Gait Training Research Articles

EFFECTIVENESS OF STRENGTHENING EXERCISES IN IMPROVING FUNCTIONAL ACTIVITIES OF HEMIPLEGIC PATIENTS

Background of the Study: To determine the Effectiveness of Strengthening (Resistance) exercises in improving functional activities such as gross motor function and walking stance in stroke patients. Methodology: A Quasi experimental study was conducted. A Quasi experimental study was conducted; patients were selected from the OPD setting of Dr. Ziauddin Hospital, Saifee Hospital and the National medical center. Data was divided into two groups. Group 1 case and group 2 controls. The patients included in group 1, received Strengthening exercises. While, the other group received exercises other than strengthening such as Balance and Coordination Exercises, Flexibility Exercises, Functional Training and Gait Training, after which their improvement was recorded at the end of 4 weeks for 3 months. The critical outcomes evaluated subsequently to resistance training using therabands and minimal weights along with gait assessment, and functional training. Gait assessment, post-treatment using a 6-minute walk test (6MWT) and functional activities assessment scales using a Barthel Index. Results: The clinical intervention revealed significant results, showing that strength on the effected side increased post treatment as the calculated P-value was less than 0.05, also the mean leg strength for the RT group (pre walk_ 1.94 and 2.28 for control at baseline improved (post walk _to 2.71 for RT group and 1.60 for controls respectively after 3 months., suggested that resistance training produced marked improvement in performing functional activities of hemiplegic patients. Conclusions: Hence, it is concluded that the strengthening exercises including resistance band training and physio ball for upper limb and resistance training for lower limb were shown to improve Muscle strength and cause considerable improvement in performing the activities of everyday living and gait strength and core stability in patients suffering from stroke. Also, improving their social interactions and participation in everyday life.

Evidence that robot-assisted gait training modulates neuroplasticity after stroke: An fMRI pilot study based on graph theory analysis

ObjectivesTo investigate alterations of whole-brain network after stroke and therapeutic mechanisms of robot-assisted gait training (RAGT). Methods21 stroke patients and 20 healthy subjects were enrolled, with the stroke patients randomized to either control group (n = 11) or robot group (n = 10), and resting-state functional magnetic resonance imaging data were collected. The global network metrics were obtained using graph theory analysis and compared between stroke patients and healthy subjects, and the effect of the RAGT on the whole-brain networks was explored. ResultsCompared to healthy subjects, area under the curve (AUC) for small-worldness (σ), clustering coefficient (Cp), global efficiency (Eg) and mean local efficiency (Eloc) were significantly lower in stroke patients, whereas AUC for characteristic path length (Lp) were significantly higher. Compared with the control group, patients in robot group showed significant improvement in lower limb motor function, balance function and walking function after intervention, with a significant reduction in the AUC of Cp. Moreover, the improvement of walking function was positively correlated with the changes of AUC of σ and Eg, and negatively correlated with the changes of AUC of Cp. ConclusionsSmall-worldness and network efficiency were significantly reduced after stroke, whereas RAGT decreased characteristic path length and promoted normalization of the whole-brain network, and this change was associated with improvement in walking function. Our findings reveal the mechanism by which RAGT regulates network reorganization and neuroplasticity after stroke.

A Study on the Design of Knee Exoskeleton Rehabilitation Based on the RFPBS Model.

The gait rehabilitation knee exoskeleton is an advanced rehabilitative assistive device designed to help patients with knee joint dysfunction regain normal gait through training and activity support. This paper introduces a design framework based on the process knowledge representation method to optimize the design and control efficiency of the knee exoskeleton. This framework integrates knowledge of design objects and processes, specifically including requirements, functions, principle work areas, and the representation and multi-dimensional dynamic mapping of the Behavior-Structure (RFPBS) matrix, achieving multi-dimensional dynamic mapping of the knee exoskeleton. This method incorporates biomechanical and physiological knowledge from the rehabilitation process to more effectively simulate and support gait movements during rehabilitation. Research results indicate that the knee rehabilitation exoskeleton design, based on the RFPBS process knowledge representation model, accomplishes multi-dimensional dynamic mapping, providing a scientific basis and effective support for the rehabilitation of patients with knee joint dysfunction.

