Improvement In Gait Parameters Research Articles

Effects of Continuous Dopaminergic Stimulation on Parkinson's Disease Gait: A Longitudinal Prospective Study with Levodopa Intestinal Gel Infusion.

Gait issues, including reduced speed, stride length and freezing of gait (FoG), are disabling in advanced phases of Parkinson's disease (PD), and their treatment is challenging. Levodopa/carbidopa intestinal gel (LCIG) can improve these symptoms in PD patients with suboptimal control of motor fluctuations, but it is unclear if continuous dopaminergic stimulation can further improve gait issues, independently from reducing Off-time. To analyze before (T0) and after 3 (T1) and 6 (T2) months of LCIG initiation: a) the objective improvement of gait and balance; b) the improvement of FoG severity; c) the improvement of motor complications and their correlation with changes in gait parameters and FoG severity. This prospective, longitudinal 6-months study analyzed quantitative gait parameters using wearable inertial sensors, FoG with the New Freezing of Gait Questionnaire (NFoG-Q), and motor complications, as per the MDS-UPDRS part IV scores. Gait speed and stride length increased and duration of Timed up and Go and of sit-to-stand transition was significantly reduced comparing T0 with T2, but not between T0-T1. NFoG-Q score decreased significantly from 19.3±4.6 (T0) to 11.8±7.9 (T1) and 8.4±7.6 (T2) (T1-T0 p = 0.018; T2-T0 p < 0.001). Improvement of MDS-UPDRS-IV (T0-T2, p = 0.002, T0-T1 p = 0.024) was not correlated with improvement of gait parameters and NFoG-Q from T0 to T2. LEDD did not change significantly after LCIG initiation. Continuous dopaminergic stimulation provided by LCIG infusion progressively ameliorates gait and alleviates FoG in PD patients over time, independently from improvement of motor fluctuations and without increase of daily dosage of dopaminergic therapy.

Prefrontal Cortex Neuromodulation Improve Gait Parameters in Latinx People Living with HIV

Background: Human Immunodeficiency Virus (H.I.V.) infection affects motor and cognitive systems and can lead to impairments in gait and balance. The application of transcranial direct current stimulation (tDCS), particularly to the prefrontal cortex, has shown encouraging results in enhancing cognition and executive functioning in individuals with H.I.V., both in the short and long term. Despite the current research, some experts have suggested that incorporating a task that stimulates higher cognitive centers in conjunction with tDCS may enhance its effects. Purpose: This study aimed to examine the effect of tDCS combined with a tracking task on the prefrontal cortex as a viable treatment for enhancing balance and gait in individuals living with H.I.V. Methods: The study evaluated nine female participants, all living with H.I.V., with an average age of 58.8 ± 4.6. As part of the experiment, each participant's gait was carefully evaluated before and after tDCS treatment to measure any potential changes in their walking patterns accurately. Transcranial Direct Current Stimulation (tDCS) was non-invasively administered to the participants' prefrontal cortex within seven days to investigate its possible effects on brain function. Results: Upon analyzing the data, the results demonstrated significant variations between single and dual tasks in numerous aspects, such as temporospatial, turn, and balance, before transcranial direct current stimulation (tDCS), ultimately shedding light on the potential cognitive difficulties that may arise. Data analysis showed noticeable improvements in various aspects, such as stride length, turn duration, and balance trends, when tDCS was applied. Conclusion: This study's findings suggest that tDCS may improve these parameters. However, it is recommended that treatments be administered over an extended time, which is longer than that observed in this study.

Association of Moderate-to-Vigorous Physical Activity, Sedentary Time, Fat Percentage, and Physical Fitness with Gait Parameters in Women with Fibromyalgia: The Al-Ándalus Project.

