Motor–Cognitive Treadmill Training With Virtual Reality in Parkinson’s Disease: The Effect of Training Duration

Treadmill training with virtual reality (TT + VR) has been shown to improve gait performance and to reduce fall risk in Parkinson’s disease (PD). However, there is no consensus on the optimal training duration. This study is a sub-study of the V-TIME randomized clinical trial (NCT01732653). In this study, we explored the effect of the duration of training based on the motor–cognitive interaction on motor and cognitive performance and on fall risk in subjects with PD. Patients in Hoehn and Yahr stages II–III, aged between 40 and 70 years, were included. In total, 96 patients with PD were assigned to 6 or 12 weeks of TT + VR intervention, and 77 patients completed the full protocol. Outcome measures for gait and cognitive performance were assessed at baseline, immediately after training, and at 1- and 6-month follow-up. The incident rate of falls in the 6-month pre-intervention was compared with that in the 6-month post-intervention. Dual-task gait performance (gait speed, gait speed variability and stride length under cognitive dual task and obstacle negotiation, and the leading foot clearance in obstacle negotiation) improved similarly in both groups with gains sustained at 6-month follow-up. A higher decrease in fall rate and fear of falling were observed in participants assigned to the 12-week intervention than the 6-week intervention. Improvements in cognitive functions (i.e., executive functions, visuospatial ability, and attention) were seen only in participants enrolled in 12-week training up to 1-month follow-up but vanished at the 6-month evaluation. Our results suggest that a longer TT + VR training leads to greater improvements in cognitive functions especially those directly addressed by the virtual environment.

Rehabilitation Interventions for Gait Problems in Patients With Diabetic Peripheral Neuropathy: A Scoping Review

Background and Objectives: Gait and balance disturbances are challenging conditions in patients with Diabetic Peripheral Neuropathy (DPN). The overall literary consensus is that rehabilitation interventions are effective in improving gait performance in this patient group. This review sought to highlight and assess the literature and provide a scoping review on the current knowledge gaps in the rehabilitation interventions for the gait problems of patients with DPN. Methods: An electronic databases search was done between 2001 and May 2020. Besides, a hand-search method was used for grey literature. Two experts reviewed the results and screened them based on the subject’s diagnosis with DPN and gait problems. Results: Of 87 studies obtained, nine met the inclusion criteria. The frequent components of the rehabilitation interventions included exercise therapy, dual-task intervention, and the use of assistive devices. The outcomes utilized most frequently included changes in balance and stability, muscle strength, proprioception, function, and gait parameters. Conclusion: Evidence was formed as a scoping review to guide rehabilitation for DPN patients with gait problems. Rigorous comparative studies with clearly defined interventions are needed.

Gait Improvement in Chronic Stroke Survivors by Using an Innovative Gait Training Machine: A Randomized Controlled Trial

Chronic stroke leads to the impairment of lower limb function and gait performance. After in-hospital rehabilitation, most individuals lack continuous gait training because of the limited number of physical therapists. This study aimed to evaluate the effects of a newly invented gait training machine (I-Walk) on lower limb function and gait performance in chronic stroke individuals. Thirty community-dwelling chronic stroke individuals were allocated to the I-Walk machine group (n = 15) or the overground gait training (control) group (n = 15). Both groups received 30 min of upper limb and hand movement and sit-to-stand training. After that, the I-Walk group received 30 min of I-Walk training, while the control followed a 30-minute overground training program. All the individuals were trained 3 days/week for 8 weeks. The primary outcome of the motor recovery of lower limb impairment was measured using the Fugl–Meyer Assessment (FMA). The secondary outcomes for gait performance were the 6-minute walk test (6 MWT), the 10-meter walk test (10 MWT), and the Timed Up and Go (TUG). The two-way mixed-model ANOVA with the Bonferroni test was used to compare means within and between groups. The post-intervention motor and sensory subscales of the FMA significantly increased compared to the baseline in both groups. Moreover, the 6 MWT and 10 MWT values also improved in both groups. In addition, the mean difference of TUG in the I-Walk was higher than the control. The efficiency of I-Walk training was comparable to overground training and might be applied for chronic stroke gait training in the community.

