Functional Ambulation Performance Score Research Articles

Determination of optimal vibration dose to treat Parkinson's disease gait symptoms: A clinical trial

IntroductionMost people with Parkinson's disease (PD) will experience gait problems. Previous studies demonstrated improved gait and balance after vibration stimulation was applied to the feet of PD patients. However, not all study participants showed improvement, perhaps due to sub-optimal vibration stimulus. Thus far, the optimal frequency and amplitude of vibration for mitigating gait dysfunction in PD have yet to be systematically explored. This study aimed to deliver vibration to the feet of 26 people with PD gait disturbances. We hypothesized that a global frequency, amplitude, and minimum duration of vibration therapy are required to improve PD gait issues. MethodsThis was a phase Ib trial to identify optimal vibration parameters. Thirteen participants were recruited at Hoehn & Yahr (H&Y) stage II and 13 participants at stage III. Each group was randomly assigned to different frequency and amplitude settings prescribed by the central composite design methodology. Each participant received vibration for 18 min per walking session, for eight sessions spread over one week. ResultsResults showed an optimal response to treatment for frequency (Hz) and amplitude (mm) of vibration based on the Functional Ambulation Performance score for stages II and III. In the H&Y stage II group, stabilization of outcomes occurred after the 4th treatment. This stabilization was not seen in stage III participants. ConclusionsA global frequency and vibration amplitude have been identified for treating PD gait disorders. Patients with more advanced disease may require a longer duration of therapy.

DETERMINATION OF OPTIMAL VIBRATION DOSE TO TREAT PARKINSON’S DISEASE GAIT SYMPTOMS: A CLINICAL TRIAL

Abstract Most people with Parkinson’s disease (PD) will experience gait problems. Previous studies demonstrated improved gait and balance after vibration stimulation was applied to the feet of PD patients. However, not all study participants showed improvement, perhaps due to sub-optimal vibration stimulus. Thus far, the optimal frequency and amplitude of vibration for mitigating gait dysfunction in PD have yet to be systematically explored. The PDVibe2TM (Resonate Forward LLC, DE) delivered vibration to the feet of 26 people with PD gait disturbances. We hypothesized that a global frequency, amplitude, and minimum duration of vibration therapy is required to improve gait. This was a phase Ib trial to identify optimal vibration parameters. Thirteen participants were recruited at Hoehn & Yahr (H&Y) stage II and 13 participants at stage III. Each group was randomly assigned to different frequency and amplitude settings prescribed by the central composite design methodology. Each participant received vibration for 18 minutes per walking session, for eight sessions spread over one week. Results showed an optimal dose response to treatment for frequency and amplitude of vibration based on the Functional Ambulation Performance score for stages II and III. In the H&Y stage II group, outcomes were stabilized after the 4th treatment. This stabilization was not seen in stage III participants. Global frequency and vibration amplitudes have been identified for treating PD gait disorders. Patients with more advanced Parkinson’s disease may require a longer duration of therapy.

Plantar pressure analysis and customized insoles in diabetic foot ulcer management: Case series

Nonhealing diabetic foot ulcers are a major health concern, reducing the quality of life of individuals and families. It is well-known that reduction and redistribution of plantar pressure prevents ulceration or its recurrence. However, studies regarding the use of customized insoles to off-load existing ulcers are limited. This case series highlights the potential of customized insoles in improving outcomes of diabetic plantar foot ulcers in three patients. Functional Ambulation Performance Score (FAPS) and plantar pressure readings obtained from barefooted gait analysis were noted. Customized insoles were crafted using fully customized insole (Boyner insole) technology at Advanced Wound Care Department, Deenanath Mangeshkar Hospital, Maharashtra, India for every subject as necessary. Gait analysis, wearing footwear with customized insoles, was performed immediately and repeated after 2 months for comparison. All three cases presented with improved FAPS, reduced plantar pressure at wound site, and accelerated healing after 4 months.

Test-retest reliability of an instrumented electronic walkway system (GAITRite) for the measurement of spatio-temporal gait parameters in young patients with Friedreich’s ataxia

BackgroundFriedreich ataxia (FRDA) affects the spatio-temporal parameters (STP) of gait. To our knowledge, proper tools to measure the variability of ataxic gait have not been validated yet. The aims of the present study were: (1) to measure the reproducibility of STP and gait scores in young patients with FRDA and (2) to describe the characteristics of gait parameters in this population. MethodsThirty-six patients (18 males, 18 females) with diagnosis of FRDA (mean age 16.4 ± 4.5 years) were asked to walk barefoot at a self-selected pace along the pressure sensitive walkway (GAITRite®). Three trials were recorded for each patient and repeated 48 h later. Collected data was put into statistical analysis tests to determine reliability and variability of STPs and two other gait scores: The Functional Ambulation Performance score (FAP) and the Gait Variability Index (GVI). ResultsAll STPs showed strong or very strong reliability (ICC > 0.7) and a low variability. The two parameters showing the lowest reliability (0.71 and 0.74) were the base of support and the foot progression angle. The FAP score and the GVI showed strong reliability (ICC > 0.8). ConclusionsThe GAITRite system allows feasible and reliable measurements of gait parameters in young patients with FRDA. Lower reliability found for the weakest parameters was attributed to the software automatic errors and the ankle laxity noted in every patient.

