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Visch L, Groen BE, Geurts ACH, van Nes IJW, Keijsers NLW. Effect of a soft exosuit on daily life gait performance in people with incomplete spinal cord injury: study protocol for a randomized controlled trial. Trials 2024; 25:592. [PMID: 39242508 PMCID: PMC11378477 DOI: 10.1186/s13063-024-08412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/21/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND People with incomplete spinal cord injury (iSCI) often have gait impairments that negatively affect daily life gait performance (i.e., ambulation in the home and community setting) and quality of life. They may benefit from light-weight lower extremity exosuits that assist in walking, such as the Myosuit (MyoSwiss AG, Zurich, Switzerland). A previous pilot study showed that participants with various gait disorders increased their gait speed with the Myosuit in a standardized environment. However, the effect of a soft exosuit on daily life gait performance in people with iSCI has not yet been evaluated. OBJECTIVE The primary study objective is to test the effect of a soft exosuit (Myosuit) on daily life gait performance in people with iSCI. Second, the effect of Myosuit use on gait capacity and the usability of the Myosuit in the home and community setting will be investigated. Finally, short-term impact on both costs and effects will be evaluated. METHODS This is a two-armed, open label, randomized controlled trial (RCT). Participants will be randomized (1:1) to the intervention group (receiving the Myosuit program) or control group (initially receiving the conventional program). Thirty-four people with chronic iSCI will be included. The Myosuit program consists of five gait training sessions with the Myosuit at the Sint Maartenskliniek. Thereafter, participants will have access to the Myosuit for home use during 6 weeks. The conventional program consists of four gait training sessions, followed by a 6-week home period. After completing the conventional program, participants in the control group will subsequently receive the Myosuit program. The primary outcome is walking time per day as assessed with an activity monitor at baseline and during the first, third, and sixth week of the home periods. Secondary outcomes are gait capacity (10MWT, 6MWT, and SCI-FAP), usability (D-SUS and D-QUEST questionnaires), and costs and effects (EQ-5D-5L). DISCUSSION This is the first RCT to investigate the effect of the Myosuit on daily life gait performance in people with iSCI. TRIAL REGISTRATION Clinicaltrials.gov NCT05605912. Registered on November 2, 2022.
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Affiliation(s)
- L Visch
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands.
- Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands.
| | - B E Groen
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - I J W van Nes
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - N L W Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
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Silva RSD, Silva STD, Cardoso DCR, Quirino MAF, Silva MHA, Gomes LA, Fernandes JD, Oliveira RANDS, Fernandes ABGS, Ribeiro TS. Psychometric properties of wearable technologies to assess post-stroke gait parameters: A systematic review. Gait Posture 2024; 113:543-552. [PMID: 39178597 DOI: 10.1016/j.gaitpost.2024.08.004] [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: 03/30/2024] [Revised: 07/16/2024] [Accepted: 08/07/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND Wearable technologies using inertial sensors are an alternative for gait assessment. However, their psychometric properties in evaluating post-stroke patients are still being determined. This systematic review aimed to evaluate the psychometric properties of wearable technologies used to assess post-stroke gait and analyze their reliability and measurement error. The review also investigated which wearable technologies have been used to assess angular changes in post-stroke gait. METHODS The present review included studies in English with no publication date restrictions that evaluated the psychometric properties (e.g., validity, reliability, responsiveness, and measurement error) of wearable technologies used to assess post-stroke gait. Searches were conducted from February to March 2023 in the following databases: Cochrane Central Registry of Controlled Trials (CENTRAL), Medline/PubMed, EMBASE Ovid, CINAHL EBSCO, PsycINFO Ovid, IEEE Xplore Digital Library (IEEE), and Physiotherapy Evidence Database (PEDro); the gray literature was also verified. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) risk-of-bias tool was used to assess the quality of the studies that analyzed reliability and measurement error. RESULTS Forty-two studies investigating validity (37 studies), reliability (16 studies), and measurement error (6 studies) of wearable technologies were included. Devices presented good reliability in measuring gait speed and step count; however, the quality of the evidence supporting this was low. The evidence of measurement error in step counts was indeterminate. Moreover, only two studies obtained angular results using wearable technology. SIGNIFICANCE Wearable technologies have demonstrated reliability in analyzing gait parameters (gait speed and step count) among post-stroke patients. However, higher-quality studies should be conducted to improve the quality of evidence and to address the measurement error assessment. Also, few studies used wearable technology to analyze angular changes during post-stroke gait.
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Affiliation(s)
- Raiff Simplicio da Silva
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Stephano Tomaz da Silva
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Daiane Carla Rodrigues Cardoso
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Maria Amanda Ferreira Quirino
- Graduation Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Maria Heloiza Araújo Silva
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Larissa Araujo Gomes
- Graduation Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
| | - Jefferson Doolan Fernandes
- Federal Institute of Science and Technology of Rio Grande do Norte, Natal, Rio Grande do Norte 59015-000, Brazil.
| | | | - Aline Braga Galvão Silveira Fernandes
- Postgraduate Program in Physical Therapy, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Rua Vila Trairi, Santa Cruz, RN 59200-000, Brazil.
| | - Tatiana Souza Ribeiro
- Postgraduate Program in Physical Therapy, Department of Physical Therapy, Federal University of Rio Grande do Norte, 3000 Av. Senador Salgado Filho, Post office box: 1524, Natal, RN 59072-970, Brazil.
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Zhang W, Dai L, Fang L, Zhang H, Li X, Hong Y, Chen S, Zhang Y, Zheng B, Wu J, Cao M, Chen J. Effectiveness of repetitive transcranial magnetic stimulation combined with intelligent Gait-Adaptability Training in improving lower limb function and brain symmetry after subacute stroke: a preliminary study. J Stroke Cerebrovasc Dis 2024:107961. [PMID: 39173684 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107961] [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: 11/20/2023] [Revised: 08/17/2024] [Accepted: 08/19/2024] [Indexed: 08/24/2024] Open
Abstract
OBJECTIVES Persistent lower limb dysfunction is a major challenge in post-stroke recovery. Repetitive transcranial magnetic stimulation is recognized for addressing post-stroke motor deficits. Our study explores the efficacy of combining rTMS with gait-adaptive training to enhance lower limb function and regulatory mechanisms in subacute stroke. MATERIALS AND METHODS This randomized controlled trial enrolled 27 patients with subacute hemiparesis, dividing them into experimental and control groups. Both groups underwent gait-adaptability training 5 times/week for 4 weeks, with the experimental group receiving daily low-frequency transcranial magnetic stimulation before training. Primary outcomes included the pairwise derived brain symmetry index, lower-extremity Fugl-Meyer Assessment, 10-meter walk test, and Berg Balance Scale. Assessments occurred before and after the four-week intervention. RESULTS The experimental and control groups showed significant improvements in the Fugl-Meyer Assessment, 10-meter walk test, and Berg Balance Scale after the 4-week intervention compared to baseline (all p<0.05). However, the experimental group demonstrated significantly greater improvements compared to the control group in the Fugl-Meyer Assessment (p=0.024) and the 10-meter walk test (p=0.033). Additionally, the experimental group exhibited a more pronounced decrease in the pairwise derived brain symmetry index (p=0.026) compared to the control group. Within the experimental group, the cortical subgroup's pairwise derived brain symmetry index was significantly lower than that of the control group (p=0.006). CONCLUSIONS Combining low-frequency transcranial magnetic stimulation with Gait-Adaptive Training effectively enhances lower limb function and Regulatory mechanisms of the cerebral hemisphere in subacute stroke recovery, and it can provide rapid and effective rehabilitation effect compared with gait adaptation training alone.
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Affiliation(s)
- Wanying Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China; Zhejiang Rehabilitation Medical Center, 310052, Hangzhou, Zhejiang, China; The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013, Hangzhou, Zhejiang, China
| | - Lei Dai
- Psychological Hospital of Anhui Medical University; Anhui Mental Health Center; Hefei Fourth People's Hospital
| | - Linjie Fang
- Zhejiang Rehabilitation Medical Center, 310052, Hangzhou, Zhejiang, China
| | - Huihuang Zhang
- The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013, Hangzhou, Zhejiang, China
| | - Xiang Li
- Xiang'an Hospital of Xiamen University, School of Medicine, 361000, Xiamen, China
| | - Yu Hong
- Zhejiang Rehabilitation Medical Center, 310052, Hangzhou, Zhejiang, China
| | - Shishi Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China
| | - Yujia Zhang
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China
| | - Beisi Zheng
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China
| | - Jianing Wu
- Department of Medical Rehabilitation, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, 310016, Hangzhou, Zhejiang, China
| | - Manting Cao
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China; Zhejiang Rehabilitation Medical Center, 310052, Hangzhou, Zhejiang, China; The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013, Hangzhou, Zhejiang, China
| | - Jianer Chen
- The Third Clinical Medical College, Zhejiang Chinese Medical University, 310053, Hangzhou, Zhejiang, China; Zhejiang Rehabilitation Medical Center, 310052, Hangzhou, Zhejiang, China; The Third Affiliated Hospital of Zhejiang Chinese Medical University, 310013, Hangzhou, Zhejiang, China.
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Yang H, Liao Z, Zou H, Li K, Zhou Y, Gao Z, Mao Y, Song C. Machine learning-based gait adaptation dysfunction identification using CMill-based gait data. Front Neurorobot 2024; 18:1421401. [PMID: 39136036 PMCID: PMC11317473 DOI: 10.3389/fnbot.2024.1421401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
Background Combining machine learning (ML) with gait analysis is widely applicable for diagnosing abnormal gait patterns. Objective To analyze gait adaptability characteristics in stroke patients, develop ML models to identify individuals with GAD, and select optimal diagnostic models and key classification features. Methods This study was investigated with 30 stroke patients (mean age 42.69 years, 60% male) and 50 healthy adults (mean age 41.34 years, 58% male). Gait adaptability was assessed using a CMill treadmill on gait adaptation tasks: target stepping, slalom walking, obstacle avoidance, and speed adaptation. The preliminary analysis of variables in both groups was conducted using t-tests and Pearson correlation. Features were extracted from demographics, gait kinematics, and gait adaptability datasets. ML models based on Support Vector Machine, Decision Tree, Multi-layer Perceptron, K-Nearest Neighbors, and AdaCost algorithm were trained to classify individuals with and without GAD. Model performance was evaluated using accuracy (ACC), sensitivity (SEN), F1-score and the area under the receiver operating characteristic (ROC) curve (AUC). Results The stroke group showed a significantly decreased gait speed (p = 0.000) and step length (SL) (p = 0.000), while the asymmetry of SL (p = 0.000) and ST (p = 0.000) was higher compared to the healthy group. The gait adaptation tasks significantly decreased in slalom walking (p = 0.000), obstacle avoidance (p = 0.000), and speed adaptation (p = 0.000). Gait speed (p = 0.000) and obstacle avoidance (p = 0.000) were significantly correlated with global F-A score in stroke patients. The AdaCost demonstrated better classification performance with an ACC of 0.85, SEN of 0.80, F1-score of 0.77, and ROC-AUC of 0.75. Obstacle avoidance and gait speed were identified as critical features in this model. Conclusion Stroke patients walk slower with shorter SL and more asymmetry of SL and ST. Their gait adaptability was decreased, particularly in obstacle avoidance and speed adaptation. The faster gait speed and better obstacle avoidance were correlated with better functional mobility. The AdaCost identifies individuals with GAD and facilitates clinical decision-making. This advances the future development of user-friendly interfaces and computer-aided diagnosis systems.
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Affiliation(s)
- Hang Yang
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, China
| | - Zhenyi Liao
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, China
| | - Hailei Zou
- College of Science, China Jiliang University, Zhejiang, China
| | - Kuncheng Li
- MeritData Technology Co., Ltd., Shanxi, China
| | - Ye Zhou
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, China
| | - Zhenzhen Gao
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, China
| | - Yajun Mao
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, China
| | - Caiping Song
- Department of Rehabilitation Medicine, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, China
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Di Bacco VE, Gage WH. Gait variability, fractal dynamics, and statistical regularity of treadmill and overground walking recorded with a smartphone. Gait Posture 2024; 111:53-58. [PMID: 38636334 DOI: 10.1016/j.gaitpost.2024.04.002] [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: 11/21/2023] [Revised: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The nonlinear variability present during steady-state gait may provide a signature of health and showcase one's walking adaptability. Although treadmills can capture vast amounts of walking data required for estimating variability within a small space, gait patterns may be misrepresented compared to an overground setting. Smartphones may provide a low-cost and user-friendly estimate of gait patterns among a variety of walking settings. However, no study has investigated differences in gait patterns derived from a smartphone between treadmill walking (TW) and overground walking (OW). RESEARCH QUESTION This study implemented a smartphone accelerometer to compare differences in temporal gait variability and gait dynamics between TW and OW. METHODS Sixteen healthy adults (8F; 24.7 ± 3.8 years) visited the laboratory on three separate days and completed three 8-minute OW and three TW trials, at their preferred speed, during each visit. The inter-stride interval was calculated as the time difference between right heel contact events located within the vertical accelerometery signals recorded from a smartphone while placed in participants front right pant pocket during walking trials. The inter-stride interval series was used to calculate stride time standard deviation (SD) and coefficient of variation (COV), statistical persistence (fractal scaling index), and statistical regularity (sample entropy). Two-way analysis of variance compared walking condition and laboratory visits for each measure. RESULTS Compared to TW, OW displayed significantly (p < 0.01) greater stride time SD (0.014 s, 0.020 s), COV (1.26 %, 1.82 %), fractal scaling index (0.70, 0.79) and sample entropy (1.43, 1.63). No differences were found between visits for all measures. SIGNIFICANCE Smartphone-based assessment of gait provides the ability to distinguish between OW and TW conditions, similar to previously established methodologies. Furthermore, smartphones may be a low-cost and user-friendly tool to estimate gait patterns outside the laboratory to improve ecological validity, with implications for free-living monitoring of gait among various populations.
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Affiliation(s)
- Vincenzo E Di Bacco
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada.
| | - William H Gage
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
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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.
