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Speight S, Reel S, Stephenson J. Can the F-Scan in-shoe pressure system be combined with the GAITRite® temporal and spatial parameter-recording walkway as a cost-effective alternative in clinical gait analysis? A validation study. J Foot Ankle Res 2023; 16:30. [PMID: 37194058 DOI: 10.1186/s13047-023-00627-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/02/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Clinical gait analysis is widely used to aid the assessment and diagnosis of symptomatic pathologies. Foot function pressure systems such as F-scan and analysis of the spatial-temporal parameters of gait using GAITRite® can provide clinicians with a more comprehensive assessment. There are systems however, such as Strideway™ that can measure these parameters simultaneously but can be expensive. F-Scan in-shoe pressure data is normally collected whilst the person is walking on a hard floor surface. The effects of the softer Gaitrite® mat upon the F-Scan in-shoe sensor pressure data is unknown. This study therefore aimed to assess the agreement between F-Scan pressure measurements taken from a standard walkway (normal hard floor), and those from a GAITRite® walkway to establish whether these two pieces of equipment (in-shoe F-Scan and GAITRite®) can be used simultaneously, as a cost-effective alternative. METHOD Twenty-three participants first walked on a standard floor and then on a GAITRite® walkway wearing F-Scan pressure sensor insoles with same footwear. They repeated these walks three times on each surface. Mid gait protocols were utilised by analysing the contact pressure of the first and second metatarsophalangeal joint of the third, fifth and seventh step from each walk. For both joints, 95% Bland-Altman Limits of Agreement was used to determine a level of agreement between the two surfaces, using mean values from pressure data collected from participants who successfully completed all required walks. The intraclass correlation coefficient (ICC) and Lin's concordance correlation coefficient were calculated as indices of reliability. FINDINGS ICC results for the hard surface and the GAITRrite® walkway at the first and second metatarsophalangeal joints were 0.806 and 0.991 respectively. Lin's concordance correlation coefficient for the first and second metatarsophalangeal joints were calculated to be 0.899 and 0.956 respectively. Both sets of statistics indicate very good reproducibility. Bland-Altman plots revealed good repeatability of data at both joints. CONCLUSION The level of agreement in F-Scan plantar pressures observed between walking on a normal hard floor and on a GAITRite® walkway was very high, suggesting that it is feasible to use F-Scan with GAITRite® together in a clinical setting, as an alternative to other less cost-effective standalone systems. Although it is assumed combining F-Scan with GAITRite® does not affect spatiotemporal analysis, this was not validated in this study.
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Affiliation(s)
- Stephanie Speight
- Sheffield Teaching Hospitals NHS FT, Woodhouse Clinic, 3 Skelton Lane, Sheffield, England, S13 7LY
| | - Sarah Reel
- University of Huddersfield, Queensgate, Huddersfield, England, HD1 3DH.
| | - John Stephenson
- University of Huddersfield, Queensgate, Huddersfield, England, HD1 3DH
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Sacco G, Ben-Sadoun G, Gautier J, Simon R, Goupil M, Laureau P, Terrien J, Annweiler C. Comparison of spatio-temporal gait parameters between the GAITRite® platinum plus classic and the GAITRite® CIRFACE among older adults: a retrospective observational study. BMC Geriatr 2023; 23:132. [PMID: 36882705 PMCID: PMC9993600 DOI: 10.1186/s12877-023-03811-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 02/08/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The GAITRite® system is one of the gold standards for gait electronic analysis, especially for older adults. Previous GAITRite® systems were composed of an electronic roll-up walkway. Recently, a new GAITRite® electronic walkway, named CIRFACE, was commercialized. It is composed of a changeable association of stiff plates, unlike previous models. Are the gait parameters measured similar between these two walkways among older adults and according to the cognitive status, the history of falls, and the use of walking aids? METHODS In this retrospective observational study, 95 older ambulatory participants (mean, 82.6 ± 5.8 years) were included. Ten spatio-temporal gait parameters were measured simultaneously with the two GAITRite® systems in older adults while walking at comfortable self-selected pace. The GAITRite® Platinum Plus Classic (26') was superimposed on the GAITRite® CIRFACE (VI). Comparisons between the parameters of the two walkways were performed using Bravais-Pearson correlation, between-method differences (corresponding to bias), percentage errors and Intraclass Correlation Coefficients (ICC2,1). Subgroup analyses were performed according to the cognitive status, the history of falls in the last 12 months and the use of walking aids. RESULTS The whole walk parameters recorded by the two walkways were extremely correlated with a Bravais-Pearson correlation coefficient ranging from 0.968 to 0.999, P < .001, indicating a very high correlation. According to the ICC2,1 calculated for absolute agreement, all gait parameters had excellent reliability (ranging from 0.938 to 0.999). Mean bias for 9 parameters out of 10 were ranged from - 0.27 to 0.54, with clinically acceptable percentage errors (1.2-10.1%). Step length showed a substantially higher bias (1.4 ± 1.2 cm), nevertheless the percentage errors remained clinically acceptable (5%). CONCLUSION When walking at comfortable self-selected pace, the standard spatio-temporal walk parameters provided by both the GAITRite® PPC and the GAITRite® CIRFACE seem similar and very highly correlated in older adults with various cognitive or motor status. The data of studies using these systems can be compared and mixed with a very low risk of bias in a meta-analytic process. Also, the geriatric care units can choose the most ergonomic system according to their infrastructure without affecting their gait data. TRIAL REGISTRATION NCT04557592 (21/09/2020).