Gait impairments have been found in women with fibromyalgia, reducing the physical activity possibilities in this population and leading to a negative correlation with fibromyalgia impact. The aim of this study was to analyze the individual and independent associations of moderate-to-vigorous physical activity (MVPA), sedentary time, fat percentage, and physical fitness with gait parameters in women with fibromyalgia. A total of 84 women with fibromyalgia were included. MVPA and sedentary time were assessed with accelerometry, fat percentage with bioimpedance analysis, and physical fitness with field-based fitness tests. Gait was assessed during a "6 min walk test" and categorized in velocity, cadence, step length, step cycle duration, unipedal stance phase, and bipedal stance phase. Individual relationships were analyzed by partial correlations and independent relationships by linear regressions, adjusting by age and height. MVPA, sedentary time, fat percentage, and physical fitness were correlated with most gait parameters (rpartial between |0.842| and |0.219|; p ≤ 0.05). Physical fitness was independently associated with all gait parameters (β between |0.346| and |0.761|; p ≤ 0.002). In addition, MVPA was independently associated with velocity and step length (β = 0.241 and 0.292; both p = 0.004), and fat percentage was associated with bipedal stance phase (β = 0.242; p = 0.049). Good levels of MVPA, physical fitness, and adequate weight balance are associated with improved gait parameters in women with fibromyalgia.

The effect of HVLA manipulation on static and dynamic postural parameters – a case study of a patient with a blocked atlanto-occipital transition

Objective. The study aimed to assess the effects of high velocity low amplitude (HVLA) manipulations on force distribution, pressures, and balance in individuals with atlanto-occipital blockage, focusing on post-treatment improvements. Research methods. Diagnostic tests (cervical spine compression, Spurling, de Kleyn) and pedobarography (using an EPS/R2 mat and BIOMECH STUDIO software) assessed functionality and postural parameters pre and post HVLA therapy. Results. Initial diagnosis showed significant disturbances in force distribution, balance, and gait. Post-HVLA therapy improvements included: 1. Balanced forefoot load during standing, with a decrease in heel load percentage. 2. Improved global body pressure distribution, with a notable decrease in left-side body pressure. 3. Enhanced anteroposterior and lateral body oscillation ranges, with a reduced ratio of extreme deflection distances to deflection surface and a decreased average speed of displacements. 4. Normalization of the right foot abduction angle, with no significant change in the left foot's visitation angle. 5. Slight improvements in foot vault index (AI) and average foot pressure during gait, with minimal changes in maximum foot pressure during gait. Conclusions. HVLA manipulation significantly improves static balance parameters but shows minimal improvement in gait parameters. This indicates a complex relationship between atlanto-occipital blockage and postural disorders, suggesting the need for further research to explore the association between postural defects and atlanto-occipital transition blockage, as well as the impact of these blockages on postural changes. Keywords atlanto-occipital blockage, HVLA manipulation, postural disorders, balance improvement, pedobarography

Intraarticular monomethyl fumarate as a perspective therapy for osteoarthritis by macrophage polarization.

Osteoarthritis (OA) is a chronic disease that may lead to joint structure degeneration, cartilage destruction, osteophyte formation, subchondral bone disruption, and pain. In this scenario, a higher proportion of the proinflammatory macrophage type 1 (M1) than the anti-inflammatory macrophage type 2 (M2) could be highlighted as a hallmark of OA progression. The balance between these two macrophage types emerges as a new therapeutic target in OA. This study aimed to evaluate the analgesia and macrophage profile in the treatment of experimental osteoarthritis (EOA) with systemic dimethyl fumarate (DMF) or local intra-articular monomethyl fumarate (MMF). DMF via gavage or MMF via intra-articular in the right knee of EOA rats showed improvements in gait parameters and the nociceptive recovery of the mechanical threshold assessment by adapted electronic von Frey treatment on the twenty-first day (long-lasting phase). DMF treatment decreased proinflammatory TNF-α while increasing anti-inflammatory IL-10 cytokines from the macerated capsule on the fifth day (inflammatory phase). MMF treatment showed joint capsule mRNA extraction downregulating iNOS and TNF-α gene expression while upregulating IL-10 and MCP-1. However, CD206 was not significant but higher than untreated EOA rats' joints on the seventh day (inflammatory phase). Our studies with EOA model induced by MIA suggest a new perspective for human treatment committed with OA based on macrophage polarization as a therapeutic target, switching the proinflammatory profile M1 to the anti-inflammatory profile M2 with DMF systematic or by MMF locally treatment according to the OA severity.