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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
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Kuijpers R, Groen BE, Smulders E, der Sanden MWGNV, Weerdesteyn V. Is the Walking Adaptability Ladder test for Kids (WAL-K) reliable and valid in ambulatory children with Cerebral Palsy? Disabil Rehabil 2024:1-7. [PMID: 38400694 DOI: 10.1080/09638288.2024.2321325] [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: 07/01/2023] [Accepted: 02/15/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Walking adaptability is essential for children to participate in daily life. We studied whether the Walking Adaptability Ladder test for Kids (WAL-K) is reliable and valid for assessing walking adaptability in 6-12 year old ambulatory children with Cerebral Palsy (CP). MATERIALS AND METHODS Thirty-six children with CP (26 GMFCS-level I, 10 GMFCS-level II) completed the single and double run of the WAL-K. Intra- and inter-rater reliability were determined by Intraclass Correlation Coefficients (ICCs). Construct validity was determined by comparing WAL-K scores between 122 typically developing (TD) and CP children taking age into account, comparing WAL-K scores between CP children in GMFCS-levels I and II, and correlating WAL-K scores with scores of the 10 times 5 m Sprint Test (10 × 5mST). RESULTS ICCs for reliability varied between 0.997 and 1.000. WAL-K scores were significantly higher (i.e., worse) in CP children compared to TD children (p < 0.001), and in children in GMFCS-level II compared to GMFCS-level I (p = 0.001). Significant positive correlations were found between the WAL-K and 10 × 5 mST (single run r = .89, double run r = .84). CONCLUSIONS The WAL-K shows to be a promising reliable, valid, and easy-to-use tool for assessing walking adaptability in children with CP. Responsiveness to change has yet to be evaluated.
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Affiliation(s)
- Rosanne Kuijpers
- Sint Maartenskliniek Research, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Brenda E Groen
- Sint Maartenskliniek Research, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Ellen Smulders
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- Master Specialized Physical Therapy, Avans+, Breda, The Netherlands
| | - Maria W G Nijhuis-van der Sanden
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
- IQ Healthcare, Research Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Sint Maartenskliniek Research, Nijmegen, The Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Yang H, Gao Z, Zhou Y, Liao Z, Song C, Mao Y. Effects of gait adaptation training on augmented reality treadmill for patients with stroke in community ambulation. Int J Qual Health Care 2024; 36:mzae008. [PMID: 38334696 DOI: 10.1093/intqhc/mzae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/08/2024] [Accepted: 02/08/2024] [Indexed: 02/10/2024] Open
Abstract
Gait adaptability is essential for stroke survivors to achieve efficient and safe community ambulation. However, conventional treadmill rehabilitation is only a repetitive practice of leg movement. This study compared the effects of augmented reality treadmill-based gait adaptation training with regular treadmill programs for patients with stroke. Forty patients with stroke (n = 40) were randomly assigned to the gait adaptation training {n = 20, age: 49.85 [standard deviation (SD) 8.44] years; onset of stroke: 107.80 (SD 48.31) days} and regular training [n = 20, age: 50.75 (SD 8.05) years, onset of stroke: 111.60 (SD 49.62) days] groups. Both groups completed three sessions of training per week for 5 weeks (15 sessions). The primary outcomes were the 10-m walk test and success rate of obstacle avoidance, while secondary outcomes included the Berg balance scale, component timed-up-and-go, and fall rate in a 6-month follow-up period. Assessments were performed before and after the intervention. The paired t-test was applied to compare the differences within groups and independent sample t-test was performed to compare the differences between groups. The 10-m walk test, success rate of obstacle avoidance, Berg balance scale, and component timed-up-and-go all significantly improved in the both groups (P < .001). The success rate of obstacle avoidance [P = .02, 95% confidence interval (CI): -21.07, -1.64], Berg Balance Scale (P = .02, 95% CI: -8.03, -0.67), 'turning around time' (P = .04, 95% CI: 0.08, 2.81), 'stand-to-sit' (P = .03, 95% CI: 0.16, 2.41) and 'total time' (P = .048, 95% CI: 0.04, 10.32) improved significantly in gait adaptation training group after intervention, while the 10-m walk test (P = .09, 95% CI: -0.17, 0.01), timed 'sit-to-stand' (P = .09, 95% CI: -0.14, 2.04), and 'linear walking' (P = .09, 95% CI: -0.27, 3.25) in gait adaptation training group did not show statistical difference compared to the regular training group. Total fall rate during the follow-up period was statistically decreased in the gait adaptation training group (P = .045). Both interventions improved mobility outcomes, with augmented reality treadmill-based gait adaptation indicating greater improvement in obstacle avoidance, balance, turning, and stand-to-sit. Augmented reality treadmill-based gait adaptation training emerges as an effective and promising intervention for patients with stroke in early rehabilitation.
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Affiliation(s)
- Hang Yang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310001, China
| | - Zhenzhen Gao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310001, China
| | - Ye Zhou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310001, China
| | - Zhenyi Liao
- Center of Physiotherapy, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310001, China
| | - Caiping Song
- Center of Physiotherapy, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310001, China
| | - Yajun Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang 310001, China
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DeMark LA, Fox EJ, Manes MR, Conroy C, Rose DK. The 3-Meter Backward Walk Test (3MBWT): Reliability and validity in individuals with subacute and chronic stroke. Physiother Theory Pract 2023; 39:2698-2705. [PMID: 35658807 DOI: 10.1080/09593985.2022.2085638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Backward walking (BW) is an important gait adaptation and BW speed may be an important indicator of walking function and fall risk. However, the measurement characteristics of a standardized assessment of BW post-stroke have not been fully established. OBJECTIVES To determine intra- and interrater reliability, concurrent validity and minimal detectable change (MDC) scores for the 3-Meter Backward Walk Test (3MBWT) post-stroke. METHODS Thirty-four individuals with subacute and 29 individuals with chronic stroke participated. Two trials of comfortable BW was measured over a total distance of 5-meters, while speed was calculated during the middle 3-meters of the walking distance. Intra and interrater reliability were determined by comparing the two trials from one rater and simultaneous assessment of two raters, respectively. Two additional trials were performed and BW speed was calculated using 3MBWT and an instrumented walkway to determine concurrent validity. Intraclass correlation coefficients (ICC) estimated reliability and validity. The MDC was calculated from the standard error of measurement. RESULTS Excellent ICC values were obtained for the 3MBWT in the subacute (interrater: ICC2,1 = 0.99; intrarater: ICC2,1 = 0.96; validity: ICC2,1 = 0.96) and chronic (interrater: ICC2,1 = 0.99; intrarater: ICC2,1 = 0.94; validity: ICC2,1 = 0.97) groups. The MDC was 0.07 m/s (subacute) and 0.11 m/s (chronic). CONCLUSIONS Establishment of the 3MBWT as a reliable and valid measure in assessing BW speed is an important addition to the assessment toolbox for rehabilitation post-stroke.
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Affiliation(s)
| | - Emily J Fox
- Brooks Rehabilitation, Jacksonville, FL, USA
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
| | | | | | - Dorian K Rose
- Brooks Rehabilitation, Jacksonville, FL, USA
- Department of Physical Therapy, University of Florida, Gainesville, FL, USA
- Malcolm Randall VA Medical Center, Gainesville, FL, USA
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10
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Bansal K, Clark DJ, Fox EJ, Rose DK. Sympathetic nervous system responses during complex walking tasks and community ambulation post-stroke. Sci Rep 2023; 13:20068. [PMID: 37974001 PMCID: PMC10654447 DOI: 10.1038/s41598-023-47365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023] Open
Abstract
Stroke survivors frequently report increased perceived challenge of walking (PCW) in complex environments, restricting their daily ambulation. PCW is conventionally measured through subjective questionnaires or, more recently, through objective quantification of sympathetic nervous system activity during walking tasks. However, how these measurements of PCW reflect daily walking activity post-stroke is unknown. We aimed to compare the subjective and objective assessments of PCW in predicting home and community ambulation. In 29 participants post-stroke, we measured PCW subjectively with the Activities-specific Balance Confidence (ABC) Scale and objectively through electrodermal activity, quantified by change in skin conductance levels (SCL) and skin conductance responses (SCR) between outdoor-complex and indoor-steady-state walking. High-PCW participants were categorized into high-change SCL (ΔSCL ≥ 1.7 μs), high-change SCR (ΔSCR ≥ 0.2 μs) and low ABC (ABC < 72%) groups, while low-PCW participants were categorized into low-change SCL (ΔSCL < 1.7 μs), low-change SCR (ΔSCR < 0.2 μs) and high-ABC (ABC ≥ 72%) groups. Number and location of daily steps were quantified with accelerometry and Global Positioning System devices. Compared to low-change SCL group, the high-change SCL group took fewer steps in home and community (p = 0.04). Neither ABC nor SCR groups differed in home or community steps/day. Objective measurement of PCW via electrodermal sensing more accurately represents home and community ambulation compared to the subjective questionnaire.
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Affiliation(s)
- Kanika Bansal
- Department of Physical Therapy, University of Mount Union, 1972, Clark Ave, Alliance, OH, 44601-3993, USA.
| | - David J Clark
- University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcolm Randall Veterans Affair Medical Center, Gainesville, FL, USA
| | - Emily J Fox
- University of Florida, Gainesville, FL, USA
- Brooks Rehabilitation, Jacksonville, FL, USA
| | - Dorian K Rose
- University of Florida, Gainesville, FL, USA
- Brain Rehabilitation Research Center, Malcolm Randall Veterans Affair Medical Center, Gainesville, FL, USA
- Brooks Rehabilitation, Jacksonville, FL, USA
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Marusic U, Peskar M, Šömen MM, Kalc M, Holobar A, Gramann K, Wollesen B, Wunderlich A, Michel C, Miladinović A, Catalan M, Buoite Stella A, Ajcevic M, Manganotti P. Neuromuscular assessment of force development, postural, and gait performance under cognitive-motor dual-tasking in healthy older adults and people with early Parkinson's disease: Study protocol for a cross-sectional Mobile Brain/Body Imaging (MoBI) study. OPEN RESEARCH EUROPE 2023; 3:58. [PMID: 38009088 PMCID: PMC10674089 DOI: 10.12688/openreseurope.15781.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/28/2023]
Abstract
Background Neuromuscular dysfunction is common in older adults and more pronounced in neurodegenerative diseases. In Parkinson's disease (PD), a complex set of factors often prevents the effective performance of activities of daily living that require intact and simultaneous performance of the motor and cognitive tasks. Methods The cross-sectional study includes a multifactorial mixed-measure design. Between-subject factor grouping the sample will be Parkinson's Disease (early PD vs. healthy). The within-subject factors will be the task complexity (single- vs. dual-task) in each motor activity, i.e., overground walking, semi-tandem stance, and isometric knee extension, and a walking condition (wide vs. narrow lane) will be implemented for the overground walking activity only. To study dual-task (DT) effects, in each motor activity participants will be given a secondary cognitive task, i.e., a visual discrimination task for the overground walking, an attention task for the semi-tandem, and mental arithmetic for the isometric extension. Analyses of DT effects and underlying neuronal correlates will focus on both gait and cognitive performance where applicable. Based on an a priori sample size calculation, a total N = 42 older adults (55-75 years) will be recruited. Disease-specific changes such as laterality in motor unit behavior and cortical control of movement will be studied with high-density surface electromyography and electroencephalography during static and dynamic motor activities, together with whole-body kinematics. Discussion This study will be one of the first to holistically address early PD neurophysiological and neuromuscular patterns in an ecologically valid environment under cognitive-motor DT conditions of different complexities. The outcomes of the study aim to identify the biomarker for early PD either at the electrophysiological, muscular or kinematic level or in the communication between these systems. Clinical Trial Registration ClinicalTrials.Gov, NCT05477654. This study was approved by the Medical Ethical Committee (106/2021).
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Affiliation(s)
- Uros Marusic
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Department of Health Sciences, Alma Mater Europaea Evropski Center Maribor, Maribor, Slovenia
| | - Manca Peskar
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Department of Psychology and Ergonomics, Faculty V: Mechanical Engineering and Transport Systems, Technische Universitat Berlin, Berlin, Berlin, Germany
| | - Maja Maša Šömen
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
| | - Miloš Kalc
- Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Ales Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Klaus Gramann
- Department of Psychology and Ergonomics, Faculty V: Mechanical Engineering and Transport Systems, Technische Universitat Berlin, Berlin, Berlin, Germany
| | - Bettina Wollesen
- Department of Psychology and Ergonomics, Faculty V: Mechanical Engineering and Transport Systems, Technische Universitat Berlin, Berlin, Berlin, Germany
- Institute of Human Movement Science, Faculty of Psychology and Human Movement, University Hamburg, Hamburg, Germany
| | - Anna Wunderlich
- Department of Psychology and Ergonomics, Faculty V: Mechanical Engineering and Transport Systems, Technische Universitat Berlin, Berlin, Berlin, Germany
| | - Christoph Michel
- Functional Brain Mapping Lab, Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | | | - Mauro Catalan
- Clinical Unit of Neurology, Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
| | - Milos Ajcevic
- Clinical Unit of Neurology, Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery, and Health Sciences, University of Trieste, Trieste, Italy
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Hernandez S, Mill C, Irvine D, Clarke K, Granger CL, Da Silva A, Bower W. Can gait outcomes be predicted early after a stroke? Physiother Theory Pract 2023; 39:2154-2162. [PMID: 35437107 DOI: 10.1080/09593985.2022.2064379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the ability of clinical measures collected within 72 hours of neurological insult to predict independent gait 6 and 12 months after a stroke. METHODS Patients with a confirmed stroke diagnosis were eligible for inclusion in this prospective cohort study. Sitting balance, National Institutes of Health Stroke Scale (NIHSS) motor leg, NIHSS motor arm, and Motricity Index (MI) were measured within 72 hours post-stroke. Follow-up assessments were conducted at 6 and 12 months post-stroke to measure gait recovery. RESULTS A total of 78 patients were included at baseline for analysis. At 6 and 12 months, 38% (n = 38) and 35% (n = 42) of patients used a gait aid, and 80% and 87% were independently ambulant, respectively. Sitting balance, NIHSS motor leg, and NIHSS motor arm were not significantly associated with ambulation at 6 or 12 months or with the use of a gait aid. Thrombolysis was significantly associated with independent outdoors ambulation at 6 months (p = .011). A worse MI score was significantly associated with a higher number of falls at 6 months (p < .010) but not with the need for a gait aid. The number of falls at 6 months was independently predicted by urinary incontinence post-stroke (p < .001), NIHSS leg score (p < .005), and depression and anxiety while in acute care (p < .005). CONCLUSIONS Clinical bedside assessments may be less important in predicting safe, independent gait than previously thought. Urinary incontinence and poor mental health should be addressed in the hospital. Increased utilization of reperfusion techniques may alter functional recovery patterns.
