Assessment Of Walking Ability Research Articles

Walking performance in individuals with lumbar spinal stenosis- possible outcome measures and assessment of known-group validity

BACKGROUND CONTEXTOne of the primary goals of treatments received by individuals with lumbar spinal stenosis with neurogenic claudication is to improve walking ability. Thus, a thorough and valid assessment of walking ability in patients with lumbar spinal stenosis is needed. Duration of continuous walking and steps per day could be relevant when evaluating walking ability in daily living. PURPOSETo describe and evaluate a method for estimating continuous walking periods in daily living and to evaluate the known-group validity of steps per day in individuals with lumbar spinal stenosis. STUDY DESIGNThis is a cross-sectional observational study. PATIENT SAMPLEThe study contains three study groups: individuals with lumbar spinal stenosis, individuals with low back pain, and a background population from the Lolland-Falster Health Study (LOFUS). OUTCOME MEASURESParticipants in all three study groups wore an accelerometer on the thigh for seven days. METHODSAccelerometer data were processed to summarize the continuous walking periods according to their length: the number of short (4–9 seconds), moderate (10–89 seconds), and extended (≥90 seconds) continuous walking periods per day, and the number of steps per day. Results from the three groups were compared using negative binomial regression with lumbar spinal stenosis as the reference level. RESULTSContinuous walking periods of moderate length were observed 1.48 (95% CI 1.27, 1.72) times more often in individuals from the background population than in individuals with LSS. Continuous walking periods of extended length were observed 1.53 (95% CI 1.13, 2.06) times more often by individuals with low back pain and 1.60 (95% CI 1.29, 1.99) times more often by individuals from the background population. The number of steps per day was 1.22 (95% CI 1.03, 1.46) times larger in individuals with LBP and 1.35 (95% CI 1.20, 1.53) times larger in individuals from background population. CONCLUSIONSThe impact of neurogenic claudication on walking ability in daily living seems possible to describe by continuous walking periods along with steps per day. The results support known-group validity of steps per day. This is the next step toward a clinically relevant and comprehensive assessment of walking in daily living in individuals with lumbar spinal stenosis.

Self-assessed Dynamic Gait Index correlates with physical therapist assessed Dynamic Gait Index in people with multiple sclerosis

BackgroundThe Dynamic Gait Index (DGI) is a clinical measure of walking ability comprised of eight walking tasks. In people with multiple sclerosis (PwMS) the DGI has demonstrated validity, reliability, and ability to identify fallers. A self-assessed version of the DGI that demonstrates concurrent validity with the original DGI in people with MS would be valuable for remote assessment of walking ability. We therefore developed a questionnaire-based self-assessed version of the DGI (sDGI) that asks participants to self-rate their predicted ability to perform the eight DGI walking tasks. The purpose of this study was to determine the validity and internal consistency of the sDGI in people with MS who had self-reported gait impairment. MethodsWe enrolled 53 ambulatory people with MS with self-reported gait impairment. Participants completed the sDGI, the Multiple Sclerosis Walking Scale-12 (MSWS-12), the Telephone Interview for Cognitive Status (TICS), and self-reported their number of falls in the past 3 months. Then, up to 4 weeks later, they completed the DGI by in-person evaluation by a physical therapist (PT). We calculated the internal consistency of the sDGI and concordance between the sDGI and DGI. To determine if cognition impacted concordance, we calculated concordance in the cognitively impaired and non-impaired groups and also tested the difference between groups. We also calculated correlation between the sDGI and the DGI and the MSWS-12. The ability of the sDGI and the DGI to identify fallers was evaluated using receiver operating characteristic curves. Results51 participants completed the study. They had a mean age of 60.9 (SD 11.5) years, median PDDS of 4.0 (interquartile range 3, 5), 32 % used walking aids, 25 % were cognitively impaired, and 62 % were female. The sDGI was internally consistent (Cronbach's alpha 0.85, 95 % CI 0.76, 0.90) but was not concordant (CCC = 0.45, 95 % CI: 0.28–0.60) with the DGI. Concordance between the sDGI and DGI was not different for cognitively intact versus cognitively impaired individuals. The sDGI was moderately correlated with the DGI (R = 0.64, p < 0.01) and strongly correlated with the MSWS-12 (R = -0.71, p < 0.01). Neither the sDGI nor the DGI identified fallers in this sample. ConclusionThe moderate to strong correlation among the sDGI, DGI and MSWS-12 supports the validity of the sDGI as a measure of walking ability in people with MS. However, because there is poor concordance between the sDGI and the DGI performed in clinic by a PT in both cognitively intact and cognitively impaired participants, the sDGI should not be used as a substitute for the DGI. The sDGI could be used as a screening tool because most participants underestimated their walking performance compared to assessment by a PT so the sDGI would be unlikely to miss poor walking ability. As neither the sDGI nor the DGI identified fallers in this sample, our results do not support using these tools to identify fallers in people with MS and self-reported gait impairment.

