Changes In Gait Performance Research Articles

Stimulation of the withdrawal reflex in gait training after stroke: A systematic review and meta-analysis.

After a stroke many people experience hemiparesis, resulting in walking difficulties which affects independence, mobility, and participation in activities of daily living. Activating the nociceptive withdrawal reflex (NWR) during gait training aims to support the initiation and facilitation of the swing phase of the paretic leg. The aim of this review is to investigate the orthotic and therapeutic effects of a NWR stimulation intervention to improve gait in patients after a stroke. We searched the databases CENTRAL, DORIS, MEDLINE, and PEDro, trial registers and reference lists. We selected randomized controlled trials using any type of stimulation of the NWR in people after stroke, comparing it to any control intervention, and reporting a change in gait performance assessed by means of any appropriate measurement method. We included three studies in this review, all of which used electrical stimulation to elicit the NWR during walking. The orthotic effect was investigated in one study, and the therapeutic effect in two studies, comparing walking with and without electrical stimulation-triggered NWR. The meta-analysis revealed a borderline statistical significance result for the therapeutic effect. The pooled mean difference between the treatment and control group (random-effects model) for walking speed was 0.13 m/s (95% CI -0.04 to 0.29; I2 = 72%) after treatment and 0.17 m/s (95% CI -0.03 to 0.37; I2 = 62%) at follow-up. Activating the NWR during gait training has not been investigated frequently so far. By using electrical stimulation-elicited NWR, severely affected hemiparetic patients may improve their walking speed.

Watch your step: A pilot study of smartphone use effect on young females’ gait performance while walking up and down stairs and escalators

The increasingly ubiquitous use of smartphones has made distracted walking common, not only on flat ground, but also on stairs. Available information regarding changes in gait performance while walking and using a smartphone in different environments is still lacking. We aimed to investigate the differences in gait behavior and subjective walking confidence while walking up and down stairs and escalators, with and without smartphone use. A field experiment involving 32 female adults was conducted at a subway station. Gait parameters collected included step frequency, acceleration root mean square, step variability, step regularity, and step symmetry. The results showed that walking task, walking environment, and walking direction significantly affected gait performance and walking confidence. Overall, playing games or texting while walking down escalators resulted in the lowest walking confidence and the largest gait performance decrement: slower step frequency; reduced root mean square; decreased step regularity and step symmetry; and increased step variability. Step frequency, step variability, and step regularity significantly correlated with walking confidence. Smartphone use while walking on stairs and escalators significantly affects gait behavior and might increase the risk of falls. Interventions and prevention are needed to increase safety education and hazard warnings for the general population.

A Cable-driven Exoskeleton with Personalized Assistance Improves the Gait Metrics of People in Subacute Stroke.

Most stroke survivors have mobility deficits and show a pathological gait pattern. Seeking to enhance the gait performance among this population, we have developed a hybrid cable-driven lower limb exoskeleton (called SEAExo). This study aimed to determine the effects of SEAExo with personalized assistance on immediate changes in gait performance of people after stroke. Gait metrics (i.e., the foot contact angle, knee flexion peak, temporal gait symmetry indices) and muscle activities were the primary outcomes to evaluate the assistive performance. Seven subacute stroke survivors participated and completed the experiment with three comparison sessions, i.e., walking without SEAExo (served as baseline) and without/with personalized assistance, at their preferred walking speeds. Compared to the baseline, we observed increases in the foot contact angle and knee flexion peak by 70.1% (p < 0.05) and 60.0% (p < 0.05) with personalized assistance. Personalized assistance contributed to the improvements in temporal gait symmetry of more impaired participants (p < 0.05), and it led to a 22.8% and 51.3% (p < 0.05) reduction in the muscle activities of ankle flexor muscles. These results demonstrate that SEAExo with personalized assistance has the potential to enhance post-stroke gait rehabilitation in real-world clinical settings.

