Fast Gait Velocity Research Articles

Lateralized Subthalamic Stimulation for Axial Dysfunction in Parkinson's Disease: Exploratory Outcomes and Open-Label Extension.

A randomized trial suggested that reducing left-sided subthalamic stimulation amplitude could improve axial dysfunction. To explore open-label tolerability and associations between trial outcomes and asymmetry data. We collected adverse events in trial participants treated with open-label lateralized settings for ≥3 months. We explored associations between trial outcomes, location of stimulation and motor asymmetry. 14/17 participants tolerated unilateral amplitude reduction (left-sided = 10, right-sided = 4). Two hundred eighty-four left-sided and 1113 right-sided stimulated voxels were associated with faster gait velocity, 81 left-sided and 22 right-sided stimulated voxels were associated with slower gait velocity. Amplitude reduction contralateral to shorter step length was associated with 2.4-point reduction in axial MDS-UPDRS. Reduction contralateral to longer step length was associated with 10-point increase in MDS-UPDRS. Left-sided amplitude reduction is potentially more tolerable than right-sided amplitude reduction. Right-sided more than left-sided stimulation could be associated with faster gait velocity. Shortened step length might reflect contralateral overstimulation.

Assessing lower limb angles from sagittal plane images captured with a smartphone for post-stroke gait

BACKGROUND: Clinical gait analysis of sagittal plane lower-limb kinematics using video images is a quantitative tool for clinicians. However, the reliability and validity of limb kinematics after stroke using video images has not been fully investigated. OBJECTIVE: This study aimed to examine the within-session inter-rater reliability and criterion-related validity of lower limb angles measured in sagittal plane images captured using a smartphone for assessing post-stroke gait and to determine which asymmetric parameters are associated with faster gait velocity. METHODS: Thirty-two patients with stroke were included; video images were recorded as they walked at their preferred pace for 1–3 cycles. Lower limb angles (contact, push-off, and excursion angles) and degree of asymmetry were determined based on video images using markers of acromion, greater trochanter, and fifth metatarsal head. Measurement reliability was calculated using the two-way random effects model of intraclass correlation coefficients and minimal detectable change. The criterion validity investigated Pearson’s correlation between lower limb angles and their asymmetry and gait velocity. RESULTS: The lower value of the 95% confidence interval of intraclass correlation coefficients (2.3) of the lower limb was 0.891, and the maximum minimal detectable change was 9.6 degrees. Push-off angle showed a moderate-to-strong correlation with gait velocity, whereas the asymmetry of the push-off angle showed a weak correlation with gait velocity. CONCLUSIONS: Assessing post-stroke gait utilizing video images using a smartphone is feasible. The push-off angle, in particular, may provide insight into the clinical assessment of post-stroke gait.

Feasibility of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability: a randomized controlled trial.

Treadmill training shows advantages in the specificity, amount, and intensity of gait and balance practice for the rehabilitation of stroke patients. To investigate the feasibility and effectiveness of challenging treadmill speed-dependent gait and perturbation-induced balance training in chronic stroke patients with low ambulation ability. For this randomized controlled trial (Chinese Clinical Trials.gov registration number ChiCTR-IOR-16009536) with blinded testers, we recruited 33 ambulatory stroke participants with restricted community ambulation capacity and randomly assigned them into two groups: the experimental group with 2 week treadmill speed-dependent gait training combined with 2 week treadmill perturbation-induced balance training (EXP) or the control group with traditional gait and balance training (CON). Various variables were recorded during EXP training, including the rating of perceived exertion, heart rate, causes of pauses, treadmill speed, and perturbation intensity. Outcome measures were examined before training and at 2 and 4 weeks after training. They included gait velocity during five-meter walk test at comfortable and fast speed and reactive balance ability in the compensatory stepping test as primary outcome measures, as well as dynamic balance ability (timed up-and-go test and 5 times sit-to-stand test) and balance confidence as secondary outcome measures. All participants completed the study. The treadmill speed and perturbation intensity significantly increased across training sessions in the EXP group, and no adverse effects occurred. The normal and fast gait velocities showed significant time and group interaction effects. They significantly increased after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05). Likewise, dynamic balance ability measured using the timed up-and-go test at a fast speed significantly improved after 2 and 4 weeks of training in the EXP group (p < 0.05) but not in the CON group (p > 0.05), although without a significant time and group interaction effect. Surprisingly, the reactive balance ability did not show improvement after treatment in the EXP group (p > 0.05). Challenging treadmill speed-dependent gait and treadmill perturbation-induced balance training is feasible and effective to improve ambulation function in chronic stroke patients with low ambulation ability.