Comparison of FAP scores with the use of safety footwear and regular walking shoes

ABSTRACTGait analysis has been used for the assessment of gait-related disabilities and to provide detailed information. The gait characteristics of a healthy adult population have often been utilised to evaluate and monitor a subject's walk and patterns. This paper summarises a study that aims to compare the Functional Ambulation Performance (FAP) scores in male subjects wearing safety shoes versus regular walking shoes (RWS). Participants walked with RWS along the GAITRite® electronic walkway 30 times in self-selected speed and were analysed by the FAP; the subjects then repeated the same procedure with safety footwear. The data were then gathered in test groups containing 15 measured walks enabling the research team to establish an accurate and average FAP score for each test group. A descriptive statistic for the collected data was performed to determine the gait variables of the FAP score. Walking velocity, step and stride length, step and stride time, and step width among other measures were collected by the GAITRite® system and analysed in this research. Results show a slightly lower FAP score for test subjects walking with safety footwear and the parameters mainly affected were the step length and the stride length.

Use of Functional Ambulation Performance Score as measurement of gait ability: review.

Gait analysis systems are widely used for the assessment of gait disabilities and provide more accurate and detailed information than clinical tests. Scores and indexes have been proposed to summarize the large volume of data produced, each emphasizing different aspects of gait. Based on specific spatiotemporal parameters, the Functional Ambulation Performance Score (FAPS) quantifies gait at a self-selected speed. Integrated within electronic walkways, the FAPS is commonly used for clinical evaluations and has been used in an increasing number of publications over the past few years. However, its use is sometimes distorted by misunderstandings of its composition and calculation, practical and/or conceptual limits, and even the meaning of the score. This technical report reviews the use of the FAPS for the evaluation of gait based on peer-reviewed articles and clinical experience and addresses important issues that must be considered for an optimal unbiased understanding and analysis of the score.

Validity of Functional Ambulation Performance Score for the Evaluation of Spatiotemporal Parameters of Children's Gait

ABSTRACT Gait characteristics of a healthy adult population have been used to develop the Functional Ambulation Profile (FAP) score to evaluate gait in patients with neuromuscular or musculoskeletal involvement (A. J. Nelson, 1974). Further technological progress allowed a more precise recording of walk parameters and propitiated the development of the Functional Ambulation Performance Score (FAPS). The authors aimed to explore the evolution of the FAPS in healthy children to determine what the lower limit of age would be to ensure reliability of this score. Participants were 32 children with normal development. A GAITRite® walkway was used to log the spatiotemporal parameters. Compared with values obtained in adults, the average FAPS was significantly lower for children under 12 years old. The interparticipant variability was particularly high for the younger children and decreased with age. Similar trends were observed regarding the intraparticipant variability. In conclusion, the authors observed that the FAPS is not suitable to compare the gait of different children younger than 12 years old. At least, the adult standards used to calculate FAPS would need to be modified if the score has to be applied to a pediatric population.

Modified Flexor Hallucis Longus Transfer for Achilles Insertional Rupture in Elderly Patients

Elderly patients with symptomatic Achilles tendinopathy who develop insertional ruptures develop are at risk of persistent pain and poor functional outcome. Extensive debridement of the tendinopathy creates a defect that adds to the difficulty of Achilles insertional rupture repair. Complete excision of the tendinopathy segment was proposed to minimize persistent pain. Reconstruction of the defect using modified flexor hallucis longus transfer might better restore Achilles function. Five patients older than 50 years (mean age, 58.8 years) who had symptomatic Achilles tendinopathy and subsequently had insertional ruptures were treated. The outcome was assessed at an average of 28.8 months after the reconstruction. There was good pain relief. All patients were able to do single-leg stance. Cybex isokinetic testing showed plantar flexion peak torque deficits of 10.9% and 3.9% when tested at 60 degrees /second and 120 degrees /second, respectively. The Functional Ambulation Performance score indicated a near normal gait pattern. The American Orthopaedic Foot and Ankle Society hindfoot score improved from 64.4 to 94.4. There was no major surgical complication and no re-rupture. Excision of Achilles tendinopathy segment followed by modified flexor hallucis longus transfer can achieve good pain relief and functional recovery in elderly patients with symptomatic Achilles tendinopathy who have Achilles insertional ruptures develop.