Comparative effectiveness of exercise on cardiorespiratory function or exercise efficiency after stroke: A network meta-analysis of randomized control trials.

The network meta-analysis (NMA) was to compare and rank the effectiveness of different exercises on cardiorespiratory function or exercise efficiency in post-stroke patients. A NMA of randomized controlled trials (RCTs) was conducted. PubMed, Embase, Cochrane Library, and Web of Science were searched. The impact of exercises including individual and combination of aerobic exercise (AE), resistance exercise (RE), task-oriented training (TOT), gait training (GT), breathing exercise (BE), and regular rehabilitation training (RRT) on 6-min walk test (6MWT), peak oxygen consumption (VO2peak), maximum oxygen consumption (VO2max), resting heart rate (HRrest), resting systolic blood pressure (SBPrest), and resting diastolic blood pressure (DBPrest) were assessed. In total, 36 studies were included in the meta-analysis. AEGT (AE + GT) (63.06%) had the highest likelihood of improving 6MWT performance in post-stroke patients. RRTRE (RRT + RE) was the most favourable exercise in terms of 6MWT performance assessing by minimum clinically significant difference (MCID). AERE (AE + RE) had the highest likelihood of improving VO2peak and reducing HRrest in post-stroke patients. Different types of exercise demonstrated the benefits of improving cardiorespiratory function in stroke patients. Further research is needed to determine the best exercise regimen to maximize the benefits of rehabilitation interventions for post-stroke patients.

Combining Neuromodulation Strategies in Spinal Cord Injury Gait Rehabilitation: A Proof of Concept, Randomized, Crossover Trial

ObjectivesTo evaluate if acute intermittent hypoxia (AIH) coupled with transcutaneous spinal cord stimulation (tSCS) enhances task-specific training and leads to superior and more sustained gait improvements as compared with each of these strategies used in isolation in persons with chronic, incomplete spinal cord injury. DesignProof of concept, randomized crossover trial. SettingOutpatient, rehabilitation hospital. InterventionsTen participants completed 3 intervention arms: (1) AIH, tSCS, and gait training (AIH + tSCS); (2) tSCS plus gait training (SHAM AIH + tSCS); and (3) gait training alone (SHAM + SHAM). Each arm consisted of 5 consecutive days of intervention with a minimum of a 4-week washout between arms. The order of arms was randomized. The study took place from December 3, 2020, to January 4, 2023. Main Outcome Measures10-meter walk test at self-selected velocity (SSV) and fast velocity, 6-minute walk test, timed Up and Go (TUG) and secondary outcome measures included isometric ankle plantarflexion and dorsiflexion torque ResultsTUG improvements were 3.44 seconds (95% CI: 1.24-5.65) significantly greater in the AIH + tSCS arm than the SHAM AIH + tSCS arm at post-intervention (POST), and 3.31 seconds (95% CI: 1.03-5.58) greater than the SHAM + SHAM arm at 1-week follow up (1WK). SSV was 0.08 m/s (95% CI: 0.02-0.14) significantly greater following the AIH + tSCS arm than the SHAM AIH + tSCS at POST. Although not significant, the AIH + tSCS arm also demonstrated the greatest average improvements compared with the other 2 arms at POST and 1WK for the 6-minute walk test, fast velocity, and ankle plantarflexion torque. ConclusionsThis pilot study is the first to demonstrate that combining these 3 neuromodulation strategies leads to superior improvements in the TUG and SSV for individuals with chronic incomplete spinal cord injury and warrants further investigation.

Subtrochanteric Femoral Derotation Osteotomy for Correcting Idiopathic Excessive Femoral Anteversion with Intoeing Gait: A Case Report

