Walking Ability In Subjects Research Articles

Association Between Balance Self-efficacy and Walking Ability in Those With New Lower Limb Amputations.

A relationship between walking ability and self-efficacy has been demonstrated in various rehabilitation patient populations. In experienced prosthetic ambulators, walking ability is related to self-efficacy of balance, however, this relationship has not been quantified for those with newly acquired lower limb amputations (LLA). To investigate the association between walking performance (objective) and self-reported walking abilities (subjective) on balance self-efficacy in those with LLA. Cross-sectional study of 27 people (17 men; mean age=63.57±9.33) at discharge from inpatient prosthetic rehabilitation for first major unilateral LLA. Individuals completed 6m straight path walking and the L-Test under single- and dual-task conditions. The Prosthesis Evaluation Questionnaire (PEQ) was administered, and the Ambulation subscale provided subjective measures of walking ability. A single PEQ question on satisfaction with walking (16B) was also used as a proxy for subjective walking ability. The Activities-specific Balance Confidence Scale measured balance self-efficacy. Multivariable linear regression was used to evaluate the strength of association between walking ability (objective and subjective) and balance self-efficacy (dependent variable). Walking velocity on the 6m straight path under single-task (p=0.011) and dual-task conditions (p=0.039), the single-task L-Test (p=0.035) and self-reported satisfaction with walking (p=0.019) were associated with self-efficacy of balance. Objective measures of walking ability that were independently associated with balance self-efficacy included straight path walking velocity under single and dual-task conditions and the single-task L-Test. Satisfaction with walking was also associated with balance self-efficacy. This highlights the interplay between physical and psychological factors during rehabilitation. More research in the area of self-efficacy and walking ability is needed to establish self-efficacy as a target during prosthetic rehabilitation for those with LLA.

Comparison of the Efficacy of Two Different Medial Linkage Mechanisms in Knee-Ankle-Foot Orthoses on Walking Ability in Subjects with Spinal Cord Injury

ABSTRACT Introduction This study evaluated the efficacy of two different medial linkage mechanisms (sliding mechanism [SM] and medial linkage mechanism associated with reciprocating gait motion (MLRGM), used within otherwise identical knee-ankle-foot orthoses (KAFOs) on patients with spinal cord injury (SCI). Methods Three volunteer subjects with SCI were fitted with a KAFO equipped with 1) an SM and 2) a medial linkage mechanism (MLRGM). Subjects walked at their self-selected speed along a flat walkway to enable a comparison of walking speed, endurance, and the resulting physiological cost index to be performed. Results The use of a KAFO fitted with the MLRGM resulted in improvements in walking speed, distance walked, and energy costs when compared with the more standard SM. However, the time required to don the KAFO increased with use of the MLRGM, but doffing time was approximately equal for both types. Conclusions This study demonstrated that the use of a KAFO with an MLRGM could provide significant benefits for patients with SCI when compared with a KAFO with a standard SM.

Is the impact of fatigue related to walking capacity and perceived ability in persons with multiple sclerosis? A multicenter study

