Walking Ability In Individuals Research Articles

Machine Learning Model for Predicting Walking Ability in Lower Limb Amputees

Background/Objectives: The number of individuals with lower limb loss (LLL) is rising. Therefore, identifying the walking potential in individuals with LLL and prescribing adequate prosthetic systems are crucial. Various factors can influence participants’ walking ability, to different extents. The aim of the present study was to apply machine learning methods to develop a predictive mode. This model can assist rehabilitation and limb loss care teams in making informed decisions regarding prosthesis prescription and predicting walking ability in individuals with LLL. Methods: The present study was designed as a prospective cross-sectional study encompassing 104 consecutively recruited participants with LLL (average age 62.1 ± 10.9 years, 80 (76.9%) men) at the Medical Rehabilitation Clinic. Demographic, physical, psychological, and social status data of patients were collected at the beginning of the rehabilitation program. At the end of the treatment, K-level estimation of functional ability, a Timed Up and Go Test (TUG), and a Two-Minute Walking Test (TMWT) were performed. Support vector machines (SVM) were used to develop the prediction model. Results: Three decision trees were created, one for each output, as follows: K-level, TUG, and TMWT. For all three outputs, there were eight significant predictors (balance, body mass index, age, Beck depression inventory, amputation level, muscle strength of the residual extremity hip extensors, intact extremity (IE) plantar flexors, and IE hip extensors). For the K-level, the ninth predictor was The Multidimensional Scale of Perceived Social Support (MSPSS). Conclusions: Using the SVM model, we can predict the K-level, TUG, and TMWT with high accuracy. These clinical assessments could be incorporated into routine clinical practice to guide clinicians and inform patients of their potential level of ambulation.

Mobilization with movement is effective for improving ankle range of motion and walking ability in individuals after stroke: A systematic review with meta-analysis.

Mobilization with movement has been recommended to improve foot mobility in people with ankle impairments and could improve walking after stroke. To examine the effects of the addition of mobilization with movement to commonly used exercises in physiotherapy for improving ankle range of motion and walking in people who have had a stroke. Systematic review of randomized controlled trials. Not applicable. Ambulatory adults at any time after stroke. The experimental intervention was exercises plus ankle mobilization with movement, in comparison with exercises alone. Ankle range of motion. Walking parameters (ie., walking speed, cadence, step length). Six trials, involving 160 participants, were included. The mean PEDro score of the trials was 6 (range 4 to 7). Mobilization with movement in addition to exercises improved range of motion by 4° (95% CI 2 to 6), walking speed by 0.08 m/s (95% CI 0.05 to 0.11), cadence by 9 steps/min (95% CI 7 to 12), and step length by 5 cm (95% CI 3 to 7) more than exercises alone. The quality of evidence was low for range of motion and moderate for walking outcomes. This systematic review provided evidence that the addition of mobilization with movement to commonly used exercises in neurological rehabilitation increases ankle dorsiflexion, and benefits are carried over to improving walking speed, cadence, and step length in moderately disabled individuals with chronic stroke. PROSPERO (CRD42023405130).

Effects of insoles adapted in flip-flop sandals in patients with persistent plantar heel pain: A sham-controlled randomised trial.

To evaluate the use of custom-made insoles adapted to flip-flops on pain intensity, foot function, and functional walking ability in individuals with persistent plantar heel pain in the short and medium term. Randomised controlled trial. Flip-flop sandals in patients with persistent plantar heel pain. Participants (n = 80) were assessed at baseline, six and 12 weeks after the intervention, and 4 weeks post-intervention. For the primary outcomes, after 6 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.4 (95% confidence intervals = -1.5 to 0.8). Similarly, after 12 weeks of intervention, no between-group difference was observed in the intensity of morning pain or pain with walking, mean difference = -0.7 (95% confidence intervals = -1.9 to 0.6). Finally, at 4 weeks after the end of the intervention, there was no between-group difference in morning pain or pain on walking, mean difference = 0.01 (95% confidence intervals = -1.4 to 1.4). All differences and confidence intervals were smaller than the minimum clinically important difference for pain (2 points). There were no differences between the groups for the secondary outcomes. In addition, the mean differences were smaller than the minimum clinically important differences for pain intensity, foot function and functional walking ability. Custom-made insoles fitted to flip-flops did not differ from flip-flops with sham insoles in improving pain intensity, foot function and functional walking ability in people with persistent heel pain.Trial registration: ClinicalTrials.gov (Identifier: NCT04784598). Data of registration: 2023-01-20.

