10-meter Walk Test Research Articles

Early robotic gait training after stroke (ERA Stroke): study protocol for a randomized clinical trial

BackgroundWalking impairment after stroke is associated with substantial limitations in functional independence, quality of life, and long-term survival. People in the subacute phase after stroke who are unable to walk are most likely to benefit the greatest from use of overground robotic gait training (RGT). This study will provide preliminary evidence regarding the clinical use and efficacy of RGT during the subacute phase of stroke recovery as well as observational findings associated with the safety, tolerability, feasibility, and cost of delivering RGT during inpatient stroke rehabilitation.MethodsThis prospectively registered randomized controlled trial will enroll 54 patients admitted to inpatient rehabilitation within six months of stroke. Admitted patients will be screened at admission to inpatient rehabilitation for eligibility. Consented patients will be randomized based on stroke severity to receive either RGT or usual care for 90 minutes per week of gait training intervention during inpatient rehabilitation length of stay. Patients will complete assessments on walking and health outcomes at admission and discharge from inpatient rehabilitation and at 1- and 3-month follow-up. Intent-to-treat and per protocol analysis will be performed to evaluate safety [rate of adverse events, visual analog scale, and treatment completion rate], walking function [gait speed via 10-Meter Walk Test, Functional Ambulation Category, gait endurance via 6-Minute Walk Test] and health outcomes [Modified Rankin Scale, Stroke Rehabilitation Assessment of Movement, Continuity Assessment Record and Evaluation Tool, 5 Times Sit-to-Stand Test, Berg Balance Scale, and Stroke Impact Scale–16], and cost-analysis.DiscussionThis study will provide foundational evidence regarding the clinical use and efficacy of a RGT program during the subacute phase of stroke recovery with specific findings associated with the safety, tolerability, feasibility, and cost-analysis of delivering RGT during inpatient stroke rehabilitation.Trial registrationNCT06430632.

The Effect of Single-and Dual-Task Exercises on Functional Balance of Children with Autism Spectrum Disorder: A Randomized Clinical Trial

Background: Autism Spectrum Disorder (ASD) is a neurodevelop-mental disorder. According to the DSM-V, this condition has a variety of symptoms including impaired social relationships, and behavioral disorders. Various studies have shown that these children also have balance problems that are rarely investigated in this population. The purpose was to investigate the effect of single- and dual-task exercises on the functional balance of these children. Methods: The study design was a clinical trial research. The participants were 40 children with ASD (9 to 14 years) who were randomly divided into two groups. The single-task exercise group only performed balance exercises, while the dual-task exercises group performed both balance exercises and cognitive tasks at the same time. The sessions consisted of 45-minute sessions (3 times a week for 4 weeks). The functional balance tests were performed before and after the intervention. Results: There were no significant differences between two groups in the Timed Up and Go test, 10-meter walk test and Mini-BESTest endpoint of the study, but there was a significant difference in Pediatric Berg Balance Scale (p=0.01, effect size=0.82). Dual-task exercises could not cause significant improvements in the functional balance of the participants compared to the single-task group. Conclusion: It seems that evidence that dual-task exercises cause significant improvements of functional balance of the participants compared to the single-task group is inconclusive.

Gait speed after mild stroke/transient ischemic attack was associated with long-term adverse outcomes: A cohort study.

The association between gait speed and adverse outcomes after stroke has not been fully illustrated. This study aimed to explore the association of gait speed on long-term outcomes in minor stroke or transient ischemic attack (TIA). We performed a longitudinal study with acute minor stroke or TIA based on a subgroup of the Third China National Stroke Registry data. The gait speed was evaluated using a 10-meter walking test at discharge and 3 months after the stroke onset. The primary outcomes were poor functional outcomes at 1 year, defined by a modified Rankin Score (mRS) of 2-6. Additional outcomes included all-cause death, ambulate dependency (mRS score 4-6), cognitive impairment (Montreal Cognitive Assessment <26), stroke recurrence, and composite vascular events. The study sample included a total of 1542 stroke patients with a median age of 60 (53-68). At 1-year follow-up, 140 (9.20%) patients experienced poor functional outcomes. Faster gait speed at discharge was associated with lower incidence of poor functional outcome (OR = 0.89; 95% CI, 0.84-0.94), cognitive impairment (OR = 0.93; 95% CI, 0.89-0.96), ischemic stroke recurrence (HR = 0.92; 95% CI, 0.87-0.98), and composite vascular events (HR =0.94; 95% CI, 0.89-0.99) at 1 year. Faster gait speed at 3 months was associated with lower incidence of poor functional outcome (OR = 0.90; 95% CI, 0.85-0.95), ambulate dependency (OR = 0.86; 95% CI, 0.77-0.97), and cognitive impairment (OR = 0.92; 95% CI, 0.88-0.95) at 1 year. Our findings indicated that slow gait speed after minor stroke or TIA may be an independent predictor for long-term poor outcomes. Gait speed may be considered as a vital sign during follow-up in post-stroke patients.

