Improve Gait Performance Research Articles

Implicit learning provides advantage over explicit learning for gait-cognitive dual-task interference

Dual-task performance holds significant relevance in real-world scenarios. Implicit learning is a possible approach for improving dual-task performance. Analogy learning, utilizing a single metaphor to convey essential information about motor skills, has emerged as a practical method for fostering implicit learning. However, evidence supporting the effect of implicit learning on gait-cognitive dual-task performance is insufficient. This exploratory study aimed to examine the effects of implicit and explicit learning on dual-task performance in both gait and cognitive tasks. Tandem gait was employed on a treadmill to assess motor function, whereas serial seven subtraction tasks were used to gauge cognitive performance. Thirty healthy community-dwelling older individuals were randomly assigned to implicit or explicit learning groups. Each group learned the tandem gait task according to their individual learning styles. The implicit learning group showed a significant improvement in gait performance under the dual-task condition compared with the explicit learning group. Furthermore, the implicit learning group exhibited improved dual-task interference for both tasks. Our findings suggest that implicit learning may offer greater advantages than explicit learning in acquiring autonomous motor skills. Future research is needed to uncover the mechanisms underlying implicit learning and to harness its potential for gait-cognitive dual-task performance in clinical settings.

Motor adaptation to continuous lateral trunk support force during walking improves trunk postural control and walking in children with cerebral palsy: A pilot study

PurposeTo determine whether the application of continuous lateral trunk support forces during walking would improve trunk postural control and improve gait performance in children with CP. Materials and methodsNineteen children with spastic CP participated in this study (8 boys; mean age 10.6 ± 3.4 years old). Fourteen of them were tested in the following sessions: 1) walking on a treadmill without force for 1-min (baseline), 2) with lateral trunk support force for 7-min (adaptation), and 3) without force for 1-min (post-adaptation). Overground walking pre/post treadmill walking. Five of them were tested using a similar protocol but without trunk support force (i.e., control). ResultsParticipants from the experimental group showed enhancement in gait phase dependent muscle activation of rectus abdominis in late adaptation period compared to baseline (P = 0.005), which was retained during the post-adaptation period (P = 0.036), reduced variability of the peak trunk oblique angle during the late post-adaptation period (P = 0.023), and increased overground walking speed after treadmill walking (P = 0.032). Participants from the control group showed modest changes in kinematics and EMG during treadmill and overground walking performance. These results suggest that applying continuous lateral trunk support during walking is likely to induce learning of improved trunk postural control in children with CP, which may partially transfer to overground walking, although we do not have a firm conclusion due to the small sample size in the control group.

Investigating spatiotemporal and kinematic gait parameters in individuals with Parkinson's disease with a history of freezing of gait and exploring the effects of dopaminergic therapy on freezing of gait subtypes.

Freezing of Gait (FOG) is a prevalent and debilitating symptom in idiopathic Parkinson's disease (PD). This study evaluated spatiotemporal and kinematic gait parameters in individuals with PD with a history of FOG and explored the effects of dopaminergic therapy on FOG subtypes. One hundred and nine individuals with PD underwent clinical assessments and quantitative biomechanical measures during walking cycles before and after dopaminergic therapy. Individuals with FOG were classified into levodopa-responsive and levodopa-unresponsive groups. Individuals with FOG displayed longer disease duration and higher Unified Parkinson's Disease Rating Scale (UPDRS) II, III, IV scores, and total scores and levodopa equivalent dose, than those without FOG (all p < 0.0001). Following propensity score matching of 15 pairs based on UPDRS total score and disease duration during the off-medication state, the analysis comparing the FOG and non-FOG groups revealed no significant differences in spatiotemporal and kinematic parameters. In 39 cases of FOG, dopaminergic therapy improved gait performance in individuals with PD, enhancing spatiotemporal parameters (speed, stride length, step length, step variability) and kinematic parameters (shoulder and elbow flexion/extension range of motion (ROM), pelvic rotation, and hip abduction/adduction ROM) regardless of FOG responsiveness to dopaminergic therapy. A significant difference in trunk sway ROM (p = 0.029) remained before and after dopaminergic therapy, even after adjusting for disease duration and clinical severity. Dopaminergic therapy had varying effects on PD with FOG, improving several spatiotemporal and kinematic gait parameters but being less effective in levodopa-unresponsive cases. Quantitative biomechanical measures offer detailed insights into gait performance, aiding personalized fall risk assessment and guiding individualized rehabilitation programs.