Ankle dorsiflexion asymmetry and the relationship with walking performance in people with multiple sclerosis

BackgroundMultiple sclerosis (MS) is a neurological disease characterized by demyelination disrupting the central nervous system. Persons with MS may exhibit symptomatic strength asymmetry (SA) that impacts motor gait and ankle mobility. The purpose of the present study was to investigate ankle dorsiflexion SA in people with MS and its relationship to functional performance. Research QuestionIs their a difference in dorsiflexion SA in MS participants compared to healthy individuals and does it impact functional performance? Methods13 MS participants (EDSS 3.5 + 1.8) and 13 age matched NON-MS participants underwent maximal isometric (MVC) dynamometry testing for ankle dorsiflexion in both limbs to determine SA. Participants performed three functional tasks of walking performance. ResultsThere was a significant intra-limb MVC difference in the MS group, and significantly greater isometric SA (p < 0.007) and isokinetic SA (p < 0.04) in the MS group compared to healthy individuals. The MS group exhibited significant correlations between outcomes of functional walking performance with isokinetic but not isometric SA. There was no significant correlation between disability status and functional task performance. SignificanceAnkle dorsiflexion SA is negatively correlated with functional performance in MS participants. MS disability status was not a predictor of functional task performance, and symptom testing may be appropriate to assess walking ability in persons with MS.

Assessing walking ability using a robotic gait trainer: opportunities and limitations of assist-as-needed control in spinal cord injury

BackgroundWalking impairments are a common consequence of neurological disorders and are assessed with clinical scores that suffer from several limitations. Robot-assisted locomotor training is becoming an established clinical practice. Besides training, these devices could be used for assessing walking ability in a controlled environment. Here, we propose an adaptive assist-as-needed (AAN) control for a treadmill-based robotic exoskeleton, the Lokomat, that reduces the support of the device (body weight support and impedance of the robotic joints) based on the ability of the patient to follow a gait pattern displayed on screen. We hypothesize that the converged values of robotic support provide valid and reliable information about individuals’ walking ability.MethodsFifteen participants with spinal cord injury and twelve controls used the AAN software in the Lokomat twice within a week and were assessed using clinical scores (10MWT, TUG). We used a regression method to identify the robotic measure that could provide the most relevant information about walking ability and determined the test–retest reliability. We also checked whether this result could be extrapolated to non-ambulatory and to unimpaired subjects.ResultsThe AAN controller could be used in patients with different injury severity levels. A linear model based on one variable (robotic knee stiffness at terminal swing) could explain 74% of the variance in the 10MWT and 61% in the TUG in ambulatory patients and showed good relative reliability but poor absolute reliability. Adding the variable ‘maximum hip flexor torque’ to the model increased the explained variance above 85%. This did not extend to non-ambulatory nor to able-bodied individuals, where variables related to stance phase and to push-off phase seem more relevant.ConclusionsThe novel AAN software for the Lokomat can be used to quantify the support required by a patient while performing robotic gait training. The adaptive software might enable more challenging training conditions tuned to the ability of the individuals. While the current implementation is not ready for assessment in clinical practice, we could demonstrate that this approach is safe, and it could be integrated as assist-as-needed training, rather than as assessment.Trial registrationClinicalTrials.gov Identifier: NCT02425332.

