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.

Systematic review of the effects of fatigue on spatiotemporal gait parameters

PURPOSE: This systematic review aimed to assess changes on spatiotemporal gait parameters due to fatigue. MATERIAL AND METHOD: A search was carried out in literature published from 1950 to December 2010 and retrieved 771 articles using terms referring to walking and fatigue in the title, abstract or keywords. Two researchers assessed the selection and quality of each article independently. RESULTS: Seven studies were selected for this systematic review, two of which reported on the same data set. Several spatiotemporal parameters were reported to change with fatigue, but the few variables studied in multiple studies, gait speed and stride or step length and stride time, were affected only in single studies. Fatigue appears to modulate spatiotemporal gait parameters, but the effects of fatigue appear to be dependent on the muscles that were fatigued, and age that appears to be a moderator of the effects of fatigue on gait. © 2013 - IOS Press and the authors. All rights reserved.

Efeito de um treinamento de FNP sobre variáveis biomecânicas em idosos caidores

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Revisão sistemática do efeito do envelhecimento no andar livre e adaptativo

Aging seems to impair the walking. However, it is not clear the effects of aging on walking. The aim of this study was to determine changes in kinematic, kinetic and electromyographic parameters of the free and adaptive gait, in preferred velocity, caused by aging. The initial search strategy was performed to identify all articles that examined the free and adaptive gait. The electronic databases analyzed were: MEDLINE, PubMed, EMBASE, CINAHL, Sports Discus, DARE, PsychInfo, ERIC, AusportMed, AMI, Cochrane and PEDro. Twenty-three articles were reviewed in full. Elderly are slower, with shorter step length and longer double support duration than young adults during free and adaptive gait. Even, they showed higher muscular demands, with redistribution of joint power and torque and decreased force in the propulsion and absorption phases. It was concluded that elderly present altered kinematic, kinetic and electromyographic parameters of free and adaptive gait compared to young adults.

Efeito do treinamento com haste vibratória na biomecânica da marcha com dupla-tarefa em idosas

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

Visual cues and gait improvement in Parkinson's disease: which piece of information is really important?

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

Comportamento de indivíduos com doença de Parkinson no levantar da cadeira e no início da marcha: relações com o envelhecimento

Large motor dysfunctions are observed in older adults with the age advance. Parkinson’s disease (PD) patients have motor deficits to perform daily living activities. To raise from a chair, a daily task necessary to live independently, requires both large muscle recruitment and large joint range of motion to achieve the vertical position safely. Normally, we initiate gait after raise from a chair. The aim of this study was to analyze the PD patients’ behavior when rising from a chair and initiating gait and to compare it according to the age advance. In order to do that, 23 PD patients (66.61±7.64 years old) were distributed in three age groups: Young group, between 51 and 60 years of age (n=7); intermediary group, between 61 and 70 years of age (n=7); and elderly group, over 70 years of age (n=9). There were no statistical differences among groups either for the disease evolution stage or for it compromising. The task was to stand from a chair and to initiate gait forward in three attempts. The dependent variables were: spatial and temporal (first step length and duration, and stride length, duration and velocity) and angular (flexion and extension of head, shoulder, hip, knee, and ankle). The motion of standing from a chair was divided in two phases. The data was statistically treated by means of Analyses of Variance with group as the only factor. The Scheffé’s post hoc test was used to localize differences among groups and the significance level was adjusted to p≤0.017. There were statistical differences for stride...(Complete abstract click electronic access below)

