Walkable school neighborhoods are not playable neighborhoods

The objectives were to determine whether: (1) playability features differed across walkable and non-walkable school neighborhoods, and (2) physical activity differed in children living in walkable and non-walkable school neighborhoods. A total of 3912 grade 6–8 students from 132 school neighborhoods were studied. There was more developed park space in high walkability neighborhoods than low walkability neighborhoods. Other playability features were more preferable in the low (e.g., undeveloped treed and water areas) and moderate (e.g., physical disorder/esthetics) walkability neighborhoods. Children from low walkability neighborhoods were more likely to engage in free-time physical activity outside of school and to achieve recommended levels of moderate-to-vigorous physical activity than were children from high walkability neighborhoods.     

Assessment of extensor and flexor strength in the individual gonarthrotic patient: Interpretation of performance changes

Summary The intra-session and inter-session reproducibility of knee extensor and flexor strength measurements were examined in 21 gonarthrotic subjects (ten women and eleven men). Using the Cybex 6000 dynamometer, isokinetic peak torque and total work at 30 and 120 degrees/second and isometric peak torque were measured three times on separate days within two weeks by the same examiner. The reproducibility of walking and stair climbing time measurements was also assessed. The concept of critical difference (i.e. the difference between two measurements which would be statistically significant when applied to a reference group in steady state) for the interpretation of muscle strength data obtained by monitoring individual patients is presented.Individual coefficients of variation (CV) were calculated for each muscle strength variable. Depending on the velocity and on whether peak torque or total work were measured, the median CV of intra-session and inter-session extensor strength measurements ranged from 1.5–4.9% and 7.4–10.1%, respectively. CVs for flexor strength measurements were significantly higher. Substantial variability of within subject variances were found, e.g. the 80% central range of CVs for extensor toruqe at 30 degrees/second was 2.5–29.5% (inter-session). Calculated from CVs, critical differences for inter-session measurements exceeded 30% for all muscle strength variables. Median CVs for walking and stair-climbing time were 7.0% and 4.9%, respectively.In conclusion, the large CVs and corresponding critical differences may be a major limitation in the use of muscle strength measurements in the individual gonarthrotic patient.     

Talk the walk: the importance of teaching patients how to use their walking stick effectively and safely

Background: Walking sticks are used widely by people with arthritis, principally to reduce pain and improve stability and balance. However, they are frequently used incorrectly and can be dangerous if not properly maintained. Methods: Fifty randomly selected patients attending a rheumatology department were surveyed to determine whether their stick was appropriate to their needs and whether they were using it correctly. Results: Of the 50 patients, 38% used their stick incorrectly, usually in the wrong hand. Forty‐four per cent of sticks were of the wrong length and 54% were in imperfect condition, the main defect being a worn ferrule. Among the minority (18 patients) who had received instruction and training, 72% used their stick correctly, while only 50% of those who had not been trained used their stick in the correct hand where applicable to their condition. Conclusions: These findings highlight the importance of educating patients on how to obtain greatest benefit from their walking stick and of the necessity to check it regularly for defects to ensure safe usage.     

Age-related gait development in children with autism spectrum disorder

BackgroundA better understanding of gait development and asymmetries in children with autism spectrum disorder (ASD) may improve the development of treatment programs and thus, patient outcomes.Research questionDoes age affect walking kinematics and symmetry in children with ASD?MethodTwenty-nine children (aged 6–14 years old) with mild ASD (level one) were recruited and assigned to one of the three groups based on their ages: 6–8 years (U8), 9–11 years (U11) and 12–14 years (U14). Walking kinematics were captured using an inertia measurement unit system placed bilaterally on participants’ foot, lower leg, upper leg, upper arm, pelvis, and thoracic spine. Joint angles were computed and compared among the age groups. Symmetry angles were used to assess the gait symmetry and were compared among the age groups.ResultsOlder children exhibited less ankle dorsiflexion and knee flexion angles at heel-strike and greater plantarflexion angles at toe-off compared with younger children. In addition, a decreased pelvis and thorax axial rotation range of motion and increased shoulder flexion/extension range of motion were observed for older children. However, no age-related difference in gait symmetry was observed.SignificanceThese findings could suggest that older children with ASD may develop gait kinematics to a more energy-efficient walking pattern.     

