Hip flexor fatigue limits walking in Charcot–Marie–Tooth disease

Charcot–Marie–Tooth (CMT) disease results in distal lower limb weakness that affects walking. In this study we assess the role of the hip flexors in compensating for distal weakness while walking and the effects of prolonged walking on these putative compensatory strategies. Eighteen subjects with CMT disease were compared with 14 matched controls while they walked on a treadmill to a predetermined point of perceived effort. A significant reduction was observed in peak hip flexor velocity during walking and hip flexor maximal voluntary contraction. In a second session following selective fatigue of the hip flexors, hip flexor velocity decreased immediately on walking, and walking duration was greatly reduced. This study suggests that hip flexors compensate for distal weakness and that fatigue in the hip flexors can limit walking duration. Treatments directed toward improving proximal muscle strength may therefore help to delay onset of hip flexor fatigue and thus prolong walking duration. Muscle Nerve, 2009     

Assessing fear of falling: Can a short version of the Activities‐specific Balance Confidence scale be useful?

We present the process of further validation of the 16-item Activities-specific Balance Confidence scale (ABC-16) and a short version (ABC-6) derived by us, to assess balance confidence and fear of falling (FOF). The ABC-16 was administrated to three groups who were anticipated to have a range of balance confidence: 70 patients with higher level gait disorders (HLGDs), 68 healthy controls, and 19 patients with Parkinson's disease (PD). Item reduction was based on identifying items with the lowest scores (high FOF) among the patients. Internal consistency and discriminative validity were assessed using Cronbach's alpha and logistic regression, respectively. The intraclass correlation (ICC) between the short and long versions was assessed using a mixed model approach, accounting for the difference between the scores of the two versions. Six items were found to reflect the most frightening conditions, especially in the patient groups, and to form the short version (ABC-6). Internal consistency of the ABC-16 and ABC-6 were high in the three groups: Cronbach's alpha was between 0.83 and 0.91 and 0.81 and 0.90, respectively. Compared to the control group, the sensitivity of the ABC-16 was 96% for identification of patients with HLGDs (greatest FOF) and 58% for identification of PDs (moderate FOF), based only on the ABC scores. Similar values were obtained for the short version, i.e., 91% for HLGDs and 53% for PDs. ICCs between the short and the long versions was 0.88 (HLGDs), 0.83 (PDs), and 0.78 (Controls). To conclude, the short version of the ABC has properties analogous to the parent questionnaire and is apparently useful in assessing FOF.     

Changes in motor subtype and risk for incident dementia in Parkinson's disease.

The objective of this study was to assess the temporal relationship between changes in predominant motor symptoms and incident dementia in Parkinson's disease (PD). A community-based sample of 171 nondemented patients with PD was followed prospectively and examined at baseline and after 4 and 8 years. The motor subtype of Parkinsonism was classified into tremor-dominant (TD), indeterminate, or postural instability gait difficulty (PIGD) subtype at each visit, based on defined items in the Unified Parkinson's Disease Rating Scale, subscales II and III. Dementia was diagnosed according to DSM-III-R criteria, based on clinical interview, cognitive rating scales, and neuropsychological examination. Logistic regression was used to analyze the relationship between subtype of Parkinsonism and dementia. Transition from TD to PIGD subtype was associated with a more than threefold increase in the rate of Mini-Mental State Examination decline. Compared to patients with persistent TD or indeterminate subtype, the odds ratio for dementia was 56.7 (95% CI: 4.0-808.4; P = 0.003) for patients changing from TD or indeterminate subtype to PIGD subtype, and 80.0 (95% CI: 4.6-1400.1; P = 0.003) for patients with persistent PIGD subtype. Patients with TD subtype at baseline did not become demented until they developed PIGD subtype, and dementia did not occur among patients with persistent TD subtype of Parkinsonism. In a substantial proportion of PD patients who develop postural instability and gait disorder during the course of the disease, this transition is associated with accelerated cognitive decline and highly increased risk for subsequent dementia. These findings raise the question whether PIGD and dementia share common or parallel neuropathology.     

