Conventional Walking Training Research Articles

Exoskeletal-Assisted Walking During Acute Inpatient Rehabilitation Enhances Recovery for Persons with Spinal Cord Injury-A Pilot Randomized Controlled Trial.

Spinal cord injury (SCI) negatively impacts individuals' functional independence, and motor and sensory function. Intense walking training has been shown to facilitate recovery for individuals with chronic SCI. Powered robotic exoskeletons provide therapists with a tool that allows them to conduct walking training with less therapist effort as compared to conventional walking training. Exoskeletal-assisted walking (EAW) has been studied in the chronic SCI population with preliminary reports showing benefits in mobility, health, and quality-of-life outcomes. However, few reports have studied EAW's benefits in the acute (<90 days post) SCI population at a time when neural plasticity is most dynamic and modifiable. The purpose of the study was to conduct a pilot randomized controlled trial (RCT) to understand the effects of incorporated EAW in acute inpatient rehabilitation (AIR) for individuals with SCI on functional, motor, and sensory recovery. The study outcomes included the Spinal Cord Independence Measure (SCIM) III and International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) motor and sensory scores that were assessed by unblinded assessors. We also recorded EAW session data, including adverse events, walking and up time, step counts, Borg Rating of Perceived Exertion (RPE), and compliance with scheduled EAW training. From August 2019 to July 2022, 16 participants completed the AIR with incorporated EAW, and 12 completed the standard AIR, all with SCI and preserved leg function within 90 days post-injury. During each session, the AIR with incorporated EAW group averaged 34.3 (±9.4) min of up time, 25.4 (±7.7) min of walk time, and 536 (±157) steps. Analysis via two-by-two mixed-effects models showed significant increases in the SCIM total score and ISNCSCI total motor and sensory scores over time for the AIR with incorporated EAW group [SCIM total score: F(1, 26) = 5.59, p = 0.03; total motor score: F(1, 26) = 8.06, p < 0.01; total sensory score: F(1, 19.2) = 5.08, p = 0.04], outperforming the standard AIR group. The AIR with incorporated EAW group showed 13, 14, and 22 points higher changes in the SCIM total score, total motor score, and total sensory score (respectively) by discharge compared with the standard AIR group. Incorporating EAW into AIR may facilitate functional, motor, and sensory recovery for individuals with SCI during AIR better than standard AIR. However, the study had a limited sample size. Further studies are needed to clarify the effects of EAW in AIR.

Effects of backward walking training on balance, gait, and functional mobility in people with multiple sclerosis: A randomized controlled study.

Backward walking training (BWT) can have a positive effect on balance, gait, and functional mobility in neurological diseases; however, the effectiveness of BWT has not been examined in multiple sclerosis (MS). Therefore, the study aimed to investigate the effects of BWT on balance, gait, and functional mobility in people with MS (PwMS). Nineteen PwMS were randomly allocated to either the experimental group (n=10) and the control group (n=9). The experimental group received BWT in addition to conventional walking training (CWT) while the control group only received CWT. Both groups performed training three times a week for 8 weeks. Participants were assessed with the Berg Balance Scale (BBS), four square step test (FSST), activities-specific balance confidence scale (ABC), timed 25-foot walk test (T25FW), dynamic gait index (DGI), 3-meter backward walk test (3MBWT), Multiple Sclerosis Walking Scale-12 (MSWS-12), and timed up and go test (TUG) before and after training. After training, both groups showed significant improvements on the T25FW, and TUG (p<0.05) while only the experimental group showed significant improvements on the BBS, FSST, ABC, DGI, 3MBWT, and MSWS-12 (p<0.05). The experimental group significantly improved more than the control group in all outcomes (p<0.05) except for the T25FW (p=0.202). BWT in addition to CWT is an effective way to improve balance, gait, and functional mobility for PwMS. These results suggest that BWT may be a potentially useful treatment approach when added to CWT in the rehabilitation of MS.

The Effectiveness of Physiotherapy Interventions for Mobility in Severe Multiple Sclerosis: A Systematic Review and Meta-Analysis

Background People with Multiple Sclerosis (pwMS) prioritise gait as the most valuable function to be affected by MS. Physiotherapy plays a key role in managing gait impairment in MS. There is little evidence on the effectiveness of physiotherapy for severe MS. Objective To undertake a systematic review and meta-analysis of the literature to identify evidence for the effectiveness of physiotherapy for gait impairment in severe MS. Methods. The available literature was systematically searched, using a predetermined protocol, to identify research studies investigating a physiotherapy intervention for mobility in people with severe MS (EDSS ≥ 6.0). Data on mobility related endpoints was extracted. Meta-analysis was performed where a given mobility end point was reported in at least 3 studies. Results 37 relevant papers were identified, which included 788 pwMS. Seven mobility-related endpoints were meta-analysed. Robot-Assisted Gait Training (RAGT) was found to improve performance on the 6-minute walk test, 10-metre walk test, fatigue severity scale, and Berg Balance Scale. Neither body weight supported training nor conventional walking training significantly improved any mobility-related outcomes. Conclusion Physiotherapy interventions are feasible for mobility in severe MS. There is some evidence for the effectiveness of RAGT.

