Increase In Gait Speed Research Articles

A walking dance to improve gait speed for people with Parkinson disease: a pilot study.

Aim: To determine the effectiveness of a targeted dance intervention to improve walking speed for people with Parkinson disease (PD) by increasing motor motivation. Materials & methods:11participants with PD participated in a 6-week pilot study in which they learned a contemporary dance composed of walking steps and designed to mimic everyday walking. 1 hclasses occurred twice-weekly. Results: Pre-and post-intervention assessments revealed a significant increase in gait speed (t9=3.30; p= 0.009), cadence (t9=2.345; p=0.044), and stride length (t9=3.757; p=0.005), and a significant decrease (improvement) in single support time variability (t9= -2.744; p= 0.022). There were nosignificant changes in other measures of gait variability nor in motor symptoms, mood and anxiety, extent of life-space mobility, or quality of life. No adverse events were reported. Conclusion: Joywalk provides preliminary evidence that a targeted physical intervention for people with PD may specifically counter bradykinesia.

Change in intersegmental foot and ankle motion after a high tibial osteotomy in genu varum patients.

High tibial osteotomy (HTO) is a well-established treatment for medial compartment knee osteoarthritis (OA), which shifts the weight-bearing axis from the medial to the lateral side of the knee. As the adjacent ankle joint may be directly affected by the change in biomechanics, this study aimed to evaluate the change in the intersegmental foot and ankle motion after HTO in patients with genu varum. The study included 24 patients who underwent HTO, and 48 older healthy participants as a control group. Segmental foot kinematics were evaluated using a 3D multisegment foot model, and gait data of temporal and spatial parameters were obtained. After HTO, normalized stride length significantly increased with a tendency for increases in gait speed. In hallux kinematics relative to the forefoot, the sagittal motions of both the patients and the control group were similar throughout the majority of the gait cycle. In forefoot kinematics relative to the hindfoot, the pre-HTO state revealed significant pronation throughout the gait cycle, while the post-HTO state showed a similar position and motion to the control group. In hindfoot kinematics relative to the tibia, coronal motions of the pre-HTO state showed supination throughout the gait cycle, while supination during the stance phase decreased after HTO. Genu varum patients with medial compartment knee OA showed different gait parameters and intersegmental motion during gait when compared with age- and gender-matched controls. The effect of HTO was demonstrated by the normalization of midfoot compensation in patients with genu varum.

Multiple sclerosis treatment: dry needling, new therapeutic frontiers

Due to high prevalence of spasticity in Multiple Sclerosis (MS) and functional limitations that pain and gait alterations cause, is necessary to investigate possible benefits of Dry Needling (DN) in this pathology.A case study of a 35 years old Secondary Progressive MS woman with 6,5 points on Expanded Disability Status Scaleby performing deep DN intervention on Rectus Femoris (RF) and Gastronecmius Medialis (GM) muscles of higherspasticity lower limb was carried out. Spasticity level, perceived pain, range of motion (ROM) and superficial electromyography activity of this lower limb, together with functional capacity, life quality and Spatial-Temporal Gaitparameters before and after intervention were evaluated.After intervention, spasticity decrease (especially on RF) and gait speed increase was noticed. Also, less muscle activity on walking and less delay time of step execution was observed.Our results suggest a functional improvement of the patient’s gait motion, but conclusive changes were not objectified in pain perception and ROM. More research studies about the effect of DN in MS must be necessary in order toobtain better evidence.

Multiple sclerosis treatment: dry needling, new therapeutic frontiers

Due to high prevalence of spasticity in Multiple Sclerosis (MS) and functional limitations that pain and gait alterations cause, is necessary to investigate possible benefits of Dry Needling (DN) in this pathology. A case study of a 35 years old Secondary Progressive MS woman with 6,5 points on Expanded Disability Status Scale by performing deep DN intervention on Rectus Femoris (RF) and Gastronecmius Medialis (GM) muscles of higher spasticity lower limb was carried out. Spasticity level, perceived pain, range of motion (ROM) and superficial electromyography activity of this lower limb, together with functional capacity, life quality and Spatial-Temporal Gait parameters before and after intervention were evaluated. After intervention, spasticity decrease (especially on RF) and gait speed increase was noticed. Also, less muscle activity on walking and less delay time of step execution was observed. Our results suggest a functional improvement of the patient’s gait motion, but conclusive changes were not objectified in pain perception and ROM. More research studies about the effect of DN in MS must be necessary in order to obtain better evidence.

