Functional Ambulation Research Articles

Abstract TP216: Sex-Based Differences in Endovascular Thrombectomy Outcomes for Large Ischemic Stroke: A SELECT2 Subanalysis

Introduction: Multiple randomized controlled trials demonstrated better functional outcomes with endovascular therapy (EVT). Potential heterogeneity in EVT treatment effect by sex is an important question as several social and biological factors are shown to differentially affect stroke outcomes between men and women. We aimed to evaluate if clinical outcomes and thrombectomy treatment effect differed by sex among patients with large ischemic stroke. Methods: In the SELECT2 RCT, baseline characteristics and outcomes were compared between men and women. The primary outcome was a shift in modified Rankin Scale score, with functional independence (mRS 0-2), independent ambulation (mRS 0-3) and symptomatic ICH as secondary outcomes. Effect modification was examined using multiplicative sex-by-treatment interaction term. Additionally, repeated measure mixed effect models were used to evaluate if recovery in functional status differed by sex at discharge/ 5 to7-day, 30-day, and 90-day follow-up. Results: Of 352 enrolled patients, 71/145 (49%) of women and 109/207 (53%) of men underwent EVT. EVT was uniformly associated with better functional outcomes without evidence of treatment effect modification [Men - aGenOR: 1.66(1.24-2.23) vs women - aGenOR: 1.73(1.22-2.45), p-int: 0.94], functional independence [men - aRR: 1.99(0.99-4.02) vs women - aRR: 5.04(1.59-16.02), p-int: 0.20] and independent ambulation [men - aRR: 1.98(1.29-3.03) vs women - aRR: 2.44(1.40-4.24), p-int: 0.67]. There were no significant differences between the two cohorts’ recovery at discharge/5 to 7-day, 30-day, and 90-day follow-up (figure). Conclusions: EVT was associated with higher rates of functional independence and independent ambulation in both men and women, without significant heterogeneity in treatment effect or recovery arc between discharge and 90-day follow-up. Trial Registration: NCT03876457

A Prospective Study of the IlluminOss Photodynamic Nail System for Pelvic Stabilization: Treatment of Impending and Actual Fractures from Metastatic Bone Disease, Multiple Myeloma, and Primary Bone Lymphoma.

The stabilization of metastatic lesions in the periacetabular region can be successfully performed using percutaneous techniques. Photodynamic nails (PDNs) are among the available tools for stabilization. Data on postoperative complications and functional outcomes are, however, scarce. Patients undergoing percutaneous stabilization using PDNs (IlluminOss Medical) for impending or actual minimally displaced pathological fractures of the pelvis from metastatic bone disease, multiple myeloma, or primary bone lymphoma were enrolled prospectively. Outcomes were assessed preoperatively and postoperatively at the 2-day, 2-week, 6-week, 3-month, 6-month, and 1-year time points. Functional outcomes assessed included the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function, PROMIS Pain Interference, Combined Pain and Ambulatory Function (CPAF), EuroQol-Visual Analogue Scale (EQ-VAS), and Musculoskeletal Tumor Society (MSTS) scores. Pain was assessed using a VAS. A total of 30 patients treated with PDNs were included. The median VAS pain score dropped from 60 points preoperatively to 30 at 6 weeks postoperatively (p = 0.004). The median CPAF score improved from 6 preoperatively to 7 postoperatively at the 6-week mark. The median EQ-VAS score showed significant improvement at 6 weeks (70 versus 50; p = 0.006). The median 2-week PROMIS Pain Interference score was significantly lower than preoperatively (64.1 versus 66.9; p = 0.03). An improvement in the median PROMIS Physical Function score was seen at 6 weeks following surgery compared with preoperatively (37 versus 30.1; p = 0.001). A significant improvement in the MSTS score was seen as soon as 2 days after surgery (77% versus 40%; p < 0.0001). Among patients with pelvic bone metastases, multiple myeloma, or primary bone lymphoma, we found that treatment using PDNs resulted in immediate return to ambulation and rapid functional outcome improvement, with low complication rates. In this population, this technique represents a safe alternative to open surgery. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Phenotypic spectrum of inclusion body myositis.

