1
|
Ringsten M, Ivanic B, Iwarsson S, Lexell EM. Interventions to improve outdoor mobility among people living with disabilities: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1407. [PMID: 38882933 PMCID: PMC11177337 DOI: 10.1002/cl2.1407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 06/18/2024]
Abstract
Background Around 15% of the global population live with some form of disabilities and experience worse health outcomes, less participation in the community and are part of fewer activities outside the home. Outdoor mobility interventions aim to improve the ability to move, travel and orient outside the home and could influence the number of activities outside the home, participation and quality of life. However, outdoor mobility interventions may also lead to harm like falls or injuries or have unforeseen effects which could lead to mortality or hospitalization. Objectives To assess the efficacy of interventions aiming to improve outdoor mobility for adults living with disabilities and to explore if the efficacy varies between different conditions and different intervention components. Search Methods Standard, extensive Campbell search methods were used, including a total of 12 databases searched during January 2023, including trial registries. Selection Criteria Only randomized controlled trials were included, focusing on people living with disabilities, comparing interventions to improve outdoor mobility to control interventions as well as comparing different types of interventions to improve outdoor mobility. Data Collection and Analysis Standard methodological procedures expected by Campbell were used. The following important outcomes were 1. Activity outside the home; 2. Engagement in everyday life activities; 3. Participation; 4. Health-related Quality of Life; 5. Major harms; 6. Minor harms. The impact of the interventions was evaluated in the shorter (≤6 months) and longer term (≥7 months) after starting the intervention. Results are presented using risk ratios (RR), risk difference (RD), and standardized mean differences (SMD), with the associated confidence intervals (CI). The risk of bias 2-tool and the GRADE-framework were used to assess the certainty of the evidence. Main Results The screening comprised of 12.894 studies and included 22 studies involving 2.675 people living with disabilities and identified 12 ongoing studies. All reported outcomes except one (reported in one study, some concerns of bias) had overall high risk of bias. Thirteen studies were conducted in participants with disabilities due to stroke, five studies with older adults living with disabilities, two studies with wheelchair users, one study in participants with disabilities after a hip fracture, and one study in participants with cognitive impairments. Skill training interventions versus control interventions (16 studies) The evidence is very uncertain about the benefits and harms of skill training interventions versus control interventions not aimed to improve outdoor mobility among all people living with disabilities both in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Skill training interventions may improve engagement in everyday life activities among people with disabilities in the shorter term (RR: 1.46; 95% CI: 1.16 to 1.84; I 2 = 7%; RD: 0.15; 95% CI: -0.02 to 0.32; I 2 = 71%; 692 participants; three studies; low certainty evidence), but the evidence is very uncertain in the longer term, based on very low certainty evidence. Subgroup analysis of skill training interventions among people living with disabilities due to cognitive impairments suggests that such interventions may improve activity outside the home in the shorter term (SMD: 0.44; 95% CI: 0.07 to 0.81; I 2 = NA; 118 participants; one study; low certainty evidence). Subgroup analysis of skill training interventions among people living with cognitive impairments suggests that such interventions may improve health-related quality of life in the shorter term (SMD: 0.49; 95% CI: 0.12 to 0.88; I 2 = NA; 118 participants; one study; low certainty evidence). Physical training interventions versus control interventions (five studies) The evidence is very uncertain about the benefits and harms of physical training interventions versus control interventions not aimed to improve outdoor mobility in the shorter term (≤6 months) and longer term (≥7 months) for: Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. Physical training interventions may improve activity outside the home in the shorter (SMD: 0.35; 95% CI: 0.08 to 0.61; I 2 = NA; 228 participants; one study; low certainty evidence) and longer term (≥7 months) (SMD: 0.27; 95% CI: 0.00 to 0.54; I 2 = NA; 216 participants; one study; low certainty evidence). Comparison of different outdoor mobility interventions (one study) The evidence is very uncertain about the benefits and harms of outdoor mobility interventions of different lengths in the shorter term (≤6 months) and longer term (≥7 months) for Activity outside the home; Engagement in everyday life activities; Participation; Health-related Quality of Life; Major harms; and Minor harms, based on very low certainty evidence. No studies explored the efficacy of other types of interventions. Authors’ Conclusions Twenty-two studies of interventions to improve outdoor mobility for people living with disabilities were identified, but the evidence still remains uncertain about most benefits and harms of these interventions, both in the short- and long term. This is primarily related to risk of bias, small underpowered studies and limited reporting of important outcomes for people living with disabilities. For people with disabilities, skill training interventions may improve engagement in everyday life in the short term, and improve activity outside the home and health-related quality of life for people with cognitive impairments in the short term. Still, this is based on low certainty evidence from few studies and should be interpreted with caution. One study with low certainty evidence suggests that physical training interventions may improve activity outside the home in the short term. In addition, the effect sizes across all outcomes were considered small or trivial, and could be of limited relevance to people living with disabilities. The evidence is currently uncertain if there are interventions that can improve outdoor mobility for people with disabilities, and can improve other important outcomes, while avoiding harms. To guide decisions about the use of interventions to improve outdoor mobility, future studies should use more rigorous design and report important outcomes for people with disabilities to reduce the current uncertainty.
