Unlimited Community Research Articles

Speed- and Endurance-Based Classifications of Community Ambulation Post-Stroke Revisited: The Importance of Location in Walking Performance Measurement

Background Gait speed or 6-minute walk test are frequently used to project community ambulation abilities post-stroke by categorizing individuals as household ambulators, limited, or unlimited community ambulators. However, whether improved clinically-assessed gait outcomes truly translate into enhanced real-world community ambulation remains uncertain. Objective This cross-sectional study aimed to examine differences in home and community ambulation between established categories of speed- and endurance-based classification systems of community ambulation post-stroke and compare these with healthy controls. Methods Sixty stroke survivors and 18 healthy controls participated. Stroke survivors were categorized into low-speed, medium-speed, or high-speed groups based on speed-based classifications and into low-endurance, medium-endurance, or high-endurance groups based on the endurance-based classification. Home and community steps/day were quantified using Global Positioning System and accelerometer devices over 7 days. Results The low-speed groups exhibited fewer home and community steps/day than their medium- and high-speed counterparts (P < .05). The low-endurance group took fewer community steps/day than the high-endurance group (P < .05). Despite vast differences in clinical measures of gait speed and endurance, the medium-speed/endurance groups did not differ in their home and community steps/day from the high-speed/endurance groups, respectively. Stroke survivors took 48% fewer home steps/day and 77% fewer community steps/day than healthy controls. Conclusions Clinical classification systems may only distinguish home ambulators from community ambulators, but not between levels of community ambulation, especially beyond certain thresholds of gait speed and endurance. Clinicians should use caution when predicting community ambulation status through clinical measures, due to the limited translation of these classification systems into the real world.

Rehabilitative outcomes with preparatory suction prostheses following traumatic Gritti-Stokes amputation: A case series.

Gritti-Stokes amputation (GSA) is a knee disarticulation variant, where the femur is transected at the level of the epicondyle and the patella is fixated to the distal end. GSA results in a long residual limb with little postoperative swelling and less potential for muscular atrophy, so stable limb volume may allow the use of seal-in suction for suspension for preparatory prostheses. The purpose of this case series was to report on the efficacy of seal-in suction preparatory prostheses for 2 adults with traumatic GSA. Between October and December of 2021, 2 participants with unilateral traumatic Gritti-Stokes amputation, who had received seal-in suction suspension for their preparatory prostheses, were recruited. Information was extracted from medical charts regarding prosthetic care and mobility at preparatory and definitive prosthesis evaluation, and participants underwent standardized measurement of their residual limb and prosthesis. Duration of preparatory prosthesis use was >6 months; neither participant reported loss of suspension nor significant complications with socket fit. Participant 1 required socket replacement because of residual limb pain secondary to osteophyte formation, and Participant 2 required component replacement because of weight gain. At definitive prosthesis evaluations, both participants were unlimited community ambulators; both successfully returned to work before provision of their definitive prostheses. Results indicate that seal-in suction suspension may be viable for preparatory prostheses among adults with traumatic GSA, but knee center height discrepancies persist. GSA may yield highly functional outcomes for adults with traumatic amputation. Further research is required to substantiate these findings.

Predictive discriminative accuracy of walking abilities at discharge for community ambulation levels at 6 months post-discharge among inpatients with subacute stroke.

[Purpose] This study aimed to compare the predictive accuracy of walking ability at discharge among subacute stroke inpatients at 6 months post-discharge in terms of community ambulation level and establish optimal cut-off values. [Participants and Methods] This prospective observational study included 78 patients who completed follow-up assessments. Patients were classified into three groups based on the Modified Functional Walking Category (household/most limited community walkers, least limited community walkers, and unlimited community walkers) obtained by telephone survey at 6 months post-discharge. Predictive accuracy and cut-off values for discriminating among groups were calculated from 6-minute walking distance and comfortable walking speed measured at the time of discharge using receiver operating characteristic curves. [Results] Between household/most limited and least limited community walkers, 6-minute walking distance and comfortable walking speed offered similar predictive accuracy (area under the curve, 0.6-0.7), with cut-off values of 195 m and 0.56 m/s, respectively. Between least limited and unlimited community walkers, the areas under the curve were 0.896 for 6-minute walking distance and 0.844 for comfortable walking speed, with cut-off values of 299 m and 0.94 m/s, respectively. [Conclusion] Walking endurance and walking speed among inpatients with subacute stroke provided superior predictive accuracy for unlimited community walkers at 6 months post-discharge.

