Walking Ability In Individuals Research Articles

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<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<0.05), but no significant difference was found in the mean of 6MWT between land-based exercise group and combined exercise group (p>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.

Effects of exercise therapy on walking ability in individuals with knee osteoarthritis: a systematic review and meta-analysis of randomised controlled trials

Objective: To examine the effect of exercise therapy on the walking ability of individuals with knee osteoarthritis. Data sources: Randomised clinical trials (RCTs) were identified by searching through PubMed, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature. All literature published to October 2014 were included in the search. Review methods: Data were collected from RCTs that compared the effects of exercise therapy on walking ability with the effects of no intervention or psychoeducational intervention in participants with knee osteoarthritis. The outcome data on the total distance walked (6-minute walk test); the amount of time spent walking (the time to walk arbitrary distances); and gait velocity were obtained and analysed. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Results: Twenty-eight RCTs were identified. Meta-analysis provided very-low-quality evidence that exercise therapy increased the total distance walked in the 6-minute walk test, in comparison with the effects of the control interventions (SMD = 0.44, 95% CI 0.27 to 0.60). Meta-analysis also provided low- or moderate-quality evidence that the amount of time spent walking and gait velocity were improved more by exercise therapy than by the control interventions (the amount of time spent walking: SMD = −0.50, 95% CI −0.70 to −0.30; gait velocity: SMD = 1.78, 95% CI 0.98 to 2.58). Conclusion: In individuals with knee osteoarthritis, exercise therapy can improve the amount of time spent walking, gait velocity, and maybe the total distance walked.

A Comparative Study of Conventional Physiotherapy Versus Robotic Training Combined with Physiotherapy in Patients with Stroke

Background: There has been a growing interest in the use of robotic therapy to improve walking ability in individuals following stroke. Objectives: The aim of this retrospective study was to compare conventional physiotherapy (CP) with robotic training (RT) combined with CP and to measure the effects on gait, balance, functional status, cognitive function, and quality of life in patient with stroke. Methods: We retrospectively identified 107 cases of new cerebral stroke. They were allocated into 2 groups. In the RT group (n = 36), patients received RT (Lokomat; 2 times per week) combined with CP (3 times per week) for at least 30 sessions. In the CP group (n = 71), patients received a program at least 30 sessions, 5 times per week. The evaluation parameters included modified Ashworth Spasticity Scale (MASS), Brunnstrom Recovery Scale (BRS), Functional Independence Measure (FIM), Functional Ambulation Categories (FAC), Berg Balance Scale (BBS), Mini-Mental State Examination (MMSE), and Short Form-36 (SF-36) Health Survey. Results: Posttreatment results showed significant improvements for all parameters (except lower extremity MASS scores) in both groups. However, when we compared the percentage changes of parameters at discharge relative to pretreatment values, improvements in FIM, MMSE, and all subparts of SF-36 were better in the RT group (P < .05). Comparison of posttreatment evaluation parameters for categorical variables showed that the lower extremity categories in the BRS were significantly better in the RT group than the CP group (P < .05). Conclusion: RT combined with CP produced better improvement in FIM, MMSE, BRS lower extremity categories, and all subparts of SF-36 of the patients with subacute and chronic stroke (up to 1 year) than the CP program.

A randomized trial of functional electrical stimulation for walking in incomplete spinal cord injury: Effects on walking competency