Collapse
Affiliation(s)
- Martin Ringsten
- Cochrane Sweden, Research and Development Skåne University Hospital Lund Sweden
- Department of Health Sciences Lund University Lund Sweden
| | | | | | - Eva Månsson Lexell
- Department of Health Sciences Lund University Lund Sweden
- Department of Neurology, Rehabilitation Medicine, Cognitive Medicine and Geriatrics Skåne University Hospital Lund-Malmö Sweden
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Lee YS, Oh DW. One-year follow-up of problem-based task training for a child presenting cerebellar ataxia after brainstem glioma surgery: A single-subject experimental study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1908. [PMID: 33884710 DOI: 10.1002/pri.1908] [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: 02/01/2021] [Revised: 03/11/2021] [Accepted: 03/25/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE For the rehabilitation of patients with cerebellar ataxia, task training aids in achieving functional benefits. This study aimed to investigate the effects of problem-based task training on balance and motor function in a child with cerebellar ataxia after brainstem glioma surgery. METHODS This study used a single-subject reversal design (A-B) with a 1-year follow-up. A 5-year old child with cerebellar ataxia due to a brain glioma completed problem-based task training, including a 10-step walk and return trial, walking while carrying an object, walking between parallel lines, and kicking a ball. Assessments were made using the Pediatric Balance Scale (PBS) and motor function tests (International Cooperative Ataxia Rating Scale (ICARS), Gross Motor Function Measure (GMFM), and Pediatric Evaluation of Disability Inventory (PEDI). RESULTS During the intervention phase, the PBS score showed clinically and statistically significant improvement compared to the baseline score. The ICARS and GMFM scores improved by 10.53% and 3.56%, respectively, after the intervention. Furthermore, in the PEDI score, functional skills and caregiver assistance in the mobility domain increased by 7.58% and 5.02%, respectively, after the intervention. The improvements in all parameters were maintained or increased at further follow-up phases. CONCLUSION These findings suggest that problem-based task training has a positive effect on balance and motor function in a child with cerebellar ataxia after brainstem glioma surgery.
Collapse
Affiliation(s)
- Ye-Seul Lee
- Department of Physical Therapy, National Traffic Injury Rehabilitation Hospital, Yangpyeong-gun, Republic of Korea
| | - Duck-Won Oh
- Department of Physical Therapy, College of Health and Medical Science, Cheongju University, Cheongju, Republic of Korea
| |
Collapse
|
4
|
Kafri M, Atun-Einy O. From Motor Learning Theory to Practice: A Scoping Review of Conceptual Frameworks for Applying Knowledge in Motor Learning to Physical Therapist Practice. Phys Ther 2019; 99:1628-1643. [PMID: 31407003 DOI: 10.1093/ptj/pzz118] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/13/2018] [Accepted: 05/05/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND The importance of motor learning knowledge for physical therapist practice is well known; however, its application is lacking. Conceptual frameworks that place motor learning knowledge within a clinical context are a potential mediator to overcome this gap. PURPOSE This study aimed to conduct a scoping review of the literature to identify and describe the content of such conceptual frameworks in physical therapy/rehabilitation, including the approaches taken in their development and the "elements" or building blocks of motor learning-based interventions within each conceptual framework. DATA SOURCES The data sources used were PubMed, CINAHL, and PsychInfo databases. STUDY SELECTION Articles that were selected had a primary focus on motor learning and its application in physical therapy/rehabilitation and were published between 2000 and 2017. DATA EXTRACTION Twelve of 62 relevant articles met the inclusion criteria. DATA SYNTHESIS Papers attempted to translate theoretical knowledge into a coherent, clinically accessible conceptual framework via 3 main approaches: synthesizing selected motor learning elements into original new conceptual frameworks, mapping motor learning elements in current clinical practices, and assembling selected motor learning elements. The elements of motor learning that were common across papers included theoretical concepts (such as "meaningful goal setting" and "active involvement"); practice variables (including the type, frequency, and timing of feedback; the focus of instructions; task breakdown; and the amount, variability, and order of practice); and intervention strategies (task specific and mental practice). Psychological aspects related to self-efficacy and motivation were also considered integral. LIMITATIONS Papers published before the year 2000 were excluded. CONCLUSION The scoping review revealed that the presentation of motor learning elements in a coherent framework encompassed very diverse approaches and used different categorization systems. In addition, to fully grasp the complexity of clinical practice, motor learning should be coupled with other fields of knowledge.