Investigating the Impact of Tourism Destination Brand Equity on Trust, Satisfaction and Loyalty to Destination Brand (Case Study: Bamyan-Afghanistan)

ABSTRACT The aim of the present research is to investigate the effect of the destination brand equity on domestic and foreign tourists emphasizing their satisfaction and trust regarding the tourism destination of Bamyan province in Afghanistan. This province is a famous and important part of the central plateau, which is the property of ancient civilization. Its distance from Kabul is 245 km. The research is applied, descriptive and correlational. The population of the study includes tourists of Bamyan tourism destination. The sample size based on Morgan’s table for an unlimited community was equivalent to 384 tourists, and finally 387 questionnaires were analyzed. The research findings indicate the destination brand awareness has a positive and significant effect on the destination brand quality (services and natural). The destination brand quality (services and natural) have a positive and significant effect on the destination brand value (functional and hedonic). The above-mentioned values have a positive effect on the destination brand trust. The destination brand trust has a significant effect on the destination brand satisfaction. Moreover, the destination brand satisfaction has a significant effect on brand introduction and tourists’ re-visit. This study examines the special value of the tourist destination brand for one of the lesser known tourist destinations in Afghanistan, namely Bamyan province and its attractions. The effect of this value on tourists’ satisfaction and loyalty has also been measured.

Reading Readers Reading: A Brief Reply to my Interlocutors

Reading Readers Reading: A Brief Reply to my Interlocutors

Peirce’s open community in light of sentimentalism and normative sciences

Peirce’s idea of an unlimited community has been usually analyzed from its role in science and the normative ideal of truth. However, it is essential to understand the role of the community of inquiry in light of the other normative sciences, aesthetics and ethics, since according to Peirce, any endeavor to know that is not guided by the esthetical ideal of admirable per se should not be considered as proper science, but as a power tool to benefit some elite. This article aims to analyze Peirce’s idea of community of inquiry in light of sentimentalism and the normative sciences in order to evidence that such community is not elitist, but open, insofar as it is also lured by the summum bonum and the admirable per se. Finally, we provide a more organic reading of Peirce’s work, opening the way to consider possible consequences of this position from an ethical and political perspective.

Design an Artificial Neural Network by MLP Method; Analysis of the Relationship between Demographic Variables, Resilience, COVID-19 and Burnout

In addition to the effect that the COVID-19 pandemic has had on the physical and mental health of individuals, it has also led to a change in the mental and emotional state of many employees. Especially among businesses and private companies, which faced many restrictions due to the special conditions of the pandemic. Therefore, the present study aimed to design an artificial neural network with MLP technique to analyze the relationship between demographic variables, resilience, COVID-19 and burnout in start-ups in Iran. The research method was quantitative. Managers and employees of start-ups formed the statistical population of the study, based on the statistical sample size of the unlimited community, 384 of them were tested. For data gathering, standard questionnaires include of MBI-GS and BRCS and researcher-made questionnaire of stress caused by COVID-19 were used. The validity of the questionnaires was confirmed by a panel of experts and their reliability was confirmed by Cronbach’s alpha coefficient. The number of neurons in the input layer was equal to 10, the number of neurons in the 1st hidden layer was equal to 7, the number of neurons in the output layer was equal to 1, and the number of epochs was equal to 500. 70% of the data were used for training and 30% for testing. In the designed artificial neural network, all experiment data except one were correctly predicted and the obtained MAE error was less than 0.012%. Finally, he precision and correction of the presented model was confirmed by the obtained results.

Effects of prosthetic feet on metabolic energy expenditure in people with transtibial amputation: A systematic review and meta-analysis.