Effects of motor and cognitive complex training on obstacle walking and brain activity in people with Parkinson's disease: a randomized controlled trial.

The difficulties in obstacle walking are significant in people with Parkinson's disease (PD) leading to an increased fall risk. Effective interventions to improve obstacle walking with possible training-related neuroplasticity changes are needed. We developed two different exercise programs, complex walking training and motor-cognitive training, both challenging motor and cognitive function for people with PD to improve obstacle walking. To investigate the effects of these two novel training programs on obstacle walking and brain activities in PD. A single-center randomized, single-blind controlled study. University laboratory; outpatient. Individuals with idiopathic PD. Thirty-two participants were randomly assigned to the complex walking training group (N.=11), motor-cognitive training group (N.=11) or control group (N.=10). Participants in training groups received exercises for 40 minutes/session, with a total of 12-session over 6 weeks. Control group did not receive additional training. Primary outcomes included obstacle walking, and brain activities (prefrontal cortex (PFC), premotor cortex (PMC), and supplementary motor area (SMA)) during obstacle walking by using functional near-infrared spectroscopy. Secondary outcomes included obstacle crossing, timed up and go test (TUG), cognitive function in different domains, and fall efficacy scale (FES-I). The motor-cognitive training group demonstrated greater improvements in obstacle walking speed and stride length, SMA activity, obstacle crossing velocity and stride length, digit span test, and TUG than the control group. The complex walking training did not show significant improvement in obstacle walking or change in brain activation compared with control group. However, the complex walking training resulted in greater improvements in Rey-Osterrieth Complex Figure test, TUG and FES-I compared with the control group. Our 12-session of the cognitive-motor training improved obstacle walking performance with increased SMA activities in people with PD. However, the complex walking training did not lead such beneficial effects as the cognitive-motor training. The cognitive-motor training is suggested as an effective rehabilitation program to improve obstacle walking ability in individuals with PD.

Exploring the challenges of avoiding collisions with virtual pedestrians using a dual-task paradigm in individuals with chronic moderate to severe traumatic brain injury.

Individuals with a moderate-to-severe traumatic brain injury (m/sTBI), despite experiencing good locomotor recovery six months post-injury, face challenges in adapting their locomotion to the environment. They also present with altered cognitive functions, which may impact dual-task walking abilities. Whether they present collision avoidance strategies with moving pedestrians that are altered under dual-task conditions, however, remains unclear. This study aimed to compare between individuals with m/sTBI and age-matched control individuals: (1), the locomotor and cognitive costs associated with the concurrent performance of circumventing approaching virtual pedestrians (VRPs) while attending to an auditory-based cognitive task and; (2) gaze behaviour associated with the VRP circumvention task in single and dual-task conditions. Twelve individuals with m/sTBI (age = 43.3 ± 9.5 yrs; >6 mo. post injury) and 12 healthy controls (CTLs) (age = 41.8 ± 8.3 yrs) were assessed while walking in a virtual subway station viewed in a head-mounted display. They performed a collision avoidance task with VRPs, as well as auditory-based cognitive tasks (pitch discrimination and auditory Stroop), both under single and dual-task conditions. Dual-task cost (DTC) for onset distance of trajectory deviation, minimum distance from the VRP, maximum lateral deviation, walking speed, gaze fixations and cognitive task accuracy were contrasted between groups using generalized estimating equations. In contrast to CTLs who showed locomotor DTCs only, individuals with m/sTBI displayed both locomotor and cognitive DTCs. While both groups walked slower under dual-task conditions, only individuals with m/sTBI failed to modify their onset distance of trajectory deviation and maintained smaller minimum distances and smaller maximum lateral deviation compared to single-task walking. Both groups showed shorter gaze fixations on the approaching VRP under dual-task conditions, but this reduction was less pronounced in the individuals with m/sTBI. A reduction in cognitive task accuracy under dual-task conditions was found in the m/sTBI group only. Individuals with m/sTBI present altered locomotor and gaze behaviours, as well as altered cognitive performances, when executing a collision avoidance task involving moving pedestrians in dual-task conditions. Potential mechanisms explaining those alterations are discussed. Present findings highlight the compromised complex walking abilities in individuals with m/sTBI who otherwise present a good locomotor recovery.

