Changes In Gait Velocity Research Articles

Effects of trunk stability exercise using proprioceptive neuromuscular facilitation with changes in chair height on the gait of patients who had a stroke

[Purpose] The purpose of this study was to identify the effects of trunk stability exercise using proprioceptive neuromuscular facilitation with changes in chair heights on the gait of stroke patients. [Subjects and Methods] The subjects of this study were 11 stroke patients. The intervention method was trunk stability exercise using proprioceptive neuromuscular facilitation with different chair heights (50, 60, and 70 cm). These exercises were performed 5 times per week for 6 weeks. Gait velocity, cadence, stride length, gait cycle, and stance phase duration were used to measure gait function. [Results] Significant changes in gait velocity, cadence, and stride length were observed on the affected side. However, no significant changes in gait cycle and stance phase were observed on the affected side. [Conclusion] These results indicate that trunk stability exercise using proprioceptive neuromuscular facilitation with change in chair heights were effective in improving gait velocity, cadence, and stride length on the affected side. However, in this study, no significant changes were observed in gait cycle and stance phase on the affected side. Therefore, various interventions for stroke patients should be investigated in further studies.

The effects of balance training and ankle training on the gait of elderly people who have fallen.

[Purpose] The aim of this study was to examine the effects of balance training and muscle training around the ankle joints on the gait of elderly people who have experienced a fall. [Subjects] Twenty-six elderly people with a risk of falling and a Berg Balance Scale score of 37 to 50 points who had experienced a fall in the last year were randomly and equally assigned to either a balance training group or an ankle training group. The balance training group received training on a hard floor, training while maintaining balance on a cushion ball in a standing position, and training while maintaining balance on an unstable platform in a standing position; the ankle training group received training to strengthen the muscles around the ankle joints and conducted stretch exercise for the muscles around the ankle joints. [Results] There were significant changes in gait velocity, step length, and stride length in the balance training group after the intervention; there were significant changes in gait velocity, cadence, step time, cycle time, step length, and stride length in the ankle training group after the intervention. In a between-group comparison, the gait velocity of the balance training group showed a significant improvement compared with the ankle training group. [Conclusion] Both balance training and ankle joint training are effective in enhancing the gait ability of elderly people with a risk of falling; in particular, balance training is effective in improving the gait velocity of elderly people who have experienced a fall compared with ankle joint training.

The effects of isometric trunk exercises and dynamic trunk exercises on gait in elderly people.

The purpose of this study was to compare the effects of dynamic trunk exercises and isometric trunk exercises on gait in elderly people. [Subjects] This study randomly allocated 20 elderly people to an isometric trunk exercise group (n=10) and a dynamic trunk exercise group (n=10). The exercises were performed for 30 minutes three times a week for 12 weeks. Gait speed, stride length, cadence, and step width were measured at a normal pace using GAITRite. All groups were evaluated before and after 12 weeks. [Results] The isometric exercise group showed a significant change in gait velocity, cadence, and left and right step lengths. The dynamic trunk exercise group showed a significant change in gait velocity, cadence, left and right step lengths, left and right step times, and left and right stride lengths. Moreover, a comparison of the exercise effect between the two groups showed a significant difference in gait velocity. [Conclusion] The results of this study suggest that isometric trunk exercises and dynamic trunk exercises have a positive effect on gait function in elderly people. In particular, isometric trunk exercises are recommended to promote gait velocity.

The relationship between motor recovery and gait velocity during dual tasks in patients with chronic stroke.

[Purpose] The aims of this study were to identify the relationship between motor recovery and gait velocity during dual tasks in patients with chronic stroke and determine automatic gait ability following stroke. [Subjects and Methods] Thirty-three outpatients and twelve healthy subjects participated in a cross-sectional assessment. Community ambulation was assessed using a self-administered questionnaire. Outcome measures included the Motricity index, Berg Balance Scale, and gait speed under three conditions (self-paced ambulation for 10 m, ambulation while performing dual cognitive tasks, and ambulation while performing dual manual tasks). Gait automaticity was calculated. [Results] No significant differences were observed for muscle strength or balance between the limited community ambulation and the community ambulation groups. However, a significant difference in gait velocity was observed between the groups under the three conditions. In particular, a significant difference was detected only in the limited community ambulation group depending on the level of motor function recovery during cognitive and manual dual task ambulation. Additionally, we revealed that the community ambulation group had a lower level of gait automaticity compared with that in the normal group. [Conclusion] Our results show the influence of motor recovery on the change in gait velocity depending on the task if a patient is limitedly ambulatory. We revealed that community ambulators did not have a sufficient level of gait automaticity.

