Gait Performance Research Articles

Slow Gait Speed Predicts Incident Dementia, Mortality, and Long-Term Functional Outcome in Cerebral Small-Vessel Disease.

Gait impairment is observed in patients with small vessel disease (SVD); however, the association between gait function and long-term outcome remains unclear. This study aimed to clarify the predictive value of gait function on incident dementia, survival and functional outcome. Data were derived from a Japanese cohort of patients with SVD. This study included 522 participants who underwent 3-m timed up and go test (TUG), and gait speed, TUG time, was divided into tertiles. Magnetic resonance imaging was used to evaluate severity of white matter hyperintensities, lacunes, and medial temporal atrophy. Primary outcome was dementia. All-cause death and functional outcome by modified Rankin scale at the last visit was also evaluated. The median age was 71 years, and median TUG time was 9.91 s. During follow-up period of 4.8 years, 32 cases of dementia occurred. Cox proportional hazard analysis revealed that slow gait speed (TUG time > 10.88 s) was associated with a significantly higher risk of incident dementia than fast (TUG time < 9.03) and middle (TUG time, 9.04-10.87 s) speeds after adjusting risk factors, Mini-Mental State Examination, SVD severity and brain atrophy (adjusted hazard ratio, 2.73; 95% confidence interval, 1.16-6.42, p = 0.022). Slow speed was also associated with mortality and poor functional outcome compared with other speeds (adjusted odds ratio, 4.19; 95% confidence interval 1.92-9.18, p < 0.001). Gait function was associated with incident dementia, mortality and poor functional outcome independently of cognitive function, brain atrophy, and SVD severity.

Perception and control of a virtual body in immersive virtual reality for rehabilitation.

This review explores recent advances in using immersive virtual reality to improve bodily perception and motor control in rehabilitation across musculoskeletal and neurological conditions, examining how virtual reality's unique capabilities can address the challenges of traditional approaches. The potential in this area of the emerging metaverse and the integration of artificial intelligence in virtual reality are discussed. In musculoskeletal rehabilitation, virtual reality shows promise in enhancing motivation, adherence, improving range of motion, and reducing kinesiophobia, particularly postsurgery. For neurological conditions like stroke and spinal cord injury, virtual reality's ability to manipulate bodily perceptions offers significant therapeutic potential, with reported improvements in upper limb function and gait performance. Balance and gait rehabilitation, especially in older adults, have also seen positive outcomes. The integration of virtual reality with brain-computer interfaces presents exciting possibilities for severe speech and motor impairments. Current research is limited by small sample sizes, short intervention durations, and variability in virtual reality systems. Future studies should focus on larger, long-term trials to confirm findings and explore underlying mechanisms. As virtual reality technology advances, its integration into rehabilitation programs could revolutionize treatment approaches, personalizing treatments, facilitating home training, and potentially improving patient outcomes across a wide variety of conditions.

Effectiveness of Technological Interventions for Older Adults With Parkinson Disease: Systematic Review.

Among the older population, Parkinson disease (PD) stands out as a leading contributor to disability. Clinically, the foremost objectives in managing PD involve proactively delaying and preventing disability. Understanding the pivotal role of gait and balance in daily functionality holds substantial clinical significance, signaling imminent disability and prompting a reevaluation of management approaches. A key priority lies in identifying novel and effective interventions for symptoms that substantially contribute to disability. This paper presents a systematic review that critically examines the existing body of literature on the use of technology in the rehabilitation of older patients with PD. By synthesizing current evidence, we aim to provide insights into the state of the field, identify gaps in knowledge, and offer recommendations for future research and clinical practice. A systematic review of the literature was conducted in September 2023 analyzing manuscripts and papers of the last 5 years from the PubMed, Scopus, Embase, Web of Science, and CINAHL databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 14 papers were included. The inclusion criteria are as follows: (1) randomized controlled trial, (2) PD in people aged 65 years and older, and (3) use of technology in the rehabilitation training in the older population. A large portion of effective interventions relies on the incorporation of technology, particularly through virtual reality exergames. This technology appears to have effects not only on the cognitive aspect but also on the physical domain. The analysis of the results clearly indicates that, in terms of gait and balance performance, the technological intervention outperforms the traditional approach, irrespective of the specific technology employed. This systematic review seeks to shed light on the evolving landscape of technology-assisted rehabilitation for older individuals with PD. As we delve into the available evidence, we will assess the extent to which technology can serve as a valuable adjunct to conventional therapy, offering new avenues for optimized care and improved outcomes in this growing patient demographic. As we sift through the existing evidence, our goal is to evaluate the potential of technology as a valuable supplement to traditional therapy, presenting fresh opportunities for enhanced care and better outcomes in this expanding patient demographic.

