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Costamagna E, Thies SB, Kenney LPJ, Howard D, Liu A, Ogden D. A generalisable methodology for stability assessment of walking aid users. Med Eng Phys 2017; 47:167-175. [PMID: 28684213 DOI: 10.1016/j.medengphy.2017.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/15/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
To assist balance and mobility, older adults are often prescribed walking aids. Nevertheless, surprisingly their use has been associated with increased falls-risk. To address this finding we first need to characterise a person's stability while using a walking aid. Therefore, we present a generalisable method for the assessment of stability of walking frame (WF) users. Our method, for the first time, considers user and device as a combined system. We define the combined centre of pressure (CoPsystem) of user and WF to be the point through which the resultant ground reaction force for all feet of both the WF and user acts if theresultant moment acts only around an axisperpendicular tothe ground plane. We also define the combined base of support (BoSsystem) to be the convex polygon formed by the boundaries of the anatomical and WF feet in contact with the ground and interconnecting lines between them. To measure these parameters we have developed an instrumented WF with a load cell in each foot which we use together with pressure-sensing insoles and a camera system, the latter providing the relative position of the WF and anatomical feet. Software uses the resulting data to calculate the stability margin of the combined system, defined as the distance between CoPsystem and the nearest edge of BoSsystem. Our software also calculates the weight supported through the frame and when each foot (of user and/or frame) is on the floor. Finally, we present experimental work demonstrating the value of our approach.
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Affiliation(s)
- E Costamagna
- Centre for Health, Sport and Rehabilitation Sciences Research, Salford University, Brian Blatchford Bldg Room, Salford, Greater Manchester M6 6PU, UK .
| | - S B Thies
- Centre for Health, Sport and Rehabilitation Sciences Research, Salford University, Brian Blatchford Bldg Room, Salford, Greater Manchester M6 6PU, UK
| | - L P J Kenney
- Centre for Health, Sport and Rehabilitation Sciences Research, Salford University, Brian Blatchford Bldg Room, Salford, Greater Manchester M6 6PU, UK
| | - D Howard
- School of Computing, Science and Engineering, Salford University, Newton Bldg, Salford, Greater Manchester M5 4WT, UK
| | - A Liu
- Centre for Health, Sport and Rehabilitation Sciences Research, Salford University, Brian Blatchford Bldg Room, Salford, Greater Manchester M6 6PU, UK
| | - D Ogden
- School of Engineering, University of Edinburgh, Sanderson Bldg, Edinburgh EH9 3FB, UK
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Abstract
Interacting with other people and the environment is fundamental to quality of life. Canes, walkers, and crutches increase, maintain, or improve functional capabilities of many individuals with neurologic disorders. Canes offer a choice of handle, shaft, and base. Walkers have various types of base, uprights, handgrips, platforms, and accessories. Crutch designs include underarm, triceps, forearm, and platform. Orthoses, particularly ankle foot orthoses and knee ankle foot orthoses, are often used to stabilize or immobilize lower limb segments while walking. Studies have shown the benefits of traditional assistive devices on gait, when prescribed and used properly.
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Boonsinsukh R, Saengsirisuwan V, Carlson-Kuhta P, Horak FB. A cane improves postural recovery from an unpracticed slip during walking in people with Parkinson disease. Phys Ther 2012; 92:1117-29. [PMID: 22628583 PMCID: PMC3432949 DOI: 10.2522/ptj.20120036] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 05/16/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about the effects of use of a cane on balance during perturbed gait or whether people with Parkinson disease (PD) benefit from using a cane. OBJECTIVES The purpose of this study was to evaluate the effects of cane use on postural recovery from a slip due to repeated surface perturbations in individuals with PD compared with age- and sex-matched individuals who were healthy. DESIGN This was a prospective study with 2 groups of participants. METHODS Fourteen individuals with PD (PD group) and 11 individuals without PD (control group) walked across a platform that translated 15 cm rightward at 30 cm/s during the single-limb support phase of the right foot. Data from 15 trials in 2 conditions (ie, with and without an instrumented cane in the right hand) were collected in random order. Outcome measures included lateral displacement of body center of mass (COM) due to the slip and compensatory step width and length after the perturbation. RESULTS Cane use improved postural recovery from the first untrained slip, characterized by smaller lateral COM displacement, in the PD group but not in the control group. The beneficial effect of cane use, however, occurred only during the first perturbation, and those individuals in the PD group who demonstrated the largest COM displacement without a cane benefited the most from use of a cane. Both PD and control groups gradually decreased lateral COM displacement across slip exposures, but a slower learning rate was evident in the PD group participants, who required 6, rather than 3, trials for adapting balance recovery. LIMITATIONS Future studies are needed to examine the long-term effects of repeated slip training in people with PD. CONCLUSIONS Use of a cane improved postural recovery from an unpracticed slip in individuals with PD. Balance in people with PD can be improved by training with repeated exposures to perturbations.
