Significant Improvement In Walking Speed Research Articles

Developing a self-management and exercise model for people with multiple sclerosis

Aims The recognition of lack of support for people with multiple sclerosis (MS) with minimal to moderate disability, and growing evidence to support the benefits of exercise, initiated the development of an interdisciplinary self-management model. This article describes the development and components of the model, and the evaluation of the programme to date. Methods The service model was developed to include four programmes over a 2-year time frame. The study group comprised 33 people with MS. The group programme consisted of 6 weeks of information and exercise in the hospital setting, followed by 8 weeks of supervised exercise sessions in a leisure centre setting. Measures of gait, quality of life, fatigue levels and mood were obtained at baseline and following programme completion and the perceived benefits were recorded using a patient satisfaction questionnaire. Findings The evaluation demonstrated significant improvements in walking speed and quality of life and the participants reported a range of perceived physical and psychological benefits. It was identified that tighter selection criteria is required, with consideration of the time since diagnosis and how participants have adapted to their condition. The need for guidelines for other therapists setting up similar programmes was also identified. Conclusions This model provides evidence of the potential benefits of earlier intervention for people with MS and encouraging exercise through self-management programmes. It can therefore, with further refinement, meet a perceived shortfall in service provision both now and in the future.

Value of anaesthetic blocks in assessing spastic foot. A series of 64 motor blocks

IntroductionAnaesthetic blocks are used by many teams for assessing spasticity and its complications.PatientsFifty nine patients with spastic foot were selected over a four and half year period (starting June 2003), from patients having attended a specialist consultation. The patients were aged 13 to 70 (average 42.6 ± 22 years), and presented the following ailments: cerebral palsy in 26 cases, stroke in 25 cases, brain injury in three cases, degenerative disease in three cases and spinal cord injury in two cases.MethodMotor blocks were performed with specific needles plus neurostimulator, using the technique for locating the tibialis posterior nerve and its branches. The anaesthetic used was mainly 2% non-adrenalized etidocaine (Xylocaïne®), which is generally effective and quick-acting. Spasticitywas analysed using theAshworth scale andwalking was assessed using Bessou’s locometer.ResultsSixty-four anaesthetic blocks were performed. Forty nine blocks were performed on the tibialis posterior nerve. The Ashworth modified scores constantly showed a decrease in spasticity (two points). The average gain in joint motion was 12.25, and in antagonist strength was 0.92 points. There was no significant improvement in walking speed or step length after the blocks. Results concerning quality and motor blocks were technique-dependent and required patient cooperation. Local anaesthetic blocks determined the relative contributions of over-activity and muscle shortening in generating pathological posture. Selective blocks help identify the muscle or muscles responsible for spastic patterns. There was no significant improvement in walking speeds following the blocks.ConclusionAnaesthetic motor blocks are a necessary and often decisive procedure as regards spastic foot assessment. They reveal the most spastic muscles and determine the relative contributions of overactivity and muscle shortening.

Quantitative motion analysis in patients with hallux rigidus before and after cheilectomy

The purpose of this study was to quantify changes in temporal-spatial parameters and multisegmental foot/ankle kinematics in a group of patients with hallux rigidus following cheilectomy. Three-dimensional motion analysis was conducted using a 15-camera Vicon Motion Analysis System on a population of 19 patients who underwent cheilectomy for hallux rigidus. Data were analyzed using the four-segment Milwaukee Foot Model. Preoperative and postoperative tests were compared using paired parametric methods. Results showed significant improvements in walking speed, cadence, stride length, and stance/swing ratio from preoperative to postoperative state. Altered hallux and forefoot positions preoperatively showed shifts towards normal after cheilectomy. Although clinical improvements in pain and passive range of motion were statistically significant, similar improvements in range of motion were not demonstrated during ambulatory testing. The results of this study provide insight into ambulatory improvements following cheilectomy, and suggest further study of the rehabilitation process to improve the recovery of functional range of motion.

