Association between nutritional status and gait performance in Alzheimer's disease

AIMS

This study aimed to comprehensively explore the nutrition and gait of AD patients at different stages and the relationship between them.

METHODS

A total of 85 AD patients were consecutively enrolled in this cross-sectional study and divided into the mild cognitive impairment (MCI) due to AD (AD-MCI) and the dementia due to AD (AD-D) groups. Demographic information, nutritional status, and gait performance were compared between the two groups, and the correlation between nutritional status and gait performance was subsequently analyzed by Pearson and Spearman correlation analyses.

RESULTS

The AD-D group had lower scores on Mini-Nutritional Assessment (MNA) and MNAm scales, lower levels of urea nitrogen, folic acid, and vitamin B12 in blood, and higher homocysteine level than those in the AD-MCI group (all p < 0.05). The AD-D group had slower step speed, shorter step length, and shorter stride length than those in the AD-MCI group (all p < 0.05). AD patients with decreased scores of MNA and MNAm scales, and declined levels of urea nitrogen and vitamin B12 in blood had reduced gait speed and gait cadence, and prolonged step length time and stride length time, whereas homocysteine showed the almost opposite results (all p < 0.05). In the AD-MCI group, the score of scale was negatively correlated with the coefficient of variation (CV) of stride length, and the folic acid level was negatively correlated with the CV of stride length and cadence (all p < 0.05).

CONCLUSIONS

AD patients at the dementia stage had worse nutritional status and gait performance than those at the MCI stage, which was associated with worse global cognition and activities of daily living. Poorer nutritional status was associated with higher gait variability in patients at the MCI stage and with poorer gait performance in patients at the dementia stage. Early identification and intervention of patients with nutritional risk or malnutrition may improve gait performance, thus reducing the risk of falling and cognitive decline, as well as the mortality.

Determination of breeding criteria for gait proficiency in leisure riding and racing dromedary camels: a stepwise multivariate analysis of factors predicting overall biomechanical performance

To date, the biomechanical dynamics in camelids have not been addressed, although it might be a factor that can affect selection and breeding in this species. Therefore, the aim of this article is to conduct curve fitting and discriminant canonical analysis to identify the mathematical function that best captures the dynamics of camel locomotion and to study the impact of kinematic, morphometric, physiological, and phaneroptic variables on gait performance in leisure riding and racing activities in dromedaries, respectively. The cubic function emerged as the most suitable mathematical model to represent the locomotive behavior of camels. Various factors were found to play a pivotal role in the athletic performance of leisure riding and racing dromedary camels. Concretely, angular measurements at the distal fore and rear extremity areas, pelvis inclination, relative volume of the hump, impact forces of the front limbs, post-neutering effects, and the kinematic behavior of the scapula, shoulder, carpus, hip, and foot are the factors that greatly impact gait performance in leisure riding and racing camels. The biomechanical performance at these specific body regions has a profound impact on weight absorption and minimization of mechanic impact during camel locomotion, static/dynamic balance, force distribution, energy of propulsion, movement direction and amplitude, and storage of elastic strain in leisure riding and racing dromedaries. In contrast, other animal- and environment-dependent factors do not exert significant influence on camel gait performance, which can be attributed to species-specific, inherited adaptations developed in response to desert conditions, including the pacing gait, broad foot pads, and energy-efficient movements. The outcomes of our functional data analysis can provide valuable insights for making informed breeding decisions aimed at enhancing animal functional performance in camel riding and racing activities. Furthermore, these findings can open avenues for exploring alternative applications, such as camel-assisted therapy.

The Effectiveness of a Single Dry Needling Session on Gait and Quality of Life in Multiple Sclerosis: A Double-Blind Randomized Sham-Controlled Pilot Trial

INTRODUCTION

Gait disorders are a major cause of disability and reduced health-related quality of life in people with multiple sclerosis (pwMS). Dry needling (DN) has demonstrated positive results to improve gait parameters in patients with stroke. The main aim of this study was to evaluate the effect of a single session of DN in the gait performance of pwMS.

