Rolling Walker Research Articles

Changes in Dual-task Voice Reaction Time Among Elders Who Use Assistive Devices

Assistive devices are prescribed for a variety of reasons and have the obvious benefit of enhancing gait performance for some individuals. However, the use of an assistive device may make walking a more complex and cognitively challenging task. The purpose of this study was to use a dual-task voice reaction time (VRT) paradigm to examine the attentional demands of walking with an assistive device in a group of elderly adults. Standing and walking VRTs were measured in a sample of 105 elderly adults who ambulated independently with either a rolling walker (RW; mean age = 87.8 +/- 5.5 yrs), a straight cane (SC; mean age = 84.1 +/- 5.6 yrs), or used no device (ND; mean age = 79. 9 +/- 4.5 yrs). A 3 (group) by 2 (task condition) ANOVA with repeated measures on the last factor was used to examine between and within group differences in VRTs. The main effects of group (p = 0.004) and task (P < 0.001) and the interaction of group with task (P = 0.025) were all statistically significant. There were no statistically significant between group differences in standing VRT. Between group differences appeared during the walking task, VRT for the RW group was significantly longer than for the ND group. When examining within group difference, walking VRT was significantly longer than standing VRT for the SC and RW groups. The results demonstrated that there is an increase in the attentional demands of walking for elderly adults who are experienced assistive device users. The increased attention required to walk with an assistive device may be a factor leading to increased fall risk.

Oncogenic osteomalacia: Muscular weakness and multiple fractures

We report a case of oncogenic osteomalacia that resulted in a disabling quadriparesis and multiple fractures before recognition of this treatable metabolic bone disease. A 61-year-old man presented with generalized weakness, muscle wasting, and diffuse bone pain of 7 years' duration. His symptoms began with gradual onset of hip flexor weakness and hip pain. Two years after onset, he required the assistance of a rolling walker, and within 4 years, he became wheelchair bound and had developed weakness of his shoulder girdle and arms. Prior outside neuromuscular evaluation revealed no specific diagnosis. Electrodiagnostic studies were normal, and muscle biopsy demonstrated type 2 fiber atrophy. Despite physical therapy, he progressed to dependence in all activities of daily living. He later developed multiple spontaneous fractures and diffuse pain of his shoulders, ribcage, and hips. Neurologic examination 7 years after onset revealed diffuse atrophy without fasciculation of both upper and lower extremities and thoracic paraspinal muscles. Although muscle strength testing was painful, he was found to have a quadriparesis …

Respect Patient Autonomy in Difficult Situations

Respect Patient Autonomy in Difficult Situations

An acute care episode of a patient following bilateral total knee arthroplasty

More patients with bilateral joint problems are choosing to go through one surgery to replace both joints simultaneously rather than having two separate surgeries. The goals of physical therapy following the surgery are to decrease pain, maximize range of motion (ROM) and strength, improve ambulation, and improve overall function. Few studies have focused on the importance of the acute phase of rehabilitation and most concentrate instead on long-term outcomes and outpatient care. The patient was a 62-year-old male diagnosed with osteoarthritis of both knees. The day before the initial physical therapy evaluation, the patient underwent a bilateral total knee arthroplasty. By the end of his stay, active knee ROM increased to −6° to 88° on the right and −6° to 83° on the left. Passive ROM also increased to −5° to 90° on the right and −5° to 86° on the left. The patient was able to perform supine to sit transfers with supervision and sit to stand transfers with contact guard assistance and his ambulation progressed to walking 100 feet on level surfaces with a rolling walker and supervision. The positive gains of this patient suggest the potential value of high motivation combined with early aggressive physical therapy.

Locomotor Training Progression and Outcomes After Incomplete Spinal Cord Injury

The use of locomotor training with a body-weight-support system and treadmill (BWST) and manual assistance has increased in rehabilitation. The purpose of this case report is to describe the process for retraining walking in a person with an incomplete spinal cord injury (SCI) using the BWST and transferring skills from the BWST to overground assessment and community ambulation. Following discharge from rehabilitation, a man with an incomplete SCI at C5-6 and an American Spinal Injury Association (ASIA) Impairment Scale classification of D participated in 45 sessions of locomotor training. Walking speed and independence improved from 0.19 m/s as a home ambulator using a rolling walker and a right ankle-foot orthosis to 1.01 m/s as a full-time ambulator using a cane only for community mobility. Walking activity (mean+/-SD) per 24 hours increased from 1,054+/-543 steps to 3,924+/-1,629 steps. In a person with an incomplete SCI, walking ability improved after locomotor training that used a decision-making algorithm and progression across training environments.