Static and Dynamic Plantar Pressure and Normalized Plantar Pressure Characteristics among Children, Adults, and the Elderly

Background: A better understanding of plantar pressure while standing and walking would help in improving balance and gait performance across different age ranges. Objective: To clarify the differences of plantar pressure while standing and walking among children, adults, and the elderly. Materials and Methods: Fifty-three participants including eleven aged 3 to 8 years, thirty aged 20 to 40 years, and twelve aged 60 to 90 years were included in the present study. Plantar pressure and related parameters while quiet standing and walking with self-selected speed were assessed. Results: In static plantar pressure, no significant differences were observed of mean different pressure and mean different contact area between dominant and non-dominant limbs among the three groups, while center of pressure (COP) displacement was shown as significantly greater between children and adults (p<0.05). For dynamic plantar pressure, no significant differences in COP velocity were found among the three groups. The elderly showed significant lower normalized maximum plantar pressure in areas of the second and third metatarsal, and internal heel compared with the young adults (p<0.05). Additionally, normalized maximum plantar pressures among children seemed to differ from adults. Conclusion: Plantar pressure characteristics could indicate that children develop gait ability in braking and propulsion phases with greater heel and toe function, while the ability of braking and propulsion declined with aging. These could reflect balance ability while standing or walking. Keywords: Foot pressure; Children; Elderly; Normalization

Combining Transcranial Direct Current Stimulation With Tai Chi to Improve Dual-Task Gait Performance in Older Adults With Mild Cognitive Impairment: A Randomized Controlled Trial

Introduction: Engaging in a secondary task while walking increases motor-cognitive interference and exacerbates fall risk in older adults with mild cognitive impairment (MCI). Previous studies have demonstrated that Tai Chi (TC) may improve cognitive function and dual-task gait performance. Intriguingly, with emerging studies also indicating the potential of transcranial direct current stimulation (tDCS) in enhancing such motor-cognitive performance, whether combining tDCS with TC might be superior to TC alone is still unclear. The purpose of this study was to investigate the effects of combining tDCS with TC on dual-task gait in patients with MCI.Materials and Methods: Twenty patients with MCI were randomly assigned to receive either anodal or sham tDCS, both combined with TC, for 36 sessions over 12 weeks. Subjects received 40 min of TC training in each session. During the first 20 min, they simultaneously received either anodal or sham tDCS over the left dorsolateral prefrontal cortex. Outcome measures included dual-task gait performance and other cognitive functions.Results: There were significant interaction effects between groups on the cognitive dual task walking. Compared to sham, the anodal tDCS group demonstrated a greater improvement on cadence and dual task cost of speed.Conclusion: Combining tDCS with TC may offer additional benefits over TC alone in enhancing dual-task gait performance in patients with MCI.Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [TCTR20201201007].

The Effect of Implanted Functional Electrical Stimulation on Gait Performance in Stroke Survivors: A Systematic Review

The emerging literature suggests that implantable functional electrical stimulation may improve gait performance in stroke survivors. However, there is no review providing the possible therapeutic effects of implanted functional electrical stimulation on gait performance in stroke survivors. We performed a web-based, systematic paper search using PubMed, the Cochrane Library, and EMBASE. We limited the search results to human subjects and papers published in peer-reviewed journals in English. We did not restrict demographic or clinical characteristics. We included 10 papers in the current systematic review. Across all included studies, we found preliminary evidence of the potential therapeutic effects of functional electrical stimulation on walking endurance, walking speed, ankle mobility, and push-off force in stroke survivors. However, due to the heterogeneity between the included studies, small sample size, and lack of randomized controlled trials, more studies are critically needed to confirm whether implanted functional electrical stimulation can improve gait performance in stroke survivors.

Effects of Combining Online Anodal Transcranial Direct Current Stimulation and Gait Training in Stroke Patients: A Systematic Review and Meta-Analysis

Objective: Combining transcranial direct current stimulation (tDCS) and repetitive gait training may be effective for gait performance recovery after stroke; however, the timing of stimulation to obtain the best outcomes remains unclear. We performed a systematic review and meta-analysis to establish evidence for changes in gait performance between online stimulation (tDCS and repetitive gait training simultaneously) and offline stimulation (gait training after tDCS).Methods: We comprehensively searched the electronic databases Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature, and included studies that combined cases of anodal tDCS with motor-related areas of the lower limbs and gait training. Nine studies fulfilled the inclusion criteria and were included in the systematic review, of which six were included in the meta-analysis.Result: The pooled effect estimate showed that anodal tDCS significantly improved the 10-m walking test (p = 0.04; I2 = 0%) and 6-min walking test (p = 0.001; I2 = 0%) in online stimulation compared to sham tDCS.Conclusion: Our findings suggested that simultaneous interventions may effectively improve walking ability. However, we cannot draw definitive conclusions because of the small sample size. More high-quality studies are needed on the effects of online stimulation, including various stimulation parameters.

