Spatiotemporal Gait Parameters Research Articles

The Effect of a New Generation of Ankle Foot Orthoses on Sloped Walking in Children with Hemiplegia Using the Gait Real Time Analysis Interactive Lab (GRAIL).

Cerebral palsy poses challenges in walking, necessitating ankle foot orthoses (AFOs) for stability. Gait analysis, particularly on slopes, is crucial for effective AFO assessment. The study aimed to compare the performance of commercially available AFOs with a new sports-specific AFO in children with hemiplegic cerebral palsy and to assess the effects of varying slopes on gait. Eighteen participants, aged 6-11, with hemiplegia, underwent gait analysis using GRAIL technology. Two AFO types were tested on slopes (uphill +10 deg, downhill -5 deg, level-ground). Kinematic, kinetic, and spatiotemporal parameters were analyzed. The new AFO contributed to significant changes in ankle dorsi-plantar-flexion, foot progression, and trunk and hip rotation during downhill walking. Additionally, the new AFO had varied effects on spatiotemporal gait parameters, with an increased stride length during downhill walking. Slope variations significantly influenced the kinematics and kinetics. This study provides valuable insights into AFO effectiveness and the impact of slopes on gait in hemiplegic cerebral palsy. The findings underscore the need for personalized interventions, considering environmental factors, and enhancing clinical and research approaches for improving mobility in cerebral palsy.

Motion acquisition of gait characteristics one week after total hip arthroplasty: a factor analysis

IntroductionClinical gait analysis can be used to evaluate the recovery process of patients undergoing total hip arthroplasty (THA). The postoperative walking patterns of these patients can be significantly influenced by the choice of surgical approach, as each procedure alters distinct anatomical structures. The aim of this study is twofold. The first objective is to develop a gait model to describe the change in ambulation one week after THA. The secondary goal is to describe the differences associated with the surgical approach.Materials and methodsThirty-six patients undergoing THA with lateral (n = 9), anterior (n = 15), and posterior (n = 12) approaches were included in the study. Walking before and 7 days after surgery was recorded using a markerless motion capture system. Exploratory Factor Analysis (EFA), a data reduction technique, condensed 21 spatiotemporal gait parameters to a smaller set of dominant variables. The EFA-derived gait domains were utilized to study post-surgical gait variations and to compare the post-surgical gait among the three groups.ResultsFour distinct gait domains were identified. The most pronounced variation one week after surgery is in the Rhythm (gait cycle time: +32.9%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$+32.9\\mathrm{\\%}$$\\end{document}), followed by Postural control (step width: +27.0%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$+27.0\\mathrm{\\%}$$\\end{document}), Phases (stance time: +11.0%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$+11.0\\%$$\\end{document}), and Pace (stride length: − 9.3%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$9.3\\%$$\\end{document}). In postsurgical walking, Phases is statistically significantly different in patients operated with the posterior approach compared to lateral (p-value = 0.017) and anterior (p-value = 0.002) approaches. Furthermore, stance time in the posterior approach group is significantly lower than in healthy individuals (p-value < 0.001).ConclusionsThis study identified a four-component gait model specific to THA patients. The results showed that patients after THA have longer stride time but shorter stride length, wider base of support, and longer stance time, although the posterior group had a statistically significant shorter stance time than the others. The findings of this research have the potential to simplify the reporting of gait outcomes, reduce redundancy, and inform targeted interventions in regards to specific gait domains.

Effect of levodopa on pathological gait in Dravet syndrome: A randomized crossover trial using three-dimensional gait analysis.