Spinal cord compression secondary to metastatic non-Hodgkin’s lymphoma: A case report

Luo CC. Spinal cord compression secondary to metastatic non-Hodgkin’s lymphoma: a case report. Non-Hodgkin’s lymphoma spine metastasis is a rare entity. A woman in her mid fifties with history of non-Hodgkin’s lymphoma was admitted to the hospital with bilateral leg weakness, anesthesia, and incontinence. Magnetic resonance imaging of the spine showed diffuse metastatic disease involving the cervical, thoracic, lumbar, and sacral spine. She was treated with radiation therapy and high doses of corticosteroids. When discharged to home, she could ambulate with a rolling walker independently, was capable of self-catheterization, and could insert suppositories for a bladder and bowel program.

Angioplasty and Stenting of the Intracerebral Circulation

A 44-yr-old, right-hand–dominant man was found by his spouse in the early morning in an unresponsive state. During urgent transfer to a hospital emergency room, he was described as being lethargic, vomiting, and occasionally nodding his head. His pupils were at 2 mm and dysconjugate gaze was noted. Questionable right-sided weakness was observed. The patient was immediately intubated and administered ventilatory support. A brain computerized tomography scan raised the question of a basilar artery thrombosis. A neurologic consultation concluded that his clinical situation was grave, likely to decline, and possibly develop into a “locked-in” state. Interventional neuroradiologic consultation was therefore immediately obtained. Angiography revealed that the patient had a complete basilar artery obstruction (Fig. 1), and therefore, a balloon angioplasty with thrombolysis (injection of urokinase) was performed with underlying stenosis noted. An 8-mm-long stainless steel coronary stent was then inserted into the basilar artery. Excellent restoration of blood flow was achieved (Fig. 2). This entire procedure was performed within 3 hrs of the patient’s initial arrival in the emergency room. He tolerated the procedure well, with no further decline in neurologic status. In fact, he began to rapidly improve such that 4 days after admission, he was weaned from the ventilator and able to be extubated. Nutritionally, he was supported with nasogastric tube feeds. A modified barium swallow revealed severe oropharyngeal dysphagia with aspiration and an inability to protect his airway. Hence, 14 days after his emergency admission, an upper endoscopy with percutaneous endoscopic gastrostomy was performed.Figure 1:: Preangioplasty view of the posterior circulation, with complete obstruction of the basilar artery.Figure 2:: Postangioplasty view showing thrombolysis and stenting with dramatic improvement of posterior circulation blood flow.Several days after this procedure, this patient was admitted to the acute hospital’s rehabilitation unit where he remained for approximately 3 wks. At admission, he was found to have just barely antigravity strength in his right upper and lower limbs, with poor dynamic balance and slurred speech. During his rehabilitation stay, he regained motor strength to near normal bilaterally and made significant gains in balance such that by the time of discharge from the rehabilitation unit, he was able to ambulate 600 feet using a rolling walker with only standby assistance. His swallowing ability continued to improve, and after 2 wks on the rehabilitation unit, he was started on a pureed diet, which was advanced to a mechanical soft diet with strict aspiration precautions. At follow-up outpatient examination several weeks later, this gentleman was now completely safe in ambulation, with no assistive device. He was also independent in all activities of daily living. He could safely climb the one flight of steps (using a hand rail) to his second-floor apartment. A repeat modified barium swallow revealed moderate pharyngeal dysphagia with a delay of swallowing and minimal penetration of thin liquids. It was recommended that he continue a mechanical soft diet with strict aspiration precautions. Although successful angioplasty of the basilar artery was first reported over two decades ago, angioplasty and stenting of the intracranial circulation does not at present have dedicated approval from the Food and Drug Administration, and therefore, this experimental procedure is performed for “humanitarian reasons.”1–4 Increasingly in recent years, flexible cardiac stents have been used postangioplasty in an attempt to reduce vessel recoil and re-stenosis. As there are no absolute indications for its performance, intracerebral angioplasty and stenting of the posterior circulation usually follows a reasoned judgment by the attending physicians that without this procedure the patient is likely to die or significantly deteriorate. On a nonacute basis, recurrent ischemic symptoms, despite medical treatment (e.g., antiplatelet or anticoagulant therapy), could also be considered an indication for this treatment.

