Walking Function Research Articles

Evaluating the implementation of personalised outcomes forecasts to optimise supervised exercise therapy in patients with intermittent claudication in the Netherlands: a multimethods study

BackgroundTo support the optimisation of supervised exercise therapy (SET) in patients with intermittent claudication, we developed personalised outcomes forecasts (POFs), which visualise estimated walking distance and quality of life for...

Noninvasive Neuromodulation Combined With Rehabilitation Therapy Improves Balance and Gait Speed in Patients With Stroke: A Systematic Review and Network Meta-analysis.

This study aimed to determine repetitive transcranial magnetic stimulation, transcranial direct current stimulation, and cranial nerve noninvasive neuromodulation affect functional balance, gait speed, and walking cadence in stroke patients. We searched PubMed, Embase, Cochrane, and Scopus (June 22, 2022) for randomized controlled trials. Three reviewers independently performed data extraction and assessed the risk of bias. Network and pairwise meta-analyses were performed to assess indirect and direct comparisons. We included 34 studies ( N = 915 patients). Sixty percent had moderate-to-high methodological quality. The meta-analyses showed positive effects of repetitive transcranial magnetic stimulation combined with rehabilitation therapy compared with sham on gait speed, walking cadence, and balance function with weighted mean differences and 95% confidence interval of 0.08 (0.03 to 0.13), 7.16 (3.217 to 11.103), and 3.05 (0.52 to 5.57), respectively. Transcranial direct current stimulation showed improvement on the time up and go test (-0.88 [-1.68 to -0.08]). From the surface under the cumulative ranking analyses, repetitive transcranial magnetic stimulation is the best ranked treatment for gait speed and functional balance improvement compared with transcranial direct current stimulation and sham interventions. There were not enough studies to include cranial nerve noninvasive neuromodulation in the meta-analysis. Walking cadence and speed, functional balance significantly improved after repetitive transcranial magnetic stimulation with short-term effects, which were superior to that of transcranial direct current stimulation and sham treatments. Transcranial direct current stimulation showed short-term beneficial effects on the Time Up and Go test.

Standard Versus Intensive Blood Pressure Control in Acute Ischemic Stroke Patients Successfully Treated With Endovascular Thrombectomy: A Systemic Review and Meta-Analysis of Randomized Controlled Trials.

The optimal blood pressure (BP) control after successful endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) with large vessel occlusion (LVO) remains debatable. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluate the efficacy and safety of standard BP control (with systolic BP ≤180 mm Hg) versus intensive BP control (systolic BP <140 mm Hg) during the 24 hours after successful EVT in AIS with LVO. PubMed, Scopus, the Cochrane Central Register of Controlled Trials, and Embase were searched to identify relevant trials. The crude odds ratio (OR) and 95% confidence interval (CI) were calculated and estimates using random-effects models were pooled. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO ID: CRD42023450673). Four RCTs involving 1,559 participants were included. Regarding efficacy outcomes, intensive BP control was associated with a lower likelihood of functional independence (OR: 0.68; 95% CI: 0.51-0.91 for modified Rankin Scale [mRS] ≤2) and walking without assistance (OR: 0.65; 95% CI: 0.53-0.81 for mRS ≤3). For safety outcomes, consistent with the efficacy findings, intensive BP control was significantly associated with severe disability or death (mRS 5 or 6) (OR: 1.34; 95% CI: 1.07-1.69). However, there were no significant differences including all-cause mortality, any intracerebral hemorrhage (ICH), symptomatic ICH, parenchymal hematoma type 2, and stroke recurrence. While all four RCTs were conducted to demonstrate the superiority of intensive BP control over standard BP control, standard BP control may be beneficial for the outcome after EVT for AIS with LVO without increasing adverse safety outcomes. Caution should be needed with the application of intensive BP control during the 24 hours following successful recanalization after EVT.

A Portable, Neurostimulation-Integrated, Force Measurement Platform for the Clinical Assessment of Plantarflexor Central Drive.

