Improvement In Stride Length Research Articles

Structural connectivity of low-frequency subthalamic stimulation for improving stride length in Parkinson’s disease

BackgroundA reduction in stride length is considered a key characteristic of gait kinematics in Parkinson’s disease (PD) and has been identified as a predictor of falls. Although low-frequency stimulation (LFS) has been suggested as a method to improve gait characteristics, the underlying structural network is not well understood. ObjectiveThis study aims to investigate the structural correlates of changes in stride length during LFS (85 Hz). MethodsObjective gait performance was retrospectively evaluated in 19 PD patients who underwent deep brain stimulation (DBS) at 85 Hz and 130 Hz. Individual DBS contacts and volumes of activated tissue (VAT) were computed using preoperative magnetic resonance imaging (MRI) and postoperative computed tomography (CT) scans. Structural connectivity profiles to predetermined cortical and mesencephalic areas were estimated using a normative connectome. ResultsLFS led to a significant improvement in stride length compared to 130 Hz stimulation. The intersection between VAT and the associative subregion of the subthalamic nucleus (STN) was associated with an improvement in stride length and had structural connections to the supplementary motor area, prefrontal cortex, and pedunculopontine nucleus. Conversely, we found that a lack of improvement was linked to stimulation volumes connected to cortico-diencephalic fibers bypassing the STN dorsolaterally. The robustness of the connectivity model was verified through leave-one-patient-out, 5-, and 10-fold cross cross-validation paradigms. ConclusionThese findings offer new insights into the structural connectivity that underlies gait changes following LFS. Targeting the non-motor subregion of the STN with LFS on an individual level may present a potential therapeutic approach for PD patients with gait disorders.

Effect of subthalamic coordinated reset deep brain stimulation on Parkinsonian gait.

Coordinated Reset Deep Brain Stimulation (CR DBS) is a novel DBS approach for treating Parkinson's disease (PD) that uses lower levels of burst stimulation through multiple contacts of the DBS lead. Though CR DBS has been demonstrated to have sustained therapeutic effects on rigidity, tremor, bradykinesia, and akinesia following cessation of stimulation, i.e., carryover effect, its effect on Parkinsonian gait has not been well studied. Impaired gait is a disabling symptom of PD, often associated with a higher risk of falling and a reduced quality of life. The goal of this study was to explore the carryover effect of subthalamic CR DBS on Parkinsonian gait. Three non-human primates (NHPs) were rendered Parkinsonian and implanted with a DBS lead in the subthalamic nucleus (STN). For each animal, STN CR DBS was delivered for several hours per day across five consecutive days. A clinical rating scale modified for NHP use (mUPDRS) was administered every morning to monitor the carryover effect of CR DBS on rigidity, tremor, akinesia, and bradykinesia. Gait was assessed quantitatively before and after STN CR DBS. The stride length and swing speed were calculated and compared to the baseline, pre-stimulation condition. In all three animals, carryover improvements in rigidity, bradykinesia, and akinesia were observed after CR DBS. Increased swing speed was observed in all the animals; however, improvement in stride length was only observed in NHP B2. In addition, STN CR DBS using two different burst frequencies was evaluated in NHP B2, and differential effects on the mUPDRS score and gait were observed. Although preliminary, our results indicate that STN CR DBS can improve Parkinsonian gait together with other motor signs when stimulation parameters are properly selected. This study further supports the continued development of CR DBS as a novel therapy for PD and highlights the importance of parameter selection in its clinical application.

Effects of Motor Imagery Training for Lower Limb Dysfunction in Patients With Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

The aim of the study is to determine the effects of motor imagery training associated with conventional rehabilitation therapies on lower limb motor function recovery in poststroke patients. Comprehensive literature searches were performed to identify studies published before June 5, 2022. RevMan 5.3 software was used for meta-analysis. The quality of the included studies was assessed using the Cochrane risk-of-bias tool and the modified Jadad scale. The certainty of the evidence was evaluated with the Grading of Recommendations, Assessment, Development and Evaluations system. Twenty-three trials and/or 1109 participants with motor imagery training ability were included in this review. Motor imagery training combined with conventional rehabilitation therapies versus conventional rehabilitation therapies demonstrated significant benefits in motor function, balance function, temporospatial gait variables (walking speed, stride length, and cadence) and activities of daily living. Subgroup analysis demonstrated that motor imagery training-conventional rehabilitation therapies had a better effect on improvement in motor function and activities of daily living in the acute phase and had a greater benefit on walking speed in the chronic phase. In addition, motor imagery training-conventional rehabilitation therapies resulted in greater improvements in stride length, cadence, walking ability, and balance function in the subacute phase. Motor imagery training-conventional rehabilitation therapies have better effects on the recovery of lower limb motor function in poststroke patients than conventional rehabilitation therapies, which may be most beneficial for lower extremity motor function recovery in the first 7 days to 6 mos.

