Gait Velocity In Patients Research Articles

P114. Cervical decompression surgery improves postural stability and gait velocity in patients with cervical spondylotic myelopathy

<h3>BACKGROUND CONTEXT</h3> Cervical spondylotic myelopathy (CSM) is a progressive degenerative condition that can lead to functional deficits and gait instability. Biomechanical changes to a patient's dynamic and postural stability after decompressive surgery are poorly understood. <h3>PURPOSE</h3> The aim of this study was to determine how spatiotemporal gait parameters, postural stability and dynamic stability change after decompressive surgery in patients with CSM. <h3>STUDY DESIGN/SETTING</h3> Prospective cohort study. <h3>PATIENT SAMPLE</h3> Patients aged 40 to 80 years old with Nurick grade 2 or 3 CSM spanning one to four levels undergoing decompressive surgery were prospectively enrolled in this study. Decompression surgery was defined as decompression with or without fusion of the cervical vertebra. Exclusion criteria included: patients who could not ambulate independently, had a history of surgery within 6 months of initial gait evaluation or gait altering lower extremity surgery. <h3>OUTCOME MEASURES</h3> A tilted ellipse area with bidirectional variance was used to assess postural stability metrics. Generated ground reaction forces (GRF) and variation in bidirectional center of pressure (CoP) motion were recorded and represented in an ellipse area around patient-generated CoP. Additionally, the analysis consisted of the examination of the following spatiotemporal gait parameters: stride length (distance over the ground between ipsilateral heel strikes), cadence (steps per minute), velocity (the speed of the patient's center of mass (CoM), step width (distance between two feet during period of double support), toe-off (percentage of the pre-swing portion of the gait cycle where ipsilateral limb leaves the ground and initializes single leg support) and double support (percentage of gait cycle spent with two feet on the ground). Dynamic stability of gait is inversely proportional to angular momentum regulation, where greater stability is shown by minimizing angular momentum excursion. Angular momentum was calculated using exported joint centers and joint angles, where each segment's angular momentum was computed as the sum of its local angular momentum and the angular momentum of the segment about the whole-body CoM, which was taken to be the sum of 15 body segments. <h3>METHODS</h3> A total of 47 subjects, including 23 Nurick grade 2 or 3 CSM patients and 24 controls, were included. Measurements were taken at baseline in both cohorts and then at 3- and 6-months following decompression in the CSM cohort. Standing balance trials were performed on a single force plate, and walking trials were conducted at a self-selected pace over a 15m runway and a series of five force plates. All trials were recorded with 3D motion analysis cameras, and gait modeling software was utilized. Repeated measures ANOVA was used to compare measurements at three timepoints, followed by paired t-tests. The significance value was set at P<0.05. <h3>RESULTS</h3> Patients with CSM had a significant increase in gait velocity postoperatively at 6 months (0.948 ± 0.248 m/s) compared to baseline (0.852 ± 0.257 m/s) (P = 0.008). CSM patients had a significant decrease in tilted ellipse area from baseline (979.8 ± 856.7 mm2) to 6 months (598.0 ± 391.1 mm2) (P = 0.018) postoperatively. There was no significant difference in angular momentum excursion between baseline and postoperative measurements. <h3>CONCLUSIONS</h3> Decompressive surgery in CSM patients was associated with significant improvement in gait velocity and postural stability. However, there was no significant change in dynamic stability throughout the study period. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Multichannel Transcranial Direct Current Stimulation Combined With Treadmill Gait Training in Patients With Parkinson's Disease: A Pilot Study.

