scholarly journals Enhancement of a prosthetic knee with a microprocessor-controlled gait phase switch reduces falls and improves balance confidence and gait speed in community ambulators with unilateral transfemoral amputation

2017 ◽  
Vol 42 (2) ◽  
pp. 228-235 ◽  
Author(s):  
Sara Agueda Fuenzalida Squella ◽  
Andreas Kannenberg ◽  
Ângelo Brandão Benetti
Keyword(s):  
Outcome Measures ◽  
Gait Speed ◽  
Standard Of Care ◽  
Walking Distance ◽  
Walk Test ◽  
Transfemoral Amputation ◽  
Prosthetic Knee ◽  
Balance Confidence ◽  
Highly Active ◽  
Prosthetic Knees

Background:Despite the evidence for improved safety and function of microprocessor stance and swing-controlled prosthetic knees, non-microprocessor-controlled prosthetic knees are still standard of care for persons with transfemoral amputations in most countries. Limited feature microprocessor-control enhancement of such knees could stand to significantly improve patient outcomes.Objectives:To evaluate gait speed, balance, and fall reduction benefits of the new 3E80 default stance hydraulic knee compared to standard non-microprocessor-controlled prosthetic knees.Study design:Comparative within-subject clinical study.Methods:A total of 13 young, high-functioning community ambulators with a transfemoral amputation underwent assessment of performance-based (e.g. 2-min walk test, timed ramp/stair tests) and self-reported (e.g. falls, Activities-Specific Balance Confidence scale, Prosthesis Evaluation Questionnaire question #1, Satisfaction with the Prosthesis) outcome measures for their non-microprocessor-controlled prosthetic knees and again after 8 weeks of accommodation to the 3E80 microprocessor–enhanced knee.Results:Self-reported falls significantly declined 77% ( p = .04), Activities-Specific Balance Confidence scores improved 12 points ( p = .005), 2-min walk test walking distance increased 20 m on level ( p = .01) and uneven ( p = .045) terrain, and patient satisfaction significantly improved ( p < .01) when using the 3E80 knee. Slope and stair ambulation performance did not differ between knee conditions.Conclusion:The 3E80 knee reduced self-reported fall incidents and improved balance confidence. Walking performance on both level and uneven terrains also improved compared to non-microprocessor-controlled prosthetic knees. Subjects’ satisfaction was significantly higher than with their previous non-microprocessor-controlled prosthetic knees. The 3E80 may be considered a prosthetic option for improving gait performance, balance confidence, and safety in highly active amputees.Clinical relevanceThis study compared performance-based and self-reported outcome measures when using non-microprocessor and a new microprocessor-enhanced, default stance rotary hydraulic knee. The results inform rehabilitation professionals about the functional benefits of a limited-feature, microprocessor-enhanced hydraulic prosthetic knee over standard non-microprocessor-controlled prosthetic knees.

scholarly journals Proposing Development and Utility of a Mobility Composite Measure in Patients with a Neurologic Disorder

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Chad Swank ◽  
Sattam Almutairi ◽  
Ann Medley
Keyword(s):  
Outcome Measures ◽  
Walk Test ◽  
Composite Measure ◽  
Balance Confidence ◽  
Sit To Stand ◽  
Neurologic Disorders ◽  
The Individual ◽  
Abc Scale ◽  
A Prospective Study ◽  
10 Meter Walk Test

