Mobility Assessment Tool Research Articles

An Analysis of the Reliability and Validity of a Korean Version of the Mobility and Gait Assessment Tools for Patients with Stroke

Purpose: This study aimed to systematically analyze the reliability and validity of Korean versions of mobility and gait assessment tools for patients with stroke. Methods: Two reviewers conducted an independent literature search and systematically reviewed the literature. Literature published until June of 2017 was searched using search engines for electronic databases. The 2 reviewers reviewed the title and abstract of each article. Among the articles examined, we read the full text of those judged to be suitable for our study. We classified the selected data into research methods and results. The determination was made through mutual agreement. Results: The reviewers selected 5 articles related to the purpose of this study. The DGI was found to be moderately associated with BBS, 10MWT, and TUG in intra-rater reliability (ICC=0.92), inter-rater reliability (ICC=0.88), and concurrent validity tests. The FGA demonstrated a high level of reliability with intra-rater (ICC=0.92-0.95) and inter-rater reliability (ICC=0.91, 0.95). The intra-rater reliability of the RMI was high at ICC=0.98. Its concurrent validity showed a high association with STREAM and BI. The intra-rater reliability of the MAS was ICC=0.75-0.99. Its inter-rater reliability was very high, exceeding 0.99. The inter-rater reliability of the Tinetti-gait Scale was ICC=0.91, and its concurrent validity was moderately associated with the DGI, 10WMT, OLST, FM-L/E, and STS. Conclusion: The results of this study revealed that the reliability and validity of the Korean versions of the mobility and gait assessment tools were high.

HiMAT: High-Level Mobility Assessment Tool

HiMAT: High-Level Mobility Assessment Tool

White matter alterations and their associations with motor function in young adults born preterm with very low birth weight.

Very low birth weight (VLBW: ≤ 1500 g) individuals have an increased risk of white matter alterations and neurodevelopmental problems, including fine and gross motor problems. In this hospital-based follow-up study, the main aim was to examine white matter microstructure and its relationship to fine and gross motor function in 31 VLBW young adults without cerebral palsy compared with 31 term-born controls, at mean age 22.6 ± 0.7 years. The participants were examined with tests of fine and gross motor function (Trail Making Test-5: TMT-5, Grooved Pegboard, Triangle from Movement Assessment Battery for Children-2: MABC-2 and High-level Mobility Assessment Tool: HiMAT) and diffusion tensor imaging (DTI). Probabilistic tractography of motor pathways of the corticospinal tract (CST) and corpus callosum (CC) was performed. Fractional anisotropy (FA) was calculated in non-crossing (capsula interna in CST, body of CC) and crossing (centrum semiovale) fibre regions along the tracts and examined for group differences. Associations between motor test scores and FA in the CST and CC were investigated with linear regression. Tract-based spatial statistics (TBSS) was used to examine group differences in DTI metrics in all major white matter tracts. The VLBW group had lower scores on all motor tests compared with controls, however, only statistically significant for TMT-5. Based on tractography, FA in the VLBW group was lower in non-crossing fibre regions and higher in crossing fibre regions of the CST compared with controls. Within the VLBW group, poorer fine motor function was associated with higher FA in crossing fibre regions of the CST, and poorer bimanual coordination was additionally associated with lower FA in crossing fibre regions of the CC. Poorer gross motor function was associated with lower FA in crossing fibre regions of the CST and CC. There were no associations between motor function and FA in non-crossing fibre regions of the CST and CC within the VLBW group. In the TBSS analysis, the VLBW group had lower FA and higher mean diffusivity compared with controls in all major white matter tracts. The findings in this study may indicate that the associations between motor function and FA are caused by other tracts crossing the CST and CC, and/or by alterations in the periventricular white matter in the centrum semiovale. Some of the associations were in the opposite direction than hypothesized, thus higher FA does not always indicate better function. Furthermore, widespread white matter alterations in VLBW individuals persist into young adulthood.

