A mechanized gait trainer for restoration of gait

The newly developed gait trainer allows wheel-chair-bound subjects the repetitive practice of a gait-like movement without overstressing therapists. The device simulates the phases of gait, supports the subjects according to their abilities, and controls the center of mass (CoM) in the vertical and horizontal directions. The patterns of sagittal lower limb joint kinematics and of muscle activation for a normal subject were similar when using the mechanized trainer and when walking on a treadmill. A non-ambulatory hemiparetic subject required little help from one therapist on the gait trainer, while two therapists were required to support treadmill walking. Gait movements on the trainer were highly symmetrical, impact free, and less spastic. The vertical displacement of the CoM was bi-phasic instead of mono-phasic during each gait cycle on the new device. Two cases of non-ambulatory patients, who regained their walking ability after 4 weeks of daily training on the gait trainer, are reported.     

Outcomes of Botulinum Toxin Type A for equinovarus deformity in patients with CVA: A case series

Background: There is evidence that Botulinum Toxin-A (BTX-A) reduces focal spasticity associated with equinovarus to improve gait in patients poststroke. However, there is little research examining whether gait improvements are maintained after the effectiveness period of BTX-A injections. The purpose of this observational study was to determine whether there was a difference in gait parameters in three patients before BTX-A injection versus four and ten weeks after. Case Series: Three women, ages 63, 60, and 42 postischemic stroke with hemiparesis and equinovarus underwent measurements for: plantar flexor spasticity, ankle dorsiflexion ROM, temporal–spatial gait parameters, and gait endurance. All participants improved in ankle ROM. At week 10, spasticity had returned to initial measurement levels in participants A and C. Base of support and step length symmetry ratios did not improve following injections. Participants A and B, who received physical therapy during the study, showed modest gains in gait endurance and velocity. Conclusion: Although BTX-A injections improved spasticity, this improvement did not translate to gait outcomes. Addition of physical therapy interventions appeared to improve gait outcomes in this case series. We suggest future randomized control studies to compare effects of physical therapy alone to BTX-A combined with physical therapy on gait outcomes.     

The effects of body weight unloading on kinetics and muscle activity of overweight males during Overground walking

BackgroundExcess body weight has become a major worldwide health and social epidemic. Training with body weight unloading, is a common method for gait corrections for various neuromuscular impairments. In the present study we assessed the effects of body weight unloading on knee and ankle kinetics and muscle activation of overweight subjects walking overground under various levels of body weight unloading.MethodsTen overweight subjects (25 ≤ BMI < 29.9 kg/m²) walked overground under a control and three (0%, 15%, 30%) body weight unloading experimental conditions. Gait parameters assessed under these conditions included knee and ankle flexion moments and the Electromygraphic activity of the Tibialis Anterior, Lateral Gastrocnemius and Vastus Lateralis.FindingsIncreasing body weight unloading levels from 0% to 30% was found to significantly reduce the peak knee flexion and ankle plantarflexion moments. Also observed was a significant reduction in muscle activity of the Tibialis Anterior, Lateral Gastrocnemius and Vastus Lateralis under the three body-weight unloading conditions.InterpretationOur results demonstrate that a reduction of up to 30% overweight subjects' body weight during gait is conducive to a reduction in the knee and ankle flexion moments and in the balancing net quadriceps moment and ankle flexors moment. The newly devised body weight unloading device is therefore an effective method for reducing joint loads allowing overweight people who require controlled weight bearing scenarios to retrain their gait while engaging in sustained walking exercise.     

Comparison of the inertial properties and forces required to initiate movement for three gait trainers

The purpose of this study was to evaluate the inertial properties and forces required to initiate movement on two different surfaces in a sample of three commonly prescribed gait trainers. Tests were conducted in a laboratory setting to compare the Prime Engineering KidWalk, Rifton Pacer, and Snug Seat Mustang with and without a weighted anthropometric test dummy configured to the weight and proportions of a 4-year-old child. The Pacer was the lightest and the KidWalk the heaviest while footprints of the three gait trainers were similar. Weight was borne fairly evenly on the four casters of the Pacer and Mustang while 85% of the weight was borne on the large wheels of the mid-wheel drive KidWalk. These differences in frame style, wheel, and caster style and overall mass impact inertial properties and forces required to initiate movement. Test results suggest that initiation forces on tile were equivalent for the Pacer and KidWalk while the Mustang had the highest initiation force. Initiation forces on carpet were lowest for the KidWalk and highest for the Mustang. This initial study of inertia and movement initiation forces may provide added information for clinicians to consider when selecting a gait trainer for their clients.     

