Gait Balance Research Articles

Ab. No. 149 Therapeutic Effects of Yoga On Gait Variables, Walking Capacity, Balance, Lower Extremity Strength, and Flexibility in Ambulatory Children With Cerebral Palsy

Introduction: The purpose is to explore the effects of Yoga on gait variables, walking capacity, balance, and lower extremity strength and flexibility in ambulatory children with cerebral palsy. Children with cerebral palsy have limited access to skill-based movement programs that combine therapeutic principles of movement rehabilitation with community involvement, the need for activity-grounded therapeutics in cerebral palsy is the need of the hour. Rehabilitation typically focuses on range of motion exercises to prevent and delay contractures, flexibility exercises to increase range of motion, progressive resistance exercises to enhance strength, and varied interventions to improve posture, balance, and the acquisition of functional skills. Thus, the therapeutic movement that improves motor control and imitates social interaction. Methods: Twenty-one children with the potential to participate and corresponding to the inclusion criteria were recruited in the study. The mean average age group of the participants was 8.97 years with 5 girls and 16 boys. Children with cerebral palsy with Gross Motor Function Classification I–III were divided into a control group and an experimental group. Throughout 12 weeks, the control group received conventional physiotherapy treatment while the experimental group an additional one-hour yoga sessions three times each week. The Walking capacity (6 Minute Walk Test), Balance (Pediatric Balance Scale), Muscle strength (Manual Muscle Test Score), and Flexibility (rotational profile using goniometric measurements) were administered before, and after the interventions in each group. Wilcoxon signed-rank test was used to evaluate thedata. Results: Statistically significant differences were found in the walking capacity (p < 0.004), dynamic balance (p 0.002), Strength (p 0.007), and flexibility (p 0.007). Conclusion: Yoga can be used as an adjunct to conventional physiotherapy interventions. Implications: An improvement in walking capacity, and balance leads to increased mobility and improved functional activities of the children with cerebral palsy. As yoga was an additional therapy, this showed better engagement in therapy as it improved the zeal to attend the therapy. These further improved the quality of life as children could engage amongsttheir typically developing peers.

Efficacy of exercise interventions combined with Selegiline in ameliorating freezing of gait in Parkinson's disease patients.

To evaluate the efficacy of exercise interventions combined with Selegiline in ameliorating freezing of gait (FOG) in Parkinson's disease (PD) patients. A total of 60 PD patients with FOG treated in the First People's Hospital of Fuyang District from January 2020 to January 2023 were retrospectively collected and analyzed. Patients were divided into a control group (n = 28, treated with Selegiline alone) and an observation group (n = 32, treated with Selegiline and exercise interventions). Gait parameters, FOG indices, motor and balance functions, Berg Balance, psychological status, and quality of life were compared between the groups pre- and post-treatment. After treatment, the observation group exhibited longer step length, higher step speed, and lower step frequency (P = 0.000, 0.003, 0.001, respectively), with enhanced balance as indicated by lower Timed Up and Go Test and higher Berg Balance Scale scores than the control group (P = 0.000, 0.000, respectively). The Beck Depression Inventory and Beck Anxiety Inventory scores were notably lower in the observation group than those in the control group (P = 0.000, 0.004, respectively). Additionally, the observation group showed better quality of life across several dimensions of the Parkinson's Disease Quality of Life Questionnaire, including mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication, and bodily discomfort (P = 0.000, 0.000, 0.000, 0.000, 0.017, 0.000, 0.000, 0.000, respectively) than the control group. The combination of exercise interventions and Selegiline effectively rectifies the gait parameters, enhances the balance function, alleviates psychological distress, and improves the overall quality of life in PD patients experiencing FOG.

Effects of repetitive transcranial magnetic stimulation on lower extremity motor function and optimal parameters in stroke patients with different stages of stroke: a systematic evaluation and meta-analysis.