Abstract Intoeing gait is a prevalent pediatric condition characterized by an inward rotation of the feet during ambulation. Primary causes include metatarsus adductus, internal tibial torsion and increased femoral anteversion. Hereby, we describe a case of subtrochanteric femoral derotation osteotomy in idiopathic excessive femoral anteversion. We present a case of 10-year-old child who had a complaint of hip pain. The main concerns of his parents were inward rotation of foot and frequent falls while walking. Upon clinical examination, he had negative foot progression angle with intoeing gait, decreased external rotation, and increased internal rotation of hip: Craigs test demonstrated increased femoral anteversion. On radiographs, no hip pathology was found. Upon CT scan, femoral anteversion of right side was found 40° and 42° on the left side. He was prescribed vigorous physiotherapy and gait training. But even after 6 months, his symptoms failed to improve. He was then considered for proximal femoral derotation osteotomy. Post-operatively, his intoeing got corrected with improvement of external rotation and foot progression angle. At 1 year follow-up, his hip pain and frequent falls stand corrected. Excessive femoral anteversion is a frequent cause of intoeing gait in children and can also present with unexplained hip, thigh and knee pain. Subtrochanteric femoral derotational corrective osteotomy can certainly be a procedure of choice in carefully selected cases, and it also comes with a very favorable outcome.

The Effectiveness of Strengthening Exercise on Improving Physical Function in Chronic Dialysis with Comorbidity: A Case Study

BACKGROUND: Individuals living with End stage renal disease (ESRD) on long term hemodialysis (HD) generally has a sedentary life style. This leads to reduction of physical function and poor quality of life. Exercise intervention improves muscular strength, physical fitness and Quality of life (QOL) in maintained hemodialysis Individuals. CASE SCENARIO: A 67-year-old female presented with chronic hemodialysis period was carried on wheelchair with the help of relative as she was referred to physiotherapy department with chief complain of weakness in both lower limb and difficulty in walking for 1 year. In this case along with chronic dialysis related dysfunction, patient had atherosclerosis had an acute coronary event and she was on AKT since last one year as she was having pott’s spine. METHODOLOGY: In our evaluation, she had full range of motion of lower limb with muscle weakness by manual muscle testing (MMT=3-4/5), Reduced balance and physical performance by short physical performance battery (SPPB=4/12), and partially dependent for functional activity by functional independent measure (FIM= 81/126). In Physiotherapy intervention: Exercise program started with active exercise, cycling, balance and gait training. Progressively in active exercise increased weight with weight cuff, increase cycling time and task specific balance activities with independent walking each week. RESULT: After four week of intervention improvement in muscle strength (MMT=4-5/5), balance (SPPB=7/12), minimal assistance in functional activities (FIM=109/126). CONCLUSION: Individualized strengthening exercise program improve physical function and muscle strength in chronic dialysis patient. Keywords: Hemodialysis, physical function, muscle strength.

Short Step Length Estimation for Parkinson's Disease Patients by Using Fusion Data From Camera-IMU in Smart Glasses.

Shortened step length is a prominent motor abnormality in Parkinson's disease (PD) patients. Current methods for estimating short step length have the limitation of relying on laboratory scenarios, wearing multiple sensors, and inaccurate estimation results from a single sensor. In this paper, we proposed a novel method for estimating short step length for PD patients by fusing data from camera and inertial measurement units in smart glasses. A simultaneous localization and mapping technique and acceleration thresholding-based step detection technique were combined to realize the step length estimation. Two sets of experiments were conducted to demonstrate the performance of our method. In the first set of experiments with 12 healthy subjects, the proposed method demonstrated an average error of 8.44% across all experiments including six fixed step lengths below 30 cm. The second set of straightly walking experiments were implemented with 12 PD patients, the proposed method exhibited an average error of 4.27% compared to a standard gait evaluation technique in total walking distance. Notably, among the results of step lengths below 40 cm, our method agreed with the standard technique (R 2=0.8659). This study offers a promising approach for estimating short step length for PD patients during smart glasses-based gait training.

Intrinsic Risk Factors for Lateral Ankle Sprains in Adolescent Soccer Players: A Prospective Cohort Study