Poster 32: Rehabilitative outcome after simultaneous bilateral hip replacement: a case report

Setting: Acute Midwestern medical center and university-based rehabilitation hospital. Patient: 55-year-old postmenopausal woman with a medical history remarkable for L4-5 laminectomy. Case Description: Bilateral total hip arthroplasty (THA) was performed. Postoperative course was complicated by anemia and pain. The patient was admitted to acute rehabilitation 4 days after surgery. We report on the rehabilitation outcome after simultaneous bilateral THA. Assessment/Results: On admission, the patient ambulated 50ft using a standard walker at a maximum assist level and total assistance for stairs. She did quite well and had a rather short inpatient course. On day 7 of rehabilitation admission, the patient was discharged and was ambulating 400ft using a rolling walker with supervision and was climbing 6 stairs with maximum assistance. At 1-month follow-up, she was ambulating with a cane approximately 0.5 mile daily. At 6 months, she is ambulating without a cane over 1 mile daily, swimming 1 mile daily, and participating in low-impact aerobics twice weekly. Discussion: Osteoarthritis is a major cause of pain and disability in the United States with hip involvement often leading to significant functional impairment. THA, undertaken after conservative management failure, involves invasive surgery followed by a long and demanding rehabilitation program. THA is invariably performed unilaterally and sequentially if both hips are involved. Orthopedic surgical literature reports cases of simultaneous bilateral THA, but provides little information about rehabilitation outcome. Conclusions: This case illustrates that simultaneous THA can be performed with favorable surgical and functional outcome. Our patient had an excellent outcome and this could be attributed, in part, to her age, limited comorbidities, and good physical conditioning prior to surgery. Further prospective research needs to be performed to help determine exact patient criteria, surgical approach, and rehabilitative techniques when performing simultaneous bilateral THA.

Assessing the Risk of Falls in Elders With Mental Retardation and Developmental Disabilities

A modified version of the Timed-Up-and-Go Test (TUAG) was tried on a sample of community-based elders with mental retardation and developmental disabilities. Eighteen subjects aged 55 and older were tested under 3 conditions: free walking, walking with a rolling walker, and walking with a personal assistant. Trials were done on a 10-ft walkway; each subject performed 3 trials of each condition. The test failed to distinguish fallers from persons who did not have a history of falls. In addition, subjects had great difficulty using the rolling walker and 14 subjects walked slower with the personal assistant than when walking freely. The Modified Up and Go Test (MUAG) has good reliability but poor validity for this sample. The use of traditional compensatory strategies, such as rolling walkers, should be reconsidered for this population.

New controller for functional electrical stimulation systems

A novel, self-contained controller for functional electrical stimulation systems has been designed. The development was motivated by the need to have a general purpose, easy to use controller capable of stimulating many muscle groups, thus restoring complex motor functions (e.g. standing, walking, reaching, and grasping). The designed controller can regulate the frequency, pulse duration, and charge balance on up to 16 channels, and execute pre-programmed and sensory-driven control operations. The controller supports up to eight analog and six digital sensors, and comprises a memory block for including history of the sensory data (time series). Five independent timers provide the basis for the multi-modal and multi-level control of movement. The PC compatible interface is realised via an IR serial communication channel. The PC based software is user friendly and fully menu driven. This paper also presents a case study where the controller was implemented to restore walking in a paraplegic subject. The assistive system comprised the novel controller, the power and output stages of an eight-channel FES system (IEEE Trans Rehabil Eng, TRE-2 (1994) 234), ankle-foot orthoses, and a rolling walker. Stimulation was applied with surface electrodes positioned over the motoneurons that innervate muscles responsible for the hip and knee flexion and extension. The sensory system included goniometers at knee and hip joints, force-sensing resistors built in the shoe insoles, and digital accelerometers at the hips. A rule-based control algorithm was generated following a two-step procedure: (1) simulation and (2) machine learning as described in earlier studies (IEEE Trans Rehab Eng, TRE-7 (1999) 69). The paraplegic subject walked faster, and with less physiological effort, when automatic control was applied as compared to hand-control. This case study, as well as a previous one for assisting grasping (The design and testing of a new programmable electronic stimulator. N. Fisekovic, MS thesis. University of Belgrade, Belgrade, 2000) indicate that the novel control unit is effectively applicable to FES systems.