A mechanized gait trainer for restoring gait in nonambulatory subjects

OBJECTIVE: To construct an advanced mechanized gait trainer to enable patients the repetitive practice of a gaitlike movement without overstraining therapists. DEVICE: Prototype gait trainer that simulates the phases of gait (by generating a ratio of 40% to 60% between swing and stance phases), supports the subjects according to their ability (lifts the foot during swing phase), and controls the center of mass in the vertical and horizontal directions. PATIENTS: Two nonambulatory, hemiparetic patients who regained their walking ability after 4 weeks of daily training on the gait trainer, a 55-year-old woman and a 62-year-old man, both of whom had a first-time ischemic stroke. INTERVENTION: Four weeks of training, five times a week, each session 20 minutes long. MAIN OUTCOME MEASURES: Functional ambulation category (FAC, levels 0-5) to assess gait ability and ground level walking velocity. Rivermead motor assessment score (RMAS, 0-13) to assess gross motor function. RESULTS: Patient 1: At the end of treatment, she was able to walk independently on level ground with use of a walking stick. Her walking velocity had improved from .29m/sec to .59m/sec. Her RMAS score increased from 4 to 10, meaning she could walk at least 40 meters outside, pick up objects from floor, and climb stairs independently. Patient 2: At end of 4-week training, he could walk independently on even surfaces (FAC level 4), using an ankle-foot orthosis and a walking stick. His walking velocity improved from .14m/sec to .63m/sec. His RMAS increased from 3 to 10. CONCLUSION: The gait trainer enabled severely affected patients the repetitive practice of a gaitlike movement. Future studies may elucidate its value in gait rehabilitation of nonambulatory subjects.     

A revised group exercise program for osteoarthritis of the knee

The purpose of this study was to determine the effectiveness of a group exercise program for subjects with osteoarthritis of the knee referred for physiotherapy in terms of pain, physical function and gait. This study was initiated after an initial group exercise program at this centre failed to demonstrate significant changes in pain, physical function or gait. The study was based on repeated measures with a two month follow up, carried out in the outpatients department of a large public hospital. Pain levels in various functional situations were assessed on visual analogue scales, physical function with the Stanford Health Assessment Questionnaire, and quantitative gait variables at a normal and a fast self-selected speed with an electric foot switch walkway. On completion of the program (n=40) more than 90% of the pain and physical function scores demonstrated significant improvements without increases in medication, use of walking aids or fatigue. The gait variables of velocity, cadence and stride length at both self-selected speeds demonstrated significant increases at this assessment without deterioration of gait symmetry. All improvements were maintained at the two month follow up assessments. This study suggests that a clinically realistic group exercise program supplemented with a home program can reduce pain, increase physical function and objective gait measures in subjects with osteoarthritis of the knee. Copyright © 1997 Whurr Publishers Ltd.     

中国正常成人步行时空参数分析

目的:探讨中国正常成人的步行特征,为临床步态分析提供科学参考依据。方法:365名正常受试者,按性别、年龄分为20—29岁组、30—39岁组、40—49岁组、50—59岁组、60—75岁组共10组。应用人体步态垫测量与分析系统,测试受试者自由行走时的步速、步长、步幅、步长时间、摆动时间、支撑时间、单足支撑时间、双足支撑时间等时空参数,并对每位受试者的身高、体重进行测试。结果:年龄组内平均步速,除30—39岁组、60—75岁组外,男性均大于女性(P<0.05),50岁以后,男、女步速均减慢,与50岁以前相比差异具有显著性(P<0.01);各年龄组步长,男性均大于女性(P<0.05),女性步长在50岁以后减小,与50岁以前相比差异具有显著性(P<0.01),男性步长在60岁以后减小,明显小于60岁以前步长(P<0.01)。结论:应用人体步态垫测量与分析系统,首次建立中国正常成人步行时空参数值参考范围,初步揭示中国正常成人的步行时空特征。     

