Validation of a Laser Ranged Scanner-Based Detection of Spatio-Temporal Gait Parameters Using the aTUG Chair

This article covers the suitability to measure gait-parameters via a Laser Range Scanner (LRS) that was placed below a chair during the walking phase of the Timed Up&Go Test in a cohort of 92 older adults (mean age 73.5). The results of our study demonstrated a high concordance of gait measurements using a LRS in comparison to the reference GAITRite walkway. Most of aTUG’s gait parameters demonstrate a strong correlation coefficient with the GAITRite, indicating high measurement accuracy for the spatial gait parameters. Measurements of velocity had a correlation coefficient of 99%, which can be interpreted as an excellent measurement accuracy. Cadence showed a slightly lower correlation coefficient of 96%, which is still an exceptionally good result, while step length demonstrated a correlation coefficient of 98% per leg and stride length with an accuracy of 99% per leg. In addition to confirming the technical validation of the aTUG regarding its ability to measure gait parameters, we compared results from the GAITRite and the aTUG for several parameters (cadence, velocity, and step length) with results from the Berg Balance Scale (BBS) and the Activities-Specific Balance Confidence-(ABC)-Scale assessments. With confidence coefficients for BBS and velocity, cadence and step length ranging from 0.595 to 0.798 and for ABC ranging from 0.395 to 0.541, both scales demonstrated only a medium-sized correlation. Thus, we found an association of better walking ability (represented by the measured gait parameters) with better balance (BBC) and balance confidence (ABC) overall scores via linear regression. This results from the fact that the BBS incorporates both static and dynamic balance measures and thus, only partly reflects functional requirements for walking. For the ABC score, this effect was even more pronounced. As this is to our best knowledge the first evaluation of the association between gait parameters and these balance scores, we will further investigate this phenomenon and aim to integrate further measures into the aTUG to achieve an increased sensitivity for balance ability.

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Using Biofeedback to Reduce Step Length Asymmetry Impairs Dynamic Balance in People Poststroke

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211019346 ◽

2021 ◽

pp. 154596832110193

Author(s):

Sungwoo Park ◽

Chang Liu ◽

Natalia Sánchez ◽

Julie K. Tilson ◽

Sara J. Mulroy ◽

...

Keyword(s):

Angular Momentum ◽

Sagittal Plane ◽

Dynamic Balance ◽

Objective Measure ◽

Frontal Plane ◽

Step Length ◽

Berg Balance Scale ◽

Whole Body ◽

Functional Gait ◽

Full Body

Background People poststroke often walk with a spatiotemporally asymmetric gait, due in part to sensorimotor impairments in the paretic lower extremity. Although reducing asymmetry is a common objective of rehabilitation, the effects of improving symmetry on balance are yet to be determined. Objective We established the concurrent validity of whole-body angular momentum as a measure of balance, and we determined if reducing step length asymmetry would improve balance by decreasing whole-body angular momentum. Methods We performed clinical balance assessments and measured whole-body angular momentum during walking using a full-body marker set in a sample of 36 people with chronic stroke. We then used a biofeedback-based approach to modify step length asymmetry in a subset of 15 of these individuals who had marked asymmetry and we measured the resulting changes in whole-body angular momentum. Results When participants walked without biofeedback, whole-body angular momentum in the sagittal and frontal plane was negatively correlated with scores on the Berg Balance Scale and Functional Gait Assessment supporting the validity of whole-body angular momentum as an objective measure of dynamic balance. We also observed that when participants walked more symmetrically, their whole-body angular momentum in the sagittal plane increased rather than decreased. Conclusions Voluntary reductions of step length asymmetry in people poststroke resulted in reduced measures of dynamic balance. This is consistent with the idea that after stroke, individuals might have an implicit preference not to deviate from their natural asymmetry while walking because it could compromise their balance. Clinical Trials Number: NCT03916562.