Balance and Walking Speed Outcomes in Individuals Receiving Inpatient Rehabilitation for Acute Cerebellar Stroke.

Cerebellar strokes account for only 2-3% of all strokes occurring annually in the United States but represent a disproportionally higher share of morbidity and mortality. Evidence examining the effect of inpatient rehabilitation on functional outcomes following a cerebellar stroke is limited. This study aimed to examine the effects of inpatient rehabilitation on balance and walking speed in individuals with cerebellar stroke. A secondary purpose of this study was to examine the length of inpatient rehabilitation stay of the included patients. A retrospective analysis was conducted using review of patient records during their inpatient rehabilitation stay from January 2021 to February 2022 at a large hospital system in the southeast United States. Balance and gait outcomes were examined on admission and discharge from inpatient rehabilitation that included physical therapy interventions. A paired t-test examined for changes in outcomes from admission to discharge. Pearson correlation examined for the association between length of stay and outcomes. A total of 15 records were reviewed. There were significant improvements in the Berg Balance Scale (BBS), Postural Assessment Scale for Stroke (PASS), and the 10-Meter Walk Test (10MWT) (p's < 0.01) from admission to discharge with large effect sizes (range d = 0.70-1.67) following inpatient rehabilitation. The average length of stay was 12.67 days (SD = 6.5) and the mean total hours of combined occupational, physical, and speech therapy was 27.33 (SD = 6.52) h. There was a moderate association between length of stay and PASS (r = 0.525, p = 0.04) and BBS (r = 0.546, p = 0.04) outcomes. Patients who underwent inpatient rehabilitation following acute cerebellar strokes demonstrated improvements in balance and gait speed. Study results could assist clinicians designing interventions for patients with cerebellar strokes in the inpatient rehabilitation setting.

The effect of motor dual-task training on gait and mobility performances in children with intellectual disabilities.

The study investigated the impact of motor dual-task training on gait and mobility in children with intellectual disabilities. Performance was assessed using the Timed Up and Go Test (TUGT) and the 10-Meter Walking Test (TMWT) before and after an 8-week training period, with participants divided into a Trained Group (n=12) and a Control Group (n=14). Results indicated that, across both groups and regardless of session, TUGT and TMWT scores were significantly higher (p < 0.001) in the motor dual-task condition compared to the single-task condition. Post-training, TUGT scores significantly decreased (p < 0.05) in the single-task condition. The Trained Group showed significant improvements in second motor-task performance on both TUGT (p < 0.05) and TMWT (p < 0.001) under dual-task conditions, while the Control Group showed no change. The study demonstrated the effectiveness of motor dual-task training in enhancing mobility in children with intellectual disabilities.

Post-rehabilitation programme to support upper limb recovery in community-dwelling stroke survivors: a mixed methods cluster-feasibility controlled trial

BackgroundLess than 50% of stroke survivors regain their pre-stroke level of upper limb function, compounded with a lack of long-term rehabilitation options available. The Graded Repetitive Arm Supplementary Programme (GRASP)...

Effectiveness of an exercise therapy program based on sports in adults with acquired brain injury: a randomized controlled trial