Influence of Verbal Instruction on Gait Training in Parkinson Disease: A Randomized Controlled Trial.

Verbal instruction is one of the most commonly used methods that therapists use to correct walking pattern for people with Parkinson disease. This study aimed to compare the long-term training effects of two different verbal instructions that either asked the participants to "take big steps" or "strike the ground with the heel" on walking ability in individuals with Parkinson disease. Forty-five participants with Parkinson disease were randomized into the big-step or heel strike group. The participants underwent 12 sessions of treadmill and overground gait training. Throughout the interventions, the big-step group received an instruction to "take big steps," while the heel strike group received an instruction to "strike the ground with your heel." The primary outcome was gait performance, including velocity, stride length, cadence, and heel strike angle. The participants were assessed before, immediately after, and 1 mo after training. Both groups showed significant improvements in gait performance after training. The heel strike group showed continuous improvements in velocity and stride length during the follow-up period; however, the big-step group showed slightly decreased performance. A verbal instruction emphasizing heel strike can facilitate long-term retention of walking performance in people with Parkinson disease.

The NewGait Rehabilitative Device Corrects Gait Deviations in Individuals With Foot Drop.

The purpose of this quasiexperimental study was to test the effects of wearing the NewGait rehabilitative device on walking abilities in individuals with foot drop. The study involved 16 participants with foot drops caused by stroke (11 participants), multiple sclerosis (one participant), and peripheral neuropathies (four individuals). During a single testing session, participants walked 12 m at their self-selected speed in four experimental conditions: walking without any orthotic device; walking while wearing a regular plastic posterior leaf ankle foot orthosis (AFO); walking with the NewGait device assisting ankle dorsiflexion only; and walking with the NewGait device assisting the hip, knee, and ankle joint motions. Body motions during walking were recorded using a 3D system for motion analysis and analyzed with a set of spatiotemporal and kinematic parameters and a gait decomposition index. The gait decomposition index indicated sagittal interjoint coordination in the three joint pairs (hip-knee, knee-ankle, and hip-ankle) of the paretic (foot drop) leg during walking and was validated in a previous study. Overall, wearing all three orthotic devices improved the gait velocity, ankle dorsiflexion, and foot clearance compared to gait trials in which no assistive devices were used. However, wearing the AFO significantly restricted the plantarflexion range of motion and decreased interjoint coordination as measured by joint decomposition. In contrast, the NewGait device altered the ankle plantarflexion motions but also increased coordinated movement (reduced the decomposition) in most lower-extremity joint pairs and conditions. Therefore, the NewGait rehabilitative device can be considered superior to a regular AFO in correcting gait deviations caused by foot drop.

Effectiveness of Repetitive Transcranial Magnetic Stimulation Combined with Visual Feedback Training in Improving Neuroplasticity and Lower Limb Function after Chronic Stroke: A Pilot Study.

After a stroke, sustained gait impairment can restrict participation in the activities listed in the International Classification of Functioning, Disability, and Health model and cause poor quality of life. The present study investigated the effectiveness of repetitive transcranial magnetic stimulation (rTMS) and visual feedback training (VF) training in improving lower limb motor performance, gait, and corticospinal excitability in patients with chronic stroke. Thirty patients were randomized into three groups that received either rTMS or sham stimulation over the contralesional leg region accompanied by VF training groups in addition to the conventional rehabilitation group. All participants underwent intervention sessions three times per week for four weeks. Outcome measures included the motor-evoked potential (MEP) of the anterior tibialis muscle, Berg Balance Scale (BBS) scores, Timed Up and Go (TUG) test scores, and Fugl-Meyer Assessment of Lower Extremity scores. After the intervention, the rTMS and VF group had significantly improved in MEP latency (p = 0.011), TUG scores (p = 0.008), and BBS scores (p = 0.011). The sham rTMS and VF group had improved MEP latency (p = 0.027). The rTMS and VF training may enhance the cortical excitability and walking ability of individuals with chronic stroke. The potential benefits encourage a larger trial to determine the efficacy in stroke patients.