Healthy body, healthy mind: A mixed methods study of outcomes, barriers and supports for exercise by people who have chronic moderate-to-severe acquired brain injury

BackgroundFew people with chronic moderate-to-severe brain injury are following recommended physical activity guidelines. ObjectiveInvestigate effects of planned, systematic physical activity while cultivating social and emotional well-being of people with chronic moderate-to-severe brain injury. HypothesisModerate-to-intensive physical activity would be associated with improvements in impairment and activity limitation measures (endurance, mobility, gait speed) immediately post-intervention and six weeks later (study week 12). MethodsThe intervention was a single group pre-/post-intervention study with 14 people with chronic moderate-to-severe brain injury who live in brain injury group homes and exercised 60–90 min, 3 days per week for 6 weeks at a maximum heart rate of 50–80%. Pre-post measures (administered weeks 0, 6 and 12) were the 6 Minute Walk Test, High-level Mobility Assessment Tool and 10 Meter Walk Test. The qualitative component used a brief survey and semi-structured interview guide with participants, family members, and staff. ResultsFollowing program completion, post-intervention group changes were noted on all outcome measures and greater than minimal detectable change for people with brain injury. Three transitioned from low to high ambulatory status and maintained this change at 12 weeks. During interviews, participants agreed the program was stimulating. More than eighty percent liked working out in a group and felt better being active. ConclusionsProgram impact included physical, cognitive and social/emotional aspects. Social aspects (group format, trainers) were highly motivating and supported by residents, family, and staff. Investments in transportation and recruiting and training interns to assist participants are critical to program sustainability and expansion.

The effect of a running intervention on running ability and participation in children with cerebral palsy: a randomized controlled trial

Purpose: The purpose of this study is to evaluate effects of a running intervention on running ability and participation in children with cerebral palsy.Materials and method: Children with cerebral palsy (9–18 years) with Gross Motor Function Classification System levels I-III were randomly assigned to a 12-week running intervention or usual care. Primary outcomes included improvement in running ability (assessed by Goal Attainment Scaling, high level mobility (assessed by the High-Level Mobility Assessment Tool) and participation (assessed by the Participation and Environment Measure for Children and Youth). Secondary outcomes were aerobic and anaerobic fitness and agility. Blinded assessments took place at baseline and 12 weeks. Regression analysis adjusting for baseline differences was used to determine between group differences.Results: Forty-two participants (mean age 12.5 years, SD 2.8 years; 15 female) completed the study. Statistically significant group differences at 12-weeks were found for improvements in running ability (86% treatment group versus 0% control group achieved or exceeded their running goals, p < 0.001), and participation in the school environment (Participation and Environment Measure mean difference 1.18: 95%CI 1.00–1.39, p = 0.045).Conclusion: A 12-week individualized running training skills intervention results in achievement of running ability goals and participation in the school environment in children with cerebral palsy.Implications for RehabilitationChildren with cerebral palsy who can walk unaided demonstrate impairments in higher level mobility such as running.Running is a motor skill that can be trained in children with cerebral palsy.Individually tailored running skills intervention, delivered in a group context can improve goal-identified running ability and translate into a higher frequency of participation in school activities.

Characteristics associated with physical activity capacity and performance in children and adolescents with an acquired brain injury

ABSTRACTAim: To examine characteristics associated with physical activity capacity and performance in children with acquired brain injury (ABI).Methods: 58 children (32 men; age 11 years 11 months ± 2 years 6 months; Gross motor function classification system [GMFCS] equivalent I = 29, II = 29) >12 months post ABI were recruited. Physical activity capacity measures included: (i) combined score of three 30-second repetition maximum functional strength exercises; (ii) timed up and go; (iii) 6-minute walk test and (iv) high-level mobility assessment tool (HiMAT). Physical activity performance determined time spent in sedentary, light and moderate to vigorous physical activity (MVPA). Full scale intelligence quotient (FSIQ) was assessed using the Wechsler intelligence scale for Children-IV. Regression models were constructed with functional strength score (n = 56), activity counts/minutes and time spent in MVPA and sedentary (n = 37).Results: The HiMAT and FSIQ explained 69% of the variance in functional strength. Age explained 12% of the variance in counts/min and 14% of the variance in time spent sedentary. GMFCS explained 10% of the variance in time spent in MVPA.Conclusions: The ability to perform functional strength exercises is associated with mobility beyond independence and adequate intellectual ability for children with ABI. Age was the most significant factor associated with physical activity performance, and interventions should target adolescents with ABI.