To examine the effects of a sport-based exercise therapy program combined with usual care (sET+UC) compared with usual care alone (UC) on health-related quality of life, upper limb motor control, functional capacity, mobility, balance, and physical activity participation in ambulant adults with acquired brain injury (ABI). Single-blind, parallel-group, randomized controlled trial. Rehabilitation center. Twenty-three adults with ABI (82.6% stroke; 17 males; mean age of 59.6±10.3 yr) INTERVENTION: Participants received either sET+UC (n=11) or UC (n=12). The sET+UC group received sixteen 60-minute sessions of a sport-based ET program in addition to sixteen 60-minute sessions of usual care, whereas the UC group attended usual care only. Primary outcome measures were health-related quality of life (Short Form-36, SF-36) and upper limb motor control (Fugl Meyer-Upper Extremity; FM-UE), while the secondary included functional capacity (6-Minute Walk Test, 10-Meter Walk Test), mobility (Timed Up and Go Test), balance (Berg Balance Scale) and physical activity participation (Global Physical Activity Questionnaire). Significant differences were found in all outcome analyses at post-intervention when comparing between groups. The sET+UC group showed significant improvements in both the physical (p=.027, r=.46) and mental component summary (p=.001, r=.71) of the SF-36 as well as FM-UE (p=.004, r=.60), with large effect sizes. In turn, all secondary outcomes were also significantly improved in this group (all p<.05 r>.05). In contrast, the UC group showed slight improvements in post-intervention scores but did not reach significance in any of these measures. This study shows that a sport-based exercise therapy program combined with usual care can effectively improve all the aforementioned outcomes measures in ABI population. Further research with larger sample sizes and follow-up assessments is crucial to gain a more comprehensive understanding of the long-term effects of the intervention in this specific population.

10-meter Walk Test Predicts Cardiorespiratory Fitness In People Moderately Affected By Stroke

10-meter Walk Test Predicts Cardiorespiratory Fitness In People Moderately Affected By Stroke

The POISE Study: POcus for Identification of Sarcopenia in Emergency departments

Abstract Background Sarcopenia is a progressive loss of muscle mass and strength, primarily affecting older adults, with a prevalence of up to 20% in &amp;gt;65-year-olds. It is associated with poor outcomes such as fractures, falls, loss of independence and mortality. Recent studies into the use of ultrasonography for sarcopenia diagnosis have yielded promising results, with good validity to estimate muscle mass when compared to DXA, CT or MRI. While point-of-care ultrasound (POCUS) is a commonly used technique in Emergency Medicine, its applicability to sarcopenia diagnosis in an ED setting has not been investigated. Methods This was a prospective, cross-sectional, observational pilot study. Patients &amp;gt;65 years were recruited sequentially from the ED triage list. Each subject had a POCUS scan of their thighs, to visualise and measure the thickness of the femoral quadriceps. Subjects’ handgrip was then measured using a digital grip strength dynamometer. Subjects’ gait speed was measured in metres per second using a standard 6 metre walk test. Data was then analysed to examine any correlation between muscle thickness on POCUS and functional measures of sarcopenia. Results 60 patients were recruited into this pilot study. Of these, 50% had evidence of sarcopenia on functional assessment. There was a statistically significant correlation between muscle thickness on POCUS and performance on functional assessment. Conclusion This pilot study demonstrates a possible new application for POCUS in the ED. This could guide therapy for falls prevention and may prevent further morbidity in this vulnerable population. Further research is needed to confirm the results of this pilot study within a wider population. Additional research examining the correlation between POCUS findings, Clinical Frailty Scale, and BMI would also be of benefit.

The relationship between cognitive function and physical activity, functional status and social participation in older adults: a cross-sectional study

Aims: Cognitive function in older adults has been a topic of growing interest in recent years. This study aimed to investigate the relationship between cognitive function and physical activity, functional status, and social participation in older adults. Methods: A cross-sectional study was conducted involving 123 older adults aged 65 years and older who met the study’s inclusion criteria. The inclusion criteria for the study were as follows: who were aged 65 years or older, literate, volunteering to participate in the study, had no hearing or vision defects that prevented the measurement of the scales used in the study, had no chronic disease that prevented the scales used in the study. The data in the study were collected with sociodemographic form, Montreal cognitive assessment, international physical activity questionnaire, timed-up-and-go test, 10-meter walk test, and Keele assessment of participation. Results: The average age of the participants was 69.5±4.6. The study included 46.3% women and, 57.7% primary school graduates. A positive and moderate relationship was found between cognitive functions and physical activity level, functional status, and social participation in older adults. Additionally, there was a moderate positive relationship found between the level of physical activity, functional status, and social participation. In the cognitive function risk model, it was found that age, education level, and social participation significantly impact cognitive functions in older adults. Conclusion: Increasing physical activity, functionality, and especially social participation in older adults can be considered an important intervention to protect and improve the cognitive functions of older adults.