Inclusion body myositis (IBM) is a progressive, debilitating muscle disease commonly encountered in patients over the age of 50. IBM typically presents with asymmetric, painless, progressive weakness and atrophy of deep finger flexors and/or quadriceps muscle. Many patients with IBM develop dysphagia. However, atypical presentations of IBM with isolated dysphagia, asymptomatic hyper-CKemia, foot drop, proximal weakness, axial weakness, and facial diplegia have been reported. Other acquired and some inherited disorders may present similar to IBM, and this list gets more expansive when considering atypical presentations. In general, disease progression of IBM leads to loss of hand function and impaired ambulation, and most IBM patients become wheelchair dependent within 13-15 years of disease onset. Hence, IBM impacts negatively patients' quality of life and reduces longevity compared to the general population. Acknowledging the complete clinical spectrum of IBM presentation and excluding mimics would shorten the time to diagnosis, lead to prompt initiation of supportive management and avoid unproven therapy. Ongoing advanced phase studies in IBM provide hope that a therapy may soon be available. Therefore, an added potential benefit of early diagnosis would be prompt initiation of disease-modifying therapy once available.

Application of machine learning models on predicting the length of hospital stay in fragility fracture patients

BackgroundThe rate of geriatric hip fracture in Hong Kong is increasing steadily and associated mortality in fragility fracture is high. Moreover, fragility fracture patients increase the pressure on hospital bed demand. Hence, this study aims to develop a predictive model on the length of hospital stay (LOS) of geriatric fragility fracture patients using machine learning (ML) techniques.MethodsIn this study, we use the basic information, such as gender, age, residence type, etc., and medical parameters of patients, such as the modified functional ambulation classification score (MFAC), elderly mobility scale (EMS), modified Barthel index (MBI) etc, to predict whether the length of stay would exceed 21 days or not.ResultsOur results are promising despite the relatively small sample size of 8000 data. We develop various models with three approaches, namely (1) regularizing gradient boosting frameworks, (2) custom-built artificial neural network and (3) Google’s Wide & Deep Learning technique. Our best results resulted from our Wide & Deep model with an accuracy of 0.79, with a precision of 0.73, with an area under the receiver operating characteristic curve (AUC-ROC) of 0.84. Feature importance analysis indicates (1) the type of hospital the patient is admitted to, (2) the mental state of the patient and (3) the length of stay at the acute hospital all have a relatively strong impact on the length of stay at palliative care.ConclusionsApplying ML techniques to improve the quality and efficiency in the healthcare sector is becoming popular in Hong Kong and around the globe, but there has not yet been research related to fragility fracture. The integration of machine learning may be useful for health-care professionals to better identify fragility fracture patients at risk of prolonged hospital stays. These findings underline the usefulness of machine learning techniques in optimizing resource allocation by identifying high risk individuals and providing appropriate management to improve treatment outcome.

Factors associated with oral frailty among community-dwelling older people -A comparison between those

This study investigated the factors associated with oral frailty among community-dwelling older adults. In particular, we compared the factors between individuals in the young-old and old-old groups and clarified the differences between the two groups. We measured the basic attributes, body composition, grip strength, gait function, oral function, cognitive function, and daily living function using the Kihon checklist in older people living independently in T City, Aichi Prefecture. The risk of oral frailty was assessed using the Oral Frailty Screening and Evaluation Form (OFI-8), and the measurement results were compared between two groups: those with and those without risk. To identify the factors associated with oral frailty, we performed a multivariate analysis with the risk of oral frailty as the dependent variable and a univariate analysis separately for the young-old and old-old groups. The mean age of the 100 subjects was 76.6±4.6 years old. Forty-four subjects were at risk of oral frailty, and 55 subjects were not at risk. The high-risk group had significantly higher rates of polypharmacy, depression, and a slow walking speed than the no-risk group. The risk factors associated with oral frailty were living alone, polypharmacy, and depression. The risk factors for oral frailty were a poor ambulatory function in the young-old and a poor ambulatory function, decline in the cognitive function, and depression in the old-old. The results of this study suggest that the risk factors for oral frailty differ between older individuals in the young-old and old-old groups and that age-appropriate support is necessary to prevent oral frailty in older people.