Collapse
Affiliation(s)
- Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
| | - Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel
| |
Collapse
|
5
|
El Semary MM, Daker LI. Influence of percentage of body-weight support on gait in patients with traumatic incomplete spinal cord injury. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0076-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
6
|
Atun-Einy O, Kafri M. Physical therapists' perspectives of the construct of motor learning, and their motor learning-based practice: a qualitative study. Physiother Theory Pract 2019; 37:1377-1390. [PMID: 31742466 DOI: 10.1080/09593985.2019.1693676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: The perceptions and beliefs of physical therapists play an important role in their clinical behavior. These clinician-related aspects may contribute to the knowledge-action gap in the field of motor learning (ML). Accordingly, this study explored how a sample of physical therapists perceive ML in their practice.Methods: A qualitative phenomenological study was conducted. Twelve physical therapists with a wide range of work experience were purposefully selected. Data were collected through semi-structured interviews and analyzed using content analysis methodology. Themes and categories were identified.Results: We identified five key themes: 1) 'ML within the scope of PT' showed that participants perceived ML as a fundamental part of the profession; 2) 'Understanding of ML' showed that participants had difficulty understanding the field comprehensively; 3) 'Self-efficacy toward the topic of ML' revealed that participants had low self-efficacy about their knowledge of the topic; 4) 'Features of ML implementation' showed that physical therapists tended to implement ML intuitively; and 5) 'Barriers to implementation and ways to facilitate it' showed that lack of knowledge was perceived as a main barrier to implementation.Conclusions: Physical therapists' perceptions of and experiences with ML showed the complexity of the field and the lack of clarity regarding its theoretical content and clinical applications. There is a need to reinforce knowledge of ML among physical therapists at different levels of professional development and to promote self-efficacy toward its use, possibly by increasing ML knowledge and education while emphasizing its clinical context.
Collapse
Affiliation(s)
- Osnat Atun-Einy
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Michal Kafri
- Department of Physical Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| |
Collapse
|
7
|
Barela AMF, Gama GL, Russo-Junior DV, Celestino ML, Barela JA. Gait alterations during walking with partial body weight supported on a treadmill and over the ground. Sci Rep 2019; 9:8139. [PMID: 31148585 PMCID: PMC6544641 DOI: 10.1038/s41598-019-44652-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 05/21/2019] [Indexed: 11/29/2022] Open
Abstract
Understanding the changes induced by body weight support (BWS) systems when non-disabled adults walk can help develop appropriate rehabilitation protocols. The purpose of this study was to investigate spatial-temporal gait alterations during walking with BWS on a treadmill and over the ground. Fourteen non-disabled young adults (including seven women) walked over the ground and on a treadmill with 0%, 10%, and 20% of BWS at 80% of their self-selected comfortable walking speed (baseline). The stride length and speed, step length, and stance and double-limb support durations were calculated and compared among the different conditions. The non-disabled adults modulated their spatial-temporal gait parameters according to the surface and percentage of BWS. They walked with shorter and slower strides and shorter steps and spent more time in contact with the support surface as they walked on the treadmill than as they did over the ground. Walking on the treadmill promoted less variability and a higher rate of change than did walking over the ground. Both the surface and amount of BWS should be taken into consideration when using BWS systems for (re)learning and/or reestablishing gait.