Individuals with Dravet syndrome (DS) exhibit progressive gait disturbance. No quantitative studies have been conducted to evaluate the effectiveness of medication for gait disturbance. Therefore, the aim of this study was to evaluate the effectiveness of levodopa for pathological gait in people with DS using three-dimensional gait analysis (3DGA). Nine individuals with DS, ages 6-20 years, participated in a crossover study of levodopa and were randomly assigned to the levodopa precedence or no levodopa precedence group. Levodopa/carbidopa hydrate was prescribed at a dose of 5 mg/kg/day (body weight <60 kg) or 300 mg/day (body weight ≥60 kg). The medication was taken for 4-6 weeks (4-week washout period). 3DGA was performed three times before the study, with and without levodopa. A mixed-effects model was used to evaluate the effectiveness of levodopa. The primary outcome was the change in the Gait Deviation Index (GDI). In addition, spatiotemporal gait parameters, 6-minute walking distance (6MD), and balance were evaluated. The correlation between the effectiveness of levodopa and age or gait performance before starting levodopa was analyzed. Levodopa improved the GDI by 4.2 points, (p = .029), 6MD by 52 m (p = .002), and balance test result by 4.1 mm (p = .011) in participants with DS. No severe adverse events were observed, with the exception of one participant, who exhibited fever and consequently stopped taking levodopa. Levodopa was more effective in younger participants with a higher baseline gait performance. Our randomized crossover trial showed that levodopa has the potential to improve gait disturbance in people with DS.

Exploring gait velocity as a predictor of cardiometabolic disease risk in young adults.

The association between poor gait and functional movement ability and metabolic syndrome (MetS) has been well established in older adults. A continuous cardiometabolic risk score, MetSindex, may more easily identify individuals at risk for cardiometabolic disease who do not yet meet the stringent criteria for a formal MetS diagnosis. Although the association between MetS and gait velocity is well established in older adults, no such relationship has been identified in younger adults; a group experiencing a rapid increase in the development of MetS. MetSindex was determined for 21 young adults using standard procedures. Gait velocity was measured as participants completed a ten-meter walk test. Spatiotemporal parameters of gait were also derived using a motion capture system. Simple linear regression was used to determine the relationship between MetSindex and gait velocity, as well as MetSindex and spatiotemporal parameters of gait. There was a large inverse relationship between MetSindex and gait velocity. A large inverse relationship was also observed between MetSindex and cadence, and a large positive relationship was observed between stance time and double limb support time. Gait velocity slows in young adults who do not necessarily meet the criterion for positive diagnosis of MetS-but demonstrate an increased risk for MetS and cardiovascular disease through higher MetSindex scores. The mechanism underlying reduced gait velocity may be fewer, but not shorter steps. Determining easy-to-use surrogates of MetS (e.g., gait velocity) may help combat the growing prevalence of MetS by increasing access to preventative approaches.

The influence of prosthetic suspension on gait and cortical modulations is persons with a transfemoral amputation: socket-suspended versus bone-anchored prosthesis

BackgroundPersons with a transfemoral amputation (TFA) often experience difficulties in daily-life ambulation, including an asymmetrical and less stable gait pattern and a greater cognitive demand of walking. However, it remains unclear whether this is effected by the prosthetic suspension, as eliminating the non-rigid prosthetic connection may influence stability and cortical activity during walking. Spatiotemporal and stability-related gait parameters, as well as cortical activity during walking, were evaluated between highly active individuals (MFC-level K3-4) with a TFA and able-bodied (AB) persons, and between persons with a bone-anchored prosthesis (BAP) and those with a socket-suspended prosthesis (SSP).Methods18 AB persons and 20 persons with a unilateral TFA (10 BAP-users, 10 SSP-users) walked on a treadmill at their preferred speed. Spatiotemporal and margin of stability parameters were extracted from three-dimensional movement recordings. In addition, 126-channel electroencephalogram (EEG) was recorded. Brain-related activity from several cortical areas was isolated using independent component analysis. Source-level data were divided into gait cycles and subjected to time–frequency analysis to determine gait-cycle dependent modulations of cortical activity.ResultsPersons with TFA walked with smaller and wider steps and with greater variability in mediolateral foot placement than AB subjects; no significant differences were found between BAP- and SSP-users. The EEG analysis yielded four cortical clusters in frontal, central (both hemispheres), and parietal areas. No statistically significant between-group differences were found in the mean power over the entire gait cycle. The event-related spectral perturbation maps revealed differences in power modulations (theta, alpha, and beta bands) between TFA and AB groups, and between BAP- and SSP-users, with largest differences observed around heel strike of either leg.ConclusionsThe anticipated differences in gait parameters in persons with TFA were confirmed, however no significant effect of the fixed suspension of a BAP was found. The preliminary EEG findings may indicate more active monitoring and control of stability in persons with TFA, which appeared to be timed differently in SSP than in BAP-users. Future studies may focus on walking tasks that challenge stability to further investigate differences related to prosthetic suspension.