A gamified virtual environment intervention for gait rehabilitation in Parkinson’s Disease: co-creation and feasibility study

BackgroundTreadmill gait training has been shown to improve gait performance in People with Parkinson’s Disease (PwPD), and in combination with Virtual Reality, it can be an effective tool for gait rehabilitation. The addition of gamification elements can create a more stimulating and adherent intervention. However, implementation of new technologies in healthcare can be challenging. This study aimed to develop and evaluate the feasibility of a treadmill rehabilitation program in a Gamified Virtual Reality Environment (GVRE) for PwPD.MethodsThe GVRE was developed following a user-centered design approach, involving both PwPD and physiotherapists in the development and evaluation of the intervention. The intervention consisted of a walking simulation in three different environments (countryside, city, and park), which had a progressive increase in difficulty. To test its feasibility, three sessions were carried out with four PwPD and four physiotherapists. To assess the usability, the System Usability Scale (SUS), Assistive Technology Usability Questionnaire for people with Neurological diseases (NATU Quest) and Simulator Sickness Questionnaire (SSQ) were used. To assess the intervention’s acceptability, feedback and in-game performance was collected from participants.ResultsResults showed the feasibility of the intervention, with a SUS score of 74.82 ± 12.62, and a NATU Quest score of 4.49 ± 0.62, and positive acceptability feedback. Participants showed clear preferences for naturalistic environments, and gamification elements were seen as positive. Difficulty settings worked as intended, but lowered enjoyment of the experience in some cases.ConclusionsThis intervention was successfully shown as a feasible option for the training of gait under Dual Task conditions for PwPD. It offers a safe and replicable environment in which complex situations can be trained. However, further iterations of the intervention need to be improved in order to guarantee accurate tracking and a more realistic training progression.Trial registration numberNCT05243394–01/20/2022.

The effects of combining repetitive transcranial magnetic stimulation with task-specific training on gait performance in individuals with Parkinson's disease: A review article.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor impairments, especially in the area of gait disturbances. Physiotherapy, with a focus on task-specific training, has demonstrated a level of efficacy as regards alleviating symptoms and enhancing functional capabilities in individuals with PD. Repetitive Transcranial Magnetic Stimulation (rTMS) has emerged as a potential therapeutic intervention for improving motor functions in individuals with PD. This review article aims to investigate the effects of combining rTMS with task-specific training on gait performance in individuals with PD. PubMed, Physiotherapy Evidence Database (PEDro), and Scopus were all searched for relevant studies. The focus of the search was on studies that investigated the efficacy of combining rTMS with task-specific training to improve gait performance in individuals with PD. Four studies were identified as fulfilling the eligibility criteria and were included in the study. The combination of rTMS with specific treadmill training and weight-bearing exercises can significantly enhance walking efficiency, including improvements in walking speed, self-mobility, and step rate. In addition, the combination of rTMS and task-specific training, such as treadmill-based training, shows promise in enhancing gait performance in individuals with PD. High-frequency rTMS targeting the primary motor cortex (or M1) can result in improved walking speed, self-mobility, and step rate. However, limited research exists regarding low-frequency stimulation of the supplementary motor area (SMA) in individuals with gait issues. Further research is required to determine the optimal parameters of rTMS, such as strength, frequency, and duration of stimulation and it is worth considering the incorporation of additional training modalities, including cognitive exercises.

