Measuring Kinematic Response to Perturbed Locomotion in Young Adults

Daily life activities often require humans to perform locomotion in challenging scenarios. In this context, this study aimed at investigating the effects induced by anterior-posterior (AP) and medio-lateral (ML) perturbations on walking. Through this aim, the experimental protocol involved 12 participants who performed three tasks on a treadmill consisting of one unperturbed and two perturbed walking tests. Inertial measurement units were used to gather lower limb kinematics. Parameters related to joint angles, as the range of motion (ROM) and its variability (CoV), as well as the inter-joint coordination in terms of continuous relative phase (CRP) were computed. The AP perturbation seemed to be more challenging causing differences with respect to normal walking in both the variability of the ROM and the CRP amplitude and variability. As ML, only the ankle showed different behavior in terms of joint angle and CRP variability. In both tasks, a shortening of the stance was found. The findings should be considered when implementing perturbed rehabilitative protocols for falling reduction.

ASSOCIATION BETWEEN BALANCE SELF-EFFICACY AND WALKING ABILITY IN THOSE WITH NEW LOWER LIMB AMPUTATIONS

BACKGROUND: A relationship between walking ability and self-efficacy has been demonstrated in various rehabilitation patient populations. In experienced prosthetic ambulators, walking ability is related to self-efficacy of balance, however, this relationship has not been quantified for those with newly acquired lower limb amputations (LLA). OBJECTIVE(S): To investigate the association between walking performance (objective) and self-reported walking abilities (subjective) on balance self-efficacy in those with LLA. METHODOLOGY: Cross-sectional study of 27 people (17 men; mean age=63.57±9.33) at discharge from inpatient prosthetic rehabilitation for first major unilateral LLA. Individuals completed 6m straight path walking and the L-Test under single- and dual-task conditions. The Prosthesis Evaluation Questionnaire (PEQ) was administered, and the Ambulation subscale provided subjective measures of walking ability. A single PEQ question on satisfaction with walking (16B) was also used as a proxy for subjective walking ability. The Activities-specific Balance Confidence Scale measured balance self-efficacy. Multivariable linear regression was used to evaluate the strength of association between walking ability (objective and subjective) and balance self-efficacy (dependent variable). FINDINGS: Walking velocity on the 6m straight path under single-task (p=0.011) and dual-task conditions (p=0.039), the single-task L-Test (p=0.035) and self-reported satisfaction with walking (p=0.019) were associated with self-efficacy of balance. CONCLUSION: Objective measures of walking ability that were independently associated with balance self-efficacy included straight path walking velocity under single and dual-task conditions and the single-task L-Test. Satisfaction with walking was also associated with balance self-efficacy. This highlights the interplay between physical and psychological factors during rehabilitation. More research in the area of self-efficacy and walking ability is needed to establish self-efficacy as a target during prosthetic rehabilitation for those with LLA. Layman's Abstract Self-efficacy is a person’s belief in their ability to do a certain task well. Improving self-efficacy can be done by watching others complete a task, by getting praise from experts, or by doing the task yourself. There is a link between how well some people walk and their confidence with walking, however this has not been studied in people learning to use a lower limb prosthesis. The goal of this paper was to study the link between balance self-efficacy, scores on walking tests and self-reported walking ability in those with lower limb amputations (LLA) when they leave rehabilitation. To do this, two walking tests were done (straight path and complex path) in two settings (walking only and walking with distraction). A survey about walking ability and a questionnaire on balance self-efficacy were also done. Results showed that self-efficacy of balance was related to the straight path walking test under both settings and the complex walking test during walking alone. A person’s satisfaction with walking ability was also linked. The only test not related was the complex walking test under distracting conditions. It might be that more time is needed for people with LLA to confidently do this task. This shows the link between physical and mental factors during rehabilitation. More research is needed to find other factors that might impact self-efficacy and walking ability in people with LLA when they leave rehabilitation. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36695/28904 How To Cite: Frengopoulos C, Zia Z, Payne M.W.C, Viana R, Hunter S.W. Association between balance self-efficacy and walking ability in those with new lower limb amputations. Canadian Prosthetics & Orthotics Journal. 2022; Volume 5, Issue 1, No.4. https://doi.org/10.33137/cpoj.v5i1.36695 Corresponding Author: Courtney Frengopoulos,University of Western Ontario, Room 1408, Elborn College, London, Ontario, Canada, N6G 1H1.E-Mail: [email protected] ID: https://orcid.org/0000-0002-4131-2727