The effect of co-dependent (thinking in motion [TIM]) versus single-modality (CogniFit) interventions on cognition and gait among community-dwelling older adults with cognitive impairment: a randomized controlled study

BackgroundCognition and motor skills are interrelated throughout the aging process and often show simultaneous deterioration among older adults with cognitive impairment. Co-dependent training has the potential to ameliorate both domains; however, its effect on the gait and cognition of older adults with cognitive impairment has yet to be explored. The aim of this study is to compare the effects of the well-established single-modality cognitive computerized training program, CogniFit, with “Thinking in Motion (TIM),” a co-dependent group intervention, among community-dwelling older adults with cognitive impairment.MethodsEmploying a single-blind randomized control trial design, 47 community-dwelling older adults with cognitive impairment were randomly assigned to 8 weeks of thrice-weekly trainings of TIM or CogniFit. Pre- and post-intervention assessments included cognitive performance, evaluated by a CogniFit battery, as a primary outcome; and gait, under single- and dual-task conditions, as a secondary outcome.ResultsCogniFit total Z scores significantly improved from baseline to post-intervention for both groups. There was a significant main effect for time [F (1, 44) = 17.43, p < .001, ηp2 = .283] but not for group [F (1, 44) = 0.001, p = .970]. No time X group interaction [F (1, 44) = 1.29, p = .261] was found. No changes in gait performance under single and dual-task performance were observed in both groups.ConclusionsThe findings show that single-modality (CogniFit) and co-dependent (TIM) trainings improve cognition but not gait in older adults with cognitive impairment. Such investigations should be extended to include various populations and a broader set of outcome measurements.Trial registrationACTRN12616001543471. Date: 08/11/2016.

Quantitative gait analysis value as a predictor of shunt surgery effectiveness in normal pressure hydrocephalus: A technical note

IntroductionShunt surgery (SS) remains the most effective treatment for idiopathic Normal pressure hydrocephalus (iNPH), but the selection of the patients with the greatest potential benefit remains elusive. ObjectiveIdentify gait features predictive of best response to SS in iNPH. MethodsEight patients with iNPH were assessed at baseline, after Cerebrospinal fluid tap-test (CSF-TT) and SS, with clinical scales (Clinical/Patient Global Clinical Impression, EuroQol-5D, Clinical Dementia Rating Scale(CDR), MoCA test, Hoehn-Yahr Scale) and gait analysis with inertial sensors. ResultsThe 8 included iNPH patients had a mean age of 73 years(59−81), moderate cognitive (CDR-1.5 (0.5–2); MoCA-9.5 (3−21)) and motor impairment (Hoehn-Yahr-2.75(2−3)). After SS, patients had a significant improvement in cognition (MoCA, p = 0.001) and quality of life. At baseline, patients with lower improvement (no change/ minimally improved) (n = 2), in comparison to patient with higher improvement (much/very much improved) (n = 6), already had higher cognitive impairment (MoCa-3(3−3) vs. 11(7−21)). Patients with lower improvement had a lower % of change in gait performance at LP (mean 10.2 %) and were absent of additional benefit after SS(mean −0.8 %). In contrast, gait performance in patients with higher improvement consistently got better from baseline to LP (mean 23.1 %) and from baseline to SS (mean 82.9 %). A significant negative correlation was observed between CDR score and several gait variables: speed (rpb=−0.92,p = 0.009); stride length (rpb=−0.92,p = 0.009); lift-off angle (rpb=−0.96,p = 0.003); and maximum heel (rpb=−0.81,p = 0.049). ConclusionThe magnitude of gait improvement after CSF-TT, quantified by gait analysis, can be used as an integral variable in the multimodal clinical approach to the prediction of improvement after SS.

Immediate effects of transcutaneous electrical nerve stimulation on gait patterns in chronic stroke survivors: A single group, pretest-posttest clinical trial.