The Effects of Nordic Walking Compared to Conventional Walking on Aerobic Capacity and Lipid Profile in Women Over 55 Years of Age.

The purpose of this study was to investigate the effects of Nordic Walking compared to conventional walking on aerobic capacity, the lipid profile, left ventricular ejection fraction, body mass, and body mass index in women over 55years old. The study was comprised of 74 women over 55years of age. Participants were randomized to the Nordic Walking (n = 38) or conventional walking (n = 36) training groups. The echocardiogram, treadmill exercise stress test, lipid profile, and body mass were assessed at baseline (pretest) and after 12weeks (posttest). The authors found a significant main effect over time in duration (effect size [ES] = 0.59, P < .0001), distance covered (ES = 0.56, P < .0001), peak oxygen consumption (ES = 0.43, P < .0001), metabolic equivalent (ES = 0.29, P < .0001), peak heart rate (ES = 0.2, P < .0001), peak diastolic blood pressure (ES = 0.11, P = .0045), total cholesterol (ES = 0.26, P < .0001), and low-density lipoprotein cholesterol (ES = 0.16, P = .0005). The authors did not observe a time versus group interaction or the effect between groups. Post hoc tests revealed significant pretraining to posttraining differences in low-density lipoprotein cholesterol after the Nordic Walking training program and in peak diastolic blood pressure after the conventional walking training program. The heart rate, systolic blood pressure, and diastolic blood pressure at rest, peak diastolic blood pressure, somatic parameters (body mass and body mass index), and left ventricular ejection fraction did not change in either group. Both training programs resulted in increases in aerobic capacity and decreases in total cholesterol.

Efficacy of robot-assisted gait training in multiple sclerosis: A systematic review and meta-analysis

BackgroundMultiple sclerosis is a progressive disease responsible for gait disabilities and cognitive impairment, which affect functional performance. Robot-assisted gait training is an emerging training method to facilitate body-weight–supported treadmill training in many neurologic diseases. Through this study, we aimed to determine the efficacy of robot-assisted gait training in patients with multiple sclerosis. MethodsWe performed a systematic review and meta-analysis of randomized controlled trials evaluating the effect of robot-assisted gait training for multiple sclerosis. We searched PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov registry for articles published before May 2019. The primary outcome was walking performance (gait parameters, balance, and ambulation capability). The secondary outcomes were changes in perceived fatigue, severity of spasticity, global mobility, physical and mental quality of life, severity of pain, activities of daily living, and treatment acceptance. ResultsWe identified 10 studies (9 different trials) that included patients with multiple sclerosis undergoing robot-assisted gait training or conventional walk training. The meta-analysis showed comparable effectiveness between robot-assisted gait training and conventional walking therapy in walking performance, quality of life, pain, or activities of daily living. The robot-assisted gait training was even statistically superior to conventional walking therapy in improving perceived fatigue (pooled SMD: 0.34, 95% CI: 0.02–0.67), spasticity (pooled SMD: 0.70, 95% CI: 0.08–1.33, I² = 53%), and global mobility (borderline) after the intervention. ConclusionOur results provide the most up-to-date evidence regarding the robot-assisted gait training on multiple sclerosis. In addition to the safety and good tolerance, its efficacy on multiple sclerosis is comparable to that of conventional walking training and is even superior in improving fatigue and spasticity.

Impacts of a lower limb exoskeleton robot on anxious stroke patients

To explore the intervention effect of exoskeleton robot training on anxiety of stroke patients. Methods 24 stroke patients with hemiplegia were randomly divided into experimental group and control group, with 12 cases in each group. Moreover, the robot group took the walking training with UGO 210, a lower limb exoskeleton walking rehabilitation, once per day, 30 minutes per time, a total of 20 times of treatment. Before the trial and at the end of the trial cycle, patients’ emotions were assessed using the Self-rating Anxiety scale (SAS), and the efficacy of the two groups was compared. Results: The scores of anxiety scale decreased in both groups (P &lt;0.05), and there was no difference between the two groups (P &lt;0.05). Conclusion: The use of exoskeleton robot can improve the anxiety of stroke patients, but there is no difference compared with the conventional walking training.