Enteral plasma supports brain repair in newborn pigs after birth asphyxia

Newborns exposed to birth asphyxia transiently experience deficient blood flow and a lack of oxygen, potentially inducing hypoxic-ischaemic encephalopathy and subsequent neurological damage. Immunomodulatory components in plasma may dampen these responses. Using caesarean-delivered pigs as a model, we hypothesized that dietary plasma supplementation improves brain outcomes in pigs exposed to birth asphyxia. Mild birth asphyxia was induced by temporary occlusion of the umbilical cord prior to caesarean delivery. Motor development was assessed in asphyxiated (ASP) and control (CON) piglets using neonatal arousal, physical activity and gait test parameters before euthanasia on Day 4. The ASP pigs exhibited increased plasma lactate at birth, deficient motor skills and increased glial fibrillary acidic protein levels in CSF and astrogliosis in the putamen. The expression of genes related to oxidative stress, inflammation and synaptic functions was transiently altered in the motor cortex and caudate nucleus. The number of apoptotic cells among CTIP2-positive neurons in the motor cortex and striatal medium spiny neurons was increased, and maturation of preoligodendrocytes in the internal capsule was delayed. Plasma supplementation improved gait performance in the beam test, attenuated neuronal apoptosis and affected gene expression related to neuroinflammation, neurotransmission and antioxidants (motor cortex, caudate). We present a new clinically relevant animal model of moderate birth asphyxia inducing structural and functional brain damage. The components in plasma that support brain repair remain to be identified but may represent a therapeutic potential for infants and animals after birth asphyxia.

From injury to rehabilitation: How kinesiology taping helps patients with first metatarsophalangeal joint sprain (turf toe) in pain reduction, gait parameters and functional ability improvement. A randomized clinical trial

ObjectiveTurf toe is a common sports injury that may affect mobility and functional ability. For complete recovery, rehabilitation modalities are required to overcome these issues. This study investigated whether kinesio taping (KT) would reduce pain, improve gait performance, and enhance the functional capacity of turf toe patients undergoing physical therapy. Methodssixty patients with grade II turf toe (age; 25–30 years) assigned randomly into three treatment groups; KT applied alongside an exercise program conducted three times/week for 12 successive weeks. (KT group; n = 20), placebo taping plus exercise (Placebo group; n = 20), or exercise only (Control group; n = 20). Pain, gait parameters, and functional ability assessed using VAS, 3D gait analysis, and 6MWT respectively pre- and post-treatment. ResultsThere was a significant post-treatment decrease in VAS score in the KT group lower than the control or placebo group and a significant increase in 6MWT distance in the KT group higher than the control or placebo group (p < 0.001). Additionally, there was a significant post-treatment increase in step length, stride length, cadence and velocity of KT group higher than control and placebo group (p < 0.05). There was no significant difference in gait parameters between control and placebo groups post treatment (p > 0.05). ConclusionsThe findings of the study demonstrated that KT is a useful complementary modality to exercise in patients with turf toe, as it may result in more favorable improvements to pain, gait characteristics, and functional abilities. Further studies should be conducted to assess the long-term effects, different KT application methods, and tailored treatment protocols on turf toe.

Enhancing walking performance in patients with peripheral arterial disease: An intervention with ankle-foot orthosis