Repetitive transcranial magnetic stimulation (rTMS), as an emerging non-invasive neuromodulation technique, is now widely employed in rehabilitation therapy. The purpose of this paper is to comprehensively summarize existing evidence regarding rTMS intervention for lower limb motor function in patients at different stages of stroke. A systematic search was conducted to identify randomized controlled trials (RCTs) assessing the efficacy of rTMS for treating lower limb motor dysfunction after stroke. Multiple databases, including China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, VIP Database, PubMed, Embase, Web of Science, and Cochrane Library, were searched. The search period extended from the inception of the libraries to June 2024. Literature information was extracted, and methodological quality was evaluated using the risk of bias assessment tool in the Cochrane Handbook. Meta-analysis was performed using Stata 17.0 software. Overall, 49 appropriate studies (including 3,558 stroke subjects) were found. Meta-analysis results demonstrated that rTMS effectively improved lower limb motor function across all stages of stroke. The intervention was particularly more effective in patients in the subacute stage than in the acute or chronic stages. Subgroup analysis revealed that, for acute-stage patients, low-frequency stimulation targeting the M1 or DLPFC brain regions on the unaffected side with 20-40 sessions significantly improved FMA-LE scores. In subacute-phase patients, low-frequency stimulation targeting the M1 brain regions on the unaffected side with 18 sessions significantly improved FMA-LE scores. The results demonstrated that HF-rTMS was more effective than LF-rTMS in improving walking speed, with the greatest efficacy observed at 20 sessions. While for enhancing gait balance in stroke patients, LF-rTMS with the best therapeutic effect was observed at a frequency of 20-40 treatments. This study demonstrates the efficacy of rTMS in improving lower limb motor function, balance, and walking speed in stroke patients at various stages. The findings provide a valuable reference for the development of optimized rTMS treatment plans in clinical practice.Systematic review registration: PROSPERO: CRD42023466094.

Changes in body balance due to exposure to trauma – multi-center studies

Aim. The purpose of the study was to assess the impact of a traumatic event experienced by the subject on postural balance and biomechanical parameters of gait. Research methodology. The study involved 31 people (n = 100%), including 22 women (nk% = 70.97%), 9 men (nm% = 29.03), aged 29-60. People with diseases and dysfunctions affecting body balance and gait pattern were excluded from the study. Balance and gait tests were performed using pedobarography (pedobarograph mod. EPS R2, Biomech Studio v2 software). The balance test was performed while standing, for 20 seconds, with sampling every 1 ms (millisecond) – the number of samples during one test is 20,000. The balance and gait assessment tests were performed twice. Test I included testing in neutral conditions, Test II included testing in conditions in which the subject was exposed to a traumatic event he or she had experienced in the past (so-called exposure to “experienced trauma”). Results. The obtained results of studies on the impact of exposure to experienced trauma on body balance while standing showed significant differences in body fluctuations in the most important parameters of stabilometric assessment. The obtained results of research on the impact of exposure to trauma on the subject’s gait showed no significant differences between the test in neutral conditions and the test during exposure. Conclusions. (1) Exposure to the trauma experienced by the subject significantly affects the body’s balance in a standing position. (2) The research showed no influence of exposure to the experienced trauma on the subject’s gait in the area of the time of contact of the feet with the ground and on the values of maximum and average pressure; The area of the plane where the feet are placed on the ground changes significantly before and after exposure to the trauma experienced by the subject. (3) In research on the impact of trauma on body posture, detailed results of studies on the range of COP fluctuations in each plane should be taken into account – the study showed that the analysis of only average results may significantly indicate an incorrect result in the assessment of body balance.