METHODS

A double-blind parallel randomized sham-controlled pilot trial was conducted. Study participants received a single session of active DN or sham DN in the gastrocnemius medialis muscle. Pre-treatment and immediately post-treatment measurements were taken, as well as at one and four weeks after the intervention. Outcomes related to gait performance (Timed 25-Foot Walk), self-perceived walking capacity (Multiple Sclerosis Walking Scale), risk of falls (Timed Up and Go test), disability level (Expanded Disability Status Score) and quality of life (Multiple Sclerosis Quality of Life-54 questionnaire and Analogic Quality of Life scale) were evaluated.

RESULTS

18 patients who had multiple sclerosis participated in the study. The group who received active DN showed within-group significant statistical differences immediately after treatment for gait performance (p = 0.008) and risk of falls (p = 0.008), as well as for self-perceived walking capacity at one week (p = 0.017) and four weeks (p = 0.011) and quality of life at four weeks (p = 0.014). Regarding the comparison between groups, only significant results were obtained in the physical domain of the quality of life at four weeks (p = 0.014).

CONCLUSIONS

DN seems to be a promising therapeutic tool for the treatment of gait disorders in pwMS. However, when results were compared with sham DN, no differences were found.

Effects of cross-training on motor function and length of stay after total hip arthroplasty: A randomized controlled trial

BACKGROUND

There is no consensus about which training methods will give better early outcomes after total hip arthroplasty (THA).

OBJECTIVE

To investigate the short-term effects of cross trainer exercise on physical function and walking ability following THA.

METHODS

Fifty patients who underwent THA were randomly allocated into two groups. The intervention program was started 3 days after surgery. The main physical function results were pain, hip range of motion, knee extensor strength, single-leg stance time, and walking performance test. In addition, the number of days of requiring to walk and the length of hospital stay were recorded.

RESULTS

In the comparison between groups at discharge, the patients in the cross trainer group had significantly less hip pain while walking, improvement in knee extensor strength, increased single-leg stance time, as well as increased walking speed and stride length at discharge. The number of days required to walk and length of stay were also significantly lower in the intervention group.

CONCLUSIONS

Conclusions: Cross trainer exercise commencing 3 days postoperatively improves physical function and walking ability after THA.

Effectiveness of the Pelvic Clock and Static Bicycle Exercises on Wisconsin Gait Scale and Trunk Impairment Scale in Chronic Ambulatory Hemiplegic Patients: A Single Group Pre-Post Design

BACKGROUND

Most Hemiplegic patients achieve ambulatory function during the sub-acute stage of stroke. Though ambulatory, they still perform an unpleasant awkward gait with remarkable compensations requiring more energy expenditure. Fatigue arises at an early duration as a result of increased energy expenditure. The walking pattern becomes circumduction, featured by asymmetry with an extensor synergy of the lower limb. Each step is rotated away from the body then towards the body, forming a semicircle. This leads to changes in various parameters of gait (spatiotemporal, kinematic, and kinetic) in hemiparetic patients.

PURPOSE

Many studies reveal the effectiveness of various therapeutic techniques in managing hemiplegic circumduction gait. Pelvic clock exercises aid in improving pelvic rotation components and cause dissociation in impaired pelvic mobility due to spasticity. A static bicycle helps in enhancing proper control between the hamstrings and quadriceps. It also helps in improving knee flexion range. As the patient places the foot in the cycle's petals, it helps to enhance dorsiflexion and eversion functions as well. As the lower body is exercised, there could be relative changes in the upper body, i.e., the trunk. Thus, this study aimed to determine the changes in gait functions and trunk performance of chronic ambulatory hemiplegic patients in response to the above therapies for four weeks.

METHOD

Twenty-five subjects (post-stroke duration (2.8 ± 0.6) years) who could walk 10 m independently without assistance or support of aid participated in a pelvic clock and static bicycle exercise intervention. The session duration was 30 min a day, and therapy was delivered six days a week and continued for four weeks. The entire program was carried out in an outpatient neurorehabilitation center.