Variability of gross and fine motor control in different tasks in fibromyalgia patients

Fibromyalgia (FM) is normally defined as a widespread pain syndrome or disease that presents disturbances in gross and fine motor control. As a gross motor control skill, gait requires coordination, balance, and muscle strength, and it could be an essential factor for FM patients to perform daily activities. Measuring the spatial and temporal gait parameters or gait variability has been used to assess motor pathologies and identify gait disorders. The Lyapunov exponent is a non-linear measure of variability, which quantifies the ability that the system has to attenuate small perturbances, indicating that there might be a relationship between balance and spatiotemporal gait parameters. This technique has already been used for gait analysis and could be used in fine and gross daily tasks, such as the finger tapping test (FTT) or the sit-and-stand test. Inertial Measurement Units have also been used to analyze gross motor control, namely in gait variability. So, the aim of this study is to analyze and compare the variability of gross and fine motor movements between patients with FM and a control group. The sample included 20 female participants, 10 with FM and 10 without (46.150 ± 12.835 years old). To analyze gross motricity, participants were asked to perform the gait task for two minutes and the 30-second chair sit-and-stand test; and to analyze fine motor control, they were asked to perform six trials of FTT test with both hands. To collect the data, an inertial sensor (IMU) was used. FM patients showed a more irregular pattern of linear acceleration peaks than controls in both tasks. Lyapunov values in FM patients show greater instability and variability in the anteroposterior and vertical movements for gait analysis and present significantly higher variability in the anteroposterior movements when performing the sit and stand task and the finger tapping test. Keywords: Fibromyalgia; Gross Motor Control; Gait; Sit and Stand; Variability; Lyapunov; IMU

Kinematic Effects of Combined Subthalamic and Dorsolateral Nigral Deep Brain Stimulation in Parkinson's Disease.

Additional stimulation of the substantia nigra (SNr) has been proposed to target axial symptoms and gait impairment in patients with Parkinson's disease (PD). This study aimed to characterize effects of combined deep brain stimulation (DBS) of the subthalamic nucleus (STN) and SNr on gait performance in PD and to map stimulation sites within the SNr. In a double-blinded crossover design, 10 patients with PD and gait impairment underwent clinical examination and kinematic assessment with STN DBS, combined STN+SNr DBS and OFF DBS 30 minutes after reprogramming. To confirm stimulation within the SNr, electrodes, active contacts, and stimulation volumes were modeled in a common space and overlap with atlases of SNr was computed. Overlap of stimulation volumes with dorsolateral SNr was confirmed for all patients. UPDRS III, scoring of freezing during turning and transitioning, stride length, stride velocity, and range of motion of shank, knee, arm, and trunk as well as peak velocities during turning and transitions and turn duration were improved with STN DBS compared to OFF. On cohort level, no further improvement was observed with combined STN+SNr DBS but additive improvement of spatiotemporal gait parameters was observed in individual subjects. Combined high frequency DBS of the STN and dorsolateral SNr did not consistently result in additional short-term kinematic or clinical benefit compared to STN DBS. Stimulation intervals, frequency, and patient selection for target symptoms as well as target region within the SNr need further refinement in future trials.

