scholarly journals Assessing Gait Adaptability in People With a Unilateral Amputation on an Instrumented Treadmill With a Projected Visual Context

2012 ◽  
Vol 92 (11) ◽  
pp. 1452-1460 ◽  
Author(s):  
Han Houdijk ◽  
Mariëlle W. van Ooijen ◽  
Jos J. Kraal ◽  
Henri O. Wiggerts ◽  
Wojtek Polomski ◽  
...  
Keyword(s):  
Obstacle Avoidance ◽  
Walking Speed ◽  
Fear Of Falling ◽  
Avoidance Performance ◽  
Limb Amputation ◽  
Control Group ◽  
Walking Ability ◽  
Visual Context ◽  
Walking Tests ◽  
Stepping Accuracy

Background Gait adaptability, including the ability to avoid obstacles and to take visually guided steps, is essential for safe movement through a cluttered world. This aspect of walking ability is important for regaining independent mobility but is difficult to assess in clinical practice. Objective The objective of this study was to investigate the validity of an instrumented treadmill with obstacles and stepping targets projected on the belt's surface for assessing prosthetic gait adaptability. Design This was an observational study. Methods A control group of people who were able bodied (n=12) and groups of people with transtibial (n=12) and transfemoral (n=12) amputations participated. Participants walked at a self-selected speed on an instrumented treadmill with projected visual obstacles and stepping targets. Gait adaptability was evaluated in terms of anticipatory and reactive obstacle avoidance performance (for obstacles presented 4 steps and 1 step ahead, respectively) and accuracy of stepping on regular and irregular patterns of stepping targets. In addition, several clinical tests were administered, including timed walking tests and reports of incidence of falls and fear of falling. Results Obstacle avoidance performance and stepping accuracy were significantly lower in the groups with amputations than in the control group. Anticipatory obstacle avoidance performance was moderately correlated with timed walking test scores. Reactive obstacle avoidance performance and stepping accuracy performance were not related to timed walking tests. Gait adaptability scores did not differ in groups stratified by incidence of falls or fear of falling. Limitations Because gait adaptability was affected by walking speed, differences in self-selected walking speed may have diminished differences in gait adaptability between groups. Conclusions Gait adaptability can be validly assessed by use of an instrumented treadmill with a projected visual context. When walking speed is taken into account, this assessment provides unique, quantitative information about walking ability in people with a lower-limb amputation.

Physical, cognitive and psychosocial effects of telerehabilitation-based motor imagery training in people with multiple sclerosis: A randomized controlled pilot trial

2019 ◽  
Vol 26 (5) ◽  
pp. 251-260 ◽  
Author(s):  
Turhan Kahraman ◽  
Sema Savci ◽  
Asiye Tuba Ozdogar ◽  
Zumrut Gedik ◽  
Egemen Idiman
Keyword(s):  
Quality Of Life ◽  
Motor Imagery ◽  
Cognitive Functions ◽  
Walking Speed ◽  
Dynamic Balance ◽  
Pilot Trial ◽  
Control Group ◽  
Walking Ability ◽  
Balance Confidence

Introduction Motor imagery training delivered at home via telerehabilitation is a novel rehabilitation concept. The aim was to investigate the effects of telerehabilitation-based motor imaging training (Tele-MIT) on gait, balance and cognitive and psychosocial outcomes in people with multiple sclerosis (pwMS). Methods This randomized, controlled pilot trial included pwMS and healthy individuals. pwMS were randomly divided into two groups, intervention and control. The intervention group received Tele-MIT twice a week for 8 weeks. The control group was a wait-list group without any additional specific treatment. Healthy participants served as a baseline comparison. The Dynamic Gait Index, used to assess dynamic balance during walking, was the primary outcome. Secondary outcomes included assessments of walking speed, endurance and perceived ability, balance performance assessed by a computerized posturography device, balance confidence, cognitive functions, fatigue, anxiety, depression and quality of life. Results Baseline comparisons with healthy individuals revealed that motor imagery abilities were preserved in pwMS ( p > 0.05). The intervention group exhibited significant improvements in dynamic balance during walking ( p = 0.002), walking speed ( p = 0.007), perceived walking ability ( p = 0.008), balance confidence ( p = 0.002), most cognitive functions ( p = 0.001–0.008), fatigue ( p = 0.001), anxiety ( p = 0.001), depression ( p = 0.005) and quality of life ( p = 0.002). No significant changes were observed in the control group in any of the outcome measures ( p > 0.05). Discussion Tele-MIT is a novel method that proved feasible and effective in improving dynamic balance during walking, walking speed and perceived walking ability, balance confidence, cognitive functions, fatigue, anxiety, depression and quality of life in pwMS.

scholarly journals Early Recovery of Walking Ability in Patients After Total Knee Arthroplasty Using a Hip-Wearable Exoskeleton Robot: A Case-Controlled Clinical Trial