Lateral ankle sprain (LAS) is the most common injury in Korean adolescent soccer players. However, intrinsic risk factors for LAS in adolescent soccer players remain unclear. Therefore, this prospective cohort study aimed to identify intrinsic risk factors for LAS in Korean adolescent soccer players. This study included 100 adolescent soccer players (age=13.21±0.95 years, height=1.62±0.09 m, weight=53.37±9.54 kg, BMI-for-age percentile=63.78±20.89%, athletic career=3.95±1.96 years). Baseline measurements were performed in the preseason, and the injury surveillance on LAS was conducted for 1 year. Independent variables included participants’ demographic and anthropometric data, self-reported questionnaire, lower extremity alignments, range of motion, static, and dynamic balance, coordination, and ankle kinematics during running. Independent t-test and Chi-square analysis were used for potential risk factors, which were imported to the binary logistic regression to identify intrinsic risk factors for LAS. Data on intrinsic risk factors identified by the logistic regression were analyzed using the receiver operating characteristic curve analysis to determine a cutoff point of each variable. In this study, age, body mass index, previous LAS history, the number of LAS history, and maximum dorsiflexion and inversion during the stance phase of running were potential risk factors for LAS. Our major findings showed that decreased dorsiflexion and increased inversion at initial contact during running significantly affected LAS occurrence in Korean adolescent soccer players. Considering our major findings, to prevent LAS in adolescent soccer players, gait training must not be overlooked and should be included in warm-up sessions.

Current Trends in Effectiveness of Robotic Assisted Gait Training (RAGT) for Gait Recovery in Neuro Rehabilitation - An Evidence-Based Scoping Review

Robotic-assisted gait training plays a pivotal role in the rehabilitation of individuals recovering from post-stroke and post-spinal cord injuries. By employing sophisticated robotics, this therapy facilitates repetitive, task-specific movements essential for relearning walking patterns. The precision and customisation of robotic systems ensure tailored interventions targeting specific impairments. Moreover, these technologies provide real-time feedback, enhancing patient engagement and motivation. In this review, 11 articles were finalized for review, five were for post-stroke rehabilitation and 6 for spinal cord injuries. Results show that there is improvement in Spatiotemporal parameters of gait, functional outcomes and quality of life. In Conclusion, robotic-assisted gait training ultimately accelerates recovery, improves functional outcomes, and restores independence, profoundly impacting rehabilitation effectiveness. KEYWORDS: Assistive technology, Robotics, Gait parameters, Neurorehabilitation, Functional outcome.

Clinical machine learning predicting best stroke rehabilitation responders to exoskeletal robotic gait rehabilitation

BACKGROUND: Although clinical machine learning (ML) algorithms offer promising potential in forecasting optimal stroke rehabilitation outcomes, their specific capacity to ascertain favorable outcomes and identify responders to robotic-assisted gait training (RAGT) in individuals with hemiparetic stroke undergoing such intervention remains unexplored. OBJECTIVE: We aimed to determine the best predictive model based on the international classification of functioning impairment domain features (Fugl– Meyer assessment (FMA), Modified Barthel index related-gait scale (MBI), Berg balance scale (BBS)) and reveal their responsiveness to robotic assisted gait training (RAGT) in patients with subacute stroke. METHODS: Data from 187 people with subacute stroke who underwent a 12-week Walkbot RAGT intervention were obtained and analyzed. Overall, 18 potential predictors encompassed demographic characteristics and the baseline score of functional and structural features. Five predictive ML models, including decision tree, random forest, eXtreme Gradient Boosting, light gradient boosting machine, and categorical boosting, were used. RESULTS: The initial and final BBS, initial BBS, final Modified Ashworth scale, and initial MBI scores were important features, predicting functional improvements. eXtreme Gradient Boosting demonstrated superior performance compared to other models in predicting functional recovery after RAGT in patients with subacute stroke. CONCLUSION: eXtreme Gradient Boosting may be an invaluable prognostic tool, providing clinicians and caregivers with a robust framework to make precise clinical decisions regarding the identification of optimal responders and effectively pinpoint those who are most likely to derive maximum benefits from RAGT interventions.

Wearable biofeedback device to assess gait features and improve gait pattern in people with parkinson’s disease: a case series