Does Texting While Walking Affect Gait's Plantar Pressure Parameters?

This study aims to examine the possible effects of mobile phone use on plantar pressure and spatiotemporal parameters during walking. Thirty volunteers (18 males and 12 females) participated in the study. A 10-m walking path was prepared, and a messaging connection was established. They were asked to write three posts without word or character mistakes and participants walked on the path walk as much as they wanted on the trail to make sure they were walking at their own pace. The gait's spatiotemporal parameters and plantar pressure parameters were recorded while walking. A paired samples t-test was used to determine whether there was a difference between normal walking and walking while texting. While walking and writing a message, cadence, speed, and step length decreased significantly (P < 0.05). In the plantar pressure parameters, the fore- and midfoot load and pressure were significantly increased (P < 0.05). Compared to normal walking, the forces on the forefoot and midfoot and the pressure per unit area increased in walking while texting. It is thought that the pace of walking slows down, and focus and attention shift to the front of the body.

Sensorimotor Training Improves Gait, Ankle Joint Proprioception, and Quality of Life in Patients With Diabetic Peripheral Neuropathy: A Single-Blinded Randomized Controlled Trial.

To investigate the effect of sensorimotor training on gait, ankle joint proprioception, and quality of life in diabetic peripheral neuropathy patients. A prospective, single-blind, randomized controlled experiment was performed. Forty patients with diabetic peripheral neuropathy aged 50-65 yrs were distributed randomly into two groups, the sensorimotor training group ( n = 20), and the control group ( n = 20). Both groups attended awareness sessions about diabetes and foot care for 30 mins, every 2 wks. Moreover, the sensorimotor training group received 6 wks (3 d/wk) of sensorimotor training. Spatiotemporal gait parameters, proprioception accuracy of the ankle joint, and quality of life were measured before and after 6 wks of intervention. Regarding baseline data, no significant differences were identified among groups ( P > 0.05). After 6-wk intervention, the sensorimotor training group exhibited significant improvements in all outcome variables ( P < 0.001), while the control group showed significant changes in quality of life only ( P = 0.03). Comparing groups after intervention reveals statistically significant differences in all measured variables in favor of the sensorimotor training group ( P < 0.001). Sensorimotor training may improve spatiotemporal gait parameters, ankle joint proprioception, and quality of life of patients with diabetic peripheral neuropathy.

Факторная структура показателей походки у пожилых мужчин и женщин

Ageing negatively affects the quality of walking. There is a relationship between old age and changes in the main spatiotemporal gait parameters. However, this relationship differs between men and women. The question of the influence of sex on postural balance remains relevant today, since conflicting data are found in various sources. The purpose of this research was to study sex-related differences in the factor structure of gait parameters in older adults. Materials and methods. The study involved 80 subjects aged 60–74 years. The mean age was 67.2 ± 2.1 years in the group of women (n = 40) and 67.4 ± 2.0 years in the group of men (n = 40). Gait was assessed using the computer-aided stabilometric complex Balance Manager. The following tests were performed: Sit-to-Stand, Walk Across, Tandem Walk, Step/Quick Turn, and Step-UpandOver. Results. Sex-related features of the factor structure of gait parameters in older adults were revealed. We established that the leading factor in the group of older women is the factor that combines the following parameters: time to execute a motor act (stepping over an obstacle) and speed of simple and tandem walking. In the group of older men, however, the leading factor combines the parameters of time, accuracy and muscle force when performing complex motor acts (turning while walking and stepping over an obstacle).