Transcutaneous electrical nerve stimulation (TENS) has been used to reduce muscle spasticity and improve locomotion in stroke survivors. We speculate that acute changes in gait performance after TENS mediate functional improvement in the long-term. However, no previous study has investigated the effect of TENS on ankle kinetics and kinematics during walking in stroke survivors. We aimed to investigate whether TENS applied over the paretic leg could rapidly improve the plantar flexion moment and ankle kinematics in chronic stroke survivors with lower limb paresis. Twenty chronic stroke survivors were recruited. They underwent 30min of TENS over the area innervated by the common peroneal nerve on the paretic leg. Three-dimensional (3D) motion capture was performed and ankle plantar flexor spasticity was assessed before and immediately after stimulation. Ankle kinematics and kinetic and spatiotemporal data were collected using 3D motion capture. Ankle plantar flexor spasticity was assessed using the Modified Tardieu Scale. A significant increase in the ankle plantar flexion moment of the paretic side during the pre-swing phase was observed immediately after stimulation (p=0.009, maximal mean difference=0.035, 95%CI=0.0125 to 0.0575). The step length of the paretic limb also increased significantly after stimulation (p=0.023, mean difference=-0.02, 95%CI=-0.04 to -0.004). TENS had no immediate effect on paretic ankle spasticity, as measured by the Modified Tardieu Scale, or on other temporo-spatial parameters. The findings support the use of TENS to improve the motor function and gait pattern in chronic stroke survivors. The study indicated that the application of TENS to the paretic leg before gait training might improve rehabilitation outcomes. Future studies investigating the effects of TENS on functional outcomes, the optimal stimulation duration, and assessing spasticity using more sensitive measures are warranted.

Combining Neuromodulation Strategies to Improve Locomotor Function in SCI: A Proof of Concept Case Study

<h3>Research Objectives</h3> Acute intermittent hypoxia (AIH) and transcutaneous spinal cord stimulation (tSCS) are two non-invasive neuromodulation treatments that have been shown to individually induce spinal plasticity in persons with chronic incomplete spinal cord injury (iSCI). However, these two interventions have never been tested in combination to see if their combined effect is greater than each intervention alone. This proof of concept case study investigated how AIH combined with tSCS during ambulation training may facilitate improvements in walking function in individuals with iSCI. <h3>Design</h3> Single-blind, randomized, crossover trial. <h3>Setting</h3> Outpatient, Rehabilitation Hospital. <h3>Participants</h3> 1 participant (male, 70 years) with chronic iSCI. <h3>Interventions</h3> The participant completed 3 arms, in random order: 1. AIH+tSCS 2. Sham-AIH+Sham-tSCS 3. Sham-AIH+tSCS Each arm consisted of 5 treatment sessions on consecutive days. <h3>Main Outcome Measures</h3> Assessments were performed at Baseline, Post-intervention (Post), and 1-week follow-up (1WFU), with a 4-week wash out between arms. Changes in gait performance were measured using the 10-meter walk test (10MWT) for fast and comfortable speeds, and the 6-minute walk test (6MWT). <h3>Results</h3> Overall, the participant showed potential improvements in his walking performance with AIH+tSCS at Post, relative to Baseline (10MWT-Fast: 5.6%; 10MWT-Comfortable: 7.0%; 6MWT: 15.6%), with further improvements at 1WFU (10MWT-Fast: 6.9%; 10MWT-Comfortable: 19.2%; 6MWT: 19.3%). The participant also showed potential improvements at Post, relative to Baseline with Sham-AIH+Sham-tSCS (10MWT-Fast: 12.2%; 10MWT-Comfortable: 6.6%; 6MWT: 15.1%) and with Sham-AIH+tSCS (10MWT-Fast: -2.5%; 10MWT-Comfortable: 15.3%; 6MWT: 6.0%). However, sustained improvements were not present at 1WFU with the Sham-AIH+Sham-tSCS (10MWT-Fast: 3.8%; 10MWT-Comfortable: -2.5%; 6MWT: 8.3%) or Sham-AIH+tSCS (10MWT-Fast: -3.9%; 10MWT-Comfortable: -5.5%; 6MWT: -2.1%), suggesting the combined intervention yielded retention effects. <h3>Conclusions</h3> AIH +tSCS with gait training may promote persistent improvements in walking function compared to tSCS with gait training or gait training alone in persons with iSCI. Further studies are warranted to investigate this novel, combinational neuromodulation strategy. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest to disclose.