Reliability, Validity and Minimal Detectable Change of a Power Leg Press Test in Individuals with Cerebral Palsy

Background Lower extremity muscle power influences walking ability in individuals with Cerebral Palsy (CP). Aim Determine the reliability, validity, and minimal detectable change (MDC) of a novel power leg press (PLP) test to measure muscle power in individuals with CP. Methods Individuals with spastic CP (n = 26 (10 adults, 16 children); mean (SD) age = 19.3 (7.8) years(all); 27.9 (4.89) years (adults); 13.85(2.68) years (children)) performed 2 sessions of the PLP test, 2–10 days apart. A linear position transducer and custom computer code were used to calculate mean and peak power in watts (W). Intraclass correlation coefficients (ICC), standard error of measurement, MDC, and percent change of MDC (MDC%) were calculated for 4 power measures (average and maximum of mean and peak powers) for all participants (AP) and separately for adults (A) and children (C). Validity was evaluated against isokinetic knee extensor power. Results Test-retest reliability was excellent for all measures of power (ICC = 0.94–0.99). Ranges for MDC/MDC% by the group for power measures were between 33.7–80.7W/15.5–29.4% (AP), 41.1–65.3W/10.7–22.3% (A), and 27.6–79.8W/19–34.3% (C). Correlations were good to excellent between PLP and isokinetic power at all speeds (r = 0.75–0.88, p < .001). Conclusions The PLP test demonstrates excellent validity, reliability, and precision for measuring muscle power in those with CP.

Oxygen pulse best predicts energy expenditure during stair ascent and descent in individuals with chronic stroke.

To determine whether minute ventilation-to-carbon dioxide production (VE/VCO2), oxygen pulse (VO2/HR), and rate pressure product (RPP: VO2 * HR/1000) can explain energy expenditure during stair ascent/descent and whether energy expenditure during stair ascent/descent can discriminate between walking abilities in individuals with chronic stroke. Regression analysis of cross-sectional data from 50 individuals between 1 and 4 years post-stroke was carried out to investigate the prediction of energy expenditure during stair ascent/descent. In addition, discriminant analysis was carried out to investigate the discrimination between walking abilities for energy expenditure: community (walking speed ≥ 0.8 m/s) and non-community (walking speed < 0.8 m/s) walkers. Oxygen pulse and rate pressure product were retained in the model. Oxygen pulse alone explained 70% of the variance in energy expenditure during stair ascent/descent. By adding rate pressure product, 79% of the variance was explained. Energy expenditure was able to discriminate the community from the non-community walkers, with a cutoff value of 13.8 ml∙kg-1∙min-1 and correctly classified 62% of the non-community and 78% of the community walkers. Oxygen pulse and rate pressure product significantly predicted energy expenditure during stair ascent/descent in individuals with chronic stroke. Energy expenditure during stair ascent/descent discriminated community from non-community walkers.

Immediate effect of different ankle-foot orthosis functions with the same dorsiflexed setting of initial ankle joint angle on walking ability in individuals with chronic stroke: a randomized crossover trial

[Purpose] To investigate how different ankle-foot orthosis functions with the same dorsiflexed setting of initial ankle joint angle affect the walking ability in individuals with chronic stroke. [Participants and Methods] In this randomized crossover study, participants underwent a 10-m walking test and walked on a WalkWay MW-1000 three times under these conditions: (1) without ankle-foot orthosis; (2) with ankle-foot orthosis with an adjustable posterior strut at 5° of fixed dorsiflexion; and (3) with ankle-foot orthosis with an adjustable posterior strut at 5–20° of restricted dorsiflexion. The primary outcome was walking speed on the 10-m walking test. The secondary outcomes were walking speed and spatiotemporal factors measured by the WalkWay MW-1000. [Results] Fifteen individuals (mean [standard deviation] age, 60.9 [8.6] years; male, 12) were enrolled. Walking speeds of the ankle-foot orthosis with fixed and restricted dorsiflexion groups were significantly higher than those without the orthosis; however, no outcomes differed significantly between ankle-foot orthosis with fixed versus restricted dorsiflexion groups. [Conclusion] In individuals with chronic stroke, ankle-foot orthosis function may be less important than the dorsiflexed setting of initial ankle joint angle in the ankle-foot orthosis.