Lower extremity peripheral artery disease (PAD) is a cardiovascular condition manifesting from narrowed or blocked arteries supplying the legs. Gait is impaired in patients with PAD. Recent evidence suggests that walking with carbon fiber ankle foot orthoses (AFOs) can improve patient mobility and delay claudication time. This study aimed to employ advanced biomechanical gait analysis to evaluate the impact of AFO intervention on gait performance among patients with PAD. Patients with claudication had hip, knee, and ankle joint kinetics and kinematics assessed using a cross-over intervention design. Participants walked over the force platforms with and without AFOs while kinematic data was recorded with motion analysis cameras. Kinetics and kinematics were combined to quantify torques and powers during the stance period of the gait cycle. The AFOs effectively reduced the excessive ankle plantar flexion and knee extension angles, bringing the patients' joint motions closer to those observed in healthy individuals. After 3 months of the AFO intervention, the hip range of motion decreased, likely due to changes occurring within the ankle chain. With the assistance of the AFOs, the biological power generation required from the ankle and hip during the push-off phase of walking decreased. Wearing AFOs resulted in increased knee flexor torque during the loading response phase of the gait. Based on this study, AFOs may allow patients with PAD to maintain or improve gait performance. More investigation is needed to fully understand and improve the potential benefits of ankle assistive devices.

The acute effects of a stretching and conditioning exercise protocol for the lower limbs on gait performance- a proof of concept and single-blind study.

Due to improvement in movement performance, post-activation performance enhancement (PAPE) may open new possibilities to improve gait performance. However, no study has attempted to translate this phenomenon into walking. Therefore, the study aimed to test whether acute stretching followed by a conditioning exercise can improve subsequent gait performance in healthy adults. Can an exercise protocol subsequently improve gait performance? Sixteen individuals walked four 10-m trials (in each period) before and after 7 min of an exercise protocol composed of stretching (focusing on the lower limb) and a conditioning exercise (standing calf-raise wearing a vest of 20 kg). Gait spatialtemporal parameters and muscle activity of tibialis anterior and gastrocnemius medialis and lateralis muscles were obtained by a 3D-motion system and wireless electromyography, respectively. Before and after the exercise protocol, kinematic and muscle activity parameters were compared by a one-way ANOVA and the Wilcoxon signed-rank test, respectively. After the exercise protocol, the participants walked with a faster step velocity (p < 0.018) and with a lower step duration (p < 0.025). Also, higher peak muscle activity (p < 0.008) and low-frequency (p < 0.034) activation of the anterior tibial muscle after the exercise protocol were observed. In conclusion, the protocol improves the stability and the muscles' efficiency during gait, contributing to a new approach to enhancing gait rehabilitation programs.

Functional electrical stimulation to enhance reactive balance among people with hemiparetic stroke.

Individuals with stroke demonstrate a twofold higher fall incidence compared to healthy counterparts, potentially associated with deficits in reactive balance control, which is crucial for regaining balance from unpredictable perturbations to the body. Moreover, people with higher stroke-related motor impairment exhibit greater falls and cannot recover balance during higher perturbation intensities. Thus, they might need supplemental agents for fall prevention or even to be included in a perturbation-based protocol. Functional electrical stimulation is a widely used clinical modality for improving gait performance;however, it remains unknown whether it can enhance or interfere with reactive balance control. We recruited twelve ambulatory participants with hemiparetic stroke (61.48 ± 6.77years) and moderate-to-high motor impairment (Chedoke-McMaster Stroke Leg Assessment ≤ 4/7). Each participant experienced 4 unpredicted paretic gait-slips, with and without functional electrical stimulation (provided 50-500ms after perturbation) in random order. The paretic quadriceps muscle group was chosen to receive electrical stimulation, considering the role of support limb knee extensors for preventing limb-collapse. Outcomes includingprimary (laboratory falls), secondary (reactive stability, vertical limb support) and tertiary (compensatory step length, step initiation, execution time) measureswere compared between the two conditions. Participants demonstrated fewer falls, higher reactive stability, and higher vertical limb support (p < 0.05) following gait-slips with functional electrical stimulation compared to those without. This was accompanied by reduced step initiation time and a longer compensatory step (p < 0.05). The application of functional electrical stimulation to paretic quadriceps following gait-slips reduced laboratory fall incidence with enhanced reactive balance outcomes among people with higher stroke-related motor impairment. Our results lay the preliminary groundwork for understanding the instantaneous neuromodulatory effect of functional electrical stimulation in preventing gait-slip falls, future studies could test its therapeutic effect on reactive balance. Clinical registry number: NCT04957355.

