Improvement In Gait Parameters Research Articles

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.
 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.
 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.
 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<0.05). However, the results of the sensory integration tests while standing on a stable surface with eyes closed (p<0.001), with eyes open on an unstable surface (p<0.001) and with eyes closed on an unstable surface (p=0.021) improved only post physiotherapy with integrated dynamic neuromuscular stabilization.
 Conclusions. Both conventional physiotherapy and physiotherapy with integrated dynamic neuromuscular stabilization significantly improved gait and balance parameters in stroke patients.
 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.

Effectiveness of backward walking with functional electrical stimulation on the rectus femoris and tibialis anterior for patients with chronic stroke.

Backward walking is considered as a newly rising method used to enhance gait abilities, but evidence remains unclear. To identify whether backward walking with functional electrical stimulation (FES) triggered by a foot switch on the rectus femoris and tibialis anterior could be effective in improving gait parameters of stroke survivors. This was a cross-sectional study that included fourteen subjects with chronic stroke. Three walking conditions were performed at random: backward walking with FES attached onto the rectus femoris and tibialis anterior (RF+TA), backward walking with FES attached onto the tibialis anterior (TA only), and without electrical intervention (non-FES). The Zebris was used to assess the spatiotemporal gait parameters. Each condition was measured three times and the average value was used for analysis. Results showed significant increases in gait speed, cadence, step length, mid-stance percentage, maximal force in the affected midfoot (p < 0.05), and significant decreases in the double stance phase in the RF+TA condition compared to the TA only and the non-FES conditions (p < 0.05). Functional electrical stimulation to the rectus femoris and tibialis anterior during backward walking could be a clinically effective method to improve gait ability of stroke survivors.

Effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors: a study protocol for a randomised controlled trial

BackgroundPost-stroke gait deviations contribute to significant functional disability, impaired walking ability and poor quality of life. Prior studies suggest that gait training with paretic lower limb loading may improve gait parameters and walking ability in post-stroke. However, most gait training methods used in these studies are not readily available, and studies using cheaper methods are limited.ObjectiveThe purpose of this study is to describe a protocol for a randomised controlled trial on the effectiveness of an 8-week overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors.MethodsThis is a two-center, single-blind, two-arm parallel randomised controlled trial. Forty-eight stroke survivors with mild to moderate disability will be recruited from two tertiary facilities and randomly assigned into two intervention arms; overground walking with paretic lower limb loading or overground walking without paretic lower limb loading in a 1:1 ratio. All interventions will be administered thrice weekly for 8 weeks. Primary outcomes will be step length and gait speed whereas the secondary outcomes will include step length symmetry ratio, stride length, stride length symmetry ratio, stride width, cadence and motor function. All outcomes will be assessed at baseline, 4, 8 and 20 weeks after the start of intervention.DiscussionThis will be the first randomised controlled trial to report the effects of overground walking with paretic lower limb loading on spatiotemporal gait parameters and motor function among chronic stroke survivors from low-resource setting.Trial registrationClinicalTrials.gov NCT05097391. Registered on 27 October 2021.

Efficacy of rhythmic auditory stimulation on gait parameters in hemiplegic stroke patients: a randomized controlled trial

BackgroundGait disorders which caused by stroke are one of the most common causes of functional disabilities in hemiparetic stroke patients that leads to significant impact on quality of life and financial cost. In this study, we focused on how certain gait metrics in stroke patients were affected by rhythmic auditory stimulation and treadmill training.ResultsIn this randomized controlled experiment, which involved 30 male stroke patients, there was a significant increase in post treatment walking speed, step cycle, step length, percent of time on each foot and ambulation index in both groups. The post treatment improvement in gait parameters was significantly higher in the study group compared to the controls.ConclusionsCombination of rhythmic auditory stimulation with treadmill training enhances the gait performance.

Effect of Medication and Deep Brain Stimulation on Gait in Parkinson's Disease and its Quantitative Analysis Using Mobishoe - A Comparative Study.