Complexidade do ambiente e assimetria no andar de idosos com doença de Parkinson

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

New Optimization Algorithms for Structural Reliability Analysis

Solution of structural reliability problems by the First Order method require optimization algorithms to find the smallest distance between a limit state function and the origin of standard Gaussian space. The Hassofer-Lind-Rackwitz-Fiessler (HLRF) algorithm, developed specifically for this purpose, has been shown to be efficient but not robust, as it fails to converge for a significant number of problems. On the other hand, recent developments in general (augmented Lagrangian) optimization techniques have not been tested in aplication to structural reliability problems. In the present article, three new optimization algorithms for structural reliability analysis are presented. One algorithm is based on the HLRF, but uses a new differentiable merit function with Wolfe conditions to select step length in linear search. It is shown in the article that, under certain assumptions, the proposed algorithm generates a sequence that converges to the local minimizer of the problem. Two new augmented Lagrangian methods are also presented, which use quadratic penalties to solve nonlinear problems with equality constraints. Performance and robustness of the new algorithms is compared to the classic augmented Lagrangian method, to HLRF and to the improved HLRF (iHLRF) algorithms, in the solution of 25 benchmark problems from the literature. The new proposed HLRF algorithm is shown to be more robust than HLRF or iHLRF, and as efficient as the iHLRF algorithm. The two augmented Lagrangian methods proposed herein are shown to be more robust and more efficient than the classical augmented Lagrangian method.

Model based experimental investigation on Powered Gait Orthosis (PGO)

Research on rehabilitation showed that appropriate and repetitive mechanical movements can help spinal cord injured individuals to restore their functional standing and walking. The objective of this paper was to achieve appropriate and repetitive joint movements and approximately normal gait through the PGO by replicating normal walking, and to minimize the energy consumption for both patients and the device. A model based experimental investigative approach is presented in this dissertation. First, a human model was created in Ideas and human walking was simulated in Adams. The main feature of this model was the foot ground contact model, which had distributed contact points along the foot and varied viscoelasticity. The model was validated by comparison of simulated results of normal walking and measured ones from the literature. It was used to simulate current PGO walking to investigate the real causes of poor function of the current PGO, even though it had joint movements close to normal walking. The direct cause was one leg moving at a time, which resulted in short step length and no clearance after toe off. It can not be solved by simply adding power on both hip joints. In order to find a better answer, a PGO mechanism model was used to investigate different walking mechanisms by locking or releasing some joints. A trade-off between energy consumption, control complexity and standing position was found. Finally a foot release PGO virtual model was created and simulated and only foot release mechanism was developed into a prototype. Both the release mechanism and the design of foot release were validated through the experiment by adding the foot release on the current PGO. This demonstrated an advancement in improving functional aspects of the current PGO even without a whole physical model of foot release PGO for comparison.

Análisis biomecánico zancada a zancada de la prueba "60 metros vallas" durante los campeonatos del mundo y de España de pista cubierta Valencia 2008