Feature reduction and multi-classification of different assistive devices according to the gait pattern

Total knee arthroplasty (TKA) is a surgical procedure used in patients with Osteoarthritis to improve their state. An understanding about how gait patterns differ from patient to patient and are influenced by the assistive device (AD) that is prescribed is still missing. This article focuses on such purpose. Standard walker, crutches and rollator were tested. Symmetric indexes of spatiotemporal and postural control features were calculated. In order to select the important features which can discriminate the differences among the ADs, different techniques for feature selection are investigated. Classification is handled by Multi-class Support Vector Machine. Results showed that rollator provides a more symmetrical gait and crutches demonstrated to be the worst. Relatively to postural control parameters, standard walker is the most stable and crutches are the worst AD. This means that, depending on the patient’s problem and the recovery goal, different ADs should be used. After selecting a set of 16 important features, through correlation, it was demonstrated that they provide important quantitative information about the functional capacity, which is not represented by velocity, cadence and clinical scales. Also, they were capable of distinguishing the gait patterns influenced by each AD, showing that each patient has different needs during recovery.

• Implications of Rehabilitation

• An understanding about how gait patterns of post-surgical patients differ from person to person and how they are influenced by the type of device that is prescribed during their recovery might help in physical therapy. Research specifically addressing these issues is still missing.

• Inter-limb asymmetry and postural control features can be evaluated in an outpatient setting, supplying important additional information about individual gait pattern, which is not represented by gait velocity, cadence and scales usually used.

• The features calculated in this study are able to provide complementary information to gait velocity, cadence and clinical scales to assess the functional capacity of patients that passed through TKA. The selected parameters make a new clinical tool useful for tracking the evolution of patients’ recovery after TKA.

     

Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept

Background and Purpose . Patients with multiple sclerosis (MS) tend to have movement difficulties, and the effect of physiotherapy for this group of patients has been subjected to limited systematic research. In the present study physiotherapy based on the Bobath concept, applied to MS patients with balance and gait problems, was evaluated. The ability of different functional tests to demonstrate change was evaluated. Method . A single‐subject experimental study design with ABAA phases was used, and two patients with relapsing–remitting MS in stable phase were treated. Tests were performed 12 times, three at each phase: A (at baseline); B (during treatment); A (immediately after treatment); and A (after two months). The key feature of treatment was facilitation of postural activity and selective control of movement. Several performance and self‐report measures and interviews were used. Results . After intervention, improved balance was shown by the Berg Balance Scale (BBS) in both patients, and improved quality of gait was indicated by the Rivermead Visual Gait Assessment (RVGA). The patients also reported improved balance and gait function in the interviews and scored their condition as ‘much improved’. Gait parameters, recorded by an electronic walkway, changed, but differently in the two patients. Among the physical performance tests the BBS and the RVGA demonstrated the highest change, while no or minimal change was demonstrated by the Rivermead Mobility Index (RMI) and Ratings of Perceived Exertion (RPE). Conclusion . The findings indicate that balance and gait can be improved after physiotherapy based on the Bobath concept, but this should be further evaluated in larger controlled trials of patients with MS. Copyright © 2006 John Wiley & Sons, Ltd.     

Quantitative analysis of gait in the visually impaired

In this comparative study concerning characteristics of independent walking by visually impaired persons, we used a motion analyser system to perform gait analysis of 15 late blind (age 36–54, mean 44–3 years), 15 congenitally blind (age 39–48, mean 43–8 years) and 15 sighted persons (age 40–50, mean 44–4 years) while walking a 10-m walkway. All subjects were male. Compared to the sighted, late blind and congenitally blind persons had a significantly slower walking speed, shorter stride length and longer time in the stance phase of gait. However, the relationships between gait parameters in the late and congenitally blind groups were maintained, as in the sighted group. In addition, the gait of the late blind showed a tendency to approximate the gait patterns of the congenitally blind as the duration of visual loss progressed. Based on these results we concluded that the gait of visually impaired persons, through its active use of non-visual sensory input, represents an attempt to adapt to various environmental conditions in order to maintain a more stable posture and to effect safe walking.     