Investigating the Relationship Between Kinesiophobia, Catastrophizing, Pain Intensity, Disability, and Gait Performance in Chronic Neck Pain

Introduction: There is little evidence regarding the relationship between gait performance and psychological factors in people with chronic neck pain. This study evaluates gait performance in patients with neck pain and explores the relationship between gait performance and kinesiophobia, pain catastrophizing, pain intensity, and disability. Materials and Methods: A cross-sectional study was conducted on 34 patients with chronic neck pain and 29 age- and sex-matched controls were recruited for this study. The participants performed timed up-and-go (TUG), and 10-m walk tests (TMW) with and without head-turning tests. The associations between clinical gait tests, kinesiophobia (Tampa scale of kinesiophobia (TSK), pain catastrophizing scale, pain intensity (visual analog scale), and disability (neck disability index) were assessed. Results: People with neck pain had significant differences in the TUG, and TMW with and without head-turning tests compared to controls (P&lt;0.01). Kinesiophobia and pain catastrophism were significantly correlated with TMW tests (r range=0.45 to 0.71, and 0.40 to 0.47, respectively). Pain intensity and disability were not correlated with gait tests. Conclusion: The gait performance, as represented by TUG and TMWs test scores, altered in patients with chronic neck pain in comparison controls. Fear of motion and pain catastrophizing thoughts correlated with clinical gait test scores.

Effect of a soft exosuit on daily life gait performance in people with incomplete spinal cord injury: study protocol for a randomized controlled trial

BackgroundPeople with incomplete spinal cord injury (iSCI) often have gait impairments that negatively affect daily life gait performance (i.e., ambulation in the home and community setting) and quality of life. They may benefit from light-weight lower extremity exosuits that assist in walking, such as the Myosuit (MyoSwiss AG, Zurich, Switzerland). A previous pilot study showed that participants with various gait disorders increased their gait speed with the Myosuit in a standardized environment. However, the effect of a soft exosuit on daily life gait performance in people with iSCI has not yet been evaluated.ObjectiveThe primary study objective is to test the effect of a soft exosuit (Myosuit) on daily life gait performance in people with iSCI. Second, the effect of Myosuit use on gait capacity and the usability of the Myosuit in the home and community setting will be investigated. Finally, short-term impact on both costs and effects will be evaluated.MethodsThis is a two-armed, open label, randomized controlled trial (RCT). Participants will be randomized (1:1) to the intervention group (receiving the Myosuit program) or control group (initially receiving the conventional program). Thirty-four people with chronic iSCI will be included. The Myosuit program consists of five gait training sessions with the Myosuit at the Sint Maartenskliniek. Thereafter, participants will have access to the Myosuit for home use during 6 weeks. The conventional program consists of four gait training sessions, followed by a 6-week home period. After completing the conventional program, participants in the control group will subsequently receive the Myosuit program. The primary outcome is walking time per day as assessed with an activity monitor at baseline and during the first, third, and sixth week of the home periods. Secondary outcomes are gait capacity (10MWT, 6MWT, and SCI-FAP), usability (D-SUS and D-QUEST questionnaires), and costs and effects (EQ-5D-5L).DiscussionThis is the first RCT to investigate the effect of the Myosuit on daily life gait performance in people with iSCI.Trial registrationClinicaltrials.gov NCT05605912. Registered on November 2, 2022.