镍钛器械不同运动方式根管预备后牙根微裂的体外研究

目的：比较Waveone与ProTaper Universal镍钛器械采用不同运动方式根管预备后牙根微裂的发生。方法：40颗离体下颌切牙随机分成4组（n=10）,实验组分别使用Waveone Primary单支锉往复式运动、ProTaper Universal F2单支锉往复式运动、ProTaper Universal全序列至F2连续旋转运动模式预备根管,对照组不进行根管预备。根管预备后,距根尖孔3 mm、6 mm、9 mm处进行水平切盘,体视显微镜下观察牙根不同横截面牙根微裂的发生情况。结果：对照组未观察到牙根微裂。实验组中,Waveone Primary单支锉往复式运动组、ProTaper Universal F2单支锉往复式运动组和ProTaper Universal全序列连续旋转运动组产生根裂的比例分别为20%、30%和60%。往复式运动组和连续旋转运动组之间差异均有统计学意义（P<0．05）,Waveone Primary单支锉组和ProTaper Universal F2单支锉组差异无显著性（P>0．05）。结论：机用镍钛器械采用往复式运动可减少牙根微裂的发生。     

步态训练矫正仪对脑卒中足下垂患者步态改善的效果分析

目的 探讨步态训练矫正仪对脑卒中足下垂患者的步态改善情况。方法 收集符合本研究标准的脑卒中足下垂患者共30例,按随机数字表法随机分为对照组和观察组,每组各15例。两组患者均给予常规的药物治疗及功能康复训练,在此基础上观察组加用步态训练矫正仪治疗,1天2次,每次10～15 min。治疗前及治疗4周后,分别对两组患者下肢运动功能评定量表(FMA评分)、异常步态模式评定量表及步态时空参数的结果进行分析比较。结果 治疗4周后,两组患者的FMA评分、异常步态模式评分及步行参数均较治疗前改善(P <0.05),且观察组优于对照组(P <0.05)。结论 步态训练矫正仪可改善脑卒中患者足下垂步态。     

Walking and balance ability gain from two types of gait intervention in adult patients with chronic hemiplegic stroke: A pilot study

This study examined whether the walking and balance ability of adult patients with chronic hemiplegic stroke are associated differentially with the degree of gain after two types of gait intervention. Twenty-four subjects with hemiplegic stroke were enrolled in this randomized study. Each subject participated in one of two gait intervention strategies: gait training with auditory feedback caused by active weight bearing on the paralyzed side (experimental group; EG), or general gait intervention over the ground (control group; CG). The walking and balance abilities were assessed before and after gait intervention. Significant improvements in the 10-m walking test, functional gait assessment (FGA) score, and center of pressure (COP) path length were observed after gait training in both groups (p < 0.05). The EG showed a larger increase in the 10-m walking test, FGA score, and COP path length in the state of eyes opened and closed than the CG (18.2%, 27.0%, 24.8%, and 18.2%, respectively). The auditory feedback caused by active weight bearing on the paralyzed side appeared to be a more effective approach for improving the walking and balance ability in adult patients with hemiplegic stroke during walking training than general gait intervention.     

Which interventions incorporating physical and cognitive elements are most effective to improve gait in cognitively impaired older adults? A systematic review

Abstract

Background: The primary objective of this systematic review was to determine effective interventions to improve gait (speed, stride length, double limb support) in older adults with cognitive impairments.

Methods: Eligibility criteria included randomized controlled trials in English, older adults aged 45?years and over with mild to severe cognitive impairments, outcomes of gait, and interventions including exercise/physical activity, cognitive elements, or both. Databases searched were PubMed, CINAHL, Scopus, ProQuest, and Cochrane. PEDro was utilized to assess risk of bias.

Results: Ten randomized controlled trials were included. Statistically significant changes were found in different aspects of gait with dual task, exercise programs, multimodal exercises, and functional training.

Conclusion: It was found that performing multiple modes of interventions to treat older adults with cognitive impairments demonstrated best results. Gait performance of older adults with cognitive impairments is shown to improve with a myriad of interventions that challenge the physical and cognitive performance of this population. The strengths of the review are performing a comprehensive search. All included articles were randomized controlled trials and a moderate agreement. The limitations of the review are small exclusion criteria, small sample sizes, and detail reporting issues.     

帕金森病跌倒与非跌倒者平衡评估及步态分析结果比较

目的:探讨帕金森病跌倒与非跌倒者平衡评估及步态分析结果差异,为康复治疗提供临床依据。方法:将帕金森病患者32例,据其是否有跌倒史分为跌倒组15例和非跌倒组17例,比较2组平衡评估及步态分析各项参数结果差异。结果:同非跌倒组比较,跌倒组患者平均/最大轨迹误差更大、单足支撑时间更短、摆动相踝背屈角度更小(P0.05)。结论:帕金森病康复训练中应强调本体感觉、肌力、单侧下肢负重、步态方面的训练,以降低患者跌倒风险。