Functional Ambulation In Patients Research Articles

Declínio da deambulação funcional e fatores associados na esclerose lateral amiotrófica

Abstract Introduction: Amyotrophic lateral sclerosis (ALS) is a disabling neurodegenerative disease, which compromises locomotion and functional independence. As the goal of physical therapy is to maintain the individual's locomotion capacity and independence as long as possible, it is necessary to gain a better understanding of the possible factors associated with the loss of this capacity. Objective: To evaluate functional ambulation in patients with ALS and possible factors associated with its decline. Methods: A cross-sectional study was conducted with sporadic ALS patients. Demographic and clinical/functional aspects were evaluated. ALS Functional Rating Scale-Revised (ALSFRS-R), Functional Ambulation Category, Medical Research Council scale and Fatigue Severity Scale were used. Descriptive and comparative analyses were conducted of the groups capable and incapable of functional ambulation. Binary logistic regression (stepwise forward method) was performed to determine potential factors associated with the loss of functional ambulation. Results: Among the 55 patients (mean age: 56.9 ± 11.2 years), 74.5% were able to walk functionally. Differences were found between groups regarding time of diagnosis, number of falls, pain, use of noninvasive ventilation, gastrostomy, ability to turn in bed, mobility aids, home adaptations, functional performance, muscle strength and fatigue. The possible predictors of walking disability were overall muscle strength (OR = 0.837; p = 0.003) and fatigue (OR =1.653; p = 0.034). Conclusion: Muscle strength and fatigue are associated with the decline in ambulation capacity in patients with ALS. In view of the complexity of elements involved in walking, further studies are needed to investigate the influence of these aspects in this population.

Nabiximols plus robotic assisted gait training in improving motor performances in people with Multiple Sclerosis.

BackgroundMultiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system, affecting ambulation even in people with only mild neurological signs. Patients with MS frequently experience spasticity, which contributes significantly to impair their motor functions, including ambulation, owing to muscle stiffness, spasms, and pain. ObjectivesTo clarify the role of delta-9-tetrahydrocannabinol(THC):cannabidiol(CBD) oromucosal spray, coupled to robot-aided gait training (RAGT) using the Lokomat©Pro to improve functional ambulation in patients with MS. MethodsWe compared 20 patients with MS, who were treated with THC:CBD oromucosal spray in add-on to the ongoing oral antispastic therapy (OAT) (group A), with 20 individuals with MS (matched for clinical-demographic characteristics) who were treated only with OAT (group B). Both the groups underwent RAGT using the Lokomat-Pro (three 45-minute sessions per week). Our primary outcome measures were the Functional Independence Measure (FIM) and the 10 meters walking test (10MWT). As secondary outcome measures we evaluated the brain cortical excitability by using Transcranial Magnetic Stimulation. Both parameters were taken before and after the end of the RAGT. ResultsFIM improved in group A more than in group B (p<0.001). Moreover, 10MWT decreased in group A more than in group B (p<0.001). These clinical findings were paralleled by a more evident reshape of intracortical excitability in both upper and lower limbs, as suggested by motor evoked potential amplitude increase (p<0.001), intracortical inhibition strengthening (p<0.001), and intracortical facilitation decrease (p=0.01) in group A as compared to group B. ConclusionsOur results suggest that the combined THC:CBD-RAGT approach could be useful in improving gait performance in patients with MS.

Effect of ankle foot orthosis on gait parameters and functional ambulation in patients with stroke.

This study aims to investigate the effect of ankle foot orthosis (AFO) on temporospatial parameters, ankle kinematics, and functional ambulation level in patients with stroke. Records of 286 adult patients with stroke assessed in the gait and motion analysis laboratory between April 2005 and January 2013 were reviewed. The data of 28 patients (16 males, 12 females; mean age 43.2±15.9 years; range 20 to 72 years) who were analyzed with and without AFO during the same session were selected for the study. Temporospatial parameters (walking speed, cadence, opposite foot contact, double support time, single support time, step time, and step length) and ankle kinematics (ankle dorsiflexion at initial contact and midswing) were measured using the Vicon 512 motion analysis system. The video and medical records of patients were examined to determine their ambulation level according to Functional Ambulation Category. Walking speed, cadence, and ankle dorsiflexion at initial contact and midswing were significantly increased while walking with AFO compared to walking barefoot (p<0.05). There were significant reduction in step time and significant increase in step length and opposite foot contact with AFO on the affected side (p<0.05). Single support time reduced significantly with AFO on the unaffected side (p<0.05). Functional Ambulation Category score improved significantly with use of AFO (p<0.05). The use of AFO has positive effects on gait parameters and functional ambulation in patients with stroke.

