Improved Gait Velocity Research Articles

Effects of a single session of whole body vibration on ankle plantarflexion spasticity and gait performance in patients with chronic stroke: a randomized controlled trial

Objective: To investigate the effects of a single session of whole body vibration training on ankle plantarflexion spasticity and gait performance in chronic stroke patients. Design: Randomized controlled trial. Setting: Rehabilitation unit in university hospital. Participants: Thirty subjects with chronic stroke were randomized into either a control group (n = 15) or a group receiving a single session of whole body vibration (n = 15). Intervention: The intervention group was actually treated with whole body vibration while the control group was treated with placebo treatment. Main measures: The spastic changes were measured clinically and neurophysiologically. Subjective evaluation of ankle spasticity was performed via a visual analogue scale. Gait performances were evaluated by the timed up and go test, 10-meter walk test and cadence. A forceplate was used for measuring foot pressure. Results: The changes between whole body vibration and control groups were significantly different in Modified Ashworth Scale (1.33, 95% confidence interval (CI) = 1.06~1.60). The Hmax/Mmax ratio (0.14, 95% CI = 0.01~0.26) and visual analogue scale (1.87, 95% CI = 1.15~2.58) were significantly decreased. Whole body vibration could significantly improve gait velocity, timed up and go test (6.03, 95% CI = 3.17~8.89) and 10-meter walk test (1.99, 95% CI = 0.11~3.87). The uneven body weight posture on bilateral feet was also improved after vibration. Conclusion: These results suggest that a single session of whole body vibration training can reduce ankle plantarflexion spasticity in chronic stroke patients, thereby potentially increasing ambulatory capacity.

Compelled Body Weight Shift Technique to Facilitate Rehabilitation of Individuals with Acute Stroke.

BackgroundThe study evaluates the effectiveness of Compelled Body Weight Shift (CBWS) approach in the rehabilitation of individuals with stroke. CBWS involves a forced shift of body weight towards a person’s affected side by means of a shoe insert that establishes a lift of the nonaffected lower extremity.MethodsEleven patients with acute stroke were randomly assigned to experimental and control groups. The experimental group received a two-week conventional physical therapy combined with CBWS and the control group received only a two-week conventional therapy. Weight bearing, Gait velocity, Berg’s Balance, and Fugl-Meyer’s Scores were recorded before and after the intervention.ResultsWeight bearing on the affected side increased in the experimental group and decreased in the control group. The increase in gait velocity with treatment was significant in both the groups (P < 0.05). However, experimental group (P = 0.01) demonstrated larger improvements in gait velocity compared to the control group (P = 0.002). Berg Balance and Fugl-Meyer scores increased for both the groups.ConclusionThe implementation of a two-week intervention with CBWS resulted in the improvement in weight bearing and gait velocity of individuals with acute stroke. The present preliminary study suggests that CBWS technique could be implemented as an adjunct to conventional rehabilitation program for individuals with acute stroke.

Effect of subthalamic deep brain stimulation on turning kinematics and related saccadic eye movements in Parkinson disease

BackgroundPersons with Parkinson disease (PD) experience turning difficulty, often leading to freezing of gait and falls. Visual information plays a significant role in locomotion and turning, and while the effects of deep brain stimulation (DBS) on oculomotor function have been well documented, the effects of DBS on oculomotor function during turning and on turning itself have yet to be fully elucidated. ObjectiveTo determine the effects of STN DBS on turning performance and related oculomotor performance in PD. MethodsEleven subjects with PD and DBS of the subthalamic nucleus performed a seated voluntary saccade task and standing 180° turns in DBS OFF and DBS ON conditions. Oculomotor data were captured using an infrared eye tracking system while segment rotations were measured using 3-D motion capture. ResultsDuring the seated saccade task, DBS did not improve saccade amplitude or latency. DBS also did not improve gait velocity and stride length during forward walking. During turning, DBS improved turn performance (turn duration), reduced the number of saccades performed during the turns, and increased the amplitude and velocity of the saccade initiating the turn. DBS decreased the intersegmental latencies (eye–head, eye–foot, and head–trunk) but this effect was lost for eye–head and eye–foot after controlling for the duration of the first gait cycle. ConclusionsDBS significantly improves turn performance and related oculomotor performance. These findings add to the growing list of therapeutic benefits offered by DBS.

