Gait Improvement Research Articles

A systematic review evaluating the efficacy of treadmill training in geriatric care as an intervention for improving balance and reducing fall risks in elderly population

Background & Purpose Falls and balance issues are significant concerns for the elderly. Treadmill training is increasingly recognized as a potential intervention to improve balance and reduce fall risk in this population. This systematic review evaluates the effectiveness of treadmill training on balance in the elderly. Methods A comprehensive search was conducted in databases including MEDLINE, EMBASE, CINAHL Plus, PEDro, Cochrane Library, and ERIC from January 1, 1980, to May 31, 2023. The search focused on treadmill training’s impact on balance in older adults. From 74 identified studies, outcome measures were categorized into groups like “Balance Improvement,” “Gait Improvement,” “Mobility Enhancement,” “Muscle Strength Improvement,” “Cognitive Function and Quality of Life,” and others. Articles were excluded for reasons like irrelevance to treadmill training, language barriers, or duplication, resulting in 16 final studies. Results Treadmill training shows diverse positive effects on the elderly. Perturbation-based training reduces falls, and treadmill walking enhances balance and quality of life, particularly in institutionalized older individuals. Benefits were noted for Parkinson’s patients’ gait, cognitive changes in neurophysiology, fitness and mobility improvements through underwater treadmill sessions, and refined gait in hemiparetic patients. Conclusion Treadmill training interventions are promising for improving balance and mobility in the elderly, including those with Parkinson’s disease, spinal cord injuries, and age-related balance issues. While these interventions show potential, further research is needed to determine optimal protocols, durations, and combinations with other interventions. This could lead to a more comprehensive approach for addressing balance and mobility challenges in the elderly, promoting healthy aging and reducing fall risks.

A Comprehensive Review: Robot-Assisted Treatments for Gait Rehabilitation in Stroke Patients.

Robot-assisted gait training (RAGT) is at the cutting edge of stroke rehabilitation, offering a groundbreaking method to improve motor recovery and enhance the quality of life for stroke survivors. This review investigates the effectiveness and application of various RAGT systems, including both end-effector and exoskeleton robots, in facilitating gait enhancements. The selection process for this comprehensive analysis involved a meticulous review of the literature from databases such as PubMed, the Cochrane Library, and EMBASE, focusing on studies published between 2018 and 2023. Ultimately, 27 studies met the criteria and were included in the final analysis. The focus of these studies was on the various RAGT systems and their role in promoting gait and balance improvements. The results of these studies conclusively show that patients experience significant positive effects from RAGT, and when combined with other physiotherapy methods, the outcomes are notably superior in enhancing functional ambulation and motor skills. This review emphasizes RAGT's capability to deliver a more customized and effective rehabilitation experience, highlighting the importance of tailoring interventions to meet the specific needs of each patient.

Predicting post-surgical outcomes in idiopathic normal pressure hydrocephalus using clinically important changes from the cerebrospinal fluid tap test

ObjectivePatients diagnosed with idiopathic Normal Pressure Hydrocephalus (iNPH) typically experience symptom improvements after undergoing a cerebrospinal fluid-tap test (CSF-TT), These improvements are recognized as indicative of potential improvements following surgical intervention. As gait disturbance is the most common iNPH symptom, gait improvements are of predominant interest. The purpose of this study was to examine if clinically important changes in gait and balance from CSF-TT predict meaningful changes following surgery. MethodThe study involved analysis of data collected in a prospective observational study for 34 iNPH patients who underwent a CSF-TT and subsequent surgery. Linear regression, logistic regression and classification trees were used for predictive modelling comparing changes from CSF-TT with post-surgical changes in Tinetti, Timed Up and Go (TUG) and Berg Balance Scale (BBS) outcomes. ResultsPredictive models for minimal clinically important differences (MCIDs) from CSF-TT to surgery were significant for Tinetti (odds ratio = 1.42, p = 0.02) and BBS (odds ratio = 1.57, p < 0.01). Four items on Tinetti and two items on BBS were identified with a predictive accuracy of 79% and 76% respectively. BBS has the highest sensitivity (85%) and negative predictive value (77%). TUG had a 100% specificity and 100% positive predictive value. The predictive model using MCIDs for TUG was not significant (odds ratio = 1.13, p = 0.06). ConclusionClinically important changes from CSF-TT are useful in predicting post-surgical outcomes in iNPH patients. Tinetti and BBS, both have predictive value using MCID scores as cut off values, of which BBS is a stronger outcome measure for prediction.