Training in Varying Environmental Contexts Facilitates Transfer of Improved Gait Performance to New Contexts for Individuals With Parkinson Disease: A Randomized Controlled Trial

ObjectiveTo investigate whether varying practice context during gait training could reduce context dependency and facilitate transfer of improved gait performance to a new context. DesignA single-blind, parallel-group randomized controlled trial. SettingMedical university rehabilitation settings. ParticipantsForty-nine participants with Parkinson disease were recruited and randomized into the constant (CONS) or varied (VARI) context group. InterventionsAll participants received 12 sessions of treadmill and over-ground gait training. The CONS group was trained in a constant environmental context throughout the study, whereas the VARI group received training in 2 different contexts in an alternating order. Main Outcome MeasuresThe primary outcome was gait performance, including velocity, cadence, and stride length. The participants were assessed in the original training context as well as in a novel context at posttest to determine the influence of changed environmental context on gait performance. ResultsThough both groups improved significantly after training, the CONS group showed greater improvement in stride length than the VARI group when assessed in the original practice context. However, the CONS group showed a decreased velocity and stride length in the novel context, whereas the VARI group maintained their performance. ConclusionsVarying practice context could facilitate transfer of improved gait performance to a novel context.

Reflex Locomotion Therapy for Balance, Gait, and Fatigue Rehabilitation in Subjects with Multiple Sclerosis.

This study evaluates the effects of a rehabilitation program based on reflex locomotion therapy (RLT) on balance, gait, and fatigue in patients with multiple sclerosis (MS). Twenty-three patients diagnosed with MS participated in this study. Reversal design was carried out. The assessment tools included the Berg Balance Scale (BBS), the Performance Oriented Mobility Assessment (POMA), the Fatigue Severity Scale (FSS) and the instrumental analysis of the gait recorded by Vicon Motion System®. We analyzed spatio-temporal parameters and kinematic variables of the hip, knee, and ankle joints. Additionally, the Client Satisfaction Questionnaire (CSQ-8) was administrated. We did find a significant improvement in balance and gait tools after the RLT period. Regarding instrumental analysis, the statistical analysis of spatio-temporal parameters showed a significant improvement in stride length, double support, and velocity after the RLT period. Concerning kinematic parameters, the analysis showed improvements in hip and knee range of motion (ROM) after RLT period. RLT could improve gait and balance in patients with MS. The patients reported a high level of satisfaction with the therapy received.

Effect of Neuromuscular Electrical Stimulation Verses Electrical Stimulation On Gait Parameters in Subjects Having Plantar Fascitis

Objective: 1. To investigate the effect of neuromuscular electrical stimulation verses electrical stimulation on gait parameters in subjects having plantar fasciitis 2. To investigate the ratio of the effect in both males and females. 3. To compare the effect of neuromuscular electrical stimulation verses electrical stimulation on gait parameters in subjects having plantar fascitis Method: Total 30 subjects were selected according to inclusion and exclusion criteria aged between 40 to 60 years. The outcome measures were foot and ankle ability measures scale, gait parameters - stride length, step length and cadence. The subjects were divided into two groups,group A was treated with Electrical Stimulation and group B with Neuromuscular Electrical Stimulation. Result: The result was extremely significant within the group on foot and ankle ability measured scale and gait parameters post 4 weeks for Group A. The neuromuscular electrical stimulation on gait parameter in individual having plantar fasciitis there result was extremely significant (p=?0.0001) post 4 weeks for Group B. Between the group comparison: Post test there was significant difference between outcome variables in FAAM (p=?0.001) and gait parameters. Following are the p values which lead to analysis of improvement in stride length (0.0021), step length (0.0378) and cadence (p=?0.001). The result from the statistical analysis of present study support the null hypothesis is rejected which stated that there will be beneficial effect to the subject treated with neuromuscular stimulation than electrical stimulation Conclusion: Based on the statistical results and interpretation it was concluded that Neuromuscular electrical stimulation showed reduction in pain and improvement in gait parameters in individual having plantar fasciitis. Both the groups showed significant results but, post intervention Neuromuscular electrical stimulation group showed extremely significant effect than the electrical stimulation group