Individuality of a group: detailed walking ability analysis of broiler flocks using optical flow approach

Impaired walking ability is one of the most important factors affecting broiler welfare. Routine monitoring of walking ability provides insights in the welfare status of a flock and assists farmers in taking remedial measures at an early stage. Several computer vision techniques have been developed for automated assessment of walking ability, providing an objective and biosecure alternative to the currently more subjective and time-consuming manual assessment of walking ability. However, these techniques mainly focus on assessment of averages at flock level using pixel movement. Therefore, the aim of this study was to investigate the potential of optical flow algorithms to identify flock activity, distribution and walking ability in a commercial setting on levels close to individual monitoring. We used a combination of chicken segmentation and optical flow methods, where chicken contours were first detected and were then used to identify activity, spatial distribution, and gait score distribution (i.e. walking ability) of the flock via optical flow. This is a step towards focusing more on individual chickens in an image and its pixel representation. In addition, we predicted the gait score distribution of the flock, which is a more detailed assessment of broiler walking ability compared to average gait score of the flock, as slight changes in walking ability are more likely to be detected when using the distribution compared to the average score. We found a strong correlation between predicted and observed gait scores (R2 = 0.97), with separate gait scores all having R2 > 0.85. Thus, the algorithm used in this study is a first step to measure broiler walking ability automatically in a commercial setting on a levels close to individual monitoring. These validation results of the developed automatic monitoring of flock activity, distribution and gait score are promising, but further validation is required (e.g. for chickens at a younger age, with very low and very high gait scores).

Influence of Transcranial Direct Current Stimulation and Exercise on Physical Capacity and Gait in Multiple Sclerosis: A Cross-Over Pilot Study.

Physical capacity provides a link between disease or impairment and limitations in activity; in multiple sclerosis (MS), it is limited and decreased. The aim of this study was to study the effects of exercise and transcranial direct current stimulation (tDCS) on the left dorsolateral prefrontal cortex area in MS patients with fatigue and an impaired gait ability. A cross-over design was carried out on fifteen patients with two disability associations, but three were excluded. Before and after each intervention, the 6 min walk test (6MWT) and the 2 min walk test (2MWT) were used to assess walking ability and the Modified Fatigue Impact Scale (MFIS) was used to assess fatigue. A total of twelve patients were enrolled (48.0 median age, Kurtzke Disability Scale (EDSS) 3.66 ± 1.3): five females and seven males. After the application of the exercise program, significant improvements were observed in the 6MWT (p < 0.001, g = 0.159) and 2MWT (p < 0.001, g = 0.182). Furthermore, fatigue was significantly reduced after the application of the exercise program (p < 0.05, g = 0.742) and after tDCS (p < 0.05, g = 0.525). We could consider therapeutic exercise in the future to improve the walking ability and fatigue in MS patients. Furthermore, tDCS did not exert a significant improvement in walking ability, but it appeared to influence fatigue. Clinical trial registration code: ACTRN12622000264785.

Validation of the Self-Assessed Dynamic Gait Index in People with Multiple Sclerosis

Background and Purpose The Dynamic Gait Index (DGI) is a validated clinical measure of walking ability in people with multiple sclerosis (MS). There is need for a self-assessed version of the DGI that can be conducted remotely and that demonstrates concurrent validity with the original DGI in people with MS. We therefore developed a self-assessed Dynamic Gait Index (sDGI). The purpose of this study is to evaluate the relationship between the sDGI, clinically-assessed DGI, and falls in people with MS with gait impairment. Methods We will enroll 50 ambulatory people with MS with gait impairment. Participants will complete the sDGI (online questionnaire) and then, within 4-weeks, the DGI (in-person evaluation by a physical therapist). Other outcome measures include: modified Telephone Interview for Cognitive Status (TICS-M) and self-reported fall history in the past 3 months. We will calculate concordance between the sDGI and DGI, and use linear regression to determine if concordance is impacted by cognition. The ability of the sDGI to identify fallers will be evaluated using the receiver operating characteristic curve. Results At time of submission, 41 participants are enrolled, 31 have completed the study. Anticipated date of study completion is March 2023. Full study results will be presented at the meeting. Discussion The sDGI has potential to be used by physicians, physical therapists, and others to remotely assess walking ability and identify fallers in people with MS. Information from this study will determine how self-assessment of walking ability compares with clinically-assessed walking ability in people with MS. Our study will also determine if cognition impacts the validity of the sDGI. If concordance between sDGI and DGI is lower in those with worse cognitive performance, users of the sDGI might exercise greater caution using this measure to approximate DGI and predict fall risk in individuals with cognitive impairment. The Dynamic Gait Index (DGI) is a validated clinical measure of walking ability in people with multiple sclerosis (MS). There is need for a self-assessed version of the DGI that can be conducted remotely and that demonstrates concurrent validity with the original DGI in people with MS. We therefore developed a self-assessed Dynamic Gait Index (sDGI). The purpose of this study is to evaluate the relationship between the sDGI, clinically-assessed DGI, and falls in people with MS with gait impairment. We will enroll 50 ambulatory people with MS with gait impairment. Participants will complete the sDGI (online questionnaire) and then, within 4-weeks, the DGI (in-person evaluation by a physical therapist). Other outcome measures include: modified Telephone Interview for Cognitive Status (TICS-M) and self-reported fall history in the past 3 months. We will calculate concordance between the sDGI and DGI, and use linear regression to determine if concordance is impacted by cognition. The ability of the sDGI to identify fallers will be evaluated using the receiver operating characteristic curve. At time of submission, 41 participants are enrolled, 31 have completed the study. Anticipated date of study completion is March 2023. Full study results will be presented at the meeting. The sDGI has potential to be used by physicians, physical therapists, and others to remotely assess walking ability and identify fallers in people with MS. Information from this study will determine how self-assessment of walking ability compares with clinically-assessed walking ability in people with MS. Our study will also determine if cognition impacts the validity of the sDGI. If concordance between sDGI and DGI is lower in those with worse cognitive performance, users of the sDGI might exercise greater caution using this measure to approximate DGI and predict fall risk in individuals with cognitive impairment.