RESULTS

After the intervention with pelvic clock and static bicycle exercises, there was a remarkable change in gait and trunk functions in chronic hemiplegic patients.

CONCLUSION

The exercises comprising pelvic clock and static bicycle showed positive differences in gait and trunk functions in chronic stage hemiplegic patients. Later, randomized controlled studies involving larger sample sizes, advanced activation techniques, and increased intervention duration will explore in-depth information on their effectiveness and clinical significance.

Association Between Cancer-Related Fatigue and Falls in Patients With Myeloproliferative Neoplasms: Results of a Multicenter Cross-Sectional Survey From the East German Study Group for Hematology and Oncology (OSHO #97)

OBJECTIVE

This study retrospectively examined the association between cancer-related fatigue (CrF) and the number of falls during the last 12 months in patients with myeloproliferative neoplasms (MPNs).

METHODS

A multicenter, 1-time anonymous survey was conducted using analog and digital questionnaires. Sex-stratified multinomial logistic regression analysis was applied to investigate the association between CrF and number of falls. All analyses were adjusted for age, school education, body mass index, MPN subtype, and quality of life.

RESULTS

The final sample comprised 688 patients (mean age 57.4 ± 13.8, 62.4% women). The fall rate was 16.2% in women and 12.2% in men (P = .153). There were no differences between women and men in terms of CrF between individuals with more than 1 fall, whereas women with 1 fall had a higher CrF compared to those without a fall (RRR = 1.019; 95% CI [1.002-1.039]), respectively.

CONCLUSION

CrF increases the risk of falls in women with MPN. Physicians should evaluate and manage CrF symptoms and implement fall prevention strategies for those who are at increased risk. Further research is needed to better understand the effects of CrF on gait performance and associated fall risk.

Using Sensor Technology to Measure Gait Capacity and Gait Performance in Rehabilitation Inpatients with Neurological Disorders

The aim of this study was to objectively assess and compare gait capacity and gait performance in rehabilitation inpatients with stroke or incomplete spinal cord injury (iSCI) using inertial measurement units (IMUs). We investigated how gait capacity (what someone can do) is related to gait performance (what someone does). Twenty-two inpatients (11 strokes, 11 iSCI) wore ankle positioned IMUs during the daytime to assess gait. Participants completed two circuits to assess gait capacity. These were videotaped to certify the validity of the IMU algorithm. Regression analyses were used to investigate if gait capacity was associated with gait performance (i.e., walking activity and spontaneous gait characteristics beyond therapy time). The ankle positioned IMUs validly assessed the number of steps, walking time, gait speed, and stride length (r ≥ 0.81). The walking activity was strongly (r ≥ 0.76) related to capacity-based gait speed. Maximum spontaneous gait speed and stride length were similar to gait capacity. However, the average spontaneous gait speed was half the capacity-based gait speed. Gait capacity can validly be assessed using IMUs and is strongly related to gait performance in rehabilitation inpatients with neurological disorders. Measuring gait performance with IMUs provides valuable additional information about walking activity and spontaneous gait characteristics to inform about functional recovery.

Paretic-Limb-Only Plyometric Training Outperforms Volume-Matched Double-Limb Training for Ameliorating Balance Capability and Gait Symmetry in Adolescents with Unilateral Cerebral Palsy: A Comparative Study