BackgroundMulti-channel surface functional electrical stimulation (FES) for walking has been used to improve voluntary walking and balance in individuals with spinal cord injury (SCI).ObjectiveTo investigate short- and long-term benefits of 16 weeks of thrice-weekly FES-assisted walking program, while ambulating on a body weight support treadmill and harness system, versus a non-FES exercise program, on improvements in gait and balance in individuals with chronic incomplete traumatic SCI, in a randomized controlled trial design.MethodsIndividuals with traumatic and chronic (≥18 months) motor incomplete SCI (level C2 to T12, American Spinal Cord Injury Association Impairment Scale C or D) were recruited from an outpatient SCI rehabilitation hospital, and randomized to FES-assisted walking therapy (intervention group) or aerobic and resistance training program (control group). Outcomes were assessed at baseline, and after 4, 6, and 12 months. Gait, balance, spasticity, and functional measures were collected.ResultsSpinal cord independence measure (SCIM) mobility sub-score improved over time in the intervention group compared with the control group (baseline/12 months: 17.27/21.33 vs. 19.09/17.36, respectively). On all other outcome measures the intervention and control groups had similar improvements. Irrespective of group allocation walking speed, endurance, and balance during ambulation all improved upon completion of therapy, and majority of participants retained these gains at long-term follow-ups.ConclusionsTask-oriented training improves walking ability in individuals with incomplete SCI, even in the chronic stage. Further randomized controlled trials, involving a large number of participants are needed, to verify if FES-assisted treadmill training is superior to aerobic and strength training.

Activity-Based Therapy for Recovery of Walking in Individuals With Chronic Spinal Cord Injury: Results From a Randomized Clinical Trial

ObjectiveTo examine the effects of activity-based therapy (ABT) on neurologic function, walking ability, functional independence, metabolic health, and community participation. DesignRandomized controlled trial with delayed treatment design. SettingOutpatient program in a private, nonprofit rehabilitation hospital. ParticipantsVolunteer sample of adults (N=48; 37 men and 11 women; age, 18–66y) with chronic (≥12mo postinjury), motor-incomplete (ASIA Impairment Scale grade C or D) spinal cord injury (SCI). InterventionsA total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression. Main Outcome MeasuresNeurologic function (International Standards for Neurological Classification of Spinal Cord Injury); walking speed and endurance (10-meter walk test, 6-minute walk test, and Timed Up and Go test); community participation (Spinal Cord Independence Measure, version III, and Reintegration to Normal Living Index); and metabolic function (weight, body mass index, and Quantitative Insulin Sensitivity Check). ResultsSignificant improvements in neurologic function were noted for experimental versus control groups (International Standards for Neurological Classification of Spinal Cord Injury total motor score [5.1±6.3 vs 0.9±5.0; P=.024] and lower extremity motor score [4.2±5.2 vs −0.6±4.2; P=.004]). Significant differences between experimental and control groups were observed for 10-meter walk test speed (0.096±0.14m/s vs 0.027±0.10m/s; P=.036) and 6-minute walk test total distance (35.97±48.2m vs 3.0±25.5m; P=.002). ConclusionsABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, further analysis is needed to determine for whom ABT is going to lead to meaningful clinical benefits.

Activity-Based Therapy for Recovery of Walking in Chronic Spinal Cord Injury: Results From a Secondary Analysis to Determine Responsiveness to Therapy

ObjectiveTo gain insight into who is likely to benefit from activity-based therapy (ABT), as assessed by secondary analysis of data obtained from a clinical trial. DesignSecondary analysis of results from a randomized controlled trial with delayed treatment design. SettingOutpatient program in a private, nonprofit rehabilitation hospital. ParticipantsVolunteer sample of adults (N=38; 27 men; 11 women; age, 22–63y) with chronic (≥12mo postinjury), motor-incomplete (American Spinal Injury Association [ASIA] Impairment Scale [AIS] grade C or D) spinal cord injury (SCI). InterventionsA total of 9h/wk of ABT for 24 weeks including developmental sequencing; resistance training; repetitive, patterned motor activity; and task-specific locomotor training. Algorithms were used to guide group allocation, functional electrical stimulation utilization, and locomotor training progression. Main Outcome MeasuresWalking speed and endurance (10-meter walk test and 6-minute walk test) and functional ambulation (timed Up and Go test). ResultsThis secondary analysis identified likely responders to ABT on the basis of injury characteristics: AIS classification, time since injury, and initial walking ability. Training effects were the most clinically significant in AIS grade D participants with injuries <3 years in duration. This information, along with information about preliminary responsiveness to therapy (gains after 12wk), can help predict the degree of recovery likely from participation in an ABT program. ConclusionsABT has the potential to promote neurologic recovery and enhance walking ability in individuals with chronic, motor-incomplete SCI. However, not everyone with goals of walking recovery will benefit. Individuals with SCI should be advised of the time, effort, and resources required to undertake ABT. Practitioners are encouraged to use the findings from this trial to assist prospective participants in establishing realistic expectations for recovery.