Self-supervised learning of wrist-worn daily living accelerometer data improves the automated detection of gait in older adults

Progressive gait impairment is common among aging adults. Remote phenotyping of gait during daily living has the potential to quantify gait alterations and evaluate the effects of interventions that may prevent disability in the aging population. Here, we developed ElderNet, a self-supervised learning model for gait detection from wrist-worn accelerometer data. Validation involved two diverse cohorts, including over 1000 participants without gait labels, as well as 83 participants with labeled data: older adults with Parkinson's disease, proximal femoral fracture, chronic obstructive pulmonary disease, congestive heart failure, and healthy adults. ElderNet presented high accuracy (96.43 ± 2.27), specificity (98.87 ± 2.15), recall (82.32 ± 11.37), precision (86.69 ± 17.61), and F1 score (82.92 ± 13.39). The suggested method yielded superior performance compared to two state-of-the-art gait detection algorithms, with improved accuracy and F1 score (p < 0.05). In an initial evaluation of construct validity, ElderNet identified differences in estimated daily walking durations across cohorts with different clinical characteristics, such as mobility disability (p < 0.001) and parkinsonism (p < 0.001). The proposed self-supervised method has the potential to serve as a valuable tool for remote phenotyping of gait function during daily living in aging adults, even among those with gait impairments.

Patterns of cortical thickness alterations in degenerative cervical myelopathy: associations with dexterity and gait dysfunctions.

Degenerative cervical myelopathy (DCM) can lead to significant brain structural reorganization. The association between the cortical changes and specific motor symptoms in DCM has yet to be fully elucidated. We investigated the associations between cortical thickness changes with neurological symptoms, such as dexterity and gait abnormalities, in patients with DCM in a case-control study. A 3 Tesla MRI scanner was used to acquire high-resolution T1-weighted structural scans from 30 right-handed patients with DCM and 22 age-matched healthy controls. Pronounced cortical thinning was observed in DCM patients relative to healthy controls, particularly in the bilateral precentral and prefrontal gyri, left pars triangularis, left postcentral gyrus, right transverse temporal and visual cortices (P ≤ 0.04). Notably, cortical thickness in these regions showed strong correlations with objective motor deficits (P < 0.0001). Specifically, the prefrontal cortex, premotor area and supplementary motor area exhibited significant thickness reductions correlating with diminished dexterity (R2 = 0.33, P < 0.0007; R2 = 0.34, P = 0.005, respectively). Similarly, declines in gait function were associated with reduced cortical thickness in the visual motor and frontal eye field cortices (R2 = 0.39, P = 0.029, R2 = 0.33, P = 0.04, respectively). Interestingly, only the contralateral precuneus thickness was associated with the overall modified Japanese Orthopaedic Association (mJOA) scores (R2 = 0.29, P = 0.003). However, the upper extremity subscore of mJOA indicated an association with the visual cortex and the anterior prefrontal (R2 = 0.48, P = 0.002, R2 = 0.33, P = 0.0034, respectively). In conclusion, our findings reveal patterns of cortical changes correlating with motor deficits, highlighting the significance of combining objective clinical and brain imaging assessments for understanding motor network dysfunction in DCM.

Long-term repeated botulinum toxin a treatment over 12 years gradually changes gait characteristics: single-case study

Objective: To demonstrate the long-term efficacy of repeated botulinum toxin A injections into the same muscles for ameliorating lower limb spasticity and gait function. Design: Single-case study Patient: A 36-year-old woman with right cerebral haemorrhage received her first botulinum toxin A injection 1,296 days after onset. The patient underwent 30 treatments over 12 years after the first injection to improve upper and lower limb spasticity and abnormal gait patterns. The mean duration between injections was 147 days. Methods: The Modified Ashworth Scale, passive range of motion, gait velocity, and degree of abnormal gait patterns during treadmill gait were evaluated pre-injection and at 2, 6, and 12 weeks after every injection. Results: The follow-up period showed no injection-related adverse events. Comfortable overground gait velocity gradually improved over 30 injections. The Modified Ashworth Scale and passive range of motion improved after each injection. Pre-injection values of the degree of pes varus, circumduction, hip hiking, and knee extensor thrust improved gradually. However, the degree of contralateral vaulting, excessive lateral shift of the trunk, and insufficient knee flexion did not improve after 30 injections. Conclusion: Repeated botulinum toxin A injections effectively improve abnormal gait patterns, even when a single injection cannot change these values.