Adolescents with unilateral cerebral palsy (U-CP) experience an asymmetrical posture because the less-affected lower limb is preferred for bodyweight support as a strategy of compensating for the paretic side’s muscular weakness. This study was designed to compare the effect of 12 weeks of paretic-limb-only plyometric training (PLPT) and volume-matched double-limb training (DLPT) on balance capability and gait symmetry in adolescents with U-CP. Sixty-nine adolescents with U-CP were randomly assigned to PLPT, DLPT, or a control group (n = 23 each). Treatment was delivered twice/week (with at least 48 h recovery intervals) for 12 weeks in succession. The directional (LoSdirectional) and overall (LoSoverall) limits of stability in addition to the temporal (T-GSI) and spatial (S-GSI) gait symmetry indicis were assessed pre- and post-treatment. The LoSdirectional improved significantly in the PLPT group compared to either the DLPT or control group (for the forward (p = 0.027 and <0.001, respectively), backward (p = 0.037 and <0.001, respectively), affected-side (p = 0.038 and 0.004, respectively), and less-affected-side (p = 0.018 and 0.016, respectively)), and this was also the case for the LoSoverall (p < 0.001). Additionally, The T-GSI and S-GSI scores decreased significantly in the PLPT group compared to the DLPT (p = 0.003 and 0.047, respectively) or control (p = 0.003 and 0.036, respectively) group, indicating the development more symmetrical gait patterns. In conclusion, PLPT is likely more effective for enhancing balance capabilities and promoting symmetrical gait patterns than DLPT. Thereupon, it is worthwhile for physical rehabilitation practitioners to include the PLPT paradigm into the intervention plans for adolescents with U-CP.

Effect of traditional Chinese exercise combined with massage on pain and disability in patients with lumbar disc herniation: A multi-center, randomized, controlled, assessor-blinded clinical trial

Background

Herniation of the nucleus pulposus caused by disc degeneration and other reasons can cause low back pain and disability. In China, traditional Chinese exercises (TCEs) and traditional Chinese massage (TCM) are widely used to improve symptoms of pain and disability in patients with lumbar disc herniation (LDH). The safety and efficacy of combination therapy have not been studied.

Objectives

To assess the effect of traditional Chinese exercise combined with massage vs. traditional Chinese massage alone on pain, disability, lumbar mobility and gait performance in patients with LDH.

Methods

Multi-center, randomized clinical trial conducted at 4 hospitals in China and enrolling 272 patients with LDH. Participants were randomly assigned to TCEs plus TCM group or TCM alone group. The combined therapy group received 18 Tai Chi training sessions (30-min sessions 3 times a week) and regular TCM treatments over 6 weeks. The control group received TCM therapy alone and was instructed to maintain their usual daily physical activity. Outcome variables measured included Visual Analog Scale (VAS), Short Form of McGill Pain Questionnaire (SF-MPQ), Oswestry Disability Index (ODI), lumbar spine range of motion (ROM) and gait performance.

Results

Among the 272 randomized participants, 259 completed the study. The mean VAS score was 51.77 mm at baseline in the TCEs plus TCM group, and 50.93 mm for the TCM alone group. The reduction in the VAS score at week 6 was greater in the TC group than in the TCM group with a mean difference of 4.05 (95% CI, 2.15-5.95; P < 0.001), and the ODI score with between-group differences of 3.57 points (95% CI, 2.84-4.30 points; P < 0.001). Similar significantly different results were observed in SF-MPQ, walking speed, cadence, and lumbar ROM. No serious adverse events were reported throughout the study period.

Conclusion

Compared with TCM alone, TCEs combined with TCM treatment performed better in reducing pain and improving disability. The combination therapy could be considered a valuable treatment option for LDH patients, with potential therapeutic utility for middle-aged and elderly patients with LDH.

Increased Trailing Limb Angle is Associated with Regular and Stable Trunk Movements in Patients with Hemiplegia

OBJECTIVES

In post-stroke patients, shifts in the center of gravity may affect joint movement patterns of the paraplegic lower limb during walking. The impact of changes in ankle dorsiflexion angle and trailing limb angle due to slight weight-shifting is unknown. This study aimed to investigate the effect of the abovementioned parameters on gait characteristics measured by trunk acceleration.

MATERIALS AND METHODS

During walking, the ankle dorsiflexion angle and trailing limb angle were assessed using two-dimensional motion analysis. Shifts in the center of gravity were assessed to evaluate symmetry, regularity, and sway of trunk movements by calculating the harmonic ratio, autocorrelation coefficient, and root mean square using a wearable trunk accelerometer.