BackgroundThe relationship between fatigue impact and walking capacity and perceived ability in patients with multiple sclerosis (MS) is inconclusive in the existing literature. A better understanding might guide new treatment avenues for fatigue and/or walking capacity in patients with MS. ObjectiveTo investigate the relationship between the subjective impact of fatigue and objective walking capacity as well as subjective walking ability in MS patients. MethodsA cross-sectional multicenter study design was applied. Ambulatory MS patients (n = 189, age: 47.6 ± 10.5 years; gender: 115/74 women/men; Expanded Disability Status Scale (EDSS): 4.1 ± 1.8 [range: 0–6.5]) were tested at 11 sites. Objective tests of walking capacity included short walking tests (Timed 25-Foot Walk (T25FW), 10-Metre Walk Test (10mWT) at usual and fastest speed and the timed up and go (TUG)), and long walking tests (2- and 6-Minute Walk Tests (MWT). Subjective walking ability was tested applying the Multiple Sclerosis Walking Scale-12 (MSWS-12). Fatigue impact was measured by the self-reported modified fatigue impact scale (MFIS) consisting of a total score (MFIStotal) and three subscales (MFISphysical, MFIScognitive and MFISpsychosocial). Uni- and multivariate regression analysis were performed to evaluate the relation between walking and fatigue impact. ResultsMFIStotal was negatively related with long (6MWT, r = −0.14, p = 0.05) and short composite (TUG, r = −0.22, p = 0.003) walking measures. MFISphysical showed a significant albeit weak relationship to walking speed in all walking capacity tests (r = −0.22 to −0.33, p < .0001), which persisted in the multivariate linear regression analysis. Subjective walking ability (MSWS-12) was related to MFIStotal (r = 0.49, p < 0.0001), as well as to all other subscales of MFIS (r = 0.24–0.63, p < 0.001), showing stronger relationships than objective measures of walking. ConclusionsThe physical impact of fatigue is weakly related to objective walking capacity, while general, physical, cognitive and psychosocial fatigue impact are weakly to moderately related to subjective walking ability, when analysed in a large heterogeneous sample of MS patients.

Effectiveness of Automated Locomotor Training in Patients with Acute Incomplete Spinal Cord Injury: A Randomized, Controlled, Multicenter Trial.

The aim of this study was to evaluate whether the effect of longer training times (50 instead of 25 min per day) using a robotic device results in a better outcome of walking ability of subjects with a subacute motor complete (American Spinal Injury Association Impairment Scale [AIS]-B) and incomplete (AIS-C) spinal cord injury. Twenty-one patients were enrolled in the study, whereof 18 completed, on average, 34 trainings in 8 weeks. Longer training times resulted in better locomotor function. The second important result of the study is that a beneficial effect can be achieved by the application of a robotic device for prolonged training sessions without requiring more personal resources. It has to remain open whether even longer training times (more than 50 min) would result in a still better outcome. In any case, the extent of possible recovery in an individual patient is determined by the level and severity of spinal cord damage.

A multidisciplinary rehabilitation programme improves disability, kinesiophobia and walking ability in subjects with chronic low back pain: results of a randomised controlled pilot study

To evaluate the effect of a multidisciplinary rehabilitation programme on disability, kinesiophobia, catastrophizing, pain, quality of life and gait disturbances in patients with chronic low back pain (CLBP). This was a parallel-group, randomised, superiority-controlled pilot study in which 20 patients were randomly assigned to a programme consisting of motor training (spinal stabilising exercises plus usual-care) and cognitive-behavioural therapy (experimental group, 10 subjects) or usual-care alone (control group, 10 subjects). Before treatment, 8 weeks later (post-treatment), and 3 months after the end of treatment, the Oswestry Disability Index, the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, a pain numerical rating scale, and the Short-Form Health Survey were assessed. Spatio-temporal gait parameters were also measured by means of an electronic walking mat. A linear mixed model for repeated measures was used for each outcome measure. The programme had significant group (p = 0.027), time (p < 0.001), and time-by-group interaction (p < 0.001) effects on disability, with the experimental group showing an improvement after training of about 61 % (25 % in the control group). The analyses of kinesiophobia, catastrophizing, and the quality of life also revealed significant time, group, and time-by-group interaction effects in favour of the experimental group, and there was a significant effect of time on pain. Both groups showed a general improvement in gait parameters, with the experimental group increasing cadence significantly more. The multidisciplinary rehabilitation programme including cognitive-behavioural therapy was superior to the exercise programme in reducing disability, kinesiophobia, catastrophizing, and enhancing the quality of life and gait cadence of patients with CLBP.