Association between measures of cognitive function on physical function in novice users of a lower limb prosthesis

BackgroundCognitive impairment is prevalent in people with lower limb amputations (PLLA) and is associated with adverse outcomes, such as falls and worse rehabilitation outcomes. Physical function tests are essential to examine abilities; however, no research in PLLA has clarified the magnitude of cognitive demands amongst available tests in users novice at walking with a prosthesis. Research questionIs there an association between cognitive and physical function for PLLA novice at walking with a prosthesis? MethodsPeople from inpatient prosthetic rehabilitation were recruited. Inclusion criteria were: age ≥ 50 years, unilateral transtibial amputation and able to walk independently. Gait velocity and the L Test under single-task (usual) and dual-task (walking while counting backwards) conditions assessed functional mobility. The Four Square Step Test (FSST) examined dynamic balance. The Montreal Cognitive Assessment (MoCA) and the Trail Making Test (TMT-B) assessed global cognitive status and executive function, respectively. Multivariable linear regressions evaluated the association of cognition on physical function. ResultsTwenty-two people participated (age: 62.3 ± 8.9 years, male: 68.18%). The mean MoCA score was 26.23 ± 2.90. A 1-point MoCA increase was independently associated with faster gait velocity (cm/s) [single-task: 5.45 (95%CI: 2.35–8.54, AdjR2 =0.46), dual-task: 5.04 (95%CI: 1.33–8.75, AdjR2 =0.20) and a quicker L Test (s) [single-task: − 4.75 (95%CI: 7.22–2.28, AdjR2 =0.45), dual-task: − 5.27 (95%CI: 8.74–1.80, AdjR2 =0.38)]. A 1-second TMT-B increase was also independently associated with worse L Test performance [single-task: 0.21 s (95%CI: 0.03–0.39, AdjR2 =0.20), dual-task: 0.29 s (95%CI: 0.06–0.51, AdjR2 =0.30)]. No association was observed between MoCA or TMT-B on the FSST (p > 0.13). SignificanceBetter global cognitive function and executive function were independently associated with faster gait velocity and improved functional mobility, but not dynamic balance. The present study demonstrates a unique relationship between cognition and physical function that warrants further research on the cognitive demands among clinical tests of physical function in PLLA.

Self-Reported Measures Have a Stronger Association With Dizziness-Related Handicap Compared With Physical Tests in Persons With Persistent Dizziness.