IntroductionPeople with Parkinson’s Disease (PD) show abnormal gait patterns compromising their independence and quality of life. Among all gait alterations due to PD, reduced step length, increased cadence, and decreased ground-reaction force during the loading response and push-off phases are the most common. Wearable biofeedback technologies offer the possibility to provide correlated single or multi-modal stimuli associated with specific gait events or gait performance, hence promoting subjects’ awareness of their gait disturbances. Moreover, the portability and applicability in clinical and home settings for gait rehabilitation increase the efficiency in the management of PD. The Wearable Vibrotactile Bidirectional Interface (BI) is a biofeedback device designed to extract gait features in real-time and deliver a customized vibrotactile stimulus at the waist of PD subjects synchronously with specific gait phases. The aims of this study were to measure the effect of the BI on gait parameters usually compromised by the typical bradykinetic gait and to assess its usability and safety in clinical practice.MethodsIn this case series, seven subjects (age: 70.4 ± 8.1 years; H&Y: 2.7 ± 0.3) used the BI and performed a test on a 10-meter walkway (10mWT) and a two-minute walk test (2MWT) as pre-training (Pre-trn) and post-training (Post-trn) assessments. Gait tests were executed in random order with (Bf) and without (No-Bf) the activation of the biofeedback stimulus. All subjects performed three training sessions of 40 min to familiarize themselves with the BI during walking activities. A descriptive analysis of gait parameters (i.e., gait speed, step length, cadence, walking distance, double-support phase) was carried out. The 2-sided Wilcoxon sign-test was used to assess differences between Bf and No-Bf assessments (p < 0.05).ResultsAfter training subjects improved gait speed (Pre-trn_No-Bf: 0.72(0.59,0.72) m/sec; Post-trn_Bf: 0.95(0.69,0.98) m/sec; p = 0.043) and step length (Pre-trn_No-Bf: 0.87(0.81,0.96) meters; Post-trn_Bf: 1.05(0.96,1.14) meters; p = 0.023) using the biofeedback during the 10mWT. Similarly, subjects’ walking distance improved (Pre-trn_No-Bf: 97.5 (80.3,110.8) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.028) and the duration of the double-support phase decreased (Pre-trn_No-Bf: 29.7(26.8,31.7) %; Post-trn_Bf: 27.2(24.6,28.7) %; p = 0.018) during the 2MWT. An immediate effect of the BI was detected in cadence (Pre-trn_No-Bf: 108(103.8,116.7) step/min; Pre-trn_Bf: 101.4(96.3,111.4) step/min; p = 0.028) at Pre-trn, and in walking distance at Post-trn (Post-trn_No-Bf: 112.5(97.5,124.5) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.043). SUS scores were 77.5 in five subjects and 80.3 in two subjects. In terms of safety, all subjects completed the protocol without any adverse events.ConclusionThe BI seems to be usable and safe for PD users. Temporal gait parameters have been measured during clinical walking tests providing detailed outcomes. A short period of training with the BI suggests improvements in the gait patterns of people with PD. This research serves as preliminary support for future integration of the BI as an instrument for clinical assessment and rehabilitation in people with PD, both in hospital and remote environments.Trial registrationThe study protocol was registered (DGDMF.VI/P/I.5.i.m.2/2019/1297) and approved by the General Directorate of Medical Devices and Pharmaceutical Service of the Italian Ministry of Health and by the ethics committee of the Lombardy region (Milan, Italy).

Effects of Early Gait Training on Inpatient Frailty After Transcatheter Aortic Valve Implantation.

This study aimed to clarify the relationship between the number of days of early gait training and frailty in in-hospital patients undergoing transcatheter aortic valve implantation (TAVI) for aortic stenosis, focusing on the Clinical Frailty Scale (CFS) and clinical laboratory data. Sixty-nine patients admitted to the Ichinomiya West Hospital from November 1, 2019 to November 30, 2023 were included in the study. Of the 69 patients, those who started gait training on postoperative day 0 or 1 were defined as the early gait training group and those who started gait training later than postoperative day 1 were defined as the delayed gait training group. There was a significant difference in the number of days to gait training initiation, which was 3.9 days in the delayed gait training group and 0.9 days in the early gait training group. The early gait training group started early mobilization and had a significantly shorter postoperative hospital stay than the delayed gait training group. Clinical laboratory data showed that walking speed was significantly faster and grip strength was significantly higher in the early group. The number of days to gait training initiation was an independent predictor of changes in CFS scores. Early gait training in patients after TAVI may predict early improvements in physical function and movement, shorter hospital stay, and frailty at discharge.

Facilitators and Barriers to Implementing High-Intensity Gait Training in Inpatient Stroke Rehabilitation: A Mixed-Methods Study.