Movement abnormalities pertaining to balance, posture, and gait are observed in Parkinson's disease patients. Gait characteristics vary widely and their analysis has been performed traditionally in gait labs. Freezing and festination usually occur at an advanced stage of the disease and are associated with reduced quality of life. Therapeutic strategies and surgical interventions are often modulated by the physician depending upon the clinical manifestations. Introduction of accelerometers and wireless data transmission systems made quantitative gait analysis possible and cost-effective. To assess spatiotemporal gait parameters (step height, length (spatial), and swing support time of each foot and double support time (temporal)) in subjects who underwent deep brain stimulation surgery using a purpose-built instrument-Mobishoe. A simple footwear-based gait sensing device-Mobishoe was built in-house. Thirty-six participants were included in the study after obtaining consent. Participants were made to wear Mobishoe and walk an empty corridor of 30m before Deep Brain Stimulation (DBS) in the drug on and off stated and post DBS in DBS stimulation on and medication off state (B1M0), DBS stimulation off-medication off state (B0M0), DBS stimulation off-medication on (B0M1), and DBS stimulation on and on medication (B1M1). Data was electronically captured and analyzed offline in MATrix LABoratory (MATLAB). Various gait parameters were extracted and analyzed. Improvement in gait parameters was observed when the subject was on medication, on stimulation, or on both when compared to baseline. Improvement was similar with both medication and stimulation and was synergistic when both were used. Significant improvement was noted in spatial characteristics when the subjects were on both the treatments, which is the ideal treatment modality. Mobishoe is an affordable device which can measure spatiotemporal characteristics of gait. The best improvement was seen when the subjects were on both the treatment groups and the improvement can be justified as a synergistic effect of stimulation and medication.

Protocol: a randomized parallel-group study of women after hallux valgus correction surgery to compare the effects of "core foot system" training vs. traditional rehabilitation methods.

Purpose: The aim of this study is to compare the effects of Core Foot System muscle training vs. traditional rehabilitation methods in female patients after a hallux valgus correction surgery. Methods: The project will involve 60 women who have undergone a Scarf osteotomy to correct the deformity. Participants will be divided into a control and experimental group. The experimental group will follow the Core Foot System protocol, whereas the control group will perform standard lower-limb exercises. Outcome measures will be collected twice: before the intervention and after eight weeks. Gait will be assessed using the Zebris FDM-2 platform, measuring ground reaction forces during walking. Results: The effects of the exercises on the cross-sectional area of the abductor hallucis muscle and the flexor digitorum brevis muscle will be measured. Foot architecture and arch height will be measured using a podoscope. In addition, the participants will complete the Short Form Health Survey and the American Orthopaedic Foot and Ankle Society questionnaires. Conclusions: The study is expected to provide evidence of the effectiveness of foot muscle training using the protocol. The findings may lead to an improved protocol of rehabilitation in patients after a correction surgery that may result in improved gait parameters and quality of daily life. In the future, an improved therapeutic method should make it possible to boost the effectiveness of physiotherapy in patients after a corrective surgery in the forefoot area. The study has been registered with clinicaltrials.org (NCT05210127; 13 January 2022).

Effect of Motor Relearning Program with Obstacle Walking on Dynamic Gait Performance and Functional Mobility in Subacute Stroke Subjects