Associations between expiratory spirometry parameters and limitations in daily life activities in patients with schizophrenia

ObjectiveThis cross-sectional study considered whether variability in respiratory functioning could explain the variability in walking ability of individuals with schizophrenia taking into account variability in body mass index (BMI), lifestyle factors, psychiatric symptoms, antipsychotic medication use and muscular fitness. MethodEighty patients with schizophrenia and 40 age-, gender- and BMI-matched controls underwent a spirometry and the 6-min walk test (6MWT) and completed the International Physical Activity Questionnaire. Patients were additionally screened for psychiatric symptoms. ResultsCompared to health controls, patients with schizophrenia achieved a lower distance on the 6MWT (583.6±109.7 m versus 710.6±108.4 m, P<.001) and had a lower forced vital capacity (3.7±1.1 L versus 4.3±0.9 L, P<.001) and forced expiratory volume in 1 s (FEV1) (3.0±1.0 L versus 3.6±0.7 L, P<.001). In multiple regression analysis, 68.1% of the variance in walking distance was explained by FEV1, BMI, muscular fitness and total energy expenditure. ConclusionThe respiratory health of patients with schizophrenia should be of concern for clinicians. In addition, future research interventions should seek to investigate the impact of an impaired respiratory health upon individuals with schizophrenia.

Operant conditioning to increase ankle control or decrease reflex excitability improves reflex modulation and walking function in chronic spinal cord injury

Ankle clonus is common after spinal cord injury (SCI) and is attributed to loss of supraspinally mediated inhibition of soleus stretch reflexes and maladaptive reorganization of spinal reflex pathways. The maladaptive reorganization underlying ankle clonus is associated with other abnormalities, such as coactivation and reciprocal facilitation of tibialis anterior (TA) and soleus (SOL), which contribute to impaired walking ability in individuals with motor-incomplete SCI. Operant conditioning can increase muscle activation and decrease stretch reflexes in individuals with SCI. We compared two operant conditioning-based interventions in individuals with ankle clonus and impaired walking ability due to SCI. Training included either voluntary TA activation (TA↑) to enhance supraspinal drive or SOL H-reflex suppression (SOL↓) to modulate reflex pathways at the spinal cord level. We measured clonus duration, plantar flexor reflex threshold angle, timed toe tapping, dorsiflexion (DF) active range of motion, lower extremity motor scores (LEMS), walking foot clearance, speed and distance, SOL H-reflex amplitude modulation as an index of reciprocal inhibition, presynaptic inhibition, low-frequency depression, and SOL-to-TA clonus coactivation ratio. TA↑ decreased plantar flexor reflex threshold angle (-4.33°) and DF active range-of-motion angle (-4.32°) and increased LEMS of DF (+0.8 points), total LEMS of the training leg (+2.2 points), and nontraining leg (+0.8 points), and increased walking foot clearance (+ 4.8 mm) and distance (+12.09 m). SOL↓ decreased SOL-to-TA coactivation ratio (-0.21), increased nontraining leg LEMS (+1.8 points), walking speed (+0.02 m/s), and distance (+6.25 m). In sum, we found increased voluntary control associated with TA↑ outcomes and decreased reflex excitability associated with SOL↓ outcomes.