(1) Background: High-intensity gait training (HIT) is a recommended intervention that improves walking function (e.g., speed and distance) in individuals who are undergoing stroke rehabilitation. This study explored clinicians' perceived barriers and facilitators to implementing HIT utilizing a mixed-methods approach comprising a survey and exploratory qualitative research. (2) Methods: Clinicians (n = 13) who were implementing HIT at three facilities participated. We collected and analyzed data using the consolidated framework for implementation research. Three focus groups were recorded and transcribed, and data were coded and thematically categorized. (3) Results: Survey results identified that the facilitators with a strong impact on implementation were access to knowledge/resources and intervention knowledge/beliefs. The only agreed-upon barrier with a strong impact was lack of tension for change. The focus groups resulted in 87 quotes that were coded into 27 constructs. Frequently cited outer setting facilitators were cosmopolitanism and peer pressure, and the only barrier was related to the patient needs. Innovation characteristics that were facilitators included relative advantage and design quality and packaging, and complexity was a barrier. Inner setting facilitators included networks and communication, learning climate, leadership engagement, and readiness for implementation. However, communication, leadership engagement, and available resources were also barriers. Regarding characteristics of individuals, knowledge and beliefs were both barriers and facilitators. In the implementation process domain, common facilitators were formally appointed implementation leaders and innovation participants. Barriers in this domain were related to the patients. (4) Conclusions: Clinicians identified many barriers and facilitators to implementing HIT that often varied between facilities. Further research is warranted to deepen our understanding of clinicians' experiences with HIT implementation.

Modeling Neuromotor Adaptation to Pulsed Torque Assistance During Walking.

Multiple mechanisms of motor learning contribute to the response of individuals to robot-aided gait training, including error-based learning and use-dependent learning. Previous models described either of these mechanisms, but not both, and their relevance to gait training is unknown. In this paper, we establish the validity of existing models to describe the response of healthy individuals to robot-aided training of propulsion via a robotic exoskeleton, and propose a new model that accounts for both use-dependent and error-based learning. We formulated five state-space models to describe the stride-by-stride evolution of metrics of propulsion mechanics during and after robot-assisted training, applied by a hip/knee robotic exoskeleton for 200 consecutive strides. The five models included a single-state, a two-state, a two-state fast and slow, a use-dependent learning (UDL), and a newly-developed modified UDL model, requiring 4, 9, 5, 3, and 4 parameters, respectively. The coefficient of determination (R 2) and Akaike information criterion (AIC) values were calculated to quantify the goodness of fit of each model. Model fit was conducted both at the group and at the individual participant level. At the group level, the modified UDL model shows the best goodness-of-fit compared to other models in AIC values in 15/16 conditions. At the participant level, both the modified UDL model and the two-state model have significantly better goodness-of-fit compared to the other models. In summary, the modified UDL model is a simple 4-parameter model that achieves similar goodness-of-fit compared to a two-state model requiring 9 parameters. As such, the modified UDL model is a promising model to describe the effects of robot-aided gait training on propulsion mechanics.

Postoperative Rehabilitation Program for Increasing Muscle Mass in Patients With Hip Fracture: A Retrospective Study.

Hip fractures are most likely to occur in older people, and after hip surgery muscle mass and the ability to perform activities of daily living often decline. In this study, we conducted inpatient rehabilitation after surgery for hip fracture and measured changes in muscle mass and physical performance. We retrospectively analyzed patients aged 65 years or older who underwent surgery (prosthetic replacement or internal fixation) and inpatient rehabilitation for hip fracture at our hospital between August and December 2020. The training included a joint range of motion exercise, muscle-strengthening exercise, gait training, early mobilization training, and neuromuscular electrical stimulation. We measured the following factors after one and six weeks postoperatively: muscle mass, body weight, fat mass, grip strength, bilateral knee extension strength, ability to walk, and ability to perform activities of daily living. Seventeen patients were included. Median age was 84 years (interquartile range, 72-90). Lower limbs skeletal muscle mass increased(median 4.8 kg to 4.9 kg, p = 0.045), while upper limbs skeletal muscle mass and body weight decreased(median 1.2 kg to 1.1 kg, p = 0.0027), (median 46.8 kg to 45.5 kg, p = 0.0039), respectively. Total skeletal muscle mass and fat mass remained unchanged. Grip strength was maintained, and knee extension muscle strength on the healthy and affected sides increased (healthy side median 10.7 kgf to 13.7 kgf, p = 0.019; affected side median 5.5 kgf to 9.5 kgf, p < 0.001). All patients exhibited improved ability to perform activities of daily living; however, 52.9% of patients regained their pre-injury walking ability. Our rehabilitation program increased lower limbskeletal muscle mass in patients with hip fractures.