Increases in speed do not change gait symmetry or variability in world-class race walkers

ABSTRACT The aim of this study was to analyse changes in gait variability and symmetry with increasing speed in race walkers. Eighteen international athletes race walked on an instrumented treadmill at speeds of 11, 12, 13 and 14 km·h−1 in a randomised order for 3 min each. Spatiotemporal and ground reaction force data were recorded for 30 s at each speed. Gait variability was measured using median absolute deviation and inter-leg symmetry was measured using the symmetry angle. There was an overall effect of speed on all absolute values except push-off force, but symmetry and variability (except flight time) did not change with increased speed, step length and step frequency. Most athletes were asymmetrical for at least one variable, but none was asymmetrical for more than half of the variables measured. Therefore, being asymmetrical or having higher variability (<5%) in a few variables is normal. Taking all findings together, practitioners should exercise caution when deciding on the need for corrective interventions and should not be concerned that increasing gait speed could increase injury risk through changes to athletes’ asymmetry. Race walking coaches should test at competition speeds to ensure that flight times, and any variability or asymmetry, are measured appropriately.

Improved Gait of Persons With Multiple Sclerosis After Rehabilitation: Effects on Lower Limb Muscle Synergies, Push-Off, and Toe-Clearance.

Introduction: Persons with MS (PwMS) have markedly reduced push-off and toe-clearance during gait compared to healthy subjects (HS). These deficits may result from alterations in neuromotor control at the ankle. To optimize rehabilitation interventions for PwMS, a crucial step is to evaluate if and how altered neuromotor control, as represented by muscle synergies, improves with rehabilitation. In this study we investigated changes in ankle motor control and associated biomechanical parameters during gait in PwMS, occurring with increase in speed after gait rehabilitation.Methods: 3D motion and EMG data were collected while 11 PwMS (age 50.3 + 11.1; EDSS 5.2 + 1.2) walked overground at self-selected speed before (T0) and after 20 sessions (T1) of intensive treadmill training. Muscle synergies were extracted using non-negative matrix factorization. Gait parameters were computed according to the LAMB protocol. Pearson's correlation coefficient was used to evaluate the similarity of motor modules between PwMS and HS. To assess differences in distal module activations representing neuromotor control at the ankle [Forward Propulsion (FPM) and Ground Clearance modules (GCM)], each module's activation timing was integrated over 100% of the gait cycle and the activation percentage index (API) was computed in six phases.Ten age matched HS provided two separate speed-matched normative datasets for T0 and T1. For speed independent comparison for the PwMs Z scores were calculated for all their gait variables.Results: In PwMS velocity increased significantly from T0 to T1 (0.74–0.90 m/s, p < 0.05). The activation profiles (API) of FPM and GCM of PwMS improved in pre-swing (p < 0.05): FPM (Mean [95% CI] [%]: T0: 12.5 [5.7–19.3] vs. T1: 9.0 [2.7–15.3]); GCM (T0: 26.7 [18.2–35.3] vs. T1: 24.5 [18.2–30.7]). This was associated with an increase in toe clearance (80.3 to 103.6 mm, p < 0.05) and a higher ankle power peak in pre-swing (1.53–1.93 W/kg, p < 0.05).Conclusion: Increased gait speed of PwMS after intensive gait training was consistent with improvements in spatio-temporal gait parameters. The most important finding of this study was the re-organization of distal leg modules related to neurophysiological changes induced by rehabilitation. This was associated with an improved ankle performance.

