Physiological Cost Index Of Walking Research Articles

Physiological Cost Index of Walking Performance Over Treadmill and Synthetic Track in Post-COVID Patients

Background A majority Covid patients discharged from the hospital suffered challenges with long-term complications such as fatigue shortness of breath and endurance. The energy demand increases in all the activities especially while walking. Data for identifying the efficiency of ambulation after COVID-19 infection is lacking. Objectives To identify the difference in the lsquoPhysiological Cost Indexrsquo of walking on the treadmill and on a synthetic track in individuals recovering from COVID-19.Methods A single-group repeated study design was adopted in which 11 COVID-19-recovered individuals participated following discharge from institutional care. The physiological cost index was estimated by walking on a synthetic track and treadmill. Medically stable adults discharged from Alvarsquos Health center following the diagnosis of COVID-19 were recruited for the study. The physiological cost index was measured in Alvas Fitmaxx Moodbidri Dakshina Kannada Karnataka.Results Walking speed heart rate and time taken were the variables measured and the physiological cost index was estimated from these variables. A significant P lt0.003 relationship between the physiological cost index of walking on a synthetic track and treadmill was established. The energy efficiency of walking on synthetic tracks was noted to be economical compared to treadmills.Conclusion Treadmill walking had no role in improving the physiological cost index of patients recovered from COVID-19 and hence any post-COVID outpatient rehabilitation is ideal to be performed on a synthetic track rather than on a treadmill. Future studies with larger sample sizes on various walking surfaces could validate the results of this present study.

Physiological Cost Index of Walking among Non Smokers, Smokers and Smokers with Chronic Obstructive Pulmonary DiseaseAn Observational Study

Introduction: Most of the Chronic Obstructive Pulmonary Disease (COPD) patients are smokers and their disease progresses with increasing age. The energy cost of walking has strong association with aging and cigarette smoking. Its implication in COPD remains unclear. Aim: To evaluate the Physiological Cost Index (PCI) of walking among non smokers, smokers and smokers with COPD and to find its association with age and duration of cigarette smoking. Materials and Methods: The cross-sectional study was carried out in the Department of Physical medicine and Rehabilitation (PMR) at Rajah Muthiah Medical College and Hospital, Annamalai University at Chidambaram, Tamil Nadu, India, from November 2019 to February 2020. The PCI was carried out in 77 males, aged between 50-75 years with body mass index between 18.5-24.9 kg/m2 . There were 24 smokers with COPD, 27 were smokers and 26 were non smokers. The evaluation of six minute walk distance, resting, and post walk heart rate was applied in MacGregor's equation to estimate the PCI. Results: The mean PCI of smokers with COPD was 0.67±0.3 which was significantly (p-value=0.001) higher than those of smokers (0.22±0.07) and non smokers (0.14±0.04). The smokers and non smokers had no significant variation in PCI (p-value=0.122). Age had no association with PCI (p-value=0.213) whereas the duration of smoking years was found to have significant association (p=0.014). Conclusion: The PCI was found to be significantly higher in smokers with COPD and a significant association was established with years of smoking rather than age.

Physiological Cost Index of Walking in Stroke Patients and their Functional Ambulation Category

Background: Mobility, defined as the ability to walk safely and independently, is integral to theperformance of basic activities of daily living.An interruption in the normal gait cycle and the energyconserving characteristics of the trunk and limb motion results in an increased energy expenditure.Objective: The objective of the study was to compare the Physiological Cost Index(PCI) of walking instroke survivors with their Functional Ambulation Category(FAC).Design:Cross Sectional StudyMethods: 30 participants meeting the inclusion and exclusion criteria were included in the study. Theparticipants were graded on FAC. Their heart rate(HR) was recorded pre- and post- 6-Minute-Walk-Test(6MWT). The distance walked was measured and recorded. The PCI was calculated and the datawas subjected to statistical analysis.Results: The mean PCI of all the participants was 0.72(±0.68). A moderate negative correlation existedbetween the PCI and FAC. The category of FAC increased as the patients PCI of walking decreased.Conclusion: Increased PCI values could imply lower functional mobility scores on FAC. Therapeuticinterventions that alter PCI values and interventions that effectively reduce energy consumption couldbe identified for better rehabilitation outcomes.

The physiological cost index of walking with a powered knee-ankle-foot orthosis in subjects with poliomyelitis: A pilot study.

