Functional Mobility In Individuals Research Articles

Effects of Walkbot gait training on kinematics, kinetics, and clinical gait function in paraplegia and quadriplegia.

The robotic-assisted gait training (RAGT) system has gained recognition as an innovative, effective paradigm to improve functional ambulation and activities of daily living in spinal cord injury and stroke. However, the effects of the Walkbot robotic-assisted gait training system with a specialized hip-knee-ankle actuator have never been examined in the paraplegia and quadriplegia population. The aim of this study was to determine the long-term effects of Walkbot training on clinical for hips and knee stiffness in individuals with paraplegia or quadriplegia. Nine adults with subacute or chronic paraplegia resulting from spinal cord injury or quadriplegia resulting from cerebral vascular accident (CVA) and/or hypoxia underwent progressive conventional gait retraining combined with the Walkbot RAGT for 5 days/week over an average of 43 sessions for 8 weeks. Clinical outcomes were measured with the Functional Ambulation Category (FAC), Modified Rankin Scale (MRS), Korean version of the Modified Barthel Index (K-MBI), Modified Ashworth Scale (MAS). Kinetic and kinematic data were collected via a built-in Walkbot program. Wilcoxon signed-rank tests showed significant positive intervention effects on K-MBI, maximal hip flexion and extension, maximal knee flexion, active torque in the knee joint, resistive torque, and stiffness in the hip joint (P < 0.05). These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. These improvements were associated with functional recovery in gait, balance, mobility and daily activities. These findings suggest that the Walkbot RAGT was effective for improving knee and hip kinematics and the active knee joint moment while decreasing hip resistive force. This is the first clinical evidence for intensive, long-term effects of the Walkbot RAGT on active or resistive moments and stiffness associated with spasticity and functional mobility in individuals with subacute or chronic paraplegia or quadriplegia who had reached a plateau in motor recovery after conventional therapy.

Myelin status is associated with change in functional mobility following slope walking in people with multiple sclerosis.

BackgroundThe level of myelin disruption in multiple sclerosis patients may impact the capacity for training-induced neuroplasticity and the magnitude of therapeutic response to rehabilitation interventions. Downslope walking has been shown to increase functional mobility in individuals with multiple sclerosis, but it is unclear if myelin status influences therapeutic response.ObjectiveThe current study aimed to examine the relationship between baseline myelin status and change in functional mobility after a walking intervention.MethodsThe Timed Up and Go test was used to measure functional mobility before and after completion of a repeated, six-session slope walking intervention in 16 participants with relapsing–remitting multiple sclerosis. Multi-component T2 relaxation imaging was used to index myelin water fraction of overall water content in brain tissue compartments.ResultsResults demonstrated that the ratio of the myelin water fraction in lesion to normal-appearing white matter (myelin water fraction ratio) significantly predicted 31% of the variance in change in Timed Up and Go score after the downslope walking intervention, where less myelin disruption was associated with greater intervention response.ConclusionsMyelin water content fraction ratio may offer a neural biomarker of myelin to identify potential responders to interventions targeting functional impairments in multiple sclerosis.

Pre- and unplanned walking turns in Parkinson’s disease – Effects of dopaminergic medication

Although dopaminergic medication improves functional mobility in individuals with Parkinson’s disease (PD), its effects on walking turns are uncertain. Our goals was to determine whether dopaminergic medication improves preplanned and unplanned walking turns in individuals with PD, compared to healthy controls. Nineteen older adults with mild-to-moderate PD and 17 healthy controls performed one of the following three tasks, presented randomly: walking straight, or walking and turning 180° to the right or left. The walking direction was visually cued before starting to walk (preplanned) or after (unplanned, i.e., 0.6m before reaching the turning point). Subjects with PD were assessed off dopaminergic medication (OFF) and on dopaminergic medication (ON) medication. Turning strategy (step and spin turns), turning performance (turning distance and body rotation) and walking pattern were analyzed for three turning steps. Irrespective of medication state and turning condition, step and spin turns followed a nearly 50:50 distribution. After intake of dopaminergic medication, subjects with PD increased their turning distance but not the amount of body rotation or their walking pattern. Compared to controls, turning impairments in subjects with PD remained while ON medication and problems regulating step width were the most prominent features of their walking pattern. Specifically, subjects with PD turned with narrower cross-over steps, i.e. when the external foot crossed over the line of progression of the internal leg. We conclude that turning impairments remained even after dopaminergic medication and problems modulating step width appears to be a critical feature for turning in PD.

