Improve Walking Ability Research Articles

Objective and subjective measures of dalfampridine efficacy in clinical practice.

BackgroundMultiple sclerosis affects mobility in over 80% of patients. Dalfampridine is the only approved treatment for walking impairment in multiple sclerosis. We assessed dalfampridine utilization in our practice and investigated response using timed 25 foot walk (T25FW) improvement and a patient-reported ambulation inventory.MethodsChart review identified patients with multiple sclerosis for whom dalfampridine was prescribed. T25FW data were extracted from medical records. Participants completed a dalfampridine-specific version of the multiple sclerosis walking scale (dMSWS-12) to assess the qualitative impact of dalfampridine on ambulation. We evaluated two responder categories: liberally defined as any improvement in T25FW; and over 20% T25FW improvement.ResultsThe dMSWS-12 questionnaire was completed by 39 patients. Eighteen patients (46%) did not show any T25FW improvement. Of the 21 patients (54%) with T25FW improvement, four patients (11%) showed improvement greater than 20%. Analysis of dMSWS-12 scores showed a median score of 40 (range 12–60). Eleven patients (28%) showed no improvement (dMSWS-12 score ≤36). In contrast to objective T25FW improvement (54%), 28 patients (72%) reported improvement in walking ability (dMSWS-12 score ≥37).ConclusionOur results suggest that T25FW alone might not be sufficient for response characterization and that adding patient-reported measures may further elucidate the therapeutic response.

Rhythmic Auditory Music Stimulation Enhances Walking Distance in Patients With Claudication: A FEASIBILITY STUDY.

Patients with claudication have altered gait, characterized by slower pace and shorter stride length, compared with matched controls. Rhythmic auditory music stimulation has been used successfully to reduce symptoms of pain and improve walking ability in patients with neurological gait alterations. The purpose of this study was to test the hypothesis that rhythmic auditory music stimulation via increased tempo and bass would immediately increase total walking distance in patients with claudication compared with music-without rhythm-enhancement condition or a no-music condition (standard). Fourteen patients with claudication (mean age = 66.1 ± 7.7 y; ankle-brachial index = 0.63 ± 17) underwent three 6-min walk tests on the same day in random order. One with music-without rhythm enhancement with the tempo set at the usual walking cadence of the patient, one without music, and one with rhythmically enhanced music with the tempo increased 10 to 15 beats/min above the usual walking cadence of the patient. This increase in tempo is considered imperceptible to the untrained ear. The paired t test indicated an increase in total walking distance by 22.1 ± 25.4 m (P = .006) during the rhythmic auditory stimulation condition compared with the no-music condition and by 20.7 ± 24.4 m compared with the music-without enhancement condition (P = .007). Functional claudication distance increased by 40.0 ± 49.0 m during the rhythmically enhanced music condition (P = .009) compared with the no-music condition. These results suggest that rhythmic auditory stimulation immediately increases total walking distance in patients with claudication due to peripheral artery disease. This technology may provide a tool for clinicians to use when prescribing exercise, improve motivation, and increase adherence to exercise rehabilitation programs.

The effects of non-elastic taping combined with exercises training on motor function in cane-assisted individuals after stroke

Cane is one of the common assistive devices prescribed for individuals with stroke to improve walking ability and safety. It was revealed that long-term cane-assisted individuals with chronic stroke perform abnormal gait pattern during walking. To improve these impairments, strengthening, balance training, task-specific training and intensive mobility training have been suggested. However, the training effects on motor function were limited in cane-assisted individuals with chronic stroke. It is supposed that musculoskeletal alignment of these individuals is not on the efficient position, which may restrict the training effects. The immediate effects of joint alignment adjusted with Luekotape ® P on muscle strength, balance and gait performance has been proved in individuals with stroke. However, the effects of taping combined with exercise training is unknown. This study aimed to investigate the effects of non-elastic tape combined with exercise training on motor function in cane-assisted individuals with chronic stroke. Subjects were randomized into either the experiment group with Luekotape ® P or control group with sham tape. Subjects in both groups received the same exercise training for six weeks. The primary outcomes were gait performance and Berg balance scale. The secondary outcomes were muscle strength of hip extensors and abductors, endurance and fear of falling. Outcomes measurements were performed before and after the intervention and then one-month follow-up. The intervention significantly improved cadence, stance time of affected side, spatial asymmetry ratio, Berg balance scores, and fall efficacy scale scores as well as 6-minutes walk test in the experimental group. In the control group, only the Berg balance scores and 6-minutes walk test had been significantly improved. Although all outcomes did not show significant differences between groups. Our results suggested that exercise combined with Luekotape ® P may have more improvement than exercise alone in stance time, cadence, spatial asymmetry ratio, endurance, and fall efficacy scale.

Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial

ObjectivesTo compare the effectiveness of a comprehensive nonsurgical training program to a self-directed approach in improving walking ability in lumbar spinal stenosis (LSS). DesignRandomized controlled trial. SettingAcademic hospital outpatient clinic. ParticipantsParticipants (N=104) with neurogenic claudication and imaging confirmed LSS were randomized. The mean age was 70.6 years, 57% were women, 84% had leg symptoms for >12 months, and the mean maximum walking capacity was 328.7 m. InterventionsA 6-week structured comprehensive training program or a 6-week self-directed program. Main Outcome MeasuresContinuous walking distance in meters measured by the Self-Paced Walk Test (SPWT) and proportion of participants achieving at least 30% improvement (minimally clinically important difference [MCID]) in the SPWT at 6 months. Secondary outcomes included the Zurich Claudication Questionnaire (ZCQ), Oswestry Disability Index (ODI), ODI walk score, and the Short-Form General Health Survey subscales. ResultsA total of 48 versus 51 participants who were randomized to comprehensive (n=51) or self-directed (n=53) treatment, respectively, received the intervention and 89% of the total study sample completed the study. At 6 months, the adjusted mean difference in walking distance from baseline was 421.0 m (95% confidence interval [95% CI], 181.4-660.6), favoring the comprehensive program and 82% of participants in the comprehensive group and 63% in the self-directed group achieved the MCID (adjusted relative risk, 1.3; 95% CI, 1.0-1.7; P=.03). Both primary treatment effects persisted at 12 months favoring the comprehensive program. At 6 months, the ODI walk score and at 12 months the ZCQ, Medical Outcomes Study 36-Item Short-Form Health Survey-physical function and -bodily pain scores showed greater improvements favoring the comprehensive program. ConclusionsA comprehensive conservative program demonstrated superior, large, and sustained improvements in walking ability and can be a safe nonsurgical treatment option for patients with neurogenic claudication due to LSS.

Stem Cell Therapy Using Bone Marrow-Derived Mononuclear Cells in Treatment of Lower Limb Lymphedema: A Randomized Controlled Clinical Trial.

Up till now, there is no satisfactory treatment for lymphedema. The aim of this study is to evaluate stem cell therapy in lymphedema. This prospective randomized study includes 40 patients with chronic lymphedema divided randomly into two groups: group I (stem cell therapy group) and group II (control group). In group I, bone marrow was aspirated and mononuclear cells were separated and then transplanted into the patients. In group II, patients compression therapy alone was applied. Group I included 20 patients (12 males and 8 females), their age ranged from 18 to 38 years with a mean age of 24.8 ± 6.39 years, whereas group II included 20 patients (10 males and 10 females), their age ranged from 18 to 36 years with a mean value of 25.6 ± 8.18 years. In group I, there was a decrease in the mean circumference at ankle after 6 months, which was statistically significant (t = 3.250, p = 0.014). This was associated with marked improvement of pain and walking ability. Whereas in group II, the change in the circumference was statistically insignificant (t = 1256, p = 0.349) with no satisfactory pain relief and improvement in walking ability. Biopsies examined by immunohistochemistry showed marked increase in the number of lymphatic capillaries in group I. Stem cell therapy can achieve improvement in limb circumference as well as pain relief and improvement in walking ability in patients with chronic lymphedema compared with those in control group.