Current Evidence for Rhythmic Cueing and its Effects on Walking Ability in Individuals With Parkinson's Disease

<h3>Objective(s)</h3> To summarize the current evidence of rhythmic cueing (RC) and its effects on walking in Parkinson's disease (PD) to help guide clinicians in clinical application. <h3>Data Sources</h3> PubMed and GoogleScholar were searched using "Parkinson's Disease", "cueing", and "movement" MeSH terms. The search was filtered to include full-text articles from the last 10 years and to exclude articles not in English or done in animals. <h3>Study Selection</h3> Inclusion criteria: idiopathic PD; investigated the effects of RC on walking, and described type and application of RC. Two researchers independently screened and extracted data, a third researcher was used for consensus. Initial search identified 371 articles, and 44 were included after full-text review. <h3>Data Extraction</h3> A data extraction table was used and once completed, was further categorized by type of RC (auditory only, visual only, tactile only, comparative). <h3>Data Synthesis</h3> All but 3/44 included studies reported improvements in spatiotemporal parameters and freezing of gait. Positive results were seen acrossed types of RC but primarily demonstrated when integrated into a weekly gait training or exercise program over time; cue rates set between -80% to +25% of a participant's baseline cadence, and when RC was salient to participants. <h3>Conclusions</h3> Cueing provides a well-established technique as an adaptive strategy that has been shown to improve freezing and spatiotemporal parameters of gait in PD when implemented through a variety of methods and types that should be individualized. Despite the reported effectiveness of RC found within this review, future studies should explore characteristics training dosage, transferability, and responsiveness based on one's learning style. <h3>Author(s) Disclosures</h3> No conflicts to declare

Evaluation of gait initiation using inertial sensors in Huntington's Disease: insights into anticipatory postural adjustments and cognitive interference.

Understanding the contribution of anticipatory postural adjustments (APA) to walking ability in individuals with Huntington's disease (HD) may provide insight into motor planning and the functional consequences of HD-specific cortical-basal ganglia pathway dysfunctions. How do inertial measurement unit (IMU)-derived APAs and first step parameters differ between individuals with HD and non-HD peers under no load and cognitive load conditions, and what is their relationship to gait speed and clinical measures? 33 individuals with manifest HD and 15 non-HD peers wore three Opal APDM IMUs during a 14-meter walk under no load and cognitive load conditions. APA acceleration amplitudes, APA durations, first step range of motion (ROM), and first step durations were compared, along with their relationship to gait speed. Individuals with HD had greater APA acceleration amplitudes, smaller first step ROM and longer first step durations compared to non-HD peers. No differences in APA durations were present between groups in both conditions. Cognitive loading influenced first step ROM but not other APA parameters. Mediolateral APA acceleration amplitudes were a significant predictor of gait speed and were related to disease-specific measures. Larger acceleration amplitudes and smaller first step ROMs of greater duration, accompanied by the preservation of APA durations, reveal a discrepancy in movement scaling in HD. Additionally, the mediolateral component of the APA is likely a rate-limiting factor that drives a compensatory response in gait initiation. Further research is needed to explore the neural correlates of HD-related movement scaling.

Relation of exercise capacity to comprehensive physical functions in individuals with ischemic stroke.

Impaired motor control, balance, muscle strength, and respiratory function may affect the exercise capacity related to motor performance and activities in individuals with stroke. To identify a physical parameter that the exercise capacity has the most significant relationship among physical parameters related to motor function, trunk control, balance, and motor performance and activities in individuals with ischemic stroke. In total, 241 ischemic stroke patients were recruited in this retrospective study. The clinical measurements included the 6-minute walk test (6 MWT), Montreal cognitive assessment (MoCA), Fugl-Meyer assessment-lower extremity motor function (FMA-LE), trunk impairment scale (TIS), Berg balance scale (BBS), timed up and go test (TUG), 10-meter walk test (10 MWT), functional ambulation category (FAC), and functional independence measure (FIM). The 6 MWT was significantly correlated with the FMA-LE, BBS, TUG, 10 MWT, FAC, and FIM, indicating negative or positive moderate correlations. Additionally, the FMA-LE, TIS, BBS, TUG, 10 MWT, FAC, and FIM, excluding the 6 MWT, showed moderate to strong correlations with all of the other outcome measures, whereas the MoCA showed significant correlations only with the BBS and FIM. In this study, the exercise capacity has the most significant relationship with the TUG parameter in stroke patients. Additionally, we suggest that significant relationships between 6 MWT and other comprehensive physical functions measurements are closely related to walking ability in individuals with stroke.