BackgroundAssociations between dizziness-related handicap and a variety of self-reported measures have been reported. However, research regarding associations between dizziness-related handicap and aspects of functioning that includes both physical tests and self-reported measures is scarce.ObjectiveThe purpose of the study was to describe the variations in signs and symptoms in people with persistent dizziness using physical tests and self-reported outcomes across three severity levels of the Dizziness Handicap Inventory (DHI) and investigate their associations with the DHI.MethodParticipants with persistent dizziness (n = 107) were included in this cross-sectional study. The participants underwent (1) physical tests (gait tests, grip strength, body flexibility, and movement-induced dizziness) and completed questionnaires regarding (2) psychological measures (Mobility Inventory of Agoraphobia, Body Sensation Questionnaire, Agoraphobic Cognitions Questionnaire, and Hospital Depression and Anxiety Questionnaire), and (3) fatigue, dizziness severity, and quality of life (Chalders Fatigue Scale, Vertigo Symptom Scale-Short Form, and EQ visual analog scale), in addition to the DHI. Data were presented by descriptive statistics for three DHI severity levels (mild, moderate, and severe). A multiple linear backward regression analysis was conducted for each group of measures in relation to the DHI total score, with additional analyses adjusting for age and sex. Based on these results, significant associations were tested in a final regression model.ResultsWith increasing severity levels of DHI, the participants demonstrated worse performance on most of the physical tests (preferred and fast gait velocity, dizziness intensity after head movements), presented with worse scores on the self-reported measures (avoidance behavior, fear of bodily sensation, fear of fear itself, psychological distress, fatigue, dizziness severity, quality of life). After adjusting for age and sex, significant associations were found between total DHI and avoidance behavior, psychological distress, dizziness severity, and quality of life, but not with any of the physical tests, explaining almost 56% of the variance of the DHI total score.ConclusionThere was a trend toward worse scores on physical tests and self-reported measurements with increasing DHI severity level. The DHI seems to be a valuable tool in relation to several self-reported outcomes; however, several signs and symptoms may not be detected by the DHI, and thus, a combination of outcomes should be utilized when examining patients with persistent dizziness.

Impact of Rehabilitation on Gait Kinematic following Grade II Anterior Cruciate Ligament Injury among Wrestlers.

Background Anterior cruciate ligament (ACL) injuries are among the most common injuries in wrestling. Even though there are several studies available in the literature about the changes in gait kinematics following ACL injury and ACL reconstruction surgery, none of these studies investigated the changes in gait kinematics following nonoperative rehabilitation protocol. So, this study is aimed at investigating the changes in gait kinematic following a supervised ACL rehabilitation protocol among wrestlers following a grade II ACL injury. Methods Fifteen male professional wrestlers with recent grade II ACL injury with mean age: 19.93 ± 2.01 years, weight: 72.33 ± 7.46 kg, and height: 173 ± 4.95 cm volunteered for this single-arm pretest-posttest study. Kinematic parameters during walking pre- and postrehabilitation were examined by two-dimensional (2D) video graphic analysis. Paired sample t-test and Cohen's d were used to determine significant differences and effect size of segmental angle, cadence, step length, stride length, etc. Results Injured wrestlers after the rehabilitation program walked significantly faster and had a 10.13% higher cadence, a 10.89% faster gait velocity, a 05% greater step length, and a 4.69% longer stride length, compared with a prerehabilitation program of injured wrestlers. Furthermore, joint angles at the hip, knee, and ankle were significantly different between pre- and postrehabilitation. Conclusion Research findings suggest that rehabilitation programs significantly impact the gait pattern of injured wrestlers. A 19-week supervised rehabilitation protocol can increase gait velocity and related parameters in ACL injured wrestlers.

Lateralized Subthalamic Stimulation for Axial Dysfunction in Parkinson's Disease: A Randomized Trial.

Patients with Parkinson's disease might develop treatment-resistant axial dysfunction after bilateral subthalamic stimulation. To study whether lateralized stimulation (unilateral 50% amplitude reduction) for ≥21 days results in ≥0.13 m/s faster gait velocity in the dopaminergic ON state in these patients, and its effects on motor and axial function, quantitative gait and speech measures, quality of life, and selected cognitive tasks. Randomized, double-blinded, double-crossover trial. In 22 participants (51-79 years old, 15 women), there were no significant changes in gait velocity, quality of life, cognitive, and speech measures. Reducing left-sided amplitude resulted in a 2.5-point improvement in axial motor Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) (P=0.005, uncorrected) and a 1.9-point improvement in the Freezing of Gait Questionnaire (P=0.024, uncorrected). Lateralized subthalamic stimulation does not result in meaningful improvement in gait velocity in patients with Parkinson's disease who develop treatment-resistant axial dysfunction after bilateral subthalamic stimulation. Left subthalamic overstimulation may contribute to axial deterioration in these patients. © 2022 International Parkinson and Movement Disorder Society.