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Affiliation(s)
- Guillaume Sacco
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Clinique Gériatrique de soins ambulatoires, Nice, France.,Université Côte d'Azur, CoBTek, Nice, France.,LPPL, Laboratoire de Psychologie des Pays de la Loire, Univ Angers, Université de Nantes, EA 4638 LPPL, SFR CONFLUENCES, Angers, F-49000, France
| | - Grégory Ben-Sadoun
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France. .,Normandie Université, UNICAEN, INSERM, COMETE, CYCERON, CHU Caen, 14000, Caen, France. .,Centre de Recherche sur l'Autonomie et la Longévité (CeRAL), Service de Gériatrie, CHU d'Angers, 4, rue Larrey, 49933, Angers Cedex 9, France.
| | - Jennifer Gautier
- LPPL, Laboratoire de Psychologie des Pays de la Loire, Univ Angers, Université de Nantes, EA 4638 LPPL, SFR CONFLUENCES, Angers, F-49000, France.,Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Romain Simon
- LPPL, Laboratoire de Psychologie des Pays de la Loire, Univ Angers, Université de Nantes, EA 4638 LPPL, SFR CONFLUENCES, Angers, F-49000, France.,Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France
| | - Maude Goupil
- School of Medicine, Health Faculty, University of Angers, Angers, France
| | - Pauline Laureau
- School of Medicine, Health Faculty, University of Angers, Angers, France
| | - Jade Terrien
- School of Medicine, Health Faculty, University of Angers, Angers, France
| | - Cédric Annweiler
- LPPL, Laboratoire de Psychologie des Pays de la Loire, Univ Angers, Université de Nantes, EA 4638 LPPL, SFR CONFLUENCES, Angers, F-49000, France. .,Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, Angers, France. .,School of Medicine, Health Faculty, University of Angers, Angers, France. .,Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada. .,UMR-S 1075 Inserm, COMETE, Pôle des Formations et de Recherche en Santé, 2 Rue des Rochambelles, CS 14032, 14 032, CAEN Cedex, France.
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Ganapathy VS, James TT, Philip M, Kamble N, Bhattacharya A, Dhargave P, Pal PK. Anteroposterior Stability: A Determinant of Gait Dysfunction and Falls in Spinocerebellar Ataxia. Ann Indian Acad Neurol 2021; 24:518-523. [PMID: 34728944 PMCID: PMC8513964 DOI: 10.4103/aian.aian_1090_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Establishing an association between gait variability and direction specific balance indices may help in identifying the risk of falls in patients with spinocerebellar ataxia (SCA) which may help in developing an appropriate intervention. This study is intended to identify the association between balance and gait parameters especially gait variability in these patients. Methods: Patients with genetically confirmed SCA (n = 24) as well as controls (n = 24) who met the study criteria were recruited. Gait was assessed using the GAITRite system and balance was assessed using dynamic posturography (Biodex) to record direction-specific dynamic balance indices. Disease severity was assessed using international cooperative ataxia rating scale (ICARS). Results: The mean age of the SCA group (38.83 ± 13.03 years) and the control group (36.38 ± 9.09 years) were comparable. The age of onset of illness was 32 ± 10.62 years and duration of 5.67 ± 3.62 years. The mean ICARS was 45.10 ± 16.75. There was a significant difference in the overall balance index (OBI), anterior–posterior index (API), medial/lateral index (MLI) between SCA patients (4.56 ± 2.09, 3.49 ± 1.88, 2.94 ± 1.32) and the controls (2.72 ± 1.25, 2.08 ± 0.85, 1.85 ± 0.97). However, correlation was observed only between gait stability and balance parameters in API direction. Conclusions: There was an increased anteroposterior oriented balance deficit in patients with SCA, which was significantly correlating with the gait parameters. The balance training intervention may focus on improving anteroposterior direction to prevent falls and improving walking efficiency.
