Impaired Scaling of Step Length in Parkinsonian Postural Instability

Background: Postural stepping is an important strategy for recovery of balance in response to postural perturbations. It is disrupted by Parkinson's disease (PD) and other conditions. The nature of this disruption remains poorly understood. Understanding the motor control nature of this impairment can guide the development of novel interventions. Objectives: To identify the motor control abnormalities responsible for parkinsonian impairment of postural stepping. Methods: We studied four groups of participants: control, aged, PD, and normal-pressure hydrocephalus (NPH). We performed kinematic analysis of postural stepping by recording participants' body motion during a modified version of the clinical pull test, which was performed multiple times with different amounts of pulling forcefulness. Results: Successful postural stepping in the control group was accompanied by linear scaling of their first step's length and latency to the body's initial motion: more forceful pulls caused larger initial body acceleration, which resulted in longer steps that began earlier. PD patients exhibited reduced scaling of step length: they maintained normal reaction time but took steps that were inadequately short. Reduced step length scaling was present, but less severe, in aged individuals, and was more severe in NPH patients. Aged individuals and PD patients exhibited partial compensation for reduced step length scaling: their step length included a component that was independent of initial body acceleration, which was absent in control and NPH groups. Conclusions: the impairment of postural stepping caused by PD and related conditions is due to inadequate scaling of movement amplitude and is thus a form of hypokinesia.

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Feasibility and Preliminary Efficacy of Gait Training Assisted by Multichannel Functional Electrical Stimulation in Early Stroke Rehabilitation: A Pilot Randomized Controlled Trial

Neurorehabilitation and Neural Repair ◽

10.1177/1545968320981942 ◽

2021 ◽

Vol 35 (2) ◽

pp. 131-144

Author(s):

Maijke van Bloemendaal ◽

Sicco A. Bus ◽

Frans Nollet ◽

Alexander C. H. Geurts ◽

Anita Beelen

Keyword(s):

Electrical Stimulation ◽

Functional Electrical Stimulation ◽

Step Length ◽

Gait Training ◽

Control Group ◽

Significant Group ◽

Gait Symmetry ◽

Gait Parameters ◽

Walking Capacity ◽

Experimental Group

Background. Many stroke survivors suffer from leg muscle paresis, resulting in asymmetrical gait patterns, negatively affecting balance control and energy cost. Interventions targeting asymmetry early after stroke may enhance recovery of walking. Objective. To determine the feasibility and preliminary efficacy of up to 10 weeks of gait training assisted by multichannel functional electrical stimulation (MFES gait training) applied to the peroneal nerve and knee flexor or extensor muscle on the recovery of gait symmetry and walking capacity in patients starting in the subacute phase after stroke. Methods. Forty inpatient participants (≤31 days after stroke) were randomized to MFES gait training (experimental group) or conventional gait training (control group). Gait training was delivered in 30-minute sessions each workday. Feasibility was determined by adherence (≥75% sessions) and satisfaction with gait training (score ≥7 out of 10). Primary outcome for efficacy was step length symmetry. Secondary outcomes included other spatiotemporal gait parameters and walking capacity (Functional Gait Assessment and 10-Meter Walk Test). Linear mixed models estimated treatment effect postintervention and at 3-month follow-up. Results. Thirty-seven participants completed the study protocol (19 experimental group participants). Feasibility was confirmed by good adherence (90% of the participants) and participant satisfaction (median score 8). Both groups improved on all outcomes over time. No significant group differences in recovery were found for any outcome. Conclusions. MFES gait training is feasible early after stroke, but MFES efficacy for improving step length symmetry, other spatiotemporal gait parameters, or walking capacity could not be demonstrated. Trial Registration. Netherlands Trial Register (NTR4762).