Evaluation of the Effectiveness of Stepping in Place with Rhythmic Auditory Stimulation on Improving Gait in a Community Dwelling Stroke Population

Stroke survivors often exhibit asymmetric walking patterns associated with one-sided weakness, or hemiparesis, resulting in a reduced walking ability and lower levels of independence. Rhythmic Auditory Stimulation (RAS) is an emerging strategy that uses music with a strong beat to help cue walking. RAS has successfully improved walking ability and symmetry in stroke survivors, yet the use of RAS while stepping in place has been only minimally explored. Due to limited mobility in this population, stepping in place may be a more feasible method of practicing walking patterns. The purpose of this study is two-fold: 1) to determine the immediate effects of stepping in place with RAS on kinematic walking parameters, and 2)to evaluate whether any changes in gait parameters translate to walking following a RAS session. The study is currently underway, with an objective of testing 8 to 10 participants who have experienced a stroke resulting in hemiparesis and reduced walking ability. The testing protocol is divided into two parts; part one involves an initial walking assessment to determine stepping cadence. In part two, participants complete a gait analysis and functional assessment before and after the stepping in place with RAS session. Two-dimensional analysis using a motion capture system and force plates allows for multiple spatiotemporal and kinematic outcome measures to be collected such as walking speed, step length, and joint angles. Ultimately, findings from this study will help to determine if and how stepping in place with RAS can improve gait in stroke survivors.

Factors influencing change in walking ability in patients with heart failure undergoing exercise-based cardiac rehabilitation

ObjectivesExercise-based cardiac rehabilitation (CR) is an effective intervention for patients with heart failure (HF), in which one of the main targets is to increase physical capacity. In the HF population this is traditionally assessed using distance covered during a walking test. This study aims to establish the extent to which change in walking ability, in HF patients attending CR, is determined by patient characteristics and service provision. MethodsThe study utilised routine clinical data from the National Audit of Cardiac Rehabilitation to perform a robust analysis. Change, in metres, between pre- and post-CR six-minute walk tests was calculated. Multivariate linear regression models were used to explore the relationship between patient characteristics, service-level variables, and change in metres walked. ResultsComplete and valid data from 633 patients was analysed, and a mean change of 51.30 m was calculated. Female gender (−34.13 m, p = 0.007), being retired (−36.41 m, p = 0.001) and being married/in a relationship (−32.54 m, p = 0.023) were all significant negative predictors of change. There was an additional negative relationship with body mass index (BMI) whereby for every unit increase in BMI, predicted change reduces by 2.48 m (p = 0.006). ConclusionsThis study identified significant patient-level characteristics strongly associated with limited improvement in walking ability following CR. Improving physical capacity is a core component of CR, therefore services should aim to account for baseline characteristics identified in this study as part of tailoring the CR intervention around the individual. Pre- and post-CR physical capacity assessments, which constitute minimum standards for CR, are worryingly low and should be given high priority.

Effect of forward-directed aiding force on gait mechanics in healthy young adults while walking faster

BackgroundForces can be applied to people while they are walking on a treadmill in different ways that aid individuals to walk at faster walking speeds with potentially less effort. Forward-directed aiding forces (FAF) are a special class of aiding forces where “push” or “pull” forces are mechanically applied to the person’s pelvis in the forward direction. ObjectiveTo determine if FAF, applied by a robotic interface, can be effective in providing assistance to walk at a faster walking speed with reduced kinetic requirements. MethodsTwenty non-neurologically impaired physical active young adults were recruited and biomechanical gait mechanics were measured during walking at two constant treadmill belt speeds (1.0 m/s and 1.6 m/s), with the robotic device in aiding mode to provide FAF (FAF), and also outside of the robotic device (no-FAF). The spatiotemporal gait parameters, anterior-posterior force, sagittal impulse, and hip, knee and ankle power and net work were calculated from kinematic and kinetic data, comparing changes in parameters from slower to faster speeds within each mode, and then, comparing values between each mode. ResultsThe spatiotemporal gait parameters were not different between conditions, but in FAF condition, the propulsive force impulse change was not increased, there was smaller propulsion increase, and smaller maximal power generation and ankle work done at the faster speed, whereas all of these parameters were appropriately increased in the no-FAF condition. ConclusionsThese results indicate that providing FAF at the pelvis is an effective means for reducing the amount of mechanical effort required to walk faster and thus could be used as a training tool to improve walking ability.

