Effectiveness of Gait Training Using Dynamic Bodyweight Support System on Locomotor Abilities of Ambulatory Children With Different Neural Disorders

Activate-CP: Let's Ride a Bike! Efficacy of a functional-electrical-stimulation cycling, adapted cycling and goal-directed training program for children with cerebral palsy

Objective: To examine the relationship between Five times sit-to-stand Test (FTSST) and functional tests and investigate the effects of task-specific training on functional ability in children with mild to moderate cerebral palsy (CP).Methods: Twenty-one subjects were randomly assigned to experimental and control groups. Motor Assessment Scale (MAS: sit-to-stand), Pediatric Balance Scale (PBS), Functional Reach Test and FTSST were tested before training, after training and at follow-up at 6 weeks post training.Results: FTSST correlated significantly with MAS (ρ = −0.733) and with PBS (ρ = −0.813) in all children with CP. There were no significant differences in all outcomes between groups. However, FTSST and MAS in children with Gross Motor Function Classification System-Expanded and Revised levels I–II were significantly different between pre and post training within the experimental group (p = 0.03).Conclusions: FTSST is a reliable and valid functional outcome measure after the task-specific training in children with mild to moderate CP.

Effectiveness of Gait Training Using an Electromechanical Gait Trainer, With and Without Functional Electric Stimulation, in Subacute Stroke: A Randomized Controlled Trial

This study aimed to quantify test-retest reliability and minimal detectable change (MDC) of the four commonly used functional tests in older adults with a high risk of falling. The cross-sectional study was conducted with 30 community-dwelling older adults (26 females, 4 males; mean age: 73.7±6.0 years; range, 65 to 88 years) with a high fall risk identified by the Thai falls risk assessment test between November 2018 and May 2019. Data from the 10-m walk test at a comfortable gait speed (CGS) and fast gait speed (FGS), timed up and go (TUG) test, five times sit to stand test (FTSST), and 6-min walk test (6MWT) were collected twice for each participant. The interval between test sessions was one week. Test-retest reliability was analyzed by the intraclass correlation coefficient (ICC). Standard error of measurement (SEM) and MDC at the 95% confidence interval (MDC95) were also calculated. The four functional tests had ICC in the range of 0.92 to 0.97. The SEM values of the CGS, FGS, TUG, FTSST, and 6MWT were 0.06 m/sec, 0.04 m/sec, 1.10 sec, 1.30 sec, and 20.60 m, respectively. The MDC95 values of the CGS, FGS, TUG, FTSST, and 6MWT were 0.16 m/sec, 0.12 m/sec, 3.00 sec, 3.50 sec, and 57.20 m, respectively. All functional tests demonstrated excellent test-retest reliability. The SEM and MDC95 of all functional tests were established. These findings can help clinicians interpret the effectiveness of interventions and determine changes in functional ability over time in older adults at high risk of falls.

Functional gait training in cerebral palsy can involve over ground gait training or treadmill-based gait training which incorporates partial body weight support (PBWS) system. Insufficient clinical evidence prevails to recommend the superiority over the other intervention. ICF model has created a paradigm shift in understanding motor learning mechanisms, with the use of repetitive, task-specific movements beneficial to restructuring motor pathways. The primary aim of the study was to compare the effect of integrated task oriented Body Weight Supported overground Training (BWSOGT) against the Body Weight Supported Treadmill Training (BWSTT) and the conventional gait training protocols to improve the functional mobility in Cerebral Palsy. Methods: A Single-blinded, randomised control design. Sixty-children with GMFCS Level of III, IV were recruited in the study with an age ranges between 4 to 14 years (mean age = 9). Participants were randomly assigned into three groups using simple randomisation method with 20 subjects in each group for 8 weeks. The training programme consists of Group A with 40% of body weight supported walker with overhead pulley system which allows multiple degrees of freedom. Body weight- supported treadmill training (Group B) in a closed environment and conventional gait protocol using standard walkers (Group C). Outcome measures: Gross Motor Function Measure dimension-88 (GMFM-88) score. Gait kinematics (Stride length, Step length, Cadence) and 10 meter walk test. Tukey’s Post Hoc for group and time interactions, Krushkal Wallis test for overall significance and Mann Whitney’s U test to compare the significance between the groups. BWSOGT group showed significance over the BWSTT and Control group in GMFM score with p = 0.000 p = 0.002, respectively. Step length of gait parameter remained unchanged in all the three groups. Integrated task oriented BWSOGT might be an effective intervention to improve functional ambulation in children with spastic cerebral palsy due to the usage of a context specific environment and the training protocol.

