Rivermead Visual Gait Assessment Research Articles

Pengaruh Penggunaan Sandal Drop Foot Terhadap Perbaikan Pola Jalan Penderita Drop Foot Akibat Kusta Di Rumah Sakit Kusta Sumberglagah Mojokerto

In handling Drop Foot due to leprosy, Prosthetic Orthotics can provide services in the form of ortosis, namely Sandal Drop Foot, which aims to reduce the drop foot in the ankle joint caused by a decrease in flexor dorsal muscle tone. Sampling is done by purposive sampling. The sample count consisted of 10 drop foot sufferers due to leprosy at Sumberglagah Mojokerto Leprosy Hospital. The instrument used is Rivermead Visual Gait Assessment form, video gait analysis equipment (handycam, goniometre, stationery). Drop Foot sandals have a big effect on leprosy patients who experience drop foot in improving road patterns compared to without when using Drop foot sandals. Drop foot sandals are sutu aids or correction tools to prevent prolonged drop foot or prevent further disability, but can not cure and restore normal in people with drop foot due to leprosy. The purpose of this study is to find out the Effect of Using Drop Foot Sandals On Improving Road Patterns of People With Drop Foot Due to Leprosy. This study uses the research design" Quasi experiment pre post test with out control design" one groups pre and post design, where in this study there is only one group of conscientious subjects who will be measured the pattern of the path before and after being given treatment. From the alternative test Wilcoxon obtained a value of significance with a value of p = 0.004, because p < 0.05, it can be said that there is an effect on the use of Drop Foot Sandals on improving the road pattern of drop foot sufferers due to leprosy

Pengaruh Penggunaan Sandal Drop Foot Terhadap Perbaikan Pola Jalan Penderita Drop Foot Akibat Kusta Di Rumah Sakit Kusta Sumberglagah Mojokerto

In handling Drop Foot due to leprosy, Prosthetic Orthotics can provide services in the form of ortosis, namely Sandal Drop Foot, which aims to reduce the drop foot in the ankle joint caused by a decrease in flexor dorsal muscle tone. Sampling is done by purposive sampling. The sample count consisted of 10 drop foot sufferers due to leprosy at Sumberglagah Mojokerto Leprosy Hospital. The instrument used is Rivermead Visual Gait Assessment form, video gait analysis equipment (handycam, goniometre, stationery). Drop Foot sandals have a big effect on leprosy patients who experience drop foot in improving road patterns compared to without when using Drop foot sandals. Drop foot sandals are sutu aids or correction tools to prevent prolonged drop foot or prevent further disability, but can not cure and restore normal in people with drop foot due to leprosy. The purpose of this study is to find out the Effect of Using Drop Foot Sandals On Improving Road Patterns of People With Drop Foot Due to Leprosy. This study uses the research design" Quasi experiment pre post test with out control design" one groups pre and post design, where in this study there is only one group of conscientious subjects who will be measured the pattern of the path before and after being given treatment. From the alternative test Wilcoxon obtained a value of significance with a value of p = 0.004, because p < 0.05, it can be said that there is an effect on the use of Drop Foot Sandals on improving the road pattern of drop foot sufferers due to leprosy

Construct Validity of the Gait Assessment and Intervention Tool (GAIT) in People With Multiple Sclerosis.

In clinical practice, observational scales are the most common approach used to assess gait pattern in people with neurological disorders. The Gait Assessment and Intervention Tool (GAIT) is an observational gait scale, and it has proved to be the most comprehensive, homogeneous, and objective of all the observational gait scales studied in people with neurological conditions. To study the construct validity of the GAIT in people with multiple sclerosis (MS). An observational study was conducted. Multiple Sclerosis Foundation in Madrid (Spain). Thirty-five patients with MS were assessed. GAIT construct validity was assessed using the following scales: Rivermead Visual Gait Assessment (RVGA), Tinetti Gait Scale (TGS), 10-Meter Walking Test (10MWT), Timed Up&Go (TUG), Hauser Ambulatory Index (HAI), Multiple Sclerosis Walking Scale-12 (MSWS-12), Functional Gait Assessment (FGA), Modified Ashworth Scale (MAS), and Rivermead Mobility Index (RMI). A total of 35 subjects with MS were assessed. The correlations between the GAIT and the RVGA were excellent (r > .90) and moderate with TGS (values between -.62 and -.59). Correlations with HAI, FGA, MSWS-12, and RMI were moderate (with values between .57 and .67). Correlations were lower for the velocity scales TUG and MAS. The construct validity of the GAIT is high, as a measure of gait coordination in people with MS. Specifically, there was excellent correlation with the RVGA. There was a moderate correlation for the GAIT with measures of functional mobility, but a lesser correlation of the GAIT with measures restricted to temporal gait characteristics (speed measures) or measurements of impairments underlying gait patterns such as balance or muscle tone.