The Effects of Robot-Assisted Gait Training on the Gait Pattern and Balance Ability of Patients with Chronic Stroke

The Effects of Robot-Assisted Gait Training on the Gait Pattern and Balance Ability of Patients with Chronic Stroke

Immediate Effect of Non-Elastic Taping on Gait Balance in Stroke Patients: Randomized Controlled Trial

Objective: After a stroke, most patients have poor ankle control and difficulty walking. Considering that proper foot placement will provide a more balanced and controlled gait, the aim of this study was to investigate the immediate effect of non-elastic ankle taping providing eversion support on gait balance in stroke patients.
 Material-Method: 
 The study included 30 stroke patients. Participants were randomly assigned to two groups: intervention group (n=15) and the control group (n=15). The control group received 45 min of conventional physiotherapy. The intervention group received 45 min of conventional physiotherapy after nonelastic taping, which provides eversion support. The gait balance of both groups was evaluated using the Dynamic Gait Index before and after treatment.
 Results:
 A significant difference was found in the Dynamic Gait Index total score of the intervention and control groups before and after treatment (p

GAIT ANALYSIS OF ELDERLY PEOPLE IN ANGOLA: COMPARISON BETWEEN ESTABLISHED ROUTE AND VIRTUAL REALITY AND TIME UP AND GO

Abstract Background Aging limits physical and mental abilities, particularly gait, compromising quality of life and increasing the risk of falls, which is a public health challenge in Angola. Technologies, such as virtual reality, may offer a promising alternative for treatment and prevention of these limitations. Objective: This study aimed to analyze the gait of elderly individuals in Angola by comparing gait on an established course and in a virtual environment, using motion analysis software and SPSS for statistical analysis with a p>0.05. Methods Seven elderly individuals, aged 60-80, participated in the study. Gait was evaluated using the Timed Up and Go (TUG) test, an established course, and gait in a virtual environment. Results Statistically significant differences were found between gait on the established course and in virtual reality, with elderly individuals showing slower and more variable gait in the virtual environment. There were also significant correlations between gait and TUG, highlighting the importance of motor coordination and balance in elderly gait. Conclusion Gait analysis in elderly individuals can be performed precisely and stably through virtual reality technology. The results of this study suggest that virtual reality may be an interesting alternative for the treatment and prevention of falls in the elderly. The findings also emphasize the importance of motor coordination and balance in gait and the need for further research on the use of virtual reality technology in this population.

GERIATRIC MEASURES OF PHYSICAL FUNCTION HAVE THEIR ROOTS IN EARLY CHILDHOOD BRAIN HEALTH

Abstract Midlife is a pivotal period in the life course in terms of investing resources to mitigate challenges that can come in older age. It is important to understand the relationship between childhood and midlife health, as it could have predictive properties for aging. We investigated the association between early childhood brain health and midlife physical function in the Dunedin Study, a longitudinal birth cohort (n=1,037). Brain health was measured when Study members were age 3 using a neurological examination, tests of cognitive functioning, and temperament rating. Physical function was measured at age 45 using gait speed, step-in-place, chair stands, balance, and grip strength tests. Children with worse brain health had significantly worse physical function as adults (β, 0.23; 95% CI, 0.16 to 0.30; P < .001), after controlling for sex and childhood socioeconomic status. This relationship supports a link between cognitive and physical function in the aging and development process, the reconceptualization of aging and development on the same ontological path, and the utility of physical function tests – which can be used in many clinical settings – as reflections of lifelong, integrated health in addition to indicators of musculoskeletal integrity in older adults.