The effect of a training program combined with augmented afferent feedback from the feet using shoe insoles on gait performance and muscle power in older adults: a randomised controlled trial

Background.?Aged-related loss of afferent feedback of the feet plays an important role in gait performance. Although strength, balance and gait training can significantly improve the muscle power and functional abilities of older individuals, it remains unclear whether training effects can be enhanced by augmenting afferent feedback from the feet adding shoe insoles complementary to conventional training.

Objective.?The current study investigated the effect of physical exercise combined with wearing MedReflex® shoe insoles on the gait performance and muscle power in older adults.

Methods.?Twenty-eight independent living, older adults aged 65–91 years were randomly assigned to either an insole group (IG; n?=?14) or a training group (TG; n?=?14). Further 14 subjects matched to the IG and TG were recruited as a control group (CG; n?=?14) (no exercise). The IG and TG completed the same training program consisting of aerobic exercises, progressive resistance strength training and stretching exercises twice per week for 12 weeks, whereas, the IG wore the insoles during everyday life and during training sessions. Assessments included the Falls Efficacy Scale – International (FES-I), gait analysis and muscle power measurements of the knee and ankle joint at pre- and post-training.

Results.?There were significant time?×?group interactions in walking speed, step length and in several muscle power measurements. The positive effects of gait parameters ranged between 1% and 12% and between 1% and 8% and the trend to improvements of muscle power ranged between 15–79% and 20–79% for the IG and TG, respectively. The IG and TG did not differ significantly in their improvements. The CG showed a trend to deteriorations between 0% and??5% for gait parameters and between??4% and??14% for muscle power. No significant change in FES-I score occurred in neither groups.

Conclusions.?The results of this study provide evidence of significant improvements in gait performance and muscle power after a conventional training program in independent living, older adults. However, there is no additional effect of long-term adaptation of gait caused by wearing insoles concurrent to physical training.     

双小腿截肢者假肢辅助下行走能力的评价

目的比较双小腿截肢者穿戴假肢的行走能力与正常人的差别,制定双小腿截肢者穿戴假肢行走能力参考指标。方法选择11 例双小腿截肢者作为截肢组,12 名健康成年人作为对照组,分别进行室内步态分析测试、室外行走1 km所用时间及能量消耗测试、静态站立平衡能力测试。结果室内步态分析测试中,截肢组自我感觉最舒适平均速度为1.07 m/s,对照组为1.29m/s。当受试者以自我感觉最舒适的速度行走时,截肢组部分步态时空参数与对照组存在显著性差异(P<0.05);室外行走1 km所用时间及能量消耗与对照组存在显著性差异(P<0.05);静态站立平衡与对照组比较无显著性差异(P>0.05)。结论双小腿截肢者与正常人的行走能力存在差异,对截肢者行走能力定量的评价能够为截肢者的康复提供更准确的参考。     

老年脑血管病跌倒患者平衡与步态的评定分析及护理对策

目的 了解并分析老年脑血管病跌倒患者的平衡能力，提出针对性的护理措施，指导临床预防跌倒，保证护理安全。方法对52例老年脑血管病患者进行跌倒情况调查，采用Tinetti平衡与步态评定量表评定其平衡与步态，寻找跌倒发生与平衡能力各因素之间的关系。结果有87．6％的老年脑血管病患者平衡及步态两者相加总分〈19分，显示有跌倒的危险，即刻站立平衡、转立平衡、胸部轻推反应、闭眼站立平衡不能很好完成者居多。其中在即刻站立平衡、转立平衡上跌倒≥3次者比跌倒1次者下降明显，有显著差异（P〈0．05）。结论老年脑血管病患者在即刻站立及转立时容易发生多次跌倒，该两方面是护理人员预防工作的重点。详细观察老人平衡功能和步态，可为采取护理措施提供良好的依据。     