What are the relationships between trunk control, balance and walking in individuals with multiple sclerosis with minor to moderate disability?

Purpose This study aimed to identify relationships between trunk control, balance and walking in individuals with multiple sclerosis (MS) with minor to moderate disability to guide the content of interventions to optimise balance and walking. Methods and materials Correlation analysis of baseline data from a prospective randomised controlled study comprising 79 individuals with MS was conducted using the Expanded Disability Status Scale (EDSS) 1.0–6.5 (mean 2.36), Trunk Impairment Scale-Norwegian Version (TIS-modNV), Mini Balance Evaluation Systems Test (Mini-BESTest), 2-min walk test (2MWT), 10-m walk test (10MWT), MS Walking Scale-12 (MSWS-12), Rivermead Visual Gait Assessment (RVGA) and number of steps using ActiGraphsWgt3X-BT. Log-transformations of skewed variables were conducted and Pearson correlation coefficients were calculated. Results Strong correlations (r = 0.70–0.90) between the 2MWT and 10MWT, the 10MWT preferred speed and number of steps, and the Mini-BESTest and 2MWT and 10MWT were identified. Moderate relationships (r = 0.50–0.70) were detected between the TIS-modNV and Mini-BESTest, as well as the 2MWT, 10MWT and RVGA. Conclusions The strong relationships support the need to address several aspects of balance to improve walking, while the moderate associations suggest that dynamic trunk control should be considered addressed in interventions for individuals with minor to moderate disability to optimise balance and walking.

Interlimb coupling in poststroke rehabilitation: a pilot randomized controlled trial

ABSTRACTBackground: The interlimb coupling, coordination between the limbs, gets hampered in post-stroke hemiparesis. Most of the poststroke motor regimes primarily focus on the more affected limb.Objectives: To develop an interlimb coupling protocol and assess its feasibility and effect on motor recovery, gait and disability among post-stroke subjects.Design: A pilot randomized controlled, doubled blinded trialSetting: A rehabilitation instituteMethods: 50 post-stroke (> 6 months) hemiparetic subjects (Brunnstrom recovery stage ≥ 3) were randomly divided into experimental (n=26) and control (n=24) groups. The 8-week experimental intervention (3 sessions of 1 hour each, per week) comprised activities demanding coordinated, alternate, and rhythmic use of the affected as well as the less-affected limbs. The outcome measures were feasibility of activities, Fugl-Meyer assessment (FMA), Rivermead visual gait assessment (RVGA), Functional ambulation category (FAC) and modified Rankin scale (mRS).Results: The experimental protocol was found to be feasible by the participants. Post intervention, the experimental group exhibited highly significant difference for FMA (mean difference = 7.12, 95% CI = 5.71 – 8.53, p < 0.001), RVGA reduction (mean difference = - 6.32, 95% CI = 7.51 – 5.13, p < 0.001), and median FAC enhancement (p < 0.001) in comparison to the controls. However, the median mRS level of experimental group did not change significantly (p = 0.056) when compared with the controls.Conclusions: The interlimb coupling training, a feasible program may enhance recovery of the upper and lower limbs and gait in stroke. Further definitive randomized trials are warranted to validate the present findings.

Group-based, individualized, comprehensive core stability and balance intervention provides immediate and long-term improvements in walking in individuals with multiple sclerosis: A randomized controlled trial.