COGNITIVE IMPAIRMENT IS ASSOCIATED WITH INFERIOR POSTURAL BALANCE AND REDUCED GAIT SPEED

Abstract Fall-related sequelae including balance as well as gait impairments are more pronounced in older adults with cognitive impairment (CIOA) compared to cognitively healthy older adults (CHOA). Evidence is scarce about differences in postural balance and gait in CHOA and CIOA after a fall, even though these are major risks for recurrent falls. Especially, there is a dearth of data based on validated sensor technologies. Thus, it is our aim to use sensor-based data to investigate differences between these two groups. Postural balance and gait were measured using three wirelessly synchronized IMU’s (APDM, Inc., Portland, USA) in n=50 CHOA, mean age 73.82±8.25 years and n= 56 CIOA, mean age 78.27±8.0 years. Data were collected at participants’ homes as part of a comprehensive geriatric assessment in the “SeFallED” study within four weeks after presentation to the emergency department (ED) after a sentinel fall (German Clinical Trials Register ID: 00025949). Differences in postural balance and gait between two groups were analyzed by using a Mann-Whitney-U-Test. Statistical analysis revealed a significantly poorer postural balance in CIOA compared to CHOA for the parameters Jerk (m2/s5; p=0.039) and mean velocity (m/s; p=0.036). Further, CIOA had a significantly lower gait speed (m/s; p=0.035) and stride length (m/s; p=0.028) compared to CHOA. Even though both groups had shortly experienced a fall with presentation to the ED, impairments in gait and balance parameters were more prominent in CIOA. Based on these results, physical exercise interventions should focus on the improvement of impaired gait speed and balance particularly in CIOA.

Falls and Cognition in Adults Aging with Down Syndrome

AbstractBackgroundAdults with Down syndrome (DS), who are at risk, will show the neuropathological changes of Alzheimer’s Disease (AD) within their 40s, partially due to an overexpression of beta‐amyloid, which accumulates in the brain across their lifespan. The risk of developing AD in adults aging with DS increases with age and is marked by increased confusion, short‐term memory problems, and/or a loss of the ability to complete daily activities. There is limited evidence on the functional changes that happen to adults aging with DS prior to any marked AD symptoms. Growing evidence suggests that functional mobility abnormalities and an increase in falls may precede cognitive impairment and marked AD symptoms. The relationship between falls and cognition in adults with DS has not been thoroughly investigated; and could potentially serve as a less invasive method of assessment.MethodThe purpose of this study is to assess patterns of falls and functional mobility impairments that occur within an adult population aging with DS and their relationship with cognition. The participant receives an initial home visit, conducted by the PI, who completes and collects data on functional performance, fall risk(s), and the environment. The participant agrees to document any fall incidents using a calendar journal, and completes the monthly check‐in calls and/or emails initiated by the study team.ResultWe conducted a correlation analysis with the preliminary data from this cohort of 17 participants, 9 male and 8 female, with a mean age of 38.5 years (SD = 8.81). Increased falls were significantly related (p < .05) to impaired gait speed (r = .528) and balance (r = ‐.624), while cognition (r = .474, p >.05) was not associated with falls. Increased fear of falling assessment scores were correlated with impaired gait speed (r = .687), lower extremity (r = ‐.502) and mean grip strength (r = ‐.492), and balance (r = ‐.596).ConclusionWe demonstrated that (1) participants were willing to enroll; (2) the assessment and monitoring plan were well tolerated; and (3) fear of falling scores and decreased functional mobility were similar in aging adult with DS populations to older adult (≥ 65 years of age) populations.

The Effect of the Task-oriented Treadmill Gait on the Improvement in Gait Function, Balance Ability and Functional Activities in Subacute Stroke Patients: Results of a Randomized Controlled Trial

The Effect of the Task-oriented Treadmill Gait on the Improvement in Gait Function, Balance Ability and Functional Activities in Subacute Stroke Patients: Results of a Randomized Controlled Trial

Comparison between Exercise Program-Foot Orthoses Treatment and Exercise Program Alone after Pilon Fracture Surgery: Study Protocol for a Randomized Controlled Trial.

The management of tibial pilon fractures is challenging and often leads to complications and limitations in ankle function. The study aims to investigate myotonometric parameters and muscle strength of ankle muscles, as well as gait pattern and balance among patients following surgical treatment of pilon fractures. The randomized controlled study will analyze the differences between the patients who will follow a 3-month physical exercise program and will wear customized foot orthoses (i.e., customized orthotic arch support insoles) versus patients who will attend only the physical exercise program. For each group, at least 21 patients will be required. The assessment involves four different testing procedures: myotonometry (anterior tibialis, medial and lateral gastrocnemius, and longus peroneus assessed using MyotonPRO), muscle strength testing (ankle dorsiflexors, plantar flexors, and peroneal muscles assessed using MicroFET2 dynamometer), analysis of gait parameters (using Scheinworks treadmill), and double-leg and single-leg balance tests (using K-Force plate). After 3 months, the assessments will record which of the two treatments (physical exercise program with or without wearing customized foot orthoses) has better outcomes in regaining ankle muscle properties and tone, as well as the restoration of gait and balance.