To assess the effects of different prosthetic feet on energy costs associated with walking and running in people with transtibial amputation. The Pubmed, CINAHL, and Web-of-Science bibliographic databases were searched for original research published through June 30, 2018. References from identified articles were also reviewed. Two reviewers screened titles, abstracts, and articles for pertinent studies. Details were extracted with a standardized template. Risk of bias was assessed using domain-based methods. Prosthetic feet were grouped into categories and compared according to energy costs associated with walking or running over various terrain conditions. Meta-analyses were conducted when data quantity and homogeneity permitted. Evidence statements were formed when results were consistent or undisputed. Fifteen studies were included. Participants (n=141) were predominantly male (87.9%), had unilateral amputation (95.7%) from non-dysvascular causes (87.9%), and were classified as unlimited community ambulators or active adults (56.0%). Participants were often young but varied in age (mean age 24.8-66.6 years). Available evidence indicates that feet with powered dorsiflexion reduce energy costs relative to dynamic response feet in unlimited community ambulators or active adults when walking on level or declined surfaces. Dynamic response feet do not significantly reduce energy costs compared to energy storing, flexible keel, or solid ankle feet when walking on level terrain. Running feet do not reduce energy costs relative to dynamic response in active adults when running. Select feet may reduce energy costs under specific conditions, but additional research is needed to confirm preliminary results. The overall body of evidence is based on small samples, comprised mostly of participants who may not well represent the population of prosthesis users and test conditions that may not well reflect how prostheses are used in daily life. However, evidence suggests energy costs are affected by prosthetic foot type only under select conditions.

Hydraulic- and Microprocessor-Controlled Ankle-Foot Prostheses for Limited Community Ambulators with Unilateral Transtibial Amputation: Pilot Study

ABSTRACT Introduction In the United States, access to microprocessor-controlled prosthetic ankles is limited to patients with lower-limb loss classified as unlimited community ambulators or greater. However, the potential benefits of these devices have not been evaluated among patients classified as household or limited community ambulators. This study examined the benefit of hydraulic- and microprocessor-controlled prosthetic ankles for patients classified as limited community ambulators. Materials and Methods Four different treatment configurations were evaluated using a randomized crossover study design. These four configurations included the participant's current flexible keel (FK) prosthetic foot, an energy-storage-and-return foot (ESAR), a hydraulic ankle (HA), and a microprocessor ankle (MPA). After a 2-week accommodation period, both patient-reported and performance-based outcome measures were recorded for each ankle foot system. A StepWatch activity monitor and two-dimensional video motion analysis were also used to evaluate each system. Results A single participant meeting the inclusion criteria was recruited. The patient-reported mobility and socket fit instruments were greatest with the HA system. When assessed on slopes and stairs, the MPA demonstrated benefits on hill ascent and stair descent. In considering the walking speed and perceived exertion jointly, the HA system allowed similar walking speed but lower exertion compared with fixed-ankle systems. The patient-reported low back pain and balance confidence instruments did not provide useful data for interpretation. Two-dimensional video motion analysis showed that the HA and MPA contributed to improved ankle and knee postures when ascending and descending a slope. The step activity data showed the greatest activity with the HA. Discussion The results from the outcome measures showed a varying level of benefit across all four of the treatment configurations. Both the HA and MPA had favorable scores in varying performance-based outcome measures, but the HA scored the most favorable in a majority of the patient-reported outcome measures. Conclusion The results show varying benefits of the microprocessor- and hydraulic-controlled prosthetic components over fixed-ankle ESAR and FK feet, based on both performance-based and patient-reported outcome measures. Further studies are needed to fully evaluate these benefits in larger sample sizes.

Which Balance Evaluation Systems Test sections best distinguish levels of post-stroke functional walking status?

