Intermediate Walking Research Articles

Transcranial direct current stimulation (tDCS) in addition to walking training on walking, mobility, and reduction of falls in Parkinson\u2019s disease: study protocol for a randomized clinical trial

BackgroundTranscranial direct current stimulation (tDCS) has the potential to modulate cortical excitability and enhance the effects of walking training in people with Parkinson’s disease. This study will examine the efficacy of the addition of tDCS to a task-specific walking training to improve walking and mobility and to reduce falls in people with Parkinson’s disease.MethodsThis is a two-arm, prospectively registered, randomized trial with concealed allocation, blinded assessors, participants and therapists, and intention-to-treat analysis. Twenty-four individuals with Parkinson’s disease, categorized as slow or intermediate walkers (walking speeds ≤ 1.0 m/s), will be recruited. The experimental group will undertake a 30-min walking training associated with tDCS, for 4 weeks. The control group will undertake the same walking training, but with sham-tDCS. The primary outcome will be comfortable walking speed. Secondary outcomes will include walking step length, walking cadence, walking confidence, mobility, freezing of gait, fear of falling, and falls. Outcomes will be collected by a researcher blinded to group allocation at baseline (week 0), after intervention (week 4), and 1 month beyond intervention (week 8).DiscussiontDCS associated with walking training may help improve walking of slow and intermediate walkers with Parkinson’s disease. If walking is enhanced, the benefits may be accompanied by better mobility and reduced fear of falling, and individuals may experience greater free-living physical activity at home and in the community.Trial registrationBrazilian Registry of Clinical Trials (ReBEC) RBR-6bvnx6. Registered on September 23, 2019

Changes in Walking Performance between Childhood and Adulthood in Cerebral Palsy: A Systematic Review

ABSTRACT Purpose: To examine the changes in walking performance between childhood and adulthood in cerebral palsy. Methods: Cohort studies were included if the participants were children with cerebral palsy at Gross Motor Function Classification System (GMFCS) Level I-IV, initial measurement of walking by 13 years of age and follow-up measurement by 30 years of age. Results: At GMFCS Level I+ II, 7% (95% CI 6–8) had declined to GMFCS Level III. At GMFCS Level III, 4% (95% CI 3–6) had declined to GMFCS Level IV and 31% (95% CI 27–34) had improved to GMFCS Level I+ II. At GMFCS Level IV, 2% (95% CI 1–4) had improved to GMFCS Level III and 3% (95% CI 2–4) had improved to GMFCS Level I+ II. Discussion: The results suggest that walking performance is stable from childhood to adulthood at either end of the spectrum of ability but is more changeable for intermediate walkers.

Effect of the provision of a cane on walking and social participation in individuals with stroke: protocol for a randomized trial

BackgroundCanes are usually prescribed for individuals with stroke with the purpose of improving walking and increasing safety. However, there is no consensus regarding the clinical effects of these aids on walking and participation. ObjectiveThis study will examine the efficacy of the provision of a cane to improve walking and increase participation after stroke. MethodsThis is a two-arm, prospectively registered, randomized trial with concealed allocation, blinded measurers, and intention-to-treat analysis. Fifty individuals with chronic stroke, categorized as slow or intermediate walkers (walking speeds ≤0.8m/s), will participate. The experimental group will receive a single-point cane and instructions to use the cane anytime they need to walk. The control group will receive a placebo intervention, consisting of self-stretching exercises of the lower limb muscles and instructions to not use assistive devices. The primary outcome will be comfortable walking speed. Secondary outcomes will include walking step length, walking cadence, walking capacity, walking confidence, and participation. Outcomes will be collected by a researcher blinded to group allocation at baseline (Week 0), after intervention (Week 4), and one month beyond intervention (Week 8). ConclusionThe provision of a single-point cane may help improving walking of slow and intermediate walkers after stroke. If walking is enhanced, the benefits may be carried over to participation, and individuals may experience greater free-living physical activity at home and in the community.

Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000-2015.

Influence of Studies Published by the Journal of the American Geriatrics Society: Top 20 Articles from 2000-2015.

The provision of a cane provides greater benefit to community-dwelling people after stroke with a baseline walking speed between 0.4 and 0.8 metres/second: an experimental study

ObjectiveTo investigate the effect of the provision of a cane on walking ability in ambulatory people with chronic stroke. DesignExperimental study. SettingClinics within the community. ParticipantsTwenty-four people on average 6 years after a stroke, who were not regular users of walking sticks. Participants were categorized as slow (<0.4 metres/second), intermediate (0.4–0.8 metres/second), or fast walkers (>0.8 metres/second) on the basis of their baseline walking ability. Experimental conditionsWalking with and without a cane. Main outcome measuresWalking ability was measured using the 10-m Walk Test and reported as speed (metres/second), step length (metres), and cadence (steps/minute). ResultsOverall, the provision of a cane produced no significant change in speed (0.05 metres/second, 95% CI −0.01 to 0.11) or cadence (−3 steps/minute; 95% CI −8 to 3), but a small increase in step length (0.04 metres, 95% CI 0.03 to 0.06). For the intermediate walkers, the cane increased speed by 0.18 metres/second (95% CI 0.11 to 0.24), step length by 0.07 metres (95% CI 0.05 to 0.09), but not cadence. The provision of a cane to the intermediate walkers also produced 0.27 metres/second (95% CI 0.18 to 0.36) more increase in speed compared with the fast walkers, and 0.12 metres/second (95% CI 0.03 to 0.21) more increase compared with the slow walkers. ConclusionThe provision of a cane produced most benefit to a subgroup of intermediate walkers in a group of community-dwelling people with chronic stroke whose walking had stabilized, without detriment to quality of walking.