Predictors and biomarkers of treatment gains in a clinical stroke trial targeting the lower extremity.

Behavioral measures are often used to distinguish subgroups of patients with stroke (eg, to predict treatment gains, stratify clinical trial enrollees, or select rehabilitation therapy). In studies of the upper extremity, measures of brain function using functional magnetic resonance imaging (fMRI) have also been found useful, but this approach has not been examined for the lower extremity. The current study hypothesized that an fMRI-based measure of cortical function would significantly improve prediction of treatment-induced lower extremity behavioral gains. Biomarkers of treatment gains were also explored. Patients with hemiparesis 1 to 12 months after stroke were enrolled in a double-blind, placebo-controlled, randomized clinical trial of ropinirole+physical therapy versus placebo+physical therapy, results of which have previously been reported (NCT00221390).(15) Primary end point was change in gait velocity. Enrollees underwent baseline multimodal assessment that included 19 measures spanning 5 assessment categories (medical history, impairment, disability, brain injury, and brain function), and also underwent reassessment 3 weeks after end of therapy. In bivariate analysis, 8 baseline measures belonging to 4 categories (medical history, impairment, disability, and brain function) significantly predicted change in gait velocity. Prediction was strongest, however, using a multivariate model containing 2 measures (leg Fugl-Meyer score and fMRI activation volume within ipsilesional foot sensorimotor cortex). Increased activation volume within bilateral foot primary sensorimotor cortex correlated positively with treatment-induced leg motor gains. A multimodal model incorporating behavioral and fMRI measures best predicted treatment-induced changes in gait velocity in a clinical trial setting. Results also suggest potential use of fMRI measures as biomarkers of treatment gains.

Spatial-Temporal Gait Variability Poststroke: Variations in Measurement and Implications for Measuring Change

ObjectiveTo determine the responsiveness to change of spatial-temporal gait parameters among stroke survivors for 3 different variability measures: SD, coefficient of variation (CV), and median absolute deviation (MAD). DesignRetrospective chart review. SettingClinical laboratory in a Canadian hospital. ParticipantsStroke survivors (N=74) receiving inpatient rehabilitation. InterventionsNot applicable. Main Outcome MeasuresSpatial-temporal gait variability was calculated for step length, step width, stance time, swing time, and double support time. Responsiveness to change was determined by comparing (1) trials without versus trials with a concurrent cognitive task and (2) admission to discharge from rehabilitation. ResultsVariability estimators (SD, CV, and MAD) increased with the addition of a cognitive task and decreased from admission to discharge of rehabilitation. However, these changes were not statistically significant when change in gait velocity was included as a covariate. The effect size values were similar for all variability estimators with a trend toward a greater SD response to temporal parameters. The CV displayed a larger response to change for step length than did the SD and MAD. Although gait variability decreased between admission and discharge, the effect size was larger for the condition without the cognitive task than for the condition with the cognitive task. ConclusionsOur results show that gait variability estimators demonstrate a similar responsiveness to a concurrent cognitive task and improved walking ability with recovery from stroke. Future work may focus on evaluating the clinical utility of these measures in relation to informing therapy and response to gait-specific training protocols.

Temporal but not spatial variability during gait is reduced after selective dorsal rhizotomy in children with cerebral palsy.