BackgroundGait problems are critical impairments in Parkinson's disease (PD) and are related to increased risk of fall and negatively impact activities of daily life. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that can modify the cortical excitability of gait-related brain regions. In this study, we investigated whether multichannel tDCS with simultaneous treadmill gait training could improve gait in PD.MethodsTwenty-four patients with PD were assigned randomly to a real or sham tDCS group. Before intervention, one patient of the real tDCS group was dropped out, leaving 23 patients to be analyzed in this study. Each patient underwent 30 min of treadmill gait training for 10 sessions over four consecutive weeks. Multichannel 4x1 tDCS was applied using five 6-cm-diameter round electrodes. One anode was placed on the CZ, and four cathodes were positioned symmetrically over the FZ, C5, C6, and PZ. Anodal tDCS (2mA) and sham tDCS were delivered for 20 min. The secondary outcomes were gait performance, as measured by the timed up and go test (TUG) and freezing of gait questionnaire (FOG-Q), and balance was assessed using the dynamic gait index (DGI), Berg balance scale (BBS), and functional reach test (FRT). Motor and non-motor performance of patients with PD were assessed using the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS). Participants were assessed before the intervention, immediately after the intervention, and 4 weeks after completion of the intervention.ResultsThe real tDCS group showed a significant improvement in the 10-m walk test, but the sham group did not. Among the secondary outcome measures, MDS-UPDRS part II, TUG, and BBS were improved only in the real tDCS group. Particularly, MDS-UPDRS part II showed a significant group*time interaction effect, indicating that real tDCS demonstrated a better effect on the activities of daily living patients with PD.ConclusionsThe results of this pilot study suggest that multichannel tDCS applied on the leg motor cortex during treadmill gait training is a safe and effective means to improve gait velocity in patients with PD. Additional rigorous, large-sample, multicenter, randomized controlled trials are needed to confirm the effect of tDCS as a therapeutic adjunct for gait rehabilitation of patients with PD.

Effects of Health Qigong Exercise on Lower Limb Motor Function in Parkinson's Disease.

PurposeThis study explored the effects of Health Qigong exercise on lower limb motor function in patients with Parkinson's disease (PD).Patients and MethodsA total of 40 patients with PD were recruited and randomly allocated into the experimental group and the control group. The experimental group completed an intervention of Health Qigong exercise over 12 weeks, while the control group did not perform any regular physical activity. Data relating to gait, lower-limb joint range of motion, Timed Up and Go, as well as scores for motor function scale from the Unified Parkinson's Comprehensive Rating Scale III (UPCRS III) before and after the intervention were collected for Repeated Measure ANOVA.ResultsCompared to the control group, Health Qigong exercise improved the constant- and high-speed stride length and gait velocity of patients, but not constant- and high-speed stride frequency. Left and right hip flexion and extension range were improved as well as left and right knee flexion range. Finally, Timed Up and Go time became significantly slower and UPCRS III score significantly decreased.ConclusionHealth Qigong exercise can improve walking ability and lower limb joint range of motion in patients with PD, lessen motor difficulties, and improve the quality of life. This non-pharmacological exercise intervention may be a useful adjustment treatment for PD.

Lateralized Subthalamic Stimulation for Axial Dysfunction in Parkinson's Disease: A Randomized Trial.

Patients with Parkinson's disease might develop treatment-resistant axial dysfunction after bilateral subthalamic stimulation. To study whether lateralized stimulation (unilateral 50% amplitude reduction) for ≥21 days results in ≥0.13 m/s faster gait velocity in the dopaminergic ON state in these patients, and its effects on motor and axial function, quantitative gait and speech measures, quality of life, and selected cognitive tasks. Randomized, double-blinded, double-crossover trial. In 22 participants (51-79 years old, 15 women), there were no significant changes in gait velocity, quality of life, cognitive, and speech measures. Reducing left-sided amplitude resulted in a 2.5-point improvement in axial motor Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) (P=0.005, uncorrected) and a 1.9-point improvement in the Freezing of Gait Questionnaire (P=0.024, uncorrected). Lateralized subthalamic stimulation does not result in meaningful improvement in gait velocity in patients with Parkinson's disease who develop treatment-resistant axial dysfunction after bilateral subthalamic stimulation. Left subthalamic overstimulation may contribute to axial deterioration in these patients. © 2022 International Parkinson and Movement Disorder Society.