A Step in the Right Direction: Body Location Determines Activity Tracking Device Accuracy in Total Knee and Hip Arthroplasty Patients.

Step counts measured by activity monitoring devices (AMDs) and smartphones (SPs) can objectively measure a patient's activity levels after total hip and knee arthroplasty (total joint arthroplasty [TJA]). This study investigated the use and optimal body location of AMDs and SPs to measure step counts in the postoperative period. This was a two-armed, prospective, observational study of TJA inpatients (n = 24) and 2-week status after TJA (n = 25) completing a 100-ft walk. Observer-counted steps were compared with those measured by AMDs (wrist and ankle) and SPs (hip and neck). Acceptable error was defined as <30%. Error rates were treated as both dichotomous and continuous variables. AMD and SP step counts had overall unacceptable error in TJA inpatients. AMDs on the contralateral ankle and SPs on the contralateral hip had error rates less than 30% at 2 weeks postoperatively. Two-week postoperative patients required lower levels of assist (11/25 walker; 4/25 no assist), and significant improvements in stride length (total hip arthroplasty 1.27 versus 1.83 ft/step; total knee arthroplasty 1.42 versus 1.83 ft/step) and cadence (total hip arthroplasty 74.6 versus 166.0 steps/min; total knee arthroplasty 73.5 versus 144.4 steps/min) were seen between inpatient and postoperative patients. Regression analysis found that increases in postoperative day and cadence led to a decrease in device error. In inpatients with TJA, AMDs and SPs have unacceptable variability and limited utility for step counting when using a walker. As gait normalizes and the level of ambulatory assist decreases, AMDs on the contralateral ankle and SPs on the contralateral hip demonstrated low error rates. These devices offer a novel method for measurement of objective outcomes and potential for remote monitoring of patient progress after TJA. Level II, prospective, three-armed study, prognostic study.

Effectiveness of 4-week backward walking training program incorporated with rhythmic auditory cueing on spatial and temporal gait parameters and balance in subjects with hemiparesis: An experimental randomized control trial

AIM: The aim of the study was to investigate the effectiveness of a 4-week backward walking training (BWT) program incorporated with rhythmic auditory cueing on spatial and temporal gait parameters and balance in subjects with hemiparesis. MATERIALS AND METHODS: This was a experimental randomized control trial and random allocation was done using chit method. The study was conducted in the physiotherapy department with required infrastructure of tertiary health-care center. Forty subjects (male/female) aged 18–60, in Brunnstrom recovery stage 3, 4, and 5, and diagnosed with hemiparesis from onset to 2 years' duration were included in the study. Each subject was assessed for stride length, step length (paretic and nonparetic), cadence, walking velocity, 3-meters (3-m) backward walk test, Dynamic Gait Index (DGI), and Berg's Balance Scale (BBS) at baseline and 4 weeks post intervention. In addition to conventional physiotherapy exercises, Group A, experimental (n = 20), underwent backward walking training with rhythmic auditory cueing using metronome and Group B, control (n = 20), underwent backward walking training without rhythmic auditory cueing for 4 weeks. RESULTS: Post 4 weeks of training, in the experimental group,cadence improved by 20%(5% in control group), walking velocity reduced by 15% (0.3% control group), 3-m BWT reduced by 32% (20% in the control group), DGI improved by 40% (20% control group), and BBS improved by 20% (12% in the control group). There was no statistically significant improvement in stride length and step length in both the groups. CONCLUSIONS: It is concluded that backward walking training incorporated with rhythmic auditory cueing and conventional physiotherapy exercises is effective in improving cadence, walking velocity, 3-m backward walk test, DGI, and BBS in stroke subjects.