Comparison of Two Circuit Class Therapy Programs on Walking Capacity, Gait Velocity and Stair Ambulation among Patients with Chronic Stroke: a Parallel Pretest-Posttest Pilot Study

Objective. Circuit class therapy is a cost-efficient model of treatment that can be beneficial in a setting with limited resources. Current literature has conflicting results regarding which is a more effective approach to stroke rehabilitation: focusing on functional training or on improving impairments. This pilot study provides preliminary information comparing the effects of a task-oriented versus an impairment-focused circuit class therapy on walking ability among patients with chronic stroke.&#x0D; Method. Eighteen participants with a single episode of chronic stroke and limited mobility were randomized into task-oriented circuit class (task group) (n=9) and impairment-focused circuit class (impairment group) (n=9). Both groups underwent intervention thrice a week for four weeks. Blind examination was done using the Ten Meter Walk Test for comfortable gait velocity (CGV) and fast gait velocity (FGV), Time Up and Down Stairs (TUDS), and Six Minute Walk Test (6MWT).&#x0D; Results. All participants completed the treatment sessions without adverse effects. After four weeks of treatment, the task group showed statistically significant within-group change in CGV (0.12±0.08, p=0.003) and FGV (0.25±0.22, p=0.007). The impairment group only showed statistically significant improvement in 6MWT (25.80±31.2, p=0.038). There were no statistically significant changes between the groups in all outcome measures.&#x0D; Conclusions. The preliminary data from this pilot study suggest either program can improve walking-related outcomes and may not be different, although this needs to be confirmed using an appropriately-powered trial.

Gait Metrics For Older Adults Using Different Walking Devices After A Six-week Walking Intervention

Falls have detrimental effects to older adults’ physical and mental wellbeing and can even result in death. The medical system spends billions of dollars on treatment for falls every year. Measuring different aspects of gait, such as gait velocity, can help predict the risk for falling. PURPOSE: This study investigated how walking with no device, walking poles, or the gait trainer impacted gait metrics in older adults. METHODS: Fourteen participants (3 men, 11 women, aged 77.53 ± 7.28 years) were randomized to one of three walking groups: Control (C) (n=4), Walking Poles (WP) (n=5), or Gait Trainer (GT) (n=5). The gait trainer is a new device aimed at preventing age-related gait decline. Assessments were performed at three separate times: prior to the intervention (Pre-test), immediately after the intervention (Post1), and six weeks after Post1 (Post2). Assessments included measurements of gait velocity, cadence, and left and right step lengths for the subjects’ normal and fast gait speeds. For the six-week intervention, all participants walked three times per week for 30 minutes in their assigned walking group. RESULTS: An ANOVA showed there were no statistically significant differences between the groups at Pre-test for all metrics (p > 0.05). Between group measurements across time were analyzed using linear regression models for all metrics, with an alpha set at p < 0.05. The only statistically significant difference was found for left step length (L SL) for fast gait velocity between the C and WP groups from Pre-test to Post1 (p = 0.03). From Pre-test to Post1, L SL increased in C from 68.4 cm to 73.7 cm and decreased in WP from 73.0 cm to 70.6 cm. There were no statistically significant differences for all other metrics analyzed. CONCLUSION: The results from this study found that walking group did not impact gait velocity over time. Gait velocity is determined by step length and cadence, and can be used as a predictor of falls; therefore, walking group did not impact fall risk with the six-week walking intervention, despite the increase in L SL for the C group. The current sample size was relatively high-functioning and did not show improvement; however, trends indicated a subset of lower functioning participants who have experienced notable age-related gait decline may benefit from the gait trainer.

Mobility performance among community-dwelling older Filipinos who lived in urban and rural settings: A preliminary study.