Abstract P276: Aerobic Endurance and Leg Strength are Predictive of Gait Velocity among Community-Dwelling Stroke Survivors

Background: Gait velocity is an objective, fundamental indicator of post-stroke walking ability. Most stroke survivors have diminished aerobic endurance and paretic leg strength, with one or both of these conditions affecting their gait velocity. Other reported underlying factors affecting gait velocity include functional disability, balance and cognitive impairment. Objective: To examine potential independent predictors of gait velocity in chronic stroke. Methods: Cross-sectional design using baseline data from the first 100 community-dwelling stroke survivors enrolled in an exercise intervention study. Eligible subjects included men and women aged ≥ 50 years and at ≥ 3 months post-stroke. Subjects completed a comprehensive, self-administered health survey prior to their baseline study visit. At the baseline visit, functional disability (Modified Rankin Scale), aerobic endurance (2-minute step-test), leg strength (timed 5-chair stand test), balance (single-leg stance) and cognitive impairment (Mini-Mental Status Exam) were assessed. Gait speed was assessed using a valid and reliable timed 4-meter walk test designed for older adults with disabilities; to calculate gait velocity (meters/second). Multiple linear regression was conducted to explore potential independent predictors of gait velocity. Results: Subjects (n=100) were on average 70±10 years old, and 39±49 months post-stroke. The majority reported an ischemic stroke (68/100) with hemiparesis (80/100); and were married (59/100), White/European-American (78/100), college-educated (79/100), men (54/100). Subjects had an average gait velocity of 0.75±0.23 meters/second, categorized as limited community walkers. Approximately 37% of the variance in gait velocity, could be explained by the optimal combination of the independent variables in the model: functional disability, aerobic endurance, leg strength, balance, and cognitive impairment (R 2 =0.37, F 5,74 =8.64, p&lt;0.01). Only better aerobic endurance (t 1,74 =3.41, p&lt;0.01) and leg strength (i.e. faster chair stand time) (t 1,74 =–2.23, p=0.03) contributed uniquely and significantly to faster gait velocity. Conclusion: A hallmark of gait dysfunction in chronic stroke is slow gait velocity, even among well-educated, community-dwelling survivors. Gait velocity is simple to measure requiring only a stopwatch and flat surface for walking. Our findings are similar to reports by others that diminished aerobic endurance and leg strength are major contributors to slow gait velocity in chronic stroke. Long term rehabilitation efforts are needed to improve gait velocity in chronic stroke, and may need to incorporate multifaceted strategies concurrently, focusing on aerobic endurance and leg strength, to maximize community ambulation and reintegration.

Evidence to Practice: Botulinum Toxin in the Treatment of Spasticity Post Stroke

Introduction: Spasticity is a significant problem following stroke. Although there is extensive research examining the efficacy of botulinum toxin as a treatment, there are challenges in implementing its use. Methods: The results from previously published randomized controlled trials and systematic reviews examining the use of botulinum toxin as a treatment for poststroke spasticity of the upper and lower limb and the shoulder are summarized. Several barriers to implementation are discussed. Results: There is strong evidence that denervation of muscles, in the lower extremity and upper extremity post stroke, with botulinum toxin reduces focal spasticity. There is also strong evidence that it is associated with a small but significant improvement in gait velocity based on a recent meta-analysis. However, evidence that botulinum toxin injections are associated with improved function and improved quality of life is not as compelling. There is evidence that botulinum toxin injected into the subscapularis muscle can reduce spastic shoulder pain and improve passive range of motion of the hemiplegic shoulder. There are a number of challenges with botulinum toxin, including uncertainty over its role in improving motor dysfunction following stroke, the determination of which subsets of patients may benefit, the cost of treatment, and the identification of meaningful outcome measures. Conclusions: Botulinum toxin has been shown to be an effective treatment in reducing tone and managing spasticity post stroke. However, its effectiveness in improving function has been more controversial.

