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Gordon KE, Dusane S, Kahn JH, Shafer A, Brazg G, Henderson H, Kim KYA. Amplify Gait to Improve Locomotor Engagement in Spinal Cord Injury (AGILE SCI) trial: study protocol for an assessor blinded randomized controlled trial. BMC Neurol 2024; 24:271. [PMID: 39097695 PMCID: PMC11297765 DOI: 10.1186/s12883-024-03757-2] [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: 07/01/2024] [Accepted: 07/11/2024] [Indexed: 08/05/2024] Open
Abstract
BACKGROUND Among ambulatory people with incomplete spinal cord injury (iSCI), balance deficits are a primary factor limiting participation in walking activities. There is broad recognition that effective interventions are needed to enhance walking balance following iSCI. Interventions that amplify self-generated movements (e.g., error augmentation) can accelerate motor learning by intensifying sensorimotor feedback and facilitating exploration of motor control strategies. These features may be beneficial for retraining walking balance after iSCI. We have developed a cable-driven robot that creates a movement amplification environment during treadmill walking. The robot applies a continuous, laterally-directed, force to the pelvis that is proportional in magnitude to real-time lateral velocity. Our purpose is to investigate the effects of locomotor training in this movement amplification environment on walking balance. We hypothesize that for ambulatory people with iSCI, locomotor training in a movement amplification environment will be more effective for improving walking balance and participation in walking activities than locomotor training in a natural environment (no applied external forces). METHODS We are conducting a two-arm parallel-assignment intervention. We will enroll 36 ambulatory participants with chronic iSCI. Participants will be randomized into either a control or experimental group. Each group will receive 20 locomotor training sessions. Training will be performed in either a traditional treadmill environment (control) or in a movement amplification environment (experimental). We will assess changes using measures that span the International Classification of Functioning, Disability and Health (ICF) framework including 1) clinical outcome measures of gait, balance, and quality of life, 2) biomechanical assessments of walking balance, and 3) participation in walking activities quantified by number of steps taken per day. DISCUSSION Training walking balance in people with iSCI by amplifying the individual's own movement during walking is a radical departure from current practice and may result in new strategies for addressing balance impairments. Knowledge gained from this study will expand our understanding of how people with iSCI improve walking balance and how an intervention targeting walking balance affects participation in walking activities. Successful outcomes could motivate development of clinically feasible tools to replicate the movement amplification environment within clinical settings. TRIAL REGISTRATION NCT04340063.
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Affiliation(s)
- Keith E Gordon
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA.
- Research Service, Edward Hines Jr. VA Hospital, Hines, IL, 60141, USA.
| | - Shamali Dusane
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Jennifer H Kahn
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Anna Shafer
- Research Service, Edward Hines Jr. VA Hospital, Hines, IL, 60141, USA
| | | | - Heather Henderson
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Kwang-Youn A Kim
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, IL, 60611, USA
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Shafi H, Awan WA, Olsen S, Siddiqi FA, Tassadaq N, Rashid U, Niazi IK. Assessing Gait & Balance in Adults with Mild Balance Impairment: G&B App Reliability and Validity. SENSORS (BASEL, SWITZERLAND) 2023; 23:9718. [PMID: 38139564 PMCID: PMC10747653 DOI: 10.3390/s23249718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/24/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023]
Abstract
Smartphone applications (apps) that utilize embedded inertial sensors have the potential to provide valid and reliable estimations of different balance and gait parameters in older adults with mild balance impairment. This study aimed to assess the reliability, validity, and sensitivity of the Gait&Balance smartphone application (G&B App) for measuring gait and balance in a sample of middle- to older-aged adults with mild balance impairment in Pakistan. Community-dwelling adults over 50 years of age (N = 83, 50 female, range 50-75 years) with a Berg Balance Scale (BBS) score between 46/56 and 54/56 were included in the study. Data collection involved securing a smartphone to the participant's lumbosacral spine. Participants performed six standardized balance tasks, including four quiet stance tasks and two gait tasks (walking looking straight ahead and walking with head turns). The G&B App collected accelerometry data during these tasks, and the tasks were repeated twice to assess test-retest reliability. The tasks in quiet stance were also recorded with a force plate, a gold-standard technology for measuring postural sway. Additionally, participants completed three clinical measures, the BBS, the Functional Reach Test (FRT), and the Timed Up and Go Test (TUG). Test-retest reliability within the same session was determined using intraclass correlation coefficients (ICCs) and the standard error of measurement (SEM). Validity was evaluated by correlating the G&B App outcomes against both the force plate data and the clinical measures using Pearson's product-moment