Improvement In Gait Pattern Research Articles

Effect of adapted dance program on gait in adults with cerebral palsy: a pilot study.

The gait function in adults with cerebral palsy (CP) deteriorates rapidly with age. Dance has been used as an effective intervention to improve balance, postural control, and gait. This study aimed to investigate the feasibility and effects of an adapted dance program (ADP) on the gait in adults with CP. The ADP, which consists of floor and barre workouts, was designed to be adapted for individuals with CP. Ten female adults with spastic diplegic CP (mean age 52.3 ± 6.34, Gross Motor Function Classification System level II) participated in this study. Outcome measures, examined using 3D gait analysis, included spatiotemporal gait parameters and the Gait Deviation Index (GDI) based on nine kinematic variables in all planes of motion. To assess feasibility, we conducted post-questionnaires and a group interview. The ADP, each lasting 90 min, was held twice per week for 12 weeks. A statistically significant improvement was observed in GDI (Δ5.74 points, p = 0.014), with a large effect size (d = 0.76). Foot off (Δ-0.72%), first double support (Δ-0.2%), second double support (Δ1.5%), and single support (Δ0.64%) showed no significant differences. Step length (Δ1.48 cm), cadence (Δ3.95 steps/min), and walking speed (Δ6.41 cm/s) tended to increase, though the differences were not statistically significant. Participants expressed high levels of physical and emotional satisfaction, suggesting a need for early intervention. The ADP may improve gait patterns in adults with spastic diplegic CP. The feasibility results indicated that the ADP is suitable for adults with spastic diplegic CP. This study provides evidence for improvement in gait patterns through dance, which has not been reported in previous dance studies on individuals with CP, offering additional information on the benefits of dance.

Wearable biofeedback device to assess gait features and improve gait pattern in people with parkinson’s disease: a case series

IntroductionPeople with Parkinson’s Disease (PD) show abnormal gait patterns compromising their independence and quality of life. Among all gait alterations due to PD, reduced step length, increased cadence, and decreased ground-reaction force during the loading response and push-off phases are the most common. Wearable biofeedback technologies offer the possibility to provide correlated single or multi-modal stimuli associated with specific gait events or gait performance, hence promoting subjects’ awareness of their gait disturbances. Moreover, the portability and applicability in clinical and home settings for gait rehabilitation increase the efficiency in the management of PD. The Wearable Vibrotactile Bidirectional Interface (BI) is a biofeedback device designed to extract gait features in real-time and deliver a customized vibrotactile stimulus at the waist of PD subjects synchronously with specific gait phases. The aims of this study were to measure the effect of the BI on gait parameters usually compromised by the typical bradykinetic gait and to assess its usability and safety in clinical practice.MethodsIn this case series, seven subjects (age: 70.4 ± 8.1 years; H&Y: 2.7 ± 0.3) used the BI and performed a test on a 10-meter walkway (10mWT) and a two-minute walk test (2MWT) as pre-training (Pre-trn) and post-training (Post-trn) assessments. Gait tests were executed in random order with (Bf) and without (No-Bf) the activation of the biofeedback stimulus. All subjects performed three training sessions of 40 min to familiarize themselves with the BI during walking activities. A descriptive analysis of gait parameters (i.e., gait speed, step length, cadence, walking distance, double-support phase) was carried out. The 2-sided Wilcoxon sign-test was used to assess differences between Bf and No-Bf assessments (p < 0.05).ResultsAfter training subjects improved gait speed (Pre-trn_No-Bf: 0.72(0.59,0.72) m/sec; Post-trn_Bf: 0.95(0.69,0.98) m/sec; p = 0.043) and step length (Pre-trn_No-Bf: 0.87(0.81,0.96) meters; Post-trn_Bf: 1.05(0.96,1.14) meters; p = 0.023) using the biofeedback during the 10mWT. Similarly, subjects’ walking distance improved (Pre-trn_No-Bf: 97.5 (80.3,110.8) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.028) and the duration of the double-support phase decreased (Pre-trn_No-Bf: 29.7(26.8,31.7) %; Post-trn_Bf: 27.2(24.6,28.7) %; p = 0.018) during the 2MWT. An immediate effect of the BI was detected in cadence (Pre-trn_No-Bf: 108(103.8,116.7) step/min; Pre-trn_Bf: 101.4(96.3,111.4) step/min; p = 0.028) at Pre-trn, and in walking distance at Post-trn (Post-trn_No-Bf: 112.5(97.5,124.5) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.043). SUS scores were 77.5 in five subjects and 80.3 in two subjects. In terms of safety, all subjects completed the protocol without any adverse events.ConclusionThe BI seems to be usable and safe for PD users. Temporal gait parameters have been measured during clinical walking tests providing detailed outcomes. A short period of training with the BI suggests improvements in the gait patterns of people with PD. This research serves as preliminary support for future integration of the BI as an instrument for clinical assessment and rehabilitation in people with PD, both in hospital and remote environments.Trial registrationThe study protocol was registered (DGDMF.VI/P/I.5.i.m.2/2019/1297) and approved by the General Directorate of Medical Devices and Pharmaceutical Service of the Italian Ministry of Health and by the ethics committee of the Lombardy region (Milan, Italy).

