Lower Limb Mobility Research Articles

The Effectiveness of a Student‐Centered, Experiential Learning Curriculum on Musculoskeletal Anatomy of the Lower Limb Using Yoga Asanas

Background and purposeTraditional human anatomy pedagogy has been experiencing paradigm shifts over the years as curricula evolve to better engage students with student‐centered, experiential learning. Today, these conceptual strategies are integrated into Dance Technique Education, as a way to increase dancers' knowledge and understanding of how to use their own bodies. The same active learning approach has a future in applications to other physical activities including yoga practice. Using the three representations (Iconic, Symbolic, and Enactive) of curriculum design from Bruner's Theory and Kolb's two‐fold Experiential Learning Theory, the primary purpose of this study was to fashion a new teaching curriculum dedicated to the learning and understanding of the anatomy of the lower limb. The secondary purpose was to document and assess improvements in participants' Range of Motion (ROM), flexibility, strength, and balance in the lower limbs post completion of the experiential learning curriculum.MethodFollowing literature reviews on the successful impact of Active and Experiential Learning, 17 experimental participants were recruited to participate in a two‐hour, lower‐limb musculoskeletal anatomy learning session using yoga asanas and inspired by Bruner's three Representations. In contrast, 17 control participants were recruited to participate in yoga sessions lacking anatomical instruction. All participants were assessed on anatomical knowledge retention, ROM, flexibility, strength, and balance performance over a two‐month time period. Participants attended two follow‐ups sessions where the researcher documented changes in lower limb mobility. Participants' qualitative feedbacks were used to study the overall impact of a learner‐centered and experiential learning experience.ResultsBased on participant feedback and documented results, the Experiential Learning program was well received, effective in teaching anatomical concepts, and notably increased participants' ROM, flexibility, and strength. Experimental participants outperformed control participants in knowledge retention and overall improvement in lower limb mobility over two months.Discussion and ConclusionBruner's theory on curriculum design and Kolb's theory on experiential learning proved effective when implemented into a two‐hour anatomy‐yoga learning session. The positive outcomes yielded from the two‐hour learning session and the two follow‐ups sessions over the span of two months holds promise for this curriculum's future application using any movement‐based practice. Future work should focus on the development of anatomical experiential learning curricula to compliment traditional didactic teaching approaches.Support or Funding InformationQueen's UniversityThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

How to Explore Fetal Sacral Agenesis Without Open Dysraphism: Key Prenatal Imaging and Clinical Implications.

The estimated prevalence of fetal caudal dysgenesis is 1 per 100,000 births. The functional prognosis of sacral agenesis is dominated by the large spectrum of associated caudal malformations. Except for cases associated with hydrocephalus secondary to open spinal dysraphism or chromosomal anomalies, association with mental deficiency is rare. We propose a systematic prenatal approach to cases of fetal sacral agenesis based on 9 etiologic items: clinical context, type of sacral dysgenesis, associated spinal cord malformations, mobility of lower limbs, investigation of the presacral region, analysis of the gastrointestinal tract, analysis of the genitourinary tract, associated vertebral defects, and cytogenetic analysis.

Effectiveness of robotic assisted rehabilitation for mobility and functional ability in adult stroke patients: a systematic review.