Background. Outcome measures typically assess single domains making holistic assessment difficult. Our purpose was to develop a mobility composite measure (MCM) based on four commonly used outcome measures and compare this composite score to the individual measures in patients with neurologic disorders.Methods. We retrospectively reviewed 148 medical records for inclusion of primary neurologic diagnosis and scoring for 5 times sit-to-stand test (5TSST), 10-meter walk test (10MWT), 2-minute walk test (2MWT), and activities-specific balance confidence (ABC) scale.Results. After establishing that a single concept was being assessed with interitem correlations, raw scores were converted to percentage of normal and combined into the MCM for analysis from admission to discharge. Scores on each measure significantly improved after intervention (5TSST,p<.001; 10MWT,p<.001; 2MWT,p<.001; ABC,p=.02). Mean MCM (n=93) admission scores were67.55±31.88% and discharge scores were74.81±34.39% (p=.002). On average, patients improved 7.26% on the MCM exceeding the threshold of expected error (MDC95= 3.59%).Conclusions. MCM detected change in patient outcomes statistically and clinically and appears to capture a holistic picture of functional status. We recommend a prospective study to further investigate a “composite measure” incorporating measures from several functional domains.

scholarly journals Performance-based outcome measures are associated with cadence variability during community ambulation among individuals with a transtibial amputation

2020 ◽  
Vol 44 (4) ◽  
pp. 215-224
Author(s):  
Emma Haldane Beisheim ◽  
Elisa Sarah Arch ◽  
John Robert Horne ◽  
Jaclyn Megan Sions
Keyword(s):  
Physical Performance ◽  
Outcome Measures ◽  
Gait Speed ◽  
The United States ◽  
Clinical Settings ◽  
Walk Test ◽  
Community Based ◽  
Transtibial Amputation ◽  
Community Ambulation ◽  
10 Meter Walk Test

Background: In the United States, Medicare Functional Classification Level (K-level) guidelines require demonstration of cadence variability to justify higher-level prosthetic componentry prescription; however, clinical assessment of cadence variability is subjective. Currently, no clinical outcome measures are associated with cadence variability during community ambulation. Objectives: Evaluate whether physical performance, i.e. 10-meter Walk Test (10mWT)-based walking speeds, L-Test, and Figure-of-8 Walk Test scores, is associated with community-based cadence variability among individuals with a transtibial amputation. Study design: Cross-sectional. Methods: Forty-nine participants, aged 18–85 years, with a unilateral transtibial amputation were included. Linear regression models were conducted to determine whether physical performance was associated with cadence variability (a unitless calculation from FitBit® OneTM minute-by-minute step counts), while controlling for sex, age, and time since amputation ( p ⩽ .013). Results: Beyond covariates, self-selected gait speed explained the greatest amount of variance in cadence variability (19.2%, p < .001). Other outcome measures explained smaller, but significant, amounts of the variance (11.1–17.1%, p = .001–.008). For each 0.1 m/s-increase in self-selected and fast gait speeds, or each 1-s decrease in L-Test and F8WT time, community-based cadence variability increased by 1.76, 1.07, 0.39, and 0.79, respectively ( p < .013). Conclusions: In clinical settings, faster self-selected gait speed best predicted increased cadence variability during community ambulation. Clinical relevance The 10-meter Walk Test may be prioritized during prosthetic evaluations to provide objective self-selected walking speed data, which informs the assessment of cadence variability potential outside of clinical settings.

Abstract 46: A New Rehabilitation Strategy to Improve Gait Speed and Balance Self-Efficacy Following Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Dorian K Rose ◽  
Lou DeMark ◽  
Christy Conroy ◽  
Emily Fox ◽  
David Clark
Keyword(s):  
Lower Extremity ◽  
Gait Speed ◽  
Fall Risk ◽  
Step Length ◽  
Walk Test ◽  
Post Intervention ◽  
Backward Walking ◽  
Balance Confidence ◽  
Post Stroke ◽  
Abc Scale