Plantarflexor central drive is a promising biomarker of neuromotor impairment; however, routine clinical assessment is hindered by the unavailability of force measurement systems with integrated neurostimulation capabilities. In this study, we evaluate the accuracy of a portable, neurostimulation-integrated, plantarflexor force measurement system we developed to facilitate the assessment of plantarflexor neuromotor function in clinical settings. Two experiments were conducted with the Central Drive System (CEDRS). To evaluate accuracy, experiment #1 included 16 neurotypical adults and used intra-class correlation (ICC2,1) to test agreement of plantarflexor strength capacity measured with CEDRS versus a stationary dynamometer. To evaluate validity, experiment #2 added 26 individuals with post-stroke hemiparesis and used one-way ANOVAs to test for between-limb differences in CEDRS' measurements of plantarflexor neuromotor function, comparing neurotypical, non-paretic, and paretic limb measurements. The association between paretic plantarflexor neuromotor function and walking function outcomes derived from the six-minute walk test (6MWT) were also evaluated. CEDRS' measurements of plantarflexor neuromotor function showed high agreement with measurements made by the stationary dynamometer (ICC = 0.83, p < 0.001). CEDRS' measurements also showed the expected between-limb differences (p's < 0.001) in maximum voluntary strength (Neurotypical: 76.21 ± 13.84 ft-lbs., Non-paretic: 56.93 ± 17.75 ft-lbs., and Paretic: 31.51 ± 14.08 ft-lbs.), strength capacity (Neurotypical: 76.47 ± 13.59 ft-lbs., Non-paretic: 64.08 ± 14.50 ft-lbs., and Paretic: 44.55 ± 14.23 ft-lbs.), and central drive (Neurotypical: 88.73 ± 1.71%, Non-paretic: 73.66% ± 17.74%, and Paretic: 52.04% ± 20.22%). CEDRS-measured plantarflexor central drive was moderately correlated with 6MWT total distance (r = 0.69, p < 0.001) and distance-induced changes in speed (r = 0.61, p = 0.002). CEDRS is a clinician-operated, portable, neurostimulation-integrated force measurement platform that produces accurate measurements of plantarflexor neuromotor function that are associated with post-stroke walking ability.

Chronic Spinal Cord Injury Regeneration with Combined Therapy Comprising Neural Stem/Progenitor Cell Transplantation, Rehabilitation, and Semaphorin 3A Inhibitor.

Spinal cord injury (SCI) often results in various long-term sequelae, and chronically injured spinal cords exhibit a refractory feature, showing a limited response to cell transplantation therapies. To our knowledge, no preclinical studies have reported a treatment approach with results surpassing those of treatment comprising rehabilitation alone. In this study of rats with SCI, we propose a novel combined therapy involving a semaphorin 3A inhibitor (Sema3Ai), which enhances axonal regeneration, as the third treatment element in combination with neural stem/progenitor cell transplantation and rehabilitation. This comprehensive therapeutic strategy achieved significant improvements in host-derived neuronal and oligodendrocyte differentiation at the SCI epicenter and promoted axonal regeneration even in the chronically injured spinal cord. The elongated axons established functional electrical connections, contributing to significant enhancements in locomotor mobility when compared with animals treated with transplantation and rehabilitation. As a result, our combined transplantation, Sema3Ai, and rehabilitation treatment have the potential to serve as a critical step forward for chronic SCI patients, improving their ability to regain motor function.

One-Leg Robotic-Assisted Gait Training Efficiently Improves Gait Independence for Acute Stroke Hemiplegic Patients: A Prospective Pilot Study.