A gamified virtual environment intervention for gait rehabilitation in Parkinson’s Disease: co-creation and feasibility study

BackgroundTreadmill gait training has been shown to improve gait performance in People with Parkinson’s Disease (PwPD), and in combination with Virtual Reality, it can be an effective tool for gait rehabilitation. The addition of gamification elements can create a more stimulating and adherent intervention. However, implementation of new technologies in healthcare can be challenging. This study aimed to develop and evaluate the feasibility of a treadmill rehabilitation program in a Gamified Virtual Reality Environment (GVRE) for PwPD.MethodsThe GVRE was developed following a user-centered design approach, involving both PwPD and physiotherapists in the development and evaluation of the intervention. The intervention consisted of a walking simulation in three different environments (countryside, city, and park), which had a progressive increase in difficulty. To test its feasibility, three sessions were carried out with four PwPD and four physiotherapists. To assess the usability, the System Usability Scale (SUS), Assistive Technology Usability Questionnaire for people with Neurological diseases (NATU Quest) and Simulator Sickness Questionnaire (SSQ) were used. To assess the intervention’s acceptability, feedback and in-game performance was collected from participants.ResultsResults showed the feasibility of the intervention, with a SUS score of 74.82 ± 12.62, and a NATU Quest score of 4.49 ± 0.62, and positive acceptability feedback. Participants showed clear preferences for naturalistic environments, and gamification elements were seen as positive. Difficulty settings worked as intended, but lowered enjoyment of the experience in some cases.ConclusionsThis intervention was successfully shown as a feasible option for the training of gait under Dual Task conditions for PwPD. It offers a safe and replicable environment in which complex situations can be trained. However, further iterations of the intervention need to be improved in order to guarantee accurate tracking and a more realistic training progression.Trial registration numberNCT05243394–01/20/2022.

Improving Spasticity by Using Botulin Toxin: An Overview Focusing on Combined Approaches.

Spasticity is a very common sign in the neurological field. It can be defined as "a motor disorder marked by a velocity-dependent increase in muscle tone or tonic stretch reflexes" associated with hypertonia. It leads to a high risk of limb deformities and pain that prejudices residual motor function, impairing quality of life". The treatment of spasticity depends on its severity and its location and, in general, it is based on rehabilitation, oral therapies (the gamma-aminobutyric acid b agonist baclofen) and injectable medications (i.e., botulin toxins, acting on polysynaptic reflex mechanisms). The botulin toxin type A (BoNT-A) injection has been effectively used to improve different types of spasticity. However, when BoNT-A is not sufficient, a combination of nonpharmacological approaches could be attempted. Therefore, additional intervention, such as conventional physical therapy by itself or further combined with robotic gait training, may be needed. Indeed, it has been shown that combination of BoNT-A and robotics has a positive effect on activity level and upper limb function in patients with stroke, including those in the chronic phase. The aim of this review is to evaluate the efficacy of pharmacological or nonpharmacological treatment in combination with BoNT-A injections on spasticity. The combined therapy of BoNT with conventional or adjunct activities or robot-assisted training, especially with end-effectors, is a valid tool to improve patients' performance and outcomes. The combined strategies might rise the toxin's effect, lowering its dosages of botulinum and reducing side effects and costs.

Optimal dosage ranges of various exercise types for enhancing timed up and go performance in Parkinson's disease patients: a systematic review and Bayesian network meta-analysis.