Influence of Verbal Instruction on Gait Training in Parkinson Disease: A Randomized Controlled Trial.

Verbal instruction is one of the most commonly used methods that therapists use to correct walking pattern for people with Parkinson disease. This study aimed to compare the long-term training effects of two different verbal instructions that either asked the participants to "take big steps" or "strike the ground with the heel" on walking ability in individuals with Parkinson disease. Forty-five participants with Parkinson disease were randomized into the big-step or heel strike group. The participants underwent 12 sessions of treadmill and overground gait training. Throughout the interventions, the big-step group received an instruction to "take big steps," while the heel strike group received an instruction to "strike the ground with your heel." The primary outcome was gait performance, including velocity, stride length, cadence, and heel strike angle. The participants were assessed before, immediately after, and 1 mo after training. Both groups showed significant improvements in gait performance after training. The heel strike group showed continuous improvements in velocity and stride length during the follow-up period; however, the big-step group showed slightly decreased performance. A verbal instruction emphasizing heel strike can facilitate long-term retention of walking performance in people with Parkinson disease.

Association between nutritional status and gait performance in Alzheimer's disease.

This study aimed to comprehensively explore the nutrition and gait of AD patients at different stages and the relationship between them. A total of 85 AD patients were consecutively enrolled in this cross-sectional study and divided into the mild cognitive impairment (MCI) due to AD (AD-MCI) and the dementia due to AD (AD-D) groups. Demographic information, nutritional status, and gait performance were compared between the two groups, and the correlation between nutritional status and gait performance was subsequently analyzed by Pearson and Spearman correlation analyses. The AD-D group had lower scores on Mini-Nutritional Assessment (MNA) and MNAm scales, lower levels of urea nitrogen, folic acid, and vitamin B12 in blood, and higher homocysteine level than those in the AD-MCI group (all p < 0.05). The AD-D group had slower step speed, shorter step length, and shorter stride length than those in the AD-MCI group (all p < 0.05). AD patients with decreased scores of MNA and MNAm scales, and declined levels of urea nitrogen and vitamin B12 in blood had reduced gait speed and gait cadence, and prolonged step length time and stride length time, whereas homocysteine showed the almost opposite results (all p < 0.05). In the AD-MCI group, the score of scale was negatively correlated with the coefficient of variation (CV) of stride length, and the folic acid level was negatively correlated with the CV of stride length and cadence (all p < 0.05). AD patients at the dementia stage had worse nutritional status and gait performance than those at the MCI stage, which was associated with worse global cognition and activities of daily living. Poorer nutritional status was associated with higher gait variability in patients at the MCI stage and with poorer gait performance in patients at the dementia stage. Early identification and intervention of patients with nutritional risk or malnutrition may improve gait performance, thus reducing the risk of falling and cognitive decline, as well as the mortality.

Decellularized allogeneic cartilage paste with human costal cartilage and crosslinked hyaluronic acid-carboxymethyl cellulose carrier augments microfracture for improved articular cartilage repair