Collapse
Affiliation(s)
- Ana Maria F Barela
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP, Brazil.
| | - Gabriela L Gama
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP, Brazil
| | - Douglas V Russo-Junior
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP, Brazil
| | - Melissa L Celestino
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Rua Galvão Bueno, 868, São Paulo, SP, Brazil
| | - José A Barela
- Department of Physical Education, Institute of Biosciences, São Paulo State University, Av. 24-A, 1515, Rio Claro, SP, Brazil
| |
Collapse
|
8
|
Ridao-Fernández C, Ojeda J, Chamorro-Moriana G. Analysis of Spatial and Temporal Step Parameters During Crutch-Assisted Gait as a Dual-Task: A Pilot Study. J Biomech Eng 2018; 140:2679582. [PMID: 30029235 DOI: 10.1115/1.4040020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Indexed: 11/08/2022]
Abstract
The main objective was to analyze the changes in the spatial and temporal step parameters during a dual-task: walking with a forearm crutch to partially unload the body weight of the subject. The secondary objective was to determine the influence of the use of the crutch with the dominant or nondominant hand in the essential gait parameters. Seven healthy subjects performed gait without crutches (GWC) and unilateral assisted gait (UAG) with the crutch carried out by dominant hand (dominant crutch (DC)) and nondominant hand (nondominant crutch (NDC)). Gait was recorded using a Vicon System; the GCH System 2.0 and the GCH Control Software 1.0 controlled the loads. The variables were step length, step period, velocity, step width, and step angle. The Wilcoxon signed-rank test compared GWC and UAG while also analyzing the parameters measured for both legs with DC and NDC in general and in each subject. Wilcoxon test only found significant differences in 1 of the 15 general comparisons between both legs. In the analysis by subject, step length, step period, and velocity showed significant differences between GWC and UAG. These parameters obtained less differences in DC. The effect of a forearm crutch on UAG caused a reduction in step length and velocity, and an increase in step period. However, it did not entail changes in step angle and step width. UAG was more effective when the DC carried the crutch. The unloading of 10% body weight produced an assisted gait which closely matched GWC.
Collapse
Affiliation(s)
- Carmen Ridao-Fernández
- Department of Physiotherapy, Research Group "Area of Physiotherapy CTS-305," University of Seville, Seville 41009, Spain e-mail:
| | - Joaquín Ojeda
- Department of Mechanical Engineering and Manufacture, Research Group "Mechanical Engineering," University of Seville, Seville 41092, Spain e-mail:
| | - Gema Chamorro-Moriana
- Department of Physiotherapy, Research Group "Area of Physiotherapy CTS-305," University of Seville, Seville 41009, Spain e-mail:
| |
Collapse
|
9
|
Liu W. A narrative review of gait training after stroke and a proposal for developing a novel gait training device that provides minimal assistance. Top Stroke Rehabil 2018; 25:375-383. [PMID: 29718796 DOI: 10.1080/10749357.2018.1466970] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Gait impairment is common in stroke survivors. Recovery of walking ability is one of the most pressing objectives in stroke rehabilitation. OBJECTIVES Of this report are to briefly review recent progress in gait training after stroke including the use of partial body weight-supported treadmill training (PBWSTT) and robot-assisted step training (RAST), and propose a minimal assistance strategy that may overcome some of limitations of current RAST. METHODS The literature review emphasizes a dilemma that recent randomized clinical trials did not support the use of RAST. The unsatisfactory results of current RAST clinical trials may be partially due to a lack of careful analysis of movement deficiencies and their relevance to gait training task specificity after stroke. Normal movement pattern is implied to be part of task specificity in the current RAST. Limitations of such task specificity are analyzed. RESULTS Based on the review, we redefine an alternative set of gait training task specificity that represents a minimal assistance strategy in terms of assisted body movements and amount of assistance. Specifically, assistances are applied only to hip flexion and ankle dorsiflexion of the affected lower limb during swing phase. Furthermore, we propose a conceptual design of a novel device that may overcome limitations of current RAST in gait training after stroke. The novel device uses a pulling cable, either manually operated by a therapist or automated by a servomotor, to provide assistive forces to help hip flexion and ankle dorsiflexion of the affected lower limb during gait training. CONCLUSION The proposed minimal assistance strategy may help to design better devices for gait or other motor training.