Self-reported Walking Ability in Persons With Chronic Stroke and the Relationship With Gait Performance Tests

To assess self-reported walking ability in individuals with chronic stroke and to determine the relationship with gait performance tests. Descriptive analysis of a convenience sample. A university hospital rehabilitation medicine clinic. Fifty ambulatory community-dwelling poststroke individuals (mean age, 64 years [range, 44-74 years] and mean time since stroke onset 42 months [range, 6-101 months]). The Walking Impact Scale (the Walk-12) to assess self-reported walking ability, and the Timed "Up & Go" test, 10-m Comfortable Gait Speed and Fast Gait Speed tests, and 6-Minute Walk Test to assess gait performance. A majority of the participants (94%) reported limitations in their walking ability. The most common limitations were related to standing or walking, walking speed and distance, effort, and gait quality aspects. The ability to run was reported as most affected, whereas the need for support indoors or outdoors was least affected. Significant correlations (P < .01) were found between the Walk-12 and the 4 gait performance tests (ρ = -0.60 to 0.60). Persons with chronic stroke perceive limitations in their walking ability. The relationship between the Walk-12 and the 4 gait performance tests indicates that self-reports and quantitative assessments are associated. Because the Walk-12 reflects broader dimensions than the gait performance tests, it can be a complementary tool when walking ability in persons with chronic stroke is evaluated.

Regaining walking ability in individuals with Rett syndrome: a case study

Rett syndrome (RS) is a neurodevelopmental syndrome characterized by arrested brain development. The disorder is caused by a faulty gene on the X chromosome, mainly affecting females. The syndrome usually manifests itself through vast clinical impairments in functional abilities, including motor ones. According to different studies, only 50%–75% of all affected females will achieve walking abi­lity, and some will lose this ability later in life. The benefits of living a physically active life both for handicapped and non-handicapped individuals have been vastly described in the literature. As the life expectancy of individuals with RS is around 50 years of age and because of the medical and functional difficulties accompanying this syndrome, it is extremely important that the person with RS will have a continuous active lifestyle from a young age. Several case studies have described the re-gaining of lost walking ability, aside from the achievements of gait, in this population because of intensive intervention. The present article explores the benefits of walking for this population and describes a person with RS who regained her walking ability at the age of 28 because of an intensive and comprehensive program after being in a wheelchair for over 5 years. The present case study supports the existing literature and calls for health-related professionals working with this population to implement similar programs with individuals with RS because of the importance of maintaining an active lifestyle for all human beings, especially those with disabilities.

Multilevel Surgery Improves Gait in Spastic Hemiplegia But Does Not Resolve Hip Dysplasia

Multilevel orthopaedic surgery may improve gait in Type IV hemiplegia, but it is not known if proximal femoral osteotomy combined with adductor release as part of multilevel surgery in patients with hip dysplasia improves hip development. We asked whether varus derotational osteotomy of the proximal femur, combined with adductor release, influenced hip development in patients with Type IV hemiplegia having multilevel surgery. We retrospectively reviewed 11 children and adolescents with Type IV hemiplegia who had a proximal femoral osteotomy due to unilateral hip displacement to correct gait dysfunction between 1999 and 2006. The mean age at the time of surgery was 11.1 years (range, 7 to 16 years). We obtained the Movement Analysis Profile and Gait Profile Score before and after surgery. We also measured the Migration Percentage of Reimers and applied the Melbourne Cerebral Palsy Hip Classification System (MCPHCS). The minimum followup was 2 years 3 months (mean, 6 years 6 months; range, 2 years 3 months to 10 years 8 months). The majority of gait parameters improved but hip development was not normalized. According to the MCPHCS at last followup, no hips were classified as Grade I, two hips were classified as Grade II, and the remainder were Grade III and IV. Unilateral surgery including a proximal femoral osteotomy improved gait and walking ability in individuals with spastic hemiplegic cerebral palsy. However, hip dysplasia persists. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Self-efficacy is associated with walking ability in persons with diabetes mellitus and peripheral arterial disease