Can transcranial direct current stimulation on the dorsolateral prefrontal cortex improves balance and functional mobility in Parkinson’s disease?

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique increasingly explored for Parkinson’s disease (PD). Although evidence is still inconsistent, there are preliminary findings suggesting its efficacy to improve motor function in individuals with PD, as the role of secondary motor areas remains unclear. The goal of this study was to investigate the effects of left dorsolateral prefrontal cortex (DLPFC) tDCS on balance and functional mobility of individuals with PD. Seventeen individuals with PD, on-medication, aged between 40 and 90 years were recruited to enroll in a double-blind, randomized, cross-over trial. Each participant completed two conditions at least 48h apart, namely anodal-tDCS and sham-tDCS (placebo). The a-tDCS condition targeted the left DLPC (F3) and was applied during 20min using a 2mA current intensity. In the sham-tDCS condition, electrode position remained the same but the stimulator was turned off after 30s. Functional mobility and balance were assessed using the Berg Balance Scale, Dynamic Gait Index and Timed Up and Go. There were significant differences between conditions on all outcome measures, as the a-tDCS condition was associated with better performance in comparison to the sham condition (p<0.05). Our findings suggest that a-tDCS on the left DLPFC improves balance and functional mobility in comparison to sham-tDCS. Compensatory mechanisms that support motor function in individuals with PD may have been enhanced by a-tDCS on the DLPFC, leading to improved functional mobility and balance. Future trials should explore left DLPFC stimulation with larger samples and compare t-DCS protocols targeting several brain regions.

Association Between Montreal Cognitive Assessment Scores and Measures of Functional Mobility in Lower Extremity Amputees After Inpatient Rehabilitation

ObjectiveTo determine whether scores on a cognitive measure are associated with walking endurance and functional mobility of individuals with transfemoral or transtibial amputations at discharge from inpatient prosthetic rehabilitation. DesignRetrospective cohort study. SettingRehabilitation hospital. ParticipantsConsecutive admissions (N=176; mean age ± SD, 64.27±13.23y) with transfemoral or transtibial amputation that had data at admission and discharge from an inpatient prosthetic rehabilitation program. InterventionsNot applicable. Main Outcome MeasuresCognitive status was assessed using the Montreal Cognitive Assessment (MoCA). The L Test and the 2-minute walk test (2MWT) were used to estimate functional mobility and walking endurance. ResultsThe mean ± SD MoCA score was 24.05±4.09 (range, 6–30), and 56.3% of patients had scores <26. MoCA scores had a small positive correlation with the 2MWT (r=.29, P<.01), and a small negative correlation to the L Test (r=−.24, P<.01). In multivariable linear regression, compared with people with the highest MoCA score quartile, there was no difference on the 2MWT, but people in the lowest 2 quartiles took longer to complete the L Test. ConclusionsCognitive impairment was very prevalent. The association between MoCA and functional mobility was statistically significant. These results highlight the potential for differences on complex motor tasks for individuals with cognitive impairment but does not indicate a need to exclude them from rehabilitation on the basis of cognitive impairment alone.

Exercise and Myasthenia Gravis: A Review of the Literature to Promote Safety, Engagement and Functioning

Currently no exercise protocol exists to inform healthcare practitioners how to advise individuals with myasthenia gravis how to begin exercise after stabilization of symptoms, which exercises are most beneficial for improving functioning, or detailing how to progress difficulty of the exercises as improvements in physiological functioning are made. However, with improved strength and endurance, individuals with myasthenia gravis will have a more meaningful life and the ability to engage in activities that are important to them. This literature review demonstrates that with skilled supervision by a rehabilitation professional, exercise is safe for those with mild myasthenia gravis and that strength gains and improvements in physiological functioning are possible. This research supports that exercise may decrease fatigue, increase strength, and improve functional mobility in individuals with myasthenia gravis. Additional rehabilitation research needs to be conducted on the physiological effects of exercise on individuals with myasthenia gravis and which exercises have the most significant impact on function and levels of fatigue.