IntroductionVariability in task output is a ubiquitous characteristic that results from non-continuous motor neuron firing during muscular force generation. However, variability can also be attributed to errors in control and coordination of the motor neurons themselves in diseases such as cerebral palsy (CP). Selective dorsal rhizotomy (SDR), a neurosurgical approach to sever sensory nerve roots, is thought to decrease redundant or excessive afferent signalling to intramedullary neurons. In addition to its demonstrated ability to reduce muscular spasticity, we hypothesised that SDR is able to decrease variability during gait, the most frequent functional motor activity of daily living.MethodsTwelve CP children (aged 6.1±1.3yrs), who underwent SDR and performed gait analysis pre- and 12 months postoperatively, were compared to a control group of eleven typically developing (TD) children. Coefficients of variability as well as mean values were analysed for: temporal variables of gait, spatial parameters and velocity.ResultsGait parameters of cadence (p = 0.006) and foot progression angle at mid-stance (p = 0.041) changed significantly from pre- to post-SDR. The variability of every temporal parameter was significantly reduced after SDR (p = 0.003–0.049), while it remained generally unchanged for the spatial parameters. Only a small change in gait velocity was observed, but variability in cadence was significantly reduced after SDR (p = 0.015). Almost all parameters changed with a tendency towards normal, but differences between TD and CP children remained in all parameters.DiscussionThe results confirm that SDR improves functional gait performance in children with CP. However, almost exclusively, parameters of temporal variability were significantly improved, leading to the conjecture that temporal variability and spatial variability may be governed independently by the motor cortex. As a result, temporal parameters of task performance may be more vulnerable to disruption, but also more responsive to treatment success of interventions such as SDR.

“Functional Pain,” Functional Outcomes, and Quality of Life After Hyaluronic Acid Intra-articular Injection for Knee Osteoarthritis

To compare the effect of hyaluronic acid (HA) intra-articular knee injections on pain and functional outcomes in persons with knee osteoarthritis (OA) over 6 months, and to determine whether or not changes in functional pain are related to improvements in quality of life. A prospective cohort study. A research laboratory in an academic medical center. Patients with knee OA (N = 53) who were receiving medical care for OA. Intra-articular knee injections of HA (3 injections, each separated by 1 week) and a comparative noninjection group. Functional pain and outcomes assessments during chair rise, stair climbing, and a 6-minute walking test (by using 0-10 point numerical pain ratings during each test); gait parameters; Medical Outcomes Short Form-36 (SF-36) scores and subscores; the Western Ontario McMaster University Osteoarthritis Index (WOMAC). Six months after HA, the completion times for the chair rise and stair climb tasks, and the distance covered during the 6-minute walk were not different between the groups. However, functional pain ratings during stair climbing decreased in the HA-treated group (P = .05). Six-month changes in gait velocity, cadence, stride length, step length, and the percentage of the gait cycle spent in single support were all higher after HA injection at month 6 (all P < .05). Significant group-by-time interactions existed for total WOMAC scores. SF-36 Vitality subscores improved by 13%, and Role Physical scores were higher in patients treated with HA injection compared with participants in the noninjection group (P < .05). Regression analyses revealed that changes in the functional pain measures did not correspond with SF-36 scores. HA is associated with lower functional pain severity, with minimal impact on functional test scores. We interpreted this finding to represent an increase in the quality of the movement and functional activity. The change in functional pain did not correspond to changes in SF-36 quality-of-life scores.

EEG and Neuronal Activity Topography analysis can predict effectiveness of shunt operation in idiopathic normal pressure hydrocephalus patients