Therapeutic effects of brain-computer interface-controlled functional electrical stimulation training on balance and gait performance for stroke: A pilot randomized controlled trial.

Background:Brain-computer interface-controlled functional electrical stimulation (BCI-FES) approaches as new feedback training is increasingly being investigated for its usefulness in improving the health of adults or partially impaired upper extremity function in individuals with stroke.Objective:To evaluate the effects of BCI-FES on postural control and gait performance in individuals with chronic hemiparetic stroke.Methods:A total of 25 individuals with chronic hemiparetic stroke (13 individuals received BCI-FES and 12 individuals received functional electrical stimulation [FES]). The BCI-FES group received BCI-FES on the tibialis anterior muscle on the more-affected side for 30 minutes per session, 3 times per week for 5 weeks. The FES group received FES using the same methodology for the same periods. This study used the Mann-Whitney test to compare the two groups before and after training.Results:After training, gait velocity (mean value, 29.0 to 42.0 cm/s) (P = .002) and cadence (mean value, 65.2 to 78.9 steps/min) (P = .020) were significantly improved after BCI-FES training compared to those (mean value, 23.6 to 27.7 cm/s, and mean value, 59.4 to 65.5 steps/min, respectively) after FES approach. In the less-affected side, step length was significantly increased after BCI-FES (mean value, from 28.0 cm to 34.7 cm) more than that on FES approach (mean value, from 23.4 to 25.4 cm) (P = .031).Conclusion:The results of the BCI-FES training shows potential advantages on walking abilities in individuals with chronic hemiparetic stroke.

Neuroplasticity of Cortical Planning for Initiating Stepping Poststroke: A Case Series.

Therapeutic exercise improves balance and walking ability in individuals after stroke. The extent to which motor planning improves with therapeutic exercise is unknown. This case series examined how outpatient physical therapy affects motor planning and motor performance for stepping. Individuals poststroke performed self-initiated stepping before (baseline), after (postintervention), and 1 month after (retention) intervention. Amplitude and duration of the movement-related cortical potential (MRCP) was measured using an electroencephalograph from the Cz electrode. Electromyography (EMG) of biceps femoris (BF) was collected. Additionally, clinical measures of motor impairment and function were evaluated at all 3 time points by a blinded assessor. Two types of outpatient physical therapy were performed for 6 weeks: CONVENTIONAL (n = 3) and FAST (n = 4, Fast muscle Activation and Stepping Training). All 7 participants reduced MRCP duration, irrespective of the type of physical therapy. The MRCP amplitude and BF EMG onset changes were more variable. Clinical outcomes improved or were maintained for all participants. The extent of motor impairment was associated with MRCP amplitude. Changes in MRCP duration suggest that outpatient physical therapy may promote neuroplasticity of motor planning of stepping movements after stroke; however, a larger sample is needed to determine whether this finding is valid.This case series suggests motor planning for initiating stepping may improve after 6 weeks of outpatient physical therapy for persons with stroke.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A307).

Influences of Dual-Task Training on Walking and Cognitive Performance of People With Relapsing Remitting Multiple Sclerosis: Randomized Controlled Trial

ObjectiveWe sought to investigate whether there is any additional effect of coupled cognitive and physical rehabilitation compared to exercise training alone on walking and cognitive performance in individuals with relapsing remitting multiple sclerosis (RRMS). MethodsA randomized controlled trial was conducted from March to November 2015 with 30 individuals with RRMS (aged 20 to 50 years; 21 women, 9 men), who underwent detailed medical and neurologic examination. They were randomly allocated using sealed envelopes to either the study group, who received physical and cognitive rehabilitation (dual-task training), or the control group, who received physical rehabilitation alone. Participants (in both groups) were assessed twice (8 weeks apart), before and after rehabilitation. Assessment tools were the Mini-Mental State Examination (MMSE), the Expanded Disability Status Scale (EDSS), neuropsychological evaluation (using RehaCom), and walking tests. ResultsAfter training, the control group significantly improved regarding MMSE, attention/concentration test, and 10-meter walking test, whereas the scores of the study group significantly improved in all studied parameters (Expanded Disability Status Scale, MMSE, logical reasoning, and attention/concentration and walking tests). The differential (delta) scores from before to after rehabilitation were significantly higher in the study group for logical reasoning, attention/concentration, and 2-minute walking distance scores. ConclusionsCoupled physical and cognitive (dual-task) training showed concurrent improvement in cognitive and walking abilities in individuals with RRMS which exceeded that achieved by physical training alone.