Dopamine-independent effects of combining transcranial direct current stimulation with cued gait training on cortical excitability and functional mobility in Parkinson's disease.

To investigate the dopamine-dependent effect of combining transcranial direct current stimulation (tDCS) with visually cued gait training on cortical excitability and functional mobility in individuals with Parkinson's disease. A pilot, randomized, double-blind, controlled trial. Twenty-two patients with Parkinson's disease were randomly assigned to 2 groups: (i) active anodal tDCS over the supplementary motor area (experimental group), or (ii) sham tDCS (control group). After tDCS, both groups participated in a visually cued gait training. Functional mobility was evaluated with the Timed Up and Go test (TUG). Cortical excitability was assessed by active motor threshold and motor-evoked potential amplitudes elicited by transcranial magnetic stimulation in patients in on and off medication states. In the TUG test both groups achieved improvements either in on or off medication condition compared with baseline. However, for both medication conditions, these gains were maintained only in the experimental group during 1-month follow-up, compared with baseline. In the experimental group, enhancement of cortical excitability was observed at post-intervention and 1-month follow-up (both only for the "on" phase) compared with baseline. These findings suggest that tDCS, independent of dopaminergic medication state, might prolong the positive effect induced by cued gait training on functional mobility.

Context-Dependency of Mobility in Children and Adolescents With Cerebral Palsy: Optimal and Natural Environments

According to the International Classification of Functioning, Disability and Health (ICF), the mobility of individuals with spastic cerebral palsy (SCP) is influenced by the interaction between their health and the personal and environmental contexts in which they conduct their lives. In accord with the ICF, this observational study aimed to analyze and compare the functional mobility of children and adolescents with SCP in both natural environments (places typically encountered in their daily routine) and optimized environments (flat surfaces). The observed effects of the environment suggest that the functional mobility of individuals with cerebral palsy depends on the environmental context. The characteristics of the natural and optimized environments may act as barriers and/or facilitators to covering short and long distances among individuals of different ages with cerebral palsy.

Impact of Caryolanemagnolol on Gait and Functional Mobility on Individuals with Huntington’s Disease

Purpose: To highlight the impact of caryolanemagnolol on gait measures in forward walking, balance and mobility measures, as well as in hand and forearm function measures.Methods: Twenty patients with Huntington’s disease (HD) on stable doses of caryolanemagnolol were evaluated after medication and again following resumption of medication. The improvement in spatiotemporal gait parameters was measured by GAITRite, balance and/or mobility using Tinetti mobility test (TMT), five times sit-to-stand test (5TSST), and six-condition Romberg tests, as well as the function of the hand and forearm by finger tapping and Luria tests on Huntington's disease rating scale (UHDRS) motor scale.Results: The results demonstrated significant improvement in the unified UHDRS motor scores, Tinetti mobility test (TMT) total and balance subscale scores, and the five times sit-to-stand test when oncaryolanemagnolol compared to off-caryolanemagnolol. Spatiotemporal gait measures, the six condition Romberg test, and UHDRS hand and forearm function items remained unaffected on caryolanemagnolol treatment. Improved TMT and 5TSST performance when on drug indicates that caryolanemagnolol use may improve balance and functional mobility in individuals with HD.Conclusions: Caryolanemagnolol improves chorea and functional mobility by improving dynamic balance in individuals without any negative impact on motor function in walking and transfers.Keywords: Huntington's disease, Caryolanemagnolol, Gait measures, Choreic movements, Mobility tests

Impact of tetrabenazine on gait and functional mobility in individuals with Huntington's disease

Chorea may contribute to balance problems and walking difficulties that lead to higher fall rates in individuals with Huntington's disease (HD). Few studies have examined the effects of tetrabenazine (TBZ), an anti-choreic drug, on function and mobility in HD. The purpose of this study was to compare: 1) gait measures in forward walking, 2) balance and mobility measures, and 3) hand and forearm function measures on and off TBZ. We hypothesized that use of TBZ would improve gait, transfers and hand and forearm function. Eleven individuals with HD on stable doses of TBZ were evaluated while off medication and again following resumption of medication. Significant improvements were found on the Unified Huntington's Disease Rating Scale (UHDRS) motor scores, Tinetti Mobility Test (TMT) total (t=4.20, p=0.002) and balance subscale (t=−4.61, p=0.001) scores, and the Five Times Sit-to-Stand test (5TSST, t=3.20, p=.009) when on-TBZ compared to off-TBZ. Spatiotemporal gait measures, the Six Condition Romberg test, and UHDRS hand and forearm function items were not changed by TBZ use. Improved TMT and 5TSST performance when on drug indicates that TBZ use may improve balance and functional mobility in individuals with HD.