Lower-Limb Muscular Strength, Balance, and Mobility Levels in Adults Following Severe Thermal Burn Injuries.

Severe burn injuries are associated with hypermetabolic response and increased catabolism. These lead to a vast loss of muscle mass and reduced muscle strength and function. Therefore, the aim of this study is to determine the impact of severe burn injuries on lower-limb muscular strength, balance, and mobility level in adults. Forty burned adults with burned TBSA (burned TBSA) ≥40% participated in this study. The peak torque and total work of quadriceps and knee flexors were calculated at 150°/sec using Biodex isokinetic dynamometer. Balance and mobility were tested via the Biodex balance device and the high mobility assessment tool, respectively. Twenty-three matched nonburned healthy adults were evaluated and served as a control group. Severely burned adults exhibited significantly lower peak torque and total work in their quadriceps (27.50 and 22.58%, P < .05) and knee flexors (23.72, and 21.65%, P < .05) relative to the nonburned adults. Burned adults had a significant decrease in stability index and balance including the dynamic limits of stability (P < .05). The high mobility assessment tool scores were significantly lower (42 ± 7.64, P < .05) when compared with control subjects (51 ± 1.62). Patients who had severe burns (burned TBSA ≥ 40%) showed muscular weakness, limited balance, and mobility levels between 16 and 24 weeks after discharge from the hospital compared with matched nonburned control subjects. These results can guide therapists in creating rehabilitation programs that focus on the specific difficulties faced by burned patients.

Ankle plantarflexor spasticity is not differentially disabling for those who are weak following traumatic brain injury

Primary objectives: The main aim of this study was to determine whether the presence of distal lower-limb spasticity had a greater impact on mobility for those who had greater levels of muscle paresis following traumatic brain injury (TBI).Research design: This was a cross-sectional cohort study of convenience. Seventy-five people attending physiotherapy for mobility limitations following TBI participated in this study. All participants had sustained a moderate–severe TBI and were grouped according to the presence or absence of ankle plantarflexor spasticity for comparison.Main outcomes and results: The primary outcome measure for mobility was self-selected walking speed and the primary outcome measure for muscle strength was hand-held dynamometry. Secondary outcome measures for mobility and muscle strength were the High-level Mobility Assessment Tool (HiMAT) and ankle power generation (APG) at push-off. Spasticity was quantified with the Modified Tardieu scale. Participants with ankle plantarflexor spasticity (Group 2) had slower self-selected walking speeds. There was no statistically significant effect for Group and plantarflexor strength (p = 0.81).Conclusion: Although participants with ankle plantarflexor spasticity walked significantly slower than those without, the presence of ankle plantarflexor spasticity did not lead to greater mobility limitations for those who were weak.

French translation and psychometric properties of high level mobility assessment tool for people with neurological diseases: Preliminary results

The high-level mobility assessment tool (HiMAT) was developed to quantify balance and mobility problems after traumatic brain injury (TBI). The revised HiMAT is valid for people with neurological diseases. The aim of this cohort study was to translate and investigate the internal consistency, reliability of the French version in people with neurological conditions. The original version of HiMAT was translated into French, cross-culturally adapted and field tested. Patients were recruited from “L’Espoir” Rehabilitation Center. All patients were tested with the HiMAT (range of scores = 0 [worst] to 54 [best]). There was one day between 2 tests to avoid fatigue. Two testers independently rated patients. Testers were an experienced physiotherapist and a young physiotherapist (less than 1 year after graduate). Young physiotherapist was trained by a view of the test and the instructions sheet. Internal consistency was investigated with Cronbach alpha. Intraclass correlation coefficients (ICCs) were used for assessing interrater and intrarater reliability (HiMAT sum score and each HiMAT item). Minimal detectable change (MDC) for the HiMAT was estimated. A Friedman test was used to investigate the presence of a learning effect. Currently, 9 patients were included. Six had a stroke, 1 a Guillain-Barré syndrome, 1 a spinal cord tumor treated by neurosurgery and 1 had an unknown peripheral disease affecting lower limbs. The HiMAT had no floor or ceiling effect. Internal consistency was excellent ( α = . 975). Interrater and intrarater reliability of the HiMAT score was high (interrater ICC = . 99, intrarater ICC = . 99). The MDC was −2 to + 4 points. No learning effect occurred ( P = 0, 845). The French version of the HiMAT seems to be a reliable tool to measure high-level mobility in people with neurological conditions.