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Pressure Changes Induced by Whole Body Acceleration Shocks

Journal of Biomechanical Engineering ◽

10.1115/1.2894081 ◽

1991 ◽

Vol 113 (1) ◽

pp. 27-29 ◽

Cited By ~ 2

Author(s):

E. Belardinelli ◽

M. Ursino ◽

G. Fabbri ◽

A. Cevese ◽

F. Schena

Keyword(s):

Mathematical Model ◽

Carotid Artery ◽

Normal Pressure ◽

Compressed Air ◽

Whole Body ◽

Body Acceleration ◽

Vascular Bed ◽

Pressure Changes ◽

The Mathematical Model

In the present paper pressure changes induced by sudden body acceleration are studied “in vivo” on the dog and compared to the results obtainable with a recently developed mathematical model. A dog was fixed to a movable table, which was accelerated by a compressed air piston for less than 1 s. Acceleration was varied by changing the air pressure in the piston. Pressure was measured during the experiment at different points along the vascular bed. However, only data obtained in the carotid artery and abdominal aorta are presented here. The results demonstrated that impulse body accelerations cause significant pressure peaks in the vessel examined (about + 25 mmHg in the carotid artery with body acceleration of g/2). Moreover, pressure changes are rapidly damped, with a time constant of about 0.1s. From the present results it may be concluded that, according to the prediction of the mathematical model, body accelerations such as those occurring in normal life can induce pressure changes well beyond the normal pressure value.

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EFFECT OF ACCUPRESSURE PEN ON DISTANCE VARIABLE IN SCIATICA PATIENTS -A RANDOMIZED CONTROL TRIAL

10.36106/ijsr/8718134 ◽

2021 ◽

pp. 28-31

Author(s):

Urja S. Vaidya ◽

Roshani S. Patel

Keyword(s):

Randomized Control Trial ◽

Stride Length ◽

Step Length ◽

Control Group ◽

Exclusion Criteria ◽

Parametric Test ◽

Group A ◽

Randomized Control ◽

Experimental Group ◽

Distance Variable

Background: Sciatica is a radiating pain which is treated with manual accupressure and after a time electro accupressure came into introduction. Aim And Objective: Aim: To nd out the effectiveness of accupressure pen to improve the distance variable To nd out the effect of Objective: accupressure pen on pain and distance variable in sciatica patient To compare the experimental group to the control group On the basis of Method: inclusion and exclusion criteria 30 participants were selected. They were treated with electro accupressure pen for 3 alternative days / week for 3 weeks, after that re-assessment was taken with NPRS, Slump and Distance variables. The data was analyzed using SPSS Version Results: 21.Parametric test was used .In Group A improvement was seen Accupressure Conclusions: pen is effective to reduce pain and improve step length and stride length in Sciatica Patients

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Cross-transfer of motor control in visuomotor tasks. Systematic review

Archivos de Medicina del Deporte ◽

10.18176/archmeddeporte.00063 ◽

2021 ◽

Vol 38 (5) ◽

pp. 358-366

Author(s):

Javier Ruiz-Seijoso ◽

Yaiza Taboada-Iglesias

Keyword(s):

Motor Control ◽

Randomized Trials ◽

Web Of Science ◽

Control Group ◽

Motor Ability ◽

Short Term ◽

Exclusion Criteria ◽

Cross Education ◽

Visuomotor Tasks ◽

Visuomotor Skills

Introduction: The term “cross-education” describes the perfomance improvement, both in motor control and strength, of a limb after training the opposite. Despite its current interest, there is no consensus on many concepts of the transfer of a visuomotor skill. The aim of the present research was to review the current literature on the phenomenon of cross-education in visuomotor skills in order to determine the magnitude of transference and its relationships with the context of the intervention. Results: A literature search was conducted during December 2019 in the databases Pubmed, CINAHL, MEDLINE, Web of Science, SPORTdiscus and Scopus. The descriptors “Motor ability” and “Motor skill” were used, in addition to the keywords “Motor control”, “skill”, “Task”, “cross over effect”, “cross exercise”, “contralateral learning”, “inter limb transfer “,” cross transfer “,” cross education “. After applying the inclusion and exclusion criteria, a total of 19 articles were obtained for analysis. Of these articles, 12 are RCTs, 4 crossover clinical trial, 2 are non-randomized trials and only 1 lacks a control group. Most of the articles consist of a short-term intervention. Only 5 studies are of a duration of between 4 and 6 weeks. Conclusion: the cross-education phenomenon occurs in visuomotor skills. However, the magnitude of transference and its relation to the amount of learning of the trained member seems to be very variable depending on the context of the intervention. Likewise, the scarce consensus and the methodological differences in the studies make it difficult to draw firm conclusions about the effects of the context on the transference.