The Immediate Effects of a Single 20-Minute Session of Transcranial Direct Current Stimulation (tDCS) on Muscle Strength in Older Adults

The older population often experiences a gradual age-related decline in the primary motor cortex, leading to muscle weakness that can harm their physical performances. Exercise could improve physical performance and prevent falling in older adults. However, the decrease in motor function and motor skills in older adults reduces the efficiency of fall prevention. Transcranial Direct Current Stimulation (tDCS) is a non-invasive intervention aimed at improving muscle strength in various conditions by utilizing transcranial direct current stimulation applied to the primary motor cortex (M1). Pre- and post-studies were conducted to demonstrate the effects of a single 20-minute session of tDCS alone, as well as to assess any potential side effects. Sixteen older individuals, both male and female, aged 65 years or older, with or without underlying diseases, were assessed for leg and hand grip strength, followed by physical performance tests. Subsequently, they underwent stimulation of the primary motor cortex through the placement of anodal tDCS (a-tDCS) over the left M1 for 20 min. Immediate effects were evaluated within 24 h, and side effects were recorded for up to 2 weeks after the stimulation. The results demonstrated that a single session of tDCS led to a significant increase in leg strength by 13 kg (5.9 to 20.1 kg, p &lt; 0.01). There was also a significant correlation observed with hand grip strength (r = 0.68, p &lt; 0.01). All physical performance tests, except the fastest speed in the 10-meter walk test, showed statistically significant improvements (p &lt; 0.01). Participants reported no serious side effects, and the intervention will now be incorporated into prospective clinical studies involving older populations to compare its effectiveness with other treatments. HIGHLIGHTS A single session of tDCS led to a significant increase in leg strength. A single session of tDCS, with a significant correlation observed with hand grip strength. Physical performance tests showed statistically significant improvements after a single session of tDCS. Participants reported no serious side effects. This intervention will now be incorporated into prospective clinical studies involving older populations to compare its effectiveness with other treatments. GRAPHICAL ABSTRACT

Visual and Demographic Risk Factors for Falls and the Impact of Cataract Surgery in Elderly Patients.

To evaluate the effect of cataract surgery and visual impairment and the associated risk factors on the frequency of falls among older adults in northeast Iran. This cross-sectional study, conducted between 2019 and 2020, analyzed the potential risk factors of falling in older adults over 50 years of age. To this end, 380 patients were randomly selected by convenience sampling and classified into two groups: those who had undergone cataract surgery in the last 12 months (surgery group) and those who had not (cataract group). The data were collected from the medical records and face-to-face interviews, and logistic regression was used to identify potential risk factors for falling. The frequency of falls in the cataract and surgery groups was 18.9% and 11.6%, respectively. The mean decimal visual acuity of the dominant eye was significantly lower in the cataract group than in the surgery group (P 0.001). There were no significant differences in the mean number of medications used, Charlson Comorbidity Index score, Instrumental Activities of Daily Living score, and 10-Meter Walk Test speed between the two groups. According to the results of backward logistic regression, taking more than four medications per day and slow gait speed were the most important factors influencing the frequency of falls in older adults. Logistic regression analysis indicated that undergoing cataract surgery is not a significant protective factor against falls. However, older adults in the surgery group experienced fewer falls than in the other group. Besides, the results suggest that taking more than four medications daily and having a slow gait speed are significant fall risk factors.

Characterizing the Longitudinal Impact of Backward Locomotor Treadmill Training on Walking and Balance Outcomes in Chronic Stroke Survivors: A Randomized Single Center Clinical Trial.