Idiopathic normal pressure hydrocephalus (iNPH) is a neuropsychiatric syndrome characterized by gait disturbance, cognitive impairment and urinary incontinence that affect elderly individuals. These symptoms can potentially be reversed by cerebrospinal fluid (CSF) drainage or shunt operation. Prior to shunt operation, drainage of a small amount of CSF or “CSF tapping” is usually performed to ascertain the effect of the operation. Unfortunately, conventional neuroimaging methods such as single photon emission computed tomography (SPECT) and functional magnetic resonance imaging (fMRI), as well as electroencephalogram (EEG) power analysis seem to have failed to detect the effect of CSF tapping on brain function. In this work, we propose the use of Neuronal Activity Topography (NAT) analysis, which calculates normalized power variance (NPV) of EEG waves, to detect cortical functional changes induced by CSF tapping in iNPH. Based on clinical improvement by CSF tapping and shunt operation, we classified 24 iNPH patients into responders (N = 11) and nonresponders (N = 13), and performed both EEG power analysis and NAT analysis. We also assessed correlations between changes in NPV and changes in functional scores on gait and cognition scales before and after CSF tapping. NAT analysis showed that after CSF tapping there was a significant decrease in alpha NPV at the medial frontal cortex (FC) (Fz) in responders, while nonresponders exhibited an increase in alpha NPV at the right dorsolateral prefrontal cortex (DLPFC) (F8). Furthermore, we found correlations between cortical functional changes and clinical symptoms. In particular, delta and alpha NPV changes in the left-dorsal FC (F3) correlated with changes in gait status, while alpha and beta NPV changes in the right anterior prefrontal cortex (PFC) (Fp2) and left DLPFC (F7) as well as alpha NPV changes in the medial FC (Fz) correlated with changes in gait velocity. In addition, alpha NPV changes in the right DLPFC (F8) correlated with changes in WMS-R Mental Control scores in iNPH patients. An additional analysis combining the changes in values of alpha NPV over the left-dorsal FC (∆alpha-F3-NPV) and the medial FC (∆alpha-Fz-NPV) induced by CSF tapping (cut-off value of ∆alpha-F3-NPV + ∆alpha-Fz-NPV = 0), could correctly identified “shunt responders” and “shunt nonresponders” with a positive predictive value of 100% (10/10) and a negative predictive value of 66% (2/3). In contrast, EEG power spectral analysis showed no function related changes in cortical activity at the frontal cortex before and after CSF tapping. These results indicate that the clinical changes in gait and response suppression induced by CSF tapping in iNPH patients manifest as NPV changes, particularly in the alpha band, rather than as EEG power changes. Our findings suggest that NAT analysis can detect CSF tapping-induced functional changes in cortical activity, in a way that no other neuroimaging methods have been able to do so far, and can predict clinical response to shunt operation in patients with iNPH.

Cerebral blood flow responses to dorsal and ventral STN DBS correlate with gait and balance responses in Parkinson's disease

ObjectivesThe effects of subthalamic nucleus (STN) deep brain stimulation (DBS) on gait and balance vary and the underlying mechanisms remain unclear. DBS location may alter motor benefit due to anatomical heterogeneity in STN. The purposes of this study were to (1) compare the effects of DBS of dorsal (D-STN) versus ventral (V-STN) regions on gait, balance and regional cerebral blood flow (rCBF) and (2) examine the relationships between changes in rCBF and changes in gait and balance induced by D-STN or V-STN DBS. MethodsWe used a validated atlas registration to locate and stimulate through electrode contacts in D-STN and V-STN regions of 37 people with Parkinson's disease. In a within-subjects, double-blind and counterbalanced design controlled for DBS settings, we measured PET rCBF responses in a priori regions of interest and quantified gait and balance during DBS Off, unilateral D-STN DBS and unilateral V-STN DBS. ResultsDBS of either site increased stride length without producing significant group-level changes in gait velocity, cadence or balance. Both sites increased rCBF in subcortical regions and produced variable changes in cortical and cerebellar regions. DBS-induced changes in gait velocity are related to premotor cortex rCBF changes during V-STN DBS (r=−0.40, p=0.03) and to rCBF changes in the cerebellum anterior lobe during D-STN DBS (r=−0.43, p=0.02). ConclusionsDBS-induced changes in gait corresponded to rCBF responses in selected cortical and cerebellar regions. These relationships differed during D-STN versus V-STN DBS, suggesting DBS acts through distinct neuronal pathways dependent on DBS location.

A novel conceptual framework for balance training in Parkinson’s disease-study protocol for a randomised controlled trial

BackgroundThere is increasing scientific knowledge about the interaction between physiological (musculoskeletal, neuromuscular, cognitive and sensory) systems and their influence on balance and walking impairments in Parkinson’s disease. We have developed a new conceptual framework for balance training, emphasising specific components of balance control related to Parkinson’s disease symptoms by using highly challenging, progressive and varying training conditions. The primary aim of this proposed randomised controlled trial will be to investigate the short-term and long-term effects of a 10-week balance training regime in elderly with Parkinson’s disease.Methods/DesignEighty participants with mild to moderate idiopathic Parkinson’s disease will be recruited and randomly allocated to an intervention group receiving balance training or a control group whose participants will continue to receive their usual care. The intervention will consist of a 10-week group training regime (1-hour training, three times per week), which will be led by two physiotherapists to ensure training progression and safety. The conceptual framework will be applied by addressing specific balance components (sensory integration, anticipatory postural adjustments, motor agility, stability limits) through varying training conditions and structured progression. Assessment will be conducted through a multi-dimensional battery of outcomes, prior to and immediately after the 10-week intervention, and at 9 and 15 months’ follow-up after entering the study. Primary outcome measures will be balance performance (assessed using the Mini Balance Evaluation Systems Test), change in gait velocity (m/s) between single and dual task walking, and fear of falling (evaluated using the Fall Efficacy Scale International).DiscussionThis study has the potential to provide new insight and knowledge of the effects of specific, varied and challenging balance training on a wide health spectrum in elderly with PD. If found to be effective, this pragmatic approach with translation of theory into practice, can be implemented in existing outpatient care.Trial registrationNCT01417598