Articular cartilage lacks natural healing abilities and necessitates surgical treatments for injuries. While microfracture (MF) is a primary surgical approach, it often results in the formation of unstable fibrocartilage. Delivering hyaline cartilage directly to defects poses challenges due to the limited availability of autologous cartilage and difficulties associated with allogeneic cartilage delivery. We developed a decellularized allogeneic cartilage paste (DACP) using human costal cartilage mixed with a crosslinked hyaluronic acid (HA)-carboxymethyl cellulose (CMC) carrier. The decellularized allogeneic cartilage preserved the extracellular matrix and the nanostructure of native hyaline cartilage. The crosslinked HA-CMC carrier provided shape retention and moldability. In vitro studies confirmed that DACP did not cause cytotoxicity and promoted migration, proliferation, and chondrogenic differentiation of human bone marrow-derived mesenchymal stem cells. After 6 months of implantation in rabbit knee osteochondral defects, DACP combined with MF outperformed MF alone, demonstrating improved gait performance, defect filling, morphology, extracellular matrix deposition, and biomechanical properties similar to native cartilage. Thus, DACP offers a safe and effective method for articular cartilage repair, representing a promising augmentation to MF. Statement of significanceDirectly delivering hyaline cartilage to repair articular cartilage defects is an ideal treatment. However, current allogeneic cartilage products face delivery challenges. In this study, we developed a decellularized allogeneic cartilage paste (DACP) by mixing human costal cartilage with crosslinked hyaluronic acid (HA)-carboxymethyl cellulose (CMC). DACP preserves extracellular matrix components and nanostructures similar to native cartilage, with HA-CMC ensuring shape retention and moldability. Our study demonstrates improved cartilage repair by combining DACP with microfracture, compared to microfracture alone, in rabbit knee defects over 6 months. This is the first report showing better articular cartilage repair using decellularized allogeneic cartilage with microfracture, without the need for exogenous cells or bioactive substances.

Unraveling the unparalleled benefits of orienteering versus hiking on gait performance and cognition: A randomized clinical trial

MethodsPhysical activities and sports in nature offer opportunities for leisure, health, and well-being. A randomized clinical trial (RCT) compared the effects of training, dualtask orienteering and single-task hiking in independent older adults (n = 90) allocated into three groups: orienteering group (OG), hiking group (HG) and control group (CG). Timed Up and Go (TUG) tests, including a dual-task (TUG-DT), and cognitive tests were administered. Differences were analyzed by Generalized Estimating Equations (GEE) and the effect size (ES) was calculated. Unpaired and paired tests were used for the evaluation of basic differences and after 24 weeks of intervention. ResultsThis RCT highlights the interaction effects between groups and time. Only the OG in TUGDT reduced by 6 s, with change of 42% (ES=0.77). Likewise, Dual TUG + cognitive stops (TUG-DT+ CS) and Dual TUG + cognitive stops + cognitive errors (TUG-DT + CS + CE), reduced 7 (ES=0.85) and 8 (ES=0.90) seconds (<0.001). The task cost improved by 75% for OG and 24% for HG (p = 0.001), with an ES of 0.56 for OG. For cognition, there was a 49.2% increase (ES=2.00) for OG and 16.5% for HG in executive functions and visuospatial skills, a 31.4% increase (ES=1.64) for OG and 14.7% for HG in processing speed, and a 39.8% increase (ES=1.62) for OG and 6.5% for HG in memory. All interactions were <0.001. ConclusionThe orienteering demonstrated that has potential benefits in effectively improving gait performance and preventing cognitive decline in older adults. Brazilian Registry of Clinical Trials (ReBEC): RBR-99jmmpf.

EFFORT EVALUATION OF CHILDREN WITH CEREBRAL PALSY IN ROBOTIC TREADMILL THERAPY WITH AND WITHOUT MOTIVATION

Although the task-specific robot treadmill therapies can improve gait performance of children with cerebral palsy, not all the institutions have the possibility to access to the sensor robot information to obtain quantitative measures related actual progress of the children. The aim of this study is to propose a computer vision system to investigate the effort of children with cerebral palsy during robot treadmill therapy. Ten participants diagnosed with cerebral palsy underwent single robot therapy sessions consisting of a motivated period (active: kicking a ball), followed by an unmotivated period (passive: simple walking). The outcome measure was the ankle trajectory recorded by a video camera. Indexes based on the ankle trajectory between active and passive therapy were computed: (a) the gait analysis based on the difference on a sample-by-sample manner, and b) the step cycles with dynamic time warping (DTW). Inference statistical analysis shows that the robot trajectories for passive and active therapies with the gait analysis presents statistical differences (p-[Formula: see text]. Likewise, DTW showed significant differences in robot trajectories related to passive and active therapy (p-[Formula: see text]. We found that the statistical differences are independent of the severity of central gait impairment. This suggests that information about patient involvement could be given to the therapist and could be used to assess patient participation. The method showed the potential to be used as a tool for the assessment the improvement progress.