Collapse
Affiliation(s)
- Wen Liu
- a Department of Physical Therapy & Rehabilitation Science , University of Kansas Medical Center , Kansas City , KS , USA
| |
Collapse
|
10
|
Zamani H, Dadgoo M, Ebrahimi Takamjani I, Hajouj E, Jamshidi Khorneh AA. The Effects of Two Months Body Weight Supported Treadmill Training on Balance and Quality of Life of Patients With Incomplete Spinal Cord Injury. JOURNAL OF REHABILITATION 2018. [DOI: 10.21859/jrehab.18.4.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
11
|
Grobbelaar R, Venter R, Welman KE. Backward compared to forward over ground gait retraining have additional benefits for gait in individuals with mild to moderate Parkinson's disease: A randomized controlled trial. Gait Posture 2017; 58:294-299. [PMID: 28843186 DOI: 10.1016/j.gaitpost.2017.08.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 07/28/2017] [Accepted: 08/13/2017] [Indexed: 02/02/2023]
Abstract
Over ground gait retraining in the reverse direction has shown to be beneficial for neurological rehabilitation, but has not yet been investigated in Parkinson's disease (PD). Backwards walking (BW) might be a useful training alternative to improve PD gait and possibly reduce fall risk during complex multi-directional daily activities. The primary aim was to compare the effect of an eight-week forward (FWG) and backwards (BWG) gait retraining program on gait parameters in PD individuals. Twenty-nine participants (aged 71.0±8.8years; UPDRS-III 38.1±12.3; H&Y 2.7±0.5) were randomly assigned to either the control (FWG; n=14) or experimental group (BWG; n=15). Baseline measures included disease severity (UPDRS III), global cognition (MoCA) and depression (PHQ-9). Outcome measures were selected gait variables on the 10m-instrumented-walk-test (i10mWT) assessed before and after the interventions. Both groups improved usual gait speed (FWG: p=0.03, d=0.35; BWG: p<0.01, d=0.35) and height-normalized gait speed (FWG: p=0.04, d=0.35; BWG: p<0.01, d=0.57). Additionally, the BWG demonstrated improved cadence (p<0.01, d=0.67) and stride length (SL; p=0.02, d=0.39). Both interventions were effective to improved gait speed sufficiently to independently navigate in the community.
Collapse
Affiliation(s)
- Roné Grobbelaar
- Sport Science Department, Stellenbosch University, Stellenbosch, South Africa; Movement Laboratory, Stellenbosch University, Stellenbosch, South Africa.
| | - Ranel Venter
- Sport Science Department, Stellenbosch University, Stellenbosch, South Africa
| | - Karen Estelle Welman
- Sport Science Department, Stellenbosch University, Stellenbosch, South Africa; Movement Laboratory, Stellenbosch University, Stellenbosch, South Africa
| |
Collapse
|
12
|
Jeong YG, Koo JW. The effects of treadmill walking combined with obstacle-crossing on walking ability in ambulatory patients after stroke: a pilot randomized controlled trial. Top Stroke Rehabil 2016; 23:406-412. [DOI: 10.1080/10749357.2016.1168592] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
13
|
Kwon OH, Woo Y, Lee JS, Kim KH. Effects of task-oriented treadmill-walking training on walking ability of stoke patients. Top Stroke Rehabil 2015; 22:444-52. [DOI: 10.1179/1074935715z.00000000057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
14
|
DePaul VG, Wishart LR, Richardson J, Thabane L, Ma J, Lee TD. Varied Overground Walking Training Versus Body-Weight-Supported Treadmill Training in Adults Within 1 Year of Stroke. Neurorehabil Neural Repair 2014; 29:329-40. [DOI: 10.1177/1545968314546135] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Although task-related walking training has been recommended after stroke, the theoretical basis, content, and impact of interventions vary across the literature. There is a need for a comparison of different approaches to task-related walking training after stroke. Objective: To compare the impact of a motor-learning-science–based overground walking training program with body-weight-supported treadmill training (BWSTT) in ambulatory, community-dwelling adults within 1 year of stroke onset. Methods: In this rater-blinded, 1:1 parallel, randomized controlled trial, participants were stratified by baseline gait speed. Participants assigned to the Motor Learning Walking Program (MLWP) practiced various overground walking tasks under the supervision of 1 physiotherapist. Cognitive effort was encouraged through random practice and limited provision of feedback and guidance. The BWSTT program emphasized repetition of the normal gait cycle while supported on a treadmill and assisted by 1 to 3 therapy staff. The primary outcome was comfortable gait speed at postintervention assessment (T2). Results: In total, 71 individuals (mean age = 67.3; standard deviation = 11.6 years) with stroke (mean onset = 20.9 [14.1] weeks) were randomized (MLWP, n = 35; BWSTT, n = 36). There was no significant between-group difference in gait speed at T2 (0.002 m/s; 95% confidence interval [CI] = −0.11, 0.12; P > .05). The MLWP group improved by 0.14 m/s (95% CI = 0.09, 0.19), and the BWSTT group improved by 0.14 m/s (95% CI = 0.08, 0.20). Conclusions: In this sample of community-dwelling adults within 1 year of stroke, a 15-session program of varied overground walking-focused training was not superior to a BWSTT program of equal frequency, duration, and in-session step activity.