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Affiliation(s)
- Sabrina Hernandez
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Chloe Mill
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Damon Irvine
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Katherine Clarke
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Catherine L Granger
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Alisha Da Silva
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wendy Bower
- Discipline of Physiotherapy, Department of Allied Health, The Royal Melbourne Hospital, Parkville, VIC, Australia
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13
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Ngan S, Lemay JF, Chan K, Walden K, Gagnon DH, Musselman KE. Interrater reliability of the Standing and Walking Assessment Tool for spinal cord injury. Spinal Cord 2023; 61:556-561. [PMID: 37524758 DOI: 10.1038/s41393-023-00921-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/02/2023]
Abstract
STUDY DESIGN Psychometric study. OBJECTIVES The Standing and Walking Assessment Tool (SWAT) is a standardized approach to the evaluation of standing and walking capacity following traumatic spinal cord injury (tSCI) in Canada. The SWAT classifies individuals with a tSCI into 12 stages of standing and walking capacity that are paired with well-established outcome measures, such as the Berg Balance Scale and 10-m Walk Test. Prior research has demonstrated the validity and responsiveness of the SWAT stages; however, the reliability remains unknown. The objective of this study was to evaluate the interrater reliability of the SWAT stages. SETTING Inpatient units of two Canadian rehabilitation hospitals. METHODS Adults with sub-acute tSCI were recruited. SWAT stage was evaluated for each participant by two physical therapists separately. The two therapists aimed to complete the evaluations within one day of each other. To evaluate interrater reliability, the percentage agreement between the SWAT stages rated by the two physical therapists was calculated, along with a linear weighted kappa statistic with a 95% CI. RESULTS Forty-five individuals with sub-acute tSCI (36 males, 9 females, mean (SD) age of 54.8 (17.9) years) participated. The percentage agreement in SWAT stages between the two physical therapists was 75.6%. A kappa statistic of 0.93 with a 95% CI, 0.81-1.05 was obtained. In cases where therapists disagreed (18% of participants), therapists differed by 1-2 stages only. CONCLUSIONS The SWAT stages have high interrater reliability, providing further support for the use of the SWAT in rehabilitation practice in Canada.
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Affiliation(s)
- Sara Ngan
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jean-François Lemay
- School of Physical and Occupational Therapy, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Katherine Chan
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | | | - Dany H Gagnon
- Centre intégré universitaire de santé et de services sociaux (CIUSSS) du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), Montréal, QC, Canada
| | - Kristin E Musselman
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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14
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de Jong LAF, Kerkum YL, Altmann VC, Geurts ACH, Keijsers NLW. Orthopedic footwear has a positive influence on gait adaptability in individuals with hereditary motor and sensory neuropathy. Gait Posture 2023; 106:18-22. [PMID: 37639960 DOI: 10.1016/j.gaitpost.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/30/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Individuals with Hereditary Motor and Sensory Neuropathy (HMSN) are commonly provided with orthopedic footwear to improve gait. Although orthopedic footwear has shown to improve walking speed and spatiotemporal parameters, its effect on gait adaptability has not been established. RESEARCH QUESTION What is the effect of orthopedic footwear on gait adaptability in individuals with HMSN? METHODS Fifteen individuals with HMSN performed a precision stepping task on an instrumented treadmill projecting visual targets, while wearing either custom-made orthopedic or standardized footwear (i.e. minimally supportive, flexible sneakers). Primary measure of gait adaptability was the absolute Euclidean distance [mm] between the target center and the middle of the foot (absolute error). Secondary outcomes included the relative and variable error [mm] in both anterior-posterior (AP) and medial-lateral (ML) directions. Dynamic balance was assessed by the prediction of ML foot placement based on the ML center of mass position and velocity, using linear regression. Dynamic balance was primarily determined by foot placement deviation in terms of root mean square error. Another aspect of dynamic balance was foot placement adherence in terms of the coefficient of determination (R2). Differences between the footwear conditions were analyzed with a paired t-test or Wilcoxon signed-rank test (α = 0.05). RESULTS The absolute error, relative error (AP) and variable error (AP and ML) decreased with orthopedic footwear, whereas the relative error in ML-direction slightly increased. As for dynamic balance, no effect on foot placement deviation or adherence was found. SIGNIFICANCE Gait adaptability improved with orthopedic compared to standardized footwear in people with HMSN, as indicated by improved precision stepping. Dynamic balance, as a possible underlying mechanism, was not affected by orthopedic footwear.
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Affiliation(s)
- Lysanne A F de Jong
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Research and Development, OIM Orthopedie, Assen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Yvette L Kerkum
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Viola C Altmann
- Klimmendaal Revalidatie Specialisten, Arnhem, the Netherlands; Peter Harrison Centre for Disability Sport, Loughborough University, Loughborough, UK
| | - Alexander C H Geurts
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Noel L W Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Sensorimotor Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
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15
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Muto K, Shiratsuchi D, Nanbu K, Sakamoto H, Furuya N, Nakamura K, Yushi M, Tsujita N, Makizako H. Ability to walk 10 m within the first week of stroke predicts independent outdoor walking and destination. J Stroke Cerebrovasc Dis 2023; 32:107145. [PMID: 37210777 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107145] [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: 12/26/2022] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
OBJECTIVES We aimed to determine if achieving a 10-m walk target within the first week of stroke onset correlates with independent outdoor walking at discharge and discharge to home for patients with stroke. MATERIALS AND METHODS This study included 226 patients transferred to the subacute rehabilitation hospital (SRH) between January 2018 and March 2021. Data obtained from hospital records included age, sex, stroke type, lesion side, body mass index, presence of acute treatment, length of days from onset to physical therapy intervention, National Institutes of Health Stroke Scale, length of hospital stay, Functional Independence Measure score, and the ability to complete the 10 m walk target within the first week of stroke onset. The primary outcomes were independent outdoor walking ability and discharge destination from the SRH. A logistic regression analysis was performed to determine if the 10 m walking ability correlated with the outdoor walking ability and discharge destination. RESULTS Compared with the inability to walk 10 m, walking 10 m independently walking within the first week of stroke onset correlated with the ability to walk independently outdoors at discharge (odds ratio [OR]: 4.38, p = 0.003) and being discharged home (OR: 4.52, p = 0.002), whereas, walking 10 m with assistance was associated with being discharged home (OR: 3.09, p = 0.043). CONCLUSIONS The ability to walk 10 m within the first week of stroke onset may be a helpful marker for prognosis.
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Affiliation(s)
- Kento Muto
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishitacho, Nakamuraku, Nagoya-shi, Aichi, 453-8511, Japan.
| | - Daijo Shiratsuchi
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Kazuki Nanbu
- Nishino hospital, 13-27 Sanjimatsuomachi, Yahatahigasiku, Kitakyusyushi, Fukuoka 805-0033, Japan
| | - Hayato Sakamoto
- Division of Rehabilitation Services, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Naohiro Furuya
- Department of Rehabilitation, Saitama Sekishinkai Hospital, 2-37-20 Irumagawa, Sayamashi, Saitama, 350-1305, Japan
| | - Kazushi Nakamura
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishitacho, Nakamuraku, Nagoya-shi, Aichi, 453-8511, Japan
| | - Mitani Yushi
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishitacho, Nakamuraku, Nagoya-shi, Aichi, 453-8511, Japan
| | - Nako Tsujita
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishitacho, Nakamuraku, Nagoya-shi, Aichi, 453-8511, Japan
| | - Hyuma Makizako
- Department of Physical Therapy, School of Health Sciences, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8544, Japan
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Algabbani MF, Almass BA, Shaheen AAM, Alhusaini A, Almurdi MM, Alqabbani S. Psychometric properties of the Obstacles and Curb tests and their discriminative ability across functional levels in ambulatory children with spastic cerebral palsy. Int J Rehabil Res 2023; 46:178-186. [PMID: 37042182 PMCID: PMC10155681 DOI: 10.1097/mrr.0000000000000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 04/13/2023]
Abstract
The Obstacles and Curb tests are timed walking assessments that have emerged from the Spinal Cord Injury Functional Ambulation Profile and have been modified for children; however, their psychometric properties have not been adequately investigated. The aim of this research was to examine the psychometric properties of the Obstacles and Curb tests for children with cerebral palsy (CP). This cross-sectional study included 68 children aged 6-12 years; there were 34 children with CP and 34 age- and sex-matched typically developing children. Validity was examined by correlation with the 10-m Walk Test (10-MWT), Modified Time Up and Go test (mTUG), and Pediatric Balance Scale (PBS). Differences in the Obstacle and Curb test scores were calculated between children with CP and typically developing children and within different Gross Motor Function Classification System (GMFCS) levels. Children with CP completed the tests twice within a 30-min interval in the same session. The tests showed significant strong to very strong correlations with the 10-MWT, mTUG, and PBS. The within-session reliability was excellent, typically developing children were significantly faster than children with CP with high sensitivity and specificity, and the time differed significantly within the GMFCS level. Thus, the Obstacles and Curb tests can be considered valid, reliable, and sensitive walking tests for ambulatory children with CP.
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Affiliation(s)
- Maha F. Algabbani
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
| | - Banan A. Almass
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Afaf A. M. Shaheen
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
- Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Adel Alhusaini
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
| | - Muneera M. Almurdi
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh
| | - Samiah Alqabbani
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
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Di Bacco VE, Gage WH. Evaluation of a smartphone accelerometer system for measuring nonlinear dynamics during treadmill walking: Concurrent validity and test-retest reliability. J Biomech 2023; 151:111527. [PMID: 36948001 DOI: 10.1016/j.jbiomech.2023.111527] [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: 09/23/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Abstract
The accelerometers embedded within smartphones may be a promising tool to capture gait patterns outside the laboratory and for extended periods of time. The current study evaluated the agreement and reliability of gait measures derived from a smartphone accelerometer system, compared to reference motion capture and footswitch systems during treadmill walking. Seventeen healthy young adults visited the laboratory on three separate days and completed three 8-minute treadmill walking trials, during each visit, at their preferred walking speed. The inter-stride interval series was calculated as the time difference between consecutive right heel contacts, located within the signals of the smartphone accelerometer, motion capture, and footswitch systems. The inter-stride interval series was used to estimate common linear gait measures and nonlinear measures, including fractal scaling index, approximate entropy, and sample entropy. Bland Altman plots with 95% limits of agreement and intraclass correlation coefficients assessed agreement and reliability, respectively. The smartphone system was found to be within the acceptable limits of agreement when compared to either reference system. The intraclass correlation coefficients values revealed moderate-to-excellent reliability for the smartphone system, with greater reliability found for linear compared to nonlinear measures and were similar to both reference systems, except for the fractal scaling index. These findings suggest the smartphone accelerometer system is a valid and reliable method for estimating linear and nonlinear gait measures during treadmill walking.
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Affiliation(s)
- Vincenzo E Di Bacco
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
| | - William H Gage
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
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18
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Almass BA, Algabbani MF, Shaheen AA, Alqabbani S. Normative reference values for Obstacles Test and Curb Test and their correlation with demographic characteristics: a cross-sectional study in Saudi children. Int J Rehabil Res 2023; 46:70-76. [PMID: 36538585 PMCID: PMC9907697 DOI: 10.1097/mrr.0000000000000562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
The Obstacles Test and Curb Test have been used to measure gait speed and functional balance in adults. Recently, they have been modified for use in children but the normative values have not been established. This requires correlating the sex, age, height, weight, and BMI% of children with the test results and developing prediction equations. In this cross-sectional study, the Obstacles Test and Curb Test were administered to a convenience sample of 240 typically developing children aged 6-11 years. The factors associated with the time to complete each test were studied and prediction equations were established. The completion times were 5.27 ± 0.81 s for the Obstacles Test and 2.82 ± 0.45 s for the Curb Test. The Obstacles Test showed a fair negative relationship with height (Pearson's r = -0.41, P < 0.001), age ( r = -0.35, P < 0.001), and weight ( r = -0.32, P < 0.05). The Curb Test also had fair negative correlations with height ( r = -0.42, P < 0.001), age ( r = -0.39, P < 0.001), and weight ( r = -0.31, P < 0.001). Both tests showed poor correlations with the sex [eta ( η ) = 0.15 and 0.12, respectively]. Nonetheless, age and sex emerged as the main predictors of both test scores, accounting for 14% and 17% of the total variance in the Obstacles Test and Curb Test times, respectively. Normative values and prediction equations for both tests in typically developing children may be used for individual comparisons and in clinical research for the evaluation of interventions targeting disabled children.
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Affiliation(s)
- Banan A. Almass
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al-Majmaah
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Maha F. Algabbani
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Afaf A.M. Shaheen
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
- Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Samiah Alqabbani
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box: 84428, Riyadh 11433, Saudi Arabia
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19
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Schiavo A, Martins LA, Wearick-Silva LE, Orso R, Xavier LL, Mestriner RG. Can anxiety-like behavior and spatial memory predict the extremes of skilled walking performance in mice? An exploratory, preliminary study. Front Behav Neurosci 2023; 17:1059029. [PMID: 36926582 PMCID: PMC10011164 DOI: 10.3389/fnbeh.2023.1059029] [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: 09/30/2022] [Accepted: 01/26/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Skilled walking is influenced by memory, stress, and anxiety. While this is evident in cases of neurological disorders, memory, and anxiety traits may predict skilled walking performance even in normal functioning. Here, we address whether spatial memory and anxiety-like behavior can predict skilled walking performance in mice. Methods A cohort of 60 adult mice underwent a behavioral assessment including general exploration (open field), anxiety-like behavior (elevated plus maze), working and spatial memory (Y-maze and Barnes maze), and skilled walking performance (ladder walking test). Three groups were established based on their skilled walking performance: superior (SP, percentiles ≥75), regular (RP, percentiles 74-26), and inferior (IP, percentiles ≤25) performers. Results Animals from the SP and IP groups spent more time in the elevated plus maze closed arms compared to the RP group. With every second spent in the elevated plus maze closed arms, the probability of the animal exhibiting extreme percentiles in the ladder walking test increased by 1.4%. Moreover, animals that spent 219 s (73% of the total time of the test) or more in those arms were 4.67 times more likely to exhibit either higher or lower percentiles of skilled walking performance. Discussion We discuss and conclude anxiety traits may influence skilled walking performance in facility-reared mice.