The Use of TheraTogs Versus Twister Cables in the Treatment of In-toeing During Gait in a Child With Spina Bifida

To present the effects of TheraTogs and twister cables (TCs) on in-toeing during gait in a child with spina bifida while comparing overall parent and patient satisfaction. The participant was a 2-year-old girl with L4 spina bifida with bilateral in-toeing during gait. The child was given a 6-week intervention of TheraTogs followed by 6 weeks of TCs. Kinematic data indicated optimal foot progression with the use of TCs, achieved by the rotation of the lower leg. Gait data for the use of TheraTogs indicated improved foot progression with external rotation at the hips. Gait characteristics indicated improved gait velocity in TheraTogs, but stride length was better with TCs. The parent reported satisfaction and preference for TheraTogs. As the first step in investigating the 2 interventions, both TheraTogs and TCs were effective in management of in-toeing for the child but parental preference favored TheraTogs.

Predictors of gait velocity among community-dwelling stroke survivors

IntroductionGait velocity is an objective, fundamental indicator of post-stroke walking ability. Most stroke survivors have diminished aerobic endurance or paretic leg strength affecting their walking ability. Other reported underlying factors affecting gait velocity include functional disability, balance, cognitive impairment, or the distance they are required to walk. ObjectiveTo examine the relationship between gait velocity and measures of physical and cognitive functioning in chronic stroke. MethodsCross-sectional design using baseline data from community-dwelling stroke survivors enrolled in an exercise intervention study. Functional disability (modified Rankin Scale), aerobic endurance (2-min step-test), leg strength (timed 5-chair stand test), balance (single-leg stance) and cognitive impairment (Mini-Mental Status Exam) were assessed. Gait velocity was assessed using a timed 4-m walk test. Multiple linear regression was used to explore potential independent predictors of gait velocity. ResultsSubjects had an average gait velocity of 0.75±0.23m/s, categorized as limited community walkers. Approximately 37% of the variance in gait velocity, could be explained by the 5 independent variables, functional disability, aerobic endurance, leg strength, balance, and cognitive impairment (R2=0.37, F5,74=8.64, p<0.01). Aerobic endurance (t1,74=3.41, p<0.01) and leg strength (t1,74=−2.23, p=0.03) contributed significantly to gait velocity. ConclusionDiminished aerobic endurance and leg strength are major contributors to slow gait velocity in chronic stroke. Long term rehabilitation efforts are needed to improve gait velocity in chronic stroke, and may need to incorporate multifaceted strategies concurrently, focusing on aerobic endurance and leg strength, to maximize community ambulation and reintegration.

Clinical and Spatiotemporal Gait Effects of Canes in Hip Osteoarthritis

To investigate the effects of cane use on spatiotemporal gait parameters, pain, and function in adults with hip osteoarthritis (OA). Prospective observational study. An academic tertiary Veterans Affairs Healthcare Center. Thirteen adults with symptomatic hip OA and 13 healthy adults. We undertook gait analysis in all subjects with an optoelectronic camera system. Pain, stiffness, and physical function in subjects with hip OA were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Baseline spatiotemporal measures of unaided gait were obtained for healthy subjects. Baseline and 4-week spatiotemporal gait parameters were assessed for hip OA subjects while they walked with and without a cane. Participants with hip OA completed the WOMAC at baseline and after 4 weeks of cane use. At baseline when walking unaided, the subjects with hip OA (age range 60-75 years) had a significantly slower gait velocity, shorter affected limb stride length, and longer double-stance time compared with healthy control subjects. When walking with a cane, they had a reduction in gait velocity (P < .05) caused by a decrease in cadence (P < .05) compared with walking unaided. After 4 weeks of cane use, the participants with hip OA demonstrated significant improvements in gait velocity (P < .05) and double-stance time (P < .05) when walking with a cane in comparison with baseline data. There was no improvement in pain and function after 4 weeks of cane use, a period in which only approximately 60% of the hip OA subjects used the cane 6 or more times per week. Initial use of a cane led to decreased gait velocity and cadence in people with hip OA compared with walking unaided. This difference in gait velocity diminished after they practiced walking with the cane. Inconsistent use of the cane may have contributed to the lack of improvement in the subjects' hip OA pain and function.

