Significant Improvements In Gait Research Articles

Effects of physiotherapy and home-based training in parkinsonian syndromes: protocol for a randomised controlled trial (MobilityAPP)

IntroductionGait and mobility impairment are pivotal signs of parkinsonism, and they are particularly severe in atypical parkinsonian disorders including multiple system atrophy (MSA) and progressive supranuclear palsy (PSP). A pilot...

157 Minimally Invasive Treatment of Idiopathic Normal Pressure Hydrocephalus Using the Endovascular eShunt Implant

INTRODUCTION: Idiopathic Normal Pressure Hydrocephalus (NPH) is a reversible form of dementia typically treated with ventriculo-peritoneal shunt surgery. Recently we have described the first percutaneous transfemoral transvenous deployment of an endovascular CSF shunt (eShunt® System; CereVasc, Inc., Auburndale, MA, USA) to treat communicating hydrocephalus. METHODS: Patients were included after demonstrating >20% gait improvement in lumbar drainage trial. Gait was assessed using Timed Up & Go (TUG) test, cognition using Montreal cognitive assessment (MoCA), and urinary incontinence using Neurogenic Bladder Symptom Score (NBSS). Results were normalized per-patient to pre-treatment scores. A composite outcome score (COS) incorporating TUG/MOCA/NBSS was computed. RESULTS: Eleven patients (4 female; mean age 74.8 ± 4.2 years) underwent successful eShunt placement. Follow-up data showed significant improvement in gait by 35.4% at 30-days (n = 6, P < 0.003), 24.8% at 90-days (n = 6, p < 0.03) and by 32.8% at 180-days (n = 4, p < 0.01) compared to baseline. MOCA and NBSS showed significant improvements at 30-days and the COS was significantly improved at all time points (p < 0.005 at 30-, 90- and 180-days). No procedural/delayed hemorrhage or unexpected readmissions were encountered during this early follow-up phase. CONCLUSIONS: In elderly patients affected by NPH and its insidious effect on mobility, cognition and urinary continence, these results show that the endovascular eShunt implant can be safely deployed with a favorable risk profile and with rapid and sustained improvements in functional outcome scores.

Effect of Combined Neuromuscular Electrical Stimulation and Disease-Modifying Antirheumatic Drug Therapy Versus Disease-Modifying Antirheumatic Drug Therapy Alone on Enhancing Gait and Reducing Fall Risks in Patients with Rheumatoid Arthritis and Peripheral Neuropathy

Background: Rheumatoid Arthritis (RA) with Peripheral Neuropathy (PN) significantly impacts gait and balance, posing challenges in patient management. While Disease-Modifying Antirheumatic Drug (DMARD) therapy is effective for RA, it may not fully address these functional impairments. Neuromuscular Electrical Stimulation (NMES) has been proposed as a complementary therapy to improve these outcomes. Objective: This study aimed to assess the effectiveness of combining NMES with DMARD therapy versus DMARD therapy alone in enhancing gait and reducing fall risks among RA patients with PN. Methods: In a randomized controlled trial, 66 RA patients with PN were allocated to either Group A (NMES + DMARD, n=33) or Group B (DMARD only, n=33). Baseline demographics (age, gender, BMI, RA duration) and clinical outcomes (stride length, gait speed, cadence, etc.) were measured. Assessments were conducted at the study’s onset and after an 8-week intervention period, with data analyzed using independent t-tests. Results: Baseline data revealed no significant differences between the groups. Post-intervention, Group A exhibited marked improvements: stride length reduced to 58.26 cm (± 5.0) compared to Group B’s 69.1 cm (± 5.2, p=0.036), gait speed decreased to 0.77 m/s (± 5.1) against Group B’s 0.94 m/s (± 5.2, p=0.020), and cadence lowered to 81.43 steps/min (± 4.5) versus Group B’s 97.06 steps/min (± 4.7, p=0.029). Significant improvements were also seen in step width, double support time, and balance scales in Group A. However, biochemical markers did not show significant differences post-intervention. Conclusion: The integration of NMES with DMARD therapy resulted in significant improvements in gait and balance parameters compared to DMARD therapy alone in RA patients with PN. These findings suggest that NMES could be an effective adjunct to DMARDs in managing functional impairments in this population.

Go Across Immersive Technology: A Preliminary Study of the Design and Development of a System for Gait Training Using Virtual Reality.