Gait Analysis in Patients with Symptomatic Pes Planovalgus Following Subtalar Arthroereisis with the Talus Screw.

Pes planovalgus is one of the most common pediatric skeletal deformities. There have been no studies to analyze in detail the spatiotemporal variables of gait following arthroereisis. The purpose of our study was to assess gait parameters in patients with symptomatic flexible flatfoot following treatment with the talus screw. This was a prospective study assessing the 22 patients treated surgically due to symptomatic flexible flatfoot with the talus screw. Patients underwent gait assessment with a G-Sensor. We analyzed the following gait parameters: gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, cadence, velocity, step length. The post-operative gait parameter assessment for the operated and non-operated foot showed a significant difference only in terms of step length. Cadence increased from the pre-operative mean of 82.29 steps/min to a post-operative mean of 102.94 steps/min. Gait velocity increased significantly from 0.81m/s before to 0.96m/s after surgery. Arthroereisis with the talus screw helps improve gait parameters following surgery. Post-operatively, we observed increased gait velocity and cadence and decreased gait cycle duration in the operated limb. Short-term biomechanical outcomes of pes planovalgus treatment with the talus screw are good.

Improved gait parameters following surgical revascularization in patients with intermittent claudication

ObjectiveIntermittent claudication (IC) is known to be associated with impaired gait parameters, with a higher incidence of falls and higher oxygen consumption due to uneconomic walking. However, the influence of arterial disobliteration in patients with IC on their gait pattern has rarely been investigated to date. The aim of this study was to examine the gait patterns before and after inflow revascularization by surgical disobliteration of pelvic and inguinal arteries (ie, common iliac artery, external iliac artery, common femoral artery, profound femoral artery, superficial femoral artery) in IC patients. Successful surgical disobliteration of inflow arteries (improvement of ankle brachial pressure index of ≥0.2 and patent common iliac, external iliac, common femoral, profound femoral, and superficial femoral arteries) is known to improve the painless walking distance for patients with IC due to peripheral arterial disease; however, its influence on gait parameters is unclear. We hypothesized that the gait parameters would also improve after surgery. Improved gait parameters can lead to a more economic walking process, lower oxygen consumption, a lower risk of falls, and a higher quality of life. MethodsIn a single-center, exploratory, longitudinal study, we examined the gait parameters of 20 IC inpatients of our hospital before and after surgical disobliteration of pelvic and inguinal arteries. Spatiotemporal parameters such as range of motion of the hip and knee joint, stance phase, cadence, and foot rotation were obtained using the Diers 4Dmotion Lab (Diers International). The gait parameters were obtained under painful walking conditions preoperatively and with the patients walking pain free at the same speed postoperatively. ResultsA total of 20 patients were examined. Surgical revascularization led to a higher walking cadence (mean, plus 7.88 steps; 95.5 steps/min vs 87.6 steps/min; P = .024), an increased range of motion of the hip joint (mean, plus 2.0°; 35.1° vs 33.1°; P = .038), and improved foot rotation (mean, plus 2.0°; 11.0° vs 9.0°; P = .02). Regarding other parameters such as step length, stance phase, and step duration, smaller differences were detected in this study. ConclusionsIn this exploratory study, we found that surgical revascularization of pelvic and inguinal arteries in IC patients improved certain gait parameters. Further studies with larger patient numbers are needed to confirm these data and provide more evidence on this subject.