Immediate effects of electrical stimulation combined with passive locomotion-like movement on gait velocity and spasticity in persons with hemiparetic stroke: a randomized controlled study

Objective: Research to examine the immediate effects of electrical stimulation combined with passive locomotion-like movement on gait velocity and spasticity. Design: A single-masked, randomized controlled trial design. Subjects: Twenty-seven stroke inpatients in subacute phase (ischemic n=16, hemorrhagic n=11). Interventions: A novel approach using electrical stimulation combined with passive locomotion-like movement. Main measures: We assessed the maximum gait speed and modified Ashworth scale before and 20 minutes after the interventions. Results: The gait velocity of the electrical stimulation combined with passive locomotion-like movement group showed the increase form 0.68±0.28 (mean±SD, unit: m) to 0.76±0.32 after the intervention. Both the electrical stimulation group and passive locomotion-like movement group also showed increases after the interventions (from 0.76±0.37 to 0.79±0.40, from 0.74±0.35 to 0.77±0.36, respectively). The gait velocity of the electrical stimulation combined with passive locomotion-like movement group differed significantly from those of the other groups (electrical stimulation combined with passive locomotion-like movement versus electrical stimulation: P=0.049, electrical stimulation combined with passive locomotion-like movement versus passive locomotion-like movement: P=0.025). Although there was no statistically significant difference in the modified Ashworth scale among the three groups, six of the nine subjects (66.6%) in the electrical stimulation combined with passive locomotion-like movement group showed improvement in the modified Ashworth scale score, while only three of the nine subjects (33.3%) in the electrical stimulation group and two of the nine subjects (22.2%) improved in the passive locomotion-like movement group. Conclusion: These findings suggest electrical stimulation combined with passive locomotion-like movement could improve gait velocity in stroke patients.

Effects of Intensive Physical Rehabilitation on Neuromuscular Adaptations in Adults with Poststroke Hemiparesis

Hemiparesis-disability and muscle weakness of 1 side of the body-is a common consequence of stroke. High-intensity strength training may be beneficial to regain function, but strength coaches in the field of rehabilitation need evidence-based guidelines. The purpose of this study was to evaluate the effect of intensive physical rehabilitation on neuromuscular and functional adaptations in outpatients suffering from hemiparesis after stroke. A within-subject repeated-measures design with the paretic leg as the experimental leg and the nonparetic leg as the control leg was used. Eleven outpatients with hemiparesis after stroke participated in 12 weeks of intensive physical rehabilitation comprising unilateral high-intensity strength training with near-maximal loads (4-12 repetition maximum) and body weight supported treadmill training. At baseline and 12-week follow-up, the patients went through testing consisting of isokinetic muscle strength, neuromuscular activation measured with electromyography (EMG), electrically evoked muscle twitch contractile properties, and gait performance (10-m Walk Test and 6-min Walk Test). After the 12-week conditioning program, knee extensor and flexor strength increased during all contraction modes and velocities in the paretic leg. Significant increases were observed for agonist EMG amplitude at slow concentric and slow eccentric contraction. Twitch torque increased, whereas twitch time-to-peak tension remained unchanged. By contrast, no significant changes were observed in the nonparetic control leg. Gait performance increased 52-68%. In conclusion, intensive physical rehabilitation after stroke leads to clinically relevant neuromuscular improvements, leading to increased voluntary strength during a wide range of contraction modes and velocities, and improved gait velocity. Strength training coaches working in the field of rehabilitation can use this knowledge to safely and efficiently add high-intensity strength training to existing rehabilitation paradigms.

Comparison of tibialis anterior muscle electromyography, ankle angle, and velocity when individuals post stroke walk with different orthoses

Ankle-foot orthoses (AFO) have been used to improve the gait of individuals post stroke, but their use has come into question secondary to increased understanding of motor re-learning. The purpose of this study was to determine if there is a change in tibialis anterior muscle electromyography, ankle angle, or gait velocity when individuals post stroke walk with a posterior leaf-spring AFO (PLAFO) or a dynamic ankle orthosis (DAO). Repeated measures. Fifteen participants post stroke walked without an orthosis, with a PLAFO, and with a DAO. Data were gathered using electromyography, force plates, and three-dimensional motion analysis cameras. A repeated measures ANOVA was used to test for statistical significance (p ≤ 0.05). Participants exhibited significantly less tibialis anterior muscle electromyography during the swing phase of gait with use of a DAO (p < 0.001). No change in velocity or ankle angle was exhibited with use of either orthosis. The results support therapists' notions that bracing can lead to a decline in tibialis anterior muscle activity during the swing phase of gait. The results also showed no improvement in gait velocity when either orthosis was used by participants who could walk without an orthosis.