Evidence of slow and variable choice-stepping reaction time in cancer survivors with chemotherapy-induced peripheral neuropathy

BackgroundChemotherapy-induced peripheral neuropathy (CIPN) is reported to affect up to 70 % of cancer survivors. Despite evidence that CIPN-related impairments often translate into balance and mobility deficits, the effects on stepping and quality of gait, well-documented risk factors for falls, are unclear.Aims(i) Establish choice-stepping reaction time (CSRT) performance in survivors with CIPN compared to young and older healthy controls and people with Parkinson’s disease; (ii) document walking stability; (iii) investigate relationships between stepping and gait data to objective and patient-reported outcomes.Methods41 cancer survivors with CIPN (mean (SD) age: 60.8 (9.7) years) who were ≥3months post chemotherapy, performed tests of simple and inhibitory CSRT. Walking stability measures were derived from 3-D accelerometry data during the 6-minute walk test. CIPN was assessed using neurological grading and patient-reported outcome measures (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire in CIPN Questionnaire scale EORTC CIPN20).ResultsIn both stepping tests, CIPN participants performed at the level of adults aged 10 years older and people with mild to moderate Parkinson’s disease. Mean (SD) total stepping response times in both CSRT (1160 (190) milliseconds) and inhibitory CSRT (1191 (164) milliseconds) tests were not associated with objective neurological grading but were correlated with increased difficulty feeling the ground. Participants with lower-limb vibration sensation deficit had slower and more variable CSRT times. There were no associations between walking stability and objective measures of CIPN, and limited correlations with the EORTC-CIPN20.ConclusionsCancer survivors with CIPN showed deficits in voluntary stepping responses and seemed to compensate for their sensory and motor deficits by walking slower to maintain stability. Objective and patient-reported outcomes of CIPN were correlated with slower and more variable stepping response times. Future studies should aim to identify the causes of the apparent premature decline in cognitive-motor function and develop remediating interventions.     

Minimal clinically important difference in walking velocity,gait profile score and two minute walk test for individuals with lower limb amputation

BackgroundIndividuals with lower limb amputation are routinely assessed with a variety outcome measures, however there is a lack of published data to indicate minimal clinically important differences (MCID) for many of these outcome measures. Three such important gait-specific outcome measures include walking velocity, gait profile score (GPS) and the two minute walk test (2MWT).Research questionDetermine the MCIDs for walking velocity, GPS and 2MWT for individuals with lower limb amputation.MethodsWalking velocity and GPS (n = 60), and 2MWT (n = 119) data for individuals with unilateral transfemoral or knee disarticulation were identified retrospectively from a database held at the study centre. An anchor-based method was used with Medicare functional classification level (MFCL) acting as the impairment-related criterion, and a least-squares linear regression approach was used to calculate the gradient required for a change between MFCL levels.ResultsAn increase of 0.21 m/s (95 % CI: 0.13,0.29) for walking velocity, a reduction of 1.7° (95 % CI: -2.449,-1.097) for GPS and an increase of 37.2 m (95 % CI: 28.8,45.5) for 2MWT were found to correspond to an increase in MFCL of one level. Walking velocity, GPS and 2MWT correlated with MFCL with R² values of 0.333, 0.322 and 0.398 respectively (p < 0.00001). The authors propose that 0.21 m/s for walking velocity, 1.7° for GPS and 37.2 m for 2MWT be used as MCID values for individuals with lower limb amputation.SignificanceThe results of this study can be used to help both researchers and clinicians to objectively evaluate if interventions for individuals with lower limb amputation are effective.     

Effects of age,physical and self-perceived balance abilities on lateral stepping adjustments during competing lateral balance tasks