High cadence cycling not high work rate, increases gait velocity post-exercise

ABSTRACT Gait velocity, or walking speed, has been referred to as the sixth vital sign, and research suggests that it is highly sensitive to change. Previous research has demonstrated the utility of cycling to improve gait parameters and in particular gait velocity in a variety of populations. However, it is unclear if the benefits from cycling to gait velocity stem from increased cadence, increased work rate, or the interaction between them. Therefore, the objective of the current research was to explicitly test the relationship between cycling work rate, cycling cadence, and gait velocity. 45 recreationally active young adults were randomly assigned to cycle at a normalised cadence and work rate, a higher cadence, or a higher work rate (CONTROL, FAST, HARD). All participants completed two ten-metre walk tests (10 MWT) pre- and post-cycling intervention. There was a significant interaction between group and time and post hoc comparisons showed that the FAST group walked significantly faster than the HARD group post-cycling. These results support the hypothesis that cycling at a cadence greater than the comfortable walking cadence, and not cycling at an increased work rate, increased gait velocity post-exercise for all members of our sample of healthy young adults.

Gait Variability and its Relationship to Functional Mobility in Hemiparetic Stroke

Background: Stroke remains a leading cause of long-term disability worldwide, with hemiplegia being one of the most common outcomes, significantly impairing gait and functional mobility. The integration of sensory stimulation techniques into rehabilitation practices offers a promising avenue for enhancing recovery outcomes in hemiplegic stroke survivors. Objective: This study aimed to investigate the effectiveness of auditory and visual sensory stimulation on improving gait parameters and functional mobility in hemiplegic stroke patients. Methods: Conducted at Mayo Hospital, Lahore, this analytical cross-sectional study involved 24 stroke survivors with hemiplegia, randomly assigned to two intervention groups. Inclusion criteria included a Modified Ashworth Scale score of 1 to 1+ and a Mini-Mental State Examination score of ≥25. One group received auditory feedback gait training (AFGT) with smart insoles, while the other engaged in sit-to-stand training with visual feedback using a Wii Balance Board, alongside conventional rehabilitation therapies. The interventions lasted four weeks, with assessments conducted pre and post-intervention. Outcome measures included the Dynamic Gait Index (DGI), Fugl-Meyer Assessment for Lower Extremity (FMA-LE), and various gait parameters. Statistical analysis was performed using SPSS version 25. Results: Post-intervention, the study observed significant improvements in DGI (mean increase: 3.5 points, p&lt;0.01), FMA-LE scores (mean increase: 10 points, p&lt;0.01), and enhanced gait parameters including step length and stride length (p&lt;0.05). The group receiving AFGT with smart insoles showed notable improvements in spatiotemporal gait parameters and balance compared to the control group, indicating the efficacy of sensory feedback in rehabilitation. Conclusion: The study demonstrates that incorporating auditory and visual feedback into rehabilitation regimens can significantly improve gait dynamics and functional mobility in hemiplegic stroke patients. These findings suggest the potential for sensory stimulation techniques to enhance the effectiveness of stroke rehabilitation, advocating for their integration into standard care practices.

Comparing the effects of augmented virtual reality treadmill training versus conventional treadmill training in patients with stage II-III Parkinson's disease: the VIRTREAD-PD randomized controlled trial protocol.

Intensive treadmill training (TT) has been documented to improve gait parameters and functional independence in Parkinson's Disease (PD), but the optimal intervention protocol and the criteria for tailoring the intervention to patients' performances are lacking. TT may be integrated with augmented virtual reality (AVR), however, evidence of the effectiveness of this combined treatment is still limited. Moreover, prognostic biomarkers of rehabilitation, potentially useful to customize the treatment, are currently missing. The primary aim of this study is to compare the effects on gait performances of TT + AVR versus TT alone in II-III stage PD patients with gait disturbance. Secondary aims are to assess the effects on balance, gait parameters and other motor and non-motor symptoms, and patient's satisfaction and adherence to the treatment. As an exploratory aim, the study attempts to identify biomarkers of neuroplasticity detecting changes in Neurofilament Light Chain concentration T0-T1 and to identify prognostic biomarkers associated to blood-derived Extracellular Vesicles. Single-center, randomized controlled single-blind trial comparing TT + AVR vs. TT in II-III stage PD patients with gait disturbances. Assessment will be performed at baseline (T0), end of training (T1), 3 (T2) and 6 months (T3, phone interview) from T1. The primary outcome is difference in gait performance assessed with the Tinetti Performance-Oriented Mobility Assessment gait scale at T1. Secondary outcomes are differences in gait performance at T2, in balance and spatial-temporal gait parameters at T1 and T2, patients' satisfaction and adherence. Changes in falls, functional mobility, functional autonomy, cognition, mood, and quality of life will be also assessed at different timepoints. The G*Power software was used to estimate a sample size of 20 subjects per group (power 0.95, α < 0.05), raised to 24 per group to compensate for potential drop-outs. Both interventions will be customized and progressive, based on the participant's performance, according to a predefined protocol. This study will provide data on the possible superiority of AVR-associated TT over conventional TT in improving gait and other motor and non-motor symptoms in persons with PD and gait disturbances. Results of the exploratory analysis could add information in the field of biomarker research in PD rehabilitation.