Improved Gait After Repetitive Locomotor Training in Children with Cerebral Palsy

The aim of this study was to evaluate the effectiveness of repetitive locomotor training with an electromechanical gait trainer in children with cerebral palsy. In this randomized controlled trial, 18 ambulatory children with diplegic or tetraplegic cerebral palsy were randomly assigned to an experimental group or a control group. The experimental group received 30 mins of repetitive locomotor training with an applied technology (Gait Trainer GT I) plus 10 mins of passive joint mobilization and stretching exercises. The control group received 40 mins of conventional physiotherapy. Each subject underwent a total of 10 treatment sessions over a 2-wk period. Performance on the 10-m walk test, 6-min walk test, WeeFIM scale, and gait analysis was evaluated by a blinded rater before and after treatment and at 1-mo follow-up. The experimental group showed significant posttreatment improvement on the 10-m walk test, 6-min walk test, hip kinematics, gait speed, and step length, all of which were maintained at the 1-mo follow-up assessment. No significant changes in performance parameters were observed in the control group. Repetitive locomotor training with an electromechanical gait trainer may improve gait velocity, endurance, spatiotemporal, and kinematic gait parameters in patients with cerebral palsy.

The impact of attentional, auditory, and combined cues on walking during single and cognitive dual tasks in Parkinson disease

Auditory and attentional cues improve gait in Parkinson disease (PD), but it is unclear if combining the two cueing strategies offers additional benefit. Further, the effect of a secondary cognitive task on cue efficacy is unknown. Therefore, this study aimed to assess the effects of cue type and task complexity on gait in PD. 11 participants with PD, 11 age-matched controls, and 11 young controls performed 3 walking trials on a GAITRite walkway under the following cueing conditions: no cue (baseline), rhythmic auditory cue at 10% below (AUD−10) and 10% above (AUD+10) self selected cadence, attentional cue (ATT; “take long strides”), and a combination of AUD and ATT (COM−10, COM+10). Each condition was also performed concurrently with a secondary word generation task (dual task, DT). Baseline gait velocity and stride length were less for those with PD and age-matched controls compared to young controls, and the ability of those with PD to use cues differed from the other groups. Gait velocity and stride length increased in PD with ATT, but not with auditory cues. Similar increases in gait velocity and stride length were observed with the combined cues, but additional benefit beyond ATT alone was not observed. Cues did not improve gait velocity during dual task walking, although stride length did increase with COMB+10. It appears persons with PD are able to benefit from attentional cueing and can combine attentional and auditory cues, but do not gain additional benefit from such a combination. During walking while performing a secondary cognitive task, attentional cues may help to facilitate a longer stride length.

Transcutaneous Electrical Stimulation on Acupoints Combined With Task-Related Training to Improve Motor Function and Walking Performance in an Individual 7 Years Poststroke

Impaired walking function and spasticity are common sequelae of stroke. Prior studies have shown that a rehabilitation program combining transcutaneous electrical stimulation (TES) with task-related training (TRT) improves motor function in individuals with stroke. However, it is unclear if this approach is beneficial for individuals with long-standing stroke. The subject of this case study was a 61-year-old man who was 7 years poststroke. He exhibited limitations of walking function, impaired strength of the ankle muscles, and severe plantarflexor spasticity. For 4 weeks, the patient performed a 5-day/wk home program consisting of 60 minutes of TES (below motor threshold) to the acupoints in the affected lower leg, followed by 60 minutes of TRT. He documented his daily home program activities in a log, and 3 times a week he received a call from the therapist to verify his adherence. The patient also had 8 clinic visits, which focused on instruction to ensure adherence to the (TES + TRT) protocol and progression of the program. After the 4-week program, plantarflexor spasticity decreased and ankle dorsi- and plantarflexor strength improved. More important, there were notable improvements in gait velocity, walking endurance, and functional mobility. These gains were maintained at 4 weeks posttreatment. This accessible home program was safe and effective for decreasing impairment and improving function in an individual with long-term, chronic stroke. The gains were maintained 4 weeks posttreatment. Details are provided for developing a home program integrating somatosensory TES and TRT.

