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Hadouiri N, Fournel I, Thauvin-Robinet C, Jacquin-Piques A, Ornetti P, Gueugnon M. Walking test outcomes in adults with genetic neuromuscular diseases: a systematic literature review of their measurement properties. Eur J Phys Rehabil Med 2024; 60:257-269. [PMID: 38300152 PMCID: PMC11114158 DOI: 10.23736/s1973-9087.24.08095-x] [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: 06/16/2023] [Revised: 12/11/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Neuromuscular diseases (NMDs) include a large group of heterogeneous diseases. NMDs frequently involve gait disorders, which affect quality of life. Several walking tests and tools have been described in the literature, but there is no consensus regarding the use of walking tests and tools in NMDs or of their measurement properties for walking outcomes. The aim of this review is to present an overview of walking tests, including their measurement properties when used in adults with inherited or genetic NMDs. The aim is to help clinicians and researchers choose the most appropriate test for their objective. EVIDENCE ACQUISITION A systematic review was conducted after consulting MEDLINE (via PubMed), EMBASE, Science direct, Google Scholar and Cochrane Central Register of Controlled Trials databases for published studies in which walking outcome measurement properties were assessed. The validity, reliability, measurement error and responsiveness properties were evaluated in terms of statistical methods and methodological design qualities using the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. EVIDENCE SYNTHESIS We included 46 studies in NMDs. These studies included 15 different walking tests and a wide variety of walking outcomes, assessed with six types of walking tools. Overall, the 6MWT was the most studied test in terms of measurement properties. The methodological design and statistical methods of most studies evaluating construct validity, reliability and measurement error were "very good." The majority of outcome measurements were valid and reliable. However, studies on responsiveness as minimal important difference or minimal important change were lacking or were found to have inadequate methodological and statistical methods according to the COSMIN guidelines. CONCLUSIONS Most walking outcomes were found to be valid and reliable in NMDs. However, in view of the growing number of clinical trials, further studies are needed to clarify additional measurement properties.
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Affiliation(s)
- Nawale Hadouiri
- Department of Physical Medicine and Rehabilitation, Dijon-Bourgogne University Hospital, Dijon, France -
- UMR-Inserm 1231, Génétique des Anomalies du Développement (GAD), Bourgogne Franche-Comté University, Dijon, France -
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, Dijon, France -
| | - Isabelle Fournel
- Clinical Investigation Center, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Christel Thauvin-Robinet
- UMR-Inserm 1231, Génétique des Anomalies du Développement (GAD), Bourgogne Franche-Comté University, Dijon, France
- Fédération Hospitalo-Universitaire Médecine Translationnelle et Anomalies du Développement (TRANSLAD), CHU Dijon Bourgogne, Dijon, France
- Centre de Référence Maladies Rares "Maladies neurogénétiques", CHU Dijon Bourgogne, Dijon, France
| | - Agnès Jacquin-Piques
- Centre de Compétences Maladies Rares "Maladies neuromusculaires", Department of Neurology, Dijon University Hospital, Dijon, France
| | - Paul Ornetti
- Department of Rheumatology, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM, UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France
| | - Mathieu Gueugnon
- INSERM, CIC 1432, Clinical Investigation Center, Plurithematic Module, Technological Investigation Platform, Dijon-Bourgogne University Hospital, Dijon, France
- INSERM, UMR1093-CAPS, Bourgogne Franche-Comté University, Dijon, France
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Buurke TJW, van de Venis L, Keijsers N, Nonnekes J. The effect of walking with reduced trunk motion on dynamic stability in healthy adults. Gait Posture 2023; 103:113-118. [PMID: 37156163 DOI: 10.1016/j.gaitpost.2023.05.004] [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: 11/03/2022] [Revised: 01/13/2023] [Accepted: 05/03/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Most people with Parkinson's disease (PD) walk with a smaller mediolateral base of support (BoS) compared to healthy people, but the underlying mechanisms remain unknown. Reduced trunk motion in people with PD might be related to this narrow-based gait. Here, we study the relationship between trunk motion and narrow-based gait in healthy adults. According to the extrapolated center of mass (XCoM) concept, a decrease in mediolateral XCoM excursion would require a smaller mediolateral BoS to maintain a constant margin of stability (MoS) and remain stable. RESEARCH QUESTION As proof of principle, we assessed whether walking with reduced trunk motion results in a smaller step width in healthy adults, without altering the mediolateral MoS. METHODS Fifteen healthy adults walked on a treadmill at preferred comfortable walking speed in two conditions. First, the 'regular walking' condition without any instructions, and second, the 'reduced trunk motion' condition with the instruction: 'Keep your trunk as still as possible'. Treadmill speed was kept the same in the two conditions. Trunk kinematics, step width, mediolateral XCoM excursion and mediolateral MoS were calculated and compared between the two conditions. RESULTS Walking with the instruction to keep the trunk still significantly reduced trunk kinematics. Walking with reduced trunk motion resulted in significant decreases in step width and mediolateral XCoM excursion, but not in the mediolateral MoS. Furthermore, step width and mediolateral XCoM excursion were strongly correlated during both conditions (r = 0.887 and r = 0.934). SIGNIFICANCE This study shows that walking with reduced trunk motion leads to a gait pattern with a smaller BoS in healthy adults, without altering the mediolateral MoS. Our findings indicate a strong coupling between CoM motion state and the mediolateral BoS. We expect that people with PD who walk narrow-based, have a similar mediolateral MoS as healthy people, which will be further investigated.
