactive obstacle-avoidance did not change (p > 0.285). Reactive obstacle-avoidance improved for persons with a high balance score at baseline (p = 0.037), but not for those with lower scores (p = 0.531). No other time by subgroup interactions were found (p > 0.126). CONCLUSION Walking adaptability did not change in persons with late effects of polio over 2 years, and walking adaptability course did not differ between subgroups stratified for walking adaptability determinants, except for balance. Since falls are a major problem among persons with late effects of polio, future studies should investigate whether walking adaptability declines over a longer time and which persons are most at risk.
Collapse
Affiliation(s)
- Jana Tuijtelaars
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Merel-Anne Brehm
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
| | - Jos W R Twisk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| |
Collapse
|
2
|
Raijmakers B, Brehm MA, Nollet F, Koopman FS. Safety, walking ability, and satisfaction outcomes of the NEURO TRONIC stance-control knee-ankle-foot orthosis (SCKAFO): A comparative evaluation to the E-MAG active SCKAFO. Prosthet Orthot Int 2024; 48:30-38. [PMID: 38019018 PMCID: PMC10852034 DOI: 10.1097/pxr.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/06/2023] [Accepted: 10/23/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Stance control knee-ankle-foot orthoses (SCKAFOs) ensure knee stability by locking during stance while allowing knee flexion during swing. Differences in function of the knee joints and building principles between devices may affect their effectiveness. OBJECTIVE To investigate the preliminary effectiveness of a NEURO TRONIC on safety outcomes, net energy cost (EC), and user experiences in individuals already using an E-MAG Active SCKAFO. STUDY DESIGN Prospective uncontrolled intervention study. METHODS A convenience sample of 10 subjects with flaccid lower extremity muscle weakness, including the quadriceps, due to neuromuscular disorders already using an E-MAG Active SCKAFO were provided with a newly fabricated NEURO TRONIC SCKAFO. Outcomes included knee joint locking failures and unlocking failures (ULFs) (i.e., percentage of steps the knee joint failed to lock/unlock) when walking under challenging conditions on an instrumented treadmill while wearing a safety harness; net EC (J/kg per meter) assessed with a 6-min walk test at comfortable speed; 3D gait kinematics and kinetics; and patient-reported outcomes. RESULTS No differences between devices were found for knee joint locking failures (both devices 0%) and ULFs (9.9% for the NEURO TRONIC vs. 13.9% for the E-MAG Active SCKAFO). The mean (standard deviation) net EC with the NEURO TRONIC SCKAFO was 8.2% (from 3.68 [0.81] to 3.38 [0.75] J/kg per meter, p = 0.123) lower, although not significantly, compared with that with the E-MAG Active SCKAFO. Significant improvements with the NEURO TRONIC SCKAFO were found for ankle power ( p = 0.003), perceived walking effort ( p = 0.014), and reported falls ( p = 0.034). CONCLUSION Both the NEURO TRONIC SCKAFO and the E-MAG Active SCKAFO were safe in terms of knee joint locking, while ULFs were frequent with both devices. The net EC with the NEURO TRONIC SCKAFO decreased, although not significantly, by 8.2%, likely due to insufficient power. Perceived walking effort was in favor of the NEURO TRONIC SCKAFO.