A Reliable Mobility Assessment Tool for Multidisciplinary Use

A Reliable Mobility Assessment Tool for Multidisciplinary Use

Test–re-test reproducibility of activity capacity measures for children with an acquired brain injury

Objective: To determine test–re-test reproducibility of the Timed Up & Go (TUG) test, 30-second repetition maximum (repmax) of functional exercises, 6-Minute Walk Test (6MWT) and High-level Mobility Assessment Tool (HiMAT) in children with Acquired Brain Injury (ABI). Secondarily, to assess the accuracy between hand-timed and video-timed scores for the TUG test and HiMAT.Methods: Thirty children at least 1 year post-ABI (mean age at assessment = 11 years 11 months, SD = 2 years 4 months; 14 males; Gross Motor Function Classification Scale I = 17, II = 13) were assessed twice. Intra-class correlation coefficients (ICC), standard error of measurement and minimum detectable change (MDC) were determined. The Bland-Altman method and 95% limits of agreement (LOA) were used to assess the agreement between hand and video-timed TUG test and HiMAT scores.Results: Test–re-test reproducibility was acceptable for the TUG test (ICC = 0.92; MDC = 1.2s); repmax of functional exercises (ICC = 0.84–0.98; MDC = 4–8 reps); 6MWT (ICC = 0.90; MDC = 69.38 m) and HiMAT (ICC = 0.98; MDC = 6). Comparison of hand and video scores for the TUG test and HiMAT demonstrated a mean difference of 0.23 (LOA = –0.3–0.7) and –0.07 (LOA = –1.99–1.85), respectively.Conclusions Test–re-test reproducibility of lower limb activity capacity measures in children with ABI are acceptable. The MDC scores provide a useful reference to interpret treatment effectiveness. Video timing was more accurate than hand-timing for the TUG test.

Ballistic strength training compared with usual care for improving mobility following traumatic brain injury: protocol for a randomised, controlled trial.

Traumatic brain injury is the leading cause of disability in young adults aged 15 to 45 years. Mobility limitations are prevalent, and range in severity from interfering with basic day-to-day tasks to restricting participation in higher level social, leisure, employment and sporting activities. Despite the prevalence and severity of physical impairments, such as poor balance and spasticity, the main contributor to mobility limitations following traumatic brain injury is low muscle power generation. Strengthening exercises that are performed quickly are termed 'ballistic' as they are aimed at improving the rate of force production and, hence, muscle power. This is compared with conventional strength training, which is performed slowly and aims to improve maximum force production, yet has limited impact on mobility. In people recovering from traumatic brain injury: (1) is a 12-week ballistic strength-training program targeting the three muscle groups critical for walking more effective than usual care at improving mobility, strength and balance; and (2) does improved mobility translate to better health-related quality of life? A prospective, multi-centre, randomised, single-blind trial with concealed allocation will be conducted. Participants will be patients with a neurologically based movement disorder affecting mobility as a result of traumatic brain injury. Patients will be recruited during the acute phase of rehabilitation (n=166), from brain injury units in large metropolitan hospitals in Melbourne and Sydney, Australia. For 12 weeks, participants in the experimental group will have three 60-minute sessions of usual physiotherapy intervention replaced by three 60-minute sessions of strength training (ballistic strength, gait). The three key muscle groups responsible for forward propulsion will be targeted: ankle plantarflexors, hip flexors and the hip extensors. Initial loads will be low, to facilitate high contraction velocities. Progression to higher loads will occur only if participants can perform the exercises ballistically. The control group will have their three 60-minute sessions of usual physiotherapy intervention (balance, strength, stretch, cardiovascular fitness, gait) standardised so that all participants have equivalent therapy time. Both groups will continue to receive usual rehabilitation. The primary outcome will be mobility, measured using the High Level Mobility Assessment Tool. The secondary outcomes will be walking speed, muscle strength, balance and health-related quality of life. Walking speed will be measured using the 10-m walking test. Strength will be measured by a 6 repetition maximum, seated, single leg press test. Balance will be measured as the single limb support time. Health-related quality of life will be measured using the Assessment of Quality of Life. Outcomes will be measured at baseline (0 months), at completion of the intervention phase (3 months), and 3 months after cessation of intervention (6 months). Baseline measures will be completed prior to randomisation. Assessors blinded to group allocation will perform all measures. Baseline characteristics of participants will be determined according to group, using descriptive statistics. The proportion of patients compliant with the intervention will be calculated according to group and compared using Fisher's exact test. Compliance with the intervention will be defined as those who have satisfactorily completed at least 80% of the allocated sessions (29 of 36 sessions). The between-group difference for all outcomes will be estimated using analysis of covariance, adjusting for baseline High Level Mobility Assessment Tool score, age, gender and length of post-traumatic amnesia. Analyses will be conducted on an intention-to-treat basis. Strength training in neurological rehabilitation is highly topical because muscle weakness has been identified as the primary impairment leading to mobility limitations in many neurological populations. This project represents the first international study of ballistic strength training after traumatic brain injury. The novelty of ballistic strength training is that the exercises attempt to replicate how lower limb muscles work, by targeting the high angular velocities attained during walking and higher level activities.