157 Minimally Invasive Treatment of Idiopathic Normal Pressure Hydrocephalus Using the Endovascular eShunt Implant

INTRODUCTION: Idiopathic Normal Pressure Hydrocephalus (NPH) is a reversible form of dementia typically treated with ventriculo-peritoneal shunt surgery. Recently we have described the first percutaneous transfemoral transvenous deployment of an endovascular CSF shunt (eShunt® System; CereVasc, Inc., Auburndale, MA, USA) to treat communicating hydrocephalus. METHODS: Patients were included after demonstrating &gt;20% gait improvement in lumbar drainage trial. Gait was assessed using Timed Up &amp; Go (TUG) test, cognition using Montreal cognitive assessment (MoCA), and urinary incontinence using Neurogenic Bladder Symptom Score (NBSS). Results were normalized per-patient to pre-treatment scores. A composite outcome score (COS) incorporating TUG/MOCA/NBSS was computed. RESULTS: Eleven patients (4 female; mean age 74.8 ± 4.2 years) underwent successful eShunt placement. Follow-up data showed significant improvement in gait by 35.4% at 30-days (n = 6, P &lt; 0.003), 24.8% at 90-days (n = 6, p &lt; 0.03) and by 32.8% at 180-days (n = 4, p &lt; 0.01) compared to baseline. MOCA and NBSS showed significant improvements at 30-days and the COS was significantly improved at all time points (p &lt; 0.005 at 30-, 90- and 180-days). No procedural/delayed hemorrhage or unexpected readmissions were encountered during this early follow-up phase. CONCLUSIONS: In elderly patients affected by NPH and its insidious effect on mobility, cognition and urinary continence, these results show that the endovascular eShunt implant can be safely deployed with a favorable risk profile and with rapid and sustained improvements in functional outcome scores.

Effect of Virtual Reality Game Based training in Gait Improvement of Post Stroke Patients: A Quasi-experimental Study

Background: Stroke, also known as a cerebro-vascular accident (CVA), is the second largest cause of mortality and the top leading cause of disability worldwide, with 6.7 million people dying from stroke attacks each year. Stroke patients face different difficulties in which gait abnormalities is the most common. Objective: The objective of this study was to determine the effect of virtual reality game based training for improving gait in post stokes patients. Methodology: This was a quasi-experimental study (single group) with non-probability convenient sampling for which sample size was 40, calculated through Open Epi. Baseline assessment was taken at start of study and final assessment was done after 8 weeks through outcome measures (TUG test, MAS scale, forward stepping test and Functional reach test). SPSS version 23 was used to analyze and record the data. Descriptive statistics were used to calculate mean and SD for all continuous data and percentages were calculated for all categorical data. Paired T test was used to compare mean change in data before and after intervention. Results: Although there was some improvement post scoring on outcome measurement scales applied in this study, still there was no significant difference between pre and post walking speed (P = 0.702), TUG test (P = 0.146), MAS scale (P = 0.227), forward stepping test (P = 0.089) and functional reach test (P = 0.415). Conclusion: This study concluded that, VR game based task specific training has improved the gait in post stroke patients but statistically there was no significant difference.

Improvement of gait and balance function in chronic post-stroke patients induced by Lower Extremity – Constraint Induced Movement Therapy: a randomized controlled clinical trial

ABSTRACT Objective To evaluate the effects of Lower Extremity – Constraint Induced Movement Therapy on gait function and balance in chronic hemiparetic patients. Methods Randomized, controlled, single-blinded study. We recruited chronic post stroke patients and allocated them to Lower Extremity – Constraint Induced Movement Tharapy (LE-CIMT) or Control Group. The LE-CIMT group received this protocol 2.5 hour/day for 15 followed days, including: 1) intensive supervised training, 2) use of shaping as a strategy for motor training, and 3) application of a transfer package. The control group received conventional physiotherapy for 2.5 hours/day for 15 followed days. Outcomes were assessed at baseline, after the interventions, and after 6 months, through 6-minute walk test and Mini-Balance Evaluation Systems Test; 10-meter walk test, Timed Up and Go, 3-D gait analysis, and Lower Extremity – Motor Activity Log. Results LE-CIMT was superior on the Assistance and confidence subscale of Lower Extremity – Motor Activity Log, Mini-BESTest and 6-minute walk test. The effect size for all outcomes was small when comparing both groups. LE-CIMT showed clinically significant differences in daily activities, balance, and gait capacity, with no clinically significant difference for spatiotemporal parameters. Conclusion The LE-CIMT protocol had positive outcomes on balance, performance, and confidence perception.