Physical Activity is Associated with Walking Capacity in Persons with Multiple Sclerosis

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system which affects 1 in 1000 persons in the United States. MS results in functional limitations, including impairments in walking capacity, balance, and increases in overall fatigue, leading to decreased physical activity. However, the potential associations between physical activity, walking ability and functional capacity are not clear in this population. PURPOSE: To evaluate the association between physical activity, walking ability and functional capacity in individuals with MS. METHODS: Fifty-eight individuals with MS between the ages of 18-70 (Male = 15, 47 ± 12 years, BMI = 28.8 ± 6.5, EDSS = 0-4) performed a maximal incremental cycle test to assess peak aerobic capacity (VO2 peak). Subjects completed a timed 25-foot walk test (T25FW), 6 minute walk test (6MW), and wore an accelerometer for one week to determine physical activity. Moderate / vigorous physical activity (MVPA) was defined as >1722 counts per minute. RESULTS: MVPA was correlated with 6MW, T25FW and VO2peak (p<0.05, Table 1). In stepwise regression analyses, MVPA was a stronger predictor of T25FW (β: –0.44, p<0.01) and 6MW (β: 0.48, p<0.01) than VO2peak (β: –0.29, p=0.03; β: 0.32, p<0.01). CONCLUSION: Although both MVPA and VO2 peak provide unique contributions to the prediction of 6MW and T25FW, MVPA is a stronger predictor. These results suggest that improving both physical activity and cardiovascular fitness may improve walking ability in persons with MS.Table: No title available.

Effect of a Home-Based Exercise Intervention of Wearable Technology and Telephone Coaching on Walking Performance in Peripheral Artery Disease

Clinical practice guidelines support home-based exercise for patients with peripheral artery disease (PAD), but no randomized trials have tested whether an exercise intervention without periodic medical center visits improves walking performance. To determine whether a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching improves walking ability over 9 months in patients with PAD. Randomized clinical trial conducted at 3 US medical centers. Patients with PAD were randomized between June 18, 2015, and April 4, 2017, to home-based exercise vs usual care for 9 months. Final follow-up was on December 5, 2017. The exercise intervention group (n = 99) received 4 weekly medical center visits during the first month followed by 8 months of a wearable activity monitor and telephone coaching. The usual care group (n = 101) received no onsite sessions, active exercise, or coaching intervention. The primary outcome was change in 6-minute walk distance at 9-month follow-up (minimal clinically important difference [MCID], 20 m). Secondary outcomes included 9-month change in subcomponents of the Walking Impairment Questionnaire (WIQ) (0-100 score; 100, best), SF-36 physical functioning score, Patient-Reported Outcomes Measurement Information System (PROMIS) mobility questionnaire (higher = better; MCID, 2 points), PROMIS satisfaction with social roles questionnaire, PROMIS pain interference questionnaire (lower = better; MCID range, 3.5-4.5 points), and objectively measured physical activity. Among 200 randomized participants (mean [SD] age, 70.2 [10.4] years; 105 [52.5%] women), 182 (91%) completed 9-month follow-up. The mean change from baseline to 9-month follow-up in the 6-minute walk distance was 5.5 m in the intervention group vs 14.4 m in the usual care group (difference, -8.9 m; 95% CI, -26.0 to 8.2 m; P = .31). The exercise intervention worsened the PROMIS pain interference score, mean change from baseline to 9 months was 0.7 in the intervention group vs -2.8 in the usual care group (difference, 3.5; 95% CI, 1.3 to 5.8; P = .002). There were no significant between-group differences in the WIQ score, the SF-36 physical functioning score, or the PROMIS mobility or satisfaction with social roles scores. Among patients with PAD, a home-based exercise intervention consisting of a wearable activity monitor and telephone coaching, compared with usual care, did not improve walking performance at 9-month follow-up. These results do not support home-based exercise interventions of wearable devices and telephone counseling without periodic onsite visits to improve walking performance in patients with PAD. clinicaltrials.gov Identifier: NCT02462824.