Collapse
Affiliation(s)
- Vincent G. DePaul
- McMaster University, Hamilton, ON, Canada
- St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- University Health Network, Toronto, ON, Canada
| | | | | | | | - Jinhui Ma
- McMaster University, Hamilton, ON, Canada
| | | |
Collapse
|
15
|
Abstract
BACKGROUND Treadmill training, with or without body weight support using a harness, is used in rehabilitation and might help to improve walking after stroke. This is an update of a Cochrane review first published in 2005. OBJECTIVES To determine if treadmill training and body weight support, individually or in combination, improve walking ability, quality of life, activities of daily living, dependency or death, and institutionalisation or death, compared with other physiotherapy gait training interventions after stroke. The secondary objective was to determine the safety and acceptability of this method of gait training. SEARCH METHODS We searched the Cochrane Stroke Group Trials Register (last searched June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Database of Reviews of Effects (DARE) (The Cochrane Library 2013, Issue 7), MEDLINE (1966 to July 2013), EMBASE (1980 to July 2013), CINAHL (1982 to June 2013), AMED (1985 to July 2013) and SPORTDiscus (1949 to June 2013). We also handsearched relevant conference proceedings and ongoing trials and research registers, screened reference lists and contacted trialists to identify further trials. SELECTION CRITERIA Randomised or quasi-randomised controlled and cross-over trials of treadmill training and body weight support, individually or in combination, for the treatment of walking after stroke. DATA COLLECTION AND ANALYSIS Two authors independently selected trials, extracted data and assessed methodological quality. The primary outcomes investigated were walking speed, endurance and dependency. MAIN RESULTS We included 44 trials with 2658 participants in this updated review. Overall, the use of treadmill training with body weight support did not increase the chances of walking independently compared with other physiotherapy interventions (risk difference (RD) -0.00, 95% confidence interval (CI) -0.02 to 0.02; P = 0.94; I² = 0%). Overall, the use of treadmill training with body weight support in walking rehabilitation for patients after stroke increased the walking velocity and walking endurance significantly. The pooled mean difference (MD) (random-effects model) for walking velocity was 0.07 m/s (95% CI 0.01 to 0.12; P = 0.02; I² = 57%) and the pooled MD for walking endurance was 26.35 metres (95% CI 2.51 to 50.19; P = 0.03; I² = 60%). Overall, the use of treadmill training with body weight support in walking rehabilitation for patients after stroke did not increase the walking velocity and walking endurance at the end of scheduled follow-up significantly. The pooled MD (random-effects model) for walking velocity was 0.04 m/s (95% CI -0.06 to 0.14; P = 0.40; I² = 40%) and the pooled MD for walking endurance was 32.36 metres (95% CI -3.10 to 67.81; P = 0.07; I² = 63%). However, for ambulatory patients improvements in walking endurance lasted until the end of scheduled follow-up (MD 58.88 metres, 95% CI 29.10 to 88.66; P = 0.0001; I² = 0%). Adverse events and drop outs did not occur more frequently in people receiving treadmill training and these were not judged to be clinically serious events. AUTHORS' CONCLUSIONS Overall, people after stroke who receive treadmill training with or without body weight support are not more likely to improve their ability to walk independently compared with people after stroke not receiving treadmill training, but walking speed and walking endurance may improve. Specifically, stroke patients who are able to walk (but not people who are not able to walk) appear to benefit most from this type of intervention. This review found that improvements in walking endurance in people able to walk may have persisting beneficial effects. Further research should specifically investigate the effects of different frequencies, durations or intensities (in terms of speed increments and inclination) of treadmill training, as well as the use of handrails, in ambulatory patients, but not in dependent walkers.