RESULTS

Ankle dorsiflexion angle showed a significant negative correlation with the root mean square of the anteroposterior axis (r = -0.460, p = 0.005). Trailing limb angle was significantly correlated with the autocorrelation coefficient of the vertical axis (r = 0.585, p < 0.001) and root mean square of the vertical (r = -0.579, p < 0.001), mediolateral (r = -0.474, p = 0.004), and anteroposterior axes (r = -0.548, p = 0.001). Trailing limb angle was a significant predictor (autocorrelation coefficient vertical axis, p = 0.001; root mean square vertical axis, p = 0.001; mediolateral axis, p = 0.007; anteroposterior axis, p = 0.001).

CONCLUSIONS

Trailing limb angle can indicate the acquisition of forward propulsion during walking; an increase in it may contribute to improvements of the regular vertical movement ability and stability of the center of gravity sway.

Do Older Brazilian Women Who Participate in a Regular Physical Exercise Program Have Higher Habitual Physical Activity Levels? A Cross-Sectional Study Based on Accelerometer Data

A cross-sectional study was conducted to compare the habitual physical activity level, measured by accelerometry, gait performance, assessed by the GAITRite® system, handgrip strength, and static balance between older Brazilian women who participate (n = 50; 70.7 ± 5.5 years) and do not participate (n = 50; 70.1 ± 5.6 years) in a regular physical exercise program, and to investigate whether participation in a regular exercise program ensures compliance with physical activity recommendations. Older women who participated in a regular physical exercise program had significantly shorter sedentary activity time (effect size [ES] = 0.54), longer moderate activity time (ES = 0.85), and higher energy expenditure (ES = 0.64), number of steps (ES = 0.82), gait speed (ES = 0.49), and step length (ES = 0.45). However, regular participation in an exercise program did not guarantee compliance with physical activity recommendations. Behavioral changes to increase physical activity levels among older women who do and do not participate in a regular exercise program are necessary.

Multimodal Exercise Effects in Older Adults Depend on Sleep, Movement Biography, and Habitual Physical Activity: A Randomized Controlled Trial

Background: The promotion of healthy aging is one of the major challenges for healthcare systems in current times. The present study investigates the effects of a standardized physical activity intervention for older adults on cognitive capacity, self-reported health, fear of falls, balance, leg strength and gait under consideration of movement biography, sleep duration, and current activity behavior. Methods: This single-blinded, randomized controlled trial included 49 community-dwelling older adults (36 women; 82.9 ± 4.5 years of age (Mean [M] ± SD); intervention group = 25; control group = 24). Movement biography, sleep duration, cognitive capacity, self-reported health status, and fear of falls were assessed by means of questionnaires. Leg strength, gait, and current activity levels were captured using a pressure plate, accelerometers, and conducting the functional-reach and chair-rising-test. The multicomponent intervention took place twice a week for 45 min and lasted 16 weeks. Sub-cohorts of different sleep duration were formed to distinguish between intervention effects and benefits of healthy sleep durations. Change scores were evaluated in univariate analyses of covariances (ANCOVAs) between groups and sub-cohorts of different sleep duration in both groups. Changes in cognitive capacity, self-reported health, fear of falls, balance, leg strength, and gait were investigated using the respective baseline values, movement biography, and current activity levels as covariates. Analysis was by intention-to-treat (ITT). Results: We found sub-cohort differences in cognitive capacity change scores [F _(3,48) = 5.498, p = 0.003, ηp ² = 0.287]. Effects on fear of falls [F _(1,48) = 12.961, p = 0.001, ηp ² = 0.240] and balance change scores F _(1,48) = 4.521, p = 0.040, ηp ² = (0.099) were modified by the level of current activity. Effects on gait cadence were modified by the movement biography [F _(1,48) = 4.545; p = 0.039, ηp ² = 0.100]. Conclusions: Unlike for functional outcomes, our multicomponent intervention in combination with adequate sleep duration appears to provide combinable beneficial effects for cognitive capacity in older adults. Trainability of gait, fear of falls, and flexibility seems to be affected by movement biography and current physical activity levels. Trial registration: This study was registered at the DRKS (German Clinical Trials Register) on November 11, 2020 with the corresponding trial number: DRKS00020472.