Outcome of individualized task related circuit training program on walking ability in a 9 years old female child with Moya-moya disease: a case report

Walking difficulty of childhood stroke due to Moya-moya disease needs functional rehabilitation to recover to a normal state of walking. Task related circuit training program is one of the rehabilitation programs that improve functional strength of lower limb muscles to aid in improved walking ability. This case report aimed at investigating the effectiveness of task related circuit training on walking ability of a 9 years old female child diagnosed with stroke due to Moya-moya Disease. The child was attending Indoor rehabilitation services, Department of Occupational Therapy, National Institute for Locomotor Disabilities, Kolkata, West Bengal. Baseline measurement of the child’s lower limb muscle strength, 10m walk test, 6-minute walk test was done prior to the circuit training. After baseline measurement, the child was explained the sequence of tasks to be used in circuit training and was given individualized task related circuit training for a session of 45 minutes, 3 days per week for 08 weeks. Post training the child showed improvement in lower limb muscle strength, 10m walk test (walking speed) and 6-minute walk test (walking endurance), thereby an improved walking ability.

Use of Hybrid Assistive Limb (HAL\xae) for a postoperative patient with cerebral palsy: a case report

BackgroundThe Hybrid Assistive Limb (HAL®) is an exoskeleton wearable robot suit that assists in voluntary control of knee and hip joint motion. There have been several studies on HAL intervention effects in stroke, spinal cord injury, and cerebral palsy. However, no study has investigated HAL intervention for patients with cerebral palsy after surgery.Case presentationWe report a case of using HAL in a postoperative patient with cerebral palsy. A 15-year-old boy was diagnosed with spastic diplegia cerebral palsy Gross Motor Function Classification System level IV, with knee flection contracture, equinus foot, and paralysis of the right upper extremity with adduction contracture. He underwent tendon lengthening of the bilateral hamstrings and Achilles tendons. Although the flexion contractures of the bilateral knees and equinus foot improved, muscle strength decreased after the soft tissue surgery. HAL intervention was performed twice during postoperative months 10 and 11. Walking speed, stride, and cadence were increased after HAL intervention. Post HAL intervention, extension angles of the knee in stance phase and hip in the pre-swing phase were improved. In the gait cycle, the proportion of terminal stance in the stance and swing phase was increased.ConclusionsHybrid Assistive Limb intervention for postoperative patients with cerebral palsy whose muscle strength decreases can enhance improvement in walking ability. Further studies are needed to examine the safety and potential application of HAL in this setting.

The efficacy of functional gait training in children and young adults with cerebral palsy: a systematic review and meta-analysis.

The aim of this systematic review was to investigate the effects of functional gait training on walking ability in children and young adults with cerebral palsy (CP). The review was conducted using standardized methodology, searching four electronic databases (PubMed, Embase, CINAHL, Web of Science) for relevant literature published between January 1980 and January 2017. Included studies involved training with a focus on actively practising the task of walking as an intervention while reporting outcome measures relating to walking ability. Forty-one studies were identified, with 11 randomized controlled trials included. There is strong evidence that functional gait training results in clinically important benefits for children and young adults with CP, with a therapeutic goal of improved walking speed. Functional gait training was found to have a moderate positive effect on walking speed over standard physical therapy (effect size 0.79, p=0.04). Further, there is weaker yet relatively consistent evidence that functional gait training can also benefit walking endurance and gait-related gross motor function. There is promising evidence that functional gait training is a safe, feasible, and effective intervention to target improved walking ability in children and young adults with CP. The addition of virtual reality and biofeedback can increase patient engagement and magnify effects. Functional gait training is a safe, feasible, and effective intervention to improve walking ability. Functional gait training shows larger positive effects on walking speed than standard physical therapy. Walking endurance and gait-related gross motor function can also benefit from functional gait training. Addition of virtual reality and biofeedback shows promise to increase engagement and improve outcomes.

Improving balance and walking ability in community-dwelling people with lower limb loss: a narrative review with clinical suggestions