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Affiliation(s)
- Aniuska Schiavo
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Lucas Athaydes Martins
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Luís Eduardo Wearick-Silva
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Rodrigo Orso
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Léder Leal Xavier
- Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Régis Gemerasca Mestriner
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Neuroplasticity and Rehabilitation Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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20
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Amanzonwé ER, Tedesco Triccas L, Codjo L, Hansen D, Feys P, Kossi O. Exercise dosage to facilitate the recovery of balance, walking, and quality of life after stroke. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2023; 79:1846. [PMID: 36873960 PMCID: PMC9982519 DOI: 10.4102/sajp.v79i1.1846] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/09/2022] [Indexed: 02/05/2023] Open
Abstract
Background Although aerobic training (AT) and resistance training (RT) are recommended after stroke, the optimal dosage of these interventions and their effectiveness on balance, walking capacity, and quality of life (QoL) remain conflicting. Objectives Our study aimed to quantify the effects of different modes, dosages and settings of exercise therapy on balance, walking capacity, and QoL in stroke survivors. Method PubMed, CINHAL, and Hinari databases were searched for randomised controlled trials (RCTs) evaluating the effects of AT and RT on balance, walking, and QoL in stroke survivors. The treatment effect was computed by the standard mean differences (SMDs). Results Twenty-eight trials (n = 1571 participants) were included. Aerobic training and RT interventions were ineffective on balance. Aerobic training interventions were the most effective in improving walking capacity (SMD = 0.37 [0.02, 0.71], p = 0.04). For walking, capacity, a higher dosage (duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve) of AT interventions demonstrated a significantly greater effect (SMD = 0.58 [0.12, 1.04], p = 0.01). Combined AT and RT improved QoL (SMD = 0.56 [0.12, 0.98], p = 0.01). Hospital located rehabilitation setting was effective for improving walking capacity (SMD = 0.57 [0.06, 1.09], p = 0.03) compared with home and/or community and laboratory settings. Conclusion Our findings showed that neither AT nor RT have a significant effect on balance. However, AT executed in hospital-located settings with a higher dose is a more effective strategy to facilitate walking capacity in chronic stroke. In contrast, combined AT and RT is beneficial for improving QoL. Clinical implications A high dosage of aerobic exercise, duration ≥ 120 min/week; intensity ≥ 60% heart rate reserve is beneficial for improving walking capacity.
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Affiliation(s)
- Elogni R Amanzonwé
- Unit of NeuroRehabilitation, Department of Neurology NeuroRehabilitation, University of Parakou, Parakou, Benin.,REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Lisa Tedesco Triccas
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Léopold Codjo
- Department of Cardiology, Faculty of Medicine, University of Parakou, Parakou, Benin
| | - Dominique Hansen
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Peter Feys
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium
| | - Oyéné Kossi
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Hasselt, Belgium.,Unit of NeuroRehabilitation, Department of Neurology NeuroRehabilitation, University Hospital of Parakou, Parakou, Benin.,ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
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21
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Wolf F, Eschweiler M, Rademacher A, Zimmer P. Multimodal Agility-Based Exercise Training for Persons With Multiple Sclerosis: A New Framework. Neurorehabil Neural Repair 2022; 36:777-787. [PMID: 36373854 DOI: 10.1177/15459683221131789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Multimodal agility-based exercise training (MAT) has been described as a framework for fall prevention in the elderly but might also be a valuable concept for exercise training in persons with Multiple Sclerosis (pwMS). THE PROBLEM Current recommendations advise pwMS to perform a multitude of different exercise training activities, as each of these has its separate evidence. However, pwMS struggle even more than the general population to be physically active. Additionally, Multiple Sclerosis often leads to co-occurring mobility and cognitive dysfunctions, for which simultaneous, time-efficient, and engaging training approaches are still limited in clinical practice and healthcare. THE SOLUTION The MAT framework has been developed to integratively improve cardiovascular, neuromuscular, and cognitive function by combining aspects of perception and orientation, change of direction, as well as stop-and-go patterns (ie, agility), in a group-training format. For pwMS, the MAT framework is conceptualized to include 3 Components: standing balance, dynamic balance (including functional leg strength), and agility-based exercises. Within these Components sensory, cognitive, and cardiovascular challenges can be adapted to individual needs. RECOMMENDATIONS We recommend investigating multimodal exercise interventions that go beyond easily standardized, unimodal types of exercise (eg, aerobic or resistance exercise), which could allow for time-efficient training, targeting multiple frequent symptoms of persons with mild disability at once. MAT should be compared to unimodal approaches, regarding sensor-based gait outcomes, fatigue-related outcomes, cognition, as well as neuroprotective, and (supportive) disease-modifying effects.
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Affiliation(s)
- Florian Wolf
- Neurological Rehabilitation Center Godeshoehe, Bonn, Germany.,Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | | | - Annette Rademacher
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Philipp Zimmer
- Department for Performance and Health, Institute for Sport and Sport Science, Technical University Dortmund, Dortmund, Germany
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22
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Booij M, van Royen B, Nolte P, Twisk J, Harlaar J, van den Noort J. Total knee arthroplasty improves gait adaptability in osteoarthritis patients; a pilot study. J Orthop 2022; 34:304-309. [PMID: 36176586 PMCID: PMC9513089 DOI: 10.1016/j.jor.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 11/15/2022] Open
Abstract
Background Gait adaptability is of utmost importance for keeping balance during gait in patients with knee osteoarthritis, also after total knee arthroplasty (TKA). The aims of this explorative study are: (1) assess the effect of age, knee osteoarthritis and TKA on gait adaptability; (2) assess changes in gait adaptability pre-to post-TKA and (3) their relation to functional outcomes. Methods Gait adaptability was measured using a Target Stepping Test (TST) in knee osteoarthritis patients before (preTKA) and 12 months after TKA (postTKA) and compared to asymptomatic old (AsOld) and young adults (AsYng). TST imposed an asymmetrical gait pattern with projected stepping targets at high walking speed. Gait adaptability was determined through stepping accuracy on the targets. The Oxford Knee Score (OKS) and Timed-Up-and-Go test (TUG) measured patients' physical function. Results 12 preTKA, 8 postTKA, 18 AsYng, 21 AsOld were tested. Age showed no effect on TST-stepping accuracy. PreTKA showed worse TST-stepping accuracy compared to AsYng and AsOld (7.7; 6.2 cm difference). PostTKA showed an improvement of 52% in TST-stepping accuracy compared to preTKA (3.2 cm).Higher stepping accuracy preTKA predicted higher stepping accuracy post-TKA. In addition, low preTKA stepping accuracy predicted more improvement postTKA. Pre-to post-TKA improvement of stepping accuracy was related to improvement on the TUG (Beta = 0.17, p = 0.024), but not to OKS. Conclusions Gait adaptability is improved following TKA in knee osteoarthritis patients and no longer significantly worse than asymptomatic adults. The relation of gait adaptability to function is shown by its relation to the TUG and shows to have predictive value pre-to post-TKA.
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Affiliation(s)
- M.J. Booij
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan, 1117, Amsterdam, the Netherlands
| | - B.J. van Royen
- Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - P.A. Nolte
- Spaarne Gasthuis, Department of Orthopaedic Surgery, Spaarnepoort 1, Hoofddorp, the Netherlands
| | - J.W.R. Twisk
- VU University Medical Centre, Department of Epidemiology and Biostatistics, Amsterdam, the Netherlands
| | - J. Harlaar
- Delft University of Technology, Department of Biomechanical Engineering, Mekelweg 2, Delft, the Netherlands
- Erasmus Medical Center, Department of Orthopedics and Sports Medicine, Dr. Molewaterplein 40, Rotterdam, the Netherlands
| | - J.C. van den Noort
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Medical Imaging Quantification Center, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
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23
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Task demand and load carriage experience affect gait variability among military cadets. Sci Rep 2022; 12:18347. [PMID: 36319838 PMCID: PMC9626617 DOI: 10.1038/s41598-022-22881-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Load carriage is an inevitable daily task for soldiers. The purposes of this study were to explore the extent to which gait variability (GV) is affected by load carriage and experience among military cadets, and whether experience-related differences in GV are dependent on task demand. Two groups of cadets (30 experienced, 30 less experienced) completed a load carriage task in each of three load conditions (no load, 16 kg, 32 kg). Three categories of GV measures were obtained: spatiotemporal variability, joint kinematic variability, and Lyapunov exponents. Compared to traditional mean gait measures, GV measures were more discriminative of experience: although both groups showed similar mean gait measures, the experienced participants had reduced variability in spatiotemporal measures (p ≤ 0.008) and joint kinematics (p ≤ 0.004), as well as lower levels of long-term local dynamic stability at the ankle (p = 0.040). In both groups, heavier loads were also caused increased GV (p ≤ 0.018) and enhanced short-term local dynamic stability at the knee (p = 0.014). These results emphasize the importance of GV measures, which may provide a more complete description of adaptability, stability, and control; highlight alternate movement strategies during more difficult load carriage; and capture experience-related differences in load carriage strategies.
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Kinematic Analysis of Exoskeleton-Assisted Community Ambulation: An Observational Study in Outdoor Real-Life Scenarios. SENSORS 2022; 22:s22124533. [PMID: 35746315 PMCID: PMC9228687 DOI: 10.3390/s22124533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: In neurorehabilitation, Wearable Powered Exoskeletons (WPEs) enable intensive gait training even in individuals who are unable to maintain an upright position. The importance of WPEs is not only related to their impact on walking recovery, but also to the possibility of using them as assistive technology; however, WPE-assisted community ambulation has rarely been studied in terms of walking performance in real-life scenarios. (2) Methods: This study proposes the integration of an Inertial Measurement Unit (IMU) system to analyze gait kinematics during real-life outdoor scenarios (regular, irregular terrains, and slopes) by comparing the ecological gait (no-WPE condition) and WPE-assisted gait in five able-bodied volunteers. The temporal parameters of gait and joint angles were calculated from data collected by a network of seven IMUs. (3) Results: The results showed that the WPE-assisted gait had less knee flexion in the stance phase and greater hip flexion in the swing phase. The different scenarios did not change the human–exoskeleton interaction: only the low-speed WPE-assisted gait was characterized by a longer double support phase. (4) Conclusions: The proposed IMU-based gait assessment protocol enabled quantification of the human–exoskeleton interaction in terms of gait kinematics and paved the way for the study of WPE-assisted community ambulation in stroke patients.
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25
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Wade FE, Kellaher GK, Pesquera S, Baudendistel ST, Roy A, Clark DJ, Seidler RD, Ferris DP, Manini TM, Hass CJ. Kinematic analysis of speed transitions within walking in younger and older adults. J Biomech 2022; 138:111130. [PMID: 35569430 PMCID: PMC9284670 DOI: 10.1016/j.jbiomech.2022.111130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 02/02/2023]
Abstract
The ability to adapt to environmental and task demands while walking is critical to independent mobility outside the home and this ability wanes with age. Such adaptability requires individuals to acutely change their walking speed. Regardless of age, changes between walking speeds are common in daily life, and are a frequent type of walking adaptability. Here, we report on older and younger adults when transitioning from preferred walking speed overground to either slower or faster walking. Specifically, we evaluated biomechanical parameters prior to, during, and post transition. Individuals approached the walking speed transition similarly, independent of whether the transition was to slower or faster walking. Regardless of age or walking speed, the step during which a walking speed transition occurred was distinct from those prior- and post- transition, with on average 0.15 m shorter step lengths, 3.6° more hip flexion, and 3.3° more dorsiflexion during stance. We also found that peak hip flexion occurred 22% later, and peak hip extension (39%), knee flexion (26%), and dorsiflexion (44%) occurred earlier in stance for both typical to slower and typical to faster walking. Older adults had altered timing of peak joint angles compared with younger adults across both acceleration and deceleration conditions, indicating age-dependent responses to changing walking speed. Our findings are an important first step in establishing values for kinematics during walking speed transitions in younger and typical older adults.
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Affiliation(s)
- Francesca E Wade
- Department of Applied Physiology & Kinesiology, University of Florida, United States.
| | - Grace K Kellaher
- Department of Applied Physiology & Kinesiology, University of Florida, United States; Department of Kinesiology & Applied Physiology, University of Delaware, United States
| | - Sarah Pesquera
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, United States; Center for the Intrepid, San Antonio, United States
| | - Sidney T Baudendistel
- Department of Applied Physiology & Kinesiology, University of Florida, United States; Department of Physical Therapy, Washington University St. Louis, School of Medicine, United States
| | - Arkaprava Roy
- Department of Biostatistics, University of Florida, United States
| | - David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, United States; Department of Aging and Geriatric Research, University of Florida, United States
| | - Rachael D Seidler
- Department of Applied Physiology & Kinesiology, University of Florida, United States; Norman Fixel Institute for Neurological Diseases, University of Florida, United States
| | - Daniel P Ferris
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, United States
| | - Todd M Manini
- Institute on Aging, University of Florida, United States; Department of Health Outcomes and Biomedical Informatics, University of Florida, United States
| | - Chris J Hass
- Department of Applied Physiology & Kinesiology, University of Florida, United States; Norman Fixel Institute for Neurological Diseases, University of Florida, United States
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Martins LA, Schiavo A, Xavier LL, Mestriner RG. The Foot Fault Scoring System to Assess Skilled Walking in Rodents: A Reliability Study. Front Behav Neurosci 2022; 16:892010. [PMID: 35571280 PMCID: PMC9100421 DOI: 10.3389/fnbeh.2022.892010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/28/2022] [Indexed: 11/21/2022] Open
Abstract
The foot fault scoring system of the ladder rung walking test (LRWT) is used to assess skilled walking in rodents. However, the reliability of the LRWT foot fault score has not been properly addressed. This study was designed to address this issue. Two independent and blinded raters analyzed 20 rats and 20 mice videos. Each video was analyzed twice by the same rater (80 analyses per rater). The intraclass correlation coefficient (ICC) and the Kappa coefficient were employed to check the accuracy of agreement and reliability in the intra- and inter-rater analyses of the LRWT outcomes. Excellent intra- and inter-rater agreements were found for the forelimb, hindlimb, and both limbs combined in rats and mice. The agreement level was also excellent for total crossing time, total time stopped, and the number of stops during the walking path. Rating individual scores in the foot fault score system (0–6) ranged from satisfactory to excellent, in terms of the intraclass correlation indexes. Moreover, we showed that experienced and inexperienced raters can obtain reliable results if supervised training is provided. We concluded that the LRWT is a reliable and useful tool to study skilled walking in rodents and can help researchers address walking-related neurobiological questions.