Introduction: Impaired balance and decreased balance confidence contribute to slow gait speed and increased fall risk post-stroke. Standard balance exercises and gait training do not adequately address these impairments. Backward Walking Training (BWT), incorporating the unique postural and lower extremity motor control demands of walking backward, may reduce these gait impairments. This study compared the effects of BWT to Forward Walking Training (FWT) on forward and backward gait speed, dynamic balance and balance confidence. Methods: Thirty adults with first time stroke (18 male; 15 right hemisphere lesion; mean time post-stroke 12.7±6.6 months; mean age 58.8±10.1 yrs; mean Lower Extremity Fugl-Meyer Motor Score 22.7±1.4) were randomized to receive eighteen exercise sessions (3x/week for 6 weeks) of BWT (n=15) or FWT (n=15) consisting of 20 minutes training on a treadmill with Body Weight Support followed by 20 minutes overground. Gait was facilitated by a physical therapist-led team. Speed, limb loading and bout duration were progressed across sessions. The Ten Meter Walk Test (10MWT), Activities-Specific Balance Confidence (ABC) Scale, 3-meter Backward Walk Test (3MBWT), Functional Gait Assessment (FGA) and spatial-temporal gait characteristics were assessed pre- and post-intervention. Results: Pre- to post-intervention increases in the 3MBWT (BWT: 0.23±0.4 to 0.32±0.06 m/s ; FWT 0.21±0.4 to 0.23±0.04 m/s: ), ABC (BWT: 55.2±5.2% to 61.8±7.1% ; FWT: 52.9±6.5% to 53.5±6.2%: ), 10MWT (BWT: 0.42±0.07 to 0.51±0.08 m/s ; FWT: 0.44±0.08 to 0.47±0.07 m/s ) and backward paretic step length (BWT: 0.19±0.04 to 0.34±0.03 cm ; FWT: 0.21±0.03 to 0.20±0.04 cm were greater for the BWT than the FWT group. These gains were all statistically significant (p < 0.01). Group differences in FGA did not reach statistical significance. Conclusions: The greater increase in backward paretic step length, backward walking speed and balance confidence observed in the BWT group are all known contributors to reduced fall risk. BWT may be an important addition to the rehabilitation plan for individuals post-stroke. A longitudinal examination of fall incidence following BWT is the next important step in determining the overall utility of this novel rehabilitation approach.

scholarly journals Avaliação do Tempo Atribuído à Travessia de Peões: Contributo para uma Lisboa Mais Inclusiva

2020 ◽  
Vol 33 (6) ◽  
pp. 401
Author(s):  
Sílvia Boaventura ◽  
Jorge Rodrigues ◽  
Teresa Plancha ◽  
Mariana Martins ◽  
Marta Silva ◽  
...  
Keyword(s):  
Public Transport ◽  
Gait Speed ◽  
Walk Test ◽  
Physical Medicine ◽  
Portuguese Population ◽  
Balance Confidence ◽  
The Disabled ◽  
Pedestrian Crossing ◽  
10 Meter Walk Test ◽  
Confidence Scale

Introduction: With progressive ageing of the Portuguese population, it is paramount that the conditions of outdoor accessibility and safety are adapted to this age group. The aim of this study was to assess whether the time allocated to pedestrian crossing in the crosswalks with pedestrian crossing lights between Curry Cabral Hospital and local public transport is enough to allow safe passage of the elderly.Material and Methods: We evaluated 100 ambulatory care patients from the Physical Medicine and Rehabilitation department. All of them answered a questionnaire, the Activities-Specific Balance Confidence Scale (Portuguese version) and performed a 10-meter walk test. All crosswalks with pedestrian crossing lights between the hospital and local public transport were analyzed, in a total of 26, and the gait speed required to perform a safe crossing was calculated.Results: Mean age of patients was 75 years and the majority (73%) were female. The study showed that all patients could safely cross 17 (65%) crosswalks. The nine remaining crosswalks (35%) represented an obstacle to our sample.Discussion: If the required gait speed as currently set in legislation for the disabled was implemented, 99% of the patients would have been able to cross the crosswalks safely.Conclusion: It is essential to apply the gait speed set in legislation, since non-compliance endangers elderly patients in Curry Cabral Hospital, increasing the likelihood of accidents and the feeling of insecurity on the streets.

scholarly journals Effects of Perturbation-Based Balance Training in Subacute Persons With Stroke: A Randomized Controlled Trial