The Impact of Pabinafusp Alfa on the Disease Burden in Hunter's Syndrome: Patient-Reported Outcomes

AbstractSevere mucopolysaccharidosis type II (MPS-II) patients present with progressive mental impairment and reduced life expectancy. While current available treatment cannot cross the blood–brain barrier, the enzyme replacement therapy with pabinafusp alfa (a recombinant iduronate-2-sulfatase fused to an antihuman transferrin receptor antibody) was designed to penetrate it using transferrin receptor-mediated transcytosis. In this cross-sectional retrospective study, we aimed to report the impact of this new therapy using patient-reported outcomes. Data were collected using standardized questionnaire replied by patients or their caregivers (as proxies). Nine patients received intravenous administration of pabinafusp alfa for at least 104 weeks. All patient showed improvements in behavior (mainly aggressiveness), speech, motor ability, muscle strength, facial expression, breathing, and cognitive skills. Gait improvement was also found in 78% of participants. Caregivers also reported improvements in emotion demonstration as ability to smile, establish eye contact, and give hugs. Collectively, our results indicate a positive impact of pabinafusp alfa on quality of life of individuals with MPS-II and their relatives/caregivers. Future studies are warranted to elucidate the mechanisms underlying these beneficial effects.

Digital exoscope versus surgical microscope in spinal dural arteriovenous fistula surgery: a comparative series.

Surgical treatment of spinal dural arteriovenous fistulas (DAVFs) has been reported to be superior to endovascular treatment in terms of occlusion of the fistula. Despite the increased availability of digital 3D exoscopes, the potential benefits of using an exoscope in spinal DAVF surgery have not been studied. The purpose of this study was to report and compare the results of exoscope- and microscope-assisted surgery for spinal DAVFs. All consecutive adult patients (≥ 18 years of age) treated surgically for spinal DAVFs from January 2016 to January 2023 in a tertiary neurosurgical referral center were included. All patients were operated on by one neurosurgeon. Their pre- and postoperative clinical findings, imaging studies, and intra- and postoperative events were evaluated and surgical videos from the operations were analyzed. Altogether, 14 patients received an operation for spinal DAVF during the study period, 10 (71%) with an exoscope and 4 (29%) with a microscope. The DAVFs were most commonly located in the lower parts of the thoracic spine in both groups. The duration of exoscopic surgeries was shorter (141 vs 151 minutes) and there was less blood loss (60 vs 100 ml) than with microscopic surgeries. No major surgical complications were observed in either group. Of the 14 patients, 10 had gait improvement postoperatively: 7 (78%) patients in the exoscope group and 3 (75%) in the microscope group. None of the patients experienced deterioration following surgery. Exoscope-assisted surgery for spinal DAVFs is comparable in safety and effectiveness to traditional microscopic surgery. With practice, experienced neurosurgeons can adapt to using the exoscope without major additional risks to the patient.

Is Resistance Training an Option to Improve Functionality and Muscle Strength in Middle-Aged People with Multiple Sclerosis? A Systematic Review and Meta-Analysis.