Welwalk is a one-leg robotic-assisted gait system for stroke hemiplegic patients. This study examined the feasibility and efficacy of gait training using Welwalk (Welwalk training) for hemiplegic patients in the early phase after stroke onset, via cooperation between acute care and rehabilitation hospitals. Seven acute stroke patients (mean number of days from onset = 7.9) with severe lower extremity paralysis participated. Patients underwent Welwalk training for 40 min/d, 5 d/wk in an acute care hospital, then 7 d/wk in a rehabilitation hospital with a seamless transition. Functional Independence Measure scores for walking were assessed weekly. The endpoint was reaching Functional Independence Measure walk score of 5 (supervision level). The primary outcome was improvement efficiency of Functional Independence Measure walk, which was the increase in Functional Independence Measure walk score divided by the number of weeks required. Functional Independence Measure walk score for all patients improved from 1.1 to 5 ( P = 0.01, r = 0.96). The mean number of weeks to achieve Functional Independence Measure walk score of 5 was 5 wks, and the improvement efficiency of Functional Independence Measure walk had a mean value of 0.9. No adverse events were reported during Welwalk training. Hemiparetic patients' gait independence may be safely and rapidly improved by starting Welwalk training in the early phase after stroke onset.

Walking and physical performance in black and white adults with multiple sclerosis controlling for social determinants of health

BackgroundThere is evidence for reduced walking and physical performance in persons with multiple sclerosis (MS) compared with healthy controls (HCs). There is further evidence suggesting increased overall mobility disability in Black persons with MS compared with White counterparts, yet little is known about the interplay of social determinants of health (SDOH) when considering differences in walking and physical performance. PurposeThis cross-sectional, comparative study examined differences in walking and physical performance in Black and White persons with MS and HCs (MS Status), statistically controlling for SDOH. MethodsThe study sample consisted of 208 persons with MS (141 White participants and 67 Black participants) and 95 HCs (59 White participants and 36 Black participants). Walking and physical function were measured using timed 25-foot walk (T25FW), six-minute walk (6MW), timed-up-and-go (TUG), and short physical performance battery (SPPB). We examined the differences in the walking and physical functions as a function of MS Status (MS vs. HCs) and Race (Black vs. White) using Multivariate Analysis of Covariance, controlling for age, sex, marital status and SDOH (i.e., education, employment, income). ResultsThere were no significant interactions between MS Status and Race on the outcomes, and the main effects of MS Status and Race remained statistically significant, controlling for SDOH and covariates. The main effects indicated significant lower T25FW (F = 34.6, p < .001, Ƞp2 = 0.11), 6MW (F = 58.5, p < .001, Ƞp2 = 0.18), TUG (F = 22.1, p < .001, Ƞp2 = 0.08), and SPPB (F = 25.2, p < .001, Ƞp2 = 0.09) performance for MS than HCs, and lower T25FW (F = 15.5, p < .001, Ƞp2 = 0.05), 6MW (F = 11.6, p < .001, Ƞp2 = 0.04), and TUG (F = 4.1, p < .05, Ƞp2 = 0.02) performance in Black than White samples. ConclusionsWe conclude that MS Status and Race independently influence walking and physical performance even after accounting for SDOH, and Black persons with MS have compromised walking and physical performance, perhaps necessitating focal rehabilitation.

Relationship between sensory processing patterns and gross motor function of children and adolescents with Down syndrome and typical development: a cross-sectional study.

Children and adolescents with Down syndrome (DS) may experience impairments in sensory and motor skills that can be interrelated. The purposes of this study were (i) to compare the sensory processing patterns and gross motor function between children and adolescents with DS and with typical development (TD) and (ii) to explore associations between these areas in both DS and TD groups. This cross-sectional study involved a sample size of 25 participants with DS (mean age 10.24±2.04years) and 25 participants with TD (mean age 10.04±2.82years). The sensory processing patterns were assessed using the Sensory Profile Second Version questionnaire, and the gross motor function was measured with the Gross Motor Function Measure (GMFM-88) dimensions (D) standing, and (E) walking, running, and jumping. Differences between groups were tested using the Mann-Whitney test, and the relationship between the variables was examined using Spearman's correlation tests, with a significance level set at 5%. Children with DS showed greater difficulties with sensory processing than TD children in Seeker (P<0.001), Avoider (P<0.001), Sensitivity (P<0.001), Registration (P<0.001), Auditory (P<0.001), Touch (P=0.001), Movements (P=0.001), Oral (P=0.028), Conduct (P=0.005), Socioemotional (P<0.001), and Attentional (P<0.001) domains. Additionally, children with DS presented lower gross motor function than TD in GMFM-88, standing (P<0.001) and walking, running, and jumping (P<0.001). Correlations were found between greater difficulties with sensory processing in Touch and lower gross motor function in walking, running, and jumping for the DS group. Our results suggest there are more difficulties in sensory processing patterns and gross motor function in children with DS than in TD. Also, there is a single association between more difficulties in sensory processing and less well-developed motor function in the DS group. Therefore, a comprehensive assessment of all these aspects should be performed in children and adolescents with DS, along with the provision of relevant interventions addressing specific needs.