Background: The number of people with lower limb loss has increased rapidly, and more than half do not become independent in community walking. Balance impairment has been identified as a primary constraint to independent walking. However, few physiotherapy programs to improve balance and walking have been researched.Objectives: This narrative review describes (1) programs improving balance and walking ability in community-dwelling people with lower limb loss and (2) clinical recommendations from the reviewed literature.Methods: The Cochrane, Ovid-Medline, and CINAHL databases, and the Journal of Prosthetics and Orthotics archive were searched from 1990 to 2016. Randomized control trials, repeated-measures cohorts, or case-control studies that involved physiotherapy intervention for community-dwelling people with major limb amputations were included.Major findings: Thirteen studies investigated programs to improve balance or walking ability, including 2 randomized control trials with ≥40 subjects; and 10 studies with ≤16 subjects. Six studies used enhanced sensory feedback, external balance perturbations, and stabilization exercises to improve balance ability. Nine studies used primarily functional gait training, progressive resistive exercises, and stabilization exercises to improve walking ability. Few comparison studies, small sample sizes, and subjects without vascular disease limited conclusions about specific treatment approaches for most people with lower limb loss.Conclusions: Evidence supporting physiotherapy for improving balance and gait has recently emerged. Manual therapy, exercise, balance training, resisted gait training, and walking all can benefit people with lower limb loss, but more controlled studies are required to determine the effectiveness of different physiotherapy programs.

Exercise Rehabilitation for Peripheral Artery Disease: A REVIEW.

To summarize evidence regarding exercise therapy for people with lower extremity peripheral artery disease (PAD). Literature was reviewed regarding optimal strategies for delivering exercise interventions for people with PAD. Randomized trial evidence and recent studies were emphasized. Randomized clinical trial evidence consistently demonstrates that supervised treadmill exercise improves treadmill walking performance in people with PAD. A meta-analysis of 25 randomized trials (1054 participants) concluded that supervised treadmill exercise was associated with 180 m of improvement in maximal treadmill walking distance and 128 m of improvement in pain-free walking distance compared with a control group. Three randomized trials of 493 patients with PAD demonstrated that home-based walking exercise interventions that incorporate behavioral change techniques improve walking ability in patients with PAD. Furthermore, evidence suggests that home-based walking exercise improves the 6-min walk more than supervised treadmill exercise. Upper and lower extremity ergometry also significantly improved walking endurance in PAD. The Centers for Medicare & Medicaid Services recently determined that Medicare would cover 12 wk (36 sessions) of supervised treadmill exercise for patients with PAD. Supervised treadmill exercise and home-based walking exercise each improve walking ability in patients with PAD. The availability of insurance coverage for supervised treadmill exercise for patients with PAD will make supervised treadmill exercise more widely available and accessible. Home-based exercise that incorporates behavioral change technique is an effective alternative for patients unwilling or unable to attend 3 supervised exercise sessions per week.

Dual-Task Walking Performance in Older Persons With Hearing Impairment: Implications for Interventions From a Preliminary Observational Study.

Adults with "hearing loss" have an increased falls risks. There may be an association between hearing impairment and walking performance under dual-task (DT) and triple-task (TT) conditions. The aim of this study was to identify DT and TT effects on walking speed, step length, and cadence in adults with hearing impairment, previous falls, and physical limitations. The observational study included 73 community-dwelling older people seeking audiology services. Data were collected on sociodemographic characteristics, previous falls, fear of falling, physical limitations, and walking performance under three task conditions. Differences between the task conditions (single task [ST], DT, and TT) and the hearing groups were analyzed with a two-way ANOVA with repeated measures. The influence of fall risks and limited physical functioning on walking under ST, DT, and TT conditions was analyzed with ANOVAs, with ST, DT, and TT performance as repeated measurement factor (i.e., walking speed, step length and Cadence × Previous falls, or short physical performance battery <12 × Hearing Groups). Walking speed was reduced accompanied by decreased step length and increased cadence in people with more severe hearing loss. Larger negative effects on DT and TT walking were found with increasing hearing loss (speed and cadence decreased with higher DT costs). Highest DT costs were found for the walking-manual conditions. These results were accompanied by small effects of older age and more comorbidities. This first screening data of walking performance under different conditions for people with hearing loss warrants the need for development and investigation of training interventions to improve walking abilities. DT training may be beneficial to enhance motor and cognitive flexibility and to reduce fall risks.

Real-life adaptations in walking patterns in patients with established peripheral arterial disease assessed using a global positioning system in the community: a cohort study.