Walking impairments are common in individuals with multiple sclerosis. Trunk control is a prerequisite for walking; however, knowledge regarding whether core stability and balance training influence walking is limited. This study aimed to investigate the immediate and long-term effects of a group-based, individualized, comprehensive core stability and balance intervention (GroupCoreDIST) compared with those of standard care on walking. This assessor-blinded, prospective randomized controlled trial included 80 participants (Expanded Disability Status Scale scores 1-6.5) randomly allocated to GroupCoreDIST, conducted in groups of three for 60min three times per week for 6weeks (18 sessions) or standard care (n=40/40). One participant attended no posttests, leaving 79 subjects for intention-to-treat analysis. The assessments were performed at baseline and at Weeks 7, 18, and 30. Outcomes included the 2-min walk test (2MWT), 10-m walk test-preferred/fast/slow speed (10MWT), Multiple Sclerosis Walking Scale-12 (MSWS-12), Patient Global Impression of Change-walking (PGIC-walking), Rivermead Visual Gait Assessment (RVGA), and ActiGraphsWgt3X-BT activity monitors (ActiGraph). The statistical analyses included repeated-measures mixed models performed in IBM SPSS Version 24. There were no significant between-group differences in the outcome measurements at baseline. The mean differences between groups were significant at all follow-up time points in favour of GroupCoreDIST for the 2MWT, 16.7m at 7weeks (95% CI [8.15, 25.25], 15.08m at 18weeks (95% CI [6.39, 23.77]) and 16.38m at 30weeks (95% CI [7.65, 25.12]; and the PGIC-walking, 0.89 points at 7weeks (95% CI [1.34, 0.45]), 0.97 points at 18weeks (95% CI [1.42, 0.52]), and 0.93 points at 30weeks (95% CI [1.39, 0.48]; all p≤.001). The 10MWT-fast speed and the MSWS-12 showed significant between-group differences at 7 and 18weeks and the RVGA at 7weeks. No between-group differences were found regarding activity level (ActiGraph) or the 10MWT-preferred or slow speed. Compared with standard care, GroupCoreDIST significantly improved walking immediately after the intervention for up to 24weeks of follow-up.

Post-stroke Visual Gait Measure for Developing Countries: A Reliability and Validity Study.

Visual gait assessment is a cost-effective clinical method to assess post-stroke gait deviations. The Rivermead Visual Gait Assessment (RVGA) is a one such measure that assesses the kinematic aspect of the gait deviations in stroke. However, the available information on psycho-clinocometric properties of the measure is not adequate. To establish reliability and validity of RVGA using walking-videos of the post-stroke subjects. Design: Observational study. A rehabilitation institute Participants: A convenience sample of 40 chronic stroke patients. RVGA, Fugl-Meyer assessment (lower extremity), 10-m walk test, Time up and go test, and Berg balance scale (BBS). Walking was video-taped from the anterior aspect, posterior aspect, affected side, and less-affected side. After coding the tapes, a research staff member provided them to four different raters in a random order. Each rater scored the coded video on the RVGA data collection sheet twice: one at the baseline and another after 1 month to eliminate any recollection of the initial assessment. The findings exhibit that there was good-to-excellent agreement between the scores of the raters and also between the assessments (correlation coefficient = 0.94 to 0.95; P < 0.001). The measure also exhibits acceptable validity when correlated with scores of BBS (r = 0.4; P < 0.001). Video-based RVGA is a reliable and valid tool to assess gait-related impairment in post-stroke hemiparesis. This cost-effective measure may be incorporated in the clinical and research practice to discern and quantify complex phenomenon of the gait deviation. RVGA may be considered as a useful tool, especially in developing countries where expensive gait analyzer is usually not available.

Effects of robot-assisted gait training in chronic stroke patients treated by botulinum toxin-a: A pivotal study.