Effects of resistance training on gait velocity and knee adduction moment in knee osteoarthritis patients: a systematic review and meta-analysis

The systematic review aimed to analyze the effects of resistance training in knee osteoarthritis (OA) rehabilitation from a biomechanical perspective. A meta-analysis was performed to determine the potential benefits of resistance training on patients with knee OA. Relevant studies based on the inclusion and exclusion criteria were selected from CENTRAL, PubMed, Scopus, and Web of Science databases inception to August 2020. Outcome measures included gait velocity and knee adduction moment (KAM). The mean differences of the data with a 95% confidence interval were analyzed using STATA 15.1 software The search identified eight studies that satisfied all the inclusion criteria, in which 164 patients were involved in gait velocity studies and another 122 patients were part of KAM studies. Analysis of the pooled data showed that resistance training significantly improved the gait velocity in patients with knee OA (p < 0.01, z = 2.73), ES (95% CI) = 0.03 (0.01, 0.06) m/s. However, resistance training had no significant effect on improving KAM in patients with knee OA (p = 0.98, z = 0.03), ES (95% CI) = 0.00 (− 0.16, 0.16) percentage of body weight × height (%BW × Ht). Therefore, resistance training may enhance gait velocity but not KAM in knee OA patients. The protocol was registered at PROSPERO (registration number: CRD42020204897).

Cognitive Impairment in Patients with Atrial Fibrillation without Stroke

Background: Vascular dementia is the second leading cause of dementia worldwide; however, the causation is multifactorial and may be preventable. There is increasing evidence that atrial fibrillation (AF) is independently correlated with cognitive decline. Assessing cognition in an outpatient setting is challenging. Gait speed may be able to transcend language in assessing cognition. We aim to assess cognitive impairment in patients with AF without known history of stroke with gait speed. Methods: This was a prospective, observational study of patients attending cardiology outpatient department. Patients were screened for a history of valvular or nonvalvular AF. Controls were patients without AF. Patients underwent structured interview, Montreal cognitive assessment (MoCA), and gait velocity assessment. Gait velocity and MoCA scores were compared in control and cases using Student's t-test. Results: A total of 189 patients were consented; 88 cases with AF and 101 controls. Mean ± standard deviation age was 60 ± 12 years. The median (interquartile range) gait velocity in patients with AF and nonAF was similar (0.80 [0.65–0.93] m/s vs. 0.80 [0.65–0.93] m/s, P = 0.708). The mean MoCA scores in patients with AF and without AF were also similar (17.38 ± 5.66 vs. 18.36 ± 5.30, P = 0.229). A cutoff value of &lt;0.80 m/s had sensitivity of 66% and specificity of 61.4% to diagnose dementia. Conclusion: There is a high occurrence of cognitive deficits in patients with and without AF visiting a cardiology outpatient clinic. Future studies are needed to target this group of the patient to reduce the burden of vascular dementia.

Effects of robot-assisted gait training in patients with Parkinson\u2019s disease: study protocol for a randomized controlled trial