Quantifying differences in passive knee laxity and finite helical axis measures between healthy and anterior cruciate ligament deficient individuals

Quantifying differences in passive knee laxity and finite helical axis measures between healthy and anterior cruciate ligament deficient individuals

Clinical feasibility of action observation training for walking function of patients with post-stroke hemiparesis: a randomized controlled trial

Objective: To identify the effects of action observation training (AOT) on the walking ability of subjects with post-stroke hemiparesis. Design: Randomized, single-blind, controlled pilot study. Setting: Inpatient rehabilitation hospital. Subjects: Twenty-one subjects with post-stroke hemiparesis were randomly allocated to either the experimental group (EG) or the control group (CG), with 11 and 10 patients, respectively. Interventions: The subjects in the EG and CG watched video clips demonstrating four functional walking tasks and showing different landscape images, respectively. All subjects subsequently performed the walking tasks (a total of 30 min, once a day, 3 times weekly for a 4-week period). Main measures: 10-m walk test, figure-of-8 walk test (time and steps), dynamic gait index (DGI), and gait symmetry score (swing and stance phases, and stride length) before and after the intervention. Results: The changes between the pre- and post-test values of the 10-m walk test (median [interquartile range], -5.10 [-15.80–-1.60] versus 0.00 [-6.60–4.06]), figure-of-8 walk test (time: -3.50 [-12.60–-2.00] versus -1.25 [-4.98–0.25]; steps:-5.00 [-8.00–-2.00] versus 0.00 [-3.25–0.25]), and DGI (4.00 [3.00–6.00] versus 1.00 [-4.00–3.00]) showed significant differences between the EG and CG (p < 0.05). In the EG, the 10-m walk test, time and steps of figure-of-8 walk test, DGI, and gait symmetry score in the stance phase showed significant differences between pre- and post-test (p < 0.05). Conclusions: The findings suggest that AOT can be beneficial in enhancing walking ability of patients with post-stroke hemiparesis, and may be clinically feasible as a practical adjunct to routine rehabilitation therapy. A power calculation on our data showed that 20 subjects in each group were required for further definitive studies.

Effects of a visuotemporal cue on walking ability of independent ambulatory subjects with spinal cord injury as compared with healthy subjects

An experimental, cross-sectional study. To investigate effects of using a visuotemporal cue on the walking ability of independent ambulatory subjects with spinal cord injury (SCI) as compared with healthy subjects. A tertiary rehabilitation center, Thailand. Forty independent ambulatory subjects with SCI and healthy subjects participated in the study (20 subjects per group). All of them were assessed for their walking speed, stride length, cadence and percents of step symmetry under two conditions, including walking at their fastest speed with and without a visuotemporal cue along a 10 m walkway. When walking with a visuotemporal cue, walking speed, stride length and cadence of the subjects were significantly increased from the uncued condition (P<0.01). However, the healthy subjects showed a significantly greater increase in walking speed and cadence, whereas, subjects with SCI demonstrated significantly higher improvement in stride length as compared with the other group (P<0.001). In addition, the effects of the visuotemporal cue were significantly greater in those with less severity of SCI (P<0.01). The findings confirm the benefits of using a visuotemporal cue to improve variables relating to walking ability in subjects with intact integrative capability of the brain but with different levels of sensorimotor deterioration. The findings suggest the use of a visuotemporal cue to improve the effectiveness of programs in sport and exercise sciences, and rehabilitation treatments.

Research on Design Theory and Compliant Control for Underactuated Lower-extremity Rehabilitation Robotic Systems code: (51175368); 2012.01-2015.12.

[Purpose] The aim of this study was to investigate the immediate effect of Lokomat versus Ergo_bike training using the Probe Reaction Time (P-RT) and 10-m maximum walking speed as the outcome measures, on incomplete spinal cord injury (iSCI) patients. [Subjects] Thirty male T8–L3 level spinal cord injury patients were the subjects. [Methods] The subjects were randomly divided into 2 groups: a Lokomat group and an Ergo_bike group. Each group consisted of 15 subjects. The P-RT and 10 m maximum walking speed were measured before and after the intervention for each group. [Results] The P-RT and the time taken to cover 10 m at maximum walking speed decreased significantly in the Lokomat group. [Conclusion] The Lokomat training not only decreased P-RT, but also improved the walking ability of subjects with iSCI.