Background:The impact of residential setting on the performance of older adults on commonly used instruments of mobility has not been closely investigated.Objective:This study aimed to (1) explore whether mobility test performance differed between those who lived in urban and rural communities, and (2) report preliminary reference values for these tests according to residential setting.Methods:The study used a descriptive design. Individuals who were aged 60 years and above, had no significant disability, and resided in urban and rural areas in the Philippines , participated in the study. Researchers measured mobility performance using the 10-Meter Walk Test (10MWT) (both comfortable gait velocity (CGV) and fast gait velocity (FGV)), Five Times Sit to Stand Test (FTSST), and Six-Minute Walk Test (6MWT). Preliminary reference values for the mobility tests were presented as means, standard deviations, and 95% confidence intervals. Scores were compared based on residential setting (urban versus rural).Results:Urban-dwellers scored consistently better compared to their rural counterparts on the CGV, FGV, FTSST, and 6MWT using independent samples -test . Data were further divided according to age and sex, and comparison of the mobility test scores between urban- and rural-dwellers within each subgroup showed similar differences .Conclusion:Results provide preliminary evidence for the influence of residential setting on the mobility test performance of Filipino older adults. The study provides a good starting point for confirmatory research with a representative sample to (1) illustrate differences in mobility performance according to residential setting, (2) investigate how specific factors associated with residential settings contribute to differences in mobility performance, and (3) determine the extent to which clinicians should consider an older person’s residential setting when interpreting mobility test results.

Functional outcomes of an integrated Parkinson's Disease Wellbeing Program.

There is growing evidence that exercise provides benefit in treating motor and non-motor symptoms in Parkinson's disease (PD). The aims of this study were to determine (a) whether a 5-week PD-specific program resulted in sustained physical and psychosocial benefits, and (b) the relationship between patient characteristics, exercise, falls and physical and psychosocial parameters. Single-centre prospective observational study. A total of 135 consecutive patients with mild-to-moderate PD underwent a 5-week PD-specific education and exercise program from August 2013 to March 2015. Gait, mobility and psychosocial measures were compared at baseline, 6weeks and 12months. Significant improvements in physical (walking distance in 2minutes, number of "Sit To Stands" in 30seconds, time in seconds taken to "Timed Up and Go," fast gait velocity over 10m, Berg Balance Scale [BBS]) and psychosocial (quality of life (QoL) [PDQ-39], depression and anxiety [DASS-21], and fatigue [PSF-16]) measures were seen at 6weeks (all P<.01) with physical improvements sustained at 12months (all P<.001). The number of patients at 12months with ≥1 fall reduced from 66% to 33%, and the number not exercising reduced from 42% to 21%. A lack of exercise correlated with ≥1 fall at 12months (OR 3.39, 95% CI 1.36-8.39, P=.009). It was also associated with poorer balance and psychosocial parameters at 12months (all P<.05). Patients recruited into a 5-week Parkinson's disease education and exercise program achieved significant 12-month benefits in physical but not psychosocial measures. Patients with ≥1 fall post-treatment were less likely to have been exercising at 12-month follow-up.

Emotional states influence forward gait during music listening based on familiarity with music selections

Music elicits a wide range of human emotions, which influence human movement. We sought to determine how emotional states impact forward gait during music listening, and whether the emotional effects of music on gait differ as a function of familiarity with music. Twenty-four healthy young adults completed walking trials while listening to four types of music selections: experimenter-selected music (unfamiliar-pleasant), its dissonant counterpart (unfamiliar-unpleasant), each participant’s self-selected favorite music (familiar-pleasant), and its dissonant counterpart (familiar-unpleasant). Faster gait velocity, cadence, and stride time, as well as longer stride length were identified during pleasant versus unpleasant music conditions. Increased gait velocity, stride length, and cadence as well as reduced stride time were positively correlated with subjective ratings of emotional arousal and pleasure as well as musical emotions such as happiness-elation, nostalgia-longing, interest-expectancy, pride-confidence, and chills, and they were negatively related to anger-irritation and disgust-contempt. Moreover, familiarity with music interacted with emotional responses to influence gait kinematics. Gait velocity was faster in the familiar-pleasant music condition relative to the familiar-unpleasant condition, primarily due to longer stride length. In contrast, no differences in any gait parameters were found between unfamiliar-pleasant and unfamiliar-unpleasant music conditions. These results suggest emotional states influence gait behavior during music listening and that such effects are altered by familiarity with music. Our findings provide fundamental evidence of the impact of musical emotion on human gait, with implications for using music to enhance motor performance in clinical and performance settings.