BackgroundRobot-assisted gait training (RAGT) was developed to restore gait function by promoting neuroplasticity through repetitive locomotor training and has been utilized in gait training. However, contradictory outcomes of RAGT have been reported for patients with Parkinson’s disease (PD). In addition, the mechanism of the RAGT treatment effect is still unknown. This study aims to investigate the effects of RAGT on gait velocity in patients with PD and to unveil the mechanisms of these effects.MethodsThis is a prospective, single-blind, single-center, randomized controlled trial. Eligible participants will be randomly allocated to: 1) a Walkbot-S™ RAGT group or 2) a treadmill training group. The participants will receive three 45-min sessions of each intervention per week for 4 weeks. Gait speed during RAGT will be targeted to the maximal speed depending on the participant’s height; the same principle will be applied to the treadmill training group to match the training intensity. The primary outcome measure is gait speed measured by the 10-Meter Walk Test at a comfortable pace under single-task conditions. Secondary outcomes include dual-task interference, the Berg Balance Scale, Timed Up and Go test, the Korean version of the Falls Efficacy Scale-International, New Freezing of Gait Questionnaire, Movement Disorder Society-sponsored revision of the Unified Parkinson’s Disease Rating Scale, and functional connectivity measured by resting-state functional magnetic resonance imaging. Baseline assessments (T0) will be conducted to acquire clinical characteristics and outcome measure values before the intervention. Postintervention assessments (T1) will compare immediate efficacies within 3 days after the intervention. Follow-up assessments (T2) will be conducted 1 month after the intervention. Considering an alpha of 0.05 and a power of 80%, the total number of participants to be recruited is 44.DiscussionThis study will reveal the effect of RAGT using an exoskeletal robot, not only on gait speed, but also on gait automaticity, balance function, fall risk, quality of life, and disease severity. In addition, the study will shed new light on the mechanism of the RAGT effect by evaluating changes in gait automaticity and brain functional networks.Trial registrationClinicalTrials.gov, NCT03490578. Registered on 21 March 2018.

Effects of ankle joint mobilization with movement and weight-bearing exercise on knee strength, ankle range of motion, and gait velocity in patients with stroke: a pilot study.

[Purpose] The purpose of this study was to investigate the effects of ankle joint mobilization with movement on knee strength, ankle range of motion, and gait velocity, compared with weight-bearing exercise in stroke patients. [Subjects and Methods] Thirty subjects with chronic stroke were divided into three groups: MWM (n = 12), WBE (n = 8), and control (n = 10). All groups attended physical therapy sessions 3 times a week for 5 weeks. Subjects in the MWM group performed mobilization with movement exercises, whilst participants in the WBE group performed weight-bearing exercises. Knee peak torque, ankle range of motion, and spatiotemporal gait parameters were evaluated before and after the interventions. [Results] Knee extensor peak torque increased significantly in both MWM and WBE groups. However, only the MWM group showed significant improvement in passive and active ankle range of motion and gait velocity, among the three groups. [Conclusion] Ankle joint mobilization with movement intervention is more effective than simple weight-bearing intervention in improving gait speed in stroke patients with limited ankle motion.

Influence of botulinum toxin in injection in gait velocity of patients with lower limb spasticity

Influence of botulinum toxin in injection in gait velocity of patients with lower limb spasticity

The Effect of Lumbosacral Stabilization Exercise on Oswestry Disability Index and Gait Velocity of Patients with Chronic Low Back Pain

The present study is to determine the effect of lumbosacral stabilization exercise program on back pain disorder and gait velocity of patients with chronic low back pain. The subject was extracted randomly from 34 patients with chronic low back pain and divided into 18 patients of experimental group and 16 patients of control group. Before the experiment, the Oswestry disability index examination and analysis of gait speed were performed. Then, a conventional interventional therapy of physiotherapy was performed with the experimental group along with the lumbosacral stabilization exercise while only the conventional interventional therapy was done to the control group. Both groups did the above treatment every 30 minutes, four times a week for four weeks. Then, post-examination was carried out followed by comparing the back pain disorder index and gait velocity before and after the experiment for the two groups. The back pain disorder index showed that both experimental and control groups had significant difference within the group (p>.01)(p>.05), With regard to the gait velocity, both experimental and control groups had a significant difference within the experimental group and between the groups (p>.001)(p>.05).