Perception of tourists and residents on the pedestrian environment of heritage cities

In China, most heritage sites are car-free destinations due to narrow roads, a result of government policy. This study examines the relationship between environmental factors and pedestrian perceptions in Gulangyu, China, among both residents and tourists. It analyses how different groups perceive the environment while walking, aiming to create a more functional walking environment that balances the needs of both groups. The study employed a quantitative approach, specifically logistic regression analysis, to examine the relationship between environmental factors and pedestrian perceptions. Statistical software, SPSS, was utilized for data analysis. The results of logistic regression analysis indicate that resident&amp;rsquo;s perceptions are significantly influenced by comfort level, lighting, building maintenance, commercial attractiveness, and historic buildings. For tourists, the four factors significantly impacting the walking experience are road cleanliness, the indicating system, building facades along the street, and walking pleasure. The study reveals that the walking perceptions of residents and tourists suggest diverse concerns and experiences of the environment due to the different purposes of walking for each group.

Beyond pediatrics: noninvasive spinal neuromodulation improves motor function in an adult with cerebral palsy.

Regaining motor function in individuals with cerebral palsy (CP) has been predominantly studied in children, resulting in an underrepresentation of adults in research efforts. We tested the efficacy of noninvasive spinal neuromodulation with neurorehabilitation (Spinal Cord Innovation in Pediatrics; SCiP™ therapy). A 60-year-old CP participant underwent 8 weeks of SCiP™ therapy, resulting in significant motor recovery measured by 14.2-points increase in gross motor function measure (GMFM-88) score, ~ three times the Minimal Clinically Important Difference (MCID) of 5-points. This represented gains in kneeling, sitting, and walking functions. The improvement in GMFM-88 score was maintained above the MCID at the follow up visit (10.3 points above the baseline), twenty weeks following the last therapy session, indicating a persistent effect of the therapy. Our preliminary findings support the therapeutic promise of SCiP™ therapy for enhancing motor function in CP adults. Broader investigations are needed to establish its wider applicability.

Dynamics of motor and functional disorders in the early recovery period after ischemic stroke

To study the dynamics and degrees of motor and functional disorders in patients with hemiparesis during the first 6 months after ischemic stroke under the impact of medical rehabilitation, including kinesiotherapy, physiotherapy and transcranial magnetic stimulation. Motor disorders and functional limitations were assessed using validated scales (Fugl-Meyer, Medical Research Committee Scale, Modified Ashworth Scale of muscle spasticity, Modified Frenchay scale, Wolf Motor Function Test, Action Research Arm Test, Rivermead mobility index, Hauser ambulation index, Functional Independence Measurement). Diagnostic and therapeutic transcranial magnetic stimulation was performed using the «Neuro-MS/D» magnetic stimulator. The dynamics of types and degrees of motor and functional disorders were evaluated in 113 patients with hemiparesis in the first 6 months after ischemic stroke. Severe disorders of the tone and strength characteristics of paretic muscles and limitation of movement in the joints of paretic extremities have been found in 2/3 of patients. The balance function (it is difficult to maintain a vertical position of the body) was impaired in 1/2 of patients. The correlations of electrophysiological indicators (diagnostic transcranial magnetic stimulation and surface electromyography) with clinical ones (degree of paresis, tone of paretic muscles, motor abilities and motor skills of the paretic hand, independence in daily living) have been determined. Positive impact of medical rehabilitation, including kinesiotherapy, physiotherapy and transcranial magnetic stimulation, on the strength of paretic muscles of the hand and leg, mobility of patients, walking function, activity of the paretic hand (transfer by the hands, manipulation of extremities' segments and objects) has been revealed. Electrophysiological investigation has shown that the functional activity of the paretic muscles increased. Severe motor and functional disorders, most pronounced in distal segments of the extremities (lack of movements in 14-26% of cases), are prevalent in the first six months after ischemic stroke in the carotid system. The regression of motor disorders leads to an enhancement of functional abilities (use of the paretic extremities for the realization of various motor actions) under the impact of rehabilitation.