Background: Currently, it is essential to adopt physical therapy strategies, such as resistance training, to enhance muscle strength and gait in middle-aged individuals (ages 45-65) suffering from Multiple Sclerosis. This is crucial in combating the typical symptoms of neurodegenerative diseases associated with functional loss. The objective of this study is to determine the effects of resistance training interventions on walking and muscle strength in middle-aged people with Multiple Sclerosis. Methods: A systematic review with meta-analysis was conducted by searching specific keywords in the PubMed, Scopus, Cochrane, and Web of Science databases. For inclusion, studies had to incorporate resistance training as a primary or significant component of the overall intervention for middle-aged patients with MS. Out of the 3675 articles identified, 12 randomized clinical trials met the criteria for inclusion in the review, with resistance training being a consistent feature in all of them. Results: Muscle strength and gait were evaluated as the main variables, with fatigue and the quality of life as secondary variables. This review reveals that resistance training significantly improves muscle strength. Resistance training achieves modest and non-significant improvements in gait. Notably, studies combining resistance training with motor control exercises achieve results of greater clinical significance in terms of gait. However, resistance training yields variable positive effects on perceived fatigue and the quality of life. Conclusion: Resistance training is useful for improving muscle strength; however, walking needs to be combined with motor control training.

Optimizing 3D printed ankle-foot orthoses for patients with stroke: Importance of effective elastic modulus and finite element simulation

Patients with stroke often use ankle-foot orthoses (AFOs) for gait improvement. 3D printing technology has become a popular tool in recent years for the production of AFOs due to its strengths on customization and rapid manufacturing. However, the porosity of the 3D printed materials affects the kinetic features of these orthoses, leading to its lower-strength than solid ones. The effective elastic modulus of 3D printed material was measured following standard test method to obtain the kinetic features precisely in a finite element simulation. This study demonstrated that the porosity of 3D printed samples using 100% fill density was 11% for PLA and 16% for Nylon. As a result, their effective elastic modulus was reduced to 1/3 and 1/12 of fully solid objects, respectively, leading to a lower stiffness of 3D printed orthoses. A fatigue testing platform was built to verify our finite element model, and the findings of the fatigue test were consistent with the analysis of the finite element model. Further, our AFO has been proven to have a lifespan exceeding 200 thousand steps. Our study highlights the significance of determining the actual porosity of 3D printed samples by calculating the effective elastic modulus, which leads to a more precise finite element simulation and enables reliable prediction of the kinetic features of the AFO. Overall, this study provides valuable insights into the production and optimization of 3D printed AFOs for patients with stroke.

The effects of combined transcranial brain stimulation and a 4-week visuomotor stepping training on voluntary step initiation in persons with chronic stroke-a pilot study.

Evidence suggests that transcranial direct current stimulation (tDCS) can enhance motor performance and learning of hand tasks in persons with chronic stroke (PCS). However, the effects of tDCS on the locomotor tasks in PCS are unclear. This pilot study aimed to: (1) determine aggregate effects of anodal tDCS combined with step training on improvements of the neural and biomechanical attributes of stepping initiation in a small cohort of persons with chronic stroke (PCS) over a 4-week training program; and (2) assess the feasibility and efficacy of this novel approach for improving voluntary stepping initiation in PCS. A total of 10 PCS were randomly assigned to one of two training groups, consisting of either 12 sessions of VST paired with a-tDCS (n = 6) or sham tDCS (s-tDCS, n = 4) over 4 weeks, with step initiation (SI) tests at pre-training, post-training, 1-week and 1-month follow-ups. Primary outcomes were: baseline vertical ground reaction force (B-vGRF), response time (RT) to initiate anticipatory postural adjustment (APA), and the retention of B-VGRF and RT. a-tDCS paired with a 4-week VST program results in a significant increase in paretic weight loading at 1-week follow up. Furthermore, a-tDCS in combination with VST led to significantly greater retention of paretic BWB compared with the sham group at 1 week post-training. The preliminary findings suggest a 4-week VST results in improved paretic limb weight bearing (WB) during SI in PCS. Furthermore, VST combined with a-tDCS may lead to better retention of gait improvements (NCT04437251) (https://classic.clinicaltrials.gov/ct2/show/NCT04437251).

