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Miyahara Y, Phokaewvarangkul O, Kerr S, Anan C, Toriumi H, Bhidayasiri R. Comparing the efficacy of therapeutic Thai acupressure on plantar acupoints and laser cane therapy on freezing of gait in Parkinson's disease: a randomized non-inferiority trial. Front Neurol 2024; 15:1327448. [PMID: 38348165 PMCID: PMC10859456 DOI: 10.3389/fneur.2024.1327448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 01/15/2024] [Indexed: 02/15/2024] Open
Abstract
Background ON-freezing of gait (ON-FOG) in Parkinson's disease (PD), often resistant to medication, is linked to sensory deficits and proprioceptive impairment, and results in falls and reduced life quality. While visual cues from a laser cane (LC), which rapidly accesses the motor cortex, are commonly used to compensate for proprioceptive impairment, increased visual reliance may be affected by disease progression. Emerging evidence suggests that modulation of peripheral sensory processing may alleviate ON-FOG, and therapeutic Thai acupressure (TTA) may be a solution. This study aims to evaluate the effect of TTA in alleviating ON-FOG and compare its effectiveness to LC in patients with PD. Methods This open-label, non-inferiority trial randomized 90 PD patients with ON-FOG equally into three arms: TTA for plantar nerve stimulation for 96 s, LC for visual cueing, and sham control (SC). Stride length was the primary non-inferiority endpoint [non-inferiority margin: lower limit of 95% confidence interval (CI) above -10 cm in mean change difference in pre- and immediately post-intervention in TTA versus LC (one-sided)]. Secondary outcomes included FOG episodes, double support time, velocity, cadence, step length, timed up and go (TUG) test, and visual analog scale (VAS) score. Results TTA showed non-inferiority to LC in stride length (mean = -0.7 cm; 95% CI: -6.55; 5.15) (one-sided). The improvements with TTA and LC versus SC were comparable between (mean = 13.11 cm; 95% CI: 7.26; 18.96) and (mean = 13.8 cm; 95% CI: 7.96; 19.65) (one-sided). Secondary outcomes favored TTA and LC over SC with improved FOG, velocity, step length, and VAS scores, while only TTA resulted in improved double support time, cadence, and TUG test results. No complications occurred. Conclusion The efficacy of TTA, which improves stride length, is non-inferior to that of LC and consequently alleviates FOG comparable to LC. TTA might enhance proprioceptive function and reduce visual dependence. Therefore, TTA, characterized by its non-invasive, simple, and safe techniques, is a potential non-pharmacological alternative for ON-FOG treatment and might enhance overall quality of life. However, further research into the mechanism, efficacy, and utilization of TTA is essential. Clinical trial registration https://www.thaiclinicaltrials.org/show/TCTR20200317001, identifier TCTR20200317001.
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Affiliation(s)
- Yuka Miyahara
- Doctor of Philosophy Program in Medical Sciences (International Program), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Wat Pho Thai Traditional Medical School, Bangkok, Thailand
| | - Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Stephen Kerr
- Biostatistics Excellence Centre, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Chanawat Anan
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Haruki Toriumi
- Department of Acupuncture, Shonan Keiiku Hospital, Fujisawa, Japan
- Toriumi Acupuncture Clinic, Tokyo, Japan
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson’s Disease and Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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Montané E, Cormier C, Scandella M, Cangelosi A, Marque P, Moissenet F, Gasq D. ToulGaitViz: a tool for the systematic description of lower limb clearance during the swing phase of hemiparetic gait after stroke. A cohort study. Eur J Phys Rehabil Med 2023; 59:669-681. [PMID: 37869760 PMCID: PMC10899889 DOI: 10.23736/s1973-9087.23.07979-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/04/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND In post-stroke hemiparetic subjects, a systematic and quantified description of the shortening default and compensatory movements during the swing phase of gait is essential to guide treatments and assess the impact of therapeutic interventions. However, such a systematic approach does not exist in the current clinical practice. AIM The aim of this study was to present a method improving the quantification and visualization of the kinematics of both lower limbs during the swing phase of gait, more specifically the origin of shortening default and the weight of compensations, based on