ATP1A2-related epileptic encephalopathy and movement disorder: Clinical features of three novel patients.

Variants in the ATP1A2 gene exhibit a wide clinical spectrum, ranging from familial hemiplegic migraine to childhood epilepsies and early infantile developmental epileptic encephalopathy (EIDEE) with movement disorders. This study aims to describe the epileptology of three unpublished cases and summarize epilepsy features of the other 17 published cases with ATP1A2 variants and EIDEE. Medical records of three novel patients with pathogenic ATP1A2 variants were retrospectively reviewed. Additionally, the PUBMED, EMBASE, and Cochrane databases were searched until December 2023 for articles on EIDEE with ATP1A2 variants, without language or publication year restrictions. Three female patients, aged 6 months-10 years, were investigated. Epilepsy onset occurred between 5 days and 2 years, accompanied by severe developmental delay, intellectual disability, drug-resistant epilepsy, severe movement disorder, and recurrent status epilepticus. All individuals had pathogenic variants of the ATP1A2 gene (ATP1A2 c.720_721del (p.Ile240MetfsTer9), ATP1A2c.3022C > T (p.Arg1008Trp), ATP1A2 c.1096G > T (p.Gly366Cys), according to ACMG criteria. Memantine was p) rescribed to three patients, one with a reduction in ictal frequency, one with improvement in gait pattern, coordination, and attention span, and another one in alertness without significant side effects. This study reinforces the association between ATP1A2 variants and a severe phenotype. All patients had de novo variants, focal motor seizures with impaired awareness as the primary type of seizure; of the 11 EEGs recorded, 10 presented a slow background rhythm, 7 multifocal interictal epileptiform discharges (IED), predominantly temporal IEDs, followed by frontal IED, as well as ten ictal recordings, which showed ictal onset from the same regions mentioned above. Treatment with antiseizure medication was generally ineffective, but memantine showed moderate improvement. Prospective studies are needed to enlarge the phenotype and assess the efficacy of NMDA receptor antagonist therapies in reducing seizure frequency and improving quality of life.

Analyzing the Efficacy of Anti-Gravity Treadmill in Enhancing Gait and Balance among Patients with Spastic Cerebral Palsy – A Critical Review

Background: In the pediatricpopulation, cerebral palsy is the most prevalent neurological condition. As the result of prenatal or perinatal events, the cause of this complex physical disability is cast over the congenital fragility. There is often a challenge in gait and balance forindividuals with spastic cerebral palsy. Innovative interventions for spastic cerebral palsy such as the anti-gravity treadmill which simulatespartial weight-bearing have been sparked in innovative rehabilitation technologies. This study aims to assess published studies on anti-gravity treadmill training, evaluating their strengths and weaknesses, considering study design, sample size, outcomes, and limitations. This critical review will make recommendations for future research and addressthe limitationsidentified in the current body of literature. Methods: A quantitative research critical review form is used to analyze the eleven studies with different study designs, including 6 Randomized Control Trials, 2 Experimental Study, 1 Prospective Study, 1 Systematic review and meta-analysis and 1 study where not clearly mentioned about their study design. This review includes studies obtained from Google Scholar, PubMed, Cochrane, and ResearchGate databases. Our primary focus revolves around the studies with populations of spastic cerebral palsy and outcomes associated with balance and gait.Conclusion:This critical review concludes that the anti-gravity treadmill enhances gait and balance for children with spastic cerebral palsy. There were positive outcomesdespite variations in methodologies and limited studies, including improved gait patterns and enhanced balance. In spite of the necessity for standardized research, anti-gravity treadmills may be an effective way to address the motor challenges of those with spastic cerebral palsy. The long-term efficacy of this intervention needs to be confirmed and compared with alternatives through further robust studies