Narrow doorways alter brain connectivity and step patterns in isolated REM sleep behaviour disorder

BackgroundMotor impairments in those with isolated REM sleep behaviour disorder (iRBD) significantly increases the likelihood of developing Lewy body disease (e.g. Parkinson’s disease and Dementia with Lewy Bodies). ObjectiveThis study sought to explore the prodromal process of neurodegeneration by examining the neural signature underlying motor deficits in iRBD patients. MethodsA virtual reality (VR) gait paradigm (which has previously been shown to elicit adaptive changes in gait performance whilst navigating doorways in Parkinson’s Disease - PD) was paired with fMRI to investigate whether iRBD patients demonstrated worsened motor performance and altered connectivity across frontoparietal, motor and basal ganglia networks compared to healthy controls. Forty participants (23 iRBD and 17 healthy controls) completed the virtual reality gait task whilst in the MRI scanner, and an additional cohort of 19 Early PD patients completed the behavioural virtual reality gait task. ResultsAs predicted, iRBD patients demonstrated slower and more variable stepping compared to healthy control participants and demonstrated an exaggerated response when navigating narrow compared to wide doorways, a phenomenon characteristically seen in PD. The iRBD patients also demonstrated less BOLD signal change in the left posterior putamen and right mesencephalic locomotor region, as well as reduced functional connectivity between the frontoparietal network and the motor network, when navigating narrow versus wide doorways compared to healthy control participants. ConclusionsTaken together, this study demonstrates that iRBD patients have altered task-related brain connectivity, which may represent the neural underpinnings of early motor impairments that are evident in iRBD.

Exoskeleton-assisted Gait Training in Spinal Disease With Gait Disturbance.

Gait impairment reduces a patient's quality of life. Exoskeletons and wearable robotics enable patients with gait disturbance to stand up and walk. An exoskeleton was developed for use in patients with stroke and spinal cord injuries. This study aimed to evaluate the effectiveness of overground exoskeleton-assisted gait training (OEGT) in spine diseases with gait disturbance. This was a single-group preliminary study. Five participants with gait disorders because of root dysfunction accompanying spinal stenosis were included in this study. All participants underwent surgical treatment and an exoskeleton training protocol scheduled for 2 or 3 days per week for 4 weeks. Each session was 60 minutes. Clinical tests were performed before (T1) and at the end of the training (T2). One patient dropped out of the study because of medical issues that were not associated with the exoskeleton. Exoskeleton-assisted rehabilitation was feasible for all participants. All participants showed positive changes in gait performance, balance, proximal muscle strength, psychological state, and satisfaction with the rehabilitation. However, there was no significant improvement in neurological deficits. OEGT is a feasible rehabilitation method for patients with gait disorders caused by degenerative spinal disease.

Effects of Combining Online Anodal Transcranial Direct Current Stimulation and Gait Training in Stroke Patients: A Systematic Review and Meta-Analysis

Objective: Combining transcranial direct current stimulation (tDCS) and repetitive gait training may be effective for gait performance recovery after stroke; however, the timing of stimulation to obtain the best outcomes remains unclear. We performed a systematic review and meta-analysis to establish evidence for changes in gait performance between online stimulation (tDCS and repetitive gait training simultaneously) and offline stimulation (gait training after tDCS).Methods: We comprehensively searched the electronic databases Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature, and included studies that combined cases of anodal tDCS with motor-related areas of the lower limbs and gait training. Nine studies fulfilled the inclusion criteria and were included in the systematic review, of which six were included in the meta-analysis.Result: The pooled effect estimate showed that anodal tDCS significantly improved the 10-m walking test (p = 0.04; I2 = 0%) and 6-min walking test (p = 0.001; I2 = 0%) in online stimulation compared to sham tDCS.Conclusion: Our findings suggested that simultaneous interventions may effectively improve walking ability. However, we cannot draw definitive conclusions because of the small sample size. More high-quality studies are needed on the effects of online stimulation, including various stimulation parameters.