Randomized controlled trial of web-based multimodal therapy for children with acquired brain injury to improve gross motor capacity and performance

Objective: To compare efficacy of a web-based multimodal training programme, ‘Move it to improve it’ (MitiiTM), to usual care on gross motor capacity and performance for children with an acquired brain injury. Design: Randomized waitlist controlled trial. Setting: Home environment. Participants: A total of 60 independently ambulant children (30 in each group), minimum 12 months post-acquired brain injury were recruited and randomly allocated to receive either 20 weeks of MitiiTM training (30 minutes/day, six days/week, total 60 hours) immediately, or waitlisted (usual care control group) for 20 weeks. A total of 58 children completed baseline assessments (32 males; age 11 years 11 months ± 2 years 6 months; Gross Motor Function Classification System equivalent I = 29, II = 29). Intervention: The MitiiTM program comprised of gross motor, upper limb and visual perception/cognitive activities. Main measures: The primary outcome was 30-second, repetition maximum functional strength tests for the lower limb (sit-to-stand, step-ups, half-kneel to stand). Secondary outcomes were the 6-minute walk test, High-level Mobility Assessment Tool, Timed Up and Go Test and habitual physical activity as captured by four-day accelerometry. Results: Groups were equivalent at baseline on demographic and clinical measures. The MitiiTM group demonstrated significantly greater improvements on combined score of functional strength tests (mean difference 10.19 repetitions; 95% confidence interval, 3.26–17.11; p = 0.006) compared with the control group. There were no other between-group differences on secondary outcomes. Conclusion: Although the MitiiTM programme demonstrated statistically significant improvements in the functional strength tests of the lower limb, results did not exceed the minimum detectable change and cannot be considered clinically relevant for children with an acquired brain injury. Clinical Trial Registration: Australian New Zealand Clinical Trials Registration Number, ANZCTR12613000403730.

Self-reported Mobility in Older Patients Predicts Early Postoperative Outcomes after Elective Noncardiac Surgery