Magnetically-Actuated Endoluminal Soft Robot With Electroactive Polymer Actuation for Enhanced Gait Performance

Abstract Endoluminal devices are indispensable in medical procedures in the natural lumina of the body, such as the circulatory system and gastrointestinal tract. In current clinical practice, there is a need for increased control and capabilities of endoluminal devices with less discomfort and risk to the patient. This paper describes the detailed modeling and experimental validation of a magneto-electroactive endoluminal soft (MEESo) robot concept that combines magnetic and electroactive polymer (EAP) actuation to improve the utility of the device. The proposed capsule-like device comprises two permanent magnets with alternating polarity connected by a soft, low-power ionic polymer-metal composite (IPMC) EAP body. A detailed model of the MEESo robot is developed to explore quantitatively the effects of dual magneto-electroactive actuation on the robot’s performance. It is shown that the robot’s gait is enhanced, during the magnetically-driven gait cycle, with IPMC body deformation. The concept is further validated by creating a physical prototype MEESo robot. Experimental results show that the robot’s performance increases up to 68% compared to no IPMC body actuation. These results strongly suggest that integrating EAP into the magnetically-driven system extends the efficacy for traversing tract environments.

Factors influencing gait performance in persons with spinal cord injury

Factors influencing gait performance in persons with spinal cord injury

Improvement in Body's Dynamic Adaptation during Walking with Vestibular Rehabilitation Therapy in Patients with Cerebellopontine Angle Tumor Resection.

Our study aimed to investigate the effects of vestibular rehabilitation therapy on functional gait performance in patients with balance disorders. A total of 40 post-operative patients with balance disorders were included in the study. They were divided into two groups and participated in a vestibular rehabilitation program during their hospital stay. After discharge, the intervention group performed vestibular exercises at home, while the control group did not. Balance was assessed using the Functional Gait Assessment Scale at discharge and three months after surgery. The intervention group included 15 women and 5 men with an average age of 45 years, while the control group included 7 women and 13 men with an average age of 50 years. Three months after surgery, the change in Functional Gait Assessment (FGA) scores exceeded the clinically significant threshold of 5 points in 17 patients in the intervention group and 14 in the control group. There was a statistically significant difference in FGA progression between the groups (p = 0.034). After three months post-surgery, 7 patients in the intervention group experienced falls compared to 12 in the control group. Three months after surgery, we observed a significant improvement in the performance of balance tasks while walking and a lower risk of falls in the intervention group.

Physical Education in the Restoration of Damaged Functions in Students After Blast Tbi Complicated By Acuborotrauma

Background. In the conditions of a long armed conflict, and, therefore, a permanent increase in the number of students affected by the war, there is a need to reorganize the content of physical education in higher schools, in accordance with modern requests and needs. Objectives. The purpose of the article is to reveal the effectiveness of the implementation of a differentiated PE program in restoring gait and balance functions in students after blast TBI, complicated by acuborotrauma. Materials and methods. The “10 Meter Walk Test” was used for the implementation of the experiment, the results of which were processed using the methods of mathematical statistics. The studied sample consisted of 20 students after blast TBI, complicated by acuborotrauma, in the first year of study at a higher education institution. Results. In conclusion, according to the results of the final test cut, there is every reason to consider the implemented differential program effective in achieving the effectiveness of the correction of vestibular dysfunctions. This was reflected in the improvement of the results of the “10 Meter Walk Test” both in integral results and in intermediate sections, as well as in the results of tests used to control the level of balance development. The recorded positive dynamics within 9-19% of all students of the studied sample is evidence in favor of the implemented program. Conclusions. Research-experimental verification of the effectiveness of the implementation of the developed differentiated physical education course program for students after blast TBI, complicated by acuborotrauma, proved the effectiveness of the proposed innovations. The established dynamics of the studied indicators and their analysis made it possible to answer questions about the effectiveness of the implemented differentiated program aimed at eliminating functional disorders in the body of students as a result of blast TBI, complicated by acuborotrauma. The effectiveness of the implementation of the program is proven on the basis of the established improvement of the test results of the students of the studied sample.