Virtual reality (VR) allows visuotactile interaction in a virtual environment. VR has several potential applications such as surgical training, phobia treatments, and gait rehabilitation. However, further interface development is required. Therefore, the objective of this study was to develop a noninvasive wearable device control to a VR gait training program. It consists of custom-made insoles with vibratory actuators, and plantar pressure sensor-based wireless interface with a VR game. System usability testing involved a habituation period and three gaming sessions. Significant gait improvement was associated with game scores (P < 0.05). This VR gait training system allowed real-time virtual immersive interaction with anticipatory stimulus and feedback during gait.

Effect of sacroiliac fusion on gait, standing balance, and pelvic mobility for unilateral sacroiliac joint dysfunction

BackgroundSacroiliac joint fusion (SIF) has been shown to effectively alleviate pain and improve functional deficits associated with sacroiliac joint dysfunction (SIJD). Previous studies have demonstrated significant improvements in gait function, however, none have reported both over-ground walking and quiescent standing, and additionally, none have included analysis of pelvic kinematics which may contain important information regarding pain avoidant compensatory behaviors. The purpose of this study was to identify objective functional differences between symptomatic and asymptomatic sides of unilateral sacroiliac joint dysfunction (SIJD) patients and to demonstrate the effectiveness of unilateral sacroiliac fusion (SIF) to improve gait and balance function compared to matched controls. MethodsThirteen unilateral SIJD patients were evaluated before and 6 months after SIF and were compared to matched asymptomatic controls. Pain and disability were assessed using visual analog scales and the Oswestry disability index respectively. Over ground walking and standing balance were assessed using 3D joint kinematics and kinetic ground reaction force analyses. ResultsPreoperatively, SIJD patients reported high levels of pain and disability and exhibited significant deficits in gait including elevated step width, reduced hip flexion/extension, and elevated pelvic motion as well as elevated center of pressure sway characteristics during standing. After unilateral SIF, patients reported significant reductions in pain and demonstrated significant improvements in gait including normalization of step width between sides and improved hip motion however elevated pelvic obliquity and rotation motion remained. Improvements in standing balance included reduced coronal sway characteristics and normalization of loading symmetry between sides. ConclusionUnilateral SIF resulted in significant improvements in both gait and balance function among SIJD patients to levels comparable to matched controls, however elevated pelvic motion remained. These findings help inform surgeons on the effectiveness of SIF for unilateral SIJD and provide important information regarding interpretation of functional outcomes.

A Randomized Clinical Trial to Evaluate a Digital Therapeutic to Enhance Gait Function in Individuals With Parkinson's Disease.

Postural instability and gait dysfunction (PIGD) is a cardinal symptom of Parkinson's disease (PD) and is exacerbated under dual-task conditions. Dual-task training (DTT), enhances gait performance, however it is time and cost intensive. Digitizing DTT via the Dual-task Augmented Reality Treatment (DART) platform can expand the availability of an effective intervention to address PIGD. The aim of this project was to evaluate DART in the treatment of PIGD in people with PD compared to a Traditional DTT intervention. It was hypothesized that both groups would exhibit significant improvements in gait, and the improvements for the DART group would be non-inferior to Traditional DTT. A single-blind randomized controlled trial was conducted with 47 PD participants with PIGD. Both groups completed 16 therapeutic sessions over 8 weeks; the DART platform delivered DTT via the Microsoft HoloLens2. Primary outcomes included clinical ratings and single- and dual-task gait biomechanical outcomes. Clinical measures of PD symptoms remained stable for DART and Traditional DTT groups. However, both groups exhibited a significant increase in gait velocity, cadence, and step length during single- and multiple dual-task conditions following the interventions. Improvements in gait velocity in the DART group were non-inferior to Traditional DTT under the majority of conditions. Non-inferior improvements in gait parameters across groups provides evidence of the DART platform being an effective digital therapeutic capable of improving PIGD. Effective digital delivery of DTT has the potential to increase use and accessibility to a promising, yet underutilized and difficult to administer, intervention for PIGD. ClinicalTrials.gov Dual-task Augmented Reality Treatment for Parkinson's Disease (DART) NCT04634331; posted November 18, 2020.