a tool specifically developed: ToulGaitViz. DESIGN Observational cohort study. SETTING Three-dimensional kinematic gait analyses of outpatients evaluated in Toulouse university hospital. POPULATION ToulGaitViz was applied to 151 post-stroke hemiparetic participants and 48 healthy control participants. METHODS ToulGaitViz is a standalone software allowing to compute 1) limb clearance as the sum of the shortening related to hip, knee and ankle flexion in the sagittal plane; 2) compensations related to the abduction of the limb and hip hiking at mid-swing. Both centimetric and angular values of the clearance were reported as well as their correlations with walking speed. RESULTS Overall, the contribution of compensations in clearance was higher in post-stroke hemiparetic subjects than in healthy control participants with both centimetric (130% vs. 33%; P<0.001) and angular methods (23% vs. 1.4%; P<0.001). The centimetric method better represents the specific contribution of each segment to the clearance than the angular method. Symbolically, mean kinematic data from the cohort supports the claim that 2° of pelvic obliquity is equivalent to 10° of knee flexion to increase clearance by 1 cm, emphasizing the non-proportionality between the angular values and the actual contribution to the shortening. ToulGaitViz allows visualization of clearance, segmental shortening and compensation evolution before and after any therapeutic intervention with quantitative and comprehensive data. CONCLUSIONS The ToulGaitViz could be systematically used in clinical practice to extract relevant kinematic data from the origin of shortening default and the weight of compensations. CLINICAL REHABILITATION IMPACT This tool allows better understanding of the mechanisms of action of treatments to better link them to the subjects' needs.
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Affiliation(s)
- Emmeline Montané
- Toulouse University Hospital Center, Department of Physiological Explorations, Toulouse, France
| | - Camille Cormier
- Toulouse University Hospital Center, Department of Physiological Explorations, Toulouse, France
- Toulouse NeuroImaging Center (ToNIC), Inserm, Toulouse University3, Toulouse III - Paul Sabatier University, Toulouse, France
| | - Marino Scandella
- Gait Analysis Laboratory, Toulouse University Hospital, Toulouse, France
| | - Adrian Cangelosi
- Toulouse University Hospital Center, Department of Physiological Explorations, Toulouse, France
| | - Philippe Marque
- Toulouse NeuroImaging Center (ToNIC), Inserm, Toulouse University3, Toulouse III - Paul Sabatier University, Toulouse, France
- Department of Physical and Rehabilitation Medicine, Toulouse University Hospital, Toulouse, France
| | - Florent Moissenet
- Kinesiology Laboratory, Geneva University Hospitals, Geneva University, Geneva, Switzerland
| | - David Gasq
- Toulouse University Hospital Center, Department of Physiological Explorations, Toulouse, France -
- Toulouse NeuroImaging Center (ToNIC), Inserm, Toulouse University3, Toulouse III - Paul Sabatier University, Toulouse, France
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A. Castillo-Torres S, A. Soto-Rincón C, H. Gil-Valadez A, E. Chávez-Luévanos B, Góngora-Rivera F. A neglected symptom? Parietal gait lateropulsion as primary manifestation of acute is-chemic stroke. Rev Neurol 2023; 76:69-73. [PMID: 36631966 PMCID: PMC10364037 DOI: 10.33588/rn.7602.2021349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Gait disorders are commonly overlooked as a presenting manifestation of stroke and underrepresented in case series. We describe four cases of sudden-onset gait lateropulsion as primary manifestation of parietal lobe stroke. CASE REPORT Four patients presented after sudden-onset gait lateropulsion. On neurological examination, all patients had at least one cortical sensory deficit and wide-based gait with lateropulsion towards the side of the cortical deficit. Neuroimaging revealed a subacute parietal lobe stroke contralateral to the side of gait lateropulsion. In two patients we found bilateral lateropulsion with predominance towards the side of cortical deficit and increase of unsteadiness with eye closure (an apparent Romberg sign), with neuroimaging revealing bilateral parietal strokes (subacute contralateral and chronic ipsilateral to gait lateropulsion). CONCLUSION We report gait lateropulsion as a novel primary manifestation of acute stroke of the parietal lobe (parietal gait lateropulsion). Given its role as the destination of proprioceptive pathways, parietal strokes can result in gait lateropulsion, with bilateral lesions even mimicking sensory ataxia with bilateral lateropulsion and unsteadiness upon eye closure.