The effects of rhythmic auditory stimulation on functional ambulation after stroke: a systematic review

BackgroundSeveral studies have reported the effect of rhythmic auditory stimulation (RAS) on functional ambulation in stroke patients, yet no systematic overview has yet been published. This study aims to synthesize the available evidence describing changes in stroke patients after RAS intervention for functional ambulation and the use of walking assistive devices, and to find out if the effect of RAS and music-based RAS differs depending on the lesioned area.MethodsThe PubMed, PEDro, Cochrane Central Register of Controlled Trials, Web of Science, Scopus and CINAHL electronic databases were searched for reports evaluating the effect of RAS on walking in stroke patients, applying the PICOS criteria for the inclusion of studies.ResultsTwenty one articles were included (948 stroke survivors). Most studies were of good methodological quality according to the PEDro scale, but they had a high risk of bias. The most consistent finding was that RAS improves walking and balance parameters in stroke patients in all phases compared to baseline and versus control groups with conventional treatment. Functional ambulation and the use of walking assistive devices were inconsistently reported. Several studies also suggest that RAS may be as good as other complementary therapies (horse-riding and visual cueing).ConclusionsDespite the beneficial effects of RAS, the question remains as to whether it is better than other complementary therapies. Given the heterogeneity of the interventions, the interventions in control groups, the varied durations, and the different outcome measures, we suggest that care should be taken in interpreting and generalizing findings.PROSPERO RegistrationCRD42021277940.

Evaluation of the health literacy in patients with stroke and relationship between health literacy and functional status on quality of life in patients with stroke

Aims: This study was aimed to evaluate the health literacy in patients with stroke and relationship between health literacy and functional status on quality of life. Methods: This cross-sectional study was studied on 50 participants with stroke (mean age: 59.4±10.6 years) and 50 healthy controls (mean age: 61.7±10.1 years). Clinical and demographic and characteristics were recorded. Health literacy levels of the participants were assessed with the Turkish version of European Health Literacy Scale (EHLS-TR), Motor development for hand, upper and lover extremity with Brunnstrom staging, evaluation of health-related quality of life with Notthingham Health Profile (NHP), pain with assessed with numeric rating scale (NRS). Results: Age, gender, marital status, education, job and residential area were similar between the groups. The EHLS-TR scores were significantly lower, in patients with stroke compared to the control group (p=0.041δ). There was a statistically significant negative correlation between EHLS-TR scores, age and positive correlation with educational status. EHLS-TR scores were found to be higher in patients younger than 60 years old and university graduates. Health releated quality of life levels are similar between the groups. EHLS-TR scores were found to be statistically effective on Nottingham Health Profile (NHP) total scores (rho:-0,357 and p=0,011) and also physical activity sub domain and energy level sub domains. There was moderate negative correlation between the EHLS-TR scores and NHP energy sub domain (p=0.002, r:-0.436) and weak negative correlation between the EHLS-TR scores and NHP emotional, sleep, physical activity sub domains (r:-0.279 p=0.049, r:-0.344 p=0.015, r:-0.288 p=0.043). There was no correlation between the EHLS-TR scores and Brunnstrom staging, Functional ambulation and pain levels in patients with stroke. Conclusion: Our study results suggest that healthy literacy level is lower in patients with stroke compared to healthy controls. In addition, healthy literacy is associated with age and education. Health literacy has been found to have an impact on quality of life and energy, emotional, sleep and physical activity subdomains of NHP. There was no association found between functional status on health literacy in this patient population.

Adaptive functioning and neurodevelopment in patients with Dravet syndrome: 12-month interim analysis of the BUTTERFLY observational study