Exploring the social position of tactile maps in Japan

Abstract. It seems that the aim of conventional studies on tactile maps for visually impaired people have been to improve their utility in terms of instrumentalism. However, given the recent progress of disability studies in social science and post-representational approach in recent map studies, it is necessary to examine how tactile maps work in the society and how they relate to “disability” as a social phenomenon. These are also important issues to think about how geospatial information technology for visually impaired people embed in the society. Hence, regarding the map as more-than-representation, this paper analysed various documents (e.g. newspaper articles, essays, instruction manuals for orientation and mobility specialist), and considered the social position of tactile maps in Japan. The results showed the following.The tactile map has a long history as a teaching material of geography. It was used for education for the blind in Western countries in the late 18th century. This situation was introduced to Japan by overseas memoir. For example, in the late Edo era, Namura Gohachirou who was a member of Japanese Embassy to the United States witnessed geography education using tactile maps at the blind school in New York. In his diary named Akou Nikki, Namura said that the education for blinds using tactile maps seemed to “translation” from the words of those who can see both eyes well to the words of visually impaired people. His statement clearly shows the material difference of tactile maps. Many tactile maps have acquired social status as “translated objects”. The material form of tactile maps is different from the “map” (visual map) known to the general public, so it makes awareness of physical differences between the body of visually impaired people and sighted people. In 1880, the first blind school in Japan, Kyoto Moua In had exhibited teaching materials and other instruments to the exposition, including a tactile map representing the city of Kyoto. Such a social event also had a role to attract the attention of sighted people to the material heterogeneity of the tactile map and visually impaired people.The 1960s-80s was the period of the situation of tactile maps changed significantly in Japan. In the 1960s, rehabilitation techniques for visual impairments was introduced to Japan from USA, and the concept of “orientation” which was lacking in conventional walking training diffused. In accordance with these movement, the teaching manual of orientation and mobility (O&amp;amp;M) training became write the methodologies to make and use the tactile map for the training. In 1964, Kazuo Honma, the founder of Japan Brail Library, visited all over the world and bought lots of tools for visually impaired people, including tactile maps, at the blind libraries in various places and brought them back to Japan. He held an exhibition to show those materials in the following year. Furthermore, as the International Year of Disabled Persons 1981 and the subsequent enforcement of various laws related to people with disability, it has been emphasized to create cities where physically impaired people can go out of their homes. Since that time the tactile maps began to be installed in public facilities, and were introduced in the assistive technology catalogs. In this way, the tactile map was incorporated into the context of “outdoor behavior” and “walking”. Not only the body of visually impaired people but also the tactile maps as material objects have increasingly been exposed to the “outside” spaces (e.g. city, road). As a result, the tactile map became understood from the viewpoint of “safety”, and it became involved with human and non-human actors (e.g. government offices, volunteer organizations, barrier-free laws, traffic guidelines) different from those of geography education.

Does robot-assisted gait training improve ambulation in highly disabled multiple sclerosis people? A pilot randomized control trial

Background: Robotic training is commonly used to assist walking training in patients affected by multiple sclerosis (MS) with non-conclusive results. Objective: To compare the effect of robot-assisted gait training (RAGT) with that of conventional walking training (CWT) on gait competencies, global ability, fatigue and spasticity in a group of severely affected patients with MS. Methods: A pilot, single-blind randomized controlled trial was conducted in 43 severe (Expanded Disability Status Scale (EDSS) score of 6–7.5) and non-autonomous ambulant in-patients with MS. Experimental group performed 12 sessions of RAGT, whereas control group performed the same amount of CWT. Primary outcome measures were gait ability assessed by 2 minutes walking test and Functional Ambulatory Category; secondary outcomes were global ability (modified Barthel Index), global mobility (Rivermead Mobility Index), severity of disease (EDSS) and subjectively perceived fatigue (Fatigue Severity Scale). Results: The number of subjects who achieved a clinical significant improvement was significantly higher in RAGT than in CWT (p < 0.05 for both primary outcome measures). RAGT also led to an improvement in all the other clinical parameters (global ability: p < 0.001, global mobility: p < 0.001, EDSS: p = 0.014 and fatigue: p = 0.001). Conclusions: RAGT improved the walking competencies in non-autonomous ambulant patients with MS, with benefits in terms of perceived fatigue.

The effects of treadmill walking combined with obstacle-crossing on walking ability in ambulatory patients after stroke: a pilot randomized controlled trial

Background and objective: Treadmill walking training (TWT) provides greater amount and intensity of stepping practice than conventional walking training in patients with chronic stroke. However, there is not any conclusive evidence regarding the effects of TWT for ambulatory post-stroke patients. This study investigated the effects of treadmill walking combined with obstacle-crossing on the walking ability of ambulatory post-stroke patients.Methods: Twenty-nine subjects from a university hospital-based rehabilitation center were randomly assigned to one of the following: experimental group (15 subjects) or control group (14 subjects). All subjects underwent 30 min of active/passive exercises and 30 min of gait training in the form of treadmill walking. The subjects in the experimental group underwent simultaneous training in obstacle-crossing while walking on the treadmill for 30 min/day, 5 times/week, for 4 weeks. Main measures were the 10-m walk test (10MWT), 6-min walk test (6MWT), Berg Balance Scale (BBS), timed “Up & Go” (TUG) test, and Activities-specific Balance Confidence (ABC) scale used before and after the intervention.Results: The changed values of the 6MWT and BBS were significantly higher in the experimental group than in the control group after adjusting for each baseline value, with large effects of 1.12 and 0.78, respectively, but not in the 10MWT, TUG, and ABC scale scores. Both groups showed a significant difference in all variables before and after the intervention.Conclusion: Treadmill walking combined with obstacle-crossing training may help improve the walking ability of patients with hemiplegic stroke and can possibly be used as an adjunct to routine rehabilitation therapy as a task-oriented practice based on community ambulation.