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Affiliation(s)
- V S Ganapathy
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Tittu T James
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Mariamma Philip
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nitish Kamble
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Amitabh Bhattacharya
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pradnya Dhargave
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Kegelmeyer DA, Kostyk SK, Fritz NE, Scharre DW, Young GS, Tan Y, Schubert R, Reilmann R, Kloos AD. Immediate effects of treadmill walking in individuals with Lewy body dementia and Huntington's disease. Gait Posture 2021; 86:186-191. [PMID: 33756407 DOI: 10.1016/j.gaitpost.2021.03.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/11/2021] [Accepted: 03/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Treadmill training may improve gait disorders associated with neurodegenerative diseases. In Parkinson's disease (PD), treadmill training alters gait patterns after one session, and long-term training improves gait parameters, fall risk, and quality of life. RESEARCH QUESTION What is the feasibility and safety of using this intervention for people with Lewy body dementia (LBD) or Huntington's disease (HD)? METHODS In this observational study, 10 individuals with HD, 8 individuals with LBD, and 10 control individuals walked for 20 min on a treadmill using a speed dependent protocol starting at a slow comfortable speed and increasing incrementally toward their normal overground speed. Feasibility was determined by compliance to protocol and safety by no incidents of abnormal vital signs or expressions of distress. Changes in gait measures, Timed Up and Go (TUG) scores and quantitative motor function measures (Q-Motor; precision grasp force variability, finger and foot tapping frequency) before and after treadmill walking were analyzed using linear models. RESULTS Treadmill training is feasible and safe in LBD and HD; although, participants could not initiate treadmill walking at their comfortable overground speeds, and only 3 participants with HD were able to achieve their overground walking speed within the 20-minute session. No changes in gait measures, TUG times, and Q-Motor measures were found among LBD and HD participants after treadmill walking, although control participants demonstrated significant increases in several gait measures, and foot tap frequency (estimated difference = 0.290; p = 0.026). SIGNIFICANCE Longer and more frequent treadmill sessions may be needed to see gait and motor function effects in LBD and HD. Motor and cognitive impairments associated with these diseases may make them less amenable to the effects of treadmill training.
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Affiliation(s)
- Deb A Kegelmeyer
- The Ohio State University, College of Medicine, Division of Physical Therapy, Columbus, OH, United States.
| | - Sandra K Kostyk
- The Ohio State University, College of Medicine, Department of Neurology, Columbus, OH, United States; The Ohio State University, College of Medicine, Department of Neuroscience, Columbus, OH, United States.
| | - Nora E Fritz
- The Ohio State University, College of Medicine, Division of Physical Therapy, Columbus, OH, United States.
| | - Douglas W Scharre
- The Ohio State University, College of Medicine, Department of Neurology, Columbus, OH, United States.
| | - Gregory S Young
- The Ohio State University, Center for Biostatistics, Columbus, OH, United States.
| | - Yubo Tan
- The Ohio State University, Center for Biostatistics, Columbus, OH, United States.
| | | | - Ralf Reilmann
- George Huntington Institute, Technology Park, Germany; Dept. of Radiology, University of Muenster, Muenster, Germany; Department of Neurodegenerative Diseases and Hertie-Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany.
| | - Anne D Kloos
- The Ohio State University, College of Medicine, Division of Physical Therapy, Columbus, OH, United States.
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Messerschmidt EL, Hall EE, Ketcham CJ, Patel K, Vallabhajosula S. Gait Assessment in College Athletes: Do Concussion History, Symptoms, Gender, and Type of Sport Matter? J Sport Rehabil 2021;:1-12. [PMID: 33418540 DOI: 10.1123/jsr.2019-0331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 09/20/2020] [Accepted: 10/17/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Though previous research has focused on examining the effects of concussion history using a dual-task paradigm, the influence of factors like symptoms (unrelated to concussion), gender, and type of sport on gait in college athletes is unknown. OBJECTIVE To examine the effect of concussion history, symptoms, gender, and type of sport (noncontact/limited contact/contact) individually on gait among college athletes. DESIGN Exploratory cross-sectional study. SETTING Laboratory. PARTICIPANTS In total, 98 varsity athletes (age, 18.3 [1.0] y; height, 1.79 [0.11] m; mass, 77.5 [19.2] kg; 27 with concussion history, 58 reported at least one symptom, 44 females; 8 played noncontact sports and 71 played contact sports) walked under single- and dual-task (walking while counting backward by 7) conditions. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Dual-task cost (DTC; % difference between single task and dual task) of gait speed, cadence, step length and width, percentage of swing and double-support phases, symptom score, and total symptom severity score. Independent samples t tests and 1-way analysis of variance were conducted (α value = .05). RESULTS Self-reported concussion history resulted in no significant differences (P > .05). Those who reported symptoms at testing time showed significantly greater DTC of step length (mean difference [MD], 2.7%; 95% confidence interval [CI], 0.3% to 5.1%; P = .012), % of swing phase (MD, 1.0%; 95% CI, -0.2 to 2.1%; P = .042), and % of double-support phase (MD, 3.9%; 95% CI, 0.2% to 7.8%; P = .019). Females demonstrated significantly higher DTC of gait speed (MD, 5.3%; 95% CI, 1.3% to 9.3%; P = .005), cadence (MD, 4.0%; 95% CI, 1.4% to 6.5%; P = .002), % of swing phase (MD, 1.2%; 95% CI, 0.1% to 2.3%; P = .019), and % of double-support phase (MD, 4.1%; 95% CI, 0.4% to 7.9%; P = .018). Noncontact sports athletes had significantly greater step width DTC than contact sports athletes (MD, 14.2%; 95% CI, 0.9% to 27.6%; P = .032). CONCLUSIONS Reporting symptoms at testing time may influence gait under dual-task conditions. Additionally, female athletes showed more gait changes during a dual task. Sports medicine professionals should be aware that these variables, while unrelated to injury, may affect an athlete's gait upon analysis.