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Affiliation(s)
- Lucas Athaydes Martins
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Neurorehabilitation and Neural Repair Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Aniuska Schiavo
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Neurorehabilitation and Neural Repair Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Léder Leal Xavier
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Régis Gemerasca Mestriner
- Graduate Program in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- Neurorehabilitation and Neural Repair Research Group (NEUROPLAR), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- *Correspondence: Régis Gemerasca Mestriner, , orcid.org/0000-0001-9837-1691
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Sekiguchi Y, Honda K, Izumi SI. Effect of Walking Adaptability on an Uneven Surface by a Stepping Pattern on Walking Activity After Stroke. Front Hum Neurosci 2022; 15:762223. [PMID: 35058764 PMCID: PMC8764227 DOI: 10.3389/fnhum.2021.762223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022] Open
Abstract
Real-world walking activity is important for poststroke patients because it leads to their participation in the community and physical activity. Walking activity may be related to adaptability to different surface conditions of the ground. The purpose of this study was to clarify whether walking adaptability on an uneven surface by step is related to daily walking activity in patients after stroke. We involved 14 patients who had hemiparesis after stroke (age: 59.4 ± 8.9 years; post-onset duration: 70.7 ± 53.5 months) and 12 healthy controls (age: 59.5 ± 14.2 years). The poststroke patients were categorized as least limited community ambulators or unlimited ambulators. For the uneven surface, the study used an artificial grass surface (7 m long, 2-cm leaf length). The subjects repeated even surface walking and the uneven surface walking trials at least two times at a comfortable speed. We collected spatiotemporal and kinematic gait parameters on both the even and uneven surfaces using a three-dimensional motion analysis system. After we measured gait, the subjects wore an accelerometer around the waist for at least 4 days. We measured the number of steps per day using the accelerometer to evaluate walking activity. Differences in gait parameters between the even and uneven surfaces were calculated to determine how the subjects adapted to an uneven surface while walking. We examined the association between the difference in parameter measurements between the two surface properties and walking activity (number of steps per day). Walking activity significantly and positively correlated with the difference in paretic step length under the conditions of different surface properties in the poststroke patients (r = 0.65, p = 0.012) and step width in the healthy controls (r = 0.68, p = 0.015). The strategy of increasing the paretic step length, but not step width, on an uneven surface may lead to a larger base of support, which maintains stability during gait on an uneven surface in poststroke patients, resulting in an increased walking activity. Therefore, in poststroke patients, an increase in paretic step length during gait on an uneven surface might be more essential for improving walking activity.
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Affiliation(s)
- Yusuke Sekiguchi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
- *Correspondence: Yusuke Sekiguchi,
| | - Keita Honda
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Graduate School of Medicine, Tohoku University, Sendai, Japan
- Department of Physical Medicine and Rehabilitation, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
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28
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Walking-adaptability therapy after stroke: results of a randomized controlled trial. Trials 2021; 22:923. [PMID: 34911566 PMCID: PMC8672482 DOI: 10.1186/s13063-021-05742-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ability to adapt walking to environmental properties and hazards, a prerequisite for safe ambulation, is often impaired in persons after stroke. RESEARCH QUESTION The aim of this study was to compare the efficacy of two walking-adaptability interventions: a novel treadmill-based C-Mill therapy (using gait-dependent augmented reality) and the standard overground FALLS program (using physical context). We expected sustained improvements for both treatment groups combined but hypothesized better outcomes for C-Mill therapy than the FALLS program due to its expected greater amount of walking practice. METHODS In this pre-registered single-centre parallel group randomized controlled trial, forty persons after stroke (≥ 3 months ago) with walking and/or balance deficits were randomly allocated to either 5 weeks of C-Mill therapy or the FALLS program. The primary outcome measure was the standard walking speed as determined with the 10-meter walking test (10MWT). Additionally, context-specific walking speed was assessed in environments enriched with either stationary physical context (10MWT context) or suddenly appearing visual images (Interactive Walkway obstacles). The walking-adaptability scores of those enriched walking tests served as secondary outcome measures. Furthermore, a cognitive task was added to all three assessments to evaluate dual-task performance in this context. Finally, the participants' experience and amount of walking practice were scored. The outcome measures were assessed at four test moments: pre-intervention (T0), post-intervention (T1), 5-week post-intervention retention (T2), and 1-year post-intervention follow-up (T3). RESULTS No significant group differences were found between the interventions for the primary outcome measure standard walking speed, but we found a greater improvement in context-specific walking speed with stationary physical context of the C-Mill therapy compared to the FALLS program at the post-intervention test, which was no longer significant at retention. Both interventions were well received, but C-Mill therapy scored better on perceived increased fitness than the FALLS program. C-Mill therapy resulted in twice as many steps per session of equal duration than the FALLS program. The "change-over-time" analyses for participants of both interventions combined showed no significant improvements in the standard walking speed; however, significant improvements were found for context-specific walking speed, walking adaptability, and cognitive dual-task performance. SIGNIFICANCE This study showed no between-group differences between the novel treadmill-based C-Mill therapy and the standard overground FALLS program with respect to the primary outcome measure standard walking speed. However, the greater amount of walking practice observed for the C-Mill group, an essential aspect of effective intervention programs after stroke, may underlie the reported increased perceived fitness and observed increased context-specific walking speed for the C-Mill group directly after the intervention. Although the "change-over-time" results for all participants combined showed no improvement in the standard walking speed, context-specific walking speed and walking adaptability showed sustained improvements after the interventions, underscoring the importance of including walking-adaptability training and assessment in rehabilitation post stroke. TRIAL REGISTRATION The Netherlands Trial Register NTR4030 . Registered 11 June 2013.
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Luque-Moreno C, Kiper P, Solís-Marcos I, Agostini M, Polli A, Turolla A, Oliva-Pascual-Vaca A. Virtual Reality and Physiotherapy in Post-Stroke Functional Re-Education of the Lower Extremity: A Controlled Clinical Trial on a New Approach. J Pers Med 2021; 11:1210. [PMID: 34834562 PMCID: PMC8622451 DOI: 10.3390/jpm11111210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/13/2021] [Accepted: 11/15/2021] [Indexed: 01/10/2023] Open
Abstract
Numerous Virtual Reality (VR) systems address post-stroke functional recovery of the lower extremity (LE), most of them with low early applicability due to the gait autonomy they require. The aim of the present study was to evaluate the feasibility of a specific VR treatment and its clinical effect on LE functionality, gait, balance, and trunk control post-stroke. A controlled, prospective, clinical trial was carried out with 20 stroke patients, who were divided into two groups: the first group (VR + CP; n = 10) received combined therapy of 1 h VR and 1 h of conventional physiotherapy (CP) and the second group (CP; n = 10) received 2 h of CP (5 days/week, for 3 weeks). The following pre-post-intervention measuring scales were used: Functional Ambulatory Scale (FAC), Functional Independence Measure (FIM), Fugl-Meyer Assessment (FM), Berg Balance Scale (BBS), and Trunk Control Test (TCT). Only VR + CP showed a significant improvement in FAC. In FIM, CP presented a tendency to significance, whereas VR + CP showed significance. Both groups improved significantly in FM (especially in amplitude/pain in VR + CP and in sensitivity in CP) and in BBS. In TCT, there was a non-significant improvement in both groups. The results indicate that the intervention with VR is a feasible treatment in the post-stroke functional re-education of the LE, with the potential to be an optimal complement of CP.
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Affiliation(s)
- Carlos Luque-Moreno
- Department of Physiotherapy, University of Seville, 41009 Seville, Spain;
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS, 30126 Venezia, Italy;
| | - Pawel Kiper
- Physical Medicine and Rehabilitation Unit, Azienda ULSS 3 Serenissima, 30126 Venice, Italy;
| | - Ignacio Solís-Marcos
- Unit of Humans in the Transport System, Swedish National Road and Transport Research Institute (VTI), Linköping University, 58330 Linköping, Sweden;
| | - Michela Agostini
- Department of Neuroscience, Section of Rehabilitation, University-General Hospital of Padova, 35128 Padova, Italy;
| | - Andrea Polli
- Pain in Motion International Research Group, Department of Physiotherapy, Vrije University Brussel, 1050 Brussel, Belgium;
| | - Andrea Turolla
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS, 30126 Venezia, Italy;
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Clark DJ, Rose DK, Butera KA, Hoisington B, DeMark L, Chatterjee SA, Hawkins KA, Otzel DM, Skinner JW, Christou EA, Wu SS, Fox EJ. Rehabilitation with accurate adaptability walking tasks or steady state walking: A randomized clinical trial in adults post-stroke. Clin Rehabil 2021; 35:1196-1206. [PMID: 33722075 PMCID: PMC10416755 DOI: 10.1177/02692155211001682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess changes in walking function and walking-related prefrontal cortical activity following two post-stroke rehabilitation interventions: an accurate adaptability (ACC) walking intervention and a steady state (SS) walking intervention. DESIGN Randomized, single blind, parallel group clinical trial. SETTING Hospital research setting. SUBJECTS Adults with chronic post-stroke hemiparesis and walking deficits. INTERVENTIONS ACC emphasized stepping accuracy and walking adaptability, while SS emphasized steady state, symmetrical stepping. Both included 36 sessions led by a licensed physical therapist. ACC walking tasks recruit cortical regions that increase corticospinal tract activation, while SS walking activates the corticospinal tract less intensely. MAIN MEASURES The primary functional outcome measure was preferred steady state walking speed. Prefrontal brain activity during walking was measured with functional near infrared spectroscopy to assess executive control demands. Assessments were conducted at baseline, post-intervention (three months), and follow-up (six months). RESULTS Thirty-eight participants were randomized to the study interventions (mean age 59.6 ± 9.1 years; mean months post-stroke 18.0 ± 10.5). Preferred walking speed increased from baseline to post-intervention by 0.13 ± 0.11 m/s in the ACC group and by 0.14 ± 0.13 m/s in the SS group. The Time × Group interaction was not statistically significant (P = 0.86). Prefrontal fNIRS during walking decreased from baseline to post-intervention, with a marginally larger effect in the ACC group (P = 0.05). CONCLUSIONS The ACC and SS interventions produced similar changes in walking function. fNIRS suggested a potential benefit of ACC training for reducing demand on prefrontal (executive) resources during walking.
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Affiliation(s)
- David J. Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608, USA
- Department of Aging and Geriatric Research, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA
| | - Dorian K. Rose
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608, USA
- Department of Physical Therapy, University of Florida, 101 Newell Dr, Gainesville, FL 32603, USA
- Brooks Rehabilitation, 3901 University Blvd S #101, Jacksonville, FL 32216, USA
| | - Katie A. Butera
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608, USA
- Department of Physical Therapy, University of Florida, 101 Newell Dr, Gainesville, FL 32603, USA
| | - Brooke Hoisington
- Brooks Rehabilitation, 3901 University Blvd S #101, Jacksonville, FL 32216, USA
| | - Louis DeMark
- Brooks Rehabilitation, 3901 University Blvd S #101, Jacksonville, FL 32216, USA
| | - Sudeshna A. Chatterjee
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608, USA
- Department of Physical Therapy, University of Florida, 101 Newell Dr, Gainesville, FL 32603, USA
| | - Kelly A. Hawkins
- Department of Physical Therapy, University of Florida, 101 Newell Dr, Gainesville, FL 32603, USA
| | - Dana M. Otzel
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, 1601 SW Archer Rd, Gainesville, FL 32608, USA
| | - Jared W. Skinner
- VA Geriatric Research, Education and Clinical Center, North Florida/South Georgia Veterans Health System, 1601 SW Archer Rd, Gainesville, FL 32608, USA
| | - Evangelos A. Christou
- Department of Applied Physiology and Kinesiology, University of Florida, 1864 Stadium Rd, Gainesville, FL 32603
| | - Samuel S. Wu
- Department of Biostatistics, University of Florida, 2004 Mowry Rd, Gainesville, FL 32611, USA
| | - Emily J. Fox
- Department of Physical Therapy, University of Florida, 101 Newell Dr, Gainesville, FL 32603, USA
- Brooks Rehabilitation, 3901 University Blvd S #101, Jacksonville, FL 32216, USA
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Wischke-Baltes A, Tyson SF, Braun T. Die deutsche Version des Brunel Balance Assessments zur Erfassung der Gleichgewichtsfähigkeit bei Menschen nach einem Schlaganfall: kulturelle Adaptation und erste psychometrische Evaluation. PHYSIOSCIENCE 2021. [DOI: 10.1055/a-1331-6615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Hintergrund Das Brunel Balance Assessments (BBA) ist ein klinisches Messinstrument zur Erfassung der Gleichgewichtsfähigkeit von Menschen nach Schlaganfall. Die englischsprachige Originalversion des Assessments weist gute Gütekriterien auf.
Ziel Übersetzung und kulturelle Adaptation des BBA für den deutschsprachigen Raum sowie erste Einschätzung der Praktikabilität und Konstruktvalidität.
Methode Das BBA wurde konform einer etablierten Leitlinie ins Deutsche übersetzt. Als Teil dieses Prozesses wurde eine präfinale deutsche Version des Assessments über einen Zeitraum von 10 Wochen in einem ambulanten Rehabilitationszentrum von Physiotherapeut*innen klinisch angewendet. Die anschließende Überarbeitung des Assessments basierte auf den Erfahrungen der Anwender*innen. Eine erste Analyse der Konstruktvalidität folgte dem Ansatz des Hypothesentestens. Es wurde angenommen, dass das BBA stark mit Testwerten anderer Assessments des funktionellen Gleichgewichts und der Gehfähigkeit korreliert. Als Indikator der Praktikabilität wurde die Durchführungszeit des BBA erfasst.
Ergebnisse Die präfinale deutsche Version wurde von 10 Therapeut*innen mit 25 Patient*innen nach Schlaganfall klinisch angewendet. Durch geringfügige Anpassungen wurde eine finale deutsche Version des BBA erstellt. BBA-Testwerte korrelierten moderat mit Testwerten des TUG und Testwerten der FAC. Die durchschnittliche Durchführungszeit des BBA betrug 17 ± 4 Minuten.
Schlussfolgerung Das BBA wurde übersetzt, kulturell für den deutschsprachigen Raum adaptiert und steht nun für die klinische Anwendung zur Verfügung. Vorläufige Analysen weisen auf eine moderate Konstruktvalidität bei Patient*innen nach einem Schlaganfall im ambulanten Setting hin. Eine ausführliche Überprüfung der Gütekriterien steht aus.