The validity of the GaitRite and the Functional Ambulation Performance scoring system in the analysis of Parkinson gait1

The purpose of this study was (1) to determine the validity of the GaitRite System in detecting footfall patterns and selected gait characteristics of person with early stage Parkinson's disease (PD) and (2) to investigate whether the Functional Ambulation Performance (FAP) scoring system is a valid tool to distinguish between selected gait characteristics of patients with early stage Parkinson's disease and similar age of non-impaired individuals. The FAP score is a quantitative means of assessing gait based on specific spatial and temporal gait parameters. 11 volunteers with idiopathic Parkinson's disease, (mean age = 74.3), and 11 age matched volunteers, (mean age = 70.3), with no history of neurological disorder participated in the study. The non-impaired control group were not matched in age and sex but of similar age and males and females were represented in the control group. Temporal and spatial parameters of gait were analyzed for both preferred- speed and fast-speed walking using the computerized GaitRite system. The system integrates specific components of locomotion to provide a single, numerical representation of gait, the Functional Ambulation Performance Score (FAP) score. The most powerful and discriminating variable between Parkinson's and non-impaired groups for both walking speeds was the mean normalized velocity (MNV). Which is velocity divided by leg length. The MNV was 0.83 for PD at preferred walking speed and 1.14 at fast speed, the non-impaired group preferred-speed group walking was 1.33, while fast-speed walking MNV was 1.70. Note the fast walking of PD was slower than the preferred velocity of the non-impaired group. For preferred-speed walking, all gait variables analyzed in the study were different between the two groups beyond the p < 0.05 level of confidence with the single exception of right stance percentage. For fast-speed walking, three of the entered variables did not discriminate between the two groups: the fast walking FAP score, left fast-walking cadence, and right fast-walking single support percentage. Our results indicate that persons with Parkinson's disease (PD) attain a significantly lower FAP score when ambulating at their preferred rate and demonstrate shorter step length and a longer step time than the age matched non-impaired group during both preferred and fast velocities of walking. Stance duration and double support duration were increased for the Parkinson's population, whereas single support duration, mean cadence, and heel-to-heel base of support were markedly reduced for both walking speeds. The FAP score was significantly different from the non-impaired control group for preferred-speed walking. These results indicate that the GaitRite system can be useful in detecting footfall patterns and selected time and distance measurements of persons with early stage Parkinson's disease and the FAP score discriminates between the PD population and the non-impaired controls when walking at preferred rate but not at fast walking.

The effects of pulsed auditory stimulation on various gait measurements in persons with Parkinson's Disease

The purpose of this study was to examine the Functional Ambulation Performance Score (FAP; a quantitative gait measure) in persons with Parkinson's Disease (PD) using the auditory stimulation of a metronome (ASM). Participants (n = 16; 5F/11M; range 60--84 yrs.) had a primary diagnosis of PD and were all independent ambulators. Footfall data were collected while participants walked multiple times on an electronic walkway under the following conditions: 1) PRETEST: establishing baseline cadence, 2) ASM: metronome set to baseline cadence, 3) 10ASM: metronome set to 10% FAP scores increased between PRETEST and POSTTEST. PRE/POSTTEST comparisons also indicated decreases in cycle time and double support and increases in step length and step-extremity ratio (step length/leg length). The results confirm prior findings that auditory stimulation can be used to positively influence the gait of persons with PD and suggest beneficial effects of ASM as an adjunct to dopaminergic therapy to treat gait dysfunctions in PD.

The functional ambulation performance of elderly fallers and non-fallers walking at their preferred velocity

The purpose of the researchers was to determine if there is a difference in the Functional Ambulation Performance score and step/extremity ratio of senior adults with and without a history of falls walking at a preferred velocity. A random sample of twenty-four senior adults was selected to participate in this study. The participants underwent several tests for balance, strength, ankle flexibility, and foot sensation. Statistical analysis of the two groups demonstrated a significant decrease in FAP score for those with a history of falls. They had lower values for step/extremity ratios, mean normalized velocity, and greater values for step times, heel to heel base of support, and percent in double support. There was also a significant decrease in balance, strength, and tactile sensation between the two groups. These findings suggest that there is a measurable decrease in the performance of gait in senior adults who have fallen that may be related to diminished strength, balance, and tactile sensation.