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Riis J, Byrgesen SM, Kragholm KH, Mørch MM, Melgaard D. Validity of the GAITRite Walkway Compared to Functional Balance Tests for Fall Risk Assessment in Geriatric Outpatients. Geriatrics (Basel) 2020; 5:geriatrics5040077. [PMID: 33080775 PMCID: PMC7720110 DOI: 10.3390/geriatrics5040077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/02/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
This study examined the concurrent validity between gait parameters from the GAITRite walkway and functional balance test commonly used in fall risk assessment. Patients were sampled from one geriatric outpatient clinic. One physiotherapist evaluated the patients on the GAITRite walkway with three repetitions in both single- and dual-task conditions. Patients were further evaluated with Bergs Balance scale (BBS), Dynamic Gait index (DGI), Timed Up and Go (TUG), and Sit To Stand test (STS). Correlations between quantitative gait parameters and functional balance test were analyzed with Spearman’s rank correlations. Correlations strength was considered as follows: negligible <0.1, weak 0.10–0.39, moderate 0.40–0.69, and strong ≥0.70. We included 24 geriatric outpatients in the study with a mean age of 80.6 years (SD: 5.9). Patients received eight (SD: 4.5) different medications on average, and seven (29.2%) patients used walkers during ambulation. Correlations between quantitative gait parameters and functional balance test ranged from weak to moderate in both single- and dual-task conditions. Moderate correlations were observed for DGI, TUG, and BBS, while STS showed weak correlations with all GAITRite parameters. For outpatients analyzed on the GAITRite while using walkers, correlations showed no clear pattern across parameters with large variation within balance tests.
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Affiliation(s)
- Johannes Riis
- Center for Clinical Research, North Denmark Regional Hospital, 9800 Hjørring, Denmark; (S.M.B.); (K.H.K.); (D.M.)
- Correspondence: ; Tel.: +45-22-17-46-64
| | - Stephanie M. Byrgesen
- Center for Clinical Research, North Denmark Regional Hospital, 9800 Hjørring, Denmark; (S.M.B.); (K.H.K.); (D.M.)
| | - Kristian H. Kragholm
- Center for Clinical Research, North Denmark Regional Hospital, 9800 Hjørring, Denmark; (S.M.B.); (K.H.K.); (D.M.)
| | - Marianne M. Mørch
- Department of Geriatric Medicine, North Denmark Regional Hospital, 9800 Hjørring, Denmark;
| | - Dorte Melgaard
- Center for Clinical Research, North Denmark Regional Hospital, 9800 Hjørring, Denmark; (S.M.B.); (K.H.K.); (D.M.)
- Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark
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Rehman RZU, Del Din S, Shi JQ, Galna B, Lord S, Yarnall AJ, Guan Y, Rochester L. Comparison of Walking Protocols and Gait Assessment Systems for Machine Learning-Based Classification of Parkinson's Disease. Sensors (Basel) 2019; 19:E5363. [PMID: 31817393 PMCID: PMC6960714 DOI: 10.3390/s19245363] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/26/2019] [Accepted: 12/02/2019] [Indexed: 01/05/2023]
Abstract
Early diagnosis of Parkinson's diseases (PD) is challenging; applying machine learning (ML) models to gait characteristics may support the classification process. Comparing performance of ML models used in various studies can be problematic due to different walking protocols and gait assessment systems. The objective of this study was to compare the impact of walking protocols and gait assessment systems on the performance of a support vector machine (SVM) and random forest (RF) for classification of PD. 93 PD and 103 controls performed two walking protocols at their normal pace: (i) four times along a 10 m walkway (intermittent walk-IW), (ii) walking for 2 minutes on a 25 m oval circuit (continuous walk-CW). 14 gait characteristics were extracted from two different systems (an instrumented walkway-GAITRite; and an accelerometer attached at the lower back-Axivity). SVM and RF were trained on normalized data (accounting for step velocity, gender, age and BMI) and evaluated using 10-fold cross validation with area under the curve (AUC). Overall performance was higher for both systems during CW compared to IW. SVM performed better than RF. With SVM, during CW Axivity significantly outperformed GAITRite (AUC: 87.83 ± 7.81% vs. 80.49 ± 9.85%); during IW systems performed similarly. These findings suggest that choice of testing protocol and sensing system may have a direct impact on ML PD classification results and highlight the need for standardization for wide scale implementation.