El principal objetivo del presente trabajo de investigación fue determinar las diferencias en distintas variables relacionadas con el rendimiento físico entre atletas de distinto nivel durante la prueba de los 60 metros vallas. Un total de 59 vallistas masculinos (los 31 participantes en el Campeonato del Mundo Absoluto de Pista Cubierta y los 28 participantes en el Campeonato de España Absoluto de Pista Cubierta, ambos celebrados en Valencia en el año 2008) formaron la muestra del estudio. El análisis biomecánico se realizó mediante un sistema fotogramétrico en dos dimensiones que permitió calcular, aplicando algoritmos basados en el procedimiento de la DLT (Abdel-Aziz y Karara, 1971), las coordenadas (x, y) de los sucesivos apoyos de los pies de los atletas sobre toda la superficie de competición. La filmación de las pruebas se llevó a cabo con seis cámaras de vídeo, ubicadas sobre la gradas, con una frecuencia de muestreo para el tratamiento de los datos de 50 Hz. En la fase de salida, los atletas de nivel superior mostraron una menor longitud (p<0,05) y tiempo de zancada (p<0,001), debido a un menor tiempo de vuelo (p<0,05). En la fase de vallas, los atletas de nivel más elevado presentaron mayores distancia de ataque a la valla (p<0,001), así como menores distancias de caída de la valla (p<0,001), tiempos de zancada (p<0,01-0,001) y de apoyo (p<0,01-0,001 ) en los cuatro pasos que conforman cada ciclo de vallas, así como un menor tiempo de vuelo en el paso de valla (p<0,001) y en el paso de transición (p<0,001). De manera adicional, se encontraron importantes diferencias en el reparto de los pasos entre vallas entre la primera y tercera valla y el resto de obstáculos. En la fase final, se observó una mayor longitud de zancada en los atletas de nivel superior (p<0,001), así como un menor tiempo de zancada (p<0,01) y de apoyo (p<0,01). Los resultados obtenidos en el presente estudio de investigación avalan la utilización de la fotogrametría en dos dimensiones para el análisis biomecánico de la prueba de 60 metros vallas en competición. Su aplicación en competiciones del máximo nivel internacional ha posibilitado conocer las características de los vallistas a lo largo de toda la prueba y determinar posibles implicaciones de cara al proceso de entrenamiento. ABSTRACT The aim of this research was to determine the differences in different variables related to physical performance among athletes of different levels during the race of 60 meter hurdles. A total of 59 male hurdlers (the 31 participants in the World Indoor Championship and the 28 participants in the Spanish Indoor Championship, both held in Valencia in 2008) formed the sample of the study. The biomechanical analysis of athletes was performed using a two-dimensional photogrammetric system which enabled calculation, applying algorithms based on the DLT method (Abdel -Aziz y Karara , 1971), the coordinates (x , y) of the successive supports of the feet on the entire competition surface. Filming test was conducted with six video cameras, located on the bleachers, with a sampling frequency for data processing of 50 Hz. In the approach run phase, the top-level athletes showed a smaller length step (p<0.05), and shorter step time (p<0.001), due to a shorter step flight time (p<0.05). In the hurdle unit phase, the higher level athletes had greater take-off distances (p<0.001), shorter landing distances (p<0.001), smaller step times (p<0.01-0.001), and support times (p<0.01- 0.001) in the four steps that comprised each hurdle unit, and smaller flight times in the hurdle step (p < 0.001), and the recovery step (p<0.001). Additionally, differences in the distribution of hurdle unit steps between the first and third hurdle, and other hurdles were found. In the run-in phase, a greater step length in top-level athletes (p<0.001), and a shorter step time (p<0.01) and contact time (p<0.01) was observed. The results obtained in this study support the use of photogrammetry in two dimensions for biomechanical analysis in 60 meter hurdles competition events. Its application at the highest international level competitions has allowed to know the characteristics of the hurdlers over the entire race and identify possible implications for the training process.

Optimización del método de ensayo del péndulo de fricción para la evaluación del riesgo de deslizamiento en pavimentos pulidos