Collapse
Affiliation(s)
- Bart Raijmakers
- Amsterdam UMC location University of Amsterdam, Rehabilitation, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Merel Anne Brehm
- Amsterdam UMC location University of Amsterdam, Rehabilitation, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Frans Nollet
- Amsterdam UMC location University of Amsterdam, Rehabilitation, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Fieke Sophia Koopman
- Amsterdam UMC location University of Amsterdam, Rehabilitation, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| |
Collapse
|
3
|
van Duijnhoven E, van der Veen M, Koopman FS, Nollet F, Bruijn SM, Brehm MA. Gait stability and the relationship with energy cost of walking in polio survivors with unilateral plantarflexor weakness. Gait Posture 2024; 107:104-111. [PMID: 37801868 DOI: 10.1016/j.gaitpost.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 09/13/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Polio survivors often exhibit plantarflexor weakness, which impairs gait stability, and increases energy cost of walking. Quantifying gait stability could provide insights in the control mechanisms polio survivors use to maintain gait stability and in whether impaired gait stability is related to the increased energy cost of walking. RESEARCH QUESTION Is gait stability impaired in polio survivors with plantarflexor weakness compared to able-bodied individuals, and does gait stability relate to energy cost of walking? METHODS We retrospectively analyzed barefoot biomechanical gait data of 31 polio survivors with unilateral plantarflexor weakness and of 24 able-bodied individuals. We estimated gait stability by calculating variability (SD) of step width, step length, double support time, and stance time, and by the mean and variability (SD) of the mediolateral and anteroposterior margin of stability (MoSML and MoSAP). In addition, energy cost of walking (polio survivors only) at comfortable speed was analyzed. RESULTS Comfortable speed was 31% lower in polio survivors compared to able-bodied individuals (p < 0.001). Corrected for speed differences, step width variability was significantly larger in polio survivors (+41%), double support time variability was significantly smaller (-27%), MoSML (affected leg) was significantly larger (+80%), and MoSAP was significantly smaller (affected leg:-17% and non-affected leg:-15%). Step width and step length variability (affected leg) were positively correlated with energy cost of walking (r = 0.502 and r = 0.552). MoSAP (non-affected leg) was negatively correlated with energy cost of walking (r = -0.530). SIGNIFICANCE Polio survivors with unilateral plantarflexor weakness demonstrated an impaired gait stability. Increased step width and step length variability and lower MoSAP could be factors related to the elevated energy cost of walking in polio survivors. These findings increase our understanding of stability problems due to plantarflexor weakness, which could be used for the improvement of (orthotic) interventions to enhance gait stability and reduce energy cost in polio survivors.
Collapse
Affiliation(s)
- Elza van Duijnhoven
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.
| | - Marit van der Veen
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Fieke S Koopman
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Frans Nollet
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Sjoerd M Bruijn
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Merel-Anne Brehm
- Amsterdam UMC location University of Amsterdam, Department of Rehabilitation Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Alemdaroğlu-Gürbüz İ, İpek C, Bulut N, Karaduman A, Yılmaz Ö. The Impact of "Fear of Falling" on Physical Performance, Balance, and Ambulation in Duchenne Muscular Dystrophy. Neuropediatrics 2022; 53:330-337. [PMID: 36030791 DOI: 10.1055/s-0042-1750722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE The aim of this study was to investigate falls and the fear of falling (FOF) in children with Duchenne muscular dystrophy (DMD) and to determine the relationships between the FOF and physical performance, balance, and ambulation. METHODS Thirty-eight ambulatory children with DMD were included in the study. The functional level, falling history, FOF, physical performance, balance, and ambulation were assessed by using Brooke Lower Extremity Functional Classification, History of Falls Questionnaire, Pediatric Fear of Falling Questionnaire (Ped-FOF), timed performance tests, Timed "Up and Go" (TUG) test, and North Star Ambulatory Assessment (NSAA), respectively. RESULTS Of the 38 children (mean age: 9.00 ± 2.03 years) 97.4% had a history of serious fall last year and 62.2% were injured due to this fall. The Ped-FOF score was 13.79 ± 7.20. Weak to moderate relations were determined between Ped-FOF and functional level (r = 0.33), frequency of falls (r = 0.41), duration of climbing 4-steps (r = 0.38), TUG (r = 0.36), and NSAA (r = -0.32) (p < 0.05). CONCLUSION Ambulatory children with better performance scores had lower levels of FOF despite their history of serious falls and injuries. FOF tends to increase as the symptoms of the disease progresses. Investigating the history of falls and FOF from the earliest period will guide to take precautions and make necessary interventions on time in treatment programs.