To investigate combined effects of robot-assisted training (RAT) and physical therapy versus physical therapy only on balance and gait function of chronic stroke patients after botulinum toxin-A (BoNT-A) treatment. Forty-eight chronic stroke patients, received BoNT-A treatment for lower extremity spastic muscles, were randomly assigned to RAT (n=32) and control (n=16) groups in a 2:1 ratio. RAT group received 30min of RAT (RoboGait®) plus 60min of physical therapy, whereas controls received 90min of physical therapy for 3weeks during weekdays. Outcome assessments were measured at baseline and post-treatment Weeks 6 and 12. Spasticity was assessed by Modified Ashworth Scale and Tardieu Scale. Balance and gait functions were assessed by Berg Balance Scale, Timed Up and Go test, and Rivermead Visual Gait Assessment. Demographic and baseline characteristics were similar in both groups (p>.05) for all parameters. Significant improvements were determined in both RAT and control groups regarding spasticity, balance, and gait functions after treatment. However, at post-treatment Weeks 6 and 12, change from baseline Timed Up and Go test (p=.003 and p=.002, respectively), Berg Balance Scale (p=.001 and p<.001, respectively), and Rivermead Visual Gait Assessment (p<.001 and p<.001, respectively) were significantly higher in RAT group than those of the control group. Integrated treatment with RAT and physical therapy might provide additional benefits in chronic stroke patients whom spasticity was treated by BoNT-A.

Effect of activity-based mirror therapy on lower limb motor-recovery and gait in stroke: A randomised controlled trial

ABSTRACTObjective: To determine the effect of activity-based mirror therapy (MT) on motor recovery and gait in chronic poststroke hemiparetic subjects.Design: A randomised, controlled, assessor-blinded trial.Setting: Rehabilitation institute.Participants: Thirty-six chronic poststroke (15.89 ± 9.01 months) hemiparetic subjects (age: 46.44 ± 7.89 years, 30 men and functional ambulation classification of median level 3).Interventions: Activity-based MT comprised movements such as ball-rolling, rocker-board, and pedalling. The activities were provided on the less-affected side in front of the mirror while hiding the affected limb. The movement of the less-affected lower limb was projected as over the affected limb. Conventional motor therapy based on neurophysiological approaches was also provided to the experimental group. The control group received only conventional management.Main outcome measures: Brunnstrom recovery stages (BRS), Fugl-Meyer assessment lower extremity (FMA-LE), Rivermead visual gait assessment (RVGA), and 10-metre walk test (10-MWT).Results: Postintervention, the experimental group exhibited significant and favourable changes for FMA-LE (mean difference = 3.29, 95% CI = 1.23–5.35, p = .003) and RVGA (mean difference = 5.41, 95% CI = 1.12–9.71, p = .015) in comparison to the control group. No considerable changes were observed on 10-MWT.Conclusions: Activity-based MT facilitates motor recovery of the lower limb as well as reduces gait deviations among chronic poststroke hemiparetic subjects.

Effect of Shoe Raise along with Motor Relearning Programme (MRP) on Ambulation in Chronic Stroke

Background:&nbsp;Stroke subjects face reduced tolerance to activity and sedentary lifestyle due to various impairments, such as muscle weakness, pain, spasticity, and poor balance. Thus, loss of independent ambulation especially outdoors is generally observed in them.Methods:&nbsp;Chronic stroke patients (&gt; 6 months) with Functional Ambulation Category score &gt; 2 and able to walk at least 10 meters of distance with and without assistance from a tertiary healthcare centre were selected and treated. Subjects were randomly divided into 2 groups control group (n=14) and experimental group (n=13). Each group received Motor Relearning Programme for 60 minutes, 6 times a week for 4 weeks. The experimental group received an additional shoe-raise of 1 cm on the unaffected side along with while ambulating during therapy as well as at home. Pre and post treatment the patients were assessed for spatio-temporal parameters using foot print analysis method and Rivermead Visual Gait Assessment (RVGA) Score using RVGA scale.Results:&nbsp;There was significant improvement seen in almost all the spatio-temporal gait parameters and RVGA score in within group analysis. Whereas on between group the results from between group comparison suggests that subjects in MRP with shoe-raise group showed better results in spatio-temporal parameters of gait than subjects receiving MRPalone. But there was no additional benefit of shoe-raise seen on RGVA score and angle of toe-out parameter.Conclusion:&nbsp;Additional use of shoe-raise helps to improve spatio-temporal gait parameters. However, there was no additional change seen in RVGA score.