Modifications in Prefrontal Cortex Oxygenation in Linear and Curvilinear Dual Task Walking: A Combined fNIRS and IMUs Study

Increased oxygenated hemoglobin concentration of the prefrontal cortex (PFC) has been observed during linear walking, particularly when there is a high attention demand on the task, like in dual-task (DT) paradigms. Despite the knowledge that cognitive and motor demands depend on the complexity of the motor task, most studies have only focused on usual walking, while little is known for more challenging tasks, such as curved paths. To explore the relationship between cortical activation and gait biomechanics, 20 healthy young adults were asked to perform linear and curvilinear walking trajectories in single-task and DT conditions. PFC activation was assessed using functional near-infrared spectroscopy, while gait quality with four inertial measurement units. The Figure-of-8-Walk-Test was adopted as the curvilinear trajectory, with the "Serial 7s" test as concurrent cognitive task. Results show that walking along curvilinear trajectories in DT led to increased PFC activation and decreased motor performance. Under DT walking, the neural correlates of executive function and gait control tend to be modified in response to the cognitive resources imposed by the motor task. Being more representative of real-life situations, this approach to curved walking has the potential to reveal crucial information and to improve people' s balance, safety, and life's quality.

Gait Performance as an Indicator of Cognitive Deficit in Older People

Background: The purpose of this study was to analyze which gait variables are the best for detecting cognitive impairment and to determine if age and gender can influence gait variations in older people. Methods: 65 participants took part in this study (22 men and 43 women; age: 73.88 ± 9.56 years). We use the Montreal Cognitive Assessment (MoCA) to assess mild cognitive impairment (MCI). Gait speed (GS) and the complex gait test (CGT) were analyzed with photocells Witty (Microgate, Italia). The OptoGait system (Microgate, Italia) was used to analyze step length (SL) and step coefficient of variation (CV sl). Results: There was a significant association between MoCA and SL (r = 0.420; p = 0.002), CV sl (r = −0.591; p < 0.001), and CGT (r = −0.406; p = 0.001). Instrumental activities of daily living showed significant association with SL (r = 0.563; p < 0.001); CV sl (r = −0.762; p < 0.001), CGT (r = −0.622; p < 0.001), and GS (r = 0.418; p < 0.001). CV sl showed the best results with MoCA when linear regression analysis was applied (R² = 0.560; p = 0.007; Y = 23.669 − 0.320x). Participants older than 79 years showed lower MoCA scores and poorer gait parameters than people younger than 79 years. Conclusions: CV sl, SL, CGT, and GS make it possible to detect MCI in older people, especially when these variables are evaluated as a whole.

The effects of small-needle-knife therapy on pain and mobility from knee osteoarthritis: a pilot randomized-controlled study

OBJECTIVE

To investigate the effect of small needle-knife therapy in people with painful knee osteoarthritis.

DESIGN

Pilot randomised, controlled trial.

SETTING

Rehabilitation hospital.

SUBJECTS

In-patients with osteo-arthritis of the knee.

INTERVENTIONS

Either 1 to 3 small needle-knife treatments over seven days or oral Celecoxib. All patients stayed in hospital three weeks, receiving the same mobility-focused rehabilitation.

MEASURES

Oxford Knee Score (OKS), gait speed and kinematics were recorded at baseline, at three weeks (discharge) and at three-months (OKS only). Withdrawal from the study, and adverse events associated with the small needle knife therapy were recorded.

RESULTS

83 patients were randomized: 44 into the control group, of whom 10 were lost by three weeks and 12 at 3 months; 39 into the experimental group of whom eight were lost at three weeks and three months. The mean (SE) OKS scores at baseline were Control 35.86 (1.05), Exp 38.38 (0.99); at three weeks 26.64 (0.97) and 21.94 (1.23); and at three months 25.83 (0.91) and 20.48 (1.14) The mean (SE) gait speed at baseline was 1.07 (0.03) m/sec (Control) and 0.98 (0.03), and at three weeks was 1.14 (0.03) and 1.12 (0.03) (P < 0.05). Linear mixed model statistical analysis showed that the improvements in the experimental group were statistically significant for total OKS score at discharge and three months.