Uphill treadmill walking plus physical therapy versus physical therapy alone in the management of individuals with knee osteoarthritis: a randomized clinical trial

Purpose This study aims to compare the effectiveness of uphill walking and physical therapy versus physical therapy alone on knee pain, excursion ranges, stride length, and walking speed in individuals with knee osteoarthritis. Methods In this randomized clinical trial, 30 patients with knee osteoarthritis participated. Both control and intervention groups received 10-session physical therapy. Moreover, the intervention group received an 8-degree treadmill walking at a speed of 1.1 m/s for 30 min in each session. Outcome measures, including pain, excursion ranges, stride length, and walking speed, were measured at baseline, post-treatment, and a 20-day follow-up. Results Significant improvements in stride length and walking speed were observed just in the intervention group from baseline to post-treatment (p ≤ 0.001) and from baseline to follow-up (p ≤ 0.001). Furthermore, significant improvement in excursion ranges was observed just in the intervention group from baseline to follow-up (p < 0.05). Conclusions This study revealed that the addition of uphill walking to physical therapy results in stride length and walking speed improvements and that it also has persistent effects on knee ranges, stride length, and walking speed as compared with physical therapy alone. This clinical trial was registered at irct.ir (study ID: IRCT20171115034920N1). Implications for Rehabilitation Stretching exercises are recommended to correct knee flexion contracture and uphill treadmill walking is a form of functional stretching. This study shows 10 sessions of combined uphill treadmill walking and physical therapy provided superior improvements in stride length and walking speed at 10-session or 20-day follow-up, and active and passive excursion ranges at 20-day follow-up compared with physical therapy alone. Physical therapist may consider uphill treadmill walking when designing a physical therapy for patients with knee osteoarthritis to promote the results of the rehabilitation programs.

Effect of Kinesio Taping on the Walking Ability of Patients with Foot Drop after Stroke.

Objective The purpose of this study was to investigate the effect of kinesio taping on the walking ability in patients with foot drop after stroke. Methods Sixty patients were randomly divided into the experimental group (with kinesio taping) and the control group (without kinesio taping). The 10-Meter Walking Test (10MWT), Timed Up and Go Test (TUGT), stride length, stance phase, swing phase, and foot rotation of the involved side were measured with the German ZEBRIS gait running platform analysis system and were used to evaluate and compare the immediate effects of kinesio taping. All the measurements were made in duplicate for each patient. Results The demographic variables of patients in both groups were comparable before the treatment (p>0.05). After kinesio taping treatment, significant improvement was found in the 10MWT and the TUGT for patients in the experimental group (p<0.05). There were significant differences in the 10MWT and TUGT between the experimental and control groups after treatment (p<0.05). In terms of gait, we found significant improvement in stride length (p<0.001), stance phase (p<0.001), swing phase (p<0.001), and foot rotation (p<0.001) of the involved side in experimental group after treatment compared with those before treatment. Further, the functional outcomes and gait ability were significantly improved in the experimental group after treatment (p<0.05), compared to the control group. Conclusion Kinesio taping can immediately improve the walking function of patients with foot drop after stroke.

Spatiotemporal Gait Analysis and Lower Limb Functioning in Foot Dystonia Treated with Botulinum Toxin.

Foot dystonia (FD) is a disabling condition causing pain, spasm and difficulty in walking. We treated fourteen (14) adult patients experiencing FD with onabotulinum toxin A injection into the dystonic foot muscles. We analyzed the spatiotemporal gait utilizing the GaitRite system pre- and 3 weeks post-botulinum toxin injection along with measuring dystonia by the Fahn–Marsden Dystonia Scale (FMDS), pain by the Visual Analog Scale (VAS) and other lower limb functional outcomes such as gait velocity, the Berg Balance Scale (BBS), the Unified Parkinson’s Disease Rating Scale–Lower Limb Score (UPDRS–LL), the Timed Up and Go (TUG) test and the Goal Attainment Scale (GAS). We found that stride length increased significantly in both the affected (p = 0.02) and unaffected leg (p = 0.01) after treatment, and the improvement in stride length was roughly the same in each leg. Similar results were found for step length (p = 0.02) with improvement in the step length differential (p = 0.01). The improvements in the lower limb functional outcomes were also significant—FMDS, VAS, TUG, and UPDRS–LL decreased significantly after treatment (all p < 0.001), and BBS (p = 0.001), GAS (p < 0.001) except cadence (p = 0.37). BT injection improved walking in foot dystonia as evidenced through gait analysis, pain and lower limb functional outcomes. Main study limitations were small sample size and lack of control.