The Hybrid Assistive Limb® intervention for a postoperative patient with spinal dural arteriovenous fistula and chronic spinal cord injury: A case study

Context: The purpose of this report was to describe the improvement in walking ability using the Hybrid Assistive Limb® (HAL®) intervention in the case of a patient with paraplegia after spinal cord injury whose condition deteriorated because of a spinal dural arteriovenous fistula (SDAVF).Findings: A 48-year-old man started the HAL® intervention twice per week (total 10 sessions), after his neurologic improvement had plateaued from 3 to 6 months postoperatively for an SDAVF. During the HAL® intervention, the 10-m walk test (10MWT) without HAL® was performed before and after each session. An electromyography system was used to evaluate muscle activity of both the gluteus maximus (Gmax) and quadriceps femoris (Quad) muscles in synchronization with the Vicon motion capture system. The International Standards for Neurological and Functional Classification of Spinal Cord Injury (ISNCSCI) motor scores of the lower extremities and the Walking Index for Spinal Cord Injury II (WISCI II) score were also assessed to evaluate motor function. The HAL® intervention improved gait speed and cadence during the 10MWT. Before the intervention, both the Gmax and left Quad muscles were not activated. After the intervention, the right Gmax and both Quad muscles were activated in stance phase rhythmically according to the gait cycle. The ISNCSCI motor score also improved from 14 to 16, and the WISCI II scored improved from 7 to 12.Conclusion/clinical relevance: Our experience with this patient suggests that the HAL® can be an effective tool for improving functional ambulation in patients with chronic spinal cord injury.

Effect of Orthotic Rehabilitation with Isocentric Reciprocating Gait Orthosis on Functional Ambulation in Patients with Spinal Cord Injury

ABSTRACT Objectives Functional ability defines a person's ability to walk, with or without the aid of appropriate assistive devices, safely and sufficiently to carry out mobility-related activities of daily living. Longitudinal evaluation of the efficiency of gait training positively affecting these parameters has not been reported. Therefore, the aim of this study is to provide evidence supporting the progression of walking speed and functional ambulation over 12 weeks of orthotic gait rehabilitation using an isocentric reciprocating gait orthosis (IRGO) in patients with spinal cord injury (SCI). Materials and Methods Twelve patients with SCI participated in this study. Gait evaluation was performed at baseline and at 4, 8, and 12 weeks following intervention with an IRGO and specific gait training. Gait speed and endurance were measured by the 10-m walk test and the 6-minute walk test, respectively. The Functional Independence Measure (FIM) locomotor subscale and the Walking Index for Spinal Cord Injury II (WISCI II) were used to measure the locomotor ability. Results Improvement in speed of walking was observed after 4 weeks and continued to improve with time. The distance of walking, FIM, and WISCI also increased significantly during the study period when compared with the baseline. Conclusion Patients with SCI showed an increase in walking functional ambulation ability during a longitudinal period of orthotic gait training with an IRGO. In conclusion, wearing IRGO associated with gait training can provide individuals with thoracic-level SCI the ability to walk faster.

Ankle Foot Orthosis Improves Functional Ambulation and Balance in Patients with Peripheral Nerve Palsy

Background: Several studies have examined the benefits of ankle foot orthosis (AFO) in patients with hemiparesis, but little is known about their effects in patients with peripheral nerve palsy. The purpose of this study was to compare the effects of AFO on functional ambulation in patients with hemiplegia and unilateral lower-extremity palsy. Subjects and methods: This study design was Case control study in rehabilitation units of five hospitals in Japan. The study subjects were 50 normal subjects (control), 49 patients with post-stroke hemiparesis (PSH), and 13 with lower extremity palsy (LEP) due to peripheral nerve palsy. Functional ambulation was assessed with AFO and without AFO by 10-meter maximum walking speed (10 MMWS) and the distance walked in a 6-minute walking test (6 MWT). Functional balance was assessed using the Berg balance scale. Results: The 10 MMWS test showed significantly lower walking speed in PSH and LEP without AFO compared with the control group, and that the speed was faster in the two patient groups with AFO than without AFO. The distance walked during the 6 MWT was significantly shorter in PSH and LEP than the control, but it increased significantly in both groups after wearing the AFO. Furthermore, the significant difference between the control and LEP groups disappeared after wearing the AFO. The Berg balance scale was significantly lower in PSH and LEP groups compared with the control group, but improved significantly with AFO. Conclusion: The results suggest that AFO is beneficial for patients with PSH and those with LEP through improvement of walking distance, walking speed, and functional balance. Many physicians and technicians often avoid the use AFO. However, AFO improved not only walking ability but also functional balance in both groups of patients. Physicians and technicians are encouraged to consider the use of AFO in LEP.