Gait Velocity and Joint Power Generation After Stroke: Contribution of Strength and Balance.

The aim of the study was to assess the degree to which isometric strength of multiple lower limb muscle groups and balance is associated with gait velocity and joint power generation during gait after stroke. Sixty-three participants in a multisite, multinational, cross-sectional, observational study underwent assessment of gait velocity (10-m walk test), standing balance (computerized posturography), and isometric strength (hand-held dynamometry). Twenty-seven participants had joint power generation assessed (three-dimensional gait analysis). Bivariate associations were examined using Spearman's correlations. Regression models with partial F tests were used to compare the contribution to gait between measures. Although all muscle groups demonstrated significant associations with gait velocity (ρ = 0.40-0.72), partial F tests identified that ankle plantar flexor and hip flexor strength made the largest contribution to gait velocity. Ankle plantar flexor strength also had strong associations with habitual and fast-paced ankle power generation (ρ = 0.65 and 0.75). Balance had significant associations with habitual and fast gait velocity (ρ = -0.57 and -0.53), with partial F tests showing that the contribution was independent of strength. Ankle plantar flexor and hip flexor strength had the largest contribution to gait velocity. Future research may wish to refocus strength assessment and treatment to target the ankle plantar flexors and hip flexors. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Differentiate the contribution that lower limb strength of each muscle group has on gait velocity after stroke; (2) Appraise the relationship between isometric strength and joint power generation during gait; and (3) Interpret the contribution of both strength and balance to gait after stroke. Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity.

Modified dynamic gait index and limits of stability in myotonic dystrophy type 1.

The purpose of this study was to describe and compare the performance of balance and walking tests in relation to self-reported fall history in adults with myotonic dystrophy type 1 (DM1). Twenty-two (13 male) participants with DM1 completed, a 6-month fall history questionnaire, the modified Dynamic Gait Index (mDGI), limits of stability (LoS) testing, and 10-m walking tests. Mean (SD) falls in 6 months was 3.7 (3.1), and 19 (86%) participants reported at least 1 fall. Significant differences in mDGI scores (P = 0.006) and 10-m fast walking gait velocity (P = 0.02) were found between those who had been classified as "fallers" and those who had been classified as "nonfallers." Significant correlations were found between mDGI scores and 10-m walking time. Falls are common in DM1, and the mDGI may have potential to distinguish fallers from nonfallers, whereas the LoS failed to detect such impairment. Future studies should further explore use of the mDGI in DM1. Muscle Nerve 58: 694-699, 2018.

Step length determines minimum toe clearance in older adults and people with Parkinson’s disease