Walking and balance impairments after stroke are a global health concern, causing significant morbidity and mortality. However, effective strategies for achieving meaningful recovery in the chronic stages are limited. Backward locomotor treadmill training (BLTT) is a novel walking rehabilitation protocol that is safe, feasible, and likely beneficial in stroke survivors; however, its efficacy has not been tested. This single-center, randomized, assessor-blind clinical trial aims to test the preliminary efficacy of BLTT compared to forward locomotor treadmill training (FLTT) on walking speed, symmetry, and postural stability. Forty stroke survivors [BLTT (N=19), FLTT (N=21); mean age= 56.3 ± 8.6 years; 53% Female; 30% Non-Hispanic Black] with mild-moderate walking impairment were enrolled. Participants underwent nine 30-minute BLTT or FLTT sessions over three weeks. The primary outcome was the mean change in the 10-meter walk test (10 MWT) at 24 hours post-training (24 hr POST). Secondary outcome measures were changes in spatiotemporal walking symmetry and postural stability during quiet standing at 24 hr POST. Retention was explored at Days 30- and 90 POST. We report clinically meaningful (≥ 0.16 m/s) improvements in overground walking speed at 24 hr POST, with retention up to Day 90 POST with BLTT and FLTT. However, contrary to our working hypothesis, no between-group differences in walking speed were observed. Nonetheless, we found that BLTT resulted in offline improvements in spatial symmetry and retention of subcomponents of the modified clinical test of sensory interaction on balance (mCTSIB), including the testing of proprio-vestibular integration up to Day 30 POST. Among chronic stroke patients with mild-moderate walking impairment, BLTT and FLTT both resulted in long-lasting and clinically meaningful improvement in walking speed. However, preliminary findings suggest that BLTT may better comprehensively target walking asymmetry and sensory systems processing and integration.

Effects of high-intensity interval robot-assisted gait training on cardiopulmonary function and walking ability in chronic stroke survivors: A multicenter single-blind randomized controlled trial.

Chronic stroke can impair cardiopulmonary function, mobility, and daily activities. This study assessed the impact of robot-assisted gait training (RAGT) on such impairments. To investigate the effects of robot-assisted gait training on cardiopulmonary function, walking ability, lower extremity function and strength, activities of daily living (ADLs), and blood test results among individuals with chronic stroke. A multicenter, prospective, single-blinded, randomized controlled trial with 22 chronic stroke participants compared RAGT against a control exercise regimen. RAGT involved three days weekly sessions of high-intensity interval training for 8 weeks (24 sessions) with a Morning Walk® device. The control group also performed home exercises. (24 sessions) Measures included VO2max, Functional Ambulatory Category, 2-minute walk test, 10-meter walk test, Motricity Index-Lower, Korean version of the Fugl-Meyer Assessment Scale, Modified Barthel Index, Berg Balance Scale, muscle strength, InBody body composition, and blood tests (cholesterol, lipid, glucose). RAGT significantly improved VO2max, gait, balance, and lower limb strength compared with controls, with significant improvements in 2-minute walk test, 10-meter walk test, Motricity Index-Lower, and Fugl-Meyer Assessment outcomes. No changes were seen in muscle mass or blood markers. RAGT enhances cardiopulmonary function and ambulatory capacity in chronic stroke patients, underscoring its potential in stroke rehabilitation.

Sarcopenia, frailty prevalence, and related factors in patients with stroke: A cross-sectional analytical study from Turkey.

Sarcopenia and frailty may develop at varying rates depending on the metabolic, structural, and functional changes in the muscle structure after stroke. To evaluate the prevalence of sarcopenia and frailty in patients with stroke and affecting clinical parameters. This was a cross-sectional and analytical study. Twenty-six (49.1%) women and 27 men (50.9%) with stroke with an average age of 60.2 ± 10.3 (median = 62) years were included in the study. To evaluate physical performance, balance, and mobility, we used the 4-meter walk test (4-MWT), timed up and go test, chair sit and stand test, and the Berg Balance Scale (BBS). Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 criteria. The SARC-F scale was used for sarcopenia. The average stroke duration was 21.6 ± 18.2 months. Prefrailty was present in 14 (26.4%) patients, frailty was present in 34 (64.2%) patients, and two (3.8%) patients were normal. Sarcopenia was detected in 28 (52.8%) patients. According to handgrip strength, the prevalence of low muscle strength was 17% (n= 9). In the sarcopenic group, female sex (p= 0.005) was more frequent, 4-MWT was longer (p= 0.003), chair stand test results were lower (p< 0.001), the clinical frailty scale (CFS) was higher (p< 0.001), fall risk was higher compared with the BBS (p< 0.001), there was lower HG strength (p= 0.009), lower malnutrition scores (PNI, prognostic nutritional index, p< 0.001), and lower lymphocyte counts (p= 0.037). EAT-10 scores and dysphagia presence (p= 0.026), the presence of malnutrition (p< 0.021) and Nottingham Health Profile score (p< 0.001) were higher in the sarcopenic group. Sarcopenia and frailty frequently develop in patients with chronic stroke, with low lymphocyte counts, physical performance, muscle strength, and mobility and balance scores, and it is associated with poor prognostic factors including high disease severity, dysphagia, malnutrition, risk of falling, and poor quality of life.