Ambulatory assistive devices and walking performance in patients with incomplete spinal cord injury

A cross-sectional study. To primarily explore types of ambulatory assistive device (AAD) used and secondarily describe walking performance in independent ambulatory patients with spinal cord injury (SCI) who walked without and with various AADs as determined using walking speed and distance walked in 6 min. A tertiary rehabilitation center and community hospitals, Thailand. The data of 195 independent ambulatory patients with SCI were used to describe the use of an AAD. Among these, only 140 subjects were assessed for their walking speed and distance walked in 6 min. More than half of the subjects (64%) walked with an AAD in which most of them used a standard walker (45%), followed by a single-tip cane (11%) and bilateral crutches (8%), respectively. The walking speed and distance showed significant differences among the groups (P<0.001), except those who used walker versus crutches, and those who used crutches versus cane (P>0.05). Among the significant variables, types of AAD used had the greatest influence on walking speed and distance of the subjects. More than half of ambulatory subjects with SCI walked with an AAD in which most of them used a standard walker. However, the non-significant differences of walking performance between the groups may suggest the heterogeneity of walking ability in subjects who used the same type of AAD. Therefore, a method to facilitate the use of an AAD with less supportive ability would increase levels of independence for the patients.

Analysis for the Gait Patterns of Healthy Subjects During March

Walking is one of the most fundamental and important activities of human that is strongly connected with human health, and there has already been many researches on the human gait. However, these studies mainly investigate the gait patterns related to some specific injuries or diseases, and there is few studies on the gait of healthy people. We thus in this study tried to analyze the gait patterns of healthy subjects, and to establish some criteria for estimating the walking ability of the healthy subjects. To reach these goals, we performed our experiment using 66 students from National Defense Academy of Japan who perform their daily training for march, namely, controlled walking. The gait patterns from the students were integratively analyzed by using cluster analysis and principal component analysis, and as a result, we succeeded to classify the walking abilities of the subjects.

Commentary: Validity and responsiveness of measures of walking in lumbar spinal stenosis—what are we measuring?

COMMENTARY ON Rainville J, Childs LA, Pena EB, et al. Quantification of walking ability in subjects with neurogenic claudication from lumbar spinal stenosis—a comparative study. Spine J 2012;12:101–9 ( in this issue ).

Quantification of walking ability in subjects with neurogenic claudication from lumbar spinal stenosis—a comparative study

Walking limitations caused by neurogenic claudication (NC) are typically assessed with self-reported measures, although objective evaluation of walking using motorized treadmill test (MTT) or self-paced walking test (SPWT) has periodically appeared in the lumbar spinal stenosis (LSS) literature. This study compared the validity and responsiveness of MTT and SPWT for assessing walking ability before and after common treatments for NC. Prospective observational cohort study. Fifty adults were recruited from an urban spine center if they had LSS and substantial walking limitations from NC and were scheduled to undergo surgery (20%) or conservative treatment (80%). Walking times, distances, and speeds along with the characteristics of NC symptoms were recorded for MTT and SPWT. Self-reported measures included back and leg pain intensity assessed with 0 to 10 numeric pain scales, disability assessed with Oswestry Disability Index, walking ability assessed with estimated walking times and distances, and NC symptoms assessed with the subscales from the Spinal Stenosis Questionnaires. Motorized treadmill test used a level track, and SPWT was conducted in a rectangular hallway. Walking speeds were self-selected, and test end points were NC, fatigue, or completion of the 30-minute test protocol. Results from MTT and SPWT were compared with each other and self-reported measures. Internal responsiveness was assessed by comparing changes in the initial results with the posttreatment results and external responsiveness by comparing walking test results that improved with those that did not improve by self-reported criteria. Mean age of the participants was 68 years, and 58% were male. Neurogenic claudication included leg pain (88%) and buttock(s) pain (12%). Five participants could not safely perform MTT. Walking speeds were faster and distances were greater with SPWT, although the results from both tests correlated with each other and self-reported measures. Of the participants, 72% reported improvement after treatment, which was confirmed by significant mean differences in self-reported measures. Motorized treadmill test results did not demonstrate internal responsiveness to change in clinical status after treatment but SPWT results did, with increased mean walking times (6 minutes) and distances (387 m). When responsiveness was assessed against external criterion, both SPWT and MTT demonstrated substantial divergence with self-reported changes in clinical status and alternative outcome measures. Both MTT and SPWT can quantify walking abilities in NC. As outcome tools, SPWT demonstrated better internal responsiveness than MTT, but neither test demonstrated adequate external responsiveness. Neither test should be considered as a meaningful substitution for disease-specific measures of function.