Changes In Dual-task Gait Speed Following A 10-week Golf Program In Older Adults

PURPOSE: To examine the change in dual-tasking ability during gait in response to a golf exercise program in healthy, older adults. BACKGROUND: The ability of older adults to perform dual-tasking during gait has been studied as a predictor of fall risk. Therefore, it is important to investigate exercise programs that not only improve fitness and balance in older adults, but also enhance the ability to dual-task. METHODS: Fifteen healthy, older adults without previous golf experience were enrolled in a golf program with fitness testing before and after the intervention. One participant had to drop out of the study due to a work-related injury at week 8. Dual-task performance was measured using a fast-gait task while counting backwards by threes on a ProtokineticsTM walking mat. Cognitive cost was determined by normalizing the dual-task responses to a seated counting task. Paired t tests were run to determine significance. Results are presented as mean±SD. Cohen’s d effect sizes were calculated and reported as small=0.2, medium=0.5, and large=0.8. RESULTS: Gait speed during the dual-task was significantly increased following the golf program with a large effect size (1.75±0.19m/s to 1.91±0.22m/s; p=0.007; d=0.85). This increase in gait speed coincided with increases in both average stride length (2.3%; p=0.061; d=0.55) and average cadence (5.8%; p=0.059; d=0.55). Cognitive dual cost did not change between pre and post testing but trended towards improving (40.94%; p=0.207; d=0.35). CONCLUSION: Golf is a unique, multimodal activity that has a beneficial impact on fitness in healthy, older adults. This study demonstrated that a golf program can improve the ability to perform dual tasking. Participants were able to increase their gait speed without compromising the amount of numbers they could recite correctly. The participants trended towards an improved correct response rate following the program as shown by the improvement in cognitive dual cost. Golf should be encouraged as a physical activity program for older adults. Supported by R&A Grant GHA0012017.

IMPROVING REHABILITATION IN SARCOPENIA (IRIS) BY MUSCLE-TARGETED NUTRITIONAL SUPPORT: A DOUBLE-BLIND RCT

We evaluated the efficacy of a muscle-targeted nutritional support on the outcome of a physical exercise rehabilitation program in old adults with sarcopenia. A double-blind RCT (NCT03120026) in sarcopenic old adults (65 years) without severe cognitive impairment and admitted to an in-patient rehabilitation facility for a physical rehabilitation program. In addition to a standard hospital diet, patients (n=140) were randomized to receive until discharge (for at least 4 weeks and up to 8 weeks) a whey protein-based nutritional supplement enriched with leucine and vitamin D or an iso-caloric placebo twice daily. The primary efficacy endpoint was the change in 4-meter gait speed per month. Key secondary endpoints were change in physical performance outcome measures: chair-stand test, Timed up and go test, Short Physical Performance Battery. The overall economic benefits (surrogates: length of stay; duration of rehabilitation) were also evaluated. Intention-to-treat analyses were based on patients re-assessed at discharge (n=127). Supplementation with the experimental formula (n=64) resulted in greater increase in gait speed than placebo (n=63): mean difference, 0.063 meters/sec/month [95%CI, 0.043 to 0.082] (P<0.001). A significant effect was also found for all physical performance, functional and cognitive function endpoints (P<0.001 for all) and body composition. Supplementation resulted also in in shorter rehabilitation (P<0.001) and hospital stay (p<0.001). In old adults with sarcopenia admitted to hospital for rehabilitation the consumption of a whey protein-based nutritional formula enriched with leucine and vitamin D improved physical performance and function, muscle mass and reduced the intensity and costs of care.

Can Increased Gait Speed Improve Knee Loading Mechanics Following Anterior Cruciate Ligament Reconstruction?

Can Increased Gait Speed Improve Knee Loading Mechanics Following Anterior Cruciate Ligament Reconstruction?

Functional recovery in multiple sclerosis patients undergoing rehabilitation programs is associated with plasma levels of hemostasis inhibitors

