Pilot-study of ridden walk on the circle – effects of progressive collection and lateral exercises

When collecting the horse, the rider influences stride length, forehand/hindquarters balance, and head-neck position. The study aim was to describe the vertical excursion of the withers and croup, and the sagittal cannon angles during collection and lateral exercises. Ten horses were ridden by five riders during 14 trials (1-5 per rider) on 10 m circles. Each trial included free walk, four degrees of increasing collection, and haunches-in and shoulderin. Inertial measurement units (100 Hz) were positioned on the withers, the first sacral vertebra (S1) and laterally on the cannons. Data for each exercise were stride-split. Range of motion (ROM), minima and maxima were studied in mixed models, controlling for stride duration. S1 vertical ROM ranged between 30-32 mm (highest degree of collection) and 51 mm (free walk), significantly smaller with increasing collection. S1 ROM during the inside hind limb step was smaller in haunches-in and shoulder-in compared to at the lowest degree of collection. Withers ROM ranged between 12 mm (lowest degree of collection) and 16-18 mm (highest degree of collection). Fore cannon protraction-retraction ROM ranged between 57° (highest degree of collection) and 63° (free walk). Hind cannon protraction-retraction ROM ranged between 47-50° (highest degree of collection) and 51-56° (free walk). All limbs had significantly smaller ROM at the highest degree of collection. Cannon ROMs were smaller for the outer limbs in haunches-in, and all limbs but the outer fore in shoulder-in, compared to the lowest degree of collection. Progressively decreasing ROM for fore- and hind limb cannons and S1 suggest that the riders achieved a shortening of the gait at higher degrees of collection. In shoulder-in and haunches-in, the diagonal oriented in the direction of motion showed decreased hind limb cannon ROM while forelimb cannon ROM was maintained, which could suggest increased shoulder freedom and collection of the targeted diagonal.

Gait training with a wearable curara® robot for cerebellar ataxia: a single-arm study

Background Ataxic gait is one of the most common and disabling symptoms in people with degenerative cerebellar ataxia. Intensive and well-coordinated inpatient rehabilitation improves ataxic gait. In addition to therapist-assisted gait training, robot-assisted gait training has been used for several neurological disorders; however, only a small number of trials have been conducted for degenerative cerebellar ataxia. We aimed to validate the rehabilitative effects of a wearable “curara®” robot developed in a single-arm study of people with degenerative cerebellar ataxia. Methods Twenty participants with spinocerebellar ataxia or multiple system atrophy with predominant cerebellar ataxia were enrolled. The clinical trial duration was 15 days. We used a curara® type 4 wearable robot for gait training. We measured the following items at days 0, 7, and 14: Scale for the Assessment and Rating of Ataxia, 10-m walking time (10 mWT), 6-min walking distance (6 mWD), and timed up and go test. Gait parameters (i.e., stride duration and length, standard deviation of stride duration and length, cadence, ratio of the stance and swing phases, minimum and maximum knee joint angles, and minimum and maximum hip joint angles) were obtained using a RehaGait®. On days 1–6 and 8–13, the participants were instructed to conduct gait training for 30 ± 5 min with curara®. We calculated the improvement rate as the difference of values between days 14 and 0 divided by the value on day 0. Differences in the gait parameters were analyzed using a generalized linear mixed model with Bonferroni’s correction. Results Data from 18 participants were analyzed. The mean improvement rate of the 10 mWT and 6 mWD was 19.0% and 29.0%, respectively. All gait parameters, except the standard deviation of stride duration and length, improved on day 14. Conclusions Two-week RAGT with curara® has rehabilitative effects on gait function comparable to those of therapist-assisted training. Although the long-term effects after a month of RAGT with curara® are unclear, curara® is an effective tool for gait training of people with degenerative ataxia. Trial registration jRCT, jRCTs032180164. Registered: 27 February 2019; retrospectively registered. https://jrct.niph.go.jp/en-latest-detail/jRCTs032180164.

The Effects of Intensive Neurorehabilitation on Sequence Effect in Parkinson's Disease Patients With and Without Freezing of Gait