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Affiliation(s)
- Rumpa Boonsinsukh
- Division of Physical Therapy, Faculty of Health Sciences, Srinakharinwirot University, Nakhonnayok, Thailand.
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El Helou A, Bastuji-Garin S, Paillaud E, Gracies JM, Skalli W, Decq P. Determinants for the use of ambulation AIDS in a geriatric rehabilitation care unit: a retrospective study. J Am Med Dir Assoc 2011; 13:279-83. [PMID: 21450233 DOI: 10.1016/j.jamda.2010.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/03/2010] [Accepted: 12/07/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed at assessing the profile of ambulation aid users among patients admitted for geriatric rehabilitation care. DESIGN Retrospective chart review. SETTING Geriatric Rehabilitation Department of the Hôpital Albert Chenevier, Créteil, France. PARTICIPANTS The sample comprised 206 records of patients aged 65 or older with no previous use of assistive device before admission and length of stay longer than 7 days. MEASUREMENTS Ambulation levels were classified as independent ambulators (IA, reference category), ambulation aid users (AA), or nonambulatory patients (NA). we explored age, gender, purpose of initial admission, comorbidities, and past medical history as factors potentially associated with ambulation levels, using multinomial logistic regression. RESULTS The study population (mean age 84 years [6.1 standard deviation], 68.5 % women) comprised 110 IA (53.4% of the overall population), 72 AA (34.9%), and 24 NA (11.6%). Factors independently associated with AA use were the following: older age (odds ratio = 1.17; [95% confidence interval 1.09-1.25]), previous history of lower limb surgery (2.15; [1.0-4.73]), and admission for hip surgery (8.14; [2.60-25.53]). Factors independently associated with NA were the following: older age (1.12 [1.02-1.23]) and low Mini-Mental State Exam score (0.77 [0.70-0.85]). A borderline association was observed for visual impairment (3.36 [0.93-12.95]). Cardiac disease, respiratory disease, falls, and dementia were not associated with ambulation aid use. CONCLUSIONS History of lower-limb surgery, particularly recent hip surgery, and old age are the primary predictive factors of ambulation aid use in a geriatric rehabilitation hospital.
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Affiliation(s)
- Amine El Helou
- Arts et Métiers ParisTech, Laboratoire de Biomécanique (LBM), Paris, France.
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Giriko CH, Azevedo RAN, Kuriki HU, Carvalho ACD. Capacidade funcional de hemiparéticos crônicos submetidos a um programa de fisioterapia em grupo. FISIOTERAPIA E PESQUISA 2010. [DOI: 10.1590/s1809-29502010000300005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo tem como objetivos analisar a eficácia da fisioterapia em grupo sobre a marcha, o equilíbrio corporal e o risco de queda, e verificar se há correlação entre a capacidade funcional da marcha e o equilíbrio em indivíduos com hemiparesia crônica. Participaram do estudo 21 adultos hemiparéticos, com idade média de 58,9±10,6 anos, com seqüela de no mínimo 1 ano após acidente vascular encefálico isquêmico ou hemorrágico. Os sujeitos foram submetidos a um programa de 1 hora de fisioterapia em grupo duas vezes por semana durante seis meses. Foram avaliados por meio da escala de equilíbrio de Berg (EEB) e do teste de levantar e caminhar cronometrado TLCC (TUG, na sigla em inglês de timed up & go) antes do programa, após 13 e ao fim de 26 semanas. Os resultados mostram uma redução progressiva, embora não-significativa, no tempo de execução do TLCC e aumento progressivo, também não-significativo, do escore na EEB. Foi observada forte correlação entre as duas escalas (r=0,7, p<0,05). Assim, a terapia não foi efetiva para produzir melhora nos escores dos testes, mas contribuiu para manter a mobilidade.