To examine the dose-response relationship between specific types of exercise for alleviating Timed up and Go (TUG) in Parkinson's disease PD. Systematic review and Bayesian network meta-analysis. PubMed, Medline, Embase, PsycINFO, Cochrane Library, and Web of Science were searched from inception until February 5th, 2024. Data analysis was conducted using R software with the MBNMA package. Effect sizes of outcome indicators were expressed as mean deviation (MD) and 95% confidence intervals (95% CrI). The risk of bias in the network was evaluated independently by two reviewers using ROB2. A total of 73 studies involving 3,354 PD patients. The text discusses dose-response relationships in improving TUG performance among PD patients across various exercise types. Notably, Aquatic (AQE), Mix Exercise (Mul_C), Sensory Exercise (SE), and Resistance Training (RT) demonstrate effective dose ranges, with AQE optimal at 1500 METs-min/week (MD: -8.359, 95% CI: -1.398 to -2.648), Mul_C at 1000 METs-min/week (MD: -4.551, 95% CI: -8.083 to -0.946), SE at 1200 METs-min/week (MD: -5.145, 95% CI: -9.643 to -0.472), and RT at 610 METs-min/week (MD: -2.187, 95% CI: -3.161 to -1.278), respectively. However, no effective doses are found for Aerobic Exercise (AE), Balance Gait Training (BGT), Dance, and Treadmill Training (TT). Mind-body exercise (MBE) shows promise with an effective range of 130 to 750 METs-min/week and an optimal dose of 750 METs-min/week (MD: -2.822, 95% CI: -4.604 to -0.996). According to the GRADE system, the included studies' overall quality of the evidence was identified moderate level. This study identifies specific exercise modalities and dosages that significantly enhance TUG performance in PD patients. AQE emerges as the most effective modality, with an optimal dosage of 1,500 METs-min/week. MBE shows significant benefits at lower dosages, catering to patients with varying exercise capacities. RT exhibits a nuanced "U-shaped" dose-response relationship, suggesting an optimal range balancing efficacy and the risk of overtraining. These findings advocate for tailored exercise programs in PD management, emphasizing personalized prescriptions to maximize outcomes.Systematic Review Registration: International Prospective Register of Systematic Reviews (PROSPERO) (CRD42024506968).

The Effect of Visual Feedback on Knee Pain and Function in Women Aged 45–75 Following Total Knee Arthroplasty

Background. Knee replacement surgery is a standard treatment that relieves the problems caused by advanced knee osteoarthritis. Postoperative rehabilitation programs are extremely important because they can improve knee function and reduce pain in patients after EP surgery. The aim. To assess the effect of visual feedback on knee joint function and pain in patients who underwent arthroplasty. Methods. The study involved 30 women experiencing pain after knee replacement surgery. Subjects were randomly divided into two groups: experimental (n = 15) and control (n = 15). Patients in both groups received one hour of physical therapy every day from Monday to Saturday. The patients of the study group performed 30 minutes of conventional physiotherapy in the hall, which includes exercises for increasing the range of motion of the knee, increasing strength and endurance, and 30 minutes of gait and balance training supplemented with visual feedback. The patients in the control group received regular physiotherapy in the hall lasting 60 minutes. The duration of the study is three weeks. Knee joint pain, range of motion, leg extensor and flexor muscle strength, and body balance were evaluated. Results. Both physical therapy programs significantly reduced knee pain and improved knee function. The control group's pain decreased by 63.4 percent, while the experimental group's pain decreased by 60.8 percent. The knee joint flexion amplitude improved by 42.9 percent in the control group and 43.4 percent in the experimental group. The improvement in the knee joint flexion amplitude was 88.3 percent in the control group and 92.7 percent in the experimental group. In the control group, the strength of the calf extensor muscles increased by 30.0 percent, and in the experimental group, it increased by 34.23 percent. The strength of the calf flexor muscles increased by 29.4 percent in the control group and 34.2 percent in the study group. Balance and gait indicators, according to the Tinetti scale, improved statistically significantly in the control group by 27.6 percent, and in the study group by 45.1 percent. In the study group, only balance and gait were better after the interventions (p&lt;0.05) than in the control group. Conclusion. Both interventions: conventional physical therapy and supplemented with visual feedback significantly improved the subjects' functionality and reduced knee pain. Physiotherapy with visual feedback was more effective than conventional physiotherapy in recovering balance and gait in subjects after knee arthroplasty. Keywords: knee arthroplasty, exercises, visual feedback.