Walking Ability In Individuals Research Articles

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.

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.

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.

Effect of 8-Week Aquatic, Land- based and Combined (Aquatic-Land) Training Programs On Walking Capacity in Women with Multiple Sclerosis (MS): A Burdenko Approach

Multiple sclerosis (MS) is a chronic disease affecting all aspects of life in patients with this disease and causes a wide range of functional problems, including reduced walking capacity. The aim of this study was to compare the effects of 8 weeks aquatic, land-based and combined (aquatic-land (exercise programs according to Burdenko method on the walking capacity measured by 6-Minute Walk Test (6MWT). This was a pre- post design study. Thirty one women diagnosed with MS, age range 30-50 years, EDSS&lt;4.5, and living in Amol, Iran participated in this study. The paired t-test results demonstrated a significant improvement in the walking ability of individuals after aquatic exercises (t = -2.23, α=0.048), land-based exercises (t = -5.31, α= 0.001) and combined exercises (t = -4.00, α = 0.001) compared to the pretest. The results of covariance test indicated that aquatic, land-based and combined exercise programs had different effects on the walking ability (power = 0.80, P = 0.001, and F30, 2 = 8.98). Results of LSD post hoc analysis further indicated that the mean 6MWT in the land-based exercise group and combined exercise group was significantly higher than the aquatic exercise group (p&lt;0.05), but no significant difference was found in the mean of 6MWT between land-based exercise group and combined exercise group (p&gt;0.05). According to the results of this study, the combined and land-based exercises can be suggested for people with MS in order to improve their walking capacity. These methods can be suggested as appropriate non-pharmacologic complementary therapies in the rehabilitation centers.

Effects of an intensive Nordic walking intervention on the balance function and walking ability of individuals with Parkinson's disease: a randomized controlled pilot trial.

Parkinson's disease (PD) is associated with impairment in balance and postural control, accompanied by a progressive reduction in the speed and amplitude of movement. The aim of our study was to evaluate the therapeutic effects of Nordic walking on a treadmill on the balance function and walking ability of individuals with PD. Twenty participants with stage 1-3 PD in the Hoehn and Yahr scale were randomly allocated to the Nordic walking training (NWT) group and treadmill training (TT) group, with ten participants per group. Measured outcomes included: the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRS-M), the Berg balance scale (BBS), the Timed Up-and-go test (TUG), the 10-meter walk test (10MWT), and the 6-minute walk test (6MWT). Improvement on all outcome measures was identified from pre-to-post intervention for both groups (p<0.05). Post-intervention, there was a significant between-group difference on measured outcomes (p<0.05). The NWT group exhibited greater improvement in the UPDRS-M (p=0.006; 95%CI 0.825-4.374), BBS (p=0.002; 95%CI 1.307-5.092), TUG (p=0.048; 95%CI 0.028-2.582), 10MWT (p=0.047; 95%CI 0.108-2.306), and 6MWT (p=0.003; 95%CI 20.302-42.097) compared to the TT group. Our outcomes provide evidence of the therapeutic benefit of Nordic walking on a treadmill to improve balance function and walking ability in individuals with PD.

Validity of the shuttle walk test as a functional assessment of walking ability in individuals with polyneuropathy

Purpose: This study assessed the validity of the shuttle walk test (SWT) to evaluate walking ability in patients with polyneuropathy.Methods: Forty-one patients with chronic idiopathic axonal polyneuropathy (CIAP) and 49 patients with multifocal motor neuropathy (MMN) performed both the 10-meter walk test (10MWT) and the SWT. Face validity was assessed by evaluating whether patients considered both tests to reflect their walking ability (Likert scale: 1 = not at all, 10 = very well). Concurrent validity was determined by Spearman rank-correlation analyses performed on the outcomes of both tests.Results: Mean (SD) scores for how well the 10MWT and SWT reflected daily walking ability were 6.8 (1.3) and 7.4 (1.6) (p = 0.117) in patients with CIAP and 6.9 (1.2) and 7.9 (1.0) (p = 0.001) in patients with MMN, respectively. Correlation scores between both tests ranged from −0.70 to −0.82, except for 18 patients with MMN with a “normal” walking speed at the 10MWT (−0.21).Conclusion: The SWT seems a valid instrument for assessing walking ability in individuals with CIAP and MMN. Moreover, the SWT seems to be useful for investigating the symptoms elicited by walking long distances and may be more sensitive to changes when compared to the 10MWT.Implications for RehabilitationPatients with polyneuropathy mainly experience problems when walking long distances.The 10-meter walk test does not possess sufficient psychometrics to diagnose walking abilities in these circumstances.The shuttle walk test is a valid instrument for assessing walking ability in individuals with polyneuropathy and might be the preferred instrument of choice when compared to the 10-meter walk test.