单侧全髋关节置换后遗症期的下肢步态参数

背景：全髋关节置换可以为患者缓解疼痛、恢复步行功能,数年后步态是否能达到正常化仍存在争议。目的：分析单侧髋关节置换后遗症期患者平地步行中下肢的时空参数特征,探讨患者步行能力。 方法：根据运动重建实验室检测病例数据库资料分析的方法,选择全髋关节置换后5-10年的患者14例为实验组,14例相匹配的健康人为对照组。采用Vicon Nexus采集患者平地步行时下肢的步态参数,应用Polygon分析步态周期中下肢时空参数特征。 结果与结论：与对照组相比,实验组术侧和健侧步速减慢,步频减小,步幅、跨步长变短,双支撑相延长,对侧足离地比增大（P0.05）。结果表明全髋关节置换后5-10年的患者步态对称性较好,但仍没有达到正常水平,步行能力差于正常人,需要系统康复训练以恢复其步行能力。     

Influence of dual task and frailty on gait parameters of older community-dwelling individuals

Background:

Gait parameters such as gait speed (GS) are important indicators of functional capacity. Frailty Syndrome is closely related to GS and is also capable of predicting adverse outcomes. The cognitive demand of gait control is usually explored with dual-task (DT) methodology.

Objective:

To investigate the effect of DT and frailty on the spatio-temporal parameters of gait in older people and identify which variables relate to GS.

Method:

The presence of frailty was verified by Fried''s Frailty Criteria. Cognitive function was evaluated with the Mini-Mental State Exam (MMSE) and gait parameters were analyzed through the GAITRite^(r) system in the single-task and DT conditions. The Kolmogorov-Smirnov, ANOVA, and Pearson''s Correlation tests were administered.

Results:

The participants were assigned to the groups frail (FG), pre-frail (PFG), and non-frail (NFG). During the DT, the three groups showed a decrease in GS, cadence, and stride length and an increase in stride time (p<0.001). The reduction in the GS of the FG during the DT showed a positive correlation with the MMSE scores (r=730; p=0.001) and with grip strength (r=681; p=0.001).

Conclusions:

Gait parameters are more affected by the DT, especially in the frail older subjects. The reduction in GS in the FG is associated with lower grip strength and lower scores in the MMSE. The GS was able to discriminate the older adults in the three levels of frailty, being an important measure of the functional capacity in this population.     

Group aquatic training improves gait efficiency in adolescents with cerebral palsy

Purpose.?To evaluate the effect and feasibility of a 10-week group aquatic training programme on gait efficiency in adolescents with cerebral palsy (CP). The secondary purpose was to determine the exercise intensity during aquatic training in a heterogeneous group of adolescents with CP and to investigate the impact of the training programme on the musculoskeletal system.

Method.?Twelve ambulatory adolescents with spastic CP were recruited. They participated in 20 aquatic training sessions (45?min twice a week). Three physical therapists and a sports teacher supervised the training sessions. Participants wore a heart rate monitor to assess sessions' intensity and a floatation device as appropriate. The primary outcome measure was gait efficiency as measured by the gait energy expenditure index (EEI). The secondary measures were (1) gait spatiotemporal parameters, (2) maximal isometric knee strength and (3) gross motor function.

Results.?Ten adolescents completed the training programme. No adverse effect was reported. Average exercise intensity was mild to moderate for more than half of the training session. A significant reduction of the EEI and the heart rate during walking was observed following the training programme. No significant change was observed on secondary outcome measures.

Conclusions.?Group aquatic training increases gait efficiency in adolescents with CP. This improvement is related to systemic cardiorespiratory adaptations. Group aquatic training programme is feasible in adolescents presenting CP at different levels of severity.     

A review of gait disorders in the elderly and neurological patients for robot-assisted training

Abstract

Purpose: Ambulation is an important objective for people with pathological gaits. Exoskeleton robots can assist these people to complete their activities of daily living. There are exoskeletons that have been presented in literature to assist the elderly and other pathological gait users. This article presents a review of the degree of support required in the elderly and neurological gait disorders found in the human population. This will help to advance the design of robot-assisted devices based on the needs of the end users.

Methods: The articles included in this review are collected from different databases including Science Direct, Springer Link, Web of Science, Medline and PubMed and with the purpose to investigate the gait parameters of elderly and neurological patients. Studies were included after considering the full texts and only those which focus on spatiotemporal, kinematic and kinetic gait parameters were selected as they are most relevant to the scope of this review. A systematic review and meta-analysis were conducted.