BackgroundIncreasing evidence for contribution of hemostasis components in multiple sclerosis (MS) has been reported. Hemostasis protein inhibitors display key regulatory roles, extending to regulation of innate immune response and inflammation, and promotion of blood–brain barrier integrity. Whereas the effects on hemostasis of exercise and rehabilitation strategies have been extensively investigated, relationships between MS rehabilitation strategies and hemostasis have not been previously reported. ObjectivesTo investigate in MS patients the association between outcomes of rehabilitative exercise and plasma levels of selected hemostasis inhibitors. MethodsSixty-one severely disabled progressive-MS (P-MS) patients were randomized in the RAGTIME trial to receive 12 walking session of robot-assisted gait training (RAGT) or conventional overground therapy (CT). Outcome parameters were: timed 25-foot walk test (T25FWT) speed, 6-minute walking test (6MWT), Berg Balance Scale (BBS), and MS impact scale-29 (MSIS-29). Plasma levels of coagulation inhibitors protein S (PS), soluble thrombomodulin (sTM), and tissue factor pathway inhibitor (TFPI) were assayed by multiplex assay and ELISA at 4-time points: baseline (T0), intermediate (T1), end of rehabilitation (T2), 3-month follow-up (T3). Descriptive analysis, trend analysis, Spearman's rank and Pearson's correlations, and multiple regression models were used. ResultsRehabilitative exercises moderately modified plasma protein concentrations. A significant trend to increase was observed for PS (p=0.015) and TFPI (p=0.047) in the whole population, and for PS (p=0.011) in the CT group. Correlation between TFPI and sTM levels was detectable at all time points in the whole P-MS patients and in RAGT group. The correlation between TFPI and PS, present at T0, was lost during the rehabilitation, and recovered at T3 in the whole population and CT group. During rehabilitation, positive variations of TFPI were inversely related with changes in 6MWT in the whole population (r=-0.309, p=0.021), and in the RAGT group (r=-0.51, p=0.004). In all P-MS, PS T0 levels were associated (r=0.379, p=0.004) with increased gait speed, which in the RAGT group was associated both with PS T0 (r=0.378, p=0.040), and sTM T0 (r=0.453, p=0.012). Accordingly, in the regression model including age, sex and EDSS and the stepwise enter of PS T0, higher PS T0 levels predicted increased gait speed in all P-MS (F=3.4, p=0.016) The regression model in the RAGT group indicated that higher PS and sTM T0 levels were both predictors of increased gait speed (F=5.7, p=0.001). ConclusionsPlasma levels of coagulation inhibitors were related to variations of outcome measurements after high-intensity walking rehabilitation programs. Patients with decreased TFPI levels from T0 to T2 displayed the most significant functional recovery following rehabilitation, and particularly after RAGT. Higher baseline total PS levels were associated with favorable outcomes of rehabilitation therapies in MS. These novel findings, which suggest that plasma levels of hemostasis inhibitors might have implication for rehabilitative therapy options in MS, warrant further investigation.

Gait speed is a preoperative indicator of postoperative events after elective proximal aortic surgery

ObjectiveThe study objective was to evaluate whether 5-m gait speed, an established marker of frailty, is associated with postoperative events after elective proximal aortic surgery. MethodsWe performed a retrospective review of 435 patients aged more than 60 years who underwent elective proximal aortic surgery, defined as surgery on the aortic root, ascending aorta, or aortic arch through median sternotomy. Patients completed a 5-m gait speed test within 30 days before surgery. We evaluated the association between categoric (slow, ≤0.83 m/s and normal, >0.83 m/s) and continuous gait speed and the likelihood of experiencing the composite outcome before and after adjustment for European System for Cardiac Operative Risk Evaluation II. The composite outcome included in-hospital mortality, renal failure, prolonged ventilation, and discharge location. Secondary outcomes were 1-year mortality and 5-year survival. ResultsOf the study population, 30.3% (132/435) were categorized as slow. Slow walkers were significantly more likely to have in-hospital mortality, prolonged ventilation, and renal failure, and were less likely to be discharged home (all P < .05). The composite outcome was 2 times more likely to occur for slow walkers (gait speed categoric adjusted odds ratio, 2.08; 95% confidence interval, 1.27-3.40; P = .004). Moreover, a unit (1 m/s) increase in gait speed (continuous) was associated with 73% lower risk of experiencing the composite outcome (odds ratio, 0.27; 95% confidence interval, 0.11-0.68; P = .006). ConclusionsSlow gait speed is a preoperative indicator of risk for postoperative events after elective proximal aortic surgery. Gait speed may be an important tool to complement existing operative risk models, and its application may identify patients who may benefit from presurgical and postsurgical rehabilitation.

The effects of metronome frequency differentially affects gait on a treadmill and overground in people with Parkinson disease