A review on Parkinson’s disease symptoms before and after deep brain stimulation treatment

Introduction: Parkinson’s disease (PD), followed by Alzheimer’s disease, is the most common progressive neurodegenerative disease. Tremors, rigidity, akinesia, and disorders are common PD symptoms. Over the last few decades, deep brain stimulation (DBS) of the subthalamic nucleus has become a standard treatment for advanced PD. The aim of this systematic review paper is to see the difference between the symptoms of PD before and after DBS. Methods: We conducted a literature search using PubMed and Google Scholar. We chose research from the past 10 years. We retrieved 64 papers, and seven duplicated papers were removed. We reviewed the abstract for the remaining 57 papers which led to the selection of 29 papers. After applying inclusion and exclusion criteria for the remaining 29 papers, 23 papers in the English language were chosen for our review. Results: Five Randomized Clinical Trials (RCTs) studied the outcomes of DBS and eight RCTs about effects on posture and motor function. Four RCTs investigated the effects on gait and balance, two on tremors, and the remaining two on posture. The effects of DBS on speech and language were compared in two RCTs. Three studies looked at cognitive performance. One RCT studied sleeping versus awake DBS on PD. These studies showed that with DBS treatment, there was significant improvement in posture, motor function, gait, balance, speech, and language. However, more studies are required for the further analysis on dysphagia and urinary dysfunction. Conclusion: Our study contributed to a better understanding of the advantages of DBS for a range of symptoms, but it concluded that additional RCT on dysphagia and urinary dysfunction was required to reach a reliable conclusion. More research is required to determine the effects of DBS on different motor and non-motor PD symptoms to standardize treatment.

Digital 3D Exoscope is Safe and Effective in Surgery for Intradural Extramedullary Tumors: A Comparative Series

Digital 3D exoscopes have been shown to be comparably safe and effective as surgical microscopes in complex microneurosurgical procedures. However, the results of exoscopic spinal tumor surgeries are scarce. The purpose of this study is to compare results of a transition from microscope to exoscope in surgeries for spinal intradural extramedullary tumors. We included all consecutive patients with intradural extramedullary spinal tumors operated on by the senior author during January 2016 to October 2023. The 3D exoscope was used in the latter half of the series from November 2020. We evaluated pre- and postoperative clinical findings, imaging studies, intra- and postoperative events, and analyzed surgical videos from the operations retrospectively. We operated 35 patients (exoscope n= 19, microscope n= 16) for intradural extramedullary tumors (meningioma n= 18, schwannoma n= 12, other n= 5). Tumors in the cervical and thoracic spine were more common than in the lumbar region. The duration of surgery was slightly longer (median 220 vs. 185 minutes) in the exoscope group. However, the rate of gross total resection of the tumor was higher (81% vs. 67%) and the tumors more often located anteriorly to the spinal cord (42% vs. 13%) in the exoscope group. No major complications (i.e., permanent motor deficit or postoperative hematoma) occurred in either group. We saw postoperative gait improvement in 81% and 85% of the patients with preoperative deterioration of gait after exoscopic and microscopic surgeries, respectively. This study demonstrates that exoscope-assisted surgery for spinal intradural extramedullary tumors is comparable in safety and effectiveness to traditional microscopic surgery.

Delayed Diagnosis of Spinal Dural Arteriovenous Fistula: A Case Report and Scoping Review

Spinal dural arteriovenous fistula (SDAVF) is among the most common arterial shunt diseases typically found in middle aged or older men. Herein, we aimed to clarify the reasons for misdiagnoses and delayed diagnoses of SDAVF, determine how these affect prognoses, and establish how they can be prevented. We conducted a PubMed/MEDLINE literature search using “spinal dural arteriovenous fistula”, “delayed diagnosis”, “late diagnosis”, and “misdiagnosis” terms. We identified 18 articles, including 965 SDAVF cases. Patients were predominantly males (71.8–100.0%) (mean age: 53.5–71.0 years). Misdiagnoses rates varied (17.5–100.0%) and encompassed many conditions. The mean time between early manifestations and confirmed diagnosis was approximately 10–15 months and from the first radiologic image revealing dural arteriovenous fistula (DAVF) features to diagnosis was 9.2–20.7 months. Posttreatment outcomes showed a significant improvement in motor functions, gait, and micturition, particularly in patients exhibiting preoperative symptoms over a short period. SDAVF is frequently misdiagnosed or subject to delayed diagnosis, causing poor clinical outcomes. SDAVF symptoms including progressive lower-limb weakness, paresthesia, and vesicorectal dysfunction are indications for spinal magnetic resonance imaging with subsequent spinal angiography, wherein DAVF is evidenced by extensive T2 hyperintensity and flow-void abnormalities. We reported a representative case with delayed diagnosis.

Intravenous administration of human amnion-derived mesenchymal stem cells improves gait and sensory function in mouse models of spinal cord injury.