Lower extremity peripheral arterial disease (PAD) is a chronic condition most commonly presenting with intermittent claudication (IC). Intermittent claudication limits walking ability and may negatively affect health-related quality of life. Treadmill assessment of maximal walking distance (MWD) is the gold standard to assess PAD symptom severity. Despite being a well-established and reproducible tool, it may be inappropriate (due to frailty or fear) for some patients and only describes maximal abilities for a single walk test. Global positioning systems (GPS) have been proposed as reliable and reproducible tool to measure total, mean and maximal walking distances in patients with PAD, in the community setting. Using GPS, our study attempted to explore what happens to the walking ability of patients with IC following no intervention under 'real-life' conditions. Using the GlobalSat DG100 GPS, forty-three patients (69±9years; nine female; no invasive interventions or rehabilitation) undertook two 60-min walking assessments, 6months apart. Assessments took place in community spaces that had even terrain, no tall trees or buildings and were free from motorized vehicles. Global positioning systems-measured maximum walking distance was the main study outcome measure. Over the 6-month period, patients demonstrated significantly shorter GPS-measured, mean (552m versus 334m; P=0·02) and maximum (714m versus 545m; P=0·04) walking distances, stopping also more frequently (nine versus five times; P=0·03). Given the reported symptom progression, we advocate early intervention (e.g. exercise interventions) combined with frequent patient monitoring in attempts to maintain or improve walking ability.

Relationship between functional balance and walking ability in individuals with chronic stroke.

[Purpose] The objective of this cross sectional study was to investigate the validity of Functional Ambulation Category in evaluating functional balance and identifying the relationship between balance impairment and functional ambulation in individuals with chronic stroke. [Participants and Methods] A total of 31 chronic stroke patients with first ever ischemic middle cerebral artery strokes, with no cognitive deficits were recruited. Participants had a mean age of 54.84 (SD=7.05) years and a time after stroke of 22.74 (SD=27.13) months. Community ambulation was determined by Functional Ambulation Category and functional balance was assessed by Berg Balance Scale. [Results] The mean Berg Balance Scale and the Functional Ambulation Category scores were 47.38 (SD=7.54) and 3.8 (SD=0.79), respectively. Correlation analysis revealed that balance impairment and ambulatory function was significantly positively correlated with each other (r=0.80). [Conclusion] The results shows that the Functional Ambulation Category is a valid tool in evaluating functional balance and suggest that functional balance may be an important goal for rehabilitation to achieve improvement in walking ability in people with chronic stroke.

Prolonged-release fampridine in multiple sclerosis: clinical data and real-world experience. Report of an expert meeting.

Prolonged-release (PR) fampridine is the only approved medication to improve walking in multiple sclerosis (MS), having been shown to produce a clinically meaningful improvement in walking ability in the subset of MS patients with Expanded Disability Status Scale 4–7. Recent responder subgroup analyses in the phase III ENHANCE study show a large effect size in terms of an increase of 20.58 points on the patient-reported 12-item MS Walking Scale in the 43% of patients classified as responders to PR-fampridine, corresponding to a standardized response mean of 1.68. Use of PR-fampridine in clinical practice varies across Europe, depending partly on whether it is reimbursed. A group of European MS experts met in June 2017 to discuss their experience with using PR-fampridine, including their views on the patient population for treatment, assessment of treatment response, re-testing and re-treatment, and stopping criteria. This article summarizes the experts’ opinions on how PR-fampridine can be used in real-world clinical practice to optimize the benefits to people with MS with impaired walking ability.

Systematic Review of Appropriate Robotic Intervention for Gait Function in Subacute Stroke Patients.

The purpose of this study was to critically evaluate the effects of robot-assisted gait training (RAGT) on gait-related function in patients with acute/subacute stroke. We conducted a systematic review of randomized controlled trials published between May 2012 and April 2016. This search included 334 articles (Cochrane, 51 articles; Embase, 175 articles; PubMed, 108 articles). Based on the inclusion and exclusion criteria, 7 studies were selected for this review. We performed a quality evaluation using the PEDro scale. In this review, 3 studies used an exoskeletal robot, and 4 studies used an end-effector robot as interventions. As a result, RAGT was found to be effective in improving walking ability in subacute stroke patients. Significant improvements in gait speed, functional ambulatory category, and Rivermead mobility index were found with RAGT compared with conventional physical therapy (p < 0.05). Therefore, aggressive weight support and gait training at an early stage using a robotic device are helpful, and robotic intervention should be applied according to the patient's functional level and onset time of stroke.