Dual-Task Complexity Affects Gait in People With Mild Cognitive Impairment: The Interplay Between Gait Variability, Dual Tasking, and Risk of Falls

Montero-Odasso M, Muir SW, Speechley M. Dual-task complexity affects gait in people with mild cognitive impairment: the interplay between gait variability, dual tasking, and risk of falls. ObjectiveTo determine the effect of 2 different dual tasks on gait variability in people with mild cognitive impairment (MCI) compared with control subjects. DesignCross-sectional study. SettingMemory clinic at a university hospital. ParticipantsOlder adults with MCI (n=43) and cognitively normal control subjects (n=25) from the community. Gait was assessed under single (usual walking) and dual tasking (naming animals and subtracting serial 7s), using an electronic walkway. InterventionsNot applicable. Main Outcome MeasuresThe dependent variable was the coefficient of variation of gait variability, a marker of gait stability and an established risk factor for falls. Two-way repeated-measures analysis of variance was used to examine main effects (group, task) and their interaction. ResultsA significant difference was found within and between groups (P=.016) of increasing gait variability as dual-task complexity increased. Gait velocity decreased within groups as dual-task complexity increased. The magnitude of increased gait variability across tasks was greater for the MCI group (2.68%– 9.84%) than for the control group (1.86%–3.74%), showing a significant between-group difference (P=.041). ConclusionsDual-task load significantly increased gait variability in the MCI group compared with the control group, an effect that was larger than the changes in gait velocity. The magnitude of this impairment on gait stability was related to the complexity of the dual task applied. Our findings help to explain the high risk of falls recently described in older adults with MCI, and may help in the identification of fall risk in cognitively impaired persons.

Effects of Gait Training Using Functional Electrical Stimulation on Stroke Patients' Balance and Gait Velocity

The purpose of this study is to examine the effects of gait training using functional electrical stimulation on the improvement of hemiplegic patients` functions for balance and gait velocity. The subjects of the experiment were determined to be 10 each hemiplegic patients who had been diagnosed with stroke or brain damage six months or longer earlier assigned to an experimental group and a control group respectively. The subjects were evaluated before the experiment using Tetrax and 10M gait tests, received gait training five times a week for four weeks using functional electrical stimulation and were evaluated after the experiment in the same method as used in the evaluation before the experiment. In order to examine differences between the experimental group that received gait training using functional electrical stimulation and the control group that was treated by functional electrical stimulation and received gait training thereafter, differences between before and after the experiment were analyzed using paired sample t-tests and differences in changes after the experiment between the experimental group and the control group were analyzed using independent sample t-tests in order to compare the two groups with each other. Experimental results showed significant differences in weight bearing, balance and gait velocity between before and after the experiment in the experimental group(p .05), balance showed significant differences(p<.05). Weight bearing, balance and gait velocity change rates showed significant differences between the experimental group and the control group(p<.05). In conclusion, it was indicated that gait training using functional electrical stimulation is effective for enhancing stroke patients` weight bearing rates, balance abilities and gait velocity.