Walking Speed and Global Cognition: Results from the OKLAHOMA Study

ABSTRACT Executive functioning and processing speed have been related to physical functioning in non-demented, elderly samples; however, the relationship between walking speed and global cognition has not been examined. Six hundred and seventy-five community dwelling older adults were enrolled through their primary care physicians. Walking speed was assessed on a 50-foot course at usual pace. Global cognition was assessed with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Total Scale score. After adjusting for age, gender, and education, there was a strong inverse relationship between walking speed and global cognition, with slower walkers performing worse on the cognitive measures, faster walkers performing better on the cognitive measures, and the intermediate walkers performing in the middle. In these older adults, global cognition was related to walking speed.

Control of Foot Trajectory in Walking Toddlers: Adaptation to Load Changes

On earth, body weight is an inherent constraint, and accordingly, load-regulating mechanisms play an important role in terrestrial locomotion. How do toddlers deal with the effects of their full body weight when faced with the task of independent upright locomotion for the first time? Here we studied the effect of load variation on walking in 12 toddlers during their first unsupported steps, 15 older children (1.3-5 yr), and 10 adults. To simulate various levels of body weight, an experimenter held the trunk of the subject with both hands and supplied an approximately constant vertical force during stepping on a force platform. During unsupported stepping, the shape of the foot path in toddlers (typically single-peak toe trajectory) was different from that of adults and older children (double-peak trajectory). In contrast to adults and older children, who showed only limited changes in kinematic coordination, the "reduced-gravity" condition considerably affected the shape of the foot path in toddlers: they tended to make a high lift and forward foot overshoot at the end of swing. In addition, stepping at high levels of body unloading was characterized by a significant change in the initial direction of foot motion during early swing. Intermediate walkers (1.5-5 mo after walking onset) showed only partial improvement in foot trajectory characteristics. The results suggest that, at the onset of walking, changes in vertical body loads are not compensated accurately by the kinematic controllers; compensation necessitates a few months of independent walking experience.

The Development of Compensatory Stepping Skills in Children

The development of the ability to use the step for balance recovery was studied among twenty-five 9- to 19-month-old children. The children were grouped according to walking experience (4 levels) and exposed to backward support surface translations, 8 cm in amplitude, under 3 velocity conditions: 15, 20, and 25 cm/s. New walkers (up to 2 weeks' walking experience) used the step infrequently and ineffectively in response to threats to balance. Intermediate walkers (1-3 months' walking experience) showed an increasing use of the step and significant improvement in step execution compared with new walkers. Advanced walkers (> 3 months' walking experience) experienced no falls throughout the protocol, capturing balance with feet-in-place or step responses under all perturbation conditions. A significant developmental transition in the emergence of the compensatory step occurred between the new walker and the intermediate walker experience levels, that is, within the first 3 months of walking experience. Three to 6 months' experience was required for the development of an effective stepping response. A concomitant change in mediolateral stability paralleled the emergence of compensatory stepping.

The efficacy of accumulated short bouts versus single daily bouts of brisk walking in improving aerobic fitness and blood lipid profiles

Fifty-six subjects (19 men and 37 woman) aged between 40 and 66 completed the study. They were allocated into three walking groups and a control group (C). The three walking groups performed the same total amount of walking for 18 weeks, but completed it in bouts of differing durations and frequencies. These were Long Walkers (LW; 20-40 min/bout), Intermediate Walkers (IW; 10-15 min/bout) and Short Walkers (SW; 5-10 min/bout); with the IW and SW performing more than one bout of walking a day. Following the 18 week walking programme, compared to the C group all walking groups showed similar improvements in fitness as determined by a reduction in blood lactate during a graded treadmill walking test (LW 1.0 mmol/l; IW 0. 8 mmol/l; SW 1.2 mmol/l; C 0.2 mmol/l; P = 0.003) and reduction in final heart rate (LW 8 beats/min; IW 6 beats/min; SW 10 beats/min; C 0 beats/min; P = 0.056). Also compared to the C group, the LW and IW groups recorded statistically significant decreases in low-density lipoprotein cholesterol (LW 0.29 mmol/l; IW 0.41 mmol/l; P = 0.024), whereas the control group showed a mean increase of 0.22 mmol/l. The LW and IW groups also showed significant reductions in apolipoprotein (apo) A-II (LW 0.05 g/l; IW 0.02 g/l; SW 0.01 g/l; C 0.00 g/l; P = 0.012) with the LW recording a statistically significant increase in the ratio of apo A-I/A-II (LW, 0.19, P = 0. 044). In conclusion, some health benefits were achieved from all walking programmes. However, whilst the changes in aerobic fitness were similar, the effects upon blood lipid profiles were not. The findings from this study suggest that the LW regimen was most effective in benefiting blood lipid profile, followed by the IW regimen, with the SW being least potent. Nevertheless, for the sedentary/low-active members of society, any improvement in health may be considered as important. Therefore accumulated bouts of moderate intensity exercise, which according to theories of exercise behaviour may be more easily incorporated into an individual's lifestyle than single prolonged bouts, may be advocated for health promotion but may not be as effective as the traditionally prescribed 20-40 min bouts.