Gait Variability and its Relationship to Functional Mobility in Hemiparetic Stroke

Background: Stroke remains a leading cause of long-term disability worldwide, with hemiplegia being one of the most common outcomes, significantly impairing gait and functional mobility. The integration of sensory stimulation techniques into rehabilitation practices offers a promising avenue for enhancing recovery outcomes in hemiplegic stroke survivors. Objective: This study aimed to investigate the effectiveness of auditory and visual sensory stimulation on improving gait parameters and functional mobility in hemiplegic stroke patients. Methods: Conducted at Mayo Hospital, Lahore, this analytical cross-sectional study involved 24 stroke survivors with hemiplegia, randomly assigned to two intervention groups. Inclusion criteria included a Modified Ashworth Scale score of 1 to 1+ and a Mini-Mental State Examination score of ≥25. One group received auditory feedback gait training (AFGT) with smart insoles, while the other engaged in sit-to-stand training with visual feedback using a Wii Balance Board, alongside conventional rehabilitation therapies. The interventions lasted four weeks, with assessments conducted pre and post-intervention. Outcome measures included the Dynamic Gait Index (DGI), Fugl-Meyer Assessment for Lower Extremity (FMA-LE), and various gait parameters. Statistical analysis was performed using SPSS version 25. Results: Post-intervention, the study observed significant improvements in DGI (mean increase: 3.5 points, p&lt;0.01), FMA-LE scores (mean increase: 10 points, p&lt;0.01), and enhanced gait parameters including step length and stride length (p&lt;0.05). The group receiving AFGT with smart insoles showed notable improvements in spatiotemporal gait parameters and balance compared to the control group, indicating the efficacy of sensory feedback in rehabilitation. Conclusion: The study demonstrates that incorporating auditory and visual feedback into rehabilitation regimens can significantly improve gait dynamics and functional mobility in hemiplegic stroke patients. These findings suggest the potential for sensory stimulation techniques to enhance the effectiveness of stroke rehabilitation, advocating for their integration into standard care practices.

Validation of portable in-clinic video-based gait analysis for prosthesis users

Despite the common focus of gait in rehabilitation, there are few tools that allow quantitatively characterizing gait in the clinic. We recently described an algorithm, trained on a large dataset from our clinical gait analysis laboratory, which produces accurate cycle-by-cycle estimates of spatiotemporal gait parameters including step timing and walking velocity. Here, we demonstrate this system generalizes well to clinical care with a validation study on prosthetic users seen in therapy and outpatient clinics. Specifically, estimated walking velocity was similar to annotated 10-m walking velocities, and cadence and foot contact times closely mirrored our wearable sensor measurements. Additionally, we found that a 2D keypoint detector pretrained on largely able-bodied individuals struggles to localize prosthetic joints, particularly for those individuals with more proximal or bilateral amputations, but after training a prosthetic-specific joint detector video-based gait analysis also works on these individuals. Further work is required to validate the other outputs from our algorithm including sagittal plane joint angles and step length. Code for the gait transformer and the trained weights are available at https://github.com/peabody124/GaitTransformer.

Gait Analysis of Hemiparetic Adult Patients with a Quadripod Cane and a Rolling Cane.

Stroke consequences include hemiparesis and difficulty walking. Several types of canes exist to overcome these alterations, but little data compares the quadripod cane and the rolling cane in hemiparetic patients. The objective of this work is twofold: to determine whether the gait speed-the most often used parameter to assess gait performance-depends on the type of cane, and to establish which spatiotemporal parameters have the most influence. Thirty-four hemiparetic patients performed 10 m walking tests at comfortable and fast speed conditions, using both canes on two different days. To objectively analyze their gait patterns, we used a tri-axial Inertial Measurement Units (IMU)-based system to record the walking signals from which we extracted the gait spatiotemporal parameters. We particularly examined the speed, stride length, and durations of stance, swing, and double support phases. The results showed that hemiparetic patients walked faster with the rolling cane during both speed conditions. These speed increases could be explained by the decrease in the stance phase duration of the affected leg, the decrease in the double support duration, and the increase in cadence. Our findings suggest that the rolling cane allows safe and faster walking.