Spinal cord injury (SCI) leads to severe disabilities and remains a significant social and economic challenge. Despite advances in medical research, there are still no effective treatments for SCI. Human amnion-derived mesenchymal stem cells (hAMSCs) have shown potential due to their anti-inflammatory and neuroprotective effects. This study evaluates the therapeutic potential of intravenously administered hAMSCs in SCI models. Three days after induction of SCI with forceps calibrated with a 0.2 mm gap, hAMSCs or vehicle were administered intravenously. Up to 4 weeks of SCI induction, motor function was assessed by scores on the Basso Mouse Locomotor Scale (BMS) and the Basso-Beattie-Bresnahan Scale (BBB), and sensory function by hindlimb withdrawal reflex using von Frey filaments. Six weeks after SCI induction, gait function was assessed using three-dimensional motion analysis. Immunohistochemistry, polymerase chain reaction (PCR), flow cytometry, and ELISA assay were performed to clarify the mechanisms of functional improvement. The hAMSC treatment significantly improved sensory response and gait function. In the SCI site, immunohistochemistry showed a reduction in Iba1-positive cells and PCR revealed decreased TNFα and increased BDNF levels in the hAMSC-treated group. In assessing the systemic inflammatory response, hAMSC treatment reduced monocytic bone marrow-derived suppressor cells (M-MDSCs) and Ly6C-positive inflammatory macrophages in the bone marrow by flow cytometry and serum NO levels by ELISA assay. This study demonstrates the therapeutic potential of the hAMSC in SCI, with improvements in gait and sensory functions and reduced inflammation both locally and systemically. The findings support further investigation of the hAMSC as a potential treatment for SCI, focusing on their ability to modulate inflammation and promote neuroprotection.

Effect of Yoga on Gait, Balance, Trunk Control and Lower Limb Functions after Stroke: An Experimental Study

Introduction: Stroke is a leading cause of long-term disability, with lower limb dysfunction being the most common symptom. Impairments in balance, trunk control, and gait significantly impact mobility and quality of life. While conventional rehabilitation methods target these deficits, therapies like yoga may provide added benefits. This study aims to evaluate the effect of integrating yoga with conventional therapy on gait, balance, trunk control, and lower limb function in stroke patients. Methods: 32 subjects were randomly assigned to two groups. Group 1 received conventional therapy, while Group 2 underwent conventional therapy with yoga, 4-5 days per week for 4 weeks. Outcome measures included Brunnstrom Recovery Stage of Lower Extremity (BRS-LE), Fugl-Meyer Assessment Lower Extremity (FMA-LE), Barthel Index (BI), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and Trunk Impairment Scale (TIS). Intra-group comparisons were analyzed using the Wilcoxon Signed Ranks Test, and inter-group differences were assessed using Mann-Whitney U test. Results: Both groups showed significant improvements in gait, balance, trunk control, and lower limb function. However, the experimental group demonstrated significantly greater improvements in BRS-LE, FMA-LE, BBS, and DGI scores compared to control group. Conclusion: Adding yoga to conventional therapy significantly enhances recovery of gait, balance, trunk control, and lower limb function in stroke patients.

Neurophysiological, balance and motion evidence in adolescent idiopathic scoliosis: A systematic review.

Adolescent idiopathic scoliosis (AIS) is a spinal deformity that affects approximately 4% of the world's population. Several hypotheses regarding the etiology of AIS have been investigated. In the last decades, impaired visual-spatial perception, alterations in spatial body orientation and sensory integration deficits have been documented. We aimed to summarize the neurophysiological, balance, and motion evidence related to AIS published in the last fifteen years, between January 2008 and April 2023. Both observational and interventional studies were considered. Only studies using quantitative assessment methods, such as electroencephalography (EEG), electromyography (EMG), magnetic resonance imaging (MRI), somatosensory evoked potentials, force platform, or motion capture, were included. 1250 eligible records identified from online database searching were filtered by duplicate removal, title and abstract screening, and qualitative analysis. 61 articles met the inclusion criteria (i.e., Cobb range 10°-35°, age range 10-18 years) and were summarized. We found significant evidence of impaired standing balance in individuals with AIS who greatly rely on visual and proprioceptive information to stay upright. EMG studies frequently reported an increased activity on the convex side of the intrinsic spinae muscles. EEG data show increased delta and theta power, higher alpha peak frequencies, and significant suppression in the alpha and beta bands in subjects with AIS during standing tasks. MRI studies report changes in white matter structures, differences in the vestibular system, and abnormal cortical activations over motor-related areas in subjects with AIS. Bracing appears to be an effective treatment for AIS, leading to improvements in static balance and gait. Methodological issues prevent reliable conclusions about the effects of other treatment options. This review underscores the importance of quantitative assessment methods to explore the etiology and pathophysiology of AIS. Further research is needed to measure the impact of physical therapy and orthotic treatments on the neurophysiological mechanisms of the disease.