Clemastine Enhances Myelination, Delays Axonal Loss and Promotes Functional Recovery in Spinal Cord Injury

Recent evidence has shown that demyelination occurs along with axonal degeneration in spinal cord injury (SCI) during the secondary injury phase. Oligodendrocyte precursor cells (OPC) are present in the lesions but fail to differentiate into mature oligodendrocytes and form new myelin. Given the limited recovery of neuronal functions after SCI in adults without effective treatment available so far, it remains unknown whether enhancing OPC differentiation and myelination could benefit the recovery of SCI. To show the significance of myelin regeneration after SCI, the injury was treated with clemastine in the rat model. Clemastine is an FDA-approved drug that is potent in promoting oligodendrocyte differentiation and myelination in vivo, for four weeks following SCI. Motor function was assessed using sloping boards and grid walking tests and scored according to the Basso, Beattie, and Bresnahan protocol. The myelin integrity and protein expression were evaluated using transmission electron microscopy and immunofluorescence, respectively. The results indicated that clemastine treatment preserves myelin integrity, decreases loss of axons and improves functional recovery in the rat SCI model. The presented data suggest that myelination-enhancing strategies may serve as a potential therapeutic approach for the functional recovery in SCI.

Clinical Walking Tests and Gait Pattern Characterization During 6-Minute Walk Test Using Inertial Sensors: Follow-Up in Individuals With Lower Limb Amputation

Inertial measurement units and normative values enable clinicians to quantify clinical walking tests and set rehabilitation goals. Objectives of this study were (1) to compare time- and distance-based walking tests in individuals with lower limb amputation (iLLA) and normative values following rehabilitation discharge (T1) and 6 weeks after discharge (T2) and (2) to investigate spatiotemporal and foot kinematic parameters over a 6-minute walk test using inertial measurement units. Twelve iLLA participated in this study. Distance, cadence, stance ratio, loading rate ratio, push-up ratio, path length, and minimum toe clearance were analyzed during 6-minute walk test. Nonparametric repeated-measures analysis of variance tests, Bonferroni corrections, were performed. Time of distance-based walking tests diminished at T2 (P < .02). Compared with normative values, walking performance in iLLA was reduced. Cadence at T2 increased significantly (P = .026). Stance ratio increased in both legs at T2 (P < .05). Push-up ratio tended to decrease at T2 in the amputated leg (P = .0003). Variability of path length and minimum toe clearance at T2 were less than at T1 in the nonamputated leg (P < .05). Spatiotemporal improvement at T2 could be due to prosthesis adaptation in iLLA. The lower performance of the functional walk test compared with normative values could be due to amputation and pain-related fatigue.

Walking Impairment Questionnaire and Walking Tests are Reliable Indicators of Success of Treatment of Peripheral Artery Disease

The functional capacity of patients with peripheral arterial disease (PAD) represents an important indicator of patient health and quality of life. The aim of this prospective study was to investigate the validity of a walking impairment questionnaire (WIQ) compared with walking tests for the estimation of the therapeutic effect of lower limb revascularization. The study included 36 patients with PAD in whom successful percutaneous revascularization of a lower limb was performed due to disabling intermittent claudication. Before the revascularization procedure and 4–6 weeks after successful revascularization, clinical examination, ankle brachial index (ABI) measurement, 6-min walk test, treadmill test, and WIQ were performed. After revascularization, significant improvement in walking capacity was shown by both 6-min walk test and treadmill exercise test as well as with WIQ. However, the increase in ABI was borderline. Significant correlations between improvement of 6-min walk test and treadmill exercise test results and the sum of WIQ points were found. The ABI was significantly correlated with treadmill maximal walking distance only. According to our results, the WIQ correlates well with walking tests and is a reliable indicator of effective revascularization of lower limb arterial occlusions, even in patients with a nonsignificant improvement of the ABI.