Re-learning mental representation of walking after a brain lesion. Effects of a cognitive-motor training with a robotic orthosis.

Stroke-related deficits often include motor impairments and gait dysfunction, leading to a limitation of social activities and consequently affecting the quality of life of stroke survivors. Neurorehabilitation takes advantage of the contribution of different techniques in order to achieve more benefits for patients. Robotic devices help to improve the outcomes of physical rehabilitation. Moreover, motor imagery seems to play a role in neurological rehabilitation since it leads to the activation of the same brain areas as actual movements. This study investigates the use of a combined physical and cognitive protocol for gait rehabilitation in stroke patients. Specifically, we tested the efficacy of a 5-week training program using a robotic orthosis (P.I.G.R.O.) in conjunction with motor imagery training. Twelve chronic stroke patients participated in the study. We evaluated balance and gait performance before and after the training. Six of them underwent fMRI examination before and after the training to assess the effects of the protocol on brain plasticity mechanisms in motor and imagery tasks. Our results show that the rehabilitation protocol can effectively improve gait performance and balance and reduce the risk of falls in stroke patients. Furthermore, the fMRI results suggest that rehabilitation is associated with cerebral plastic changes in motor networks. The present findings, if confirmed by future research, have the potential to advance the development of new, more effective rehabilitation approaches for stroke patients, improving their quality of life and reducing the burden of stroke-related disability.

Effect of antiparkinsonian medication on spatiotemporal gait parameters of individuals with Parkinson’s disease: comparison between individuals with and without freezing of gait

BACKGROUND: The gait of individuals with Parkinson’s disease (PD) tends to be slower, characterized by narrow and short steps. During the medication, the self-selected gait speed of individuals with PD increases. However, when looking individually at the spatiotemporal parameters of gait, the medication induces different and not always consistent effects. However, the effects of medication and freezing of gait during walking in individuals with PD are unknown. AIM: To analyze the effect of antiparkinsonian medication and freezing of gait (FoG) on spatiotemporal gait parameters in individuals with PD. METHOD: For this purpose, we compared gait parameters in individuals with FoG (freezers, n=11) and without FoG (non-freezers, n=11). Spatiotemporal gait parameters (speed, cadence, step length, step time, step width, stride length, stride time, swing phase, and double support) and clinical scales (parts II and III of the Unified Parkinson’s Disease Rating Scale, Hoehn and Yahr, Montreal Cognitive Assessment questionnaire and Mini-Test scale of Balance Assessment System) were analyzed in two experimental sessions, counterbalanced between individuals: one in the ON medication state (1h after ingestion), and another in the OFF medication state (~12h after the last ingestion). Linear mixed effects models 2-groups X 2-conditions were used. RESULTS: We found that gait speed, stride, and step length were significantly higher in the ON than in the OFF condition for both freezers and non-freezers, and significantly lower in the freezers than in the non-freezers, regardless of the medication state. CONCLUSION: These results indicate that medication improved gait performance equivalently in both freezers and non-freezers.

Hierarchical Optimization for Control of Robotic Knee Prostheses Toward Improved Symmetry of Propulsive Impulse.