Adductor Catheter Insertion Through the Knee Arthrotomy: Can This Technique Be as Safe and Effective as Ultrasound-Guided Insertion?

BackgroundEarly postoperative pain following total knee arthroplasty remains challenging. We devised a technique for inserting a continuous catheter intraoperatively in the adductor canal and aimed to compare its efficacy and safety with that of an ultrasound-guided anesthetist-administered continuous catheter. MethodsThis single-center, single-surgeon, prospective, interventional, randomized controlled trial included 330 patients, who were randomized into two groups with similar preoperative status and demographics. There were 18 patients who met the exclusion criteria. Group A (n = 152) received the block from an anesthetist, while group B (n = 160) received the block from the surgeon. Patients had visual analog scale scores, range of motion, maximum ambulation distance, time to straight leg raise, length of stay, and results from a 10-meter walk test, Timed Up and Go test, and a 30-second chair test measured preoperatively and at 6, 12, and 24 hours postoperatively by a physiotherapist and pain nurse blinded to the group assignment. ResultsThe visual analog scale scores at 12 hours postsurgery were significantly lower in group B (0.66) compared to group A (0.77, P = 0.04). Range of motion (supine flexion 43.2 versus 43.1, P = 0.72; sitting flexion 90.0 versus 89.9, P = 0.17), Timed Up and Go test (126.1 versus 136.9, P = 0.9), 10-meter walk test (163.5 versus 165.4, P = 0.7), 30-second chair test (3.7 versus 3.8, P = 0.7), time to active straight leg raise (4.0 versus 4.1, P = 0.3), time to ambulation with walker (4.02 versus 4.05, P = 0.3), and length of stay (1.44 versus 1.39, P = 0.49) showed no significant differences between the groups. No serious complications were reported in either group. ConclusionsWe concluded that this technique was at least as safe and effective as the USG-guided, anesthetist-administered adductor canal catheter.

Comparison of the Efficacy of 2 Different Botulinum Toxin Injection Techniques in Gastrocnemius Muscle Spasticity in Hemiplegic Patients: A Randomized Double-Blind Controlled Study

ObjectiveTo compare the efficacy of the innervation zone–targeted injection technique (EUROMUSCULUS/USPRM (Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine) spasticity approach) and the injection technique along the muscle length. DesignA double-blind randomized controlled trial. SettingDepartment of rehabilitation medicine of a medical center. ParticipantsOne hundred patients with stroke experiencing ankle plantar flexor spasticity. InterventionsIn addition to conventional rehabilitation, eligible patients were randomly assigned to 2 groups. The experimental group was injected with botulinum toxin along the length of the muscle, whereas the control group was injected with the same dose and volume of botulinum toxin 25%-35% proximal to the medial head and 20%-30% proximal to the lateral aspect of the head of the gastrocnemius muscle. Main Outcome MeasuresModified Ashworth scale, modified Tardieu scale, ankle range of motion measurement, and 10-meter walk test were used before and 1 month after injection. ResultsThe study was completed by 60 participants with a mean age of 59.96±12.15 years. Both injection methods were found to be effective on range of motion, spasticity level, ambulation, and walking speed. There was no statistically significant difference between injection methods. ConclusionsBoth injection methods of botulinum toxin A produce similar clinical effects.

Robotic exoskeleton-assisted gait training in patients with motor incomplete myelopathy