The association of pain with gait spatiotemporal parameters in children with hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder

BackgroundChildren with hypermobility spectrum disorder/hypermobile Ehlers-Danlos syndrome (HSD/hEDS) have a high prevalence of chronic pain, which may influence gait dynamics. However, little is known about pain outcomes and their association with gait spatiotemporal parameters in children with HSD/hEDS. Research questionDoes pain correlate with gait spatiotemporal parameters in children with HSD/hEDS? MethodsEighteen children with HSD/hEDS and eighteen typically developing (TD) children participated in the study. The current level of pain (0–10 on the numeric rating scale), modified Brief Pain Inventory, and Pain Catastrophizing Scale-Child version were implemented to assess pain in children with HSD/hEDS. All children completed a gait analysis at a self-selected speed. Mean and variability (measured using the coefficient of variation) of gait spatiotemporal parameters were analyzed. Gait parameters included stride length, stride time, gait speed, percent stance time, and step width. A Mann-Whitney U-test was used to compare the gait parameters between children with HSD/hEDS and TD children. Spearman correlations were used to examine the relationships between pain and gait spatiotemporal parameters in children with HSD/hEDS. ResultsChildren with HSD/hEDS had a longer percent stance time compared to TD children (p = 0.03). Lower pain interference in relationships with other people was significantly associated with faster gait speeds (ρ = −0.55, p = 0.03). Children with HSD/hEDS also had greater pain interference during mobility (ρ = 0.5, p = 0.05) and going to school (ρ = 0.65, p = 0.01), which were significantly correlated with greater stride length variability. Greater pain interference during enjoyment of life was significantly associated with greater percent stance time variability (ρ = 0.5, p = 0.05). Greater pain catastrophizing was correlated with decreased step width variability in children with HSD/hEDS (ρ = −0.49, p = 0.05). SignificancePain interference and catastrophe were significantly associated with gait spatiotemporal variability. Our findings suggest that assessing pain-associated gait alterations may help understand the clinical features and gait kinematics of children with HSD/hEDS.

Brain-IT: Targeting the brain using information technology for secondary prevention of mild neurocognitive disorder

Brain-IT: Targeting the brain using information technology for secondary prevention of mild neurocognitive disorder

Dynamic Measures of Balance during Obstacle-Crossing in Self-Selected Gait in Individuals with Mild-to-Moderate Parkinson’s Disease

Individuals with Parkinson’s disease (PD) have postural instability and gait dysfunction that lead to falls and disability with disease progression. Increased fall risk is particularly seen during challenging gait tasks such as obstacle-crossing. The purpose of this study was to determine if there were differences in dynamic postural control during self-paced walking and obstacle-crossing between persons with mild-to-moderate PD and healthy controls. Participants included nine individuals with PD and nine age- and gender-matched controls (CON). This study examined margin of stability metrics using instrumented 3D motion analysis during the two-step sequence of the obstacle-crossing task. Dynamic balance variables and spatiotemporal (ST) parameters at distinct gait events related to the leading (step one) and trailing leg (step two) were compared for the PD and CON groups using a mixed-model ANOVA. No differences were found between groups for ST gait parameters during obstacle-crossing, except for a significantly reduced step length (p = 0.005) for the trailing limb for the PD group. The PD group demonstrated significantly larger mean values for mediolateral center of pressure–center of mass (COP–COM) distance at first double support (p = 0.004) and center of pressure–extrapolated center of mass (COP–XCOM) distance at second double support (p = 0.016) for the second step. Our results suggest that the margin of stability may be useful in discerning postural control adaptations during obstacle negotiation in persons with PD.