ObjectiveThe BUTTERFLY observational study aims to elucidate the natural trajectory of Dravet syndrome (DS) and associated comorbidities in order to establish a baseline for clinical therapies. We present the 12-month interim analysis of the study. Materials and methodsPatients with a genetically confirmed diagnosis of DS were enrolled in the study. Adaptive functioning and neurodevelopmental status were measured using the Vineland Adaptive Behavior Scale, Third Edition (Vineland-III), Bayley Scales of Infant Development, Third Edition (BSID-III), and Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV). Executive function, ambulatory function and locomotor activities, and overall clinical status were measured using the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P) scale, Gillette Functional Assessment Questionnaire (Gillette FAQ), and Clinician or Caregiver Global Impression of Change scales (CGI-C or CaGI-C) respectively. ResultsOverall, 36 patients were enrolled across three age groups, with 35 patients completing at least part or all of one post-baseline visit through Month 12. Significant improvements in receptive communication, as assessed by Vineland-III and BSID-III raw scores, and in verbal comprehension subtests, as assessed by WPPSI-IV raw scores, were observed in BUTTERFLY patients for the all-patient group. Many patients performed on the impaired end of the BRIEF-P Global Executive Composite scale at baseline suggesting difficulties in executive function, and no significant change was observed in BRIEF-P scores for the all-patient group. Most patients performed in the dynamic range of the Gillette FAQ at baseline, and no significant change was observed in Gillette FAQ scores for the all-patient group. Lastly, there was significant improvement observed in the CaGI-C scores for the all-patient group. SignificanceThis BUTTERFLY interim analysis shows small improvements in communication skills along with stability in other developmental abilities across patients with DS enrolled in the study from baseline to Month 12.

Effects of Transcranial Brain Stimulation Combined with Physiotherapy on Lower Limb Motor Recovery in Post-Stroke Patients: a Systematic Review and Meta-analysis.

Introduction: Transcranial stimulation (TS) can integrate motor therapy with satisfactory results in the correction of pathological neural configurations found after stroke. The objective of the study was to synthesize evidence on the effects of TS in post-stroke patients, combined with physiotherapeutic interventions compared with no physiotherapeutic intervention, in improving gait and in reducing spasticity. Methods: Electronic databases PubMed, Embase, Scopus, and Cochrane were searched from 2011 until February 2021. Studies were included if they were randomized clinical trials, that combined TS with physiotherapeutic intervention and were of any nature; the studies included measures related to mobility and muscle tone of the lower limbs and those that approached adults, of legal age, affected by ischemic or hemorrhagic stroke, in the acute, subacute or chronic stage of the disease. We excluded studies that contemplated other neurological diseases; studies aiming only to evaluate efficacy between TS currents and those with samples under ten individuals. Risk of bias assessment of randomized clinical trials was based on the PEDro scale. The meta- analysis was performed according to the random effect model in the R software, comparing the differences between the pre- and post-test of each variable. Results: Five randomized controlled trials (pooled n=133) were included in the meta-analysis. The results of the 10-meters walk test (10MWT) and 6-minute walk test (6MWT) showed a small effect favoring the use of TS combined with physiotherapy in improving gait speed, while the timed up and go test (TUG) and the Functional Ambulation Category (FAC) showed a large effect. The 95% confidence interval (CI) was adopted. Conclusion: TS combined with physical therapy intervention seems to be a useful resource for improving gait performance in post-stroke patients. TS was shown not to be effective in reducing lower limb spasticity. This review is limited by the small number of articles identified in the literature.

Identifying best fall-related balance factors and robotic-assisted gait training attributes in 105 post-stroke patients using clinical machine learning models.

Despite the promising effects of robot-assisted gait training (RAGT) on balance and gait in post-stroke rehabilitation, the optimal predictors of fall-related balance and effective RAGT attributes remain unclear in post-stroke patients at a high risk of fall. We aimed to determine the most accurate clinical machine learning (ML) algorithm for predicting fall-related balance factors and identifying RAGT attributes. We applied five ML algorithms- logistic regression, random forest, decision tree, support vector machine (SVM), and extreme gradient boosting (XGboost)- to a dataset of 105 post-stroke patients undergoing RAGT. The variables included the Berg Balance Scale score, walking speed, steps, hip and knee active torques, functional ambulation categories, Fugl- Meyer assessment (FMA), the Korean version of the Modified Barthel Index, and fall history. The random forest algorithm excelled (receiver operating characteristic area under the curve; AUC = 0.91) in predicting balance improvement, outperforming the SVM (AUC = 0.76) and XGboost (AUC = 0.71). Key determinants identified were knee active torque, age, step count, number of RAGT sessions, FMA, and hip torque. The random forest algorithm was the best prediction model for identifying fall-related balance and RAGT determinants, highlighting the importance of key factors for successful RAGT outcome performance in fall-related balance improvement.

Effects of visual feedback balance system combined with weight loss training system on balance and walking ability in the early rehabilitation stage of stroke: a randomized controlled exploratory study.