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Jutai J, Coulson S, Teasell R, Bayley M, Garland J, Mayo N, Wood-Dauphinee S. Mobility Assistive Device Utilization in a Prospective Study of Patients With First-Ever Stroke. Arch Phys Med Rehabil 2007; 88:1268-75. [PMID: 17908568 DOI: 10.1016/j.apmr.2007.06.773] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2007] [Revised: 06/08/2007] [Accepted: 06/24/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To estimate the extent to which clinical and functional features of stroke were related to the use of mobility assistive technology devices. DESIGN Longitudinal study of quality of life after stroke. SETTING Hospitals, rehabilitation centers, and universities in Ontario and Quebec. PARTICIPANTS Subjects (N=316) with confirmed initial stroke were included in this analysis. Fifty-eight percent of the overall sample were men (n=184). The mean age of this sample at the time of the stroke +/- standard deviation was 65.3+/-15.3 years (range, 19-96y). One hundred thirty-five patients received a mobility assistive device poststroke, and 181 did not. INTERVENTION Assistive devices for mobility (canes, walkers, wheelchairs). MAIN OUTCOME MEASURES Assistive device use and mobility capacity. RESULTS Mobility device nonusers were less physically disabled than device users on a variety of measures. Poor physical functioning but good cognition were reliably associated with mobility device use. Use of multiple mobility assistive devices was more often associated with poorer physical functioning than was single device use. For single device users, wheelchair use was predicted by cognition, functional independence, and stroke recovery. Cane users, compared with walker users, had better mobility and were less physically impaired by stroke. CONCLUSIONS Patients were well matched to device type based on their mobility capacity. The findings of this study suggest that assistive device prescription-outcome relationships in stroke can be effectively and meaningfully modeled.
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Affiliation(s)
- Jeffrey Jutai
- Lawson Health Research Institute, St. Joseph's Health Care London, Parkwood Hospital Site, London, ON, Canada.
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Soma T, Onishi H, Oyama M, Ehara Y, Yukio K, Katsuhiko T. Electromyography Analysis of Shoulder Joint Muscles in Standing with Three Ambulatory Aids. J Phys Ther Sci 2007. [DOI: 10.1589/jpts.19.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Toshio Soma
- Department of Physical Therapy, School of Health Sciences, Niigata University of Health and Welfare
| | - Hideaki Onishi
- Department of Physical Therapy, School of Health Sciences, Niigata University of Health and Welfare
| | - Mineo Oyama
- Department of Occupational Therapy, School of Health Sciences, Niigata University of Health and Welfare
| | - Yoshihiro Ehara
- Department of Physical Therapy, School of Health Sciences, Niigata University of Health and Welfare
| | - Kurokawa Yukio
- Department of Physical Therapy, School of Health Sciences, Niigata University of Health and Welfare
| | - Tachino Katsuhiko
- Department of Impairment Study, Graduate Course of Rehabilitation Science, Division of Health Sciences, Graduate School of Medical Science, Kanazawa University
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Geurts ACH, de Haart M, van Nes IJW, Duysens J. A review of standing balance recovery from stroke. Gait Posture 2005; 22:267-81. [PMID: 16214666 DOI: 10.1016/j.gaitpost.2004.10.002] [Citation(s) in RCA: 273] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2004] [Accepted: 10/26/2004] [Indexed: 02/02/2023]
Abstract
Recently, interest in the mechanisms underlying balance recovery following stroke has grown, because insight into these mechanisms is necessary to develop effective rehabilitation strategies for different types of stroke. Studies dealing with the recovery of standing balance from stroke are, however, limited to rehabilitation inpatients with a unilateral supratentorial brain infarction or haemorrhage. In most of these patients, stance stability improves in both planes as well as the ability to compensate for external and internal body perturbations and to control posture voluntarily. Although there is evidence of true physiological recovery of paretic leg muscle functions in postural control, particularly during the first three months post-stroke, substantial balance recovery also occurs in patients when there are no clear signs of improved support functions or equilibrium reactions exerted through the paretic leg. This type of recovery probably takes much longer than 3 months. Apparently, mechanisms other than the restoration of paretic leg muscle functions may determine the standing balance recovery in patients after severe stroke. No information is available about the role of stepping responses as an alternative to equilibrium reactions for restoring the ability to maintain upright stance after stroke. The finding that brain lesions involving particularly the parieto-temporal junction are associated with poor postural control, suggests that normal sensory integration is critical for balance recovery. Despite a considerable number of intervention studies, no definitive conclusions can be drawn about the best approach to facilitate the natural recovery of standing balance following stroke.