Collapse
Affiliation(s)
- Jan Mehrholz
- Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbHWissenschaftliches InstitutAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Marcus Pohl
- Klinik Bavaria KreischaAbteilung Neurologie und Fachübergreifende RehabilitationAn der Wolfsschlucht 1‐2KreischaGermany01731
| | - Bernhard Elsner
- Technical University DresdenDepartment of Public Health, Dresden Medical SchoolFetscherstr. 74DresdenGermany01307
| |
Collapse
|
16
|
Brach JS, Vanswearingen JM. Interventions to Improve Walking in Older Adults. CURRENT TRANSLATIONAL GERIATRICS AND EXPERIMENTAL GERONTOLOGY REPORTS 2013; 2:10.1007/s13670-013-0059-0. [PMID: 24319641 PMCID: PMC3851025 DOI: 10.1007/s13670-013-0059-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Interventions to improve walking in older adults have historically been multifactorial (i.e. strengthening, endurance and flexibility programs) focusing on improving the underlying impairments. These impairment-based programs have resulted in only modest improvements in walking. In older adults, walking is slow, less stable, inefficient, and the timing and coordination of stepping with postures and phases of gait is poor. We argue the timing and coordination problems are evidence of the loss of motor skill in walking. Taking a lesson from the sports world and from neurorehabilitation, task-oriented motor learning exercise is an essential component of training to improve motor skill and may be a beneficial approach to improving walking in older adults. In this article we: 1) briefly review the current literature regarding impairment-based interventions for improving mobility, 2) discuss why the results have been only modest, and 3) suggest an alternative approach to intervention (i.e. task oriented motor learning).
Collapse
|
17
|
Ada L, Dean CM, Lindley R. Randomized Trial of Treadmill Training to Improve Walking in Community-Dwelling People after Stroke: The AMBULATE Trial. Int J Stroke 2013; 8:436-44. [DOI: 10.1111/j.1747-4949.2012.00934.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Residual walking deficits are common in community-dwelling people after stroke. Aims The aim of this study was to determine if a four-month treadmill and overground walking program is more effective than a two-month program, compared with control, at improving walking in community-dwelling people with stroke who walk slowly. Method A three-arm randomized trial with concealed allocation, assessor blinding, and intention-to-treat analysis involving 102 people with stroke living in the community who walked slowly was undertaken. Experimental group 1 undertook 30 min of treadmill and overground walking thrice per week for four-months, experimental group 2 undertook training for two-months, while the control group had no intervention. The primary outcome was walking measured as the distance covered during the six-min walk test. Other outcomes were walking speed, step length and cadence, health status, community participation, self-efficacy and falls. Results By two-months, the experimental groups, who were both undergoing training, had improved their six-min walk distance compared with the control group. The four-month training group continued training beyond two-months and improved further so that by four months they walked 38 m (95% confidence interval 15–60) more than the control group and 29 m (95% confidence interval 4–53) more than the two-month training group. However, by 12 months, well after the cessation of training, both experimental groups had returned to near baseline levels, and there was no difference between the groups. Conclusion Four months of treadmill training results in better walking. However, these effects disappear once training ceases. Therefore, training should be ongoing.
