Single Limb Stance Time Research Articles

EXERCISE CAN DIMINISH FRAILTY IN THE ELDERLY 629

The purpose of this project was to test the hypothesis that physical therapy exercises designed to improve flexibility, balance, strength and speed of movement, can reduce physical frailty in older ([horizontal bar over]x=82 yr) men and women. Subjects were considered frail if scores on a physical performance test modified from Reuben and Siu (JAGS, 1990) were less than 30/36 points. Exercise subjects participated in 3 mo of activity (36 sessions) while controls stretched at home for 3 mo. Significant improvements (p<.05) were made in static and dynamic balance (e.g. time to negotiate an obstacle course [11.1 vs 8.9s] and balance beam [10.1 vs. 5.0s], single limb stance time [3.8 vs. 10.5s], and Berg balance scale [51 vs. 54 pts]). Strength (Cybex isokinetic dynamometer) increased in the knee extensors (11, 11, 39%) and flexors (7, 16, 29%) @ 0, 60 and 180°/s. Significant increases in Cybex measured strength were also noted for the ankle dorsiflexors at 0°/s and the plantar flexors at 120°/s. Abdominals and hip extensors improved significantly but hip abduction strength remained unchanged. Range of motion increased at the glenohumeral and hip joints, ankle and trunk (rotation, forward bending). Improvements also were noted in the time required to pick up an object [3.0 vs. 2.4s], put on a coat [11.2 vs 9.2s], get up from and down to a chair [13.2 vs. 10.3], and lifting a weighted object. Findings indicate that older adults with impairments in strength, balance, flexibility and function, can adapt to physical therapy type exercise, thereby diminishing physical frailty.

Improved Gait Symmetry in Hemiparetic Stroke Patients Induced During Body Weight-Supported Treadmill Stepping

Background: Body weight-supported treadmill training (BWSTT) is being investigated as an adjunct to conventional gait training for the treatment of hemiparetic stroke patients. The potential efficacy of the technique may, in part, be related to optimiz ing locomotor-related sensory inputs to the nervous system, which in turn may improve the timing and coordination of motor activity. Objectives and Methods : This pilot study evaluated the effects of varying two types of sensory inputs, limb load and treadmill belt speed, during BWSTT. We assessed the effects of three levels of body weight sup port (BWS) and three treadmill speeds on the single limb stance time ratio (SLSR) and the single limb loading ratio (SLLR) in four subacute hemiparetic stroke patients. In three additional subjects, we studied the effects on SLSR of changing only the level of BWS at the one treadmill speed equal to best overground speed. Results: In comparison to overground walking, treadmill walking increased the SLSR toward 1.0. Higher belt speeds generally did not alter this increase in symmetry. A significant rela tionship was also found between SLLR and BWS. Fifteen percent BWS was most often associated with a SLLR close to 1.0, independent of the treadmill speed. Conclusion: During BWSTT, the moving treadmill belt entrains greater symmetry of single limb stance time in hemiparetic subjects who otherwise step asymmetrically. Optimal limb loading and treadmill speeds can increase the symmetry of stepping-associated sen sory inputs, which may enhance the locomotor output derived from activity-depen dent plasticity. Key Words: Body weight support—Treadmill training—Stroke— Hemiparesis—Gait training.

Resection arthroplasty following infected total hip replacement arthroplasty

Thirty-nine patients with 41 hips with resection arthroplasty for infected total hip replacement arthroplasty were evaluated for functional level and factors that contribute to that level. Eighty-three percent were either minimal community ambulators or nonambulators, and only two patients walked without assistive devices. At last follow-up, 93% of the patients had pain in their hips. The best function was obtained in patients with a healed wound and heterotopic ossification. The worst functional result was in patients with chronic drainage. Fifteen of the patients with resection arthroplasties had foot-switch studies to determine gait velocity and single-limb stance time. Ten patients also had oxygen consumption studies performed. The average gait velocity was 35 m/minute (41% of normal). The average oxygen consumption was 0.41 ml/gm (264% normal) with an average heart rate of 121. The energy consumption was greater than that recorded in patients with above-knee amputation.