ObjectiveTo determine which sections of the Balance Evaluation Systems Test (BESTest) distinguish levels of post-stroke functional walking status and to establish their cut-off scores.DesignA retrospective cross-sectional study.Subjects and methodsThe BESTest was administered to 87 stroke patients who were able to walk without physical assistance upon discharge from the hospital. Subjects were divided into 3 functional walking status groups: namely, household ambulators, limited community ambulators, and unlimited community ambulators. The receiver operating characteristic curve was determined and the cut-off score and area under the receiver operating characteristic curve (AUROC) of each section calculated.ResultsIn the comparison of household and limited community ambulators, the accuracies of all BESTest sections were moderate (AUROC>0.7), and the cut-off scores were 36.1–78.6%. In the comparison of limited and unlimited community ambulators, one section (stability in gait) had high accuracy (AUROC=0.908, cut-off scores=73.8%) and 3 sections (biomechanical constraints, anticipatory postural adjustments, and postural response) had moderate accuracy (AUROC=0.812–0.834, cut-off scores=75.0–83.4%).ConclusionThis study demonstrated that different sections of the BESTest had different abilities to discriminate levels of post-stroke functional walking status, and identified cut-off values for targeted improvement.LAY ABSTRACTThe Balance Evaluation Systems Test (BESTest), a clinical postural control measure, categorizes postural control systems in 6 different sections. This study investigated which sections of the BESTest distinguish levels of post-stroke functional walking status, which, in turn, is based on walking speed. Among the slower walkers, all sections of the BESTest showed moderate relationships to categories of walking status. Among the faster walkers, 4 sections showed moderate to strong relationships and 2 sections showed weak relationships. This study may have clinical implications for rehabilitation aimed at improving functional walking status in individuals with stroke. These findings will help rehabilitation professionals assess postural control in relation to stroke patients’ ability to walk in different settings (e.g. their household or the community) and determine which postural control systems should be prioritized in therapeutic interventions.

Instrumented Four Square Step Test in Adults with Transfemoral Amputation: Test-Retest Reliability and Discriminant Validity between Two Types of Microprocessor Knees.

Technology-based outcomes have recently been proposed to complement the standard Four Square Step Test (FSST) by providing a decomposition of the sequences and information about the stepping pattern. A test-retest study and a randomized crossover design have been used to determine immediate test-retest reliability and to assess discriminant validity, in persons with a unilateral transfemoral amputation, for the parameters computed by an instrumented version of the Four Square Step Test. Twenty adults, independent and unlimited community ambulators, with a unilateral transfemoral amputation, performed two Four Square Step Tests on a pressure mat first with a microprocessor knee, then, a few weeks later with another one. One of these prosthetic knees was acknowledged to be superior and to provide functional improvement. Test-retest, intraclass correlation coefficients and minimal detectable change at 95% confidence level were calculated for each variable. Paired samples t-tests were then used to identify differences between the two microprocessor knee systems. The test-retest reliability of most outcome measures was good to excellent. Few variables showed a systematic difference and a trend to improve between test 1 and test 2. When comparing both microprocessor knees, significant differences in the expected direction were observed, with interpretation in accordance with a functional improvement. Importantly, we highlighted that various strategies to improve the performance in the test might complexify the interpretation of the most detailed measurement. The instrumented Four Square Step test provides reliable measures with satisfactory test-retest reliability and discriminant validity in persons with unilateral transfemoral amputation.

Walking Characteristics In Individuals With Stroke Differ Based On Walking Speed, Endurance And Daily Steps

PURPOSE: Walking is an ideal means of obtaining physical activity, yet people with stroke take few daily steps. The purpose of this study was to examine how the walking characteristics of bouts per day, maximum steps per bout and time spent walking differ between individuals with various walking speeds, walking endurance and daily steps. Additionally, we aimed to identify cutoff values for differentiating active and inactive ambulators (i.e. those who do and do not achieve physical activity guidelines through walking). METHODS: Stepping data from 252 individuals with chronic stroke (>6 months) with mean age of 63 (13) years and step count of 4,277 (3,064) steps per day were analyzed. Individuals were placed into previously established levels of ambulation (i.e. household ambulators, limited community and unlimited community ambulators), based on walking speed, walking endurance and daily steps (via two days of StepWatch activity monitoring). Differences in walking characteristics were assessed between ambulation levels (e.g. household vs. community ambulators). Linear regression determined which characteristics best predicted daily step counts. Receiver Operating Characteristic (ROC) curves and area under the curve (AUC) determined which variable was most accurate in classifying active (>5,500 steps) and inactive (<5,500 steps) individuals. RESULTS: Regardless of categorization by walking speed, walking endurance or daily steps, household ambulators had significantly fewer bouts per day, maximum steps per bout and time spent walking compared to both limited and unlimited community ambulators (p = <0.001). Only 81 (32%) participants obtained >5,500 steps per day. The two highest AUC values were 0.91 (95% CI 0.88, 0.95) for maximum steps per bout and 0.83 (95% CI 0.78, 0.88) for bouts per day. Cutoff values of 648 maximum steps per bout or 53 bouts were used to differentiate active and inactive ambulators. CONCLUSIONS: Walking characteristics differed based on an individual’s walking speed, walking endurance and daily steps. Differences in daily steps between household and community ambulators are largely due to shorter and fewer walking bouts. Interventions aimed at improving walking after stroke should promote increased walking bouts of any length to increase physical activity after stroke.