Intramedullary Sarcoidosis Presenting as Incomplete Paraplegia: Case Report and Literature Review

Sarcoidosis is a chronic, multisystem noncaseating granulomatous disease of unknown etiology. Sarcoidosis typically presents clinically in individuals between the ages of 20 and 40 years. Although sarcoidosis most commonly affects the respiratory system, nearly any organ system can be involved. Spinal cord involvement by sarcoidosis is a rare event, occurring in less than 1% of patients with systemic disease. The case presented is that of a 29-year-old black male with benign past medical history who presented with a 6-week history of progressive incomplete paraplegia arid bowel dysfunction. Magnetic resonance imaging revealed an intramedullary mass at the T-4-T-5 levels. The patient underwent thoracic laminectomy and debulking of the mass. The pathology was consistent with granulomatous disease. Postoperatively, the patient was placed on prednisone. He subsequently received comprehensive inpatient and outpatient rehabilitation and at present is bowel and bladder continent and ambulating at community levels with a rolling walker. The diagnosis of sarcoidosis; potential treatment options, including debulking and long-term steroid use; and prognosis will be discussed.

Evaluation of a training program for persons with SCI paraplegia using the Parastep®1 ambulation system: Part 5. Lower extremity blood flow and hyperemic responses to occlusion are augmented by ambulation training

Objective: To test whether 12 weeks of exercise conditioning using functional neuromuscular stimulation (FNS) ambulation alters the resting lower extremity blood flow and hyperemic responses to vascular occlusion in subjects with paraplegia, and to determine whether an association exists between limb flow and lower extremity fat-free mass. Design: Pretest, posttest. Setting: Academic medical center. Participants: Subjects with chronic neurologically complete paraplegia. Intervention: Thirty-two sessions of microprocessor-controlled ambulation using electrically stimulated contractions of lower extremity muscles and a rolling walker. Outcome Measures: Subjects underwent quantitative Doppler ultrasound examination of the common femoral artery (CFA) before and after training. End-diastolic arterial images and arterial flow-velocity profiles obtained at rest and after 5 minutes of suprasystolic thigh occlusion were computer-digitized for analysis of heart rate (HR), CFA peak systolic velocity (PSV), CFA cross-sectional area (CSA), flow velocity integral (FVI), pulse volume (PV), and CFA (arterial) inflow volume (AIV). Results: Significant effects of training on CSA ( p < .0001), FVI ( p < .05), computed PV ( p < .001), and computed AIV ( p < .01) were observed. Resting HR was lower following training ( p < .05). The change for resting PSV approached but did not reach significance ( p = .083). Analysis of postocclusion PV and AIV showed significant effects for conditioning status ( p values < .01), postcompression time ( p values < .0001), and their interaction ( p values < .01). At 1 minute after occlusion, the posttraining AIV response was 78.2% greater in absolute magnitude and 17.4% more robust when expressed as a percentage change from its resting value than before training. Significant correlations were found between thigh fat free mass and both AIV and PV ( p values < .05). Conclusion: Exercise training using FNS ambulation increases the resting lower extremity AIV in individuals with paraplegia and augments the hyperemic response to vascular occlusion. Improved posttraining blood flow is attributable both to vascular structural changes and upregulation of vascular flow control mechanisms. Limb mass is associated with the volume of arterial blood flow.

KIENBÖCK DISEASE IN A CHILD WHO HAS CEREBRAL PALSY. A CASE REPORT

The etiology and treatment of Kienbock disease, or osteonecrosis of the lunate, remain controversial. The condition is frequently associated with repetitive trauma, and the typical patient is twenty to forty years old and has noted an insidious onset of pain and stiffness in the wrist. Kienbock disease is uncommon in children. In four large series, only five (1 per cent) of 404 patients were less than sixteen years old at the time of diagnosis7,9,36,44. Furthermore, the children in those reports were involved either in sports activities that had caused repetitive trauma to the wrist, such as gymnastics, or they had sustained an acute injury. A ten-year-old child who had diplegic cerebral palsy and Kienbock disease is described in the present report. A ten-year and ten-month-old white girl who had moderately severe diplegic cerebral palsy was seen two weeks after the onset of pain and decreased motion of the left wrist. The pain in the wrist was mild, but it had compromised her ability to grasp a walker. The patient reported no recent episodes of trauma to the wrist and had not needed to use analgesics. The patient was highly motivated and intelligent and had been able to walk independently about the house since the age of seven years. She needed a reverse rolling walker as an aid for walking and, before the onset of pain in the wrist, she had used a wheelchair only for long distances, such as when she went to a shopping mall. Previous operations included iliopsoas recession and adductor myotomy bilaterally when she was three years old and lengthening of the gastrocnemius aponeurosis bilaterally when she was six years old. Physical examination revealed no obvious swelling and only slight tenderness to palpation over the mid-part of the dorsum …