Recurrent Neural Network Methods for Extracting Dynamic Balance Variables during Gait from a Single Inertial Measurement Unit.

Monitoring dynamic balance during gait is critical for fall prevention in the elderly. The current study aimed to develop recurrent neural network models for extracting balance variables from a single inertial measurement unit (IMU) placed on the sacrum during walking. Thirteen healthy young and thirteen healthy older adults wore the IMU during walking and the ground truth of the inclination angles (IA) of the center of pressure to the center of mass vector and their rates of changes (RCIA) were measured simultaneously. The IA, RCIA, and IMU data were used to train four models (uni-LSTM, bi-LSTM, uni-GRU, and bi-GRU), with 10% of the data reserved to evaluate the model errors in terms of the root-mean-squared errors (RMSEs) and percentage relative RMSEs (rRMSEs). Independent t-tests were used for between-group comparisons. The sensitivity, specificity, and Pearson's r for the effect sizes between the model-predicted data and experimental ground truth were also obtained. The bi-GRU with the weighted MSE model was found to have the highest prediction accuracy, computational efficiency, and the best ability in identifying statistical between-group differences when compared with the ground truth, which would be the best choice for the prolonged real-life monitoring of gait balance for fall risk management in the elderly.

Dynamic Gait Stability and Spatiotemporal Gait Parameters During Overground Walking in Professional Ballet Dancers.

Introduction: It has been recognized that practicing ballet could strengthen the leg muscles, improve balance, and reduce fall risk. However, few studies have investigated how ballet practice alters a person's gait pattern, and this knowledge gap could present a barrier to designing ballet-based training programs. This study examined dynamic gait stability and spatiotemporal gait parameters among professional ballet dancers during normal level overground walking. Methods: Twenty young adults were recruited: 10 ballet dancers (24.5 ± 4.9 years) and 10 age- and sex-matched non-dancers (22.6 ± 3.4 years). Participants walked on a 10 m linear walkway at their self-selected speed. Dynamic gait stability and common gait parameters (step length, step width, gait speed, and cadence) were determined from the collected kinematic data and compared between groups with a significance level of .05. Results: The results showed that both groups displayed comparable dynamic gait stability at touchdown (P = .140) and liftoff (P = .638). However, ballet dancers walked with a longer (P = .054), narrower (P = .009), and faster step (P = .014) at a marginally quicker speed (P = .063) than non-dancers. Conclusion: Our study suggests that young professional ballet dancers have different gait patterns, but similar dynamic gait stability compared to non-dancers. These findings not only provide insight into the mechanisms of dynamic stability control among young ballet dancers during gait but expand our understanding of the control of dynamic gait balance of human locomotion across a wide variety of populations and walking conditions.

Telehealth Implementation and Teaching Strategies During COVID-19 and Beyond in Gait, Balance, and Mobility Clinic for Community-Dwelling Older Adults

COVID-19 provided an opportunity to determine the effectiveness of telehealth physical therapy as part of a pro bono gait balance and mobility clinic. The aim of this case study is 2-folds—(1) to provide evidence for clinicians on telehealth physical therapy implementation while using mobile health platform and remote patient monitoring for a community-dwelling older adult with gait and balance disorder and (2) to provide evidence for clinical educators on telehealth-based teaching strategies to implement virtual clinical education for treating geriatric patient population. It is also important to note that this telehealth clinic model may be applicable outside of this patient population as well.