Immediate and Short-Term Effects of In-Shoe Heel-Lift Orthoses on Clinical and Biomechanical Outcomes in Patients With Insertional Achilles Tendinopathy

Background: Physical therapists frequently employ heel lifts as an intervention to reduce Achilles tendon pain and restore function. Purpose: To determine the short-term effect of heel lifts on clinical and gait outcomes in participants with insertional Achilles tendinopathy (IAT). Study Design: Case series; Level of evidence, 4. Methods: Participants with IAT underwent eligibility screening and completed assessments at baseline and 2 weeks later. Primary outcomes included symptom severity (Victoria Institute of Sports Assessment-Achilles [VISA-A]), gait analysis with the 10-m walk-test at 2 speeds (normal and fast), and pain during walking. Pain and gait analysis were assessed under 3 conditions: before fitting 20-mm heel lifts, immediately after heel-lift fitting, and after 2 weeks of wearing heel lifts. Ultrasound images and measurements at the Achilles insertion were obtained from prone and standing positions (with and without heel lifts). Spatiotemporal gait parameters and tibial tilt angles were evaluated at normal speed using inertia measurement units during the 3 study conditions. Differences between the conditions were analyzed using paired t test or analysis of variance. Results: Overall, 20 participants (12 female, 13 with bilateral IAT; mean age, 51 ± 9.3 years; mean body mass index 31.6 ± 6.8 kg/m2) completed all assessments. Symptom severity (VISA-A) of the more symptomatic side significantly improved at 2 weeks (60 ± 20.6) compared with baseline (52.2 ± 20.4; P &lt; .01). Pain during gait (Numeric Pain Rating Scale) was significantly reduced immediately after heel-lift fitting (0.7 ± 2.0) when compared with baseline (2.2 ± 2.7, P = .043). Spatiotemporal gait parameters and tibial tilt angle before and after using heel lifts at normal walking speed were not significantly different; however, gait speed, stride length, and tibial tilt angle on both sides increased significantly immediately after using heel lifts and were maintained after 2 weeks of wear. Conclusion: Using heel lifts not only improved symptom severity after 2 weeks but also immediately reduced pain during gait and had a positive impact on gait pattern and speed.

LSVT® BIG versus progressive structured mobility training through synchronous telerehabilitation in Parkinson’s disease: A randomized controlled trial

BackgroundParkinson’s disease (PD) is a common neurodegenerative illness associated with motor symptoms.AimThe aim of study was to compare the effects of synchronous telerehabilitation-based Lee Silverman Voice Treatment® BIG (LSVT® BIG) protocol and progressive structured mobility training in patients with Parkinson’s disease (PD).MethodsThirty-two patients diagnosed with PD (aged 40–72 years, Hoehn-Yahr stage 1–3) were randomly allocated into LSVT® BIG (Group 1) and Progressive Structured Mobility Training (Group 2) groups. Exercises were performed in both groups for 60 min a day, 4 days a week, for 4 weeks under the supervision of a physiotherapist with synchronous online videoconference method. Dynamic balance was assessed with Mini-Balance Evaluation Systems Test (Mini-BESTest) as a primary outcome measure. The secondary outcome measurements were Timed Up and Go Test (TUG), spatiotemporal parameters of gait from Kinovea® software, and postural stability from the Biodex Balance System. Other outcome measures were Activity-Specific Balance Confidence Scale-Short Form (ABC-SF), Parkinson’s Activity Scale (PAS), and Parkinson’s Disease Quality of Life Questionnaire (PDQ-39).ResultsThis study showed significant group-by-time interactions on Mini-BEST (p = 0.042), ABC-SF (p = 0.029), and PAS (p = 0.022) in favor of group 1. Also, TUG (p < 0.01), spatiotemporal parameters of gait (p < 0.01), and PDQ-39 (p < 0.01) were improved in both groups.ConclusionBoth synchronous telerehabilitation-based exercise protocols enhanced balance and gait, as well as activity level and quality of life in patients with PD. LSVT® BIG may be preferred to improve dynamic balance, balance confidence, and activity status in the early stages of PD. These results should be confirmed in future studies with more robust methodology.Trial registrationNCT04694872.

