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Fantozzi S, Borra D, Cortesi M, Ferrari A, Ciacci S, Chiari L, Baroncini I. Aquatic Therapy after Incomplete Spinal Cord Injury: Gait Initiation Analysis Using Inertial Sensors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811568. [PMID: 36141834 PMCID: PMC9517342 DOI: 10.3390/ijerph191811568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 05/16/2023]
Abstract
Populations with potential damage to somatosensory, vestibular, and visual systems or poor motor control are often studied during gait initiation. Aquatic activity has shown to benefit the functional capacity of incomplete spinal cord injury (iSCI) patients. The present study aimed to evaluate gait initiation in iSCI patients using an easy-to-use protocol employing four wearable inertial sensors. Temporal and acceleration-based anticipatory postural adjustment measures were computed and compared between dry-land and water immersion conditions in 10 iSCI patients. In the aquatic condition, an increased first step duration (median value of 1.44 s vs. 0.70 s in dry-land conditions) and decreased root mean squared accelerations for the upper trunk (0.39 m/s2 vs. 0.72 m/s2 in dry-land conditions) and lower trunk (0.41 m/s2 vs. 0.85 m/s2 in dry-land conditions) were found in the medio-lateral and antero-posterior direction, respectively. The estimation of these parameters, routinely during a therapy session, can provide important information regarding different control strategies adopted in different environments.
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Affiliation(s)
- Silvia Fantozzi
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
- Health Sciences and Technologies—Interdepartmental Centre for Industrial Research, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Davide Borra
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Matteo Cortesi
- Department for Life Quality Studies, University of Bologna, Via del Pilastro 8, 40126 Bologna, Italy
- Correspondence:
| | - Alberto Ferrari
- Health Sciences and Technologies—Interdepartmental Centre for Industrial Research, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Simone Ciacci
- Department Biomedical and Neuromotor Sciences, University of Bologna, Via del Pilastro 8, 40126 Bologna, Italy
| | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
- Health Sciences and Technologies—Interdepartmental Centre for Industrial Research, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - Ilaria Baroncini
- Montecatone Rehabilitation Institute S.p.A., Via Montecatone 37, 40026 Imola, Italy
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Casal MZ, Peyré-Tartaruga LA, Zanardi APJ, Ivaniski-Mello A, Alves LDL, Haas AN, Martinez FG. Postural Adjustments and Biomechanics During Gait Initiation and Obstacle Negotiation: A Comparison Between Akinetic-Rigid and Hyperkinetic Parkinson's Disease. Front Physiol 2021; 12:723628. [PMID: 34803726 PMCID: PMC8600270 DOI: 10.3389/fphys.2021.723628] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Individuals with Parkinson's disease (PD) exhibit different combinations of motor symptoms. The most frequent subtypes are akinetic-rigid (AK-R) and hyperkinetic (HYP). Motor symptoms, such as rigidity and bradykinesia, can directly affect postural adjustments and performance in daily tasks, like gait initiation and obstacles negotiation, increasing the risk of falls and functional dependence. Objective: To compare postural adjustments and biomechanical parameters during the gait initiation and obstacle negotiation of people with AK-R and HYP PD and correlate with functional mobility and risk of falls. Methods: Cross-sectional study. Thirty-three volunteers with PD were divided into two groups according to clinical motor manifestations: AK-R (n = 16) and HYP (n = 17). We assessed the anticipatory (APA), compensatory (CPA) postural adjustments analyzing kinematic, kinetic and, electromyographic parameters during the gait initiation and obstacle negotiation tests. We applied independent T-tests and Pearson correlation tests for comparisons and correlations, respectively (α = 0.05). Results: In the APA phase of the gait initiation test, compared to the functional HYP group, the AK-R group showed shorter time for single support (p = 0.01), longer time for double support (p = 0.01) accompanied by a smaller first step (size, p = 0.05; height, p = 0.04), and reduced muscle activation of obliquus internus (p = 0.02). Similarly, during the first step in the obstacle negotiation test, the AK-R group showed less step height (p = 0.01) and hip excursion (p = 0.02), accompanied by a reduced mediolateral displacement of the center of pressure (p = 0.02) during APA, and activation of the gluteus medius (p = 0.02) and the anterior tibialis (p = 0.04) during CPA in comparison with HYP group. Conclusion: The findings suggest that people with AK-R present impaired postural adjustments during gait initiation and obstacles negotiation compared to hyperkinetic PD. Based on defined motor symptoms, the proposition presented here revealed consistent postural adjustments during complex tasks and, therefore, may offer new insights onto PD motor evaluation and neurorehabilitation.