2019 ◽  
Vol 33 (3) ◽  
pp. 213-224 ◽  
Author(s):  
Shirley Handelzalts ◽  
Michal Kenner-Furman ◽  
Ganit Gray ◽  
Nachum Soroker ◽  
Guy Shani ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Balance Training ◽  
Treadmill Walking ◽  
Secondary Outcome ◽  
Walk Test ◽  
Balance Confidence ◽  
Abc Scale ◽  
Reactive Balance ◽  
Weight Shifting ◽  
Multiple Step

Background: Reactive balance responses are critical for fall prevention. Perturbation-based balance training (PBBT) has shown a positive effect in reducing the risk of falls among older adults and persons with Parkinson’s disease. Objective: To explore the effect of a short-term PBBT on reactive balance responses, performance-based measures of balance and gait and balance confidence. Methods: Thirty-four moderate-high functioning, subacute persons with stroke (PwS) (lower extremity Fugl-Meyer score 29.2 ± 4.3; Berg Balance Scale [BBS] score 43.8 ± 9.5, 42.0 ± 18.7 days after stroke onset) hospitalized in a rehabilitation setting were randomly allocated to PBBT (n = 18) and weight shifting and gait training (WS&GT) (n = 16). Both groups received 12 training sessions, 30 minutes each, for a period of 2.5 weeks. PBBT included unexpected balance perturbations during standing and treadmill walking, WS&GT included weight shifting in standing and treadmill walking without perturbations. The main outcome measures, that is, multiple step-threshold and fall-threshold were examined at baseline, immediately postintervention, and about 5 weeks postintervention. The secondary outcome measures, that is, BBS, 6-minute walk test (6MWT), 10-meter walk test (10MWT), and Activity-specific Balance Confidence (ABC) scale were examined at baseline and immediately postintervention. Results: Compared with the WS&GT group, immediately postintervention participants in the PBBT group showed higher multiple-step thresholds in response to forward and backward surface translations (effect size [ES] = 1.07 and ES = 1.10, respectively) and moderate ES in the ABC scale (ES = 0.74). No significant differences were found in fall-threshold, BBS, 6MWT, and 10MWT between the groups. Conclusions: Inclusion of perturbation training during rehabilitation of PwS improved reactive balance and balance confidence.

Improvement in walking abilities in transfemoral amputees with a distal weight bearing implant

2016 ◽  
Vol 41 (1) ◽  
pp. 26-32 ◽  
Author(s):  
Lluis Guirao ◽  
C Beatriz Samitier ◽  
Maria Costea ◽  
Josep Maria Camos ◽  
Maria Majo ◽  
...  
Keyword(s):  
Gait Speed ◽  
Weight Bearing ◽  
Titanium Implant ◽  
Walk Test ◽  
Transfemoral Amputation ◽  
Post Intervention ◽  
Cost Index ◽  
Physiological Cost ◽  
The Mean ◽  
Distal Support

Background:The ability to walk with a prosthesis is the main objective of rehabilitation following amputation, and distance and speed of walking achieved are considered determining factors in amputees’ perception of quality-of-life.Objectives:To assess walking abilities and improvement in gait distance and speed parameters in patients undergoing transfemoral amputation with a femoral implant that allows distal support of the residuum.Study design:Experimental before-and-after study.Methods:Ten transfemoral amputation patients received a titanium implant that allowed distal weight bearing of the residuum within the socket. The post-intervention follow-up period was 14 months. We evaluated the functionality using a 2-min walk test and the physiological cost index.Results:The etiology of amputation was traumatic in six patients (60%). The mean 2-min walk test score was 98.4 ± 19.5 m prior to the femoral implant and 122.5 ± 26.1 m at 14 months ( p < 0.008), representing an improvement of 24.5%. The mean gait speed prior to the femoral implant was 0.82 ± 0.16 and 1.02 ± 0.21 m/s at 14 months ( p < 0.008). The physiological cost index showed no differences ( p < 0.55).Conclusion:The results of this study show an improvement in the distance walked and gait speed in amputees 14 months after having received a femoral implant.Clinical relevanceThis article provides additional insight into the use of a femoral implant that allows distal support of the residuum to improve walking abilities and gait distance and speed parameters in patients undergoing transfemoral amputation, mainly those of vascular origin.