correlation coefficients. To assess the G&B App's sensitivity to differences in balance across tasks and repetitions, one-way repeated measures analyses of variance (ANOVAs) were conducted. During quiet stance, the app demonstrated moderate reliability for steadiness on firm (ICC = 0.72) and compliant surfaces (ICC = 0.75) with eyes closed. For gait tasks, the G&B App indicated moderate to excellent reliability when walking looking straight ahead for gait symmetry (ICC = 0.65), walking speed (ICC = 0.93), step length (ICC = 0.94), and step time (ICC = 0.84). The TUG correlated with app measures under both gait conditions for walking speed (r -0.70 and 0.67), step length (r -0.56 and -0.58), and step time (r 0.58 and 0.50). The BBS correlated with app measures of walking speed under both gait conditions (r 0.55 and 0.51) and step length when walking with head turns (r = 0.53). Force plate measures of total distance wandered showed adequate to excellent correlations with G&B App measures of steadiness. Notably, G&B App measures of walking speed, gait symmetry, step length, and step time, were sensitive to detecting differences in performance between standard walking and the more difficult task of walking with head turns. This study demonstrates the G&B App's potential as a reliable and valid tool for assessing some gait and balance parameters in middle-to-older age adults, with promise for application in low-income countries like Pakistan. The app's accessibility and accuracy could enhance healthcare services and support preventive measures related to fall risk.
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Affiliation(s)
- Hina Shafi
- Riphah College of Rehabilitation & Allied Health Sciences, Riphah International University, Islamabad 46000, Pakistan
- Foundation Institute of Rehabilitation Sciences, Foundation University, Islamabad 44000, Pakistan
| | - Waqar Ahmed Awan
- Riphah College of Rehabilitation & Allied Health Sciences, Riphah International University, Islamabad 46000, Pakistan
| | - Sharon Olsen
- Health & Rehabilitation Research Institute, Faculty of Health & Environmental Sciences, AUT University, Auckland 1010, New Zealand
| | - Furqan Ahmed Siddiqi
- Foundation Institute of Rehabilitation Sciences, Foundation University, Islamabad 44000, Pakistan
| | - Naureen Tassadaq
- Foundation Institute of Rehabilitation Sciences, Foundation University, Islamabad 44000, Pakistan
| | - Usman Rashid
- Health & Rehabilitation Research Institute, Faculty of Health & Environmental Sciences, AUT University, Auckland 1010, New Zealand
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
| | - Imran Khan Niazi
- Health & Rehabilitation Research Institute, Faculty of Health & Environmental Sciences, AUT University, Auckland 1010, New Zealand
- Centre for Chiropractic Research, New Zealand College of Chiropractic, Auckland 1060, New Zealand
- Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
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Dusane S, Shafer A, Ochs WL, Cornwell T, Henderson H, Kim KYA, Gordon KE. Control of center of mass motion during walking correlates with gait and balance in people with incomplete spinal cord injury. Front Neurol 2023; 14:1146094. [PMID: 37325225 PMCID: PMC10262050 DOI: 10.3389/fneur.2023.1146094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Background There is evidence that ambulatory people with incomplete spinal cord injury (iSCI) have an impaired ability to control lateral motion of their whole-body center of mass (COM) during walking. This impairment is believed to contribute to functional deficits in gait and balance, however that relationship is unclear. Thus, this cross-sectional study examines the relationship between the ability to control lateral COM motion during walking and functional measures of gait and balance in people with iSCI. Methods We assessed the ability to control lateral COM motion during walking and conducted clinical gait and balance outcome measures on 20 ambulatory adults with chronic iSCI (C1-T10 injury, American Spinal Injury Association Impairment Scale C or D). To assess their ability to control lateral COM motion, participants performed three treadmill walking trials. During each trial, real-time lateral COM position and a target lane were projected on the treadmill. Participants were instructed to keep their lateral COM position within the lane. If successful, an automated control algorithm progressively reduced the lane width, making the task more challenging. If unsuccessful, the lane width increased. The adaptive lane width was designed to challenge each participant's maximum capacity to control lateral COM motion during walking. To quantify control of lateral COM motion, we calculated lateral COM excursion during each gait cycle and then identified the minimum lateral COM excursion occurring during five consecutive gait cycles. Our clinical outcome measures were Berg Balance Scale (BBS), Timed Up and Go test (TUG), 10-Meter Walk Test (10MWT) and Functional Gait Assessment (FGA). We used a Spearman correlation analysis (ρ) to examine the relationship between minimum lateral COM excursion and clinical measures. Results Minimum lateral COM excursion had significant moderate correlations with BBS (ρ = -0.54, p = 0.014), TUG (ρ = 0.59, p = 0.007), FGA (ρ = -0.59, p = 0.007), 10MWT-preferred (ρ = -0.59, p = 0.006) and 10MWT-fast (ρ = -0.68, p = 0.001). Conclusion Control of lateral COM motion during walking is associated with a wide range of clinical gait and balance measures in people with iSCI. This finding suggests the ability to control lateral COM motion during walking could be a contributing factor to gait and balance in people with iSCI.