Correlation between balance, speed, and walking ability in individuals with chronic hemiparesis

Abstract Alterations in balance and gait are frequently present in patients with hemiparesis. This study aimed at determining whether there is a correlation between static and functional balance, gait speed and walking capacity. To that end, 17 individuals with chronic hemiparesis of both sexes (58.8% men and 42.25 women), mean age of 56.3 ± 9.73 years, took part in the study. Static balance was assessed by computerized baropodometry, under two different sensory conditions: eyes open (EO) and eyes closed (EC). Functional balance was evaluated by Berg Balance Scale and walking ability by the Functional Ambulation Classification. Gait speed was assessed by kinemetry. The Kolmogorov-Smirnov test was used to verify data distribution normality. Parametric variables were correlated by Pearson's test and their non-parametric parameters by Spearman's test. Functional balance showed a positive correlation with gait speed (p=0.005; r=0.64) and walking ability (p = 0.019; r = 0.56). Anteroposterior (AP) and mediolateral (ML) alterations with EO and EC exhibited negative correlations with gait speed (EO: AP amplitude (p = 0.0049 and r = -0.48); mean ML deviation (p = 0.019 and r =-0.56)/ EC: mean AP deviation (p = 0.018 and r = -0.56) and mean ML deviation (p = 0.032 and r = -0.52); AP amplitude (p = 0.014 and r = -0.57) and ML amplitude (p = 0.032 and r = -0.52); postural instability (p = 0.019 and r = -0.55)) and walking ability (EO: mean AP deviation (p = 0.05 and r = -0.47) and AP amplitude (p = 0.024 and r = -0.54)). The results suggest correlations between static and functional balance and gait speed and walking ability, and that balance training can be an important component of gait recovery protocols.

Comparison of Cardiorespiratory Responses between Pool Floor and Overground Walking in People Post-Stroke

Hemiparetic gait is often associated with stroke, limiting functional mobility and contributing to excessive energy expenditure. Elevated energy demand is an indicator of compromised aerobic capacity and may hinder people post-stroke from participating in activities of daily living as well as other physical activities. Walking in water can offer a supportive and effective method of training to increase cardiovascular fitness and walking ability of individuals with gait impairment. No studies have examined the cardiorespiratory responses to exercise in water among people post-stroke. PURPOSE: To compare cardiorespiratory responses between pool floor and overground walking in people post-stroke. METHODS: 15 individuals post-stroke (aged 56.57 ± 10.24 years) and 15 healthy controls (age- and gender-matched) participated in this cross-sectional comparative study. During the initial visit, participants performed a six-minute walk test both in water and on land. The second and third visit consisted of either pool floor walking (PFW) or overground walking (OW) at a matched speed. Walking speed was matched based on the maximum walking speed of the initial aquatic six-minute walk test. To measure cardiorespiratory responses including oxygen consumption (VO2), energy expenditure (EE), and minute ventilation (VE), participants wore a telemetric metabolic system (K4b2, COSMED Inc., Rome, Italy) during rest and walking sessions. Lap times and cadence were used to control walking speed. Participants were instructed to rest in a seated position for ten minutes before walking for six minutes at a matched speed paced by a metronome. RESULTS: Both groups showed increases in mean cardiorespiratory responses during PFW compared to OW at a matched speed. There was no significant group interaction. During PFW, healthy controls increased mean VO2 values by 72.6%, mean EE values by 61.0% and mean VE values by 57.1%. The stroke group showed increases in mean VO2 values by 42.4%, mean EE values by 43.6%, and mean VE values by 37.4%. CONCLUSIONS: Walking in water demonstrated increased metabolic cost compared to walking overground. Gait training in water may not be ideal for people post-stroke who fatigue easily. However, it can be an effective method of cardiovascular exercise.