Collapse
Affiliation(s)
- İpek Alemdaroğlu-Gürbüz
- Department of Physical Therapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Canan İpek
- Department of Physical Therapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Numan Bulut
- Department of Physical Therapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Ayşe Karaduman
- Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
| | - Öznur Yılmaz
- Department of Physical Therapy and Rehabilitation, Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| |
Collapse
|
5
|
The Influence of Walking Limitations on Daily Life: A Mixed-Methods Study of 14 Persons with Late Effects of Polio. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19138157. [PMID: 35805815 PMCID: PMC9265635 DOI: 10.3390/ijerph19138157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 12/04/2022]
Abstract
Reduced walking ability is common in persons with late effects of polio (LEoP). Here, we explored how many walking limitations persons with LEoP perceive, and how these limitations influence daily life, by using a mixed-methods design. Fourteen persons (mean age 70 years, whereof 7 women) with LEoP responded to the Walking Impact Scale (Walk-12), and were interviewed individually. Qualitative data were analysed by systematic text condensation, and each quotation was deductively analysed in relation to the items in Walk-12. Running was perceived as most limited, whereas walking indoors without using support was perceived as least limited. A majority (>70%) were moderately to extremely limited in standing or walking, in walking speed and distance, which affected concentration and effort, as well as gait quality aspects. The limited walking ability intruded on many everyday activities, both indoors and outdoors, which affected social participation negatively. To increase safety when walking and reduce the fall risk, various strategies were adopted such as using aids, walking carefully, and avoiding risky activities. In conclusion, LEoP-related walking limitations influence participants’ activity and participation greatly. By using both the Walk-12 scale and face-to-face interviews, an increased understanding of how walking limitations influence everyday life was achieved.
Collapse
|
6
|
Brogårdh C, Lexell J, Westergren A. Measurement properties of the Falls Efficacy Scale-International (FES-I) in persons with late effects of polio: a cross-sectional study. PM R 2022. [PMID: 35666019 DOI: 10.1002/pmrj.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/29/2022] [Accepted: 05/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Fear of falling (FoF) is very common in persons with late effects of polio (LEoP). An internationally recognized rating scale to assess FoF is the Falls Efficacy Scale-International (FES-I). Yet, there is limited knowledge about its measurement properties in persons with LEoP. OBJECTIVE To investigate the measurement properties of FES-I (16-item version) and short FES-I (7-item version) in persons with LEoP. DESIGN Explorative factor analysis and Rasch model analysis of cross-sectional data. SETTING University Hospital. PARTICIPANTS A total of 321 persons with LEoP (mean age 70 ± 10 years, 173 women). MAIN OUTCOME MEASUREMENT The FES-I and short FES-I, comprising four response options about concerns of falling ranging from 1 (not at all concerned) to 4 (very concerned). METHODS Data were collected by a postal survey. First, a factor analysis was performed to investigate unidimensionality of the scale. Thereafter, a Rasch model analysis was used to further analyze the measurement properties of FES-I and short FES-I, such as local dependency, targeting, hierarchical order of items, Differential Item Functioning (DIF), response category functioning and reliability (Person Separation Index, PSI). Raw score transformation to interval measurements was also performed. RESULTS The factor analysis revealed that FES-I was unidimensional, even though the Rasch analysis showed some misfit to the Rasch model and local dependency. Targeting for FES-I and short FES-I was somewhat suboptimal as the participants on average reported less FoF than expected. A negligible gender DIF was found for two items in FES-I and for one item in short FES-I. Reliability was high (PSI >0.86), and the response category thresholds worked as intended for both FES-I, and short FES-I. CONCLUSION The FES-I and the short FES-I have sufficient measurement properties in persons with LEoP. Both versions can be used to assess fear of falling in this population. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Christina Brogårdh
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
| | - Albert Westergren
- Department of Health Sciences, Lund University, Lund, Sweden.,The Research Platform for Collaboration for Health, and The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| |
Collapse
|
7
|
Tuijtelaars J, Jeukens-Visser M, Nollet F, Brehm MA. Factors associated with walking adaptability and its association with falling in polio survivors. Arch Phys Med Rehabil 2022; 103:1983-1991. [PMID: 35644215 DOI: 10.1016/j.apmr.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Jana Tuijtelaars
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Martine Jeukens-Visser
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Frans Nollet
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Merel-Anne Brehm
- Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands.