Fix or Replace? Patient Preferences for the Treatment of Geriatric Lower Extremity Fractures: A Discrete Choice Experiment.

When considering treatment options for geriatric patients with lower extremity fractures, little is known about which outcomes are prioritized by patients. This study aimed to determine the patient preferences for outcomes after a geriatric lower extremity fracture. We administered a discrete choice experiment survey to 150 patients who were at least 60years of age and treated for a lower extremity fracture at a Level I trauma center. The discrete choice experiment presented study participants with 8 sets of hypothetical outcome comparisons, including joint preservation (yes or no), risk of reoperation at 6 months and 24months, postoperative weightbearing status, disposition, and function as measured by return to baseline walking distance. We estimated the relative importance of these potential outcomes using multinomial logit modeling. The strongest patient preference was for maintained function after treatment (59%, P < .001), followed by reoperation within 6months (12%, P < .001). Although patients generally favored joint preservation, patients were willing to change their preference in favor of joint replacement if it increased function (walking distance) by 13% (SE, 66%). Reducing the short-term reoperation risk (12%, P < .001) was more important to patients than reducing long-term reoperation risk (4%, P = .33). Disposition and weightbearing status were lesser priorities to patients (9%, P < .001 and 7%, P < .001, respectively). After a lower extremity fracture, geriatric patients prioritized maintained walking function. Avoiding short-term reoperation was more important than avoiding long-term reoperation. Joint preservation through fracture fixation was the preferred treatment of geriatric patients unless arthroplasty or arthrodesis provides a meaningful functional benefit. Hospital disposition and postoperative weightbearing status were less important to patients than the other included outcomes. Geriatric patients strongly prioritize function over other outcomes after a lower extremity fracture.

Feasibility of a self-management intervention to improve mobility in the community after stroke (SIMS): A mixed-methods pilot study.

To evaluate the feasibility of implementing a self-management intervention to improve mobility in the community for stroke survivors. A two-phase sequential mixed methods design was used (a pilot randomised controlled trial and focus groups). Participants were adult stroke survivors within six months post discharge from hospital with functional and cognitive capacity for self-management. The intervention included education sessions, goal setting and action planning, group sessions, self-monitoring and follow up. The control group received usual care and both groups enrolled for 3 months in the study. Feasibility outcomes (recruitment and retention rates, randomisation and blinding, adherence to the intervention, collection of outcome measures, and the fidelity and acceptability of the intervention). Participants assessed at baseline, 3 months and 6 months for functional mobility and walking, self-efficacy, goal attainment, cognitive ability, and general health. A descriptive analysis was done for quantitative data and content analysis for the qualitative data. Findings of quantitative and qualitative data were integrated to present the final results of the study. Twenty-four participants were recruited and randomised into two groups (12 each). It was feasible to recruit from hospital and community and to deliver the intervention remotely. Randomisation and blinding were successful. Participants were retained (83%) at 3 months and (79.2%) at 6 months assessments. Adherence to the intervention varied due to multiple factors. Focus groups discussed participants' motivations for joining the programme, their perspectives on the intervention (fidelity and acceptability) and methodology, perceived improvements in mobility, facilitators and challenges for self-management, and suggestions for improvement. The self-management intervention seems feasible for implementation for stroke survivors in the community. Participants appreciated the support provided and perceived improvement in their mobility. The study was not powered enough to draw a conclusion about the efficacy of the program and a future full-scale study is warranted.