2021 ◽  
Vol 12 ◽  
pp. 215145932110276
Author(s):  
Kazunori Koseki ◽  
Hirotaka Mutsuzaki ◽  
Kenichi Yoshikawa ◽  
Koichi Iwai ◽  
Yuko Hashizume ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Walking Speed ◽  
Gait Training ◽  
Control Group ◽  
Walking Ability ◽  
Early Improvement ◽  
Exoskeleton Robot ◽  
Significant Difference ◽  
Total Knee ◽  
Wearable Exoskeleton

Introduction: The Honda Walking Assist (HWA) is a hip-wearable exoskeleton robot for gait training that assists in hip flexion and extension movements to guide hip joint movements during gait. This study aimed to evaluate the effects of walking exercises with HWA in patients who underwent total knee arthroplasty (TKA). Materials and Methods: This study involved 10 patients (11 knees) in the HWA group and 11 patients (11 knees) in the control group who underwent conventional physical therapy. The patients assigned to the HWA group underwent a total of 17-20 gait training sessions, each lasting approximately 20 min from week 1 to 5 following TKA. Self-selected walking speed (SWS), maximum walking speed (MWS), range of motion (ROM), knee extension and flexion torque, and Western Ontario and McMaster Universities Osteoarthritis Index subscales of pain (WOMAC-p) and physical function (WOMAC-f) scores were measured preoperatively, at 2, 4, and 8 weeks following TKA. Results: Interventions were successfully completed in all patients, with no severe adverse events. A significant difference was noted in the time × group interaction effect between preoperative and week 2 SWS and MWS. Regarding knee function, there was a significant difference in the time × group interaction between preoperative and week 2 active ROM extension; however, no significant difference in knee torque, WOMAC-p, and WOMAC-f scores were observed. In the between-group post hoc analysis, WOMAC-f in the HWA group was higher than that in the control group at week 8. Discussion: Although the control group showed a temporary reduction in SWS and MWS 2 weeks after TKA, the HWA group did not. These results suggest that HWA intervention promotes early improvement in walking ability after TKA. Conclusions: The gait training using HWA was safe and feasible and could be effective for the early improvement of walking ability in TKA patients.

scholarly journals Effect of pelvic laparoscopic implantation of neuroprosthesis in spinal cord injured subjects: a 1-year prospective randomized controlled study

Spinal Cord ◽  
2021 ◽  
Author(s):  
Helge Kasch ◽  
Uffe Schou Løve ◽  
Anette Bach Jønsson ◽  
Kaare Eg Severinsen ◽  
Marc Possover ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Outcome Measures ◽  
Outcome Measure ◽  
Secondary Outcome ◽  
Controlled Study ◽  
Control Group ◽  
Walking Ability ◽  
Data Set ◽  
Cord Injury

Abstract Study design 1-year prospective RCT. Objective Examine the effect of implantable pulse generator and low-frequency stimulation of the pelvic nerves using laparoscopic implantation of neuroprosthesis (LION) compared with neuromuscular electrical stimulation (NMES) in SCI. Methods Inclusion criteria: traumatic spinal cord injury (SCI), age 18–55 years, neurological level-of-injury Th4–L1, time-since-injury >1 year, and AIS-grades A–B. Participants were randomized to (A) LION procedure or (B) control group receiving NMES. Primary outcome measure: Walking Index for Spinal Cord Injury (WISCI-II), which is a SCI specific outcome measure assessing ability to ambulate. Secondary outcome measures: Spinal Cord Independence Measure III (SCIM III), Patient Global Impression of Change (PGIC), Penn Spasm Frequency Scale (PSFS), severity of spasticity measured by Numeric Rating Scale (NRS-11); International Spinal Cord Injury data sets-Quality of Life Basic Data Set (QoLBDS), and Brief Pain Inventory (BPI). Results Seventeen SCI individuals, AIS grade A, neurological level ranging from Th4–L1, were randomized to the study. One individual was excluded prior to intervention. Eight participants (7 males) with a mean age (SD) of 35.5 (12.4) years were allocated to the LION procedure, 8 participants (7 males) with age of 38.8 (15.1) years were allocated to NMES. Significantly, 5 LION group participants gained 1 point on the WISCI II scale, (p < 0.013; Fisher´s exact test). WISCI II scale score did not change in controls. No significant changes were observed in the secondary outcome measures. Conclusion The LION procedure is a promising new treatment for individuals with SCI with significant one-year improvement in walking ability.

scholarly journals Effect of hypoxic conditioning on functional fitness, balance and fear of falling in healthy older adults: a randomized controlled trial