Effects of gait training with a voluntary-driven wearable cyborg, Hybrid Assistive Limb (HAL), on quality of life in patients with neuromuscular disease, able to walk independently with aids

Effects of gait training with the Hybrid Assistive Limb on gait ability in stroke patients: A systematic review of randomized controlled trials

Background/Objectives: Physical examination techniques are commonly used for the diagnosis and evaluation of Arteriosclerosis Obliterans (ASO). However, these methods do not objectively reflect the degree of claudication or functional impairment reported by patients. Moreover, standardized functional metrics to facilitate consistent clinical communication and prognostic assessments among healthcare providers are lacking. This study aimed to identify performance-based functional tests that enable quantitative assessment of symptoms and gait limitation in patients with ASO and to propose them as objective, reproducible clinical indicators. Methods: Fifty-six participants (27 patients with ASO and 29 healthy controls) underwent multiple functional tests, including the Five Times Sit-to-Stand Test (FTSS), six-minute walk test (SMWT), gait speed, Short Physical Performance Battery (SPPB), and grip strength. Test results were compared between the groups and evaluated against ankle-brachial index (ABI) values for diagnostic and functional relevance. Results: Patients with ASO demonstrated significantly lower SPPB scores, slower gait speed, longer FTSS times, and shorter SMWT distances than controls, whereas grip strength did not differ. Random forest and receiver operating characteristic analyses identified the FTSS, SMWT, and gait speed as significant predictors of ASO. Conclusions: The FTSS, SMWT, and gait speed are simple and clinically meaningful performance-based measures that can complement the ABI in the evaluation of ASO. Combining the FTSS with the SMWT and gait speed may provide a more comprehensive and reliable functional assessment and facilitate early screening, guide clinical decision-making, and enable objective evaluation of functional recovery before and after treatment, while improving patient self-assessment and communication among healthcare providers.

Introduction: Whole body cryotherapy with kinesitherapy can potentially improve the everyday functioning of patients. The aim of the study was to assess the influence of whole body cryotherapy on the pain perception and functional efficiency of patients with pain syndromes in a different age and to assess the occurrence of adverse effects during treatment. Material and Methods: The study involved 40 patients with pain syndromes aged between 24 and 73 divided into 2 groups: group I (younger) up to 55 years old and group II (older) over 55 years old. The subjects underwent a series of 10 treatments of cryotherapy. The following tests were used to assess functional performance and pain: FTSST (Five Times Sit- to- Stand Test), TUG (Timed Up and Go Test), VAS (Visual Analogue Scale) Modified Pain Questionnaire according to Laitinen. Results: In the group I: the intensity of pain on the VAS scale was reduced after the first treatment (p=0.003); after a series of 10 treatments improvement in pain scales (VAS: p = 0.001, Laitinen Questionnaire: p = 0.002) and functional tests (TUG: p = 0.002, FTSST: p <0.001) was obtained. In the group II: improvement in pain perception at VAS scale after first treatment (p = 0.01) was achieved and after a series of 10 treatments, functional improvement (TUG: p = 0.006, FTSST: p <0.001) and in results in pain scales (VAS: p = 0.04, Laitinen questionnaire: p = 0.05) was obtained. Conclusions: Whole body cryotherapy with kinesitherapy contribute to the reduction of pain after only a single exposure, and after a series of 10 treatments occur to improve performance of functional tests. Cryotherapy may be associated with adverse effects, which are relatively rare, disappear quickly and do not endanger the life or health of patients. The age of patients has no significant effect on the final outcomes of therapy and on the occurrence of adverse effects.

Objective To explore the effects of gait training with an alternative gait orthosis (AGO) on the neurogenic bladders of patients with spinal cord injury (SCI). Method Twelve patients with complete SCI at the thoracic and lumbar level were trained for 8 weeks on motor and bladder function. After that, specific gait training with an AGO was given for another 8 weeks. American Spinal Injury Association ( ASIA ) sensation and motor function assessments were done before and after the gait training with the AGO, and bladder capacity, residual urine and urine flow rates were also assessed. Results Compared with pre-treatment there was no significant difference in average ASIA senzsation and motor scores after training, but the maximum rate of urine flow, average urine volume and single urination had significantly increased and residual urine volume had significantly decreased. Conclusions Therapeutic gait training with an AGO can improve bladder function after SCI. Key words: Neurogenic bladder; Spinal cord injury; Gait training; Orthoses