BackgroundTreadmills and rhythmic auditory cueing can influence stepping rhythm for individuals with Parkinson disease (PD). Of concern, however, is that auditory cueing directly addresses the temporal features of gait, whereas adjusting step length may be more important for people with PD. Stepping to a faster cadence when walking overground may increase gait speed, but without requiring an increased step length. Furthermore, given the potentially valuable role of walking on a treadmill for individuals with PD, we are concerned that increasing cadence with rhythmic auditory cueing while walking at a constant treadmill speed will induce even shorter steps. Research questionWhat is the effect of different metronome cue frequencies on spatiotemporal gait parameters when walking overground compared to walking on a treadmill in people with PD? MethodsUsing a repeated-measures design, 21 people with PD (stage 1–3) walked overground and on a treadmill with and without metronome cues of 85 %, 100 %, and 115 % of their baseline cadence frequency for one minute each. We assessed step length, and cadence during all conditions. Gait speed was assessed during overground gait. ResultsAn interaction effect between cue frequency and walking environment revealed that participants took longer steps during the 85 % condition on the treadmill only. When walking overground, metronome cues of 85 % and 115 % of baseline cadence yielded decreases and increases, respectively, in both cadence and gait speed with no associated change in step length. SignificanceThese data suggest that people with PD are able to alter spatiotemporal gait parameters immediately when provided the appropriate metronome cue and walking environment. We propose to target shortened step lengths by stepping to the beat of slow frequency auditory cues while walking on a treadmill, whereas the use of fast frequency cues during overground walking can facilitate faster walking speeds.

Subthreshold stochastic vestibular stimulation affects balance-challenged standing and walking.

Subthreshold stochastic vestibular stimulation (SVS) is thought to enhance vestibular sensitivity and improve balance. However, it is unclear how SVS affects standing and walking when balance is challenged, particularly when the eyes are open. It is also unclear how different methods to determine stimulation intensity influence the effects. We aimed to determine (1) whether SVS affects stability when balance is challenged during eyes-open standing and overground walking tasks, and (2) how the effects differ based on whether optimal stimulation amplitude is derived from sinusoidal or cutaneous threshold techniques. Thirteen healthy adults performed balance-unchallenged and balance-challenged standing and walking tasks with SVS (0–30 Hz zero-mean, white noise electrical stimulus) or sham stimulation. For the balance-challenged condition, participants had inflatable rubber hemispheres attached to the bottom of their shoes to reduce the control provided by moving the center of pressure under their base of support. In different blocks of trials, we set SVS intensity to either 50% of participants’ sinusoidal (motion) threshold or 80% of participants’ cutaneous threshold. SVS reduced medial-lateral trunk velocity root mean square in the balance-challenged (p < 0.05) but not in the balance-unchallenged condition during standing. Regardless of condition, SVS decreased step-width variability and marginally increased gait speed when walking with the eyes open (p < 0.05). SVS intensity had minimal effect on the standing and walking measures. Taken together, our results provide insight into the effectiveness of SVS at improving balance-challenged, eyes-open standing and walking performance in healthy adults.

Effects of Low-Dye Taping Applied to Chronic Stroke Patients on Gat Speed

Background/Objectives: This study examines the effects of the normal biomechanical maintenance of the feet through Low-Dye taping on the gait treatment in chronic stroke patients and presents the basis of clinical intervention.Method/Statistical Analysis: In this study, 5 cm-wide elastic tapings was applied to improve gait ability in 20 chronic stroke patients. Low-Dye taping was applied for foot alignment. Gait was measured by BTS G-walk (G-walk, BTS, Italy). In this study, taping was applied after the initial assessment, and post measurement was performed after 30 min of taping to examine the immediate effects of taping on the gait parameters. The main outcome of this study is gait speed, and the secondary outcomes are cadence and stride length.Findings: The research group showed significant increases in gait speed and cadence except for the stride length at 30 min after applying the taping.Improvements/Applications: After applying the Low-Dye taping to chronic stroke patients, their gait speed and cadence showed significant differences due to the effects of ankle joint alignment and medial longitudinal arch lift and support. Therefore, Low-Dye taping was effective in improving the gait ability of chronic stroke patients.

Home-Based Gait Training Using Rhythmic Auditory Cues in Alzheimer's Disease: Feasibility and Outcomes.