Background: The sequence effect (SE), defined as a reduction in amplitude of repetitive movements, is a common clinical feature of Parkinson's disease (PD) and is supposed to be a major contributor to freezing of gait (FOG). During walking, SE manifests as a step-by-step reduction in step length when approaching a turning point or gait destination, resulting in the so-called destination sequence effect (dSE). Previous studies explored the therapeutic effects of several strategies on SE, but none of them evaluated the role of an intensive rehabilitative program.Objectives: Here we aim to study the effects of a 4-week rehabilitative program on dSE in patients with PD with and without FOG.Methods: Forty-three patients (30 males, 70.6 ± 7.5 years old) with idiopathic PD were enrolled. The subjects were divided into two groups: patients with (PD + FOG, n = 23) and without FOG (PD – FOG, n = 20). All patients underwent a standardized 4-week intensive rehabilitation in-hospital program. At hospital admission (T0) and discharge (T1), all subjects were evaluated with an inertial gait analysis for dSE recording.Results: At T0, the dSE was more negative in the PD + FOG group (−0.80 ± 0.6) when compared to the PD – FOG group (−0.39 ± 0.3) (p = 0.007), even when controlling for several clinical and demographic features. At T1, the dSE was reduced in the overall study population (p = 0.001), with a more pronounced improvement in the PD + FOG group (T0: −0.80 ± 0.6; T1: −0.23 ± 0.4) when compared to the PD – FOG group (T0: −0.39 ± 0.3; T1: −0.22 ± 0.5) (p = 0.012). At T1, we described in the overall study population an improvement in speed, cadence, stride duration, and stride length (p = 0.001 for all variables).Conclusions: dSE is a core feature of PD gait dysfunction, specifically in patients with FOG. A 4-week intensive rehabilitative program improved dSE in PD patients, exerting a more notable beneficial effect in the PD + FOG group.

A Novel Tool for Gait Analysis: Validation Study of the Smart Insole PODOSmart®

The new smart insole PODOSmart®, is introduced as a new tool for gait analysis against high cost laboratory based equipment. PODOSmart® system measures walking profile and gait variables in real life conditions. PODOSmart® insoles consists of wireless sensors, can be fitted into any shoe and offer the ability to measure spatial, temporal, and kinematic gait parameters. The intelligent insoles feature several sensors that detect and capture foot movements and a microprocessor that calculates gait related biomechanical data. Gait analysis results are presented in PODOSmart® platform. This study aims to present the characteristics of this tool and to validate it comparing with a stereophotogrammetry-based system. Validation was performed by gait analysis for eleven healthy individuals on a six-meters walkway using both PODOSmart® and Vicon system. Intraclass correlation coefficients (ICC) were calculated for gait parameters. ICC for the validation ranged from 0.313 to 0.990 in gait parameters. The highest ICC was observed in cadence, circumduction, walking speed, stride length and stride duration. PODOSmart® is a valid tool for gait analysis compared to the gold standard Vicon. As PODOSmart®, is a portable gait analysis tool with an affordable cost it can be a useful novel tool for gait analysis in healthy and pathological population.

Ability of a Set of Trunk Inertial Indexes of Gait to Identify Gait Instability and Recurrent Fallers in Parkinson’s Disease

The aims of this study were to assess the ability of 16 gait indices to identify gait instability and recurrent fallers in persons with Parkinson’s disease (pwPD), regardless of age and gait speed, and to investigate their correlation with clinical and kinematic variables. The trunk acceleration patterns were acquired during the gait of 55 pwPD and 55 age-and-speed matched healthy subjects using an inertial measurement unit. We calculated the harmonic ratios (HR), percent recurrence, and percent determinism (RQAdet), coefficient of variation, normalized jerk score, and the largest Lyapunov exponent for each participant. A value of ≤1.50 for the HR in the antero-posterior direction discriminated between pwPD at Hoehn and Yahr (HY) stage 3 and healthy subjects with a 67% probability, between pwPD at HY 3 and pwPD at lower HY stages with a 73% probability, and it characterized recurrent fallers with a 77% probability. Additionally, HR in the antero-posterior direction was correlated with pelvic obliquity and rotation. RQAdet in the antero-posterior direction discriminated between pwPD and healthy subjects with 67% probability, regardless of the HY stage, and was correlated with stride duration and cadence. Therefore, HR and RQAdet in the antero-posterior direction can both be used as age- and-speed-independent markers of gait instability.

Repeatability vs complexity: kinematic comparison between a dressage simulator and real horses

Riding simulators are designed to replicate movement of a horse for the purpose of assessment and training of horse riders, but little is known about their similarity in replicating movement of horses. This study tested the validity of a dressage simulator, by measuring cycle/stride duration, range and symmetry of displacement of the simulator and comparing displacement vectors to that of real horses trotting on a treadmill. A reflective marker was placed on the midline of the simulator at the estimated level of the 18th thoracic vertebrae (T18), and over the T18 spinous process of ten horses. The simulator displacement was recorded in trot mode, while the real horses trotted at a comfortable speed on a treadmill. Displacements in three axes of motion were measured using 10 high-speed video cameras sampling at 240 Hz. Correlation tests showed high levels of statistical repeatability and symmetry of the simulator between multiple runs. Mean cycle/stride duration of the simulator was significantly faster than the group of horses by 0.17 s. Significant differences between the simulator and horses were shown in overall displacement in two axes, the simulator displaying 70% greater displacement in the mediolateral axis, 22% greater displacement in the craniocaudal axis, but displaying 12% less movement in the dorsoventral axis, which was not statistically significant. Displacement trajectories showed similarities in the frontal plane, displaying a butterfly-shaped sequence, but clear differences in the sagittal plane, with the horses showing an oval pattern of displacement and the simulator a clear linear displacement. Caution must therefore be taken with assumptions that riders will move in the same way on a simulator as they would on a real horse.