Specific geriatric assessment tools may complement traditional perioperative risk stratification. The aim of this study was to evaluate whether self-reported mobility is predictive of postoperative outcomes in older patients undergoing elective noncardiac surgery. Patients aged 69 yr or older (n = 197) underwent (1) traditional risk assessments (American Society of Anesthesiologists physical status classification and Revised Cardiac Risk Index), (2) five-point frailty evaluation, (3) self-reported mobility assessment using the Mobility Assessment Tool-short form (range, 30.21 [poor] to 69.76 [excellent]), and (4) measurements of high-sensitivity C-reactive protein. Outcomes were postoperative complications, time to discharge, and nursing home placement (NHP). In the sample of this study (mean age, 75 ± 5 yr; 51% women), 72% had intermediate- or high-risk surgery. Median time to discharge was 3 days (interquartile range, 1 to 4 days). Thirty patients (15%) developed postoperative complications, and 27 (13%) required NHP. After controlling for age, sex, body mass index, pain score, Revised Cardiac Risk Index, American Society of Anesthesiologist physical status, surgical risk, and high-sensitivity C-reactive protein, worse self-reported mobility (per 10-point decrease in Mobility Assessment Tool, which is equivalent to 1 SD) was associated with more postoperative complications (odds ratio [OR], 1.69; 95% CI, 1.05 to 2.73), later time to discharge (hazards ratio, 0.81; 95% CI, 0.68 to 0.96), and increased NHP (OR, 2.01; 95% CI, 1.13 to 3.56). By using the same model, intermediate frailty or frailty increased NHP (OR, 3.11; 95% CI, 1.02 to 9.54) but was not related to either postoperative complications or time to discharge. Preoperative self-reported mobility using a novel and brief assessment may help identify elderly patients at risk for adverse postoperative events.

High-level mobility skills in children and adolescents with traumatic brain injury

Aim: To evaluate the reliability, validity and responsiveness of the High-level Mobility Assessment Tool (HiMAT) in children and adolescents with traumatic brain injury (TBI) and to compare the mobility skills of children with TBI to those of healthy peers.Method: The mobility skills of 52 children with moderate and severe TBI (36 males; mean age = 12 years, range = 6–17) were assessed using the HiMAT and the Pediatric Evaluation of Disability Inventory (PEDI). Inter-rater reliability, re-test reliability and responsiveness of the HiMAT were evaluated in sub-groups by comparing results scored at several time-points. The HiMAT scores of children with TBI were compared with those of a healthy comparative cohort.Results: The HiMAT demonstrated excellent inter-rater reliability (ICC = 0.93), re-test reliability (ICC = 0.98) and responsiveness to change (p = 0.002). The PEDI demonstrated a ceiling effect in mobility assessment of ambulant children with TBI. The HiMAT scores of children with TBI were lower than those of their healthy peers (p < 0.001).Interpretation: The HiMAT is a reliable, valid and sensitive measure of high-level mobility skills following childhood TBI. The high-level mobility skills of children with TBI are less proficient than their peers.

Impact of Intensive Exercise on Physical Function of Adults with Chronic-Moderate-to-Severe Brain Injury

Objective(s): Effects of high-intensity group exercise on the endurance, advanced mobility, and gait speed of adults with chronic moderate-tosevere acquired brain injury (ABI) were investigated. Design: Prospective, non-randomized, unblinded interventional trial. Setting: Fitness center in a community based, supported, independent living environment. Participants: Fourteen adults with chronic moderate-to-severe ABI in supported independent living who could stand with minimal or no assist and walk with or without ambulation device and/or bracing were studied. Eight presented with low ambulatory status, and six had high ambulatory status at baseline. Interventions: Subjects received a 6-week high-intensity exercise group intervention for 90 minutes, 3 days/week assisted by personal trainers under physical therapist supervision. Strengthening (e.g. lifting free weights), endurance, balance exercises and stretching, as recommended by the American College of Sports Medicine. Main Outcome Measure(s): Six Minute Walk Test (6MWT); Gait speed; High Level Mobility Assessment Tool (HiMAT); Participation Objective, Participation Subjective (POPS); Self-Efficacy Scale. Results: Changes in impairment and activity limitation measures were statistically significant for the group and greater than the minimal detectable change (MDC) for this population. Average change on the 6MWT from baseline to after the intervention was greater than five times the MDC for people with chronic stroke. 10MWT outcomes indicate that three subjects transitioned from low to high ambulatory status and maintained the change six weeks later. Conclusions: People living with chronic ABI can significantly improve endurance, demonstrate ability to do advanced gait, and improve ambulatory status with six weeks of intensive exercise. Study impact on participation in community life is not yet known. Challenges to sustainability of exercise programs for people with chronic moderate-to-severe ABI remain.