Motion tracking virtual reality technology in improving gait in the elderly: A randomized controlled trial

Objective This study aimed to assess the effectiveness of virtual reality-based treadmill training on gait performance and tolerance in the elderly. Design Two-armed randomized controlled trial. Setting The Medical Rehabilitation Sciences Department, Umm Al Qura University, Saudi Arabia. Participants Sixty Saudi elderly of both sexes, aged 65–75 years, were included. Interventions Participants were divided into two groups. The control group received treadmill training without virtual reality, alongside a conventional exercise program. The experimental group received a training program that was similar to the control group's exercises but with C-Mill virtual reality treadmill training. The program lasted one hour, three times per week, over four consecutive weeks. Main Measures The study assessed changes in outcome measures at baseline, Post-1 (after four weeks of training), and Post-2 (four weeks post-training). These measures encompassed the primary outcome, the 6-minute walk test (meter), as well as secondary outcomes such as stride length (meter), stride time (second), cadence (steps/minute), and velocity (meter/second). These parameters were evaluated using the GaitRite electronic gait analysis walkway. Results The experimental group showed better improvement in the mean values of the 6-minute walk test, stride length, stride time, cadence, and velocity compared to the control group at post-1 and post-2. The P-values were respectively at post-1 (0.019, 0.015, 0.041, 0.013, and 0.021) and (0.011, 0.025, 0.073, 0.061, and 0.017) at post-2 (all, P < .05). Conclusions C-Mill virtual reality treadmill training shows potential in improving gait parameters and walking tolerance in the elderly in Saudi Arabia.

The Effectiveness of a Single Dry Needling Session on Gait and Quality of Life in Multiple Sclerosis: A Double-Blind Randomized Sham-Controlled Pilot Trial.

Gait disorders are a major cause of disability and reduced health-related quality of life in people with multiple sclerosis (pwMS). Dry needling (DN) has demonstrated positive results to improve gait parameters in patients with stroke. The main aim of this study was to evaluate the effect of a single session of DN in the gait performance of pwMS. A double-blind parallel randomized sham-controlled pilot trial was conducted. Study participants received a single session of active DN or sham DN in the gastrocnemius medialis muscle. Pre-treatment and immediately post-treatment measurements were taken, as well as at one and four weeks after the intervention. Outcomes related to gait performance (Timed 25-Foot Walk), self-perceived walking capacity (Multiple Sclerosis Walking Scale), risk of falls (Timed Up and Go test), disability level (Expanded Disability Status Score) and quality of life (Multiple Sclerosis Quality of Life-54 questionnaire and Analogic Quality of Life scale) were evaluated. 18 patients who had multiple sclerosis participated in the study. The group who received active DN showed within-group significant statistical differences immediately after treatment for gait performance (p = 0.008) and risk of falls (p = 0.008), as well as for self-perceived walking capacity at one week (p = 0.017) and four weeks (p = 0.011) and quality of life at four weeks (p = 0.014). Regarding the comparison between groups, only significant results were obtained in the physical domain of the quality of life at four weeks (p = 0.014). DN seems to be a promising therapeutic tool for the treatment of gait disorders in pwMS. However, when results were compared with sham DN, no differences were found.

Effect of psychostimulant medications on physical function in children with cerebral palsy: scoping review.