Low gait speed is associated with low physical activity and high sedentary time following stroke

Purpose This study describes physical activity levels and factors associated with physical activity at the end of stroke rehabilitation. Methods Primary stroke survivors were assessed at completion of physical rehabilitation. Outcomes included physical activity (e.g. step count, moderate-vigorous physical activity duration) and sedentary time measured with the Sensewear Armband, gait speed, and cognition. The number of participants meeting physical activity recommendations was calculated. Differences in physical activity were examined between household ambulators (gait speed <0.4 m/s), limited community ambulators (0.4–0.8 m/s), and unlimited community ambulators (>0.8 m/s). The influence of age, cognition, and gait speed on physical activity was determined by multiple regression. Results Seventy-nine stroke survivors participated. Twenty-one participants achieved 30 min/day of moderate-vigorous physical activity accumulated in 10 min bouts. Unlimited community ambulators took more steps/day (median 4975 vs. 469 limited, 355 household, p < 0.001), had higher moderate-vigorous physical activity (median 74 min/day vs. 22 limited, 31 household, p < 0.001) and lower sedentary time (mean 1105 vs. 1239 limited, 1232 household minutes/day, p < 0.001). Age, gait speed, and cognition predicted 21.3% of the variance in moderate-vigorous physical activity (p = 0.001); adding employment status to the model predicted 57.3% of the variance in step count (p < 0.001). Conclusions Physical activity is low following stroke and should be a target for treatment, particularly in those with gait speeds ≤0.8 m/s. Implications for rehabilitation Seventy-three percent of stroke survivors performed ≥30 minutes of moderate to vigorous physical activity throughout the day. Twenty-seven percent of stroke survivors accumulated ≥30 minutes of moderate to vigorous physical activity in 10 minute bouts. Despite relatively good physical ability, daily step count was low in this sample. Those with gait speeds ≤0.8 m/s had lower physical activity levels and higher sedentary time.

Classification Tree to Determine the Probability of Functional Ambulation Levels Among Lower Limb Prosthesis Users

Eligibility for many prosthetic components is based on an individual's assigned functional ambulation level. Recent efforts to collect big data on prosthetic outcomes has provided the ability to develop predictive models regarding functional ambulation potential. This effort describes the development of a model to assist in determining whether an individual will function at either a limited community/household ambulator (LA) or an unlimited community ambulator (UA).

Reflexive Justification and the Problem of its Reception in Robert Alexy’s theory

The aim of following paper is to reconstruct the discussion concerning reflexive justification on the basis of philosophy and philosophy of law. At first, the presented proposition is a project of Immanuel Kant’s philosophy transformation, framed within the study of the philosophy of language and realized by K.-O. Apel and W. Kuhlmann. This analysis concerns both its construction and its relation to the theory of argumentation, using the concept of an ideal and unlimited communicative community. The next discussed issue is the pleas concerning this approach, formulated by J. Habermas from reconstructive perspective, which rejects the reflexive justification and, instead of the conditions of argumentation’s possibility, it examines conditions of possibility of communication as such. The analysis also concerns R. Alexy’s transcendentalpragmatic argument, which shows similarities between the reconstructive approach of J. Habermas and the reflexive justification theories of K.-O. Apel and W. Kuhlmann. In this paper, there are two streams of critique presented regarding this approach – the first concerning justification of general practical discourse’s rules, and the second concerning reception of discursive ethics in legal argumentation, a so-called Sonderfallthese. The critique of R. Alexy’s legal discourse may be interpreted as a theory searching for the difficult to accept third way between reflection and reconstruction.