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Affiliation(s)
- Marcela Zimmermann Casal
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | | | | | - André Ivaniski-Mello
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Lucas de Liz Alves
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Aline Nogueira Haas
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Flávia Gomes Martinez
- Exercise Research Laboratory, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Marinho-Buzelli AR, Barela AMF, Craven BC, Masani K, Rouhani H, Popovic MR, Verrier MC. Effects of water immersion on gait initiation: part II of a case series after incomplete spinal cord injury. Spinal Cord Ser Cases 2019; 5:84. [PMID: 31700682 PMCID: PMC6821750 DOI: 10.1038/s41394-019-0231-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/24/2019] [Accepted: 09/28/2019] [Indexed: 11/09/2022] Open
Abstract
Study design Case series. Objectives This case series describes how the aquatic environment influences gait initiation in terms of the center of pressure (COP) excursion, impulses, trunk acceleration, and perceptions of participants with incomplete spinal cord injury (iSCI). Setting Tertiary Rehabilitation Hospital, Ontario, Canada. Methods Five individuals with iSCI (four cervical injuries/one thoracic injury, AIS D) participated in the study. Baseline clinical balance was evaluated by Berg Balance Scale and Mini-Balance Evaluation System Test. Participants initiated gait on a waterproof force plate and walked ~4 steps, in water and on land. COP trajectories during anticipatory and execution phases, impulses, and trunk acceleration parameters were investigated. Perceptions of walking in both environments were obtained using an interview. Results COP trajectory was prominently longer when individuals stepped forward. A decrease in velocity of COP was observed predominantly in the AP direction during stepping. Non-normalized vertical impulses decreased as the AP impulses increased, in water compared to land. Upper to lower trunk acceleration ratios showed how water resistance influenced the lower trunk acceleration. Most of participants reported that walking in water was challenging, but safer than on land. Conclusions Participants with higher balance function seemed to have more pronounced changes in anticipatory and execution phases' duration, length and velocity of COP. A faster anticipatory phase and a slower execution phase were observed in water than on land. Participants walked in water using a different trunk control strategy than on land and reported no fear of falling when walking in water versus land.
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Affiliation(s)
| | - Ana Maria Forti Barela
- Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - B. Catharine Craven
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Department of Medicine & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
| | - Kei Masani
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON Canada
| | - Hossein Rouhani
- Department of Mechanical Engineering, University of Alberta, Edmonton, AB Canada
| | - Milos R. Popovic
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON Canada
| | - Mary C. Verrier
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON Canada
- Department of Physical Therapy & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
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Enoki H, Tani T, Ishida K. Foot Tapping Test as Part of Routine Neurologic Examination in Degenerative Compression Myelopathies: A Significant Correlation between 10-sec Foot-tapping Speed and 30-m Walking Speed. Spine Surg Relat Res 2019; 3:207-213. [PMID: 31440678 PMCID: PMC6698509 DOI: 10.22603/ssrr.2018-0033] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/18/2018] [Indexed: 11/23/2022] Open
Abstract
Introduction Leg spasticity in degenerative compression myelopathy causes impairment of fast and rapid repetitive movements, which tends to appear despite the disproportionate paucity of clinical weakness. As clinically useful measures used to quantify the slowness of voluntary leg movements in this pathological condition, we compared the foot tapping test (FTT) with the simple walking test, which is now considered the gold standard in this field. Methods We compared the FTT with the simple walking test, the grip-and-release test, and the functional scales of Nurick and the Japanese Orthopedic Association (JOA) in 77 patients with cervical compression myelopathy and 56 age-matched healthy subjects. The FTT was conducted on both sides separately, and the subject, while being seated on a chair, moved his/her toes up and down repeatedly to tap the floor as fast and as vigorously as possible for 10 sec with his/her heels planted on the floor. Results The number of 10-sec foot tapping in the patient group significantly correlated with the Nurick grades (r = −0.566; P < 0.0001), the JOA scores (r = 0.520; P < 0.0001), and the grip-and-release rates (r = 0.609; P < 0.0001). It also significantly correlated with the 30-m walking time (r = −0.507; P < 0.0001) and the number of steps taken (r = −0.494; P < 0.0001). Assessments of wheelchair-dependent patients and side-to-side comparison, in which the simple walking test plays no role, revealed significantly fewer FTT taps in wheelchair-bound patients than in the ambulatory patients and a significant trend for cervical compression myelopathy to dominantly affect the upper and lower limbs on the same side. Conclusions This study contributes to the reassessment of the currently underutilized FTT as part of a routine neurologic examination of degenerative compression myelopathy.