Gender Differences in Functional Outcomes from the Cerebral Palsy Adult Transition Study Cohort (CPAT)

<h3>Research Objectives</h3> To evaluate gender differences in cognitive function and physiological outcomes associated with physical function on the Cerebral Palsy Adult Transition Study (CPAT) cohort. <h3>Design</h3> Cross-sectional, cohort, study. <h3>Setting</h3> Accredited clinical motion analysis laboratory at a regional Children's Hospital. <h3>Participants</h3> 72 ambulatory adults with CP [mean ± SD of age=20± 5.3] representing a balanced gender sample (38 females and 34 males). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Physiological outcomes included BMI, waist-to-hip ratio, grip strength and rate of force development (RFD). An instrumented gait analysis was utilized to assess walking ability, in which Gait Deviation Index and walking speed adjusted for height were collected. Cognitive function was evaluated using the WMS-IV and the WAIS- IV subtests. Blood biomarkers consisted of glucose, insulin, lipids (CHOL, HDL, Non-HDL, LDL) and BDNF. Simple T-tests were performed to determine differences between females and males. <h3>Results</h3> Grip strength (p-value = 0.006) showed differences between females and males, in which males showing higher scores. For cognitive function, differences were observed within the WMS-IV subtests; Visual Reproduction delayed recall (p-value = 0.0252) and delayed recognition (p-value = 0.0498), in which females had higher scores compared to males. For the blood biomarkers, only BDNF (p-value =0.02) and HDL (p-value =0.0003) showed differences, in which females showing the highest levels. There were no differences in walking performance between females and males. <h3>Conclusions</h3> The analysis showed that there is gender-specific health outcome differences in adults with CP. Physiological and biological markers are important to guide precision medicine models. Biomarkers can generate diagnosis and treatments accordingly to patient unique health needs. As such, it could assist clinicians to accurately differentiate those at risk for disease as well as to design disease-modifying interventions. <h3>Author(s) Disclosures</h3> There is no conflict of interest.

Reliability and validity of Six-Spot Step Test (SSST) in stroke survivors.