The aim of this scoping review is to examine the extent and depth of the literature on effects of central nervous system (CNS) stimulant medications on physical function in children with cerebral palsy (CP). A systematic search for relevant peer-reviewed studies was conducted of PubMed, CINAHL, Cochrane, SPORTDiscus, Embase, & Scopus (January 2002 & August 2022). We included studies that examined the effects of CNS stimulants on physical function in children with CP. Four studies met our selection criteria. All studies explored the effect of Modafinil on physical function outcomes. Three studies of the four included studies reported positive effects of Modafinil on spasticity, motor performance, and gait, whereas one study reported no significant effects of Modafinil. Our findings suggest that there is very low-quality evidence that suggests that Modafinil may enhance physical improvements in body structure and function, including reduction in spasticity and improvements in gait parameters. IMPACT: Central nervous system stimulants were examined for efficacy on physical function and spasticity in children with cerebral palsy. The evidence on the effects of central nervous system stimulants on physical function in children with CP is limited and inconsistent.

L’efficacité des semelles posturales dans la gestion de la posture chez les personnes atteintes de paralysie cérébrale : une revue de portée

BackgroundChildren with cerebral palsy often have gait abnormalities that can affect their daily activities. Insoles have been used as a treatment option to improve walking in children with cerebral palsy, but their efficacy remains uncertain. The aim of this study was to investigate the effects of postural insoles with corrective elements on gait parameters in children with cerebral palsy. MethodsChildren with cerebral palsy often have gait abnormalities that can affect their daily activities. Insoles have been used as a treatment option to improve walking in children with cerebral palsy, but their efficacy remains uncertain. The aim of this study was to investigate the effects of postural insoles with corrective elements on gait parameters in children with cerebral palsy. ResultsOf 35 initial registrations, three studies met the inclusion criteria. Results showed that postural insoles are effective in improving foot biomechanics and posture. However, the quality of the evidence was generally low, and further high-quality studies are needed to confirm these results. ConclusionsPostural insoles with corrective elements may be an effective treatment option for improving gait parameters in children with cerebral palsy. The use of these semelles can lead to an increase in cadence and speed, as well as an improvement in the range of motion of ankle dorsiflexion and a decrease in the range of motion of knee flexion and hip internal rotation.

Influence of Posture on Gait Parameters in Severe Symptomatic Lumbar Stenosis Before and After Decompression Surgery

BackgroundWe searched to quantify the influence of sagittal vertical axis (SVA) on the improvement of spatiotemporal gait parameters using a gait motion analysis (GMA) before and after decompression surgery in patients suffering from lumbar stenosis (LSS). MethodsThirty-nine patients with severe LSS planned for lumbar decompression underwent a full body biplanar radiographs (EOS®) to quantify the SVA, and have benefited from a three-dimensional GMA one month before surgery (M0) and 6 month (M6) after surgery. The first step of this study was to confirm the validation of three dimensional SVA (3D SVA) for posture analysis. An analysis of modification of the 3D SVA and spatio-temporal gait parameters was then carried out in order to identify any correlation. ResultsDecompression surgery did not significantly improve 3D SVA between M0 and M6 (respectively 49.1 (50.3) versus 49.84 (19.02), p=0.42). Concerning spatio-temporal parameters, we found significant difference for all parameters between M0 and M6. A strong correlation (R2>0.65) between static SVA (EOS®) and 3D SVA was demonstrated using a statistical regression equation. There was also a statistically significant correlation between SVA (static and 3D) and improvement in spatiotemporal gait parameters after decompression surgery. ConclusionThis study analyses the relationship between postural change (SVA) and improvement in gait parameters measured during GMA before and after decompression surgery for lumbar spinal stenosis. This specific analysis of gait parameters may represent a prognostic assessment tool for the recovery of patients undergoing surgery for a lumbar spinal stenosis.

