Gait training with partial body weight support during overground walking for individuals with chronic stroke: a pilot study

Background: It is not yet established if the use of body weight support (BWS) systems for gait training is effective per se or if it is the combination of BWS and treadmill that improves the locomotion of individuals with gait impairment. This study investigated the effects of gait training on ground level with partial BWS in individuals with stroke during overground walking with no BWS.Methods: Twelve individuals with chronic stroke (53.17 +/- 7.52 years old) participated of a gait training program with BWS during overground walking, and were evaluated before and after the gait training period. In both evaluations, individuals were videotaped walking at a self-selected comfortable speed with no BWS. Measurements were obtained for mean walking speed, step length, stride length and speed, toe-clearance, durations of total double stance and single-limb support, and minimum and maximum foot, shank, thigh, and trunk segmental angles.Results: After gait training, individuals walked faster, with symmetrical steps, longer and faster strides, and increased toe-clearance. Also, they displayed increased rotation of foot, shank, thigh, and trunk segmental angles on both sides of the body. However, the duration of single-limb support remained asymmetrical between each side of the body after gait training.Conclusions: Gait training individuals with chronic stroke with BWS during overground walking improved walking in terms of temporal-spatial parameters and segmental angles. This training strategy might be adopted as a safe, specific and promising strategy for gait rehabilitation after stroke.

Effects of fatigue induced by prolonged gait when walking on the elderly

Purpose. Fatigue has been pointed as a fall risk in the elderly; however, the effects of prolonged gait on neuromuscular recruitment and on its pattern remain unknown. The aim of this study was to evaluate the effects of prolonged gait on neuromuscular recruitment levels and spatial-temporal gait variables. Methods. Eight healthy older women (age: 72.63 ± 6.55 years) walked at their preferred walking speed for twenty minutes on a treadmill. The Root Mean Square (RMS) from the vastus-lateralis, femoral biceps, tibialis anterior and lateral gastrocnemius muscles were determined at the first and last minute of the test during the moments of Heel Strike (HS), Terminal Stance and Terminal Swing (TS). In addition, coactivation in the knee and ankle as well as the stride cadence and length were measured in the test. The two RMS data (taken at the first and last minute) were compared by means of a Student's t-test. Results. Twenty minutes of walking induced fatigue in the subjects, as observed through an increase in RMS, notably during the HS and TS. Coactivation was also influenced by the prolonged gait test. The only gait phase where a risk of falling was enhanced was the HS. Nonetheless, subjects developed strategies to maintain a safe motor pattern, which was evidenced by an increase in stride length and a decrease in stride cadence. Conclusion. Tests lasting just twenty minutes on a treadmill were enough to induce fatigue in older adults. However, the level of fatigue was not enough to present a danger or fall risk to elderly individuals.

Coordination of spinal motion in the transverse and frontal planes during walking in people with and without recurrent low back pain

STUDY DESIGN. Observational cohort study. OBJECTIVE. To investigate spinal coordination during preferred and fast speed walking in pain-free subjects with and without a history of recurrent low back pain (LBP). SUMMARY OF BACKGROUND DATA. Dynamic motion of the spine during walking is compromised in the presence of back pain (LBP), but its analysis often presents some challenges. The coexistence of significant symptoms may change gait because of pain or adaptation of the musculoskeletal structures or both. A history of LBP without the overlay of a current symptomatic episode allows a better model in which to explore the impact on spinal coordination during walking. METHODS. Spinal and lower limb segmental motions were tracked using electromagnetic sensors. Analyses were conducted to explore the synchrony and spatial coordination of the segments and to compare the control and subjects with LBP. RESULTS. We found no apparent differences between the groups for either overall amplitude of motion or most indicators of coordination in the lumbar region; however, there were significant postural differences in the mid-stance phase and other indicators of less phase locking in controls compared with subjects with LBP. The lower thoracic spinal segment was more affected by the history of back pain than the lumbar segment. CONCLUSION. Although small, there were indicators that alterations in spinal movement and coordination in subjects with recurrent LBP were due to adaptive changes rather than the presence of pain. © 2013, Lippincott Williams & Wilkins.