Ankle Training With a Robotic Device Improves Hemiparetic Gait After a Stroke

Background. Task-oriented therapies such as treadmill exercise can improve gait velocity after stroke, but slow velocities and abnormal gait patterns often persist, suggesting a need for additional strategies to improve walking. Objectives. To determine the effects of a 6-week visually guided, impedance controlled, ankle robotics intervention on paretic ankle motor control and gait function in chronic stroke. Methods. This was a single-arm pilot study with a convenience sample of 8 stroke survivors with chronic hemiparetic gait, trained and tested in a laboratory. Subjects trained in dorsiflexion–plantarflexion by playing video games with the robot during three 1-hour training sessions weekly, totaling 560 repetitions per session. Assessments included paretic ankle ranges of motion, strength, motor control, and overground gait function. Results. Improved paretic ankle motor control was seen as increased target success, along with faster and smoother movements. Walking velocity also increased significantly, whereas durations of paretic single support increased and double support decreased. Conclusions. Robotic feedback training improved paretic ankle motor control with improvements in floor walking. Increased walking speeds were comparable with reports from other task-oriented, locomotor training approaches used in stroke, suggesting that a focus on ankle motor control may provide a valuable adjunct to locomotor therapies.

Does the treatment of spastic equinovarus deformity following stroke with botulinum toxin increase gait velocity? A systematic review and meta‐analysis

While botulinum toxin-A (BT-A) has been used to treat lower-limb focal spasticity successfully, its effect on characteristics of gait has not been well defined. The objective of this systematic review was to establish the treatment effect associated with the use of BT-A for equinovarus to improve gait velocity following stroke, using a meta-analytic technique. Relevant studies were identified through a literature search encompassing the years 1985 to November 2009. Studies were included if (i) the sample was composed of adult subjects recovering from either first or subsequent stroke, presenting with spastic equinovarus deformity of the ankle preventing full active dorsiflexion, and (ii) subjects who received BT-A were compared with subjects who had received a placebo, or (iii) in the absence of a placebo-controlled condition, subject had received BT-A and was assessed before and after treatment. A standardized mean difference (SMD) ± standard error and 95% confidence interval (CI) for gait velocity between the treatment and control group was calculated for each study, using Hedges's g, and the results pooled. Eight trials, five randomized controlled trials, and three single group intervention studies were included. Data representing 228 subjects were available for pooled analysis. Treatment with BT-A was associated with a small improvement in gait velocity (Hedge's g = 0.193 ± 0.081; 95% CI: 0.033 to 0.353, P < 0.018) representing an increase of 0.044 meters/s. The use of BT-A for lower-limb post-stroke equinovarus because of spasticity was associated with a small, but statistically significant increase in gait velocity.

Effect of Cognitive Remediation on Gait in Sedentary Seniors

Attention and executive functions show strong associations with slow gait and falls in seniors and have been shown to be amenable to cognitive remediation. However, cognitive remediation as a strategy to improve mobility has not been investigated. Using a randomized single-blind control design, 24 sedentary older adults (exercise less than or equal to once weekly and gait velocity <1 m/s) were randomly assigned to an 8-week computerized cognitive remediation program or wait-list. Primary outcome was change in gait velocity during normal pace and "walking while talking" conditions. We also compared the proportion of improvers (velocity change ≥4 cm/s) in each group. The 10 participants who completed cognitive remediation improved gait velocity from baseline during normal walking (68.2 ± 20.0 vs 76.5 ± 17.9 cm/s, p = .05) and walking while talking (36.7 ± 13.5 vs 56.7 ± 20.4 cm/s, p = .002). The 10 intervention participants improved gait velocity over the 8-week intervention both during normal walking (change: 8.2 ± 11.4-1.3 ± 6.8 cm/s, p = .10) and walking while talking (change: 19.9 ± 14.9-2.5 ± 20.1 cm/s, p = .05) compared with the 10 control participants. Six intervention participants were improvers on normal pace walking compared with three controls (odds ratio = 3.0, 95% confidence interval = 0.5-19.6). All 10 intervention participants improved on walking while talking compared with 3 controls (odds ratio = 3.5, 95% confidence interval = 1.5-8.0). The findings of this pilot trial are promising and suggest that cognitive remediation may improve mobility in sedentary seniors. This approach should be validated in larger scale trials.