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Affiliation(s)
- Rana Zia Ur Rehman
- Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (R.Z.U.R.); (S.D.D.); (B.G.); (S.L.); (A.J.Y.)
| | - Silvia Del Din
- Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (R.Z.U.R.); (S.D.D.); (B.G.); (S.L.); (A.J.Y.)
| | - Jian Qing Shi
- School of Mathematics, Statistics, and Physics, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK;
| | - Brook Galna
- Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (R.Z.U.R.); (S.D.D.); (B.G.); (S.L.); (A.J.Y.)
- School of Biomedical, Nutritional and Sport Sciences, Newcastle University, Newcastle Upon Tyne NE1 7RU, UK
| | - Sue Lord
- Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (R.Z.U.R.); (S.D.D.); (B.G.); (S.L.); (A.J.Y.)
- Department of Physiotherapy, Auckland University of Technology, Auckland 92006, New Zealand
| | - Alison J. Yarnall
- Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (R.Z.U.R.); (S.D.D.); (B.G.); (S.L.); (A.J.Y.)
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK
| | - Yu Guan
- School of Computing, Newcastle University, Newcastle Upon Tyne NE4 5TG, UK;
| | - Lynn Rochester
- Institute of Neuroscience/Institute for Ageing, Newcastle University, Newcastle Upon Tyne NE4 5PL, UK; (R.Z.U.R.); (S.D.D.); (B.G.); (S.L.); (A.J.Y.)
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne NE7 7DN, UK
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Gomez G, Khanna M, Gupta A, Nalini A, Thennarasu K, Nashi S, Polavarapu K, Vengalil S. GNE myopathy - A cross-sectional study on spatio-temporal gait characteristics. Neuromuscul Disord 2019; 29:961-7. [PMID: 31787465 DOI: 10.1016/j.nmd.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 12/14/2022]
Abstract
GNE myopathy is a rare, predominantly distal myopathy, involving mainly the lower limbs and presenting with gait disturbances. In this cross-sectional study gait evaluation of 23 (14 men) genetically confirmed GNE myopathy patients was done using Instrumented walkway analysis (GAITRite®) along with video gait capture. We recorded the topographical pattern of muscles involvement in lower limbs and correlated Functional Ambulation Profile-FAP and Medical Research council-MRC grading of lower limb scores with duration of illness. Early foot flat, foot drop gait with wider out-toed stance and higher perturbations with increased pressure at heel and decreased arm swing were noted. Muscle topography showed predominant weakness in ankle dorsi-flexors, flexor hallucis longus, extensor hallucis longus, hip adductors and knee flexors with stark sparing of quadriceps and relative sparing of hip- abductors, extensors, flexors and ankle plantar-flexors. Gait parameters in women were significantly more affected than men (p < 0.05) for the same duration of illness. FAP score and MRC grading of lower limb scores correlated significantly with duration of illness (p < 0.05). We observed that ankle dorsiflexors were affected earliest with sparing of quadriceps muscles in these patients.
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Roche B, Simon AL, Guilmin-Crépon S, Boizeau P, Andriss B, Alberti C, Presedo A, Ilharreborde B, Husson I. Test-retest reliability of an instrumented electronic walkway system ( GAITRite) for the measurement of spatio-temporal gait parameters in young patients with Friedreich's ataxia. Gait Posture 2018; 66:45-50. [PMID: 30145474 DOI: 10.1016/j.gaitpost.2018.08.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/13/2018] [Accepted: 08/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Friedreich ataxia (FRDA) affects the spatio-temporal parameters (STP) of gait. To our knowledge, proper tools to measure the variability of ataxic gait have not been validated yet. The aims of the present study were: (1) to measure the reproducibility of STP and gait scores in young patients with FRDA and (2) to describe the characteristics of gait parameters in this population. METHODS Thirty-six patients (18 males, 18 females) with diagnosis of FRDA (mean age 16.4 ± 4.5 years) were asked to walk barefoot at a self-selected pace along the pressure sensitive walkway (GAITRite®). Three trials were recorded for each patient and repeated 48 h later. Collected data was put into statistical analysis tests to determine reliability and variability of STPs and two other gait scores: The Functional Ambulation Performance score (FAP) and the Gait Variability Index (GVI). RESULTS All STPs showed strong or very strong reliability (ICC > 0.7) and a low variability. The two parameters showing the lowest reliability (0.71 and 0.74) were the base of support and the foot progression angle. The FAP score and the GVI showed strong reliability (ICC > 0.8). CONCLUSIONS The GAITRite system allows feasible and reliable measurements of gait parameters in young patients with FRDA. Lower reliability found for the weakest parameters was attributed to the software automatic errors and the ankle laxity noted in every patient.