Gait analysis and other functional parameters in foot dystonia following botulinum toxin A injection

Foot dystonia (FD) is a movement disorder characterised by sustained or intermittent muscle contractions causing abnormal, often repetitive movements resulting in pain, spasm and difficulty in walking. The most effective treatment for FD is botulinum toxin injection. The spatiotemporal gait analysis in Gait Rite is well validated and may help clinicians to record the outcomes more objectively. In this paper, we discuss the spatiotemporal gait parameters in FD pre- and post-botulinum toxin injection along with other lower limb functional outcomes. Fourteen (14) adult patients with FD were assessed in the multidisciplinary spasticity clinic pre-and post-injection of botulinum toxin. We conducted gait analysis in the Gait rite system besides recording Fan Marsden Dystonia Scale (FMDS), Visual Analog Scale (VAS) of pain, Berg Balance Score (BBS), Unified Parkinson's Disease Rating Scale - Lower Limb Score (UPDRSLL), Timed Up and Go (TUG) test and the Goal Attainment Scale (GAS). We used the random effects panel data estimators in Stata to examine the difference from before the intervention to after to assess whether there was significant change in gait parameters. In all models the test for the time effect was adjusted for age, sex, and side (left or right). We found that stride length increased significantly in both the affected ( P = 0.021) and unaffected leg (0.010) after treatment, and that the improvement in stride length was roughly the same in each leg. Similar results were found for step length ( P = 0.021) with improvement in the step length differential ( P = 0.016). The improvement in the lower limb functional outcomes were also significant (FMDS, P < 0.001, VAS, P < 0.001, TUG, P < 0.001, BBG, P = 0.001, UPDRSLL, P < 0.001, GAS, P < 0.001, GV, P = 028) except Cadence, P = 0.367. BT is effective in improving walking in foot dystonia as evidenced through gait analysis and improved lower limb functional outcomes.

A COMPARISON OF RESISTED AND ASSISTED SPRINT TRAINING IN COLLEGIATE SPRINTERS

Sprint time (ST) is the product of stride length (SL) and stride rate (SR). Increases in either of these variables results in speed improvement. Purpose: To compare resisted (RST) and assisted sprint training (AST) on sprint performance. Methods: Twenty (10 male, 10 female) collegiate sprinters and hurdlers were randomly divided into two training groups: RST (age: 21.8±1.8yrs, height: 1.73±0.10m, mass: 69.5±12.8kg) and AST (age: 22.2±2.4yrs, height: 1.76±0.10m, mass: 69.1±9.9kg). Each group trained 3 days/week for 6 weeks. The RST group used a combination of weighted sled pulls, uphill sprinting and depth jumps. The AST group combined downhill running, towing, sprint ladders and single leg bounds. Prior to and following the training interventions SL and ST (10 meter sprint time) were recorded at sprint distances of 30m, 60m, and 120m during the last 10 meters of each sprint distance. Pre-post training ST and SL were compared within training groups at each sprint distance using paired t-tests. Additionally, a gain score was calculated by taking the difference between the post and pre test scores. The gain scores for SL and ST were compared between training groups via independent t-tests at each sprint distance. Results: For the RST 30m, ST (1.18±0.08s vs 1.14±0.08s, p<0.01) and SL (2.06±0.08m vs. 2.09±1.14m, p<0.01) were significantly improved. For the AST, 30m ST (1.19±0.08s vs. 1.18±0.08s, p<0.01) and SL (2.10±0.13m vs. 2.11±0.13, p=0.04) were significantly improved. No improvements in ST or SL were detected for either the RST or AST groups at the 60m sprint distance. For the RST 120m, ST (1.13±0.07s vs. 1.12±0.08s, p<0.01) was significantly improved. For the AST 120m, ST (1.12±0.07s vs. 1.11±0.07s, p<0.01) and SL (2.30±0.08 vs. 2.33±0.08, p<0.01) were significantly improved. At the 30M interval, the RST demonstrated significant improvements in SL and ST as compared to the AST (p<0.01). However, at the 120M interval, the AST demonstrated a significant improvement in SL as compared to the RST (p<0.01). Conclusion: Within the parameters of this study, RST and AST methods have proven effective at improving sprint performance. It appears that RST protocols may be of greatest benefit for improving sprint performance at shorter distances, while AST protocols may be of greater benefit at longer sprinting distances. Article visualizations:

A COMPARISON OF RESISTED AND ASSISTED SPRINT TRAINING IN COLLEGIATE SPRINTERS

Sprint time (ST) is the product of stride length (SL) and stride rate (SR). Increases in either of these variables results in speed improvement. Purpose: To compare resisted (RST) and assisted sprint training (AST) on sprint performance. Methods: Twenty (10 male, 10 female) collegiate sprinters and hurdlers were randomly divided into two training groups: RST (age: 21.8±1.8yrs, height: 1.73±0.10m, mass: 69.5±12.8kg) and AST (age: 22.2±2.4yrs, height: 1.76±0.10m, mass: 69.1±9.9kg). Each group trained 3 days/week for 6 weeks. The RST group used a combination of weighted sled pulls, uphill sprinting and depth jumps. The AST group combined downhill running, towing, sprint ladders and single leg bounds. Prior to and following the training interventions SL and ST (10 meter sprint time) were recorded at sprint distances of 30m, 60m, and 120m during the last 10 meters of each sprint distance. Pre-post training ST and SL were compared within training groups at each sprint distance using paired t-tests. Additionally, a gain score was calculated by taking the difference between the post and pre test scores. The gain scores for SL and ST were compared between training groups via independent t-tests at each sprint distance. Results: For the RST 30m, ST (1.18±0.08s vs 1.14±0.08s, p<0.01) and SL (2.06±0.08m vs. 2.09±1.14m, p<0.01) were significantly improved. For the AST, 30m ST (1.19±0.08s vs. 1.18±0.08s, p<0.01) and SL (2.10±0.13m vs. 2.11±0.13, p=0.04) were significantly improved. No improvements in ST or SL were detected for either the RST or AST groups at the 60m sprint distance. For the RST 120m, ST (1.13±0.07s vs. 1.12±0.08s, p<0.01) was significantly improved. For the AST 120m, ST (1.12±0.07s vs. 1.11±0.07s, p<0.01) and SL (2.30±0.08 vs. 2.33±0.08, p<0.01) were significantly improved. At the 30M interval, the RST demonstrated significant improvements in SL and ST as compared to the AST (p<0.01). However, at the 120M interval, the AST demonstrated a significant improvement in SL as compared to the RST (p<0.01). Conclusion: Within the parameters of this study, RST and AST methods have proven effective at improving sprint performance. It appears that RST protocols may be of greatest benefit for improving sprint performance at shorter distances, while AST protocols may be of greater benefit at longer sprinting distances. Article visualizations:

Quantitative assessment of the effects of 6 months of adapted physical activity on gait in people with multiple sclerosis: a randomized controlled trial

Purpose: The purpose of this study is to quantitatively assess the effect of 6 months of supervised adapted physical activity (APA i.e. physical activity designed for people with special needs) on spatio-temporal and kinematic parameters of gait in persons with Multiple Sclerosis (pwMS).Methods: Twenty-two pwMS with Expanded Disability Status Scale scores ranging from 1.5 to 5.5 were randomly assigned either to the intervention group (APA, n = 11) or the control group (CG, n = 11). The former underwent 6 months of APA consisting of 3 weekly 60-min sessions of aerobic and strength training, while CG participants were engaged in no structured PA program. Gait patterns were analyzed before and after the training using three-dimensional gait analysis by calculating spatio-temporal parameters and concise indexes of gait kinematics (Gait Profile Score – GPS and Gait Variable Score – GVS) as well as dynamic Range of Motion (ROM) of hip, knee, and ankle joints.Results: The training originated significant improvements in stride length, gait speed and cadence in the APA group, while GPS and GVS scores remained practically unchanged. A trend of improvement was also observed as regard the dynamic ROM of hip, knee, and ankle joints. No significant changes were observed in the CG for any of the parameters considered.Conclusions: The quantitative analysis of gait supplied mixed evidence about the actual impact of 6 months of APA on pwMS. Although some improvements have been observed, the substantial constancy of kinematic patterns of gait suggests that the full transferability of the administered training on the ambulation function may require more specific exercises.Implications for rehabilitationAdapted Physical Activity (APA) is effective in improving spatio-temporal parameters of gait, but not kinematics, in people with multiple sclerosis.Dynamic range of motion during gait is increased after APA.The full transferability of APA on the ambulation function may require specific exercises rather than generic lower limbs strength/flexibility training.