Stroke is a leading cause of long-term disability, and rehabilitation, involving repetitive, high intensity, task-specific exercises, is the pathway to restoring motor skills. Robotic assistive devices are increasingly being used and it is hoped that with robotic devices, rehabilitation progress can be achieved for patients. To examine the effectiveness of robotic devices in the rehabilitation of stroke patients for upper limb mobility, lower limb mobility, and activities of daily living. The sustainability of treatment effect was also examined. Adult stroke patients 18 years and over. Rehabilitation of stroke patients using robotic devices with assistive automation, compared to conventional physiotherapy. Motor movements of upper limbs, walking movement of lower limbs and activities of daily living, including follow-up measurements to examine the sustainability of treatment effect. Randomized and controlled clinical trials. Published and unpublished studies in English were searched. All studies meeting the review inclusion criteria were independently assessed for methodological quality by two reviewers. Quantitative data were extracted using the standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Quantitative data were pooled in statistical meta-analysis. Effect sizes expressed as standardized mean difference, 95% confidence intervals and levels of heterogeneity (I) were calculated. Where statistical pooling was not possible, the findings were presented in narrative form. Fifty-one studies with 1798 patients were included in this review. Thirty studies examined upper limb interventions and 21 studies evaluated lower limb gait training. Non-significant results were found for upper limb (SMD 0.07, 95% CI -0.11 to 0.26, I = 41%, P = 0.45), lower limb (SMD 0.17, 95% CI -0.15 to 0.48, I = 75%, P = 0.31) and activities of daily living (SMD 0.11, 95% CI -0.11 to 0.33, I = 66%, P = 0.32). For patients with severely impaired lower limbs, a significant difference was observed in favor of robotics (SMD 0.41, 95% CI 0.19 to 0.63, I = 28%, P = 0.0003). P-value analysis did not show significant results for the sustainability of treatment effect post intervention. Robotic training is just as effective as conventional training for upper limb motor movement, lower limb walking mobility and for activities of daily living. For lower limb patients with severe impairment, robotic training produces better outcomes than conventional training. The sufficient quantity of studies included and the reasonable quality of Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence support the findings.For treatment sustainability of upper and lower limbs, robotic training is just as effective as conventional training. However, the low quality of GRADE evidence and the lower number of studies included require caution for this finding. For treatment sustainability of activities of daily living, the better quality of GRADE evidence and the larger number of studies analyzed indicate that robotic training is just as effective as conventional training.

IntelliCane: A Cane System for Individuals with Lower-Limb Mobility and Functional Impairments

IntelliCane: A Cane System for Individuals with Lower-Limb Mobility and Functional Impairments

Effects of Activity-Based Therapy Interventions on Mobility, Independence, and Quality of Life for People with Spinal Cord Injuries: A Systematic Review and Meta-Analysis.

The aim of this study was to review the literature about the effects of activity-based therapy (ABT) interventions on mobility, functional independence, and quality of life for people with a spinal cord injury (SCI). A systematic review with meta-analysis of randomized and non-randomized trials was performed, including adults with a non-progressive SCI at any level. The intervention of interest was ABT, defined as any intervention that sought to improve muscle activation or sensory function below the level of injury in the spinal cord and does not rely on compensatory mechanisms for improving function. The comparison was either no intervention or conventional physical interventions targeted to regions above the level of injury. The outcome measures were quality-of-life questionnaires, mobility assessments, and functional independence scales. Nineteen trials were included in this systematic review. Three compared ABT to no intervention and 16 to conventional physical rehabilitation. The methodological quality of the trials was assessed using the PEDro scale as moderate. Six studies investigated the effects of ABT interventions for the upper limbs, 11 investigated gait-related interventions, and two applied multi-modal interventions. Compared with no intervention, the meta-analysis found that ABT was not more effective for improving independence or lower limb mobility, but conferred a large positive effect on upper limb function. Compared with conventional physical interventions, there was no significant effect of ABT on lower limb mobility, independence, or quality of life; however, it had positive effects on upper limbs. In conclusion, there is evidence that ABT can improve independence and functional ability when applied to the upper limbs in people with SCI. However, it is not superior to conventional physical interventions when applied to the lower limbs.