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Affiliation(s)
- Hayato Enoki
- Department of Physical Therapy Faculty of Health and Welfare, Tokushima Bunri University, Tokushima, Japan
| | - Toshikazu Tani
- Department of Orthopaedic Surgery, Kubokawa Hospital, Kochi, Japan.,Department of Rehabilitation Center, Kochi Medical School Hospital, Kochi, Japan
| | - Kenji Ishida
- Department of Rehabilitation Center, Kochi Medical School Hospital, Kochi, Japan
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Stansfield B, Hawkins K, Adams S, Church D. Spatiotemporal and kinematic characteristics of gait initiation across a wide speed range. Gait Posture 2018; 61:331-338. [PMID: 29427858 DOI: 10.1016/j.gaitpost.2018.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 01/04/2018] [Accepted: 02/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Gait initiation can be performed at a range of speeds. Those with disability tend to use a slower speed compared to those without disability. In assessing the spatiotemporal and kinematic characteristics of gait initiation it is therefore important to consider the effects of speed on outcomes. RESEARCH QUESTION What is the effect of speed of performance on spatiotemporal and kinematic characteristics of gait initiation? METHODS Spatiotemporal and kinematic characteristics were measured across a wide range of speeds from very slow to very fast (normalised initiating leg (swing or SW limb) step speed 0.1-0.5) for 20 health adults (10 men/10 women, 22-44 years) using three-dimensional motion analysis of the first two steps of gait. RESULTS Mixed linear modelling of 295 walking trials indicated differences between individuals, sexes and strong non-linear relationships between normalised initiating leg step speed and cadence and step lengths (R2 > 0.5). Particular characteristics of joint kinematics (maxima and minima for both initiating (SW) and contralateral limb (stance or ST limb)) demonstrated significant non-linear (squared, cubic and power law) changes with speed. Moderate to strong relationships were identified for sagittal plane pelvis, hip and knee kinematics as well as hip adduction (0.3 < R2 < 0.7). SIGNIFICANCE Gait initiation spatiotemporal and kinematic characteristics were quantified across the maximum range of speeds achievable, providing comprehensive characterisation of changes with speed. Significant, non-linear changes with speed were identified, suggesting different strategies are employed to modify speed at low and high speeds. The highlighted changes with speed illustrate the importance of taking speed into account when comparing outcomes between healthy adults and those with pathology.