Effects of Combining Physical and Cognitive Training on Older Adults’ Physical Performance and Functional Abilities: A Systematic Review

Background: The combination of physical and cognitive training effectively enhances the physical function of the elderly by preventing and reducing the incidence of falls as well as increasing independence in daily activities. However, the optimal combination of strategies to achieve the best physical performance and functional capacity in healthy elderly is still being explored. Objective: This study aimed to explore effective combinations to improve physical function. Methods: A comprehensive database search was done through Web of Science, Medline, Embase and PubMed, and was supplemented with Google scholar since September 2022. Titles and abstracts were used to search for keywords, and data were extracted using the Participants; Interventions; Comparisons, and Outcomes (PICO). Results: The 23 included studies recruited subjects aged 65 and older, comprising 872 females and 497 males, while some research did not identify the gender of 216 participants. Among the included studies, 16 were of high quality while 7 were of low quality. Ten studies showed a significant improvement in gait among older adults who underwent combined physical-cognitive training, while two studies found no positive effect on dual-task gait performance. All five studies showed a significant improvement in strength. Out of the four studies conducted, only one showed no improvement in endurance. All five studies showed improved mobility, while only one study found no effect on agility. However, eight out of the eleven papers showed a significant improvement in balance for older adults who underwent combined cognitive and physical training. The three papers that effectively reduced the fear of falling were also significant. Two studies showed that those who received combined training exhibited a significantly better quality of life compared to those who did not. Conclusion: Combined motor-cognitive training is an advanced, feasible and effective method that can promote the improvement of gait, balance and overall health in the elderly. This type of training has a more significant impact on the elderly’s fall response compared to general physical or cognitive training. Additionally, it contributes to promoting functional independence.

Tremor, Gait, and Balance Disorders in Essential Tremor and the Efficacy of Atenolol

ABSTRACT Background: To assess gait and balance in patients with essential tremor (ET), which is the most common tremor disorder characterized by bilateral action tremor of the hands with possible involvement of further tremor locations and to test the efficacy of atenolol on tremor and gait and balance. Methods: In this prospective study, gait and balance were evaluated by static posturography in addition to International Cooperative Ataxia Rating Scale (ICARS) in 22 ET patients without any additional neurologic signs on examination. Tremor severity was assessed by The Essential Tremor Rating Assessment Scale (TETRAS). The efficacy of atenolol 100 mg/day both on tremor and gait and balance was investigated. Posturographic recordings were performed in gender, age-, and height-matched healthy volunteers who constituted the control group. Results: The mean center of gravity sway velocity of the ET patients recorded on firm and foam surfaces with eyes open and closed was not significantly different from the healthy controls but sway velocity on tandem stance was significantly increased (P = 0.032). Gait speed (P = 0.015) was decreased and step width was increased (P = 0.001). An improvement in TETRAS scores was recorded with atenolol treatment (P = 0.046). An improvement not reaching statistical significance was present in ICARS scores (P = 0.059). However, posturographic parameters did not change significantly (P &gt; 0.05). Conclusion: Increased sway velocity on tandem stance, decreased gait speed and increased step width are consistent with midline cerebellar dysfunction in ET patients with no obvious gait and balance deficits on clinical examination. Atenolol seems to be effective on tremor but does not cause a significant improvement in gait and balance deficits.

Split-Belt Training but Not Cerebellar Anodal tDCS Improves Stability Control and Reduces Risk of Fall in Patients with Multiple Sclerosis.

The objective of this study was to examine the therapeutic potential of multiple sessions of training on a split-belt treadmill (SBT) combined with cerebellar anodal transcranial direct current stimulation (tDCS) on gait and balance in People with Multiple Sclerosis (PwMS). Twenty-two PwMS received six sessions of anodal (PwMSreal, n = 12) or sham (PwMSsham, n = 10) tDCS to the cerebellum prior to performing the locomotor adaptation task on the SBT. To evaluate the effect of the intervention, functional gait assessment (FGA) scores and distance walked in 2 min (2MWT) were measured at the baseline (T0), day 6 (T5), and at the 4-week follow up (T6). Locomotor performance and changes of motor outcomes were similar in PwMSreal and PwMSsham independently from tDCS mode applied to the cerebellum (anodal vs. sham, on FGA, p = 0.23; and 2MWT, p = 0.49). When the data were pooled across the groups to investigate the effects of multiple sessions of SBT training alone, significant improvement of gait and balance was found on T5 and T6, respectively, relative to baseline (FGA, p < 0.001 for both time points). The FGA change at T6 was significantly higher than at T5 (p = 0.01) underlining a long-lasting improvement. An improvement of the distance walked during the 2MWT was also observed on T5 and T6 relative to T0 (p = 0.002). Multiple sessions of SBT training resulted in a lasting improvement of gait stability and endurance, thus potentially reducing the risk of fall as measured by FGA and 2MWT. Application of cerebellar tDCS during SBT walking had no additional effect on locomotor outcomes.