Gait performance in older adults across the cognitive spectrum: Results from the GAIT cohort.

Gait performance can provide valuable insights into cognitive functioning in older adult and may be used to screen for cognitive impairment. However, the optimal test condition and spatiotemporal parameter for accuracy have not yet been determined. This study aims to determine the gait measure with the highest accuracy identifying cognitive decline. A total of 711 participants were recruited, including 332 cognitively healthy individuals, 264 with mild cognitive impairment (MCI), and 115 with dementia, with a mean age of 72 years (interquartile range 69-76), and 43% (n = 307) of women. The participants underwent gait assessment in three different conditions, including a single task and dual tasks of counting backward by ones and naming animals. Gait performance was deteriorated as cognitive impairment progressed. The gait test performed during naming animals condition was the most accurate in differentiating between cognitive groups. Specifically, the naming animals gait speed was more accurate in discriminating control participants from those with cognitive impairment (area under the curve [AUC] = 76.9% for MCI and 99.7% for people with dementia with control group as reference). The coefficient of stride length variability while naming animals was the most effective parameter in discriminating between MCI and dementia groups (AUC = 96.7%). The naming animals dual-task gait test can be a valuable assessment for screening cognitive impairment in older adults, regardless of their cognitive abilities. The test is useful in clinical settings for subjects with a range of cognitive profiles.

Influence of texting while walking on lower extremity gait function in young adults

Texting while walking (TWW) is a dual-task activity that young adults perform in their everyday lives. TWW has been reported to affect gait characteristics such as gait speed, stride length, and cadence. However, the influence of TWW on lower extremity gait function has not been investigated. Therefore, the purpose of this study was to quantify gait function by examining gait symmetry and using a time series analysis. Twenty-eight young adults (14 males, 14 females) walked at their preferred speed for 10 m as a baseline condition and a 10 m TWW task. Three-dimensional segment tracking was achieved utilizing a lower extremity and trunk marker set and the Model Statistic was used to test for statistical differences between the hip, knee, and ankle angular joint positions. The hip yielded the most asymmetries (25 out of 101 points) throughout the gait cycle, while asymmetries for the knee and ankle joints yielded 16 out of 101 points and 11 out of 101 points, respectively. The outcomes of this study suggest there are differences between baseline and TWW gait symmetry, however, the percentage of the gait cycle affected was less than 25 % - indicating gait function is not strongly influenced by texting while walking in young adults.

Sensor-Based Gait and Balance Assessment in Healthy Adults: Analysis of Short-Term Training and Sensor Placement Effects.

While the analysis of gait and balance can be an important indicator of age- or disease-related changes, it remains unclear if repeated performance of gait and balance tests in healthy adults leads to habituation effects, if short-term gait and balance training can improve gait and balance performance, and whether the placement of wearable sensors influences the measurement accuracy. Healthy adults were assessed before and after performing weekly gait and balance tests over three weeks by using a force plate, motion capturing system and smartphone. The intervention group (n = 25) additionally received a home-based gait and balance training plan. Another sample of healthy adults (n = 32) was assessed once to analyze the impact of sensor placement (lower back vs. lower abdomen) on gait and balance analysis. Both the control and intervention group exhibited improvements in gait/stance. However, the trends over time were similar for both groups, suggesting that targeted training and repeated task performance equally contributed to the improvement of the measured variables. Since no significant differences were found in sensor placement, we suggest that a smartphone used as a wearable sensor could be worn both on the lower abdomen and the lower back in gait and balance analyses.

Effects of body weight support training on balance and walking function in stroke patients: a systematic review and meta-analysis.