Reliability and validity of walk tests for older adults with dementia: A systematic review

AbstractBackgroundWalk tests are the most common, simple, and easy‐to‐administer tests to measure walking ability, monitor changes in gait performance and evaluate the effects of interventions in clinical settings. To apply walk tests with confidence, clinicians need to understand their psychometrically properties (e.g., reliability and validity) for a particular population. This systematic review aimed to analyze the reliability and validity of clinically‐oriented walk tests for older adults with dementia.MethodA systematic literature search was conducted using PUBMED, MEDLINE, EMBASE and CINAHL by two independent reviewers (last search done in November 2020). The methodological quality of the studies was evaluated using the Consensus‐based Standards for the selection of health Measurement Instruments (COSMIN) checklist.ResultSeventeen articles published from 1997 to 2020 were included in this systematic review. For the distance‐based walk tests, the Timed‐Up‐and‐Go test (TUG), Groningen Meander Walk Test (GMWT), walk speed tests using 4‐meter (4MeWT), 6‐meter (6MeWT) and 10‐meter corridor (10MeWT), and Figure of 8 test had good to excellent test‐retest reliability [intraclass correlation coefficient (ICC) ≥ 0.76]. For the time‐based walk tests, both the 2‐minute walk test (2MWT) and 6‐minute walk test (6MWT) had good to excellent test‐retest reliability (ICC ≥ 0.76). The TUG, GMWT, 10MeWT, 2MWT and 6MWT also had moderate to strong correlations with other walk tests and functional outcomes.ConclusionThe TUG, GMWT, 10MeWT, 2MWT and 6MWT have good to excellent reliability and validity in older adults with dementia. Future research using the recommended protocols for conducting psychometric studies is warranted to enhance the quality of research and to investigate other psychometric properties of walk tests in this population.

Longitudinal Relation Between Structural Network Efficiency, Cognition, and Gait in Cerebral Small Vessel Disease.

BackgroundTo investigate changes in gait performance over time and how these changes are associated with the decline in structural network efficiency and cognition in older patients with cerebral small vessel disease (SVD).MethodsIn a prospective, single-center cohort with 217 older participants with SVD, we performed 1.5T MRI scans, cognitive tests, and gait assessments evaluated by Timed UP and Go (TUG) test twice over 4 years. We reconstructed the white matter network for each subject based on diffusion tensor imaging tractography, followed by graph-theoretical analyses to compute the global efficiency. Conventional MRI markers for SVD, that is, white matter hyperintensity (WMH) volume, number of lacunes, and microbleeds, were assessed.ResultsBaseline global efficiency was not related to changes in gait performance, while decline in global efficiency over time was significantly associated with gait decline (ie, increase in TUG time), independent of conventional MRI markers for SVD. Neither baseline cognitive performance nor cognitive decline was associated with gait decline.ConclusionsWe found that disruption of the white matter structural network was associated with gait decline over time, while the effect of cognitive decline was not. This suggests that structural network disruption has an important role in explaining the pathophysiology of gait decline in older patients with SVD, independent of cognitive decline.

9세 아동의 보행 가변성 연구

The purpose of this study is to determine how the control of covariates (height, weight, and walking speed) affects the changes in gait performance and gait variability in walking of 9-year-old children and young adults in their 20s. It is to understand how age affects actual gait performance and variability regardless of physical condition. Thirteen male 9-year-old children (9.43±0.19) and 13 young adults (21.69±1.60) living in the community, a total of 26 participants participated in this study. Participants wore 7D IMU sensors on both feet and walked for 6 minutes. From the data measured through the 6-minute walk, the gait performance variables was calculated as the average value of measured gait parameters. Gait variability was calculated by defining CV values of the measured gait parameters. As a result of performing ANCOVA controlled by a covariate in the gait performance comparison, there was no difference in performance between children and young adults, and there was a difference in gait variability in gait cycles (s), cadence (step/min), and stride length (m). This shows that children

Temporal Changes in Electromyographic Activity and Gait Ability during Extended Walking in Individuals Post-Stroke: A Pilot Study.

Abnormal gait, particularly in patients with stroke, causes neuromuscular fatigue. We aimed to clarify temporal changes in gait performance and lower limb muscle activity during extended walking in people with stroke hemiplegia. Twelve adults with stroke and eleven healthy controls performed an extended trial involving 20-min continuous walk at a comfortable speed. The primary outcome was electromyography amplitude during the trial and secondary outcomes were walking performance and the instantaneous mean frequency of electromyography during the trial. Data at 1, 6, 12, and 18 min after initiating walking were compared. Performance during extended walking in people with stroke was maintained over time. The electromyography amplitude decreased in the tibialis anterior during the pre-swing phase and increased in the rectus femoris during the single-support phase over time; these changes were similar on the paretic and nonparetic sides. Instantaneous mean frequency decreased over time on the nonparetic side in the tibialis anterior and on the paretic side in the rectus femoris. Healthy subjects did not show any changes over time. The changes in muscle activity in patients with stroke differed between the paretic and nonparetic sides, muscle type, and gait phase; walking performance was maintained despite being affected by neuromuscular fatigue.