El riesgo de caída por deslizamiento en los edificios es un riesgo muy importante ya que supone numerosas muertes, perdida de días laborales y secuelas, así como importantes costes económicos. Se trata de accidentes difíciles de predecir debido al número de factores que intervienen para que se produzcan, muchos de los cuales son difícilmente controlables, como el calzado del usuario o su comportamiento. Para evitar un resbalón es necesario que la fricción del conjunto pavimento/calzado/contaminante supere el coeficiente de fricción requerido para la estabilidad y que depende de la forma de caminar, la longitud del paso, etc. Por ello, es necesario medir la contribución del pavimento al riesgo de deslizamiento y limitarla adecuadamente. A lo largo de la historia reciente se han diseñado y desarrollado multitud de aparatos con la intención de medir esta contribución en la forma de coeficientes de fricción —dinámicos, estáticos, de transición— sin llegar a un acuerdo sobre cuál es el método más apropiado. La reglamentación española de edificación, que ha sufrido un importante cambio recientemente con la adopción de un nuevo código basado en prestaciones, ha sido innovadora en este campo introduciendo por primera vez una medida contrastable de la contribución del pavimento al riesgo de deslizamiento mediante el ensayo del péndulo de fricción en húmedo. Sin embargo, el desacuerdo a nivel europeo sobre un ensayo único y las limitaciones en las normas de ensayo existentes derivadas de esta falta de consenso, han sido la causa de que la solución aportada por el Código Técnico de la Edificación (CTE) se cimentara en normas que no contemplaban todas las modalidades de ensayo. Esto ha generado algunos problemas de aplicación que han afectado fundamentalmente a los pavimentos pulidos, que han visto prácticamente vetada su utilización en los edificios incluso en las zonas donde, por no existir presencia de agua, el riesgo es menor. El objetivo de esta tesis es analizar estos problemas de aplicación, ligados al ensayo del péndulo de fricción, y tratar de resolverlos optimizando el procedimiento de ensayo empleado, modificando sus condiciones, para representar de forma mucho más adecuada el riesgo que se pretende limitar. Para ello se ha estudiado de forma exhaustiva la literatura científica y las normas y reglamentaciones, tanto españolas como extranjeras. Se han detectado los posibles problemas que podría plantear la introducción del ensayo del péndulo de fricción en seco y se ha diseñado una campaña de ensayos, tanto de coeficiente de fricción con el péndulo, como de la rugosidad superficial, para confirmarlos o desecharlos. El análisis de los resultados de la campaña de ensayos ha permitido validar la modalidad de ensayo planteada y proponer una medida complementaria de la rugosidad superficial que resulte útil para facilitar la evaluación de este riesgo no poco importante. Los resultados de esta tesis han permitido desarrollar una modificación del CTE de próxima aparición y un documento de apoyo que ya la adelanta, y con ello, resolver el problema de aplicación del CTE a los pavimentos pulidos. ABSTRACT Slipping accidents in building environments are a serious problem involving numerous fatal accidents, loss of work days, incapacity and great costs. Prediction of such accidents is difficult due to the number of factors involved, many of which are not controllable, like footwear or users behavior. To prevent a slip the coefficient of friction provided by the combination floor-footwear-contaminant must be greater than the required coefficient of friction for stability, that depends on the step length and the walking speed among other factors. It is then necessary to measure the contribution of the floor to the slipping risk so it can be limited to an adequate extent. In the recent history many apparatuses have been developed in order to measure this contribution in the form of friction coefficients —dynamic, static or even transition COFs— but none of them seems to be internationally accepted as sufficiently valid. The Spanish Building Code, which has recently undergone a big change to a performance based code, has been innovative in this area, introducing for the first time a measurement of this contribution by means of the friction pendulum test. However, due to the European disagreement about an unique test for slip resistance, and to the limitations of the European standards derived from it, the Spanish Building Code relies on standards that do not take into account all possible methods. As a consequence, smooth floors have been seriously affected and cannot be installed in almost any place, not even in dry areas where the risk of slipping is much lower. The aim of this research is to analyze these problems associated with the pendulum test and resolve them proposing some changes to the test conditions in order to represent in a proper manner the real risk that is to be considered: the slip in dry conditions. Relevant scientific literature has been studied as well as Spanish and foreign codes and standards. Potential problems of the pendulum test in dry conditions have been detected and an experiment has been designed to confirm or discard them, testing both friction coefficient and surface roughness. The results of the experiment have permitted to validate the pendulum test in dry conditions and to suggest a complementary measurement of the surface roughness to help evaluate the slip resistance of a floor. These results have also permitted to develop an amendment to the building code that will appear soon. In the meanwhile it has been included in a support document issued by the administration to resolve this urgent problem.

Adequabilidade ambiental dos biomas brasileiros à ocorrência do lobo-guará (Chrysocyon brachyurus) e efeitos da composição da paisagem em sua ecologia espacial, atividade e movimentação