| |
Collapse
|
8
|
Falls in Post-Polio Patients: Prevalence and Risk Factors. BIOLOGY 2021; 10:biology10111110. [PMID: 34827103 PMCID: PMC8614826 DOI: 10.3390/biology10111110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/16/2022]
Abstract
Simple Summary People with post-polio syndrome (PPS) suffer frequent falls due to muscle weakness and problems with their balance. In order for a rehabilitation clinician to fit the patient with the optimal treatment plan to prevent imbalance and falls, we performed a simple 10-min walking test with 50 PPS patients. We also asked the patients how many falls they had experienced in the last year and they filled out a questionnaire regarding their balance confidence. We found that we can predict the occurrence of falls in PPS patients based on the consistency of their walking pattern. Since it is very easy to measure the walking pattern, our results may help rehabilitation clinicians to identify individuals at risk of fall and reduce the occurrence of falls in this population. Abstract Individuals with post-polio syndrome (PPS) suffer from falls and secondary damage. Aim: To (i) analyze the correlation between spatio-temporal gait data and fall measures (fear and frequency of falls) and to (ii) test whether the gait parameters are predictors of fall measures in PPS patients. Methods: Spatio-temporal gait data of 50 individuals with PPS (25 males; age 65.9 ± 8.0) were acquired during gait and while performing the Timed Up-and-Go test. Subjects filled the Activities-specific Balance Confidence Scale (ABC Scale) and reported number of falls during the past year. Results: ABC scores and number of falls correlated with the Timed Up-and-Go, and gait cadence and velocity. The number of falls also correlated with the swing duration symmetry index and the step length variability. Four gait variability parameters explained 33.2% of the variance of the report of falls (p = 0.006). The gait velocity was the best predictor of the ABC score and explained 24.8% of its variance (p = 0.001). Conclusion: Gait variability, easily measured by wearables or pressure-sensing mats, is an important predictor of falls in PPS population. Therefore, gait variability might be an efficient tool before devising a patient-specific fall prevention program for the PPS patient.
Collapse
|
9
|
Lee D, Tak SH. Fear of Falling and Related Factors in Older Adults With Spinal Diseases. J Gerontol Nurs 2021; 47:29-35. [PMID: 34309452 DOI: 10.3928/00989134-20210624-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Fear of falling is common among older adults with spinal diseases. The purpose of the current study was to examine fear of falling and related factors in this population. A total of 138 participants were recruited and completed survey questionnaires along with the Timed Up & Go Test. Participants were 73.7 years old on average, 52% had fall experience, and 56% were taking more than four medications. Multivariate regression analyses revealed that the use of sleeping pills, residence type, pain, activities of daily living, gait ability, and gait efficacy were significant predictors of fear of falling. Findings suggest that a fall prevention intervention for older adults with spinal diseases should include pain management, functional improvement, and gait rehabilitation with a focus on gait performance and gait efficacy. In addition, it is important to improve living environment and sleep hygiene, which are conducive to falls. [Journal of Gerontological Nursing, 47(8), 29-35.].