Do older adults take action to reduce fall risk after attending a community-based fall risk screening?

&lt;p&gt;We investigated whether older adults take action to reduce their fall risk after attending a community-based fall risk screening and receiving individual fall prevention recommendations. Older adults attending a free community-based fall risk screening received tailored advice from occupational and physical therapists based on their risk factors. Approximately three months after the screening, participants completed an interview survey via phone to understand actions taken due to the screening and recommendations. Sixteen participants completed the follow-up, and eleven took action or made behavioral changes. The most reported changes included being more cautious with functional mobility, walking speed, or stance, increased physical activity or exercise participation, and increased awareness of environmental hazards. Community-based fall risk screenings may motivate older adults to make behavioral changes to reduce fall risk; however, further research is needed to identify ways to improve the impact of community fall risk screenings and fall prevention recommendations.&lt;/p&gt;

Enhanced Parkinson's gait, reduced fall risk, and improved cognitive function through multimodal rehabilitation combined with rivastigmine treatment.

This study aimed to examine the effects of combined rehabilitation and rivastigmine treatment on patients with Parkinson's disease (PD). Gait parameters were assessed using the Gibbon Gait Analyzer in fifteen patients. Baseline gait data and cognitive assessments were collected. Each patient underwent external counterpulsation therapy, transcranial magnetic stimulation therapy, and exercise therapy for one hour per day, five days a week for three weeks. Post-intervention, gait and cognitive data were re-evaluated. Alongside their standard PD medications, all participants were administered rivastigmine throughout the study period. The intervention significantly enhanced motor function in the single-task test, evidenced by marked improvements in gait metrics such as stride width and walking speed, and a substantial reduction in fall risk. Cognitive function, assessed by mini-mental state examination and Montreal cognitive assessment, showed an improvement trend after the three-week intervention. Improvements in dual-task walking function were observed, although these changes did not reach statistical significance. Multimodal exercise training combined with rivastigmine treatment significantly improves certain gait parameters in the single-task test, enhances balance, and reduces the risk of falling in patients with PD. Cognitive function also demonstrated improvement.

Lower limb vertical stiffness and frontal plane angular impulse during perturbation-induced single limb stance and their associations with gait in individuals post-stroke

After stroke, deficits in paretic single limb stance (SLS) are commonly observed and affect walking performance. During SLS, the hip abductor musculature is critical in providing vertical support and regulating balance. Although disrupted paretic hip abduction torque production has been identified in individuals post-stroke, interpretation of previous results is limited due to the discrepancies in weight-bearing conditions. Using a novel perturbation-based assessment that could induce SLS by removing the support surface underneath one limb, we aim to investigate whether deficits in hip abduction torque production, vertical body support, and balance regulation remain detectable during SLS when controlling for weight-bearing, and whether these measures are associated with gait performance. Our results showed that during the perturbation-induced SLS, individuals post-stroke had lower hip abduction torque, less vertical stiffness, and increased frontal plane angular impulse at the paretic limb compared to the non-paretic limb, while no differences were found between the paretic limb and healthy controls. In addition, vertical stiffness during perturbation-induced SLS was positively correlated with single support duration during gait at the paretic limb and predicted self-selected and fast walking speeds in individuals post-stroke. The findings indicate that reduced paretic hip abduction torque during SLS likely affects vertical support and balance control. Enhancing SLS hip abduction torque production could be an important rehabilitation target to improve walking function for individuals post-stroke.