Dual-channel functional electrical stimulation improvements in speed-based gait classifications

BackgroundFunctional electrical stimulation (FES) is becoming an accepted treatment method for enhancing gait performance in patients who present with gait difficulties resulting from hemiparesis. The purpose of this study was to test whether individuals with hemiparesis who have varied gait speeds, which place them in different functional categories, benefit to the same extent from the application of FES.MethodsThirty-six subjects with chronic hemiparesis demonstrating foot-drop and deficits in knee and/or hip control were fitted with a dual-channel FES system activating the dorsiflexors and hamstring muscles. Gait was assessed during a 2-minute walk test with and without stimulation. A second assessment was conducted after 6 weeks of daily use. Analysis was performed with the subjects stratified into three functional ambulation classes according to their initial gait categories.ResultsThe dual-channel FES improved the gait velocity of all three subgroups. No minimal gait velocity was required in order to gain benefits from FES. For example, subjects with limited household ambulation capabilities improved their gait speed by 63.3% (from 0.30 ± 0.09 m/sec to 0.49 ± 0.20 m/sec; P < 0.01), while subjects with functional community ambulation capabilities improved their gait speed by 25.5% (from 0.90 ± 0.11 m/sec to 1.13 ± 0.22 m/sec; P < 0.01).ConclusionDual-channel FES positively affects gait velocity in patients with chronic hemiparesis, regardless of their initial gait velocity. Furthermore, gait velocity gains may be large enough to change an individual’s ambulation status to a higher functional category.

Minimum Detectable Change in Gait Velocity during Acute Rehabilitation following Hip Fracture

Early ambulation and rehabilitation are recommended for patients undergoing surgical fixation of hip fracture. Gait velocity may be used as an outcome measure for these patients during acute rehabilitation. As an outcome measure, an estimate of meaningful change (responsiveness) in gait velocity for these patients, however, has not been described. The minimum detectable change (MDC) is a value that represents true change in a measure beyond that accounted for by measurement error. The purpose of this study was to quantify MDC in gait velocity as an index of responsiveness for persons in the acute stage of rehabilitation following hip fracture. The study design was a descriptive cohort study with one repeated measure. A volunteer sample of 16 subjects over the age of 65, at a mean of 4.7 days postsurgical fixation of unilateral hip fracture, participated in the study. The study was conducted in an acute care rehabilitation practice in a large, tertiary care hospital. We measured gait velocity with the 10-meter walk test, estimated test-retest reliability with an intraclass correlation coefficient and quantified responsiveness of gait velocity as the MDC at a 95% level of confidence. Mean gait velocity was 15 cm/s and the test-retest reliability coefficient was equal to 0.823. The MDC in gait velocity during acute rehabilitation following surgical repair for hip fracture was 8.2 cm/s. Self-selected gait velocity in patients during acute rehabilitation following surgical fixation for hip fracture must improve by 8.2 cm/s or more to designate the change as being real change beyond the bounds of measurement error.

MINIMUM DETECTABLE CHANGE IN GAIT VELOCITY DURING ACUTE REHABILITATION FOLLOWING HIP FRACTURE.

Purpose/Hypothesis: Clinicians can measure and document a patient's gait velocity as a means for providing an objective assessment of functional improvement during rehabilitation following hip fracture. Interpreting the magnitude of change in gait velocity that is clinically meaningful, however, can be difficult. The purpose of this study was to calculate the minimum detectable change (MDC) as a measure of responsiveness of gait velocity in patients hospitalized following surgical fixation for traumatic hip fractures. Subjects: Fifteen adults age 65 or older with acute, traumatic, unilateral, intra-capsular hip fractures were recruited from St. Marys Hospital in Rochester, MN, to participate in this study. Subjects included six men and nine women who provided consent to participate in the study. Materials/Methods: Subjects performed two timed trials of the 10 meter walk test (10 MWT). Subjects were permitted to walk with the use of a gait aid, most often a rolling walker, but no verbal or tactile cueing was given to aid ambulation. Investigators used a stopwatch to measure the time it took for subjects to complete the 10 MWT and subsequently calculated gait velocity. The mean and standard deviation (SD) of subjects' first 10 MWT trial was calculated and a test-retest (ICC3,1) reliability coefficient was calculated using gait velocity data obtained from the second trial of the 10 MWT. The SD and testretest reliability coefficient data were then used to calculate the MDC at a 95% level of confidence. Results: Across subjects, mean gait velocity was equal to 15 cm/s with a SD of 5 cm/s. The test-retest reliability, estimated with the ICC3,1 coefficient, was equal to 0.813 (95% CI = 0.515 to 0.936). The MDC was equal to 6 cm/s. Conclusions: Based on these preliminary results, the gait velocity of a patient in the acute phase of rehabilitation following surgical fixation of a traumatic, unilateral hip fracture must improve by 6 cm/s or more in order to designate the change as being meaningful and beyond the bounds of measurement error. Clinical Relevance: Clinicians may use this data to establish a threshold for interpreting meaningful change in gait velocity.