CONCLUSIONS

Small needle-knife therapy added to standard therapy for patients with knee osteoarthritis, was acceptable, safe and reduced pain and improved global function on the Oxford Knee Score. Further research is warranted.

The mental representation of the human gait in patients with severe knee osteoarthrosis: a clinical study to aid understanding of impairment and disability

OBJECTIVE

Objectives were (1) to explore differences in gait-specific long-term memory structures and gait performance between knee osteoarthrosis patients and healthy subjects and (2) to identify the extent to which the gait-specific mental representation is associated with gait performance.

DESIGN

Cross-sectional study.

SUBJECTS

In total, 18 knee osteoarthrosis patients and 18 control subjects.

METHODS

Spatio-temporal (gait speed, step length) and temporophasic (stance time, swing time, single support time, total double support time) gait parameters and gait variability were measured with an electronic walkway (OptoGait). The mental representation was assessed using the structural dimensional analysis of mental representations (SDA-M).

RESULTS

(1) Patients showed significantly longer stance times ( P < 0.002) and total double support times, shorter swing times and single support times, a decreased gait speed ( P-values < 0.001) and structural differences in the gait-specific mental representation as compared with the healthy controls. (2) Correlation analyses revealed the mental representation of the human gait to be associated with actual gait performance in osteoarthrosis patients. Double support times were positively associated with the structural quality of the mental representation and step length variability was positively associated with the number of sequencing errors in the representation.

CONCLUSION

The gait-specific mental representation and actual gait performance differ between patients with severe knee osteoarthrosis and healthy controls, and both are linked to one another. This finding suggests that musculoskeletal disorders can lead to changes in the mental representation of the gait, and as such the SDA-M could provide useful information to improve the rehabilitation following osteoarthrosis.

Relationship between gait performance and hearing input during childhood assessed in pre-lingual cochlear implant users

CONCLUSIONS

The results suggest that auditory input is not neutral in motor skills and the complex interaction between them is generated in the earlier stages of childhood development. Objective The assessment of gait performance in pre-lingual deaf children with cochlear implant (CI).

METHODS

Gait velocity (GV), using a 10-meter test, was measured by means of three inertial sensors in 10 pre-lingual cochlear implant users (CIU) (10-16 years old) in three sensory conditions: (1) cochlear implant turned on with environmental noise (EN), (2) cochlear implant turned on with EN and with cognitive dual task (DT), and (3) CI turned off (CI-OFF). GV with EN and DT was assessed in a normal hearing control group (CG) (n = 14). Mann-Whitney and Wilcoxon Signed ranked test were used for significance validation.

RESULTS

(1) GV in CG was lower in DT than with EN (p = .019). (2) GV was faster in CG with EN compared with the three conditions in CIU (EN, p = .006; DT, p = .0001; CI-OFF, p = .03). (3) CIU had slower GV walking with EN (p = .037) and with DT (p = .022). (4) Dividing the CIU sample by age, the acoustic information generates a slower gait for those implanted after 3 years old.

Adaptations of Prefrontal Brain Activity, Executive Functions, and Gait in Healthy Elderly Following Exergame and Balance Training: A Randomized-Controlled Study