Trajectory of Walking Function in Late-Stage Older Individuals Managed with a Regular Exercise Program: A 5-Year Longitudinal Tracking with an IoT Gait Analysis System Using Accelerometers

Trajectory of Walking Function in Late-Stage Older Individuals Managed with a Regular Exercise Program: A 5-Year Longitudinal Tracking with an IoT Gait Analysis System Using Accelerometers

Effects of Baduanjin on balance and walking function in stroke survivors

OBJECTIVE: This study was designed to systematically assess the impacts of the Baduanjin exercise on the balance and walking ability of stroke survivors. METHODS: A search for relevant randomized controlled trials was carried out in three Chinese and English electronic databases. RESULTS: Eight randomized controlled trials were included in this study. By analyzing the results of the eight trials, it was found that Baduanjin exercise could significantly help stroke survivors balance in later rehabilitation. Additionally, Baduanjin exercise can effectively improve the ability of daily living and cognitive function, thus improving living quality. CONCLUSION: The findings suggest that Baduanjin may be a beneficial rehabilitation technique for improving balance, motor, trunk and neurological function, activities of daily living and overall living quality in stroke survivors. However, the results pertaining to improvements in walking function associated with Baduanjin remain inconclusive. Further high quality RCTs are needed to validate these findings.

What are the key and catalytic external factors affecting the vitality of urban blue-green space? a case study of Nanjing Main Districts, China

In recent years, urban blue-green space has received increasing attention as an important carrier of urban spatial vitality. It has become increasingly clear that urban blue-green spaces both cities and citizens, though these concepts of spatial vitality and the underlying mechanisms influencing spatial vitality have yet to be explored in depth. Using blue-green spaces in the Nanjing Main Districts as an example, this study employs precise Location Based Services (LBS) data as a proxy for spatial vitality to explore the influence of external factors and their interaction(s) on spatial vitality. The results demonstrate that (1) functional mixing and walking accessibility are the dominant external factors affecting blue-green spatial vitality; (2) the interaction of external factors has a significant impact on spatial vitality, and finally (3), that public transportation accessibility and regional economic conditions are the catalytic factors affecting spatial vitality, explaining the contradictory research results discovered by other scholars. This study provides a foundation for the planning and construction of urban blue-green spaces.

Results of evaluation of neurometabolic and rehabilitation therapy for vincristine polyneuropathy in children with acute lymphoblastic leukemia

Introduction. Vincristine-induced peripheral neuropathies (VIPN) is a current problem in the management of pediatric acute lymphoblastic leukemia (ALL). There are no effective therapeutic strategies for VIPN. The aim of the study to present the results of evaluation of neurometabolic therapy in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period. Materials and methods. The single-center prospective comparative pilot study involved 69 children with VIPN who were treated in the acute period with the following drugs: group 1 - pyridoxine, group 2 - thioktovic acid, group 3 - inosine + nicotinamide + riboflavin + succinic acid. Clinical and electrophysiological parameters before and after drug treatment were analyzed. Among 10 children with motor deficits in the lower extremities in the recovery period of VIPN, rehabilitation with immersive virtual reality was performed, and the clinical parameters before and after the course were compared. Results. A positive effect of the studied drugs on the clinical condition of patients by the 30th day of therapy was revealed. In groups 1 and 3 the total score on the NIS-LL scale correlated with mild polyneuropathy - 4 [2÷8] and 2 [2÷6] points, respectively. Neurologic impairment in each of these groups persisted for 19 [14÷25] and 19 [13÷30] days, which was less in contrast to the duration of symptoms in group 2 (p1-2 = 0.021 and p2-3 = 0.046). In the VIPN recovery period before and after virtual rehabilitation: muscle strength in the lower limbs increased (p = 0.025); the severity of polyneuropathy decreased according to the NIS-LL scale (p = 0.003); balance improved according to the Berg scale (p = 0.017); and patients’ mobility increased according to the Functional Walking Category test (p = 0.025) and walking speed according to the time-recorded walking test (p = 0.008). Discussion. Improvement of clinical parameters with neurometabolic therapy and virtual rehabilitation in children with VIPN has been shown. Conclusion. Preliminary results of the effectiveness of pyridoxine and inosine + nicotinamide + riboflavin + succinic acid in the acute period of VIPN in children with ALL and the method of virtual rehabilitation in the recovery period were obtained.