Mulligan Mobilization Versus Stretching on the Management of Piriformis Syndrome a Comparative Study

Background: Piriformis syndrome is a commonly overlooked specific cause of low back pain. Apart from mimicking the sciatica-like symptoms, unilateral piriformis tightness can cause rotational dysfunction and pain in the lumbar region. This could lead to low back pain which is a common musculo skeletal problem and a major reason for activity limitation. Stretching the piriformis tightened muscle is a preferred choice of treatment against surgical intervention to release the muscle. Mulligan’s mobilization is based on movement with mobilization which is proven to be effective in many musculo skeletal dysfunctions including the lumbar spine. The purpose of this study is to explore and compare the two treatment methods in relieving the low back pain in clinical conditions with piriformis syndrome.Methods: In this experimental study, 40 patients with piriformis syndrome were selected and divided into two groups. One group was given only piriformis stretching for the tightened muscle and the other group given Mulligan mobilization for lumbo sacral joints. VAS and lower limb functional index were taken to compare before and after the treatment regime of 4 weeks.Results: There was no significant difference between the two groups in both pain scale and lower limb mobility and function. But there was significant improvement in pain relief and LLFI after the treatment regime in both groups compared to the pre-treatment status.Conclusion: Even as the piriformis syndrome is caused by the tightness of the muscle, the consequence in the lower back and lumbar spine mobility can be improved by a Mulligan mobilization as a single mode of intervention .

Gender differences in the relationship between physical functioning and depressive symptoms in low‐income older adults living alone

This study examined gender differences in the relationship between physical functioning and depressive symptoms in low-income older adults living alone in Korea, and the variables influencing these symptoms. Data from a total of 317 older adults in the 2011 Korean National Survey were used. Upper limb mobility, lower limb mobility, activities of daily living, instrumental activities of daily living, and depressive symptoms were measured. Data were analyzed using multiple regression analysis. Low-income older men and women living alone experienced depressive symptoms. Regression analysis showed that lower limb mobility and age together explained 35.4% of the variance in depressive symptoms in men. Subjective health status explained 16.7% of the same in women. These findings suggest that low-income older adults living alone should be carefully monitored by public healthcare managers to improve their physical and mental health, considering gender-specific elements.

Asymmetry measurement for vibroactive correction in lower limbs mobility

We developed a wearable device to improve lower limb sport training. The presented system consists of a pair of spandex shorts which embed a processor unit, 2 accelerometers and 2 vibro motors. The accelerometers are located in proximity to the knees and measure tri-axial accelerations. We present a novel method to compute and correct asymmetry of lower limbs during training. The user performs an initial calibration phase which sets the accelerometer reference frames. While running, the system continuously refines the calibration using principal component analysis to take in account occasional shorts assessments. The system activates a corrective vibro feedback on the specific leg according to an asymmetry metric based on: (i) foot ground impact, (ii) phase error between legs, (iii) transversal knee movements. User tests demonstrated that the device is ergonomic to wear, easy to use and the corrective vibro feedback is appreciated during the training.

Living with locked-in syndrome: an explorative study on health care situation, communication and quality of life

Purpose: to explore and describe the health care situation, the use of aids, the way of communicating and the quality of life of Locked-in syndrome patients in Flanders (Belgium) and to collect information on their fulfilled and unfulfilled needs. Method: in depth interviews with eight LIS-patients by means of an extensive questionnaire consisting of five parts: (i) general information and medical history, (ii) health care, rehabilitation and follow-up, (iii) speech and communication, (iv) quality of life, (v) needs and problems experienced. Results: the patients’ condition, mostly caused by ischemic stroke, persisted for a mean period of 6 years 8 months. Their mean age was 41;10 years. At the moment of our study all the patients were living at home. Care was provided by an extensive care team. Some recovery of head and neck movements was mentioned, recovery of upper and lower limb mobility however was very limited. Most patients use an alphabet system to communicate, all of them had access to and made use of a PC with internet connection. Except for the domain of physical functioning, the quality of life scores of our patient group are rather high. As for unfulfilled needs, half of the patients experience a lack of information on their condition and a lack of appropriate information on (communication) aids. Conclusion: most results seem to be in line with those of other studies, though larger scale and follow-up studies are needed to confirm these findings.Implications for RehabilitationAccess to a personal computer with internet connection is very important for LIS-patients and thus should be provided.LIS-patients feel the need for more and better adapted information on LIS and on available aids.Most chronic LIS-patients feel the need for extensive, multidisciplinary and continued care.