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Affiliation(s)
- Sergio A. Castillo-Torres
- Neurology Department. Hospital Universitario Dr. José Eleuterio González. Monterrey, MexicoNeurology DepartmentHospital Universitario Dr. José Eleuterio GonzálezMonterreyMexico
| | - Carlos A. Soto-Rincón
- Neurology Department. Hospital Universitario Dr. José Eleuterio González. Monterrey, MexicoNeurology DepartmentHospital Universitario Dr. José Eleuterio GonzálezMonterreyMexico
| | - Alfonso H. Gil-Valadez
- Neurology Department. Hospital Universitario Dr. José Eleuterio González. Monterrey, MexicoNeurology DepartmentHospital Universitario Dr. José Eleuterio GonzálezMonterreyMexico
| | - Beatriz E. Chávez-Luévanos
- Neurology Department. Hospital Universitario Dr. José Eleuterio González. Monterrey, MexicoNeurology DepartmentHospital Universitario Dr. José Eleuterio GonzálezMonterreyMexico
| | - Fernando Góngora-Rivera
- Neurovascular Care UnitNeurovascular Care UnitNeurovascular Care UnitMonterreyMexico
- Neurology Department. Hospital Universitario Dr. José Eleuterio González. Monterrey, MexicoNeurology DepartmentHospital Universitario Dr. José Eleuterio GonzálezMonterreyMexico
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Volpini M, Aquino M, Holanda AC, Emygdio E, Polese J. Clinical effects of assisted robotic gait training in walking distance, speed, and functionality are maintained over the long term in individuals with cerebral palsy: a systematic review and meta-analysis. Disabil Rehabil 2021; 44:5418-5428. [PMID: 34232847 DOI: 10.1080/09638288.2021.1942242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To identify the short-term effects of robotic-assisted gait training (RAGT) on walking distance, gait speed and functionality of cerebral palsy (CP) patients, and to verify if the effects of RAGT are maintained in the long term. METHODS A systematic literature review was performed in PubMed, PEDro, CINAHL, and LILACS databases. Studies were included considering: (1) population (CP individuals); (2) study design (experimental studies); (3) type of intervention (RAGT); (4) outcome (gait parameters and function); and (5) period (short and long term). RESULTS This systematic review included seven articles in meta-analysis. Only walking distance, thru six minutes walking test, increased statistically after RAGT. However, RAGT demonstrated large clinical effects differences (minimal clinically important difference - MCID) in gait speed and Gross Motor Function Measure score (dimensions D and E), for CP population. After RAGT intervention, differences in short term (comparison 1) were maintained in long term (comparison 2) for all outcomes. Gait speed results were not significant. CONCLUSIONS Evidence from the present study demonstrated that RAGT can be an important intervention to improve gait parameters and functionality, in children with CP, that are maintained over long-term.Implications for RehabilitationRobotic-assisted gait training (RAGT) is a beneficial treatment for children with cerebral palsy (CP).RAGT improvements in walking distance are maintained over the long-term in children with CP.RAGT demonstrated large clinical effect differences in gait speed and functionality in CP population.