BackgroundDaily walking paths exhibit varying environment features and require continuous adjustments to locomotor trajectories. Humans maintain lateral balance while navigating paths by modifying stepping in accordance with changing side-to-side path limitations (e.g. path width, lateral location). These processes are influenced by one’s actual physical ability to maintain balance, as well as their self-perceived balance ability. Older adults experience decreases in each of these abilities, which may alter their capacity to execute appropriate lateral stepping adaptations.Research QuestionHow do age, physical and self-perceived balance abilities interact to influence lateral stepping adaptations of older adults walking in complex environments with dynamic lateral path features?MethodsTwenty young (age mean ± SD: 21.7 ± 2.6) and 18 older adults (age mean ± SD: 71.6 ± 6.0) walked on an instrumented treadmill in a virtual-reality system. Participants adjusted lateral stepping during two competing lateral balance sub-tasks that manipulated either path width or location. Participants began walking on a gradually-narrowing path (sub-task A), then decided when/ how to laterally maneuver to an adjacent path (sub-task B). Recorded path characteristics were used to quantify spatial thresholds for stepping error onset and sub-task exchange.ResultsOlder adults made sub-task A stepping errors on wider paths and exchanged sub-tasks earlier. These differences were not directly attributed to age. Statistical path analyses revealed that physical balance ability mediated age effects on stepping error onset, while self-perceived balance ability mediated age effects on sub-task exchange. Both age groups exchanged sub-tasks when stepping accuracy likelihoods were similar and high, ∼90 %.SignificanceThis work demonstrates important mechanisms for how age, via degradation of physical and self-perceived balance abilities, indirectly and differentially influences navigation of competing lateral balance tasks. Mediating physical and perceptual factors are potential targets for improving older adults’ navigation of complex environments.     

Effects of a posture shirt with back active correction keeper on static and dynamic balance in Parkinson's disease

BackgroundPatients with Parkinson's disease (PD) suffer from postural disorders. This study aims at investigating the short- and medium-term effects of a shirt with appropriate tie-rods that allows to correct the posture of the trunk.MethodsThis is a longitudinal clinical study in which a pressure platform was used to assess the static and dynamic baropodometry and the static stabilometry of 20 patients with PD (70.95 ± 8.39 years old; 13 males, time from the onset of symptoms: 6.95 ± 4.04 years, Unified Parkinson's Disease Rating Scale score: UPDRS = 7.25 ± 6.26) without and with a shirt, specifically designed for improving posture, at baseline and after one month of wearing.ResultsThe results showed a significant improvement in symmetry of loads (p = 0.015) and an enlargement of the foot contact surface (p = 0.038). A significant correlation was found between the change in forefoot load and time spent daily in wearing the shirt (R = 0.575, p = 0.008), with an optimal value identified at 8 h per day.ConclusionThe use of a postural shirt in patients with PD symmetrized the postural load and enlarged the foot contact surface improving their balance.     

平衡训练系统辅助特定任务性平板步行训练对卒中患者下肢运动功能的影响

目的探讨Biodex平衡训练系统辅助特定性平板步行训练对卒中后下肢运动功能的影响。方法选取卒中后平衡和下肢运动功能障碍的偏瘫患者40例,按病例号奇偶数分为平衡训练组和常规训练组,每组20例。常规训练组给予常规康复治疗及传统的平衡训练,平衡训练组在常规康复治疗的基础上,应用Biodex平衡训练系统辅助特定任务性平板步行训练。于治疗前及治疗后4周评价两组患者的下肢稳定性指数、Berg平衡量表评分(BBS)、"起立-行走"计时(TUGT)、最大步速和步长、Fugl-Meyer运动功能量表(下肢部分)评分(FMA-L)、改良Barthel指数(MBI)及功能性步行量表评分(FAC),综合评定患者的平衡和下肢运动功能。结果治疗前,两组患者的各项指标比较,差异均无统计学意义(P0.05)。治疗后,两组患者各项指标均较治疗前好转,差异有统计学意义(P0.01);平衡训练组与常规训练组比较,稳定性指数(分别为6.5±1.3、8.5±2.1)、BBS评分[分别为(49±4)、(34±3)分]、TUGT[分别为(13.5±3.2)、(22.3±2.8)s]、最大步速[分别为(60±23)、(50±21)m/min]、最大步长[分别为(54±12)、(42±11)m]、FMA评分[分别为(31±4)、(24±5)分]、MBI评分[分别为(81±14)、(70±11)分]及FAC分级评分[分别为(4.31±0.39)、(3.21±0.19)分]改善程度均优于常规训练组,差异有统计学意义(P0.01或P0.05)。结论应用Biodex平衡训练系统辅助特定任务性平板步行训练对卒中后患者的平衡和下肢运动功能有很好的改善作用。