Collapse
Affiliation(s)
- Louise Ada
- Department of Physiotherapy, The University of Sydney, Lidcombe, NSW, Australia
| | - Catherine M Dean
- Department of Physiotherapy, The University of Sydney, Lidcombe, NSW, Australia
- Department of Physiotherapy, Macquarie University, Sydney, NSW, Australia
| | - Richard Lindley
- Discipline of Medicine, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
18
|
Park IM, Lee YS, Moon BM, Sim SM. A Comparison of the Effects of Overground Gait Training and Treadmill Gait Training According to Stroke Patients’ Gait Velocity. J Phys Ther Sci 2013. [DOI: 10.1589/jpts.25.379] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- In-mo Park
- Major in Physical Therapy, Department of Public Health, The Graduate School of Konyang University
| | - Yeon-seop Lee
- Department of Physical Therapy, Konyang University: 158 Gwanjeodong-ro, Seo-gu, Daejeon, Republic of Korea
| | - Byeong-mu Moon
- Department of Rehabilitation Science, Graduate School, Daegu University
| | - Sun-mi Sim
- Department of Rehabilitation Center, Youseong Wellness Hospital
| |
Collapse
|
19
|
Abstract
OPINION STATEMENT Rehabilitation of walking after stroke has been investigated with a variety of interventions, which will be outlined in this review. To date, the majority of interventions have demonstrated a positive, but similar effect in the primary clinical outcome of self-selected walking speed. Consistent among the most successful interventions is a focus on the intensity of the intervention and the ability to progress rehabilitation in a structured fashion. Successful progression of rehabilitation of walking likely lies in the ability to combine interventions based on an understanding of contributing underlying deficits (eg, motor control, strength, cardiovascular endurance, and dynamic balance). Rehabilitation programs must account for the need to train dynamic balance for falls prevention. Lastly, clinicians and researchers need to measure the effects of rehabilitation on participation and health related quality of life.
Collapse
|
20
|
Tse T, Douglas J, Lentin P, Carey L. Measuring participation after stroke: a review of frequently used tools. Arch Phys Med Rehabil 2012; 94:177-92. [PMID: 22982555 DOI: 10.1016/j.apmr.2012.09.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/29/2012] [Accepted: 09/02/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify and critique the measures currently used to assess participation in clinical stroke studies. DATA SOURCES Relevant articles published between January 2001 and April 2012 identified through Medline, CINAHL, and ProQuest Central databases. STUDY SELECTION Published articles involving poststroke assessment of participation. Case studies, cohort studies, and randomized controlled trials were included. DATA EXTRACTION The most frequently used measures were identified and the psychometric properties evaluated. Three raters independently evaluated each measure relative to the first and second coding levels of the International Classification of Functioning, Disability and Health (ICF) Activities and Participation domain categories. DATA SYNTHESIS Thirty-six measures were identified. The Stroke Impact Scale (SIS), London Handicap Scale, Assessment of Life Habits (LIFE-H), Frenchay Activities Index, and Activity Card Sort (ACS) were used most frequently. No single measure met criteria across all psychometric indices, and not one covered all 9 of the ICF Activities and Participation domains. The SIS, LIFE-H, and ACS covered the widest range. The domains covered most frequently were Community, Social and Civic Life, Domestic Life, and Mobility. Learning and Applying Knowledge, General Tasks and Demands, and Communication were the domains less frequently covered. CONCLUSIONS This review identified and evaluated the most frequently used participation measures in clinical stroke studies. The SIS, LIFE-H, and ACS covered the ICF Activities and Participation domain categories most comprehensively. However, none of the measures covered all the ICF Activities and Participation domain categories. The information provided in this systematic review can be used to guide the selection of participation measures to meet specific clinical and research purposes.
Collapse
Affiliation(s)
- Tamara Tse
- The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, Stroke Division, Heidelberg, Victoria, Australia.
| | | | | | | |
Collapse
|
21
|
Lee Y, Kwon O, Seo D, Jung S, Lee K, Choi S, Lee S. Changes of Normal Adult Physiological States and Gait Parameters with Treadmill Inclined. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- YongWoo Lee
- Department of Physical Therapy, Sahmyook University
| | - OhSung Kwon
- Department of Physical Therapy, Sahmyook University
| | - DongKwon Seo
- Department of Physical Therapy, Sahmyook University
| | - SangWoo Jung
- Department of Physical Therapy, Sahmyook University
| | | | - Sejong Choi
- Department of Physical Therapy, Sahmyook University
| | - SeungWon Lee
- Department of Physical Therapy, Sahmyook University
| |
Collapse
|