Background: Gait difficulties are common post-stroke due to muscle weakness and postural imbalance. Motorrelearning program is known to improve motor skills through task oriented practice, appropriate feedback andactive participation of subjects. Obstacle walking helps in improving gait parameters, stepping over objects,walking endurance and reduces fall risk.Objectives: To determine effect of Motor Relearning Program with obstacle walking on dynamic gait performanceand functional mobility in sub-acute stroke subjects.Materials and Methods: 30 sub-acute stroke subjects were assigned to one of the two groups. Group-A receivedMotor Relearning Program and Group-B received Motor Relearning Program with obstacle walking for 30 minutes,5 days a week for 4 weeks. Both groups received 15 minutes of conventional exercises for upper limb. Dynamicgait performance and functional mobility were assessed pre- and post-intervention at 4 weeks using Dynamic GaitIndex and Motor Assessment Scale.Results: Pre-test scores of DGI and MAS were 11.53±3.53 and 3.83±0.48 in Group-A, 12.43±4.12 and 3.67±0.81in Group-B which improved to 15.80±3.82 and 4.07±0.59 in Group-A, 18.67±4.86 and 4.73±0.96 in Group-B, postintervention.Within group comparison of pre to post-test scores of DGI and MAS was found to be statisticallysignificant in both groups. When post-test scores of DGI and MAS were compared in between groups, Group-Bwas found to be statistically significant than Group-A (p&lt;0.05).Conclusion: Both interventions were individually effective but Motor Relearning Program with obstacle walkingwas better than Motor Relearning Program alone to improve dynamic gait performance and functional mobilityin sub-acute stroke subjects.

Effects of gait training with and without proprioceptive neuromuscular facilitation on balance and gait in chronic stroke patients

IntroductionTo compare the effects of gait training with and without proprioceptive neuromuscular facilitation (PNF) on balance and gait in chronic stroke individuals.MethodsIt was a double-blind randomized control trial conducted at University Physical Therapy and Rehabilitation clinic, Lahore, Pakistan from March 2020 to November 2020 using non-probability convenient sampling. Sixty patients in the chronic phase of a stroke, aged between 35 and 85 years, were randomly allocated into two groups. Group A received proprioceptive neuromuscular facilitation-based gait training along with routine physical therapy, while group B received only gait training and routine physical therapy. Berg balance scale (BBS) and GAITRite platinum were used as measuring equipment. The rules and regulations set by the ethical committee of the university of Lahore were followed. Data was analysed by a statistical package for social sciences, version 24.ResultsBalance improved more significantly in group A than in group B (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Participants improved significantly in terms of stride length (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), step length (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), % swing phase (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), BBS (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), cadence (&lt;i&gt;p&lt;/i&gt; &lt; 0.001) and velocity (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), and decreased significantly for ambulation time (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), and % stance phase of gait cycle (&lt;i&gt;p&lt;/i&gt; &lt; 0.001), over the treatment period within both groups. The results of stride length, step length, ambulation time, cadence, velocity, % of swing and stance phase were insignificant for between-group comparisons.ConclusionsProprioceptive neuromuscular facilitation-based gait training along with routine physical therapy is more effective in improving balance as compared to routine physical therapy alone. However, for improving gait parameters, proprioceptive neuromuscular facilitation (PNF) proves to be as effective as routine physical therapy and gait training.

The Efficacy of Virtual Reality Training in the Rehabilitation of Orthopedic Ankle Injuries: A Systematic Review and Meta-analysis.

Orthopedic ankle injuries are considered among the most common musculoskeletal injuries. A wide variety of modalities and techniques have been used for the management of these injuries, and virtual reality (VR) is one modality that has been examined in ankle injuries rehabilitation. This study aims to systemically review previous studies evaluating the effect of virtual reality in rehabilitating orthopedic ankle injuries. We searched six online databases: PubMed, Web of Science (WOS), Scopus, the Physiotherapy Evidence Database (PEDro), Virtual Health Library (VHL), and Cochrane Central Register of Controlled Trials (CENTRAL). Ten randomized clinical trials met the inclusion criteria. Our results showed that VR had a significant effect on overall balance compared to conventional physiotherapy (SMD = 0.359, 0.009-0.710 P = 0.04), [I 2= 17%, P = 0.30]. Compared with conventional physiotherapy, VR programs significantly improved gait parameters such as speed and cadence, muscle power, and perceived ankle instability; however, no significant difference was detected in the foot and ankle ability measure (FAAM). Additionally, significant improvements in static balance and perceived ankle instability were reported after the use of VR balance and strengthening programs. Finally, only two articles were deemed to have good quality, and the other studies' quality ranged from poor to fair. VR rehabilitation programs can be used to rehabilitate ankle injuries, as they are regarded as safe interventions and have promising effects. However, there is a need for studies with high quality since most included studies' quality varied from poor to fair.