Augmented visual feedback of movement performance to enhance walking recovery after stroke: study protocol for a pilot randomised controlled trial

BackgroundIncreasing evidence suggests that use of augmented visual feedback could be a useful approach to stroke rehabilitation. In current clinical practice, visual feedback of movement performance is often limited to the use of mirrors or video. However, neither approach is optimal since cognitive and self-image issues can distract or distress patients and their movement can be obscured by clothing or limited viewpoints. Three-dimensional motion capture has the potential to provide accurate kinematic data required for objective assessment and feedback in the clinical environment. However, such data are currently presented in numerical or graphical format, which is often impractical in a clinical setting. Our hypothesis is that presenting this kinematic data using bespoke visualisation software, which is tailored for gait rehabilitation after stroke, will provide a means whereby feedback of movement performance can be communicated in a more meaningful way to patients. This will result in increased patient understanding of their rehabilitation and will enable progress to be tracked in a more accessible way.MethodsThe hypothesis will be assessed using an exploratory (phase II) randomised controlled trial. Stroke survivors eligible for this trial will be in the subacute stage of stroke and have impaired walking ability (Functional Ambulation Classification of 1 or more). Participants (n = 45) will be randomised into three groups to compare the use of the visualisation software during overground physical therapy gait training against an intensity-matched and attention-matched placebo group and a usual care control group. The primary outcome measure will be walking speed. Secondary measures will be Functional Ambulation Category, Timed Up and Go, Rivermead Visual Gait Assessment, Stroke Impact Scale-16 and spatiotemporal parameters associated with walking. Additional qualitative measures will be used to assess the participant’s experience of the visual feedback provided in the study.DiscussionResults from the trial will explore whether the early provision of visual feedback of biomechanical movement performance during gait rehabilitation demonstrates improved mobility outcomes after stroke and increased patient understanding of their rehabilitation.Trial registrationCurrent Controlled Trials ISRCTN79005974

Task-Oriented Circuit Class Training Program with Motor Imagery for Gait Rehabilitation in Poststroke Patients: A Randomized Controlled Trial

Background and Objective: The ability to walk is impaired in more than 80% of poststroke patients. The objective of the present study was to evaluate the effectiveness of the task-oriented circuit class training (TOCCT) with motor imagery (MI) on the gait during the subacute phase after a stroke. Method: This was a randomized, controlled, assessor-blinded trial in a neurology department of a university hospital. A convenience sample of 30 people, 4 to 12 weeks (mean, 6.3 weeks) after the stroke was randomized into 2 groups (the TOCCT with MI and standard training group) of 15 people each. Twenty-nine participants completed the 6-week follow-up. Participants were assigned to receive either the TOCCT with MI or dose-matched standard training program based on the Bobath’s neurodevelopmental technique, 7 days a week for 2 weeks, as outpatients or inpatients. Outcome measures were the Functional Ambulation Classification (FAC), the Rivermead Visual Gait Assessment (RVGA), step length asymmetry, walking speed, and 6-minute walk test (6MWT). Results: The TOCCT with MI group showed a positive improvement in the mean/median scores on most of the outcome measures at post and follow-up assessments in comparison to the control group. However, statistically significant differences were observed in changes between the groups at post and follow-up assessment for FAC, RVGA, walking speed, and 6MWT (ANOVA, P = .001 to .049; Mann-Whitney U test, P = .001). Conclusion: Among the patients who had a stroke within the previous 4 to 12 weeks, the TOCCT with MI produced statistically significant and clinically relevant improvements in the gait and the gait-related activities.