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Affiliation(s)
- Ben Stansfield
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK.
| | - Katrina Hawkins
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Sarah Adams
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
| | - Doireann Church
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, UK
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Pérez-Nombela S, Barroso F, Torricelli D, de Los Reyes-Guzmán A, Del-Ama AJ, Gómez-Soriano J, Pons JL, Gil-Agudo Á. Modular control of gait after incomplete spinal cord injury: differences between sides. Spinal Cord 2016; 55:79-86. [PMID: 27349606 DOI: 10.1038/sc.2016.99] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 03/21/2016] [Accepted: 05/24/2016] [Indexed: 01/11/2023]
Abstract
STUDY DESIGN This is an analytical descriptive study. OBJECTIVES The main goal of this study was to compare the modular organization of bilateral lower limb control in incomplete spinal cord injury (iSCI) patients during overground walking, using muscle synergies analysis. The secondary goal was to determine whether the similarity between the patients and control group correlate with clinical indicators of walking performance. SETTING This study was conducted in National Hospital for Spinal Cord Injury (Toledo, Spain). METHODS Eight iSCI patients and eight healthy subjects completed 10 walking trials at matched speed. For each trial, three-dimensional motion analysis and surface electromyography (sEMG) analysis of seven leg muscles from both limbs were performed. Muscle synergies were extracted from sEMG signals using a non-negative matrix factorization algorithm. The optimal number of synergies has been defined as the minimum number needed to obtain variability accounted for (VAF) ⩾90%. RESULTS When compared with healthy references, iSCI patients showed fewer muscle synergies in the most affected side and, in both sides, significant differences in the composition of synergy 2. The degree of similarity of these variables with the healthy reference, together with the composition of synergy 3 of the most affected side, presented significant correlations (P<0.05) with walking performance. CONCLUSION The analysis of muscle synergies shows potential to detect differences between the two sides in patients with iSCI. Specifically, the VAF may constitute a new neurophysiological metric to assess and monitor patients' condition throughout the gait recovery process.
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Affiliation(s)
- S Pérez-Nombela
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
| | - F Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain.,Centre ALGORITMI, University of Minho, Azurém, Guimarães, Portugal
| | - D Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - A de Los Reyes-Guzmán
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
| | - A J Del-Ama
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
| | - J Gómez-Soriano
- Sensoriomotor Function Group, National Hospital for Spinal Cord Injury, Toledo, Spain.,Toledo Physiotherapy Research Group (GIFTO). Nursing and Physical Therapy School, Castilla-La Mancha, Toledo, Spain
| | - J L Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Á Gil-Agudo
- Biomechanical and Technical Aids Department, National Hospital for Spinal Cord Injury, Toledo, Spain
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Quantitative measurement of Parkinsonian gait from walking in monocular image sequences using a centroid tracking algorithm. Med Biol Eng Comput 2015; 54:485-96. [PMID: 26109520 DOI: 10.1007/s11517-015-1335-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease of the central nervous system that results from the degeneration of dopaminergic neurons in the substantia nigra. Abnormal gait begins in the early stage and becomes severe as the disease progresses; therefore, the assessment of gait becomes an important issue in evaluating the progression of PD and the effectiveness of treatment. To provide a clinically useful gait assessment in environments with budget and space limitations, such as a small clinic or home, we propose and develop a portable method utilizing the monocular image sequences of walking to track and analyze a Parkinsonian gait pattern. In addition, a centroid tracking algorithm is developed and used here to enhance the method of quantifying kinematic gait parameters of PD in different states. Twelve healthy subjects and twelve mild patients with PD participate in this study. This method requires one digital video camera and subjects with two joint markers attached on the fibula head and the lateral malleolus of the leg. All subjects walk with a natural pace in front of a video camera during the trials. Results of our study demonstrate the stride length and walking velocity significantly decrease in PD without drug compared to PD with drug in both proposed method and simultaneous gait assessment performed by GAITRite(®) system. In gait initiation, step length and swing velocity also decrease in PD without drug compared to both PD with drug and controls. Our results showed high correlation in gait parameters between the two methods and prove the reliability of the proposed method. With the proposed method, quantitative measurement and analysis of Parkinsonian gait could be inexpensive to implement, portable within a small clinic or home, easy to administer, and simple to interpret. Although this study is assessed Parkinsonian gait, the proposed method has the potential to help clinicians and researchers assess the gait of patients with other neuromuscular diseases, such as traumatic brain injury and stroke patients.