Effect of Treadmill Training on Specific Gait Parameters in Older Adults With Frailty

Treadmill-walking training (TWT) as an intervention to improve the gait of frail older adults has not been well studied. In this pilot study, we describe the feasibility, tolerance, and effect of TWT on specific gait parameters during overground walking in 4 frail older adults as a prelude to developing larger-scale exercise intervention trials in this high-risk population. Four community-residing frail older individuals (age > 70 years) with Mini-Mental State Examination score of 26 or higher and no activity limitations. Frailty was defined as the presence of at least 3 of the following 5 attributes: slow gait (<1 m/s); unintentional weight loss (>10 lb in prior year); self-report of poor grip strength; exhaustion; and low level of physical activity. The TWT consisted of 24 sessions (3 times per week for 8 weeks). Five quantitative gait parameters (velocity, stride length, swing time, percentage of double support phase, and coefficient of variation [COV] of stride length) during overground walking were measured at baseline, weekly during training, and immediately post-TWT. All participants tolerated TWT without significant complications. Following TWT, gait velocity increased in all participants by 6.4 to 26.8 cm/s, which was larger than the reported value for meaningful change in gait velocity (4 cm/s). Stride length and double support phase also showed improvement in all participants (mean percentage increase of 10.8% for stride length and 17.1% reduction for double support phase posttraining compared with baseline). Swing time improved in 3 participants (mean reduction of 4.5%). The COV of stride length did not show consistent improvement. This case series shows that TWT is feasible and well tolerated by frail older adults and may improve most gait parameters in this high-risk population.

Lower limbs function and pain relationships after unilateral total knee arthroplasty

The aim of the study was to evaluate gait characteristics, lower limbs joint function, and pain relationships associated with knee osteoarthritis of female patients before and 3 months after total knee arthroplasty at an outpatient clinic rehabilitation department. Gait parameters were registered, the active range of lower extremity joints was measured, and pain was evaluated. Gait characteristics, walking velocity, and knee joint's extension improved and pain diminished considerably 3 months after arthroplasty, nevertheless did not reach control group level. In conclusion, single support phase and gait velocity change reflect the recovery of gait function after total knee arthroplasty. Beside the affected knee joint's range of motion, attention should be paid to the restoration of the functional reserve of the adjacent joints and joints of contralateral lower extremity after total knee arthroplasty. Affected knee joint pain perceived during level walking influenced the gait velocity of patients before total knee arthroplasty but not 3 months after arthroplasty.

Effect of Cognitive Remediation on Gait in Sedentary Seniors

Attention and executive functions show strong associations with slow gait and falls in seniors and have been shown to be amenable to cognitive remediation. However, cognitive remediation as a strategy to improve mobility has not been investigated. Using a randomized single-blind control design, 24 sedentary older adults (exercise less than or equal to once weekly and gait velocity <1 m/s) were randomly assigned to an 8-week computerized cognitive remediation program or wait-list. Primary outcome was change in gait velocity during normal pace and "walking while talking" conditions. We also compared the proportion of improvers (velocity change ≥4 cm/s) in each group. The 10 participants who completed cognitive remediation improved gait velocity from baseline during normal walking (68.2 ± 20.0 vs 76.5 ± 17.9 cm/s, p = .05) and walking while talking (36.7 ± 13.5 vs 56.7 ± 20.4 cm/s, p = .002). The 10 intervention participants improved gait velocity over the 8-week intervention both during normal walking (change: 8.2 ± 11.4-1.3 ± 6.8 cm/s, p = .10) and walking while talking (change: 19.9 ± 14.9-2.5 ± 20.1 cm/s, p = .05) compared with the 10 control participants. Six intervention participants were improvers on normal pace walking compared with three controls (odds ratio = 3.0, 95% confidence interval = 0.5-19.6). All 10 intervention participants improved on walking while talking compared with 3 controls (odds ratio = 3.5, 95% confidence interval = 1.5-8.0). The findings of this pilot trial are promising and suggest that cognitive remediation may improve mobility in sedentary seniors. This approach should be validated in larger scale trials.

Two-level control strategy of an eight link biped walking model

This paper presents an adaptive two-level control strategy for a biped walking model and demonstrates its performance in a wide range of walking modes with considerably diverse model and control parameter settings. Proposed control strategy inherits a push off that resembles considerably to forceful extension of the trailing leg during push off in human locomotion and represents a very important source of forward propulsion. Extensive simulations have shown that adjustments in the push off related parameter on higher between-step control level after each step enable evolution of various walking modes of the biped walker at selected walking speeds and distinctive gait patterns. It also allows us to investigate the changes in gait kinematics and kinetics of the biped walking model due to changes in gait velocity, torso inclination and propulsion distribution profiles.