The Six-Spot Step Test (SSST) was originally developed to assess walking ability while challenging balance during walking in patients with multiple sclerosis. It provides more comprehensive information on ambulatory abilities than several existing measures such as the Timed Up and Go test (TUG test), the Functional Gait Assessment, and the Dynamic Gait Index. To assess the advanced balance control ability of stroke survivors, we modified the SSST to serve this purpose. The aim of this study was to expand the current understanding of the psychometric properties of the SSST using healthy older adults and stroke survivors. This study adopted an experimental design. University-affiliated neurorehabilitation laboratory. A total of 50 study participants, including 25 chronic stroke survivors and 25 healthy older adults, were recruited from the community. The SSST was administered to the stroke survivors twice (day 1 and 2) with a 1-week interval. The Fugl-Meyer assessment for the lower extremities (FMA-LE), the Berg Balance scale (BBS), the limit of stability (LOS) test, the Timed Up and Go test (TUG test), and the Chinese version of the Community Integration Measures (CIM-C) were assessed on day 1 by random order. The healthy control group was assessed with the Six-Spot Step Test only on day 1. The SSST showed excellent inter-rater, intra-rater, and test-retest reliability (intraclass correlation coefficient >0.95, P<0.001). Significant correlations were found between SSST performance and the FMA-LE results (r=0.517, P<0.05), BBS scores (r=-0.531, P<0.05), and TUG test scores (r=0.828, P<0.001). The MDC in the mean SSST time for the affected leg and the unaffected leg in stroke survivors was 6.05s. The cutoff time was 10.11s (sensitivity, 80%; specificity, 92%) when kicking obstacles with the affected leg and 10.18s (sensitivity, 80%; specificity, 92%) when kicking obstacles with the unaffected leg. The SSST was a reliable test and showed a significant correlation with FMA-LE scores, BBS scores, and TUG test times in stroke survivors. The SSST can be used to assess the advanced balance control of stroke survivors.

Prevalence of Walking Limitation After Acute Stroke and Its Impact on Discharge to Home.

The purpose of this study was to provide contemporary estimates of the prevalence of lower extremity motor impairment and walking limitation after first-ever stroke and to characterize the predictive nature of early walking ability for being discharged home after acute hospitalization. In this cohort study, data were collected from a metropolitan acute care hospital in Canada at admission for 487 adults with first-ever acute ischemic or hemorrhagic stroke. Lower extremity motor impairment and walking limitation were measured using the National Institutes of Health Stroke Scale and AlphaFIM, respectively. Parallel multivariable logistic regression models were built to predict discharge home after acute hospitalization compared with further hospitalization. For patients surviving a first-ever stroke, 44.1% presented with some degree of lower extremity motor impairment and 46.0% were unable to walk. In a multivariable model built around a binary classification of walking (Nagelkerke R2 = 0.41), those with any ability to walk at admission (with or without therapist assistance) had 9.48 times greater odds of being discharged home (odds ratio = 9.48, 95% CI = 6.11-14.92) than those who were unable. In a parallel multivariable model built around an ordinal classification of walking (Nagelkerke R2 = 0.49), patients had 2.07 times greater odds (odds ratio = 2.07, 95% CI = 1.82-2.38) of being discharged home for each increment on a 6-point walking scale (total dependence to complete independence) assessed at acute admission. Approximately one-half of patients with first-ever stroke present with lower extremity weakness and walking limitation. Early walking ability is a significant predictor of returning home after acute hospitalization, independent of stroke severity. Discharge planning may be facilitated early after stroke with the familiar assessment of walking ability. An early assessment of walking function within days of stroke admission can help to streamline discharge planning. Nearly one-half of all individuals who experience a first-time stroke have walking difficulty when they arrive at the hospital. The severity of the walking limitation can predict whether a patient will eventually be discharged home or go on to further hospitalization.

Walking Ability Outcome Measures in Individuals with Spinal Cord Injury: A Systematic Review.

Walking function recovery in spinal cord injury (SCI) is tackled through several therapeutic approaches in which precise evaluation is essential. A systematic review was performed to provide an updated qualitative review of walking ability outcome measures in SCI and to analyze their psychometric properties. PubMed, Cochrane, and PEDro databases were consulted until 1 April 2020. Seventeen articles written in English were included. Five of them studied the walking index for SCI, four studied the 10 meter walk test, and two studied the six-minute walk test, the timed Up and go test, and the Berg balance scale. The rest of the articles studied the following metrics: gait profile score, spinal cord injury functional ambulation profile, five times sit-to-stand test, spinal cord injury functional ambulation inventory, spinal cord independence measure (indoors and outdoors mobility items), locomotor stages in spinal cord injury, community balance and mobility scale, and activity-based balance level evaluation scale. The choice of a single or a set of metrics should be determined by the clinician. Based on the results obtained in this review, a combination of outcome measures is proposed to assess walking ability. Future work is required to integrate a more realistic environment for walking assessment.

To What Extent is Walking Ability Associated with Participation in People after Stroke?