Enriched Rehabilitation Improves Gait Disorder and Cognitive Function in Parkinson’s Disease: A Randomized Clinical Trial

Background: Studies on non-pharmacological strategies for improving gait performance and cognition in Parkinson’s disease (PD) are of great significance. We aimed to investigate the effect of and mechanism underlying enriched rehabilitation as a potentially effective strategy for improving gait performance and cognition in early-stage PD.Methods: Forty participants with early-stage PD were randomly assigned to receive 12 weeks (2 h/day, 6 days/week) of enriched rehabilitation (ER; n = 20; mean age, 66.14 ± 4.15 years; 45% men) or conventional rehabilitation (CR; n = 20; mean age 65.32 ± 4.23 years; 50% men). In addition, 20 age-matched healthy volunteers were enrolled as a control (HC) group. We assessed the general motor function using the Unified PD Rating Scale—Part III (UPDRS-III) and gait performance during single-task (ST) and dual-task (DT) conditions pre- and post-intervention. Cognitive function assessments included the Montreal Cognitive Assessment (MoCA), the Symbol Digit Modalities Test (SDMT), and the Trail Making Test (TMT), which were conducted pre- and post-intervention. We also investigated alteration in positive resting-state functional connectivity (RSFC) of the left dorsolateral prefrontal cortex (DLPFC) in participants with PD, mediated by ER, using functional magnetic resonance imaging (fMRI).Results: Compared with the HC group, PD participants in both ER and CR groups performed consistently poorer on cognitive and motor assessments. Significant improvements were observed in general motor function as assessed by the UPDRS-III in both ER and CR groups post-intervention. However, only the ER group showed improvements in gait parameters under ST and DT conditions post-intervention. Moreover, ER had a significant effect on cognition, which was reflected in increased MoCA, SDMT, and TMT scores post-intervention. MoCA, SDMT, and TMT scores were significantly different between ER and CR groups post-intervention. The RSFC analysis showed strengthened positive functional connectivity between the left DLPFC and other brain areas including the left insula and left inferior frontal gyrus (LIFG) post-ER.Conclusion: Our findings indicated that ER could serve as a potentially effective therapy for early-stage PD for improving gait performance and cognitive function. The underlying mechanism based on fMRI involved strengthened RSFC between the left DLPFC and other brain areas (e.g., the left insula and LIFG).

THE EFFECTS OF TRAINING ON DIFFERENT SURFACES, ON BALANCE AND GAIT PERFORMANCE IN STROKE HEMIPLEGIA

ABSTRACT Although many studies have focused on balance exercises for elderly or stroke patients, no comprehensive studies have investigated the use of training on different surfaces (TDS) with analysis of gait performance in elderly male stroke patients. The active properties of balance and subjective reporting of functional gait ability were used to identify the effects of TDS. Static balance (SB), dynamic balance (DB) and gait analysis was measured in 30 elderly stroke patients. The patients were divided into the TDS group (n=15) and a control group (CG, n=15). Fifteen elderly stroke patients underwent TDS five times a week for 12 weeks. The data was analyzed using repeated measures analysis of variance. Significant differences were observed between the two groups (TDS and Control): SB (p < 0.0001), DB (OSI: p < 0.0001, APSI: p < 0.001, MLSI: p < 0.004) and gait analysis (right: temporal step time: p < 0.0001, temporal cycle time: p < 0.001, temporal double support time: p < 0.0001; left: temporal step time: p < 0.0001, temporal cycle time: p < 0.0001, temporal double support time: p < 0.0001). TDS in elderly male stroke patients suggests that the characteristics of gait performance in these patients may be improved by increasing static balance, dynamic balance and gait velocity. It is hoped that the results of this trial will provide new information on the effects of TDS on balance stability and gait ability in stroke patients, through changes in stability of the lower extremities. Level III, Case-control Study.

Finding Factors in Footfalls: Exploring the Factor Structure of Gait in Older Adults

Gait is a reputed marker of global health spanning various bodily systems (MacDonald et al., 2017) and is a robust predictor of deleterious age-related outcomes (Van Kan et al., 2009). However, the sheer number of individual gait variables employed as predictors in the existing literature can obscure interpretations. To address this issue, researchers have explored the factor structure of gait indicators to explain variance in age-related gait performance, identifying disparate models characterized by three to five underlying latent gait constructs comprised of 8 to 23 indicators (Hollman et al., 2011; Lord et al., 2013). Beyond this heterogeneity, additional limitations characterizing this literature include solutions that assume statistical independence among gait constructs, as well as inclusion of severely multicollinear indicators. Using data from the Healthy Minds Healthy Bodies (HMHB) study, the present research focused upon replicating and contrasting previous factor analytic efforts. HMHB participants (n=128) were healthy community-dwelling adults (Mage=72.81±5.24 years; female=100). Gait indicators from a GAITRite computerized walkway were selected according to a priori theoretical rationale, compatibility with previous studies, and consideration of multicollinearity. Gait factor structure was initially analyzed using principal component analysis. Results indicate the presence of three latent gait domains reflecting pace, rhythm, and variability, accounting for over 82.4% of the variance in gait performance. Current proceedings involve implementing confirmatory factor analysis to compare competing gait models. Findings will address disparities across factor models in the gait literature, as well as discuss the optimal number of factors for describing the underlying dimensionality of gait.