Effectiveness of motor imagery in patients with multiple sclerosis: a systematic review

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. Motor imagery (MI) has been proposed as a treatment to improve gait, fatigue and quality of life in these dysfunctions. To assess the effectiveness of MI, action observation therapy or mirror therapy approaches compared to other rehabilitation modality or no intervention, in MS. A systematic review of randomized controlled trials was conducted. Studies published in the last ten years investigating MI versus other interventions or no intervention in patients with MS were included. PEDro scale was used to assess methodological quality of included studies. Eight studies met the eligibility criteria. For fatigue, the MI and its combination with relaxation seem to be superior compared with other types of interventions or no intervention. The MI combined with music also showed significant improvements in gait and quality of life (QoL). MI and its combination with relaxation exercises have been shown to be effective in the treatment of fatigue, gait, balance, depression and QoL in patients with MS. The action observation therapy is useful in upper limb rehabilitation and improvement in attention, executive control and activation of sensorimotor networks. Further research with high methodological quality is needed to support these findings and to evaluate their effectiveness in long term.

Endoscopic Endonasal Transclival Odontoidectomy for Basilar Invagination: Operative Video and Technical Nuances.

Basilar invagination is a congenital or acquired craniovertebral junction abnormality where the tip of the odontoid process projects through the foramen magnum which can cause severe symptomatic compression of the brainstem and spinal cord. If left untreated, patients can develop progressive quadriparesis. Traditionally, basilar invagination can be treated with cervical traction and posterior stabilization. However, in irreducible cases, anterior decompression via a transoral or endonasal approach may be necessary. In this operative video, we demonstrate an endoscopic endonasal transclival approach for odontoidectomy to successfully treat a 37-year-old female with severe basilar invagination causing symptomatic compression on the cervicomedullary junction resulting in unsteady gait and motor weakness. The patient had Klippel–Feil syndrome where the C1 arch was assimilated to the foramen magnum and transclival drilling was needed to adequately access the odontoid process for removal. A second-stage posterior occipitocervical stabilization and fusion was performed the following day. Immediate postoperative imaging showed excellent decompression of the cervicomedullary junction. Postoperatively, the patient had significant improvement in gait and motor strength in all extremities, and was ambulating independently without assistance at 1 year after surgery. The endoscopic endonasal transclival odontoidectomy is a useful strategy to treat severe irreducible basilar invagination causing symptomatic neural compression. The surgical technique and nuances are described in a step-by-step fashion in this illustrative operative video.The link to the video can be found at: https://youtu.be/HL4K7KqJEJM.

Physical performance outcome measures used in exercise interventions for adults with childhood-onset disabilities: A scoping review.

People with childhood-onset disabilities face unique physical and social challenges in adulthood. Exercise interventions may improve physical performance in children, but there is a lack of research on adults. To describe studies that investigate exercise interventions and to evaluate the quality of physical performance outcome measures for adults with childhood-onset disabilities. Eligible studies reported on exercise interventions for adults (ages 16+) with cerebral palsy, spina bifida, or acquired brain injuries. Only randomized controlled trials published in English from 2008 to 2019 were included. MEDLINE, CINAHL, PEDro, EMBASE, and Cochrane Central Register of Controlled Trials were searched. Two reviewers independently screened studies and abstracted data. This scoping review included 4 trials reporting on cerebral palsy only. Three strength training programs found significant improvements in gait, and one mixed training program found significant improvements in strength and fitness. Only two outcome measures used are valid/reliable for adults (6 Minute Walk Test and Borg-20 Grades). Certain interventions may improve physical performance, but there is a lack of research on appropriate exercise interventions and physical performance outcome measures for adults with childhood-onset disabilities. Different exercise interventions should be investigated using larger sample sizes and outcome measures should be standardized.

Anti-Gravity Treadmill Training for Freezing of Gait in Parkinson's Disease.