The effect of functional electrical stimulation on the physiological cost of gait in people with multiple sclerosis

Objective Functional electrical stimulation (FES) is used clinically in the management of drop foot in people suffering from neurological conditions. The aim of the study was to investigate the effects of FES, in terms of speed and physiological cost of gait, in people with multiple sclerosis (pwMS). Methods Twelve pwMS and 12 healthy matched controls walked at their own preferred walking speed (PWS) for 5 min around a 10 m elliptical course. Subjects with MS completed the protocol with and without using their FES. In addition, control subjects completed the protocol twice more walking at the same PWS of the pwMS to which they were matched. Results Wearing FES lead to a significant improvement in walking speed (0.49 ms−1 and 0.43 ms−1 with and without their FES respectively; P < 0.001) and a significant reduction in the physiological cost of gait (0.41 mL min−1 kg−1 m−1 and 0.46 mL min−1 kg−1 m−1 with and without FES respectively; P = 0.017) in pwMS. The speed of walking, oxygen uptake, and physiological cost were significantly different between pwMS and controls both at preferred and matched speeds. Although pwMS exhibit a higher physiological cost of walking, FES offers an orthotic benefit to pwMS and should be considered as a possible treatment option.

Effects of Stroke Severity and Training Duration on Locomotor Recovery After Stroke: A Pilot Study

Background. Locomotor training using partial body weight-supported treadmill (BWST) walking has been widely investigated for people after stroke, yet there remains a lack of evidence concerning the optimal training duration and the effect of locomotor impairment severity. Previous protocols have not emphasized the transfer of locomotor skills from the BWST environment to overground. Objectives. To assess the feasibility of a program combining locomotor training using BWST with task-specific overground training and to obtain pilot data on the effects of severity and training duration on recovery of locomotion. Methods. Seven adults with chronic poststroke hemiparesis and gait speed less than 0.8 m/s were recruited to participate in a 12-week (36 session) locomotor training program. Each session comprised 20 to 30 minutes of training using BWST with manual assistance, followed by 10 to 15 minutes of overground training to transfer the skills trained in the BWST environment. Gait speed was the primary outcome measure. Results. Six out of the 7 enrolled individuals completed the intervention program; 1 was withdrawn due to transportation difficulties affecting compliance with the training schedule. Four of the 6 participants had a functionally significant improvement in walking speed after 36 sessions, defined as having achieved a 0.4 m/s gait speed or greater for those with initial severe gait speed impairment (<0.4 m/s) or as having achieved a 0.8 m/s gait speed or greater for persons with initial moderate gait speed impairment (≥0.4 m/s and <0.8 m/s). All participants improved in balance and distance walked over 6 minutes, and 5 of the 6 participants showed increases in their daily home and community step activity. Conclusions. A locomotor training program combining walking using BWST and manual assistance with overground practice is feasible for people with chronic poststroke hemiparesis and moderate or severe gait speed impairment. This intervention shows promise for achieving functionally significant improvements in walking speed.

Physical exercise and comorbidity. Results from the Fitness and Arthritis in Seniors Trial (FAST)

Physical exercise is associated with a lower risk of disability. The impact of comorbidity on the benefits from physical exercise has not been clearly investigated. Elders with comorbidity may benefit from physical exercise to preserve physical function. Data are from 435 participants with knee osteoarthritis aged > or = 60 years enrolled in the Fitness and Arthritis in Seniors Trial (FAST), who were randomly assigned to 18-month health educational (HE), weight training (WT), or aerobic exercise (AE) interventions. Comorbidity was defined as the presence of osteoarthritis and > or = 2 clinical conditions. Percent changes in the 6-minute walk test, self-reported disability and knee pain from baseline to 3-, 9-, and 18-month follow-up visits were analyzed according to comorbidity, using analysis of variance. Significances were adjusted using the Bonferroni method. Mean age of the sample was 68.7 years. In participants with comorbidity (n=197), those in the AE intervention showed significant improvement in walking speed, compared to WT and HE groups, since the beginning of follow-up. Subjects with comorbidity in AE and WT groups showed improvement of the disability score at the 3-month follow-up visit compared to those in the HE group. This improvement was maintained at the end of the follow-up by the only AE group compared to the HE one (p=0.06). In participants with comorbidity, the pain score was improved by the AE intervention. AE and WT interventions improve physical function in individuals with comorbidity. AE improves physical function and knee pain independently of the presence of comorbidity.

The quantitative assessment of the influence of spinal cord stimulation on motor function in patients with multiple sclerosis.

This paper gives the results of quantitative measurements of motor function made in a group of 23 patients receiving spinal cord stimulation (SCS) for multiple sclerosis. Although 14 out of the 23 patients reported subjective improvement in motor function and many felt these improvements were significant to them, only 4 patients showed an improvement in pyramidal function, only 1 in cerebellar function. There was no statistically significant improvement in walking speed. It is concluded that SCS does not have a major impact upon motor disability in multiple sclerosis and bladder dysfunction remains the main indication for SCS.