Effect of overground gait training with ‘Mobility Assisted Robotic System-MARS’ on gait parameters in patients with stroke: a pre-post study

ObjectiveTo observe the effect of overground gait training with ‘Mobility Assisted Robotic System-MARS’ on gait parameters in patients with stroke.Patients & methodsThis prospective pre-post study was conducted in a tertiary teaching research hospital with 29 adult stroke patients, with age up to 65 years. Patients fulfilling the inclusion criteria were divided in 2 groups based on the duration of stroke (≤ 6 months-sub-acute & > 6 months-chronic stroke) and provided overground gait training with MARS robot for 12 sessions (1 h/session) over a period of 2–3 weeks. Primary outcome measures were; 10-Meter walk test-10MWT, 6-min’ walk test-6MWT and Timed up & Go-TUG tests. Secondary outcome measures were Functional Ambulation Category-FAC, Modified Rankin Scale-MRS and Scandinavian Stroke Scale-SSS.ResultsNo adverse events were reported. Twenty-five patients who were able to perform 10-MWT at the beginning of study were included in the final analysis with 12 in sub-acute and 13 in chronic stroke group. All primary and secondary outcome measures showed significant improvement in gait parameters at the end of the training (p < 0.05) barring 10-Meter walk test in sub-acute stroke group (p = 0.255). Chronic stroke group showed significant minimum clinically important difference-MCID difference in endurance (6MWT) at the end of the training and both groups showed better ‘minimal detectable change-MDC’ in balance (TUG) at the end of the training.ConclusionsPatients in both the groups showed significant improvement in walking speed, endurance, balance and independence at the end of the training with overground gait training with MARS Robot.Clinical trial registryNational Clinical Trial Registry of India (CTRI/2021/08/035695,16/08/2021).

A Randomized Clinical Trial to Evaluate a Digital Therapeutic to Enhance Gait Function in Individuals With Parkinson's Disease.

Postural instability and gait dysfunction (PIGD) is a cardinal symptom of Parkinson's disease (PD) and is exacerbated under dual-task conditions. Dual-task training (DTT), enhances gait performance, however it is time and cost intensive. Digitizing DTT via the Dual-task Augmented Reality Treatment (DART) platform can expand the availability of an effective intervention to address PIGD. The aim of this project was to evaluate DART in the treatment of PIGD in people with PD compared to a Traditional DTT intervention. It was hypothesized that both groups would exhibit significant improvements in gait, and the improvements for the DART group would be non-inferior to Traditional DTT. A single-blind randomized controlled trial was conducted with 47 PD participants with PIGD. Both groups completed 16 therapeutic sessions over 8 weeks; the DART platform delivered DTT via the Microsoft HoloLens2. Primary outcomes included clinical ratings and single- and dual-task gait biomechanical outcomes. Clinical measures of PD symptoms remained stable for DART and Traditional DTT groups. However, both groups exhibited a significant increase in gait velocity, cadence, and step length during single- and multiple dual-task conditions following the interventions. Improvements in gait velocity in the DART group were non-inferior to Traditional DTT under the majority of conditions. Non-inferior improvements in gait parameters across groups provides evidence of the DART platform being an effective digital therapeutic capable of improving PIGD. Effective digital delivery of DTT has the potential to increase use and accessibility to a promising, yet underutilized and difficult to administer, intervention for PIGD. ClinicalTrials.gov Dual-task Augmented Reality Treatment for Parkinson's Disease (DART) NCT04634331; posted November 18, 2020.

Impact of Different Physiotherapy Programs on Balance and Gait in Patients with Cerebral Infarction