Background: Parkinson’s disease (PD) is a neurodegenerative disorder characterized by motor impairment. Freezing of gait, impaired mobility and falls are common problems in these patients. We aimed to evaluate the effect of a novel therapy for these patients. Methods: We studied patients with moderate to severe freezing of gait who underwent antigravity treadmill training twice a week for 4 consecutive weeks with 50% reduction of body weight. Results: We enrolled 26 consecutive patients with PD, 19 completed the study. There were 10 males; mean age at evaluation was 72.7 ± 10.1 years. Compared to baseline, patients showed improvement in the Freezing of Gait Questionnaire (p = 0.001); and a mean reduction of 7 s in the Timed Up & Go (TUG) test (p = 0.004). Moderate or significant improvement in gait was reported by 84% of patients. Conclusions: Antigravity treadmill training improved freezing of gait and mobility in patients with PD.

Influence of Vitexin on ataxia-like condition initiated by lead exposure in mice

The study was aimed at investigating the influence of Vitexin on motor deficits and ataxia-like condition caused by Pb neurotoxicity in mice. Twenty four adult male albino mice were divided into four groups of six animals. Group A (Control) was administered 0.2 ml of normal saline; Group B was administered with Pb acetate 100 mg/kg/b.wt./d for 14 days; Group C was administered Vitexin 1 mg/kg/b.wt./d for 14 days; and Group D was administered 100 mg/kg/b.wt./d of Pb acetate + 1 mg/kg/b.wt./d of Vitexin for 14 days. Footprint pattern and Hang wire tests were carried out, while the level of malondialdehyde (MDA) and superoxide dismutase (SOD) in the cerebellum were assayed. Furthermore, cerebellum sections were stained with Haematoxylin and Eosin, while Purkinje cells were counted. Pb treated group showed that the MDA level was significantly high while the SOD level was low when compared with other groups. Also, loss of Purkinje cells, poor gait, and motor coordination were observed. In Pb + Vitexin treated group, the SOD level was significantly high while the MDA level was low. Besides, there was a significant improvement in gait, and motor coordination in Pb + Vitexin treated group. Pb neurotoxicity caused an increase in oxidative stress, loss of Purkinje cells, and ataxic-like symptoms. However, concurrent administration of Pb and Vitexin was able to neutralize oxidative stress and improve ataxic-like motor coordination.

EXERCÍCIOS FÍSICOS PARA PARKINSON.

Parkinson's disease has been described by James Parkinson and is called shaking palsy. Parkinson's disease is a brain disorder with features of a disease that destroys specific neurons responsible for the release of dopamine, an important substance in the brain. It is a progressive and disabling disease in which there is a loss of pigmented neurons in the substantia nigra with decreased dopamine. Acetylcholine has an excitatory effect, whereas dopamine is inhibitory. Both are found richly in the striated body. Parkinsonism, on the other hand, has its symptoms resulting from the imbalance between these two systems. It is a neurodegenerative disease that mainly affects the basal ganglia, specifically the dopaminergic system. Although clinically characterized by the motor symptoms of resting tremor, bradykinesia and asymmetric stiffness, Parkinson's disease today also includes non-motor symptoms caused by dysfunction of multiple neuronal populations. It is the second most common neurodegenerative disease, after Alzheimer's dementia, affecting 1-2% of the population over 60/65 years in different countries. Although no risk factors are clearly identified except for age, the etiology of the disease remains unknown. With the use of bodybuilding activity after 12 months, a significant improvement in gait of the individual in question was observed. Gait that has compromised the sinister side and generates a “circumference” to achieve foot elevation at the beginning of the gait, lost this circumference and generated significant knee extension, which contributed to the improvement of gait. Therefore, it is concluded that lower limb weight training exercises contribute to the improvement of gait in individuals with Parkinson's disease.

The Effect of Dual Tasking and Deep Brain Stimulation Frequency Parameters on Gait in Advanced Parkinson's Disease.