Effects of Functional Electrical Stimulation (FES) on Motor Functions and Functional Mobility in Hemiparetic Individuals

This study was designed to observe the effects of functional electrical stimulation on the promotion of motor function and functional mobility in individuals with hemiparesis who have regained walking ability, yet demonstrate ankle and knee dysfunction. We hypothesised that single channel FES would augment the motor function and functional mobility beyond the benefits of conservative management.

Neuroanatomical Predictors for Dysphagia Severity After First-Ever Acute Ischemic Stroke

Objective: This study was designed to observe the effects of functional electrical stimulation on the promotion of motor function and functional mobility in individuals with hemiparesis who have regained walking ability, yet demonstrate ankle and knee dysfunction. We hypothesised that single channel FES would augment the motor function and functional mobility beyond the benefits of conservative management. Design: Quasi experimental study Design Setting: Vidyasagar Institute of Mental Health, Neuro and Allied Sciences (VIMHANS), New Delhi, India. Participants: 28 right-handed subjects with hemiplegia were included in the study Interventions: All the participants who fulfilled the inclusion criteria were included in the study and divided into two respective groups (13 in experimental and 15 in control). Both the groups received conservative physiotherapy treatment in the form of exercises for 45 minutes for 3 weeks (5 days/week). However, the participants in experimental group underwent additionally for FES therapy for 30 minutes. Main Outcome Measure(s): Participants were assessed on ten meter walking test (10MWT), dynamic gait index (DGI), and composite spasticity index (CSI), pre and post 3 weeks of functional electrical stimulation (FES) therapy. Results: The group with FES therapy resulted in better improvement on 10MWT, DGI and CSI, when compared with the control group who were treated conservatively. Conclusions: This study provides an evidence to support the use of functional electrical stimulation on hemiparetic individuals as an adjunct with other rehabilitation program.

Normative values for the Timed ‘Up and Go’ test in children and adolescents and validation for individuals with Down syndrome

To determine normative values for the Timed Up and Go (TUG) test in typically developing children and adolescents and to validate its use in individuals with Down syndrome. Participants in this cross-sectional study were South Brazilian schoolchildren aged 3 to 18 years. In phase 1, 459 typically developing individuals (227 males, 232 females; mean age 10 y 8 mo (SD 4 y 4 mo) were included; and in phase 2, 40 individuals with Down syndrome (16 males, 24 females; mean age 10 y 6 mo (SD 4 y 4 mo). Anthropometric measurements, real leg length, TUG test scores, and Gross Motor Function Measure (GMFM) scores were evaluated. The association between the TUG test and possible predictive variables was analyzed. In phase 1, the mean time to perform the TUG test was 5.61 seconds (SD 1.06). Values were stratified in age groups that served as normative data for both sexes. A multiple linear regression analysis was conducted and the best variables to predict TUG scores were age and weight. The best model obtained presented an R(2) of 0.25 and a standard error of the estimate of 0.92. Excellent intrasession reliability in the three tests performed (intraclass correlation coefficient [ICC] of 0.93, 0.94, and 0.95) and between the sessions (both with an ICC of 0.95) was demonstrated. In phase 2, the test also showed excellent reproducibility (ICC=0.82 between the two tests performed). The performance time was significantly longer (p<0.001) in individuals with Down syndrome compared with sex- age-, and weight-matched typically developing children with a mean difference of -3.53 (95% confidence interval -4.05 to -3.00). Dimension E of the GMFM (Walking, Running and Jumping) showed the highest correlation (r=-0.55, p<0.001) with the test. This study provides normative values for the TUG test and shows that TUG scores can be predicted as a function of age and weight in typically developing individuals. The test can also be used for assessment of functional mobility in individuals with Down syndrome.