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Affiliation(s)
- Agnes Wischke-Baltes
- Neurologisches interdisziplinäres Behandlungszentrum (NiB) Köln, Deutschland
- Döpfer Schulen Köln, Deutschland
| | - Sarah F Tyson
- Division of Nursing, Midwifery and Social Work, The University of Manchester, United Kingdom
| | - Tobias Braun
- Hochschule für Gesundheit, Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Bochum, Deutschland
- IB Hochschule für Gesundheit und Soziales, Studienzentrum Köln, Deutschland
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Mohan DM, Khandoker AH, Wasti SA, Ismail Ibrahim Ismail Alali S, Jelinek HF, Khalaf K. Assessment Methods of Post-stroke Gait: A Scoping Review of Technology-Driven Approaches to Gait Characterization and Analysis. Front Neurol 2021; 12:650024. [PMID: 34168608 PMCID: PMC8217618 DOI: 10.3389/fneur.2021.650024] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 05/07/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Gait dysfunction or impairment is considered one of the most common and devastating physiological consequences of stroke, and achieving optimal gait is a key goal for stroke victims with gait disability along with their clinical teams. Many researchers have explored post stroke gait, including assessment tools and techniques, key gait parameters and significance on functional recovery, as well as data mining, modeling and analyses methods. Research Question: This study aimed to review and summarize research efforts applicable to quantification and analyses of post-stroke gait with focus on recent technology-driven gait characterization and analysis approaches, including the integration of smart low cost wearables and Artificial Intelligence (AI), as well as feasibility and potential value in clinical settings. Methods: A comprehensive literature search was conducted within Google Scholar, PubMed, and ScienceDirect using a set of keywords, including lower extremity, walking, post-stroke, and kinematics. Original articles that met the selection criteria were included. Results and Significance: This scoping review aimed to shed light on tools and technologies employed in post stroke gait assessment toward bridging the existing gap between the research and clinical communities. Conventional qualitative gait analysis, typically used in clinics is mainly based on observational gait and is hence subjective and largely impacted by the observer's experience. Quantitative gait analysis, however, provides measured parameters, with good accuracy and repeatability for the diagnosis and comparative assessment throughout rehabilitation. Rapidly emerging smart wearable technology and AI, including Machine Learning, Support Vector Machine, and Neural Network approaches, are increasingly commanding greater attention in gait research. Although their use in clinical settings are not yet well leveraged, these tools promise a paradigm shift in stroke gait quantification, as they provide means for acquiring, storing and analyzing multifactorial complex gait data, while capturing its non-linear dynamic variability and offering the invaluable benefits of predictive analytics.
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Affiliation(s)
- Dhanya Menoth Mohan
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Ahsan Habib Khandoker
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Sabahat Asim Wasti
- Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sarah Ismail Ibrahim Ismail Alali
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Herbert F Jelinek
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Kinda Khalaf
- Department of Biomedical Engineering, Health Engineering Innovation Center (HEIC), Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
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Butera KA, Fox EJ, Bishop MD, Coombes SA, George SZ. Empirically derived back pain subgroups differentiated walking performance, pain, and disability. Pain 2021; 162:1806-1815. [PMID: 33306502 PMCID: PMC8765081 DOI: 10.1097/j.pain.0000000000002167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/03/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Low back pain (LBP) is a leading cause of disability. However, the processes contributing to disability are not well understood. Therefore, this study (1) empirically derived LBP subgroups and (2) validated these subgroups using walking performance, pain, and disability measures. Seventy adults with LBP underwent testing for a priori determined sensory (temporal summation; conditioned pain modulation), psychological (positive affect/coping; negative coping), and motor (trunk extensor muscle activation during forward bending and walking) measures. A hierarchical cluster analysis determined subgroups that were then validated using walking (walking speed; Timed Up and Go [TUG]; TUG-Cognitive [TUG-Cog]; obstacle negotiation) and clinical (Brief Pain Inventory; Oswestry Disability Index; low back pressure pain threshold) measures. Two subgroups were derived: (1) a "Maladaptive" subgroup (n = 21) characterized by low positive affect/coping, high negative coping, low pain modulation, and atypical trunk extensor activation and (2) an "Adaptive" subgroup (n = 49) characterized by high positive affect/coping, low negative coping, high pain modulation, and typical trunk extensor activation. There were subgroup differences on 7 of 12 validation measures. The Maladaptive subgroup had reduced walking performance (slower self-selected walking speed, TUG completion, and obstacle approach and crossing speed) and worse clinical presentation (higher pain intensity, pain interference, and disability) (moderate to large effect sizes; P's < 0.05). Findings support the construct validity of this multidimensional subgrouping approach. Longitudinal studies are needed to determine whether the Maladaptive subgroup is predictive of poor outcomes, such as pain chronicity or persistent disability.
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Affiliation(s)
- Katie A. Butera
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Emily J. Fox
- Department of Physical Therapy, University of Florida, Gainesville, FL
- Brooks Rehabilitation, Jacksonville, FL
| | - Mark D. Bishop
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Stephen A. Coombes
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, FL
| | - Steven Z. George
- Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, NC
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Chen ZY, Yan HJ, Qi L, Zhen QX, Liu C, Wang P, Liu YH, Wang RD, Liu YJ, Fang JP, Su Y, Yan XY, Liu AX, Xi J, Fang B. C-Gait for Detecting Freezing of Gait in the Early to Middle Stages of Parkinson's Disease: A Model Prediction Study. Front Hum Neurosci 2021; 15:621977. [PMID: 33828470 PMCID: PMC8019899 DOI: 10.3389/fnhum.2021.621977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/12/2021] [Indexed: 12/28/2022] Open
Abstract
Objective Efficient methods for assessing walking adaptability in individuals with Parkinson's disease (PD) are urgently needed. Therefore, this study aimed to assess C-Gait for detecting freezing of gait (FOG) in patients with early- to middle-stage PD. Method People with PD (PWP) diagnosis (Hoehn and Yahr stages 1-3) were recruited from April 2019 to November 2019 in Beijing Rehabilitation Hospital. The participants performed six items of walking adaptability on an instrumented treadmill augmented with visual targets and obstacles (C-Mill). The patient's walking adaptability was evaluated by C-Gait assessment and traditional walking tests, and FOG-related indexes were collected as outcome measures. Two discriminant models were established by stepwise discriminant analysis; area under the receiver operating characteristic (ROC) curve (AUC) was used to validate the models. Result In total, 53 patients were included in this study. Most C-Gait assessment items had no or low correlations with traditional walking tests. The obstacle avoidance (r = -0.639, P = 0.003) and speed of adaptation (r = -0.486, P = 0.035) items could lead to FOG with high sensitivity. In addition, the C-Gait assessment model (AUC = 0.755) had slightly better discrimination of freezers from non-freezers compared with traditional walking test models (AUC = 0.672); specifically, obstacle avoidance and speed of adaptation have uniquely discriminant potential. Conclusion C-gait assessment could provide additional value to the traditional walking tests for PD. Gait adaptability assessment, as measured by C-Gait, may be able to help identify freezers in a PD population.
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Affiliation(s)
- Zi-Yan Chen
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Hong-Jiao Yan
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Lin Qi
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Qiao-Xia Zhen
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Cui Liu
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Ping Wang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yong-Hong Liu
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Rui-Dan Wang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yan-Jun Liu
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jin-Ping Fang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Yuan Su
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Xiao-Yan Yan
- Peking University Clinical Research Institute, Beijing, China
| | - Ai-Xian Liu
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Jianing Xi
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
| | - Boyan Fang
- Beijing Rehabilitation Hospital, Capital Medical University, Beijing, China
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Deblock-Bellamy A, Lamontagne A, McFadyen BJ, Ouellet MC, Blanchette AK. Virtual reality-based assessment of cognitive-locomotor interference in healthy young adults. J Neuroeng Rehabil 2021; 18:53. [PMID: 33752704 PMCID: PMC7983256 DOI: 10.1186/s12984-021-00834-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A recent literature review emphasized the importance of assessing dual-task (DT) abilities with tasks that are representative of community ambulation. Assessing DT ability in real-life activities using standardized protocols remains difficult. Virtual reality (VR) may represent an interesting alternative enabling the exposure to different scenarios simulating community walking. To better understand dual-task abilities in everyday life activities, the aims of this study were (1) to assess locomotor and cognitive dual-task cost (DTC) during representative daily living activities, using VR, in healthy adults; and 2) to explore the influence of the nature and complexity of locomotor and cognitive tasks on DTC. METHODS Fifteen healthy young adults (24.9 ± 2.7 years old, 8 women) were recruited to walk in a virtual 100 m shopping mall corridor, while remembering a 5-item list (DT condition), using an omnidirectional platform and a VR headset. Two levels of difficulty were proposed for the locomotor task (with vs. without virtual agent avoidance) and for the cognitive task (with vs. without items modification). These tasks were also performed in single task (ST) condition. Locomotor and cognitive DTC were measured by comparing performances in ST and DT conditions. Locomotor performance was characterized using walking speed, walking fluidity, and minimal distance between the participant and the virtual agent during avoidance. Cognitive performance was assessed with the number of items correctly recalled. Presence of DTC were determined with one-sample Wilcoxon signed-rank tests. To explore the influence of the tasks' complexity and nature on DTC, a nonparametric two-way repeated measure ANOVA was performed. RESULTS No locomotor interference was measured for any of the outcomes. A cognitive DTC of 6.67% was measured (p = .017) while participants performed simultaneously both complex locomotor and cognitive tasks. A significant interaction between locomotor task complexity and cognitive task nature (p = .002) was identified on cognitive DTC. CONCLUSIONS In challenging locomotor and cognitive conditions, healthy young adults present DTC in cognitive accuracy, which was influenced by the locomotor task complexity task and the cognitive task nature. A similar VR-based protocol might be used to investigate DT abilities in older adults and individuals with a stroke.
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Affiliation(s)
- Anne Deblock-Bellamy
- Center for interdisciplinary research in rehabilitation and social integration (Cirris), CIUSSS de la Capitale-Nationale, 525 Boulevard Wilfrid-Hamel, Quebec City, QC G1M 2S8 Canada
- Faculty of Medicine, Universite Laval, 1050 Avenue de la Medecine, Quebec City, QC G1V 0A6 Canada
| | - Anouk Lamontagne
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Jewish Rehabilitation Hospital, CISSS de Laval, 3205 Alton-Goldbloom Place, Laval, QC H7V 1R2 Canada
- School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC H3G 1Y5 Canada
| | - Bradford J. McFadyen
- Center for interdisciplinary research in rehabilitation and social integration (Cirris), CIUSSS de la Capitale-Nationale, 525 Boulevard Wilfrid-Hamel, Quebec City, QC G1M 2S8 Canada
- Faculty of Medicine, Universite Laval, 1050 Avenue de la Medecine, Quebec City, QC G1V 0A6 Canada
- Department of Rehabilitation, Universite Laval, 1050 Avenue de la Medecine, Quebec City, QC G1V 0A6 Canada
| | - Marie-Christine Ouellet
- Center for interdisciplinary research in rehabilitation and social integration (Cirris), CIUSSS de la Capitale-Nationale, 525 Boulevard Wilfrid-Hamel, Quebec City, QC G1M 2S8 Canada
- Faculty of Social Sciences, School of Psychology, Universite Laval, 2325 rue des Bibliothèques, Quebec City, QC G1V 0A6 Canada
| | - Andreanne K. Blanchette
- Center for interdisciplinary research in rehabilitation and social integration (Cirris), CIUSSS de la Capitale-Nationale, 525 Boulevard Wilfrid-Hamel, Quebec City, QC G1M 2S8 Canada
- Faculty of Medicine, Universite Laval, 1050 Avenue de la Medecine, Quebec City, QC G1V 0A6 Canada
- Department of Rehabilitation, Universite Laval, 1050 Avenue de la Medecine, Quebec City, QC G1V 0A6 Canada
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de Rooij IJM, van de Port IGL, Punt M, Abbink-van Moorsel PJM, Kortsmit M, van Eijk RPA, Visser-Meily JMA, Meijer JWG. Effect of Virtual Reality Gait Training on Participation in Survivors of Subacute Stroke: A Randomized Controlled Trial. Phys Ther 2021; 101:6136818. [PMID: 33594443 PMCID: PMC8122468 DOI: 10.1093/ptj/pzab051] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/14/2020] [Accepted: 12/17/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE After stroke, people experience difficulties with walking that lead to restrictions in participation in daily life. The purpose of this study was to examine the effect of virtual reality gait training (VRT) compared to non-virtual reality gait training (non-VRT) on participation in community-living people after stroke. METHODS In this assessor-blinded, randomized controlled trial with 2 parallel groups, people were included between 2 weeks and 6 months after stroke and randomly assigned to the VRT group or non-VRT group. Participants assigned to the VRT group received training on the Gait Real-time Analysis Interactive Lab (GRAIL), and participants assigned to the non-VRT group received treadmill training and functional gait exercises without virtual reality. Both training interventions consisted of 12 30-minute sessions during 6 weeks. The primary outcome was participation measured with the restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) 3 months postintervention. Secondary outcomes included subjective physical functioning, functional mobility, walking ability, dynamic balance, walking activity, fatigue, anxiety and depression, falls efficacy, and quality of life. RESULTS Twenty-eight participants were randomly assigned to the VRT group and 27 to the non-VRT group, of whom 25 and 22 attended 75% or more of the training sessions, respectively. No significant differences between the groups were found over time for the USER-P restrictions subscale (1.23; 95% CI = -0.76 to 3.23) or secondary outcome measures. Patients' experiences with VRT were positive, and no serious adverse events were related to the interventions. CONCLUSIONS The effect of VRT was not statistically different from non-VRT in improving participation in community-living people after stroke. IMPACT Although outcomes were not statistically different, treadmill-based VRT was a safe and well-tolerated intervention that was positively rated by people after stroke. VR training might, therefore, be a valuable addition to stroke rehabilitation. LAY SUMMARY VRT is feasible and was positively experienced by people after stroke. However, VRT was not more effective than non-VRT for improving walking ability and participation after stroke.