Ground reaction forces during level ground walking with body weight unloading

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Step Counting and Energy Expenditure Estimation in Patients With Chronic Obstructive Pulmonary Disease and Healthy Elderly: Accuracy of 2 Motion Sensors

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

A Simple Approach to Assess VT During a Field Walk Test

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Relationship between lower-limb muscle strength and frailty among elderly people

CONTEXTO E OBJETIVO: A sarcopenia é o principal fator envolvido no desenvolvimento da síndrome de fragilidade. O objetivo foi investigar a relação entre força muscular de membros inferiores e as variáveis sexo, idade e critérios de fragilidade; comparar a força muscular de membros inferiores com cada critério de fragilidade e verificar seu poder de estimativa do risco para fragilidade em idosos ambulatoriais. TIPO DE ESTUDO E LOCAL: Estudo transversal no Ambulatório de Geriatria de um hospital universitário de Campinas. MÉTODO: Foi avaliada uma amostra de conveniência não-probabilística de 150 idosos de ambos os sexos em acompanhamento ambulatorial, com coleta de dados sócio-demográficos (sexo e idade) e de saúde física (critérios de fragilidade e teste de levantar e sentar da cadeira cinco vezes consecutivamente). Foram realizadas análises descritivas, de comparação e de regressão logística multivariada. RESULTADOS: A maioria dos idosos (77,3%) apresentou idade igual ou superior a 70 anos, com predomínio do sexo feminino (64,0%) e baixo escore no teste de levantar e sentar da cadeira cinco vezes consecutivas (81,4% escore 0 ou 1), 55,3% dos idosos apresentaram três ou mais critérios de fragilidade. Verificou-se associação significativa entre a força muscular de membros inferiores e as variáveis idade e número de critérios de fragilidade. CONCLUSÕES: Menores níveis de força muscular de membros inferiores estão associados a idade avançada e maior presença de sinais de fragilidade. Além disso, a força muscular de membros inferiores também está associada com os critérios redução da velocidade de marcha e da força de preensão palmar.

Use of vitamin D to reduce lameness in broilers reared in harsh environments

In tropical poultry-producing countries, poultry houses usually have little environmental control. This study investigated the effect of dietary vitamin D on the incidence of leg abnormalities of a fast-growing broiler strain reared under harsh conditions. In this study, 300 one-day-old male broilers were distributed in two treatments with three replicates of 50 birds each. One group was fed a placebo and the other group was fed 25-hydroxycholecalciferol (25-OH-D3) in a soluble form. The environmental variables were weekly recorded during until birds were 49 days old. Birds were weekly gait scored, and their walking speed and vertical force while walking were assessed. Post-mortem examination was performed and skeletal lesions were assessed. Control birds presented more leg problems than those that ingested 25-OH-D3. These results suggest that dietary vitamin D is effective in decreasing the severity of lameness by reducing tibial dyschondroplasia and other leg abnormalities.

An examination of constraints affecting the intralimb coordination of hemiparetic gait

A dynamical systems approach to the study of locomotor intralimb coordination in those with hemiparesis led to an examination of the utility of the shank-thigh relative phase (RP) as a collective variable and the identification of potential constraints that may shape this coordination. Eighteen non-disabled individuals formed three groups matched to the age and gender of six participants with chronic right hemiparesis. The three groups differed in the constraints imposed on their walking: (1) walking at their preferred walking speed; (2) walking as slowly as those with hemiparesis; and, (3) walking slowly with a right ankle-foot orthosis (AFO). The results revealed an asymmetry in intralimb coordination between the unaffected and affected leg of those with hemiparesis localized to the latter third of the gait cycle when the limb is advanced from the end of stance to the reestablishment of a new stance. Walking slowly with or without an AFO resulted in no measureable effect in the non-disabled, but accounts for 22% of the variance in the intralimb coordination of the hemiplegic's affected limb and 16% in the unaffected limb. The AFO offered little additional contribution. These results derive from shank-thigh RP that is shown to provide more information about intralimb coordination than knee angle displacement. Implications for these results and the use of RP for rehabilitation are discussed. (C) 2000 Elsevier B.V. B.V. All rights reserved. PsycINFO classification. 3297. 2330.

Safety in road crossing of children with cerebral palsy

Aim: Children with cerebral palsy (CP) are regularly confronted with physical constraints during locomotion. Because abnormalities in motor control are often related to perceptual deficits, the aim of this study was to find out whether children with CP were able to walk across a road as safely as their non-handicapped peers. Method: Ten children with CP and 10 non-handicapped children aged 4-14 y were asked to cross a simulated road if they felt the situation was safe. Results: With respect to safety and accuracy of crossings, the behaviour of children with CP was comparable with that of non-handicapped children. However, a closer examination of children's individual crossing behaviour showed considerable differences within the CP group. In contrast to children with damage to the left hemisphere, children with damage to the right hemisphere made unsafe decisions and did not compensate for them by increasing walking speed.Conclusion: the differences in unsafe behaviour and in the ability to compensate for it within the group of children with CP might be related to damage to specific regions of the brain that are involved in the processing of spatial or temporal information.