To comprehensively and quantitatively evaluate the impact of body weight support training (BWST) on balance and gait function in stroke patients based on an evidence-based basis and to identify the most effective intervention strategies. PubMed, Web of Science, The Cochrane Library, CNKI, Wanfang, and Chinese SinoMed Database were searched until November 25, 2023. Quality assessment and meta-analysis were performed using RevMan 5.2 and Stata 14.0 software. A total of 31 randomized controlled trials involving 1,918 patients were included in the study. The meta-analysis demonstrated that body weight support training (BWST) significantly improved Berg Balance Scale (BBS) scores (MD = 3.60; 95% CI: 1.23 to 5.98; p = 0.003), gait speed (SMD = 0.77; 95% CI: 0.38 to 1.15; p < 0.0001), and step length (SMD = 0.46; 95% CI: 0.19 to 0.72; p = 0.0008) in stroke patients compared to conventional rehabilitation. For enhancing balance function, the most effective interventions were identified as a disease duration of 3-6 months (MD = 5.16; 95% CI: 0.76 to 9.57; p = 0.02), intervention time of 4-8 weeks (MD = 5.70; 95% CI: 2.90 to 8.50; p < 0.0001), a maximum body weight support level above 30% (MD = 3.80; 95% CI: 1.48 to 6.13; p = 0.001), and a maximum training walking speed of 0.2 m/s or more (MD = 4.66; 95% CI: 0.37 to 9.70; p = 0.03). For improving walking function, the optimal interventions were also a disease duration of 3-6 months (gait speed: SMD = 0.59; 95% CI: 0.15 to 1.03; p = 0.008; step length: SMD = 0.27; 95% CI: 0.06 to 0.56; p = 0.04), intervention time of 4-8 weeks (gait speed: SMD = 1.01; 95% CI: 0.44 to 1.59; p = 0.0006; step length: SMD = 0.83; 95% CI: 0.54 to 1.12; p < 0.00001), a maximum body weight support level above 30% (gait speed: SMD = 0.79; 95% CI: 0.36 to 1.22; p = 0.0003; step length: SMD = 0.79; 95% CI: 0.47 to 1.11; p < 0.00001), and a maximum training walking speed of 0.2 m/s or more (gait speed: SMD = 1.26; 95% CI: 0.62 to 1.90; p = 0.0001; step length: SMD = 0.85; 95% CI: 0.38 to 1.31; p = 0.0003). Compared with conventional rehabilitation training, BWST demonstrates superior efficacy in enhancing balance and walking function in stroke patients, with a consistent optimal intervention strategy. The most effective program includes a disease duration of 3-6 months, an intervention period of 4-8 weeks, a maximum body weight support of 30% or more, and a maximum training walking speed of 0.2 m/s or greater. http://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022358963.

The Effect of Ten Weeks of Dual-Task Training on Functional Balance and Gait Speed Under Dual-Task Conditions in Bipolar Patients

Background: In mood disorders, disturbance in balance control and walking is a main motor symptom. Objectives: The aim of this study was to explore the impact of ten weeks of dual-task training on balance and gait speed under dual-task conditions in bipolar patients. Methods: Thirty male patients (age mean 43.13 ± 8.91) with bipolar disorder living in Urmia Psychiatric Center were assigned to the control group and the dual task training group. Dual-task training with moderate intensity, including 20 sessions, 2/week, per 75 min. To detect the changes in the balance and the gait speed, a timed up and go Test (TUG) under dual task conditions and a 10-m walking course under dual task conditions were administered before and after the exercise protocol. It was analyzed using analysis of covariance test. Results: The findings showed that the two groups had significant differences in TUG under motor dual task conditions, gait speed under motor dual task conditions, and gait speed under cognitive dual task conditions (P ≤ 0.05). Conclusions: Considering the effectiveness of cognitive dual-task training in improving gait speed and functional balance, dual-task training may be a potentially important supplement to conventional treatment in people identified as being at high risk of falling.