Differential Effects of Cardiovascular and Resistance Exercise on Functional Mobility in Individuals With Advanced Cancer: A Randomized Trial

ObjectiveTo compare the effects of resistance and cardiovascular exercise on functional mobility in individuals with advanced cancer. DesignProspective, 2-group pretest-posttest pilot study with randomization to either resistance or cardiovascular exercise mode. SettingComprehensive community cancer center and a hospital-based fitness facility. ParticipantsVolunteer sample of individuals (N=66; 30 men; 36 women; mean age, 62y) with advanced cancer recruited through the cancer center, palliative care service, rehabilitation department, and a local hospice. InterventionsTen weeks of individualized resistance or cardiovascular exercise, prescribed and monitored by oncology-trained exercise personnel. Main Outcome MeasuresFunctional mobility was assessed using the Short Physical Performance Battery (SPPB); self-reported pain and fatigue were assessed secondarily using visual analog scales. Data were analyzed using a split plot 2×2 analysis of variance (α=.05). ResultsFifty-two patients (78.8%) completed the study: 23 (67.7%) of 34 patients in the resistance arm and 29 (90.6%) of 32 patients in the cardiovascular arm. No participant withdrew because of study adverse events. Ten-week outcomes (n=52) included a significant increase in SPPB total score (P<.001), increase in gait speed (P=.001), and reduction in fatigue (P=.05). Although cardiovascular exercise participants had a modestly greater improvement in SPPB total score than resistance training participants (F1,49=4.21, P=.045), the difference was not confirmed in a subsequent intention-to-treat analysis (N=66). ConclusionsIndividuals with advanced cancer appear to benefit from exercise for improving functional mobility. Neither resistance nor cardiovascular exercise appeared to have a strong differential effect on outcome.

Effects of whole body vibration on strength and functional mobility in multiple sclerosis

The aim of this study was to examine the effectiveness of regular whole body vibration (WBV) training on lower limb muscle strength and functional mobility in individuals with multiple sclerosis. A single subject experimental design was replicated on three subjects. Phases included a 4-week baseline phase without intervention, 6 weeks of twice weekly WBV intervention on a VibroGym apparatus, and a 4-week baseline phase without intervention. During all phases, strength of the ankle plantarflexors and knee extensors was assessed twice weekly with the Nicholas Manual Muscle tester and functional mobility with the Timed Up and Go test. All subjects improved significantly in plantarflexor strength (p<0.05). One subject improved significantly in knee extensor strength bilaterally and one subject in the weaker leg. Two subjects improved significantly in functional mobility. These improvements in strength and mobility were maintained in the final baseline phase. In conclusion, regular WBV training can improve lower limb strength and mobility in some individuals with multiple sclerosis. Individuals who do not perform any other exercise, are in a moderate stage of disease progression, and have a more intensive exercise protocol in conjunction with WBV seem to benefit most. However, further high-quality studies are needed.

O038 Biomechanical differences in transtibial amputee fallers vs. non-fallers during level walking

To determine whether scores on a cognitive measure are associated with walking endurance and functional mobility of individuals with transfemoral or transtibial amputations at discharge from inpatient prosthetic rehabilitation.Retrospective cohort study.Rehabilitation hospital.Consecutive admissions (N=176; mean age ± SD, 64.27±13.23y) with transfemoral or transtibial amputation that had data at admission and discharge from an inpatient prosthetic rehabilitation program.Not applicable.Cognitive status was assessed using the Montreal Cognitive Assessment (MoCA). The L Test and the 2-minute walk test (2MWT) were used to estimate functional mobility and walking endurance.The mean ± SD MoCA score was 24.05±4.09 (range, 6–30), and 56.3% of patients had scores <26. MoCA scores had a small positive correlation with the 2MWT (r=.29, P<.01), and a small negative correlation to the L Test (r=−.24, P<.01). In multivariable linear regression, compared with people with the highest MoCA score quartile, there was no difference on the 2MWT, but people in the lowest 2 quartiles took longer to complete the L Test.Cognitive impairment was very prevalent. The association between MoCA and functional mobility was statistically significant. These results highlight the potential for differences on complex motor tasks for individuals with cognitive impairment but does not indicate a need to exclude them from rehabilitation on the basis of cognitive impairment alone.