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Bateni H, Maki BE. Assistive devices for balance and mobility: Benefits, demands, and adverse consequences. Arch Phys Med Rehabil 2005; 86:134-45. [PMID: 15641004 DOI: 10.1016/j.apmr.2004.04.023] [Citation(s) in RCA: 321] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To provide information on the advantages and possible disadvantages of using canes and walkers. DATA SOURCES English-language articles were identified by searching MEDLINE and PubMed (1966-May 2003) for key words cane or walker , excluding articles unrelated to mobility aids. Bibliographies were reviewed and ISI Web of Science citation searches were run to identify additional references. Over 1000 articles were selected for further evaluation. STUDY SELECTION We extracted all studies of single-tip canes or pickup walkers addressing: (1) functional, biomechanic, or neuromotor benefits; (2) biomechanic, attentional, neuromotor, metabolic, or physiologic demands; and (3) falls, injuries, or other problems. We included approximately 10% of the articles originally identified. DATA EXTRACTION The methodology of each selected article, and findings relevant to the benefits, demands, or adverse effects of cane or walker use were summarized. DATA SYNTHESIS Findings were synthesized by considering their relation to basic biomechanic principles. Some biomechanic findings appear to support the clinical view that canes and walkers can improve balance and mobility for older adults and people with other clinical conditions. However, a large proportion of users experience difficulties, and the use of such devices is associated with increased risk of falling. A small number of studies have characterized some of the specific demands and problems associated with using mobility aids. CONCLUSIONS Clinical and biomechanic evaluations of canes and walkers confirm that these devices can improve balance and mobility. However, they can also interfere with ones ability to maintain balance in certain situations, and the strength and metabolic demands can be excessive. More research is needed to identify and solve specific problems. Such research may lead to improved designs and guidelines for safer use of canes and walkers.
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Affiliation(s)
- Hamid Bateni
- Centre for Studies in Aging, Sunnybrook and Women's College Health Sciences Centre, Toronto, ON, Canada
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Teasell RW, Foley NC, Bhogal SK, Speechley MR. An evidence-based review of stroke rehabilitation. Top Stroke Rehabil 2003; 10:29-58. [PMID: 12970830 DOI: 10.1310/8yna-1yhk-ymhb-xte1] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A comprehensive evidence-based review of stroke rehabilitation was created to be an up-to-date review of the current evidence in stroke rehabilitation and to provide specific conclusions based on evidence that could be used to help direct stroke care at the bedside and at home. A literature search using multiple data-bases was used to identify all trials from 1968 to 2001. Methodological quality of the individual randomized controlled trials was assessed using the Physiotherapy Evidence Database (PEDro) quality assessment scale. A five-stage level-of-evidence approach was used to determine the best practice in stroke rehabilitation. Over 403 treatment-based articles investigating of various areas of stroke rehabilitation were identified. This included 272 randomized controlled trials.
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Affiliation(s)
- Robert W Teasell
- Department of Physical Medicine and Rehabilitation, St. Joseph's Health Care London and University of Western Ontario, London, Ontario, Canada.
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