Introduction of the Watzmann Severity Scale: A sensorimotor approach to estimate the course of inpatient rehabilitation in multiple sclerosis

Multiple sclerosis is an autoimmune disease with a plethora of potentially arising impairments and a coarse standard clinical estimation of severity, the expanded disability status scale (EDSS). In this study, we introduced the Watzmann Severity Scale (WSS), a sensorimotor function based statistical model of the EDSS of 113 patients. Using the WSS, we examined the rehabilitation course of 87 patients. The WSS revealed to be a reliable estimate of the EDSS with an R²adjusted of 0.81, although lower EDSS grades were systematically overestimated. Further, patients slightly improved during their inpatient stay of in average 17d by 0.21 on the WSS, with changes in gait performance being the driving factor (|β|-weight of 0.84). We were not able to reliably predict changes in the WSS and found no association with the duration of hospitalization. We conclude and advise that rehabilitation should start earlier, if lower EDSS grades were not overestimated, to emphasize gait less in rehabilitation, and to change from a perspective of impairment and disability to performance in order to maximize patient rehabilitation.

Changes in Gait Performance in Stroke Patients after Taping with Scapular Setting Exercise.

The purpose of this study was to investigate the effects of combined taping with scapular setting exercise on the gait performance of stroke patients. Twenty stroke patients were randomly allocated to two groups: the taping with scapular setting exercise (TSSE) group (n = 10) and scapular setting exercise (SSE) group (n = 10). Intervention was performed for one week, and pre- and postintervention results for TSSE and SSE were compared. Outcomes were determined using the inertia measurement unit, which can measure spatiotemporal gait parameters, and using the timed up-and-go test. Two-way repeated analysis was used to compare pre- and postintervention results. In the TSSE group, intervention significantly improved cadence, gait speed, stride length, step length, gait cycle, swing phase duration, double support duration, and timed up-and-go test results more than in the SSE group. TSSE was found to improve all spatiotemporal gait parameters examined; thus, we recommend TSSE be considered as an intervention to improve gait parameters in stroke patients.

The influence of lateral stabilization on walking performance and balance control in neurologically-intact and post-stroke individuals

BackgroundIndividuals post-stroke have an increased risk of falling, which can lead to injuries and reduced quality of life. This increased fall risk can be partially attributed to poorer balance control, which has been linked to altered post-stroke gait kinematics (e.g. an increased step width). The application of lateral stabilization to the pelvis reduces step width among neurologically-intact young and older adults, suggesting that lateral stabilization reduces the need for active frontal plane balance control. This study sought to determine if lateral stabilization is effective at improving common measures of gait performance and dynamic balance in neurologically-intact and post-stoke individuals who responded to the stabilization by reducing their step width. MethodsGait performance was assessed by foot placement and propulsion symmetry while dynamic balance was assessed by peak-to-peak range of frontal plane whole body angular momentum (HR) and pelvis and trunk sway. FindingsControls and post-stroke Responders who reduced their step width in response to stabilization also reduced their mediolateral pelvis sway, but did not exhibit changes in gait performance. Contrary to expectations, both groups exhibited an increased HR, possibly indicative of decreased balance control. This increase was the result of increased relative velocity between the pelvis and head, arms and trunk segment. InterpretationThese results suggest that a reduction in pelvis motion alone, as opposed to relative motion between the pelvis and upper body, may increase HR, decrease balance control and diminish gait performance. This finding has important implications for locomotor therapies that may seek to reduce pelvis motion.