EFFECTS OF COMPELLED BODY WEIGHT SHIFT TECHNIQUE BY USING INSOLE FOR REHABILITATION OF INDIVIDUALS WITH CHRONIC

Background: Stroke is one of the leading causes of long-term disability worldwide. The stroke survivors usually become complicated with sensor and motor problems which lead to compromised walking ability and functional limitation, after stroke occurrence the recovery of walking ability is considered one of the vital outcomes of stroke rehabilitation. Objective: To determine the effects of Compelled Body Weight Shift (CBWS) technique by using insole in the individuals with chronic stroke. Materials and methods: A randomized control trial (NCT04479774) was conducted from March 2020 to August 2020. The data was collected through non probability convenient sampling technique. The duration of the study was 6 months after the approval from Rehman medical Institute and Northwest General Hospital. A total n=27 were divided into control n=14 which received conventional physical therapy (CPT) and experimental group n=13 additionally received compelled body weight shift (CBWS) technique using insole shoe lift of 0.6 cm thickness. The tinetti (POMA) for balance and gait, 10 Meter walk test for gait parameters and analogue weight scale for weight distribution on both limbs were assessed at the baseline and after 6th week of intervention. Results: The mean age and BMI of the study participants was 49.84±6.18 years and 34±5.13 kg/m2 respectively. Between the groups analyses showed that all the domains showed no significant difference, but step length showed significant difference (p&lt;0.001) after 6th week. The stride length showed significant difference after 3rd week and 6th week (p&lt;0.01). while the cadence showed significant difference after 3rd week only (p=0.02) and no significant difference was observed after the 6th week of the treatment. Conclusions: There was slight improvement in cadence, stride length and step length after the treatment. Furthermore, it is evident that CBWS is effective for improving gait parameters. Keywords: Balance, gait training, physical therapy, stroke, stroke rehabilitation.

Effect of Treadmill Training with Visual Biofeedback on Selected Gait Parameters in Subacute Hemiparetic Stroke Patients

Functional limitations after a stroke are unique to each person and often include impaired independent mobility. A reduction in existing gait deficits after a stroke is often one of the main goals of rehabilitation. Gait re-education after stroke is a complex process, which consists of the effects of many therapeutic interventions. The study aimed to analyze the effects of using a treadmill with visual feedback in gait re-education in the sub-acute stroke period and assess the impact of biofeedback treadmill training on selected gait parameters, improving static balance and reducing the need for orthopedic aids. The study included 92 patients (F: 45, M: 47) aged 63 ± 12 years, with post-ischemic sub-acute (within six months onset) stroke hemiparesis, treated at a neurological rehabilitation ward. All patients participated in a specific rehabilitation program, and in addition, patients in the study group (n = 62) have a further 10 min of treadmill training with visual feedback. Patients in the control group (n = 30) participated in additional conventional gait training under the direct supervision of a physiotherapist. The evaluation of static balance was assessed with the Romberg Test. A Biodex Gait Trainer 3 treadmill with biofeedback function was used to evaluate selected gait parameters (walking speed, step length, % limb loading, and traveled distance). The use of an orthopedic aid (walker or a crutch) was noted. After four weeks of rehabilitation, step length, walking speed, traveled distance, and static balance were significantly improved for the study and control group (p < 0.05). Treadmill gait training yielded significantly better results than a conventional rehabilitation program. Only the study group observed a corrected walking base (p < 0.001). All participants showed a reduction in the use of walking aids (p = 0.006). There was no asymmetry in the % of limb loading for either group prior to or following rehabilitation. The treadmill with visual biofeedback as conventional gait training has resulted in a significant improvement in parameters such as step length, walking speed, static balance, and a reduction in the use of locomotion aids. However, the achieved improvement in gait parameters is still not in line with the physiological norm.