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Affiliation(s)
- Tom J W Buurke
- University of Groningen, University Medical Center Groningen, Department of Human Movement Sciences, Groningen, the Netherlands; KU Leuven, Department of Movement Sciences, Leuven, Belgium.
| | - Lotte van de Venis
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Noël Keijsers
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, The Netherlands; Sint Maartenskliniek, Department of Research, Nijmegen, the Netherlands; Radboud University, Donders Institute for Brain, Cognition and Behaviour, Department of Sensorimotor Neuroscience, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Center of Expertise for Parkinson & Movement Disorders, Department of Rehabilitation, Nijmegen, The Netherlands; Sint Maartenskliniek, Department of Research, Nijmegen, the Netherlands
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The Immediate Effect of Exercising in a Virtual Reality Treadmill (C-Mill) on Skin Temperature of a Man with Lower Limb Amputation. Case Rep Vasc Med 2023. [DOI: 10.1155/2023/7081000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background. In amputees, exercising can impact the distribution of body temperature. The aim of this case report is to verify the acute effect of exercising in C-Mill on the temperature distribution in the lower limbs of a man with unilateral transfemoral amputation. Materials and Methods. The thigh and legs of a man with left distal transfemoral amputation were evaluated by thermography (infrared sensor FLIR T650sc) before and after a single 30-minute exercise session performed in a virtual reality treadmill device (C-Mill). Results. The thermographic evaluation showed a difference in temperature between the thighs both before and after the intervention. However, there was a decrease in asymmetry, which went from 4.0°C to 3.1°C in the anterior view and from 5.3°C to 2.9°C in the posterior view, after the intervention. Conclusion. Thermography allowed us to assess the difference in temperature in the lower limbs. Even though the temperature discrepancy has decreased after the single exercise session using the C-Mill, this difference persisted.
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van de Venis L, van de Warrenburg B, Weerdesteyn V, Geurts ACH, Nonnekes J. Gait-Adaptability Training in People With Hereditary Spastic Paraplegia: A Randomized Clinical Trial. Neurorehabil Neural Repair 2023; 37:27-36. [PMID: 36695288 PMCID: PMC9896539 DOI: 10.1177/15459683221147839] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND OBJECTIVES In people with hereditary spastic paraplegia (HSP), reduced gait adaptability is common and disabling. Gait impairments result from lower extremity spasticity, muscle weakness, and impaired proprioception. The aim of this study was to assess the efficacy of a 5-week gait-adaptability training in people with pure HSP. METHOD We conducted a randomized clinical trial with a cross-over design for the control group, and a 15-week follow-up period after training. Thirty-six people with pure HSP were randomized to 5 weeks of (i) gait-adaptability training (10 hours of C-Mill training-a treadmill equipped with augmented reality) or (ii) a waiting-list control period followed by 5 weeks gait-adaptability training. Both groups continued to receive usual care. The primary outcome was the obstacle subtask of the Emory Functional Ambulation Profile. Secondary outcome measures consisted of clinical balance and gait assessments, fall rates, and spatiotemporal gait parameters assessed via 3D motion analysis. RESULTS The gait-adaptability training group (n = 18) did not significantly decrease the time required to perform the obstacle subtask compared to the waiting-list control group (n = 18) after adjusting for baseline differences (mean: -0.33 seconds, 95% CI: -1.3, 0.6). Similar, non-significant results were found for most secondary outcomes. After merging both groups (n = 36), the required time to perform the obstacle subtask significantly decreased by 1.3 seconds (95% CI: -2.1, -0.4) directly following 5 weeks of gait-adaptability training, and this effect was retained at the 15-week follow-up. CONCLUSIONS We found insufficient evidence to conclude that 5 weeks of gait-adaptability training leads to greater improvement of gait adaptability in people with pure HSP.