A powered knee-ankle-foot orthosis was developed to provide restriction of knee flexion during stance phase and active flexion and extension of the knee during swing phase of gait. The purpose of this study was to determine its effect on the physiological cost index, walking speed and the distance walked in people with poliomyelitis compared to when walking with a knee-ankle-foot orthosis with drop lock knee joints. Quasi experimental study. Seven subjects with poliomyelitis volunteered for the study and undertook gait analysis with both types of knee-ankle-foot orthosis. Walking with the powered knee-ankle-foot orthosis significantly reduced walking speed (p = 0.015) and the distance walked (p = 0.004), and also, it did not improve physiological cost index values (p = 0.009) compared to walking with the locked knee-ankle-foot orthosis. Using a powered knee-ankle-foot orthosis did not significantly improve any of the primary outcome measures during walking for poliomyelitis subjects. This powered knee-ankle-foot orthosis design did not improve the physiological cost index of walking for people with poliomyelitis when compared to walking with a knee-ankle-foot orthosis with drop lock knee joints. This may have been due to the short training period used or the bulky design and additional weight of the powered orthosis. Further research is therefore warranted.

The physiological cost index of walking with mechanical and powered gait orthosis in patients with spinal cord injury

Mechanical orthoses, such as the hip knee ankle foot orthosis (HKAFO) and the isocentric reciprocating gait orthosis (IRGO), are both used for walking in spinal cord injury (SCI) patients. The aim of this study was to analyze the energy expenditure during walking with these orthoses compared with a powered gait orthosis (PGO) in patients with SCI. Five patients with SCI who were experienced users of HKAFOs participated in this study. Subjects were also fitted with an IRGO and PGO and underwent a specific gait training program. Patients walked along a flat walkway using the three types of orthosis at their self-selected walking speed. A stop watch and a polar heart rate monitor were used to measure the speed of walking and heart rate. Walking speed, the distance walked and the physiological cost index (PCI) all improved with both the new PGO and the IRGO as compared with the HKAFO. A PGO can improve walking speed and the distance walked and reduce the PCI of walking as compared with mechanical orthoses, probably due to the activated movements of the lower limb joints.

Measurement of physical performance and objective fatigability in people with mild-to-moderate traumatic brain injury

The aims of this study were to objectively measure the physical performance and physical endurance of patients with traumatic brain injury with minimization of cognitive and psychological fatigue, and to compare the physical performance of brain injured patients with that of healthy controls. This was a nonrandomized partially blinded controlled study. The study setting was the Outpatient Multidisciplinary Brain Injury Clinic in the Department of Physical Medicine and Rehabilitation of a tertiary care university teaching hospital. Participants included an experimental group that comprised independently ambulant men (age 18-55 years) with mild-to-moderate traumatic brain injury (n = 24) who complained of greater fatigue than before their injury and an age-matched and sex-matched control group (n = 24). The intervention included the Six-Minute Walk Test. The primary outcome measures were the Six-Minute Walk Distance, the Fatigue Severity Scale, Addenbrooke's Cognitive Examination, and the Fatigue Visual Numeric Scale; the secondary outcome measures were the Physiological Cost Index of Walking and the Borg Scale of Perceived Exertion. The Six-Minute Walk Distance of the experimental group (452.33+/-68.816) when compared with that of the control group (518.08+/-92.114) was reduced by 12.7 and 30.5%, respectively, when compared with the predicted Six-Minute Walking Distance (650.04+/-79.142) for the same age and sex. The mean Fatigue Severity Scale values were 2.51 and 1.62 for the experimental and control groups, respectively. The mean Addenbrooke's Cognitive Examination Score for the patients was 85.5+/-7.265. In conclusion, the Six-Minute Walk Test is useful in segregating physical fatigue from cognitive and psychological aspects of fatigue when cognitive and psychological dimensions are known. The Six-Minute Walk Test can be used as a tool for exercise intensity prescription in men with mild-to-moderate brain injury, to avoid the deleterious effects of fatigue.

Un test d’escalier dans l’évaluation des patients atteints de BPCO

Patients suffering from Chronic Obstructive Pulmonary Disease (COPD) are usually evaluated for cardio-respiratory capacity on a flat surface even though these patients generally encounter discomfort only when climbing stairs or ascending a slope. The purpose of this study was to describe the cardio-respiratory evaluation of these patients on climbing stairs. A staircase test was carried out and compared to the 6-min walking test. The maximum duration of ascent was 2 min, covering a maximum of four flights of stairs. The conditions of the staircase test and the instructions given to the patients regarding walking were designed to be consistent with the activities of daily life. We recorded the height reached and the distance covered; we also recorded dyspnoea, oxygen saturation (SpO2) and heart rate (HR); we estimated the maximal oxygen consumption (VO2max) and the physiological cost index (PCI) during each test. The statistical analysis of the results was surprising: it showed that there was no significant difference between the 6-min walking test and the stair climbing test on the following criteria: estimated VO2max, SpO2, and variation in heart rate between rest and effort (DeltaHR); it also showed that these two tests correlated well for dyspnoea (p<0.0001). It appears that the PCI of stair climbing is much higher than the PCI of walking on a level surface. These results may be explained partly by the anaerobic metabolic pathway used predominantly by patients with COPD in brief periods of exertion and partly by the muscular dysfunction which also accompanies brief exertion. The use of the PCI adds greater precision to the interpretation of the results of cardio-respiratory evaluation of COPD patients. The value of this index is proportional to the incapacity described by these patients. The staircase test is complementary to the 6-min walking test, making it possible to evaluate restriction of activity in COPD patients. Its implementation is simple and accessible.