Background/Purpose: Although gait disorders occur early in the course of Alzheimer's disease (AD) and increase the risk of falling, methods to improve walking in the home setting are poorly understood. This study aimed to determine the feasibility of a home-based gait training program using rhythmic auditory cues for individuals living with mild to moderately severe AD.Methods: Participants had probable AD with no other major conditions affecting locomotion. The intervention consisted of eight progressively modified 45-min gait training sessions delivered during home visits over 4 weeks. Experienced physiotherapists provided the therapy that incorporated rhythmic music cues for a range of locomotor tasks and ambulatory activities. On the days when the physiotherapist did not attend, participants independently performed a seated music listening activity. Walking speed, cadence, stride length, double limb support duration, and gait variability (coefficient of variation) were measured using an 8-m GAITRite® computerized walkway immediately before and after the physiotherapy intervention. Participant satisfaction was also assessed using a purpose-designed questionnaire.Results: Eleven (median age, 77.0 years; median ACE III score, 66/100; 3 females and 8 males) community-dwelling adults living with AD participated. Wilcoxon signed rank tests revealed statistically significant increases in gait speed following the home-based physiotherapy intervention (baseline = 117.5 cm/s, post-intervention = 129.9 cm/s, z = −2.40, p < 0.05). Stride length also improved (baseline = 121.8 cm, post-intervention = 135.6 cm, z = −2.67, p < 0.05). There was no significant change in gait variability. The program was found to be feasible and safe, with no attrition. Participant satisfaction with the home-based music-cued gait training was high, and there were no adverse events.Conclusion: A progressively modified gait training program using rhythmic auditory cues delivered at home was feasible, safe, and enjoyable. Music-cued gait training can help to reduce the rate of decline in gait stride length and speed in some individuals living with AD.Trial Registration: http://www.anzctr.org.au/Default.aspx, ACTRN12616000851460.Universal Trial Number: U1111-1184-5735.

The Effect of Increased Gait Speed on Asymmetry and Variability in Children With Cerebral Palsy.

Gait of children and adolescents with cerebral palsy (CP) is often reported to be more asymmetric and variable than gait of typically developing (TD) peers. As this may lead to less stable and less efficient gait, a relevant clinical question is how asymmetry may be improved and variability reduced in this population. The main objective of the current study was to investigate whether higher walking speed would affect gait symmetry and gait variability in children and adolescents with CP. Data from clinical gait analyses of 43 children and adolescents (29 males and 14 females) with unilateral (n = 28) or bilateral (n = 15) CP were included. Mean age was 11.3 ± 3.4 years, with level I (n = 26) or level II (n = 17) according to the Gross Motor Function Classification System (GMFCS). Corresponding data from 20 TD peers, matched in age and gender, were included as reference. Step time, step length, single support, and stance phase were studied at two different gait speeds: preferred and fast walking speed. Symmetry index and coefficient of variation were used as measures of asymmetry and variability, respectively. Results indicated that all participants managed to increase gait speed when instructed to do so. Overall, increased speed did not result in a more asymmetrical or variable gait, except for an increase in step length asymmetry and a difference in response between GMFCS levels I and II in variability. This implies that manipulation of gait speed may be useful clinically without necessarily making gait more unstable. However, some increase in step length asymmetry may be inevitable when gait speed is increased in people with CP.

Design, Control, and Pilot Study of a Lightweight and Modular Robotic Exoskeleton for Walking Assistance After Spinal Cord Injury

Abstract Walking rehabilitation using exoskeletons is of high importance to maximize independence and improve the general well-being of spinal cord injured subjects. We present the design and control of a lightweight and modular robotic exoskeleton to assist walking in spinal cord injured subjects who can control hip flexion, but lack control of knee and ankle muscles. The developed prototype consists of two robotic orthoses, which are powered by a motor-harmonic drive actuation system that controls knee flexion–extension. This actuation module is assembled on standard passive orthoses. Regarding the control, the stance-to-swing transition is detected using two inertial measurement units mounted on the tibial supports, and then the corresponding motor performs a predefined flexion–extension cycle that is personalized to the specific patient’s motor function. The system is portable by means of a backpack that contains an embedded computer board, the motor drivers, and the battery. A preliminary biomechanical evaluation of the gait-assistive device used by a female patient with incomplete spinal cord injury at T11 is presented. Results show an increase of gait speed (+24.11%), stride length (+7.41%), and cadence (+15.56%) when wearing the robotic orthoses compared with the case with passive orthoses. Conversely, a decrease of lateral displacement of the center of mass (−19.31%) and step width (−13.37% right step, −8.81% left step) are also observed, indicating gain of balance. The biomechanical assessment also reports an overall increase of gait symmetry when wearing the developed assistive device.