This study examined the association between Gait Deviation Index (GDI) and the five-times-sit-to-stand test (FTSST) or gait speed results, which represent mobility and muscle strength of the lower extremities in ambulatory children with Gross Motor Function Classification System (GMFCS) level I and II spastic cerebral palsy. In this cross-sectional, observational study, three-dimensional gait analysis data were obtained during gait trials to evaluate the GDI in 35 children (age 5–16 years) with spastic palsy. Motor function was evaluated using FTSST and gait speed. Gross motor function was evaluated using GMFCS. Children with GMFCS level II spastic cerebral palsy demonstrated lower GDI (p < 0.001) and poorer FTSST (p = 0.031) than those with GMFCS level I spastic cerebral palsy. Correlation analysis showed that FTSST results were significantly correlated with GDI (r = −0.624; p < 0.001). Motor function may be important for the maintenance of gait quality in patients with GMFCS level I and II spastic cerebral palsy and should not be ignored. In conclusion, reduction in gait impairment may affect the values of FTSST and GDI in patients with spastic cerebral palsy who can ambulate without an assistive device.

Dynamic Body Weight Support (BWS) systems have gained attention in recent years for their potential in gait training. However, maintaining a natural gait and vertical unloading have been less explored. In our previous work, we developed a body Motion Tracking (MT) walker that can move with patients. In this study, we introduce a novel Motion Tracking Variable Body Weight Support (MTVBWS) system for overground walkers. This system utilizes Center of Mass (COM) tracking and gait phase detection to not only dynamically support the user's body weight in the vertical direction but also to facilitate movement in all directions. The system achieves this horizontal omnidirectional movement by employing active Mecanum wheels, guided by COM recognition. The validation experiments were implemented with the MT mode, passive mode, and BWS mode in “static,” “fixed unloading ratio (FUR),” and “variable unloading ratio (VUR)” settings with unloading force of 20 and 30%. The result shows that, compared to other modes, the proposed system in the MTVBWS mode can reduce the dragging effect in the horizontal plane caused by the walker. Moreover, the unloading force can be adjusted automatically to minimize the fluctuations in the force experienced by each lower limb during the rehabilitation walking training process. In comparison to natural walk, this mode presents smaller force fluctuations for each lower limb.

A cross-sectional study. To investigate reliability, discriminative ability and concurrent validity of three functional tests (including the 10-meter walk test (10MWT), timed up and go test (TUGT) and five times sit-to-stand test (FTSST)) using the Functional Independence Measure Locomotor (FIM-L) scores as a standard criterion. A tertiary rehabilitation center, Thailand. Subjects were 66 patients with spinal cord injury (SCI), who were able to walk at least 50 m unassisted with or without a walking device (FIM-L scores 6-7). They were tested for functional ability using the 10MWT, TUGT and FTSST. Sixteen subjects also assessed the ability using three assessors to evaluate the inter-tester reliability of the tools. The three functional tests demonstrated excellent inter-tester reliability (intraclass correlation coefficient (3,3)=0.997-1.00) and could clearly distinguish between subjects who walked with and without a walking device. In addition, the tests showed significant correlation with walking categories or FIM-L scores (r(pb)=0.778, -0.692 and -0.595 for the 10MWT, TUGT and FTSST, respectively, P<0.001). The findings support reliability and validity of the 10MWT, TUGT and FTSST to assess levels of independences in ambulatory subjects with SCI.

Purpose: This study aimed to assess knee joint function in post-stroke patients using wireless motion sensors and functional tests. This type of evaluation may be important for improving gait quality. Methods: The study included 25 post-stroke patients (age 53.5 ± 8.4 years) and 25 healthy controls (age 51.1 ± 7.7 years). Knee function was assessed using passive range of motion (PROM), active range of motion (AROM) at any speed, maximum speed AROM (FROM), and joint position sense (JPS). Orthyo® motion sensors and a mobile app were used for measurements. The following functional tests have been used: Five Times Sit-to-Stand Test (FTSST) and Timed Up and Go Test (TUG). Results: Before rehabilitation, the average values of PROM ( p = 0.006), AROM ( p = 0.005), FROM average ( p < 0.001) and maximal velocity ( p < 0.001), JPS 30° ( p = 0.002), JPS 60° ( p = 0.002) and JPS 80° ( p < 0.001) were significantly worse in the paretic limb than in healthy people. The applied rehabilitation contributed to improving the PROM and AROM and the average and maximum speed of rapid movement in the knee joint. Proprioception (JPS) also improved. Only the average ( p < 0.001) and maximum speed ( p < 0.001) in the FROM test in the knee joint of the paretic limb after rehabilitation significantly differed from the values in healthy people. The patients' performance (functional tests) improved after rehabilitation (TUG ( p < 0.001) and FTSST ( p < 0.001)), but it did not reach the level of healthy people. Conclusions: The function of the knee joint in the paretic limb is significantly impaired and requires inclusion in the therapy plan in the early period after stroke.

Effects of Gait Training With Body Weight Support on a Treadmill Versus Overground in Individuals With Stroke