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Short-latency inhibition mitigates the relationship between conscious movement processing and overly cautious gait

Age and Ageing ◽

10.1093/ageing/afaa230 ◽

2020 ◽

Author(s):

Toby J Ellmers ◽

Elmar C Kal ◽

James K Richardson ◽

William R Young

Keyword(s):

Older Adults ◽

Step Length ◽

Berg Balance Scale ◽

Short Latency ◽

Gait Velocity ◽

Functional Balance ◽

Inhibitory Function ◽

Gait Parameters ◽

Base Of Support ◽

The Relationship

Abstract Background Overly cautious gait is common in older adults. This is characterised by excessively slow gait, shortened steps, broadened base of support and increased double limb support. The current study sought to (1) evaluate if overly cautious gait is associated with attempts to consciously process walking movements, and (2) explore whether an individual’s ability to rapidly inhibit a dominant motor response serves to mitigate this relationship. Methods A total of 50 older adults walked at a self-selected pace on an instrumented walkway containing two raised wooden obstacles (height = 23 cm). Trait conscious movement processing was measured with the Movement-Specific Reinvestment Scale. Short-latency inhibitory function was assessed using a validated electronic go/no-go ruler catch protocol. We used linear regressions to explore the relationship between these variables and gait parameters indicative of overly cautious gait. Results When controlling for general cognitive function (MoCA), and functional balance (Berg Balance Scale), the interaction between trait conscious movement processing and short-latency inhibition capacity significantly predicted gait velocity, step length and double limb support. Specifically, older adults with higher trait conscious movement processing and poorer inhibition were more likely to exhibit gait characteristics indicative of cautious gait (i.e. reduced velocity, shorter step lengths and increased double limb support). Neither conscious movement processing nor inhibition independently predicted gait performance. Conclusion The combination of excessive movement processing tendencies and poor short-latency inhibitory capacity was associated with dysfunctional or ‘overly cautious’ gait. It is therefore plausible that improvement in either factor may lead to improved gait and reduced fall risk.

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

Journal of Telemedicine and Telecare ◽

10.1177/1357633x18822355 ◽

2019 ◽

Vol 26 (5) ◽

pp. 251-260 ◽

Cited By ~ 2

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.

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Effects of application of texture insoles on the balance of subjects with Multiple Sclerosis

ConScientiae Saúde ◽

10.5585/conssaude.v16n1.6860 ◽

2017 ◽

Vol 16 (1) ◽

pp. 9-16

Author(s):

Wildja De Lima Gomes ◽

Thais Botossi Scalha ◽

Lucas Brino Mota ◽

Viviane Almeida Kuroda ◽

Juliana Cintra Garrafa ◽

...

Keyword(s):

Multiple Sclerosis ◽

Dynamic Balance ◽

Step Length ◽

Berg Balance Scale ◽

Measuring Instruments ◽

Balance Scale ◽

Functional Gait ◽

Dynamic Gait Index ◽

Dynamic Gait ◽

Gait Index

Objective: The aim of this study was to evaluate the effects on static and dynamic balance after the use of textured insoles. Method: Fifteen subjects with multiple sclerosis were evaluated before using the insoles, after using them for 1 month, and after 2 months without using, them using the following measuring instruments: the Berg Balance Scale, Dynamic Gait Index, and 10-meter Walk Test, a means of functional gait assessment. Results: Improvement was observed in the Berg Balance Scale and Dynamic Gait Index scores, walking time, number of steps and step length after using the insoles for 1 month. The improvement in Berg Balance Scale score remained after two months without the insoles and there were no changes in gait speed. Conclusion: The use of textured insoles was effective as an intervention to improve static and dynamic balance in patients with multiple sclerosis.