Distribution of Lower Limb Spasticity Does Not Influence Mobility Outcome Following Traumatic Brain Injury: An Observational Study.

To examine the association between lower limb spasticity and mobility limitations following traumatic brain injury (TBI) and determine the influence of spasticity distribution on mobility outcomes following TBI. A large metropolitan rehabilitation hospital. Ninety-three ambulant people with TBI who were attending physiotherapy for mobility limitations. Cross-sectional cohort study. The High-Level Mobility Assessment Tool, gait velocity, and the Tardieu scale. Lower limb spasticity was common following TBI, with a distal distribution being the most prevalent. Participants with spasticity had significantly greater initial mobility limitations than participants without spasticity. However, the distribution of lower limb spasticity and the presence of unilateral or bilateral spasticity had no additional impact on mobility outcomes. There was no significant difference in mobility outcomes at the 6-month follow-up for people with spasticity, indicating that individuals have equivalent ability to improve their mobility over time despite the presence of spasticity. Following TBI, people with lower limb spasticity have significantly greater mobility limitations than those without spasticity, yet the presence and distribution of spasticity does not appear to impact mobility outcomes. There is long-term potential to improve mobility despite the presence of spasticity.

Assessing Walking Activity in Older Adults: Development and Validation of a Novel Computer-Animated Assessment Tool.

Assessing volume of physical activity (PA) in older adults is critical to understanding the role that PA has on health outcomes and the effectiveness of treatment interventions to increase PA. The purpose of this study was to investigate the psychometric properties of a novel computer-animated self-report questionnaire designed to assess walking activity of older adults: the Mobility Assessment Tool for Walking--the MAT-W. We recruited 249 older adults (66.9±4.7 years, 71% female, 32% black) with cardiovascular disease and/or metabolic syndrome as part of the Cooperative Lifestyle Intervention Program-II study. Participants completed the MAT-W at baseline and after 6 months of a walking and weight loss (n = 78) or weight loss only (n = 69) intervention. Test-retest reliability was assessed in 31 participants. Walking speed at usual and fast pace was measured using a GAITRite mat, and 7-day accelerometry data were collected at baseline and 6 months. The mCHAMPS5, a modified version of a widely used self-report PA questionnaire, was completed at baseline. The test-retest reliability of MAT-W was excellent (intraclass correlation coefficient > .85). The MAT-W was correlated with mCHAMPS5 (Spearman r = .66, p < .001) and moderate/vigorous levels of PA as assessed by accelerometry (Spearman r = .65, p < .001) and was responsive to an intervention-induced change in PA at 6 months when comparing the Cooperative Lifestyle Intervention Program-II walking and weight loss group with the weight loss only group (p < .001). The MAT-W is a brief, reliable, and valid tool to assess PA and has promise for the assessment of walking behavior in older adults under free-living conditions.

Severity and distribution of spasticity does not limit mobility or influence compensatory strategies following traumatic brain injury

Primary objectives: To determine whether the severity of lower limb spasticity had a differential effect on mobility following traumatic brain injury (TBI) and to investigate whether the distribution of lower limb spasticity influenced compensation strategies when walking.Research design: Ninety-three people attending physiotherapy for mobility limitations following TBI participated in this study. Participants were grouped according to the presence and distribution of lower limb spasticity for comparison.Main outcomes and results: Mobility was measured using a 10-metre walk test and the high level mobility assessment tool. Three dimensional gait analysis was used to measure power generation and spasticity was assessed using the Tardieu scale. No significant relationship was found between the severity of lower limb spasticity and mobility limitations. There was a strong relationship between ankle power generation and mobility performance. Proximal compensation strategies did not vary significantly between groups with different distributions of lower limb spasticity.Conclusion: The ability to generate ankle power has a large impact on mobility outcome following TBI. Although spasticity was prevalent, the severity and distribution did not appear to impact mobility outcomes. Proximal compensation strategies were not influenced by the distribution of lower limb spasticity following TBI.

A modified performance-oriented mobility assessment tool for assessing clinically relevant gait impairments and change in children with hypophosphatasia: development and validation

A modified performance-oriented mobility assessment tool for assessing clinically relevant gait impairments and change in children with hypophosphatasia: development and validation