Background. An ischemic stroke has long-term adverse effects on the physical, emotional, and social well-being of the stroke survivor, so it is very important to help the patient regain independence and lost functions as quickly and efficiently as possible. Dynamic Neuromuscular Stability exercises can restore movement patterns in these patients by simulating central nervous system.&#x0D; The aim. To compare the effects of conventional physiotherapy and dynamic neuromuscular stabilization integrated into conventional physiotherapy on balance and gait in patients with cerebral infarction.&#x0D; Methods. The study included 30 subjects who survived an ischemic stroke. Subjects were randomly divided into two groups of 15 people in each for different interventions: Conventional physiotherapy and Conventional physiotherapy combined with integrated dynamic neuromuscular stabilization. Subjects were examined at a baseline and after the interventions. Patients’ balance was assessed using the Biodex platform, which was chosen to evaluate fall risk, trunk stability, stability limits and sensory organization. Gait parameters (step length and step width) of the affected and unaffected leg were assessed using the Zebris FDM-T treadmill.&#x0D; Results. Both conventional physiotherapy and physiotherapy with integrated dynamic neuromuscular stabilization improved gait parameters of the patients, as well as improving the results of the tests of fall risk, postural stability, stability limits, and the results of the sensory integration test when testing with eyes open on a stable surface (p&lt;0.05). However, the results of the sensory integration tests while standing on a stable surface with eyes closed (p&lt;0.001), with eyes open on an unstable surface (p&lt;0.001) and with eyes closed on an unstable surface (p=0.021) improved only post physiotherapy with integrated dynamic neuromuscular stabilization.&#x0D; Conclusions. Both conventional physiotherapy and physiotherapy with integrated dynamic neuromuscular stabilization significantly improved gait and balance parameters in stroke patients.&#x0D; Keywords: Dynamic neuromuscular stabilization, stroke, balance, trunk stability, gait.

Gait Recovery in Spinal Cord Injury: A Systematic Review with Metanalysis Involving New Rehabilitative Technologies.

Gait recovery is a fundamental goal in patients with spinal cord injury to attain greater autonomy and quality of life. Robotics is becoming a valid tool in improving motor, balance, and gait function in this patient population. Moreover, other innovative approaches are leading to promising results. The aim of this study was to investigate new rehabilitative methods for gait recovery in people who have suffered spinal cord injuries. A systematic review of the last 10 years of the literature was performed in three databases (PubMed, PEDro, andCochrane). We followed this PICO of the review: P: adults with non-progressive spinal cord injury; I: new rehabilitative methods; C: new methods vs. conventional methods; and O: improvement of gait parameters. When feasible, a comparison through ES forest plots was performed. A total of 18 RCTs of the 599 results obtained were included. The studies investigated robotic rehabilitation (n = 10), intermittent hypoxia (N = 3) and external stimulation (N = 5). Six studies of the first group (robotic rehabilitation) were compared using a forest plot for 10MWT, LEMS, WISCI-II, and SCIM-3. The other clinical trials were analyzed through a narrative review of the results. We found weak evidence for the claim that robotic devices lead to better outcomes in gait independence compared to conventional rehabilitation methods. External stimulation and intermittent hypoxia seem to improve gait parameters associated with other rehabilitation methods. Research investigating the role of innovative technologies in improving gait and balance is needed since walking ability is a fundamental issue in patients with SCI.

Effects of wearable visual cueing on gait pattern and stability in patients with Parkinson's disease.

The present study examined the effects of wearable visual cues, provided by a wearable laser device, on the gait pattern and stability in patients with Parkinson's disease (PD). In total, 18 patients with a clinical diagnosis of idiopathic PD (Hoehn and Yahr stage II-III) and 18 healthy controls were included. The main outcome measures included spatiotemporal parameters, sagittal plane kinematic parameters of joints in lower limbs, and dynamic center of pressure (COP) parameters. Significant intra-group improvement in gait parameters was observed in PD patients. Compared with that at baseline, the gait pattern improved in PD patients under the cued condition, with longer stride length and higher toe clearance, as well as shortening of double stance phase, especially the stride length, double stance phase and toe clearance were not significantly different between cued condition and healthy control groups. In kinematics, the ankle peak dorsiflexion in swing phase and the hip range of motion (ROM) in gait cycle was significantly improved in PD patients with visual cues and close to healthy controls. Decreased anteroposterior (AP) position of COP improved gait stability in patients with PD under the cued condition. Multiple linear regression analysis showed that the AP position has a negative correlation with ankle peak dorsiflexion in swing phase. Pearson's correlation coefficients showed that the minimum toe clearance (Mini TC) was positively correlated with the ankle peak dorsiflexion in swing phase. The immediate effect of wearable visual cues improved the gait pattern and stability in PD patients, suggesting that it may be effective when applied as an alternative technique in rehabilitation training for PD patients.