The Use of Rhythmic Auditory Stimulation on Gait Parameters in Parkinson’s Disease: A Systematic Review

Introduction: Parkinson’s disease (PD) is a neurodegenerative disorder that commonly affects the basal ganglia dopaminergic signaling system, which can contribute to moderate-severe gait impairments in individuals. Many therapies have been proposed to mitigate this effect, however, there are often issues to consider such as the relative invasiveness of the procedure and other side effects. Rhythmic auditory stimulation (RAS) is a non-invasive therapeutic avenue with the potential to mitigate associated impairments in gait parameters. This review aims to evaluate the recent literature regarding the efficacy of this intervention in improving gait parameters in individuals with Parkinson’s disease. Methods: PubMed and OVID Medline databases were consulted to find nine randomized controlled trials (RCTs) written in the English language, published between 2012 and 2022 and subject to a strict inclusion criterion. Keywords included, but were not limited to, “Parkinson’s disease”, “rhythmic auditory stimulation”, and “gait”. Outcomes were critically analyzed, and their implications were evaluated in the context of existing research within this field. Results: Many of the studies showed a strong immediate improvement in several of the gait parameters, such as speed, stride length, cadence, balance, and falls, identified across a variety of RCT designs. However, many reviewed studies included a small sample size (n ≤ 30) and showed no significant outcomes in specific parameters, and several lacked an adequate follow-up period, limiting assessment of long-term efficacy. Discussion: The findings showed strong implications surrounding the use of rhythmic cues to prime the motor system to facilitate gait relearning and motor rehabilitation, at least in the short term. This method can be applied in future therapeutic avenues to address gait rehabilitation in a non-invasive manner. Conclusion: Existing literature demonstrates that RAS therapy is a promising method to incorporate into such therapeutic avenues; however, further research for the long-term efficacy of this approach is required.

Exploring a New Cueing Device in People Who Experience Freezing of Gait: Acceptance of a Study Design.

Freezing of Gait (FoG) is a disabling symptom of Parkinson's Disease (PD) and is defined as a "brief episodic absence or marked reduction of forward progression of the feet despite the intention to walk." Compensatory strategies such as cueing and high frequency vibrotactile stimulation can reduce FoG severity and improve gait parameters. A new Sternal high frequency Vibrotactile Stimulation Device (SVSD) with cueing function has been developed, however the clinical effects of this device are yet to be fully investigated. The aim of this study was to investigate, if the proposed study design using a SVSD and gait analysis sensor insoles was acceptable for people with PD. This feasibility study was designed as a randomized cross-over study. Thirteen participants took part in a one off 60-minute data collection session. The acceptability of the study design was assessed with a mixed methods questionnaire considering each step of the study process. Secondary outcome measures were the feasibility of using the 10 Metre Walk Test (10MWT), the Freezing of Gait Score (FoG-Score), and Patient Global Impression of Change (PGI-C) with and without the SVSD. The participants scored all aspects of the study design as very satisfactory. In addition, all participants could perform the secondary outcome measures and were deemed feasible. Feedback from open ended questions provided ideas and considerations for adaptations of future clinical studies. The proposed study design was acceptable for people with PD. Implications. This study design, with small adaptations, can be used for larger studies to evaluate the effect of an SVSD on FoG in people with PD.

Neurologic Music Therapy in Geriatric Rehabilitation: A Systematic Review.

(1) Introduction: Neurologic music therapy (NMT) is a non-pharmacological approach of interaction through the therapeutic use of music in motor, sensory and cognitive dysfunctions caused by damage or diseases of the nervous system. (2) Objective: This study aimed to critically appraise the available literature on the application of particular NMT techniques in the rehabilitation of geriatric disorders. (3) Methods: PubMed, ScienceDirect and EBSCOhost databases were searched. We considered randomized controlled trials (RCTs) from the last 12 years using at least one of the NMT techniques from the sensorimotor, speech/language and cognitive domains in the therapy of patients over 60 years old and with psychogeriatric disorders. (4) Results: Of the 255 articles, 8 met the inclusion criteria. All papers in the final phase concerned the use of rhythmic auditory stimulation (RAS) (sensorimotor technique) in the rehabilitation of both Parkinson's disease (PD) patients (six studies) and stroke patients (SPs) (two studies). (5) Conclusion: All reports suggest that the RAS technique has a significant effect on the improvement of gait parameters and the balance of PD patients and SPs, as well as the risk of falls in PD patients.