ObjectivesThis study aims to 1) identify the relation between walking ability and participation after stroke and 2) explore whether change in walking ability is associated with change in participation over time in community living-people after stroke. Materials and MethodsFifty-two people after stroke were assessed at baseline and after a 6-week gait training intervention. People were included between two weeks and six months after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation was used to measure participation. Assessment of walking ability included the six-minute walking test for walking endurance, Timed-up & Go test for functional mobility, Mini Balance Evaluation Systems Test for dynamic balance, and total duration of walking activity per day to measure walking activity. ResultsAt baseline, six-minute walking test, Timed-up & Go test, and Mini Balance Evaluation Systems Test were univariately associated with participation (P < 0.001). Backward multiple regression analysis showed that the Mini Balance Evaluation Systems Test independently explained 55.7% of the variance in participation at baseline. Over time, only change in the six-minute walking test was positively associated with change in participation (R2 = 0.087, P = 0.040). ConclusionsCross-sectional associations showed that walking ability, and especially dynamic balance, contributes to participation after stroke. Dynamic balance, as underlying variable for walking, was an important independently related factor to participation after stroke which needs attention during rehabilitation. Longitudinally, improvement in walking endurance was significantly associated with improvement in participation, which indicates the relevance of training walking endurance to improve participation after stroke.

Safety, Patient-Reported Well-Being, and Physician-Reported Assessment of Walking Ability in Patients with Multiple Sclerosis for Prolonged-Release Fampridine Treatment in Routine Clinical Practice: Results of the LIBERATE Study.

BackgroundProlonged-release fampridine (PR-FAM) 10-mg tablet twice daily is the only approved pharmacological treatment for improvement of walking ability in adults with multiple sclerosis (MS). LIBERATE assessed the safety/effectiveness of PR-FAM in the real-world.ObjectivesThe aim of this study was to collect additional safety data, including the incidence rate of seizures and other adverse events (AEs) of interest, from patients with MS taking PR-FAM in routine clinical practice (including patients aged ≥ 65 years and those with pre-existing cardiovascular risk factors). Other objectives included change over time in patient-reported evaluation of physical and psychological impact of MS while taking PR-FAM, and change over time in physician-reported assessment of walking ability in MS patients taking PR-FAM.MethodsPatients with MS newly prescribed PR-FAM were recruited (201 sites, 13 countries). Demographic/safety data were collected at enrolment through 12 months. Physician-rated Clinical Global Impression of Improvement (CGI-I) scores for walking ability, and Multiple Sclerosis Impact Scale-29 (MSIS-29) were assessed.ResultsSafety analysis included 4646 patients with 3534.8 patient-years of exposure; median (range) age, 52.6 (21–85) years, 87.3% < 65 years, and 65.7% women. Treatment-emergent AEs (TEAEs) were reported in 2448 (52.7%) patients, and serious TEAEs were reported in 279 (6.0%) patients, of whom 37 (< 1%) experienced treatment-emergent serious AEs (TESAEs) considered related to PR-FAM. AEs of special interest (AESI) occurred in 1799 (38.7%) patients, and serious AESI in 128 (2.8%) patients. Seventeen (< 1%) patients experienced actual events of seizure. Overall, 1158 (24.9%) patients discontinued treatment due to lack of efficacy. At 12 months, a greater proportion of patients on-treatment had improvement from baseline in CGI-I for walking ability versus those who discontinued (61% vs. 11%; p <  0.001). MSIS-29 physical impact score improved significantly for patients on-treatment for 12 months versus those who discontinued (mean change, baseline to 12 months: − 9.99 vs. − 0.34 points; p <  0.001). Results were similar for MSIS-29 psychological impact.ConclusionNo new safety concerns were identified in this real-world study, suggesting that routine risk-minimization measures are effective. CGI-I and MSIS-29 scores after 12 months treatment with PR-FAM treatment show clinical benefits consistent with those previously reported.Trial RegistrationClinicalTrials.gov: NCT01480063.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40263-021-00840-x.