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Comparing the short and original versions of the Activities-specific Balance Confidence (ABC) scale in older adults

Innovation in Aging ◽

10.1093/geroni/igab046.2891 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 790-790

Author(s):

Chad Tiernan ◽

Allon Goldberg

Keyword(s):

Older Adults ◽

Correlation Coefficient ◽

Strong Association ◽

Secondary Analysis ◽

Community Dwelling ◽

Tool Selection ◽

Balance Confidence ◽

Confidence Assessment ◽

Abc Scale ◽

Primary Predictor

Abstract Balance confidence assessment in older adults has implications for falls and quality of life. It remains unclear whether the original Activities-specific Balance Confidence (ABC-16) scale or the shortened 6-item (ABC-6) scale is recommended. To further inform the decision-making process of balance confidence tool selection, a secondary analysis of an existing dataset consisting of 77 community-dwelling older adults was performed. ABC-16 and ABC-6 association and agreement, internal consistencies, and relationships with self-rated health (SRH) were assessed. Participants were primarily female (80.5%) between the ages of 60 and 87 years. Results indicated a strong association between the scales [r = .97, p<.001); ICC(2,1) = .80] but limited agreement (95% Limits of Agreement range = 22.1; mean difference of 7.2 points in the direction of the ABC-16). Cronbach’s alphas were .95 (ABC-16) and .89 (ABC-6), suggesting high internal consistency for both scales but possible item redundancy with the ABC-16. Regression model 1 (ABC-6 = primary predictor) explained more of the variance (R2=.36) in SRH compared to model 2 (ABC-16 = primary predictor; R2=.29). Hotelling’s t-test [t(74)=2.4, p=.008] indicated that the correlation coefficient (Multiple R) from the ABC-6 model was significantly higher than the correlation coefficient from the ABC-16 model. In conclusion, despite a high correlation, the two scales did not agree strongly and should not be considered interchangeable. Given that the ABC-16 takes longer to administer, does not relate to SRH as strongly, and could have redundant items, the ABC-6 should be considered for balance confidence assessment in older adults.

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Dynamic Balance Gait for Walking Assistance Exoskeleton

Applied Bionics and Biomechanics ◽

10.1155/2018/7847014 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 9

Author(s):

Qiming Chen ◽

Hong Cheng ◽

Chunfeng Yue ◽

Rui Huang ◽

Hongliang Guo

Keyword(s):

Dynamic Balance ◽

External Disturbance ◽

Sensory Information ◽

Step Length ◽

Orbital Energy ◽

Gait Planning ◽

Lower Limb Exoskeleton ◽

Gait Parameters ◽

Cord Injury ◽

One Step

Purpose. Powered lower-limb exoskeleton has gained considerable interests, since it can help patients with spinal cord injury(SCI) to stand and walk again. Providing walking assistance with SCI patients, most exoskeletons are designed to follow predefined gait trajectories, which makes the patient walk unnaturally and feels uncomfortable. Furthermore, exoskeletons with predefined gait trajectories cannot always maintain balance walking especially when encountering disturbances. Design/Methodology/Approach. This paper proposed a novel gait planning approach, which aims to provide reliable and balance gait during walking assistance. In this approach, we model the exoskeleton and patient together as a linear inverted pendulum (LIP) and obtain the patients intention through orbital energy diagram. To achieve dynamic gait planning of exoskeleton, the dynamic movement primitive (DMP) is utilized to model the gait trajectory. Meanwhile, the parameters of DMP are updated dynamically during one step, which aims to improve the ability of counteracting external disturbance. Findings. The proposed approach is validated in a human-exoskeleton simulation platform, and the experimental results show the effectiveness and advantages of the proposed approach. Originality/Value. We decomposed the issue of obtain dynamic balance gait into three parts: (1) based on the sensory information of exoskeleton, the intention estimator is designed to estimate the intention of taking a step; (2) at the beginning of each step, the discrete gait planner utilized the obtained gait parameters such as step length S and step duration T and generate the trajectory of swing foot based on S,T; (3) during walking process, continuous gait regulator is utilized to adjust the gait generated by discrete gait planner to counteract disturbance.

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

Stroke ◽

10.1161/str.51.suppl_1.46 ◽

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.