Results: The meta-analysis report on the spatiotemporal, kinematic and kinetic gait parameters of elderly and neurological patients revealed a significant difference based on the type and level of impairment. Healthy elderly population showed deviations in the gait parameters due to age, however, significant difference is observed in the gait parameters of the neurological patients.

Conclusion: A level of agreement was observed in most of the studies however the review also noticed some controversies among different studies in the same group. The review on the spatiotemporal, kinematics and kinetic gait parameters will provide a summary of the fundamental needs of the users for the future design and development of robotic assistive devices.

• Implications for rehabilitation

• The support requirements provide the foundation for designing assistive devices.

• The findings will be crucial in defining the design criteria for robot assistive devices.

     

基于数字视频和图像处理的步态分析系统信度研究

目的研究基于数字视频和图像处理的二维步态分析系统的可靠性、敏感性。方法由同一名评定者对20名正常人进行间隔1周的2次测试,检验评定者内部信度;另由2名评定者再分别重复测试2次,检验评定者间信度;比较偏瘫患者患侧和正常人的测试结果,检验系统敏感性。结果20名正常人2次测试结果各指标高度相关,偏瘫患者患侧和正常人的各项测试指标有显著性差异。结论本系统具有良好的可靠性和敏感性。     

脑卒中患者步行能力与下肢三维运动学及动力学相关性分析

目的:通过对脑卒中偏瘫患者下肢三维运动学和动力学的分析,寻找偏瘫患者步态特点,比较分析步行能力与运动学和动力学之间的关系,从运动力学角度探讨偏瘫患者异常步行的原因,寻找康复治疗中需解决的关键问题。方法:选择首次脑卒中后可以独立步行10m以上的右侧偏瘫患者20例为实验组,正常健康中老年人16例为对照组。采用Vicon和AMTOR6-7进行三维步态运动学和动力学检测和分析。结果:实验组与正常对照组比较,脑卒中患者与健康中老年人在步频、跨步时间、双腿支撑时间、步时、离地比率、步长、跨步长和步速同侧比较差异有显著性意义(P<0.05),患侧离地占步态周期百分比和健侧单腿支撑时间实验组与对照组比较差异有显著性意义(P<0.05)。矢状面上同侧髋关节伸展角度、膝关节屈曲角度和踝关节背伸及跖屈角度比较差异都有显著性意义(P<0.05)。同侧髋关节屈伸力矩、同侧膝关节伸直力矩和患侧踝关节背伸力矩实验组和对照组相比差异有显著性意义(P<0.05),步行能力(步速)与患侧髋关节伸展、健侧膝关节屈曲、双侧膝关节伸展、双侧踝关节背伸和跖屈角度相关,均有显著性意义(P<0.05);同时也和双侧髋关节屈伸、膝关节伸展和踝关节背伸力矩相关(P<0.01)。结论:①步长是脑卒中偏瘫患者步态异常的重要参考指数;②髋关节和膝关节伸展,踝关节背伸和跖屈是步态异常的重要表现;③下肢髋关节和膝关节屈伸肌群和踝关节背伸肌群的力量是影响步行能力的重要因素。     

Effect of load and carrying position on the electromyographic activity of the gluteus medius muscle during walking

Physical therapists often teach people with hip osteoarthritis ways to decrease gluteus medius muscle activity of the stance limb during gait. The rationale for decreasing this muscle activity is that hip muscle contraction needed for frontal plane hip stabilization is responsible for a large component of the hip joint compressive forces during stance. The magnitude and carrying position of external loads during walking are both variables that influence requirements of gluteus medius muscle force. Therefore, the purpose of this study was to determine through EMG, the relative amounts of gluteus medius muscle electrical activity produced during the stance phase of gait when subjects used varying combinations of load size (10 and 20% of body weight) and carrying position of the hands (contralateral or ipsilateral to a given hip, or anterior or posterior to the chest). We studied 24 healthy subjects and used their EMG activity during the stance phase of gait as an indication of the relative amount of myogenic hip compression force. Results indicated statistical differences in EMG according to carrying condition with the contralateral position (with loads of 10 and 20% of body weight) producing the highest levels of EMG. We discuss the kinesiologic reasons for results and the prevention of hip osteoarthritis in occupational settings.