Inflammatory Biomarkers and Gait Impairment in Older Adults: A Systematic Review.

Peripheral inflammation and gait speed alterations are common in several neurological disorders and in the aging process, but the association between the two is not well established. The aim of this systematic literary review is to determine whether proinflammatory markers are a positive predictor for gait impairments and their complications, such as falls in older adults, and may represent a risk factor for slow gait speed and its complications. The systematic review was performed in line with the Preferred Report Items for Systematic Review and Meta-Analyses (PRISMA). A protocol for literature searches was structured a priori and designed according to the International Perspective Register of Systemic Review (PROSPERO: CRD42023451108). Peer-reviewed original articles were identified by searching seven electronic databases: Excerpta Medica Database (EMBASE), SciVerse (ScienceDirect), Scopus, PubMed, Medline, Web of Science, and the Cochrane Library. The search strategy was formulated based on a combination of controlled descriptors and/or keywords related to the topic and a manual search was conducted of the reference lists from the initially selected studies to identify other eligible studies. The studies were thoroughly screened using the following inclusion criteria: older adults, spatiotemporal gait characteristics, and proinflammatory markers. A meta-analysis was not performed due to the heterogeneity of the studies, and the results were narratively synthesized. Due to the clinical and methodological heterogeneity, the studies were combined in a narrative synthesis, grouped by the type of biomarkers evaluated. A standardized data extraction form was used to collect the following methodological outcome variables from each of the included studies: author, year, population, age, sample size, spatiotemporal gait parameters such as gait velocity, and proinflammatory markers such as TNF-α, high sensitivity C-reactive (CRP) proteins, and IL-6. We included 21 out of 51 studies in our review, which examined the association between inflammatory biomarkers and gait impairment. This review highlights the role of TNF-α, CRP, and IL-6 in gait impairment. Biomarkers play an important role in the decision-making process, and IL-6 can be an effective biomarker in establishing the diagnosis of slow gait speed. Further longitudinal research is needed to establish the use of molecular biomarkers in monitoring gait impairment.

Powered single hip joint exoskeletons for gait rehabilitation: a systematic review and Meta-analysis.

Gait disorders and as a consequence, robotic rehabilitation techniques are becoming increasingly prevalent as the population ages. In the area of rehabilitation robotics, using lightweight single hip joint exoskeletons are of significance. Considering no prior systematic review article on clinical outcomes, we aim to systematically review powered hip exoskeletons in terms of gait parameters and metabolic expenditure effects. Three databases of PubMed, Scopus, and Web of science were searched for clinical articles comparing outcomes of gait rehabilitation using hip motorized exoskeleton with conventional methods, on patients with gait disorder or healthy individuals. Of total number of 37 reviewed articles, 14 trials were quantitatively analyzed. Analyses performed in terms of gait spatiotemporal parameters like speed (self-speed and maximum speed), step length, stride length, cadence, and oxygen consumption. Improved clinical outcomes of gait spatiotemporal parameters with hip joint exoskeletons are what our review's findings show. In terms of gait values, meta-analysis indicates that rehabilitation with single hip joint exoskeleton enhanced parameters of maximum speed by 0.13 m/s (0.10-0.17) and step length by 0.06 m (0.05-0.07). For the remaining investigated gait parameters, no statistically significant difference was observed. Regarding metabolic parameters, oxygen consumption was lower in individuals treated with hip exoskeleton (- 1.23 ml/min/kg; range - 2.13 to - 0.32). Although the analysis demonstrated improvement with just specific gait measures utilizing powered hip exoskeletons, the lack of improvement in all parameters is likely caused by the high patient condition heterogeneity among the evaluated articles. We also noted in patients who rehabilitated with the hip exoskeleton, the oxygen cost was lower. More randomized controlled trials are needed to verify both the short- and long-term clinical outcomes, including patient-reported measures. Level I (systematic review and meta-analysis).