Evidence for the Efficacy of Commercially Available Wearable Biofeedback Gait Devices: Consumer-Centered Review.

The number of wearable technological devices or sensors that are commercially available for gait training is increasing. These devices can fill a gap by extending therapy outside the clinical setting. This was shown to be important during the COVID-19 pandemic when people could not access one-on-one treatment. These devices vary widely in terms of mechanisms of therapeutic effect, as well as targeted gait parameters, availability, and strength of the evidence supporting the claims. This study aimed to create an inventory of devices targeting improvement in gait pattern and walking behavior and identify the strength of the evidence underlying the claims of effectiveness for devices that are commercially available to the public. As there is no systematic or reproducible way to identify gait training technologies available to the public, we used a pragmatic, iterative approach using both the gray and published literature. Four approaches were used: simple words, including some suggested by laypersons; devices endorsed by condition-specific organizations or charities; impairment-specific search terms; and systematic reviews. A findable list of technological devices targeting walking was extracted separately by 3 authors. For each device identified, the evidence for efficacy was extracted from material displayed on the websites, and full-text articles were obtained from the scientific databases PubMed, Ovid MEDLINE, Scopus, or Google Scholar. Additional information on the target population, mechanism of feedback, evidence for efficacy or effectiveness, and commercial availability was obtained from the published material or websites. A level of evidence was assigned to each study involving the device using the Oxford Centre for Evidence-Based Medicine classification. We also proposed reporting guidelines for the clinical appraisal of devices targeting movement and mobility. The search strategy for this consumer-centered review yielded 17 biofeedback devices that claim to target gait quality improvement through various sensory feedback mechanisms. Of these 17 devices, 11 (65%) are commercially available, and 6 (35%) are at various stages of research and development. Of the 11 commercially available devices, 4 (36%) had findable evidence for efficacy potential supporting the claims. Most of these devices were targeted to people living with Parkinson disease. The reporting of key information about the devices was inconsistent; in addition, there was no summary of research findings in layperson's language. The amount of information that is currently available to the general public to help them make an informed choice is insufficient, and, at times, the information presented is misleading. The evidence supporting the effectiveness does not cover all aspects of technology uptake. Commercially available technologies help to provide continuity of therapy outside the clinical setting, but there is a need to demonstrate effectiveness to support claims made by the technologies.

Effects of age-related changes in trunk and lower limb range of motion on gait

BackgroundThe ability to walk is crucial for maintaining independence and a high quality of life among older adults. Although gait characteristics have been extensively studied in older adults, most studies have investigated muscle activity in the joints of the trunk or the lower limbs without assessing their interactions. Thus, the causes of altered trunk and lower limb movement patterns in older adults remain to explore. Therefore, this study compared the joint kinematic parameters of both trunk and lower limbs between young and older adults to identify kinematic factors associated with changes in gait among older adults.MethodsIn total, 64 older (32 males, aged 68.34 ± 7.38 years; 32 females, aged 67.16 ± 6.66 years) and 64 young (32 males, aged 19.44 ± 0.84 years; 32 females, aged 19.69 ± 0.86 years) healthy adults participated in this study. The range of motion (ROM) of the thorax, pelvis, and trunk in the horizontal plane and of the hip, knee, and ankle joints of the lower limbs in the sagittal plane were measured using a motion capture system with wearable sensors. Two-way analysis of variance assessed differences in ROM by group, sex, and spatio-temporal gait parameters; Pearson correlation analysis assessed the correlation of the trunk and lower limbs.ResultsStep length, gait speed, and stride length were greater in young adults (p < 0.001) than in older adults, but older women displayed the fastest gait speed (p < 0.05). ROM values for the pelvis, thorax, trunk, knee joint, and ankle joint of young adults were greater (p < 0.05) than those in older adults. However, hip ROM in older adults was significantly greater than that in young adults (p < 0.05).ConclusionWith increasing age, ROM of the lower limbs, especially the ankle joint, decreased significantly, resulting in a significant decrease in gait speed. As ROM of the pelvis decreased, stride length decreased significantly in older adults, who compensate through thoracic rotation. Thus, older adults should enhance muscle strength and increase ROM to improve gait patterns.