The Physiological Cost Index of Walking with an Isocentric Reciprocating Gait Orthosis Among Patients with T12–L1 Spinal Cord Injury

The objective of this study was to compare the Physiological Cost Index of walking with a reciprocating gait orthosis to that of walking with bilateral knee-ankle-foot orthoses (KAFOs) by subjects with paraplegia resulting from T(12) - L(1) spinal cord lesions. Six chronic paraplegic subjects who had T(12) - L(1) spinal cord lesions and who previously wore bilateral KAFOs were recruited. Each subject was fitted with an isocentric reciprocating gait orthosis (IRGO) and received a standardized training program. Subjects were then asked to walk using the two orthotic devices along a 40 m rectangular pathway at a speed that was comfortable for them. The walking speed was measured using a stop watch, and a Polar Heart Rate Monitor was used to measure the heart rate of the subjects. The Physiological Cost Index (PCI) was calculated for comparison. Ambulation using the IRGO (10.46 +/- 2.00 m/min) was significantly faster (p = 0.009) than ambulation using the bilateral KAFOs (5.51 +/- 4.30 m/min). The PCI demonstrated when walking with the IRGO (2.85 +/- 0.77 beats/m) was significantly lower (p = 0.0306) than that of the bilateral KAFOs (6.77 +/- 3.28 beats/m). Paraplegic patients with T(12) - L(1) spinal cord lesions walk faster and more efficiently using the isocentric reciprocating gait orthosis as compared to using the bilateral KAFOs.

22.17 An investigation of the physiological cost index of walking

Physiological energy expenditure measurement has proven to be a reliable method of quantitatively assessing the penalties imposed by gait disability. The purpose of this review is to outline the basic principles of exercise physiology relevant to human locomotion; detail the energy expenditure of normal walking; and summarize the results of energy expenditure studies performed in patients with specific neurologic and orthopedic disabilities. The magnitude of the disabilities and the patients’ capacity to tolerate the increased energy requirements are compared. This paper also will examine the effectiveness of rehabilitation interventions at mitigating the energetic penalties of disability during ambulation.

Effects of joint motion constraints on the gait of normal subjects and their implications on the further development of hybrid fes orthosis for paraplegic persons

In this study the effects of angular motion constraints of the lower limbs on the gait of normal subjects were investigated. An assessment orthosis was developed with a new hip coupling mechanism which allows its ratio of reciprocal flexion to extension to be altered. The knee and ankle joints of the orthosis could also be set to be free or locked in specific directions of angular motion in the sagittal plane. A total of 12 different orthosis configurations was tested on three normal subjects. The kinematic, kinetic and electromyographic (EMG) data were collected using the VICON system, two Kistler forceplates, foot switches and an eight channel EMG system. The physiological cost index of walking was assessed by measuring the heart rate and walking speed. It was found that (1) a higher hip flexion-extension ratio was associated with lower energy cost and faster walking; (2) allowing the knee to flex significantly reduced the energy cost and increased the walking speed; (3) allowing the ankle to plantarflex during early stance phase reduced the knee flexing moment. The implications of these effects on the further development of hybrid functional electrical stimulation orthotic systems are discussed.

Physiological cost index of walking in able-bodied adolescents and adults

Fifty-four able-bodied adolescents and 40 adults were assessed in the gait laboratory using an infrared telemetry system. Physiological Cost Index (PCI) of walking ranged from 0.15 beats/metre (b/m) to 0.65 b/m (mean 0.35 b/m, SD 0.09) in adolescents and from 0.2 b/m to 0.55 b/m (mean 0.36 b/m, SD 0.08) in adults. There was no significant difference between median values of PCI in the two study groups. It would appear that the range of PCI values is similar for all age groups. Adult males showed lower PCI than adult females (males 0.31 b/m, SD 0.07 and females 0.4 b/m, SD 0.07; p &lt; 0.001). Quetelet Index of each subject was taken into consideration in order to standardize subjects' body mass and height. There was no correlation between the PCI and the Quetelet Index in either group. Estimation of PCI is a convenient and reliable method to monitor changes in the energy expenditure of walking, is relatively easy and does not require elaborate instrumentation.