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Affiliation(s)
- Ilona J M de Rooij
- Revant Rehabilitation Centres, Breda, the Netherlands,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | | | - Michiel Punt
- Research Group Lifestyle and Health, Utrecht University of Applied Sciences, Utrecht, the Netherlands
| | | | | | - Ruben P A van Eijk
- Department of Neurology, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, the Netherlands,Biostatistics & Research Support, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands,Address all correspondence to Dr Visser-Meily at:
| | - Jan-Willem G Meijer
- Revant Rehabilitation Centres, Breda, the Netherlands,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands,De Hoogstraat Rehabilitation, Utrecht, the Netherlands
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Bansal K, Clark DJ, Fox EJ, Rose DK. Does Falls Efficacy Influence the Relationship Between Forward and Backward Walking Speed After Stroke? Phys Ther 2021; 101:6130812. [PMID: 33561276 PMCID: PMC8152901 DOI: 10.1093/ptj/pzab050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/14/2020] [Accepted: 12/27/2020] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Forward walking speed (FWS) is known to be an important predictor of mobility, falls, and falls-related efficacy poststroke. However, backward walking speed (BWS) is emerging as an assessment tool to reveal mobility deficits in people poststroke that may not be apparent with FWS alone. Since backward walking is more challenging than forward walking, falls efficacy may play a role in the relationship between one's preferred FWS and BWS. We tested the hypothesis that people with lower falls efficacy would have a stronger positive relationship between FWS and BWS than those with higher falls efficacy. METHODS Forty-five individuals (12.9 ± 5.6 months poststroke) participated in this observational study. We assessed FWS with the 10-meter walk test and BWS with the 3-meter backward walk test. The modified Falls-Efficacy Scale (mFES) quantified falls efficacy. A moderated regression analysis examined the hypothesis. RESULTS FWS was positively associated with BWS (R2 = 0.26). The addition of the interaction term FWS × mFES explained 7.6% additional variance in BWS. As hypothesized, analysis of the interaction revealed that people with lower falls efficacy (mFES ≤ 6.6) had a significantly positive relationship between their preferred FWS and BWS, whereas people with higher falls efficacy (mFES > 6.6) had no relationship between their walking speed in the 2 directions. CONCLUSIONS FWS is positively related to BWS poststroke, but this relationship is influenced by one's perceived falls efficacy. Our results suggest that BWS can be predicted from FWS in people with lower falls efficacy, but as falls efficacy increases, BWS becomes a separate and unassociated construct from FWS. IMPACT This study provides unique evidence that the degree of falls efficacy significantly influences the relationship between FWS and BWS poststroke. Physical therapists should examine both FWS and BWS in people with higher falls efficacy, but further investigation is warranted for those with lower falls efficacy.
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Affiliation(s)
- Kanika Bansal
- University of Florida, Gainesville, Florida, USA,Brooks Rehabilitation, Jacksonville, Florida, USA
| | - David J Clark
- University of Florida, Gainesville, Florida, USA,Malcom Randall VAMC, Gainesville, Florida, USA
| | - Emily J Fox
- University of Florida, Gainesville, Florida, USA,Brooks Rehabilitation, Jacksonville, Florida, USA
| | - Dorian K Rose
- University of Florida, Gainesville, Florida, USA,Brooks Rehabilitation, Jacksonville, Florida, USA,Malcom Randall VAMC, Gainesville, Florida, USA,Address all correspondence to Dr Rose at:
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Kuijpers R, Smulders E, Groen BE, Smits-Engelsman BCM, Nijhuis-Van der Sanden MWG, Weerdesteyn V. Reliability and construct validity of the Walking Adaptability Ladder Test for Kids (WAL-K): a new clinical test for measuring walking adaptability in children. Disabil Rehabil 2020; 44:1489-1497. [PMID: 32776854 DOI: 10.1080/09638288.2020.1802523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Walking adaptability is essential for children to participate in daily life, but no objective measurement tools exist. We determined psychometric properties of the Walking Adaptability Ladder test for Kids (WAL-K) in 6-12 year old children. MATERIALS AND METHODS In total, 122 typically developing (TD) children and 26 children with Developmental Coordination Disorder (DCD) completed the single and double run conditions of the WAL-K. Intra-rater, inter-rater and test-retest reliability were determined by ICCs and Smallest Detectable Change (SDC) in 53 TD children. Construct validity was determined by comparing WAL-K scores between 69 TD and all DCD children and correlating these scores with age and MABC-2 scores. RESULTS ICCs for reliability varied between 0.76 and 0.99. Compared to the first test performance, WAL-K scores were lower (i.e., better) at retest. SDCs for test-retest reliability varied between 20.8 and 26.1% of the mean scores. WAL-K scores were significantly higher (i.e., worse) in DCD children compared to TD children (p < 0.001). Significant negative correlations were found with MABC-2 (-0.52 and -0.60) and age (-0.61 and -0.68). CONCLUSIONS The WAL-K shows to be a valid, reliable and easy-to-use tool for measuring walking adaptability in children. Adding an extra practice trial may reduce the observed learning effect.Implications for rehabilitationWalking adaptability is an essential skill for children to participate in daily life, but no objective measurement tools are available.The Walking Adaptability Ladder test for Kids (WAL-K) is a new measurement tool for evaluating walking adaptability in children.The WAL-K shows to be a reliable and valid measurement tool for evaluating walking adaptability in 6-12 year old children.
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Affiliation(s)
- Rosanne Kuijpers
- Sint Maartenskliniek Research, Nijmegen, The Netherlands.,Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Ellen Smulders
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands.,Master Specialized Physical Therapy, Avans+, Breda, The Netherlands
| | - Brenda E Groen
- Sint Maartenskliniek Research, Nijmegen, The Netherlands.,Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
| | - Bouwien C M Smits-Engelsman
- Department of Health & Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Maria W G Nijhuis-Van der Sanden
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands.,IQ Healthcare, Research Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Vivian Weerdesteyn
- Sint Maartenskliniek Research, Nijmegen, The Netherlands.,Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands
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Farid L, Jacobs D, Do Santos J, Simon O, Gracies JM, Hutin E. FeetMe® Monitor-connected insoles are a valid and reliable alternative for the evaluation of gait speed after stroke. Top Stroke Rehabil 2020; 28:127-134. [PMID: 32654627 DOI: 10.1080/10749357.2020.1792717] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND One of the main challenges after stroke is gait recovery. To provide patients with an individualized rehabilitation program, it is helpful to have real-life objective evaluations at baseline and at regular follow-ups to adjust the program and verify potential improvements. OBJECTIVES To evaluate the accuracy and reliability of a fully stand-alone system of connected insoles (FeetMe® Monitor) against a widely used clinical walkway system (GAITRite®). METHODS Twenty-nine subjects with a stroke that occurred >6 months prior participated in the study. Their comfortable gait over three 8-m trials was evaluated by four raters, on Day 1 and Day 7, using simultaneously FeetMe® Monitor and GAITRite®. Velocity, stride length, cadence, stance, and swing duration were calculated on both sides over three sequences of gait: one single stride, 8 m, and three 8-m trials pooled. The Intra-class Correlation Coefficient (ICC) and the Bland-Altman plot evaluated the construct validity (inter-device) and the reliability (test-retest and inter-rater) of FeetMe® Monitor. RESULTS Through all gait analysis sequences, the inter-device ICCs were >0.95 for velocity, stride length, and cadence. Ranges of inter-device ICCs were [0.77-0.94] for stance duration for both limbs, and for swing duration [0.32-0.57] on the non-paretic side and [0.75-0.90] on the paretic side. Test-retest and inter-rater ICCs for all parameters were >0.73 for one single stride, >0.88 for 8-m trials and >0.94 for three 8-m trials. CONCLUSION FeetMe® Monitor is an accurate and reliable system for measurement of gait velocity, stride length, cadence, and stance duration in chronic hemiparesis.
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Affiliation(s)
| | | | | | | | - Jean-Michel Gracies
- Laboratoire Analyse Et Restauration Du Mouvement (ARM), Hôpital Henri MONDOR, Université Paris-Est Créteil , Paris, France.,Bioingénierie, Tissus Et Neuroplasticité (BIOTN), Université Paris-Est Créteil , Paris, France
| | - Emilie Hutin
- Laboratoire Analyse Et Restauration Du Mouvement (ARM), Hôpital Henri MONDOR, Université Paris-Est Créteil , Paris, France.,Bioingénierie, Tissus Et Neuroplasticité (BIOTN), Université Paris-Est Créteil , Paris, France
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Geerse DJ, Roerdink M, Marinus J, van Hilten JJ. Assessing walking adaptability in stroke patients. Disabil Rehabil 2020; 43:3242-3250. [DOI: 10.1080/09638288.2020.1731852] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Daphne J. Geerse
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Melvyn Roerdink
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Clark DJ, Manini TM, Ferris DP, Hass CJ, Brumback BA, Cruz-Almeida Y, Pahor M, Reuter-Lorenz PA, Seidler RD. Multimodal Imaging of Brain Activity to Investigate Walking and Mobility Decline in Older Adults (Mind in Motion Study): Hypothesis, Theory, and Methods. Front Aging Neurosci 2020; 11:358. [PMID: 31969814 PMCID: PMC6960208 DOI: 10.3389/fnagi.2019.00358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022] Open
Abstract
Age-related brain changes likely contribute to mobility impairments, but the specific mechanisms are poorly understood. Current brain measurement approaches (e.g., functional magnetic resonance imaging (fMRI), functional near infrared spectroscopy (fNIRS), PET) are limited by inability to measure activity from the whole brain during walking. The Mind in Motion Study will use cutting edge, mobile, high-density electroencephalography (EEG). This approach relies upon innovative hardware and software to deliver three-dimensional localization of active cortical and subcortical regions with good spatial and temporal resolution during walking. Our overarching objective is to determine age-related changes in the central neural control of walking and correlate these findings with a comprehensive set of mobility outcomes (clinic-based, complex walking, and community mobility measures). Our hypothesis is that age-related walking deficits are explained in part by the Compensation Related Utilization of Neural Circuits Hypothesis (CRUNCH). CRUNCH is a well-supported model that describes the over-recruitment of brain regions exhibited by older adults in comparison to young adults, even at low levels of task complexity. CRUNCH also describes the limited brain reserve resources available with aging. These factors cause older adults to quickly reach a ceiling in brain resources when performing tasks of increasing complexity, leading to poor performance. Two hundred older adults and twenty young adults will undergo extensive baseline neuroimaging and walking assessments. Older adults will subsequently be followed for up to 3 years. Aim 1 will evaluate whether brain activity during actual walking explains mobility decline. Cross sectional and longitudinal designs will be used to study whether poorer walking performance and steeper trajectories of decline are associated with CRUNCH indices. Aim 2 is to harmonize high-density EEG during walking with fNIRS (during actual and imagined walking) and fMRI (during imagined walking). This will allow integration of CRUNCH-related hallmarks of brain activity across neuroimaging modalities, which is expected to lead to more widespread application of study findings. Aim 3 will study central and peripheral mechanisms (e.g., cerebral blood flow, brain regional volumes, and connectivity, sensory function) to explain differences in CRUNCH indices during walking. Research performed in the Mind in Motion Study will comprehensively characterize the aging brain during walking for developing new intervention targets.
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Affiliation(s)
- David J Clark
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States.,Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - Daniel P Ferris
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Chris J Hass
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Babette A Brumback
- Department of Biostatistics, University of Florida, Gainesville, FL, United States
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
| | - Marco Pahor
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | | | - Rachael D Seidler
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
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de Rooij IJM, van de Port IGL, van der Heijden LLM, Meijer JWG, Visser-Meily JMA. Perceived barriers and facilitators for gait-related participation in people after stroke: From a patients' perspective. Physiother Theory Pract 2019; 37:1337-1345. [PMID: 31793365 DOI: 10.1080/09593985.2019.1698085] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: An important focus of post-stroke physical therapy is to improve walking and walking capacity. However, many people after stroke experience difficulties with gait-related participation, which includes more than walking capacity alone. Gait-related participation involves walking with a participation goal and requires to deal with changes in the environment during walking and perform dual tasks, for example.Objective: To explore barriers and facilitators for gait-related participation from the perspective of people after stroke. This knowledge can contribute to the development of effective interventions to improve gait-related participation.Methods: Semi-structured interviews were conducted to investigate how people after stroke experience gait-related participation. Audio-recorded interviews were transcribed, anonymized, and analyzed thematically. Barriers and facilitators were categorized according to the International Classification of Functioning, Disability and Health (ICF) framework.Results: Twenty-one people after stroke participated. Median age was 65 years, median time since stroke 16 weeks. Barriers were reported in movement-related functions, cognitive functions, mobility, personal factors, and environmental factors. Facilitators were found on participation level and in personal and environmental factors, such as motivation and family support.Conclusion: People after stroke who were physically able to walk independently still described multiple barriers to gait-related participation in all components of the ICF framework.
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Affiliation(s)
- Ilona J M de Rooij
- Revant Rehabilitation Centres, Breda, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | | | | | - Jan-Willem G Meijer
- Revant Rehabilitation Centres, Breda, the Netherlands.,Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.,Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
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Mobility Function and Recovery After Stroke: Preliminary Insights From Sympathetic Nervous System Activity. J Neurol Phys Ther 2019; 42:224-232. [PMID: 30138228 DOI: 10.1097/npt.0000000000000238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND PURPOSE Poststroke hemiparesis increases the perceived challenge of walking. Perceived challenge is commonly measured by self-report, which is susceptible to measurement bias. A promising approach to objectively assess perceived challenge is measuring sympathetic nervous system (SNS) activity with skin conductance to detect the physiological stress response. We investigated the feasibility of using skin conductance measurements to detect task-related differences in the challenge posed by complex walking tasks in adults poststroke. METHODS Adults poststroke (n = 31) and healthy young adults (n = 8) performed walking tasks including typical walking, walking in dim lighting, walking over obstacles, and dual-task walking. Measures of skin conductance and spatiotemporal gait parameters were recorded. Continuous decomposition analysis was conducted to assess changes in skin conductance level (ΔSCL) and skin conductance response (ΔSCR). A subset of participants poststroke also underwent a 12-week rehabilitation intervention. RESULTS SNS activity measured by skin conductance (both ΔSCL and ΔSCR) was significantly greater for the obstacles task and dual-task walking than for typical walking in the stroke group. Participants also exhibited "cautious" gait behaviors of slower speed, shorter step length, and wider step width during the challenging tasks. Following the rehabilitation intervention, SNS activity decreased significantly for the obstacles task and dual-task walking. DISCUSSION AND CONCLUSIONS SNS activity measured by skin conductance is a feasible approach for quantifying task-related differences in the perceived challenge of walking tasks in people poststroke. Furthermore, reduced SNS activity during walking following a rehabilitation intervention suggests a beneficial reduction in the physiological stress response evoked by complex walking tasks.Video Abstract available for more insights from the authors (See Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A234).