Assessment of Walking Ability in Patients with Intermittent Claudication Using a Smartphone Accelerometer

<strong>Objectives:</strong> It is challenging to accurately monitor the progress of intermittent claudication patients during or after treatment. Furthermore, diagnostic tools for intermittent claudication are not always adequate to determine whether other diseases are the primary cause of any walking complaints. This makes it difficult to determine the optimal treatment for the patient and impairs proper follow-up. The objective was to investigate the feasibility of measuring disease specific changes in the gait pattern of intermittent claudication patients by using a smartphone accelerometer. <strong>Methods:</strong> This study is a clinical Proof-of-concept study. Included were 12 subjects. Seven of the subjects were healthy controls, the other five intermittent claudication patients. Raw accelerometer data was collected during a standardized walking test with an Iphone. Processed data was analyzed using the GaitPy package in Python, resulting in 20 different gait parameters per gait cycle. The data were divided, resulting in three groups: The control group, the patient group without symptoms and the patient group with active symptoms. Mann-Whitney U tests and Wilcoxon ranks test were used to examine the outcomes. <strong>Results:</strong> Five of the 20 parameters are significantly different between patients before symptoms and patients with active symptoms. All parameters except cadence and stride duration differ between our control group and the patients while experiencing symptoms. Nine of 20 parameters where significantly different between the control group and the patient group without symptoms. <strong>Conclusions:</strong> This study demonstrated the potential clinical applicability of measuring changes in intermittent claudication gait characteristics with a smartphone.

Transcutaneous Spinal Cord Stimulation Enhances Walking Performance and Reduces Spasticity in Individuals with Multiple Sclerosis.

Gait dysfunction and spasticity are common debilitating consequences of multiple sclerosis (MS). Improvements of these motor impairments by lumbar transcutaneous spinal cord stimulation (tSCS) have been demonstrated in spinal cord injury. Here, we explored for the first time the motor effects of lumbar tSCS applied at 50 Hz for 30 min in 16 individuals with MS and investigated their temporal persistence post-intervention. We used a comprehensive protocol assessing walking ability, different presentations of spasticity, standing ability, manual dexterity, and trunk control. Walking ability, including walking speed and endurance, was significantly improved for two hours beyond the intervention and returned to baseline after 24 h. Muscle spasms, clonus duration, and exaggerated stretch reflexes were reduced for two hours, and clinically assessed lower-extremity muscle hypertonia remained at improved levels for 24 h post-intervention. Further, postural sway during normal standing with eyes open was decreased for two hours. No changes were detected in manual dexterity and trunk control. Our results suggest that transcutaneous lumbar SCS can serve as a clinically accessible method without known side effects that holds the potential for substantial clinical benefit across the disability spectrum of MS.

Reproducibility of the Persian Version of the ABILOCO Questionnaire for Stroke Patients.

Background:The ABILOCO is a questionnaire assessing and measuring the locomotion ability to perform activities daily living from easy to hard in stroke patients.Methods:The ABILOCO was translated into Persian and retranslated into English. Forty hemiplegic stroke patients with an average age (60 ± 7.5 years) participated in the study. The participants were interviewed using ABILOCO and were assessed by the interviewer and observer. The total logit score of the participants was also assessed by using the interclass correlation coefficient (ICC).Results:The results were showed the high correlation between the first interview of interviewer and the observer (ICC = 0.8, P < 0.05). In addition, a strong relationship was observed between the interviewer's first and second interviews after a week (ICC = 0.85, P < 0.05).Conclusions:The Persian edition of ABILOCO is reliable to assess walking ability of stroke patients in clinics and studies.

Walking efficiency before and after long-term muscle stretch in patients with spastic paraparesis

Eight patients with stationary, spastic paraparesis were treated with long-term stretch of the hip adductor muscles to improve walking ability. Gait pattern, walking speed and perceived exertion of walking were assessed. Walking efficiency was assessed before and after treatment by measuring oxygen consumption and blood lactate level. After treatment walking pattern was improved. Perceived exertion decreased but walking speed was unchanged. Oxygen cost directly after treatment was lower in six patients, unchanged in one and higher in one. In the patient with unchanged oxygen cost the blood lactate level decreased, probably due to decreased recruitment of fast, type II muscle fibres. Blood lactate was unchanged in the other patients. When assessing walking ability, measurement of energy cost was found to be a valuable supplement to clinical judgement, but in spastic patients both oxygen cost and blood lactate must be considered.

Is the rotarod test an objective alternative to the gait score for evaluating walking ability in chickens?