Collapse
|
10
|
Fall-Related Activity Avoidance among Persons with Late Effects of Polio and Its Influence on Daily Life: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137202. [PMID: 34281139 PMCID: PMC8295840 DOI: 10.3390/ijerph18137202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/02/2021] [Accepted: 07/03/2021] [Indexed: 11/17/2022]
Abstract
Falls are common among persons with late effects of polio (LEoP), which may lead to fear of falling and activity avoidance in everyday life. Here, we assessed the occurrence of fall-related activity avoidance among persons with LEoP and explored how these experiences influenced daily life. Fourteen ambulatory persons (seven women; mean age 70 years) with LEoP participated. They responded to the modified Survey of Activities and Fear of Falling in the Elderly (mSAFFE) and participated in individual interviews, which were analysed by systematic text condensation. Each quotation was deductively analysed from its representation with regard to mSAFFE. We found that many persons often avoided activities related to standing and walking, for example, taking a bath, performing household chores, walking outdoors, attending social events if there were stairs in the building and travelling by public transport, due to fear of falling, increased pain and fatigability. To facilitate the performance of daily activities participants expressed that strategic thinking and aids were important to use. In conclusion, fall-related activity avoidance is common in persons with LEoP, which negatively influence daily life and social participation. To increase daily functioning in this population, fall-related activity avoidance should be included in a multifaceted fall management program.
Collapse
|
11
|
Polio survivors have poorer walking adaptability than healthy individuals. Gait Posture 2021; 87:143-148. [PMID: 33915437 DOI: 10.1016/j.gaitpost.2021.04.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/29/2021] [Accepted: 04/16/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Falling is a major health problem in polio survivors, often occurring as a result of tripping, slipping or misplaced steps. Therefore, reduced walking adaptability possibly plays an important role. RESEARCH QUESTION Does walking adaptability, assessed on an interactive treadmill, differ between polio survivors and healthy individuals? METHODS In this cross-sectional study, 48 polio survivors with at least one reported fall in the past year and/or fear of falling and 25 healthy individuals of similar age walked at self-selected comfortable fixed speed on an instrumented treadmill. Walking adaptability was measured as i) target-stepping accuracy (determined as variable error [VE] in mm independent of speed) in three conditions; 0 %, 20 % and 30 % variation in step length and width, and ii) anticipatory and reactive obstacle avoidance (ObA and ObR, in percentage successfully avoided). All trials were checked for valid step detection. RESULTS 46 polio survivors (mean ± SD age: 63.2 ± 8.7 years) and 25 healthy individuals (64.3 ± 6.6 years, p = 0.585) showed valid step detection. Compared to healthy individuals (mean±SE VE: 30.6±1.2 mm), polio survivors stepped less accurately onto targets (36.4±0.9 mm, p = 0.001), especially with their least-affected leg. Polio survivors avoided fewer obstacles successfully (mean±SE ObA: 83±3 %, ObR: 59±4 %) than healthy individuals (100±0.3 %, p < 0.001 and 94±3 %, p < 0.001, respectively), with a stronger decline in success rates from anticipatory to reactive obstacle avoidance for polio survivors (p < 0.001). SIGNIFICANCE Polio survivors reporting falls and/or fear of falling had a demonstrably reduced walking adaptability, especially so for reactive obstacle avoidance, which requires step adjustments under high time-pressure demands. Future research should study the merit of walking-adaptability assessment to currently used clinical methods of fall-risk assessment within this population.