Mobility Analysis of AmpuTees (MAAT 4): classification tree analysis for probability of lower limb prosthesis user functional potential

Purpose: To develop a predictive model to inform the probability of lower limb prosthesis users’ functional potential for ambulation.Materials and Methods: A retrospective analysis of a database of outcomes for 2770 lower limb prosthesis users was used to inform a classification and regression tree analysis. Gender, age, height, weight, body mass index adjusted for amputation, amputation level, cause of amputation, comorbid health status and functional mobility score [Prosthetic Limb Users Survey of Mobility (PLUS-M™)] were entered as potential predictive variables. Patient K-Level was used to assign dependent variable status as unlimited community ambulator (i.e., K3 or K4) or limited community/household ambulator (i.e., K1 or K2). The classification tree was initially trained from 20% of the sample and subsequently tested with the remaining sample.Results: A classification tree was successfully developed, able to accurately classify 87.4% of individuals within the model’s training group (standard error 1.4%), and 81.6% within the model’s testing group (standard error 0.82%). Age, PLUS-M™ T-score, cause of amputation and body weight were retained within the tree logic.Conclusions: The resultant classification tree has the ability to provide members of the clinical care team with predictive probabilities of a patient’s functional potential to help assist care decisions.Implications for RehabilitationClassification and regression tree analysis is a simple analytical tool that can be used to provide simple predictive models for patients with a lower limb prosthesis.The resultant classification tree had an 81.6% (standard error 0.82%) accuracy predicting functional potential as an unlimited community ambulator (i.e., K3 or K4) or limited community/ household ambulator (i.e., K1 or K2) in an unknown group of 2770 lower limb prosthesis users.The resultant classification tree can assist with the rehabilitation team’s care planning providing probabilities of functional potential for the lower limb prosthesis user.

Functional assessment and satisfaction of transfemoral amputees with low mobility (FASTK2): A clinical trial of microprocessor-controlled vs. non-microprocessor-controlled knees

BackgroundThe benefits of a microprocessor-controlled knee are well documented in transfemoral amputees who are unlimited community ambulators. There have been suggestions that transfemoral amputees with limited community ambulation will also benefit from a microprocessor-controlled knee. Current medical policy restricts microprocessor-controlled knees to unlimited community ambulators and, thereby, potentially limits function. This clinical trial was performed to determine if limited community ambulators would benefit from a microprocessor-controlled knee. Methods50 unilateral transfemoral amputees, mean age 69, were tested using their current non-microprocessor-controlled knee, fit with a microprocessor-controlled knee and allowed 10 weeks of acclimation before being tested, and then retested with their original mechanical knee after 4 weeks of re-acclimation. Patient function was assessed in the free-living environment using tri-axial accelerometers. Patient satisfaction and safety were also measured. FindingsThe subjects demonstrated improved outcomes when using the microprocessor-controlled knee. Subjects had a significant reduction in falls, spent less time sitting, and increased their activity level. Subjects also reported significantly better ambulation, improved appearance, and greater utility. InterpretationThis clinical trial demonstrated that transfemoral amputees with limited mobility clearly benefit from a microprocessor-controlled knee. Notably, a reduction in falls occurred while the subjects engaged in more physical activity, which resulted in increased subject satisfaction. The increased activity resulted in a greater exposure to fall risk, but that risk was moderated by the advanced technology.ClinicalTrials.gov No: NCT02240186

Examination of Sustained Gait Speed During Extended Walking in Individuals With Chronic Stroke