Associations between white and grey matter damage and gait impairment in cerebral amyloid angiopathy

BackgroundCerebral amyloid angiopathy (CAA) is associated with white matter damage and neurodegeneration. Gait is impaired in CAA; however, the neural basis of this impairment is unclear. Research questionAre gait impairments in patients with CAA associated with altered cerebral white matter diffusivity and/or atrophy of cortical and subcortical grey matter. MethodsParticipants with CAA (n=29), Alzheimer’s disease (AD; n=16), and normal controls (n=47) were included. Gait was assessed using a 6 m walkway with parameters categorized into rhythm, pace, postural control, and variability domains. The dual-task cost (DTC) of gait speed was calculated for counting backwards, animal fluency, and serial sevens tasks. Whole-brain white matter disruption was quantified using the peak width of skeletonized mean diffusivity (PSMD), and thickness and volume of select cortical, subcortical, and cerebellar regions were quantified using FreeSurfer. ResultsIn CAA participants, associations were found between PSMD and pace (standardized parameter estimate (β), 95 % confidence interval (CI): 0.17, 0.03–0.32), and medial orbital frontal cortical thickness and counting backwards DTC (parameter estimate (PE), 95 % CI: −5.7 %/SD, −0.24 to −11.23). Across all groups, including CAA, associations were found between PSMD and pace, variability, counting backwards DTC, and animal fluency DTC; between frontal cortical thickness and pace, counting backwards DTC, and animal fluency DTC; between cortical regions affected by AD (inferior parietal cortex, inferior and middle temporal gyrus) and counting backwards DTC; and between thalamus volume and postural control. SignificanceReduced white matter structural integrity and grey matter loss is associated with poor overall gait performance in CAA, AD, and normal controls.

Effectiveness of Physiotherapy for Improving Functionality, Participation, and Quality of Life after a Stroke: Study Protocol for a Randomized Controlled Clinical Trial.

Stroke survivors experience significant alterations in their daily functionality that has a negative impact on their functionality, participation, and quality of life. Person-centered approaches in Physical Therapy interventions that are focused on functional and meaningful goals help to minimize the impact of the alterations. Therefore, the aim of this study is to assess the effectiveness of a Physical Therapy intervention based on a goal-oriented approach with task-specific training for improving functionality, participation, and quality of life for people with Stroke. A single-blinded randomized controlled clinical trial will be developed. Adults over 50 years old diagnosed with Stroke over 6 months will be included in this study. Participants (n = 62) will be randomly allocated into two groups: The experimental group (n = 31) will receive 30 sessions, three per week during 10 weeks, of Physical Therapy sessions of goal-directed and task-specific training. The control group (n = 31) will follow the same intervention intensity of their usual Physical Therapy treatment. The primary outcome variables quality of life (NewsQol), participation (Ox-PAQ), and gait functionality (FAC) and the secondary outcome variables functional disability (BI), postural control (PASS), dynamic trunk balance (TIS), and functional goals (GAS) will be measured at baseline, after group interventions (10 weeks), and 6 months after the baseline. Statistical analyses will include repeated-measures ANOVA, Student's t-test, or the Mann-Whitney U-test, with a 95% confidence interval and significance level of p < 0.05. Person-centered approaches in Physical Therapy interventions may yield better outcomes in functionality, participation, and quality of life for Stroke patients compared to standardized interventions. ClinicalTrials.gov: NCT06165666 (December 2023).

Effects on Gait and Balance of VIM Gamma Knife Radiosurgery in Essential Tremor

Introduction: Essential tremor (ET) is the most common movement disorder, characterized by an action tremor in the upper limbs. Neurosurgical techniques targeting the thalamic ventrointermediate nucleus (VIM) including thermocoagulation demonstrated a potential risk for gait and posture worsening. This study evaluates the potential effect of VIM Gamma Knife radiosurgery (GKR) in ET on gait and posture performances. Methods: We conducted a prospective study to quantitatively assess gait and balance in severe ET patients before and 1 year after unilateral GKR. Seventy-three patients were included in this series. Results: First, we confirmed the unilateral GKR efficacy in severe ET patients: global tremor score and impairments in activities of daily living improved, respectively, by 67% and 71.7%. The global gait and posture analysis found no significant differences before and 1 year after GKR. Three patients (4.1%) developed mild to moderate gait and posture impairment with proprioceptive ataxia. All of these AEs were induced by a hyper-response to radiosurgery. Conclusions: Gait and posture performances were not statistically significant at the population. Nevertheless, gait and posture worsened in 4% of patients after GKR, all in the setting of hyper-response. This study shows that GKR may be a safe neurosurgical alternative to improve ADL in a population of patients with TE.