O lobo-guará é uma espécie de ampla distribuição na América do Sul, tendo no Brasil sua maior área de ocorrência. No entanto, as modificações das áreas naturais principalmente destinadas à agropecuária tornam a espécie vulnerável à extinção. A investigação objetivou conhecer em larga escala a área de distribuição potencial gerada por atributos ambientais favoráveis e áreas adequadas à sua ocorrência nos biomas brasileiros e investigar como a espécie responde à estrutura da paisagem, avaliando os efeitos de ambientes modificados pelo homem na sua ecologia espacial, nos padrões de atividade e na movimentação. Modelos de distribuição de espécie foram gerados pelo Maxent, utilizando uma base de pontos de localização de presença a partir de 2000 para o Cerrado (Ce), Pantanal (Pa), Mata Atlântica (MA) e Pampas (Pp) e um conjunto de onze variáveis ambientais não correlacionadas (topográficas, climáticas e paisagísticas). Para análises de ecologia espacial, das atividades e de movimentação, utilizou-se localizações de telemetria (GPS) de animais habitantes de áreas protegidas (AP), e indivíduos em paisagens modificados (AM). Análises de áreas de vida (AV) foram realizadas utilizando o estimador AKDE e associadas com classificação da paisagem local. Os modelos de distribuição do lobo-guará apresentaram uma área de distribuição potencial de 78% do total dos biomas. Apesar de possuírem grandes proporções de áreas adequadas (Ce, 90%; Pa, 93%; MA, 65% e Pp, 6%), somente um pequeno percentual (4,4% do Ce e 4,7% da MA) possui adequabilidade ambiental acima de 50%. Dos atributos que favorecem sua presença, a altitude (para todos os biomas), a precipitação (Ce e Pa), diferenças de temperatura e uso e cobertura do solo (Ma e Pp) foram os mais importantes. Em nível local, animais apresentaram média de AV de 90Km2 em AP e 41Km2 em AM, uma diferença significativa (p<0,01) com áreas diretamente proporcionais ao percentual de áreas naturais na paisagem. Ainda, apesar dos padrões regulares de atividade não mostrarem grandes mudanças, o período de repouso foi significativamente maior (p<0,01) entre os animais AM (46% do dia) que em animais AP (25% do dia). Lobos-guarás de AP e AM não apresentaram grandes diferenças no deslocamento diário com média geral de 14km caminhados por dia, com comprimentos de passos de 1Km. Diferenças no comprimento de passo foram relacionadas à composição da diversidade de contato de classes da paisagem com a proporção de ambientes naturais no passo (quanto maior as variáveis, maior o passo). Passos menores refletem menor persistência de movimento interferindo no deslocamento diário. Com os resultados desse estudo identificou-se a MA e Pa muito importantes, mas o Ce como bioma mais adequado à espécie. Foram encontrados indícios de que a estrutura de suas AV, o uso da paisagem, as atividades e movimentação são afetados pela paisagem modificada. Isso pode comprometer a viabilidade populacional, interferindo na presença em uma área e refletindo no seu potencial de distribuição. As estratégias de manejo de uso do solo, e a recuperação e conexão de áreas adequadas são urgentes e necessárias para que o lobo-guará permaneça presente e funcional nas paisagens dos biomas brasileiros.

Balance and gait in children with dyslexia

Tests of postural stability have provided some evidence of a link between deficits in gross motor skills and developmental dyslexia. The ordinal-level scales used previously, however, have limited measurement sensitivity, and no studies have investigated motor performance during walking in participants with dyslexia. The purpose of this study was to investigate if continuous-scaled measures of standing balance and gait could discriminate between groups of impaired and normal readers when investigators were blind to group membership during testing. Children with dyslexia (n=22) and controls (n=18), aged 10-12 years, performed walking tests at four different speeds (slow-preferred-fast-very fast) on an even and an uneven surface, and tests of unperturbed and perturbed body sway during standing. Body movements were registered by a triaxial accelerometer over the lower trunk, and measures of reaction time, body sway, walking speed, step length and cadence were calculated. Results were controlled for gender differences. Tests of standing balance with eyes closed did not discriminate between groups. All unperturbed standing tests with eyes open showed significant group differences (P<0.05) and classified correctly 70-77.5% of the subjects into their respective groups. Mean walking speed during very fast walking on both flat and uneven surface was ≥0.2 m/s (P≤0.01) faster for controls than for the group with dyslexia. This test classified 77.5% and 85% of the subjects correctly on flat and uneven surface, respectively Cadence at preferred or very fast speed did not differ statistically between groups, but revealed significant group differences when all subjects were compared at a normalised walking speed (P≤0.04). Very fast walking speed as well as cadence at a normalised speed discriminated better between groups when subjects were walking on an uneven surface compared to a flat floor. Continuous-scaled walking tests performed in field settings may be suitable for motor skill assessment as a component of a screening tool for developmental dyslexia.

On the convergence of the method of successive averages for calculating user equilibrium in traffic networks

Peer reviewed