Objective:To study the effect of dual tasking and deep brain stimulation frequency parameters on gait in advanced Parkinson's diseaseMaterials and Methods:This is an open label interventional study evaluating 40 post STN-DBS patients with gait disturbances. All patients were diagnosed as PD by a movement disorder specialist using the United Kingdom Parkinson's Disease Society Brain Bank (UKPDSBB) criteria. Patients underwent bilateral subthalamic deep brain stimulation by a qualified neurosurgeon. Patients were managed on a combination of dopamine replacement therapy as well as deep brain stimulation. Patients were assessed by stand walk sit (SWS) test for a 5 meter distance and FOG scoring during medication 'ON' state and device “ON” state, at four frequencies 180, 130, 90, 60 HZ and device “OFF” state.Results:Out of 40 patients, 38 patients showed a significant improvement in gait at a single frequency (best response frequency) which is different for each patient. The mean FOG score showed significant improvement at all stimulation frequencies when compared to OFF stimulation (P < 0.05). The mean number of steps was 18.9 at best response frequency and 21.48 at 130 Hz (P < 0.0001). Number of freezing episodes also were significantly less with best frequency when compared to 130 Hz stimulation (0.28 and 0.65 respectively, (P < 0.0001). The mean FOG score was 6.45 at best frequency and 9.48 at 130 Hz (P < 0.0001). Mean Dual tasking score was 3.53 at best frequency and 5.15 at 130 Hz (P < 0.0002).Conclusion:Optimization of frequency setting for each patient can improve gait and that each patient may have a different optimal frequency.

47. The effect of surgical decompression on spine and lower extremity range of motion during gait in patients with cervical spondylotic myelopathy

BACKGROUND CONTEXT Cervical spondylotic myelopathy (CSM) is a neurologic condition resulting from spinal cord compression due to degenerative narrowing of the spinal canal. It is the most common cause of spinal cord dysfunction in patients older than 50. Symptoms of CSM may include numbness or weakness in the extremities, loss of fine motor dexterity, and difficulty with balance and gait. The natural history is typically one of progressive decline in neurologic function, so surgery to decompress the spinal cord is generally indicated to prevent progression in symptomatic patients. Despite the prevalence of this condition, relatively little quantitative kinematic information is available on the effect of surgical intervention on the gait of patients with CSM. PURPOSE To evaluate for changes in the spine and lower extremity range of motion (RoM) during gait in patients with CSM before and after surgical intervention. STUDY DESIGN/SETTING Non-randomized, prospective, concurrent cohort study. PATIENT SAMPLE Thirty-eight patients with symptomatic CSM. OUTCOME MEASURES Lower extremity and spine range of motion (RoM), spatiotemporal parameters, and pain level. METHODS Clinical gait analysis was performed one week before surgery (Pre) and three months after surgery (Post). Fifty reflective markers (9.5 mm diameter) attached to the patients; bodies were utilized to collect full body three-dimensional kinematics using 10 cameras (VICON) at a sampling rate of 100 Hz. Each patient performed a series of over-ground gait trials at a comfortable, self-selected speed. Neck and mid-back visual analog scale (VAS), Oswestry Disability Index (ODI), and Neck Disability Index (NDI) scores were also collected at both time points. Repeated measurements ANOVA was used to analyze data. RESULTS When comparing preoperative to postoperative gait parameters, significant increases in walking cadence (98.28 vs 103.37 steps/minutes, p=0.004), stride length (1.02 vs 1.07 m, p=0.018), and walking speed (0.86 vs 0.94 m/s, p=0.001) were observed. The amount of time spent in double support decreased after surgery (0.37 vs 0.32 s, p=0.032). The only significant difference in spine and lower extremity joint RoM measures was a decline in coronal RoM of both the knees and ankles postoperatively. VAS neck and mid-back as well as ODI improved significantly postoperatively, while the reduction in NDI did not attain statistical significance. CONCLUSIONS Despite conventional teaching that the goal of surgical intervention for CSM is to halt symptomatic progression, the data presented here demonstrate that significant improvements in gait are frequently observed after surgical management of CSM. Postoperative patients walk more quickly as a result of increased stride length and cadence. Furthermore, they lift their knees and dorsiflex/plantarflex their ankles less, consistent with a more efficient gait pattern. While surgeons should remain conservative with respect to how they counsel patients and set expectations preoperatively, cautious optimism regarding improvements in gait may be warranted in the setting of surgery for CSM. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