Effects of Resistance Training in Individuals with Lower Limb Amputation: A Systematic Review

Individuals with lower-limb amputations may have a significant strength deficit. This deficit may be related to the stump length and can lead to changes in gait, reduced energy efficiency, walking resistance, altered joint load, and increased risk of osteoarthritis and chronic low back pain. This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines to examine the effects of resistance training in lower limb amputees. Interventions with resistance training and other training methods were sufficient to achieve muscle strength gain in muscles of the lower limbs, improved balance, and improvements in gait pattern and speed when walking. However, it was impossible to determine from the results whether resistance training was mainly responsible for these benefits or even whether the positive effects presented would be observed with only this training method. When combined with other exercises, interventions with resistance training made possible gains for this population. Accordingly, it is noteworthy that the main finding of this systematic review is that the effects may be different according to the level of amputation, with mainly transtibial and transfemoral amputations studied.

Visual Feedback and Virtual Reality in Gait Rehabilitation of Hemiparetic Children and Teenagers after Acquired Brain Injury: A Pilot Study

Hemiparesis as a term refers to a neurological disorder that can be extremely variable, especially with regard to walking abilities. Few works have assessed the use of virtual reality and biofeedback in children and adolescents with hemiparesis. The aim of this study is to provide insights about the rehabilitation of hemiparetic children and teenagers with visual biofeedback in a virtual reality environment. Six hemiparetic subjects (mean age 13.13 years, age range (7-18), 4 males) received 20 personalized rehabilitation GRAIL (Gait Real-time Analysis Interactive Lab) sessions plus 20 sessions of traditional physiotherapy. After an initial evaluation of rehabilitation needs, training focused on gait pattern correction (GP), walking endurance (WE), or gross motor functions (GMFs). All subjects were assessed for their gait analysis by GRAIL, the Gross Motor Function Measure (GMFM), and the 6-Minute Walking Test (6MWT) before and after rehabilitation. All subjects reached their rehabilitation goals, save for one who showed reduced collaboration. In addition, 4 subjects reached a better GP, 3 subjects reported improvements in WE, and 2 subjects improved in GMF. This personalized training with visual biofeedback delivered in a VR setting appears to be effective in modifying motor control and improving gait pattern, in addition to resistance and functional activities, in subjects with hemiparesis.

Neuromuscular electrical stimulation to augment lower limb exercise and mobility in individuals with spastic cerebral palsy: A scoping review.

Background: Neuromuscular Electrical Stimulation (NMES) is an emerging assistive technology applied through surface or implanted electrodes to augment skeletal muscle contraction. NMES has the potential to improve function while reducing the neuromuscular impairments of spastic cerebral palsy (CP). This scoping review examines the application of NMES to augment lower extremity exercises for individuals with spastic CP and reports the effects of NMES on neuromuscular impairments and function in spastic CP, to provide a foundation of knowledge to guide research and development of more effective treatment. Methods: A literature review of Scopus, Medline, Embase, and CINAHL databases were searched from 2001 to 2 November 2021 with identified inclusion and exclusion criteria. Results: Out of 168 publications identified, 33 articles were included. Articles on three NMES applications were identified, including NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction. NMES-assisted strengthening included the use of therapeutic exercises and cycling. NMES-assisted gait included the use of NMES to improve gait patterns. NMES-spasticity reduction included the use of transcutaneous electrical stimulation or NMES to decrease tone. Thirteen studies investigated NMES-assisted strengthening, eleven investigated therapeutic exercise and demonstrated significant improvements in muscle structure, strength, gross motor skills, walking speed, and functional mobility; three studies investigated NMES-assisted cycling and demonstrated improved gross motor skills and walking distance or speed. Eleven studies investigated NMES-assisted gait and demonstrated improved muscle structure, strength, selective motor control, gross motor skills, and gait mechanics. Seven studies investigated NMES for spasticity reduction, and five of the seven studies demonstrated reduced spasticity. Conclusion: A growing body of evidence supports the use of NMES-assisted strengthening, NMES-assisted gait, and NMES for spasticity reduction to improve functional mobility for individuals with spastic CP. Evidence for NMES to augment exercise in individuals with spastic CP remains limited. NMES protocols and parameters require further clarity to translate knowledge to clinicians. Future research should be completed to provide richer evidence to transition to more robust clinical practice.