Automatically personalizing complex control of robotic prostheses to improve gait performance, such as gait symmetry, is challenging. Recently, human-in-the-loop (HIL) optimization and reinforcement learning (RL) have shown promise in achieving optimized control of wearable robots for each individual user. However, HIL optimization methods lack scalability for high-dimensional space, while RL has mostly focused on optimizing robot kinematic performance. Thus, we propose a novel hierarchical framework to personalize robotic knee prosthesis control and improve overall gait performance. Specifically, in this study the framework was implemented to simultaneously design target knee kinematics and tune 12 impedance control parameters for improved symmetry of propulsive impulse in walking. In our proposed framework, HIL optimization is used to identify an optimal target knee kinematics with respect to symmetry improvement, while RL is leveraged to yield an optimal policy for tuning impedance parameters in high-dimensional space to match the kinematics target. The proposed framework was validated on human subjects, walking with robotic knee prosthesis. The results showed that our design successfully shaped the target knee kinematics as well as configured 12 impedance control parameters to improve propulsive impulse symmetry of the human users. The knee kinematics that yielded best propulsion symmetry did not preserve the normative knee kinematics profile observed in non-disabled individuals, suggesting that restoration of normative joint biomechanics in walking does not necessarily optimize the gait performance of human-prosthesis systems. This new framework for prosthesis control personalization may be extended to other wearable devices or different gait performance optimization goals in the future.

Perspectives on ankle-foot technology for improving gait performance of children with Cerebral Palsy in daily-life: requirements, needs and wishes

BackgroundAnkle-foot orthoses (AFOs) are extensively used as a primary management method to assist ambulation of children with Cerebral Palsy (CP). However, there are certain barriers that hinder their prescription as well as their use as a mobility device in all kinds of daily-life activities. This exploratory research attempts to further understand the existing limitations of current AFOs to promote a better personalization of new design solutions.MethodsStakeholders’ (professionals in CP and end-users with CP) perspectives on AFO technology were collected by two online surveys. Respondents evaluated the limitations of current assistive solutions and assessment methods, provided their expectations for a new AFO design, and analyzed the importance of different design features and metrics to enrich the gait performance of these patients in daily-life. Quantitative responses were rated and compared with respect to their perceived importance. Qualitative responses were classified into themes by using content analysis.Results130 survey responses from ten countries were analyzed, 94 from professionals and 36 from end-users with CP. The most highly rated design features by both stakeholder groups were the comfort and the ease of putting on and taking off the assistive device. In general, professionals preferred new features to enrich the independence of the patient by improving gait at functional levels. End-users also considered their social acceptance and participation. Health care professionals reported a lack of confidence concerning decision-making about AFO prescription. To some degree, this may be due to the reported inconsistent understanding of the type of assistance required for each pathological gait. Thus, they indicated that more information about patients’ day-to-day walking performance would be beneficial to assess patients’ capabilities.ConclusionThis study emphasizes the importance of developing new approaches to assess and treat CP gait in daily-life situations. The stakeholders’ needs and criteria reported here may serve as insights for the design of future assistive devices and for the follow-up monitoring of these patients.

Does Music Therapy Improve Gait after Traumatic Brain Injury and Spinal Cord Injury? A Mini Systematic Review and Meta-Analysis

There is a growing body of research examining the potential benefits of music therapy-based auditory stimulation (MT) for individuals with movement disorders in improving gait performance. However, there is limited knowledge about the effects of MT on gait outcomes in individuals with traumatic brain injury (TBI) or spinal cord injury (SCI). A previous review of MT's impact on gait in TBI had limitations, and there are no studies on its effects on gait in SCI. In this study, we conducted a meta-analysis to more thoroughly evaluate the impact of MT on gait outcomes in individuals with TBI and SCI. We systematically searched through eight databases and found six studies on MT in TBI and four on SCI. Our meta-analysis showed that MT has positive medium effect improvements on spatiotemporal aspects of gait in individuals with TBI (Hedge's g: 0.52) and SCI (0.53). These findings suggest that MT could be a practical intervention for enhancing different aspects of gait in these populations, although the limited number and "fair" quality of the studies included in the meta-analysis may affect the generalizability of the outcomes. Further research is needed to fully understand the mechanisms by which MT may influence gait and determine the optimal parameters for its use.