The effects of muscle vibration on gait control: a review

Background: The purpose of the review is to summarize the literature surrounding the use of muscle vibration as it relates to modifying human gait.Methods: After a brief introduction concerning historical uses and early research identifying the effect of vibration on muscle activation, we reviewed 32 articles that used muscle vibration during walking. The review is structured to address the literature within four broad categories: the effect of vibration to ‘trigger’ gait-like lower limb motions, the effect of vibration on gait control of healthy individuals and individuals with clinical conditions in which gait disorders are a prominent feature, and the effect of vibration training protocols on gait.Results: The acute effects of vibration during gait involving healthy participants is varied. Some authors reported differences in segmental kinematic and spatiotemporal measures while other authors reported no differences in these outcome measures. The literature involving participants with clinical conditions revealed that vibration consistently had a significant impact on gait, suggesting vibration may be an effective rehabilitation tool. All of the studies that used vibration therapy over time reported significant improvement in gait performance.Conclusions: This review highlights the difficulties in drawing definitive conclusions as to the impact of vibration on gait control, partly because of differences in walking protocols, site of vibration application, and outcome measures used across different investigative teams. It is suggested that the development of common investigative methodologies and outcome measures would accelerate the identification of techniques that may provide optimal rehabilitation protocols for individuals experiencing disordered gait control.

A Six Week Therapeutic Ballet Intervention Improved Gait and Inhibitory Control in Children With Cerebral Palsy-A Pilot Study.

Children with cerebral palsy (CP) have motor impairments that make it challenging for them to participate in standard physical activity (PA) interventions. There is a need to evaluate adapted PA interventions for this population. Dance can promote coordination, posture, muscle strength, motor learning, and executive functioning. This pilot study evaluated the feasibility and the effects of a new therapeutic ballet intervention specifically designed for children with CP.Methods: Eight children with CP (9–14 y/o; 75% female) participated in a 6-week therapeutic ballet intervention. Outcomes were measured in multiple domains, including body composition (DXA), muscle strength (hand-grip dynamometer), habitual physical activity, gait and selective motor control functions, and executive functioning. Follow-up assessments of habitual physical activity, gait, and executive functioning were completed 4 to 5 weeks post-intervention.Results: Five of the eight participants were overfat or obese based on DXA percentage of body fat. All participants were below the 50th percentile for their age and gender for bone density. Four participants showed a trend to improve hand-grip strength in one hand only, while one improved in both hands. There were significant improvements in gait across time points (pre, post, and follow-up), specifically in time of ambulation (Xpre = 4.36, Xpost = 4.22, Xfollow−up = 3.72, d = 0.056, p = 0.02), and in step length (cm) on the right: Xpre = 48.29, Xpost = 50.77, Xfollow−up = 52.11, d = 0.22, p = 0.027, and left stride: Xpre = 96.29, Xpost = 102.20, Xfollow−up = 104.20, d = 0.30, p = 0.027, indicating gait changes in bilateral lower extremities. There was improvement in inhibitory control (d = 0.78; 95% Confidence Limit = ±0.71, p < 0.05) with large individual responses primarily among those above the mean at baseline.Conclusions: Therapeutic ballet may prove to be a useful intervention to promote physiological and cognitive functions in children with CP. Results demonstrated feasibility of the physical, physiological, and cognitive assessments and suggested improvements in participants' gait and inhibitory control with large individual responses. Modifications to personalize the intervention may be needed to optimize positive outcomes.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03681171

Efficacy of istradefylline for gait disorders with freezing of gait in Parkinson’s disease: A single-arm, open-label, prospective, multicenter study

ABSTRACTBackground: Gait disorders are common in Parkinson’s disease patients who respond poorly to dopaminergic treatment. Blockade of adenosine A2A receptors is expected to improve gait disorders. Istradefylline is a first-in-class selective adenosine A2A receptor antagonist with benefits for motor complications associated with Parkinson’s disease.Research design and methods: This multicenter, open-label, single-group, prospective interventional study evaluated changes in total gait-related scores of the Part II/III Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and Freezing of Gait Questionnaire (FOG-Q) in 31 Parkinson’s disease patients treated with istradefylline. Gait analysis by portable gait rhythmogram was performed.Results: MDS-UPDRS Part III gait-related total scores significantly decreased at Weeks 4–12 from baseline with significant improvements in gait, freezing of gait, and postural stability. Significant decreases in MDS-UPDRS Part II total scores and individual item scores at Week 12 indicated improved daily living activities. At Week 12, there were significant improvements in FOG-Q, new FOG-Q, and overall movement per 48 h measured by portable gait rhythmogram. Adverse events occurred in 7/31 patients.Conclusions: Istradefylline improved gait disorders in Parkinson’s disease patients complicated with freezing of gait, improving their quality of life. No unexpected adverse drug reactions were identified.Trial registration: UMIN-CTR (UMIN000020288).