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Serial Tap Test of Patients With Idiopathic Normal Pressure Hydrocephalus - Impact on Cognitive Function and Its Meaning

10.21203/rs.3.rs-174045/v1 ◽

2021 ◽

Author(s):

Samanta Fabricio Blattes da Rocha ◽

Pedro Andre Kowacs ◽

Ricardo Krause Martinez de Souza ◽

Matheus Kahakura Franco Pedro ◽

Ricardo Ramina ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Normal Pressure Hydrocephalus ◽

Digit Span ◽

Normal Pressure ◽

Stroop Test ◽

Control Group ◽

Test Protocol ◽

Tap Test ◽

Cognitive Improvement ◽

Cerebrospinal Fluid Shunting

Abstract BackgroundIdiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, urinary incontinence and cognitive decline. Symptoms are potentially reversible and treatment is based on cerebrospinal fluid shunting. The tap test (TT) is used to identify patients that will benefit from surgery. This procedure consists on the withdrawal of 20 to 50 mL of cerebrospinal fluid (CSF) through a lumbar puncture (LP) after which the symptoms of the triad are tested. Improvement in the quality and speed of gait are already recognized but cognitive improvement depends on several factors such as tests used, time elapsed after LP for re-testing, and number of punctures. Serial punctures may trigger similar conditions as external lumbar drainage (ELD) to the organism. ObjectiveThis study aimed to identify how serial punctures affect cognition in order to increase the sensitivity of the test and consequently the accuracy of surgical indication. MethodsSixty-one patients with INPH underwent baseline memory and executive tests repeatedly following the 2-Step Tap Test protocol (2-STT – two procedures of 30 mL lumbar CSF drainage separated by a 24-hour interval). The baseline scores of INPH patients were compared with those of 55 healthy controls, and with intragroup post-puncture scores of the 2-STT. ResultsThe group with INPH had lower performance than the control group in all cognitive tests (RAVLT, Stroop, CFT, FAR-COWA, FAB, MMSE, orientation, mental control), except for the forward digit span test (p = 0.707). After conducting LP procedures, the Stroop test (words, colors and errors), RAVLT (stage A1, A6 and B1), and CFT (immediate and delayed R) scores were equal to those of the control group (p > 0.05). The INPH group presented significant improvement after the first puncture in MMSE (p = 0.031) and in the Stroop Test (points) (p < 0.001). After the second puncture, subjects improved in orientation, MMSE, RAVLT (B1), Stroop (points, words, errors) and CFT (IR). ConclusionProgressive cognitive improvement occurred over the 2-STT and changes were more significant after the second LP in all cognitive domains except for RAVLT (A7). Encephalic alert system ‘arousal’ seems to participate in early improvements observed during 2-STT. The second LP increased the sensitivity of the drainage test to detect changes in cognitive variables, and consequently improved the quality of the method.

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Evaluation of the Effectiveness of Nordic Walking Training in Improving the Gait of Persons with Down Syndrome

BioMed Research International ◽

10.1155/2019/6353292 ◽

2019 ◽

Vol 2019 ◽

pp. 1-11

Author(s):

Agnieszka Skiba ◽

Jakub Marchewka ◽

Amadeusz Skiba ◽

Szymon Podsiadło ◽

Iwona Sulowska ◽

...