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Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: a randomized clinical trial. Phys Ther 2011; 91:48-60. [PMID: 21051593 PMCID: PMC3017322 DOI: 10.2522/ptj.20090359] [Citation(s) in RCA: 201] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Impaired walking limits function after spinal cord injury (SCI), but training-related improvements are possible even in people with chronic motor incomplete SCI. OBJECTIVE The objective of this study was to compare changes in walking speed and distance associated with 4 locomotor training approaches. DESIGN This study was a single-blind, randomized clinical trial. SETTING This study was conducted in a rehabilitation research laboratory. PARTICIPANTS Participants were people with minimal walking function due to chronic SCI. INTERVENTION Participants (n=74) trained 5 days per week for 12 weeks with the following approaches: treadmill-based training with manual assistance (TM), treadmill-based training with stimulation (TS), overground training with stimulation (OG), and treadmill-based training with robotic assistance (LR). MEASUREMENTS Overground walking speed and distance were the primary outcome measures. RESULTS In participants who completed the training (n=64), there were overall effects for speed (effect size index [d]=0.33) and distance (d=0.35). For speed, there were no significant between-group differences; however, distance gains were greatest with OG. Effect sizes for speed and distance were largest with OG (d=0.43 and d=0.40, respectively). Effect sizes for speed were the same for TM and TS (d=0.28); there was no effect for LR. The effect size for distance was greater with TS (d=0.16) than with TM or LR, for which there was no effect. Ten participants who improved with training were retested at least 6 months after training; walking speed at this time was slower than that at the conclusion of training but remained faster than before training. LIMITATIONS It is unknown whether the training dosage and the emphasis on training speed were optimal. Robotic training that requires active participation would likely yield different results. CONCLUSIONS In people with chronic motor incomplete SCI, walking speed improved with both overground training and treadmill-based training; however, walking distance improved to a greater extent with overground training.
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Influence of a locomotor training approach on walking speed and distance in people with chronic spinal cord injury: a randomized clinical trial. PHYSICAL THERAPY 2010. [PMID: 21051593 DOI: 10.2522/ptj.20090359; 10.2522/ptj.20090359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Impaired walking limits function after spinal cord injury (SCI), but training-related improvements are possible even in people with chronic motor incomplete SCI. OBJECTIVE The objective of this study was to compare changes in walking speed and distance associated with 4 locomotor training approaches. DESIGN This study was a single-blind, randomized clinical trial. SETTING This study was conducted in a rehabilitation research laboratory. PARTICIPANTS Participants were people with minimal walking function due to chronic SCI. INTERVENTION Participants (n=74) trained 5 days per week for 12 weeks with the following approaches: treadmill-based training with manual assistance (TM), treadmill-based training with stimulation (TS), overground training with stimulation (OG), and treadmill-based training with robotic assistance (LR). MEASUREMENTS Overground walking speed and distance were the primary outcome measures. RESULTS In participants who completed the training (n=64), there were overall effects for speed (effect size index [d]=0.33) and distance (d=0.35). For speed, there were no significant between-group differences; however, distance gains were greatest with OG. Effect sizes for speed and distance were largest with OG (d=0.43 and d=0.40, respectively). Effect sizes for speed were the same for TM and TS (d=0.28); there was no effect for LR. The effect size for distance was greater with TS (d=0.16) than with TM or LR, for which there was no effect. Ten participants who improved with training were retested at least 6 months after training; walking speed at this time was slower than that at the conclusion of training but remained faster than before training. LIMITATIONS It is unknown whether the training dosage and the emphasis on training speed were optimal. Robotic training that requires active participation would likely yield different results. CONCLUSIONS In people with chronic motor incomplete SCI, walking speed improved with both overground training and treadmill-based training; however, walking distance improved to a greater extent with overground training.