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Affiliation(s)
- Mariana Volpini
- Physical Therapy Department, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.,Associação Mineira de Reabilitação, Orthotics for Humans Laboratory (OhLab), Belo Horizonte, Brazil
| | - Mariana Aquino
- Associação Mineira de Reabilitação, Orthotics for Humans Laboratory (OhLab), Belo Horizonte, Brazil
| | - Ana Carolina Holanda
- Physical Therapy Department, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Elizabeth Emygdio
- Physical Therapy Department, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
| | - Janaine Polese
- Physical Therapy Department, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.,Physical Therapy Department, Graduate Program in Health Sciences, Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil
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Infarinato F, Romano P, Goffredo M, Ottaviani M, Galafate D, Gison A, Petruccelli S, Pournajaf S, Franceschini M. Functional Gait Recovery after a Combination of Conventional Therapy and Overground Robot-Assisted Gait Training Is Not Associated with Significant Changes in Muscle Activation Pattern: An EMG Preliminary Study on Subjects Subacute Post Stroke. Brain Sci 2021; 11:brainsci11040448. [PMID: 33915808 PMCID: PMC8066552 DOI: 10.3390/brainsci11040448] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Overground Robot-Assisted Gait Training (o-RAGT) appears to be a promising stroke rehabilitation in terms of clinical outcomes. The literature on surface ElectroMyoGraphy (sEMG) assessment in o-RAGT is limited. This paper aimed to assess muscle activation patterns with sEMG in subjects subacute post stroke after training with o-RAGT and conventional therapy. Methods: An observational preliminary study was carried out with subjects subacute post stroke who received 15 sessions of o-RAGT (5 sessions/week; 60 min) in combination with conventional therapy. The subjects were assessed with both clinical and instrumental evaluations. Gait kinematics and sEMG data were acquired before (T1) and after (T2) the period of treatment (during ecological gait), and during the first session of o-RAGT (o-RAGT1). An eight-channel wireless sEMG device acquired in sEMG signals. Significant differences in sEMG outcomes were found in the BS of TA between T1 and T2. There were no other significant correlations between the sEMG outcomes and the clinical results between T1 and T2. Conclusions: There were significant functional gains in gait after complex intensive clinical rehabilitation with o-RAGT and conventional therapy. In addition, there was a significant increase in bilateral symmetry of the Tibialis Anterior muscles. At this stage of the signals from the tibialis anterior (TA), gastrocnemius medialis (GM), rectus femoris (RF), and biceps femoris caput longus (BF) muscles of each lower extremity. sEMG data processing extracted the Bilateral Symmetry (BS), the Co-Contraction (CC), and the Root Mean Square (RMS) coefficients. Results: Eight of 22 subjects in the subacute stage post stroke agreed to participate in this sEMG study. This subsample demonstrated a significant improvement in the motricity index of the affected lower limb and functional ambulation. The heterogeneity of the subjects’ characteristics and the small number of subjects was associated with high variability research, functional gait recovery was associated with minimal change in muscle activation patterns.
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Affiliation(s)
- Francesco Infarinato
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Paola Romano
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Michela Goffredo
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
- Correspondence: ; Tel.: +39-0652252319
| | - Marco Ottaviani
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Daniele Galafate
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Annalisa Gison
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Simone Petruccelli
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Sanaz Pournajaf
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
| | - Marco Franceschini
- Neurorehabilitation Research Laboratory, IRCCS San Raffaele Roma, 00163 Rome, Italy; (F.I.); (P.R.); (M.O.); (D.G.); (A.G.); (S.P.); (S.P.); (M.F.)