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Affiliation(s)
- Bastien Roche
- Assistance Publique des Hôpitaux de Paris (AP-HP), Robert Debré University Hospital, Gait and Motion Analysis Laboratory, France.
| | - Anne-Laure Simon
- Assistance Publique des Hôpitaux de Paris (AP-HP), Robert Debré University Hospital, Gait and Motion Analysis Laboratory, France; AP-HP, Robert Debré University Hospital, Pediatric Orthopaedic Surgery Department, France
| | - Sophie Guilmin-Crépon
- AP-HP, Robert Debré University Hospital, Clinical Epidemiology Department, France; INSERM UMR-S 1123, ECEVE and CIC-EC 1426, Robert Debré University Hospital, France
| | - Priscilla Boizeau
- AP-HP, Robert Debré University Hospital, Clinical Epidemiology Department, France
| | - Béatrice Andriss
- AP-HP, Robert Debré University Hospital, Clinical Epidemiology Department, France
| | - Corinne Alberti
- AP-HP, Robert Debré University Hospital, Clinical Epidemiology Department, France; INSERM UMR-S 1123, ECEVE and CIC-EC 1426, Robert Debré University Hospital, France
| | - Ana Presedo
- AP-HP, Robert Debré University Hospital, Pediatric Orthopaedic Surgery Department, France
| | - Brice Ilharreborde
- AP-HP, Robert Debré University Hospital, Pediatric Orthopaedic Surgery Department, France
| | - Isabelle Husson
- AP-HP, Robert Debré University Hospital, Physical Rehabilitation Department, France; INSERM UMR-S 1141, Robert Debré University Hospital, France
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10
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Silsupadol P, Teja K, Lugade V. Reliability and validity of a smartphone-based assessment of gait parameters across walking speed and smartphone locations: Body, bag, belt, hand, and pocket. Gait Posture 2017; 58:516-522. [PMID: 28961548 DOI: 10.1016/j.gaitpost.2017.09.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/12/2017] [Accepted: 09/22/2017] [Indexed: 02/02/2023]
Abstract
The assessment of spatiotemporal gait parameters is a useful clinical indicator of health status. Unfortunately, most assessment tools require controlled laboratory environments which can be expensive and time consuming. As smartphones with embedded sensors are becoming ubiquitous, this technology can provide a cost-effective, easily deployable method for assessing gait. Therefore, the purpose of this study was to assess the reliability and validity of a smartphone-based accelerometer in quantifying spatiotemporal gait parameters when attached to the body or in a bag, belt, hand, and pocket. Thirty-four healthy adults were asked to walk at self-selected comfortable, slow, and fast speeds over a 10-m walkway while carrying a smartphone. Step length, step time, gait velocity, and cadence were computed from smartphone-based accelerometers and validated with GAITRite. Across all walking speeds, smartphone data had excellent reliability (ICC2,1≥0.90) for the body and belt locations, with bag, hand, and pocket locations having good to excellent reliability (ICC2,1≥0.69). Correlations between the smartphone-based and GAITRite-based systems were very high for the body (r=0.89, 0.98, 0.96, and 0.87 for step length, step time, gait velocity, and cadence, respectively). Similarly, Bland-Altman analysis demonstrated that the bias approached zero, particularly in the body, bag, and belt conditions under comfortable and fast speeds. Thus, smartphone-based assessments of gait are most valid when placed on the body, in a bag, or on a belt. The use of a smartphone to assess gait can provide relevant data to clinicians without encumbering the user and allow for data collection in the free-living environment.
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Affiliation(s)
- Patima Silsupadol
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kunlanan Teja
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Vipul Lugade
- Department of Physical Therapy, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand; Control One LLC, Albuquerque, NM, USA.
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11
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Russell DM, Kelleran KJ, Morrison S. Bracing the trunk and neck in young adults leads to a more aged-like gait. Gait Posture 2016; 49:388-393. [PMID: 27500447 DOI: 10.1016/j.gaitpost.2016.07.268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/24/2016] [Accepted: 07/28/2016] [Indexed: 02/02/2023]
Abstract
Older individuals typically walk at slower speeds, with shorter step lengths, greater step widths and spend a larger proportion of the gait cycle in double stance. Changes in neck and trunk mobility may underlie some of the changes in walking seen with increasing age. Consequently, this study was designed to assess whether externally increasing trunk/neck stiffness in young adults leads to similar changes in gait pattern observed with aging. Twelve young adults (20-29 years), sixteen old adults (60-69 years) and fifteen older adults (70-79 years) walked across a 20' pressure sensitive GAITRite© instrumented walkway at their preferred speed. The young adults also walked under three bracing conditions: (1) Neck braced, (2) Trunk braced, and (3) Neck and Trunk braced. The results revealed that the old and older age groups walked significantly slower, with a shorter step length and with a narrower base of support (p's<0.05) compared to the young adults. In young adults, combined neck and trunk bracing led to reduced walking speed, shorter step length, wider base of support and a larger proportion of the gait cycle spent in double stance (p's<0.05). The walking speed and step length of older adults remained less than fully braced young adults (p's<0.05). Overall these results indicate that artificially stiffening the trunk and neck of young individuals leads to systematic gait changes similar to aging. Consequently, age-related changes in mobility of the neck and torso may in part contribute to the decrements in walking seen for older adults.