Do Sociodemographic Factors Relate to Walking Ability in Individuals Who Underwent Total Knee Arthroplasty?

Knee osteoarthritis is one of the most common health problems in older adults and total knee arthroplasty (TKA) is able to improve walking ability in these individuals. There have been few studies investigating whether sociodemographic factors influence walking ability after TKA. The aim of this study was to examine which sociodemographic factors relate to walking ability in Japanese older adults following TKA during the acute stage of recovery. This prospective cohort study included 388 participants, from a multicenter database, who underwent TKA. The Timed Up and Go test 2 weeks after TKA was the dependent variable. Sociodemographic factors including age, sex, body mass index, marital status, and academic qualification were independent variables. In addition, type of surgery and severity of osteoarthritis were measured as confounding variables. A hierarchical multiple regression analysis was used to predict the factors that have the greatest influence on walking ability. Models were examined with and without confounding factors. In the final regression model, older age, conventional TKA approaches, increased severity of Kellgren-Lawrence grade, and women were associated with longer Timed Up and Go time. Academic qualification and marital status were not related to walking ability. Our results suggest that age, type of surgery, severity of osteoarthritis, and sex are related to Timed Up and Go time during the acute stage following TKA and need to be assessed.

Whole-body vibration improves ankle spasticity, balance, and walking ability in individuals with incomplete cervical spinal cord injury.

This study aimed to investigate the effects of whole-body vibration (WBV) training on ankle spasticity, balance, and walking ability in patients with incomplete spinal cord injury (iSCI) at cervical level. Twenty-eight patients with cervical iSCI were randomly assigned to WBV (n = 14) or control group (n = 14). WBV group received WBV training, while control group was treated with placebo-treatment. All interventions were given for 20-min, twice a day, 5-days a week for 8-weeks. The spasticity of ankle plantar-flexors was assessed by estimating passive resistive force using a hand-held dynamometer. Balance was analyzed based on postural sway length (PSL) using a force plate. Timed-Up and Go test (TUG) and 10 m-Walk Test (10MWT) were used to assess walking ability. Both groups showed significant improvements in spasticity, balance and walking ability. Also, the significant differences between two groups were demonstrated in the outcomes of spasticity (3.0±1.7 vs 0.9±1.2), PSL (6.4±1.2 vs 3.2±0.9 with eyes-open, and 15.1±10.9 vs 7.4±4.3 with eyes-closed), TUG (2.3±1.3 vs 1.0±1.0), and 10MWT (3.5±2.3 vs 1.3±1.4). WBV may be a safe and effective intervention to improve spasticity, balance and walking ability in individuals with cervical iSCI. Thus, WBV may be used to improve these symptoms in clinics.

Relationship between functional balance and walking ability in individuals with chronic stroke.

[Purpose] The objective of this cross sectional study was to investigate the validity of Functional Ambulation Category in evaluating functional balance and identifying the relationship between balance impairment and functional ambulation in individuals with chronic stroke. [Participants and Methods] A total of 31 chronic stroke patients with first ever ischemic middle cerebral artery strokes, with no cognitive deficits were recruited. Participants had a mean age of 54.84 (SD=7.05) years and a time after stroke of 22.74 (SD=27.13) months. Community ambulation was determined by Functional Ambulation Category and functional balance was assessed by Berg Balance Scale. [Results] The mean Berg Balance Scale and the Functional Ambulation Category scores were 47.38 (SD=7.54) and 3.8 (SD=0.79), respectively. Correlation analysis revealed that balance impairment and ambulatory function was significantly positively correlated with each other (r=0.80). [Conclusion] The results shows that the Functional Ambulation Category is a valid tool in evaluating functional balance and suggest that functional balance may be an important goal for rehabilitation to achieve improvement in walking ability in people with chronic stroke.