Assessment of Gait Balance Control Using Inertial Measurement Units — A Narrative Review

This narrative review examines the use of inertial measurement units (IMUs) for assessing gait balance control. Impaired gait balance control is associated with an increased risk of falls and reduced mobility, particularly in older adults. Traditional methods of assessing gait balance control, such as clinical balance assessments and camera-based motion analysis, have limitations in terms of reliability, cost, and practicality. Wearable sensor technology, including IMUs, offers a more accessible and cost-effective alternative for assessing gait and balance performance in real-world settings. IMUs, equipped with tri-axial accelerometers, gyroscopes, and magnetometers, can directly measure body movement and provide quantifiable data. This review explores the advantages and limitations of using IMUs for assessing gait balance control, including the measurement of anticipatory postural adjustments (APAs) for gait initiation, spatiotemporal gait parameters, center of mass (COM) motion during walking, and data-driven machine learning models. IMUs have shown promise in quantifying APAs, estimating gait spatiotemporal parameters, assessing COM motion, and using machine learning algorithms to classify and predict balance-related outcomes. However, further research is needed to establish standardized protocols, validate IMU-based measurements, and determine the specific IMU parameters that correlate with balance control ability. Overall, IMUs have the potential to be a valuable tool for assessing gait balance control, monitoring changes over time, and tracking interventions to improve balance control in both clinical and research settings.

Effect of wearable chair on gait, balance, and discomfort of new users during level walking with anterior loads

Introduction: Walking with anterior loads is common in industrial scenarios, but as exoskeletons are increasingly used in work environments to alleviate musculoskeletal disorders (MSDs), this new “human-robot” system composed of the human body and exoskeleton may be associated with new risks and harm that warrant further investigation. Therefore, this study will discuss the effect of a wearable chair on the gait, balance, and discomfort of new users with different weights of anterior loads during level walking. Method: Twenty-two healthy subjects (sex balanced) participated in the experiment. Each exposure comprised one of two exoskeleton states (with/without) and four load conditions: No carried load, carrying an empty box (0.3 kg), 5%Body Weight (BW), and 10%BW. The order of exoskeleton states and load conditions was randomly assigned. Using an eight-camera motion capture system to record the entire movement. And the subjective discomfort and perceived balance after each exposure were recorded on an 11-point numeric rating scale, respectively. Using SPSS 26.0 software (IBM Inc., Chicago) to conduct statistical analyses. Results: Level walking with a wearable chair in different load conditions significantly affected gait parameters (like cadence) and gait balance. The perceived balance decreased with the exoskeleton, consistent with objective results. For subjective discomfort, wearing the exoskeleton significantly impacted global discomfort. Also, it increased the local discomfort of the shoulders, waist, thighs, shanks, and feet/ankles. Conclusions: For new users, the risk of losing balance or falling may be increased when wearing an exoskeleton for non-target task behaviors (level walking/anterior load), and caution is recommended when the anterior load exceeds 5% BW. Practical Application: The proposed strategy for assessing human gait, balance, and discomfort in wearable chairs may be applied during the iterative design of the product. These controls will help develop training programs and implementation guidelines for this exoskeleton type.

Effect of exoskeleton robot-assisted training on gait function in chronic stroke survivors: a systematic review of randomised controlled trials

ObjectivesNumbers of research have reported the usage of robot-assisted gait training for walking restoration post-stroke. However, no consistent conclusion has been reached yet about the efficacy of exoskeleton robot-assisted training...

Cognitive and gait in Wilson's disease: a cognitive and motor dual-task study.