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Rafael Timon ◽  
Marta Camacho-Cardeñosa ◽  
Adrián González-Custodio ◽  
Guillermo Olcina ◽  
Narcis Gusi ◽  
...  
Keyword(s):  
Older Adults ◽  
Fear Of Falling ◽  
Controlled Trial ◽  
Training Group ◽  
Training Programme ◽  
Control Group ◽  
Functional Fitness ◽  
Healthy Older Adults ◽  
Hypoxia Exposure ◽  
Hypoxic Conditions

Abstract Background Hypoxic conditioning has been proposed as a new tool to mitigate the sarcopenia and enhance health-related function, but decrements in standing balance have been observed during hypoxia exposure. The aim of the study was to evaluate the effect of a hypoxic conditioning training on functional fitness, balance and fear of falling in healthy older adults. Methods A total of 54 healthy older adults (aged 65–75 years), who voluntarily participated in the study, were randomly divided into three groups: the control group (CON), the normoxia training group (NT) that performed strength training in normoxia, and the hypoxia training group (HT) that trained under moderate hypoxic conditions at a simulated altitude of 2500 m asl. The training programme that was performed during 24 weeks was similar in both experimental groups and consisted of a full-body workout with elastic bands and kettlebells (three sets × 12–15 reps). The Senior Fitness Test (SFT), the Single Leg Stance test (SLS) and the Short Falls Efficacy Scale-International (FES-I) were assessed before and after the intervention. Results Results showed that after training, either in normoxia or in hypoxia, the participants increased upper and lower body strength, and the aerobic endurance, and decreased the fear of falling. Conclusions The moderate hypoxic conditioning seems to be a useful tool to increase the functional capacity in healthy older adults without observing a decline in balance. Trial registration ClinicalTrials.gov NCT04281264. Registered February 9, 2019-Retrospectively registered.

scholarly journals The relationship between relative aerobic load, energy cost, and speed of walking in individuals post-stroke

2021 ◽  
Author(s):  
Ilse Johanna Blokland ◽  
Arianne S Gravesteijn ◽  
Mathijs C Busse ◽  
Floor P Groot ◽  
Coen AM van Bennekom ◽  
...  
Keyword(s):  
Energy Expenditure ◽  
Aerobic Capacity ◽  
Energy Cost ◽  
Walking Speed ◽  
Ventilatory Threshold ◽  
Research Question ◽  
Walking Ability ◽  
Cross Sectional ◽  
Relative Load ◽  
Post Stroke

Background: Individuals post-stroke walk slower than their able-bodied peers, which limits participation. This might be attributed to neurological impairments, but could also be caused by a mismatch between aerobic capacity and aerobic load of walking. Research question: What is the potential impact of aerobic capacity and aerobic load of walking on walking ability post-stroke? Methods: In a cross-sectional study, forty individuals post-stroke (more impaired N=21; preferred walking speed (PWS)<0.8m/s, less impaired N=19), and 15 able-bodied individuals performed five, 5-minute treadmill walking trials at 70%, 85%, 100%, 115% and 130% of PWS. Energy expenditure (mlO2/kg/min) and energy cost (mlO2/kg/m) were derived from oxygen uptake (VO2). Relative load was defined as energy expenditure divided by peak aerobic capacity (%VO2peak) and by VO2 at ventilatory threshold (%VO2-VT). Relative load and energy cost at PWS were compared between groups with one-way ANOVAs. The effect of speed on these parameters was modeled with GEE. Results: Both more and less impaired individuals post-stroke showed lower PWS than able-bodied controls (0.44[0.19-0.76] and 1.04[0.81-1.43] vs 1.36[0.89-1.53] m/s) and higher relative load at PWS (50.2±14.4 and 51.7±16.8 vs 36.2±7.6 %VO2 peak and 101.9±20.5 and 97.0±27.3 vs 64.9±13.8 %VO2-VT). No differences in relative load were found between stroke groups. Energy cost at PWS of more impaired (0.30[.19-1.03] mlO2/kg/m) was higher than less-impaired (0.19[0.10-0.24] mlO2/kg/m) and able-bodied (0.15[0.13-0.18] mlO2/kg/m). For post-stroke individuals, increasing walking speed above PWS decreased energy cost, but resulted in a relative load above endurance threshold. Significance: Individuals post-stroke seem to reduce walking speed to prevent unsustainably high relative aerobic loads at the expense of reduced economy. When aiming to improve walking ability in individuals post-stroke, it is important to consider training aerobic capacity.

scholarly journals Concurrent Validity of Physiological Cost Index in Walking over Ground and during Robotic Training in Subacute Stroke Patients

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Anna Sofia Delussu ◽  
Giovanni Morone ◽  
Marco Iosa ◽  
Maura Bragoni ◽  
Stefano Paolucci ◽  
...  
Keyword(s):  
Random Sequence ◽  
Pearson Correlation ◽  
Control Group ◽  
Stroke Patients ◽  
Robotic Training ◽  
Cost Index ◽  
Physiological Cost ◽  
Subacute Stroke ◽  
Weight Support ◽  
Walking Tests