Previous studies have suggested that the Pro-Kin visual feedback balance system can promote the recovery of balance function in stroke patients. However, this system has not been used effectively in the early stages of stroke rehabilitation. This study aimed to investigate the effect of Pro-Kin system combined with weight loss system for the early recovery of balance and walking ability following a stroke. A total of 62 patients who underwent radiological diagnosis of stroke were randomly divided into two groups: a control group (n = 31) and a treatment group (n = 31). Both groups received conventional balance training. The treatment group also received training on the Pro-Kin system in conjunction with a weight loss system. Balance was measured using the Berg Balance Scale (BBS), Timed 'Up & Go' (TUG) test and Pro-Kin system. Walking ability was assessed using the Functional Ambulation Classification (FAC). The tests were performed before the start of treatment and on the 4th week following the training. There was no statistically significant difference between the groups before training. After 4 weeks of training in both groups, there were significant improvements in balance and walking ability. BBS values and FAC were significantly higher (p < 0.01), TUG times, ellipse area and motion trajectory length were significantly reduced (p < 0.01, p < 0.05) after training. The treatment group outperformed the control group (p < 0.05). In addition, there was a positive correlation between balance function and walking ability (p < 0.01). The Pro-Kin system combined with weight loss system is a viable method that promotes early reconstruction of balance and walking ability following a stroke. Clinical trial number ChiCTR1900026370. https://www.chictr.org.cn/showprojEN.html?proj=43736.

Identification of the Types of Healthcare Services Available to Individuals in Various Communities in Abia State, Nigeria

Primary health care (PHC) is the backbone of a health system. It refers to “essential healthcare” that is based on scientifically sound and appropriate technology. PHC is the initial point of contact with the health care system for most Nigerians. This study assessed the available services within the PHCs in Abia State, Nigeria. The study employed a descriptive cross-sectional and observational survey designs to achieve the objectives. A semi-structured questionnaire which was self-administered was used to collect information from 486 healthcare providers in the selected PHCs across the zones. A validated checklist was used to determine the functionality of the PHCs. Data were cleaned, coded, and entered into SPSS, version 26, which was used for the analysis and categorical variables were summarized using frequencies and proportions. Association was tested at p-value &lt;0.05. Findings from the study showed that some healthcare facilities such as child survival strategy and sick child consultation were available and statistically significant, p-&lt;0.05. Some healthcare facilities such as intra- uterine device (IUD) insertion kit and toilet facilities were in use and statistically significant, p&lt;0.05. Several intervention services were available such as immunizations, dietary supplements, growth monitory, family planning services and control of communicable diseases (Malaria, TB, HIV/AIDS), p- &gt;0.05. Facilities such as light microscope and centrifuge were available but non-functional. Obstetric facilities were available but not in all the zones. However, there were no functional ambulance services in the PHCs studied.

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.

Comparison of biomechanical parameters in lower limb joints of stroke patients according to conventional evaluation scores during level walking.

Objective: Patients with chronic stroke capable of independent gait were classified into functional ambulation category (FAC) 4 or 5, and the kinetic and kinematic data on their lower limb joints on the affected and unaffected sides were compared with that of healthy individuals. Finally, the qualitative changes in the gait of patients with stroke were investigated based on the differences in FAC scores. Methods: Twelve healthy participants and 19 patients with stroke capable of independent gait were included. The three-dimensional (3D) motion analysis and conventional assessment were conducted for all patients with stroke. Results: The FAC 5 group exhibited a larger range of motion (ROM) than the FAC 4 group in knee and hip joints on the affected side and only in the hip on the unaffected side. In the FAC 5 group, ROM differences in the healthy group on either the affected or unaffected side were absent. The peak of the hip flexion moment on the affected side in both the FAC 4 and 5 groups was smaller than that in the healthy group and in the FAC 4 group on the unaffected side. The absorption power minimum on the affected side was smaller only in the FAC 4 group than that in the healthy group and was larger in the FAC 5 group than that in the FAC 4 group. On the unaffected side, the absorption power minimum was smaller only in the FAC 4 group than that in the healthy group. Conclusion: Functional differences in gait were found in patients classified based on conventional evaluation capable of independent gait after post-stroke rehabilitation. Patients may not exhibit complete recovery in the kinetic indices even if they are judged to be normal in the conventional evaluation, and the kinematic gait indices indicate recovery. Evaluating kinetic indices in addition to kinematic indices is necessary, and joint power may be an especially useful index.