Impact of lameness on broiler well-being

Various degrees of lameness were compared among male broilers ranging in age from 28 to 49 d that had been randomly selected from a commercial farm. Gait scores were given to the broilers while they walked on a force measurement platform system, and the force exerted by their feet was measured and compared in 2 distinct conditions: with and without administration of an analgesic. Postmortem femoral degenerative lesions were observed, and the femur strength in response to a compression load was measured and compared. Results showed a difference in the peak vertical forces of the right and left feet before and after medication. The researchers also found that as BW increased, the locomotion ability of broilers tended to decrease. After birds received the analgesic, the peak vertical force increased among the more severely lame broilers at 35 to 49 d of age and their walking speed was decreased, indicating that they might have felt pain during locomotion. No difference was found between the femur (right and left) strength in response to a compression load; however, the results showed that femurs of 28-d-old birds were less resistant to compression (P < 0.05) than those of older broilers. The foot force platform was a useful tool for assessing the walking ability of broilers.

The effect of muscle fatigue on the last stride before stepping down a curb

The stride before landing may be important during stepping down. The aim of this study was to analyze variability of the kinematics and muscle activity in the final stride before stepping down a curb, with and without ankle and knee muscle fatigue. Ten young participants walked at self-selected speed and stepped down a height difference (10-cm) in ongoing gait. Five trials were performed before and after a muscle fatigue protocol (one day: ankle muscle fatigue, another day: knee muscle fatigue). The analysis focused on the trailing leg during the last but one and the last step on the higher level. Kinematics and muscle activity were recorded. Fatigue increased variability of foot-step horizontal distance in the last step on the higher level of the trailing limb, as well as in the first steps on the lower level for both limbs. This appeared due to an increase in the range of motion of the knee joint after both fatigue protocols. Participants additionally showed an increased ankle and hip ROM and decreased knee ROM. Our results suggest a loss of control under fatigue reflected in a higher variability of trailing and leading limb-step horizontal distances, with compensatory changes to limit fatigue effects, such as a redistribution of movement over joints. © 2012 Elsevier B.V.

Associação entre fatores de risco cardiovascular e capacidade funcional de idosos longevos

Study design: cross-sectional study. Objective: To assess the association between the presence of cardiovascular risk factor (CRP) and functional capacity of the oldest old. Methods: The sample 9onsisted of 91 elderly aged 80 and 90 years (83.0 ± 2.5 years) with 60 women (82.2 ± 2.1 years) and 31 men (83.2 ± 2,6 years) residing in the city of Presidente Prudente - SP. The FRC were analyzed: arterial hypertension (AH) and excess body fat (total and trunk). The presence of hypertension was verified by means of self-reported questionnaire based on the Standard Health Questionnaire (SHQ). Assessment of body was made by absorpiometria dual energy X-ray absorptiometry (DXA) and functional capacity was assessed by the functional tests (static balance, normal walking speed and force of the lower limbs). For statistical analysis we carried out the chi-square test, the software used was SPSS (13.0) and the significance level was set at 5%. Results. In males, with hypertension and the presence of excess %BF had lower performance in the lower limbs (83.3% lower and 16.7% higher), p = 0.011 compared to those with only a VCF. The elderly women with hypertension and the presence of excess GTron% also had lower performance on the same test (80.6% lower and 19.4% higher), p = 0.018 and the test of walking speed (80.6% lower and 19.4% higher), p = 0.034. Conclusion: Arterial hypertension and excess body fat (total and trunk) aggregated are FRC, which are associated with reduced functional capacity of the oldest old.

Influence of visual feedback sampling on obstacle crossing behavior in people with Parkinson's disease

The purpose of the current study was to investigate the role of visual information on gait control in people with Parkinson's disease as they crossed over obstacles. Twelve healthy individuals, and 12 patients with mild to moderate Parkinson's disease, walked at their preferred speeds along a walkway and stepped over obstacles of varying heights (ankle height or half-knee height), under three visual sampling conditions: dynamic (normal lighting), static (static visual samples, similar to stroboscopic lighting), and voluntary visual sampling. Subjects wore liquid crystal glasses for visual manipulation. In the static visual sampling condition only, the patients with Parkinson's disease made contact with the obstacle more often than did the control subjects. In the successful trials, the patients increased their crossing step width in the static visual sampling condition as compared to the dynamic and voluntary visual sampling conditions; the control group maintained the same step width for all visual sampling conditions. The patients showed lower horizontal mean velocity values during obstacle crossing than did the controls. The patients with Parkinson's disease were more dependent on optic flow information for successful task and postural stability than were the control subjects. Bradykinesia influenced obstacle crossing in the patients with Parkinson's disease. © 2013 Elsevier B.V.