Keyword(s):

Down Syndrome ◽

Three Dimensional ◽

Training Group ◽

Step Length ◽

Positive Influence ◽

Control Group ◽

Kinematic Parameters ◽

Nordic Walking ◽

Infrared Video ◽

Spatiotemporal Parameters

People with Down syndrome (DS) show dysfunction of gait, expressed by disturbed character of angular changes and values of the spatiotemporal parameters as compared to the physiological norm. It is known that exercises and various activities have positive effect on balance and gait, but there are only a few scientific proofs concerning above-mentioned in people with DS. Furthermore, the effect of Nordic Walking (NW) training on gait in people with DS is unexplored. We enrolled 22 subjects with DS, aged 25-40 years, with moderate intellectual disability. Participants were randomly divided into 2 groups: NW training group which underwent 10 weeks of training at a frequency of 3 times a week and control group with no specific intervention. Subjects were examined twice: 1 week before training and a week immediately after intervention. Gait was evaluated by the Vicon 250: a computerized system of three-dimensional analysis of motion, connected to 5 infrared video cameras. We conducted mixed-design ANOVA model to assess the effects of time and type of training on spatiotemporal parameters. We found significant favorable time by group interaction in the following parameters: step length in right leg: F(1,15) =14,47, p=0.002; left leg accordingly F(1,15) =5,15, p=0.038, cycle length in right leg: F(1,15) =14,48, p=0.002; left leg accordingly F(1,15) =15,09, p=0.001; and gait standardised speed F(1,15) =5,35, p=0.035. Statistically significant changes were observed in numerous kinematic parameters of ankle, knee, pelvis, and shoulder in NW group. Regular NW training has positive influence on selected spatiotemporal and kinematic parameters in people with Down Syndrome and may be an attractive and safe form of rehabilitation.

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Severe Dizziness Related to Postural Instability, Changes in Gait and Cognitive Skills in Patients with Chronic Peripheral Vestibulopathy

International Archives of Otorhinolaryngology ◽

10.1055/s-0039-1695025 ◽

2019 ◽

Vol 24 (01) ◽

pp. e99-e106 ◽

Cited By ~ 1

Author(s):

Almir Resende Coelho ◽

Júlia Licursi Lambertti Perobelli ◽

Lilian Shizuka Sonobe ◽

Renato Moraes ◽

Camila Giacomo de Carneiro Barros ◽

...

Keyword(s):

Cognitive Skills ◽

Elderly Women ◽

Center Of Pressure ◽

Dynamic Balance ◽

Step Length ◽

Control Group ◽

Vestibular Disorders ◽

Cognitive Assessments ◽

Cognitive Balance ◽

Peripheral Vestibulopathy

Abstract Introduction Peripheral vestibular disorders can lead to cognitive deficits and are more common in elderly patients. Objective To evaluate and correlate cognitive, balance and gait aspects in elderly women with chronic peripheral vestibular dizziness, and to compare them with elderly women without vestibular disorders. Methods Twenty-two women presenting peripheral vestibular dizziness episodes for at least six months participated in the study. The individuals were categorized by dizziness severity level: moderate (n = 11) or severe (n = 11). The control group (n = 11) included women showing no vestibulopathy, light-headedness or dizziness. Cognitive assessments and semi-static and dynamic balance assessments were performed with the Balance Master (Neurocom International, Inc., Clackamas, OR), while the Dizziness Handicap Inventory provided a score for the severity of the symptoms. The groups were submitted to statistics of inference and correlation between cognitive, balance and stability variables. Results The group with severe dizziness showed higher sway speed of the center of pressure in the anteroposterior direction, smaller step length, and slower gait than the control group. Regarding the cognitive variables, the group with severe dizziness symptoms presented significant correlations with stability and gait variables. Conclusion The relationship between cognitive aspects, balance and gait was stronger in women with severe dizziness than in those with no vestibulopathy.