Cognitive and motor dual-tasks play important roles in daily life. Dual-task interference impacting gait performance has been observed not only in healthy subjects but also in subjects with neurological disorders. Approximately 44-75% of Wilson's disease (WD) patients have gait disturbance. According to our earlier research, 59.7% of WD patients have cognitive impairment. However, there are few studies on how cognition affects the gait in WD. Therefore, this study aims to explore the influence of cognitive impairment on gait and its neural mechanism in WD patients and to provide evidence for the clinical intervention of gait disturbance. We recruited 63 patients who were divided into two groups based on their scores on the Addenbrooke's cognitive examination III (ACE-III) scale: a non-cognitive impairment group and a cognitive impairment group. In addition to performing the timed up and go (TUG) single task and the cognitive and motor dual-task digital calculation and animal naming tests, the Tinetti Balance and Gait Assessment (POMA), Berg Balance Scale (BBS), and brain MRI severity scale of WD (bMRIsc-WD) were evaluated. The dual-task cost (DTC) was also computed. Between the two groups, the results of the enhanced POMA, BBS, and bMRIsc-WD scales, as well as gait performance measures such as TUG step size, pace speed, pace frequency, and DTC value, were compared. (1) Among the 63 patients with WD, 30 (47.6%) patients had gait disturbance, and the single task TUG time was more than 10 s. A total of 43 patients had cognitive impairment, the incidence rate is 44.4%. Furthermore, 28 (44.4%) patients had cognitive impairment, 39 (61.9%) patients had abnormal brain MRI. (2) The Tinetti gait balance scale and Berg balance scale scores of patients with cognitive impairment were lower than those of patients without cognitive impairment (p < 0.05), and the pace, step size, and pace frequency in the single task TUG were slower than those of patients without cognitive impairment (p < 0.05). There was no change in the pace frequency between the dual-task TUG and the non-cognitive impairment group, but the pace speed and step size in the dual-task TUG were smaller than non-cognitive impairment group (p < 0.05). There was no difference in DTC values between cognitive impairment group and non-cognitive impairment group when performing dt-TUG number calculation and animal naming respectively (p > 0.05). However, regardless of cognitive impairment or not, the DTC2 values of number calculation tasks is higher than DTC1 of animal naming tasks in dt-TUG (p < 0.05). (3) Pace speed and step size were related to the total cognitive score, memory, language fluency, language understanding, and visual space factor score of the ACE-III (p < 0.05), and step frequency was correlated with memory and language comprehension factors (p < 0.05). There was no correlation between the attention factor scores of the ACE-III and TUG gait parameters of different tasks (p > 0.05). Brain atrophy, the thalamus, caudate nucleus, and cerebellum were correlated with cognitive impairment (p < 0.05), the lenticular nucleus was related to the step size, brain atrophy was related to the pace speed, and the thalamus, caudate nucleus, and midbrain were involved in step frequency in WD patients (p < 0.05). WD patients had a high incidence of cognitive impairment and gait disorder, the pace speed and step size can reflect the cognitive impairment of WD patients, cognitive impairment affects the gait disorder of WD patients, and the different cognitive and motor dual-tasks were involved in affecting gait parameters. The joint participation of cognitive impairment and lesion brain area may be the principal neural mechanism of gait abnormality in WD patients.

Game-based intradialytic non-weight-bearing exercise training on gait speed and balance in older adults with diabetes: a single-blind randomized controlled trial

Older adults with diabetes receiving hemodialysis have impaired gait speed and balance compared to the general population, which have been associated with increased risks of falls and mortality. This study evaluated the effectiveness of a game-based intradialytic exercise training program (iExergame) on improving gait speed and balance. This was a single-blind randomized controlled trial. The intervention group (IG) received iExergame training using real-time audiovisual feedback with wearable inertial sensors. The control group (CG) received conventional training without any technology. Both trainings were intradialytic, non-weight-bearing, and used ankle range of motion. Gait and balance parameters were collected at baseline and 4-week follow-up. Data from 70 adults (age 64.2 ± 9.0 years) were analyzed. Compared to the CG, the IG showed greater changes between baseline and 4-week follow-up in several parameters. Gait parameters included faster speeds and longer stride lengths, particularly during dual task walking (p < 0.050). Balance parameters included reductions in center of mass (p = 0.004), ankle (p < 0.001), and hip (p = 0.010) sways during semi-tandem stance, particularly in users of assistive devices. iExergame training could improve gait speed and balance in this population and might be an option to increase intradialytic exercise adherence while reducing burdens of exercise administration.