Changes in Parkinsonian gait kinematics with self-generated and externally-generated cues: a comparison of responders and non-responders

Purpose: Rhythmic auditory stimulation such as listening to music can alleviate gait bradykinesia in people with Parkinson disease (PD) by increasing spatiotemporal gait features. However, evidence about what specific kinematic alterations lead to these improvements is limited, and differences in responsiveness to cueing likely affect individual motor strategies. Self-generated cueing techniques, such as singing or mental singing, provide similar benefits but no evidence exists about how these techniques affect lower limb joint movement. In this study, we assessed immediate effects of external and self-generated cueing on lower limb movement trajectories during gait.Methods: Using 3D motion capture, we assessed sagittal plane joint angles at the hip, knee, and ankle across 35 participants with PD, divided into responders (n = 23) and non-responders (n = 12) based on a clinically meaningful change in gait speed. Joint motion was assessed as overall range of motion as well as at two key time points during the gait cycle: initial contact and toe-off.Results: Responders used both cue types to increase gait speed and induce increases in overall joint ROM at the hip while only self-generated cues also increased ROM at the ankle. Increased joint excursions for responders were also evident at initial contact and toe-off.Conclusions: Our results indicate that self-generated rhythmic cues can induce similar increases in joint excursions as externally-generated cues and that some people may respond more positively than others. These results provide important insight into how self-generated cueing techniques may be tailored to meet the varied individual needs of people with PD.

Effectiveness of exercise interventions for children with cerebral palsy: A systematic review and meta-analysis of randomized controlled trials.

ObjectiveThe results of previous research into exercise interventions for children with cerebral palsy are inconsistent. The aim of this study is to assess the effectiveness of such exercise interventions.DesignSystematic review and meta-analysis.MethodsSystematic searches of the PubMed, Embase and Cochrane Library databases for randomized controlled trials involving exercise interventions for children with cerebral palsy, from inception to January 2020, were performed. Pooled weighted mean differences (WMDs) with 95% confidence intervals (95% CI) for gross motor function, gait speed, and muscle strength were calculated using random-effects models.ResultsA final total of 27 trials, including 834 children with cerebral palsy, were selected for quantitative analysis. Exercise interventions had no significant effect on the level of gross motor function (WMD 1.19; 95% CI −1.07 to 3.46; p = 0.302). However, exercise interventions were associated with higher levels of gait speed (WMD 0.05; 95% CI 0.00–0.10; p = 0.032) and muscle strength (WMD 0.92; 95% CI 0.19–1.64; p = 0.013).ConclusionThese results suggest that exercise interventions may have beneficial effects on gait speed and muscle strength, but no significant effect on gross motor function in children with cerebral palsy.LAY ABSTRACTCerebral palsy is the most common cause of physical impairment in children. This study evaluated the effectiveness of exercise interventions for children with cerebral palsy. Exercise interventions were significantly associated with increased gait speed and muscle strength, while gross motor function was not affected. Exercise interventions should therefore be used for children with cerebral palsy.

Immediate Effects of Posteroanterior Cervical Mobilization on Pressure Pain Threshold and Gait Parameters in Patients with Chronic Neck Pain: A Pilot Study

Background: Mobilization and cranio-cervical flexion exercise has been reported in reducing pain from cervical part and improving its motor function; also, has been represented that alleviate of neck pain and recover of neck muscles improve the normal gait performance. However, few studies have identified the effects of mobilization and exercise on pain and gait parameters with preceding issues. Objective: To examine the effects or changes of pressure pain threshold (PPT) and gait parameters in patients with chronic neck pain. Design: Cross-Sectional Clinical Trials Methods: Twenty patients with the history of neck pain (>3 months) performed the cervical mobilization and cranio-cervical flexion exercise. Gait parameters were assessed with wireless device and collected data were transmitted to the personal computer via Bluetooth. The PPT was measured posteroanterior direction at the prone position and the mean of subsequent three PPT meas­urements was used for the final analysis. Results: Both cervical central posteroanterior mobilization (CCPAM) (p<.000) and sling-based cranio-cervical flexion exercise (SBCCFE) (p<.000) group showed a significant increase in the PPT and the gait parameters, cadence (p<.023), was significantly increased in the CCPAM group, however slightly increased in the SBCCFE group. The comparison between the CCPAM and the SBCCFE groups after treatment did not show significant differences for the score on the PPT and gait parameters. Conclusions: This study suggests that CCPAM and SBCCFE increase PPT, cadence, and gait speed.