ObjectivesTo determine if individuals with chronic stroke were able to sustain their peak gait speed during the 6-minute walk test (6MWT), and to explore this sustainability across community ambulation potential subgroups. DesignProspective cross-sectional study. SettingUniversity-based research laboratory, hospitals, and stroke support groups. ParticipantsA sample of individuals with chronic stroke (N=48) completed a series of questionnaires and physical outcome measures, including gait mat assessment, during a single visit. InterventionsNot applicable; 1-time cross-sectional data collection. Main Outcome MeasuresDuring the 6MWT, we measured peak gait speed and end gait speed to assess sustainability, along with beginning gait speed, total distance walked, and rating of perceived exertion. We also assessed maximum gait speed during the 10-meter walk test (10MWT). Finally, we examined these gait outcomes across the subgroups. ResultsDuring the 6MWT, peak gait speed declined from .89m/s (SD=.38) to an end speed of .82m/s (SD=.36), whereas perceived exertion increased from 7.7 (SD=2.6) to 11.8 (SD=3.6). This peak gait speed was slower than the 10MWT maximum speed of 1.06m/s (SD=.51), but faster than the 6MWT beginning speed of .81m/s (SD=.34). The unlimited community ambulator subgroup was the primary contributor to sustainability differences. ConclusionsPredicting community ambulation potential based on the discrete gait speed from the 10MWT and endurance based on the average from the 6MWT might be incomplete if gait speed sustainability is not also assessed.

The Structure of Walking Activity in People After Stroke Compared With Older Adults Without Disability: A Cross-Sectional Study

People with stroke have reduced walking activity. It is not known whether this deficit is due to a reduction in all aspects of walking activity or only in specific areas. Understanding specific walking activity deficits is necessary for the development of interventions that maximize improvements in activity after stroke. The purpose of this study was to examine walking activity in people poststroke compared with older adults without disability. A cross-sectional study was conducted. Fifty-four participants poststroke and 18 older adults without disability wore a step activity monitor for 3 days. The descriptors of walking activity calculated included steps per day (SPD), bouts per day (BPD), steps per bout (SPB), total time walking per day (TTW), percentage of time walking per day (PTW), and frequency of short, medium, and long walking bouts. Individuals classified as household and limited community ambulators (n=29) did not differ on any measure and were grouped (HHA-LCA group) for comparison with unlimited community ambulators (UCA group) (n=22) and with older adults without disability (n=14). The SPD, TTW, PTW, and BPD measurements were greatest in older adults and lowest in the HHA-LCA group. Seventy-two percent to 74% of all walking bouts were short, and this finding did not differ across groups. Walking in all categories (short, medium, and long) was lowest in the HHA-LCA group, greater in the UCA group, and greatest in older adults without disability. Three days of walking activity were captured. The specific descriptors of walking activity presented provide insight into walking deficits after stroke that cannot be ascertained by looking at steps per day alone. The deficits that were revealed could be addressed through appropriate exercise prescription, underscoring the need to analyze the structure of walking activity.

Evaluation of rehabilitated bilateral lower limb amputees – an Indian study

Objective: This study assessed activities of daily living (ADL) and ambulation of rehabilitated bilateral lower limb amputees with relation to their level of amputation in an Indian setting. Subjects and Methods: This retrospective study of 25 subjects comprised 12 bilateral Trans-femoral (TF) amputees, 8 bilateral Trans-tibial (TT) amputees and 5 a combination of ipsilateral Trans-femoral and contralateral Trans-tibial amputation. All subjects were contacted by post/telephone, were physically examined and assessed at the Orthopaedic clinic at a mean follow-up of 6.6 years. Physical rehabilitation was evaluated using ADL score and by grading the level of ambulation. Results: ADL scores showed no significant difference according to level of amputation (p > 0.05), but the scores of prosthetic users were significantly higher than non-prosthetic users (p = 0.002). Only 11/25 amputees became prosthetic ambulators and most (50%, 6/12) were TF amputees. All prosthetically rehabilitated subjects were mobilising with their prostheses at follow-up and graded as unlimited or limited community ambulators. Conclusion: Though it is well documented that the potential for successful rehabilitation is best for bilateral TT amputees, given the subjects’ economic constraints, higher prosthesis rehabilitation among bilateral TF amputees indicates that successful rehabilitation is possible in most subjects irrespective of the level of amputation.Implications for RehabilitationRehabilitation of a bilateral lower limb amputee requires a team effort and constitutes a very difficult challenge for the subject.Low prosthesis ownership is largely due to subjects’ inability to afford a pair of prostheses in a developing country like India.Activities of daily living improve significantly with use of prostheses.Though it is well documented that the potential for successful rehabilitation is best for a bilateral TT amputee, higher prosthesis rehabilitation among bilateral TF subjects in this study indicates that successful rehabilitation is possible in most subjects irrespective of the level of amputation.