Hip and trunk stability in paraplegic electrically augmented gait

Research conducted to investigate functional electrical stimulation in the paraplegic individual to provide functional walking is reviewed. To understand better the problems of hip and trunk stability, crutch walking video tapes depicting trial crutch walking sessions experienced by four implanted complete paraplegic individuals were reviewed and all segments demonstrating instability were copied to provide a tape of walking errors. Additional information was gathered from direct observations of similar episodes during muscle programming sessions and exercise walking sessions using a rolling walker. Attempts to use forearm crutches to replace the rolling walker resulted in numerous gait deviations at the hip and spine, the first being a strong tendency to lean forward. It is postulated that adequate hip and trunk stability using electrical stimulation can be achieved through a combination of additional subject training, improved muscle implantation techniques, and improved programming techniques. >

The Dual-Task Methodology and Assessing the Attentional Demands of Ambulation with Walking Devices

The purposes of this article are (1) to provide a preliminary examination of the attentional demands of ambulating with two commonly prescribed walking aids (a standard walker and a rolling walker) and (2) to introduce the dual-task methodology to the physical therapy community. Five subjects familiar with the appropriate use of the walkers and five subjects uninformed as to the correct use of the walkers participated in the study. Each subject completed the three phases of the experiment: (1) performing the reaction time (RT) task only; (2) performing each of the walking tasks only; and (3) performing each of the walking tasks in conjunction with the RT task, which constituted the dual-task conditions. The findings indicated that walking aided by either the rolling walker or the standard walker was highly attention demanding. More importantly, it appears that greater attentional demand was required when ambulating with the standard walker. These results are discussed with respect to the gait modifications and accuracy demands required when using these walkers. The usefulness of the dual-task methodology as a research tool for addressing clinically oriented questions is emphasized, and some potential applications of this methodology for the therapist within the clinic are discussed.

The Effects of Posterior Rolling Walkers vs the Standard Rolling Walker on Gait Characteristics of Children with Spastic Cerebral Palsy

The Effects of Posterior Rolling Walkers vs the Standard Rolling Walker on Gait Characteristics of Children with Spastic Cerebral Palsy

The Effects of the Standard Rolling Walker and Two Posterior Rolling Walkers on Gait Variables of Normal Children

The purpose of this study was to determine the effects of the standard rolling walker (SRW) and two veresions of the posteriorly placed posterior rolling walker on gait variable of a sample of normal children. The two versions of the posterior rolling walker included the two-wheeled model (PRW2) and the four-wheeled model (PRW4). Nineteen children aged six to eight years old from two suburban first and second grade classrooms comprised the sample. The footprint method of analysis was used to record and measure the variables of velocity, cadence, step length, stride length, base of support, and toe angle. Each child was initially recorded while walking unassisted, and then with ths SRW, PRW2 and PRW4 presented in randomized order for a total of four trials per child. The mean values for each gait variable were obtained for each trial for each child. A Multiple Analysis of Variance with one repeated measure and Duncan Multiple Comparison Tests were used to analyze these data. Results indicated that use of a walker, regardless of model, changed normal (unassisted) gait in all variables measured except toe angle. Gait using the PRW4 most closely approximated unassisted gait. Results may have implications for clinicians both in setting the optimal level of function that might be expected from children using walkers and in choosing among walker models for their patients.

The Effects of Posterior Rolling Walkers vs. the Standard Rolling Walker on Gait Characteristics of Children with Spastic Cerebral Palsy

The Effects of Posterior Rolling Walkers vs. the Standard Rolling Walker on Gait Characteristics of Children with Spastic Cerebral Palsy

The Effects of Posterior Rolling Walkers vs. the Standard Rolling Walker on Gait Characteristics of Children with Spastic Cerebral Palsy

The purpose of this study was to determine if significant differences occurred in the gait characteristics of thirteen 2 to 10 year-old children with cerebral palsly(CP) when using a standard rolli...

The Effects of the Standard Rolling Walker and Two Posterior Rolling Walkers on Gait Variables of Normal Children

The purpose of this study was to determine the effects of the standard rolling walker (SRW) and two veresions of the posteriorly placed posterior rolling walker on gait variable of a sample of normal children. The two versions of the posterior rolling walker included the two-wheeled model (PRW2) and the four-wheeled model (PRW4). Nineteen children aged six to eight years old from two suburban first and second grade classrooms comprised the sample. The footprint method of analysis was used to record and measure the variables of velocity, cadence, step length, stride length, base of support, and toe angle. Each child was initially recorded while walking unassisted, and then with ths SRW, PRW2 and PRW4 presented in randomized order for a total of four trials per child. The mean values for each gait variable were obtained for each trial for each child. A Multiple Analysis of Variance with one repeated measure and Duncan Multiple Comparison Tests were used to analyze these data. Results indicated that use of a...