Knee disarticulation following oncologic total knee arthroplasty: A 5-year follow-up case report

BackgroundThe present case report describes the 5-year follow-up results of an atypical knee disarticulation of a man previously treated with an oncologic total knee arthroplasty due to an Ewing sarcoma. MethodsThe patient presented an aseptic loosened tibial component of a tumor prosthesis system and requested final amputation, as he had previously suffered from five revision surgeries. To encourage the most functional outcome regarding an exoskeletal prosthesis, we decided to disarticulate the knee joint while retaining the currently fixed femoral component to create a full end-bearing stump. FindingsThe patient could be mobilized as a functional knee disarticulated amputee. Seven months after amputation, he showed a slightly less symmetrical gait compared to the preoperative status (preoperative mean Symmetry Index: 0.984 for kinematics and 0.940 for kinetics, 7-month postoperative Symmetry Index: 0.858 and 0.915). At the 5-year follow-up, the femoral component is still stably fixated and shows no loosening signs. In addition, the Symmetry Index increased to 0.908 and 0.949. InterpretationEven after 5 years, the presented amputation appears to be consistent with “conventional” knee disarticulation. The femoral component still withstands the altered loads and the patient shows a further improved gait pattern.

Experts' Perceived Patient Burden and Outcomes of Knee-ankle-foot-orthoses (Kafos) Vs. Microprocessor-stance-and-swing-phase-controlled-knee-ankle-foot Orthoses (Mp-sscos).

Patients with neuromuscular knee-instability assisted with orthotic devices experience problems including pain, falls, mobility issues and limited engagement in daily activities. The aim of this study was to analyse current real-life burden, needs and orthotic device outcomes in patients in need for advanced orthotic knee-ankle-foot-orthoses (KAFOs). An observer-based semi-structured telephone interview with orthotic care experts in Germany was applied. Interviews were transcribed and content-analysed. Quantitative questions were analysed descriptively. Clinical experts from eight centres which delivered an average of 49.9 KAFOs per year and 13.3 microprocessor-stance-and-swing-phase-controlled-knee-ankle-foot orthoses (MP-SSCOs) since product availability participated. Reported underlying conditions comprised incomplete paraplegia (18%), peripheral nerve lesions (20%), poliomyelitis (41%), post-traumatic lesions (8%) and other disorders (13%). The leading observed patient burdens were "restriction of mobility" (n=6), followed by "emotional strain" (n=5) and "impaired gait pattern" (n=4). Corresponding results for potential patient benefits were seen in "improved quality-of-life" (n=8) as well as "improved gait pattern" (n=8) followed by "high reliability of the orthosis" (n=7). In total, experts reported falls occurring in 71.5% of patients at a combined annual frequency of 7.0 fall events per year when using KAFOs or stance control orthoses (SCOs). In contrast, falls were observed in only 7.2 % of MPSSCO users. Advanced orthotic technology might contribute to better quality of life of patients, improved gait pattern and perceived reliability of orthosis. In terms of safety a substantial decrease in frequency of falls was observed when comparing KAFO and MP-SSCO users.