Reduced foot clearance when walking may increase the risk of trips and falls in people with Parkinson’s disease (PD). Changes in foot clearance in people with PD are likely to be associated with temporal-spatial characteristics of gait such as walking slowly which evokes alterations in the temporal-spatial control of stepping patterns. Enhancing our understanding of the temporal-spatial determinants of foot clearance may inform the design of falls prevention therapies.Thirty-six people with PD and 38 age-matched controls completed four intermittent walks under two conditions: self-selected and fast gait velocity. Temporal-spatial characteristics of gait and foot (heel and toe) clearance outcomes were obtained using an instrumented walkway and 3D motion capture, respectively. A general linear model was used to quantify the effect of PD and gait velocity on gait and foot clearance. Regression evaluated the temporal and spatial gait predictors of minimum toe clearance (MTC).PD walked slower regardless of condition (p = .016) and tended to increase their step length to achieve a faster gait velocity. Step length and the walk ratio consistently explained the greatest proportion of variance in MTC (>28% and >33%, respectively) regardless of group or walking condition (p < .001).Our results suggest step length is the primary determinant of MTC regardless of pathology. Interventions that focus on increasing step length may help to reduce the risk of trips and falls during gait, however, clinical trials are required for robust evaluation.

Longitudinal gait and balance decline in Friedreich’s Ataxia: A pilot study

IntroductionFriedreich’s Ataxia (FA) is a devastating, progressive, neurodegenerative disease. Objective measures that detect changes in neurological function in FA patients are needed to facilitate therapeutic clinical trials. The purpose of this pilot study was to analyze longitudinal changes in gait and balance in subjects with FA using the GAITRite Walkway System® and Biodex Balance System™, respectively, and to test the ability of these measures to detect change over time compared to the Friedreich’s Ataxia Rating Scale (FARS). MethodsThis was a 24-month longitudinal study comparing ambulatory FA subjects with age- and gender-matched, healthy controls. Eight FA subjects and 8 controls were tested at regular intervals using the GAITRite and Biodex Balance systems and the FARS. ResultsIn the FA group, comfortable and fast gait velocity declined 8.0% and 13.9% after 12 months and 24.1% and 30.3% after 24 months, respectively. Postural stability indices increased in FA subjects an average of 41% from baseline to 24 months, representing a decline in balance. Subjects with FA also demonstrated a 17.7% increase in FARS neurological exam scores over 24 months. There were no changes in gait or balance variables in controls. In the FA group, multiple gait and balance measures correlated significantly with FARS neurological exam scores. ConclusionsThe GAITRite and Biodex Balance systems provided objective and clinically relevant measures of functional decline in subjects with FA that correlated significantly with performance measures in the FARS. Gait velocity may be an important objective measure to identify disease progression in adults with FA.

Kinematic Mechanisms of How Power Training Improves Healthy Old Adults' Gait Velocity.

Slow gait predicts many adverse clinical outcomes in old adults, but the mechanisms of how power training can minimize the age-related loss of gait velocity is unclear. We examined the effects of 10 wk of lower extremity power training and detraining on healthy old adults' lower extremity muscle power and gait kinematics. As part of the Potsdam Gait Study, participants started with 10 wk of power training followed by 10 wk of detraining (n = 16), and participants started with a 10-wk control period followed by 10 wk of power training (n = 16). We measured gait kinematics (stride characteristic and joint kinematics) and isokinetic power of the ankle plantarflexor (20°·s, 40°·s, and 60°·s) and knee extensor and flexor (60°·s, 120°·s, and 180°·s) muscles at weeks 0, 10, and 20. Power training improved isokinetic muscle power by ~30% (P ≤ 0.001) and fast (5.9%, P < 0.05) but not habitual gait velocity. Ankle plantarflexor velocity measured during gait at fast pace decreased by 7.9% (P < 0.05). The changes isokinetic muscle power and joint kinematics did not correlate with increases in fast gait velocity. The mechanisms that increased fast gait velocity involved higher cadence (r = 0.86, P ≤ 0.001) rather than longer strides (r = 0.49, P = 0.066). Detraining did not reverse the training-induced increases in muscle power and fast gait velocity. Because increases in muscle power and modifications in joint kinematics did not correlate with increases in fast gait velocity, kinematic mechanisms seem to play a minor role in improving healthy old adults' fast gait velocity after power training.

Effects of 2 Years of Exercise on Gait Impairment in People With Parkinson Disease: The PRET-PD Randomized Trial.