Closed-loop auditory feedback for the improvement of gait in patients with Parkinson's disease

ObjectiveTo study the effects of closed-loop auditory feedback cues, corresponding to patient self-motion, on the walking abilities of patients with Parkinson's disease, in comparison to the effects of open-loop (metronome-like) auditory cues. MethodsSixteen patients on their regular medication schedule participated.A device which translates patient steps into a clicking cue sounded by earphones provides auditory feedback for gait pattern correction. Walking speed and stride length are measured. Device-on performance is compared to device-off performance and to baseline performance, and short-term residual performance following 15min rest is compared to baseline performance. ResultsDevice-on performance was found to represent, on average, 10.72%±19.53% improvement in walking speed and 6.77%±6.57% improvement in stride length with respect to device-off performance, and an average improvement of 12.37%±18.37% in walking speed and 4.30%±3.64% in stride length with respect to baseline performance, with 87.5% and 81.25% of the patients improving their walking speed and stride length, respectively. Average short-term residual performance showed 9.09%±6.34% improvement in walking speed and 6.52%±4.36% improvement in stride length, compared to baseline performance, with 85.71% of the patients improving in both walking speed and stride length. ConclusionsClosed-loop auditory feedback improves walking speed and stride length in patients with Parkinson's disease. Improvement in walking speed is more pronounced than improvement in stride length. Yet, in contrast to previously studied open-loop auditory cues, training with closed-loop auditory feedback results in non-negligible on-line improvement in stride length. Moreover, in contrast to previously reported results of open-loop auditory cuing, training with closed-loop auditory feedback has residual effects, which suggest the examination of this approach in a comprehensive therapy program.

Effects of a visuotemporal cue on walking ability of independent ambulatory subjects with spinal cord injury as compared with healthy subjects

An experimental, cross-sectional study. To investigate effects of using a visuotemporal cue on the walking ability of independent ambulatory subjects with spinal cord injury (SCI) as compared with healthy subjects. A tertiary rehabilitation center, Thailand. Forty independent ambulatory subjects with SCI and healthy subjects participated in the study (20 subjects per group). All of them were assessed for their walking speed, stride length, cadence and percents of step symmetry under two conditions, including walking at their fastest speed with and without a visuotemporal cue along a 10 m walkway. When walking with a visuotemporal cue, walking speed, stride length and cadence of the subjects were significantly increased from the uncued condition (P<0.01). However, the healthy subjects showed a significantly greater increase in walking speed and cadence, whereas, subjects with SCI demonstrated significantly higher improvement in stride length as compared with the other group (P<0.001). In addition, the effects of the visuotemporal cue were significantly greater in those with less severity of SCI (P<0.01). The findings confirm the benefits of using a visuotemporal cue to improve variables relating to walking ability in subjects with intact integrative capability of the brain but with different levels of sensorimotor deterioration. The findings suggest the use of a visuotemporal cue to improve the effectiveness of programs in sport and exercise sciences, and rehabilitation treatments.

Tai Chi training is effective in reducing balance impairments and falls in patients with Parkinson's disease