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van Keeken HG, Vrieling AH, Hof AL, Halbertsma JPK, Schoppen T, Postema K, Otten B. Controlling Propulsive Forces in Gait Initiation in Transfemoral Amputees. J Biomech Eng 2008; 130:011002. [DOI: 10.1115/1.2838028] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
During prosthetic gait initiation, transfemoral (TF) amputees control the spatial and temporal parameters that modulate the propulsive forces, the positions of the center of pressure (CoP), and the center of mass (CoM). Whether their sound leg or the prosthetic leg is leading, the TF amputees reach the same end velocity. We wondered how the CoM velocity build up is influenced by the differences in propulsive components in the legs and how the trajectory of the CoP differs from the CoP trajectory in able bodied (AB) subjects. Seven TF subjects and eight AB subjects were tested on a force plate and on an 8m long walkway. On the force plate, they initiated gait two times with their sound leg and two times with their prosthetic leg. Force measurement data were used to calculate the CoM velocity curves in horizontal and vertical directions. Gait initiated on the walkway was used to determine the leg preference. We hypothesized that because of the differences in propulsive components, the motions of the CoP and the CoM have to be different, as ankle muscles are used to help generate horizontal ground reaction force components. Also, due to the absence of an active ankle function in the prosthetic leg, the vertical CoM velocity during gait initiation may be different when leading with the prosthetic leg compared to when leading with the sound leg. The data showed that whether the TF subjects initiated a gait with their prosthetic leg or with their sound leg, their horizontal end velocity was equal. The subjects compensated the loss of propulsive force under the prosthesis with the sound leg, both when the prosthetic leg was leading and when the sound leg was leading. In the vertical CoM velocity, a tendency for differences between the two conditions was found. When initiating gait with the sound leg, the downward vertical CoM velocity at the end of the gait initiation was higher compared to when leading with the prosthetic leg. Our subjects used a gait initiation strategy that depended mainly on the active ankle function of the sound leg; therefore, they changed the relative durations of the gait initiation anticipatory postural adjustment phase and the step execution phase. Both legs were controlled in one single system of gait propulsion. The shape of the CoP trajectories, the applied forces, and the CoM velocity curves are described in this paper.
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Affiliation(s)
- Helco G. van Keeken
- Center for Human Movement Sciences, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Aline H. Vrieling
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - At L. Hof
- Center for Human Movement Sciences, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands; Center for Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Jan P. K. Halbertsma
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Tanneke Schoppen
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Klaas Postema
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, P.O. Box 30001, 9700 RB Groningen, The Netherlands
| | - Bert Otten
- Center for Human Movement Sciences, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Hass CJ, Waddell DE, Fleming RP, Juncos JL, Gregor RJ. Gait Initiation and Dynamic Balance Control in Parkinson’s Disease. Arch Phys Med Rehabil 2005; 86:2172-6. [PMID: 16271566 DOI: 10.1016/j.apmr.2005.05.013] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Revised: 05/23/2005] [Accepted: 05/23/2005] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether the magnitude of the separation between the center of pressure (COP) and the whole-body center of mass (COM) during gait initiation can differentiate patients with varying severity of Parkinson's disease (PD) disability. DESIGN Cross-sectional, intact groups research design. SETTING Biomechanics research laboratory. PARTICIPANTS Forty-three patients were stratified into 2 groups based on the Hoehn and Yahr (H&Y) disability score, which heavily favors balance in determining disability. The 2 groups were: H&Y score of 2.0 or less (n=23; age, 61+/-10y) or H&Y score of 2.5 or higher (n=20; age, 70+/-9y). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The peak COP-COM distance represents the maximum separation between the location of the whole-body COM and the ground reaction force's COP, and thus is an indicator of dynamic balance control. The peak COP-COM was evaluated during 3 phases of the COP trajectory during a gait initiation task. RESULTS The peak magnitude of the COP-COM distance was significantly greater during the end of the single-support phase in the less disabled patients (H&Y score <or=2.0) than in more balance disabled patients (H&Y score >or=2.5) (P=.004). CONCLUSIONS The differences in COP-COM distances between these H&Y groups suggest that patients with PD who have impaired postural control produce shorter COM-COP distances than do persons without clinically detectable balance impairment. This method of evaluation could prove a useful quantitative index to examine the impact of interventions designed to improve ambulation and balance in PD.
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Affiliation(s)
- Chris J Hass
- Department of Biobehavioral Sciences, Teachers College Columbia University, New York, NY 10027, USA.
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