AbstractWalking ability is related to motor co-ordination which, in rodents, can be assessed by an established test in pharmacological studies — the rotarod test. The purpose of this study was to evaluate a modified rotarod test for chickens and its relation to the often-used gait score system. At the end of their rearing period, we tested 138 male chickens (Gallus gallus domesticus) from three differing growth performance strains: Ross 308 (fast-growing; n = 46), Lohmann Dual (medium-growing; n = 46) and Lohmann Brown Plus (slow-growing; n = 46). First, the chickens’ gait scores were assessed and, immediately following this, they were placed gently onto a steady rod. The velocity of the rotating rod gradually increased, and the latency to leave the rod was recorded. By using a linear mixed model, we were able to show that the latency to leave the rotating rod was significantly predicted by the gait score. Fast-growing chickens had shorter durations on the rotating rod, and these durations were associated with gait score. We conclude that the rotarod test provides an objective alternative method for assessing walking ability in chickens without the need for intense observer training or the risk of observer biases and propose that this novel methodology has the potential to function as a precise, objective indicator of animal welfare.

The Validity, Reliability, Measurement Error, and Minimum Detectable Change of the 30-Second Fast-Paced Walk Test in Persons with Knee Osteoarthritis: A Novel Test of Short-Distance Walking Ability.

ObjectiveTo develop and establish the reliability, validity, measurement error, and minimum detectable change of a novel 30‐second fast‐paced walk test (30SFW) in persons with knee osteoarthritis (OA) that is easy to administer and can quantify walking performance in persons of all abilities.MethodsTwenty females with symptomatic knee OA (mean age [SD] 58.30 [8.05] years) and 20 age‐ and sex‐matched asymptomatic controls (57.25 [8.71] years) participated in the study. Participants completed questionnaires of demographic and clinical data, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the 36‐item Short Form Health Survey (SF‐36) followed by 30SFW performance. Participants returned 2‐7 days later and performed the 30SFW again.ResultsThe knee OA group reported function that was worse than controls (all KOOS subscales; P < 0.0001). The 30SFW intrarater and interrater reliability were excellent [ICC (2,1) = 0.95‐0.99]. Knee OA participants walked a shorter distance in the 30SFW than controls (mean [SD]: OA 44.4 m [9.5 m]; control 58.1 m [7.8 m]; P < 0.0001). Positive strong correlations were found between the 30SFW and the KOOS–Activity of Daily Living, SF‐36‐Physical Functioning, and SF‐36‐Physical Health Composite scores (P < 0.0001). A nonsignificant, weak correlation between 30SFW and SF‐36‐Mental Health scores was present (r = 0.32, P = 0.05).ConclusionThe 30SFW has excellent intrarater and interrater reliability. The 30SFW demonstrated excellent known groups, convergent, and discriminant validity as a measure of short‐distance walking ability in persons with knee OA. Clinicians and researchers should consider using the 30SFW to quantify walking ability in persons with knee OA and assess walking ability change.

A systematic review: Efficacy of botulinum toxin in walking and quality of life in post-stroke lower limb spasticity

We performed a systematic review of the randomized control trials (RCT) to evaluate effectiveness of Botulinum toxin A (BoNTA) injection on walking and Quality of Life (QOL) in post-stroke lower limb spasticity (PSLLS). We searched PubMed, Web of Science, Embase, CINAHL, ProQuest Thesis and Dissertation checks and Google Scholar, WHO International Clinical Trial Registry Platform, ClinicalTrials.gov, Cochrane, ANZ and EU Clinical Trials Register for RCTs looking at improvement in walking and QOL following injection of BoNTA in PSLLS. The original search was carried out prior to 16 September 2015. We conducted an additional verifying search on CINHAL, EMBASE, and MEDLINE (via PubMed) from 16 September 2015 to 6 June 2017 using the same clauses. Of 2026 records, we found 107 full text records and 5 RCTs qualifying our criteria. Two independent reviewers assessed methodological validity prior to inclusion in the review. Two studies reported significant improvement in gait velocity ( P = 0.020 and < 0.05, respectively). One study showed significant improvement in 2-min-walking distance ( P < 0.05). QOL was recorded in one study without any significant improvement. Meta-analysis of reviewed studies could not be performed because of different methods of assessing walking ability, and small sample size with large confidence interval. This review identifies the need for a well-designed RCT to adequately investigate the issues highlighted. This review could not conclude there was sufficient evidence to support or refute improvement on walking or QOL following BoNTA injection. Reasons for this are discussed and methods for future RCTs are developed.