This study presents a secondary analysis from the Progressive Resistance Exercise Training in Parkinson Disease (PRET-PD) trial investigating the effects of progressive resistance exercise (PRE) and a Parkinson disease (PD)-specific multimodal exercise program, modified Fitness Counts (mFC), on spatial, temporal, and stability-related gait impairments in people with PD. Forty-eight people with PD were randomized to participate in PRE or mFC 2 times a week for 24 months; 38 completed the study. Gait velocity, stride length, cadence, and double-support time were measured under 4 walking conditions (off-/on-medication, comfortable/fast speed). Ankle strength was also measured off- and on-medication. Twenty-four healthy controls provided comparison data at one time point. At 24 months, there were no significant differences between exercise groups. Both groups improved fast gait velocity off-medication, cadence in all conditions, and plantarflexion strength off-/on-medication. Both groups with PD had more gait measures that approximated the healthy controls at 24 months than at baseline. Plantarflexion strength was significantly associated with gait velocity and stride length in people with PD at baseline and 24 months, but changes in strength were not associated with changes in gait. Twenty-four months of PRE and mFC were associated with improved off-medication fast gait velocity and improved cadence in all conditions, which is important because temporal gait measures can be resistant to medications. Spatial and stability-related measures were resistant to long-term improvements, but did not decline over 24 months. Strength gains did not appear to transfer to gait.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A161).

Hip mechanics underlie lower extremity power training-induced increase in old adults’ fast gait velocity: The Potsdam Gait Study (POGS)

BackgroundAging is associated with slowed gait and old compared with young adults generally walk with greater positive hip work (H1) and reduced positive ankle work (A2). The role of exercise interventions on old adults’ gait mechanics that underlie training-induced improvements in gait velocity is unclear. We examined the effects of lower extremity power training and detraining on old adults’ gait kinetics. MethodsAs part of the Potsdam Gait Study (POGS), healthy old adults completed a no-intervention control period (69.1±4.4yrs, n=14) or a power training program followed by detraining (72.9±5.4yrs, n=15). We measured isokinetic knee extensor and plantarflexor power and measured hip, knee and ankle kinetics at habitual, fast and standardized walking speeds. ResultsPower training significantly increased isokinetic knee extensor power (25%), plantarflexor power (43%), and fast gait velocity (5.9%). Gait mechanics underlying the improved fast gait velocity included increases in hip angular impulse (29%) and H1 work (37%) and no changes in positive knee (K2) and A2 work. Detraining further improved fast gait velocity (4.7%) with reductions in H1 (−35%), and increases in K2 (36%) and A2 (7%). ConclusionPower training increased fast gait velocity in healthy old adults by increasing the reliance on hip muscle function and thus further strengthened the age-related distal-to-proximal shift in muscle function.

The Influence of Rocker Bar Ankle Foot Orthosis on Gait in Patients with Chronic Hemiplegia

This study aimed to evaluate the effect of rocker bar ankle foot orthosis (RAFO) on the spatiotemporal characteristics of gait in chronic hemiplegic patients compared with the effect of solid ankle foot orthosis (SAFO). Following ethical approval, 18 patients with chronic hemiplegia, at least 6 months post stroke, were investigated in barefoot condition, with SAFO and RAFO in random sequences. Their spatiotemporal characteristics were examined by 2 force platforms and a Vicon motion analysis system. There were significant changes in spatiotemporal outcome measures between barefoot condition and using SAFO and RAFO (P < .05). Compared with SAFO, RAFO resulted in significantly more step length, faster gait velocity, and less preswing time (P < .05), although no significant differences were seen regarding step width and cadence (P > .05). Furthermore, RAFO led to significant increases in hip extension and knee flexion at toe-off, whereas SAFO did not change these parameters (P < .05). Findings of the present study showed that RAFO further improves gait abilities in chronic hemiplegic patients compared with SAFO, which could be due to the positive effect of added rocker bar on push-off function during the late stance phase of gait.