Correlation between time to diagnosis and rehabilitation outcomes in patients with spinal dural arteriovenous fistula

BackgroundSpinal dural arteriovenous fistulas (SDAVFs) are the most common spinal vascular malformations and can be a significant cause of myelopathy although they are under diagnosed. Surgical or embolization treatment of SDAVFs improved significantly in the last decade. However, a high percentage of patients are still left with severe disability.ObjectiveTo describe the correlation between time to diagnosis and the rehabilitation outcomes of eight patients with SDAVFs.DesignRetrospective chart study of all SDAVF patients in 20 years.SettingA tertiary university rehabilitation center.Main outcome measuresThe lower extremities motor score (LEMS), Functional Independence Measure (FIM), Spinal Cord Independence Measure (SCIM) and Walking Scale for Spinal Cord Injury (WISC II). Overall prognosis was evaluated using the Aminoff-Logue scale (ALS).ResultsThere were seven men and one woman with mean age of 61.3 ± 15 (30–72) and mean time until the diagnosis of SDAVF of 265.5 ± 245 days (4–730). At the end of rehabilitation period, five of the eight patients remained wheelchair dependent. Strong correlation was found between LEMS, FIM, SCIM, and WISC II scores and the functional level according to the ALS scale. A significant correlation was found between time to diagnosis and the height of the SDAVF, the clinical and rehabilitation outcomes. Patients with high SDAVF which were diagnosed late had the poorest prognosis.ConclusionsThe potential for functional ambulation in patients with SDAVF is related to the time of intervention. This finding emphasizes the important of early diagnosis and early intervention in SDAVF.

Lower extremity muscle force measures and functional ambulation in patients with amyotrophic lateral sclerosis

Objective: To examine the relation between lower extremity muscle force production and functional ambulation in patients with amyotrophic lateral sclerosis (ALS). Design: Retrospective analysis of data collected from 1979 to 1995. Patients: Two hundred forty ALS patients referred to the New England Medical Center Neuromuscular Research Unit. Main Outcome Measures: Muscle force production during a maximum, voluntary isometric contraction of ankle dorsiflexors, knee flexors, knee extensors, hip flexors, and hip extensors was calculated as percent predicted maximal force (PPMF). Functional ambulation status was classified as unable, home, or community. Results: The probability of community ambulation compared with home increased with progressively higher PPMF for all muscle groups. Subjects with knee flexion strength greater than 75% PPMF were 395 times more likely to ambulate in the community. Subjects with hip extension strength over 50% PPMF showed improved chance of ambulation at home. Conclusion: Lower extremity PPMF is a critical factor determining functional ambulation in patients with ALS. Knee flexors play an important role in community ambulation while the hip extensors are important for home ambulation.

Functional ambulation in patients with myelomeningocele : M. M. Hoffer, E. Feiwell, R. Perry, J. Perry, and C. Bonnett. J. Bone Joint Surg. (Am): 55 A:137–148 (January), 1973

Functional ambulation in patients with myelomeningocele : M. M. Hoffer, E. Feiwell, R. Perry, J. Perry, and C. Bonnett. J. Bone Joint Surg. (Am): 55 A:137–148 (January), 1973

Functional Ambulation in Patients with Myelomeningocele

The factors important in achieving good walking status in myelomeningocele include level of paraplegia, the additional anomalies of brain and kidney, the intelligence, and the home environment. In a group of fifty-six patients none of those with lesions of the thoracic level walked and all of those with lesions of the sacral level walked. In those with lesions at lumbar levels (twenty-one lower and nineteen upper) fourteen were community ambulators and five household ambulators. The other twenty-one were either wheel-chair (nineteen) or non-functional ambulators (two) and the level of paraplegia did not seem to matter nor did the extent of surgery. Some very young non-functional ambulators rose in functional level, but in most instances the trend was to deteriorate.