Rhythmic auditory cueing in atypical parkinsonism: A pilot study.

Rhythmic auditory cueing (RAC) can improve gait parameters in neurological disorders such as Parkinson's disease and stroke. However, there is a lack of research on the effects of RAC in patients with atypical parkinsonian disorders (APD). Using a smartphone metronome application, we aimed to investigate the immediate effects of RAC in patients with clinically diagnosed APD, namely Progressive Supranuclear Palsy (PSP-Richardson Syndrome and other variants, PSP-nonRS), Corticobasal Syndrome (CBS), Multiple System Atrophy (MSA), and Dementia with Lewy Bodies (DLB). A total of 46 APD participants (25 PSP, 9 CBS, 8 MSA and 4 DLB; age: mean = 70.17, standard deviation = 7.15) walked at their preferred pace for 2 min without any rhythmic auditory cueing (RAC). Participants then walked the same path for another 2 min with RAC set at a tempo 10% faster than the baseline cadence of each participant. After a 10-15-min break, participants walked the same path for another 2 min without RAC to observe for carryover effects. Gait parameters [cadence (steps/minute), gait velocity (meters/minute), and stride length (centimeters)] were collected at baseline, during RAC, and post-RAC. There was a significant improvement in cadence in all participants from baseline to during RAC and post-RAC (corrected p-values = 0.009 for both). Gait velocity also improved from baseline to during RAC and post-RAC in all participants, although this improvement was not significant after correcting for multiple comparisons. The changes in cadence and gait velocity were most pronounced in PSP. In addition, our exploratory analysis showed that the cadence in the suspected TAU group (PSP+CBS) showed a significant improvement from baseline to during RAC and post-RAC (corr. p-value = 0.004 for both). This pilot study using short-term RAC in APD patients demonstrated improvements in cadence and velocity. There is an urgent need for effective gait rehabilitation modalities for patients with APD, and rhythmic cueing can be a practical and useful intervention to improve their gait pattern.

Effect of Functional Electrical Stimulation on Gait Parameters in Children with Cerebral Palsy: A Meta-Analysis.

Objective At present, there are controversies on the effectiveness of functional electrical stimulation devices in gait improvement in the clinic, and the results reported in limited literature are contradictory. This paper summarizes and analyzes the relationship between functional electrical stimulation treatment and gait parameter changes in children with cerebral palsy, thus exploring the above controversies' results. Methods Two researchers conducted a detailed search of the literature from the establishment of the database to June 2022. Literature retrieved from databases, including PubMed, Embase, Ovid, Cochrane Library, and Web of Science and the search process followed the principles of Cochrane. The search keywords were “cerebral palsy”, “functional electrical stimulation”, “gait”, or “walk”. Gait and balance parameters were extracted from the literature. Gait parameters, such as walking speed and step length, were included in the meta-analysis. The study used standard mean difference (STD) and 95% confidence interval (CI) to calculate the mean difference between the two groups. The statistic I2 was used to evaluate the heterogeneity between the evaluation studies. Begg's test detected publication bias and the funnel chart was used for visual analysis. Furthermore, Review Manager software was used to make a risk bias map for literature publication bias analysis. Results 9 literatures were included in the analysis, with a total of 282 children with cerebral palsy, including 142 patients in the functional electrical stimulation treatment group and 140 patients in the comfort treatment, general nursing, or other physical therapy. The randomization scheme and result report used in most studies were low risk, which was important for the credibility of this study. Most studies have limitations in the blinding method of participants and subjects, and most of them were single-blind studies, which might have a high risk. The results showed that functional electrical stimulation could increase the walking speed of children with cerebral palsy (SMD = 0.82, P < 0.0001) and increase the walking step length of children with cerebral palsy (SMD = 1.34, 95%CI = 1.07, 1.60, Z = 9.91, P < 0.0001). Funnel plot analysis showed that the literature distribution was uniform and symmetrical, and Begg's test showed no publication bias in included literature. Conclusion This study compared the effects of the functional nerve stimulation treatment group and control group on improving gait parameters of children with cerebral palsy. The results indicated that functional nerve stimulation treatment could increase the gait speed and step length of children with cerebral palsy, which could improve the walking of children with cerebral palsy. Furthermore, this study needs more research data to support our findings. The results of this study might better guide the clinical practice and better use of health as well as financial resources.