Intra-individual biomechanical effects of a non-microprocessor-controlled stance-yielding prosthetic knee during ramp descent in persons with unilateral transfemoral amputation

2018 ◽  
Vol 43 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Yusuke Okita ◽  
Nobuya Yamasaki ◽  
Takashi Nakamura ◽  
Tomoki Mita ◽  
Tsutomu Kubo ◽  
...  
Keyword(s):  
Ground Reaction Force ◽  
Lower Limb ◽  
Knee Flexion ◽  
Reaction Force ◽  
Transfemoral Amputation ◽  
Contralateral Limb ◽  
Prosthetic Knee ◽  
Limb Loading ◽  
Internal Joint ◽  
Prosthetic Knees

Background: A stance-yielding mechanism for prosthetic knees may reduce lower limb loading during specific activities, but quantitative data are insufficient. Objectives: To clarify the biomechanical effect of a non-microprocessor-controlled stance-yielding mechanism on ramp descent for individuals with unilateral transfemoral amputation. Study design: Intra-subject intervention study. Methods: Seven individuals with unilateral transfemoral amputation underwent three-dimensional motion analysis of ramp descent with and without activating a stance-yielding mechanism. Regarding early-stance internal joint moment and ground reaction force, whole-group and subgroup analyses stratified by stance prosthetic knee flexion were performed to verify differences in prosthetic side and contralateral limb loading between conditions. Results: Whole-group analysis revealed significant reduction in early-stance prosthetic knee extension moment with stance-yielding mechanism activation. Changes in prosthetic side hip extension moment and contralateral limb loading were inconsistent between conditions. Subjects with prosthetic stance knee flexion walked slower with a smaller stride and greater increase in aft ground reaction force and ankle dorsiflexion moment when stance-yielding was activated. Conclusion: Stance-yielding mechanism has a biomechanical potential to decrease excessive knee hyperextension. However, prosthetic side stance knee flexion induced by the stance-yielding mechanism might not necessarily reduce the mechanical load on residual hip or contralateral lower limb joints. Clinical relevance This study showed individual variability in the possibility of reducing the load on the remaining lower limb when using a non-microprocessor-controlled stance-yielding knee. This suggests that individualized prosthetic management and monitoring the activities of individuals wearing a stance-yielding prosthetic knee are crucial to maximize the benefits of stance-yielding prosthetic knees.

scholarly journals Validation of Clinical Characteristics and Effectiveness of Pulmonary Rehabilitation in a COPD Population with Discrepancy between Exercise Tolerance and FEV1

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 53
Author(s):  
Jun Horie ◽  
Koichiro Takahashi ◽  
Shuuichi Shiranita ◽  
Kunihiko Anami ◽  
Shinichiro Hayashi
Keyword(s):  
Gait Speed ◽  
Pulmonary Rehabilitation ◽  
Exercise Tolerance ◽  
Respiratory Illness ◽  
Forced Expiratory Volume ◽  
Walking Distance ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
St George's Respiratory Questionnaire ◽  
History Of