Objectives: To assess the effect of gait training with robotic exoskeleton-assisted rehabilitation systems on gait parameters, balance, and overall disability in motor incomplete myelopathy. Design: Prospective pre-post study. Setting: Neurological rehabilitation unit in a tertiary university teaching hospital. Participants: Thirty-four motor incomplete myelopathy patients [22 males, mean age 36.7 y (12.7)] were included in this prospective, pre-post study. Twenty-two had nontraumatic etiology, and 17 had tetraplegia. American Spinal Injury Association impairment scale suggested 23 as C and 11 as American Spinal Injury Association impairment scale-D. The mean duration of the lesion was 333 days. Intervention: Twenty-four sessions of robotic gait training (1-h session, 5–6 sessions/wk) for 4–6 weeks. Outcome measures: Gait speed was assessed using a 10-meter walk test (10MWT), endurance with a 2-minute walk test (2MWT) and 6-minute walk test (6MWT), walking ability by Walking Index in Spinal Cord Injury-walking index for spinal cord injury II, functionality using Spinal cord Independence Measure-SCIM III, and balance by Timed-up-and-go (TUG) test. Results: At baseline, 20 patients were nonwalkers-NWB, and 14 were walkers-WB. The walking index for spinal cord injury II and SCIM III suggested significant improvement in both groups by the end of the study (P&lt;0.05). Among the WB group, 10MWT, 2MWT, and TUG showed significant improvement (P=0.004, 0.02, and 0.01, respectively) with training. Patients in NWB group were able to perform 10MWT, 2MWT, 6MWT, and TUG by the end of the study. Conclusions: Gait training with robotic exoskeleton-assisted rehabilitation systems can lead to a significant improvement in gait endurance, speed, balance, and functional outcomes in individuals with incomplete myelopathy. The effect is more pronounced among already ambulatory patients.

Feasibility of Using Standardized Outcome Measures in the Remote Assessment of Patients with Chronic Stroke: A Case Series

Introduction: With the increase of telerehabilitation utilization worldwide after the COVID-19 pandemic, a review of the current literature shows a concurrent increase in telerehabilitation studies focusing on interventions and delivery models. There is a gap in research on valid and reliable tests and measures that can be used in the physical therapy examination of people with stroke via telerehabilitation. Current reports on psychometric properties of most standardized outcome measures are only applicable in an in-person setting and may not be directly applicable in a remote setting where various challenges contribute to the reliability of results. This report describes the feasibility of administering selected standardized outcome measures in the remote assessment of three patients with chronic stroke with different contexts. Methods: Three patients with chronic stroke underwent physical therapy examination and intervention sessions via telerehabilitation with varying contexts. Results: Various factors affected the results of the assessment including patient and caregiver’s (if present) ability to follow instructions, availability of material and spatial resources, and stability of internet connection. Strategies to improve reliability of assessment results can also be employed such as performing repeat trials, reviewing recordings for accuracy and confirmation, using highly visible markers, and confirming measurement accuracy on video. Discussion: Physical therapy outcome measures that can feasibly be administered remotely are the Timed Up and Go Test, the 10-Meter Walk Test, the 6-Minute Walk Test, the 5-Times Sit to Stand Test, and the Stroke Impact Scale. The Mini Balance Evaluation Systems Test could not be administered remotely as close to standard protocol as possible due to the difficulty of administering the reactive postural component with patient anxiety and safety considerations and materials required.

The effect of rectus femoris transfer on kinematics and functional outcomes in adult stroke patients walking with a stiff knee gait

BackgroundStiff knee gait is characterized by a reduced peak knee flexion during swing. Overactivity of the rectus femoris is often cited as a main cause for stiff knee gait. Little is known about the effect of an isolated rectus femoris transfer treatment on kinematic and functional outcomes in a group of stroke survivors. ObjectiveTo perform an experimental study to evaluate the effect of an isolated rectus femoris transfer on knee and hip kinematics and functional outcomes in adult stroke patients walking with a stiff knee gait. MethodIn this experimental study, 10 stroke survivors were included. During the surgical procedure, the distal rectus femoris tendon of the affected side was transferred to the medial knee flexors to improve knee flexion during swing. Knee and hip kinematics and a variety of functional outcomes were measured within 3 weeks before surgery and between 6 and 7 months after the surgery. ResultsWe found a statistically significant improvements in peak knee flexion during swing and knee range of motion of 10.6° (sd 4.7, p=0.000) and 10.5° (sd 6.2, p=0.001) post-surgery, respectively. Hip kinematics showed no significant differences.In addition, we found statistically significant improvements on the 6-minute walk test (42.5, sd 36.7, p=0.008), 10-meter walk test (1.26, sd 1.4, p=0.030), Timed up-and-go test (1.34, sd 1.18, p=0.009), L-test (2.97 sd 2.85, p=0.014) and on a subjective BORG scoring of foot clearance (1.8, sd 0.6, p=0.006). No significant differences were found on other measured functional outcomes. ConclusionsRectus femoris transfer is a valuable treatment option for stroke patients walking with a stiff knee gait to improve knee kinematics and a selection of functional outcomes. There are no detrimental side effects on hip kinematics.