Static and Dynamic Gait Parameters Before and After Multilevel Soft Tissue Surgery in Ambulating Children With Cerebral Palsy

Recent studies have questioned the efficacy of releasing hip flexion contractures and the resulting ankle position after tendoachilles lengthening in ambulating children with cerebral palsy (CP). Twenty-three ambulatory children with CP underwent 96 soft tissue-lengthening procedures without bony surgery. Preoperative and postoperative clinical and computerized gait data were reviewed. Static contractures improved reliably, with improvements in all areas measured, including hip flexion contracture (14 degree improvement), hip abduction (19 degree improvement), popliteal angle (26 degree improvement), and ankle dorsiflexion (11 degree improvement). The changes in computerized gait data were less uniform. The knees showed significant benefits, as evidenced by improved maximal knee extension in stance phase (37.3 degree preop and 19.9 degree postop) and at initial contact (51.6 degree preop and 34.8 degree postop). At the hip, a statistically significant improvement was only seen in maximum hip extension in stance phase (minimum hip flexion), and the magnitude of this change was only 4.6 degree (15.3 to 10.7 degree). There were no significant changes at the pelvis. At the ankle, the tendency was toward calcaneal gait after Achilles tendon lengthening, with excessive dorsiflexion seen both in stance (17.3 degree) and at toe off (-6.9 degree). Tempero-spatial parameters showed improved stride length, but no significant changes in gait velocity or cadence. The persistence of crouch postoperatively, though improved, likely limited the potential changes in hip kinematics. As this study excluded patients undergoing osseous surgery, it is possible that lever arm dysfunction may have contributed to the ongoing crouch. The results of this study suggest that static contractures and knee kinematics improve reliably after soft tissue surgery in children with CP, but that caution must be exercised when considering heel cord lengthening in these children. Therapeutic level II. See Instructions to Authors for a complete description of levels of evidence.

High tibial osteotomy compared with unicompartmental arthroplasty for the treatment of medial compartment osteoarthritis: a meta-analysis

Background The objective of our meta-analysis was to compare the clinical outcomes of high tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) for the treatment of isolated medial compartment osteoarthritis (OA). Methods We searched the major medical databases for randomized trials and observational studies comparing HTO and UKA. After testing for publication bias and heterogeneity, the data were aggregated by fixed-effects modeling. Our primary outcome was the percentage of good or excellent outcomes in each group. Our secondary outcomes were implant survivorship and change in gait velocity. Results Six studies met our inclusion criteria for review. We found no evidence of publication bias or heterogeneity between studies for all outcome measures. The combined odds ratio for a good or excellent outcome in the UKA group was 2.03 (95% CI: 1.16 to 3.6) P = 0.01. The combined odds ratio for survival from aseptic loosening for the UKA group was 2.14 (95% CI: 0.93 to 4.93) P = 0.07. The pooled mean difference for gait velocity was 0.39 (95% CI: −0.12 to 0.90), P = 0.14. Conclusion UKA yields a greater percentage of good or excellent outcomes and a strong trend towards improved survivorship over HTO for medial compartment OA. Level of Evidence: Therapeutic Level II.

Effects of dual-task cognitive-gait intervention on memory and gait dynamics in older adults with a history of falls: A preliminary investigation

The present study highlights the effects of the dual-task cognitive-gait intervention (CGI) on working memory and gait functions in older adults with a history of falls. Thirteen older adults with a history of falls were recruited from local community centers and randomly stratified into either the control (n = 5) or experimental (n = 8) group. The experimental group received the dual-task cognitive-motor intervention involving simultaneous motor (walking) and cognitive (memory recall) task whereas the control group received a placebo treatment (walking with simple music). The intervention was provided 30 minutes per session, over a 6-week period. Memory measures included a combination of word recall and arithmetic task. Gait function measures included velocity and center of pressure (COP) stability. Non-parametric tests were used at p < 0.05. The experimental group showed a greater memory performance than the control (p < 0.05). However, no significant intervention-related changes in gait velocity and stability were observed. Our findings provide the first evidence in literature to demonstrate that the long-term dual-task cognitive-motor intervention improved memory of older adults with a history of falls under the dual cognitive motor task condition.