This study’s objective was to examine the characteristics of patients with chronic obstructive pulmonary disease (COPD) presenting with various exercise tolerance levels. A total of 235 patients with stable COPD were classified into 4 groups: (1) LoFlo + HiEx—patients with a six-minute walking distance (6MWD) ≥350 m and percentage of predicted forced expiratory volume in 1 s (%FEV1.0) <50%; (2) HiFlo + HiEx—patients with a 6MWD ≥350 m and a %FEV1.0 ≥50%; (3) LoFlo + LoEx—patients with a 6MWD < 350 m and %FEV1.0 < 50%; and (4) HiFlo + LoEx—patients with a 6MWD <350 m and %FEV1.0 ≥ 50%. Aspects of physical ability in the HiFlo + LoEx group were significantly lower than those in the HiFlo + HiEx group. The HiFlo + LoEx group was characterized by a history of hospitalization for respiratory illness within the past year, treatment with at-home oxygen therapy, and lacking daily exercise habits. Following three months of pulmonary rehabilitation, the LoFlo + HiEx group significantly improved in the modified Medical Research Council dyspnea score, maximum gait speed, and 6MWD, while the HiFlo + LoEx group significantly improved in the percentage of maximal expiratory pressure, maximum gait speed, 6MWD, incremental shuttle walking distance, and St. George’s Respiratory Questionnaire score. The HiFlo + LoEx group had the greatest effect of three-month pulmonary rehabilitation compared to other groups.

scholarly journals Prognostic value of cardio-hepatic-skeletal muscle syndrome in patients with heart failure

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Takumi Noda ◽  
Kentaro Kamiya ◽  
Nobuaki Hamazaki ◽  
Kohei Nozaki ◽  
Takafumi Ichikawa ◽  
...  
Keyword(s):  
Heart Failure ◽  
Physical Function ◽  
Grip Strength ◽  
Liver Dysfunction ◽  
Gait Speed ◽  
International Normalized Ratio ◽  
Walking Distance ◽  
Leg Strength ◽  
Function Test ◽  
End Stage

AbstractAlthough heart failure (HF) and liver dysfunction often coexist because of complex cardiohepatic interactions, the association between liver dysfunction and physical dysfunction, and between coexistence of both and prognosis in HF patients remains unclear. We reviewed 895 patients with HF (mean age, 69.4 ± 14.2 years) who underwent liver function test using model for end-stage liver disease excluding international normalized ratio (MELD-XI) score and physical function test (grip strength, leg strength, gait speed, and 6-min walking distance [6MWD]). In the multiple regression analysis, MELD-XI score was independently associated with lower grip strength, leg strength, gait speed, and 6MWD (all P < 0.001). One hundred thirty deaths occurred over a median follow-up period of 1.67 years (interquartile range: 0.62–3.04). For all-cause mortality, patients with high MELD-XI scores and reduced physical functions were found to have a significantly higher mortality risk even after adjusting for several covariates (grip strength, hazard ratio [HR]: 3.80, P < 0.001; leg strength, HR: 4.65, P < 0.001; gait speed, HR: 2.49, P = 0.001, and 6MWD, HR: 5.48, P < 0.001). Liver dysfunction was correlated with reduced physical function. Moreover, the coexistence of lower physical function and liver dysfunction considerably affected prognosis in patients with HF.

Gender-Related Differences in Physical Performance among Seniors

2005 ◽  
Vol 13 (3) ◽  
pp. 239-253 ◽  
Author(s):  
Kristin Musselman ◽  
Brenda Brouwer
Keyword(s):  
Gender Differences ◽  
Physical Performance ◽  
Gait Speed ◽  
Community Dwelling ◽  
Activity Level ◽  
Muscle Performance ◽  
Related Factors ◽  
Balance Confidence ◽  
Limits Of Stability ◽  
Gender Specific

This study examined gender differences in balance, gait, and muscle performance in seniors and identified gender-specific factors contributing to physical performance. Forty (20 men, 20 women) healthy, community-dwelling seniors (74.5 ± 5.3 years) participated. Limits of stability, gait speed, lower limb flexor and extensor isokinetic concentric peak torques, self-reported activity level, and balance confidence were measured. No gender differences were detected in gait speed, limits of stability when normalized to height, activity level, or balance confidence (p≥ .188). Women were weaker than men (p≤ .007), even after controlling for weight and body-mass index, suggesting that other gender-related factors contribute to strength. Gender accounted for 18–46% of the variance in strength and served as a modifier of the relationship between activity level and strength in some muscle groups. The primary factors relating to gender-specific strength was activity level in men and body weight in women.

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