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele University, 00166 Rome, Italy
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Molteni F, Guanziroli E, Goffredo M, Calabrò RS, Pournajaf S, Gaffuri M, Gasperini G, Filoni S, Baratta S, Galafate D, Le Pera D, Bramanti P, Franceschini M, On Behalf Of Italian Eksogait Study Group. Gait Recovery with an Overground Powered Exoskeleton: A Randomized Controlled Trial on Subacute Stroke Subjects. Brain Sci 2021; 11:104. [PMID: 33466749 DOI: 10.3390/brainsci11010104] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/09/2021] [Accepted: 01/11/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Overground Robot-Assisted Gait Training (o-RAGT) provides intensive gait rehabilitation. This study investigated the efficacy of o-RAGT in subacute stroke subjects, compared to conventional gait training. Methods: A multicenter randomized controlled trial was conducted on 75 subacute stroke subjects (38 in the Experimental Group (EG) and 37 in the Control Group (CG)). Both groups received 15 sessions of gait training (5 sessions/week for 60 min) and daily conventional rehabilitation. The subjects were assessed at the beginning (T1) and end (T2) of the training period with the primary outcome of a 6 Minutes Walking Test (6MWT), the Modified Ashworth Scale of the Affected lower Limb (MAS-AL), the Motricity Index of the Affected lower Limb (MI-AL), the Trunk Control Test (TCT), Functional Ambulation Classification (FAC), a 10 Meters Walking Test (10MWT), the modified Barthel Index (mBI), and the Walking Handicap Scale (WHS). Results: The 6MWT increased in both groups, which was confirmed by both frequentist and Bayesian analyses. Similar outcomes were registered in the MI-AL, 10MWT, mBI, and MAS-AL. The FAC and WHS showed a significant number of subjects improving in functional and community ambulation in both groups at T2. Conclusions: The clinical effects of o-RAGT were similar to conventional gait training in subacute stroke subjects. The results obtained in this study are encouraging and suggest future clinical trials on the topic.
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Aguilar-Zafra S, Del Corral T, Montero-González N, de-Gabriel-Hierro A, López-de-Uralde-Villanueva I. Urinary incontinence and impaired physical function are associated with expiratory muscle weakness in patients with multiple sclerosis. Disabil Rehabil 2021; 44:3531-3539. [PMID: 33427502 DOI: 10.1080/09638288.2020.1867908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Patients with multiple sclerosis (MS) with respiratory muscle weakness could have physical function impairments, given the functional/biomechanical link of the trunk stabilising system. Thus, clinicians could employ new treatment strategies targeting respiratory muscles to improve their physical function. This study pretends to evaluate the relationship between respiratory muscle strength, pulmonary function and pelvic floor function, and also to correlate these variables with physical function (gait function, disability and quality of life) in patients with MS. METHODS 41 patients participated in this descriptive cross-sectional study. Respiratory muscle strength [maximal respiratory pressures (MIP/MEP)], pulmonary function (forced spirometry), pelvic floor function [urinary incontinence (UI)], physical function [Timed Up & Go (TUG) test, Barthel index and health status questionnaire (SF-12)] were evaluated. RESULTS Respiratory muscle strength and pulmonary function were moderately related to UI (MIP: rho = -0.312; MEP: rho = -0.559). MEP was moderately related to physical function (TUG: rho = -0.508; Barthel index: rho = 0.418). Patients with and without expiratory muscle weakness showed differences in UI, pulmonary and physical function. CONCLUSION Patients with MS with greater deterioration in pulmonary function and respiratory muscle strength, especially expiratory muscles, showed greater deterioration in UI and physical function. Expiratory muscle weakness had a negative impact on urinary, physical and pulmonary function.Implications for rehabilitationPulmonary function is associated with urinary incontinence and gait functionality in patients with multiple sclerosis (MS).Expiratory muscle weakness is associated with impaired urinary and physical function in patients with MS.The inclusion of respiratory muscle training to the rehabilitation programs of patients with MS could improve their pelvic floor disorders and physical function.