Recent Findings Regarding the Efficacy of Functional Electrical Stimulation in Patients With Chronic Hemiplegia and Multiple Sclerosis: A Narrative Literature Review

In Brief In recent years, numerous studies have reported the effects of functional electrical stimulation (FES) in the management of foot drop. The purpose of this article is to review these latest findings according to both the diagnoses and various functional domains of the individual clinical trials. These findings support the assertion that FES systems facilitate both immediate and extended improvements in gait velocity across both smooth and irregular surfaces in patients with chronic hemiparesis. In addition, beneficial effects on the symmetry and rhythmicity of gait, along with positive “therapeutic” or “carry-over” effects, have been identified. Patient-derived data indicate high acceptance rates and may provide further insights into what aspects of FES usage are perceived by patients to be the most beneficial. Any empirical advantages of FES systems over ankle-foot orthoses for patients with chronic hemiparesis seem to require a degree of acclimation to the FES intervention. Recent evidence supports the efficacy of an orthotic effect associated with the use of FES during both short-distance and endurance walking events among patients with more debilitating multiple sclerosis (MS). In contrast, the use of FES by less debilitated patients with MS does not seem to increase the speed of short-distance walking events. The benefit of FES interventions during endurance walking events in less debilitated patients has not been evaluated. To the limited extent that it has been investigated, there is no apparent evidence of a therapeutic or a carry-over effect associated with FES among the more debilitating forms of MS. This effect has not been investigated among more functional walkers with MS. This paper reviews recent research relating to the effects of functional electrical stimulation (FES) in the management of foot drop according to both the diagnoses and various functional domains of the individual clinical trials.

Walking with Music Is a Safe and Viable Tool for Gait Training in Parkinson's Disease: The Effect of a 13-Week Feasibility Study on Single and Dual Task Walking

This study explored the viability and efficacy of integrating cadence-matched, salient music into a walking intervention for patients with Parkinson's disease (PD). Twenty-two people with PD were randomised to a control (CTRL, n = 11) or experimental (MUSIC, n = 11) group. MUSIC subjects walked with an individualised music playlist three times a week for the intervention period. Playlists were designed to meet subject's musical preferences. In addition, the tempo of the music closely matched (±10–15 bpm) the subject's preferred cadence. CTRL subjects continued with their regular activities during the intervention. The effects of training accompanied by “walking songs” were evaluated using objective measures of gait score. The MUSIC group improved gait velocity, stride time, cadence, and motor symptom severity following the intervention. This is the first study to demonstrate that music listening can be safely implemented amongst PD patients during home exercise.

Effects of Dynamic Elastomeric Fabric Orthoses on Children with Cerebral Palsy

This phase 1 exploratory study aimed to establish proof of concept of the effects of dynamic elastomeric fabric orthoses (DEFOs) on the gait of children with spastic diplegic cerebral palsy. Replicated single case experiments employing an ABA methodology were carried out on eight subjects (median age 5.5 years, range 3-13 years; 4 girls/boys) utilizing quantitative/qualitative data collection. Outcome measures were: Ten metre walking test (10MWT); physiological cost index (PCI); visual analogue scale (VAS) scoring of perceived gait changes; functional mobility changes using Patient Specific Functional Scale (PSFS); subject/carer perceptions recorded in daily diaries. Results identified following analysis of quantitative data indicated a treatment effect from the orthoses which could be corroborated by participant subjective impressions and comments. Statistically significant (p < 0.05) intervention-related improvements in gait velocity and gait consistency were identified respectively in 5/8 and 4/8 subjects. Power calculations support the feasibility of a larger controlled study to further investigate this orthotic intervention. This study indicates that DEFO leggings can confer beneficial effects on the gait of some children with spastic diplegia resulting from CP. These findings have implications for orthotic intervention with this subject group.