EVALUATION OF CHONDROPROTECTIVE EFFECTS OF HYALURONIC ACID IN A RAT MODEL OF OSTEOARTHRITIS

Objective: To evaluate the chondroprotective effects of hyaluronic acid in a rat model of osteoarthritis.&#x0D; Study Design: Laboratory based experimental study.&#x0D; Place and Duration of Study: Department of Pharmacology, Army Medical College, Rawalpindi, in alliance with National Institute of health, Islamabad and Department of Pathology, Army Medical College Rawalpindi, from Apr to Jun 2019.&#x0D; Methodology: Sixteen (16) rats of Sprague Dawley breed were procured in this study. Osteoarthritis was induced in right knee joint of rats by surgical resection of medial meniscus and anterior cruciate ligament. They were allocated into two (02) groups with eight (08) rats in both groups. Group-I was control group that was treated with 0.2 ml intra articular saline once weekly for four weeks. While group-II was treatment group that was intra particularly administered with 0.2ml hyaluronic acid once weekly for four weeks. One week after the last dosage, gait pattern of the animals was scored. Then animals were sacrificed and a part of proximal tibia was obtained for histopathologic analysis.&#x0D; Results: Mean gait score of control group and treatment group was 3.25 ± 0.707 and 1.00 ± 0.756 respectively with a statistically significant p-value of &lt;0.001, while mean histopathological Modified Mankin score of control and treatment group was 11.5 ± 1.195 and 5.50 ± 1.195 respectively with a significant p-value of &lt;0.001.&#x0D; Conclusion: Intra articular viscosupplementation of hyaluronic acid in rat model of osteoarthritis resulted in improved gait pattern and histopathology.

Effect of antigravity moon shoes on gait cycle in children with diplegic cerebral palsy

IntroductionThe study aimed to evaluate the effect of antigravity moon shoes on the values of stance and swing phases of the gait cycle in children with diplegia.MethodsThe study involved 30 children with spastic diplegia, aged 6–8 years, of both genders. They were randomly divided into 2 groups: A and B. All children were evaluated before and after 4 successive months of a rehabilitation program with 2-dimension gait analysis for measuring step lengths and values of stance and swing phases for both lower limbs. Both groups received a designed program which included stretching exercises for tight flexors of the lower limbs, progressive resisted exercises for extensors, and standing and weight shifting exercises. In addition, classical gait training was applied in group A and gait training with antigravity moon shoes in group B. Mann-Whitney U test served to assess differences in means of step length between the groups. Wilcoxon signed rank test was used to evaluate differences in means of step length and values of stance and swing phases during gait cycles.ResultsPost-treatment results revealed a decrease in step lengths and stance phase values, as well as increased values of swing phase for both groups. The changes were more significant in group B.ConclusionsAntigravity moon shoes are a new idea to improve gait pattern in children with diplegia by decreasing stance time and increasing swing time in the gait cycle.

Different Effects of Robot-Assisted Gait and Independent Over-Ground Gait on Foot Plantar Pressure in Incomplete Spinal Cord Injury: A Preliminary Study.

Background: There is insufficient evidence to establish the optimal treatment protocol for robot-assisted gait training. Objective: This study aimed to analyze the effects of robot-assisted gait and independent over-ground gait on foot pressure and to determine an effective training protocol for improvement of gait pattern in patients with incomplete spinal cord injury due to industrial accidents. Methods: Four patients with incomplete spinal cord injury due to an industrial accident who had gait disturbance underwent measurement of peak foot pressure and stance phase duration using a foot pressure analysis system with robot-assisted gait and independent over-ground gait. Results: The robot-assisted gait condition has lower peak foot pressure and shorter stance phase duration than the independent over-ground gait. Conclusions: In this study, robot-assisted gait was found to limit gait pattern improvement in patients with gait disturbance caused by incomplete spinal cord injury due to industrial accidents. Therefore, future research will be conducted to determine the optimal protocol for robot-assisted gait training for gait pattern improvement.