Self-efficacy is a known predictor for behavior change. Little is known about the association of self-efficacy with walking ability in individuals with diabetes mellitus and peripheral arterial disease (PAD). The objective of this study was to determine the association of self-efficacy with walking ability in individuals with diabetes mellitus and PAD. In this cross-sectional study, baseline data were analyzed from individuals with diabetes mellitus type 1 or 2 and PAD who were enrolled in a walking intervention clinical trial. As part of the baseline assessment, individuals completed questionnaires to ascertain self-efficacy and co-existing illnesses. In addition, participants completed a treadmill walking test and a 6-minute walking test. A total of 145 individuals were enrolled (mean age 66.5 +/- 10.1 years) with diabetes mellitus and PAD; 45 (31%) were women. The mean ankle-bracial index was 0.70 (range - 0.18-2.20) and the mean glycosylated hemoglobin value was 7.1 (SD 1.2). The mean distance walked, as per the treadmill walking test, was 418 meters (SD 258) and the mean distance walked, as per the 6-minute walking test, was 272 meters (SD 74). As measured by the treadmill walking test and the 6-minute walking test, self-efficacy was associated with treadmill walking distance, coefficient 33.0 (95% CI 11.0, 55.1; p = 0.0036), and the 6-minute walking test, coefficient 10.4 (95% CI 3.0, 17.7; p = 0.0061), after adjusting for comorbidities, social habits, and disease severity. In conclusion, self-efficacy, a psychosocial mediator for behavior change, was significantly associated with walking ability in individuals with diabetes mellitus and PAD. Future studies should determine the benefits of targeting self-efficacy to improve adherence to walking therapy in patients with PAD.

Comparison of Effect of Aerobic Cycle Training and Progressive Resistance Training on Walking Ability After Stroke: A Randomized Sham Exercise–Controlled Study

To determine whether changes in strength or cardiorespiratory fitness after exercise training improve walking ability in individuals who have had a stroke. A sham exercise-controlled, randomized two-by-two factorial design, in which the two factors investigated were cycle training (AEROBIC) and resistance training (STRENGTH). University exercise laboratory. Fifty-two individuals with a history of stroke (aged 63+/-9; time since stroke, 57+/-54 months). Participants undertook 30 exercise sessions over 10 to 12 weeks. Depending on group allocation, individuals underwent aerobic cycling plus sham progressive resistance training (PRT) (n=13), sham cycling plus PRT (n=13), aerobic cycling plus PRT (n=14), or sham cycling plus sham PRT (n=12). Primary outcomes were 6-minute walk distance, habitual and fast gait velocities, and stair climbing power. Secondary outcomes included measures of cardiorespiratory fitness; muscle strength, power, and endurance; and psychosocial attributes. Neither AEROBIC nor STRENGTH improved walking distance or gait velocity significantly more than sham exercise, although STRENGTH significantly improved participants' stair climbing power by 17% (P=.009), as well as their muscle strength, power, and endurance; cycling peak power output; and self-efficacy. Conversely, AEROBIC improved indicators of cardiorespiratory fitness only. Cycling plus PRT produced larger effects than either single modality for mobility and impairment outcomes. Single-modality exercises targeted at existing impairments do not optimally address the functional deficits of walking but do ameliorate the underlying impairments. The underlying cardiovascular and musculoskeletal impairments are significantly modifiable years after stroke with targeted robust exercise.