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Affiliation(s)
- Shamali Dusane
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Anna Shafer
- Edward Hines Jr. VA Hospital, Hines, IL, United States
| | - Wendy L. Ochs
- Edward Hines Jr. VA Hospital, Hines, IL, United States
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, United States
| | - Tara Cornwell
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Heather Henderson
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kwang-Youn A. Kim
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Keith E. Gordon
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Edward Hines Jr. VA Hospital, Hines, IL, United States
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Olsen S, Rashid U, Allerby C, Brown E, Leyser M, McDonnell G, Alder G, Barbado D, Shaikh N, Lord S, Niazi IK, Taylor D. Smartphone-based gait and balance accelerometry is sensitive to age and correlates with clinical and kinematic data. Gait Posture 2023; 100:57-64. [PMID: 36481647 DOI: 10.1016/j.gaitpost.2022.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Gait&Balance (G&B) App has produced valid and reliable measures of gait and balance in young healthy adults but has not been tested in older adults. RESEARCH QUESTION In healthy middle-to-older aged adults, are G&B App measurements sensitive to age, valid against clinical and kinematic measures, and reliable? METHOD Healthy participants (n = 34, 14 male, 42-94 years) completed the G&B App protocol three times within a single session. 3D kinematics were collected concurrently. Clinical balance measures were collected (Modified Clinical Test of Sensory Interaction in Balance (mCTSIB), Mini Balance Evaluation Systems Test (MBT), and Functional Gait Assessment (FGA)). Sensitivity to age was assessed with Pearson's correlations. Validity tests included Pearson's correlations and Bland-Altman limits of agreement. Reliability tests included intra-class correlation coefficients and standard error of the measure. RESULTS During quiet stance on a compliant surface, the G&B App was sensitive to age-related differences not detectable with the mCTSIB. During walking tasks, there was adequate convergent validity between the MBT and G&B App measures of step length, and between the FGA and G&B App measures of walking speed, step length, and periodicity. The G&B App had moderate-to-excellent validity against 3D kinematics for postural stability during quiet stance (r 0.98 [0.98, 0.99]), step time (r 0.97 [0.96, 0.98]), walking speed (r 0.79 [0.7, 0.86]), and step length (r 0.73 [0.61, 0.81]). Test-retest reliability was moderate-to-excellent for G&B App measures of postural stability, walking speed, periodicity, step length, and step time. G&B App measures of step length asymmetry, step length variability, step time asymmetry, and step time variability had poor validity and reliability. SIGNIFICANCE The G&B App was sensitive to age-related differences in balance not detectable with clinical measurement. It provides valid and reliable measures of postural stability, step length, step time, and periodicity, which are not currently available in standard practice.
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Affiliation(s)
- Sharon Olsen
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; Centre for Chiropractic Research, New Zealand College of Chiropractic, PO Box 113-044, Newmarket, Auckland 1149, New Zealand
| | - Celia Allerby
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Eliza Brown
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Michaela Leyser
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Gabrielle McDonnell
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Gemma Alder
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - David Barbado
- Department of Sport Science, Sports Research Centre, Miguel Hernandez University of Elche, Avda. de la Universidad s/n, Elche 03202, Spain; Institute for Health and Biomedical Research (ISABIAL Foundation), Avda. Pintor Baeza, 12 HGUA, Alicante 03550, Spain
| | - Nusratnaaz Shaikh
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Sue Lord
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Imran Khan Niazi
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; Centre for Chiropractic Research, New Zealand College of Chiropractic, PO Box 113-044, Newmarket, Auckland 1149, New Zealand; Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Denise Taylor
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
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