Collapse
|
12
|
Brehm MA, Ploeger HE, Nollet F. Self-reported functional ambulation is related to physical mobility status in polio survivors; a cross-sectional observational study. Ann Phys Rehabil Med 2020; 64:101428. [PMID: 32805457 DOI: 10.1016/j.rehab.2020.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/23/2020] [Accepted: 06/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The condensed 3-level version of the self-reported ambulation classification by Perry is a validated, simple-to-use instrument in clinical practice to classify functional ambulation. OBJECTIVE To further validate the clinical meaning of the classification for polio survivors, we compared physical mobility status across 3 functional ambulation categories and investigated the relation between physical mobility and functional ambulation category. METHODS We investigated a convenience sample of 140 individuals with polio [mean (SD) age 59.4 (12.1) years; 74 men] who were able to walk at least indoors. For indicators of physical mobility status, we assessed the walked distance (m) and walking energy cost (Jkg-1m-1) during a 6-min walk test at a comfortable speed. Furthermore, self-reported physical functioning and fatigue were assessed with the 36-item Short Form Health Survey physical functioning scale (SF36-PF) and Fatigue Severity Scale (FSS), respectively. Self-reported functional ambulation was classified as household walker, limited community walker or full community walker. RESULTS The mean (SD) walked distance, energy cost, and SF36-PF and FSS scores significantly differed between household walkers (n=48) and limited community walkers (n=63) [275 (67) m; 6.35 (1.80) Jkg-1m-1; 27.7 (13.5), 5.53 (1.06), respectively, and 323 (73) m; 5.49 (1.50) Jkg-1m-1; 40.1 (15.1); 4.81 (1.38) (P<0.018)] and full community walkers (n=29) [383 (66) m; 4.68 (0.85) Jkg-1m-1; 63.9 (18.5), 3.85 (1.54) (P<0.001)], with significant differences also present between limited and full community walkers (P<0.05). Walked distance and SF36-PF score were significantly associated with functional ambulation level, determining 46% of the variance in ambulation level. CONCLUSION The simple, self-reported classification of functional ambulation in 3 levels is clinically meaningful for polio survivors because it consistently corresponds to differences in objective and self-reported indicators of physical mobility and, as such, can be used to better manage rehabilitation treatment.
Collapse
Affiliation(s)
- Merel-Anne Brehm
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Hilde E Ploeger
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Frans Nollet
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| |
Collapse
|
13
|
Skough Vreede K, Broman L, Borg K. Is Intervention to Prevent Falls Necessary in Prior Polio Patients? JOURNAL OF REHABILITATION MEDICINE - CLINICAL COMMUNICATIONS 2020; 3:1000023. [PMID: 33884127 PMCID: PMC8008737 DOI: 10.2340/20030711-1000023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 11/19/2022]
Abstract
Objective To investigate whether intervention to prevent falls is necessary in prior polio patients, by identifying the frequency, circumstances and consequences of falls among patients in Sweden with prior polio. Subjects Patients with prior polio diagnosis. Methods A falls history questionnaire was completed by patients with prior polio visiting the outpatient clinic at the Department of Rehabilitation Medicine, Danderyd University Hospital, Stock-holm, Sweden, or participating in group activities organized by the patient organization. Results A total of 80 patients answered the questionnaire; 32 men and 48 women. Eighty-one percent (n = 63/77) of respondents walked outdoors, but rarely more than 1 km, or only inside and near the house. Three-quarters of patients had fallen one or more times over the past year and one-quarter of patients had fallen 5 times or more. The falls often occurred during daytime in an environment known to the patient. Sixty-nine percent (n = 40/58) of respondents had been injured due to falling during the past year. The most common injuries were minor injuries. Conclusion Falls are common in patients in Sweden with prior polio. Interventions to prevent falls in people with prior polio are therefore clinically relevant.
Collapse
Affiliation(s)
- Katarina Skough Vreede
- Division of Rehabilitation Medicine, Danderyd University Hospital and the Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Lisbet Broman
- Division of Rehabilitation Medicine, Danderyd University Hospital and the Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Kristian Borg
- Division of Rehabilitation Medicine, Danderyd University Hospital and the Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
14
|
Da Silva CP, Miller LA, Morrel EC, Wang W. Predictive Abilities of Balance Confidence and Fear of Falling Measures on Falls in Polio Survivors. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019. [DOI: 10.1080/02703181.2019.1610542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Carolyn P. Da Silva