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Affiliation(s)
- Daniel M Russell
- School of Physical Therapy and Athletic Training, College of Health Sciences, Old Dominion University, 3118 Health Sciences Building, Norfolk, VA 23529, USA.
| | - Kyle J Kelleran
- Department of Human Movement Sciences, College of Education, Old Dominion University, Norfolk, VA 23508, USA.
| | - Steven Morrison
- School of Physical Therapy and Athletic Training, College of Health Sciences, Old Dominion University, 3118 Health Sciences Building, Norfolk, VA 23529, USA.
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12
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Abstract
The skeletal muscle manifestations of late-onset Pompe disease (LOPD) cause significant gait impairment. However, the specific temporal and spatial characteristics of abnormal gait in LOPD have not been objectively analyzed or described in the literature. This pilot study evaluated the gait of 22 individuals with LOPD using the GAITRite® temporospatial gait analysis system. The gait parameters were compared to normal reference values, and correlations were made with standard measures of disease progression. The LOPD population demonstrated significant abnormalities in temporospatial parameters of gait including a trend towards decreased velocity and cadence, a prolonged stance phase, prolonged time in double limb support, shorter step and stride length, and a wider base of support. Precise descriptions and analyses of gait abnormalities have much potential in increasing our understanding of LOPD, especially in regards to how its natural history may be modified by the use of enzyme replacement therapy (ERT) and other interventions. Gait analysis may provide a sensitive early marker of the onset of clinical symptoms and signs, offer an additional objective measure of disease progression and the impact of intervention, and serve as a potentially important clinical endpoint. The additional data from comprehensive gait analysis may personalize and optimize physical therapy management, and the clarification of specific gait patterns in neuromuscular diseases could be of clinical benefit in the ranking of a differential diagnosis.
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Affiliation(s)
- Paul T McIntosh
- Duke University Medical Center, DUMC 103857, 905 La Salle, GSRB1, 4(th) Floor Durham, NC 27710.
| | - Laura E Case
- Duke University Medical Center, DUMC 103857, 905 La Salle, GSRB1, 4(th) Floor Durham, NC 27710
| | - Justin M Chan
- Duke University Medical Center, DUMC 103857, 905 La Salle, GSRB1, 4(th) Floor Durham, NC 27710
| | - Stephanie L Austin
- Duke University Medical Center, DUMC 103857, 905 La Salle, GSRB1, 4(th) Floor Durham, NC 27710
| | - Priya Kishnani
- Duke University Medical Center, DUMC 103857, 905 La Salle, GSRB1, 4(th) Floor Durham, NC 27710
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13
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Pradhan C, Wuehr M, Akrami F, Neuhaeusser M, Huth S, Brandt T, Jahn K, Schniepp R. Automated classification of neurological disorders of gait using spatio-temporal gait parameters. J Electromyogr Kinesiol 2015; 25:413-22. [PMID: 25725811 DOI: 10.1016/j.jelekin.2015.01.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 01/05/2015] [Accepted: 01/19/2015] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Automated pattern recognition systems have been used for accurate identification of neurological conditions as well as the evaluation of the treatment outcomes. This study aims to determine the accuracy of diagnoses of (oto-)neurological gait disorders using different types of automated pattern recognition techniques. METHODS Clinically confirmed cases of phobic postural vertigo (N = 30), cerebellar ataxia (N = 30), progressive supranuclear palsy (N = 30), bilateral vestibulopathy (N = 30), as well as healthy subjects (N = 30) were recruited for the study. 8 measurements with 136 variables using a GAITRite(®) sensor carpet were obtained from each subject. Subjects were randomly divided into two groups (training cases and validation cases). Sensitivity and specificity of k-nearest neighbor (KNN), naive-bayes classifier (NB), artificial neural network (ANN), and support vector machine (SVM) in classifying the validation cases were calculated. RESULTS ANN and SVM had the highest overall sensitivity with 90.6% and 92.0% respectively, followed by NB (76.0%) and KNN (73.3%). SVM and ANN showed high false negative rates for bilateral vestibulopathy cases (20.0% and 26.0%); while KNN and NB had high false negative rates for progressive supranuclear palsy cases (76.7% and 40.0%). CONCLUSIONS Automated pattern recognition systems are able to identify pathological gait patterns and establish clinical diagnosis with good accuracy. SVM and ANN in particular differentiate gait patterns of several distinct oto-neurological disorders of gait with high sensitivity and specificity compared to KNN and NB. Both SVM and ANN appear to be a reliable diagnostic and management tool for disorders of gait.