The use of a treadmill with biofeedback function in assessment of relearning walking skills in post-stroke hemiplegic patients – a preliminary report

Background and purposeOne of the most important goals of rehabilitation of post-stroke hemiplegic patients is the recovery of their locomotion function. The aim of the study was to assess walking function recovery by means of in-patient rehabilitation procedures, as well as the effectiveness of treadmill gait training with the use of biological feedback. Material and methodsThe research involved groups of chronic post-stroke hemiplegic patients receiving treatment in the rehabilitation ward. Factors under scrutiny included walking speed and capacity, number of steps, weight bearing symmetry for lower extremities while standing, lower limb mobility on the Brunnström scale, and muscle tone on the Ashworth Scale. The study group patients followed a rehabilitation regime that included treadmill training aided with biofeedback function. Each study group participant exercised every day (a total of 15 times), with a single practice time ranging from 5 to 20 minutes. Control patients followed a rehabilitation regime without the additional treadmill exercises. ResultsPatients in both groups demonstrated improvement in locomotion abilities. In the group following the physiotherapy regime supplemented with treadmill training with the use of biofeedback, the measures of walking speed, weight bearing symmetry for lower extremities, and number of steps were better than in controls. ConclusionsTreadmill gait training with the use of biofeedback is effective for relearning locomotion functions in post-stroke hemiplegic patients and can constitute a significant type of exercise in a physiotherapy regime.

The effects of an exercise program on several abilities associated with driving performance in older adults

The purpose of this study was to investigate the effects of participation in an exercise program on several abilities associated with driving performance in older adults. Thirty-two subjects were randomly assigned to either an exercise group (60–81 years, n = 16) or a control group (60–82 years, n = 16). The exercise program was planned to stress perceptive, cognitive, and physical abilities. It lasted 12 weeks with a periodicity of three sessions of 60 min per week. Assessments were conducted before and after the intervention on behavioral speed (in single- and dual-task conditions), visual attention, psychomotor performance, speed perception (time-to-contact), and executive functioning. Significant positive effects were found at 12-week follow-up resulting from participation in the exercise program. Behavioral speed improvements were found in reaction time, movement time, and response time (both in single- and dual-task conditions); visual attention improvements took place in speed processing and divided attention; psychomotor performance improvements occurred in lower limb mobility. These results showed that exercise is capable of enhancing several abilities relevant for driving performance and safety in older adults and, therefore, should be promoted.

The Contribution of Cognition and Spasticity to Driving Performance in Multiple Sclerosis

Marcotte TD, Rosenthal TJ, Roberts E, Lampinen S, Scott JC, Allen RW, Corey-Bloom J. The contribution of cognition and spasticity to driving performance in multiple sclerosis. Objective To examine the independent and combined impact of cognitive dysfunction and spasticity on driving tasks involving high cognitive workload and lower-limb mobility in persons with multiple sclerosis (MS). Design Single-visit cohort study. Setting Clinical research center. Participants Participants included 17 drivers with MS and 14 referent controls. The group with MS exhibited a broad range of cognitive functioning and disability. Of the 17 patients with MS, 8 had significant spasticity in the knee used to manipulate the accelerator and brake pedals (based on the Modified Ashworth Scale). Interventions Not applicable. Main Outcome Measures A brief neuropsychologic test battery and 2 driving simulations. Simulation 1 required participants to maintain a constant speed and lane position while attending to a secondary task. Simulation 2 required participants to adjust their speed to accelerations and decelerations of a lead car in front of them. Results Patients with MS showed greater variability in lane position (effect size, g=1.30), greater difficulty in maintaining a constant speed ( g=1.25), and less ability to respond to lead car speed changes ( g=1.85) compared with controls. Within the MS group, in a multivariate model that included neuropsychologic and spasticity measures, cognitive functioning was the strongest predictor of difficulty in maintaining lane position during the divided attention task and poor response time to lead car speed changes, whereas spasticity was associated with reductions in accuracy of tracking the lead car movements and speed maintenance. Conclusions In this preliminary study, cognitive and physical impairments associated with MS were related to deficits in specific components of simulated driving. Assessment of these factors may help guide the clinician regarding the types of driving behaviors that would put patients with MS at an increased risk for an automobile crash.