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
- TIRR-Memorial Hermann Rehabilitation and Research Out-Patient Medical Specialty Clinic, Post-Polio Clinic, Houston, Texas, USA
| | - Lesley A. Miller
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
- Physical Therapy Department, Lyndon B Johnson Hospital, Houston, Texas, USA
| | - Emily C. Morrel
- School of Physical Therapy, Texas Woman’s University, Houston, Texas, USA
- Vitalico, Houston, Texas, USA
| | - Wanyi Wang
- Center for Research Design and Analysis, Office of Research and Sponsored Programs, Texas Woman's University, Houston, Texas, USA
| |
Collapse
|
15
|
Galvão TS, Magalhães Júnior ES, Orsini Neves MA, de Sá Ferreira A. Lower-limb muscle strength, static and dynamic postural stabilities, risk of falling and fear of falling in polio survivors and healthy subjects. Physiother Theory Pract 2018; 36:899-906. [PMID: 30183497 DOI: 10.1080/09593985.2018.1512178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION This study investigated the association between preserved lower-limb muscle strength, dynamic and static postural stability, risk of falling, and fear of falling in polio survivors. We also investigated whether these clinical features differ between polio survivors and healthy controls. Methods: This quasi-experimental study enrolled 16 polio survivors (13 underwent a complete-case analysis) and 12 age- and sex-matched healthy controls. Participants were assessed by the manual muscle test, Berg Balance Scale, force platform posturography, and Falls Efficacy Scale. Between-group mean differences with confidence intervals (MD, CI 95%) and Spearman's ρ are reported. Results: Compared to healthy controls, polio survivors presented reduced muscle strength (MD = -13, CI 95% -16 to -9 points), lower dynamic postural stability (MD = -14, CI 95% -19 to -8 points), and increased fear of falling (MD = 14, CI 95% 10-18 points) (all P < 0.001). In polio survivors, lower-limb muscle strength was correlated with dynamic (ρ = 0.760) and static postural stability (ρ = 0.738-0.351), risk of falling (ρ = -0.746), and fear of falling (ρ = -0.432). Dynamic postural stability was correlated with risk of falling (ρ = -0.841), fear of falling (ρ = -0.277), and static postural stability (ρ = -0.869 to -0.435; ρ = -0.361 to -0.200, respectively). Risk and fear of falling were also correlated (ρ = 0.464). Discussion: Polio survivors exhibited impaired dynamic postural stability but preserved static stability and increased risk of falling and fear of falling. Preserved lower-limb muscle strength, postural stability, fear of falling, and risk of falling are associated clinical features in this population.
Collapse
Affiliation(s)
- Thaiana Santos Galvão
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM , Rio de Janeiro, RJ, Brazil
| | - Egídio Sabino Magalhães Júnior
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM , Rio de Janeiro, RJ, Brazil
| | - Marco Antonio Orsini Neves
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM , Rio de Janeiro, RJ, Brazil
| | - Arthur de Sá Ferreira
- Postgraduate Program in Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM , Rio de Janeiro, RJ, Brazil
| |
Collapse
|
16
|
Flansbjer UB, Lexell J, Brogårdh C. Predictors of changes in gait performance over four years in persons with late effects of polio. NeuroRehabilitation 2018; 41:403-411. [PMID: 28946571 DOI: 10.3233/nre-162057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Reduced gait performance is common in persons with late effects of polio. OBJECTIVE To identify predictors of change in gait performance over four years in persons with late effects of polio. METHODS Gait performance was assessed annually in 51 ambulatory persons (mean age 64 years, SD 6) by the Timed "Up & Go" (TUG), Comfortable and Fast Gait Speed (CGS, FGS), and 6-Minute Walk Test (6MWT). Isokinetic knee extensor and flexor muscle strength was measured with a Biodex dynamometer. Mixed Linear Models were used to analyze changes in gait performance and to identify any predictors of change among the covariates gender, age, body mass index, time with new symptoms, baseline reduction in gait performance and knee muscle strength. RESULTS There were significant linear effects over time (reduction per year) for three gait performance tests; CGS (0.8%; p < 0.05), FGS (1.7%; p < 0.001), and 6MWT (0.7%; p < 0.05) with significant random effects for all tests. The strongest predictor of a change in gait performance was the individual variations in the knee flexor strength (p < 0.001). CONCLUSION The small gradual reduction in gait performance over time in persons with late effects of polio is primarily determined by the individual variations in the knee flexor strength.
Collapse
Affiliation(s)
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.,Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Christina Brogårdh
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| |
Collapse
|