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A Randomized Controlled Trial of a Passive Accessory Joint Mobilization on Acute Ankle Inversion Sprains

Physical Therapy ◽

10.1093/ptj/81.4.984 ◽

2001 ◽

Vol 81 (4) ◽

pp. 984-994 ◽

Cited By ~ 144

Author(s):

Toni Green ◽

Kathryn Refshauge ◽

Jack Crosbie ◽

Roger Adams

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Step Length ◽

Control Group ◽

Joint Mobilization ◽

Randomized Controlled ◽

Ankle Inversion ◽

Before And After ◽

Experimental Group ◽

Support Time

Abstract Background and Purpose. Passive joint mobilization is commonly used by physical therapists as an intervention for acute ankle inversion sprains. A randomized controlled trial with blinded assessors was conducted to investigate the effect of a specific joint mobilization, the anteroposterior glide on the talus, on increasing pain-free dorsiflexion and 3 gait variables: stride speed (gait speed), step length, and single support time. Subjects. Forty-one subjects with acute ankle inversion sprains (<72 hours) and no other injury to the lower limb entered the trial. Methods. Subjects were randomly assigned to 1 of 2 treatment groups. The control group received a protocol of rest, ice, compression, and elevation (RICE). The experimental group received the anteroposterior mobilization, using a force that avoided incurring any increase in pain, in addition to the RICE protocol. Subjects in both groups were treated every second day for a maximum of 2 weeks or until the discharge criteria were met, and all subjects were given a home program of continued RICE application. Outcomes were measured before and after each treatment. Results. The results showed that the experimental group required fewer treatment sessions than the control group to achieve full pain-free dorsiflexion. The experimental group had greater improvement in range of movement before and after each of the first 3 treatment sessions. The experimental group also had greater increases in stride speed during the first and third treatment sessions. Discussion and Conclusion. Addition of a talocrural mobilization to the RICE protocol in the management of ankle inversion injuries necessitated fewer treatments to achieve pain-free dorsiflexion and to improve stride speed more than RICE alone. Improvement in step length symmetry and single support time was similar in both groups.

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Diffusion Tensor Imaging in Patients With Adult Chronic Idiopathic Hydrocephalus

Neurosurgery ◽

10.1227/01.neu.0000367801.35654.ec ◽

2010 ◽

Vol 66 (5) ◽

pp. 917-924 ◽

Cited By ~ 67

Author(s):

Elke Hattingen ◽

Alina Jurcoane ◽

Julia Melber ◽

Stella Blasel ◽

Friedhelm E. Zanella ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Diffusion Tensor ◽

Mean Diffusivity ◽

Normal Pressure ◽

Clinical Findings ◽

Control Group ◽

Microstructural Changes ◽

Automated Method ◽

Definition Of ◽

Lumbar Cerebrospinal Fluid

Abstract OBJECTIVE Diffusion tensor imaging (DTI) parameters were investigated in patients with chronic idiopathic hydrocephalus to evaluate microstructural changes of brain tissue caused by chronic ventricular dilatation. METHODS Eleven patients fulfilling the criteria for possible or probable idiopathic normal pressure hydrocephalus and 10 healthy control subjects underwent MRI at 3 Tesla, including DTI with 12 gradient directions. Patients were scanned before lumbar cerebrospinal fluid (CSF) withdrawal tests. Differences in fractional anisotropy (FA) and mean diffusivity (MD) between patients and controls were assessed using 2 different methods: manual definition of regions of interest and a fully automated method, TBSS (Tract-Based Spatial Statistics). DTI parameters were correlated with clinical findings. RESULTS Compared with the control group, patients with chronic idiopathic hydrocephalus had significantly higher MD values in both the periventricular corticospinal tract (CST) and the corpus callosum (CC), whereas FA values were significantly higher in the CST but lower in the CC. DTI parameters of the CST correlated with the severity of gait disturbances. CONCLUSION Microstructural changes in periventricular functionally relevant white matter structures (CSF, CC) in chronic idiopathic hydrocephalus can be visualized using DTI. Further studies should investigate the change of DTI parameters after CSF shunting and its relation to neurologic outcome.

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