Effects of a long-term exercise program on lower limb mobility, physiological responses, walking performance, and physical activity levels in patients with peripheral arterial disease

The purpose of the study was to examine the effects of a 12-month exercise program on lower limb mobility (temporal-spatial gait parameters and gait kinematics), walking performance, peak physiological responses, and physical activity levels in individuals with symptoms of intermittent claudication due to peripheral arterial disease (PAD-IC). Participants (n = 21) with an appropriate history of PAD-IC, ankle-brachial pressure index (ABI) <0.9 in at least one leg and a positive Edinburgh claudication questionnaire response were prospectively recruited. Participants were randomly allocated to either a control PAD-IC group (CPAD-IC) (n = 11) that received standard medical therapy and a treatment PAD-IC group (TPAD-IC) (n = 10), which also took part in a 12-month supervised exercise program. A further group of participants (n = 11) free of PAD (ABI >0.9) and who were non-regular exercisers were recruited from the community to act as age and mass matched controls (CON). Lower limb mobility was determined via two-dimensional video motion analysis. A graded treadmill test was used to assess walking performance and peak physiological responses to exercise. Physical activity levels were measured via a 7-day pedometer recording. Differences between groups were analyzed via repeated measures analysis of variance (ANOVA). The 12-month supervised exercise program had no significant effect on lower limb mobility, peak physiological responses, or physical activity levels in TPAD-IC compared with CPAD-IC participants. However, the TPAD-IC participants demonstrated significantly greater walking performance (171% improvement in pain free walking time and 120% improvement in maximal walking time compared with baseline). The results of this study confirm that a 12-month supervised exercise program will result in improved walking performance, but does not have an impact on lower limb mobility, peak physiological responses, or physical activity levels of PAD-IC patients.

Exploring How Peak Leg Power and Usual Gait Speed Are Linked to Late-Life Disability

To investigate the relation of both peak leg power and usual gait speed in their association with varying domains of late-life disability. Participants (> or =60 yrs of age, n = 1753) were from the National Health and Nutrition Examination Survey, 1999-2002. Disability in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities was obtained by self-report. Peak muscle power was the product of isokinetic peak leg torque and peak force velocity. Functional limitations were evaluated via usual gait speed, which was obtained from a 20-foot timed walk. Low usual gait speed was associated with disability independent of basic demographics, cognitive performance, co-morbidities, health behaviors, and inflammatory markers. The odds ratios for disabilities in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities for each standard-deviation increase in walking speed were 0.72 (95% confidence interval [CI], 0.59-0.87), 0.63 (95% CI, 0.52-0.77), 0.57 (95% CI, 0.45-0.72), 0.56 (95% CI, 0.47-0.67), and 0.74 (95% CI, 0.64-0.85), respectively. The odds ratios for disabilities in activities of daily living, instrumental activities of daily living, leisure and social activities, lower limb mobility, and general physical activities for each standard-deviation increase in leg power were 0.70 (95% CI, 0.55-0.89), 0.67 (95% CI, 0.53-0.86), 0.62 (95% CI, 0.47-0.83), 0.58 (95% CI, 0.47-0.72), and 0.73 (95% CI, 0.61-0.87), respectively. Supplementary adjustment for walking speed mildly attenuated the relation of leg power to disability. Peak leg power and habitual gait speed were associated with varying domains of late-life disability. The association between peak leg power and disability seems to be partially mediated through usual gait speed.