Physiological Cost Index (PCI) has been proposed to assess gait demand. The purpose of the study was to establish whether PCI is a valid indicator in subacute stroke patients of energy cost of walking in different walking conditions, that is, over ground and on the Gait Trainer (GT) with body weight support (BWS). The study tested if correlations exist between PCI and ECW, indicating validity of the measure and, by implication, validity of PCI. Six patients (patient group (PG)) with subacute stroke and 6 healthy age- and size-matched subjects as control group (CG) performed, in a random sequence in different days, walking tests overground and on the GT with 0, 30, and 50% BWS. There was a good to excellent correlation between PCI and ECW in the observed walking conditions: in PG Pearson correlation was 0.919 (p<0.001); in CG Pearson correlation was 0.852 (p<0.001). In conclusion, the high significant correlations between PCI and ECW, in all the observed walking conditions, suggest that PCI is a valid outcome measure in subacute stroke patients.

Factors associated with mobility apprehension in persons with lower limb amputation

2020 ◽  
Vol 44 (4) ◽  
pp. 208-214
Author(s):  
Shannon L Mathis
Keyword(s):  
Standard Deviation ◽  
Lower Limb ◽  
Avoidance Behavior ◽  
Pain Catastrophizing ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Walking Ability ◽  
Factors Associated ◽  
The Mean ◽  
The Impact

Background: Factors that are related to mobility apprehension were measured in a sample of persons with lower-limb amputation. Objectives: The purpose was to determine whether intensity, interference, or catastrophizing are associated with mobility apprehension. Study design: Cross-sectional study. Methods: Persons with amputation of a lower limb who were attending a national limb loss conference were recruited to complete a survey. Subjects were administered the Tampa Scale for Kinesiophobia to measure mobility apprehension. The Brief Pain Inventory was administered to quantify the affect of pain on general activity, walking ability, and enjoyment of life. The Pain Catastrophizing Scale was administered to assess the tendency to ruminate and magnify pain sensations. A multivariable linear regression was performed to determine factors associated with mobility apprehension. Results: Fifty-three people with lower-limb amputation participated in the study. The mean (standard deviation) score for mobility apprehension was 34.2 (6.0). Mean (standard deviation) pain intensity and interference scores were 1.6 (1.7) and 2.5 (2.6), respectively. The mean (standard deviation) pain catastrophizing score was 9.1 (10). Pain catastrophizing was the only variable associated with higher mobility apprehension ( β = 0.31, p < 0.001, R2 = 0.32). Results suggest that for every one-point increase in the pain catastrophizing score, mobility apprehension will increase by 0.3 of a point. Conclusion: These preliminary results suggest that pain catastrophizing was related to mobility apprehension in this cohort of persons with lower-limb amputation. This relationship indicates that the exploration of avoidance behaviors, such as pain catastrophizing, may be useful when developing a program for physical rehabilitation. Clinical relevance Pain catastrophizing, an avoidance behavior, may be associated with higher levels of mobility apprehension in persons with major lower-limb amputation. Understanding the impact of fear-avoidance behavior will allow clinicians to identify individuals at risk for poor outcomes following amputation surgery and to develop psychological strategies to complement treatment.

scholarly journals Dual Mode Gait Sonification for Rehabilitation After Unilateral Hip Arthroplasty

2019 ◽  
Vol 9 (3) ◽  
pp. 66 ◽  
Author(s):  
Julia Reh ◽  
Tong-Hun Hwang ◽  
Gerd Schmitz ◽  
Alfred Effenberg
Keyword(s):  
Hip Arthroplasty ◽  
Inertial Sensor ◽  
Gait Training ◽  
Control Group ◽  
Walking Ability ◽  
Dual Mode ◽  
Gait Symmetry ◽  
Home Based ◽  
Mode Method ◽  
The Impact

The pattern of gait after hip arthroplasty strongly affects regeneration and quality of life. Acoustic feedback could be a supportive method for patients to improve their walking ability and to regain a symmetric and steady gait. In this study, a new gait sonification method with two different modes—real-time feedback (RTF) and instructive model sequences (IMS)—is presented. The impact of the method on gait symmetry and steadiness of 20 hip arthroplasty patients was investigated. Patients were either assigned to a sonification group (SG) (n = 10) or a control group (CG) (n = 10). All of them performed 10 gait training sessions (TS) lasting 20 min, in which kinematic data were measured using an inertial sensor system. Results demonstrate converging step lengths of the affected and unaffected leg over time in SG compared with a nearly parallel development of both legs in CG. Within the SG, a higher variability of stride length and stride time was found during the RTF training mode in comparison to the IMS mode. Therefore, the presented dual mode method provides the potential to support gait rehabilitation as well as home-based gait training of orthopedic patients with various restrictions.

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