Minimal important change in the Berg Balance Scale in older women with vertebral compression fractures: A retrospective multicenter study.

Vertebral compression fractures, which are commonly associated with older age and osteoporotic fractures, have an increased risk of re-fracture. Therefore, improving balance is important to prevent falls. The minimal important change (MIC) has been recommended for interpreting clinically meaningful changes in rating scales. The MIC of the Berg Balance Scale (BBS) for use in older women with vertebral compression fractures has not been established. To identify the MIC of the BBS that can be used in older women with vertebral compression fractures using predictive modeling methods and the receiver-operating characteristic (ROC)-based method. A retrospective longitudinal multicenter study. Sixty older women (mean age ± standard deviation: 84.1 ± 7.0 years) with vertebral compression fractures who were unable to ambulate independently on a level surface. A change of one point in the Functional Ambulation Category (FAC) was used as an anchor to calculate the MIC of the BBS based on the change between admission and discharge. We calculated the MIC for the women whose FAC score improved by ≥1 point. We used three anchor-based methods to examine the MIC: the ROC-based method (MICROC ), the predictive modeling method (MICpred ), and the MICpred -based method adjusted by the rate of improvement and reliability of transition (MICadj ). Thirty-nine women comprised the "important change" group based on their FAC score improvement. In this group, the MICROC (95% confidence interval [CI]) value of the BBS was 10.0 points (5.5-15.5), with an area under the curve of 0.71. The MICpred (95% CI) value was 9.7 (8.1-11.0), and the MICadj (95% CI) was 7.0 (5.5-8.5) points. For women with vertebral compression fractures who are unable to ambulate independently, a 7.0-point improvement in the BBS score may be a useful indicator for reducing the amount of assistance required for walking.

Motor function outcomes in children with open prenatal repair of Spina Bifida Aperta at 36-month follow-up: The Zurich cohort.

This study aimed to describe outcomes of motor function with a special focus on ambulation ability at 36 months among children with open prenatal repair of spina bifida aperta (SB). A prospective cohort study was conducted including 87 patients with open prenatal repair of SB at the investigating center born between 2010 and 2018. Anatomic lesion level and motor function level in the neonatal period, as well as motor function level, ambulation status, and use of orthotics and assistive devices at 36 months were assessed. At 36 months, ambulation was assessed in 86 children; of those, 86% (n = 74) were ambulating. Independent of ambulation, orthotics were worn in 81.6% (71/87) and assistive devices in 47.1% (41/87). Children with a lower lumbar or sacral motor function level were the first to reach independent ambulation and were more likely to ambulate at 36 months than children with higher motor function levels (p = < .001). The anatomic lesion level determined on the neonatal MRI correlated with ambulation status at 36 months (p = < 0.001). At 36 months, most children with open prenatal repair for SB showed favourable ambulation status. However, most still used assistive devices or orthotics. Anatomic lesion level on neonatal MRI, motor function level during the neonatal period, and motor function level at 36 months were associated with ambulation status at 36 months.

Retrospective case-control study to compare exoskeleton-assisted walking with standard care in subacute non-traumatic brain injury patients.

Advanced technologies are increasingly used to address impaired mobility after neurological insults, with growing evidence of their benefits for various populations. However, certain robotic devices have not been extensively investigated in specific conditions, limiting knowledge about optimal application for healthcare. To compare effectiveness of conventional gait training with exoskeleton-assisted walking for non-traumatic brain injury during early stage rehabilitation. Clinical evaluation data at admission and discharge were obtained in a retrospective case-control design. Patients received standard of care physical therapy either using Ekso GT or not. Within- or between-group statistical tests were performed to determine change over time and interventional differences. This study analyzed forty-nine individuals (33% female), 20 controls and 29 Ekso participants who were equivalent at baseline. Both groups improved in Functional Independence Measure scores and ambulation ability (p < .00001 and p < .001, respectively). Control subjects demonstrated significantly different distance walked and assistance level values at discharge from those who were treated with the exoskeleton (p < .01). Robotic locomotion is non-inferior for subacute functional recovery after non-traumatic brain injury. Conventional therapy produced larger gait performance gains during hospitalization. Further research is needed to understand specific factors influencing efficacy and the long-term implications after rehabilitation.