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Timmermans C, Roerdink M, Janssen TWJ, Beek PJ, Meskers CGM. Automatized, Standardized, and Patient-Tailored Progressive Walking-Adaptability Training: A Proof-of-Concept Study. Phys Ther 2019; 99:882-892. [PMID: 31087062 PMCID: PMC6602157 DOI: 10.1093/ptj/pzz013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 10/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treadmill training augmented with visual images projected on the belt's surface can help improve walking adaptability. Moreover, patient-tailored automatization and standardization can increase the feasibility of walking-adaptability therapy. We developed C-Gait, a treadmill protocol consisting of a baseline walking-adaptability assessment involving 7 putatively distinct walking-adaptability tasks and a decision algorithm, to automatically update training content and execution parameters to a patients' performance and perceived challenge. OBJECTIVES The main objective was to examine the feasibility, acceptability, and clinical potential of C-Gait training. The secondary objective was to evaluate the validity of the baseline assessment. DESIGN This was a longitudinal proof-of-concept study with pretraining, posttraining, and retention tests encompassing baseline assessment and walking-related clinical measures. METHODS Twenty-four healthy adults, 12 healthy older persons, and 28 patients with gait and/or balance deficits performed the baseline assessment; the gait deficit group received 10 C-Gait training sessions over a 5-week period. Baseline assessment scores and walking-related clinical measures served as outcome measures. RESULTS C-Gait training exhibited significant progression in training content and execution, with considerable between-patient variation and minimal overruling by therapists. C-Gait training was well accepted and led to improvements in walking adaptability and general walking ability, which persisted after training cessation. Baseline assessment scores differed over groups and difficulty levels, had no-to-moderate correlations with walking-related clinical measures, and had limited correlations among walking-adaptability tasks. LIMITATIONS C-Gait was evaluated in a small yet diverse cohort. More encompassing studies are required to further establish its apparent merits. The validity of treadmill-based walking-adaptability assessment against an overground standard remains to be established. CONCLUSIONS C-Gait offers automatized, standardized, and patient-tailored walking-adaptability training that is feasible and well accepted, with good potential for improving task-specific and generic measures of walking.
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Affiliation(s)
- Celine Timmermans
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Van der Boechorststraat 9, Amsterdam 1081 BT; and Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands,Address all correspondence to Ms Timmermans at:
| | - Melvyn Roerdink
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences
| | - Thomas W J Janssen
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, and Amsterdam Rehabilitation Research Center
| | - Peter J Beek
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences
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Chatterjee SA, Rose DK, Porges EC, Otzel DM, Clark DJ. A Perspective on Objective Measurement of the Perceived Challenge of Walking. Front Hum Neurosci 2019; 13:161. [PMID: 31139069 PMCID: PMC6527756 DOI: 10.3389/fnhum.2019.00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
Perceived challenge of walking is a broad term that we use to encompass walking-related anxiety, balance self-efficacy/confidence, and fear of falling. Evidence shows that even after accounting for physical performance capabilities, a higher perceived challenge can cause individuals to self-impose restrictions in walking-related activities. Perceived challenge is typically measured by self-report, which is susceptible to subjective measurement bias and error. We assert that measurement of perceived challenge can be enhanced by augmenting self-report with objective, physiologically based measures. A promising approach that has emerged in the literature is measurement of sympathetic nervous system (SNS) activity by recording skin conductance. Heightened SNS activity is a physiological stress response to conditions that are cognitively, emotionally, or physically challenging. In the present article, we explain the rationale and physiological basis for measuring SNS activity to assess perceived challenge of walking. We also present existing and new evidence supporting the feasibility of this approach for assessing perceived challenge in lab-based and real-world walking environments. Future research directions are also discussed.
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Affiliation(s)
- Sudeshna A Chatterjee
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States.,Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Dorian K Rose
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States.,Department of Physical Therapy, University of Florida, Gainesville, FL, United States
| | - Eric C Porges
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, United States
| | - Dana M Otzel
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States.,Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
| | - David J Clark
- Brain Rehabilitation Research Center, Malcom Randall VA Medical Center, Gainesville, FL, United States.,Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, United States
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Hawkins KA, Balasubramanian CK, Vistamehr A, Conroy C, Rose DK, Clark DJ, Fox EJ. Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators. Top Stroke Rehabil 2019; 26:382-388. [PMID: 31081491 DOI: 10.1080/10749357.2019.1609182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: While over half of stroke survivors recover the ability to walk without assistance, deficits persist in the performance of walking adaptations necessary for safe home and community mobility. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes backward walking (BW) assessment and BW deficits have not been quantified in post-stroke community ambulators. Objective: To quantify spatiotemporal and kinematic BW characteristics in post-stroke community ambulators and compare their performance to controls. Methods: Individuals post-stroke (n = 15, 60.1 ± 12.9 years, forward speed: 1.13 ± 0.23 m/s) and healthy adults (n = 12, 61.2 ± 16.2 years, forward speed: 1.40 ± 0.13 m/s) performed forward walking (FW) and BW during a single session. Step characteristics and peak lower extremity joint angles were extracted using 3D motion analysis and analyzed with mixed-method ANOVAs (group, walking condition). Results: The stroke group demonstrated greater reductions in speed, step length and cadence and a greater increase in double-support time during BW compared to FW (p < .01). Compared to FW, the post-stroke group demonstrated greater reductions in hip extension and knee flexion during BW (p < .05). The control group demonstrated decreased plantarflexion and increased dorsiflexion during BW, but these increases were attenuated in the post-stroke group (p < .05). Conclusions: Assessment of BW can unmask post-stroke walking impairments not detected during typical FW. BW impairments may contribute to the mobility difficulties reported by adults post-stroke. Therefore, BW should be assessed when determining readiness for home and community ambulation.
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Affiliation(s)
- Kelly A Hawkins
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA.,b Brooks Rehabilitation , Jacksonville , FL , USA
| | | | | | | | - Dorian K Rose
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA.,b Brooks Rehabilitation , Jacksonville , FL , USA.,d Brain Rehabilitation Research Center of Excellence, North FL/South GA Veterans Health System , Gainesville , FL , USA
| | - David J Clark
- d Brain Rehabilitation Research Center of Excellence, North FL/South GA Veterans Health System , Gainesville , FL , USA.,e Department of Aging and Geriatric Research , University of Florida , Gainesville , FL , USA
| | - Emily J Fox
- a Department of Physical Therapy , University of Florida , Gainesville , FL , USA.,b Brooks Rehabilitation , Jacksonville , FL , USA
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Pournajaf S, Goffredo M, Agosti M, Massucci M, Ferro S, Franceschini M. Community ambulation of stroke survivors at 6 months follow-up: an observational study on sociodemographic and sub-acute clinical indicators. Eur J Phys Rehabil Med 2018; 55:433-441. [PMID: 30543267 DOI: 10.23736/s1973-9087.18.05489-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Despite the importance of walking recovery in real life contexts, only 7% of stroke survivors at discharge from neuro-rehabilitation units recover independent walking in the community. However, studies on outcome indicators of walking ability restoration following stroke rarely regard the community ambulation. AIM The aim of the study is to investigate how sociodemographic and sub-acute clinical characteristics of stroke survivors at admission and at discharge may predict a good participation in community walking activity 6 months post-stroke. DESIGN Retrospective observational study. SETTING Inpatient neuro-rehabilitation centers. POPULATION Three-hundred-ten stroke survivors. METHODS A secondary analysis were performed on collected sociodemographic and clinical data of subjects after first-ever stroke within 72 hours of admission to acute care facilities (T1), at discharge (T2), and subsequently after 6-months post-stroke (T3). The regression analysis between every independent variable at T1 and T2 and Walking Handicap Scale-WHS (negative: 1-3; positive: 4-6) assessed at T3 were performed to identify the most important early predictors. RESULTS At T1, being younger, having a good ability to walk, early mobilization out of bed, not having TACI, and being female are significant positive indicators while, clinical complications are significantly negative for a WHS:4-6 at T3. No correlation was found between WHS and gender, etiology, the side of lesion, the presence of aphasia, and the presence of risk factors. The combination of risk factors indicates a negative WHS at T3. CONCLUSIONS The presence of risk factors and clinical complications delay significantly the walking ability restoration and return to social life. Such status consistently with the patient's compliance must not postpone the rehabilitation relatively, rehabilitation must be facilitated with targeted programs taking care particularly of people with negative indicators for recovery of community ambulation 6 months post-stroke. CLINICAL REHABILITATION IMPACT Early indicators are considerable in order to predict a targeted prognosis and better provide a tailored rehabilitation program.
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Affiliation(s)
- Sanaz Pournajaf
- Department of Neurorehabilitation, San Raffaele Pisana Institute of Research and Care, Rome, Italy -
| | - Michela Goffredo
- Department of Neurorehabilitation, San Raffaele Pisana Institute of Research and Care, Rome, Italy
| | - Maurizio Agosti
- Department of Rehabilitation, Parma University Hospital, Parma, Italy
| | - Maurizio Massucci
- Unit of Rehabilitation, Passignano sul Trasimeno Hospital, Perugia, Italy
| | | | - Marco Franceschini
- Department of Neurorehabilitation, San Raffaele Pisana Institute of Research and Care, Rome, Italy.,San Raffaele University, Rome, Italy
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Geerse DJ, Roerdink M, Marinus J, van Hilten JJ. Assessing Walking Adaptability in Parkinson's Disease: "The Interactive Walkway". Front Neurol 2018; 9:1096. [PMID: 30631302 PMCID: PMC6315126 DOI: 10.3389/fneur.2018.01096] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022] Open
Abstract
Introduction: In people with Parkinson's disease (PD) many aspects of walking ability deteriorate with advancing disease. Clinical tests typically evaluate single aspects of walking and to a lesser extent assess more complex walking tasks involving a combination of the three key aspects of walking ability (i.e., generating stepping, maintaining postural equilibrium, adapting walking). The Interactive Walkway allows for assessing more complex walking tasks to address features that are relevant for daily life walking of patients, including adaptive walking and dual-task walking. Methods: To evaluate the expected added value of Interactive Walkway assessments in people with PD, we first evaluated its known-groups validity for outcome measures of unconstrained walking, adaptive walking and dual-task walking. Subsequently, these outcome measures were related to commonly used clinical test scores. Finally, we evaluated the expected added value of these outcomes over clinical tests scores in discriminating people with PD with and without freezing of gait. Results: Interactive Walkway outcome measures showed significant differences between freezers, non-freezers and healthy controls, in expected directions. Most Interactive Walkway outcome measures were not or at best moderately correlated with clinical test scores. Finally, Interactive Walkway outcome measures of adaptive walking slightly better discriminated freezers from non-freezers than clinical tests scores. Conclusion: We confirmed the added value of Interactive Walkway assessments, which provides a comprehensive evaluation of walking ability incorporating features of its three key aspects. Future studies are warranted to examine the potential of the Interactive Walkway for the assessment of fall risk and informing on tailored falls prevention programs in people with PD and in other populations with impaired walking ability.
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Affiliation(s)
- Daphne J Geerse
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.,Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Melvyn Roerdink
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
| | - Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands
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Neptune RR, Vistamehr A. Dynamic Balance during Human Movement: Measurement and Control Mechanisms. J Biomech Eng 2018; 141:2718203. [PMID: 30516241 PMCID: PMC6611347 DOI: 10.1115/1.4042170] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 11/16/2018] [Indexed: 11/08/2022]
Abstract
Walking can be exceedingly complex to analyze due to highly nonlinear multi-body dynamics, nonlinear relationships between muscle excitations and resulting muscle forces, dynamic coupling that allows muscles to accelerate joints and segments they do not span, and redundant muscle control. Walking requires the successful execution of a number of biomechanical functions such as providing body support, forward propulsion and balance control, with specific muscle groups contributing to their execution. Thus, muscle injury or neurological impairment that affects muscle output can alter the successful execution of these functions and impair walking performance. The loss of balance control in particular can result in falls and subsequent injuries that lead to the loss of mobility and functional independence. Thus, it is important to assess the mechanisms used to control balance in clinical populations using reliable methods with the ultimate goal of improving rehabilitation outcomes. In this review, we highlight common clinical and laboratory-based measures used to assess balance control and their potential limitations, show how these measures have been used to analyze balance in several clinical populations, and consider the translation of specific laboratory-based measures from the research laboratory to the clinic.
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Affiliation(s)
- Richard R. Neptune
- Walker Department of Mechanical Engineering,
The University of Texas at Austin,
Austin 204 E. Dean Keeton Street,
Stop C2200,
Austin, TX 78712
e-mail:
| | - Arian Vistamehr
- Brooks Rehabilitation Motion Analysis Center,
Jacksonville, FL 32216
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50
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Stone AE, Terza MJ, Raffegeau TE, Hass CJ. Walking through the looking glass: Adapting gait patterns with mirror feedback. J Biomech 2018; 83:104-109. [PMID: 30503256 DOI: 10.1016/j.jbiomech.2018.11.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 11/16/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
Abstract
Clinical locomotor research seeks to facilitate adaptation or retention of new walking patterns by providing feedback. Within a split-belt treadmill paradigm, sagittal plane feedback improves adaptation but does not affect retention. Representation of error in this manner is cognitively demanding. However, it is unknown in this paradigm how frontal plane feedback, which may utilize a unique learning process, impacts locomotor adaptation. Frontal plane movement feedback has been shown to impact retention of novel running mechanics but has yet to be evaluated in gait conditions widely applicable within neurorehabilitation, such as walking. The purpose of this study was to investigate the effects of frontal plane mirror feedback on gait adaptation and retention during split-belt treadmill walking. Forty healthy young adults were divided into two groups: one group received mirror feedback during the first split-belt exposure and the other received no mirror feedback. Individuals in the mirror feedback group were asked to look at their legs in the mirror, but no further instructions were given. Individuals with mirror feedback displayed more symmetric stance time during the first strides of adaptation and maintained this pattern into the second split-belt exposure when no feedback was provided. Individuals with mirror feedback also demonstrated more symmetric double support time upon returning to normal walking. Lastly, the mirror feedback also allowed individuals to walk with smaller gait variability during the final steps of both split-belt exposures. Overall, mirror feedback allowed individuals to reduce their stance time asymmetry and led to a more consistent adapted pattern, suggesting this type of feedback may have utility in gait training that targets symmetry and consistency in movement.
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Affiliation(s)
- Amanda E Stone
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, 1864 Stadium Rd, P.O. Box 118205, Gainesville, FL 32611, United States.
| | - Matthew J Terza
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, 1864 Stadium Rd, P.O. Box 118205, Gainesville, FL 32611, United States.
| | - Tiphanie E Raffegeau
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, 1864 Stadium Rd, P.O. Box 118205, Gainesville, FL 32611, United States.
| | - Chris J Hass
- Department of Applied Physiology and Kinesiology, College of Health and Human Performance, University of Florida, 1864 Stadium Rd, P.O. Box 118205, Gainesville, FL 32611, United States.
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