Stride Revolution: Moonwalkers' Technological Leap, Ethical Considerations, and Future Frontiers in Enhanced Mobility

Moonwalkers are novel shoes designed by Shift Robotics which employ a machine learning drivetrain, enabling users to walk at speeds akin to running. The shoes, tested among diverse age groups, showcase rapid proficiency in gait improvement and injury reduction. However, their high cost and limited availability pose challenges. It is important to understand this biotechnology beyond its technical aspects, exploring social determinants of health (SDoH) and their impacts. Housing conditions, education, and employment dynamics influence Moonwalker usage, underscoring the need for universal accessibility. Intersectionality of these determinants is evident, emphasizing the complex interplay between various factors. Emerging research suggests Moonwalkers' application goes beyond the intended use, especially in sports for older adults. While there are potential benefits to Moonwalker use, limitations in spatial gait parameter assessments and consumer considerations should also be considered. Ongoing research to maximize benefits and minimize potential harms is encouraged, emphasizing the importance of ethical scrutiny in the integration of biotechnologies.

The Impact of Aquatic Therapy on Balance and Mobility in Individuals with Spinal Cord Injury- A Systematic Review and Meta-Analysis

Background: Although the evidence was conflicting, earlier studies suggested that aquatic therapy (AT) may improve balance and mobility in people with spinal cord injuries (SCI). This population's comprehensive review and meta-analysis aimed to assess how AT affected mobility and balance. Methods: We thoroughly searched the most extensive databases to find pertinent observational studies and randomized controlled trials (RCTs) contrasting AT with control therapies. After extracting data, two impartial reviewers evaluated the quality of the study. Using a random-effects model, the mean difference (MD) in balance and mobility improvement was determined. statistics were used to evaluate heterogeneity. Outcomes: The evaluation contained six studies. AT was considerably improved, as evidenced by the pooled MD for gait improvement of . Additionally demonstrating a substantial effect of AT was the pooled MD for mobility improvement, which was . On the other hand, the mobility data showed significant heterogeneity . Conclusion: The results imply that AT may considerably enhance movement and balance in people with SCI. The general results favor integrating assistive technology (AT) into rehabilitation programs for patients with spinal cord injuries (SCI), notwithstanding considerable variation in the research, especially about mobility. More investigation is required to investigate the causes of heterogeneity and enhance AT methods.

Clinical evaluation of Nirabhishankita Basti Karma administered by three piecemeal Putak - A Pilot Clinical Study

Background: Pain has globally become an attention problem which causes discomfort by affecting the body as well as the mind. Pain (Ruja) is the cardinal feature of most of the musculoskeletal disorders and it can be affect the quality of life. In Ayurveda all types of pain are under the umbrella of Vata which is the prime for generating and spreading the pain. Basti is given more importance because it directly pacifies the vitiated Vata Dosha. Aim and Objective: To evaluate the efficacy of Nirabhisankita Basti Karma administered by three piecemeal Putak. Materials and Methods: Randomly selected 5 patients were examined on the ground of Astavidha Pariksha (eight-fold examination) and specially prepared data research questionnaire. Selected subjects were administered with three piecemeal Putak Basti for 3 days and it was followed up of 15 days. Assessment was done through various variables like pain, stiffness, numbness, tingling, and gait. Results: The study showed that Nirabhisankit Basti produced an extremely significant improvement in pain and gait with 85.7 &amp; 90 percentage reliefs while very significant in stiffness, numbness and tingling. Conclusion: Nirabhisankit Basti is found to be effective in musculoskeletal pain.