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 &amp; Yahr (H&amp;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&amp;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.

Becker Muscular Dystrophy: Could Altering the Natural History of Decline Help Tackle Unmet Medical Need?

This symposium was held as part of the 28th International Annual Congress of the World Muscle Society (WMS), held in Charleston, South Carolina, USA. Speakers reviewed the natural history of Becker muscular dystrophy (Becker), outlined the top line, 12-month data from the ARCH open label study of investigational agent EDG-5506, and aimed to put those results into clinical context. Becker is a serious rare disease with significant physical, emotional, financial, and social impact on the affected individuals and their caregivers. Once function begins to decline, males affected by the progressive X-linked genetic disorder continue to irreversibly lose muscle, ultimately leading to the loss of ambulatory and cardiopulmonary function. After discussing the aetiology of the condition, Erik Niks, Paediatric and Adult Neurologist, Leiden University Medical Center (LUMC), the Netherlands, presented the findings of natural history studies. They showed that while the age at which decline begins varies, once it does start, patients tend to experience a consistent decline in function equivalent to around 1.2–1.3 North Star Ambulatory Assessment (NSAA) points each year. This finding, combined with data on using MRI as a biomarker of disease progression, provides an evidence-based framework for clinical trial design, he argued. Sam Collins, Vice President of clinical development, Edgewise Therapeutics, Boulder, Colorado, USA, then presented topline 12-month data from the ARCH study. It found that EDG-5506 was well tolerated, and, importantly, recorded the stabilisation of functional assessments, including the NSAA, with a trend towards improvement, as well as rapid, sustained, and significant decreases in biomarkers of progression, including those related to muscle damage. Putting the ARCH study data into context, Barry Byrne, Director of the Health Center for Advanced Therapeutics and Powell Gene Therapy Center, University of Florida (UF), Gainesville, USA, explained exactly how declining NSAA status translated into life-altering function loss. Stabilising function, or even reducing the speed of decline, was an important goal for patients, he said, adding that meeting it could help to address significant unmet medical need.

Effects of Neuromuscular Electrical Stimulation on Spasticity and Walking Performance among Individuals with Chronic Stroke: A Pilot Randomized Clinical Trial.

Stroke and its associated complications are a major cause of long-term disability worldwide, with spasticity being a common and severe issue. Physical therapy, involving stretching exercises and electrical stimulation, is crucial for managing spasticity. Therefore, this study aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) combined with a conventional rehabilitation program (CRP) on plantarflexor muscle spasticity and walking performance among individuals with chronic stroke. A pilot randomized clinical trial (RCT) with two groups (active NMES and placebo) was conducted at the physical therapy departments of King Fahad Specialist Hospital, Buraydah, and Sultan Bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia (November 2020). The assessor and participants were blinded for the group assignment. The active NMES group received exercise and stimulation at the dorsiflexor muscles on the paretic leg for 30 min for 12 sessions. The placebo group received exercise and sham stimulation at the same position and duration as the active group. Of interest were the outcomes for plantarflexor muscle spasticity measured by the modified Ashworth scale (MAS), gait speed measured by 10 m walk test (10-MWT), and functional mobility measured by functional ambulatory category (FAC). Nineteen participants were randomized into active NMES (n = 10) and sham NMES (n = 9) groups, with no significant baseline differences. Within the active NMES group, significant improvements were observed in MAS (p = 0.008), 10-MWT (p = 0.028), and FAC (p = 0.046), while only 10-MWT time improved significantly in the sham NMES group (p = 0.011). Between-group analysis showed that only MAS was significantly lower in the active NMES group (p = 0.006). Percent change analysis indicated a significantly higher increase in percent change for MAS in the active NMES group compared to the sham NMES group (p = 0.035), with no significant differences in other outcome measures. This study showed that NMES in the active group led to significant improvements in spasticity, walking performance, and functional ambulation. Further research is needed to determine the ideal parameters, protocols, and patient selection criteria for NMES interventions in stroke rehabilitation.