Facilitation of supplementary motor area excitability improves dual-task walking in young adults

Activations of the DLPFC and SMA have been shown to correlate with dual-task walking. However, very few investigations have directly perturbed the activations of these areas to establish a cause-and-effect relationship. The objectives of this study were: 1) to investigate the role of DLPFC and SMA in dual-task walking using rTMS and 2) to determine whether the secondary task difficulty mediates the roles of these cortical areas. Nineteen young healthy adults were divided into two groups: Count-by-3 s (N = 9) and Count-by-7 s (N = 10) groups. During dualtask walking, the Count-by-3 s group walked and counted backward by 3 s while the other group counted backward by 7. Each participant received facilitatory rTMS (5 Hz) administered to the left DLPFC, SMA and M1 across 3 sessions (approximately a week apart). Single- and dual-task walking were assessed both before and after rTMS. Gait speed under the 2 walking conditions was analyzed with repeated measure ANOVA. rTMS to the SMA significantly increased dual-task walking speed (p = .02) but not singletask walking speed. In contrast, rTMS to the DLPFC or M1 did not result in any significant changes in gait speed. Secondary task difficulty did not moderate the effects of rTMS on dual-task gait because both groups had similar changes in gait performance after rTMS. SMA is an important neural substrate mediating dual-task walking and might be a therapeutic target for gait intervention.

Measuring change in gait performance of children with motor disorders: assessing the Functional Mobility Scale and the Gillette Functional Assessment Questionnaire walking scale.

AimTo examine the responsiveness and minimal important change (MIC) of two gait performance measures, the Functional Mobility Scale (FMS) and the Gillette Functional Assessment Questionnaire walking scale (FAQ), in a paediatric inpatient setting.MethodSixty‐four children and adolescents with a motor disorder, including cerebral palsy, traumatic brain injury, or stroke (25 females, 39 males; mean age [SD] 12y 6mo [3y 2mo], range 6–18y 6mo), were recruited. Physiotherapists scored the FMS and FAQ at the start and end of active gait rehabilitation. Change scores were compared with changes in gait capacity tests, the walking item of the Functional Independence Measure for Children, and a global rating scale (GRS) on the physiotherapists’ perceived change of the child's functional mobility. The GRS was also used to define the MIC.ResultsChange scores of the FMS and FAQ correlated between 0.35 and 0.49 with those of the capacity tests, 0.54 to 0.76 with the Functional Independence Measure for Children walking item change scores, and 0.57 to 0.76 with the GRS. The MIC values for the FMS and FAQ were 0.5 and 1.5 respectively.Interpretation FMS and FAQ can illustrate change in inpatient gait performance of children and adolescents with motor disorders. An improvement of one level in the FMS and two levels in the FAQ is considered as a clinically meaningful change.What this paper adds The Functional Mobility Scale (FMS) can detect change in children's inpatient gait performance.The Gillette Functional Assessment Questionnaire walking scale (FAQ) can also detect change in children's inpatient gait performance.A one‐level improvement in the FMS is clinically relevant.A two‐level improvement in the FAQ is clinically relevant.

Intra-rater repeatability of gait parameters in healthy adults during self-paced treadmill-based virtual reality walking

Self-paced treadmill walking is becoming increasingly popular for the gait assessment and re-education, in both research and clinical settings. Its day-to-day repeatability is yet to be established. This study scrutinised the test-retest repeatability of key gait parameters, obtained from the Gait Real-time Analysis Interactive Lab (GRAIL) system. Twenty-three male able-bodied adults (age: 34.56 ± 5.12 years) completed two separate gait assessments on the GRAIL system, separated by 5 ± 3 days. Key gait kinematic, kinetic, and spatial-temporal parameters were analysed. The Intraclass-Correlation Coefficients (ICC), Standard Error Measurement (SEM), Minimum Detectable Change (MDC), and the 95% limits of agreements were calculated to evaluate the repeatability of these gait parameters. Day-to-day agreements were excellent (ICCs > 0.87) for spatial-temporal parameters with low MDC and SEM values, <0.153 and <0.055, respectively. The repeatability was higher for joint kinetic than kinematic parameters, as reflected in small values of SEM (<0.13 Nm/kg and <3.4°) and MDC (<0.335 Nm/kg and <9.44°). The obtained values of all parameters fell within the 95% limits of agreement. Our findings demonstrate the repeatability of the GRAIL system available in our laboratory. The SEM and MDC values can be used to assist researchers and clinicians to distinguish ‘real’ changes in gait performance over time.