Effect of multilayer high-compression bandaging on ankle range of motion and oxygen cost of walking.

ObjectiveTo evaluate the effects of multilayer high-compression bandaging on ankle range of motion, oxygen consumption and subjective walking ability in healthy subjects.MethodA volunteer sample of 22 healthy subjects (10 women and 12 men; aged 67 [63–83] years) were studied. The intervention included treadmill-walking at self-selected speed with and without multilayer high-compression bandaging (Proforeº), randomly selected. The primary outcome variables were ankle range of motion, oxygen consumption and subjective walking ability.ResultsTotal ankle range of motion decreased 4% with compression. No change in oxygen cost of walking was observed. Less than half the subjects reported that walking-shoe comfort or walking distance was negatively affected.ConclusionAnkle range of motion decreased with compression but could probably be counteracted with a regular exercise programme. There were no indications that walking with compression was more exhausting than walking without. Appropriate walking shoes could seem important to secure gait efficiency when using compression garments.

The six‐minute walk test in outpatients with obesity: reproducibility and known group validity

To assess the reproducibility and validity of the six-minute walk test (6MWT) in men and women with obesity in order to facilitate evaluation of treatment outcome. A test--retest design was used to test reproducibility and a comparative design to test known group validity. Forty-three obese outpatients (16 male), mean age 47 (21-62) years, mean body mass index (BMI) 40 (3-62)kg-m(-2) performed the 6MWT twice within one week. Intraclass correlation (ICC1.1) and measurement error (S(w)) were calculated from the mean square values derived from a one-way repeated-measures ANOVA (fixed effect model). The reproducibility was also analysed by means of coefficient of variation (CV) and the Bland Altman method including 95% limits of agreement. The variance of the distance walked was analysed by means of regressions. The known group validity of the 6MWT (distance walked and the work of walking) in obese participants was shown by comparisons with 41 lean participants (18 male), mean age 47 (24-65) years, mean BMI 22.7 kg-m(-2) (19-25). The obese group walked 534 m (confidence interval [CI] 508-560 the first and 552 m (CI 523-580) the second walk (p < 0.001). S(w) was 25 m, CV 4.7%, ICC1.1 was 0.96. The limits of agreement were -46 m+80 m. The validity tests showed that they walked 162 m shorter (p < 0.001) and performed much heavier work (p < 0.001) than the lean group. In the obese group, BMI alone explained 38% of the variance of the distance walked. The 6MWT showed good reproducibility and known group validity and can be recommended for evaluating walking ability in subjects with obesity. For individual evaluation, however, an improved walking distance of at least 80 m was required to make the difference clinically significant. Despite shorter walking distance the obese participants performed heavier work than the lean.