Intravenous injection of adipose-derived mesenchymal stromal cells benefits gait and inflammation in a spontaneous osteoarthritis model.

Osteoarthritis (OA) is a leading cause of morbidity among aging populations, yet symptom and/or disease-modification remains elusive. Adipose-derived mesenchymal stromal cells (adMSCs) have demonstrated immunomodulatory and anti-inflammatory properties that may alleviate clinical signs and interrupt disease onset and progression. Indeed, multiple manuscripts have evaluated intra-articular administration of adMSCs as a therapeutic; however, comparatively few evaluations of systemic delivery methods have been published. Therefore, the aim of this study was to evaluate the short-term impact of intravenous (IV) delivery of allogeneic adMSCs in an established model of spontaneous OA, the Hartley guinea pig. Animals with moderate OA received once weekly injections of 2 × 106 adMSCs or vehicle control for 4 weeks in peripheral veins; harvest occurred 2 weeks after the final injection. Systemic administration of adMSCs resulted in no adverse effects and was efficacious in reducing clinical signs of OA (as assessed by computer-aided gait analysis) compared to control injected animals. Further, there were significant decreases in key inflammatory mediators (including monocyte chemoattractant protein-1, tumor necrosis factor, and prostaglandin E2 ) both systemically (liver, kidney, and serum) and locally in the knee (joint tissues and synovial fluid) in animals treated with IV adMSCs relative to controls (as per enzyme-linked immunosorbent assay and/or immunohistochemistry, dictated by tissue sample). Thus, systemic administration of adMSCs by IV injection significantly improved gait parameters and reduced both systemic and intra-articular inflammatory mediators in animals with OA. These findings demonstrate the potential utility of alternative delivery approaches for cellular therapy of OA, particularly for patients with multiple affected joints.

Effectiveness of Early Rehabilitation with Exergaming in Virtual Reality on Gait in Patients after Total Knee Replacement.

Total knee replacement (TKR) is the treatment of choice for advanced stages of osteoarthritis but it requires good postoperative rehabilitation. This study aimed to assess the effectiveness of exercises using virtual reality to improve gait parameters in patients after TKR. Fifty-nine patients 7–14 days after TKR surgery were divided into a study group (VRG, n = 38) and a control group (CG, n = 21). Both groups underwent the same 4-week rehabilitation protocol. The VRG group had 12 additional nonimmersive virtual reality game sessions on the Virtual Balance Clinic prototype system at 30 min each, focusing on gait and balance improvement. Spatiotemporal, force and foot plantar pressure parameters were collected on an instrumented treadmill during a 30 s walk. The most significant improvement was in the symmetry indices of forefoot force, maximum forefoot force, loading response time, and preswing time (p < 0.05) in both groups. Gait speed increased by 31.25% and 44% in the VRG and CG groups, respectively (p < 0.005). However, the extra exergaming sessions did not significantly improve rehabilitation outcomes. Therefore, additional VR training does not improve gait better than standard rehabilitation alone, but the improvement of gait, especially its symmetry, is significant within the first six weeks after surgery.