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Affiliation(s)
- Cauchy Pradhan
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
| | - Max Wuehr
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Farhoud Akrami
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Maximilian Neuhaeusser
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Sabrina Huth
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Institute of Clinical Neurosciences, University of Munich, Munich, Germany
| | - Klaus Jahn
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neurology, Schön Klinik Bad Aibling, 83043 Bad Aibling, Germany
| | - Roman Schniepp
- German Center for Vertigo and Balance Disorders, DSGZ, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany; Department of Neurology, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
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14
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Davalos-Bichara M, Zuniga MG, Agrawal Y, Carey JP, Schubert MC. Forward and backward locomotion in individuals with dizziness. Gait Posture 2014; 40:499-503. [PMID: 25042815 DOI: 10.1016/j.gaitpost.2014.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 05/13/2014] [Accepted: 06/16/2014] [Indexed: 02/02/2023]
Abstract
The vestibular system plays an important role in locomotion. Individuals with vestibular pathology present with gait abnormalities, which may increase their fall frequency. Backward walking (BW) has been suggested as a predictor of falls in other patient populations; however it has not been studied in individuals with dizziness. Our aims were: (1) to investigate the differences in forward walking (FW) and BW both between and within 3 groups: Healthy controls, individuals with dizziness and vestibular pathology, and individuals with dizziness without vestibular pathology, (2) describe differences in FW and BW between individuals that have fallen and those that have not. We studied 28 healthy controls (mean 53.8 ± 17 years), 21 individuals with pathophysiology of the vestibular system (mean 68.5 ± 13 years), and 18 individuals without a vestibular cause for their dizziness (mean 67.4 ± 17 years). Subjects performed 2 FW and 2 BW trials over the GAITRite walkway. Data on history of falls in the preceding year were collected. We found BW was different to FW within each group. When comparing between groups and correcting for age and gender, only BW velocity (beta=-11.390, p=0.019), cadence (beta=-8.471, p=0.021), step time (beta=0.067, p=0.007) and stride time (beta=0.137, p=0.005) were significantly affected by having dizziness, with no differences in FW characteristics. There were no differences between FW and BW between fallers and non-fallers. BW appears to be a better biomarker than FW for identifying individuals with symptoms of dizziness; though it does not appear to characterize those who fall.
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Affiliation(s)
- Marcela Davalos-Bichara
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Maria Geraldine Zuniga
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Yuri Agrawal
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - John P Carey
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Michael C Schubert
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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15
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Manella C, Backus D. Gait characteristics, range of motion, and spasticity changes in response to massage in a person with incomplete spinal cord injury: case report. Int J Ther Massage Bodywork 2011; 4:28-39. [PMID: 21589693 PMCID: PMC3088529 DOI: 10.3822/ijtmb.v4i1.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Our study set out to measure the effect of a specific routine of massage on gait characteristics, range of motion, and spasticity in a person with incomplete spinal cord injury. METHODS This descriptive, pre-post case study, conducted at the outpatient program of a rehabilitation facility, used neuromuscular techniques in massage for a 42-year-old man with incomplete chronic C5 spinal cord injury. The massage was applied to the iliopsoas, triceps surae, and hamstring muscle groups for 3 consecutive days. MAIN OUTCOME MEASURES Pre- and post-intervention testing included standard goniometric measurement of joint range of motion in the lower extremities, spasticity evaluation using the modified Ashworth scale, and evaluation of gait characteristics using GAITRite Walkway (CIR Systems, Havertown, PA, USA) pressure mapping for ambulation time, cadence, velocity, stride length, base of support, and single- and double-limb support. RESULTS AFTER THE THERAPEUTIC INTERVENTION, THE FOLLOWING GAIT CHANGES WERE DEMONSTRATED: increase in velocity and cadence of gait, decrease in ambulation time, increase in stride length, and improvements in the percentages of the swing and stance phases of the gait cycle. CONCLUSIONS Specific application of massage therapy influenced gait speed, stride length, and swing and stance phase percentages in one person with incomplete spinal cord injury. Further study is warranted to determine the extent to which massage may affect musculoskeletal and neural impairments that limit gait in people with incomplete spinal cord injury, and the method or routine whose application will yield the most benefit.
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Affiliation(s)
- Christine Manella
- Multiple Sclerosis/Spinal Cord Injury Programs, Shepherd Center, and
| | - Deborah Backus
- Spinal Cord Injury Research, Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
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