Lower limb function as predictor of falls and loss of mobility with social repercussions one year after discharge among elderly inpatients

Poor mobility of the lower limbs in community-dwelling elderly people is a predictor of functional decline in terms of disability, falls, nursing home admission, and death. However, its predictive value has not been studied in acute care hospital settings. The aims of this observational, prospective study were: 1) to assess the prognostic value of lower limb function; and 2) to compare the predictive value of three performance tests in elderly inpatients. We studied 144 patients aged 70 or older (60 men and 84 women, mean age 78.7 +/- 5.6 years), admitted consecutively to a general internal medicine ward. Before discharge, patients underwent multidimensional assessment, including static and dynamic equilibrium and gait, by the Performance-Oriented Mobility Assessment (POMA), Short Physical Performance Battery (SPPB), and Functional Reach (FR). One-year outcomes were falls, loss of mobility with social repercussions (inability to leave home, or need for nursing home care) and death. In univariate analysis, poor results on any of the three tests were associated with an increased risk of falls, loss of mobility with social repercussions, and death. In multivariate analysis, age, two or more falls, and a low POMA score were predictive of future falls, whereas dependency in instrumental activities of daily living and a low SPPB score were predictive of loss of mobility with social repercussions. No multivariate model was superior to univariate ones in predicting death. No associations were found between other medical or geriatric characteristics and outcomes. Lower limb mobility tests performed in an acute care hospital setting are predictive of future falls, inability to leave home, and/or need for nursing home care.

Dislocation traumatique cervicale périnatale

We report on a case of cervical dislocation in which the severity of the lesion contrasts with the paucity of the symptoms. An eight-month-old girl presented with weakness of the left upper limb. She had a normal cephalic delivery. On the following days, increased weakness of the limb showed a spontaneous, partial regression. Clinical examination at eight months showed a normal physical and psychical development, a falling neck and an impossibility to maintain the sitting position, but a normal mobility of the lower limbs. Cervical radiography performed showed a complete dislocation. CT confirmed the diagnosis and eliminated congenital vertebral anomalies. Magnetic resonance imaging showed an important stretching and compression of the spinal cord. Cervical spine damage in the newborn are scarce and serious. The here reported case is characterized by a complete vertebral dislocation associated with medullar stretching and compression, but few initial symptoms.

Design Issues for Therapeutic Robot Systems: Results from a Survey of Physiotherapists

Over the years, research into rehabilitation robots has increased considerably. Using robots for rehabilitation can improve persons with physical disabilities to perform the basic activities of daily living. However, rehabilitation robots are not welcome yet in clinical environments. While surveys concerning how patients respond to robots used for rehabilitation have been conducted, no survey exists in the literature concerning how the therapists themselves think of these robotic devices, and what functionality they should possess in order to be effective. This paper presents a survey of physiotherapists concerning their thoughts, experience, and what functionality should be included in robots used for rehabilitation. In particular, the therapists were asked about the development of an intelligent robotic device capable of performing repetitive tasks for patients who suffer from reduced upper and lower limb mobility. In general, the results from this survey suggest that therapists respond positively to the idea of robotic devices in a clinical setting. Furthermore, the majority of respondents are interested in rehabilitation robotics. The results of the survey will be very helpful in the design of robotic systems for use during physiotherapy.

Blood Lactate and Stroke Parameters During Front Crawl in Elite Swimmers With Disability

The purpose of this investigation was to compare the blood lactate concentration ([La]), stroke distance (D(s)), and swim index (SI) during an incremental swim test (IST) in elite swimmers who had a loss in mobility (LM) (n = 6) or who had full mobility (FM) (n = 5) of the lower limbs. The IST consisted of 5 repeats of either 100 or 200 m front crawl depending upon the ability level of the swimmer. The [La] and heart rate measured during the IST showed no significant differences (p > 0.05). However, velocity (V(s)) and D(s) were all significantly lower (p < 0.01) during the IST. SI was significantly (p < 0.01) lower during repeats 1 to 3 and 5, but not repeat 4. These data indicate that the [La] response to incremental exercise is similar during incremental front crawl activity in swimmers suffering from loss of lower limb mobility. However, a critical V(s) is reached in LM swimmers where swimming efficiency is optimal compared with FM swimmers.