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Affiliation(s)
- Lotte van de Venis
- Department of Rehabilitation, Center of
Expertise for Rare and Genetic Movement Disorders, Donders Institute for Brain,
Cognition and Behavior, Radboud University Medical Center, Nijmegen, The
Netherlands,Lotte van de Venis, Radboud University
Medical Center, PO Box 9101, Reinier Postlaan 4, 6500 HB Nijmegen, The
Netherlands.
| | - Bart van de Warrenburg
- Department of Neurology, Center of
Expertise for Rare and Genetic Movement Disorders, Donders Institute for Brain,
Cognition and Behavior, Radboud University Medical Center, Nijmegen, The
Netherlands
| | - Vivian Weerdesteyn
- Department of Rehabilitation, Center of
Expertise for Rare and Genetic Movement Disorders, Donders Institute for Brain,
Cognition and Behavior, Radboud University Medical Center, Nijmegen, The
Netherlands,Research, Sint Maartenskliniek,
Nijmegen, The Netherlands
| | - Alexander C. H. Geurts
- Department of Rehabilitation, Center of
Expertise for Rare and Genetic Movement Disorders, Donders Institute for Brain,
Cognition and Behavior, Radboud University Medical Center, Nijmegen, The
Netherlands,Department of Rehabilitation, Sint
Maartenskliniek, Nijmegen, The Netherlands
| | - Jorik Nonnekes
- Department of Rehabilitation, Center of
Expertise for Rare and Genetic Movement Disorders, Donders Institute for Brain,
Cognition and Behavior, Radboud University Medical Center, Nijmegen, The
Netherlands,Department of Rehabilitation, Sint
Maartenskliniek, Nijmegen, The Netherlands
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Vinolo Gil MJ, Gonzalez-Medina G, Lucena-Anton D, Perez-Cabezas V, Ruiz-Molinero MDC, Martín-Valero R. Augmented Reality in Physical Therapy: Systematic Review and Meta-analysis. JMIR Serious Games 2021; 9:e30985. [PMID: 34914611 PMCID: PMC8717132 DOI: 10.2196/30985] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/11/2021] [Accepted: 09/24/2021] [Indexed: 01/26/2023] Open
Abstract
Background Augmented reality (AR) is a rapidly expanding technology; it comprises the generation of new images from digital information in the real physical environment of a person, which simulates an environment where the artificial and real are mixed. The use of AR in physiotherapy has shown benefits in certain areas of patient health. However, these benefits have not been studied as a whole. Objective This study aims to ascertain the current scientific evidence on AR therapy as a complement to physiotherapy and to determine the areas in which it has been used the most and which variables and methods have been most effective. Methods A systematic review registered in PROSPERO (International Prospective Register of Systematic Reviews) was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) recommendations. The search was conducted from July to August 2021 in the PubMed, PEDro, Web of Science, Scopus, and Cochrane Library scientific databases using the keywords augmented reality, physiotherapy, physical therapy, exercise therapy, rehabilitation, physical medicine, fitness, and occupational therapy. The methodological quality was evaluated using the PEDro scale and the Scottish Intercollegiate Guidelines Network scale to determine the degree of recommendation. The Cochrane Collaboration tool was used to evaluate the risk of bias. Results In total, 11 articles were included in the systematic review. Of the 11 articles, 4 (36%) contributed information to the meta-analysis. Overall, 64% (7/11) obtained a good level of evidence, and most had a B degree of recommendation of evidence. A total of 308 participants were analyzed. Favorable results were found for the Berg Balance Scale (standardized mean change 0.473, 95% CI −0.0877 to 1.0338; z=1.65; P=.10) and the Timed Up and Go test (standardized mean change −1.211, 95% CI −3.2005 to 0.7768; z=−1.194; P=.23). Conclusions AR, in combination with conventional therapy, has been used for the treatment of balance and fall prevention in geriatrics, lower and upper limb functionality in stroke, pain in phantom pain syndrome, and turning in place in patients with Parkinson disease with freezing of gait. AR is effective for the improvement of balance; however, given the small size of the samples and the high heterogeneity of the studies, the results were not conclusive. Future studies using larger sample sizes and with greater homogeneity in terms of the devices used and the frequency and intensity of the interventions are needed. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020180766; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=180766
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Affiliation(s)
- Maria Jesus Vinolo Gil
- Department of Nursing and Physical Therapy, University of Cadiz, Cadiz, Spain.,Clinical Management Unit Rehabilitation Intercentre-Interlevel, University Hospitals of Puerto Real and Cadiz, Cadiz Bay-La Janda Health District, Cadiz, Spain.,Institute for Biomedical Research and Innovation of Cádiz, Cadiz, Spain
| | - Gloria Gonzalez-Medina
- Department of Nursing and Physical Therapy, University of Cadiz, Cadiz, Spain.,Institute for Biomedical Research and Innovation of Cádiz, Cadiz, Spain
| | - David Lucena-Anton
- Department of Nursing and Physical Therapy, University of Cadiz, Cadiz, Spain
| | | | - María Del Carmen Ruiz-Molinero
- Department of Nursing and Physical Therapy, University of Cadiz, Cadiz, Spain.,Institute for Biomedical Research and Innovation of Cádiz, Cadiz, Spain
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