C-Gait for Detecting Freezing of Gait in the Early to Middle Stages of Parkinson’s Disease: A Model Prediction Study

Graphical AbstractPatients with early- to middle-stage PD (Hoehn and Yahr stages 1–3) were enrolled for C-Gait assessment and traditional walking ability assessments. The correlation of C-Gait assessment and traditional walking tests were studied. Two models were established based on C-Gait assessment and traditional walking tests to explore the value of C-Gait assessment in predicting freezing of gait.

Application of the Modified Incremental Step Test for Pulmonary Rehabilitation

Objective A modified incremental step test (MIST) performed in the home may facilitate entirely home-based pulmonary rehabilitation programs. The aims of this study were to investigate the reliability and responsiveness, and the utility of the MIST for exercise prescription in people with stable chronic lung disease. Methods The MIST was undertaken at the centre and home in random order, before and after pulmonary rehabilitation, with two tests at each time point. Reliability was assessed using intraclass correlation coefficient. Responsiveness was evaluated as effect size. The minimal important difference was appraised using distribution and anchor-based methods. In a sub-study, physiological responses to MIST were measured by a portable metabolic system, followed by a constant step rate test at 60% of peak oxygen uptake (v̇O2peak), to evaluate utility for exercise prescription. Results Forty-six participants were recruited (29% of eligible candidates). There was excellent reliability for number of steps recorded in home and centre-based settings (intraclass correlation coefficient 0.954, 95%CI 0.915 to 0.976). A small-moderate effect size was demonstrated following pulmonary rehabilitation (0.34) and the minimal detectable change was 7 steps. All participants in the sub-study achieved 60% of v̇O2peak and achieved steady state by the 4th minute, with 60% of v̇O2 peak corresponding to mean 37% (95%CI 29 to 44) of the MIST final level. Conclusions The MIST is reliable and responsive to pulmonary rehabilitation in people with stable chronic respiratory disease. It provides new opportunities to assess exercise capacity, prescribe exercise training and reassess exercise program outcomes in environments where established field walking tests are not feasible. Impact Pulmonary rehabilitation is a highly effective treatment that is underutilised worldwide. Home-based pulmonary rehabilitation may improve access for patients and deliver equivalent clinical outcomes, but is limited by the availability of a robust exercise test that can be used at home to assess exercise capacity and prescribe training intensity. This study tested the clinimetric properties of the modified incremental step test and demonstrated a new way to assess exercise capacity, prescribe exercise training of an appropriate intensity and reassess exercise capacity in environments where established field walking tests are not feasible.

Treadmill-to-Overground Mapping of Marker Trajectory for Treadmill-Based Continuous Gait Analysis

A treadmill was used to perform continuous walking tests in a limited space that can be covered by marker-based optical motion capture systems. Most treadmill-based gait data are analyzed based on gait cycle percentage. However, achieving continuous walking motion trajectories over time without time normalization is often required, even if tests are performed under treadmill walking conditions. This study presents a treadmill-to-overground mapping method of optical marker trajectories for treadmill-based continuous gait analysis, by adopting a simple concept of virtual origin. The position vector from the backward moving virtual origin to a targeted marker within a limited walking volume is the same as the position vector from the fixed origin to the forward moving marker over the ground. With the proposed method, it is possible (i) to observe the change in physical quantity visually during the treadmill walking, and (ii) to obtain overground-mapped gait data for evaluating the accuracy of the inertial-measurement-unit-based trajectory estimation. The accuracy of the proposed method was verified from various treadmill walking tests, which showed that the total travel displacement error rate was 0.32% on average.