Unilateral non-electric assistive walking device helps neurological and orthopedic patients to improve gait patterns

BackgroundPathological gait patterns are common in neurological and orthopedic patients. These put them at risk of falling and restrict their autonomy and social participation. Novel assistive walking devices are designed to actively support physiological gait patterns by means of motor guidance and mechanical support of the lower limbs. Research questionDoes a non-electric assistive walking device powered by a cam-spring mechanism (aLQ, Imasen) improve or otherwise affect pathological gait patterns in neurological and orthopedic patients? MethodsA three-dimensional instrumented gait analysis was conducted on a treadmill (quasar, hp cosmos) using spatiotemporal, kinetic, and kinematic data obtained from synchronized motion capturing (Miqus M3, Qualisys), surface EMG (sEMG; Ultium, Noraxon), and pressure distribution measurements (FMD-T, Zebris). Participants with impaired walking were tested in a randomized repeated measures design (assisted/unassisted; at preferred/fast speed) and analyzed with regard to their medical condition (orthopedic or neurological group, n = 20 each). ResultsIn both groups, participants showed a significant increase of step length and decrease of cadence during assisted walking compared to baseline. Immediate kinematic effects included enhanced sagittal hip flexion but reduced extension. On the contrary, knee joint angles and muscle activity of M. gastrocnemius and M. rectus femoris seemed to be unaffected by the aLQ device. SignificanceParticipants appear to benefit from the assistive walking device regarding gait and movement patterns, which suggests that the tested device may help to improve patients’ functional health status and quality of life. Activities of daily living (ADLs) that involve extensive hip flexion like stairs or curb climbing are promising applications. We propose the implementation of an invertible cam-spring that provides an additional resistance training option.

Efficacy of axial TheraTogs on gait pattern in children with dyskinetic cerebral palsy: a randomized controlled trial

BackgroundTheraTogs promotes proprioceptive sense of a child with cerebral palsy and improves abnormal muscle tone, posture alignment, balance, and gait. Therefore, the aim of this study was to investigate the efficacy of TheraTogs orthotic undergarment on gait pattern in children with dyskinetic cerebral palsy. Thirty children with dyskinetic cerebral palsy were selected for this randomized controlled study. They were randomly assigned to (1) an experimental group that received TheraTogs orthotic undergarment (12 h/day, 3 days/week) plus traditional physical therapy for 3 successive months and (2) a control group that received only traditional physical therapy program for the same time period. Gait parameters were measured at baseline and after 3 months of intervention using Pro-Reflex motion analysis.ResultsChildren in both groups showed significant improvements in the gait parameters (P < 0.05), with significantly greater improvements in the experimental group than in the control group.ConclusionsThe use of TheraTogs may have a positive effect to improve gait pattern in children with dyskinetic cerebral palsy.Trial registrationThis trial was registered in the ClinicalTrial.gov PRS (NCT03037697).

Effects of knee extension exercise starting within 4h after total knee arthroplasty.

To determine the beneficial effects of knee extension exercise applied from 4h after TKA. Patients undergoing TKA for osteoarthritis were assigned to early rehabilitation (n = 41) and control rehabilitation (n = 39) groups. Rehabilitation of knee extension exercise was started within 4h postoperative in the early group and 2days after surgery in the control group. Joint range of motion and pain were assessed before surgery and at 3days to 12months after surgery. Muscle strength and gait parameters were assessed before and 3weeks after surgery. Extension range of motion was significantly increased in the early group than the control at 3days, 3weeks and 6months after surgery. In gait parameters, peak knee flexion and extension angles during stance phase were significantly improved in the early group than the control group at 3weeks after surgery. Flexion range of motion was increased in the early group than the control at 12months after surgery. Starting knee extension exercise within 4h after TKA reduced the early loss of extension range of motion and improved gait pattern and seemed to contribute to be better functional outcome one year after surgery.