Treadmill training for ataxic patients: a single-subject experimental design

Objective: To investigate changes in gait quality, balance and mobility associated with treadmill training for ataxic individuals. Design: Single-subject ABA design. Baseline phases (A) lasted three weeks and intervention (B) lasted four weeks. Setting: University rehabilitation clinic. Subjects: A woman (25 years) and a man (53 years) with chronic ataxia due to head trauma. Intervention: Three 20-minute treadmill training sessions each week with progression in velocity and step length. Main measures: Rivermead Visual Gait Assessment, Timed Up and Go, time to complete a balance task, walking speed, cadence, and stride length assessments three times a week during the 10 weeks. Data were analysed with the celeration line technique and two standard deviation band. Results: Both individuals demonstrated gains in all parameters over initial baseline and subsequent phases, with performance increases ranging from 26% to 233% when first and last assessments were compared. Significantly superior effects of treadmill training over baseline conditions on cadence were detected (P<0.05). Gains in walking speed were not significantly better during intervention, but intervention withdrawal produced deceleration of performance gains. Gains in Timed Up and Go, step length and balance were not consistent and were possibly caused by a learning effect of the association between repeated testing and treadmill training. Rivermead Visual Gait Assessment gains reached significance only for subject 2 (P<0.05), probably because of increased variability of performance of subject 1. Results suggest that the association between repeated testing and treadmill training might have been responsible for the observed gains in the two ataxic patients.

Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept

Patients with multiple sclerosis (MS) tend to have movement difficulties, and the effect of physiotherapy for this group of patients has been subjected to limited systematic research. In the present study physiotherapy based on the Bobath concept, applied to MS patients with balance and gait problems, was evaluated. The ability of different functional tests to demonstrate change was evaluated. A single-subject experimental study design with ABAA phases was used, and two patients with relapsing-remitting MS in stable phase were treated. Tests were performed 12 times, three at each phase: A (at baseline); B (during treatment); A (immediately after treatment); and A (after two months). The key feature of treatment was facilitation of postural activity and selective control of movement. Several performance and self report measures and interviews were used. After intervention, improved balance was shown by the Berg Balance Scale (BBS) in both patients, and improved quality of gait was indicated by the Rivermead Visual Gait Assessment (RVGA). The patients also reported improved balance and gait function in the interviews and scored their condition as 'much improved'. Gait parameters, recorded by an electronic walkway, changed, but differently in the two patients. Among the physical performance tests the BBS and the RVGA demonstrated the highest change, while no or minimal change was demonstrated by the Rivermead Mobility Index (RMI) and Ratings of Perceived Exertion (RPE). The findings indicate that balance and gait can be improved after physiotherapy based on the Bobath concept, but this should be further evaluated in larger controlled trials of patients with MS.

17. Further Validation of the Rivermead Visual Gait Assessment Sue Lord (Nelson, New Zealand

17. Further Validation of the Rivermead Visual Gait Assessment Sue Lord (Nelson, New Zealand

Visual gait analysis: the development of a clinical assessment and scale.

To develop and evaluate a four-point scale visual gait assessment form, the Rivermead Visual Gait Assessment (RVGA), for clinical use with patients with neurological deficits. Preliminary clinical testing of reliability, validity and sensitivity to change. Patients were recruited from the Rivermead Rehabilitation Centre (RRC), a centre specializing in rehabilitation for patients with neurological disease. Ten inpatients were assessed by up to seven physiotherapists for the main reliability study, and eight different patients were also assessed by two raters one week apart. Twenty outpatients with multiple sclerosis (MS) who were receiving physiotherapy to improve their mobility and 27 inpatients with various neurological conditions were also assessed and the data used to examine validity, re iability and sensitivity to change. The other comparative measures used were walking time, stride length, step length asymmetry, balance and the Rivermead Mobility Index. Inter-rater reliability between multiple raters was reasonable both for the global scores from the gait assessment form (Kendall's coefficient of concordance; p < 0.001), and for individual items (complete agreement occurred on 63.8% of all observations). There was a significant correlation between the global RVGA score and the various criterion measures (r = 0.53-0.79; p < 0.001) and between change in the RVGA score and change in walking time in patients who received treatment (r = 0.68; p < 0.01). The RVGA provides the clinician with a clinical assessment of the quality of gait which may be used in conjunction with other measures to inform and monitor the value of physiotherapy treatment for people with MS and stroke, and possibly other neurological deficits.