Does Tai Chi improve postural control in patients with Parkinson's disease? Randomised, controlled trial and blinded outcome assessment. University clinic in USA. Individuals with Parkinson's disease (Hoehn and Yahr Stage 1-4) between the age of 40 and 85 years, and ability to walk with or without an assistive device were key inclusion criteria. Mini-Mental State examination score <24 and concurrent participation in other instructor-led exercise programs were key exclusion criteria. Randomisation of 195 participants allocated 65 to each of the Tai Chi, resistance, and stretching groups. The Tai Chi group underwent a Tai Chi program, the resistance group 8 to 10 leg muscle strengthening exercises, while the stretching group performed stretching exercises involving the upper body and lower extremities. All three groups trained for 24 weeks (60 minutes per session, two sessions per week). The primary outcomes were two indicators of postural stability - maximum excursion and directional control derived from dynamic posturography. The secondary outcomes were stride length, gait velocity, knee flexion and extension peak torque, functional reach, timed-up-and-go test, and motor section of the Unified Parkinson's Disease Rating Scale (UPDRS III). The outcomes were measured at baseline, at 12 and 24 weeks, and 3 months after termination of the intervention. 185 participants completed the study. At the end of the 24-week training period, the change in maximum excursion in the Tai Chi group was significantly more than that in the resistance group (by 5%, 95% CI 1.1 to 10.0) and the stretching group (by 12%, 95% CI 7.2 to 16.7). Direction control improved significantly more in the Tai Chi group compared with the resistance group (by 11%, 95% CI 3.9 to 17.0) and the control group (by 11%, 95% CI 5.5 to 17.3). The Tai Chi group also had significantly more improvement in stride length and functional reach than the other two groups. The change in knee flexion and extension peak torque, timed-up-and-go test, and UPDRS III score in the Tai Chi group was only significantly more than that in the stretching group, but not the resistance group. The falls incidence was also lower in the Tai Chi group than the stretching group during the 6-month training period (incidence-rate ratio: 0.33, 95% CI 0.16 to 0.71). Tai Chi training is effective in reducing balance impairments in patients with mild to moderate Parkinson's disease.

The Effect of Textured Insoles on Gait in People with Multiple Sclerosis: An Exploratory Study

Purpose This study aimed to investigate whether textured insoles can improve gait in people with multiple sclerosis (MS). Relevance Previous studies have shown that footwear, including textured insoles, may improve postural stability in healthy young and older adults (Palluel et al., 2008; Hatton et al., 2009; Hatton et al., 2011), and there is some evidence to show that footwear interventions may be beneficial for people with MS (Ramdharry et al., 2006; Kelleher et al., 2010). Participants Forty-six people with MS (34 women), mean age (SD) 49 years (7), who reported that they were able to walk 100 m with or without resting with the use of one stick or crutch, participated in the study. Methods Ethical approval was granted by the Local Research Ethics Committee. Participants were randomized to one of two textured insole groups: texture A (Algeos UK Ltd, Liverpool, UK), which was used in our previous studies (Hatton et al., 2009; Hatton et al., 2011), or texture B, a commercial insole (Crocs™, Den Haag, The Netherlands). Participants conducted baseline walking tests at their preferred speed along an instrumented walkway (GAITRite) in a laboratory setting, and temporal–spatial gait parameters were extracted. Participants then wore the insoles for two weeks and returned for repeat testing. Analysis Paired t-tests were used to evaluate changes between baseline and follow-up. Results Stride length increased between baseline and follow-up in both legs in group A (left p = 0.01, right p = 0.02) and group B (left p = 0.02, right p = 0.02). Velocity and cadence did not change significantly in either group. Discussion This finding that textured insoles can produce improvements in stride length requires further investigation. It is consistent with research on foot orthoses in MS showing an improvement in balance after four weeks of wear (Ramdharry et al., 2006). Copyright © 2011 John Wiley & Sons, Ltd.

The effect of dividing attention between walking and auxiliary tasks in people with Parkinson’s disease

This controlled study examined the effects of dividing attention between walking and the performance of a secondary cognitive task in people with mild to moderate Parkinson’s disease (Hoehn and Yahr stages 2–3.5). Participants in the training group (n=6) received 30min divided attention training in taking big steps while simultaneously performing serial three subtractions. Participants in the control group (n=6) received no training. Stride length, gait velocity and accurate enumeration rate were measured at baseline, immediate after training and 30min after training under single-task (walk only or subtract only) and dual-task (walk and subtract) conditions. Data were also collected at training in the training group. Immediate improvement in stride length and gait velocity was found when instruction was given to participants to pay equal attention to gait and subtractions (p=0.001, p=0.05) compared to baseline. Short-term improvement in the gait variables was also found after training when compared to the controls (p=0.001, p=0.001). Nevertheless, there was no significant difference in the accurate enumeration rate. Based on the findings, we conclude that divided attention can be used as a strategy to improve slow and short-stepped gait under dual-task conditions. Divided attention can also be used in gait training for short term stride length and gait velocity improvement.