Dual-Task Exercise Improves Walking Ability in Chronic Stroke: A Randomized Controlled Trial

Yang YR, Wang RY, Chen YC, Kao MJ. Dual-task exercise improves walking ability in chronic stroke: a randomized controlled trial. Objective To examine the effectiveness of a dual-task–based exercise program on walking ability in subjects with chronic stroke. Design Single-blind randomized controlled trial. Setting General community. Participants Twenty-five subjects with chronic stroke who were at least limited community ambulatory subjects (a minimum gait velocity, 58cm/s). Interventions Participants were randomized into a control group (n=12) or experimental group (n=13). Subjects in the control group did not receive any rehabilitation training. Subjects in the experimental group underwent a 4-week ball exercise program. Main Outcome Measures Gait performance was measured under single task (preferred walking) and tray-carrying task. Gait parameters of interest were walking speed, cadence, stride time, stride length, and temporal symmetry index. Results The experimental group showed significant improvement in all selected gait measures except for temporal symmetry index under both task conditions. In the control group, there were no significant changes over the 4-week period for all selected measures. There was a significant difference between groups for all selected gait variables except for temporal symmetry index under both task conditions. Conclusions The dual-task–based exercise program is feasible and beneficial for improving walking ability in subjects with chronic stroke.

Assessing walking ability in subjects with spinal cord injury: Validity and reliability of 3 walking tests

van Hedel HJ, Wirz M, Dietz V. Assessing walking ability in subjects with spinal cord injury: validity and reliability of 3 walking tests. Objective To assess the validity and reliability of 3 timed walking tests (Timed Up & Go [TUG], 10-meter walk test [10MWT], 6-minute walk test) in subjects with spinal cord injury (SCI). Design Cross-sectional study and repeated assessments. Setting The SCI center of a university hospital in Switzerland. Participants Validity was assessed by using the data of 75 patients with SCI, and reliability was determined with 22 patients with SCI. Intervention Patients performed the timed tests and the Walking Index for Spinal Cord Injury II (WISCI II) on the same day. Three measurements within 7 days were taken to assess reliability. Main outcome measures The measures were scatterplots, correlation coefficients ( r), and the Bland-Altman plot. Validity was determined in patients with different walking abilities. Results Overall, correlation of the 3 timed walking tests was excellent with each other (| r|>.88) and moderate with the WISCI II (| r|>.60). The correlation between the timed tests for patients with poor walking ability remained high (| r|>.70) but decreased in WISCI II (| r|<.35). High correlation coefficients ( r>.97) were found for intra- and interrater reliability. However, TUG and 10MWT reliability were negatively influenced by a poor walking function. Conclusions The 3 timed tests are valid and reliable measures for assessing walking function in patients with SCI.

Functional Electrical Stimulation Improves Motor Recovery of the Lower Extremity and Walking Ability of Subjects With First Acute Stroke

The effectiveness of functional electrical stimulation (FES) has been investigated in chronic hemiplegia. The present study examines whether FES, given during acute stroke, was more effective in promoting motor recovery of the lower extremity and walking ability than standard rehabilitation alone. Forty-six subjects, 70.9+/-8.0 years old and 9.2+/-4.1 days after stroke, were assigned randomly to 1 of 3 groups receiving standard rehabilitation with FES or placebo stimulation or alone (control). FES was applied 30 minutes and placebo stimulation 60 minutes, 5 days per week for 3 weeks. Outcome measurements included composite spasticity score, maximum isometric voluntary contraction of ankle dorsi-flexors and planter-flexors, and walking ability. They were recorded before treatment, weekly during the 3-week treatment, and at week 8 after stroke. No significant differences were found in the baseline measurements. After 3 weeks of treatment, there was a significant reduction in the percentage of composite spasticity score, and a significant improvement in the ankle dorsiflexion torque, accompanied by an increase in agonist electromyogram and a reduction in electromyogram cocontraction ratio in the FES group, when compared with the other 2 groups (P<0.05). All subjects in the FES group were able to walk after treatment, and 84.6% of them returned home, in comparison with the placebo (53.3%) and control (46.2%, P<0.05) groups. Fifteen sessions of FES, applied to subjects with acute stroke plus standard rehabilitation, improved their motor and walking ability to the degree that more subjects were able to return to home.