Knee Muscle Strength, Gait Performance, and Perceived Participation After Stroke

Flansbjer U-B, Downham D, Lexell J. Knee muscle strength, gait performance, and perceived participation after stroke. Objective To assess the relation between knee muscle strength, gait performance, and perceived participation in subjects with chronic mild to moderate poststroke hemiparesis. Design Descriptive analysis of convenience sample. Setting University hospital. Participants Fifty men and women (mean age, 58±6.4y) 6 to 46 months poststroke. Interventions Not applicable. Main Outcome Measures Isokinetic concentric knee extension and flexion strength was measured at 60°/s. Gait performance was assessed by Timed Up & Go, comfortable and fast gait speed, stair climbing ascend and descend, and 6-minute walk test. Perceived participation was assessed with the Stroke Impact Scale. Results There was a significant correlation ( P<.01) between knee muscle strength and gait performance for the paretic but not for the nonparetic lower limb. Strength for the paretic limb explained 34% to 50% of the variance in gait performance; the addition of strength for the nonparetic limb explained at most a further 11% of the variance in gait performance. There was a significant correlation ( P<.01) between gait performance and perceived participation; gait performance explained 28% to 40% of the variance in perceived participation. Conclusions Knee muscle strength is a moderate to strong predictor of walking ability in individuals with chronic mild to moderate poststroke hemiparesis. Walking ability influences perceived participation, but the strengths of the relations indicate that other factors are also important.

Locomotor Training Approaches for Individuals with Spinal Cord Injury

Body weight supported (BWS) locomotor training improves overground walking ability in individuals with motor-incomplete spinal cord injury (SCI). While there are various approaches available for locomotor training, there is no consensus regarding which of these is optimal. The purpose of this ongoing investigation is to compare outcomes associated with these different training approaches. Twenty-seven subjects with chronic motor-incomplete SCI have completed training and initial and final testing at the time of this preliminary report. Subjects were randomly assigned to 1 of 4 different BWS assisted-stepping groups, including: (1) treadmill training with manual assistance (TM), (2) treadmill training with stimulation (TS), (3) overground training with stimulation (OG), or (4) treadmill training with robotic assistance (LR). Prior to and following participation we assessed walking-related outcome measures including overground walking speed, training speed, step length, and step symmetry. Data pooled across all subject groups showed a significant effect of training on walking speed. While the differences between groups were not statistically significant, there was a trend toward greater improvement in the TS and OG groups. Post hoc subgroup analysis of outcomes from subjects with slower initial walking speed (< 0.1 m/s; n = 15) compared to those with faster initial walking speeds (> or = 0.1 m/s; n = 12) identified meaningful differences in outcomes with walking speed increasing by 85% in the slower group and by only 9% in the faster group. Step length of both stronger and weaker limb increased in all groups with the exception of those in the LR group. Step symmetry was increased in the TM and LR groups. These results represent preliminary findings of changes in walking-related function associated with different forms of BWS locomotor training for individuals with chronic, motor-incomplete SCI. Early data indicates that locomotor outcomes in these individuals appear to be comparable across training approaches. For the individuals in this study sample, those with the greatest deficits in walking function benefitted the most from locomotor training.

The Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI).

The development and testing of an observational gait assessment instrument, the Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI) is described. To assess validity and reliability, 22 subjects with incomplete spinal cord injury were scored by four raters. Raters scored each subject three times, once live (LS) and twice from videotaped records (VS1, VS2). A moderate-good negative correlation (r = -0.742 and -0.700, for VS1 and VS2, respectively) was found between the gait score and time required to walk a demarcated path. Inter-rater reliability was moderate-good for the live score and the videotaped records (ICC = 0.703, 0.800, and 0.840, respectively). Intra-rater reliability was good (ICC = 0.903, 0.960, 0.942, and 0.850 for Raters 1-4, respectively). To assess sensitivity, another group of 19 subjects with SCI were assessed prior to and following participation in an intensive walking program. A moderate correlation was found between change in gait score and change in lower extremity strength (Pearson r = 0.58). These results indicate that the SCI-FAI is a reliable, valid and sensitive measure of walking ability in individuals with spinal cord injury. In addition, the results suggest that gait analysis using this instrument is equally reliable whether the observation is performed live or from videotaped records.