Gait training with a wearable curara® robot for cerebellar ataxia: a single-arm study

Background: Ataxic gait is one of the most common and problematic symptoms in people with degenerative cerebellar ataxia. Intensive and well-coordinated inpatient rehabilitation has been shown to improve ataxic gait. In addition to therapist-assisted gait training, robot-assisted gait training has been introduced for several neurological disorders; however, only a small number of trials have been conducted for degenerative cerebellar ataxia. We aimed to validate the rehabilitation effect of a wearable “curara®” robot we developed in a single-arm study of people with degenerative cerebellar ataxia.Methods: Twenty participants with spinocerebellar ataxia or multiple system atrophy with predominant cerebellar ataxia were enrolled. The clinical trial period was 15 days. We used a curara® type 4 wearable robot for gait training. We measured the following items on days 0, 7, and 14: Scale for the Assessment and Rating of Ataxia, 10-m walking time (10mWT), 6-min walking distance (6MWD), and timed up and go test. Gait parameters (i.e., stride duration and length, standard deviation of stride duration and length, cadence, ratio of the stance/swing phases, minimum/maximum knee joint angle, and minimum/maximum hip joint angle) were obtained using a RehaGait®. On the other days (days 1–6 and 8–13), the participants were instructed to conduct gait training for 30 ± 5 min with curara®. We calculated the improvement rate as the difference of values between days 14 and 0 divided by the value on day 0. Differences in the gait parameters were analyzed using a generalized linear mixed model with Bonferroni’s correction.Results: Eighteen participants were analyzed. The mean improvement rate of the 10mWT and 6MWD was 19.0% and 29.0%, respectively. All gait parameters, except the standard deviation of stride duration and length, improved on day 14.Conclusions: The wearable curara® robot has the potential to facilitate gait training in people with degenerative cerebellar ataxia.Trial registration: jRCT, jRCTs032180164. Registered 27 February 2019 - Retrospectively registered, https://jrct.niph.go.jp/en-latest-detail/jRCTs032180164

Clinical utility of the over-ground bodyweight-supporting walking system Andago in children and youths with gait impairments

Background The Andago is a rehabilitation robot that allows training walking over-ground while providing bodyweight unloading (BWU). We investigated the practicability, acceptability, and appropriateness of the device in children with gait impairments undergoing neurorehabilitation. Concerning appropriateness, we investigated whether (i) stride-to-stride variability of the stride time and inter-joint coordination was higher when walking over-ground in Andago versus treadmill walking, and (ii) activation of antigravity leg muscles decreased with higher levels of BWU. Methods Eighteen children and adolescents with gait impairments participated in three sessions. Practicability was assessed by determining the time needed to get a patient in and out of Andago, the accuracy of the BWU system, and other aspects. Acceptability was assessed by patients responding to questions, while six therapists filled out the System Usability Scale. To determine appropriateness, the participants were equipped with surface electromyography (sEMG) electrodes, electrogoniometers and accelerometers. Various parameters were compared between walking over-ground and on a treadmill, and between walking with three different levels of BWU (median: 20%, 35% and 50% of the bodyweight) over-ground. Results Practicability: the average time needed to get in and out of Andago amounted to 60 s and 16 s, respectively. The BWU system seemed accurate, especially at higher levels. We experienced no technical difficulties and Andago prevented 12 falls. However, participants had difficulties walking through a door without bumping into it. Acceptability: after the second session, nine participants felt safer walking in Andago compared to normal walking, 15 preferred walking in Andago compared to treadmill walking, and all wanted to train again with Andago. Therapists rated the usability of the Andago as excellent. Appropriateness: stride-to-stride variability of stride duration and inter-joint coordination was higher in Andago compared to treadmill walking. sEMG activity was not largely influenced by the levels of BWU investigated in this study, except for a reduced M. Gluteus Medius activity at the highest level of BWU tested. Conclusions The Andago is a practical and well-accepted device to train walking over-ground with BWU in children and adolescents with gait impairments safely. The system allows individual stride-to-stride variability of temporospatial gait parameters without affecting antigravity muscle activity strongly. Trial registration: ClinicalTrials.gov Identifier: NCT03787199.