TEST-RETEST RELIABILITY AND MINIMAL DETECTABLE CHANGE OF GAIT VELOCITY IN INDIVIDUALS UNDERGOING REHABILITATION AFTER STROKE

Purpose/Hypothesis: Gait velocity is commonly used to assess walking ability in persons with stroke. Previous research related to the psychometric properties of gait velocity has been conducted primarily with individuals who were able to walk independently and/or were in the later stages of recovery. The purpose of this research was to examine the test-retest reliability and minimal detectable change (MDC90) of gait velocity with individuals with stroke undergoing inpatient rehabilitation who required varying levels of assistance to ambulate. Number of Subjects: Thirty-five individuals participated. The mean age was 67.4 years (std 13.8), mean time since stroke was 34.5 days (std 17.7), and median FIM™ locomotion score was 5 (range 2–7). Materials/Methods: Gait velocity was measured using a 5m walk test at a self selected comfortable pace on two occasions separated by one to three days. Test-retest reliability was assessed using ICC2, 1, and the MDC90 was calculated using the technique described by Stratford. Results: For all the subjects combined the ICC2, 1=0.862 and MDC90=0.30 m/s. For the 13 subjects that required physical assistance to walk the ICC2, 1=0.971 and MDC90=0.07 m/s. For the 22 subjects that could walk without physical assistance the ICC2, 1=0.80 and MDC90=0.36 m/s. Conclusions: Gait velocity is a reliable measure for both individuals who require physical assistance to walk and those who do not after stroke. These results indicate that in order to be certain that a change in gait velocity is not a result of chance variation there needs to be a greater change in individuals who can ambulate without physical assistance compared to those who require physical assistance. Clinical Relevance: Assessing walking ability using gait velocity in patients with stroke undergoing rehabilitation who do not require physical assistance requires a change greater than 0.36 m/s to be certain the change is not a result of measurement variability. For patients who require physical assistance to ambulate the change in gait velocity need only be greater than 0.07 m/s to be certain that the change is not a result of measurement variability.

Fear of falling, balance, and gait velocity in patients with stroke

After a stroke balance can be impaired, that may influence the physical activities which can be undertaken. A person's confidence in performing activities without falling could be as important as the real balance ability in situations of daily living. The aims of the study were to evaluate the relationship between perceived self-confidence in task performance without falling, using the Falls Efficacy Scale, Swedish version, (FES(S)) and observer-assessed balance, measured by the BDL Balance Scale (BDL BS) and also between the FES(S) and gait velocity. Thirty-one subjects with stroke, 32–62 years of age, time since onset between 3 and 104 months, participated. The FES(S) was significantly correlated with the BDL BS (r = 0.49, p = 0.008). Furthermore there were significant correlations between the FES(S) and self-selected (r = 0.53, p = 0.003) as well as for maximum (r = 0.55, p = 0.002) gait velocity. The results indicate that the use of the FES(S) can be recommended in subjects with stroke and balance deficit in order to map out the dimension of self-confidence in balance problems. However, in more highly functioning subjects with stroke other fall-efficacy assessments with major demands on balance performance may be preferable due to partly ceiling effect in the study population.