During aging, the prefrontal cortex (PFC) undergoes age-dependent neuronal changes influencing cognitive and motor functions. Motor-learning interventions are hypothesized to ameliorate motor and cognitive deficits in older adults. Especially, video game-based physical exercise might have the potential to train motor in combination with cognitive abilities in older adults. The aim of this study was to compare conventional balance training with video game-based physical exercise, a so-called exergame, on the relative power (RP) of electroencephalographic (EEG) frequencies over the PFC, executive function (EF), and gait performance. Twenty-seven participants (mean age 79.2 ± 7.3 years) were randomly assigned to one of two groups. All participants completed 24 trainings including three times a 30 min session/week. The EEG measurements showed that theta RP significantly decreased in favor of the exergame group [L₍₁₄₎ = 6.23, p = 0.007]. Comparing pre- vs. post-test, EFs improved both within the exergame (working memory: z = -2.28, p = 0.021; divided attention auditory: z = -2.51, p = 0.009; divided attention visual: z = -2.06, p = 0.040; go/no-go: z = -2.55, p = 0.008; set-shifting: z = -2.90, p = 0.002) and within the balance group (set-shifting: z = -2.04, p = 0.042). Moreover, spatio-temporal gait parameters primarily improved within the exergame group under dual-task conditions (speed normal walking: z = -2.90, p = 0.002; speed fast walking: z = -2.97, p = 0.001; cadence normal walking: z = -2.97, p = 0.001; stride length fast walking: z = -2.69, p = 0.005) and within the balance group under single-task conditions (speed normal walking: z = -2.54, p = 0.009; speed fast walking: z = -1.98, p = 0.049; cadence normal walking: z = -2.79, p = 0.003). These results indicate that exergame training as well as balance training positively influence prefrontal cortex activity and/or function in varying proportion.

Improved walking ability with wearable robot-assisted training in patients suffering chronic stroke

Wearable robotic devices provide safe and intensive rehabilitation, enabling repeated motions for motor function recovery in stroke patients. The aim of this small case series was to demonstrate the training effects of a three-week robotic leg orthosis, and to investigate possible mechanisms of the sensory-motor alterations and improvements by using gait analysis and EMG. Three survivors of chronic strokes participated in robot-assisted gait therapy for three weeks. EMG signals from the rectus femoris (RF), tibialis anterior (TA), biceps femoris (BF), and medial gastrocnemius (MG), as well as kinetics and kinematics data of the lower limb, were recorded before and after the training. The normalized root mean squared (RMS) values of the muscles, the joint moments, joint angles, and the results of two clinical scales (Berg Balance scale, BBS, and the lower extremity subscale of Fugl-Meyer assessment, LE-FMA) were used for analysis. All participants experienced improved balance and functional performances and increased BBS and LE-FMA scores. The EMG results showed there was an increase of the normalized RMS values of the MG and BF on the affected side. Additionally, EMG activities of the agonist and antagonist pair (i.e. RF and BF) appeared to return to similar levels after training. The peak moment of hip flexor, knee extensor, and plantar flexor, which all contributed to push-off power, were found to have increased after training. In summary, the three-week training period using the wearable RLO improved the three participants' gait performance by regaining push-off power and improved muscle activation and walking speed.

Effects of combined exercise on gait variability in community-dwelling older adults

Training that focuses on strength, balance, and endurance, the so-called combined exercise, can enhance physical function, including gait, according to a literature review. However, the effects of combined exercise on improving gait variability are limited. The objective of this study is to investigate the effects of 12 weeks of combined exercise comprised of resistance, endurance, and balance training on gait performance in older adults. Twenty-nine community-dwelling older adults were recruited and assigned to either the experimental group (n = 17) or the control group (n = 12). The 12-week intervention was a combined exercise program at 1 h per day and 3 days per week. The participants received an assessment for both a 6-min walk and gait during both habitual walking and fast walking conditions at pre-intervention and after 8 and 12 weeks of exercise. The 6-min walk was used to assess gait endurance. GAITRite was used to evaluate gait. An analysis of covariance with the pretest score as the covariate was used to determine the difference in each dependent variable between groups. The level of significance was set as p less than 0.05. Our results showed significant between-group effects in the 6-min walk and velocity, stride time, and stride length in both conditions after 8 weeks of exercise and significant between-group effects in the 6-min walk test and all selected gait parameters in both conditions after 12 weeks of exercise. Our findings demonstrate that a 12-week combined exercise program may positively affect gait endurance and gait performance including gait variability in habitual walking and fast walking conditions among older adults. The current study provides important evidence of short-term combined exercise effects on improvements in gait performance.