EVALUATION OF CHONDROPROTECTIVE EFFICACY OF TRIAMCINOLONE IN OSTEOARTHRITIS INDUCED RAT MODEL

ABSTRACT&#x0D; BACKGROUND AND OBJECTIVE:&#x0D; Osteoarthritis is one of the most common joint diseases afflicting human, characterized by progressive degeneration of articular cartilage in which chondrocytes fails to adequately repair. Objective of this study is to evaluate the chondroprotection offered by triamcinolone in osteoarthritis induced rat model&#x0D; METHODOLOGY:&#x0D; This Laboratory based experimental study was conducted in Department of Pharmacology, Army Medical College, Rawalpindi, in collaboration with National Institute of health, Islamabad from April-June2019. Osteoarthritis was induced by surgical removal of medial meniscus and anterior cruciate ligament resection in right knee joint of Sixteen (16) anesthetized rats of Sprague Dawley breed. They were divided in two (02) groups with eight (08) rats in each group. Group I was disease control in which 0.2 ml Intra articular saline was administered for three weeks. While group II was treatment group that was treated by 70 µl intra articular triamcinolone once weekly for three weeks. After that gait pattern of rats was scored. Animals were euthanized with over dosage of inhaled chloroform and sample of proximal tibia was taken for histopathological analysis.RESULTS:&#x0D; Mean gait score of control group and treatment group was 3.25±.707 and 2.25±.463 with a p value of .028 that is statistically significant. While mean histopathological modified Mankin score of control and treatment group was 11.5±1.195 and 8.5±1.195 respectively with a significant P-value of &lt;0.01.&#x0D; CONCLUSION:&#x0D; Intra articular administration of triamcinolone in Osteoarthritis induced rats resulted in improvement in gait pattern and histopathology.&#x0D; Keywords: Chondroprotective efficacy, Osteoarthritis, Triamcinolone.

Effects of elastic neutral ankle-foot orthoses on 3 dimensional parameters during gait training in patients with stroke: A pilot study

BackgroundGeneral ankle-foot orthosis (AFO) cannot be flexibly adjusted to volumetric change in the lower leg because the molding is custom-fit. Thus, we developed a flexible assistive device called elastic neutral AFO (EN-AFO) to help stroke patients hold a neutral ankle position. The purpose of this study was to investigate the effects of EN-AFO and improve gait patterns in stroke patients with rearfoot varus deformity. MethodsFifteen stroke patients with a varus deformity of the foot performed a walking test with and without the use of EN-AFO. Kinematic data were measured with a 3D motion analysis system with inertial measurement unit (IMU) sensors. ResultsIn the stance phase, maximal pelvic tilt and maximal ankle dorsiflexion in the affected side changed, and maximal and minimal pelvic tilts and maximal hip abduction in the less-affected limb effectively changed, as well. During the swing phase, minimal pelvic tilt and minimal ankle abduction in the affective limb greatly changed; particularly, the reduction of maximal ankle inversion was significantly cleared. ConclusionsThe EN-AFO was effective in controlling the tendency of foot inversion in patients with varus deformities. This is suitable for gait training, as it can adjust the orthosis stiffness according to the foot condition.

Effect of shockwave therapy on kinematic gait parameters in children with spastic diplegic cerebral palsy

Background/aims Extracorporeal shockwave therapy might be a considerable substitute to present treatment alternatives to reduce spasticity and improve range of motion in patients with cerebral palsy, which could improve their quality of life and gait pattern. The aim of this study was to investigate the effect of extracorporeal shockwave therapy on gait parameters in children with spastic diplegic cerebral palsy. Methods A total of 34 children with spastic diplegia (19 boys and 15 girls) participated in the study. Their ages ranged from 5–7 years (mean 5.8 ± standard deviation 1.2 years). They were randomly assigned into two equal groups, the study and the control group. Both groups received the traditional physiotherapy programme, three sessions a week consecutively for 3 months. Children in the study group also received extracorporeal shockwave therapy one session a week for 3 months. Results There was a significant improvement of spasticity, step length and stride width in the control group (P=0.017, 0.015, 0.033 respectively). Walking speed did not show a significant change in the control group (P=0.1). In the study group, there was a significant improvement in spasticity, stride length, stride width, and walking speed (P=0.0001, 0.005, 0.029, 0.014 respectively). Comparing the gained improvement in the study and the control group, the results showed that the improvement in the study group significantly exceeded that of the control group in spasticity, stride length, stride width and walking speed (P=0.0003, 0.011, 0.043, 0.002 respectively). Conclusions Extracorporeal shockwave therapy is effective in reducing spasticity and improving gait patterns in children with spastic diplegia cerebral palsy.