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Efficacy of the structured balance awareness program on perceived balance confidence and fear-related maladaptive behaviour in post-stroke survivors

Neurorehabilitation ◽

10.3233/nre-210144 ◽

2021 ◽

pp. 1-6

Author(s):

Abdul Rahim Shaik ◽

Fuzail Ahmad ◽

Mohammad Miraj ◽

Mazen Alqahtani ◽

Msaad Alzhrani ◽

...

Keyword(s):

Berg Balance Scale ◽

T Test ◽

Stroke Survivors ◽

Healthy Older Adults ◽

Balance Confidence ◽

Post Stroke ◽

Awareness Program ◽

Maladaptive Behaviour ◽

Physical Functions ◽

Abc Scale

BACKGROUND: The risk of falling for individuals with stroke is about twice that of healthy older adults. Lack of appropriate initiative to address the fear-related maladaptive behaviour can manifest itself in the form of loss of physical functions resulting in disability and handicap. OBJECTIVE: To examine the effectiveness of the structured balance awareness program (SBAP) in improving the perceived balance confidence, and thereby modifying the fear-related maladaptive behaviour in post-stroke survivors. METHODS: A randomized experimental control design was used on a sample of 97 post-stroke survivors aged between 55 to 75 years. The patients received either the SBAP or health awareness program (HAP) for eight weeks and were compared on Activities-specific Balance Confidence (ABC) Scale, Berg Balance Scale (BBS) and Falls Efficacy Scale International (FESI). RESULTS: A paired t-test demonstrated statistically significant improvement among all the variables in the SBAP group. An independent t-test exhibited a statistically significant improvement on ABC (t = 2.57, p = 0.012 *), BBS (t = 3.32, p = 0.001 *) and FESI (t = 3.38, p = 0.001 *) in the SBAP group. CONCLUSION: The study showed that the SBAP was effective in minimizing the fear-related maladaptive behaviour in post-stroke survivors.

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Effects on Balance and Walking with the CoDuSe Balance Exercise Program in People with Multiple Sclerosis: A Multicenter Randomized Controlled Trial

Multiple Sclerosis International ◽

10.1155/2016/7076265 ◽

2016 ◽

Vol 2016 ◽

pp. 1-10 ◽

Cited By ~ 11

Author(s):

Anette Forsberg ◽

Lena von Koch ◽

Ylva Nilsagård

Keyword(s):

Multiple Sclerosis ◽

Postural Sway ◽

Dynamic Balance ◽

Controlled Trial ◽

Exercise Program ◽

Core Stability ◽

Balance Confidence ◽

Balance Exercise ◽

Multicenter Randomized Controlled Trial ◽

Abc Scale

Background. Balance and walking impairments are frequent in people with multiple sclerosis (MS).Objective. The aim was to investigate the effects of a group-based balance exercise program targeting core stability, dual tasking, and sensory strategies (CoDuSe) on balance, postural sway, walking, perceived walking limitations, and balance confidence.Design. A single-blinded randomized multicenter trial. No intervention was given to controls.Participants. People with MS able to walk 100 meters but unable to maintain tandem stance ≥30 seconds. Eighty-seven participants were randomized to intervention or control.Intervention. The 60-minute CoDuSe group program, twice weekly for seven weeks, supervised by physical therapists.Measurements. Primary outcome was dynamic balance (Berg Balance Scale (BBS)). Secondary outcomes were postural sway, walking (Timed-Up and Go test; Functional Gait Assessment (FGA)), MS Walking Scale, and Activities-specific Balance Confidence (ABC) Scale. Assessments were performed before and after (week 8) the intervention.Results. 73 participants fulfilled the study. There were significant differences between the intervention and the control groups in change in the BBS and in the secondary measures: postural sway with eyes open, FGA, MS Walking Scale, and ABC scale in favor of the intervention.Conclusions. The seven-week CoDuSe program improved dynamic balance more than no intervention.

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