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Affiliation(s)
- Sandra Aguilar-Zafra
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Motion in Brains Research Group, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain.,Téxum S.L Physiotherapy Center, Coslada, Madrid, Spain
| | - Tamara Del Corral
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
| | - Noelia Montero-González
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Almudena de-Gabriel-Hierro
- Departamento de Fisioterapia, Facultad de Ciencias de la Salud. Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, Madrid, Spain
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Mataki Y, Mutsuzaki H, Kamada H, Takeuchi R, Nakagawa S, Yoshikawa K, Takahashi K, Kuroda M, Iwasaki N, Yamazaki M. Effect of the Hybrid Assistive Limb on the Gait Pattern for Cerebral Palsy. ACTA ACUST UNITED AC 2020; 56:E673. [PMID: 33297300 DOI: 10.3390/medicina56120673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/06/2023]
Abstract
Background and objectives: Cerebral palsy (CP) is the most frequent childhood motor disability. Achieving ambulation or standing in children with CP has been a major goal of physical therapy. Recently, robot-assisted gait training using the Hybrid Assistive Limb® (HAL) has been effective in improving walking ability in patients with CP. However, previous studies have not examined in detail the changes in gait pattern after HAL training for patients with spastic CP, including gait symmetry. This study aimed to evaluate the immediate effect of HAL training on the walking ability and the changes in gait pattern and gait symmetry in patients with spastic CP. Materials and Methods: We recruited 19 patients with spastic CP (13 male and six female; mean age, 15.7 years). Functional ambulation was assessed using the 10-Meter Walk Test and gait analysis in the sagittal plane before and after a single 20-min HAL intervention session. Results: The walking speed and stride length significantly increased after HAL intervention compared to the pre-intervention values. Two-dimensional gait analysis showed improvement in equinus gait, increase in the flexion angle of the swing phase in the knee and hip joints, and improvement in gait symmetry. Immediate improvements in the walking ability and gait pattern were noted after HAL training in patients with spastic CP. Conclusions: The symmetry of the joint angle of the lower limb, including the trunk, accounts for the improvement in walking ability after HAL therapy.
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Gaßner H, Raccagni C, Eskofier BM, Klucken J, Wenning GK. The Diagnostic Scope of Sensor-Based Gait Analysis in Atypical Parkinsonism: Further Observations. Front Neurol 2019; 10:5. [PMID: 30723450 PMCID: PMC6349719 DOI: 10.3389/fneur.2019.00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/03/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Differentiating idiopathic Parkinson's disease (IPD) from atypical Parkinsonian disorders (APD) is challenging, especially in early disease stages. Postural instability and gait difficulty (PIGD) are substantial motor impairments of IPD and APD. Clinical evidence implies that patients with APD have larger PIGD impairment than IPD patients. Sensor-based gait analysis as instrumented bedside test revealed more gait deficits in APD compared to IPD. However, the diagnostic value of instrumented bedside tests compared to clinical assessments in differentiating APD from IPD patients have not been evaluated so far. Objective: The objectives were (a) to evaluate whether sensor-based gait parameters provide additional information to validated clinical scores in differentiating APD from matched IPD patients, and (b) to investigate if objective, instrumented gait assessments have comparable discriminative power to clinical scores. Methods: In a previous study we have recorded instrumented gait parameters in patients with APD (Multiple System Atrophy and Progressive Supranuclear Palsy). Here, we compared gait parameters to those of retrospectively pairwise disease duration-, age-, and gender-matched IPD patients in order to address this new research questions. To this aim, the PIGD score was calculated as sum of the MDS-UPDRS-3-items “gait,” “postural stability,” “arising from chair,” and “posture.” Gait characteristics were evaluated in standardized gait tests using an instrumented, sensor-based gait analysis system. Machine learning algorithms were used to extract spatio-temporal gait parameters. Receiver Operating Characteristic analysis was performed in order to detect the discriminative power of the instrumented vs. the clinical bedside tests in differentiating IPD from APD. Results: Sensor-based stride length, gait velocity, toe off angle, and parameters representing gait variability significantly differed between IPD and APD groups. ROC analysis revealed a high Area Under the Curve (AUC) for PIGD score (0.919), and UPDRS-3 (0.848). Particularly, the objective parameters stance time variability (0.841), swing time variability (0.834), stride time variability (0.821), and stride length variability (0.804) reached high AUC's as well. Conclusions: PIGD symptoms showed high discriminative power in differentiating IPD from APD supporting gait disorders as substantial diagnostic target. Sensor-based gait variability parameters provide metric, objective added value, and serve as complementary outcomes supporting clinical diagnostics and long-term home-monitoring concepts.
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Affiliation(s)
- Heiko Gaßner
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Cecilia Raccagni
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bjoern M Eskofier
- Machine Learning and Data Analytics Lab, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Gregor K Wenning
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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